AMAVATA: REVIEW OF LITERATURE

Amavata is disease of Rasavaha strotasa it is generally compared with Rheumatoid Arthritis. Amavata is the outcome of Agnidushti, Amotpatti and Sandhivikruti. The therapy which normalize Agni, Metabolizes Ama, and Regulates Vata and maintain healthy Sandhi and Sandhistha Shleshma will be the supreme one for this disease. Many peoples in society are unaware about disease and its complications which is responsible for lifelong joint deformities. Many herbal as well as Ayurvedic preparations are mentioned in the classics which are very effective remedy in Amavata.


Introduction
Madhava was the 1 st physician who describes the disease Amavata. It seems to be simple disease but its prognosis is not so good. Before the Acharya Madhava the concept of Amavata was vague.
Amavata develops due to Dushti or Prakopa of Ama as well as Vata dosha. The concept of Ama is unique in Ayurvedic science and this Ama is main cause of the various disorders. There is no equivalent term of Ama in modern science.
The disease Amavata can be compared to Rheumatoid Arthritis. The sign and symptoms of both diseases are near about same. Rheumatoid Arthritis is an autoimmune disease. It is chronic inflammatory, destructive and deforming symmetrical poly-arthritis associated with systemic involvement. Http://www.granthaalayah.com ©International Journal of Research -GRANTHAALAYAH [129] When disease becomes chronic and the patient develops deformity in the joints such as Sandhisankoch (Joint stiffness) , Akarmanyata (Limited movements) etc. cannot be corrected with medicines alone.
Many herbal as well as Ayurvedic preparations are mentioned in the classics which are very effective remedy in Amavata. Guggula is the drug of choice in Amavata as well as various metallic preparations like Suvarna Bhasma, Tamra Bhasma, Loha Bhasma, Parada and Gandhaka are proved to effective drugs on Amavata.

1) Viruddha Ahara (Incompatible food)
The food that provokes the Doshas but does not expel them out of the body is called viruddha. Ex. Mixing of milk with fish in a diet. Viruddha ahara plays important role in causing Ama. 2) Viruddha Cheshta (Improper physical activity) The physical activity performed without following the procedure is called viruddha cheshta. Ex. Physical exercise or sexual act when an individual is already suffering from ajeerna. Viruddha cheshta ----Agnimandya ----Ama visha. 3) Mandagni (Decreased digestive power) :-Amavata is produced due to Mandagni. 4) Nischalata (Lack of physical activity) :-Lack of physical activity or sedentary life style is the main cause of accumulation of Ama in the body. 5) Snigndham bhuktavato vyayaamam :-Performing physical exercise soon after intake of heavy food causes Ama in the body.
It is very difficult to elicit the exact cause of Amavata. The above mentioned etiologies are not satisfactory those are not frequently observed in the patients.
When we see according to modern science they also states that the exact etiopathogenesis of Rheumatoid Arthritis is not known. However, present concept on etiology and pathogenesis proposes that Rheumatoid Arthritis occurs in an immunogenetically predisposed individual to the effect of microbial agents acting as trigger antigens which are produced by several microorganisms with capacity to bind to HLA-DR molecules has been proposed.

Ama Vichar
The concept of Ama is a unique contribution of Ayurvedic science. There is no equivalent term as such in Modern medical science which can be compared to Ama. There are number of diseases caused due to Ama alone.
The main cause in formation of Ama is Mandagni or Kayagni Dourbalyata i.e. low digestive power. In other words it can be explained that there will be disturbance in the secretion of digestive juices and enzymes which makes the intestinal movement sluggish, such an environment is favorable for fermentation in intestine and gives way to form the Ama. Thus formed Ama has qualities similar to that of Visha (Toxins).

Samprapti of Amavata
As discussed earlier whenever the function of Agni is disturbed in the body Ama is produced. This produced Ama is slimy in nature, such Ama get together with Dushit Vata / Prakopit Vata and circulates all over the body through Shira and Dhamani and gets lodged in Kaphasthana i.e. Sandhi because Shleshak Kapha is located in Sandhi and Amvata is developed.

Other joints are involved in Chronic Rheumatoid Arthritis
Joint Deformity in R.A.
2) Boutonniere (Deformity in R.A. with flexion at proximal interphalangeal joint & hyperextension at distal interphalangeal joint). 3) Z deformity in the thumb. 4) Volar subluxation and ulnar deviation occurs at metacarpophalangeal joint. 5) Bilateral flexion contractures of the elbow. 6) Synovitis at the wrist may cause carpel tunnel syndrome.

Diagnosis of R.A.
The diagnosis of R.A. is essentially clinical since there is no specific laboratory test to diagnose it. The occurrence of symmetrical peripheral inflammatory polyarthritis along with early morning stiffness should suggest the possibility of R.A.

Prognosis of Amavata
It is depending upon the involvement of doshas, dhatus, number of symptoms and upadrava exhibited in the patient.
Considering its severity Madhava opines that Amavata is a dreadful disease. The nature of disease is such that the patient will go to acute condition very immediately.
Commenting on the involvement of joints and its complication Madhava concludes that the management of Amavata is very difficult, if the swelling and pain are affected to all the joints. When compared to other diseases amavata is very difficult to cure.

Discussion and Conclusion
[1] Drugs like vatsanabha and ahiphena helps in inducing sleep and relaxing muscles, hence pain is relieved.
[3] Guggulu acts as bhagnasandhankara hence prevents the erosion of bone, osteoporosis and deformity of joints. It also acts shothahara hence reduces the inflammation of synovial membrane, connective tissue and ligaments of affected joints.
[5] Some drugs simply by their virtue of prabhava act as amavataghna.