Journal of Clinical Rheumatology in Ayurveda

REVIEW ARTICLE
Year
: 2013  |  Volume : 1  |  Issue : 1  |  Page : 32--40

Anti-arthritic natural medicine: Classical Ayurvedic and ethnomedical source


Reshmi Pushpan, K Nishteswar, Harshitha Kumari 
 Department of Dravyaguna, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India

Correspondence Address:
Reshmi Pushpan
Department of Dravyaguna, IPGT and RA, Gujarat Ayurved University, Jamnagar - 361 008, Gujarat
India

Abstract

Seers of Ayurveda recorded their clinical findings from drugs of vegetable, animal, and mineral origin. Ayurvedic therapeutics contains single, simple as well as poly-herbal formulations for the management of arthritic disorders such as Āmavāta, Vātarakta , and Sandhigatavāta0. In this paper, in addition to scientifically validated pharmacological studies, information about herbs from classical as well as ethno botanical sources are compiled, analyzed, and presented. Rāsnā (Pluchea lanceolata (DC) Oliv. and Hiern), Gudūcī (Tinospora cordifolia (Thunb.) Miers), Źunthi (Zingiber officinalis Roxb), Guggulu (Commiphora mukul (Stocks) Hook), Aśvagandhā (Withania somnifera (L.) Dunal), Śatāvarī (Asparagus racemosus Willd.), Balā (Sida cordifolia L.), Erandamūla (Ricinus communis L.), Punarnavā (Boerhavia diffusa L.) are a few prominent drugs in classical Ayurvedic literature recorded for joint disorders. Plants like Azadirachta indica A. Juss (seed oil and stem bark), Cardiospermum halicacabum L.(leaf) Drynaria quercifolia (rhizome), Hemidesmus indicus (L) R.Br, Dodonaea viscosa Jacq, and Leonotis nepetifolia (L.) R.Br were found to have multiple modes of administration for arthritis in ethno medicine.



How to cite this article:
Pushpan R, Nishteswar K, Kumari H. Anti-arthritic natural medicine: Classical Ayurvedic and ethnomedical source.ASL Muscuskel Dis 2013;1:32-40


How to cite this URL:
Pushpan R, Nishteswar K, Kumari H. Anti-arthritic natural medicine: Classical Ayurvedic and ethnomedical source. ASL Muscuskel Dis [serial online] 2013 [cited 2020 Oct 1 ];1:32-40
Available from: http://msd.ancientscienceoflife.org/text.asp?2013/1/1/32/111937


Full Text

In recent years, the disease of connective tissue, joints, and bones have become a topic of growing interest for modern researchers with an aim to evolve safer anti-inflammatory drugs from alternative systems like Ayurveda and native healing practices. Surveys in general practice suggest that nearly 10% of the clinical practice is devoted to the diagnosis and treatment of musculoskeletal disorders viz. rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, systemic lupus erythematosis, gout, intervertebral disc disease, etc., which are grouped under the term “rheumatism.”[1] The conditions like Āmavāta, Sandhivāta, Vātarakta, Katīśūla, Krostukaśīrsa, and Grdhrasī etc., described in Ayurveda classics[2],[3],[4],[5],[6] are the major conditions afflicting the joints. The diseases namely Āmavāta, Sandhivāta, and Vātarakta are interpreted as rheumatoid arthritis, osteoarthritis, and gout respectively by most of the Ayurvedic scholars. Some of the Ayurvedic scholars especially of the Kerala tradition consider rheumatoid arthritis as Vatarakta under the chronic stage known as Gambhira Vatarakta.[1]

The information recorded in Ayurvedic classics about phyto-medicinal formulations clearly indicates that Ācāryas of Ayurveda had utilized the source of ethno medicine.[3] Pandit Narahari advocates that the information collected from ethnic sources should be evaluated on the basis of pharmacodynamic principles promulgated by wise scholars of Ayurveda.[7] A series of clinical enquiries conducted by ancient seers were documented well in the works of Ayurveda. Acharya Caraka delineated his clinical observations in the chapter on Vātarakta (more akin to rheumatoid arthritis and other auto-immune connective tissue disorders like systemic lupus erythematosus). A lot of plants are used singly or in poly herbal formulations in various dosage forms like decoctions, powders, medicated oils, paste, etc., either externally or internally for the management of Vātarakta by Ācārya Caraka. Scientific investigations have been carried out by modern research scientists successfully to assess the safety, efficacy, and anti-inflammatory potential of a few of these drugs like Zingiber officinale,[8],[9] Ricinus communis,[10] Commiphora mukul,[11] Boswellia serrata, Nyctanthes arbortristis, etc., which were included in the prescriptions of arthritis and other musculoskeletal disorders of Ayurvedic texts. The paper is an attempt to review the anti-arthritic drugs from Ayurveda and ethno medicine.

 Materials and Methods



Collection and analysis of the data with regard to anti-arthritic herbs from Ayurvedic classical literature such as Caraka Samhitā, Suśruta Samhitā, Astāṅga Hrdaya, and Bhāvaprakāśa has been carried out. Similarly, ethno medicinal information of plants used in India for joint complaints was compiled, tabulated, and analyzed from books, published scientific papers and online ethno botany journals. In addition, to online biomedical journals, the herbs with proven anti-arthritic activity in experimental models were collected from books, pharmacology, and biomedical journals.

Anti-arthritic herbs of Ayurveda

The common pathology for all the clinical conditions like Āmavāta, Sandhigatavāta, Vātarakta, etc., is the malfunctioning of Jatharāgni (the factors which participate in and direct the course of digestion and metabolism) leading to the formation of Āma (incompletely or partially metabolized).[12],[13] This plays a pivotal role in the pathogenesis of Āmavata, a condition more akin to arthritis and related conditions. When Āma is not properly treated it reaches the toxic state called Āmavisa and cause a condition exactly similar to metabolic histotoxic anoxia.[14] All these conditions are considered difficult to treat, having non-specific Pūrvarūpa (prodroma)[15] hence making these conditions difficult for an early diagnosis. The intention of treatment is to provide symptomatic relief, slow down the disease process, improve mobility and expel the accumulated Āma out of the body. The pharmacotherapeutics furnished in the Ayurvedic literature incorporates the drugs having Dīpanīya, Āmapācaka, Śūlahara, and Rasāyana activities for the management of these clinical conditions. The most common poly-herbal formulations adopted in clinical practice for treating joint conditions are Pañcakolacūrna, Vaiśvānara cūrṇa, Pañcakolakvātha, Rasnāsaptakakvātha, Rasnādikvātha, Daśamūlakvātha, Yogarājaguggulu, Kaiśoraguggulu, Simhanādaguggulu, Triphalāguggulu, Śatapākībalātaila, Piṇḍataila, Śatāvarīghṛta, Balāghṛta, etc., Formulations are selected based on Doṣa preponderance, Prakṛti, stage of the disease, clinical presentation, deśa, kāla, bala etc., The plants commonly found repeated in anti-arthritic formulations is enumerated in [Table 1].

Some of the important plants includes Rasnā, Hiṅgu, Śuṇṭhī, Rasona, Guḍūcī, Eraṇḍa, Devadāru, Gokṣura, Punarnavā, Citraka, Katukī (Picrorhiza.kurroa Royle ex Benth), Muṇḍī, Varuṇa (Crataeva nurvala Buch. Ham), Triphalā, Mustā, Ajamodā, Viṣṇukrāntā (Evolvulus alsinoides L.), Prasāraṇī (Paedaria foetida L.), Haridrā, Yaṣṭi, Kokilākṣa, Guggulu, Balā, Atibalā, Vāsā, Āragvadha, Śatāvarī, and Nāgabalā. Aśvattha, Guḍūcī, Yaṣṭi, Balā and Guggulu have been incorporated under the single drug therapy in Caraka Samhitā. Vāgbhaṭa, after making a careful review of Caraka's experience shortlisted the most important drugs and identified the herb Guḍucī as the prime drug for management of Vātarakta.[17] He has further included Kokilākṣa as one of the important drugs in the treatment of Vātarakta. Instead of Rāsnā, Gokṣura and Priśniparṇī are employed by Suśruta in the management of Vāta dominant symptoms of Vātarakta, Guḍūcī in pitta dominant Vātarakta and Guḍaharītakī in Sarvajavātarakta. The pharma industry of the current times is procuring the above listed herbs in bulk quantities while processing anti-arthritic formulations. The herbs namely Guggulu, Rasnā, Balā, Guḍūcī, Sahacara, Eraṇḍa, Aśvagandhā, Śatāvarī, and Daśamūla forms the core list of drugs used in treating all form of rheumatic conditions and the annual consumption of all these medicinal plants are estimated to be more than 100 metric tons[18] (some even more than 1000 metric tons). All these plant material is being collected mainly from the wild. Drugs like Śrāvaṇī, Rāsnā, Pṛśniparṇī, Pāṣāṇabheda, Trāyamāṇā, Śaṅkhapuṣpī, Jīvantī, Padmakāṣṭha, Sahacara, Balā, etc., have divergent sources being used in different parts of the country.[19],[20] Some of the species like Commiphora mukul, Aegle marmelos, Oroxylum indicum, Piper longum, Nigirianthus ciliates, Decalepis hamiltonii, Gentiana kurroo, Holostemma ada-kodien, Pueraria tuberosa, Santalum album, etc., are reported to be placed anywhere from near-threatened to critically endangered.[21] Thus, it becomes essential to look out for lesser known locally available Indian medicinal plants which are effective in joint complaints.{Table 1}

Anti-arthritic herbs from ethno medicine

Ethno botanical information of plants used in India for treating various joint complaints is recorded in books on ethno medicinal claims and also as reports in leading journals on ethno botany and traditional medicine. In this review, attempt has been made to analyze such plants, which are extensively used in tribal or folk systems and have been reported in ethno botanical literature for joint complaints. The part used and route of administration has been compiled as research needs to be done specifically using the specified plant part in traditional or folklore medicine rather than random screening of the medicinal plant. Some lesser known indigenous medicinal plants of India used for joint complaints have been tabulated in [Table 2].{Table 2}

During the literary search in books and research journals on ethno medicinal claims for rheumatism or joint complaints on Indian medicinal plants it was observed that the plants like Allium sativum, Asparagus racemosus, Alpinia galanga, Argyreia speciosa, Asteracantha longifolia, Barleria prionitis, Boerhavia diffusa, Boswellia serrata, Cedrus deodara, Commiphora mukul, Pseudarthria viscida, Ricinus communis, Sida cordifolia, etc., which are classical Ayurvedic drugs used in treating joint disorders are also used by different tribes and folklore healers in various parts of India for the same. About 398 drugs were identified as being used in treating joint conditions in ethno medicine, out of which approximately 250 drugs were classical Ayurvedic drugs. The present review thus revealed that folk medicine or tribal medicine is quite prevalent and still forms an integral part of primary health care. Maximum numbers of medicinal plants are used externally in the form of paste, oil, poultice, etc., over the affected area to relieve pain. Mustard oil, neem oil, and coconut oil were found documented as base oils for external application. The plants with both internal and external application include Achyranthes aspera, Allium sativum L., Cleome gynandra L., Cissus quadrangularis L., Dalbergia lanceolaria L.f., Dodonaea viscose Jacq., Erythrina stricta Roxb., and among them Cissus quadrangularis is reported to have phytogenic steroids possessing bone healing properties. The aqueous extract of the plant is reported to hasten fracture healing by reducing the total convalescent period by 33% in experimental animals and aid in recovery of the strength of the bone up to 90% in 6 weeks.[37] Allium sativum is another drug considered to be prime drug for vata disorders in Ayurvedic texts that relieves pain in inflammatory conditions. Plants like Azadirachta indica A. Juss (seed oil and stem bark), Cardiospermum halicacabum L. (leaf) Drynaria quercifolia (rhizome), Hemidesmus indicus (L) R. Br were found to have multiple modes of administration. Solanum nigrum L., Allium sativum L, Cardiospermum halicacabum L, Capsicum annum L. etc., were consumed as modified diet for preventing rheumatic complaints.

Analysis of medico-ethno botanical claims recorded above clearly indicates that tribals prefer such a part of the plant viz, leaf and bark which prevents the total destruction of the species. Renewable plant parts like leaves, flowers, fruits, stem, and bark are utilized predominantly. Plants of Fabaceae, Malvaceae, Verbenaceae, Rutaceae, Lamiaceae, Apocynaceae, Acanthaceae, and Asteraceae pre-dominate the anti-arthritic herbs in tribal practice of which maximum number are herbs or shrubs.

Scientifically validated anti-arthritic herbs using experimental models

It is not only very essential to conserve the wealth of knowledge and wisdom found among the tribe's and indigenous practitioners but, also to find out effective formulations utilizing these herbs for mainstreaming these practices. A large number of plants have been scientifically validated and reported for its anti-arthritic activity through experimental models. A very few of the classical Ayurvedic and folklore medicinal plants validated pharmacologically with anti-arthritic property has been enumerated in [Table 3]. Plants with proven anti-arthritic activity are included while anti-inflammatory activity was not considered in this present review.{Table 3}

The analysis of published papers about anti-inflammatory and anti-arthritic drugs clearly indicate that the anti-inflammatory activity of many a plants were reported in comparison to the anti-arthritic activity of medicinal plants. Based on the details furnished about ethno medicinal claims of anti-arthritic activity it appears that there is a wide scope for exploring the anti-arthritic activity of non-classical herbs which are not in popular use.

 Conclusion



The drugs from natural source like Guḍūcī, Aśvagandhā, Guggulu are occupying prime place in anti-rheumatic classical and proprietary formulations. The plants namely Rāsnā, Nirguṇdī, Pippalīmūla, Aśvagandhā, Kulañjana, Pārijāta are found to have broad spectrum anti-rheumatic activity and found to be useful in the arthritic conditions like rheumatoid arthritis, gout, and osteoarthritis which are considered in autoimmune, metabolic, and degenerative pathologies respectively. Lāṅgalī (Gloriosa superba Linn.) is having colchicine which is useful in gouty arthritis.[61] Bhāvaprakāśa designed a formulation namely Lāṅgalyādiguṭikā consisting of Lāṅgalī, Guḍūcī, Triphalā, Trikaṭu, Guggulu, Drākṣā, Mātuluṅga, and Iron for acute conditions of Vatarakta.[6] The anti-rheumatic herbal industry is currently limited to a certain few which if continued to be used to meet the global demand could lead to over exploitation and extinction of these species. The herbs like Cleome gynandra, Justicia gendarussa, Leonotis nepetifolia, Premna herbacea, Dodonaea viscosa, etc., may be screened thoroughly for anti-rheumatic new drug development.

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