1. DR. SRINIDHI.S
1ST YEAR PG SCHOLAR
CASE REPORT-LOCOMOTOR SYSTEM
AMAVATA
GUIDE:
DR.AMRITHA RAJAN
ASSISTANT PROFESSOR
DEPARTMENT OF PANCHAKARMA
SRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF AYURVEDA
AND HOSPITAL,HASSAN
2. ABSTRACT:-
PATIENT HAD PAIN IN ALL MINOR AND MAJOR JOINTS OF THE
BODY SINCE 2 YEARS ALONG WITH STIFFNESS AND SWELLING
IN ALL JOINTS SINCE 1 YEAR.
DVIPANCHAMOOLADI KSHARA BASTI WAS ADMINISTERED AS
KALA BASTI SCHEDULE ALONG WITH SHAMANOUSHADHI.
THERE WAS SIGNIFICANT REDUCTION IN PAIN AND STIFFNESS
OF JOINTS.THUS AMA NIRHARANA , VIRECHANA , BASTI HELPS
IN RELIEVING THE SYMPTOMS OF AMAVATA.
4. BIODATA
NAME : Meghashree
AGE : 24YRS
SEX : FEMALE
RELIGION : HINDU
MARITAL STA : MARRIED
OCCUPATION : HOUSE WIFE
ADDRESS : BANGALORE
D.O.A :02-08-17
D.O.D :02-09-17
OP NO :17513
IP NO :3476
5. CHIEF COMPLAINTS
STIFFNESS IN THE JOINTS
SWELLING IN ALL JOINTS
SINCE 2 years
PAIN IN ALL MINOR AND MAJOR JOINTS OF THE BODY-
SINCE since 4 years
7. H/O PRESENT ILLNESS
•As per the patient words she was normal 2year back.
•One day she developed pain in inter-phalangeal joints bilaterally.
•After a week she noticed stiffness in the fingers.
•Later pain started in the elbow joints.
•Gradually pain started in wrist, shoulder, knee and ankle bilaterally.
•Severity of the pain started increasing and sometimes associating with
swelling.
•Later Stiffness in the body during morning hours started.
15. SYSTEMIC EXAMINATION
Respiratory system – NVBS +
Cardiovascular system- NAD
Musculo skeletal system – On inspection –
difficulty in extension of fingers
difficulty in lifting arms
swelling in interphalangeal joints
On palpation –
rise in temp in joints
tenderness in joints
23. TREATMENT
Langhana:- laghu bhojana (mudga yusha).
Sweda:- valuka sweda
Deepana Pachana:- Panchakola Phanta 50 ml
tid for 4 days
Snehapana with:- Indukanta gritha
Virechana:- with 60 ml of Gandharvahastadi
Eranda taila
Discharged with Samsajana krama.
Admission after 1 week
Planned for Kshara basti
24. DWIPANCHAMOOLADI KSHARA BASTI
Anuvasana Basti:- Brihat saindavadi taila- 80 ml
Niruha basti:-
Honey:-120 ml
S.lavana:- 5 g
B.S.Taila:- 80 ml
Dwipanchamooladi kalka:- 50 g
Dwipanchamooladi kwatha:- 300 ml
Gomutra:- 50 ml
1st 2nd 3rd 4th 5th 6th 7th 8th 9th
A N N N N N N A A
A A A A A A A
25. RESULTS
Parameters BT AT
Swelling:- +++ Nil
Pain:- +++ + (Slight pain on
motion)
Stiffness:- +++ Normal
Tenderness ++ Absent
Lab Investigation BT AT
ESR 60 12
RA 612 126
42. OSTEO ARTHRITIS
Restricted movement (capsular thickening,
blocking by osteophyte)
Palpable, sometimes audible, coarse crepitus
(rough articular surfaces)
Bony swelling (osteophyte) around joint margins
Deformity, usually without instability
Joint-line or periarticular tenderness
Muscle weakness, wasting
No or only mild synovitis (effusion, increased
warmth)
43. RHEUMATOID ARTHRITIS
Diagnostic Criterias of Rheumatoid Arthritis :
• Morning stiffness (>1hr)
• Arthritis of 3 or more joints
• Symmetrical arthritis
• Rheumatoid nodule
• Rheumatoid factor
• Duration of 6 weeks or more
Now let us see what are the samanya lakshana’s of Amavata. The disease amavata is characterised by angamar…
No sloka. Explain the sloka.. The disease amavata is corelated with ra. Now let us have a look on few facts about RA.
It is very important tat the disease am
लंघनं स्वेदनं तिक्त दीपनानि कटुनि च ।
विरेचनं स्नेहपानं बस्तयः च आममारुते ॥
रुक्षस्वेदो विधातव्यो वालुका पोटलैः तथा ।
उपनाहश्च कर्तव्याः तेऽपि स्नेह विवर्जिताः ॥(यो.र)
रुक्षस्वेदो विधातव्यो वालुका पोटलैः तथा ।
उपनाहश्च कर्तव्याः तेऽपि स्नेह विवर्जिताः ॥(यो.र)
लंघनं स्वेदनं तिक्त दिपनानि कटुनि च ।
विरेचनं स्नेहपानं बस्तयश्चाममारुते ॥
सैन्धवाध्येनानुवास्य क्षारबस्ति प्रशस्यते । (च.द)
avata should be handled very tactfully. The avasthanusari management of amavata is important…
Where I am mainly dealing with the treatment aspects of Sama and Nirama avastha’s of Amavata which are very important avasthas.
Sushrutha in vatavyadhi chikitsa adhyaya have clearly stated that (tell sloka here) that is when the prakupita vata is present in pakvashaya then one should so for snehavirechana and then shodhana basti’s. while commenting on same sloka dalhana says that “ पक्वाशय: पुनरिह द्विविध: - पित्तवाताशयभेदेन, तयोर्मध्ये पित्ताशयगते वोयौ स्नेहविरेचनं तिल्वकसिद्धम् एरण्डतैलादिभिर्वा, वातशयगतस्य तु वायो: मलकफैरावृतस्य यथादोषं कषायकल्कस्नेहबस्तय:।
Very much importance have been given to eranda sneha in the treatment of amavata. Vangasena had said that eranda taila is like a gajakerasi in controling the amavata gajendra..hence many of the yoga’s have been mentioned with eranda taila in the management of amavata. The use of eranda taila in amavata suggests that in this disease snigdha and not ruksha virechana should be employed, since it does not produce generalised snehana effect but by its snigdha, ushna etc. characteristics, it augments the agni in addition to its vata anulomana action.
Last in treatment of amavata basti is mentioned if the dosha’s are gambeeragata and the disease is pravruddha (chronic), after shodhana karma, physisian should plan for basti karma. This is because if dosha’s are gambheeragata, then there is a chance that the pravruddha vaata will enter pakvashaya and may cause agnimandya and apakarshana of bala. Hence it is important that basti should be planned in gambheeragata doshas or in pravruddha avastha of disease after shodhana because kaayashodhana will not be able to remove entire dosha’s from body.. The same thing had been clearly mentioned by Bhela in siddhi stana with the verse which goes like this (sloka here)
