Amavata by Dr.Swatika Sharma

Amavata described by Acharya Madhav Nidan

1. आमवात DR.SWATIKA SHARMA ASST.PROFESSOR DEPT.OF ROGNIDAN PIA&R

2. references Amavata was first described by Madhukosakara in Madhava nidana . Later in books like yogaratnakara , bhaishyaja ratnavali etc quoted . Madhava nidana - 25 th chapter

3. आमवातस्य निदान विरुद्धाहारचेष्टस्य मन्दाग्नेर्निश्चलस्य च | स्निग्धं भुक्तवतो ह्यन्नं व्यायामं कुर्वतस्तथा ||१|| Virudha ahara - means unwholesome foods or combination of food which affects adversely. Poor digestion power , defective metabolism Sedentary lifestyle and also too much exercise Consumption of sticky food followed by exercise.

4. पूर्वरुप The only text which describes the premonitory signs and symptoms is Vangasena Samhita namely- गात्ररुजा शिरोरुजा

5. सम्प्राप्तिः वायुना प्रेरितो ह्यामः श्लेष्मस्थानं प्रधावति | तेनात्यर्थं विदग्धोऽसौ धमनीः प्रतिपद्यते ||२|| वातपित्तकफैर्भूयो दूषितः सोऽन्नजो रसः | स्रोतांस्यभिष्यन्दयति नानावर्णोऽतिपिच्छिलः ||३|| जनयत्याशु दौर्बल्यं गौरवं हृदयस्य च | व्याधीनामाश्रयो ह्येष आमसञ्ज्ञोऽतिदारुणः ||४|| युगपत्कुपितावन्त स्त्रिकसन्धि प्रवेशकौ | स्तब्धं च कुरुतो गात्रमामवातः स उच्यते ||५||

6. Due to ingestion of etiological factors it disturbs the normal function of agni as a result food not properly digested, yields immature rasa in the amashaya and this undergoes fermentation and /or putrefaction because of its retention for longer duration , manifest ama . Then it absorbed in the system and it is taken up by the aggravated and vitiated vayu specially to the kapha sthana mainly amashaya , sandhi, uras , kantha etc. and same undergoes in the above mentioned sites and enter the dhamini by circulation with the help of vata . Here it amalgamates with the existing dosas and vitiated further in excess and produces distress in the body channels due to excess of snigdha nature and some other qualities of amarasa . This leads to general weakness and heaviness in the precordial region and this amarasa is responsible for genesis of symptoms complex .

7. संप्राप्ति घटक Dosa - Vata – Vyana , Samana , Prana Pitta- Pachaka Kapha – Sleshma Dusya - Dhatu – Rasa, Meda , Majja Upadhatu - Sira , Snayu Sarira Mala – Purisa Agni – Jatharagni And Dhatvaagni Agnidusti – Mandagni Ama – Agnijanaya Srotas – Annavaha , Rasavaha , Asthivaha Srotodusti - Sanga

8. Udbhavsthana – Amashaya Sancharsthana - Annavaha Srotas , Dhamini , Kaphasthana Adhisthana – Kaphasthana Like Sandhi, Amshaya Vyaktasthana - Kaphasthana i.e Sandhi, Amashaya , Uras Etc Svabhava – Kastasadhya Rogamaga – Madhyama

9. अङ्गमर्दोऽरुचिस्तृष्णा [ १ ] आलस्यं गौरवं ज्वरः | अपाकः [ २ ] शूनताऽङ्गानामामवातस्य लक्षणम् ||६|| Bodyache Anorexia Thirst Heaviness Fever Indigestion numbness आमवातस्य सामान्यलक्षणम्

10. स कष्टः सर्वरोगाणां यदा प्रकुपितो भवेत् | हस्तपादशिरोगुल्फत्रिकजानूरुसन्धि षु ||७|| करोति सरुजं शोथं यत्र दोषः प्रपद्यते | स देशो [ १ ] रुज्यतेऽत्यर्थं व्याविद्ध इव वृश्चिकैः ||८|| जनयेत् सोऽग्निदौर्बल्यं प्रसेकारुचिगौरवम् | उत्साहहानिं वैरस्यं दाहं च बहुमूत्रताम् ||९|| कुक्षौ कठिनतां शूलं तथा निद्राविपर्ययम् | तृट्छर्दिभ्रममूर्छाश्च हृद्ग्रहं विड्विबद्धताम् | जाड्यान्त्रकूजमानाहं कष्टांश्चान्यानुपद्रवान् ||१०|| प्रकुपितस्यामवातस्य लक्षणम्

11. Painful swelling of joints i.e hands , feet, ankle , knee, hip and spinal column. Nature of pain is like that of scorpion sting. Stiffness Hindered digestive mechanism Excessive salivation Anorexia Heaviness Lack of enthusiasm Distaste in the mouth Burning sensation excessive urination Hardness and pain in the abdomen Disturbed sleep

12. Vertigo Fainting Stiffness in precordium Constipation Stiffness Intestinal sounds Distention of abdomen Severe difficulties with complication

13. आमवातस्य विशेषलक्षणानि पित्तात् सदाहरागं च, सशूलं पवनानुगम् | स्तिमितं गुरुकण्डूं च कफदुष्टं तमादिशेत् ||११|| Totally 7 types of amavata mentiomed according to dominancy of dasa in Madhava nidana and yogaratnakara . Vataja amavata – characterised by pain in the affected areas Pittaja amavata – characterised by burning sensation and redness in the affected area Slaismika amavata – characterised by rigid, heaviness, itching of the affected area. Vata - pittaja amavata - combination Pitta kapahaja amavata -combination Vataja – kapahaja amavata – combination Sannipataja amavata

14. आमवातस्य साध्यासाध्यविचारः एकदोषानुगः साध्यो, द्विदोषो याप्य उच्यते | सर्वदेहचरः शोथः स कृच्छ्रः सान्निपातिकः ||१२|| Single Dosha – Sadhya Two Dosha Involvement- Yapya Tridosha with sotha in full bodyS - Krucha Sadhya

15. Differential diagnosis VATARAKTA KROSTUKA SIRSA AMAVATA SANDHIGATAVATA SANDHISHULA PRESENT PRESENT(MAHARUJA) PRESENT PRESENT SANDHISOTHA PRESENT PRESENT PRESENT PRESENT ARAMBHA SANDHI PARVA SANDHI KEVALA JANU SANDHI BRUHATA SANDHI BRUHATA SANDHI JVARA AS ARAMBH LAKSHANA MAY BE ⁄ MAY BE NOT PRESENT PRESENT NOT PRESENT SPARSH-ASAHTVAM PRESENT PRESENT TIVRA MAY BE/ MAY BE NOT USHNA SPARSHA PRESENT PRESENT PRESENT PRESENT /MAY NOT BE PRESENT ITAR LAKSHANA SANDHI PRADESH PIDIKO-UTAPATTI , SPREAD LIKE AKHU VISHA KNEE JOINT LOOK LIKE JACKAL’S HEAD PAIN LIKE SCORPION BITE VATA PURNA DHRUTI SPARSHA- PRASARAN , AKUNCHAN SA-VEDANA

16. Ra – rheumatoid arthritis

17. definition Rheumatoid arthritis is an autoimmune disorder (body immune system starting attacking own healthy cells) in which Immune system identifies the synovial membrane as "foreign" and begins attacking it.  Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that may affect many tissues and organs, but mainly attacks the joints producing an inflammatory synovitis. NOTE- Synovial membrane is also known as –synovial stratum, synovium

18. Overview of ra The cause of rheumatoid arthritis is not known. In rheumatoid arthritis, multiple joints are usually , but not always, affected in a symmetrical pattern. Rheumatoid arthritis can affect people of all ages. The " rheumatoid factor " is an antibody that can be found in the blood of 80% of people with rheumatoid arthritis.

19. Hallmark feature of ra Is persistent symmetric polyarthritis (synovitis) that affect the hands and feet.

20. Risk factors Idiopathic Sex – women>men Positive family history Smoking Bacterial and Fungal Infection Herpes simplex virus infections Epstein-Barr virus (EBV) Vitamin D deficiency

21. Incidence rate Females > males 3:1 People of any age can be affected Peak age 45-65 yrs but onset early from age 20-45 yrs About 75% of these are women. The disease strikes women three times more often than men

22. Clinical features Tender, warm, swollen joints Morning stiffness that may last for hours Firm bumps of tissue under the skin on your arms (rheumatoid nodules) Fatigue Fever Weight loss

23. RA can affect many non joint structures, inclu ding – Skin Eyes Lungs Heart Kidney Blood vessels

24. complications Osteoporosis Rheumatoid nodules Dry eyes and mouth Infections Carpel tunnel syndrome Lymphoma

25. Swan neck deformity- is deformed position of the finger , in which the joint closet to the fingertips is permanently bent toward the palm while the nearest joint to the palm is bent away from it. Cock up toe deformity – extension of the toes Rheumatoid Nodules – are firm lumps that develop under the skin, unique symptom to rheumatoid arthritis and usually occur near joints affected by condition. Z deformity of thumb – hyperextension of the interphalangeal joint Button hole deformity- (boutonniere deformity)

26. Diagnosis Hematologic tests Erythrocyte sedimentation rate C-reactive protein Antinuclear antibodies Rheumatoid Factor X-rays MRI scanning

27. Differential diagnosis Osteoarthritis Fibromyalgia Reactive arthritis Psoriatic arthritis Infectious arthritis

28. QUESTION BANK 10 MARKS AMAVATA IN DETAIL WITH NIDANA PANCHAKA . EXPLAIN AMAVATA WITH MODERN CORELATION. 5 MARKS – AMAVATA SAMPRAPTI AMAVATA NIDANA RA

29. Thank you