Ranasinghe and Ediriweera UJAHM 2015, 03 (03): Page 68-75 Unique Journal of Ayurvedic and Herbal Medicines, 03 (03), May-June 2015 68 UNIQUE JOURNAL OF AYURVEDIC AND HERBAL MEDICINES Available online: www.ujconline.net Case Report ISSN 2347-2375 EFFECTS OF DHANYAMLA PARISHEKA IN THE MANAGEMENT OF AMAVATA WITH SPECIAL REFERENCE TO RHEUMATOID ARTHRITIS- A CASE STUDY Ranasinghe RLDS 1* , Ediriweera ERHSS 2 1 Medical Officer, MD (Ayu) Scholar, Department of Nidana Chikitsa, Institute of Indigenous Medicine, University of Colombo, Sri Lanka 2 Professor, Department of Nidana Chikitsa, Institute of Indigenous Medicine, University of Colombo, Sri Lanka Received 30-04-2015; Revised 29-05-2015; Accepted 28-06-2015 Corresponding Author: Ranasinghe RLDS, Medical Officer, MD (Ayu) Scholar, Department of Nidana Chikitsa, Institute of Indigenous Medicine, University of Colombo, Sri Lanka, Contact No. +94718403682. ABSTRACT Amavata is a disease which possesses a challenge to the physician owing to its apparent chronicity, incurability, complications and morbidity. The pathological factors responsible for the manifestation of the disease are Ama and Vata. Ama is resultant from the derangement of Agni (digestive power). The clinical entity of Amavata can be correlated with rheumatoid arthritis (RA).The study was carried out in a clinically diagnosed case of Amavata (rheumatoid arthritis). The patient was appeared to outpatient department first and then admitted to the Panchakarma female ward. Thereafter the patient was treated for 17 days and followed up for one month. At first the patient was given10 ml of Dhanyamla orally, twice a day for subsequent three days. The purpose of oral administration of Dhanyamla was to normalize deranged Agni (digestive power) as it possesses Deepana and Pachana actions in the body. Then the patient was given Dhanyamla Parisheka (affusion sudation) for 14 days. Ayurvedic pharmacodynamic properties, phytochemicals and bioactivities of the ingredients were also gathered to identify the therapeutic values of Dhanyamla. Statistically significant improvement was observed in clinically, functionally and haematologically at the end of the treatment schedule. Oral administration of Dhanyamla followed by Dhanyamla Parisheka has supposed to be an effective therapeutic regimen in the management of Amavata. Keywords: Amavata, Rheumatoid arthritis, Dhanyamla, Deepana, Pachana, Parisheka. INTRODUCTION In Samhita period (1000 BC to 600 AD) there are no references available on the disease Amavata. Amavata is explained as a specific disease entity for the first time in Madhava Nidana written by Acharya Madhava (900 A.D) 1 . Ama and Vata are the two major pathological components of Amavata. According to Vijayarakshita Ama and Vata get combined together and this state is known as Amavata 2 . If food is not totally digested, it is known as Ama 3 . Ama is formed due to impairment of Kayagni 4 . Vata Dosha becomes unbalanced by indulgence of improper diet and regimen. Then the vitiated Vata spreads this Ama in the whole body through the Srotas (body channels) and gets located in the Sandhi (joints) to produce the disease. General clinical features of Amavata are Angamarda (body aches), Aruchi (anorexia), Trushna (thirst), Alasya (malaise), Gaurava (feeling of heaviness in the body), Apaka (indigestion) and Angashunatva (oedema of the body parts) 5 .When the condition gets exacerbate Bahusandhi Shotha (Joint Swelling), Bahusandhi Shula (Joint Pain), Sandhi Stabdhata (Joint stiffness) may be presented 6 . Acharya Chakrapanidatta elaborately describes the principles and line of treatment for Amavata 7 . Langhana (fasting), Swedana (sudation), use of drug of Tikta (bitter) and Katu (pungent) Rasa, Deepana drugs (stimulating hunger) are beneficial in the management of Ama stage of Amavata. In Nirama stage Snehapana (oleation), Virechana Karma (therapeutic purgation) and Vasti Karma (enemas) can be performed. Parisheka is one of the thirteen types of Swedana described by Maharshi Charaka 8 . Parisheka Sweda (Affusion sudation) is especially prescribed in the diseases where Vata is predominant. According to Acharya Sushruta and Vagbhata it can be categorized in to Drava Sweda (Liquid sudation) 9, 10 . In Sushruta Samhita Dhanyamla is mentioned as Vata alleviating drug which is suitable to use in Drava Sweda (Liquid sudation) 11 . The outcome of Amavata is strikingly similar to the disease rheumatoid arthritis (RA). Rheumatoid arthritis is an autoimmune disease in which the body’s immune system mistakenly attacks the joints 12 . The cause of rheumatoid arthritis is not yet fully understood. Rheumatoid arthritis typically affects the small joints in hands and the feet. Along