A case of Gambheera Vathasonitha

Vathasonitha Arthritis is a common health issue in the present life sans urban-rural divide. It appears in different forms, in different joints and with different gravity. Its management is always a challenge to the treating physician and the outcome is dependent on a multitude of factors like age, sex, chronicity and the like.  Generally patients with arthritis come for Ayurvedic treatments as the last resort.  And this makes the management quite difficult and the outcome limited.  Still, as a matter of fact, it may be seen that the Ayurvedic management of arthritis is quite effective, safe and sustainable.  Moreover, it is quite economical as well.  Let me share with the reader one outstanding example of managing arthritis on Ayurvedic lines.

50-year-old Satheedevi, a resident of Theni District of Tamil Nadu, a Keralite by birth, came to our OPD in June 2015 with complaints of severe pain on almost all of her joints, more pronounced on finger joints, wrists, and elbows which she was suffering for last 4-5 years.  There was marked swelling on the affected areas, and the fingers looked deformed.  She had a history of recurrent feverishness along with the flaring up of joint pains.  Satheedevi was a lady with an obese body frame, not on any specific medicines for other systemic illnesses like Diabetes, Hypertension or the like.  Her only concern was the joint pain and related problems.  She had tried almost all branches of medicines from different practitioners of Tamil Nadu and Kerala.  She had even attended an In-Patient treatment in an Ayurvedic hospital. But the outcome was not at all inspiring.  But still she had a feeling that IP therapies will help her, and she expressed her willingness to get admitted in our centre.  She was on some Allopathic medications like Hydroxychloroquine Sulphate (HCQs), Methotrexate (weekly once) and a moderate daily dose of corticosteroids along with analgesics for the management of pain.

On detailed case taking the findings were like this: her appetite was not satisfactory; normal thirst and sweat; sleep disturbed because of the pain; and bowels and urine normal.  She had tenderness of the involved joints and their movements showed restriction of moderate extent.  She had her menopause a couple of years back.  She was feeling her body heavy; moving around was not comfortable.  The skin over the finger-joints showed deep brownish hyper-pigmentation.

This was a case of Vathasonitha as per Ayurvedic diagnosis, in the stage of Gambheera.  Considering the long history of the complaint and the tendency of developing deformities, the case was repeatedly evaluated for the line of management and possible outcome.  Though the patient was volunteering for admission, it was not a case to be treated with conventional types of Sneha-Sweda (oil-application & fomenting) treatments.  And I did expect a worsening of the condition with that line.  The patient was admitted in the hospital for two days for further observations along with oral medicines; and she was discharged on the third day with a prescription for next two months. The main choice was Guduchi in different combinations with other selected herbs. Basic dietary modifications were also suggested.  And she was advised to withdraw HCQs and analgesics immediately. She was reporting positive changes over phone every fortnight and came for a review after 2 months. The condition was stable with significant reduction in pain and swelling. She looked more comfortable and confident. The steroid dose and methotrexate were withdrawn this time, and the prescription still revolved around Guduchi.  After another two months, the pain and swelling subsided completely; and the fingers looked normal except for the mild deformity.  Other joints were moving freely without pain.  Her general health was also better with the body weight reduced to 5-6 kilograms, and the hyper pigmentation over the skin resolved completely.  The dietary changes continued.  Now after 7 months, she is totally symptom-free.  Kashayam still continuing and purgation with Nimbamruthadi Erandam is done once in two weeks.

The case of Satheedevi is an example which shows that-

  1. a proper evaluation of the disease and its stage is the most important exercise that the physician should practice before rushing to a prescription;
  2. more medicines should never be mis-equated with better outcome;
  3. hospitalised treatments and therapies are not essential for the management of Arthritis always;
  4. Ayurvedic understanding of the condition is the perfect path for the optimal outcome, not its Allopathic name or prognosis. (here in the case of Satheedevi, Allopathy had a diagnosis of Rheumatoid Arthritis which is an incurable type of autoimmune disease)

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