Early Stage Of Rheumatoid Arthritis: Ayurvedic Treatment, Remedies

Article by Dr Raghuram Y.S. MD (Ay)
Rheumatoid Arthritis (RA) is the king of painful disorders affecting the musculoskeletal system. It is a long-standing autoimmune disorder that primarily affects the joints. The joints affected by RA are usually hot, swollen and painful. Pain and stiffness often worsen after a period of rest. 

Causes of RA are believed to involve a combination of genetic and environmental factors. Moreover, the underlying mechanism involves the body’s immune system attacking the joints (autoimmune process). This results in inflammation and thickening of joint capsule. It also affects the underlying bone and cartilage.

RA affects between 0.5 and 1% of adults in the developed world with between 5 and 50 per 100,000 people newly developing the condition each year.

Signs and symptoms

Signs and Symptoms of Rheumatoid arthritis – Amavata:
Rheumatoid arthritis mainly affects the joints. Other organs are also affected in more than 15-25% people. it affects many joints and is therefore a polyarthritis. Most commonly affected joints are the small joints of hands and feet, cervical spine and also larger joints like shoulder and knee joints. The main symptoms are –
Tender warm and 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
In Ayurveda, Rheumatoid Arthritis is compared to a condition called as Amavata.
Read related: causes and symptoms of rheumatoid arthritis: Ayurveda and modern perspective

Amavata –
The word Amavata has 2 components
i.e. Ama and Vata. These 2 components contribute to the morbidity and disease process in Amavata.

Vata component

Vata component in the cause for painful conditions in Amavata – The body functions are governed by 3 basic entities called Vata (the wind element), Pitta (the fire element) and Kapha (the water element). When these 3 are functioning by coordinating and cooperating with each other we are at the best of our health. Even among these 3, Vata is the important one which governs Pitta and Kapha, the tissue components, the distribution of essential nutrients in the body, the elimination of wastes and toxins, the normal functioning of the organs of the body, mind and intellect and all other activities. All the activities are disturbed when Vata is vitiated due to various factors. Vitiated Vata causes blocks at various parts of the body, causes either excessive or deficit discharge of essential and or non-essential things, disturbs the body functions, degenerates the tissues, breaks the integrity of the body components, disturbs the immunity and causes various dysfunctions resulting in painful diseases. Thus, Vata when vitiated causes many painful conditions at the place of its vitiation and lodgement.

Ama component

Ama component in the cause for painful conditions in Amavata – Similarly Ama too has a capacity to create blocks in the body due to its property of sticking to the surface of the cells and channels of the body (transport systems). Ama is a metabolic toxin which has been created due to errors in metabolism, both at the gut as well as cellular levels.

Sluggish digestion or weak metabolic fire (gut fire, the active components taking part in the digestion of food at the gut level including the stomach acids) leads to indigestion. This leads to the formation of erratic or unprocessed food essence (ahara rasa) which is about to get into the circulation for being distributed to nourish the body tissues. From this, the first tissue, rasa dhatu is improperly formed and is unprocessed. This unprocessed and contaminated ahara rasa formed in the amashaya (stomach or upper gut) is called ama.

Characteristics of Ama –
Avipakwam asamyuktam durgandham bahu pichchilam
Sadanam sarva gaatraanaam aama iti abhidheeyate (Ref – Madhava Nidanam, Amavata nidanam, Madhukosha teeka)
Avipakwam – unprocessed
Asamyuktam – disintegrated
Durgandham – foul smelling
Bahu pichchilam – very sticky
Sadanam sarvagatrani – causes weakness of all the body parts

Due to the above said characteristic features, ama tends to stick within the cells and the channels of transportation in the body leading to multiple blocks. Due to these blocks the tissues are not nourished in a good way resulting in weakness and fatigue due to deficit nutrition. Ama further predisposes to sluggish gut and tissue metabolism. Sluggish metabolism leading to indigestion and formation of ama and ama once again predisposing to weak digestion and formation of more ama becomes a vicious cycle as time progresses. If this condition is not attended ama acts as a toxin and starts producing pain, swelling and stiffness at the site of its adherence and localisation. Thus ama when vitiated causes many painful conditions at the place of its vitiation and lodgement.

By the above said explanations it is clear that both vitiated Vata and unattended ama are individually capable of producing painful diseases and or syndromes.

Amavata

Amavata – a rheumatological double dose:
Amavata is a disease in which there is a double dose of painful conditions. It is formed due to a deadly combination of morbid Vata and Ama. It is caused due to the consumption of incompatible foods and activities, sedentary life activities, prevailing sluggish digestion and getting indulged in physical activities and exercises after taking oil rich unctuous foods. All these causes predispose to the aggravation of Vata and formation of ama leading to the manifestation of the disease Amavata.

Amavata is considered to be a disease afflicting the joints, soft tissues and bones, in a sense the whole musculoskeletal system. But when we see the above said explanation, we get an impression that it is basically a disease which belongs to the disturbances in the metabolic activities. This means to tell that Amavata has its origin in a weak stomach.

Agnimandya

Sluggish metabolism – Root cause of Amavata vis-à-vis Rheumatoid Arthritis –
Agnimandhya / Mandagni (Sluggish metabolism or weak digestion process is the chief cause in the causation of Amavata. As described above, the initial pathological changes take place at the level of gut, i.e. in the stomach or upper part of digestive apparatus. These changes can be considered as the predisposing factors or premonitory symptoms of Amavata with special reference to Rheumatoid Arthritis. This means to tell that the earlier symptoms of Rheumatoid Arthritis are manifested as gut-related symptoms. These symptoms are the earliest manifestations of the disease which appear much before the manifestation of joint or soft tissue related symptoms. Attending or treating the disease at this stage when it is still in the sprouting stage would have prevented the manifestation of a dangerous rheumatic condition like rheumatoid arthritis.

In those who are susceptible to get joint related diseases like Amavata, the gut manifestation of the disease will just be in the Sanchaya (stage of accumulation of dosha morbidity in its own site) or Prakopa (stage succeeding Sanchaya in which the dosha morbidity further increases in quality and quantity in its own place or site, stage of aggravation).

If the disease is not addressed in these 2 stages, the dosha morbidity tends to overflow and encroach into the sites of other doshas (stage of overflow of morbid doshas i.e. Prasara stage). Example, the morbid ama and kapha tends to spread into the sites of pitta and vata. When there is a susceptibility and platform to form joint diseases in the body, the morbid doshas tend to move to the joints and bones, the sites of Vayu or Vata, vitiate the local dosha (Vata in bones and joints) and cause the disease process. This stage of lodgement of the morbid doshas in the joints leading to the manifestation of diseases related to bones and joints is called Sthanasamshraya stage (stage of lodgement of morbidity) of the disease. Though the doshas get lodged in weak and susceptible dhatus (tissues) in this stage, the disease doesn’t get manifested in its fullest strength because the pathological process (dosha-dushya sammurchana) is not yet completed. But the disease shows the signals of its manifestation in near future. These signals are in the form of signs and symptoms of an impending or yet to be manifested disease. These symptoms are called Purvarupa’s or premonitory symptoms.

When the disease is not diagnosed even in this condition, the Vyakta stage (stage of manifestation of the disease proper) occurs which presents itself as a full blown diseases with all its signs and symptoms (Rupa’s). This is a stage in which we name a disease. We name the disease as Amavata in this stage. Not addressing the disease in this stage is that we have allowed the disease to progress to the stage of complications (Bheda stage of the disease).

The key is to avoid the disease from progressing to the successive stages of pathogenesis wherein the treatment becomes much more complicated than its preceding stages.

When speaking about Amavata vis-à-vis Rheumatoid Arthritis also, the disease can be best treated, and its progression halted when skillful administration of medicines is done in the earlier stages of pathogenesis i.e. in the Sanchaya and Prasara stages in which the disease is yet in the budding condition and are presenting with gut-related symptoms. The bones, joints and soft tissues are still distant factors for the morbidity to reach. Treating the disease at this stage means securing the health of our bones and joints and also preventing Rheumatoid arthritis from getting manifested.

Early manifestation signs, treatment

Symptoms of Gut-stage (premonitory stage) or early manifestation of Rheumatoid Arthritis (Amavata) –
Angamarda aruchi trushna aalasyam gauravam jwaraha
Apakataa shoonataa angaanaam aamavatasya lakshanam (Ref – Madhava Nidanam, Amavata nidanam 25/6)

Angamarda – Vague body pains (beating pains all over the body)
Aruchi – Tastelessness
Trushna – Thirst
Aalasya – Lethargy / Loss of interest in all activities
Gauravam – Heaviness of the body
Jwara – Fever
Apakata – Indigestion
Shoonataa angaanaam – Swelling in the body parts

Effective Ayurvedic Measures and Medicines during early manifestation of Rheumatoid Arthritis

Principles of treatment:
The principle of treatment of early manifestation of Amavata (Rheumatoid Arthritis) when the disease is still at the gut level and has not reached the bones and joints is –

Agni Deepana

Since the digestive fire or gut fire (agni) will be depleted in this condition, the primary target of treatment will be to kindle the fire and establish its capacity to identify and digest food properly. When the fire gets kindled and starts digesting the food properly, the ama which is a greater part of morbidity in Rheumatoid arthritis will not be formed. Deepana herbs will not have an effect on ama and do not contribute towards ama-pachana. Mainly the Deepana medicines which have Tikta (bitter) and Katu (pungent) tastes are effective in handling the premonitory condition of RA.

The best herbs used for Deepana are –
Pippali – Piper longum
Pippalimula – Root of Piper longum
Chavya – Piper retrofractum
Chitraka – Plumbago zeylanica
Shunti – Zingiber officinale
Amlavetasa – Garcinia pedunculata
Maricha – Piper nigrum
Ajamoda – Trachyspermum ammi
Bhallataka – Semecarpus anacardium
Hingu – Ferula foetida
Madhya – alcoholic or fermented products (medicated)
Lavana –salt
Ativisha – Aconitum heterophyllum
Kiratatikta – Swertia chirata
Hingu – Ferula foetida
Triphala – fruits of Terminalia chebula, Terminalia bellirica and Emblica officinalis
Mishreya – Bishop’s weed
Shatapushpa – Anethum sowa
Jeeraka – Cumin seeds
Krishna Jeeraka – Black caraway
Takra – buttermilk
Pippalyadi group of herbs
Bilwadi group of herbs
Guduchyadi group of herbs
Amalakyadi group of herbs

The first 5 herbs are called Panchakola, they are the best in the business to tackle Rheumatoid arthritis

Ama Pachana

Ama, as already discussed will be the chief culprit causing blocks at many sites all over the body in Amavata leading to pain and related symptoms. We need to digest, dry-up and separate the adhering Ama from the tissues. Removing ama induces lightness and health back into the tissues. The channels of nutrition and circulation open up and there is free flow of essential things all through the body. The pathology starts regressing and the metabolism comes back to rhythm.

The best herbs which can get rid of ama are –
Dhanyaka – Coriander
Musta – Cyperus rotundus
Pippalimula – Roots of Piper longum
Maricha – Piper nigrum
Shunti – Ginger – Zingiber officinale
Lavanga – Syzygium aramaticum
Shaileya – Permelliya perforate
Mulaka – Radish – Raphenus sativus
Erandakarkati – Carica papaya
Nagakeshara – Mesua ferrea
Haridra – Turmeric
Daruharidra – Berberis aristata
Haritaki – Terminalia chebula
Amalaki – Emblica officinalis
Bibhitaki – Terminalia bellirica
Kushta – Saussurea lappa
Vacha – Acorus calamus
Patha – Cissampelos pareira, Cyclea peltata
Katuki – Picrorrhiza kurroa
Ativisha – Aconitum heterophyllum
Ela – Cardamom
Bhallataka – Semecarpus anacardium
Chitraka – Plumbago zeylanica
Kiratatikta – Swertia chirata
Trayamana – Gentiana kurroo
Patola – Trichosanthes dioica
Chandana – Santalum album
Murva – Marsdenia tenacissima
Guduchi – Tinospora cordifolia
Parijata – Nyctanthes arbortristis
Karavellaka – Bitter gourd
Shigru – Drumstick
Shana – Crotalaria juncea
Tila – Sesame
Sarshapa – Mustard
Atasi – Flax seed
Tikta skanda – bitter group of herbs
Pippalyadi gana – herbsbelonging to Pippalyadi group
Dashamula – 10 roots
Haridradi – herbs belonging to Haridradi group
Vachadi – herbs of Vachadi group

Vata shamana

Vatashamaka and Vatanulomana –
Morbid Vata will be responsible for the foul play in the body. It will keep displacing and misplacing the morbid elements like ama in the susceptible sites like bones, soft tissues and joints and will head the pathological process. Vata vitiation should be controlled at the earliest. This is possible only after having controlled ama by deepana and pachana measures. When the body gets devoid of ama, it becomes easy to expel and control the vitiated vayu or vata by means of vata controlling / mobilizing medicines (Vatanulomana – mobilizing the morbid vata in a downward direction, out of the body) and effective treatments which can effectively control vayu like Virechana (purgation) and Vasti (herbal medicated enemas).

The best Vata alleviating and expelling herbs are:
Eranda – Ricinus communis
Hingu – Ferula foetida
Yavani – Bishop’s weed
Devadaru – Cedrus deodara
Kushta – Saussurea lappa
Varuna – Crataeva nurvala
Bala – Sida cordifolia
Shallaki – Boswellia serrata
Agnimantha – Clerodendrum phlomidis
Guduchi – Tinospora cordifolia
Arka – Calotropis gigantea
Shatavari – Asparagus racemosus
Punarnava – Boerhavia diffusa
Dhattura – Dattura metel
Bharangi – Clerodendrum serratum
Raktachandana – Red sandalwood
Badara – Zizyphus jujuba
Yava – barley
Kulattha – horsegram
Dashamula – 10 roots
Herbs belonging to Vidarigandhadi group

Laghu Ahara

Light digestible food forms the key for effective treatment of RA in its earlier stages of manifestation. Since the metabolism is weak, the gut will be able to digest only the lightest of the foods. Hot liquid diet garnished with kitchen spices like ginger, pepper, cumin seeds etc should be prescribed. Laghu ahara(light diet) also serves the purpose of deepana and pachana.

The lightest food format comes in the forms of:
Yavagu – is a liquid preparation in the form of thin gruel wherein rice (1part) is processed in 6 times water. It is seen that the final preparation has more of liquid than solid.

Vilepi – is a liquid preparation in the form of thin gruel wherein rice (1part) is processed in 4 times water. It is seen that the final preparation is of semisolid nature. Apart from being nutritious and tasty, it is known to destroy ama by its root and kindle the belly fire. It helps in recovery from early stages of RA and halts the progression of disease process.

Peya – is a liquid preparation in the form of thin gruel wherein rice (1part) is processed in 14 times water. It is seen that the final preparation has a small quantity of solid portion left over.

Manda – is a liquid preparation in the form of thin gruel wherein rice (1part) is processed in 14 times water. It is seen that the entire solid content is filtered out from the final preparation such that only liquid remains.

Yusha – is a liquid preparation in the form of thin gruel wherein dal i.e., grams mainly green gram (1part) is processed in 18 times water and its extract is filtered out.

Langhana

Langhana means lightening therapies. These are the therapies which induce lightness of the body and establish health.
Yat kinchit laaghava karam dehe tat langhanam smrutam (Ref – Charaka Sutra 22/9)

Anything which induces a feel of lightness in the body is called Langhana
Laghu ushna teekshna vishadam rooksham sookshmam kharam saram
Kathinam cha eva yat dravyam praayaha tat langhanam smrutam (Ref –  Charaka Sutra 22/ 12)

Any medicine or treatment which acts as Langhana functions on the virtue of the below said qualities –
Laghu – light
Ushna – hot
Teekshna – intense
Vishada – clear
Ruksha – dry
Sukshma – minute
Kharam – rough
Saram – flow
Kathinam – hard

When morbidity is prevailing in the body as evident by the pathological activities caused by ama, vata, pitta and kapha, there is a feeling of heaviness and ill-health in the body. Langhana helps the body to recover from the blocks and damages caused by the morbid factors, ama and vata in this context. Langhana also destroys the morbidity by serving the purposes of deepana and pachana.

There are 10 types of Langhana but the forms of Langhana which could come hand in hand, in dealing with premonitory condition of Rheumatoid arthritis are –

Upavasa – means partial or complete fasting.
Pipasa Nigrahana – controlling the urge to take water.
Pachana aushadha – medicines which digest and mobilize the morbid ama
Aatapa – exposure to sun’s heat
Vyayama – exercise

These types of Langhana help in kindling the digestive fire, rectifies metabolism, controls ama and vata, removes stagnation and blocks in tissues and channels, brings lightness and sense of healthiness in the body, regresses the initial pathological processes, strengthens the digestive system, cleanses the tissues of the blocks and helps in their recovery and halts the progression of the gut-stage RA towards a full blown Rheumatoid arthritis. These should be taken under medical advice and supervision.

The other forms of Langhana are – Vamana (therapeutic emesis), Virechana (therapeutic purgation), Shiro-virechana (nasal medications), Niruha Vasti (decoction enemas) and Maruta (exposure to wind). The first 4 are called Samshodhana procedures (evacuating, purificatory or detoxifying therapies) which will be more effective when the disease is in advanced stages or has manifested in full blown form with clear cut signs and symptoms or with complications. They can also be selectively used as preventive treatments but only after Deepana, Pachana, Langhana etc methods have been successfully implemented. Samshodhana serves the purpose of providing a long-standing immunity and halts the recurrence of the disease. Exposure to wind might not be useful in Rheumatoid arthritis.

Signs of Adequate Langhana –
Vata mutra pureeshaanaam visarge gaatra laaghave
Hridaya udgaara kantha aasya shuddau tandraa klame gate
Svede jaate ruchau chaiva kshut pipaasa saha udaye
Krutam langhanam aadeshyam nirvyathe cha antraatmani (Ref- Charaka Sootra 22/34, 35)

Below mentioned are the signs of properly administered Langhana –
Vata mutra pureeshaanaam visarge – proper and timely elimination of flatus, urine and stools
Gaatra laghave – feeling of lightness in the body
Hrudaya shuddhi – feeling of lightness and comfort in the region of heart
Udgaara shuddhi – clear and tasteless belching
Kantha shuddhi – feeling of cleanliness and lightness in the throat
Aasya shuddhi – feeling (and appearance) of cleanliness and lightness in the mouth
Gata tandra – reduction of drowsiness or feel to rest and sleep
Gata klama – reduction of tiredness
Swede jaate – manifestation of sweating
Ruchau – manifestation of taste in food
Kshut udaya – manifestation of hunger
Pipasa udaya – manifestation of thirst
Nirvyathe antaraatmani – soul at ease and free from the feel of discomfort and pain

Some medicines when taken induce the effect of Langhana therapy and produce lightness in the body. The Langhana group of herbs have the above said qualities of Langhana therapy. The best herbs which serve the purpose of Langhana are –
Guduchi – Tinospora cordifolia
Musta – Cyperus rotundus
Triphala – Fruits of Terminalia chebula, Terminalia bellirica and Emblica officinalis
Takrarishta – fermented liquid prepared on buttermilk base
Madhu – honey
Vidanga – Embelia ribes
Shunti – Zingiber officinale
Kshara – Alkali
Lauha bhasma – calx or ash of iron
Yava churna – Barley powder
Aamalaka – Emblica officinalis

Brihat Panchamula – Roots of greater Panchamula group of herbs i.e. Roots of Aegle Marmalos, Clerodendrum phlomidis, Oroxylum indicum, Stereospermum suaveolens and Gmelina arborea (along with honey)
Shilajit – Asphaltum
Priyangu – Callicarpa macrophylla
Shyamaka – Setaria italica
Kodrava – Paspalum scrobiculatum
Mudga – Green grams
Kulattha – Horse gram
Chakramarda – Cassia tora
Aadhaki – Cajanus cajan
Patola – Trichosanthes dioica
Madhoodaka – Honey water etc

Other treatment principles

Other beneficial strategies in handling earlier stages of RA:
Truptighna Gana herbs –
Trupti means satiation or saturation. It is a kapha related disorder of the stomach in which ama is formed due to indigestion and sluggish metabolism which in turn may predispose to the manifestation of Amavata vis-à-vis Rheumatoid arthritis. In this condition the person feels early satiety or satisfaction after consumption of a small quantity of food. The medicines which destroy Trupti can be effectively used in handling the early stages of Amavata because they too destroy ama and excessive kapha in the stomach. Some of the Truptighna herbs are:

Nagara – Zingiber officinale
Chavya – Piper retrofractum
Chitraka – Plumbago zeylanica
Vidanga – Embelia ribes
Murva – Marsdenia tenacissima
Guduchi – Tinospora cordifolia
Vacha – Acorus calamus
Musta – Cyperus rotundus
Pippali – Piper longum
Patola – Trichosanthes dioica
Dhanyaka – Coriandrum sativum
Ajamoda – Apium graveolens
Brihatyadi group of herbs
Guduchyadi group of herbs
Amalakyadi group of herbs

Rochana herbs –
Ruchi means taste. Tastelessness is one of the prime manifestations of gut related disorders including Amavata vis-à-vis Rheumatoid arthritis. Aruchi is one of the symptoms of Amavata. The herb which increases taste are called Rochana herbs. The Rochana herbs are also effective in tackling the early condition of RA. The below said are important Rochana herbs:
Amra – mango
Amrataka – Spondias pinnata
Lakucha – Artocarpus lakoocha
Karamarda – Carissa carandas
Vrikshamla – Garcinia cambogia
Amlavetasa – Garcinia pedunculata
Badara – Zizyphus jujube
Dadima – Pomegranate
Matulunga – Citrus medica
Changeri – Oxalis corniculata
Jambira – Citrus limon
Amlaskanda dravya – fruits which are sour
Hrudhya gana – herbs which are cardiac tonics
Parushakadi group of herbs etc

Lepa –
Lepa means application. Powders of herbs which alleviate pain are made into paste. The paste is applied over the sore joints. It is allowed to stay in place for a prescribed period or till the paste starts to dry. Depending on the disease and dosha involved, the Lepa is applied either hot / warm (vata, kapha vitiation and association of ama) or cold (pitta, rakta vitiation). The common medicines which are used for Lepa are –

Rasnadi Churnam
Kottamchukkadi Churnam
Grihadhoomadi Churnam
Ellumnishadi Churnam
Guluchipatradi Churnam
Dashanga Lepam etc

Swedana –
Swedana or fomentation (sudation, sweat inducing treatments, steaming treatment) is a specialized treatment of Ayurveda which helps in providing unparalleled relief in pain, swelling and stiffness associated with diseases like Amavata vis-à-vis Rheumatoid arthritis, Osteoarthritis, Low back pain etc.

Swedana is a treatment procedure in which sweat is induced by application of heat and warmth in the form of steam or by bringing the body / body parts in contact with heated medicaments (powders, leaves, processed rice, sand etc) tied in boluses. Swedana provides relief from Stambha (stiffness and catches), Gaurava (heaviness) and Sheeta (coldness) in the body or body parts.

Swedana is said to be the best form of treatment in expelling morbid Ama, Vata and Kapha and also destroying the diseases manifested due to morbid Ama, Vata and Kapha including Amavata vis-à-vis Rheumatoid arthritis in its earliest stages. After Swedana, the cells get activated and flush the toxins away. The cellular metabolism improves, and we feel light and at ease.

There are many types of Swedana as explained in Ayurvedic texts. There are about 13 types of Sagni Sweda’s (sweat inducing treatments administered by procedures involving utilisation of fire or heated materials) and 10 types of Niragni Sweda (sweat inducing treatments where in the fire or heated materials are not utilised ex. sleeping covering thick blankets until we sweat etc).

Again, Swedana can be done in 2 ways – Ruksha Sweda (dry fomentation) and Snigdha Sweda (wet fomentation or sweat inducing treatment done after giving oil massage or by using the medicinal herbs which are processed or fried in herbal oils). In some pathological conditions both forms can be skillfully combined as and when required.

In conditions where pain and associated symptoms are due to ama (metabolic toxins having a sticky nature, tending to block the transport systems of the body and cause painful conditions), meda (contaminated or accumulated fat) and or kapha (morbid kapha) as in earlier stages of Rheumatoid Arthritis (Amavata) we generally prefer doing Ruksha Sweda or dry fomentation. In conditions where the pain and related symptoms are due to vitiation of only morbid Vayu, we generally prefer Snigdha Sweda (wet or unctuous fomentation)

Every form of Sweda can provide relief from pain, stiffness and swelling. But their area of utilisation and the diseases and pathological conditions in which they are administered or preferred will differ.

In the early manifestations of Amavata (RA) where the symptoms are gut-related, ruksha sweda is preferred. In the later conditions, when ama has been relieved due to administration of ama expelling medicines, snigdha sweda can be administered.

The best forms of swedana methods used in early conditions of Rheumatoid Arthritis are –

Bashpa Sweda – steam fomentation either to individual affected joints (as in Nadi sweda or tubular fomentation) or for the whole body (steam chamber) can be given depending on the site of affliction

Valuka Sweda (Sand or sand bag fomentation) – In this treatment, the sand is heated to tolerable temperature and tied in a bolus. The bolus is heated in a pan. The heated bolus is continuously rubbed over the afflicted area, low back in this case. This treatment is preferred in the presence of ama (intermediate products of digestion and cell metabolism, circulating or tissue toxins which get adhered in the cells due to their sticky nature, block the channels and transport systems of the body and cause pain and stiffness) and symptoms of morbid kapha (stiffness, swelling, heaviness etc). Valuka Sweda is said to be unparalleled treatment in the systemic manifestation of Amavata (Rheumatoid arthritis). Read more about Valuka Sweda

Upanaha Sweda – Poultice fomentation
Churna Pinda Sweda – Bolus fomentation using herbal powders
Avagaha Sweda – Tub bath fomentation

Parisheka (Sarvanga Dhara) – Stream pouring of medicated liquids over the body is called Parisheka or Sarvanga Sweda. Dhanyamla dhara (stream pouring of fermented liquids) is the best form of Parisheka done in early and late manifestation of inflammatory arthritis such as RA.

Virechana and Basti as preventive therapies in early stages of RA:
Virechana –
Virechana means therapeutic purgation. Virechana is generally given after the administration of Snehana and Swedana. Virechana expels the morbid dosha’s especially pitta and vata, thus preventing or curing the back related ailments caused by these morbid dosha’s. But in the early gut-manifestation of RA (Amavata), this form of extended Virechana may not be required. Nitya Virechana is the best form of Virechana which can be given in the early manifestation of Rheumatoid Arthritis.

This is a variant of Virechana where in the medicines which have a laxative property are given in low doses on a daily basis. This will target expulsion of morbid doshas on a daily basis, as and when they are formed and tending to cause some pathological changes in the low back area. Apart from expelling morbid vata and pitta, it also relieves pain, inflammation and stiffness of the joints.

Nitya Virechana should be administered only after the initial stages have been dealt with after effective administration of Deepana and Pachana medicines. If not done, Virechana might just give an adverse reaction.

Best medicines used for Virechana (depending on the morbid dosha and morbidity):
Trivrit Leha
Sukumara Leha
Kalyana Gulam
Gandharvahastadi Kashayam
Gandharvahastadi Eranda Tailam
Nimbamritadi Eranda Tailam
Higutriguna Tailam
Hingutriguna leham
Shaddharana Churnam
Narayana churnam etc

Vasti –
Vasti means medicated enemas. Vasti or Basti is said to be the best treatment for vitiated Vayu, which is the chief culprit in pain games. When Vayu is controlled by the action of Vasti all the other disturbed body elements fall into rhythm and equilibrium. Vasti strengthens the tissues of the joints, rejuvenates health, aids fast healing and prevents recurrence.

Many times, constipation and accumulation of gases in the belly is the cause for back pain. Virechana and Vasti acts as a effective purgatives and relieve the mentioned conditions.

Vasti is given in the below mentioned forms:
Asthapana Vasti (Kashaya Vasti) – Herbal decoctions or milk (ksheera vasti) processed with decoctions is given as enemas.
Below mentioned are some of the best Asthapana Vasti’s in low back pain –
Erandamuladi Kashaya Vasti
Dashamula Kashaya Vasti
Dashamula Ksheera Vasti
Vaitarana Vasti
Mustadi Yapana Vasti etc.

Vasti is generally preferred in chronic Rheumatoid arthritis conditions or at later stages. But in acute manifestations or early stages of RA when the disease has not yet set its foot in the joints and soft tissues short course Enema’s should be administered. Enema is preferred after most of the morbidity in the form of vitiated Vata, Kapha and ama has been expelled by the administration of Deepana, Pachana and Virechana.

Virechana and Vasti given in gut-manifestation of RA are more of supportive treatments rather than curative. They help in prevention and recurrence of RA. They also halt the progression of the disease towards joint affliction.

Anuvasana Vasti – Medicated oils or ghee is used for enemas. It is given in combination with Asthapana Vasti (alternatively). Anuvasana Vasti is generally not preferred in early conditions. It is again brought into picture as a preventive measure and to avoid progression of the disease once the ama has been dealt with by administration of Deepana, Pachana and Virechana. Matra Vasti – It is also a variant of Anuvasana Vasti but given in small doses.

Best medicines used for Anuvasana and Matra Vasti are –
Guggulutiktakam Ghritam
Tiktakam Ghritam
Ksheerabala Tailam
Mahamasha Tailam
Sahacharadi Tailam
Brihat Saindhavadya Tailam
Bala Tailam etc.

Ayurvedic medicines

Important formulations in early stages of Rheumatoid Arthritis –
Decoction of Shunti (Zingiber officinale) and Gokshura (Tribulus terrestris) should be taken every day early in the morning.

Decoction of Shunti (Zingiber officinale) and Guduchi (Tinospora cordifolia) should be taken every day early in the morning.

Pippalyadi Kwatha – Decoction of Pippali (Piper longum), Pippalimula (Root of Piper longum), Chavya (Piper retrofractum), Chitraka (Plumbago zeylanica) and Shunti (Zingiber officinale)

Shunti Churna (readily available in Ayurvedic pharmacies) – Ginger powder in 1 gram dosage mixed in Kanji (fermented liquid) should be taken 2-3 times daily after food

Panchasama churnam – This powder should be taken in a dose of 3-5 grams mixed in hot water half an hour after food, twice daily or at bedtime. This powder when taken in large quantities causes purgation and hence should be taken under supervision of doctor. It is a powder prepared by mixing equal quantities of powders of Shunti (ginger), Haritaki (Terminalia chebula), Pippali (long pepper), Trivrit (Operculina turpethum) and Sauvarchala Lavana (Black salt)

Phalatrikadi Churnam  (readily available in Ayurvedic pharmacies) – Powder of fruits of Terminalia chebula, Terminalia bellirica and Emblica officinalis should be taken in a quantity of 3-5 grams mixed in buttermilk or supernatant layer of curd or curd water or milk or meat soup or as directed by the physician

Panchakola churnam (readily available in Ayurvedic pharmacies) – Powder of equal quantities of Pippali (Piper longum), Pippalimula (Root of Piper longum), Chavya (Piper retrofractum), Chitraka (Plumbago zeylanica) and Shunti (Zingiber officinale) should be taken mixed in hot water (1-1 ½ gram dose) before or after food.

Vaishwanara Churna  (readily available in Ayurvedic pharmacies) –   should be taken in a dose of 2-3 grams mixed in curd water, kanji (fermented liquid), gomutra (cow urine), Madhya (alcohol or fermented medicated alcoholic liquid) or hot water at bedtime.

Likewise Chitrakadi churnam and Alambhushadi churnam explained in the Ayurvedic texts should be prepared and consumed (Ref – Yoga Ratnakara, Amavata Chikitsa, verses 43-46).

Yogas from Sahasra Yoga Text book

1.Maharasnadi kwatha
2. Amruta Guggulu
3. Yogaraja guggulu
4. Amavatari rasa

Other Ayurvedic medicines for rheumatoid arthritis: 
Rasnapanchakam Kashayam
Rasnasaptakam Kashayam
Amrutottaram Kashayam
Simhanada Guggulu
Ajamodadi Churnam

Wholesome diet

Dietetic inclusions (Pathya) useful in preventing the progression of the disease –
Yava – barley
Kulattha – horse gram
Shyamaka – Setaria italic
Kodrava – Paspalum scrobiculatum
Rakta shali – Red rice
Shigru – drumstick
Punarnava – Boerhavia diffusa
Karavellakam – bitter gourd
Patola – pointed gourd
Ardraka – ginger
Taptaneeram – hot water
Takra samskrutam Lashunam – garlic processed in buttermilk
Jangala mamsa – meat of animals living in desert and dry lands
Water processed with Panchakola churna
Read related: diet for rheumatoid arthritis: Ayurvedic recommended food

Unwholesome diet

Avoidable diet in RA –
Dadhi – curds
Matsya – fish
Guda – jaggery
Dugdha – milk
Masha pishti – flour of black gram
Dushta neeram – contaminated water
Purva vatam – wind blowing from east
Viruddha bhojana – mutually incompatible foods
Asatmya bhojana – foods that doesn’t suit us
Vegavarodham – forcibly controlling the natural body urges or reflexes
Jagaram – habit of awakening throughout the night
Guru ahara – foods heavy to digest
Abhishyandi ahara – foods which cause blockage in cells and channels of the body
Related: Rheumatoid arthritis diet – food to avoid

Just before finishing –
In this article we have learnt that it is our stomach which gives origin to diseases like Rheumatoid arthritis. If we take care of our gut in a good way we can curb RA in its earlier stage itself. In this way we would have avoided the morbidity from reaching our bones and joints and would have avoided being victims of a crippling disorder. Ayurveda has given the symptoms of early manifestation of RA. Identify these symptoms at the earliest and take the help of your doctor. Ayurveda has lot of options to tackle this latent phase of RA as seen above and it is left out for each one of us to make the best utilization of them.
Click to Consult Dr Raghuram Y.S. MD (Ayu)