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शुक्रवार, 2 अक्तूबर 2015



At least 50% people suffer from joint pain after the age of 50. There are many types of Arthritis noticed during childhood but the intensity is mild and mostly they are self limiting. Arthritis during young age and maturity onset are more distressing and needs proper attention. Hence we have focused in the area of maturity onset Arthritis and elaborating in easy and convincing language. The information not only covers medication but also the causes, after effects, regimes for prevention, diet, lifestyle and much more.
What is Arthralgia? How it initiates?
Arthralgia means pain in joints, whereas Arthritis is a condition where heat (calor), pain (dolor), redness (rubor), and swelling (tumor) are the chief symptoms. Arthritis is conventionally called as “Sandhi-Vaata”, where Sandhi means joints and Vata is the inflammatory condition.
Ayurveda has classified the age into 3 groups. Childhood is Kapha predominant, Youth is Pitta predominant and old age is Vata predominant. Accordingly, the occurrence of diseases are also mainly as per the predominance of these doshas. In childhood, diseases of Kapha are experienced more, Pitta diseases in the youth and Vata diseases in the old age.
Ayurveda has further classified the parts of the body in 3 sections. From chest and above part is the seat of Kapha, between chest and umbilicus is the seat of Pitta and below the naval is the seat of Vata diseases. As per the theory of Ayurveda, the symptoms of Kapha – Pitta – Vaata are Itching, Burning and Pain respectively.
In consideration to all these principles, Arthritis is a condition in old age, mainly representing pain and that too in the lower parts of the body. Practically there are over 350 joints in the body but the maximum symptoms are spotted in the lower parts which include lumbar area and lower limbs. The simple reason here is that all these joints are weight bearing and are more predisposed to wear and tear.
Ayurveda has also explained the vulnerability to joints only as -
"तत्रास्थिनि स्थितो वायुः पित्तं तु स्वेदरक्त्योः श्लेष्मा शेषेषु . . . ”
Meaning – Physiologically, the bones accommodate Vata, Blood accommodates Pitta & sweat and all the rest tissues accommodate Kapha. Hence the part of the bones involving maximum movements is attacked by inflammatory disorders.
Causes of Arthritis –
There are 2 commonest disorders associated in the area of Arthritis; Osteoarthritis and Rheumatoid Arthritis. Ayurveda has defined them as “Sandhi-Vaata and Aama-Vaata” respectively. No doubt, in both the conditions, arthralgia is a common symptom but it is essential to have a clear idea about both the diseases. Symptoms of Sandhi-Vaata or Osteoarthritis are confined to specific joints whereas Aama-Vaata includes systemic disorders and changing location of the inflamed joints. Sandhi-Vaata or Osteoarthritis is the sequel of Vaata imbalance whereas Aama-Vaata is due to imbalance of many functional components. Sandhi-Vaata or Osteoarthritis settles due to aggravation of Vaata in old age, predisposition of Vaata seat towards the joints, wrong food habits and lifestyle, lack of adequate exercise, excess consumption of cold beverages, over weight and genetic predisposition.
Aama-Vaata is an altogether different and serious entity where one should know the concept of ‘Aama’ for proper understanding. Madhav-Nidan, a classic of Ayurvedic etiology, has explained it in an appropriate manner:
विरुद्धाहारचेष्टस्य मन्दाग्नेर्निश्चलस्य च ।
स्निग्धं भुक्तवतो ह्यन्नं व्यायामं कुर्वतस्तथा ।।
वायुना प्रेरितो ह्यामः श्लेष्मस्थानं प्रधावति ।
तेनात्यर्थं विदग्धोऽसौ धमनीः प्रतिपद्यते ।।
वातपित्तकफैर्भूयो दूषितः सोऽन्नजो रसः ।स्रोतांस्यभिष्यन्दयति नानावर्णोऽतिपिच्छिलः ।।
जनयत्याशु दौर्बल्यं गौरवं हृदयस्य च l व्याधीनामाश्रयो ह्येष आमसंज्ञोऽतिदारुणः ।।
Erroneous food habits, inadequate digestive strength, lack of exercise, rigorous exercise after consuming heavy and fatty diet leads to a toxic indigestible constituent termed as “Aama”. This Aama combines with Vaata and rushes to the areas of Kapha. Further, it gets absorbed in the digestive channels contaminating body fluids, Vaata, Kapha and Pitta leading to cause slummy and varied colouration. All this pathogenic amalgam sets in the place of Kapha in the joints (Synovial sacs) and a clinical picture of Aama-Vaata sets on. It is difficult to comprehend this patho-physiology explained by Ayurveda. In brief, to prevent Aama-Vaata, one should avoid performing exercise after consuming heavy and fatty diet.
Pain and Inflammation - Special Information-
Cold temperature aggravates pain and warmth helps to reduce it. Mild fomentation also even helps to reduce pain if a child is mildly injured while playing on ground. Fomentation with Hot Water Bag or Infrared light for back-ache, lumbar pain is a popular household first-aid. For quick relief, applying medicated massage oil or a liniment and then fomentation is recommended. In an extremely cold climate, a mild trauma generates excruciating pain but the same intensity of trauma is relatively tolerable if the climate is warm. Usually doctors recommend applying ice on any kind of blunt injury because it is essential to seize the capillary oozing to prevent swelling and hematoma. Immediately after the trauma, the part gets anesthetized and the pain is minimized. After some time, only fomentation helps to reduce the pain. Cold compression doesn’t help in such situation.
5 symptoms of Inflammation –
1. Local warmth
2. Redness
3. Pain/ tenderness
4. Increased size/ swelling
5. Restricted movements
Pathophysiology of Inflammation –
Human body has a lipid like component called arachidonic acid. During inflammatory process, the oxidative stress in this is increased leading to two way signaling. Prostaglandins are formed through Cyclooxygenase (COX) and through 5-lipoxygenase, Leukotrines are formed. Prostaglandins contain many chemicals leading to increased vascularity, pain, inflammation, redness and tenderness. The chemical LTB4 from Leukotrines concentrates the dead WBCs at the injured part causing inflammation. Therefore keeping check on Prostaglandines and Leukotrines is the main stream treatment for treating inflammations. The significance of this theory will help to understand the treatment.
The primordial symptoms of Arthritis –
Before Arthritis sets on, following symptoms are noticed. Typical sound called ‘crepitus’ and intolerance to sustain pressure on a particular joint. If untreated, the symptoms aggravate and the disease progresses. In case of Rheumatoid Arthritis, body ache, anorexia, excessive thirst, fatigue, feeling of heaviness in the whole body, fever, indigestion and inflammation on joints are evident.
Main symptoms of Arthritis -
1. Mainly arises in the old age and aggravates as the age grows. Usually doesn’t settle in young age even after any trauma.
2. Incidence is very high compared to the population.
3. The cartilage wears off and the bones generate rubbing sound (crepitus) over each other.
4. The symptoms are restricted to the joints, without any systemic ailment.
5. The inflammation is less but pain is more confined to weight bearing joints like knees, lower back and back bones.
6. The swelling is stable on affected joints without changing the location.
7. There are spurs around the affected joints.
8. Absence of subcutaneous nodules (as in R.A.)
9. Incidence is equal in both sexes.
10. Ageing, Genetic inheritance, trauma, excess body weight, deficiency of hormones, muscular weaknesses are common contributing factors.
11. Pain and swelling increases gradually without shifting the site.
12. Morning stiffness and pain reduces after movements but aggravates after more exertion.
13. There are hardly other symptoms except pain and inflammation on the affected joints.
14. Except inflamed and painful joints, there is no systemic involvement which would lessen the life span.
1. Can occur at very young age, but more during the age between 30 and 50 years.
2. Incidence is low compared to the population.
3. The pathology sets in the synovial sac however the cartilage is intact.
4. Associated symptoms like Fever, whole body swelling (Anasarca), heaviness in chest, lung disease, ophthalmic diseases etc. are common.
5. Symptoms like inflammation, pain, redness and warmth are prominent on phalanges, toes and wrist joints.
6. The location of swelling is shifting from one joint to another which may involve about 30 joints.
7. If not treated in time, may lead to permanent crippling and disabilities.
8. Subcutaneous nodules are noticed in about 20 to 30% cases.
9. Females are affected 3 times more compared to males.
10. It’s an autoimmune disease causing onslaught on synovial sac.
11. Can fulminate or regress without any reason and can involve many joints at a time.
12. Morning stiffness is long lasting seldom for the entire day.
13. Constant feeling of illness with fever, severe weakness and muscular pain. The chances of cardiac illness and cancer are more.
14. Due to systemic involvement and complications thereof, the lifespan may lessen eventually.
The master key of prevention is to refrain from the causative factors. Lower the body weight lesser the chances of illness and more the body weight more susceptibility to diseases. This is true not only about Arthritis, but in general this statement is an established truth. Slim individuals are relatively healthy, in case of any illness, they respond fast to the treatment, the complications are negligible, span of treatment requirement is less and lastly the lifespan is also more compared to obese individuals. Hence, the food intake should be ‘slightly less’ than ‘slightly more’.
Rigorous workout may lead to tissue damage and deteriorate overall health. Therefore moderate exercise with regularity is of immense value. Without falling prey to temptations of glamorous advertisements, one should avoid taking ice-creams, cold drinks and fast-food etc.
Nature has designated specific movement to each joint, hence it is essential to operate the joint at least 5 times daily in that manner. For example, the wrist joint can perform 5 movements as follows:
1. Flexion
2. Extension
3. Adduction
4. Abduction
5. Clockwise rotation
6. Anti-clockwise rotation
Arthritis can be treated by 2 ways, oral medication and local application. Now let us understand how VAATMUKTA Tablets and Liniment help to treat Arthritis.
Deodar (Cedrus deodara), Erandmool (Ricinus communis), Haadjoda (Cessus quadrangularis), Shallaki gum (Boswellia serrata), Shuddha Guggul (Balsamodendron mukul), Shuddha Kuchala (Strychnous Nux-vomica)
Lipoxygenase plays a key role in the process of inflammation and this herb has an established lipoxygenase inhibitory activity. Further, it has a pronounced pain controlling activity.
ERANDMOOL (RICINUS COMMUNIS): Diclofenac Sodium is a known analgesic in modern medicine. It is effective in pain management of even unknown etiology. The comparative study of its therapeutic activity was performed and was proved to be equally effective.
Ayurveda also mentions a verse “आमवातगजेन्द्र स्य शरीरवनचारिणःl एक एव निहन्ताऽयमैरण्डस्नेहकेसरी ll”
which means, “For an intoxicated elephant called Amavata (Rheumatoid Arthritis) dwelling and destroying the garden called body at will, there is only one controller and that is a Lion named Eranda Sneha(Castor oil).”
HAADJODA (CESSUS QUADRANGULARIS): Ayurveda mentions that an individual should perform exercise only up to his half the capacity of his physical strength. If it exceeds the defined limit, the result is erosion and swelling of the joints. Due to ignorance, some young people perform such painstaking exercise for rapid weight loss or body building and eventually suffer from arthritis. It is researched that this herb is amazingly effective in restructuring the joint erosion.
SHALLAKI GUM (BOSWELLIA SERRATA): The gum of this herb is used as an active ingredient. Boswellic acid is the dynamic constituent of this gum. It is clinically proved and established that Boswellic acid helps to limit the inflammation, pain and improves mobility in very short period. It helps in both, osteoarthritis and rheumatoid arthritis as it inhibits Leukotrienes and Prostaglandins, the key elements responsible for inflammatory disorders.
SHUDDHA GUGGUL (BALSAMODENDRON MUKUL): It’s again a gum derived from the said plant. It is not only anti-inflammatory but specially identified as anti-arthritic. It is also effective in balancing the lipid levels in the blood and an established ingredient for weight management. Its dual utility is amazing because of the weight lowering effect and anti-arthritic activity. Practically, reducing body weight also helps to lower the damage on the joints. It has proven Prostaglandin inhibitory activity.
SHUDDHA KUCHALA (STRYCHNOUS NUX-VOMICA): It is a poisonous herb. It proves the dictum “Poison can be as effective as nectar if used intelligently and nectar can be as harmful as poison if used without proper knowledge”. Ayurveda has described an authentic process to purify this herb and eliminate the toxic element and fortify the active medicinal constituent. Strychnine and Brucine are the two toxic elements where Strychnine is highly poisonous. The purification process described in Ayurveda, removes the Strychnine and converts Brucine into Isobrucine which is an incredible painkiller. It acts as a local analgesic and also effective in controlling the pain receptors in the brain (CNS). After appropriate purification, the hidden constructive benefits also become apparent. It helps to sharpen memory, improves humoral immunity, corrects the liver function, reduces the relapse of epilepsy attacks, effective in some types of cancers, corrects digestion and also helps to purge the snake venom.
Vishagarbha Tel, Mahamasha Tel, Narayan Tel and Gandhapura Tel (Indian Wintergreen oil)
The most important ingredient of this oil is Shuddha Kuchala (Strychnous Nux-vomica). As seen in the description of tablets, it is equally effective as an external application. Sciatica, Headache, Pain in the Bones, Tinitus, Muscle wasting, Body-ache due to excessive walking, Paralysis, Stiffness in jaws are some of the important indications for this generic oil formula. It should not be used on delicate skin, cracked skin, infective skin diseases, children and pregnant women.
This is an age old formula recommended in Paralysis, Stiffness in jaws, facial paralysis, Neck pain, Stiffness in joints, Diseases of the back bone (Spondylosis), Blunt injuries, Rheumatoid and osteoarthritis. Its special therapeutic role in treating old-age degenerative diseases is promising. It is used various treatment modalities like body massage, nasal medication, powering over the head (Shiro-dhara), Enema (Basti) and also for oral consumption.
This is traditionally used in body-ache due to lon distance travelling, Osteoarthritis, Rheumatoid arthritis, Gout, diseases of the back bone (Spondylosis) and especially recommended for strengthening the skeletal bones. It is also used for body massage, nasal medication, powering over the head (Shiro-dhara), Enema (Basti) and also for oral consumption.
GANDHAPURA TEL (Indian Wintergreen oil):
The plant remains evergreen even in the snowfall, hence called Wintergreen. The yellowish aromatic oil derived from this plant is used worldwide. It contains Methyl salicylate, a renowned painkiller. It smells like eucalyptus oil, recommended for external use only. It imparts warmth when applied on the skin, improves subcutaneous blood circulation and helps in pain management. It should not be used on delicate skin, cracked skin, infective skin diseases and should be kept away from eye contact.
One should not attempt searching for water after getting thirsty. Similarly, the treatment for Arthritis should be initiated as soon as the prodromal symptoms are seen. The initial symptoms like crepitus, mild pain should not be ignored.
VAATMUKTA should be started in low doses to avoid exacerbation of the disease and further complications like joint replacement, keeping in mind that prevention is better than cure.
Pregnant women and children below 6 years should not use this unless recommended by the doctor.
Pain, Inflammation, Back-ache, Lumbar pain, Frozen shoulder, Sciatica and other inflammatory disorders can be easily treated with VAATMUKTA tablets and Liniment.
Tablets: 2 – 2 tablets on empty stomach with warm water
Liniment: Massage over the affected area and fomentation, twice daily.
Rarely the oral treatment may cause mild hyperacidity. In that case, the tablets may be taken after meals. Liniment should not be used in pregnancy, particularly on the abdominal area. In childhood, the skin is very delicate and may react after applying the liniment.
It should not be used on delicate skin, cracked skin, infective skin diseases and should be kept away from eye contact.
This article is for the general information of the readers. It is always good to consult the doctor and avoid self medication.
Dr. Santosh Jalukar


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