हुताग्निहोत्रमासीनमृषिमध्येपुनर्वसुम् |
पृष्टवान् गुरुमेकाग्रमग्निवेशोऽग्निवर्चसम् ||३||
अग्निमारुततुल्यस्य संसर्गस्यानिलासृजोः |
हेतुलक्षणभैषज्यान्यथास्मै गुरुरब्रवीत् ||४||
After finishing his daily worship and yagna (religious sacrifice), Punarvasu was sitting admidst the sages.
Then with concentrated mind, looking like a flame of fire, Agnivesha asked him, “Sir, please explain the etiology, symptomatology and treatment of disease (vatashonita) which is a combination of vata and rakta, and is like that of fire and wind. The teacher (Punarvasu) explained.
Etiological factors
लवणाम्लकटुक्षारस्निग्धोष्णाजीर्णभोजनैः |
क्लिन्नशुष्काम्बुजानूपमांसपिण्याकमूलकैः ||५||
कुलत्थमाषनिष्पावशाकादिपललेक्षुभिः |
दध्यारनालसौवीरशुक्ततक्रसुरासवैः ||६||
विरुद्धाध्यशनक्रोधदिवास्वप्नप्रजागरैः |
प्रायशः सुकुमाराणां मिष्टान्नसुखभोजिनाम् [१] ||७||
अचङ्क्रमणशीलानां कुप्यते वातशोणितम् |
अभिघातादशुद्ध्या च प्रदुष्टे शोणिते नृणाम् ||८||
कषायकटुतिक्ताल्परूक्षाहारादभोजनात् |
हयोष्ट्रयानयानाम्बुक्रीडाप्लवनलङ्घनैः [२] ||९||
उष्णे चात्यध्ववैषम्याद्व्यवायाद्वेगनिग्रहात् [३] |
वायुर्विवृद्धो वृद्धेन रक्तेनावारितः पथि ||१०||
कृत्स्नं सन्दूषयेद्रक्तं तज्ज्ञेयं वातशोणितम् |
खुडं वातबलासाख्यमाढ्यवातं च नामभिः ||११||
Excess intake of salty, sour, pungent, alkalies and fatty substances, hot food, consumption of rotten and dried flesh, fleshes of aquatic animals like fish, animals living in the area where there are dense forest and heavy rainfall, cake of oil seeds after extraction of oil (pindyaka), radish (Raphanus sativus), red gram, black gram, green vegetables, palala (grated flesh), sugarcane, curd, sour gruel, sauvira and shukta (vinegar), butter milk, sura and asava (alcohol and medicinal preparations having high concentration of alcohol), intake of food inspite of indigestion (ajirna), incompatible food (viruddhahara), eating food before proper digestion of previous one (adhyashana), anger, sleeping in daytime and vigil during the night; in general the delicate persons who are indulged in sweet and delicious food substances and are not in habit of physical activities, the vata and shonita vitiates.
Due to injuries, not purifying the body (by shodhana karma) and indulged in consuming astringent, pungent, bitter, ruksha food items (grains of low nutritional content), starvation, traveling by horses, camels and carts, sporting in water, jumping, leaping, excessive walking in hot season, excessive sexual intercourse and suppression of natural urges are responsible for vitiation of vata.
Due to etiological factors described earlier and obstruction in passage by vitiated rakta the vata aggravates, which again vitiates the rakta and known as vatashonita, having synonyms as khuda, vatabalasa and adhyavata. [5-11]
Sites of affliction
तस्य स्थानं करौ पादावङ्गुल्यः सर्वसन्धयः |
कृत्वाऽऽदौ हस्तपादे तु मूलं देहे विधावति ||१२||
Its sites are hands, feet, fingers and all other joints. At first it settles its root (initial involvement) in hands and feet and then spread all over the body. [12]
सौक्ष्म्यात् सर्वसरत्वाच्च पवनस्यासृजस्तथा |
तद्द्रवत्वात् सरत्वाच्च देहं गच्छन् सिरायनैः ||१३||
पर्वस्वभिहतं क्षुब्धं वक्रत्वादवतिष्ठते |
स्थितं पित्तादिसंसृष्टं तास्ताः सृजति वेदनाः ||१४||
करोति दुःखं तेष्वेव तस्मात् प्रायेण सन्धिषु |
भवन्ति वेदनास्तास्ता अत्यर्थं दुःसहा नृणाम् ||१५||
Due to subtleness and pervasiveness of vata, and liquidity and flowing property of rakta, they travel all over the body through blood vessels.
Near the parva sandhis (small joints of fingers), as blood vessels are in slanting pattern, the vitiated blood is stagnated there and thereafter the vitiated vata and rakta along with pitta etc. produce different types of vedana (unpleasant sensation like pain etc.) so that there are dukha (pain and other abnormal sensation) in the joints. The vedana (pain) is so severe, which is difficult to tolerate. [13–15]
Premonitory symptoms
स्वेदोऽत्यर्थं न वा कार्ष्ण्यं स्पर्शाज्ञत्वं क्षतेऽतिरुक् |
सन्धिशैथिल्यमालस्यं सदनं पिडकोद्गमः ||१६||
जानुजङ्घोरुकट्यंसहस्तपादाङ्गसन्धिषु |
निस्तोदः स्फुरणं भेदो गुरुत्वं सुप्तिरेव च ||१७||
कण्डूः सन्धिषु रुग्भूत्वा भूत्वा नश्यति चासकृत् |
वैवर्ण्यं मण्डलोत्पत्तिर्वातासृक्पूर्वलक्षणम् ||१८||
There is excessive or absence of perspiration, blackishness of the body, poor or lack of tactile sensation, high intensity of pain on trauma, laxity of joints, lassitude, malaise, appearance of boils, feeling of heaviness, numbness and itching in knee, thigh, waist, shoulder, hands, legs and other joints of the body, appearance of pain in the joints and abatement (without treatment), discoloration of body, appearance of mandala (circular skin lesions) are the premonitory symptoms of vatashonita. [16–18]
Types of vatarakta
उत्तानमथ गम्भीरं द्विविधं तत् प्रचक्षते |
त्वङ्मांसाश्रयमुत्तानं गम्भीरं त्वन्तराश्रयम् ||१९||
As this is said there are two types of vatashonita – uttana (superficial) and gambhira (deep). The uttana is located in twaka(skin) and mamsa dhatu (muscles) while the gambhira is located in the deep tissues. [19]
Clinical features of uttana vatarakta (superficial type)
कण्डूदाहरुगायामतोदस्फुरणकुञ्चनैः |
अन्विता श्यावरक्ता त्वग्बाह्ये ताम्रा तथेष्यते ||२०||
Symptoms of uttana vatashonita are itching, burning sensation, pain, stretching sensation, piercing pain, fasciculation, feeling of constricting and the color of skin becomes blackish, red or coppery. [20]
Clinical features of gambhira vatarakta (deep type)
गम्भीरे श्वयथुः स्तब्धः कठिनोऽन्तर्भृशार्तिमान्|
श्यावस्ताम्रोऽथवा दाहतोदस्फुरणपाकवान् ||२१||
रुग्विदाहान्वितोऽभीक्ष्णं वायुः सन्ध्यस्थिमज्जसु |
छिन्दन्निव चरत्यन्तर्वक्रीकुर्वंश्च वेगवान् ||२२||
करोति खञ्जं पङ्गुं वा शरीरे सर्वतश्चरन् |
सर्वैर्लिङ्गैश्च विज्ञेयं वातासृगुभयाश्रयम् ||२३||
Symptoms of gambhira vatashonita are – edema in the involved parts of the body, stiffness of joints, hardness of the part, severe pain inside, the color of the part involved becomes either blackish or coppery. There is burning sensation, pricking pain, fasciculation and finally the part become inflamed and ulcerated. When vata reaches sandhi, asthi dhatu and majja dhatu (joints, bones and bone marrow) it causes severe pain and burning sensation. The forcefully moving vayu having reached the joints causes cutting nature of pain whereby making them crooked, produces limping or lameness while moving all over the body. When the symptoms of both types – uttana and gambhira are present in a patient, it should be considered as ubhayashrita (superficial and deep both). [21–23]
Differential features as per dosha dominance
तत्र वातेऽधिके वा स्याद्रक्ते पित्ते कफेऽपि वा |
संसृष्टेषु समस्तेषु यच्च तच्छृणु लक्षणम् ||२४||
विशेषतः सिरायामशूलस्फुरणतोदनम् [१] |
शोथस्य कार्ष्ण्यं रौक्ष्यं च श्यावतावृद्धिहानयः ||२५||
धमन्यङ्गुलिसन्धीनां सङ्कोचोऽङ्गग्रहोऽतिरुक् |
कुञ्चनस्तम्भने शीतप्रद्वेषश्चानिलेऽधिके ||२६||
श्वयथुर्भृशरुक् [२] तोदस्ताम्रश्चिमिचिमायते |
स्निग्धरूक्षैः शमं नैति कण्डूक्लेदान्वितोऽसृजि [३] ||२७||
विदाहो वेदना मूर्च्छा स्वेदस्तृष्णा मदो भ्रमः |
रागः पाकश्च भेदश्च शोषश्चोक्तानि पैत्तिके ||२८||
स्तैमित्यं गौरवं स्नेहः सुप्तिर्मन्दा च रुक् कफे |
हेतुलक्षणसंसर्गाद्विद्याद्द्वन्द्वत्रिदोषजम् ||२९||
Now listen the clinical features found in predominance of vata, rakta, pitta, kapha or in combination of two or all three dosha. If vata is predominant, there is sirayama (stretching sensation in sira or veins), pain, fasciculation, pricking pain, swollen part becomes blackish , dry , increasing and decreasing grayish hue, constrictions of dhamani (arteries, ligaments) of fingers, stiffness of body parts and intense pain, constriction, stiffness and hatred to cold by the patient. These are the symptoms of vata predominance.
If rakta is predominant, there is swelling, severe pain of pricking nature, tingling sensation, colour of part of skin becomes coppery, not diminished by application of either unctuous or dry substances associated with itching and moistening over the part. If pitta is predominant, there is burning sensation over the part, pain, fainting, perspiration, thirst, narcosis, giddiness, redness of the part affected, pain of tearing nature, inflammation and atrophy of the part.
If kapha is predominant there is feeling of wetness of the skin, heaviness, unctuousness, numbness and mild pain. When there is predominance of two dosha or all three dosha there will be combination of symptoms and etiological factors as well. [24–29]
Prognosis
एकदोषानुगं साध्यं नवं, याप्यं द्विदोषजम् |
त्रिदोषजमसाध्यं स्याद्यस्य च स्युरुपद्रवाः ||३०||
When there is recent onset and predominance of single dosha, vatashonita is sadhya (curable). The disease arising from predominance of two dosha is yapya (palliable). The disease arising from predominance of all three dosha and has developed upadrava (complications) as well, is asadhya (incurable). [30]
Complications
अस्वप्नारोचकश्वासमांसकोथशिरोग्रहाः |
मूर्च्छायमदरुक्तृष्णाज्वरमोहप्रवेपकाः ||३१||
हिक्कापाङ्गुल्यवीसर्पपाकतोदभ्रमक्लमाः |
अङ्गुलीवक्रता स्फोटा दाहमर्मग्रहार्बुदाः ||३२||
एतैरुपद्रवैर्वर्ज्यं मोहेनैकेन वाऽपि यत् |
सम्प्रस्रावि विवर्णं च स्तब्धमर्बुदकृच्च यत् ||३३||
वर्जयेच्चैव सङ्कोचकरमिन्द्रियतापनम् |
अकृत्स्नोपद्रवं याप्यं साध्यं स्यान्निरुपद्रवम् ||३४||
Insomnia, anorexia, dyspnea, gangrene, stiffness in the head, fainting, narcosis, pain, thirst, fever, mental confusion, shivering, hiccup, lameness, eryseplas, inflammation and ulceration, pricking pain, giddiness, exhaustion, crook like deformity of fingers, appearance of blisters, burning sensation, stiffness in marma (vital part of the body), appearance of tumors, if these symptoms have appeared the disease is incurable. Even if there is mental confusion alone, then also the disease is incurable. The patient should not be treated if there is profuse discharge from the ulcer, discoloration, stiffness, the lesion has become like tumor, constriction of the part and damage to the senses.
If all the above complications are not present, then the disease is yapya (palliable). If the complications are not present, then it is curable. [31–34]
रक्तमार्गं निहन्त्याशु शाखासन्धिषु मारुतः |
निविश्यान्योन्यमावार्य वेदनाभिर्हरेदसून् ||३५||
Vitiated vata having reached the joints of extremities obstruct the way of the rakta and vitiated rakta obstructs the way of vata, thus causes the unbearable pain and leads to death. [35]
Treatment principles
तत्र मुञ्चेदसृक् शृङ्गजलौकःसूच्यलाबुभिः |
प्रच्छनैर्वा सिराभिर्वा यथादोषं यथाबलम् ||३६||
In this condition, the blood should let out with shringa (horn), jalauka (leech application), suchi (needle), alabu (hollow bitter gourd), pracchana (scratching) or siravyadha (venesection) depending on morbidity and strength of the patient. [36]
Modes of raktamokshana
रुग्दाहशूलतोदार्तादसृक् स्राव्यं जलौकसा |
शृङ्गैस्तुम्बैर्हरेत् सुप्तिकण्डूचिमिचिमायनात् ||३७||
Bloodletting should be done by applying the leech if one is suffering from discomfort, burning sensation, pain and pricking sensation. If the patient is suffering from tactile dysfunction, itching and tingling, his blood should let out with either shringa (animal horn) or alabu (hollow gourd). [37]
देशाद्देशं व्रजत् स्राव्यं सिराभिः प्रच्छनेन वा |
अङ्गग्लानौ न तु स्राव्यं रूक्षे वातोत्तरे च यत् [४] ||३८ ||
If the symptoms and complications in vatashonita are not localised to a specific part rather are of fleeting nature, the blood should be let out with siravyadha (venesection) or by pracchana. In case if there are angaglani (anga shosha i.e.atrophy), dryness, and other symptoms of vata dominance, the bloodletting should not be done. [38]
Complications of blood letting in vata dominant condition
गम्भीरं श्वयथुं स्तम्भं कम्पं स्नायुसिरामयान् |
ग्लानिं चापि ससङ्कोचां कुर्याद्वायुरसृक्क्षयात् ||३९||
खाञ्ज्यादीन् वातरोगांश्च मृत्युं चात्यवसेचनात् |
कुर्यात्तस्मात् प्रमाणेन स्निग्धाद्रक्तं विनिर्हरेत् ||४०||
Blood loss due to blood letting may cause aggravation of vata dosha, leading to deep swelling, stiffness, tremors, disorders of sira and snayu (blood vessels and ligaments), debility and constriction of the part. If there is excessive blood loss, the complications like limping and other vāta disorders and even death will occur. Hence one should let the blood out in proper quantity, after proper oleation. [39–40]
General principles of management
विरेच्यः स्नेहयित्वाऽऽदौ स्नेहयुक्तैर्विरेचनैः |
रूक्षैर्वा मृदुभिः शस्तमसकृद्वस्तिकर्म च ||४१||
सेकाभ्यङ्गप्रदेहान्नस्नेहाः प्रायोऽविदाहिनः |
वातरक्ते प्रशस्यन्त … |४२|
After proper oleation, vatarakta patient shall be treated with mild therapeutic purgation with unctuous substances or with dry substances (in case of excess oleated patient). After purgation, the patient should be given frequent basti (enema of medicated substances) including anuvasana basti (unctuous enema) and niruha basti (enema made from decoction of medicinal herbs). Besides fomentation, massage, ointments, food and sneha (unctuous substances) be given to the patient which do not cause burning sensation. Now listen; specific remedies. [41–42]
Specific treatment
……विशेषं तु निबोध मे||४२||
बाह्यमालेपनाभ्यङ्गपरिषेकोपनाहनैः| विरेकास्थापनस्नेहपानैर्गम्भीरमाचरेत् ||४३||
सर्पिस्तैलवसामज्जापानाभ्यञ्जनबस्तिभिः |
सुखोष्णैरुपनाहैश्च वातोत्तरमुपाचरेत् ||४४||
विरेचनैर्घृतक्षीरपानैः सेकैः सबस्तिभिः |
शीतैर्निर्वापणैश्चापि रक्तपित्तोत्तरं जयेत् ||४५||
वमनं मृदु नात्यर्थं स्नेहसेकौ विलङ्घनम् |
कोष्णा लेपाश्च शस्यन्ते वातरक्ते कफोत्तरे ||४६||
In case of uttana vatashonita affecting superficial tissues only, the patient should be treated with alepana (affected part is covered with medicinal paste), abhyanga (massage), parisheka (bathing in warm decoction or unctuous substances) and upanaha (application of poultice).
In the case of gambhira vatarakta the patient should be treated with purgation, asthapana basti (enema with decoction of medicinal plants) and snehapana(drinking medicated oil/ghee).
In the disease where the vata is predominant, one should over come the disease with medicated ghee, taila, vasa, majja (ghee, oil, fat, and bone marrow of animals) either by intake or massage or enema and the diseased part should be treated with warm upanaha (warm poultice).
Where the rakta and pitta both are predominant, patient should be treated by mild purgation, after ghrita pana (intake of medicated ghee), intake of milk, bathing in decoction made from medicinal plants and basti (enema). The rakta-pitta dominance should be treated with cold and refrigerant alepa (paste of herbs).
Where the kapha is predominant, in patient of vatarakta he should be treated with mild emesis and avoid excessive oleation, sudation and fasting. Lukewarm lepa (pastes of herbs) are useful. [43–46]
कफवातोत्तरे शीतैः प्रलिप्ते वातशोणिते |
दाहशोथरुजाकण्डूविवृद्धिः स्तम्भनाद्भवेत् ||४७||
रक्तपित्तोत्तरे चोष्णैर्दाहः क्लेदोऽवदारणम् |
भवेत्तस्माद्भिषग्दोषबलं बुद्ध्वाऽऽचरेत्क्रियाम् ||४८||
In the patients of vatarakta with vata–kapha predominance, if cold pralepa is applied then there will be complications like burning sensation, swelling of the part, pain and itching due to stasis of the dosha, like wise in the patients suffering from vatarakta with rakta and pitta predominance, if are applied with ushna dravya will cause daha (burning sensation), kleda (moistening) and tearing of the skin. Therefore, in cases of vatarakta, the physician should apply the treatment measures after well considering the bala (strength) of the dosha. [47–48]
Contra-indications for vatarakta
दिवास्वप्नं ससन्तापं व्यायामं मैथुनं तथा |
कटूष्णं गुर्वभिष्यन्दि लवणाम्लं च वर्जयेत् ||४९||
The patient of vatarakta should abstain from day sleep, exposure to heat, excessive physical exertion, coitus, eating of pungent, salty, sour, ushna, guru (difficult to digest) and abhishyandi food (food articles which after consumption are responsible for the excessive secretions in the body) substances. [49]
Dietary regimen
पुराणा यवगोधूमनीवाराः शालिषष्टिकाः |
भोजनार्थं रसार्थं वा विष्किरप्रतुदा हिताः ||५०||
आढक्यश्चणका मुद्गा मसूराः समकुष्ठकाः |
यूषार्थं बहुसर्पिष्काः प्रशस्ता वातशोणिते ||५१|
Old barley, wheat, nevara, shali and shashtika dhanya (special qualities of red rice) are good to eat and soup of flesh of vishkira (birds which scratch the ground) and pratuda (birds which pick the food and eat like pigeon) or soup of pulses, pea, bengal gram, lentils and makushtha (motha) can be taken by adding plenty of ghee, by the patients of vatarakta.
