Conceptual Study of Shatpushpadi Lepa in Amavata

Introduction

The changing life style of human being by means of dietetic and behavior pattern (anger, stress etc) plays a major role in causing Mandagni (due to hypo secretion of digestive juices). This Mandagni leads to formation of Ama. Ama is considered as toxins produced due to improper functioning of Agni therefore Ama can be considered as unripe or un-metabolized food metarial. Ama ultimately leads to manifestation of several disorders_. Amavata_ was first explained as independent disease in Madhav Nidana. Amavata comprises of two words- Ama and Vata. Ama when combined with vitiated Vata and goes to Shleshma Sthana causes the disease Amavata [1]. The signs and symptoms of Amavata includes Angamarda (generalized bodyache), Aruchi (anorexia), Trishna (excessive thirst), Alasaya (lethargy), Gaurava (heaviness), Apaka (indigestion) and Angashunta (edema in different parts of body). Signs and symptoms of Pravriddha Amavata includes Saruja shotha (pain and swelling in hands, legs, ankle, knee, wrist, shoulder and hip joints) Vrishchika Danshavata Vedana (scorpion bite like pain), Bahumutrata (polyuria), Agnidaurbalya (indigestion), Praseka (salivation), Aruchi (anorexia), Gaurava (heaviness), Utsah hani, Vairasya (tastelessness), Daha (burning sensation), Kukshikathiny_a and _Kukshishool (abdominal pain), Nidraviparyaya (sleep disturbance). These symptoms can be seen in Pravriddha Awastha of Amavata [2]. On the basis of its clinical symptoms, it is correlated with Rheumatoid arthritis (RA). It is chronic autoimmune inflammatory disease of unknown cause. Although there are variety of systemic manifestations, the characteristic features of RA are persistent inflammatory synovitis, usually involving peripheral joints in symmetric distribution [3]. Now a days rheumatoid arthritis has been more common and distressing among all joints problem. It affects approximately 0.8% of the population (ranges from 0.3-2.1%) worldwide [4]. The prevalence of RA in India is

0.7% [5]. In recent years, it affects individual of every age i.e., from teenage to adult. Unfortunately, there is no cure for this disease due to its complex and autoimmune nature. DMARDS (Disease Modifying Anti- Rheumatic Drugs), Steroids and NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) are major line of treatment for this disease which offers only symptomatic treatment and prolonged use of these medicine ultimately cause many systemic illnesses.In

Drug Review

Ayurveda Langhana, Swedana, Katu-Tikta Deepaniya Dravya, Virechana, Basti and other Shamana Aushadhis are described. Shatpushpadi Lepa is one of the polyherbal compound mentioned in Yogaratnakara Amavata Chikitsa Adhikara [6]. By topical application Lepa controls Doshas at localized levels and may offers instant relief. It is easy to use and is also cost effective.

Preparation of Lepa: All the ingredients are taken in equal amount and mixed Kanji (Dhanyaamla) and applied Sukhoshna (luke warm) to the affected joint. The Lepa is removed after it get dried and affected joint is washed with lukewarm water.

Rules for Application of Lepa

• According to Acharaya Sushruta the thickness of ideal Lepa should be Ardramahishcharmotsedha i.e., moist buffalo’s skin which is considered approximately 4-5 mm.
• Lepa should not be applied during night.
• Lepa should be prepared fresh and never be applied stale.
• The Lepa should not be left in-situ after drying because it loses their potency and cause irritation to the skin.
• The Lepa should not be applied over the previous one [20].

Discussion

Most of the drugs in Shatpushpadi Lepa are of Katu- Tikta Rasa (Pungent-bitter taste_), Laghu-Tikshana Rukhsa_ Guna (levity-sharp-dry properties), Ushna Veerya (hot in potency) and of Katu Vipaka (pungent taste after digetion). These properties are against the properties of Ama (Guru, Snigdha, Pichchhil and Sheeta) hence alleviates Ama locally from affected joints by application of Lepa. Properties of Ama are much similar to Kapha so it helps to reduce the Sthanika Prapoka of Ama and Vata due to its Vata Kapha Shamaka properties. Almost all the drugs in Shatpushpadi Lepa have Vednashamaka (analgesic) and (Shothahara) anti-inflammatory in nature so help relieve Sandhi-Shula (joint pain), Sandhi-Shotha (joint swelling) and Sandhi- Saprshaashayata (joint tenderness). When Lepa is applied over the affected joints, the active ingredients of Lepa enter the skin through Romkupa and further get absorbed through the Swedvahi Srotas and Siramukha it does the cutaneous biotransformation and which will pacify the Doshas and helps in Samprapti-Vighatana (breakdown of pathogenesis) of the disease locally.

Conclusion

Amavata is a condition where stiffness of body occurs due to lodging of vitiated ama and Vata in Trika Sandhi because of diminished Agni at Jatharagni, Bhutagni, and Dhatwagni level. Pravriddha Awastha of Amavata closely resembles Rheumatoid Arthritis in accordance with their similarities on clinical features like pain, swelling, stiffness, fever, general debility and fatigue. Shatpushpadi Lepa is useful for local application over joints where there is swelling of synovial membrane and destruction of cartilage. It has Vednasthapaka (analgesic), Shothahara (anti-inflammatory) karma and has Vata-Kapha Shamaka properties. Hence, helps to reduce pain, swelling and tenderness of the affected joints and alleviates symptoms of Amavata by its local application over the affected joints. It is also cost effective and easy to use so can be used as ayurvedic pain reliever in the management of Amavata.