Rheumatoid Arthritis In Ayurveda

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (known as Amavata in Ayurveda) is an autoimmune disease that causes chronic inflammation of the joints.

Autoimmune diseases are illnesses that occur when the body’s tissues are mistakenly attacked by their own immune system. Patients with autoimmune diseases have antibodies in their blood that target their own body tissues, which can be associated with inflammation.

The joints affected by RA are usually hot, swollen and painful. Pain and stiffness often worsen after a period of rest.

Rheumatoid Arthritis Causes

  • Increased intake of indigestible
  • heavy and incompatible foods
  • having food at improper times
  • indigestion
  • intake of milk and milk products, especially yoghurt
  • intake of meat of aquatic animals
  • lack of physical activity or doing exercise after having fatty foods

Pathology of RA

This ailment stems from the formation of endotoxins called “Aam’. “Aam’ is basically undigested and unassimilated food in our body. “Aam’ is formed due to the malfunctioning of the digestive system mainly due to

  • the intake of incompatible foods.

A classic example of incompatible foods (i.e. foods opposite in nature) would be

eating tomato ketchup with milk or radish with milk etc.

  • “Aam’ also results from leading an unhealthy lifestyle that promotes constipation.
  • Exercising soon after a meal
  • Mental tension and stress 

“Aam’ often gets deposited around joints and causes intense pain and hence Rheumatoid Arthritis. It is against this “aam’ that our immune system creates antibodies.

Rheumatoid Arthritis – Signs and Symptoms

Signs

If you have 4 or more of these, then a case of Rheumatoid Arthritis is confirmed

  • Morning Stiffness around joints for more than 1 hour.
  • Swelling or Stiffness around three or more joints at the same time.
  • At least one area, around the hand, wrist or finger is swollen
  • Symmetric Arthritis – That is, the same part affected by Arthritis on both sides of the body
  • Rheumatoid factor — Positive.
  • Erythrocytic sedimentation rate (ESR) is on the higher side in acute cases.
  • Total leukocyte count (TLC) and differential leukocyte count (DLC) are also high.
  • X-Rays of Hands and Wrists show Signs of Damage.

Symptoms

  • Occurrence of unbearable pain with stiffness due to inflammation in joints.
  • The ailment often originates as pain and swelling of the middle finger in the hand. Soon it spreads to other fingers.
  • Very often similar joints of both hands and feet stiffen, ache and swell simultaneously.
  • The pain in the joints is acute in the morning and gradually subsides in a couple of hours after some physical movements.
  • Joint pains remain moderate during the daytime and increase sharply at night once again.
  • The patient often feels heaviness, lethargy, mild fever and fatigue without effort.
  • Sleepiness during the daytime, insomnia at night,
  • Constant regurgitation in the stomach, flatulence and constipation

Rheumatoid Arthritis Treatment

Modern(Allopathic) Perspective

The treatment of rheumatoid arthritis includes analgesics and non‐steroidal anti-inflammatory drugs (NSAIDs) for symptomatic relief.

The non‐biological disease‐modifying anti‐rheumatic drugs (DMARDs) (hydroxychloroquine, leflunomide, methotrexate, minocycline, sulphasalazine) are used to slow disease progression, induce remission, and improve quality of life.

Steroids are used for symptomatic relief, anti‐inflammatory actions, and to reduce joint damage. 

Biological agents inhibit specific steps in inflammatory processes and include those that do not target tumour necrosis factors (TNF) such as abatacept, rituximab, and tocilizumab and those that are anti‐TNF such as adalimumab, etanercept, infliximab, certolizumab pegol, and golimumab.

Indications for their use as monotherapy and in combination are detailed in the 2012 update of the 2008 American College of Rheumatology (ACR) recommendations and in the guidance provided by the National Institute for Health and Clinical Excellence and the National Collaborating Centre for Chronic Conditions in the UK.

As per allopathic practitioners, there is no cure for RA. Medications can reduce inflammation in joints in order to relieve pain and prevent or slow joint damage. Occupational and physical therapy can help in protecting joints. If joints are severely damaged by RA, surgery may be necessary. Many drugs used to treat RA have potentially serious side effects.

However, to date, no satisfactory modern medical management has been developed for this problem. Hence the management of this disease is merely insufficient in other systems of medicine and patients are continuously looking with hope towards Ayurveda to overcome this challenge.

The Ayurveda perspective

RA cannot be correlated with one single disease entity in Ayurveda. The treatment protocol described here combines the treatments for Amavata and Vatarakta mentioned in the classical texts.

Conditions equivalent to rheumatoid and musculoskeletal diseases are described in detail in Charaka Samhita.

There are two schools of thought in Ayurveda regarding the diagnosis of rheumatoid arthritis

Madhava Nidana  and 

Ashtanga Hridaya.

Madhava Nidana (a treatise of diagnostic guidelines from the 9th century) describes a clinical condition known as ‘Amavata’ that is considered to be similar to rheumatoid arthritis.

The majority of Ayurveda practitioners consider Amavata to be equivalent to rheumatoid arthritis. 

Amavata is linked to the gut and is considered to be the result of the production of ‘ama’ (a toxic and pro‐inflammatory waste‐product of disturbed metabolism) and vitiated Vata dosha. 

According to this model, joints and soft tissues are affected by ‘ama’, produced in the gut due to weakened Agni, food indiscretions, or disturbed ‘dosha’ equilibrium, resulting in inflammatory and obstructive processes.

This model of etiopathogenesis is depicted in the Figure below-

According to Ayurveda–In general people with Vata Prakriti are more prone to develop joint diseases with severe pain.

    In Ashtanga Hridaya, another ancient compendium of the Ayurvedic system, the clinical condition considered similar to rheumatoid arthritis is called Vatarakta. 

A smaller proportion of Ayurveda practitioners, particularly those from states in southern India, consider Vatarakta to be equivalent to rheumatoid arthritis, while those who consider Amavata to represent rheumatoid arthritis equate Vatarakta with gout. 

Vatarakta is considered to be the result of faulty lifestyle and dietary habits that lead to vitiated Rakta and aggravation of Vata that further aggravates the vitiated Rakta, leading to Vidhana in the blood (similar to inflammation). 

Vatarakta manifests as the insidious onset of stiffness, and inflammation of the joints of the fingers and toes that is often symmetrical, sometimes associated with cutaneous manifestations in the prodromal stages and is characterized by flare-ups and remissions.

Treatment of Amavata (Rheumatoid Arthritis)

Agnimandhya / Mandagni (Sluggish metabolism or weak digestion) process is the chief cause of the causation of Amavata. As described above, the initial pathological changes take place at the level of the gut, i.e. in the stomach or upper part of the digestive apparatus.

Principles of treatment can be categorized under the following headings—

Amavastha:

                     Langhana, Rukshana procedures, medicines.

Niramavastha:

                      Shamana drugs and Panchakarma procedures

First do Agni Deepana   and  Ama Pachana .

Amavastha-

Langhana is the line of treatment. It can be done by fasting or giving light food like green gram soup or gruel. With this rukshana can be achieved by some procedures like application of sudation by sand pottali (Valuka sweda) or salt pottali. If pitta is involved in the disease, this rukshana can be done with dhanyamla dhara or dashmoola kashaya dhara to get better effect.

Externally lepas (paste) can be applied to reduce pain and inflammation.

Ayurveda Medicines for Rheumatoid Arthritis

  1. Decoctions
  • Rasna-panchak
  • Gulgulu thikthakam
  • Decoction of Shunti (Zingiber officinale) and Gokshura (Tribulus terrestris)
  • Decoction of Shunti (Zingiber officinale) and Guduchi (Tinospora cordifolia)
  • Pippalyadi Kwatha – Decoction of Pippali (Piper longum), Pippalimula (Root of Piper longum), Chavya (Piper retrofractum), Chitraka (Plumbago zeylanica) and Shunti (Zingiber officinale) can be used.

2. Gutika or Vati

  • Rason Vati
  • Agnitundi Vati
  • Ama pachana vati,
  • Kaishore Guggulu,
  • Sanjivani vati.
  • Amvatari Guggulu
  • Sihnad Guggulu
  • Tryodashang Guggulu

3. Powders 

  • Shunthi (Ginger),
  • Vaishwanar
  • guduchi
  • Panchasama churnam
  • Phalatrikadi Churnam
  • Panchakola churnam  
  • Ajmodadi Churan

4. Rasa

  • Hinguleshwar rasa
  • Vatagajaankush Rasa
  • Samirpanga Rasa
  • Mahavatvidvansan Rasa

5. Taila

  • Mahavishgarabh tail
  • Panchgun Tail
  • Parsarni Tail
  • Mahnarayan Tail

6. Aasava-arishta

  • Punarnava asana
  • Amritarist
  • Maharasanadi Kawath
  • Mahamanjishthadi Kawath
  • Ashawgandarist

Basti like vaitarana, kshar basti is more effective in this condition.

Niramavastha-

Internal Medicines:

  • Decoctions like Rasnasaptakam, Manjishthadi, Kokilakshadi can be used.
  • Gulika like Yogaraja, Kaishore Guggulu, Simhanad guggulu.
  • Powders like Rasayana, guduchi etc will be more beneficial.

Panchakarma management For RA

Virechana:

Virechana means therapeutic purgation. Virechana is generally given after the administration of Snehana and Swedana.

Nitya Virechana is the best form of Virechana which can be given in the early manifestation of Rheumatoid Arthritis.

Nitya Virechana should be administered only after the initial stages have been dealt with after the effective administration of Deepana and Pachana medicines. If not done, Virechana might just give an adverse reaction.

Best medicines used for Virechana (depending on the morbid dosha and morbidity):

  • Trivrit Leha
  • Sukumara Leha
  • Kalyana Gulam
  • Gandharvahastadi Kashayam
  • Gandharvahastadi
  • Eranda Tailam
  • Nimbamritadi Eranda Tailam
  • Higutriguna Tailam
  • Hingutriguna leham
  • Shaddharana Churnam
  • Narayana churnam etc

Acharyas have also mentioned that at first, the patient should undergo Virechana. Virechana is explained in the management of Vatarakta as a prime treatment modality. It cleans the Dhatu by doing purification of the body.

 Virechana drug due to its Ushna, Tikshna, and Sukshma Guna reaches to heart by the virtue of their potency and thereby circulates all over the body. They liquefy the morbid Dosha and bring them up to the Amashaya from here the morbid factors through the anal canal route are expelled out leading to Virechana.

 It has a direct effect on Agnisthana and is thus also helpful in increasing Agni. In the disease RA, Srotorodha is present which is clear due to the property of Srotovishyandana of Virechana drugs. Virechana also helps in normalizing the Pratiloma Gati of Vata thus releasing the general symptoms. Thus, Virechana help in breaking the Samprapti of disease.

Basti or Vasti:
Vasti means medicated enemas. Vasti or Basti is said to be the best treatment for vitiated Vayu . When Vayu is controlled by the action of Vasti all the other disturbing body elements fall into rhythm and equilibrium. Vasti strengthens the tissues of the joints, rejuvenates health, aids fast healing and prevents recurrence.

Virechana and Vasti act as effective purgative and relieve the mentioned conditions.

Vasti is given in the below-mentioned forms:
Asthana Vasti (Kashaya Vasti) – Herbal decoctions or milk (ksheera vasti) processed with decoctions are given as enemas.
Below mentioned are some of the best Asthapana Vasti’s in low back pain –

  • Erandamuladi Kashaya Vasti
  • Dashamula Kashaya Vasti
  • Dashamula Ksheera Vasti
  • Vaitarana Vasti
  • Mustadi Yapana Vasti etc.

Vasti is generally preferred in chronic Rheumatoid arthritis conditions or at later stages. But in acute manifestations or early stages of RA when the disease has not yet set its foot in the joints and soft tissue, a short course of Enema should be administered. Enema is preferred after most of the morbidity in the form of vitiated Vata, Kapha and ama have been expelled by the administration of Deepana, Pachana and Virechana.

Virechana and Vasti given in gut manifestation of RA are more supportive treatments rather than curative. They help in the prevention and recurrence of RA. They also halt the progression of the disease towards joint affliction.

Anuvasana Vasti – Medicated oils or ghee are used for enemas. It is given in combination with Asthapana Vasti (alternatively). Anuvasana Vasti is generally not preferred in early conditions. It is again brought into the picture as a preventive measure to avoid the progression of the disease once the ama has been dealt with by the administration of Deepana, Pachana and Virechana. Matra Vasti – It is also a variant of Anuvasana Vasti but is given in small doses.

The best medicines used for Anuvasana and Matra Vasti are –

  • Guggulutiktakam Ghritam
  • Tiktakam Ghritam
  • Ksheerabala Tailam
  • Mahamasha Tailam
  • Sahacharadi Tailam
  • Brihat Saindhavadya Tailam
  • Bala Tailam etc

There is no treatment of Vatarakta equal to Basti Because of its vast field of therapeutic action, it has also been recognized as a complete therapy. Basti is not merely the enema, rather it is a highly complex, sophisticated and systemic therapy having a wider range of therapeutic actions and indications. It is considered a prime treatment modality for Vata Dosha. Since Vitiated Vata is involved in the pathology of Vatarakta, Basti karma has been explained as the main treatment modality in the management of Vatarakta.

Lepa: 

A type of therapy wherein a paste of drug is applied to the affected part. The drug enters through Romakupa and further gets absorbed through channels leading to desired effects.

Abhyanga (Oil massage):

Abhyanga can increase the fresh oxygenated blood supply to the muscles and organs, and aid the drainage of venous blood, promoting the removal of waste products from the body.

Parisheka: 

Pouring of warm drava (liquid) over the body from a specific height for a specific time. It has Vatahara action and relieves tiredness and confers stability of tissues.

Upnaha: 

Upnaha is the application of a warm paste of roots of Vata mitigating drugs macerated with a sour liquid and added with more salts and fats, made unctuous and tied on the affected part.

Rasayana: Pippalivardhamana Rasayana: 

They start with 3 gm and increase to 18 gm with QS cow milk and Chyavanaprasha: 5-15 gm with hot water/ milk in the morning for 1-3 months.

Common herbs used in RA in medicines and purification procedures

Erand (Castor oil): Eranda taila has Vata-kapha-shamaka property which is more specifically required in the disease RA. Along with this it also has Ushna Virya and Ama Pachana properties. Ricine present in the Eranda Taila on the action of lipase enzyme gets hydrolyzed to Recionelic acid which is responsible for purgation.

  • Shunthi (Ginger)
  • Guggulu (Commiphora wightii )
  • Guduchi (Tinospora cordifolia )
  • Yashtimadhu (Glycyrrhiza glabra )
  • Milk
  • Shallaki (Boswellia serrata )
  • Pippali (Piper longum )

What to eat in RA

Dietetic inclusions (Pathya) are useful in preventing the progression of the disease.

  • Yava – barley
  • Kulattha – horse gram
  • Shyamaka – Panicum frumentaceum
  • Kodrava – Paspalum scrobiculatum
  • Rakta shali – Red rice
  • Shigru – drumstick
  • Punarnava – Boerhavia diffusa
  • Karavellakam – bitter gourd
  • Patola – pointed gourd
  • Ardraka – ginger
  • Taptaneeram – hot water
  • Takra samskrutam Lashunam – garlic processed in buttermilk
  • Jangala mamsa – meat of animals living in desert and dry lands
  • Water processed with Panchakola churna

Food to avoid in RA

Avoidable diet in RA 

  • Dadhi – curds
  • Matsya – fish
  • Guda – jaggery
  • Dugdha – milk
  • Masha pishti – flour of black gram
  • Dushta neeram – contaminated water
  • Purva vatam – wind blowing from the east
  • Viruddha bhojana – mutually incompatible foods
  • Asatmya bhojana – food that do not suit us
  • Vegavarodham – forcibly controlling the natural body urges or reflexes
  • Jagaran – habit of awakening throughout the night
  • Guru ahara – food heavy to digest
  • Abhishyandi ahara – food which causes blockage in cells and channels of the body

Home Remedies For Rheumatoid Arthritis

  • Castor oil.  10-15ml of castor oil with warm water or milk at night before going to bed 
  • Take 3 g Rason Pind (Garlic) with warm water after meals.
  • At night, take 3 g of Giloya Churan and 1g of Saunth Churan with warm water.
  • Oil massage is only after the “aam’ has been completely eradicated from the body.
  • Go for absolute fasting or rely on a liquid or semi-solid diet for an entire day, depending on your strength.

Special food for Joints pain

  • Coriander
  • Turmeric 
  • Ginger
  • Pineapple
  • Blackstrap molasses
  • Green tea
  • Sour cherries and pomegranates
  • Fish oil

Diet & Lifestyle For Rheumatoid Arthritis

  • Increase intake of barley flour, horse gram (a type of bean), split green gram, honey, celery seeds, cumin seeds, dried ginger root powder, garlic, bitter gourd and castor oil.
  • Avoid eating fish and milk together or milk and jaggery together.
  • Avoid incompatible, heavy, and oily foods.
  • Avoid an improper diet and lifestyle, such as waking up late at night, suppressing the natural urges of the body, and getting direct exposure to cold winds.

To What Extent Ayurveda Is Effective In Rheumatoid Arthritis?

 Ayurvedic treatment of Rheumatoid Arthritis starts with the pacification of Vata and the elimination of toxins from the body.

With the above discussion, it should be clear that RA can be cured and Ayurveda has lots of options to tackle RA as seen above. It is only up to us to make the best utilization of them.

There are many types of research done on this topic which are the evidence to support this fact. There are no chances of recurrence if a person follows the Ayurveda concept of a healthy, lifestyle and regular cleansing of the body through Panchakarma.

    We don’t recommend self-medication of the above said Ayurveda medicines for Rheumatoid Arthritis. These are just for your knowledge that Ayurveda cures the disease effectively. These medicines are very effective when taken under the proper guidance of an Ayurveda expert.

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