EFFECTIVE MANAGEMENT OF PAIN IN AMAVATA WITH THE USE OF UPAVISHA BHALLATAKA- A CASE REPORT

About Author

Correspondence Address

Government ayurved college and hospital Nagpur
Contact No. : 9545636314, Email : krutikaachaudhari@gmail.com

Date of Acceptance : 09 Jun 2024

Date of Publication : 29 Jun 2024

Article ID : SD-IJAY_092

How to cite this article : http://doi.org/10.55552/SDNJAY.2024.2212

Abstract

Rheumatoid arthritis, an autoimmune disease that causes chronic symmetrical polyarthritis with systemic involvement, correlates with Amavata. According to Ayurveda, the regular formation of Ama, impairment of Agni, and vitiation of Vata Dosha cause tender, swollen joints and joint stiffness, which typically worsen in the morning, along with fatigue, fever, and loss of appetite. In medical science, long-term use of steroids for disease management leads to many side effects. Acharya Charak asserted that a potent toxin can serve as the most effective remedy, provided it receives a suitable dosage and formulation. This case report features a 31-year-old female patient with Amavata, who has been using steroids and painkillers for two years without any relief. However, upon receiving a prescription for Upavisha Bhallataka, she experienced immediate and reassuring results. This case report highlights the effective management of amavata with Upavisha Bhallataka.

KEY WORDS:- Amavata, Rheumatoid Arthritis, Upavisha, Bhallataka, Steroids.

Introduction

Amavata as a disease can be found in Madhav Nidana. This study provides a systematic evaluation of Amavata w.s.r. rheumatoid arthritis in all classics of Ayurveda [11]. According to Ayurveda, ‘Shoolam nasti vina vatat’ means vitiated Vata Dosha causes pain, and pacification of such Doshas reduces the pain. Amavata is a disease in which vitiation of Vata Dosha and accumulation of Ama take place in joints, and it simulates rheumatoid arthritis. And Bhallataka, by its mode of action, pacifies the Vata and Kapha Dosha, thereby leading to relief in painful joints. Amavata can be correlated with rheumatoid arthritis, which is an autoimmune disease causing chronic symmetrical polyarthritis with systemic involvement. In Ayurveda, it is due to the regular formation of Ama, impairment of Agni, and vitiation of Vata Dosha that causes tender, swollen joints and joint stiffness that usually worsens in the morning, along with fatigue, fever, and loss of appetite. which correlates with the Amavata lakshana such as Angamarda (bodyache), Aruchi (loss of taste), Trishna, Alasya (fatigue), Gaurava (heaviness in body), Jwara (fever), Apaktata (indigestion), and Soonangata (swelling) [4]. In medical science, the management of disease includes the use of NSAIDs, glucocorticoids, and DMRADs, which lead to many side effects on long-term use.

The prevalence of rheumatoid arthritis is 0.8% of the population. Women are affected approximately three times more often than men. Hence, effective management of pain is needed in the case of Amavata. Acharya Charaka said that even a strong poison could be the best medicine if it is used after proper shodhan in a proper therapeutic dose and formulation [3].

As per Ayurveda, Bhallataka is categorised under Sthavar Vanaspatij Visha (vegetable poison). Bhallataka has been mentioned in various Samhitas as Bhavprakash Nighantu, Raj Nighantu, Kaiyadeva Nighantu, Shaligram Nighantu, and also in Bruhatrayi [2]. It is one of the 11 Upavisha Dravyas explained in Rasaratnasamucchaya, which has Ushna Tikshna gunas along with Vatkaphaghana properties that help normalise function and thereby reduce pain [1]. There are different formulations of Shuddha Bhallataka explained by Acharya's for effective management of pain in various diseases [2]. In the Sutrasthan of Charaka Samhita, Aacharya Charaka has explained 50 Mahakashaya. Bhallataka is mentioned in Deepaniya, Mutrasangrahaniya, and Kusthaghna Guna [2]. In Rasayana Adhyaya, ten different types of Bhallataka preparation have been described. And the present case report highlights the mode of action of Bhallataka as an analgesic in the case of Amavata.

Discussion

Yogratnakar has mentioned the use of Bhallatakadi Churnam for the management of pain in Amavata and Katishool, which also helps in reducing the time duration of morning stiffness, shotha, sparshasahatva, and levels of RA, CRP, and ESR [2]. In Bhaishajyaratnavali, it is mentioned that Mahabhallatka gud is effective in the pain management of Vatarakta and Arsha. Bhallataka Kshirapaka seems to effectively reduce the pain in Amavata by lowering the levels of ESR and RA factors, thereby increasing the range of movement of affected joints, average foot pressure, and hand pressure, and decreasing the walking time [1]. Similarly, the Amrutbhallataka and the Naimittik Rasayan have tremendous results in reducing the severity of pain, swelling, tenderness, and stiffness of joints. In Charak Samhita, ten different types of Bhallataka preparation have been described in Rasayan Adhyay, which can be used for various disease conditions. Bhallatakadi Kwath is effective in Urusthambha in reducing stiffness in the thigh muscles. Acharya Sushrut has also explained the use of Bhallataka as Dhupan Dravya for external haemorrhoids for local analgesic effects [2]. Hence, it shows that different formulations of Bhallataka have tremendous results in reducing the pain in vatakaphajvyadhi. So in this patient market preparation of Bhallataka, which is serrenkottai nei in capsule form with extract of Bhallataka, which also contains cow ghee and cow milk, which will counteract any side effects of Bhallataka in pittajprakriti patient if any.

Panchakolasav mainly contains Pippali (piper longum), Pippalimool (root of piper nigrum), Chavya (piper chaba), Chitraka (plumbago zeylanica), and Nagar (zingiber officinale). The drugs mentioned in Panchakol have anti-inflammatory properties; hence, they help to reduce pain and swelling in joints. Dipan and Amapachan are also done by Panchakolasav, so it helps to rectify mandagni. As panchakol has strotoshodhan properties, it reduces symptoms like aruchi (loss of appetite), klama (weakness), and gauravata (heaviness of the body). Malasanga was also relieved by the dipan pachan properties of Chitraka and Nagar [8].

Gandharva haritaki churna contains the haritaki churna process in its bharjan with Arand taila. It is a polyherbal, classical Ayurvedic medicine. The ailment resides in Kati Pradesh, which is the seat of Vata Dosha, whereas Mridu Virechan is the line of treatment for Vatavyadhi, Sandhivata, Gridhrasi, and Ardita. This formulation is used for anulomana, ajeerna, and aruchi-induced diseases. It induces vatashamana, strotoshodhana, and shothahara effects; hence, it can be used as an excellent analgesic, anti-inflammatory, and nutritive therapy for such degenerative entities [7].

Conclusion

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