Rheumatoid Arthritis affects thousands of people each year throughout the world. Rheumatoid Arthritis is an autoimmune disorder with the manifestation of chronic inflammation in the joints. The joints affected by this disease are the peripheral joints, synovial joints, and synovial cavities. There is a constant feeling of warmth, swelling, redness, and pain in the affected joints as a result of the inflammation. The progressive stages of the disease can lead to the destruction of cartilage and bone of the peripheral and synovial joints. This autoimmune destruction leads fingers and the toes becoming crooked.1
The prevalence rate of Rheumatoid Arthritis all over the globe is estimated to be between 0.3% to 1%. When it comes to India, the prevalence rate is 0.75%. In developed countries, the major Rheumatoid Arthritis majorly affects the women population.2 The common allopathic therapies given for pain relief and maintenance dose includes analgesics like tramadol, paracetamol; non-steroidal anti-inflammatory drugs like ibuprofen, celecoxib, diclofenac; and Disease-modifying antirheumatic drugs (DMARD) like sulphasalazine, methotrexate, chloroquine, hydroxychloroquine, and folic acid supplements.
Rheumatoid Arthritis and Ayurveda
Ayurveda or Ayurvedic treatment has its roots in India since the Vedic age. The diseases in Ayurveda have been denoted by different names and the common colloquial term used to define Rheumatoid Arthritis is Amavata. The condition of patients with Amavata as described in Ayurveda is dreadful, painful, and swollen polyarticular affection which is likely to be similar to the condition of Rheumatoid Arthritis. Ayurvedic theory states that the ama produced in the gut due to weakened digestion or digestive disorder is the major reason for joint and soft tissue pain and inflammation. The Ayurvedic treatment targets joints, guts, and immune system as it is believed that there is an essential immune-mediated link between inflammation of rheumatoid arthritis and gut disorders.3
Panchakarma Treatment for Rheumatoid Arthritis
When it comes to Ayurvedic treatment of patients suffering from Rheumatoid Arthritis, there are various therapies used. But seeking help from the therapy that provides relief and improves their quality of life is known as Panchakarma Therapy. Panchakarma is a term used to refer to the five pillars of Ayurvedic therapy collectively. The Panchakarma treatment is one of the most important modalities with high receptivity and effectiveness.4 The five processes of Panchakarma treatment that cures the imbalance are as follows:
- Emetics or Vamana
- Purgatives or Virechana
- A medicated oily enema or Anuvasana Basti
- A medicated decoction or dry enema which is also known as Asthapana Basti or Niruhana
- Oleation or nasal purgation which is also called Shirovirechana or Nasya3
The Panchkarma therapy works as a purification therapy aiming to detoxify the enzymes and reactions of the body. It is believed that this detoxification or purification process keeps in check the auto-immune reaction and thus regulates control over Rheumatoid Arthritis.
Virechana Therapy of Panchakarma is the primary treatment modality for the management of Vata involved in Rheumatoid Arthritis. The major role that Virechana plays is to purify the body by cleaning the Dhatu. The medicinal or oil purgatives used for Virechana are mildly rough or have a greasy and soapy feel. The potency of the drugs used in Virechana Therapy helps them to reach the heart and thereby circulates throughout the body. The potency of the drug is a result of their Ushna (heat), Tikshna (sharp and sensitive), and Sukshma Guna (delicate).
The mechanism of this therapy lies in liquefaction of morbid doshas especially Vata in the case of Rheumatoid Arthritis. The liquefied doshas are then brought up to the Amashaya (stomach). Once the doshas are accumulated in the Amashaya (stomach), they are then expelled through the anal canal. The final expulsion of Vata dosha is the Virechana Therapy for Rheumatoid Arthritis. Once the Vata dosha is eliminated from the body it has a direct positive effect on the Agnisthana thereby increasing the Agni. This helps to regulate the digestive function properly. The Srotrodha present in patients of Rheumatoid Arthritis is a clear fluid due to Srotovi shyandana property of the drugs used for Virechana Therapy. Virechana Therapy also helps to normalize the balance and functioning of Vata which has been hampered due to Rheumatoid Arthritis. Thus the Pratiloma Gati of Vata (reversal of disorder) with the help of drugs used in Virechana Therapy breaks the Samaprati (the general symptoms) of the disease relieving pain, swelling, and inflammation.
Basti or Vati
The acharyas of the Ayurvedic Treatment in India have recognized Basti or Vati as a complete therapy for the treatment of Vata dosha which includes Rheumatoid Arthritis. The wide spectrum of therapeutic action exhibited by Basti or Vati therapy makes it a superior treatment option among other Panchakarma Therapy. As compared to Virechana Therapy, Basti or Vasti is a highly complex, sophisticated, and systemic therapy rather than just enema. It is believed that the Vata dosha of Rheumatoid Arthritis has pathophysiology of vitiated Vata. As mentioned in the classical texts of Panchakarma Therapy, the external Vata (Uttana Vatakrata) can be treated with the help of Lepa, Abhyanga, Parisheka, and Upanaha.
Lepa: Lepa is the treatment therapy where the drug is made in the form of a paste and is applied externally to the affected area. The drug from the paste gets absorbed through the skin and enters the underlying channels reaching the inflamed or swollen regions affected by Rheumatoid arthritis. It relieves pain and swelling
Abhyanga: Abhyanga is an oil treatment therapy used for treating Vatakrata. It includes massage of the body and the severely affected area with medicinal oils. The massage improves blood circulation throughout the body and helps to remove toxins or toxic substances from the body. The improved circulation aids in the drainage of venous blood from different organs as well as the flow of lymphatic tissues. The drainage of waste from blood and lymph boosts the natural immune system and also increases the production of white blood cells The condition of Rheumatoid arthritis is alleviated as the oil massage creates an equilibrium in the nervous system. Abhyanga is one of the oldest methods of Panchakarma therapy practiced to date to provide relief from muscular fatigue and pain. The oil massage benefits the skin and joints in Rheumatoid arthritis patients by improving the flexibility, softness, and firmness of their extremities
Parisheka: This method also includes the use of medicinal oils but instead of massaging it on the body or affected area, the oil is poured over the body. The oil is warmed to a tolerable temperature and then form a specific height, it is poured over the body for a specific period of time. The Vatahara or anti-rheumatoid action of this therapy helps patients to get rid of tiredness and tissue instability
Upanaha: Upanaha method of Panchakarma therapy involves the use of medicinal paste. The Vata mitigating drugs are converted into a paste and are then warmed before application. The paste is prepared by macerating the drug in a sour liquid with salts and fats. The composition is oily and greasy in nature which is then applied or tied on the affected area like a poultice
Rasayana or Pippali Vardhaman Rasayana: This therapy is a dietary supplement that requires including 3gm to 18 hm of QS cow milk and 5 to 15 gm of Chyawanprash. This amount is to be increased accordingly and it is taken with hot milk or water for a period of 1-3 months 5
Kshara Basti is a specific purification therapy of Panchakarma which is known to be highly beneficial in Amavata or Rheumatoid arthritis. The main components of Kshara Basti are Saindhava, Guda, Chincha, Shatava, and Gomutra. The component that forms the major part is the Gomutra. It is present in a maximum quantity having Kshara Guna. Kshara has the property of Lekhana and Vishoshana by the virtue of which it shows antagonistic action to Ama. This property makes it a good choice to treat people with Amavata or Rheumatoid arthritis. In some cases, there are chances that Kshara Basti may likely cause aggravation of Vata condition. In such instances, the condition of patients are combated using Vatashamaka drug Guggulu or Vatari Guggulu.6
Dietary Requirements and Restrictions During Panchakarma Therapy for Rheumatoid arthritis
Panchakarma therapy is performed in stages. For proper recovery, during various stages of the therapy, it is important to keep in mind some dietary restrictions and requirements. In the initial stages of the therapy, some patients are subjected to fasting known as Langhana. This acute stage is done to facilitate the working of their digestive and metabolic systems. A good digestive system helps to digest and eliminate the accumulated Ama. Then patients are advised to take special foods that can be digested easily. If there is excess Vata or dosha present in the body, leeches and venesection are applied to remove them.
Advantage of Yoga During Panchakarma Therapy for Rheumatoid arthritis
Yoga has been practiced in India since the dawn of civilization and Vedic ages. It has been claimed as one of the best methods to achieve mental and physical fitness. Yoga asanas and Ayurveda are known to share some basic fundamental aspects when it comes to anatomy, physiology, pathogenesis, and treatment of various diseases. The same theory applies to the patient of Rheumatoid arthritis. The traditional practitioner or acharyas of Ayurvedic medicine in India has advocated that Yoga plays a major role in treating chronic ailments like Rheumatoid arthritis when combined with Panchakarma therapy. Apart from yoga, general exercises are also beneficial which increases the mobility of the peripheral limbs. It keeps the extremities flexible and light and thus subduing the symptoms like swelling and pain.3
The Panchakarma Therapy In Pregnant Women With Rheumatoid Arthritis
Panchakarma therapy has been found very useful in women patients who suffer postpartum Rheumatoid arthritis. Postpartum Rheumatoid arthritis becomes a great hindrance when it comes to the daily care and upbringing of the child. A case study showed evidence that on the diagnosis of Amavata after pregnancy, Panchakarma therapy was used to treat a patient according to the Amavata principles. The therapy included administration of oral ayurvedic medicine for four months along with the application of Kala Basti, Lepa, abhyanga, and virechana for a course of 10 days. Within the span of two months, there was a remarkable improvement noticed in the pain, swelling, and morning stiffness of the patient.2
Drugs Used In Panchakarma Therapy For Rheumatoid Arthritis
The drugs used for Panchakarma therapy for Rheumatoid arthritis patients involves a number of natural herbs obtained from plants and animals. Some of them are as follows:
- Erand oil or castor oil. It is known for its Vata Shamaka property which is useful for the treatment of Rheumatoid arthritis. The presence of Ricin in castor oil is responsible for the purgatory effect
- Ginger or Shunthi
- Guggulu or Commiphora wightii
- Guduchi or Tinospora cordifolia
- Yashtimadhu or Glycyrrhiza glabra
- Shallaki or Boswellia serrata
- Pippali or Piper longum
Panchakarma therapy for Rheumatoid arthritis is a justified Ayurvedic treatment that has been used for ages to relieve patients of Amavata. The improvement in the condition of the patients are due to the pacification of Ama with the help of Virechana, dissolution of toxic products with the help of Kshara Basti, and pacification of aggravated condition by using Vatari Guggulu.
Drugs like Triphala used in Panchakarma therapy helps to increase antioxidants in the body which in turn combats the inflammation caused as a result of auto-immune pathophysiology of Rheumatoid arthritis. The primary therapies like Kshara Basti and Virechana play a major role in accumulating and removing toxic waste products from the body. Apart from these two treatment modalities other therapies of Panchakarma holds significant importance in various stages to provide relief from swelling, pain, and inflammation. Yogasana, exercises, and dietary restriction and requirements also help to show better results of Panchakarma therapy. The Ayurvedic treatment is an alternative and better option of treatment for Rheumatoid patients as there is no permanent cure for Rheumatoid arthritis in allopathic treatment. On the other hand, Panchakarma therapy has been known to provide long term and stable effects on patients with Rheumatoid arthritis.
- Ramteke, R. (2016). Management of Rheumatoid Arthritis through Ayurveda. J Tradi Med Clin Natur, 5(189), 2.
- Deshpande, S. V., Deshpande, V. S., & Potdar, S. S. (2017). Effect of panchakarma and Ayurvedic treatment in postpartum rheumatoid arthritis (Amavata): A case study. Journal of Ayurveda and integrative medicine, 8(1), 42-44.
- Chopra, A., Saluja, M., & Tillu, G. (2010). Ayurveda–modern medicine interface: A critical appraisal of studies of Ayurvedic medicines to treat osteoarthritis and rheumatoid arthritis. Journal of Ayurveda and integrative medicine, 1(3), 190.
- Vinjamury, S. P., Vinjamury, M., Sucharitakul, S., & Ziegler, I. (2012). Panchakarma: ayurvedic detoxification and allied therapies—is there any evidence?. In Evidence-based practice in complementary and alternative medicine (pp. 113-137). Springer, Berlin, Heidelberg.
- Tuhin, K. B. A Comparative Clinical Study on Vatariguggulu and Panchakarma Therapy with Special Reference to Kshara Basti and Virechana Karma in the Management of Amavata (Rheumatoid Arthritis).
- Dubey, S., Tripathi, J. S., Gupta, S., & Reddy, K. R. C. (2010). A comparative clinical trial on the role of Panchakarma therapy and Unmada Gajankusha Rasa in the cases of major depressive disorder vis-à-vis kaphaja Unmada. Ayu, 31(2), 205.
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