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Critical comparative study of the concept of VATHARAKTHA in

Charaka and Susrutha Samhitha

Critical comparative study of the concept of VATHARAKTHA in

Charaka and Susrutha Samhitha

Dr. Jayagovinda UkkinadkaUKKINADKAS AYURVEDA

www.ukkinadkas.com

PRESENTATION BY

Content

• Cardinal features• Nidana- Caraka and Susrutha• Samprapthi• Poorvaroopa• Roopa• Upadrava• Sadhyasadhyatha• Comparison and discussion

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Introduction

• Vata shonitha or vataraktha is the disease first explained in Charaka and Susrutha Samhitha.

• We can see lot of difference of opinion in Charaka and Susrutha while explaining the types and symptoms.

• At some point it seems that the disease understood as Vatashonitha by Charaka and Susrutha are different

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Vata shonitha (VS) as told by Charaka- Cardinal S & S

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Cardinal features of VS-Charaka

• The main seat of VS is Phalangeal joints of Hands and foot and later the features will be seen in multiple joints

• This is the same explanation what we see even today in modern texts while explaining Rheumatoid arthritis and other Rheumatisms.

Vata shonitha as told by Susrutha- Cardinal S & S

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Aakhu Visha Lakshana -Susrutha

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Cardinal features of VS - Susrutha

• The main seat of the disease is PADA- FOOT, and occasionally seen in HANDS and if aggravates spreads like poisonous effect of rat bite, spreads fast and produces symptoms like

• Rat bite effect- Formation of nodules, circular skin lesions, severe bullous eruptions, scaly skin lesions, bodyache, severe pain, unconciousness, heavyness in the body, fever, loss of appetite, vomitting.

Nidana & samprapthi- Caraka

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Vishesha Samprapthi- Caraka

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Patho physiology- Charaka

• Due to the etiological factors the aggravated Vayu obstructed by the aggravated Raktha produces this disease

• Vata because of its subleness and Raktha due to its liquid nature moves in vessels and gets obstructed in bends and mostly at joints and also may interfeared by Pittadi doshas and produces severe symptoms in those areas.

Nidana and Samprapthi- Susrutha

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Nidana and Samprapthi- Susrutha

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Vata Pitta and Vata Kapha involvement- Susrutha

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Patho physiology in Susrutha

• Some change in etiology seen, but samanya samprapthi is almost similar, but not explained the vishesha samprapthi

Poorvarupa- Caraka

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Prodromal symptoms- Charaka

• Excessive or no sweating, blackish discoloration, severe pain on hitting, numb or tingling feeling in skin, stiffness in joints, weakness, formation of nodules, multiple joint pain, pricking pain, severe pain, or tingling sensation in joints, itching in joints, spontaneous remission and exacerbation of symptoms, skin discoloration and skin eruptions may be the prodromal features in Vata shonitha.

Poorvarupa-Samprathi Susrutha

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Prodromal symptoms- Susrutha

• Due to the etiological factors the aggravated Vatha and Raktha produces Vataraktha and the prodromal symptoms are- Symptoms are first seen in Feet and occasionally in hand and later symptoms will be seen in all over the body.

• 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.

Poorvarupa Susrutha- in Feet

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In feet

• In feet the skin condition will be bad, there may be excessive or no sweating, may be cold or hot to touch, patient may have pricking pain, numbness, or severe burning sensaton. Discoloration of the skin is very common

Two types of Vatarakhta- Caraka

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Types Charaka

• Uthana- Superficial• Gambhira- Deep seatedAnd also Ubhayashritha- both superficial and deep seatedThese are depending upon the extent of damage

and also explained depending upon the doshik involvement.

Two stages of Vataraktha- Susrutha

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Susrutha- not types they are the stages of the disease

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

Uttana Vataraktha - Caraka

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Gambhira Vataraktha- Caraka

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Uttana and Gambhira of Charaka

• Uttana- There will be itching and burning sensation, and pain in the joint on movement, pricking pain in joints and also feeling of squeezing type of pain. Skin discoloration is also seen in the skin near the joints.

• Gambhira- Severe itching and pain in the joints affected, hard to touch, severe pain, within the joint, burning sensation. Skin discoloraton and even ulceration is also possible.

Ubhayashrita Vataraktha- Caraka

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Ubhayashritha- or systemic

• Severe pain, burning sensation, the joint deformities are very fast, all the features of Vataraktha will be seen in this variety.

Vataja Vataraktha- Caraka

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Pittaja Vataraktha- Caraka

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Kaphaja Vataraktha -Caraka

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Rakthaja Vataratha- Caraka

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Features- Susruta

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Features Importance given only to Pada

• Burning sensation, pricking pain, and other features according to doshik involvement seen in Pada (Kadachith in Hastha)

Upadrava- Caraka

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Upadrava- Charaka

• Desturbed sleep, breathlessness, poor appetite, Deep ulcerations, stiffness in the head, loss of conciousness, delerious, excessive thirst, high fever, syncope and tremors. Hiccups, limping, bullous skin lesions, ulcers with suppuration, pricking pain, giddyness, exausted, Deformities in fingers, skin eruptions, burning sensation all over the body, damage to vital organs, and those who develops cancerous tumors are the main complications and should not be treated as they are incurable.

Chikistya Vataraktha-Susrutha

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Treat those without complicatons like- Susrutha

• Susrutha advice to treat those without following complicaton

• Gangrene formation, debilitated, unconcious ness, poor appetite, high fever, heavyness, delerious, convulsions,- may be those without septicemia

• Treat those who are having full strength, with good will power and having the all shastras and anushastras ready, then only start the treatment.

Sadhyasadhyatha- Caraka

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Reason for Asadhyatha- Caraka

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Prognosis Charaka

• With all upadravas- Asadhya- Incurable• Mild upadravas- Yapya- can be Maintained• Without complicaton - Curable

Asadhya Lakshana- Susrutha

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Prognosis Susrutha

• 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.

The Main differences are- 1

• Charaka has given importance to the involvement of Joint and Joint Pain as the main feature.

• Susrutha no where mentions involvement of the joints and also joint pain.

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2

• Charaka has also given importance to skin manifestation but only in Upadravas.

• But Susrutha has explained Vataraktha as a skin condition with Ulceration which commonly manifests in foot, rarely in hand.

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3

• In Asadhya vataraktha Susrutha says that ulceration with pus and slough which reaches up to Knee is Asadhya.

• While Caraka explains skin complication along with Anguli vakrata, Pangulya, Paka, Toda, Bhrama, Klama, Arbuda, daha, Murcha, Mada, ruk, Trishna, Pravepaka, Shirograha etc.

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• Susrutha while explaining Chikitsya Vataraktha says that those without Prana, Mamsakshaya, pipasa, Jvara, Murcha, Shwasa, kasa, sthambha Arochaka vipaka, visarana Sankochana like Upadrava rahitha Patients who are Balavantha, Atmavantha and Upakaranavantha as Chikitsya. There the symptomatology resembles a septicemia patient.

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• Charaka explains almost all symptoms involved in Rheumatism except morning stiffness and symmetric involvement.

• But susrutha no where mentions involvement of joint or symptomatology similar to Rheumatism.

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• Charaka explains Uttana, Gambhira and Ubhayashritha as three types of Vataraktha which is like articular, extra articular and systemic involvement explained in rheumatism.

• But Susrutha says that Uttana and Gambhira are the two stages as superficial and deep in skin conditions (Kustavat)

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Why vataraktha can be RA and other rheumatic condition?

THASYA STHANAM KARAU PADAVANGULYAHA SARVASANDHAYAHA.

HASTHAPADE THU MOOLAM- DEHE VIDHAVATHI. • LEADING SYMPTOMS SEEN IN SANDHIS, MAINLY

PHALANGEAL JOINTS AND TOES, AND THEN MULTIPLE JOINTS.

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VATHARAKTHA- CLINICAL FEATURES

• MULTIPLE JOINT PAIN• PRICKING PAIN• TENDERNESS• RECCURENT EXACERBATION AND REMISSION• MALAISE• FORMATION OF NODULES• SKIN RASHES, EXCESSIVE OR NO SWEATING, TINGLING AND

ITCHING SENSATION OVER JOINTS.• JOINT DEFORMITIES, STIFFNESS, RIGIDITY• IN GAMBHIRA VATHARAKTHA, PAIN IS SEVERE AND PAKA

USUALLY OCCURS.

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VATHARAKTHA FEATURES

• 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).

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Vataraktha of Charaka- Rheumatism, all differential diagnosis of rheumatism

• SO CONSIDERING ALL THE CRITERIAS, RA MAY BE CONSIDERED UNDER VATHARAKTHA AND ALL DIFFERENTIAL DIAGNOSIS OF RA INCLUDING GOUTY ARTHRITS MAY ALSO BE CONSIDERED UNDER VATHARAKTHA.

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SUSHRUTHAS VATHARAKTHA MAY BE FOOT ULCER AND …

• Sushrutha explains Vatharaktha briefly, but he has not given importance to the involvement of multiple joints, but explains symptoms related with skin lesion, which is painful, reddish, with swelling and burning sensation or whitish with itching. But the main site of lesion is mainly feet, but sometimes hands, and symptom may spread to whole body as poisonous rat bite.

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PERIPHERAL VASCULAR OBSTRUCTION & VENOUS ULCERS MAY ALSO BE CONSIDERED.

• While explaining the symptoms he says that there may be severe tenderness at the site of lesion or sometimes numbness.

• Sushrutha while explaining incurable vathashonitha, says that, if the lesion spreads up to knee (from foot), and ulcerates with secretion of serum, blood and pus & in case of muscle wasting & in a debilitated person,it is incurable. So here he clearly mentions ulceration in the leg, from foot up to knee as a complication and also incurable.

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Gambhira and Uthana Vatharaktha are not two types according to Sushrutha

• Sushrutha says that gambhira and Uthana are not two types of vatharaktha, but two stages of disease.

• So Sushruthas explanation may not be related with RA, or he may not have given much importance to vathashonitha with joint involvement as his main subject was surgery.

CONCLUSION

• Probably Vataraktha of Caraka and Susrutha are different diseases, but with same name.

• Lot of difference of opinion may be because of disease consideration which may be Rheumatism and Gout by Caraka and Gangrenous and other non healing ulcers by Susrutha

• Further we can also consider the commentaries and the other texts further eloborate on this subject

• The gap between period of Charaka and Susrutha is 100 to 300 years according to the historians which could be the another reason for misunderstading.

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Thank You

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