Changes

|data5 = carakasamhita@gmail.com

|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:

|label6 = Publisher

|data6 = August 18, 2021

|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label7 = DOI

|label7 = Date of first publication:

|data7 = In process

 

|label8 = DOI

|data8 = 10.47468/CSNE.2021.e01.s09.072

}}

}}

*Dietary: Intake of incompatible combinations of foods. [M.Ni 25/01]<ref name=MNi> Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>, irregular dietary habits.

*Dietary: Intake of incompatible combinations of foods. [M.Ni 25/01]<ref name=MNi> Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>, irregular dietary habits.

*Lifestyle: Indulging in strenuousactivities immediately after intake of unctuous/heavy to digest foods. [M.Ni 25/01]<ref name=MNi/>

*Lifestyle: Indulging in strenuous activities immediately after intake of unctuous/heavy to digest foods. [M.Ni 25/01]<ref name=MNi/>

*Psychological: Negative mental states while taking meals. [Cha.Sa. [[Vimana Sthana]] 2/9 ] Stress is a triggering factor for rheumatoid arthritis.<ref name=Moov>Mooventhan A, Shetty GB. Effect of integrative naturopathy and yoga in a patient with rheumatoid arthritis associated with type 2 diabetes and hypertension. Ancient Sci Life 2017;36:163-6.</ref>

*Psychological: Negative mental states while taking meals. [Cha.Sa. [[Vimana Sthana]] 2/9 ] Stress is a triggering factor for rheumatoid arthritis.<ref name=Moov>Mooventhan A, Shetty GB. Effect of integrative naturopathy and yoga in a patient with rheumatoid arthritis associated with type 2 diabetes and hypertension. Ancient Sci Life 2017;36:163-6.</ref>

*Others: Improper management in pregnancy and post partum period causing aggravation of [[vata]] can lead to amavata.<ref name=Desh>Deshpande SV, Deshpande VS, Potdar SS. Effect of panchakarma and Ayurvedic treatment in postpartum rheumatoid arthritis (amavata): A case study. J Ayurveda Integr Med. 2017 Jan-Mar;8(1):42-44. doi: 10.1016/j.jaim.2016.10.003. Epub 2017 Mar 14. PMID: 28302414; PMCID: PMC5377475. </ref>

*Others: Improper management in pregnancy and post partum period causing aggravation of [[vata]] can lead to amavata.<ref name=Desh>Deshpande SV, Deshpande VS, Potdar SS. Effect of panchakarma and Ayurvedic treatment in postpartum rheumatoid arthritis (amavata): A case study. J Ayurveda Integr Med. 2017 Jan-Mar;8(1):42-44. doi: 10.1016/j.jaim.2016.10.003. Epub 2017 Mar 14. PMID: 28302414; PMCID: PMC5377475. </ref>

When the disease is in chronic stage, the quality of tissues is depleted. Thus the defence mechanism is weak. The treatment objective is focused to strengthen the defence mechanism and manage the aggravating factors. The defence strategy includes restoring equilibrium of [[dosha]] and agni, clearing channels by removing ama and thereafter enhancing strength of tissues.

When the disease is in chronic stage, the quality of tissues is depleted. Thus the defence mechanism is weak. The treatment objective is focused to strengthen the defence mechanism and manage the aggravating factors. The defence strategy includes restoring equilibrium of [[dosha]] and agni, clearing channels by removing ama and thereafter enhancing strength of tissues.

'''Symbiohealth approach:'''

'''[[Symbiohealth]] approach:'''

[[File:Simbiohealth.JPG|500px|'''Figure 1: Symbiohealth approach [Source: Basisht et.al. AYU Journal]'''|thumb]]

[[File:Simbiohealth.JPG|500px|'''Figure 1: Symbiohealth approach [Source: Basisht et.al. AYU Journal]'''|thumb]]

Symbiohealth approach focuses on comprehensive management of disease by including offence and defence strategies of management. A comparative study of the pathogenesis and treatment of RA according to modern medicine and Ayurveda gives many insights helpful in the management of this potentially crippling disease [Figure 1]. It broadens the horizon to win the war against disease. This approach depends upon severity and stage of disease.

[[Symbiohealth]] approach focuses on comprehensive management of disease by including offence and defence strategies of management. A comparative study of the pathogenesis and treatment of RA according to modern medicine and [[Ayurveda]] gives many insights helpful in the management of this potentially crippling disease [Figure 1]. It broadens the horizon to win the war against disease. This approach depends upon severity and stage of disease.

===Preventive strategies===

===Preventive strategies===

====Wholesome foods or Pathya====

====Wholesome foods or Pathya====

#Warm water medicated with Panchkola (Pippali, Pippalimula, Chavya, Chitraka, Shunthi) in small quantity at a time helps in digestion and disintegration of Aama.

#Warm water medicated with Panchkola (Pippali, Pippalimula, Chavya, Chitraka, Shunthi) in small quantity at a time helps in digestion and disintegration of ama.

#Barley, horse gram, kodo millet and the red variety of rice are recommended. These foods are light and easy to digest. Barley kernels and other products made from barley lower inflammatory markers.

#Barley, horse gram, kodo millet and the red variety of rice are recommended. These foods are light and easy to digest. Barley kernels and other products made from barley lower inflammatory markers.

#Green leafy vegetables and fruits contain a variety of polyphenols, bioflavonoids, catechins, carotenoids, vitamin C, riboflavin, vitamin E, and low molecular weight compounds. These constituents have antioxidant, fibrinolytic and anti-inflammatory characteristics. Vegetables preferably with bitter taste like bitter melon (Memordica charantia), Neem (Azadirachta indica), Patola or luffa, Gokharu (Tribulus terrestris) are recommended.

#Green leafy vegetables and fruits contain a variety of polyphenols, bioflavonoids, catechins, carotenoids, vitamin C, riboflavin, vitamin E, and low molecular weight compounds. These constituents have antioxidant, fibrinolytic and anti-inflammatory characteristics. Vegetables preferably with bitter taste like bitter melon (Memordica charantia), Neem (Azadirachta indica), Patola or luffa, Gokshura (Tribulus terrestris) are recommended.

#Spices like ginger, turmeric and garlic help to add flavor to these dishes and also have antimicrobial, anti-inflammatory and analgesic properties besides their Agni promoting impact.

#Spices like ginger, turmeric and garlic help to add flavor to these dishes and also have antimicrobial, anti-inflammatory and analgesic properties besides their Agni promoting impact.

#Wine-old wine, Asava and Arishta.

#Wine-old wine, Asava and Arishta.

'''Asteracantha longifolia (kokilaksha)''' is found to effective in treating rheumatoid arthritis. Its anti-inflammatory property is already reported. The higher protein content may help to enhance the immunity. It may also help to destruct the immune aggregate, which is one of the basic causes for the disease.<ref name=Thanka>Thankamma A. Rheumatoid arthritis and astercantha longifolia. Anc Sci Life. 1999 Jan;18(3-4):247-9. PMID: 22556897; PMCID: PMC3336470.</ref>  

'''Asteracantha longifolia (kokilaksha)''' is found to effective in treating rheumatoid arthritis. Its anti-inflammatory property is already reported. The higher protein content may help to enhance the immunity. It may also help to destruct the immune aggregate, which is one of the basic causes for the disease.<ref name=Thanka>Thankamma A. Rheumatoid arthritis and astercantha longifolia. Anc Sci Life. 1999 Jan;18(3-4):247-9. PMID: 22556897; PMCID: PMC3336470.</ref>  

Tinospora cordifolia (guduchi), Zingiber officinale (shunthi), Semecarpus anacardium (bhallataka) are also usedbased on clinical conditions. [Chikitsapradeepa Amavataroga]<ref name=Pradeep>Gokhale B.V. Amavataroga.In: Chikitsapradeep.Pune:Dhanwantary Pratishthan;1989</ref> Shunthi possess active principles gingerol, dehydrozingerone and gingerdione. These are potent prostaglandin inhibitors. Thus, it attains anti – arthritic effect. Glycosides present in Guduchi acts like NSAIDs thus producing anti – arthritic effect.<ref name=Lekur>Lekurwale PS, Pandey K, Yadaiah P. Management of Amavata with 'Amrita Ghrita': A clinical study. Ayu. 2010 Oct;31(4):430-5. doi: 10.4103/0974-8520.82033. PMID: 22048534; PMCID: PMC3202259. </ref>

Tinospora cordifolia (guduchi), Zingiber officinale (shunthi), Semecarpus anacardium (bhallataka) are also used based on clinical conditions. [Chikitsapradeepa Amavataroga]<ref name=Pradeep>Gokhale B.V. Amavataroga.In: Chikitsapradeep.Pune:Dhanwantary Pratishthan;1989</ref> Shunthi possess active principles gingerol, dehydrozingerone and gingerdione. These are potent prostaglandin inhibitors. Thus, it attains anti – arthritic effect. Glycosides present in Guduchi acts like NSAIDs thus producing anti – arthritic effect.<ref name=Lekur>Lekurwale PS, Pandey K, Yadaiah P. Management of Amavata with 'Amrita Ghrita': A clinical study. Ayu. 2010 Oct;31(4):430-5. doi: 10.4103/0974-8520.82033. PMID: 22048534; PMCID: PMC3202259. </ref>

====Currently used important herbal formulations====

====Currently used important herbal formulations====

'''Decoctions:'''

'''Decoctions:'''

MahaRasnadikwatha, Ashwagandharistha, RasnaPanchakKwatha, RasnaSaptakaKwatha, Dashamoolarishta, and Amritarishta.

Maharasnadi kwatha, Ashwagandharistha, Rasnapanchak Kwatha, Rasnasaptaka Kwatha, Dashamoolarishta, and Amritarishta.

'''Herbal powder mixtures/Churnas:'''

'''Herbal powder mixtures/Churnas:'''

A 54 year old woman diagnosed as Rheumatoid arthritis associated with hypertension and type 2 diabetes was reported to be treated through an integrative approach which includes Naturopathy, Yoga and Acupuncture. The patient complains of moderate to severe pain, swelling and morning stiffness in multiple joints especially over bilateral small joints, elbow, shoulder, knees and hip. Hydrotherapy, mud therapy, massage therapy, yoga therapy and acupuncture were given for 10 days as a supportive treatment. There was improvement in pain, ESR, FBS, PPBS counts. These therapies are reported to have analgesic action. Mud therapy may reduce the inflammation. Sulphur minerals present in mud might get absorbed through skin results in analgesic effect. The action over thermo and mechano receptors through hydro therapy may block nociceptors there by reducing pain. Muscle relaxation achieved through massage might be the cause for pain reduction through massage therapy. Pain reduction through acupuncture might be through modulation of nor adrenaline and serotonin signalling system.  Formation of endogenous opioids, somatostatin and other neurotrophins may block the passage of pain signals. Yoga reduces stress and has action over musculo- skeletal system. Stress itself can act as triggering factor for rheumatoid arthritis.<ref name=Moov/>

A 54 year old woman diagnosed as Rheumatoid arthritis associated with hypertension and type 2 diabetes was reported to be treated through an integrative approach which includes Naturopathy, Yoga and Acupuncture. The patient complains of moderate to severe pain, swelling and morning stiffness in multiple joints especially over bilateral small joints, elbow, shoulder, knees and hip. Hydrotherapy, mud therapy, massage therapy, yoga therapy and acupuncture were given for 10 days as a supportive treatment. There was improvement in pain, ESR, FBS, PPBS counts. These therapies are reported to have analgesic action. Mud therapy may reduce the inflammation. Sulphur minerals present in mud might get absorbed through skin results in analgesic effect. The action over thermo and mechano receptors through hydro therapy may block nociceptors there by reducing pain. Muscle relaxation achieved through massage might be the cause for pain reduction through massage therapy. Pain reduction through acupuncture might be through modulation of nor adrenaline and serotonin signalling system.  Formation of endogenous opioids, somatostatin and other neurotrophins may block the passage of pain signals. Yoga reduces stress and has action over musculo- skeletal system. Stress itself can act as triggering factor for rheumatoid arthritis.<ref name=Moov/>

A 45 year old female with multiple joint pain associated with swelling, morning stiffness, movement restricted and loss of appetite. She was diagnosed with amavata. Treatment includes [[deepana]]-[[pachana]] with amapachanavati for 1 week. It was followed by internal administration of cow’s ghee in escalating dose pattern for 5 days. Fomentation was done for the next 3 days which was followed by therapeutic purgation ([[virechana]]) with Trivritaavaleha (100gm) and castor oil (20ml). After completion of [[virechana]] and diet protocol (samsarjana krama), the 40% reduction in pain and stiffness of joints. RA factor was reduced from 94 IU/ml to 50 IU/ml after [[virechana]]. The patient was put on specific diet pattern after [[virechana]]. After 3 months of treatment, there was significant reduction in all signs and symptoms of amavata. IgE was reduced from 680 kU/L to 53.7 kU/L.<ref name=Gupta>Gupta SK, Thakar AB, Dudhamal TS, Nema A. Management of Amavata(rheumatoid arthritis) with diet and Virechanakarma. Ayu 2015;36:413-5. </ref>

A 45 year old female with multiple joint pain associated with swelling, morning stiffness, movement restricted and loss of appetite. She was diagnosed with amavata. Treatment includes [[deepana]]-[[pachana]] with amapachanavati for 1 week. It was followed by internal administration of cow’s ghee in escalating dose pattern for 5 days. Fomentation was done for the next 3 days which was followed by therapeutic purgation ([[virechana]]) with Trivritaavaleha (100gm) and castor oil (20ml). After completion of [[virechana]] and diet protocol (samsarjana krama), there was 40% reduction in pain and stiffness of joints. RA factor was reduced from 94 IU/ml to 50 IU/ml after [[virechana]]. The patient was put on specific diet pattern after [[virechana]]. After 3 months of treatment, there was significant reduction in all signs and symptoms of amavata. IgE was reduced from 680 kU/L to 53.7 kU/L.<ref name=Gupta>Gupta SK, Thakar AB, Dudhamal TS, Nema A. Management of Amavata(rheumatoid arthritis) with diet and Virechanakarma. Ayu 2015;36:413-5. </ref>

===Research updates===

===Research updates===

   

   

A double dummy randomized pilot trail was conducted to compare classic [[Ayurveda]], methotrexate (MTX), and their combination in rheumatoid arthritis (RA) for 36 weeks. Forty-three seropositive RA patients were diagnosed on criteria by American College of Rheumatology (ACR) criteria. The treatment groups included  MTX plus Ayurvedic placebo (n = 14), Ayurveda plus MTX placebo (n = 12), or Ayurveda plus MTX (n = 17). It was observed that all three treatments were approximately equivalent in efficacy. Adverse events were numerically fewer in the [[Ayurveda]]-only group. <ref>Furst, Daniel E. MD*; Venkatraman, Manorama M. PhD†; McGann, Mary MPH, MSW**; Manohar, P. Ram MD (Ayurveda)‡; Booth-LaForce, Cathryn PhD†; Sarin, Reshmi MD (Ayurveda)‡; Sekar, P.G. MBBS**✠; Raveendran, K.G. BAM&S‡; Mahapatra, Anita MD§; Gopinath, Jidesh BS‡; Kumar, P.R. Krishna BAM&S‡ Double-Blind, Randomized, Controlled, Pilot Study Comparing Classic Ayurvedic Medicine, Methotrexate, and Their Combination in Rheumatoid Arthritis, Journal of Clinical Rheumatology: June 2011 - Volume 17 - Issue 4 - p 185-192 doi: 10.1097/RHU.0b013e31821c0310</ref>

A double dummy randomized pilot trail was conducted to compare classic [[Ayurveda]], methotrexate (MTX), and their combination in rheumatoid arthritis (RA) for 36 weeks. Forty-three seropositive RA patients were diagnosed on criteria by American College of Rheumatology (ACR) criteria. The treatment groups included  MTX plus Ayurvedic placebo (n = 14), Ayurveda plus MTX placebo (n = 12), or Ayurveda plus MTX (n = 17). It was observed that all three treatments were approximately equivalent in efficacy. Adverse events were numerically fewer in the [[Ayurveda]]-only group. <ref>Furst, Daniel E. MD*; Venkatraman, Manorama M. PhD†; McGann, Mary MPH, MSW**; Manohar, P. Ram MD (Ayurveda)‡; Booth-LaForce, Cathryn PhD†; Sarin, Reshmi MD (Ayurveda)‡; Sekar, P.G. MBBS**✠; Raveendran, K.G. BAM&S‡; Mahapatra, Anita MD§; Gopinath, Jidesh BS‡; Kumar, P.R. Krishna BAM&S‡ Double-Blind, Randomized, Controlled, Pilot Study Comparing Classic Ayurvedic Medicine, Methotrexate, and Their Combination in Rheumatoid Arthritis, Journal of Clinical Rheumatology: June 2011 - Volume 17 - Issue 4 - p 185-192 doi: 10.1097/RHU.0b013e31821c0310</ref>

==References==

==References==