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Review Article

Dosha-Dushya Sammurchana

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 8 August
Publisherwww.maharshicharaka.in

Dosha-Dushya Sammurchana in Vatarakta: A Comparative View with Gout Pathophysiology

Bhardwaj H1*, Kashish2, Saini S3
DOI:10.21760/jaims.10.8.29

1* Harsh Bhardwaj, Post Graduate Scholar Final Year, Dept of Rog Nidan Evam Vikriti Vigyan, Rajiv Gandhi Government Post Graduate Ayurvedic College and Hospital, Paprola, Distt Kangra, Himachal Pradesh, India.

2 Kashish, Post Graduate Scholar Final Year, Dept of Rog Nidan Evam Vikriti Vigyan, Rajiv Gandhi Government Post Graduate Ayurvedic College and Hospital, Paprola, Distt Kangra, Himachal Pradesh, India.

3 Swapnil Saini, Reader, Dept of Rog Nidan Evam Vikriti Vigyan, Rajiv Gandhi Government Post Graduate Ayurvedic College and Hospital, Paprola, Distt Kangra, Himachal Pradesh, India.

Health is an intricate concept that encompasses physical, physiological, mental, emotional, spiritual, and social well-being, all of which are deeply affected by dietary and lifestyle choices. Ayurvedic texts consistently highlight the vital importance of Ahara (diet) and Vihara (lifestyle) in maintaining Swasthya (health) and Vikara (diseases). This focus is particularly pertinent today, in light of the notable increase in metabolic disorders related to lifestyle. According to Ayurveda, Vatarakta is a disease that involves an imbalance of Vata Dosha that affects Rakta Dhatu. The Vata, whose pathways are impeded by Rakta, is further vitiated, contaminating the Rakta or blood. Vatarakta is a profound Vatavyadhi produced by Avarana (occlusion) disease. Vatarakta have two Avasthas i.e., Uttana and Gambhira. Uttana Vatrakta affects Twacha and Mamsa Dhatu whereas Gambhira mainly affects Asthi, Majjadi Gambhira Dhatu. One of the best and most significant methods for determining a disease's causes, prognosis, and diagnosis is Nidan Panchak. The five parts of Nidan Panchak are Purvarupa, Rupa, Upshaya, Samprapti, and Nidan. The primary and crucial diagnostic technique in Ayurveda is the Nidana Panchak. The symptoms of gout are very similar to those described in Vatarakta. Gout is a common type of arthritis caused by uric acid disruption, in which excess uric acid in the bloodstream forms crystals in the joint, causing acute pain, swelling, and stiffness. 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.

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

Corresponding Author How to Cite this Article To Browse
Harsh Bhardwaj, Post Graduate Scholar Final Year, Dept of Rog Nidan Evam Vikriti Vigyan, Rajiv Gandhi Government Post Graduate Ayurvedic College and Hospital, Paprola, Distt Kangra, Himachal Pradesh, India.
Email: 		Bhardwaj H, Kashish, Saini S, Dosha-Dushya Sammurchana in Vatarakta: A Comparative View with Gout Pathophysiology. J Ayu Int Med Sci. 2025;10(8):177-183.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-06-16 2025-06-25 2025-07-05 2025-07-15 2025-07-25
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© 2025 by Bhardwaj H, Kashish, Saini S and 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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Harsh B et al. Dosha-Dushya Sammurchassna in Vatarakta

Introduction

Vata & Rakta are two words that make up term Vatarakta. Vitiated Vata & Rakta generated multiple health illnesses & most important of them is Vatarakta. Vatarakta is disease explained in Ayurveda involving Vata Dosha imbalance affecting Rakta dhatu. It is one of significant illnesses that is well-described in classical Ayurvedic literature. Among key signs of this illness is Sandhi-Shoola especially big toes. Patients with Vatarakta experience pain as major symptom that affects their daily routine.

Charaka Samhita (2000 B.C.)[1]:

Vatashonitachikitsam, 29th chapter of Chikitsa Sthana, explains Vatarakta. As Bahya & Abhyantara, such as Shodhana, Shamanaas, & Rasayana, information about disease included Nidana, Samprapti, Bheda, Upadrava, Sadhyaasadhyatva, Pathya-Apathya, & Chikitsa Sutra & Chikitsa. Vatarakta was treated with Shilajatu, Eranda, Sneha, Lepas, Ghrita, Kashaya, Guggulu, Tailas, & so on. few surgical techniques are also mentioned in addition to medical treatment, such as Rakta-Visravana (blood-letting) performed by Siravedh, Shring, Jalauka, & Suchior Alabu Yantra.

Sushruta Samhita (1000-1500 B.C.)[2]:

Regarding its types, Sushruta Samhita has a different interpretation of Vatarakta. According to this, the Uttana and Avagadha Vatarakta are its Avasthavishesh rather than the illness's types. A detailed description of every facet of the disease can be found in the first chapter of Vatavyadhi Nidan Sthana and the fifth chapter of Mahavatavyadhi Chikitsa Sthana of the Sushruta Samhita.

Ashtanga Samgraha (400 A.D) / Ashtanga Hridaya (500 A.D)[3]:

Detailed explanation of Nidana, Samprapti, Bheda, Upadrava, Sadhya-asadhyatva, Pathya-Apathya, Chikitsa sutra, & Chikitsa is available in Ashtanga Samgraha (Vatashonita Nidana Adyaya) & Ashtanga Hridaya (Vatashonita Nidana Adyaya, 16th & 24th chapters, respectively). Moreover, Ashtanga Hridaya has included administration of Sama & Nirama stages of Vatarakta.

Madhava Nidan (800 A. D.)[4]:

Madhava in chapter 23 of "Vatarakta Nidanam",

explains in detail of Vatarakta Nidana, Samprapti, Purvarupa, Upadrava, and Asadhya lakshana.

Synonyms of Vatarakta[5]

In Charaka Samhita, Acharya Charaka gave synonyms for Vatarakta and they are: Vatarakta, Khudda vata, Vatabalasa and Adhyavata etc. 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 Panchaka of Vatarakta

The knowledge of the disease is obtained by the study of Nidana, Purvarupa, Rupa, Samprapti and Upashaya, which are termed as Nidana Panchaka.

Nidana of Vatarakta

Ayurvedic texts describe the different Nidana of Vatarakta. The elements that disrupt the active state of Dosha balance and exacerbate the condition are commonly referred to as Nidana. Vata Dosha and Rakta Dhatu are two main components of Nidana of Vatarakta. when this morbid Rakta Dhatu obstructs the vitiated Vata Dosha then Vatarakta is manifested Even though each has got its own aetiology, Acharyas while talking about Vatarakta have clubbed the etiological factors together and explained. the etiological factors, or causes, of Vata-Rakta can be categorized as follows:

1. Aharaja Nidana - causes related to dietary habits (Excessive intake of Snigdha, Ushna, Ruksha Aahar. Alpabhojan, Abhojan etc).

2. Viharaja Nidana - causes related to various habitual and factors (Mithya Vihara, Ativyayam, Vibhrama Achankramansheelata.

3. Mansika Nidana - causes related to psychological factors (Bhaya, Krodha, Irshya etc).

4. Agantuja Nidana - Exogenous factors (Abhighata).

5. Prakriti based Nidana - Miscellaneous factors (obese, Kapha-Medas Dushti further adds up to the etiology of this disease. (Su.Ni.1/39-41)

Comprehensive study of all etiological factors

A. Factors that aggravate Rakta Dhatu

  • Lavana

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  • Amla
  • Katu
  • Kshara
  • Snigdha
  • Ajeerna
  • Anoop Mamsa
  • Pinyaka
  • Mulakam
  • Kulathika
  • Masha
  • Nishpava
  • Dadhi
  • Shukta
  • Takra
  • Virudh-Adhyasana
  • Krodh
  • Divaswapana
  • Prajagara

B. Factors that aggravate Vata

  • Kashaya Katu Tikta Rasa
  • Alpa Ruksh Aaharat Bhojna
  • Hastyoaushtra Yaan

Purvarupa of Vatarakta[6]

Purvarupa, these are the symptoms which are produced in body before the arrival of disease. These are as follows

  • Atisweda/Asweda
  • Karshnyata
  • Sparshgnatwa
  • Kshate Atiruk
  • Sandhi Shaithilya
  • Alasya
  • Sadana
  • Pidakodgama
  • Nisthoda
  • Spurana
  • Bhedana

  • Gurutwa
  • Supti
  • Kandu
  • Sandi Ruk
  • Vaivarnya
  • Mandalotpatti
  • Sheetalata
  • Osha
  • Daha
  • Sopha
  • Twak Parushya
  • Sira Dhamani Spandana
  • Sakti Dourbalya
  • Ati Slakshna Khara Sparsha
  • Shrama

Lakshana (Rupa) of Vatarakta[7]

The symptoms are characteristics manifestation which develops during the course of the disease. In Charaka Samhita, Vatarakta has been classified on the basis of Dhatu in two forms: (Ch.Chi. 29/12)

1. Uttana Vatarakta
2. Gambhira Vatarakta

On the other hand, Acharya Sushruta (Su.Chi. 5/3) contends that these are distinct stages, such as Kushtha, rather than types. It first impacts surface-level structures like Twaka and Mamsa, but eventually it transforms into Gambhira, which impacts deeper structures.

1. Uttana Vatarakta (Ch.Chi.29/20)

  • Kandu - Itching
  • Daha - Burning sensation
  • Ruja - Pain
  • Sira Ayama - Dilatation of the vessels
  • Toda - Pricking pain
  • Sphuranam - Throbbing sensation
  • Uchana - Contraction
  • Shyava Twaka - Cyanosis of the skin
  • Rakta Twaka - Reddish coloration of skin
  • Bheda - Splitting type of pain

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  • Gouravata - Heaviness
  • Suptata - Numbness

2. Gambhira Vatarakta (Ch.Chi.29/21)

  • Svayathu Stabdta - Swelling, which is fixed
  • Svayathu Kathinya - Swelling with indurations
  • Arti - Deep pain
  • Shyavata - Black discoloration
  • Tamra Twaka - Coppery discoloration of skin
  • Daha - Burning sensation
  • Toda - Pricking sensation
  • Sphurana - Throbbing sensation
  • Paakavaan - Suppuration

3. Ubhayashrita Vatarakta (Ch.Chi.29/23)

When there is presence of symptoms of both Uttana as well as Gambhira Vatarakta, it is called as Ubhayashrita Vatarakta.

  • Ruja - Pain
  • Vidaha - Burning sensation
  • Sandhi-Asthi-Majja Chinndni - Cutting like pain in Sandhi-Asthi-Majja
  • Angasya Vakrikarana - Disfigurement of the joints
  • Khanjatwa - Lameness
  • Pangutwa - Paraplegia
  • Vatasya Sarva Shareera Charana - Vitiated Vata moves all over the body.

According to the predominance of Dosha

On the basis of Doshavariation, Vatarakta can be classified as follows

1. Vataja Vatarakta: Ayama, Shoola, Sphurana, Toda, Shotha Shyavata, change in color of Shotha and Vriddhi or Hani, Ruksha.

2. Pittaja Vatarakta: Vidaha, Vedana, Murcha, Sweda Adhikya, Trishna Adhikya, Mada, Bhrama

3. Kaphaja Vatarakta: Staimitya, Gauravama, Sneha Snigdhata, Supti, Manda Vedana, Shitalta, Kandu.

4. Raktaja Vatarakta: Shwayathu, Atiruka, Toda, Tamra Varna, Chimchimayata, Snigdha Ruksha SamaAbhava, Kandu.

5. Dwandaj Vatarakta: Vata-Pittaja, Pitta-Kaphaja, Vata- Kaphaja

6. Sannipataja Vatarakta: Mixed symptoms of Vata, Pitta and

Samprapti[8]

The relation between the Nidana & Dosha vitiation and the manifestation of disease is known as Samprapti. According to Acharya Charaka, the pathogenesis of Vatarakta can be understood through two perspectives:

A) Samanya Samprapti (General pathogenesis) and
B) Vishishta Samprapti (Specific pathogenesis).

In Samanaya Samprapti, causative factors which are responsible for vitiation of Vata Dosha and Rakta Dhatu, have been specified and the disease progression is explained in brief. (Ch. Chi. 29/8-11).

Vishishta Samprapti explains the pathogenesis of Vatarakta in a very detailed understanding of the pathogenesis of Vatarakta, including the nature of Vata dosha, Rakta Dhatu, and the channels (Srotas) involved in the disease.

Samanaya Samprapti of Vatarakta[9]

There are specific general causal variables that lead to the vitiation of the Vata and Rakta Doshas. As was previously indicated under the etiological aspects, Vatarakta tends to arise in people with a fragile and sensitive body who follow poor eating and lifestyle habits when starts taking Kashaya, Katu, Tikta Rasa, consume Alpa Aahara or Ruksha Aahara or avoid food, become prone to Vata- Vriddhi (Ch.Chi.29/8-11). These elements cause the Vata and Rakta Doshas to worsen. Similarly, other human activities that cause Vata to become vitiated include frequent riding of horses, elephants, or camels, swimming, jumping, walking long distances on foot during the summer, excessive sexual activity, and suppressing natural urges like urinating or feces. Vata Dosha is vitiated by all of these acts. The Vata must travel down the channel of Vriddh Vata, which is blocked by already vitiated Rakta Dhatu. The entire Rakta is vitiated by vriddh and blocked Vata, which then takes the form of Vatarakta.

Vishishta Samprapti of Vatarakta

In order to explain Vishishta Samprapti, Acharya Charaka proposed the theory that Vata is Suksham,


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or subtle in nature, and has the capability to move in all of the body's joints and channels, while Rakta is Drava in nature and has the ability to flow in all of the body's Srotas. As a result, both vitiated Vata and Rakta travel quickly throughout the body's Siramarga (circulating channels), but as they pass through the joints, they become obstructed due to the complex anatomical structure of the joint. As a result, both Vata and Rakta become lodged in the joints, producing various pain sensations, each of which is caused by its association with either Pitta or Kapha Dosha (Ch.Chi.29/13-15). According to Acharya Charaka and Acharya Sushruta, Vatarakta (Gout) primarily affects the joints of the hands, feet, fingers, and other joints. The disease typically starts with an attack on the hands and feet and gradually spreads to other parts of the body. According to Sushruta, the expression of Vatarakta results from the combination of severely exacerbated Vata, which is exceedingly prominent, and vitiated Rakta.

Acharya Charaka proposes the hypothesis that Vata is sukshma (subtle) in character and has the ability to move in all of the body's joints and channels (Srotas) in order to explain the unique pathophysiology (vishishtasamprapti) of Vatarakta. However, Rakta is Drava (liquid) in nature and possesses the ability to flow through all of the body's Srotas. These innate characteristics cause vitiated Vata and Rakta to travel quickly through the body's Sira Marga, or circulation pathways. However, because of the joints' intricate anatomical structure, they confront obstacles as they come across joints. As a result, the vitiated or aggravated Vata and Rakta tend to accumulate in the joints, causing various types of pain sensations. The different types of pain sensations experienced in Vatarakta are attributed to the association of Vata and Rakta with either Pitta or Kapha Dosha. These Doshas influence the qualities and characteristics of pain experienced in joints affected by Vatarakta.

Schematic Representation of Samprapti

jaims_4658_01.JPG

Sadhya-Asadhyata

The term "Sadhya-Asadhyata" or prognosis describes a disease's ability to be cured or treated. Three categories are used to classify the prognosis of Vatarakta (gout) according to several factors: -

1. Sadhya: Nirupdrava, Ekadoshaja, Nava.
2. Yapya: Dvidoshaja, Akritsnoupdrava, Samvatsa-rothitta.

3. Asadhya: Tridoshaja, Upadravayukta, Sravi, Vaivarnya, Stabdhata, Arbuda, Samkocha, Indriya Santapa, Ajanu Sphutitama, Prabhinna, Prana- Kshaya, Mamsa- Kshaya, Moha.

Gout

Gout is a metabolic disease that most often affects middle-aged to elderly men and postmenopausal women.


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It results from an increased body pool of urate with hyperuricemia. It typically is characterized by episodic acute arthritis or chronic arthritis caused by deposition of MSU crystals in joints and connective tissue tophi and the risk for deposition in kidney interstitium or uric acid nephrolithiasis.[10]

Pathogenesis

jaims_4658_02.JPG

Clinical features[11]:

The classical presentation is with an acute monoarthritis, which affects the first MTP joint in over 50% of cases. Other common sites are the ankle, midfoot, knee, small joints of hands, wrist and elbow. The axial skeleton and large proximal joints are rarely involved. Typical features include:

  • rapid onset, reaching maximum severity in 2–6 hours, worse in the early morning severe pain, often described as the ‘worst pain ever’
  • extreme tenderness, so the patient is unable to wear a sock or to let bedding rest on the joint
  • marked swelling with overlying red,
  • shiny skin self-limiting over 5–14 days, with complete resolution.
  • During the attack, the joint shows signs of marked synovitis, swelling and erythema.

Historically, gout was refe. to as "disease of kings" or "rich man's disease" since it was thought to be a result of a rich food and a longer life expectancy.

jaims_4658_03.JPG

Gout is also known as Podagra (seizing the foot) when it includes the big toe.

Recurrent and chronic gout

  • After an acute attack some people never have a second episode; in others the next episode occurs after years.
  • In most, however, a second attack occurs within 1 year and the frequency of attacks gradually increases with time.
  • Continued MSUM deposition causes joint damage and chronic pain.
  • The interval between the first attack and the development of chronic symptoms is variable, but averages around 10 years.
  • The main determinant is the serum uric acid level-the higher it is, the earlier and more extensive the development of joint damage and MSUM deposits.
  • The joints most commonly involved with signs of damage and varying degrees of synovitis are: -
  • First Metatarsophalangeal joint
  • Midfoot
  • Finger joints and wrists,
  • Occasionally with severe deformity and marked functional impairment, especially of feet and hands.
  • As with tophi, asymmetry is characteristic.

Investigations[12]

  • A biochemical screen, including renal function, uric acid, glucose and lipid profile, should be performed because of the association with metabolic syndrome.
  • Hyperuricaemia is usually present in gout, but levels may be normal during an attack because serum urate falls during inflammation.
  • Acute gout is characterised by an elevated ESR and CRP and with a neutrophilia, all of which return to normal as the attack subsides. Tophaceous gout may be accompanied by a modest but chronic elevation in ESR and CRP.
  • X-rays are usually normal in acute gout, but well-demarcated erosions may be seen in patients with chronic or tophaceous gout. Tophi may also be visible on X-rays as soft tissue swellings.

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Discussion

Vatarakta is a disorder resulting from vitiation of both Vata and Rakta. Vitiated Rakta blocks aggravated Vata, exacerbating the problem. Aggravated Vata vitiates Rakta, causing complex effects on joints and resulting in Vatarakta. Nidana names include Katu, Amla, Ushna, Vidahi Aahara and Gaja Ustrayaana. It includes two stages: Uttana and Gambhira. Uttana Vatarakta mostly affects Twaka and Mamsa, while Gambhira Vatarakta affects Asthi Dhatu and distributes Ruja as Aakhu Visha.

Conclusion

Vatarakta is a kind of Vatavyadhi that is linked to gouty arthritis. Lifestyle problems and poor dietary habits distinguish it from other diseases in that they are possibly preventable and can be alleviated by adopting appropriate food habits and lifestyles, as in the case of Vatarakta. Hetus are the underlying causes of a particular disease. Acharyas suggested various sorts of Hetus for different ailments. They are included in the Nidanpanchak. By avoiding the causative reasons for Vatarakta and following the Pathyaapathya prescribed by the Ayurveda Acharyas, one can overcome Vatarakta and live a healthy life. Vatarakta is a rare example of Avarana Janya Vata Vyadhi. Vata and Rakta are the primary Doshas engaged in Vatarakta.

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