Ayurvedic Treatment for Rheumatoid Arthritis: How It Works

The treatment principle of Amavata is mentioned in classical texts of Ayurveda as 

लङ्घनं स्वेदनं तिक्तं दीपनानि कटूनि च ।

विरेचनं  स्नेहपानं बस्तयश्चाममारुते ||

सैन्धवाद्येनानुवास्य क्षारवस्तिः प्रशस्यते ॥ १ ॥ (Chakradutta)

Langhana, Swedana, Deepana, Virechana, Snehapana, Vasti are the major therapies administered. Lets explore each modalities – 

• Langhana: Therapeutic fasting as first-line management of Rheumatoid Arthritis is a measure that seeks to decrease the concentration of ama (metabolic toxins) in the body. An improvement in digestion and metabolism allows the proper breakdown of Ama. The duration will depend on the patient’s strength and disease severity. Autophagy, a cleaning mechanism of the cell body that breaks down damaged components of cells to mitigate harm and inflammation, is triggered by fasting. It also improves gut microbiome health which is linked with the severity of RA.
• Snehapana: medicated ghee enriched with herbs that have a bitter and pungent taste when administered in graduated doses , helping to pacify Vata and Kapha. Medicated ghee contains fatty acids that decrease the inflammation within the joints.
• Swedana: Fomentation therapy is given to liquefy and eliminate Ama from the body with sweating. It includes therapies such as Bhaspa Sweda, Churna Pinda Sweda, Upanaha, Patra Pinda Sweda, Valuka Sweda, or Salvana Sweda. The treatment decreases joint stiffness and pain. It enhances blood circulation, reduces inflammation, enhances lymphatic drainage, relaxes the muscles alleviates stiffness, and increases the production of synovial fluid that lubricates and makes the joints more flexible.
• Virechana: One of the most important Panchakarma procedures that removes excess Dosha and Ama from the body through controlled purgation. The therapy helps remove pro-inflammatory compounds through the gut, reduces gut permeability associated with autoimmune conditions, improves gut microbiota to lower systemic inflammation, and supports the removal of inflammatory mediators (such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)) via the liver and bile system.

Before Virechana, the patient is prepared with Snehana and Swedana to achieve maximum results.

• Vasti: A procedure where medicated oil or decoction is administered through the rectal route. It offers comfort to Vata Dosha primarily the reason for joint pain and stiffness. Based on Dosha dominance Tikshna Kshara Vasti or Alkaline Enema, Vaitarana Vasti, and Saindhavadi Anuvasana Vasti are prescribed. Vasti delivers the anti-inflammatory factors straight to the large intestine affecting the enteric nervous system, enhancing the absorption of lipid-soluble nutrients, and restoring balance in the gut microbiome. Tikshara Vasti has an alkaline nature which neutralizes inflammatory environments, increases absorption of essential minerals for strong bone and healthy joints, and helps regulate PH balance in Synovial fluids.
• The internal medicines with Tikta and Katu Rasa (Bitter and Pungent Taste) are prescribed to enhance digestion, remove Ama, reduce inflammation, and balance Vata and Kapha Doshas. Bitters and pungent herbs have potent compounds that inhibit inflammatory pathways and modulate the T-cell responses of autoimmune reactions; they can even hinder some pro-inflammatory enzymes.

The sequence of treatment is usually followed in the order mentioned for maximum effectiveness:

1. 1. First, Ama is reduced by Langhana, while systemic inflammation also reduces.
   2. Swedana is applied to mobilize toxins, improving circulation to affected joints.
   3. Virechana follows, enhancing the removal of inflammatory mediators.
   4. Vasti treatments balance Vata and treat other underlying gastrointestinal factors that may contribute to RA while also supporting tissue repair and regeneration.
   5. Long-term management continues with internal medicines to modulate immune responses.