Amavata: Causes, Pathology, Treatment, Panchakarma, Medicines

Article by Dr Raghuram YS BAMS, MD (Ay)
Amavata is a painful condition which has been explained in Ayurvedic texts. The disease initially manifests as a gut disorder with symptoms of indigestion and anorexia. Later the disease is seen to encroach all the tissues, mainly bones, muscles and joints and multiple organs to cause a symptom complex. This condition is often compared to Rheumatoid arthritis of modern day. Some authors have also compared it to stages of gouty arthritis. 

The disease is formed due to vicious amalgamation of morbid Vata and ama.

Ama – is the immature nutritional essence formed in the stomach due to sluggish digestion (agnimandhya and ajeerna). This essence goes into circulation in immature and unprocessed form. It is made available to all the tissues and organs of the body. Since it is immature, the tissues can take it but cannot metabolize it due to lack of identification. They are therefore stored in the cells and are neither digested nor flushed out. Owing to their sticky nature ama blocks and clogs all the channels of nutrition in the body. This depletes the nutrition and essential materials to the tissues and organs. As a result there is multiple tissue damage and wide array of diseases are manifested.

Causes:

  • Viruddha ahara – mutually incompatible foods
  • Viruddha chesta – unwholesome lifestyle practices
  • Mandagni – having low metabolism and sluggish digestion for a longer period
  • Nischala – sedentary life activities
  • Snigdha bhojana, vyayama – consuming unctuous, oily and high caloric food and immediately getting indulged in exercises

How is amavata formed?
Due to the above said causes plenty of ama is formed in the body. The vata also gets vitiated and pushes the ama into different parts of the body through circulation. Mainly Vayu pushes the ama into the shleshma sthana (sites of kapha), mainly the bony joints and muscles. The ama on further vitiation by vata and kapha enters the circulation and later gets associated with morbid pitta. This gives the combination a corrosive nature and they tend to destroy any tissue or organ with which they come into contact. The vitiated ama and vata get lodged in various joints, mainly in the low back, pelvis and hips and causes stiffness of the body along with severe pain.

Symptoms –
Initially the symptoms appear like those of indigestion. In this condition, the disease process has just begun and the morbidity has not reached the joints. These symptoms are:

  • Angamarda – pain in body parts, general body ache
  • Aruchi – anorexia, tastelessness
  • Trishna – thirst
  • Alasya – lethargy, weakness
  • Gaurava – heaviness of the body
  • Jwara – fever
  • Apaka – indigestion
  • Shunata – swelling of body parts

In the later stages when the disease spreads to the joints, tissues and organs the symptoms of multiple tissue and organ damage occur. They are:

  • Saruja shopha – painful swelling in the joints of hasta (hand), pada (foot), shira (head and neck), gulpha (ankle), trika (sacrum and coccygeal), janu (knee), uru (thigh, i.e. hip)
  • Vrishika damshavat peeda – pain mimicking that of a scorpion sting
  • Agni dourbalya – sluggish digestion
  • Praseka – excessive salivation, nausea
  • Aruchi – tastelessness, anorexia
  • Gouravam – heaviness of the body
  • Utsaha hani – lack of enthusiasm
  • Vairasyam – feeling of perverted and abnormal tastes in the mouth
  • Daaha – burning sensation
  • Bahumutrata – excessive urination
  • Grahani dosha – contamination of intestines
  • Apakwa mala – stools comprise of indigested food
  • Kukshi kathinata – hardness of abdomen
  • Shulam – colic
  • Nidra viparyaya – sleep disturbances
  • Trishna – thirst
  • Chardi – vomiting
  • Bhrama – giddiness
  • Murcha – fainting
  • Hrid graham – feeling of tightness of chest
  • Antra kujana – gurgling sounds in the abdomen
  • Anaha – flatulence

Basic principles of treatment of Amavata

  • Langhana – fasting
  • Swedana – fomentation, sweating treatment, steaming, sudation
  • Tikta, katu deepana – digestion promoting medicines having bitter and pungent tastes
  • Virechana – purgation
  • Vasti – enemas

External treatments –

  • Abyanga – massage
  • Swedana – steaming treatments
  • Pinda sweda – bolus fomentation especially churna pinda sweda (medicated powder bolus), Patra pinda sweda (leaf bolus) and Valuka sweda (sand bolus)
  • Dhara – stream pouring of medicated liquids, mainly dhanyamla dhara (fermented herbal liquids)
  • Upanaha – poultices

Classic formulations from the treatises:

Shuntyadi Kwatha – decoction of shunti (ginger) and gokshura (Tribulus terrestris)

Shatyadi kwatha – decoction of shati (Hedychium spicatium), shunti (ginger), haritaki (Terminalia chebula), vacha (Acorus calamus), devadaru (Cedrus deodara), Ativisha (Aconitum heterophyllum), Guduchi (Tinospora cordifolia)

Pippalyadi Kwatha – decoction of Pippali (long pepper), pippalimula (root of long pepper), chavya (Piper retrofractum), chitraka (Plumbago zeylanica) and Shunti (ginger)

Dashamula Kashayam – decoction of 10 roots mixed with eranda taila (castor oil)

Shunti-guduchi kwatha – decoction of shunti (ginger) and guduchi (Tinospora cordifolia)

Shunti-guda – Powder of shunti (ginger) taken with powder of guda (jaggery)

Bhallatakadi churna – powder of bhallataka (Semecarpus anacardium), tila (sesame) and haritaki (Terminalia chebula) with guda (jaggery)

Panchasama churna – powder of shunti (ginger), haritaki (Terminalia chebula), Pippali (long pepper), trivrit (Operculina turpethum) and Saindhava lavana (rock salt)

Phalatrikadi churna – powder of amalaki (Emblica officinalis), Haritaki (Terminalia chebula), bibhitaki (Terminalia bellirica) and shunti (ginger)

Hingwadi churna – powder of hingu (asafoetida), chavya (Piper retrofractum), vida lavana (bida salt), shunti (ginger), pippali (long pepper), jeeraka (cumin) and pushkara mula (Inula racemosa)

Nagara churna – powder of nagara or ginger taken with kanji (fermented herbal drink)

Panchakola churna – powder of Pippali (long pepper), pippalimula (root of long pepper), chavya (Piper retrofractum), chitraka (Plumbago zeylanica) and Shunti (ginger) taken with hot water

Eranda Beeja – the payasa (sweetened milk recipe) prepared from purified eranda beeja (seeds of castor plant)

Erandabeejadi yoga – the pulp of seeds of eranda beeja (castor seeds) mixed with shunti churna (powder of dry ginger) and sharkara (sugar) mixed together should be taken early in the morning.

External applications:
Shatapushpadi lepa
– paste of shatapushpa (dill seeds), vacha (Acorus calamus), shunti (ginger), gokshura (Tribulus terrestris), varuna (Crataeva nurvula), devadaru (Cedrus deodara), punarnava (Boerhavia diffusa), kachura (Curcuma zedoaria), mundi (Sphaeranthus indicus), prasarini (Paederia foetida) and madana phala (Randia dumetorum)
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