|Year : 2013 | Volume
| Issue : 1 | Page : 1-3
Rheumatoid arthritis: Ayurvedic perspectives
AVP Research Foundation, Tamil Nadu, India
|Date of Web Publication||23-May-2013|
136/137, Trichy Road, Ramanathapuram P.O., Coimbatore - 641 045, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Manohar R. Rheumatoid arthritis: Ayurvedic perspectives. ASL Muscuskel Dis 2013;1:1-3
We have great pleasure in placing the first issue of ASL-Musculoskeletal Diseases before the Ayurvedic community. In one way, this is the first journal dedicated to a clinical specialty in the field of Ayurveda. Musculoskeletal Diseases make up a large chunk of the number of patients that come to Ayurvedic physicians for consultation. There is a lot of data that can be generated just from the ongoing clinical practices on musculoskeletal diseases. ASL-Musculoskeletal Diseases was conceived to serve as a platform to report and showcase the strengths and limitations of Ayurveda in handling musculoskeletal diseases. We hope that this journal will help to bring good science to back up the medicines and treatments that Ayurveda offers for the management of musculoskeletal diseases so that informed decisions can be taken in clinical practice and new directions can be discovered for research and innovation.
In spite of the clinical exposure to musculoskeletal diseases, the number of research papers published from the field of Ayurveda on this clinical specialty is rather scarce. Submission of research papers exclusively on a clinical specialty area is negligible when we look at publication trends in existing research journals. This fact becomes explicitly evident when we consider the long wait to launch the first issue of the journal after the call for papers was announced. It took more than a year to get a handful of papers that could make up the inaugural issue of the journal. For this reason, ASL-Musculoskeletal Diseases will be published only twice a year. To make up for the long wait between the publications of issues, ASL-Musculoskeletal Diseases has adopted an Online First publication Policy, where the accepted paper will be immediately published ahead of print on the journal website before allocation to a particular issue.
We have a new baby and there are the teething problems. As the journal turns into a toddler in the next few issues, we really hope that it will receive good nourishment in the form of high quality submissions that reflect authentic clinical experience and good science. Moreover, we hope that the journal will serve as a platform for dialog between researchers and practitioners in not only the field of Ayurveda but also in other allied disciplines in the realm of healthcare.
This editorial begins with a debate to stimulate dialog between physicians in the Ayurvedic community. As the adage goes, "Physicians should engage in dialog with each other"-(bhiṣak bhiṣajā saha saṃbhāṣeta).  We focus on rheumatoid arthritis (RA) and the Ayurvedic understanding of the disease. Is RA mentioned in the Ayurvedic texts at all? How do Ayurvedic physicians approach the diagnosis of the disease and chalk out a plan of treatment? We would like to sketch some initial thoughts on this subject to initiate a conversation.
RA is a long-term inflammatory disease primarily involving the joints of the body. It may also affect other organs.
The etiology of the disease is not well understood. However, the diagnostic criteria for RA are well developed and help identify the condition in clinical practice.
Typically, the disease begins slowly and affects the smaller joints first. The symptoms are mild joint pain associated with stiffness and fatigue. Symmetrical involvement of joints is a characteristic sign of RA, as is morning stiffness. Other joints get affected in due course of time. RA seems to have been known to Ayurveda since centuries, and Ayurvedic physicians treat the condition, albeit scientific studies have not yet generated undisputable evidence supporting efficacy of Ayurvedic interventions in RA.
There are two schools of thought regarding the understanding of RA from an Ayurvedic perspective. One school equates RA with the condition described in Ayurveda as Āmavāta. The other school equates it with the condition described as Vātarakta in Ayurveda. These opinions have developed over a period of time based on the experiences of clinicians and the accounts in the classical texts. However, the issue has not been taken up for a formal debate or discussion to arrive at a conclusion that is objective and logical.
The larger section of the Ayurvedic community considers RA to be Āmavāta, while a smaller section of Ayurvedic physicians, especially from the tradition of Ayurveda in Kerala, prefer to correlate RA with Vātarakta. Those who consider Āmavāta to be RA correlate Vātarakta with gouty arthritis. The Ayurvedic Pharmacopoieia of India equates Āmavāta with Rheumatism and Vātarakta with gout. 
It is important to note at this juncture that Āmavāta appears as a well-defined clinical entity only around the 8 th or 9 th century CE in the textbook on diagnostics known as Mādhavanidānam. This name does not occur in the earlier textbooks like Caraka Saṃhitā or Su?ruta Saṃhitā or even in the works of Vāgbhaṭa-the Aṣṭāṅga Hṛdaya or Aṣṭāṅga Saṃgraha. 
For the above reason, many clinicians argue that there is no room for debate on this issue. In the period of Caraka, Su?ruta and Vāgbhaṭa , RA would have been correlated with the syndrome of joint diseases described in Ayurveda as Vātarakta. Whereas, after Mādhava's period,  RA has been described more specifically as Āmavāta. Those who follow Caraka's school of thought consider RA as Vātarakta and those who follow Mādhava's consider RA as Āmavāta.
The clinical presentation of Āmavāta and Vātrarakta converge and diverge with respect to certain characteristic clinical features. Moreover, there are overlaps and deviations in the treatment protocol of both these conditions. Therefore, it is necessary to engage in debates and discussions to bring clarity in the understanding of RA from the perspective of Ayurveda.
There are two basic approaches that can be adopted to resolve the conflicting views on the identity of RA from the point of view of Ayurvedic nosology. One approach would be to compare the clinical features of RA with those of Āmavāta and Vātarakta. The other approach would be to compare the efficacy of the treatments for Āmavāta and Vātarakta in the management of established cases of RA.
Systematic studies comparing the clinical features of RA with that of either Āmavāta or Vātarakta are not available. There are many published clinical studies that have evaluated the efficacy of Ayurvedic treatment in the management of RA. It would be an interesting exercise to find out how many of these studies treated RA as Āmavāta and Vātarakta as well as compare the outcomes of treatment based on the differences in diagnosis.
We would like to nurture a healthy debate on the identity of RA from an Ayurvedic perspective, and, beginning with this issue, we would present some key arguments for discussion with the participation of the readers of the journal. To begin with, we can look at the onset of RA in comparison with the descriptions of Āmavāta and Vātarakta. The onset of RA is insidious and the development of signs and symptoms happens slowly over weeks and months, with exception of some cases that progress rapidly. In some cases, general symptoms like malaise, fever, fatigue, loss of appetite, weight loss, muscle aches, and weakness of energy can manifest before the joints are affected.
RA primarily affects the joints of the hands, wrists, elbows, knees, ankles, and feet. Shoulders, hips, and jaw can also be affected. In very chronic conditions, the vertebrae of the neck may also be affected. It is a typical sign of RA for joints to be affected symmetrically. Affected joints become stiff, inflamed, swollen, and painful. Stiffness of joints, especially in the morning, that improves as the day passes, is a characteristic of RA.
Let us look at the signs and symptoms of Āmavāta as described by Mādhava. According to Mādhava, Āmavāta progresses in at least three distinct stages. In the first phase, there is a build-up of Āma in the body, which can be understood as a byproduct of improper or defective metabolism. This condition may produce symptoms of Āma in general and makes the person susceptible to Āmavāta. When such an individual indulges in unwholesome activities that make the joints vulnerable, the disease manifests.
Vāta and Kapha get deranged simultaneously and affect the Trika Sandhi (joints of the hip and low back or neck and shoulder) and causes generalized stiffness of the body.
Body ache, fever, fatigue, heaviness, swelling of body parts, loss of appetite, and thirst are the general signs of Āmavāta. When this condition aggravates, the joints of the hand, feet, head, ankle, low back, knee, and hip joints are affected with swelling and pain of a severity comparable to that by a scorpion bite.
In comparison, Vātarakta is caused by diet and habits that vitiate rakta and vāta. A process of vidāha (akin to inflammation) that happens in the blood due to faulty diet coupled with bad lifestyle is the underlying pathology in Vātarakta. The Caraka Saṃhitā mentions explicitly that Vātarakta first affects the joints of the hands and feet, especially the joints of the fingers, and then later affects the other joints. Vāgbhaṭa and Mādhava point out that it predominantly affects the feet and sometimes the hands and spreads to other joints slowly, just like rat poison. The commentators mention that the allusion to rat's poison is to point out the slow progress of the disease, although it is difficult to comprehend what is meant by rat's poison here. It is interesting to note that Caraka mentions the hands first, whereas Vāgbhaṭa and Mādhava point out that the joints of the feet are affected first.
Another important feature in the onset of Vātarakta is repeated flare ups and remissions for some time before the disease establishes. The descriptions of Vātarakta indicate that joints of both legs and both hands get affected simultaneously. This seems to point to the symmetrical involvement of the joints. We have summarized the typical descriptions of the onset of RA, Āmavāta, and Vātarakta in [Table 1].
|Table 1: Comparison of onset and clinical features of rheumatoid arthritis, Amavata, and Vatarakta|
Click here to view
This preliminary discussion shows the need for a more careful examination of the conditions Āmavāta and Vātarakta based on textual descriptions and the features of RA. We hope to continue the discussion in the next issue of the journal and solicit comments from the Ayurveda community.
| References|| |
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|2.||Department of Indian Systems of Medicine and Homoeopathy. Ayurvedic Pharmacopoeia of India, Part 1, vol. 1., Ministry of Health and Family Welfare, Govt. of India; 2001. |
|3.||Vaidya J, Trikamji A. Sushruta Samhita. Varanasi: Chaukhambha Surbharti Prakashan; 1997. |
|4.||Harisastri. Ashtanga Hridayam. Varanasi: Chaukhambha Orientalia; 2002. |
|5.||Vachaspati V. Madhava Nidana. Varanasi: Chaukhambha Orientalia; 1986. |