Changes

==Research on ayurvedic formulations==

==Research on ayurvedic formulations==

   

   

'''Rasonarasnadighanavati, Simhanadaguggulu:''' In a study, 101 amavata patients were divided into two groups. In one group Rasonarasnadighanavati (250mg) was administered in the dosage of 2 tablets three times a day with hot water for 3 months. In addition to this,rasonarasnadilepa was applied at the affected joints twice a day for three months. In another group, simhanadaguggulu was administered in the dose of 2 tablets thrice a day with hot water for 3 months. General signs and symptoms of amavata were reduced in both the groups. Rasonarasnadighanavati showed better pain reliving action. Simhanadaguggulu showed better reduction in swelling of joints. Most of the drugs in rasonarasnadighanavati possess pungent and bitter taste, hot potency, [[rasayana]] and ama digesting properties. This helps to break the disease pathogenesis. Moreover, it has immunomodulatory action too. Simhanadaguggulu possess [[vata]]-[[kapha]] pacifying action and stimulates digestive capacity. It has antioxidant properties also.<ref name=Mahto/> Bitter and pungent taste, hot potency, dry and light properties of the drugs help to break the pathogenesis. All these properties are antagonistic to ama and [[vata]]. Kindling the digestive capacity helps to correct the ama status and there by removes the obstruction in the channels.<ref name=Pandey>Pandey SA, Joshi NP, Pandya DM. Clinical efficacy of Shiva Guggulu and SimhanadaGuggulu in Amavata (Rheumatoid Arthritis). Ayu. 2012 Apr;33(2):247-54. doi: 10.4103/0974-8520.105246. PMID: 23559798; PMCID: PMC3611626.</ref>

'''Rasonarasnadi ghanavati, Simhanada guggulu:''' In a study, 101 amavata patients were divided into two groups. In one group Rasonarasnadi ghanavati (250mg) was administered in the dosage of 2 tablets three times a day with hot water for 3 months. In addition to this, rasonarasnadi lepa was applied at the affected joints twice a day for three months. In another group, simhanada guggulu was administered in the dose of 2 tablets thrice a day with hot water for 3 months. General signs and symptoms of amavata were reduced in both the groups. Rasonarasnadi ghana vati showed better pain reliving action. Simhanada guggulu showed better reduction in swelling of joints. Most of the drugs in rasonarasnadi ghana vati possess pungent and bitter taste, hot potency, [[rasayana]] and ama digesting properties. This helps to break the disease pathogenesis. Moreover, it has immunomodulatory action too. Simhanada guggulu possess [[vata]]-[[kapha]] pacifying action and stimulates digestive capacity. It has antioxidant properties also.<ref name=Mahto/> Bitter and pungent taste, hot potency, dry and light properties of the drugs help to break the pathogenesis. All these properties are antagonistic to ama and [[vata]]. Kindling the digestive capacity helps to correct the ama status and there by removes the obstruction in the channels.<ref name=Pandey>Pandey SA, Joshi NP, Pandya DM. Clinical efficacy of Shiva Guggulu and Simhanad aGuggulu in Amavata (Rheumatoid Arthritis). Ayu. 2012 Apr;33(2):247-54. doi: 10.4103/0974-8520.105246. PMID: 23559798; PMCID: PMC3611626.</ref>

In an experimental study, rheumatoid arthritis was induced in male wister rats. A formulation containing Commifora mukul, Strychnosnux vomica, Boswellia sereta, Maharasnadi kwatha and Suvarna bhasma was administered. It was found effective in reducing the signs and symptoms of Rheumatoid arthritis. These drugs have proven anti-inflammatory activity. The active principles like guggulsterones, boswellic acid, brucine can inhibit inflammatory mediator over production.<ref name=PatelSS>Patel SS, Shah PV. Evaluation of anti-inflammatory potential of the multidrug herbomineral formulation in male Wistar rats against rheumatoid arthritis. J Ayurveda Integr Med 2013;4:86-93.</ref>

In an experimental study, rheumatoid arthritis was induced in male wister rats. A formulation containing Commifora mukul, Strychnosnux vomica, Boswellia sereta, Maharasnadi kwatha and Suvarna bhasma was administered. It was found effective in reducing the signs and symptoms of Rheumatoid arthritis. These drugs have proven anti-inflammatory activity. The active principles like guggulsterones, boswellic acid, brucine can inhibit inflammatory mediator over production.<ref name=PatelSS>Patel SS, Shah PV. Evaluation of anti-inflammatory potential of the multidrug herbomineral formulation in male Wistar rats against rheumatoid arthritis. J Ayurveda Integr Med 2013;4:86-93.</ref>

'''Vatari guggulu:''' A study on 58 patients diagnosed with amavata reported vatari guggulu is effective in reducing the symptoms such as pain, swelling, stiffness and tenderness in joints. There was statistically significant reduction in RA factor,too. However, the study showed the efficacy of drug decreases with increase in the chronicity of disease.<ref name=Maraga/> The general symptoms like bodyache, heaviness, anorexia were significantly reduced significantly by vatari guggulu.<ref name=Khagram>Khagram R, Mehta CS, Shukla VD, Dave AR. Clinical effect of Matra Basti and VatariGuggulu in the management of Amavata (rheumatoid arthritis). Ayu. 2010 Jul;31(3):343-50. doi: 10.4103/0974-8520.77167. PMID: 22131737; PMCID: PMC3221069.</ref>

'''Vatari guggulu:''' A study on 58 patients diagnosed with amavata reported vatari guggulu is effective in reducing the symptoms such as pain, swelling, stiffness and tenderness in joints. There was statistically significant reduction in RA factor,too. However, the study showed the efficacy of drug decreases with increase in the chronicity of disease.<ref name=Maraga/> The general symptoms like bodyache, heaviness, anorexia were significantly reduced significantly by vatari guggulu.<ref name=Khagram>Khagram R, Mehta CS, Shukla VD, Dave AR. Clinical effect of Matra Basti and Vatari Guggulu in the management of Amavata (rheumatoid arthritis). Ayu. 2010 Jul;31(3):343-50. doi: 10.4103/0974-8520.77167. PMID: 22131737; PMCID: PMC3221069.</ref>

'''Alambushadi Ghana vati:''' Alambushadi ghana vati is observed effective in reducing the pain, stiffness, swelling and tenderness associated with amavata.  There was 60% reduction in anorexia and more than 66% reduction in fever.<ref name=Sasane>Sasane P, Saroj UR, Joshi RK. Clinical evaluation of efficacy of Alambushadi Ghana Vatiand Vaitarana Basti in the management of Amavatawith special reference to rheumatoid arthritis. Ayu 2016;37:105-12.</ref>

'''Alambushadi Ghana vati:''' Alambushadi ghana vati is observed effective in reducing the pain, stiffness, swelling and tenderness associated with amavata.  There was 60% reduction in anorexia and more than 66% reduction in fever.<ref name=Sasane>Sasane P, Saroj UR, Joshi RK. Clinical evaluation of efficacy of Alambushadi Ghana Vatiand Vaitarana Basti in the management of Amavatawith special reference to rheumatoid arthritis. Ayu 2016;37:105-12.</ref>

'''Amrita ghrita:''' A study conducted on 28 patients of amavata patients reported that administration of amrita ghrita is helpful in managing the signs and symptoms of amavata. There was 43% reduction in ESR, 51% reduction in ASO titer and CRP reduced by 63% after 45 days of administration of 15 gm of amrita ghrita with milk.<ref name=Lekur/>

'''Amrita ghrita:''' A study conducted on 28 patients of amavata patients reported that administration of amrita ghrita is helpful in managing the signs and symptoms of amavata. There was 43% reduction in ESR, 51% reduction in ASO titer and CRP reduced by 63% after 45 days of administration of 15 gm of amrita ghrita with milk.<ref name=Lekur/>

Rasnerandadi kwatha<ref name=Edava/>,Rasnasaptaka kwatha, Rasnapanchaka kwatha, Rasnadashamula kwatha,  Yogaraja guggulu, Vaishwanara churna are also mentioned for the treatment of amavata. [Chakradatta]<ref name=Chakradatta/>

Rasna erandadi kwatha<ref name=Edava/>,Rasnasaptaka kwatha, Rasnapanchaka kwatha, Rasnadashamula kwatha,  Yogaraja guggulu, Vaishwanara churna are also mentioned for the treatment of amavata. [Chakradatta]<ref name=Chakradatta/>

==Currently used important herbo-mineral formulations==  

==Currently used important herbo-mineral formulations==  

A diagnosed case of Ankylosing spondylitis was treated according to the treatment principles of amavata. A 21 years old male patient complaining of severe pain in low back and both knee joints with morning stiffness for more than an hour. Intermittent fever with chills and headache were also present. Reduced appetite and constipation was associated complaints.  The investigations like ESR was 140 mm/hr, MRI of lumbar spine suggested bilateral sacrolitis and Human leukocyte antigen (HLA B27) was positive. The diagnosis of amavata was made based on clinical features. Initially to reduce the fever, Amrutotaram kwata, Amavatari rasa and Amritarishta were given. Since the fever persists after two weeks Amavatari rasa and Amritarishta were replaced with Vettumaran gulika and Chitrakasava. After the subsidence of fever lepa was applied over the painful areas with Kottamchukkadi churna and dhanyamla. Swelling and pain in joint subsides but since the patient develops skin rashes kottamchukkadi was replace with Grihadumadi churna. After 1 month the patient was able to walk without support and the fever subsided completely. Then the internal medications were revised to Indukantam kwatha, Marmagulika and Shaddharana churna. Fomentation with bolus of Kolakulathadi powder was also applied for 10 days. Therapeutic purgation ([[virechana]]) with Gandharvaeranda was administered on alternate days. After fomentation, pain in low back  and other joints was reduced. Morning stiffness was still present. Therapeutic enema ([[basti]]) was administered in kala basti pattern. It included six balaguduchyadi niruha basti and 9 anuvasana basti. Significant improvement in pain and stiffness was noticed after the [[basti]]. Niruha basti is the main treatment for rheumatic disorders. After that as pacifying therapy Rasna-erandadi kwata, Simhanada guggulu and Gandharva-eranda was administered.  His ESR was reduced to 5mm/hr after 3 months of treatment.<ref name=Edava/>

A diagnosed case of Ankylosing spondylitis was treated according to the treatment principles of amavata. A 21 years old male patient complaining of severe pain in low back and both knee joints with morning stiffness for more than an hour. Intermittent fever with chills and headache were also present. Reduced appetite and constipation was associated complaints.  The investigations like ESR was 140 mm/hr, MRI of lumbar spine suggested bilateral sacrolitis and Human leukocyte antigen (HLA B27) was positive. The diagnosis of amavata was made based on clinical features. Initially to reduce the fever, Amrutotaram kwata, Amavatari rasa and Amritarishta were given. Since the fever persists after two weeks Amavatari rasa and Amritarishta were replaced with Vettumaran gulika and Chitrakasava. After the subsidence of fever lepa was applied over the painful areas with Kottamchukkadi churna and dhanyamla. Swelling and pain in joint subsides but since the patient develops skin rashes kottamchukkadi was replace with Grihadumadi churna. After 1 month the patient was able to walk without support and the fever subsided completely. Then the internal medications were revised to Indukantam kwatha, Marmagulika and Shaddharana churna. Fomentation with bolus of Kolakulathadi powder was also applied for 10 days. Therapeutic purgation ([[virechana]]) with Gandharvaeranda was administered on alternate days. After fomentation, pain in low back  and other joints was reduced. Morning stiffness was still present. Therapeutic enema ([[basti]]) was administered in kala basti pattern. It included six balaguduchyadi niruha basti and 9 anuvasana basti. Significant improvement in pain and stiffness was noticed after the [[basti]]. Niruha basti is the main treatment for rheumatic disorders. After that as pacifying therapy Rasna-erandadi kwata, Simhanada guggulu and Gandharva-eranda was administered.  His ESR was reduced to 5mm/hr after 3 months of treatment.<ref name=Edava/>

A 27 year old female patient developed amavata, 1 month after her delivery. She complaints of pain and swelling in bilateral corpo-phalangel joints, both knees and ankles along with morning stiffness, anorexia and bodyache for six months. Tenderness along with raised body temperature and stiffness was present in the affected joints. Her RA factor and Anti CCP antibody were positive. RA factor 160 IU/ml and anti CCP more than 200 units/ml. Patient was treated with oral medications and [[panchakarma]] treatments. During the entire course of treatment, she continued breast feeding and the baby showed normal growth and development. The treatment for four months includes oral administration of Simhanada guggulu, Pratapalankeshwara rasa, Dashamoolakatutraya kashaya, combination of Swarnabhupati rasa, mahavatavidhvansa rasa, Tapyadiloha along with Smilax china (chopachini), Zinziber officinale (shunthi) and Tinospora cordifolia (guduchi).  [[Panchakarma]] treatment includes whole body massage with Vishagharbhataila, fomentation in wooden chamber (bashpa sweda) and therapeutic enema ([[basti]]). The [[basti]] schedule consists of total 16 basti, including 10 unctuous enema and 6 decoction enema. For unctuous enema, 60 ml Pippalyadi taila, 10ml honey and 3gm rock salt were used. For decoction enema, 500ml decoction is prepared with dashamoola etc. drugs with paste (100ml) of tamarind and jaggery, 100ml cow’s urine, 40 ml Pippalyaditaila, 30ml honey and 5 gm rock salt. After the [[panchakarma]] treatment patient continued the oral medications and application of Vishagarbha taila for three months. There was marked reduction in bodyache and anorexia after the first 15 days of treatment but morning stiffness persists. After 1 month of [[panchakarma]] treatment, morning stiffness reduced. After 75 days of treatment, there was considerable reduction in tenderness and edema in joints and complete subsidence of anorexia and bodyache. After 4 months of treatment, the patient become completely symptom free and RA factor came to normal level. Pratapalankeshwara rasa is beneficial in reducing [[vata]] especially in postpartum stage.  Dasamoolakatutraya pacifies [[vata]], improves digestion, nourishes blood and is having the ability to reduce the pain in joints. Swarnabhupati rasa acts on [[vata]][[kapha]] disorders related with musculoskeletal system. Tapyadiloha improves blood, Chopachini, shunthi and guduchi digests the ama and clears the obstruction in the path of [[vata]].<ref name=Desh/>

A 27 year old female patient developed amavata, 1 month after her delivery. She complaints of pain and swelling in bilateral corpo-phalangel joints, both knees and ankles along with morning stiffness, anorexia and bodyache for six months. Tenderness along with raised body temperature and stiffness was present in the affected joints. Her RA factor and Anti CCP antibody were positive. RA factor 160 IU/ml and anti CCP more than 200 units/ml. Patient was treated with oral medications and [[panchakarma]] treatments. During the entire course of treatment, she continued breast feeding and the baby showed normal growth and development. The treatment for four months includes oral administration of Simhanada guggulu, Pratapalankeshwara rasa, Dashamoolakatutraya kashaya, combination of Swarnabhupati rasa, mahavatavidhvansa rasa, Tapyadiloha along with Smilax china (chopachini), Zinziber officinale (shunthi) and Tinospora cordifolia (guduchi).  [[Panchakarma]] treatment includes whole body massage with Vishagharbhataila, fomentation in wooden chamber (bashpa sweda) and therapeutic enema ([[basti]]). The [[basti]] schedule consists of total 16 basti, including 10 unctuous enema and 6 decoction enema. For unctuous enema, 60 ml Pippalyadi taila, 10ml honey and 3gm rock salt were used. For decoction enema, 500ml decoction is prepared with dashamoola etc. drugs with paste (100ml) of tamarind and jaggery, 100ml cow’s urine, 40 ml Pippalyadi taila, 30ml honey and 5 gm rock salt. After the [[panchakarma]] treatment patient continued the oral medications and application of Vishagarbha taila for three months. There was marked reduction in bodyache and anorexia after the first 15 days of treatment but morning stiffness persists. After 1 month of [[panchakarma]] treatment, morning stiffness reduced. After 75 days of treatment, there was considerable reduction in tenderness and edema in joints and complete subsidence of anorexia and bodyache. After 4 months of treatment, the patient become completely symptom free and RA factor came to normal level. Pratapalankeshwara rasa is beneficial in reducing [[vata]] especially in postpartum stage.  Dasamoola katutraya pacifies [[vata]], improves digestion, nourishes blood and is having the ability to reduce the pain in joints. Swarnabhupati rasa acts on [[vata]][[kapha]] disorders related with musculoskeletal system. Tapyadiloha improves blood, Chopachini, shunthi and guduchi digests the ama and clears the obstruction in the path of [[vata]].<ref name=Desh/>

A 54 yearold 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), 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>