70 years old female patient came with c/o pain and stiffness at knuckles and finger joints. It started 2years back with morning stiffness in MCP joints of right hand and then also in left hand MCP and Phalangeal joints. Gradually also felt pain in calf muscles and back that can’t bend. On examination- Legs now feel sore and stiff if standing for a long time. Appetite is not good. Also c/o dry eyes and mouth in the morning. Has a long standing job profile. C/o of heaviness and stiffness in the body especially early morning.
Blood test shows ANA, RH and ENA positive
Joints- tender and swollen
Doshas- Vyana vata, shleshaka kapha, apana vata
Dhatu- Rasa, asthi, mamsa
Srotas- Annavaha, asthivaha
Samprapti- Patient being indulged in incompatible food and lack of physical activity and digestive fire already poor resulted in ama formation. The patient has job where she needs to stand for a lontime resulted in vata vitiation as well. Both vata and ama increased at the same time. Then vyana vata took ama throughout the body and it settled in the weakest part which is joint in this case. Resulting in amavata.
Diet and lifestyle- Patient is a case of Rheumatoid arthritis. She needs tips for RA diet and lifestyle as well as some recipes to be followed for detox program.
Diet and lifestyle for Vatapitta
|Vegetables||Asparagus, (Cooked), Squash, Leafy Greens, Pumpkin, Cilantro, Okra, Carrots, Bok Choy, Celery||Broccoli, Beets, Spinach, Sweet Potato, Cauliflower, Cucumber, Parsley, Lettuce, Peas, Green Beans, Onion||Peppers, Corn, Tomato, Eggplant, Mushrooms, Turnips, Brussels Sprouts, Cabbage, Onion (raw)|
|Fruits||Avocado, Figs (fresh), Pineapple, Dates, Mango, Watermelon, Coconut, Apricots, Plums (sweet),|
|Oranges, Lemons, Banana, Limes, Cherries,|
Pink Grapefruit, Apples, Strawberries, Pears, Grapes,
|Kiwi, Persimmon, Yellow Grapefruit, Cranberries|
|Grains||Basmati rice, Wheat, Oats (cooked), Barley,||Quinoa, Brown rice (cooked well), Amaranth, Wild Rice Couscous||Rye, Buckwheat, Corn, Millet,|
|Nuts and Seeds||Coconut, pumpkin seeds, Sunflower seeds, Sesame seeds, Almonds (soaked & peeled), Flax seed||Psyllium, Cashews, Almonds (with skin), Pistachios, Brazil nuts, Pecan nuts, Pine nuts, Poppy seeds||Peanuts, all nuts and seeds in large quantities|
|Meat||None||Fish and seafood (esp. white fish), Chicken, Turkey,||Pork, Beef, Lamb, Kangaroo, Duck & other game birds, Rabbit|
|Oils||Coconut, Olive oil, Sesame||Avocado, Almond, Canola, Safflower||Corn, Mustard, Animal fats/lard|
|Beans/ Legumes||Mung, Lentils (red and brown)||Urud Dhal, Tofu and soy products, Kidney beans, Navy beans, Chickpeas, Black eyed peas,||Aduki beans, Miso|
|Dairy||Ghee, butter milk||All Dairy Products Milk (unhomogenized/organic)||Yoghurt at night time, Ice-cream, Salted butter, Sour cream|
|Sweeteners||Natural Sweetener (barley malt, amasake, brown rice syrup, sucanat – whole cane sugar), Maple syrup||Honey, Jaggery, Molasses||All white sugar and its products, Artificial sweeteners, Large quantities of any sweet|
|Herbs and Spices||Cardamom, Coriander, Cinnamon, Fennel, Dill, Cumin, Curry Leaves, Mint, Saffron, Turmeric, Basil, Peppermint, Vanilla, Spearmint||Black Pepper, Ginger, Garlic, Bay leaf, Rosemary, Sage, Thyme, Paprika, Mustard, Nutmeg, Fenugreek, Asofoetida||Chilli, Mustard, Cloves, Marjoram,|
- Body Constitution (Prakruti) Type or for Current imbalances (Vikruti) – Combination of Pitta and Vata doshas. Favour diet and lifestyle of these doshas.
- This diet advice should be considered as a guide to help improve your condition. Try and involve the foods favourable more into your daily diet and try and avoid the foods unfavourable as much as possible. But you may find some foods in the favourable list not suiting you occasionally. Avoid them and adjust your diet accordingly. Also remember that Ayurveda recommends every couple of weeks to indulge in something that may not be the best thing for us but will help switch on your body’s natural intelligence, make sure to smile and enjoy while you eat something yummy!
- Avoid fried and heavy foods as much as possible. Favour a plant based diet.
- Minimise oils, fats, dairy products, sweets and cold foods in general.
- Eat nourishing foods rich in calcium and iron recipes such as dates soaked in ghee and high calcium recipes have been included for you.
- Alcohol, aerated and caffeinated drinks like coffee, tea, cola, etc and ice cream are to be avoided.
- Avoid food combinations with different rates of digestion, ie. Heavy and light foods. Some examples are: Fish with dairy; Yoghurt with sour fruits and melons (melons should be eaten on their own); Vegetables with fruit or milk.
- Eat as many nourishing meals cooked with love as possible.
- Add cooling digestives to your meals like cumin, cardamom, fennel and coriander.
- Leave 4-5 hours between each meal to ensure previous meal is digested
- Do not consume liquid just before, during (except for a glass of warm water) or directly after your meal as this will disrupt your digestion.
- Make lunch the main meal.
- Eat dinner by 7pm.
- Drink only room temperature or warm water.
- Drink coriander water: soak handful of seeds in water, particularly on hot days and after exercise.
- Avoid eating when angry.
- Take a short walk in afternoons or mornings in nature as often as possible, walk mindfully taking in the environment around you and focusing also on the rhythm of your breath, taking deep breathes.
- using hot water, not cold, to bathe in and drink
- avoiding exposure to cold breezes
- Proper sleep- going to bed early and rising early. Avoiding late-night or late-afternoon naps. T king a shower before bed. Practicing night time meditation or yoga. Massaging soles of feet with warm sesame oil before bed.
- Practicing yoga to relieve mental stress
- Using massage therapy with herbal oils to reduce pain and stiffness
- Avoid smoking, alcohol as it increases the acidity in the body resulting in more ama formation
- Grains: easy to digest grains like cooked oats, rice, and cream of wheat
- Legumes: lentils, dal, mung beans, miso, and tofu, Green, leafy vegetables, Berries
- Lukewarm water, or water boiled with ginger root, to help with digestion and remove toxins
- Spices: ginger, turmeric, and garlic, which are anti-inflammatory and aid with digestion, buttermilk
A sample diet- Breakfast- Tea, fruit, hot porridge or oatmeal with cinnamon
Lunch- Sprouted rice or buckwheat, roasted vegetables (sweet potato, squash, pumpkin)
Snacks- fruit sprinkled with cinnamon, instant miso soup, tea
Dinner- Soups, Curry with brown rice
Before bed- Warm almond milk with honey
Suggested yoga exercise: Moon Salutation performed moderately fast building up to 16 cycles with gaze forward also yin yoga or restorative yoga will be beneficial.
Suggested breathing technique: Nadi shodhana: alternate nostril breathing will also be beneficial
Nadi Shodhana Pranayama:
Highly beneficial in reducing stress and anxiety. Primarily aimed at clearing and purifying the subtle channels of the mind & body, balancing all aspects. It is pacifying for all Doshas and is a suitable daily practice.
- Close the right nostril with your right thumb and inhale through the left nostril. Do this to the count of 4
- Immediately close the left nostril with your right ring finger and little finger, and at the same time remove your thumb from the right nostril, and exhale through this nostril. Do this to count of eight. This completes a half round.
- Inhale through the right nostril to the count of four. Clos the right nostril with your right thumb and exhale through the left nostril to the count of eight. This completes one full round.
Complete at least four rounds to begin with and gradually increase up to eight to ten once you feel comfortable with the practice.
Vata Spice Mix
1 tsp. coriander seeds
5g (5cm) dried ginger root
1 tsp. fennel seeds
1 tsp. cumin
1 tsp. whole cloves
5g (5cm) cinnamon stick
1 tsp. green cardamon capsules Seeds from two anise stars
1 tsp. cayenne pepper
1/2 tsp. dried red chillies
1 tsp. turmeric
This masala is especially good for vegetable curries, sauces and soups. Dry roast all ingredients except the paprika and turmeric in a teflon-coated pan. Heat the items until they begin to pop and smoke, but do not let them turn black. Grind this mixture with mortar and pestle or in a coffee bean grinder and then add paprika and turmeric.
Pitta Spice mix (Churna)
1 tsp. coriander seeds
5g (5cm) dried ginger root 1 tsp. fennel seeds
1 tsp. cumin
5g (5cm) cinnamon stick
1 tsp. green cardamom capsules 1⁄2 tsp mustard seeds
Seeds from two anise stars
1/2 tsp. cayenne pepper Shredded coconut
1 tsp poppy seeds
1/2 tsp. dried red chillies 2 Bay leaves
1 tsp. turmeric
This masala is especially good for vegetable curries, sauces and soups. Dry roast all ingredients except the paprika and turmeric in a Teflon-coated pan. Heat the items until they begin to pop and smoke, but do not let them turn black. Grind this mixture with mortar and pestle or in a coffee bean grinder and then add paprika and turmeric.
You can add vata or Pitta spice mix to your meals according to your digestion on daily basis. For instance if feeling more heat or symptoms such as diarrhea or in hotter weather you can use the pitta mix. If digestion is erratic use vata mix at that time.
Treatment and herbal combo-
Chikitsa of Amavata comprises of Langhana, Swedana, Deepana, Pachana (Tikta Katu Dravya), Snehapana, Virechana & Basti.
- Boswellia serrata
Case is presented by : Lata – Ayurvedic Practitioner
Case seen by: Kumar – Ayurvedic Practitioner
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