Amavata described by Acharya Madhav Nidan

2. references
Amavata was first described by Madhukosakara in Madhava
nidana.
Later in books like yogaratnakara, bhaishyaja ratnavali etc quoted .
Madhava nidana- 25th chapter

3. आमवातस्य निदाि
ववरुद्धाहारचेष्टस्य मन्दाग्िेनििश्चलस्य च |
स्स्िग्धं भुक्तवतो ह्यन्िं व्यायामं कु वितस्तथा ||१||
Virudha ahara- means unwholesome foods or combination of food
which affects adversely.
Poor digestion power , defective metabolism
Sedentary lifestyle and also too much exercise
Consumption of sticky food followed by exercise.

4. पूविरुप
The only text which describes the premonitory signs and
symptoms is Vangasena Samhita namely-
गात्ररुजा
शिरोरुजा

5. सम्प्रास््तिः
वायुिा रेररतो ह्यामिः श्लेष्मस्थािं रधावनत |
तेिात्यथं ववदग्धोऽसौ धमि िः रनतपद्यते ||२||
वातवपत्तकफै भूियो दूवितिः सोऽन्िजो रसिः |
स्रोतांस्यशभष्यन्दयनत िािावर्णोऽनतवपस्छिलिः ||३||
जियत्यािु दौर्िल्यं गौरवं हृदयस्य च |
व्याध िामाश्रयो ह्येि आमसञ्ज्ञोऽनतदारुर्णिः ||४||
युगपत्कु वपतावन्तस्स्त्रकसस्न्धरवेिकौ |
स्तब्धं च कु रुतो गात्रमामवातिः स उछयते ||५||

6. Due to ingestion of etiological factors it disturbs the normal function of agni as a
result food not properly digested, yields immature rasa in the amashaya and this
undergoes fermentation and /or putrefaction because of its retention for longer
duration , manifest ama.
Then it absorbed in the system and it is taken up by the aggravated and vitiated
vayu specially to the kapha sthana mainly amashaya, sandhi, uras , kantha etc.
and same undergoes in the above mentioned sites and enter the dhamini by
circulation with the help of vata.
Here it amalgamates with the existing dosas and vitiated further in excess and
produces distress in the body channels due to excess of snigdha nature and some
other qualities of amarasa.
This leads to general weakness and heaviness in the precordial region and this
amarasa is responsible for genesis of symptoms complex .

7. संरास््त घटक
Dosa- Vata – Vyana , Samana, Prana
Pitta- Pachaka
Kapha – Sleshma
Dusya - Dhatu – Rasa, Meda, Majja
Upadhatu- Sira , Snayu
Sarira Mala – Purisa
Agni – Jatharagni And Dhatvaagni
Agnidusti – Mandagni
Ama – Agnijanaya
Srotas – Annavaha, Rasavaha, Asthivaha
Srotodusti - Sanga

8. Udbhavsthana – Amashaya
Sancharsthana- Annavaha Srotas, Dhamini, Kaphasthana
Adhisthana – Kaphasthana Like Sandhi, Amshaya
Vyaktasthana- Kaphasthana i.e Sandhi, Amashaya, Uras Etc
Svabhava – Kastasadhya
Rogamaga – Madhyama

10. अङ्गमदोऽरुचचस्तृष्र्णा [१] आलस्यं गौरवं ज्वरिः |
अपाकिः [२] िूिताऽङ्गािामामवातस्य लक्षर्णम ् ||६||
 Bodyache
 Anorexia
 Thirst
 Heaviness
 Fever
 Indigestion
 numbness
आमवातस्य सामान्यलक्षर्णम्

11. स कष्टिः सविरोगार्णां यदा रकु वपतो भवेत ् |
हस्तपादशिरोगुल्फत्रत्रकजािूरुसस्न्धिु ||७||
करोनत सरुजं िोथं यत्र दोििः रपद्यते |
स देिो [१] रुज्यतेऽत्यथं व्याववद्ध इव वृस्श्चकै िः ||८||
जियेत ् सोऽस्ग्िदौर्िल्यं रसेकारुचचगौरवम् |
उत्साहहानिं वैरस्यं दाहं च र्हुमूत्रताम् ||९||
कु क्षौ कठिितां िूलं तथा निद्राववपयियम् |
तृट्िठदिभ्रममूिािश्च हृद्रहं ववड्ववर्द्धताम् |
जाड्यान्त्रकू जमािाहं कष्टांश्चान्यािुपद्रवाि ् ||१०||
रकु वपतस्यामवातस्य लक्षर्णम ्

12. Painful swelling of joints i.e hands , feet, ankle , knee, hip and spinal
column.
Nature of pain is like that of scorpion sting.
Stiffness
Hindered digestive mechanism
Excessive salivation
Anorexia
Heaviness
Lack of enthusiasm
Distaste in the mouth
Burning sensation
excessive urination
Hardness and pain in the abdomen
Disturbed sleep

13. Vertigo
Fainting
Stiffness in precordium
Constipation
Stiffness
Intestinal sounds
Distention of abdomen
Severe difficulties with complication

14. आमवातस्य वविेिलक्षर्णानि
वपत्तात ् सदाहरागं च, सिूलं पविािुगम् |
स्स्तशमतं गुरुकण्ूं च कफदुष्टं तमाठदिेत ् ||११||
Totally 7 types of amavata mentiomed according to dominancy of dasa in
Madhava nidana and yogaratnakara.
1. Vataja amavata – characterised by pain in the affected areas
2. Pittaja amavata – characterised by burning sensation and redness in the
affected area
3. Slaismika amavata – characterised by rigid, heaviness, itching of the
affected area.
4. Vata- pittaja amavata- combination
5. Pitta kapahaja amavata-combination
6. Vataja –kapahaja amavata – combination
7. Sannipataja amavata

15. आमवातस्य साध्यासाध्यववचारिः
एकदोिािुगिः साध्यो, द्ववदोिो या्य उछयते |
सविदेहचरिः िोथिः स कृ छरिः सास्न्िपानतकिः ||१२||
 Single Dosha – Sadhya
 Two Dosha Involvement- Yapya
 Tridosha with sotha in full bodyS - Krucha Sadhya

16. Differential diagnosis
VATARAKTA KROSTUKA SIRSA AMAVATA SANDHIGATAVATA
SANDHISHULA PRESENT PRESENT(MAHARUJ
A)
PRESENT PRESENT
SANDHISOTHA PRESENT PRESENT PRESENT PRESENT
ARAMBHA SANDHI PARVA SANDHI KEVALA JANU
SANDHI
BRUHATA SANDHI BRUHATA SANDHI
JVARAAS ARAMBH
LAKSHANA
MAY BE ⁄ MAY BE
NOT
PRESENT PRESENT NOT PRESENT
SPARSH-
ASAHTVAM
PRESENT PRESENT TIVRA MAY BE/ MAY BE
NOT
USHNA SPARSHA PRESENT PRESENT PRESENT PRESENT /MAY NOT
BE PRESENT
ITAR LAKSHANA SANDHI PRADESH
PIDIKO-UTAPATTI ,
SPREAD LIKE
AKHU VISHA
KNEE JOINT LOOK
LIKE JACKAL’S
HEAD
PAIN LIKE
SCORPION BITE
VATA PURNA
DHRUTI SPARSHA-
PRASARAN ,
AKUNCHAN SA-
VEDANA

17. Ra –
rheumatoid arthritis

18. definition
Rheumatoid arthritis is an autoimmune disorder (body immune system
starting attacking own healthy cells) in which Immune system identifies
the synovial membrane as "foreign" and begins attacking it.
Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that may
affect many tissues and organs, but mainly attacks the joints producing an
inflammatory synovitis.
NOTE- Synovial membrane is also known as –synovial stratum, synovium

19. Overview of ra
The cause of rheumatoid arthritis is not known.
In rheumatoid arthritis, multiple joints are usually , but not always,
affected in a symmetrical pattern.
Rheumatoid arthritis can affect people of all ages.
The "rheumatoid factor" is an antibody that can be found in the
blood of 80% of people with rheumatoid arthritis.

20. Hallmark feature of ra
Is persistentsymmetricpolyarthritis (synovitis) that affect the hands and feet.

21. Risk factors
Idiopathic
Sex – women>men
Positive family history
Smoking
Bacterial and Fungal Infection
Herpes simplex virus infections
Epstein-Barr virus (EBV)
 Vitamin D deficiency

22. Incidence rate
 Females > males 3:1
People of any age can be affected
Peak age 45-65 yrs but onset early from age 20-45 yrs
About 75% of these are women.
The disease strikes women three times more often than men

25. Clinical features
Tender, warm, swollen joints
Morning stiffness that may last for hours
Firm bumps of tissue under the skin on your arms (rheumatoid
nodules)
Fatigue
Fever
Weight loss

26. RA can affect many non joint structures, including –
Skin
Eyes
Lungs
Heart
Kidney
Blood vessels

27. complications
Osteoporosis
Rheumatoid nodules
Dry eyes and mouth
Infections
Carpel tunnel syndrome
Lymphoma

28. Swan neck deformity- is deformed position of the finger , in which the
joint closet to the fingertips is permanently bent toward the palm while
the nearest joint to the palm is bent away from it.
Cock up toe deformity – extension of the toes
 Rheumatoid Nodules – are firm lumps that develop under the skin,
unique symptom to rheumatoid arthritis and usually occur near joints
affected by condition.
Z deformity of thumb – hyperextension of the interphalangeal joint
Button hole deformity- (boutonniere deformity)

33. Diagnosis
Hematologic tests
Erythrocyte sedimentation rate
C-reactive protein
Antinuclear antibodies
Rheumatoid Factor
 X-rays
MRI scanning

35. Differential diagnosis
Osteoarthritis
Fibromyalgia
Reactive arthritis
Psoriatic arthritis
Infectious arthritis

38. QUESTIONBANK
10 MARKS
1. AMAVATA IN DETAIL WITH NIDANA PANCHAKA .
2. EXPLAIN AMAVATA WITH MODERN CORELATION.
5 MARKS –
1. AMAVATA SAMPRAPTI
2. AMAVATA NIDANA
3. RA