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Introduction

Metabolic disorders refer to a heterogeneous cluster of chronic conditions resulting from derangements in carbohydrate, lipid, protein, and mineral metabolism, characterized by impaired glucose regulation, dyslipidaemia, obesity, hypertension, and insulin resistance, collectively increasing cardiovascular and inflammatory disease risk¹. Type 2 diabetes mellitus (T2DM) is defined as a chronic metabolic disease characterized by persistent hyperglycemia due to insulin resistance and relative insulin deficiency². Obesity is described as excessive accumulation of body fat associated with increased morbidity and mortality, commonly assessed using body mass index (BMI)³. Dyslipidemia refers to abnormal serum lipid levels, particularly elevated low-density lipoprotein cholesterol and triglycerides, contributing to systemic inflammation and atherogenesis?. Rheumatoid Arthritis (RA) is a chronic autoimmune inflammatory disorder primarily affecting synovial joints, leading to pain, stiffness, progressive joint destruction, and systemic complications?. The coexistence of metabolic disorders and RA is well documented and reflects a complex metabolic–endocrine–inflammatory interplay, mediated through shared mechanisms such as chronic low-grade inflammation, oxidative stress, altered cytokine profiles, immune dysregulation, and mitochondrial dysfunction?. Clinical evidence suggests that obesity, insulin resistance, and dyslipidemia not only increase the risk of RA but also worsen disease activity and therapeutic outcomes. Conventional management of such multisystem involvement relies on long-term use of antidiabetic agents, statins, antihypertensives, corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). Although these therapies effectively control disease parameters, prolonged use of drugs such as metformin, statins, methotrexate, and hydroxychloroquine is associated with adverse effects including gastrointestinal intolerance, hepatotoxicity, myopathy, bone marrow suppression, and increased susceptibility to infections???. This often results in polypharmacy with limited improvement in overall quality of life. Ayurveda explains such multisystem involvement through Agnimandya (impaired metabolic fire), Ama utpatti (formation of metabolic toxins), Kapha–Meda du?ti (vitiation of bio-structural and adipose components), and secondary Vata prakopa (aggravation of bio-functional principle), ultimately manifesting as conditions such as Prameha (metabolic disorders including diabetes) and Amavata (autoimmune inflammatory joint disorder) ¹??¹². Hence, Ayurveda emphasizes a holistic and individualized therapeutic approach aimed at correcting Agni, eliminating Ama, and restoring Dosha–Dhatu–Mala equilibrium, rather than merely suppressing isolated symptoms

Aim and Objectives

Aim:
To evaluate the role of integrative Ayurvedic management in improving clinical outcomes and quality of life in a patient with metabolic disorder and autoimmune comorbidity.

Objectives:

• To assess improvement in metabolic and inflammatory parameters
• To evaluate reduction in joint symptoms and disease activity
• To observe reduction in dependency on long-term allopathic medications
• To assess improvement in quality of life.

Materials and Methods

Study Design

Single-patient observational case study.

Patient Demographics

• Age: 45 years
• Gender: Female
• Occupation: Housewife
• Marital Status: Married

Chief Complaints

• Pain in multiple joints with early morning stiffness for 1.5 years
• Increased blood glucose levels for 4 years with numbness in lower limbs
• Reduced appetite for 2 years
• Hair fall and facial puffiness for 4 years

Past Medical History

• Hypothyroidism – 25 years
• Type 2 Diabetes Mellitus – 4 years
• Hypertension – 4 years
• Rheumatoid Arthritis – 3 years
• Hyperlipidaemia – 2 years

Personal History

• Diet: Mixed
• Appetite: Reduced
• Bowel: Regular (once daily)
• Micturition – 6-7 times/day
• Sleep: Sound
• Tongue: coated

Medication History

Patient was on Thyroxine, Metformin, Methotrexate, HCQ, antihypertensive, statins, aspirin, and vitamin supplements.

Clinical Examination

• BMI: 34.7 kg/m²
• BP: 140/90 mmHg
• Multiple joint tenderness, warmth, and swelling (bilateral involvement)
• Cardiovascular, respiratory, and neurological examinations were found to be normal.

Investigations

(Table -1- investigations done on different follow-up periods)

Treatment Protocol

 (Table -2 - Detailed treatment with procedures, oral medications, and follow-up improvements)

Results

The patient demonstrated progressive improvement in metabolic parameters, inflammatory markers, and functional capacity. Glycemic control improved with reduction in FBS, PPBS, and HbA1c. Lipid profile showed a declining trend. ESR reduced and CRP became negative. RAPID-3 score reduced from 20 to 7, and WHOQOL score improved from 38 to 60. Under medical

supervision, doses of metformin, antihypertensives, HCQ, methotrexate, and analgesics were reduced or discontinued.

Discussion

The clinical presentation in this case reflects Agnimandya–Ama utpatti–Srotorodha sequence with predominance of Kapha and Vata dosha, affecting Meda dhatu and Rasa–Rakta vaha srotas, eventually manifesting as a metabolic disorder with autoimmune overlap. Classical texts describe Prameha and related metabolic states as conditions originating from deranged Jatharagni and Medodhatvagni, leading to excessive production of Ama and pathological accumulation of Kapha and Meda, which further obstructs normal Vata gati and tissue metabolism. ¹?-¹¹ This samprapti provided the rationale for adopting a Shodhana–Shamana–Rasayana based integrative approach. Modern medicine explains metabolic syndrome as a state of chronic low-grade inflammation driven by insulin resistance, central obesity, dyslipidemia, and mitochondrial dysfunction. Excess adipose tissue acts as an active endocrine organ, releasing pro-inflammatory cytokines such as TNF-α, IL-6, and resistin, which impair insulin signaling and promote systemic inflammation. Persistent oxidative stress further damages pancreatic β-cells and vascular endothelium, worsening metabolic dysregulation. Autoimmune diseases like rheumatoid arthritis share similar pathogenic pathways, characterized by immune dysregulation, loss of self-tolerance, and sustained cytokine-mediated inflammation. Increased production of reactive oxygen species (ROS) and imbalance between pro- and anti-inflammatory cytokines perpetuate tissue injury and disease progression. Hence, therapeutic interventions targeting oxidative stress, inflammatory cytokines, immune modulation, and metabolic stabilization are considered central to disease control and improvement in quality of life. Initial Shodhana measures such as Sarvanga Udvartana and M?udu Sweda were employed to do the Pravilapana (liquification) and Vimlapana (destroying) of the excess Kapha and Meda accumulated.12 It also enhances peripheral circulation, and improve insulin sensitivity. Studies have shown Udvartana to be effective in reducing BMI, lipid levels, and inflammatory markers13 and regular Udvartana may reduce serum leptin levels and improve adiponectin balance, thereby positively influencing metabolic homeostasis. Additionally, reduction in systemic low-grade inflammation through improved circulation and detoxification aligns with the concepts of Ama nirharana and Srotoshodhana. Basti therapy, being the prime treatment for Vata, helped in breaking the Ama–Vata sammurchana, resulting in early relief in joint pain and stiffness14 Vaishwanara churna Basti acts by correcting Agnimandya (poor digestive and metabolic fire) and regulating Apana Vata, which is central to metabolic and inflammatory disorders. Research and clinical observations suggest that Basti therapy improves gut metabolism, reduces systemic inflammation, and enhances insulin sensitivity by modulating the gut–immune–metabolic axis. In this case, Basti supported better digestion, reduced toxin (Ama) load, and contributed to overall metabolic balance.15 Shamana aushadhis like Dashamula Kwatha does Amapachana and vedanaharan. It exerts anti-inflammatory, analgesic effects which are supported by experimental evidence showing inhibition of pro-inflammatory cytokines16. Nirgundi Ghana Vati is well documented for its analgesic and anti-arthritic properties, particularly in musculoskeletal disorders17.

Immunomodulation and metabolic correction were achieved using Guduchi-based formulations, including Samshamani Vati, which has demonstrated immune-regulatory, antipyretic, and anti-inflammatory actions through modulation of macrophage and cytokine activity18. Shiva Gutika and Rasayana therapy improved Dhatvagni, enhanced Ojas, and supported long-term disease control, correlating with studies showing improved insulin sensitivity and antioxidant status19. It is a classical Rasayana formulation indicated in conditions of Agnimandya (impaired metabolism), Ama sanchaya (toxin accumulation), and Kapha–Vata du?ti. It acts by restoring Jatharagni and Dhatvagni (tissue metabolic activity), thereby reducing Ama formation and improving Medovaha srotas function. Experimental studies on its key constituents-Guduci (Tinospora cordifolia), Haritaki (Terminalia chebula), Amalaki (Emblica officinalis), Pippali (Piper longum), and Su?thi (Zingiber officinale)-have demonstrated antioxidant, anti-inflammatory, hypoglycemic, lipid-lowering, and immunomodulatory effects. Shilajatu has a high ORAC (Oxygen Radical Absorbance Capacity) value, which means it is a strong antioxidant and helps neutralize harmful free radicals in the body. By reducing oxidative stress-a key factor in insulin resistance and autoimmune inflammation- it supports better insulin action and protects cells from damage. These actions collectively improve insulin sensitivity, reduce oxidative stress and inflammatory cytokines, and support immune regulation. In the present case, Shiva Gutika likely contributed to metabolic stabilization and immune balance, facilitating symptom control and reduction in long-term drug dependency. Definitive Shodhana with Snehapana and Virechana eliminated residual Ama and Pitta, resulting in sustained symptom relief, reduction in disease activity, and improvement in quality of life. The integrative approach facilitated gradual withdrawal of long-term allopathic medications, minimizing drug-related adverse effects and highlighting Ayurveda’s role in reducing polypharmacy.

Conclusion

This case study highlights the beneficial role of integrative Ayurvedic management in a patient with metabolic disorder and autoimmune comorbidity. Correction of Agnimandya, reduction of Ama, and normalization of Medodosha through Shodhana, Shamana, and Rasayana therapies resulted in improved metabolic control, reduction in inflammatory symptoms, and enhanced functional capacity. Significant improvement in quality of life, as reflected by RAPID-3 and WHOQOL-BREF scores, was observed alongside objective laboratory improvements. Importantly, the integrative approach supported gradual reduction of conventional medications under medical supervision without disease flare. This case suggests that Ayurveda, when used as an adjunct to modern medicine, can improve overall well-being, reduce symptom burden, and enhance quality of life in chronic metabolic and autoimmune conditions.