ARTHRITIS AND AYURVEDIC TREATMENT - Dr. Murali Manohar Chirumamilla, M.D.

(Ayurveda)
The rheumatic diseasesrheumatic fever, rheumatism, and rheumatoid arthritisare acute and chronic conditions as the body is filled with rheum, a form of aama (residual impurities deposited in the cells as a result of improper digestion). This rheumatic disease provides a good example of an auto-immune condition (a disordered self-protective mechanism) characterised by inflammation, soreness and stiffness of muscles, and pain in joints and associated structures. This can often be successfully managed by an Ayurvedic approach. Rheumatoid arthritis is called Aama-vaata in Sanskrit, which means that it occurs when vaata (one of the three constituents that govern physicochemical and physiological activities of the body) circulates aama in the body. While improper diet is the most important cause, other causes include exhaustion, frequent sex, intense worry, and emotional disturbances. Improper fat metabolism in the digestive system creates a variety of aama, which shows a special affinity for the bones and joints. Since the membrane lining the colon is intimately connected with the nutrition of cartilage and bone, this aama swiftly reaches its preferred location and deposits itself. The immune system sweeps into attack, and the disease is created. If allowed to continue unchecked, the inflammation becomes chronic and destroys the joint, which causes nearby muscles to shrink. All this happens because of undigested material in the colon. The pain and stiffness in the muscles and joints increase gradually over weeks or months, accompanied by unusual tiredness and a general feeling of unease. In one out of every ten victims, however, it develops all of a sudden, followed by fever, severe uneasiness, body ache, indigestion, and tastelessness. Like other autoimmune diseases, chronic rheumatoid arthritis displays two separate, alternating phases: exacerbation and remission. During the exacerbation phase, there is acute inflammation of the joints. During remission, the symptoms disappear because the acute accumulation of the doshas (causative forces in the disease process) in the joints is scattered.

Because there is much aama in arthritic joints, any dosha accumulation in the digestive tract always tends to return to the joints and exacerbate the condition again. Health can return to the joint only if aama is treated. Effective management of arthritis involves immediate elimination of doshas during exacerbation, and gradual elimination of deep aama during remission.

Guidelines & Ayurvedic Remedies

The basic philosophy of therapy for rheumatoid arthritis is as follows: Food during an exacerbation should be light, little and liquid. Weak ginger tea taken with lemon and honey, if necessary, is best when your tongue is thickly coated. Then take rice, gruel, and green gram soup. Continue it for at least a week before going back to your normal diet. You should try to avoid animal fats, fried foods, dairy products, refrigerated food, white sugar, alcohol, chillies, potatoes, tomatoes, peppers, and tobacco. Reduce the use of salt. Of the oils, castor oil alone can reduce the inflammation and scrape out the aama. A film of castor oil should be applied on the affected joint, and then dry heat should be applied. Wet heat aggravates obstruction and congestion. Take a mixture of equal parts of sand and powdered rock salt, heat it in a pan and pour the heated powder into a cotton or linen bag, and apply it to the joint. It helps dry out congestion in the joint. Sunbath is also good for arthritic joints. The intake of bitter and pungent substances controls vaata and relieves aama. Especially during exacerbation, they stimulate digestion indirectly and help reduce, inflammation. Bitterness is especially needed when there is severe and generalised body ache, loss of appetite, loss of taste, indigestion, and fever. Some commonly available substances which are wholly or partly bitter include: gudochee (Tinospora cordifolia), neem bark, etc. Bitter Ayurvedic compounds like Mahaasudarshan choorna, etc., actively help eliminate the allergic state from the system if used regularly for at least six weeks. Triphala guggulu, a compound preparation, is often useful in such conditions, since triphalas (three myrobalans) in it purify the system and long pepper improves digestion while guggulu, a plant exudate, controls the inflammation in the body. However, Simhanaada guggulu is the best medicine during exacerbation. It contains castor oil as one of the important ingredients. If the digestive tract is coated with aama, it is wise to take 2 to 4

tablespoonfuls of castor oil plus a cup of strong tea made of dry ginger to thoroughly flush the colon and purify the joints. There is one simple recipe for rheumatic complaints. Crush 2-3 cloves of garlic, add it to a glass of diluted milk, then reduce to a quarter and drink it just before bed-time. Eating a balanced anti-allergic diet is appropriate when the exacerbation diminishes. Good Ayurvedic oils for rheumatic conditions are Dhanwantara tailam, Ksheerabalaa tailam, Sahachaaradi tailam and Vishagarbha tailam. All these oils are medicated to purify and lubricate the joints. Intermittent medicated enemas, especially when bowel habits change and the lower tract is full of gas, are important to keep the lining of the colon healthy and clear of aama. Guggulu is useful during remission to remove old, adherent aama from the dhaatus (basic body structures which perform some specific actions). The best varieties here are Yogaraaja guggulu and Mahaayogaraaja guggulu. Both contain more than two dozen pungent herbs for improving digestion, but Mahaayogaraaja guggulu also has minerals in it for a greater rejuvenating effect. Simple yoga postures and breathing exercises encourage elimination of aama. As your health improves, supplement the yoga with energetic exercise. A regular exercise programme is especially important for overweight patients since heavy limbs put extra strain on muscles and joints. Mahaa raasnadi kaada in the dose of 20 ml with equal quantity of lukewarm water twice a day is beneficial. Brihat vaata chintaamani ras in the dose of 125 mg to 250 mg twice or thrice daily is the drug of choice.

Anti-inflammatory Herbs
The ayurvedic-materia-medica lists a wide range of anti-inflammatory drugs that can reduce the pain and swelling in case of different arthritic conditions. The treatises like Charaka samhita, Sushruta samhita, Bhaava prakaasa etc, described these drugs. A good number of scientific inquiries have been made for evaluating the anti-inflammatory activity of these medicinal plants by several researchers. Ginger: The Department of Environmental Medicine, Odenes University, Denmark (1989) conducted clinical studies on patients suffering from arthritis by giving dry ginger powder and fresh ginger. Better movement of joints was observed in these studies. Recent studies have shown that ginger is capable of preventing the synthesis of prostaglandins which are

responsible for inflammation. These observations were published in the Chemical and Pharmaceutical Bulletin, 1992. For stomach ache, just take the infusion of dry ginger with a tablespoonful of castor oil. Dry ginger with sarjakshaara and a pinch of hing (asafoetida) is also a popular remedy. In chronic rheumatism, take the infusion of dry ginger just before going to bed, and cover your body with blankets to produce copious perspiration. Externally for the relief of arthritic pain, you can apply ginger as paint or plaster made by rubbing the tuber with little water. Licorice root: Gujral and his associates (1956) have claimed that yashtimadhu or licorice is the best herb for treating inflammatory diseases. After this study, Malhotra and Ahuja investigated and came up with the fact that the efficacy of licorice is due to glycyrrhinitic acid and its steroid nature. Licorice is popular today as it was 3,000 years ago and is freely available even at the grocery shops. Chew a piece of licorice or try its extract, which is even more effective. Its decoction taken after meals, aids digestion and acts as an antidote for peptic ulcers, gastritis and gouty arthritis. Asafoetida: If 2 gm of hing or asafoetida is dissolved in one tablespoonful of coconut oil and applied as an analgesic balm, it gives immediate relief from inflammatory conditions. In addition, the paste of hing mixed with lime juice can be applied over wasp, bee and scorpion stings. Turmeric: A volatile oil isolated from the fresh rhizomes of turmeric was found to possess marked anti-inflammatory activity. So, take a pinch of turmeric a day to keep degenerating diseases away. Externally you can even apply a poultice prepared by mixing turmeric powder with a little slaked lime and the white of an egg and give a mild fomentation for relief of pain caused by sprains, myalgia, dislocation of joints, boils, cuts, wounds etc. Garlic: Recent studies established the anti-arthritic nature of garlic. Daily doses can strengthen your immune system; rid you of pain, and even clear up your arthritic conditions. Vitex negundo (Nirgundi): Leaves of Nirgundi or Vitex negundo are recommended mainly in inflammatory, glandular and rheumatic swellings by Ayurvedic treatises. Marking nut (Bhallataka): Application of marking nut to ease joint pains is still prevalent in suburban areas of India. Recently, in some of the experimental studies, its use in the treatment of rheumatoid arthritis has shown that the patients ESR had been reduced and Dxylose absorption had also improved. However, as this drug is a potent irritant, it should be handled very carefully. Nyctanthes arbortristis (Paarijaata): The alcoholic extract of the leaves of

paarijaata has a significant tranquilizing as well as a dose dependent antipyretic effect and histamine antagonistic and purgative activities. In a clinical study, the leafy decoction, 30 ml per day of this drug was administered in 24 cases of sciatica and statistically significant results were observed.

Note
As we all are genetically different with different constitutions and patterns, we respond to treatments in many different ways. Hence Standard Ayurvedic Treatments are always individually formulated. This article is intended only for information. It is not a substitute to the standard medical diagnosis, personalized Ayurvedic treatment or qualified Ayurvedic physician. For specific treatment, always consult with a qualified Ayurvedic physician.