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S. K. TIWARI *
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
Alambushadi Compound and its Vasti in Amavata (Rheumatoid Arthritis) : TIWARI & SINGH
63
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
No tenderness
Mild tenderness
Moderate tenderness
Severe tenderness
64
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
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
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
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
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
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
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
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
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
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
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
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
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
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