Critics on Pathogenesis of Vatarakta

Introduction

Vata Rakta is a unique example of Avarana Janya Vata Vyadhi. Get manifested Due to specific etiological factors. Due to specific pathology and treatment it is explained exclusively. The condition is Agni Maruta Tulya because of the severity in presentation of its symptoms that is due to the Samsarga of Rakta and Vata. Hence it is Durnivaratva (difficult to treat) and Sheegrakari (fast spreading) to be more specific the obstruction is caused due to the vitiated rakta leads to the pathology of Vata Rakta.Khuda Vata, Vata Balasaka and Adhyavata are synonymously mentioned to denote the condition.¹ Comprehensive review on pathogenesis is mentioned in Bruhattrayee and Laghutrayee plays considerable role in manifestation of Vatarakta.

Aims and objective: To analyze the critical interpretation about the pathogenesis of Vata Rakta.

Material and methods: Concept related to proposed title is collected from various classical texts as well as various published research papers.

Review on vata rakta

Nidana: Doshas are the Samavayi Karana for the disease manifestation and etiological factors are the cause for the Dosha vitiation so they are considered as Nimitta Karana for the Vyadhi manifestation. Evaluation of each etiological factors helps in understanding the pathogenesis of the disease.

The etiological factors are categorized as,

1.Factors vitiates the rakta and vata

2.Factors aggravate the vata dosha

Following Factors vitiates the rakta and vata

1. Lavana, Amla, Katu, Kshara: Excessive Intake of salty, sour, spicy and alkaline food causes the Vata Rakta. These substances are Agni Mahabhoota Pradhana thus leads the Vidagdhata of Rakta and also aggravates the Vata Dosha. Lavana rasa mainly causes the Rakta Dusti.

2. Snigdha Ushana bhojana: Excessive intake of fatty items and hot things are the cause for Agnidushti and Pitta Vidagdhata.

3. Ajeerna bhojana: If a person takes meal before the complete digestion of previous meal leads to indigestion. Ajeerna Bhojana does the Tridosha Prakopa. Ajeerna acts as independent hetu in disease manifestation.

4. Klinna and Shushaka Bhojana: The food gets fermented by keeping it for overnight that is Klinna Bhojana.Intake of Shushka Bhojana is Viparita to Ahavidhi Vidhana (Snighamashniyata) thus leads the improper digestion and causes the Shonita Dusti.

5. Ambuja Anoopa Mamsa:Ambuja and Anoopa Mamsa are Mahaabishyandi in nature thus leads Rakta Dustti. They are cause for the Santarpanajanya disease.

6. Pinyaka, Moolaka, Kulatha, Masha: Excessive intake of these leads to Pitta Vidagdhata with Anubandha Kapha leading toward the Samprapti.

7. Palala, Ikshu, Nishpava: These are Drava Mahabhoota Pradhana Dravaya and excessive consumption of these leads the soma guna atireka, cause the the Rakta Dusti.

8. Dadhi, Aranaala, Sauveera, Sukta, Takra, Sura, Asava: These are Amla Varga acts as Vidahi. Regular intake of these alcoholic beverages such as sauveera, arnala and asava causes the rakta dusti and pitta vriddhi.

9. Virudhahara, Adhyashana: Virudhahara and Adhyashana comes under the Avidhi Yukta Ahara(improper method of taking food) They are the cause for Ajeerna leading toward the Vatarakta Samprapti.

10. Krodha, Diwaswpna, Prajagara: They come under the Mithyaviharaja Nidanas. Excess Krodha causes the Pitta Vridhi and Agni Dusti thus leads the Ama. Diwaswapna leads Pitta and Kapha vitiation, Ratri Jagrana disturbed the normal function of digestion.

11. Ashudhya, Abhighata: Person, who does not undergo in seasonal purification and also met with an accident, will suffer from Rakta Dusti.

12. Sukumaranam Achankramanasheela: The person leading luxurious life with lack of physical activities and habituated for excessive intake of sweets and rich protein diet regularly are prone to suffer from Rakta Dusti.

Factors aggravate the vata dosha:

1. Kashya, katu, tikta rasa Bhojana: Regular intake of these rasa for long period aggravates the Vata Dosha.

2. Alpabhojana,ruksha bhojana, abhojana: Alpabhojana and Abhojana derange the Agni and Ruksha bhojana aggravates the Vata.

3. Haya,ushtra yana: Riding on horse or camel on uneven roads for long hours causes the Vata prakopa. (This is understood in present era with the one who is involved in excessive travel by train and other vehicle.)

4. Langhana: Repeatedly undergoing Upavasa and shodhana leads Dhatu kshaya and aggravates the Vata Dosha.

5. Ushne adhogamana:Excessive walking in summer season aggravates the Vata Dosha.

6. Vaishamyad Vyavaya: Shukra and oja being the the Snehamsha of Shareera Shukra Dhatu and Oja get decreased due to excessive Maithuna which leads to Vata prakopa both.

7. Vega Nigrahat: There are number of diseases occurs by the suppression of natural urges. It also hampers the normalcy of Vata Dosha along with other Dosha in the body.

8. Atisantapa: aggravates the pitta dosha leads the Rakta dusti

Poorvaroopa (prodromal symptoms):

Poorvaroova Awastha is the Pradurbhava stage of the vyadhi. Poorvarupa of Vata Rakta which is enlisted in classics is similar to Kushta that is due to the involvement of the Rakta as Dushya and other respective Doshas. Physician has to differentiate the symptoms by assessing the cardinal prodromal symptoms of Vata Rakta. Assessment of Poorvaroopa will help in combating the disease in its early stage.

1. Atisweda: it is the Lakshana of Prakupita Pitta that is manifest due to the predominantly involvement of the Pitta Dosha in Samprapti of Vata rakta.

2. Asweda: it is due to the Swedavaha Srotoavarodha due to Santarpanajanya Ahara.

3. Karshyam: The blackish discoloration over the affected area is the Lakshana of Prakupita Vata Dosha.

4. Sparsha Agyatwama: Due to the Vata Dushti there will be loss of sensation in chronic stage.

5. Kshate Atiruk: Even on small injury person feel severe pain due to the Rakta Dusti.

6. Alasya: Patient feels tiredness even while doing daily activities and it is due to Amaa or due to the Shleshma avarodha.

7. Sandhi Shaithilyata: The activities of particular joint get affected.

8. Pidikas: will appear at the site of manifestation of the Vyadhi that is due to the Santarpanajanya Dust Rakta.

9. There will presence of pricking pain, pulsation, cutting pain, heaviness, numbness, sucking pain and burning sensation in affected joints particularly limbs, lower back and shoulders, Sometimes pain will present in affected part and sometimes there is absence of pain.

10. Vaivarnya: There is discoloration over the affected joint. The color could be coppery, dark greenish, bluish and reddish.

11. Mandal Uttpatti: The cause of rashes is vitiated Rakta Dhatua with other superfacial dushya as well other agitated dosha Samanya Samprapti:( pathogenesis ) Nidana sevana (vata+rakta dusti janya)

A comprehensive understanding is essential to enlighten the concept of the disease manifestation it plays an important role while treating the condition. Acharya Charaka has put forth the clear picture of the Avarana Janya Vatavyadhi by providing detail explanation about Vata Rakta. Here pathology of Vata Rakta revolves around Avarana. Vata dosha by its nature has the Prasaranasheela Guna that helps Vata Dosha to circulate even in minute channels of the body. Rakta Dhatu is called as Jivana because of its Saratva and Dravatva qualities it is responsible for the circulation. When both Vata Dosha and Rakta Dhatu get vitiated by Nidana Sevana, the Dooshita Rakta Dhatu does the Avarana of aggravated Vata Dosha and that obstructed Vata becomes more powerful and leads to the sanga in the rakta marga along with other Pittadi Dosha due to the curvature of the particular joint. It produces the severe pain The disease initially starts from small joints like toe and later on it spreads all over the body and affects all the joints slowly,¹⁰ the spreading of the pain is correlated to the Mooshika Visha.

Roopa (symptoms): The Roopa has classified into two types based on Asharaya and dosha involvement. As per the asharaya further two types of of presentation explained as Uttan Vata Rakata and Gambhir Vata rakta.¹¹ Acharaya Sushruta mentioned as that the Uttan and Gambhira are the progressive stages of the Vyadhi similary as Kushta.¹² Initially there will be the superficial tissue involvement be present later on due to the chronicity it affects the deeper tissue also.

Classification of symptoms on basis of Dosha predominant

Vata Dosha: Predominance of vata dosha results in Sirayama (stretching pain in vain) of pulsating or pricking type and swelling of joints which appear dry and blackish. There is either increase or decrease of swelling. Contractions, stiffness and deformity of fingers are also the common presentation which further associated with loss of ability to perform any type of routine activity. There is severe pricking and piercing type of pain in lower extremities and the person cannot bear even the slight external stimulus (hyperesthesia). In later stage, the legs become atrophied and there is loss of sensation in the affected area. It is further associated with aversion towards the cold items irrespective of drug or food.¹³

Predominance of Rakta: Predominance of Rakta results in swelling associated with severe pain, itching and burning sensation of affected area which is mentioned as Chimchimayte. The affected area becomes coppery red in color. Complains does not get reduced by either oil or dry massage.¹⁴

Predominance of Pitta: Predominance of Pitta leads to Vidaha (burning sensation), Moha (confused state of mind where person does not like to involve in any type of activity), profuse sweating and even loss of consciousness. Similarly, the Pitta Dushta Rakta results in intoxication, excessive thirst, tenderness over the affected area with severe pain which is associated with swelling, inflammation, increased localized temperature and dryness.¹⁵

Predominance of Kapha: When there is predominance of Kapha Dosha a person complains as if his body is covered with wet cloth. There is heaviness of body due to accumulation of Kapha in Srotas, It is associated with unctuousness in body and numbness over the affected part with mild pain. However, in Samsargaja and Sannipatika condition follows the prakruti samasamaveta sidhanata in lakshana as well as in chikitsa.¹⁶

Sadhyasadhata (prognosis): Vata Rakta with Upadrava is considered as Asadhya. Ekdoshja, newly manifest sannipataja without Upadrava are Sadhya, Dwidoshaja is Yapya and Tridosha is Asadhya. Acharya vagbhata has mentioned that Vata Rakta associated with Stabdhata, Srava and Arbuda is Asadhya.

Discussion

Vata rakta is a type of Vata Vyadhi explained by Acharya Charaka in separate chapter. Acharya Shushruta included it under Mahavatavydhi Chkitsa this indicates the severity and the importance of the condition in clinical presentation. Distinct etiological factors of Vata Dosha and Rakta Dushya separately cause the morbidity of Vata Dosha and rakta dushya in association with other dosha. Vata and Rakta does not having Ashraya Ashryee Bhava relation but both are equally responsible for the manifestation of the condition, because by nature both are responsible for the circulation (Sara and Chala guna) also get affected soon by the etiological factors. Thus these are factors influence the pathogenesis of Vata Rakta. Due to the rakta involvement in the pathogenesis makes the condition difficult to treat a minute understanding of the pathogenesis needed while dealing with such type of diseases. In classics Acharyas have discussed the management of vatarakta considering the predominance of dosha and different stages vatarakta. Adhya Vata is a disease which affects the people with comfort and royalty. Khuda Vata is a condition which most commonly affects the smaller joints, particularly toe. Vatabalasaka is due to the predominance of vata and severity of disease

Conclusion

Vata rakta is the finest example of Avarana Janya Vata Vyadhi. Due to its unique pathogenesis Vatarakta presents dynamic and contrasting features in both its Purvaroopa and its Roopavastha it typically affects the loco motor system along with the other systemic involvement. Dosha within the Rakta Marga is the prime pathology in Vatarakta.