Patient details

• Name: Mrs XYZ
• Age & gender: 30 year /Female
• Marital status: Married
• Occupation: Housewife
• Weight: 57kg
• Height: 5.2inch

Presenting complaints

Pain and swelling over both knee joints, both wrist joint ,both hands, fingers of both hands since 1.5 years

Associated complaints

• Morning stiffness about 60 minutes
• Difficulty in holding objects and lifting weights
• Difficulty in walking after sitting for long hours

History of presenting complaints

A 30 year old female patient who is not a known case of any metabolic disorders came to the OPD complaints of pain and swelling over bilateral knee joints ,bilateral wrist joints , bilateral shoulder joints and bilateral interphalangeal joints of the hands since 1.5 years associated with morning stiffness for about 60 mins . The patient was apparently normal 1.5 years back .After 3 months of her second delivery,patient gradually developed knee pain and swelling. Thereafter she developed pain over
bilateral wrist joints as well as interphalangeal joints of hand and gradually to bilateral upper limbs. She consulted an allopathic physician and took steroids for one year and discontinued due to recurrent mouth ulcers and peptic ulcer while taking the steroids.

Personal history

• Bowel: Normal
• Appetite: Poor
• Micturation: Within normal limits
• Sleep: Sound
• Allergy: Nil
• Diet: Mixed, reheated foods

General examination

• Temp: 98.6 F
• Pulse: 81/min
• BP: 140/90
• Chest: clear
• CVS: S1S2 normal
• Pallor: Absent
• Lymphadeopathy: Absent

Systemic examination-locomotory system before treatment

Ashtavidha pareeksha

• Nadi –vata kapha
• Mala – sadharana
• Mutra –anavilam
• Jihwa –upalepathvam
• Shabdha –prakrut
• Sparsha –anushna sheeta
• Druk –spashta
• Akruti –madhyama

Dashavidha pareeksha

• Prakruti – Vata pradhana Kapha anubandha
• Vikruti –Vata pradhana tridosha
• Dooshya –Rasa , Medas ,Asthi ,majja
• Sara –majja
• Satwa –madhyama
• Samhana –madhyama
• Aharashakthi –avara
• Vyayamasakthi –avara
• Vayas –madhyama

Differential diagnosis

• Vataraktha
• Sandhivata
• Amavata

Diagnosis

AMAVATA

Nidhana (causes)

• Virudha ahara (incompatible food ) –it can cause an important role in forming Ama
• Virudha kriyas (improper physical activities) –amavata is produced due to manda agni )
• Nishchalathva (lack of physical activities)snigdham bukthvo annam vyayamam(performing physical activities immediately after taking heavy meels can cause ama in body)

Samprapthi Ghataka

• Nidana –amaprakopa and vata prakopa nidhana
• Dosha –vata pradhana tridhosha
• Dooshya-rasa, asthi snayu sira
• Uthbhavasthanam –amashayam
• Athishtanam –asthisandhi
• Srothas –rasavaha and raktha vaha
• Srotodushti -sanga

Samprapthi

Due to Nidhana sevana

Line of management

• Langhana: 1 st line of treatment is langhana which help in digestion of ama. Here langhana means not complete fasting but with light food
• Swedana: Sweating which releaves Stambha (stiffness) gaurava (heaviness ) and sheeta (coldness). Main lakshanas of amavata is shoola sthamba gaurava. choorna pinda sweda can be given dhanyamla dhara
• Snehana: Eventhough snehana can aggravate amavastha ,but to pacify vata dosha and to remove dosha sangha snehana is required. Pinda tailam can be used for snehana
• Vasti: Vasthi help in pacifying vata dosha. Anuvasana vastis are indicated in amavata
• Virechanam: Nithya virechana can be given .Nimbamrutha eranda tailam can be used as eranda taila is one of the best drug mentioned in amavata
• Aushadhi chikitsa: Deepana pachana aushadas can be given. Drugs with katu tikta rasas can be used as it can digest the Ama hence help in relieving pain and swelling

Internal medicines given

• Amavatari kashayam (BD before food)
• Kaisora guggulu (2-0-2 After food)
• Nimbamrutha eranda tailam (5ml every morning empty stomach)

External therapies given

Locomotory examinations after the course of treatment

Improvements

• Patient is able to hold objects without much difficulties
• Morning stiffness reduced (duration reduced from 60 mi to 5-10 min
• Swelling over knee joint and wrist joint reduced
• Pain over knee joint and wrist joint reduced
• Range of movement of wrist joint and knee joint is possible without restriction

Conclusion

Amavata is one among the most prevalent disease in the present era .Ama and vata is having the opposite qualities and involvement of rasa and asthi makes the treatment difficult. So it is important to take the treatment according to the ayurveda protocol. Early diagnosis is helpful in preventing the deformities. External therapies as well as internal medicines help in improving the immunity and relieving the pain and swelling .This study shows that vasti karma is a better modality of treatment for relieving symptoms as well as correction in biochemical parameters.

Even nithya virechana with nimbaernada tailam help in relieving swelling and correcting the vitiated dosas.