Patient contacted Jiva doctor regarding her joint problem. She explained that in beginning her pain started with right knee only that later radiated to her left knee also. At time of consultation, she complained of pain in both knees, heels and fingers of her hand. She had earlier consulted an allopathic doctor who diagnosed RA on investigation and prescribed medicines accordingly.Even with regular treatment, patient did not have relief. Painkillers helps temporarily. Patient explained that because of intense pain, she was unable to walk, move or work properly. Her problems increase especially after sitting down for prolonged periods. Besides that, she experienced stiffness and swelling in her joints and heaviness in her body.RA started a year after delivery. She had history of Tuberculosis that manifested in multiple nodes in her neck; it was treated by allopathic medication and patient said that she used painkillers as per requirement.Specific History (H/0 Present Illness)Patient’s RA was diagnosed 10 months before consultation at Jiva.Physical/ Systemic FindingsBM – regular, once daily, clear, Appetite – normal, Urine -normal, Gas/Acidity – occasionally, Sleep – normal, Mind – Irritation, Memory – poor, Digestion – normalH/0 Past illness/ Family HistoryPatient was diagnosed with Glandular tuberculosis and she took allopathic treatment. She had no history of hypertension, diabetes or thyroid problem.
Samprapti Ghataka Dosha: Vata pradhan tridosha Dushya: Ras, mansa, asthi, majja
Srotas: Ras vaha, anna vaha, asthi, majja vaha Adhishthan: Sandhi
Nidana: Dosha vitiating diet and lifestyle that contains dry, light, cold items, overthinking, fasting, ignoring
natural urges, stress, lack of proper care post-delivery etc.
Chikitsa Sutra
• Nidana parivarjan – Avoid things in diet and routine that accelerates the progression of the disease
• Shaman Chikitsa – Vata-kapha shaman, deepan, ama pachan, srotoshodhan, vedna shaman, rasayan
• Shodhan Chikitsa – Some effective and easy to implement methods are shared to practice at home
• Sattvavjay Chikitsa – Patient education, expectation management, and approach of treatment is shared
Specific Advice:
Pathya: Patient was advised to make a warm potli with a mixture of balu (sand) and saindha namak and apply on the affected part, gentle walks, boil ginger and coriander seed in water and drink when cool, massage with til oil mixed with ajwain for relief in calf pain, regular practice of yoga-pranayam, etc.
Apathya: The patient was asked to avoid frozen foods, white flour, acidic-citrus foods, deep-fried, oily, spicy, gas and ama forming food items, bhindi, arabi, gobhi, katahal, rajma, chana, udad, ice cream, carbonated drinks, fast foods, exposure to cold, staying awake till late at night, sleeping during the day, excessive stress and anxiety, etc.
Modifications/Changes made in prescription during course Below changed medicines were given as per patient’s feedback:
In Dec 2015
No change was done in medicines. Maharasnadi kwath and Amla pittantak rasayan was given additionally in products.
In March 2016
In powder, Dasavatar churna and rasnadi ghan sattava was prescribed instead of soth har churna and Amrit rasayan respectively. In tablets, Maha vatvidhvans rasa was replaced with Acidity tablet. Ksheerbala oil was added in products.
In May 2016
In powder, Sandhidoshahar churna and rasnadi ghan sattva was removed. Erandmool churna and Go amrit bhasma was added. In tablets, Kamdusha ras vishesh and Rasnadi guggulu was given in place of Ama vatadi ras and Mahavatvidhvans ras.
In June 2016
Pain was present in right side calf and heel area but pain in knee had reduced. Patient reported early menstruation. Digestion was normal. All medicines were repeated same but Rasna Saptak kwath was replaced with Maha rasnadi kwath.
Rasna saptak kwath and Nari sakhi capsule was advised in products.
In Oct 2016
Amritadi guggulu was given in place of Rasnadi guggulu, rest all combinations were repeated without change.
Outcome
In the beginning, the patient was explained about the prognosis and nature of the disease along with the relief path as per Ayurveda. After one year of medication, the patient reported significant improvement in all complications that were hindering her daily routine. She responded slowly in the initial months of treatment and symptoms fluctuated.
But as per periodic feedback from the patient, her medicines kept changing to give better improvement that eventually turned into remarkable relief. RA-related morbidities i.e. pain, stiffness, swelling, heaviness, the movement was not experienced for a long time before closing the treatment in December.
Parameters before, during & after treatment were recorded.
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