DD SERIES: AN EFFORT TO UNDERSTAND THE DIFFERENTIAL DIAGNOSIS OF AMAVATA, AMAPRADOSHA, AMAVISHA & AMAVATIKA-JWARA (RHEUMATIC FEVER)

  

AN EFFORT TO UNDERSTAND THE DIFFERENTIAL DIAGNOSIS OF AMAVATA,  AMAPRADOSHA,  AMAVISHA & AMAVATIKA-JWARA (RHEUMATIC FEVER)

No.	BHEDAKATVA {D/D POINTS}		AMAVATA	AMAPRADOSHA	AMAVISHA	AMAVATIKA JWARA {RHEUMATIC FEVER}
1	Sandarbha/ Vyadhitva		Not established in Brihat-trayi, Acharya Madhav (700 AD) described first as a separate disease	Acharya Charaka has given description of Amapradosha in matrashitiya adhyaya of vimanasthana.	Acharya Charaka mentioned Aamavisha while describing Dandalasaka in vimanasthana and grahani adhyaya in chikitsasthana.	There is no direct reference of Amavatika jwara in Samhita.   Rheumatic fever is clinical syndrome in which inflammation of the heart, joints, brain, and skin occurs.
2	Synonyms		Aama-maruta	Amadosha	-	Jwara, Roga, Vikara, Atanka, Vyadhi Inflammatory Rheumatism
3	Nirukti		आमोऽपाकहेतु: वात: | स्वनामख्यातरोगविशेष: | Amarakosha	आमस्यापक्वस्याहारस्य प्रदोष आमप्रदोषः| Chakrapani	आमदोषमामविषमाचक्षत इत्यत्र विषसदृशलिङ्ग एवामप्रदोषोऽभिप्रेतः | Chakrapani	ज्वर सन्तापे || (Ch.Ni.1/35) Rheum = Bodily humor Fever = Pyrexia, Febris
4	NIDANA	Rasa	Madhura, Amla, Lavana	ß same as Aama-hetu in excessive quantity à		As per Vata-Kaphaja Prakopaka hetu
		Guna	Shita, Snigdha, Picchila, Guru, Manda	Sthira, Guru, Bahu, Ruksha	Sthira, Guru, Bahu, Ruksha
		Virya	Shita	Shita	Shita/Ushna
		Aahara samanya	Viruddha-Aahara, Ati-shita, Ati-Ruksha, Ati-Guru, Asatmya-Bhojana, Sandushta Bhojana	Viruddhahara, Vidahi. Vistambhi, Asuchi, Dwishta	Viruddha-Aahara, Asatmya-Bhojana, Ati-shita, Ati-Ruksha, Ati-Guru, Sandushta Bhojana	As per Vata-Kaphaja jwara hetu
		Aahara vidhi	Abhojana, Ajirne Bhojana, Adhyashana, Atibhojana, Vishamashana	Akala bhojana	Ajirne Bhojana, Adhyashana
		Vihara	Viruddha Cheshta, Vegasandharana	Vata-Mutra-Purisha vegadharana	Vegasandharana
		Environmental factors	Desha Vaishamya, Kala Vaishamya, Rutu Vaishamya	Desha Vaishamya, Kala Vaishamya, Rutu Vaishamya	Desha Vaishamya, Kala Vaishamya, Rutu Vaishamya	Overcrowding, Poverty, Poor hygeine Ayu – as per Vata Kaphaja jwara
		Manasa bhava	Irshya, Bhaya, Krodha, Lobha, Ruja, Dainya, Pradwesha, Shoka, Chinta	Chinta, Shoka, Bhaya, Krodha, Prajagarana, Moha, Lobha	Not mentioned but it should be understood as per Amapradosha in exaggerated form.	As per Vata Kaphaja jwara
		Nidanartha-karatva	Not mentioned specifically But Agnidushti can be taken	Durbala, Alpa-agni	Durbala, Alpa-agni	As per Vata Kaphaja jwara
		Sannikrusht nidana	स्निग्धं भुक्तवतो ह्यन्नं व्यायामं कुर्वतस्तथा || Ma.Ni.25/1	न च खलु केवलमतिमात्रमेवाहारराशिमामप्रदोषकरमिच्छन्ति…| Ch.vi.2/8   मात्रयाऽप्यभ्यवहृतं पथ्यं चान्नं न जीर्यति| चिन्ताशोकभयक्रोधदुःखशय्याप्रजागरैः|| Ch.vi.2/9	विरुद्धाध्यशनाजीर्णाशनशीलिनः| Ch.vi.2/12   विरुद्धाध्यशनाजीर्णशीलिनो विषलक्षणम्|| आमदोषं महाग़ोरं वर्जयेद्विषसंज्ञकम्|A.H.S.8/14	Group-A streptococci infection   Ayu. – Hina Vyadhikshamatva (Compromised immunity), Amadosha
5	Samprapti		वायुना प्रेरितो ह्यामः श्लेष्मस्थानं प्रधावति| तेनात्यर्थं विदग्धोऽसौ धमनीः प्रतिपद्यते || वातपित्तकफैर्भूयो दूषितः सोऽन्नजो रसः | स्रोतांस्यभिष्यन्दयतिनानावर्णोऽतिपिच्छिलः|| जनयत्याशु दौर्बल्यं गौरवं हृदयस्य च | व्याधीनामाश्रयोह्येष आमसञ्ज्ञोऽतिदारुणः|| युगपत्कुपितावन्तस्त्रिकसन्धिप्रवेशकौ | Ma.Ni.25/2-5	तं द्विविधमामप्रदोषमाचक्षते भिषजः- विसूचिकाम्, अलसकं च|| तत्र विसूचिकामूर्ध्वं चाधश्च प्रवृत्तामदोषां यथोक्तरूपां विद्यात्||   अलसकमुपदेक्ष्यामः- दुर्बलस्याल्पाग्नेर्बहुश्लेष्मणो वातमूत्रपुरीषवेगविधारिणः स्थिरगुरुबहुरूक्षशीतशुष्कान्नसेविनस्तदन्नपानमनिलप्रपीडितं श्लेष्मणा च विबद्धमार्गमतिमात्रप्रलीनमलसत्वान्न बहिर्मुखीभवति, ततश्छर्द्यतीसारवर्ज्यान्यामप्रदोषलिङ्गान्यभिदर्शयत्यतिमात्राणि| Cha.Vi.2/10-12	दुष्यत्यग्निः, स दुष्टोऽन्नं न तत् पचति लघ्वपि| अपच्यमानं शुक्तत्वं यात्यन्नं विषरूपताम् || Cha.Chi.15/44   अतिमात्रप्रदुष्टाश्च दोषाः प्रदुष्टामबद्धमार्गास्तिर्यग्गच्छन्तः कदाचिदेव केवलमस्य शरीरं दण्डवत् स्तम्भयन्ति, ततस्तं दण्डालसकमसाध्यं ब्रुवते| विरुद्धाध्यशनाजीर्णाशनशीलिनः पुनरामदोषमामविषमित्याचक्षते | Cha.Vi.2/12	An immune-mediated delayed response to infection with specific strains of group A streptococci antigens that cross-react with cardiac myosin and sarcolemmal membrane proteins. Antibodies produced against the streptococcal antigens cause inflammation in the endocardium, myocardium, pericardium and joints and skin.   Ayu. – As per Vata-Kapha jwara
6	Dosha		Kapha Pradhana Tridosha	Alasaka- Kapha Vata Visuchika- Kapha Pitta	Kapha Pitta Pradhana Tridosha	Tridosha
7	Dushya		Inititally - Rasa, Rakta Later - Mamsa, Asthi	Rasa, Mutra, Purisha, Sweda	Saptadhatu, Ojas	Rasa, Rakta, Mamsa, Asthi
8	Srotasa		Initially - Rasavaha, Raktavaha, Annavaha Later - Mamsavaha, Asthivaha	Rasavaha, Annavaha, Purishavaha, Mutravaha, Swedavaha	Sarvasrotasa	Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Pranavaha
9	Srotodushti prakara		Sanga, Vimargagamana, (Siragranthi – in later stage)	Alasaka - Sanga Visuchika – Atipravrtti	Sanga, Vimargagamana, Ati-pravratti, Siragranthi (at multiple level)	Sanga, Vimargagamana, Siragranthi (at multiple level)
10	Rogamarga		Kostha, Shakha and Marmasthisandhi (depending on the stage of disease)	Koshtha	Kostha, Shakha and Marmasthisandhi	Kostha, Shakha and Marmasthisandhi
11	Adhisthana		Sharira mainly	Sharira & Manasa	Sharira & Manasa	Sharira mainly
12	Vyakti-sthana		Sandhi	Alasaka - Amashaya Visuchika - Amashaya & Pakwasaya	Sarva gatra	Sarva gatra
13	Ashaya		Aamashaya Samuttha	Alasaka – Amashaya samuttha Visuchika - Amashaya or Pakwasaya samuttha	Aamashaya or Pakwasaya samuttha	Aamashaya samuttha
14	Agni		Manda/Vishama	Manda/Vishama	Ati-Manda	Manda
15	Sama/Nirama		Sama	Sama	Sama	Sama
16	Vyadhiprakara		Chirakari	Ashukari	Ashukari	Ashukari / Chirakari
17	Purvaroopa		स्रोतोरोध बलभ्रंश गौरवानिलमूढताः॥ आलस्यापक्तिनिष्ठीवमलसङ्गारुचिक्लमाः। लिङ्गं मलानां सामानां .| A.H.S.13/24	Ajirna, Arochaka, Agni-dushtyadi grahya	Aamapradosha avastha	Streptococcal Pharyngitis Ayu. - As per Vata-Kapha jwara
18	Pratyatma lakshana		स्तब्धं च कुरुतो गात्रमामवातः स उच्यते || Ma.Ni.25/6	विष्टम्भयन्तोऽलसकं  च्यावयन्तो विसूचिकाम्|| A.H.S.8/5	विषलक्षणं,-देहव्यापिविषतुल्यलक्षणम्|Hemadri	Fever, Anorexia, Lethargy, Joint pain Ayu. - As per Vata-Kapha jwara
19	Samanya lakshana		अङ्गमर्दोऽरुचिस्तृष्णा आलस्यं गौरवंज्वरः | अपाकः शूनताऽङ्गानामामवातस्य लक्षणम् || Ma.Ni.25/6	विसूचिका - तत्र विसूचिकामूर्ध्वं चाधश्च प्रवृत्तामदोषां यथोक्तरूपां विद्यात्|Cha.Vi.2/11   अलसक -ततश्छर्द्यतीसारवर्ज्यान्यामप्रदोषलिङ्गान्यभिदर्शयत्यतिमात्राणि|Cha.Vi.2/12	तस्य लिङ्गमजीर्णस्य विष्टम्भः सदनं तथा| शिरसो रुक् च मूर्च्छा च भ्रमः पृष्ठकटिग्रहः| जृम्भाऽङ्गमर्दस्तृष्णा च ज्वरश्छर्दिः प्रवाहणम्| अरोचकोऽविपाकश्च, घोरमन्नविषं च तत्|| Cha.Chi.15/45-46	Fever, Polyarthritis, Carditis, Chorea, Sub-cutaneous nodule, Arthralgia, Odema   सन्ध्यस्थिशिरसः शूलं प्रलापो गौरवं भ्रमः ।  वातोल्बणे स्याद् द्वयनुगे तृष्णा कण्ठास्यशुष्कता ||९४|| CH.CHI.3 व्यथाऽतिशयिता भवेच्छ्वयथुसंयुता सन्धिषु, प्रभूतकफता मुखे विगतनिद्रता कासरुक् ।  समस्तमिति कीत्तितं भवति लक्ष्म यत्र ज्वरे, त्रिदोषजनिते बुधैः स हि निगद्यते सन्धिगः ॥५६१ B.P.M.
20	Types		There is not established types in texts but dominance of doshas are there	Alasaka, Visuchika	Not mentioned	--
21	Avarana		Yes	Possibility	Possibility	No
22	Sadhyasadhyta		एकदोषानुगःसाध्यो, द्विदोषो याप्य उच्यते| सर्वदेहचरः शोथः स कृच्छ्रः सान्निपातिकः|| Ma.Ni.25/12	Krichha-sadhya	परम असाध्य	Krichha-sadhya
23	Upadrava		स कष्टः सर्वरोगाणां यदा प्रकुपितो भवेत् | हस्तपादशिरोगुल्फत्रिकजानूरुसन्धिषु || करोति सरुजं शोथं यत्र दोषः प्रपद्यते | स देशो रुज्यतेऽत्यर्थं व्याविद्ध इव वृश्चिकैः || जनयेत् सोऽग्निदौर्बल्यं प्रसेकारुचिगौरवम् | उत्साहहानिं वैरस्यं दाहं च बहुमूत्रताम् || कुक्षौ कठिनतां शूलं तथा निद्राविपर्ययम् | तृट्छर्दिभ्रममूर्छाश्च हृद्ग्रहं विड्विबद्धताम् | जाड्यान्त्रकूजमानाहं कष्टांश्चान्यानुपद्रवान् || Ma.Ni.25/7-10	अतिमात्रप्रदुष्टाश्च दोषाः प्रदुष्टामबद्धमार्गास्तिर्यग्गच्छन्तः कदाचिदेव केवलमस्य शरीरं दण्डवत् स्तम्भयन्ति, ततस्तं  दण्डालसकमसाध्यं ब्रुवते| विरुद्धाध्यशनाजीर्णाशनशीलिनः पुनरामदोषमामविषमित्याचक्षते | Cha.Vi.2/12	Mrityu	If rheumatic fever is not treated properly, rheumatic heart disease may occur. Rheumatic heart disease weakens the valves. Severe rheumatic heart disease can require heart surgery and result in death.   Ayu. – full blown Sannipatajwara manifestation and Udarka – joint deformity, Hrada marma dushti
24	Chikitsa		लंघनं स्वेदनं तिक्तं दीपनानि कटूनि च । विरेचनं स्नेहपान बस्त्याश्वाममारुते || सैन्धवाद्येनानुवास्य क्षारवस्तिः प्रशस्यते | Chakradatta	तत्र साध्यमामं प्रदुष्टमलसीभूतमुल्लेखयेदादौ पाययित्वा सलवणमुष्णं वारि, ततः स्वेदनवर्तिप्रणिधानाभ्यामुपाचरेदुपवासयेच्चैनम्| विसूचिकायां तु लङ्घनमेवाग्रे विरिक्तवच्चानुपूर्वी| ……… आमप्रदोषजानां पुनर्विकाराणामपतर्पणेनैवोपरमो भवति, सति त्वनुबन्धे कृतापतर्पणानां व्याधीनां निग्रहे निमित्तविपरीतमपास्यौषधमातङ्कविपरीतमेवावचारयेद्यथास्वम्|  Cha.vi.2/13	तत् परमसाध्यम्, आशुकारित्वाद्विरुद्धोपक्रमत्वाच्चेति|| Cha.vi.2/12   विरुद्धोपक्रमत्वादिति आमापेक्षया यदुष्णं क्रियते तद्विषविरुद्धं, यच्च विषापेक्षया शीतं क्रियते तदामविरुद्धम्| Chakrapani	Bed rest, Aspirin, Antibiotics, Glucocorticoids, Treatment of cardiac failure   Ayu. - As per Vata-Kapha jwara / Sandhiga sannipatajwara / Vatolbana sama kapha pitta sannipata jwara (Cha,chi,3/94)

                                                                                                                                                   

 CONCLUSION -

1.    'Amavata' is such a condition where doshas lodge or reach the 'Shakha/Marma-Asthi-Sandhi' from 'Koshtha' because of preexisting daurbalya (weakness), Kshinata (emiciation) and specific dietery nidanas/ irregular vyayam where Koshtha/GIT features are minimum.

2.    While in 'Amapradosha' Doshas are still situated in koshtha or GIT and the 'dhatu-saushthava-janita-vyadhikshamatva' (tissue enriched immunity) trying to expel it out (visuchika) or hold (alasaka) to spread in shakha either activating or hampering the GIT activities or functions.

3.    'Amavisha' is life threatening condition where endotoxins is generated very rapidly and spread all over the body involving the all vitals.

4.    'Amapradosha' condition if not treated properly or persists for longer duration then it may progress or convert into 'Amavisha'.

5.    Alasaka may lead to dandalasaka and visuchika may lead to death because of endotoxin condition caused by various nidanas.

6.    'Amavatika-jwara' is a specific type of fever, it does not have “Ama”-condition like Amavata, Amapradosha and Amavisha. The nomenculture ‘Amavatika jwara’ is Sanskrit/Hindi translation of Rhuematic fever mentioned in allopathic literature only while as per Ayurveda it is may be nearest to 'Sandhiga-sannipata-jwara' (Bhavaprakash) or 'Vatolbana-sama-kapha-pitta-sannipata-jwara' (Charak).

 

Presented by

Dr. Alpesh B. Munjani

Final Year P.G. Scholar

P.G. Department of Kayachikitsa

Government Akhandanand Ayurveda College

Bhadra, Ahmedabad, Gujarat, India.

Email: alpeshmunjani2012@gmail.com

Guided by 

Prof. Dr. Surendra A. Soni

H.O.D.

P.G. Department of Kayachikitsa

Government Akhandanand Ayurveda College

Bhadra, Ahmedabad, Gujarat, India.

Email: kayachikitsagau@gmail.com