ROLE OF PANCHAKARMA IN MANAGEMENT OF RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a systemic autoimmune disease that causes chronic inflammation of the joints.It causes inflammation of the tissue around the joints. As the disease advancement, the inflamed synovium occupies and damages the cartilage and bone of the joint. An autoimmune disease is a condition characterized by an abnormal immune response to a normal body part. Because it can affect various organs of the body, rheumatoid arthritis is referred to as a systemic disease and ultimately called rheumatoid disease. In Ayurvedaamavata is correlated with rheumatoid arthritis. Vitiatedvata and ama plays major role in the manifestation of amavata. Improper digestion of Rasaadidhatu leads to the formation of ama.

Rheumatoid arthritis is a systemic autoimmune disease that causes chronic inflammation of the joints.It causes inflammation of the tissue around the joints. As the disease advancement, the inflamed synovium occupies and damages the cartilage and bone of the joint. An autoimmune disease is a condition characterized by an abnormal immune response to a normal body part. Because it can affect various organs of the body, rheumatoid arthritis is referred to as a systemic disease and ultimately called rheumatoid disease. In Ayurvedaamavata is correlated with rheumatoid arthritis. Vitiatedvata and ama plays major role in the manifestation of amavata. Improper digestion of Rasaadidhatu leads to the formation of ama. Vitiated ama leads swelling, pain, stiffness, in many joints along with loss of function. Modern science does not offer any cure of RA, the management aims are limited. This article reviews the line of treatment for the management of amavata described by Acharyachakradatta. It was concluded that rheumatoid arthritis can be completely cured or treated with Ayurveda medication and Panchakarma therapies without any side effects.

…………………………………………………………………………………………………….... Introduction:-
Rheumatoid arthritis is an autoimmune chronic inflammatory disorder. The characteristic features of rheumatoid arthritis is persistent inflammatory disease of joints, usually involving peripheral joints in a symmetric distribution. The synovium becomes inflamed causing warmth, redness, swelling and pain. With the advance stage of diseases, the inflamed synovium occupies and damages the cartilage and bone of the joint. i Normally the immune system shows self-tolerance and does not attack the body's own constituents. In autoimmune diseases this self-tolerance fails. The immune system fails to identify self antigens and mounts a misguided attack against them. ii In Ayurvedaamavata is disease of Rasavahastrotasa. It is generally correlated with RA. Amavata is the outcome of Agnidusthi (abnormal digestive fire), Amotpatti (toxin accumulation) and sandhiVikriti (joint deformity). Amavata develops due to dusti or prakopa of Ama as well as vatadosha. The Panchakarmatherapy which normalize agni (digestive fire), metabolizers Ama (toxins), and regulates vata and maintain healthy sandhi and sandhisthashelshma (synovial fluid) will be the supreme treatment for this disease. iii 123

Aetiopathogenesis Of Amavata
Due to etiological factors like, Aharaj nidan (food habits) like Virudha ahar (Antagonist food), Snigdha ahar, Guru ahar (heavy diet) Viharaj nidan (life style related) like Diwa Swapna(day dream), Ratri-jagran (Night awakening) and Mansika nidan (Mental diagnosis) like Chinta (anxiety), Shoka(mouring), Bhaya(fear), Krodh (anger). The function of agni is disturbed in the body and ama is produced. This this produced ama is mucky in nature, such ama get together with prakupitvata and circulates all over the body through shira and dhamni and gets lodged in kaphaSthana.i.e., sandhi because sandhi is the Sthanaof shleshakkapha and develops amavata. iv Criteria to diagnose R.A As per American rheumatism association (1988) the following criteria has been laid down:-1. Morning stiffness 2. Pain in three or more joints area 3. Arthritis of hand joint 4. Symmetrical arthritis 5. Rheumatoid nodules 6. Rheumatoid factors 7. Radiological changes 8. Above starting 1-4 criteria should be present for 6 weeks or more. 9. Diagnosis of RA is made with 4 or more criteria.

Langhana
Any measure which brings in laghuta in the body, is known as langhana, ten types of langhana have been said in charaka samhita. Acharya vagbhatta in ashtang hridya has considered langhana similar to aptarpana and has described under the heading shodhana and shaman. The excessive vitiation of kapha, pitta, blood and waste products, are afflicted with obstructed vata and cause bulky and strong body is treated using langhana procedures. Upvasa (no consumption of food material) is the main type of langhana useful in case of amavata.Amavata is amasayothayadhi and also rasaja vikara,langhana is the first line of treatment in such conditions. The pathology originates in amashya due to poor digestion in presence of mandagni, ultimately resulting in formation of ama. So the langhana will further stop the production of ama, and helps in digestion of ama. vi

Shunthi:-
It contains an Aromatic volatile oil 1-5%, which contains Camphene, Phellandrene, Zingiberine, Cineol, Borneol, Gingerol, Gingerin. Essential oil (rhizomes); Dihydrogingerdione, Gingerdione and gingerol (root);Aspartic acid, Threonine, Senine, Glycine, Cysteine, Valine, leucine and isoleucine (aerial parts and tuber). After treatment significant symptomatic relief was observed without any side effects during and after treatment. x 2. A study was conduct on 86 patients of RA. All patients were administered with 5g of Ashwagandha powder for three weeks and SidhMakardhwaj (100 mg) daily for the next four weeks. The follow up of patients was achieved every two weeks.The outcomes of this study recommendthatAyurvedic treatment (Ashwagandha powder and SidhMakardhwaj) has a potential to be used for the treatment of rheumatoid arthritis without any side effects. xi 3. A study was conduct on Forty-three RA patients.The following treatment were divided in three groups: MTX plus Ayurvedic placebo, Ayurveda plus MTX placebo, or Ayurveda plus MTX.All measures were attained every 12 weeks for 36 weeks.All 3 treatments were approximately equivalent in efficacy, within the limits of a pilot study. In Ayurveda -only group has less adverse event. xii 4. A study was conduct on female RA patient. Virechanakarma was done after Snehna, swedana and deepanpachanaby the administration of 100gm TrivritaAvaleha and 20ml castor oil for 3 months. After Virechanakarma and avoiding specific nidanas, significant symptomatic relief was observed and no need of any medication. xiii 5. A study was conduct on 32 years old female RA patient with administered 250 mg AmavatariRasathrice a day for 8 weeks. After treatment CRP and ESR was decreased and significant symptomatic relief was observed. No any adverse effect was found. xiv

Discussion:-
From above description it is clear that vitiated vata and Ama plays major role in the manifestation of Amavata. Incomplete digestion of RasaadiDhatu leads to the formation of Ama. Vitiated Ama cause swelling, pain, stiffness, in many joints along with loss of function. Arthritis is also found in children below 16 years of age and it is termed as JIA (JUVINILE IDIOPATHIC ARTHRITIS) which is an umbrella term for group of chronic childhood arthritis present with inflammation of joints and stiffness of unknown cause in children. It persists for at least 6 weeks. The symptoms in JIA resembles AmavataVyadhi which is mentioned in Ayurveda text. Though it is not mentioned for pediatric field but due to its similar clinical appearance same reference require for Ayurvedic treatment. Ayurveda medicines and Panchakarma therapies can be cured RA completely or manage without any side effects.

Conclusion:-
Health issues like inappropriate digestion or food habits, sleep disturbance, chronic fatigue or tiredness result into serious disease like rheumatoid arthritis in patients having hereditary predilection. These can be managed as per line of treatment of vitiated vata and Amai.e. Snehna(oleation therapy),Swedana(sudation therapy), Basti(enema therapy) and Virechana(purgation therapy).Langhan helps in digestion of ama.Swedan relieves the symptomslike pain, stiffness, inflammation and softens the body. Basti eliminates vitiated vata from its sthana and virechana helps to remove kledak kapha from pittasthana and reduce symptoms like Anaha(distension of abdomen), Vibandha(constipation), Antrakujana(intestinal gurgling) and Katishoola(back pain).Panchakarma therapies detoxifies the body and give strength to the immune system.It proves that Panchakarma therapy is very beneficial and effective in rheumatoid arthritis. xv