A Study of Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata W....

[Full title: A Study of Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata W. S. R. to Rheumatoid Arthritis]

© 2024 D. K. Sharma, et al . This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). ( https://creativecommons.org/licenses/by/4.0/ ) ORIGINAL RESEARCH ARTICLE A Study of Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata W. S. R. to Rheumatoid Arthritis D. K. Sharma 1 , Sandeep Charak 1 , Amit Mahajan 1 , K. S. Sakhitha 2 1 Medical Officer, Department of Ayush, Jammu, Jammu and Kashmir, India 2 Assistant Professor, P. G. Department of Rasashastra and Bhaishajya Kalpana, NIA Jaipur, Rajasthan, India ABSTRACT The present study was aimed to assess the effectiveness of Amavatari rasa and Rasanadi guggulu in Amavata and compare the effect of these two preparations in the treatment. A total of 30 patients of Amavata were registered for the present study and were randomly divided into 2 groups. In group A- Amavatari Rasa 125 mg BD per day was given for 14 days, while in group B- Rasnadi Guggulu 250 mg BD per day was given for 14 days. The effect of therapy in both groups was assessed by a specially prepared pro forma. The results of the study showed that both the groups showed significant relief in symptoms; however, comparing the overall effect of the therapies, Amavatari Rasa proved to be more effective than Rasnadi Guggulu 1. INTRODUCTION Rheumatoid arthritis (RA) is a chronic systemic disease that affects the joints, connective tissues, muscles, tendons, and fibrous tissue. It tends to strike during the most productive years of adulthood, between the ages of 20 and 40 and is a chronic disabling condition often causing pain and deformity [1] In Ayurveda, the disease has been described in detail in several Ayurvedic literature after Madhav, Madhavakara was the first author who described Amavata as a separate disease in his book Madhava Nidana which was previously known as Rogaviniścaya [2] The prevalence varies between 0.3% and 1% and is more common in women and in developed countries [2] The changing lifestyle of human beings by means of dietetic and behavioral patterns plays a major role in the manifestation of several diseases and Amavata is one among these [3] The clinical presentation of Amavata closely mimics the special variety of rheumatological disorders called RA, similarities in clinical features such as pain, swelling. Stiffness, fever, and general debility are almost identical [4] According to the nature of the disease, it is essential to work on such therapy which has Ama and Vatahara properties [5] Āyurveda offers a holistic approach to the management of a disease, it emphasizes inclusion Corresponding Author: D. K. Sharma, Medical Officer, Department of Ayush, Jammu and Kashmir, India. Email: HYPERLINK “mailto:drdksmd 2009@gmail.com” drdksmd 2009@gmail.com D. K. Sharma, Email: drdksmd 2009@gmail.com of both Samśodhana and Samśamana therapies for the management of a disease. The Sattvājaya approach has been described to manage the psychological component of any disease [6] At the same time, Āyurveda never undermines the importance of Nidāna Parivarjana and Pathya- Apathya, that is, specific dietary approach during the management of a disease. The relatively lower therapeutic response in Āmavāta by the Āyurveda mode of therapy may be because of the current style of halfhearted practice. The present study has been conducted with the same intention and has been designed to include all the essential components of basic concepts of Āyurveda i.e. Samśodhana and Samśamana Cikitsā regarding the management of Āmavāta [7] The Ayurveda approach toward the treatment of Amavata is the need of the hour as no system is successful in providing the complete cure for the disease, so Amavata is a challenging and burning problem of medical science Due to the wide spectrum of diseases, much prevalence in society, and a lack of effective management, the disease has been chosen for the present study. A clinical study was planned to assess the clinical effectiveness of Amavatari rasa and Rasanadi guggulu and to compare the effect of these two therapies in the treatment of the condition. In the study, in both groups, Amavatari rasa [8] and Rasanadi guggulu [9] have been selected. Due to its Amapachaka and Vatashamaka properties, it helps to disrupt the Samprapti of Amavata. All the raw drugs for the purpose of research work were collected from the Pharmacy of the National Institute of Ayurveda, Jaipur. The correct identity and authenticity of raw materials were confirmed by studying International Research Journal of Ayurveda & Yoga Vol. 7(7), pp. 1-8, July, 2024 Available online at http://irjay.com ISSN: 2581-785 X DOI: 10.48165/IRJAY.2024.70701 ARTICLE INFO Article history: Received on: 1-07-2024 Accepted on: 21-07-2024 Published on: 31-07-2024 Key words : Amavata , Rheumatoid arthritis, Amavatari rasa, Rasanadi guggulu

Sharma, et al. : Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata 2024; 7(7):1-8 2 their organoleptic and powder microscopy and then comparing them with the characters mentioned in Ayurvedic Pharmacopeia of India 1.1. Aims and Objectives • To establish the Āyurveda treatise in the management of Āmavāta • Clinical evaluation of the efficacy of Amavatari Rasa and Rasnadi Guggulu in management of Āmavāta W.S.R. to RA • To provide safe and cost-effective drugs to society 2. MATERIALS AND METHODS 2.1. Selection of Cases A total of 30 patients of Āmavāta were randomly selected for the present study from the Kayachikitsa outpatient department (OPD), Rasashastra OPD, Pañcakarma OPD, and IPD department of the National Institute of Ayurveda, Jaipur. The case selection was random regardless of age, sex, occupation, and socio-economic conditions. A regular record of assessment of all patients was maintained according to the pro forma prepared for the purpose as per CCRAS protocol 2.2. Inclusion Criteria The following criteria were included in the study: • Patients between the age of 18–60 years of either sex or signs and symptoms of Āmavāta. • Patients classified as RA as approved by the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) with RA score ≥6/10 [10] • Patients who were willing to sign the informed consent form 2.3. Exclusion Criteria The following criteria were excluded from the study: • Rheumatic fever patients • RA (of): Juvenile, Spine • Patients with severe deformities, severe ankylosed joints, etc • Patients suffering from tuberculosis, uncontrolled diabetes mellitus, HIV, Hepatitis-B & C patients, or any other serious disease • Pregnancy and lactating mothers 2.4. Grouping and Administration of Drug A total of 30 clinically diagnosed and registered patients of Āmavāta were divided randomly into two groups, each group with 15 patients 2.4.1. Group-A Amavatari Rasa 125 mg BD per day after meals with lukewarm water for 14 days 2.4.2. Group-B Rasnadi Guggulu 250 mg BD for 14 days after meals with lukewarm water • Pathya-Apathya was advised to patients of both groups 3. OBSERVATION The data obtained by the clinical study were subjected to resolutions on varied parameters to know the etiopathogenesis, progress of the disease, and the effect of interventions on various signs and symptoms of the disease. In the present study, the observations and results have been made under the following headings 3.1. Demography of General Profile The prevalence of Āmavāta in different age groups was worked out, the highest number of cases of Āmavāta was seen in the age group of 41–50 years with 12 cases (40%), 07 cases i.e. (23.33%) from 31– 40 years of age groups, 5 cases, that is, (16.67%) from 51–60 years of age groups, 4 cases (13.33%) each from 21–30 years and 02 cases from 11–20 years of age group. This shows that the prevalence of Āmavāta is more in the middle age shown in table 1 This table shows that a maximum of 21 patients (70%) were reported to be females and 9 patients (30%) were males among the 30 patients of Āmavāta. This suggests that the prevalence of Āmavāta is more in females than males shown in table 2. The observations in the above table indicate that 17 patients (56.67%) had Mandāgni, 8 patients (26.67%) had Viṣamagnii, 4 patients (13.33%) had Samagni and 1 patient (3.33%) had Tikṣnagni shown in table 3 In the current series of patients, 4 patients (13.34%) had their duration of illness <2 years, 10 patients (33.33%) complained their illness for 2–4 years, 6 patients (20%) had their duration of illness since 5–6 years, while 10 patients (33.33%) had history of Āmavāta more than 6 years shown in table 4. The table number 5 shows that all patients (100%) had gradual onset Āhāraja Nidāna - Among 30 patients of Āmavāta, 24 patients (80%) were taking Ati Guru Āhāra, followed by 23 patients (76.66%) were taking Singdha Āhāra, 17 patients (56.67%) Ati Madhura, and 15 patints (50%) Atidrava Āhāra,these Āhāra produce Kapha Prakopa and finally lead to Mandāgni a nd production of Āma (Apakva Anna Rasa) which plays an important role in the Samprapti of Āmavāta . Twenty-three patients (76.66%) were having the habit of Adhyaśana and 21 patients (70%) had the habit of Viṣamaśana, these lead to Jātharāgni Mandya which finally leads to the formation of Āma. Vihāraja Nidāna - 23 patients (76.66%) had Viruddha-Ceśtā like Divāsvapna and Niścalatā, 19 patients (63.33%) had Bhojanottara Vyāyāma and Ratri Jāgarana, 13 patients (43.33%) had Viṣama Śayyā . Divāsvapna and Niścalatā lead to Kapha Prakopa, Ratri Jāgarana and Viṣama Śayyā lead to Vāta Prakopa these are the two main pathological factors in Āmavāta. Mānasika Nidāna – 13 patients (43.33%) had Cintā, 07 patients (23.33%) had Bhaya, 06 patients (20%) had Śoka. These factors lead to Vāta Prakopa shown in table 6 Aggravating factors were cold climate in 30 patients (100%), oil application in 23 patients (76.67%), morning hours in 30 patients (100%) and heavy meal in 21 patients (70%), these were increasing the sign and symptoms of Āmavāta. This shows that Kapha aggravating factors worsen the sign and symptoms of disease in Āmavāta patients. Thus, highlights the role of Kapha dosha in the pathogenesis of Āmavāta shown in table 7 . Relieving factors: Summer season in 27 patients (90%), Balukā Svedana in 25 patients (83.33%) and hot water fomentation was found to reduce the severity of the symptoms in 20 patients (66.67%) shown in table 8. During the present trial, 9 patients (30%) had positive family history whereas 21 patients (70%) had no family history of the RA. This shows that hereditary has a role in RA shown in table 9. Joint involvement: Incidence of involvement of joint Shows that a maximum of 93.33% of patients had proximal interphalangeal (of hand) joints involvement, 90% metacarpophalangeal, 70% wrist joint, 50% elbow joint, 46.67% shoulder joint, 50% knee joint, and ankle joint involvement in 23.33% shown in table 10.

Sharma, et al. : Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata 2024; 7(7):1-8 3 The data of the present study reveal that 4 patients (13.33%) were C-RP positive, 4 patients (13.33%) were R.A. positive, and 4 patients (13.33%) were ASLO test positive shown in table 11 Data shows that among 30 patients of Āmavāta, 100% of patients had complaints of pain in the joint, stiffness of joint, swelling of joint, restriction of movements, tenderness at joints, and Ālasya; 96.67% of patients had complaints of Angamarda; 93.33% of patients had complaints of Gaurava ; 83.33% of patients had complaints of Aruci ; 66.67% of patients had complaints of Triṣnā and Apaka ; 53.33% of patients had complaints of J vara ; 30% of patients had complaints of Bahumūtratā shown in table 12 . 3.2. Clinical Study • Follow-up: A follow-up was done 1 month after completion of the treatment to check for any recurrences • Study Design: Single Blind. Randomized, Comparative, Interventional, and Efficacy study • Criteria for Assessment: Both subjective and objective parameters were employed for assessment of the impact of the treatment • Subjective criteria: Sandhiśūla (pain in joints), Angmarda (Bodyaches), Aruci (Anorexia), Triṣnā (Polydipsia), Ālasya (Lassitude), Gorava (Heaviness of body), Jvara (Fever), Apāka (Indigestion of food), and Bahumūtratā (Polyuria ) • Objective parameters: For the purpose of diagnosis of disease its assessment, severity, clinical improvement, and to assess the possible side effects, certain routine and specific investigations were performed in every patient viz • Tender joints count (0–28) as per DAS - 28 • Swollen joints count (0–28) as per DAS - 28 • Visual Analog Scale (VAS) in mm for pain • Blood Investigations - Hemoglobin g%, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), RA factor, anti-streptolysin-O test (ASL-O test) • Classification criteria for RA: The 2010 ACR and EULAR classification criteria for RA • Physical examination: Under the physical examination patient’s general condition, pulse rate, blood pressure, pallor, icterus, cyanosis, lymphadenopathy, and body weight were recorded at the basal level and each successive follow-up • Criteria for withdrawal: • During the course of the trial, if any serious condition or any serious adverse effects occur it requires urgent treatment • The patient himself wants to withdraw from the clinical trial • Patients lost in follow-up • Criteria for assessment of overall effects • For the gross assessment of the result obtained with the clinical trial, the response of the treatment was determined in terms of: a. Degree of remission of signs and symptoms b. Reduction in subjective and objective parameters c. Percentage of relief 3.3. Statistical Analysis For statistical analysis, In Stat Graph Pad 3 software was used. For intra-group comparison of nonparametric data, Wilcox on matchedpairs signed ranks test was used while for parametric data paired “t” test was used and the results were calculated. For intergroup comparisons of non-parametric variables, Mann–Whitney test for statistical analysis was used & for the parametric data unpaired “t” test was used. The results were interpreted as • Insignificant: P > 0.05 • Significant: P ≤0.05 • Very significant: P ≤ 0.01 • Extremely significant: P ≤0.001 3.4. Results of Therapeutic Trial • The effect of therapies on cardinal signs and symptoms has been assessed by giving a specific gradation to these symptoms which has been described earlier. According to that, the results have been made by applying appropriate tests Group A: This group provides extremely significant results in joint pain (Sandhishula), morning stiffness, sparsha asahataa, sandhigraham, Angamarda, Aruchi, Trishna, symptoms while Aalasya and Bahumutrataa show very significant results. Jvara symptom shows a significant result, sandhi shootha and bahumutrataa showed non-significant relief Group B: This group provided extremely significant results in joint pain (Sandhishula), morning stiffness, sparsha asahataa, Angamarda, Aruchi, Trishna, symptoms while sandhi graham, jvara, and bahumutrataa showed very significant results. Aalasya showed significant results. From the above data, it can be analysed that Group A provided highly significant relief in Sandhi shula and morning stiffness as compared to Group B while Group B provided highly significant relief in sandhi sootha and bahumutrataa as that of Group A 3.4.1. Hb% Group A: Mean Hb% before treatment was increased from 13.173 g% to 13.093 g% having 0.6% change which was statistically nonsignificant Group B: Mean Hb% before treatment was increased from 13.3 g% to 12.93 g% having a 2.75% change which was statistically significant 3.4.2. TLC Group A: Mean TLC before treatment changed from 7560 to 7367 having a 2.56% change which was statistically non-significant Group B: Mean TLC before treatment changed from 7673 to 7467 having a 2.69% change which was statistically highly significant 3.4.3. ESR Group A: Mean ESR value was changed from 22.4 to 21.33 after treatment having a 4.76% improvement which was statistically significant Group B: Mean ESR value was changed from 12.13 to 10.6 after treatment having 12.64% improvement which was highly significant BSF: In both groups, results were significant with a minor change of 2.42% in group A and a 3.75% change in group B after the trial period 3.4.4. RA FACTOR, ASLO, CRP Non-significant results were found details of results are given in table 13,14, 15 and graph 1 &2 below . 4. DISCUSSION Àmavata is one of the most challenging joint disorders for the human being, because of its chronic and life-threatening nature. Changes in lifestyle like sedentary and stressful situations and fast food dietetic patterns are responsible for the manifestation of disease. Etiological factors such as Guru Ahara , Viruddhahara , Viruddha Chesta ,

Sharma, et al. : Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata 2024; 7(7):1-8 4 Mandagni , and Snigdhabhuktattvata Vyayama are responsible for Àmavata . Derangement of Agni that is Agnimandya is a chief factor responsible for the formation of Àma , which is the main pathological entity of the disease. In the Samprapti the Mandagni , Amotpatti, and Vataprakopa are important factors. The Pratyatma Laksnas are Sandhishula , Sandhisotha , Gatrastabdhata , and Sparsasahyta . It is mostly the disease of Madhyama Roga Marga with Chirakari Swabhava . Àmavata is a Kricchasadhya disease by its nature. On the basis of clinical features, Àmavata should be differentiated from the other Sandhivedanapradhana diseases such as Vatarakta , Sandhigata Vata , Kostukasirsa . Due to their similar mode of presentation, the term RA can be broadly grouped under the heading of Àmavata [11] Indications and contraindications play a chief role in the treatment of the disease. Acharya Chakrapani was the pioneer in describing the principles of treatment of Àmavata which are Langhana , Swedana , drugs having Tikta , Katu Rasa and Deepana property, Virechana , Snehapana and Basti [12] The fundamentals of Ayurvedic pharmacology are capable of giving a better scientific lead in the mode of drug action. The pharmacology of Ayurveda is based on the theory of Rasa , Guna , Virya , Vipaka, and Prabhava which were the simplest parameters in those days to ascertain the action of the drug. Ayurvedic classics provide clear therapeutic guidance for the treatment of Amavata . Normaly langhana , swedana , Tikta - katu - Deepana drugs, virechana etc. were found. The treatment is based on Ama pachana and amelioration of vitiated vata . In assessing the overall effect of therapy, it was seen that – In Group A ( Amavatari Rasa ), 15 patients were treated, out of which, 6 (46.15%) patients got marked improvement, 5 (38.47%) patients got cured and 2 patients (15.38) got mild improvement. In Group B ( Rasnadi Guggulu ) -out of 15 patients, 6 patients (40%) got marked improvement, 5 patients (33.33%) got improved and 4 patients (26.67%) were cured 5. CONCLUSION RA is the second most common arthritis of the joints after osteoarthritis and it is the most prevalent inflammatory disease of the joints. It can be concluded that Ama formation due to Mandagni and Vata vitiation are two chief factors in the pathogenesis of the disease. Amavata is a Tridoṣaja disease having Kapha and Vāta predominance, having its origin in Amaśaya and Pakvaśaya . On comparing the overall effect of the therapies, Amavatari Rasa proved to be more effective than Rasnadi Guggulu . No major adverse or side effects were encountered during the course of the study. It may be concluded that Ayurveda management is comparatively safe in the treatment of Amavata Regarding trial drugs Amavatari Rasa and Rasnadi Guggulu it can be concluded that both the drugs are effective in the management of Amavata however the overall results of Amavatari Rasa are better than Rasnadi Guggulu due to its yogvahi guna . Also, in those patients where Amavatari Rasa cannot be administered due to any reason, that is, adverse drug reaction, Rasnadi Guggulu can be used as a substitute. Furthermore, there are many formulations named as Amavatari Rasa / Amavatari Vatika but the present formulation has having convenient pharmaceutical process and is having lesser and safer drugs as ingredients 6. ACKNOWLEDGEMENT Nil 7. AUTHORS’ CONTRIBUTIONS All the authors contributed equally to the design and execution of the article 8. FUNDING Nil 9. ETHICAL APPROVALS The study is approved by the institutional ethical committee of the National Institute of Ayurveda, Jaipur vide letter number - IEC/ ACA/2016/48 dated 26/05/2016 10. CONFLICTS OF INTEREST Nil 11. DATA AVAILABILITY This is an original manuscript and all data are available for only review purposes from principal investigators 12. PUBLISHERS NOTE This journal remains neutral with regard to jurisdictional claims in published institutional affiliation REFERENCES 1. Available from: https://www.who.int/chp/topics/rheumatic/en [Last accessed on 2017 Feb 03] 2. Shastri SS. Madhavakara Madhava Nidana Poorvardha with Madhukosha Sanskrit Commentry by Vijayarakhita and Srikanthadatta, Vidyotini Hindi. 29 th ed., Ch. 25-508. Varanasi, Uttar Pradesh: Chaukhambha Sanskrit Samsthan; 1999 3. Available from: https://www.ijrams.com/uploads/185/6861_pdf [Last accessed on 2017 Feb 03] 4. Lekurwale PS, Pandey K, Yadaiah P. Management of Amavata with “Amrita Ghrita”: A clinical study. Ayu 2010;31:430-5 5. Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040. Arthritis Rheumatol 2016;68:1582-7 6. Available from: https://www.who.int/mental_health/evidence/en/ prevention_of_mental_disorders_sr.pdf [Last accessed on 2017 Nov 12] 7. Shastri SS. Madhavakara Madhava Nidana Poorvardha with Madhukosha Sanskrit Commentry by Vijayarakhita and Srikanthadatta. 29 th ed., Ch. 25/7-509. Varanasi, Uttar Pradesh: Chaukhambha Sanskrit Samsthan; 1999 8. Das GS. Bhaishjya Ratnavali. Varanasi: Chaukhambha Prakashan; 2013. p. 619 9. Bhatta T, Naryan H. Brhad Yoga Tarangini. Vol. 1. Puna: Anandashrama mudranalaya; 1913 10. Available from: https://ard.bmj.com/content/71/1/4 [Last accessed on 2017 Dec 12] 11. Shastri SS. Madhavakara Madhava Nidana Poorvardha with Madhukosha Sanskrit Commentry by Vijayarakhita and Srikanthadatta. 29 th ed., Ch. 25/7-509. Varanasi, Uttar Pradesh: Chaukhambha Sanskrit Samsthan; 1999 12. Available from: https://iamj.in/images/upload/903_908_2.pdf [Last accessed on 2017 Dec 13] How to cite this article: Sharma DK, Charak S, Mahajan A, Sakhitha KS. A Study of Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata W. S. R. to Rheumatoid Arthritis. IRJAY. [online] 2024;7(&);1-8 Available from : https://irjay.com DOI link- https://doi.org/10.48165/IRJAY.2024.70701

Sharma, et al. : Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata 2024; 7(7):1-8 5 Table 3: Distribution of patients according to agni S. no. Status of agni No. of patients Total Percentage Group-A Group-B 1 Viṣamagni 4 4 8 26.67 2 Tikṣnagni 0 1 1 3.33 3 Mandāgni 8 9 17 56.67 4 Samagni 3 1 4 13.33 Total 15 15 30 100 Table 1: Distribution of patients according to age S. No. Age (in years) No. of patients Total Percentage Group-A Group-B 1 11–20 02 00 02 6.67 2 21–30 02 02 04 13.33 2 31–40 05 02 07 23.33 3 41–50 04 08 12 40 4 51–60 02 03 05 16.67 Total 15 15 30 100 Table 5: Distribution of patients according to mode onset of disease S. no. Mode onset of disease No. of patients Total Percentage Group-A Group-B 1 Gradual 15 15 30 100 2 Acute 0 0 0 0 Total 15 15 30 100 Table 2: Distribution of patients according to sex S. No. Sex No. of patients Total Percentage Group-A Group-B 1 Male 05 04 09 30 2 Female 10 11 21 70 Total 15 15 30 100 Table 4: Distribution of patients according to duration of illness S. no. Duration of illness (in years) No. of patients Total Percentage Group-A Group-B 1 <2 years 2 2 4 13.34 2 2–4 years 4 6 10 33.33 3 5–6 years 3 3 6 20 4 >6 years 6 4 10 33.33 Total 15 15 30 100

Sharma, et al. : Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata 2024; 7(7):1-8 6 Table 6: Distribution of patients according to Nidāna Nidāna Number of patients Total Percentage Group-A Group-B Āhāraja Nidāna Viruddha 07 06 13 43.33 Viṣamaśana 10 11 21 70.00 Addhyaśana 11 12 23 76.66 Snigdha 13 10 23 76.66 Ati Guru 13 11 24 80.00 Ati Madhura 08 09 17 56.67 Ati Drava 08 07 15 50.00 Rūkṣa 02 05 07 23.33 Vihāraja Nidāna Bhojanottara Vyāyāma 09 10 19 63.33 Viṣama Śayyā 05 08 13 43.33 Ati Vyāyāma 04 03 07 23.33 Divāsvapna 11 12 23 76.66 Ratri Jāgarana 10 09 19 63.33 Niścalatā 11 12 23 76.66 Mānsika Nidāna Cintā 07 06 13 43.33 Bhaya 04 03 07 23.33 Śoka 04 02 06 20.00 Table 7: Distribution of patients according to aggravating factor S. No. Aggravating factor No. of patients Total Percentage Group-A Group-B 1 Cold climate 15 15 30 100 2 Oil application 11 12 23 76.67 3 Morning hours 15 15 30 100 4 Heavy meal 10 11 21 70 Table 8: Distribution of patients according to relieving factor S. No. Relieving factor No. of patients Total Percentage Group-A Group-B 1 Summer 13 14 27 90 2 Balukā svedana 12 13 25 83.33 3 Hot water fomentation 09 11 20 66.67 Table 9: Distribution of patients according to family history S. No. Family history of rheumatoid arthritis No. of patients Total Percentage Group-A Group-B 1 Positive 5 4 9 30 2 Negative 10 11 21 70 Total 15 15 30 100

Table 12: Distribution of patients according to signs and symptoms S. No. Signs and symptoms No. of patients Total Percentage Group-A Group-B 1 Pain in joints 15 15 30 100 2 Stiffness of joints 15 15 30 100 3 Swelling of joints 15 15 30 100 4 Restriction of movement 15 15 30 100 5 Tenderness in joints 15 15 30 100 6 Angamarda 14 15 29 96.67 7 Aruci 15 10 25 83.33 8 Triṣnā 10 10 20 66.67 9 Ālasya 15 15 30 100 10 Gaurava 13 15 28 93.33 11 Jvara 8 8 16 53.33 12 Apaka 8 12 20 66.67 13 Bahumūtratā 5 4 9 30 Table 13: Improvement grading scale S. no. Observation Percentage 1 No relief 0 2 Mild relief 1–25 3 Moderate relief 26–50 4 Significant relief 51–75 5 Excellent relief 76–100 Table 11: Distribution of patients according to positive C-RP, R.A. factor, and ASL-O test S. no. Investigations No. of patients Total Percentage Group-A Group-B 1 CRP 1 3 4 13.33 2 R.A. factor 1 3 4 13.33 3 ASL-O test 2 2 4 13.33 CRP: C-reactive protein, ASL-O: Anti-streptolysin-O Sharma, et al. : Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata 2024; 7(7):1-8 7 Table 10: Distribution of patients according to involvement of joints as per DAS-28 S. no. Joints involvement No. of patients Total Percentage Group-A Group-B 1 Proximal interphalangeal (UL) 13 15 28 93.33 2 Metacarpophalangeal 15 12 27 90 3 Wrist 10 11 21 70 4 Elbow 08 07 15 50 5 Shoulder 07 07 14 46.67 6 Knee 08 07 15 50 7 Ankle 3 4 7 23.33

Sharma, et al. : Amavatari Rasa and Rasnadi Gugglu in the Management of Amavata 2024; 7(7):1-8 8 Table 14: The effect of the trial drug on both groups in various subjective parameters of the disease can be highlighted as follows Symptoms % of relief Group A ( Amavatari Rasa ) Group B ( Rasnadi guggulu ) Joint pain (sandhi shula) 79 38 Morning stiffness 68 45 Sandhi Shotha (swelling/edema) 14 31 Sparsha asahata (tenderness) 60 60.4 Sandhi Graha (restricted movement) 34.2 20 Angmard 53 57 Aruchi 51.5 51.3 Trishna 68.7 53.3 Aalasya 50 29 Gaurava 65.5 58 Jvara 50 57.9 Apaka 80.6 70 Bahumutrataa 28.6 68.7 Table 15: Effect of the trial drug on both groups in laboratory parameters can be highlighted as follows Investigation % of improvement Group A Group B Hb 0.6 2.75 TLC 2.56 2.69 ESR 4.76 12.64 RA FACTOR 0 0 ASLO 0 0 CRP 0 0 FBS 2.42 3.75 ESR: Erythrocyte sedimentation rate, CRP: C-reactive protein, ASL-O: Anti-streptolysin-O, FBS: Fetal blood sampling 0 2 4 6 8 10 12 14 Hb TL C ESR RA FA CT OR ASL O CR P FB S % of improvement Group A % of improvement Group B Graph 2: Effect of trial drug on both groups in Laboratory parameters 0 10 20 30 40 50 60 70 80 90 Joints pain (Sandhi Shula) Morning stif fnes s Sandhi Shotha (Swelling/Oedema ) Sparsha asahata (T enderness) Sandhi Graha( Restricted movement ) Angmar d Aruch i Tr ishna Aalasya Gaurav a Jvara Apak a Bahumutrata a % of Relief Group A (Amavatari Rasa) % of Relief Group B (Rasnadi Guggulu) Graph 1: The effect of the trial drugs on both groups in various subjective

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