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Introduction

Ayurveda the “science of life” or longevity is the holistic alternative science it has since vedic era.Vatarakta is a Santarpana-janya Vyadhi thus Aam-Dosha is dominant initially The origin of the word Vatarakta comes from two words Vata and Rakta.Rakta which is vitiated by vata is derived as vatarakta . It is also known as Adhyavaata means the disease which generally affects the people with comfort and royalty and secondly as it is difficulty to cure ‘SYNONYMS

Khudha Vata- The word “Khudda” has two meanings i.e small & joint. Hence disease which occurs mostly in Khudda Desha i.e near the ankle or in smaller joints.

 Vata Balasa- The disease manifested after provoking Kapha.

Vatashonita – This disease results due to vitiated Vata and Rakta, hence called Vatashonita.

Adhyavaata – As explained above

CLASSIFICATION

Depends on site of Pathogenesis

*Charaka Samhita

1)UTTANA Vatarakta:  where twak and mamsa are involved

2)Gambhira vatarakta: All the other dhatus are taking part in pathogenesis

3)Ubhayashrita vatarakta: signs and symptoms of both these types are present

According to Doshas predominance:

1)vataja, 2)pittaja, 3)Kaphaja, 4)Raktaja                                                            5) Vatapittaja, 6)Vatakaphaja, 7) Kaphapittaja   

8) Sannipatik

SAMPRAPTI (PATHOGENESIS)

 Vatarakta is caused due to the vitiation of both Vata dosha and Rakta dhatu. Aggravated Vata leads to the aggravation of Rakta as a result causes pain and inflammation in joints. Due to Vata evam Rakta Parkopak  aahara-vihara sevana.vitiated doshas circulate through the Srotas and become localised in  the  Raktavahstrotas,where there is Khaivagunaya,as it is obstructed there and the disease is evolved by doshas get  Localised in Sandhi is called Gambhira Vatarakta (deep seated)and that get localisied in Twak, mamsa is called Uttana Vatarakta(superficial).The spread of doshas in joints is compared with mushika visha producing the symptoms of Daha (Burning sensation), Toda (pricking pain), Kandu (itching), Vaivarnaya (discoloration), Sparshasahshnuta (tenderness), Stabadha(stiffness). On the basis of similarity in symptoms Vatarakta can be correlated with gouty arthritis in contemporary science. Gout is a heterogeneous group of diseases characterized by hyperuricemia. Gout is found to have increased prevalence in recent years. Gout is seen predominantly in men during middle life. The male female ratio is 7:1 to 9:1. Conventional treatment of the disease includes analgesics, anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), Colchicines, Uric Acid lowering therapy, Xanthine oxidase inhibitor, and Uricosurics drugs. The main pathways for uric acid production and elimination are shown along with the site of action for urate lowering therapies.

Various modalities of treatment for Vatarakta have good outcome. Highly praised treatment modality includes Vasti karma in Vatarakta.  Vasti karma treatment has got some edge over all other modalities in terms of relieving the symptoms early, modifying the underlying pathology and also reducing the duration of treatment. Importantly it can bring down the disease severity. Vasti is the best therapy to control the Vata and thus it controls the Pitta and Kapha also. The given vasti when enters the Pakvasaya by its Virya, draws the vitiated Doshas lodged in the entered body from foot to the head, just as the sun situated in the sky sucks up the moisture from the earth. The Tikshna Guna of Vasti helps in overcoming the Sroto Dushti resulting due to Sanga.Thus Vasti dravya after reaching to large and small intestine get absorbed due to Laghu, Ushna, Tikshna, and Ruksha Guna of Dravyas, it breaks the obstruction and expel out the morbid material from all over the body. Vasti by its Srotosodhan, Vatanulomana and Brumhana properly achieves both the goals. A Vasti which is Brumhana, Vatashamana,Rakta prasadana and Rasayanas more appropriate .Different type of Vasti can be used in Vatarakta and it is found to be very effective. Vatarakta located in Paani (hands) is caused by upward Dosha and in Paada (feet) is due to downward Dosha.So, a treatment which is capable of dislodging the deep seated Doshas and bringing Bala to the Rogi is found to be appropriate.

Material and Methods

Case Report as Follows

A female pt of age 42 yrs admitted in female ward of Kayachikitsa Department.

NAME: A.B.C.42 years female DOA -17/08/2023

OPD .NO-11574                         IPD.NO- 994

Presenting complaints:

-Bilateral knee joint pain and swelling

 -Bilateral ankle joint pain 

-Difficulty in walking                                                                     from 1year

 -Burning sensation of both sole region and pain.

 -backpain

H/o Past illness – No

Investigation  

• HBG:11.7g/dl
• WBC:5100 /Cumm
• RBCs:4.31/Cu.mm
• Uric acid :8.91mg/dl
• BSL(R):102.9Mg/dl
• ESR:15mmhr
• RA:Negative

Based on the clinical presentation (pain and swelling she developed difficulty in walking) with an increased ESR level of 15 mm/1hr and serum uric acid level of 8.91mg/dl the patient was diagnosed as a case of Acute Gouty Arthritis.

Criteria for assessment-Subjective

 Visual analogue scale (0-10 Scale)

Grade

0 =No pain

1-3= Mild pain

4-7= Moderate pain

8-10 =Severe pain   

Tab No:1Showing gradation of symptoms according to WHO scoring pattern

Criteria for assessment-objective

Objective criteria

Hb

ESR

Serum Uric Acid

Materials=CHIKITSA

Samanya Chikitsa

a) Shodhana Chikitsa b) Shamana Chikitsa = Antahparimarjana Chikitsa

c) Rakta-mokshana Karma d) Lepa, Avgahana, Seka Chikitsa =Bahiparimarjana Chikitsa

Shamana chikitsa

 Most commonly Gokshura, Guduchi, Musta, Punarnava drugs are mentioned in Charaka Samhita which helps in reducing symptoms of Vatarakta. Some formulations found to be effective are Amrutarishta,Punarnava ghanavati ,Vatavidhwansa ras Most of these drugs have Vatashamaka properties and Mutra-virechaka quality so help in excretion of excess uric acid present in the body.

Shodhan chikitsa:

 This pt treated with yogavasti (Guduchi kwath) for 8 days                                                          

 Contents of the Vasti

1.  Guduchi (Tinospora cordifolia)
2.  Til taila (Oil of Sesamum indicum)
3.  Saindhava (type of a salt)
4.  Madhu (Honey)
5. Pinda tail
6.  Catheter (female)
7. Bowl & Vasti pot

Vasti dravya will be mixed in the following order. Initially madhu and saindhava are to be mixed and then til tail will be mixed then Guduchi kwatha will be mixed properly [Charak siddhisthana 3/23]. All total 650ml niruha basti given to the patient.

Tab No:2: Showing Panchkarma Done

Niruha had given on empty stomach and Anuvasana vasti had given after meal.  Anuvasan vasti and niruha vasti in yatyasata ,8 vasti should be given to the pt.

Purva karma: Sarvanga abhyanga with Pinda tail + sarvanga swedana with Dashmool kwatha for 8 days.

Pradhan karma: After snehan, swedana (purvakarma)

Firstly, one snehabasti and lastly one Sneha basti are given. There are 3 niruha vasti between these two3 anuvasan basti are given in between them.  This way the totle numer of these vasti become 8. The method used in this sequence is called yogabasti.

Pachhata karma: Sansarjana krama, Vishranti.

Shaman Chikitsa                                                                  

In consideration with the findings of clinical examinations & investigations following treatments was given as table

Tab No: 3

Medication takes 30 days for 3 months

Pathya:

AAHARA - Cereals like the old Barley, Saali as well as shashtika Rice, leafy vegetables like – Kakamachi, Vastuka, Upodika Perwal, Soup of adhaki, Chanaka, Masura, Mudga added with Ghrita, Pratuda and Vishkira Mamarasa. Milk of cow, buffalo and goat.

VIHARA – Use of soft pillows and bed. Warm poultices

Apathya: Avoid deep fried,oily food, divaswap varja.

RESULTS:

There was reported a remarkable improvement in the complaints Hematological parameters were reinvestigated. Very good response was noted after the completion of therapeutic interventions. Reduction in symptoms like severe joint pain, stiffness, fatigue along with Acute phase reactants (ESR) and Serum Uric Acid level were noticed. Overall functional capacity and general condition of the patient were improved with medication.

: Criteria for assessment-Objective:

SUBJECTIVE CRITERIA (JOINT SYMPTOMS ASSESSMENT)

Scoring Pattern: VAS Scale (0-10 scale)

Showing changes in symptoms before and after treatment

Tab No: 4

Discussion

In this study, observation was done before and after treatment based on symptoms gradation pattern. Shamana Chikitsa and Shodhan chikitsa. This particular case was treated based on the Vatarakta line of management. Snehana (oleation), Swedana (sudation) followed by Yoga Vasti (medicated enema) which was given for eight days along with Samanaushadhies (oral medicines) Acharya Charaka and Vagbhata documented, “Na hi vasti samam kincit Vatarakta chikitsitam” (there is no other therapeutic measures equivalent to vasti in treating Vatarakta). Vasti is considered as Agrya Aushadha for Vata.

Amrutadiguggulu: Tridosha shamak mainly Vata and Pitta shamak for Vatarakta patient guggulu is considered to be a good, useful medicine. It contains Amruta, Guggulu, Triphala, Trikatu,Vidanga Tvacha,Trivrut .etc. It is one of the important guggulu kalpana for Vatarakta. Vatavidhwans ra:Vatashamaka Amrutarisht:Pittadosh shamak Pinda taila: for Pain management, local application of Pinda taila is useful. It is mentioned by Acharya Charaka, for Ruja, Daha shaman. Guduchi: Guduchi is considered as drug of choice in Vatarakta. The alkaloid presenti in Guduchi such as Berberina acts as xanthine oxidase inhibitor. Most of the Aushadhas is having Guduchi as their Main ingredient. Guduchi (Tinospora cordifolia) is said as the Agrya (best) Aushadhi for Vatarakta. Uricosuric activity which causes an additional excretion of uric acid.  It is proved to have anti-inflammatory and antiarthritic action. Tinosporin (chemical constituent) is a natural diuretic agent. Tinosporin also possesses gastro protective activity which is a beneficial property while using it as an analgesic. It has Vyadhi pratyaneeka as well as Rasayana. Punarnava: Punarnava speeds up the filtration process of kidney and flushes out the excessive fluids and other waste products. Trivrit and Danti possess anti-inflammatory properties

Conclusion

This case showed significant improvement during and after the combined therapeutic intervention. From the above case, it can be clearly concluded that Chikitsa mentioned in Vatarakta by Acharyas can clearly bring down the Symptoms as well as the serum uric acid level.In this case all symptoms like Pain & Burning sensation in ubhaya janu sandhi, ubhaya hastaparva sandhi, throbbing pain in the muscles, mild swelling in the affected joints are markedly diminished in 3 months study.

Vasti is much beneficial in the patient of Vatarakta (Gout) by relieving the local pain, swelling and tenderness as most of its contents are Vataghna, Vednasthapan and Shothahara Dravya and bloodpurifier which detoxify body.Shamana chikitsa and Yogvasti are significantly effective in Vatarakta, followed by proper Pathya Apathya.