Vatarakta Chikitsa
Chikitsa Sthana Chapter 29. Management of diseases involving vata and rakta
| Section/Chapter | Chikitsa Sthana Chapter 29 |
|---|---|
| Preceding Chapter | Vatavyadhi Chikitsa |
| Succeeding Chapter | Yonivyapat Chikitsa |
| Other Sections | Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana |
| Translator and commentator | Sati R., Deole Y. S. |
| Reviewer | Ram Manohar P., Kadlimatti S. |
| Editors | Ojha S.N., Deole Y.S., Basisht G. |
| Year of publication | 2020 |
| Publisher | Charak Samhita Research, Training and Skill Development Centre |
| DOI | 10.47468/CSNE.2020.e01.s06.030 |
Abstract
The chapter refers to vatashonita (or vatarakta), a condition caused by vitiated vata dosha and rakta dhatu. As the disease is caused by predominantly vitiated vata and rakta, it follows Vatavyadhi Chikitsa (vatika disorder). The manifestations 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 dosha and dhatu in each individual of unique Prakriti. This reflects each patient’s unique disease requiring specific personalized treatment which is unique to Ayurvedic system of management. The chapter has description of etiological factors along with types of vatashonita, purvarupa (prodromal symptoms), rupa (clinical features) of different types, rupa of dosha predominance, upadrava (complication) ,sadhya-asadhyatva (prognosis), treatment of different types of vatashonita, precautions during treatment as well as symptomatic treatment for relief in non-curable state of disease.
Keywords: Vata, rakta, gout, connective tissue diseases, inflammatory arthritis, polyarthritis, vasculitis.
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 doshaand 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 sukumaratva (youthful personality) is the characteristic feature of pitta Prakriti.
In vatashonita, there is abnormality in movements of vata dosha due to abnormality of rakta. It is a group of inflammatory rheumatic disorders covering gouty arthritis, rheumatoid arthritis, connective tissue disorders, inflammatory polyarthritis, vasculitis depending upon the site of vitiation.
The vitiated factors impair agni (digestion and metabolism) at jatharagni and dhatvagni level. In vatarakta, the vitiated vata dosha affects jatharagni to cause vishamagni and rakta dhatvagni. This impairment leads to increase in blood and serological parameters like uric acid, C-reactive protein etc. These can be used as biomarkers for assessment of efficacy of therapy.
In process of rakta-dhatvagni, sira (vessels) and kandara (tendons) are byproducts. Therefore, impairment of rakta-dhatvagni leads to involvement of deep vessels and connective tissues. This indicates vatarakta also covers diseases like vasculitis along with thrombosis and embolism, Thromboangiitis obliterans (Burger’s disease), and Raynaud’s disease.
The chapter explains various conditions of involvement of dosha, dushya and the site of vitiation. Treatment depends upon the assessment and correction of these factors causing the conditions.
Sanskrit Text, Transliteration and English Translation
Now we shall expound the chapter "Vatashonita (or vatarakta) Chikitsa" (Management of diseases involving vata and rakta). Thus said Lord Atreya. [1–2]
Agnivesha's query
हुताग्निहोत्रमासीनमृषिमध्येपुनर्वसुम् |
पृष्टवान् गुरुमेकाग्रमग्निवेशोऽग्निवर्चसम् ||३||
अग्निमारुततुल्यस्य संसर्गस्यानिलासृजोः |
हेतुलक्षणभैषज्यान्यथास्मै गुरुरब्रवीत् ||४||
After finishing his daily worship and yagna (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 etiology, symptomatology and treatment of disease (vatashonita) 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||
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), radish (Raphanus sativus), red gram, black gram, green vegetables, palala (grated 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 (viruddhahara), eating food before proper digestion of previous one (adhyashana), anger, sleeping in daytime and vigil during the night; in general the delicate persons who are indulged in sweet and delicious food substances and are not in habit of physical activities, the vata and shonita vitiates.
Due to injuries, not purifying the body (by shodhana karma) and indulged in consuming astringent, pungent, bitter, ruksha food items (grains of low nutritional content), starvation, traveling by horses, camels and carts, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges are responsible for vitiation of vata.
Due to etiological factors described earlier and obstruction in passage by vitiated rakta the vata aggravates, which again vitiates the rakta and known as vatashonita, having synonyms as khuda, vatabalasa and adhyavata. [5-11]
Sites of affliction
तस्य स्थानं करौ पादावङ्गुल्यः सर्वसन्धयः |
कृत्वाऽऽदौ हस्तपादे तु मूलं देहे विधावति ||१२||
Its sites are hands, feet, fingers and all other joints. At first it settles its root (initial involvement) in hands and feet and then spread all over the body. [12]
सौक्ष्म्यात् सर्वसरत्वाच्च पवनस्यासृजस्तथा |
तद्द्रवत्वात् सरत्वाच्च देहं गच्छन् सिरायनैः ||१३||
पर्वस्वभिहतं क्षुब्धं वक्रत्वादवतिष्ठते |
स्थितं पित्तादिसंसृष्टं तास्ताः सृजति वेदनाः ||१४||
करोति दुःखं तेष्वेव तस्मात् प्रायेण सन्धिषु |
भवन्ति वेदनास्तास्ता अत्यर्थं दुःसहा नृणाम् ||१५||
Due to subtleness and pervasiveness of vata, and liquidity and flowing property of rakta, they travel all over the body through blood vessels.
Near the parva sandhis (small joints of fingers), as blood vessels are in slanting pattern, the vitiated blood is stagnated there and thereafter the vitiated vata and rakta along with pitta etc. produce different types of vedana (unpleasant sensation like pain etc.) so that there are dukha (pain and other abnormal sensation) in the joints. The vedana (pain) is so severe, which is difficult to tolerate. [13–15]
Premonitory symptoms
स्वेदोऽत्यर्थं न वा कार्ष्ण्यं स्पर्शाज्ञत्वं क्षतेऽतिरुक् |
सन्धिशैथिल्यमालस्यं सदनं पिडकोद्गमः ||१६||
जानुजङ्घोरुकट्यंसहस्तपादाङ्गसन्धिषु |
निस्तोदः स्फुरणं भेदो गुरुत्वं सुप्तिरेव च ||१७||
कण्डूः सन्धिषु रुग्भूत्वा भूत्वा नश्यति चासकृत् |
वैवर्ण्यं मण्डलोत्पत्तिर्वातासृक्पूर्वलक्षणम् ||१८||
There is excessive or absence of perspiration, blackishness of the body, poor or lack of tactile sensation, high intensity of pain on trauma, laxity of joints, lassitude, malaise, appearance of boils, feeling of heaviness, numbness and itching in knee, thigh, waist, shoulder, hands, legs and other joints of the body, appearance of pain in the joints and abatement (without treatment), discoloration of body, appearance of mandala (circular skin lesions) are the premonitory symptoms of vatashonita. [16–18]
Types of vatarakta
उत्तानमथ गम्भीरं द्विविधं तत् प्रचक्षते |
त्वङ्मांसाश्रयमुत्तानं गम्भीरं त्वन्तराश्रयम् ||१९||
As this is said there are two types of vatashonita - uttana (superficial) and gambhira (deep). The uttana is located in twaka(skin) and mamsa dhatu (muscles) while the gambhira is located in the deep tissues. [19]
Clinical features of uttana vatarakta (superficial type)
कण्डूदाहरुगायामतोदस्फुरणकुञ्चनैः |
अन्विता श्यावरक्ता त्वग्बाह्ये ताम्रा तथेष्यते ||२०||
Symptoms of uttana vatashonita are itching, burning sensation, pain, stretching sensation, piercing pain, fasciculation, feeling of constricting and the color of skin becomes blackish, red or coppery. [20]
Clinical features of gambhira vatarakta (deep type)
गम्भीरे श्वयथुः स्तब्धः कठिनोऽन्तर्भृशार्तिमान्|
श्यावस्ताम्रोऽथवा दाहतोदस्फुरणपाकवान् ||२१||
रुग्विदाहान्वितोऽभीक्ष्णं वायुः सन्ध्यस्थिमज्जसु |
छिन्दन्निव चरत्यन्तर्वक्रीकुर्वंश्च वेगवान् ||२२||
करोति खञ्जं पङ्गुं वा शरीरे सर्वतश्चरन् |
सर्वैर्लिङ्गैश्च विज्ञेयं वातासृगुभयाश्रयम् ||२३||
Symptoms of gambhira vatashonita are – edema in the involved parts of the body, stiffness of joints, hardness of the part, severe pain inside, the color of the part involved becomes either blackish or coppery. There is burning sensation, pricking pain, fasciculation and finally the part become inflamed and ulcerated. When vata reaches sandhi, asthi dhatu and majja dhatu (joints, bones and bone marrow) it causes severe pain and burning sensation. The forcefully moving vayu having reached the joints causes cutting nature of pain whereby making them crooked, produces limping or lameness while moving all over the body. When the symptoms of both types – uttana and gambhira are present in a patient, it should be considered as ubhayashrita (superficial and deep both). [21–23]
Differential features as per dosha dominance
तत्र वातेऽधिके वा स्याद्रक्ते पित्ते कफेऽपि वा |
संसृष्टेषु समस्तेषु यच्च तच्छृणु लक्षणम् ||२४||
विशेषतः सिरायामशूलस्फुरणतोदनम् [१] |
शोथस्य कार्ष्ण्यं रौक्ष्यं च श्यावतावृद्धिहानयः ||२५||
धमन्यङ्गुलिसन्धीनां सङ्कोचोऽङ्गग्रहोऽतिरुक् |
कुञ्चनस्तम्भने शीतप्रद्वेषश्चानिलेऽधिके ||२६||
श्वयथुर्भृशरुक् [२] तोदस्ताम्रश्चिमिचिमायते |
स्निग्धरूक्षैः शमं नैति कण्डूक्लेदान्वितोऽसृजि [३] ||२७||
विदाहो वेदना मूर्च्छा स्वेदस्तृष्णा मदो भ्रमः |
रागः पाकश्च भेदश्च शोषश्चोक्तानि पैत्तिके ||२८||
स्तैमित्यं गौरवं स्नेहः सुप्तिर्मन्दा च रुक् कफे |
हेतुलक्षणसंसर्गाद्विद्याद्द्वन्द्वत्रिदोषजम् ||२९||
Now listen the clinical features found in predominance of vata, rakta, pitta, kapha or in combination of two or all three dosha. If vata is predominant, there is sirayama (stretching sensation in sira or veins), pain, fasciculation, pricking pain, swollen part becomes blackish , dry , increasing and decreasing grayish hue, constrictions of dhamani (arteries, ligaments) of fingers, stiffness of body parts and intense pain, constriction, stiffness and hatred to cold by the patient. These are the symptoms of vata predominance.
If rakta is predominant, there is swelling, severe pain of pricking nature, tingling sensation, colour of part of skin becomes coppery, not diminished by application of either unctuous or dry substances associated with itching and moistening over the part. If pitta is predominant, there is burning sensation over the part, pain, fainting, perspiration, thirst, narcosis, giddiness, redness of the part affected, pain of tearing nature, inflammation and atrophy of the part.
If kapha is predominant there is feeling of wetness of the skin, heaviness, unctuousness, numbness and mild pain. When there is predominance of two dosha or all three dosha there will be combination of symptoms and etiological factors as well. [24–29]
Prognosis
एकदोषानुगं साध्यं नवं, याप्यं द्विदोषजम् |
त्रिदोषजमसाध्यं स्याद्यस्य च स्युरुपद्रवाः ||३०||
When there is recent onset and predominance of single dosha, vatashonita is sadhya (curable). The disease arising from predominance of two dosha is yapya (palliable). The disease arising from predominance of all three dosha and has developed upadrava (complications) as well, is asadhya (incurable). [30]
Complications
अस्वप्नारोचकश्वासमांसकोथशिरोग्रहाः |
मूर्च्छायमदरुक्तृष्णाज्वरमोहप्रवेपकाः ||३१||
हिक्कापाङ्गुल्यवीसर्पपाकतोदभ्रमक्लमाः |
अङ्गुलीवक्रता स्फोटा दाहमर्मग्रहार्बुदाः ||३२||
एतैरुपद्रवैर्वर्ज्यं मोहेनैकेन वाऽपि यत् |
सम्प्रस्रावि विवर्णं च स्तब्धमर्बुदकृच्च यत् ||३३||
वर्जयेच्चैव सङ्कोचकरमिन्द्रियतापनम् |
अकृत्स्नोपद्रवं याप्यं साध्यं स्यान्निरुपद्रवम् ||३४||
Insomnia, anorexia, dyspnea, gangrene, stiffness in the head, fainting, narcosis, pain, thirst, fever, mental confusion, shivering, hiccup, lameness, eryseplas, inflammation and ulceration, pricking pain, giddiness, exhaustion, crook like deformity of fingers, appearance of blisters, burning sensation, stiffness in marma (vital part of the body), appearance of tumors, if these symptoms have appeared the disease is incurable. Even if there is mental confusion alone, then also the disease is incurable. The patient should not be treated if there is profuse discharge from the ulcer, discoloration, stiffness, the lesion has become like tumor, constriction of the part and damage to the senses.
If all the above complications are not present, then the disease is yapya (palliable). If the complications are not present, then it is curable. [31–34]
रक्तमार्गं निहन्त्याशु शाखासन्धिषु मारुतः |
निविश्यान्योन्यमावार्य वेदनाभिर्हरेदसून् ||३५||
Vitiated vata having reached the joints of extremities obstruct the way of the rakta and vitiated rakta obstructs the way of vata, thus causes the unbearable pain and leads to death. [35]
Treatment principles
तत्र मुञ्चेदसृक् शृङ्गजलौकःसूच्यलाबुभिः |
प्रच्छनैर्वा सिराभिर्वा यथादोषं यथाबलम् ||३६||
In this condition, the blood should let out with shringa (horn), jalauka (leech application), suchi (needle), alabu (hollow bitter gourd), pracchana (scratching) or siravyadha (venesection) depending on morbidity and strength of the patient. [36]
Modes of raktamokshana
रुग्दाहशूलतोदार्तादसृक् स्राव्यं जलौकसा |
शृङ्गैस्तुम्बैर्हरेत् सुप्तिकण्डूचिमिचिमायनात् ||३७||
Bloodletting should be done by applying the leech if one is suffering from discomfort, burning sensation, pain and pricking sensation. If the patient is suffering from tactile dysfunction, itching and tingling, his blood should let out with either shringa (animal horn) or alabu (hollow gourd). [37]
देशाद्देशं व्रजत् स्राव्यं सिराभिः प्रच्छनेन वा |
अङ्गग्लानौ न तु स्राव्यं रूक्षे वातोत्तरे च यत् [४] ||३८ ||
If the symptoms and complications in vatashonita are not localised to a specific part rather are of fleeting nature, the blood should be let out with siravyadha (venesection) or by pracchana. In case if there are angaglani (anga shosha i.e.atrophy), dryness, and other symptoms of vata dominance, the bloodletting should not be done. [38]
Complications of blood letting in vata dominant condition
गम्भीरं श्वयथुं स्तम्भं कम्पं स्नायुसिरामयान् |
ग्लानिं चापि ससङ्कोचां कुर्याद्वायुरसृक्क्षयात् ||३९||
खाञ्ज्यादीन् वातरोगांश्च मृत्युं चात्यवसेचनात् |
कुर्यात्तस्मात् प्रमाणेन स्निग्धाद्रक्तं विनिर्हरेत् ||४०||
Blood loss due to blood letting may cause aggravation of vata dosha, leading to deep swelling, stiffness, tremors, disorders of sira and snayu (blood vessels and ligaments), debility and constriction of the part. If there is excessive blood loss, the complications like limping and other vāta disorders and even death will occur. Hence one should let the blood out in proper quantity, after proper oleation. [39–40]
General principles of management
विरेच्यः स्नेहयित्वाऽऽदौ स्नेहयुक्तैर्विरेचनैः |
रूक्षैर्वा मृदुभिः शस्तमसकृद्वस्तिकर्म च ||४१||
सेकाभ्यङ्गप्रदेहान्नस्नेहाः प्रायोऽविदाहिनः |
वातरक्ते प्रशस्यन्त ... |४२|
After proper oleation, vatarakta patient shall be treated with mild therapeutic purgation with unctuous substances or with dry substances (in case of excess oleated patient). After purgation, the patient should be given frequent basti (enema of medicated substances) including anuvasana basti (unctuous enema) and niruha basti (enema made from decoction of medicinal herbs). Besides fomentation, massage, ointments, food and sneha (unctuous substances) be given to the patient which do not cause burning sensation. Now listen; specific remedies. [41–42]
Specific treatment
……विशेषं तु निबोध मे||४२||
बाह्यमालेपनाभ्यङ्गपरिषेकोपनाहनैः| विरेकास्थापनस्नेहपानैर्गम्भीरमाचरेत् ||४३||
सर्पिस्तैलवसामज्जापानाभ्यञ्जनबस्तिभिः |
सुखोष्णैरुपनाहैश्च वातोत्तरमुपाचरेत् ||४४||
विरेचनैर्घृतक्षीरपानैः सेकैः सबस्तिभिः |
शीतैर्निर्वापणैश्चापि रक्तपित्तोत्तरं जयेत् ||४५||
वमनं मृदु नात्यर्थं स्नेहसेकौ विलङ्घनम् |
कोष्णा लेपाश्च शस्यन्ते वातरक्ते कफोत्तरे ||४६||
In case of uttana vatashonita affecting superficial tissues only, the patient should be treated with alepana (affected part is covered with medicinal paste), abhyanga (massage), parisheka (bathing in warm decoction or unctuous substances) and upanaha (application of poultice).
In the case of gambhira vatarakta the patient should be treated with purgation, asthapana basti (enema with decoction of medicinal plants) and snehapana(drinking medicated oil/ghee).
In the disease where the vata is predominant, one should over come the disease with medicated ghee, taila, vasa, majja (ghee, oil, fat, and bone marrow of animals) either by intake or massage or enema and the diseased part should be treated with warm upanaha (warm poultice).
Where the rakta and pitta both are predominant, patient should be treated by mild purgation, after ghrita pana (intake of medicated ghee), intake of milk, bathing in decoction made from medicinal plants and basti (enema). The rakta-pitta dominance should be treated with cold and refrigerant alepa (paste of herbs).
Where the kapha is predominant, in patient of vatarakta he should be treated with mild emesis and avoid excessive oleation, sudation and fasting. Lukewarm lepa (pastes of herbs) are useful. [43–46]
कफवातोत्तरे शीतैः प्रलिप्ते वातशोणिते |
दाहशोथरुजाकण्डूविवृद्धिः स्तम्भनाद्भवेत् ||४७||
रक्तपित्तोत्तरे चोष्णैर्दाहः क्लेदोऽवदारणम् |
भवेत्तस्माद्भिषग्दोषबलं बुद्ध्वाऽऽचरेत्क्रियाम् ||४८||
In the patients of vatarakta with vata-kapha predominance, if cold pralepa is applied then there will be complications like burning sensation, swelling of the part, pain and itching due to stasis of the dosha, like wise in the patients suffering from vatarakta with rakta and pitta predominance, if are applied with ushna dravya will cause daha (burning sensation), kleda (moistening) and tearing of the skin. Therefore, in cases of vatarakta, the physician should apply the treatment measures after well considering the bala (strength) of the dosha. [47–48]
Contra-indications for vatarakta
दिवास्वप्नं ससन्तापं व्यायामं मैथुनं तथा |
कटूष्णं गुर्वभिष्यन्दि लवणाम्लं च वर्जयेत् ||४९||
The patient of vatarakta should abstain from day sleep, exposure to heat, excessive physical exertion, coitus, eating of pungent, salty, sour, ushna, guru (difficult to digest) and abhishyandi food (food articles which after consumption are responsible for the excessive secretions in the body) substances. [49]
Dietary regimen
पुराणा यवगोधूमनीवाराः शालिषष्टिकाः |
भोजनार्थं रसार्थं वा विष्किरप्रतुदा हिताः ||५०||
आढक्यश्चणका मुद्गा मसूराः समकुष्ठकाः |
यूषार्थं बहुसर्पिष्काः प्रशस्ता वातशोणिते ||५१|
Old barley, wheat, nevara, shali and shashtika dhanya (special qualities of red rice) are good to eat and soup of flesh of vishkira (birds which scratch the ground) and pratuda (birds which pick the food and eat like pigeon) or soup of pulses, pea, bengal gram, lentils and makushtha (motha) can be taken by adding plenty of ghee, by the patients of vatarakta. [50–51]
सुनिषण्णकवेत्राग्रकाकमाचीशतावरी |
वास्तुकोपोदिकाशाकं शाकं सौवर्चलं तथा ||५२||
घृतमांसरसैर्भृष्टं शाकसात्म्याय दापयेत् |
व्यञ्जनार्थं, तथा गव्यं माहिषाजं पयो हितम् ||५३||
इति सङ्क्षेपतः प्रोक्तं वातरक्तचिकित्सितम् |
एतदेव पुनः सर्वं व्यासतः सम्प्रवक्ष्यते ||५४||
Green vegetables like sunishnaka (Marsilia minula), vetagra (new buddings of Salix caprea), kakmachi (Solanaum nigrum) buddings of shatavari (new buddings of Asparagus racesmosa), vastuka (Chemopodium album), upodika and sauvarchala (Gynandropis pentaphylla), cooked with either ghee or mamsa rasa (soup of fleshes) can be given to the patients who are suited for these and followed by intake of milk of cow, buffaloes, or goats is beneficial. Thus, the treatment of vatarakta is said to be in brief, the same will be said again in details. [52–54]
Various formulations
श्रावणीक्षीरकाकोलीजीवकर्षभकैः समैः |
सिद्धं समधुकैः सर्पिः सक्षीरं वातरक्तनुत् ||५५||
Sravani (Gorakha mundi), kshirakakoli, jeevaka, rishabhaka and madhuka are to be taken in equal quantity, after crushing these all, the kalka (paste) to be cooked with cow’s milk and ghee, this sravani ghrita alleviates vatarakta. [55]
बलामतिबलां मेदामात्मगुप्तां शतावरीम् |
काकोलीं क्षीरकाकोलीं रास्नामृद्धिं च पेषयेत् ||५६||
घृतं चतुर्गुणक्षीरं तैः सिद्धं वातरक्तनुत् |
हृत्पाण्डुरोगवीसर्पकामलाज्वरनाशनम् ||५७||
Bala, atibala, meda, shatavari, atmagupta, kakoli, kshirakakoli, rasna, riddhima is to be taken in equal quantity and crushed then take one part kalka, four times ghee and milk and mix it and carryout snehasiddhi. This baladi ghrita alleviates vatarakta, hridroga (Cardiac disorders), pandu (anemia), visarpa (erysepales), kamala (jaundice) and jwara (fever). [56–57]
Parushaka ghee
त्रायन्तिकातामलकीद्विकाकोलीशतावरी |
कशेरुकाकषायेण कल्कैरेभिः पचेद्धृतम् ||५८||
दत्त्वा परूषकाद्राक्षाकाश्मर्येक्षुरसान् समान् |
`पृथग्विदार्याः स्वरसं तथा क्षीरं चतुर्गुणम् ||५९||
एतत् प्रायोगिकं सर्पिः पारूषकमिति स्मृतम् |
वातरक्ते क्षते क्षीणे वीसर्पे पैत्तिके ज्वरे ||६०||
इति पारूषकम घृतं
Decoction of trayamana, tamalaki (Phyllinthus niruri), kakoli, kshirkakoli, shatavari and kasheru (Scirpus kysoor) is to be prepared by using paste of same drugs and decoction of all to be taken with juice of parushaka (Grewia asciatica), draksha (Vitis vinifera), kashmarya (Gmelina arboria), ikshu (Saccharum officinarium) and vidarikanda (Pueraria tuberose) are to be taken in equal quantity. Add one part of kalka, four times ghee, five times juice, and sixteen times cow’s milk and then cook it till the liquid part is dried, the ghee is separated. This parushaka ghrita alleviates vātarakta, wasting due to injury or trauma, visarpa and paittika jwara. [58–60]
Jivaniya ghee
द्वे पञ्चमूले वर्षाभूमेरण्डं सपुनर्नवम् |
मुद्गपर्णीं महामेदां माषपर्णीं शतावरीम् ||६१||
शङ्खपुष्पीमवाक्पुष्पीं रास्नामतिबलां बलाम् |
पृथग्द्विपलिकं कृत्वा जलद्रोणे विपाचयेत् ||६२||
पादशेषे समान् क्षीरधात्रीक्षुच्छागलान् रसान् |
घृताढकेन संयोज्य शनैर्मृद्वग्निना पचेत् ||६३||
कल्कानावाप्य मेदे द्वे काश्मर्यफलमुत्पलम् |
त्वक्क्षीरीं पिप्पलीं द्राक्षां पद्मबीजं पुनर्नवाम् ||६४||
नागरं क्षीरकाकोलीं पद्मकं बृहतीद्वयम् |
वीरां शृङ्गाटकं भव्यमुरुमाणं निकोचकम् ||६५||
खर्जूराक्षोटवाताममुञ्जाताभिषुकांस्तथा |
एतैर्घृताढके सिद्धे क्षौद्रं शीते प्रदापयेत् ||६६||
सम्यक् सिद्धं च विज्ञाय सुगुप्तं सन्निधापयेत् |
कृतरक्षाविधिं चौक्षे प्राशयेदक्षसम्मितम् ||६७||
पाण्डुरोगं ज्वरं हिक्कां स्वरभेदं भगन्दरम् |
पार्श्वशूलं क्षयं कासं प्लीहानं वातशोणितम् ||६८||
क्षतशोषमपस्मारमश्मरीं शर्करां तथा |
सर्वाङ्गैकाङ्गरोगांश्च मूत्रसङ्गं च नाशयेत् ||६९||
बलवर्णकरं धन्यं वलीपलितनाशनम् |
जीवनीयमिदं सर्पिर्वृष्यं वन्ध्यासुतप्रदम् ||७०||
Both laghu and brihad panchamula (dashmula), varshabhu (Trianthema portulacastrum), eranda, punarnava, mudgaparni (Phaseolus trilobus), mahameda, mashaparni (Teramnus labialis), shatavari, shankhapushpi, avakpushpi, rasna (Pluchea lanceolata), bala, atibala, are to be taken 80 gm each and crushed then boiled in one drone water (approximately 10.24 litre) when the water is reduced to one fourth then liquid portion is taken away. Cow’s milk, amalaki (Phyllanthus emblica), sugarcane and soup of goat meat each to be taken in equal quantity of decoction. Milk, decoction, amalaki juice, sugarcane juice and meat soup are mixed and then added one adhaka (2.56 kg) ghee and then cooked in mild heat. Meda, mahameda, fruit of kashmarya, utpalam, tvakkshiri (Bambusa arundinacia), pippali (Piper longum), draksha (Vitis vinifera), padmabeeja (Nelumbium speciosum), punarnava, brihati (Solanum indicum), kantakari,(Solanum xanthocarpum), vidarikanda, shringataka (Trapa bispinosa), bhavya, urumana (Prunna armeniaca), nikocha (roots of Alangium lamarckii thwaites), kharjura (Phoenix dactylifera), akshothaka (Juglans regia), vatama (Prunus amygdalus), munjata (Pistacia vera), and abhishuka (Pinus gerardiana) are to be taken in equal quantity and crushed to powder and about 64 gm of the powder is added with them when the ghritasiddhi is observed then ghrita should be separated, allow to cool and then 640 gm honey should be added to it. The preparation should be stored well and protected in a clean container. After observing rituals the jeevaniya ghrita in the dose of one tola (about 10 gm) be given to the patient. This ghrita alleviates pandu (anemia), jwara (fever), hikka (hiccup), svarabheda (abnormality of voice), bhagandara (fistula in ano) parshvashula (chest pain), kshaya (tuberculosis), kasa (cough), pleeha (disorders of spleen), vatarakta, urakshata (internal injury of chest), shosha (wasting), apasmara (epilepsy), ashmari (urinary calculus), sharkara (urinary gravels), generalized or localized vātik disorders and mutra sanga (retention of urine). This ghrita promotes strength, complexion and is auspicious, it also removes wrinkles and graying of hairs, is aphrodisiac and may provide progeny even to a sterile woman. [61–70]
द्राक्षामधु(धू)कतोयाभ्यां सिद्धं वा ससितोपलम् |
पिबेद्धृतं तथा क्षीरं गुडूचीस्वरसे शृतम् ||७१||
Patient of vatarakta should take ghee cooked with decoction of draksha (vitis vinifera) and madhuka (Bassia latifolia), along with sugar candy or be given with milk, which is well boiled with juice of guduchi (Tinospora cordifolia). [71]
जीवकर्षभकौ मेदामृष्यप्रोक्तां शतावरीम् |
मधुकं मधुपर्णीं च काकोलीद्वयमेव च ||७२||
मुद्गमाषाख्यपर्णिन्यौ दशमूलं पुनर्नवाम् |
बलामृताविदारीश्च साश्वगन्धाश्मभेदकाः ||७३||
एषां कषायकल्काभ्यां सर्पिस्तैलं च साधयेत् |
लाभतश्च वसामज्जधान्वप्रातुदवैष्किरम् ||७४||
चतुर्गुणेन पयसा तत् सिद्धं वातशोणितम् |
सर्वदेहाश्रितं हन्ति व्याधीन् घोरांश्च वातजान् ||७५||
Jeevaka, rishabhaka, meda, rishyaprokta, shatavari, madhuka, madhuparni, kakoli, kshirakakoli mudgaparni (Phaseolus trilobus), mashaparni (Teramnus labialis), dashamula, punarnava, bala, amrita, vidari, aswagandha and pasanabheda (Saxifraga lingulata), decoction of all these substances is made and again paste of these substances is added to decoction, then oil and ghee cooked along with four times milk, vasā (fat) and majja (marrow) of pecking and gallinaceous birds living in dhanva (dessert) area may be added. Prepared ghee alleviates vatarakta and severe vātik disorders pertaining to all over the body. [72–75]
स्थिरा श्वदंष्ट्रा बृहती सारिवा सशतावरी |
काश्मर्याण्यात्मगुप्ता च वृश्चीरो द्वे बले तथा ||७६||
एषां क्वाथे चतुःक्षीरं पृथक् तैलं पृथग्घृतम् |
मेदाशतावरीयष्टिजीवन्तीजीवकर्षभैः ||७७||
पक्त्वा मात्रा ततः क्षीरत्रिगुणाऽध्यर्धशर्करा |
खजेन मथिता पेया वातरक्ते त्रिदोषजे ||७८||
Oil and ghee should be cooked separately with decoction of sthira (Desmodium gangeticum), shvadamishtra (Tribulus terrestris), brihati (Solanum indicum), sariva, shatavari, kashmarya, kapikachhu, vrischira (Boerhavia diffusa), bala and atibala with four times milk and paste of meda, shatavari, madhuyashti, jivanti, jivaka and rishabhaka. Prepared yamaka (combination of two sneha) is kept. One part of yamaka (about 12 ml), three times milk and one and half times sugar mixed together and churned with the churning stick. This mixture should be given to the patient suffering from tridoshaja vatarakta. [76-78]
तैलं पयः शर्करां च पाययेद्वा सुमूर्च्छितम् |
सर्पिस्तैलसिताक्षौद्रैर्मिश्रं वाऽपि पिबेत् पयः ||७९||
Oil, sugar and milk mixed together and churned should be given to the patient or ghee, taila, sugar and honey mixed with milk should be given to the patients of vatarakta (tridoshaja). [79]
अंशुमत्या शृतः प्रस्थः पयसो द्विसितोपलः |
पाने प्रशस्यते तद्वत् पिप्पलीनागरैः शृतः ||८०||
Milk (640 ml) boiled in decoction of shalaparni and added with 80 gm sugar is recommended for drink. Like wise milk boiled with pippali and shunthi is useful in vatarakta. [80]
बलाशतावलीरास्नादशमूलैः सपीलुभिः |
श्यामैरण्डस्थिराभिश्च वातार्तिघ्नं शृतं पयः ||८१||
Milk boiled with bala, shatavari, rasna, dashamula, peelu (Salva dorapersica), shyama, eranda and shalaparni, alleviates vatika disorders (and vatarakta) [81]
Anulomana treatment
धारोष्णं मूत्रयुक्तं वा क्षीरं दोषानुलोमनम् |
पिबेद्वा सत्रिवृच्चूर्णं पित्तरक्तावृतानिलः ||८२||
For the anulomana of the dosha (downward movement of the mala dosha), dharoshana dugdha (fresh warm milk) mixed with mutra (cow’s urine) should be given to drink, if the vata is avrita by the pitta and rakta, the patient should be given fresh warm milk mixed with trivrita churna to drink. [82]
Purgative formulations
क्षीरेणैरण्डतैलं वा प्रयोगेण पिबेन्नरः |
बहुदोषो विरेकार्थं जीर्णे क्षीरौदनाशनः ||८३||
कषायमभयानां [१] वा घृतभृष्टं पिबेन्नरः |
क्षीरानुपानं त्रिवृताचूर्णं द्राक्षारसेन वा ||८४||
In the patient whom dosha are excessively aggravated should be given eranda taila (castor oil) with milk for purgation. After digestion, the patient should be given rice with milk.
One should be given decoction of abhaya (Terminalia chebula) fried with ghee of trivrita churna (powder of Operculina turpethum) either with milk or grape juice. [83–84]
काश्मर्यं त्रिवृतां द्राक्षां त्रिफलां सपरूषकाम् |
शृतं पिबेद्विरेकाय लवणक्षौद्रसंयुतम् ||८५||
त्रिफलायाः कषायं वा पिबेत् क्षौद्रेण संयुतम् |
धात्रीहरिद्रामुस्तानां कषायं वा कफाधिकः ||८६||
For purgation, decoction of kashmarya, trivrita, draksha and parushaka (Grewia asiatica) added with salt and honey should be given.
One should take decoction of triphala added with honey or decoction of amalaki, haridra and musta added with honey to the patients of kapha predominant vatarakta. [85–86]
योगैश्च कल्पविहितैरसकृत्तं विरेचयेत् |
मृदुभिः स्नेहसंयुक्तैर्ज्ञात्वा वातं मलावृतम् ||८७||
In case when vata is avrita with mala (waste products of the body) the patient should be given mridu virechana (mild purgatives) mentioned in Kalpa Sthana along with sneha (unctuous substances). [87]
Importance of basti
निर्हरेद्वा मलं तस्य सघृतैः क्षीरबस्तिभिः |
न हि बस्तिसमं किञ्चिद्वातरक्तचिकित्सितम् ||८८||
Mala (excrements) of the patients of vatarakta should be eliminated by administrating basti (enema) of ksheera (milk) mixed with ghrita. There is no treatment of vatarakta efficient as basti. [88]
बस्तिवङ्क्षणपार्श्वोरुपर्वास्थिजठरार्तिषु |
उदावर्ते च शस्यन्ते निरूहाः सानुवासनाः ||८९||
If the patient is suffering from pain in pelvis, groin, flanks, thighs, small joints, bones, upper abdomen and if there is udavarta, niruha basti (enema of decoction made from medicinal herbs) along with anuvasna basti(unctuous enema) are recommended. [89]
दद्यात्तैलानि चेमानि बस्तिकर्मणि बुद्धिमान् |
नस्याभ्यञ्जनसेकेषु दाहशूलोपशान्तये ||९०||
The wise physician should administer the following oils as basti (enema) or nasya (nasal medication), abhyanga (massage) and parisheka to alleviate daha (burning sensation) and pain. [90]
Madhuparnyadi tailam
मधुयष्ट्यास्तुलायास्तु [१] कषाये पादशेषिते |
तैलाढकं समक्षीरं पचेत् कल्कैः पलोन्मितैः ||९१||
शतपुष्पावरीमूर्वापयस्यागुरुचन्दनैः |
स्थिराहंसपदीमांसीद्विमेदामधुपर्णिभिः ||९२||
काकोलीक्षीरकाकोलीतामलक्यृद्धिपद्मकैः |
जीवकर्षभजीवन्तीत्वक्पत्रनखवालकैः ||९३||
प्रपौण्डरीकमञ्जिष्ठासारिवैन्द्रीवितुन्नकैः |
चतुष्प्रयोगात्तद्धन्ति तैलं मारुतशोणितम् ||९४||
सोपद्रवं साङ्गशूलं सर्वगात्रानुगं तथा |
वातासृक्पित्तदाहार्तिज्वरघ्नं बलवर्णकृत् ||९५||
इति मधुपर्ण्यादितैलम् |
Decoction of four kg madhuyashti (Glycyrrhiza glabra) should be prepared and than 2.56 kg oil with equal quantity of milk be cooked with decoction in mild flame, during cooking kalka ( paste ) of shatapushpa, shatavari, murva, payasya (Holostemma rheedianum), aguru, chandana, shalparni, hansapadi(Adiantum lunulatum), mansi, meda, mahameda, madhuparni (Tinospora cordifolia), kakoli, kshirakakoli, tamalaki, ṛiddhi,padmaka, jeevaka, risbhaka, jeevanti (Leptadenia reticulate), twak, patra, nakha (Helix aspera), sugandhabala (Pabonia podorata), prapondarika (Cassia absus), manjishtha, sariva, aindri (Citrullus colocynthis) and vitunnaka (Coriandrum sativum) be added. This madhuparnayadi tailam be used in four ways pana, nasya, basti and snehana (intake, nasal medication, enema of medicated substance and massage with medicated oils) alleviates vatarakta associated with complications, pain in the body and disease spread all over the body. This oil is very effective in vatarakta with daha (burning sensation) caused by pitta and fever, it also promotes strength of the body and complexion. [91–95]
Sukumaraka tailam
मधुकस्य शतं द्राक्षा खर्जूराणि परूषकम् |
मधूकौदनपाक्यौ च प्रस्थं मुञ्जातकस्य च ||९६||
काश्मर्याढकमित्येतच्चतुर्द्रोणे पचेदपाम् |
शेषेऽष्टभागे पूते च तस्मिंस्तैलाढकं पचेत् ||९७||
तथाऽऽमलककाश्मर्यविदारीक्षुरसैः समैः |
चतुर्द्रोणेन पयसा कल्कं दत्त्वा पलोन्मितम् ||९८||
कदम्बामलकाक्षोटपद्मबीजकशेरुकम् |
शृङ्गाटकं शृङ्गवेरं लवाणं पिप्पलीं सिताम् ||९९||
जीवनीयैश्च संसिद्धं क्षौद्रप्रस्थेन संसृजेत् |
नस्याभ्यञ्जनपानेषु बस्तौ चापि नियोजयेत् ||१००||
वातव्याधिषु सर्वेषु मन्यास्तम्भे हनुग्रहे |
सर्वाङ्गैकाङ्गवाते च क्षतक्षीणे क्षतज्वरे ||१०१||
सुकुमारकमित्येतद्वातास्रामयनाशनम् |
स्वरवर्णकरं तैलमारोग्यबलपुष्टिदम् ||१०२||
इति सुकुमारकतैलम् |
Madhuka 100 pala (about 4 kg) draksha, kharjura (Phoenix dactylifera), parushaka, madhuka (Bassia latifolia), audanapaki (abutilon indicum), munjataka (Saccharum munja) each one pala (400 gm) kashmarya, one adhaka (about 2.56 kg) all ingredients to be crushed and boiled in 40.96 liters of water, reduced to one eighth and filtered, with the decoction 2.56 kg oil, equal quantity of the juices of amalaki, kashmarya, vidari (Pueraria tuberosa) and sugarcane alongwith 40.96 liters of milk and 40 gms each of paste of following drugs– kadamba (Anthocephalus kadama),amalaki, akshota (Juglans regia), lotus seeds (Nelumbium speciosum), kasheruka (Scirpus kysoor), shringataka (Trapa bispinosa), shunthi, saindhava, lavana (rock salt), pippali, sarkara (cane sugar), and herbs of jeevaniya gana (Ca. Su 4 /8-1) to be mixed and cooked. Then oil is prepared it allow to cool and then honey 640 gm should be added with and kept. This sukumaraka taila should be used in the form of nasyam (nasal medication), abhyanga (massage with medicated oils), pāna (intake) and basti (enema) in all vata disorders, manyastambha (torticollis), hanugraha (lock jaw) sarvanga vata (generalized vata), ekanga vata (localized vata), kshatakshina (wasting caused by injury) and kshataja jwara (fever caused by wound) and it alleviates vatarakta; promotes voice, complexion, health, strength and corpulence of the body. [96–102]
This ends explanation of sukumarakam tailam.
Amritadya tailam
गुडूचीं मधुकं ह्रस्वं पञ्चमूलं पुनर्नवाम् |
रास्नामेरण्डमूलं च जीवनीयानि लाभतः ||१०३||
पलानां शतकैर्भागैर्बलापञ्चशतं तथा |
कोलबिल्वयवान्माषान्कुलत्थांश्चाढकोन्मितान् ||१०४||
काश्मर्याणां सुशुष्काणां द्रोणं द्रोणशतेऽम्भसि |
साधयेज्जर्जरं धौतं चतुर्द्रोणं च शेषयेत् ||१०५||
तैलद्रोणं पचेत्तेन दत्त्वा पञ्चगुणं पयः |
पिष्ट्वा त्रिपलिकं चैव चन्दनोशीरकेशरम् ||१०६||
पत्रैलागुरुकुष्ठानि तगरं मधुयष्टिकाम् |
मञ्जिष्ठाष्टपलं चैव तत् सिद्धं सार्वयौगिकम् ||१०७||
वातरक्ते क्षतक्षीणे भारार्ते क्षीणरेतसि |
वेपनाक्षेपभग्नानां सर्वाङ्गैकाङ्गरोगिणाम् ||१०८||
योनिदोषमपस्मारमुन्मादं खञ्जपङ्गुताम् |
हन्यात् प्रसवनं [१] चैतत्तैलाग्र्यममृताह्वयम् ||१०९||
इत्यमृताद्यं तैलम् |
Guduchi, madhuka, laghu panchamula (shalparni, prishnaparni, choti kateri, badi kateri, gokshura), punarnava, rasna, eranda moola, herbs of jeevaniya gana (each 4 kg), bala (20 kg), kola (Zizyphus jujuba), bilwa, yava, masha (black gram) and kulattha (horse shoe gram ) each 2.56 kg, dried fruit of kashmarya, all substances well crushed and then boiled in 1024 liters water and reduced to about 40.96 liters and filtered, now 10.24 liters oil and five times (about 56.20 liters ) milk is added with decoction and cooked alongwith the paste of chandana, usheera (Andropogon muricatus), keshara, tejapatra, aguru, kustha, tagara, madhuyashti and manjishtha each 120 gm be added with. After well cooked as per sneha siddhi lakshana the oil is separated. This oil known as amritadya taila is very effective in vatarakta, kshatakshina (wasting caused by injury), affliction by carrying heavy load, ksheena sukra (weakness/ dyskinesia of semen), vepana (tremors), convulsions, fractures and generalized or localized diseases. It also alleviates yonidosha (diseases of female reproductive system), apasmara (epilepsy), unmada (insanity), khanjapangutam (limping and lameness) and makes possible easy delivery of foetus. [103–109]
This explains amritadyam tailam.
Mahapadma tailam
पद्मवेतसयष्ट्याह्वफेनिलापद्मकोत्पलैः |
पृथक्पञ्चपलैर्दर्भबलाचन्दनकिंशुकैः ||११०||
जले शृतैः पचेत्तैलप्रस्थं सौवीरसम्मितम् |
लोध्रकालीयकोशीरजीवकर्षभकेशरैः ||१११||
मदयन्तीलतापत्रपद्मकेशरपद्मकैः |
प्रपौण्डरीककाश्मर्यमांसीमेदाप्रियङ्गुभिः ||११२||
कुङ्कुमस्य पलार्धेन मञ्जिष्ठायाः पलेन च |
महापद्ममिदं तैलं वातासृग्ज्वरनाशनम् ||११३||
इति महापद्मं तैलम् |
Padma, vetasa (Salix caprea), madhuyashti, phenila (Sapindus mukorossi), kamala, utapala, bala, chandana and kinshuka (butea frondośa) each 200 gm crushed and decocted in water. With this decoction 640 gm of oil should be cooked with equal quantity of sauvira (type of vinegar) and paste of lodhra, kaliyaka (Barberis aristata), ushira, jeevaka, risbhaka (in lieu Pueraria tuberosa) nagakeshara, padmaka, prapaundrika, kashmarya, mansi, meda, priyangu and kumkuma 20 gm and manjishta 40 gm. This mahapadma taila alleviates vatarakta and jwara (fever). [110-113]
This ends explanation of mahapadma tailam.
Khuddaka padmaka tailam
पद्मकोशीरयष्ट्याह्वरजनीक्वाथसाधितम् |
स्यात् पिष्टैः सर्जमञ्जिष्ठावीराकाकोलिचन्दनैः ||११४||
खुड्डाकपद्मकमिदं तैलं वातास्रदाहनुत् |११५|
इति खुड्डाकपद्मकं तैलम् |
Oil fortified with the decoction of padmaka, ushira, madhuyashti, and haridra along with the paste of sarja (Shorea robusta) manjishtha, veera, kakoli, and chandana. This khuddakapadmaka taila alleviates vatarakta and daha (burning sensation) [114–115]
This ends explanation of khuddakapadmaka tailam.
Shatapaki madhuka tailam
शतेन यष्टिमधुकात् साध्यं दशगुणं पयः ||११५||
तस्मिंस्तैले चतुर्द्रोणे मधुकस्य पलेन तु |
सिद्धं मधुककाश्मर्यसैर्वा वातरक्तनुत् ||११६||
मधुपर्ण्याः पलं पिष्ट्वा तैलप्रस्थं चतुर्गुणे|
क्षीरे साध्यं शतं कृत्वा तदेवं मधुकाच्छते ||११७||
सिद्धं देयं त्रिदोषे [१] स्याद्वातास्रे श्वासकासनुत् |
हृत्पाण्डुरोगवीसर्पकामलादाहनाशनम् ||११८||
इति शतपाकं मधुकतैलम् ||
4 kg of madhuyaśti is boiled in ten times of milk (40 litres) and reduced to 10 litres, with this oil 40.96 litres should be cooked with the paste of 40 gm of madhuka or juice of madhuka and kashmarya. This taila alleviates vatarakta.
Paste of madhuparni 40 gm, oil 640 gm should be cooked with the paste of madhuparni 40 gm and 2.56 liter milk and taila is obtained. This should be repeated hundred times, adding paste of madhuka 40 gms each times. It should be used in tridoshaja vatarakta and is also beneficial in dyspnea, cough, cardiac disorders, anemia, erysepales, jaundice and burning sensation. [115–118]
This ends explanation of shatapakam madhuka tailam.
Shatapaki or sahastrapaki bala tailam
बलाकषायकल्काभ्यां तैलं क्षीरसमं पचेत् |
सहस्रं [१] शतवारं वा वातासृग्वातरोगनुत् ||११९||
रसायनमिदं श्रेष्ठमिन्द्रियाणां प्रसादनम् |
जीवनं बृंहणं स्वर्यं शुक्रासृग्दोषनाशनम् ||१२०||
इति सहस्रपाकं शतपाकं वा बलातैलम् |
Take decoction of bala, paste of bala, milk and oil and cook till siddha lakshana is observed. The process should be repeated either hundred or thousand times. This bala taila alleviates vatarakta and vata disorders. It is an excellent rasayana, which is very good promoter of sensual well being, vitaliser, promote body build, very well for voice, and alleviates shukra dhatu elated as well as menstrual disorders. [119–120]
गुडूचीरसदुग्धाभ्यां तैलं द्राक्षारसेन वा |
सिद्धं मधुककाश्मर्यरसैर्वा वातरक्तनुत् ||१२१||
आरनालाढके तैलं पादसर्जरसं शृतम् |
प्रभूते खजितं तोये ज्वरदाहार्तिनुत् परम् ||१२२||
Oil cooked with the juice of the guduchi and milk or with grape juice or with the juice of madhuka and kashmarya alleviates vatarakta.
Oil 650 ml cooked in l2.56 liters of sour gruel with one fourth sarja rasa (resin of Shorea robusta) and then churned in plenty of water and separated. This oil is an excellent alleviator of discomfort of jwara and daha (fever and burning sensation). [121–122]
Pinda tailam
समधूच्छिष्टमाञ्जिष्ठं ससर्जरससारिवम् |
पिण्डतैलं तदभ्यङ्गाद्बातरक्तरुजापहम् ||१२३||
इति पिण्डतैलम् |
Oil cooked with the honey bee wax, manjistha, sarja rasa (resin of shorea robusta) and sariva. This oil known as pinda taila, if applied on the body alleviates pain in vatarakta. [123]
This ends the explanation of pinda tailam.
Dashamula processed milk
दशमूलशृतं क्षीरं सद्यः शूलनिवारणम् |
परिषेकोऽनिलप्राये तद्वत् कोष्णेन सर्पिषा ||१२४||
The milk boiled with decoction of dashamula alleviates pain immediately. Application of warm ghee on the body may remove vatika shula (pain caused by vata). [124]
Various external applications
स्नेहैर्मधुरसिद्धैर्वा चतुर्भिः परिषेचयेत् |
स्तम्भाक्षेपकशूलार्तं कोष्णैर्दाहे तु शीतलैः ||१२५||
तद्वद्गव्याविकच्छागैः क्षीरैस्तैलविमिश्रितैः |
क्वाथैर्वा जीवनीयानां पञ्चमूलस्य वा भिषक् ||१२६||
In case, if the patient of vatarakta is suffering from stambha (stiffness of the joints), akshepa (convulsions), and pain, one should apply four types of sneha (taila, ghee, vasa and majja) all over the body processed with herbs of madhura gana (jeevaniya gana) and apply warm sneha, if there is burning sensation than cold sneha be applied. Milk of cow, sheep and goat mixed with oil or decoction of jeevaniya gana mixed with oil or decoction of panchamula mixed with oil is sprinkled over in similar ways. [125-126]
द्राक्षेक्षुरसमद्यानि दधिमस्त्वम्लकाञ्जिकम् |
सेकार्थे तण्डुलक्षौद्रशर्कराम्बु च शस्यते ||१२७||
Either juice of grapes or decoction of dried grapes (Vitis vinifera), juice of sugarcane, wine, curd water, sour gruel, rice water, honey and sugar well mixed and sprinkled over the body of the patient suffering from vatarakta to alleviate daha (burning sensation). [127]
कुमुदोत्पलपद्माद्यैर्मणिहारैः सचन्दनैः |
शीततोयानुगैर्दाहे प्रोक्षणं स्पर्शनं हितम् ||१२८||
In case of burning sensation sponging and contact with the flowers of kumuda, utpala, padma (different varieties of lotus) etc, necklace of gems and sandal wood pieces immersed in cold water is beneficial. [128]
चन्द्रपादाम्बुसंसिक्ते क्षौमपद्मदलच्छदे |
शयने पुलिनस्पर्शशीतमारुतवीजिते ||१२९||
चन्दनार्द्रस्तनकराः प्रिया नार्यः प्रियंवदाः |
स्पर्शशीताः सुखस्पर्शा घ्नन्ति दाहं रुजं क्लमम् ||१३०||
The patient lying on a bed moistened with dews, exposed to moon rays, covered with flax and lotus leaves and fanned with breeze cooled by contact of sandy beach, and touched by beloved and sweet spoken women who have applied sandal paste on their breasts and hands due to which their body touch has become cold and smooth, it reduces burning sensation, pain and exhaustion. [129-130]
सरागे सरुजे दाहे रक्तं विस्राव्य लेपयेत् |
मधुकाश्वत्थत्वङ्मांसीवीरोदुम्बरशाद्वलैः ||१३१||
जलजैर्यवचूर्णैर्वा सयष्ट्याह्वपयोघृतैः |
सर्पिषा जीवनीयैर्वा पिष्टैर्लेपोऽर्तिदाहनुत् ||१३२||
In case of patient of vatarakta having redness, pain, and burning sensation, blood letting should be done followed by application of paste prepared from madhuka, ashvattha, mamsi, udumbara, shadvala (green Cynodon dactylon) and kshirakakoli or paste prepared either from aquatic flowers (lotus etc.) or barley, yashtimadhu, milk and ghee or that of herbs of jeevaniya gana mixed with ghee. [131–132]
तिलाः [१] प्रियालो मधुकं बिसं मूलं च वेतसात् |
आजेन पयसा पिष्टः प्रलेपो दाहरागनुत् ||१३३||
Tila (sesame), priyala, madhuka, bisa (lotus rhizome) and vetas (root of salix capria) pounded with goat’s milk and applied on the body in the form of paste relieves burning sensation (in vatarakta). [133]
प्रपौण्डरीकमञ्जिष्ठादार्वीमधुकचन्दनैः |
सितोपलैरकासक्तुमसूरोशीरपद्मकैः ||१३४||
लेपो रुग्दाहवीसर्परागशोफनिवारणः |
पित्तरक्तोत्तरे त्वेते, लेपान् वातोत्तरे शृणु ||१३५||
वातघ्नैः साधितः स्निग्धः सक्षीरमुद्गपायसः [२] |
तिलसर्षपपिण्डैर्वाऽप्युपनाहो रुजापहः ||१३६||
Prapaundarika, manjishtha, daru haridra, madhuka, chandana, ereka, saktu (flour of roasted grains), masura (lentil), uśira and padmaka all are crushed (and made paste with water), its paste is applied on the body, it alleviates pain, burning sensation, visarpa (cellulitis or erysipalus), redness, shopha (inflammation). This formulation is beneficial in pitta and rakta predominant vatarakta. Porridge of green gram prepared with milk, unctuous substance and vata subjugator herbs or poultice prepared with sesame and mustard alleviate pain of vata predominant vatarakta. [134–136]
औदकप्रसहानूपवेशवाराः सुसंस्कृताः |
जीवनीयौषधैः स्नेहयुक्ताः स्युरुपनाहने ||१३७||
स्तम्भतोदरुगायामशोथाङ्गग्रहनाशनाः |
जीवनीयौषधैः सिद्धा सपयस्का वसाऽपि वा ||१३८||
Poultice of vesavara (crushed and fried boneless meat) prepared from the meat of prasaha (animals who catch their food by the teeth and eat for eg. cow, ass, mule, horse, camel, leopard, lion, bear, dog, cat, rat etc.) well processed with the herbs of jeevaniya gana and sneha (ghee, taila, vasa, majja), applied on the part of the body affected by the vata predominant vatarakta alleviate stiffness, pricking pain, organ tension, immobility and edema or crushed powder of herbs of jeevaniya gana processed with milk and fat is equally effective. [137–138]
घृतं सहचरान्मूलं जीवन्ती च्छागलं पयः |
लेपः पिष्टास्तिलास्तद्वद्भृष्टाः पयसि निर्वृताः ||१३९||
Root of sahachara and jeevanti are mashed with goat’s milk and added with ghrita then applied on the body, like wise roasted sesame mashed with goat’s milk and applied on the body, both formulations are effective in relieving daha (burning sensation). [139]
क्षीरपिष्टमुमालेपमेरण्डस्य फलानि च |
कुर्याच्छूलनिवृत्त्यर्थं शताह्वामनिलेऽधिके ||१४०||
If the paste of either seeds of eranda or uma (Foeniculum vulgare) mashed with goat’s milk, applied on the body relieves pain caused by predominance of vata in vatarakta. [140]
समूलाग्रच्छदैरण्डक्वाथे द्विप्रास्थिकं पृथक् |
घृतं तैलं वसा मज्जा चानूपमृगपक्षिणाम् ||१४१||
कल्कार्थे जीवनीयानि गव्यं क्षीरमथाजकम् |
हरिद्रोत्पलकुष्ठैलाशताह्वाश्वहनच्छदान् [३] ||१४२||
बिल्वमात्रान् पृथक् पुष्पं काकुभं चापि साधयेत् |
मधूच्छिष्टपलान्यष्टौ दद्याच्छीतेऽवतारिते ||१४३||
शूलेनैषोऽर्दिताङ्गानां लेपः सन्धिगतेऽनिले |
वातरक्ते च्युते भग्ने खञ्जे कुब्जे च शस्यते ||१४४||
320 ml decoction of new leaves and root of eranda is prepared and then total 1.28 kg of ghrita, taila, vasa (fat) and majja (marrow derived from marshy animals and birds) are mashed and cooked. During cooking kalka (crushed powder) of jeevaniya gana, cow’s milk, goat’s milk, and kalka of haridra, utpala, kushtha, ela, shatahva, leaves of karavira and flowers of kakubha 40 gms each be mixed with and obtained sneha (fatty material) after sneha siddhi lakshana and allowed to become cooled, then 320 gm of bee wax should be added. This formulation is applied on the body in case of pain (bodyache), sandhivata (osteoarthritis), vatarakta (conditions like gouty arthritis and others), sandhichyuti (dislocation of joint), bhagna (fracture), khanja (limping) and kubjatwa (humpedness). [141–144]
शोफगौरवकण्ड्वाद्यैर्युक्ते त्वस्मिन् कफोत्तरे |
मूत्रक्षारसुरापक्वं घृतमभ्यञ्जने हितम् ||१४५||
In case of kapha predominant vatarakta with swelling, heaviness, and itching etc. than the part be applied ghr̥ta which is cooked with cow’s urine, alkalies and wine. [145]
पद्मकं त्वक् समधुकं सारिवा चेति तैर्घृतम् |
सिद्धं समधुशुक्तं स्यात् सेकाभ्यङ्गे कफोत्तरे ||१४६||
Ghrita cooked with padmaka, tvak, madhuka sariva and madhushukta (type of vinegar) be mixed with prepared ghrita. This formulation is useful if sprinkled and massaged in kapha predominant vatarakta. [146]
क्षारस्तैलं [४] गवां [५] मूत्रं जलं च कटुकैः शृतम् |
परिषेके प्रशंसन्ति वातरक्ते कफोत्तरे ||१४७||
Alkalies, oil, urine, pungent herbs and water in equal quantity and decocted. Parisheka (sprinkling) of this decoction is beneficial in kapha predominant vatarakta and this is well praised. [147]
लेपः सर्षपनिम्बार्कहिंस्राक्षीरतिलैर्हितः |
श्रेष्ठः सिद्धः [६] कपित्थत्वग्घृतक्षीरैः ससक्तुभिः ||१४८||
Paste prepared from sarshapa, nimba, arka, himsra, tila and bark of kapittha, milk and ghee with saktu (flour of roasted grains) is effective. [148]
गृहधूमो वचा कुष्ठं शताह्वा रजनीद्वयम् |
प्रलेपः शूलनुद्वातरक्ते वातकफोत्तरे ||१४९||
Paste preparation from grihadhumo (soot), vacha, kushtha, shatahva, haridra and daru haridra alleviates pain of vata- kapha predominant vatarakta. [149]
तगरं त्वक् शताह्वैला कुष्ठं मुस्तं हरेणुका |
दारु व्याघ्रनखं चाम्लपिष्टं वातकफास्रनुत् ||१५०||
Tagara, tvak, satahva, ela, kushtha, mushta, harenuka, devadaru, vyaghranakha (Capparis sepiaria), all these are pounded with sour liquid and applied as a paste, alleviates vata kapha predominant vatarakta. [150]
मधुशिग्रोर्हितं तद्वद्बीजं धान्याम्लसंयुतम् |
मुहूर्तं लिप्तमम्लैश्च सिञ्चेद्वातकफोत्तरम् ||१५१||
Seeds of sweet shigru triturated with dhanyamla (sour gruel) and paste applied on the part of the body for a while and then washed with sour liquid in vata kapha predominant vatarakta (to alleviate pain). [151]
त्रिफलाव्योषपत्रैलात्वक्क्षीरीचित्रकं वचाम् |
विडङ्गं पिप्पलीमूलं रोमशं वृषकत्वचम् ||१५२||
ऋद्धिं तामलकीं चव्यं समभागानि पेषयेत् |
कल्यं लिप्तमयस्पात्रे [७] मध्याह्ने भक्षयेत्ततः ||१५३||
वर्जयेद्दधिशुक्तानि क्षारं वैरोधिकानि च |
वातास्रे सर्वदोषेऽपि हितं शूलार्दिते परम् ||१५४||
Triphala, vyosha (trikatu), patra (Cinnamomum lamella), ela, tvakkshiri (Bambusa arundinacia), chitraka, vacha, vidanga, pippalimula, romasha (kasheesa), bark of adulsa (Adhatoda vasica), riddhi, tamalaki and chavya, take all in equal quantity and crushed. The powder of all herbs is pasted on the iron utensil in early morning and be eaten in the noon. During this treatment one should avoid curd, vinegar, alkalies and incompatible food items. It is very efficacious in removing pain of vatarakta caused by all dosha. [152–154]
बुद्ध्वा स्थानविशेषांश्च दोषाणां च बलाबलम् |
चिकित्सितमिदं कुर्यादूहापोहविकल्पवित् ||१५५||
After considering specific position and strength of vitiated dosha, the physician who is well conversant in reasoning and variation should apply aforesaid treatment. [155]
Treatment of obstruction by excess meda dhatu and kapha
कुपिते मार्गसंरोधान्मेदसो वा कफस्य वा |
अतिवृद्ध्याऽनिले [१] नादौ शस्तं स्नेहनबृंहणम् ||१५६||
व्यायामशोधनारिष्टमूत्रपानैर्विरेचनैः |
तक्राभयाप्रयोगैश्च क्षपयेत् कफमेदसी ||१५७||
If vata is vitiated due to obstruction either by excessive aggravated meda dhatu or kapha, one should not apply unctuous and stouting drugs in the beginning. Instead kapha and meda dhatu subjugate with physical exercises, shodhana (purification), virechana (purgation), and intake of arishta (fermentated preparation of medicinal herbs etc.) and butter milk with abhaya.[156-157]
बोधिवृक्षकषायं तु प्रपिबेन्मधुना सह |
वातरक्तं जयत्याशु त्रिदोषमपि दारुणम् ||१५८||
One should take decoction of bodhivriksa with honey. It vanquishes severe vatarakta even caused by all three dosha. [158]
पुराणयवगोधूमसीध्वरिष्टसुरासवैः |
शिलाजतुप्रयोगैश्च गुग्गुलोर्माक्षिकस्य च ||१५९||
One should use old wheat and barley to eat and sidhu, arishtha, sura, asava (medicated beverages) to drink and shilajatu (black bitumen), guggulu (commiphora mukul) and makshika as well. [159]
Treatment of severe vitiation of rakta
गम्भीरे रक्तमाक्रान्तं स्याच्चेत्तद्वातवज्जयेत् |
पश्चाद्वाते क्रियां कुर्याद्वातरक्तप्रसादनीम् ||१६०||
In gambhira vatarakta if blood is vitiated severely, it should be treated like vāta first and there after steps should be taken to pacify vatarakta. [160]
Treatment of complications
रक्तपित्तातिवृद्ध्या तु पाकमाशु नियच्छति |
भिन्नं स्रवति वा रक्तं विदग्धं पूयमेव वा ||१६१||
तयोः क्रिया विधातव्या भेदशोधनरोपणैः [१] |
कुर्यादुपद्रवाणां च क्रियां स्वां स्वाच्चिकित्सितात् ||१६२||
The disordered part due to excessive aggravation of rakta and pitta get inflammed or torn and discharging blood or pus with property of burning sensation should be treated with incision, cleansing and healing applications. Complications should be managed according to their respective treatment (mentioned earlier). [161–162]
Summary
तत्र श्लोकाः-
हेतुः स्थानानि मूलं च यस्मात् प्रायेण सन्धिषु |
कुप्यति प्राक् च यद्रूपं द्विविधस्य च लक्षणम् ||१६३||
पृथग्भिन्नस्य लिङ्गं च दोषाधिक्यमुपद्रवाः |
साध्यं याप्यमसाध्यं च क्रिया साध्यस्य चाखिला ||१६४||
वातरक्तस्य निर्दिष्टा समासव्यासतस्तथा |
महर्षिणाऽग्निवेशाय तथैवावस्थिकी क्रिया ||१६५||
In this chapter of vatarakta the etiological factors, location and root, reason for its prevalence of aggravation in general in joints, prodromal symptoms, clinical features, symptoms of both types (uttana and gambhira), different symptom produced by the dosha predominance and complications, prognostic description of different stages of the disease (sadhya, yapya and asadhya), management of sadhya vatarakta (curable vatarakta) and symptomatic treatment of all stages as well has been described in brief and details by the great sage Atreya for Agnivesha.
Thus ends the 29th Chapter (Vatarakta Chikitsa) in Chikitsa Sthana in treatise composed by Agnivesha, redacted by Charak and reconstructed by Dridhabala. [163–165]
Tattva Vimarsha (Fundamental Principles)
- Vatashonita occurs when aggravated vata is afflicted with vitiated shonita. Vata is the constantly moving and shonita is also constantly flowing tissue, both need clear passage for uninterrupted movement. There is simultaneous aggravation of vata, vitiation of rakta and damage to potency of channels (arteries and veins). When channels pass through narrow and circuitous path of small joints, vitiated rakta and aggravated vata gets seated there to start inflammation of local tissues.
- A combination of vata aggravating factors and pitta-rakta vitiating factors gives rise to vatarakta.
- Etiological factors of vata vitiation are virudha ahara (incompatible food), adhyasana (taking food before complete digestion of previous one), ratri jagrana (vigil in night), kashaya (astringent), katu (pungents), tikta (bitter), alpabhojana (inadequate quantity of food), ruksha bhojana (food substances of low nutritional values), abhojana (starvation), excess travelling in uncomfortable vehicles, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges.
- Pitta, shonita and shonita vaha srotasa, vitiating factors are lavana, amla, katu, kshara, ushna bhojana, ajeerna bhojana (salty, sour, pungent, alkaline, fatty substances, very hot food, taking food during indigestion), various pulses (kulattha, masha etc), various beverages having quite good percentage of alcohol, excess walking in hot season, vigil during night are responsible for vitiation of pitta dosha as well as shonita and shonita vaha srotasa.
- Pitta predominant person leading a delicate life style is more susceptible for early progression of vatarakta.
- There are two types of vatashonita:
- Uttana or superficial, located in blood vessels between skin and muscles. It manifests as itching, burning, piercing pain in skin, constricting and expanding sensation of skin, black red and coppery boils of skin, and
- Gambhira or deep: Located in blood vessels of small joints of extremities but more in lower extremities and big toe is most affected. Manifested inflammation, hard, non- shifting and painful, pulsating inflammation with coppery black color and cause of disability.
- Based on dosha, vatshonita is classified into four types, three of them due to one dosha and one due to three dosha, the last one is incurable.
- Treatment is four-fold with six types of blood letting, therapeutic purgation, purifying enema and palliative treatment for vata.
- In vatarakta, rakta obstructs pathway of vata and vice-versa i.e. vata obstructing pathway of rakta. Bloodletting helps in the movement of vata.
- The purgation should be mild because strong purgation may cause vataprakopa.
- After proper oleation, vatarakta patient shall be treated with mild therapeutic purgation with unctuous substances or with dry substances (in case of excess oleated patient). After purgation, the patient should be given frequent basti (enema of medicated substances) including anuvasana basti (unctuous enema) and niruha basti (enema made from decoction of medicinal herbs). Besides fomentation, massage, ointments, food and sneha (unctuous substances) be given to the patient which do not cause burning sensation.
- In case of uttana vata shonita affecting superficial tissues only, the patient should be treated with alepana (affected part is covered with medicinal paste), abhyanga (massage), parisheka (bathing in warm decoction or unctuous substances) and upanaha (application of poultice).
- In the case of gambhira vata rakta the patient should be treated with purgation, asthapana basti(enema with decoction of medicinal plants) and snehapana (drinking medicated oil/ghee).
- In the disease where the vata is predominant, one should over come the disease with medicated ghee, taila, vasa, majja(ghee, oil, fat, and bone marrow of animals) either by intake or massage or enema and the diseased part should be treated with warm upanaha (warm poultice).
- Where the rakta and pitta both are predominant, patient should be treated by mild purgation, after ghrita pana (intake of medicated ghee), intake of milk, bathing in decoction made from medicinal plants and basti (enema). The raktapitta should be treated with cold and refrigerant alepam (paste of herbs).
- Where the kapha is predominant, patient of vatarakta should be treated with mild emesis and avoid excessive oleation, sudation and fasting. Luke warm lepa (pastes of herbs) are useful.
- External application of unctuous substances like ghee and oil processed with herbs having cold potency, sweet and bitter tastes are effective to reduce burning sensation.
- If vata is vitiated due to obstruction either by excessive aggravated meda dhatu or kapha, one should not apply unctuous and stouting drugs in the beginning. Instead kapha and meda dhatu subjugate with physical exercises, shodhana (purification), virechana (purgation), and intake of arishta (fermentated preparation of medicinal herbs etc.) and butter milk with abhaya.
Vidhi Vimarsha (Applied Inferences )
Vatarakta is a group of inflammatory rheumatic diseases. Pathogenesis of these ailments is related to aggravation of vata dosha due to vitiation of rakta dhatu. The primary sites of involvement are small joints of hands and feet.
Etiological factors
Diet
Excess intake of salty, sour and pungent foods with spices and deep fried in oil are observed to cause the disease. The soft drinks with alkalis, excess consumption of fatty substances, alcohol, aquatic animals, dried flesh are known to vitiate rakta. A study carried on 178 participants revealed that excess intake of amlarasa could be a risk factor for joint inflammation, dentine hypersensitivity, stomatitis, halitosis, heartburn and papules.[1] Consumption of astringent, pungent, bitter, ruksha food items (grains of low nutritional values and those with dry property) vitiate vata dosha. Consumption of tikshna[2] (sharply acting) and vidahi (which causes burning) are other factors responsible for vitiating rakta.[3]
The dietary habits like intake of food during indigestion (ajirna), incompatible food (viruddhahara), eating food before proper digestion of previous meal (adhyashana) are causes of vitiation of vata due to improper digestion and metabolism.
Psychological factors
Anger is known to vitiate pitta and secondarily rakta.
Lifestyle habits
Sleeping in daytime and vigil during the night; injuries, not purifying the body (by shodhana karma); starvation, excess traveling, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges are responsible for vitiation of vata.
In general, the delicate persons who are indulged in sweet and rich food substances and are not in habit of physical activities, the vata and rakta are vitiated. Those who have sedentary lifestyles with least walking are most prone to vatarakta. [2],[3],[4]
The above factors can cause vitiation of blood by aggravation of its tikshna (sharply acting) property and vitiation of vata dosha by aggravation of its ruksha (dry) property. The properties like sukshma (minuteness) and sara (moving) of both vata and rakta are affected to cause the disease process. Drava (fluidity) of rakta is affected leading to obstruction in free movement of vata.
Pathogenesis
The pathogenesis involves aggravation by avarana(obstruction) of movement of vata by the vitiated rakta. Therefore, the treatment is focused upon pacification of rakta to remove obstruction and pacification of vata. The pathogenesis starts from small joints of lower extremities.[3] The onset of disease is acute and the vitiation of rakta occurs quickly. [2]
Clinical features
- Pain, swelling, redness, increased temperature and tenderness of small joints especially thumb or big toes. This slowly spreads to affect all joints.
- Itching, burning, pricking, pulsating, breaking pain in skin
- Greyish, copperish discolouration of skin
- In case of involvement of deeper tissues, swelling, hardness of affected site, discoloration, suppuration, pulsating, pricking or burning sensation can occur.
Above features are observed at sites of joints, ligaments and blood vessels as per the dosha dominance in vatarakta.
Types
Uttana vatarakta involves twacha (skin) and mamsa dhatu (muscular tissue). Gambhira vatarakta involves all other tissues. The uttana vatarakta progresses to gambhira vatarakta in due course of time.[2],[3]
Differential diagnosis
Vatarakta, amavata and sandhigata vata are three most common rheumatological clinical conditions. The clinical presentations need to be differentiated for diagnosis and designing treatment protocol.
| Criteria | Vatarakta | Amavata | Sandhigata Vata |
|---|---|---|---|
| Dosha | Vata associated with pitta | Vata associated with ama, mainly kapha | Vata associated with vata |
| Dushya | Rakta dhatu,Twak, Mamsa dhatu | Rasa dhatu | Asthi dhatu,Majja dhatu |
| Clinical Features | Pain, Burning Sensation, Swelling, Tenderness | Pain, Swelling, Tenderness | Painful movements |
| Nature of pain/spread of disease pathogens | Spreads like rat poison (moderate), pulsating | Like scorpion bite (severe), fleeting | Pain on movement, stable |
| Joints involved | Small joints like metacarpal and metatarsal joints | Big joints like knee, elbow, shoulder and sacroiliac joint. | Wear and tear of excessively used joints |
| Reaction to sneha (oleation) | Mild sneha is indicated | Strictly contraindicated, as pain increases after massage and oleation | Indicated, pain reduces after massage and oleation |
| Aggravating factors in diet | Hot, sour, salty, pungent | Salt, sweet, heavy to digest food | Bitter, pungent, light to digest food |
| General aggravating factors | Exposure to heat, traveling | Sedentary lifestyle, exertion immediately after taking food | Overuse of joints |
| Treatment | Sneha, virechana, basti with drugs of mild property, raktamokshana | Langhana, basti with drugs of sharp acting property | Snehana, basti, brimhana |
Constituent conditions of vatarakta
Rheumatoid arthritis and gout are two most common rheumatological conditions.
Those patients with involvement of small joints of extremities resemble rheumatoid arthritis, on the other hand patients with mono-articular or oligo-articular arthritis and associated elevated uric acid resemble gout. There is a difference of opinion among Ayurvedic physicians, some call vatarakta as gout and others call rheumatoid arthritis. Some Ayurvedic physicians consider amavata as rheumatoid arthritis. However, it can be observed that the patients diagnosed as rheumatoid arthritis show clinical features of vitiation of vata associated with kapha dosha. Whereas, the patients diagnosed as gouty arthritis show clinical features of vitiation of vata associated with pitta dosha. Therefore, the former case can be treated on the lines of vatarakta associated with kapha, while the latter can be treated on principles of vatarakta associated with pitta. On close observation it is noted that in amavata there is involvement of large joins of extremities and sacroiliac joints which is consistent with rheumatoid variant or ankylosing spondylitis. Ayurvedic management depends upon correction of imbalance of dosha, dushya and Prakriti of the individual and can be viewed as working through epigenetic pathway. On the other hand, modern medicine system works by antagonizing the pro-inflammatory proteins or acting through “genetic pathway”. It becomes clear that both systems achieve the objective using different ways. It can be compared to digging the tunnel from both sides. However, the direction of diagnosis and treatment needs to be clearly based upon clinical assessment of dosha dominance. The serological parameters can only be utilized for assessment of therapy.
The condition in which blood vessels, connective tissues and tendons are involved such as vasculitis along with thrombosis and embolism, thrombo-angiitis obliterans (Burger’s disease), Raynaud’s disease are also considered under the disease vatarakta.
The treatment focus on correction of rakta-dhatvagni, through which mechanisms in sira(vessels) and kandara(tendons) are corrected.
Investigations
- Serological investigations like Erythrocyte sedimentation rate, C-reactive protein, uric acid, quantitative and qualitative assessment of rheumatoid factor may be investigated as biomarkers.
- Radiological investigations including X-rays of affected part
- Ultrasound, histopathological study and angiography.
Complications
Insomnia, permanent joint deformity, gangrene, necrosis, tumor can occur as complication of vatarakta.
Prognosis considering present developments in medicine
The disease with involvement of single dosha and new (diagnosed within one year) is curable. The disease with involvement of more than one dosha and chronic (more than one year) is palliable with medicines and appropriate therapies.
Management of diseases (Treatment protocols)
Principles of management
- Basti (therapeutic enema): Basti with herbs of ruksha (dry) property or mridu (mild) property are used to treat both uttana (superficial) and gambhira (deep) types of vatarakta.
- Raktamokshana (bloodletting): Bloodletting is prescribed as per dosha dominance in vatarakta patients. This gives better results to remove obstruction and reduce vitiation of blood.
Main drugs:
- Guduchi
- Kokilaksha
- Suranjana
| Type | Name | Dosage | Time | Anupana |
|---|---|---|---|---|
| Vataja | Kaishora guggulu | 500-1000 mg | Between two meals | Kokilaksha kwatha + ghee + honey |
| Pittaja and Raktaja | Mauktika kamduha | 60-250 mg | Between two meals | Milk and guduchi kwatha |
| Kaphaja | Gud-Bhallataka-haritaki vati | 1-3 grams | Before meals, two times | Milk or lukewarm water |
Evidence based clinical practices
A study reviewing anti-rheumatic formulations showed that 247 formulations are enlisted in Ayurveda texts. rasnasaptaka kwath, ajmodadi choorna, vatavidhvanasana rasa, vatari rasa, sinhanad guggulu, yogaraj guggulu, khandashunthyavaleha, amrit bhallatak, guggulu panchatikta ghrita, vishagarbha taila are common formulations used to treat rheumatic conditions. Yogaraja guggulu is used in 50% prescriptions [5] for rheumatic cases.
A research on vatarakta concluded that the notion of margavarana (obstruction in pathway) can be correlated to the pathology of atherosclerosis, and the state of uttana vatarakta to that of peripheral arterial disease. Identical therapeutic efficacy of kaishora guggulu and amrita guggulu was observed in thirty patients of uttana vatarakta. [6]
Another study was carried out to evaluate the antioxidant effect of five kashayams (kwaths - decoctions) manjishtadi kashayam (MK), rasna erandadi kashayam (REK), sahacharadhi kashayam (SK), maharasnadi (or rasna dwiguna bhagam) kashayam (MRK) and dhanwantharam kashayam (DK) used in the management of diseases manifested due to vitiation of vata and vatarakta (mostly diseases of connective tissues, bones, joints and nervous system). It concluded that the total phenolic content and the antioxidant property of the products justify the protective and corrective effects produced by the products in vata and vatarakta disorders. The phenolic content is highest in MK, followed by DK. The phenolic content of MRK, SK and REK are comparable [7]. This shows the formulations act by scavenging the free radicals in rheumatic diseases.
Potential areas /scope for further research
Study to evaluate the efficacy of basti and bloodletting therapies in the management of vatarakta is needed. Further studies to evaluate the effect of Ayurvedic formulations in management of vatarakta are needed.
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References
- ↑ Panara KB, Acharya R. Consequences of excessive use of Amlarasa (sour taste): A case-control study. AYU [serial online] 2014 [cited 2018 Aug 15];35:124-8.Sourced from: http://www.ayujournal.org/text.asp?2014/35/2/124/146204
- ↑ Jump up to: 2.0 2.1 2.2 2.3 Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Adhyaya verse 42. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
- ↑ Jump up to: 3.0 3.1 3.2 3.3 Vagbhata. Nidana Sthana, Cha.16 Vatavyadhi Nidana Adhyaya verse 1. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.page no:535
- ↑ Madhavakara Vata rakta Nidana. In:Brahmananda Tripathi ,editor,Madhava Nidana. Volume I,?ed,Varanasi:Chaukhambha Sanskrit Pratishthana.2002. Pg.556-563
- ↑ A. A. Raut, A. D. Joshi, D. S. Antarkar, V. R. Joshi, A. B. Vaidya, Anti-Rheumatic Formulations From Ayurveda Ancient Science of Life, Vol No. XI No.1 & 2, July & October 1991, pp. 66 – 69
- ↑ Ramachandran AP, Prasad SM, Prasad U N, Jonah S. A comparative study of Kaishora Guggulu and Amrita Guggulu in the management of Utthana Vatarakta. AYU [serial online] 2010 [cited 2018 Aug 15];31:410-6. Available from: http://www.ayujournal.org/text.asp?2010/31/4/410/82027
- ↑ Sruthi CV, Sindhu A. A comparison of the antioxidant property of fi ve Ayurvedic formulations commonly used in the management of vata vyadhis. J Ayurveda Integr Med 2012;3:29-32.