DR GANGABAI S HIROL

A STUDY ON AETIOPATHOGENESIS OF VATARAKTAWITH

SPECIAL REFERENCE TO GOUTY ARTHRITIS

By

DR GANGABAI S HIROL

Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bengaluru

In partial fulfillment

Of the requirements for the degree of

AYURVEDA VACHASPATHI M. D. (AYURVEDA)

In

ROGA NIDANA

Under the guidance of

DR ANANTA S DESAI

DEPARTMENT OF ROGA NIDANA

GOVERNMENT AYURVEDA MEDICAL COLLEGE,

DHANWANTRI ROAD, BENGALURU-560009

KARNATAKA

2015- 2018

Scanned by CamScanner

ABBREVIATIONS

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS iii

Sl No ABBREVIATIONS FULL FORM

1 Sha. Ka. Dr. Shabda kalpa druma

2 Cha. Su. Charaka Sutrasthana

3 Cha. Vi. CharakaVimanasthana

4 Cha. Ni. Charaka Nidanasthana

5 Cha. Chi. Charaka Chikitsasthana

6 Cha. Si. Charaka Siddisthana

7 Su. Su. Sushrutha Sutrasthana

8 Su. Sha. Sushrutha Shareerasthana

9 Su. Ni. Sushrutha Nidanasthana

10 Ha. Sa. Harita Samhita

11 An. Ni AnjanaNidana

12 A. S. Su. Astanga Sangraha Sutrasthana

13 A. Hsr. Su. Astanga Hridaya Sutrasthana

14 Ma. Ni. Madhava Nidana

LIST OF ABBREVIATIONS

ABBREVIATIONS

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS iv

15 Bh. Pr. Ma. Kh Bhavaprakasha Madhyama Khanda

16 Y. R. Yogaratnakara

17 Ch. D Chakradatta

18 B.R Bhaishajya Ratnavali

19 B.S Bhela Samhita

20 G.N Gada Nigraha

21 G.P Garuda Purana

22 H.P.I.M Harrisons Principles of Internal Medicine

23 V.S Vangasena Samhita

24 SUA Serum Uric Acid

25 GA Gouty Arthritis

26 SLE Systemic Lupus Erythematosus

27 PVD Peripheral Vascular Disease

28 IHD Ischemic Heart Disease

LIST OF TABLES

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS v

S.No NAME OF THE TABLES Page No

1 Table No.1: Showing Historical Review 10

2 Table No 2: Showing Aharaja Nidana of Vatarakta 22 - 23

3 TableNo. 3 :Showing Viharaja Nidana of Vatarakta 23

4 Table No.4: Showing Manasika Nidana of Vatarakta 24

5 Table No.5: Showing Anya Nidana of Vatarakta 24

6 Table No. 6: Showing Purvarupa of Vatarakta 25-26

7 Table No. 7: showing lakshanas of Utthana Vatarakta 30

8 Table No. 8 :showing lakshanas of GambheeraVatarakta 34

9 Table No.9 :showing lakshanas of Vatadhika Vatarakta 36

10 Table No.10 : showing lakshanas of Raktadhika Vatarakta 38

11 Table No.11 : showing lakshanas of Pittadhika Vatarakta 39-40

12 Table No.12: showing lakshanas of Kaphadhika Vatarakta 42

13 Table No.13: showing Upadravas of Vatarakta

55

14 Table No.14:Showing Localised Complications 56

15 Table No.15: Showing Systemic Complications

58

16 Table No.16: Showing Sadhya Asadhyata of Vatarakta 63

17 Table No.17: Showing Pathya Apathya of Vatarakta

64

18 Table No.18: Distribution of patients based on Age 81

19 Table No.19: Distribution of patients based on Sex 81

20 Table No.20: Distribution of patients based on Religion 81

LIST OF TABLES

LIST OF TABLES

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS vi

21 Table No.21: Distribution of patients based on Education 82

22 Table No.22: Distribution of patients based on Marital Status 82

23 Table No.23: Distribution of patients based on Socio-Economic Status

82

24 Table No.24 : Distribution of patients based on Purva Vyadhi

Vruttanta

83

25 Table No.25: Distribution of patients based on Occupation 83

26 Table No.26: Distribution of patients based on Ahara 83

27 Table No.27: Distribution of patients based on Agni 84

28 Table No.28: Distribution of patients based on Kosta 84

29 Table No.29: Distribution of patients based on Ahara

Abhyavarana Shakti

84

30 Table No.30: Distribution of patients based on Ahara Jarana

Shakti

85

31 Table No.31: Distribution of patients based on Nidra 85

32 Table No.32: Distribution of patients based on Mala 85

33 Table No.33: Distribution of patients based on Mutra 86

34 Table No.34: Distribution of patients based on Vyasana 86

35 Table No.35: Distribution of patients based on Desha 86

36 Table No.36: Distribution of patients based on Family History 87

37 Table No.37: Distribution of patients based on Prakruti 87

38 Table No.38: Distribution of patients based on Sara 87

39 Table No.39: Distribution of patients based on Samhanana 87

40 Table No.40: Distribution of patients based on Satva 88

41 Table No.41: Distribution of patients based on Satmya 88

42 Table No.42: Distribution of patients based on Vyayama Shakti88

43 Table No.43: Distribution of patients based on Manasika 89

LIST OF TABLES

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS vii

Nidana

44 Table No.44: Distribution of patients based on Ahara Abhyasa 89

45 Table No.45: Distribution of patients based on Aharaja Nidana89-90

46 Table No.46: Distribution of patients based on Viharaja

Nidana

90

47 Table No.47: Distribution of patients based on Purvarupa 90-91

48 Table No.48: Distribution of patients based on Utthana

Vtarakta

91

49 Table No.49: Distribution of patients based on Gambheera

Vtarakta

92

50 Table No.50: Distribution of patients based on Vtarakta

Upadrava

92

51 Table No.51: Distribution of patients based on Serum Uric

Acid Levels

93

FIGURES

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS viii

SL No NAME OF THE GRAPH Page No

1 Graph No.1: Incidence of Age 94

2 Graph No.2: Incidence of Sex 94

3 Graph No.3: Incidence of Religion 94

4 Graph No.4: Incidence of Education 95

5 Graph No.5: Incidence according to Marital Status 95

6 Graph No.6: Incidence according to socio economic status

96

7 Graph No.7: Incidence according to Purva Vyadhi Vruttanta

96

8 Graph No.8: Incidence according to Occupation 97

9 Graph No.9: Incidence according to Ahara 97

10 Graph No.10: Incidence according to Agni 97

11 Graph No.11: Incidence according to Kosta 98

12 Graph No.12: Incidence according to Ahara Abhyavarana Shakti

98

13 Graph No.13: Incidence according to Ahara Jarana Shakti

98

14 Graph No.14: Incidence according to Nidra 99

15 Graph No:15: Incidence according to Mala 99

16 Graph No.16: Incidence according to Mutra 99

17 Graph No.17: Incidence according to Vyasana 100

18 Graph No.18: Incidence according to Desha 100

19 Graph No.19: Incidence according to Family History 101

20 Graph No.20: Incidence according to Prakruti 101

21 Graph No.21: Incidence according to Sara 101

22 Graph No.22: Incidence according to Samhanana 102

LIST OF GRAPHS

FIGURES

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS ix

23 Graph No.23: Incidence according to Satva 102

24 Graph No.24: Incidence according to Satmya 102

25 Graph No.25: Incidence according to Vyayama Shakti 103

26 Graph No.26: Incidence According To Manasika Nidana 103

27 Graph No.27: Incidence According To Ahara Abhyasa 108

28 Graph No.28: Incidence According To Aharaja Nidana(1)

104

29 Graph No.29: Incidence According To Aharaj Nidana(2) 104

30 Graph No.30: Incidence According To Viharaja Nidana 105

31 Graph No.31: Incidence According To Purvarupa(1) 105

32 Graph No.32: Incidence According To Purvarupa(2) 106

33 Graph No.33: Incidence According To Utthana Vatarakta

106

34 Graph No.34: Incidence Accoring To Gambheera Vtarakta

106

35 Graph No.35: Incidence According To Upadrava(1) 107

36 Graph No.36: Incidence According To Upadrava(2) 107

37 Graph No.38: Incidence According To Serum Uric Acid Levels

108

LIST FLOW CHART

SL NO

Name Of Flow Chart Page No.

1 Samprapti of Utthana Vatarakta 50

2 Samprapti of Gambheera Vatarakta 51

3 Purine Metabolism 73

ABSTRACT

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS xi

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS

In present revolutionary era the life of a person is hectic and materialistic. For

the survival of fitness, the men expected to remain healthy physically as well as

mentally. It is quite difficult due to the various obstacles which are experienced by

men during his routine life. The disease VATARAKTA is one among them. It has

attracted the attention of world’s scientists working on the problem, not due to its

fatality but due to its remote complications.

Vatarakta is a disorder of vata associated with Rakta . The chief complaint

of the patient is severe joint pain with onset at Hasta, Pada, Mulagata sandhi and

then migrates to other joints in a way similar to Akhuvisha.

Vatarakta can be better correlated with “Gouty Arthritis” in the modern

medical science. It is a form of arthritis caused by hyperuricemia. Hyperuricemia is

defined as a plasma urate(uric acid) level greater than 420µmol/l(7.0mg/dl),

hyperuricemia is a major laboratory finding of Gouty arthritis that results in

deposition of uric acid , salts and crystals in and around joints and soft tissues. Gout is

the most common cause of inflammatory arthritis in men aged more than 50yrs,

affecting approximately 1-2% of adult men in the western world, they usually present

in the form of acute pain in joint, erythema and swelling of first metatarsophalangeal

joint. Gouty arthritis develops more in men than women (10:1). Globally the

incidence of Gouty arthritis has increased double in last two decades because of

multiple factors like increased longevity, increased prevalence of hypertension,

rampant use of diuretics ,epidemic of obesity and metabolic syndrome, dietary trends,

increased alcohol consumption, increased chronic kidney disease .Gout is essentially

ABSTRACT

ABSTRACT

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS xii

due to decreased excretion (90%) and increased production(10%) of uric acid , with

an overall prevalence of 2-26 per 1000.Affects about 2.1million worldwide.

A definite protocol for the detailed evaluation of the nidana, samprapti and

lakshana of the disease is required for prevention and effective management. Hence

there is a need to frame protocol for evaluating the aetiopathogenesis of vatarakta.

Thus, here an attempt is made to understand the aetiopathogenesis of vatarakta wsr to

Gouty Arthritis with the help of serum uric acid as a diagnostic tool.

AIMS AND OBJECTIVES OF THE STUDY:

1. To study the aetiopathogenesis of vatarakta.

2. To study the aetiopathogenesis Gouty arthritis.

3. To study the role of serum uric acid in diagnosis of vatarakta vis a vis Gouty

arthritis.

4. To study and analyze the aetiopathogenesis of vatarakta wsr Gouty Arthritis.

MATERIALS AND METHODS:

SOURCE OF DATA:

Patients attending both OPD and IPD of Jayachamarajendra Institute of Indian

Medicine and Hospital, Bengaluru will be screened for study.

METHOD OF COLLECTION OF DATA:

A minimum of 40 patients who are fulfilling the criteria for diagnosis and

inclusion will be selected for the study randomly irrespective of sex, religion,

educational, professional background and economic status.

A special case proforma will be prepared with details of history taking, physical

signs and symptoms as mentioned in our classics and allied science.

The study will be done using a structured questionnaire which will have the

factors covering ahara, vihara, family history, occupation etc.

ABSTRACT

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS xiii

RESULTS:

The highest incidence was seen in Middle age and Male patient and Upper

class status who indulges in sedentary life style and intake of high calorie

diet,the patients who were following irregular dietic habits like

Vishamashana, Viruddhashana and excessive intake of Lavana,Amla,Katu

Rasa Ahara,Dhanya like Masha,Mamsa Ahara like Shuska,Anupa and

Ambuja Mamsa and Gorasa like Dadhi and having the addictions like

tea,coffee,smoking,alcohol intake etc.Manasika Nidanas like Chinta

Bhaya,Shoka etc played a major role in the development of Vatarakta.

Vatarakta is a collection of different symptoms among them a few can be

seen in Gouty Arthritis and Serum uric acid have got moderate role in

diagnosing Vatarakta so we can’t stick on to a single lab parameter instead

other biochemical parameter has to be evaluated in detail.

KEY WORDS:

Vatarakta,Gouty Arthritis,Hyperuricemia,Serum Uric Acid,Dietary Trends,Alcohol

Consumption.

INTRODUCTION

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS Page 1

A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH

SPECIAL REFERENCE TO GOUTY ARTHRITIS

The present rapid modernization in developing countries like India, the

culture of fastfood, junk foods, eating in standing posture, smoking, alcohol intake &

drug addiction habbits are spreading even to remote villages. The over indulges in

Viruddhaahara,especially Lavana, Amla, Katu, Kshara, Ajirnabhojana,

Shuskambu,Anupamamsa sevana by Sukumara and Vihara like travelling in jerk leads

to Vyadhi called Vata Rakta1.

Two distinct etiopathogensis of Vatarakta are due to etiological factors

Vatadosha & Raktadhathu separately leading to morbidity of the same with the

involvement of Raktamarga is the first2. The second one is etiological factors of

Kapha & Medas in return gets accumulated in Raktamarga3. Due to Nidana

Raktadushti occurs which restrict the Vayumarga. Rakta combines with Dushtavata

and travels throughout the body causing symptoms in skin, joints and deep tissues.

Due to provocation of Vata as well as Rakta the disease is called as Vatarakta.

Here the Dushtavastha of Raktadhatu in Vatarakta is assessed with the help

of serum uric acid level. Uric acid is normal by product of purine(protein) metabolism

in the body4 .Uric acid is present naturally in body and in various food such as

asparagus,mushrooms, meat,anchovies usually high protein food with fat5.The

concentration of uric acid in body fluids depends on a balance between purine

synthesis plus ingestion and elimination through the kidneys and intestine6.

The Nidana for Vatarakta and food that cause increase in serum uric acid level

are almost similar and Prodromal symptoms like excessive sweating, absence of

sweating, skin discolouration are more analogous to that of Kustha. Vatarakta

INTRODUCTION

INTRODUCTION


exhibits different cryptograms based upon Utthana and Gambheera Avastha. The

illness also displays various symptoms when particular Doshadhikyata is more

evident. Manifestations related to skin are to be distinguished from the disease

Visarpa. Joint pain and swelling which are the major symptoms of the Vatarakta is

also present in Sandhigatavata and Amavata. Thus Vatarakta mimics to multiple

disorders in different stages of the course, which has to be distinguished from other

illness with the help of proper History taking, Physical examination and Laboratory

investigations. Thus laboratory investigations play an essential role in diagnosing the

disease at early stage and also assists in predicting the prognosis.

To find how serum uric acid helps in diagnosing vatarakta. Vatarakta that is also to

know the prevalence of Vatarakta in the locality of my study this topic is been

selected for the study.

OBJECTIVES


AIMS AND OBJECTIVES OF THE STUDY:




arthritis.


Review of liteRatuRe

a StuDY oN aetioPatHoGeNeSiS of vataRaKta witH SPeCial RefeReNCe to GoutY aRtHRitiS Page 4

The knowledge of the ancient science helps in having a better future. A critical

review of the history from the primitive age to the present advanced world assists one

to show the pathway for future. Man always struggled with his present and attempted

to create better tomorrow. This can be achieved with a better perspective when the

errors of the past and difficulties of the present experiences are overcome, checked

and planned at proper time. So an attempt has been made to explore the past literature,

to explain the historical background of the Vatarakta.

Thus, it becomes necessary to discuss the history of Vatarakta which will help us

to understand the Ahara-Vihara, traditions, culture, ways of living and other diseases

prevailed at that time which might have influenced its manifestations.

VEDA KALA (10,000- 500 BC):

Vedas are considered to be the oldest written literature, Vedas give numerous

individual references of Vata and Rakta along with their qualities as dosha and

dhatu,there is a description about Rakta Dhamani. But the various disorders produced

by them collectively and the description about the disease vatarakta is not available in

any of the vedas.

PURANA KALA:

There is no much information available in the Puranas except the Garuda

Purana and Agni Purana. Details of Vatarakta including Nidana, Samprapti and

Lakshanas are discussed in Garuda Purana. It also gives a vivid management of

Vatarakta using Guduchi in the form of Kalka, Swarasa, Churna and Kwatha. Use of

Vardhamana Pippali along with Pathya like Guda, Patola, Triphala and Katuki has

been prescribed to alleviate the burning sensation in Vatarakta.

HISTORICAL REVIEW



Brief description about Vatarakta is also available in Agni Purana along with

Pathya like Raktashali, Godhuma, Yava, Mudga, and Madhu which have been

advised in Vataraktarogi.

SAMHITA KALA:

Samhitas are the main stay among the Ayurvedic literature. Most of the

information in Ayurveda including Vatarakta has been well documented in the

Samhitas.

Charaka Samhita (1500 B.C):

Acharya charaka has explained Vatarakta in 29th chapter of the chikitsasthana after

vatavyadhi adyaya and before Yoni Vyapat chikitsa. Starting the chapter with Nidana,

he identified Sukumara and Achankramanasheelapurusha to be more prone for this

disease and also identified Haya, Ushtrayana as one of the causative factors of

Vatarakta. Followed by Nidana, he has described Samprapti of Aavarana in

manifestation of Vatarakta. Charaka has given some of the Paryaya Pada for

Vatarakta as Khudavata, Vata Balasa and Aadhyavata.As the bala of Vata increases

by getting Rakta Aavarana the condition is called Vata Balasa.

He has mentioned Visheshasthana of Vatarakta as Anguli of Hasta, Pada and

Sarvasandhi. After this Acharya has explained Purvarupa where he identified

Sandhishu Ruk Bhutva Bhutva Nashyati as different Lakshana. Later on there is

detailed description of Utthana, Gambheera and Ubhayashrita Vatarakta followed by

Doshanusara Vatarakta Lakshana. Moha and Angulivakrata are identified as

Upadrava. Sadhyasadhyata and Chikitsa Sutra with multiple formulations are

explained for the management of the same. In later verses involvement of Kapha and

Meda causing Margavarana to Raktadhatu and ultimately resulting in Vatarakta is

explained7.



Even though there is no description about Vatavyadhi in Nidana Sthana,

Gulma Samprapti of both Dhatukshaya and Aavarana patterns holds good in

explaining Vatavyadhi.

Anjana Nidana (1500 B.C):

Anjana Nidana is claimed to be written by Agnivesa. The explanation

regarding Nidana, Lakshana, symptoms, types of Vatarakta based on Dosha and 9

complications of Vatarakta are explained.

Sushruta Samhita(600B.C-400B.C)

In Sushruta samhita,Vatarakta is explained in 1st chapter i.e Vatavyadhi

Nidana sthana.The description of the disease starts with causative factors just after

explanation of Avarana concept.Rutu and Satmyaviparyaya is identified as one of the

cause.Later,there is description of Samprapti followed by Purvarupa and

Rupa.Acharya Sushruta identified the spreading of disease as Akhuvisha. Again in the

5th chapter of chikistasthana under Mahavatavyadhichikitsa he has explained details

of vatarakta starting with Avastha as Utthana and Avagadha this is followed by

Purvarupa,Samprapti,Vishesha Nidana, Chikitsyarogi Lakshana,detailed description

of chikitsa,pathyaapathya ,Pippali vardhamanakam is the unique contribution of

Sushruta in treatment of all types of Vatarakta8.

SANGRAHA KALA:

Asthanga Sangraha (5thCentury A.D):

He has explained this topic in Nidanasthana 16th chapter as Vatashonita

Nidana and Chikitsa is explained in 24th chapter of Chikitsasthana. In Gambheera

Avastha if there is Raktakranta then it should not be treated9.



Asthanga Hridaya (5thCentury A.D):

He has followed the Charak Samhita in placing Vatashonita Adhyaya after

Vatavyadhi Nidana in 16th chapter. He has also identified that Sravi and Sthabdha

Vatarakta causes Arbuda where the condition is Asadhya10. Elaboration of Nidana to

Chikitsa along with Shodhana and Shamana yoga is well explained11.

Ashtangahridaya has also added the management of Sama and Nirama stage of

Vatarakta12.

MEDIEVAL PERIOD:

Kharanada Samhita (650 A.D):

Kharanada has mentioned 36 types of Vatarakta13.

Bhela Samhita (7th century):

Bhela has mentioned this topic under Visarpa Vatashonitaadhyaya. He has

given explanation of Vatashonitaaushadhanirdesha and Vatakrantashota and also

Shastra Karma when it cannot be treated medically and has become suppurated14.

Madhava Nidana (7th century):

Madhavakara has explained about Nidana, Samprapti, Purvaroopa, Roopa,

Bheda according to Doshadhikyata, Deshantaragamana, Upadrava and

Sadhyasadhyata15.

Kashyapa Samhita (7th century):

There is no description about vatarakta.

Kalyanakaraka (8th century):

Ugradiytacharya has explained Vatarakta Nidana, Samprapti and Lakshana in

the Vatarogadhikara16.



Chakradatta(11th century):

Chakradatta has explained about the Raktamokshana according to the

symptoms and chikitsa for Utthana and Gambheera Vatarakta17 .

Harita Samhita (12th century):

Harita Samhita mentioned about Nidana, Lakshana, and Chikitsa as told by

Maharshi Atreya18.

Gadanigraha (12th century):

Shodala has explained about Nidana, Samprapti, Purvaroopa, Roopa, Bheda

according to Doshadhikyata, Upadrava and Sadhyasadhyata, Samanya chikitsa and

Raktamokshana19.

Sharangadhara Samhita (13th century):

Sharangadhara has explained about the eight types of Vatarakta- Vataja,

Pittaja, Kaphaja, Raktaja, Dwandwaja 3 types, Sannipataja20.

Basavarajiyam (15th century):

Basavarajiyam has not mentioned about the disease Vatarakta.

Bhavaprakash (16th century):

Explained about the Viprakrustha Nidana, Purvaroopa, Bheda according to

Doshadhikyata, Vatarakta Upadrava, Sadhyasadhyata, Chikitsa, Pathya and

Apathya21.

Yogaratnakara (17th century):

Mentioned about Nidana, Samprapti, Purvaroopa, types of Vatarakta,

Sadhaysadhyata, Upadrava, Chikitsa, Pathya and Apathya. He has explained some of

the yogas like Kokilakshadikwatha and Grihadhumadilepa in Vatakaphaja

Vatarakta22.



Bhaishajyaratnavali (18th century):

The description about Vatarakta is explained in 27th chapter before explaining

Urustambhaadhyaya. At the end of the chapter there has been explanations regarding

Pathya and Apathya23.

Veerasimhavalokana:

This text is authorised by Rajaveerasimha Tohar who has mainly described the

diseases as per Jyotishshastra, Dharma shastra and Ayurveda. Author has mentioned

that in the persons horoscope if Mangala is in 10th place and which is under the

influence of Shanigraha they will develop Vatarakta. To please this Mangala

Graham one has to adopt Japa, Homa, Dana etc. As per Bodhayana the person who

indulges in intercourse with female of different Varna (Asavarna) will suffer from

Vatarakta disease in next birth. As a Daivavyapashraya Chikitsa one has to offer

statue of god Lakshmi Narayana prepared out of gold24.



Table No. 1: Showing available information from various texts

Texts Definition

Synonyms

Etiology

Pathogenesis

Types

Purvarupa

Rupa

Vedas - - - - - - - Garuda Purana

+ - - - - - +

Agni Purana

- - - - - - -

Charaka Samhita

+ + + + + + +

Sushruta Samhita

+ + + + + + +

Kashyapa Samhita

- - - - - - -

Harita Samhita

- - + - + - +

Bhela Samhita

- - - - - - -

Kharanad Samhita

- - - - + - -

Sharangdhar Samhita

- - - - + - -

Astanga Sanghraha

+ + + + + + +

Astanga Hridaya

+ + + + + + +

Madhava Nidana

+ + + + + + +

Gada Nigraha

+ - + + + + +

Bhava Prakasha

+ + + + + + +

Yoga Ratnakar

+ - + + + + +

Bhaishajya Ratnavali

+ - + + + + +



Vyadhi Namakarana Siddhanta is one of the contributions of Acharya Charaka

in the context of Trishothiya Adhyaya. Where he clearly says that diseases are

innumerable in number and their nomenclature is based on Ruja, Varna, Samuthana

and Samsthana25. Vatarakta is a disease where its naming is based on involvement of

Dosha and Dushya.

Along with Vatarakta, many other diseases like Amavata and Raktapitta have

been named on the basis of Dosha and Dushya involved. As understood, the term

Vatarakta is derived from two words, Vata and Rakta26. To be precise, it is the

involvement of Vata Dosha and the Rakta Dhatu which decides the manifestation and

prognosis of this disease.

VATA :

Vaa + Tan Pratyaya = Vata

Vateeti.Va + Vatah

“Ramanath astugatimukhasevyoritimatwagatosukham gatisukham”

Vata is that which makes the movement promising or effortless.

RAKTA:

‘Ranja + Raktah’

“Ranjanataangamanenaiti”

Rakta is one which imparts red colour to the object.

VATARAKTA :

1) Shabdakalpadruma gives a very clear definition of Vatarakta as

“Vata dushita raktam yatra rogavishesha”. The disease which is caused due to the

vitiation of Rakta initiated by the morbid Vata is called Vatarakta27.

ETYMOLOGY



2) Charaka Samhita also gives further explanation on the definition of Vatarakta as :

a) “Vataraktabhyam janitor vyadhihi vataraktam” the disease caused due to Vata

dosha and Rakta dhatu is called as Vatarakta28.

b) “Vatarakteeva avasthantara prapte vataraktam” the factors Vata and Rakta in

a diseased state is called as Vatarakta29.

3) “Vataraktam hi dushtena vatena dushtena raktena ca vishista sampraptikam

vikarantarameva”. The disorder which results due to the vitiation of Vata dosha and

Rakta dhatu leading to a specific samprapti is known as Vatarakta30.

4) “Asruja Ruddho Vayuhu Vatashonitam” The obstruction of Vata dosha due to

vitiated Rakta dhatu results in Vatshonita31.

5) “Rakta pradhano vata rogavishesha” The Vatavyadhi which manifests due to

involvement of Rakta Dhatu as prime factor32.

UTTHANA :

The term Utthana refers to

1) “Uthbhava sthane vistaroyasmat” That which spreads and gets localized in its

own originating place.

2) “Agambheeram” The disease which has not entered into the deeper state.

DEFINITION:

The definition of Vatarakta also enumerates its Samprapti. Charaka Samhita

defines Vatarakta as

“Vayuhvivridho Vridhena Raktenavarita pathi

Kritsna Samdushayet Raktam tat jneyamvatashonitam”

When the vitiated Rakta dhatu causes obstruction to the path of morbid Vata, it

leads to further aggravation of Vatadosha. This causes the derangement of Rakta

dhatu resulting in Vatashonita33.



Sushruta Samhita defines Vatarakta as

“Kruddhoatyartam margarodhaat sa vayuh atyudriktam dushayet

raktamashu tat sampruktam vayuna dushitena tatprabalyat uchyate vataraktam”

The specific etiological factors result in vitiation of Vata dosha and Rakta dhatu.

This morbid Rakta Dhatu in turn causes obstruction to the passage of morbid Vata

Dosha. When this process continues there will be further vitiation of both the Dosha

and Dhatu. This condition finally manifests as Vatarakta34.



PARYAYA

Adhyavata

Adhyamaruta

Adhyapavana

Khudavata

Vatarakta

Vatabalasa

Adhyavata: “Adhyanaam prayo iti adhyarogah”

Since the disease is mainly seen in rich people, hence it is named as Adhyavata35

Khudavata: “Khuda desha praptya khudhakhu shabden sandhiruchyate”

The term Khuda refers to Sandhi. Since the manifestation of Vatarakta involves

joints this name has been attributed36.

Vatabalasa: “Vatasya avaranena balam asmin shonite iti vatabalasah”

The sternness of the illness depends upon the Rakta Dhatu which is get worse

by obstructed Vayu. So it is named as Vatabalasa. According to other Acharyas there

is a major role played by Kapha Dosha in the pathology of Vatarakta. So the name

Vatabalasa is given. As one of the synonym for Kapha Dosha is Balasa37.

Vatarakta: “Vataraktabhyam janitor vyadhihi vataraktam’’

The disorder caused due to Vata Dosha and Rakta Dhatu is called Vatarakta38.



Nidana is the one which gives the complete knowledge about the causative

factors related to Utpanna Vyadhi. The word Nidana has been employed in two

different views, Vyadhi Janaka i.e which gives the complete knowledge about the

causative factors of the disease and other is the Vyadhi Bodhaka which gives the

complete knowledge about the disease which includes Nidana Panchaka39.

As Vata and Rakta are involved in producing Vatarakta, so to produce this

specific pathology two separate etiological factors are responsible. These factors

cause an independent vitiation of Vata and Rakta.

Ayurveda classifies Nidana into two main categories Abhyantara Hetu and

Bahya Hetu.

ABHYANTARA HETU:

Dosha and Dushya are considered under Abhyantara Hetu, Dosha Dushya

Sammurchana is considered as Samavayi Karana in the manifestation of the diseases.

In Vatarakta Vata Dosha and Rakta Dhatu are mainly involved in production of the

disease. In other variant of Vatarakta where Santarpana Nidana acts as main cause

for Kapha Dosha and Medo Dhatu are considered as Abhyantara Hetu.

BAHYA HETU:

It can be again divided into Samanya and Vishesha Hetu. This kind of

classification of Vyadhi Nidana helps in complete understanding of the disease.

Samanya Hetu:

Nidana which causes Prakopa of Vata Dosha and Rakta Dhatu Dushti are

considered as Samanya Nidana which are related with manifestation of Vatarakta in

NIDANA



the present context. Hence Aahara, Vihara and Manasikabhava which are mentioned

in the context of Vatarakta are segregated into Vataprakopaka and Rakta Dushaka

Nidana as follow.

Aharaja Hetu for Vata Prakopa includes Katu, Kshara, Shushkamamsa,

Viruddhashana and Adhyashana. Viharaja Bhava like Prajagara, Travelling on

Haya, Ushtra etc, Atiplavana, Jalakrida, and Langhana causes aggravation of Vata

Dosha. Manasikabhava like Krodha also causes Vata Prakopa. Anya Karana like

Vega Dharana, Abhighata also helps in manifestation of Vatavyadhi by provocating

Vata Dosha40.

For Rakta Dhatu Dushti Aharaja Hetu can be considered as excess intake of

Lavana, Amla, Snigdha, Ushna Bhojana, Klinna and Anupa Mamsa, Pinyaka, Dadhi

and Madya Varga etc. Viharaja Karana like excessive walking in hot weather etc.

Krodha as Manasika Karana also causes Rakta Dushti. Nidana which are explained

in Vidhishonitiya Adhyaya show much similarities with Vatarakta Nidana by which

one can consider few more additional Nidana like intake of Green leafy vegetables,

Chardi Vega Dharana, and association of Sharat Rutu in manifestation of Shighrakari

Vyadhi Vatarakta41.

Where as in case of the variant form of Vatarakta the etiological factors are of

Santarpana in nature, resulting in excessive accumulation of Kapha Dosha and Medo

Dhatu in Rakta Marga. The etiology is mainly related to the imbalance between the

intake and utilization. Here it is the excessive nutrition and lack of its utilization by

physical exercise causes the specific pathology, which are very much similar to

etiology of Prameha and Sthoulya.These dietary factors mainly include increase and

frequent intake of Nava Dhanya, Gramya-Anupa-Oudaka Mamsa, Tila, Pishtanna,

Payasa, Krishara, Ksheera, and Dadhi etc in which most of them are Vidahi in



nature. Viharaja Nidana like Achankramanasheelata, Diwaswapna, Ashuddhi etc.,

other factors like Avyayama, Diwaswpnashila, Asyasukhi, Avyavaya, Rutu Satmya

Viparyata and Snehadi Chikitsa Vibhrama etc factors precipitates morbidity of Kapha

and Medas also. Manasika Bhava like Harsha Nityatwa also one of the causes for

Kapha and Medo Dushti.

Vishesha Hetu:

Vishesha Hetu are those which are specific to the disease in this context

Sukumara person, travelling in hot weather after intake of Ushna Aahara can be

considered as Vishesha Nidana. Bija Dushti can also be considered under this

category. As per Acharya Sushruta Sthoulyata is one of the cause for Vatarakta42 and

Bija Dushti is cause for Sthula43.

SANNIKRISTHA HETU:

The word meaning of Sannikrishta is nearer. It means one which is very nearer

or main cause for the disease. These Hetu do not depend on any other Hetu to cause

the disease. Here in this context the vitiation of Vata and Rakta can be considered as

Sannikrishta Nidana and in other variant of Vatarakta Kapha and Meda are

considered as the Sannikrishta Nidana.

VIPRAKRISTHA NIDANA:

Viprakristha is such an etiology which demands prolonged indulgence, but it

may not directly influence the manifestation of the disease. In case of Vatarakta

continuous intake of Nidana which causes aggravation of Vata and Kapha Dosha and

vitiation of Rakta and Medo Dhatu are considered as Viprakristha Nidana.

VYABHICHARI HETU:

In Vyabhichari Hetu, Nidana, Dosha and Dushya will not be capable of

producing disease or they may not co-ordinate each other to produce the disease. In



this state it may not produce the disease completely or it will produce the disease with

Alpa Lakshanas. Excessive travelling and other similar factors that predispose the

illness in patient suffering from Vatarakta are suggestive of Vyabhichari nature of

causative factors.

PRADHANIKA HETU:

The Hetu which produces immediate effect like Visha is called as Pradhanika

Hetu. Abhighata can be considered as Pradhanika Nidana for Vatarakta.

UTPADAKA HETU

Utpadaka Hetu can be classified clearly under 3 varieties

1. Doshabala Pravrutta

2. Adibala Pravrutta

3. Janmabala Pravrutta

Doshabala Pravrutta

The diseases which are formed due to the vitiation of Shareerika Dosha Vata,

Pitta and Kapha, Manasika Dosha Raja and Tama Dosha are termed as Doshabala

Pravrutta Vyadhi. So Nidana which causes vitiation of Vata Dosha will fall under the

category of Doshabala Pravrutta Nidana.

Adibala Pravrutta

Adibala Pravrutta Karana is not mentioned in the classics but it can be

understood in following ways: Beejaupaghata, Beejabhagaavayava Dushti. Any

abnormality in these two may lead to Vatarakta.



Janmabala Pravrutta

Janmabala Pravrutta Karana are not mentioned in the classics but it can be

understood in following ways Janmabala Pravrutta Karana (congenital factors) are in

the form of Vikruti in Raktavaha Dhamani during development of foetus.

VYANJAKA HETU:

Vyanjaka Hetus are the supporting factor. Here Vata Prakopaka and Rakta

Dushaka Nidana are considered as Vyanjaka Hetu as they worsen the condition of

Vatarakta. Santarpanottha Nidana are also included under the category of Vyanjaka

Hetu as they are responsible for manifesting variant of Vatarakta.

ASATMENDRIYARTA SAMYOGA:

Asatmendriyarta Samyoga is the Atiyoaga, Ayoga and Mithyayoga of both

Karmendriya and Jnanendria.

Karmendriya Atiyoaga like Haya Ushtra Yana, Ambukrida, Plavana, Atyadhwa44.

Karmendriya Ayoga like Achankramanasheelata45

Karmendriya Mithyayoga like Vega Dharana46

Jnanendria Atiyoaga like Ati Amla, Lavana, Ruksha Aahara Sevana47

Jnanendria Ayoga like Abhojana48

Jnanendria Mithyayoga like intake of Klinna, Shushka Mamsa are considered as

Asatmendriyarta Samyoga nidana49.

PRAJNAPARADA

Prajnaparadha is the Nidana which is done by the person who lost his Dhee,

Dhruti and Smrithi, like intake Santarpanottha Nidana in the form Dadhi, Madya

Varga, Diwaswapna, Ratrijagarana etc50.



PARINAMA:

Parinama is Kala, it plays a very important role in manifestation of disease

as Vata Sanchaya Kala is the Greeshma and Prakopa Kala is Varsha whereas Rakta

Dushti may be considered Pitta Dosha because of their Ashrayaashrayee Bhava and it

is obvious that Sharad Rutu is considered as Pitta Prakopa Kala (Rakta Dushti) and

Lakshana of Vatarakta gets aggravated in Sharad Rutu51.

DOSHA HETU:

They produce Dosha Chaya, Prakopa, Prashamana and leads to

manifestation of disease. In this case the Nidana like Kashaya, Ruksha, and Katu etc.

Aahara Sevana will be considered as Dosha Hetu, which is responsible for the

Sanchaya, Prakopa and Prashamana of the Vata Dosha.

VYADHI HETU:

In this condition Vatarakta Arambhaka Beeja Dusthi can be considered as

Vyadhi Hetu, other causes like Abhighata and excessive travelling after intake of

Vidahi Aahara can be included under the same.

UBHAYA HETU:

Excessive travelling after intake of Vidahi Aahara causes Vata Prakopa

hence it is Dosha Hetu same time it is said to cause the illness Vatarakta.

ANUBANDHYA NIDANA:

Analysis of Vatarakta Samprapti denotes the Pradhanyata of Vata Dosha,

whereas according to the clinical course of the disease and principles of treatment,

both Kapha and Pitta are seemed to be involved hence Vata holds prime importance

in the management of Vatarakta.



ANUBANDHA NIDANA:

Pitta and Kapha are said to be Anubandha Dosha in the appearance of the

disease Vatarakta.

PURIN RICH FOOD ITEMS:

Purin rich food like shell fish,Green leafy vegetables,Bakery items. Uric acid

is causative factor in production of Gouty Arthritis. Nidana like Kulattha, Masha,

Nishpava which comes under the Shimbi Dhanya Varga, green leafy vegetables,

Shaka, Palala etc, and different variety of meat like Shushka and Anupa Mamsa are

rich in Uric acid which are responsible for development of Vatarakta Vyadhi52.

DAIRY PRODUCTS:

Nidana as explained in our classics like Dadhi and Takra comes under dairy

products which are mainly Santarpanottha Karana in the manifestation of Vatarakta53

ALCOHOLIC BEVERAGES:

As explained by Acharya Charaka different variety of Madya is responsible

for Rakta Dushti and Medo Dhatu Dushti. The same is explained in Vatarakta Nidana

as Aranala, Sauveera, Shukta etc causes the disease. These Nidana also act as

Santarpanottha where Meda Dhatu and Kapha Dosha may bring Avarana in the form

of Dhamani Pratichaya leading to Vatarakta54.

SEDENTARY LIFE STYLES

Sushruta has identified Sthoulya and person who do not indulges in Vyavaya

are more prone for the disease Vatarakta55. Charaka also mentions that

Achankramanasheelata as one of the Pradhana Karana for the same56. Other factors

like Misthanna Sukha Bhojina all come under the umbrella of sedentary life style that

will be having more chances of developing Varicose Veins, Gouty Arthritis.



Table No. 2: Aharaja Nidana of Vatarakta

AHARA:

SL

NO

AHARA Reference Texts

C.S S.S M.N Y.R B.P A.H A.S G.P G.N V.S

1 Lavana + - + + + - - - + +

2 Amla + + + + + - - - + +

3 Katu + - + + + - - - + +

4 Kshara + + + + + - - - + +

5 Snigdha

Bhojana

+ - + + + - - - + +

6 Ushna Bhojana + + + + + - - - + +

7 Ajeerna Bhojan + - + + + - - - + +

8 Klinna + - + + + - - - + +

9 Shuska + - + + + - - - + +

10 Ambuja Mamsa + - + + + - - - + +

11 Anupa Mamsa + - + + + - - - + +

12 Pinyaka + - + + + - - - + +

13 Kulatta + - + + + - - - + +

14 Masha + - + + + - - - + +

15 Nishpava + - + + + - - - + +

16 Shaaka + - + + + - - - + +

17 Palala + - + + + - - - + +

18 Ikshu + - + + + - - - + +

19 Dadhi + - + + + - - - + +

20 Aranala + - + + + - - - + +

21 Souvira + - + + + - - - + +

22 Shukta + - + + + - - - + +

23 Takra + - + + + - - - + +

24 Sura + - + + + - - - + +

25 Asava + - + + + - - - + +

26 Viruddhasana + - + + + - - + + +

27 Adhyashana + + + + + - - + + +



28 Kashaya + - + + - - - - - -

29 Katu + - - - - - - - - -

30 Tikta + - - - - - - - - -

31 Alpahara + - - - - - - - - -

32 Mulaka - - + - - - - - - +

33 Madhu - - - - - - - - - +

34 Chukra - - - - - - - - - +

35 Vidahi Anna - - - - - + + - - -

36 Viruddha Anna - - - - - + + - - -

37 Madya - + - - - - - - - -

38 Teekshna - + - + - - - - - -

39 Shaka - + + + - - - - - +

Table No.3-Viharaja Nidana of Vatarakta

VIHARA:

Reference Texts

S.N VIHARA C.S S.S M.N Y.R B.P A.H A.S G.P G.N V.S

1 Divaswapna + - + + - + + + + +

2 Prajagara + - + + - + + + + +

3 Achankrama

sheelanam

+ - - - - + + - - -

4 Hayayana + + - + + - - - - -

5 Ushtrayana + + - + + - - - - -

6 Ambukrida + - - - - - - - - -

7 Plavana + - - - - - - - - -

8 Langana + - - - - - - - - -

9 Ushnecaatiadva + - - - - - - - - -

10 Vaishamyavyavaya + - - - - + - - - -

11 Vega nigraha + - - - - - - - - -

12 Avyavaya - + - - - - - - - -

13 Hasti yana - + - + + - - - - -



Table No.4-Manasika Nidana of Vatarakta

MANASIKA NIDANA:

MANASIKA

Reference Texts

S.N C.S S.S M.N Y.R B.P A.H A.S G.P G.N V.S

1 Krodha + - + + + - - + + +

2 Dukhita - - - - - - - - - +

Table No.5-Anya Nidana of Vatarakta

Reference Texts

S.

N

ANYA

NIDANA


1 Pramada - + - - - - - - - -

2 Snehadivibrama - + - - - - - - - -

3 Rutuviparyasat - + - - - - - - - -

4 Sthula - + + + + - - + + +

5 Sukumara - + + + + + + + + +

6 Abhigata + - - - - + + - - -

7 Ashuddhi + - - - - + + - - -



The Lakshana which appear in the course of Samprapti before

manifestation of the Pratyatma Lakshana is called Purvaroopa. In this stage

conglomeration of Dosha and Dhatu will begin. And these Lakshana will be seen in

Sthanasamshraya Avastha of Shatkriya Kala as mentioned by Acharya Sushruta. If

the physician is able to diagnose the disease in this stage then appropriate treatment

can be planned and one can prevent further aggravation of the disease.

Alpa Lakshana of Vyadhi is nothing but Purvaroopa and these Purvaroopa

are classified into Samanya Purvaroopa and Vishesha Purvaroopa. Acharya have

mentioned Purvaroopa in relation to particular Vyadhi in many diseases except few.

In such case one has to consider the Avyakta Lakshana as Purvaroopa, for e.g.in case

of Vatavyadhi and Kshataksheena Purvaroopa are mentioned as Avyakta.

Even though Vatashonita is a Vatavyadhi but its Purvaroopa are mentioned

distinctly. This shows the importance and severity of the disease.

Table No. 6: Purvaroopa of Vatarakta

S

L

N

LAKSHANA Reference Text

C.

S

S.

S

M.

N

Y.

R

B.

P

A.

H

A.

S

G.

P

G.

N

V.

S

1 Svedoatyartham + - + + + - - - + +

2 Na Sveda + - + + + - - - + +

3 Karshnya + - + + + - - - + +

4 Sparshaajnatva + - + + + - - - + +

5 Kshate Atiruk + - + + + - - - + +

6 Sandhi Shaithilya + - + + + - - - + +

7 Alasya + - + + + - - - + +

8 Sadana + - + + + - - - + +

9 Pidakodgama + - + + + - - - + +

PURVAROOPA



10 Nistoda + + + + + + + + + +

11 Spurana + - + + + + + + + +

12 Bheda + - + + + + + + + +

13 Gurutva + - + + + + + + + +

14 Supti + + + + + + + + + +

15 Kandu + - + + - + + + + +

16 Sandhiruk + - + + - - - - + +

17 Rukbhutvabhutvan

shyati

+ - + + - - - - + +

18 Vaivarnya + + + + - - - - + +

19 Mandalotpatti + + + - - - - + +

20 Shitila - + - - - - - - - -

21 Katina - + - - - - - - - -

22 Svinna - + - - - - - - - -

23 Asvinna - + - - - - - - - -

24 Sheeta - + - - - - - - - -

25 Ushna - + - - - - - - - -

26 Guru + + - + - - - - + -

27 Osha - + - - - - - - - -

28 Dahabhutvanshyati - - - - + - - - - +

29 Sadah - - - - - + + - - -

30 Slathangata - - - - - + + - - -

31 Bhutvabhutvapranashya

nti

- - - - - + + + - -

32 Muhuavibhavanti - - - - - + + + - -

Swedo Atyartham Na Va: Abnormality of sweating

Swedo Atyartham or Na Va57 i.e. Excessive sweating or Deficient sweating

is one among the Purvaroopa of Vatarakta. Sweda is one among the three Mala,

having its main function as Kledavidruti58, Kleda Twak Soukumaryakrut59, Sarve

Vatarti Haarina60. Svedavaha Srotas has its Moola as Meda and Romakoopa61.



Sweating is controlled by the action of Samana Vayu62. The morbidity of Vata Dosha

causes alteration in the Swedavaha Srotas causing either excessive sweating or

deficient sweating.

Karshnyata and Vaivarnyata: Alteration in the colour of the skin

Twak is the largest organ that covers the entire body; it is the shield between

the external environment and the internal organs. Twak is of 6 layers as explained in

the literature63. Avabhasini64 is the superficial layer of the skin which imparts the

complexion and lustre to the skin. The physiology of skin coloration is controlled by

the Udana Vayu65. In Vatarakta if the morbid Vata Dosha affects the Avabhasini layer

there will be discoloration of the skin. Reddish, Blackish, Bluish or Coppery

coloration may be seen66.

Supti and Kshate Atiruk: Alteration in the tactile sensation

Twak is the dwelling place of Sparshanendriya and the Vata that resides here

is the Vyana Vata67 which is responsible for the tactile sensation. The morbidity of

Vata Dosha in Vatarakta disturbs the physiological activity of the Twak leading to

disturbance in the sensation (Supti) which is also termed as Sparshaajnanata-

numbness or Kshate Atiruk68- Hyperesthesia.

Kandu: Itching sensation

As per Acharya Sharangadhara Kandu is considered under Vataja Nanatmaja

Vyadhi. Morbid Vata Dosha brings dryness in the skin and patient is likely to suffer

from itching sensation.Alteration in the sweating may also contribute for the

development of the itching sensation69.



Ruja: Pain

Pain is the major manifestation of Vatarakta due to the morbidity of Vata

Dosha. Morbid Vata Dosha when affects the Twak, Rakta. Pain is a clinical

manifestation. Toda, Bheda, Shoola, Sphurana, Kshate Atiruk, Kunchana, Osha, Ruk

Bhutva Bhutva Nashyati70 all may manifest in the patient suffering from Vatarakta.

Sandhi Ruk: Joint pain

Vitiated Vata Dosha in Vatarakta tends to involve the joints. The

involvement of joints is characterized by pain, swelling around the joints Janu, Uru,

Kati and Hasta and Padanguli Sandhi71.

Constitutional symptoms:

Few of the symptoms like Alasya, Gaurava and Sadana are seen in the initial

stages72 of Vatarakta.

Swedo Atyartham Na Va (excessive sweating i.e. Hyperhydrosis or absence

of sweating i.e. Anhydrosis), Karshnyam (blackish discolouration of skin),

Sparshaajnanata (altered tactile sensation), Kshate Atiruk (severe pain on injury at the

site), Kandu (itching) these are seen in Varicose Veins and Venous Hypertension.

Toda in Janu, Jangha, Hasta, Pada etc parts (acute throbbing type of pain in various

joints), Ruk Bhutwa Bhutwa Nashyati (episodic pain) are characteristic features of

Gouty Arthritis.

All these above mentioned Poorvarupa mimic Kushta Vyadhi. Hence it is

mandatory to differentiate the condition from actual disease with the help of Nidana

Panchaka and proper Ayurvedic clinical methods with Trividha Pariksha.



Manifestation of Pratyatma Lakshana of the Vyadhi is called Roopa73. It

has got different synonyms like Linga, Chihna, Akruti, Lakshana, Samsthana and

Vyanjana. All these give the same meaning with slight differences74. For e.g. Akruti,

Chihna etc indicates signs of the particular disease. This Lakshana manifest in the

Vyakta Avastha of Vyadhi and this Avastha is considered as fifth Avastha of

Kriyakala. In the stage of Sthana Samshraya Avastha if Dosha attain further

aggravation then there will be complete manifestation of Lakshana. With the help of

these Roopa one can infer the Abhyantara Vikruti, So Lakshana plays enormous role

both in the diagnosis and prognosis as well as to plan treatment.

Acharya charaka mentioned Lakshanas based on two ways that is Avastha

Bheda and Dosha Bheda .Avasta Bheda Vatarakta is divided in to two Uthana and

Gambheera Avasta. The reason for mentioning Avasta is for better treatment.When

the Prakupitha Dosha affects the superficial Dhatus till Mamsa Dhatu it is considered

as Uthana Vatarakta.When the prakupita Dosha affects the deeper Dhatus i.e beyond

Mamsa Dhatu it is Gambeera Avasta.In Uthana Vatarakta the Lakshanas area similar

to that of kushta.It is because the prakupita Dhatu involved in both Uthana Vatarakta

and kustha are similar.Not only kustha the contents are similar to that of any Twak

Vikara i.e Rasa,Rakta and Mamsa.Drava Guna is common for these Dhatus and

Dravaguna gets Dushana and produce the lakshanas like

Kandu,Toda,Spurana,Ruk,Ayama and Akunjana.In Gambheera Vatarakta the deep

seated Dhatus are involved the prognosis is less both generalised and localised

symptoms are present like Swayathu,Sthabdhata,Paka later produces deformities

like Khanja and Pangu.

ROOPA



The Lakshana of Vatarakta are enumerated under various headings such as

Utthana Vatarakta, Gambheera Vatarakta, Ubhayashrita Vatarakta and Lakshana

based on Doshadhikyata like Vataja, Pittaja, Raktaja and Kaphaja Vatarakta.

Table No. 7: Lakshana of UtthanaVatarakta75

Lakshana

Reference Text


Kandu + - - - - + + - - -

Daha + - - - - + + - - -

Ruk + - - - - - - - - -

Ayama + - - - - + + - -

Toda + - - - - - - - - -

Spurana + - - - - - - - - -

Kunchana + - - - - + + - - -

Shyava

Twaka

+ - - - - + + - - -

Tamra

Twak

+ - - - - + + - - -

Osha - - - - - + + - - -



Kandu :Kandum Gatra Vigharshane76

Kandu which is literally means Itching. This particular symptom may occur due to

Kupita Kapha Dosha and Dushita Rakta Dhatu. Even though all the three Dosha

presence or absence of discharge will be decided by predominance of Dosha. One

can get several references of this particular Lakshana in various forms like Ardra

Kandu, Shushka Kandu, Ushna Kandu, Sheeta Kandu based on involvement of

Dosha. Sweda is the Jaleeyaroopi Mala which is excreted through Twacha and the

function of Sweda is Kleda Vidhruti. Kleda Vidhruti refers to organisation of Kleda. It

is also explained in classics that Kleda Abhava leads to conditions like Sweda

Shoshana and this may give rise to Kandu which can be considered as Shushka Kandu

where Vata Dosha brings about the symptoms. Kleda Vruddhi results into Ati Sweda

and Kandu which arises in this pathology and is regarded as Ardra Kandu, where

Rakta Dhatu may be considered as culprit.

In case of Utthana Vatarakta both varieties are possible i.e Asweda and

Atisweda resulting in to kandu which may be due to action of Vata and Rakta

respectively.As per modern science, severe itching followed by serous discharge is

one of the presentations in venous eczema,this can be considered as Ardra Kandu.In

early stage of Disease,itching is noted which will not be associated with discharge and

this can be considered as Ruksha Kandu.

Daha:Tapa Dahe77

As per the Panchabhoutika composition of the Rakta Dhatu,Tejo Mahabhuta

imparts red colour and Ushmata to Rakta.In Utthana Vatarakta,there is vitiation of

Rakta which leads to Sthanika Pitta Dosha Vruddhi in Twacha leading to Lakshana

like Daha i.e burning sensation. The temperature of the body is regulated by



blood.Vitiation of blood leads in localised rise of temperature which manifests as

burning sensation of the skin by dilated and torturous veins.

Ruk:Rujati Deham78

Ruk implicates pain. Manifestation of different varieties of pain like Toda,

Bheda, Vedha etc are chiefly due to Prakupita Vata Dosha79, in case of Utthana

Vatashonita, Vata Dosha plays a pivotal role in manifestation of the disease and is

also responsible for producing different kinds of pain.

Aayama: Dairghyama80/ Vistaram81

Aayama or Anaha denotes Dairghyata or dilatation. Aayama in this context

should be considered as Sira Aayama i.e., dilatation of veins. Prakupita Vata Dosha

by its action causes Sankocha in Sira in terms of tortuousness. Rakta Dusthikara

Nidana which mainly increases Kledamsha in Rakta Dhatu leading to Dravata

Vruddhi of Rakta Dhatu results in Sankuchit sira leading to Sira Aayama.

Toda:Tyuddyate Anena/Tud Vyathane82

Toda which is having synonyms like Totra and prajana indicates pricking type of

pain.Again ,this kind of pain will be brought by Prakupita Vata Dosha in Utthana Vatarakta

Condition Pricking type of pain is the major presentation of Gouty Arthritis.

Sphurana: Kinchit Kampana83

Acharya Charaka in the context of Upadhatu Pradoshaja Vikara mentions

that vitiation of Sira, Snayu, Kandara leads to appearance of Sphurana, Sankocha

etc84. And this Sphurana will result by the aggravation of Vata Dosha85 which in turn

vitiates Rakta Dhatu. In the context of Uttana Vatarakta, Sphurana must be limited to

Sira Sphurana.



Kunchana :Kuncha Koutilye86

The word meaning Kuncha is Kutilata or Vakrata which means bending of

the body parts. Sankocha and Kunchana words are interchangeable in Ayurvedic

classics as per the context. Prakupita Vata Dosha results in Vakrata of Hastagata or

Padagata Sandhi, Dhamani and Anguli, which may present as Sandhi Sankocha,

Dhamani Sankocha and Anguli Sankocha. But in the context of Utthana Vatabalas,

Kunchana should be limited to Dhamani Kunchana or Dhamani Sankocha. Varicosity

of Veins presents as elongated, dilated and tortuous veins.

Rakta /Tamra/ Shyama Varna Twacha: Altered skin colour

Altered skin colour in Utthana Vatarakta is due to Dushita Rakta Dhatu in

different Avastha. Vitiation of Rakta Dhatu in various level, may result in variation of

the skin colour. In case of Utthana Vatarakta vitiated Rakta and Mamsa may result in

different colour changes in Twacha like Rakta, Tamra and Shyama in order.

Osha: Sweda Aratiman87 / Osha Dahe88

As Rakta and Pitta are having Ashraya Ashrayee Bhava, hence Vruddhi in

Rakta Dhatu indicates Pitta Prakopa, which brings about Lakshana like Osha. Osha

in this context refers to severe burning sensation with excessive sweating at that site.



Table No. 8: Lakshana of Gambheera Vatarakta

Reference Text

Lakshana C.S S.S M.N Y.R B.P A.H A.S G.P G.N V.S

Swayathu Sthabdah + - - - - - + + - -

Swayathu Katina + - - - - - - - - -

Shyava twak + - - - - - - + - -

Tamra twak + - - - - - - + - -

Daha + - - - - - - - - -

Toda + - - - - - - - - -

Spurana + - - - - - - - - -

Paka + - - - - + + - - -

Ruk + - - - - - - - - -

Vidaha + - - - - - - - - -

Vayusandhyasthimajjasu + - - - - + + + - -

Chidannivacharanti + - - - - - - + - -

Anta vakrikurvan + - - - - - - + - -

Khanja + - - - - + + + - -

Pangu + - - - - + + + - -

Shareeresarvatahcharan + - - - - + + + - -

Lohitatwak - - - - - - - + - -

As the disease progresses and involves deeper and deeper tissue, severity of the

symptoms which are seen in Utthana Vatarakta will increase along with manifestation of

new signs and symptoms.

Sthabdha Shwayathu:

Stabdhata refers to stiffness or immobility. Occurrence of swelling which is stiff in

nature may be due to involvement of Kapha and Vata. Sheeta Guna is one which causes

Stabdhata89, which is unique quality of both Vata and Kapha. Hence vitiation of Mamsa



Dhatu along with Kapha and Vata Prakopa may result into Sthabdha Shwayathu. Hard

swelling in calf region.

Grathitha Shwayathu :Grathitha Ghanabhootam90

Any sort of swelling which is hard in nature again indicates contribution of

Mamsa Dhatu and Prakupita Vata Dosha.

Bhrusharti :Bhrusham – Atyantam 91

Arti refers to Vedana or Shoola, which means pain. Adjective Bhrusham again

indicates severity of pain. As a result of participation of Vata and Rakta one may experience

severe pain.

Khanja:

As the chronicity of the disease increases, affliction of deeper dhatu becomes more

evident. Involvement of Asthi along with Kandara of Sakthi Pradesh may result into

Khanjata.



Table No. 9: Lakshana of Vatadhika Vatarakta

Lakshana Reference Text

C.S S.S M.N Y.R B.P A.H A.S G.P G.N V.S Sirayama + - + + + + + + + + Shoola + - + + + + + + + + Spurana + - + + + + + + + + Toda + + + + + + + + + + Karshnya Shotha

+ - + + + + + + + +

Rukshashotha + - + + + + + + + + Shyavata Vridhihanaya

+ - + + + + + + + +

Sankocha in damani,anguli and Sandhi

+ - + + + + + + + +

Angagraha + - + + + + + + + + Atiruk + - + + + + + + + Kunchana + - - + - - - - - - Sthambhana + - + + + + - + + + Sheetapradvesha + - + + + + + + + + Vepatu - - + - + + + + + + Supti - - + - + + + + + + Sparshadvigna - + - - - - - - - - Bheda - + - - - - - - - - Prashosha - + - - - - - - - - Bhanjana - - + - - - - + - -

Sirayama:

Aayama word refers to the dilatation. Sirayama is a prominent feature of

Vatanubandhi Vatarakta. The elongated, dilated and torturous veins are pathgnomonic of

Venous hypertension.

Shoola:

Pain on standing or walking is also a main feature of Venous hypertension. The

pain at certain times become cramping in nature due to the improper circulation at muscular

level.



Sphurana:

Due to the dilated and torturous veins along the calf, added by the cramping pain,

the patient also suffers from a throbbing sensation throughout the course of Varicose Veins.

Shothasya Shyavata Rukshata:

Rukshata and Shyavatha of Twacha is the consequence of Vata Prakopa at the level

of Rasa and Rakta Dhatu which is expressed on Twacha92. Discolouration of the skin and

indurated swelling predominantly of lower one third of the skin is usually found in Venous

Hypertension. Chronic valvular incompetence causes inflammation and pericapillary fibrosis,

which results in subcutaneous thickening and induration.

Sheeta Pradvesha :

Sheeta Guna is one among the Atma Guna of Vata Dosha. Hence in Vatadhika

Vatarakta patient may show intolerance to cold. Cold environmental temperature causes the

blood vessels to constrict which in turn causes an increase in the pain which is unbearable.

The inability to tolerate cold temperatures is seen as an Anupashaya and aggravating factor in

Venous hypertension.

Sparshodvigna:

Most often the varicosities in the leg may cause a nerve injury leading to

Paraesthesia.

Prashosha :Prakrusthena Shosha

Excessive Shosha or dryness of skin is the effect of Prakupita Vata Dosha at the

level of Rakta Dhatu93. Dermatitis is one of the complications of Varicose Veins where

severe itching is seen.



Supti :Sparsha Ajnanatha

Sparshanendriya i.e, Twacha is one of the Pradhana Sthana of Vata Dosha. Hence

its affliction by Prakupita Vata Dosha and Rakta Dhatu may end up in Sparsha Ajnanatha.

Ischemic Neuropathy can result in numbness which is a long term complication of Peripheral

Arterial Disease94.

Vepathu: Kampa95

Vepathu is one of the Vata Nanatmaja Vikara which means trembling of the body.

Its manifestation in Vatarakta may be due to Prakupita Vata Dosha.

Anguli Vakrata: Vakratwat Iti Parvanam Vakratwat96

When there is involvement of Asthi Dhatu along with other Dooshya in Gambheera

Vatarakta, there will be crooking of phalanges of both upper and lower limb. This stage will

occur when disease reaches to chronic stage.

Table No. 10: Lakshana of Raktadhika Vatarakta



Swayathu + - - - - - - - - -

Bhrusharuk + - - - - - - - - -

Toda + - + + + + + + + +

Tamra + - + + + + - + + +

Chimachimayana + - + + + + + + + +

Snigdharukshaihshamamnaiti + - + + + + + + + +

Kandu + - + + + + + + + +

Kleda + - + + + + + + + +

Shotha - - + + + + + + - +

Atiruk - - + + + + + + + +

Ugradaha - + - - - - - - - -



Kleda: Ardrata97

When there is involvement of Drava Dhatu like Rasa, Rakta and to some extent

Mamsa, there will be more production of Ardrata or moistness. As a result there may be

continuous discharge from the site affected by Vatarakta.

Chimachimayan :Sarshapaliptavat Dukha Anubhava98

Chimachimayanam is a variant of Kandu where patient feels comfort on frequent

touching of the affected part99. In case of Raktadhika Vatarakta, due to predominance of

Rakta Dhatu there will be more production of Kleda. By the action of Vata Dosha it gets

dried up and results into Chimachimayanam variety of itching.

Table No. 11: Lakshana of Pittadhika Vatarakta



Vidaha + - + + + + + + + +

Vedana + - - - - - - - - -

Murcha + - + + + + + + + +

Sveda + - + + + + + + + +

Trishna + - + + + + + + + +

Mada + - + + + - - - - +

Bhrama + - - - - - - - - -

Raga + - - - - - - - - -

Paka + - + + + - - + + +

Bheda + - - - - - - - - -

Shosha + - - - - - - + - -

Sammoha - - + + + + + + - -

Sparshaakshamatva - - + + + + + + + +

Bhrushoshnata - - - + - - - - - +

Shopha - - - + - - - - + +

Rugnangah - - - + - - - - - +

Ushna - + - - - - - - - +



Raktashopha - + - - - - - - - -

Rukugra - - + - + + + + - -

Shotha - - + - + + + - - -

Paka - - + - + + + - + -

Bhrushoshmata - - + - + + + + + -

Daha - - - - + - - - - -

Trishna :Jala Icha100

Trishna which is also termed as Pipasa is a clinical condition where patient

desires to consume water. This particular entity may present as the symptom of a disease or

even as a separate disease. In the condition of Vatarakta when there is association of Pitta

Dosha, entity like Trishna may develop secondary to the disease.

Raga: Ranjanam101

Raga is one of the Lakshana of Prakupita Pitta which means red in colour. In

the conditions of Raktadhika and Pittadhika Vatarakta the affected part will become red in

colour. There is one more different meaning for the same as explained by Ayurveda

Rasayana where he mentions that Ranjana refers to loss of own colour i.e., Swavarna

Apadanam.

Paka :Pachakatwam102

The process of attaining Pachana is called Paka. Three stages of Vranashotha

are Amavastha, Pachynamanaavastha and Pakwaavastha. In the stage of

Pachynamanaavastha due to involvement of Gambheera Dhatu and due to action of Pitta

Dosha there will be suppuration in Dhatu.

Vidaha :Pani Pada Amsamooleshu Vividha Santapo103

Burning sensation at the region of palm, sole and scapular region is called

Vidaha. This particular Lakshana of Vatarakta is mainly due to vitiated Rakta Dhatu which



in turn leads to Pitta Prakopa. And in the case of Vatarakta, Vidaha mainly attributes to

Pada104.

Sparsha Asahatwam:

Due to predominance of Pitta Dosha, there will be severe pain on touching the

affected part. Hence individual may not allow to touch that part. This symptom may be

visible in Pittadhika Vatarakta.

Mada: Visha Madhya Shonitotta Vikara105

As explained by Acharya Charaka, Mada belongs to the category of Shonita Roga.

In the derivation of Mada, it is said that Mattata is a condition where mental faculties are

deranged and ability of perception is affected. This condition will occur mainly due to Visha,

Madya and Rakta. In illness like Vatarakta when predominantly afflicted by Pitta Dosha and

Rakta Dhatu, patient may experience Delirium.

Bhrama :Chakrasthitasya Eva Samvedanam106

Bhrama is one of the 80 types of Nanatmaja diseases of Vata. This condition may

manifest as a symptom of many diseases or may present as disease itself. This can be

considered as dizziness where patient perceives unsteadiness. This disease is mainly due to

contribution of Raja (Manasika Guna), Pitta and Vata Dosha. Bhrama is also one among

Majja Pradoshaja Vikara. When Vatarakta becomes importunate there will be affliction of

Majja Dhatu, hence symptoms like Bhrama may appear.

Sweda:

Excessive sweating in Pada Pradesha is again a feature of Raktadhika and

Pittadhika Vatarakta.

Table No. 12: Lakshana of Kaphadhika Vatarakta





Sthaimitya + - + + + + + + + +

Gourava + - + + + + + + + +

Snehah + - + + + + + + + +

Supti + - + + + + + + + +

Mandaruk + - + - + + + + + +

Snigdha - - + + + + + + + +

Kandu - + + + + + + + + +

Sheetata - + + + + + + + + +

Sveta - + - - - - - - - -

Shopha - + - - - - - - - -

Pina - + - - - - - - - -

Sthabda - + - - - - - - - -

Guruta :Gouravama Gurutwam107

Guruta is the Lakshana of Kapha Prakopa, which means heaviness. In this

particular Vyadhi it should be limited to Pada rather than considering Sarva Shareera108

Staimitya: Gatranama Patutwam109

It is a type of sensation where patient feels as if he is covered by cold cloth. In the

condition of Kaphadhika Vatarakta this particular Lakshana is seen which will be mainly

attributed to Pada as mentioned by Acharya Bhavamishra110.



Swayathu :Utsedhah

Swayathu or Shopha is accumulation of fluid between Twacha and Mamsa Dhatu.

In the context of Gambheera Vatarakta, Shotha will be either Kathina i.e. hard due to

aggravated Vata Dosha or it may be Sthabdha i.e. fixed due to Kapha dominance.

Bhrusharti: Arti – Arda Himsayam111

Himsa refers to killing type of pain. In Gambheera Vatarakta as there is

involvement of deeper Dhatu and when Majja is affected, it may cause severe excruciating

pain112.

Vaivarnyata: Twak Kanti Kshaya113

Loss of skin lustre is called Kanti Kshaya. This is one of the manifestations of Rasa

Rakta Kshaya. Vaivarnyata may also indicate altered colour of skin like Tamra Varnata,

Shyava Varnata, and Aruna Varnata which is dependent on predominant Dosha.

Kotha: Pootibhava114

Presence of Kotha in Vatarakta indicates deeper involvement of Dhatu along with

Pitta Dosha. Pootibhava refers to putrefaction which results due to the improper or absence

of blood circulation to affected part. This may be considered as Gangrene.

Khanja :Eka Padasya Pangutwam115

Chronic stage of Vatarakta may also result in Khanjata if Vata gets localised in

Sakthi Aashrita Kandara.

Pangu:Dwayo Sakthno Vadhat116

When Vata Dosha affects Kandara of Kati Pradesha, it results into loss of strength

in both Sakthi and this condition is termed as Pangu. This is also one of the Vata Vikara. In

the persistent stage of the Vatarakta, when there is involvement of Kandara of both sides it

may lead to Pangutwam.



Comparison of Vatarakta Lakshana with contemporary science:

It is important to set apart the above said Lakshana which are also seen in

diseases of contemporary science. An endeavour may facilitate to understand the disease

Vatarakta in a following way.

The condition where abnormal deposition of monosodium crystals are seen in

Gouty Arthritis which clinically presents as Sandhi Shoola (joint pain), Sandhi Shotha

(swelling of joints), Raga (redness), Sparsha Asahatwa (unbearable pain), Sandhishu Ruk

Bhutwa Bhutwa Nashyati (episodic pain), Sandhi Sankocha (abnormal bending of joints

contracture) are notable features in Vatarakta.



Upashaya and Anupashaya is one among the Panchanidana117.

Upashaya is the suitable use of Aushadha (drug), Aahara (diet) and Vihara (regimen)

which are contrary to the aetiology and (or) disease. On the contrary, those which

when employed aggravate the symptoms of the disease are entitled as Anupashaya118.

Upashaya and Anupashaya helps in diagnosing the diseases which are unmanifested

or difficult to understand119.

Upashaya and the Anupashaya of the Vatarakta is not clearly mentioned

in treatises but Aahara and Vihara which are cited under the umbrella of Nidana can

be considered as the Anupashaya. Aahara and Vihara which are enumerated under the

treatment can be considered as Upashaya.

As Vata Dosha is the key factor in deciding the prognosis of the illness,

so in Upashaya one has to follow such regimens which alleviate Vata Dosha. At the

same time, factors which have got similar properties of Vata Dosha cause corrosion of

the condition.

Upashaya:

All the Apatarpanottha nidana are Upashaya for Vatarakta if there is

involvement of Kapha and Meda.

Aahara Sambhandhi:

While explaining about the Chikitsa Acharya Charaka has explained some of

the food items to be consumed in Vatarakta. Which are as follows, Purana Dhanya,

Yava, Shashtika Shali, Masoora, Godugdha, Ajadugdha, Vishkira and Pratuda

Mamsa Sevana etc can be considered as Upashaya120.

UPASHAYA ANUPASHAYA



Vihara Sambhandhi:

Ratriswapna, Vishrama, Nirvata Pradesha, Mrudu Samvahana as explained

by Acharya Sushruta can be considered as Vihara Sambhandhi Upashaya121.

Aushadha Sambhandhi:

Aushadha Kalpa which are mentioned in the context of Chikitsa are said to

be Aushadha Sambhandha Upashaya.

Anupashaya :

All the Santarpanottha Nidana are Anupashaya for Vatarakta when there is

Margavarana pathology leading to Dhamanipratichaya as a result of vitiation of

Kapha and Meda along with Vata Dosha.

Aahara Sambhandhi:

Aahara which is predominant of Lavana, Amla, Katu, Tikta, and Kashaya

Rasa, Snigdha and Ushna Gunayukta, Abhishyandi and Guru Aahara, Klinna,

Shushka, Ambuja and Anupa Mamsa, intake of Kulattha, Masha, Nishpava, Dadhi,

etc are Anupashaya. Sauveera, Shukta, Aranala variety of Madya also comes under

same category122.

Vihara Sambhandhi:

Diwaswapna, Vyayama, Maithuna123, Achankramanasheelata,

Abhighata, Ratrijagarana, Haya Ushtra Yana etc.124



Pathophysiological events undergoing inside the body from the very

beginning of etiology to the clinical expression of different severity ranging from

Prodromal to Complication pace is broadly termed as Samprapti.

The study of Samprapti helps in understanding how the disease manifests

after Nidana Sevana. Thus Samprapti deals with the whole pathological process,

which is responsible for clinical signs and symptoms of the disease. In Ayurveda

much importance has been given for Samprapti Vighatana because Chikitsa is mainly

to disintegrate the Samprapti.

Ayurvedic understanding of pathology:

External milieu cannot produce a disease on its own. External milieu

interacts with internal milieu i.e. Dosha as internal milieu gets vitiated and intern

vitiates Dooshya viz a viz tissues of body resulting in the disease. This interaction of

Dosha with Dooshya may produce a Disease or a Syndrome or a Symptom complex

which clinically looks alike. Vitiated Dosha interacts with the Dooshya in a particular

Adhisthana and generally produces a disease. Hence permutation and combination of

Dosha with Dooshya i.e., innumerable tissue elements of the body will produce

innumerable diseases125. At times vitiated Dosha interacts with tissue at an

Adhisthana and may also produce multiple disease entity126.

Ayurveda also explains the pathological events taking place in a Srotas such

as Sanga, Vimargagamana, Atipravrutti and Sirajagranti. All the existing

innumerable disease will have one or more of this kind of event in the disease process.

Samprapti of Vatarakta revolves around Avarana as a pathological process which

SAMPRAPTI



apparently looks different from the above cited pathological events. Though the term

Avarana is different, it eventually means obstruction only127,128,129

SAMPRAPTI

According to Acharya Charaka as Agni and Marutha are involved in

Vatarakta attain the feature of Durnivaratwam and Sheeghrakaaritwam. Here main

importance is given to Shonitadushti Kaaranas and mentioned first followed by

Vatadushti Kaaranas. Ashuddha is another word used having different meanings like

the person had undergone periodical Shodhana, Abhighata and by which

Vatavaishamya is caused. Here Krudha Vayu gets Avarana by already Kruddha Rakta

and produces this disease.

Agni and Vayu are essential for life to happen and they both are involved in

this disease. Here Agni is nothing but Rakta (due to its Samana Guna with Pitta) and

Vayu is Vata Dosha in combination produce this grave disease. Here Vata Vaishamya

mainly refers to hamperment in Chalaguna of Vata in turn affects the circulation.

Through circulation already Dushita Rakta is carried all over the body produce Sanga

and Khavaigunya and affects the Khuda Pradesha.

The Khudapradesha is affected, Khuda means Sandhi and mainly

Paadamoola Sandhi’s. The other Gunas affected here are Sukshmaguna, Dravaguna

and Saraguna along with Chalaguna mentioned previously. By Sukshmaguna the

Prakupitha Dosha affects the distal ends. By Dravaguna the fluid consistency is

affected and is nothing but the Rakta Dhatu consistency. By Sara and Chalaguna the

circulation is affected. Due to particular Nidanas like Hasti, Ushtra yana the

Dushita Rakta gets settles down in Paadamoola due to the continuous jerky

movements. And as Rakta is Dushita by its Drava, Saraguna produce Lakshanas.



Acharya Sushrutha tells that by Rakta Prakopaka Nidanas, Rakta reaches

the Vidahi Avasta and it starts moving through the Vayumarga. Here Athyudrikta and

Atishayena Vridhigata are the two words that denote the Prakupita Avasta of Rakta.

Vayu in Prabalaavasta along with this Shonitha produce the disease Vatarakta. Along

with this he specially mentions that it happens to the Sukumara who indulges in

MithyaaharaVihara. Sushrutha again tells as the Shonita is in Vidagdha Avasta when

person indulges in Hastiyana it reaches the Paada and thus Vatarakta affects

Paada first.



Flow Chart No.1- UTTANA VATARAKTA NIDANA Is affected Prakup Medas in t Dushita Rakt Chalaguna of vata is Upachaya of Rakta Kapha/Ama Utpatti Affected in Tiryakmarga Prakupita rakta Vidahi Rakta Obstructing Kapha & Medas in siras Dushita Rakta Prakupita vata gets Avarana by Dushita Rakta due to obstruction in siras Dushita Rakta Sancharana in sarvashareera &moves to the peripheries Dushita Rakta settles in Vayumarga Sthanasamshraya of Rakta in Adhobhaga Prakupita Rakta undergoes sanga in Twak,Rakta and Mamsa Dhatus of lower limb Especially in Padamula There it mixes with local Dosha(Pitta,Kapha) Producing the symptoms like Twak Vaivarnyata,Ruja,Daha,Toda,Sphurana,Suptata UTTANA VATARAKTA

Katu Rasa

Mulaka

Mityaahara

Mristanna Bhojana

Achankramanasheela

Masha

Vidahi Bhojana

Dadhi,Takra,Katu Rasa,Masha



Flow Chart No.2 - GAMBHEERA VATARAKTA NIDANA Prakupita vata in vimargagamana Pradushya Rakta in vigatagati Pradushya Rakta affects Twak,Rakta,Mamsa,Meda,Asthi and Majja Dhatu Produces Twak Vaivarnyata,Raktata &Daha By further Dushana of Rakta and Vata(due toTeekshna and Ushna Guna of Rakta) Paka of Rasa,Rakta and Mamsa Dhatu Producing Mamsakotha By further Dushana of Rakta and Vata Involvement of dushti of Asthi,Majja and Sukra Dhatus GAMBHEERA VATARAKTA

Anupa Mamsa

Virudhabhojana,

Achankramanasheela

Jalaja Mamsa

Lavana Rasa

Madyasevana

Katu Rasa

Mityaahara

Ratrijagarana

Obstruction of siras due to Medodusti

Upachaya & Pradhushana of Rakta

Prakupita avasta of vata



SAMPRAPTI GHATAKA-

Dosha :Vata PradanaTridosha

Vata : Vyana vata and Samana vata

Pitta : Bhrajaka Pitta

Kapha : Shleshaka

Dooshya : Uthhana- Tvak, Rakta, Mamsa,

Gambheera- Meda, Asthi, Majja

Upadhatu : Sira,Snayu,Kandara

Mala : Sweda

Srotas : Rasavaha, Raktavaha, Mamsavaha, Medavaha, Asthivaha,

Majjavaha, Svedavaha

Srotodusti : Sanga

Udbhavasthana: Pakvashaya

Sancharasthana: Sarvasharira

Adhistana : Adhahshaka

Vyadhimarga : Bahya and Madhyamarogamarga

SAMPRAPTI LAKSHANAYO SAMBHANDHA:

The symptoms like excessive sweating or deficient sweating are indicative

vitiation of Samana Vata130. Altered sensations and decreased range of joint

movements is in favour of morbidity of Vyana Vayu131. Occurrence of discoloration

of the skin in the form of reddish, bluish or blackish tinge is suggestive of morbidity

of vyanavayu132.

Alteration of tactile sensation is pathgnomonic of involvement of

Sparshanendriya. The different altered states of consciousness like Mada, Moha,

Moorcha that occur in the later stage of the illness is suggestive incriminatory effect

on Manas and Hridaya133.



Different forms of discoloration of the skin are highly suggestive of

involvement of the Rakta Dhatu. The same is also suggestive of abnormality of

Raktavaha Srotas. Appreciation of Dhamanipratichaya also corroborates the same.

Margavarana tending inhibition of movement of Vata Dosha in the

Raktamarga being the prime pathology of the Vatarakta, this fact specifies the Sanga

as the Srotodusti Prakara134.

The symptoms of Vatarakta like Shoola, Ruk, Toda etc point towards the

pathogenesis of Mamsa Dhatu. Sandhishoola are the symptoms because of morbid

Asthi Dhatu135.

Involvement of Majja Dhatu is identified by the presence of symptoms like

murcha136 etc. Excessive or deficient sweating is indicative of involvement of both

Sweda and Aswedavaha Srotas in the pathogenesis of vatarakta137.

Affliction of Dhatu like Twak, Rakta etc is suggestive of relationship of

Bahya Rogamarga in the disease. In contrast to this presence of symptoms evocative

of affliction of Sandhi corroborates the relationship of Madhyama Rogamarga in

Vatarakta138.

Occurrence of constitutional symptoms like Jwara, Alasya etc affirms the

Sarvasharira as the Sancharasthana of the Dosha. In spite of this fact, it is stated that

the morbid Dosha tend to circulate in the lower limbs to a larger extent.

Gout and Vatarakta:

In Classics Sthoulya is considered as Santarpanothajanya Vyadhi while

Vatarakta is considered as Vatajananatmaja Vyadhi and is named as Vatashonita or

Aadhyavata. Dhamanipratichaya has been mentioned as a Shleshma Vikara which is

caused due to obesity and is the cause for Vatarakta.



Gout is considered as a disease of lifestyle and is associated with rich people

with high status, and their excessive consumption of drinks and food rich in

purine(protein), also in classics the word “Aadhya” means “Rich” and Aadhyavata

means the disease affecting the rich class due to involvement of Vata. On the other

hand, obesity is also a disease which affects people who indulge in excessive

consumption of drinks and rich foods.

Nidana mentioned in context of vatarakta like mistanna sukha bhojana,madya

sevana (which are said to be rich sources of proteins and gives more calories to body)

Achankramana and Diwaswapna which belongs to category of imbalance in energy139

and Ama are likely to cause vitiation of medo dhatu and may manifest

stoulya,prameha etc140.Ama in this context should be considered as mala

sanchaya141.Mala is one which causes uneasiness to the body Aparipakva Dhatu(uric

acid crystals) is also considered as mala142.According to chakrapani ama can also be

considered as Avarana which is nothing but sanga143.So based on this reference one

can consider excessive deposition of uric acid crystals i.e Ama in the joint spaces

which leads to Gouty Arthritis is the vatarakta as explained in ayurvedic classics.

Lakshana of Vatarakta like

– Sandhi Shoola

– Raga

– Paka

– Ruk Bhutwa Bhutwa Nashyati etc helps to understand the Samprapti of Gouty

Arthritis in terms of Vatarakta.



It is a state (a disorder itself) which manifests in the later period of the

disease144. ‘Upadrava’ is named so because it appears after the disease manifestation.

Hence disease is the primary stage while Upadrava is secondary. The Upadrava is

often pacified when the main disease is treated. But as it appears later it becomes

more agonising because a person is being already suffering from disease145. The stage

is manifested with continued practice of unwholesome regimen. It is a later stage of

the disease when Dosha get lodged in Gambheera Dhatu and Dosha Dooshya

Sammurchana become dense on strong, causing disease of chronic nature.

Vatarakta is a disease of chronic, crippling nature affecting Twacha,

Sandhi Pradesh and other organs too. The pathology gradually become deep rooted

and later stage of the disease presents with Upadrava.

Table No. 13: Segregation of Upadrava as per involvement of Srotas:

Srotus Involved Lakshana

Rasavaha Arochaka,Jwara,Klama

Raktavaha Paka,Spota,Daha,Visarpa,Mada,Sankocha,Pangu

Mamsavaha Mamsakotha,Arbuda,Stambha

Asthivaha Marmagraha,Angulivakrata

Majjavaha Murcha,Ruk,Moha,Bhrama,Pravepaka,Shirograha

Udakavaha Trishna

Annavaha Avipaka

Pranavaha Shwasa,Hikka

Upadrava of Vatarakta can be categorised under two broad headings local

and systemic complications.

UPADRAVA



Table No. 14: Localised complications:

Mamsakotha Angulivakrata

Pangulya Sphota

Visarpa Daha

Paka Sanckocha

Toda Stabdhata

Mamsakotha:

As a result of Dushita Rakta, Ushna and Teekshna Guna of Pitta Dosha

increases. Once there is manifestation of Pidaka in the Paadamoola, Dushita Rakta

gets stasis due to affected circulation. Ushna and Teekshna Guna of Pitta lead to Paka

of Pidaka in Sthanika Mamsa Dosha which manifests as Mamsakotha.

Pangulya:

In Gambheera Avastha of Vatarakta it affects the Gambheera Dhatu of

both the lower limbs producing contractures and permanent deformity. When the

Sakthi Aashrita Kandara of both leg affected, it ends up in Pangulyata146.

Visarpa:

Spreading of Sphota and Shopha in Urdhwa, Adha and Tiryaka Marga is

called Visarpa147. Nidana mentioned in both Visarpa and Vatarakta share similar

characters leading to vitiation of Vata and Rakta etc, Dhatu. In this context Visarpa

refers to Antarashrita Visarpa which results into Marmabhighata, Moha, Agni and

Balanasha148.

Paka:

Paka may be the consequence of Dushita Rakta Dhatu along with Prakupita

Pitta Dosha in turn vitiating localised Mamsa Dhatu leading to Paka.



Toda:

Toda at the localised area may be the effect of Prakupita Vata Dosha.

Anguli Vakrata

Prolonged illness of Vatarakta where joints are affected to a greater extent

may result into some irreversible permanent deformities of inter phallengeal joints.

Sphota:

Sphota refers to Pidaka, which are mainly seen in Utthana Vatarakta.

Pidaka may manifest as Sasravayukta i.e. with discharge and Nisravayukta which

means without discharge.

Daha:

Daha is one among Pitta Nanatmaja Vikara. Vitiation of Rakta Dhatu may

cause Prakopa of Bhrajaka Pitta at the level of Twacha in Hasta and Pada ending

with Daha.

Sankocha:

Permanent damage to joints, vessels may end up in contractures and

narrowing of vessels respectively.

Stabdhata: “Stabdha Gatrata Janwadeh Namana Asamarthyam” 149

It means inability to perform the Namanadi Karma(bending movement)

by the affected joints.Acharya Madhava also said:-“ Stabdham Cha Kurute Gatra”

According to Hemadri- ‘Graha’ means Stabdhata 150. It is an adjective

Stambha which means ‘Sankochadi Abhava’ or Nishkriyata.151

All these meaning signifies the restriction of range of movement in joints.

Sandhi becomes stiff and unable to move in their normal range. A musculoskeletal

complication of autoimmune disorders includes contracture of joints affecting the

mobility of affected joints.



Table No. 15: Systemic complications-

Arochaka Moha

Avipaka Bhrama

Trishna Klama

Hikka Prvepaka

Shwasa Marmagraha

Kasa Shirograha

Jwara Mamsakshaya

Aswapna Pranakshaya

Arochaka:

Arochaka may present as minor to major complication. Aruchi may occur

due to vitiation of Rasa Dhatu as explained by Acharya Charaka while explaining

Rasa Vruddhi Lakshana152. In this Avastha Sannipataja Arochaka should be taken

into consideration. As mentioned by Dalhana it is Asadhya in nature153.

Avipaka:

Involvement of Annavaha Srotas in later stages of Vatarakta may end up

in Lakshana like Avipaka.

Trishna:

In the Upadrava Avastha of Vatarakta Ushna Guna of Pitta and Rakta

along with Ruksha Guna of Vata causes Apa Dhatu Kshaya which leads to Shoshana

of Gala, Talu and Ostha resulting into Trishna. This particular complication can be

considered as Upasargaja Trishna.



Hikka:

Mahahikka a fatal variety of Hikka can be considered as Upadrava of

Vatarakta as it also exhibits Lakshana like Prana, Mamsa Kshaya and

Marmagraha154.

Shwasa:

In this case one should consider Asadhya variety of Shwasa like

Mahashwasa and Chinnashwasa as Upadrava, where there are features like

Pranasthagyana, Vigyana155 and Marmagraha156.

Kasa:

This Upadrava is a result of Pranavaha Srotodusti by Vruddha Kapha &

Vata. Kasa results as a consequence of extensive Dhatu Kshaya. Hence in this case

Asadhya type of Kasa like Kshayaja Kasa should be considered as complication.

Jwara:

Jwara is due to Pitta Pradhanyata among Tridosha. As the disease attains

chronicity Dhatu Paka begins as a result it enhances Dhatu Kshaya and Ojo Kshaya.

Reduced Vyadhikshamatva in body may lead to Jwara.

Aswapna:

Aswapna or Nidranasha is one of the Lakshana of Vata Vrudhi Avastha157.

It is obvious that Prakupita Vata Dosha in chronic stage of Vatarakta will result into

this condition. But the severity of this Lakshana will be more. Acharya Charaka also

explains that Majjagata Vata will result into Aswapna158.

Moha:

Moha refers to Agnyana or Vichara Ashakti159, which means loss of ability

to think. Whereas the word meaning is considered as illusion. Moha in Vatarakta may

result when there is affliction of Jnanendriya.



Klama:

Without any physical or mental work, tiredness of the body and mind called

Klama160. Charaka has mentioned Klama under Shonitaja Roga hence due to Dushti

of Rakta, it will be manifested 161.

Bhrama:

Bhramaha Chakraaroodahsyeva Bhramanam162.It is mainly due to Pitta or

Vata 163or both and due to Raja164 Dosha of Manas. This Upadrava is produced when

Gambheera Dhatu like Majja is involved.

Pravepaka:

Pravepaka or Kampa which means tremors occur as a result of Prakupita

Vata Dosha

Marmagraha:

As the disease becomes Chirakari and Madhyama Rogamarga gets

involved, Lakshana related to Marmagraha may be invariably seen. Graha refers to

Nishkriyata165, which means abnormal functioning or loss of functions of Marma.

Mamsa Kshaya:

As involvement of deeper and deeper Dhatu progresses and reaches to

Mamsa Dhatu, Ruksha Guna of Vata and Ushna Guna of Pitta may result into Mamsa

Kshaya.

Prana Kshaya:

Acharya Charaka has explained Dasha Pranayatana where Prana is mainly

located and any injury to these parts may result into death166. So involvement of these

Ayatana in chronic stage of Vatarakta may take life of an individual.



The physician, who knows the classification of curable and incurable diseases

and proceeds with treatment in time after thorough knowledge certainly succeeds. On

the other hand, the physician treating incurable disease certainly suffers from the loss

of wealth, erudition and reputation and from censure and unpopularity167.

Sadhyasadhyata of any disease usually depends upon –

Nidana

Rogamarga

Rogadhisthana

Upadrava

Samprapti Ghataka etc.

According to Charaka some disease by their nature are incurable where as

others are curable. If a disease is not treated timely it reaches to incurable stage after

sometime.

Acharya Charaka in Indriyasthana while explaining about

Asthamahagada which are Asadhya by nature, has considered Vatavyadhi as one

among them168. As Vatarakta is one of the Vatavyadhi same is applicable here also.

Acharya Sushruta has counted Vatavyadhi as Mahavyadhi which is cured

with difficulty. He also quoted that if the patient of Vatavyadhi develops the

complications like Shoonam (oedema/inflammatory), Suptatvacha (tactile

senselessness), Bhagna (Fracture), Kampa (tremors), Adhmana (distension of

abdomen) and pain in internal organs, then he doesn’t survive169.

SADHYASADHYATA



SADHYA

If these factors are present it determines the curability of Vatarakta

Navottitha Vatarakta

Ekadosha involvement in Samprapti

Uttama Rogibala and presence of Chikitsa Chatushpada

YAPYA

Vatarakta of one year duration

Involvement of two Dosha in the Samprapti

Absence of Upadrava

Uttama Rogibala

ASADHYA

Involvement of all three Dosha in the Samprapti

Presence of Upadrava

Presence of specific symptom indicative of incurability like Ajanusputitha



Table No.16: Showing available information from various texts for Sadhya

Asadhyata

Reference Text

C.S S.S M.N Y.R B.P A.H A.S G.N V.S

SADHYA

Ekadoshaja + - + + + + + + -

Nava + - + + + + + + -

Nirupadrava + + + + + - - + -

YAPYA

Dvidoshaja + - + + + + + + -

Akritsnopadrava + - + + + - - + -

Samvatsarotita + + + + + - - + +

ASADHYA

Upadravayukta + + - + - - - - -

Tridoshaja + - + - + + + + -

Moha + - + - + + + + -

Samprasava + + - + + + + + -

Vaivarnya + - - - - - - + -

Stabdhata + - - - - - - + -

Ajanusputitha - + + - - - - - +

Arbudakari + - + + + + + + -



Table No.17- Showing Pathya and Apathya mentioned by Acharyas:

Pathya Apathya

Purana yava Divaswapna,Santaapa,Vyayama

Godhuma Maituna

Neevara Katu,Ushna,Guru,Abhisyandi,Lavana

Shastika shali Amla Ahara

Vishkira

Pratuda

PATHYA APATYA



Certain Lakshana produced in disease suggest the definite death of a

patient and such dangerous & warning symptoms are called Aristha170.

Lakshana that does not respond to any treatment and remains progressive,

that Lakshana is called as Aristha171. As blossomed flower indicates the future fruit

similarly Aristha Lakshana indicates death in near future172. Aristha Lakshana have

their effect on Shareera, Indriya and Manas.

Vatarakta is one of the Vatavyadhi which is one of the Asthamahagada.

The patient may end up with fatal condition if a Vatavyadhi is persisting with Bala

and Mamsa Kshaya.

Patient of Vatarakta if lands up into Upadrava like Moha should be

rejected and this Lakshana can be considered as Aristha.

ARISTHA



Acharya Charaka has given due importance in the diagnosis of the disease

and also mentioned about variant of diagnosis. As he clearly mentions that a good

physician should not be embarrassed if he fails in nomenclature of the disease as

diseases are innumerable in number and not all are identified by name174.Charaka

enumerates three modes of diagnosis. They are Vikara Prakruti, Samutthana Vishesha

and Adhisthana Antarani. To attain these kind of diagnosis one has to follow the

Aaptopadesha which can be proved with Pratyaksha and Anumana Pramana.

Cardinal feature is the important criteria for the diagnosis. When the

cardinal features are supported by Nidana, Samanya Lakshana/Vishesha Lakshana,

Purvaroopa and Upashaya-Anupashaya etc the diagnosis is made.

The foremost appearance of Utthana Vatarakta is the symptoms related to

Twacha and Mamsa. In the same way Raktavruta Vata is a diseased condition where

symptoms related to Twacha will be seen. So manifestation related to the Twacha is a

part and parcel of the symptomatology of both the diseases. So it is mandatory to

make a peculiarity of these two conditions.

In the parallel way in Gambheera Avastha of Vatarakta the presentation

is predominantly related to the Sandhi. Aamavata and Sandhigata Vata are the other

two conditions where symptoms related to joints are the major manifestations. So

Vatarakta has to be distinguished from the above two disorders.

This goal can be attained by the accurate usage of Nidana Panchaka with

Ayurvedic clinical methods of examination using Pramana.

SAPEKSHA NIDANA



SANDHIGATA VATA:175

Nidana which are enlisted in Vatavyadhi holds good for the causation of

the disease Sandhigata Vata but one cannot find Rakta Dushti Nidana in the same

list176. But in case of Vatarakta it has got etiological factors which cause morbidity of

both Vata Dosha and Rakta Dhatu177.

When it comes to the point of Samprapti, Gatatwa pathology is involved

in Sandhigata Vata and there is no corroboration of Rakta Dushti anywhere in the

body throughout the course of Samprapti. Whereas in the case of Vatarakta as there is

Margavarana pathology between Vata Dosha and Rakta Dhatu which further worsens

the condition. The Purvaroopa of Vatavyadhi are mentioned as Avyakta or if they are

Vyakta then they will be hardly visible. Same applies for the Purvaroopa of

Sandhigata Vata. Whereas in Vatarakta very particular list of Lakshana are

mentioned which are highly beneficial in the diagnosis. The Samprapti of Sandhigata

Vata is Prakupita Vata Dosha afflicts the Sandhi Pradesh which is the main seat of

Shleshaka Kapha resulting into localised Shotha leading to restriction and pain on

movements like Prasarana and Akunchana. Also the patient of Sandhigata Vata

never develop Paka, Kotha or Angapatana but such kind of complications are

invariably seen in chronic stages of Vatarakta. Thus lack of such Upadrava is a useful

criteria for the differential diagnosis.

AMAVATA:178

The Nidana which are enlisted in the context of Amavata by Acharya

Madhavakara shows more prevalence in the causation of Ama. Further in the process

of Samprapti Ama plays pivotal role in the genesis of the disease Amavata, along with



Prakupita Vata Dosha. Hence it is evident that Ama associated with Prakupita Vata

Dosha is pathologically prime factor in the genesis of Amavata. Ama in this context

refers to Rasanimittaja Ama which accumulates in Kapha Sthana like Sandhi.

While coming to the Lakshana, Amavata presents some of the similar

symptoms as that of Vatarakta and Sandhigata Vata like Sandhi Shoola, Shotha and

restricted movements of joints. But presence of typical Ama features i.e.,

Bahumutrata, worsening of the symptoms on application of Snigdha Dravya, etc

makes it notorious from other two conditions. On the contrary usage of Snigdha

Dravya in Sandhigata Vata and Vatarakta brings more benefits in the patients.

In addition to this Lakshana which suggest involvement of Dushita Rakta

Dhatu and Twacha are entirely absent in Amavata. Contrary to Vatarakta there is no

reference of Purvaroopa in Amavata. So the disease will be manifesting with straight

away involvement of Sandhi. During the onset of Amavata it tend to begin from major

joints like Kati whereas Vatarakta begins from minor joints and spread to major joints

like Akhu visha as Akhu Visha is slow spreading in nature hence the simile is given to

prove the slow spreading nature of Vatarakta. Amavata has got specific list of

symptomatology which are different from that of Vatarakta and Sandhigata Vata.

Based on all these parameters Vatarakta and Amavata can be best differentiated.

KUSHTA

The Purvaroopa observed in both Kushta and Vatarakta are almost one

and the same. This may be for the reason that in both these conditions the

Sthanasamshraya of Dosha are occurring in Twacha and Mamsa. Amongst the 7

Maha Kushta and 11 Kshudra Kushta barely the Maha Kushta manifests with

aforementioned appearance of Purvaroopa. In the Samprapti of Maha Kushta all the

Saptadravyas are involved where as in Vatarakta only Vata and Rakta takes part in



Samprapti. Due to the same grounds itself Vatarakta exhibits only the symptoms

allied to morbidity of Vata Dosha and Rakta Dhatu. In case of Kushta each and every

Maha Kushta has got its own clear features. So it is easy to make a distinction of

Vatarakta from these seven Maha Kushta. Kushta is predominantly a Bahya

Rogamarga Vyadhi and Vatarakta based on the distribution of Dosha can be a Bahya

Rogamarga, Madhyama Rogamarga and even the both in case of Ubhayashrita

Vatarakta. Kushta is said to be an Aupasargika Roga whereas Vatarakta is not so.

Incidence of the illness Vatarakta is more in Aadhya people hence called as

Aadhyavata but influence of such high socioeconomic status of the patient doesn’t

play a role in manifestation of Kushta.

RAKTAVRUTA VATA

In Raktavruta Vata the symptoms are generally attributed to Twacha,

Rakta and Mamsa. So undoubtedly Vatarakta has to be differentiated from this state.

The Nidana mentioned for Samanya Vatavyadhi holds good for the Raktavruta Vata

too but Vatarakta has got distinct Nidana. In case of Samprapti Prakupita Vata

Dosha brings about the illness whereas in Vatarakta both Vata and Rakta are equally

involved. The major disparity in symptomatology is that in Raktavruta Vata the

Lakshana related to Avruta Dosha i.e., Prakupita Vata Dosha Lakshana are absent.

And symptoms related to Rakta Dhatu are only seen but in case of

Vatarakta symptoms related to both Vata and Rakta Dhatu are more evident. As

explained by Acharya Sushruta where he has mentioned that the Lakshana like Suchi

Bhedanavatvedana, Pittaja Vikara and Prasupti etc belongs to Raktavruta Vata

indicates different type of pain or sensation experienced by the patient. And there will

not be any symptom like of Sandhi Shoola which is more evident in Vatarakta.

Purvaroopa in Raktavruta Vata are Avyakta or else minimally visible.Throughout the



course of disease the joints are not involved. Based on these criteria Vatarakta and

Raktavruta Vata are well differentiated.

ASRIGGATA VATA:

In this condition the Lakshana which are mentioned as Teevra Ruja, Vaivarnyata and

Aruchi etc are generalised in nature where as in Vatarakta involvement of Sandhi is

must along with Twacha. There is imperceptibility of Purvaroopa in this context

which is quite opposite to that of Vatarakta. Hence one can differentiate this condition

from Vatarakta.

KROSTHUKA SHEERSHA179:

As described by Acharya Sushruta the disease entity where in the

involvement of Prakupita Vata Dosha associated with Dushita Rakta Dhatu causing

Shotha at the site of Janu Pradesh which will be characterised by severe pain is called

Krosthukasheersha. Here author has given the simile that the Shotha resembles to that

of head of Krosthuka(fox). Specific Nidana are not mentioned in manifestation of the

Krosthukasheersha. But Samanya Vatavyadhi Nidana can be considered as causative

factors. Purvaroopa of the illness are not visible. In this case disease is limited to

Janu Sandhi alone and in Vatarakta the disease mainly starts with minor joints and

later may involve other major joints. Hence specific Nidana, Purvaroopa, Roopa will

help to differentiate the condition from Vatarakta.



PADADAHA180:

As explained by Acharya Madhavakara in the context of Vatavyadhi, when

a person indulges in Ati Achankramana (excessive walking), this leads to Prakopa of

Vata and Pitta Dosha along with vitiation of Rakta Dhatu and facilitates in

manifesting symptoms like Padadaha which is also a notable feature in Vatarakta.

But absence of Vaivarnyata in Padadaha distinguishes the illness from Vatarakta.



The main pathology behind gout is due to increased urate production. Diet

contributes to the serum urate in proportion to its purine content. Strict restriction of

purine intake reduces the mean serum urate level by about 1mg/dL and urinary uric

acid excretion by 200mg/dl. Foods high in nucleic acid content include liver, sweet

bread , kidney and anchovy

Gout is a true crystal deposition disease,and is defined as the pathological

reaction of the joint or periarticular tissues to the presence of monosodium urate

monohydrate(MSU) crystals.MSU crystals preferentially deposit in peripheral

connective tissues in and around synovial joints,initially favouring lower rather than

upper limbs and especially targeting the first MTP joint and small joints of feet and

hands.As the crystal deposits slowly increase and enlarge,there is progressive

involvement of more proximal sites and the potential for cartilage and bone damage

with secondary OA. MSU crystals take months or years to grow to a detectable

size,implying a long asymptomatic phase.

Epidemiology

The prevalence of gout varies between populations but is approximately 1-

2%,with a strong male predominance (>5:1).It is the most common inflammatory

arthritis in men and in older women.Prevalence increases with increasing serum uric

acid(SUA) and with age.

SUA levels are distributed in the community as a continuous variable.Levels

are higher in men than women ,they rise from the age of 20 in men and after the

menopause in women(highest in New Zealand Maoris).

GOUTY ARTHRITIS



AETIOLOGY181

Primary Gout

About one-third of the body uric acid pool is derived from dietary sources and

two-thirds from endogenous purine metabolism.The concentration of uric acid in

body fluids depends on the balance between its synthesis and elimination by the

kidneys(two-thirds) and gut(one-third)

Flow Chart No-3

(=600-700mg/day)

(=300-600mg/day)

2/3rd 1/3rd

Renal excretion Intestinal uricolysis

(=600mg/day) (=300mg/day)

De novo purine

synthesis

Dietary

Purines

Purine

Nucleotides

Tissue

Nucleotides

Purine

Bases

Uric Acid

Pool

=1200mg



Increased production of uric acid

Increased purine synthesis de novo

Hypoxanthine guanine phosphoribosyl transferase(HGPRT)deficiency

Phosphoribosyl pyrophosphate(PRPP)synthetase overactivity

Glucose-6-phosphatase deficiency

Idiopathic

Increased turnover of purines

Myeloproliferative disorders

Lymphoproliferative disorders

Cancer chemotherapy

Haemolysis

Decreased renal excreation of uric acid

Renal failure

Inherited isolated renal tubular defect(under excreators)

Lead poisoning

Alcohol

Drugs-Diuretics,low dose aspirin,pyrazinamide,cyclosporine,levodopa

Lactic acidosis

Hyperparathyroidism

Myxoedema

Down’s syndrome

Unidentified inherited defects



Secondary Gout

Secondary gout results from hyperuricaemia due to renal impairment or chronic

diuretic use.In diuretic –induced gout,nodal generalised OA is a further risk

factor,especially in elderly women.

CLINICAL FEATURES

Acute Gout

Extremely rapid onset,reaching maximum severity in just 2-6 hours,often

waking the patient in the early morning

Severe pain, often described as the worst pain ever

Extreme tenderness:the patient is unable to wear a socks or to let bedding rest

on the joint

Marked swelling with overlying red,shiny skin

Self- limiting over 5-14days,with complete return to normality.

During attack the joint shows signs of marked synovitis but also

periarticular swelling and erythema.there may be accompanying fever,malaise

and even confusion,especially if large joint such as the knee is involved.As the

attack subsides,pruritus and desquamation of overlying skin are common.

Recurrent and Chronic Gout

In most,however,a second attack occurs within 1year and the frequency

of attacks gradually increases with time. Later attacks are more likely to involve

several joints and be more severe.

Eventually, continued MSU deposition causes joint damage and chronic pain.

Occasionally there may be severe deformity and marked functional

impairment,especially of feet and hands.As with tophi,asymmetry is

characteristic.



Chronic Tophaceous Gout

Large MSU crystal deposits produce irregular firm nodules(tophi) around

extensor surfaces of fingers,hands ,forearm,elbows,Achilles tendons and

sometimes the helix of the ear.

The white colour of MSU crystals may be evident and permits distinction

from rheumatoid nodules.Large nodules may ulcerate,discharging white gritty

material and associating with local inflammation(erythema,pus)

Other features

Gout may be associated with increased incidence of hypertension and

cardiovascular disorders.

On the other hand,hypertension is also a risk factor for development of gout.

Serum uric acid levels are elevated.However,during an acute attack serum uric

acid may be normal in 50% cases.

Synovial fluid examination by compensated polarised microscopy can

demonstrate urate crystals.They are seen as slender needle-shaped,negatively

birefringent structures.

Plain radiographs are helpful to differentiate chronic tophaceous gout from

RA.

Erosions in Gout are characteristically punched out with overhanging

sclerotic margins and are situated away from joint

margins,sometimes outside the joint capsule.

RA causes marginal erosions,always within the limits of the

jointcapsule.Periarticular osteopenia is absent and joint space is

preserved in Gout.



Risk Factors for Gout

Diuretic use

Alcohol intake -Beer

-Spirits

- Wine

Hypertension

Body mass index

Sweetened beverage consumption

Fructose Intake

Sea food consumption

Meat consumption

Dairy product consumption

Vitamin C intake

Coffee consumption

Bakery products like bread,cakes,pastries etc

Green leafy vegetables like spinach,cabbage,broccoli etc

Prophylaxis

Avoidance of alcohol.

Avoidance of meat and seafood.However ,consumption of oatmeal and

purine rich vegetables (for example-

peas,beans,lentils,spinach,mushrooms and cauliflower)does not produce

increased risk of gout.

Controlled weight reduction in obese patients.

Avoiding use of thiazides or loop diuretics.



SERUM URIC ACID

Uric acid is the end product of purine metabolism. Uric acid is excreted to a

larger extent by the kidneys and to a smaller degree in the intestinal tract by microbial

degradation.In kidney uric acid is free filtered by the glomerulus,partially reabsorbed

and partially excreated in the proximal convoluted tubules.Uric acid is sparingly

soluble in water. Hyperuricemia is defined as a plasma (or serum) urate concentration

>405 mol/L (6.8 mg/dL). Hyperuricemia can result from increased production or

decreased excretion of uric acid or from a combination of the two processes.Increased

levels are found in Gouty Arthritis,impaired renal functions and starvation.Decreased

levels are found in Wilson’s disease,Fanconis syndrome and yellow atrophy of the

liver. In gouty arthritis uric acid level is usually between 6.5 and 12mg/dl, though

higher values have been reported. The determination has some diagnostic value,

because it helps to differentiate gouty from non-gouty arthritis.

CLINICAL RELEVANCE182

Factors Affecting Serum Uric Acid levels

Increased Production,Raised Serum Levels

Idiopathic mechanisms associated with primary gout

Excessive dietary purines(organ meats,legumes etc.)

Cytolytic treatment of malignancies,especially leukemias and lymphomas

Polycythemia

Myeloid metaplasia

Psoriasis

Sickle cell anaemia.



Decreased Excretion,Raised Serum Levels

Alcohol ingestion

Thiazide diuretics

Lactic acidosis

Ketoacidosis especially diabetes or starvation

Renal failure due to any cause.

Increased Excretion,Lowered Serum Levels

Probenecid,slphinpyrazone,aspirin doses above 4 gm/day

Corticosteroids and ACTH

Cumarin anticoagulants.

Estogens

Decreased Production,Lowered Serum Levels

Allopurinol

METHODOLOGY


OBJECTIVES OF THE STUDY:




arthritis.


MATERIALS AND METHODS:

SOURCE OF DATA:

Patients attending both OPD and IPD of Jayachamarajendra Institute of Indian

Medicine and Hospital, Bengaluru will be screened for study.

METHOD OF COLLECTION OF DATA:

A minimum of 40 patients who are fulfilling the criteria for diagnosis and

inclusion will be selected for the study randomly irrespective of sex, religion,

educational, professional background and economic status.

A special case proforma will be prepared with details of history taking, physical

signs and symptoms as mentioned in our classics and allied science.

The study will be done using a structured questionnaire which will have the

factors covering ahara, vihara, family history, occupation etc.

INCLUSION CRITERIA

Patients having classical symptoms of vatarakta as told under diagnostic

criteria.

METHODOLOGY


Patients having elevated serum uric acid level more than 6mg/dl (In male) and

7mg/dl(In female).

Age group between 20-70yrs.

EXCLUSION CRITERIA:

Systemic disorders : Patient’s with Carcinomatous changes, Cardiovascular

diseases and pregnancy.

DIAGNOSTIC CRITERIA :

The diagnosis of the disease is mainly based on the signs and symptoms and

investigations as fallows

Intense joint pain in Hasta, Pada, Mulagatasandhi(Metatarsophalangeal joint).

Shwayathu(Inflammation).

Krishnatva,shyavatva,tamrata(Skin of the afflicted area shows darkish red or

coppery discolouration).

Sandhishaithilyam(lingering discomfort).

Sparshaasahatva(Tenderness)

Brushosmata(AtyadhikaUshnata)

Restricted movements of effected joints(limited range of motion)

Investigations : Patient with uric Acid level more than 6 mg/dl (In male),more

than 7mg/dl(In female)

STUDY DESIGN

It will be an observational and diagnostic study of patients suffering from

lakshana of vatarakta in relation to Gouty Arthritis.

METHODOLOGY


DURATION OF STUDY

Since this is observational study, patients will be kept under observation till

the evaluation is done.

FOLLOW UP

Study doesn’t require follow up as it is an observational study.

INVESTIGATION

Investigation-Serum uric acid

OBSERVATIONS AND RESULTS



Table No.18 : Distribution of patients based on Age

AGE NO. OF PATIENTS PERCENTAGE 20-30 7 17.5% 31-40 10 25% 41-50 12 30% 51-60 6 15% 61-70 5 12.5%

Patients selected for the study were in the age group between 20-70yrs,In present

study maximum no. of patients i.e 30% belonged to the age group of 41-50yrs

followed by 25% belonged to the age group of 31-40yrs,17.5% patients belonged to

20-30yrs,15% patients belonged to 51-60yrs and 12.5% patients belonged to 61-

70yrs.

Table No.19 :Distribution of patients based on Sex

SEX NO. OF PATIENTS PERCENTAGE Male 32 80% Female 08 20% Total 40 100%

In present study out of 40 patients 80% patients are male and 20% patients are female

Table No.20 :Distribution of patients based on Religion

RELIGION NO.OF PATIENTS PERCENTAGE Hindu 24 60% Muslim 10 25% Chritian 06 15% Total 40 100%

In present study Maximum no. of patients i.e 60% belonge to Hindu religion

followed by 25% patients belonged to Muslim community and 15% of them belonged

to Christian community.



Table No.21 :Distribution of patients based on Education

EDUCATION NO. OF PATIENTS PERCENTAGE Uneducated 07 17.5% Primary 04 10% High school 05 12.5% Post High school 06 15% Graduate 18 45% Total 40 100%

In present study 45% of patients were Graduate ,17.5% were Uneducated,15%

patients are Post high School,12.5% patients are High School education and 10% of

patients are Primary education.

Table No.22 :Distribution of patients based on Marital Status

MARITAL STATUS NO. OF PATIENTS PERCENTAGE Married 33 82.5% Unmarried 07 17.5% Total 40 100

In present study 82.5% patients are Married and 17.5% patients are Unmarried.

Table No.23 :Distribution of patients based on Socio-Economic Status

SOCIO-ECONOMIC STATUS

NO.OF PATIENTS PERCENTAGE

Upper 14 35% Middle 12 30% Upper Middle 07 17.5% Lower Middle 02 5% Lower 05 12.5% Total 40 100%

In present study maximum patients i.e 35% were from Upper class,30% are

Middle class,17.5% patients are from Upper Middle class,12.5% patients are from

Lower class and 5% patients are from Lower Middle class.



Table No.24 :Distribution of patients based on Poorva Vyadhi Vruttanta

POORVA VYADHI NO.OF PATIENTS PERCENTAGE Diabetis Mellitus 15 37.5% Hypertension 12 30% Hypothyroidism 05 12.5% Renal 02 2% Not associated 11 27.5%

In present study 37.5% patients are having Diabetis Mellitus,30% patients are

having Hypertension,27.5% patients are not associated with any othe poorva

vyadhi,12.5% patients are suffering from Hypothyrodism and 2% patients are

suffering from Renal diseases.

Table No.25 :Distribution of patients based on Occupation

NATURE OF WORK NO.OF PATIENTS PERCENTAGE Manual 02 05% Sedentary 11 27.5% Labour 04 10% Sitting 09 22.5% Travelling 08 20% Housewife 06 15% Total 40 100%

In present study maximum no. of patients i.e 27.5% were Sedentary,22.5%

Patients were sitting,20% patients were comes under Travelling,15% patients are

Housewife,10% patients are Labour and 5% patients are doing Manual work.

Table No.26:Distribution of patients based on Ahara

AHARA NO.OF PATIENTS PERCENTAGE Vegetarian 06 15% Mix 34 85%

In present study Maximum no. of patients i.e 85% are Mix type of diet and

15% are Vegetarian type of diet.



Table No.27 :Distribution of patients based on Agni

AGNI NO. OF PATIENTS PERCENTAGE Samagni 25 62.5% Vishamagni 05 12.5% Teekshnagni 07 17.5% Mandagni 03 7.5%

In present study Maximum no.of patients i.e 62.5% are Samagni,17.5%

patients are Teekshnagni,12.5% patients are Vishamagni and 7.5% patients are

Mandagni.

Table No.28 :Distribution of patients based on Kosta

KOSTA NO. OF PATIENTS PERCENTAGE Mrudu 06 15% Madyama 24 60% Krura 10 25%

In present study maximum no.of patients i.e 60% were having Madyama

kosta,25% patients were Krura kosta and 15% patients are Mrudu kosta.

Table No.29:Distribution of patients based on Ahara Abhyavarana Shakti

AHARA ABHYAVARANA SHAKTI


Avara 10 25% Madyama 22 55% Pravara 08 20% Total 40 100%

In present study maximum no. of patients i.e 55% were Madyama Ahara

Abhyavarana shakti,25% patients were Avara Ahara Abhyavarana shakti and 20%

patients were Pravara Ahara Abhyavara shakti.



Table No.30 :Distribution of patients based on Ahara Jarana shakti

AHARA JARANA SHAKTI


Avara 15 37.5% Madyama 20 50% Pravara 05 12.5% Total 40 100%

In present study Maximum no. of patients i.e 50% were having Madyama

Ahara jarana shakti,37.5% patients are Avara type of Ahara jarana shakti and 12.5%

patients are Pravara type of Ahara jarana shakti.

Table No.31 :Distribution of patients based on Nidra

NIDRA NO.OF PATIENTS PERCENTAGE Sound 16 40% Disturbed 24 60%

Out of 40 patients 60% 0f patients had Disturbed sleep and 40% of patients had

sound sleep.

Table No.32:Distribution of patients based on Mala

MALA NO.OF PATIENTS PERCENTAGE Regular 10 25% Irregular 19 47.5% Constipation 11 27.5%

Above table shows that 47.5% patients had Irregular type of bowel

habbit,27.5% patients had constipation and 25% patients had Regular bowel habbit.



Table No.33 :Distribution of patients based on Mutra

MUTRA NO.OF PATIENTS PERCENTAGE Normal 26 65% Polyuria 12 30% Dysuria 02 05% Oliguria 00 00

Out of 40 patients 65% patients were found to have Normal urination followed

by 30% of patients had Polyuria and 5% patients are having Oliguria.

Table No.34 :Distribution of patients based on Vyasana

VYASANA NO.OF PATIENTS PERCENTAGE Smoking 28 70% Alcohol 25 62.5% Smoking+Alcohol 15 37.5% Tobacco 10 25% Snuff 04 10% Tea 14 35% Coffee 18 45%

Above table reveals that maximum i.e 70% patients were having habbit of

smoking followed by 62.5% patients were having habbit of Alcohol intake and

37.5% patients are having smoking and Alcohol intake habbit,45% patients are having

habbit of coffee intake 35% patients are having habbit of Tea intake and 10% patients

are having habbit of Snuff.

Table No.35 :Distribution of patients based on Desha

DESHA NO.OF PATIENTS PERCENTAGE Jangala 00 00 Anoopa 00 00 Sadharana 40 100%

Among 40 patients 100% of patients are from Sadharana Desha,as Bangalore is

comes under Sadharana Desha.



Table No.36 :Distribution of patients based on Family History

FAMILY HISTORY NO.OF PATIENTS PERCENTAGE Present 00 00 Absent 40 100%

All patients i.e 100% of patients are not having any Familial history.

Table No.37 :Distribution of patients based on Prakruti

PRAKRUTI NO.OF PATIENTS PERCENTAGE Vatapitta 23 57.5% Pittakapha 14 35% Vatakapha 03 7.5% Total 40 100%

Incidence studied in terms of prakruti showed that 57.5% patients are

vatapitta prakruti followed by 35% patients belonged to pittakapha prakruti and 7.5%

patients are belonged to vatakapha prakruti.

Table No.38 :Distribution of patients based on Sara

SARA NO.OF PATIENTS PERCENTAGE Avara 13 32.5% Madyama 25 62.5% Pravara 02 05% Total 40 100%

Incidence related to Sara showed that 62.5% patients are comes under

Madyama Sara,32.5% patients are comes under Avara Sara and 5% patients are

Pravara Sara.

Table No.39:Distribution of patients based on Samhanana

SAMHANANA NO.OF PATIENTS PERCENTAGE Avara 04 10% Madyama 26 65% Pravara 10 25% Total 40 100%



Incidence related to Samhanana showed that maximum no. of patients i.e

65% patients are having Madyama type of Samhanana and 25% patients are having

Pravara Samhanana followed by 10% patients are avara samhanana.

Table No.40 :Distribution of patients based on Satwa

SATWA NO.OF PATIENTS PERCENTAGE Avara 06 15% Madyama 34 85% Pravara 00 00 Total 40 100%

Incidence related to Satwa reveals that maximum no.of patents i.e 85%

patients are having Madyama Satwa followed by 15% patients are having Avara

Satwa.

Table No.41 :Distribution of patients based on Satmya

SATMYA NO.OF PATIENTS PERCENTAGE Avara 05 12.5% Madyama 35 87.5% Pravara 00 00 Total 40 100%

Incidence related to Satmya reveals that maximum no. of patients i.e 87.5%

patients are Madyama Satmya and 12.5% patients are having Avara Satmya.

Table No.42:Distribution of patients based on Vyayama Shakti

VYAYAMA SHAKTI NO.OF PATIENTS PERCENTAGE Avara 06 15% Madyama 31 77.5% Pravara 03 7.5% Total 40 100%

In present study 77.5% patients are having Madyama Vyayama shakti ,15%

patients are having Avara Vyayama shakti and 7.5% patients are having Pravara

Vyayama shakti.



Table No.43:Distribution of patients based on Manasika Nidana

MANASIKA VRITTANTA NO. OF PATIENTS PERCENTAGE Kama 00 00 Krodha 18 45% Chinta 25 62.5% Bhaya 08 20% Shoka 20 50%

In this study it was found that maximum no. of patients i.e 62.5% patients are

having Chinta,50% patients are having Shoka,45% patients are having Krodha,20%

patients are having Bhaya.

Table No.44:Distribution of patients based on Ahara Abhyasa

AHARA ABHYASA NO. OF PATIENTS PERCENTAGE Anashana 02 5% Viruddhashana 10 25% Vishamashana 25 62.5% Adyashana 03 7.5%

In this study maximum no. of patients i.e 62.5% are doing

Vishamashana,25% are Viruddhasana,7.5% are Adyashana and 5% patients are doing

Anashana.

Table No.45 :Distribution of patients based on Aharaja Nidana

AHARA NO. OF PATIENTS PERCENTAGE RASA Lavana 20 50% Amla 18 45% Katu 24 60% Kshara 05 12.5% GUNA Ushna 19 47.5% Snigdha 25 62% DHANYA Kulattha 06 15%

Masha 34 85% Nishpava 00 00 HARITA VARGA Moolaka 28 70% Green leafy

vegetables 35 87.5%



MAMSA Ambuja 32 80% Anupa 15 37.5% Shuska 20 50% GORASA Dadhi 36 90%

In this study it was found that 90% patients are taking Dadhi,87.5% patients

are taking Green leafy vegetables,85% patients are taking Masha,80% patients are

taking Ambuja Mamsa,70% patients are taking Mulaka,62% patients are taking

Snigdha Guna Ahara,60% patients are taking Katu Rasa Pradhana Ahara,50%

patients are taking Sushka Mamsa and Lavana Rasa Pradhana Ahara, 47.5% patients

are taking Ushna Guna Ahara,45% patients are taking Amla Rasa Pradhana

Ahara,37.5% patients are taking Anupa Mamsa,15% patients are taking kulattha and

12.5% patients are taking Ksharayukta Ahara.

Table No.46 :Distribution of patients based on Viharaja Nidana

VIHARA NO.OF PATIENTS PERCENTAGE Divaswapna 22 55% Veganigraha 15 37.5% Hasti,Ashwa,Ustra yana(Travelling in two wheeler)

29 72.5%

Ambukrida plavana 02 5%

In this present study 72.5% patients are travelling in two wheeler,55% patients

are doing Diwaswapna,37.5% patients are doing Veganigraha,5% patients are

Ambukrida Plavana.

Table No.47:Distribution of patients based on Purvarupa

LAKSHANA NO.OF PATIENTS PERCENTAGE Atisweda 18 45% Asweda 10 25% Karshnyata 23 57.5% Kshate Atiruk 09 22.5%

Sandhi Shaithilya 20 50% Aalasya 15 37.5%



Pidaka 08 20% Kandu 14 35% Supti 10 25% Gouravata 23 57.5% Sandhi Ruk 28 70% Vaivarnya 32 80% Daha 12 30% Shopa 30 75% Shrama 16 40%

In present study in Purvarupa Avasta 80% are having Vaivarnya,75% are

having shopa,70% are having Sandhi Ruk,57.5% are having Gouravata and

Karshnyata,45% are having Atisweda,40% are having Shrama,37.5% are having

Alasya,35% are having Kandu,30% are having Daha,25% are having Asweda and

Supti,22.5% are having Kshate Atiruk and 20% are having Pidaka.

Table No.48 :Distribution of patients based on Utthana Vatarakta Lakshana

LAKSHANA NO.OF PATIENTS PERCENTAGE Kandu 14 35% Daha 07 17.5% Ruk 26 65% Aayama 05 12.5% Toda 15 37.5% Spurana 08 20% Akunchana 05 12.5% Shyavatwak 12 30% Raktatwak 09 22.5%

In this Avastha 65 % each had Ruk, 37.5% had Toda and 35% had Kandu

,30% each had Shyavatwak, 22.5% each had Rakta Twak , 20% each had Sphurana

,17.5% each had Daha, 12.5% each had Aayama and Akunchana .



Table No.49:Distribution of patients based on Gambheera Vatarakta Lakshana

LAKSHANA NO.OF PATIENTS PERCENTAGE Swayatu 10 25% Stabdhata 02 5% Syavatwak 12 30% Tamratwak 11 27.5% Toda 15 37.5% Daha 12 30% Spurana 08 20% Paka 05 12.5% Ruja 26 65% Vidaha 12 30% Khanjatwa 00 00 Pangutwa 00 00

In Gambheera Avastha of the Vyadhi, 65% each had Ruja , 37.5% each had

Toda,30% had Shyava Twak, Vidaha,27.5% had Tamra Twak ,25% had Swayatu

,20% had Spurana,12.5% had Paka and 5% had Stabdhata .

Table No.50:Distribution of patients based on Vatarakta Upadrava

LAKSHANA NO.OF PATIENTS PERCENTAGE Aswapna 12 30% Arochaka 08 20% Shwasa 03 7.5% Mamsakotha 00 00 Shirograha 04 10% Murcha 00 00 Ruk 07 17.5% Trishna 10 25% Jwara 05 12.5% Pangulya 00 00 Angulivakrata 07 17.5% Marmagraha 00 00 Arbuda 00 00 Sankocha 09 22.5%

In Upadrava avastha 30% presented with Aswapna, 25% with Trishna, 22.5%

with Sankocha,20% with Arochaka, 17.5% each with Ruk and Angulivakrata,

12.5%% each with Jwara and 10% with Shirograha and 7.5% with Shwasa



Table No.51:Distribution of patients based on Serum Uric Acid Levels

URIC ACID LEVEL NO. OF PATIENTS PERCENTAGE 6-8mg/dl 08 20% 8-9mg/dl 05 12.5% 9-10mg/dl 17 42.5% >10mg/dl 10 25%

In this present study 42.5% patients has 9-10mg/dl serum uric acid,25% has

>10mg/dl,20% has 6-8mg/dl and 12.5% has 8-9mg/dl.



GRAPHS

Graph No.1-Showing Incidence of Age

Graph No.2- Showing Incidence of sex

Graph No.3-Showing Incidence of Religion

0

2

4

6

8

10

12

20-30 31-40 41-50 51-60 61-70

710

12

6 5

AGE

NO. OF PATIENTS

0

10

20

30

40

Male Female Total

32

8

40

SEX

NO. OF PATIENTS

0

10

20

30

40

Hindu Muslim Chritian Total

2410 6

40

RELIGION

NO.OF PATIENTS



Graph No.4-Showing Incidence of Education

Graph No.5-Showing Incidence of Marital Status

7

4

5

6

18

EDUCATION

Uneducated

Primary

High school

Post High school

Graduate

33

7

40

MARITAL STATUS

Married

Unmarried

Total



Graph No.6-Showing Incidence of Socio-Economic Status

Graph No.7-Showing Incidence of Purva Vyadhi Vruttanta

0

10

20

30

40

Upper Middle UpperMiddle

LowerMiddle

Lower Total

14 12 7 2 5

40

SOCIO-ECONOMIC STATUS

NO.OF PATIENTS

02468

10121416

1512

52

11

PURVA VYADHI VRUTTANTA

NO.OF PATIENTS



Graph No.8-Showing Incidence of Nature of Work

Graph No.9-Showing Incidence of Ahara

Graph No.10-Showing Incidence of Agni

2 114

9

8

6

40

NATURE OF WORK

Manual

Sedentary

Labour

Sitting

Travelling

Housewife

Total

0

10

20

30

40

Vegetarian Mix

6

34

AHARA

NO.OF PATIENTS

05

10152025

25

5 7 3

AGNI

NO. OF PATIENTS



Graph No.11-Showing Incidence of Kosta

Graph No.12-Showing Incidence of Ahara Abhyavarana Shakti

Graph No.13- Showing Incidence of Ahara Jarana Shakti

0

10

20

30

40

Avara Madyama Pravara Total

1022

8

40

AHARA ABHYAVARANA SHAKTI

NO.OF PATIENTS

0

5

10

15

20

25

Mrudu Madyama Krura

6

24

10

KOSTA

NO. OF PATIENTS

15

20

5

40

AHARA JARANA SHAKTI

Avara

Madyama

Pravara

Total



Graph No.14-Showing Incidence of Nidra

Graph No.15-Showing Incidence of Mala

Graph No.16-Showing Incidence of Mutra

16

24

NIDRA

Sound

Disturbed

0

5

10

15

20

10

1911

MALA

NO.OF PATIENTS

26

12

2 0

MUTRA

Normal

Polyuria

Dysuria

Oliguria



Graph No.17-Showing Incidence of Vyasana

Graph No.18-Showing Incidence of Desha

05

1015202530

28 2515 10

414 18

VYASANA

NO.OF PATIENTS

0

10

20

30

40

Jangala Anoopa Sadharana

40

DESHA

NO.OF PATIENTS



Graph No.19-Showing Incidence of Family History

Graph No.20-Showing Incidence of Prakruti

Graph No.21-Showing Incidence of Sara

0

10

20

30

40

Present Absent

40

FAMILY HISTORY

NO.OF PATIENTS

010203040

23 143

40

PRAKRUTI

NO.OF PATIENTS

0

10

20

30

40


1325

2

40

SARA

NO.OF PATIENTS



Graph No.22-Showing Incidence of Samhanana

Graph No.23-Showing Incidence of Satwa

Graph No.24-Showing Incidence of Satmya

0

10

20

30

40


4

26

10

40

SAMHANANA

NO.OF PATIENTS

0

10

20

30

40

6

34

0

40

SATWA

NO.OF PATIENTS

0

10

20

30

40


5

35

0

40

SATMYA

NO.OF PATIENTS



Graph No.25-Showing Incidence of Vyayama Shakti

Graph No.26-Showing Incidence of Manasika Vrittanta

0

18

25

8

20

MANASIKA VRITTANTA

Kama

Krodha

Chinta

Bhaya

Shoka

0

10

20

30

40


6

31

3

40

VYAYAMA SHAKTI

NO.OF PATIENTS



Graph No.27-Showing Incidence of Aharaja Nidana(1)

Graph No.28-Showing Incidence of Aharaja Nidana(2)

0

5

10

15

20

25

30

35

20 1824

5

1925

6

34

0

AHARAJA NIDANA(1)

NO. OF PATIENTS

05

10152025303540

28 35 3215 20

36

AHARAJA NIDANA(2)

NO. OF PATIENTS



Graph No.29-Showing Incidence of Viharaja Nidana

Graph No.30-Showing Incidence of Purvarupa(1)

22

15

29

2

VIHARAJA NIDANA

Divaswapna

Veganigraha

Hasti,Ashwa,Ustrayana(Travelling in twowheeler)

Ambukrida plavana

18

10

23

920

15

8 14

PURVARUPA(1)

Atisweda

Asweda

Karshnyata

Kshate Atiruk

Sandhi Shaithilya

Aalasya

Pidaka



Graph No.31-Showing Incidence of Purvarupa(2)

Graph No.32-Showing Incidence of Utthana Vatarakta Lakshana

Graph No.33-Showing Incidence of Gambheera Vatarakta Lakshana

1023

28

32

12

30

16

PURVARUPA(2)

Supti

Gouravata

Sandhi Ruk

Vaivarnya

Daha

Shopa

Shrama

0

5

10

15

20

25

30

147

26

5

158 5

12 9

UTTHANA VATARAKTA LAKSHANA

NO.OF PATIENTS

102

12

11

15128

5

2612

0 0

GAMBHEERA VATARAKTA LAKSHANA

Swayatu

Stabdha

Syavatwak

Tamratwak

Toda

Daha

Spurana



Graph No.34- Showing Incidence of Upadrava(1)

Graph No.35 –Showing Incidence of Upadrava(2)

02468

1012

128

30

40

7

UPADRAVA(1)

NO.OF PATIENTS

0

2

4

6

8

10

10

5

0

6

0 0

9

UPADRAVA(2)

NO.OF PATIENTS



Graph No.36-Showing Incidence of Ahara Abhyasa

Graph N0.37-Showing Incidence of Serum Uric Acid Level

2

10

25

3

AHARA ABHYASA

Anashana

Viruddhasana

Vishamashana

Addyasana

8

5

17

10

SERUM URIC ACID LEVEL

6-8mg/dl

8-9mg/dl

9-10mg/dl

>10mg/dl

DISCUSSION


Discussion improves the knowledge and discussion on the basis of the

Shastra, becomes the root of establishment of the concept. Hence the discussion and

interpretation of the research study becomes an essential and important thing for

research scholars to put their study on the scientific platform and then only it can be

granted to be considered as a true study. Each and every study, it may be either

conceptual or clinical, is always required to be proved on the basis of logic, correct

reasoning, supported by achieved practical data as Pramana and then only it can be

taken as a principal of that science. Following and fulfilling the same requirement,

here also an attempt has been made to critically discuss and interpret the same.

Among the diseases which are enlisted in Vatavyadhi, Vatarakta has got

prime importance in current clinical practice due to its high prevalence in elderly,

progressive nature. Causative factors enlisted in the manifestation of the disease bring

severe morbidity of Vata Dosha and Rakta Dhatu. Obstruction of Raktamarga or

Raktavaha Srotas is leading pathology involved in appearance of signs and symptoms

of the disease.

Vatarakta is not only a disease entity but a syndrome where multiple system

involvement is more evident. The disease which can be considered under the broad

heading of Vatarakta are musculoskeletal diseases like Gouty Arthritis ,connective

tissue disorders like Scleroderma, Systemic Lupus Erythematosus, , and vascular

diseases like Peripheral Vascular Diseases, varicose vein.

DISCUSSION ON CONCEPTUAL STUDY:

By studying all the literature from the Veda Kala the ancient written literature

available, illustrate about the individual mentioning of the Vata and Rakta but the

DISCUSSION

DISCUSSION


disease as such of Vatarakta is not available. As the ages pass on up-to-the-minute

diseases were added on, this can be witnessed by the literature where the Vatarakta

disease added in the period of Purana Kala with the explanation about the details of

the Vyadhi along with its treatment.

Samhita’s are considered as the important part of Ayurveda where the

diseases are explained in detail with elaboration from its origin to the conclusion.

Sangraha period with the same continuation from the Samhita added with the

treatment aspect little more, following same the later authors enclosed explanation of

the disease.

Two distinct etiopathogenesis may cause the illness Vatarakta. Individual

etiological factors of Vatadosha as well as Rakta Dhatu may culminate in the

development of Vatarakta and is the usual variety of Vatarakta. Where in the morbid

Vata Dosha as well as vitiated Rakta Dhatu leads to the Raktamargavarana and is the

principal pathology of the Vatarakta. In other variety of Vatarakta, to start on there is

no role of etiological factors of either Vata Dosha or Rakta Dhatu. Contrary to this

the etiological factors which grounds the aggravation of Kapha Dosha and vitiation of

Medo Dhatu ends up in accumulation of Kapha Dosha and Medo Dhatu in the

Raktamarga there by contributing the principal pathology of Raktamargavarana. The

similar qualities of Kapha Dosha and Medo Dhatu speed up the pathogenesis as two

factors support mutually.To be precise, the santarpana category of the etiological

factors causes the morbidity of kapha dosha and medho dhatu and these in turn

accumulate in Raktamarga leading to the provocation of vata dosha and finally

manifesting as vatarakta. Evidently in this variety of vatarakta all the santarpana

category of causes, similar to the aetiology of sthoulya and prameha take the leading

role in the causation of the illness.

DISCUSSION


The movement of Vata Dosha is inhibited by the unique pathology of

Raktamargavarana in Vatarakta. This in turn initially manifest with certain clinical

signs and symptoms in the form of Purvaroopa. Alteration in the colour and texture

of the skin in the affected part, alteration of sweating, alteration in the sensation,

different forms of pain and similar other manifestations are listed as Purvaroopa.

Depending upon the superficial or deeper Dhatu involved, the Vatarakta is

of two types. When the pathogenesis of Vatarakta is limited to Twak and Mamsa

Dhatu it is regarded as Utthana (Anavagada) Vatarakta. Involvement of deeper Dhatu

like Asthi ,Majja and Sandhi signifies the Gambheera (Avagada) Vatarakta. A third

variety of Ubhayashrita Vatarakta is also mentioned in literature where in both the

superficial as well as deeper Dhatu is affected. Vatarakta is a progressive disorder and

initially the illness may be limited to either superficial Dhatu or deeper Dhatu alone,

but in the later stages the Uttana Vatarakta progresses to deeper Dhatu. Similarly the

Gambheera Vatarakta may involve the superficial Dhatu in the later stages. Hence in

the later stages the Vatarakta develops as Ubhayashrita Vatarakta. With the support

of Rogamarga further rmore categorization of Vatarakta can be done. Vatarakta

Lakshana pertaining to Twak, Raktadi Dhatu falls under the category of Bahya Roga

Marga. As well as when Lakshana related with Sandhi, Asthi and Marma Pradesha

the disease comes in the group of Madhyama Rogamarga. The symptoms like Kandu,

Daha, Ruk, Aayama, Toda, Sphurana, Akunchana, Shyava/ Rakta/ Tamra Twak and

other such symptoms probably limited to the Twak indicates Utthana Vatarakta.

Persistent hard swelling of the affected part, suppurations, involvement of

Sandhi, Asthi and Majja, deformities like Vakrata, Khanja and Pangu all these point

towards Gambheera Vatarakta. Presence of symptoms indicative of both Utthana as

well as Gambheera vatarakta signifies the Ubhayashrita vatarakta.

DISCUSSION


Clinical varieties of Vatarakta are also elaborated according to the

association of morbid Dosha in the primary pathology of Vata and Rakta and are

named as Vatadhika Vatarakta, Pittadhika Vatarakta, Kaphadhika Vatarakta and

Raktadhika Vatarakta.

Even though Morbidity of the Vata Dosha is the basic pathology of the illness but

involvement of Rakta Dhatu is the deciding factor for Upashaya and Anupashaya.

Varied response to Sheeta- Ushna, Snigdha-Ruksha specifies association of Sheeta

Dosha and Ushna Dhatu which is seen in Vatarakta. It is well explained in classics

stating that the disease which doesn’t respond to exclusive Ushnopachara and

Sheetopachara should be deemed as Rakta Pradoshaja Vikara.

The Sadhyasadhyata of disease depends on the virulence of vitiated Dosha,

presence or absence of Upadrava as well as chronicity of disease.

Symptom which are attributed to joint involvement are cardinal

manifestation of the disease in Sandhigata Vata and Amavata, thus these diseases

need to be differentiated from Vatarakta. In addition to this the skin manifestation of

the Kushta is skin to the same presentation of Vatarakta. Hence the Kushta should be

distinguished from the Vatarakta again. Differential diagnosis is best made by the

analysis of the Samprapti Ghataka as well as clinical manifestations of these diseases

with the aid of laboratory investigations.

DISCUSSION ON DEMOGRAPHICAL DATA:

Age:

In this present study, maximum number of patient were in age group between

the 41-50 years i.e 30% and 31-40 years i.e 25% . This reveals that most of the

patients are middle age group as Hyperurecemia is mostly occurring from 30-60 age

group.

DISCUSSION


Sex:

The study showed that the 80% of males were affected and 20% females were

affected, which also shows the increase incidence in the male gender. This may be

due occupational, nature of work, addictions etc, which indicates exposure of males to

these Nidana, are more. This may lead to increased prevalence of the disease in

males.

Religion:

In present study shows maximum no of patients i.e 60 % of the patients

belong to the Hindu religion, though the illness does not show any specific religion,

the preponderance of the illness among Hindus represent only the dominance of

Hindu population taken for the study.

Marital status:

Marriage does not influence on the incidence of illness. 82.5 % of the patients

were married persons. This only represents the preponderance of the married people

in the age group 30-70 years, in which the incidence of the illness is maximum.

Socio-Economic status:

The study shows that most of the patients belong to the upper class status.

Sedentary life style and intake of high calorie diet is quite common among this class

of people. Both these factors have definite role in causation of the illness. Similarly

the sample indicates the prevalence of the disease in the upper middle class people.

Education:

In this study maximum number of patients are graduates i.e 45%, as most

of the subjects are graduates who lead sedentary life style which is the main cause for

vatarakta.

DISCUSSION


Occupation and nature of work :

It is observed in this study that maximum people belong to sedentary

nature of work, where it is mentioned in classics that sedentary work style is one of

the predisposing factors in the manifestation of illness.

Dietary habits:

In the present study the maximum number of patients i.e 85% belongs to

the mixed diet. People those who consume more red meat are highly to get increased

uric acid levels in blood which may lead to Gouty Arthritis. Those who consume

more pulses are also at the risk of Hyperuricaemia. It is also told in classics that intake

of Shimbhi Dhanya and utilization of Anupa Mamsa as a contributory factors.

Sleep:

Among total patients 60% had disturbed sleep this may be due to the pain

which is most commonly experienced in night hours, burning sensation and sudden

pain during hours of darkness in Gouty Arthritis.

Mala Pravrutti:

In this study among 40 pateints 25% had normal bowel habits whereas

remaining patients had altered bowel habits. Some patients had constipated stool

whereas few had loose stool. This may be due to variation in food consumption

pattern. Non vegetarian food is having less fibre content which may cause constipated

stools.

Mutra Pravrutti:

In this study among 40 patients 65% had normal micturation whereas

remaining patients had altered micturition.Some patients had polyuria and few had

dysuria.This may be due to associated illness like DM.

DISCUSSION


Desha:

Majority of the patients in this study belong to Sadharana Desha. This may

be due to geographical area where Bangalore belongs to Sadharana Desha. Hence

Desha doesn’t influence on the illness.

Vyasana:

Maximum number of patients had addictions to the smoking 70 % and

alcohol about 62.5% and 37.5% had addiction to both smoking and alcohol. The

smokers and alcoholics are more prone to get the disease Gouty Arthritis and the

same has been shown in this study, ingestion of alcohol results in prompt increase of

uric acid. Same has been emphasised by Acharya that Madya Sevana as a Nidana in

Vatarakta Vyadhi.

Family history:

In the present study it was found to have negative family history. Even though

it is mentioned in contemporary science that Gouty Arthritis has genetic predisposal.

But a conclusion can’t be drawn as sample size was smaller.

Prakruti:

It was assessed based on the major physical, psychological and behavioural

features of the patient. In the present study it was observed that majority of the

patients had Vata Pittaja Prakruti i.e 57.5% and also Pitta Kaphaja prakruti was

noticed in 35% of the patients. Since most of the patients were in Madhyama Avastha,

Pitta Dosha had its importance along with Vata Dosha. It is well known that Pitta and

Rakta are having inseparable relation so increase level of Pitta Dosha also results in

indirect vitiation of Rakta Dhatu, which plays a important role in manifestation of the

illness along with Vata Dosha.

DISCUSSION


Sara:

Maximum number of the patient’s i.e, 62.5% had Madhyama Sara.Nothing

can be drawn from this.

Satva:

Maximum number of patients about 85% had Madhyama satva.

Samhanana:

Maximum number of patients i.e 65% had Madhyama Samhanan.

Satmya:

In the present study 87.5% of patients belonged to Madhyama Satmya.This

depends on the individuals Desha,Prakriti etc.

Agni:

As per the data provided by patients, incidence studied in terms of Jatharagni

showed maximum i.e, 62.5% Samagni indicating minimum impact of Nidana on

Jatharagni to induce Vatarakta.

Kostha:

Screening of the patients as per Kostha showed 60% belonging to Madhyama

Kostha which was based on information given by patients.

Aahara shakti :

Ahara Abhyavarana Shakti:

Present study revealed 55% of patients having Madhyama Aahara

Abhyavarana Shakti, which was assessed as per the patients data.

Jarana Shakti:

Present study revealed that 50% 0f patients having Madyama Ahara Jarana

shakti,which was assessed as per the patients data.

DISCUSSION


Vyayama shakti:

77.5% of the patients had Madhyama Vyayama shakti. 15% patients had

Avara Vyayama Shakti. Avara Vyayama Shakti may be due to Sthoola and Sukumara

nature, this category of people are having less tolerance to exercise.

Poorva Vyadhi Vruttanta(Associated illness):

Most of the the patient i.e, 37.5% had diabetes mellitus in the present study

followed by hypertension which was around 30%,12.5% of patients had

Hypothyroidism. Followed by least incidence of Renal i.e.2% . The Nidana

enumerated in Vatarakta are likely to precipitate the Santarpanotha Vyadhi like

Prameha, Sthoulya, Shonitabhishyanda etc. As it is well established fact in parallel

science that metabolic disorders like Gouty Arthritis and Type2 Diabetes Mellitus

coexist in people who are either obese or over weight. Hypertension is the result of

atherosclerosis which can causes different systemic illness. Antihypertensive drugs

like diuretics, beta blockers are associated with an increased risk of Gout.

DISCUSSION ON NIDANA:

Aharaja Nidana:

Predominance of Rasa:

Lavana Rasa:

As observed in this study 50% had Ati Lavana Rasa Sevana. It is well said in

classics that Lavana rasa which is having ushna,teekshna,sukshma , kapha and pitta

krutha.Lavana Rasa is pittaprakopaka,Rakta vardhaka and Rakta prakopaka,Lavana

Rasa has capacity to cause Kleda in Shareera in turn cause Kleda Vruddhi in Rakta

Dhatu. Also it has potency to aggravate Pitta Dosha and vitiates Rakta Dhatu there by

producing Vatarakta. People also add salt in the preparation of rice for better taste.

DISCUSSION


With these evidences it can be concluded that Lavana Rasa Ati Sevana plays major

role in production of the disease.

Amla Rasa:

45% of the patients had excessive consumption of Amla Rasa in routine

food. Amla Rasa is said to increase Pitta Dosha and vitiates Rakta Dhatu. It also

increases Kledata in the body, there by leading to Rakta Pradoshaja Vikara like

Vatarakta.

Katu Rasa

In present study Katu Rasa was observed to be 60%.Katu Rasa is ushna in

nature Acharya Charaka has mentioned that due to predominance of Vayu and Agni

Mahabhuta it is likely to cause Vataja and Pittaja Vikara. Vatarakta is one such

condition where both Vata and Pitta in terms of Rakta Dhatu are extensively involved

in causation of the disease.

Dhanya Varga:

Masha:

Black gram is largely used in the form of Dal, Idli,Dosa, Vada, Papad. The

percentage of amino acids in black gram is considerably high whose end product is

uric acid thereby forms a major food content in the manifestation of the disease Gouty

Arthritis. As per Acharya Charaka Masha is considered as Ahitatama Dravya which

means unwholesome food as it increases Pitta and Shleshma. And its properties like

Madhura Rasa, Guna like Snigdha, Ushna and Guru mainly contribute in

Dhamanipratichaya and Shonitadusthi resulting into Shonita Pradoshaja Vikara like

Vatarakta.

DISCUSSION


Kulattha:

Even though Kulattha is considered as major risk factor in Rakta Dushti and

genesis of Vatarakta incidence of its consumption is negligible in this geographical

area.

Harita Varga:

Acharya Charaka clarifies that the drugs which comes under Harita Varga

(Moolaka, Dhanyaka, Palandu) i.e., green leafy vegetables are suppose to vitiate

Rakta Dhatu there by contribute in appearance of Rakta Pradoshaja Vikara like

Vatarakta. As per parallel science green leafy vegetables are rich in proteins.

Vegetables like cauliflower, spinach are well established to cause metabolic arthritis.

This strengthens the claim made by ancient Acharya.

Mamsa:

Acharya Charaka has explained Mamsavarga in detail where he has

categorised into various forms as Anoopa Mamsa like Mahisha, Go (Beef), Varaha

(Pork) Jalaja Mamsa like Matsya (Fish). Acharya Charaka emphasises that Anoopa

Mamsa like Gomamsa and Mahisha Mamsa have properties like Guru, Snigdha,

Ushna, Madhura which results in Kapha Vruddhi and Medo Dhatu Dushti. As a

consequence of this Dhamanipratichaya may be obvious and leads to Vatarakta. Red

meat is a rich source of cholesterol and protein there by contributing in atherosclerosis

and Hyperuricaemia which results in Peripheral Vascular Disease and Metabolic

Arthritis like diseases. Acharya Vagbhata clearly states that Matsya is Shrestha

Kaphakara Dravya hence it may act as Santarpanottha Nidana. Fish is loaded with

high proteins in it there by increases risk of gouty arthritis. In the present study it

showed that 80% of the patients had habbit of fish consumption,50% of the patients

had habbit of dry meat consumption,37.5% had habbit of taking Anupamamsa. Thus

DISCUSSION


Mamsa acts both Santarpanottha and Apatarpanottha Nidana. It also depends on

method of preparation. Klinna Mamsa is likely to cause Kapha Prakopa thereby act as

Santarpanottha Nidana. Shushka Mamsa is likely to aggravate Vata and Rakta thus it

may act as Apatarpanottha Nidana.

Gorasa:

Dadhi:

Properties of Dadhi as explained in classics are Amla Rasa and Amla Vipaka,

Ushna Veerya, Brumhana and major being its Mahaabhishyandhi Guna. These

properties of Dadhi cause Raktaja, Pittaja and Kaphaja Vikara on long term usage and

inappropriate way of consumption. Hence it may cause Vatarakta. Curd and its

products like paneer and cheese on regular consumption may result in weight gain

leading to obesity. Obesity increases likelihood of various diseases like

Dyslipidaemia,Type 2 Diabetes Mellitus, Cardiovascular Diseases, Peripheral

Vascular Diseases like Varicose Veins, and Gouty Arthritis etc. in the present study it

revealed that 90% of the patients had consumption of curds which proves the ancient

facts logically.

Aahara Abhyasa Krama:

It was found in the study that 62.5% of the patients had Vishamashana and

25% patients had viruddhashana. Such faulty diet regimen and unwholesome diet is

responsible for derangement of the Agni and vitiation of Dosha. A person in such

state is most likely to get inflicted by Ama and various Amaja vyadhi. Ama in this

context should be considered as Mala Sanchaya. Mala is one which causes discomfort

to the body. Aparipakwa dhatu are also considered as mala. Based on this reference of

Charaka Samhita one can consider excessive deposition of uric acid crystals in the

joint spaces as explained in Gouty Arthritis as Mala which is nothing but Ama.

DISCUSSION


Vihara:

Diwaswapna:

In the present study it was found that 55% of the patients had Diwaswapna.

As told by Acharya Charaka while describing about contraindications for

Diwaswapna explains that Diwaswapna causes aggravation of Shleshma and Pitta as

it brings Snigdhata in the body. This may result into Sthoolatha and may act as

predisposing factor in the genesis of Vatarakta. Few of the recent studies show that

untimely sleep can alter circadian rhythms, so the cycling of many genes is impaired.

It is not yet proved in the parallel science that how day sleep is going to bring

different systemic illness.

Manasika Bhava:

Due to Raja and Tama Dosha the Manas is always in search of

materialistic pleasures and to satisfy its desires, it is always doing good and bad

deeds. Brihatrayi have mentioned Chinta, Bhaya, Krodha as Vata Prakopaka Nidana

and Bhaya, Krodha and Shoka also cause Dushti of Swedavaha Srotas. Aggravation

of Pitta also results by Krodha thereby vitiates Rakta Dhatu. Chinta causes Dushti of

Rasavaha Srotas. Thus Manasika Bhava also play crucial role in the manifestation of

the disease. In modern science also stress, anxiety, etc. are stated as the favourable

factors for various metabolic and autoimmune disorders. In this study 62.5% patients

had Chinta and 50% had Bhaya,45% had Krodha and 20% had Bhaya.

POORVARUPA:

In poorvarupa avastha 80% had Vaivarnya ,75% had Shopa , 70% had Sandhi

Ruk , 57.5% had Karshnyata and Gouravata,50% had Sandhi Shaithilya,45% had

Atisweda,40% had Shrama,37.5% had Alasya,35% had Kandu,30% had Daha,25%

had Asweda,Supti,22.5% had Kshate Atiruk,20% had Pidak.

DISCUSSION


The morbidity of Vata Dosha causes alteration in the Swedavaha Srotas

causing either excessive sweating or deficient sweating. Sweda is the Mala of Medo

Dhatu hence vitiation of Medo Dhatu causes Atisweda, which is evidently seen in

Sthoulya and Prameha. In Vatarakta if the morbid Vata Dosha affects the Avabhasini

layer there will be discoloration of the skin. Reddish, Blackish, Bluish or Coppery

discolouration may be seen. Episodic pain is more evident in Gout.

Uttana Vatarakta Lakshanas

Twakvaivarnyata

Twakvaivarnyata. Vaivarnyatha is Varnaheenatha or the normal

colour is lost or it can be Vivarnatha or difference in colour is observed. Brajaka Pitta

is the one which provides normal colour to the skin. In Vaivarnyatha, Shyavatha is

caused due to Vata Dosha and Tamra Varna is caused due to Rakta Dhathu,

shyavatwak is found in 30% of patients and Rakta twak is found in 22.5% patients

,blackish discoloration is due to thrombophlebitis due blood clot in the inflamed vein

most commonly in legs which can be close to skin.

Ruja

Ruja is found in 65% of patients with Uttana Vatarakta . Ruja is Peeda or

Vedana and it is always Vedana Kara. Ruja Lakshana is caused by Dushti of Vata.

When

muscle activity increases need of oxygen also increases due to which increased pain

in the areas like interphalangeal joints and calf muscles.

Daha

Daha is found in 17.5% patients with Uttana Vatarakta. The Santapa that

causes the Sarvanga Dahana is Daha. It is purely a Pittaja Vikara. The Vedana is

similar to that of burn caused by Agni. Dushitha Rakta circulating all over the body

DISCUSSION


due to its excess Ushna and Teekshna Guna produces Daha in the body. The burning

pain in the feet and toes

while resting is the one of the feature of Gouty Arthritis.

Toda

Toda is found in 37.5% of patients with Uttana Vatarakta . The pain is

similar to Thudyatha or pricking in nature. It is Vichinna Shoola i.e pain is of

intermittent type. Toda occurs mainly due to Rakta Dhatu. Dushitha Raktha due to its

change in consistency gets stasis in the body and blocks the minute channels of

circulation. Hence when Rakta tries to flow with force it produces Toda.

Sphurana

Sphurana is found in 20% of patients with Uttana Vatarakta. Sphurana is

Spandana or Kampa. It is of pulsating in nature. Sphurana occurs mainly due to Vata

Dosha. Painful cramping in hip,thigh and calf muscles is mainly due to intermittent

claudication. The location of pain depends on the location of the blocked arteries. Due

to block of the arteries cannot supply more blood during any activity.

Gambheera Vatarakta Lakshanas

Daha

Daha is found in 30% of patients with Gambheera Vatarakta. The Santapa

that causes the Sarvanga Dahana is Daha. It is purely a Pittaja Vikara. The Vedana is

similar to that of burn caused by Agni.Dushitha Rakta circulating all over the body

due to its excess Ushna and Teekshna Guna produces Daha in the body.

Shyava Varna Twak

Shyava twak found in 30% of patients, Shyavatha of Twak is caused due to

Vata Dosha. The normal colour of the skin is provided by the Bhrajaka Pitta. Dushita

DISCUSSION


Vata dries up and Dushita Rakta burns up the normal colour of the skin giving

blackish discolouration of the skin.

UPADRAVA:

Among 40 patients 30% patients had Aswapna this may be due to increased

pain in night hours seen in Gout,25% of patients had Trishna, 20% patients had

Arochaka this may be due to psychiatric problem where chronicity of the disease is

identified as cause, Shirograha was observed in 10% of the patients, Ruja was seen as

a complication in 17.5% of the disease where patients of PVD was found to have

severe pain. 17.5% of the patient had Angulivakrata

Vakrata

Anguli Vakrata is found in 17.5%. Vakrata is a type of Asthi Bhanga.

There will be dislocation of the Asthi from the Sandhis and it will cause Vakratha i.e

there will be

abnormal curving over the area due to dislocation. Pradooshitha Rakta affects the

other Mamsadi Dhathus Sthanasamshraya will be there in Padamoola. It affects the

Asthi and Majja Dhathu and produces the Anguli Vakrata. Vakrata is caused due to

Sankocha of Dhamani, Kandara, Anguli and Sandhi. In gout due to deposition of uric

acid crystals in joints causes Vakrata where multi organ dysfunction was perceived.

DISCUSSION ON LABORATORY FINDINGS

Relation between Vatarakta and serum uric acid levels

Among 40 patients 27 members uric acid level was raised. Among that 16

members got uric acid levels more than 9 mg/dl who were having the features of

gouty arthritis.11 patients with raised uric acid level more than 9 mg/dl is observed

even in patients of peripheral vascular disease and varicose veins,and rest of 13

members got uric acid

DISCUSSION


between 6mg/dl and 9mg/dl were not having the features of gout and comes under

peripheral vascular disease and varicose vein. Therefore Vatarakta and uric acid are

not related on the basis of Lakshanas and Nidana. Vatarakta and uric acid are not

related in laboratory findings. Vatarakta is collection of different symptoms,among

them a few can be seen in gout. When whole Lakshanas of Vatarakta are taken it does

not come significant in my topic as many diseases can come under the heading of

Vatarakta. We can’t stick on to a single lab parameter such as uric acid to diagnose

Vatarakta. Instead biochemical parameters have to be evaluated in detail. Hence

serum uric acid is not a conclusive diagnostic criteria in diagnosing Vatarakta.

CONCLUSION


Literature cited Vatarakta under the umbrella of Vataja Nanatmaja Vyadhi.

Due to its diverse pathogenesis, Vatarakta presents varied and contrasting

features in both its Purvaroopa and its Roopavastha. Hence, Vatarakta when

viewed through under the light of conventional medicine can be correlated

with multitude of disorders. These disorders range from auto-immune to

metabolic disorders, SLE to Gouty Arthritis.

The first objective was to study the Etiopathogenesis of Vatarakta from the

classics of Ayurveda. Two distinct set of etiological factors take part in the

causation of the illness.

These distinct sets of etiological factors may be related to Aahara, Vihara

and/or the one influencing the Manas. One set of aetiology leads to the

vitiation of Vatadosha and the other set separately causes morbidity in Rakta

Dhatu leading to Anyonyavarana of both. In spite of this, in the variant form

of Vatarakta where in Santarpana category of factors leads to the abnormal

accumulation of Kapha as well as Medo Dhatu, and more particularly in the

Raktamarga culminates in the pathology of Vatarakta.

The following Nidanas have a definite role in etiopathogenesis of

Vatarakta and they are Dadhi,Ambuja Mamsa,Masha,Sushka Mamsa,Lavana

Rasa, Katu Rasa,Mulaka and Vihara like Travelling in two

wheeler,Diwaswapna, Veganigraha etc.

The following Lakshanas are maximum seen in Vatarakta.They are

Ruk,Toda,Kandu,Shyvatwak,Rakta twak,Spurana,Daha etc.

CONCLUSION

CONCLUSION


Vatarakta Nidanas in texts matches with patients but uric acid increased

causative factors are not seen in patients.

Therefore Vatarakta and uric acid are not related on the basis of Nidana.

Vatarakta and uric acid are not related as per Lakshanas.

Vatarakta and uric acid are not related in laboratory findings.

Vatarakta is a collection of different symptoms, among them a few can be

seen in Gout.

When whole Lakshanas of Vatarakta are taken it does not come significant in

my subjects as many diseases can come under the heading of Vatarakta.

We can’t stick on to a single lab parameter such as serum uric acid to

diagnose Vatarakta.

Instead other s biochemical parameter has to be evaluated in detail.

Serum Uric Acid have got moderate role.

Hence serum uric acid is not a conclusive diagnostic criteria in diagnosing

Vatarakta.

SCOPE FOR FURTHER STUDY:

We can’t stick on to a single lab parameter such as serum uric acid to

diagnose Vatarakta. Instead other biochemical parameter has to be evaluated

in detail.

SUMMARY


This dissertation work entitled “A STUDY ON AETIOPATHOGENESIS

OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS”

comprises of five parts, namely, introduction, conceptual part, Materials and Methods,

discussion and conclusion.

Introduction –

Introduction is the first part, comprising a brief introduction to the disease

Vatarakta and Gouty Arthritis.

Conceptual part –

This is the second section which has been divided into three chapters

comprising the whole literary aspect of the present study.

Historical Review

In first chapter, the etymological derivation of Vatarakta, brief historical

review of disease Vatarakta starting from the Vedic period to Sangraha period is dealt.

Ayurvedic Disease Review

The second chapter elaborates the comprehensive narration of the disease

Vatarakta. A detailed description regarding the possible Nidana is analyzed. An

attempt is made to build the probable Samprapti in accordance with the Nidana is

dealt in detail. The diagnosis of the Vatarakta is made on clinical examinations and

investigation . The Purvaroopa of the disease Vatarakta are explained . Lakshana are

explained in detail, other topics i.e. Upadrava, Sapekshanidana,

Sadhyasadhyata,Pathya Apathya and Aristha Lakshana are also explained in detail.

SUMMARY

SUMMARY


Modern Disease Review

In third chapter description about Epidemiology,Aetiology,clinical

features,Risk factors of Gouty Arthritis are explained, investigation Serum Uric Acid

and its clinical revelences are explained.

Materials and Methods

The materials and methods of the present work with complete description of

the observational study are given here. In this study 40 patients having signs and

symptoms of Vatarakta were taken for the study. Diagnosis was made on the basis of

clinical presentations, investigation Serum Uric Acid. The observation of the study

includes the etiological factors and clinical presentation of the disease and variations

in the Serum Uric Acid. The observations and results are presented in the form of

tables and graphs.

Discussion –

This part deals with discussion regarding conceptual study and the clinical

study starting from the incidence of the disease to the clinical observations. Here an

attempt is made to establish the probable cause for the observational findings and how

investigation Serum Uric Acid helps in diagnosing Vatarakta.

Conclusion - conclusion drawn from various sections of work are given.

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CONSENT


RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALORE-562107

TITLE: “A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS”

SCHOLAR: DR.GANGABAI S HIROL

GUIDE:DR.ANANTA S DESAI

INFORMED CONSENT FORM

I ..................………………... Daughter/Wife of …………………..am exercising my

free will, to participate in above study as a subject. I confirm that the study has been

explained to me adequately understood the above study & had the opportunity to ask

questions .The information given by me will be used for Medical Research only & I

will not be identified in any way in the analysis & reporting of the Results. I hope to

complete the study, but I understood that my participation is voluntary & I am free to

withdraw at any time, without giving a reason & without any medical care or legal

rights being affected.

Signature of the investigator Signature of the Volunteer

Signature of the guide

CASE PROFORM


DEPARTMENT OF P.G. STUDIES IN ROGANIDANA EVAM VIKRUTI VIGNANA

GOVERNMENT AYURVEDIC MEDICAL COLLEGE,BANGALORE-09

CASE PROFORMA : A STUDY ON AETIOPATHOGENESIS OF VATARAKTA WITH SPECIAL REFERENCE TO GOUTY ARTHRITIS

Name of Scholar: Dr.Gangabai S Hirol Guide: Dr. Ananta S Desai

-------------------------------------------------------------------------------------------------------

--------------

PRADHANA VEDANA WITH KALA PRAKARSHA(Chief complaints with

duration)

Uttana Vatarakta Duration Gambeera Vatarakta Duration

Daha(Burning sensation) Svayathu(Swelling)

Kandu(Itching sensation) Stabda (Stiffness)

Toda (Pricking type of pain) AntarPeeda(Squeezing type of pain)

Aayama(Stretching ) Katina (Hard)

Bheda(Breaking type of pain) Vakrata(Twisted)

NAME: OPD/IPD NO:

AGE: DOA:

GENDER: Male/Female DOD:

RELIGION: H/M/C/J/B/Others OCCUPATION:

ADDRESS AND CONTACT NO:

EDUCATION: IL/P/M/ H/POST HIGH SCHOOL /G

MARITAL STATUS-M/ UM

SOCIO-ECONOMIC STATUS: Upper/Upper Middle/Lower middle/Upper

lower/Lower

CASE PROFORM


Sphurana (Pulsation) Vidaha(Burning sensation )

Aakunchana (Bending) Sphurana(Pulsation)

Syavaraktatwak

(Dark brown color skin) Paka(Inflammation)

Ruja (Pain) SyavatamraVarna

(Dark brown coppery colour skin )

TamraTwak

(Coppery red color skin) Daha(Burning sensation)

Gauravatha (Heaviness) Toda (Pricking type of pain)

Supthatha (numbness)

Other-

ANUBANDA VEDANA WITH KALA PRAKARSHA (Associated symptoms with duration)

PRADHANA VYADHI VRUTTANTA(History of Present Illness):

1) Onset:Sudden/Gradual/Insidious 2) Duration:Acute/Chronic 3) Aggravating Factors:

4) Relieving Factors:

POORVA VYADHI VRUTTANTA(History of Past Illness):

Diabetes mellitus/Hypertension/Hypothyroidism/Renal disease

CHIKITSA VRUTTANTA (Treatment History):

Modern Medicine Ayurvedic Medicine/Therapy Other System

KAUTUMBIKA VRUTTANTA(Family History):

Genetic Background of

a).Diabetes mellitus-Father/Mother/Brother/Sister/Others

b).Hypertension-Father/Mother/Brother/Sister/Others

c).Hypothyroidism-Father/Mother/Brother/Sister/Others

CASE PROFORM


d).Renal-Father/Mother/Brother/Sister/Others

e).Gouty arthritis-Father/Mother/Brother/Sister/Others

VYAVASAYA VRUTTANTA (Occupational History):

Occupation:

Nature of work: Manual/Sedentary/Labour/Sitting/Travelling/Studying/House wife

Working hours:………../day

………../night

RUTU CHAKRA VRUTTANTA:

a.Gynaec History:

Menarche:………….Years of age

MC: …………….days Regular/Irregular

Dysmenorrhea/Leucorrhoea/Metrorrhagia

Menopause:…………..Years of age

b.Obstretic History:

Married Life: …………Years

No. of delivery:

No.of LSCS

No. of abortion

VAYAKTIKA VRUTTANTA (Personal History):

1. AHARA: Vegetarian( ) Mixed( )

a. Agni : Samagni/ Vishamagni/ Teekshanagni/ Mandagni

b.Kosta :Mrudu/ Madyama/ Krura

c. Ahara Abhyasa :Anashana/ Addyasana/ Viruddshana/ Pramitashana/

Vishamasana

2.VIHARA: a).Nature of work: Hard ( ) Moderate ( ) Sedentary ( )

b).Nidra:Sound/disturbed Day…….hours Night…….hours

If disturbed reason: Mental strain:Y/N If Yes,since…….

Jagarana:Y/N If Yes,since…….

CASE PROFORM


c).Vyayama:Regular/Irregular/No/Less/Proper/Excess

Type of exercise………..…….mins

d).Vyavaya:

3. VYASANA:

VYASANA DURATION FREQUENCY

Smoking

Alcohol

Tobacco Chewing

Snuff

Tea

Coffee

Others

MALA PRAVRUTTI

Regular /Irregular/ Constipation/ Loose Motion

Frequency:

Sama / Nirama

Mala with Krimi/ Rakta / Kapha

Varna – Peeta/ Krishna / Shukla / Aruna/ Others

MUTRA PRAVRUTTI:

Normal / Polyuria/Dysuria/ Oliguria

Day - times Night - times

Varna – Aruna/ Peeta/Shukla/Krishna/ Other

MANASIKA VRUTTANTA:

Kama _ Chinta_ Bhaya_ Shoka Krodha

CASE PROFORM


ROGI PARIKSHA

SAMANYA PARIKSHA(General Examination)

Built Well ( ) Moderate ( ) Poor ( )

Nourishment Well ( ) Moderate( ) Poor ( )

General Appearance

Consciousness

Height Feets

Weight Kgs

Blood pressure mm/Hg

Pulse /min

Respiratory Rate /min

Temperature

Pallor

Icterus

Clubbing

Edema

Cyanosis

Lymphadenopathy

Gait

ASTHA STHANA PAREEKSHA

1 Nadi /min

2 Mala /day

3 Mutra /day /night

4 Jihwa Alipta/Alpalipta/Lipta

5 Shabda Prakrut/Vikrut

6 Sparsha Ushna/Anushna

7 Drik Prakruta/Vikruta

8 Akruti Sthula/Krisha/Madyama

CASE PROFORM


DASHAVIDHA PAREEKSHA

1 Prakruti V/P/KVP/PK/KV/Sama

2 Vikruti Dosha Dhatu Mala

3 Sara Pravara/Madhyama/Avara

4 Samhanana Susamhita/Madhyama/Heena Samhita

5 Pramana Supramanita/Adhika/Heena

6 Satmya Ekarasa/Sarvarasa/Vymishra/Rooksha

Satmya/Snigdha Satmya

7 Satwa Pravara/Madhyama/Avara

8 Ahara Shakti a) Abhyavarana shakti: P/M/A

b) Jarana Shakti:P/M/A

9 Vyayama Shakti Pravara/Madhyama/Avara

10 Vaya Balya/Madhyama/Vrudha

SROTAS PAREEKSHA

Srotas Lakshana

Pranavaha Srotas

Udakavaha Srotas

Annava Srotas

Rasavaha Srotas

Raktavaha Srotas

Mamasavaha Srotas

Medovaha Srotas

Asthivaha Srotas

Majjavaha Srotas

Sukravaha Srotas

Mootravaha Srotas

Purishavaha Srotas

CASE PROFORM


Swedavaha Srotas

ATURA BHOOMI DESHA PAREEKSHA:

Jata: Jangala/Anupa/Sadharana

Vardhita: Jangala/Anupa/Sadharana

Vyadhita:Jangala/Anupa/Sadharana

STHANIKA PAREEKSHA

SANDHI

Darshana

Sparshana

Prashna

TWACHA Grade 0(-) Grade 1(+) Grade 2(++) Grade 3(+++)

Twakvaivarnyatha

Ruja

Sparshajnana

Sparshaasahishnutha

Others

Joint /Skin:

Colour:

Moiture:

Temperature:

Turgor:

Vascularity:

Lesions:

CASE PROFORM


UTTANA VATARAKTA

Lakshana Grade 0(-) Grade 1(+) Grade 2(++) Grade 3(+++)

Daha

Kandu

Aayama

Toda

Bheda

Aakunjana

Syavatwak

Gauravatha

Tamratwak

Supthata

Spurana

GAMBHEERA VATARAKTA

Lakshana Grade 0(-) Grade 1(+) Grade 2(++) Grade 3(+++)

Svayathu

Gradhitha

Peeda

Ruja

Vakratha

Vidaha

Paka

Khanja

Pangu

CASE PROFORM


SYSTEMIC EXAMINATION:

1) Cardiovascular System

2) Respiratory System

3) Gastro Intestinal System

4) Locomotor System

5) Nervous System

LOCAL EXAMINATION

INSPECTION

General appearance of extremities

Abnormality

Muscle wasting Symmetry -Present/ Absent

Swelling - Present/ Absent

Color of the skin - Blackish discoloration/ Reddish discoloration /Scar/Pallor / Other

Texture of the skin -Present/ Absent

Ulcers - Present/ Absent

Gangrene -Present/ Absent

Varicose veins -Present/ Absent

PALPATION

Temperature -

Edema - Pitting

-Non pitting

CASE PROFORM


VIKRUTHITA PARIKSHA:

Nidana:

Aharaja:

Sl no

Ahara Yes/No Frequently Occasionally

1 Lavan 2 Amla 3 Kshara 4 Snigdha 5 Ushna 6 Klinna Mamsa 7 Shuska Mamsa 8 Ambuja Mamsa 9 Anupa Mamsa 10 Pinyaka 11 Mulaka 12 Kulatta 13 Masha 14 Aranala 15 Nishpava 16 Ikshu 17 Dadhi 18 Sauvira 19 Sukta 20 Viruddhahara 21 Adhyasana 22 Ajirna Bhojana 23 Vidahi Ahara

Viharaja:

Sl No

Vihara Yes/No Frequently Occasionally

1 Divaswapna/Prajagara 2 Vyavaya 3 Veganigraha 4 Hasti,Ashwa,Ustra Yana 5 Ambu Krida Plavana

Manasika Nidana: Kroda

Vishesh Nidana : Sukumararogi /Sthoolarogi / Sukhopayogi / Achankramanasheela / Mristhannabhoji /Rogavith / Madyasevi / Ati Vyayam

CASE PROFORM


PURVARUPA:

Complaints Present/Absent Duration Atisweda/Asweda Karshnyata Kshate atiruk Sandhi shaithilya Alasya Sadana Pidakodgama Nisthoda Spurana Bhedana Gurutwa Supthi Kandu Sandhi ruk Vaivarnya Mandalotpatti Osha/Daha Shopa Twak Parushya Sira dhamani spandana

Atislakshna Khara Sparsha Shrama

RUPA:

UPASHAYA:

ANUPASHAYA:

CASE PROFORM


UPADRAVA:

Upadrava Present/Absent Duration Aswapna Arochaka Swasa Ruja Jwara Hikka Paka Klama Angulivakrata Daha Arbuda Avipaka

SAMPRAPTI GHATAKAS

Dosha V/P/K/VK/PK/KV/VPK Dushya Rasa/Rakta/Mamsa/Meda/Asthi/Majja/Sukra Mala Purisha/Mutra/Sweda/Kesha/Nakha/Loma/Shmashru Srotas Rasa/Rakta/Mamsa/Meda/Asthi/Majja/Sukra/Prana/Anna/Udaka Srotodustiprakara Atipravrutti/Vimargagamana/Sanga/Siragranti Agni Sama/Vishama/Tikshna/Manda Ama Present/Absent Udbhavasthana Sancharasthana Vyatkasthana Adhisthana Rogamarga Kosta/Shakha/Marma Swabhava

CASE PROFORM


INVESTIGATIONS:

Serum uric acid :

VYDHI VINISCHAYA:

Signature of P.G scholar Signature of the Guide (Dr.GANGABAI S HIROL ) (Dr.ANANTA S DESAI)

CASE PROFORM


Twacha 1.Twakvaivarnyatha 0 – Nil/ Absent 1 – Area limited to Interphalangeal/Metacarpophalangeal/Metatarsophalangeal joint 2 – Spread till wrist/Ankle/both 3 – Spread till elbow/knee/both joints 2.Ruja 0 – Absent 1 – Mild , Daily activities are not disturbed 2 – Moderate , Daily activities are disturbed 3 – Severe, Daily activities are hampered 3.Sparshajnana Kandu ,daha , toda , bheda , sphurana , ayama , sankocha 0 – Absent 1 – Less than 2 symptoms 2 –Two to four symptoms 3 – More than four symptoms 4.Sparshaasahishnutha 0 – Absent 1 – Single without exudates 2 – Single with exudates 3 – Multiple with ulceration and exudates Uttana Vatarakta 1.Daha 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 2.Kandu 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 3.Toda 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body

CASE PROFORM


4.Aayama 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 5.Bheda 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 6.Sphurana 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 7.Aakunjana 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 8.Syavatwak 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 9.Tamratwak 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 10.Gauravatha 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 11.Supthatha 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body

CASE PROFORM


Gambeera Vatarakta 1.Svayathu 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 2.Gradhitha 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 3.Peeda 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 4.Ruja 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 5.Vakratha 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 6.Vidaha 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 7.Paaka 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body

CASE PROFORM


8.Khanja 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body 9.Pangu 0 – Nil/Absent 1 – Area limited to Interphalangeal joint /Metacarpophalangeal joint 2 – Spreads till wrist / Ankle 3 – Spreads all over the body

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CHRONIC GOUTY ARTHRITIS

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URIC ACID CRYSTALS IN TOE

DR GANGABAI S HIROL

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