Vatarakta Chikitsa
29. Vata Shonita Chikitsitam ( Management of disorders involving vata and rakta) Abstract The chapter refers to vata shonita (vata rakta), a condition caused by vitiated vata dosha and rakta. As the disease is caused by predominantly vitiated vata and rakta, it follows the chapter of vatavyadhi (vatik disorder). The manifetstions of vatashonita resemble various metabolic and connective tissue diseases like gout, inflammatory polyarthritis and vasculitis. This variation in manifestation depends upon degree of vitiation of doshas and dhatu. The chapter has description of etiological factors along with types of vata shonita, purvarupa (prodromal symptoms), rupa (clinical features) of different types, rupa of dosha predominance, upadrava (complication) sadhyasadhyatwa (prognosis), treatment of different types of vatashonita, precautions during treatment as well as symptomatic treatment for relief in non-curable state of disease. Key Words: Vata, rakta, gout, connective tissue diseases, inflammatory arthritis, polyarthritis, vasculitis.
| Section/Chapter | Chikitsa Sthana Chapter 29 |
|---|---|
| Preceding Chapter | Urusthambha Chikitsa |
| Succeeding Chapter | Vatarakta Chikitsa |
| Other Sections | Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana |
Introduction
After describing the chapter on various presentations of vata dominant disorders, the chapter on vata being afflicted by vitiated rakta is narrated. Vatashonita is caused by vitiated vata dosha and rakta which impede the gati (movement) of each other. It is also called as adhyaroga because it affects mainly affluent people who are not habitual to physical activity and indulged in factors responsible for vitiation of rakta.. People of pitta prakriti (pitta constitution) are prone to develop vatashonita, because sukumaratwa (delicate personality) is the characteristic feature of pitta prakriti. In vata shonita there is abnormality in movemental activity (vāta dosha) due to abnormality of rakta. It is widey considered similar to gouty arthritis, however it also covers the rheumatic disorders, connective tissue disorders, inflammatory polyarthritis, vasculitis depending upon the site of vitiation.Owing to metabolic disturbances (dhatwagni vaishamya) there is overproduction of metabolites like uric acid etc.. High concentration of these metabolites in blood should be considered as raktadushti which slows the circulation of blood in capillaries and hence there is stagnation of it near the joints and dependent parts of the body. Uric acid escapes and enters the joints and other tissues from the stagnated hyperuricemic blood, and at the same time there may be reduced excretion of uric acid through kidneys, these all disturbed movemental activities are considered as vata dushti and over accumulation of metabolites because of decreased digestive capability may be considered as agniduśti. It is observed that patients suffering from vātashonita also have visamāgni (disturbed digestive capability), it is a rule that if the jatharāgni (digestive capability) is disturbed the other types of agnī (metabolism) will also be disturbed. Inflammation of joints may also occur by some other metabolites like calcium pyrophosphate crystal deposition which is also a by product and resultant of agni dushti (disturbed metabolism). Further sirā (vein), dhamani(artery) etc are the āshraya (seat) for vāta and rakta. Thus due to āshraya-āshrayi (mutual abiding )sambandha (relationship) between sirā, dhamani and vāta and rakta, whenever there will be dushti of vāta and rakta it will also cause the dushti of sirā, dhamani and other mārga (path) of vāta and rakta. Also sirā and kandarā (tendons) are the upadhātu of rakta hence dushti of rakta will always cause dushti of sirā and kandharā. The vasculitis syndrome, a group of disorders also needs consideration in vātarakta adhyaya. Vasculitis is a clinico-pathologic process characterized by inflammation and damage to blood vessels. The vessel lumen is usually compromised, and this is associated with ischemia of the tissues supplied by the involved vessel. A broad and heterogeneous group of syndromes may result from this process, since any type, size, and location of blood vessel may be involved. Vasculitis and its consequences may be the primary or sole manifestation of a disease; alternatively, vasculitis may be a secondary component of another primary disease. Vasculitis may be confined to a single organ, such as the skin (uttāna vātarakta), or it may simultaneously involve several organ systems (gambhira vātarakta). Secondly, vasculitis alongwith thrombosis and embolism is also cause for peripheral vascular disease. Thromboangiitis obliterans (Buerger’s disease) is an inflammatory occlusive vascular disorder involving small and medium-sized arteries and veins in the distal upper and lower extremities. Disease caused due to vasospasm also has inclusion in vātarakta for eg. Raynaud’s disease. Venulitis occurring in thromboangiitis obliterans, Behçet’s syndrome, and homocystinuria may also cause venous thrombosis. Thrombosis impedes the flow of blood and other nutrients thus vahan karma (transport function) of srotas sthita māruta (vata) is hampered i.e. rakta āvrita vāta takes place leading to the symptoms of vātarakta. The presence of thrombus within a superficial or deep vein and the accompanying inflammatory response in the vessel wall is termed venous thrombosis or thrombophlebitis. In sirāgata vāta, Ācharya have used two words mahati sirā and tanu sirā which resembles the two conditions related to vessels viz. aneurysm and narrowing of vessels. Atheroembolism constitutes a subset of acute arterial occlusion (dhamani pratichaya). In this condition, multiple small deposits of fibrin, platelets, and cholesterol debris embolize from proximal atherosclerotic lesions or aneurysmal sites. Thus a group of disorders explained by modern science can be included under vātashonita.
VĀTA SHONITA CIKITSITAM अथातो वातशोणितचिकित्सितं व्याख्यास्यामः ||१|| इति ह स्माह भगवानात्रेयः ||२|| athātō vātaśōṇitacikitsitaṁ vyākhyāsyāmaḥ||1|| iti ha smāha bhagavānātrēyaḥ||2|| athAto vātaśonitacikitsitaM vyAkhyAsyAmaH ||1|| iti ha smAha bhagavAnAtreyaH ||2|| Now we shall expound the chapter on treatment of vata shonita. Thus said Lord Atreya. (1 – 2) हुताग्निहोत्रमासीनमृषिमध्येपुनर्वसुम् | पृष्टवान् गुरुमेकाग्रमग्निवेशोऽग्निवर्चसम् ||३|| अग्निमारुततुल्यस्य संसर्गस्यानिलासृजोः | हेतुलक्षणभैषज्यान्यथास्मै गुरुरब्रवीत् ||४|| hutāgnihōtramāsīnamr̥ṣimadhyē punarvasum| pr̥ṣṭavān gurumēkāgramagnivēśō'gnivarcasam||3|| agnimārutatulyasya saṁsargasyānilāsr̥jōḥ| hētulakṣaṇabhaiṣajyānyathāsmai gururabravīt||4|| hutAgnihotramAsInamRuShimadhye punarvasum | pRuShTavAn gurumekAgramagnivesho~agnivarcasam ||3|| agnimArutatulyasya saMsargasyAnilAsRujoH | hētulakShaNabhaiShajyAnyathAsmai gururabravIt ||4|| After finishing his daily worship and yagya (religious sacrifice), Punarvasu was sitting admidst the sages. Then with concentrated mind, looking like a flame of fire. Agnivesha, asked him, “Sir, please explain the aetiology, symptomatology and treatment of disease (vata shonita) which is a combination of vata and rakta, and is like that of fire and wind. The teacher (Punarvasu) explained. (3 – 4) Etiological factors: लवणाम्लकटुक्षारस्निग्धोष्णाजीर्णभोजनैः | क्लिन्नशुष्काम्बुजानूपमांसपिण्याकमूलकैः ||५|| कुलत्थमाषनिष्पावशाकादिपललेक्षुभिः | दध्यारनालसौवीरशुक्ततक्रसुरासवैः ||६|| विरुद्धाध्यशनक्रोधदिवास्वप्नप्रजागरैः | प्रायशः सुकुमाराणां मिष्टान्नसुखभोजिनाम् [१] ||७|| अचङ्क्रमणशीलानां कुप्यते वातशोणितम् | अभिघातादशुद्ध्या च प्रदुष्टे शोणिते नृणाम् ||८|| कषायकटुतिक्ताल्परूक्षाहारादभोजनात् | हयोष्ट्रयानयानाम्बुक्रीडाप्लवनलङ्घनैः [२] ||९|| उष्णे चात्यध्ववैषम्याद्व्यवायाद्वेगनिग्रहात् [३] | वायुर्विवृद्धो वृद्धेन रक्तेनावारितः पथि ||१०|| कृत्स्नं सन्दूषयेद्रक्तं तज्ज्ञेयं वातशोणितम् | खुडं वातबलासाख्यमाढ्यवातं च नामभिः ||११|| lavaṇāmlakaṭukṣārasnigdhōṣṇājīrṇabhōjanaiḥ| klinnaśuṣkāmbujānūpamāṁsapiṇyākamūlakaiḥ||5|| kulatthamāṣaniṣpāvaśākādipalalēkṣubhiḥ| dadhyāranālasauvīraśuktatakrasurāsavaiḥ||6|| viruddhādhyaśanakrōdhadivāsvapnaprajāgaraiḥ| prāyaśaḥ sukumārāṇāṁ miṣṭānnasukhabhōjinām [1] ||7|| acaṅkramaṇaśīlānāṁ kupyatē vātaśōṇitam| abhighātādaśuddhyā ca praduṣṭē śōṇitē nr̥ṇām||8|| kaṣāyakaṭutiktālparūkṣāhārādabhōjanāt| hayōṣṭrayānayānāmbukrīḍāplavanalaṅghanaiḥ [2] ||9|| uṣṇē cātyadhvavaiṣamyādvyavāyādvēganigrahāt [3] | vāyurvivr̥ddhō vr̥ddhēna raktēnāvāritaḥ pathi||10|| kr̥tsnaṁ sandūṣayēdraktaṁ tajjñēyaṁ vātaśōṇitam| khuḍaṁ vātabalāsākhyamāḍhyavātaṁ ca nāmabhiḥ||11|| lavaNAmlakaTukShArasnigdhoShNAjIrNabhojanaiH | klinnashuShkAmbujAnUpamAMsapiNyAkamUlakaiH ||5|| kulatthamAShaniShpAvashAkAdipalalekShubhiH | dadhyAranAlasauvIrashuktatakrasurAsavaiH ||6|| viruddhAdhyashanakrodhadivAsvapnaprajAgaraiH | prAyashaH sukumArANAM miShTAnnasukhabhojinAm [1] ||7|| aca~gkramaNashIlAnAM kupyate vātaśonitam | abhighAtAdashuddhyA ca praduShTe shoNite nRuNAm ||8|| kaShAyakaTutiktAlparUkShAhArAdabhojanAt | hayoShTrayAnayAnAmbukrIDAplavanala~gghanaiH [2] ||9|| uShNe cAtyadhvavaiShamyAdvyavAyAdveganigrahAt [3] | vAyurvivRuddho vRuddhena raktenAvAritaH pathi ||10|| kRutsnaM sandUShayedraktaM tajj~jeyaM vātaśonitam | khuDaM vātabalAsAkhyamADhyavātaM ca nAmabhiH ||11|| Excess intake of salty, sour, pungent, alkalies and fatty substances, hot food, consumption of rotten and dried flesh, fleshes of aquatic animals like fish, animals living in the area where there are dense forest and heavy rainfall, cake of oil seeds after extraction of oil (pindyaka), raddish (Raphanus sativus), red gram, black gram, green vegetables, palala (gratted flesh), sugarcane, curd, sour gruel, sauvira and shukta (vinegar), butter milk, sura and asava (alcohol and medicinal preparations having high concentration of alcohol), intake of food inspite of indigestion (ajirna), incompatible food (viruddhahar), eating food before proper digestion of previous