International Journal of Complementary & Alternative Medicine

Review Article Open Access

Rheumatoid arthritis diagnosis according to

Ayurveda texts W.S.R. Amavata
Abstract Volume 12 Issue 3 - 2019

Ayurveda is hope for suffering humanity in today’s world where no one found complete
treatment solution for commonest chronic inflammatory joint disease Amavata (Rheumatoid Manoj Virmani,1 Arun Kumar Kaushik,2
Arthritis). This causes swelling, pain and stiffness of joints. Chronic condition may cause Gopesh Virmani3
debility, deformities of joints and crippling. Unfortunately the man has not succeeded in 1
Chief Physician,Vaidya Ayurvedguru Pvt, India
eradicating this diseases and find to come out with successful therapeutic measures that Department of Panchkarma, Himalayiya Ayurvedic Medical
2

can cure the patient completely. Ayurveda can play a wide role in treatment of Amavata. College, India
So need to study Ayurveda classics with deep understanding is demand of today. Ayurveda 3
Internee Physician at SDM College and Hospital, India
texts like charak samhita, sushruta samhita, Ashtang hridya and Asthtang samgrah had
widely mentioned about Ama and Amavrita Vata. First time, Madhav nidana mentioned Correspondence: Manoj Virmani, Director & Chief Ayurveda
Amavata as separate disease. After that vangsena, chakaradutta, bhaishjya ratnavali has Physician,Vaidya Ayurvedguru Pvt Ltd, Karnal, Haryana, India,
elaborated the treatment modalities of Amavata. Ayurveda focus on Nidaan i.e cause of Email
disease and symptoms of disease. Ayurveda has described detailed list of causative factors
of Amavata. So study of this causative factor will help scientific society to eradicate this Received: April 27, 2019 | Published: May 24, 2019
disease. As we are very well aware that in modern scientific world, cause of Rheumatoid
arthritis is still unknown. Ayurveda says chikitsa(Treatment) is Nidaan Parimarjna( removal
of cause). When cause of disease is unknown then how a physician can provide proper
treatment. This study has focus on nidaan(causative factors), samprapti(Pathogenesis) and
Sathyata/ Asathyata (Prognosis) of disease Amavata according to Ayurveda classic texts.

Keywords: amavata, rheumatoid arthritis, ayurveda texts, traditional knowledge, indian

system of medicine

Disease review according to ayurveda Definition of ama

Amavata is mainly caused by two factors ama and vata. 1. The first Rasa dhatu, which has been inadequately digested due
to the weakness of digestive fire and accumulating in the stomach
Etymology of Amavata in the abnormal state, is known as Ama.7,8
1. ‘Amena sahita vata Amavata’. The virulent Ama circulates in the 2. The undigested Adya Ahara dhatu is Ama.9
whole body propelled by the vitiated vata dashas producing block
in the body channels that stations itself in the sandhi giving rise 3. The food material which will not undergone vipaka, leads to
to Amavata.1 Durgandha, which is large in quantity, which is picchila & which
leads to Gatra Sadana is called Ama.
2. The combinations of ‘Ama’ and vata form Amavata. It shows the
predominance of Ama & vata in the samprapti of Amavata.2 4. Due to impairment of digestive fire the undigested remained food
material is ‘Ama’.
3. Ajeerna produce ‘Ama’ & along with vata it produce Amavata.3
5. Apakva Anna Rasa is Ama & some other considers the
Definition accumulation of mala as Ama & still other opines the first stage
of vitiation of dosha as Ama.
‘Ama’ is produced by agnimandya of both Jatharagni and
Dhatwagnis. Even though ama is a cause for various diseases, in Ama may be classified as below
Amavata it is the main causative factor. Ama and vata vitiated
simultaneously and disease is manifested mainly in joints of hasta, Ama produced due to hypo functioning of Agni i.e
pada, sira, trika, gulpha, janu and uru. The main symptoms produced a. Ama due to Jatharagni Mandya.
are Angamarda Aruchi, Trishna, Alasya, Gouravam, Apaka & Shotha.4
b. Ama due to Dhatvagni Mandya.
Role of ama in amavata
c. Ama due to Bhutvagni Mandya.
The main causative factor for the manifestation of Amavata is
Ama. So it is necessary to know about the Ama in detail. Ama produced irrespective of the action of Agni
Etymology of ama a. Accumulation of mala.

1. The unprocessed or undigested food partical is Ama.5 b. Ama due to interaction & virulently vitiated doshas

2. Ama means, “Which is subject of digestion”.6 c. First phase of doshic vitiation.

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Vata in amavata Symptoms of vataprakopa17

Voluntary & involuntary functions are all under the control of 1. Parava Samkocha 2. Stambha 3. Asthi Paravabheda 4.
Vayu. In Amavata the normal function of Vata is disturbed. It produces Lomaharsa, Pralapa, Hasta-Pristha-siro-graha 5. Khanjata-Pangulya
stabdhata & sandhigraha leading to the restricted movements of 6. Kubjata 7. Sosha 8. Anidra 9. Grabha-sukra-Rajonasa 10. Spandana
joints & it will become the responsible for crippling effect seen in 11. Gatra Suptata 12. Sira, Nasa, Akshi, Jatru, Grivahanunam-Bheda,
the patients. This shows the predominance of vata dosha in the Toda-Arti 13. Akshepa 14. Moha 15. Ayasa
pathogenesis of Amavata. Now let us carry a brief description of vata
dosha. The word vata derived from “Va gati gandhanyoh” it means to Cause or nidana of amavata
move, to make known, and to enthuse.10 Nidana is defined as the factors which deranges the dynamic state
It has got the other synonyms like Anila, Maruta, Pavana etc., 11 of doshic equilibrium provokes the disease is known as Nindan. This
Nidana helps us to decide the line of treatment as well as prognosis
Gunas(properties) of vata of the disease.
Ruksha, Seeta, Laghu, Sukshma, Chala, Visada, Parusha & Amavata Ninda is of multifaceted various Acharya’s mentioned
Khara.12,13 their different views for the productions of Ama in Amavata.

Functions of normal vata Madhavakara18 delt the separate Nidana as

Vayu sustains the body with expiration, inspiration, enthusiasm, 1. Viruddha Ahara (Incompatible food)
movement of various parts. Sharpness of sense perception, initiation
2. Viruddha Chestha (Incompatible actions)
of the natural urges and many other functions.14
3. Mandagni (Hypo functioning of agni)
1. Tantrayanradhara
4. Nischala (Lack of exercise)
2. Cheshta Pravartaka
5. Snigdha Ahara followed by immediate exercise.
3. Mano Niyanta & Praneta
Besides these intakes of Kanda, mula and sakha and excessive
4. Sharvendriya
exertion are etiological factors opined by Harita.19 In Anjana Nidana,
5. Uttyojaka the factors which vitiates vata, pitta and kapha are considered under
Nidana.20
6. Sharvendriya Artha Abhivodha
These all above Nidana can be included less than two heading
7. Sharva sharira dhatu Vyuhakara
1). Unwholesome diet 2). Erroneous habits.
8. Sharira Sandhanakar
Unwholesome diet means “which aggravates the body humors but
9. Vak pravartaka not expel them out of the body”.21 Charaka has mentioned 18 types of
10. Sabdasparsa Prakrti unwholesome diet (Viruddha Ahara)22 some of the virudha Ahara are
as follows
11. Srota sparsana mula
1. Milk along kulatha, 2. Panase fruit with matsya 3. Mixtures of
12. Harsha utsahayoni equal quantities of honey & ghee 4. Boiled curd23
13. Agni samirana Erroneous habits (Viruddha chesta) mainly included alternate
14. Mala ksepta use of cold and heat, suppression of natural urges, sleeping during
daytime, walking at night, over indulgence in work.
15. Grabhakrti Karta
Pathogenesis or samprapti of amavata24
16. Ayusha Anuvratti15
The impairment of Agni will produce the condition of Ama. Mainly
Importance of vata agnimandya initially affects digestion followed by metabolism. Hence
in this state of Agni, the Rasadhatu is not formed up to the standard
Pitta, Kapha, Dhatu & Mala are movement less, unless they are
level & it is considered as Ama. This ‘Ama’ along with Vyana Vayu
brought to the proper place by vata to carry out their functions. Thus
and also by virtue of its Vishakari guna it quickly moves to all kapha
Vayu makes the functions of all the tissues of body.16
sthanas, through Hridaya and Dhamanes. This Vidhagada Ama, in
Symptoms produced due to ama kapha sthana is further contaminated by doshas and assumes different
colours, because of the Atipichhilata.
1. Srotorodha 2. Bala bramasa 3. Gaurava 4. Anila Mudhata 5.
Alasya 6. Apaki 7. Nisthivana If Ama gets obstructed in to channels and promotes further
vitiation of vata dosha, this morbid Ama circulates ubiquitously in the
8. Mala sanga 9. Aruchi 10. Klama 11.Vit, Mutra, Nakha, Dhatu, body propelled by vitiated vata with predilection for sleshma sthana.
Chakshu Pitata/Raktata/Krishnata On the dhamanies with the other doshas it facilitates sroto abhisyanda
12. Prusthtasthi, Katisandhi Ruk 13. Siroruk 14. Nidra 15. and srotorodha causing sthanasmsraya manifested stabdhata
Mukhavairasya 16. Jvara 17. Atisara 18. Romaharsa. (stiffness), sandhisula (joint-pain), sandhishotha (swelling), Anga-
marda(bodyache), Apaka(indigestion), Jwara (fever), Anga gourava

Citation: Virmani M, Kaushik AK,Virmani G. Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata. Int Phys Med Rehab J.
2019;12(3):97‒103. DOI: 10.15406/ijcam.2019.12.00456
 Copyright:
Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata ©2019 Virmani et al. 99

(heaviness of body), Alasya(laoghess) etc symptoms of Amavata. 10. Sandhi vedana (Joint pain)
According to the commentators on Madhava Nidana the Samprapti Roopa of amavata
of Amavata can be summarized according to Shatkriyakal.
“Utpanna Vyadhi bhodakameva lingam rupam”26
Sanchaya & prakopa: When a person is exposed to aetiological
factors like Viruddha Ahara, does vyayama after intake of snigdha It means which gives the idea about the manifested disease is
ahara, Chinta, Krodha etc., Agnimandya is there leading to known as ‘Rupa’.
Tridoshadushti and Amotpatti in the Sanchaya and Prakopavastha. Madhavakara27 while describing Amavata lakshana, he has
Prasara: With the help of Vata (Biophysical mechanism), this Ama considered them in to two heading one is samanya lakshana another is
gets Prasara to shleshma sthana producing mild sandhishoola etc. along lakshana samachaya of pravrudhu Amavata.
with Ama symptoms. Then Ama gets interacted with Tridosha and General symptoms/samanya laxanas
further modified (Vidagdha) to great extent and yagapatakupitavanta
of Ama and Vata takes place via Rasavaha srotasa (Dhamani). 1. Angamarda (body ache) 2. Aruchi (Tastelessness) 3. Trishna
(Thirst) 4. Alasya (lack of enthusiasm) 5. Gouravam (Heaviness
Sthana sanshraya: This prasarita Ama, which viscid, unctuous and all over body) 6. Jwara (Fever) 7. Apaka (Indigestion) 8. Shunata
guru endures Sthana Sanshraya in Hridaya, Trika Sandhi and Sarvanga Anganam (Swelling all over the body mainly in joints)
(Srotoabhishyanda) leading to Dosha-dushya Sammurchchana.
Primarily the disease is not manifested completely, so only initial Acute symptoms/pravriddha lakshana
mild symptoms like Aruchi, Apaka etc. are observed which can be
It is the advanced stage of disease and very troublesome to patients
considered as purva rupa of the disease Amavata.
as well as for physicians. According to Kriyakala and stage wise
Vyakti: As it reaches vyakti stage most of the symptoms of Amavata development, it is the worst stage of disease. Articular and Extra-
are manifested like Vrishchika dashavata vedana, stabdhata etc. In articular feature present in this stage have been elucidated by Acharya
Adibala Pravrita cases (Karmajanya, Mata-pita apcharajanya etc.) Madhavakara, Bhava Mishra and Yoga Ratnakara.
Khavaigunya is already there and with the minor nidana sevana
disease in manifested. According to madhavakara28

Bheda: In chronic stage or if the disease is left untreated it reaches i. Sarujam Sandhishotha: Hasta, Pada, Shiro, Gulpha, Janu, Uru
bhedavastha- producing updrava like Sankocha, Khanjata etc. Sandhis are chiefly involved in Amavata.

The Samprapti Ghatakas, which are involved on the Amavata, are ii. Vrishchika danshavata vedana: This kind of pain shows the
as follows. presence of Ama at the site of pain.

i. Dosha- mainly vata (vyana, samana, Apana) and kapha iii. Utsahahani: A subjective feeling in which lack of enthusiasm can
(Kledaka,Bodhaka, sleshmaka) be seen in suffering person. It is due to insufficient nutrition of
Sharira Dhatus, Indriya and Mana.
ii. Dhatu -Rasa, Mamasa. Asthi, Majja.
iv. Bahumutrata: Presence of vitiated or dushita Ama causes sroto:
iii. Upadhatu -Snayu and Kandara. abhishyanda in the body, which leads to increase of kleda. This
Bahumutrata occurs for the excretion of excess kleda from the
iv. Srotases -Annavaha, Rasavaha, Asthivaha, Majjavaha.
body.
v. Srotodusti -Sanga, Vimaragagmana.
v. Kukshikathinya: Vitiated Samana and Apana Vata along with the
vi. Udbharasthana- Amashya (Ama), Pakvasaya (vata). Ama leads to Kukshikathinya, which is the rigidity of abdomen.
vii. Adhisthana -whole body vi. Kukshishoola: Srotorodha due to Ama causes obstruction to
normal movement of vitiated samana and apana Vata resulting
viii. Vyaktasthana -Sandhi
in pain in abdomen.
ix. Avayava -Sandhi.
vii. Nidra Viparyaya: Due to vata vriddhi, pain gets aggravated
x. Vyadhiswabhava -Mainly Ashukar. at night and keeps the patients awaken which leads to Nidra
Viparyaya.
xi. Sanchara Sthana -Hridya, Dhamani.
viii. Chardi:29 Continuous formation of dosha leads to excitation of
xii. Roga Marga -Madhyama roga marga amashaya by vata cause vomiting.
xiii. Agni -Jataragni Mandya, Dhatwagni Mandya. ix. Bhrama: Presence of Kapha in Srotas and Vitiated Vata causes
Prodromal symptoms/purva roopa of amavata 25 Bhrama.

Avyakta lakshana prior to the manifestation of disease is considered x. Murchcha: Inability of the sensory organs to perceive the sense
as the purva poorpa. objects is Murchcha. Loss of motor function occurs in Murchcha
due to upatapa of Indriya by Vitiated Vatadi doshas30
1. Dourbalyam (Weakness) 2. Haridaya gourava (heaviness in
chest) 3. Gatra stabdam (Stiffness of the body) 4.Apaka (indigestion) xi. Hritgraha: due to Rasavaha srotodushti (its mulasthana is
5. Anga marda (Aching all over body) 6. Gourava(Heaviness) 7. Hridaya) and vitiation of Samana Vata, Vyana Vata and
Aruchi (loss of taste) 8. Alasya (lack of enthusiasm) 9. Jwara (fever) Avlambaka kapha. Hritgaurava is also produced due to above

Citation: Virmani M, Kaushik AK,Virmani G. Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata. Int Phys Med Rehab J.
2019;12(3):97‒103. DOI: 10.15406/ijcam.2019.12.00456
 Copyright:
Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata ©2019 Virmani et al. 100

reason when vitiation is mild. In R.A. cardiac manifestations like Sandhi shoola (joint pain)
Pericarditis, Myocarditis, Conduction defects etc. can occur.
In Amavata, Vitiation of Asthi and Majjagata Vata causes pain in
xii. Vibandha: due to vitiated Apana Vata and improper degradation Sandhis and in severe stage, it is found as Vrishchika Dansha vata. The
of Ahara into Sara and Kitta. most common manifestation of established R.A. is pain in affected
joints, which is aggravated by movements. During rest and especially
xiii. Antrakujana: increased bowel sounds are present due to
early morning stiffness are also characteristic features of R.A. Pain
movement of Vitiated Vata in the intestine.
originates predominantly from joint capsule, which is abundantly
xiv. Anaha: It is the stagnation of vitiated vata in Kukshi. supplied with pain fibres and is markedly sensitive to stretching or
distension.
xv. Agnimandya: Vicious cycle of disease (Agnimandya- Shuktatva
– Annavisha) produces Agnimandya again and again. Sandhi shotha (joint swelling)
xvi. Praseka: lalasrava. Excessive thick, mucoid, salivary secretions
31
Sandhi Shotha (Ekangika shotha) results when vitiated dosha
are produced due to Samarasa, which shows Rasavaha and afflicts Twaka, Rakta, and Mamsa in joints33 Madhavakara has
Udakavaha srotodushti. described that shotha result due to the affliction of Ama and Vata
Pradhana Tridosha in joints.
xvii. Gaurava: Due to Vitiated Kapha there is feeling of heaviness in
Hridaya and body parts preferably in Joints. Joint swelling in R.A. is the result of accumulation of synovial
fluid, hypertrophy of synovium and thickening of joint capsule.
xviii. Vairasya: Perception of different taste than normal due to Sama
32

Rasa and vitiated Bodhaka Kapha. Stabdhata (stiffness)

xix. Daha: Due to Vitiation of Pitta sometimes localized or The restriction or loss of movements of joints. Gatra stabdhata
generalized Daha occurs. Warmth of the joint is usually evident is caused due to spreading of Ama throughout the body by vitiated
on examination. In its most aggressive form, rheumatoid Vata.34,35
vasculitis can cause Mononeuritis multiplex (Harrison1994).
In majority of patients, the onset is insidious with joint stiffness,
xx. Trishna: Trishna is due to Agnidushti, Sama Pitta and Vata. It especially early morning stiffness, which gradually gets reduced by
shows Rasavaha, dakavaha srotodushti in disease process (Table evening. This diurnal rhythm worse on arising in the morning and
1). then relieving towards evening probably reflects the diurnal variation
Table 1 Similarity between Amavata and Rheumatoid Arthritis in plasma cortisol level.

Sparshasahyata (tenderness)
Rheumatoid Arthritis Amavata
Sparshasahyata can be included in Sandhishoola in which patient
Morning stiffness Gatra sthabdata or sandhi sthabdata cries with pain even when the gentle pressure is applied to affected
part. Sometimes person himself cannot touch the affected part due to
Arthritis of 3 or more joints Bahu sandhi shotha pain. According to Modern text pain on movement and tenderness are
the cardinal signs of the disease (Becron -1971) (Tables 2 & 3).
Arthritis of hand joints Hasta, sandhi shotha
Differential diagnosis/sapeksha nidana
Symmetrical arthritis Bahu sandhi shotha (ubhaya) Sapeksha nidana becomes necessary when two or more disease
have a few important laxanas similar to each other and in such
Angavaikalya Rheumatoid nodule condition in order to avoid any error in adopting the line of treatment.
The differential diagnostic is done on the basis of few points such as
Rheumatoid factor ---- difference in samprapti accompanying laxanas, upashaya anupashaya
etc.
Radiological changes ----
Here the disease, which was exhibited with sandhishotha and
The first 4 criteria of RA can be correlated with the inflammatory sandhishoola specially, is considered for differential diagnosis.
condition of amavata. But rheumatoid factor and radiological
changes cannot be correlated to any conditions of amavata. Hence on 1) Vatarakta 2) Sandhigatavata 3) Krostaka sheersha 4) Sandhigat
symptomatology amavata can be best correlated to RA. sannipata 5) Sandhi aghata

Cardinal signs and symptoms/pratyatma lakshana Vatarakta

Pratyatma Lakshanas are main clinical features on which the Usually manifests with supti, discolouration and shithilatha
disease can be clearly differentiated from other identical forms of of sandhi, pain is of pricking and splitting nature, sudden onset or
disease. In Amavata, sandhis are the main site of manifestation of disappearance of joint pain. Anguli sandhies are first affected, then it
clinical features, thus joint associated symptoms are considered as spread to other parts of the body slowly like akuvisha, all the affected
Pratyatma lakshana of disease Amavata. joints are having pain equally, joint swelling is non-fleeting, no
morning stiffness.
These are as follows:

Citation: Virmani M, Kaushik AK,Virmani G. Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata. Int Phys Med Rehab J.
2019;12(3):97‒103. DOI: 10.15406/ijcam.2019.12.00456
 Copyright:
Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata ©2019 Virmani et al. 101

Table 2 Lakshans According to different Ayurvedic classics36–40 Table 3 Showing the Sthananusara Laxana

No. Lakshana MN B.P. B.R. Y.R. G.N. A.N Stanika Manasika

Shareerika Laxanas
Laxana Laxana
1 Agnidourbalya + + - + + -

2 Alasya + + - + + Sandhi Shotha, Angamarda, Kukshishoola, Aruchi,

Sandhi
3 Anaha + + - + + - Bahumutrata, Trusna, Peeta Utsahahani,
Shoola, Gatra mutrata, Alasya, Takratulyata,
4 Angamarda + + - + + - Gourava, Nidraviparyaya, Jwara, Moorcha, Bhrama,
Sthabdata, Antrakoojana, Apaka, Anaha, Alasya.
5 Anga sonata + + - + + -
Daha, Raga, Agnimandya, Grahanidosha,
6 Antra kujan + + - + + - Kandu Praseka, Asyavairasya

7 Apaka + + - + + -
Sandhigata vata
8 Aruchi + + - + + -
Because of lack of sleshmaka kapha for the friction of joints, it
9 Bahu mutrata + + - + + - causes pain and swelling. Here joint movement is accompanied with
pain. This is sthira ie., non fleeting, the hip and the knee are often
10 Bhrama + + - + +
affected usually affects middle aged or elderly persons. Symptoms
11 Chardi + + + + + - subside by using sneha therapies.
12 Daha + + - + + - Krostaka sheersha
13 Gourava + + - + + - This is the condition, wherein provocated vata and rakta give rise
to janu sandhi shotha and shoola, no other joints are involved. Janu
14 Hritgraha + + - + + -
Shotha (swollen knee) resembles the head of jackal, non-fleeting,
Janghadi severe pain in affected joint pain, which may increase during night.
15 Pradesha - - + - - -
Vyadha Sandhigat sannipata
16 Jwara + + - + -
This is a type of sannipata jwara usually manifests due to
Kukshi
17 + + - + - tridoshakaraka hetus, swelling and pain of the joints are non-fleeting,
Kathinyata
non-variant pain, usually along with anidrata and severe cough.
18 Kukshi sula + + - + -
Sandhiaaghata
19 Murcha + + - +
Nidra This is of traumatic origin, pain and swelling will be restricted to
20 + + - + the affected joint. Non-fleeting, subsides within few days.
Viparayaya
21 Pandu Varna - - + - - Types of rheumatoid arthritis (amavata)
22 Prasekam + + - + + - Madhava Nindan while explaining the doshanubandha
23 Sandhi gourava + - - - + + lakshana41 he made 3 types. Whereas while expressing regarding
the sadhyasadhayata of Amavata, he made 7 types on the basis of
24 Sandhi Ruja + + - + + + involvement of the doshas.42By combining the above two points
25
Sandhi shotha + + - + + +
Amavata is of seven types on the basis of doshas they are as given
below
26 Sandhi Graha - - - - - -
a. Vata pradhana: In this mainly predominance of sula will be
27 Sosha - - + - - - present.
28 Trishna + + + + + - b. Pitta pradhana: Daha and Raga are present in the joints.
29 Ushnata - - + - - - c. Kapha Pradhana: Staimitya, Gourava & kandhu are the main
symptom of this variety.
30 Utsaha Hani + + - + + -
d. Vata pitta paradhana: Combined symptoms of both pitta & vata.
31 Vairasyam + + - + + -
e. Vata kapha pradhana: Combined symptoms of both vata & kapha.
32 Vishuchi - - + - - -
f. Pitta kapha pradhan: Combined symptoms of both pitta & kapha.
33 Vitvibandha + + - + + -
Vruschika
g. Sannipatika -- Combined symptoms of both all doshas.
34 damsavata + - - - + - According to Sharangadhara four types of Amavata are considered
peeda
a. Vataja Amavata

Citation: Virmani M, Kaushik AK,Virmani G. Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata. Int Phys Med Rehab J.
2019;12(3):97‒103. DOI: 10.15406/ijcam.2019.12.00456
 Copyright:
Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata ©2019 Virmani et al. 102

b. Pittaja Amavata diagnose the disease and adopt the treatment. In this difficult condition
Upashaya and Anupashaya have advised. Upashaya for Amavata
c. Kaphaj Amavata
are Ruksha sweda, langhana Usnakala etc Whereas Anupasayas are
d. Sannipataja Amavata snigdha sweda, Santarpana etc.

According to the presence of lakshana Amavata is classified in to Prognosis or sadhya/asadhyata48,49

two types first one is Samanya Amavata43 and second is Pravrudha
Amavata have got Anubandha with single dosha, naveena avasta,
Amavata.44
lakshanas are in mild form, no presence of Upadrava, is indication
According to time period of Amavata it is of two types. of sadhyata of Amavata. If involvements of any two doshas produce
Vyapyata of the Amavata whereas involvement of all the three
1. Naveena Amavata, 2. Jirana Amavata.
doshas, involvement of all the joints, Purana Amavata including with
A unique classification by Harita Samhita45 based on presentation upadravas will become krichra sandhya vyadhi.
of the disease.
Acknowledgments
a. Vistambhi: This presents with constipation, feeling of heaviness,
in the abdomen, flatulence pain in the Vasti area. None.

b. Gulmee: Symptoms simulating like gulma, spasmodic pain in Conflicts of Interest

abdomen, increased audible peristaltic sounds.
Author declares there are no conflicts of interest towards the
c. Snehi: Unctuousness of the body, inactivity, loss of appetite, article.
passing of unctuous and undigested stools.
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Citation: Virmani M, Kaushik AK,Virmani G. Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata. Int Phys Med Rehab J.
2019;12(3):97‒103. DOI: 10.15406/ijcam.2019.12.00456
 Copyright:
Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata ©2019 Virmani et al. 103

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Citation: Virmani M, Kaushik AK,Virmani G. Rheumatoid arthritis diagnosis according to Ayurveda texts W.S.R. Amavata. Int Phys Med Rehab J.
2019;12(3):97‒103. DOI: 10.15406/ijcam.2019.12.00456