Rheumatoid arthritis is a chronic, disabling autoimmune disease which may affect multiple tissues and organs but principally affects movable synovial joints. Women are affected 3x’s more often than men. The autoimmune disease process invokes inflammation usually beginning in the synovial membrane and extending to the articular cartilage and bone.
Ayurvedic texts describe a number of diseases characterized by pain and swelling of joints According to Ayurveda arthritis are of three types. These three are (1) Amavāta, (2) Sandhivāta (3) Vātarakta. Note that all these designations share the common term “Vāta”. Amavāta correlates quite closely with rheumatoid arthritis as known in Western medicine while Sandhivāta is a pure vata disease most closely corresponding to osteoarthritis. Vātarakta most closely correlates to gouty arthritis.
Among these amavāta is a chronic, often progressive, and sometimes disfiguring disease. Amavāta is classified as a difficult to cure (Krichhrasadhya) disease in Ayurveda. It is characterized by pain and swelling of multiple joints. As the name denotes this disease is caused due to lowering of agni and accumulation of systemic ama which because of its physical similarity with kapha has an affinity for the seats of kapha (kaphasthana) principally the joints (sandhi) and conjoining with vitiated Vāta precipitates a condition of painful swelling of all joints. Because of its antigenic nature, ama acts like an autoantigen and creates autoimmune disease of the joints.
The concept of ama is fundamental in understanding the Ayurvedic perspective on the pathology of rheumatoid arthritis. Ama is a toxic substance which accumulates in the body and cannot be properly digested, metabolized, or utilized. There are three types of ama:
1. Rasama – formed from the gastrointestinal tract from incompletely digested foods
2. Malama – formed in any of the seven dhatus from accumulated metabolic wastes
3. Doshama – formed due to a sudden disturbance of the doshas from an external cause
Whatever the type, ama always has certain common properties. It is apakva (not cooked) and asiddhi (not achieved its final form). In general, ama means an unripe, uncooked, immature, and indigestible substance.
Amavāta which manifests peripherally in joints essentially has its origin in the gut in the form of mandagni and ama formation. Simultaneously, there is a malfunctioning of Samana Vāta subdosha, also located in the gut. Accordingly the principal line of treatment, particularly during early stages of the disease, is to treat the agni by langhana, dipana, pacana, and appropriate herbs and spices in order to promote the agni and exhaust ama. Thus Ayurveda makes a unique approach to the management of rheumatoid arthritis, the main target being the gut not the joints.. Fasting (langhana) and vegetarian light hot diet are useful in the early stages. In the context of chronic amavāta when ama is no longer actively forming and accumulating but the disease is persisting in the form of morbid continuum and residual permanent joint destruction, the line of management is different. In such cases, in addition to ama pacana one has to prescribe specific antiarthritic, anti-inflammatory and analgesic remedies along with physiotherapeutic and rehabilitative therapies.
Common Clinical Symptoms
· Angamarda (pain in specific areas of the body)
· Aruchi (loss of appetite)
· Trishna (increased thirst)
· Alasya (loss of zest or enthusiasm for life)
· Jwara (increased body temperature)
· Apaka (low agni)
· Sandhi Stabdata, Sandhi Shoota, Sandhi Shopha (stiffness, inflammation and swelling of the joints)
In addition to these symptoms, amavāta can have many others in specific individuals including frequent urination, reduction of perspiration, hyper salivation, nausea and vomiting, constipation, flatulence. Although Vāta is the pre eminent dosha involved in this condition, on the basis of doshanubandha lakshanas (signs connected to specific dosha), amavāta can be classified into three types:
· Vāta – will manifest with sharp, cutting pain and more digestive symptoms
· Pitta – will manifest with daha (burning sensation) throughout the body and in the joints with more intense redness
· Kapha–will manifest with more heaviness, rigidity and perhaps itching
Treatment of Amavāta (Rheumatoid Arthritis)
The treatment of amavāta consists of ten principle approaches:
3. Tikta-Katu Ahara
7. Niruha Vasti
8. Upanaha swedana (local)
9. Aushadis (Medicines)
10.Additional treatments according to predominant dosha of the disease
Some common preparations are combinations of guggulu gum resin (Commiphora mukul) with other herbs. They are generally taken in tablet form in dosages of 2-3 grams 3x’s/day:
Yogaraj Guggulu, Kaishore Guggulu, Simhanad Guggulu, Rasna Guggulu
Other preparations are taken as kwaths (decoctions) made by boiling 3-4 grams of powdered herb in 240 ml. of water:
Panchakola kwath, Maharasnadi kwath, Dashmoola kwath, Guduchyadi kwath, Panchtikta kwath
Powdered herbs are another dosage form for select plant medicines:
Rasna, Bhallataka, Gaurakha (Dalbergia lanceolaria), Ashwagandha, Yastimadhu, Copacini (Smilax china), Pippali, Eranda brista Haritaki (Haritaki powder cooked in eranda tailam), Vatsanabhi (Aconitum ferox), Maricha (Piper nigrum; black pepper), Haritaki (Terminalia chebula), Trivrit, Shallaki (Boswellia serrata)
External Lepas (Poultices)
Datura lepa, Eranda lepa, Arka lepa, Mustard Seed lepa
The notion that food can modify the course of rheumatoid arthritis has long been rejected by Western medicine as foolish and even quackery. However, Ayurvedic physicians have known for generations that foods definitely affect inflammation—the critical process in amavāta.
Although it is not possible to develop a standard “amavāta diet” for all individuals due to constitutional differences and idiosyncratic features of the disease in each person, the foods which help or provoke symptoms in the greatest percentage of people can be identified.
Bitter gourd, Coconut water, Loki (a type of vegetable), Coconut milk, Barley, Carrot juice, Amaranth, Beetroot juice, Old rice, Squash (all species), Buttermilk, Zucchini, Ginger, Pumpkin, Cinnamon, Leafy green salad, Cardamom, Kichadi, Turmeric, Garlic
Yogurt, Cauliflower, Black gram, Okra, Cold Beverages, Beef, Broccoli, White potato, Cola drinks, Tea, Poultry, Cabbage, Ice cream, Caffeine, Dried Fruits, White sugar, Spinach, Chocolate, Alcohol
The fundamental perception of amavāta/rheumatoid arthritis is very different in Ayurveda. From the Ayurvedic perspective, until ama can be removed, agni restored and Vāta dosha normalized, no treatment method—conventional or holistic—will be effective.
The modern, conventional treatment for rheumatoid arthritis includes some combination of steroids (usually prednisone), antimetabolites (usually methotrexate), Tissue Necrosis Factor agents (e.g. Humera, Embrel) and sometimes a non-steroidal anti-inflammatory drug (to relieve pain) and an accompanying antacid (to treat the gastric side effects of all four of these). Although this treatment can often relieve joint pain and inflammation and slow or halt the disease process, they all have significant side effects.