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EFFECT OF AYURVEDA MODALITIES AS BLACK BOX DESIGN IN THE

MANAGEMENT OF AAMVATA W.S.R. TO RHEUMATOID ARTHRITIS-A CASE
STUDY

Article · July 2018

DOI: 10.20959/wjpps20187-11920

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EFFECT OF AYURVEDA MODALITIES AS BLACK BOX DESIGN IN THE

MANAGEMENT OF AAMVATA W.S.R. TO RHEUMATOID ARTHRITIS-A CASE
STUDY

Article · July 2018

DOI: 10.20959/wjpps20187-11920

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 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
Gehija et al. World Journal of Pharmacy and Pharmaceutical Sciences
SJIF Impact Factor 7.421

Volume 7, Issue 7, 915-923 Case Study ISSN 2278 – 4357

EFFECT OF AYURVEDA MODALITIES AS BLACK BOX DESIGN IN

THE MANAGEMENT OF AAMVATA W.S.R. TO RHEUMATOID
ARTHRITIS- A CASE STUDY

Gehija Jaidev**, Prof. Patel K. S., Kori V. K., Singh Azad*, Solanki Champalal and
Boje Dojum

Department of Kaumarbhritya, IPGT & RA, (Gujrat Ayurved University), Jamnagar, India.

ABSTRACT
Article Received on
02 May 2018, Rheumatoid arthritis (RA) is a common disorder that may have
Revised on 22 May 2018,
Accepted on 12 June 2018
plagued ancient people, although it has been recognized with increased
DOI: 10.20959/wjpps20187-11920 frequency since the 19th century. In the mid-19th century, Garrod was
the first to distinguish RA from gout and rheumatic fever. In one study
of the period from 1955 to 2007, following four decades (1955 to
*Corresponding Author
Dr. Gehija Jaidev 1994) of decline, the incidence of RA during the subsequent interval
Department of (1995 to 2007) appeared to increase. The annual incidence of
Kaumarbhritya, IPGT & rheumatoid arthritis (RA) has been reported to be around 40 per
RA, (Gujrat Ayurved
100,000. The disease prevalence is about 1 percent in Caucasians but
University), Jamnagar,
varies between 0.1 percent (in rural Africans) and 5 percent (in
India.
Indians). The disease begins progressively with lethargy, morning
stiffness (lasting more than one hour), extensive muscle throbbing, loss of hunger, and
feebleness and joint pain. When the joint is not used a short time, it can become warm,
delicate, and graceless. When the lining of the joint (synovium) becomes inflamed, it gives
off more fluid and the joint becomes swollen. Joint pain is repeatedly felt bilaterally and may
affect the wrist, knees, elbows, extremities, toes, ankle or neck. According to Ayurveda,
Rheumatoid arthritis can be compared to “Amavata“. The pain in the affected joints
resembles the pain of a scorpion’s sting. Objective: To evaluate the role of Ayurveda
treatment modalities in Amavata. Methods: A 12 year Hindu female child suffering from
morning stiffness and swelling in joints of fingers since 1 year was treated with Vaitaran
Basti and Virechana karma with prior Deepana Pachana and Snehapana respectively.
Clinical assessment was done both pre and post-treatment. Relief from the complaints was
assessed by noting the changes in clinical pictures over joints. Results & Conclusion: The

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Gehija et al. World Journal of Pharmacy and Pharmaceutical Sciences

present case study reveals the efficacy of Ayurveda Modalities as Black box design in the
management of Amavata as reducing the sign and symptoms of it viz-a-viz swelling in both
extremities.

KEYWORDS: Amavata, Rheumatoid arthritis, Ayurveda.

INTRODUCTION
In Aamavata disease is a condition in which vitiation of Vata Dosha take place and
accumulation of Ama take place in joints, which simulate rheumatoid arthritis (RA) in
modern parlance. Ama is a maldigested product, which is not homogeneous for the body.[1]
Whenever that Ama gets localized in the body tissue or joints, it can lead to the production of
pain, stiffness, swelling, tenderness, etc., in the related joints. The features of Amavata are
much identical to RA, an autoimmune disorder which causes chronic inflammatory and
symmetrical polyarthritis. The causative factor of Aamvat is when Ama and Vata are united
together. (Vijayaraksihta). Vata will be associated with Ama(undigested food) creating a
disease Known as Aamavata(Vijayarakshita). Rupa- General clinical-Body ache, Anorexia,
Thirst, Malaise, A feeling of heaviness, Fever Indigestion, Inflammation of the body parts
(myositis, fibrositis, arthritis etc) whenAamavata gets exacerbates Pravruddha Aamavata.[2,5]
The affected part is excessively painful. It feels like that it is bitten by scorpions. Amavata
Cikitsa 1) Langhana(fasting) 2) Swedana (sudation) 3)Use of drugs of TiktaKatu rasa 4)
Deepana (stimulating appetite) 5) Virecana (purgation) 6) Snehapana(Oleation)7) Vasti
(enema) 8) Ruksha Sweda Valuka Pottalee (use of bags of heated sand)9)Upanaha (applying
poultices) without use of Sneha.[6,10]

Prevalence
Arthritis affects 15% people i.e. over 180 million people in India. This prevalence is higher
than many well-known diseases such as diabetes, AIDS, and cancer. RA is one of the more
common autoimmune diseases, with rates higher than a number of other conditions, including
psoriasis, Crohn’s disease, Type I (insulin-dependent) diabetes, lupus and multiple
sclerosis.[11,15]

Rheumatoid Arthritis: Key Features

May have nodules: subcutaneous or periosteal at pressure points, Rheumatoid factor :45%
positive in first 6 months, 85% positive with established disease, Not specific for RA, high

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Gehija et al. World Journal of Pharmacy and Pharmaceutical Sciences

titer early is a bad sign, Marginal erosions and joint space narrowing on x-ray, Symptoms>6
weeks’ duration, Often lasts the remainder of the patient’s life.

Pathogenesis of Rheumatoid Arthritis

Inflamed synovial tissue (synovitis)Villous hyperplasia, Intimal cell proliferation,
Inflammatory cell infiltration. T cells, B cells, macrophages and plasma cells, Production of
cytokines and proteases, Increased vascularity, Self-amplifying process.

Finger Deformities Caused By Rheumatoid Arthritis

Normal forces applied to damaged joints by the extrinsic flexors and extensors. The tightness
of the intrinsic muscles. Displacement of the lateral bands of the extensor hood. Rupture of
the central slip of the hood. Rupture of the long extensor or long flexor tendons.[16,20]

Deformity of Fingers 1) Intrinsic Plus Deformity 2) Swan Neck Deformity 3) Buttonhole

Deformity 4) Ulnar Deviation.

Swan neck deformity Deformity 1) DIP joint: Flexion 2) PIP joint: Hyperextension 3) MCP
joint: Flexion Caused by muscle imbalance & may be passively correctable.
Also seen in Volar plate laxity Ehler Danlos Syndrome.

Boutonniere Deformity (Buttonhole) Deformity 1) PIP joint: Flexion 2) DIP joint:

Hyperextension 3) MP joint: Hyperextension, Synovitis beginning in the
metacarpophalangeal joint frequently leads to a boutonnière deformity of the thumb.
Proximal phalanx: subluxation, metacarpophalangeal joint, flexioninterphalangeal joint:
hyperextension. Game Keeper’s Thumb Synovitis destruction of the capsuloligamentous
supports on the ulnar side of the metacarpophalangeal joint, Due to laxity of the ulnar
collateral ligament of the metacarpophalangeal joint, Opera Glass Hand (La Main En
Lorgnette), Arthritis Mutilans of Hand, Shortening of fingers due to the destruction of
phalanges. Excess skin gets folded transverselyresembling ‘opera glass’.[17,31]

Case study
 Preliminary data
 Name :X
 Age : 12 Yrs
 Gender : Female
 Religion :Hindu

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Gehija et al. World Journal of Pharmacy and Pharmaceutical Sciences

 Address : Jamnagar
 IPD Admission date: 03/03/2017
 OPD No. : 23788
 IPD No. : 1507
 Bed No. : 142

Chief complaints with duration

Joints pain in long and short joints Morning joint stiffness. Swelling in joints of fingers from
one year.

Family history
1) No H/O consanguineous marriage. 2) Care and support towards patient by the family
members are adequate. 3) Patient belongs to the middle-class family and was cooperative.

Birth History
FTNVD @ hospital, Cry Soon after Birth, B. Wt.- 4 kg.

Personal history
 Diet- vegetarian
 Appetite – Normal
 Bowel – Regular, 1-2 Times a day, Semisolid
 Micturition – Regular, 5-6 times per day, no bladder incontinence;
 Sleep- Normal

General Examination
1) Pulse rate-78/min
2) Respiratory Rate- 18/min
3) BP-118/78 mm of Hg
4) Others – Pain and Swelling in joints.

Systemic Examination
1) Respiratory System- Chest clear, AEBE
2) CVS- S1 S2 present
3) CNS- well oriented and conscious child
4) Musculoskeletal- Inflammation in joints presents, Movement of joints Painful.

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Gehija et al. World Journal of Pharmacy and Pharmaceutical Sciences

Treatment Detail
1) Date of admission: 03/07/2017
2) Date of discharge: 12/08/2017
3) Total days of treatment-39 days

Plan of treatment
1) Deepana Pachana- 2 days
2) Snehapana- 7 days
i) 1st day- 40 ml Goghrita
ii) 2nd day- 70 ml Goghrita
iii) 3rd day- 110 ml Goghrita
iv) 4th day- 160 ml Goghrita
v) 5th day- 180 ml Goghrita
vi) 6th day – 210 ml Goghrita
vii) 7th day- 250 ml Goghrita

3) Oral medication
i) Combination of Balchaturbhadra Churna – 1 gm
ii) Shunthi Churna - 500 mg
iii) Chopchini Churna – 500 mg
iv) Chandramrut Rasa – 125 mg
v) Guduchi Churna – 500 mg

4) This combination has given for 23 days after Virechana Karma

i) Lashunadi Vati- 2 tab BD
ii) Rasnadi Gugglu- 2 tab BD
iii) Combination of Dashmool kwath- 10 gm
iv) Rasnasaptak kwath- 10 gm.

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 Gehija et al. World Journal of Pharmacy and Pharmaceutical Sciences

RESULTS
Table No. 1: Scoring of Treatments.
Sr. No. Assessment Parameters Scoring Before Treatment After treatment
1 Severity of Pain
Severe Score 3 3
Moderate Score 2
Mild Score 1 1
Nil Score 0
2 Tenderness
Severe Score 3
Moderate Score 2 2
Mild Score 1
Nil Score 0 0
3 Swelling
Severely present Score 3
Markedly present Score 2 2
Slightly present Score 1
Absent Score 0 0
4 Grip Strength
Poor (below 38 mm Hg) Score 3
Moderate (38-140 mm Hg) Score 2 2
Mild (141-280 mm Hg) Score 1 1
Normal (above 282 mm Hg) Score 0
5 Functional Score
Unable to do Score 3
With the help of other person or device Score 2
Able to do with the difficulty Score 1 1
Able to do without difficulty Score 0 0
Total Score 10 2

 Inflammation in joints reduced

 Joint mobility increase
 Morning Sickness reduced
 Appetite increase
 Pain in joint reduced

Before treatment

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Gehija et al. World Journal of Pharmacy and Pharmaceutical Sciences

After treatment

Case paper detail

CONCLUSION
Vaitaran Basti and Virechana karma followed by the Vishishta Nidana Parivarjana in the
form of food and drugs showed remarkable symptomatic relief in the features of Aamavata.
This observation needs to be studied in more number of patients for better opinion to manage
Amavata /RA.

ACKNOWLEDGMENT
The authors thank Prof. K S PATEL, I.P.G.T. and R.A., Gujarat Ayurved University,
Jamnagar Dr. V. K. Kori for providing support to the study.

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