Arthritis in terms of ayurveda

ARTHRITIS IN TERMS OF AYURVEDA AND TREATMENT - By Dr.M.Hemanth kumar (oncobiologist, phytochemist & ayurvedic research)
Definition of Arthritis as per Centers for disease control and prevention
Although the word arthritis actually means joint inflammation, we use the term arthritis in the public health world to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. The pattern, severity and location of symptoms can vary depending on the specific form of the disease. Typically, rheumatic conditions are characterized by pain and stiffness in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.
Types of Arthritis
A brief overview of the most common forms of arthritis will be discussed in this section. Whenever possible, the format for each overview will include the following sections: background, prevalence (the number of people affected now), incidence (the number of new people affected in a given time period), mortality, hospitalizations, ambulatory care data (office, hospital outpatient, and emergency department visits), cost (direct and indirect where available), impact on quality of life and unique characteristics (such as transient nature, post infectious, etc.). References and resources for further information are provided at the end of each overview.
• Childhood Arthritis
• Fibromyalgia
• General
• Gout
• Osteoarthritis
• Rheumatoid Arthritis
• Systemic lupus erythematosus (SLE or lupus)
Fibromyalgia:
Fibromyalgia is a disorder of unknown etiology characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often psychological distress. People with fibromyalgia may also have other symptoms; such as, It is very similar to Chronic Fatigue Syndrome (CFS); only point of difference is presence of musculoskeletal pain in fibromyalgia and that of fatigue in CFS. Low level of Serotonin is considered to be most important biochemical criteria. The primary treatment goals should include raise serotonin levels, improve sleep quality, and assure adequate magnesium levels
• Morning stiffness
• Tingling or numbness in hands and feet
• Headaches, including migraines
• Irritable bowel syndrome
• Sleep disturbances
• Cognitive problems with thinking and memory (sometimes called "fibro fog")
• Problems with thinking and memory (sometimes called "fibro fog")
• Painful menstrual periods and other pain syndromes
Ayurvedic treatment for Fibromyalgia:
Fibromyalgia - Ayurvedic View :
It can be described as 'Mansa Dhatugat and Mansavrut Vata' Fibromyalgia is perceived as a Vata imbalance. Vata is the main imbalance and Aggravated Vata destabilizes the nervous system and can create hypersensitivity leading to pain and tenderness. Accumulation of Ama (toxins) and shrotorodha are also contributory factors.
Ayurvedic Treatment for Fibromyalgia and CFS:
The aggravation of Vata dosha and accumulation of Ama (toxins) are the primary causes and should be treated mainly. Associated weak digestion, constipation, and effects of chronic stress should also be tackled.
Panchakarma Therapy for Fibromyalgia and CFS:
Pre-purification Measures namely 'snehan' and 'swedan are very useful to balance 'Vata' and to loosen the toxins. Snehan is the Herbalized Oil Massage. This oil is applied to the entire body with a particular type of massage. Swedan is sudation or sweating and is given immediately following the snehan. An herbal concoction may be added to the steam to further enhancement of effect.
Daily herbalized oil massage also provides a deeply soothing and balancing effect to the entire nervous system. The motion of massage creates heat and friction which enhances circulation and helps cleanse the areas of chemical impurities that could be aggravating and hyper sensitizing nerve tissues.
Diet and Nutrition for Fibromyalgia :
Following is the diet suggested for the patients suffering form Fibromyalgia and CFS
• Vegetable juices and soups
• Coconut water and Coconut milk
• Juice of carrot, Cucumber, Beetroot
• Cooked vegetables
• Spices like cumin, coriander, ginger asafetida.
• Green salad with a dressing of lemon juice and a little salt
• Khichadi
The patient of Fibromyalgia and CFS should avoid the following:
• Eating hot, spicy and fried foods.
• Too much tea, coffee, alcohol.
• Sleeping during the day and staying up late at night
• Mental tensions
Yoga for Stress Management and Improved Mental and Emotional Function:
• It is well documented that fibromyalgia is often worsened by heightened stress, anxiety and mental fatigue.
• Meditation,Yoga, Pranayama and studying of spiritual philosophy are all recommended for supporting personal healing and relaxation of the mind.
• Efforts should be made to increase the Sattvic quality of mind.
Yogasana : Various stretching exercises are known to have a positive effect on fibromyalgia. Yogic breathing practices will also create a state of restful alertness in mind and body. Progressive deep relaxation, i.e., shavasana is recommended
Lifestyle and Daily Routine in Fibromyalgia :
Regularity in our daily routine is effective in reducing Vata imbalances.
Ayurvedic Herbs for Fibromyalgia / chronic pain:
1. Decoction of the roots of ten herbs 'Dashamula quath' or 'Dashamularishta'is useful
2. Daily use of the Ayurvedic compound 'Triphala choorna' is recommended to cleanse the colon.
3. Half a teaspoon of turmeric powder with warm water helps to reduce pain and inflammation in Fibromyalgia.
4. Garlic is useful for detoxification and to enhance immune system function.
5. Guggul is a very helpful herb for relief of pain.
6. Licorice root supports the glandular system and acts in the body like cortisone. Use with caution.
7. Ginger Tea. Ginger is a good alternative to aspirin to relieve minor aches and pains.
8. Generic preparations available in market such as -Dashamulaquath, Triphala guggul, Rasna saptak quath , Vata Vidhwans Rasa etc. can be taken under the guidance of a ayurvedic physician
Gout
Gout is a rheumatic disease resulting from deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body. This process is caused by an overproduction or under excretion of uric acid. Certain common medications, alcohol, and dietary foods are known to be contributory factors. Acute gout will typically manifest itself as an acutely red, hot, and swollen joint with excruciating pain. These acute gouty flare-ups respond well to treatment with oral anti-inflammatory medicines and may be prevented with medication and diet changes. Recurrent bouts of acute gout can lead to a degenerative form of chronic arthritis called gouty arthritis.
• Gout is an ancient and common form of inflammatory arthritis, and is the most common inflammatory arthritis among men. Gout may remit for long periods, followed by flares for days to weeks, or can become chronic.
• Gout is caused by an uncontrolled metabolic disorder, hyperuricemia, which leads to the deposition of monosodium urate crystals in tissue. Hyperuricemia means too much uric acid in the blood. Uric acid is a metabolic product resulting from the metabolism of purines (found in many foods and in human tissue).
• Hyperuricemia is caused by an imbalance in the production and excretion of urate, i.e., overproduction, underexcretion or both.
• Hyperuricemia is not the same as gout. Asymptomatic hyperuricemia does not need to be treated.
• Risk factors for gout include being overweight or obese, having hypertension, alcohol intake (beer and spirits more than wine), diuretic use, a diet rich in meat and seafood, and poor kidney function.
• Weight loss lowers the risk for gout.
• Gout can be viewed in four stages:
• Asymptomatic tissue deposition occurs when people have no overt symptoms of gout, but do have hyperuricemia and the asymptomatic deposition of crystals in tissues. The deposition of crystals, however, is causing damage.
• Acute flares occur when urate crystals in the joint(s) cause acute inflammation. A flare is characterized by pain, redness, swelling, and warmth lasting days to weeks. Pain may be mild or excruciating. Most initial attacks occur in lower extremities. The typical presentation in the metatarsophalageal joint of the great toe (podagra) is the presenting joint for 50% of people with gout. About 80% of people with gout do have podagra at some point. Uric acid levels may be normal in about half of patients with an acute flare. Gout may present differently in the elderly, with many joints affected.
• Intercritical segments occur after an acute flare has subsided, and a person may enter a stage with clinically inactive disease before the next flare. The person with gout continues to have hyperuricemia, which results in continued deposition of urate crystals in tissues and resulting damage. Intercritical segments become shorter as the disease progresses.
• Chronic gout is characterized by chronic arthritis, with soreness and aching of joints. People with gout may also get tophi (lumps of urate crystals deposited in soft tissue)—usually in cooler areas of the body (e.g., elbows, ears, distal finger joints).
• Gout is also associated with an increased risk of kidney stones.
• The gold standard for diagnosing gout is aspiration and microscopic analysis for urate crystals in joint fluid or a tophus. Urate crystals are negatively birefringent under polarized light. Infection must be ruled out.
• The treatment goals are to end the pain of acute flares and prevent future attacks and the formation of tophi and kidney stones. Therapy for acute flares consists of nonsteroidal anti-inflammatory drugs, steroids, and colchicine. Diet and lifestyle modifications (weight loss, avoiding alcohol, reducing dietary purine intake) may help prevent future attacks. Changing medications (e.g., stopping diuretics) associated with hyperuricemia may also help. Preventive therapy to lower blood uric acid levels in people with recurrent acute flares or chronic gout usually involves allopurinol or newer drugs (febuxostat and pegloticase).
Ayurvedic treatment for Gout
Gout is mentioned as ‘Vata rakta ‘ in Ayurveda means imbalance of Air and accumulation of toxins in blood. For acute attack one can use orange juice and water. Patient should on short fasts and and try to take more vegetables and fruits for four days and should avoid acid producing foods and high protein diets and also coffee and tea. The herbal preparations like Navkarshik churna (amla, haritaki, bahera, vacha, neem, manjista, kutki, giloy, daruharidra) Kishore guggul, gorakhmundi powder and Punarnava mandur should be taken for chronic stages to get relief from inflammation and pain. Uric acid levels can be reduced by above herbal treatments.
Osteoarthritis (OA)
Osteoarthritis (OA) is a disease of the entire joint involving the cartilage, joint lining, ligaments, and underlying bone. The breakdown of these tissues eventually leads to pain and joint stiffness. The joints most commonly affected are the knees, hips, and those in the hands and spine. The specific causes of OA are unknown, but are believed to be a result of both mechanical and molecular events in the affected joint. Disease onset is gradual and usually begins after the age of 40. There is currently no cure for OA. Treatment for OA focuses on relieving symptoms and improving function, and can include a combination of patient education, physical therapy, weight control, use of medications, and eventually total joint replacement.
• Also known as degenerative joint disease.
• Most common form of arthritis.
• Classified as: Idiopathic (localized or generalized) or Secondary (traumatic, congenital, metabolic/endocrine/neuropathic and other medical causes).
• Characterized by focal and progressive loss of the hyaline cartilage of joints, underlying bony changes.
• Usually defined by symptoms, pathology or combination
• Pathology = radiographic changes (joint space narrowing, osteophytes, and bony sclerosis.)
• Symptoms = pain, swelling, and stiffness.
Ayurvedic Treatment of Osteoarthritis :
The treatment can be divided in following categories.
Diet for Osteoarthritis
Fresh cooked and hot food should be consumed in regular diet.
Hot soups of lentils, pulses and meat should be taken with powder of ginger, black pepper and long pepper added to them.
Ghee and oils in moderate amount are necessary in daily diet, as these keep the normal joints properly lubricated and also provide lubrication to the dried up joints.
All the spicy, deep fried and very oily and pungent food recipes should be avoided, since these are believed to cause damage to the degenerated joints.
Exercise for Osteoarthritis
Moderate regular exercise to keep the affected joint mobile and to prevent further damage, should be carried out. Excessive strain that could damage joints should be avoided.
Ayurvedic Remedies for Osteoarthritis
Local application of various medicated oils such as Mahanarayan Taila, Bala Taila , mustard oil, etc., is very useful in all arthritic conditions.
Hot fomentation by infrared lamp or heated sandbag should be given immediately after massaging the affected joint with any oil. Decoction of the bark and roots of Deodar tree should be taken in the dose of 30 ml., thrice daily. Decoction of root of caster plant is also helpful in the dose of 30 ml., thrice a day. Caster oil should be taken in the dose of 5-10 ml., every day in the morning.
Daily use of the Ayurvedic compound 'Triphala churna'is recommended to cleanse the colon. Guggul is a very helpful herb for curing arthritis. It is most specific for cleaning and strengthening the bone tissue. Various guggul preparations are available in market.Granules of Cissus quadrangularis (Granthiman, Asthisamhari, Hadjod) is very useful in increasing bone strength by depositing the calcium . Geberal traditional preparations like Dashmool ghana, Triphala guggul, Maharasnadi quath ghana, Maharasnadi quath granules, Vata Vidhwans Rasa etc. These can be taken under the guidance of a ayurvedic physician
Rheumatoid arthritis (RA)
Rheumatoid arthritis (RA) causes premature mortality, disability and compromised quality of life in the industrialized and developing world (1). Rheumatoid arthritis is a systemic inflammatory disease which manifests itself in multiple joints of the body. The inflammatory process primarily affects the lining of the joints (synovial membrane), but can also affect other organs. The inflamed synovium leads to erosions of the cartilage and bone and sometimes joint deformity. Pain, swelling, and redness are common joint manifestations. Although the causes are unknown, RA is believed to be the result of a faulty immune response. RA can begin at any age and is associated with fatigue and prolonged stiffness after rest. There is no cure for RA, but new effective drugs are increasingly available to treat the disease and prevent deformed joints. In addition to medications and surgery, good self-management, including exercise, are known to reduce pain and disability.
• Rheumatoid arthritis (RA), an autoimmune condition, is a chronic inflammatory polyarthritis (arthritis that affects 5 or more joints).
• The natural history of RA varies considerably with at least three possible disease courses:
1. Monocyclic: Have one episode which ends within 2-5 years of initial diagnosis and did not reoccur. This may result from early diagnosis and/or aggressive treatment.
2. Polycyclic: The levels of disease activity fluctuate over the course of the condition.
3. Progressive: RA continues to increase in severity and is unremitting
• Radiographic erosion is typically fastest in the first year of disease.
Ayurvedic treatment RA
Amavata (Rheumatoid arthritis) occurs when an individual indulges in factors that aggravte Vata dosha and Ama (Toxins) in the body. Improper digestion and metabolism leads to accumulation of Ama (Toxins) in our body. This Ama combined with the aggravated Vata dosha localises in the joints and produces pain, swelling and stiffness. In the initial stage, ayurvedic medications that metabolizes the Ama (toxins) and eliminate them out of the body are prescribed. Later, medications that pacify the aggravated Vata dosha are prescribed by assessing the changes in patients condition. The choice of the treatment modality is made based on the assessment of the condition of the patient and the severity of the disease.
A Healthy planned diet is essential to support the normal functioning of our immune system, reduce the disease exacerbations and nourish the weakened joints. It thus reduces the severity or frequency of symptoms of the disease. Following a diet rich in fruit and vegetables helps control the long standing inflammation of the joints. Their nutrients have antioxidant property that helps to neutralize free radical production by the body.
To be consumed as diet:
Use garlic in your regular diet. Buttermilk with garlic is an excellent remedy of rheumatoid arthritis.Use whole grains that are rich in fibre such as wheat, millet, barley, horse gram, brown rice. Consume honey mixed with water. (older the honey, the greater its benefit) .Milk boiled with dry ginger can be taken in the morning and evening instead of tea and coffee. Consume milk mixed with 3 gms of turmeric powder. Turmeric is very effective to control inflammation of the joints. Consume fruits and vegetables such as drumsticks, bittergourd, carrot, green leafy vegetables, cabbage, mustard greens, papaya. These food items help to reduce the inflammation and hyperactivity of the immune system. Pepper should be sprinkled over the fruits and vegetables that are cooling in nature. Reduce weight if you are overweight.
To be avoided:
Unhealthy and irregular dietary habits can trigger the abnormal immune response and increase the pain in the joints. Curd, Black gram, fermented food items, deep fried oily foods should be avoided. Avoid common foods that cause allergies such as dairy products, peanuts, beets, soy, red meat, processed foods, artificial additives and preservatives, white flour and white sugar. Alcohol, tobacco, tea, coffee, soft drinks and ice creams should not be consumed. Avoid food items that cause indigestion and flatulence. Try to avoid keeping awake at nights and sleeping during daytime. Consume fruits In their whole form and avoid them in the form of juices. Whole fruits with their fibre content aids in proper digestion and regulates the bowel movements.
Herbs like Aswagandha , kalmegh (Andrographis paniculata) , Boswellia serrata , Ananas (fruit), haldi (curcuma longa) , ginger, rosemery etc are useful in getting relief from Rheumatoid arthritis.
Traditional preparations like Dashmoola ariista , aswagandharista are useful in Rheumatoid arthritis treatment.
Systemic Lupus Erythematosus
Systemic Lupus Erythematosus is an autoimmune disease in which the immune system produces antibodies to cells within the body leading to widespread inflammation and tissue damage. The causes of SLE are unknown but are believed to be linked to genetic, environmental, and hormonal factors. SLE may be characterized by periods of illness and remissions. SLE has a variety of clinical manifestations and can affect joints, skin, brain, lungs, kidneys, and blood vessels. People with SLE may experience fatigue, pain or swelling in joints, skin rashes, and fevers. A team approach in treating lupus is often warranted due to the number of organ systems involved.
Ayurvedic concept and treatment:
SLE is an auto immune disease so the main Ayurvedic system concentrates on doshas like vatsa, pitta and kafa. Ayurvedic treatment includes healthy saatvic food and fruts enriched with vitamin C are more helpful and fruits rich in Magnesium like banana , pineapples, tomato , pears, apples, avocado are mostly useful Ayurvedic preparations include Aswagandhaarista , giloy ras , vidarikand , aloe vera , satavar churna, kaunch seeds, gokshura , ashok chal etc will work efficiently in treating SLE.
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