Types of Arthritis according to Ayurveda

i) Rhematoid Arthritis
Rheumatoid arthritis is a chronic disease which usually affects middle aged persons, and is seen more in women than in men. Children too, may get affected. In this disease, the synovial membrane, or the covering tissue of the joints gets swollen, resulting in stiffness, pain and limitation of movement. In severe conditions, the joints may ultimately become deformed. A disturbed immune function is believed to be responsible for this disease.

In Ayurveda
In Ayurveda, rheumatoid arthritis is known as "Sandhi Vata". This is not to be confused with "Aam Vata" which is the name given to Rheumatic Fever, or the fever which causes pain and swelling in joints and also affect the heart.

Management Of Rhematoid Arthritis
Rheumatoid arthritis of recent origin usually responds well to standard anti-inflammatory treatment. However, by nature this is a chronic disease, and while symptoms can be controlled, there is presently no cure. Standard modern medicine may not be very helpful once the condition becomes chronic, or treatment may have significant side effects. It is in such patients that Ayurvedic herbal treatment may be very useful and effective. One major advantage of Ayurvedic herbal medicines in such an affliction is that medicines may be taken for long periods without any serious side-effects.

Ayurveda Mangement
Ayurvedic treatment of rheumatoid arthritis consists of the following procedures:
(i) "Snehan" ( use of local and oral medicated lubricants)
(ii) "Swedan" (local fomentation)
(iii) "Lep" (Local application of medications)
(iv) "Anuloman" ( mild laxative treatment for prolonged periods)
(v) "Raktamokshan" (blood letting)
(vi) "Dahan" (local heat branding ) and
(vii) "Shaman" ( symptomatic oral treatment).

Mahanarayan oil( containing mainly Asparagus racemosus), Bala (Sida cordifolia) oil, Vishgarbha oil are some of the medications used for snehan procedures. While local application is quite simple, oral use of medicated lubricants is best done under the direct supervision of a qualified and experienced Ayurvedic practitioner.While local fomentation can be done in several ways, "Naadi swedan" is the most effective. In this procedure, a jet of medicated steam is directed at the affected joints, usually after the snehan procedure. A decoction of Nirgundi (Vitex negundo) is usually used for this procedure.

Local Application
Local medicated applications include Lepgoli, Dashang lep, and a mixture of Shrung, Daruharidra ( Berberis aristata), Alum, and Rakta Chandan (Santalum album). Several medicated herbal ointments are also available.

Local pain can be immediately reduced by blood-letting. This can be done by syringe or using leeches. About 50 ml. of blood is usually withdrawn from a vein near the affected joint. Local heat branding is used by some physicians to reduce acute tenderness of the joints. Various special metal instruments are used for this procedure.Castor oil and Haritaki (Terminalia chebula) treated with castor oil are used for mild, prolonged laxative treatment.

Oral Ayurveda Management
Oral medications include Maharasnadi decoction, Triphala Guggulu, Yograj Guggulu and Ashwagandharishta. Shallaki (Boswellia serrata) and Guggulu (Commiphora mukul) compounds are given for prolonged periods. Multiple herbal compounds containing Guggulu are available, which are used according to the presenting symptoms and the staging of the disease as done by the Ayurvedic practitioner.

Diet Management
It is advisable to avoid very sour, salty and cold (refrigerated) food products, as also fermented products. Using tolerable amounts of ginger and garlic in the daily diet is helpful. Some yogic asanas have been found to be useful in arthritis, and may be performed regularly under the supervision and advice of an expert in this field. Vata-If arthritis is due to vata, your joints will crack and pop. They become dry and are not swollen as they may be if excess vata is not the cause.

Pitta-The arthritis is characterized by inflammation. The joint becomes swollen and is painful even without movement. It often looks red and feels hot to the touch.

Kapha-In kapha-type arthritis, the joint also becomes stiff and swollen, but it feels cold and clammy rather than hot. A little movement, rather than aggravating the pain, tends to relieve it.

General Treatment of Arthritis
Depending on a person's lifestyle, diet, and emotional pattern, either vata, pitta, or kapha goes out of balance. Then that particular dosha slows down agni (digestive fire), resulting in the toxic, sticky by-product of inadequate digestion known as ama.

Vata, the main active dosha, brings the ama into the colon, and from there it travels through the system and lodges in the bone tissue and in the joints, giving rise to the stiffness and pain characteristic of arthritis.

Ayurveda attempts to remove the ama from the joint and bring it back to the colon, and then to eliminate it. To do this, we need to keep the colon clean. It is best to determine the type of arthritis and manage it for the remedies recommended for the specific type. If you do not know whether the arthritis is vata, pitta, or kapha arthritis, take 1 teaspoon triphala at night with 1/2 to 1 cup warm water.

If you know positively which type it is, you can use the following (1/2 to 1 teaspoon with warm water):

Haritaki for vata-type arthritis
Amalaki for pitta-type
Bibbitaki for kapha-type arthritis

Ayurveda recommends general techniques for increasing the intensity of the digestive fire (agni) in order to burn up the toxins that are harming the body.

Hot, spicy foods and herbs, including galangal and cayenne are frequently used.

Detoxification diet
A three- to five-day detoxification diet is often prescribed. Vegetables, juices, spices and herbs are taken during the fast, which lasts until the body shows signs that the digestive fire is burning strong. These signs include a return of the appetite, a feeling of lightness and a clear coating to the tongue.

Enemas and other means of cleaning the colon are often used to help detoxify the body.

Ruby, garnet or other "hot" gems set in gold are used for all three types of arthritis.

Various oils may be applied to the skin in order to help the body clear toxins, relieve pain and restore mobility.

Mahanarayan oil improves flexibility, stiffness, muscle fatigue, and removes pain. It is mixed with sesame oil (1:1) and applied to the painful areas. This oil also breaks up blockages and begins to heal locally. After oil application, warm heat, yoga, bath, or mild exercise further improves this situation.

Narayan oil is good for muscle and joint pain, lower body circulation, and reversing imbalances caused by aging.

The patient may be asked to sit in a sauna, or may have steam applied directly to the afflicted areas.

A variety of herbs, spices and bitters are used in ayurveda. These are often applied externally or ingested. These are believed to cleanse the body and to relieve pain and stiffness. Mint, ephedra, golden seal, gentian, nirgundi, eucalyptus leaves, prasarini, quassia, coptis, scute, phellodendrom, aloe, guggul, du huo, ligusticum, Siberian ginseng, myrrh, and yucca are some of the herbs used.

Treating Vata-type arthritis

Diet-In addition to the general treatment, Vata-type arthritis responds well to a three- to five-day detoxification diet and an anti- Vata diet. This diet includes warm, heavy and moist foods that give one strength.

Herbs, Essential Oils-Take yogaraj guggulu, 1 tablet 3 times per day. it cleanses bone tissue, strengthens bones, and improves flexibility.

Take 1/2 to 1 teaspoon Haritaki with warm water Apply mahanarayan oil on the affected joint, followed by application of local moist heat. For example, apply the mahanarayan oil into the affected joint, rub it into the skin, and then soak your foot in warm to bearably hot water. Add a "teabag' of brown mustard seeds to the water. (Wrap 2 tablespoons of mustard > seeds in a handkerchief or cheesecloth to make the tea bag.)

Helpful yoga postures:

Forward Bend
Chest-Knee pose
Maha Mudra
Half Bridge pose

Treating Pitta-type arthritis
Pitta arthritis often has more pain and inflammation associated with it than other types.

In addition to the general treatment, Pitta-type arthritis responds well to a five- to seven-day detoxification diet and an anti-Pitta diet. Specific herbs for Pitta arthritis include guggul, sandalwood, aloe, saffron and chaparral. Apply ice packs on the inflammed part to quell the "fire."

Diet-The anti-Pitta diet consists of cool, slightly dry, and heavy foods.

Useful Ayurvedic Herbal Formulas

Take 1 tablet of kaishore guggulu (350 mg.) 3 times a day.
1/2 teaspoon sudarsban twice a day, washed down with warm water.
Brahmi and sandalwood oils (mixed together) are very beneficial.
Musta and nirgundi relieve pain.
Externally, apply cool castor oil or coconut oil to the painful area.
Apply a cooling substance, such as sandalwood powder paste to the affected part. Make the paste by taking 1 teaspoon of sandalwood powder and adding sufficient water to make a paste. Rub it gently onto the joint.
If the joint is hot and inflamed, put an ice-bag on it. This will help to ease the pain and inflammation.

Helpful yoga postures:

Boat
Bow
Camel
Cow
Locust
Moon Salutation

Treating Kapha-type arthritis
Arthritis is classified as kapha when the joint is painful, swollen, stiff, and feels cold and clammy to the touch.

Diet-In addition to the general treatment, Kapha-type arthritis responds well to a one- to two-week detoxification diet. The anti-Kapha diet is light, dry and warm. Avoid cold, oily, and heavy foods.

Herbs
Pure guggul is best for this condition.

Punarnava guggulu tablets (250 mg.). Take 1 tablet 3 times a day.

Apply a paste of vacha (calamus root) powder externally to the joint. To make the paste, add sufficient warm water to 1 teaspoon of powder to make a paste.

If the joint fills with fluid, make an paste of equal amounts of punarnava powder and ginger powder. Mix 1 teaspoon of each with enough warm water to form a paste, and apply on the joint.

Hot herbs are also helpful, such as cinnamon, dry ginger, turmeric, trikatu.

ii) Sciatica and Cervical Spodylosis
Sciatica is the name given to the disease in which there is pain, tingling or numbness due to irritation of the nerve roots that form the sciatic nerve, which originates in the lower back and extends down into both the legs till the feet. Cervical Spondylosis is the name given to the disease in which there is pain, tingling or numbness due to irritation of the nerve roots that form the brachial nerve, which originates in the neck and extends down into both the arms till the hands. Both diseases are discussed here together, since the causative factors, symptoms and the treatment required for both are very much similar, only the location of the pain is different. The pain of sciatica is in the lower back, radiating down to the leg and foot, whereas the pain of cervical spondylosis is in the neck and shoulder, radiating down to the arm and fingers. Sciatica pain has typically more of a dramatic onset, usually due to a ruptured or herniated disc which presses on the nerve roots and causes the pain. The pain can be severe enough to cause acute limitation of movement. This can happen in cervical spondylosis too, however, here it is more common to have a gradual onset of pain due to degeneration of the neck vertebrae.

In Ayurveda
In Ayurveda, sciatica is called as "Grudhraci" and cervical spondylosis is called as "Vishwachi".

Ayurvedic treatment of sciatica consists of the following procedures:

Panchakarma

(i) "Snehan" ( use of local medicated lubricants)
(ii) "Swedan" (local fomentation)
(iii) "Basti" (Medicated enema)
(iv) "Anuloman" ( mild laxative treatment for prolonged periods)
(v) "Dahan" (local heat branding ) and
(vi) "Shaman" ( symptomatic oral treatment).

Vishgarbha oil in acute condition, and Mahanarayan oil ( containing mainly Asparagus racemosus) for chronic pain is used for local snehan procedure. Local fomentation can be done mainly in two ways. The first is "Naadi swedan" in which, a jet of medicated steam is directed at the back and affected leg, usually after the snehan procedure. A decoction of Nirgundi (Vitex negundo) is usually used for this procedure. The second procedure is called as "Awagah swedan", in which the patient is made to recline in a tub filled with warm decoction of Nirgundi, Dashmool (Ten Roots) or ErandMool (Root of Ricinus communis). Medicated enemas are given using Vishgarbha oil, Mahasahachar oil and Mahanarayan oil. Castor oil and Haritaki (Terminalia chebula) treated with castor oil are used for mild, prolonged laxative treatment.

Ayurveda Medicine(Local)
Local heat branding is used by some physicians to reduce severe pain in the leg. The branding is usually done at the site of maximum tenderness in the lower back or buttock . Oral medications include Mahavat Vidhwans, Vata Gajankush, Maharasnadi decoction, Triphala Guggulu, and Yograj Guggulu. Guggulu (Commiphora mukul) compounds and other herbal combinations are given for prolonged periods depending upon the symptoms and severity of pain. Most patients respond well to these medicines and are usually cured in a period of 1- 3 months. For degeneration of the cartilage or bones, prolonged treatment may be required. Though rare, it is important to rule out other cause of sciatica, like tumor. If there is gross structural damage to the back-bone, this may have to be first treated surgically. Ayurvedic herbal medicines, given later, may help in recovery of nerve damage. The same treatment applies to cervical spondylosis, except that enema and laxative treatment may not be helpful here, and the heat branding is done on the shoulder blade. Fomentation is done using the "naadi swedan" procedure. A specialized form of enema, called "Tikta-ksheer basti" is used in severe cervical spondylosis, and the repeated use of this enema gives results where other treatments have failed. It is advisable to avoid cold (refrigerated) food products, as also foods which may cause abdominal bloating. It is also better to refrain from very vigorous and heavy work or exercise.

iii) Neuritis(Neuralgia)
Multiple Neuritis is a degeneration of peripheral nerves, and is also known as Peripheral Neuropathy or Polyneuritis. This is characterized by a slow onset of disturbed sensations, sensory loss, and weakness and shrinking of muscles in the hands and feet. There are various causes for this, including nutritional deficiencies, metabolic and inflammatory conditions and chronic intoxication due to alcohol, metals and drugs.

In Ayurveda
In Ayurveda, the above symptoms are believed to be due to disturbed "Vata" dosha. The disease process is believed to take place in two ways; one being a direct increase in the "Vata" dosha, usually due to quantitative decrease in the "Dhatus" or body tissues, and the other being a disorientation of the "Vata" dosha due to obstruction in the normal channel pathways. The first type of disease process is called as "Nir-upastambhit Vata-vyadhi" and the second type is termed as "Upastambhit Vata-vyadhi". The two can be differentiated by a detailed medical history and a careful observation of the symptoms.

Ayurveda Treatment :

Panchakarma

Vishgarbha oil in acute condition, and Mahanarayan oil ( containing mainly Asparagus racemosus) for chronic pain is used for local snehan procedure. Local fomentation can be done mainly in two ways. The first is "Naadi swedan" in which, a jet of medicated steam is directed at the back and affected leg, usually after the snehan procedure. A decoction of Nirgundi (Vitex negundo) is usually used for this procedure. The second procedure is called as "Awagah swedan", in which the patient is made to recline in a tub filled with warm decoction of Nirgundi, Dashmool (Ten Roots) or ErandMool (Root of Ricinus communis). Medicated enemas are given u

Ayurveda Medicine
The medicines used orally are: Ashwagandha (Withania somnifera), Shatavari (Asparagus racemosus), Masha (Phaseolus mungo), Kohla, Abhrak Bhasma, Raupya Bhasma, Suvarna Bhasma, Chandan-Bala-Laxadi Oil, Shatavari kalpa, Kushmand-avaleha, Mahayogaraj Guggulu and Vasant-kusumakar Rasa. Thus, the overall aim here is to build up and strengthen the body tissues. On the other hand, treatment for the Upa-stambhit vata is aimed at reducing or eliminating the blockage in the normal channel-pathways of the vata dosha, cutting down overgrowth of the body tissues, and causing "Anulomana", i.e., helping the vata dosha to circulate in a normal way. The medicines used orally are: Triphala Guggulu, Yogaraj Guggulu, Maharasnadi Qadha, Dashamool Qadha, Gandharva Haritaki, Lashunadi Vati, Mahavata Vidhvansa, Ekangaveer Rasa etc. Herbal medicines used are: Rasna(Pluchea lanceolata), Dashmool (Ten Roots), Guduchi (Tinospora cordifolia), Deodar (Cedrus deodara), Hinga (Ferula narthex), Bhallatak (Semicarpus anacardium), Triphala (Three fruits) and Trikatu (Three pungent herbs). A suitable diet and appropriate lifestyle is recommended in both the disease processes, which will help in reducing symptoms and preventing further deterioration. Needless to say, the treatment has to be tailor-made for each patient according to the presenting symptoms. Significantly, a carefully selected treatment regime, if followed faithfully, gives astounding results, even with very chronic and debilitating disease.

iv) Paralysis(Stroke)
Stroke is a medical emergency which results when the blood supply to a part of the brain is cut off or greatly reduced. An ischemic stroke is the most common type of stroke, occurring about 80 - 85 % of the time, and is due to a blood vessel in the brain getting blocked because of cholesterol deposits called atherosclerosis, or because of blood clots called emboli. A hemorrhagic stroke, resulting from a ruptured blood vessel in the brain, while not so commonly seen, is definitely more serious.

Depending upon what part of the brain and how much of the brain tissue is affected, stroke can cause symptoms like weakness or paralysis of the limbs, paralysis of the muscles of the face, difficulty in speaking, coordination problems, dizziness, vision problems, sudden headache, and loss of consciousness. This can result in monoplegia (paralysis of one limb), hemiplegia (paralysis of upper and lower limb in one side of the body), and paraplegia (paralysis of lower limbs). Stroke is known in Ayurveda as "Pakshaghaat". Ayurveda has mentioned facial paralysis as a separate disease entity called "Ardita". Acute stroke is a full-fledged medical emergency where immediate hospitalization and specialized medical care of the patient can be life saving and can minimize permanent disability. After a patient is discharged from hospital, it is imperative to start Ayurvedic treatment at the earliest possible, to get maximum benefit.

The ancient Ayurvedic texts mention mild purgation as a special form of treatment for stroke. This treatment modality is, surprisingly, not recommended in Ayurveda for any other neurological condition resulting from a disturbed "Vata" dosha. It is believed that this treatment helps to reverse the pathology in stroke, by normalizing the "Prana Vayu" (which regulates the functions of the brain) and bringing about normal functioning of the blood vessels, muscles and tendons. Castor oil, and Haritaki (Terminalia chebula), treated with castor oil, are recommended for this purpose. Massage of the entire body using medicated oils, followed by steam fomentation, is considered an important part of the treatment for stroke. Bala (Sida cordifolia) oil and Narayan (Asparagus racemosus) oil are commonly used for massage, while a decoction of Nirgundi( Vitex negundo), Dashmool (Ten roots), or Erandmool (Root of Ricinus communis) is used for medicated steam fomentation.

"Basti" or medicated enema is also a unique part of Ayurvedic treatment for stroke. Both the "Niruh" and "Anuvaasan" types of enemas are used in an alternating fashion. Dashmool decoction is usually recommended for Niruh Basti, and Til oil (Oil of Sesame) is recommended for Anuvaasan Basti.

Medicated nasal drops are used to stimulate and bring about early recovery of the special sense organs. This therapy is known as "Nasya". Anu Tel (oil), Shadbindu Tel, Panchendriya Vardhan Tel and medicated ghee are used for this purpose.

Traditional Ayurvedic formulations used in the treatment of stroke are: Yograj Guggulu, Mahayograj Guggulu, Vata Vidhvansa Ras, Tapyadi Loha, Sameerpannag Ras, Vata Gajankusha Ras, Ekangveer Ras and Bruhat Vata Chintamani. Herbal medicines useful in this condition are: Sarpagandha (Rauwolfia serpentina), Rasna (Pluchea lanceolata), Dashmool, Ashwagandha (Withania somnifera), Bala, Maash (Phaseolus mungo) and Nirgundi.

Results with treatment depend upon the amount of permanent damage resulting from stroke, the time of commencement of treatment, the presence of other complications like high blood pressure and diabetes, and the overall physical and mental conditioning of the patient.

v) Bell's Palsy(Facial Paralysis)
Bell's Palsy is a paralysis or weakness of the muscles of one side of the face, usually due to damage to the facial nerve. It may also affect the sense of taste, salivation and tear formation. Most patients improve spontaneously within a few weeks to a few months, however, a few may have permanent residual facial weakness.

Bell's palsy is known as "Ardit" in Ayurveda. However, the symptoms of Ardit may be a part of stroke, i.e., a complete paralysis of one half of the body, while Bell's palsy is usually considered to be self-limiting. Ayurvedic treatment of this facial paralysis consists of local application, oral intake of medicated oils, local fomentation, medicated nasal drops therapy, and oral medication in the form of tablets.

Medicated oils used for local application, oral intake and nasal therapy are: Bala (Sida cordifolia) oil, Narayan (Asparagus racemosus) oil and Chandan-Bala-Laxadi oil.

Mouth wash and gargling with luke-warm water is considered very effective in relieving symptoms. Local medicated steam fomentation is given of decoctions of Erand mool (root of Ricinus communis), Rasna (Pluchea lanceolata), Dashmool (Ten Herbal Roots) and Nirgundi (Vitex negundo). Dry fomentation is given by preparing a poultice (medicated packet) of wheat flour and oil.

Oral medications useful in facial paralysis are: Yograj Guggulu, Trayodashang Guggulu, Vata Vidhvansa Rasa, Sameerpannag Rasa, Brihat Vata Chintamani, Tapyadi Loha, Dashmoolarishta and Bhallatakasava. Single herbal medicines used are: Guggulu (Commiphora mukul), Nirgundi, Dashmool, Ashwagandha (Withania somnifera), Shatavari (Asparagus racemosus) and Kuchila (Purified Strychnos nuxvomica).

For refractory patients, some physicians advise blood-letting from a nearby vein or by leech therapy. Courses of medicated enemas are also advised in some patients. Milk, ghee, butter, mutton soup and black gram are advised in the diet in large quantities. It is best to avoid prolonged exposure to cold.