Changes

Vatarakta Chikitsa (view source)

Revision as of 22:33, 23 September 2021

176 bytes added , 22:33, 23 September 2021

→‎Potential areas /scope for further research

Line 37: Line 37:

<big>''' Abstract </big>'''

−

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.

+

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 [[dosha]] 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.

</div>

Line 45: Line 45:

== Introduction ==

−

After describing the chapter on various presentations of vata dominant disorders, the chapter on ''vata'' being afflicted by vitiated ''rakta'' is narrated. ''Vatashonita'' is caused by vitiated ''vata dosha'' and ''rakta'' which impede the ''gati'' (movement) of each other. It is also called as ''adhyaroga'' because it affects mainly affluent people who are not habitual to physical activity and indulged in factors responsible for vitiation of ''rakta''. People of ''pitta ~~prakriti''~~ (''pitta'' constitution) are prone to develop ''vatashonita'', because ''sukumaratva'' (youthful personality) is the characteristic feature of ''pitta ~~prakriti''~~.

+

After describing the chapter on various presentations of vata dominant disorders, the chapter on [[vata]] being afflicted by vitiated [[rakta]] is narrated. ''Vatashonita'' is caused by vitiated [[vata dosha]]and [[rakta]] which impede the ''gati'' (movement) of each other. It is also called as ''adhyaroga'' because it affects mainly affluent people who are not habitual to physical activity and indulged in factors responsible for vitiation of [[rakta]]. People of [[pitta]] [[Prakriti]] ([[pitta]] constitution) are prone to develop ''vatashonita'', because ''sukumaratva'' (youthful personality) is the characteristic feature of [[pitta]] [[Prakriti]].

−

In ''vatashonita'', there is abnormality in movements of ''vata dosha'' due to abnormality of ''rakta''. It is a group of inflammatory rheumatic disorders covering gouty arthritis, rheumatoid arthritis, connective tissue disorders, inflammatory polyarthritis, vasculitis depending upon the site of vitiation.

+

In ''vatashonita'', there is abnormality in movements of [[vata dosha]] due to abnormality of [[rakta]]. It is a group of inflammatory rheumatic disorders covering gouty arthritis, rheumatoid arthritis, connective tissue disorders, inflammatory polyarthritis, vasculitis depending upon the site of vitiation.

−

The vitiated factors impair ''agni'' (digestion and metabolism) at ''jatharagni'' and ''dhatvagni'' level. In ''vatarakta'', the vitiated ''vata dosha'' affects ''jatharagni'' to cause ''vishamagni'' and ''rakta dhatvagni''. This impairment leads to increase in blood and serological parameters like uric acid, C-reactive protein etc. These can be used as biomarkers for assessment of efficacy of therapy.

+

The vitiated factors impair [[agni]] (digestion and metabolism) at ''jatharagni'' and ''dhatvagni'' level. In ''vatarakta'', the vitiated [[vata dosha]] affects ''jatharagni'' to cause ''vishamagni'' and [[rakta]] dhatvagni. This impairment leads to increase in blood and serological parameters like uric acid, C-reactive protein etc. These can be used as biomarkers for assessment of efficacy of therapy.

−

In process of ''rakta-dhatvagni'', ''sira'' (vessels) and ''kandara'' (tendons) are byproducts. Therefore, impairment of ''rakta-dhatvagni'' leads to involvement of deep vessels and connective tissues. This indicates ''vatarakta'' also covers diseases like vasculitis along with thrombosis and embolism, Thromboangiitis obliterans (Burger’s disease), and Raynaud’s disease.

+

In process of [[rakta]]-dhatvagni, sira (vessels) and kandara (tendons) are byproducts. Therefore, impairment of [[rakta]]-dhatvagni leads to involvement of deep vessels and connective tissues. This indicates ''vatarakta'' also covers diseases like vasculitis along with thrombosis and embolism, Thromboangiitis obliterans (Burger’s disease), and Raynaud’s disease.

−

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 the assessment and correction of these factors causing the conditions.

== Sanskrit Text, Transliteration and English Translation ==

Line 72: Line 72:

</div></div>

−

Now we shall expound the chapter "Vatashonita (or vatarakta) Chikitsa" (Management of diseases involving vata and rakta). 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]

=== Agnivesha's query ===

Line 99: Line 99:

After finishing his daily worship and ''yagna'' (religious sacrifice), Punarvasu was sitting admidst the sages.

−

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 ===

Line 169: Line 169:

</div></div>

−

Excess intake of salty, sour, pungent, alkalies and fatty substances, hot food, consumption of rotten and dried flesh, fleshes of aquatic animals like fish, animals living in the area where there are dense forest and heavy rainfall, cake of oil seeds after extraction of oil (''pindyaka''), radish (Raphanus sativus), red gram, black gram, green vegetables, ''palala'' (grated flesh), sugarcane, curd, sour gruel, ''sauvira'' and ''shukta'' (vinegar), butter milk, ''sura'' and ''asava'' (alcohol and medicinal preparations having high concentration of alcohol), intake of food inspite of indigestion (''ajirna''), incompatible food (''viruddhahara''), eating food before proper digestion of previous one (''adhyashana''), anger, sleeping in daytime and vigil during the night; in general the delicate persons who are indulged in sweet and delicious food substances and are not in habit of physical activities, the ''vata'' and ''shonita'' vitiates.

+

Excess intake of salty, sour, pungent, alkalies and fatty substances, hot food, consumption of rotten and dried flesh, fleshes of aquatic animals like fish, animals living in the area where there are dense forest and heavy rainfall, cake of oil seeds after extraction of oil (''pindyaka''), radish (Raphanus sativus), red gram, black gram, green vegetables, ''palala'' (grated flesh), sugarcane, curd, sour gruel, ''sauvira'' and ''shukta'' (vinegar), butter milk, ''sura'' and ''asava'' (alcohol and medicinal preparations having high concentration of alcohol), intake of food inspite of indigestion (''ajirna''), incompatible food (''viruddhahara''), eating food before proper digestion of previous one (''adhyashana''), anger, sleeping in daytime and vigil during the night; in general the delicate persons who are indulged in sweet and delicious food substances and are not in habit of physical activities, the [[vata]] and ''shonita'' vitiates.

−

Due to injuries, not purifying the body (by ''shodhana karma'') and indulged in consuming astringent, pungent, bitter, ''ruksha'' food items (grains of low nutritional content), starvation, traveling by horses, camels and carts, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges are responsible for vitiation of ''vata''.

+

Due to injuries, not purifying the body (by ''shodhana karma'') and indulged in consuming astringent, pungent, bitter, ''ruksha'' food items (grains of low nutritional content), starvation, traveling by horses, camels and carts, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges are responsible for vitiation of [[vata]].

−

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 ===

Line 221: Line 221:

</div></div>

−

Due to subtleness and pervasiveness of ''vata'', and liquidity and flowing property of ''rakta'', they travel all over the body through blood vessels.

+

Due to subtleness and pervasiveness of [[vata]], and liquidity and flowing property of [[rakta]], they travel all over the body through blood vessels.

−

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 ===

Line 273: Line 273:

</div></div>

−

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 dhatu]] (muscles) while the ''gambhira'' is located in the deep tissues. [19]

=== Clinical features of ''uttana vatarakta'' (superficial type) ===

Line 323: Line 323:

</div></div>

−

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 [[vata]] reaches sandhi, [[asthi dhatu]] and [[majja dhatu]] (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 ===

+

=== Differential features as per [[dosha]] dominance ===

Line 384: Line 384:

</div></div>

−

Now listen the clinical features found in predominance of vata, rakta, pitta, kapha or in combination of two or all three dosha.

+

Now listen the clinical features found in predominance of [[vata]], [[rakta]], [[pitta]], [[kapha]] or in combination of two or all three [[dosha]].

−

If vata is predominant, there is sirayama (stretching sensation in sira or veins), pain, fasciculation, pricking pain, swollen part becomes blackish , dry , increasing and decreasing grayish hue, constrictions of dhamani (arteries, ligaments) of fingers, stiffness of body parts and intense pain, constriction, stiffness and hatred to cold by the patient. These are the symptoms of vata predominance.

+

If [[vata]] is predominant, there is sirayama (stretching sensation in sira or veins), pain, fasciculation, pricking pain, swollen part becomes blackish , dry , increasing and decreasing grayish hue, constrictions of dhamani (arteries, ligaments) of fingers, stiffness of body parts and intense pain, constriction, stiffness and hatred to cold by the patient. These are the symptoms of [[vata]] predominance.

−

If rakta is predominant, there is swelling, severe pain of pricking nature, tingling sensation, colour of part of skin becomes coppery, not diminished by application of either unctuous or dry substances associated with itching and moistening over the part.

+

If [[rakta]] is predominant, there is swelling, severe pain of pricking nature, tingling sensation, colour of part of skin becomes coppery, not diminished by application of either unctuous or dry substances associated with itching and moistening over the part.

−

If pitta is predominant, there is burning sensation over the part, pain, fainting, perspiration, thirst, narcosis, giddiness, redness of the part affected, pain of tearing nature, inflammation and atrophy of the part.

+

If [[pitta]] is predominant, there is burning sensation over the part, pain, fainting, perspiration, thirst, narcosis, giddiness, redness of the part affected, pain of tearing nature, inflammation and atrophy of the part.

−

If kapha is predominant there is feeling of wetness of the skin, heaviness, unctuousness, numbness and mild pain.

+

If [[kapha]] is predominant there is feeling of wetness of the skin, heaviness, unctuousness, numbness and mild pain.

−

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 ===

Line 407: Line 407:

</div></div>

−

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 ===

Line 466: Line 466:

</div></div>

−

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 ===

Line 512: Line 512:

</div></div>

−

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 ===

+

=== Complications of blood letting in [[vata]] dominant condition ===

Line 537: Line 537:

</div></div>

−

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 ===

Line 562: Line 562:

</div></div>

−

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 ===

Line 611: Line 611:

In case of ''uttana vatashonita'' affecting superficial tissues only, the patient should be treated with ''alepana'' (affected part is covered with medicinal paste), ''abhyanga'' (massage), ''parisheka'' (bathing in warm decoction or unctuous substances) and ''upanaha'' (application of poultice).

−

In the case of ''gambhira vatarakta'' the patient should be treated with purgation, ''asthapana basti'' (enema with decoction of medicinal plants) and ''snehapana'' (drinking medicated oil/ghee).

+

In the case of ''gambhira vatarakta'' the patient should be treated with purgation, asthapana [[basti]] (enema with decoction of medicinal plants) and snehapana(drinking medicated oil/ghee).

−

In the disease where the ''vata'' is predominant, one should over come the disease with medicated ghee, ''taila, vasa, majja'' (ghee, oil, fat, and bone marrow of animals) either by intake or massage or enema and the diseased part should be treated with warm ''upanaha'' (warm poultice).

+

In the disease where the [[vata]] is predominant, one should over come the disease with medicated ghee, taila, vasa, majja (ghee, oil, fat, and bone marrow of animals) either by intake or massage or enema and the diseased part should be treated with warm ''upanaha'' (warm poultice).

−

Where the ''rakta'' and ''pitta'' both are predominant, patient should be treated by mild purgation, after ''ghrita pana'' (intake of medicated ghee), intake of milk, bathing in decoction made from medicinal plants and ''basti'' (enema). The ~~''raktapitta''~~ dominance should be treated with cold and refrigerant ''alepa'' (paste of herbs).

+

Where the [[rakta]] and [[pitta]] both are predominant, patient should be treated by mild purgation, after ''ghrita pana'' (intake of medicated ghee), intake of milk, bathing in decoction made from medicinal plants and [[basti]] (enema). The [[rakta]]-[[pitta]] dominance should be treated with cold and refrigerant ''alepa'' (paste of herbs).

−

Where the ''kapha'' is predominant, in patient of ''vatarakta'' he should be treated with mild emesis and avoid excessive oleation, sudation and fasting. Lukewarm ''lepa'' (pastes of herbs) are useful. [43–46]

+

Where the [[kapha]] is predominant, in patient of ''vatarakta'' he should be treated with mild emesis and avoid excessive oleation, sudation and fasting. Lukewarm ''lepa'' (pastes of herbs) are useful. [43–46]

Line 640: Line 640:

</div></div>

−

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 [[vata]]-[[kapha]] 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'' ===

Line 976: Line 976:

</div></div>

−

Oil and ghee should be cooked separately with decoction of ''sthira'' (Desmodium gangeticum), ''shvadamishtra'' (Tribulus terrestris), ''brihati'' (Solanum indicum), ''sariva, shatavari, kashmarya, kapikachhu, vrischira'' (Boerhavia diffusa), ''bala'' and ''atibala'' with four times milk and paste of ''meda, shatavari, madhuyashti, jivanti, jivaka'' and ''rishabhaka''. Prepared ''yamaka'' (combination of two sneha) is kept. One part of ''yamaka'' (about 12 ml), three times milk and one and half times sugar mixed together and churned with the churning stick. This mixture should be given to the patient suffering from ~~''tridoshaja~~ vatarakta''. [76-78]

+

Oil and ghee should be cooked separately with decoction of ''sthira'' (Desmodium gangeticum), ''shvadamishtra'' (Tribulus terrestris), ''brihati'' (Solanum indicum), ''sariva, shatavari, kashmarya, kapikachhu, vrischira'' (Boerhavia diffusa), ''bala'' and ''atibala'' with four times milk and paste of ''meda, shatavari, madhuyashti, jivanti, jivaka'' and ''rishabhaka''. Prepared ''yamaka'' (combination of two sneha) is kept. One part of ''yamaka'' (about 12 ml), three times milk and one and half times sugar mixed together and churned with the churning stick. This mixture should be given to the patient suffering from tri[[dosha]]ja vatarakta. [76-78]

Line 1,034: Line 1,034:

</div></div>

−

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 ===

Line 1,059: Line 1,059:

</div></div>

−

In the patient whom dosha are excessively aggravated should be given ''eranda taila'' (castor oil) with milk for purgation. After digestion, the patient should be given rice with milk.

+

In the patient whom [[dosha]] are excessively aggravated should be given ''eranda taila'' (castor oil) with milk for purgation. After digestion, the patient should be given rice with milk.

One should be given decoction of ''abhaya'' (Terminalia chebula) fried with ghee of ''trivrita churna'' (powder of Operculina turpethum) either with milk or grape juice. [83–84]

Line 1,086: Line 1,086:

For purgation, decoction of ''kashmarya, trivrita, draksha'' and ''parushaka'' (Grewia asiatica) added with salt and honey should be given.

−

One should take decoction of ''triphala'' added with honey or decoction of ''amalaki, haridra'' and ''musta'' added with honey to the patients of ''kapha'' predominant ''vatarakta''. [85–86]

+

One should take decoction of ''triphala'' added with honey or decoction of ''amalaki, haridra'' and ''musta'' added with honey to the patients of [[kapha]] predominant ''vatarakta''. [85–86]

Line 1,100: Line 1,100:

</div></div>

−

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'' ===

+

=== Importance of [[basti]] ===

Line 1,116: Line 1,116:

</div></div>

−

''Mala'' (excrements) of the patients of ''vatarakta'' should be eliminated by administrating ''basti'' (enema) of ''ksheera'' (milk) mixed with ''ghrita''. There is no treatment of ''vatarakta'' efficient as ''basti''. [88]

+

[[Mala]] (excrements) of the patients of ''vatarakta'' should be eliminated by administrating [[basti]] (enema) of ''ksheera'' (milk) mixed with ''ghrita''. There is no treatment of ''vatarakta'' efficient as [[basti]]. [88]

Line 1,130: Line 1,130:

</div></div>

−

If the patient is suffering from pain in pelvis, groin, flanks, thighs, small joints, bones, upper abdomen and if there is ''udavarta, niruha basti'' (enema of decoction made from medicinal herbs) along with ''anuvasna basti'' (unctuous enema) are recommended. [89]

+

If the patient is suffering from pain in pelvis, groin, flanks, thighs, small joints, bones, upper abdomen and if there is udavarta, niruha [[basti]] (enema of decoction made from medicinal herbs) along with anuvasna [[basti]](unctuous enema) are recommended. [89]

Line 1,144: Line 1,144:

</div></div>

−

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 [[nasya]] (nasal medication), abhyanga (massage) and parisheka to alleviate daha (burning sensation) and pain. [90]

=== ''Madhuparnyadi tailam'' ===

Line 1,202: Line 1,202:

</div></div>

−

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, [[nasya]], [[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'' ===

Line 1,520: Line 1,520:

</div></div>

−

Take decoction of ''bala'', paste of ''bala'', milk and oil and cook till ''siddha lakshana'' is observed. The process should be repeated either hundred or thousand times. This ''bala taila'' alleviates ''vatarakta'' and ''vata'' disorders. It is an excellent ''rasayana'', which is very good promoter of sensual well being, vitaliser, promote body build, very well for voice, and alleviates ~~''sukra'' (semen) and ''asriga'' (~~menstrual) disorders. [119–120]

+

Take decoction of ''bala'', paste of ''bala'', milk and oil and cook till ''siddha lakshana'' is observed. The process should be repeated either hundred or thousand times. This ''bala taila'' alleviates ''vatarakta'' and [[vata]] disorders. It is an excellent [[rasayana]], which is very good promoter of sensual well being, vitaliser, promote body build, very well for voice, and alleviates [[shukra dhatu]] elated as well as [[menstrual disorders]]. [119–120]

Line 1,585: Line 1,585:

</div></div>

−

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 ===

Line 1,730: Line 1,730:

</div></div>

−

''Prapaundarika, manjishtha, daru haridra, madhuka, chandana, ereka, saktu'' (flour of roasted grains), ''masura'' (lentil), uśira and padmaka all are crushed (and made paste with water), its paste is applied on the body, it alleviates pain, burning sensation, ''visarpa'' (cellulitis or erysipalus), redness, ''shopha'' (inflammation). This formulation is beneficial in ''pitta'' and ''rakta'' predominant ''vatarakta''. Porridge of green gram prepared with milk, unctuous substance and ''vata'' subjugator herbs or poultice prepared with sesame and mustard alleviate pain of ''vata'' predominant ''vatarakta''. [134–136]

+

''Prapaundarika, manjishtha, daru haridra, madhuka, chandana, ereka, saktu'' (flour of roasted grains), ''masura'' (lentil), uśira and padmaka all are crushed (and made paste with water), its paste is applied on the body, it alleviates pain, burning sensation, ''visarpa'' (cellulitis or erysipalus), redness, ''shopha'' (inflammation). This formulation is beneficial in [[pitta]] and [[rakta]] predominant ''vatarakta''. Porridge of green gram prepared with milk, unctuous substance and [[vata]] subjugator herbs or poultice prepared with sesame and mustard alleviate pain of [[vata]] predominant ''vatarakta''. [134–136]

Line 1,781: Line 1,781:

</div></div>

−

If the paste of either seeds of ''eranda'' or ''uma'' (Foeniculum vulgare) mashed with goat’s milk, applied on the body relieves pain caused by predominance of ''vata'' in ''vatarakta''. [140]

+

If the paste of either seeds of ''eranda'' or ''uma'' (Foeniculum vulgare) mashed with goat’s milk, applied on the body relieves pain caused by predominance of [[vata]] in ''vatarakta''. [140]

Line 1,836: Line 1,836:

</div></div>

−

In case of ''kapha'' predominant ''vatarakta'' with swelling, heaviness, and itching etc. than the part be applied ghr̥ta which is cooked with ~~''mutra'' (~~cow’s urine), alkalies and wine. [145]

+

In case of [[kapha]] predominant ''vatarakta'' with swelling, heaviness, and itching etc. than the part be applied ghr̥ta which is cooked with cow’s urine, alkalies and wine. [145]

Line 1,850: Line 1,850:

</div></div>

−

''Ghrita'' cooked with ''padmaka, tvak, madhuka sariva'' and ''madhushukta'' (type of vinegar) be mixed with prepared ''ghrita''. This formulation is useful if sprinkled and massaged in ''kapha'' predominant ''vatarakta''. [146]

+

''Ghrita'' cooked with ''padmaka, tvak, madhuka sariva'' and ''madhushukta'' (type of vinegar) be mixed with prepared ''ghrita''. This formulation is useful if sprinkled and massaged in [[kapha]] predominant ''vatarakta''. [146]

Line 1,864: Line 1,864:

</div></div>

−

Alkalies, oil, urine, pungent herbs and water in equal quantity and decocted. ''Parisheka'' (sprinkling) of this decoction is beneficial in ''kapha'' predominant ''vatarakta'' and this is well praised. [147]

+

Alkalies, oil, urine, pungent herbs and water in equal quantity and decocted. ''Parisheka'' (sprinkling) of this decoction is beneficial in [[kapha]] predominant ''vatarakta'' and this is well praised. [147]

Line 1,892: Line 1,892:

</div></div>

−

Paste preparation from ''grihadhumo'' (soot), ''vacha, kushtha, shatahva, haridra'' and ''daru haridra'' alleviates pain of ''vata kapha'' predominant ''vatarakta''. [149]

+

Paste preparation from ''grihadhumo'' (soot), ''vacha, kushtha, shatahva, haridra'' and ''daru haridra'' alleviates pain of [[vata]]- [[kapha]] predominant vatarakta. [149]

Line 1,906: Line 1,906:

</div></div>

−

''Tagara, tvak, satahva, ela, kushtha, mushta, harenuka, devadaru, vyaghranakha'' (Capparis sepiaria), all these are pounded with sour liquid and applied as a paste, alleviates ''vata kapha'' predominant ''vatarakta''. [150]

+

''Tagara, tvak, satahva, ela, kushtha, mushta, harenuka, devadaru, vyaghranakha'' (Capparis sepiaria), all these are pounded with sour liquid and applied as a paste, alleviates [[vata]] [[kapha]] predominant ''vatarakta''. [150]

Line 1,920: Line 1,920:

</div></div>

−

Seeds of sweet ''shigru'' triturated with ''dhanyamla'' (sour gruel) and paste applied on the part of the body for a while and then washed with sour liquid in ''vata kapha'' predominant ''vatarakta'' (to alleviate pain). [151]

+

Seeds of sweet ''shigru'' triturated with ''dhanyamla'' (sour gruel) and paste applied on the part of the body for a while and then washed with sour liquid in [[vata]] [[kapha]] predominant ''vatarakta'' (to alleviate pain). [151]

Line 1,952: Line 1,952:

</div></div>

−

''Triphala, vyosha'' (''trikatu''), ''patra'' (Cinnamomum lamella), ''ela, tvakkshiri'' (Bambusa arundinacia), ''chitraka, vacha'', ''vidanga, pippalimula, romasha'' (''kasheesa''), bark of ''adulsa'' (Adhatoda vasica), ''riddhi, tamalaki'' and ''chavya'', take all in equal quantity and crushed. The powder of all herbs is pasted on the iron utensil in early morning and be eaten in the noon. During this treatment one should avoid curd, vinegar, alkalies and incompatible food items. It is very efficacious in removing pain of ''vatarakta'' caused by all ''dosha''. [152–154]

+

''Triphala, vyosha'' (''trikatu''), ''patra'' (Cinnamomum lamella), ''ela, tvakkshiri'' (Bambusa arundinacia), ''chitraka, vacha'', ''vidanga, pippalimula, romasha'' (''kasheesa''), bark of ''adulsa'' (Adhatoda vasica), ''riddhi, tamalaki'' and ''chavya'', take all in equal quantity and crushed. The powder of all herbs is pasted on the iron utensil in early morning and be eaten in the noon. During this treatment one should avoid curd, vinegar, alkalies and incompatible food items. It is very efficacious in removing pain of ''vatarakta'' caused by all [[dosha]]. [152–154]

Line 1,966: Line 1,966:

</div></div>

−

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'' ===

+

=== Treatment of obstruction by excess [[meda dhatu]] and [[kapha]] ===

Line 1,991: Line 1,991:

</div></div>

−

If ''vata'' is vitiated due to obstruction either by excessive aggravated ''meda'' or ''kapha'', one should not apply unctuous and stouting drugs in the beginning. Instead ''kapha'' and ''meda'' subjugate with physical exercises, ''shodhana'' (purification), ''virechana'' (purgation), and intake of ''arishta'' (fermentated preparation of medicinal herbs etc.) and butter milk with ''abhaya''.[156-157]

+

If [[vata]] is vitiated due to obstruction either by excessive aggravated [[meda dhatu]] or [[kapha]], one should not apply unctuous and stouting drugs in the beginning. Instead [[kapha]] and [[meda dhatu]] subjugate with physical exercises, shodhana (purification), [[virechana]] (purgation), and intake of arishta (fermentated preparation of medicinal herbs etc.) and butter milk with abhaya.[156-157]

Line 2,005: Line 2,005:

</div></div>

−

One should take decoction of ''bodhivriksa'' with honey. It vanquishes severe ''vatarakta'' even caused by all three ''dosha''. [158]

+

One should take decoction of ''bodhivriksa'' with honey. It vanquishes severe ''vatarakta'' even caused by all three [[dosha]]. [158]

Line 2,021: Line 2,021:

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'' ===

+

=== Treatment of severe vitiation of [[rakta]] ===

Line 2,060: Line 2,060:

</div></div>

−

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 ===

Line 2,100: Line 2,100:

</div></div>

−

In this chapter of ''vatarakta'' the etiological factors, location and root, reason for its prevalence of aggravation in general in joints, prodromal symptoms, clinical features, symptoms of both types (''uttana'' and ''gambhira''), different symptom produced by the ~~''doshic''~~ predominance and complications, prognostic description of different stages of the disease (''sadhya, yapya'' and ''asadhya''), management of ''sadhya vatarakta'' (curable ''vatarakta'') and symptomatic treatment of all stages as well has been described in brief and details by the great sage Atreya for Agnivesha.

+

In this chapter of ''vatarakta'' the etiological factors, location and root, reason for its prevalence of aggravation in general in joints, prodromal symptoms, clinical features, symptoms of both types (''uttana'' and ''gambhira''), different symptom produced by the [[dosha]] predominance and complications, prognostic description of different stages of the disease (''sadhya, yapya'' and ''asadhya''), management of ''sadhya vatarakta'' (curable ''vatarakta'') and symptomatic treatment of all stages as well has been described in brief and details by the great sage Atreya for Agnivesha.

Thus ends the 29th Chapter ([[Vatarakta Chikitsa]]) in [[Chikitsa Sthana]] in treatise composed by Agnivesha, redacted by Charak and reconstructed by Dridhabala. [163–165]

Line 2,106: Line 2,106:

== Tattva Vimarsha (Fundamental Principles) ==

−

#''Vatashonita'' occurs when aggravated ''vata'' is afflicted with vitiated ''shonita''. ''Vata'' is the constantly moving and ''shonita'' is also constantly flowing tissue, both need clear passage for uninterrupted movement. There is simultaneous aggravation of ''vata'', vitiation of ''rakta'' and damage to potency of channels (arteries and veins). When channels pass through narrow and circuitous path of small joints, vitiated ''rakta'' and aggravated ''vata'' gets seated there to start inflammation of local tissues.

+

#''Vatashonita'' occurs when aggravated [[vata]] is afflicted with vitiated ''shonita''. [[Vata]] is the constantly moving and ''shonita'' is also constantly flowing tissue, both need clear passage for uninterrupted movement. There is simultaneous aggravation of [[vata]], vitiation of [[rakta]] and damage to potency of channels (arteries and veins). When channels pass through narrow and circuitous path of small joints, vitiated [[rakta]] and aggravated [[vata]] gets seated there to start inflammation of local tissues.

−

#A combination of ''vata'' aggravating factors and ''pitta-rakta'' vitiating factors gives rise to ''vatarakta''.

+

#A combination of [[vata]] aggravating factors and [[pitta]]-[[rakta]] vitiating factors gives rise to vatarakta.

−

#Etiological factors of ''vata'' vitiation are ''virudha ahara'' (incompatible food), ''adhyasana'' (taking food before complete digestion of previous one), ''ratri jagrana'' (vigil in night), ''kashaya'' (astringent), ''katu'' (pungents), ''tikta'' (bitter), ''alpabhojana'' (inadequate quantity of food), ''ruksha bhojana'' (food substances of low nutritional values), ''abhojana'' (starvation), excess travelling in uncomfortable vehicles, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges.

+

#Etiological factors of [[vata]] vitiation are ''virudha ahara'' (incompatible food), ''adhyasana'' (taking food before complete digestion of previous one), ''ratri jagrana'' (vigil in night), ''kashaya'' (astringent), ''katu'' (pungents), ''tikta'' (bitter), ''alpabhojana'' (inadequate quantity of food), ''ruksha bhojana'' (food substances of low nutritional values), ''abhojana'' (starvation), excess travelling in uncomfortable vehicles, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges.

−

#''Pitta, shonita'' and ''shonita vaha srotasa'', vitiating factors are ''lavana, amla, katu, kshara, ushna bhojana, ajeerna bhojana'' (salty, sour, pungent, alkaline, fatty substances, very hot food, taking food during indigestion), various pulses (''kulattha, masha'' etc), various beverages having quite good percentage of alcohol, excess walking in hot season, vigil during night are responsible for vitiation of ''pitta dosha'' as well as ''shonita'' and ''shonita vaha srotasa''.

+

#[[Pitta]], shonita and ''shonita vaha srotasa'', vitiating factors are ''lavana, amla, katu, kshara, ushna bhojana, ajeerna bhojana'' (salty, sour, pungent, alkaline, fatty substances, very hot food, taking food during indigestion), various pulses (''kulattha, masha'' etc), various beverages having quite good percentage of alcohol, excess walking in hot season, vigil during night are responsible for vitiation of ''pitta dosha'' as well as ''shonita'' and ''shonita vaha srotasa''.

−

#''Pitta'' predominant person leading a delicate life style is more susceptible for early progression of ''vatarakta''.

+

#[[Pitta]] predominant person leading a delicate life style is more susceptible for early progression of ''vatarakta''.

#There are two types of ''vatashonita'':

##''Uttana'' or superficial, located in blood vessels between skin and muscles. It manifests as itching, burning, piercing pain in skin, constricting and expanding sensation of skin, black red and coppery boils of skin, and

##''Gambhira'' or deep: Located in blood vessels of small joints of extremities but more in lower extremities and big toe is most affected. Manifested inflammation, hard, non- shifting and painful, pulsating inflammation with coppery black color and cause of disability.

−

#Based on ''dosha, vatshonita'' is classified into four types, three of them due to one ''dosha'' and one due to three ''dosha'', the last one is incurable.

+

#Based on [[dosha]], vatshonita is classified into four types, three of them due to one [[dosha]] and one due to three [[dosha]], the last one is incurable.

−

#Treatment is four-fold with six types of blood letting, therapeutic purgation, purifying enema and palliative treatment for ''vata''.

+

#Treatment is four-fold with six types of blood letting, therapeutic purgation, purifying enema and palliative treatment for [[vata]].

−

#In ''vatarakta, rakta'' obstructs pathway of ''vata'' and vice-versa i.e. ''vata'' obstructing pathway of ''rakta''. Bloodletting helps in the movement of ''vata''.

+

#In ''vatarakta, rakta'' obstructs pathway of [[vata]] and vice-versa i.e. [[vata]] obstructing pathway of [[rakta]]. Bloodletting helps in the movement of [[vata]].

#The purgation should be mild because strong purgation may cause ''vataprakopa''.

−

#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.

+

#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.

−

#In case of ''uttana vata shonita'' affecting superficial tissues only, the patient should be treated with ''alepana'' (affected part is covered with medicinal paste), ''abhyanga'' (massage), ''parisheka'' (bathing in warm decoction or unctuous substances) and ''upanaha'' (application of poultice).

+

#In case of uttana vata shonita affecting superficial tissues only, the patient should be treated with ''alepana'' (affected part is covered with medicinal paste), ''abhyanga'' (massage), ''parisheka'' (bathing in warm decoction or unctuous substances) and ''upanaha'' (application of poultice).

−

#In the case of ''gambhira vata rakta'' the patient should be treated with purgation, ''asthapana basti'' (enema with decoction of medicinal plants) and ''snehapana'' (drinking medicated oil/ghee).

+

#In the case of gambhira vata rakta the patient should be treated with purgation, asthapana [[basti]](enema with decoction of medicinal plants) and [[snehapana]] (drinking medicated oil/ghee).

−

#In the disease where the ''vata'' is predominant, one should over come the disease with medicated ghee, ''taila, vasa, majja'' (ghee, oil, fat, and bone marrow of animals) either by intake or massage or enema and the diseased part should be treated with warm ''upanaha'' (warm poultice).

+

#In the disease where the [[vata]] is predominant, one should over come the disease with medicated ghee, taila, vasa, majja(ghee, oil, fat, and bone marrow of animals) either by intake or massage or enema and the diseased part should be treated with warm ''upanaha'' (warm poultice).

−

#Where the ''rakta'' and ''pitta'' both are predominant, patient should be treated by mild purgation, after ''ghrita pana'' (intake of medicated ghee), intake of milk, bathing in decoction made from medicinal plants and ''basti'' (enema). The ''raktapitta'' should be treated with cold and refrigerant ''alepam'' (paste of herbs).

+

#Where the [[rakta]] and [[pitta]] both are predominant, patient should be treated by mild purgation, after ''ghrita pana'' (intake of medicated ghee), intake of milk, bathing in decoction made from medicinal plants and ''basti'' (enema). The ''raktapitta'' should be treated with cold and refrigerant ''alepam'' (paste of herbs).

−

#Where the ''kapha'' is predominant, patient of ''vatarakta'' should be treated with mild emesis and avoid excessive oleation, sudation and fasting. Luke warm ''lepa'' (pastes of herbs) are useful.

+

#Where the [[kapha]] is predominant, patient of ''vatarakta'' should be treated with mild emesis and avoid excessive oleation, sudation and fasting. Luke warm ''lepa'' (pastes of herbs) are useful.

#External application of unctuous substances like ghee and oil processed with herbs having cold potency, sweet and bitter tastes are effective to reduce burning sensation.

−

#If ''vata'' is vitiated due to obstruction either by excessive aggravated ''meda'' or ''kapha'', one should not apply unctuous and stouting drugs in the beginning. Instead ''kapha'' and ''meda'' subjugate with physical exercises, ''shodhana'' (purification), ''virechana'' (purgation), and intake of ''arishta'' (fermentated preparation of medicinal herbs etc.) and butter milk with ''abhaya''.

+

#If [[vata]] is vitiated due to obstruction either by excessive aggravated [[meda dhatu]] or [[kapha]], one should not apply unctuous and stouting drugs in the beginning. Instead [[kapha]] and [[meda dhatu]] subjugate with physical exercises, ''shodhana'' (purification), [[virechana]] (purgation), and intake of ''arishta'' (fermentated preparation of medicinal herbs etc.) and butter milk with ''abhaya''.

== Vidhi Vimarsha (Applied Inferences ) ==

−

''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 [[vata dosha]] due to vitiation of [[rakta dhatu]]. The primary sites of involvement are small joints of hands and feet.

=== Etiological factors ===

Line 2,134: Line 2,134:

==== 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">Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Adhyaya verse 42. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref> (sharply acting) and ''vidahi'' (which causes burning) are other factors responsible for vitiating ''rakta''.<ref name = "multiple2">Vagbhata. Nidana Sthana, Cha.16 Vatavyadhi Nidana Adhyaya verse 1. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.page no: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">Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Adhyaya verse 42. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref> (sharply acting) and ''vidahi'' (which causes burning) are other factors responsible for vitiating [[rakta]].<ref name = "multiple2">Vagbhata. Nidana Sthana, Cha.16 Vatavyadhi Nidana Adhyaya verse 1. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.page no: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]].

−

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''. <ref name = "multiple1" />,<ref name = "multiple2" />,<ref name = "multiple3">Madhavakara Vata rakta Nidana. In:Brahmananda Tripathi ,editor,Madhava Nidana. Volume I,?ed,Varanasi:Chaukhambha Sanskrit Pratishthana.2002. Pg.556-563 </ref>

+

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''. <ref name = "multiple1" />,<ref name = "multiple2" />,<ref name = "multiple3">Madhavakara Vata rakta Nidana. In:Brahmananda Tripathi ,editor,Madhava Nidana. Volume I,?ed,Varanasi:Chaukhambha Sanskrit Pratishthana.2002. Pg.556-563 </ref>

−

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 ===

Line 2,161: Line 2,161:

#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''.

+

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 dhatu]] (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.

{| class="wikitable"

Line 2,178: Line 2,178:

! scope="col"| ''Sandhigata Vata''

|-

−

| ''Dosha''

+

| [[Dosha]]

−

| ''Vata'' associated with ''pitta''

+

| [[Vata]] associated with [[pitta]]

−

| ''Vata'' associated with ama, mainly kapha

+

| [[Vata]] associated with ama, mainly kapha

−

| ''Vata'' associated with ''vata''

+

| [[Vata]] associated with [[vata]]

|-

| ''Dushya''

−

| ''Rakta'',''Twak'', ''Mamsa''

+

| [[Rakta dhatu]],Twak, [[Mamsa dhatu]]

−

| ''Rasa''

+

| [[Rasa dhatu]]

−

| ''Asthi'',''Majja''

+

| [[Asthi dhatu]],[[Majja dhatu]]

|-

| Clinical Features

Line 2,219: Line 2,219:

|-

| Treatment

−

| ''Sneha, virechana, basti'' with drugs of mild property, ''raktamokshana''

+

| Sneha, [[virechana]], [[basti]] with drugs of mild property, ''raktamokshana''

−

| ''Langhana, basti'' with drugs of sharp acting property

+

| [[Langhana]], [[basti]] with drugs of sharp acting property

−

| ''Snehana, basti, brimhana''

+

| [[Snehana]], [[basti]], [[brimhana]]

|}

Line 2,228: Line 2,228:

Rheumatoid arthritis and gout are two most common rheumatological conditions.

−

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 ''amavata'' 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 ''amavata'' 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 ''amavata'' 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 ''amavata'' 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''.

Line 2,246: Line 2,246:

=== 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) ===

Line 2,252: Line 2,252:

==== 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''.

−

#''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:

Line 2,268: Line 2,268:

! scope="col"| Anupana

|-

−

| ~~''Vataja''~~

+

| [[Vata]]ja

| ''Kaishora guggulu''

| 500-1000 mg

Line 2,274: Line 2,274:

| ''Kokilaksha kwatha'' + ghee + honey

|-

−

| ~~''Pittaja''~~ and ~~''Raktaja''~~

+

| [[Pitta]]ja and [[Rakta]]ja

| ''Mauktika kamduha''

| 60-250 mg

Line 2,280: Line 2,280:

| Milk and ''guduchi kwatha''

|-

−

| ~~''Kaphaja''~~

+

| [[Kapha]]ja

| ''Gud-Bhallataka-haritaki vati''

| 1-3 grams

Line 2,293: Line 2,293:

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''. <ref> Ramachandran AP, Prasad SM, Prasad U N, Jonah S. A comparative study of Kaishora Guggulu and Amrita Guggulu in the management of Utthana Vatarakta. AYU [serial online] 2010 [cited 2018 Aug 15];31:410-6. Available from: http://www.ayujournal.org/text.asp?2010/31/4/410/82027 </ref>

−

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.

−

+

<big>'''[[Special:ContactMe|Send us your suggestions and feedback on this page.]]'''</big>

+

== References ==

Eganeesh

2,062

edits

Changes

Vatarakta Chikitsa (view source)

Revision as of 22:33, 23 September 2021

Navigation menu

Search