DEPARTMENT OF

KAYACHIKITSA

A Case presentation on
         AMAVATA
Guided By :- Presented By :-
Prof. (Dr.) J.B. Mishra Dr. Lopamudra Pradhan
Dr. Naidu Jagannath (Reader) Dr. Bishnupriya Pattanaik
Dr. Preetam Sahu(Lecturer) Dr. Sruti Panda
Dr. Ashutosh Dash
Dr. Abhilash Parida
               Case Presentation
• NAME-  Laxmi Pradhan
• W/O- Paramananda Pradhan
• Age- 32 years
• Sex- Female
• Address- At-Gohedadar, PS- Basna, Dist- Mahasamud, Chhattisgarh
• Occupation- Housewife
• Religion- Hindu
• Nationality- Indian
• Marrital Status- Married
• Date of Admission- 31-01-2023
Chief Complaints:-
 Pain & swelling in multiple joints (knee joint, metacarpo-
phalangeal joints, wrist joint) since 2 years.
  Constipated stool since 1 year.
History of Present Illness:-
Before 2 years, the patient was asymptomatic. Then the
above symptoms gradually appeared. So, she came to our
hospital for treatment.
History of Past Illness:-
Not a known case of HTN & DM.
Family history:-
No related family history.

Drug/surgical history:-
Not any history found.

Immunization history:-
Well immunized.

Social history :-
Middle class
Personal history :-
• Bowel – constipated
• Appetite – poor 
• Sleep-adequate
• Micturition – 5-6 times per day
• Diet – mixed 
• Addiction – no such 
General history :-
• Built – normal 
• Gait –  Limping Gait
• Pallor – absent
• Cyanosis- absent
• Pulse – 78/min
• BP- 140/90 mmHg
• Respiration – 18/min
• Temperature- 98°F
Astabidha Pariksha:-

• Nadi- Vata-kaphaja
• Jihwa- Saama
• Mala- Kathina
• Mutra- Samyak
• Kostha- Madhya
• Shabda- Sama
• Sparsha- Sama
• Drik- Sama
• Akruti- Madhyama
Dasabidha Pariksha:-
 
• Dushya- Rasa, Rakta, Mamsa, Asthi
• Desha- Jangala
• Bala- Madhyama
• Kala- Adanakala
• Agni- Mandagni
• Prakruti- Vata-kaphaja
• Vaya- Madhyama
• Satwa- Madhyama
• Satmya- Madhyama
• Ahara- Sadrasa yukta
Samprapti Ghatak:-
• Dosha- Vata, Kapha
• Dushya-
                         >  Dhatu- Rasa, Rakta, Mamsa, Asthi, Majja
                         >  Upadhatu- Kandara, sira
                         >  Mala- purisha
• Adhisthana- All Sandhis
• Srotas- Rasavaha, Annavaha
• Srota-Dusti- Sanga
• Sadhyasadhyata- Kruccha Sadhya
 Local Examination:-

1> Inspection- Patient is conscious & well oriented.

Patient is afebrile & ambulatory.
Patient is stable.
2> Palpation- No organomegally found.
3> Percussion- dull on chest
resonant on abdomen
4> Auscultation- B/L Chest - clear
Systemic Examination:-
1> Digestive System- Digestion & appetite- Poor
P/A- Soft & non-tender
Liver & Spleen- not palpable
Bowel- Constipated
2> Respiratory System- Trachea is centrally placed.
Chest- B/L Symmetrical
B/L Chest- Clear
3> Cardio-vascular System- S1, S2 audible.
No additional sound heard.
Apex beat sound- Audible.
4> Musculo-skeletal System:-
Muscle Tone- Good
Muscle Power- Good
Gait- Limping Gait
5> Nervous System:-
CNS- Pt is conscious & well-oriented.
PNS- sensory
Intact
motor
6> Urinary System:-
Bowel- normal with adequate flow.
7> Reproductive System:-
NAD
DIFFERENTIAL DIAGNOSIS
• AMAVATA
• VATARAKTA
• SANDHIVATA
Differential Diagnosis:-
AMAVATA SANDHIVATA VATARAKTA
Viruddha ahara, Vata kopakara Vata & Rakta
NIDANA Snigdha ahara, ahara vihara kopakara ahara
Alpa chesta etc.. vihara
Angamarda, Sula, Sotha, Vedana on Daha, Supti,
RUPA Aruchi, Trushna, ankunchanaprasarana Vaivarnya,
Alasya, Pain & etc.. Sphutana etc..
swelling etc..
STHANA Starts from small
joint of hand &
Mainly start with Start from the end
weigh bearing large parts of the hand &
spread. joints. feet.

DOSHA Vata, Kapha Vata Vata, Pitta

predominant
Provisional Diagnosis:-
Amavata?
Investigations:-
Hb%
DC
RBS
RA factor
Diagnosis:-
Amavata
 AMAVATA

Ayurveda
Review
NIRUKTI:-

आमेन सहितः वातः आमवातः |

- Ama & Vata unites to form Amavata.
(Vijayarakshita)

आमश्च वातश्च आमवातः |

- Vata associated with ama creating a disease known as amavata.
(Vijayarakshita)
Paribhasha:-

युगपत्कु पितावन्तस्त्रिक सन्धिप्रवेशकौ ।

स्तब्धं च कु रुतो गात्रं आमवातः स उच्यते।। (मा.नि. 25/5)

- In this vyadhi, being aggravation of both ama and vata

dosha start sthanasansraya at kostha, trik pradesh & joints
develop stiffness all over the body.
 NIDANA:-

विरुद्धाहारचेष्टस्य मन्दाग्नेर्निश्चलस्य च।
स्निग्धं भुक्तवतो ह्यन्नं व्यायामं कु र्वतस्तथा।। (मा.नि. 25/1)

> Asamyak Ahara > Viruddha ahara

> Vegavadharana > Vyayama after intake of snigdha ahara
> Sitala ahara > Viruddha chesta
> Ruksha ahara > Mandagni
> Atyanta guru ahara > Divasayana
> Asukhkara sajya > Ratri jagarana
> Manasika cause:- Kama, Krodha, Lobha, Moha, Irsha, Dwesa, Bhaya,
Chinta, Soka, Avasada etc.
SAMPRAPTI:-

वायुना प्रेरितो ह्यामः श्लेश्मस्थानं प्रधावति ।

तेनात्यर्थं विदग्धोऽसौ धमनीः प्रतिपद्यते।।
वातपित्त कफै र्भूयो दूषितः सोऽन्नजो रसः।
स्त्रोतांस्यभिष्यन्दयति नानावर्णोऽतिपिच्छिलः।
जनयत्याशु दौर्बल्यं गौरवं हृदयस्य च ।।
व्याधीनामाश्रयो ह्येष आमसंज्ञोऽति दारुणः।।
(मा.नि. 25/2-4)
SAMPRAPTI CHAKRA:-
Nidana Sevan
Agnimandya

Vata prakopa & Ama utpatti

Vata spreads with ama all over the body through srotos.

Sthanasansraya at slesma sthana

& Dosha Dushya samurchhana

Laksana like daurbalya, sula, sandhi sotha develops

AMAVATA
SAMPRAPTI GHATAK:-

Dosha- Vata pradhana tridosha

Dushya- rasa, rakta, mamsa, snayu , kandara, asthi
Adhisthana- All joints
Srotas- Annavaha, Rasavaha
Srotodusti- Sanga, Vimargagamana
Agni- Agnimandya
Vyadhi swarupa- Achira
PURVARUPA:-
> Agnimandya
> Angamarda
> Hridgourava
> Lalapraseka
> Stiffness in extremities
> Anidra
> Romaharsha
> Alasya
RUPA:-
अङ्गमर्दोऽरुचिश्तृष्णा ह्ययालस्यं गौरवं ज्वरः ।
अपाकः शूनताऽङ्गानां आमवातस्य लक्षणम्।।
(मा.नि. 25/6)

Angamarda - Bodyache
Aruchi - Anorexia
Trishna - Excessive thrist
Alasya - Lassitude
Gourava - Heaviness in body
Jwara - Fever
Ajirna - Indigestion
Sandhi sotha - Swelling of joints
Katisula - Low backache
BHEDA:-
1} According to dosha- (Ma.Ni. 25/12)
i) Vata pradhana ii) Pitta pradhana
iii) Kapha pradhana iv) Vatapitta pradhana
v) Vatakapha pradhana vi) Kaphapitta pradhana
vii) Tridoshaja
2}According to Avastha-
i) Samanya
ii) Pravrudha
3} According to doshanubandha -
i) Vatanubandha
ii) Pittanubandha
iii) Kaphanubandha
4} According to laksana -
i) Tivraavastha janya
ii) Jirnaavastha janya
5} According to Avastha -
i) Samanya
ii) Pravrudha
SADHYA ASADHYATA:-

एकदोषानुगः साध्यो द्विदोषो याप्य उच्यते।

सर्वदेहचरः शोथः सः कृ च्छ्र सान्निपातिकः।।
(मा.नि. 25/12)

> One dosha involved - Sadhya

> Two dosha involved - Yapya
> Tridosha involved - Krichhra sadhya
UPADRAVA:-
> Avasada
> Amlapitta
> Parinama shula
> Anidra
> Hridroga
> Anga vikriti
> Stress
> Hypertension
CHIKITSA SIDHANTA:-

लङ्गनं स्वेदनं तिक्तं दीपनानि कटू नि च ।

विरेचनं स्नेहपानं वस्तयश्चाममारुते।।
सैन्धवाद्येनानुवास्य क्षार वस्तिः प्रशस्यते।
(चक्रदत्त आमवात 1)

> Langhana > Snehapana

> Swedana > Basti
> Intake of tikta, katu rasa > Ruksa sweda
> Deepan pachan chikitsa > Upanaha
> Virechana
CHIKITSA:-
• The treatment of amavata is divided into 4 parts-

i) Nidana Parivarjana
ii) Sodhana Chikitsa
iii) Samana Chikitsa
iv) Yogasana

1} Nidana Parivarjana:-

• This is the first line of treatment of amavata.

• The patient have to avoid all the nidanas that causes amavata.
2} Sodhana Chikitsa:-
> Langhana
> Virechana
> Basti
3} Samana Chikitsa:-

Rasa aushadhi-
> Amavatari rasa > Vata gajankusa rasa
> Vatagajendra rasa > Rasaraj rasa
 Churna-
panchakola chura Hinguadi churna
baiswanara churna Trikatu churna
 Vati-
chitrakadi vati amavatari vati
agnitundi vati ajamodadi vati
 Guggulu yoga-
yograj guggulu vatari guggulu
simhanada guggulu amrutadi guggulu
 Kwatha-
Rasnadi dasamoola kwatha Erandadi kwatha
Rasonadi kwatha Rasnapanchaka kwatha
 Asava & Arista-
Punarnavarista Amrutarista
Lohasava Dasamoolarista

 Ghrita & Taila-

Punarnavadi ghrita Sunthi ghrita
Prasarani taila Saindhavadya taila

 Avaleha & Rasayana-

Trikantakadyavaleha
Shilajatu rasayana
Chyavanprash
Amrutabhallataka avaleha
 Bahya Prayoga-
Dasanga lepa
Satapuspadi lepa
Haridradi lepa

 Yoga asana-
Surya namaskar
Bajraasana
Padmaasana
Pranayam
RHEUMATOID ARTHRITIS

(MODERN REVIEW)
DEFINITION:-
• RA is a multisystem disease of unknown specific cause.
• RA is an inflammatory arthriitis of the peripheral joints usually with a
symmetrical distribution.
• There is a synovial inflammation to cause cartilage destruction & erosion
which produces changes in the joints.

AETIOLOGY:-
• Imunological factors
• Presence of an abnormal imunoglobulin in the serum known as RA Factor.
• Genetic influence
• Psychological factors
• Hormonal factors - Incidence of RA is more common before
menopause & remission during pregnancy.
• Low economic status
• Infectious agent
EPIDEMIOLOGY:-
• Affects 0.5-1% of the population worldwide.
• Peak prevalence between the ages of 30 to 50 years.
• RA has an incredibly high disease burden & cost to society.
• Drastic affect on quality of life.
• 80% disabled after 20 years of disease.
• Patients with RA shorter life expectancies.
SIGN & SYMPTOMS:-
• Pain, swelling, stiffness & tenderness in more than one joint.
• Stiffness, especially in the morning or after sitting for long periods
• Pain & stiffness in the same joints on the both sides of the body.
• Fatigue
• Weakness
• Fever
• Limitation of moment of affected part.
• Muscle atrophy.
• Rheumatoid vasculitis
• “Z” deformities
• Swan neck deformities
INVESTIGATIONS:-
> Hb%
> ESR
> TLC
> DC
> R.A. Factor
> CRP
> Synovial fluid analysis
> A.S.L.O. Titre
> Radiographic evaluation
MANAGEMENT:-

• Rest to the affected part in acute condition.

• NSAID
• Steroids
• JAK inhibitors
• DMARD
• Regular exercise
• Physiotherapy
Treatment given to our patient-
on date-31/01/23 , the following medicines were prescribed
Rx,
Tab. amavatari rasa-500mg BD AF
Tab. agnitundi vati- 500mg BD
Tab mahayograj guggulu- 500mg BD
Maharasnadi kwatha-15ml BD
Cap. Flexofen MR-1tab TID
Saindhavadi taila-L/A
Amyron Syp.-15ml BD
03/02/23-
• the patient complained about severe pain,so following medicines were
prescribed.
rheumayog gold - 2tab BD
vaiswanara churna-5gm BD
Panchakarma Therapies given to our patient :-
31/01/23-
• CPS given with kolakulathadi churna up to 02/02/23.
02/02/23-
• abhyanga given with saindhavadi taila.
• cps continued up to 06/02/23.
04/02/23-
• adviced for CPS 2 times in a day.
05/02/23-
• Patient complained about swelling.
• adviced to stop abhyanga.
08/02/23-
• adviced for vaitarana basti with gomutra.
10/02/23-
• patient was discharged on request.
 Impression:-
• Patient earlier came with the complaint of pain
and swelling , after the treatment her pain and
swelling got reduced .
• Patient abruptly stopped the treatment process
due to her personal problem .