E-ISSN:2456-3110

Review Article

Comparative study

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 12 December
Publisherwww.maharshicharaka.in

Comparative study of Vatarakta w.s.r. to Gouty Arthritis

Rupali K1*, Rupali2, Sakshi C3, Swapnil S4
DOI:10.21760/jaims.8.12.30

1* Kapoor Rupali, Third Year Post Graduate Scholar, Dept of Rog Nidan Evam Vikriti Vigyan, Rggpg Ayurvedic College Hospital, Paprola Dist Kangra, Himachal Pradesh, India.

2 Rupali, Second Year Post Graduate Scholar, Dept of Rog Nidan Evam Vikriti Vigyan, RGGPG Ayurvedic College and Hospital Paprola, Dist Kangra, Himachal Pradesh, India.

3 Chauhan Sakshi, Second Year Post Graduate Scholar, Dept of Rog Nidan Evam Vikriti Vigyan, RGGPG Ayurvedic College and Hospital, Paprola Dist Kangra, Himachal Pradesh, India.

4 Saini Swapnil, Sr Lecturer, Dept of Rog Nidan Evam Vikriti Vigyan, RGGPG Ayurvedic College Hospital Paprola, Dist Kangra, Himachal Pradesh, India.

A healthy lifestyle isn’t just diet and exercise. Today we go over the components of leading a healthy lifestyle and how it’s important to lead a balanced life. In general, most would agree that a healthy person doesn’t smoke, is at a healthy weight, eats a balanced healthy diet, thinks positively, feels relaxed, exercises regularly, has good relationships, and benefits from a good life balance. The World Health Organization in 1946 defined health as ‘A complete state of mental, physical and social well-being not merely the absence of disease’ Vatarakta is a metabolic condition where the most common symptom is pain, which interferes with the patients'' daily lives. Vatarakta is named on the basis of the Vata dosha & Rakta dosha which have their own independent derivation & are the main Samprapti Ghatak involved in the Vatarakta. Gouty arthritis is a purine metabolic condition and an inflammatory reaction to the MSUM (Monosodium Urate Monohydrate) crystals that are produced as a result of hyperuricemia.

Keywords: Vatarakta, Vata, Rakta, Ayurveda, Chala Sukshama Gunas, Laghu, Sheeta, Khara, Tridosha, Ruksha.

Corresponding Author How to Cite this Article To Browse
Kapoor Rupali, Third Year Post Graduate Scholar, Dept of Rog Nidan Evam Vikriti Vigyan, Rggpg Ayurvedic College Hospital, Paprola Dist Kangra, Himachal Pradesh, India.
Email: 		Rupali K, Rupali, Sakshi C, Swapnil S, Comparative study of Vatarakta w.s.r. to Gouty Arthritis. J Ayu Int Med Sci. 2023;8(12):204-212.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-10-07 2023-10-17 2023-10-25 2023-11-03 2023-11-13
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© 2023by Rupali K, Rupali, Sakshi C, Swapnil Sand 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

Vatarakta belongs to Vatavyadi's domain and primarily affects the extremities. According to conventional medicine, the term "Vatarakta" covers a wide range of ailments affecting the extremities, including connective tissue and peripheral vascular problems.

The name Vatarakta comes from the literature's emphasis on the etiological elements that cause the predominance of Vata Dosha and Rakta Dhatu as morbidities. The primary pathology is, to be more precise, the obstruction of Raktamarga or Raktavaha Srotas.

Vatarakta is one of the oldest known type of disease described in Ayurvedic classical literature like Charak Samhita, Sushruta Samhita, Ashtang Hridya. Vatarakta is named on the basis of the Vata Dosha & Rakta Dosha which have their own independent derivation & are the main Samprapti Ghatak involved in the Vatarakta.

Both Vata Prakopaka and Rakta Prakopaka Nidan are involved in Samprapti of the disease. When a person does not opt for purification process like Vamana and Virechana or due to trauma, Rakta Dhatu gets vitiated.

The same individual with vitiated Rakta Dhatu when starts taking Vata-Prakopaka Ahara and Vihara, become prone to Vata-Vridhhi.

Already vitiated Rakta Dhatu obstructs the path of Vridhhvata, in which Vata has to flow. Vitiated Vata become Aavrut with vitiated Rakta Dhatu. Vridhh and obstructed Vata inturn vitiates the whole Rakta and manifests as Vatarakta. It is characterized by severe pain, tenderness, inflammation and burning sensation in the affected joints.

Gout or gouty arthritis is a complex metabolic condition of protein metabolism and is likely the earliest form of arthritis to date. Due of its links to fatty meals and alcohol consumption, gout has earned the moniker "the disease of kings" throughout history.

The most frequent type of inflammatory arthritis is gouty arthritis, which is characterised by a poor quality of life. Gout must first develop in the presence of elevated serum uric acid (SUA) levels, also known as hyperuricaemia.

The development and deposition of monosodium urate (MSU) crystals takes place in and around joints as SUA levels rise and the physiological saturation threshold for uric acid in bodily fluids is exceeded. Clinical signs of MSU crystal deposition include tophaceous deposits of MSU crystals in the skin and joints as well as acute bouts of excruciating pain and inflammation, most frequently affecting the first Metatarsophalangeal (MTP) joint. Gouty arthritis patients experience severe joint damage. Urate nephropathy, uric acid nephropathy, and nephrolithiasis are the most frequent consequences in people with gouty arthritis.

The byproduct of purine metabolism is uric acid, and neither humans nor higher apes have the urease enzyme that further breaks down uric acid. The digestive system or kidneys remove two-thirds of the uric acid produced each day. higher purine consumption (purines are precursors to uric acid), higher turnover or synthesis, or decreased uric acid clearance by the kidneys are the causes of the rise in blood uric acid.

It is the most typical cause of inflammatory joint disease in males over 40. Vatarakta is a rare clinical condition where both Vata and Rakta have a role in the manifestation of diseases.

Synonyms of Vatarakta are:

Vata Shonita, Adyavata, Khuddavata, Vatabalasa, Vatasruk.

Aetiology:

The following etiological factors mentioned for the manifestation of Vatarakta.

Rakta Prakopaka Nidana:

Regular consumption of saline, sour, pungent, alkaline, unctuous, hot and uncooked food; regular intake of purified or dry substances; meat of aquatic or marshy land inhabiting animal; oil cakes; radish; horsegram; blackgram; Nispava; other vegetables (leguminous); sesamum paste; sugarcane; curd; sour gruel; Sauvira (sour preparation of dehusked barely, etc.),

Sukta (vinegar), butter milk, alcohol & wine; intake of mutually contradictory food; eating during indigestion, anger, sleeping during daytime and awakening at time; delicate people who indulge excess sweet preparations, eating abundantly and adopting sedentary life style; due to injury and


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avoidance of the bio-purification therapies when needed.

Vata Prakopaka Nidana

Increased consumption of astringent, pungent, bitter, and unctuous foods; reduced calorie intake or fasting; riding over horses and camels or on their carts; use of aquatic sports like swimming and jumping; excessive barefoot travel during the summer; sexual activity; and suppression of natural urges. Sushruta also mentioned other things like people who have chronic illnesses, long walk, excessive wine consumption, excessive physical activity, people who indulge in foods and activities that are out of season, people who avoid having sexual activity, people who are obese, etc.

Vata-Rakta Samprapti

Vata and Rakta exacerbate concurrently as a result of the underlying etiological causes. Affected blood vitiates all blood because it prevents the passage of exacerbated Vata. This is known as Vatarakta. Additionally, it goes by the synonyms Khuda, Vata-Balasa, and Adhya-Vata. Pitta-Rakta refers to the combination of aggravating Pitta and aggravating Kapha, whereas Kapha-Rakta refers to the combination of aggravating Kapha and vitiated blood.

Nidan Sevana (Consumption of Etiological factors)

Aggravation of Vatadi Doshas

↓

Diminution of Agni

↓

Development of Ama inside the gastro intestinal tract

↓

Exacerbation of Vata and Rakta simultaneously

↓

Obstructions in the Lohitavaha Srotas for Vata movement

↓

Vitiates the whole Rakta

↓

Vata-Rakta

(It is caused by the vitiation of Rakta by Vata)

Pathogenesis of Pitta-Rakta

Nidan Sevana (Consumption of Etiological factors)

↓

Aggravation of Pittadi Doshas

↓

Diminution of Agni

↓

Development of Ama inside the gastro intestinal tract

↓

Exacerbation of Pitta and Rakta simultaneously

↓

Obstruction in the Lohitavaha Srotas for Pitta movement

↓

Vitiates the whole Rakta

↓

Pitta -Rakta

(It is caused by the vitiation of Rakta by Pitta)

Pathogenesis of Kapha-Rakta

Nidan Sevana (Consumption of Etiological factors)
↓
Aggravation of Kaphadi Doshas
↓
Diminution of Agni
↓
Development of Ama inside the gastro intestinal tract
↓

Exacerbation of Kapha and Rakta simultaneously

↓

Obstruction in the Lohitvaha Srotas for Kapha movement

↓

Vitiates the whole Kapha

↓

Kapha-Rakta


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(It is caused by the vitiation of Rakta by Kapha)

Samprapti Ghataka of Vata-Rakta

Dosha: Vata Pradhana Tridosaja

Vata - Vyana

Pitta - Pacaka

Kapha -Slesaka

Dusya:

Uttana Vata Rakta - Rakta, Rasa, Mamsa

Gambhira Vata Rakta - Rakta, Rasa, Mamsa, Meda,

Asthi & Majja.

Updhatu - Sira, Kandara, Sandhi, Snayu, Tvaca

Saririka Mala - Mutra, Purisa

Dhatumala - Kapha, Sveda & Pitta

Agni: Jatharagnijanya, Dhatvagnijanya

Agnidushti: Mandagni

Ama: Agnijanya

Srotas: Vatavaha, Rasavaha, Raktavaha initially later all Dhatu Vaha Srotas

Srotodushti: Sanga

Adhisthana: Janu, Janga, Uru, Kati, Amsa,

Dhamani, Hastapadanga Sandhi

Udbhavasthana: Pakvasayottha, Amasayottha

Vyaktasthana: Janu, Janga, Uru, Kati, Amsa,

Dhamani, Hastapadanga Sandhi

Sancarasthana: Rasa, Raktavahinyah

Svabhava: Asukari

Prabhava:

Ekadosaja - Sadhya

Dvidosaja - Yapya

Tridosaja - Asadya

Roga Marga: Madhyama

Roga Bheda:

1. Uttana

2. Gambhira

3. Ubhayasraya

Vata- Rakta Mula Sthana

Vata-Rakta manifest in hands, feet, fingers and all joints.

The affected areas of the body initially include the hands and feet before spreading throughout. Due to the complexity and all-pervasiveness of Vata and the liquidity and dispersibility of Rakta,

which circulates throughout the body through blood vessels, it becomes clogged in the joints due to zigzag way, which aggravates them further, and becomes lodged there.

Additionally, Pittadi Doshas in conjunction with other conditions that affect the joints can result in a variety of pains that are quite acute and excruciating for the patients who experience them.

  • Svedoatyarthama na va - Excess or absence of perspiration
  • Karshnya - Black discoloration of the skin
  • Sparsa Agyatva - Numbness of Paraesthesis
  • Kshate Atiruka - Excessive pain on injury or trauma
  • Sandhi Shaithilya - Laxity in joints
  • Alasya - Lassitude
  • Sadanam - Malaise
  • Pidikoudgama - Appearance of boils
  • Sandhi Nistoda - Pricking pain in joins
  • Sphurana - Flickering
  • Bheda - Cutting pain
  • Gurutvama - Heaviness
  • Shunyata - Numbness
  • Kandu - Itching
  • Sandhishu Rug Bhutva - Unstable pain in joints
  • Mandalotpatti - Round eruptions (Ch.Chi.29/16-18)

Classification of Vata-Rakta

It is classified into two varieties

  • Uttana (Situated superficially in the skin along with muscle tissues)
  • Gambhira (Situated in deeper tissue of the body)

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Vata-Rakta classification based on predominance of Doshas

1. Vata predominant Vata-Rakta

2. Pitta predominant Vata-Rakta

3. Kapha predominant Vata-Rakta

4. Dvanda Dosa predominant Vata-Rakta

5. Tridosaja predominant Vata-Rakta

Specific signs and symptoms of different types of Vata-Rakta

SNVataja VataraktaPittaja VataraktaKaphaja VataraktaRaktaja VataraktaDvandvaja Vatarakta
1.Ayama (mainly in Sira)Vidaha (Burning sensation)StaimityaShwayathuVata-Pittaja
2.Shoola (Pain)Vedana (Pain)GauravamaAtirukaPitta-Kaphaja
3.Sphurana (Throbbing pain)MurchaSneha SnigdhataTodaVata-Kaphaja
4.Toda (Pricking pain)Sweda Adhikya (Excessive sweating)SuptiTamra Varna
5.Shotha ShyavataTrishna Adhikya (Excessive thirst)Manda VedanaChimchimayata
6.Change in color of Shotha and Vriddhi or HaniMada (Narcosis)ShitaltaSnigdha Ruksha Sama Abhava
7.RukshaBhrama (Giddiness)KanduKandu

Sadhyasadhyata:

1.Predominance of single Dosha & newly manifested is curable.

2. Dominancy of two Doshas is palliable.

3. Vatarakta caused by dominancy of all the three Doshas along with complications is incurable.


Updrava:

This can be classified into systemic and local complications as under:

SNSystematic complicationLocal Complication
1.Aswapana (Insomnia)Mamsakotha (Tissue-necrosis)
2.Arochaka (Anorexia)Pagulya (Limping)
3.Shwasa (Dyspnoea)Visarpa (Erysipelas)
4.Trishna (Thirst)Paaka (Suppuration)
5.Shirograha (Heaviness In head)Toda (Pricking pain)
6.Jwara (Fever)Angulivakrata (Disfigurement of digits)
7.Moha (Confusion)Sphota (eruption)
8.Mamsakshaya (Muscle wasting)Daha (Burning sensation)
9.Pravepaka (Tremors)Samprasavi (Discharge)
10.Hikka (Hiccough)Vivarnata (Discolouration)
11.Bhrama (Delirium)Sankocha (Contractures)
12.Klama (Mental fatigue)Arbuda (Tumours)
13Marmagraha (Affliction of vital parts)
14.Pranakshaya (Diminution of Prana)

Such patients shouldn't be treated in which Vatarakta is associated with significant discharge, an abnormal skin tone, stiffness, a tumour, contractions, or sensory impairments. Patients with a few complications may be feasible, and absence of complication is curable.

Chikitsa

The first line of treatment in Ayurveda is Nidana Parivarjana.

Morbidity of Vata Dosha and Rakta Dhatu is the primary pathology of Vatarakta, in which vitiated Rakta Dhatu obstructs the passage of already Vriddh Vata.

Samprapti Vighatan (Samprapti Disintegration) should be the next step in its management. Vatarakta management is complicated since it is a condition with substantial morbidity, chronicity, and, to some extent, incurability, as well as accompanying comorbidities.

In Ayurvedic texts, two types of treatment of Vatarakta are described:

  • Samanaya Chikitsa (General Management)
  • Vishishta Chikitsa (Specific Treatment according to classification)

Samanaya Chikitsa

a) Shodhana Chikitsa


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b) Shamana Chikitsa
c) Raktamokshana Karma
d) Lepa Chikitsa

1. Shodhana Chikitsa

Shodhana Chikitsa has been given great consideration in the management of Vatarakta. The following management strategy is described in the Charaka Samhita and subsequent classics:

  • Snehana Karma
  • Virechana Karma
  • Basti

Snehana Karma

Vatarakta patients receive Snehana or oleation therapy prior to Shodhana and Shamana Chikitsa. Before using Virechana, patients are administered Snehana together with Vatarakta. Snehana is categorised known as Abhyanga when applied externally.

Virechana Karma

Vatarakta patients receive Snehana or oleation therapy prior to Shodhana and Shamana Chikitsa. Before using Virechana, patients are administered Snehana together with Vatarakta. Snehana is categorised known Vatarakta makes reference to both Snigdha and Ruksha Virechana. If the patient has Ruksha Sharira, Snigdha Virechana is recommended. It is recommended that patients with Snigadha Sharira take Ruksha Mridu Virechana Dravya. As Tikshna Virechana causes Vata Dosha to get vitiated. In patients with Vatarakta, Mridu Virechana is therefore always justified.

Basti

Basti Karma is the greatest treatment for patients with Vatarakta, according to the Charaka Samhita. In the forms of Karma, Kala, and Yoga Basti, Basti Karma encompasses both Asthapana and Anuvasana Basti. After providing Virechana, Basti Chikitsa is suggested and is thought to be the finest for Vata Shamana.

2. Shamana Chikitsa

Shamana Chikitsa aids in establishing homeostasis and maintaining Tridosha at Samya Avastha. Numerous formulations have been provided by Charaka Samhita and Sushruta Samhita to maintain Samya Avastha of Tridosha and to lessen Vatarakta's signs and symptoms.

3. Raktamokshana Karma

Raktamokshana therapy has been promoted by Charaka, Sushruta, Vagbhatta, and their succeeding predecessors in Vatarakta. The primary pathology of Vatarakta is Rakta Margavarana, which causes an accumulation of morbid Rakta. Therefore, Raktamokshana is regarded as the primary therapy for Vatarakta. Raktamokshan may be done by Shringa, Jalouka, Suchi, Alabu, Prachhan and Siramokshan method.

4. Lepa Chikitsa (Bahiparimarjana Chikitsa)

In Uttana or Ubhayashrita Vatarakta, Bahiparimarjana Chikitsa is essential.

Use of local application in Uttana Vatarakta has been emphasised by Charaka Samhita. Alepa, Parisheka, Upnaha, and Abhyanga are examples of local applications that should be employed.

Lepa:

According to the relative dominance of the Dosha concerned, Lepa Chikitsa is designed. If the patient is exhibiting symptoms of morbid Vata Dosha, it is preferable to apply a warm paste made by mixing Ghrita or goat milk.

Parisheka:

Depending on the Doshic involvement, the affected elements are given Sheeta or Ushana Parisheka.

Abhyanga:

Depending on the dominance of the relevant Dosha, Abhyanga is prepared for the impacted area. If a patient complains of Shoola caused by vitiated Vata, warm oil treated with Vatahara medications is utilised for Abhyanga.

If a patient complains of a burning sensation brought on by morbid Pitta Dosha, a cold application of Ghrita treated with Pitta Ahara medications is recommended. If Kandu is the primary ailment brought on by a dominant Kapha Dosha, oil prepared with Kaphahara medications is used as Abhyanga.

Vishishta Chikitsa

Following a thorough diagnosis, the disease should be divided into groups according to the site and Doshic variation. It is possible to identify the dominant Dosha, and a specific course of treatment is planned with the general management approach in consideration.


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Uttana Vatarakta

According to Charaka Samhita, in Uttana Vatarakta, Bahiparimarjana Chikitsa, or external application of medications in the form of Lepa, Abhyanga, Parishek, or Upnaha, is indicated. After identifying the dominant Dosha, this course of action should be recommended. Ushna Lepa is contraindicated in Rakta and Pitta Pradhana Vatarakta. Daha, Kleda, and skin desquamation are possible side effects of Ushna Lepa.

As Sheeta Lepa causes Stambhan of Dosha, it is contraindicated in Kapha and Vata Pradhan Vatarakta.

Gambhira Vatarakta

In the Gambhira Vatarakta, Snehana, Virechana, and Basti are urged.

Vata Pradhan Vatarakta

After using the preparation, Dughdapana is indicated, along with Erand Taila with Ksheer. Aside from Ghrita, Taila, Vasa, and Majja, oleation, Snehapana, and Abhyanga have also been cited. External usage is recommended for lukewarm fomentation.

Rakta- Pitta Pradhan Vatarakta

Virechana, which is recommended the finest method to balance Pitta Dosha, is suggested. Additionally, oral usage of Ghrita, Milk, fomentation, and Basti therapy are recommended. To lessen the burning sensation, Dravya's Sheeta Lepa is also recommended.

Kapha Pradhan Vatarakta

Mridu Vamana should be given. Gomutra mixed with lukewarm milk is recommended. Different Taila preparations for Basti Karma are indicated to be utilised in Kapha Pradhan Vatarakta, as well as different Ghrita and Kwatha preparations for oral usage.

Upasaya/Pathya

Ausadha

Sravanyadi Ghrta, Bala Ghrta, Parusaka Ghrta, Jivaniya Ghrta, Sthiradya Ghrta

Taila

Sthiradya Taila, Madhuparnyadi Taila, Sukumaraka Taila, Amrtadya Taila, Mahapadmaka Taila

Anna

a) Shuka Dhanya - Puraan Yava (Old barley), Godhuma (Wheat), Nivara (Variety of rice), Shaali, Shashtika

b) Yusha of Shimbi Dhanya with Ghrita Adhakya, Chanaka (Bengal gram), Masura, Makushthak (Motha), Kulathika (Horse gram)

c) Shaaka - Sunishnaka (Marsilea minuta), Vetagra, Kakmachi, Shatavari, Vastuka (Bathua), Upodika, Patola, Karvellaka, Kushmanda, Misri, Suran Kanda, Amla, Draksha, Aadrak, Naveen Ghrita.

d) Milk and Milk products - Godugdha (cow‟s milk), Mahishi Dugdha, Aja Dugdha (Goat‟s milk), Ghrita (Clarified butter)

e) Non vegetarian food - Vishkara Mamsa, Pratuda Mamsa, Chataka Mamsa, Kukkuta Mamsa, Varahi Mamsa, Tittira Mamsa.

Vihara:

Upnaha, Parisheka, Pradeha, Abhyanjana, Comfortable room, Comfortable bedding.

Anupasaya/Apathya

Aahara:

Urad (Black gram), Kulathika (Horse gram), Nishpaav (flat beans), Kalay (garden pea), Kshara, Flesh of birds and aquatic animals, Anupa Mamsa, Virudha Bhojana, Dahi, Ikshu (surgarcane), Mulaka (Radish), Madira (alcohol), Kanji (Fermented drink), Tila (Sesame), Katu Rasa, Lavana Rasa, Amla Rasa, Abhishyandi, Ushna, Guru.

Vihara:

Divaswapna (Day sleep)

Discussion

Vayu and Rakta typically become aggravated by the above mentioned Apathya Ahara Vihara food in people with fragile health, wrong diet and regimen, obesity, and a leisurely lifestyle. As a result, his entire blood becomes vitiated and accumulates in the legs. This gets further vitiated by the aggravated Vayu. Subsequently, Vatarakta (gout) is manifested.

According to Ayurveda, Vatarakta (Gout) is a widespread chronic condition that annually affects 14–17 percent of the population.


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Various research projects on the treatment of Vatarakta / Gout have occasionally been conducted, and the results have been encouraging.

Conclusion

The following interpretation can be made based on the classical texts that are currently available.

Vatarakta is an illness brought on by an elevated standard of living. The goal of the current study piece, "Comparative study of Vatarakta" was to compile and elaborate on the subject.

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