Amavata is an autoimmune inflammatory disorder in Ayurveda caused by the accumulation of Ama (toxins due to indigestion) and vitiation of Vata dosha, primarily manifesting as joint inflammation and stiffness.

Reference: "Amaṁ pratyakṣabhojyam syāt śitaṁ guru viruddhāṁ ca | Rūkṣaṁ chaṇḍam aśoṣam cha madhuraṁ kaphahṛc ca yat ||"
(Madhava Nidana 25/1)

Amavata originates due to weakened digestion (mandagni), leading to the accumulation of Ama in the digestive tract, which combines with aggravated Vata dosha and travels to various parts of the body, primarily affecting joints and causing pain, stiffness, and swelling.

Reference:
"Agni vaiṣamyaṁ syāma ca srotāṁsi rodhayet |
Amaṁ saṁvṛṇoti tatra caṁcalaṁ cha pravartate ||"
(Charaka Samhita, Chikitsa Sthana 28/3)

• Consumption of heavy, incompatible, and oily foods that are difficult to digest (such as curd, fried foods, and incompatible combinations like dairy and fish) leads to the formation of Ama, as they overload the digestive fire.

  Reference:
  "Guru śitaṁ madhuraṁ cāmlaṁ na sātmyaṁ hyāśrayet sadā |
  Rūkṣaṁ chaṇḍaṁ kaphāṁśaṁ yat saṁśleṣaṁ janayet khalu ||"
  (Ashtanga Hridaya, Sutrasthana 6/123)

• Sedentary lifestyle, excessive day sleep, and lack of exercise contribute to Ama formation and Vata imbalance, aggravating Amavata.

  Reference:
  "Divasvapnam ati bhrāmaṇam vā |
  Ajīrṇaṁ ca kathitāṁ kathitaṁ ca"
  (Charaka Samhita, Sutra Sthana 5/3)

The pathogenesis of Amavata involves weakened digestive fire (mandagni), leading to the formation of Ama in the digestive tract, which then combines with Vata dosha. This vitiated Ama-Vata spreads to joints and tissues, obstructing channels and causing pain and swelling.

Reference:
"Amaṁ śarīre syāmaṁ ca pravṛddhaṁ vā vataṁ pravartate |
Sparśānabhidātam vā"
(Charaka Samhita, Chikitsa Sthana 28/5)

Clinical assessment includes observing Ama presence, Vata aggravation, and characteristic joint symptoms (e.g., pain, swelling, stiffness).

Initially, symptoms of Amavata (Rheumatoid Arthritis) are:

• Apaka (Indigestion): is seen and further disease when reaches to joints shows- 
• Angamarda- Pain in the whole body. 
• Aruchi- Loss of appetite.
• Trishna- Excessive thirst 
• Alasya- Latharginess
• Gaurava- Heaviness in the body. 
• Jwara- Fever
• Shunata- Swelling of body parts. 

• Severe joint pain, stiffness, swelling, reduced mobility, and fatigue, often aggravated by cold and damp weather.
• Painful swelling in hand, feet, knee, neck, ankle, wrist, and elbow.
• Vrishika Damshavat Peeda- Pain like Scorpion string.

• In later stages, when multiple tissues and organ damage occurs further symptoms are seen-

• • Saruja Shopha- Painful swelling in hand, feet, knee, neck, ankle, wrist, and elbow. 
  • Vrishika Damshavat Peeda- Pain like Scorpion string. 
  • Agni Dourbalya- Sluggish digestion
  • Praseka- Excessive salivation, nausea. 
  • Aruchi- Loss of appetite. 
  • Gouravam- Heaviness in the body. 
  • Vtsaha Hani- Lack of enthusiasm. 
  • Vair Asyam- Abnormal taste in the body. 
  • Daaha- Burning sensation.
  • Bahu Mutrata- Excessive urination 
  • Grahani Dosha- Contamination of intestine. 
  • Apakwamala- When stool consists of undigested food. 
  • Kukshi Kathinata- Hardness of abdomen. 
  • Shulam- Colic pain
  • Nidra Viparyaya- Sleep disturbance. 
  • Trishna- Thirst 
  • Chardi- Vomiting 
  • Bhrama- Giddiness
  • Murcha- Faint
  • Hrid Graham- Tightness in the chest 
  • Antra Kujana- Different sounds in the abdomen. 
  • Anaha- Flatulence. 

Vishtambhi Amavata

Symptoms-

• • Sharira Guruta- heaviness in the body. 
  • Adhmana- distention of abdomen. 
  • Vasti Shula- pain in the region of the urinary bladder. 

Gulmi Amavata 

Symptoms- 

• • Jatara Garjane- Various sounds produced in the abdomen. 
  • Gulmavata Pari pidyate- pain as in abdominal tumor. 
  • Katidesh Jadatvam- Stiffness in the pelvic region. 

Snehi Amavata 

Symptoms-

• • Gatra, Snigethata- Feeling of oiliness of body. 
  • Jadhya- Stiffness of body parts. 
  • Mandagni- Low digestive fire.
  • Snigdha Vijala Ama- Oil secretions over the body. 

Pakva Amavata 

Symptoms-

• • Pita Vijala Shyava Pakwa ama Patate Adhah- Excretion of ama appears yellow or brown due to loss of wetness caused by decreased water content in the body.
  • Navasti Shula- the absence of pain in the region of the urinary bladder. 
  • Shrama- Exhaustion
  • Klama- Languor

Sarvanga Amavata

Symptoms- 

• • Kati Prushte Vaksho Deshe Rodonam- Pricking pain in the pelvis. 
  • Vasti Shula- pain in the region of the urinary bladder.
  • Gulmato Jatharam Ggarjate- gurgling sounds in the abdomen as in abdominal tumors. 
  • Shopho- Swelling or inflammation of body parts. 
  • Shirogurutvam- The heaviness of head. 
  • Amascha Patati- Excretion of ama.

Joint deformity, decreased mobility, and potential disability in chronic stages.

Chronic, but manageable with appropriate dietary, lifestyle, and therapeutic interventions. Prognosis is favorable with early treatment but poor in advanced stages with joint deformity.

• Langhana (Fasting) and Swedana (Sudation) to reduce Ama and Vata.
• Virechana (Purgation) and Basti (Enema) therapies.
• Shamanaushadi (Palliative Medicines) for pain relief.

Reference:
"Langhanaṁ cha Vamanaṁ cha Bastiṁ syāmaṁ śodhanaṁ ca |
Tiktaṁ rasayanaṁ cha dāsyāmi śamanaṁ cha eva ||"
(Charaka Samhita, Chikitsa Sthana 28/50)

1. Langhana (Lightening Therapy)

• Description: Langhana is regarded as the primary treatment for Ama, specifically when light and easily digestible food (Laghu Ahar) is prescribed. Since Amavata is considered an Amasayotha Vyadi (disease originating in the stomach) and a Rasaja Vikara (disorder of the plasma tissue), it responds well to this treatment.
• Source: Yogaratnakara

2. Swedana (Sudation Therapy)

• Description: Swedana (sudation or sweating therapy) relieves stiffness (Stambha), heaviness (Gaurava), and pain (Shula). Due to the presence of Ama, Ruksha Sweda (dry fomentation) like Valuka Pottali (sand poultice) is recommended to pacify Vata and alleviate joint pain and stiffness.

3. Tikta, Katu, Deepana (Bitter, Pungent, Digestive Herbs)

• Description: Bitter and pungent herbs are used to enhance digestion and act as Amapachana (digestants). These herbs help in reducing Ama and alleviate symptoms such as swelling (Shotha) and pain (Shula).

4. Virechana (Purgation Therapy)

• Description: In cases of Amavata, Virechana (purgation therapy) is recommended directly without preliminary treatments. Medicated purgation is administered through the anal route to remove toxins effectively from the body.

5. Vasti (Enema Therapy)

• Description: Vasti, the introduction of medicinal substances via enema, is beneficial in Amavata. Medicated Bastis, such as Kshara Basti and Anuvasana Basti (oil enema), are indicated for reducing Ama and pacifying Vata in the body.

6. Shamanaushadi (Palliative Medicines)

• Description: Various palliative medications are prescribed to alleviate symptoms, especially joint pain. Specific pain-relieving medicines (Shoola Shamana) are advised for immediate symptom relief.

7. Rasaushadhi (Mineral Compounds)

• Description: Certain mineral preparations, known as Rasaushadhis, are used in Ayurveda for faster recovery. These preparations are carefully formulated and administered under strict supervision.

For the treatment of Amavata (Rheumatoid Arthritis) in Ayurveda, a range of classical medicines is recommended to address Ama (toxins) and Vata imbalances. These medicines are selected based on their properties to reduce inflammation, improve digestion, alleviate pain, and rejuvenate the body. Here is a selection of Ayurvedic medicines commonly used in managing Amavata, though these should be taken under the guidance of an Ayurvedic practitioner due to their potency and specific applications:

1. Amapachana and Agni Deepana (Ama Detox and Digestive Stimulants)

• Trikatu Churna: A blend of black pepper, long pepper, and ginger; used for enhancing digestion and removing Ama (toxins).
• Panchakola Churna: A combination of Pippali (long pepper), Pippalimoola (root of long pepper), Chavya, Chitraka (Plumbago zeylanica), and Nagara (ginger) for Ama digestion and reducing inflammation.
• Chitrakadi Vati: Known for stimulating digestive fire (Agni) and aiding in the digestion of Ama.

2. Shothahara (Anti-inflammatory Medicines)

• Guggulu Preparations:
  • Yograj Guggulu: Reduces joint pain and inflammation, supports digestion, and is commonly prescribed in Amavata.
  • Simhanada Guggulu: Especially useful in chronic cases of Amavata, where it aids in reducing Ama and Vata and relieving joint inflammation.
  • Mahayograj Guggulu: Stronger formulation of Yograj Guggulu, often used for severe or chronic inflammation and pain relief.
• Mahayogaraja Guggulu: Known to pacify Vata and provide anti-inflammatory effects.

3. Vata Balancing and Pain-Relieving Medicines

• Dashamoola Kwatha: A decoction of ten roots known for reducing Vata dosha and relieving pain and swelling.
• Eranda Taila (Castor Oil): Used in small quantities for internal administration to reduce Vata and relieve pain. It is also beneficial when used with purgation therapy (Virechana).

4. Shamanaushadhi (Palliative Therapies)

• Rasna Saptaka Kwatha: A decoction that alleviates joint pain and reduces inflammation, especially effective in Vata and Ama-related conditions.
• Guduchi Satva: An extract from Tinospora cordifolia that works as an immunomodulator and anti-inflammatory agent.
• Amritarishta: Fermented formulation made from Guduchi, known for reducing Ama and strengthening immunity.

5. Rasaushadhi (Mineral-based Preparations)

• Sutsekhar Rasa: Effective in relieving pain and pacifying Vata dosha.
• Pravala Bhasma: A calcium-rich compound derived from coral, which helps to strengthen bones and reduce joint pain.
• Rasraj Ras: Used for joint and muscle strength, often indicated in chronic Vata disorders like Amavata.

6. Basti (Medicated Enema Therapy)

• Ksheera Basti: A special enema with milk and herbal extracts used to nourish and pacify Vata dosha.
• Anuvasana Basti: Oil-based enema containing castor oil or sesame oil, which helps reduce Vata and improve joint lubrication.
• Tikta Kshira Basti: Enema containing medicated milk with bitter herbs like Guduchi to reduce Ama and Vata.

7. Herbal Oils for External Application

• Mahanarayan Taila: An herbal oil used for external application to reduce joint stiffness and pain.
• Karpuradi Taila: Contains camphor, which provides cooling and anti-inflammatory effects when massaged on the joints.
• Bala Ashwagandha Taila: Known for its strengthening and Vata-pacifying properties, beneficial in joint pain and inflammation.

Note: Ayurveda emphasizes personalized treatment based on an individual's Prakriti (constitution), Dosha imbalances, and the specific manifestation of Amavata. It is crucial to consult an Ayurvedic physician to determine the appropriate combination, dosage, and form of these medicines.

External Treatments for Amavata

1. Abyanga (Oil Massage)

   • Description: Regular massage (Abyanga) with medicinal oils helps to alleviate the dryness of Vata and reduce joint stiffness.

2. Swedana (Steaming)

   • Description: Steaming, or fomentation, provides relief from the coldness (Sheetaguna) of Vata, enhancing blood circulation and relieving muscular rigidity.

3. Pinda Sweda (Bolus Fomentation)

   • Description: Techniques like Churna Pinda Sweda (herbal powder bolus) and Patra Pinda Sweda (leaf bolus) target specific or general body areas to reduce pain and restricted movements.

4. Baluka Sweda (Sand Fomentation)

   • Description: Sand mixed with herbs like Ajmoda (Carum copticum), turmeric, and Sendha Namak (rock salt) is heated and applied to joints to reduce inflammation and pain.

5. Dhara (Medicated Pouring)

   • Description: Medicated liquids, such as Dhanyamla, are poured over the body to provide a calming effect, addressing the anxiety and mental stress associated with Amavata.

6. Upanaha (Poultice)

   • Description: A medicated paste is applied over the joints to relieve inflammation and swelling, providing targeted relief.

A balanced diet that pacifies Vata dosha is essential for managing Amavata. Recommended foods include:

• Grains: Easily digestible options like barley (Yava), horse gram (Kulattha), red rice (Raktha Shali).
• Vegetables: Leafy greens like Moringa leaves (Shigru), bitter gourd (Karela), and pointed gourd (Patola).
• Spices: Ginger, garlic, and turmeric for their digestive and anti-inflammatory properties.
• Fluids: Lukewarm water or water boiled with ginger root for digestive support.

Reference:
"यवाः कुलत्थाः श्यामाकाः कोद्रवा रक्तशालयः। वास्तुकं शिग्रु वर्षाभूः कारवेल्लं पटोलकम्॥
आर्द्रकं तप्तनीरं च लशुनं तकसंस्कृतम्।।"

Heavy foods, dairy in excess, cold and oily foods, and sedentary lifestyle.

Amavata corresponds to Rheumatoid Arthritis in modern medicine, where the immune system attacks joint linings, causing inflammation, pain, and potential joint deformity.

Routine blood tests, including ESR, CRP, and rheumatoid factor; imaging studies for joint assessment.