Ayurvedic Management of
Arthritis
Dr. Pradeep DuaCentral Council for Research in
Ayurvedic Sciences (CCRAS)February 14, 2011
‘Health’- Ayurveda Perspective
Samadoshaha samagnischa samadhatumalakriyaah;
Prasannatmendriyamanaah svastha ityabhidhiyate.(Sushruta Samhita)
Ayurveda defines health as balance of the three dosas (biological humors), the agni (digestion and metabolism), the dhatus (tissues) and the malas (excretion),as well as the sensorial, mental and emotional and spiritual well being (prasanna). Thus Ayurveda presents the most complete definition of health which is in coherence to that of W.H.O.
objectives of Ayurveda “swasthasya swasthya rakshanaam, aturasya vikara prashmanam”
To maintain the health of the healthy
To treat the ailingAyurveda is essentially the science of life and longevity. It presents a sound concept of aging, its prevention and management. Ayurveda specially incorporates Rasayana Tantra as one of its Astanga specialities, which is exclusively devoted to nutrition, immunology and geriatrics.
The Dimensions of Geriatric Care
Geriatric Care has two distinct dimensions, * Promotion of health and longevity, * Management of diseases of old age .
The conventional modern medicine is apparently strong in terms of the second dimension whereas, Ayurveda is notably strong in terms of the first dimension as it has rich potential to promote health of the elderly, besides the scope of rejuvenation and promotion of longevity.
The foremost classic of Ayurveda ,the Caraka Samhita begins its deliberations in its very first chapter with Deerghanjivitiya Adhyaya.
Forecasted Percentages of the Elderly (65+ years) During last few decades there has been a
noticeable rise in the average life expectancy of the people in India and now there is an obvious shift in the age distribution denoting population-aging.Country/
RegionYear 1950 -% Year 2000-% Year 2050-%
World 5 6.9 19.3
Africa 3.2 3.3 6.9
Latin America 3.7 5.4 16.9
China 4.5 6.9 22.7
India 3.3 5 14.8
Japan 4.9 17.2 36.4
Europe 8.2 14.7 29.2
U.S.A. 8.3 14.7 29.2
Ageing Scenario in India:
The ten most common diseases are
1. Hypertension 7.Cataract 2. Osteoarthritis 8.Diabetes 3. Dyspepsia 9.Constipation 4. Depression. 10.Ischaemic heart
disease 5. Benign prostatic hypertrophy 6. Chronic obstructive pulmonary disease
Osteoarthritis
‘Osteoarthritis’ is 2nd commonest(30%) musculo-skeletal disorder in the world after ‘Back ache’ (50%)-W.H.O.
‘Osteoarthritis’ clinically presents as joint pain and crepitus, mostly in the elderly people.
Risk factors: Genetic factors Age Obesity Occupation related mechanical stress Repetitive stress Joint damage (Trauma, Sepsis) Bone/ Joint related congenital defects Crystal accumulation in articular
cartilage Prior inflammatory joint disorder Metabolic/ endocrine disorders. Quadriceps weakness
Ctd.
Obese persons have a higher risk of developing ‘Osteoarthritis’.
5% reduction in weight decreases the risk of ‘Osteoarthritis’ by 50%.
Clinical Features -‘Osteoarthritis’:
Symptoms- Pain (in or around the affected
joint); often aggravated by joint use and relieved by rest. Gradually, the pain becomes persistent and in advanced cases, the night pain may be troublesome.
Morning stiffness (in the involved joints) may last up to half an hour.
Ctd.
Signs- Bony swelling Synovial effusion Crepitus (sensation of bone rubbing
against the bone, on movement) Restricted movements Joint deformity Muscle weakness and wasting
MISERABLE OLD AGE Mamsakshaya – Sandhivedana
(Arthralgia) Asthikshaya – Asthitoda (Osteodynia) Majjakshaya – Asthisoushirya
(Osteoporosis)
Ayurvedic Management:
Preventive: Sadvrutta / svasthavratta RasayanaCurative: Medicines (Single Herbs & Compound
Formulations) Panchakarma Diet & Lifestyle Home Remedies
Sadvrutta / svasthavratta ‘svasthavratta’- a comprehensive schedule of
health regimen for preservation of health as a code of health conduct
Dinacarya /Ratricarya - daily code of health conduct
Rtucarya- conduct in relation to various seasons
Sadvrtta- Details about life style, diet, exercise, personal and social hygiene
Pancakarma- periodical biological cleansing Rasayana- restorative remedies for rejuvenation
(promotion of health & longeivity)
Rasayana Rasayana (Rasa = nutrition + Ayana = circulation &
promotion) specially deals with the science of nutrition, geriatric care and rejuvenation. Rasayana signifies not a single drug or medication, rather refers to a rejuvenative regimen which of course uses rejuvenative remedies or drugs, dietetics and overall healthy life-style and positive psychosocial conduct. The use of Rasayana measures and remedies produces best qualities of Dhatus, i.e. body-tissues
Ctd. An important text of Ayurveda, namely
Sarangadhara Samhita describes the process of aging depicting the features of specific bio-losses occurring during different decades of life due to aging. These descriptions are relevant even today if the chronology is corrected with present life-span of man. This is specially significant because it can provide a guideline for selection of age-specific organ-protective Rasayanas to restore the age-related bio-losses during different decades of the life span as a measure to retard aging.
Ctd.Decade
Age related Bio-loss Restorative Rasayanas
0-10 Baalyam Gradual Loss of childhood Vacha, Gambhari
11-20 Vruddhi Gradual Loss of growth Amalki, Bala
21-30 Chhavi Gradual Loss of lusture Haridra, Kumari, Louha
31-40 Medha Gradual Loss of intellect Brahmi, Shankhapushpi
41-50 Tvaka Gradual Loss of skin glow Kumari, Somaraji
51-60 Drishti Gradual Loss of vision Triphala, Jyotishmati
61-70 Shukra Gradual Loss of virility Ashvagandha, Kapikacchhu
71-80 Vikuma Gradual Loss of strength Amalki, Bala
81-90 Buddhi Gradual Loss of cognitive ability
Brahmi, Mandukaparni
91-100 karmeindriya
Gradual Loss of locomotive ability
Amalki, Bala, Ashvagandha
Medicines
Single drugsS. No.
Drug Dosage Vehicle
1 Shunthi Churna 1-3 gm Milk
2 Eranda Mula Kvatha 10-30 ml Water
3 Nirgundi Kvatha 10-30 ml Water
4 Rasna Kvatha 10-30 ml Water
5 Rasona Ksheer Paka 30 ml milk
Ctd. Compound formulationsS. No.
Drug Dosage Vehicle
1 Maharasnadi Kwath 10-30 ml Shunthi churna
2 Rasna-erandaadi Kwath 10-30 ml Water
3 Dashmula Kwath 10-30 ml Water
4 Rasnadi Guggulu 500 mg – 1 gm
Luke warm water
5 Mahayogaraja Guggulu 500 mg – 1 gm
Luke warm water
6 Yogaraj Guggulu 500 mg – 1 gm
Luke warm water
7 Mahanarayan Taila For external application
8 Vishgarbha Taila For external application
9 Panchanga Taila For external application
10 Narayana Taila For external application
11 Mahamaash Taila For external application
12 Vatgajaankusha Rasa 125 mg Rasna kwath
Panchakarma1. Snehana: Massage with medicated oils such
as Mahanarayana taila Dashmula taila Mahamasha taila Vishagarbha taila etc.
2.Swedana Ekanga or sarvang sweda (Hot fomentation) with
decoction of Nirgundi, Dashamula, Eranda and Bala etc.
Patra pinda sweda (made from Nirgundi, Datura, Eranda, Chincha, etc.)
3. Basti Anuvasana basti with Narayana taila and niruha
basti with dasamula kwatha.
Ctd.
Upanaha sweda and; Joint specific Oleation (Janu vasti /
Kativasti)-Reduces synovial Inflammation & Pain-Drains Effusion-Regains Mobility
Ctd.Pizhichil—Sarvanga Dhara: i.e. Warm Medicated Oil Bath
-Reduces pain & inflammation-Restores mobility & range of
movement-Prevents contracture-Minimize deformity
Ctd.Pottali Svedana—Bolus Sudation:
Patrapotali Sweda- Medicinal leaves bundle Churna Pinda Sweda -Herbal powder bundle
Ctd.
SHASHTIKA PINDA SWEDAMi.e. rice bolus sudation
Vatapittahara sweda Improves muscle bulk, strength & tone Energize the old
Ctd. OSTEO NUTRITIVE ENEMA-
i.e. Thiktha saadhita ksheera vasti
Milk processed with Bitter Drugs (like Panchatikta) , kshira and ghrita.
Remarkable relief in conditions like Avascular necrosis of head of femur, Lumbar spondylosis, Generalised osteoporosis, etc
Anuvasana with Panchathikta ghritha guggulu
Diet & LifestyleDo’s / Pathya:
Masha [Black Gram], Palandu [Onion], Rasona [Garlic], Sunthi / Ardraka [Ginger], Mulaka [Radish], Kushmanda [Pumpkin], Mudga [Green gram] in regular diet.
Fruits like Dadima [Pomegranate], Amra [Mango], Draksha [Grape], etc.,
Adequate rest to joints Regular, slow and gentle exercises Maintenance of posture and flexibility of
the involved joints. Reduction in weight Gentle massage with medicated oils
Ctd.Don’ts / Apathya
Pungent and astringent or salty food and Yava [Barley] etc.
Exposing to too cold atmosphere and consumption cold water, chilled drinks, etc.
Excessive exertion, awaking up to late night and day sleep, long walks
Suppressing of natural urges
Ctd.Counseling: Patients are advised to maintain a healthy
weight Exercise should be done regularly Avoid over exertion Always sit in a right posture Eat freshly cooked food items Take diet rich in antioxidants Exercise for knees – Quadriceps exercise
(patient is asked to lie on bed and arise the legs by slowly with knees in extended position gradually, some weight may be put on ankles and same exercise to be repeated)
Home Remedies Hot fomentation followed by local massage of affected
joint with oil (Tila taila/ Sarshapa taila) Ardraka swarasa (Zingiber officinale) 1 tea spoon daily
with honey 2 times a day for 15 days. Shunthi churna 1 gm , twice daily with milk for 15 days Take equal quantity of thymol, menthol, camphor oil
and sesame oil and gently apply over affected joints. Boil 15 – 20 Harsingar (Nyctanthes arbortristis) leaves
in 4 cups of water till one cup remains and take 1 cup twice a day for 15 days.
Four Lasuna (Allium sativum) bulb-lets boil in 1 cup milk then taken twice a day for 15 days.
Take leaves of Eranda/Nirgundi/ Dhattura, apply some sesame oil; heat the leaves and then apply over affected joints twice daily.
Shunthi powder for local application.
