Amavatha

“AMAVATA” IS FIBROMYALGIA AND POORLY BE CORELATED

WITH RHEUMATISMBY

Dr Jayagovinda UkkinadkaUKKINADKAS AYURVEDA

Introduction

• Amavata is a conditon explained in Laghu thrayees, but not in Brihat Thrayees.

• First explained in Madhava Nidana, by Madhavakara who lived between 600-700AD, that is one century after Vagbhata

• Later books like Yoga Ratnakara, Bhaishajya Ratnavali etc quoted the slokas of Madhava Nidana to explain the disease Amavata without much change.

Introduction

• There is lot of difference of opinion among the Ayurvedic scholars while co-relating the diseases like Amavata, Vatashonita with the contemporary diseases explained in modern science.

• Most of the scholars co-relate Vatashonita with Gout and Amavata with Rheumatism

Introduction

• But if we go through the symptoms it seems that Amavata can poorly be co-related with Rheumatoid Arthritis and other rheumatisms.

• It is very important to identify or co-relate the Ancient diseases with the diseases explained in modern science to have correct idea of treatment principles.

What is Amavata then?

• Considering symptoms etc Amavata has many resemblence with Fibromyalgia explained in modern science or in other words we can co-related Amavata with Fibromyalgia better than that of Rheumatism.

Nidana & Samprapthi

ETIOLOGY & PATHOPHYSIOLOGY

– Viruddahara means unwholesome foods or combination of foods which effects adversely.

– Poor digestion power, defective metabolism– Sedentary life style and also too much exercise– So affected defective metabolism with the

influence of nervous system also affects the normal functioning, and the products of this reaches Dhamanis (blood vessels) and circulates all over the body and produces symptoms.

ETIOLOGY & PATHOPHYSIOLOGY

signs

signs

• These defective metabolic products with the influence of Nervous system produces symtoms in neck, lower back and all over the body and produces stiffness.

Samanya Lakshana

Main features

• Bodyache• Poor appetite, feeling thirsty, lethargic• Heavyness in the body• Feverish feeling• Non inflammatory and no suppurative nature

Ati pravridda Lakshana

Vrischika Visha Lakshana-Charaka

Severe AMAVATA features

• Very difficult to tolerate when becomes severe. Can also be considered as difficult to treat when aggravates

• Severe pain in hand, foot, head, ankle, neck, low back, knee and hip joints

• Pain and swelling is seen in different parts of body

• Pain will be severe as if bit by scorpion. (burning sensation and pain as if hit by stick)

Upadravas

Yogaratnakara Adds Grahani as Upadrava

Complications

• Poor appetite, Poor digestion, excessive salivation, lethargy

• Burning urination and increased frequency of urination

• Disturbed sleep • Giddyness and syncope• Grahani- Abdominal pain, constipation, poor

apetite etc.

Doshik involvement and Sadhyasadhyatha – No asadhya Amavata

Samanya Chikitsa- Bhai.Ra

Yogaratnakara suggests Sneha vivarjana

Saindhavadyam Tailam Brihat and Laghu in Bratnavali for Abhyanga

Brihat saindhyavadyam Tailam

Pathya

Apathya

Fibromyalgia- Cardinal signs• Persistent widespread pain• Stiffness• Fatigue• Disrupted Unrefreshing sleep• Cognitive difficulties• Often accompanied by multiple other unexplained

symptoms• Anxiety and/or depression• Functional impairment of activities of daily living • Typically presents in young or middle-aged women.

Pathophysiology- AMA

• Although the pathogenesis of fibromyalgia is not completely understood, research shows biochemical, metabolic, and immunoregulatory abnormalities. These substantiate the proposal that fibromyalgia can no longer be considered a subjective pain condition.

• Metabolic and Sensitivity related with Pitta and vata, deffective metabolism with AMA.

Body Pain- Angamarda - Apakaha

• Central process- Dopaminergic activity, Excess excitatory neurotransmitter

• Low Serotonin and elevated substance p- neurotransmitters

• Dysfunction of the hypothalamic-pituitary-adrenal axis• Growth hormone• Elevated Nerve growth factor in CSF which produces

Substance P• Pain is non inflammatory - Apakaha

Jvara Aruchi Trishna Alasya Gourava

• In some patients with fibromyalgia, negative emotional, motivational, and cognitive stressors may dominate the clinical picture, potentially leading to a self-sustaining neuroendocrine cascade that contributes to flulike symptoms, depressed mood, fatigue, myalgias, cognitive difficulties, and poor sleep.

Sleep Desruption Nidra viparyaya and Anidratha

• NREM 4th stage deranged which further worsens the metabolic function

• Lack of sleep is one of the main feature of Fibromyalgia

Other features- Bahumuthratha, Murcha, Shwasa etc

• Weight fluctuations• Allergic symptoms (eg, nasal congestion) and

hypersensitivity to environmental stimuli (eg, odors, bright lights, loud noises) and medications

• Syncope or dizziness• Shortness of breath• Urinary frequency and urgency (female

urethral syndrome, interstitial cystitis)These features are frequently seen in Fibromyalgia

Grahani vidvibaddatam jadyantrakujam anaham

• Approximately 40% of patients with fibromyalgia describe having alternating bouts of diarrhea and constipation and also experience bloating, cramping, and an increased urge to defecate

Shotha

• Approximately 50% of patients with fibromyalgia present with complaints of tissues feeling swollen and of numbness and tingling in the extremities. These symptoms generally are more common in the upper extremities than in the lower ones.

Hasta pada shirogulpha trika januru sandhishu teevra vedana

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