Ayurveda and Rheumatoid arthritis
By Dr Sajimon George BAMS, AAA, ATMS
Rheumatoid Arthritis (RA) is an autoimmune disease affecting any ethnic group. Its prevalence is 1%. Though it affect all age groups, it is more common in 30-50 years. Women are affected three times in comparison to male. It affect joints and its covering called synovial membrane and in the later stages leading to degenerative changes. During progress of the disease it may affect many other organs such as covering of lungs ie, pleura and covering of heart or pericardium. The disease starts with morning stiffness, loss of appetite, general weakness and sometimes may be associated with mild fever and generalized muscle pain. When joints are affected, it become swollen, stiff, and warm and pain starts. The common joints affected are knee, wrist fingers, neck and ankle. As joint inflammation progress, excess synovial fluid is produced and the joint become swollen. It is considered that the degenerative changes happening to the joint are not directly proportional to the swelling, pain or stiffness of the joints. In advanced stages chronic inflammation affect cartilage, bones, ligaments and deformity of joints happen. In RA patients there may be periods of remission and bouts of flare ups or increased disease activity. Ayurveda consider rheumatoid arthritis as a systemic disease caused by vitiated rakta or blood tissue and Vatha.
Signs and Symptoms:
- Pain & morning stiffness in the smaller joints of the hands & feet.
- Warm, Swollen and tender joints are affected in a symmetrical pattern or both side of body is affected.
- Generalized fatigue and feeling of unwell.
- Sleep disturbance.
- Fever and headache.
- Restricted movement in the affected joints.
- Deformed joints in advanced stages.
- Nodules or firm lumps under the skin of pressure points such as fingers, knuckles, hands and elbows.
Ayurveda and Rheumatoid arthritis (Ayurvedic approach)
Clinical presentation of RA is comparable to Vatha Raktha explained in Ayurvedic classics. Excess physical and mental activities, indulging in bitter and astringent foods, lack of activities cause aggravation of Vatha. To be specific Vyana Vatha, the sub division of Vatha is aggravated which is the cause of blood circulation. Irregular and unwholesome food habits, sedentary life style, habit of sleeping in day time, eating meat of animals of water logged areas, black gram, curd and excessive sour salty food, trauma are cause of aggravation of Raktha dhatu or blood tissue. This vitiated Raktha dhatu or blood tissue starts vitiating Vyana Vatha and Vyana Vatha in turn aggravate Raktha. These vitiated factors spread all over the body and starts pathogenesis in the joints. Vatha Raktha disease thus manifest in different joints.
Based on the progress of the disease it has two stages. Initial stage Uthana Vatha Raktha and advanced stage called Gambheera Vatha Raktha. In Uthana, Twak(Skin) and Mamsa(Muscle tissue) are affected while in Gambheera Vatha Raktha , deeper tissues Medas (Fat tissue), Asthi(Bone tissue) , Majja(Marrow) are affected.
- Excessive sweating
- Blackish discoloration of skin
- Burning sensation
Uthana Vatha Raktha
- Burning sensation
- Dilatation of blood vessels
- Reddish or Blackish discoloration of skin
- Numbness of extremities
Gambheera Vatha Raktha
- Firm and fixed nodules
- Excruciating pain
- Pricking pain
- Suppurative changes
- Stiff and immovable joints
- Gait changes
- Contracture of vessels around joints
- Wasting of muscles
Any treatment procedure or formulation will be pacifying Vatha and Raktha
Generally snehana or oleation is done with medicated ghee processed with milk and bitter medicines.
In conditions with Kapha predominant symptoms such as itching etc.
Purgatives with drying nature for patients will snigdha or oily body.
Purgatives with oily nature indicated for patients with dryness.
Medicated enema with medicated oils/ghee and Ksheeravasthi(containing medicated milk) are useful.
Paste made of suitable medicines are applied over areas where pain, discoloration, edema or burning is felt. When paste gets dried itself, it will be removed.
Mild massage with suitable oils may be done in appropriate conditions.
Pouring of herbal decoctions, medicated milk is very useful especially when patient is suffering from burning sensation or throbbing pain.
Sitting in a vessel filled with suitable herbal decoction for stipulated period.
Since Vatha Raktha is primarily caused by vitiated Raktha or blood tissue, bloodletting in a controlled manner is very useful to reduce pain. Bloodletting is done only after proper oleation with suitable medicated ghee otherwise it may result in Vatha aggravation.
In the Uthaana Vatha , Raktha Lepa, Pariseka, Abhyanga and Avagaha are the procedures required.
In Gambheera Vatha Raktha, in addition to procedures mentioned above, Panchakarma procedures are necessary.
Yoga and meditation
Yoga, Pranaayama and meditation are very useful in patients with RA. In patients who suffer from generalized fatigue and depression with chronic pain pranaayama and meditation are useful. When stiffness, pain and wasting of muscles manifest, suitable yogasanas under strict supervision of a qualified medical practitioner is useful to improve mobility.
Padhya or Desirable foods
Wheat, Pulses like green gram, bitter guard, grapes and snake guard are useful.
Apadhya or undesirable foods/things
- Day sleep,
- Regular exposure to heat
- Excess use of pungent, hot and heavy to digest food is contra indicated.
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