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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 ...

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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  • A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASA AND LEKHANA BASTI IN VATARAKTA Patil K.V , 2006 -07, Introduction DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA, S.D.M. COLLEGE OF AYURVEDA, UDUPI – 574118 INTRODUCTION 1 Vatarakta comes under the domain of Vatavyadi and mostly affecting theextremities2. The umbrella of vatarakta in parlance with conventional medicine includesmany conditions related to extremities and to mention a few are connective tissuedisorders as well as peripheral vascular disorders. In the literature it is emphasized thatthe etiological factors leads to the predominant morbidity of vata dosa and rakta dhatuand hence the name vatarakta. To be more specific, the obstruction of raktamarga orraktavaha 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 themorbidity of the same with the involvement of raktamarga is about the first clinicalvariety of vatarakta4. The etiopathogenesis of second clinical variety is different fromthis. In the second clinical type instead of etiological factors of vata and rakta, it is theetiology of kapha and medas that initiates the illness. The etiological factors of kapha andmedas obviously lead to the morbidity of the same. This abnormally increased kapha andmedas in turn gets accumulated in the rakta marga causing the provocation of vata as wellas 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 indifferent systems. Prameha, Sonitadusti, hrdroga and vatavyadhi etc all are found to bedue to incriminatory affect of kapha and medas in respective systems6. Hence forth theconcept 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 symptomsin vatarakta. Further to add, sodhana, samana, bahiparimarjana and rasayana cikitsa allare aimed at the rectification of margavarna in this disease7. The whole concept ofmargavarana can be best explained by the pathology of atherosclerosis and peripheralvascular disease in modern parlance.Peripheral vascular diseases include arterial, venous as well as lymphatic disease, and theillness has a long lingering course. Inadaquate treatment or failure of treatment may leadto fatal complications. Further to add, obstructive arterial diseases are named after the 1
  • Introductionanatomical structure affected as coronary artetry disease, cerebro vascular disorders andIschemic limb diseases etc. Atherosclerosis is the chronic pathological process likely to be asymptomaticthroughout the life, and it may have a fatal course when the same pathology involves thevital organs, to mention few are heart, brain, gut etc. in contrast to this theatherosclerosis affecting the arteries of the extremities, most commonly related to the legsmay not have a fatal course since beginning. But, it is also true that the disease runs achronic course and may land in fatal complications. Atherosclerosis leading to narrowingof the arterial branches with in the legs manifests as ischemic limb disease and isabbreviated as ILD. Rectification of Hyperlipidemia, bringing down the hypertension,reducing the hyperglycemia and when essential surgical intervention likerevascularization or amputation, all these forms the sheet anchor of the management ofILD. Progressive atherosclerosis results in narrowing of the arterial lumen, hence thename arteriosclerosis obliterans to this unique illness. Peripheral arterial disease isanother name referring to the same. Survey studies have established highest prevalence ofthe 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 arterialinsufficiency. Prevalence increases with age as noted in recent national survey. theprevalence of PAD was found to be 29% in people over aged 70 yrs. the prevalence ratewas 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 withcoronary angiography estimated that approximately one half of the patients of peripheralarterial diseases present with clinical symptoms. More interestingly, life table analysishas 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 patientwho continue to smoke cigarettes or who have uncontrolled diabetes mellitus. Theseobservations of survey studies undeniably point towards the high prevalence as well asseriousness of the problem.Depending upon the involvement of deeper or superficial dhatu in the pathogenesis ofvatarakta, it is clinically catagorised into uttanavatarakta gambhira vatarakta as well as 2
  • Introductionubhayashrita vatarakta9. Gambhira vatarakta has poor prognosis and is usually incurable.The factors like, number of dosa involed, virulence of morbid dosa, involvement ofdeeper dhatu, age, physical status all determine the prognosis of the illness10.Previous Work DoneThe review of previous works done clearly indicate that there prevailed ambiguity in theunderstanding 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 orlekhana basti treatment.In a single blind comparative clinical study entitled “The effect of lekanabasti in themanagement of sthoulya”,1122 patients suffering from sthoulya were studied in twogroups as control and test. The patients in the test group received lekhana basti as well asmurchita taila anuvasana basti in kalabasti course of 16 days followed by oral medicationwith amrita guggulu for 30 days. The patients in the control group were subjected to oralmedication with amrita guggulu for 30 days. Following the medication statisticallysignificant improvement was observed in both the groups, however better response wasrecorded in patients of test group proving the efficacy of lekhna basti in patients sufferingfrom sthoulya.In patients suffering from sthoulya roga another single blind comparative clinical studyentitled “A clinical study on the management of sthoulya by panchatikta and lekhanabasti.”12was carried out . In this study 32 patients suffering from sthoulya were studied inthree groups. In group A 12 patients were orally treated with panchatikataguggulu vati ina dose of 6 gm per day for 45 days. 10 patients in group B received panchatiktaghanavatiorally in a dose of 6 gm per day for 45 days. Further in group C 10 patients weresubjected to lekhana basti treatment. The study showed best reduction in body weight aswell as lipid profile levels in patients treated with lekhana basti course.Yet another single blind comparative clinical study entitled “Conceptual study ofvatarakta vis-à-vis TAO & clinical management with manjishthadi kshara basti ”13, 20patients suffering from ischemic limb disease were studied in two groups. 10 patients ingroup A were treated with kaishora guggulu and arogyavardhini in a dose of 400 mg eachtrice daily for 3 months with the anupana of 30 ml of manjistadi kvatha . In the second 3
  • Introductiongroup B patients were initially subjected to yogabasti course of manjistadi ksara basti anddhanvantara taila anuvasana basti followed by oral medication. The study recorded bettertherapeutic response in patients treated with manjistadi ksara basti.The analysis of previous work done in different research and post graduation studycenters unravels the ambiguity about the clinical understanding as well as treatment ofvatarakta. Many of the clinical studies regarded musculoskeletal disorders likerheumatoid arthritis, gouty arthritis and osteoarthritis as vatarakta. In these works nosignificance is being given to the unique pathology of raktamargavarodha in vatarakta.Very little number of clinical works concentrated on vascular disease of the limbs asvatarakta. More specifically speaking TAO is regarded as vatarakta. Here also the overeating and sedentary habit as the cause of arterial disease / raktamargavarodha throughthe 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 showdefinite benefit in such chronic lingering disease. Kala basti and karma basti coursesappear better in chronic progressive disorders like vatarakta.This review indicate that there is a necessity to study vatarakta as peripheral arterialdisease and its management with both sodhana and shamana line treatment with the dueconsideration of its severity chronicity as well as possible complications. Distinct etiological factors of vatadosha as well as raktadhatu together is said tocause vatarakta. A variant form of vatarakta is also elaborated in Ayurvedic literature inwhich santarpana category factors are incriminated to cause the illness. In this type ofvata rakta it is said that morbid kaphadosha and medas get accumulated inraktavahasrotas14. Irrespective of employment of established treatment the illnesscontinues to run a chronic course affecting the middle aged and elderly people. Henceany work exploring the newer effective medication mentioned in the Ayurveda is theneed of the day. Present work entitled A Clinical Study to Evaluate the therapeutic effectof Vataraktantaka Rasa and Lekhan basti in vatarakta, is carried out with theconsideration that, the therapeutic measures that reduce kapha dosha and medas as wellas alleviate the morbid Vatadosha is the sheet anchor of treatment of vatarakta15. Basti isclaimed 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
  • Introductionindicated in santarpanajanya vatarakta17. The herbo-mineral compound vataraktantakarasa consisting mainly of guggulu, shilajatu and lauha is said to be effective in negatingthe incriminatory effect of morbid kapha dosa and medas and there by ensuring completecure 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 theetymological 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 andpathyapathya, all are found in the second chapter. The details of Vataraktantaka rasa and composition of Lekhana basti are briefed underthe 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 theclinical 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 Lekhanabasti 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 formany other enthusiastic physicians to find a better cure for this lingering disease affecting theextremities. 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. Theconclusions of which are like a pilgrim stranger tarrying for a while awaiting hisdestination. New observations are added to the total body of knowledge. Some of olderobservations loose their relevance or their significance. Ayurveda is no exception to thisrule, and particularly this holds good in case of VATA RAKTA. This surveillance ofAyurvedic 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 StudyIn Sushrutasamhita The explanation of nidana, purvarupa, rupa, samprapti and upadravaof Vatashonita is available at full length. It is opined that unttana and avagadha clinicalpresentation of vatarakta is not about its prakara rather avasthavishesha of vatarakta. Allmodalities of treatment for vataja, pittaja, kaphaja, sansargana, sannipataja variety ofvatarakta are explained in this book21.Sthoulya is listed as a major illness of santarpanottha vyadhi. The description of kaphamedovrddhi in rasarakta vaha srotas is most relavant to vatarakta. It is said that in thepresence of margavarana there is every risk of developing serious illness like pramehaand vatavyadhi. In addition to this silajatu guggulu triphala and gomutra is emphasized asmost efficacious in the management of sthoulya as well as margavarana. In the samecontext the attention is called to the therapeutic efficacy of lekhana basti in the reductionof kapha as well as medo dhatu22. Literature on vatarakta in bhela samhta is limited to thejust mentioning of treatment of raktagata vata as that of vatasonita23. Vivid description ofvatarakta 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 vataratka. 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 fulllength in gadanigrana26. In the similar manner the whole description of vatarakta is foundin vataraktadhikara in vangasena samhita27. The elaboration of vatarakta in astangasamgraha and asthanga hridaya follows the opinion of caraka samhita and sushrutasamhita. Further in this treatise the add-on description of sama and nirama stages of thevatarakta is worth mentioning.Samgraha kala – both diagnostic as well as therapeutic aspect of vatarakts in its entiretyis found in the books of samgraha kala, that include Sharangadhara samhita,Bhavaprakasha. Madhavanidana, Yogaratnakara and CakradattaThe lists of references from available literature in accordance to nidana panchaka wereenlisted below28 in 8
  • Conceptual StudyTable no. 1 Definitio Synonyms Aetiolog Pathogenis Type Purvarup Rup n y i s 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 thebooks of vedic period. Contrary to this entire aspect of the illness from nidana to cikitsais found in books of samhita as well as sangraha kala of the history. 9
  • Conceptual StudyPresentation 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 cardinalmanifestation of the illness. Sula, ruk, toda, arati, and ruja are the different modes of painthat may be present in vatarakta29. Further this pain may show a variation in terms of itsseverity in regards to time of the day, season or physical activity. Including the pain theclinical signs and symptoms of the disease may be differentiated as the one restricted tothe skin, or related to the deeper tissues. Altered tactile sensation is a major symptomrelated 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 thesymptoms all related to the skin. Pathogenesis when involves the joints, patient suffersfrom symptoms like joint pain, joint swelling, reduction in the range of movements andother manifestations related to the joints32. Progressive involvement of the deeper tissues is the characteristic feature of theillness vatarakta33 and is marked by the hard stable swelling, progressive change in thecolor of the skin from redness through bluish to blackish tinge. Later even suppurationensues in the affected part34.During the later stages of the illness few of the systemic symptoms may add to the list oflocal symptoms of vatarakta. Discolorations of the affected limb, edema, different type ofpain, deformities, suppuration, gangrene etc are few of the local symptoms. In contrast tothis, Later during the course of the illness the patient may develop symptoms likeabnormal respiration, hiccough, excessive unexplained thirst, insomnia and altered statesof consciousness in the form of bhrama mada, moha, murcha etc manifest as systemicsymptoms35.Role of medo dhatu in the pathogenesis of vatarakta Two distinct etiopathogenesis may cause the illness vatarakta. Individualetiological factors of vata dosa as well as rakta dhatu may culminate in the developmentof vatarakta and is the usual variety of vatarakta. Where in the morbid vata dosa as wellas vitiated rakta dhatu leads to the rakta margavarana and is the principal pathology of thevatarakta36. In other variety of vata rakta, to begin with there is no role of etiological 10
  • Conceptual Studyfactors of either vata dosa or rakta dhatu. Contrary to this the etiological factors of kaphadosa 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 bycontributing the principal pathology of raktamargavarana37. The similar qualities ofkapha and medo dhatu speeds up the pathogenesis as two factors support mutually38. Tobe precise, the santarpana category of etiological factors causes the morbidity of kaphadosa and medo dhatu, and these in turn accumulate in the raktamarga leading to theprovocation of vata dosa and finally manifesting as vata rakta.Needless to say depending upon the variation in the etiopathogeneiss the planning of thetreatment should differ. Rectification of morbid vata dosa as well as rakta dhatu is therational treatment in the first variety of vatarkata. Kapha medo hara line of treatment isthe sheet anchor of the treatment of santarpana nidana janya vatarakta39.The pathogenesis of raktamargavarana is best correlated with the arterial obstruction dueto the atherosclerosis. This phenomenon of accumulation of kapha and medas within thedhamani is also referred as dhamani praticaya in ayurvedic literature40. Abnormalaccumulation of the lipids in the arterial wall is the leading pathology of atheroscleroticobliterans. The most common symptom of ischemic limb disease that include intermittentclaudication, ache and cramps, altered sensation, changed skin color, obliterated arterialpulse, 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 lowerextremities41. These citations of similarities are more than enough to compare theischemic limb disease with the santarpana nidana janya vatarakta.Atherosclerosis is a specific form of arteriosclerosis affecting primarily the intima oflarge and medium-sized muscular arteries and is characterized by fibro fatty plaques oratheromas. The term atherosclerosis is derived from athero-( meaning porridge) referringto the soft lipid-rich material in the centre of atheroma, and sclerosis (scarring) referringto connective tissue in the plaques. Atherosclerosis is the commonest and the mostimportant of the arterial diseases. Though any large a medium-sized artery may beinvolved in atherosclerosis the most commonly affected are the aorta, the coronary andthe cerebral arterial systems. Therefore, the major clinical syndromes resulting fromischemia due atherosclerosis are the myocardial infarcts (heart attack ) and the cerebral 11
  • Conceptual Studyinfarcts (strokes); other less common sequel are peripheral vascular disease, aneurysmdilatation due to weakened arterial wall, chronic ischemic heart disease, ischemicencephalopathy ,an mesenteric occlusion and ischemic limb disease (ILD)The understanding of vatarakta is related to collagen diseases, gouty arthritis as well asischemic limb diseases. All these comparisons are justified based on analysis ofsymptoms of vatarakta and the diseases mentioned in conventional medicine. From theforegoing citations it is clear that ischemic limb disease is also best compared to vataraktain regards to its etiopathogensis as well as clinical findings. 12
  • Conceptual Study ETYMOLOGICAL DERIVATIONUnique concept of naming the disease is adopted in Ayurvedic literatures. Illnessoccurring at a specific location is named after the specific organ as in the diseasehridroga. In contrast to this several other disorders are named after the cardinal symptomas in atisara and shwasa. Where as the name vatarakta is coined on the basis of thesamprapti ghataka that is vata dosa and rakta dhatu involved in the disease. The sameopinion 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 47 krstnam samdushayet raktam tajneyam vatashonitam” morbid vata dosa whenobstructed by vitiated rakta dhatu, further becomes virulent and once agiain adds to theabnormality of rakta dhatu, this illness is called as vata shonita. • “kruddhotyartham maargarodhaat sa vayuhu atyudriktam dushayet raktamashu tat sampruktam vayuna dushitena tatprabalyat uchyate vataraktam”48Initially there occurs distinct morbidity of vata dosa and rakta dhatu. The morbid raktadhatu in turn obstruct the passage of vitiated vata dosa. Obstruction to the passage of vatadosa causes worsening of the morbidity of vatadosa. Continuing the pathology theseverly vitiated vata dosa also furthrer disturbs the morbid rakta dhatu. This illness isknown as vararakta. 13
  • Conceptual Study SYNONYMSAdhyavata, khudha vata, vatabalasa and vatasonita are the names used to refer the illnessvatarakta.“khuda desha praptya khudah, khudashabdena sandhiruchyate”49 as the disase vataraktainvolves 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 isdependant upon morbidity of rakta dhatu worsened by the obstructed vayu and hence isknown as vata balasha.“adhyanaam prayo bhavati iti adhyarogah”51 the word adhya refers to rich person. As thedisease is common in rich it is called as adhyavata. In the same meaning this illness isalso refered by the names adhyamaruta and adhya pavana. NIDANA 55Vata and rakta are invariably involved in the pathology of vatarakta. Morbid rakta dhatuwhen obstructs the vitiated vata dosha there will be further amplification of the virulence.Severely vitiated vatadosa in turn, badly influences the morbid rakta dhatu latermanifesting as vatarakta52. Parallel to this pathology, two distinct set of etiological factorstake part in the causation of the illness. One set of etiology leads to the vitiation of vatadosa and the other set separately causes morbidity of rakta dhatu. These distinct sets ofetiological factors may be related to ahara vihara or the one influencing the manas53. Inspite of this, in the variant form of vata rakta where in santarpana category of factorsleads to the abnormal accumulation of kapha as well as medo dhatu, and moreparticularly in the rakata marga culminates in the pathology of vata rakta54. Evidently inthis variety of vata rakta all the santarpana category of causes, similar to the etiology ofsthoulya and prameha take the leading role in the causation of the illness. Thus the list ofetiological fatctors in the following lines includes both the nidana of vatarakta as well asnidana of santarpana janya vikara.Aharaja nidana56: the dietetic factors that cause the morbidity of vata dosa as well asrakta 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 qualitytend to cause vatarakta. Further Ajeerna bhojana, viruddhasana, adhyasana, these habits 14
  • Conceptual Studyof 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 andmedas. Due to the similarity in the inherent qualities of kapha and medas, identicaletiologyical factors cause the morbidity of both kapha and medas. Further similarity inthe qualities of these two factors enhances the tendency of these two involving in dosadushya samurchanaa. It is an established fact that excessive nutrition and lack of physicalexercise together known as santarpana nidana contributes to the accumulation of kaphaand medas. Dietary factors like hayanaka, yavaka, chanaka, uddalaka, mukundaka,mahavrihi, pramodaka, sugandhaka, navanna (navadhanya) etc when consumedfrequently 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 accumulationof kapha and medas. Lack of physical and metal activity further adds to the pathology. 58Viharaja nidana – the behavioral factors that may lead to the vatarakta includeabhighata, 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 snehadicikitsavibhramanaetc factors precipitates morbidity of kapha and medas also. Manasika nidana –Akrodha, acinta, harshanityatva these factors incriminated to cause accumulation ofkapha and medas in the body59. To add the relavant literature from the modern counterpart60- Atherosclerosis iswidely prevalent in industrials countries. However, majority of the incidences quote inthe literature are based on the major clinical syndromes produced by it, the mostimportant interptation being that death from myocardial infarction related to underlyingatherosclerosis. Cardiovascular disease, mostly related to atherosclerotic coronary hedisease or ischemic heart disease (IHD) is the most common cause of death in thedeveloped countries the world. 15
  • Conceptual Study Extensive epidemiologic investigations on live populations have revealed anumber of risk factors which are associated with increased risk of developing clinicalatherosclerosis. Often, these risk factors are acting in combination rather than singly.These risk factors are divided into two groupsMajor 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 isminimal, and in some cases even uncertain.Apparently, a combination of etiologic risk factors has additive effect in producing thelesions of atherosclerosis.MAJOR CONSTITUTIONAL RISK FACTORSAge, sex and genetic influences do affect the appearance of lesions of atherosclerosis.1. AGE. Atherosclerosis is an age-related disease. Though early lesions of atherosclerosismay 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 decadethan in women and the difference slowly declines with age but remains higher at all agesin men. The lower incidence of IHD in women, especially in premenopausal age, isprobably due to high levels of oestrogen and high-density lipoproteins, both of whichhave anti-atherogenic influence.3.GENETIC FACTORS: Genetic factors play a significant role in atherogenesis.Hereditary genetic derangements of lipoprotein metabolism predispose the individual tohigh 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 FACTORSThere 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 underLow –density lipoprotein (LDL) is richest in cholesterol and has the maximumassociation with atherosclerosis.Very –low- density lipoprotein (VLDL) carries much of the triglycerides and has lessmarked effect than LDL.High-density lipoprotein (HDL) is protective ‘good cholesterol’ against atherosclerosis. Many studies have demonstrated the harmful effect of diet containing largerquantities of saturated fats (e.g. in eggs, meat, milk, butter etc) which raise the plasmacholesterol level. This type of diet is consumed more often by the affluent societies whoare at greater risk of developing atherosclerosis. On the contrary, a diet low in saturatedfats 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 totalnumber of calories from carbohydrates, proteins, alcohol and sweets has adverse effects.2. HYPERTENSION: Hypertension is the other major risk factor in the development ofatherosclerotic IHD and cerebrovascular disease. It acts probably mechanical injury to thearterial wall due to increased blood pressure. A systolic pressure of over 160 mm Hg or adiastolic pressure of over 95 mm Hg is associated with five times higher risk ofdeveloping IHD than in people with blood pressure within normal range (140/90 mm Hgor less).3. SMOKING: The extent and severity of atherosclerosis are much greater in smokesthan in non-smokes. Cigarette smoking is associated with higher risk of atheroscleroticIHD and sudden cardiac death. Men who smoke a pack of cigarettes a day are 3-5 timesmore likely to die of IHD than non-smokers. The increased risk and severity ofatherosclerosis in smokers is due to reduced level of HDL and accumulation of carbon 18
  • Conceptual Studymonoxide in the blood that produces carboxy-haemoglobin and eventually hypoxia in thearterial wall favoring atherosclerosis.4. DIABETES MELLITUS: Clinical manifestations of atherosclerosis are far morecommon 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 todevelop cerebrovascular disease is high, and frequency to develop gangrene of foot isabout 100 times increased. The causes of increased severity of atherosclerosis arecomplex and numerous which include increased aggregation of platelets, increased LDLand decreased HDL.MINOR FACTORSThere are a number of less important and minor risk factors having some role in theetiology of atherosclerosis. These are as under:1. Higher incidence of atherosclerosis in developed countries and low prevalence inunderdeveloped 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 endogenousoestrogen deficiency (e.g. in post-menopausal women) has been shown to have increasedrisk of developing myocardial infarction or stroke.4. Physical inactivity and lack of exercise are associated with the risk of developingatherosclerosis and its complications.5. Stressful life, style, termed as type A behavior pattern, characterized byaggressiveness, competitive drive, ambitiousness and a sense of urgency, is associatedwith enhanced risk of IHD compared with type B behaviors of relaxed and happy-golucky type.6. Recently role of infections, particularly of Chlamydiapneumoniae and viruses such asherpes 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 beenreported to have early atherosclerosis and coronary artery disease. 19
  • Conceptual Study8. Moderate consumption of alcohol appears to have slightly beneficial effect by raisingthe level of HDL cholesterol and by causing vasodilatation but the matter remainscontroversialIn a nut shell the etiological factors of kapha medo margavarana janya vatarakta as wellas atherosclerosis is more or less identical. Diet and behavioral factors leading toatherosclerosis can be best regarded as santarpana nidana of vatarakta causingaccumulation of kapha and medas with in the raktamarga. PURVARUPAThe movement of vatadosa is inhibited by the unique pathology of raktamargavarana invatarakta. This in term initially manifest with certain clinical signs and symptoms in theform 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 othermanifestations 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 partis regarded as one among the purvarupa of vatarakta. Sweat is one among the three malaand sweating is the function of svedavaha srotas. This swvedavaha srotas is spread outbetween roma kupa and medas in the twak62. Sweating in the svedavha srotas iscontrolled by samanavayu63. This morbid vatadosa is said to alter the physiology ofsvedavaha srotas manifesting either as excessive sweating of deficient sweating64.Alteration in the tactile sensation: twak is the abode of sparshendriya, and in the sametwak there is abundance of vata dosa. It is the vyana vayu that moderates thesparshanendriya for the tactile sensations. Morbidity of vatra dosa in vatarakta disturbsthis physiological functioning of the sparshanendrya leading to either supti - numbness orksate atiruk – hyperesthesia65.Alteration in the color of the skin: twak is said to have distinct six layers66. avabhasini isthe most superficial layer of the skin. The complexion as well as luster of the skin isimparted by this layer itself. Vitiated vatadosa when affects this layer of the skin thereoccurs abnormal coloration as well as lusture of the skin. This physiology is skincoloration is controlled by udanavayu67. The same happens in vata rakta. When themorbid vatadosa affects the avabhasini layer the patient may develop macule or patches 20
  • Conceptual Studyof discoloration. Reddish, pinkish, bluish or blackish coloration of the dermis mayhappen in vatarakta.Itching sensation: morbid vatadosa when brings about dryness of the skin patient is likelyto suffer from itching sensation. So also alteration in the sweating may contribute to thedevelopment of itching sensation in patients suffering from vatarakta68.Pain: pain is the major manifestation of the morbid vatadosa. Morbid vata dosa whenaffects the twak mamsa or rakta dhatu pain is a clinical manifestation. Toda, sula, bedhapindikodvestana, ksate atiruk spurana, intermittent occurrence of pain all may manifest inpatient 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 occursduring exercise and relieved by rest. The site of claudication is distal to the location ofocclusive lesion. Eg. Buttock, thighs, hip discomfort occurs in patient with aortoiliacdisease. Whereas calf claudication develops in patients with femoral popletial disease.The symptoms are far common in lower extremities than upper because higher number ofincidence 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 whenthe legs in dependent position.Joint pain: vitiated vata dosa in vatarakta also tend the involve the joints in vatarakta. Theinvolvement of joints is characterized by pain, heaviness swelling fasculations at oraround the joints like janu, uru, kati and hasta padanguli sandhi70.Constitutional symptoms: few of he constitutionl symptoms also mark the initial stage ofvatarakta like alasya, gaurava and sadana 71etc. 72More details of the purvarupa as listed in different literatures of ayurveda is shown inthe 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 asuttana (anavagadha)vata rakta. Involvement of deeper dhatu like asthi majja and sandhisignifies the gambhira (avagadha)vatarakta. A third variety of ubhayashrita vatarakta isalso mentioned in literature where in both the superficial as well as deeper dhatu isaffected. Vatarakta is a progressive disorder and hence initially the illness may be limitedto either superficial dhatu or deeper dhatu alone, but in the later stages the uttanavatarakta progresses to deeper dhatu. Similarly the gambhira vatarakta may involve thesuperficial dhatu in the later stages. Hence in the later stages the vatarakta develops asubhayashrita vatarakta74.The symptoms like kandu, daha, ruka, ayama, toda, sphurana, shyava/ rakta tvaka andsuch other symptoms probably limited to the twak indicates the uttana vatarakta75.Persistent hard swelling of the affected part, suppurations, involvement of sandhi asthiand majja, deformities like vakrata, khanja and pangu all these point towards thegambhira vataratka76.Presence of symptoms indicative of both uttana as well as gambhira vatarakta signifiesthe ubhayashrita vata rakta. Following table shows the exclusive symptoms of uttrana andgambhira vatarakat77.UTTANA VATARAKTA:Kandu itchingDaha burning sensationRuja pain 23
  • Conceptual StudyAyama (sira ayama) dilatation of the vesselsToda pricking painSpurana trembling or throbbing sensationKunchana (sira akunchana) contractionShyava twak cyanosis of the skinRakta twak reddish coloration of the skinBheda splitting type of painGourava heavinessSuptata numbness 78Table no 3: symptoms of uttana vatarakta 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 StudyGAMBHIRA VATARAKTA79:Svayatu stabdhata fixed swellingSvayatu kathinya hard swellingBhrisharthi excruciating deep painShyavatha cyanosis or pallorTamra twak coppery discolorationDaha burning sensationToda pricking type of painSphurana throbbing sensationPaka suppurationRuja painVidaha internal burning sensationVatasya sandyasthiMajjasu chindanniva. Aggravated vayu while causing pain-burning sensation constantly moves with high speed through the sandhi, asthi and majja.Kanjatwa lamenessPangutwa paraplegiaAdhika purvaruk increased painSwayatu grathita hard swellingVatasya sarva Shareera charana vitiated vata moves all over the bodyAngasya vakrikarana disfigurement of the partsTable 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 morbiddosa in the primary pathologly of vata and rakta and are named as vatadhika vatarakta,pittadhika vatrakta, kaphadhika vatarakta and raktadhika vatarakta. 26
  • Conceptual StudyVatadhika vatarakta80:Clinical symptoms when predominate the morbidity of vata dosa the vatdhika vatarakta isdiagnosed. Following are the symptoms suggestive of vatadhika vatarakta.Sirayama dilatation of vesselsSula painSpurana throbbing sensationToda pricking painShothasya karshnyam blackish discoloration of the swollen partShothasya roukshyam dryness of the skin overlying the swellingShothasya syavata bluish discoloration overlying the skinshyavata vriddi/hani frequent increase and decrease of bluish discolorationDhamani anguli sandi sankocha contraction of vessels and sandhiAngagraha stiffness of the affected partsAtiruk severe painStambana stiffnessSheeta pradhvesha aversion towards cold surroundingsSparshodwigna inability to tolerate the touchBheda splitting type of painPrashosha atrophySwapa numbnessSheetanupashaya worsening of symptoms on exposure to coldVepathu tremorsTable 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/haniDhamani anguli + - + + + + + +sandi sankocha. Anga graham + - + + + + + + Ati ruja + - + + + + + + Kunchana + - - - - - + + Stambhana + - + + + + + + Sheeta + - + + + + + + pradveshaSparshodvigna - + - - - - - - Bheda + - - - - - + + Swapa - + + + + + - - vepathu - - + + + + - -Pittadhika vatarakta81 –Diagnosis of pittadhika vatarakta is made when more symptoms indicative of morbidpitta dosa associate the symptoms of vatarakta. Following is the list of symptomssuggestive of pittadhika vatarakta.Vidaha severe burning sensationVedana pain 28
  • Conceptual StudyMurcha faintingSweda sweatingTrishna thirstMada irrelevant behaviorBrama giddinessPaka inflammation/suppurationRaga rednessBheda splitting type of painSosha atrophyUgra daha excruciating burning sensationAti ushnatwam increased local temperatureSophasya mridutwam soft swellingSammoha confusional or unconscious stateSparshakshamatwa hyperesthesiaTable 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 + - + + + + + + 29
  • 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 sufferingfrom vatarakta the diagnosis of kaphadika vatarakta is justified. Details of the symptomsof the same is listed below.Staimitya sensation as if the body part is covered with wet clothGourava heavinessSnehatwa unctuousnessSupti numbnessManda ruja mild painKandu itchingSwetata increased pallorSeetata coldnessSopha swellingStabdatwa stiffness 30
  • Conceptual StudyTable 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 83Symptoms pertaining to severe morbidity of rakta dhatu differentiate the raktadhikavatarakta from other varieties of vatarakta. Of course, for evident reasons there may bemuch overlap between the symptoms of pittadika vatarakta and raktadhika vatarakta.However following list of symptoms are unique manifestations of raktadhika vatarakta.Sotha swellingAti ruk severe painToda pricking painTamra varna coppery discolorationChimichimayana tingling sensationSnigdha rukshahishamam naiti poor remission of symptoms to snigdha ruksa line of management 31
  • Conceptual StudyKandu itchingKleda exudationTable 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 agiven 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 ofamadosa. Symptoms of ama if associates the symptoms of vatarakta then the condition isknown as sama vatarakta. If only the symptoms of vatarakta presents with out theassociation of symptoms of ama then the illness is referred as nirama vatarakta85. Thesymptoms of sama and nirama vatarakta is depicted in the table nosSAMPRAPTIDistinct etiological factors of vatadosa and rakta dhatu separately causes the morbidity ofvata dosa as well as abnormality of rakta dhatu. Morbid vata dosa furthrer incriminatesthe abnormal rakta dhatu. This abnormal rakata dhatu by way of raktamargavarana in turninhibits the movement of vata dosa leading to severe morbidity of vatadosa. This is 32
  • Conceptual Studymarked by development of clinical signs and symptoms. Thus the illness vataraktaclinically manifests. This is the general samprapti of vataraka in which theraktamargavarana is the final stage of the sampraapti86. This raktamargavaarana canhappen in a different way also. The santarpana category of etiological factors leads to theaccumulation of kapha and medas in the raktamarga there by causing raktamargavarana.Due to the establishment of raktamargavarana there occurs inhibition of movement ofvata dosa. Inhibition of vata culminates in severe morbidity of vata dosa and once againmanifesting 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 ofexcessive accumulation of kapha and medas in the body. Other than the vatarakta, thekapha and medas can cause different other diseases like vatavyadhi, hrdroga, gulma andprameha88. Thus presence of any of these diseases is also a strong clinical evidence ofabnormality of kapha and medas in a given patient. Corroborating the same, coexistenceof 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 theconcept of raktamargavarana due to abnormal kapha and medas in the disease vatarakta.The symptoms like excessive sweating or deficient sweating are indicative vitiation ofsamana vata. Altered sensations and decreased range of joint movements is in favour ofmorbidity 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 thelater 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 therakta dhatu. The same is also suggestive of abnormality of raktavaha srotas. Appreciationof the dhamani praticaya also corroborates the same.Margavarana tending inhibition of movement of vatadosa in the raktamarga being theprime 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 ofmamsa dhatu sandhi shoola are the symptoms pathognomonic of morbid asthi dhatu92. 33
  • Conceptual StudyInvolvement of majja dhatu is identified by the presence of symptoms like murchya 93etc.Excessive or deficient sweating is indicative of involvement of both sweda andsvedavaha srotas in the pathogenesis of vatarakta94.Affliction of dhatu like twak, rakta etc is suggestive of relationship of bahyarogamarga inthe disease. In contrast to this presence of symptoms evocative of affliction of sandhicorroborates the relationship of madhyama rogamarga in vatarakta95.Occurance of constitutional symptoms like jvara, alasya etc. affirms the sarvasharira asthe sanchara sthana of the dosha. In spite of this fact, it is stated that the morbid dosa tendto circulate in the lower limbs to a larger extent.Add to this from the modern paralance of atherosclerosis96 - Most atheroma produces nosymptoms, and many never cause clinical manifestations. Numerous patients with diffuseatherosclerosis may succumb to unrelated illness without ever having experiencedclinically significant manifestations of atherosclerosis. What accounts for this variabilityin the clinical expression of atherosclerotic disease, here is the explanation - Arterialremodeling during atheroma formation represents a frequently overlooked but clinicallyimportant feature of lesion evolution. During the initial phases of atheroma development,the plaque usually grows outward, in an abluminal direction. Vessels affected byatherogenesis tend to increase in diameter, a phenomenon known as compensatoryenlargement, a type of vascular remodeling. The growing atheroma does not encroachupon the arterial lumen until the burden of atherosclerotic plaque exceeds approximately40% of the area encompassed by the internal elastic lamina. Thus, during much of its lifehistory, an atheroma will not cause stenosis that can limit issue perfusion.Flow limiting stenoses commonly form later in the history of the plaque. Many suchplaques cause stable syndromes such as demand induced angina pectoris or intermittentclaudicating in the extremities. In the coronary and other circulations, even occlusion dueto atheroma does not invariably lead to infarction. The hypoxic stimulus of repeatedbouts of ischemia characteristically induces formation of collateral vessels in themyocardium, mitigating the consequences of an acute occlusion of an epicardial coronaryartery. On the other hand, we now appreciate that many lesions may produce onlyminimal luminal irregularities on traditional angiograms and often do not meet thetraditional criteria for “significance” by arteriography. Instability of such nonocclusive 34
  • Conceptual Studystenoses may explain the frequency of myocardial infarction as an initial manifestation ofcoronary artery disease (in at least a third of cases) in patients who report no prior historyof angina pectoris, a syndrome usually caused by flow-limiting stenosesSamprapti 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 margaUPASHAYA – ANUPASHAYA Morbidity of the vatadosa is the basic pathology of the illness. And the same to a largerextent determines the upasaya and anupasaya in vatarakta. Accordingly the exposure to warmsurrounding, rest and application of sneha tend to cause remission of the symptoms, where asexposure to cold surrounding and physical exercise tend to worsen the symptoms of vatarakta97. 35
  • Conceptual StudyUshna upasaya: sita is the inherent quality of vata dosa. Elevation of the sita quality is likelyincrease the morbidity of vata dosa. This is best counteracted by the heat. Thus exposure towarm environment brings about comfort to the patient.Sita anupasaya: cold environment further worsens the morbidity of vatadosa. Hence exposureto cold is considered as anupasaya. This intolerance is verymuch pronounced in the vatadhikavatarakta.Anayasa upashaya: any form of exercise increases the vatadosa and also rest pecifies the vatadosa, hence camkramana98is listed as a nidana of vatarakta. Needless to say theAyasa anupashaya: as exercise increases vatadosa symptoms of vatarakta tend to worsenfollowing exerciseSnigdha upasaya: ruksha is the inherent quality of vatadosa and is best neutralize by snigdhacikitsa. Thus applicateion of sneha is a upasaya in vatarakta. Contrary to this severe morbidityof rakta when present even snigdha chikitsa does cuase remission of symptoms of vataraktaRuksa anupasaya: any measures that increase ruksata in the body increases vata dosa and henceworsens the symptom of vatarakta99.UPADRAVA 100 The disease vatarakta is a lingering disease and tend to run a chroniccourse.basically vata dosa and rakta dhatu is involved in the pathogenesis., as the diseaseprogresses it tend to involve deeper tissues like asthi majja and sandhi. Accordinglyduring the later course the patent may even suffer from several upadravas. Followinglines 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 36
  • 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 indigestionLocalized complication Mamsakotha necrosis of tissue Pangulya paraplegia Visarpa cellulites Paka suppuration Toda pricking pain Anguli vakrata disfigurement of digits Spota eruptions 37
  • Conceptual StudyDaha burning sensation in footVisarana necrosisSankocha contracturesTable 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 + - + + + + + - 38
  • 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 orabsence of upadrava’s as well as chronicity of disease. The same in regards ot vatarakta iselaborated in the following linesSADHYA – 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 pathogenesisAbsence of upadravaVatarakta of one year durationPhysically strong patient, having enough resources to undergo best available treatment.ASADHYA- following factors in vatarakta determine its incurability. 39
  • Conceptual StudyInvolvement of all the three dosa in the pathogenesisPresence of upadravaPresence of specific symptoms indicative of incurability like ajanausphutitaTable 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 + - + + + + + - 40
  • Conceptual StudySAPEKSHA NIDANA :Symptom around the joints is the cardinal manifestation of the diseases sandhigatavataand amavata and thus these diseases need to be differentiated from the vatarakta. Inaddition to this the skin manifestation of the kusta is akin to the same present in thevatarakta. Hence the kusta should be distinguished from the vatarakta again. Differentialdiagnosis is best made by the analysis of the samprapti ghataka as well as clinicalmanifestations 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 characteristicfeature of sandhigata vata. Absence of symptoms indicative of morbidity of rakta dhatuor ama is also characteristic. Thus vatarakta, and kustha is best differentiated fromsandhigata vata as the later does not present with symptoms suggestive of affliction ofrakta dhatu. Symptoms indicative of rakta dhatu involvement is mandatory for thediagnosis 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 beforethe involvement of joints. Thus the purvarupa helps in the differentiation of thesediseases. Presence of typical purvarupa is unique feature of vatarakta and the presence ofwhich excludes both amavata as well as sandhigata vata.Initial involvement of lower limbs followed by progressive spreading of illness to otherparts of the body is characteristic of vatarakta104. Such a progression of illness is lessevident or absent in sandhigata vata.Illness is limited to the joints in sandhigata vata. But this is not true in kustha andvatarakta as the structures in-between the joints are also affected in these diseases.Intermittent nature of joint pain, more particularly pain occurring on movement ischaracteristic of sandhigata vata. Where as in amavata and vatarkta the pain is more orless continuous, and is even felt at rest. Intermittent nature of pain is also found invataratka, but the pain is felt at rest disturbing the sleep. 41
  • Conceptual StudyDuring the chronic course of the illness the patient of sandhigata vata never developpaka, kotha or anganasha, but such a sequel is possible both in kushta and vatarakta. Thusthe presence or absence of such an upadrava is a useful criterion for the differentialdiagnosis.Affliction of joint alone is the characteristic feature of the sandhigata vata. Where as bothamavata as well as vatarakta presents with many other constitutional symptoms that helpsin the differentiation of these diseases.Amavata:Joint pain joint swelling and limitation of joint movement characterizes the diseaseamavata 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, worseningon application of fat substances, sever symptoms during morning hours, on a cloudy dayand at night times is indicative of amavata105. Contrary to this in vatarakta as well assandhigata vata there occur morbidity of vata dosa which is not associated with ama andhence symptoms remit on application of oil. There may be little difficulty indifferentiating amavata if the patient is suffering from sama vatarakta.Symptoms related to morbid rakta dhatu like discoloration of the skin is distinctive ofvatarakta. Absence of symptoms indicative of morbidity of rakta dhatu is suggestive ofamavata.Premonitory symptoms related to the skin of the affected part is the typical feature ofvatarakta and is absent in amavata. Thus joint manifestation with out purvarupa isindicatieve of amavata.About the course of the illness, amavata tend to begine from the kati region and thenspreads to different other joints or location of kapha dosa106. Contrary to this, vataraktatend to begine from the legs and then spreads to other locations and does not show anypredilection for location of kapha dosa.KusthaThe purvarupa of kusta is some what identical to the one found in vatarakta and hence itshould be differentiated107. Among the 7 maha kustha and 11 ksudra kusta only the maha 42
  • Conceptual Studykustha manifests with prior appearance of purvarupa. Hence there will not be anydifficulty in differentiating ksudra kustha from vatarakta.In maha kusta symptoms indicative of saptadravya is characteristic108. In vatarakta thesymptoms pathognomonic of vata dosa and rakta dhatu predominate. This gives the cluefor differential diagnosisThe site of development of kustha does not show any predilection, rather it can happen inany location and more or less restricted to bahya roga marga. Spread of vataratka show atypical pattern, it begins in the lower limbs and then spreads to different other locationinvolving the madhyma roga marga. This nature of the illness can be considered for thedifferential diagnosis.Kustha is contagious disorder109, and hence patient of kustha roga may give the familyhistory of the same. Vatarakta is non communicable and hence the family history may benegative in this regard.Incidence of the illness vatarakta is more among the rich110. The incidence of kustha inrich and poor is alike. Thus socioeconomic status of the patient may be a corroboratoryevidence for the diagnosis of vatarakta.Corse of the illness varies in these diseases. Though the purvarupa of kushta andvataratkta is identical to some extent; the rupa stage shows the marked difference. Hencethe rupa stage does not pose any problem in differentiation of these two diseases.Investigations:Blood: Routine examination of blood including hemoglobin estimation (low HB% candecrease 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 ofpatients. 43
  • Conceptual StudyBlood urea and Serum creatinine are the kidney function tests need to carry out as manypatient suffers from diabetes mellitus and to rule out micro vascular complications ofdiabetes 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 cholesterolusually measured after 12 hours of overnight fast. Abnormalities in plasma lipoproteinsand derangements in lipid metabolism ranks as the most firmly established and bestunderstood 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 serumcholesterol levels above 260 mg / dl in men and women between 30 and 50 years of agehas three times higher risk of developing IHD as compared with people with serumcholesterol levels within normal limits. The major classes of lipoprotein particles are chylomicrons, very-low densitylipoproteins (VLDL), low- density lipoproteins (LDL), and high-density lipoproteins(HDL). Low –density lipoprotein (LDL) is richest in cholesterol and has the maximumassociation with atherosclerosis. The cholesterol in LDL accounts for 70 % of plasmacholesterol in most indusials. So is bad cholesterol. Normal value of LDL cholesterol is65-150 mg / dl. Very –low- density lipoprotein (VLDL) carries much of the triglycerides and has lessmarked 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 ofperipheral cells to the liver by the process termed as reverse cholesterol transport and 44
  • Conceptual Studyfrom 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 LDLcholesterol 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 offrequency in the reflected beam, as compared with the transmitted beam, are due to“Doppler shift” resulting from passage of beam through moving blood. These frequencychanges are converted into audio signals. This investigation may be used effectively incases where a differential diagnosis of atherosclerosis is entertained showing the site ofblock & 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 StudyArteriography: 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 andmedium sized arteries which are not suitable for anatomic reconstruction. In thisconditions 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 vataraktaAntahparimarjana cikitsaRaktamoksana111 – raktamargavarana is the predominant pathology of vatarakta and thisleads to the accumulation of morbid rakta. Hence raktamoksana is considered as first lineof treatment of vatarakta. Raktamkoksana may be achieved by any of thesringavacarana,jalokavacaraba suchivyadha,alabuavacarana, pracchana and siramoksamethods. Raktamoksana by the jalaukavacarna method is preferred if the affected siteexhibits symptoms like ruk, daha toda and sula. Sringavacarana is the better choice if thepatient of vatarakta has symptoms like supti kandu cimacimayana etc. if the illnessprogress with spreading, raktamoksana by pracchana method is the better option. Thoughthe raktamoksana is the primary treatment of vataramkta excessive bleeding may furthervitiate the vata dosa of vatarakta hence frequent employment of raktamoksana in small 46
  • Conceptual Studyamounts is always justified. Improper or excessive employment of raktmoksana may leadto development sever complications like vatavyadhi. There fore one must be verycautious while planning the raktamoksana in patients suffering from vatarakta.Langhana112 – langhana cikitsa is advocated if the morbidity of kapha dosa associates thepathology of vatarakta. Langhana when employed reduces the morbidity of kapha dosa inkaphanuga type of vatarakta. Further, if the margavarna in vatarakta is due toaccumulation of kapha and medas langhana treatment is very much beneficial for evidentreasons.Snehapana – both shodhananga sneha as well as samananga sneha is indicated invatarakta. As preparation of patient prior to vamana or virecana patient is subjected toshodhananga sneha. Further in vatottara vatarakta following sodhana proceduresnehapana with purana grita is ideal113. Snehapana is not ideal if the patient of vataraktaexhibits excessive sneha in his body. Also in case of margavarana due to accumulation ofkapha and medas snehapana is contraindicated114.Vamana – vamana is indicated as a shodhana procedure in vatarakta. In a patient ofvatarakta if the lesions are located in the upper extremities it is suggestive of associationof morbid kapha and pitta dosa. Shodhana by vamana procedure is a better option in suchsituations115. 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 inthe patient’s body. In snigdha person vamana is carried out with minimal or no priorsnehapana. In patients with ruksata in the body, employment of vamana karma with priorsnehapana is ideal116. One should remember that, as the vatarakta is the disorder withpredominant vitiation of vata dosa, only mrudu vamana is justified as tikshna vamanatend to increase the morbidity of vatadosa.Virecana117- both snigdha virecana as well as ruksa virecana is indicated in vatarakta. Ifthe patients body exhibits snigdhata, ruksa virecana is ideal. Contrary to this if thepatient’s body exhibits rukshata in the body it is better to plan snigdha virecana. Astikshan virecana tend worsen the morbidity of vatadosa, mrdu virecana is always justifiedin patients suffering from vatarakta. Pittanuga and raktanuga types of vatarakta is bettertreated by virecana karma. Further if the involvement of upper limb is present in a patientof vatarakta, which indicates association kapha and pitta dosa in the pathogenesis of 47
  • Conceptual Studyvatarakta virecana is preferred as shodhana treatment118. Ruksaha virecana is also ideal inpatents suffering from margavarana due to morbidity of kapha and medas.Basti karma – basti karma is regarded as best treatment in patients suffering fromvatarakta119. Basti karma includes both asthapana basti as well as anuvasana basti. Thisdisease when an effect the legs, indicative of predominant vata vitiation basti is the bestoption120 Vatanuga vatarakta is better treated by basti cikitsa. The symptoms like bastisula, vanksanasula, parshvasula and udara sula when present basti is the treatment ofchoice. 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 isindicated as this basti is capabale of clearing the margavarana along with negating thedetrimental effect morbid vata dosa122.Rasayana: administration of rasayana cikitsa is very important as the disease isprogressive and runs a chronic course. Vardhamana pippali rasayana or ksheerabala tailais advised in patients suffering from vatarakta123. Further if the margavarana is due toaccumulation of kapha and medas administration of silajatu guggulu and makshika dhatuin 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 orubhayasrita vatarakta125. More details of bahiparimarjana cikitsa is given in the followinglines.Pariseka – depending upon the requirement either ushna parisheka or sita parisheka iscarried out on the affected part in patients suffering from vataraka. Dominance of vatadosa when present characterized by severe pain in the affected part, then ushna parishekashould be prescribed126. Contrary to this if daha is the symptom due to predominance ofpitta dosa and rakta dhatu, sita parisheka is ideal to relieve the discomfort127.Abhyanga: treatment with abhyanga over the affected part is planned according to thepresence of symptoms or the dominance of affected dosa. Warm oil processed withvatahara drugs is used for abhynga if the patient complains of severe pain due to vitiationof vata dosa. Cold application of the ghrita processed with pittahara drugs is ideal if thepatient complains of burning sensation due to morbidity of pitta dosa or rakta dhatu. If 48
  • Conceptual Studykandu is the leading symptom due to morbid kapha dosa oil processed with kaphaharadrugs is used in the form of abhyanga128.Pradeha: pradeha cikitsa is planned according to the relative dominance of dosainvolved. 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 tomorbid vata dosa. Medicinal paste prepared by adding ghrita applied cool on the affectedpart if the patient has burning sensation due to morbid pitta dosa. Medicinal pasteprepared with herbs having ushna quality is preferred if relative dominance of kaphadosaor vatakapha dosha is identified129.Upanahana: specific herbal powder made into a paste by the addition of kanji or suchother liquids is applied when warm as upanaha, and is very useful in relieving pain due tomorbid vata dosa130.Sastra pranidhana: severe morbidity of pitta dosa and rakta dhatu may lead tosuppuration at the affected part. This may lead to ulceration and pus discharge. In suchconditions Bhedana sodhana and ropana measures have been carried out131.Agraushadi: Amruta132Formulations useful in vatarakta:Svarasa: Guduchi svaras133Churna: 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 StudyAsavarishta : 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 147PATHYA AHARASuka dhanya varga: Shastica shali (Oryza sativa grown in 60 days), Yava (Hordeumvulgara), 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 wildanimals), 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 sugarTaila varga: Tila taila (sesaman oil), Sarshapa taila (mustard oil), Bilva taila (taila extractedfrom aegle marmilos)Harita varga: Jivanthi (Lepta denia reticulata), Gostani (vitis vinefera), Maricha (Pipernigrum), Pippali (piper longum), Shunti (Zingiber officinale), Mulaka (Raphanu sativus),Balamula (root of cida cordifol, Vataraktamardha (Cassia occidentalis), Yusha (soup) preparedwith 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 StudyAPATHYA 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 JalaPhalavarga: 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 RajoMarga 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 margavaranadue 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 vatarakta2. 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 andingredients of Lekhana Basti are compiled, and discussed Vataraktantaka Rasa 148: Vataraktantaka rasa as explained in Bhaishajya ratnavali is a Khalvirasayana with aunique herbomineral combinations of drugs to treat Vatarakta. The name suggests that it is arasa preparation, as it contains rasa (mercury) as an ingredient. Shilajatu , guggulu ,Lauhabhasma are the main ingraident targeted specifically for kapha medasavarana inraktavaha srotasa.these ingredients are treated with each three bhavana of bhringaraja svarasaand 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 ofvataraktantaka 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 formof Nasya,Pana,Basti,Abhyanjana. In the present clinical trial this oil is used for Anvasan Bastias part of Kaalabasti course of Lekhana Basti. By using Yasthimadhu kalka and ksheera,Ksheerapaka prepared,.taila paka is prepared by using ksheerapaka and murchitatilataila andMadhuka pushpa kalka is added during tailapaka. For the present study 25 lit of oil wasprepared in S.D.M. Ayurvedic pharmacy, Kuthapady, Udupi, Karnataka.. And is packed in 200ml 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 kaphaand medasa. The mixing of ingredients done as quantity mentioned in table with sequence ofmadhu , saindhava lavana ,murchita tilataila, kalka, triphala kvatha and gomutra, . Theingredients 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 ReviewDravya-Pippali 157Paryaya - Maagadhi, kruShna, vaidehi, ushanaLatin name- Piper longamaUpyuktanga - Mula, phalaRasa- KatuVirya- SheetaVipaaka - MadhuraDoshaghnata - Kapha,vataDravya-Maricha158Paryaya - Vallija, ushana krushna kolaLatin name- Piper nigrum.Upyuktanga - Phala.Rasa- Katu, tiktaVirya- UshnaVipaaka - KatuDoshaghnata - Kapha,vata. Dravya- Punarnavaa 159Paryaya - Katilla, shothaghni vishaakhaLatin name- Boerhavia diffusaUpyuktanga - Mula,patra, panchangaRasa - Katu,tikta,kashayaVirya- UshnaVipaaka - KatuDohaghnata - Kapha,vaata 160 Dravya-DevadaaruParyaya - Suradaaru kilima,bhadradaaru UtikaashtaLatin name- Cedrusa deodarUpyuktanga - KashthaRasa- 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 - KaphapittaDravya -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 , kushtanashakaDrug name- Haratala168. English name- Yellow arsenic / Orpiment.Symbol - As2S3Rasa – 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, shvasaDrug 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 , VishapahaDrug name-Lauha 170.English name - IronLatin name- Ferrum.Symbol - FeRasa - Nirasa 58
  • Drug ReviewKarma – 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-Shilajatu172English 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 - Cuso47H2OKarma – 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 ,PlihaDrug 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 - AsafoetidaLatin 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 VataraktaSource 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 20Patients who fulfilled the below mentioned criteria of inclusion were taken for thestudy. While selecting these 20 patients care was also taken to see that there was noany factor in these patients listed in the exclusion criteria. The selected patient’sdetailed profile is prepared as per the detailed proforma designed for the samepurpose, 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 inclusioncriteria-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 criteriaThe patients suffering from Vatarakta showing the presence of following criteria wereexcluded from the study The patients with severe toxicity, progressive gangrenous changes in vicinity areexcluded 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 daysMETHOD 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 mlProcedure 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 nadiswedawas carried out on the lower abdomen, back, thighs and buttocks. Swedana is continueduntil the patient developed the samyak svinna laksana.Pradhana karma -Patient was asked to lie down in left lateral position on the treatment table. Buttock andanal region is undressed. And in this position the patient is asked to flex his right hip andknee so that the right ankle resting on the extended left leg. For comfort, patient is askedto keep his left hand beneath the head. This is the position of the patient for administeringthe basti. 63
  • Clinical StudyThe enema can was filled with the basti dravya, following this some amount of bastidravya 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 thenozzle into to anal canal.The anal area of the patient is smeared with oil and then the enema can nozzle is gentlyinserted into the anal canal for a length of about 5 angula. The enema can is then raisedfor about 3 feet, to allow the basti dravya to escape into the rectum by means ofgravitational force. When the enema can is emptying into the rectum the patient is askedto deep breathing. When little amount of basti dravya is still left in the enema can, thenozzle is closed and then withdrawn from the anal canal. This prevents escape of air intothe rectum.Following the administration the patient is asked to change his position from left lateralto prone, and then from prone to rt lateral and lastly form the right lateral to the supineposition. In this position the patient is asked to rub his hands against each other. Thetherapist 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 ofdefecation. After defecation the patient was allowed to take hot water bath and lightfoods. The patient was then observed to assess the proper, excessive or poor effect of thebasti. 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 sameas 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 orotherwise was determined by adopting the standard methods of scoring for subjective,objective and special investigation criteria. The margavarana was assessed both beforeand after the intervention to note any change by using the arterial Doppler study. Lipid 64
  • Clinical Studyprofile was also studied before and after the treatment. The details of the assessmentcriteria 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 0Assessment 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 OBSERVATIONSA total of 20 patients suffering from Vatarakta fulfilling the inclusion criteria were takenfor the study. All these 20 patients who were registered have completed the stipulatedschedule 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 elaboratedin 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 AnalysisDescriptive statistical analysis of 20 patients of Vatarakta includes the followinginformation. • 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 etcDetails of the same is given in the following pages 67
  • ObservationDistribution of 20 Patients According to Age: Out of 20 patients of Vataraktastudied in this work, maximum number of 10 (50 %) patients belonged to the agegroup of 51to 60 years and 5 (25%) number of patients were belonging to 41 to50 years and 61 to 70 years age group. The details are given in the Table No. 16and fig. No. 1Table 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 25Figure No. 01 - Distribution of 20 patients according to different agegroup % of Patients 25 25 41-50 51-60 61-70 50 68
  • ObservationDistribution of 20 Patients According to their Sex:12 (60%) of patients of Vatarakta were males as against only 8(40.%) of females in thepresent 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 40Figure No. 02 - Distribution of 20 patients according to sex % of Patients 40 Male Female 60 69
  • ObservationDistribution 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 ChristiansTable No. 18 - Distribution of 20 patients according to religionRelegion of patients No.of patients %Hindu 16 80Muslim 02 10Christian 02 10Figure No. 03 - Distribution of 20 patients according to religion % of Patients 10 10 Hindu Muslim Christian 80 70
  • ObservationDistribution 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 10Figure No. 04 - Distribution of 20 patients according to Marital status % of Patients 0 10 married Unmarried Widowed 90 71
  • ObservationDistribution of 20 Patients According to Literacy:Prevalence of literates was recorded in the present study involving 20 patients ofVatarakta.25% of the patients were illiterates and the remaining 75%of patients hadeducation, 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 10Figure No. 05 - Distribution of 20 patients according to Literacy % of Patients 10 35 25 Illitrate U.G. Graduate P.G. 30 72
  • ObservationDistribution of 20 Patients According to their Occupation:It is observed that 7 (35%) of the females in this study were house wives by theiroccupation. Also, this formed the largest category of patients leaving behind the patientsengaged in other occupations. There were only 3(15%) patients in the agriculturecategory 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 35Figure No. 6 - Distribution of 20 patients according to Occupation % of Patients 35 15 Agriculter Business Employee Hous.Wif 25 25 73
  • ObservationDistribution of 20 Patients According to Socio-economical status :The study revealed that most of the patients belonged to middle socio-economic statusi.e.14 (70%) against the upper socio-economic status which comprised 4(20%). Thedetails 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 20Figure No. 07 - Distribution of 20 patients according to different Socio-economicstatus % of Patients 20 10 Lower Middle Upper 70 74
  • ObservationDistribution of 20 Patients According to Mode of Onset of the illness: Out of 20patients suffering from Vatarakta taken for the study, 10 (50%) patients had gradualonset of the disease, None of the patient had a sudden onset of illness. Details are givenin 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 0Figure No. 08 - Distribution of 20 patients according to different Mode of Onset ofthe illness % of Patients 0 50 Gradual Insidious Sudden 50 75
  • ObservationDistribution of 20 Patients According to the associated Illness : it is observed that amaximum of 9 (45.%) patients had diabetes mellitus and hypertension as associatedillness, whereas only 2 (10%) patients had a hypertension and 6 ( 30%) patients haddiabetes mellitus as associated disease. The details are given in Table no 24 andFig.no 9Table 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 20Figure No. 09 - Distribution of 20 patients according to different associated illness % of Patients 20 25 D.M. H.T.N. D.M.+H.T None 45 10 76
  • ObservationDistribution of 20 Patients According to the type of Dietary Habits:Maximum 65% of patients were having mixed diet and 35% patients werevegetarians. 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 35Figure No. 10 - Distribution of 20 patients according to different Dietary Habits % of Patients 35 Mixed Veg. 65 77
  • ObservationDistribution of 20 Patients According to Dominant Rasa in Ahara : 55% hadcomsumption of food stuffs dominant of madhura rasa, 40% were consuming more ofkatu rasa Ahara and only 1 patient was dominantly taking lavana rasa. Details are givenin Table no 26 and fig. no 11Table 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 40Figure No. 11 - Distribution of 20 patients according to different dominant rasa inAhara % of Patients 40 Madhura Lavana Katu 5 55 78
  • ObservationDistribution of 20 Patients According to their Addictions: Large percentage ofpatients in this study had none of addiction . Only 1 (5%) patient reported addiction toalcohol ,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 65Figure No. 12 - Distribution of 20 patients according to different Addictions % of Patients 5 10 Alcohole 65 Smoking Alc+Smo None 20 79
  • ObservationDistribution of 20 Patients According to Prakriti : All the patients in the present studybelonged 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 ofkaphaPitta Prakriti. Table No. 28 and fig. No. 13 give the details.Table No. 28 : Distribution of 20 Patients According to PrakritiPrakriti No. of patients % of patientsVP 3 15KP 12 60VK 5 25Figure No.13 - Distribution of 20 patients according to different Prakriti % of Patients 25 15 VP KP VK 60 80
  • ObservationDistribution of 20 Patients According to Dhatu Sara : The assessment of Sara in 20patients of Vatarakta showed maximum number of patients having Madhyama Sara20(100%) . Incidence of patients according to their Sara is detailed in the Table No. 29and fig. No. 14Table No. 29: Distribution of 20 Patients According to Sara Sara No. of patients % of patients Pravara 00 00 Madhyama 20 100 Avara 00 00Figure No. 14- Distribution of 20 patients according to different Sara % of Patients 0 Pravar Madhyam Avara 100 81
  • ObservationDistribution of 20 Patients According to Samhanana : Samhanana of every patientwas 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. 15Table No. 30 Distribution of 20 Patients According to SamhananaSara No. of patients % of patientsPravara 00 00Madhyama 20 100Avara 00 00Figure No. 15- Distribution of 20 patients according to different Samhanana % of Patients 0 Pravar Madhya m Avara 100 82
  • ObservationDistribution of 20 Patients According to Satmya : Observation of 20 patients ofVatarakta revealed that no patient had Pravara Satmya, 14 (70%) of patients showedMadhyama Satmya and the remaining 6 (30%) of patients showed Avara Satmya. TableNo. 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 30Figure No. 16 - Distribution of 20 patients according to different Satmya % of Patients 30 0 Pravar Madhyam Avara 70 83
  • ObservationDistribution of 20 Patients According to Satva : Majority of 12 (60%) patients belongto Madhyama Satva, 1 (5%) were of Pravara Satva and 7 (35%) were of Avara Satva inthis study. The details are shown in Table No. 32 and fig No. 17Table No. 32: Distribution of 20 Patients According to Satva Satva No. of patients % of patients Pravara 7 35 Madhyama 12 60 Avara 1 5Figure No. 17 - Distribution of 20 patients according to different Satva % of Patients 5 Pravar Madhya m 60 35 Avara 84
  • ObservationDistribution According to Ahara Abhyavaharana and Jarana Shakti in patients ofVatarakta: Interrogation of the 20 patients of Vatarakta revealed that 16 (80%) of thepatients had Madhyama Abhyavaharana Shakti and 2 (10%) patients had PravaraAbhyavaharan Shakti. The remaining 2 (10%) patients had Avara Abhyavaharan ShaktiDetails are given in the Table No. 33 and fig. No. 18Table No. 33: Distribution According to Ahara Abhyavaharana and Jarana Shaktiin patients of Vatarakta Abhyavaharana and Jarana Shakti No. of patients % of patients Pravara 2 10 Madhyama 16 80 Avara 2 10Figure No. 18. - Distribution of 20 patients according to different AharaAbhyavaharana and Jarana Shakti in patients of Vatarakta % of Patients 10 10 Pravar Madhya m Avara 80 85
  • ObservationDistribution According to Vyayama Shakti in patients of Vatarakta : MadhyamaVyayama Shakti is recorded in 10 (50%) of patients. 4 (20%) of the patients had AvaraVyayama Shakti and the remaining 6 (30%) patients had Pravara Vyayama Shakti. Thesame 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 20Figure No.19 - Distribution of 20 patients according to different Vyayama Shakti inpatients % of Patients 20 Pravar 30 Madhya m Avara 50 86
  • ObservationDistribution According to Pramana of patients : Amongst the 20 patients taken inthis study all 20 (100%) belonged to Madhyama pramana. None of the patient was formthe pravara and Avara pramana category. This has been shown in Table No. 35 andGraph 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 0Figure No. 20 - Distribution of 20 patients according to different Pramana ofpatients % of Patients 0 Pravar Madhyam Avara 100 87
  • ObservationDistribution According to Vaya of patients : Amongst the 20 patients taken in thisstudy all 20 (100%) belonged to Madhyama Vaya. None of the patient was form the Balaand 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 0Figure No. 21 - Distribution of 20 patients according to Vaya of patients % of Patients 0 Pravar Madhya m Avara 100 88
  • Results EFFECT OF TREATMENT IN VATARAKTA.EFFECT ON PAIN: Patients treated with Vataraktantakarasa and Lekhana basti had marked remissionof the symptom pain. 1.8 was the mean initial score of pain in 20 patients of Vataraktawhich came down to 1.0 after the treatment. The improvement to the tune of 44.44% isfound to be statistically highly significant (P≤0.001) as shown in the Table No.37 andFig. No.22Table No.37 : Effect of treatment on Pain Mean Score Difference % Paired ‘t’ test in means BT AT 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=<0.001Figure no 22: Effect of treatment on Pain Pain 2 1.5 Mean score 1 0.5 0 89
  • ResultsFFECT 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 thetreatment with Vataraktantakarasa and Lekhana basti. This improvement when analyzedby 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 Difference % Paired ‘t’ test in means BT AT 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= 0.008Figure no 23: Effect of treatment on Burning sensation Burning sensation 0.8 B.T. 0.6 Mean Score 0.4 0.2 0 90
  • ResultsEFFECT ON MALAISE : 78.57% of improvement was observed in the symptom Malaise. 0.700 was theinitial mean score of Malaise recorded in the 20 patients of Vatarakta . This was broughtdown to 0.150 after the administration of Vataraktantaka rasa and Lekhana Basti. Thisimprovement after the treatment is found to be highly significant (P≤0.001) as per thepaired‘t’ test. The details of the different statistical values are shown in the Table No.39and fig. No. 24Table No. 39: Effect of treatment on Malaise Mean Score Difference % Paired ‘t’ test in means BT AT 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= 0.001Figure no 24: Effect of treatment on Malaise Malaise 0.8 B.T., Mean score 0.6 0.4 A.T., 0.2 0 91
  • ResultsEFFECT ON DISTURBANCE OF SLEEP:0.650 was the mean initial score of disturbance of Sleep before the treatment in patientsof Vatarakta. This initial mean score came down to 0.0500 after the treatment. Theimprovement to the tune of 92.30 % was highly significant (P≤0.001) as revealed by thepaired‘t’ test.Details of the same are given in the Table No. 40 and fig. No. 25Table No. 40: Effect of treatment on disturbance of Sleep Mean Score Difference % Paired ‘t’ test in means BT AT 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 = ≤0.001Figure no 25: Effect of treatment on disturbance of Sleep Sleep 0.8 B.T., Mean score 0.6 0.4 0.2 A.T., 0 92
  • ResultsEFFECT ON TENDERNESS:Tenderness is another symptom of Vatarakta. The initial mean score of the patients intenderness was 0.100 which was reduced to 0.00 after the treatment. The improvement tothe tune of 100% was recorded, is statistically significant. Details of the same arerepresented in the Table No. 41 and fig. No. 26.Table No. 41 comparison of effect on Tenderness Mean Score Difference % Paired ‘t’ test in means BT AT S.D S.E.M. t value P value 0.1000 0.000 0.1000 100 0.308 0.0688 t = 1.453 P = 0.163Figure no 26: Effect of treatment on Tenderness Tenderness B.T., 0.1 0.08 Mean score 0.06 0.04 0.02 A.T., 0 93
  • ResultsEFFECT ON EDEMA: Before the treatment the mean score of symptom of Edema was 0.350. After thetreatment with Vataraktantak rasa and Lekhana Basti this was reduced to 0.0500 giving85.71% effect. The change that occurred with the treatment is greater than would beexpected by chance; there is a statistically significant change (P = 0.010) as assessed bythe 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 Difference % Paired ‘t’ test in means BT AT 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 = 0.010Figure no 27: Effect of treatment on Edema Edema 0.4 B.T., Mean score. 0.3 0.2 0.1 A.T., 0 94
  • ResultsEFFECT ON LOCAL COLOUR CHANGES: Patients treated with Vataraktantak rasa and Lekhana Basti had no difference inLocal color changes. 0.200 was the mean initial score in 20 patients of Vatarakta whichremained as 0.200 after the treatment.Table No. 43 Effect of treatment on Local colour changes Mean Score Difference % Paired ‘t’ test in means BT AT 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 Local colour changes B.T., A.T., 0.2 Mean score 0.15 0.1 0.05 0 95
  • ResultsEFFECT ON WALKING ABILITY: 47.22% of improvement was observed in the score of walking ability. 1.8 was theinitial mean score recorded in the 20 patients of Vatarakta This was brought down to0.950 after the administration of Vatarakta and Lekhana Basti This improvement afterthe treatment is found to be highly significant (P≤0.001) as per the paired ‘t’ test. Thedetails 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 Difference % Paired ‘t’ test in means BT AT 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 = ≤0.001Figure no 29 : Effect of treatment on walking ability Walking ability 2 B.T., 1.5 Mean score A.T., 1 0.5 0 96
  • ResultsEFFECT ON PERIPHERAL PULSES: 1.5 was the mean initial score of Peripheral pulses before the treatment in patients ofVatarakta This initial mean score came down to 1.05 after the treatment. Theimprovement 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. 30Table No. 45: comparison of effect on Peripheral pulses Mean Score Difference % Paired ‘t’ test in means BT AT S.D S.E.M. t value P value 1.500 1.050 0.450 30 0.510 0.114 t = 3.943 P = <0.001Figure no 30: Effect of treatment on Peripheral pulses Peripheral pulses B.T., 1.5 A.T., Mean score 1 0.5 0 97
  • ResultsEFFECT ON TOTAL CHOLESTEROL: Before the treatment the mean total Cholesterols was 274.950 after the treatment withVataraktantak rasa and Lekhana Basti this was reduced to 224.00. This improvementafter the treatment was found to be statistically highly significant (P<0.001) as assessedby the paired‘t’ test. The details of the same is given in the Table No. 46 and fig. No. 31Table No. 46: Effect of treatment on total Cholesterols Mean Score Difference Paired ‘t’ test in means BT AT S.D S.E.M. t value P value274.950 224.00 50.950 21.36 4.776 t = 10.667 P = <0.001Figure no 31: Effect of treatment on total Cholesterols Total cholesterol B.T., 300 A.T., Mean score 200 100 0 98
  • ResultsEFFECT ON Triglyceride Before the treatment the mean Triglyceride was 247.100 After the treatment withVataraktantak rasa and Lekhana Bastithis was reduced to 196.40. This improvement afterthe treatment was found to be statistically highly significant (P<0.001) as assessed by thepaired‘t’ test. The details of the same is given in the Table No. 47 and fig No. 32Table No. 47: Effect of treatment on Triglyceride Mean Score Difference Paired ‘t’ test in means BT AT S.D S.E.M. t value P value247.100 196.400 50.700 36.319 8.121 t = 6.243 P = <0.001Figure no 32 Effect of treatment on Triglyceride Triglyceride B.T., 250 A.T., 200 Mean score 150 100 50 0 99
  • ResultsEFFECT ON HDL CHOLESTEROL:Before the treatment the mean HDL Cholesterol was 39.850 after the treatment withVataraktantak rasa and Lekhana Basti this was increased to 44.500. This increase afterthe treatment was found to be statistically highly significant (P<0.001) as assessed by thepaired‘t’ test.The details of the same is given in the Table No. 48 and fig No33Table No. 48 Effect of treatment on HDLCholesterol Mean Score Difference Paired ‘t’ test in means BT AT S.D S.E.M. t value P value 39.850 44.500 4.650 4.705 1.052 t = -4.420 P = <0.001Figure no 33 Effect of treatment on HDLCholesterol HDL cholesterol 46 A.T., 44 Mean score 42 B.T., 40 38 36 100
  • ResultsEFFECT ON LDL CHOLESTEROL:Before the treatment the mean LDL Cholesterols was 169.200 After the treatment withVataraktantak rasa and Lekhana Basti this was reduced to 134.650 This increase after thetreatment was found to be statistically highly significant (P<0.001) as assessed by thepaired ‘t’ test. The details of the same is given in the Table No. 49and fig. No. 34Table No. 49 : Effect of treatment on LDL Cholesterols Mean Score Difference Paired ‘t’ test BT AT S.D S.E.M. t value P value169.200 134.650 34.550 30.346 6.786 t = 5.092 P = <0.001Figure no 34 : Effect of treatment on LDL Cholesterols LDL Cholesterol 200 B.T., A.T., Mean score 150 100 50 0 101
  • ResultsEFFECT ON VLDL CHOLESTEROL:Before the treatment the mean VLDL Cholesterols was 43.550 After the treatment withVataraktantak rasa and Lekhana Basti this was reduced to 33.450 This decrease in valuesafter the treatment was found to be statistically highly significant (P<0.001) as assessedby the paired ‘t’ test. The details of the same is given in the Table No. 50 and fig. No. 35Table No. 50 : Effect of treatment on VLDL Cholesterols Mean Score Difference Paired ‘t’ test in means BT AT S.D S.E.M. t value P value 43.550 33.450 10.100 9.414 2.105 t = 4.798 P = <0.001Figure no 35 : Effect of treatment on VLDL Cholesterols VLDL Cholesterol 50 B.T., 40 A.T., Mean score 30 20 10 0 102
  • ResultsEFFECT ON LDL: HDL:Before the treatment the mean LDL: HDL was 4.245 after the treatment withVataraktantak rasa and Lekhana Basti this was reduced to 3.150. This improvement afterthe treatment was found to be statistically highly significant (P<0.001) as assessed by thepaired‘t’ test. The details of the same is given in the Table No. 57 and fig. No. 36Table No. 57: Effect of treatment on LDL: HDL Mean Score Difference Paired ‘t’ test in means BT AT S.D S.E.M. t value P value 4.245 3.150 1.095 0.624 0.139 t = 7.852 P = <0.001Figure no 36: Effect of treatment on LDL: HDL LDL:HDL 5 B.T., 4 A.T., Mean score 3 2 1 0 103
  • ResultsOverall effect of the treatment in Vatarakta : After the completion of the 1 month course of treatment in Vatarakta the overallassessment of the patients were made as discussed in the assessment criteria. The analysisrevealed that no patient had complete relief from the signs and symptoms of vataraktaModerate remission of the signs and symptoms was seen in 90% of the patients treatedwith Vataraktantaka rasa and Lekhana basti . No patient showed marked improvement.One patient after treatment showed 40 % remission of the symptoms which comes underaverage remission category. Another one patient after treatment showed 20 % remissionfrom 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 thesymptoms of Vatarakta. Figure no 37: Overall Effect of treatment % of Patients 5 5 Moderate Average Unchanged 90 104
  • Conclusion CONCLUSION1. Distinct etiological factors of vatadosa and rakta dhatu separately causes the morbidityof vata dosa as well as abnormality of rakta dhatu. Morbid vata dosa furthrer incriminatesthe abnormal rakta dhatu. This abnormal rakata dhatu by way of raktamargavarana in turninhibits the movement of vata dosa leading to severe morbidity of vatadosa. This ismarked by development of clinical signs and symptoms. Thus the illness vataraktaclinically manifests. This is the general samprapti of vataraka2. The santarpana category of etiological factors leads to the accumulation of kapha andmedas in the raktamarga there by causing raktamargavarana. Due to the establishment ofraktamargavarana there occurs inhibition of movement of vata dosa. this in turnculminates 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 inthe good cholesterol following the treatment. These changes establish the efficacy oflekhana basti and vataraktantaka rasa in preventing the progression of margavarana aswell as the illness vatarakta.5. The marginal improvement in the circulation following medication with lekhana bastiand vaataraktantaka rasa confirms the effect of medicine on reducing the margavarana.Reduction in pain burning sensation etc proves the reduction in the morbidity of vatadosa following the medication.6. The combination of shodhana treatment in the form of lekhana basti and shamanatreatment in the form of vataraktantaka rasa is an ideal regimen in patient’s sufferirngfrom 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 TOEVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASAAND LEKHANA BASTI IN VATARAKTA”is a bonafide and genuine researchWork 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 VATARAKTANTAKRASA AND LEKHANA BASTI IN VATARAKTA” is a bonafide research workdone by Patil K.V. in partial fulfillment of the requirement for the degree of Doctorof 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 INSTITUTIONThis is to certify that the dissertation entitled “A CLINICAL STUDY TOEVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASAAND LEKHANA BASTI IN VATARAKTA”is a bonafide research work done byPatil 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 HealthSciences, Karnataka shall have the rights to preserve, use and disseminate thisdissertation/ 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, omniscientand omnipotent. He is the possessor of the ocean of knowledge and wisdom to whichI would like to contribute a drop in the form of my dissertation. As it is said, each andevery drop goes to make an ocean, so this is my humble endeavor towards its goal ofwisdom. My deep sense of gratification is due for my parents and brothers whoare the architects of my career. The culture, discipline and perseverance, which Icould imbibe, are solely because of their painstaking upbringing and strong moralsupport. 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 guidancefor 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 theirencouragement 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 forgiving 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. Ayurvedahospital, Udupi, Dr .Murulidhar director SDM Ayurveda pharmacy And Dr. NaveenBallal 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 supportthey provided throughout my studies. KULDEEP VILASRAO PATIL. vi
  • List of Abbreviations used1. A.H. : Ashtanga Hridaya2. A.S. : Ashtanga Sangraha3. A. N. : Adarsha nighantu4. B.P. : Bhava Prakasha5. B.R. : Bhaishajya Rathnavali6. B.L. : Bhela samhita7. C.S. : Charaka Samhita A8. C.D. : Chakra Datta9. Ckr. : Chakrapani.10. G.N. : Gada Nigraha11. H.P.I.M.: Harrison’s Principle Of Internal Medicine12. H.S. : Harita Samhita.13. M.N. : Madhava Nidana14. S.K.D. : Shabda Kalpa Druma15. Sh.S. : Sharangadhara Samhita16. Su.S. : Sushruta Samhita17. T.B.P. : Text Book Of Pathology By Harsh Mohan18. Vag. : Vagbhata19. Vang. : Vangasena20. Y.R. : Yogaratnakara20. ILD : Ischemic limb diseases21. PVD : Peripheral vascular disorders22. IHD : Ischemic heart disease23 .HDL: high-density lipoproteins24 LDL : low- density lipoproteins25 .VLDL: very-low density lipoproteins vii
  • ABSTRACTThe pathology of margavarana leads to the establishment of clinical signs andsymptoms in vatarakta. Sodhana, samana, bahiparimarjana and rasayana cikitsa all areaimed at the rectification of margavarna in this disease. The whole concept ofmargavarana can be best explained by the pathology of atherosclerosis and peripheralvascular disease in modern parlance. There is a definite need to study vatarakta asperipheral arterial disease and its management with both sodhana and samana linetreatment, with the due consideration of its severity chronicity as well as possiblecomplications. This study is planned to evaluate the therapeutic effect ofVataraktantakarasa and Lekhana basti in patients suffering from Vatarakta.Design: single blind clinical study with a pre-test and post-test designSource of the data : 20 patients of vatarakta who attended the O.P.D. and I.P.D. ofS.D.M. Ayurveda Hospital, Kuthpady, Udupi, Karnataka, during the period ofNovember 2005 to August 2006.Intervention: patients were subjected to 16 days course of lekhana basti along withoral medication with vataraktantaka rasa in a dose of 250mg tid for 30 daysOBSERVATIONS:Out of 20 patients of Vatarakta studied in this work, 50 % patients belonged to the agegroup 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 hadthe habit of mixed diet. All the patients had the dvandvaja praktiti.Results: statistically significant improvement was observed in all the criteria ofassessment that included regards to pain, burning sensation, malaise, and disturbanceof sleep, tenderness, walking ability, peripheral pulses and lipid profile.Conclusion:The combination of lekhana basti and vataraktantaka rasa is an ideal regimen inpatient’s suffering from raktamargavarana janya vataraktaa.Key Words: Vatarakta, margavarana, raktavahasrotas, ILD, PVD viii
  • TABLE OF CONTENTS1. Introduction : Page No.1-52. Objectives : Page No.63. Review of Literature : Page No.7-60 3.1 Historical review 3.2 disease review 3.4 Drug review4. Clinical study : Page No.61-104 4.1 Materials and methods 4.2 Observations and results5. Discussion : Page No.105-1176. Conclusion : Page No.1187. Summary : Page No.119-1238. Bibliography : Page No.124-1429. Annexure : Page No.143-151 ix
  • LIST OF TABLESSl. 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 31 Satmya 83 x
  • 32 Satva 8433 Aharashakti 8534 Vyayama shakti 8635 Pramana 8736 Vaya 8837 Effect on pain 8938 Effect on Burning sensation 9039 Effect on Malaise 9140 Effect on Sleep 9241 Effect on Tenderness 9342 Effect on Edema 9443 Effect on Local color changes 9544 Effect on Walking ability 9645 Effect on Peripheral pulses 9746 Effect on Total cholesterol 9847 Effect on Triglycerides 9948 Effect on HDL cholesterol 10049 Effect on LDL cholesterol 10150 Effect on VLDL cholesterol 10251 Effect on HDL : LDL 103 xi
  • LIST OF FIGURESSl. No. Figures Page No.Fig. 1 Age Distribution 68Fig. 2 Sex Distribution 69Fig. 3 Occupation Distribution 70Fig.4 Religion Distribution 71Fig. 5 Marital status Distribution 72Fig. 6 Literacy Distribution 73Fig. 7 Occupation Distribution 74Fig. 8 Socioeconomic status Distribution 75Fig. 9 Mode of onset Distribution 76Fig. 10 Associated illnesses Distribution 77Fig. 11 Dietary habits.Distribution 78Fig. 12 Analysis of Dominant rasa 79Fig 13 Analysis of Addictions 80Fig. 14 Analysis of Prakruti 81Fig. 15 Analysis of Saara 82Fig. 16 Analysis of Samhanana 83Fig. 17 Analysis of Satmya 84Fig. 18 Analysis of satva 85Fig. 19 Analysis of Ahara shakti 86Fig. 20 Analysis of Vyayama shakti. 87Fig. 21 Analysis of pramana 88Fig. 22 Analysis of type of Vaya 89Fig. 23 Effect on pain 90Fig. 24 Effect on burning sensation 91Fig. 25 Effect on malaise 92Fig. 26 Effect on Disturbed sleep. 93Fig. 27 Effect on tenderness. 94Fig. 28 Effect on edema. 95Fig. 29 Effect on Local color changes. 96Fig. 30 Effect on Walking ability. 97Fig 31 Effect on peripheral pulses 98 xii
  • Fig. 32 Effect on total cholesterol 99Fig. 33 Effect on Triglycerides 100Fig. 34 Effect on HDL cholesteral 101Fig. 35 Effect on LDL cholesterol. 102Fig. 36 Effect on VLDL cholesterol 103Fig. 37 Effect on LDL : HDL 104Fig. 37 Overall effect of the treatment. 105 xiii
  • Discussion DISCUSSIONAmong the diseases listed as vatyavyadhi the illness Vatarakta has gained primeimportance in clinical practice due its high prevalence in elderly, progressiveperpetuation, severe complications and fatal outcome. In the literature it is emphasizedthat the etiological factors leads to the predominant morbidity of vata dosa and raktadhatu. To be more specific, the obstruction of raktamarga or raktavaha srotas is theleading pathology. The umbrella of vatarakta in parlance with conventional medicineincludes many conditions related to extremities and to mention a few are connectivetissue 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 indifferent systems. Prameha, Sonitadusti, hrdroga and vatavyadhi etc all are found to bedue to incriminatory effect of kapha and medas in respective systems. Hence forth theconcept 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 symptomsin vatarakta. Further to add, sodhana samana bahiparimarjana and rasayana cikitsa all areaimed at the rectification of margavarna in this disease. The whole concept ofmargavarana can be best explained by the pathology of atherosclerosis and peripheralvascular disease in modern parlance.Progressive atherosclerosis results in narrowing of the arterial lumen, hence the namearteriosclerosis obliterans to this unique illness. Peripheral arterial disease is anothername referring to the same. Survey studies have established highest prevalence of theillness in older people. According to U.S. department of Health and Human services, anestimated 12% - 17% of population over age of 50 yrs has some form of arterialinsufficiency. Prevalence increases with age as noted in recent national survey. theprevalence of PAD was found to be 29% in people over aged 70 yrs. the prevalence ratewas 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 withcoronary angiography estimated that approximately one half of the patients of peripheralarterial diseases present with clinical symptoms. More interestingly, life table analysishas indicated patient with clauducation have a 70% 5-fear and 50% 10-year survival rate. 105
  • DiscussionMost deaths occur due to sudden or secondary to M.I. The prognosis is worse in patientswho continue to smoke cigarettes or who have uncontrolled diabetes mellitus. Theseobservations of survey studies undeniably point towards the high prevalence as well asseriousness of the problem.The analysis of previous work done in different research and post graduation studycenters unravels the ambiguity about the clinical understanding as well as treatment ofvatarakta. Many of the clinical studies regarded musculoskeletal disorders likerheumatoid arthritis, gouty arthritis and osteoarthritis as vatarakta. In these works nosignificance is being given to the unique pathology of raktamargavarodha in vatarakta.Very little number of clinical works concentrated on vascular disease of the limbs asvatarakta. More specifically speaking TAO is regarded as vatarakta. Here also the overeating and sedentary habit as the cause of arterial disease / raktamargavarodha throughthe 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 showdefinite benefit in such chronic lingering disease. Kala basti and karma basti coursesappear better in chronic progressive disorders like vatarakta.This review indicate that there is a necessity to study vatarakta as peripheral arterialdisease and its management with both sodhana and samana line treatment with the dueconsideration of its severity chronicity as well as possible complications. Present work entitled A Clinical Study to evaluate the therapeutic effect ofVataraktantaka Rasa and Lekhan basti in vatarakta, is carried out with the considerationthat, the therapeutic measures that reduce kapha dosha and medas as well as alleviate themorbid Vatadosha is the sheet anchor of treatment of vatarakta. Basti is claimed to be thebest treatment in lingering diseases due the morbidity of vatadosa. Lekhanabasti is said toallevate both kaphadosha as well as medodhatu and hence indicated in santarpanajanyavatarakta. The herbo-mineral compound vataraktantaka rasa consisting mainly ofguggulu, shilajatu and loha is said to be effective in negating the incriminatory effect ofmorbid kapha dosa and medas and there by ensuring complete cure of vatarakta.Review of the available literature unravels the minimal information of vatarakta in thebooks of vedic period. Contrary to this entire aspect of the illness from nidana to cikitsais found in books of samhita as well as sangraha kala of the history. 106
  • Discussion Two distinct etiopathogenesis may cause the illness vatarakta. Individualetiological factors of vata dosa as well as rakta dhatu may culminate in the developmentof vatarakta and is the usual variety of vatarakta. Where in the morbid vata dosa as wellas vitiated rakta dhatu leads to the rakta margavarana and is the principal pathology of thevatarakta. In other variety of vata rakta, to begin with there is no role of etiologicalfactors of either vata dosa or rakta dhatu. Contrary to this the etiological factors of kaphadosa 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 bycontributing the principal pathology of raktamargavarana. The similar qualities of kaphaand medo dhatu speed up the pathogenesis as two factors support mutually. To beprecise, the santarpana category of etiological factors causes the morbidity of kapha dosaand medo dhatu, and these in turn accumulate in the raktamarga leading to theprovocation of vata dosa and finally manifesting as vata rakta.Needless to say depending upon the variation in the etiopathogeneiss the planning of thetreatment should differ. Rectification of morbid vata dosa as well as rakta dhatu is therational treatment in the first variety of vatarkata. Kapha medo hara line of managementis the sheet anchor of the treatment of santarpana nidana janya vatarakta.The pathogenesis of raktamargavarana is best correlated with the arterial obstruction dueto the atherosclerosis. This phenomenon of accumulation of kapha and medas with in thedhamani is also referred as dhamani praticaya in ayurvedic literature. Abnormalaccumulation of the lipids in the arterial wall is the leading pathology of atheroscleroticobliterans. The most common symptom of ischemic limb disease that include intermittentclaudication, ache and cramps, altered sensation, changed skin color, obliterated arterialpulse, 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 lowerextremities. These citations of similarities are more than enough to compare the ischemiclimb disease with the santarpana nidana janya vatarakta.Atherosclerosis is a specific form of arteriosclerosis affecting primarily the intima oflarge and medium-sized muscular arteries and is characterized by fibro fatty plaques oratheromas. The term atherosclerosis is derived from athero-(meaning porridge) referringto the soft lipid-rich material in the centre of atheroma, and sclerosis (scarring) referring 107
  • Discussionto connective tissue in the plaques. Atherosclerosis is the commonest and the mostimportant of the arterial diseases. Though any large a medium-sized artery may beinvolved in atherosclerosis the most commonly affected are the aorta, the coronary andthe cerebral arterial systems. Therefore, the major clinical syndromes resulting fromischemia due atherosclerosis are the myocardial infarcts (heart attack ) and the cerebralinfarcts (strokes); other less common sequel are peripheral vascular disease, aneurysmdilatation due to weakened arterial wall, chronic ischemic heart disease, ischemicencephalopathy,an mesenteric occlusion and ischemic limb disease (ILD)The understanding of vatarakta is related to collagen diseases, gouty arthritis as well asischemic limb diseases. All these comparisons are justified based on analysis ofsymptoms of vatarakta and the diseases mentioned in conventional medicine. From thefore going citations it is clear that ischemic limb disease is also best compared tovatarakta in regards to its etiopathogensis as well as clinical findings.Unique concept of naming the disease is adopted in Ayurvedic literatures. Illnessoccurring at a specific location is named after the specific organ as in the diseasehridroga. In contrast to this several other disorders are named after the cardinal symptomas in atisara and shwasa. In case of the disease vatarakta, this name is coined on the basisof involved samprapti ghataka i.e. vata dosa as well as rakta dhatu. Adhyavata, khudhavata, 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 ofetiology leads to the vitiation of vata dosa and the other set separately causes morbidityof rakta dhatu. These distinct sets of etiological factors may be related to ahara vihara orthe one influencing the manas. In spite of this, in the variant form of vata rakta where insantarpana category of factors leads to the abnormal accumulation of kapha as well asmedo dhatu, and more particularly in the rakata marga culminates in the pathology ofvata 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 ofthe illness. Extensive epidemiologic investigations on live populations have revealed anumber of risk factors which are associated with increased risk of developing clinicalatherosclerosis. Often, these risk factors are acting in combination rather than singly. 108
  • DiscussionIncreasing age, male sex, genetic abnormalities, and familial and racial predisposition,hyperlipidaemia, hypertension, diabetes mellitus and smoking are considered as majorrisk factors. Environmental influences, Obesity, Use of exogenous hormones, Physicalinactivity, Stressful life style and infections are regarded as minor risk factors foratherosclerosis obliterance.The etiological factors of kapha medo margavarana janya vatarakta as well asatherosclerosis are more or less identical. Diet and behavioral factors leading toatherosclerosis can be best regarded as santarpana nidana of vatarakta causingaccumulation of kapha and medas with in the raktamargaThe movement of vatadosa is inhibited by the unique pathology of raktamargavarana invatarakta. This in term initially manifest with certain clinical signs and symptoms in theform 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 othermanifestations 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 asuttana (anavagadha)vata rakta. Involvement of deeper dhatu like asthi majja and sandhisignifies the gambhira (avagadha) vatarakta. A third variety of ubhayashrita vatarakta isalso mentioned in literature where in both the superficial as well as deeper dhatu isaffected. Vatarakta is a progressive disorder and hence initially the illness may be limitedto either superficial dhatu or deeper dhatu alone, but in the later stages the uttanavatarakta progresses to deeper dhatu. Similarly the gambhira vatarakta may involve thesuperficial dhatu in the later stages. Hence in the later stages the vatarakta develops asubhayashrita vatarakta.The symptoms like kandu, daha, ruka, ayama, toda, sphurana, shyava/ rakta tvaka andsuch other symptoms probably limited to the twak indicates the uttana vatarakta.Persistent hard swelling of the affected part, suppurations, involvement of sandhi asthiand majja, deformities like vakrata, khanja and pangu all these point towards thegambhira vataratka.Presence of symptoms indicative of both uttana as well as gambhira vatarakta signifiesthe ubhayashrita vata rakta. 109
  • DiscussionClinical varieties of vatarakta are also elaborated according to the association of morbiddosa 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 ofamadosa. Symptoms of ama if associates the symptoms of vatarakta then the condition isknown as sama vatarakta. If only the symptoms of vatarakta presents without theassociation of symptoms of ama then the illness is referred as nirama vatarakta.Distinct etiological factors of vatadosa and rakta dhatu separately cause the morbidity ofvata dosa as well as abnormality of rakta dhatu. Morbid vata dosa furthrer incriminatesthe abnormal rakta dhatu. This abnormal rakta dhatu by way of raktamargavarana in turninhibits the movement of vata dosa leading to severe morbidity of vatadosa. This ismarked by development of clinical signs and symptoms. Thus the illness vataraktaclinically manifests. This is the general samprapti of vataraka in which theraktamargavarana is the final stage of the samprapti. This raktamargavaarana can happenin a different way also. The santarpana category of etiological factors leads to theaccumulation of kapha and medas in the raktamarga there by causing raktamargavarana.Due to the establishment of raktamargavarana there occurs inhibition of movement ofvata dosa. Inhibition of vata culminates in severe morbidity of vata dosa and once againmanifesting 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 ofexcessive accumulation of kapha and medas in the body. Other than the vatarakta, thekapha and medas can cause different other diseases like vatavyadhi, hrdroga, gulma andprameha. Thus presence of any of these diseases is also a strong clinical evidence ofabnormality of kapha and medas in a given patient. Corroborating the same, coexistenceof 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 theconcept of raktamargavarana due to abnormal kapha and medas in the diseasevatarakta178.Add to this from the modern paralance of atherosclerosis - Most atheroma produces nosymptoms, and many never cause clinical manifestations. Numerous patients with diffuse 110
  • Discussionatherosclerosis may succumb to unrelated illness without ever having experiencedclinically significant manifestations of atherosclerosis. What accounts for this variabilityin the clinical expression of atherosclerotic disease, here is the explanation - Arterialremodeling during atheroma formation represents a frequently overlooked but clinicallyimportant feature of lesion evolution. During the initial phases of atheroma development,the plaque usually grows outward, in an abluminal direction. Vessels affected byatherogenesis tend to increase in diameter, a phenomenon known as compensatoryenlargement, a type of vascular remodeling. The growing atheroma does not encroachupon the arterial lumen until the burden of atherosclerotic plaque exceeds approximately40% of the area encompassed by the internal elastic lamina. Thus, during much of its lifehistory, 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 alarger extent determines the upasaya and anupasaya in vatarakta. Accordingly theexposure to warm surrounding, rest and application of sneha tend to cause remission ofthe symptoms, where as exposure to cold surrounding and physical exercise tend toworsen the symptoms of vata rakta.The sadhyasadhyata of disease depends on virulence of vitiated doshas, presence orabsence of upadrava’s as well as chronicity of disease.Symptom around the joints is the cardinal manifestation of the diseases sandhigatavataand amavata and thus these diseases need to be differentiated from the vatarakta. Inaddition to this the skin manifestation of the kusta is akin to the same present in thevatarakta. Hence the kusta should be distinguished from the vatarakta again. Differentialdiagnosis is best made by the analysis of the samprapti ghataka as well as clinicalmanifestations of these diseases.Morbidity of vata dosa and rakta dhatu is the basic pathology of the vatarakta. Morbidvata dosa further afflicts raktadhatu. Consequently there occur raktamargavaranainhibiting 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 theother hand in the variant form of vatarakta margavarana can happen due to abnormalaccumulation of kapha and medas. This pathology further continues to end up in thedevelopment of the illness vatarakta. Treatment aimed at negating the detrimental effect 111
  • Discussionof 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 ofdosa and site of affliction form the antahparimarjana ciktsa. Further depending upon therequirement the bahiparimarjana cikitsa like pariseka, abhyanga pradeha and upanaha isalso carried out. In case of development of complications like vidhradhi and vrana sastrapranidhana cikitsa is followed.Vataraktantaka rasa as explained in Bhaishajya ratnavali is a Khalvirasayana with uniqueherbomineral combinations of drugs to treat Vatarakta. Parada, Shilajatu, guggulu,Lauhabhasma are the main ingredient targeted specifically for kapha medasavarana inraktavaha srotasa. These ingredients are treated with each three bhavana of bhringarajasvarasa and triphala svarasa.Lekhana basti is a combination specially indicated in Sthaulya and morbid condition ofkapha and medas. The mixing of ingredients is done in a sequence of madhu , saindhavalavana ,murchita tila, kalka triphala kvatha and gomutra, . The ingredients of kalka aresuryakshara , shilajatu, kasisa ,tuttha , hingu .By using Yasthimadhu kalka and ksheera, Ksheerapaka prepared, .taila paka is thenprepared by using ksheerapaka and murchitatilataila. Madhuka pushpa kalka is addedduring 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 andpost-test design and is planned to evaluate the therapeutic effect of Vataraktantakarasaand Lekhana basti in Vatarakta. The patients who attended the O.P.D. and I.P.D. ofS.D.M. Ayurveda Hospital, Kuthpady, Udupi, Karnataka, during the period of November2005 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 forthe study.The selected patients were administered with Lekhana Basti as kaala basti course of 16days, in which Niruha Basti was administered in a dose of 480 ml for 6 days by using theenema can. 10 sittings of Anuvasana basti was also administered with Shatapakamadhukataila in a dose of 120ml. In conjunction with basti treatment the patient was also 112
  • Discussiontreated orally with Vataraktantaka Rasa in the Dose of 250 mg tid. This oral medicationwas continued for 30 days with the anupana of warm water.The state of the disease vatarakta changes after the intervention. Improvement orotherwise was determined by adopting the standard methods of scoring for subjective,objective and special investigation criteria. The margavarana was assessed both beforeand after the intervention to note any change by using the arterial Doppler study. Lipidprofile 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 thatatherosclerosis usually becomes symptomatic during the 5th or 6th decade. Presentobservation of 50% patients between the age group of 51 to 60 years corroborates thesame.The illness does not show any predilection for the sex. The same is demonstrated in thepresent sample of 20 patients as 60% patients of Vatarakta were males and the remaining40% were females.80% of patients were Hindus in the present study. Though the illness does not show anypredilection for religion, the preponderance of the illness among Hindus represents onlythe 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 sampletaken for the study, 80 % of the patients were married persons. This only represent thepreponderance of the married people in the age group of 40 60 years in which theincidence of the illness is maximum.It is observed that 7 (35%) of the females in this study were house wives by theiroccupation. Also, this formed the largest category of patients leaving behind the patientsengaged in other occupations. The prevalence of the illness among the house wives onlyrepresents the predominant occupation of the female in this locality, and this occupationhas nothing to do with causation of vatarakta.The study revealed that most of the patients belonged to middle and rich socio-economicstatus. Sedentary life style is common among this category of people. Sedentary life stylehas definite role in the causation of the illness. Similarly the sample indicates theprevalence of the illness in middle and higher class people. 113
  • DiscussionMadhumeha, soniata mada and hrdroga are the conditions in which the abnormality ofmedas is common, so also the vatarakta. In accordance with the etiology and basicpathology which is common in these diseases, they tend to coexist in patients.So also inthe present study revealing the same tendency 45% of patients of vatarakta hadmadhumeha as well as soniata mada.Vegetarian or non vegetarian food that does not make any difference, butthe excessive intake of food and less utilization predisposes to vatarakta.However in the present sample of 10 a maximum of 65% of patients hadthe habit of mixed diet.Dvandvaja prakriti is commonest amongst any population. The same is reflected in thepresent sample as all the patients had the dvandvaja praktiti.Samhanana of an individual represents the nourishment. Vatarakta being santarpanajanya vyadhi pravaraa or madhyama samhanana is likely in such patients. So also in thepresent study all the patients had either madhyama samhana. No patients had avarasamhanana.Abhyavahara or jarana shakti of the persons indicate the possibility of santarpana or otherwise. Abhyavaharana sakti and jarana sakit if it is good, then the persons are likely tohave over santarpana leading to disease manifestation. Similary in the presnt sample ofpatients suffering from santarpanajanya vatarakta, patients had either pravara ormadhyama abhyavaharana and jarana shakti. No patients having avaraa abhyavaharanaand jarana shakti were recorded in this sample.Patients treated with Vataraktantakarasa and Lekhana basti had marked remission of thesymptom pain. 1.8 was the mean initial score of pain in 20 patients of Vatarakta whichcame down to 1.0 after the treatment. The improvement to the tune of 44.44% is found tobe 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 thetreatment with Vataraktantakarasa and Lekhana basti. This improvement when analyzedby 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 initialmean score of Malaise recorded in the 20 patients of Vatarakta. This was brought down 114
  • Discussionto 0.150 after the administration of Vataraktantaka rasa and Lekhana Basti. Thisimprovement after the treatment is found to be highly significant (P≤0.001) as per thepaired‘t’ test.0.650 was the mean initial score of disturbance of Sleep before the treatment in patientsof Vatarakta. This initial mean score came down to 0.0500 after the treatment. Theimprovement to the tune of 92.30 % was highly significant (P≤0.001) as revealed by thepaired‘t’ test.Tenderness is another symptom of Vatarakta. The initial mean score of the patients intenderness was 0.100 which was reduced to 0.00 after the treatment. The improvement tothe tune of 100% was recorded, but is not statistically significant.Before the treatment the mean score of symptom of Edema was 0.350. After thetreatment with Vataraktantak rasa and Lekhana Basti this was reduced to 0.0500 giving85.71% effect. The change that occurred with the treatment is greater than would beexpected by chance; there is a statistically significant change (P = 0.010) as assessed bythe paired‘t’ test. Patients treated with Vataraktantak rasa and Lekhana Basti had no difference inLocal color changes. 0.200 was the mean initial score in 20 patients of Vatarakta whichremained as 0.200 after the treatment.47.22% of improvement was observed in the score of walking ability. 1.8 was the initialmean score recorded in the 20 patients of Vatarakta This was brought down to 0.950after the administration of Vatarakta and Lekhana Basti This improvement after thetreatment 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 ofVatarakta This initial mean score came down to 1.05 after the treatment. Theimprovement 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 withVataraktantak rasa and Lekhana Basti this was reduced to 224.00. This improvementafter the treatment was found to be statistically highly significant (P<0.001) as assessedby the paired‘t’ test. 115
  • DiscussionBefore the treatment the mean Triglyceride was 247.100 after the treatment withVataraktantak rasa and Lekhana Basti this was reduced to 196.40. This improvementafter the treatment was found to be statistically highly significant (P<0.001) as assessedby the paired‘t’ test.Before the treatment the mean HDL Cholesterol was 39.850 Basti this was increased to44.500. 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 thiswas reduced to 134.650 This increase after the treatment was found to be statisticallyhighly significant (P<0.001) as assessed by the paired ‘t’ test.Before the treatment the mean VLDL Cholesterols was 43.550 After the treatment thiswas reduced to 33.450 This decrease in values after the treatment was found to bestatistically 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 andsymptoms 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 showedmarked improvement.Prevention of progressive margavarana by the regimen: obstruction of the kapha andmedas in the raktamarga is the principal pathology of the illness, and is progressiveprocess. This pathology is solely dependant upon the abnormal levels of kapha and medasin the body. The abnormal accumulation of the medas can be very well understood by theevaluation of serum lipid profile. The abnormal levels of lipids in patients suffering fromthe illness are suggestive of its role in causation of the illness. Lipid level if it is broughtto 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 thegood cholesterol following the treatment. This is more than enough to say that thelekhana basti and vataraktantaka rasa is very useful in preventing the progression ofmargavarana as well as the illness vatarakta. Lekhana basti by virtue of its ingredientsimparts ruksana in the body and ensures lekhana of medas. Added to this the ingredientslike silajatu guggulu haritaki ect of vataraktantaka rasa also aid in the reduction of kaphaand medas. So to say both the lekhana basti as well as vataraktantaka rasa is aimed at 116
  • Discussionremoval of causative factor ie kapha and medas and there by preventing the progressionof the illeness.Remission of margavarana and thereby reducing the morbidity of vata dosa: obstructionin the raktamarga is the cause for morbidity of vata dosa. Obstruction is ascertained bythe color dopler study of arteries in the limbs. The marginal improvement in thecirculation following medication with lekhana basti and vaataraktantaka rasa confirms theeffect 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 vataraktantakarasa is said to have srotovishodhana property. The same is reflected in the results as thereis definite evidence of improvement in the circulation. Improvement in circulation meansreduction in margavaraan this in turn leads to reduced morbidity of vata dosa. Reductionin pain burning sensation ect prove the reduction in the morbidity of vata dosa followingthe medication. In addition to this the ingredients like guggulu in vataraktantaka rasa hasdefinite effect on pacifying the vata dosa and hence the reduction in severity of symptomssuggestive of morbidity of vata dosa in patients suffering from vatarakta.Rectification of morbidity of rakta dhatu: morbidity of rakta dhatu in patients sufferingfrom the vaatarakta is indicated by sympotmos like discoloration of the skin. Morbidityof rakta dhatu is dependant upon the margavarana. Rectification of margavarana achievedby the medication definitely leads to reduction in the morbidity of rakta dhatu. The sameis reflected in the present study.Change in the patients following medication is definitely favorable but not complete. Asshown in the over all affect of the treatment no patients had complete remission of theillness. Maximum number of patients had either best response or moderate response. Thisindicates that the desired response is not complete rather partial. This implies, as there isdefinite favorable response to the treatment, for the better results instead of single kalabasti course repeated karma basti course may be adapted and the duration of the samanatreatment may be further prolonged. Even addition of bahiparimarjana cikitsa mayimprove the success rate. Thus the combination of shodhana treatment in the form oflekhana basti and shamana treatment in the form of vataraktantaka rasa is an idealregimen in patient’s sufferirng from raktamargavarana janya vatarakta. 117
  • Summary SUMMARYAmong the diseases listed as vatyavyadhi the illness Vatarakta has gained primeimportance in clinical practice due to its high prevalence in elderly, progressiveperpetuation, severe complications and fatal outcome. Dietary habits and life stylemodalities plays a major role in the causation of vata rakta. Also the morbidity of kaphaand 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 ofkapha and medas in respective systems. Hence forth the concept of margavarana indifferent parts of the body is emphasized in caraka samhita. The pathology ofmargavarana leads to the establishment of clinical signs and symptoms in vatarakta.Further to add, sodhana, samana, bahiparimarjana and rasayana cikitsa all are aimed atthe rectification of margavarna in this disease. The whole concept of margavarana can bebest explained by the pathology of atherosclerosis and peripheral vascular disease inmodern parlance.The analysis of previous work done in different research and post graduation studycenters unravels very little number of clinical works concentrated on vascular disease ofthe limbs as vatarakta. Here also the over eating and sedentary habits as the cause ofarterial disease / raktamargavarodha through the pathology of atherosclerosis / dhamanipraticaya leading to ischemic limb disease / vatarakta is ignored. Hence there is anecessity to study vatarakta as peripheral arterial disease and its management with bothsodhana and samana line treatment with the due consideration of its severity chronicity aswell 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 METHODSDesign: This is a single blind clinical study with a pre-test and post-test design. 119
  • SummarySource of the data The patients who attended the O.P.D. and I.P.D. of S.D.M. AyurvedaHospital, Kuthpady, Udupi, Karnataka, during the period of November 2005 to August2006, 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 daysAssessment criteria: The state of the disease vatarakta changes after the intervention.Improvement or otherwise was determined by adopting the standard methods of scoringfor subjective, objective and special investigation criteria. The margavarana was assessedboth before and after the intervention to note any change by using the arterial Dopplerstudy. Lipid profile was also studied before and after the treatment. The change observedafter 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 weremales and the remaining 40% were females. 80% of patients were Hindus in the presentstudy. 80 % of the patients were married persons. 35% of the females were house wivesby their occupation. most of the patients belonged to middle and rich socio-economicstatus. 45% of patients of vatarakta had madhumeha as well as soniata mada. 65% ofpatients had the habit of mixed diet. all the patients had the dvandvaja praktiti.Maximum number of patients had madhyama samhanana patients had either pravara ormadhyama abhyavaharana and jarana shakti. 120
  • SummaryResults:1.8 was the mean initial score of pain in 20 patients of Vatarakta which came down to 1.0after the treatment. The improvement to the tune of 44.44% is found to be statisticallyhighly significant (P≤0.001).Burning sensation one of the cardinal symptoms of Vatarakta relieved by 57.14% as theinitial score of Burning sensation which was 0.700 reduced to 0.300 after the treatmentThis 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 initialmean score of Malaise recorded. This was brought down to 0.150 after the treatment andis 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 initialmean score came down to 0.0500 after the treatment. The improvement to the tune of92.30 % 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 0.00after the treatment. The improvement to the tune of 100% was recorded, is statisticallysignificant.Before the treatment the mean score of symptom of Edema was 0.350. After thetreatment this was reduced to 0.0500 giving 85.71% effect. The change that occurredwith the treatment is greater than would be expected by chance; there is a statisticallysignificant 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 initialmean score recorded. This was brought down to 0.950 after the treatment thisimprovement 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 ofVatarakta This initial mean score came down to 1.05 after the treatment. Theimprovement to the tune of 30 % was significant (P=<0.010)Before the treatment the mean total Cholesterols was 274.950. After the treatment thiswas reduced to 224.00. Before the treatment the mean Triglyceride was 247.100 and wasreduced to 196.40. Before the treatment the mean HDL Cholesterol was 39.850 and wasincreased to 44.500 following medication. Before the treatment the mean LDLCholesterols was 169.200, which raised to 134.650 beforethe treatment the mean VLDL 121
  • SummaryCholesterols was 43.550 and was reduced to 33.450. All these changes in the lipid profilewere 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 andsymptoms 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 showedmarked improvement.Discussion:Obstruction of the kapha and medas in the raktamarga is the principal pathology of theillness, and is progressive process. This pathology is solely dependant upon the abnormallevels of kapha and medas in the body. The abnormal accumulation of the medas can bevery well understood by the evaluation of serum lipid profile. The abnormal levels oflipids in patients suffering from the illness are suggestive of its role in causation of theillness. Lipid level if it is brought to normalcy then the progression the illness can bearrested and is an established fact. Results showed that there is definite reduction in thebad cholesterol and increase in the good cholesterol following the treatment. This is morethan enough to say that the lekhana basti and vataraktantaka rasa is very useful inpreventing the progression of margavarana as well as the illness vatarakta. Lekhana bastiby 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 rasaalso aid in the reduction of kapha and medas. So to say both the lekhana basti as well asvataraktantaka rasa is aimed at removal of causative factor ie kapha and medas and thereby preventing the progression of the illeness.Obstruction in the raktamarga is the cause for morbidity of vata dosa. Obstruction isascertained by the color Doppler study of arteries in the limbs. The marginalimprovement in the circulation following medication with lekhana basti andvaataraktantaka rasa confirms the effect of medicine on reducing the margavarana.Tikshna drugs like gomutra, ksara, tuttha, kasisa etc in the lekhana basti and guggulu aswell as silajatu in the vataraktantaka rasa is said to have srotovishodhana property. Thesame is reflected in the results as there is definite evidence of improvement in thecirculation. Improvement in circulation means reduction in margavaraan this in turn leads 122
  • Summaryto reduced morbidity of vata dosa. Reduction in pain burning sensation ect prove thereduction in the morbidity of vata dosa following the medication. In addition to this theingredients like guggulu in vataraktantaka rasa has definite effect on pacifying the vatadosa and hence the reduction in severity of symptomsmorbidity of rtakta dhatu in patients suffering from the vaatarakta is indicatied bysympotmos like discoloration of the skin. Morbidity of rakta dhatu is dependant upon themargavarana. Rectification of margavarana achieved by the medication definitely leads toreduction 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. Nopatients had complete remission of the illness. Maximum number of patients had eitherbest response or moderate response. This indicates that the desired response is notcomplete rather partial. This implies, as there is definite favorable response to thetreatment, for the better results instead of single kala basti course repeated karma basticourse may be adapted and the duration of the samana treatment may be furtherprolonged. Even addition of bahimparimarjana cikitsa may improve the success rate.Conclusion:The combination of shodhana treatment in the form of lekhana basti and samanatreatment in the form of vataraktantaka rasa is an ideal regimen in patient’s sufferirngfrom raktamargavarana janya vataraktaa. 123
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  • 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 OFDISCHARGE: 9 OCCUPATION: TREATMENTSTARTED ON ADDRESS: TREATMENTCOMPLETE ONII. MAIN COMPLAINTS: SITEDURATION 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 ASWEDAL N ATISWEDA SIRAYAMA P RAGA IKARSHNYA P Q MANDALA SUPTATA KANDU K 143
  • Annexure III. HISTORY OF PRESENT ILLNESS: L 1) PAIN: ONSET SUDEEN GRADUAL COURSE PROGRESSIVE INTERMITTENTCONTINOUS TYPE OF PAIN INTERMITTENT CLAUDICATIONRESTPAIN AGGRAVATING FACTORS: DIURENAL - NIGHT SEASONAL – MOVEMENT WALKING K REST PY 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 OTHERSV. 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) RECENTOPERATION Y I) ANY COMPLAINT RELATED TO PERIPHERAL VASCULAR DISORDER 144
  • AnnexureVI. 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 IRREGULARIX. GENRAL EXAMINATION : BUILT NOURISHMENT CYANOSIS CLUBBING LYMPHADENOPATHY TEMPERATURE PULSE RATE RYTHEM VOLUME CONDITION OFVESSEL WALL BLOOD PRESSURE RESPIRATORY RATE 145
  • AnnexureX. 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 HEIGHTWEIGHT 10. VAYATAH: BALA MADHYAM VRIDDHAXI. 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 VIKRITAXIII. 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 TRUSHNA / MADA BHRAMA RAGA PAK BHEDA / SPARSHYAAKSHAMATWA 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 MARMAGRAHA 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 MATRA NIRGAMAN VISHESHA PURVA PASCHATA TYPE TIME LAKSHANA 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. ] 150
  • AnnexureBASTI SAMYAKA YOGA: 1) PRASRUSTA VITKATA. 2) PRASRUSTAMUTRATA. 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: 151