ROLE OF VAITARANBASTI AND BRIHATVATA CHINTAMANI RASA IN THE MANAGEMENT OF AMAVATA W.S.R. RHEUMATOID ARTHRITIS.

ROLE OF VAITARANBASTI AND BRIHATVATA CHINTAMANI RASA IN THE MANAGEMENT OF AMAVATA W.S.R. RHEUMATOID ARTHRITIS.

Dr .Shiv Prasad Dwivedi

Assistant professor J.S. Ayurved college Nadiad, Gujarat

Emai.shiv1245@rediffmail.com

Mob-09867007893, 9479497749

Abstract

Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints of hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

An autoimmune disorder, rheumatoid arthritis occurs when our immune system mistakenly attacks your own body's tissues. In addition to causing joint problems, rheumatoid arthritis sometimes can affect other organs of the body such as the skin, eyes, lungs and blood vessels.

Although rheumatoid arthritis can occur at any age, it usually begins after age 40. The disorder is much more common in women.

While in Ayurveda Amavata is the most crippling of the joint disease. It occurs throughout world in the all climate and all ethical groups. Ama associated with aggravated vat play dominant role. The clinical features of Amavata such as pain, swelling, stiffness, fever, general debility are most identical mentioned in classical texts. In classics treatment mentioned in Amavata is Dipan, Pachan, Shodhan, Shaman, Asthapanbasti, Vaitaranbasti. Among them VaitaranBasti is very effective in Bahudosh and Leendoshavastha. It used in new and old Amavata as well because it brings Doshas from Shakha to Kostha and remove it from Gudmarg(anus) and gives relief.

Presently available modern medication for Rheumatoid arthritis and medication for pain (NSAID) is causing many side and toxic effect and requires long term medication which suppresses immunity and produces other diseases.

Hence there is a need to find such a therapy which gives better relief without any side or toxic effect and also natural, cost effective and easily available .hence the ayurvedic treatment required for this autoimmune diseases study was selected.

Key words –Amavata, VaitaranaBasti , BrihatvataChintamai rasa

Introduction

Amavata is first mentioned as separate disease by Madhavnidan¹, where it is stated that Mandagni plays key role in the manifestation of the disease. Acharya Madhav described most characteristics features of the disease, severe pain similar to a scorpion bite. Asthi and sandhi are chief sites of presentation of cardinal symptoms, such as sandhi shool(pain),sandhi grah (stiffness), sandhi sotha(swelling of joint) etc. this symptoms are resembles the cardinal symptoms of Rheumatoid arthritis i.e. pain, swelling, stiffness, fever, general debility etc. Amavatchikitsa described by chakradatta is Dipan,tiktakatu rasa, ksharBasti, VaitaranBasti, SaindhavadiAnuvasan and much yoga. While in modern science Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that primarily affects joints. It may result in deformed and painful joints, which can lead to loss of function. The disease may also have signs and symptoms in organs other than joints.

The cause of RA is not completely understood. The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (turgescence) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium. It also affects the underlying bone (focal erosions) and cartilage (thinning and destruction)^. 

Sign and  symptoms of Amavata.

Cardinal symptoms of Amavata² are-

1. (Vriscikdamshavatavedana)Morning pain severe in nature
2. (SanchariVedana)shifting pain
3. (Stambha) stiffness of joints
4. (Jwara )Increase temperature
5. (Karmahani) loss of movements
6. (Sandhi Vikruti) joint deformity.
7. (Kshudhamandya) Loss of appetite

Aim and objective.

1-To evaluate the efficacy of vaitarna Basti and BrihatvataChintamani Rasa in the management ofAmavata (Rheumatoid arthritis)

 2- To evaluate theefficacy of Vaitarna Basti in  the management of  Amavata.

 3-To compare the effect of Vaitaran Basti and BrihatvataChintamani rasa with Vaitaran Basti .

Drug review

VaitranaBasti4

Vaitranbasti was described by Chakrapanidatt ³and Vangsen⁴, as very safe and effective in-

Indication

Shool

Anaha

Amavata

Content and dose of Vaitranvasti⁵

Chincha (tamarindusindica)                         50gm

Guda(jiggery)                                            20gm

Saindhava                                                 5gm

Gomutra                                                    50ml

Til tail                                                        20ml

Madanphalchurna as prakshep 5gm

Content of Brihatvatachintamani rasa⁶ -

§  Swarnbhashma –   2 tola

§  Rajatbhashma -     2 tola

§  Abhrakbhashma –  2 tola

§  Motibhashma -       3 tola

§  Pravalbhashma -    3 tola

§  Lauhabhashma -    5 tola

§  Rasa sindoor -         7 tola

§  Ghritkumariswarshkibhawana -

Material and methods:

The present clinical study is an open randomized comparative study. The aim of the clinical studyis to evaluate the combined effect of vaitaranabasti and oral use of BrihatVatachintamani rasa in the patients suffering from Rheumatoid Arthritis.

Material:      1)Brihatvatachintamani rasa.

                   2) VaitaranaBasti

3) Rubbercatheter

                   4) Glycerine syringe ect.

Method

 Study was carried out over a period of 1yr in M.A. Podar Ayurved hospital, Worli Mumbai. Total 30 selected and diagnosed Patients of both the sexes between the ages 15 to 65 year with condition of Rheumatoid arthritis (Amavata) were selected on the basis of selection criteria. And divided in two group.1)Group- A and Group- B with 15 patients in each group.

In  Group-AVaitranBasti and in Group-B Vaitaran Basti along with oral administration of Brihatvatachintamani rasa 125 mg. BD was given after meal.

At the time of baseline assessment, a profile of haemogram, biochemical investigations R.A test, ASO TITER, and serum uric acid was obtained.

Duration of treatment in one cycle-10 to 15 days

Follow-up: weekly for three week,

Before starting treatment routine investigation were done as necessary.

The patients were treated and observed; comparative study was done in two groups.

Prepration of Basti Dravya-

50gm of Chincha and 20 gm of Guda will be mixed in 100ml water on previous night. Mixture will be crushed thoroughly. The mixture will be heated up to boiling on next morning.after that 40ml of til tail, 5gm of saindhava,50ml of Gomutra and 5 to 7gm of MadanphalChurna as prakshep will be added. This mixture will be used as Basti Dravya.

Time of administration- After lunch.

Mode of action of vaitaranBasti in Amavta

Chakradatta and Vangsen has mentioned VaitaranBasti is useful in the Amavata⁷. It brings DoshasShakha to kostha by utkleshan or lekhan action and it eliminated by Gudmarg.

Srotomukhvishodhanat -Gomutra cleans the channels.

Vridhdhi -Amlika increase the doshas.

Abhishyandanat – Saindhavlavan increases the abhishyandi quality.

Paka –Gudam used for doshapaka.

Vayoschnigrahat – Oil controls over the vayu.

Table no.1

S.No.	Aharavarga	Pathya	Apathya
1	Annavarga	Yava, kulattha, Raktashali, kodrava.	Navanna , amlapadartha
2	Shakavarga	Vastuka, Shigru ,karela , Patola.	Maasha
3	Dugdha varga	Ardraka or Bhallatakaksheerpaka, Takra.	Dugdha , dadhi, Grita
4	Mamsavarga	Jangalmansa	Anupamansa
5	Drava	Ushnajala , Gomutra , Sunthiphanta	Sheeta jala
6	Aushadhavarga	Katutiktdrvya ,shunthi, Gokshur, Bhallataka, varuna , Lasuna , Eranda.	Madhurdravya , Amladravya

Criteria for selection of patient-

A)    Inclusion criteria:-

1)     Sex – both male and female

2)     Age group -15 to 65 years

3)     Patients having signand symptoms of amavata as in Madhavnidan

4)     Patients full fill the American criteria of rheumatoid arthritis.

5)     Patient fit for Basti.

B)    Exclusion criteria:-

1)     Patients presenting with complication like Endocarditis, major joints deformities.

2)     Above 65yr age and below 15yr.

3)     Patient having HIV, HbsAg and other STD.

4)     Pregnancy and lactation

5)     Patient not fit for Basti.

Criteria of assessment

Tenderness

No tenderness                                                                                                    0

Subjective experiences of tenderness                                                        1

Wincing of face on pressure and withdrawal of affected part           2

Resists to tough.                                                                                              3

Joint pain:

Gradation of pain by visual analogue scale

0                                     Nil

1                                     Mild pain.

2                                     Moderate pain.

3                                     Severe pain.

Swelling over joint:

0                                  Nil

1                                  Mild tenderness, causing patient to wince on digital pressure.

2                                  Moderate tenderness, causing patient to wince on digital pressure.

3                                  Severe tenderness, patient does not allow totouch.

Morning stiffness:

0                Absence 

1                25% restriction of movement

2                25 to 50% restriction of movement

3                More than 50% restriction of movement

Discussion

1.      As per Ayurveda Basti is mainly indicated in Vata predominant diseases. The two type of abnormalities of Vatanamely; Avaran and Dhatukshayjanya can be treated by Basti karma. Direct application of this type of treatment to colon helps not only in regulating and co-ordinating and Vatadosha in its site,but also controls the other doshas involved in the pathogenesis of the disease (S.S.Chi.35/6). Basti is used in Sakhagat, Tiyarkgamidosha, kosthagatrogas. Among them vaitaranBastis is lekhan or utkleshanBasti used in those diseases in which dosha reached at deeper dhatu ex Amavata, urustambh.

Vaitaranbasti

Vaitaran is the name of a river,which a person is supported to cross during death in his astral realm. This Basti is so powerful in a sense that it can bring back life of a person who is about to cross the Vaitaran river.

While Brihatvatachintamani

Conclusion-
1. Amavata is disease of Madhyamrogmarg with chirkariswabhav. Ama and vata being contra indicatory in nature make it difficult to plan the line of treatment, in chronic stage doshas become lindoshaand reaches to the sakha. Here VaitaranBasti is utkleshkarBasti which increase the doshas so it comes out from the shakha to kostha and expel out from the body from GudmarG , hence basti is best treatment for vatarogas so Vaitaran Basti play key role in Amavat  lindoshavastha.

2.      In Group - A significant result were obtained inJoint painwith   60.08% improvement. In morning stiffness 59.29% in swelling65.38% (which was highly significant),in tenderness 61.5% result were obtained.

3.      In Group-B highly significant results were obtained in swelling, pain stiffness, and tenderness. All parameters show highly significant result of VaitranBasti along with BrihatvataChintamani rasa.

4.      It was observed that relief in sign and symptom of Amavata was found in the both group correlatively Group-B (Brihatvatachintamani rasa with VaitaranBasti) group showed better result.

5.      Amavata is chronic disease and so many individuals are affected every year from it, keeping this point in to consideration it was found that VaitranBasti and BrihatvataChintamanirasa may be a Good Ayurvedic formulation for Amavata with some other supporting treatment.

After study it is observed that the drug is highly effective in both groups the percentage relief was more in group -B. than in Group

Table no.-2                         Group-B

Parameters	Mean BT	Mean AT	Mean deff	%mean	S.D.	S.E.	t	p
Pain	2.3	0.9	1.4	60.8	0.69	0.221	6.1	<0.01
Swelling	2.6	0.9	1.7	65.38	0.82	0.26	7.005	<0.001
Stiffness	2.6	1	1.6	61.5	0.519	0.16	6	<0.01
Tenderness	2.4	1.1	1.3	59.2	0.580	0.15	5.9	<0.01

Table no.3                     Group -B

Parameters	Mean BT	Mean AT	Mean deff.	Mean %	S.D.	S.E.	t	p
Pain	2.6	.8	1.8	74.23	0.72	0.18	12	<0.001
Swelling	2.4	1	1.4	79.02	0.50	0.13	18	<0.001
Stiffness	2.5	0.9	1.6	78.21	0.50	0.13	12	<0.001
Tenderness	2.3	1.2	1.1	71.03	0.74	0.19	12	<0.001

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