in the management of Amavata (Rheumatoid Arthritis)

S. K. TIWARI *

JAI PRAKASH SINGH **

Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi.

ABSTRACT : The study was conducted in 64 clinically diagnosed cases of Amavata (Rheumatoid Arthritis) with
objectives of clinical evaluation of Alambushadi compound combined with the Alambushadi Niruha Vasti in the
management of Amavata on the basis of various scientific parameters. Statistically significant improvement was
observed in clinical, functional and hematological parameters in patients of group A (Alambushadi Group) and no
improvement was observed over these parameters in patients of group B (Placebo group) after the completion of
the course of treatment. Alambushadi Compound has been found to be an effective therapeutic regimen in the
management of uncomplicated cases of Amavata with duration of illness less than 5 years .
Key words : Amavata (Rheumatoid arthritis), Deepan, Pachana, Basti, Alambushadi Churna, Pain score.

INTRODUCTION
According to Ayurvedic literature no any
references of disease Amavata can be found in Vedic
kala and Samhita kala, but the words Ama and
Samavata1 have been used in both Vedic kala and Samhita
kala. But Acharya Madhavakara (900A.D.) the other of
Madhava Nidana, gave complete description of
Amavata2, which contains etiology, pathogenesis, signs
and symptoms and complications of the disease.
So, the disease Amavata can concern the result
of combination of Ama and Vata due to Mandagni. Both
Ama and Vata get vitiated and reach to joints and produce
swelling, pain and disability and thus the disease is
produced. According to modern medicine, it is strikingly
similar to rheumatoid arthritis, which is a chronic
autoimmune disease that causes inflammation and
deformity of the joints. Other problems throughout the
body (systemic problems) may also develop, including
inflammation of blood vessels , the development of bumps
(called rheumatoid nodules) in various parts of the body,
lung disease, blood disorders, and weakening of the bones
(osteoporosis)3,4.
The selected trial drug Alambushadi compound
is mentioned by Acharya Bhavprakash (B.P.Ut. 26/66)
in reference to Amavata Rogadhikar, with the emphasis
that it will destroy the disease from its root and is
supposed to be like Amrita (Nectar) for the patients.
Aims and Objectives :
Clinical evaluation of Alambushadi compound
combined with the Alambushadi Niruha Vasti in the
* Reader & Senior Consultant, Deptt. of Kayachikitsa.
** Senior Resident.
E-mail - drjp98@yahoo.co.in

management of Amavata (Rheumatoid Arthritis) on the

basis of various scientific parameters.
MATERIAL AND METHOD
The study was carried out at Kayachikitsa OPD
and IPD of Sir Sunder Lal Hospital, Institute of Medical
Sciences, Banaras Hindu University, Varanasi. Total 64
patients of Amavata were selected for the present study,
of them 14 patient were dropped out during the
course.The cases were randomly selected irrespective
of their age, sex, occupation and socio-economic
conditions. Both acute and chronic phases of Amavata
patients were taken for the above study, following the
criteria of the diagnosis of rheumatoid arthritis according
to the modern medical parameters and the clinical
features of Amavata described in Madhava Nidana.
Those patients were randomly divided into two groups.
Group A was treated with Samshodhana and
Samshamana therapy and Group B received Placebo.
Drug : The formulation comprised Mundi, Varuna, Sunthi,
Guduchi and Gokshura5.
Preparation of Drug : Alambushadi churna was
prepared by grinding the fresh cleaned and dried Mundi,
Amrita, Shunthi, Gokshura, Varuna. The kwath was
prepared from churna.
Follow Up Studies :Every patient registered after
fulfilling the inclusion criteria underwent assessment of
symptoms and also the assessment of different
components of inflammatory index, walking time, grip
power, pressing power.The 40 patients of RA completed
three follow ups in group A, who received
Samshodhana and Samshamana therapy6. The 40 patients
were selected based on the above clinical criteria and
subjected to comprehensive, therapeutic, regimens as per

Alambushadi Compound and its Vasti in Amavata (Rheumatoid Arthritis) : TIWARI & SINGH

classical description langhana deepana pachana, internal

snehana, swedana, Virechana and Vasti of Alambushadi
Kwath (Alambushadi Kwath + Shuddha Ghrita + Madhu
+ Saindhava Lavana + Eranda taila).
Treatment schedule7 for group A :
(i) Langhan Therapy - light meal for 3 days.
(ii) Deepana - Panchakola churna 1 gm B.D. before
meal with lukewarm water for 3 days.
(iii) Pachana - Chitrakadi vati 2 Tablet B.D. after meal
with lukewarm water for 3 days.
(iv) Snehana Karma as Abhyanga with Saindhawadi
Taila was followed by swedana karma starting from
1st day for 15 days(only in chronic Amavata and in
new cases of Amavata only ruksha swedan is given).
Snehana (Internal Snehana) was used from day 8th
day to 15th for the purpose of internal snehana and
mild virechana. For this purpose Eranda taila (Caster
oil) 15 ml was given with the luke warm milk at bed
time for 7 days.
Vasti (Yoga Basti) was given with the following
drug from 18 to 25 days. Anuvashana Basti : Alambushadi
kwath- 50ml + Goghrita 20ml + Madhu 20ml + Saindhava
Lavana 1gm + Eranda taila 15ml+Mahanaryan Taila 20ml
Niruha Vasti : Alambushadi kwath - 300ml +
Goghrita 10ml + Madhu 10ml + Saindhava Lavana 1gm
+ Eranda taila 10ml
After the completion of Vasti patients were
administered Alambushadi Churna 3 gram thrice a day
for 15 days with luke warm water.
Group B :Total 10 patients in this group were
provided lactose powder filled in capsules in a dose of 2
Capsules thrice a day and were regularly followed upto
1 month.
Inclusion Criteria : Clinical features of the disease
according to Modern and Ayurveda.
Exclusion Criteria : The patieints with Severe
deformities, Severe ankylosed joints, Major complications,
Ankylosing spondylitis, Rheumatic arthritis, Septic arthritis,
Osteoarthritis and gouty arthritis were excluded.
Clinical Assessment criteria of the Disease8,9,10 :
1. Pain
0 - No pain
1- Pain complaints but tolerable
2 - Pain complaints difficult to tolerate and taking
analgesic once a day

63

3 - Intolerable pain and taking analgesics two times

a day
4 - Intolerable pain and taking analgesics more than
two times in a day.
2. Swelling
0123-

No swelling
Feeling of swelling + Heaviness
Apparent swelling
Huge (Synovial effusion) swelling

3. Stiffness
0123-

No stiffness
20% limitation of normal range of mobility
50% limitation of mobility
75% or more reduction of normal range of
movement

4. Deformity
0123-

No deformity
Feeling of deformity
Mild deformity
Multiple joint deformities

5. General Function Capacity

0 - Complete ability to carry on all routine duties
1 - Frequent normal activity despite slight difficulty
in joint movement
2 - Few activities are persisting but patient can take
care of him or herself
3 - Few activities are persisting patient requires an
attendant to take care him/herself
4 - Patient is totally bed ridden
6. Tenderness
0123-

No tenderness
Mild tenderness
Moderate tenderness
Severe tenderness

Criteria for Assessment of Overall Effects :

For the gross assessment of the results obtained
in the clinical trial, the response of the treatment was
determined in following terms :
Subjective improvement : Patients were specifically
asked about growing feeling of well being and
improvement general function capacity after the
treatment.
Clinical improvement : Reduction in pain, swelling,
stiffness, tenderness, deformity and general function
capacity.

64

AYU-VOL. 30, NO. 1 (JAN.-MAR.) 2009

Functional assessment : Decrease in walking time and

increase in pressing power and grip power.

in terms of relieving individual symptoms as well as

reducing the severity of disease but no improvement was
noticed in group B.

Hematological and Biochemical assessment : Hb%,

TLC, DLC, ESR and certain immunological examinations
like serum Rheumatoid Factor and C-reactive protein
value were recorded before and after the treatment in
registered cases to evaluate the nature and extent of
change in relation to course of disease Amavata
(R.A.).Liver function test, serum creatinine and blood
urea value were also recorded to evaluate the safety
profile of the drug.

Functional Improvement : In group A, highly

significant improvement in grip power and pressing
power of both hands was observed. There was trend
to decrease in walking time, which is statistically highly
significant. In group B, no significant improvement was
observed.
Hematological and Biochemical changes : Even
though a total mean reduction of ESR value was
seen in Group A is statistically the effect of trial
therapy. Hb% was found to be increase in Group A.
Significant mean reduction were seen in the titer
values of rheumatoid factor and CRP titer in
Group A, patient with recent onset of disease i.e.
duration of illness upto 5 yrs showed better
improvement when compared to the relatively more
chronic patients. But no such type of improvement
were observed in group B.

OBSERVATIONS AND RESULTS

These are noted as demographic profile of
Amavata (Rheumatoid arthritis), Clinical profile of
Amavata (Rheumatoid arthritis) and Clinical & laboratory
study of the effect of Alambushadi Compound in Amavata
(Rheumatoid arthritis).
Response of Treatment : Alambushadi compound and
its Vasti exhibited good clinical improvement in group A
TABLE NO. 1 : THERAPY WISE DETAIL OF THE GROUPS (n=50) :
Group

No. of
patient
Male

No. of
patient
Female

Total
No. of
patient

No. of patient
completing
follow ups

Treatment

Dose &
Duration

10

38

48

40

Samshodhana and
Samshamana therapy

45 days

11

16

10

Lactulose powder

2 cap TD
for 45 days

TABLE NO. 2 : MEAN CHANGE IN PAIN-SCORE :

Group
Group A (n=40)
Group B (n=10)

BT

Ist FU

IInd FU

IIIrd FU

BT- AT

t test

p-value

3.26 0.62
2.38 0.52

1.77 0.62
2.13 0.83

1.15 0.52
2.63 0.52

0.92 0.64
2.63 0.52

2.24 0.928
0.250 0.707

11.41
1.00

p<0.001HS
p>0.05 NS

Group A : Samshodhana and Samshamana therapy.

Group B : Placebo.
BT : Before Treatment,
AT : After Treatment, FU : Follow up (15days of each FU) Data : Mean + SEM
TABLE NO. 3 : MEAN CHANGE IN STIFFNESS SCORE :
Group

BT

Ist FU

IInd FU

IIIrd FU

BT - AT

t test

p-value

Group A (n=40)

1.80 0.95

0.85 0.67

0.60 0.50

0.15 0.37

1.65 0.813

9.08

p<0.001

Group B (n=10)

2.25 0.715

2.25 0.715

2.38 0.74

2.50 0.53

0.250 0.707

1.00

p>0.05

TABLE NO. 4 : MEAN CHANGE IN SWELLING INDEX :

Group

BT

Ist FU

IInd FU

IIIrd FU

BT - AT

t test

p-value

Group A (n=40)

1.90 0.55

0.85 0.67

0.35 0.49

0.30 0.57

1.6000 0.681

10.51

p<0.001

Group B (n=10)

2.13 0.64

2.75 0.71

3.13 0.64

3.00 0.53

0.8750 0.835

2.97

p>0.05

TABLE NO. 5 : MEAN CHANGE IN TENDERNESS INDEX :

Group
Group A (n=40)
Group B (n=10)

BT

Ist FU

IInd FU

IIIrd FU

BT - AT

t test

p-value

2.50 0.69
2.25 0.71

1.30 .47
1.88 0.64

0.20 0.41
2.25 0.46

0.05 0.22
2.38 0.52

2.450 0.605
0.1250 0.991

18.12
0.36

p<0.001
p>0.05

Alambushadi Compound and its Vasti in Amavata (Rheumatoid Arthritis) : TIWARI & SINGH

65

TABLE NO. 6 : MEAN CHANGE IN DEFORMITY INDEX :

Group

BT

Ist FU

IInd FU

IIIrd FU

BT - AT

t test

p-value

Group A (n=40)

0.82 0.80

0.54 0.83

0.30 0.57

0.18 0.31

0.645 0.619

5.75

p<0.01

Group B(n=10)

1.13 0.64

1.25 0.46

1.25 0.46

1.25 0.46

0.125 0.354

1.00

p>0.05

TABLENO.7: MEAN CHANGE IN GENERAL FUNCTION CAPACITY INDEX :

Group

BT

Ist FU

IInd FU

IIIrd FU

BT - AT

t test

p-value

Group A (n=40)

1.52 0.75

0.68 .60

0.34 0.60

0.15 0.22

1.370 0.865

6.76

p<0.001

Group B (n=10)

1.88 0.64

2.38 0.52

2.25 0.71

2.38 0.74

0.500 1.195

1.18

p>0.05

IIIrd FU

BT -AT

t test

p-value

25.12 5.46

11.63 9.24

6.38

p<0.001

2.11

p>0.1

TABLE NO. 8 : MEAN CHANGE IN WALKING TIME INDEX :

Group

BT

Ist FU

IInd FU
28.57 7.29

Group A (n=40)

36.75 11.35

34. 11 9.24

Group B(n=10)

33.25 6.76

40.00 10.58 42.25 8.51

44.37 12.40 11.125 14.885

TABLE NO. 9 : MEAN CHANGE IN WEIGHT:

Group

BT

AT

BT - AT

t test

p-value

Group A (n=40)

52.40 6.5

49.92 6.25

2.48 1.78

5.68

p<0.01

Group B (n=10)

48.00 7.50

47.88 7.41

0.125 1.45

0.24

p>0.1

TABLE NO. 10 : MEAN CHANGE IN PRESSING POWER :

Group

BT

AT

BT ~ AT

t test

p-value

Group A (n=40)

Rt.
Lt.

56.90 21.11
47.70 15.68

77.30 15.25
61.92 13.90

20.40 15.43
14.22 6.46

5.55
9.77

p<0.001
p<0.001

Group B (n=10)

Rt.
Lt.

41.50 7.54
43.25 10.69

47.75 10.61
46.25 7.29

6.250 6.089
3.00 7.635

2.90
2.59

p>0.05
p>0.05

TABLE NO. 11 : MEAN CHANGE IN GRIP POWER :

Group

BT

AT

BT - AT

t test

p-value

Group A (n=40)

Rt.
Lt.

37.68 15.4
35.80 15.86

59.4812.9
55.10 10.22

21.80 10.92
19.30 11.35

8.66
7.77

p<0.001
p<0.01

Group B (n=10)

Rt.
Lt.

39.50 9.30
34.50 9.43

30.0 8.58
29.75 9.16

9.500 13.805
4.750 4.400

1.95
3.05

p>0.1
p>0.1

t test

p-value

TABLE NO. 12 : MEAN CHANGE IN RA TITER :

Group

BT

AT

BT - AT

Group A(n=40)

86.95 78.14

21.65 15.62

65.30 75.20

3.86

p<0.01 HS

Group B (n=10)

41.50 21.35

41.13 27.63

0.3750 20.89

0.961

p>0.05

BT

AT

BT- AT

t test

p-value

Group A (n=40)

6.75 5.64

1.78 1.29

4.97 4.78

4.58

p<0.001

Group B (n=10)

3.68 2.39

4.90 5.62

1.22 4.9

1.06

p>0.1

BT

AT

BT - AT

t test

p-value

Group A (n=40)

11.87 1.33

12.31 1.17

0.44 0.374

3.82

p<0.01

Group B (n=10)

10.65 1.40

10.68 1.40

0.025 0.498

1.08

p>0.1

AT

BT ~ AT

t test

p-value

TABLE NO. 13 : MEAN CHANGE IN CRP :

Group

TABLE NO. 14 : MEAN CHANGE IN Hb%:

Group

TABLE NO. 15 : MEAN CHANGE IN ESR :

Group

BT

Group A (n=40)

46.4010.20

29.48 7.60

16.92 10.52

7.78

p<0.00

Group B (n=10)

34.00 9.01

38.75 11.56

4.75 8.34

1.61

p>0.1

66

DISCUSSION
The trial drug was selected from Ayurvedic text
Bhavaprakasha, namely Alambushadi Churna comprising
Mundi, Amrita, Shunthi, Gokshura and Varuna.
Action of drugs :Amrita is a well known Rasayana and
Tridhoshaghana drug11,12. Considering chronic nature of
the disease, it is very useful for treating the disease and
also maintaining the health of the patients. It is also proved
to have antirheumatic, anti-inflammatory 13 and
immunostimulant14 properties. Due to chronic nature
of the disease, the patients remain in the state of
general debility (Daurbalya).Being Rasayana these
drugs improved the quality of Dhatu production and also
brought the Dushti of Dhatus (Dushyas) to a normal state.
As a consequence of this, Rasayana drugs improved
the Vyadhikshamatva in the patients.
Gokshura and Varuna, with their diuretic 15
properties, help in reducing the swelling in the joints.
Also both are having Kapha Vata Shamaka properties.
Shunthi with its Ushna Virya16 helps in digestion of Ama
and improve the Agni. Shunthi is also proved beneficial
for rheumatic and musculoskelatal disorders &
provided relief from pain and swelling. Mundi is
specially mentioned for Amavata in Bhavaprakasha.
So it is specially added to get the desired feedback.In
this combination Gokshura and Varuna are Shothaghna
and Guduchi 16 and Varuna have Vedana shamaka 17
property. So, the combination was effective to relieve
the pain and swelling, which were the chief complaints
of the patients.
Vasti 18,19: No other elimination therapy has equal
potency as of Vasti, because it expels the vitiated doshas
rapidly and easily from the body and also causes
reducing as well as nourishing the body very fastly. Vasti
can be given in all age group without any hesitation.
Vasti is especially indicated in Amavata (Rheumatoid
arthritis) in Ayurvedic text.
Statistical significance was observed in pain,
swelling, stiffness, tenderness and general function
capacity in Group A, which was statistically non significant
in Group B (progressive rise in symptoms score was seen
in the patient on placebo). On intergroup comparison
between A and B, group A revealed highly significant.
Trial therapy produced functional improvement, which
was observed in terms of walking time, grip power and
pressing power.
Even though a total mean reduction of ESR value
was seen in Group A, Hb% was found to increase in
Group A which is indicative of disease modifying effect

AYU-VOL. 30, NO. 1 (JAN.-MAR.) 2009

of trial therapy. Significant mean reductions were seen

in the titer values of rheumatoid factor and CRP titer in
Group A. Patient with recent onset of disease i.e. duration
of illness upto 5 yrs showed better improvement, when
compared to the relatively more chronic patients.
CONCLUSION
The therapy is very useful for pain, swelling,
tenderness and stiffness, which were the chief complaints
of the patients.Patient who were seronegative and of
chronicity more than 5 yrs did not showed marked
improvement.The trial drug in this study is suppose to be
very good combination of Vedanashamak, Shothaghna
and Amapachak Dravyas.The only unwanted effect of
the drug is mild weight loss in patients.
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