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Amavata : Case Study
- 1. DR. SRINIDHI.S 1ST YEAR PG SCHOLAR CASE REPORT-LOCOMOTOR SYSTEM AMAVATA GUIDE: DR.AMRITHA RAJAN ASSISTANT PROFESSOR DEPARTMENT OF PANCHAKARMA SRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF AYURVEDA AND HOSPITAL,HASSAN
- 2. ABSTRACT:- PATIENT HAD PAIN IN ALL MINOR AND MAJOR JOINTS OF THE BODY SINCE 2 YEARS ALONG WITH STIFFNESS AND SWELLING IN ALL JOINTS SINCE 1 YEAR. DVIPANCHAMOOLADI KSHARA BASTI WAS ADMINISTERED AS KALA BASTI SCHEDULE ALONG WITH SHAMANOUSHADHI. THERE WAS SIGNIFICANT REDUCTION IN PAIN AND STIFFNESS OF JOINTS.THUS AMA NIRHARANA , VIRECHANA , BASTI HELPS IN RELIEVING THE SYMPTOMS OF AMAVATA.
- 3. KEY WORDS:- CASE REPORT, AMAVATA, BASTI, RHEUMATOID ARTHRITIS
- 4. BIODATA NAME : Meghashree AGE : 24YRS SEX : FEMALE RELIGION : HINDU MARITAL STA : MARRIED OCCUPATION : HOUSE WIFE ADDRESS : BANGALORE D.O.A :02-08-17 D.O.D :02-09-17 OP NO :17513 IP NO :3476
- 5. CHIEF COMPLAINTS STIFFNESS IN THE JOINTS SWELLING IN ALL JOINTS SINCE 2 years PAIN IN ALL MINOR AND MAJOR JOINTS OF THE BODY- SINCE since 4 years
- 6. ASSOCIATED COMPLAINTS •REDUCED APPETITE •EXCESSIVE SALIVATION •LOSS OF TASTE •HEAVYNESS •NO INTEREST IN ROUTINE WORK
- 7. H/O PRESENT ILLNESS •As per the patient words she was normal 2year back. •One day she developed pain in inter-phalangeal joints bilaterally. •After a week she noticed stiffness in the fingers. •Later pain started in the elbow joints. •Gradually pain started in wrist, shoulder, knee and ankle bilaterally. •Severity of the pain started increasing and sometimes associating with swelling. •Later Stiffness in the body during morning hours started.
- 8. H/O PAST ILLNESS FAMILY HISTORY No relevant past history H/O RA in Maternal aunt
- 9. PERSONAL HISTORY Appetite : decreased, irregular food habit Bowel : 1 time/day, Hard stools Micturition : 4-5 times/day Sleep : disturbed Addiction: -
- 10. GENERAL EXAMINATION Built Moderate Pallor Present Icterus Absent Cyanosis & Clubbing Absent Lymphadenopathy Absent Tongue coating ++ Pulse rate 84/min BP 130/90 mm Hg
- 11. HIGHER MENTAL ACTIVITIES Consciousness Well conscious Orientation Good Memory Good Speech Normal
- 12. ASHTA STHANA PAREEKSHA JIHWA UPALEPATWAM NAADI KAPHA-VATA MALA AMAYUKTA MOOTRA PRAKRUTA SHABDHA PRAKRUTA SPARSHA RUKSHA DRUK PRAKRUTA AAKRUTI MADYAMA
- 13. DASHAVIDHA PAREEKSHA 1) PRAKRUTI - VATA-PITTA 2) VIKRUTI - HETU - AHARA -VATAKAPHA KARA VIHARA - AVYAYAMA MANASIKA - CHINTA DOSHA - VATA-KAPHA DUSHYA - RASA, ASTHI, SNAYU DESHA - SADHARANA BALA - MADHAYAMA
- 14. CONTD……. 3) SARA - MADYAMA 4) SAMHANANA - MADYAMA 5) PRAMANA - 58 kgs 6) SATVA - MADYAMA 7) SAATMYA - Excessive cheese, Fried, Bakery items 8) AHARA SHAKTI -Normal KOSHTA - KRURA 9) VYAYAMA SHAKTI - AVARA 10) VAYA - MADYAMA
- 15. SYSTEMIC EXAMINATION Respiratory system – NVBS + Cardiovascular system- NAD Musculo skeletal system – On inspection – difficulty in extension of fingers difficulty in lifting arms swelling in interphalangeal joints On palpation – rise in temp in joints tenderness in joints
- 16. NIDANA PANCHAKA • NIDANA - Akala ajeerna bhojana, diwaswapna, chinta • POORVARUPA- ajeerna, aruchi, shrama • RUPA - sarva sandhishula • UPASHAYA - ushnajala snana • SAMPRAPTI - Nidana jataragnimandya kaphavata prakopa sthanasamshraya in sandhi lakshana
- 17. SAMPRAPTI GHATAKA a) DOSHA - Vata – vyana, samana Pitta – pachaka kapha – shleshaka b) DUSHYA Dhatu - rasa, meda Upadhatu - sira, snayu Mala - shareera- pureesha c) SROTAS - all srotas d) AMA - jataragni & dhatvagni e) UDBAVASTHANA - amapakvashaya g) SANCHARA STHANA - sarva shareera h) VYAKTA STHANA - sarva sandhi (sleshmasthana)
- 18. CONTD……. i) ROGA MARGA – madhyama j) ROGA ADISHTANA – sarva sandhi k) VYADHI PRAKARA – chira kaleena l) SAPEKSHA NIDANA – amavata, sandhigata vata
- 19. LABORATORY INVESTIGATION HAEMATOLOGY Hb 10.4gm% T.WBC 10,400 cells/cu mm ESR 60 mm/hr DIFFERENTIAL COUNT Neutrophils 76(40-70%) Lymphocytes 21(20-40%) Monocytes 01(2-6%) Eosinophil 02(1-4%) Platelet 5.22 lakhs RBC 3.86 mil/mm3 BIO CHEMISTRY FBS RA 97.9 mg/dl 632 IU
- 20. SANDHIGATAVATA
- 21. AMAVATA
- 23. TREATMENT Langhana:- laghu bhojana (mudga yusha). Sweda:- valuka sweda Deepana Pachana:- Panchakola Phanta 50 ml tid for 4 days Snehapana with:- Indukanta gritha Virechana:- with 60 ml of Gandharvahastadi Eranda taila Discharged with Samsajana krama. Admission after 1 week Planned for Kshara basti
- 24. DWIPANCHAMOOLADI KSHARA BASTI Anuvasana Basti:- Brihat saindavadi taila- 80 ml Niruha basti:- Honey:-120 ml S.lavana:- 5 g B.S.Taila:- 80 ml Dwipanchamooladi kalka:- 50 g Dwipanchamooladi kwatha:- 300 ml Gomutra:- 50 ml 1st 2nd 3rd 4th 5th 6th 7th 8th 9th A N N N N N N A A A A A A A A A
- 25. RESULTS Parameters BT AT Swelling:- +++ Nil Pain:- +++ + (Slight pain on motion) Stiffness:- +++ Normal Tenderness ++ Absent Lab Investigation BT AT ESR 60 12 RA 612 126
- 26. NIDANA
- 27. SAMPRAPTI Nidana Ama Kapha – Pitta – Vata – Ama Saama dosha dhamani pratipadhyate Vaayuna prerito ama shleshma sthaanam pradhaavati Srotaamsya abhishyandati - picchilatvat Amavata
- 28. Atura bala – madhyama Roga bala – pravara Upadrava – none Sadhyasadhyata – kruchra sadhya
- 30. प्रवृद्ध आमवात लक्षण • उत्साह हानि • भ्रम • मूर्ाा • निद्राववपयााय etc • संधध रूजा • संधध शोथ • संधध स्तब्धत • वृष्चिक दंस्रवत्वेदिा etc • ज्वर • गौरव • दाह • शूल • अरुधि • प्रसेक • अष्निमांध्य • र्र्दा , तृचणा etc कोचटाधित सावा दैर्हक मािससकस्थानिक
- 31. र्ोषभेर्ेि लक्षण (मा.नि.आमवाताधिकार) • दाह • रागंपपत्त • शूलं पविा • ष्स्तसमतं • गौरव , कण्डूकफ
- 32. JOINTS WHICH ARE AFFECTED मन्य पृष्ठ कटी जािु त्रिक Lakshana कु ञ्िि सशब्र् स्रस्तगािl
- 34. सामान्य धिककत्सा ससदिांत लंघिं स्वेर्िं नतक्त र्ीपिानि कटुनि पवरेििंस्िेहपािंबस्स्तकमद
- 35. IMPORTANT AVASTHAS OF AMAVATA Sama and Nirama Naveena and Pravrudhh a Uttaana and Gambheer a
- 38. VIRECHANA पक्वाशयगते िापप र्ेयं स्िेहपवरेििम ्। बस्तय: शोििीयाश्ि प्राशाश्ि लवणोत्तरा:॥ (सु.धि.४/५)
- 39. AS PER BHAVAPRAKASHA आमवत गजेन्रस्य शरीरे वििाररणण। एक एव निहन्त्याशु एरण्ड गजके सरर॥
- 40. …….बस्तयश्िाममारुते प्रव्रुदिो मारुतस्य पक्विािं प्रिावनत। शीनतकरोनत कायस्नि बलं िास्यापकषदयनत॥ स्िोतस्तु शुदिाशुदिेषु यदर् बस्स्त प्रर्ीयनत। स गंभीरोगत: काये सवंशो ि निवदतदते॥ (भे.सस.५/४-५)
- 41. A/C MODERN DIFFERENTIAL DIAGNOSIS– Osteo Arthritis Rheumatoid Arthritis
- 42. OSTEO ARTHRITIS Restricted movement (capsular thickening, blocking by osteophyte) Palpable, sometimes audible, coarse crepitus (rough articular surfaces) Bony swelling (osteophyte) around joint margins Deformity, usually without instability Joint-line or periarticular tenderness Muscle weakness, wasting No or only mild synovitis (effusion, increased warmth)
- 43. RHEUMATOID ARTHRITIS Diagnostic Criterias of Rheumatoid Arthritis : • Morning stiffness (>1hr) • Arthritis of 3 or more joints • Symmetrical arthritis • Rheumatoid nodule • Rheumatoid factor • Duration of 6 weeks or more
- 45. TRIGGER FINGER
- 51. THANK YOU
Notas del editor
- Now let us see what are the samanya lakshana’s of Amavata. The disease amavata is characterised by angamar…
- No sloka. Explain the sloka.. The disease amavata is corelated with ra. Now let us have a look on few facts about RA.
- It is very important tat the disease am लंघनं स्वेदनं तिक्त दीपनानि कटुनि च । विरेचनं स्नेहपानं बस्तयः च आममारुते ॥ रुक्षस्वेदो विधातव्यो वालुका पोटलैः तथा । उपनाहश्च कर्तव्याः तेऽपि स्नेह विवर्जिताः ॥(यो.र) रुक्षस्वेदो विधातव्यो वालुका पोटलैः तथा । उपनाहश्च कर्तव्याः तेऽपि स्नेह विवर्जिताः ॥(यो.र) लंघनं स्वेदनं तिक्त दिपनानि कटुनि च । विरेचनं स्नेहपानं बस्तयश्चाममारुते ॥ सैन्धवाध्येनानुवास्य क्षारबस्ति प्रशस्यते । (च.द) avata should be handled very tactfully. The avasthanusari management of amavata is important…
- Where I am mainly dealing with the treatment aspects of Sama and Nirama avastha’s of Amavata which are very important avasthas.
- Sushrutha in vatavyadhi chikitsa adhyaya have clearly stated that (tell sloka here) that is when the prakupita vata is present in pakvashaya then one should so for snehavirechana and then shodhana basti’s. while commenting on same sloka dalhana says that “ पक्वाशय: पुनरिह द्विविध: - पित्तवाताशयभेदेन, तयोर्मध्ये पित्ताशयगते वोयौ स्नेहविरेचनं तिल्वकसिद्धम् एरण्डतैलादिभिर्वा, वातशयगतस्य तु वायो: मलकफैरावृतस्य यथादोषं कषायकल्कस्नेहबस्तय:।
- Very much importance have been given to eranda sneha in the treatment of amavata. Vangasena had said that eranda taila is like a gajakerasi in controling the amavata gajendra..hence many of the yoga’s have been mentioned with eranda taila in the management of amavata. The use of eranda taila in amavata suggests that in this disease snigdha and not ruksha virechana should be employed, since it does not produce generalised snehana effect but by its snigdha, ushna etc. characteristics, it augments the agni in addition to its vata anulomana action.
- Last in treatment of amavata basti is mentioned if the dosha’s are gambeeragata and the disease is pravruddha (chronic), after shodhana karma, physisian should plan for basti karma. This is because if dosha’s are gambheeragata, then there is a chance that the pravruddha vaata will enter pakvashaya and may cause agnimandya and apakarshana of bala. Hence it is important that basti should be planned in gambheeragata doshas or in pravruddha avastha of disease after shodhana because kaayashodhana will not be able to remove entire dosha’s from body.. The same thing had been clearly mentioned by Bhela in siddhi stana with the verse which goes like this (sloka here)