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          Friday, March 23, 2018


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Pathogenesis of Amavata
By  Todd Caldecott

The Madhava Nidanam states that when the digestive fire is weak and ama is allowed to accumulate, it moves to the different locations of Kapha in the body (Srikantha Murthy 1995, 95). Kapha is derived from the Sanskrit root word 'shlesh,' which means 'to embrace.' Thus, Kapha binds the joints together, nourishing and protecting the articular surfaces (Srikantha Murthy 1994, 169).

Like ama, Kapha is heavy (guru), moist (snigdha) and cold (shita) in nature. For this reason, ama typically associates with Kapha before the other two doshas. According to the Madhava Nidanam, when ama is allowed to accumulate in the joints they become congested with a "…hard, waxy material" (i.e. Kapha). Soon the circulatory channels (dhamanis) that supply these regions become congested as well. Eventually this blockage affects the heart (hrdaya), which then becomes the "…seat of the disease" (Srikantha Murthy 1995, 95).

Once Kapha has become vitiated the other doshas eventually become involved. To restore homeostasis the body will initiate local inflammatory processes (i.e. Pitta) in the joint in order to 'cook' the accumulated ama. Despite the inflammatory component of this condition however, the hallmark of amavata is the progressive pathological influence of Vata in the synovial joints, and the resultant joint degeneration.

The pathogenesis of amavata bears some similarity to the recently described intestinal permeability syndrome (IPS). The impetus for IPS is a process by which some agent or combination of agents initiates an inflammatory response in the digestive tract. Persistent gastrointestinal inflammation eventually disrupts the integrity of the mucosal lining of the gut, and tiny perforations allow for molecules larger than usual to pass across this barrier, including molecules from dietary protein and fats, bacteria, parasites and fungi.

In response to this infiltration, an immune response is initiated and the body begins to manufacture specific antibodies to these antigens. Unfortunately, many tissues have antigenic sites almost identical to those substances that pass across a permeable intestinal wall. Once activated, these antibodies then circulate and 'look' for more antigens. When an antigen is found, such as a tissue that has similar markers to an exogenous antigen, the antibody initiates an immune response and the tissue begins to be destroyed (Galland 1993).

The differences between IPS and amavata are obviously significant, with each using an entirely different physiological model. Nonetheless if we can translate the antigens described in IPS into the ama identified in Ayurvedic medicine, the two models become strikingly congruent (Kumar 1997, 94). Although amavata is primarily a disease of Vata, it is differentiated into three basic subtypes, namely, Vata, Pitta, and Kapha. This differentiation allows the practitioner to identify a greater range of subtlety within the diagnosis and treatment of amavata.

Where Pitta is involved the joints appear red and feel hot, and the patient complains of a burning, searing pain. With Vata the pain is severe, and migrates from place to place. With Kapha the pain is less, but there is more stiffness and immobility, often combined with sensations of itching. There may also be a combination of any two or three of the doshas. If one dosha is involved the condition is said to be easy to cure. With two doshas the situation is more difficult, and with all three doshas in a state of vitiation the condition is said to be incurable.

Similarly, when there is migrating pain and severe inflammation in the joints of the hands, feet, head, heels, waist, knees and thighs, amavata is said to be incurable (Srikantha Murthy 1995, 95-96)."

Todd Caldecott is a clinical herbalist, and known for his crisp and informative articles on Ayurveda. You can write to him at, and visit him at .


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