Management of Vatarakta with Yashtyahwa Niruha Basti: A Case Study

Neha Chaudhary; Shweta Mishra

doi:http://dx.doi.org/10.21760/jaims.8.8.44

Management of Vatarakta with Yashtyahwa Niruha Basti: A Case Study

Chaudhary N^1*, Mishra S²

DOI: http://dx.doi.org/10.21760/jaims.8.8.44

^1* Neha Chaudhary, Post Graduate Scholar, Department of Panchakarma, Government Ayurvedic College And Hospital, Varanasi, Uttar Pradesh, India.

² Shweta Mishra, Lecturer, Department of Kayachikitsa, Government Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.

Convenience and busy schedules have become typically major issues in today’s society, with unhealthy food habits and sedentary lifestyle, leading to increase in various types of health issues day by day. Vatarakta is a disease explained in Ayurveda, in which derangement of metabolism occurs due to indulgence in unwholesome dietary habits and sedentary lifestyle. It occurs when both Vata and Rakta are vitiated by distinct etiological factors.[1] Initially vitiated Vata obstructs the path of vitiated Rakta and then gets obstructed by Rakta itself. It can be correlated with Gout due to similarity in the clinical presentation. Various Ayurvedic drugs and Panchakarma procedures have been proved useful for this disease. Here is a case of Vatarakta, which was treated for 16 days with Yashtyahwa Niruha Basti.[2] Observations and results were drawn on the basis of assessment criteria. Marked improvement in signs and symptoms in Patient’s condition were seen.

Keywords: Ayurveda, Vatarakta, Vata Dosha, Rakta Dhatu, Yashtyahwa Niruha Basti

Corresponding Author	How to Cite this Article	To Browse
Neha Chaudhary, Post Graduate Scholar, Department of Panchakarma, Government Ayurvedic College And Hospital, Varanasi, Uttar Pradesh, India. Email:	Chaudhary N, Mishra S, Management of Vatarakta with Yashtyahwa Niruha Basti: A Case Study. J Ayu Int Med Sci. 2023;8(8):273-278. Available From https://jaims.in/jaims/article/view/2579

Introduction

Vatarakta is a painful condition, which is characterized by severe pain, tenderness, inflammation and burning sensation in the affected joints. Vatarakta is described in details in Brihattray’s and other Samhitas with different synonyms like Khuddavata, Vatabalasa, Aadhaya Vata.^[3]

On the basis of etiology and sign-symptoms, Vatarakta can be compared with Gout, which is a metabolic disorder resulting from abnormality of Uric acid metabolism that results in hyperuricemia, deposition of monosodium urate crystals in joints, soft tissues and renal tubules.

Nidana (Etiological Factors)

In Ayurveda Nidan of Vatarakta described in two ways, Aaharaj (dietary causes) and Viharaja Nidan.

Aaharaj Nidan

Excessive intake of foods and drinks that are having Lavana, Amla and Katu Rasa or Snigdha, Ushna, Klinna, Ruksha, Ushna, Vidahi and Kshara in quality tend to cause Vatarakta. The habit of taking Viruddha Aahara (incompatible diet), Adhyashana (intake of food prior to digestion of meal earlier taken). Intake of Anupa Mamsa, Kulathika, Masha, Nishpava, Sura and Aasava etc., are incriminated in the causation of this disease.^[4]

Viharaja Nidana

Krodha, Divaswapana, Ratrijagrana, Sukumara Prakriti, Achakramana Sheelata (Lack of physical activity), Ashuddhi, Abhighata (trauma), Ambukrida (activities in water), Plavan (excessive swimming), Vega-Nigraha (suppression of the natural urges), Riding on elephant, horse and camel etc., excessive sexual indulgence are the causes of this disease.^[5]

Prakriti based Nidana

Sushruta Samhita has mentioned that the individuals who are Sukumara (delicate in nature), Sthaulya (obese) and consuming unwholesome diet are mainly affected with Vatarakta.^[6]

Types of Vatarakta

On the basis of involvement of Dhatu

In Charak Samhita, Vatarakta has been classified in two forms as follows^[7]

Uttana Vatarakta	Gambhira Vatarakta
The disease pathology afflicts the superficial tissues i.e., skin and muscles, the symptoms are also limited to the skin. In this type, the symptoms moreover look like a skin disease or Kushta with skin lesions and muscle pain.	The disease pathology involves blood and other deeper tissues like bone and joints and also the internal viscera. This is moreover a systemic illness and the symptoms are more complicated. This moreover looks like a joint pathology because the joint symptoms are more than the skin presentation.

Acharya Sushruta has different explanation for this classification, according to Acharya Sushruta these are not the types but different stages of Vatarakta similar to Kushtha. Initially, it affects the superficial structures like Twaka and Mamsa and later on, it becomes Gambhira i.e., deep seated and affects the deep structure.^[8]

On the basis of Dosha variation

Vatarakta can be classified as follows according to the predominance of Dosha^[9]

Vata Pradhana Vatarakta	Ayama (mainly in sira), Shoola (Pain), Sphurana (Throbing pain), Toda (Pricking pain), Shyava-Ruksha Shotha (Swelling which is blackish-dry), stiffness of the body and Vridhi-Hani (aversion or aggravation of symptoms), etc.
Pitta Pradhana Vatarakta	Vidaha (Burning sensation), Vedana (Pain), Murcha (Fainting), Sweda-Aadhikya (Excessive sweating), Trishna Aadhikya (Excessive thirst), Mada, Bhrama, etc.
Kapha Pradhana Vatarakta	Staimitya, Gauravam (Heaviness), Sneha Snigdhata (unctuousness), Supti (Numbness), Manda Vedana, Shitalta (Coldness), Kandu (Itching), etc.
Rakta Pradhana Vatarakta	Shwayathu (Swelling), Atiruka (Severe pain), Toda (Pricking pain), Tamra Varna of skin, Chimchimayata (tingling sensation), etc.

Samprapti Ghataka

Dosha	Vata Pradhan
Dushya	Rakta, Twak, Mamsa
Adhisthan	Sandhi, Twak, Mamsa
Srotas	Rasavaha, Raktavaha
Agni	Mandagni
Srotodushti	Sang Pachat Vimarggaman
Udhbhavasthan	Pakwasaya
Roga Marga	Madhyama

Case Report

A 43 year old Male patient came to the OPD No. 10 of Government Ayurvedic College and Hospital, Varanasi with Chief Complaints of-

Acute pain in all major and minor joints, especially

bilateral knee joint and left shoulder joint associated with swelling over bilateral ankle joints since 1year.

Other Complaint: No associated complain.

History of Present Illness
Patient was normal before 1 year and then gradually developed Pain in bilateral knee joints along with left shoulder joint due to sedentary life style. Later he started complaining Pain in all major and minor joint along with swelling over bilateral ankle joints. He took treatment for the same but not got expected relief so now he came to Government Ayurvedic College and Hospital, Varanasi for proper treatment.

Family History: No any Family Illness of such History to any relatives.

Past History: No History of any Past illness. No History of HTN, DM, Thyroid disorder. No History of any Surgery.

Personal History

Appetite	Normal
Bowel	Constipated / irregular (sometimes)
Micturition	Regular (4/2- Day/Night)
Sleep	Normal
Diet	Vegetarian
Addiction	No

General Physical Examination

General Condition	Moderate
Blood Pressure	124/80 mmhg
Pulse	76/min
Respiratory Rate	18/min
Tongue	Coated
Temperature	98.6°F
Lymph Nodes	Absent
Pallor	Absent
Icterus	Absent
Cyanosis	Absent
Clubbing	Absent

Ashtavidh Pariksha

Nadi	Gati - 76/Min
Mutra	Day/Night - 4/2
Mala	Vibandhit Mala (sometimes)
Jivha	Lipta
Shabda	Prakrit
Sparsha	Ushna Sparsh in affected joints
Druk	Prakrit
Akriti	Madhyama

Dashvidha Pareeksha

Prakriti	Vata-Pitta
Vikriti	Vata-Shula, Pitta-Daha, Kapha-Stambha (Fingers)
Sara	Rasa, Rakta Sara
Samhana	Madhyama
Pramana	Madhyama
Satva	Madhyama
Satmya	Shadrasa Satmya
Ahara Shakti	Abhyavarana Shakti: MadhyamaJarana Shakti: Avar
Vyayama Shakti	Madhyama
Vaya	Madhyama

Objectives

To study the effect of Yashtyahwa Niruha Basti in the management of Vatarakta.

Material and Methods

Treatment Plan: Yashtyahwa Niruha Basti (500ml) is given in accordance to Kala Basti Schedule (16 days) with Anuvasan Basti of Til Taila (60ml).

Ingredients of Yashtyahwa Niruha Basti

1.	Madhu	50 ml
2.	Lavana	5gm
3.	Ghrita	100ml
4.	Kalka (Shatpushpa, Madanphala, Pippali)	15gm
5.	Dravadravya (Yashtimadhu 320 gm + Milk 320 ml + Water 1280ml)	320ml

Like every Panchakrama procedures, here treatment is planned in three steps on daily basis-

Purvakarma: For Anuvasana Basti, Patients after having Laghu Aahar, have to undergo with Mridu Abhyanga and Swedana on the area of Udara, Sphik & Pristha.

The same procedure is also to be applied to the patients before Niruha Basti, but it should be in empty stomach.

Pradhanakarma

Til Taila Anuvasan Basti - 60 ml of Til Taila is to be applied to the patient as Anuvasana Basti.

Yashtyahwa Niruha Basti - In the next day of Anuvasana Basti, 500 ml of Yashtyahwa Niruha Basti is to be administered.

Paschatkarma: Patient is to be advised to lie in the supine position & to defecate on developing urge.

Assessment Criteria

A. Subjective criteria: Gradation of symptoms according to WHO scoring pattern

Grade	Grade 0	Grade 1	Grade 2	Grade 3	Grade 4
Swelling	No Swelling	Slight Swelling	Moderate Swelling	Severe Swelling	-
Discoloration	Normal Coloration	Near to Normal	Reddish Discoloration	Slight Reddish Black Discoloration	Blackish Discoloration
Burning Sensation	No Burning Sensation	Mild Burning Sensation	Moderate Burning Sensation	Severe Burning Sensation	-
Pain	No Pain	Mild Pain	Moderate Pain but no difficulty in moving	Slight difficulty in moving due to Pain	Much difficulty
Itching	No localized Itching	Itching occurs Occasionally	Continuous Itching (disturbing normal activity)	Severe localized Itching (Desquamation of over lying skin)	-

Objective Criteria: Serum Uric Acid.

Observations and Results

Changes in Symptoms in Before and After Treatment

Symptoms	Before Treatment	After Treatment
Swelling	3	0
Discoloration	1	0
Burning Sensation	1	0
Pain	4	1
Itching	1	0

Changes in Investigations

Investigation	Before Treatment	After Treatment
CBC	Normal	Normal
S. Uric Acid	9.67	3.84
Thyroid Profile	Within Normal Limit	Within Normal Limit
Lipid Profile	Within Normal Limit	Within Normal Limit
Random Blood Sugar	89.9mg/dl	78.6mg/dl

Discussion

In Ayurveda, Basti is considered as Ardh-Chikitsa by some Acharyas and as a complete therapeutic procedure by others due to its vast areas of action.^[10] Basti Chikitsa is considered as prime among all the therapeutic measures, especially for the management of Vatavyadhies. Aachrya Charak and Vaghbhata mentioned that there is

no other therapeutic measure equivalent to Basti in treating Vatarakta- “Na Hi Basti samam kinchit Vataraktam Chikitsitam”.^[11,12] Also, Aachrya Charak has mentioned the use of Ksheer Basti alongwith Ghrita in Vatarakta Chikitsa.^[13]

Yashtimadhu used in this case for making of Yashtyahwa Niruha Basti has Madhur Rasa, Madhur Vipaka, Sheet Virya and Guru-Snigdha Guna, due to these properties it pacifies Vata Dosha and Pitta Dosha, as well as acts as a Rakta-Prasadak Dravya. It is also mentioned as one of the Medhya drug^[14] and described under Jeevniyagana, Varnya, Shonitasthapan and Kandughana by Acharya Charak, hence it implies that it mainly acts on Raktadhatu and Raktavaha Srotas, and hence on Raktavaha Srotas Mula i.e. Yakrit (Liver) and Pleeha (Spleen).^[15]As Uric acid is the end product of Purine metabolism occurring in liver and is excreted by the kidneys, Yashtimadhu can affect the Uric acid levels as it works on Raktavaha Srotas Mula. Also, studies have shown that Yashtimadhu is effective in reduction of blood urea, creatinine and Uric acid levels, and also effective in decreasing tubular necrosis.

Ksheer or Dugdh used in the prepration of Yashtyahwa Niruha Basti act as Rasayana, Balya, Medhya, Sandhaniya and also due to its Singdha-Manda-Bahal Guna, Madhur Vipaka, Sheeta Virya, it pacifies the Vata Dosha and Pitta Dosha.^[16]As Milk contains calcium and it is absorbed without the assistance Vit-D, Under the influence of lactose within the distal intestine via the paracellular route. This promotes the absorption of calcium and provides simultaneous intake of phosphorus that it essential for bone deposition. Hence Ksheer Basti has a large and effective applicability in Asthivaha Sroto Vikara.

Hence, Yashtyahwa Niruha Basti given in this case can successfully treat it, where Ksheer and Yashtimadhu both have significant effect on Vatarakta and also on uric acid.

Conclusion

Vatarakta has become a common and serious disease nowadays. Sedentary lifestyle along with unhealthy eating habits are the root cause behind this. People are so busy without patience these days and expect quick relief, without bothering about the side effects and effects in the long term.

So, it is the need of the time to find a better way to manage it. With proper knowledge of Dosha, Dushya, Vyadhi Awastha, and with understanding of Nidana, Lakshana and Samprapti of Vatarakta, one can treat it successfully with the help of Panchakarma procedures along with Ayurvedic medicines. Here, in this case study patient got relief from symptoms within 16 days. The treatment given to the patient, mainly Yashtyahwa Niruha Basti is advised for the patients of Vatarakta. The Patient had symptomatic relief and also the laboratory findings of Serum Uric Acid had lowered significantly. Therefore, the given Ayurvedic treatment was successful in treating the disease without leading to further complications.

Reference

1. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Chikitsa Sthana Chapter 29/10, Varanasi, Chaukambha Bharti Academy.

2. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Sidhi Sthana Chapter 3/46, Varanasi, Chaukambha Bharti Academy.

3. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Chikitsa Sthana Chapter 29/11, Varanasi, Chaukambha Bharti Academy.

4. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Chikitsa Sthana Chapter 29/5-7, Varanasi, Chaukambha Bharti Academy.

5. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Chikitsa Sthana Chapter 29/5-7, Varanasi, Chaukambha Bharti Academy.

6. Sushruta, Sushruta Samhita, Hindi commentary by Ambikadatta Shastri, Nidana Sthana, Chapter 1/40-41, Varanasi, Chaukambha Sanskrit Sansthana.

7. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Chikitsa Sthana Chapter 29/19-20-21, Varanasi, Chaukambha Bharti Academy.

8. Sushruta, Sushruta Samhita, Hindi commentary by Ambikadatta Shastri, Chikitsa Sthana, Chapter 5/3, Varanasi, Chaukambha Sanskrit Sansthana.

9. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Chikitsa Sthana Chapter 29/24-29, Varanasi, Chaukambha Bharti Academy.

10. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Sidhi Sthana Chapter 1/40, Varanasi, Chaukambha Bharti Academy.

11. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Chikitsa Sthana Chapter 29/88, Varanasi, Chaukambha Bharti Academy.

12. Vagbhata, Ashtanga Hridaya, Hindi commentary by Brahmanand Tripathi, Chikitsa Sthana 22/13, Varanasi, Chaukhambha Surbharti Prakshana.

13. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Chikitsa Sthana Chapter 29/88, Varanasi, Chaukambha Bharti Academy.

14. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Chikitsa Sthana Chapter 1-3/30, Varanasi, Chaukambha Bharti Academy.

15. Charak, Charak Samhita, Hindi commentary by Kashinath Shastri, Sutra Sthana Chapter 4, Varanasi, Chaukambha Bharti Academy.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2023-06-13	2023-06-17	2023-06-24	2023-07-05	2023-07-18
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Vatarakta

Journal of Ayurveda and Integrated Medical Sciences

Management of Vatarakta with Yashtyahwa Niruha Basti: A Case Study

Chaudhary N1*, Mishra S2

Introduction

Case Report

Objectives

Material and Methods

Observations and Results

Discussion

Conclusion

Reference

Chaudhary N^1*, Mishra S²