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Dr. Vikram Chauhan - MD (Ayurveda)

Saturday, July 20, 2013



Arthritic diseases have been known to exist since great antiquity.  Probably the early description of arthritis occurs in Athravaveda, having been composed about 1000 B.C. 1 Charaka Samhita, written in the post Vedic period, has dealt more accurately with the etiology, symptomatology, diagnosis and treatment of arthritis. Prognosis of arthritis, as proclaimed by the ancient physicians of India, remains unaltered.
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Diseases of the joints are better known as rheumatic diseases. Osteoarthritis, rheumatoid arthritis and gout are common varieties of arthritis encountered in clinical practice. Rheumatism is a broad term used for injury or inflammation of soft tissues. Sciatica, cervical spondylosis, and lumbago are other significant diseases included in this segment.

To understand the disease process in various types of arthritis, it is necessary to understand the basic make up of a joint. Diagram of a typical joint is shown below:

Fig 1: Anatomy of the joint
Joints possess a synovial membrane (it covers the joint from inside) and cartilage (see diagram) which covers the articulating surface of the bone and merges at its free edges with the internal synovial membrane lining of the joint cavity. The joint cavity contains a small amount of synovial fluid. The cartilage derives nutrition from the synovial fluid like a sponge. Synovial fluid acts as a shock absorber as it avoids friction between bones. It is also responsible for the nutrition of the joint.

With passage of age the synovial fluid decreases and friction between the bones increases. There is stiffness and loss of function of the joint function. This is encountered in osteoarthritis. In addition, there is pain and inflammation. Rheumatoid arthritis is an autoimmune disorder in which rheumatoid factor is found to be positive. Gout is related to high levels of uric acid in the blood. Psoriasis, a skin disorder is also associated with arthritis known as psoriatic arthritis.

Pain, inflammation (swelling), fever, loss of function, and morning stiffness are cardinal features of arthritis. Based on the character of pain, involvement of the joint and laboratory tests, the final diagnosis is arrived at. Some form of arthritis involves other organs like heart and muscles. It is common in rheumatic and rheumatoid arthritis respectively.

The management of a joint disease requires a rational approach. In obese patients, weight management is of prime importance. Āyurvedā considers malfunctioning of the digestive system responsible for disease like arthritis and rheumatism. Today we have effective drug available for treating arthritis but at the same time side effects caused by the drugs are alarming.

Pathology of Arthritis in Ayurveda
Āyurvedā suggests that arthritis is caused primarily by an excess of āma (by-product of improper digestion) and lack of agni (digestive fire). This can be caused by poor digestion and a weakened colon, resulting in the accumulation of undigested food and the buildup of waste matter. Poor digestion allows toxins to accumulate in the body, and problems with the colon allow the toxins to reach the joints.

According to ayurvedic concept, in order to treat arthritis is to stimulate agni and suppress the āma. Āyurvedā distinguishes three categories of arthritis, corresponding to vāta, pitta, and kapha. The clinical features of these three types of arthritis are enumerated in table one.

Table 1: Clinical features of three types of arthritis according to Āyurvedā

Joints crack and pop and become dry and are not swollen

This arthritis is characterized by inflammation. The joint becomes swollen and is painful even without movement. It often looks red and feels hot to the touch.
In kapha-type arthritis, the joint also becomes stiff and swollen, but it feels cold and clammy rather than hot. A little movement, rather than aggravating the pain, tends to relieve it.

Classification of Arthritis in Ayurveda:

Āmavāta (Rheumatoid arthritis): In Āyurvedā there is very detailed description about rheumatoid arthritis or "Aama vata". According to ayurvedic pathology, āmavāta is caused by āma, a toxin that is produced by imbalanced body fire). The toxin ama is carried by imbalanced vāta and reaches the kapha-dominated joints. 

2. Vātrakta (Gout): Vātrakta is the condition in which, the blood and vāta both get vitiated and troubles an individual. It is compared to gout which refers to the group of metabolic disorders. In these disorders, the crystals of the sodium urate get deposited in the tissues of the body. This results in the raised levels of uric acid level in the blood. The typical gouty condition catches the small joints of the body first.

3. Sandhivāta (Osteoarthritis): In word sandhivāta, sandhi means the joint and vāta, the vāta dośa. When activities of the vāta increase inside the sandhi or joints, it is known as the Sandhivata. Vāta is dry in nature so it absorbs the fluidity, from any part of the body and it is also destructive or catabolic in nature, due to these two reasons vāta cause destruction of the cartilage and reduction in the synovial fluid inside the joint capsule.

Some common joint and related diseases in clinical practice


Cause: Osteoarthritis is a degenerative disorder of central and peripheral joints. Exact cause of osteoarthritis is not known. It is more common in females particularly in post menopausal age. Low levels of calcium are sometimes linked to osteoarthritis. Sometimes osteoarthritis is found in joints that are used more than usual. It is said to be primary when no causal factor is encountered. In secondary cases definite cause like fracture is present.

Signs and symptoms: The arthritis has peculiarity as it first strikes the knee joint. Pain, loss of function and stiffness are the main features. Pain is aching but sudden sharp episodes of pain are also seen. The pain is aggravated in cold and damp weather. Loss of function is negligible in the initial stages but in advance cases walking is restricted. Swelling called Heberden’s nodes are common in the hand joints. 
Cracking sound (crepitus) in the knee joint is characteristic feature of osteoarthritis.

Remedies: Guggul is mainstay of treatment of arthritis in Ayurvedic system of medicine. Simhnāda guggul of a good brand, two tablets thrice a day, is highly beneficial in early stages of osteoarthritis. Joint aid plus contains Guggul as one of the ingredients.

Once pain is reduced, the dose should be decreased to three tablets, once a day. For reducing stiffness, Vatakulāntaka rasa, one tablet, twice a day, is added as adjuvant to simhnāda guggul.

Śunthī or Ginger is useful for reducing pain and inflammation. It has good anti-inflammatory activity. On teaspoonful (5 g) dried powder, thrice a day, is recommended for the treatment of osteoarthritis.  Joint aid plus has Sunthi as one of the ingredients. 

Gentle massage with oil prepared from Prasarni is helpful in reducing pain, inflammation and stiffness. Violent massage should be avoided as it can be injurious to the joint. For normal functioning of the bowel Triphala powder is good as it acts as gentle laxative.

Cause: Āma (substance produced by malfunctioning of the digestive system) is considered to be root cause of āmavāta (rheumatoid arthritis) in Āyurvedā. It circulates in the blood and finally collects in the joint surface causing pain and loss of function. Rheumatoid arthritis accounts for 15 per cent of the total rheumatic disorders. The incidence is more common in women. The disease is more prevalent in cold and damp conditions.

Signs and symptoms: Rheumatoid arthritis is a chronic form of arthritis characterized by pain and inflammation of more than two joints. It commonly strikes small joints of the hands. The arthritis has symmetrical pattern unlike gout and osteoarthritis. The finger joints are worst effected by rheumatoid arthritis. Deviation of hand and z- shaped deformity of the thumb are special features of rheumatoid arthritis.

Rheumatoid factor is found to be positive in 80 per cent of the patients. Erythrocytic sedimentation rate (ESR) is on the higher side in acute cases. Total leukocyte count (TLC) and differential leukocyte count (DLC) are also high. In rare cases anemia is found. Rheumatoid arthritis not only affects joints but it attacks organs like heart, muscle and eye also.

Remedies: Mahāyogrāja guggul of a good brand is traditional remedy for treating rheumatoid arthritis. Two tablets, twice a day, are recommended with hot water. In severe cases, one tablet of Brahatavātacintāmani rasa, is given twice a day, for one week. The medicine should be used under expert supervision. Mahārasnādī quatha six teaspoonfuls (30 ml), with water should be consumed twice a day, for better effects. JOINT AID PLUS contains herbs like Guggul and others which are very good to keep things in control. 

Trikatu powder is recommended for improving digestion. This drug is a boon for rheumatoid arthritis patients. One teaspoonful (5 g) with warm water not only corrects digestion but stimulates appetite also. Viśagarbha taila is used for local application twice a day. Hot fomentation following massage is helpful in reducing stiffness of the joints.

Precautions and diet: The patient should consume fresh vegetables, garlic and black pepper. Exposure to cold and damp conditions should be avoided. Use of curd is prohibited at night. White grams, pea, soybean, potato, and cold water bath should be avoided.
Wheat, ghee, śathi variety of rice, ginger, garlic, punarnavā, pomegranate, mango, and grape are useful in rheumatoid arthritis.

Cause: Gout is caused by aggravation the vāta humour and blood polluted by it. According to modern concept, gout is a metabolic disease, characterized by high levels of uric acid in blood. The crystals of uric acid accumulate in joint cavity leading to attack of gout. The disease is predominantly found in males. The disease has acute and chronic phases.

Signs and symptoms: The attack of gout comes suddenly and strikes the toe joint first. The joint becomes hot, swollen and extremely painful.  Sometimes fever is also met with.  It is estimated that about 17 per cent of patients having history of gout develop kidney stones in the form of urates.

Suranjāňa vatī is the drug of choice in acute attack of gout. One tablet, twice a day is recommended for a week. Suranjāňa is poisonous and prolonged use should be avoided. Navkarshik Churna and Gorakhmundi churna is a wonderful combination, along with Joint aid plus capsules to get rid of high uric acid and gout. 

Kaiśore guugul of a good brand, one tablet, thrice a day, is highly beneficial in the treatment of gout. Mahāmanjiśta quatha six teaspoonfuls (30 ml) twice a day is added with kaiśore guugul. Gudūcī sattva, one tablet, thrice a day, helps in reducing high uric acid levels in the blood.
Gudūcī taila is used as for massage. If the patient has history of constipation, kaśmaryādī quatha, in a dose of six teaspoonfuls (30 ml), twice a day, is highly beneficial.

Precautions and diet: The treatment of gout is not only limited to drugs but dietary restriction is significant. Consumption of protein rich foods should be in moderate amounts. Persons with recurrent attacks of gout may have to stop protein intake completely. Soybean, cheese and milk should be avoided. Lime mixed with milk, barley, mild tea, milk, coriander and green leafy vegetables are useful in gout. Sweets, potatoes and stale foods should be avoided.

Grīvāstambha (Cervical spondylosis)

Cause: According to modern concept, cervical spondylosis is a degenerative disorder. Sometimes injury to the neck region may lead to pain in cervical region.
Signs and symptoms: In cervical spondylosis pain is presented in two forms:
  1.  Confined to neck only (upper cervical).
  2.   Radiating to the arms (lower cervical).

Morning stiffness is characteristic feature. In chronic phase, the patient complains of pain which may be worse at night and after neck movement. There may be tingling and numbness along the arms. This is due to compression of the nerves by protrusion of the disc. Vertigo is common. The disease is exaggerated in cold weather.

Remedies: Treatment is best by immobilization of the neck in flexion in a cervical collar. Mahāyogrāja guggul, of a good brand is used in the treatment of cervical spondylosis. Two tablets, twice a day, are recommended with hot water. For weakness in the arms, Ekāňgvīra rasa of a good brand, one tablet, twice a day is added with mahāyogrāja guggul for seven days. Gentle massage with Mahamaśa taila is helpful in reducing morning stiffness.

Kativāta (Lumbago)

Cause: The condition is similar to cervical spondylosis. Kati region is known as lumbar region and the pain is caused by aggravated vāta. Injury to the lower back region may lead to lumbar disc protrusion. The pain is common in pregnancy. Exposure to cold and damp weather may precipitate pain in chronic suffers of lumbago.
Signs and symptoms: Pain is worse at night and after back movements. There may be tingling and numbness along lower back. In severe cases pain may start from lumbar region and radiate throughout the leg. Lifting of weights in standing position may lead to attack of lumbago. Disc protrusion at lumbar level may lead to paralysis of legs and urinary blabber. Urinary retention is the main problem.

Remedies: The treatment is same as that of cervical spondylosis. Extreme case may require hospital admission. Prasārinī taila is official Ayurvedic remedy for massage in lumbago. Bed rest is of prime importance.

Gradursi (Sciatica)

Cause: In Ayurveda the disease is known as gradursi. Sciatic nerve is the thickest nerve of the body and supplies the legs. Inflammation (swelling) of the nerve may lead to pain in the leg. Intramuscular injections may irritate sciatic nerve and result in sciatica. Benign prostate hypertrophy may lead to the incidence of sciatica.
Signs and symptoms: The pain stars from the lower back and radiates to hip, thigh, leg and feet. There is sensory and motor loss across the leg.
Remedies: Nirgundī is the drug of choice in treating sciatica. Three teaspoonfuls (15 ml) of the decoction, twice a day are helpful in reducing pain. Ajmodādi cūrana, one teaspoonful (5g), with warm water, thrice a day is effective in treating sciatica. Decoction of pārijāta is popular remedy for the treatment of sciatica. Six teaspoonfuls (30 ml), of the decoction are valuable in relieving pain. Nirgundī taila, warmed slightly is used for massage.

Pharmacology of Joint Aid Plus

Boswellia serrata Roxb. ex Coleb.(Burseraceae)

Synonyms: Salai (Hindi ) and Indian Olibanum tree (English).
Habitat:  B. serrata is found in India.
Morphology: B. serrata is a medium sized tree. Stem-bark is red or dusky and aromatic. Leaves are dentate and large. Flowers are small, aromatic and white coloured. Fruit is triangular having three seeds.
Chemical composition: Pentacyclic triterpene acids (boswellic acids) and oil (boswellia oil).

Rasa (Taste): Tikta (Bitter), Madhura (Sweet) and Kśāya (Astringent).
Guna (Physical property):  Laghu (Light) and Rukśa.
Vīrya (Potency):  Uśna (Hot).
Vipāka (Post digestion effect): Katu (Pungent).
Effect on Tridośa: Pacifies Pitta and Kapha.
Karma (Action): Purīśaviraňajneya.
Therapeutics: B. serrata is given in the treatment of osteoarthritis, rheumatoid arthritis and bronchial asthma.  It is also given in skin diseases, chronic cough, chronic fevers and diarrhoea.
Parts used: Oleo-resin.
Dose:  Oleo-resin (1-3 G), Decoction (50-100 ml). 
Pharmacological investigations:
Several studies have reported anti-inflammatory, analgesic an anti-arthritic activities of B. serrata and boswellic acid.
Two placebo controlled studies, involving a total of 81 people with rheumatoid arthritis, reportedly found significant reductions in swelling and pain over the course of 3 months with B. serrata.

Commiphora mukul (Hook. ex Stocks) Engl (Burseraceae.)

Synonyms: Guggul (Hindi) and East Indian Myrrh and Indian Bdellium tree (English).
Habitat: C. mukul is found in Sindha and West Himalayas.
Morphology: Oleo resin of C. mukul exists as yellow or brown and translucent pieces often mixed with other parts of the tree. Mixed with water, oleo resin forms milky emulsion.
Chemical composition: Guggulsterones (E-Z). Guggulsterones are tertracyclic and have α-ß unsaturated ketone carbonyl at position 3. They have an olifinic double bond at position 4. The standardization of extract of C. mukul is based on 2.5 per cent of guggulsterones (E and Z).

Rasa (Taste): Katu (Pungent) and Tikta (Bitter).
Guna (Physical property):  Laghu (Light) and Rukśa.
Vīrya (Potency): Uśna (Hot).
Vipāka (Post digestion effect): Katu (Pungent).
Effect on Tridośa: Pacifies Vāta, Pitta and Kapha.
Karma (Specific action): Vednāśthāpana (Analgesic).
Therapeutics: C. mukul is used in the treatment of hyperlipidemia, arthritis and rheumatism.
Contraindications: Alcohol intakes, intercourse, exercise and foods causing dyspepsia are contraindicated in C. mukul based therapy.
Side effects: Crude C. mukul can lead to stomatitis, gastritis and menstrual abnormalities.
Parts used:  Oleo-resin. 
Dose: Powder (2-4 G).
Purification of C. mukul: Crude C. mukul is boiled in milk for purification.

Pharmacological investigations:

Animal studies:
1. Sharma (1997) reported anti-inflammatory activity of C. mukul against mycobacterial adjuvant induced experimental arthritis. The anti-inflammatory activity of C. mukal was comparable to phenylbutazone and ibuprofen.
2. Dahanukar et al (1983) reported anti-inflammatory and anti- arthritic effects of a steroid fraction of C. mukul against carrageenin induced paw edema in rats and secondary inflammation caused by Freund's adjuvant arthritis.
3. Sharma et al. (1987) reported anti-inflammatory activity of C. mukul.
4. Satyavati, (1991) reported anti-inflammatory and anti-arthritic effects of C. mukul in various inflammation models (carrageenin- induced rat paw oedema, granuloma pouch and adjuvant arthritis).
5. Duwiejua et al., (1993) reported anti-inflammatory activity of the aqueous extract of C. mukul against carrageenin- induced rat paw edema.
Human studies


A study involving a total of 30 patients with osteoarthritis of knee found significant reductions in swelling and pain over the course of 2 months with Commiphora  mukul. The drug was administered in capsule form (500 mg concentrated exact delivered thrice-a-day) along with food. Based on evidence it was concluded that there were no side effects reported during the trial. C. mukul appears to be a relatively safe and effective supplement to reduce symptoms of osteoarthritis.

Rheumatoid arthritis

Clinical trials with purified C. mukul has been carried out in 35 patients of rheumatoid arthritis in order to assess its anti rheumatic activity, dose requirement, resistance development and side effects on haematology. From the results obtained it has been indicated that C. mukul acts as an analgesic agent without any toxic or side effect.

Vitex negundo Linn. (Verbenaceae)

Synonyms: Sambhaloo (Hindi) and five-leaved chaste (English).
Habitat:  V. negundo is found in India.
Morphology: V. negundo is a sharply smelling shrub. Stem of the plant is covered with hairs. Leaves digit ate with upper surface green and lower white. Flowers are tiny and of light blue colour. Fruit is black and oval.
Chemical composition: Oil and resin.
Rasa (Taste): Katu (Pungent).
Guna (Physical property): Laghu (Light) and Rukśa
Vīrya (Potency): Uśna (Hot).
Vipāka (Post digestion effect): Katu (Pungent).
Effect on Tridośa: Pacifies Vāta and Kapha.
Karma (Specific action): Vednāśthāpana (Analgesic).
Therapeutics: V. negundo is used in the treatment of arthritis and rheumatism.
Parts used:  Leaves.
Dose:  Expressed juice (10-20ml); powder (3-6G). 
Pharmacological investigations
1. Chawla, Sharma, Handa and Dhar (1992) reported anti-inflammatory activity of seeds of V. negundo in albino rats.
2. Jana, Chattopadhyay and Shaw (1999) reported anti-inflammatory activity of V. negundo.

Zingiber officinale Rosc. (Zingiberaceae)

Synonyms: Adraka (Hindi) and Ginger (English).
Note: Fresh ginger is known as Adraka and dried is known as śunthī.
Habitat: Z. officinale is cultivated in India.
Morphology: Z. officinale is perennial herb. Leaves have acute apex and flowers are greenish-yellow. Rhizome is branched having typical pungent taste.
Chemical composition: 1. Fresh ginger: Carbohydrates, proteins, calcium, phosphorus, iodine, chlorine and varmints (A, B and C).
2. Dried ginger: Ash, protein, fiber, starch and volatile oil (containing zingiberene and zingiberol).
Oleo-resin obtained from dried ginger contains gingerol and shogoal.

Rasa (Taste):  Katu (Pungent).  
Guna (Physical property): Laghu (Light) and Snigdha. ādraka: Gurū (Heavy) and Rukśa.
Vīrya (Potency): Uśna (Hot).
Vipāka (Post digestion effect):  Katu (Pungent) for ādraka and Madhura (Sweet) for śunthī.
Effect on Tridośa: Pacifies Vāta and Kapha.
Karma (Specific action): Triptighana
Therapeutics: Z. officinale is used for local application in arthritis and rheumatism. It is also used in abdominal colic, bronchitis, indigestion, urticaria, filariasis and general debility after child birth. Z. officinale is highly beneficial in rheumatoid arthritis.
Contraindications: Anaemia, bleeding diathesis, dysuria, pruritis, summer season and ulcers.
Parts used: Rhizomes. 
Dose: Powder (1-2 G).


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