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{{#seo:

|title=Amavata  

|title=Amavata  

|type=article

|type=article

}}

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<p style='text-align:justify;'>The clinical condition in which aggravated [[vata]] is associated with metabolic toxins (ama) and mainly affects joints is termed as ‘amavata’. This condition closely resembles with rheumatoid arthritis. The main culprit behind this disease is the deranged digestion and metabolism (agni). Arthralgia, stiffness and swellings of joint are main clinical features. The treatment is focused to improve digestion and metabolism and maintain equilibrium of [[vata dosha]]. Detail description of amavata as a separate disease entity is observed in the text of Madhava Nidana.

The clinical condition in which aggravated [[vata]] is associated with metabolic toxins (ama) and mainly affects joints is termed as ‘amavata’. This condition closely resembles with rheumatoid arthritis. The main culprit behind this disease is the deranged digestion and metabolism (agni). Arthralgia, stiffness and swellings of joint are main clinical features. The treatment is focused to improve digestion and metabolism and maintain equilibrium of [[vata dosha]]. Detail description of amavata as a separate disease entity is observed in the text of Madhava Nidana.

<br/>A comparative study of the pathophysiology of this disease by [[Ayurveda]] and allopathic system reveals that modern medicine emphasizes on control of  inflammation with use of NSAIDS, immunosuppressants and TNF blockers. This is an “offence strategy” which has rapid response but needs to be continued indefinitely and has high incidence of toxicity. On the other hand [[Ayurveda]] follows primarily a “defense strategy” which takes longer time to control inflammation and the symptoms but incidence of toxicity is very little, if at all. In patients with acute inflammation and severe discomfort, initial treatment should be with immunosuppressants and TNF blockers. On control of acute symptoms ayurvedic treatment should be continued. This combined ([[Symbiohealth]]) approach in the management of disease can give insight into the genetic and epigenetic phenomenon and opens the doors for groundbreaking research.<ref>Basisht GK, Singh RH, Chandola H. Management of rheumatoid arthritis (Aamavata) using symbiohealth healthcare system. AYU [serial online] 2012 [cited 2021 Jul 24];33:466-74. Available from: https://www.ayujournal.org/text.asp?2012/33/4/466/110513</ref> This article describes the etiopathogenesis and management of amavata. </p>

A comparative study of the pathophysiology of this disease by [[Ayurveda]] and allopathic system reveals that modern medicine emphasizes on control of  inflammation with use of NSAIDS, immunosuppressants and TNF blockers. This is an “offence strategy” which has rapid response but needs to be continued indefinitely and has high incidence of toxicity. On the other hand [[Ayurveda]] follows primarily a “defense strategy” which takes longer time to control inflammation and the symptoms but incidence of toxicity is very little, if at all. In patients with acute inflammation and severe discomfort, initial treatment should be with immunosuppressants and TNF blockers. On control of acute symptoms ayurvedic treatment should be continued. This combined ([[Symbiohealth]]) approach in the management of disease can give insight into the genetic and epigenetic phenomenon and opens the doors for groundbreaking research.<ref>Basisht GK, Singh RH, Chandola H. Management of rheumatoid arthritis (Aamavata) using symbiohealth healthcare system. AYU [serial online] 2012 [cited 2021 Jul 24];33:466-74. Available from: https://www.ayujournal.org/text.asp?2012/33/4/466/110513</ref> This article describes the etiopathogenesis and management of amavata.  

'''National Ayurveda Morbidity Code''': EC-6

'''National Ayurveda Morbidity Code''': EC-6

|label2 = Authors

|label2 = Authors

|data2 = Aneesh E.G., Deole Y.S.

|data2 = Aneesh E.G., [[Yogesh Deole|Deole Y.S.]]

|label3 = Reviewed by  

|label3 = Reviewed by  

|data3 = Basisht G.

|data3 = [[Gopal Basisht|Basisht G.]]

|label4 = Affiliations

|label4 = Affiliations

|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

}}

}}

'''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==