Vatarakta - A challenge to Physician Written by Kapil Thakur

Vatarakta - A challenge to Physician

In the day to day clinical practice physicians face many challenges in from of various diseases which are only palliative and not unable. Vatrakta stands conspicuously among such disorder. What adds to the trouble of both patient and physician is the severe pain associated with the disorder. Vatrakta is known to the humanity since ages and a very detailed description is available in ancient classic texts of Ayurveda like Charaka Samhita, Susrut Samhita and other Ayurvedic text.

The disorder has the prevalence of about 1% in general population with a high male predominance with a steep rise in 4^th and 5^th decade of life. It is more prevalent in people who consume protein rich diet.

Charaka considers various dietary factors and life style responsible for vatarakta e.g. excessive use of salt, alkalies, fats, excessive use of non vegetarian diet. Alcohol and pulses along with testa. Similar type of aetiological factors is mentioned in Susrut Samhita and Ashtang Hridya Modern medicine considers Hyperuricemia as the cause for manifestations of Gout. This Hyperuricemia may either be due to urate overproduction or under excretion of uric acid or a combinaton of both processes. Major factors responsible Hyperuricemia are certain enzyme deficiencies, Haemolytic processes, polycythemia vera, Proriasis, Exercise, alcohol, obesity, Purine rich diet, renal insuffiency, Polycystic kidney diseases, Diabetes inspidus, hypertension, Hyperparathyroidism, Hypothyroidism, Toxaemia of Pregnancy Drugs like salicylates, Diuretics, Alcohol levodope Ethembutol Pyrazinamide Nicotinic acid and cyclorporine.

The pathogenesis of disease vata rakta starts with aggravation of Vata. This is because of suksham (subtle) character of vata it has the capacity to move in all joints of body and Rakta being drava ( liquid) in nature has capacity to move in all channels (Srotas) of body. vitiated and agitated vata and rakta move with speed through all siromarga ( Circulatory Channels) in whole body because of these properties. While moving through joints both face obstruction because of zig zag anatomical structure of joints. Hence vitiated vata and rakta stay in joints causing different types of pain sensations which are because of their association with Pitta and Kapha Dosha.

Similarly form modern point of view plasma is saturated with monosodium urate at a conc. of 6.8 mg/dl. At higher conc. plasma is therefore supersaturated and potential exists for urate crystal precipitation. It is only precipitation of urate crystal in the joint tissue and not hyperuricaemia that produces features of acute gout.

Features of an acute attack of vatarakta include itching , burning sensation, ache, extension, pricking pain, throbbing sensation and contraction, skin overlying the affected joint become brownish black red in colour, oedema, stiffness, hardness excruciating pain in body and suppuration of the joint.

Sites at which appearance of vatarakta is mentioned are hands, feet, fingers including toes and all joints. In beginning hands and feet are afflicted. From this place it spread to all other parts of the body.

Usually me joint is affected initially but polyarticular acute gout is also seen. The metatarsophalangeal joint of the first toe is often involved but tarsal joint, ankles and knees are also commonly affected. The first episode of acute gouty arthritis frequently begins at night with dramatic joint pain and swelling, Joints rapidly become warm, red and tender.

The main investigation for the diagnosis of the disease are specific signs and symptoms and vata rakta and course of the diseases along with serum Uric acid estimation.

The general principles of management of vata rakta are

- Rakta Mokshan

- Shodhan Karma

- Shaman Karma

- Lepa

Blood letting should be performed slowly. It should not bring about symptoms of vata vridhi. Before rakta mokshan, Snehan should be given to patient

Shodan chikitsa if desirable in the patients should be followed as Snehan Virechane and vasti particularly Ksheer Vasti.

In Shaman Chikitsa the main motto of treatment is to pacify vitiated vata and rakta dosha and to reach the homeostasis of dosa, thereis detaild description in Charkas Samhita of drugs which are capable of alleviating the signs and symptoms of vata rakta.

Most commonly used to drugs are Suranjan, Guduchi, Rasna Trivrita, Punarnava, Satavari, Ksheerkakoli, Madhuk, Gorukhmundi, Gokshru etc.

Local application should be used in the form of Abhyanga parishek lepa and Upanah.

Combination of Suranjan, Manjishtha, Guduchi, Gokshru and Madhuyashti has been successfully tried on the patients of vata rakta in our institution with significant results.

Patients having the recurrent attack of gout should not consume Katu, Amla, Lavana, Ras, Ushana, Guru, Abhishyandi, Ahara, Divaswapna, Agnisantap vyayam, Aatap, Maithuna and Krodh. Such patients should take more of purana yav, Godhuma, Shashti, Shali dhanya, Adhak, Chanak, Mudga, Masura, Kulathika, Sunnishnak, Kakamachi, satavari, vastuk, Godugdha and Ghritta.

Add comment

Name (required)

E-mail (required)

Website

Notify me of follow-up comments

Refresh

Send (Ctrl+Enter)

Cancel

JComments