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ISSN : 2693 6356 

          2018 | Vol 1 | Issue 5 

 

Sama Stage Amavata (Rheumatoid Arthritis) Treatment: How Effective 

Is Erand Sneha (Castor Oil)? 
  C.Acharya1 , N.Pavan kumar2, K.Laxmi3 

AAU Jorhat - Assam Agricultural University, Jorhat 
 

    ABSTRACT 
The chronicity, incurability, comorbidities, and morbidity of Amavata (Rheumatoid Arthritis) make it a tough 

condition to treat for doctors. Eranda Sneha (Castor oil) has the ability to stimulate the digestive fire, clear 

blockages in the gastrointestinal tract, calm the Vata and Kapha Doshas, and eliminate them via purging. The 

purpose of this study is to evaluate the effectiveness of castor oil in treating Amavata at the Sama stage (the acute 

phase). CONTENT & APPROACH: From the outpatient and inpatient clinics of the Roga- Nidana Evam Vikriti 

Vijnana, department of I.P.G.T. & R.A. at the Gujarat Ayurved University in Jamnagar, 61 patients aged 20 to 60 

who met the inclusion criteria and had symptoms of Sama stage were recruited for the research. Patients were split 

into two groups: those who received Eranda Sneha (Castor oil) alone, and those who received Eranda Sneha plus 

Shunti (Zingiber officinale) once daily on an empty stomach. The results showed that after 15 days of treatment, 

both groups had a reduction in their symptoms. Only group A showed moderate improvement on maximal 

objective and subjective measures, suggesting that this treatment had a modest overall impact.The research 

suggests that Castor oil, either alone or in combination with Zingiber officinale, is helpful in eradicating the Sama 

stage of Amavata and relieving associated symptoms. 

    Keywords: Zingiber officinale, amavata, castor oil, and rheumatoid arthritis 
 
 

Introduction 
Frequent indulgence in factors which leads to altered 

status of digestive fire at all level i.e. intestinal, sub- 

cellular and cellular leads to develop various kinds of 

diseases. [1] Ayurveda advocates that the causative factor 

for all disease is Mandagni (diminished digestive fire). [2] 

In 21st century Rheumatoid arthritis (RA) has been 

more common and distressing among all joints 

problem. About 0.8% of world population is affected by 

RA. Females are three times more affected than male. It 

is a chronic inflammatory joint disease with multi 

system involvement. The onset is usually during 4th & 

5th decade of life; however people of any age group can 

be affected in any climate condition. Factor producing 

RA includes infectious triggers, genetic predisposition & 

autoimmune response. 

 

The course of the disease include an insidious / acute 

onset with fatigue, anorexia, weakness and rapid 

development of polyarthritis accompanied with 

constitutional symptoms such as fever, lymphadenopathy 

& splenomegaly. Joint involvement is usually symmetrical. 

It is characterised by pain, swelling, tenderness & painful 

limitation of movements. Generalised stiffness may occur 

but morning stiffness lasting more than one hour is a 

characteristic feature. The metacarpophalangeal & 

proximal inter phalangeal joints of the hands, wrists, 

knees & metatarsophalangeal & proximal inter 

phalangeal joints of the feet are the most common joints 

involved. [3] 

 

It is a challenging disease for the physicians and medical 

field as the uses disease modified anti-rheumatoid drug 

(DMARD), steroids and non-steroidal anti-inflammatory 

drug (NSAID) frequently have shown negative impact 

on immune system and gives only temporary relief. 

However, till date no satisfactory medical management 

has been developed for this problem. Amavata is the 

disease of Madhyama Rogamarga, bone and joints are the 

chief site for the manifestation of cardinal symptoms like 

pain, swelling and stiffness of joints, etc. 

 

All the three Doshas (bodily humours) takes part in the 

pathogenesis of disease but Ama and vitiated Vata play 

the dominant role. Amavata is made up of two words, 

Ama and Vata. Ama means incomplete digestion of food 

which   result   in   incomplete/improper   formation   of 

Annarasa (chyle), circulate in body & reach to target cell 

where it produces pathology like heaviness in body, loss 

of strength, drowsiness, aggravation of Vata & improper 

elimination of waste product. Body ache, undesirous to 

take food, thirst, fever, incomplete digestion of food, 

swelling in affected joints are the symptoms of Amavata.[4] 

The disease becomes difficult to cure when it grows in 

intensity. All symptoms mentioned are characteristic 

features of Ama & without treating Ama it is impossible to 

treat the disease so in this condition drug having Ushna 
(hot), Tikshna (strong), Deepana (stimulant), Pachani 
(digestive), Vatashamaka (pacifier of Vata),and Shothhara 
(anti-inflammatory) properties can be used. 

https://www.careers360.com/university/assam-agricultural-university-jorhat?icn=college_page&ici=clg_714_college_listing_tuple


 

 

 

In Bhavaprakash Samhita castor (Ricinis Communis) seed 

oil is mentioned as a best drug for Amavata. [5] Taking 

into above points of properties of drugs, Castor oil with 

Zingiber officinale was selected to assess their efficacy in the 

management of Amavata in Sama condition. 

 

Ethical Clearance 

Study was started after obtaining Ethical Clearance from 

the Institutional Ethics Committee, IPGT & RA, GAU, 

Jamnagar. 

 IEC - Ref. PGT/7/-A/Ethics/2015-16/1490 

[Dated: 25/08/2015] 

Study was Registered in Clinical Trial Registry of India. 

• CTRI NO. - CTRI/2016/12/007569 [Dated: 

14/12/2016] 

 

Materials & Method 

Selection of Patients 

 Patients suffering from Amavata in Sama stage were 

selected from the OPD and IPD of Rog- Nidana 
Evam Vikriti Vijnana, department, I.P.G.T. & R.A., 

Jamnagar. 

 Before registering the patients informed consent 

were taken. 
 

Criteria for Diagnosis 

Diagnosis was confirmed on the basis of symptoms of Sama 
stage of disease with cardinal symptoms of Amavata like 

pain, swelling, stiffness and tenderness along with 

symptoms of rheumatoid arthritis (As mentioned 

according to revised criteria of American association of 

rheumatology 1987). 

 
Inclusion Criteria 

• Patients fulfilling the diagnostic criteria especially 

having symptoms of Sama stage of disease 

• Age between 20 to 60 years. 

 
Exclusion Criteria 

• Patients having symptoms of rheumatoid arthritis but 

having absence of Sama symptoms 

• Patients with complications of RA e.g. Pleuro- 

Pericardial disease, cardiac disease etc 

• Patients with poorly controlled HTN, DM and other 

systemic diseases 

• Patients on prolong medication especially 

corticosteroids, anticholinergics etc. 

 
Registered patients were examined on the basis of 

specially prepared proforma containing detail 

assessment of disease encompassing Ayurveda and 

modern aspects. 

Investigations 

All the investigation were carried out before starting 

and after completion of therapy. 

1. Hematology: Hb%, TLC, DLC, ESR 

(wintergreen method) 

2. Bio-Chemistry: FBS, Blood urea, Sr. Uric 

acid,  Sr. creatinine,  LFT, RA f actor 

(Quantitative), CRP, and ASO quantitative titer. 

3. Urine analysis (Routine & Microscopic) 

4. ECG (12 leads-if needed) 

5. X- Rays of affected Joints. 

 
Posology 

Group A: Eranda Sneha & Decoction of Shunti 
Dose: 30 ml (20 ml Decoction of Shunti & 10 ml 

Eranda Sneha) 

Method of Preparation of decoction: 5 gm of 

coarse powder of Shunti is added with 80 ml of water 

is boiled until ¼ part (20 ml) is remaining, after 

preparing decoction, to which 10 ml of castor oil is 

added. 

Group B: Eranda Sneha 

Dose: 10 ml 

Time of administration: In both the group at 

morning – empty stomach 

Mode of administration: Oral 

Duration: 15 days 

Anupana: Luke warm water 

 
Criteria of Assessment 

1) Subjective: 

A. Local symptoms 

B. Systemic symptoms 

2) Objective: 

A. Serological parameters 

B. Hematological and others biochemical 

parameters. 

C. Disability index (the Indian health 

assessment questionnaire) 

Improvement in hand grip, foot pressure and walking 

time. 

 

Clinical assessment: - Assessment of cardinal and 

associated symptoms were done and recorded on the 

zero day (i.e. one day before administering the trial 

drug), 5th, 10th and 15th day after starting the 

treatment. Changes in the signs and symptoms were 

assessed by adopting suitable scoring method. 



 

 

 

Functional Assessment 

Walking time: patients were advised to move 50 

meters and time was recorded. 

Hand Grip: To find out the functional capacity of the 

affected upper limb, Patients were asked to squeeze the 

inflated cuff of the sphygmomanometer and the grip 

strength has been recorded in mm of Hg. 

Foot pressure: To have an objective view of the 

functional capacity of the legs, foot pressure was 

recorded by using a weighing machine. 

 

Following statistical test has been applied in 

this work- Wilcoxon sign rank test (for comparison of 

two group in subjective criteria), Unpaired ‘t’ test (for 

comparison of two group in objective criteria) and 

Paired‘t’ test (for same group). 

 

Software used: Sigma software was used for all 

statistical evaluation. 

 

Observations & Results 

Total 61 patients were registered, among them 53 

completed the treatment and 08 dropped out. In group 

A, 31 were registered out of which 28 completed and 

03 dropped out the course. In group B, 30 patients 

were registered out of which 25 completed and 05 

dropped out. 

 

31.14% of patients belonged to age group of 41-50 yrs. 

59.01% were female among which 68.85% were 

Housewife. 26.22% were uneducated followed by 

primary education (24.59%). 34.42% belonged to 

lower middle class. 70.49% belonged to urban area. 

78.68% were vegetarian. 57.37% had history of 

consuming sour diet. 81.96% each were taking oily and 

heavy diet followed by cold substances (70.49%). 

27.86% of patients had disturbed sleep (27.86%) and 

85.24% had a habit of day sleep. 50.81% had Krura 
Koshtha (hard and constipated stools). 72.13% had 

diminished function of digestive fire and Irregular 

function of digestive fire (11.47%). 68.85% had non 

satisfactory bowel habit and irregular bowel habit 

(44.26%). 54.09% had excessive micturition (polyuria). 

66.66% of females patients enrolled had obstetric 

history of delivering baby by normal delivery followed 

by history of abortion (19.44%), and history of LSCS 

(13.88%). 63.93% had Vata-Kaphaja Sharira Prakriti. 
80.32% had Rajajasa-Tamasika Manasa Prakriti. 14.75% 

had Avara Sara, 9.83% had Avara Samahanana and 

57.37% had Avara Satva. 31.14% were over-weight and 

18.03% were obese. 88.52% had Madhyama Satmya. 

77.04% had Avara Ahar Shakti. 59.01% belonged to Hani 
Awastha (old age) followed by 37.70% of patients in 

Sampurnata 

Avastha (Adult) and 3.27% of Yuva Awastha. The Dosha 
Avastha in the patients are represented in table 1. 

 
Table 1. Dosha Avastha in patients enrolled 

 
Dosha Vriddhi Kshaya 

Vata 31.14% 4.91% 

Pitta 22.95% 47.54% 

Kapha 34.42% 1.63% 

 
60.65% had negative family history followed by 

positive family history in 39.34%. 42.62% had 

chronicity up to 1-5 yrs. 86.80% had gradual onset. 

100% developed pain and stiffness, 95.08% had 

tenderness and swelling in 88.52%. 83.60% of 

patients showed laziness followed by 78.68%, 77.04%, 

72.13%, 62.29%, 59.01%, 44.26% and 34.42% of 

patients with features of numbness, heaviness in body, 
body ache, disturb sleep, gargling sound in abdomen, 

giddiness and burning sensation respectively. 57.37% 

of patients showed thirst, polyuria and constipation 

and 55.73% showed loss of appetite. 98.36% had 

morning time as an aggravating factors followed by 

exertion (96.72%), day sleep (81.96% ), cold wind and 

sour taste (90.16%). 95.08% had rest as a relieving 

factors followed by warm water (91.80%) and warm 

food (49.18%). 100% showed Rasavaha Srotodushti 
lakshana followed by 93.44%, 70.49%, 42.62%, 
40.98%, 16.39% and 4.91% showed Annavaha, 
Asthivaha, Purishvaha, Mutravaha, Majjavaha and 

Medavaha Shrotodushti symptoms respectively. 18.03% 

developed joints crepitation followed by Boutonniere 

deformity, ulnar deviation and Swan neck deformity 

in 4.91%. 72.13% were suffering from diminished 

digestive fire followed by 62.29% consuming 

incompatible diet. 75.40% had done exercise after 

oily diet followed by suppression of natural urges 

(70.49%) and unwholesome activities (11.47%). 

80.32% had stress as etiological factor followed by 

anger (34.42%), sadness(22.95%) and fear (4.91%). 

Comparison of effect of therapy between 

group A and B 

On comparing the effect of therapy on chief 

complaints with help of Wilcoxon sign ranked test 

both group showed statistically insignificant result 

which suggested that there was no major differences 

of effect of both group. However Group A showed 

comparatively significant efficacy clinically in 

Sandhishotha and Sparshasahatva based on the 

percentage of relief. Whereas Group B showed 

significant efficacy upon Sandhishoola and Sandhigraha 
(Table 2). 



 

 

 

Table 2: Comparison of effect of therapy on chief complaints 
Chief complaints Grup n Median Relief % Z W T+ T-  

Sandhishoola Group A 27 1.00 37% 0.382 23 138 -115 0.715 IS 

Group B 25 1.00 45.97% 

Sandhishotha Group A 27 1.00 50.97% -0.58 99.50 138 -131.50 0.569 IS 

Group B 23 1.00 48.79% 

Sandhigraha Group A 27 1.00 60.03% 0.00 0.00 85.50 -85.50 1.000 IS 

Group B 25 1.00 66.66% 

Sparshasahatva Group A 27 1.00 50.87% -1.429 -48.00 36.0 -84.000 0.188 IS 

Group B 25 1.00 50% 

 

 

On comparing the efficacy of therapy on 

associated complaints with help of Wilcoxon 

sign ranked test both group showed statistically 

insignificant result which suggested that there 

was no major differences of effect of both group. 

However based on the percentage of relief 

clinically Group A showed better relief in reliving 

symptoms like Angamarda, Trishna, Jwara, 
Apaka, Gaurav, Anga-Shunyata and Group B upon 

Aruchi, Alasya, Bahumutrata (Table 3). 

On comparing the efficacy of therapy on 

functional parameters with the help of unpaired ‘t’ 

test all the above functional parameter showed 

statistically insignificant result which suggested 

that there was not major differences of effect of 

both group, except foot pressure which showed 

significant result, Significant result means there 

was a measurable and better result in patients of 

group A than B (Table 4). 

Table 3: Comparison of effect of therapy on functional parameters 

functional parameters 
 

Functional 

parameters 

Group n Mean Relief % Mean 

difference 

SD 

 
± 

SE 

 
± 

t p 

Walking 

time 

Group A 28 3.21 7.5% -0.107 3.244 0.613 -0.094 0.925 (IS) 

Group B 25 3.32 9.35% 

Hand grip Group A 56 -5.433 9.36% -5.933 82.84 10.69 -0.464 0.643 IS 

Group B 50 0.500 10.80% 

Foot 

pressure 

Group A 56 2.242 1.19% -9.035 28.67 3.702 -2.055 0.042 S 

Group B 50 11.277 2.32% 

Disability 

index 

Group A 27 0.607 40.46% 0.127 0.653 0.131 0.689 0.494 IS 

Group B 25 0.480 47.26% 

 
Table 4: Comparison of effect of therapy on serological parameter 

 
 

Serological 

parameter 
Group n Mean Relief% 

Mean 

difference 

SD 

± 

SE 

± 
t p 

 
R.A. factor 

Group A 28 10.618 3.70% -14.566 122.21 24.44 -0.429 0.669 IS 

Group B 25 25.184 7.40% 

 
C.R.P 

Group A 28 3.914 43.16% 0.858 19.403 3.881 0.214 0.832 IS 

Group B 25 3.056 12.44% 

 
A.S.O. 

Group A 28 -16.218 12.97% -141.13 213.93 42.78 -2.413 0.019 S 

Group B 25 124.920 25.91% 



 

 

 

On comparing the efficacy of therapy on 

serological parameters with help of unpaired 

‘t’ test both group showed statistically 

insignificant result which suggested that 

there was no major differences between both 

group, but ASO titre showed significant 

result in patients of group B than that in 

group A. 

In the present study, the overall efficacy of both 

therapies suggested that Group A showed 

moderate improvement in 35.71% which 

corresponds to relief ranging between 50-74%, 

whereas in Group B it was only 20%. Which 

suggests that Group A was better than Group B in 

reducing the complaints in patients in a better way 

(Tale 5). 
 

Discussion 

While previous research has 

shown a greater frequency of 

RA in females, the current study 

found that the beginning of 

disease state in the patients 

occurred as early as 30–40 

years. Most of the affected 

persons lived in metropolitan 

areas, and their lack of exercise, 

sedentary lifestyles, and 

excessive daytime sleep 

contributed to their illness. 

According to the Charaka 

Samhita, a large percentage of 

patients had symptoms of 

impaired appetite and 

metabolism. Patients had a mean 

duration of chronicity of over 2 

years, and many had a history of 

using immunosuppressants such 

DMARDs, steroids, and 

NSAIDs. Therefore, such 

patients need prolonged therapy 

in conjunction with the rigorous 

observance of Pathyasevana 

(diet and activity). 

No significant differences in 

improvement were found in the 

statistical analysis of primary 

and secondary complaints and 

symptoms between the two 

groups of therapy. It was 

observed during the course of 

the study that patients were 

responding better 

symptomatically where ASO 

and ESR were increasing while 

CRP values were significantly 

reducing, and this was 

confirmed using the paired 't' 

test on serological parameters, 

which showed that ESR and 

ASO titre were higher in group 

A. Since such reactions cannot 

be explained scientifically, 

further research is required to 

better comprehend them. 

Eranda Sneha's Likely Mode of 

Action Because of its Sukshma 

Guma [5], Eranda Sneha is able 

to enter the microchannels and 

clear any obstructions that may 

be present there [6]. Its Katu 

Rasa and Ushna Virya also 

increase digestive fire, and its 

Snigdha Guna makes it an 

effective Vata Shamaka 

drug.[7] 
 

Probable mode of action of Shunti 

Shunti serves as both an Ama Pachaka and a 
Kapha Shamaka medicine because to its Katu Rasa 
and Ushna Virya qualities. Madhur Vipaka [8] 
causes it to operate as Vata Shamaka and increase 
digestive fire. Shunti, with its Vata-Kapha 
Shamaka [9] characteristics, helps reduce the 
symptoms of Amavata, particularly during the 
Sama stage, by inhibiting the development of Ama. 

Both groups exhibited little to moderate 
improvement in almost all of the primary 
complaints, including pain, edema, stiffness, 
soreness, and related symptoms including lack of 
appetite, heaviness in body, sleepiness, polyuria, 
fever, and excessive thirst, etc. Shunti, which has 
Amapachaka and Vata-Kapha Shamaka 
properties that calm Dosha to larger extent and 
transport them from Shakha to Koshtha, may 
explain why group A demonstrated more effective 
outcomes than group B. When taking into account 
all of the complaints, related symptoms, functional 
improvement, and serological testing, group A 
exhibited superior outcome than group B. This 
suggests that the increased dose of Shunti in group 
A may be responsible for the positive results. 

 

Conclusion 

Even though statistical analysis revealed no 

significant difference between both the groups of 

treatment, the clinical efficacy of them cannot be 

ruled out. Hence the present study concludes that 

Eranda Sneha alone and or with combination with 

Shunti is effective in the Sama stage of Amavata, 

but clinically addition of Shunti has helped in 



 

 

improving the overall condition of the patient to a better level. 
 

References 

1. Madhavakara, Madhava Nidana, Madhukosh 
Teeka, Amavata adhyaya, chapter 25, verses 1-4 
commented by Vijay Rakshit & Shri Kanthadatta, 
Vol I. Varanasi; Chaukhamba Sanskrit series ; 
2009, p- 508 

2. Vagabhata, Astang Hridaya, Vidhyotani hindi 
Teeka, Nidana Sthana, chapter 12, verses 1,Udar 
Roga Nidana, edited by Kaviraj Atrideva gupta, 
Varanasi Chaukhamba Prakashana ; 2009, p- 358 

3. Rheumatoid arthritis [Internet]. 2017 [Cited on 
2 5 / 4 / 1 7 ] . A v a i l a b l e f r o m : ht  t p / /  
en.wikipedia.org/wiki/Rheumatoid   arthritis, 
dated 20/01/17 

4. Ibidem Madhava Nidana [1], Amavata adhyaya, 
chapter 25, verses 5-8, p 508 

5. Bhava Mishra, Bhava Prakash, Vidhyotini 
commentary, Tailavarg, verses 23-25, Varanasi, 
Chaukhambha Sanskrit series Varanasi. 2009, p- 
781 

6. Sushruta, Dalhana, Sushruta Samhita, Sutra 
Sthana, Drava dravya vidhi adhyayaya, chapter 
45, verses 114, vol I, edited by Ambikadatta 
Shastri, Varanasi, Chaukhamba Sanskrit series ; 
2009, p- 230 

7. Ibidem Sushruta Samhita [6], Drava Dravya 
Vidhi Adhyayaya, 45/114, p- 231 

8. Ibidem Sushruta Samhita [6], Drava Dravya Vidhi 
Adhyayaya, 45/226, p- 261 

9. Agnivesha,   Charaka,   Charaka   Samhita,   sutra 
s thana,  v idhyotini  Hindi  commentary,  
Annadravyavidhi Adhyayaya, Chapter 27, verses 
296, edited by Padmbhushana vaidhya samrata 
shree Satyanarayana shastri, explained by 
Kashinath Shastri and Gorakhnath Chaturvedi, 
Varanasi; Chaukhambha Sanskrit series, 2009 p-
560 

 

 

 
 


