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Chinese Traditional Medical Journal 
 

Efficacy of Erand Sneha (Castor oil) in the management of Amavata 

(Rheumatoid arthritis) with respect to its Sama Stage 
  

LILLU Wei, XIONG Xingj, LI Yixua. 

, Department of Cardiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical China 
Department of Cardiology, Guang′anmen Hospital, China Academy of Chinese Medical Sciences 

, Community Healthcare Center of Shangzhuang Town China 
 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction 
 F The development of many illnesses is 
facilitated by a regular consumption of 
elements that affect the condition of digestive 
fire at all levels, i.e. intestinal, subcellular, and 

cellular. Mandagni, according to Ayurveda, is 
the root cause of all illness (diminished 
digestive fire). [2] More people are suffering 
from Rheumatoid arthritis (RA) in the 21st 
century than ever before. RA affects around 

ABSTRACT 
BACKGROUND: As a result of its long-term, incurable nature, complications, and morbidity, 
Amavata (Rheumatoid arthritis) is one of the most difficult diseases for doctors to treat. Sneha 
(castor oil) possesses qualities that stimulate digestive fire, enter into micro-channels and 
eliminate blockage from these channels, soothe Vata and Kapha Doshas, and remove them via 
purgation. 
AIM: For the purpose of determining the efficiency of Castor oil in the treatment of the acute 
stage of Amavata's Sama condition. MATERIALS & METHODS: The OPD and IPD of Roga-Nidana 
Evam Vikriti Vijnana, department of I.P.G.T. & R.A., Gujarat Ayurved University, Jamnagar, were 
used to identify 61 patients aged 20-60 years who met the inclusion criteria and had symptoms 
of the Sama stage. Eranda Sneha (Castor oil) was administered alone or in combination with 
Shunti (Zingiber officinale) once a day on an empty stomach in two separate groups of patients. 
RESULTS: Both groups had comparable clinical improvement after a 15-day course of 
treatment. Only group A showed a moderate improvement in both objective and subjective 
criteria in the overall evaluation of treatment. 
CONCLUSION: Research shows that Zingiber officinale combined with Castor oil is efficient in 
removing Amavata's Sama stage and providing symptomatic relie 
 
Keywords: Amavata, Castor oil, Rheumatoid arthritis, Zingiber officinale 

 



 

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0.8% of the global population. Three times as 
many women as men are impacted. It is a 
multisystem chronic inflammatory joint 
condition. Symptoms often begin in the 4th and 
5th decade of life, but may afflict anybody at 
any age in any environment. Infectious triggers, 
a genetic predisposition, and an autoimmune 
response are all possible causes of RA. 
 
Fatigue, anorexia, weakness, and fast 
development of polyarthritis accompany the 
disease's insidious and sudden onset, as do 
constitutional symptoms including fever, 
lymphadenopathy, and splenomegaly. 
Asymmetrical engagement is common. Pain, 
swelling, soreness, and a painful restriction of 
mobility are all hallmarks of this condition. 
There may be general stiffness, but morning 
stiffness lasting more than an hour is a common 
feature. Some of the most often affected joints 
include those in the hands, wrists, knees, and 
the metacarpophalangeal and proximal 
interphalangeal joints in the foot. [3] As 
DMARDs, steroids and NSAIDs have been 
demonstrated to have a detrimental influence 
on the immune system and only provide short-
term relief, it is a difficult illness for doctors and 
the medical community to treat. However, 
there has yet to be a successful medical solution 
to this condition. Bone and joints are the 
primary sites for the presentation of cardinal 
symptoms including pain, edoema, and stiffness 
of joints in Amavata, the illness of Madhyama 
Rogamarga. 
Disease is caused by the imbalance of the three 
body humours, although Ama and a vitiated 
Vata play the most important role. Vata is the 
second word in the phrase Amavata. If food 
digestion is inadequate or wrong, the resulting 
chyle, known as Annarasa, circulates through 
the body and reaches the target cell, where it 
causes symptoms such as weight gain, 
weakness and sleepiness, it aggravates Vata and 
impedes the body's ability to properly eliminate 
waste products. Amavata is characterised by 
aches and pains throughout the body, an 
unwillingness to eat, excessive thirst, a high 

temperature, problems digesting meals, and 
swelling in the afflicted joints. [4] As the illness 
worsens, it becomes more difficult to treat. 
Ama has all of the symptoms listed, hence a 
medicine with Ushna (hot), Tikshna (strong), 
and Deepana (medium) is needed Criteria of 
Assessment 
1)Subjective: 
2)A. Symptoms in the immediate area 
3)The signs and symptoms that affect the whole 
body 
4)Objective: 
As a first step, we need to have a look at the 
data 
Biochemical and other haematological 
measurements. 
As a measure of disability (the Indian health 
assessment questionnaire) 
Walking time, foot pressure and hand grip have 
all become better over time. 
Clinical assessment: - On the zero day (i.e. the 
day before delivering the trial medicine), on the 
5th, 10th, and 15th days following treatment, 
cardinal and related symptoms were assessed 
and documented. A acceptable scoring 
technique was used to evaluate changes in the 
patient's signs and symptoms. 
 Functional Assessment 
Walking time: To record time, patients were 
instructed to walk 50 metres. 
Hand Grip: Patients were instructed to squeeze 
the inflated cuff of the sphygmomanometer and 
the grip strength was measured in millimetres 
of mercury (mm Hg). 
Foot pressure: Foot pressure was measured 
using a weighing machine in order to provide an 
objective perspective of the leg's functional 
capability. 
Following statistical test has been applied in this 
work- The Wilcoxon signed rank test, the 
unpaired 't' test, and the paired 't' test all 
compare two groups based on subjective 
criteria (for same group). 
Software used: All of the statistical analysis was 
done with the help of Sigma programme. 
Observations & Results 



 

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61 patients signed up in all; 53 finished therapy, 
while 8 dropped out. 31 people signed up for 
group A, 28 of them finished the course and 
three dropped out. Group B had 30 patients 
enrolled, of whom 25 finished the study and 
five dropped out. 
Patients aged 41 to 50 comprised 31.14 percent 
of the total population. There were 59.01 
percent females and 68.85 percent of them 
were housewives. After elementary school, 
26.22 percent of the population was illiterate 
(24.59 percent ). In the lower middle class, 
34.42 percent of people lived. The urban region 
comprised 70.49 percent of the total. 78% of 
those polled were vegetarian. More over half of 
those surveyed reported a history of eating a 
sour diet. Oily and fatty diets were followed by 
cold items in 81% of cases (70.49 percent ). A 
total of 27.86 percent of patients experienced 
sleep problems, whereas 85.24 percent slept 
during the day. Krura Koshtha was in the 
possession of 50.81 percent of those surveyed 
(hard and constipated stools). In 72.13 percent 
of cases, the digestive fire functioned in a 
decreased capacity or was irregularly 
functioning (11.47 percent ). 68.85% of those 
surveyed reported having an unsatisfactory or 
irregular bowel movement (44.26 percent ). 
54.09 percent of those polled reported 
excessive urination (polyuria). Sixty-six percent 
of the women who took part in the study had a 
history of normal birth, followed by an abortion 
(19.44 percent) and LSCS (13.88 percent ). 
63.93% of the participants possessed Vata-
Kaphaja Sharira Prakriti. A whopping 80.32 
percent of those tested positive for the rajajasa-
tamasika manasa prakriti. All three Avara Saras 
(14.75%), 9.83%) and 57.37 % possessed Avara 
Satva, the most common kind of Avara. There 
were 31.14 percent overweight people and 
18.03 percent overweight people in the United 
States in 2013. Madhyama Satmya was present 
in 88.52 percent of those tested. More than 
seven out of ten people had avara ahar 
shaktipat. Hani Awastha (old age) accounted for 
59.01 percent of patients, whereas Sampurnata 
patients accounted for 37.70 percent.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 percent had a bad family history, 
followed by 39.34 percent with a favourable 
family history. 42.62 percent of the patients had 
been sick for 1 to 5 years. 86.80% of the cases 
were gradual. Pain and stiffness affected 
everyone, and 95.08 percent of those people 
also experienced soreness and edoema in their 
affected areas. Following the laziness, 83.60 
percent of the patients displayed laziness, 
followed by 78.04%, 770.44%, 721.33%, 
62.293%, 442.66% and 344.22% of the patients 
with characteristics of numbness, heavy body, 
body achy, disrupt sleep, gargling sound in the 
belly, giddiness, and burning feeling 
accordingly. There was 57.37 percent thirst, 
polyuria and constipation among the patients 
who were examined, and 55.73 percent 
reported a lack of appetite. 81.96% said that 
chilly wind, sour taste, and exercise were the 
most aggravating variables for them, followed 
by sleep deprivation (96.72%), morning time 
(98.36%), and exertion (96.72%). (90.16 percent 
). Recuperation rate was the highest at 95.08 
percent, followed by warm water (91.8 percent) 
and warm food (91.80 percent) (49.18 percent ) 
Rasavaha Srotodushti lakshana was also found 
in 93.44 percent, 70.49 percent, and 42.62 
percent of the samples. 
Annavaha, Asthivaha, Purishvaha, Mutravaha, 
Majjavaha, and Medavaha Shrotodushti 
symptoms were present in 40.98 percent, 16.39 
percent, and 4.91 percent of people. One-
eighth of the patients had joint crepitation; the 
remainder had Boutonniere deformity, ulnar 
deviation, and Swan neck deformation. 72.13 
percent had a decreased digestive fire, followed 
by 62.29 percent who were eating a diet that 



 

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was not suitable. A high-fat diet, repression of 
natural desires (70.49 percent), and 
unwholesome activities were followed by 75.40 
percent of participants engaging in physical 
activity (11.47 percent ). Anxiety accounted for 
80.32 percent of all cases, followed by tension 
(34.42%), anger (22.95%), despair (22.95%), and 
fear (22.95%). (4.91 percent ). 
Comparison of effect of therapy between group 
A and B 
The Wilcoxon signed ranked test indicated 
statistically insignificant results when 
comparing the impact of treatment on chief 
complaints in the two groups. This suggested 
that there were no significant differences in 
effect between the two groups. Sandhishotha 
and Sparshasahatva, on the other hand, had a 
higher proportion of alleviation after treatment 
with Group A than with Group B. When it came 
to Sandhishoola and sandigraha, Group B 
performed much better than the control group 
(Table 2). 
Table 2: Comparison of effect of therapy on 
chief complaints 

Chief complaints Group n Median Relief % Z W T+ T- p 

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% 

Table 3: Comparison of effect of therapy on 
associated symptoms     

Associated 

symptoms 
Group n Median Relief % Z W T+ T- p 

 
Angamarda 

Group A 27 0.00 55.55%  
0.000 

 
0.000 

 
52.5 

 
-52.50 

 
1.000 IS 

Group B 21 0.50 48.37% 

 Group A 13 0.00 40.62%      

Aruchi 
Group B 19 0.00 60.07% 0.688 24.00 

 
Trishna 

Group A 22 0.50 44.43%  
-0.595 

 
-27.00 

Group B 23 0.00 40.02% 

 
Alasya 

Group A 23 0.50 40.70% -0.218 9.000 

Group B 25 0.10 44.73% 

 
Jwara 

Group A 14 0.000 81.27%  
0.721 

 
22.00 

Group B 16 0.000 50.03% 

 
Apaka 

Group A 16 0.000 87.5%  
-1.147 

 
-40.00 

Group B 20 0.000 53.33% 

 
Gaurav 

Group A 17 0.000 57.16%  
1.213 

 
35.00 

Group B 24 1.000 55.21% 

Anga- 

Shunyata 

Group A 19 1.000 77.14%  
-0.790 

 
-38.00 

Group B 23 1.000 48.79% 

 
Bahumutrata 

Group A 21 0.000 46.12%  
1.414 

 
18.00 

Group B 20 0.500 53.57% 

There were no significant differences in the 
effectiveness of treatment on related 
complaints when the Wilcoxon signed rank test 
was used to compare the two groups, indicating 
that there were no substantial differences 
between them. Clinically, however, Group A 
exhibited superior results in alleviating 
symptoms such Angamarda, Jwara, Apaka and 
Gaurav than Group B in alleviating symptoms 
such as Alasya, Bahumutrata and Aruchi (Table 
3).Unpaired 't' tests used to compare the 
effectiveness of therapy on functional 
parameters showed statistically insignificant 
results for all but foot pressure, suggesting no 
significant differences in effect between the 
two groups. A significant result indicates that 
group A patients had a measurable and better 
outcome than group B patients (Table 4).  
 
Table 4: Comparison of effect of therapy on 
functional parameters functional parameters 

Functional 

parameters 

Group n Mean Relief % Mean 

difference 



 

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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 5: 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% 

Although there were no statistically significant 
differences between the two groups when 
evaluating the effectiveness of treatment on 
serological markers using an unpaired 't' test, 
the ASO titre indicated a significant difference 
between patients in groups B and A. According 
to the results of this research, Group A 
exhibited moderate improvement in 35.71 
percent of patients, which equates to 
alleviation ranging from 50 to 74%, whereas 
only 20% of patients in Group B showed the 
same improvement. Group A seems to have 
done a better job of decreasing patient 
complaints than Group B. (Table 5). 
  
Discussion 
 As many as 80% of those who participated in 
this study were female, which supports 
previous research that found a greater 
incidence of RA in females, as shown in this 
study. The condition was triggered by a history 
of reduced physical activity, lethargy, and 

daytime sleep deprivation in the majority of the 
affected population, which was concentrated in 
metropolitan areas. In accordance with Charaka 
Samhita's reference, impaired appetite and  
The majority of patients had elevated levels of 
metabolism. Patients with more than two years 
of chronic illness had a history of using 
DMARDs, steroids, and anti-inflammatory drugs 
(NSAIDs), all of which have a deleterious effect 
on the immune system. As a result, patients of 
this kind need long-term therapy and careful 
adherence to Pathyasevana (diet and exercise) 
in order to improve. 
There were no significant differences between 
the two treatment groups in the statistical 
analysis of primary complaints and their related 
symptoms. Both ESR and ASO titre rose in group 
A whereas CRP fell in both groups on paired "t" 
tests for serological parameters. Patients also 
responded better symptomatically when ASO 
and ESR increased although CRP levels 
decreased dramatically over the research. 
Despite the lack of a scientific explanation for 
this sort of reaction, additional examination and 
research are needed to comprehend the same.. 
How Eranda Sneha may go about her business 
In addition to its ability to penetrate into micro 
channels and remove obstruction in them, 
Eranda Sneha is also a potent digestive 
stimulant and a Vata Shamaka drug because of 
its Snigdha Guma, and finally enters the Dhatu 
level (cellular level) where it acts as an Ama 
Pachaka and Kapha Shamaka drug. 
[7]Shunti's most likely method of actionKatu 
Rasa and Ushna Virya characteristics of Shunti 
make it an effective Kapha Shamaka 
medication. It enhances the digestive fire and 
functions as a Vata Shamaka because of 
Madhur Vipaka [8]. Due to its Shamaka 
characteristics, Shunti may help alleviate the 
symptoms of Amavata at the Sama stage, which 
is the most common stage of the disease. There 
was a slight to moderate improvement in 
almost all of the main complaints such swollen 
joints and stiffness, along with the 
accompanying symptoms such as lack of 
appetite, sleepiness, polyuria, fever and 



 

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excessive thirst in both groups. It's possible that 
the presence of Shunti, which has Amapachaka 
and Vata-Kapha Shamaka properties, may have 
contributed to group A's more successful 
outcomes than group B's, but this isn't 
conclusive. On the basis of all complaints, 
related symptoms, functional improvement, 
and serological examinations, group A exhibited 
a superior overall improvement than group B. 
This indicates that the extra Shunti in group A is 
responsible for the increased effectiveness. 
Conclusion 
Clinical effectiveness cannot be ruled out, even 
if statistical analysis shows no difference 
between the two groups of therapy. 
Consequently, we can say from this study's 
findings that Eranda Sneha, on its alone or in 
conjunction with Shunti, is successful in the 
Sama stage of Amavata; however, clinical 
addition of Shunti has assisted in improving the 
patient's overall state.  
References 
 1.Sections 1–4 of Chapter 25, verses 1-4, 
Commentary by Vijay Rakshit and Shri 
Kanthadatta, Vol. I. Varanasi; Chaukhamba 
Sanskrit series; 2009, p. 508; 1. 
2.One may find this passage in the Nidana-
Sthana, chapter 12, verse 1 in the Udar Roga-
Nidnan edited by Kaviraj Atrideva gupta (Varahi 
Chaukhamba Prakashna ; 2009), p- 358. 2017 
[Cited on 2 5 / 4 / 1 7]. Rheumatoid arthritis 
[Internet]. From: 
http://en.wikipedia.org/wiki/Rheumatoid 
arthritis, retrieved on January 20, 2017. 
3.Ibidem Madhav Nidana [1], chapter 25, verses 
5-8 of p. 508 Amavata adhyaya, p. 508. 
4.Varanasi Chaukhambha Sanskrit series 
Varanasi, p-781 Bhava Mishra Bhava Prakash 
and Vidhyotini commentary on Tailavarg verses 
23 to 25, Tailavarg. 
5.This is the fifth chapter of Sushruta's Sutra 
Sthana and the 114th verse of chapter 45, 
verses 114 of the first volume of Chaukhamba 
Sanskrit series ; it was edited by Ambikadatta 
Shastri and published in Varanasi by 
Chaukhamba Sanskrit series in 2009, in 
Varanasi. 

cited in Sushruta Samhita [6], p. 231 (Drava 
Dravya Vidhi Adhyaya), section 45/114 
Seventh Ibidem, p. 261 of the Drava dravya 
Viddhi Adhyana, 45/226 [6]. 
Charaka Samhita, sutra s thana, v idhyotini 
Hindi commentary, Annadravyavidhi 
Adhyayaya, Chapter 27, verses 296, edited by 
Padmbhushana vaidhya samrata shree 
Satyanarayana shastri, and explained by 
Kashinath Shastri and Gorakhnath Chaturvedi, 
Varanasi; Chaukhambha Sanskrit series, 2009 p-
560 
How to Cite the article: 
Darshana H. Pandya and Gauridutt Mishra. 
Castor oil's efficacy in the treatment of Amavata 
(rheumatoid arthritis) in relation to the Sama 
stage. Traditional Medicine Journal of Research 
and Practice, Volume 3, Number 2, Pages 28-35, 
2017 
Source of Support: NIL Conflict of Interest: NIL 
© Journal of Research in Traditional Medicine 
2015-2017 
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