Vatarakta & Gout.

VATARAKTA(GOUT).

Vatarakta is the disease related with khavaigunya found in Raktavaha srotas which includes vitiated Vata and blood.

1)   NIRUKTI: -

2)   VYAKHYA: -

Vitiated blood gravitates and accumulates in the feet. Thereafter, it gets saturated with the deranged vayu, on account of the predominance of which it is called as Vatarakta.

3) HETU:- Excessive intake of salty, sour, pungent, alkaline, fatty and hot food, taking meals while one is having indigestion, curried or fried preparations of meat of aquatic or swampy animals, dried meat and cereal ball preparations, radishes, kulattha, masha, nishpava, different varieties of leafy vegetables and meat, sugarcane and yoghurt, arnala (Kanji or sour fermented rice water), sauvira (sour fermented barley water), sukta (vinegar), buttermilk, wine and asava (medicated spirit, eating incompatible articles of diet, eating before the previous meal has been digested, anger, day sleep and keeping awake at night.

The factors responsible for Gout according to modern science are as follows: -

a) Increased serum uric acid concentration (hyperuricaemia).

b) Recurrent attacks of characteristic type of acute arthritis in which crystals of monosodium urate monohydrate may be demonstrable in the leucocytes present in the synovial fluid.

c) Aggregated deposits of monosodium urate monohydrate (tophi) in and around the joints of the extremities.

d) Renal disease involving interstitial tissue and blood vessels.

e) Uric acid nephrolithiasis.

4)PURVARUPA:-The general prodromal symptoms and signs of Vatarakta are profuse perspiration or anhidrosis, blackish discolouration, loss of the sense of touch, severe pain on even mildest trauma, slacknes of the joints, indolence and malaise; the local appearance of eruptions on the knees, legs, thighs, loins, shoulders, hands, feet and the joints of the body, severe pricking type of pain, twitchings, tearing pain, heaviness, numbness and an itching sensation, pain in the joints which comes and goes again and again, local discolouration and circumscribed patches also occur.

5) RUPA:-

6) PRAKARANURUPA RUPA :-1) (a) Superficial type (Uttana):- Affected skin becomes blackish red, painful, hot to touch and there is intensive itching. The skin becomes black coloured.

                                                                 (b) Deep type (Gambhira):- There is swelling, hardness, severe pain, burning and pulsations in the affected parts. The symptoms are more prominent in the bones, nerves and muscles. Charaka has accepted these two as the type of diseases, while Sushruta accepts these two as the stages of the disease.

                                                             2) (a) Vatarakta with predominance of vata:- With predominance of vata, there is excessive pain, twitching and splitting sensation in the lesions. The inflammatory swelling is dry, black or blackish and increases or decreases at times. The arteries and the joints of the fingers and toes become narrow and severely painful. There is an aversion and intolerance to cold as well as rigidity, tremors and numbness in the limbs.

                                                             (b) Vatarakta with predominance of rakta: - With the predominance of rakta, there is severe pain as well as pricking and tingling sensations in the inflammatory swelling which is coppery red and is associated with an itching sensation and a moist discharge; it subsides neither with fatty nor with dry medicaments.

                                                             (c) Vatarakta with predominance of pitta: - With the predominance of pitta, one suffers from heart burn, mental confusion, perspiration, fainting, intoxication and thirst; there is hyperesthesia, severe pain, redness, excessive heat and suppuration in the inflammatory swelling.

                                                             (d) Vatarakta with predominance of kapha: - With the kapha predominance, the body is felt as if covered with wet clothes, heavy, insensitive to touch, oily and cold. There is an itching sensation and mild pain locally.

                                                             (e) Vatarakta with predominance of two/ (f) Three doshas: - With the predominance of two doshas or of all doshas, mixed features of the concerned doshas are present.

7) SAMPRAPTI: - Riding on an elephant, a horse or a camel and an intake of heart-burn producing articles of diet causes improper digestion of food leading quickly to vitiation of Vata and Rakta, which then gravitates and accumulates in the feet.

                                  Thereafter, the vitiated blood gets saturated with the deranged vayu, on account of the predominance of which it is called as Vatarakta. Since, in Vatarakta both Vata and Rakta gets vitiated, both are responsible for each others vitiation. The vitiated Vata vitiates Rakta during the flow of Rakta along with Vata; whereas vitiated Rakta vitiates Vata by blocking its channels and so on.

                                  Clinically, the natural history of gout comprises 4 stages: asymptomatic hyperuricaemia, acute gouty arthritis, asymptomatic intervals of intercritical periods and chronic tophaceous stage. In addition, gout nephropathy and urate nephrolithiasis may occur.

Gout may be classified into 2 types: metabolic and renal, each of which may be primary or secondary. Primary refers to cases in which the underlying biochemical defect causing hyperuricaemia is not known, while secondary denotes cases with known causes of hyperuricaemia.

a) Hyperuricaemia of metabolic origin: - Comprises about 10% cases of Gout; characterized by overproduction of uric acid. There is either an accelerated rate of purine biosynthesis de novo or an increased turnover of nucleic acids.

b) Hyperuricaemia of renal origin: - Comprises about 90% cases of Gout, characterized by reduced renal excreation of uric acid. Altered renal excreation could be due to reduced glomerular filteration of uric acid, enhanced tubular reabsorption or decreased secretion.

According to both ancient and modern sciences, the vitiation predominantly starts in the great toe and starts flowing upwards just like the rat poison (it may also floe from thumb to upwards).

                   8) DOSHA-DUSHYA ADHISTHAN: - a) Dosha: - Vatapradhan;

b) Dushya: - Rakta;

c) Srotus: - Raktavaha;

d) Adhishthan: - Sandhi;

e) Srotodushti lakshana: - Sanga;

f) Pakvashayotth: - Chirakari roga.

                

               9) UPADRAVA: - There may arise various complications in this disease such as insomnia, anorexia, dyspnoea, sloughing, fixity at the joint of neck, fainting, pain, thirst, fever, mental confusion, tremors, hiccough, inability to walk, spreading cellulites, suppuration, pricking pain, dizziness, tiredness, digital deformities, appearance of blisters, burning sensation, affection of the vital organs mainly heart, rectum and brain (hrudaya-basti-shira) and tumours and even the mental confusion.

                                  If all the complications have not appeared, the condition is relievable, whereas if there is no complication at all it is curable.

10) UDARKA:-

11) ARISHTA LAKSHANA:-

12) VYADHI VYAVACHCHHATI: -

13)  SADHYASADHYATA: -

a) Ekadoshaja and recent Vatarakta are easily curable.

b) Dvidoshaja Vatarakta, Vatarakta persistent for one year even along with the complications are yapya ;i.e.; difficult to cure.

c) Tridoshaja Vatarakta along with lots of complications is incurable. Also those Vatarakta in which the disease has been spread from thumb to the janusandhi or in which skin has become worst affected or in which there exist secreations from the skin or in which there are complications such as kshaya of strength or mansa dhatu are incurable.