E-ISSN:2456-3110

Case Report

Rheumatoid Arthritis

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 4 APRIL
Publisherwww.maharshicharaka.in

Intervention of Amavata (Rheumatoid Arthritis) through Ayurvedic approach

Bishnoi S1*, Meena PK2
DOI:10.21760/jaims.10.4.50

1* Suman Bishnoi, Post Graduate Scholar, PG Dept of Kayachikitsa, Madan Mohan Malviya Government Ayurvedic College and Hospital, Udaipur, Rajasthan, India.

2 Pradeep Kumar Meena, Assistant Professor, PG Dept of Kayachikitsa, Madan Mohan Malviya Government Ayurvedic College and Hospital, Udaipur, Rajasthan, India.

Introduction: Amavata is an Ama Pradoshaja Vikara, caused by Agnimandya, which leads to accumulation of Ama in Shleshmasthana and Prakopa of Vata Dosha. It closely resembles the chronic inflammatory auto immune disorder called Rheumatoid Arthritis. Clinical features ranges from mild inflammation to complete degenerative changes of joint. Prevalence of R.A is approximately 0.8% worldwide and 0.5-0.75% in India.

Materials and Methods: A 36 year old female patient came to OPD of Kayachikitsa Dept. with complaint of multiple joint pain, stiffness and swelling particularly affecting the wrists, knees and hands since 8 years but symptoms have exaggerated from last 8-9 months. Diagnostic evaluation confirmed the presence of rheumatoid factor (RF) and CRP was found raised. Conventional treatments, such as DMARDs & NSAIDs were initiated but resulted in only partial symptom relief. Patient was treated with Kshara Basti for 30 days along with oral ayurvedic medicine such as Rasanadi Kwatha, Eranda Sneha, Chitrakadi Vati, Simhanad Guggulu etc. These modalities help in Amapachan, Vatashaman and Srotas Shodhan. Dietary recommendations emphasized warm, easily digestible foods, and the reduction of cold, heavy, and processed items to mitigate Ama formation.

Conclusion: The Ayurvedic approach led to significant improvements in the patient's symptoms, including reduced joint pain and stiffness, enhanced mobility, and overall better quality of life. This case study illustrates the potential benefits of integrating Ayurvedic therapies with conventional treatment to manage Amavata effectively. It highlights the importance of a holistic approach in treating chronic autoimmune conditions and encourages further exploration of Ayurvedic practices in contemporary rheumatology.

Keywords: Agni, Ama, Vata Dosha, Autoimmune disease, Chronic symmetrical polyarthritis, Synovial inflammation, Cartilage destruction, Bone erosion, Joint deformities, NSAIDs, Joint pain, Swelling, Morning stiffness

Corresponding Author How to Cite this Article To Browse
Suman Bishnoi, Post Graduate Scholar, PG Dept of Kayachikitsa, Madan Mohan Malviya Government Ayurvedic College and Hospital, Udaipur, Rajasthan, India.
Email: 		Bishnoi S, Meena PK, Intervention of Amavata (Rheumatoid Arthritis) through Ayurvedic approach. J Ayu Int Med Sci. 2025;10(4):326-330.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-03-14 2025-03-24 2025-04-04 2025-04-14 2025-04-23
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© 2025 by Bishnoi S, Meena PK and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Download PDFBack To ArticleIntroductionCase ReportObservations and ResultsDiscussionConclusionReferences
Suman B et al. Intervention of Amavata through Ayurvedic approach

Introduction

Amavata (Rheumatoid arthritis) is lifestyle disorder which has high prevalence around globe. Amavata is defined as condition where Ama & Vata Dosha are vitiated simultaneously and enters Trika (Pelvic girdle) and Sandhi (joints) causing stiffness (Stabdhata) of body. Here, Ama means improperly/partially digested food or undigested Rasa Dhatu formed due to poor strength of Agni. Acharya Madhav has described causative factors for disease as Viruddhahara (Unwholesome Diet), Viruddhachesta (Erroneous Habits), Mandagni, Sedentary Lifestyle and exercising immediately after food.[1] Its symptoms include joint pain like that of scorpion bite, swelling and stiffness in multiple joints with systemic features (Sarvadaihika Lakshanas) of Ama like Angamarda (myalgia), Aruchi (anorexia), Trishna (thirst), Alasya (laziness), Gaurav (heaviness), Jwara (pyrexia), Apaaka (indigestion), Anga Shunata (oedema). The clinical presentation of Amavata closely mimics with Rheumatoid arthritis (RA), in accordance with their similarities in clinical features like multiple joint pain, swelling, stiffness, fever, general debility etc. Rheumatoid arthritis affects approximately 0.5-1% of adult population worldwide.[2] The incidence of RA increases between 25 and 55 years of age, after which it plateaus until age of 75 and then decreases.[3] Women are affected approx. 3 times more often than men.[4] Despite of various treatment measures available in Allopathic system of Medicine prevalence of disease is quite high. Moreover, Allopathic drugs have many side-effects thus, adding to misery of patients. So, study was planned for effective management of Amavata by Ayurvedic treatment. Management typically involves detoxification, digestion enhancement, and pacification of Vata and Ama.

Kṣhāra Basti, an Ayurvedic enema therapy, is a potent treatment for Vata and Kapha disorders. Śamana Chikitsā includes dietary regulation, herbal formulations, and lifestyle modifications to balance Doshas and remove Ama. This case report highlights the integrative approach of these therapies in managing Amavata.

Case Report

Pradhana Vedana Vruttanta - Pain in multiple joints associated with swelling and stiffness.

Adyatana Vyadhi Vruttanta - A female patient aged 36 years visited the OPD of Kayachikitsa, Government Ayurveda Medical College, Udaipur, Rajasthan, India. She was presented with chief complaints of pain in multiple joints associated with swelling and stiffness which lasts more than 2 hrs. Patient was diagnosed with Rheumatoid arthritis with RA factor 666 IU/ml and ESR 36 mm/1st Hr. She has undergone allopathic treatment and has taken steroids many times, but did not get any relief from her symptoms. For further management, she visited the OPD of Kayachikitsa, Government Ayurveda Medical College, Udaipur.

Poorva Vyadhi Vruttanta: Nothing significant

Koutumbika Vruttanta: Nothing significant

Vayaktika Vruttanata:

Name: xyz
Age: 36 years
Marital status: Married
Occupation: House wife
Diet: Mixed
Bowel: Constipated
Appetite: Reduced
Menstrual history: Regular
Height: 160cm
Weight: 55kg

Ashta Sthana Pareeksha

Nadi: Manda
Mala: Baddha
Mutra: Atimutrata with Avilata
Jihwa: Lipta
Shabda: Prakruta
Sparsha: Prakruta
Drik: Prakruta
Akriti: Madhyama

Systemic Examination

Table 1: Showing Musculo Skeletal System

B/L knee jointsB/L ankle jointsSmall joints of hands
SwellingPresentPresentPresent
DeformityAbsentAbsentPresent
TendernessPresentPresentPresent
TemperatureWarmthWarmthNormal
Range of movementRestrictedPainfulRestricted

Cardio vascular system: S1 S2 heard, no abnormality detected.


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Suman B et al. Intervention of Amavata through Ayurvedic approach

Respiratory system: NVBS heard, no abnormality detected.
Gastro intestinal system: P/A: Soft, non-tender

Table 2: Showing 2010 ACR/EULAR classification criteria for RA

ParametersScore
Joint distribution (0-5) >10 joints5
Serology (0-3) High RA factor (114.60IU/mL)3
Symptoms duration (0-1) >6weeks1
Acute phase reactants - Normal ESR0

Total score: >6 defines RA

Nidana Panchaka

Nidana

Aharaja: Snigdha, Abhishyandi Atisevana, Ati Sheeta Aahar Sevana (Fridge Items) , Mamsa Sevan.

Viharaja: Divaswapna after taking food.

Purvaroopa: Agnimandya

Roopa: Anga Gourava, Shoola Shotha and Stabdtha in multiple joints.

Upashaya: Summer season, afternoon hours, immersing joints in hot water

Anupashaya: Winter season, cold water.

Samprapti Ghataka

Dosha: Vata Pradhana Tridosha
Dushya: Rasa, Asthi, Majja
Agni: Jataragni, Dhatwagni
Agnidushti: Mandagni
Srotas: Rasavaha, Asthivaha, Majjavaha
Srotodusti: Sanga
Udbhavasthan: Amashaya
Sancharasthana: Sarvashareera
Vyaktasthana: Sandhi
Adhishtana: Sandhi
Rogamarga: Madhyama
Sadhyasadhyata: Kricchrasadhya

Treatment

According to Acharya Chakradatta treatment of Amavata in order is that - Langhana, Svedana, Katu – Tikta Deepaniya Dravya, Virechana, Snehapana, Basti (Saindhavadi Anuvasana Basti and Kshara Basti).[5] Satahvadi Kshar Basti and Vaitarana Basti both are main line of treatment for Amavata which has mentioned in Niruha Basti Adhikarana.[6]

Properties of Kshara should not be Ati Tikshna, Ati Mrudu, Ati Shukla, Ati Picchila. It also has Tridoshagna, Agneya, Ushna, Teekshna, Pachana, Shodhna, Ropana, Vilayana, Lekhana properties.[7] The Bastis where Kshara, Gomutra and Teekshna Dravya used as ingredients are can be considered as Kshara Basti.

Treatment protocol adopted

Panchakarma

The patient was given Kshara Basti along with Bruhatsaindhavadi Taila Anuvasana Basti in format of Kala Basti i.e.,16 days.

Shamana Yogas

  • Combination of -
  • Aamvatari Ras - 125mg
  • Chohsthaprahari Pippali - 125mg
  • Pravalpanchamrita Ras - 250mg
  • Mahavatvidhvanshak Ras - 125mg
  • Vatari Churna - 2gm - B.D - B/F
  • Rasnaerandadi Kwatha - 10ml-0-10ml (empty stomach)
  • Erand Taila - 10ml at night
  • Chitrakadi Vati - 2-0-2 A/F
  • Simhanada Gugullu - 2-0-2 A/F

Contents of Kshara Basti

  • Amlika - 50gm
  • Guda Paka - 25gm
  • Saindhava - 10gm
  • Shatahva - 10gm
  • Gomutra - 100ml

Assessment

Table 3: Scoring of the symptoms

GradeSandhi ShothaSandhi ShoolaSandhi Stabdata
0No swellingNo painNo stiffness
1Visible swelling, but no loss of joint contourMild pain with slight difficulty in flexion and extension5mins to 30mins
2swelling with Loss of normal joint contourModerate pain with much difficulty in flexion and extension30mins to 1hr
3Frank cystic swelling of jointSevere pain with restricted movements1hr to 2hrs
4--More than 2 hours

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The results were assessed on the basis of clinical signs and symptoms mentioned in Ayurvedic classics as well as 2010 ACR/EULAR classification criteria for RA

Observations and Results

DaysTreatmentObservations
D1 - D20Only Shaman Chikitsa was given to patientPain, swelling, stiffness in multiple joints reduced by 40%.
Range of movements: restricted
D25 - D40Kshara Basti along with Bruhatsaindhavadi Taila Anuvasana BastiMarked reduction in pain, swelling, stiffness. Absence of pain during night time. Heaviness of the body reduced.
After that Shaman Chikitsa continued

Table 4: Showing Overall assessment

Assessment criteriaBefore treatmentAfter treatment
Sandhi ShoolaGrade 3Grade 1
Sandhi ShothaGrade 1Grade 0
Sandhi StabdhathaGrade 4Grade 2
RA FACTOR666 IU/ML113 IU/ML
CRP5.530 mg/L5.79 mg/L
ESR36 mm/1st hr10 mm/1st hr
EULAR score108

Discussion

Madhavakara has described Viruddhahara, Viruddhacheshta, Nishchalatva and exercise immediately after Snigdha Ahara are the Nidana of the Amavata disease. Avoidance of the Nidana is the first and foremost line of treatment because these are directly or indirectly responsible for Dosha Utklesha and Agnimandhya and because of the Agnimandhya, Ahara Rasa is not digested properly which leads Ama formation. Due to Ama, Rasa Dhatu is not well formed. This pathology mainly effects the Amashaya which is the site of Kapha Dosha. Hence, Ama leads to Kapha vitiation and leading symptoms like Srotorodha, Gauravata, Alasya, Aruchi etc. when the impaired Vatadi Dosha being mixed up with Ama Dosha leads to Amavisha. It is very difficult to treat due to its Ashukriya and opposite nature of Ama and Visha’s treatment.

Avastha Vishesha Chikitsa: Based on Avastha Vishesha treatment of Amavata should be divided into two categories. Amavavastha & Niramavastha.

Langhana, Ruksha Swedan and Katu - Tikta Dipaniya Dravyas can be given in Amavastha for digestion of the Ama.

After digestion of Ama means in Niramavastha Virechana, Snehapana and Basti treatment can be given.

Doshanubandha Chikitsa: According to Acharya Charaka, the quantity of Niruha Basti’s Dravya can be increase or decrease based on various situation. i.e.,

In Vatanubandha Amavata, can be increased the amount of Sneha or Tila Taila in Kshara Basti and Decrease the Ushna and Tikshna Dravya like Satahva and Gomutra. Hence, it will help in pacify the Vata Dosha.

Like, in Pittanubandha Amavata, burning sensation and redness around the joints are seen. Hence, the quantity of Amlika and Satahva can be decrease because of its Amla Vipaka and Pittakara properties of Amlika and Katu-Tikta Rasa, Katu Vipaka and Ushna Virya of Satahva. In this condition increase the quantity of Purana Guda because of its Madhura Vipaka. so, it can be helpful to pacify the Pitta Dosha in the body.

In Kaphanubandh Amavata, Kapha Dosha is an aggravated form. Hence, Satahva and Gomutra can be added in more quantity and can be decrease the amount of Purana Guda.

Avayava Prabhava (Mode of action of an individual drugs):

Purana Guda: Ushana Virya of Guda helps in Dosha Paka.

Saindhava Lavana: It helps to dissolve and disintegrate morbid Kapha and Ama Dosha by its Kapha Vilayana or Kapha Vichhedana properties.

Amlika: Its Ruksha Guna and Ushna Virya, helps in Amapachana.

Satahva: Katu - Tikta, Ushna Virya, and Katu Vipaka properties of Satahva, help in the digestion of Ama and the bring back to Agni.

Gomutra: It helps to pacify Kapha Dosha because it contains Katu Rasa, Katu Vipaka, Ushna Virya, and Laghu, Tikshna Guna. It is also helps in Srotovishodhana due to its Teekshna Guna. Additionally, the properties of its Ruksha Guna, Tridoshghna, Agnideepaka, and Vatanuloman are beneficial in Amavata disease.

Tila Taila: It is cold in touch which counteracting the irritant potency of Kshara.


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Also, its Vata-Kapha Nashaka properties, it may help to prevent further aggravation of Vata.

Samudaya Prabhava (Probable mode of action): Niruha Basti is a uniform mixture of Makshika, Lavana, Sneha, Kalka and Kwath. But in this Kshara Basti Guda is used instead of Madhu. Lavana possesses Sukshma and Tikshna Guna which helps the Basti Dravya to reach up to the Sukshma Srotas and due to Guru Guna of Amlika helps retention of Basti Dravya.

Also, the Kalka of Satahva which gives potency to the whole Basti Dravya and its Katu-Tikshna Guna and Ushna Virya helps to digestion of Ama. In Kshara Basti, Gomutra is Pradhana Dravya which maintains the volume of Basti.

Also, helps in the spreading Basti Dravya and cleansing the Srotas. And having its Katu-Tikta Rasa, Katu Vipaka and Ushna Virya pacify the Kapha Dosha. The general properties of Mutra is Tikshna, Bhedana, Vatanulomana and Srotovishodhana which helps in the elimination of vitiated Ama Dosha from the Sukshma Srotas.

In Vaitarana type of Kshara Basti, adding Tila Taila along with these Dravya except Satahva, helps to easy elimination of Basti Dravya with vitiated Ama and Dosha without any discomfort and strains because Kshara Guna of Gomutra might have chance to cause irritation.

Guna Vishesha Siddhanta: Kshara Basti is a type of Tikshna Niruha Basti which consists Laghu, Tikshna, Ushna and Ruksha Guna which completely opposite to the Guru, Snigdha and Picchila Guna of Kapha and Ama Dosha. Thus, Kshara Basti helps to break obstruction and expel out the morbid Dosha from all over the body.

Conclusion

Amavata is most common crippling joints disorder. Ama and Vata both being contradictory in nature make difficult to treat. Thus, Kshara Basti can be effective and ultimate line of treatment for Ama and Vata Dosha. The drugs of these two Bastis have Vata-Kapha Nashaka, Agnideepaka, and Vatanulomaka properties, they might be an effective treatment for Ama and Vata Dosha. This means that Kshara Basti may be thought of as a successful treatment for Amavata disease because it is having opposing Guna to Ama and Kapha Dosha.

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