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Line 1,889:
Line 1,889: − Pathogenesis :+ + − Clinical features:+ − Pain, swelling, redness, increased temperature and tenderness of small joints especially thumb or big toes. This slowly spreads to affect all joints. + − Itching, burning, pricking, pulsating, breaking pain in skin + − Greyish, copperish discolouration of skin+ − In case of involvement of deeper tissues, swelling, hardness of affected site, discoloration, suppuration, pulsating, pricking or burning sensation can occur. + − Above features are observed at sites of joints, ligaments and blood vessels as per the dosha dominance in vatarakta. + + + + − Differential diagnosis:+ Line 1,916:
Line 1,920: − Investigations:+ − Serological investigations like Erythrocyte sedimentation rate, C-reactive protein, uric acid, quantitative and qualitative assessment of rheumatoid factor may be investigated as biomarkers. + − Radiological investigations including X-rays of affected part+ − Ultrasound, histopathological study and angiography. + − Complications: + − Prognosis considering present developments in medicine:+ − Management of diseases (Treatment protocols) + − Principles of management: 1. Basti 2. Snehana 3. Raktamokshana+ − Main drugs: 1. Guduchi 2. Kokilaksha 3. Suranjan + Line 1,937:
Line 1,941: − Evidence based clinical practices: + − A study reviewing anti-rheumatic formulations showed that 247 formulations are enlisted in ayurveda texts. rasnasaptak kwath, ajmodadi choorna, vatavidhvanasan 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 for rheumatic cases. + − A research on vatarakta concluded that the notion of margavarana (obstruction in pathway) can be correlated to the pathology of atherosclerosis, and the state of uttana vatarakta to that of peripheral arterial disease. Identical therapeutic efficacy of kaishora guggulu and amrita guggulu was observed in thirty patients of uttana vatarakta. + − 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. This shows the formulations act by scavenging the free radicals in rheumatic diseases. +
→Vidhi Vimarsha
In general, the delicate persons who are indulged in sweet and rich food substances and are not in habit of physical activities, the vata and rakta are vitiated. Those who have sedentary lifestyles with least walking are most prone to vatarakta. 2,3,
In general, the delicate persons who are indulged in sweet and rich food substances and are not in habit of physical activities, the vata and rakta are vitiated. Those who have sedentary lifestyles with least walking are most prone to vatarakta. 2,3,
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.3 The onset of disease is acute and the vitiation of rakta occurs quickly.2
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.3 The onset of disease is acute and the vitiation of rakta occurs quickly.2
Clinical features:
Pain, swelling, redness, increased temperature and tenderness of small joints especially thumb or big toes. This slowly spreads to affect all joints.
Itching, burning, pricking, pulsating, breaking pain in skin
Greyish, copperish discolouration of skin
In case of involvement of deeper tissues, swelling, hardness of affected site, discoloration, suppuration, pulsating, pricking or burning sensation can occur.
Above features are observed at sites of joints, ligaments and blood vessels as per the dosha dominance in vatarakta.
Types:
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.2,3
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.2,3
Differential diagnosis:
Vatarakta, aamavata and sandhigata vata are three most common rheumatological clinical conditions. The clinical presentations need to be differentiated for diagnosis and designing treatment protocol.
Vatarakta, aamavata and sandhigata vata are three most common rheumatological clinical conditions. The clinical presentations need to be differentiated for diagnosis and designing treatment protocol.
Criteria Vatarakta Aamvata Sandhigata vata
Criteria Vatarakta Aamvata Sandhigata vata
Those patients with involvement of small joints of extremities resemble rheumatoid arthritis, on the other hand patients with mono-articular or oligo-articular arthritis and associated elevated uric acid resemble gout. There is a difference of opinion among ayurvedic physicians, some call vatarakta as gout and others call rheumatoid arthritis. Some ayurvedic physicians consider aamvata as rheumatoid arthritis. However, it can be observed that the patients diagnosed as rheumatoid arthritis show clinical features of vitiation of vata associated with kapha dosha. Whereas, the patients diagnosed as gouty arthritis show clinical features of vitiation of vata associated with pitta dosha. Therefore, the former case can be treated on the lines of vatarakta associated with kapha, while the latter can be treated on principles of vatarakta associated with pitta. On close observation it is noted that in aamvata there is involvement of large joins of extremities and sacroiliac joints which is consistent with rheumatoid variant or ankylosing spondylitis. Ayurvedic management depends upon correction of imbalance of dosha, dushya and prakriti of the individual and can be viewed as working through epigenetic pathway. On the other hand, modern medicine system works by antagonizing the pro-inflammatory proteins or acting through “genetic pathway”. It becomes clear that both systems achieve the objective using different ways. It can be compared to digging the tunnel from both sides. However, the direction of diagnosis and treatment needs to be clearly based upon clinical assessment of dosha dominance. The serological parameters can only be utilized for assessment of therapy.
Those patients with involvement of small joints of extremities resemble rheumatoid arthritis, on the other hand patients with mono-articular or oligo-articular arthritis and associated elevated uric acid resemble gout. There is a difference of opinion among ayurvedic physicians, some call vatarakta as gout and others call rheumatoid arthritis. Some ayurvedic physicians consider aamvata as rheumatoid arthritis. However, it can be observed that the patients diagnosed as rheumatoid arthritis show clinical features of vitiation of vata associated with kapha dosha. Whereas, the patients diagnosed as gouty arthritis show clinical features of vitiation of vata associated with pitta dosha. Therefore, the former case can be treated on the lines of vatarakta associated with kapha, while the latter can be treated on principles of vatarakta associated with pitta. On close observation it is noted that in aamvata there is involvement of large joins of extremities and sacroiliac joints which is consistent with rheumatoid variant or ankylosing spondylitis. Ayurvedic management depends upon correction of imbalance of dosha, dushya and prakriti of the individual and can be viewed as working through epigenetic pathway. On the other hand, modern medicine system works by antagonizing the pro-inflammatory proteins or acting through “genetic pathway”. It becomes clear that both systems achieve the objective using different ways. It can be compared to digging the tunnel from both sides. However, the direction of diagnosis and treatment needs to be clearly based upon clinical assessment of dosha dominance. The serological parameters can only be utilized for assessment of therapy.
The condition in which blood vessels, connective tissues and tendons are involved such as vasculitis along with thrombosis and embolism, Thrombo angiitis obliterans (Burger’s disease), Raynaud’s disease are also considered under the disease vatarakta. The treatment focus on correction of rakta-dhatvagni, through which mechanisms in sira(vessels) and kandara(tendons) are corrected.
The condition in which blood vessels, connective tissues and tendons are involved such as vasculitis along with thrombosis and embolism, Thrombo angiitis obliterans (Burger’s disease), Raynaud’s disease are also considered under the disease vatarakta. 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.
Radiological investigations including X-rays of affected part
Ultrasound, histopathological study and angiography.
Complications:
Insomnia, permanent joint deformity, gangrene, necrosis, tumour can occur as complication of vatarakta.
Insomnia, permanent joint deformity, gangrene, necrosis, tumour 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: 1. Basti 2. Snehana 3. Raktamokshana
Therapeutic purification:
Therapeutic purification:
Basti (therapeutic enema): Basti with herbs of ruksha (dry) property or mrudu (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 mrudu (mild) property are used to treat both uttana (superficial) and gambhira (deep) types of vatarakta.
Raktamokshana (bloodletting): Bloodletting is prescribed as per dosha dominance in vatarakta patients. This gives better results to remove obstruction and reduce vitiation of blood.
Raktamokshana (bloodletting): Bloodletting is prescribed as per dosha dominance in vatarakta patients. This gives better results to remove obstruction and reduce vitiation of blood.
Main drugs: 1. Guduchi 2. Kokilaksha 3. Suranjan
Type Name Dose Time Anupana
Type Name Dose Time Anupana
Vataja Kaishora guggulu 500-1000 mg Between two meals Kokilaksha kwatha + ghee + honey
Vataja Kaishora guggulu 500-1000 mg Between two meals Kokilaksha kwatha + ghee + honey
Kaphaja Guda-bhallataka-haritaki vati 1 -3 grams Before meals two times Milk or lukewarm water
Kaphaja Guda-bhallataka-haritaki vati 1 -3 grams Before meals two times Milk or lukewarm water
Evidence based clinical practices:
A study reviewing anti-rheumatic formulations showed that 247 formulations are enlisted in ayurveda texts. rasnasaptak kwath, ajmodadi choorna, vatavidhvanasan 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 for rheumatic cases.
A research on vatarakta concluded that the notion of margavarana (obstruction in pathway) can be correlated to the pathology of atherosclerosis, and the state of uttana vatarakta to that of peripheral arterial disease. Identical therapeutic efficacy of kaishora guggulu and amrita guggulu was observed in thirty patients of uttana vatarakta.
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. This shows the formulations act by scavenging the free radicals in rheumatic diseases.
Potential areas /scope for further research
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.