E-ISSN:2456-3110

Research Article

Uttana Vatarakta

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 6 July
Publisherwww.maharshicharaka.in

Understanding the etiopathogenesis of Uttana Vatarakta (peripheral vascular disease) - An Observational Study

Namratha M.1*, Jain P.2, B Markande G.3
DOI: http://dx.doi.org/10.21760/jaims.7.6.11

1* MV Namratha, Final Year P.G Scholar, Dept. of P.G Studies in Roganidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

2 Prashanth Jain, Professor & HOD, Dept. of P.G Studies in Roganidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

3 Geetha B Markande, Professor, Dept. of P.G Studies in Roganidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

Advanced life style and changing food habits affects the activities of individual which leads to many diseases and Peripheral Vascular Diseases are one among them. They are characterized by reduction of blood flow and oxygen supply through peripheral vascular vessels. This can happen in arteries or veins. The incidence of Varicose vein is more common with age and high prevalence is after 30 years of life. PAD occurs in patients over 40 years old; the highest incidence occurs in the sixth and seventh decades of life and it affects 10-15% of the general population. The symptoms of Uttana Vatarakta owing to the Margavarana pathology simulate with the symptoms of Peripheral vascular diseases and some of the etiological factors of Uttana Vatarakta in the writing are specific in inclining Peripheral Vascular Diseases. Ayurveda emphasise the importance of study on etiopathogenesis of disease before the planning of treatment protocol. In this study an effort is done to identify the Nidanas and pattern of Samprapti in relation with Peripheral vascular diseases for the better understanding of different clinical presentations of Uttana Vatarakta.

Keywords: Uttana Vatarakta, Peripheral Vascular Diseases, Viruddhahara, Ayurveda

Corresponding Author How to Cite this Article To Browse
MV Namratha, Final Year P.G Scholar, Dept. of P.G Studies in Roganidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.
Email: 		MV Namratha, Prashanth Jain, Geetha B Markande, Understanding the etiopathogenesis of Uttana Vatarakta (peripheral vascular disease) - An Observational Study. J Ayu Int Med Sci. 2022;7(6):77-86.
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https://jaims.in/jaims/article/view/1948

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-05-28 2022-05-30 2022-06-06 2022-06-13 2022-06-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by MV Namratha, Prashanth Jain, Geetha B Markandeand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Ayurveda is the oldest medical discipline in human history, and it aids in the prevention of illnesses as well as the promotion of health and longevity. In present revolutionary period, a person's life is frantic and materialistic. The majority of dietary choices, social order, way of life, and environment have changed with the flow of time. The culture of fast food, junk foods, smoking, alcohol intake & drug addiction habits are spreading.

Advanced life style and changing food habits affects the activities of individual which leads to many diseases and Peripheral Vascular Diseases are one among them. They are characterized by reduction of blood flow and oxygen supply through peripheral vascular vessels. This can happen in arteries or veins. Obstructive Arterial diseases are characterized by symptoms like cold dry shiny skin with pallor or rubor, sharp stabbing type of pain, numbness and diminished or absence of pulse distal to obstruction where as in venous obstruction warm thickened skin with pigmented areas, itching, aching or cramping type of pain with dilated tortuous veins can be seen. The incidence of Varicose vein is more common with age and high prevalence is after 30 years of life.[1] PAD occurs in patients over 40 years old; the highest incidence occurs in the sixth and seventh decades of life and it affects 10-15% of the general population. There is an increased prevalence of Peripheral atherosclerotic diseases in individuals with Diabetes mellitus, Hypercholesterolemia, Hypertension and in Cigarette smokers.[2]

Vatarakta is a Vatavyadhi and is caused by the vitiation of Vata and Rakta by their own causative factors. Acharya Agnivesa explains the combination of Vata and Rakta is like Agni and Marutha. Because of its apparent chronicity, incurability, and consequences, Vataraktha possess a challenge to the physician. The regular consumption of Viruddhahara, especially Lavana, Katu, Kshara, Ajirnabhojana, Anupamamsa Sevana by Sukumara, and Viharas like Achankramana sheela, Vega dharana and excess travelling leads to Vatarakta.[3] Basic of its Samprapti includes Margavarana of Vayu by Rakta. In addition to this Vatarakta is also produced by Margavarana of Vayu by increased Kapha and Medas in Rakta. It has two stages based on the involvement of Dhatus

i.e., Uttana and Gambhira avastha. In Uttana Vatarakta, patient may present with Kandu, Daha, Ruk, Toda or Sphurana type of pain, Ayama and Syava or Tamra Varnata of Twak.[4] In Gambhira Vatarakta, Uttarottara Dhatu gets affected. The symptoms of Uttana Vatarakta owing to the Margavarana pathology simulate with the symptoms of Peripheral vascular diseases and some of the etiological factors of Uttana Vatarakta in the writing are specific in inclining Peripheral Vascular Diseases.

Ayurveda emphasise the importance of study on etiopathogenesis of disease before the planning of treatment protocol. In this study, the Nidana and pattern of Samprapti are investigated in connection to Peripheral Vascular Diseases in order to gain a better knowledge of the various clinical manifestations of Uttana Vatarakta.

Objectives

1.To study the etiopathogenesis of Uttana Vatarakta withas explained in classics with special reference to Peripheral Vascular Diseases.

2. Review of the literature unravelling the clinical understanding of Uttana Vatarakta in relation to Peripheral Vascular Diseases.

Materials and Methods

A minimum of 100 patients who were suffering from Uttana vatarakta between the age group of 20-70 years with the help of a structured case proforma which covering the Nidanas of Uttana Vatarakta along with the details of history taking, physical signs and symptoms as mentioned in our classics and allied science were selected.

Patients were analysed and selected accordingly who fulfils the diagnostic and inclusion criteria. Values obtained were assessed on the basis of percentage of gradation of individual parameters in relation with Aharaja, Viharaja, Manasika and Vishesha Nidanas of Vatarakta.

Diagnostic criteria: Diagnosis was made on the basis of Lakshanas of Uttana Vatarakta mainly Kandu, Daha, Ruk, Toda and Sphurana types of Vedana Vishesha, Ayama (Sirayama), and Syava or Tamra varnata of Twak. [5]

Inclusion Criteria

1. Patients aged between 20 - 70 yrs.


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2. Patients presenting with clinical manifestation of Uttana Vatarakta.

3. Patients presenting with symptoms of Arterial and Venous obstruction.

4. Patients with occupational varicosities.

5. Patients with primary symptoms of Varicose vein.

Exclusion criteria

1. Pregnancy induced varicosities.

2. Patients presenting with complications of varicose veins like thrombophlebitis, eczema, varicose ulcer, haemorrhage, periostitis and calcification.

3. Patients suffering from systemic diseases like SLE, Scleroderma and Gouty arthritis.

4. Patients suffering from congenital Varicose vein and Varicose vein due to muscular weakness.

5. Thromboangitis Obliterans and Atheroembolism with severe digital ischemia, trophic nail changes, painful ulceration and gangrene.

6. Varicose vein with DVT patients.

Assessment Criteria: Assessment will be based on the following parameters,

Subjective parameters

  • Ruk (Intermittent claudication, Rest pain).
  • Toda and Sphurana (Night cramps).
  • Syava or Tamra Varnata (Discoloration of skin).
  • Kandu (Itching).

Objective parameters

  • Tortuous, dilated veins of lower limb.
  • Absence of pulse distal to the obstruction.
  • Physical examination (Buerger’s Test[6] for arterial obstruction and Brodie’s Trendelenburg test[7] for varicosities).

Observations and Results

On Demographic Data: Majority of the patients, 56% were belong to the age group of 54-70 years, 58% were Females, 91% were Married, 81% were Hindu, 28% were Graduated, 65% were belong to Rural Habitat, 41% were belong to Middle class family, 30% were belong to upper class, 30% were house wives.

jaims_1948_01.JPG

Fig. 1: Distribution according to Demographic Data

On Personal Data

Among 100 patients taken for the study, 35% have habit of Smoking daily and 16% have occasional habit of Smoking, 28% have occasional habit of using Tobacco and 25% have a habit of taking Tobacco daily, 30% have habit of consuming Alcohol daily, 24% have occasional habit of taking Alcohol, 79% have habit of taking Tea daily, 16% have occasional habit of Tea intake.

50% have occasional habit of taking Coffee, 13% have daily habit of consuming Coffee, 32% have occasional habit of consuming Aerated Drinks and 20% have a habit of taking Aerated Drinks daily. Highest incidence of PVD is seen in patients habituated to Mixed diet (64%). Screening of the patients as per Agni showed 48% of patients were having Vishamagni.

Data obtained pertaining to Koshta of the patients shows highest incidence in the patients with Krura Koshta (48%). 51% were having Kalabhojana and Samashana, 48% were having Akalabhojana and 41% undergoes Vishamashana. In the distribution according to Nature of Work, it was found that 79% of the patients were involved in Walking, 72% in Standing. 57% had Disturbed Sleep.

In this study, 55% having Regular Bowel Habit and 38% having Constipated Bowel Habit.


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jaims_1948_02.JPGFig. 2: Distribution according to Personal Data

On Data related to Disease
On Uttana Vatarakta Lakshana: Among the 100 patients selected for study, about 88% of people had Ruk as a symptom, 86% had Toda, 85% had Sirayama, 82% had Akunchana, 64% had Shyava or Tamra Twak, 56% had Daha, 48% had Gourava, 44% had Suptata, 39% had Kandu, 37% had Sphurana and 33% had Bheda.

On Family History: 58% of patients presented with a positive Family History.

On Dashavidha Pareeksha: Majority of patients in this study belonged to the Vata Pitta Prakruti (49%), 80% were having Madhyama Samhanana, 80% were of Madhyama Pramana, 77% had Madhyama Satva, 76% were having Pravara Satmya. Most of the patients showed Madhyama Abhyavaharana Shakti (76%) and Madhyama Jarana Shakti (78%) and 72% showed Madhyama Vyayama Shakti.

On Aharaja Nidana: Data obtained pertaining to Kulattha, highest incidence of patients 63% occasionally uses Kulattha, 42% occasionally consumes Nishpava and 9% daily consumes Nishpava. 65% of patients occasionally consumes Mulaka, 60% daily consumes Masha and 37% occasionally consumes Masha. 48% occasionally uses Ikshu Rasa and 4% daily uses Ikshu Rasa. 50% daily consumes Dadhi and 45% occasionally consumes Dadhi. Maximum number

of patients occasionally consumes Takra, i.e., 50%. 93% daily consumes Lavana Rasa, 83% daily consumes Amla Rasa and 80% daily consumes Katu Rasa. 29% occasionally consumes Kashaya Rasa and 22% daily intakes Kashaya Rasa. 31% occasionally consumes Snigdha Ahara and 29% daily consumes Snigdha Ahara. 61% daily consumes Ushna Ahara, 49% occasionally consumes Vidahi Ahara. 50% consumes Shushka Mamsa occasionally, 10% consumes Shushka Mamsa daily. Most of the patients consuming Ambuja Mamsa daily (44%) and 21% consumes Ambuja Mamsa occasionally.

On Viharaja Nidanas: Data obtained pertaining to Divaswapna shows, 34% have habit of indulging Divaswapna daily and 31% have occasional habit of indulge in Divaswapna. 54% have occasional habit of Ratrijagarana. 57% indulges in Vyavaya occasionally. 64% of patients have a habit of Veganigraha occasionally. 40% indulged in Atiadhwagamana daily.

On Manasika Nidanas: Among 100 patients, 36% were get Short tempered occasionally and the rest 22% accepted they are of Short tempered. 34% of have some Worries occasionally and rest 21% have some sort of Worries daily. 50% are indulged in Over Thinking daily and 30% have indulged in Over Thinking occasionally.

On Vishesha Nidana of Vatarakta: In this study, 78% were involved in Ativyayama, 56% were Sukumara, 47% were Sthula, 44% were Madhyasevi, 39% were Mishtannasevi and 19% were involved in Achankramana Sheela.

jaims_1948_03.JPGFig. 3: Distribution according to Vishesha Nidana


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Discussion

Vatarakta is a condition, not only a malady, in which numerous systems are more prominently involved. It damages the musculoskeletal, vascular and integumentary systems. It has two stages based on the involvement of Dhatus i.e., Uttana and Gambhira avastha. The symptoms of Uttana Vatarakta owing to the Margavarana pathology simulate with the symptoms of Peripheral Vascular Diseases and some of the etiological factors of Uttana Vatarakta in the writing are specific in inclining Peripheral Vascular Diseases. Characterization done on Nidanas like Aharaja, Viharaja and Familial inclination holds for Uttana Vatarakta as every one of them have its own task to carry out.

Discussion on demographic data

Significant part of the subjects associated with this study had a place with the age bunch of 54-70 years (56%) followed by group of 37-53 years (39%). Various researches conducted confirmed that the incidence of Varicose veins occurs in the middle age, i.e., 4th to 7th decades of life and Peripheral Arterial Diseases occurs in occurs in the sixth and seventh decades of life. That means the majority of the patients are in Madhyama Vaya, where Pitta Dosha predominates, ingestion of the Nidana described in the classics is more likely to result in Pitta Prakopa. As Pitta and Rakta Dhatu exist in Asharya- Asharyi Sambandha, Dushana of Rakta Dhatu occurs indirectly. Majority of the patients were Females. This corresponds to the widely held theory that the incidence of PVD is four times higher in women than in men. Hyperlipidaemia, diabetes, hypertension, a history of smoking, and obesity are all substantial risk factors for vascular disease in both men and women. After menopause, the prevalence of vascular disease rises in women. Oestrogen and progesterone hormones play an important role in fertility and menstruation. These hormones cause the muscle that control the movement of blood in the veins to relax. Continuous relaxation may affect blood flow and leading to pooling. Dominant part was married. This is because the patients between the age group of 20-70 years were chosen based on the inclusion criteria. Data obtained pertaining to the Religion of the patients shows highest incidence of PVD in Hindu Community, because

of the Hindu dominated population in the area from where the patients were selected. Most of the study areas were Rural locality, so data showed highest incidence in Rural habitat. To explore the relationship between education and the occurrence of disease, a larger sample size is required. Data obtained pertaining to occupation, shows higher incidence in House wives. House wives are habituated to stand for long hours in doing the domestic activities. Other professions observed in data were used to stand, walk and travel based on their nature of work. Venous hypertension is more common in persons who stand or walk constantly for lengthy periods of time, and the current study backs this up. Sitting, standing or travelling for long periods can cause increased venous pressure and damage to the valves in veins. Continuous activities will worsen the Peripheral Arterial Disease, because they result in hypoxia. Socio-Economic Status of the patients shows the highest incidence in the Middle-Class Family. People with a lack of health awareness, irregular eating habits, and active addiction along with heavy work load are more susceptible to the condition. 30% were belongs to Upper class. This group of people frequently consumes a high-calorie, high-fat diet. This will act as a risk factor for atherosclerosis and leads to PVD. In this study, most of the patients presented with a positive Family History. It is a known fact that Varicose veins have got a hereditary factor and the present study justifies the same. In the present study patients with Arterial Obstruction have got a negative familial history.

Discussion on Personal History

Cigarette smoking is known to be a major factor in hypoxia through fixation of carbon monoxide and nitric oxide to haemoglobin. Tobacco contains nicotine, which is a potent vasoconstrictor, it may have an effect directly on endothelial cells, causing hypercoagulability and thrombosis, and enhancing inflammatory changes in the vessels. Both will result in hypoxia and contribute to the symptoms of Arterial Obstructions. The various negative consequences of tobacco smoke are thought to be related to both direct oxidative damage to essential physiological components and the activation of phagocytic cells, which produces highly reactive oxygen species. Free radical production could potentially play a role in the endothelium damage and local inflammation that cause microvascular problems in venous insufficiency.


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Madya is having Amla Rasa, Amla Vipaka and Ushna Guna hence causing Pitta Dushti and Rakta Dushana. Alcohol acts as a vasodilator at first intoxication levels, causing blood vessels to relax and expand. Regular uses of alcohol work as a vasoconstrictor, results in constriction of Arteries and leads PAD. Long-term Alcohol use will increase the blood pressure and in turn produce venous hypertension. Veins become engorged with blood more quickly, and the valves are unable to support the added strain. Veins loses all muscle tone and produces the unsightly appearance of Varicose vein. Tea and coffee contain caffeine, which dehydrates the body and causes blood vessels to contract, thus raising the blood pressure. So long term use of tea or coffee may lead to PVD. Aerated Drinks are carbonated drinks with added sugar. This has a negative impact on blood pressure and does vascular calcification which results in the manifestation of PVD. When drinking carbonated drinks carbon dioxide is converted in to carbonic acid. This will cause Pitta Dushti and in turn causes Rata Dushana. So, there is a high chance of getting Rakta pradoshaja vikara including Vatarakta. The study subjects came to our OPD were habituated to Mixed diet. One of the Nidana described for the Vatarakta is excessive consumption of Mamsa Ahara. Non-vegetarian food contains more triglycerides. In PAD, a non-vegetarian diet is not suggested since it has a higher risk of causing atherosclerosis. Highly processed food with little fibre content may cause dehydration and constipation and this can put on pressure over veins leading to varicosities of lower extremities. Irregular food habit like Akalabhojana, Vishamashana is related to gastric symptoms like gas, bloating, etc. and further leads to Vata Prakopa and Vilomagati of Vayu. Screening of the patients as per Agni showed maximum of patients were having Vishamagni. It is due to Akala Bhojana and Vishamashana. Vishamagni will results in Vataja Vikara. Most of the patients were with Krura Koshta. It signifies Uttana Varakta is more prevalent in people with Krura Koshta. Pakvashayagata Vatakopa may be the reason behind this leads to Vilomagati of Vata taking Stanasamsraya in lower and upper extremities leading to PVD. More than half of the population had Disturbed Sleep due presence of rest pain in Arterial Obstruction and Night cramps in Varicose veins. This is due to the increase in Vata dosha and will result the further increase in Vata Dosha. Dominant part of the patients

was having Constipated Bowel Habit. Straining to have bowel movements can cause extra pressure on the veins of lower limb and can results in Varicose veins. Changes in intestinal microbiota by constipation can induce atherosclerosis and blood pressure rise in arteries may results in PAD.

Discussion on Data related to Disease

Discussion on Uttana Vatarakta Lakshana

In case of Utthana Vatarakta, Kandu results due to action of both Vata and Rakta. Itching in varicose vein is called as venous stasis dermatitis. Accumulation of blood in veins causes an increase in the pressure inside the veins. Blood began to leak out of the vessel to the surrounding tissues like skin in order to reduce the pressure. This will result in Venous stasis dermatitis. In Arterial obstruction itching is rare and sometimes occurs because of the cold dry skin. There is vitiation of Rakta in Utthana Vatarakta, which leads to Sthanika Pitta Dosha Vruddhi in Twacha, which leads to Lakshana in the manner of Daha. Dilated-tortuous veins cause a localised rise in temperature, which manifests as a burning sensation on the skin. In arterial obstruction burning sensation occurs due to the disturbances in circulation. Prakupita Vata Dosha is primarily responsible for the manifestation of various types of pain, such as Toda, Bheda etc. Failure in the venous reflux will results in the pooling of blood in the veins and poor blood supply throughout the leg. Thus, the muscles are unable to relax and cramping will occur in case of Varicose veins. In Arterial obstruction, intermittent claudication is a main symptom. This pain is due to accumulation of excessive P substances in the muscle which are not absorbed properly due to inadequate blood supply. Arterial occlusion progresses, intermittent pain of the muscle will be supplanted by a continuous rest pain at the sites most distal of the arterial supply e.g., toes, foot, fingers, hand etc. this is called as Rest Pain, and is mainly due to ischaemic changes in the somatic nerves, so it is the cry of the dying nerves. Vistara, or dilatation, is denoted by the term Aayama. In this case, Aayama should be understood as Sira Aayama, or vein dilatation. Sankocha in Sira in terms of tortuousness is caused by Prakupita Vata Dosha's action. Rakta Dusthikara Nidana raises Kledamsha in Rakta Dhatu, which results in Sira Aayama. In the context of Upadhatu Pradoshaja Vikara, Acharya Charaka says that vitiation


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of Sira, Snayu, Kandara causes Sphurana, Sankocha, and other maladies. And the aggravation of Vata Dosha, which vitiates Rakta Dhatu, will cause this Sphurana. In PVD, different types of Vedana Vishesha can be seen. The word Kunchana comes from the Sanskrit word Kutilata, which means "bending of the physical parts." Kunchana should be limited to Dhamani Kunchana or Dhamani Sankocha in the context of Utthana Vatarakta. Varicosity is characterised by elongated, dilated, and convoluted veins. Shyava or Tamra Twak or Change in colour of an ischaemic limb is a main feature of Arterial Obstruction. Congestion and purple-blue cyanosed appearance particularly in dependency is noticed in chronic arterial insufficiency. When the limb is elevated, it becomes pallor. Incompetence of venous valves Incompetence of venous valves responsible for stasis of blood and chronic ambulatory venous hypertension. So, there will be defective microcirculation. RBC diffuses into tissue planes and there is lysis of RBC’s. this will result in the release of haemosiderin and finally results in the pigmentation of skin. Suptata is numbness occurs due to Dushta Vata which vitiates Rakta Dhatu. In Arterial obstruction numbness is result of lack of blood supply to the nerves and in venous insufficiency disturbances in the microcirculation results in Numbness. Gourava is a result of Rakta Dushana.

Discussion on Dashavidha Pariksha

Dwandwaja prakriti is more prevalent in society, the majority of patients in this study belonged to the Vata Pitta Prakruti. Acharyas have mentioned that Prakruti, of a person influences the disease that occur in that person. So, persons with Vata- Pitta prakruti will be more prone to Vata- Pittaja Vikaras. Since Vata and Rakta are involved in the Samprapti of Vatarakta, the persons with Vata Pitta Prakruti are more vulnerable to this disease. Dominant was showed Madhyama Sara, which has apparently no effect on this study. Madhyama Samhanana predominancy may due to continuous Dhatukshaya which in turns leads to Vata Prakopa. Most of the patients showed Madhyama Pramana. Some studies concluded that Obese people are more prone to PVD. But here, owing to small sample size, conclusion could not be drawn. Manasika Vikaras like Krodha, Shoka, Bhaya and Chinta plays a role in the manifestation of Uttana Vatarakta, i.e., these all elements may lead to Vata Prakopa and

Rakta dushana by Pitta prakopa. This study revealed that more than half of the population had Madhyama Satva. Dominant were having Pravara Satmya, because they were Satmya to Sarva Rasa. Predominancy of Madhyama Abhyavaharana Shakti and Madhyama Jarana Shakti was due to the involvement of Vishamagni. Maximum were showed Madhyama Vyayama Shakti. This data had apparently no effect on this study.

Discussion on Aharaja Nidanas

Kulatta is Ushna Virya, Amla Vipaka, and Kaphavatahara. Horse gram contains specific carbohydrate called raffinose oligosaccharides and alpha galactosyl derivatives of sucrose, they eventually ferment and causes accumulation of gas, discomfort pain etc., which may cause indigestion when used in large quantities. Thus, it will result in Ajirnata and Amlata of Ahara. It will cause Pittaprakopa, thus it vitiates Rakta Dhatu hence acts as Nidana for Uttana Vatarakta. Nishpava is having Madhura Rasa, Rukshna- Guru- Sara Guna, Ushna Virya and Amla Vipaka. It is having Vata- Pittakara and Vidahi action. Its over use will cause Vata Pitta Dushti and thus in Rakta Dushti. Mulaka is Guru, Ushna, Tikshna, Vishtambi, Aama Krut, Ushna Virya, Abhishyadhi, and hence acts as Tridoshakaraka. Consumption of excess Radish will lead to dehydration due to its diuretic effect. Dehydration will worsen the condition like intermittent pain in PAD and cramps in Varicose vein. Dehydration can cause constipation and this will result in Varicose vein. Excess dehydration can cause Vata Prakopa. Masha is largely used in the form of Idli, Dosa, Dal and Vada etc. These fermented foods are Vidahi in nature, they are difficult to digest and cause symptoms like frequent sour belching. As Masha possessing properties like Guru- Snigdha Guna and Ushna Virya causes Kapha Pitta Prakopa. These properties can result in Shonita Pradoshaja Vyadhi including Vatarakta. Sugarcane juice is Vrushya, Shita, Sara, Snigdha, Brumhana and having Madhura Rasa. It is Sleshma Vardhaka. Machine pressed juice causes burning sensation. It is having Amla, Guru, Kshara, Vidahi properties and thus it will cause Pitta Dushti. Sugar absorbs water and causes expansion of vein walls. Once blood sugar level normalize, veins will contract back to their normal size. But, over time veins lose their elasticity and become more damaged. Damaged veins pump blood less efficiently, causing Varicose veins. Dadhi is Abhishyandi,


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Guru, Ushna Virya, Amla Rasa, Pittavardhaka, Rakta-Pittakara, Shophakara and Tridosha Prakopaka. It will result in Rakta Abhishyandana and finally Srotolepa. Curd and its products like paneer and cheese on regular consumption may result in weight gain leading to obesity. Obese people are more likely to have PVD. Takra is having Madhura and Amla as Rasa and Kashaya as Anurasa. It is having Ushna Virya and Laghu Ruksha Guna. Excess use of Takra will result in Pitta and Vata Dushti. Lavana Rasa or Salt added food like chips, snacks, pickles and dried fish, etc are predominant of Lavana Rasa. Salty food contains sodium that can cause the body to retain water. It can place more pressure on the veins by increasing the volume of fluids. It will result in the increase of blood pressure and thus results in PVD. Amla Rasa is Pitta Vardhana. It produces Dhushana of Rakta and hence causes Uttana Vatarakta. Sour fruits and foods contain acids for the most part, it accounts for the increased acidity in stomach and there by Pitta Dushti. It also increases Kledata in the body, there by leading to Rakta Pradoshaja Vikara like Vatarakta. Katu Rasa is Ushna. Rakta dushana and increases Vata dosha. The pungent taste is one of dry, intense heat that can be found in spicy foods. It is usually produced by resins, mustard glycosides and aromatic volatile oils that stimulate the tissues and nerve endings of the mouth with a sensation of sharp and fiery heat. Excess use of spicy food can trigger upper GIT, ends up in indigestion. Spicy foods are also a main cause for heartburn. These factors will result in Ama Utpatti and Pitta Dushti. Kashaya Rasa is having Ruksha and Sita Guna and thus aggravates Vata in the body. Astringent food are water absorbent and there brings constipation and dryness of the body. Food items like Potato, Cauliflower, Green tea, Grapes, Unripe banana etc are predominant of Kashaya Rasa.

Snigdha Ahara will result in Kapha Medo dushti. Increase of Kapha and Meda in Raktamarga will result in the Avarana of Vata leads to Uttana Vatarakta. Studies shows that, Snigdha Ahara can results hyperlipidaemia and atherosclerosis. This will act as a risk factor for PVD. Snigdha Ahara which are majorly observed in the study are fried items, Dadhi, Ksheera and bakery items. Atisevana of Ushna Ahara will result in Pitta Prakopa. Vidahi Ahara is Dahajanaka and Pitta prakopaka and its Atisevana result in Uttana Vatarakta. Viruddhahara act as Maha abhishyandi and will cause Shonita

pradushana. Also results in the accumulation of Kapha and Medas in the Srotas leading to Uttana Vatarakta. Shushka Mamsa are Vata Vardhaka. Ambuja Mamsa or Fish meats are having Guru-Ushna Guna and Madhura Vipaka. It is also having Snigdha Guna. Over use of Ambuja Mamsa will result in the accumulation of Kapha and Medas in Srotas resulting in various diseases including Uttana Vatarakta. Anupa Mamsa (Mamsa Ahara) is Pitta Vardhaka and Ushna Virya and there by causes Rakta Dushti. They are also a high calorie diet which results in increase of Kpaha and Meda in Rakta.

Discussion on Viharaja Nidanas

Acharya Charaka explains that Diwaswapna is contraindicated since it aggravates Kapha and Pitta. This could be a risk factor for the development of Vatarakta. Some studies showed that untimely sleep can alter circadian rhythms. Abnormal circadian rhythm is having a negative impact on circulatory system and people are more likely to develop vascular diseases. Ratrijagarana is a main Nidana for Vataprakopa. Lack of sleep effects the circulation by prompting the accumulation of fatty deposits in the blood vessels which is known as atherogenesis. Studies showed that poor sleep will lead to an increase in neutrophils and inturn increases artery calcium level which results in atherosclerosis. Atherogenesis is a risk factor for PVDs. Vyavaya will cause Shukradhatu Kshaya and Vata Prakopa. Vegadharana causes Apana Vata Vaigunya. Vegadharana will result in the increase of blood pressure in the arteries and veins. Varicose veins are more common in people who stand or walk (Atiadhwagamana) for long periods of time, according to the current study. Because continuous strenuous activities like walking result in hypoxia, they aggravate Peripheral Arterial Disease.

Discussion on Manasika Nidanas

Krodha originates from the Rajo Guna and vitiates Vata and Pitta. Emotions such as anger will ramp up the “fight or flight” response and increase the production of adrenalin and cortisol. This will cause the increase in blood pressure and constriction of blood vessels. Shoka is a mental state precipitated by Rajo Dosha. Vata Dosha aggravates first in Shoka followed by Pitta Dosha aggravation. Worries or anxiety disorders are more likely in causing increased blood pressure and narrowing of blood


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vessels. Chinta will aggravate Vata Dosha. Anxiety, irritability, low appetite, irregular sleep patterns and high blood pressure etc. are the negative outcomes of Overthinking.

Discussion on Vishesha Nidana

The Nidanas like excessive standing, walking etc. can be included under Ativyayama. Patients who have Sukha Jeevana, Achankramana Sheela and those who are Mishtanna Sevi leads a sedentary life style which will leads to Ajirna of Ahara in Patients and it will result in Pitta Prakopa or Rakta Dushti as they consume Pitta Vardhaka Ahara. Sthoulya is the result of Santarpana Nidanas and the chance of getting Srotorodha by Kapha and Meda is high in Sthula. Increased Kapha and Meda plays an important role in the pathogenesis of Uttana Vatarakta. According to Acharya Chakrapani the one who affected by disease from minimal Nidana comes under Sukumara. So, the affected population comes under Sukumara. Along with previously mentioned Vata Prakopaka Ahara, the above mentioned Viharas acts as a triggering cause or Vyanjaka Hetu in the formation of Vatarakta

Conclusion

Vatarakta, is a manifestation of Prakupita Vata and Rakta where the best depictions of Margavarana can be seen in the pathogenesis. Prakupita Vata is impeded by Prakupita Rakta in Vatarakta. As a result, Gati or Chala Guna of Vata Dosha get hampered. It is also occurred by the obstruction of Vata by increased Kapha and Meda in the Raktamarga. According to the current investigation, a fraction of the Ahara, Vihara, and Manasika variables listed in our classics will contribute as a Nidana for Uttana Vatarakta, coupled with familial propensity.

In Aharaja Nidana - Excessive use of Kulattha, Masha, Dadhi, Lavana- Amla- Katu Rasa, Ushna- Vidahi- Viruddha Ahara, and Ambuja- Anupa Mamsa Sevana etc are the type of Rakta Prakopaka Nidana present in maximum number of patients which leads to Peripheral Vascular Diseases / Uttana Vatarakta. In Viharaja Nidana - Divasswapna, Ratrijagarana, Vegadharana and Atiadhwagamana are the Nidanas present in maximum number of patients which leads to Peripheral Vascular Diseases / Uttana Vatarakta. Manasika Nidanas like Krodha Shoka and Chinta also plays an important

role in the pathogenesis of Peripheral Vascular Diseases / Uttana Vatarakta. Certain habits like smoking, tobacco use, alcohol consumption and habit of taking aerated drinks are more connected with Peripheral Vascular Diseases / Uttana Vatarakta. Ativyayama, Sukumara Sukha Jeevana, Mishtanna Sevana, Madhya sevana and Habit of Smoking can be considered as the Vishesha Nidana for Peripheral Vascular Diseases / Uttana Vatarakta. Ativyayama, Madhya Sevana, Smoking Habit and Manasika Nidanas like Shoka and Chinta are the Utpadaka Hetus for Peripheral Vascular Diseases / Uttana Vatarakta. Sukumara Sukha Jeevana, Sthula, Mishtanna Sevana, and other Aharaja Nidanas can be considered as Vyanjaka Hetu.

Reference

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