A CLINICAL TRIAL ON ARNOPEN CAPSUlES(ANUBHUTA YOG) IN AMAVATA (RHEUMATOID ARTHRITIS) Dr. R.R.VASHISTHA Ph.D.Medical Suptt. H.O.D(Panchakarma Dept.

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1 A CLINICAL TRIAL ON ARNOPEN CAPSUlES(ANUBHUTA YOG) IN AMAVATA (RHEUMATOID ARTHRITIS) Dr. R.R.VASHISTHA Ph.D.Medical Suptt. H.O.D(Panchakarma Dept.) Dr. BASANT KUMAR M.D.(Ayu.) CHAUDHARY DEVllAl AYURVEDIC COllEGE AND HOSPITAL JAGADHARI, YAMUNA NAGAR (HARYANA) INTRODUCTION:- AMAVATA- The factors influencing Amavata are ama and vata. Ama isthe end product of impaired digestion/metabolism, is carried by vayu allover the body and reaches to the joints. Finally it obstructs the body channels at different sites and causes the inflammation of joints. Now, the condition has been termed as Amavata. In Ayurveda AMAVATA is compaired as Rheumatoid arthritis. Rheumatoid arthritis (R.A.)is an autoimmune systemic disorder where in the body defence mechanism identifies the normal tissuesas antigen and evokes a chain of inflammatory reaction resulting in destruction. It affects the joints commonly like wrist, hands, knees, ankle, foot and fingers. Involvement of soft tissue structures surrounding the joint too occurs like synovial capsule, tendons, muscles etc. Oxidative stressis a major factor in the pathogenesis of rheumatoid arthritis as indicated by higher concentration Clinical features (lakshan) of Amavata:- ljody ache - Angamarda Feeling of Heaviness - Garav of free radicals in synovial fluid. Inflammation of the body parts - Sunayata Anganum Fever- Jwara Anorexia - Aruchi Thirst- Trishna r'"\ni,ni",p _.. /.\11"1<:('1'.1('1 y.--.",~ _ I., ~oj ) _ Indigestion - Apaka

2 Aim of Treatment:- 1. To evaluate the effect of Arnopen capsule in amavata. Amavata treatment principles :- According To Acharaya chakradatta the Amavata treatment should be done by Langhna ( fasting), Svedana(steaming), Virechna ( purgation) Snehanan(massage etc.),anuvasana basti (unctous enema) and kshara basti. Internally the drugs possessingrasa (taste)-tikta(bitter),katu (pungent) and Deepan (enhance metabolic secretions) are indicated.thus the anubhut yog ARNOPENcontains the ingredient are selected which possessingrasa(taste)-tikta(bitter) & katu(pungent). Rheumatoid Arthritis is prevalent in the yo~~g and middle aged population. In spite of so called most effective treatment available nowadays, it cripples the patient for th~} rest of his life. So it shows that the disease need to be a drug should be selected which helps the patient to live his life normally and smoothly by keeping this in view Anubhuta Yog Arnopen capsule prepared to see the efficacy of 1hiscompound in the patient of amavata (R.A.). Systemic features of R.A. Low grade fever, malaise, fatigue and joint poin. Joints are swollen edematous} warm, tender with effusion and the movements are painful and restricted. Earlymorning joint stiffness. Synovial thickening is appreciable. Subcutaneous nodules may be palpable.

3 DRUG REVIEW DRUG NAME BOTANICAL TASTE POTENCY METABOLISM ACTION SOURCE (RAS) (VIRAYA) (VEEPAKA) (KARMA) MAHAYOGRAG GENERIC Tikta Ushna Katu Tridoshshamak GOOGAL Katu (Heating) (Pungent) Kashay i CHITRAK PLUAMBAGO Katu Ushna Katu Tridoshshamak ZEYLANCIA Tikta (Heating) (Pungent) - NIRGUNDI VITEX Katu Ushna Katu VatKaphnashak _.._- NEGUNDO Tikta (Heating) (fungent) RASANA PLUCHA Katu Ushna Katu... VatKaphnashak LANCEO (Heating) (Pungent) LATA - SAMEERPANANG GENERIC Tikta Ushna Katu Kaphvatnashak I (Heating) (Pungent) KHURASINIOWA HOSYAMUS Katu Ushna Katu Vedanashamak NIGER Tikta (Heating) (Pungent) KUNDRU Bosewallia Katu. Ushna Katu Vedanashamak serrato Tikta (Heating) (Pungent) MAHAYOGRAJ GUGGAL:- It is said to digest metabolic toxins (ama) and improves joint functions and.reserves the orthro system. Guggal Qualify:-( vatashamak),shothghan (Antiinflamatory),Analgesic (vednashamak) CHITRAK (PLUAMAGO ZEYLAMCIA):- Anti -inflammatory role of chitrok has been observed.(2) It Helps collagen induced arthritis in mice. (Ref-3) (3) Anti-oxidant activity of chitrok is also reported.(ref-3)

4 NIRGUNDI (VITEX NEGUNDO):- Higher concentration of free radicals has been reported in synovial fluid in inflammatory diseases. The oral administration of Nirgundi extract has been reported to exert positive effect on bringing anti-oxidant levels to normal level in adjuant induced arthritic rat. (J Rheumatology, 1981) ) RASNA (PLUCHA LANCEO LATA): Attenuates cadmium chloride induced oxidative stress.(6)rasna also exhibits significant ant-inflammatory activity.(7}itsextract inhibited the production of ROS( Reactive Oxygen species) in the stimulated human neutrophies.(ref-8) SAMEERPANANG:- also potentates anti-inflammatory It strengthens muscle tendons and ligaments and effects of other drugs. KHURASINI OWA (HOSYAMUS NIGER):- It is believed'to act as a muscle relaxant. KUNDRU(BOSEWLLlA SERRATA):-It restores integrity of blood vessels& builds collaterals. Dignostic Criteria:- 1. Morning stiffness (stabdhata). 2. Pain on movements/ tenderness (sparsasahyata). 3. Swelling(shotha). 4. ESRabove 40mm /1sf. 5. R.A.factor positive. 6. Fever(Local rise of temprature). Material and Methods:- 40 patients of Amavata(rheumatoid arthritis) were selected from the OPD AND IPDOF C.D.L. College & Hospital, Jagadhari. INCLUSIVE CRITERIA: Patients were selected on basis of Dignostic Criteria. Age between years. EXCLUSIVE CRITERIA: Patients with positive uric acid were excluded from he study.

5 RELIEFIN MORNING STIFFNESS -- No. Of B.T. / A.T/15 A.T/ 30 AJ/ 45 A.T /60 AJ/90 Patient M.S. days days days days days s min 10 min 5 min Omin o min o min min 5 min o min o min o min Omin 4 10 min 5 min o min o min o min Omin 3 5 min o min o min o min o min o min BT - Before Treatment, M_S.- Morning Stiffness, A.T. - After Treatement CHANGES IN ESR ---- No. Of B.T. / AJ/ 15 AJ/30 AJ /45 A.T /60 AJ/90 Patient ESR. days days days days days s In 7 patient esr before treatment was 60mm/1 hr was change to. 06mm/l hr,in 15 patient before treatment (B.T) 42 mm/1 hr was reduced to 12mm/1 hr,in 10 patient BTwas 48 mm/1 hr was re'duced to 05mm /1 hr,in 8 patient 8T was 50 and reduced to 12 mm/1 hr after 90 days of treatment. CHANGES IN R.A. FACTOR Days days days 90 days days days NO.of Patients In all the patients the RA factor was found weakly positive after 90 days treatment. IMPROVEMENT IN APPETITE [_._.. _.Days d~5s 30 days d~5s 60 days. 90 days L No~ Of Pa!ients After 15 days of treatment in 25 patients appetite was improved, in 15 patients apr=,etite was improved in 30 days with ARNOPEN cap.

6 FAllOW UP: Patient were followed after 15,30,45,60,90days from the 1 51 day of treatment started. AGE AND SEX DISTRIBUTION: AGE NO.of Patients Male Female years Total 40 patients were selected out of which 17 were males 23 were females. DOSAGE SCHEDULE: Only ARNOPENcapsules 2 tid for one month and 2 bid for next 2 months with hot water were prescribed. OBSERVATION 1) Improvement in Pain, Inflammation, Reduction in Morning Stiffness were observed in all patients during follow up period of 15,30,45,60,90days. 2) ESRtest and R.A.factor test were carried out in all the patients on 1sl day of trial and on each follow up. RESULTS:Subjective improvement in pain, inflammation, morning stiffnessand appetite were evaluated. IMPROVEMENT [-~_:_ IN INFLAMMATION After 15 days of treatment in 14 patient inflammation was relieved completely, in 19 patients after 30 days and in 7 patients inflammation r relieved after 45 days with ARNOPENcaps. IMPROVEMENT IN PAIN Days NO.of Patients After 15 days treatment the pain relieved completely in 10 patients, in 15patients after 30 days, in 12 patients after 45 days and in 3 patients ofter 60 days with ARNOPENcap.

7 CONCLUSION:- 1) Pain, inflammation, morning stiffnessand appetite showed remarkable improvement within 15to 45 days in the majority of cases acc. to severity. 2) ESRreached to normal range acc. to male, female ratio that is lessthan 10 mm/ls t in males and lessthan 20mm/lS t hr in female as shown in the table. 3) In all the patients the RAfactor was found weakly positive after 90 days. 4) No untoward adverse effects were observed with ARNOPEN capsules. Moreover, it is concluded that the presence of bitter and astringent taste present in ARNOPENingredients makes it powerful free radical scavenging agents. Overall, ARNOPENcapsules were found to be very effective in the treatment of Amavata ( rheumatoid arthritis). SUMMARY: ]) Arnopen offers complete relief from pain & associated problems in Rheumatoid arthritis (Amavata) after 3 months treatment. 2) It is free from any side effect.no side effects were observed in any patient during trial. 3) Arnopen can be used as preventive when started in earlier stage of Amavata (Rheumatoid arthritis). ARNOPEN Capsules IS A DRUG OF CHOICE FOR AMAVATA AS WELLAS RHEUMATOID ARTHRITIS

8 Mohoyogoj guggol ref:-bharat Bhaishajya Ratnakar Part 4 Siok No REFERENCES:- OTHER:- 1.Hui Linda, K.Banburry, Centre for PPhyto.&Pharma. China, Pharmaceutical Bioiogy,43, Pharmaceutical Biology,45, Redox Report,9, J.Rheumatology, Jehangir,T. et 01., J.Pharm. &Pharmaco., F.Perez-Garcia, et 01. Phytomedicine,12,2005 I<aso 8. Vocabulary:- Ushon(Hot), veeryo(potency). vipoko(end product of digestion/metobolisom), (taste), Guno(quolity), Kormo(mode of action), Shomoko(olleviotor), va tokophonashok (votko pho olleivitor). vedonoshomok(onolgesic),