 |
 |
 |
 |
 |
 |
 |
 |
 |
|
Rheumatoid
Arthirtis: A Case Study
by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
Rheumatoid arthritis is a chronic, disabling autoimmune condition which can be helped greatly by Ayurvedic measures, including pancha karma, dietary adjustments and herbal measures. In addition to the pacification of doshas, removal of ama and kindling of agni, the Ayurvedic pharmacopoeia offers specific herbal combinations that are of great effect in this condition, as we will see in the following case history.
A forty nine year old building contractor presented for Ayurvedic care complaining of rheumatoid arthritis. His symptoms began six years previously with an onset of intense shoulder pain that he initially attributed to overuse. Gradually he developed typical symptoms of ama vata, with pain appearing in his arms and hands, switching from side to side in vata fashion. The pain became increasingly intense and he noted that at this time his sense of wellbeing ‘simply vanished.’ As do so many desperate individuals, he tried various methodologies including acupuncture, colonics, dietary changes and supplements, all to no avail. Indeed, the condition stubbornly continued to worsen despite his every effort. From an Ayurvedic standpoint, we would understand that unless or until ama was removed, agni kindled and vata pacified, all or any methods would indeed be to no avail. Eventually he saw a rheumatologist and was given steroids, a standard treatment for rheumatoid arthritis. Although this treatment gave relief to his joint pain, it caused intense acidity and gastric bleeding. He was currently taking a number of medications including prednisone, methotrexate, and a non steroidal anti-inflammatory agent, as well as an antacid to alleviate the side effects of his medications. Despite all these medications he still experienced daily pain and fatigue. His hands were significantly deformed from arthritis.
During his search
for healing he had also discovered yoga, which brought more relief than
anything else. In a compassionate effort to share the benefits he was
receiving with others, he opened a yoga studio in the small town where
he resided.
Another complaint he loudly voiced was the exorbitant cost of his medicines,
which came to more than $7,000 per year. From this perspective, we can
note how inexpensive and cost effective Ayurvedic preparations are. This
is no small benefit in terms of wellbeing. For example, in the case of
our patient, the cost of his allopathic medicines drove him to work excessively
hard at a job that was extremely taxing for his affected joints.
Psychologically, rheumatoid arthritis can reflect a state of feeling rigid and immobilized by fear. Sadly, this gentle and sensitive vata individual had suffered many a severe beating from his father throughout his childhood. The intense fear he must have felt during this experience of abuse can be seen as a causative factor in his rheumatoid arthritis. In addition, anger relating to this chapter of his life contributed to his inflammation.
He was a naturally sattvic individual who had never used drugs, psychedelics or alcohol, although he had a history of smoking cigarettes in the past. Due to the demanding nature of his job his diet was poor. He ate chicken burritos for lunch every day, at a Mexican restaurant.
This individual had an unusual prakruti in that no secondary dosha could be perceived in his pulse. He appeared to be a ‘pure vata’ type with prakruti of V3 P1K1. However, due as much to the medications as to his underlying condition, his pitta was now extremely provoked, with vikruti of V4P3 K1. His ojas was very weak and vitiated by vata. Prana was also extremely low. Mamsa dhatu was impaired and there was vata invading majja dhatu. As a result of his medications, pachak and ranjak pitta were impaired, while, in relation to his underlying condition, vyana vayu and sleshak kapha were affected. The liver pulse was very low. His tongue was thickly coated and his nails were ridged. The nails were also clubbed, a residual effect from his years as a smoker.
The most well known and effective herbal preparations for rheumatoid arthritis are all based on Guggulu. However, due to the intense pitta provocation we felt it skilful to apply Guggulu later on in the treatment plan. First, we wished to reduce pitta and to address the evidence of krumi or intestinal parasites seen in his coated tongue and ridged nails. Lowering pitta would make it possible for him to do pancha karma, since at his current level of extreme provocation it could be dangerous to carry out svedan or sweat treatments.
His initial formula
was:
Guduchi 500mg
Dashamoola 200mg
Vidanga 200mg
Turmeric 300mg
Ginger 100mg
to be taken half a teaspoon three times daily before meals with honey.
This formula contained
quite a few ingredients with good anti-inflammatory properties, including
Guduchi, turmeric and ginger. Guduchi is of great value in lowering pitta,
while turmeric, as well as being a good anti-inflammatory, has valuable
anti-krumi properties and supports the action of Vidanga in this
regard.
After taking this formula for three weeks, he received seven days of in-house
pancha karma. Mahanarayana oil was used for abhyanga,
Dashamoola was added to the steam for svedan and Dashamoola and
Triphala were used in the basti formula. Several pinda svedan treatments
were included in his pancha karma regimen. This is a form of treatment
which reduces deep-seated inflammation by application of a preparation
of rice, milk and Bala. By the conclusion of this cycle of treatments,
pitta was almost back to normal levels, although vata
was still high. There was a dramatic improvement in ojas, which
was no longer vitiated by vata, and vyana vayu had likewise
improved. His low liver pulse remained a significant concern.
The next stage of his treatment was rejuvenation. We still delayed giving a Guggulu preparation until after the rejuvenation cycle, for we wanted to give our selected Guggulu preparation the maximum possible opportunity to have its near-miraculous effect. However, once again we selected herbs which would have excellent anti-inflammatory as well as rejuvenative properties.
The rejuvenative formula
was:
Ashwagandha 500mg
Vidari 500 mg
Guduchi 500mg
Shankapushpi 400mg
Liquorice200mg
Dashamoola 200mg
Shankhapushpi was chosen because of the low liver energy. Ashwagandha and Vidari of course are wonderful rasayanas for vata, while Guduchi is a rasayana for pitta and as noted above, a good anti-inflammatory. Liquorice is another herb that is both anti-inflammatory and rejuvenative. To help his strength and energy as well as for the residual lung damage from his years of smoking, he took Chyavanprash one teaspoon twice daily. He also took Triphala half a teaspoon daily mixed with ghee and honey, a method of applying Triphala to make the most of its rejuvenative aspect.
After six weeks of this protocol, he noted that while he definitely felt better and had more energy than before, he had still further to go in terms of pain reduction. It was at this point that we applied our selected Guggulu preparation, Yogaraj Guggulu. We also reintroduced turmeric into his formula and encouraged him to massage his hands with Mahanarayana oil. Tagara was also added to his formula for additional pain relief. This final stage in his protocol had the desired effect. Within a few weeks he was free of pain and no longer felt limited by his illness.
Although Allopathic medicines had helped this individual remain functional and had slowed the course of his illness, he still felt far from well, and suffered from the side effects of his medication as well as from his underlying condition. Ayurvedic herbs and cleanses did not replace his Allopathic medications but did help him regain wellbeing according to his desire. Had he been able to see an Ayurvedic practitioner earlier on in the course of his disease, it is highly possible he would have needed less in the way of immunosuppressant and anti-inflammatory medications and would have enjoyed greater wellbeing all along.
Alakananda Devi
(Alakananda Ma)
is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal
teacher of Alandi School of Ayurveda, a traditional ayurvedic school and
apprenticeship program. She can be reached at 303-786-7437 or by email
at: info@alandiashram.org.