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Introduction

The main causes of Vatarakta sickness were not made up in ancient times since people lived close to nature and did a lot of physical activity, therefore Vatarakta disease as an independent entity is not found clearly in our books, but it is present in dispersed form. Vatarakta is a combination of the terms Vata and Rakta. Rakta is a very important Dhatu that provides nutrition to each and every body tissue and keeps them normal by eliminating toxins (waste products) through the natural orifices of the body. Vata is the chief Dosha whose vitiation causes disease.[1] Vatarakta (Gout) belongs to the Vataroga and Santarpana-Janya categories. Vatarakta is also known as Khuda roga, Vata-balasa, Vatashra and Adhyavata. Morbid vata dosa when obstructed by vitiated Rakta dhatu, further becomes virulent and once again adds to the abnormality of Rakta dhatu, this illness is called as Vatarakta.[2] Adhyavata word means the disease is common in rich. As the disease Vatarakta involves the joints it is called as Khudhavata where the khudha refers to the joint. Vatarakta’s virulence is dependant on morbidity of Rakta dhatu which gets worsened by the obstructed vayu and hence is known as Vatabalasa.

Prevalence of Gout:

In developed countries, gout is the most frequent type of inflammatory arthritis, with a frequency of 1–2%.[3] It is a purine metabolism condition characterised by an elevated level of serum uric acid (>6.8 mg/dL), which crystallises and deposits in joints, tendons, and surrounding tissues, manifesting as abrupt burning pain, swelling, redness, and soreness in joints. Gout develops in around 10% of hyperuricemic adults, and they initially have no noticeable symptoms and stay asymptomatic for a long period.[4,5,6] In males over the age of fifty, gout is the most prevalent cause of arthritis. Gout is more common in males than in women because oestrogen stimulates urate waste in the urine before menopause. Gouty arthritis affects 0.2-2.5 people out of every 1000. The total incidence rate is 2-26 per 1000 people. In India, gout is uncommon in children and premenopausal women. Out of the affected population, males are more common while female of post-menopausal age are on more risk.[7,8]

Objectives:

To review the Vatarakta  its Ayurveda prospective  of Management.

Methodology: Literary review  was done on Vatarakta from classical textbooks including journals, samhitas, previous work done and co-related, analysed with the knowledge of contemporary science on the subject.

Gout:

Vatarakta possess a challenge to the physician owing to its apparent chronicity, incurability, complications and morbidity.

Nidana :

Aharaja nidana :

Amla, Katu, Lavana, Snigdha, Ushna, Pinyaka, Moolaka, Kulatha, Curd, aaranala, buttermilk, Virudhahara, Anupa mamsa, Adhysana, food which are soaked in water for long time, irregular diet habits, etc.

Viharaja nidana :

Abhighata, Asuddhi, Divasvapna, Ratrijagarana, Ambukreeda, Langhana, Vega nigraha [9]

According to  Prakruti:

Sukumara, Sthoulya, Lazy person, etc.

Some predisposing factors are trauma to the joint, surgery, excessive use of alcohol, high protein diet, diuretics, acute Infection, exposure to cold, drugs, etc.

Samprapti of Gout:

Dishaprakopa Nidana such as Katu, Tikta, Alparuksa Aharasevan, Annasana alp, Rukshaharaadhayustrayan, Ambukrida, Ratrijagran, Palvan, Vegavidharanratrijagrana causes Vata Prakopa. On the other hand, Dhatudaurbalyakara and Agni mandyakara Nidana i.e., Lavana, Amla, Katu, Ksara, Misthanasukhbhojinam, Snigdha, Ahara sevana, Klinna, Virudhadhyasana, Rukshaharaadhayustrayan, Susaka and anupa mamsa Asudhaya, Acakaraman, Pinyaka, mulaka, Kulathi results in Dhatu dushti and Ama utpatti. Vata Parkopa, Rakta Dhatu Dushti and Ama Uttpatti when occurs together in body results in Sancharan of vitiated Vata and Rakta in the whole body leading to Khaivagunaya in Raktavahstrotas.[10] All such internal processes lead to obstructed path of Vata and Sthanasanshraya. Thus vitiated Vata and Rakta get stagnated at Sandhi and thereafter produce different type of Vedana.

Samprapti Ghatakas :

• Dosha - Vata Pradhan Tridosha-Janya Vyadhi
• Dushya – Rakta,Twak ,Mamsa
• Agni - Mandagni
• Udhbhavasthana – Pakvashya
• Sancharasthana- Sarva Sharira
• Vyaktasthana – Sandhi
• Srotas - Raktavaha, Asthivaha, Majjavaha
• Srotodushthi Prakara – Sanga,Vimargagaman

Purva rupa:[11]

Some premonitory symptoms described in Ayurvedic texts are Sparsha-Agyatvam (lack of tactile sensation), Kshate-Atiruk (high intensity of pain on trauma), Sandhi-Shaithilya (laxity of joints), Alasya (lethargy), feeling of heaviness, numbness and itching at knee , thigh, waist, shoulder, hands, legs and other joints of body), Svedo-atyartham na va (excessive or absence of perspiration), Karshnyam (blackishness of the body), Sadana (fatigue), etc.

Types and stages of Gout:[12]

1. Uttana Vatarakta (Preliminary stage of gout) - When there is involvement of Twak (skin) and Mamsa (muscle) dhatus only. This type of Vatarakta has Daha (Burning Sensation), Gourava (Heaviness),  Akunchana (Contraction), Ayama (Dilatation of Vessels), Beda (Splitting type of Pain), Kandu (Itching), Rakta twak (Reddish coloration of the skin), Ruja (Pain), Shayava twak (Cyanosis of the skin), Sphurana (Trembling or throbbing sensation), Suptata (Numbness), Toda (Pricking pain), skin pigmentation and Aayas.
2. Gambhira Vatarakta (Progressive stage of gout)- When Doshas penetrate to deeper Dhatus and have complex manifestation. Symptoms like Swayatu grathita (Hard swelling), Paka (Suppuration), Daha (Burning sensation), Kanjatwa (Lameness), Shyavatha (Cyanosis or pallor), Pangutwa (Paraplegia), Bhrisharthi (Excruciating deep pain), Vidaha (Internal burning sensation), Tamra twak (Coppery discoloration), Ruja (Pain), Sphurana (Throbbing sensation), Adhika purvaruk (Increased pain), Toda (Pricking type of pain), Vatasya sandyasthi Majjasu chindanniva (Aggravated vayu while causing pain burning sensation constantly moves with high speed through the Sandhi, Asthi and Majja) are seen.

Management of gout:

1. Specific Treatment:

For Uttana vatarakta – Pralepa, Abhyanga, Parisheka, Avagaha [13]

For Gambhira vata rakta – Vireka, Asthapana, Sneha pana.

1. According to the Dosha predominance

According to Acharya Charaka, Abhyanga, Basti with the combination of Chatursneha and Usnopanaha should be given. If the disease affects the joints of the legs only it is Vata predominant gout and the treatment is Asthapana basti followed by Anuvasana basti.

If there is pain in the rectum, flanks, thighs, joints, bones and abdomen it is due to Pittadhika vatarakta and it should be treated by Virechana, pana of ghrita and milk,parisheka,vasthi, and cold application. In case of Kaphadhika vatarakta; Mridu vamana,sneha and Sweda are advised.

1. Shodhana Chikitsa (purification treatment) includes Raktamoksana (bloodletting by leech or other method), Langhana (methods for effecting leanness, reduction of body bulk or resulting in lightness), Vamana (therapeutic emesis), Virechana, Asthapana vasti (decoction enema), Snehapana (intake of medicated oils or ghee)[14]
2. Raktamoksana- Raktamargavarana is the predominant pathology of vatarakta and this leads to the accumulation of morbid rakta. Hence raktamoksana is considered as the first line of treatment of vatarakta of both varieties.
3. Shamana (pacifying treatment) includes external application like Alepana (application of medicated pastes), Abhyanga (massage), Parisheka (pouring of medicated decoction over body) and Upanaha (application of hot poultice).
4. Lepas - Jadamayadi lepa, Kottamchukkadi lepa, Manjishtadi lepa
5. Guggulu yogas- Kaisora guggulu, Mahayogaraja guggulu, Amritadi guggulu
6. Rasayana yogas - Amalaki dasamoola rasayana, Kushmanda rasayana, Amritaprasavaleha.
7. Treatment for the relief of pain - Pinda taila, Dasamoola ksheera pana
8. Treatment for the relief of burning sensation - Jeevaniya gritam, Yavachoorna, madhuka,milk,ghee, Lepa (madhuka,aswatha twak, jadamamsi,satavari,udumbara).[15]

Discussion

Vatarakta is very important vatavyadhi which is described almost in all samhitas.We can correlate Vatarakta with the Gout which is a metabolic disorder in which uric acid level is increased. Vata and Rakta are the main culprits of Vatarakta. It is mainly characterized by pain in the metatarsophalangeal joint and clinically diagnosed by elevated serum uric acid. The site of Vatarakta are joints of hands and feet and all the joints of body. The treatment principle of Vatarakta comprises of externally Abhyanga (massage), Parisheka (pouring of medicine), Aalepa (application on skin) etc., whereas internally purgative, Sneha (oil-based preparation), Basti (medicated enema) and Raktavisravana (therapeutic bloodletting).

Conclusion

Vatarakta is one of the most prevalent disorders seen in clinical practise nowadays as a result of our sedentary lifestyle. Dietary habits and life style modalities plays a major role in cause of vatarakta. Also, the morbidity of Kapha and Medas can cause different other serious diseases in different systems. As a result, this is a good time to look at the function of Ayurvedic medicines and therapies in Vatarakta. Ayurveda recommended medications, Panchakarma, yoga, and a daily regimen for illness treatment. In the case of Vatarakta, Abhyanga, Seka, and Pradeha are also recommended for symptomatic relief.