In an era when modern science is progressing with the advent of advanced techniques for disease diagnosis and novel ideas of drug designing, there are still no easy solutions for innumerable chronic, difficult to treat diseases. Rheumatoid arthritis is one of those diseases where there is no ideal recovery from disease pathology. Currently available medications are capable of providing pain relief and some reduction in inflammation. Since the etiology of rheumatoid arthritis is unknown, the pathogenesis is speculative and the mechanism of action of many therapeutic agents is uncertain. Therefore, the therapy remains empirical. Management of patients with rheumatoid arthritis involves an interdisciplinary approach to deal with various problems. On this background, Ayurved, an ancient Indian system of medicine occupies a unique position. The ancient Ayurvedic medicinal system uses herbal medicines to treat arthritis and therefore there is a strong belief that Ayurvedic medicines are safe as compared with modern medicines. However, Bhallataka or Semecarpous anacardium is an exception to this belief. Bhallataka or Semecarpous anacardium is a favorite herbal medicine for research and several publications which supports the anti-inflammatory, analgesic, antipyretic, immunomodulatory and anti oxidative (1) effect of this drug. But it remains the last option to treat many diseases including rheumatoid arthritis. The toxic effects of Bhallataka are of major concern for Ayuvedic physicians as well.
Traditionally milk extract of Semecarpous anacardium nut is used for oral administration. It contains corrosive oil which has toxic effect. Which is evident in the form of severe allergic reaction in an individual consuming the drug orally or handling it. Oil from nut is extracted by cutting it with nutcracker and boiling it with milk and water in correct proportion or the nut is burnt on flame directly, or its drops are used in milk, sugar or rice(2). Administration of Bhallataka oil thus derived is an inconvenient way of drug administration. Oil being very thick and viscous, dose determination is difficult. To overcome these drawbacks one can use Bhallataka in parpati form.
Bhallataka in dispensing form is an innovative method advocated and practiced by Vd.Y. G. Joshi.
Bhallataka parpati contains Bhallataka oil and resin from Shorea robusta in 1:3 proportions. Resin from Shorea robusta in solid form mixes with boiling oil of Bhallataka, which liquefies immediately. This boiling oil poured on banana leaves forms a uniform layer giving it a âParpatiâ like appearance. Grinding these layers thus converts a parpati in powder form, which is easy for dispensing. Bhallataka oil in powder form is now convenient way of administration. It is now a stable drug. Perfect dose determination of oil is possible when it comes in Parpati form.
250 mg of Bhallataka parpati with luke warm water(3), three times a day is a dose advised in the patients of rheumatoid arthritis, with some purgative to overcome astringent action of Bhallataka and resin from Shorea robusta as well. In addition, administration of a drug with antacid like compound is beneficial.
Action of Bhallataka parpati on Rhematoid Arthritis:
Vitiated vata dosha in kapha sthan. |
Painful and restricted movements of affected joints â vata dosha, vitiated with ruksha and khara guna.
Synovial membrane is abhyantara twacha, is vedananam adhishthanam. |
Bhallataka with its snigdha guna, reduces dryness and thus increases lubrication. Due to lubrication friction is reduced leading to analgesia and the free movement of joint is possible. |
| Vitiated kapha dosha (shleshmak kapha) shows decreased snigdha guna. (synovial fluid) |
Bhallataka with its snigdha guna(4), nourishes shleshmak kapha. |
| Research papers support action of Semecarpous anacardium as anti-inflammatory, analgesic, antipyretic, immune modulatory and anti oxidative. It regulates bone turn over as well. |
Pathology (samprapti) of rheumatoid arthritis with involvement of
joints :
Various joints in body are one of the colonies of kapha dosha (kapha sthana). Synovial membrane and synovial fluid that is, sheshmadhara kala and shleshmak kapha, which are responsible for normal functioning of a joint carry out their function with the help of snigdha and pichchhila properties.
Initiating cause, (nimmitta karan) aging (fourth and fifth decades of life) is the only etiological factor known for vitiation of vata and in an individual with tissue injury (srotovaigunya) at various joints, there is accumulation of vata (vayupuran) at joints. Tissues (at joints) as the site of disease provide the inherent factors (akin to genetic predisposition or primary tissue changes as per that they promote disease process). The tissue â dosha interaction takes place at the joint (dosha-dushya samurchhana). Rheumatoid arthritis most often causes symmetric arthritis with characteristic involvement of certain specific joints such as inter phalangeal and meta carpophalengeal joints, wrist and elbow joints and joints in the forefoot, ankles and knee joints.
Vitiated vata, shows increased dryness (ruksha iand khara guna). This leads to significant loss of snigdha and pichhila properties of shleshmaka kapha. Reduced lubrication thus affects the free movement of a joint leading to restriction of a joint function. Increased dryness (ruksha guna) is also responsible for painful movement of a joint. Skin, internal and external lining [twacha (bahya and abhyantar)] is supplied with pain fibres (adhishthan of sparshanendriya). Dryness (rukshata) leads to joint pain. Pitta dosha plays important role in disease pathology. Local edema, tenderness and raised local temperature are due to inflammation of synovial membrane, [(pak) by (pitta dosha)]. Vitiated pitta shows increased tikshna and ushna properties.
| Classification Of Fitness According To Fatigue Index |
| Fatigue Index |
Fitness |
| Below 55 |
Poor |
| 55-64 |
Low average |
| 65-79 |
Average |
| 80-89 |
Good |
| 90 and above |
Excellent |
*Professor and Head, Shalya Tantra, YMT Ayurveda Medical College, Kharghar, Mumbai
**Principal, SSAM, Hadapsar Pune
***NKDTâs Nalasopara Ayurved College, Mumbai,
****SVNH Ayurved college, Rahuri
References :
- P. C. Sharma, M. B Yelne, T. J. Dennis Ed. Database On Medicinal Plants Used In Ayurveda Vol.5 By Central Council For Research In Ayurveda & Siddha, New Dehli 2002, Page. No .11
- Pandit Kashinath Shatri Ed. Rastarangini, 24th Tarang, Motilal Banarasidas, Dehli (Reprint) 2009 24/471-479
- Vd. Y. G. Joshi, Kaychikitsa, Pune Sahitya Vitaran, Pune. Reprint 2009, page no. 658
- Prof. Krishnachandra Chunekar ed. Bhavprkash Nighantu, Chaukhamba Vishwabharti Academy, Varanasi.(reprint)2009
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