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A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASA AND LEKHANA BASTI IN VATARAKTA” Patil K.V , 2006 -07, DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA, S.D.M. COLLEGE OF AYURVEDA, UDUPI – 574118
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Introduction
INTRODUCTION Vatarakta comes under the domain of Vatavyadi 1and mostly affecting the
extremities2. The umbrella of vatarakta in parlance with conventional medicine includes
many conditions related to extremities and to mention a few are connective tissue
disorders as well as peripheral vascular disorders. In the literature it is emphasized that
the etiological factors leads to the predominant morbidity of vata dosa and rakta dhatu
and hence the name vatarakta. To be more specific, the obstruction of raktamarga or
raktavaha srotas is the leading pathology3.
Two distinct modes of etiopathogenesis of vatarakta are elaborated in the literature.
The specific etiological factors of vata dosa and rakta dhatu separately leading to the
morbidity of the same with the involvement of raktamarga is about the first clinical
variety of vatarakta4. The etiopathogenesis of second clinical variety is different from
this. In the second clinical type instead of etiological factors of vata and rakta, it is the
etiology of kapha and medas that initiates the illness. The etiological factors of kapha and
medas obviously lead to the morbidity of the same. This abnormally increased kapha and
medas in turn gets accumulated in the rakta marga causing the provocation of vata as well
as rakta5.
Dietary habits and life style modalities plays a major role in the causation of vata rakta.
Also the morbidity of kapha and medas can cause different other serious diseases in
different systems. Prameha, Sonitadusti, hrdroga and vatavyadhi etc all are found to be
due to incriminatory affect of kapha and medas in respective systems6. Hence forth the
concept of margavarana in different parts of the body is emphasized in caraka samhita.
The pathology of margavarana leads to the establishment of clinical signs and symptoms
in vatarakta. Further to add, sodhana, samana, bahiparimarjana and rasayana cikitsa all
are aimed at the rectification of margavarna in this disease7. The whole concept of
margavarana can be best explained by the pathology of atherosclerosis and peripheral
vascular disease in modern parlance.
Peripheral vascular diseases include arterial, venous as well as lymphatic disease, and the
illness has a long lingering course. Inadaquate treatment or failure of treatment may lead
to fatal complications. Further to add, obstructive arterial diseases are named after the
1
A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASA AND LEKHANA BASTI IN VATARAKTA Patil K.V , 2006 -07, DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA, S.D.M. COLLEGE OF AYURVEDA, UDUPI – 574118
Introduction
anatomical structure affected as coronary artetry disease, cerebro vascular disorders and
Ischemic limb diseases etc.
Atherosclerosis is the chronic pathological process likely to be asymptomatic
throughout the life, and it may have a fatal course when the same pathology involves the
vital organs, to mention few are heart, brain, gut etc. in contrast to this the
atherosclerosis affecting the arteries of the extremities, most commonly related to the legs
may not have a fatal course since beginning. But, it is also true that the disease runs a
chronic course and may land in fatal complications. Atherosclerosis leading to narrowing
of the arterial branches with in the legs manifests as ischemic limb disease and is
abbreviated as ILD. Rectification of Hyperlipidemia, bringing down the hypertension,
reducing the hyperglycemia and when essential surgical intervention like
revascularization or amputation, all these forms the sheet anchor of the management of
ILD.
Progressive atherosclerosis results in narrowing of the arterial lumen, hence the
name arteriosclerosis obliterans to this unique illness. Peripheral arterial disease is
another name referring to the same. Survey studies have established highest prevalence of
the illness in older people8. According to U.S. department of Health and Human services,
an estimated 12% - 17% of population over age of 50 yrs has some form of arterial
insufficiency. Prevalence increases with age as noted in recent national survey. the
prevalence of PAD was found to be 29% in people over aged 70 yrs. the prevalence rate
was the same in people around the of age 50 who also had history of smoking or diabetes,
clearly demonstrating their adverse effect on the circulation. Further, studies with
coronary angiography estimated that approximately one half of the patients of peripheral
arterial diseases present with clinical symptoms. More interestingly, life table analysis
has indicated patient with clauducation have a 70% 5-year and 50% 10-year survival rate.
Most deaths occur due to sudden or secondary to M.I. The prognosis is worse in patient
who continue to smoke cigarettes or who have uncontrolled diabetes mellitus. These
observations of survey studies undeniably point towards the high prevalence as well as
seriousness of the problem.
Depending upon the involvement of deeper or superficial dhatu in the pathogenesis of
vatarakta, it is clinically catagorised into uttanavatarakta gambhira vatarakta as well as
2
Introduction
ubhayashrita vatarakta9. Gambhira vatarakta has poor prognosis and is usually incurable.
The factors like, number of dosa involed, virulence of morbid dosa, involvement of
deeper dhatu, age, physical status all determine the prognosis of the illness10.
Previous Work Done
The review of previous works done clearly indicate that there prevailed ambiguity in the
understanding of vatarakta in modern parlance. Rheumatoid arthritis, gouty arthritis,
osteo arthritis, ischemic limb disease etc are considered as vatarakta by different scholars.
Following is the review of some clinical studies on vatarakta as ischemic limb disease or
lekhana basti treatment.
In a single blind comparative clinical study entitled “The effect of lekanabasti in the
management of sthoulya”,1122 patients suffering from sthoulya were studied in two
groups as control and test. The patients in the test group received lekhana basti as well as
murchita taila anuvasana basti in kalabasti course of 16 days followed by oral medication
with amrita guggulu for 30 days. The patients in the control group were subjected to oral
medication with amrita guggulu for 30 days. Following the medication statistically
significant improvement was observed in both the groups, however better response was
recorded in patients of test group proving the efficacy of lekhna basti in patients suffering
from sthoulya.
In patients suffering from sthoulya roga another single blind comparative clinical study
entitled “A clinical study on the management of sthoulya by panchatikta and lekhana
basti.”12was carried out . In this study 32 patients suffering from sthoulya were studied in
three groups. In group A 12 patients were orally treated with panchatikataguggulu vati in
a dose of 6 gm per day for 45 days. 10 patients in group B received panchatiktaghanavati
orally in a dose of 6 gm per day for 45 days. Further in group C 10 patients were
subjected to lekhana basti treatment. The study showed best reduction in body weight as
well as lipid profile levels in patients treated with lekhana basti course.
Yet another single blind comparative clinical study entitled “Conceptual study of
vatarakta vis-à-vis TAO & clinical management with manjishthadi kshara basti ”13, 20
patients suffering from ischemic limb disease were studied in two groups. 10 patients in
group A were treated with kaishora guggulu and arogyavardhini in a dose of 400 mg each
trice daily for 3 months with the anupana of 30 ml of manjistadi kvatha . In the second
3
Introduction
group B patients were initially subjected to yogabasti course of manjistadi ksara basti and
dhanvantara taila anuvasana basti followed by oral medication. The study recorded better
therapeutic response in patients treated with manjistadi ksara basti.
The analysis of previous work done in different research and post graduation study
centers unravels the ambiguity about the clinical understanding as well as treatment of
vatarakta. Many of the clinical studies regarded musculoskeletal disorders like
rheumatoid arthritis, gouty arthritis and osteoarthritis as vatarakta. In these works no
significance is being given to the unique pathology of raktamargavarodha in vatarakta.
Very little number of clinical works concentrated on vascular disease of the limbs as
vatarakta. More specifically speaking TAO is regarded as vatarakta. Here also the over
eating and sedentary habit as the cause of arterial disease / raktamargavarodha through
the pathology of atherosclerosis / dhamani praticaya leading to ischemic limb disease /
vatarakta is ignored. Added to this the yoga basti course of 7 days is inadequate to show
definite benefit in such chronic lingering disease. Kala basti and karma basti courses
appear better in chronic progressive disorders like vatarakta.
This review indicate that there is a necessity to study vatarakta as peripheral arterial
disease and its management with both sodhana and shamana line treatment with the due
consideration of its severity chronicity as well as possible complications.
Distinct etiological factors of vatadosha as well as raktadhatu together is said to
cause vatarakta. A variant form of vatarakta is also elaborated in Ayurvedic literature in
which santarpana category factors are incriminated to cause the illness. In this type of
vata rakta it is said that morbid kaphadosha and medas get accumulated in
raktavahasrotas14. Irrespective of employment of established treatment the illness
continues to run a chronic course affecting the middle aged and elderly people. Hence
any work exploring the newer effective medication mentioned in the Ayurveda is the
need of the day. Present work entitled A Clinical Study to Evaluate the therapeutic effect
of Vataraktantaka Rasa and Lekhan basti in vatarakta, is carried out with the
consideration that, the therapeutic measures that reduce kapha dosha and medas as well
as alleviate the morbid Vatadosha is the sheet anchor of treatment of vatarakta15. Basti is
claimed to be the best treatment in lingering diseases due the morbidity of vatadosa16.
Lekhanabasti is said to allevate both kaphadosha as well as medodhatu and hence
4
Introduction
indicated in santarpanajanya vatarakta17. The herbo-mineral compound vataraktantaka
rasa consisting mainly of guggulu, shilajatu and lauha is said to be effective in negating
the incriminatory effect of morbid kapha dosa and medas and there by ensuring complete
cure of vatarakta18.
The desertation work incorporates the following chapters:-
- conceptual study
- clinical study
- discussion
- summary and conclusion
The first chapter on conceptual study also includes sub-chapters discussing the
etymological derivation of the constituent words of Vatarakta as well as historical review.
The general description of the illness Vatarakta, that includes Nidana, poorvarupa,
rupa, samprapti, upashayanupashaya, upadrava, sadyasadyata, arista, Chikitsa and
pathyapathya, all are found in the second chapter.
The details of Vataraktantaka rasa and composition of Lekhana basti are briefed under
the title drug review.
The design of the present clinical study, materials and methods, criteria of assessment,
intervention, descriptive statistical analysis of the sample taken for the study, observations,
results, and its statistical analysis elaborated in tables as well as graphs all are narrated in the
clinical study.
The critical analysis of the result is made in the chapter on discussion.
In the final chapter entitled summary and conclusion, the whole dissertation is briefed.
This work is carried out with a predilection that the Vataraktantaka rasa and Lekhana
basti together may bring about definite relief in patients suffering from Vatarakta..
This is not the end of research work in this line; rather this step will pave ways for
many other enthusiastic physicians to find a better cure for this lingering disease affecting the
extremities. With this intention in mind this work is presented.
5
Conceptual Study
HISTORICAL REVIEW Science is a continuingly altering system of knowledge, based on logic. The
conclusions of which are like a pilgrim stranger tarrying for a while awaiting his
destination. New observations are added to the total body of knowledge. Some of older
observations loose their relevance or their significance. Ayurveda is no exception to this
rule, and particularly this holds good in case of VATA RAKTA. This surveillance of
Ayurvedic literature reveals the progressive evolution of VATA RAKTA through the ages
By going through the available literature some references are available regarding
etiology, clinical presentation, treatment and complications of vatarakta. These are
elaborated in the following lines.
Vedikakala
Ample references are available in the Vedas in relation to the vata as well as rakta. But
as such description of the disease vatarakta is not available in these literatures.
Puranakala
Not a lot of information about the disease vatarakta and its treatment is presented in the
literatures of puranakala. In Garuda purana the description of vatarakta as a
raktapradhana vyadhi is worth mentioning. The disease vatashonita is also mentioned in
Agnipurana, further to add vasa and guduchi are listed as drug of choice in this illness.
Different herbal formulations effective in vatarakta are also elaborated in this book19.
Samhita kala
Entire aspect of the illness vatarakta from etiology to treatment is described at full length
in the books of samhita kala
In caraka samhita 29th chapter of cikitsa sthana deals with the disease vatarakta. The
details of the disease included nidana, samprapti, prakar, chikitsasutra and chikitsa as
bahya and abhyantara like shodhana, shamana as well as rasayana. The book also
mentions the unique pathology of vata rakta as accumulation of kapha and medas in
raktamarga leading to margavarana and vatarakta. The treatment of this clinical variant of
vatarata included shilajatu, guggulu as well as louha. Various taila preparations are
explained along with preparation procedure and ingredients like shatapakamadhukataila
and its use in the form of pana, nasya, abhyanga and basti20.
7
Conceptual Study
In Sushrutasamhita The explanation of nidana, purvarupa, rupa, samprapti and upadrava
of Vatashonita is available at full length. It is opined that unttana and avagadha clinical
presentation of vatarakta is not about its prakara rather avasthavishesha of vatarakta. All
modalities of treatment for vataja, pittaja, kaphaja, sansargana, sannipataja variety of
vatarakta are explained in this book21.
Sthoulya is listed as a major illness of santarpanottha vyadhi. The description of kapha
medovrddhi in rasarakta vaha srotas is most relavant to vatarakta. It is said that in the
presence of margavarana there is every risk of developing serious illness like prameha
and vatavyadhi. In addition to this silajatu guggulu triphala and gomutra is emphasized as
most efficacious in the management of sthoulya as well as margavarana. In the same
context the attention is called to the therapeutic efficacy of lekhana basti in the reduction
of kapha as well as medo dhatu22. Literature on vatarakta in bhela samhta is limited to the
just mentioning of treatment of raktagata vata as that of vatasonita23. Vivid description of
vatarakta in relation to its nidana, lakshana, as well as chikitsa is given in haritasamhita24.
In ayurveda dipika few lines of kharanada samhita is quoted in relation to types of vata
ratka. In this context it is said that kharanada samhita accepts 36 types of vatarakta25.
Nidana, samprapti, lakshana, sadhyasadhyata and chikitsa of vatarakta is dealt in full
length in gadanigrana26. In the similar manner the whole description of vatarakta is found
in vataraktadhikara in vangasena samhita27. The elaboration of vatarakta in astanga
samgraha and asthanga hridaya follows the opinion of caraka samhita and sushruta
samhita. Further in this treatise the add-on description of sama and nirama stages of the
vatarakta is worth mentioning.
Samgraha kala – both diagnostic as well as therapeutic aspect of vatarakts in its entirety
is found in the books of samgraha kala, that include Sharangadhara samhita,
Bhavaprakasha. Madhavanidana, Yogaratnakara and Cakradatta
The lists of references from available literature in accordance to nidana panchaka were
enlisted below28 in
8
Conceptual Study
Table no. 1
Definitio
n
Synonyms Aetiolog
y
Pathogenis
i
Type
s
Purvarup Rup
a
Veda - - - - - - -
Puranas
(GarudaPuran
a)
+ - - - - - +
Agni puran - - - - - - -
Cha. Sam + + + + + + +
Sus.Sam + + + + + + +
Ksh. Sam - - - - - - -
Har. Sam - - + - + - +
Bel. Sam. - - - - - - -
Kar. Sam. - - - - + - -
Shar. Sam - - - - + - -
Ast. San + + + + + + +
Ast. Hr + + + + + + +
Mad. Nid + + + + + + +
Gad. Nig + - + + + + +
Bha. Pra. + + + + + + +
Yog. Ratn + - + + + + +
Bhai. Ratn + - + + + + +
Review of the available literature unravels the minimal information of vatarakta in the
books of vedic period. Contrary to this entire aspect of the illness from nidana to cikitsa
is found in books of samhita as well as sangraha kala of the history.
9
Conceptual Study
Presentation in vatarakta:
Clinical presentation of vatarakta typically varies in different stages as purvarupa stage,
rupa stage as well as upadrava stage. Pain in the affected part is the cardinal
manifestation of the illness. Sula, ruk, toda, arati, and ruja are the different modes of pain
that may be present in vatarakta29. Further this pain may show a variation in terms of its
severity in regards to time of the day, season or physical activity. Including the pain the
clinical signs and symptoms of the disease may be differentiated as the one restricted to
the skin, or related to the deeper tissues. Altered tactile sensation is a major symptom
related to skin, and may manifest in the form of numbness or hyperesthesia30.
Fasciculation, alteration in the color of the skin as pallor, blackish, reddish, bluish etc,
excessive or deficient sweating31, loss of lanugo, dryness of the skin, these are the
symptoms all related to the skin. Pathogenesis when involves the joints, patient suffers
from symptoms like joint pain, joint swelling, reduction in the range of movements and
other manifestations related to the joints32.
Progressive involvement of the deeper tissues is the characteristic feature of the
illness vatarakta33 and is marked by the hard stable swelling, progressive change in the
color of the skin from redness through bluish to blackish tinge. Later even suppuration
ensues in the affected part34.
During the later stages of the illness few of the systemic symptoms may add to the list of
local symptoms of vatarakta. Discolorations of the affected limb, edema, different type of
pain, deformities, suppuration, gangrene etc are few of the local symptoms. In contrast to
this, Later during the course of the illness the patient may develop symptoms like
abnormal respiration, hiccough, excessive unexplained thirst, insomnia and altered states
of consciousness in the form of bhrama mada, moha, murcha etc manifest as systemic
symptoms35.
Role of medo dhatu in the pathogenesis of vatarakta
Two distinct etiopathogenesis may cause the illness vatarakta. Individual
etiological factors of vata dosa as well as rakta dhatu may culminate in the development
of vatarakta and is the usual variety of vatarakta. Where in the morbid vata dosa as well
as vitiated rakta dhatu leads to the rakta margavarana and is the principal pathology of the
vatarakta36. In other variety of vata rakta, to begin with there is no role of etiological
10
Conceptual Study
factors of either vata dosa or rakta dhatu. Contrary to this the etiological factors of kapha
dosa and medo dhatu take the leading share in the pathogenesis of vatarakta. Here in,
morbid kapha dosa and medo dhatu tend to accumulate in the rakta marga there by
contributing the principal pathology of raktamargavarana37. The similar qualities of
kapha and medo dhatu speeds up the pathogenesis as two factors support mutually38. To
be precise, the santarpana category of etiological factors causes the morbidity of kapha
dosa and medo dhatu, and these in turn accumulate in the raktamarga leading to the
provocation of vata dosa and finally manifesting as vata rakta.
Needless to say depending upon the variation in the etiopathogeneiss the planning of the
treatment should differ. Rectification of morbid vata dosa as well as rakta dhatu is the
rational treatment in the first variety of vatarkata. Kapha medo hara line of treatment is
the sheet anchor of the treatment of santarpana nidana janya vatarakta39.
The pathogenesis of raktamargavarana is best correlated with the arterial obstruction due
to the atherosclerosis. This phenomenon of accumulation of kapha and medas within the
dhamani is also referred as dhamani praticaya in ayurvedic literature40. Abnormal
accumulation of the lipids in the arterial wall is the leading pathology of atherosclerotic
obliterans. The most common symptom of ischemic limb disease that include intermittent
claudication, ache and cramps, altered sensation, changed skin color, obliterated arterial
pulse, and later gangrenous changes all these may be best explained even in vatarakta.
Both peripheral arterial disease as well as vatarakta are said to be common in lower
extremities41. These citations of similarities are more than enough to compare the
ischemic limb disease with the santarpana nidana janya vatarakta.
Atherosclerosis is a specific form of arteriosclerosis affecting primarily the intima of
large and medium-sized muscular arteries and is characterized by fibro fatty plaques or
atheromas. The term atherosclerosis is derived from athero-( meaning porridge) referring
to the soft lipid-rich material in the centre of atheroma, and sclerosis (scarring) referring
to connective tissue in the plaques. Atherosclerosis is the commonest and the most
important of the arterial diseases. Though any large a medium-sized artery may be
involved in atherosclerosis the most commonly affected are the aorta, the coronary and
the cerebral arterial systems. Therefore, the major clinical syndromes resulting from
ischemia due atherosclerosis are the myocardial infarcts (heart attack ) and the cerebral
11
Conceptual Study
infarcts (strokes); other less common sequel are peripheral vascular disease, aneurysm
dilatation due to weakened arterial wall, chronic ischemic heart disease, ischemic
encephalopathy ,an mesenteric occlusion and ischemic limb disease (ILD)
The understanding of vatarakta is related to collagen diseases, gouty arthritis as well as
ischemic limb diseases. All these comparisons are justified based on analysis of
symptoms of vatarakta and the diseases mentioned in conventional medicine. From the
foregoing citations it is clear that ischemic limb disease is also best compared to vatarakta
in regards to its etiopathogensis as well as clinical findings.
12
Conceptual Study
ETYMOLOGICAL DERIVATION
Unique concept of naming the disease is adopted in Ayurvedic literatures. Illness
occurring at a specific location is named after the specific organ as in the disease
hridroga. In contrast to this several other disorders are named after the cardinal symptom
as in atisara and shwasa. Where as the name vatarakta is coined on the basis of the
samprapti ghataka that is vata dosa and rakta dhatu involved in the disease. The same
opinion is best delineated in the following derivations of the word vatarakta.
• “vata dushtam raktam yatra roga visheshah” the disease characterized by the
abnormality of raktadhatu due to morbidity of vata dosa is called as vatarakta42.
• “vataraktabhyam janito vyadhihi vataraktam” the illness caused due to vata dosa
and rakta dhatu is called as vatarakta43.
• “vatarakte eva avasthantara prapte vataraktam” the factors vata and rakta in a
diseased state is called as vata rakta44.
• “vataraktam hi dushtena vatena dushtena raktena ca vishista sampraptikam
vikarantarameva” the disease characterized by unique pathology of morbid vata
dosa and rakta dhatu is called as vatarakta45.
• “asruja ruddho vayuhu vatashonitam” the illness produced due to the obstruction
of vata dosa by rakta dhatu is known as vatarakta46.
DEFINITION:
• “vayuh vivriddho vrddhena raktena avaritha pathi
krstnam samdushayet raktam tajneyam vatashonitam” 47morbid vata dosa when
obstructed by vitiated rakta dhatu, further becomes virulent and once agiain adds to the
abnormality of rakta dhatu, this illness is called as vata shonita.
• “kruddhotyartham maargarodhaat sa vayuhu atyudriktam dushayet raktamashu
tat sampruktam vayuna dushitena tatprabalyat uchyate vataraktam”48
Initially there occurs distinct morbidity of vata dosa and rakta dhatu. The morbid rakta
dhatu in turn obstruct the passage of vitiated vata dosa. Obstruction to the passage of vata
dosa causes worsening of the morbidity of vatadosa. Continuing the pathology the
severly vitiated vata dosa also furthrer disturbs the morbid rakta dhatu. This illness is
known as vararakta.
13
Conceptual Study
SYNONYMS
Adhyavata, khudha vata, vatabalasa and vatasonita are the names used to refer the illness
vatarakta.
“khuda desha praptya khudah, khudashabdena sandhiruchyate”49 as the disase vatarakta
involves the joints it is called as khudavata where the word kudha refers to the joint.
“vatasya avarenena balam asmin shonite iti vatabalasha”50 virulence of the illness is
dependant upon morbidity of rakta dhatu worsened by the obstructed vayu and hence is
known as vata balasha.
“adhyanaam prayo bhavati iti adhyarogah”51 the word adhya refers to rich person. As the
disease is common in rich it is called as adhyavata. In the same meaning this illness is
also refered by the names adhyamaruta and adhya pavana.
NIDANA 55
Vata and rakta are invariably involved in the pathology of vatarakta. Morbid rakta dhatu
when obstructs the vitiated vata dosha there will be further amplification of the virulence.
Severely vitiated vatadosa in turn, badly influences the morbid rakta dhatu later
manifesting as vatarakta52. Parallel to this pathology, two distinct set of etiological factors
take part in the causation of the illness. One set of etiology leads to the vitiation of vata
dosa and the other set separately causes morbidity of rakta dhatu. These distinct sets of
etiological factors may be related to ahara vihara or the one influencing the manas53. In
spite of this, in the variant form of vata rakta where in santarpana category of factors
leads to the abnormal accumulation of kapha as well as medo dhatu, and more
particularly in the rakata marga culminates in the pathology of vata rakta54. Evidently in
this variety of vata rakta all the santarpana category of causes, similar to the etiology of
sthoulya and prameha take the leading role in the causation of the illness. Thus the list of
etiological fatctors in the following lines includes both the nidana of vatarakta as well as
nidana of santarpana janya vikara.
Aharaja nidana56: the dietetic factors that cause the morbidity of vata dosa as well as
rakta dhatu form the etiology of vatarakta. Excessive intake of foods that are lavana,
amla, and katu in taste snigdha, ushna, klinna, ruksha, ushna, vidahi and ksara in quality
tend to cause vatarakta. Further Ajeerna bhojana, viruddhasana, adhyasana, these habits
14
Conceptual Study
of food intake said to cause the illness. To be more specific intake of anupa mamsa,
kulatta, masha, nishpava, sura, asava etc are incriminated in the causation of the illness.
Nidana causing morbidity of kapha and medas57:
Imbalance in relation food intake and its utilization leads to the morbidity of kapha and
medas. Due to the similarity in the inherent qualities of kapha and medas, identical
etiologyical factors cause the morbidity of both kapha and medas. Further similarity in
the qualities of these two factors enhances the tendency of these two involving in dosa
dushya samurchanaa. It is an established fact that excessive nutrition and lack of physical
exercise together known as santarpana nidana contributes to the accumulation of kapha
and medas. Dietary factors like hayanaka, yavaka, chanaka, uddalaka, mukundaka,
mahavrihi, pramodaka, sugandhaka, navanna (navadhanya) etc when consumed
frequently and in excess tend to cause morbidity of kapha and medas. In general gramya
–anupa-udakamamsa, mamsahara, shaka, tila, palala, pishtanna, payasa, krishara, vilepi,
ikshuvikara, kshira, navamadya, mandaka, dadhi, dravaahar all precipitates accumulation
of kapha and medas. Lack of physical and metal activity further adds to the pathology.
Viharaja nidana 58– the behavioral factors that may lead to the vatarakta include
abhighata, ashuddhi, acankramana silata, divasvapna, ratrijagarana, riding on elephant,
horse and camel etc..It is worth to mention here that Avyayami, acankramanashila,
divasvpnashila,asyasukhi,avyavaya,rutusatmyaviparyasnataand snehadicikitsavibhramana
etc factors precipitates morbidity of kapha and medas also.
Manasika nidana –
Akrodha, acinta, harshanityatva these factors incriminated to cause accumulation of
kapha and medas in the body59.
To add the relavant literature from the modern counterpart60- Atherosclerosis is
widely prevalent in industrials countries. However, majority of the incidences quote in
the literature are based on the major clinical syndromes produced by it, the most
important interptation being that death from myocardial infarction related to underlying
atherosclerosis. Cardiovascular disease, mostly related to atherosclerotic coronary he
disease or ischemic heart disease (IHD) is the most common cause of death in the
developed countries the world.
15
Conceptual Study
Extensive epidemiologic investigations on live populations have revealed a
number of risk factors which are associated with increased risk of developing clinical
atherosclerosis. Often, these risk factors are acting in combination rather than singly.
These risk factors are divided into two groups
Major risk factors: These are further considered under 2 headings:
A) Major constitutional risk factors: These are non-modifiable major risk factor
that includes: increasing age, male sex, genetic abnormalities, and familial and
racial predisposition.
B) Major acquired risk factors: This includes major risk factors which can be
controlled and includes: hyperlipidaemia, hypertension, diabetes mellitus and
smoking.
Minor risk factors: This includes a host of factors whose role in atherosclerosis is
minimal, and in some cases even uncertain.
Apparently, a combination of etiologic risk factors has additive effect in producing the
lesions of atherosclerosis.
MAJOR CONSTITUTIONAL RISK FACTORS
Age, sex and genetic influences do affect the appearance of lesions of atherosclerosis.
1. AGE. Atherosclerosis is an age-related disease. Though early lesions of atherosclerosis
may be present in childhood, clinically significant lesions are found with increasing age.
Fully-developed atheromatous plaques usually appear in the 4th decade and beyond.
Evidence in support comes from the high death rate from IHD in this age group.
2. SEX: The incidence and severity of atherosclerosis are more in men than in women.
The prevalence of atherosclerotic IHD is about three times higher in men in 4th decade
than in women and the difference slowly declines with age but remains higher at all ages
in men. The lower incidence of IHD in women, especially in premenopausal age, is
probably due to high levels of oestrogen and high-density lipoproteins, both of which
have anti-atherogenic influence.
3.GENETIC FACTORS: Genetic factors play a significant role in atherogenesis.
Hereditary genetic derangements of lipoprotein metabolism predispose the individual to
high blood lipid level and familial hypercholesterolemia.
16
Conceptual Study
3. FAMILIAL AND RACIAL FACTORS: The familial predisposition to
atherosclerosis may be related to other risk factors like diabetes, hypertension and
hyper-lipoproteinaemia. Racial differences too exist; Blacks have generally less
severe atherosclerosis than Whites.
MAJOR ACQUIRED RISK FACTORS
There are four major acquired risk factors in atherogenesis- hyperlipidaemia,
hypertension, cigarette smoking and diabetes mellitus.
1. HYPERLIPIDAEMIA: Virchow in 19th century first identified cholesterol
crystals in the atherosclerotic lesions. Since then, extensive information on
lipoproteins and their role in atherosclerotic lesions has been gathered. It is now
well established that hypercholesterolemia has directly proportionate relationship
with atherosclerosis and IHD. The following evidences are cited in support of
this:
i) The atherosclerotic plaques contain cholesterol and cholesterol esters, largely
derived from the lipoproteins in the blood.
ii) The lesions of atherosclerosis can be induced in experimental animals by
feeding them with diet rich in cholesterol.
iii) Individuals with hypercholesterolemia due to various causes such as in
diabetes mellitus, myxoedema, nephrotic syndrome, von Gierke’s disease,
xanthomatosis and familial hypercholesterolemia have increased risk of
developing atherosclerosis and IHD.
iv) Populations having hypercholesterolemia have higher mortality from IHD.
Dietary regulation and administration of cholesterol-lowering drugs have
beneficial effect on reducing the risk of IHD.
The main lipids in blood are cholesterol (desirable normal 140-200 mg/ dl,
borderline high 240 mg/ dl) and triglycerides (below 160 mg/ dl). An elevation of
serum cholesterol levels above 260 mg / dl in men and women between 30 and 50
years of age has three times higher risk of developing IHD as compared with people
with serum cholesterol levels within normal limits. The concentration of cholesterol
in the serum reflects the concentrations of different lipoproteins in the serum. The
lipoproteins are divided into classes according to the density of solvent in which they
17
Conceptual Study
remain suspended on centrifugation at high speed. The major classes of lipoprotein
particles are chylomicrons, very-low density lipoproteins (VLDL), low- density
lipoproteins (LDL), and high-density lipoproteins (HDL). Lipids are insoluble in
blood and therefore are carrier proteins called apoproteins. Apoprotein surrounds the
lipid for carrying it, different apoproteins being named by letter A, B, C, D etc while
their sub fractions are numbered serially. The major fractions of lipoproteins and their
varying effects on atherosclerosis and IHD are as under
Low –density lipoprotein (LDL) is richest in cholesterol and has the maximum
association with atherosclerosis.
Very –low- density lipoprotein (VLDL) carries much of the triglycerides and has less
marked effect than LDL.
High-density lipoprotein (HDL) is protective ‘good cholesterol’ against atherosclerosis.
Many studies have demonstrated the harmful effect of diet containing larger
quantities of saturated fats (e.g. in eggs, meat, milk, butter etc) which raise the plasma
cholesterol level. This type of diet is consumed more often by the affluent societies who
are at greater risk of developing atherosclerosis. On the contrary, a diet low in saturated
fats and high in poly-unsaturated fats and having omega-3 fatty acids (e.g. in fish oils etc)
lowers the plasma cholesterol levels. Aside from lipid rich diet, high intake of the total
number of calories from carbohydrates, proteins, alcohol and sweets has adverse effects.
2. HYPERTENSION: Hypertension is the other major risk factor in the development of
atherosclerotic IHD and cerebrovascular disease. It acts probably mechanical injury to the
arterial wall due to increased blood pressure. A systolic pressure of over 160 mm Hg or a
diastolic pressure of over 95 mm Hg is associated with five times higher risk of
developing IHD than in people with blood pressure within normal range (140/90 mm Hg
or less).
3. SMOKING: The extent and severity of atherosclerosis are much greater in smokes
than in non-smokes. Cigarette smoking is associated with higher risk of atherosclerotic
IHD and sudden cardiac death. Men who smoke a pack of cigarettes a day are 3-5 times
more likely to die of IHD than non-smokers. The increased risk and severity of
atherosclerosis in smokers is due to reduced level of HDL and accumulation of carbon
18
Conceptual Study
monoxide in the blood that produces carboxy-haemoglobin and eventually hypoxia in the
arterial wall favoring atherosclerosis.
4. DIABETES MELLITUS: Clinical manifestations of atherosclerosis are far more
common and develop at an early age in people with both insulin-dependent and non-
insulin dependent diabetes mellitus. The risk of developing IHD is doubled, tendency to
develop cerebrovascular disease is high, and frequency to develop gangrene of foot is
about 100 times increased. The causes of increased severity of atherosclerosis are
complex and numerous which include increased aggregation of platelets, increased LDL
and decreased HDL.
MINOR FACTORS
There are a number of less important and minor risk factors having some role in the
etiology of atherosclerosis. These are as under:
1. Higher incidence of atherosclerosis in developed countries and low prevalence in
underdeveloped countries, suggesting the role of environmental influences.
2. Obesity, if the person is overweight by 20% or more, is associated with increased risk.
3. Use of exogenous hormones (e.g. oral contraceptives) by women or endogenous
oestrogen deficiency (e.g. in post-menopausal women) has been shown to have increased
risk of developing myocardial infarction or stroke.
4. Physical inactivity and lack of exercise are associated with the risk of developing
atherosclerosis and its complications.
5. Stressful life, style, termed as type A behavior pattern, characterized by
aggressiveness, competitive drive, ambitiousness and a sense of urgency, is associated
with enhanced risk of IHD compared with type B behaviors of relaxed and happy-go
lucky type.
6. Recently role of infections, particularly of Chlamydiapneumoniae and viruses such as
herpes virus and cytomegalovirus, has been found in coronary atherosclerotic lesions.
Possibly, infections may be acting in combination with some other factors.
7. Patients with homocystinuria, an uncommon inborn error of metabolism, have been
reported to have early atherosclerosis and coronary artery disease.
19
Conceptual Study
8. Moderate consumption of alcohol appears to have slightly beneficial effect by raising
the level of HDL cholesterol and by causing vasodilatation but the matter remains
controversial
In a nut shell the etiological factors of kapha medo margavarana janya vatarakta as well
as atherosclerosis is more or less identical. Diet and behavioral factors leading to
atherosclerosis can be best regarded as santarpana nidana of vatarakta causing
accumulation of kapha and medas with in the raktamarga.
PURVARUPA
The movement of vatadosa is inhibited by the unique pathology of raktamargavarana in
vatarakta. This in term initially manifest with certain clinical signs and symptoms in the
form of purvarupa. Alteration in the color and texture of the skin in the affected part,
alteration in sweating, alteration in the sensation, different forms of pain and similar other
manifestations are listed as purvarupa. The same is elaborated in the following lines61.
Abnormality of sweating: both excessive as well as deficient sweating at the affected part
is regarded as one among the purvarupa of vatarakta. Sweat is one among the three mala
and sweating is the function of svedavaha srotas. This swvedavaha srotas is spread out
between roma kupa and medas in the twak62. Sweating in the svedavha srotas is
controlled by samanavayu63. This morbid vatadosa is said to alter the physiology of
svedavaha srotas manifesting either as excessive sweating of deficient sweating64.
Alteration in the tactile sensation: twak is the abode of sparshendriya, and in the same
twak there is abundance of vata dosa. It is the vyana vayu that moderates the
sparshanendriya for the tactile sensations. Morbidity of vatra dosa in vatarakta disturbs
this physiological functioning of the sparshanendrya leading to either supti - numbness or
ksate atiruk – hyperesthesia65.
Alteration in the color of the skin: twak is said to have distinct six layers66. avabhasini is
the most superficial layer of the skin. The complexion as well as luster of the skin is
imparted by this layer itself. Vitiated vatadosa when affects this layer of the skin there
occurs abnormal coloration as well as lusture of the skin. This physiology is skin
coloration is controlled by udanavayu67. The same happens in vata rakta. When the
morbid vatadosa affects the avabhasini layer the patient may develop macule or patches
20
Conceptual Study
of discoloration. Reddish, pinkish, bluish or blackish coloration of the dermis may
happen in vatarakta.
Itching sensation: morbid vatadosa when brings about dryness of the skin patient is likely
to suffer from itching sensation. So also alteration in the sweating may contribute to the
development of itching sensation in patients suffering from vatarakta68.
Pain: pain is the major manifestation of the morbid vatadosa. Morbid vata dosa when
affects the twak mamsa or rakta dhatu pain is a clinical manifestation. Toda, sula, bedha
pindikodvestana, ksate atiruk spurana, intermittent occurrence of pain all may manifest in
patient suffering from vatarakta69. About the relavant description in modern paralance -
The most common symptom of peripheral arterial disease is intermittent claudication,
defined as pain, ache, cramps, numbness or a sense of fatigue in the muscles. It occurs
during exercise and relieved by rest. The site of claudication is distal to the location of
occlusive lesion. Eg. Buttock, thighs, hip discomfort occurs in patient with aortoiliac
disease. Whereas calf claudication develops in patients with femoral popletial disease.
The symptoms are far common in lower extremities than upper because higher number of
incidence of obstructive lesions.
Patients will complaint of rest pain or feeling cold or numbness in foot and toes.
Frequently these symptoms occurs at night when legs are horizontal and improves when
the legs in dependent position.
Joint pain: vitiated vata dosa in vatarakta also tend the involve the joints in vatarakta. The
involvement of joints is characterized by pain, heaviness swelling fasculations at or
around the joints like janu, uru, kati and hasta padanguli sandhi70.
Constitutional symptoms: few of he constitutionl symptoms also mark the initial stage of
vatarakta like alasya, gaurava and sadana 71etc.
More details of the purvarupa as listed in different literatures of ayurveda 72is shown in
the table no 2.
Purvarupa C.s S.s A.h A.s M.n. G.ni. B.p. Y.r.
Atisweda + - + + + + + +
Asweda + - + + + + + +
21
Conceptual Study
Karhnyata + - - - + + + +
Sparshgnata + - - - + + + +
Ksate ati ruk + - - - + + + +
Sandhi shaithily + + + + + + + +
Alasya + - - - + + + +
Sadana + - + + + + + +
Pidakodgama + - - - + + + +
Nistoda + + + + + + + +
Spurana + - + + + + + +
Bheda + - + + + + + +
Gourava + + + + + + + +
Supti + + + + + + + +
Kandu + - + + + + + +
Sandhi ruk + - - - + + + +
Vaivarnya + + + + + + + +
Mandalotpatti - + + + + + + +
Sheetalata - + - - - - - -
Osha - + + - - - - -
Daha - + + + + + + +
Shopha - + - - - - - -
Twak parushya - + - - - - - -
Siradhamani
spandan
- + - - - - -- -
Sakti dourbalya - + - - - - - -
Ati slakshna sparsha + + - - - + + +
Khara sparsha - - + + + - + +
22
Conceptual Study
Shrama - - + + + - - -
Vrana adika sula - - + + + - - -
Vrana chira sthiti - - + + + - - -
Vrana rudhana - - + + + - - -
Roma harsha - - + + + - - -
Asrija kshaya - - + + + - - -
RUPA :
Depending upon the superficial or deeper dhatu involved, the vatarakta is of two types73.
When the pathogenesis of vatarakta is limited to twak and mamsa dhatu it is regarded as
uttana (anavagadha)vata rakta. Involvement of deeper dhatu like asthi majja and sandhi
signifies the gambhira (avagadha)vatarakta. A third variety of ubhayashrita vatarakta is
also mentioned in literature where in both the superficial as well as deeper dhatu is
affected. Vatarakta is a progressive disorder and hence initially the illness may be limited
to either superficial dhatu or deeper dhatu alone, but in the later stages the uttana
vatarakta progresses to deeper dhatu. Similarly the gambhira vatarakta may involve the
superficial dhatu in the later stages. Hence in the later stages the vatarakta develops as
ubhayashrita vatarakta74.
The symptoms like kandu, daha, ruka, ayama, toda, sphurana, shyava/ rakta tvaka and
such other symptoms probably limited to the twak indicates the uttana vatarakta75.
Persistent hard swelling of the affected part, suppurations, involvement of sandhi asthi
and majja, deformities like vakrata, khanja and pangu all these point towards the
gambhira vataratka76.
Presence of symptoms indicative of both uttana as well as gambhira vatarakta signifies
the ubhayashrita vata rakta. Following table shows the exclusive symptoms of uttrana and
gambhira vatarakat77.
UTTANA VATARAKTA:
Kandu itching
Daha burning sensation
Ruja pain
23
Conceptual Study
Ayama (sira ayama) dilatation of the vessels
Toda pricking pain
Spurana trembling or throbbing sensation
Kunchana (sira akunchana) contraction
Shyava twak cyanosis of the skin
Rakta twak reddish coloration of the skin
Bheda splitting type of pain
Gourava heaviness
Suptata numbness
Table no 3: symptoms of uttana vatarakta78
Rupa C.s S.s As Ah M.n
.
G.n B.p y.r.
Kandu + - + + - + + +
Daha + - + + - + + +
Ruja + - - - - - - -
Ayama + - + + - + + +
Toda + - + + - + + +
Spurana + - + + - + + +
Kunchana + - - - - - - -
Shyava twak + - + + - + + +
Rakta twak + - + + - + + +
Tamra twak + - + + - + + +
Bheda - - + + - + + +
Gourava - - + + - + + +
Suptata - - + + - + + +
24
Conceptual Study
GAMBHIRA VATARAKTA79:
Svayatu stabdhata fixed swelling
Svayatu kathinya hard swelling
Bhrisharthi excruciating deep pain
Shyavatha cyanosis or pallor
Tamra twak coppery discoloration
Daha burning sensation
Toda pricking type of pain
Sphurana throbbing sensation
Paka suppuration
Ruja pain
Vidaha internal burning sensation
Vatasya sandyasthi
Majjasu chindanniva. Aggravated vayu while causing pain-burning
sensation constantly moves with high speed through
the sandhi, asthi and majja.
Kanjatwa lameness
Pangutwa paraplegia
Adhika purvaruk increased pain
Swayatu grathita hard swelling
Vatasya sarva Shareera charana vitiated vata moves all over the body
Angasya vakrikarana disfigurement of the parts
Table no 4:symptoms of gambhira vatarakta
Rupa C.s S.s A.s A.h M.n G.n. B.p. y.r.
Svathu stabdhatha + - - - - + +
Svathu kathinya + - - - - + +
Brusharti + - - - - + +
25
Conceptual Study
Shyavatha + - - - - + +
Tamra twak + - - - - + +
Daha + - - - - + +
Toda + - + + - + +
Spurana + - - - - + +
Paka + - - - - + +
Ruja + - - - - + +
Vidaha + - + + - + +
Vatasy
sandyasthimajjasu
chindanniva charana + - - - - + + +
Kanajtwa + - + + - + +
Pangutwa + - + + - + +
Adhika purva ruk - - + + - + -
Svayathu grathitha - - + + - + -
Vatasya sarva
Shareera charana
+ - + + - + -
Angasya vakrikaran + - + + - + -
Clinical varieties of vatarakta are also elaborated according to the association of morbid
dosa in the primary pathologly of vata and rakta and are named as vatadhika vatarakta,
pittadhika vatrakta, kaphadhika vatarakta and raktadhika vatarakta.
26
Conceptual Study
Vatadhika vatarakta80:
Clinical symptoms when predominate the morbidity of vata dosa the vatdhika vatarakta is
diagnosed. Following are the symptoms suggestive of vatadhika vatarakta.
Sirayama dilatation of vessels
Sula pain
Spurana throbbing sensation
Toda pricking pain
Shothasya karshnyam blackish discoloration of the swollen part
Shothasya roukshyam dryness of the skin overlying the swelling
Shothasya syavata bluish discoloration overlying the skin
shyavata vriddi/hani frequent increase and decrease of bluish
discoloration
Dhamani anguli sandi sankocha contraction of vessels and sandhi
Angagraha stiffness of the affected parts
Atiruk severe pain
Stambana stiffness
Sheeta pradhvesha aversion towards cold surroundings
Sparshodwigna inability to tolerate the touch
Bheda splitting type of pain
Prashosha atrophy
Swapa numbness
Sheetanupashaya worsening of symptoms on exposure to cold
Vepathu tremors
Table no 5: symptoms of vatadhika vatarakta
Rupa C.s. S.s. A.s. A.h. M.n. G.n. B.p. Y.r.
Sirayam + - - - - - + +
Shoola + - + + + + + +
Sphuran + - + + + + + +
Toda + - + + + + + +
27
Conceptual Study
Shothasya
karsnya
+ - + + + + + +
Shothasya
rukshata
+ - - + + + + +
Shothasya
syavata
+ - + + + + + +
Shotha
vrudhi/hani
+ - + + + + + +
Dhamani anguli
sandi sankocha.
+ - + + + + + +
Anga graham + - + + + + + +
Ati ruja + - + + + + + +
Kunchana + - - - - - + +
Stambhana + - + + + + + +
Sheeta
pradvesha
+ - + + + + + +
Sparshodvigna - + - - - - - -
Bheda + - - - - - + +
Swapa - + + + + + - -
vepathu - - + + + + - -
Pittadhika vatarakta81 –
Diagnosis of pittadhika vatarakta is made when more symptoms indicative of morbid
pitta dosa associate the symptoms of vatarakta. Following is the list of symptoms
suggestive of pittadhika vatarakta.
Vidaha severe burning sensation
Vedana pain
28
Conceptual Study
Murcha fainting
Sweda sweating
Trishna thirst
Mada irrelevant behavior
Brama giddiness
Paka inflammation/suppuration
Raga redness
Bheda splitting type of pain
Sosha atrophy
Ugra daha excruciating burning sensation
Ati ushnatwam increased local temperature
Sophasya mridutwam soft swelling
Sammoha confusional or unconscious state
Sparshakshamatwa hyperesthesia
Table no 6: symptoms of pittadhika vatarakta
Rupa C.s S.s A..S. A.h. M.n G.n. B.P. Y.r.
Vidaha + - + + + + + +
Vedana + - + + + + + +
Murcha + - + + + + + +
Sweda + - + + + + + +
Trishna + - + + + + + +
Mada + - + + + + + +
Bhrama + - + + + + + +
Paka + - + + + + + +
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Conceptual Study
Raga + + + + + + + +
Bheda + - - - - + - +
Sosha + - - - - + - +
Ugra daha - + - - - - - -
Ati ushnatwa - + + + + - + -
Sophatsya mridutwa - + - - - - - -
Sammoha - - + + + - + -
Sparshakshamatwa - - + + + - + -
Kaphadhika vatarakta 82 –
symptoms suggestive of morbidity of kapha dosa when present in a patients suffering
from vatarakta the diagnosis of kaphadika vatarakta is justified. Details of the symptoms
of the same is listed below.
Staimitya sensation as if the body part is covered with
wet cloth
Gourava heaviness
Snehatwa unctuousness
Supti numbness
Manda ruja mild pain
Kandu itching
Swetata increased pallor
Seetata coldness
Sopha swelling
Stabdatwa stiffness
30
Conceptual Study
Table no7: symptoms of kaphadika vatarakta
Rupa C.s S.s A.s. A.h. M.n. G.n. B.p. Y.r.
Staimitya + - + + + + + +
Gourava + - + + + + + +
Snehatwa + - + + + + + +
Supti + - + + + + + +
Manda ruja + - + + + + + +
Kandu - + + + + + + -
Swetata - + - - - - - -
Seetata - + + + + + + -
Sopha - + - - - - - -
Peenatwa - + - - - - - -
Stabdatwa - + - - - - - -
Raktadhika vatarakta 83
Symptoms pertaining to severe morbidity of rakta dhatu differentiate the raktadhika
vatarakta from other varieties of vatarakta. Of course, for evident reasons there may be
much overlap between the symptoms of pittadika vatarakta and raktadhika vatarakta.
However following list of symptoms are unique manifestations of raktadhika vatarakta.
Sotha swelling
Ati ruk severe pain
Toda pricking pain
Tamra varna coppery discoloration
Chimichimayana tingling sensation
Snigdha rukshahishamam naiti poor remission of symptoms to snigdha
ruksa line of management
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Conceptual Study
Kandu itching
Kleda exudation
Table no 8: symptoms of raktadhika vatarakta
Rupa C.s. S.s. A.s. A.h. M.n. G.n. B.p. Y.r.
Sotha + - + + + + + +
Ati ruk + - + + + + + +
Toda + - - + + + + +
Tamra varna + - + + + + +
Chimichimaya + - + + + + +
Snigdha
rukshakshamam
naiti
+ - + + + + + +
Kandu - - + + - + - -
Kleda - - + + - + - -
Combination of symptoms indicative of different types of vatarakta when present in a
given patient, the diagnosis of dvidosaja ro sannipataja vatarakta is clinically diagnosed84.
Vatarakta is also classified on the basis of presence or absence of symptoms suggestive of
amadosa. Symptoms of ama if associates the symptoms of vatarakta then the condition is
known as sama vatarakta. If only the symptoms of vatarakta presents with out the
association of symptoms of ama then the illness is referred as nirama vatarakta85. The
symptoms of sama and nirama vatarakta is depicted in the table nos
SAMPRAPTI
Distinct etiological factors of vatadosa and rakta dhatu separately causes the morbidity of
vata dosa as well as abnormality of rakta dhatu. Morbid vata dosa furthrer incriminates
the abnormal rakta dhatu. This abnormal rakata dhatu by way of raktamargavarana in turn
inhibits the movement of vata dosa leading to severe morbidity of vatadosa. This is
32
Conceptual Study
marked by development of clinical signs and symptoms. Thus the illness vatarakta
clinically manifests. This is the general samprapti of vataraka in which the
raktamargavarana is the final stage of the sampraapti86. This raktamargavaarana can
happen in a different way also. The santarpana category of etiological factors leads to the
accumulation of kapha and medas in the raktamarga there by causing raktamargavarana.
Due to the establishment of raktamargavarana there occurs inhibition of movement of
vata dosa. Inhibition of vata culminates in severe morbidity of vata dosa and once again
manifesting as vata rakta. This is the samprapti of variant form of vata rakta87.
Phenotypic characters indicative of fatness or obesity in a person is suggestive of
excessive accumulation of kapha and medas in the body. Other than the vatarakta, the
kapha and medas can cause different other diseases like vatavyadhi, hrdroga, gulma and
prameha88. Thus presence of any of these diseases is also a strong clinical evidence of
abnormality of kapha and medas in a given patient. Corroborating the same, coexistence
of vatavyadhi, hrdroga and prameha is also clinically reported in many occasions.
Palpation of the thickened arteries in the extremities is suggestive of dhamanipraticaya89.
In addition to this altered or absent pulsations as stressed in nadi vijnana justifies the
concept of raktamargavarana due to abnormal kapha and medas in the disease vatarakta.
The symptoms like excessive sweating or deficient sweating are indicative vitiation of
samana vata. Altered sensations and decreased range of joint movements is in favour of
morbidity of vyana vayu. Occurrence of discoloration of the skin in the form of reddish,
bluish or blackish tinge is suggestive of morbidity of vyana vayu.
Alteration of the tactile sensation is pathognomonic of involvement of sparshanendria.
The different altered states of consciousness like mada, moha, murcha, that occur in the
later stage of the illness is suggestive incriminatory effect on manas and hrdaya90.
Different forms of discoloration of the skin are highly suggestive of involvement of the
rakta dhatu. The same is also suggestive of abnormality of raktavaha srotas. Appreciation
of the dhamani praticaya also corroborates the same.
Margavarana tending inhibition of movement of vatadosa in the raktamarga being the
prime pathology of the vatarakta, this fact specifies the sanga as the srotodusti prakara91.
The symptoms of vatarakta like shoola, ruka, toda etc.point towards the pathogenesis of
mamsa dhatu sandhi shoola are the symptoms pathognomonic of morbid asthi dhatu92.
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Conceptual Study
Involvement of majja dhatu is identified by the presence of symptoms like murchya 93etc.
Excessive or deficient sweating is indicative of involvement of both sweda and
svedavaha srotas in the pathogenesis of vatarakta94.
Affliction of dhatu like twak, rakta etc is suggestive of relationship of bahyarogamarga in
the disease. In contrast to this presence of symptoms evocative of affliction of sandhi
corroborates the relationship of madhyama rogamarga in vatarakta95.
Occurance of constitutional symptoms like jvara, alasya etc. affirms the sarvasharira as
the sanchara sthana of the dosha. In spite of this fact, it is stated that the morbid dosa tend
to circulate in the lower limbs to a larger extent.
Add to this from the modern paralance of atherosclerosis96 - Most atheroma produces no
symptoms, and many never cause clinical manifestations. Numerous patients with diffuse
atherosclerosis may succumb to unrelated illness without ever having experienced
clinically significant manifestations of atherosclerosis. What accounts for this variability
in the clinical expression of atherosclerotic disease, here is the explanation - Arterial
remodeling during atheroma formation represents a frequently overlooked but clinically
important feature of lesion evolution. During the initial phases of atheroma development,
the plaque usually grows outward, in an abluminal direction. Vessels affected by
atherogenesis tend to increase in diameter, a phenomenon known as compensatory
enlargement, a type of vascular remodeling. The growing atheroma does not encroach
upon the arterial lumen until the burden of atherosclerotic plaque exceeds approximately
40% of the area encompassed by the internal elastic lamina. Thus, during much of its life
history, an atheroma will not cause stenosis that can limit issue perfusion.
Flow limiting stenoses commonly form later in the history of the plaque. Many such
plaques cause stable syndromes such as demand induced angina pectoris or intermittent
claudicating in the extremities. In the coronary and other circulations, even occlusion due
to atheroma does not invariably lead to infarction. The hypoxic stimulus of repeated
bouts of ischemia characteristically induces formation of collateral vessels in the
myocardium, mitigating the consequences of an acute occlusion of an epicardial coronary
artery. On the other hand, we now appreciate that many lesions may produce only
minimal luminal irregularities on traditional angiograms and often do not meet the
traditional criteria for “significance” by arteriography. Instability of such nonocclusive
34
Conceptual Study
stenoses may explain the frequency of myocardial infarction as an initial manifestation of
coronary artery disease (in at least a third of cases) in patients who report no prior history
of angina pectoris, a syndrome usually caused by flow-limiting stenoses
Samprapti ghataka of usual form of vatarakta
Dosha - vata
Dushya - tvak, rakta, mamsa, asthi, majja
Srotas - raktavaha srotas, svedavaha srotas
Srotas Dustiprakara - Sanga
Udbhavastana - pakvasaya
Sancharastana - sarvasarira
Adhistana - mostly lower limbs
Vyadhi marga - bahya and madhyama roga marga
SAMPRAPTI GHATAKA of variant form of vatarakta
Dosha - Kapha, vata
Dushya - medas, rakta
Srotas - raktavaha
Udbhavastana - Amashaya
Sancharastana - sarvasharira
Adhistana - mostly lower limbs
Dustiprakara - Sanga
Vyadhi marga - bahya and madhyama roga marga
UPASHAYA – ANUPASHAYA
Morbidity of the vatadosa is the basic pathology of the illness. And the same to a larger
extent determines the upasaya and anupasaya in vatarakta. Accordingly the exposure to warm
surrounding, rest and application of sneha tend to cause remission of the symptoms, where as
exposure to cold surrounding and physical exercise tend to worsen the symptoms of vata
rakta97.
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Conceptual Study
Ushna upasaya: sita is the inherent quality of vata dosa. Elevation of the sita quality is likely
increase the morbidity of vata dosa. This is best counteracted by the heat. Thus exposure to
warm environment brings about comfort to the patient.
Sita anupasaya: cold environment further worsens the morbidity of vatadosa. Hence exposure
to cold is considered as anupasaya. This intolerance is verymuch pronounced in the vatadhika
vatarakta.
Anayasa upashaya: any form of exercise increases the vatadosa and also rest pecifies the vata
dosa, hence camkramana98is listed as a nidana of vatarakta. Needless to say the
Ayasa anupashaya: as exercise increases vatadosa symptoms of vatarakta tend to worsen
following exercise
Snigdha upasaya: ruksha is the inherent quality of vatadosa and is best neutralize by snigdha
cikitsa. Thus applicateion of sneha is a upasaya in vatarakta. Contrary to this severe morbidity
of rakta when present even snigdha chikitsa does cuase remission of symptoms of vatarakta
Ruksa anupasaya: any measures that increase ruksata in the body increases vata dosa and hence
worsens the symptom of vatarakta99.
UPADRAVA 100
The disease vatarakta is a lingering disease and tend to run a chronic
course.basically vata dosa and rakta dhatu is involved in the pathogenesis., as the disease
progresses it tend to involve deeper tissues like asthi majja and sandhi. Accordingly
during the later course the patent may even suffer from several upadravas. Following
lines give the full account of the upadrava of vatarakta.
Systemic complications
Aswapna insomnia
Arochaka tasteless in the mouth
Swasa dyspnoea
Trishna excessive thirst
Sirograha stiff in the head
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Conceptual Study
Jwara fever
Moha confusional state
Mamsa kshaya wasting of muscles
Pravepaka trembling
Hikka hiccough
Bhrama giddiness
Klama mental fatigue
Marmagraha affliction of vital parts
Prana kshaya diminution of prana
Kasa cough
Stabdatha stiffness
Avipaka indigestion
Localized complication
Mamsakotha necrosis of tissue
Pangulya paraplegia
Visarpa cellulites
Paka suppuration
Toda pricking pain
Anguli vakrata disfigurement of digits
Spota eruptions
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Conceptual Study
Daha burning sensation in foot
Visarana necrosis
Sankocha contractures
Table no. 9 shows Upadrava in vatarakta
Upadrava C.s S.s A.s A.h M.n G.n B.p Y.r
Aswapna + - + + + + - +
Arochaka + + + + + + + +
Swasa + + + + + + + +
Mamsa kotha + - + + + + + +
Siro graha + - + + + + + +
Murcha + + + + + + + +
Mada + - + + + + + +
Ruja + - + + + + + +
Trishna + + + + + + + +
Jwara + + + + + + + +
Moha + - + + + + + +
Pravepaka + - + + + + + +
Hikka + - + + + + + +
Pangulya + - + + + + + +
Visarpa + - + + + + + +
Paka + - + + + + + +
Toda + - + + + + + -
Bhrama + - + + + + + -
Klama + - + + + + + -
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Conceptual Study
Angulivakrata + - + + + + + -
Spota + - + + + + + -
Daha + - + + + + + -
Marmagraha + - + + + + + -
Pranakshaya - + + + + - + +
Mamsakshaya - + + + + - + +
Kasa - + + + + - + +
Stabdata - + + + + - + +
Avipaka - + + + + - + +
Visarana - + + + + - + +
Sankocha - + + + + - + +
SADHYASADHYATHA 101:
The sadhyasadhyata of disease depends on virulence of vitiated doshas, presence or
absence of upadrava’s as well as chronicity of disease. The same in regards ot vatarakta is
elaborated in the following lines
SADHYA – following factors determine the curability of vatarakta
Presence of only one dosa in the pathogenesis of vatarakta
Absence of upadrava.Vatarakta of recent onset.
Physically strong patient, having enough resources to undergo best available
treatment.
YAPYA – following factors determine the yapyata of the vatarakta.
Involvement of two dosas in the pathogenesis
Absence of upadrava
Vatarakta of one year duration
Physically strong patient, having enough resources to undergo best available treatment.
ASADHYA- following factors in vatarakta determine its incurability.
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Conceptual Study
Involvement of all the three dosa in the pathogenesis
Presence of upadrava
Presence of specific symptoms indicative of incurability like ajanausphutita
Table no10: sadhyasadhyata of vatarakta
Sadhya C.s S.s A.s A.h M.n G.n B.p Y.r
Ekadhosaja + - + + + + + +
Nava + - + + + + + +
Nirupadrava + + - - + + + +
Yapya C.s S.s A.s A.h M.n G.n B.p Y.r
Dvidoshaja + - + + + + + +
Akritsnaopadrava + - - - + + + +
Samvatsarothitha - + - - + + + +
Asadhya C.s S.s A.s A.h M.n G.n B.p Y.r
Upadravayuktha + + - - - + - +
Tridoshaja + - + + + + + -
Moha + - + + + + + -
Samprasava + + + + - + + +
Vaivarnya + - - - - + - -
Stabdhata + - + + - + + -
Sankocha + - - - - + - -
Ajanusputitha - + - - + - - +
Prabinna - + - - + - - +
Arbhudhakari + - + + + + + -
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Conceptual Study
SAPEKSHA NIDANA :
Symptom around the joints is the cardinal manifestation of the diseases sandhigatavata
and amavata and thus these diseases need to be differentiated from the vatarakta. In
addition to this the skin manifestation of the kusta is akin to the same present in the
vatarakta. Hence the kusta should be distinguished from the vatarakta again. Differential
diagnosis is best made by the analysis of the samprapti ghataka as well as clinical
manifestations of these diseases.
SANDHIGATA VATA:
Morbid vata dosa afflicts the sandhi and leads to the clinical presentation of joint pain,
joint swelling and diminished range of joint movements102. This is the characteristic
feature of sandhigata vata. Absence of symptoms indicative of morbidity of rakta dhatu
or ama is also characteristic. Thus vatarakta, and kustha is best differentiated from
sandhigata vata as the later does not present with symptoms suggestive of affliction of
rakta dhatu. Symptoms indicative of rakta dhatu involvement is mandatory for the
diagnosis of vatarakta as well as kustha roga.
Imperceptible symptoms are the purvarupa of sandhigata vata103. Excessive sweating,
lack of sweating, loss of sensation and similar other purvarupa occur in vatarakta before
the involvement of joints. Thus the purvarupa helps in the differentiation of these
diseases. Presence of typical purvarupa is unique feature of vatarakta and the presence of
which excludes both amavata as well as sandhigata vata.
Initial involvement of lower limbs followed by progressive spreading of illness to other
parts of the body is characteristic of vatarakta104. Such a progression of illness is less
evident or absent in sandhigata vata.
Illness is limited to the joints in sandhigata vata. But this is not true in kustha and
vatarakta as the structures in-between the joints are also affected in these diseases.
Intermittent nature of joint pain, more particularly pain occurring on movement is
characteristic of sandhigata vata. Where as in amavata and vatarkta the pain is more or
less continuous, and is even felt at rest. Intermittent nature of pain is also found in
vataratka, but the pain is felt at rest disturbing the sleep.
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Conceptual Study
During the chronic course of the illness the patient of sandhigata vata never develop
paka, kotha or anganasha, but such a sequel is possible both in kushta and vatarakta. Thus
the presence or absence of such an upadrava is a useful criterion for the differential
diagnosis.
Affliction of joint alone is the characteristic feature of the sandhigata vata. Where as both
amavata as well as vatarakta presents with many other constitutional symptoms that helps
in the differentiation of these diseases.
Amavata:
Joint pain joint swelling and limitation of joint movement characterizes the disease
amavata and thus this need to be differentiated from vatarakata and sandhigata vata.
Association of ama with morbid vata dosa is the major pathological entity of amavata.
Hence presence of samavata symptoms like progressive involvement of joints, worsening
on application of fat substances, sever symptoms during morning hours, on a cloudy day
and at night times is indicative of amavata105. Contrary to this in vatarakta as well as
sandhigata vata there occur morbidity of vata dosa which is not associated with ama and
hence symptoms remit on application of oil. There may be little difficulty in
differentiating amavata if the patient is suffering from sama vatarakta.
Symptoms related to morbid rakta dhatu like discoloration of the skin is distinctive of
vatarakta. Absence of symptoms indicative of morbidity of rakta dhatu is suggestive of
amavata.
Premonitory symptoms related to the skin of the affected part is the typical feature of
vatarakta and is absent in amavata. Thus joint manifestation with out purvarupa is
indicatieve of amavata.
About the course of the illness, amavata tend to begine from the kati region and then
spreads to different other joints or location of kapha dosa106. Contrary to this, vatarakta
tend to begine from the legs and then spreads to other locations and does not show any
predilection for location of kapha dosa.
Kustha
The purvarupa of kusta is some what identical to the one found in vatarakta and hence it
should be differentiated107. Among the 7 maha kustha and 11 ksudra kusta only the maha
42
Conceptual Study
kustha manifests with prior appearance of purvarupa. Hence there will not be any
difficulty in differentiating ksudra kustha from vatarakta.
In maha kusta symptoms indicative of saptadravya is characteristic108. In vatarakta the
symptoms pathognomonic of vata dosa and rakta dhatu predominate. This gives the clue
for differential diagnosis
The site of development of kustha does not show any predilection, rather it can happen in
any location and more or less restricted to bahya roga marga. Spread of vataratka show a
typical pattern, it begins in the lower limbs and then spreads to different other location
involving the madhyma roga marga. This nature of the illness can be considered for the
differential diagnosis.
Kustha is contagious disorder109, and hence patient of kustha roga may give the family
history of the same. Vatarakta is non communicable and hence the family history may be
negative in this regard.
Incidence of the illness vatarakta is more among the rich110. The incidence of kustha in
rich and poor is alike. Thus socioeconomic status of the patient may be a corroboratory
evidence for the diagnosis of vatarakta.
Corse of the illness varies in these diseases. Though the purvarupa of kushta and
vataratkta is identical to some extent; the rupa stage shows the marked difference. Hence
the rupa stage does not pose any problem in differentiation of these two diseases.
Investigations:
Blood:
Routine examination of blood including hemoglobin estimation (low HB% can
decrease claudication distances & aggravate Rest pain).
Blood sugar examination as diabetics have worse prognosis are essential.
Total and differential W.B.C. counts are essential to assess general conditions of
patients.
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Conceptual Study
Blood urea and Serum creatinine are the kidney function tests need to carry out as many
patient suffers from diabetes mellitus and to rule out micro vascular complications of
diabetes mellitus in kidney.
E.S.R. is raised in inflammatory conditions of artery.
Liver function test to assess functional ability of liver.
Lipid Profile test:
Plasma levels of total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol
usually measured after 12 hours of overnight fast. Abnormalities in plasma lipoproteins
and derangements in lipid metabolism ranks as the most firmly established and best
understood risk factor for atherosclerosis.
The main lipids in blood are total cholesterol (desirable normal 140-200 mg/ dl,
borderline high 240 mg/ dl) and triglycerides (below 160 mg/ dl). An elevation of serum
cholesterol levels above 260 mg / dl in men and women between 30 and 50 years of age
has three times higher risk of developing IHD as compared with people with serum
cholesterol levels within normal limits.
The major classes of lipoprotein particles are chylomicrons, very-low density
lipoproteins (VLDL), low- density lipoproteins (LDL), and high-density lipoproteins
(HDL).
Low –density lipoprotein (LDL) is richest in cholesterol and has the maximum
association with atherosclerosis. The cholesterol in LDL accounts for 70 % of plasma
cholesterol in most indusials. So is bad cholesterol. Normal value of LDL cholesterol is
65-150 mg / dl.
Very –low- density lipoprotein (VLDL) carries much of the triglycerides and has less
marked effect than LDL. Norma value of VLDL cholesterol is 8-35 mg /dl.
High-density lipoprotein (HDL) is protective ‘good cholesterol’ against atherosclerosis,
because cholesterol in peripheral cells is transported from the plasma membrane of
peripheral cells to the liver by the process termed as reverse cholesterol transport and
44
Conceptual Study
from where is excreted in the form of bile or bile acid so is called as good cholesterol.
And normal value of HDL cholesterol is 35-70 mg /dl.
In general the preliminary studies shows that for each 1 mg /dl decrease in LDL
cholesterol in the plasma there is 2 %decrease in mortality due to atherosclerosis
Doppler Ultrasound:
Doppler ultrasound blood flow detection uses a continuous wave ultra sound signal,
beamed at an artery & the reflected beam is picked up by a receiver, the changes of
frequency in the reflected beam, as compared with the transmitted beam, are due to
“Doppler shift” resulting from passage of beam through moving blood. These frequency
changes are converted into audio signals. This investigation may be used effectively in
cases where a differential diagnosis of atherosclerosis is entertained showing the site of
block & extent of distal run-off.
The transmitted crystal emits ultra sound in the range of 2-10 mega cycles /sec.
The Doppler shift in frequency is proportional to blood flow velocity.
Two types are available :a) Continues wave flow meter b) Pulsed flow meter
The Normal Doppler arterial sound consists of 3 sounds.
In the 1st pitch rises to peak during systole indicating forward flow.
2nd indicates reverse flow during early diastole
3rd indicates a return to forward flow in middiastole.
The interpretations of impression of Doppler ultrasound reported as
2D findings – about vessel wall changes as vessel wall thickening and calcifications.
Flow pattern – as triphasic, biphasic or monophasic blood flow pattern.
Flow velocity – blood flow velocity in terms of cm/sec.
Newly developed collateral vessels can be also identified.
45
Conceptual Study
Arteriography:
This investigation is invasive & Doppler imaging has largely replaced it.
This is very useful for surgical intervention like revascularization.
In patients with ILD if the location of block is peripheral and segmental in small and
medium sized arteries which are not suitable for anatomic reconstruction. In this
conditions arteriogram are very rarely conducted are of less significance.
TREATMENT
Morbidity of vata dosa and rakta dhatu is the basic pathology of the vatarakta. Morbid
vata dosa further afflicts raktadhatu. Consequently there occur raktamargavarana
inhibiting the movement of vayu. This in turn further add to the virulence of vata dosa.
These pathological events finally culminate in the establishement of vatarakta. On the
other hand in the variant form of vatarakta margavarana can happen due to abnormal
accumulation of kapha and medas. This pathology further continues to end up in the
development of the illness vatarakta. Treatment aimed at negating the detrimental effect
of samprapti ghataka in the two distinct form of vatarakta forms the rational approach.
Accordingly following are the therapeutic procedures employed in patients suffering
from vatarakta
Antahparimarjana cikitsa
Raktamoksana111 – raktamargavarana is the predominant pathology of vatarakta and this
leads to the accumulation of morbid rakta. Hence raktamoksana is considered as first line
of treatment of vatarakta. Raktamkoksana may be achieved by any of the
sringavacarana,jalokavacaraba suchivyadha,alabuavacarana, pracchana and siramoksa
methods. Raktamoksana by the jalaukavacarna method is preferred if the affected site
exhibits symptoms like ruk, daha toda and sula. Sringavacarana is the better choice if the
patient of vatarakta has symptoms like supti kandu cimacimayana etc. if the illness
progress with spreading, raktamoksana by pracchana method is the better option. Though
the raktamoksana is the primary treatment of vataramkta excessive bleeding may further
vitiate the vata dosa of vatarakta hence frequent employment of raktamoksana in small
46
Conceptual Study
amounts is always justified. Improper or excessive employment of raktmoksana may lead
to development sever complications like vatavyadhi. There fore one must be very
cautious while planning the raktamoksana in patients suffering from vatarakta.
Langhana112 – langhana cikitsa is advocated if the morbidity of kapha dosa associates the
pathology of vatarakta. Langhana when employed reduces the morbidity of kapha dosa in
kaphanuga type of vatarakta. Further, if the margavarna in vatarakta is due to
accumulation of kapha and medas langhana treatment is very much beneficial for evident
reasons.
Snehapana – both shodhananga sneha as well as samananga sneha is indicated in
vatarakta. As preparation of patient prior to vamana or virecana patient is subjected to
shodhananga sneha. Further in vatottara vatarakta following sodhana procedure
snehapana with purana grita is ideal113. Snehapana is not ideal if the patient of vatarakta
exhibits excessive sneha in his body. Also in case of margavarana due to accumulation of
kapha and medas snehapana is contraindicated114.
Vamana – vamana is indicated as a shodhana procedure in vatarakta. In a patient of
vatarakta if the lesions are located in the upper extremities it is suggestive of association
of morbid kapha and pitta dosa. Shodhana by vamana procedure is a better option in such
situations115. So also in kaphanuga vatarakta shodhana is best achieved by vamana karma.
Further employment of snehapana before the sodhana depends upon the state of sneha in
the patient’s body. In snigdha person vamana is carried out with minimal or no prior
snehapana. In patients with ruksata in the body, employment of vamana karma with prior
snehapana is ideal116. One should remember that, as the vatarakta is the disorder with
predominant vitiation of vata dosa, only mrudu vamana is justified as tikshna vamana
tend to increase the morbidity of vatadosa.
Virecana117- both snigdha virecana as well as ruksa virecana is indicated in vatarakta. If
the patients body exhibits snigdhata, ruksa virecana is ideal. Contrary to this if the
patient’s body exhibits rukshata in the body it is better to plan snigdha virecana. As
tikshan virecana tend worsen the morbidity of vatadosa, mrdu virecana is always justified
in patients suffering from vatarakta. Pittanuga and raktanuga types of vatarakta is better
treated by virecana karma. Further if the involvement of upper limb is present in a patient
of vatarakta, which indicates association kapha and pitta dosa in the pathogenesis of
47
Conceptual Study
vatarakta virecana is preferred as shodhana treatment118. Ruksaha virecana is also ideal in
patents suffering from margavarana due to morbidity of kapha and medas.
Basti karma – basti karma is regarded as best treatment in patients suffering from
vatarakta119. Basti karma includes both asthapana basti as well as anuvasana basti. This
disease when an effect the legs, indicative of predominant vata vitiation basti is the best
option120 Vatanuga vatarakta is better treated by basti cikitsa. The symptoms like basti
sula, vanksanasula, parshvasula and udara sula when present basti is the treatment of
choice. Administration of ksheera basti is emphasized in all variety of vatarakta121.
Further if the margavarana is due to accumulation of kapha and medas lekhana basti is
indicated as this basti is capabale of clearing the margavarana along with negating the
detrimental effect morbid vata dosa122.
Rasayana: administration of rasayana cikitsa is very important as the disease is
progressive and runs a chronic course. Vardhamana pippali rasayana or ksheerabala taila
is advised in patients suffering from vatarakta123. Further if the margavarana is due to
accumulation of kapha and medas administration of silajatu guggulu and makshika dhatu
in the form of rasayana chikitsa is beneficial124.
Bahiparimarjana cikitsa:
Antahparimarjana cikitsa is the option in patients suffering from gamhira vatarakta.
Addition of bahiparimarjana cikitsa is essential in patients suffering from uttana or
ubhayasrita vatarakta125. More details of bahiparimarjana cikitsa is given in the following
lines.
Pariseka – depending upon the requirement either ushna parisheka or sita parisheka is
carried out on the affected part in patients suffering from vataraka. Dominance of vata
dosa when present characterized by severe pain in the affected part, then ushna parisheka
should be prescribed126. Contrary to this if daha is the symptom due to predominance of
pitta dosa and rakta dhatu, sita parisheka is ideal to relieve the discomfort127.
Abhyanga: treatment with abhyanga over the affected part is planned according to the
presence of symptoms or the dominance of affected dosa. Warm oil processed with
vatahara drugs is used for abhynga if the patient complains of severe pain due to vitiation
of vata dosa. Cold application of the ghrita processed with pittahara drugs is ideal if the
patient complains of burning sensation due to morbidity of pitta dosa or rakta dhatu. If
48
Conceptual Study
kandu is the leading symptom due to morbid kapha dosa oil processed with kaphahara
drugs is used in the form of abhyanga128.
Pradeha: pradeha cikitsa is planned according to the relative dominance of dosa
involved. As a general rule the pradeha should not cause vidaha following application.
Warm application of paste is preferred if the patient suffering from sever pain due to
morbid vata dosa. Medicinal paste prepared by adding ghrita applied cool on the affected
part if the patient has burning sensation due to morbid pitta dosa. Medicinal paste
prepared with herbs having ushna quality is preferred if relative dominance of kaphadosa
or vatakapha dosha is identified129.
Upanahana: specific herbal powder made into a paste by the addition of kanji or such
other liquids is applied when warm as upanaha, and is very useful in relieving pain due to
morbid vata dosa130.
Sastra pranidhana: severe morbidity of pitta dosa and rakta dhatu may lead to
suppuration at the affected part. This may lead to ulceration and pus discharge. In such
conditions Bhedana sodhana and ropana measures have been carried out131.
Agraushadi: Amruta132
Formulations useful in vatarakta:
Svarasa: Guduchi svaras133
Churna: Haritaki, Nimbadi, Munditiki, Godhumachurnadiyoga134etc.
Kalka:Amrutadi kalka135.
Phanta:- Guduchyadi phanta136.
Kvatha137:-Patola, Shampaka, Kokilaksha, Ashvatha, Trivrutta, Amrutadi ,Vasadi,
Navakarshika, Kashmaryadi, Laghuand Bruhata Manjishtadikvatha,
Vatsadani kvatha etc.
Taila: Laghu and Bruhat Guduchi taila, Maharudraguduchi taila, Mahavishataila,
Vishatindukataila,Rudrataila,Pindataila,Dashapakabalataila138,
Shatapakamadhukataila,sukumarataila,Khuddakapadmakataila,Nagabalataila,
Sarivaditaila ,Laghumarichaditail,Shatavhaditaila etc139.
Ghrita: Guduchighruta, Shatavarighruta, Amrutadighruta 140etc.
Avaleha:Gudaghrita ,Shilajatu, Amrutadhatakiavleha,Chayvanaprasha, Gandirarasayana,
Brahatmadhusnuhi rasayana141 etc.
49
Conceptual Study
Asavarishta : Dashamularishta , Dhattryarishta, Ashokartishta 142etc.
Arka : Guduchiarka143.
Rasa:Vataraktantakarasa,Vishveshvararasa,dvadashayasa,Guduchyadiloha,
Langalyadiloha,Sarveshvararasa,Mahataleshvararasa,Kaishoreguggulu,
Chandraprabhavati, simhanada guggulu, Panchamrutarasa , Yogasaramruta etc144.
Basti:Ardhamatrika niruhabasti 145, Lekhanabasti146.
PATHYA AND APATHYA 147
PATHYA AHARA
Suka dhanya varga: Shastica shali (Oryza sativa grown in 60 days), Yava (Hordeum
vulgara), Laja (Puffed rice), Godhuma (Trictum vulgarae)
Shami dhanya varga: Mudga (Phoseolus trilobus), Kulatha (Dolichos biflorae), Masha
(Phaseolus mungo)
Mamsa rasa varga:Gramya mamsa (meat of tame animals), Jangala mamsa (Meat of wild
animals), Bileshaya mamsa (meat of subterranean cave animals or burrowing animals)
Gorasa varga: Kshira (milk), Gritha (Ghee), Takra (Butter milk)
Jalavarga : Ushnajala (Hot water)
Phalavarga: Bimbi (Coccinia Indica), Bijapura (Citrus medica)
Madhuvarga: Madhu (Honey)
Ikshu varga: Dishes prepared out of sugar
Taila varga: Tila taila (sesaman oil), Sarshapa taila (mustard oil), Bilva taila (taila extracted
from aegle marmilos)
Harita varga: Jivanthi (Lepta denia reticulata), Gostani (vitis vinefera), Maricha (Piper
nigrum), Pippali (piper longum), Shunti (Zingiber officinale), Mulaka (Raphanu sativus),
Balamula (root of cida cordifol, Vataraktamardha (Cassia occidentalis), Yusha (soup) prepared
with pippali and kshara (alkali), Yusha (soup) prepared with kulatha & mulaka,
Food habit: Laghvanna (light diet)
Pathya Vihara: Sound sleep during night, Warm weather, Pollutant free environment
50
Conceptual Study
APATHYA Ahara:
Suka dhanya varga: Tila, Saktu etc.
Shami dhanya varga: Masha,Nishpava , Kalaya, Kulattha Etc.
Mamsa rasa varga: Matsya(Fish), Andaja and Anupa mamsa.
Gorasa varga: - Dadhi.
Jalavarga : Dusta Jala, Sheeta Jala
Phalavarga: Amlaphala.
Madhuvarga: -
Ikshu varga: Ikshu.
Taila varga: Tilataila.
Harita varga: Mulaka.
Food habit: Madhura rasa (sweet), guru ahara, Snigdha (unctious) guru (Heavy) Picchila
(slimy) Pistanna (Dishes prepared out of flour of cereals) Payasa (food prepared with milk)
Apathya Vihara: Maithuna (sexual intercourse), Dhumasevana (Smoking), Dusta Pavana Rajo
Marga Nishevana (Walking on polluted roads), Vegavarodha (suppressing on natural urges)
This is about the pathya and apathya for the usual variety of vatarakta. In case of margavarana
due to kapha and medas the pathya and apathya of sthoulya has to be followed.
51
Objectives
OBJECTIVES OF STUDY:
1. To carry out literary study on vatarakta as well as the role of kapha
and medas in its causation of vatarakta
2. To evaluate the therapeutic effect of Vataraktantakarasa and Lekhana basti in Vatarakta.
6
Drug Review
DRUG REVIEW:
In this chapter, the details of Vataraktantaka Rasa, Shatapaka Madhuka taila and
ingredients of Lekhana Basti are compiled, and discussed
Vataraktantaka Rasa 148:
Vataraktantaka rasa as explained in Bhaishajya ratnavali is a Khalvirasayana with a
unique herbomineral combinations of drugs to treat Vatarakta. The name suggests that it is a
rasa preparation, as it contains rasa (mercury) as an ingredient. Shilajatu , guggulu ,
Lauhabhasma are the main ingraident targeted specifically for kapha medasavarana in
raktavaha srotasa.these ingredients are treated with each three bhavana of bhringaraja svarasa
and triphala svarasa, following this Shana pramana or one masha matra pills are prepared.
Nimbapatra ,pushpa,tvach sambhaga is ideal as Anupana for the clinical trial 250 mg tablets of
vataraktantaka rasa was prepared at S.D.M. Ayurvedic pharmacy, Kuthapady, Udupi ,
Karnataka,
Table No11. showing the ingredients of Vataraktantaka Rasa
Drug Name Quantity. Shudha Parada. One Part Shudha Gnndhaka One Part Shudha Lauha Bhasma. One Part Shudha Abhraka Bhasma One Part Shudha Hartala One Part Shudha Manashila One Part Shudha Shilajatu One Part Shudha guggulu One Part Haritaki One Part Amalaki One Part Bibhitaki One Part Shunthi One Part Pippali One Part Maricha One Part Punarnava One Part Devadaru. One Part
51
Drug Review
Chitrakamula One Part Daruharidra One Part Bhrungaraja Q.S.
Indications :- Vatarakta
Matra – Shana Matra ( 250 mg tid )
Root of administration: - Oral
Anupana – Nimbapatra ,pushpa,tvach sambhaga.
SHATAPAKA MADHUKA TAILA 149 :
This is the tail prepration specially indicated in vatarakta and may be used in the form
of Nasya,Pana,Basti,Abhyanjana. In the present clinical trial this oil is used for Anvasan Basti
as part of Kaalabasti course of Lekhana Basti. By using Yasthimadhu kalka and ksheera,
Ksheerapaka prepared,.taila paka is prepared by using ksheerapaka and murchitatilataila and
Madhuka pushpa kalka is added during tailapaka. For the present study 25 lit of oil was
prepared in S.D.M. Ayurvedic pharmacy, Kuthapady, Udupi, Karnataka.. And is packed in 200
ml containers.
Table No 12 showing the ingredients of SHATAPAKA MADHUKA TAILA
Drug Name Quantity
Yashtimadhu 2.4 kg.
Tila taila 24 lit.
Madhuka pushapa. 24 gm.
Ksheera 24 lit.
LEKHANA BASTI 150:
This is the basti combination specially indicated in Sthaulya and morbid condition of kapha
and medasa. The mixing of ingredients done as quantity mentioned in table with sequence of
madhu , saindhava lavana ,murchita tilataila, kalka, triphala kvatha and gomutra, . The
ingredients of kalka are suryakshara , shilajatu, kasisa ,tuttha , hinga151 .
52
Drug Review
Table No 13 showing the ingredients of Lekhana Basti.
Drug Name Quantity
Madhu 80 ml
Saindhava lavana 05 gm
Tilataila 120 ml
Surya kshara 07 gm
Shudha Shilajatu 07 gm.
Shudha Kasisi 07 gm
Shudha Tuttha 07 gm
Shudha Hingu 07 gm
Triphala Kwath 180 ml
Gomutra. 60 ml.
Total 480ml.
Details of the drugs used in the above formulations are given in following pages.
Dravya- Guggulu 152
Paryaya - Palankashaa, kaushika, pura, mahishaaksha, kalaniryaasa
Latin name - Commiphora mukul.
Upyuktanga - Niryaasa.
Rasa- katu,tikta
Virya- Uushna .
Vipaaka - Katu
Doshaghnata - Kapha,vaata.
Prabhaava- Rasaayana
Dravya-Haritaki 153
Paryaya - Abhayaa, haritaki, pathyaa, shivaa ..
Latin name- Tarminalia chebula
Upayuktanga - Phala,bija.
53
Drug Review
Rasa- Lavanavarjita pancharasa
Virya- Ushna.
Vipaaka - Madhura
Doshaghnata- TridoSha
.
Dravya-Bibheetaki 154.
Paryaya - Karshaphala: aksha: kalidruma
Latin name- Terminalia bellerica .
Upayuktanga- Phala,bija
Rasa- Katu, tikta
Virya- Ushna.
Vipaaka - Madhura
Doshaghnata - Kapha,pitta
Dravya-Aamlaki 155
Paryaya - Dhaatri, dhaatriphala, vayasthaa,Shadarasaa.
Latin name- The emblica myrobalans
Upyuktanga - Phala,phalamajjaa
Rasa- Aamla,kashaaya,madhura.
Virya- Sheeta
Vipaaka - Aamla,madhura
Doshaghnata - Tridoshaghna
Dravya-Shunthee 156 .
Paryaya - Aardraka, naagara,vishvabhaishajya,shrungabera .
Latin name- Zinzibera officinale
Upyuktanga - Kanda
Rasa- Katu
Virya- Ushna
Vipaaka - Madhura
Doshaghnata - kapha,vata
54
Drug Review
Dravya-Pippali 157
Paryaya - Maagadhi, kruShna, vaidehi, ushana
Latin name- Piper longama
Upyuktanga - Mula, phala
Rasa- Katu
Virya- Sheeta
Vipaaka - Madhura
Doshaghnata - Kapha,vata
Dravya-Maricha158
Paryaya - Vallija, ushana krushna kola
Latin name- Piper nigrum.
Upyuktanga - Phala.
Rasa- Katu, tikta
Virya- Ushna
Vipaaka - Katu
Doshaghnata - Kapha,vata.
Dravya- Punarnavaa 159
Paryaya - Katilla, shothaghni vishaakha
Latin name- Boerhavia diffusa
Upyuktanga - Mula,patra, panchanga
Rasa - Katu,tikta,kashaya
Virya- Ushna
Vipaaka - Katu
Dohaghnata - Kapha,vaata
Dravya-Devadaaru 160
Paryaya - Suradaaru kilima,bhadradaaru Utikaashta
Latin name- Cedrusa deodar
Upyuktanga - Kashtha
Rasa- Tikta
55
Drug Review
Virya- Ushna
Vipaka - Katu
Doshaghnata - Kapha,vaata
Dravya-Chitraka 161
Paryaya - Agni, dahana
Latin name- Plumbago zelanica
Upyuktanga - Mula,patra
Rasa- Katu,tikta
Virya- Ushna
Vipaaka - Katu
Doshaghnata - Vaata,kapha
Dravya-Daaruharidraa 162
Paryaya - Daarunishaa, daarvi, katamkateree
Latin name- Barberisa asiatica rob
Upyuktanga- Mula,tvaka
Rasa- Katu,tikta
Virya- Ushna
Vipaaka- Katu
Doshaghnata - Kaphapitta
Dravya -Bhrungaraja 163
Paryaya - Maarkava, kesharaaja
Latin name- Ecliptia alba
Upyuktanga - Samagra
Rasa- Tikta,kaShaaya
Virya- Ushna
Vipaaka- Katu
Doshaghnata - Kaphavata
56
Drug Review
Dravya - Nimba 164
Paryaya - Arishta pichumarda, prabhadra:
Latin name- Melia azardirachta
Upyuktanga - Panchanga
Rasa- Tikta
Virya- Shita
Vipaaka - Katu
Doshaghnata - Kapha,pitta
Dravya-Yashtimadhu165
Paryaya - Yashtimadhuka, madhuyashtika, klitaka.
Latin name- Glycyrrhiza glabra
Upyuktanga- Mula, ghanasatva
Rasa- Madhura
Virya- Sheeta
Vipaaka - Madhura.
Doshaghnata - Tridosha
Drug name- Parada166.
English name - Mercury
Latin name- Hydrogyrum.
Symbol - Hg
Rasa – Shada rasa
Guna – Snigdha ,sara guru.
Virya- Ushna.
Karma - Yogavahi , balya , rasayana ,vrushya.
Vyadhi prabhava- Krumi, Kushta , Vataroga Valipalita roga.
Drug name-Gandhaka167.
English name - Sulpher.
Symbol - S
Rasa - Tikta ,katu,kasaya, madhura
Guna – Ushna,Snigdha,Sara .
57
Drug Review
Virya- Ushna.
Vipaka – Katu , madhura.
Karma – Garavishahara , deepana ,amapachana , kandugnha.
Doshadhnata – Vatakaphanashaka.
Vyadhi prabhava- Tvakavikaranashaka , dadrunashaka , kushtanashaka
Drug name- Haratala168
. English name- Yellow arsenic / Orpiment.
Symbol - As2S3
Rasa – Katu ,Kasaya.
Guna – Snigdha.
Virya- Ushna.
Vipaka – Katu.
Doshaghnata – Kaphavatahara , raktadoshahara.
Vyadhi prabhava- Arsha , katigraha ,Kandu , Kasa ,Galagraha ,Jaraa,Jvara , Nasaroga ,
Netraroga , rasayana, vajikara, Vrushya ,Visarpa, shvasa
Drug name-Manashila 169.
English name- Realgara.
Symbol - As2S3
Rasa – Tikta.
Guna – Guru , sara, Snigdha ,Lekhana.
Virya- Ushna.
Vipaka – Katu.
Karma – Rasayana,Shvasa,Kasa,Agnimandya,Anaha,Kandu ,Jvara , Vishapaha
Drug name-Lauha 170.
English name - Iron
Latin name- Ferrum.
Symbol - Fe
Rasa - Nirasa
58
Drug Review
Karma – Tridoshaghna ,rasayana ,Vajikran ,Balya ,Vrushya,Medhya,Chakshusha.
Vyadhi prabhava-Pandu , Kamala , Shula , shvasa , Grahani ,Arsha ,Sthaulya ,Jvara ,
Kasa,Agnimandya,Shotha ,Pliha,Yakrita.
Drug name-Abhraka171.
English name – Mica.
Guna- Yogavahi , Snigdha , Sheeta.
Karma – Tridoshanashaka ,Medhya ,Ayushya ,Rasayana ,vrushya ,Brumhana,
Hrudya,karnya,Netrya , Deepana ,Paachana.
Vyadhi Prabhava- Prameha , Kushta, Kushta ,Pliha ,Udara ,Shoola, Grahani ,Pandu,
Kshaya ,Granthiroganashaka.
Drug name-Shilajatu172
English name- Black bitumen or Minral pitch.
Latin name- Asphaltum Punjabinum.
Karma – Medya ,Rasayana ,Blua ,Vajikaran , Yogavahi ,Vrushay.
Vyadhi Prabhava- Prameha , Jvara ,Pandu , Mandgni, Shoola, Medoroga , Pliha,
Udararoga ,Kushta.
Drug name-Tuttha173.
English name- Copper Sulphate / Blue vitriol.
Symbol - Cuso47H2O
Karma – Lekhana,Bhedana,Rasayana,Balya,Chakshusha.
Vyadhi prabhava- Prameha ,medoroga ,Krimi , Kushta , shoola ,Shvitra ,
Amlapitta ,Hradrgo ,Arsha.
Drug name- Kasisa174.
English name- Ferrous Sulphate / Green Vitriol.
Symbol - CusO47H2O
Rasa – Amla ,Kasaya Rasa varjita
Doshaghnata – Kaphavatanashaka.
59
Drug Review
Karma – Vishaghna , Shvitraghna , Keshya , Netrya ,Kandughna ,
Raktavardhaka,Vyadhi Prabhava-Mutrakruchra , Ashmari, Pandu,
Krimi , Jvara ,Pliha
Drug name-Ushaka = Suryakshara175
English name – Potassium nitrate.
Latin name- Potassi Nitras.
Rasa - Katu
Guna – Tikshna.
Karma – Mutravirechaniya , Svedajanana, Shothahara,Plihavruddhi , Pandu.
Vyadhi prabhava- Mutrakrucha , Ashmari , Shotha , Plihavrudhi , Pandu ,
Kamala ,Prameha.
Drug name- Saindhava176.
English name – Chloride of Sodium.
Latin name- Sodium Chloried.
Guna – Ruchikara , Agnidipaka , Pachana ,Vatanulomana , Netrya,
Vranaropaka
.
Drug name- Hinga 177.
English name - Asafoetida
Latin name- Ferrula Narthox.
Karma – Vatanulomana , Deepana, pachana , Uttejana , Kaphadurgandhihara .
Vyadhi prabhava- Aadhmana , Shoola , Apasmara , Apatantraka ,
Vatavikara , Shvasa ,Kasa.
60
Clinical Study
MATERIALS AND METHODS: Aim of the study
1. To carry out literary study on vatarakta as well as the role of kapha and medas in
its causation of vatarakta .
2. To evaluate the therapeutic effect of Vataraktantakarasa and Lekhana basti in
Vatarakta
Source of the data:
The patients who attended the O.P.D. and I.P.D. of S.D.M. Ayurveda Hospital,
Kuthpady, Udupi, Karnataka, during the period of November 2005 to August 2006,
having the signs and symptoms of Vatarakta were screened. Among these patients 20
Patients who fulfilled the below mentioned criteria of inclusion were taken for the
study. While selecting these 20 patients care was also taken to see that there was no
any factor in these patients listed in the exclusion criteria. The selected patient’s
detailed profile is prepared as per the detailed proforma designed for the same
purpose, which incorporates relevant data like symptomatology, physical signs,
laboratory investigation reports as well as assessment criteria.
Inclusion criteria
20 patients taken in this clinical trial were according to the following inclusion
criteria-
The patients of Vatarakta clinically diagnosed and confirmed by investigations.
The patients between ages of 16 to 70 years were included in study.
Patients were randomly selected irrespective of sex, occupation, caste, etc.
Exclusion criteria
The patients suffering from Vatarakta showing the presence of following criteria were
excluded from the study
The patients with severe toxicity, progressive gangrenous changes in vicinity are
excluded from study.
Diseases of immunological basis and syphilis are excluded.
61
Clinical Study
Investigations
Following are the list of investigations carried out in 20 patients of Vatarakta
taken for this study.
Hb %, TC, DC, ESR, RBS, Liver function test, Blood urea, serum creatinin, Lipid
Profile,Arterial Doppler Ultra sound,Arteriography.
Design:
It is a single blind clinical study with a pre-test and post-test design. In this study
20 patients diagnosed as Vatarakta of either sex were subjected to clinical study.
Intervention:
The selected patients were administered with
1) Lekhana Basti as kaala basti course of 16 days, in which Niruha Basti is
administered in a dose of 480 ml for 6 days by using the enema can.
In this basti course 10 sittings of Anuvasana basti was also administered with
Shatapaka madhukataila in a dose of 120ml. Anuvasana basti was given by using
Plastic syringe.
2) In conjunction with basti treatment the patient was also treated orally with
Vataraktantaka Rasa in the Dose of 250 mg tid. This oral medication was
continued for 30 days with the anupana of warm water.
Duration of study: 30 days
METHOD OF ADMINISTRATION OF BASTI
Lekhana basti is administered in combination with sneha basti of
Shatapakamadhuka taila for 16 days in the form of kala basti course.The same course
of basiti is detailed in the table no 14-
DAYS BASTI MATRA
1day Sneha Basti 120 ml
2nd day Sneha Basti 120 ml
62
Clinical Study
3rd day Lekhana basti 480 ml
4th day Sneha Basti 120 ml
5th day Lekhana basti 480 ml
6th day Sneha Basti 120 ml
7th day Lekhana basti 480 ml
8th day Sneha Basti 120 ml
9th day Lekhana basti 480 ml
10th day Sneha Basti 120 ml
11th day Lekhana basti 480 ml
12th day Sneha Basti 120 ml
13th day Lekhana basti 480 ml
14th day Sneha Basti 120 ml
15th day Sneha Basti 120 ml
16th day Sneha Basti 120 ml
Procedure of Asthapana basti:
Purva karma -
The Asthapana basti was given early morning in the empty stomach.
Patient was instructed to evacuate bowel and bladder. Local abhyanga and nadisweda
was carried out on the lower abdomen, back, thighs and buttocks. Swedana is continued
until the patient developed the samyak svinna laksana.
Pradhana karma -
Patient was asked to lie down in left lateral position on the treatment table. Buttock and
anal region is undressed. And in this position the patient is asked to flex his right hip and
knee so that the right ankle resting on the extended left leg. For comfort, patient is asked
to keep his left hand beneath the head. This is the position of the patient for administering
the basti.
63
Clinical Study
The enema can was filled with the basti dravya, following this some amount of basti
dravya is allowed to escape from the nozzle so as to remove air entrapped in the tubing.
The tip of the nozzle is soaked in oil so as to prevent the friction during insertion of the
nozzle into to anal canal.
The anal area of the patient is smeared with oil and then the enema can nozzle is gently
inserted into the anal canal for a length of about 5 angula. The enema can is then raised
for about 3 feet, to allow the basti dravya to escape into the rectum by means of
gravitational force. When the enema can is emptying into the rectum the patient is asked
to deep breathing. When little amount of basti dravya is still left in the enema can, the
nozzle is closed and then withdrawn from the anal canal. This prevents escape of air into
the rectum.
Following the administration the patient is asked to change his position from left lateral
to prone, and then from prone to rt lateral and lastly form the right lateral to the supine
position. In this position the patient is asked to rub his hands against each other. The
therapist also rubs the patient’s soles vigorously. The foot end of the table is also raised.
Paschata Karma -
Patient was instructed to be in the same position till he develops strong urge of
defecation. After defecation the patient was allowed to take hot water bath and light
foods. The patient was then observed to assess the proper, excessive or poor effect of the
basti. The time of retention & expulsion of basti dravya was also noted.
Procedures of Anuvasana basti:
Anuvasana basti was given in afternoon after the food, the procedure followed was same
as that of asthapana basti, the anuvasana basti was given in dose of 120 ml
Assessment criteria:
The state of the disease vatarakta changes after the intervention. Improvement or
otherwise was determined by adopting the standard methods of scoring for subjective,
objective and special investigation criteria. The margavarana was assessed both before
and after the intervention to note any change by using the arterial Doppler study. Lipid
64
Clinical Study
profile was also studied before and after the treatment. The details of the assessment
criteria are given as in table no.15 follows.
Sl. No. Subjective criteria Scoring 1. Pain No pain 0 Mild pain 1 Moderate pain 2 Severe pain 3
2. Burning sensation No burning sensation 0 Mild burning sensation 1 Moderate burning sensation 2 Sever burning sensation 3 3 Malaise No malaise 0 Mild malaise 1 Moderate malaise 2 Sever malaise 3 4 Sleep Sound sleep 0 No sleep 1 Disturbed sleep 2
Sl.No. Objective criteria Scoring 1 Tenderness No tenderness 0
Patient complains of pain 1
Patient complains of pain & winces 2
Patient complains of pain & withdraws 3
No tenderness 0
2 Edema:
No swelling 0
Slight swelling 1
Moderate swelling 2
Gross swelling 3
65
Clinical Study
3 Local color changes in the skin No color change 0
Mild color change 1
Moderate co lour change 2
Severe colour change 3
4 Walking ability
Walks easily 0
With mild difficulty 1
With moderate difficulty 2
With marked difficulty 3
Impossible 4 5 Peripheral pulses Abscent 3 Feeble 2 Less volume 1 Full bounding 0
Assessment of overall effect:
As per the reduction in the total scores of the assessment parameters, the overall effect
is calculated as follow-
Complete remission - total score is 0 after the treatment
Marked improvement – reduction in the mean symptom score by 75 to 99% from the
initial score.
Moderate remission - reduction in the mean symptom score by 50 to 74%
Average remission - reduction in the mean symptom score by 25 to 49%
Unchanged - reduction in the mean symptom score by < 24 % from the initial score.
66
Observation
OBSERVATIONS
A total of 20 patients suffering from Vatarakta fulfilling the inclusion criteria were taken
for the study. All these 20 patients who were registered have completed the stipulated
schedule of the study. The patients were selected irrespective of age, sex, and caste.
The observation and the results as well as statistical analysis of the patients are elaborated
in the following headings:
• Descriptive statistical analysis of the patients
• Analysis of the therapeutic effect of Vataraktantaka rasa and Lekhana basti in
patients of Vatarakta,
• Assessment of the significance of the treatment by adapting the paired ‘t’ test.
Descriptive Statistical Analysis
Descriptive statistical analysis of 20 patients of Vatarakta includes the following
information.
• Vital informations like age sex marital status etc
• Reguar habits like diet, sleep ,bowel and bladder evacuation etc
• Atura bala pariksa as dasavidha pariksa
• Incidence of symptoms, severity, onset, course etc
Details of the same is given in the following pages
67
Observation
Distribution of 20 Patients According to Age: Out of 20 patients of Vatarakta
studied in this work, maximum number of 10 (50 %) patients belonged to the age
group of 51to 60 years and 5 (25%) number of patients were belonging to 41 to
50 years and 61 to 70 years age group. The details are given in the Table No. 16
and fig. No. 1
Table No. 16 - Distribution of 20 patients according to different age group
Age groups No. of patients %
41-50 05 25
51-60 10 50
61-70 05 25
Figure No. 01 - Distribution of 20 patients according to different age
group
% of Patients
25
50
25
41-5051-6061-70
68
Observation
Distribution of 20 Patients According to their Sex:
12 (60%) of patients of Vatarakta were males as against only 8(40.%) of females in the
present study. The details are elaborated in the Table No. 17 and fig No. 2.
Table No. 17 - Distribution of 20 patients according to sex
Sex of the patients No.of patients %
Male 12 60
Female 08 40
Figure No. 02 - Distribution of 20 patients according to sex
% of Patients
60
40
MaleFemale
69
Observation
Distribution of 20 Patients According to Religion:
As shown in the Table No. 3 and Graph No. 3, 16(80%) of patients were Hindus, 2(10%)
were Muslims and only 2 (10%) of patients were Christians
Table No. 18 - Distribution of 20 patients according to religion
Relegion of patients No.of patients %
Hindu 16 80
Muslim 02 10
Christian 02 10
Figure No. 03 - Distribution of 20 patients according to religion
% of Patients
80
10 10
HinduMuslimChristian
70
Observation
Distribution of 20 Patients According to Marital status:
Among the 20 patients of Vatarakta taken for this study, a maximum of 18 (90%)
patients were married as against mere 0 (0%) of unmarried people. There was 2 (10%)
widow patient in the study. The details are shown in the Table No. 19and fig No. 4.
Table No. 19 - Distribution of 20 patients according to Marital status
Marital status of Pt. No.of patients %
Married 18 90
Unmarried 00 00
Widowed 02 10
Figure No. 04 - Distribution of 20 patients according to Marital status
% of Patients
90
0 10
marriedUnmarriedWidowed
71
Observation
Distribution of 20 Patients According to Literacy:
Prevalence of literates was recorded in the present study involving 20 patients of
Vatarakta.25% of the patients were illiterates and the remaining 75%of patients had
education, as detailed in the Table No20 and fig No. 5.
Table No. 20: Distribution of 20 Patients According to Literacy:
Educational status No. of Patients % of patients
Illiterate 5 25
Under graduate 6 30
Graduate 7 35
Post Graduate 2 10
Figure No. 05 - Distribution of 20 patients according to Literacy
% of Patients
25
30
35
10
Illitrate
U.G.
Graduate
P.G.
72
Observation
Distribution of 20 Patients According to their Occupation:
It is observed that 7 (35%) of the females in this study were house wives by their
occupation. Also, this formed the largest category of patients leaving behind the patients
engaged in other occupations. There were only 3(15%) patients in the agriculture
category recorded. Details are given in the Table No. 21 and fig No. 6.
Table No. 21: Distribution of 20 Patients According to their Occupation
Occupation No. of patients % of patients
Agriculture 3 15
Business 5 25
Employee 5 25
House wife 7 35
Figure No. 6 - Distribution of 20 patients according to Occupation
% of Patients
15
2525
35
Agriculter
Business
Employee
Hous.Wif
73
Observation
Distribution of 20 Patients According to Socio-economical status :
The study revealed that most of the patients belonged to middle socio-economic status
i.e.14 (70%) against the upper socio-economic status which comprised 4(20%). The
details are given in the Table No. 22 and fig. No. 07.
Table No. 22: Distribution of 20 Patients According to Socio-economic status
Socio-economic status No. of patients % of patients
Lower 02 10
Middle 14 70
Upper 04 20
Figure No. 07 - Distribution of 20 patients according to different Socio-economic
status
% of Patients
10
70
20
Lower
Middle
Upper
74
Observation
Distribution of 20 Patients According to Mode of Onset of the illness: Out of 20
patients suffering from Vatarakta taken for the study, 10 (50%) patients had gradual
onset of the disease, None of the patient had a sudden onset of illness. Details are given
in Table no 23 and fig.no 8.
Table No. 23: Distribution of 20 Patients According to Mode of Onset of the illness
Mode of Onset No. of patients % of patients
Gradual 10 50
Insidious 10 50
Sudden 0 0
Figure No. 08 - Distribution of 20 patients according to different Mode of Onset of
the illness
% of Patients
50
500
Gradual
Insidious
Sudden
75
Observation
Distribution of 20 Patients According to the associated Illness : it is observed that a
maximum of 9 (45.%) patients had diabetes mellitus and hypertension as associated
illness, whereas only 2 (10%) patients had a hypertension and 6 ( 30%) patients had
diabetes mellitus as associated disease. The details are given in Table no 24 and
Fig.no 9
Table No. 24: Distribution of 20 Patients According to the associated illness
Associated illness No. of patients % of patients
Diabetes mellitus 05 25
Hypertension 02 10
D.M. and H.T.N. 09 45
None 04 20
Figure No. 09 - Distribution of 20 patients according to different associated illness
% of Patients
25
1045
20
D.M.H.T.N.D.M.+H.TNone
76
Observation
Distribution of 20 Patients According to the type of Dietary Habits:
Maximum 65% of patients were having mixed diet and 35% patients were
vegetarians. Table no 25 and Graph no 10 gives details.
Table No. 25 Distribution of 20 Patients According to the Dietary Habits
Dietary Habits No. of patients % of patients
Mixed 13 65
Veg 7 35
Figure No. 10 - Distribution of 20 patients according to different Dietary Habits
% of Patients
65
35
Mixed
Veg.
77
Observation
Distribution of 20 Patients According to Dominant Rasa in Ahara : 55% had
comsumption of food stuffs dominant of madhura rasa, 40% were consuming more of
katu rasa Ahara and only 1 patient was dominantly taking lavana rasa. Details are given
in Table no 26 and fig. no 11
Table No. 26: Distribution of 20 Patients According to Dominant rasa in Ahara
Dominant rasa in Ahara No. of patients % of patients
Madhura 11 55
Lavana 1 5
Katu 8 40
Figure No. 11 - Distribution of 20 patients according to different dominant rasa in
Ahara
% of Patients
555
40
Madhura
Lavana
Katu
78
Observation
Distribution of 20 Patients According to their Addictions: Large percentage of
patients in this study had none of addiction . Only 1 (5%) patient reported addiction to
alcohol ,where as number of 4 (20%) patients were addicted to alcohol and smoking.
Table No. 27and fig No. 12 show the details of the habits of patients.
Table No. 27: Distribution of 20 Patients According to their Addictions
Addictions
No. of patients % of patients
Alcohol 1 5
Alcohol and smoking 4 20
Smoking 2 10
None 13 65
Figure No. 12 - Distribution of 20 patients according to different Addictions
% of Patients
510
20
65Alcohole
Smoking
Alc+Smo
None
79
Observation
Distribution of 20 Patients According to Prakriti : All the patients in the present study
belonged to the Dvandaja Prakriti. 3 (15%) patients were of Vatapitta prakriti and 5
(20%) patients were of Vatakapha prakriti. The maximum 12 (60%) patients were of
kaphaPitta Prakriti. Table No. 28 and fig. No. 13 give the details.
Table No. 28 : Distribution of 20 Patients According to Prakriti
Prakriti
No. of patients % of patients
VP 3 15
KP 12 60
VK 5 25
Figure No.13 - Distribution of 20 patients according to different Prakriti
% of Patients
15
60
25
VP
KP
VK
80
Observation
Distribution of 20 Patients According to Dhatu Sara : The assessment of Sara in 20
patients of Vatarakta showed maximum number of patients having Madhyama Sara
20(100%) . Incidence of patients according to their Sara is detailed in the Table No. 29
and fig. No. 14
Table No. 29: Distribution of 20 Patients According to Sara
Sara No. of patients % of patients
Pravara 00 00
Madhyama 20 100
Avara 00 00
Figure No. 14- Distribution of 20 patients according to different Sara
% of Patients
0
100
0
Pravar
Madhyam
Avara
81
Observation
Distribution of 20 Patients According to Samhanana : Samhanana of every patient
was assessed before the treatment, and it was observed that among the 20 patients 20
(100%) of the patients had Madhyma Samhanana.
The detail of the same are given in the Table No. 30 and fig. No. 15
Table No. 30 Distribution of 20 Patients According to Samhanana
Sara No. of patients % of patients
Pravara 00 00
Madhyama 20 100
Avara 00 00
Figure No. 15- Distribution of 20 patients according to different Samhanana
% of Patients
0
100
0Pravar
MadhyamAvara
82
Observation
Distribution of 20 Patients According to Satmya : Observation of 20 patients of
Vatarakta revealed that no patient had Pravara Satmya, 14 (70%) of patients showed
Madhyama Satmya and the remaining 6 (30%) of patients showed Avara Satmya. Table
No. 31 and fig .No. 16 show the details.
Table No. 31: Distribution of 20 Patients According to Satmya
Satmya
No. of patients % of patients
Pravara 00 00
Madhyama 14 70
Avara 06 30
Figure No. 16 - Distribution of 20 patients according to different Satmya
% of Patients
0
70
30
Pravar
Madhyam
Avara
83
Observation
Distribution of 20 Patients According to Satva : Majority of 12 (60%) patients belong
to Madhyama Satva, 1 (5%) were of Pravara Satva and 7 (35%) were of Avara Satva in
this study. The details are shown in Table No. 32 and fig No. 17
Table No. 32: Distribution of 20 Patients According to Satva
Satva No. of patients % of patients
Pravara 7 35
Madhyama 12 60
Avara 1 5
Figure No. 17 - Distribution of 20 patients according to different Satva
% of Patients
3560
5Pravar
MadhyamAvara
84
Observation
Distribution According to Ahara Abhyavaharana and Jarana Shakti in patients of
Vatarakta: Interrogation of the 20 patients of Vatarakta revealed that 16 (80%) of the
patients had Madhyama Abhyavaharana Shakti and 2 (10%) patients had Pravara
Abhyavaharan Shakti. The remaining 2 (10%) patients had Avara Abhyavaharan Shakti
Details are given in the Table No. 33 and fig. No. 18
Table No. 33: Distribution According to Ahara Abhyavaharana and Jarana Shakti
in patients of Vatarakta
Abhyavaharana and Jarana Shakti No. of patients % of patients
Pravara 2 10
Madhyama 16 80
Avara 2 10
Figure No. 18. - Distribution of 20 patients according to different Ahara
Abhyavaharana and Jarana Shakti in patients of Vatarakta
% of Patients
10
80
10
Pravar
MadhyamAvara
85
Observation
Distribution According to Vyayama Shakti in patients of Vatarakta : Madhyama
Vyayama Shakti is recorded in 10 (50%) of patients. 4 (20%) of the patients had Avara
Vyayama Shakti and the remaining 6 (30%) patients had Pravara Vyayama Shakti. The
same is given in the Table No. 34 and fig. No. 19.
Table No. 34 Distribution According to Vyayama Shakti in patients of Vatarakta
Vyayama Shakti No. of patients % of patients
Pravara 6 30
Madhyama 10 50
Avara 4 20
Figure No.19 - Distribution of 20 patients according to different Vyayama Shakti in
patients
% of Patients
30
50
20
Pravar
MadhyamAvara
86
Observation
Distribution According to Pramana of patients : Amongst the 20 patients taken in
this study all 20 (100%) belonged to Madhyama pramana. None of the patient was form
the pravara and Avara pramana category. This has been shown in Table No. 35 and
Graph No. 20.
Table No. 35: Distribution According to Pramana of patients
Pramana No. of patients % of patients
Avara 0 0
Madhyama 20 100
pravara 0 0
Figure No. 20 - Distribution of 20 patients according to different Pramana of
patients
% of Patients
0
100
0Pravar
Madhyam
Avara
87
Observation
Distribution According to Vaya of patients : Amongst the 20 patients taken in this
study all 20 (100%) belonged to Madhyama Vaya. None of the patient was form the Bala
and vrudha age category. This has been shown in Table No. 36 and fig No. 21.
Table No. 36: Distribution According to Vaya of patients
Vaya No. of patients % of patients
Baala 0 0
Madhyama 20 100
Vrudha 0 0
Figure No. 21 - Distribution of 20 patients according to Vaya of patients
% of Patients
0
100
0Pravar
MadhyamAvara
88
Results
EFFECT OF TREATMENT IN VATARAKTA.
EFFECT ON PAIN:
Patients treated with Vataraktantakarasa and Lekhana basti had marked remission
of the symptom pain. 1.8 was the mean initial score of pain in 20 patients of Vatarakta
which came down to 1.0 after the treatment. The improvement to the tune of 44.44% is
found to be statistically highly significant (P≤0.001) as shown in the Table No.37 and
Fig. No.22
Table No.37 : Effect of treatment on Pain
Mean Score Paired ‘t’ test
BT AT
Difference
in means
%
S.D S.E.M. t value P value
1.800 1.000 0.800 44.4 0.410 0.0918 t= 8.718 P=<0.001
Figure no 22: Effect of treatment on Pain
0
0.5
1
1.5
2
Mean score
Pain
89
Results
FFECT ON BURNING SENSATION:
Burning sensation one of the cardinal symptoms of Vatarakta relieved by 57.14%
as the initial score of Burning sensation which was 0.700 reduced to 0.300 after the
treatment with Vataraktantakarasa and Lekhana basti. This improvement when analyzed
by the paired‘t’ test found to the significant (P=0.008).
Table No. 38 and Graph No. 23 provides the details.
Table No. 38: Effect of treatment on Burning sensation
Mean Score Paired ‘t’ test
BT AT
Difference
in means
%
S.D S.E.M. t value P value
0.700 0.300 0.400 57.14 0.598 0.134 t = 2.990 P= 0.008
Figure no 23: Effect of treatment on Burning sensation
B.T.
0
0.2
0.4
0.6
0.8
Mean S
core Burning sensation
90
Results
EFFECT ON MALAISE :
78.57% of improvement was observed in the symptom Malaise. 0.700 was the
initial mean score of Malaise recorded in the 20 patients of Vatarakta . This was brought
down to 0.150 after the administration of Vataraktantaka rasa and Lekhana Basti. This
improvement after the treatment is found to be highly significant (P≤0.001) as per the
paired‘t’ test. The details of the different statistical values are shown in the Table No.
39and fig. No. 24
Table No. 39: Effect of treatment on Malaise
Mean Score Paired ‘t’ test
BT AT
Difference
in means
%
S.D S.E.M. t value P value
0.700 0.150 0.550 78.57 0.510 0.114 t = 4.819 P= 0.001
Figure no 24: Effect of treatment on Malaise
B.T.,
A.T.,
0
0.2
0.4
0.6
0.8
Mean score
Malaise
91
Results
EFFECT ON DISTURBANCE OF SLEEP:
0.650 was the mean initial score of disturbance of Sleep before the treatment in patients
of Vatarakta. This initial mean score came down to 0.0500 after the treatment. The
improvement to the tune of 92.30 % was highly significant (P≤0.001) as revealed by the
paired‘t’ test.
Details of the same are given in the Table No. 40 and fig. No. 25
Table No. 40: Effect of treatment on disturbance of Sleep
Mean Score Paired ‘t’ test
BT AT
Difference
in means
%
S.D S.E.M. t value P value
0.650 0.0500 0.600 92.30 0.503 0.112 t = 5.339 P = ≤0.001
Figure no 25: Effect of treatment on disturbance of Sleep
B.T.,
A.T.,
0
0.2
0.4
0.6
0.8
Mean score
Sleep
92
Results
EFFECT ON TENDERNESS:
Tenderness is another symptom of Vatarakta. The initial mean score of the patients in
tenderness was 0.100 which was reduced to 0.00 after the treatment. The improvement to
the tune of 100% was recorded, is statistically significant. Details of the same are
represented in the Table No. 41 and fig. No. 26.
Table No. 41 comparison of effect on Tenderness
Mean Score Paired ‘t’ test
BT AT
Difference
in means
%
S.D S.E.M. t value P value
0.1000 0.000 0.1000 100 0.308 0.0688 t = 1.453 P = 0.163
Figure no 26: Effect of treatment on Tenderness
B.T.,
A.T., 0
0.020.040.060.08
0.1
Mean score
Tenderness
93
Results
EFFECT ON EDEMA:
Before the treatment the mean score of symptom of Edema was 0.350. After the
treatment with Vataraktantak rasa and Lekhana Basti this was reduced to 0.0500 giving
85.71% effect. The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = 0.010) as assessed by
the paired‘t’ test.
The details of the same are given in the Table No. 42and fig. No. 27.
Table No. 42Effect of treatment on Edema
Mean Score Paired ‘t’ test
BT AT
Difference
in means
%
S.D S.E.M. t value P value
0.350 0.0500 0.300 85.71 0.470 0.105 t = 2.854 P = 0.010
Figure no 27: Effect of treatment on Edema
B.T.,
A.T.,
0
0.1
0.2
0.3
0.4
Mean score.
Edema
94
Results
EFFECT ON LOCAL COLOUR CHANGES:
Patients treated with Vataraktantak rasa and Lekhana Basti had no difference in
Local color changes. 0.200 was the mean initial score in 20 patients of Vatarakta which
remained as 0.200 after the treatment.
Table No. 43 Effect of treatment on Local colour changes
Mean Score Paired ‘t’ test
BT AT
Difference
in means
%
S.D S.E.M. t value P value
0.200 0.200 0.000 0 - - - -
Figure no 28 : Effect of treatment on Local colour changes
B.T., A.T.,
0
0.05
0.1
0.15
0.2
Mean score
Local colour changes
95
Results
EFFECT ON WALKING ABILITY:
47.22% of improvement was observed in the score of walking ability. 1.8 was the
initial mean score recorded in the 20 patients of Vatarakta This was brought down to
0.950 after the administration of Vatarakta and Lekhana Basti This improvement after
the treatment is found to be highly significant (P≤0.001) as per the paired ‘t’ test. The
details of the different statistical values are shown in the Table No. 44 and Graph No. 29.
Table No. 44: Effect of treatment on walking ability
Mean Score Paired ‘t’ test
BT AT
Difference
in means
%
S.D S.E.M. t value P value
1.800 0.950 0.850 47.22 0.366 0.0819 t = 10.376 P = ≤0.001
Figure no 29 : Effect of treatment on walking ability
B.T.,
A.T.,
0
0.5
1
1.5
2
Mean score
Walking ability
96
Results
EFFECT ON PERIPHERAL PULSES:
1.5 was the mean initial score of Peripheral pulses before the treatment in patients of
Vatarakta This initial mean score came down to 1.05 after the treatment. The
improvement to the tune of 30 % was significant (P=<0.010) as revealed by the paired‘t’
test.
Details of the same are given in the Table No. 45 and fig No. 30
Table No. 45: comparison of effect on Peripheral pulses
Mean Score Paired ‘t’ test
BT AT
Difference
in means
%
S.D S.E.M. t value P value
1.500 1.050 0.450 30 0.510 0.114 t = 3.943 P = <0.001
Figure no 30: Effect of treatment on Peripheral pulses
B.T.,
A.T.,
0
0.5
1
1.5
Mean score
Peripheral pulses
97
Results
EFFECT ON TOTAL CHOLESTEROL:
Before the treatment the mean total Cholesterols was 274.950 after the treatment with
Vataraktantak rasa and Lekhana Basti this was reduced to 224.00. This improvement
after the treatment was found to be statistically highly significant (P<0.001) as assessed
by the paired‘t’ test. The details of the same is given in the Table No. 46 and fig. No. 31
Table No. 46: Effect of treatment on total Cholesterols
Mean Score Paired ‘t’ test
BT AT
Difference
in means S.D S.E.M. t value P value
274.950 224.00 50.950 21.36 4.776 t = 10.667 P = <0.001
Figure no 31: Effect of treatment on total Cholesterols
B.T., A.T.,
0
100
200
300
Mean score
Total cholesterol
98
Results
EFFECT ON Triglyceride
Before the treatment the mean Triglyceride was 247.100 After the treatment with
Vataraktantak rasa and Lekhana Bastithis was reduced to 196.40. This improvement after
the treatment was found to be statistically highly significant (P<0.001) as assessed by the
paired‘t’ test. The details of the same is given in the Table No. 47 and fig No. 32
Table No. 47: Effect of treatment on Triglyceride
Mean Score Paired ‘t’ test
BT AT
Difference
in means S.D S.E.M. t value P value
247.100 196.400 50.700 36.319 8.121 t = 6.243 P = <0.001
Figure no 32 Effect of treatment on Triglyceride
B.T., A.T.,
050
100150200250
Mean score
Triglyceride
99
Results
EFFECT ON HDL CHOLESTEROL:
Before the treatment the mean HDL Cholesterol was 39.850 after the treatment with
Vataraktantak rasa and Lekhana Basti this was increased to 44.500. This increase after
the treatment was found to be statistically highly significant (P<0.001) as assessed by the
paired‘t’ test.
The details of the same is given in the Table No. 48 and fig No33
Table No. 48 Effect of treatment on HDLCholesterol
Mean Score Paired ‘t’ test
BT AT
Difference
in means S.D S.E.M. t value P value
39.850 44.500 4.650 4.705 1.052 t = -4.420 P = <0.001
Figure no 33 Effect of treatment on HDLCholesterol
B.T.,
A.T.,
363840424446
Mean score
HDL cholesterol
100
Results
EFFECT ON LDL CHOLESTEROL:
Before the treatment the mean LDL Cholesterols was 169.200 After the treatment with
Vataraktantak rasa and Lekhana Basti this was reduced to 134.650 This increase after the
treatment was found to be statistically highly significant (P<0.001) as assessed by the
paired ‘t’ test. The details of the same is given in the Table No. 49and fig. No. 34
Table No. 49 : Effect of treatment on LDL Cholesterols
Mean Score Paired ‘t’ test
BT AT
Difference
S.D S.E.M. t value P value
169.200 134.650 34.550 30.346 6.786 t = 5.092 P = <0.001
Figure no 34 : Effect of treatment on LDL Cholesterols
B.T., A.T.,
0
50
100
150
200
Mean score
LDL Cholesterol
101
Results
EFFECT ON VLDL CHOLESTEROL:
Before the treatment the mean VLDL Cholesterols was 43.550 After the treatment with
Vataraktantak rasa and Lekhana Basti this was reduced to 33.450 This decrease in values
after the treatment was found to be statistically highly significant (P<0.001) as assessed
by the paired ‘t’ test. The details of the same is given in the Table No. 50 and fig. No. 35
Table No. 50 : Effect of treatment on VLDL Cholesterols
Mean Score Paired ‘t’ test
BT AT
Difference
in means S.D S.E.M. t value P value
43.550 33.450 10.100 9.414 2.105 t = 4.798 P = <0.001
Figure no 35 : Effect of treatment on VLDL Cholesterols
B.T., A.T.,
01020304050
Mean score
VLDL Cholesterol
102
Results
EFFECT ON LDL: HDL:
Before the treatment the mean LDL: HDL was 4.245 after the treatment with
Vataraktantak rasa and Lekhana Basti this was reduced to 3.150. This improvement after
the treatment was found to be statistically highly significant (P<0.001) as assessed by the
paired‘t’ test. The details of the same is given in the Table No. 57 and fig. No. 36
Table No. 57: Effect of treatment on LDL: HDL
Mean Score Paired ‘t’ test
BT AT
Difference
in means S.D S.E.M. t value P value
4.245 3.150 1.095 0.624 0.139 t = 7.852 P = <0.001
Figure no 36: Effect of treatment on LDL: HDL
B.T.,
A.T.,
0
1
23
4
5M
ean score
LDL:HDL
103
Results
Overall effect of the treatment in Vatarakta :
After the completion of the 1 month course of treatment in Vatarakta the overall
assessment of the patients were made as discussed in the assessment criteria. The analysis
revealed that no patient had complete relief from the signs and symptoms of vatarakta
Moderate remission of the signs and symptoms was seen in 90% of the patients treated
with Vataraktantaka rasa and Lekhana basti . No patient showed marked improvement.
One patient after treatment showed 40 % remission of the symptoms which comes under
average remission category. Another one patient after treatment showed 20 % remission
from the signs and symptoms of vatarakta which considered as unchanged category.
All the 20 patients taken for the study had some or the other form of improvement in the
symptoms of Vatarakta.
Figure no 37: Overall Effect of treatment
% of Patients
90
5 5
Moderate
Average
Unchanged
104
Conclusion
CONCLUSION
1. Distinct etiological factors of vatadosa and rakta dhatu separately causes the morbidity
of vata dosa as well as abnormality of rakta dhatu. Morbid vata dosa furthrer incriminates
the abnormal rakta dhatu. This abnormal rakata dhatu by way of raktamargavarana in turn
inhibits the movement of vata dosa leading to severe morbidity of vatadosa. This is
marked by development of clinical signs and symptoms. Thus the illness vatarakta
clinically manifests. This is the general samprapti of vataraka
2. The santarpana category of etiological factors leads to the accumulation of kapha and
medas in the raktamarga there by causing raktamargavarana. Due to the establishment of
raktamargavarana there occurs inhibition of movement of vata dosa. this in turn
culminates in severe morbidity of vata dosa and once again manifesting as vata rakta.
This is the samprapti of variant form of vata rakta.
3. The whole concept of margavarana can be best explained by the pathology of
atherosclerosis and peripheral vascular disease in modern parlance.
4. Results showed that there is definite reduction in the bad cholesterol and increase in
the good cholesterol following the treatment. These changes establish the efficacy of
lekhana basti and vataraktantaka rasa in preventing the progression of margavarana as
well as the illness vatarakta.
5. The marginal improvement in the circulation following medication with lekhana basti
and vaataraktantaka rasa confirms the effect of medicine on reducing the margavarana.
Reduction in pain burning sensation etc proves the reduction in the morbidity of vata
dosa following the medication.
6. The combination of shodhana treatment in the form of lekhana basti and shamana
treatment in the form of vataraktantaka rasa is an ideal regimen in patient’s sufferirng
from raktamargavarana janya vataraktaa.
118
“A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF
VATARAKTANTAK RASA AND LEKHANA BASTI IN VATARAKTA”
BY
Patil K.V. B.A.M.S.
Dissertation submitted to the Rajiv Gandhi University of Health Sciences,
Bangalore, Karnataka
In partial fulfillment of the requirements for the degree of
DOCTOR OF MEDICINE (M.D)
In
KAYACHIKITSA
UNDER THE GUIDANCE OF
DR V. K.SRIDHAR HOLLA M.D. (AYU). Professor
CO-GUIDE
DR G. SHRINIVASA ACHARYA. M.D. (Ayu). Assistant Professor and H.O.D.
DEPARTMENT OF POST GRADUATE STUDIES IN
KAYACHIKITSA
S.D.M. COLLEGE OF AYURVEDA, UDUPI – 574118
2006 -07
Rajiv Gandhi University of Health Sciences
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation / thesis entitled “A CLINICAL STUDY TO
EVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASA
AND LEKHANA BASTI IN VATARAKTA”is a bonafide and genuine research
Work carried out by me under the guidance of DR V. K.SRIDHAR HOLLA, M.D.
(Ayu) Professor, Dept of Kayachikitsa
Date: Patil K.V.
Place: Udupi Department of Kayachikitsa.
S.D.M.C.A., UDUPI
ii
Rajiv Gandhi University of Health Sciences
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A CLINICAL STUDY TO
EVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK
RASA AND LEKHANA BASTI IN VATARAKTA” is a bonafide research work
done by Patil K.V. in partial fulfillment of the requirement for the degree of Doctor
of Medicine (M.D) In Kayachikitsa.
Place: Udupi DR V. K.SRIDHAR HOLLA M.D. (AYU), Professor Dept. of kayachikitsa. Date : S.D.M College of Ayurveda
Udupi.
iii
Rajiv Gandhi University of Health Sciences
ENDORSEMENT BY THE H.O.D, PRINCIPAL / HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “A CLINICAL STUDY TO
EVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASA
AND LEKHANA BASTI IN VATARAKTA”is a bonafide research work done by
Patil K.V under the guidance of DR V. K.SRIDHAR HOLLA, M.D. (Ayu)
Professor, Dept of Kayachikitsa.
.
Dr. G. SHRINIVASA ACHARYA Dr. U. N. PRASAD. M.D. (Ayu) M.D.(Ayu)
H.O.D. Dept. Of Kayachikitsa. Principal, S.D.M.C.A. Udupi.
Date : Date:
Place: Udupi Place: Udupi
iv
COPYRIGHT
Declaration by the candidate
I hereby declare that The Rajiv Gandhi University of Health
Sciences, Karnataka shall have the rights to preserve, use and disseminate this
dissertation/ thesis in print or electronic format for academic/ research purpose.
Date: Patil K.V
Place: Udupi Department of Kayachikitsa
S.D.M.C.A., UDUPI
© Rajiv Gandhi University of Health Sciences, Karnataka
v
ACKNOWLEDGEMENT
First and foremost I pray to the almighty God, who is omnipresent, omniscient
and omnipotent. He is the possessor of the ocean of knowledge and wisdom to which
I would like to contribute a drop in the form of my dissertation. As it is said, each and
every drop goes to make an ocean, so this is my humble endeavor towards its goal of
wisdom.
My deep sense of gratification is due for my parents and brothers who
are the architects of my career. The culture, discipline and perseverance, which I
could imbibe, are solely because of their painstaking upbringing and strong moral
support.
I express my deep gratitude to my respected guide Dr. V.K.Shreedhara Holla,
co-guide Dr. G.Shreenivasa Acharya for their critical suggestions and expert guidance
for the completion of this thesis.
I wish to offer my sincere thanks to Prof.U.N.Prasad, Principal, Prof. K.
Ramchandra Rao, the Dean for Post Graduate faculty, and Dr. B.V.Prasanna,
Associate Dean for Post Graduate faculty, S.D.M. college of Ayurveda for their
encouragement and support.
I take this opportunity to thank my teachers – Dr.Mrs. Sreelatha Kamath, Dr.
Jonah, Dr.Mrs.Lavanya, Dr.Veerakumar, Dr.Prasanna Mogasale, Dr.Rajalakshmi for
giving me valuable guidance and helping me in completing my clinical work.
My gratitude due to Dr. Y. N. Shetty, superintendent and Dr. Deepak S.M.,
deputy superintendent and Mr. C.S. Hegde, manager of the S.D.M. Ayurveda
hospital, Udupi, Dr .Murulidhar director SDM Ayurveda pharmacy And Dr. Naveen
Ballal MBBS DMRD for their valuable support and encouragement.
My sincere thanks goes to– Dr. Madhusudanan I.K., Dr. Vittal Huddar, Dr.
Anilkumar Garidi, Dr. Gajanan Prabhu, Dr. Mithun Bondre , Dr.Pardhu Dr. Magan,
Dr. Ramesh N., Dr. Ranjit Patil, Dr. Deepthi M.S. and Dr. Shobha Itnal Dr.Anju , Dr.
Abu , Dr. Shyamprasad, Dr. Thiru Navakarasu, Dr. Amruta, Dr.Pradeep, Dr. Amit ,
Dr. Chaitanya Shah and Dr. Harish Kulkarni, for their valuable inputs and the support
they provided throughout my studies.
vi
KULDEEP VILASRAO PATIL.
List of Abbreviations used
1. A.H. : Ashtanga Hridaya
2. A.S. : Ashtanga Sangraha
3. A. N. : Adarsha nighantu
4. B.P. : Bhava Prakasha
5. B.R. : Bhaishajya Rathnavali
6. B.L. : Bhela samhita
7. C.S. : Charaka Samhita A
8. C.D. : Chakra Datta
9. Ckr. : Chakrapani.
10. G.N. : Gada Nigraha
11. H.P.I.M.: Harrison’s Principle Of Internal Medicine
12. H.S. : Harita Samhita.
13. M.N. : Madhava Nidana
14. S.K.D. : Shabda Kalpa Druma
15. Sh.S. : Sharangadhara Samhita
16. Su.S. : Sushruta Samhita
17. T.B.P. : Text Book Of Pathology By Harsh Mohan
18. Vag. : Vagbhata
19. Vang. : Vangasena
20. Y.R. : Yogaratnakara
20. ILD : Ischemic limb diseases
21. PVD : Peripheral vascular disorders
22. IHD : Ischemic heart disease
23 .HDL: high-density lipoproteins
24 LDL : low- density lipoproteins
25 .VLDL: very-low density lipoproteins
vii
ABSTRACT
The pathology of margavarana leads to the establishment of clinical signs and
symptoms in vatarakta. Sodhana, samana, bahiparimarjana and rasayana cikitsa all are
aimed at the rectification of margavarna in this disease. The whole concept of
margavarana can be best explained by the pathology of atherosclerosis and peripheral
vascular disease in modern parlance. There is a definite need to study vatarakta as
peripheral arterial disease and its management with both sodhana and samana line
treatment, with the due consideration of its severity chronicity as well as possible
complications. This study is planned to evaluate the therapeutic effect of
Vataraktantakarasa and Lekhana basti in patients suffering from Vatarakta.
Design: single blind clinical study with a pre-test and post-test design
Source of the data : 20 patients of vatarakta who attended the O.P.D. and I.P.D. of
S.D.M. Ayurveda Hospital, Kuthpady, Udupi, Karnataka, during the period of
November 2005 to August 2006.
Intervention: patients were subjected to 16 days course of lekhana basti along with
oral medication with vataraktantaka rasa in a dose of 250mg tid for 30 days
OBSERVATIONS:
Out of 20 patients of Vatarakta studied in this work, 50 % patients belonged to the age
group of 51to 60 years, 60% were males, 80% were Hindus, 80 % were married, 35%
of were house wives, 45% had madhumeha as well as soniata mada and 65% of had
the habit of mixed diet. All the patients had the dvandvaja praktiti.
Results: statistically significant improvement was observed in all the criteria of
assessment that included regards to pain, burning sensation, malaise, and disturbance
of sleep, tenderness, walking ability, peripheral pulses and lipid profile.
Conclusion:
The combination of lekhana basti and vataraktantaka rasa is an ideal regimen in
patient’s suffering from raktamargavarana janya vataraktaa.
Key Words: Vatarakta, margavarana, raktavahasrotas, ILD, PVD
viii
TABLE OF CONTENTS
1. Introduction : Page No.1-5
2. Objectives : Page No.6
3. Review of Literature : Page No.7-60
3.1 Historical review
3.2 disease review
3.4 Drug review
4. Clinical study : Page No.61-104
4.1 Materials and methods
4.2 Observations and results
5. Discussion : Page No.105-117
6. Conclusion : Page No.118
7. Summary : Page No.119-123
8. Bibliography : Page No.124-142
9. Annexure : Page No.143-151
ix
LIST OF TABLES Sl. No. Tables Page No.
1 Historical review 9
2 Purvarupa 21
3 Uttana vatarakta 24
4 Gambhiravatarakta 25
5 Vatadhika vatarakta 27-28
6 Pittadhika vatarakta 29
7 Kaphadhika vatarakta 30
8 Raktadhika vatarakta 31
9 Upadrava 37
10 Sadhyasadhyata 39-40
11 Ingredients of Vataraktantaka rasa 51-52
12 Ingredients of Shatapaka Madhuka taila 52
13 Ingredients of Lekhana basti 53
14 Course of Basti 62
15 Assessment criteria 65-66
16 Age groups 68
17 Sex 69
18 Religion 70
19 Marital status 71
20 Literacy 72
21 Occupation 73
22 Socio-economical status 74
23 Mode of onset. 75
24 Associated illness 76
25 Dietary habits 77
26 Dominant rasa in ahara 78
27 Addictions 79
28 Prakruti 80
29 Sara 81
30 Samhanana 82
x
31 Satmya 83
32 Satva 84
33 Aharashakti 85
34 Vyayama shakti 86
35 Pramana 87
36 Vaya 88
37 Effect on pain 89
38 Effect on Burning sensation 90
39 Effect on Malaise 91
40 Effect on Sleep 92
41 Effect on Tenderness 93
42 Effect on Edema 94
43 Effect on Local color changes 95
44 Effect on Walking ability 96
45 Effect on Peripheral pulses 97
46 Effect on Total cholesterol 98
47 Effect on Triglycerides 99
48 Effect on HDL cholesterol 100
49 Effect on LDL cholesterol 101
50 Effect on VLDL cholesterol 102
51 Effect on HDL : LDL 103
xi
LIST OF FIGURES
Sl. No. Figures Page No.
Fig. 1 Age Distribution 68
Fig. 2 Sex Distribution 69
Fig. 3 Occupation Distribution 70
Fig.4 Religion Distribution 71
Fig. 5 Marital status Distribution 72
Fig. 6 Literacy Distribution 73
Fig. 7 Occupation Distribution 74
Fig. 8 Socioeconomic status Distribution 75
Fig. 9 Mode of onset Distribution 76
Fig. 10 Associated illnesses Distribution 77
Fig. 11 Dietary habits.Distribution 78
Fig. 12 Analysis of Dominant rasa 79
Fig 13 Analysis of Addictions 80
Fig. 14 Analysis of Prakruti 81
Fig. 15 Analysis of Saara 82
Fig. 16 Analysis of Samhanana 83
Fig. 17 Analysis of Satmya 84
Fig. 18 Analysis of satva 85
Fig. 19 Analysis of Ahara shakti 86
Fig. 20 Analysis of Vyayama shakti. 87
Fig. 21 Analysis of pramana 88
Fig. 22 Analysis of type of Vaya 89
Fig. 23 Effect on pain 90
Fig. 24 Effect on burning sensation 91
Fig. 25 Effect on malaise 92
Fig. 26 Effect on Disturbed sleep. 93
Fig. 27 Effect on tenderness. 94
Fig. 28 Effect on edema. 95
Fig. 29 Effect on Local color changes. 96
Fig. 30 Effect on Walking ability. 97
xii
Fig 31 Effect on peripheral pulses 98
Fig. 32 Effect on total cholesterol 99
Fig. 33 Effect on Triglycerides 100
Fig. 34 Effect on HDL cholesteral 101
Fig. 35 Effect on LDL cholesterol. 102
Fig. 36 Effect on VLDL cholesterol 103
Fig. 37 Effect on LDL : HDL 104
Fig. 37 Overall effect of the treatment. 105
xiii
Discussion
DISCUSSION Among the diseases listed as vatyavyadhi the illness Vatarakta has gained prime
importance in clinical practice due its high prevalence in elderly, progressive
perpetuation, severe complications and fatal outcome. In the literature it is emphasized
that the etiological factors leads to the predominant morbidity of vata dosa and rakta
dhatu. To be more specific, the obstruction of raktamarga or raktavaha srotas is the
leading pathology. The umbrella of vatarakta in parlance with conventional medicine
includes many conditions related to extremities and to mention a few are connective
tissue disorders as well as peripheral vascular disorders.
Dietary habits and life style modalities plays a major role in the causation of vata rakta.
Also the morbidity of kapha and medas can cause different other serious diseases in
different systems. Prameha, Sonitadusti, hrdroga and vatavyadhi etc all are found to be
due to incriminatory effect of kapha and medas in respective systems. Hence forth the
concept of margavarana in different parts of the body is emphasized in caraka samhita.
The pathology of margavarana leads to the establishment of clinical signs and symptoms
in vatarakta. Further to add, sodhana samana bahiparimarjana and rasayana cikitsa all are
aimed at the rectification of margavarna in this disease. The whole concept of
margavarana can be best explained by the pathology of atherosclerosis and peripheral
vascular disease in modern parlance.
Progressive atherosclerosis results in narrowing of the arterial lumen, hence the name
arteriosclerosis obliterans to this unique illness. Peripheral arterial disease is another
name referring to the same. Survey studies have established highest prevalence of the
illness in older people. According to U.S. department of Health and Human services, an
estimated 12% - 17% of population over age of 50 yrs has some form of arterial
insufficiency. Prevalence increases with age as noted in recent national survey. the
prevalence of PAD was found to be 29% in people over aged 70 yrs. the prevalence rate
was the same in people around the of age 50 who also had history of smoking or diabetes,
clearly demonstrating their adverse effect on the circulation. Further, studies with
coronary angiography estimated that approximately one half of the patients of peripheral
arterial diseases present with clinical symptoms. More interestingly, life table analysis
has indicated patient with clauducation have a 70% 5-fear and 50% 10-year survival rate.
105
Discussion
Most deaths occur due to sudden or secondary to M.I. The prognosis is worse in patients
who continue to smoke cigarettes or who have uncontrolled diabetes mellitus. These
observations of survey studies undeniably point towards the high prevalence as well as
seriousness of the problem.
The analysis of previous work done in different research and post graduation study
centers unravels the ambiguity about the clinical understanding as well as treatment of
vatarakta. Many of the clinical studies regarded musculoskeletal disorders like
rheumatoid arthritis, gouty arthritis and osteoarthritis as vatarakta. In these works no
significance is being given to the unique pathology of raktamargavarodha in vatarakta.
Very little number of clinical works concentrated on vascular disease of the limbs as
vatarakta. More specifically speaking TAO is regarded as vatarakta. Here also the over
eating and sedentary habit as the cause of arterial disease / raktamargavarodha through
the pathology of atherosclerosis / dhamani praticaya leading to ischemic limb disease /
vatarakta is ignored. Added to this the yoga basti course of 7 days is inadequate to show
definite benefit in such chronic lingering disease. Kala basti and karma basti courses
appear better in chronic progressive disorders like vatarakta.
This review indicate that there is a necessity to study vatarakta as peripheral arterial
disease and its management with both sodhana and samana line treatment with the due
consideration of its severity chronicity as well as possible complications.
Present work entitled A Clinical Study to evaluate the therapeutic effect of
Vataraktantaka Rasa and Lekhan basti in vatarakta, is carried out with the consideration
that, the therapeutic measures that reduce kapha dosha and medas as well as alleviate the
morbid Vatadosha is the sheet anchor of treatment of vatarakta. Basti is claimed to be the
best treatment in lingering diseases due the morbidity of vatadosa. Lekhanabasti is said to
allevate both kaphadosha as well as medodhatu and hence indicated in santarpanajanya
vatarakta. The herbo-mineral compound vataraktantaka rasa consisting mainly of
guggulu, shilajatu and loha is said to be effective in negating the incriminatory effect of
morbid kapha dosa and medas and there by ensuring complete cure of vatarakta.
Review of the available literature unravels the minimal information of vatarakta in the
books of vedic period. Contrary to this entire aspect of the illness from nidana to cikitsa
is found in books of samhita as well as sangraha kala of the history.
106
Discussion
Two distinct etiopathogenesis may cause the illness vatarakta. Individual
etiological factors of vata dosa as well as rakta dhatu may culminate in the development
of vatarakta and is the usual variety of vatarakta. Where in the morbid vata dosa as well
as vitiated rakta dhatu leads to the rakta margavarana and is the principal pathology of the
vatarakta. In other variety of vata rakta, to begin with there is no role of etiological
factors of either vata dosa or rakta dhatu. Contrary to this the etiological factors of kapha
dosa and medo dhatu take the leading share in the pathogenesis of vatarakta. Here in,
morbid kapha dosa and medo dhatu tend to accumulate in the rakta marga there by
contributing the principal pathology of raktamargavarana. The similar qualities of kapha
and medo dhatu speed up the pathogenesis as two factors support mutually. To be
precise, the santarpana category of etiological factors causes the morbidity of kapha dosa
and medo dhatu, and these in turn accumulate in the raktamarga leading to the
provocation of vata dosa and finally manifesting as vata rakta.
Needless to say depending upon the variation in the etiopathogeneiss the planning of the
treatment should differ. Rectification of morbid vata dosa as well as rakta dhatu is the
rational treatment in the first variety of vatarkata. Kapha medo hara line of management
is the sheet anchor of the treatment of santarpana nidana janya vatarakta.
The pathogenesis of raktamargavarana is best correlated with the arterial obstruction due
to the atherosclerosis. This phenomenon of accumulation of kapha and medas with in the
dhamani is also referred as dhamani praticaya in ayurvedic literature. Abnormal
accumulation of the lipids in the arterial wall is the leading pathology of atherosclerotic
obliterans. The most common symptom of ischemic limb disease that include intermittent
claudication, ache and cramps, altered sensation, changed skin color, obliterated arterial
pulse, and later gangrenous changes all these may be best explained even in vatarakta.
Both peripheral arterial disease as well as vatarakta are said to be common in lower
extremities. These citations of similarities are more than enough to compare the ischemic
limb disease with the santarpana nidana janya vatarakta.
Atherosclerosis is a specific form of arteriosclerosis affecting primarily the intima of
large and medium-sized muscular arteries and is characterized by fibro fatty plaques or
atheromas. The term atherosclerosis is derived from athero-(meaning porridge) referring
to the soft lipid-rich material in the centre of atheroma, and sclerosis (scarring) referring
107
Discussion
to connective tissue in the plaques. Atherosclerosis is the commonest and the most
important of the arterial diseases. Though any large a medium-sized artery may be
involved in atherosclerosis the most commonly affected are the aorta, the coronary and
the cerebral arterial systems. Therefore, the major clinical syndromes resulting from
ischemia due atherosclerosis are the myocardial infarcts (heart attack ) and the cerebral
infarcts (strokes); other less common sequel are peripheral vascular disease, aneurysm
dilatation due to weakened arterial wall, chronic ischemic heart disease, ischemic
encephalopathy,an mesenteric occlusion and ischemic limb disease (ILD)
The understanding of vatarakta is related to collagen diseases, gouty arthritis as well as
ischemic limb diseases. All these comparisons are justified based on analysis of
symptoms of vatarakta and the diseases mentioned in conventional medicine. From the
fore going citations it is clear that ischemic limb disease is also best compared to
vatarakta in regards to its etiopathogensis as well as clinical findings.
Unique concept of naming the disease is adopted in Ayurvedic literatures. Illness
occurring at a specific location is named after the specific organ as in the disease
hridroga. In contrast to this several other disorders are named after the cardinal symptom
as in atisara and shwasa. In case of the disease vatarakta, this name is coined on the basis
of involved samprapti ghataka i.e. vata dosa as well as rakta dhatu. Adhyavata, khudha
vata, vatabalasa and vatasonita are the other names used to refer the illness vatarakta.
Two distinct set of etiological factors take part in the causation of the illness. One set of
etiology leads to the vitiation of vata dosa and the other set separately causes morbidity
of rakta dhatu. These distinct sets of etiological factors may be related to ahara vihara or
the one influencing the manas. In spite of this, in the variant form of vata rakta where in
santarpana category of factors leads to the abnormal accumulation of kapha as well as
medo dhatu, and more particularly in the rakata marga culminates in the pathology of
vata rakta. Evidently in this variety of vata rakta all the santarpana category of causes,
similar to the etiology of sthoulya and prameha take the leading role in the causation of
the illness.
Extensive epidemiologic investigations on live populations have revealed a
number of risk factors which are associated with increased risk of developing clinical
atherosclerosis. Often, these risk factors are acting in combination rather than singly.
108
Discussion
Increasing age, male sex, genetic abnormalities, and familial and racial predisposition,
hyperlipidaemia, hypertension, diabetes mellitus and smoking are considered as major
risk factors. Environmental influences, Obesity, Use of exogenous hormones, Physical
inactivity, Stressful life style and infections are regarded as minor risk factors for
atherosclerosis obliterance.
The etiological factors of kapha medo margavarana janya vatarakta as well as
atherosclerosis are more or less identical. Diet and behavioral factors leading to
atherosclerosis can be best regarded as santarpana nidana of vatarakta causing
accumulation of kapha and medas with in the raktamarga
The movement of vatadosa is inhibited by the unique pathology of raktamargavarana in
vatarakta. This in term initially manifest with certain clinical signs and symptoms in the
form of purvarupa. Alteration in the color and texture of the skin in the affected part,
alteration in sweating, alteration in the sensation, different forms of pain and similar other
manifestations are listed as purvarupa.
Depending upon the superficial or deeper dhatu involved, the vatarakta is of two types.
When the pathogenesis of vatarakta is limited to twak and mamsa dhatu it is regarded as
uttana (anavagadha)vata rakta. Involvement of deeper dhatu like asthi majja and sandhi
signifies the gambhira (avagadha) vatarakta. A third variety of ubhayashrita vatarakta is
also mentioned in literature where in both the superficial as well as deeper dhatu is
affected. Vatarakta is a progressive disorder and hence initially the illness may be limited
to either superficial dhatu or deeper dhatu alone, but in the later stages the uttana
vatarakta progresses to deeper dhatu. Similarly the gambhira vatarakta may involve the
superficial dhatu in the later stages. Hence in the later stages the vatarakta develops as
ubhayashrita vatarakta.
The symptoms like kandu, daha, ruka, ayama, toda, sphurana, shyava/ rakta tvaka and
such other symptoms probably limited to the twak indicates the uttana vatarakta.
Persistent hard swelling of the affected part, suppurations, involvement of sandhi asthi
and majja, deformities like vakrata, khanja and pangu all these point towards the
gambhira vataratka.
Presence of symptoms indicative of both uttana as well as gambhira vatarakta signifies
the ubhayashrita vata rakta.
109
Discussion
Clinical varieties of vatarakta are also elaborated according to the association of morbid
dosa in the primary pathologly of vata and rakta and are named as vatadhika vatarakta,
pittadhika vatrakta, kaphadhika vatarakta and raktadhika vatarakta.
Vatarakta is also classified on the basis of presence or absence of symptoms suggestive of
amadosa. Symptoms of ama if associates the symptoms of vatarakta then the condition is
known as sama vatarakta. If only the symptoms of vatarakta presents without the
association of symptoms of ama then the illness is referred as nirama vatarakta.
Distinct etiological factors of vatadosa and rakta dhatu separately cause the morbidity of
vata dosa as well as abnormality of rakta dhatu. Morbid vata dosa furthrer incriminates
the abnormal rakta dhatu. This abnormal rakta dhatu by way of raktamargavarana in turn
inhibits the movement of vata dosa leading to severe morbidity of vatadosa. This is
marked by development of clinical signs and symptoms. Thus the illness vatarakta
clinically manifests. This is the general samprapti of vataraka in which the
raktamargavarana is the final stage of the samprapti. This raktamargavaarana can happen
in a different way also. The santarpana category of etiological factors leads to the
accumulation of kapha and medas in the raktamarga there by causing raktamargavarana.
Due to the establishment of raktamargavarana there occurs inhibition of movement of
vata dosa. Inhibition of vata culminates in severe morbidity of vata dosa and once again
manifesting as vata rakta. This is the samprapti of variant form of vata rakta.
Phenotypic characters indicative of fatness or obesity in a person is suggestive of
excessive accumulation of kapha and medas in the body. Other than the vatarakta, the
kapha and medas can cause different other diseases like vatavyadhi, hrdroga, gulma and
prameha. Thus presence of any of these diseases is also a strong clinical evidence of
abnormality of kapha and medas in a given patient. Corroborating the same, coexistence
of vatavyadhi, hrdroga and prameha is also clinically reported in many occasions.
Palpation of the thickened arteries in the extremities is suggestive of dhamanipraticaya.
In addition to this altered or absent pulsations as stressed in nadi vijnana justifies the
concept of raktamargavarana due to abnormal kapha and medas in the disease
vatarakta178.
Add to this from the modern paralance of atherosclerosis - Most atheroma produces no
symptoms, and many never cause clinical manifestations. Numerous patients with diffuse
110
Discussion
atherosclerosis may succumb to unrelated illness without ever having experienced
clinically significant manifestations of atherosclerosis. What accounts for this variability
in the clinical expression of atherosclerotic disease, here is the explanation - Arterial
remodeling during atheroma formation represents a frequently overlooked but clinically
important feature of lesion evolution. During the initial phases of atheroma development,
the plaque usually grows outward, in an abluminal direction. Vessels affected by
atherogenesis tend to increase in diameter, a phenomenon known as compensatory
enlargement, a type of vascular remodeling. The growing atheroma does not encroach
upon the arterial lumen until the burden of atherosclerotic plaque exceeds approximately
40% of the area encompassed by the internal elastic lamina. Thus, during much of its life
history, an atheroma will not cause stenosis that can limit tissue perfusion.
Morbidity of the vatadosa is the basic pathology of the illness. And the same to a
larger extent determines the upasaya and anupasaya in vatarakta. Accordingly the
exposure to warm surrounding, rest and application of sneha tend to cause remission of
the symptoms, where as exposure to cold surrounding and physical exercise tend to
worsen the symptoms of vata rakta.
The sadhyasadhyata of disease depends on virulence of vitiated doshas, presence or
absence of upadrava’s as well as chronicity of disease.
Symptom around the joints is the cardinal manifestation of the diseases sandhigatavata
and amavata and thus these diseases need to be differentiated from the vatarakta. In
addition to this the skin manifestation of the kusta is akin to the same present in the
vatarakta. Hence the kusta should be distinguished from the vatarakta again. Differential
diagnosis is best made by the analysis of the samprapti ghataka as well as clinical
manifestations of these diseases.
Morbidity of vata dosa and rakta dhatu is the basic pathology of the vatarakta. Morbid
vata dosa further afflicts raktadhatu. Consequently there occur raktamargavarana
inhibiting the movement of vayu. This in turn further add to the virulence of vata dosa.
These pathological events finally culminate in the establishement of vatarakta. On the
other hand in the variant form of vatarakta margavarana can happen due to abnormal
accumulation of kapha and medas. This pathology further continues to end up in the
development of the illness vatarakta. Treatment aimed at negating the detrimental effect
111
Discussion
of samprapti ghataka in the two distinct form of vatarakta forms the rational approach.
Accordingly employment of therapies like raktamoksana, langhana, snehapana, vamana,
virecana and rasayana with the due consideration of stage of the disease, predominance of
dosa and site of affliction form the antahparimarjana ciktsa. Further depending upon the
requirement the bahiparimarjana cikitsa like pariseka, abhyanga pradeha and upanaha is
also carried out. In case of development of complications like vidhradhi and vrana sastra
pranidhana cikitsa is followed.
Vataraktantaka rasa as explained in Bhaishajya ratnavali is a Khalvirasayana with unique
herbomineral combinations of drugs to treat Vatarakta. Parada, Shilajatu, guggulu,
Lauhabhasma are the main ingredient targeted specifically for kapha medasavarana in
raktavaha srotasa. These ingredients are treated with each three bhavana of bhringaraja
svarasa and triphala svarasa.
Lekhana basti is a combination specially indicated in Sthaulya and morbid condition of
kapha and medas. The mixing of ingredients is done in a sequence of madhu , saindhava
lavana ,murchita tila, kalka triphala kvatha and gomutra, . The ingredients of kalka are
suryakshara , shilajatu, kasisa ,tuttha , hingu .
By using Yasthimadhu kalka and ksheera, Ksheerapaka prepared, .taila paka is then
prepared by using ksheerapaka and murchitatilataila. Madhuka pushpa kalka is added
during tailapaka. This medicated oil is used for the anuvasana basti.
About the clinical study, this is a single blind interventional study with a pre-test and
post-test design and is planned to evaluate the therapeutic effect of Vataraktantakarasa
and Lekhana basti in Vatarakta. The patients who attended the O.P.D. and I.P.D. of
S.D.M. Ayurveda Hospital, Kuthpady, Udupi, Karnataka, during the period of November
2005 to August 2006, having the signs and symptoms of Vatarakta were screened.
Among these patients, 20 Patients who fulfilled the criteria of inclusion were taken for
the study.
The selected patients were administered with Lekhana Basti as kaala basti course of 16
days, in which Niruha Basti was administered in a dose of 480 ml for 6 days by using the
enema can. 10 sittings of Anuvasana basti was also administered with Shatapaka
madhukataila in a dose of 120ml. In conjunction with basti treatment the patient was also
112
Discussion
treated orally with Vataraktantaka Rasa in the Dose of 250 mg tid. This oral medication
was continued for 30 days with the anupana of warm water.
The state of the disease vatarakta changes after the intervention. Improvement or
otherwise was determined by adopting the standard methods of scoring for subjective,
objective and special investigation criteria. The margavarana was assessed both before
and after the intervention to note any change by using the arterial Doppler study. Lipid
profile was also studied before and after the treatment.
Out of 20 patients of Vatarakta studied in this work, maximum number of 10 (50 %)
patients belonged to the age group of 51to 60 years. It is the established fact that
atherosclerosis usually becomes symptomatic during the 5th or 6th decade. Present
observation of 50% patients between the age group of 51 to 60 years corroborates the
same.
The illness does not show any predilection for the sex. The same is demonstrated in the
present sample of 20 patients as 60% patients of Vatarakta were males and the remaining
40% were females.
80% of patients were Hindus in the present study. Though the illness does not show any
predilection for religion, the preponderance of the illness among Hindus represents only
the dominance of the Hindu population from which this sample is taken.
Marriage does not influence the incidence of the illness. Even then in the present sample
taken for the study, 80 % of the patients were married persons. This only represent the
preponderance of the married people in the age group of 40 60 years in which the
incidence of the illness is maximum.
It is observed that 7 (35%) of the females in this study were house wives by their
occupation. Also, this formed the largest category of patients leaving behind the patients
engaged in other occupations. The prevalence of the illness among the house wives only
represents the predominant occupation of the female in this locality, and this occupation
has nothing to do with causation of vatarakta.
The study revealed that most of the patients belonged to middle and rich socio-economic
status. Sedentary life style is common among this category of people. Sedentary life style
has definite role in the causation of the illness. Similarly the sample indicates the
prevalence of the illness in middle and higher class people.
113
Discussion
Madhumeha, soniata mada and hrdroga are the conditions in which the abnormality of
medas is common, so also the vatarakta. In accordance with the etiology and basic
pathology which is common in these diseases, they tend to coexist in patients.So also in
the present study revealing the same tendency 45% of patients of vatarakta had
madhumeha as well as soniata mada.
Vegetarian or non vegetarian food that does not make any difference, but
the excessive intake of food and less utilization predisposes to vatarakta.
However in the present sample of 10 a maximum of 65% of patients had
the habit of mixed diet.
Dvandvaja prakriti is commonest amongst any population. The same is reflected in the
present sample as all the patients had the dvandvaja praktiti.
Samhanana of an individual represents the nourishment. Vatarakta being santarpana
janya vyadhi pravaraa or madhyama samhanana is likely in such patients. So also in the
present study all the patients had either madhyama samhana. No patients had avara
samhanana.
Abhyavahara or jarana shakti of the persons indicate the possibility of santarpana or other
wise. Abhyavaharana sakti and jarana sakit if it is good, then the persons are likely to
have over santarpana leading to disease manifestation. Similary in the presnt sample of
patients suffering from santarpanajanya vatarakta, patients had either pravara or
madhyama abhyavaharana and jarana shakti. No patients having avaraa abhyavaharana
and jarana shakti were recorded in this sample.
Patients treated with Vataraktantakarasa and Lekhana basti had marked remission of the
symptom pain. 1.8 was the mean initial score of pain in 20 patients of Vatarakta which
came down to 1.0 after the treatment. The improvement to the tune of 44.44% is found to
be statistically highly significant (P≤0.001).
Burning sensation one of the cardinal symptoms of Vatarakta relieved by 57.14%
as the initial score of Burning sensation which was 0.700 reduced to 0.300 after the
treatment with Vataraktantakarasa and Lekhana basti. This improvement when analyzed
by the paired‘t’ test found to the significant (P=0.008).
78.57% of improvement was observed in the symptom Malaise. 0.700 was the initial
mean score of Malaise recorded in the 20 patients of Vatarakta. This was brought down
114
Discussion
to 0.150 after the administration of Vataraktantaka rasa and Lekhana Basti. This
improvement after the treatment is found to be highly significant (P≤0.001) as per the
paired‘t’ test.
0.650 was the mean initial score of disturbance of Sleep before the treatment in patients
of Vatarakta. This initial mean score came down to 0.0500 after the treatment. The
improvement to the tune of 92.30 % was highly significant (P≤0.001) as revealed by the
paired‘t’ test.
Tenderness is another symptom of Vatarakta. The initial mean score of the patients in
tenderness was 0.100 which was reduced to 0.00 after the treatment. The improvement to
the tune of 100% was recorded, but is not statistically significant.
Before the treatment the mean score of symptom of Edema was 0.350. After the
treatment with Vataraktantak rasa and Lekhana Basti this was reduced to 0.0500 giving
85.71% effect. The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = 0.010) as assessed by
the paired‘t’ test.
Patients treated with Vataraktantak rasa and Lekhana Basti had no difference in
Local color changes. 0.200 was the mean initial score in 20 patients of Vatarakta which
remained as 0.200 after the treatment.
47.22% of improvement was observed in the score of walking ability. 1.8 was the initial
mean score recorded in the 20 patients of Vatarakta This was brought down to 0.950
after the administration of Vatarakta and Lekhana Basti This improvement after the
treatment is found to be highly significant (P≤0.001) as per the paired ‘t’ test.
1.5 was the mean initial score of Peripheral pulses before the treatment in patients of
Vatarakta This initial mean score came down to 1.05 after the treatment. The
improvement to the tune of 30 % was significant (P=<0.010) as revealed by the paired‘t’
test.
Before the treatment the mean total Cholesterols was 274.950 after the treatment with
Vataraktantak rasa and Lekhana Basti this was reduced to 224.00. This improvement
after the treatment was found to be statistically highly significant (P<0.001) as assessed
by the paired‘t’ test.
115
Discussion
Before the treatment the mean Triglyceride was 247.100 after the treatment with
Vataraktantak rasa and Lekhana Basti this was reduced to 196.40. This improvement
after the treatment was found to be statistically highly significant (P<0.001) as assessed
by the paired‘t’ test.
Before the treatment the mean HDL Cholesterol was 39.850 Basti this was increased to
44.500. This increase after the treatment was found to be statistically highly significant
(P<0.001) as assessed by the paired‘t’ test.
Before the treatment the mean LDL Cholesterols was 169.200 After the treatment this
was reduced to 134.650 This increase after the treatment was found to be statistically
highly significant (P<0.001) as assessed by the paired ‘t’ test.
Before the treatment the mean VLDL Cholesterols was 43.550 After the treatment this
was reduced to 33.450 This decrease in values after the treatment was found to be
statistically highly significant (P<0.001) as assessed by the paired ‘t’ test.
The overall analysis revealed that no patient had complete relief from the signs and
symptoms of vatarakta Moderate remission of the signs and symptoms was seen in 90%
of the patients treated with Vataraktantaka rasa and Lekhana basti No any patient showed
marked improvement.
Prevention of progressive margavarana by the regimen: obstruction of the kapha and
medas in the raktamarga is the principal pathology of the illness, and is progressive
process. This pathology is solely dependant upon the abnormal levels of kapha and medas
in the body. The abnormal accumulation of the medas can be very well understood by the
evaluation of serum lipid profile. The abnormal levels of lipids in patients suffering from
the illness are suggestive of its role in causation of the illness. Lipid level if it is brought
to normalcy then the progression the illness can be arrested and is an established fact.
Results showed that there is definite reduction in the bad cholesterol and increase in the
good cholesterol following the treatment. This is more than enough to say that the
lekhana basti and vataraktantaka rasa is very useful in preventing the progression of
margavarana as well as the illness vatarakta. Lekhana basti by virtue of its ingredients
imparts ruksana in the body and ensures lekhana of medas. Added to this the ingredients
like silajatu guggulu haritaki ect of vataraktantaka rasa also aid in the reduction of kapha
and medas. So to say both the lekhana basti as well as vataraktantaka rasa is aimed at
116
Discussion
removal of causative factor ie kapha and medas and there by preventing the progression
of the illeness.
Remission of margavarana and thereby reducing the morbidity of vata dosa: obstruction
in the raktamarga is the cause for morbidity of vata dosa. Obstruction is ascertained by
the color dopler study of arteries in the limbs. The marginal improvement in the
circulation following medication with lekhana basti and vaataraktantaka rasa confirms the
effect of medicine on reducing the margavarana. Tikshna drugs like gomutra, ksara,
tuttha, kasisa etc in the lekhana basti and guggulu as well as silajatu in the vataraktantaka
rasa is said to have srotovishodhana property. The same is reflected in the results as there
is definite evidence of improvement in the circulation. Improvement in circulation means
reduction in margavaraan this in turn leads to reduced morbidity of vata dosa. Reduction
in pain burning sensation ect prove the reduction in the morbidity of vata dosa following
the medication. In addition to this the ingredients like guggulu in vataraktantaka rasa has
definite effect on pacifying the vata dosa and hence the reduction in severity of symptoms
suggestive of morbidity of vata dosa in patients suffering from vatarakta.
Rectification of morbidity of rakta dhatu: morbidity of rakta dhatu in patients suffering
from the vaatarakta is indicated by sympotmos like discoloration of the skin. Morbidity
of rakta dhatu is dependant upon the margavarana. Rectification of margavarana achieved
by the medication definitely leads to reduction in the morbidity of rakta dhatu. The same
is reflected in the present study.
Change in the patients following medication is definitely favorable but not complete. As
shown in the over all affect of the treatment no patients had complete remission of the
illness. Maximum number of patients had either best response or moderate response. This
indicates that the desired response is not complete rather partial. This implies, as there is
definite favorable response to the treatment, for the better results instead of single kala
basti course repeated karma basti course may be adapted and the duration of the samana
treatment may be further prolonged. Even addition of bahiparimarjana cikitsa may
improve the success rate. Thus the combination of shodhana treatment in the form of
lekhana basti and shamana treatment in the form of vataraktantaka rasa is an ideal
regimen in patient’s sufferirng from raktamargavarana janya vatarakta.
117
Summary
SUMMARY
Among the diseases listed as vatyavyadhi the illness Vatarakta has gained prime
importance in clinical practice due to its high prevalence in elderly, progressive
perpetuation, severe complications and fatal outcome. Dietary habits and life style
modalities plays a major role in the causation of vata rakta. Also the morbidity of kapha
and medas can cause different other serious diseases in different systems. Prameha,
Sonitadusti, hrdroga and vatavyadhi etc all are found to be due to incriminatory affect of
kapha and medas in respective systems. Hence forth the concept of margavarana in
different parts of the body is emphasized in caraka samhita. The pathology of
margavarana leads to the establishment of clinical signs and symptoms in vatarakta.
Further to add, sodhana, samana, bahiparimarjana and rasayana cikitsa all are aimed at
the rectification of margavarna in this disease. The whole concept of margavarana can be
best explained by the pathology of atherosclerosis and peripheral vascular disease in
modern parlance.
The analysis of previous work done in different research and post graduation study
centers unravels very little number of clinical works concentrated on vascular disease of
the limbs as vatarakta. Here also the over eating and sedentary habits as the cause of
arterial disease / raktamargavarodha through the pathology of atherosclerosis / dhamani
praticaya leading to ischemic limb disease / vatarakta is ignored. Hence there is a
necessity to study vatarakta as peripheral arterial disease and its management with both
sodhana and samana line treatment with the due consideration of its severity chronicity as
well as possible complications.
Aim of study:
1. To carry out literary study on vatarakta as well as the role of kapha and medas in
its causation of vatarakta
2. To evaluate the therapeutic effect of Vataraktantakarasa and Lekhana basti in in
patients suffering from Vatarakta.
MATERIALS AND METHODS
Design: This is a single blind clinical study with a pre-test and post-test design.
119
Summary
Source of the data The patients who attended the O.P.D. and I.P.D. of S.D.M. Ayurveda
Hospital, Kuthpady, Udupi, Karnataka, during the period of November 2005 to August
2006, having the signs and symptoms of Vatarakta were screened. Among these patients,
20 Patients who fulfilled the criteria of inclusion were taken for the study.
Intervention:
The selected patients were administered with
1) Lekhana Basti as kaala basti course of 16 days, in which Niruha Basti is
administered in a dose of 480 ml for 6 days by using the enema can. In this basti
course 10 sitting of Anuvasana basti was also administered with madhukataila
in a dose of 120ml. Auvasana basti was given by using plastic syringe.
2) In conjunction with basti treatment the patient was also treated orally with
Vataraktantaka Rasa in the Dose of 250 mg tid. This oral medication was
continued for 30 days with the anupana of warm water.
Duration of study: 30 days
Assessment criteria: The state of the disease vatarakta changes after the intervention.
Improvement or otherwise was determined by adopting the standard methods of scoring
for subjective, objective and special investigation criteria. The margavarana was assessed
both before and after the intervention to note any change by using the arterial Doppler
study. Lipid profile was also studied before and after the treatment. The change observed
after the treatment is subjected to paired t test to establish the statistical significance.
OBSERVATIONS:
Out of 20 patients of Vatarakta studied in this work, maximum number of 10 (50 %)
patients belonged to the age group of 51to 60 years. 60% patients of Vatarakta were
males and the remaining 40% were females. 80% of patients were Hindus in the present
study. 80 % of the patients were married persons. 35% of the females were house wives
by their occupation. most of the patients belonged to middle and rich socio-economic
status. 45% of patients of vatarakta had madhumeha as well as soniata mada. 65% of
patients had the habit of mixed diet. all the patients had the dvandvaja praktiti.
Maximum number of patients had madhyama samhanana patients had either pravara or
madhyama abhyavaharana and jarana shakti.
120
Summary
Results:
1.8 was the mean initial score of pain in 20 patients of Vatarakta which came down to 1.0
after the treatment. The improvement to the tune of 44.44% is found to be statistically
highly significant (P≤0.001).
Burning sensation one of the cardinal symptoms of Vatarakta relieved by 57.14% as the
initial score of Burning sensation which was 0.700 reduced to 0.300 after the treatment
This improvement when analyzed by the paired‘t’ test found to be significant (P=0.008).
78.57% of improvement was observed in the symptom Malaise. 0.700 was the initial
mean score of Malaise recorded. This was brought down to 0.150 after the treatment and
is found to be highly significant (P≤0.001) as per the paired‘t’ test.
0.650 was the mean initial score of disturbance of Sleep before the treatment. This initial
mean score came down to 0.0500 after the treatment. The improvement to the tune of
92.30 % was highly significant (P≤0.001) as revealed by the paired‘t’ test.
The initial mean score of the patients in tenderness was 0.100 which was reduced to 0.00
after the treatment. The improvement to the tune of 100% was recorded, is statistically
significant.
Before the treatment the mean score of symptom of Edema was 0.350. After the
treatment this was reduced to 0.0500 giving 85.71% effect. The change that occurred
with the treatment is greater than would be expected by chance; there is a statistically
significant change (P = 0.010) as assessed by the paired‘t’ test.
47.22% of improvement was observed in the score of walking ability. 1.8 was the initial
mean score recorded. This was brought down to 0.950 after the treatment this
improvement was found to be highly significant (P≤0.001) as per the paired‘t’ test.
1.5 was the mean initial score of Peripheral pulses before the treatment in patients of
Vatarakta This initial mean score came down to 1.05 after the treatment. The
improvement to the tune of 30 % was significant (P=<0.010)
Before the treatment the mean total Cholesterols was 274.950. After the treatment this
was reduced to 224.00. Before the treatment the mean Triglyceride was 247.100 and was
reduced to 196.40. Before the treatment the mean HDL Cholesterol was 39.850 and was
increased to 44.500 following medication. Before the treatment the mean LDL
Cholesterols was 169.200, which raised to 134.650 beforethe treatment the mean VLDL
121
Summary
Cholesterols was 43.550 and was reduced to 33.450. All these changes in the lipid profile
were found to be stastisticlally highly significant as revealed by paired t test.
The overall analysis revealed that no patient had complete relief from the signs and
symptoms of vatarakta .Moderate remission of the signs and symptoms was seen in 90%
of the patients treated with Vataraktantaka rasa and Lekhana basti No any patient showed
marked improvement.
Discussion:
Obstruction of the kapha and medas in the raktamarga is the principal pathology of the
illness, and is progressive process. This pathology is solely dependant upon the abnormal
levels of kapha and medas in the body. The abnormal accumulation of the medas can be
very well understood by the evaluation of serum lipid profile. The abnormal levels of
lipids in patients suffering from the illness are suggestive of its role in causation of the
illness. Lipid level if it is brought to normalcy then the progression the illness can be
arrested and is an established fact. Results showed that there is definite reduction in the
bad cholesterol and increase in the good cholesterol following the treatment. This is more
than enough to say that the lekhana basti and vataraktantaka rasa is very useful in
preventing the progression of margavarana as well as the illness vatarakta. Lekhana basti
by virtue of its ingredients imparts ruksana in the body and ensures lekhana of medas.
Added to this the ingredients like silajatu, guggulu and haritaki etc. of vataraktantaka rasa
also aid in the reduction of kapha and medas. So to say both the lekhana basti as well as
vataraktantaka rasa is aimed at removal of causative factor ie kapha and medas and there
by preventing the progression of the illeness.
Obstruction in the raktamarga is the cause for morbidity of vata dosa. Obstruction is
ascertained by the color Doppler study of arteries in the limbs. The marginal
improvement in the circulation following medication with lekhana basti and
vaataraktantaka rasa confirms the effect of medicine on reducing the margavarana.
Tikshna drugs like gomutra, ksara, tuttha, kasisa etc in the lekhana basti and guggulu as
well as silajatu in the vataraktantaka rasa is said to have srotovishodhana property. The
same is reflected in the results as there is definite evidence of improvement in the
circulation. Improvement in circulation means reduction in margavaraan this in turn leads
122
Summary
to reduced morbidity of vata dosa. Reduction in pain burning sensation ect prove the
reduction in the morbidity of vata dosa following the medication. In addition to this the
ingredients like guggulu in vataraktantaka rasa has definite effect on pacifying the vata
dosa and hence the reduction in severity of symptoms
morbidity of rtakta dhatu in patients suffering from the vaatarakta is indicatied by
sympotmos like discoloration of the skin. Morbidity of rakta dhatu is dependant upon the
margavarana. Rectification of margavarana achieved by the medication definitely leads to
reduction in the morbidity of rakta dhatu. The same is reflected in the present study.
Change in the patients following medication is definitely favorable but not complete. No
patients had complete remission of the illness. Maximum number of patients had either
best response or moderate response. This indicates that the desired response is not
complete rather partial. This implies, as there is definite favorable response to the
treatment, for the better results instead of single kala basti course repeated karma basti
course may be adapted and the duration of the samana treatment may be further
prolonged. Even addition of bahimparimarjana cikitsa may improve the success rate.
Conclusion:
The combination of shodhana treatment in the form of lekhana basti and samana
treatment in the form of vataraktantaka rasa is an ideal regimen in patient’s sufferirng
from raktamargavarana janya vataraktaa.
123
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142
Annexure
A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASA AND LEKHANA BASTI IN
VATARAKTA” PATIENT PROFORMA – NAME: CASE NO. O AGE: OPD. NO. SEX: (MALE \FEMALE) IPD. NO. 9 RELIGION :( HINDU \ MUSLIM \ CRIS. \ OTHERS) ROOM NO. & BED SOCIOECONOMIC STATUS: DATE OF ADM . MARITAL STATUS :( M. \ U. M. \ W. \ D) DATE OF DISCHARGE: 9 OCCUPATION: TREATMENT STARTED ON ADDRESS: TREATMENT COMPLETE ON
II. MAIN COMPLAINTS: SITE DURATION RT. LIMB LT.LIMB PAIN (P) (A) (P) (A) P BURNING SENSATION (P) (A) (P) (A) P COLOUR CHANGES (P) (A) (P) (A) G ULCER (P) (A) (P) (A) P SHOOLA SHOTH DAHA ASWEDA L N ATISWEDA SIRAYAMA P RAGA I KARSHNYA P Q MANDALA SUPTATA KANDU K
143
Annexure
III. HISTORY OF PRESENT ILLNESS: L 1) PAIN: ONSET SUDEEN GRADUAL COURSE PROGRESSIVE INTERMITTENT CONTINOUS TYPE OF PAIN INTERMITTENT CLAUDICATION RESTPAIN AGGRAVATING FACTORS: DIURENAL - NIGHT SEASONAL – MOVEMENT WALKING K REST P Y 2) BURNING SENSATION: 3) PARASTHESIA: L 4) SWELLING: 5) ULCER: 6) FEVER: O 7) LOSS OF FUNCTION: IV. TREATMENT HISTORY:
TYPE DURATION EFFECT AYURVEDA ALLOPATHY OTHERS
V. PAST HISTORY:
1. HISTORY OF SIMILAR EPISODE P 2. PAST DISEASES A) CARDIAC DISEASES B) SYPHILIS U C) DIABETES PY D) HYPERTENSION E) RECCURRENT SUPERFICIAL PHLEBITIES
N F) C.V.A G) TRAUMA H) RECENT OPERATION Y I) ANY COMPLAINT RELATED TO PERIPHERAL VASCULAR DISORDER
144
Annexure
VI. FAMILY HISTORY: VII.PERSNOAL HISTORY: 1) HABBITS SMOKING: ALCOHOL: TOBACCO: v SNUFF: OTHERS: n 2) AHARA: QUANTITY : [ALPA] [PRAMITHA] [SAMA] [ATIPRAMANA] DOMINANT RASA: [M] [A] [L] [KT] [T] [KS] GUNA: [RUKSHA] [SNIGDHA] [SHEETA] [USHNA] [GURU] [LAGHU] DIETIC HABITS: [SAMASHAN] [VISHAMASHAN] [ADHYASHAN] [ANSHAN] NATURE OF WORK: [WALKING] [STANDING] [SITTNG] [LABOUR] [MANUAL] [SEDENTORY] [TRAVELLING] VISHRAMA: [PROPER] [LESS] [EXCESSIVE] VYAYAM : [NO] [LESS] [PROPER] [IRREGULAR] NIDRA: [SOUND] [DISTURBED] [NO SLEEP] VIII. GYNAEC. & OBS. HISTORY: AGE OF: MENARCHE MENOPAUSE K M.C. ____DAYS REGULAR \ IRREGULAR IX. GENRAL EXAMINATION : BUILT NOURISHMENT CYANOSIS CLUBBING LYMPHADENOPATHY TEMPERATURE PULSE RATE RYTHEM VOLUME CONDITION OF VESSEL WALL BLOOD PRESSURE RESPIRATORY RATE
145
Annexure
X. DASHAVIDHA PARIKSHA 1. PRAKRITATHA: V P K 2. VIKRITITAH: P M A 3.SARA : P M A 4 SAMAHANANA : P M A 5.SATMYA : P M A 6.SATWA : P M A 7.AHARASHAKTI - ABHYAVARAN: P M A JAARANA : P M A 8. VYAAYAMA SHAKTI: P M A 9. PRAMAANATAH: P M A HEIGHT WEIGHT 10. VAYATAH: BALA MADHYAM VRIDDHA XI. SROTAS PARIKSHAA: 1. PRANA VAHA - PRAKKRITA VIKRIT 2. UDAKA VAHA - PRAKKRITA VIKRITA 3. ANNA VAHA - PRAKKRITA VIKRITA 4. RASA VAHA - PRAKKRITA VIKRITA 5. RAKTA VAHA - PRAKKRITA VIKRITA 6. MAMSA VAHA - PRAKKRITA VIKRITA 7. MEDO VAHA - PRAKKRITA VIKRITA 8. ASTHI VAHA - PRAKKRITA VIKRITA 9. MAJJA VAHA - PRAKKRITA VIKRITA 10.SUKRA VAHA PRAKKRITA VIKRITA 11.ARTHAVA VAHA - PRAKKRITA VIKRITA 12.SWEDA VAHA - PRAKKRITA VIKRITA 13.MUTRA VAHA - PRAKKRITA VIKRITA 14. PURISHA VAHA - PRAKKRITA VIKRITA XIII. SYSTEMIC EXAMINATION: 1. C.V.S:
2. R \S: 3. C.N.S.: 4) ABDOMEN:
XIII. INVESTIGATION: BLOOD: HB %: T.L.C E.S.R. : D.L.C.: N: L: M: E: B: BLOOD SUGAR: F.B.S. – PP: R.B.S -
146
Annexure
BLOOD UREA: SR. CREATININE: : SR. V.D.R.L. : LIPID PROFILE : URINE: SUGAR: ALBUMIN: PUS CELLS: X-RAY OF THE PART: DOPPLER STUDY:
A. DORSALIS PEDIS ARTREY : B. POSTRIOR TIBIAL ARTREY : C. ANTERIOR TIBIAL ARTREY : D. POPLETIAL ARTERY : E. FEMORAL ARTERY :
XIV. LOCAL EXAMINATION: INSPECTION: RIGHT LEFT 1) CHANGE IN COLOUR [P] [A] [P] [A]
2) SIGN OF ISCHAEMIA 1. THINNING OF SKIN [P] [A] [P] [A] 2. LOSS OF HAIR [P] [A] [P] [A] 3. LOSS OF SUBCUTANEOUS FAT [P] [A] [P] [A] 4 .SHINING OF SKIN [P] [A] [P] [A] 5. TROPICAL CHANGES IN NAIL [P] [A] [P] [A] 6. ULCERATION [P] [A] [P] [A] 7. MUSCLE WESTING [P] [A] [P] [A] 8. SWELLING [P] [A] [P] [A]
147
Annexure
3) 4) SUBCUTANEOUS VEINS - PROPERLY FILLED COLLAPSED:
z 4) GANGRENE [P] [A] [P] [A] 5) THROMBOPHLEBITIS [P] [A] [P] [A] PALPATION: 1. SKIN TEMPERATURE -[ COLD / NORMAL] RIGHT LEFT 2. TENDERNESS : [P] [A] [P] [A] 3. SENSATION : [P] [A] [P] [A] 4. PPITTING OEDEMA: [P] [A] [P] [A] 5. PERIPHERAL PULSE : A. DORSALISA PEDIS ARTERY [P] [A] [P] [A] B. POSTERIOR TIBIAL ARTERY: [P] [A] [P] [A] C. ANTERIOR TIBIAL ARTERY: [P] [A] [P] [A] D. POPLETIAL ARTERY: [P] [A] [P] [A] E. FEMORAL ARTERY: [P] [A] [P] [A] G. RADIAL ARTERY: [P] [A] [P] [A] H. ULNAR ARTERY: [P] [A] [P] [A] I. BRACHIAL ARTERY: [P] [A] [P] [A] J. CAROTID ARTERY : [P] [A] [P] [A] K. SUPERFICIAL TEMP. ARTERY: [P] [A] [P] [A]
148
Annexure
6. INGUINAL LYMPH NODES: [PALPABLE / NOT PALPABLE ] 7. ASSESMENT OF CIRCULATION IN THE LIMB:
CAPILLARY REFEELING TEST RIGHT LEFT
VENOUS REFEELING TEST ALLENS TEST: BURGERS POSTURAL TEST:
XVI. SAMPRAPTI GHATAKA:
NIDANA : 1. DOSHA : 2. DUSHYA : 3. SROTASA : 4. ROGAMARGA : 5.UDBHAVA STHANA : 6. SANCHARA STHANA : 7. VYAKTA STHANA :
XVII. SAMPRAPTI: XVIII. VYADHI VINISCHYAYA:
I. UTTANA VATARAKTA: KANDU \ DAHA \ RUKA \ AYAMA \ SPHURAN
KUNCHANA\ SHYAVA TWAKA / RAKTA TWAKA \ TAMRA TWAKA .
II . GAMBHIRA VATARAKTA : STABDHA SHOTHA \ KATHINA SHOTHA PIDAYUKTA / SHOTH \ DAHA \ TODA \ SPHURAN SHYAVA TWA/ TAMRA TWAKA \ PAKA . III . UBHAYASRITA VATARAKTA : RUKA \ VIDAHA \ ASTHIVAKRATA \ SANDHI VAKRATA \ KHANJA \ PANGU . A . VATADHIKA VATARAKTA : SHOOLA \ TODA \ SPHURANA \ SIRAYAMA \SHOTHA \ KARSHNYA \ RAUKSHYATA \ SHYAVATA \ DHAMANI SANKOCHA \ ANGULI SANKOCHA \ ANGA GRAHA \ SHITA PRADWESHA . B . PITTADHIKA VATARAKTA : VIDAHA \ VEDANA \ MURCHYA \ SWEDA \
149
Annexure
150
TRUSHNA / MADA \ BHRAMA \ RAGA \ PAK \ BHEDA / SPARSHYA AKSHAMATWA C . KAPHADHIKA VATARAKTA : SHEETATA \ KANDU \ GOURAVA \ SUPTI \ SNEHA \ MANDA RUKA . D . RAKTADHIKA VATARAKTA : SHOTH \ DAHA \ TODA \ RUKA \ KANDU \ KLEDATA \ TAMRAVARNA. IV . ASADHYA VATATRAKTA : ASWAPNA \AROCHAK \ SHVASA \ MAMSA KOTHA \ MURCHYA \ MADA\ SHIRO GRAHA \ RUKA \ TRUSHNA \ JWARA \ MOHA \ HIKKA \ PRAVEPKA \ VISARPA \ PAKA \ TODA \ BHRAMA \ SPHOTA \ DAHA \ KLAMA \ PANGULYA \ ANGULI VAKRATA \ MARMA GRAHA \ PRANA KSHYAYA \ MAMSA KSHYAYA \ ARBUDA . XIX. SADHYASADHYATA: XX. CHIKITSA:
1) Shamana: Vataraktantaka Rasa- 250 mg t.i.d. for 30 days.
2) Shodhana: Lekhana Basti- 480 ml 6 Niruha Basti.
Anuvasana basti (Shatapaka Madhutaila) – 120ml, 10 basti
BASTI: DATE TIME BASTI
TYPE MATRA NIRGAMAN
TIME VISHESHA PURVA
LAKSHANAPASCHATA LAKSHANA
S.B. 120 ml L.B. 480 ml S.B. 120 ml L. B. 480 ml S.B. 120 ml L.B. 480 ml S.B. 120 ml L.B. 480 ml S.B. 120 ml L.B. 480 ml S.B. 120 ml L.B. 480 ml S.B. 120 ml S.B. 120 ml S.B. 120 ml S.B. 120 ml [S.B.=Sneha Basti : L.B. = Lekhan Basti. ]
Annexure
BASTI SAMYAKA YOGA: 1) PRASRUSTA VITKATA. 2) PRASRUSTA MUTRATA.
3) PRASRUSTA VATA. 4) LAGHUTA. 5) AGNI VRUD 6) KRAMASHA MALA, MUTRA,
5) VAYU VISARJANA. 7) PRAKRUT BALA. 8) ROGOPSHAMANA. BASTI AYOGA .: 1) SHIRO RUKA. 2) HRUTA RUKA. 3) NABHI RUKA 4) BASTI RUKA 5) GUDA RUKA . 6) MEDHRA RUKA . 7) YONI RUKA 8)SHOTHA . 9) PRATISHAYA. 10) KARTIKA 11) HRULLASA 12) VATA SANGA.
13) MUTRA SANGA. 14) ARUCHI . 15) GOURAVA . 16) SHVASAKRUCHYATA . BASTI ATIYOGA : 1) ANGA SUPTI 2) ANGA MARDA. 3) KLAMA 4) KAMPA . 5) NIDRA 6) TAMA PRAVESHA. 7) DOURBALYA. 8) UNMADA . 9)HIKKA. BASTI VYAPADA : 1) AYOGA. 2) ATIYOGA 3) KLAMA . 4) ADHMANA. 5) HIKKA. 6) HRUTPRA 7) URDHVAPRAPTI. 8)PRAVAHIKA. 9)SHIROART 10) ANGARATI 11) PARIKARTA . 12) PARISRAVA . XXI. UPADRAVA: XXII. RESULT:
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