PANCHAKARMA IN AMAVATA (RHEUMATOID ARTHRITIS): A REVIEW OF CLASSICAL CONCEPTS AND CLINICAL EVIDENCE
Background: Amavata is an Ayurvedic disease entity closely resembling rheumatoid arthritis (RA). Its classical management follows a sequence of Deepana, Amapachana, Shodhana and Shamana therapies, in which Basti is prominent. Objective: To review the classical concepts and recent evidence on Panchakarma, particularly Basti, in Amavata. Methods: Narrative review based on a PubMed search and classical texts. Findings: A systematic review of randomized trials of Ayurvedic medicine in RA identified seven studies and concluded that the evidence was insufficient. Three Basti-based clinical studies (Matra Basti, Kshara Basti and Vaitarana Basti) reported improvement in symptoms and, in two, in ESR or rheumatoid factor, but they were small and mostly single-centre. A double-blind pilot trial of 43 patients found no significant differences in efficacy among classical Ayurveda, methotrexate and their combination. A novel ama assessment instrument showed weak correlations with ESR and DAS-28. Conclusion: Basti-based protocols show encouraging preliminary results in Amavata, but robust evidence is lacking. Larger, blinded trials with validated disease-activity outcomes are required.