Undoubtedly, precise translation of Ayurvedic nomenclature into modern medical terminology is difficult. However, distinctions are made between different articular disorders, descriptions of which bear resemblance to Rheumatoid Arthritis (RA) and Osteoarthritis (OA). In many Indian languages, Vata, distinct from vata dosha
, is a common colloquial term used to denote rheumatism. When primarily affecting joints, it is often called “sandhivata” (sandhi
=joint). Many forms of arthritis were described along with the nervous system disorders in the classic texts.[8
] The condition of Amavata[10
] has been described as a dreadful, painful, swollen polyarticular affection similar to RA. Vata dosha
plays a major role in the causation of arthritis. Joints and soft tissues are affected by “ama
”, produced in the gut due to “weakened” agni, food indiscretions, or disturbed dosha
equilibrium, resulting in inflammatory and obstructive processes. In Ayurveda, “arthritis is linked to the gut”: Ayurvedic formulations invariably target joints, gut, and
immune systems. How intriguing, even surprising, that thousands of years later, modern medicine should find such an essential immune-mediated link between certain gut disorders and inflammatory arthritis!
Several publications support purported anti-inflammatory and biologic effects of some popular anti-arthritic Ayurveda medicinal plants,[11
] demonstrating immunomodulation. Such an immunologic basis is conceptually captured by the “Rasayana
” (means “strengthening and rejuvenating”) branch of Ayurvedic science.[4
] Ayurvedic pharmacopeias[10
] contain lucid descriptions of Rasayana
properties of medicinal herbs and minerals, several of which are used to treat arthritis.
aims to increase the body’s resistance to disease (vyadhi-kshamatva
), delay aging, and promote body strength and intellect. Rasayana
practices in daily life are rejuvenating and in disease promote healthy recovery. The prime example of a Rasayana
plant is Withania somnifera (Aswagandha)
] extensively used in Ayurvedic medicine, and often compared to Ginseng; its immunomodulatory, anti-inflammatory, and hence anti-arthritic, and other biologic effects have been extensively documented.
Ricinus communis (Erand/castor oil) and Guggul extracts (Commiphora mukul, Boswellia serrata) are prime examples of potent anti-arthritic medicinal plants named in Charaka Samhita (CS). Numerous other Rasayana plants, especially Withania somnifera, are common components of anti-rheumatic medications. Other well-standardized formulations manufactured on a large scale by the Indian pharmaceutical industry are Dashamool, Mahayograj Guggul, Vatavidhwansa, Suvarna Bhasma, Guggul, Yograj Guggul, and Triphala Churana. Several of these have potent laxative action. Guggul preparations often contain ash (Bhasma) of minerals such as gold (Suvarna Bhasma), silver, copper, iron, mica, mercury, sulfur, zinc, lead.
It is fascinating that “gold” in its Ayurvedic ash form has been used to treat arthritis since ancient times, while modern medicine inadvertently discovered its use as disease-modifying anti-rheumatic drug (DMARD) in the last century. CS describes complex poultice preparations made by mixing herbs, minerals, and animal meat. Certain medicated massage oils like Bala taila,[21
] also used in the treatment of arthritis, may contain more than 50 ingredients.
Treatment of arthritis usually begins with two basic processes: snehana (oleation) and swedana (sweating, heating). While diaphoretic, steam bath, may be used to carry out the latter, oily preparations are administered orally, through medicated enemas (Basti), or massage for oleation. These aim to cleanse and purify the body to restore tridosha equilibrium. Such drugs are administered to patients through multiple routes concurrently or sequentially. Panchakarma (Five Processes) comprises treatments curative to dosha imbalance, including emetics (Vamana), purgatives (Virechana), medicated oily enema (Anuvasana Basti), medicated decoction/dry enema (Asthapana Basti/Niruhana), and oleation/nasal purgation (Shirovirechana/Nasya). Guided by therapeutic response, Panchakarma procedures are indicated for specific stage of disease. They are widely used to treat many forms of arthritic conditions, including RA.
Dietary restrictions form the mainstay of treatment, and physical exercises and yoga are advocated at appropriate stages of recovery. Some patients are made to fast (Langhana
) in initial, acute stages: the digestive and metabolic systems are strengthened and digest accumulated Ama
. Similarly, patients are recommended special, easily digestible diets with attributes opposite to the offending Dosha
. Application of leaches and venesection, recommended to remove excess Dosha
, and relieve pain and swelling.[22
Pain relief for painful, swollen joints is produced by local application of plant extracts (for example, Semecarpus anacardium or marking nut), which produce chemical cauterization and superficial burn-like reactions. Similar cauterization may be achieved by applying heated probes of gold, copper, or iron known as Agnikarma.
Ayurvedic massage is very popular and is said to have several effects – alleviating vata, removing subcutaneous fat, reducing fatigue and pain, and stimulating the nervous system. In Ayurvedic massage, selection of oils and technique is guided by the patient’s Dosha and Dahtu status. Ayurvedic pressure points (marmas), as in acupuncture, are well described, and used during massage to stimulate internal organs. Exercise is recommended to make the body light and flexible, and to enable it to withstand heat, cold, hunger, thirst, and fatigue.
Yoga has been described as the best means to achieve physical and mental fitness. Yoga and Ayurveda share common fundamental principles of anatomy, physiology, pathogenesis (including tridosha), and treatment, and complement each other. Traditional practitioners advocate use of both to treat chronic ailments, including arthritis.
Ayurveda aims to “cure” (Aturasya-vyadhi-parimokshah
). Using Rasayana
, the host must be strengthened to prevent relapses. The texts describe prognostications and limitations of therapy. For example, rheumatism is likely to be incurable if all three doshas
are vitiated, and likely to persist for long time if two doshas
] In our experience, consensus among Ayurvedic physicians on how best to treat a particular form of arthritis is difficult to obtain. Differences are often attributable to patients’ diagnosis. Several components of Ayurvedic treatment of RA and OA may be similar.