E-ISSN:2456-3110

Review Article

Vatarakta

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 6 June
Publisherwww.maharshicharaka.in

Vatarakta: An Ayurvedic classical literature review

Soni S.1*
DOI: http://dx.doi.org/10.21760/jaims.8.6.34

1* Savitri Soni, Post Graduate Scholar, PG Department of Agad Tantra evum Vidhi Vaidyaka, Shri N.P.A.G.A.C., Raipur, Chhattisgarh, India.

The statement “The inequalities of basic constituents in the body are the root cause for different diseases” is the fundamental principle of the Ayurveda, which indicate the control of different fundamental elements in the body (Sharira) is the sign of good health and free from diseases. Ayurvedic remedies and therapies are found very effective and useful to sustain the equilibrium of these fundamental elements in the body. Vatarakta is a chronic joint and body pain disease accompanied by pain, stiffness, swelling over joints which involve vitiated Vatadosha as well as Raktadhatu. Aggravated Vata is blocked by vitiated Rakta, which leads to further aggravation of Vata Dosha. Vatarakta have two Avasthas i.e., Uttana and Gambhira. Uttana Vatrakta affects Twacha and Mansadhatu whereas Gambhira mainly affects Asthi, Majjadi Gambhira Dhatu. Nidan Panchak is one of the finest and important method of diagnosing disease, its causes & prognosis. Nidan Panchak consists of 5 components viz. Nidan, Purvarupa, Rupa, Upshaya & Samprapti. Every component of Nidan Panchak helps the physician for better understanding of disease growth & treating the disease at an earliest possible stage. Nidana Panchak is the main and important diagnostic tools in Ayurveda. The present life style not only disturb the healthy Aahar but Vihara also. Sedentary lifestyle along with mental stress, consumption of nonveg and highly protein diet, excessive alcohol intake are some of the causing factors which origins acute exacerbation of Vatarakta. The etiological factors responsible for Gouty arthritis, pathology and clinical features are quite similar to Vatarakta.

Keywords: Ayurveda, Vatarakta, Uttana, Gambhira, Gouty arthritis

Corresponding Author How to Cite this Article To Browse
Savitri Soni, Post Graduate Scholar, PG Department of Agad Tantra evum Vidhi Vaidyaka, Shri N.P.A.G.A.C., Raipur, Chhattisgarh, India.
Email: 		Savitri Soni, Vatarakta: An Ayurvedic classical literature review. J Ayu Int Med Sci. 2023;8(6):215-229.
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https://jaims.in/jaims/article/view/2441

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-04-26 2023-04-28 2023-05-05 2023-05-12 2023-05-19
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© 2023by Savitri Soniand 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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Soni S: Vatarakta An Ayurvedic classical literature review

Introduction

IntroductionAyurveda is an ancient medical and health care system which is not only manages chronic diseases but maintain the health of the human being i.e., retain the body healthy also. Ayurveda tell us how to live for healthy life by following the Dinacharya. The statement, “The inequalities of basic constituents in the body are the root cause for different diseases” is the fundamental principle of the Ayurveda, which indicate the control of different fundamental elements in the body (Sharira) is the sign of good health and free from diseases. It is accepted and used worldwide. Moreover, new research and revalidation of old Ayurvedic principles and concepts mentioned in Ayurvedic classics are re-establishing worldwide. Nowadays human beings are more vulnerable to metabolic disorders due to their faulty dietary habits and sedimentary life style. These disorders may be causing functional impairment or crippling diseases. Some of these disorders produced by conjugation of Vitiated Vata and Rakta generated multiple health illnesses and most important of them is Vatarakta.[1] Vatarakta is a disease explained in Ayurveda involving Vatadosha imbalance affecting Raktadhatu (blood tissue).

A lot of references along with description of this disease are available in classical texts under the name of Vatarakta, Adhyavata, Vatabalasa and Khuddavata.[2] Vatarakta is described as Adhayavata by Acharya Charaka. The name of ailment itself describe that it is more prevalent among Adhya (rich people). In this disease aggravated Vata is obstructed by aggravated Rakta, and this obstructed Vata is again aggravates Rakta. Finally, these overall affects the entire Rakta which occurs in conditions like, injury, fasting cumbersome journey and walking in hot climates. Vatarakta is also known as Khudaroga and Vatashra.[3-5]

Acharya Charaka has described that before the planning of treatment, the correct diagnosis of a disease is very much essential.[6] There are five means of diagnosis (Nidana Panchak) namely - Nidana (cause or etiology), Purva-Roopa (prodromal symptoms or premonitory symptoms), Roopa (specific sign and symptoms or clinical features), Upashaya (relieving and aggravating factors), Samprapti (pathogenesis).


These five basics collectively help in making the accurate diagnosis. The physician can diagnosis the disease at an earlier stage by using the concept of Nidana Panchak, thereby manage the disease and prevent further complications.

Aims and Objectives

1. The conceptual studies on Vatarakta.

2. Nidana Panchak diagnosis of Vatarakta.

3. Comparative analysis on Vatarakta and gout.

This conceptual study, including Nidana Panchak diagnosis and comparative analysis will be helpful in understanding of pathogenesis of Vatarakta in successive stages.

Materials and Methods

Different Ayurveda texts, journals, research papers, articles are referred to study the concept of Vatarakta and its usefulness in manifestation and sequelae of the Vatarakta before preparation of the manuscript entitled “Vatarakta : An Ayurvedic classical literature review”

Observation

Faulty & sedentary life-style and dietary habits are playing a vital role for disturbing Agni to manifest with several diseases. Vatarakta is one among all which is defined in all Samhitas very extensively and briefly. According to Ayurveda, among Tridosha, Vatadosha is playing vital role and generally responsible for occurrence of almost all Vyadhi.

The name Vatarakta is known on the basis of involved Samprapti Ghatak i.e., Vatadosha and Raktadhatu. Due to improper diet, such as Guru food materials (heavy to digest), high protein diet, meat of aquatic & marshy animals, Ahitkara, Mithyahara, Vidahi Aahar etc. in delicate & tender persons who eats protein rich food, tends to have luxurious life & do not have tendency to exercise causes Raktadushti.

Besides due to injury, fasting, journey on wheels, riding on horse, camels, sporting in water, jumping, walking in hot climates and similar other activities aggravate Vata which have been obstructed in its passages by aggravated Rakta, affects the entire Rakta and it leads to Vatarakta.



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Nirukti of Vatarakta

Vata Dushitha Rakta Yatra

Rakta which is vitiated by Vata is derived as Vatarakta.

Rakta Pradano Vata Roga Vishesha

It is a disease of Vata where Rakta is predominant

Synonyms of Vatarakta

There is different nomenclature used in Charaka Samhita for Vatarakta and they are: Vatarakta, Khudda vata, Vatabalasa and Adhyavata etc.[7] Adhyavata, Khudavata and Vatabalas are the usually used to refer the illness of Vatarakta based on clinical occurrence, anatomical side and severity of disease whereas Acharya Charaka explained Vatarakta as Vatashonoita also.

Nidana of Vatarakta

The factors which disturb the active state of Doshic equilibrium aggravates the disease is known as Nidana. This Nidana not only supports us to decide the prognosis and diagnosis but management of the disease also. For the causation of disease Vatarakta involvement of both Prakupita Vata and Prakupita Rakta is necessary. Even though each has got its own aetiology, Acharyas while talking about Vatarakta have clubbed the etiological factors together and explained.[8-9]

Ayurvedic texts describe the different Nidana of Vatarakta. Vatarakta Nidana is mentioned in Ayurvedic literatures are shown in Table no. 1.[10-11]

However, these Nidana can be broadly divided as Aharaj and Viharaj Nidana shown in Table no. 2.


Table 1: Nidana of Vatarakta

SN Nidana Causes
1. Aharaj Nidana Related to dietary habits Excessive intake of Kashaya, Katu, Tikta Rasa etc. Excessive intake of Snigdha, Ushna, Ruksha etc. Aahar. Alpabhojan, Abhojan etc.
2. Viharaj Nidana Related to individual habits and environmental factors Mithya Vihara. Ativyayam, Vibhrama. Sthula Achankramansheelata.
3. Mansika Nidana Related to physiological factors (Krodha etc.)
4. Agantuj Nidana Exogenous factors (Abhighata etc.)
5. Prakriti based Nidana Miscellaneous factors (Sukumar etc.)

Table 2: Aharaj and Viharaj Nidana of Vatarakta

Aharaj Nidana Viharaj Nidana
§   Excessive intake of Kashaya, Katu,Tikta, Amla, Lavana and Kshara Rasa Pradhana Aahar §   Mithya Vihar
§   Excessive intake of Snigdha, Ushna,Ruksha Gunayukta Aahar. §   Ativyayam, Vibharama, Avyavaya.
§   Alpabhojana, Abhojan, Adhyashana, Viruddhashana, Mishthanna Sukhbhojana, Mithya Aahar Sevana §   Sthula, Achankrama-Sheelata, Divaswapna, Aswapna
§   Ritu Satmya Viparyasat Snehadi Sevana §   Adhva, Hasti, Ashva, Ushtrayana, Krodha, Prajagarana
§   Klinna Shushka Mamsa Sevana §   Abhighata, Ambukrida, Plavana, Langhana
§   Excessive intake of Pinyaka, Mulaka Kulatha, Masha, Nishpav, Shaka, Palal, Ikshu, Dadhi, Hyaranala. §   Sukumaranam
§   Excessive use of Sauvira, Shukta, Takra, Sura and Asava preparations. §   Ushnakaleatyadhawa, Veganigrahana, Sthulanam

Purvarupa of Vatarakta[12]: Purvarupa (a group of premonitory symptoms or the symptom complex) is that which an impending illness, not assignable to the specific Dosha is characterized. These are the symptoms which are produced in body before the arrival of disease. They are used to diagnose the disease. Purvarupa gives the clue to the disease but at this stage cannot be sure disease. Purvarupa of Vatarakta given in different Samhitas are mentioned in Table no. 3 and Table no. 4.

Table 3: The different Purvarupa of Vatarakta.

Purvarupa of Vatarakta
1.        Atisweda/Asweda Hydrosis / anhydrosis
2.        Karshnyata Blackish discoloration
3.        Sparshgnatwa Paresthesia
4.        Kshate Atiruk Increased pain on touch/injury
5.        Sandhi Shaithilya Looseness of the joints
6.        Alasya Laziness
7.        Sadana Fatigue of the foot
8.        Pidakodgama Formation of papules
9.        Nisthoda Fatigue
10.     Spurana Throbbing sensation
11.     Bhedana Splitting type of pain
12.     Gurutwa Heaviness
13.     Supti Numbness
14.     Kandu Itching
15.     Sandi Ruk Pain in joints
16.     Vaivarnya Discoloration
17.     Mandalotpatti Formation of rounded patches
18.     Sheetalata Coldness of the limbs
19.     Osha Burning sensation with restlessness
20.     Daha Burning sensation
21.     Sopha Swelling
22.     Twak Parushya Roughness of the skin
23.     Sira Dhamani Spandana Increased pulsatile vessels
24.     Sakti Dourbalya Decreased strength in thigh
25.     Ati Slakshna Khara Sparsha Hard on touch
26.     Shrama Increased exertion

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Table 4: Purvarupa of Vatarakta given in different Samhitas

Purvarupa C.S S.S A.H A.S M.N B.P Y.R
Atisweda + - + + + + +
Asweda + - + + + + +
Karhnyata + - - - + + +
Sparshgnata + - - - + + +
Ksate Ati Ruk + - - - + + +
Sandhi shaithilya + + + + + + +
Alasya + - - - + + +
Sadana + - + + + + +
Pidakodgama + - - - + + +
Nistoda + + + + + + +
Spurana + - + + + + +
Bheda + - + + + + +
Gourava + + + + + + +
Supti + + + + + + +
Kandu + - + + + + +
Sandhi Ruk + - - - + + +
Vaivarnya + + + + + + +
Mandalotpatti - + + + + + +
Sheetalata - + - - - - -
Osha - + - - - - -
Daha - + + + + + +
Shopha - + - - - - -
Twak Parushya - + - - - - -
Sira Dhamani Spandana - + - - - - -
Sakti Dourbalya - + - - - - -
Ati Slakshna Sparsha - - + + + + +
Khara Sparsha - - + + + + +
Shrama - - + + + + +
Vrana Adika Sula - - + + + - -

Rupa (Lakshana) of Vatarakta: When Purvarupa (group of premonitory symptoms) are manifested in the disease, these are known as 'Rupa'. The symptoms are characteristics manifestation which develops during the course of the disease. Rupa is important in diagnosis of disease. The Rupa of the disease are always seen after the aggravation of Doshas and formation of the disease. The knowledge of Rupa is essential for the purpose to break the 'Dosha - Dushya Sammurchhana.

Vatarakta is a condition which presents with the specific symptoms. It is due to the aggravated Vayu while causing pain & burning sensation at the site of inflammation constantly moves with high speed through the joints, bones & bone marrows produce cutting pain, make the joints curved inwards and when this aggravated Vayu moves

to all over the body resulted as lame & paraplegic person. Its clinical appearance resembles with the condition gout in allopath.[13] Gouty Arthritis of contemporary medical science, by its similarity in symptoms and etiological factors, can be correlated to Vatapittadhika Vatarakta,[14] characterized by the symptoms like Sandhi Shula (joint pain), Sopha (swelling), Raga (Erythema), Sparshasahatva (Extreme tenderness in affected joints) and Stambha (Joint stiffness).

Types of Vatarakta[15-17]: Vatarakta associated with Raktadhika, Vatadhika, Pittadhika and Kaphadhika respectively may possess different features which are shown in Table no. 5.

Table 5: Vatarakta according to Doshas

SN Predominance of Features
1. Rakta Shwayatu Brisha Ruka Toda Tamrashcha Chim Chimayate (Swelling with severe distress Piercing pain coppering with pricking sensation) Snigdha Rukshaiya Shaman Na Ati Kandu Kledanvito (Not subsiding by either unctuous or rough applications and associated with itching & moistening).
2. Vata Sira Aayam Shula Bhanjanam Shothasya Karshnyam, Raukshyam Shyavata, Kunchan Stambhane Sheeta Pradvesha (Contracture & stiffness, aversion to cold).
3. Pitta Vidaho (Burning after meals), Vedana (Pain), Murchha (Fainting), Swed (Sweating), Trishna (Thirst), Mada (Narcosis). Bhrama (Giddiness), Raga (Redness), Pakashcha (Inflammation). Bhedascha (Tearing), Shoshashcha (Dryness).
4. Khapha Staymityam (Feeling of wetness), Gauravam (Heaviness), Sneha (Unctuousness), Supti (Numbness), Manda Ruk (Mild Pain).

The various stages of Vatarakta are described by Ayurvedic Acharyas in two major categories, based on its symptoms, condition and complication of the disease. Furthermore, following two types of Vatarakta are described by Acharya Charak.[18]

1. Uttana Vatarakta (Superficial) - The blackish, red or coppery brown skin is indication of this type of Vatarakta. These colours are also associated with itching, burning sensation, stretching, piercing pain, quiring and contraction. The different symptoms are shown in Table no. 6 and views of different Acharyas are mentioned in Table no. 7.

2. Gambhira Vata-Rakta (Deep) - These types of Vatarakta is recognized by swelling, stiffness and hardness with severe pain inside, blackish and coppery skin with burning sensation, piercing pain, quiring and inflammation associated with distress and burning sensation in the stomach. The different symptoms are shown in Table no. 8. These symptoms are also mentioned by different Acharyas in their Samhita which are mentioned in Table no. 9.


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When we compare the symptoms of Vatarakta, it is withstand a resemblance to Gouty Arthritis of allopathy system of medicine. The various similar symptoms of Gouty Arthritis and Vatarakta at a glance are shown in Table no. 10.

Table 6: The symptoms of Uttana Vatarakta

1. Kandu Itching
2. Daha Burning sensation
3. Ruja Pain
4. Sira Aayam Dilatation of the vessels
5. Toda Pricking pain
6. Sphurana Trembling or throbbing sensation
7. Kunchana Sira Aakunchana) Contraction
8. Shyava Twak Cyanosis or pallor of the skin
9. Rakta Twak Reddish coloration of the skin
10. Bheda Splitting type of pain
11. Gourava Heaviness
12. Suptata Numbness

Table 7: The symptoms of Uttana Vatarakta and affirming by different Acharyas

Rupa C.S S.S A.S A.H M.N. B.P Y.R.
Kandu + - + - + + +
Daha + - + - + + +
Ruja + - - - - - -
Sira Aayam + - + - + + +
Toda + - + - + + +
Sphurana + - + - + + +
Kunchana Sira Aakunchana) + - - - - - -
Shyava Twak + - + + - + +
Rakta Twak + - + + - + +
Tamra Twak + - + + - + +
Bheda - - + + - + +
Gourava - - + + - + +
Suptata - - + + - + +

Table 8: The symptoms of Gambira Vatarakta

Syavathu Stabdhata Fixed swelling
Syavathu Kathinya Hard swelling
Bhrisharti Excruciating deep pain
Shyavata Cyanosis or pallor
Tamra Twak Coppery discoloration
Daha Burning sensation
Toda Pricking pain
Sphurana Throbbing sensation
Paka Suppuration
Ruja Pain
Vidaha Internal burning sensation
Vatasya Sandyasthi Majjasu Chindanniva Aggravated Vayu while causing pain-burning sensation constantly moves with high speed through the Sandhi, Asthi and Majja.
Khanjatwa Lameness
Pangutwa Paraplegia
Adhika Parvaruk Increased pain
Svayathu Grathitata Hard swelling
Vatasya Sarva Shareera Charanam Vitiated Vata moves all over the body
Angasya Vakrikarana Disfigurement of the parts

Table 9: Symptoms of Gambhira Vatarakta given in different Samhitas

Rupa C.S S.S A.S A.H M.N B.P. Y.R.
Svayathu Stabdhatha + - - - - + -
Svayathu Kathinya + - - - - + -
Bhrisharti + - - - - + -
Shyavata + - - - - + -
Tamra Twak + - - - - + -
Daha + - - - - + -
Toda + - + + - + +
Sphurana + - - - - + -
Paka + - - - - + -
Ruja + - - - - + -
Vidaha + - + + - + +
Vatasy Sandyasthimajjasu Chindanniva Charanam + - - - - + +
Khanjatwa + - + + - + +
Pangutwa + - + + - + +
Adhika Parvaruk - - + + - - -
Svayathu Grathitha - - + + - - -
Vatasya Sarva Shareera Charanam + - + + - - -
Angasya Vakrikaranam + - + + - - +

Table 10: Symptoms shown in Vatarakta and Gout

SN Uttana Vatarakta Gambhira Vatarakta Gouty Arthritis
1. Kandu Shotha inflammation of Joint
2. Daha Sthambhata warmth in Joint
3. Ruja Kathinyata stiffness in Joint
4. Toda Shyava Tamra Twak Restricted movement in joint
5. Sphuran Daha Very reddish-purpulish skin
6. Shyava Rakta Toda tenderness in Joint
7. Tamravarnya Twak Sphuran Thrombing and crushing pain
8. - Paka in Sandhi Sthana Infection in joint

Vatarakta associated with Raktadhika, Vatadhika, Pittadhika and Kaphadhika respectively may possess different Rupa and features given in different Samhitas are shown in Table no. 11-18.

Table 11: Rupa (symptoms) of Vatadhika Vatarakta

Sirayama Dilatation of vessels
Shula Pain
Sphurana Throbbing sensation
Toda Pricking pain
Shothasya Karshnyam Blackish discoloration of inflamed area
Shothasya Roukshyam Roughness of inflamed area
Shothasya Syavata Cyanosis around the swelling
Shotha Vriddhi/Hani Intermittent increase or decrease of swelling contraction of vessels around joint
Dhamani Anguli Sandhi Sankocha Finger joint hesitation
Angagraha Stiffness in body parts
Atiruk Severe pain
Stambhana Stiffness
Sheeta Pradhvesha Aversion towards cold
Sparshodwigna Inability to tolerate the touch
Bheda Splitting type of pain
Prashosha Atrophy
Swapa Numbness
Sheetanupashaya Aversion towards cold, which leads to discomfort
Vepathu Tremors

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Table 12: Rupa (symptoms) of Vatadhika Vatarakta given in different Samhitas

Rupa C.S S.S A.S A.H M.N B.P Y.R.
Sirayama + - - - - + -
Shula + - + + + + -
Sphurana + - + + + + -
Toda + - + + + + -
Shothasya Karshanya + - + + + + -
Shothasya Rouksya + - + + + + -
Shothasya Syavata + - + + + + -
Shoth Vriddhi/Hani + - + + + + -
Dhamani Anguli Sandi Sankocha + - + + + + -
Anga Graha + - + + + + -
Atiruja + - + + + + -
Kunchana + - - - - + -
Sthmbhana + - + + + + -
Seeta Pradvesa + - + + + + -
Sparshodwigna - + - - - - +
Bheda - + + + + + -
Prashosha - + + + + - +
Swapa - + + + + - +
Seetanupashaya - - - + + - -
Vepathu - - - + + - -

Table 13: Rupa (symptoms) of Pittaadhika Vatarakta

Vidaha Severe burning sensation
Vedana Pain
Murchha Fainting
Sweda Sweating
Trishna Thirst
Mada Intoxication
Bhrama Giddiness
Paka Inflammation/suppuration
Raga Redness
Bheda Splitting type of pain
Shosha Atrophy
Ugra Daha Excruciating burning sensation
Ati Ushnatwam Increased local temperature
Sophasya Mridutwam Soft swelling
Sparshakshamatwa Inability to bear the touch
Sammoha Fascination

Table 14: Rupa (symptoms) of Pittaadhika Vatarakta given in different Samhitas

Rupa C.S S.S A.S A.H M.N B.P Y.R.
Vidaha + - + + + + -
Vedana + - + + + + -
Murcha + - + + + + -
Sweda + - + + + + -
Trishna + - + + + + -
Mada + - + + + + -
Bhrama + - + + + + -
Paka + - + + + + -
Raga + + + + + + +
Bheda + - - - - - -
Sosha + - - - - - -
Ugra Daha - + - - - - +
Ati Ushnatwa - + + + + + +
Sophatsya Mridutwa - + - - - - +
Sammoha - - + + + + -
Sparshakshamatwa - - + + + + -

Table 15: Rupa (symptoms) of Kaphadhika Vatarakta

Rupa C.S S.S A.S A.H M.N B.P Y.R
Staimitya + - + + + + -
Gourava + - + + + + -
Snehatwa + - + + + + -
Supti + - + + + + -
Manda Ruja + - + + + + -
Kandu - + + + + + +
Swetata - + - - - - +
Eetata - + + + + + +
Sopha - + - - - - +
Peenatwa - + - - - - +
Stabdhatwa - + - - - - +

Table 16: Rupa (symptoms) of Kaphadhika Vatarakta given in different Samhitas

Staimitya Timidness
Gourava Heaviness
Snehatwa Unctuousness numbness
Supti Numbness
Manda ruja Mild pain
Kandu Itching
Swetata Increased pallor
Seetata Coldness swelling
shopha Swelling
Peenatwa  
Stabdhatwa Stiffness

Table 17: Rupa (symptoms) of Raktadhika Vatarakata

Sotha Swelling
Ati Ruk Severe pain
Toda Pricking pain
Tamra Varna Coppery discoloration
Chimchimayana Tingling sensation
Snigdha Rukshashamam Naiti Not subsiding by either unctuous or rough applications
Kandu Itching exudation
Kleda Slightly Wetness or damp

Table 18: Rupa (symptoms) Raktadhika Vatarakta given in different Samhitas

Rupa C.S S.S A.S A.H M.N B.P Y.R
Shotha + - + + + + +
Ati Ruk + - + + + + +
Toda + - + + + + +
Tamra Varna + - + + + + +
Chimchimayana + - + + + + +
Snigdha Rukshashamam Naiti + - + + + + +
Kandu - - + + - - -
Kleda - - + + - - -

Pathyapathya of Vatarakta

“Pathye Sati Gadaartasya Kimoushadha Nishevanaih

Pathye Asati Gadaartasya Kimoushadha Nishevanaih”

(Vaidya Jeevanam)


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Vaidya Lolambi Raj indicated the importance of wholesome food (Pathya Aahara) by stating that if a patient intake wholesome food, then there is no need of medicine and if a patient continuously consumes unwholesome food, then also there is no need of medicine. In view of the above, Pathyapathya of Vatarakta is shown in Table no. 19.

Table 19: Pathyapathya of Vatarakta

Pathya Apathya
§   Intake of barley, wheat, Nillana, Sali and Shastika rice. §   Meat soup of pecking birds. §   Vegetable of Sunisannaka fried with ghee and meat soup in milk. §   Intake of cows or goats milk. §   Application of Pultis, Parisheka, Pradeha, residing chamber devoid of breeze. Use of soft pillows, mild massaging. §   Day sleep, exposure to heat, physical exertion coitus, eating of pungent, hot, heavy channel blocking salty and sour things. §   Anger. §   Foods, which are hot in potency, Foods, which creates more moisture inside and difficult for digestion.  

Samprapti of Vatarakta[19]

Samprapti covered the relation between the Nidana & Dosha vitiation, which include manifestation of disease process & its termination. In Vatarakta, the Vata Dosha gets vitiated, aggravated, & deranged by its own etiological factors. Simultaneously, its own etiological factors vitiate Rakata. The vitiated Rakata produces obstruct the flow of Vata. The obstructed Vayu vitiates Raktadhatu. Due to Sukshmatwa & Saratwa Guna of Vayu and Dravatwa & Saratwa Guna of Rakta, they spread all over the body. The spreading is facilitated by Vyana Vayu. The Doshas get lodged in the minute Srotases. The vitiated Rakta afflicts Raktavaha Srotas & impairs its function. Due to impairment of Raktavaha Srotas Vata gets obstructed further. The Dosha Dushya Sammurchana occurs at the site of Khavaigunya.

There are two types of Samprapti, Samanya and Vishishta Samprapti. In Samanyasamprapti, causative factors are responsible for vitiation of Vata and Raktadosha have been specified and the disease progress is explained in brief.[20]

Vishishta Samprapti explains the pathogenesis of Vatarakta.

In addition, Vishishta Samprapti enables us to understand the nature of Vatadosha and Rakta Dhatu and also about the Srotas involved in the disease.

Samanya Samprapti of Vatarakta

Generally, Vatarakta arises in persons of tender and delicate physique, who indulge in unhealthy food and activities which are

mentioned earlier in etiological factor. From these etiological factors Vata and Rakta aggravated from their aggravating factors. Aggravated vitiated Rakta quickly obstructs the path of already aggravated Vata. On obstruction of passage of Vata its Gati is hindered making it greatly aggravated. This vitiates the whole Rakta and manifest as Vatarakta. Because of the above-mentioned factors which cause mainly aggravation of Vayu being obstructed in its course by vitiated Rakta. The excessively aggravated Vayu vitiated the entire Rakta (blood). The disease is thus called Vatarakta.[21]

Upadrava[22]

Upadrava is a complication produced by a disease; these develop after the formation of main disease. That is, if disease not treated at a time then it leads to Upadrava and becomes very difficult to cure. In Vatarakta after Anyonya Avarana of Dosha & Dushya it leads to formation of Upadrava. Upadrava may systemic and localized in nature. Updravas are shown in Table no. 20. and views of different Acharyas are mentioned in Table no. 21.

Table 20: Systemic complications and localized complication of Vatarakta

Aswapna Loss of sleep
Arochaka Anorexia
Swasa Dyspnoea
Mamsa kotha putrefaction/ necrosis of tissue
Sirograha Stiff neck
Murchha Fainting
Mada Intoxication
Ruja Pain
Trishna Thirst
Jwara Fever
Moha Confusion
Pravepaka Trembling
Hikka Hiccough
Pangulya Lameness
Visarpa Cellulites/herpes
Paka Suppuration
Toda Pricking pain
Bhrama Giddiness
Klama Mental fatigue
Anguli Vakrata Disfigurement of digits
Sphota Eruptions
Daha Burning sensation in foot
Marmagraha Affliction of vital parts
Prana kshaya Wasting of vitality
Mamsa kshaya Wasting
Kasa Cough
Stabdatha Stiffness
Avipaka Indigestion
Visarana Spread
Sankocha Contracture



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Table 21: Upadrava (complications) of Vatarakta given in different Samhitas

Upadrava C.S S.S A.S A.H M.N B.P Y.R
Arochaka + + + + + + +
Swasa + + + + + + +
Mamsa Kotha + - + + + + -
Siro graha + - + + + + -
Murchha + + + + + + +
Mada + - + + + + -
Ruja + - + + + + -
Trishna + + + + + + +
Jwara + + + + + + +
Moha + - + + + + -
Pravepaka + - + + + + -
Hikka + - + + + + -
Pangulya + - + + + + -
Visarpa + - + + + + -
Paka + - + + + + -
Toda + - + + + + -
Bhrama + - + + + + -
Klama + - + + + + -
Angulivakrata + - + + + + -
Spota + - + + + + -
Daha + - + + + + -
Marmagraha + - + + + + -
Arbuda + - + + + + -
Pranakshaya - + + + + + +
Mamsakshaya - + + + + + +
Kasa - + + + + + +
Stbdata - + + + + + +
Avipaka - + + + + + +
Visarana - + + + + + +
Sankocha - + + + + + +

Sadhyasadhyata

Sadhyasadhyata of disease depends on vitiated Doshas & also depends on presence or absence of Upadrava’s chronicity of disease. Sadhyasadhyata of Vatarakta is divided on the basis of following 3 categories:

1. On the basis of vitiated Doshas.

2. On the basis of presence or absence of Upadravas.

3. On the basis of Kala (time).

Sadhya - If Vatarakta caused by only one Dosha and no Upadravas, freshly occurred, if patient is strong, who have good will power & with proper availability of treatments.

Yapya - If caused by two Doshas without Upadravas, which is of one year duration, if patient is strong, self-controlled &with sufficient means.

Asadhya - If caused by all three Doshas associated with complications like Ajanusputitha.


In view of the above, it is well understood that some diseases are Sadhya, some diseases are Yapya and some are Asadhya. However, the various Acharyas are mentioned specific Upadravas in their Samhita. The all the three conditions of Vatarakta and specific stating of various Acharyas are given in Table no. 22-24.

Table 22: Sadhya Vatarakta given in different Samhitas

Sadhya C.S S.S A.S A.H M.N
Ekadhosaja + - + + +
Nava + - + + +
Nirupadrava + + - - +

Table 23: Yapya Vatarakta given in different Samhitas

Yapya C.S S.S A.S A.H M.N
Dvidoshaja + - + + +
Akritsnaopadrava + - - - +
Samvatsarothitha - + - - +

Table 24: Asadhya Vatarakta given in different Samhitas

Asadhya C.S S.S A.S A.H M.N
Upadravayukta + + - - -
Tridoshaja + - + + +
Moha + - + + +
Samprasava + + + + -
Vaivarnya + - - - -
Stabdhata + - + + -
Sankocha + - - - -
Ajanusphutita - + - - +
Prabhinna - + - - +
Arbudakari + - + + +

Chikitsa (Treatment) of Vatarakta

Selection of the patient for treatment

  • One should take up the patient for treatment who has not complicated with Prana and Mamsa Kshaya and thirst, fever, fainting, dyspnoea, cough, stiffness, anorexia, indigestion, necrosis, etc.
  • One should take patient who is strong, self-controlled and has sufficient means.[23] Considered as Yapya Vyadhi [24]

Samanya Chikitsa (General line of treatment)

In beginning Snehana should be given followed by, he should be given Virechana with Sneha Dravyas (if patient is unctuous) or with Ruksha Virechana (if patient is unctuous). Virechana should be mild in nature. Then patient should be administered Niruha and Dnuvasana Vasti frequently.



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Then he should be given Seka (affusion), Abhyanaga (massage), Pradeha (application of thick ointments), food, and unctuous substance which do not cause burning sensation. The patient should be administered with Upanaha, Parisheka, Lepa, and Abhyanga, Rakta Mokshana.[25]

Vishishta Chikitsa (Specific line of treatment)

Vishishta Chikitsa i.e., specific line of treatment as per Ayurveda in given in table no. 25

Table 25: Specific line of treatment in Vatarakta

Vatarakta Vyadhi Treatment
Uttana Vatarakta Alepa, Abhyanga, Parisheka and Upanaha.
Gambheera Vatarakta Purgation, Asthapana and Snehapana.[26]
Vatadhika Vatarakta Abhyanga, Basti and Upanaha with Ghritha, Taila, Vasa, Majja,
Pittadhika & Raktadhika Vatarakta Purgation, Parisheka, Vasti, and Sheetala Nirvapana.
Kaphadhika Vatarakta  Mridu Vaman, Langhana and Lepa. Snehana and Parisheka should be avoided
Kaphavatadhika Vatarakta Sheeta Upanaha should be avoided

Gout[27-28]

Gout is the term used to describe the constellation of clinical features that results from deposition of microcrystals of sodium urate monohydrate or uric acid from hyperuricemic body fluids. Gout is a disorder of purine metabolism manifested by the following features, occurring singly or in combination.

a. Increased serum uric acid concentration (hyperuricemia).

b. Recurrent attacks of characteristic type of acute arthritis in which crystals of monosodium urate monohydrate may be demonstrable in the glucosides present in the synovial fluid.

c. Aggregated deposit of monosodium urate monohydrate (tophi) in and around the joint of the extremities.

d. Renal disease involving interstitial tissue and blood vessels.

e. Uric acid nephrolithiasis.

Gout was historically known as “disease of kings or rich man's disease” because it was believed that it's increasing this factors a longer life expectancy and rich diet.

Gout is also known as Podagra (seizing the foot) when it involves the big toe. Fig no. 3.

Definition: Gout is an inborn error of purine metabolism characterized by pain and swelling of first metatarsophalangeal joint initially, followed by other joints with an abnormal elevation of urate level in the body either due to overproduction or under secretion or sometimes both.

jaims_2441_01.JPGFigure 3: Gouty Arthritis: Lakshanas of Gambhira Vatarakta resembles to Gouty Arthritis shown in Table no. 26

Table 26: Lakshanas of Gambhira Vatarakta & Gouty Arthritis

SN Lakshana of Gambhira Vatarakta Symptoms of Gouty Arthritis
1. Sandhi Shotha Joint inflammation
2. Daha Joint are warmth
3. Sthabdhata Joint stiffness
4. Kathinata Limited joint movement
5. Shyavtamratwacha Very red purplish skin
6. Abhyantar Sandhi Pida Joint tenderness
7. Sandhi Toda Throbbing and crushing pain
8. Pakyukta Infection in joint
9. Sphuran Pulsation

Discussion

Vatarakta generally occurs in all over the world in all races, genders, age, and climates. It is compared with gouty arthritis. Vatarakta is caused due to vitiation of Vata as well as Rakta. Aggravated Vata is obstructed by vitiated Rakta, leads to further aggravation of Vata. Thus, aggravated Vata vitiates whole Rakta producing complex effects on the joints leading to the condition Vatarakta. Nidana like Katu, Amla, Ushna, Vidahi Aahara, Gaja Ustrayaana etc. is mentioned in Ayurveda. It has two stages Uttana and Gambhira. Uttana Vatarakta mainly affects Twaka and Mamsa whereas Gambhira Vatarakta affects Asthidhatu and causes Ruja spreads as Aakhuvisha.

Vatarakta is elaborately described in Charaka Samhita as an independent disease.


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The main causative factors for Vatarakta are excessive intake of Guru, Lavana, stringent food stuffs, excessive use of pulses, alcohol, meat, sedentary life style, and psychological components such as excessive anger, emotional distress, mainly observed in Sukumar. Aggravated Rakta quickly obstructs the path of already aggravated Vata. On obstruction in the route of Vata its Gatis obstructed leads to further aggravation.

This vitiates whole Rakta and manifests as Vatarakta. Various Pathya and Apathya mentioned by Acharya Charaka plays important role in its prevention. Faulty and sedentary lifestyle and wrong dietary habits are causative factor for Vatarakta. So, Dinacharya & Ritucharya mentioned in Ayurveda must be followed for upkeep of health. Yoga by improving physical, emotional, mental and spiritual status plays a vital role in the prevention and management of Vatarakta.

Conclusion

Vatarakta is also a type of Vatavyadhi and it is co-related to gouty arthritis. Life style disorders and wrong dietary habits are making it different from other diseases as they are potentially preventable and can be depressed by adopting healthy dietary habits and life style so as in case of Vatarakta. Hetus are the causative factors for particular disease. Different types of Hetus for different diseases have been mentioned by Acharyas. They are included in Nidanpanchak. By avoiding causative factors responsible for the Vatarakta and adopting the Pathyaapathya mentioned by the Ayurveda Acharyas one may get rid of Vatarakta and can lead a healthy life. Vatarakta is a unique example of Avarana Janya Vata Vyadhi. Vata and Rakta are the main Dosha-Dushya involved in Vatarakta. It is mostly characterized by pain in the metatarsophalangeal joint and clinically diagnosed by elevated serum uric acid. Having similar clinical presentation, Vatarakta is correlated with gouty arthritis.

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