Abstract

Ayurveda is the ancient health system of medicine in india. The disease Amavata described in Ayurveda in the Madhava Nidhan. The disease rheumatoid arthritis can be presented as a very similar to amavata. The disease rheumatoid arthritis is chronic in nature and affected mostly the middle age group. It is one of the common debilitating disease by the virtue of its chronicity and implication. The disease is frequent during 3rd to 5th decade of life with 80% of patients developing the disease between 30 to 50 years of age. The Ama when combine with vata dosha and occupies in sleshma  sthana results painful disease ”Amavata” The disease is characterized by various features like sandhishoola in the nature of Toda, swelling inability of joints movements etc.Hence I took  present study Shamana therapy on  Amavata as Triphala-Aragvadhadi Ghana vati has been chosen. Triphala-Aragvadhadi Ghana vati is described in Vrundhamadhav [25/61] with special indication of Amavata.

Keywords: 1. Triphala-Aragvadhadi Ghana vati  2. Amavata

Introduction:

The disease rheumatoid arthritis can be presented as a very similar to amavata. The disease rheumatoid arthritis is chronic in nature and affected mostly the middle age group. It is one of the common debilitating disease by the virtue of its chronicity and implication.The disease is frequent during 3rd to 5th decade of life with 80% of patients developing the disease between 30 to 50 years of age. Community prevalence study show that female suffer more than male and ratio of occurrence between them is 3:1.(A.P.I-290/Harrisons) 

The spectrum of disease that results due to  Ama ranges from acute conditions like Visuchika, Alsaka, Vilambika etc. to the chronic disorders like Amavata, Grahani and Amatisara etc. In Amavata, Vata as a Dosha and   Ama are chief pathogenic factors.  They are contradictory in nature and thus possesses difficulty in planning the line of treatment. It is mostly the disease of Madhyama Roga Marga and having Chirkari Swabhava. Sometime it can also be manifested as the acute case. Due to their similar mode of presentation, the disease rheumatoid, much prevalence in the society and lack of effective medicament, the disease is being chosen for the study.

For the present study Shamana therapy on  Amavata as Triphala-Aragvadhadi Ghana vati has been chosen. Triphala-Aragvadhadi Ghana vati is described in Vrundhamadhav [25/61] with special indication of Amavata.

Aim and Objectives:

To evaluate role of Triphala-Aragvadhadi Ghana vati in the management of Amavata

Materials and methods:

 – Collection Of Drug:

All drugs has been collected from field.
 
Preparation of drug

Triphala-Argwadhadi kwatha has been prepared as per classical method mentioned in Sharangdhar Samhita Madyam Khanda.

Triphala-Argwadhadi kwatha Ghana Vati has been prepared as follows:

Kwatha       Ghana       Vati
Vaties weighing 500 mg each has been prepared.

Clinical Trial
a. Selection of cases:

- Special case paper Performa has been prepared for the study.
- 30 patients of Aamavata has been randomly selected.
- Follow up has been taken at the interval of 15 days for 2months.

Therapy:

- Route of administration - Oral
- Dose – 500 mg Twice a day
- Time - After lunch and Dinner
- Duration - 2 months
- Anupan – Warm water
- Follow up – After every 15 days.

Criteria for assessment:

1. Subjective Parameter

1) Joint Score: The no. of clinically involved joints will determined on the basis of tenderness on pressure or painful passive movements.

Score 3       :       Involved more than 5 joints.
Score 2       :       involved joints between 3 - 5.
Score 1       :       at least 2 joints.
Score 0       :       less than 2 joints.

2) Duration of morning stiffness:

Score 3      :       above 60 min.
Score 2      :       for 30-59 min.
Score 1      :       for 0-29 min.
Score 0      :       no stiffness

3) Severity of Pain: (by VAS)

Score 3      :       Severe
Score 2      :       Moderate
Score 1      :       Mild
Score 0      :       Nil

4) Tenderness:

Score 3      :       Severe
Score 2      :       Moderate
Score 1      :       Mild
Score 0      :       Nil   

5) Swelling:

Score 3      :       Severely present
Score 2      :       Markedly present
Score 1      :       Slightly present
Score 0      :       Absent

6) Local Temperature of affected joints :

Score 3      :       Severe
Score 2      :       Moderate
Score 1      :       Mild
Score 0      :       Normal

Objective Parameters:

7) Grip Strength:

Score 3      :       Poor (below 38 mm of Hg)
Score 2      :       Moderate (40-140 mm of Hg)
Score 1      :       Mild (142-280 mm of Hg)
Score 0      :       Normal (above 282 mm of Hg)

8) Functional Score:

Score 3      :       Unable to do
Score 2      :       With the help of other person or device
Score 1      :       Able to do with difficulty
Score 0      :       Able to do without any difficulty
 
Criteria of assessment:
Overall Score:

1 – 8          :       Mild           Grade I
9 – 16        :       Moderate   Grade II
17 – 24      :       Severe      Grade III  

Relief of Symptom:

Patient has been assessed during treatment and result has been drawn.

Good Results       :- Above > 75 %
Moderate Results :- Between 50% - 74.9%
Mild Results:       :- Between 25% -49.9%
No Results          :-  Below < 25%

Laboratory investigations :

Lab investigations has been done before & after 2 months of treatment.

1) Haemogram  2) R. A. Factor  3) E. S. R.                  

Statistical analysis

Mean, percentage, SD, P value were calculated. Wilcoxon singed ‘Z’ test was applied.

Observation and Results

Majority of the patients belongs to age group >40years i.e. 60%,majority of the patients were females i.e. 66.7% as compared to males 33.3%,Majority of the patients in the study was housewives i.e. 50 %. Viruddhahara,Majority of the patients was from lower middle class economical status i.e. 40%,It was found that 53.3% patients consumed mixed type of diet while 46.7% were pure vegetarians. A considerable number of patients about 66.7% were found to be consuming viruddha ahara,Majority of the patients had mandagni i.e. 60% while 20% had vishamagni,Majority i.e. 53.3% had Krura koshtha while 33.3% had madhyama and 13.3% had mridu koshtha,In the series maximum number of patients had kapha-vata prakriti i.e. 46.7% and 33.3% patients had vata-kapha prakriti, In the study the 53.3 % vyadhi were produced in Visarga kala as compared to Aadana i.e. 46.7.

Discussion

Triphala-Aragvadhadi Ghana Vati is highly significant in Amavata.This provide highly relief in pain(58.3%),functional
capacity(45.3%),stiffness(47.9%),swelling(60%),tenderness(51.6%),local temp.(49.2%),joint score(41.6%),gripe strength(42.6%),total improvement(44.6%).

Most of drugs are Katu-Tikta rasatmaka, Ushna viryatmak, Laghu and ruksha, Madhura vipaka yukta. Being laghu guna, katu-Tikta rasa, ushna veerya it does best amapachana; it will act as Kapha-Vata shamaka, Shothahara (anti-inflammatory), Anulomana, Shoolahara (analgesic), and Srotorodhanivarana. By its kledapachaka and agnidipana properties it decreases ama, so helpful in sampraptibhanga in Amavata and reduces swelling and stiffness in Amavata. In Amavata vibandha (constipation) is one of the symptom that decreases (reveals) by anulomana property.

Conclusion:

After analyzing all the observation of raw data we come to the conclusion that Triphala-Aragvadhadi Ghana Vati is effective in Amavata.

- The trial drug in this study was very effective in agnivardhana and amapachana. It was a very good combination of Shoolahara, Shothaghna and Amapachaka Dravyas.
- Triphala-Aragvadhadi Ghana Vati is very effective in reducing pain and stiffness. It is also effective in reducing swelling. 
- No untoward effect was seen in the patients during the treatment.

Bibliography:

1. Ashtanga Hridaya: Sarvangasundara and Ayurved Rasayana commentary, Ed. by Harishastri paradkar, Chaukhamba Surbharti prakashan, Varanasi, 6th edition, 2000.
2. Ashtanga Sangraha: Ed. by Kaviraj Atridev Gupta, Krishnadas Academy, Varanasi, 1993.
3. Bharat Bhaishajya Ratnakar: part 3, Shri Nagindas Chaganlal Shah, B.Jain Publishers, New Delhi. Aug 1999.
4. Bhavaprakash: Ed. by Shri Brahmashankar Mishra and Shri Rupalalji Vaishya, Chaukhamba Sanskrit Sansthana, Varanasi, 10th edition 2002.
5. Bhela Samhita: Commentary by K. H. Krishnamurthy, edited by P. V. Sharma, Chaukhamba Vishvabharati Pub., 2005.
6. Chakradatta: by Chakrapani Datta, ed. by Vd. Ravidatta Shastri, Chaukhamba Surabharati Prakashan, Varanasi, 2000.
7. Charaka Samhita: Ayurved Deepika commentary by Chakrapani, Ed. by Vd. Yadavji Trikamji Acharya, Chaukhamba Prakashan, Varanasi, 2000.
8. Concept of ama: by Dr. Srinivasulu, Chaukhamba Sanskrit Series, Varanasi, 1st ed. 2005.
9. Database on medicinal plants used in Ayurveda: Pub. CCRAS, Dept. of ISM&H. Govt. Of India, New Delhi, Vol. I to VI, 2002.
10. Davidson’s Principles and practice of medicine: Ed. by Edwards et al. Churchill living stone, 17th Ed.
11. Dravya guna vidnyan: Part-2, Prof. P.V. Sharma, Chaukhamba bharati Academy Varanasi. 15th Edition 1994
12. Harrison’s Principles of Internal Medicine: Vol. 2, Ed. by Kasper, Braunwald, Fauci et al, The Mc Graw Hill Pub, 18th ed.
13. Indian Materia Medica:  Nadkarni, Popular Book depot, Mumbai, 3rd Ed. 1996.
14. Indian Medicinal Plants: Kirtikar- Basu, 2nd edn. 1984.
15. Kashyapa Samhita: Ed. by Shri. Satyapal Bhishagacharya, Chaukhamba Sanskrita Sansthana, Varanasi, 9th ed, 2004.
16. Madhava Nidana: By Madhavakara with commentary Madhukosha by Vijayarakshita and Srikanthadatta and Atankadarpana by vachaspati Vaidya, Nirnaya sagar press, Bombay, 5th ed. 1955.
17. Methods in Biostatistics: Mahajan B.K, Jaypee broth. Medical Publisher (P) Ltd, New Delhi, 6th Ed.
18. Sharangdhara Samhita: Ed. By Narayan Ram Acharya, Chaukhamba orientalia, Varanasi, 1st Ed.
19. Sushruta Samhita: Nibandha Sangraha commentary by Dalhana, Ed. by Vd. Yadavji Trikamji Acharya, Chaukhamba Orientalia, Varanasi, 8th Ed.
20. Vachaspatyam: By Taranath Tarka Vachaspati, Chaukhamba Sanskrit Series, Varanasi, 11th ed. 1993.