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Received: 25/4/2017! ! Revised: 3/7/2017! Accepted: 15/7/17
DOI: http://dx.doi.org/10.21276/jrtm.2017/537
JOURNAL OF RESEARCH IN
TRADITIONAL MEDICINE
VOLUME 3, ISSUE 2 | MAR- APR 2017
ISSN : 2455-3166
TITLE
Efficacy of Erand Sneha (Castor Oil) in the management
of Amavata (Rheumatoid arthritis) with respect to its
Sama Stage
AUTHORS
Gauridutt Mishra *, Darshana H Pandya1
*Post graduate Scholar, 1Assistant Professor, Department of Roga Nidana & Vikriti Vignyana,
Institute for Post Graduate Teaching and Research in Ayurveda, Jamnagar, Gujarat, India
CORRESPONDING AUTHOR:
Dr. Gauridutta Mishra,
Post graduate Scholar, Department of Roga Nidana & Vikriti Vignyana, Institute for Post
Graduate Teaching and Research in Ayurveda, Jamnagar, Gujarat, India
Email:
gauridutta@rediffmail.com
ABSTRACT
BACKGROUND: Amavata (Rheumatoid arthritis) is a disease which is difficult to cure and one of the
challenging disease for the clinicians due to its chronicity, incurability, complications and morbidity. Eranda
Sneha (Castor oil) possess properties which causes increase in digestive fire, penetrate into micro-channel,
remove obstruction from micro-channel, pacify Va ta -K apha D os ha s and remove them via purgation. AIM: To
assess the efficacy of Castor oil in the management of Sama condition (acute stage) of Amavata. MATERIALS
& METHODS: In the present study 61 patients aged between 20 to 60 years, fulfilling the inclusion criteria
and having symptoms of Sama stage were selected from the OPD and IPD of Roga- Nidana Evam Vikriti Vijnana,
department, I.P.G.T. & R.A., Gujarat Ayurved University, Jamnagar. Patients were treated in two different
groups with administration of Eranda Sneha (Castor oil) alone and with combination of Shunti (Zingiber officinale)
once in morning on empty stomach. RESULTS: After the course of therapy for 15 days, similar symptomatic
improvement was observed both the groups. Overall effect of therapy suggests that only group A provided
moderate improvement in maximum objective and subjective criteria.CONCLUSION: The study concludes
that both Castor oil alone and with combination of Zingiber officinale is effective to remove Sama stage of Amavata
and thereby provide symptomatic relief.
!
Keywords: Amavata, Castor oil, Rheumatoid arthritis, Zingiber officinale
Introduction
Frequent indulgence in factors which leads to altered
status of digestive fire at all level i.e. intestinal, sub-
cellular and cellular leads to develop various kinds of
diseases. [1] Ayurveda advocate s th at the causative factor
for all disease is Mandagni (diminished digestive fire). [2]
In 21st century Rheumatoid arthritis (RA) has been
more common and distressing among all joints
problem. About 0.8% of world population is affected by
RA. Fema le s ar e th re e ti me s mo re a ff ec te d th an m al e. It
is a chronic inflammatory joint disease with multi
system involvement. The onset is usually during 4th &
5th decade of life; however people of any age group can
be affected in any climate condition. Factor producing
RA includes infectious triggers, genetic predisposition &
autoimmune response.
The course of the disease include an insidious / acute
onset with fatigue, anorexia, weakness and rapid
development of polyarthritis accompanied with
constitutional symptoms such as fever, lymphadenopathy
& splenomegaly. Joint involvement is usually symmetrical.
It is characterised by pain, swelling, tenderness & painful
limitation of movements. Generalised stiffness may occur
but morning stiffness lasting more than one hour is a
characteristic feature. The metacarpophalangeal &
proximal inter phalangeal joints of the hands, wrists,
knees & metatarsophalangeal & proximal inter
phalangeal joints of the feet are the most common joints
involved. [3]
It is a challenging disease for the physicians and medical
field as the uses disease modified anti-rheumatoid drug
(DMARD), steroids and non-steroidal anti-inflammatory
drug (NSAID) frequently have shown negative impact
on immune system and gives only temporary relief.
However, till date no satisfactory medical management
has been developed for this problem. Amavata is the
disease of Madhyama Rogamarga, bone and joints are the
chief site for the manifestation of cardinal symptoms like
pain, swelling and stiffness of joints, etc.
All the three Doshas (bodily humours) takes part in the
pathogenesis of disease but Ama and vitiated Va ta play
the dominant role. Amavata is made up of two words,
Ama and Vata. Ama means incomplete digestion of food
which result in incomplete/improper formation of
Annarasa (chyle), circulate in body & reach to target cell
where it produces pathology like heaviness in body, loss
of strength, drowsiness, aggravation of Va ta & improper
elimination of waste product. Body ache, undesirous to
take food, thirst, fever, incomplete digestion of food,
swelling in affected joints are the symptoms of Amavata.[4]
The disease becomes difficult to cure when it grows in
intensity. All symptoms mentioned are characteristic
features of Ama & without treating Ama it is impossible to
treat the disease so in this condition drug having Ushna
(hot), Tikshna (strong), Deepana (stimulant), Pachani
(digestive), Va ta sh a ma ka (pacifier of Va t a ),and Shothhara
(anti-inflammatory) properties can be used.
!!!!!! TITLE
Efficacy of Erand Sneha (Castor oil) in the management of Amavata
(Rheumatoid arthritis) with respect to its Sama Stage
J. res. tradit. med. | VOLUME 3, ISSUE 2 | MAR - APR 2017
Mishra Gauridutta et.al: Erand Sneha in the management of Amavata in Sama Stage! 29
Original Article: Clinical Research
J. res. tradit. med. | VOLUME 3, ISSUE 1 | JAN - FEB 2017
Investigations
All the investigation were carried out before starting
and after completion of therapy.
1.!Hematology: Hb%, T LC, D LC, E SR
(wintergreen method)
2.!Bio-Chemistry: FBS, Blood urea, Sr. Uric
ac i d , S r. c r e a t ini n e , L FT, R A f act o r
(Quantitative), CRP, and ASO quantitative titer.
3.!Urine analysis (Routine & Microscopic)
4.!ECG (12 leads-if needed)
5.!X- Rays of affected Joints.
Posology
Group A: Eranda Sneha & Decoction of Shunti
Dose: 30 ml (20 ml Decoction of Shunti & 10 ml
Eranda Sneha)
Method of Preparation of decoction: 5 gm of
coarse powder of Shunti is added with 80 ml of water
is boiled until ¼ part (20 ml) is remaining, after
preparing decoction, to which 10 ml of castor oil is
added.
Group B: Eranda Sneha
Dose: 10 ml
Time of administration: In both the group at
morning – empty stomach
Mode of administration: Oral
Duration: 15 days
Anupana: Luke warm water
Criteria of Assessment
1)!Subjective:
A.!Local symptoms
B.!Systemic symptoms
2)!Objective:
A.!Serological parameters
B.!Hematological and others biochemical
parameters.
C.!Disability index (the Indian health
assessment questionnaire)
Improvement in hand grip, foot pressure and walking
time.
Clinical assessment: - Assessment of cardinal and
associated symptoms were done and recorded on the
zero day (i.e. one day before administering the trial
drug), 5th, 10th and 15th day after starting the
treatment. Changes in the signs and symptoms were
assessed by adopting suitable scoring method.
In Bhavaprakash Samhita castor (Ricinis Communis) seed
oil is mentioned as a best drug for Amavata. [5]
Taking
into above points of properties of drugs, Castor oil with
Zingiber officinale was selected to assess their efficacy in the
management of Amavata in Sama condition.
Ethical Clearance
Study was started after obtaining Ethical Clearance from
the Institutional Ethics Committee, IPGT & RA, GAU,
Jamnagar.
•IEC - Ref. PGT/7/-A/Ethics/2015-16/1490
[Dated: 25/08/2015]
Study was Registered in Clinical Trial Registry of India.
• CTRI NO. - CTRI/2016/12/007569 [Dated:
14/12/2016]
Materials & Method
Selection of Patients
•Patients suffering from Amavata in Sama stage were
selected from the OPD and IPD of Rog- Nidana
Evam Vikriti Vijnana, department, I.P.G.T. & R.A.,
Jamnagar.
•Before registering the patients informed consent
were taken.
Criteria for Diagnosis
Diagnosis was confirmed on the basis of symptoms of Sama
stage of disease with cardinal symptoms of Amavata like
pain, swelling, stiffness and tenderness along with
symptoms of rheumatoid arthritis (As mentioned
according to revised criteria of American association of
rheumatology 1987).
Inclusion Criteria
•Patients fulfilling the diagnostic criteria especially
having symptoms of Sama stage of disease
•Age between 20 to 60 years.
Exclusion Criteria
•Patients having symptoms of rheumatoid arthritis but
having absence of Sama symptoms
•Patients with complications of RA e.g. Pleuro-
Pericardial disease, cardiac disease etc
•Patients with poorly controlled HTN, DM and other
systemic diseases
•Patients on prolong medication especially
corticosteroids, anticholinergics etc.
Registered patients were examined on the basis of
specially prepared proforma containing detail
assessment of disease encompassing Ayurveda and
modern aspects.
Mishra Gauridutta et.al: Erand Sneha in the management of Amavata in Sama Stage! 30
J. res. tradit. med. | VOLUME 3, ISSUE 1 | JAN - FEB 2017
Functional Assessment
Wal king tim e: patients were advised to move 50
meters and time was recorded.
Hand Grip: To fi n d o u t t h e f u n ct i o na l ca p ac i t y o f t h e
affected upper limb, Patients were asked to squeeze the
inflated cuff of the sphygmomanometer and the grip
strength has been recorded in mm of Hg.
Foot pre ssur e: To h av e a n o b j ec t i ve v i e w o f t h e
functional capacity of the legs, foot pressure was
recorded by using a weighing machine.
Foll ow ing s ta tisti ca l tes t h as be en a ppli ed i n
this work- Wilcoxon sign rank test (for comparison of
two group in subjective criteria), Unpaired ‘t’ test (for
comparison of two group in objective criteria) and
Paired‘t’ test (for same group).
Software used: Sigma software was used for all
statistical evaluation.
Observations & Results
To ta l 6 1 p a ti e n ts w e re r eg i s te r e d, a m o ng t h e m 5 3
completed the treatment and 08 dropped out. In group
A, 31 were registered out of which 28 completed and
03 dropped out the course. In group B, 30 patients
were registered out of which 25 completed and 05
dropped out.
31.14% of patients belonged to age group of 41-50 yrs.
59.01% were female among which 68.85% were
Housewife. 26.22% were uneducated followed by
primary education (24.59%). 34.42% belonged to
lower middle class. 70.49% belonged to urban area.
78.68% were vegetarian. 57.37% had history of
consuming sour diet. 81.96% each were taking oily and
heavy diet followed by cold substances (70.49%).
27.86% of patients had disturbed sleep (27.86%) and
85.24% had a habit of day sleep. 50.81% had Krura
Koshtha (hard and constipated stools). 72.13% had
diminished function of digestive fire and Irregular
function of digestive fire (11.47%). 68.85% had non
satisfactory bowel habit and irregular bowel habit
(44.26%). 54.09% had excessive micturition (polyuria).
66.66% of females patients enrolled had obstetric
history of delivering baby by normal delivery followed
by history of abortion (19.44%), and history of LSCS
(13.88%). 63.93% had Va ta -Ka phaj a S ha ri ra P ra kri ti.
80.32% had Rajajasa-Tamasika Manasa Prakriti. 14.75%
had Avara Sara, 9.83% had Avara Samahanana and
57.37% had Avara Satva. 31.14% were over-weight and
18.03% were obese. 88.52% had Madhyama Satmya.
77.04% had Avara Ahar Shakti. 59.01% belonged to Hani
Awastha (old age) followed by 37.70% of patients in
Sampurnata
Avastha (Adult) and 3.27% of Yu va Awa sth a. The Dosha
Avastha in the patients are represented in table 1.
Table 1. Dosha Avastha in patients enrolled
60.65% had negative family history followed by
positive family history in 39.34%. 42.62% had
chronicity up to 1-5 yrs. 86.80% had gradual onset.
100% developed pain and stiffness, 95.08% had
tenderness and swelling in 88.52%. 83.60% of
patients showed laziness followed by 78.68%, 77.04%,
72.13%, 62.29%, 59.01%, 44.26% and 34.42% of
patients with features of numbness, heaviness in body,
body ache, disturb sleep, gargling sound in abdomen,
giddiness and burning sensation respectively. 57.37%
of patients showed thirst, polyuria and constipation
and 55.73% showed loss of appetite. 98.36% had
morning time as an aggravating factors followed by
exertion (96.72%), day sleep (81.96% ), cold wind and
sour taste (90.16%). 95.08% had rest as a relieving
factors followed by warm water (91.80%) and warm
food (49.18%). 100% showed Rasavaha Srotodushti
lakshana followed by 93.44%, 70.49%, 42.62%,
40.98%, 16.39% and 4.91% showed Annavaha,
Asthivaha, Purishvaha, Mutravaha, Majjavaha and
Medavaha Shrotodushti symptoms respectively. 18.03%
developed joints crepitation followed by Boutonniere
deformity, ulnar deviation and Swan neck deformity
in 4.91%. 72.13% were suffering from diminished
digestive fire followed by 62.29% consuming
incompatible diet. 75.40% had done exercise after
oily diet followed by suppression of natural urges
(70.49%) and unwholesome activities (11.47%).
80.32% had stress as etiological factor followed by
anger (34.42%), sadness(22.95%) and fear (4.91%).
Comparison of effect of therapy between
group A and B
On comparing the effect of therapy on chief
complaints with help of Wilcoxon sign ranked test
both group showed statistically insignificant result
which suggested that there was no major differences
of effect of both group. However Group A showed
comparatively significant efficacy clinically in
Sandhishotha an d Sparshasahatva base d on the
percentage of relief. Whereas Group B showed
significant efficacy upon Sandhishoola and Sandhigraha
(Table 2).
Dosha
Vridd hi
Kshaya
Vata
31.14%
4.91%
Pitta
22.95%
47.54%
Kapha
34.42%
1.63%
Mishra Gauridutta et.al: Erand Sneha in the management of Amavata in Sama Stage! 31
J. res. tradit. med. | VOLUME 3, ISSUE 1 | JAN - FEB 2017
Table 2: Comparison of effect of therapy on chief complaints
Chief complaints
Group
n
Median
Relief %
Z
W
T+
T-
p
Sandhishoola
Group A
27
1.00
37%
0.382
23
138
-115
0.715 IS
Group B
25
1.00
45.97%
Sandhishotha
Group A
27
1.00
50.97%
-0.58
99.50
138
-131.50
0.569 IS
Group B
23
1.00
48.79%
Sandhigraha
Group A
27
1.00
60.03%
0.00
0.00
85.50
-85.50
1.000 IS
Group B
25
1.00
66.66%
Sparshasahatva
Group A
27
1.00
50.87%
-1.429
-48.00
36.0
-84.000
0.188 IS
Group B
25
1.00
50%
Associated
symptoms
Group
n
Median
Relief %
Z
W
T+
T-
p
Angamarda
Group A
27
0.00
55.55%
0.000
0.000
52.5
-52.50
1.000 IS
Group B
21
0.50
48.37%
Aruchi
Group A
13
0.00
40.62%
0.688
24.00
80.0
-56.00
0.562 IS
Group B
19
0.00
60.07%
Trishna
Group A
22
0.50
44.43%
-0.595
-27.00
81.5
-108.50
0.595 IS
Group B
23
0.00
40.02%
Alasya
Group A
23
0.50
40.70%
-0.218
9.000
81.0
-90.00
0.865 IS
Group B
25
0.10
44.73%
Jwara
Group A
14
0.000
81.27%
0.721
22.00
63.5
-41.50
0.502 IS
Group B
16
0.000
50.03%
Apaka
Group A
16
0.000
87.5%
-1.147
-40.00
48.0
-88.00
0.323 IS
Group B
20
0.000
53.33%
Gaurav
Group A
17
0.000
57.16%
1.213
35.00
70.0
-35.00
0.296 IS
Group B
24
1.000
55.21%
Anga-
Shunyata
Group A
19
1.000
77.14%
-0.790
-38.00
76.0
-114.00
0.465 IS
Group B
23
1.000
48.79%
Bahumutrata
Group A
21
0.000
46.12%
1.414
18.00
27.0
-9.00
0.250 IS
Group B
20
0.500
53.57%
Table 3: Comparison of effect of therapy on associated symptoms
Mishra Gauridutta et.al: Erand Sneha in the management of Amavata in Sama Stage! 32
J. res. tradit. med. | VOLUME 3, ISSUE 1 | JAN - FEB 2017
On comparing the efficacy of therapy on associated
complaints with help of Wilcoxon sign ranked test
both group showed statistically insignificant result
which suggested that there was no major differences
of effect of both group. However based on the
percentage of relief clinically Group A showed better
relief in reliving symptoms like Angamarda, Trishna,
Jwara, Apaka, Gaurav, Anga-Shunyata and Group B upon
Aruchi, Alasya, Bahumutrata (Table 3).
On comparing the efficacy of therapy on functional
parameters with the help of unpaired ‘t’ test all the
above functional parameter showed statistically
insignificant result which suggested that there was not
major differences of effect of both group, except foot
pressure which showed significant result, Significant
result means there was a measurable and better result
in patients of group A than B (Table 4).
Functional
parameters
Group
n
Mean
Relief %
Mean
difference
SD
±
SE
±
t
p
Walking
time
Group A
28
3.21
7.5%
-0.107
3.244
0.613
-0.094
0.925 (IS)
Group B
25
3.32
9.35%
Hand grip
Group A
56
-5.433
9.36%
-5.933
82.84
10.69
-0.464
0.643 IS
Group B
50
0.500
10.80%
Foot
pressure
Group A
56
2.242
1.19%
-9.035
28.67
3.702
-2.055
0.042 S
Group B
50
11.277
2.32%
Disability
index
Group A
27
0.607
40.46%
0.127
0.653
0.131
0.689
0.494 IS
Group B
25
0.480
47.26%
Serological
parameter
Group
n
Mean
Relief%
Mean
difference
SD
±
SE
±
t
p
R.A. factor
Group A
28
10.618
3.70%
-14.566
122.21
24.44
-0.429
0.669 IS
Group B
25
25.184
7.40%
C.R.P
Group A
28
3.914
43.16%
0.858
19.403
3.881
0.214
0.832 IS
Group B
25
3.056
12.44%
A.S.O.
Group A
28
-16.218
12.97%
-141.13
213.93
42.78
-2.413
0.019 S
Group B
25
124.920
25.91%
On comparing the efficacy of therapy on
serological parameters with help of unpaired ‘t’
test both group showed statistically insignificant
result which suggested that there was no major
differences between both group, but ASO titre
showed significant result in patients of group B
than that in group A.
In the present study, the overall efficacy of both
therapies suggested that Group A showed moderate
improvement in 35.71% which corresponds to relief
ranging between 50-74%, whereas in Group B it was
only 20%. Which suggests that Group A was better
than Group B in reducing the complaints in patients
in a better way (Table 5).
Table 4: Comparison of effect of therapy on functional parameters
functional parameters
Mishra Gauridutta et.al: Erand Sneha in the management of Amavata in Sama Stage! 33
Table 5: Comparison of effect of therapy on serological parameter
Almost all the chief complaints like pain, swelling,
stiffness and tenderness with associated symptoms like
loss of appetite, heaviness in body, laziness, polyuria,
fever and over thirst etc. showed mild to moderate
improvement in both groups. But group A showed
more effective results than group B, it may be due to
presence of Shunti in group A, which is having
Amapachaka and Va ta -K ap ha S ha ma ka property which
pacify Dosha to greater extend and bring them from
Shakha to Koshtha and thereby provide better relief. On
the basis of overall improvement group A showed
better result than group B where all the complaints,
associated symptoms, functional improvement and
serological investigation are taken into consideration.
This signifies that the efficacy may be attributed to the
additional presence of Shunti in group A.
Conclusion
Even though statistical analysis revealed no significant
difference between both the groups of treatment, the
clinical efficacy of them cannot be ruled out. Hence
the present study concludes that Eranda Sneha alone
and or with combination with Shunti is effective in the
Sama stage of Amavata, but clinically addition of Shunti
has helped in improving the overall condition of the
patient to a better level.
J. res. tradit. med. | VOLUME 3, ISSUE 1 | JAN - FEB 2017
Discussion
The present study revealed the onset of the disease
condition in the patients was as early as 30-40 years
and majority of the patients enrolled were females
which justifies the various studies which claims the
higher prevalence of RA in females. Majority of the
population effected were from urban area and higher
prevalence of people had a history of decreased
physical activity, laziness and day sleep which acted as
the triggering factor for the onset of the disease. In
line with the reference mentioned in Charaka
Samhita, Impaired appetite and metabolism was
found significantly in most number of patients. Most
of the patients were having chronicity for more than 2
years with history of consuming DMARD, steroids
and NSAID frequently which have negative impact
on immune system. Hence, such kind of patients need
long time treatment along with Pathyasevana (strict diet
and activities) following for better improvement.
The statistical analysis on chief complaints and
associated symptoms did not show any changes
between the two group of therapies, however
individually they had showed significant results. On
Serological parameters, it was noted that on applying
paired ‘t’ test, ESR and ASO titre was increased in
group A while CRP decreased in both group, it was
also seen during study that patients were responding
better symptomatically where ASO and ESR were
increasing but CRP values reduced significantly.
There is no scientific reason for these type of
response, which suggests that there is the need for
further evaluation and analysis to understand the
same.
Probable mode of action of Eranda Sneha
Eranda Sneha due to its Sukshma Guma [5] penetrate into
micro channels and remove obstruction in them [6]
also due to Katu Rasa and Ushna Virya it potentiate
digestive fire, acts as Vata Shamaka due to its Snigdha
Guna, finally it enters at Dhatu level (cellular level)
where it acts as Ama Pachaka and Kapha Shamaka drug.
[7]
Probable mode of action of Shunti
Shunti due to its Katu Rasa and Ushna Virya properties
act as Ama Pachaka and Kapha Shamaka drug. It
potentiates digestive fire and due to Madhur Vipaka [8]
act as Va ta S ha ma ka . Shunti due to its Vata-K aph a
Shamaka [9] properties checks the formation of Ama
and thereby help in reducing the symptoms of
Amavata especially in Sama stage.
Mishra Gauridutta et.al: Erand Sneha in the management of Amavata in Sama Stage! 34
References
1.!Madhavakara, Madhava Nidana, Madhukosh
Teeka, Amavata adhyaya, chapter 25, verses 1-4
commented by Vijay Rakshit & Shri Kanthadatta,
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2009, p- 508
2.!Vagabhata, Astang Hridaya, Vidhyotani hindi
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Roga Nidana, edited by Kaviraj Atrideva gupta,
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3.!Rheumatoid arthritis [Internet]. 2017 [Cited on
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en.wikipedia.org/wiki/ Rheumatoid arthritis,
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4.!Ibidem Madhava Nidana [1], Amavata adhyaya,
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8. Ibidem Sushruta Samhita [6], Drava Dravya
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9.!Agnivesha, Charaka, Charaka Samhita, sutra
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Annadravyavidhi Adhyayaya, Chapter 27, verses
296, edited by Padmbhushana vaidhya samrata
shree Satyanarayana shastri, explain ed by
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Varanasi; Chaukhambha Sanskrit series, 2009
p-560
J. res. tradit. med. | VOLUME 3, ISSUE 1 | JAN - FEB 2017
How to Cite the article:
Gauridutt Mishra, Darshana H Pandya. Efficacy of
Erand Sneha (Castor Oil) in the management of
Amavata (Rheumatoid arthritis) with respect to its Sama
Stage. J. Res. Tradit. Med 2017; 3(2): 28-35
http:dx.doi.org/10.21276/jrtm.2017/537
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Mishra Gauridutta et.al: Erand Sneha in the management of Amavata in Sama Stage! 35
