Changes

#Daytime sleep after meals.

#Daytime sleep after meals.

==Principles of management==

===Principles of management===

The principles of management of amavata are focused on following:  

The principles of management of amavata are focused on following:  

[Chakradatta Amavatachikitsa]<ref name=Chakradatta>Chakrapanidatta, Cakradatta (Chikitsasangraha). Edited by Priya Vrat Sharma. 3rd ed. Varanasi: Chaukhambha publishers; 2002</ref>

[Chakradatta Amavatachikitsa]<ref name=Chakradatta>Chakrapanidatta, Cakradatta (Chikitsasangraha). Edited by Priya Vrat Sharma. 3rd ed. Varanasi: Chaukhambha publishers; 2002</ref>

===Currently used important herbs===

====Currently used important herbs====

   

   

'''Piper longum (pippali):''' In a study 73 clinically diagnosed Rheumatoid arthritis patients were administered powder of Piper longum (pippali) in increasing dose pattern. Initially, on first day 1 gm of Piper longum (pippali) powder twice a day with honey was given. The dose was increased daily by 1gm upto 5gm twice a day. The 5gm dose (maximum dose) was maintained for 5 days.  Then the dose was tapered by 1 gm daily upto 1gm twice a day. After this, mild purgation with castor oil was given. The pain, stiffness, swelling and movement restriction in joints decreased significantly by 50.56%, 48.57%, 53.22% and 46.43% respectively. A significant reduction in ESR was also reported after this treatment. Pippali leads to digestion of accumulated toxic metabolic toxins (ama) by its stimulating ([[deepana]]) and appetizer activity.  It also has rejuvenating ([[rasayana]]) and immunomodulating actions.<ref name=Soni>Soni A, Patel K, Gupta SN. Clinical evaluation of VardhamanaPippaliRasayana in the management of Amavata (Rheumatoid Arthritis). Ayu. 2011 Apr;32(2):177-80. doi: 10.4103/0974-8520.92555. PMID: 22408298; PMCID: PMC3296336.</ref>

'''Piper longum (pippali):''' In a study 73 clinically diagnosed Rheumatoid arthritis patients were administered powder of Piper longum (pippali) in increasing dose pattern. Initially, on first day 1 gm of Piper longum (pippali) powder twice a day with honey was given. The dose was increased daily by 1gm upto 5gm twice a day. The 5gm dose (maximum dose) was maintained for 5 days.  Then the dose was tapered by 1 gm daily upto 1gm twice a day. After this, mild purgation with castor oil was given. The pain, stiffness, swelling and movement restriction in joints decreased significantly by 50.56%, 48.57%, 53.22% and 46.43% respectively. A significant reduction in ESR was also reported after this treatment. Pippali leads to digestion of accumulated toxic metabolic toxins (ama) by its stimulating ([[deepana]]) and appetizer activity.  It also has rejuvenating ([[rasayana]]) and immunomodulating actions.<ref name=Soni>Soni A, Patel K, Gupta SN. Clinical evaluation of VardhamanaPippaliRasayana in the management of Amavata (Rheumatoid Arthritis). Ayu. 2011 Apr;32(2):177-80. doi: 10.4103/0974-8520.92555. PMID: 22408298; PMCID: PMC3296336.</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 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>

===Currently used important herbal formulations===

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

If the condition is associated with fever, Amrutottaram kwatha, Amritarishta and Chitrakasava are used.<ref name=Edava>Edavalath M. Ankylosing spondylitis. J Ayurveda Integr Med. 2010 Jul;1(3):211-4. doi: 10.4103/0975-9476.72619. PMID: 21547050; PMCID: PMC3087367. </ref>

If the condition is associated with fever, Amrutottaram kwatha, Amritarishta and Chitrakasava are used.<ref name=Edava>Edavalath M. Ankylosing spondylitis. J Ayurveda Integr Med. 2010 Jul;1(3):211-4. doi: 10.4103/0975-9476.72619. PMID: 21547050; PMCID: PMC3087367. </ref>

Various preparations of Bhallataka can be used in Amavata. However, these preparations shall be used with precaution in case of dominance of [[pitta dosha]].

Various preparations of Bhallataka can be used in Amavata. However, these preparations shall be used with precaution in case of dominance of [[pitta dosha]].

====Research on ayurvedic formulations====

=====Research on ayurvedic formulations=====

   

   

'''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>

'''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>

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/>

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====  

If associated with fever: Amavatari rasa, Vettumaran gulika<ref name=Edava/>

If associated with fever: Amavatari rasa, Vettumaran gulika<ref name=Edava/>

==[[Panchakarma]] procedures with safety precautions==

===[[Panchakarma]] procedures with safety precautions===

===Therapeutic enema ([[basti]])===

====Therapeutic enema ([[basti]])====

'''Panchamuladi basti:''' In a study, 12 patients having rheumatoid arthritis (amavata) were managed with Ayurvedic treatment protocol. It included initial 3 days of fasting followed by 3 days of [[deepana]] and [[pachana]] therapy with 10gm trikatu powder 3 times a day with hot water after food. This is followed by 15 days of therapeutic enema ([[basti]]) schedule. Here the schedule of [[basti]] includes 2 medicated unctuous enema (anuvasana basti) initially, 5 decoction enema (niruha basti) and 5 medicated unctuous enema (anuvasana basti) intermittently and 5 medicated unctuous enema (anuvasana basti) in the end. Panchamuladi basti is used as niruha and panchamuladi taila is used for anuvasana. There were highly significant results in disease specific symptoms like pain in joints, swelling, stiffness, warmth and tenderness in joints. Highly significant results were also seen in general symptoms like heaviness (gaurava), malaise (angamarda), indigestion (apaka), edema (angashunata) and laziness (alasya). Total 70% reduction in thirst and a complete recovery from feverishness were also reported. The alkaline nature of this [[basti]] cures the ama along with it controls the [[vata dosha]] also. Unctuous enema also helps to control [[vata dosha]] by acting directly over the main site of [[vata]] that is colon (pakwashaya).<ref name=Baria/>

'''Panchamuladi basti:''' In a study, 12 patients having rheumatoid arthritis (amavata) were managed with Ayurvedic treatment protocol. It included initial 3 days of fasting followed by 3 days of [[deepana]] and [[pachana]] therapy with 10gm trikatu powder 3 times a day with hot water after food. This is followed by 15 days of therapeutic enema ([[basti]]) schedule. Here the schedule of [[basti]] includes 2 medicated unctuous enema (anuvasana basti) initially, 5 decoction enema (niruha basti) and 5 medicated unctuous enema (anuvasana basti) intermittently and 5 medicated unctuous enema (anuvasana basti) in the end. Panchamuladi basti is used as niruha and panchamuladi taila is used for anuvasana. There were highly significant results in disease specific symptoms like pain in joints, swelling, stiffness, warmth and tenderness in joints. Highly significant results were also seen in general symptoms like heaviness (gaurava), malaise (angamarda), indigestion (apaka), edema (angashunata) and laziness (alasya). Total 70% reduction in thirst and a complete recovery from feverishness were also reported. The alkaline nature of this [[basti]] cures the ama along with it controls the [[vata dosha]] also. Unctuous enema also helps to control [[vata dosha]] by acting directly over the main site of [[vata]] that is colon (pakwashaya).<ref name=Baria/>