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ISSUE 5 (2014) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eISSN

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Saroj Kumar Debnath et.al., Comparative Clinical Evaluation of Amavata (Rheumatoid Arthritis) with Yoga Therapy and Naturopathy Management, Int. J. Ayu. Alt. Med., 2014;2(5):28-35

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RESEARCH ARTICLE eISSN 2348- 0173 Global Impact Factor (GIF) – 0.187 (2013)

COMPARATIVE CLINICAL EVALUATION OF AMAVATA (RHEUMATOID ARTHRITIS) WITH YOGA THERAPY AND NATUROPATHY MANAGEMENT

Saroj Kumar Debnath1*, Suresh Chandra Dash2, Gourang Jagdishchandra Vyas3

1. * Research Officer (Scientist-I) (Ayurveda), Ayurveda Regional Research Institute, Gangtok, Sikkim, Unit of Central Council for Research in Ayurvedic Sciences, Department. of AYUSH, Ministry of Health & Family welfare, Govt. of India. Contact No. +919477404010 / +919748257719, E-mail: [email protected]

2. Ex Principal, Maharshi Patanjali Institute for Yoga Naturopathy Education and Research, Gujarat Ayurved University, Jamnagar. Contact No. 9428816927 or 02882662239, E-mail: [email protected]

3. Ex Co-ordinator & Assistant Physician, Maharshi Patanjali Institute for Yoga Naturopathy

Education and Research, Gujarat Ayurved University, Jamnagar. Contact No. 9426385864, E-mail: [email protected]

Article Received on - 28th Oct 2014 Article Revised on - 27th Nov 2014 Article Accepted on 28th Nov 2014

All articles published in IJAAM are peer-reviewed and can be downloaded, printed and distributed freely for non commercial purpose (see copyright notice below).

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RESEARCH ARTICLE eISSN 2348- 0173 *Corresponding Author Saroj Kumar Debnath Research Officer (Scientist-I) (Ayurveda), Ayurveda Regional Research Institute, Gangtok, Sikkim, Unit of Central Council for Research in Ayurvedic Sciences, Department. of AYUSH, Ministry of Health & Family welfare, Govt. of India. Contact No. +919477404010 / +919748257719, E-mail: [email protected] QR Code IJAAM

ABSTRACT: In this clinical study 88 Amavata (Rheumatoid arthritis) patients were registered

from the O.P.D. of the Maharshi Patanjali Institute for Yoga Naturopathy Education and Research, Gujarat Ayurved University, Jamnagar and 8 patients discontinued before completion of the treatment. In Group-A (Yoga-Group), 40 patients completed the treatment out of 43 patients and 3 patients left the treatment before completion of the course and the treatment schedule was certain Yoga processes i.e. Prarthana (Prayer), Sutraneti, Jalaneti, Vaman (Kunjal), Kapalbhati, Stretching & rotation exercise, Asana, Mudra, Pranayam, Relaxation with Dharana, Omkara and Shanti mantra for three weeks (21 days) in every day morning in empty stomach. In Group-B (Naturopathy-Group), 40 patients completed the treatment out of 45 patients and 5 patients left the treatment before completion of the course and the treatment schedule was certain Naturopathy processes i.e. Mud pack application, Prayer, Exercise of stretching & rotations, Breathing exercise, Relaxation, Hip bath, Shiatsu massage, Acupressure, Warm sand and Infrared ray application, Small and mild vibretor continuous three weeks (21 days) for every day morning in empty stomach and also followed tentative planning of Fast for 1st week and Diet planning systemically in Group-B. In Group-A, 60 % and in Group-B, 55% showed Major improvement, 35% in Group-A and 40% in Group-B showed Minor improvement, 05% in both the Groups showed No-improvement and Complete remission was nil in both groups. No complication was observed in this clinical study and Group-A therapy was more effective than Group-B therapy.

Key Words: Amavata, Rheumatoid arthritis, Female, 30 to 50 years, Yoga therapy, Naturopathy.

INTRODUCTION In Ayurveda, Madhava kar (700AD) in his book Madhav Nidan first mentioned the Amavata as a special disease entity and where Ama (biotoxin) as well as Vata (bio-kinetics) plays a predominant role in the samprapti (pathogenesis) of this disease [1]. According to the clinical manifestations, the disease Amavata very closely resembles with the Rheumatoid arthritis. Rheumatoid arthritis is a chronic, progressive autoimmune arthropathy and characterized by bilateral symmetrical involvement of joints with some systemic clinical manifestations [2]. Ayurvedic Pathology book, Madhav Nidan, describes the etiological factors of Amavata those are Viruddha ahara (maldiet habit), Viruddha chesta (malwork habit), Mandagni (impaired digestive capacity), Nischalavastha (sedentary habit), Singddham bhuktavata annam Vyayam (physical work immediately after intake of oily food) [3] .

The disease Amavata or Rheumatoid arthritis is a most remarkable problem in the society in modern era. The suitable effective treatment of this disease is not available in the modern medicine till now. The national economy is badly affected due to this disease problem as the young aged people are

mostly affected by this disease and the patients are gradually crippled both physically and mentally regarding to the worse prognosis of this disease. So it draws a major attention nowadays to different scholars for research purpose. Yoga is the way for spiritual well being as well as natural way of living and Naturopathy is the art of living according to the nature. The certain processes are mentioned in the Yoga and Naturopathy which are helpful in the prevention of disease and maintenance as well as promotion of physical, mental and spiritual wellbeing [4] , [5]. Such processes are drug less, easily applicable, less complicated and less cost effective. So, certain Yoga therapy and Naturopathy processes had been selected for the management of the Amavata (Rheumatoid arthritis) in this comparative clinical study [6], [7], [8]. Aim & Objectives:

To ameliorate the clinical features of Amavata (Rheumatoid arthritis) and increase the work ability.

To minimize the periodic fluctuation of the disease Amavata (Rheumatoid arthritis).

COMPARATIVE CLINICAL EVALUATION OF AMAVATA (RHEUMATOID ARTHRITIS) WITH YOGA THERAPY AND NATUROPATHY MANAGEMENT

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To assess the effect of the Yoga therapy and Naturopathy in the management of Amavata (Rheumatoid arthritis).

To compare the efficacy of the Yoga therapy and Naturopathy in the management of Amavata (Rheumatoid arthritis).

MATERIALS AND METHODS Total 88 patients were registered for the present clinical study as per the criteria for the diagnosis of the disease Amavata (Rheumatoid-arthritis) and 8 patients were dropped out from the treatment before the completion of the therapy. The patients were selected from the O.P.D. of the Maharshi Patanjali Institute for Yoga Naturopathy Education and Research, Gujarat Ayurved University, Jamnagar as per following criteria:- a) Inclusion criteria: Patient between 18 to 60 years of both sexes. The patient who fulfilled the clinical features of

Amavata according to Ayurvedic classics. The patient who fulfilled the American College

of Rheumatology (ASIA), 1987-reversed criteria for Rheumatoid arthritis [9]

b) Exclusion criteria: Osteoarthritis, Rheumatic arthritis, Septic

arthritis, Gouty arthritis, Psoriatic arthritis, Trumatic arthritis, SLE (Systemic lupus erythematosus).

Diabetes Mellitus, Hypertension, Tuberculosis, Thyroid disorders, Cardiac problems, Renal problems, Liver problems, HIV and any Malignancy.

Age below 18 years and above 60 years. The disease Amavata (Rheumatoid arthritis) was diagnosed on the basis of clinical features as described in Ayurvedic and Modern texts, aided by the revised criteria for Rheumatoid arthritis fixed by the American College of Rheumatology in 1987. R-A-factor and C-Reactive-Protein investigations had been done in all the patients for diagnosis and severity of the disease. Routine Blood, Urine and Stool examinations along with Serum uric acid, urea, creatinine, ASO titer, ANF, Lipid profile, Liver function test, ECG, Fasting Blood Sugar had been done to exclude other pathological conditions of the registered patients. Plan of Study: The selected patients were randomly divided into following two groups i.e. Group-A (Yoga-group) and Group-B (Naturopathy group). In Group-A (Yoga-group), out of register 43 patients 40 patients completed the therapy and 3 patients left the therapy before completion of the course. In Group-B (Naturopathy group), out of register 45 patients 40 patients completed the therapy and 5 patients left the therapy before completion of the course. In Group-A (Yoga-group), the selected patients were given Yoga therapy management in the every day morning at 6 a.m. in the empty stomach for three weeks (21 days) which is presented in the table 1.

Table No.-1: Yoga processes

1st week 2nd week 3rd week

Prarthana (Prayer): 2 minutes (min.) Prarthana: –2 minutes (min.) Prarthana: –2 minutes (min.)

Suddhi kriya: 40 min. Neti (sutra & jala neti) : 6min. (twice in week) Dhouti[vaman (kunjal)]: 30 min (twice in week) Kapalbhati: 5min.(daily)

Suddhi kriya: 40 min. Neti (sutra & jala neti): 6min. (thrice in week) Dhouti[vaman(kunjal)]: 30 min (thrice in week) Kapalbhati: 5min.(daily)

Suddhi kriya: 40 min. Neti: (sutra & jala neti): 6min. (twice in week) Dhouti[vaman(kunjal)]: 30 min (twice in week) Kapalbhati: 5min.(daily)

Stretches & Rotations: 15 min. Stretches & Rotations:15 min. Stretches & Rotations: 15 min.

Asana & Mudra: 30 min. Standing :Tadasana Trikonasana Katichakrasana Sitting :Janushirasana Bhadrasana Vakrasana Ardhakumbhasana Supine : Pavanmuktasana Uttanpadasana Setubandhasana Prone : Makarasana

Asana & Mudra: 30 min. Tadasana Trikonasana Katichakrasana Paschimottanasana Vakrasana Gomukhasana Ashwini mudra Yoga mudra Ardhahalasana Viparitkaranimudra Matsyasana Shalabhasana

Asana & Mudra: 30 min. Triknosana Vrikshasana

Paschimottanasana Ardhamatsyendrasana Akarnadhanurasana Ashwini mudra Yoga mudra Halasana Sarvangasana Matsyasana Shalabhasana

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Ardhasalbhasana Bhujangasana Niralambasana Mul bandha

Sarpasana

Sarpasana Dhanurasana

Pranayams: 10 min. Nadisodhana, Bhamari, Suryabhedana.

Pranayams: 10 min. Nadisodhana, Bhamari, Ujjai, Bhastrika.

Pranayams: 10 min. Nadisodhana, Bhamari, Ujjai, Bhastrika.

Relaxation with Dharana: 10 min.



Omkara & Shanti mantra: 3 min.



In Group-B (Naturopathy group), the selected Amavata (Rheumatoid arthritis) patients were given Naturopathy management for three weeks (21 days) and in that Naturopathy management included Naturopathy processes, Tentative

planning of Fast for 1st week and Diet planning which all are presented consecutively in the table 2, 3 and 4.

Table No.-2: Naturopathy processes:

1st week 2nd week 3rd week Mud pack application: 10 to 20 minutes (min.)

Mud pack application: 10 to 20 minutes (min.)

Mud pack application: 10 to 20 minutes (min.)

Prayer: 2 min. Prayer: 2 min. Prayer: 2 min. Physical exercise (only joint rotation & muscle stretching exercise):10min.

Physical exercise (only joint rotation & muscle stretching exercise): 10 min.

Physical exercise (only joint rotation & muscle stretching exercise):10min.

Breathing exercise: 5min. Breathing exercise: 5min. Breathing exercise: 5min. Relaxation: 10min. Relaxation: 10min. Relaxation: 10min. Hip bath: 10 min. Hip bath: 10 min. Hip bath: 10 min. Shiatsu massage with Acupressure: 15 min.

Shiatsu massage with Acupressure: 15 min.

Shiatsu massage with Acupressure: 15 min.

Warm Sand application: 05 min.

Warm Sand application: 0 5 min.

Warm Sand application: 05 min.

Infrared ray: 05 min. over the affected joints



Small & mild vibretor: 05 min.

Small & mild vibretor: 05 min. Small & mild vibretor: 05 min.

The above Naturopathy management was given in every day morning in empty stomach for continuous three weeks (21 days).

Table No.-3: Tentative planning of Fast for 1st week: Timing Instruction

6.00 am Wake up, tooth brash, mouth wash and take two glass of water. 6.30 am to 7.30am Natural urges, bathing with luke warm etc. 7.30 am Prayer 7.45 am Intake 1 cup luke warm Shunthi (Zingiber officinale)fant (1 gm dry ginger powder boiled with 1

glass of water) 8.15am to 8.30am Intake 1 glass luke warm boiled green gram (mung dal) (Vigna radiate) water. 11.30am to 12.30pm Boiled rice (semi liquid) with boiled green gram (mung dal)

(Vigna radiate) water. 4.30pm to 5.30pm Intake 1 glass luke warm boiled green gram (mung dal) (Vigna radiate) water. 7.30pm to 8.00pm Boiled rice (semi liquid) with boiled green gram (mung dal) (Vigna radiate) water. 9.45pm Prayer & intake 5 ml Eranda taila (Ricinus communis) with 1 glass luke warm water. 10.00pm Go to sleep [first Vamkukshi shayan (left lateral posture)-10 to15 min, then as usual].

Patient should follow the above diet plan on 3rd, 4th & 5th day of the 1st week. On 6th day patient should take boiled rice in moderate quantity with mung dal [(green gram) (Vigna radiate)]in the lunch & dinner

time. On 7th day patient should take boiled rice or homemade roti with mung dal [(green gram) (Vigna radiate)]in the lunch time & dinner

time.

Table No.-4: Diet planning Timing Instruction

6.00 am Wake up, tooth brash, mouth wash and take two glass of water. 6.30 am to 7.30 am Natural urges, bathing with luke warm etc. 7.30 am Prayer 7.45 am Intake 1 cup luke warm Shunthi fant ( Zingiber officinale) (1 gm dry ginger powder boiled with 1

glass of water) 8.15 am to 8.30 am Breakfast (dalia/mamra/upma etc. with toned milk.)

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11.30 am to 12.30 pm

Light Lunch [Boiled rice, dal (pulses), vegetable soup or vegetable khichidi or roti, dal (pulses), vegetable soup], then Shatapad gaman (slow walking for 100 steps). Never sleep in day time.

1.00 pm to 1.15 pm Intake fresh seasonal fruit (e.g. apple, pear, pomegranate, guava etc.) never take ripe banana & mango.

4.30pm to 5pm Evening snacks, if needed, take toned milk with rice puff or rice flacks in moderate quantity. 7.30 pm to 8.00 pm Light dinner (Boiled rice, dal (pulses), vegetable soup or vegetable khichidi or roti, dal (pulses),

vegetable soup), then Shatapad gaman (slow walking for 100 steps). 9.45pm Prayer & intake of 5ml Eranda taila (Ricinus communis) with 1 glass luke warm toned milk. 10.00pm Go to sleep [first Vamkukshi shayan (left lateral posture)-10 to15 min, then as usual]. The above diet plan was strictly followed for continuous three weeks (21 days). Patients of the both groups were given some important instructions during the therapy those were to avoid cold drinks, ice cream, curds, banana, coconut, black gram, fast food, junk food, non-veg (i.e. egg, fish and meat), tobacco, smoking, alcohol, alcohol containing other beverages, cold water for bathing, sleep in day time and to use luke warm water for bathing [10]. Assessment parameters: Three parameters were adopted for the assessment of present clinical study:- Assessment of Clinical Features: The progress of the clinical manifestations of the Amavata (Rheumatoid arthritis) patients was assessed on the basis of clinical features of the disease Amavata (Rheumatoid arthritis) which are mentioned in Ayurvedic classics as well as with the help of criteria fixed by American Rheumatology Association in 1988 and implemented it after some modification. Sandhishula (Joint pain), Sandhishotha (Joint swelling), Sandhisthabdhata (Joint stiffness), Sandhi-sparshaasahyatva (Joint tenderness), Angamarda (Bodyache), Gaurava (Heaviness of the Body), Agnidourblya (Impaired digestive capacity) were selected as important common clinical features of Amavata (Rheumatoid arthritis) for this study and the scoring pattern was adopted separately for assessment of those clinical features. Assessment of Functional Capacity: Functional capacity of the treated patients was assessed with the help of following parameters:- (a) Walking time: The patients were asked to walk a distance of 30 feet and the time taken was recorded before and after the treatment by using stop watch. (b) Grip Strength: To measure the functional capacity of the affected upper limb, especially for both hands with wrist joints, the patient’s ability to compress an inflated ordinary sphygmomanometer cuff under standard conditions (i.e. 20 mmHg) was recorded before and after the treatment.

(c) Foot pressure: To measure the functional capacity of the affected leg, especially affected ankle with metatarsphalangeal joints, foot pressure was recorded by the ability of the patients to press a weighing machine. Assessment of Overall Effect of the Therapy: The overall effect of the therapy or management was assessed with the help of the criteria collected from ARA (American Rheumatoly Association) (1988) and it was implemented after some modification. Results of that clinical study were evaluated in to four groups as follows: a) Complete Remission, b) Major Improvement, c) Minor Improvement and d) No-improvement. OBSERVATIONS Maximum patients i.e. 69.37 % belonged to 30 – 50 years of age group. 86.47% patients were female, 89.59 % patients were Hindu (As, Jamnagar is Hindu majority area), 98.88 % patients were Married, 75.17 % patients were Housewives (as, Maximum patients were middle aged female), 68.68 % were coming from Middle class, 77.48 % were in urban habitat, 88.95 % were Educated from primary to graduate level. Majority of the patients i.e. 59.98 % were having Negative Family history, 85.47 % patients were having Gradual Onset, 95.34 % patients were having Relapsing Course and 47.46 % were having Chronicity of less than 2 years. Cold and moist environment was Aggravating factor for all the patients. Most of the patients i.e. 88.68 % were Vegetarian (as, the diet pattern of Jamnagar people is mainly Veg), 84.53 % patients were Poor Appetite, and 48.88 % were Krura Kostha (Constipated). All the patients were more suffered in Varsha ritu (Rainy season) and Shita ritu (winter season). In majority of patients (95.33 %) wrist joint was involved along with Metacarpophalangeal (86.33 %), Metatersophalangeal (84.47 %), Ankle (80.25 %), Knee (77.58 %), Elbow (29.59 %), PIP (29.77 %), Shoulder (12.43 %), Hip (8.45 %), Jaw (6.55

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%), DIP (9.46 %), Lumbo-sacral (7.34%) and Cervical (4.34%) joints were involved. C-Reactive-Protein positive was found in 71.56 % patients and R.A. factor positive was found in 27.31 % patients, Rheumatoid nodule was present in 22.23 % patients and Deformity was observed in 5.11 % patients. According to Pratyatma Lakshana (Cardinal clinical features) all the patients were suffering from Sandhi-shula (Joint-pain), Sandhi-shotha (Joint-swelling), Sandhi-stabdhata (Joint-stiffness) and Sandhi-sparshasahyata (Joint-tenderness).

According to Samanya Lakshana (General clinical features) Angamarda (body ache), Gaurava (heaviness of the body) & Agni–daurbalya (impaired digestive capacity) were observed in 71.56 %, 68.69 % & 87.87 % patients respectively. RESULTS AND DISCUSSION Effect of the therapy in Group-A (Yoga-group) and Group-B (Naturopathy group) is presented consecutively in the table 5, 6, 7, 8, 9, 10, 11, 12 and 13.

In Group-A (Yoga-group):

Table No.-5: Effect of the Yoga therapy on the following Clinical features: Clinical features Mean Score % of

Relief S.D. S.E. ‘t’ P B.T. A.T. Sandhishula (Joint pain) 2.21 0.79 64.66 0.49 0.07 17 <0.001 Sandhishotha (Joint swelling) 1.92 0.74 61.02 0.37 0.05 19.30 <0.001 Sandhi-sthabdhata (Joint stiffness) 2.22 0.79 66.28 0.49 0.07 18.44 <0.001 Sandhi-sparsha-asahyatva (Joint tenderness) 2.02 0.74 62.95 0.44 0.06 17.82 <0.001 Angamarda (Body ache) 2.1 0.70 65.39 0.48 0.08 17.48 <0.001 Gaurava (Heaviness of the Body) 2.1 0.81 60.02 0.42 0.07 18.74 <0.001 Agni-dourblya (Impaired digestive capacity) 2.1 0.94 53.76 0.28 0.05 25.50 <0.001

Table No.-6: Effect of the Yoga therapy on the following parameters of Functional Capacity:

Criteria Mean Score % of Relief S.D. S.E. ‘t’ P B.T. A.T. Walking time 12.64 10.64 15.80 0.22 0.03 55.88 <0.001 Grip strength 88.74 97.74 10.13 5.49 0.86 10.32 <0.001 Foot pressure 19.77 22.59 14.28 0.86 0.13 20.44 <0.001

Table No.-7: Overall Effect of the Yoga therapy:

Effects No. of Patients

Percentage (%)

Complete Remission 00 00 Major Improvement 24 60 Minor Improvement 14 35 No-Improvement 02 05

In Group-B (Naturopathy group):

Table No.-8: Effect of the Naturopathy on the following Clinical features:

Clinical features Mean Score % of Relief S.D. S.E. ‘t’ P B.T. A.T.

Sandhishula (Joint pain) 2.14 1.47 31.38 0.46 0.07 8.5 <0.001 Sandhishotha (Joint swelling) 1.42 0.77 45.60 0.47 0.07 8.4 <0.001 Sandhi-sthabdhata (Joint stiffness) 2.17 1.39 35.62 0.41 0.06 11.58 <0.001 Sandhi-sparsha-asahyatva (Joint tenderness) 1.77 1.12 36.61 0.47 0.07 8.50 <0.001 Angamarda (Body ache) 2.1 1.16 42.51 0.37 0.07 14.88 <0.001 Gaurava (Heaviness of the Body) 2.1 1.4 35.1 0.47 0.08 9.55 <0.001 Agni-dourblya (Impaired digestive capacity) 2.1 1.04 48.69 0.17 0.04 37.01 <0.001

Table No.-9: Effect of the Naturopathy on the following parameters of Functional Capacity:

Criteria Mean Score % of Relief S.D. S.E. ‘t’ P B.T. A.T. Walking time 12.19 11.01 9.66 0.56 0.10 13.53 <0.001 Grip strength 94.01 98.18 4.45 2.03 0.35 12.21 <0.001 Foot pressure 21.74 23.56 8.41 0.88 0.15 13.22 <0.001

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Table No.-10: Overall Effect of the Naturopathy:

Effects No. of Patients Percentage (%)

Complete Remission 00 00 Major Improvement 22 55 Minor Improvement 16 40 No-Improvement 02 05

Effect of the therapy on following parameters of Functional Capacity in Group A & B:

Table No.-11: Walking time:

Group-A Group-B S.D.

S.E.

‘t’

P n 1 X1 n 2 X2

40 2.1 40 1.19 1.09 0.10 8.8 <0.001

Table No.-12: Grip strength: Group-A Group-B

S.D.

S.E.

‘t’

P n 1 X1 n 2 X2 40 9.1 40 4.18 2.05 0.37 13.31 <0.001

Table No.-13: Foot pressure:

Group-A Group-B S.D.

S.E.

‘t’

P n 1 X1 n 2 X2

40 2.84 40 1.84 1.36 0.20 5.13 <0.001 In the Group-A and Group-B of this clinical study, the results were statistically highly significant (P<0.001) on the parameters of Clinical features and Functional capacity which are shown respectively in the table 5, 6, 8 and 9. The results of comparative clinical study between Group A and B were statistically highly significant (P<0.001) on the parameters of Functional capacity of Walking time, Grip strength and Foot pressure which are shown in the table 11, 12 and 13 respectively. It is revealed that group-A treatment was more effective than group-B treatment in respect of Functional capacity parameters [11]. Overall Effect of the Therapy of the both group A and B which is shown respectively in the table 7 and 10, expresses that maximum patients i.e. 60 % in Group-A and 55% in Group-B showed Major improvement. 35% in Group-A and 40% in Group-B showed Minor improvement, 5% in both the Groups showed No-improvement and Complete remission was nil in both groups. Probable mode of action of Yoga therapy management of the present clinical study is that Suddhi kriya helps to eliminate the vitiated shlema (vitiated body fluids) from the body. Stretching & Rotations exercise increases the joint mobility and diminishes the joint stiffness. Asana improves the muscle tone & power of the body & also improves the functions of different organs of the body. Mudra enhances the normal functional activity of glands of the body. Pranayam improves the

functions of the respiratory and cardiovascular systems of the body. Relaxation with Dharana decreases the anxiety, tension, mental stress and depression. Omkara & Shanti mantra develops the spiritual aspects of the mind and Prarthana (Prayer) promotes the mental & spiritual wellbeing. Other Advise helps to prevent the further formation of Ama (biotoxins) into the body. Probable mode of action of Naturopathy management of this clinical study is that Mud pack application improves digestive capacity (Agni-bala) and the functional capacity of the abdominal organs. As a result the Ama (biotoxin) formation is prevented. More over it also absorbs the biotoxin from that applied area. Prayer helps to improve the spiritual aspect of the life and also increases the mental strength. Physical exercise (Stretching & Rotations) increases the joint mobility and diminishes the joint stiffness. Breathing exercise improves the functions of the respiratory and cardiovascular systems of the body. Relaxation helps to decrease the anxiety, tension, mental stress and depression. Warm Hip bath improves the health of the lower abdominal organs & improves the normal bowel activity. Shiatsu massage & Acupressure encourage the self healing processes of the body to repair the affected area & gradually relief joint pain, swelling, stiffness and tenderness. Infrared ray & Warm Sand application improve the health of the affected joints and reduce the joint pain, swelling, stiffness & tenderness. Small vibretor helps to relax the stiffness of the muscles. Fasting helps to give some rest of the body from usual daily life activities,

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improves the functional capacity of all organs of the body & reduces the biotoxins into the body. Diet planning gives proper nutrition of the body & enhances the vital capacity of the body. Other Advise helps to prevent the further formation of Ama (biotoxins) into the body. CONCLUSION It can be concluded on the basis of the present clinical study that Amavata looks similar to Rheumatoid arthritis in its clinical appearance. Yoga & Naturopathy, both the managements were satisfactory effective in the treatment of Amavata (Rheumatoid arthritis) and Yoga management was more effective than Naturopathy management in this clinical study. No complication was found in this clinical study. Therefore, these drug less, easy affordable, less economic, free of side effects & more natural alternative treatments may be designed with both Yoga therapy & Naturopath management simultaneously for getting better result on the treatment of Amavata (Rheumatoid arthritis). ACKNOWLEDGEMENT Authors are grateful to the Vice chancellor of Gujarat Ayurveda University, Jamnagar, the Principal of Maharshi Patanjali Institute for Yoga Naturopathy Education and Research, Jamnagar and also grateful to the patients who had participated in the clinical study, other experts and

staff for their continuous support and cooperation for the study. REFERENCES

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.CITE THIS ARTICLE AS – Saroj Kumar Debnath et.al., Comparative Clinical Evaluation of Amavata (Rheumatoid Arthritis) with Yoga Therapy and Naturopathy Management, Int. J. Ayu. Alt. Med., 2014;2(5):28-35 Source of Support – Nil Conflict of Interest – None Declared

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comparative clinical evaluation of amavata (rheumatoid arthritis)

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