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Line 394: − ==== Complications ====+ Line 453:
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Line 1,005: − ==== ''Anulomana'' treatment ====+ Line 1,021:
Line 1,021: − ==== Purgative formulations ====+ Line 1,087:
Line 1,087: − ==== Importance of ''basti'' ====+ Line 1,131:
Line 1,131: − ==== ''Madhuparnyadi tailam'' ====+ Line 1,189:
Line 1,189: − ==== ''Sukumaraka tailam'' ====+ Line 1,267:
Line 1,267: − ==== ''Amritadya tailam'' ====+ Line 1,345:
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Line 1,476: − ==== ''Shatapaki'' or ''sahastrapaki bala tailam'' ====+ Line 1,532:
Line 1,532: − ==== ''Pinda tailam'' ====+ Line 1,556:
Line 1,556: − ==== ''Dashamula'' processed milk ====+ Line 1,572:
Line 1,572: − ==== Various external applications ====+ Line 1,953:
Line 1,953: − ==== Treatment of obstruction by excess ''meda'' and ''kapha'' ====+ Line 2,006:
Line 2,006: − ==== Treatment of severe vitiation of ''rakta'' ====+ Line 2,022:
Line 2,022: − ==== Treatment of complications ====+ Line 2,047:
Line 2,047: − ==== Summary ====+ Line 2,115:
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Line 2,135: − ==== Pathogenesis ====+ − ==== Clinical features ====+ Line 2,148:
Line 2,148: − ===== Types =====+ − ==== Differential diagnosis ====+ Line 2,209:
Line 2,209: − ==== Constituent conditions of ''vatarakta'' ====+ Line 2,219:
Line 2,219: − ==== Investigations ====+ Line 2,225:
Line 2,225: − ==== Complications ====+ − ==== Prognosis considering present developments in medicine ====+ − ==== Management of diseases (Treatment protocols) ====+ − ===== Principles of management ===== + Line 2,272:
Line 2,272: − ===== Evidence based clinical practices =====+ Line 2,280:
Line 2,280: − ==== Potential areas /scope for further research ====+ − === References ===+
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|keywords=Vata, rakta, gout, connective tissue diseases, inflammatory arthritis, polyarthritis, vasculitis
|keywords=Vata, rakta, gout, connective tissue diseases, inflammatory arthritis, polyarthritis, vasculitis
|description=Chikitsa Sthana Chapter 29. Management of disorders involving vata and rakta
|description=Chikitsa Sthana Chapter 29. Management of diseases involving vata and rakta
}}
}}
<big>''' [[Chikitsa Sthana]] Chapter 29. Management of disorders involving vata and rakta </big>'''
<big>''' [[Chikitsa Sthana]] Chapter 29. Management of diseases involving vata and rakta </big>'''
<big>''' Abstract </big>'''
<big>''' Abstract </big>'''
The chapter refers to ''vatashonita'' (or ''vatarakta''), a condition caused by vitiated ''vata dosha'' and ''rakta''. As the disease is caused by predominantly vitiated ''vata'' and ''rakta'', it follows [[Vatavyadhi Chikitsa]] (''vatika'' disorder). The manifestations of ''vatashonita'' resemble various metabolic and connective tissue diseases like gout, inflammatory polyarthritis and vasculitis. This variation in manifestation depends upon degree of vitiation of ''doshas'' and ''dhatu'' in each individual of unique ''prakriti''. This reflects each patient’s unique disease requiring specific personalized treatment which is unique to Ayurvedic system of management. The chapter has description of etiological factors along with types of ''vatashonita, purvarupa'' (prodromal symptoms), ''rupa'' (clinical features) of different types, ''rupa'' of ''dosha'' predominance, ''upadrava'' (complication) ,''sadhya-asadhyatva'' (prognosis), treatment of different types of ''vatashonita'', precautions during treatment as well as symptomatic treatment for relief in non-curable state of disease.
The chapter refers to ''vatashonita'' (or ''vatarakta''), a condition caused by vitiated [[vata]] [[dosha]] and [[rakta dhatu]]. As the disease is caused by predominantly vitiated ''vata'' and ''rakta'', it follows [[Vatavyadhi Chikitsa]] (''vatika'' disorder). The manifestations of ''vatashonita'' resemble various metabolic and connective tissue diseases like gout, inflammatory polyarthritis and vasculitis. This variation in manifestation depends upon degree of vitiation of ''doshas'' and ''dhatu'' in each individual of unique ''prakriti''. This reflects each patient’s unique disease requiring specific personalized treatment which is unique to Ayurvedic system of management. The chapter has description of etiological factors along with types of ''vatashonita, purvarupa'' (prodromal symptoms), ''rupa'' (clinical features) of different types, ''rupa'' of ''dosha'' predominance, ''upadrava'' (complication) ,''sadhya-asadhyatva'' (prognosis), treatment of different types of ''vatashonita'', precautions during treatment as well as symptomatic treatment for relief in non-curable state of disease.
'''Keywords''': ''Vata, rakta,'' gout, connective tissue diseases, inflammatory arthritis, polyarthritis, vasculitis.
'''Keywords''': ''Vata, rakta,'' gout, connective tissue diseases, inflammatory arthritis, polyarthritis, vasculitis.
The chapter explains various conditions of involvement of ''dosha, dushya'' and the site of vitiation. Treatment depends upon assessment and correction of these factors causing the conditions.
The chapter explains various conditions of involvement of ''dosha, dushya'' and the site of vitiation. Treatment depends upon assessment and correction of these factors causing the conditions.
== Sanskrit Text, Transliteration and English Translation ==
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Now we shall expound the chapter on treatment of ''vatashonita''. Thus, said Lord Atreya. [1–2]
Now we shall expound the chapter "Vatashonita (or vatarakta) Chikitsa" (Management of diseases involving vata and rakta). Thus said Lord Atreya. [1–2]
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Then with concentrated mind, looking like a flame of fire, Agnivesha asked him, “Sir, please explain the etiology, symptomatology and treatment of disease (''vatashonita'') which is a combination of ''vata'' and ''rakta'', and is like that of fire and wind. The teacher (Punarvasu) explained. [3–4]
Then with concentrated mind, looking like a flame of fire, Agnivesha asked him, “Sir, please explain the etiology, symptomatology and treatment of disease (''vatashonita'') which is a combination of ''vata'' and ''rakta'', and is like that of fire and wind. The teacher (Punarvasu) explained. [3–4]
=== Etiological factors ===
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Due to etiological factors described earlier and obstruction in passage by vitiated ''rakta'' the ''vata'' aggravates, which again vitiates the ''rakta'' and known as ''vatashonita'', having synonyms as ''khuda, vatabalasa'' and ''adhyavata''. [5-11]
Due to etiological factors described earlier and obstruction in passage by vitiated ''rakta'' the ''vata'' aggravates, which again vitiates the ''rakta'' and known as ''vatashonita'', having synonyms as ''khuda, vatabalasa'' and ''adhyavata''. [5-11]
=== Sites of affliction ===
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Near the ''parva sandhis'' (small joints of fingers), as blood vessels are in slanting pattern, the vitiated blood is stagnated there and thereafter the vitiated ''vata'' and ''rakta'' along with ''pitta'' etc. produce different types of ''vedana'' (unpleasant sensation like pain etc.) so that there are ''dukha'' (pain and other abnormal sensation) in the joints. The ''vedana'' (pain) is so severe, which is difficult to tolerate. [13–15]
Near the ''parva sandhis'' (small joints of fingers), as blood vessels are in slanting pattern, the vitiated blood is stagnated there and thereafter the vitiated ''vata'' and ''rakta'' along with ''pitta'' etc. produce different types of ''vedana'' (unpleasant sensation like pain etc.) so that there are ''dukha'' (pain and other abnormal sensation) in the joints. The ''vedana'' (pain) is so severe, which is difficult to tolerate. [13–15]
=== Premonitory symptoms ===
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There is excessive or absence of perspiration, blackishness of the body, poor or lack of tactile sensation, high intensity of pain on trauma, laxity of joints, lassitude, malaise, appearance of boils, feeling of heaviness, numbness and itching in knee, thigh, waist, shoulder, hands, legs and other joints of the body, appearance of pain in the joints and abatement (without treatment), discoloration of body, appearance of mandala (circular skin lesions) are the premonitory symptoms of ''vatashonita''. [16–18]
There is excessive or absence of perspiration, blackishness of the body, poor or lack of tactile sensation, high intensity of pain on trauma, laxity of joints, lassitude, malaise, appearance of boils, feeling of heaviness, numbness and itching in knee, thigh, waist, shoulder, hands, legs and other joints of the body, appearance of pain in the joints and abatement (without treatment), discoloration of body, appearance of mandala (circular skin lesions) are the premonitory symptoms of ''vatashonita''. [16–18]
=== Types of ''vatarakta'' ===
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As this is said there are two types of ''vatashonita'' - ''uttana'' (superficial) and ''gambhira'' (deep). The ''uttana'' is located in ''twaka'' (skin) and ''mamsa'' (muscles) while the ''gambhira'' is located in the deep tissues. [19]
As this is said there are two types of ''vatashonita'' - ''uttana'' (superficial) and ''gambhira'' (deep). The ''uttana'' is located in ''twaka'' (skin) and ''mamsa'' (muscles) while the ''gambhira'' is located in the deep tissues. [19]
=== Clinical features of ''uttana vatarakta'' (superficial type) ===
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Symptoms of ''uttana vatashonita'' are itching, burning sensation, pain, stretching sensation, piercing pain, fasciculation, feeling of constricting and the color of skin becomes blackish, red or coppery. [20]
Symptoms of ''uttana vatashonita'' are itching, burning sensation, pain, stretching sensation, piercing pain, fasciculation, feeling of constricting and the color of skin becomes blackish, red or coppery. [20]
=== Clinical features of ''gambhira vatarakta'' (deep type) ===
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Symptoms of ''gambhira vatashonita'' are – edema in the involved parts of the body, stiffness of joints, hardness of the part, severe pain inside, the color of the part involved becomes either blackish or coppery. There is burning sensation, pricking pain, fasciculation and finally the part become inflamed and ulcerated. When ''vayu'' reaches ''sandhi, asthi'' and ''majja'' (joints, bones and bone marrow) it causes severe pain and burning sensation. The forcefully moving ''vayu'' having reached the joints causes cutting nature of pain whereby making them crooked, produces limping or lameness while moving all over the body. When the symptoms of both types – ''uttana'' and ''gambhira'' are present in a patient, it should be considered as ''ubhayashrita'' (superficial and deep both). [21–23]
Symptoms of ''gambhira vatashonita'' are – edema in the involved parts of the body, stiffness of joints, hardness of the part, severe pain inside, the color of the part involved becomes either blackish or coppery. There is burning sensation, pricking pain, fasciculation and finally the part become inflamed and ulcerated. When ''vayu'' reaches ''sandhi, asthi'' and ''majja'' (joints, bones and bone marrow) it causes severe pain and burning sensation. The forcefully moving ''vayu'' having reached the joints causes cutting nature of pain whereby making them crooked, produces limping or lameness while moving all over the body. When the symptoms of both types – ''uttana'' and ''gambhira'' are present in a patient, it should be considered as ''ubhayashrita'' (superficial and deep both). [21–23]
=== Differential features as per ''dosha'' dominance ===
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When there is predominance of two dosha or all three dosha there will be combination of symptoms and etiological factors as well. [24–29]
When there is predominance of two dosha or all three dosha there will be combination of symptoms and etiological factors as well. [24–29]
=== Prognosis ===
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When there is recent onset and predominance of single ''dosha'', ''vatashonita'' is ''sadhya'' (curable). The disease arising from predominance of two ''dosha'' is ''yapya'' (palliable). The disease arising from predominance of all three ''dosha'' and has developed ''upadrava'' (complications) as well, is ''asadhya'' (incurable). [30]
When there is recent onset and predominance of single ''dosha'', ''vatashonita'' is ''sadhya'' (curable). The disease arising from predominance of two ''dosha'' is ''yapya'' (palliable). The disease arising from predominance of all three ''dosha'' and has developed ''upadrava'' (complications) as well, is ''asadhya'' (incurable). [30]
=== Complications ===
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Vitiated ''vata'' having reached the joints of extremities obstruct the way of the ''rakta'' and vitiated ''rakta'' obstructs the way of ''vata'', thus causes the unbearable pain and leads to death. [35]
Vitiated ''vata'' having reached the joints of extremities obstruct the way of the ''rakta'' and vitiated ''rakta'' obstructs the way of ''vata'', thus causes the unbearable pain and leads to death. [35]
=== Treatment principles ===
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In this condition, the blood should let out with ''shringa'' (horn), ''jalauka'' (leech application), ''suchi'' (needle), ''alabu'' (hollow bitter gourd), ''pracchana'' (scratching) or ''siravyadha'' (venesection) depending on morbidity and strength of the patient. [36]
In this condition, the blood should let out with ''shringa'' (horn), ''jalauka'' (leech application), ''suchi'' (needle), ''alabu'' (hollow bitter gourd), ''pracchana'' (scratching) or ''siravyadha'' (venesection) depending on morbidity and strength of the patient. [36]
=== Modes of ''raktamokshana'' ===
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If the symptoms and complications in ''vatashonita'' are not localised to a specific part rather are of fleeting nature, the blood should be let out with ''siravyadha'' (venesection) or by ''pracchana''. In case if there are ''angaglani'' (''anga shosha'' i.e.atrophy), dryness, and other symptoms of ''vata'' dominance, the bloodletting should not be done. [38]
If the symptoms and complications in ''vatashonita'' are not localised to a specific part rather are of fleeting nature, the blood should be let out with ''siravyadha'' (venesection) or by ''pracchana''. In case if there are ''angaglani'' (''anga shosha'' i.e.atrophy), dryness, and other symptoms of ''vata'' dominance, the bloodletting should not be done. [38]
=== Complications of blood letting in ''vata'' dominant condition ===
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Blood loss due to blood letting may cause aggravation of ''vata dosha'', leading to deep swelling, stiffness, tremors, disorders of ''sira'' and ''snayu'' (blood vessels and ligaments), debility and constriction of the part. If there is excessive blood loss, the complications like limping and other vāta disorders and even death will occur. Hence one should let the blood out in proper quantity, after proper oleation. [39–40]
Blood loss due to blood letting may cause aggravation of ''vata dosha'', leading to deep swelling, stiffness, tremors, disorders of ''sira'' and ''snayu'' (blood vessels and ligaments), debility and constriction of the part. If there is excessive blood loss, the complications like limping and other vāta disorders and even death will occur. Hence one should let the blood out in proper quantity, after proper oleation. [39–40]
=== General principles of management ===
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After proper oleation, ''vatarakta'' patient shall be treated with mild therapeutic purgation with unctuous substances or with dry substances (in case of excess oleated patient). After purgation, the patient should be given frequent ''basti'' (enema of medicated substances) including ''anuvasana basti'' (unctuous enema) and ''niruha basti'' (enema made from decoction of medicinal herbs). Besides fomentation, massage, ointments, food and ''sneha'' (unctuous substances) be given to the patient which do not cause burning sensation. Now listen; specific remedies. [41–42]
After proper oleation, ''vatarakta'' patient shall be treated with mild therapeutic purgation with unctuous substances or with dry substances (in case of excess oleated patient). After purgation, the patient should be given frequent ''basti'' (enema of medicated substances) including ''anuvasana basti'' (unctuous enema) and ''niruha basti'' (enema made from decoction of medicinal herbs). Besides fomentation, massage, ointments, food and ''sneha'' (unctuous substances) be given to the patient which do not cause burning sensation. Now listen; specific remedies. [41–42]
=== Specific treatment ===
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In the patients of ''vatarakta'' with ''vatakapha'' predominance, if cold pralepa is applied then there will be complications like burning sensation, swelling of the part, pain and itching due to stasis of the ''dosha'', like wise in the patients suffering from ''vatarakta'' with ''rakta'' and ''pitta'' predominance, if are applied with ''ushna dravya'' will cause ''daha'' (burning sensation), ''kleda'' (moistening) and tearing of the skin. Therefore, in cases of ''vatarakta'', the physician should apply the treatment measures after well considering the ''bala'' (strength) of the ''dosha''. [47–48]
In the patients of ''vatarakta'' with ''vatakapha'' predominance, if cold pralepa is applied then there will be complications like burning sensation, swelling of the part, pain and itching due to stasis of the ''dosha'', like wise in the patients suffering from ''vatarakta'' with ''rakta'' and ''pitta'' predominance, if are applied with ''ushna dravya'' will cause ''daha'' (burning sensation), ''kleda'' (moistening) and tearing of the skin. Therefore, in cases of ''vatarakta'', the physician should apply the treatment measures after well considering the ''bala'' (strength) of the ''dosha''. [47–48]
=== Contra-indications for ''vatarakta'' ===
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The patient of ''vatarakta'' should abstain from day sleep, exposure to heat, excessive physical exertion, coitus, eating of pungent, salty, sour, ''ushna, guru'' (difficult to digest) and ''abhishyandi'' food (food articles which after consumption are responsible for the excessive secretions in the body) substances. [49]
The patient of ''vatarakta'' should abstain from day sleep, exposure to heat, excessive physical exertion, coitus, eating of pungent, salty, sour, ''ushna, guru'' (difficult to digest) and ''abhishyandi'' food (food articles which after consumption are responsible for the excessive secretions in the body) substances. [49]
=== Dietary regimen ===
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Green vegetables like ''sunishnaka'' (Marsilia minula), ''vetagra'' (new buddings of Salix caprea), ''kakmachi'' (Solanaum nigrum) buddings of ''shatavari'' (new buddings of Asparagus racesmosa), ''vastuka'' (Chemopodium album), ''upodika'' and ''sauvarchala'' (Gynandropis pentaphylla), cooked with either ghee or ''mamsa rasa'' (soup of fleshes) can be given to the patients who are suited for these and followed by intake of milk of cow, buffaloes, or goats is beneficial. Thus, the treatment of ''vatarakta'' is said to be in brief, the same will be said again in details. [52–54]
Green vegetables like ''sunishnaka'' (Marsilia minula), ''vetagra'' (new buddings of Salix caprea), ''kakmachi'' (Solanaum nigrum) buddings of ''shatavari'' (new buddings of Asparagus racesmosa), ''vastuka'' (Chemopodium album), ''upodika'' and ''sauvarchala'' (Gynandropis pentaphylla), cooked with either ghee or ''mamsa rasa'' (soup of fleshes) can be given to the patients who are suited for these and followed by intake of milk of cow, buffaloes, or goats is beneficial. Thus, the treatment of ''vatarakta'' is said to be in brief, the same will be said again in details. [52–54]
=== Various formulations ===
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''Bala, atibala, meda, shatavari, atmagupta, kakoli, kshirakakoli, rasna, riddhima'' is to be taken in equal quantity and crushed then take one part ''kalka'', four times ghee and milk and mix it and carryout ''snehasiddhi''. This ''baladi ghrita'' alleviates ''vatarakta, hridroga'' (Cardiac disorders), ''pandu'' (anemia), ''visarpa'' (erysepales), ''kamala'' (jaundice) and ''jwara'' (fever). [56–57]
''Bala, atibala, meda, shatavari, atmagupta, kakoli, kshirakakoli, rasna, riddhima'' is to be taken in equal quantity and crushed then take one part ''kalka'', four times ghee and milk and mix it and carryout ''snehasiddhi''. This ''baladi ghrita'' alleviates ''vatarakta, hridroga'' (Cardiac disorders), ''pandu'' (anemia), ''visarpa'' (erysepales), ''kamala'' (jaundice) and ''jwara'' (fever). [56–57]
=== ''Parushaka'' ghee ===
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Decoction of ''trayamana, tamalaki'' (Phyllinthus niruri), ''kakoli, kshirkakoli, shatavari'' and ''kasheru'' (Scirpus kysoor) is to be prepared by using paste of same drugs and decoction of all to be taken with juice of ''parushaka'' (Grewia asciatica), ''draksha'' (Vitis vinifera), ''kashmarya'' (Gmelina arboria), ''ikshu'' (Saccharum officinarium) and ''vidarikanda'' (Pueraria tuberose) are to be taken in equal quantity. Add one part of ''kalka'', four times ghee, five times juice, and sixteen times cow’s milk and then cook it till the liquid part is dried, the ghee is separated. This ''parushaka ghrita'' alleviates vātarakta, wasting due to injury or trauma, ''visarpa'' and ''paittika jwara''. [58–60]
Decoction of ''trayamana, tamalaki'' (Phyllinthus niruri), ''kakoli, kshirkakoli, shatavari'' and ''kasheru'' (Scirpus kysoor) is to be prepared by using paste of same drugs and decoction of all to be taken with juice of ''parushaka'' (Grewia asciatica), ''draksha'' (Vitis vinifera), ''kashmarya'' (Gmelina arboria), ''ikshu'' (Saccharum officinarium) and ''vidarikanda'' (Pueraria tuberose) are to be taken in equal quantity. Add one part of ''kalka'', four times ghee, five times juice, and sixteen times cow’s milk and then cook it till the liquid part is dried, the ghee is separated. This ''parushaka ghrita'' alleviates vātarakta, wasting due to injury or trauma, ''visarpa'' and ''paittika jwara''. [58–60]
=== ''Jivaniya'' ghee ===
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Milk boiled with ''bala, shatavari, rasna, dashamula, peelu'' (Salva dorapersica), ''shyama, eranda'' and ''shalaparni'', alleviates ''vatika'' disorders (and ''vatarakta'') [81]
Milk boiled with ''bala, shatavari, rasna, dashamula, peelu'' (Salva dorapersica), ''shyama, eranda'' and ''shalaparni'', alleviates ''vatika'' disorders (and ''vatarakta'') [81]
=== ''Anulomana'' treatment ===
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For the ''anulomana'' of the ''dosha'' (downward movement of the ''mala dosha''), ''dharoshana dugdha'' (fresh warm milk) mixed with ''mutra'' (cow’s urine) should be given to drink, if the ''vata'' is ''avrita'' by the ''pitta'' and ''rakta'', the patient should be given fresh warm milk mixed with ''trivrita churna'' to drink. [82]
For the ''anulomana'' of the ''dosha'' (downward movement of the ''mala dosha''), ''dharoshana dugdha'' (fresh warm milk) mixed with ''mutra'' (cow’s urine) should be given to drink, if the ''vata'' is ''avrita'' by the ''pitta'' and ''rakta'', the patient should be given fresh warm milk mixed with ''trivrita churna'' to drink. [82]
=== Purgative formulations ===
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In case when ''vata'' is ''avrita'' with ''mala'' (waste products of the body) the patient should be given ''mridu virechana'' (mild purgatives) mentioned in [[Kalpa Sthana]] along with ''sneha'' (unctuous substances). [87]
In case when ''vata'' is ''avrita'' with ''mala'' (waste products of the body) the patient should be given ''mridu virechana'' (mild purgatives) mentioned in [[Kalpa Sthana]] along with ''sneha'' (unctuous substances). [87]
=== Importance of ''basti'' ===
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The wise physician should administer the following oils as ''basti'' (enema) or ''nasyam'' (nasal medication), ''abhyanga'' (massage) and ''parisheka'' to alleviate ''daha'' (burning sensation) and pain. [90]
The wise physician should administer the following oils as ''basti'' (enema) or ''nasyam'' (nasal medication), ''abhyanga'' (massage) and ''parisheka'' to alleviate ''daha'' (burning sensation) and pain. [90]
=== ''Madhuparnyadi tailam'' ===
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Decoction of four kg ''madhuyashti'' (Glycyrrhiza glabra) should be prepared and than 2.56 kg oil with equal quantity of milk be cooked with decoction in mild flame, during cooking ''kalka'' ( paste ) of ''shatapushpa, shatavari, murva, payasya'' (Holostemma rheedianum), ''aguru, chandana, shalparni, hansapadi''(Adiantum lunulatum), ''mansi, meda, mahameda, madhuparni'' (Tinospora cordifolia), ''kakoli, kshirakakoli, tamalaki, ṛiddhi,padmaka, jeevaka, risbhaka, jeevanti'' (Leptadenia reticulate), ''twak, patra, nakha'' (Helix aspera), ''sugandhabala'' (Pabonia podorata), ''prapondarika'' (Cassia absus), ''manjishtha, sariva, aindri'' (Citrullus colocynthis) and ''vitunnaka'' (Coriandrum sativum) be added. This ''madhuparnayadi tailam'' be used in four ways ''pana, nasyam, basti'' and ''snehana'' (intake, nasal medication, enema of medicated substance and massage with medicated oils) alleviates ''vatarakta'' associated with complications, pain in the body and disease spread all over the body. This oil is very effective in ''vatarakta'' with ''daha'' (burning sensation) caused by pitta and fever, it also promotes strength of the body and complexion. [91–95]
Decoction of four kg ''madhuyashti'' (Glycyrrhiza glabra) should be prepared and than 2.56 kg oil with equal quantity of milk be cooked with decoction in mild flame, during cooking ''kalka'' ( paste ) of ''shatapushpa, shatavari, murva, payasya'' (Holostemma rheedianum), ''aguru, chandana, shalparni, hansapadi''(Adiantum lunulatum), ''mansi, meda, mahameda, madhuparni'' (Tinospora cordifolia), ''kakoli, kshirakakoli, tamalaki, ṛiddhi,padmaka, jeevaka, risbhaka, jeevanti'' (Leptadenia reticulate), ''twak, patra, nakha'' (Helix aspera), ''sugandhabala'' (Pabonia podorata), ''prapondarika'' (Cassia absus), ''manjishtha, sariva, aindri'' (Citrullus colocynthis) and ''vitunnaka'' (Coriandrum sativum) be added. This ''madhuparnayadi tailam'' be used in four ways ''pana, nasyam, basti'' and ''snehana'' (intake, nasal medication, enema of medicated substance and massage with medicated oils) alleviates ''vatarakta'' associated with complications, pain in the body and disease spread all over the body. This oil is very effective in ''vatarakta'' with ''daha'' (burning sensation) caused by pitta and fever, it also promotes strength of the body and complexion. [91–95]
=== ''Sukumaraka tailam'' ===
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This ends explanation of ''sukumarakam tailam''.
This ends explanation of ''sukumarakam tailam''.
=== ''Amritadya tailam'' ===
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This explains ''amritadyam tailam''.
This explains ''amritadyam tailam''.
=== ''Mahapadma tailam'' ===
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This ends explanation of ''mahapadma tailam''.
This ends explanation of ''mahapadma tailam''.
=== ''Khuddaka padmaka tailam'' ===
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This ends explanation of ''khuddakapadmaka tailam''.
This ends explanation of ''khuddakapadmaka tailam''.
=== ''Shatapaki madhuka tailam'' ===
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This ends explanation of ''shatapakam madhuka tailam''.
This ends explanation of ''shatapakam madhuka tailam''.
=== ''Shatapaki'' or ''sahastrapaki bala tailam'' ===
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Oil 650 ml cooked in l2.56 liters of sour gruel with one fourth ''sarja rasa'' (resin of Shorea robusta) and then churned in plenty of water and separated. This oil is an excellent alleviator of discomfort of ''jwara'' and ''daha'' (fever and burning sensation). [121–122]
Oil 650 ml cooked in l2.56 liters of sour gruel with one fourth ''sarja rasa'' (resin of Shorea robusta) and then churned in plenty of water and separated. This oil is an excellent alleviator of discomfort of ''jwara'' and ''daha'' (fever and burning sensation). [121–122]
=== ''Pinda tailam'' ===
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This ends the explanation of ''pinda tailam''.
This ends the explanation of ''pinda tailam''.
=== ''Dashamula'' processed milk ===
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The milk boiled with decoction of ''dashamula'' alleviates pain immediately. Application of warm ghee on the body may remove ''vatika shula'' (pain caused by ''vata''). [124]
The milk boiled with decoction of ''dashamula'' alleviates pain immediately. Application of warm ghee on the body may remove ''vatika shula'' (pain caused by ''vata''). [124]
=== Various external applications ===
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After considering specific position and strength of vitiated ''dosha'', the physician who is well conversant in reasoning and variation should apply aforesaid treatment. [155]
After considering specific position and strength of vitiated ''dosha'', the physician who is well conversant in reasoning and variation should apply aforesaid treatment. [155]
=== Treatment of obstruction by excess ''meda'' and ''kapha'' ===
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One should use old wheat and barley to eat and ''sidhu, arishtha, sura, asava'' (medicated beverages) to drink and ''shilajatu'' (black bitumen), ''guggulu'' (commiphora mukul) and ''makshika'' as well. [159]
One should use old wheat and barley to eat and ''sidhu, arishtha, sura, asava'' (medicated beverages) to drink and ''shilajatu'' (black bitumen), ''guggulu'' (commiphora mukul) and ''makshika'' as well. [159]
=== Treatment of severe vitiation of ''rakta'' ===
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In ''gambhira vatarakta'' if blood is vitiated severely, it should be treated like vāta first and there after steps should be taken to pacify ''vatarakta''. [160]
In ''gambhira vatarakta'' if blood is vitiated severely, it should be treated like vāta first and there after steps should be taken to pacify ''vatarakta''. [160]
=== Treatment of complications ===
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The disordered part due to excessive aggravation of ''rakta'' and ''pitta'' get inflammed or torn and discharging blood or pus with property of burning sensation should be treated with incision, cleansing and healing applications. Complications should be managed according to their respective treatment (mentioned earlier). [161–162]
The disordered part due to excessive aggravation of ''rakta'' and ''pitta'' get inflammed or torn and discharging blood or pus with property of burning sensation should be treated with incision, cleansing and healing applications. Complications should be managed according to their respective treatment (mentioned earlier). [161–162]
=== Summary ===
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''Vatarakta'' is a group of inflammatory rheumatic diseases. Pathogenesis of these ailments is related to aggravation of v''ata dosha'' due to vitiation of ''rakta dhatu''. The primary sites of involvement are small joints of hands and feet.
''Vatarakta'' is a group of inflammatory rheumatic diseases. Pathogenesis of these ailments is related to aggravation of v''ata dosha'' due to vitiation of ''rakta dhatu''. The primary sites of involvement are small joints of hands and feet.
=== Etiological factors ===
==== Diet ====
Excess intake of salty, sour and pungent foods with spices and deep fried in oil are observed to cause the disease. The soft drinks with alkalis, excess consumption of fatty substances, alcohol, aquatic animals, dried flesh are known to vitiate ''rakta''. A study carried on 178 participants revealed that excess intake of ''amlarasa'' could be a risk factor for joint inflammation, dentine hypersensitivity, stomatitis, halitosis, heartburn and papules.<ref>Panara KB, Acharya R. Consequences of excessive use of Amlarasa (sour taste): A case-control study. AYU [serial online] 2014 [cited 2018 Aug 15];35:124-8.Sourced from: http://www.ayujournal.org/text.asp?2014/35/2/124/146204</ref> Consumption of astringent, pungent, bitter, ''ruksha'' food items (grains of low nutritional values and those with dry property) vitiate ''vata dosha''. Consumption of ''tikshna''<ref name= "multiple1">Yadavji Trikamji Acharya (edit.), Sushruta Samhita, Nidana Sthana Vatarakta Nidana chapter 1, verse 42 page 263; Chaukhambha Orientalia.8th reprint.2005.Varanasi.</ref> (sharply acting) and ''vidahi'' (which causes burning) are other factors responsible for vitiating ''rakta''.<ref name = "multiple2">Harishastri Paradkar Vaidya, Vagbhata Ashtanga Hridaya, Nidana Sthana chapter 16, verse 1. Reprint 2000. Krishanadas Academy, Varanasi 535</ref>
Excess intake of salty, sour and pungent foods with spices and deep fried in oil are observed to cause the disease. The soft drinks with alkalis, excess consumption of fatty substances, alcohol, aquatic animals, dried flesh are known to vitiate ''rakta''. A study carried on 178 participants revealed that excess intake of ''amlarasa'' could be a risk factor for joint inflammation, dentine hypersensitivity, stomatitis, halitosis, heartburn and papules.<ref>Panara KB, Acharya R. Consequences of excessive use of Amlarasa (sour taste): A case-control study. AYU [serial online] 2014 [cited 2018 Aug 15];35:124-8.Sourced from: http://www.ayujournal.org/text.asp?2014/35/2/124/146204</ref> Consumption of astringent, pungent, bitter, ''ruksha'' food items (grains of low nutritional values and those with dry property) vitiate ''vata dosha''. Consumption of ''tikshna''<ref name= "multiple1">Yadavji Trikamji Acharya (edit.), Sushruta Samhita, Nidana Sthana Vatarakta Nidana chapter 1, verse 42 page 263; Chaukhambha Orientalia.8th reprint.2005.Varanasi.</ref> (sharply acting) and ''vidahi'' (which causes burning) are other factors responsible for vitiating ''rakta''.<ref name = "multiple2">Harishastri Paradkar Vaidya, Vagbhata Ashtanga Hridaya, Nidana Sthana chapter 16, verse 1. Reprint 2000. Krishanadas Academy, Varanasi 535</ref>
The dietary habits like intake of food during indigestion (''ajirna''), incompatible food (''viruddhahara''), eating food before proper digestion of previous meal (''adhyashana'') are causes of vitiation of ''vata'' due to improper digestion and metabolism.
The dietary habits like intake of food during indigestion (''ajirna''), incompatible food (''viruddhahara''), eating food before proper digestion of previous meal (''adhyashana'') are causes of vitiation of ''vata'' due to improper digestion and metabolism.
==== Psychological factors ====
Anger is known to vitiate ''pitta'' and secondarily ''rakta''.
Anger is known to vitiate ''pitta'' and secondarily ''rakta''.
==== Lifestyle habits ====
Sleeping in daytime and vigil during the night; injuries, not purifying the body (by ''shodhana karma''); starvation, excess traveling, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges are responsible for vitiation of ''vata''.
Sleeping in daytime and vigil during the night; injuries, not purifying the body (by ''shodhana karma''); starvation, excess traveling, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges are responsible for vitiation of ''vata''.
The above factors can cause vitiation of blood by aggravation of its ''tikshna'' (sharply acting) property and vitiation of ''vata dosha'' by aggravation of its ''ruksha'' (dry) property. The properties like ''sukshma'' (minuteness) and ''sara'' (moving) of both ''vata'' and ''rakta'' are affected to cause the disease process. ''Drava'' (fluidity) of ''rakta'' is affected leading to obstruction in free movement of ''vata''.
The above factors can cause vitiation of blood by aggravation of its ''tikshna'' (sharply acting) property and vitiation of ''vata dosha'' by aggravation of its ''ruksha'' (dry) property. The properties like ''sukshma'' (minuteness) and ''sara'' (moving) of both ''vata'' and ''rakta'' are affected to cause the disease process. ''Drava'' (fluidity) of ''rakta'' is affected leading to obstruction in free movement of ''vata''.
=== Pathogenesis ===
The pathogenesis involves aggravation by ''avarana''(obstruction) of movement of ''vata'' by the vitiated ''rakta''. Therefore, the treatment is focused upon pacification of ''rakta'' to remove obstruction and pacification of ''vata''. The pathogenesis starts from small joints of lower extremities.<ref name = "multiple2" /> The onset of disease is acute and the vitiation of ''rakta'' occurs quickly. <ref name = "multiple1" />
The pathogenesis involves aggravation by ''avarana''(obstruction) of movement of ''vata'' by the vitiated ''rakta''. Therefore, the treatment is focused upon pacification of ''rakta'' to remove obstruction and pacification of ''vata''. The pathogenesis starts from small joints of lower extremities.<ref name = "multiple2" /> The onset of disease is acute and the vitiation of ''rakta'' occurs quickly. <ref name = "multiple1" />
=== Clinical features ===
#Pain, swelling, redness, increased temperature and tenderness of small joints especially thumb or big toes. This slowly spreads to affect all joints.
#Pain, swelling, redness, increased temperature and tenderness of small joints especially thumb or big toes. This slowly spreads to affect all joints.
Above features are observed at sites of joints, ligaments and blood vessels as per the ''dosha'' dominance in ''vatarakta''.
Above features are observed at sites of joints, ligaments and blood vessels as per the ''dosha'' dominance in ''vatarakta''.
==== Types ====
''Uttana vatarakta'' involves ''twacha'' (skin) and ''mamsa'' (muscular tissue). ''Gambhira vatarakta'' involves all other tissues. The ''uttana vatarakta'' progresses to ''gambhira vatarakta'' in due course of time.<ref name ="multiple1" />,<ref name ="multiple2" />
''Uttana vatarakta'' involves ''twacha'' (skin) and ''mamsa'' (muscular tissue). ''Gambhira vatarakta'' involves all other tissues. The ''uttana vatarakta'' progresses to ''gambhira vatarakta'' in due course of time.<ref name ="multiple1" />,<ref name ="multiple2" />
=== Differential diagnosis ===
''Vatarakta, amavata'' and ''sandhigata vata'' are three most common rheumatological clinical conditions. The clinical presentations need to be differentiated for diagnosis and designing treatment protocol.
''Vatarakta, amavata'' and ''sandhigata vata'' are three most common rheumatological clinical conditions. The clinical presentations need to be differentiated for diagnosis and designing treatment protocol.
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=== Constituent conditions of ''vatarakta'' ===
Rheumatoid arthritis and gout are two most common rheumatological conditions.
Rheumatoid arthritis and gout are two most common rheumatological conditions.
The treatment focus on correction of ''rakta-dhatvagni'', through which mechanisms in ''sira''(vessels) and ''kandara''(tendons) are corrected.
The treatment focus on correction of ''rakta-dhatvagni'', through which mechanisms in ''sira''(vessels) and ''kandara''(tendons) are corrected.
=== Investigations ===
#Serological investigations like Erythrocyte sedimentation rate, C-reactive protein, uric acid, quantitative and qualitative assessment of rheumatoid factor may be investigated as biomarkers.
#Serological investigations like Erythrocyte sedimentation rate, C-reactive protein, uric acid, quantitative and qualitative assessment of rheumatoid factor may be investigated as biomarkers.
#Ultrasound, histopathological study and angiography.
#Ultrasound, histopathological study and angiography.
=== Complications ===
Insomnia, permanent joint deformity, gangrene, necrosis, tumor can occur as complication of ''vatarakta''.
Insomnia, permanent joint deformity, gangrene, necrosis, tumor can occur as complication of ''vatarakta''.
=== Prognosis considering present developments in medicine ===
The disease with involvement of single ''dosha'' and new (diagnosed within one year) is curable. The disease with involvement of more than one ''dosha'' and chronic (more than one year) is palliable with medicines and appropriate therapies.
The disease with involvement of single ''dosha'' and new (diagnosed within one year) is curable. The disease with involvement of more than one ''dosha'' and chronic (more than one year) is palliable with medicines and appropriate therapies.
=== Management of diseases (Treatment protocols) ===
==== Principles of management ====
#''Basti'' (therapeutic enema): ''Basti'' with herbs of ''ruksha'' (dry) property or ''mridu'' (mild) property are used to treat both ''uttana'' (superficial) and ''gambhira'' (deep) types of ''vatarakta''.
#''Basti'' (therapeutic enema): ''Basti'' with herbs of ''ruksha'' (dry) property or ''mridu'' (mild) property are used to treat both ''uttana'' (superficial) and ''gambhira'' (deep) types of ''vatarakta''.
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==== Evidence based clinical practices ====
A study reviewing anti-rheumatic formulations showed that 247 formulations are enlisted in [[Ayurveda]] texts. ''rasnasaptaka kwath'', ''ajmodadi choorna, vatavidhvanasana rasa, vatari rasa, sinhanad guggulu, yogaraj guggulu, khandashunthyavaleha, amrit bhallatak, guggulu panchatikta ghrita, vishagarbha taila'' are common formulations used to treat rheumatic conditions. ''Yogaraja guggulu'' is used in 50% prescriptions <ref> A. A. Raut, A. D. Joshi, D. S. Antarkar, V. R. Joshi, A. B. Vaidya, Anti-Rheumatic Formulations From [[Ayurveda]] Ancient Science of Life, Vol No. XI No.1 & 2, July & October 1991, pp. 66 – 69 </ref> for rheumatic cases.
A study reviewing anti-rheumatic formulations showed that 247 formulations are enlisted in [[Ayurveda]] texts. ''rasnasaptaka kwath'', ''ajmodadi choorna, vatavidhvanasana rasa, vatari rasa, sinhanad guggulu, yogaraj guggulu, khandashunthyavaleha, amrit bhallatak, guggulu panchatikta ghrita, vishagarbha taila'' are common formulations used to treat rheumatic conditions. ''Yogaraja guggulu'' is used in 50% prescriptions <ref> A. A. Raut, A. D. Joshi, D. S. Antarkar, V. R. Joshi, A. B. Vaidya, Anti-Rheumatic Formulations From [[Ayurveda]] Ancient Science of Life, Vol No. XI No.1 & 2, July & October 1991, pp. 66 – 69 </ref> for rheumatic cases.
Another study was carried out to evaluate the antioxidant effect of five ''kashayams'' (''kwaths'' - decoctions) ''manjishtadi kashayam'' (MK), ''rasna erandadi kashayam'' (REK), ''sahacharadhi kashayam'' (SK), ''maharasnadi'' (or ''rasna dwiguna bhagam'') ''kashayam'' (MRK) and ''dhanwantharam kashayam'' (DK) used in the management of diseases manifested due to vitiation of ''vata'' and ''vatarakta'' (mostly diseases of connective tissues, bones, joints and nervous system). It concluded that the total phenolic content and the antioxidant property of the products justify the protective and corrective effects produced by the products in ''vata'' and ''vatarakta'' disorders. The phenolic content is highest in MK, followed by DK. The phenolic content of MRK, SK and REK are comparable <ref> Sruthi CV, Sindhu A. A comparison of the antioxidant property of fi ve Ayurvedic formulations commonly used in the management of vata vyadhis. J [[Ayurveda]] Integr Med 2012;3:29-32.</ref>. This shows the formulations act by scavenging the free radicals in rheumatic diseases.
Another study was carried out to evaluate the antioxidant effect of five ''kashayams'' (''kwaths'' - decoctions) ''manjishtadi kashayam'' (MK), ''rasna erandadi kashayam'' (REK), ''sahacharadhi kashayam'' (SK), ''maharasnadi'' (or ''rasna dwiguna bhagam'') ''kashayam'' (MRK) and ''dhanwantharam kashayam'' (DK) used in the management of diseases manifested due to vitiation of ''vata'' and ''vatarakta'' (mostly diseases of connective tissues, bones, joints and nervous system). It concluded that the total phenolic content and the antioxidant property of the products justify the protective and corrective effects produced by the products in ''vata'' and ''vatarakta'' disorders. The phenolic content is highest in MK, followed by DK. The phenolic content of MRK, SK and REK are comparable <ref> Sruthi CV, Sindhu A. A comparison of the antioxidant property of fi ve Ayurvedic formulations commonly used in the management of vata vyadhis. J [[Ayurveda]] Integr Med 2012;3:29-32.</ref>. This shows the formulations act by scavenging the free radicals in rheumatic diseases.
=== Potential areas /scope for further research ===
Study to evaluate the efficacy of ''basti'' and bloodletting therapies in the management of ''vatarakta'' is needed. Further studies to evaluate the effect of Ayurvedic formulations in management of ''vatarakta'' are needed.
Study to evaluate the efficacy of ''basti'' and bloodletting therapies in the management of ''vatarakta'' is needed. Further studies to evaluate the effect of Ayurvedic formulations in management of ''vatarakta'' are needed.
== References ==