I.R.A.S. J'DI. XJ', ND. 1-2, pp. 17-22

Arsenic Disulphide (Rasa Manikya) in thetreatment of Rehumatoid Arthritis (Amavata)

N.C. Dalhl and B.K. Das2

(Received on 7th Jan., 1993)

A clinical trial was carried out on 20number of seropositive Rheumatoidarthritis (Amavata) of Kaphaja type. Thetrial drug was Rasamanikya and Godantias a single dose of 250 mg each every11 hour interval for a period of30 days, The study discloses aneffect of complete remisston=S'Z;maximum improvement 65% and minimumimprovement 30%. The above resultsincludes clinical remission includingseronegativity of R.~. Factor and declin-ing in the E.S. R. patients preference overrecovery and healthyness with the trialdrug for 30 days duration were satisfying.

Introduction

In the last few decades a group of con-ditions primarily involving the musculo-skeletal structures has been a subject

1-2. Post Graduate Deptt, of Kayachikitsa,Gopbandhu Ayurveda Maha Vidyalaya.Puri (Orissa)-7S2002.

of intense study. Among the connectivetissue disorders rheumatoid arthritis is achronic non-supperative polyarthritisaffecting mainly the peripheral smalljoints running in a course of excerbationand remission accompanied by swellingof synovial membrances, erosion of carti-lages and bones and wasting of associat-ed muscles along with general systemicdistur bances. It is prevalent among 3%of adult population, not directly fatalbut victims with severe affliction tend todie 10 or more years prematurely. Thedisease still possess an incuable statusand permanent remission is yet to bedeclared.

In the field of management the prog-nosis of the disease has been changed toa great extent as the exacerbation can besuppressed quickly, the period of remis-sion can be enhanced, deformities can beprevented and disability can be com-pensated by better orthopedic appliances

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DASH AND DAS

but there is still search for a better drugto induce satisfactory benefit.

The clinical features of rheumatoidarthritis has got superisingly maximumresemblance with the disease "Amavata"described in compediams of Ayurvedicsystem of medicine.

Material and Methods

Twenty numbers seropositive rheu-matoid arthritis cases (Amavata ofKaphaja type) having more than sixweeks, duration of chronicity were triedwith an indigenous compound. Theselection ctiteria was positive R.A.factor (Latex slide test) with clinical signand symptoms refering to A.R.A. JointCount. E.S.R. was estimated to asses theprognosis. Either Sex of various agegroup were the Subjects.

Exclussion Criteria

Trldosaja Amavata a,1j Pittaoubaodbee

Eficacy Study:

Sandhi ruja (Pain)

Sparsa Sahatwa (Tenderness-R.A.I)Compliance.

Sandhi Sotha (Swelling by measure-ment.

Morning stiffness-(Length of time).

R.A. factor-(Titration Value) (Latexslide.)

E.S.R-West green method.

Asses~meDtof Result

The sign and symptoms observedduring pre and post trial were separated,compared and carefully adjudicated. Inview of percentage of relief it wasdeclared in the language as follows :-

(a) Complete remisson

=No sign of swelling, pain andstiffness.

=E.S.R-below 15 m.m.

=R.A. Factor-below 80.

(b) Maximum Improvement

=Pain and stiffness improved 75%and above.

=Minor swelling.

=Elevated E.S. R. from 15 to 50 mm.

=R.A. Factor-8! to 320.

(c) Minor Improvement

=Pain and stiffness releived about50 to 75%.

=Dimunution of sweJling.

-=Elevated E.S.R-above 50 mm.

=R.A. Factor-32l to 640.

(d) No Improvement

=No relief of pain, stiffness andswelling.

= Unchanged E.S.R.

=R.A. Factor-Unchanged andabove 640.

AltS!NlC DISULPHIDB (Rasa M anikya) •••

Drug/Dose/DurationRasamanikya 250 mg with Godanti

250 mg as a single dose with honey every12 hour interval for thirty days.

Observation and ResultNo patient was noticed with acute

toxicity or intolerance. The objectiveprogression and subjective relief weremore satisfying besides the highly posi-tive patients preference/compliance anda very faster healthyness. Previoustreatment with other anti-infiamatoryand, immuno-suppressive drugs couldnot render same feeling as that ofArsenic disulphide Compound.

Table-lShowlng the R.A. Factor

Range of B.T., No. A.T. No.R.A. Factor of Patient of Patientper dilution

Below- 40 0 981 -160 4 6

161 -240 0 0241 -32(' 6 3321 -400 3 0401 -480 0 0481 -560 0 0560 & above 7 2Mean ± S.D. 566 ± 430.68 184 ± 179.06

~ of "t" "p"relief Value Value32.51 > 3.88 < 0.001

The statistical analysis shows that the drugia significantly effective to reduce the R. A.Factor with P. Value less than 0.001 (Table I).

t 19, 0.1 ~,=3.88 (Hypothetical t value), /t/in the above is calculated t-value > greaterthan sign is used because it is verified thattu > 3,88.

Table-IIShowlag the E.S.R.

Range of B.T. A.T.E.S.R.

0- 10 0 011- 30 0 731- 50 1 951- 70 4 471- 90 5 091-110 4 0

111-130 6 0

Mean ± S.D. 95.7 ± 26.57 37.25 ± 16.81

~ of t-value P-valuorelief

40.18 > 3.88 < 0.001

Within the E.S.R range of 70 we haveobserved that B.T. 5 Patients were there butafter the treatment, 20 patients and percentageof relief was 40.18 and the test of significanceshows the T.D. is highly significant to reduceE.S.R (Table II)

t 19,0.%=3.88 (Hypothetical t-value) /t/-Calculated t-value > sign is used because itis varified that /t/>3.88.

Dlseussloa

Rheumatoid arthritis could be tracedas Amavata following ancient scripts. Theword Amrvata is a combination of twowords-Ama and Vata. Ama is a patho-logical factor which is described to beformed from undigested food materialconsequent upon hypofunctioning ofAgni (metabolism) and impaired diges-tion. Vata is the functional elementwhich acts as the vector.

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Measures

Table-IIIShowing tbe Different Measures for the Sign and Symptoms

Morningstiffiness

Pain orTenderness

Compliance Swelling

Mean Score ± SD (B.T.)

Mean Score ± SD (A.T.)

% of relief (Improvement)

t-value

P-Valuo

Remark

1.6 ± 0.4~P

0.6 ± 0.66

37.S

>3.88

<0.001

HighlySianificant.

1.75 ± 0.77

0.4 ± 0.49

22.86

>3.88

>0.001

HiahlySignificant.

o±o1 ± 0

100

>3.88

>0.001

HighlySignificant.

Swelling was present

In 20 patients, but

after takina teat

drug, improvement

observed in case of 60%

of patientsHighly Significant.

t 19,0.1%-3.88 (Hypothetical value)/t/- The t used in the table is the ca1culated t-value.">"greater than Sign used, because it is verified that in almostall the above sign and symptoms, the calculated /t/ is greaterthan the hypothetical t at 0.1 % level of significance.

••••o

ABSENIe DISULPmDJ! (Rasa Manekya) ...

Agni is the occult pathology can besimulated with immune responses. It ispresumed, the disease R.A. is a collagendisorder and an immunological dearange-ment. In the human body immune res-ponses are via humoral antibodies madeby plasma cells derived from B-lymphocytes and cellular responses by T.lymphocytes. In autoimmune diseasetissue damage may be caused by eitherhumoral antibody, immune complexesor cell mediated immunity. Among theimmuno-globulins Ig M is referred to asR.A. Factor.

Ama Pachana is the mechanism to becarried out at the level of digestion aswell as metabolism. The drugs mostlyTikta and Katu in taste having AkasaVayu and Agni Ma'. e ,nbhutas inpredominance-with Laghu and Ruksaby nature are said to be antagonistic toAmavata, for the reason that Ama isGuru, Snigdha, Pichhila and Sthira i.e.Pritkvi and Apya Mahabhutas are inabundance.

The drug under trial inherits bothUshna Virya, Ruksa and Tiksna Gunawhich is the basic and classical treatmentfor Amavata. This is inferred to havecorrecting the Agni or acts as immunosupressive. The E.S R is markedlydecreased along with remission ofclinico-objectives parameter.

The drug has probably interfered withthe state of Kapha dosa in the body andas such counter acted the formation of"Ama" by increasing Agni.

Further the features of Sandhisothaand Ruja could be remarkably broughtunder control which is due to Ruksaand Ushna virya atributed with the drug.The properties of Tiksna inherited withthe drug was an advantage since thisproperty renders Chhedan and capableto enter in to the minute channels. Theobstrnctive phenomena caused by Amamight have been corrected in this way.The effect of seronegativity is howevernot well understood except it counteracts the formation of Ama by increasingAgni which is established by clinicalremission.

Keeping the above under reflectionon the ground of improvement as well asstatistical adjudication the result couldbe revealed as-

Complete remission - 1 Case (5%)

Maximum Improvement-13 Cases (65%)Minimum Improvement- 6 Cases (30%)No Improvement - Nil ( 0 %)

It thus concluded that Arsenic disul-phide (Rasamanikya), is unfailing,effective against seropositive RheumatoidArthritis-Amavata (Kaphanubandhi).

Adams J.C. 1987

REFERENCES

Out line of Orthopaedics l Oth Edition,U.K. 1987, ELBS Chunhill Livingstone.

21

DA!H AND DAS

Boyd William

Chakravarty and Battacharya

Colin Ogilvie

Golding D.N.

Sastri Ambika Dutta

Sastri Sudarsan

1977 An Introduction to the study ofDiseases. 7th Edition-1977. Lea andFebiger, Philadelphia.

1987 A hand book of Clinical Pathology 3rdEdition of 1987. Academic publishers,Calcutta.

1980 Symptoms and signs in clinical medicine.ELBS. Bristol-1980.

1989 A synopsis of Rheumatic Diseases5th Edition-1989. Page Bros. Ltd.Norwich. England.

1969 Bhaisajya Ratnavali, Chowkhamba,Sanskrit Series Office. Varanasi-1969.

1968 Madhava NidanThe Chowkhamba Sanskrit Series Office.Varanasi-1968.

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22