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<big>''' Abstract </big>'''

<big>''' Abstract </big>'''

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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 ''doshas'' 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.

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.  

'''Keywords''': [[Vata]], [[rakta]], gout, connective tissue diseases, inflammatory arthritis, polyarthritis, vasculitis.  

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== Introduction ==

== Introduction ==

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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 ''sukumaratva'' (youthful personality) is the characteristic feature of ''pitta prakriti''.

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 ''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.  

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.  

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.  

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 assessment and correction of these factors causing the conditions.  

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 ==

== Sanskrit Text, Transliteration and English Translation ==

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Now we shall expound the chapter "Vatashonita (or vatarakta) Chikitsa" (Management of diseases involving vata and rakta). Thus said Lord Atreya. [1–2]

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 ===

=== Agnivesha's query ===

After finishing his daily worship and ''yagna'' (religious sacrifice), Punarvasu was sitting admidst the sages.

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]

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 ===

=== Etiological factors ===

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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.  

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 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]

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 ===

=== Sites of affliction ===

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Due to subtleness and pervasiveness of ''vata'', and liquidity and flowing property of ''rakta'', they travel all over the body through blood vessels.  

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]

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 ===

=== Premonitory symptoms ===

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As this is said there are two types of ''vatashonita'' - ''uttana'' (superficial) and ''gambhira'' (deep). The ''uttana'' is located in ''twaka'' (skin) and ''mamsa'' (muscles) while the ''gambhira'' is located in the deep tissues. [19]

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) ===

=== Clinical features of ''uttana vatarakta'' (superficial type) ===

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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 ''vayu'' reaches ''sandhi, asthi'' and ''majja'' (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]

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'' (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 ===

=== Differential features as per ''dosha'' dominance ===