We see many difference of opinion while explaining the disease Vatha shonitha or Vatha Raktha explianed in Charaka Samhitha and Susrutha Samhitha which are the most ancient books of Ayurveda. Here Charakas Vathashonitha is compared with mainly disease manifesting as multiple joint pain which starts in smaller joints and gradually seen in other larger joints. The presentation of many rheumatism are like Vata shonitha of Charaka, where Susrutha explains Vata shonitha with reference to skin manifestation in Feet and also occasionally in hands and Susruthas explanation holds good for Peripheral vascular obstruction, Ischemic ulcers, Varicose ulcers, Pressure ulcers and other non healing ulcers. He no where mentions the involvement of joint directly. For detailed analysis please go through the slide. I request all the scholars of Ayurveda to go through the slides and give your valuable opinion.

1. 1
Critical comparative study of the
concept of VATHARAKTHA in
Charaka and Susrutha Samhitha
Dr. Jayagovinda Ukkinadka
UKKINADKAS AYURVEDA
www.ukkinadkas.com
PRESENTATION BY

2. Content
• Cardinal features
• Nidana- Caraka and Susrutha
• Samprapthi
• Poorvaroopa
• Roopa
• Upadrava
• Sadhyasadhyatha
• Comparison and discussion
2

3. Introduction
• Vata shonitha or vataraktha is the disease
first explained in Charaka and Susrutha
Samhitha.
• We can see lot of difference of opinion in
Charaka and Susrutha while explaining the
types and symptoms.
• At some point it seems that the disease
understood as Vatashonitha by Charaka and
Susrutha are different
3

4. Vata shonitha (VS) as told by
Charaka- Cardinal S & S
4

5. Cardinal features of VS-Charaka
• The main seat of VS is Phalangeal joints of
Hands and foot and later the features will
be seen in multiple joints
• This is the same explanation what we see
even today in modern texts while
explaining Rheumatoid arthritis and other
Rheumatisms.

6. Vata shonitha as told by
Susrutha- Cardinal S & S
6

7. Aakhu Visha Lakshana -Susrutha
7

8. Cardinal features of VS - Susrutha
• The main seat of the disease is PADA- FOOT,
and occasionally seen in HANDS and if
aggravates spreads like poisonous effect of rat
bite, spreads fast and produces symptoms like
• Rat bite effect- Formation of nodules, circular
skin lesions, severe bullous eruptions, scaly
skin lesions, bodyache, severe pain,
unconciousness, heavyness in the body, fever,
loss of appetite, vomitting.

9. Nidana & samprapthi- Caraka
9

10. Vishesha Samprapthi- Caraka
10

11. Patho physiology- Charaka
• Due to the etiological factors the aggravated
Vayu obstructed by the aggravated Raktha
produces this disease
• Vata because of its subleness and Raktha due
to its liquid nature moves in vessels and gets
obstructed in bends and mostly at joints and
also may interfeared by Pittadi doshas and
produces severe symptoms in those areas.

12. Nidana and Samprapthi-
Susrutha
12

13. Nidana and Samprapthi-
Susrutha
13

14. Vata Pitta and Vata Kapha
involvement- Susrutha
14

15. Patho physiology in Susrutha
• Some change in etiology seen, but samanya
samprapthi is almost similar, but not explained
the vishesha samprapthi

16. Poorvarupa- Caraka
16

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

18. Poorvarupa-Samprathi Susrutha
18

19. Prodromal symptoms- Susrutha
• Due to the etiological factors the aggravated
Vatha and Raktha produces Vataraktha and the
prodromal symptoms are- Symptoms are first
seen in Feet and occasionally in hand and later
symptoms will be seen in all over the body.
• Symptoms are pricking pain, burning sensation,
itching, swelling, numbness, sudden eruption of
blackish or reddish rashes over the skin which
are seen in hand, feet, wrist or ankle.

20. Poorvarupa Susrutha- in Feet
20

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

22. Two types of Vatarakhta- Caraka
22

23. Types Charaka
• Uthana- Superficial
• Gambhira- Deep seated
And also
Ubhayashritha- both superficial and deep seated
These are depending upon the extent of damage
and also explained depending upon the doshik
involvement.

24. Two stages of Vataraktha-
Susrutha
24

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

26. Uttana Vataraktha - Caraka
26

27. Gambhira Vataraktha- Caraka
27

28. Uttana and Gambhira of Charaka
• Uttana- There will be itching and burning
sensation, and pain in the joint on movement,
pricking pain in joints and also feeling of
squeezing type of pain. Skin discoloration is also
seen in the skin near the joints.
• Gambhira- Severe itching and pain in the joints
affected, hard to touch, severe pain, within the
joint, burning sensation. Skin discoloraton and
even ulceration is also possible.

29. Ubhayashrita Vataraktha- Caraka
29

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

31. Vataja Vataraktha- Caraka
31

32. Pittaja Vataraktha- Caraka
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33. Kaphaja Vataraktha -Caraka
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34. Rakthaja Vataratha- Caraka
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35. Features- Susruta
35

36. Features Importance given only to
Pada
• Burning sensation, pricking pain, and other
features according to doshik involvement seen
in Pada (Kadachith in Hastha)

37. Upadrava- Caraka
37

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

39. Chikistya Vataraktha-Susrutha
39

40. Treat those without complicatons like-
Susrutha
• Susrutha advice to treat those without following
complicaton
• Gangrene formation, debilitated, unconcious
ness, poor appetite, high fever, heavyness,
delerious, convulsions,- may be those without
septicemia
• Treat those who are having full strength, with
good will power and having the all shastras and
anushastras ready, then only start the treatment.

41. Sadhyasadhyatha- Caraka
41

42. Reason for Asadhyatha- Caraka
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43. Prognosis Charaka
• With all upadravas- Asadhya- Incurable
• Mild upadravas- Yapya- can be Maintained
• Without complicaton - Curable

44. Asadhya Lakshana- Susrutha
44

45. Prognosis Susrutha
• Those Vataraktha with the ulcers extending up
to Knee with discharge of Pus, with Upadravas
like Murcha, Jvara, Pipasa, etc, those who are
very much debilitated, emaciated are
incurable.
• Vataraktha with history of one year or more
can be maintained with continuous treatment.

46. The Main differences are- 1
• Charaka has given importance to the
involvement of Joint and Joint Pain as the
main feature.
• Susrutha no where mentions involvement of
the joints and also joint pain.
46

47. 2
• Charaka has also given importance to skin
manifestation but only in Upadravas.
• But Susrutha has explained Vataraktha as a
skin condition with Ulceration which
commonly manifests in foot, rarely in hand.
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48. 3
• In Asadhya vataraktha Susrutha says that
ulceration with pus and slough which
reaches up to Knee is Asadhya.
• While Caraka explains skin complication
along with Anguli vakrata, Pangulya, Paka,
Toda, Bhrama, Klama, Arbuda, daha,
Murcha, Mada, ruk, Trishna, Pravepaka,
Shirograha etc.
48

49. 4
• Susrutha while explaining Chikitsya
Vataraktha says that those without Prana,
Mamsakshaya, pipasa, Jvara, Murcha,
Shwasa, kasa, sthambha Arochaka vipaka,
visarana Sankochana like Upadrava rahitha
Patients who are Balavantha, Atmavantha
and Upakaranavantha as Chikitsya. There the
symptomatology resembles a septicemia
patient.
49

50. 5
• Charaka explains almost all symptoms
involved in Rheumatism except morning
stiffness and symmetric involvement.
• But susrutha no where mentions
involvement of joint or symptomatology
similar to Rheumatism.
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51. 6
• Charaka explains Uttana, Gambhira and
Ubhayashritha as three types of Vataraktha
which is like articular, extra articular and
systemic involvement explained in rheumatism.
• But Susrutha says that Uttana and Gambhira
are the two stages as superficial and deep in
skin conditions (Kustavat)
51

52. 52
Why vataraktha can be RA and other
rheumatic condition?
THASYA STHANAM KARAU PADAVANGULYAHA
SARVASANDHAYAHA.
HASTHAPADE THU MOOLAM- DEHE VIDHAVATHI.
• LEADING SYMPTOMS SEEN IN SANDHIS, MAINLY
PHALANGEAL JOINTS AND TOES, AND THEN
MULTIPLE JOINTS.

53. 53
VATHARAKTHA- CLINICAL FEATURES
• MULTIPLE JOINT PAIN
• PRICKING PAIN
• TENDERNESS
• RECCURENT EXACERBATION AND REMISSION
• MALAISE
• FORMATION OF NODULES
• SKIN RASHES, EXCESSIVE OR NO SWEATING, TINGLING AND
ITCHING SENSATION OVER JOINTS.
• JOINT DEFORMITIES, STIFFNESS, RIGIDITY
• IN GAMBHIRA VATHARAKTHA, PAIN IS SEVERE AND PAKA
USUALLY OCCURS.

54. 54
VATHARAKTHA FEATURES
• Almost all the features of RA is explained except
morning stiffness and symmetrical involvement,
which is a diagnostic feature to consider RA.
• Extra articular symptoms like necrotic ulcers(paka) as
seen in vasculitis, mandalothpatti (butterfly rash in
sle), visarpa (skin lesions with bullous ulcers, necrotic
or gangrenous ulcers with systemic symptoms)
• Almost all differetials of Rheumatism can be included
under Vatashonita of Charaka including septic
arthritis(Pittaja Vataraktha).

55. 55
Vataraktha of Charaka- Rheumatism, all
differential diagnosis of rheumatism
• SO CONSIDERING ALL THE CRITERIAS, RA MAY
BE CONSIDERED UNDER VATHARAKTHA AND
ALL DIFFERENTIAL DIAGNOSIS OF RA
INCLUDING GOUTY ARTHRITS MAY ALSO BE
CONSIDERED UNDER VATHARAKTHA.

56. 56
SUSHRUTHAS VATHARAKTHA MAY BE
FOOT ULCER AND …
• Sushrutha explains Vatharaktha briefly, but he has
not given importance to the involvement of multiple
joints, but explains symptoms related with skin
lesion, which is painful, reddish, with swelling and
burning sensation or whitish with itching. But the
main site of lesion is mainly feet, but sometimes
hands, and symptom may spread to whole body as
poisonous rat bite.

57. 57
PERIPHERAL VASCULAR OBSTRUCTION &
VENOUS ULCERS MAY ALSO BE CONSIDERED.
• While explaining the symptoms he says that there
may be severe tenderness at the site of lesion or
sometimes numbness.
• Sushrutha while explaining incurable vathashonitha,
says that, if the lesion spreads up to knee (from
foot), and ulcerates with secretion of serum, blood
and pus & in case of muscle wasting & in a
debilitated person,it is incurable. So here he clearly
mentions ulceration in the leg, from foot up to knee
as a complication and also incurable.

58. 58
Gambhira and Uthana Vatharaktha are not
two types according to Sushrutha
• Sushrutha says that gambhira and Uthana are
not two types of vatharaktha, but two stages
of disease.
• So Sushruthas explanation may not be related
with RA, or he may not have given much
importance to vathashonitha with joint
involvement as his main subject was surgery.

59. CONCLUSION
• Probably Vataraktha of Caraka and Susrutha are
different diseases, but with same name.
• Lot of difference of opinion may be because of
disease consideration which may be Rheumatism
and Gout by Caraka and Gangrenous and other non
healing ulcers by Susrutha
• Further we can also consider the commentaries and
the other texts further eloborate on this subject
• The gap between period of Charaka and Susrutha is
100 to 300 years according to the historians which
could be the another reason for misunderstading.
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60. Thank You
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