(Also read a Marathi article on Inflammatory Arthritis and Indian Systems of Medicine and Ayurveda Therapy and lead toxicity and Ayurveda drugs)
Ayurveda (Knowledge of Life), ancient health care system of India, aims at promoting health, preventing diseases and restore life. A large survey indicated that Ayurveda is a preferred by 18.7% people for common ailments. 13.8% cases attending Ayurveda dispensaries are those of arthritis. 28% patients of rheumatoid arthritis use Ayurveda drugs. Department of AYUSH (Ministry of Health) aims at growth and development of Ayurveda and other Indian medical systems and their integration into health care delivery. Indian Government is implementing good manufacturing practices in Ayurveda pharmacies. Central councils conduct and support various aspects of research in Ayurveda. There is increasing global interest in traditional systems of medicine. Rich biodiverse phytopharmacological leads in Ayurveda offer immense chance for new drug development. Evidence based practice can easily be implemented with more research and scientific approach. Integrated functioning Ayurveda and modern medicine can then be practiced for health promotion and disease management.
The Universe is made up of 5 basic elements viz. Earth, Water, Fire, Air and Space. Human body, too, is made up of mind and spirit in addition to these 5 elements. Vata, Pitta and Kapha are 3 vital biological forces (Dosha) that govern every living body. Vata controls body movements and functions, Pitta controls biotransformation and metabolism whereas Kapha manifests as cohesiveness of body constituents. Imbalance of these Doshas leads to disease state. Human body is constituted of 7 body tissues (Dhatu). Quantitative and qualitative optimization of these is desirable for maintainance of health and longevity. Mala are waste products excreted out of the system.
Agni implies capacity for digestion (Jatharagni), metabolism (Bhootagni) and assimilation (Dhatwagni) of food substances. The process of biotransformation and transportation takes place in various body channels (Srotas). Hypofunctioning of Agni and derangement of Srotas are major contributors in development of disease state. Aam, a toxic substance, is generated in human body due inappropriate digestion and inadequate biotransformation of foods, inefficient clearance of waste products and inadvertently ingested or formed non food substances. Aam can be correlated with antigen-antibody complexes responsible for many autoimmune rheumatic diseases.
Vata, the most important Dosha, is responsible for pain in rheumatological and other conditions. The main sites of Vata activity are pelvis, bones, thighs, ears and skin. Vata tends to increase due to various factors including bitter, pungent, astringent, stale and stored foods, hectic lifestyle and frequent traveling, cool and dry climate and advancing age.
Avoidance of causative and precipitating factors, forced expulsion of vitiated Dosha, drug therapy, modification of diet and behavior and Rasayana (therapy for repair and rejuvenation) are important constituents of Ayurveda therapy.
Rheumatology in Ayurveda
Ayurveda has a detailed description of structure and functions of360 bones and 210 joints. Formation of fluid inside the joints is also described. Various rheumatological syndromes described in Ayurveda include: Sandhigata Vata (degenerative-noninflammatory joint disease), Aam Vata (inflammatory joint disease, swollen joints), Vata Rakta, Asthikshaya (osteoporosis, osteomalacia), Kroshtuksheersha, Grudhrasi, Avabahuk, Vishvachi, etc. Management principles remain same as above though details of some of these diseases are unavailable. Fasting and diet modifications are important constituents of therapy. Basti (rectal administration of drugs) is also important in management of rheumatological diseases.
Many plants and formulations have shown promising results in reducing swelling and pain in arthritis. More clinical studies with larger sample size are necessary to establish evidence on efficacy of these drugs.
**Read more about links between Ayurveda and Modern Rheumatology in publications.
Ayurveda plants for Arthritis:
|Guggulu (Commiphora wightii)
||Nirgundi (Vitex negundo)
|Bhallatak (Semecarpus anacardium)
||Pippali (Piper longum)
|Ginger (Zingiber officinalis)
||Rasna (Inula helenium)
|Ashwagandha (Withania somnifera)
||Guduchi (Tinospora cordifolia)
|Turmeric (Curcuma longa)
||Eranda (Ricinus communis)
|Amalaki (Emblica officinalis)
Ayurveda formulations for Arthritis:
(Drugs must be used on prescription from a qualified Ayurveda professional)
|Aam Vata ||Sandhigata Vata
Adverse events and other issues
- Heavy metal contamination : Lead, mercury and arsenic are toxic metals used in Ayurveda drugs. Innumerable Ayu rveda drugs contain mercury. Lead is a constituent of Mahayograj guggulu and Vatavidhwans - drugs used in arthritis. Various purification processes are described in Ayurveda literature before medicinal use of raw metals. The reported incidence of adverse events appears to be small as compared to estimated consumption of these drugs. Similar to vegetables, lead is found in pure herbal formulations due to environmental contamination (pesticides, fuel, rubber, paints, plastic, etc.).
- Drug interactions : Ginger and garlic are associated with increased risk of bleeding. They must be consumed with caution alongwith painkillers and steroids.
- Adulteration : Many reports indicate addition of steroids in dispensed herbal products. Charak calls such physicians as Chadmachar (dishonest, deceptive, fraudulent, feigned) doctors. (Read seven danger signs about a therapist) @ Arthritis.org
- Cost of Therapy : Higher price does not necessarily mean effective treatment. Many of the therapies appear costly and lead to diversion and wastage of valuable resources.
- Delay in diagnosis : Practitioners of complementary medicine are not trained in modern rheumatology diagnosis. There is enough evidence to suggest that conditions such as early rheumatoid arthritis and joint pains due to SLE, vasculitis and other inflammatory connective tissue diseases require early diagnosis and aggressive modern therapy. Delay in seeking rheumatology advice can be detrimental and even be life-threatening in these situations.
Instructions for patients using herbomineral formulations
- Do not take on empty stomach. Take drugs after food.
- Use for limited period not exceeding 3-4 months.
- Do not use in children, pregnant women, elderly.
- Do not use in anaemia and kidney failure (Check blood before starting the drug).
- Do not take unlabelled drugs with unknown contents.
Wagh Shrikant, Raut Ashwinikumar, Datta Kumar, Rheumatology and Indian systems of Medicine: Manual of Rheumatology, 3rd Ed, Indian Rheumatology Association