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By Kester Marshall
The most common complaint when it comes to arthritis is pain, swelling and stiffness in the joints. This can be the fingers, the hands, the toes, the feet, the ankles, knees, wrists, shoulders, hips, spine… anywhere. And it doesn’t have to be ‘full blown’ arthritis before we start to experience this sort of discomfort. Often pain or stiffness can be mild to begin with and most of us tend to overlook it, push it to the back of our minds or put it down to over exercising, age or normal wear and tear. Unfortunately this means that we often don’t get around to doing anything about it until later, when the symptoms are generally worse and the underlying problem harder to treat.
Arthritis is a word taken from greek and literally means ‘Joint-Inflammation’. This inflammation can affect one or more joints depending on the type of arthritis and the chronicity or severity of the condition. There are many types of arthritis, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout and even psoriatic arthritis. It can also be a symptom that is secondary to another disease such as SLE (Systemic Lupus Erythematosus), Inflammatory Bowel Disease, Ross River Virus or Barmah Forest Virus (both of which are quite common on the north coast), Ehlers-Danlos Symdrome, Familial Mediterranean Fever, Haemochromatosis and Sarcoidosis.
In this article I’ve chosen to look at osteoarthritis and rheumatoid arthritis as these are generally the most common and things could get very geeky and boring if we start considering the rest as well. Lets start by looking at the main differences between them from a western point of view.
The Western Viewpoint
The Disease Process
Osteoarthritis develops as a result of stress and resultant wear and tear on a particular joint (this can be due to injury or infection, excess weight, congenital reasons or other neuro/muscular dysfunction). First the cartilage degenrates which then means bone surfaces are less well protected and can become damaged. This is very painful and can be accompanied by stiffness and even locking of the joint.
Rheumatoid arthritis on the other hand is a systemic inflammatory disorder that as well as affecting the joints can also affect other tissues and organs. It involves an inflammation and swelling of the capsule around the joints, excess synovial fluid and the development of fibrous tissue in the joint capsule. Long-term this can lead to the destruction of cartilage and even fusion of the joints. Rheumatoid arthritis can also produce inflammation in the lungs, the membranes of the lung (pleura), the membrane around the heart (pericardium), and whites of the eyes (sclera). Although the cause of rheumatoid arthritis is unknown, it is considered to be a systemic Autoimmune Disease.
According to conventional medicine, there is no known cure for any form of arthritis and treatment is aimed at minimizing symptoms or modifying the disease process. This is usually done using pain killers and NSAIDS (non steroidal anti-inflammatory drugs), cortisone (steroids) orally or as injections and in the case of rheumatoid arthritis, DMARDS (Disease-modifying anti-rheumatic drugs). DMARDS are drugs that are used alone or in combination to try and prevent degenerative tissue changes; they include Methotrexate, Sulphasalazine and Hydroxychloroquine. Apart from pharmaceuticals, physical therapy, weight control and exercise may be recommended depending on the type of arthritis.
The Ayurvedic Viewpoint
The Disease Process
The ancient Ayurvedic texts describe two basic types of arthritis that correspond with osteoarthritis (Sandhigat Vata) and rheumatoid arthritis (Ama Vat). It is important to remember when considering any disease from an Ayurvedic perspective that it is not just the disease that is treated, it is the person. Every person is treated as a unique case and many variables are taken into account to ensure that a treatment program is specifically tailored for them as an individual.
Having said that, lets take a look at the disease states of osteoarthritis and rheumatoid arthritis from an Ayurvedic perspective….
In Ayurveda, osteoarthritis is considered a disease of malnutrition that tends to affect vulnerable joints (due to previous injury or infection, congenital reasons etc). However, as with all disease, to find the root cause of osteoarthritis, we first must look at the processes of digestion, or Agni. When Agni (the ‘digestive fire’ ) is not working properly, wastes or toxins known as Ama are produced instead of useful nutrients for the tissues. These toxins accumulate in the gut and at the same time, Vata (Air/Ether) accumulates in the colon.
Causes of Vata aggravation include: eating excessively cold, dry, rough, bitter, astringent or pungent foods (including an excess of raw foods); irregular schedules or meal times; excessive travelling; constant multitasking and rushing around; high stress or high anxiety jobs or situations; lack of sound sleep; excessively cold or dry environments; a physically or mentally traumatic event; extreme grief, change or shock; taking drugs; and excessive stimulation and movement.
Aggravated Vata along with Ama (toxins) move from the gut into the channels of circulation, find places in the body that are weak or vulnerable (in this case the joints) and settle in. The qualities of Vata and this particular type of Ama have a catabolic/drying effect that causes deterioration of the soft tissues in the joints and eventually the bones. At the same time, Ama can block the channels supplying nutrients to the joints causing further malnutrition. The deterioration and subsequent irritation in the joint causes inflammation, stiffness, swelling and pain.
In Ayurveda, rheumatoid arthritis is seen as a disease of toxic accumulation and immune malfunction. In the case of rheumatoid arthritis, there is a very high level of accumulated Ama (hence the name) and in many cases, a considerable amount of excess heat (or Pitta). This Ama, combined with aggravated Vata and Pitta moves into the channels of the body and begins to affect Ojas (the vital essence of the tissues and the body-mind’s strength and immunity). This causes Ojas to become depleted and its qualities are changed. At the same time Ama blocks the channels and prevents the production of Ojas, depleting it further. This is the basis of autoimmune-disease. Ojas begins to function incorrectly and, along with Ama, causes the inflammatory responses, swelling and pain that we recognize as rheumatoid arthritis.
Causes of Pitta aggravation include: eating excessively heating, fried, stimulating, pungent, sour or salty foods and drinks (including red meat, fermented foods, alcohol, coffee, chilli, acidic foods); exposure to excessively hot or humid environments; not eating when hungry; living with highly irritating situations; excessively heating exercise; excessively hot showers; excessive exposure to anger, violence, conflict and highly competitive situations.
Things that deplete Ojas: excessive sexual activity, overwork, stress, physical trauma (such as a severe car accident), psychological trauma (such as excessive stress or intense grief) and vigorous exercise beyond your capacity.
This is where Ayurveda and Western Medicine differ dramatically. If the condition is particularly chronic or severe, Ayurvedic treatments can greatly reduce its debilitating effects or help prevent it from getting any worse. If it is medium-level chronicity, Ayurveda can help to reverse the disease process, leading to a state of remission. In many cases, Ayurveda can actually offer a cure. Because the disease process is very well understood, treatments can be applied that effect change at the root cause of the disease.
In both cases of arthritis, strengthening Agni and removing Ama is the immediate concern. Without this any other treatment will be of little effect. This is achieved by following a special diet that allows the Agni to become stronger and the body to begin eliminating excess toxins. In fact, vast improvements can be made in terms of inflammation, pain, swelling and stiffness just by diligently following the correct diet.
Along with a well structured approach to diet, home remedies can also be very helpful, especially if the condition is not chronic or severe. Castor oil (1 tsp taken before bed with ginger tea), fenugreek (½ tsp of powder in warm water before breakfast) and turmeric (1 tsp twice daily) are common household items and can be very effective when taken consistently and in the correct way.
In osteoarthritis the next step after diet and home remedies is to provide support using traditional herbal formulations. These will work more deeply to reduce inflammation and swelling, calm the aggravated Vata and begin nourishing the tissues that have become malnourished or depleted. In the case of rheumatoid arthritis, the emphasis should remain on a longer-term program of Ama reduction, plus herbs that reduce inflammation and nourish Ojas in order to correct the inappropriate immune response. Ayurvedic body therapies such as Pindaswed also help enormously with the reduction of Ama, swelling, pain and inflammation.
But for the best possible results, Ayurveda’s unique deep cleansing and rejuvenation process known as Panchakarma is essential. Panchakarma (which means Five-Actions) will remove Ama and imbalanced Doshas from deep in the tissues enabling progress to be made in a much shorter period of time and enormously reducing the likelihood of any relapse.
From an Ayurvedic point of view these forms of arthritis build in the body for a long time before they become fully noticeable as ‘Arthritis’. They are therefore considered chronic diseases and are usually well established in the body by the time any treatment for them is sought. As with any chronic disease, two of the most important medicines are patience and persistence. Sticking with a line of treatment over a prolonged period of time (sometimes up to 2 years) is necessary but the results are well worth it.
But the best medicine for all of us is that of prevention - following a way of life that supports strong Agni, reduced Ama and balanced Doshas… and seeking help from an Ayurvedic Practitioner when joint pain is still in its earliest stages.
If you are in any doubt about your health please be sure to consult an Ayurvedic Practitioner or your local health physician.
Agni - the digestive fire.
Ama or Aama - undigested food waste, toxins.
Ojas- the foundation of our immune system and longevity.
Dhatus - the tissues of the body.
Srotas - the channels of the body.
Vata - the air/ether
intelligence in the body.
Pitta- the fire/water
intelligence in the body.
Kapha- the water/earth intelligence in the body.
Sattva- the quality of purity, intelligence, peace and love.
Rajas- the quality of
turbulence and activity.
Tamas- the quality of
dullness, darkness and inertia.
Rasa - the taste of a food (Sweet, Sour, Salty, Pungent, Bitter, Astringent)
Virya - second level of digestion (either Heating or Cooling)
Vipaka - third level of digestion, the deep taste of a food (can be Sweet, Sour or Pungent)
Prabhav - the 'special effect' of a food or herb/spice
Rasa - also the name for plasma tissue
Rakta - blood tissue
Mamsa - muscle tissue
Meda - fat tissue
Asthi - bone tissue
Majja - nerve & bone marrow tissue
Shukra - sexual reproductive tissue