Nidana,Purvarupa,Rupa, Upshaya,Samprapti of Vatarakta

Dr LAL RAVI SAHU2nd year PG scholar

Department of PG studies,SDMCAH Hassan

Contents

IntroductionNidanaPurvarupaRupaSampraptiDiscussion Conclusion

Introduction Due to Mithya Aahar and Vihaar, the excessively aggravated Vata

vitiates the entire Rakta and causes disease known as Vata-Rakta.It is also known by the synonyms like Kuddha, Vata Balasa and Adya Vata.

29th chapter of Charaka Samhita Chikitsa Sthana- Vata shonita adhayaya deals with causes, types and treatment for Vatarakta.

In Sushrut samhita it has been described under Nidanasthana 1st chapter and Chikitsa sthana 5th Chapter Mahavata vyadhi.

Nidana लवणाम्लकटुक्षारस्नि� ग्धोष्णाजीण�भोज ैः|

क्लि�लन्नशुष्काम्बुजा ूपमांसपिपण्याकमूलकैः||५|| कुलत्थमाषपि ष्पावशाकादि)पललेक्षुभिभः| )ध्यार ालसौवीरशुक्ततक्रसुरासवैः||६|| पिवरुद्धाध्यश क्रोधदि)वा�वप्नप्रजागरैः| प्रायशः सुकुमाराणां मिमष्टान्नसुखभोजिज ाम् [१] ||७|| अचङ्क्रमणशीला ां कुप्यते वातशोभिणतम्| अभिभघाता)शुद्ध्या च प्रदुष्टे शोभिणते ृणाम्||८|| (cha. Chi. 19)

Generally people of tender health Sukumar who indulge in sweet food,and sedentary habits get afflicted by Vatarakta because of the following:lavaṇāmla kaṭu kṣāra snigdhoṣṇājīrṇa bhojanaihi – Excessive intake of salt, sour, pungent, alkaline, unctuous, hot and uncooked food.

klinna śuṣkāmbujānūpa māṃsa piṇyāka mūlakaiḥ – Intake of dry meat of aquatic (Ambuja)  or marshy land (Anupa) inhabiting animals

kulattha māṣa niṣpāva śākādipalalekṣubhiḥ – Excessive intake of oil-cake preparation or radish, excessive intake of Kulattha – horse gram, black gram,Leafy vegetables, etc. meat and sugarcane

dadhyāranāla sauvīra śukta takra surāsavaiḥ – Excessive intake of curd, Aranala(Kanji), Sauvira (sour preparation of dehusked barley), Sukta (vinegar), Buttermilk, alcohol and wine,

Virudhha ahara – Intake of mutually contradictory food.Adhyashana – Intake of food before the previous meal is digestedAti Krodha – Resorting to anger in excessDivasvapna – Sleeping during day time andPrajagara – remaining awake at night.

Nidana are almost same in Charaka and Sushruta.

Purvarupa �वे)ोऽत्यर्थंK वा काष्ण्यK स्पशा�ज्ञत्वं क्षतेऽपितरुक्| सस्निNशैथिर्थंल्यमाल�यं स) ं पिपडकोद्गमः||१६||

जा ुजङ्घोरुकटं्यसह�तपा)ाङ्गसस्निNष|ु (cha.chi.19)

Svedo atyartham na va – Excess or absence of perspiration.Karshnyam – Black coloration of the jointsSparsha ajnatvam – Insensibility to touch, andKshate ati ruk – excessive pain if there is injury to the afflicted partSandhi shaithilya – fragile jointsAalasyam – indolence andSadanam – astheniaPidaka udgamah – Appearance of pimples

According to Sushruta Symptoms are pricking pain, burning sensation, itching, swelling, numbness, sudden eruption of blackish or reddish rashes over the skin which are seen in hand, feet, wrist or ankle. AAKHUVISHA

Rupa Janu jangha uru kati amsha hasta pada anga sandhi nistoda –

Pricking pain, twitching sensation, splitting pain, heaviness and numbness in the knees, calf, thighs, umbilical region, shoulders, hands, feet and joints in the body.Kandu – Itching

Sandhi shu ruk bhutva nashyati – Frequently, the pain while appearing in the joints disappears[suddenly] and

Vaivarnyam – Discoloration of the skin and

Mandala utpatti – Appearance of circular patches over the body. 

Types - उत्ता मर्थं गम्भीरं पिY पिवधं तत् प्रचक्षते|

त्वङ्मांसाश्रयमुत्ता ं गम्भीरं त्वन्तराश्रयम्||१९||(cha.chi.19) Vatarakta is of 2 types:

Uthana Vatarakta (superficial) – located in the skin as well as muscle tissues and Kandu – ItchingDaha – burning sensationRuk – acheAayama – extensionToda – pricking painSphurana – throbbing sensation andAakunchana – contraction andShyava rakta tvak – The skin becomes brownish black, red or coppery in color

Gambheera Vatarakta (deep seated) – located in deeper tissues

Shvayathu – OedemaStabdha – stiffnessKathina – hardness andAntar bhrusha arti – excruciating pain in the interior of the bodyShyava tamra tvak – Blackish brown or coppery coloration [of the skin] andDaha – Burning sensationToda – pricking painSphurana – twitching sensation andPakavan – suppuration of the joints.

Susrutha denies the opinion of Charaka and says that Uttan and Gambheer are not two types but they are just the stages of the disease as in any skin disease situated in superficial and deep structures.

If Vatarakta is located both in (Uthana) and (gambhira) of the body, then the following signs and symptoms are manifested:Aggravated Vata while causing pain and burning sensation constantly, moves with high speed through the joints, bones and bone marrow as if cutting them to make the joints curved inwardsWhile moving all over the body, this aggravated Vata Dosha makes the person lame and paraplegic and all the signs and symptoms described above (in respect of Uthana and Gambhira types of Vatarakta) are manifestedBeing localized in joints, they get further associated with Pitta, etc., (i.e Kapha and Vata Dosha aggravated associated with Pitta and Kapha, the disease produces different types of pain characterized by nature of these elements. Therefore, in general, the disease gives rise to pain in all these joints. These different types of pain become excessively unbearable for the patients. 

UpshayaAccording to Charak if Vatarakta is caused by:

Only 1 Dosha, and if it is of recent origin, then it is curable.

The combination of 2 Doshas, then it is only Palliable.

All the 3 Doshas then it is incurable.

If the curable varieties are attended with complications then they also become incurable.

According to sushruta Those Vataraktha with the ulcers extending up to Knee with

discharge of Pus, with Upadravas like Murcha, Jvara, Pipasa, etc, those who are very much debilitated, emaciated are incurable.

Vataraktha with history of one year or more can be maintained with continuous treatment

Samprapti

अचङ्क्रमणशीला ां कुप्यते वातशोभिणतम्| अभिभघाता)शुद्ध्या च प्रदुष्टे शोभिणते ृणाम्||८|| कषायकटुपितक्ताल्परूक्षाहारा)भोज ात्| हयोष्ट्रया या ाम्बुक्रीडाप्लव लङ्घ ैः [२] ||९|| उष्णे चात्यध्ववैषम्याद्व्यवायाYेगपि ग्रहात् [३] | वायुर्विवfवृद्धो वृदे्ध रके्त ावारिरतः पथिर्थं||१०|| (cha.Ch. 19)

Because of nidana, Vata gets aggravated. Being obstructed in its course by the vitiated blood, the excessively aggravated Vata vitiates the entire blood. The disease thus, caused is called Vata-Rakta (gout).It is also known by the synonyms like Kuddha, Vata Balasa and Adya Vata.

The sites where Vatarakta is manifested are –

Hands, feet, fingers including toes and all joints. In the beginning, the hands and feet are afflicted. From this base, it spreads to all other body parts because of the subtle (Sookshma) pervasive nature of Vata and Rakta.

Because of their fluidity (Dravatvaat) and mobility (Saratvaat), they (Vata and Rakta), while moving through the chhannels; get obstructed in the joints which makes them further aggravated. Because of the tourtous nature of the course in the joints, the morbid matter gets lodged there.

Discussion Charaka has given importance to the involvement of Joint and Joint

Pain as the main feature. Charaka has also given importance to skin manifestation but only in Upadravas.

Susrutha no where mentions involvement of the joints clearly and also joint pain. But Susrutha has explained Vataraktha as a skin condition with Ulceration which commonly manifests in foot, rarely in hand.

Conclusion Almost all the features of RA is explained except morning stiffness

and symmetrical involvement, which is a diagnostic feature to consider RA.

Extra articular symptoms like necrotic ulcers(paka) as seen in vasculitis, mandalothpatti (butterfly rash in sle), visarpa (skin lesions with bullous ulcers, necrotic or gangrenous ulcers with systemic symptoms)

Almost all differetials of Rheumatism can be included under Vatashonita of Charaka including septic arthritis(Pittaja Vataraktha).