Introduction

INTRODUCTION Vatarakta comes under the domain of Vatavyadi 1and mostly affecting the

extremities2. The umbrella of vatarakta in parlance with conventional medicine includes

many conditions related to extremities and to mention a few are connective tissue

disorders as well as peripheral vascular disorders. In the literature it is emphasized that

the etiological factors leads to the predominant morbidity of vata dosa and rakta dhatu

and hence the name vatarakta. To be more specific, the obstruction of raktamarga or

raktavaha 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 the

morbidity of the same with the involvement of raktamarga is about the first clinical

variety of vatarakta4. The etiopathogenesis of second clinical variety is different from

this. In the second clinical type instead of etiological factors of vata and rakta, it is the

etiology of kapha and medas that initiates the illness. The etiological factors of kapha and

medas obviously lead to the morbidity of the same. This abnormally increased kapha and

medas in turn gets accumulated in the rakta marga causing the provocation of vata as well

as 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 in

different systems. Prameha, Sonitadusti, hrdroga and vatavyadhi etc all are found to be

due to incriminatory affect of kapha and medas in respective systems6. Hence forth the

concept 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 symptoms

in vatarakta. Further to add, sodhana, samana, bahiparimarjana and rasayana cikitsa all

are aimed at the rectification of margavarna in this disease7. The whole concept of

margavarana can be best explained by the pathology of atherosclerosis and peripheral

vascular disease in modern parlance.

Peripheral vascular diseases include arterial, venous as well as lymphatic disease, and the

illness has a long lingering course. Inadaquate treatment or failure of treatment may lead

to fatal complications. Further to add, obstructive arterial diseases are named after the

1

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

Introduction

anatomical structure affected as coronary artetry disease, cerebro vascular disorders and

Ischemic limb diseases etc.

Atherosclerosis is the chronic pathological process likely to be asymptomatic

throughout the life, and it may have a fatal course when the same pathology involves the

vital organs, to mention few are heart, brain, gut etc. in contrast to this the

atherosclerosis affecting the arteries of the extremities, most commonly related to the legs

may not have a fatal course since beginning. But, it is also true that the disease runs a

chronic course and may land in fatal complications. Atherosclerosis leading to narrowing

of the arterial branches with in the legs manifests as ischemic limb disease and is

abbreviated as ILD. Rectification of Hyperlipidemia, bringing down the hypertension,

reducing the hyperglycemia and when essential surgical intervention like

revascularization or amputation, all these forms the sheet anchor of the management of

ILD.

Progressive atherosclerosis results in narrowing of the arterial lumen, hence the

name arteriosclerosis obliterans to this unique illness. Peripheral arterial disease is

another name referring to the same. Survey studies have established highest prevalence of

the 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 arterial

insufficiency. Prevalence increases with age as noted in recent national survey. the

prevalence of PAD was found to be 29% in people over aged 70 yrs. the prevalence rate

was 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 with

coronary angiography estimated that approximately one half of the patients of peripheral

arterial diseases present with clinical symptoms. More interestingly, life table analysis

has 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 patient

who continue to smoke cigarettes or who have uncontrolled diabetes mellitus. These

observations of survey studies undeniably point towards the high prevalence as well as

seriousness of the problem.

Depending upon the involvement of deeper or superficial dhatu in the pathogenesis of

vatarakta, it is clinically catagorised into uttanavatarakta gambhira vatarakta as well as

2

Introduction

ubhayashrita vatarakta9. Gambhira vatarakta has poor prognosis and is usually incurable.

The factors like, number of dosa involed, virulence of morbid dosa, involvement of

deeper dhatu, age, physical status all determine the prognosis of the illness10.

Previous Work Done

The review of previous works done clearly indicate that there prevailed ambiguity in the

understanding 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 or

lekhana basti treatment.

In a single blind comparative clinical study entitled “The effect of lekanabasti in the

management of sthoulya”,1122 patients suffering from sthoulya were studied in two

groups as control and test. The patients in the test group received lekhana basti as well as

murchita taila anuvasana basti in kalabasti course of 16 days followed by oral medication

with amrita guggulu for 30 days. The patients in the control group were subjected to oral

medication with amrita guggulu for 30 days. Following the medication statistically

significant improvement was observed in both the groups, however better response was

recorded in patients of test group proving the efficacy of lekhna basti in patients suffering

from sthoulya.

In patients suffering from sthoulya roga another single blind comparative clinical study

entitled “A clinical study on the management of sthoulya by panchatikta and lekhana

basti.”12was carried out . In this study 32 patients suffering from sthoulya were studied in

three groups. In group A 12 patients were orally treated with panchatikataguggulu vati in

a dose of 6 gm per day for 45 days. 10 patients in group B received panchatiktaghanavati

orally in a dose of 6 gm per day for 45 days. Further in group C 10 patients were

subjected to lekhana basti treatment. The study showed best reduction in body weight as

well as lipid profile levels in patients treated with lekhana basti course.

Yet another single blind comparative clinical study entitled “Conceptual study of

vatarakta vis-à-vis TAO & clinical management with manjishthadi kshara basti ”13, 20

patients suffering from ischemic limb disease were studied in two groups. 10 patients in

group A were treated with kaishora guggulu and arogyavardhini in a dose of 400 mg each

trice daily for 3 months with the anupana of 30 ml of manjistadi kvatha . In the second

3

Introduction

group B patients were initially subjected to yogabasti course of manjistadi ksara basti and

dhanvantara taila anuvasana basti followed by oral medication. The study recorded better

therapeutic response in patients treated with manjistadi ksara basti.

The analysis of previous work done in different research and post graduation study

centers unravels the ambiguity about the clinical understanding as well as treatment of

vatarakta. Many of the clinical studies regarded musculoskeletal disorders like

rheumatoid arthritis, gouty arthritis and osteoarthritis as vatarakta. In these works no

significance is being given to the unique pathology of raktamargavarodha in vatarakta.

Very little number of clinical works concentrated on vascular disease of the limbs as

vatarakta. More specifically speaking TAO is regarded as vatarakta. Here also the over

eating and sedentary habit as the cause of arterial disease / raktamargavarodha through

the 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 show

definite benefit in such chronic lingering disease. Kala basti and karma basti courses

appear better in chronic progressive disorders like vatarakta.

This review indicate that there is a necessity to study vatarakta as peripheral arterial

disease and its management with both sodhana and shamana line treatment with the due

consideration of its severity chronicity as well as possible complications.

Distinct etiological factors of vatadosha as well as raktadhatu together is said to

cause vatarakta. A variant form of vatarakta is also elaborated in Ayurvedic literature in

which santarpana category factors are incriminated to cause the illness. In this type of

vata rakta it is said that morbid kaphadosha and medas get accumulated in

raktavahasrotas14. Irrespective of employment of established treatment the illness

continues to run a chronic course affecting the middle aged and elderly people. Hence

any work exploring the newer effective medication mentioned in the Ayurveda is the

need of the day. Present work entitled A Clinical Study to Evaluate the therapeutic effect

of Vataraktantaka Rasa and Lekhan basti in vatarakta, is carried out with the

consideration that, the therapeutic measures that reduce kapha dosha and medas as well

as alleviate the morbid Vatadosha is the sheet anchor of treatment of vatarakta15. Basti is

claimed 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

Introduction

indicated in santarpanajanya vatarakta17. The herbo-mineral compound vataraktantaka

rasa consisting mainly of guggulu, shilajatu and lauha is said to be effective in negating

the incriminatory effect of morbid kapha dosa and medas and there by ensuring complete

cure 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 the

etymological 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 and

pathyapathya, all are found in the second chapter.

The details of Vataraktantaka rasa and composition of Lekhana basti are briefed under

the 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 the

clinical 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 Lekhana

basti 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 for

many other enthusiastic physicians to find a better cure for this lingering disease affecting the

extremities. 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. The

conclusions of which are like a pilgrim stranger tarrying for a while awaiting his

destination. New observations are added to the total body of knowledge. Some of older

observations loose their relevance or their significance. Ayurveda is no exception to this

rule, and particularly this holds good in case of VATA RAKTA. This surveillance of

Ayurvedic 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 Study

In Sushrutasamhita The explanation of nidana, purvarupa, rupa, samprapti and upadrava

of Vatashonita is available at full length. It is opined that unttana and avagadha clinical

presentation of vatarakta is not about its prakara rather avasthavishesha of vatarakta. All

modalities of treatment for vataja, pittaja, kaphaja, sansargana, sannipataja variety of

vatarakta are explained in this book21.

Sthoulya is listed as a major illness of santarpanottha vyadhi. The description of kapha

medovrddhi in rasarakta vaha srotas is most relavant to vatarakta. It is said that in the

presence of margavarana there is every risk of developing serious illness like prameha

and vatavyadhi. In addition to this silajatu guggulu triphala and gomutra is emphasized as

most efficacious in the management of sthoulya as well as margavarana. In the same

context the attention is called to the therapeutic efficacy of lekhana basti in the reduction

of kapha as well as medo dhatu22. Literature on vatarakta in bhela samhta is limited to the

just mentioning of treatment of raktagata vata as that of vatasonita23. Vivid description of

vatarakta 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 vata

ratka. 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 full

length in gadanigrana26. In the similar manner the whole description of vatarakta is found

in vataraktadhikara in vangasena samhita27. The elaboration of vatarakta in astanga

samgraha and asthanga hridaya follows the opinion of caraka samhita and sushruta

samhita. Further in this treatise the add-on description of sama and nirama stages of the

vatarakta is worth mentioning.

Samgraha kala – both diagnostic as well as therapeutic aspect of vatarakts in its entirety

is found in the books of samgraha kala, that include Sharangadhara samhita,

Bhavaprakasha. Madhavanidana, Yogaratnakara and Cakradatta

The lists of references from available literature in accordance to nidana panchaka were

enlisted below28 in

8

Conceptual Study

Table no. 1

Definitio

n

Synonyms Aetiolog

y

Pathogenis

i

Type

s

Purvarup Rup

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 the

books of vedic period. Contrary to this entire aspect of the illness from nidana to cikitsa

is found in books of samhita as well as sangraha kala of the history.

9

Conceptual Study

Presentation 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 cardinal

manifestation of the illness. Sula, ruk, toda, arati, and ruja are the different modes of pain

that may be present in vatarakta29. Further this pain may show a variation in terms of its

severity in regards to time of the day, season or physical activity. Including the pain the

clinical signs and symptoms of the disease may be differentiated as the one restricted to

the skin, or related to the deeper tissues. Altered tactile sensation is a major symptom

related 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 the

symptoms all related to the skin. Pathogenesis when involves the joints, patient suffers

from symptoms like joint pain, joint swelling, reduction in the range of movements and

other manifestations related to the joints32.

Progressive involvement of the deeper tissues is the characteristic feature of the

illness vatarakta33 and is marked by the hard stable swelling, progressive change in the

color of the skin from redness through bluish to blackish tinge. Later even suppuration

ensues in the affected part34.

During the later stages of the illness few of the systemic symptoms may add to the list of

local symptoms of vatarakta. Discolorations of the affected limb, edema, different type of

pain, deformities, suppuration, gangrene etc are few of the local symptoms. In contrast to

this, Later during the course of the illness the patient may develop symptoms like

abnormal respiration, hiccough, excessive unexplained thirst, insomnia and altered states

of consciousness in the form of bhrama mada, moha, murcha etc manifest as systemic

symptoms35.

Role of medo dhatu in the pathogenesis of vatarakta

Two distinct etiopathogenesis may cause the illness vatarakta. Individual

etiological factors of vata dosa as well as rakta dhatu may culminate in the development

of vatarakta and is the usual variety of vatarakta. Where in the morbid vata dosa as well

as vitiated rakta dhatu leads to the rakta margavarana and is the principal pathology of the

vatarakta36. In other variety of vata rakta, to begin with there is no role of etiological

10

Conceptual Study

factors of either vata dosa or rakta dhatu. Contrary to this the etiological factors of kapha

dosa 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 by

contributing the principal pathology of raktamargavarana37. The similar qualities of

kapha and medo dhatu speeds up the pathogenesis as two factors support mutually38. To

be precise, the santarpana category of etiological factors causes the morbidity of kapha

dosa and medo dhatu, and these in turn accumulate in the raktamarga leading to the

provocation of vata dosa and finally manifesting as vata rakta.

Needless to say depending upon the variation in the etiopathogeneiss the planning of the

treatment should differ. Rectification of morbid vata dosa as well as rakta dhatu is the

rational treatment in the first variety of vatarkata. Kapha medo hara line of treatment is

the sheet anchor of the treatment of santarpana nidana janya vatarakta39.

The pathogenesis of raktamargavarana is best correlated with the arterial obstruction due

to the atherosclerosis. This phenomenon of accumulation of kapha and medas within the

dhamani is also referred as dhamani praticaya in ayurvedic literature40. Abnormal

accumulation of the lipids in the arterial wall is the leading pathology of atherosclerotic

obliterans. The most common symptom of ischemic limb disease that include intermittent

claudication, ache and cramps, altered sensation, changed skin color, obliterated arterial

pulse, 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 lower

extremities41. These citations of similarities are more than enough to compare the

ischemic limb disease with the santarpana nidana janya vatarakta.

Atherosclerosis is a specific form of arteriosclerosis affecting primarily the intima of

large and medium-sized muscular arteries and is characterized by fibro fatty plaques or

atheromas. The term atherosclerosis is derived from athero-( meaning porridge) referring

to the soft lipid-rich material in the centre of atheroma, and sclerosis (scarring) referring

to connective tissue in the plaques. Atherosclerosis is the commonest and the most

important of the arterial diseases. Though any large a medium-sized artery may be

involved in atherosclerosis the most commonly affected are the aorta, the coronary and

the cerebral arterial systems. Therefore, the major clinical syndromes resulting from

ischemia due atherosclerosis are the myocardial infarcts (heart attack ) and the cerebral

11

Conceptual Study

infarcts (strokes); other less common sequel are peripheral vascular disease, aneurysm

dilatation due to weakened arterial wall, chronic ischemic heart disease, ischemic

encephalopathy ,an mesenteric occlusion and ischemic limb disease (ILD)

The understanding of vatarakta is related to collagen diseases, gouty arthritis as well as

ischemic limb diseases. All these comparisons are justified based on analysis of

symptoms of vatarakta and the diseases mentioned in conventional medicine. From the

foregoing citations it is clear that ischemic limb disease is also best compared to vatarakta

in regards to its etiopathogensis as well as clinical findings.

12

Conceptual Study

ETYMOLOGICAL DERIVATION

Unique concept of naming the disease is adopted in Ayurvedic literatures. Illness

occurring at a specific location is named after the specific organ as in the disease

hridroga. In contrast to this several other disorders are named after the cardinal symptom

as in atisara and shwasa. Where as the name vatarakta is coined on the basis of the

samprapti ghataka that is vata dosa and rakta dhatu involved in the disease. The same

opinion 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

krstnam samdushayet raktam tajneyam vatashonitam” 47morbid vata dosa when

obstructed by vitiated rakta dhatu, further becomes virulent and once agiain adds to the

abnormality of rakta dhatu, this illness is called as vata shonita.

• “kruddhotyartham maargarodhaat sa vayuhu atyudriktam dushayet raktamashu

tat sampruktam vayuna dushitena tatprabalyat uchyate vataraktam”48

Initially there occurs distinct morbidity of vata dosa and rakta dhatu. The morbid rakta

dhatu in turn obstruct the passage of vitiated vata dosa. Obstruction to the passage of vata

dosa causes worsening of the morbidity of vatadosa. Continuing the pathology the

severly vitiated vata dosa also furthrer disturbs the morbid rakta dhatu. This illness is

known as vararakta.

13

Conceptual Study

SYNONYMS

Adhyavata, khudha vata, vatabalasa and vatasonita are the names used to refer the illness

vatarakta.

“khuda desha praptya khudah, khudashabdena sandhiruchyate”49 as the disase vatarakta

involves 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 is

dependant upon morbidity of rakta dhatu worsened by the obstructed vayu and hence is

known as vata balasha.

“adhyanaam prayo bhavati iti adhyarogah”51 the word adhya refers to rich person. As the

disease is common in rich it is called as adhyavata. In the same meaning this illness is

also refered by the names adhyamaruta and adhya pavana.

NIDANA 55

Vata and rakta are invariably involved in the pathology of vatarakta. Morbid rakta dhatu

when obstructs the vitiated vata dosha there will be further amplification of the virulence.

Severely vitiated vatadosa in turn, badly influences the morbid rakta dhatu later

manifesting as vatarakta52. Parallel to this pathology, two distinct set of etiological factors

take part in the causation of the illness. One set of etiology leads to the vitiation of vata

dosa and the other set separately causes morbidity of rakta dhatu. These distinct sets of

etiological factors may be related to ahara vihara or the one influencing the manas53. In

spite of this, in the variant form of vata rakta where in santarpana category of factors

leads to the abnormal accumulation of kapha as well as medo dhatu, and more

particularly in the rakata marga culminates in the pathology of vata rakta54. 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 of the illness. Thus the list of

etiological fatctors in the following lines includes both the nidana of vatarakta as well as

nidana of santarpana janya vikara.

Aharaja nidana56: the dietetic factors that cause the morbidity of vata dosa as well as

rakta 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 quality

tend to cause vatarakta. Further Ajeerna bhojana, viruddhasana, adhyasana, these habits

14

Conceptual Study

of 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 and

medas. Due to the similarity in the inherent qualities of kapha and medas, identical

etiologyical factors cause the morbidity of both kapha and medas. Further similarity in

the qualities of these two factors enhances the tendency of these two involving in dosa

dushya samurchanaa. It is an established fact that excessive nutrition and lack of physical

exercise together known as santarpana nidana contributes to the accumulation of kapha

and medas. Dietary factors like hayanaka, yavaka, chanaka, uddalaka, mukundaka,

mahavrihi, pramodaka, sugandhaka, navanna (navadhanya) etc when consumed

frequently 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 accumulation

of kapha and medas. Lack of physical and metal activity further adds to the pathology.

Viharaja nidana 58– the behavioral factors that may lead to the vatarakta include

abhighata, 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 snehadicikitsavibhramana

etc factors precipitates morbidity of kapha and medas also.

Manasika nidana –

Akrodha, acinta, harshanityatva these factors incriminated to cause accumulation of

kapha and medas in the body59.

To add the relavant literature from the modern counterpart60- Atherosclerosis is

widely prevalent in industrials countries. However, majority of the incidences quote in

the literature are based on the major clinical syndromes produced by it, the most

important interptation being that death from myocardial infarction related to underlying

atherosclerosis. Cardiovascular disease, mostly related to atherosclerotic coronary he

disease or ischemic heart disease (IHD) is the most common cause of death in the

developed countries the world.

15

Conceptual Study

Extensive epidemiologic investigations on live populations have revealed a

number of risk factors which are associated with increased risk of developing clinical

atherosclerosis. Often, these risk factors are acting in combination rather than singly.

These risk factors are divided into two groups

Major 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 is

minimal, and in some cases even uncertain.

Apparently, a combination of etiologic risk factors has additive effect in producing the

lesions of atherosclerosis.

MAJOR CONSTITUTIONAL RISK FACTORS

Age, sex and genetic influences do affect the appearance of lesions of atherosclerosis.

1. AGE. Atherosclerosis is an age-related disease. Though early lesions of atherosclerosis

may 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 decade

than in women and the difference slowly declines with age but remains higher at all ages

in men. The lower incidence of IHD in women, especially in premenopausal age, is

probably due to high levels of oestrogen and high-density lipoproteins, both of which

have anti-atherogenic influence.

3.GENETIC FACTORS: Genetic factors play a significant role in atherogenesis.

Hereditary genetic derangements of lipoprotein metabolism predispose the individual to

high 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 FACTORS

There 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 under

Low –density lipoprotein (LDL) is richest in cholesterol and has the maximum

association with atherosclerosis.

Very –low- density lipoprotein (VLDL) carries much of the triglycerides and has less

marked effect than LDL.

High-density lipoprotein (HDL) is protective ‘good cholesterol’ against atherosclerosis.

Many studies have demonstrated the harmful effect of diet containing larger

quantities of saturated fats (e.g. in eggs, meat, milk, butter etc) which raise the plasma

cholesterol level. This type of diet is consumed more often by the affluent societies who

are at greater risk of developing atherosclerosis. On the contrary, a diet low in saturated

fats 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 total

number of calories from carbohydrates, proteins, alcohol and sweets has adverse effects.

2. HYPERTENSION: Hypertension is the other major risk factor in the development of

atherosclerotic IHD and cerebrovascular disease. It acts probably mechanical injury to the

arterial wall due to increased blood pressure. A systolic pressure of over 160 mm Hg or a

diastolic pressure of over 95 mm Hg is associated with five times higher risk of

developing IHD than in people with blood pressure within normal range (140/90 mm Hg

or less).

3. SMOKING: The extent and severity of atherosclerosis are much greater in smokes

than in non-smokes. Cigarette smoking is associated with higher risk of atherosclerotic

IHD and sudden cardiac death. Men who smoke a pack of cigarettes a day are 3-5 times

more likely to die of IHD than non-smokers. The increased risk and severity of

atherosclerosis in smokers is due to reduced level of HDL and accumulation of carbon

18

Conceptual Study

monoxide in the blood that produces carboxy-haemoglobin and eventually hypoxia in the

arterial wall favoring atherosclerosis.

4. DIABETES MELLITUS: Clinical manifestations of atherosclerosis are far more

common 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 to

develop cerebrovascular disease is high, and frequency to develop gangrene of foot is

about 100 times increased. The causes of increased severity of atherosclerosis are

complex and numerous which include increased aggregation of platelets, increased LDL

and decreased HDL.

MINOR FACTORS

There are a number of less important and minor risk factors having some role in the

etiology of atherosclerosis. These are as under:

1. Higher incidence of atherosclerosis in developed countries and low prevalence in

underdeveloped 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 endogenous

oestrogen deficiency (e.g. in post-menopausal women) has been shown to have increased

risk of developing myocardial infarction or stroke.

4. Physical inactivity and lack of exercise are associated with the risk of developing

atherosclerosis and its complications.

5. Stressful life, style, termed as type A behavior pattern, characterized by

aggressiveness, competitive drive, ambitiousness and a sense of urgency, is associated

with enhanced risk of IHD compared with type B behaviors of relaxed and happy-go

lucky type.

6. Recently role of infections, particularly of Chlamydiapneumoniae and viruses such as

herpes 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 been

reported to have early atherosclerosis and coronary artery disease.

19

Conceptual Study

8. Moderate consumption of alcohol appears to have slightly beneficial effect by raising

the level of HDL cholesterol and by causing vasodilatation but the matter remains

controversial

In a nut shell the etiological factors of kapha medo margavarana janya vatarakta as well

as atherosclerosis is more or less identical. Diet and behavioral factors leading to

atherosclerosis can be best regarded as santarpana nidana of vatarakta causing

accumulation of kapha and medas with in the raktamarga.

PURVARUPA

The movement of vatadosa is inhibited by the unique pathology of raktamargavarana in

vatarakta. This in term initially manifest with certain clinical signs and symptoms in the

form 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 other

manifestations 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 part

is regarded as one among the purvarupa of vatarakta. Sweat is one among the three mala

and sweating is the function of svedavaha srotas. This swvedavaha srotas is spread out

between roma kupa and medas in the twak62. Sweating in the svedavha srotas is

controlled by samanavayu63. This morbid vatadosa is said to alter the physiology of

svedavaha srotas manifesting either as excessive sweating of deficient sweating64.

Alteration in the tactile sensation: twak is the abode of sparshendriya, and in the same

twak there is abundance of vata dosa. It is the vyana vayu that moderates the

sparshanendriya for the tactile sensations. Morbidity of vatra dosa in vatarakta disturbs

this physiological functioning of the sparshanendrya leading to either supti - numbness or

ksate atiruk – hyperesthesia65.

Alteration in the color of the skin: twak is said to have distinct six layers66. avabhasini is

the most superficial layer of the skin. The complexion as well as luster of the skin is

imparted by this layer itself. Vitiated vatadosa when affects this layer of the skin there

occurs abnormal coloration as well as lusture of the skin. This physiology is skin

coloration is controlled by udanavayu67. The same happens in vata rakta. When the

morbid vatadosa affects the avabhasini layer the patient may develop macule or patches

20

Conceptual Study

of discoloration. Reddish, pinkish, bluish or blackish coloration of the dermis may

happen in vatarakta.

Itching sensation: morbid vatadosa when brings about dryness of the skin patient is likely

to suffer from itching sensation. So also alteration in the sweating may contribute to the

development of itching sensation in patients suffering from vatarakta68.

Pain: pain is the major manifestation of the morbid vatadosa. Morbid vata dosa when

affects the twak mamsa or rakta dhatu pain is a clinical manifestation. Toda, sula, bedha

pindikodvestana, ksate atiruk spurana, intermittent occurrence of pain all may manifest in

patient 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 occurs

during exercise and relieved by rest. The site of claudication is distal to the location of

occlusive lesion. Eg. Buttock, thighs, hip discomfort occurs in patient with aortoiliac

disease. Whereas calf claudication develops in patients with femoral popletial disease.

The symptoms are far common in lower extremities than upper because higher number of

incidence 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 when

the legs in dependent position.

Joint pain: vitiated vata dosa in vatarakta also tend the involve the joints in vatarakta. The

involvement of joints is characterized by pain, heaviness swelling fasculations at or

around the joints like janu, uru, kati and hasta padanguli sandhi70.

Constitutional symptoms: few of he constitutionl symptoms also mark the initial stage of

vatarakta like alasya, gaurava and sadana 71etc.

More details of the purvarupa as listed in different literatures of ayurveda 72is shown in

the 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 as

uttana (anavagadha)vata rakta. Involvement of deeper dhatu like asthi majja and sandhi

signifies the gambhira (avagadha)vatarakta. A third variety of ubhayashrita vatarakta is

also mentioned in literature where in both the superficial as well as deeper dhatu is

affected. Vatarakta is a progressive disorder and hence initially the illness may be limited

to either superficial dhatu or deeper dhatu alone, but in the later stages the uttana

vatarakta progresses to deeper dhatu. Similarly the gambhira vatarakta may involve the

superficial dhatu in the later stages. Hence in the later stages the vatarakta develops as

ubhayashrita vatarakta74.

The symptoms like kandu, daha, ruka, ayama, toda, sphurana, shyava/ rakta tvaka and

such other symptoms probably limited to the twak indicates the uttana vatarakta75.

Persistent hard swelling of the affected part, suppurations, involvement of sandhi asthi

and majja, deformities like vakrata, khanja and pangu all these point towards the

gambhira vataratka76.

Presence of symptoms indicative of both uttana as well as gambhira vatarakta signifies

the ubhayashrita vata rakta. Following table shows the exclusive symptoms of uttrana and

gambhira vatarakat77.

UTTANA VATARAKTA:

Kandu itching

Daha burning sensation

Ruja pain

23

Conceptual Study

Ayama (sira ayama) dilatation of the vessels

Toda pricking pain

Spurana trembling or throbbing sensation

Kunchana (sira akunchana) contraction

Shyava twak cyanosis of the skin

Rakta twak reddish coloration of the skin

Bheda splitting type of pain

Gourava heaviness

Suptata numbness

Table no 3: symptoms of uttana vatarakta78

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 Study

GAMBHIRA VATARAKTA79:

Svayatu stabdhata fixed swelling

Svayatu kathinya hard swelling

Bhrisharthi excruciating deep pain

Shyavatha cyanosis or pallor

Tamra twak coppery discoloration

Daha burning sensation

Toda pricking type of pain

Sphurana throbbing sensation

Paka suppuration

Ruja pain

Vidaha internal burning sensation

Vatasya sandyasthi

Majjasu chindanniva. Aggravated vayu while causing pain-burning

sensation constantly moves with high speed through

the sandhi, asthi and majja.

Kanjatwa lameness

Pangutwa paraplegia

Adhika purvaruk increased pain

Swayatu grathita hard swelling

Vatasya sarva Shareera charana vitiated vata moves all over the body

Angasya vakrikarana disfigurement of the parts

Table 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 morbid

dosa in the primary pathologly of vata and rakta and are named as vatadhika vatarakta,

pittadhika vatrakta, kaphadhika vatarakta and raktadhika vatarakta.

26

Conceptual Study

Vatadhika vatarakta80:

Clinical symptoms when predominate the morbidity of vata dosa the vatdhika vatarakta is

diagnosed. Following are the symptoms suggestive of vatadhika vatarakta.

Sirayama dilatation of vessels

Sula pain

Spurana throbbing sensation

Toda pricking pain

Shothasya karshnyam blackish discoloration of the swollen part

Shothasya roukshyam dryness of the skin overlying the swelling

Shothasya syavata bluish discoloration overlying the skin

shyavata vriddi/hani frequent increase and decrease of bluish

discoloration

Dhamani anguli sandi sankocha contraction of vessels and sandhi

Angagraha stiffness of the affected parts

Atiruk severe pain

Stambana stiffness

Sheeta pradhvesha aversion towards cold surroundings

Sparshodwigna inability to tolerate the touch

Bheda splitting type of pain

Prashosha atrophy

Swapa numbness

Sheetanupashaya worsening of symptoms on exposure to cold

Vepathu tremors

Table 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/hani

+ - + + + + + +

Dhamani anguli

sandi sankocha.

+ - + + + + + +

Anga graham + - + + + + + +

Ati ruja + - + + + + + +

Kunchana + - - - - - + +

Stambhana + - + + + + + +

Sheeta

pradvesha

+ - + + + + + +

Sparshodvigna - + - - - - - -

Bheda + - - - - - + +

Swapa - + + + + + - -

vepathu - - + + + + - -

Pittadhika vatarakta81 –

Diagnosis of pittadhika vatarakta is made when more symptoms indicative of morbid

pitta dosa associate the symptoms of vatarakta. Following is the list of symptoms

suggestive of pittadhika vatarakta.

Vidaha severe burning sensation

Vedana pain

28

Conceptual Study

Murcha fainting

Sweda sweating

Trishna thirst

Mada irrelevant behavior

Brama giddiness

Paka inflammation/suppuration

Raga redness

Bheda splitting type of pain

Sosha atrophy

Ugra daha excruciating burning sensation

Ati ushnatwam increased local temperature

Sophasya mridutwam soft swelling

Sammoha confusional or unconscious state

Sparshakshamatwa hyperesthesia

Table 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 suffering

from vatarakta the diagnosis of kaphadika vatarakta is justified. Details of the symptoms

of the same is listed below.

Staimitya sensation as if the body part is covered with

wet cloth

Gourava heaviness

Snehatwa unctuousness

Supti numbness

Manda ruja mild pain

Kandu itching

Swetata increased pallor

Seetata coldness

Sopha swelling

Stabdatwa stiffness

30

Conceptual Study

Table 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 83

Symptoms pertaining to severe morbidity of rakta dhatu differentiate the raktadhika

vatarakta from other varieties of vatarakta. Of course, for evident reasons there may be

much overlap between the symptoms of pittadika vatarakta and raktadhika vatarakta.

However following list of symptoms are unique manifestations of raktadhika vatarakta.

Sotha swelling

Ati ruk severe pain

Toda pricking pain

Tamra varna coppery discoloration

Chimichimayana tingling sensation

Snigdha rukshahishamam naiti poor remission of symptoms to snigdha

ruksa line of management

31

Conceptual Study

Kandu itching

Kleda exudation

Table 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 a

given 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 of

amadosa. Symptoms of ama if associates the symptoms of vatarakta then the condition is

known as sama vatarakta. If only the symptoms of vatarakta presents with out the

association of symptoms of ama then the illness is referred as nirama vatarakta85. The

symptoms of sama and nirama vatarakta is depicted in the table nos

SAMPRAPTI

Distinct etiological factors of vatadosa and rakta dhatu separately causes the morbidity of

vata dosa as well as abnormality of rakta dhatu. Morbid vata dosa furthrer incriminates

the abnormal rakta dhatu. This abnormal rakata dhatu by way of raktamargavarana in turn

inhibits the movement of vata dosa leading to severe morbidity of vatadosa. This is

32

Conceptual Study

marked by development of clinical signs and symptoms. Thus the illness vatarakta

clinically manifests. This is the general samprapti of vataraka in which the

raktamargavarana is the final stage of the sampraapti86. This raktamargavaarana can

happen in a different way also. The santarpana category of etiological factors leads to the

accumulation of kapha and medas in the raktamarga there by causing raktamargavarana.

Due to the establishment of raktamargavarana there occurs inhibition of movement of

vata dosa. Inhibition of vata culminates in severe morbidity of vata dosa and once again

manifesting 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 of

excessive accumulation of kapha and medas in the body. Other than the vatarakta, the

kapha and medas can cause different other diseases like vatavyadhi, hrdroga, gulma and

prameha88. Thus presence of any of these diseases is also a strong clinical evidence of

abnormality of kapha and medas in a given patient. Corroborating the same, coexistence

of 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 the

concept of raktamargavarana due to abnormal kapha and medas in the disease vatarakta.

The symptoms like excessive sweating or deficient sweating are indicative vitiation of

samana vata. Altered sensations and decreased range of joint movements is in favour of

morbidity 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 the

later 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 the

rakta dhatu. The same is also suggestive of abnormality of raktavaha srotas. Appreciation

of the dhamani praticaya also corroborates the same.

Margavarana tending inhibition of movement of vatadosa in the raktamarga being the

prime 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 of

mamsa dhatu sandhi shoola are the symptoms pathognomonic of morbid asthi dhatu92.

33

Conceptual Study

Involvement of majja dhatu is identified by the presence of symptoms like murchya 93etc.

Excessive or deficient sweating is indicative of involvement of both sweda and

svedavaha srotas in the pathogenesis of vatarakta94.

Affliction of dhatu like twak, rakta etc is suggestive of relationship of bahyarogamarga in

the disease. In contrast to this presence of symptoms evocative of affliction of sandhi

corroborates the relationship of madhyama rogamarga in vatarakta95.

Occurance of constitutional symptoms like jvara, alasya etc. affirms the sarvasharira as

the sanchara sthana of the dosha. In spite of this fact, it is stated that the morbid dosa tend

to circulate in the lower limbs to a larger extent.

Add to this from the modern paralance of atherosclerosis96 - Most atheroma produces no

symptoms, and many never cause clinical manifestations. Numerous patients with diffuse

atherosclerosis may succumb to unrelated illness without ever having experienced

clinically significant manifestations of atherosclerosis. What accounts for this variability

in the clinical expression of atherosclerotic disease, here is the explanation - Arterial

remodeling during atheroma formation represents a frequently overlooked but clinically

important feature of lesion evolution. During the initial phases of atheroma development,

the plaque usually grows outward, in an abluminal direction. Vessels affected by

atherogenesis tend to increase in diameter, a phenomenon known as compensatory

enlargement, a type of vascular remodeling. The growing atheroma does not encroach

upon the arterial lumen until the burden of atherosclerotic plaque exceeds approximately

40% of the area encompassed by the internal elastic lamina. Thus, during much of its life

history, an atheroma will not cause stenosis that can limit issue perfusion.

Flow limiting stenoses commonly form later in the history of the plaque. Many such

plaques cause stable syndromes such as demand induced angina pectoris or intermittent

claudicating in the extremities. In the coronary and other circulations, even occlusion due

to atheroma does not invariably lead to infarction. The hypoxic stimulus of repeated

bouts of ischemia characteristically induces formation of collateral vessels in the

myocardium, mitigating the consequences of an acute occlusion of an epicardial coronary

artery. On the other hand, we now appreciate that many lesions may produce only

minimal luminal irregularities on traditional angiograms and often do not meet the

traditional criteria for “significance” by arteriography. Instability of such nonocclusive

34

Conceptual Study

stenoses may explain the frequency of myocardial infarction as an initial manifestation of

coronary artery disease (in at least a third of cases) in patients who report no prior history

of angina pectoris, a syndrome usually caused by flow-limiting stenoses

Samprapti 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 marga

UPASHAYA – ANUPASHAYA

Morbidity of the vatadosa is the basic pathology of the illness. And the same to a larger

extent determines the upasaya and anupasaya in vatarakta. Accordingly the exposure to warm

surrounding, rest and application of sneha tend to cause remission of the symptoms, where as

exposure to cold surrounding and physical exercise tend to worsen the symptoms of vata

rakta97.

35

Conceptual Study

Ushna upasaya: sita is the inherent quality of vata dosa. Elevation of the sita quality is likely

increase the morbidity of vata dosa. This is best counteracted by the heat. Thus exposure to

warm environment brings about comfort to the patient.

Sita anupasaya: cold environment further worsens the morbidity of vatadosa. Hence exposure

to cold is considered as anupasaya. This intolerance is verymuch pronounced in the vatadhika

vatarakta.

Anayasa upashaya: any form of exercise increases the vatadosa and also rest pecifies the vata

dosa, hence camkramana98is listed as a nidana of vatarakta. Needless to say the

Ayasa anupashaya: as exercise increases vatadosa symptoms of vatarakta tend to worsen

following exercise

Snigdha upasaya: ruksha is the inherent quality of vatadosa and is best neutralize by snigdha

cikitsa. Thus applicateion of sneha is a upasaya in vatarakta. Contrary to this severe morbidity

of rakta when present even snigdha chikitsa does cuase remission of symptoms of vatarakta

Ruksa anupasaya: any measures that increase ruksata in the body increases vata dosa and hence

worsens the symptom of vatarakta99.

UPADRAVA 100

The disease vatarakta is a lingering disease and tend to run a chronic

course.basically vata dosa and rakta dhatu is involved in the pathogenesis., as the disease

progresses it tend to involve deeper tissues like asthi majja and sandhi. Accordingly

during the later course the patent may even suffer from several upadravas. Following

lines 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 indigestion

Localized complication

Mamsakotha necrosis of tissue

Pangulya paraplegia

Visarpa cellulites

Paka suppuration

Toda pricking pain

Anguli vakrata disfigurement of digits

Spota eruptions

37

Conceptual Study

Daha burning sensation in foot

Visarana necrosis

Sankocha contractures

Table 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 or

absence of upadrava’s as well as chronicity of disease. The same in regards ot vatarakta is

elaborated in the following lines

SADHYA – 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 pathogenesis

Absence of upadrava

Vatarakta of one year duration

Physically strong patient, having enough resources to undergo best available treatment.

ASADHYA- following factors in vatarakta determine its incurability.

39

Conceptual Study

Involvement of all the three dosa in the pathogenesis

Presence of upadrava

Presence of specific symptoms indicative of incurability like ajanausphutita

Table 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 Study

SAPEKSHA NIDANA :

Symptom around the joints is the cardinal manifestation of the diseases sandhigatavata

and amavata and thus these diseases need to be differentiated from the vatarakta. In

addition to this the skin manifestation of the kusta is akin to the same present in the

vatarakta. Hence the kusta should be distinguished from the vatarakta again. Differential

diagnosis is best made by the analysis of the samprapti ghataka as well as clinical

manifestations 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 characteristic

feature of sandhigata vata. Absence of symptoms indicative of morbidity of rakta dhatu

or ama is also characteristic. Thus vatarakta, and kustha is best differentiated from

sandhigata vata as the later does not present with symptoms suggestive of affliction of

rakta dhatu. Symptoms indicative of rakta dhatu involvement is mandatory for the

diagnosis 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 before

the involvement of joints. Thus the purvarupa helps in the differentiation of these

diseases. Presence of typical purvarupa is unique feature of vatarakta and the presence of

which excludes both amavata as well as sandhigata vata.

Initial involvement of lower limbs followed by progressive spreading of illness to other

parts of the body is characteristic of vatarakta104. Such a progression of illness is less

evident or absent in sandhigata vata.

Illness is limited to the joints in sandhigata vata. But this is not true in kustha and

vatarakta as the structures in-between the joints are also affected in these diseases.

Intermittent nature of joint pain, more particularly pain occurring on movement is

characteristic of sandhigata vata. Where as in amavata and vatarkta the pain is more or

less continuous, and is even felt at rest. Intermittent nature of pain is also found in

vataratka, but the pain is felt at rest disturbing the sleep.

41

Conceptual Study

During the chronic course of the illness the patient of sandhigata vata never develop

paka, kotha or anganasha, but such a sequel is possible both in kushta and vatarakta. Thus

the presence or absence of such an upadrava is a useful criterion for the differential

diagnosis.

Affliction of joint alone is the characteristic feature of the sandhigata vata. Where as both

amavata as well as vatarakta presents with many other constitutional symptoms that helps

in the differentiation of these diseases.

Amavata:

Joint pain joint swelling and limitation of joint movement characterizes the disease

amavata 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, worsening

on application of fat substances, sever symptoms during morning hours, on a cloudy day

and at night times is indicative of amavata105. Contrary to this in vatarakta as well as

sandhigata vata there occur morbidity of vata dosa which is not associated with ama and

hence symptoms remit on application of oil. There may be little difficulty in

differentiating amavata if the patient is suffering from sama vatarakta.

Symptoms related to morbid rakta dhatu like discoloration of the skin is distinctive of

vatarakta. Absence of symptoms indicative of morbidity of rakta dhatu is suggestive of

amavata.

Premonitory symptoms related to the skin of the affected part is the typical feature of

vatarakta and is absent in amavata. Thus joint manifestation with out purvarupa is

indicatieve of amavata.

About the course of the illness, amavata tend to begine from the kati region and then

spreads to different other joints or location of kapha dosa106. Contrary to this, vatarakta

tend to begine from the legs and then spreads to other locations and does not show any

predilection for location of kapha dosa.

Kustha

The purvarupa of kusta is some what identical to the one found in vatarakta and hence it

should be differentiated107. Among the 7 maha kustha and 11 ksudra kusta only the maha

42

Conceptual Study

kustha manifests with prior appearance of purvarupa. Hence there will not be any

difficulty in differentiating ksudra kustha from vatarakta.

In maha kusta symptoms indicative of saptadravya is characteristic108. In vatarakta the

symptoms pathognomonic of vata dosa and rakta dhatu predominate. This gives the clue

for differential diagnosis

The site of development of kustha does not show any predilection, rather it can happen in

any location and more or less restricted to bahya roga marga. Spread of vataratka show a

typical pattern, it begins in the lower limbs and then spreads to different other location

involving the madhyma roga marga. This nature of the illness can be considered for the

differential diagnosis.

Kustha is contagious disorder109, and hence patient of kustha roga may give the family

history of the same. Vatarakta is non communicable and hence the family history may be

negative in this regard.

Incidence of the illness vatarakta is more among the rich110. The incidence of kustha in

rich and poor is alike. Thus socioeconomic status of the patient may be a corroboratory

evidence for the diagnosis of vatarakta.

Corse of the illness varies in these diseases. Though the purvarupa of kushta and

vataratkta is identical to some extent; the rupa stage shows the marked difference. Hence

the rupa stage does not pose any problem in differentiation of these two diseases.

Investigations:

Blood:

Routine examination of blood including hemoglobin estimation (low HB% can

decrease 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 of

patients.

43

Conceptual Study

Blood urea and Serum creatinine are the kidney function tests need to carry out as many

patient suffers from diabetes mellitus and to rule out micro vascular complications of

diabetes 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 cholesterol

usually measured after 12 hours of overnight fast. Abnormalities in plasma lipoproteins

and derangements in lipid metabolism ranks as the most firmly established and best

understood 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 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 major classes of lipoprotein particles are chylomicrons, very-low density

lipoproteins (VLDL), low- density lipoproteins (LDL), and high-density lipoproteins

(HDL).

Low –density lipoprotein (LDL) is richest in cholesterol and has the maximum

association with atherosclerosis. The cholesterol in LDL accounts for 70 % of plasma

cholesterol in most indusials. So is bad cholesterol. Normal value of LDL cholesterol is

65-150 mg / dl.

Very –low- density lipoprotein (VLDL) carries much of the triglycerides and has less

marked 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 of

peripheral cells to the liver by the process termed as reverse cholesterol transport and

44

Conceptual Study

from 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 LDL

cholesterol 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 of

frequency in the reflected beam, as compared with the transmitted beam, are due to

“Doppler shift” resulting from passage of beam through moving blood. These frequency

changes are converted into audio signals. This investigation may be used effectively in

cases where a differential diagnosis of atherosclerosis is entertained showing the site of

block & 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 Study

Arteriography:

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 and

medium sized arteries which are not suitable for anatomic reconstruction. In this

conditions 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 vatarakta

Antahparimarjana cikitsa

Raktamoksana111 – raktamargavarana is the predominant pathology of vatarakta and this

leads to the accumulation of morbid rakta. Hence raktamoksana is considered as first line

of treatment of vatarakta. Raktamkoksana may be achieved by any of the

sringavacarana,jalokavacaraba suchivyadha,alabuavacarana, pracchana and siramoksa

methods. Raktamoksana by the jalaukavacarna method is preferred if the affected site

exhibits symptoms like ruk, daha toda and sula. Sringavacarana is the better choice if the

patient of vatarakta has symptoms like supti kandu cimacimayana etc. if the illness

progress with spreading, raktamoksana by pracchana method is the better option. Though

the raktamoksana is the primary treatment of vataramkta excessive bleeding may further

vitiate the vata dosa of vatarakta hence frequent employment of raktamoksana in small

46

Conceptual Study

amounts is always justified. Improper or excessive employment of raktmoksana may lead

to development sever complications like vatavyadhi. There fore one must be very

cautious while planning the raktamoksana in patients suffering from vatarakta.

Langhana112 – langhana cikitsa is advocated if the morbidity of kapha dosa associates the

pathology of vatarakta. Langhana when employed reduces the morbidity of kapha dosa in

kaphanuga type of vatarakta. Further, if the margavarna in vatarakta is due to

accumulation of kapha and medas langhana treatment is very much beneficial for evident

reasons.

Snehapana – both shodhananga sneha as well as samananga sneha is indicated in

vatarakta. As preparation of patient prior to vamana or virecana patient is subjected to

shodhananga sneha. Further in vatottara vatarakta following sodhana procedure

snehapana with purana grita is ideal113. Snehapana is not ideal if the patient of vatarakta

exhibits excessive sneha in his body. Also in case of margavarana due to accumulation of

kapha and medas snehapana is contraindicated114.

Vamana – vamana is indicated as a shodhana procedure in vatarakta. In a patient of

vatarakta if the lesions are located in the upper extremities it is suggestive of association

of morbid kapha and pitta dosa. Shodhana by vamana procedure is a better option in such

situations115. 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 in

the patient’s body. In snigdha person vamana is carried out with minimal or no prior

snehapana. In patients with ruksata in the body, employment of vamana karma with prior

snehapana is ideal116. One should remember that, as the vatarakta is the disorder with

predominant vitiation of vata dosa, only mrudu vamana is justified as tikshna vamana

tend to increase the morbidity of vatadosa.

Virecana117- both snigdha virecana as well as ruksa virecana is indicated in vatarakta. If

the patients body exhibits snigdhata, ruksa virecana is ideal. Contrary to this if the

patient’s body exhibits rukshata in the body it is better to plan snigdha virecana. As

tikshan virecana tend worsen the morbidity of vatadosa, mrdu virecana is always justified

in patients suffering from vatarakta. Pittanuga and raktanuga types of vatarakta is better

treated by virecana karma. Further if the involvement of upper limb is present in a patient

of vatarakta, which indicates association kapha and pitta dosa in the pathogenesis of

47

Conceptual Study

vatarakta virecana is preferred as shodhana treatment118. Ruksaha virecana is also ideal in

patents suffering from margavarana due to morbidity of kapha and medas.

Basti karma – basti karma is regarded as best treatment in patients suffering from

vatarakta119. Basti karma includes both asthapana basti as well as anuvasana basti. This

disease when an effect the legs, indicative of predominant vata vitiation basti is the best

option120 Vatanuga vatarakta is better treated by basti cikitsa. The symptoms like basti

sula, vanksanasula, parshvasula and udara sula when present basti is the treatment of

choice. 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 is

indicated as this basti is capabale of clearing the margavarana along with negating the

detrimental effect morbid vata dosa122.

Rasayana: administration of rasayana cikitsa is very important as the disease is

progressive and runs a chronic course. Vardhamana pippali rasayana or ksheerabala taila

is advised in patients suffering from vatarakta123. Further if the margavarana is due to

accumulation of kapha and medas administration of silajatu guggulu and makshika dhatu

in 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 or

ubhayasrita vatarakta125. More details of bahiparimarjana cikitsa is given in the following

lines.

Pariseka – depending upon the requirement either ushna parisheka or sita parisheka is

carried out on the affected part in patients suffering from vataraka. Dominance of vata

dosa when present characterized by severe pain in the affected part, then ushna parisheka

should be prescribed126. Contrary to this if daha is the symptom due to predominance of

pitta dosa and rakta dhatu, sita parisheka is ideal to relieve the discomfort127.

Abhyanga: treatment with abhyanga over the affected part is planned according to the

presence of symptoms or the dominance of affected dosa. Warm oil processed with

vatahara drugs is used for abhynga if the patient complains of severe pain due to vitiation

of vata dosa. Cold application of the ghrita processed with pittahara drugs is ideal if the

patient complains of burning sensation due to morbidity of pitta dosa or rakta dhatu. If

48

Conceptual Study

kandu is the leading symptom due to morbid kapha dosa oil processed with kaphahara

drugs is used in the form of abhyanga128.

Pradeha: pradeha cikitsa is planned according to the relative dominance of dosa

involved. 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 to

morbid vata dosa. Medicinal paste prepared by adding ghrita applied cool on the affected

part if the patient has burning sensation due to morbid pitta dosa. Medicinal paste

prepared with herbs having ushna quality is preferred if relative dominance of kaphadosa

or vatakapha dosha is identified129.

Upanahana: specific herbal powder made into a paste by the addition of kanji or such

other liquids is applied when warm as upanaha, and is very useful in relieving pain due to

morbid vata dosa130.

Sastra pranidhana: severe morbidity of pitta dosa and rakta dhatu may lead to

suppuration at the affected part. This may lead to ulceration and pus discharge. In such

conditions Bhedana sodhana and ropana measures have been carried out131.

Agraushadi: Amruta132

Formulations useful in vatarakta:

Svarasa: Guduchi svaras133

Churna: 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 Study

Asavarishta : 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 147

PATHYA AHARA

Suka dhanya varga: Shastica shali (Oryza sativa grown in 60 days), Yava (Hordeum

vulgara), 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 wild

animals), 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 sugar

Taila varga: Tila taila (sesaman oil), Sarshapa taila (mustard oil), Bilva taila (taila extracted

from aegle marmilos)

Harita varga: Jivanthi (Lepta denia reticulata), Gostani (vitis vinefera), Maricha (Piper

nigrum), Pippali (piper longum), Shunti (Zingiber officinale), Mulaka (Raphanu sativus),

Balamula (root of cida cordifol, Vataraktamardha (Cassia occidentalis), Yusha (soup) prepared

with 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 Study

APATHYA 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 Jala

Phalavarga: 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 Rajo

Marga 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 margavarana

due 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 vatarakta

2. 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 and

ingredients of Lekhana Basti are compiled, and discussed

Vataraktantaka Rasa 148:

Vataraktantaka rasa as explained in Bhaishajya ratnavali is a Khalvirasayana with a

unique herbomineral combinations of drugs to treat Vatarakta. The name suggests that it is a

rasa preparation, as it contains rasa (mercury) as an ingredient. Shilajatu , guggulu ,

Lauhabhasma are the main ingraident targeted specifically for kapha medasavarana in

raktavaha srotasa.these ingredients are treated with each three bhavana of bhringaraja svarasa

and 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 of

vataraktantaka 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 form

of Nasya,Pana,Basti,Abhyanjana. In the present clinical trial this oil is used for Anvasan Basti

as part of Kaalabasti course of Lekhana Basti. By using Yasthimadhu kalka and ksheera,

Ksheerapaka prepared,.taila paka is prepared by using ksheerapaka and murchitatilataila and

Madhuka pushpa kalka is added during tailapaka. For the present study 25 lit of oil was

prepared in S.D.M. Ayurvedic pharmacy, Kuthapady, Udupi, Karnataka.. And is packed in 200

ml 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 kapha

and medasa. The mixing of ingredients done as quantity mentioned in table with sequence of

madhu , saindhava lavana ,murchita tilataila, kalka, triphala kvatha and gomutra, . The

ingredients 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 Review

Dravya-Pippali 157

Paryaya - Maagadhi, kruShna, vaidehi, ushana

Latin name- Piper longama

Upyuktanga - Mula, phala

Rasa- Katu

Virya- Sheeta

Vipaaka - Madhura

Doshaghnata - Kapha,vata

Dravya-Maricha158

Paryaya - Vallija, ushana krushna kola

Latin name- Piper nigrum.

Upyuktanga - Phala.

Rasa- Katu, tikta

Virya- Ushna

Vipaaka - Katu

Doshaghnata - Kapha,vata.

Dravya- Punarnavaa 159

Paryaya - Katilla, shothaghni vishaakha

Latin name- Boerhavia diffusa

Upyuktanga - Mula,patra, panchanga

Rasa - Katu,tikta,kashaya

Virya- Ushna

Vipaaka - Katu

Dohaghnata - Kapha,vaata

Dravya-Devadaaru 160

Paryaya - Suradaaru kilima,bhadradaaru Utikaashta

Latin name- Cedrusa deodar

Upyuktanga - Kashtha

Rasa- 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 - Kaphapitta

Dravya -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 , kushtanashaka

Drug name- Haratala168

. English name- Yellow arsenic / Orpiment.

Symbol - As2S3

Rasa – 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, shvasa

Drug 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 , Vishapaha

Drug name-Lauha 170.

English name - Iron

Latin name- Ferrum.

Symbol - Fe

Rasa - Nirasa

58

Drug Review

Karma – 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-Shilajatu172

English 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 - Cuso47H2O

Karma – 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 ,Pliha

Drug 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 - Asafoetida

Latin 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

Vatarakta

Source 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 20

Patients who fulfilled the below mentioned criteria of inclusion were taken for the

study. While selecting these 20 patients care was also taken to see that there was no

any factor in these patients listed in the exclusion criteria. The selected patient’s

detailed profile is prepared as per the detailed proforma designed for the same

purpose, 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 inclusion

criteria-

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 criteria

The patients suffering from Vatarakta showing the presence of following criteria were

excluded from the study

The patients with severe toxicity, progressive gangrenous changes in vicinity are

excluded 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 days

METHOD 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 ml

Procedure 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 nadisweda

was carried out on the lower abdomen, back, thighs and buttocks. Swedana is continued

until the patient developed the samyak svinna laksana.

Pradhana karma -

Patient was asked to lie down in left lateral position on the treatment table. Buttock and

anal region is undressed. And in this position the patient is asked to flex his right hip and

knee so that the right ankle resting on the extended left leg. For comfort, patient is asked

to keep his left hand beneath the head. This is the position of the patient for administering

the basti.

63

Clinical Study

The enema can was filled with the basti dravya, following this some amount of basti

dravya 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 the

nozzle into to anal canal.

The anal area of the patient is smeared with oil and then the enema can nozzle is gently

inserted into the anal canal for a length of about 5 angula. The enema can is then raised

for about 3 feet, to allow the basti dravya to escape into the rectum by means of

gravitational force. When the enema can is emptying into the rectum the patient is asked

to deep breathing. When little amount of basti dravya is still left in the enema can, the

nozzle is closed and then withdrawn from the anal canal. This prevents escape of air into

the rectum.

Following the administration the patient is asked to change his position from left lateral

to prone, and then from prone to rt lateral and lastly form the right lateral to the supine

position. In this position the patient is asked to rub his hands against each other. The

therapist 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 of

defecation. After defecation the patient was allowed to take hot water bath and light

foods. The patient was then observed to assess the proper, excessive or poor effect of the

basti. 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 same

as 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 or

otherwise was determined by adopting the standard methods of scoring for subjective,

objective and special investigation criteria. The margavarana was assessed both before

and after the intervention to note any change by using the arterial Doppler study. Lipid

64

Clinical Study

profile was also studied before and after the treatment. The details of the assessment

criteria 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 0

Assessment 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

OBSERVATIONS

A total of 20 patients suffering from Vatarakta fulfilling the inclusion criteria were taken

for the study. All these 20 patients who were registered have completed the stipulated

schedule 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 elaborated

in 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 Analysis

Descriptive statistical analysis of 20 patients of Vatarakta includes the following

information.

• 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 etc

Details of the same is given in the following pages

67

Observation

Distribution of 20 Patients According to Age: 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 and 5 (25%) number of patients were belonging to 41 to

50 years and 61 to 70 years age group. The details are given in the Table No. 16

and fig. No. 1

Table 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 25

Figure No. 01 - Distribution of 20 patients according to different age

group

% of Patients

25

50

25

41-5051-6061-70

68

Observation

Distribution of 20 Patients According to their Sex:

12 (60%) of patients of Vatarakta were males as against only 8(40.%) of females in the

present 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 40

Figure No. 02 - Distribution of 20 patients according to sex

% of Patients

60

40

MaleFemale

69

Observation

Distribution 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 Christians

Table No. 18 - Distribution of 20 patients according to religion

Relegion of patients No.of patients %

Hindu 16 80

Muslim 02 10

Christian 02 10

Figure No. 03 - Distribution of 20 patients according to religion

% of Patients

80

10 10

HinduMuslimChristian

70

Observation

Distribution 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 10

Figure No. 04 - Distribution of 20 patients according to Marital status

% of Patients

90

0 10

marriedUnmarriedWidowed

71

Observation

Distribution of 20 Patients According to Literacy:

Prevalence of literates was recorded in the present study involving 20 patients of

Vatarakta.25% of the patients were illiterates and the remaining 75%of patients had

education, 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 10

Figure No. 05 - Distribution of 20 patients according to Literacy

% of Patients

25

30

35

10

Illitrate

U.G.

Graduate

P.G.

72

Observation

Distribution of 20 Patients According to their Occupation:

It is observed that 7 (35%) of the females in this study were house wives by their

occupation. Also, this formed the largest category of patients leaving behind the patients

engaged in other occupations. There were only 3(15%) patients in the agriculture

category 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 35

Figure No. 6 - Distribution of 20 patients according to Occupation

% of Patients

15

2525

35

Agriculter

Business

Employee

Hous.Wif

73

Observation

Distribution of 20 Patients According to Socio-economical status :

The study revealed that most of the patients belonged to middle socio-economic status

i.e.14 (70%) against the upper socio-economic status which comprised 4(20%). The

details 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 20

Figure No. 07 - Distribution of 20 patients according to different Socio-economic

status

% of Patients

10

70

20

Lower

Middle

Upper

74

Observation

Distribution of 20 Patients According to Mode of Onset of the illness: Out of 20

patients suffering from Vatarakta taken for the study, 10 (50%) patients had gradual

onset of the disease, None of the patient had a sudden onset of illness. Details are given

in 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 0

Figure No. 08 - Distribution of 20 patients according to different Mode of Onset of

the illness

% of Patients

50

500

Gradual

Insidious

Sudden

75

Observation

Distribution of 20 Patients According to the associated Illness : it is observed that a

maximum of 9 (45.%) patients had diabetes mellitus and hypertension as associated

illness, whereas only 2 (10%) patients had a hypertension and 6 ( 30%) patients had

diabetes mellitus as associated disease. The details are given in Table no 24 and

Fig.no 9

Table 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 20

Figure No. 09 - Distribution of 20 patients according to different associated illness

% of Patients

25

1045

20

D.M.H.T.N.D.M.+H.TNone

76

Observation

Distribution of 20 Patients According to the type of Dietary Habits:

Maximum 65% of patients were having mixed diet and 35% patients were

vegetarians. 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 35

Figure No. 10 - Distribution of 20 patients according to different Dietary Habits

% of Patients

65

35

Mixed

Veg.

77

Observation

Distribution of 20 Patients According to Dominant Rasa in Ahara : 55% had

comsumption of food stuffs dominant of madhura rasa, 40% were consuming more of

katu rasa Ahara and only 1 patient was dominantly taking lavana rasa. Details are given

in Table no 26 and fig. no 11

Table 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 40

Figure No. 11 - Distribution of 20 patients according to different dominant rasa in

Ahara

% of Patients

555

40

Madhura

Lavana

Katu

78

Observation

Distribution of 20 Patients According to their Addictions: Large percentage of

patients in this study had none of addiction . Only 1 (5%) patient reported addiction to

alcohol ,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 65

Figure No. 12 - Distribution of 20 patients according to different Addictions

% of Patients

510

20

65Alcohole

Smoking

Alc+Smo

None

79

Observation

Distribution of 20 Patients According to Prakriti : All the patients in the present study

belonged 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 of

kaphaPitta Prakriti. Table No. 28 and fig. No. 13 give the details.

Table No. 28 : Distribution of 20 Patients According to Prakriti

Prakriti

No. of patients % of patients

VP 3 15

KP 12 60

VK 5 25

Figure No.13 - Distribution of 20 patients according to different Prakriti

% of Patients

15

60

25

VP

KP

VK

80

Observation

Distribution of 20 Patients According to Dhatu Sara : The assessment of Sara in 20

patients of Vatarakta showed maximum number of patients having Madhyama Sara

20(100%) . Incidence of patients according to their Sara is detailed in the Table No. 29

and fig. No. 14

Table No. 29: Distribution of 20 Patients According to Sara

Sara No. of patients % of patients

Pravara 00 00

Madhyama 20 100

Avara 00 00

Figure No. 14- Distribution of 20 patients according to different Sara

% of Patients

0

100

0

Pravar

Madhyam

Avara

81

Observation

Distribution of 20 Patients According to Samhanana : Samhanana of every patient

was 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. 15

Table No. 30 Distribution of 20 Patients According to Samhanana

Sara No. of patients % of patients

Pravara 00 00

Madhyama 20 100

Avara 00 00

Figure No. 15- Distribution of 20 patients according to different Samhanana

% of Patients

0

100

0Pravar

MadhyamAvara

82

Observation

Distribution of 20 Patients According to Satmya : Observation of 20 patients of

Vatarakta revealed that no patient had Pravara Satmya, 14 (70%) of patients showed

Madhyama Satmya and the remaining 6 (30%) of patients showed Avara Satmya. Table

No. 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 30

Figure No. 16 - Distribution of 20 patients according to different Satmya

% of Patients

0

70

30

Pravar

Madhyam

Avara

83

Observation

Distribution of 20 Patients According to Satva : Majority of 12 (60%) patients belong

to Madhyama Satva, 1 (5%) were of Pravara Satva and 7 (35%) were of Avara Satva in

this study. The details are shown in Table No. 32 and fig No. 17

Table No. 32: Distribution of 20 Patients According to Satva

Satva No. of patients % of patients

Pravara 7 35

Madhyama 12 60

Avara 1 5

Figure No. 17 - Distribution of 20 patients according to different Satva

% of Patients

3560

5Pravar

MadhyamAvara

84

Observation

Distribution According to Ahara Abhyavaharana and Jarana Shakti in patients of

Vatarakta: Interrogation of the 20 patients of Vatarakta revealed that 16 (80%) of the

patients had Madhyama Abhyavaharana Shakti and 2 (10%) patients had Pravara

Abhyavaharan Shakti. The remaining 2 (10%) patients had Avara Abhyavaharan Shakti

Details are given in the Table No. 33 and fig. No. 18

Table No. 33: Distribution According to Ahara Abhyavaharana and Jarana Shakti

in patients of Vatarakta

Abhyavaharana and Jarana Shakti No. of patients % of patients

Pravara 2 10

Madhyama 16 80

Avara 2 10

Figure No. 18. - Distribution of 20 patients according to different Ahara

Abhyavaharana and Jarana Shakti in patients of Vatarakta

% of Patients

10

80

10

Pravar

MadhyamAvara

85

Observation

Distribution According to Vyayama Shakti in patients of Vatarakta : Madhyama

Vyayama Shakti is recorded in 10 (50%) of patients. 4 (20%) of the patients had Avara

Vyayama Shakti and the remaining 6 (30%) patients had Pravara Vyayama Shakti. The

same 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 20

Figure No.19 - Distribution of 20 patients according to different Vyayama Shakti in

patients

% of Patients

30

50

20

Pravar

MadhyamAvara

86

Observation

Distribution According to Pramana of patients : Amongst the 20 patients taken in

this study all 20 (100%) belonged to Madhyama pramana. None of the patient was form

the pravara and Avara pramana category. This has been shown in Table No. 35 and

Graph 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 0

Figure No. 20 - Distribution of 20 patients according to different Pramana of

patients

% of Patients

0

100

0Pravar

Madhyam

Avara

87

Observation

Distribution According to Vaya of patients : Amongst the 20 patients taken in this

study all 20 (100%) belonged to Madhyama Vaya. None of the patient was form the Bala

and 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 0

Figure No. 21 - Distribution of 20 patients according to Vaya of patients

% of Patients

0

100

0Pravar

MadhyamAvara

88

Results

EFFECT OF TREATMENT IN VATARAKTA.

EFFECT ON PAIN:

Patients treated with Vataraktantakarasa and Lekhana basti had marked remission

of the symptom pain. 1.8 was the mean initial score of pain in 20 patients of Vatarakta

which came down to 1.0 after the treatment. The improvement to the tune of 44.44% is

found to be statistically highly significant (P≤0.001) as shown in the Table No.37 and

Fig. No.22

Table No.37 : Effect of treatment on Pain

Mean Score Paired ‘t’ test

BT AT

Difference

in means

%

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=<0.001

Figure no 22: Effect of treatment on Pain

0

0.5

1

1.5

2

Mean score

Pain

89

Results

FFECT 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 the

treatment with Vataraktantakarasa and Lekhana basti. This improvement when analyzed

by 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 Paired ‘t’ test

BT AT

Difference

in means

%

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= 0.008

Figure no 23: Effect of treatment on Burning sensation

B.T.

0

0.2

0.4

0.6

0.8

Mean S

core Burning sensation

90

Results

EFFECT ON MALAISE :

78.57% of improvement was observed in the symptom Malaise. 0.700 was the

initial mean score of Malaise recorded in the 20 patients of Vatarakta . This was brought

down to 0.150 after the administration of Vataraktantaka rasa and Lekhana Basti. This

improvement after the treatment is found to be highly significant (P≤0.001) as per the

paired‘t’ test. The details of the different statistical values are shown in the Table No.

39and fig. No. 24

Table No. 39: Effect of treatment on Malaise

Mean Score Paired ‘t’ test

BT AT

Difference

in means

%

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= 0.001

Figure no 24: Effect of treatment on Malaise

B.T.,

A.T.,

0

0.2

0.4

0.6

0.8

Mean score

Malaise

91

Results

EFFECT ON DISTURBANCE OF SLEEP:

0.650 was the mean initial score of disturbance of Sleep before the treatment in patients

of Vatarakta. This initial mean score came down to 0.0500 after the treatment. The

improvement to the tune of 92.30 % was highly significant (P≤0.001) as revealed by the

paired‘t’ test.

Details of the same are given in the Table No. 40 and fig. No. 25

Table No. 40: Effect of treatment on disturbance of Sleep

Mean Score Paired ‘t’ test

BT AT

Difference

in means

%

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 = ≤0.001

Figure no 25: Effect of treatment on disturbance of Sleep

B.T.,

A.T.,

0

0.2

0.4

0.6

0.8

Mean score

Sleep

92

Results

EFFECT ON TENDERNESS:

Tenderness is another symptom of Vatarakta. The initial mean score of the patients in

tenderness was 0.100 which was reduced to 0.00 after the treatment. The improvement to

the tune of 100% was recorded, is statistically significant. Details of the same are

represented in the Table No. 41 and fig. No. 26.

Table No. 41 comparison of effect on Tenderness

Mean Score Paired ‘t’ test

BT AT

Difference

in means

%

S.D S.E.M. t value P value

0.1000 0.000 0.1000 100 0.308 0.0688 t = 1.453 P = 0.163

Figure no 26: Effect of treatment on Tenderness

B.T.,

A.T., 0

0.020.040.060.08

0.1

Mean score

Tenderness

93

Results

EFFECT ON EDEMA:

Before the treatment the mean score of symptom of Edema was 0.350. After the

treatment with Vataraktantak rasa and Lekhana Basti this was reduced to 0.0500 giving

85.71% effect. The change that occurred with the treatment is greater than would be

expected by chance; there is a statistically significant change (P = 0.010) as assessed by

the 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 Paired ‘t’ test

BT AT

Difference

in means

%

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 = 0.010

Figure no 27: Effect of treatment on Edema

B.T.,

A.T.,

0

0.1

0.2

0.3

0.4

Mean score.

Edema

94

Results

EFFECT ON LOCAL COLOUR CHANGES:

Patients treated with Vataraktantak rasa and Lekhana Basti had no difference in

Local color changes. 0.200 was the mean initial score in 20 patients of Vatarakta which

remained as 0.200 after the treatment.

Table No. 43 Effect of treatment on Local colour changes

Mean Score Paired ‘t’ test

BT AT

Difference

in means

%

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

B.T., A.T.,

0

0.05

0.1

0.15

0.2

Mean score

Local colour changes

95

Results

EFFECT ON WALKING ABILITY:

47.22% of improvement was observed in the score of walking ability. 1.8 was the

initial mean score recorded in the 20 patients of Vatarakta This was brought down to

0.950 after the administration of Vatarakta and Lekhana Basti This improvement after

the treatment is found to be highly significant (P≤0.001) as per the paired ‘t’ test. The

details 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 Paired ‘t’ test

BT AT

Difference

in means

%

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 = ≤0.001

Figure no 29 : Effect of treatment on walking ability

B.T.,

A.T.,

0

0.5

1

1.5

2

Mean score

Walking ability

96

Results

EFFECT ON PERIPHERAL PULSES:

1.5 was the mean initial score of Peripheral pulses before the treatment in patients of

Vatarakta This initial mean score came down to 1.05 after the treatment. The

improvement 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. 30

Table No. 45: comparison of effect on Peripheral pulses

Mean Score Paired ‘t’ test

BT AT

Difference

in means

%

S.D S.E.M. t value P value

1.500 1.050 0.450 30 0.510 0.114 t = 3.943 P = <0.001

Figure no 30: Effect of treatment on Peripheral pulses

B.T.,

A.T.,

0

0.5

1

1.5

Mean score

Peripheral pulses

97

Results

EFFECT ON TOTAL CHOLESTEROL:

Before the treatment the mean total Cholesterols was 274.950 after the treatment with

Vataraktantak rasa and Lekhana Basti this was reduced to 224.00. This improvement

after the treatment was found to be statistically highly significant (P<0.001) as assessed

by the paired‘t’ test. The details of the same is given in the Table No. 46 and fig. No. 31

Table No. 46: Effect of treatment on total Cholesterols

Mean Score Paired ‘t’ test

BT AT

Difference

in means S.D S.E.M. t value P value

274.950 224.00 50.950 21.36 4.776 t = 10.667 P = <0.001

Figure no 31: Effect of treatment on total Cholesterols

B.T., A.T.,

0

100

200

300

Mean score

Total cholesterol

98

Results

EFFECT ON Triglyceride

Before the treatment the mean Triglyceride was 247.100 After the treatment with

Vataraktantak rasa and Lekhana Bastithis was reduced to 196.40. This improvement after

the treatment was found to be statistically highly significant (P<0.001) as assessed by the

paired‘t’ test. The details of the same is given in the Table No. 47 and fig No. 32

Table No. 47: Effect of treatment on Triglyceride

Mean Score Paired ‘t’ test

BT AT

Difference

in means S.D S.E.M. t value P value

247.100 196.400 50.700 36.319 8.121 t = 6.243 P = <0.001

Figure no 32 Effect of treatment on Triglyceride

B.T., A.T.,

050

100150200250

Mean score

Triglyceride

99

Results

EFFECT ON HDL CHOLESTEROL:

Before the treatment the mean HDL Cholesterol was 39.850 after the treatment with

Vataraktantak rasa and Lekhana Basti this was increased to 44.500. This increase after

the treatment was found to be statistically highly significant (P<0.001) as assessed by the

paired‘t’ test.

The details of the same is given in the Table No. 48 and fig No33

Table No. 48 Effect of treatment on HDLCholesterol

Mean Score Paired ‘t’ test

BT AT

Difference

in means S.D S.E.M. t value P value

39.850 44.500 4.650 4.705 1.052 t = -4.420 P = <0.001

Figure no 33 Effect of treatment on HDLCholesterol

B.T.,

A.T.,

363840424446

Mean score

HDL cholesterol

100

Results

EFFECT ON LDL CHOLESTEROL:

Before the treatment the mean LDL Cholesterols was 169.200 After the treatment with

Vataraktantak rasa and Lekhana Basti this was reduced to 134.650 This increase after the

treatment was found to be statistically highly significant (P<0.001) as assessed by the

paired ‘t’ test. The details of the same is given in the Table No. 49and fig. No. 34

Table No. 49 : Effect of treatment on LDL Cholesterols

Mean Score Paired ‘t’ test

BT AT

Difference

S.D S.E.M. t value P value

169.200 134.650 34.550 30.346 6.786 t = 5.092 P = <0.001

Figure no 34 : Effect of treatment on LDL Cholesterols

B.T., A.T.,

0

50

100

150

200

Mean score

LDL Cholesterol

101

Results

EFFECT ON VLDL CHOLESTEROL:

Before the treatment the mean VLDL Cholesterols was 43.550 After the treatment with

Vataraktantak rasa and Lekhana Basti this was reduced to 33.450 This decrease in values

after the treatment was found to be statistically highly significant (P<0.001) as assessed

by the paired ‘t’ test. The details of the same is given in the Table No. 50 and fig. No. 35

Table No. 50 : Effect of treatment on VLDL Cholesterols

Mean Score Paired ‘t’ test

BT AT

Difference

in means S.D S.E.M. t value P value

43.550 33.450 10.100 9.414 2.105 t = 4.798 P = <0.001

Figure no 35 : Effect of treatment on VLDL Cholesterols

B.T., A.T.,

01020304050

Mean score

VLDL Cholesterol

102

Results

EFFECT ON LDL: HDL:

Before the treatment the mean LDL: HDL was 4.245 after the treatment with

Vataraktantak rasa and Lekhana Basti this was reduced to 3.150. This improvement after

the treatment was found to be statistically highly significant (P<0.001) as assessed by the

paired‘t’ test. The details of the same is given in the Table No. 57 and fig. No. 36

Table No. 57: Effect of treatment on LDL: HDL

Mean Score Paired ‘t’ test

BT AT

Difference

in means S.D S.E.M. t value P value

4.245 3.150 1.095 0.624 0.139 t = 7.852 P = <0.001

Figure no 36: Effect of treatment on LDL: HDL

B.T.,

A.T.,

0

1

23

4

5M

ean score

LDL:HDL

103

Results

Overall effect of the treatment in Vatarakta :

After the completion of the 1 month course of treatment in Vatarakta the overall

assessment of the patients were made as discussed in the assessment criteria. The analysis

revealed that no patient had complete relief from the signs and symptoms of vatarakta

Moderate remission of the signs and symptoms was seen in 90% of the patients treated

with Vataraktantaka rasa and Lekhana basti . No patient showed marked improvement.

One patient after treatment showed 40 % remission of the symptoms which comes under

average remission category. Another one patient after treatment showed 20 % remission

from 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 the

symptoms of Vatarakta.

Figure no 37: Overall Effect of treatment

% of Patients

90

5 5

Moderate

Average

Unchanged

104

Conclusion

CONCLUSION

1. Distinct etiological factors of vatadosa and rakta dhatu separately causes the morbidity

of vata dosa as well as abnormality of rakta dhatu. Morbid vata dosa furthrer incriminates

the abnormal rakta dhatu. This abnormal rakata dhatu by way of raktamargavarana in turn

inhibits the movement of vata dosa leading to severe morbidity of vatadosa. This is

marked by development of clinical signs and symptoms. Thus the illness vatarakta

clinically manifests. This is the general samprapti of vataraka

2. The santarpana category of etiological factors leads to the accumulation of kapha and

medas in the raktamarga there by causing raktamargavarana. Due to the establishment of

raktamargavarana there occurs inhibition of movement of vata dosa. this in turn

culminates 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 in

the good cholesterol following the treatment. These changes establish the efficacy of

lekhana basti and vataraktantaka rasa in preventing the progression of margavarana as

well as the illness vatarakta.

5. The marginal improvement in the circulation following medication with lekhana basti

and vaataraktantaka rasa confirms the effect of medicine on reducing the margavarana.

Reduction in pain burning sensation etc proves the reduction in the morbidity of vata

dosa following the medication.

6. The combination of shodhana treatment in the form of lekhana basti and shamana

treatment in the form of vataraktantaka rasa is an ideal regimen in patient’s sufferirng

from 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 TO

EVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASA

AND LEKHANA BASTI IN VATARAKTA”is a bonafide and genuine research

Work 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 VATARAKTANTAK

RASA AND LEKHANA BASTI IN VATARAKTA” is a bonafide research work

done by Patil K.V. in partial fulfillment of the requirement for the degree of Doctor

of 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 INSTITUTION

This is to certify that the dissertation entitled “A CLINICAL STUDY TO

EVALUATE THE THERAPEUTIC EFFECT OF VATARAKTANTAK RASA

AND LEKHANA BASTI IN VATARAKTA”is a bonafide research work done by

Patil 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 Health

Sciences, Karnataka shall have the rights to preserve, use and disseminate this

dissertation/ 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, omniscient

and omnipotent. He is the possessor of the ocean of knowledge and wisdom to which

I would like to contribute a drop in the form of my dissertation. As it is said, each and

every drop goes to make an ocean, so this is my humble endeavor towards its goal of

wisdom.

My deep sense of gratification is due for my parents and brothers who

are the architects of my career. The culture, discipline and perseverance, which I

could imbibe, are solely because of their painstaking upbringing and strong moral

support.

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 guidance

for 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 their

encouragement 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 for

giving 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. Ayurveda

hospital, Udupi, Dr .Murulidhar director SDM Ayurveda pharmacy And Dr. Naveen

Ballal 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 support

they provided throughout my studies.

vi

KULDEEP VILASRAO PATIL.

List of Abbreviations used

1. A.H. : Ashtanga Hridaya

2. A.S. : Ashtanga Sangraha

3. A. N. : Adarsha nighantu

4. B.P. : Bhava Prakasha

5. B.R. : Bhaishajya Rathnavali

6. B.L. : Bhela samhita

7. C.S. : Charaka Samhita A

8. C.D. : Chakra Datta

9. Ckr. : Chakrapani.

10. G.N. : Gada Nigraha

11. H.P.I.M.: Harrison’s Principle Of Internal Medicine

12. H.S. : Harita Samhita.

13. M.N. : Madhava Nidana

14. S.K.D. : Shabda Kalpa Druma

15. Sh.S. : Sharangadhara Samhita

16. Su.S. : Sushruta Samhita

17. T.B.P. : Text Book Of Pathology By Harsh Mohan

18. Vag. : Vagbhata

19. Vang. : Vangasena

20. Y.R. : Yogaratnakara

20. ILD : Ischemic limb diseases

21. PVD : Peripheral vascular disorders

22. IHD : Ischemic heart disease

23 .HDL: high-density lipoproteins

24 LDL : low- density lipoproteins

25 .VLDL: very-low density lipoproteins

vii

ABSTRACT

The pathology of margavarana leads to the establishment of clinical signs and

symptoms in vatarakta. Sodhana, samana, bahiparimarjana and rasayana cikitsa all are

aimed at the rectification of margavarna in this disease. The whole concept of

margavarana can be best explained by the pathology of atherosclerosis and peripheral

vascular disease in modern parlance. There is a definite need to study vatarakta as

peripheral arterial disease and its management with both sodhana and samana line

treatment, with the due consideration of its severity chronicity as well as possible

complications. This study is planned to evaluate the therapeutic effect of

Vataraktantakarasa and Lekhana basti in patients suffering from Vatarakta.

Design: single blind clinical study with a pre-test and post-test design

Source of the data : 20 patients of vatarakta 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.

Intervention: patients were subjected to 16 days course of lekhana basti along with

oral medication with vataraktantaka rasa in a dose of 250mg tid for 30 days

OBSERVATIONS:

Out of 20 patients of Vatarakta studied in this work, 50 % patients belonged to the age

group 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 had

the habit of mixed diet. All the patients had the dvandvaja praktiti.

Results: statistically significant improvement was observed in all the criteria of

assessment that included regards to pain, burning sensation, malaise, and disturbance

of sleep, tenderness, walking ability, peripheral pulses and lipid profile.

Conclusion:

The combination of lekhana basti and vataraktantaka rasa is an ideal regimen in

patient’s suffering from raktamargavarana janya vataraktaa.

Key Words: Vatarakta, margavarana, raktavahasrotas, ILD, PVD

viii

TABLE OF CONTENTS

1. Introduction : Page No.1-5

2. Objectives : Page No.6

3. Review of Literature : Page No.7-60

3.1 Historical review

3.2 disease review

3.4 Drug review

4. Clinical study : Page No.61-104

4.1 Materials and methods

4.2 Observations and results

5. Discussion : Page No.105-117

6. Conclusion : Page No.118

7. Summary : Page No.119-123

8. Bibliography : Page No.124-142

9. Annexure : Page No.143-151

ix

LIST OF TABLES Sl. 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

x

31 Satmya 83

32 Satva 84

33 Aharashakti 85

34 Vyayama shakti 86

35 Pramana 87

36 Vaya 88

37 Effect on pain 89

38 Effect on Burning sensation 90

39 Effect on Malaise 91

40 Effect on Sleep 92

41 Effect on Tenderness 93

42 Effect on Edema 94

43 Effect on Local color changes 95

44 Effect on Walking ability 96

45 Effect on Peripheral pulses 97

46 Effect on Total cholesterol 98

47 Effect on Triglycerides 99

48 Effect on HDL cholesterol 100

49 Effect on LDL cholesterol 101

50 Effect on VLDL cholesterol 102

51 Effect on HDL : LDL 103

xi

LIST OF FIGURES

Sl. No. Figures Page No.

Fig. 1 Age Distribution 68

Fig. 2 Sex Distribution 69

Fig. 3 Occupation Distribution 70

Fig.4 Religion Distribution 71

Fig. 5 Marital status Distribution 72

Fig. 6 Literacy Distribution 73

Fig. 7 Occupation Distribution 74

Fig. 8 Socioeconomic status Distribution 75

Fig. 9 Mode of onset Distribution 76

Fig. 10 Associated illnesses Distribution 77

Fig. 11 Dietary habits.Distribution 78

Fig. 12 Analysis of Dominant rasa 79

Fig 13 Analysis of Addictions 80

Fig. 14 Analysis of Prakruti 81

Fig. 15 Analysis of Saara 82

Fig. 16 Analysis of Samhanana 83

Fig. 17 Analysis of Satmya 84

Fig. 18 Analysis of satva 85

Fig. 19 Analysis of Ahara shakti 86

Fig. 20 Analysis of Vyayama shakti. 87

Fig. 21 Analysis of pramana 88

Fig. 22 Analysis of type of Vaya 89

Fig. 23 Effect on pain 90

Fig. 24 Effect on burning sensation 91

Fig. 25 Effect on malaise 92

Fig. 26 Effect on Disturbed sleep. 93

Fig. 27 Effect on tenderness. 94

Fig. 28 Effect on edema. 95

Fig. 29 Effect on Local color changes. 96

Fig. 30 Effect on Walking ability. 97

xii

Fig 31 Effect on peripheral pulses 98

Fig. 32 Effect on total cholesterol 99

Fig. 33 Effect on Triglycerides 100

Fig. 34 Effect on HDL cholesteral 101

Fig. 35 Effect on LDL cholesterol. 102

Fig. 36 Effect on VLDL cholesterol 103

Fig. 37 Effect on LDL : HDL 104

Fig. 37 Overall effect of the treatment. 105

xiii

Discussion

DISCUSSION Among the diseases listed as vatyavyadhi the illness Vatarakta has gained prime

importance in clinical practice due its high prevalence in elderly, progressive

perpetuation, severe complications and fatal outcome. In the literature it is emphasized

that the etiological factors leads to the predominant morbidity of vata dosa and rakta

dhatu. To be more specific, the obstruction of raktamarga or raktavaha srotas is the

leading pathology. The umbrella of vatarakta in parlance with conventional medicine

includes many conditions related to extremities and to mention a few are connective

tissue 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 in

different systems. Prameha, Sonitadusti, hrdroga and vatavyadhi etc all are found to be

due to incriminatory effect of kapha and medas in respective systems. Hence forth the

concept 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 symptoms

in vatarakta. Further to add, sodhana samana bahiparimarjana and rasayana cikitsa all are

aimed at the rectification of margavarna in this disease. The whole concept of

margavarana can be best explained by the pathology of atherosclerosis and peripheral

vascular disease in modern parlance.

Progressive atherosclerosis results in narrowing of the arterial lumen, hence the name

arteriosclerosis obliterans to this unique illness. Peripheral arterial disease is another

name referring to the same. Survey studies have established highest prevalence of the

illness in older people. 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 arterial

insufficiency. Prevalence increases with age as noted in recent national survey. the

prevalence of PAD was found to be 29% in people over aged 70 yrs. the prevalence rate

was 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 with

coronary angiography estimated that approximately one half of the patients of peripheral

arterial diseases present with clinical symptoms. More interestingly, life table analysis

has indicated patient with clauducation have a 70% 5-fear and 50% 10-year survival rate.

105

Discussion

Most deaths occur due to sudden or secondary to M.I. The prognosis is worse in patients

who continue to smoke cigarettes or who have uncontrolled diabetes mellitus. These

observations of survey studies undeniably point towards the high prevalence as well as

seriousness of the problem.

The analysis of previous work done in different research and post graduation study

centers unravels the ambiguity about the clinical understanding as well as treatment of

vatarakta. Many of the clinical studies regarded musculoskeletal disorders like

rheumatoid arthritis, gouty arthritis and osteoarthritis as vatarakta. In these works no

significance is being given to the unique pathology of raktamargavarodha in vatarakta.

Very little number of clinical works concentrated on vascular disease of the limbs as

vatarakta. More specifically speaking TAO is regarded as vatarakta. Here also the over

eating and sedentary habit as the cause of arterial disease / raktamargavarodha through

the 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 show

definite benefit in such chronic lingering disease. Kala basti and karma basti courses

appear better in chronic progressive disorders like vatarakta.

This review indicate that there is a necessity to study vatarakta as peripheral arterial

disease and its management with both sodhana and samana line treatment with the due

consideration of its severity chronicity as well as possible complications.

Present work entitled A Clinical Study to evaluate the therapeutic effect of

Vataraktantaka Rasa and Lekhan basti in vatarakta, is carried out with the consideration

that, the therapeutic measures that reduce kapha dosha and medas as well as alleviate the

morbid Vatadosha is the sheet anchor of treatment of vatarakta. Basti is claimed to be the

best treatment in lingering diseases due the morbidity of vatadosa. Lekhanabasti is said to

allevate both kaphadosha as well as medodhatu and hence indicated in santarpanajanya

vatarakta. The herbo-mineral compound vataraktantaka rasa consisting mainly of

guggulu, shilajatu and loha is said to be effective in negating the incriminatory effect of

morbid kapha dosa and medas and there by ensuring complete cure of vatarakta.

Review of the available literature unravels the minimal information of vatarakta in the

books of vedic period. Contrary to this entire aspect of the illness from nidana to cikitsa

is found in books of samhita as well as sangraha kala of the history.

106

Discussion

Two distinct etiopathogenesis may cause the illness vatarakta. Individual

etiological factors of vata dosa as well as rakta dhatu may culminate in the development

of vatarakta and is the usual variety of vatarakta. Where in the morbid vata dosa as well

as vitiated rakta dhatu leads to the rakta margavarana and is the principal pathology of the

vatarakta. In other variety of vata rakta, to begin with there is no role of etiological

factors of either vata dosa or rakta dhatu. Contrary to this the etiological factors of kapha

dosa 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 by

contributing the principal pathology of raktamargavarana. The similar qualities of kapha

and medo dhatu speed up the pathogenesis as two factors support mutually. To be

precise, the santarpana category of etiological factors causes the morbidity of kapha dosa

and medo dhatu, and these in turn accumulate in the raktamarga leading to the

provocation of vata dosa and finally manifesting as vata rakta.

Needless to say depending upon the variation in the etiopathogeneiss the planning of the

treatment should differ. Rectification of morbid vata dosa as well as rakta dhatu is the

rational treatment in the first variety of vatarkata. Kapha medo hara line of management

is the sheet anchor of the treatment of santarpana nidana janya vatarakta.

The pathogenesis of raktamargavarana is best correlated with the arterial obstruction due

to the atherosclerosis. This phenomenon of accumulation of kapha and medas with in the

dhamani is also referred as dhamani praticaya in ayurvedic literature. Abnormal

accumulation of the lipids in the arterial wall is the leading pathology of atherosclerotic

obliterans. The most common symptom of ischemic limb disease that include intermittent

claudication, ache and cramps, altered sensation, changed skin color, obliterated arterial

pulse, 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 lower

extremities. These citations of similarities are more than enough to compare the ischemic

limb disease with the santarpana nidana janya vatarakta.

Atherosclerosis is a specific form of arteriosclerosis affecting primarily the intima of

large and medium-sized muscular arteries and is characterized by fibro fatty plaques or

atheromas. The term atherosclerosis is derived from athero-(meaning porridge) referring

to the soft lipid-rich material in the centre of atheroma, and sclerosis (scarring) referring

107

Discussion

to connective tissue in the plaques. Atherosclerosis is the commonest and the most

important of the arterial diseases. Though any large a medium-sized artery may be

involved in atherosclerosis the most commonly affected are the aorta, the coronary and

the cerebral arterial systems. Therefore, the major clinical syndromes resulting from

ischemia due atherosclerosis are the myocardial infarcts (heart attack ) and the cerebral

infarcts (strokes); other less common sequel are peripheral vascular disease, aneurysm

dilatation due to weakened arterial wall, chronic ischemic heart disease, ischemic

encephalopathy,an mesenteric occlusion and ischemic limb disease (ILD)

The understanding of vatarakta is related to collagen diseases, gouty arthritis as well as

ischemic limb diseases. All these comparisons are justified based on analysis of

symptoms of vatarakta and the diseases mentioned in conventional medicine. From the

fore going citations it is clear that ischemic limb disease is also best compared to

vatarakta in regards to its etiopathogensis as well as clinical findings.

Unique concept of naming the disease is adopted in Ayurvedic literatures. Illness

occurring at a specific location is named after the specific organ as in the disease

hridroga. In contrast to this several other disorders are named after the cardinal symptom

as in atisara and shwasa. In case of the disease vatarakta, this name is coined on the basis

of involved samprapti ghataka i.e. vata dosa as well as rakta dhatu. Adhyavata, khudha

vata, 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 of

etiology leads to the vitiation of vata dosa and the other set separately causes morbidity

of rakta dhatu. These distinct sets of etiological factors may be related to ahara vihara or

the one influencing the manas. In spite of this, in the variant form of vata rakta where in

santarpana category of factors leads to the abnormal accumulation of kapha as well as

medo dhatu, and more particularly in the rakata marga culminates in the pathology of

vata 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 of

the illness.

Extensive epidemiologic investigations on live populations have revealed a

number of risk factors which are associated with increased risk of developing clinical

atherosclerosis. Often, these risk factors are acting in combination rather than singly.

108

Discussion

Increasing age, male sex, genetic abnormalities, and familial and racial predisposition,

hyperlipidaemia, hypertension, diabetes mellitus and smoking are considered as major

risk factors. Environmental influences, Obesity, Use of exogenous hormones, Physical

inactivity, Stressful life style and infections are regarded as minor risk factors for

atherosclerosis obliterance.

The etiological factors of kapha medo margavarana janya vatarakta as well as

atherosclerosis are more or less identical. Diet and behavioral factors leading to

atherosclerosis can be best regarded as santarpana nidana of vatarakta causing

accumulation of kapha and medas with in the raktamarga

The movement of vatadosa is inhibited by the unique pathology of raktamargavarana in

vatarakta. This in term initially manifest with certain clinical signs and symptoms in the

form 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 other

manifestations 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 as

uttana (anavagadha)vata rakta. Involvement of deeper dhatu like asthi majja and sandhi

signifies the gambhira (avagadha) vatarakta. A third variety of ubhayashrita vatarakta is

also mentioned in literature where in both the superficial as well as deeper dhatu is

affected. Vatarakta is a progressive disorder and hence initially the illness may be limited

to either superficial dhatu or deeper dhatu alone, but in the later stages the uttana

vatarakta progresses to deeper dhatu. Similarly the gambhira vatarakta may involve the

superficial dhatu in the later stages. Hence in the later stages the vatarakta develops as

ubhayashrita vatarakta.

The symptoms like kandu, daha, ruka, ayama, toda, sphurana, shyava/ rakta tvaka and

such other symptoms probably limited to the twak indicates the uttana vatarakta.

Persistent hard swelling of the affected part, suppurations, involvement of sandhi asthi

and majja, deformities like vakrata, khanja and pangu all these point towards the

gambhira vataratka.

Presence of symptoms indicative of both uttana as well as gambhira vatarakta signifies

the ubhayashrita vata rakta.

109

Discussion

Clinical varieties of vatarakta are also elaborated according to the association of morbid

dosa 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 of

amadosa. Symptoms of ama if associates the symptoms of vatarakta then the condition is

known as sama vatarakta. If only the symptoms of vatarakta presents without the

association of symptoms of ama then the illness is referred as nirama vatarakta.

Distinct etiological factors of vatadosa and rakta dhatu separately cause the morbidity of

vata dosa as well as abnormality of rakta dhatu. Morbid vata dosa furthrer incriminates

the abnormal rakta dhatu. This abnormal rakta dhatu by way of raktamargavarana in turn

inhibits the movement of vata dosa leading to severe morbidity of vatadosa. This is

marked by development of clinical signs and symptoms. Thus the illness vatarakta

clinically manifests. This is the general samprapti of vataraka in which the

raktamargavarana is the final stage of the samprapti. This raktamargavaarana can happen

in a different way also. The santarpana category of etiological factors leads to the

accumulation of kapha and medas in the raktamarga there by causing raktamargavarana.

Due to the establishment of raktamargavarana there occurs inhibition of movement of

vata dosa. Inhibition of vata culminates in severe morbidity of vata dosa and once again

manifesting 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 of

excessive accumulation of kapha and medas in the body. Other than the vatarakta, the

kapha and medas can cause different other diseases like vatavyadhi, hrdroga, gulma and

prameha. Thus presence of any of these diseases is also a strong clinical evidence of

abnormality of kapha and medas in a given patient. Corroborating the same, coexistence

of 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 the

concept of raktamargavarana due to abnormal kapha and medas in the disease

vatarakta178.

Add to this from the modern paralance of atherosclerosis - Most atheroma produces no

symptoms, and many never cause clinical manifestations. Numerous patients with diffuse

110

Discussion

atherosclerosis may succumb to unrelated illness without ever having experienced

clinically significant manifestations of atherosclerosis. What accounts for this variability

in the clinical expression of atherosclerotic disease, here is the explanation - Arterial

remodeling during atheroma formation represents a frequently overlooked but clinically

important feature of lesion evolution. During the initial phases of atheroma development,

the plaque usually grows outward, in an abluminal direction. Vessels affected by

atherogenesis tend to increase in diameter, a phenomenon known as compensatory

enlargement, a type of vascular remodeling. The growing atheroma does not encroach

upon the arterial lumen until the burden of atherosclerotic plaque exceeds approximately

40% of the area encompassed by the internal elastic lamina. Thus, during much of its life

history, 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 a

larger extent determines the upasaya and anupasaya in vatarakta. Accordingly the

exposure to warm surrounding, rest and application of sneha tend to cause remission of

the symptoms, where as exposure to cold surrounding and physical exercise tend to

worsen the symptoms of vata rakta.

The sadhyasadhyata of disease depends on virulence of vitiated doshas, presence or

absence of upadrava’s as well as chronicity of disease.

Symptom around the joints is the cardinal manifestation of the diseases sandhigatavata

and amavata and thus these diseases need to be differentiated from the vatarakta. In

addition to this the skin manifestation of the kusta is akin to the same present in the

vatarakta. Hence the kusta should be distinguished from the vatarakta again. Differential

diagnosis is best made by the analysis of the samprapti ghataka as well as clinical

manifestations of these diseases.

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

111

Discussion

of 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 of

dosa and site of affliction form the antahparimarjana ciktsa. Further depending upon the

requirement the bahiparimarjana cikitsa like pariseka, abhyanga pradeha and upanaha is

also carried out. In case of development of complications like vidhradhi and vrana sastra

pranidhana cikitsa is followed.

Vataraktantaka rasa as explained in Bhaishajya ratnavali is a Khalvirasayana with unique

herbomineral combinations of drugs to treat Vatarakta. Parada, Shilajatu, guggulu,

Lauhabhasma are the main ingredient targeted specifically for kapha medasavarana in

raktavaha srotasa. These ingredients are treated with each three bhavana of bhringaraja

svarasa and triphala svarasa.

Lekhana basti is a combination specially indicated in Sthaulya and morbid condition of

kapha and medas. The mixing of ingredients is done in a sequence of madhu , saindhava

lavana ,murchita tila, kalka triphala kvatha and gomutra, . The ingredients of kalka are

suryakshara , shilajatu, kasisa ,tuttha , hingu .

By using Yasthimadhu kalka and ksheera, Ksheerapaka prepared, .taila paka is then

prepared by using ksheerapaka and murchitatilataila. Madhuka pushpa kalka is added

during 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 and

post-test design and is planned to evaluate the therapeutic effect of Vataraktantakarasa

and Lekhana basti in Vatarakta. 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, 20 Patients who fulfilled the criteria of inclusion were taken for

the study.

The selected patients were administered with Lekhana Basti as kaala basti course of 16

days, in which Niruha Basti was administered in a dose of 480 ml for 6 days by using the

enema can. 10 sittings of Anuvasana basti was also administered with Shatapaka

madhukataila in a dose of 120ml. In conjunction with basti treatment the patient was also

112

Discussion

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.

The state of the disease vatarakta changes after the intervention. Improvement or

otherwise was determined by adopting the standard methods of scoring for subjective,

objective and special investigation criteria. The margavarana was assessed both before

and after the intervention to note any change by using the arterial Doppler study. Lipid

profile 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 that

atherosclerosis usually becomes symptomatic during the 5th or 6th decade. Present

observation of 50% patients between the age group of 51 to 60 years corroborates the

same.

The illness does not show any predilection for the sex. The same is demonstrated in the

present sample of 20 patients as 60% patients of Vatarakta were males and the remaining

40% were females.

80% of patients were Hindus in the present study. Though the illness does not show any

predilection for religion, the preponderance of the illness among Hindus represents only

the 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 sample

taken for the study, 80 % of the patients were married persons. This only represent the

preponderance of the married people in the age group of 40 60 years in which the

incidence of the illness is maximum.

It is observed that 7 (35%) of the females in this study were house wives by their

occupation. Also, this formed the largest category of patients leaving behind the patients

engaged in other occupations. The prevalence of the illness among the house wives only

represents the predominant occupation of the female in this locality, and this occupation

has nothing to do with causation of vatarakta.

The study revealed that most of the patients belonged to middle and rich socio-economic

status. Sedentary life style is common among this category of people. Sedentary life style

has definite role in the causation of the illness. Similarly the sample indicates the

prevalence of the illness in middle and higher class people.

113

Discussion

Madhumeha, soniata mada and hrdroga are the conditions in which the abnormality of

medas is common, so also the vatarakta. In accordance with the etiology and basic

pathology which is common in these diseases, they tend to coexist in patients.So also in

the present study revealing the same tendency 45% of patients of vatarakta had

madhumeha as well as soniata mada.

Vegetarian or non vegetarian food that does not make any difference, but

the excessive intake of food and less utilization predisposes to vatarakta.

However in the present sample of 10 a maximum of 65% of patients had

the habit of mixed diet.

Dvandvaja prakriti is commonest amongst any population. The same is reflected in the

present sample as all the patients had the dvandvaja praktiti.

Samhanana of an individual represents the nourishment. Vatarakta being santarpana

janya vyadhi pravaraa or madhyama samhanana is likely in such patients. So also in the

present study all the patients had either madhyama samhana. No patients had avara

samhanana.

Abhyavahara or jarana shakti of the persons indicate the possibility of santarpana or other

wise. Abhyavaharana sakti and jarana sakit if it is good, then the persons are likely to

have over santarpana leading to disease manifestation. Similary in the presnt sample of

patients suffering from santarpanajanya vatarakta, patients had either pravara or

madhyama abhyavaharana and jarana shakti. No patients having avaraa abhyavaharana

and jarana shakti were recorded in this sample.

Patients treated with Vataraktantakarasa and Lekhana basti had marked remission of the

symptom pain. 1.8 was the mean initial score of pain in 20 patients of Vatarakta which

came down to 1.0 after the treatment. The improvement to the tune of 44.44% is found to

be 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 the

treatment with Vataraktantakarasa and Lekhana basti. This improvement when analyzed

by 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 initial

mean score of Malaise recorded in the 20 patients of Vatarakta. This was brought down

114

Discussion

to 0.150 after the administration of Vataraktantaka rasa and Lekhana Basti. This

improvement after the treatment is 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 in patients

of Vatarakta. This initial mean score came down to 0.0500 after the treatment. The

improvement to the tune of 92.30 % was highly significant (P≤0.001) as revealed by the

paired‘t’ test.

Tenderness is another symptom of Vatarakta. The initial mean score of the patients in

tenderness was 0.100 which was reduced to 0.00 after the treatment. The improvement to

the tune of 100% was recorded, but is not statistically significant.

Before the treatment the mean score of symptom of Edema was 0.350. After the

treatment with Vataraktantak rasa and Lekhana Basti this was reduced to 0.0500 giving

85.71% effect. The change that occurred with the treatment is greater than would be

expected by chance; there is a statistically significant change (P = 0.010) as assessed by

the paired‘t’ test.

Patients treated with Vataraktantak rasa and Lekhana Basti had no difference in

Local color changes. 0.200 was the mean initial score in 20 patients of Vatarakta which

remained as 0.200 after the treatment.

47.22% of improvement was observed in the score of walking ability. 1.8 was the initial

mean score recorded in the 20 patients of Vatarakta This was brought down to 0.950

after the administration of Vatarakta and Lekhana Basti This improvement after the

treatment 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 of

Vatarakta This initial mean score came down to 1.05 after the treatment. The

improvement 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 with

Vataraktantak rasa and Lekhana Basti this was reduced to 224.00. This improvement

after the treatment was found to be statistically highly significant (P<0.001) as assessed

by the paired‘t’ test.

115

Discussion

Before the treatment the mean Triglyceride was 247.100 after the treatment with

Vataraktantak rasa and Lekhana Basti this was reduced to 196.40. This improvement

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 HDL Cholesterol was 39.850 Basti this was increased to

44.500. 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 this

was reduced to 134.650 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 VLDL Cholesterols was 43.550 After the treatment this

was reduced to 33.450 This decrease in values after the treatment was found to be

statistically 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 and

symptoms 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 showed

marked improvement.

Prevention of progressive margavarana by the regimen: obstruction of the kapha and

medas in the raktamarga is the principal pathology of the illness, and is progressive

process. This pathology is solely dependant upon the abnormal levels of kapha and medas

in the body. The abnormal accumulation of the medas can be very well understood by the

evaluation of serum lipid profile. The abnormal levels of lipids in patients suffering from

the illness are suggestive of its role in causation of the illness. Lipid level if it is brought

to 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 the

good cholesterol following the treatment. This is more than enough to say that the

lekhana basti and vataraktantaka rasa is very useful in preventing the progression of

margavarana as well as the illness vatarakta. Lekhana basti by virtue of its ingredients

imparts ruksana in the body and ensures lekhana of medas. Added to this the ingredients

like silajatu guggulu haritaki ect of vataraktantaka rasa also aid in the reduction of kapha

and medas. So to say both the lekhana basti as well as vataraktantaka rasa is aimed at

116

Discussion

removal of causative factor ie kapha and medas and there by preventing the progression

of the illeness.

Remission of margavarana and thereby reducing the morbidity of vata dosa: obstruction

in the raktamarga is the cause for morbidity of vata dosa. Obstruction is ascertained by

the color dopler study of arteries in the limbs. The marginal improvement in the

circulation following medication with lekhana basti and vaataraktantaka rasa confirms the

effect 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 vataraktantaka

rasa is said to have srotovishodhana property. The same is reflected in the results as there

is definite evidence of improvement in the circulation. Improvement in circulation means

reduction in margavaraan this in turn leads to reduced morbidity of vata dosa. Reduction

in pain burning sensation ect prove the reduction in the morbidity of vata dosa following

the medication. In addition to this the ingredients like guggulu in vataraktantaka rasa has

definite effect on pacifying the vata dosa and hence the reduction in severity of symptoms

suggestive of morbidity of vata dosa in patients suffering from vatarakta.

Rectification of morbidity of rakta dhatu: morbidity of rakta dhatu in patients suffering

from the vaatarakta is indicated by sympotmos like discoloration of the skin. Morbidity

of rakta dhatu is dependant upon the margavarana. Rectification of margavarana achieved

by the medication definitely leads to reduction 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. As

shown in the over all affect of the treatment no patients had complete remission of the

illness. Maximum number of patients had either best response or moderate response. This

indicates that the desired response is not complete rather partial. This implies, as there is

definite favorable response to the treatment, for the better results instead of single kala

basti course repeated karma basti course may be adapted and the duration of the samana

treatment may be further prolonged. Even addition of bahiparimarjana cikitsa may

improve the success rate. Thus the combination of shodhana treatment in the form of

lekhana basti and shamana treatment in the form of vataraktantaka rasa is an ideal

regimen in patient’s sufferirng from raktamargavarana janya vatarakta.

117

Summary

SUMMARY

Among the diseases listed as vatyavyadhi the illness Vatarakta has gained prime

importance in clinical practice due to its high prevalence in elderly, progressive

perpetuation, severe complications and fatal outcome. 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 in different systems. Prameha,

Sonitadusti, hrdroga and vatavyadhi etc all are found to be due to incriminatory affect of

kapha and medas in respective systems. Hence forth the concept 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 symptoms in vatarakta.

Further to add, sodhana, samana, bahiparimarjana and rasayana cikitsa all are aimed at

the rectification of margavarna in this disease. The whole concept of margavarana can be

best explained by the pathology of atherosclerosis and peripheral vascular disease in

modern parlance.

The analysis of previous work done in different research and post graduation study

centers unravels very little number of clinical works concentrated on vascular disease of

the limbs as vatarakta. Here also the over eating and sedentary habits as the cause of

arterial disease / raktamargavarodha through the pathology of atherosclerosis / dhamani

praticaya leading to ischemic limb disease / vatarakta is ignored. Hence there is a

necessity to study vatarakta as peripheral arterial disease and its management with both

sodhana and samana line treatment with the due consideration of its severity chronicity as

well 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 METHODS

Design: This is a single blind clinical study with a pre-test and post-test design.

119

Summary

Source 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,

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 days

Assessment criteria: The state of the disease vatarakta changes after the intervention.

Improvement or otherwise was determined by adopting the standard methods of scoring

for subjective, objective and special investigation criteria. The margavarana was assessed

both before and after the intervention to note any change by using the arterial Doppler

study. Lipid profile was also studied before and after the treatment. The change observed

after 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 were

males and the remaining 40% were females. 80% of patients were Hindus in the present

study. 80 % of the patients were married persons. 35% of the females were house wives

by their occupation. most of the patients belonged to middle and rich socio-economic

status. 45% of patients of vatarakta had madhumeha as well as soniata mada. 65% of

patients had the habit of mixed diet. all the patients had the dvandvaja praktiti.

Maximum number of patients had madhyama samhanana patients had either pravara or

madhyama abhyavaharana and jarana shakti.

120

Summary

Results:

1.8 was the mean initial score of pain in 20 patients of Vatarakta which came down to 1.0

after the treatment. The improvement to the tune of 44.44% is found to be 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 the treatment

This 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 initial

mean score of Malaise recorded. This was brought down to 0.150 after the treatment and

is 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 initial

mean score came down to 0.0500 after the treatment. The improvement to the tune of

92.30 % 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 0.00

after the treatment. The improvement to the tune of 100% was recorded, is statistically

significant.

Before the treatment the mean score of symptom of Edema was 0.350. After the

treatment this was reduced to 0.0500 giving 85.71% effect. The change that occurred

with the treatment is greater than would be expected by chance; there is a statistically

significant 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 initial

mean score recorded. This was brought down to 0.950 after the treatment this

improvement 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 of

Vatarakta This initial mean score came down to 1.05 after the treatment. The

improvement to the tune of 30 % was significant (P=<0.010)

Before the treatment the mean total Cholesterols was 274.950. After the treatment this

was reduced to 224.00. Before the treatment the mean Triglyceride was 247.100 and was

reduced to 196.40. Before the treatment the mean HDL Cholesterol was 39.850 and was

increased to 44.500 following medication. Before the treatment the mean LDL

Cholesterols was 169.200, which raised to 134.650 beforethe treatment the mean VLDL

121

Summary

Cholesterols was 43.550 and was reduced to 33.450. All these changes in the lipid profile

were 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 and

symptoms 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 showed

marked improvement.

Discussion:

Obstruction of the kapha and medas in the raktamarga is the principal pathology of the

illness, and is progressive process. This pathology is solely dependant upon the abnormal

levels of kapha and medas in the body. The abnormal accumulation of the medas can be

very well understood by the evaluation of serum lipid profile. The abnormal levels of

lipids in patients suffering from the illness are suggestive of its role in causation of the

illness. Lipid level if it is brought to 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 the good cholesterol following the treatment. This is more

than enough to say that the lekhana basti and vataraktantaka rasa is very useful in

preventing the progression of margavarana as well as the illness vatarakta. Lekhana basti

by 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 rasa

also aid in the reduction of kapha and medas. So to say both the lekhana basti as well as

vataraktantaka rasa is aimed at removal of causative factor ie kapha and medas and there

by preventing the progression of the illeness.

Obstruction in the raktamarga is the cause for morbidity of vata dosa. Obstruction is

ascertained by the color Doppler study of arteries in the limbs. The marginal

improvement in the circulation following medication with lekhana basti and

vaataraktantaka rasa confirms the effect 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 vataraktantaka rasa is said to have srotovishodhana property. The

same is reflected in the results as there is definite evidence of improvement in the

circulation. Improvement in circulation means reduction in margavaraan this in turn leads

122

Summary

to reduced morbidity of vata dosa. Reduction in pain burning sensation ect prove the

reduction in the morbidity of vata dosa following the medication. In addition to this the

ingredients like guggulu in vataraktantaka rasa has definite effect on pacifying the vata

dosa and hence the reduction in severity of symptoms

morbidity of rtakta dhatu in patients suffering from the vaatarakta is indicatied by

sympotmos like discoloration of the skin. Morbidity of rakta dhatu is dependant upon the

margavarana. Rectification of margavarana achieved by the medication definitely leads to

reduction 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. No

patients had complete remission of the illness. Maximum number of patients had either

best response or moderate response. This indicates that the desired response is not

complete rather partial. This implies, as there is definite favorable response to the

treatment, for the better results instead of single kala basti course repeated karma basti

course may be adapted and the duration of the samana treatment may be further

prolonged. Even addition of bahimparimarjana cikitsa may improve the success rate.

Conclusion:

The combination of shodhana treatment in the form of lekhana basti and samana

treatment in the form of vataraktantaka rasa is an ideal regimen in patient’s sufferirng

from raktamargavarana janya vataraktaa.

123

Bibliography

BIBLIOGRAPHY VATARAKTA. 1) Chakrapani,on Agnivesa: Charaka Samhita ,Varanasi, Chaukambha Sanskrit

sansthana, 5th edition,2001, Chikitsa sthana, chapter 29, Slok 1, 738 PP, Page no. 628

2)Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 1-48, 824 PP, Page no. 264

3) Agnivesa: Charaka Samhita ,Varanasi, Chaukambha Sanskrit sansthana, 5th

edition,2001, Chikitsa sthana, chapter 29, Slok 1 - 100, 738 PP, Page no. 627-634

4) Agnivesa:Charaka samhita,,Varanasi,

Chaukambha Sanskrit sansthana, 5th edition,2001, Chikitsa sthana, chapter 29, Slok 10-

738 PP, Page no. 627

5) Agnivesa: Charaka Samhita,Varanasi, Chaukambha Sanskrit sansthana, 5th eition,

2001, Chikitsa sthana, chapter 29, Slok 156, 738 PP, Page no. 634

6) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Sutrasthana, chapter 15, slok 32, 824 PP, Page no. 73

7) Agnivesa: Charaka Samhita,Varanasi, Chaukambha Sanskrit sansthana, 5th

edition,2001, Chikitsa sthana, chapter 29, Slok 156-158, 738 PP, Page no. 634

8) Henry n, Ginsburg, ira j, Goldburg; Harrison’s principles of internal medicine, New

York, Mc Graw Hill publications, volume II, 15th edition, 2000, chapter 232, P. 1486-

9) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok19, 738 PP, Page no. 628

10)Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 30, 738 PP, Page no. 629

11) Nisargi.S.Ramachandra, the effect of lekhana basti in the management of sthoulya,

(Unpublished Doctoral Dissertation, Mysore University, Mysore 2002) p 121.

12) Sanjeevani Rekha, A clinical study on the management of Sthoulya By Panchatikta

and Lekhana basti.

(Unpublished Doctoral Dissertation, IPGTand RA, Jamanagar 2001)page 136.

13 ) Sathish, Conceptual study of vatarakta VIS-A-VIS T.A.O. and clinical management

with, Manjistadi ksara basti. (Unpublished Doctoral Dissertation, Rajiv Gandhi

124

Bibliography

University of health sciences, Bangalore 2003) p 133.

14) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 156 738 PP, Page no. 634

15) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 157, 738 PP, Page no. 634

16) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 88 738 PP, Page no. 631

17) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

chikitsasthana, chapter 38 slok 82, 824 PP, Page no. 545

18 ) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 421, 891 pp.

19 ) Dr. Vivekananda Pandeya , Agnipurana ki Ayurvediya anusandhanata

Samiksha,Delhi,Satguru publications , 1997 , PP 358 Page no 252

20 ) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 1-105, 738 PP, Page no. 627-634

21 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 40-52, 824 PP, Page no. 264

22 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Sitrasthana, chapter 15, slok 32, 824 PP, Page no. 73

23 ) Acharya Bhela’s, Bhela Samhita, Varanasi, Chaukambha Vishwabharati, 1999,

285 PP, Chikitsasthana, vatasonita visarpa chikitsa adhyaya, slok 36-41, page 181.

24 ) Harita’s, Harita samhita, Varanasi, Prachy prakashana,1985,first edition page 279

Sloka – 24 PP 454.Page no.327

25) Chakrapani ,Agnivesa:Charaka samhita, Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Chikitsa sthana, chapter 29, Slok 24-28, 738 PP, Page no. 629

26 ) Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana,

Chikitsa Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 2-24, PP - 870

125

Bibliography

page 522-526

27 ) Vangasena’s, Vangasena Samhita, Mumbai,Khemaraj Krishnaraja prakashana,1996

Sloka - 34 PP 1096 Page no. - 890

28 ) Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Chikitsasthana, chapter 22 , slok 1-38, 956 PP, page no. 728-734

Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition,

1999, Vatarakta nidana 23,sloka PP-412 page 181-183

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 1-101, page 522-527 PP 894.

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda chikitsaprakarana chapter 8, sloka 1-30

Page no.: 295- 303 pp 824.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana

16 Sloka-3-19 Page no. 403-407 pp 407

29 ) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 29, 738 PP, Page no. 629

30 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 25, 738 PP, Page no. 629

31) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 20, 738 PP, Page no. 628

32 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 17, 738 PP, Page no. 628

33) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 13 738 PP, Page no. 628

34 ) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 21, 738 PP, Page no. 628

35 ) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 31, 738 PP, Page no. 627-634

36 ) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

126

Bibliography

2001, Chikitsa sthana, chapter 29,Slok 0-100, 738 PP, Page no. 629

37 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 156, 738 PP, Page no. 634

38 ) Chakrapani , Agnivesa:Charaka samhita, Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Nidana sthana, chapter 4, Slok 8, 738 PP, Page no. 213.

39 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 156, 738 PP, Page no. 634

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Chikitsasthana, chapter 22 , slok 47, 956 PP, page no. 732

40 ) Chakrapani , Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Sutrasthana, chapter 20, Slok 17, 738 PP, Page no. 115

41 ) Dallhana , Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia,

7th edition, 2002, Nidanasthana, chapter 1, slok 48, 824 PP, Page no. 264

42 ) Devaraja Radhakanta, Shabdhakalpadruma, Delhi, Naga Publisher, 1988,

part II, Page 25.

43)Chakrapani , Agnivesa:Charaka samhita,Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Chikitsa sthana, chapter 29, Slok 1, 738 PP, Page no. 627

44) Chakrapani Agnivesa:Charaka samhita, Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Chikitsa sthana, chapter 29, Slok 1-2 738 PP, Page no. 627

45) Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition,

1999, Vatarakta nidana 23,sloka 181 PP-412 page 181

46 ) Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 3, 956 PP, page no. 536

47 ) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 10, 738 PP, Page no. 628

48 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 43-44, 824 PP, Page no. 263

127

Bibliography

49 ) Chakrapani , Agnivesa:Charaka samhita,Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Chikitsa sthana,chapter 29, Slok 11, 738 PP, Page no. 628

50 ) Chakrapani , Agnivesa:Charaka samhita,Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Chikitsa sthana,chapter 29, Slok 11, 738 PP, Page no. 628

51 ) Chakrapani , Agnivesa:Charaka samhita,Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Chikitsa sthana, chapter 29, Slok 11 738 PP, Page no. 628

52) Chakrapani , Agnivesa:Charaka samhita, Varanasi, Chaukambha Sanskrit sansthana,

5th edition,2001, Chikitsa sthana, chapter 29, Slok 35, 738 PP, Page no. 629

53) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 0-100, 738 PP, Page no. 627-634

54) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 5-11, 738 PP, Page no. 628

55) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 5-11, 738 PP, Page no. 627-628

Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 43, 824 PP, Page no. 264

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 4,5, 956 PP, page no. 536

Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition,

1999, Vatarakta nidana 23,sloka1-3 PP-412 page 181

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda chikitsaprakarana chapter 8, sloka 1 -5 Page no.: 295 pp 824.

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 2-4, PP - 870 page 522

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

128

Bibliography

1998, Vatarakta chikitsa, sloka 1-4, page 429 PP 894.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana

Sloka-4-5 Page no. 403 pp 407

56 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 5,6, 738 PP, Page no. 527

57 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Nidana sthana, chapter 29, Slok 4,5, 738 PP, Page no. 202

58 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 7,8738 PP, Page no. 628

59 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Sutra sthana, chapter 21, Slok 4, 738 PP, Page no. 116

60 ) Harsha Mohana,Text book of pathology,New delhi,Jayapee Brothers,Fifth edition,

2005 PP 940 page. No 283.

61) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 16-18, 738 PP, Page no. 628

62) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

Vimana sthana, chapter 5, Slok 8, 738 PP, Page no. 251

63) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 28 Slok 8,738 PP, Page no. 616

64) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, vimana sthana, chapter 5, Slok 8, 738 PP, Page no. 212

65) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 28 Slok 202, 738 PP, Page no. 625

66) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

sharira sthana, chapter 4, slok 4, 824 PP, Page no. 355

129

Bibliography

67) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 28, Slok 71, 738 PP, Page no. 616

68) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 18 738 PP, Page no. 628

69) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 25, 738 PP, Page no. 629

70) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 0-100, 738 PP, Page no. 627-634

71) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 17, 738 PP, Page no. 628

72) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 28 Slok 202, 738 PP, Page no. 625

Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 47, 824 PP, Page no. 264

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 5,6, 956 PP, page no. 5356Madhavakara’s,

Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition, 1999, Vatarakta

nidana 23,sloka 5-7 PP-412 page 182

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda chapter 29, sloka 6-8 Page no.: 298 pp 824.

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 8-10, PP - 870 page 524

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 11-13, page 440 PP 894.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana

16 Sloka- 6-8 Page no. 403 pp 403

73 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 19, 738 PP, Page no. 628

130

Bibliography

74) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Chikitsasthana, chapter 5, slok 3, 824 PP, Page no. 424

75 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 20, 738 PP, Page no. 628

76 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 20-21, 738 PP, Page no. 628

77 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 22-23, 738 PP, Page no. 628

78 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 20, 738 PP, Page no. 628

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 9, 956 PP, page no. 5356

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda chapter 29, sloka 8-9 Page no.: 299 pp 824.

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 24, PP - 870 page 526

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 14, page 522-527 PP 441

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana

16 Sloka-11 Page no. 404 pp 407

79 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 21-22, 738 PP, Page no. 628

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 10-11, 956 PP, page no. 536

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda,chapter 8, sloka 1 Page no.: 295 303 pp 824.

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

131

Bibliography

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 9, PP - 870 page 527

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 23, page 441 PP 894.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana 16

Sloka- 12-13 Page no. 404 pp 407

80 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition

,2001, Chikitsa sthana, chapter 29, Slok 25-26, 738 PP, Page no. 629

Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 45, 824 PP, Page no. 261

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 19, 956 PP, page no. 537

Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition, 1999,

Vatarakta nidana 23,sloka 8-9 PP-412 page 181-183

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda chapter 29, sloka 9-10 Page no.: 303 pp 824.

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 11-12, PP - 870 page 524

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 1-101, page 522-527 PP 894.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana

16 Sloka-14-15 Page no. 404 pp 407

81 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 28, 738 PP, Page no. 629

Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 45, 824 PP, Page no. 264

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 15 956 PP, page no. 537

132

Bibliography

Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition,

1999, Vatarakta nidana 23,sloka 11 PP-412 page 182

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda chapter 8, sloka 1 Page no.: 295 303 pp 824.

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 14, PP - 870 page 525

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 11, page 441 PP 894.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana

16 Sloka- 17 Page no. 404 pp 407

82 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 29, 738 PP, Page no. 629

Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 46, 824 PP, Page no. 264

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 16, 956 PP, page no. 537

Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition,

1999, Vatarakta nidana 23,sloka 10 PP-412 page 182

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000,Madhyama khanda chapter 29, sloka 11 Page no.: 300 pp 824.

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 2-24, PP - 870 page 522-526

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 16, page 441 PP 894.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana

16 Sloka- 18 Page no. 404 pp 407

83 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

133

Bibliography

2001, Chikitsa sthana, chapter 29, Slok 27, 738 PP, Page no. 629

Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 46, 824 PP, Page no. 264

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 14, 956 PP, page no.537

Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition,

1999, Vatarakta nidana 23,sloka12. PP-412 page 182

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda chapter 8, sloka 11 Page no.: 303 pp 824.

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 13, PP - 870 page 524

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 18, page 441 PP 894.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana 16

Sloka- 18 Page no. 404 pp 407

84 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 29, 738 PP, Page no. 629

85 ) Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 29-30, 956 PP, page no. 538

86 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 35, 738 PP, Page no. 629

87 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 156, 738 PP, Page no. 637.

88) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Sutrasthana, chapter 15, slok 32, 824 PP, Page no. 73

89 )Chakrapani, Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Sutra sthana, chapter 20, Slok 17, 738 PP, Page no. 115

90 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

134

Bibliography

2001, Sutra sthana, chapter 24, Slok 25, 738 PP, Page no. 116

91) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Vimana sthana, chapter 5, Slok 24, 738 PP, Page no. 252

92) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition, ,

Sutra sthana, chapter 28, Slok 16, 738 PP, Page no. 179

93) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, sutra sthana, chapter 28, Slok 17 738 PP, Page no. 179

94) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Vimana sthana, chapter 5, Slok 8,738 PP, Page no. 251

95) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, SUTRA sthana, chapter 11, Slok 48 738 PP, Page no. 477

96) Henry n, Ginsburg, ira j, Goldburg; Harrison’s principles of internal medicine, New

York, Mc Graw Hill publications, volume II, 15th edition, 2000, chapter 232, P. 1486.

97) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 26-27, 738 PP, Page no. 629

98) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 0-100, 738 PP, Page no. 627-634

99) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 27100, 738 PP, Page no. 627-634

100) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 0-100, 738 PP, Page no. 629

Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 49, 824 PP, Page no. 264

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 11, 956 PP, page no. 536

Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition,

1999, Vatarakta nidana 23,sloka 16-17 PP-412 page 183

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda chapter 23, sloka 15 Page no.: 301pp 824.

135

Bibliography

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 18-19, PP - 870 page 526

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 21-24, page 441 PP 894.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana

16 Sloka- 13 Page no. 404 pp 407

101 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 30, 738 PP, Page no. 629

Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 1, slok 49, 824 PP, Page no. 264

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Nidanasthana, chapter 16 , slok 17, 956 PP, page no537

Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition,

1999, Vatarakta nidana 23,sloka 18 PP-412 page 183

Bhavamishra’s, Bhavaprakasha, Varanasi, Chaukhamba Sanskrit Series 7th edition,

2000, Madhyama khanda chapter 29, sloka 1 8-19Page no.: 303 pp 824.

Vaidhya Shodala’s, Gadanigraha, Varanasi, Chaukhamba Sanskrit Sansthana, Chikitsa

Kanada, 2nd part, 2st edition, 1999, chapter 20, sloka 17, PP - 870 page 525

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th edition,

1998, Vatarakta chikitsa, sloka 90, page 441PP 894.

Vagbhata , Astanga sangraha , Varanasi , Krishnadasa Acadamy , 1993,Nidanasthana

16 Sloka- 19 Page no. 404 pp 407

102) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 28, Slok 37, 738 PP, Page no. 627-634

103 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 0-100, 738 PP, Page no. 618

104 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 28, Slok 19, 738 PP, Page no. 617

136

Bibliography

105 ) Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Sutrasthana, chapter 13 , slok 27, 956 PP, page no. 216

106 ) Madhavakara’s, Madhavanidana Varanasi, Chaukhamba orientalia, eighth edition,

1999, Vatarakta nidana 23,sloka 2 PP-412 page 183

107 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 7, Slok 11-12738 PP, Page no. 451

108 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 7, Slok 9, 738 PP, Page no. 450

109 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Nidanasthana, chapter 6, slok 33-34, 824 PP, Page no. 289

110 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 11, 738 PP, Page no. 628

111) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 35-40, 738 PP, Page no. 629

Vagbhata’s, Ashtanga Hridaya, Varanasi, Chaukambha orientalia, 9th edition, 2002,

Chikitsasthana, chapter 22 , slok 1-4, 956 PP, page no. 728-729

112 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 46, 738 PP, Page no. 630

113 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 0-100, 738 PP, Page no. 627-634

114 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 44, 738 PP, Page no. 630

115 ) Dalhhan ,Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th

edition, 2002, Chikitsasthana, chapter 5, slok 7, 824 PP, Page no. 424

116 ) Chakrapani,Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana,

137

Bibliography

5th edition, 2001, Chikitsa sthana, chapter 29, Slok 41, 738 PP, Page no. 630

117) chakrapani Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana,

5th edition, 2001, Chikitsa sthana, chapter 29, Slok 41, 738 PP, Page no. 630

118 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

chikitsathana, chapter 5, slok 7, 824 PP, Page no. 425

119 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 17, 738 PP, Page no. 627-634

120 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Chikitsasthana, chapter 5, slok 7, 824 PP, Page no. 424

121 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 88, 738 PP, Page no. 631

122 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

sutrasthana, chapter 15, slok 1-32, 824 PP, Page no. 73

123 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Chikitsasthana, chapter 5, slok 12, 824 PP, Page no. 426

124 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 159, 738 PP, Page no. 634

125 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 42 738 PP, Page no. 630

126 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 124, 738 PP, Page no. 634

127 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 129, 738 PP, Page no. 633

128 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

138

Bibliography

2001, Chikitsa sthana, chapter 29, Slok 140-145, 738 PP, Page no. 633

129 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 131-135, 738 PP, Page no. 635

130 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 136-137, 738 PP, Page no. 634

131 ) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 161-162, 738 PP, Page no. 634

132) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Sutraa sthana, chapter 25, Slok 40, 738 PP, Page no. 131

133 ) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 418, 891 pp.

134 ) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 419, 891 pp.

135 ) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 419, 891 pp.

136 ) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 421, 891 pp.

137 ) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 418-419, 891 pp.

138 ) Chakrapani datta , Chakradatta , Varanasi , Choukhamba Samskrita Bhavana ,

Third edition 1997 , PP – 472 Page no . – 158-159

139 ) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 426-430, 891 pp

Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 92-123, 738 PP, Page no. 631-632

140 ) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 426, 891 pp

141 ) Anonymous ,Sahasrayoga , Haidrabada, Dakshina prakashana

Third edition 2002, PP 318 page no.192-202.

139

Bibliography

142 ) Anonymous ,Sahasrayoga , Haidrabada, Dakshina prakashana,Third edition

2002, PP 318 page no.160-167

143) Lankapati Ravana , arkaprakasha, varanasi, Krishnadasa Academy,First edition

1995 PP 172 page no -74

144) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 421-426, 891 pp

Vangasena’s, Vangasena Samhita, Mumbai,Khemaraj Krishnaraja prakashana,1996

Sloka - 117 PP 1096 Page no. - 190

146) Vangasena’s, Vangasena Samhita, Mumbai,Khemaraj Krishnaraja prakashana,1996

Sloka – 191-196 PP 1096 Page no. –1000

145) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Sutra sthana, chapter 15, slok 12, 824 PP, Page no. 73

147) Agnivesa:Charaka samhita,,Varanasi,Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 49-54, 738 PP, Page no. 630

Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Chikitsasthana, chapter 5, slok 17, 824 PP, Page no. 427

Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 420-434, 891 pp

Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, 5th

edition, 1998, Vatarakta chikitsa, sloka 94-101, page 448 PP 894.

148 ) Govindadas, Bhaishajya Ratnavali,Chaukhamba samskrita samsthan,Varanasi,2000

p: 421, 891 pp

149 ) Agnivesa:Charaka samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,

2001, Chikitsa sthana, chapter 29, Slok 115-116,738 PP, Page no. 632

150 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

chikitsasthana, chapter 38, slok 82, 824 PP, Page no. 632

151 ) Sushruta’s, Sushruta Samhita, Varanasi, Chaukambha orientalia, 7th edition, 2002,

Sutraasthana, chapter 38, slok 37, 824 PP, Page no. 167

140

Bibliography

152 ) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no –258-263

153) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no -550-564

154) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no – 576-579

155) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Uttarardha PP-782 Page no -403-406

156) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no - 567

157) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Uttarardha PP-782 Page no - 348

158) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Uttarardha PP-782 Page no -358

159) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no - 638

160) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Uttarardha PP-782 Page no - 541

161) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no -297

162) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no - 49

163) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no - 765

164) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no - 271

165) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no -435

166) Dr.Siddhinandana Mishra ,Ayurvediya rasashastra , Varanasi, Chaukhamba

Orientaliya, seventh edition 1997 ,PP 703 , Page no.- 163

167) Dr.Siddhinandana Mishra ,Ayurvediya rasashastra , Varanasi, Chaukhamba

141

Bibliography

Orientaliya, seventh edition 1997 ,PP 703 , Page no.- 416

168) Dr.Siddhinandana Mishra ,Ayurvediya rasashastra , Varanasi, Chaukhamba

Orientaliya, seventh edition 1997 ,PP 703 , Page no.-443

169) Dr.Siddhinandana Mishra ,Ayurvediya rasashastra , Varanasi, Chaukhamba

Orientaliya, seventh edition 1997 ,PP 703 , Page no.-451

170) Dr.Siddhinandana Mishra ,Ayurvediya rasashastra , Varanasi, Chaukhamba

Orientaliya, seventh edition 1997 ,PP 703 , Page no.- 543

171) Dr.Siddhinandana Mishra ,Ayurvediya rasashastra , Varanasi, Chaukhamba

Orientaliya, seventh edition 1997 ,PP 703 , Page no.-350

172) Dr.Siddhinandana Mishra ,Ayurvediya rasashastra , Varanasi, Chaukhamba

Orientaliya, seventh edition 1997 ,PP 703 , Page no.-389

173) Dr.Siddhinandana Mishra ,Ayurvediya rasashastra , Varanasi, Chaukhamba

Orientaliya, seventh edition 1997 ,PP 703 , Page no.- 401

174) Dr.Siddhinandana Mishra ,Ayurvediya rasashastra , Varanasi, Chaukhamba

Orientaliya, seventh edition 1997 ,PP 703 , Page no.- 432

175) Bhavamishra,Bhavaprakasha nighantu, Comentrt by K.C.Chunekar.Varanasi

Choukhamba bharati Academy,1999 Page 814 PP-842

176) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no -691

177) Vaidya Bapalala shaha , Nighantu Adarsha , Varanasi Choukhamba bharati

Academy, Second edition, 1999 Purvardha PP-782 Page no -691

178) Shri.Tarashankara Mishra ,Nadi darashana ,Varanasi , Motilala banarasidasa ,Third

edition ,1978 PP-167 page no . 89

142

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 OF DISCHARGE: 9 OCCUPATION: TREATMENT STARTED ON ADDRESS: TREATMENT COMPLETE ON

II. MAIN COMPLAINTS: SITE DURATION 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 ASWEDA L N ATISWEDA SIRAYAMA P RAGA I KARSHNYA P Q MANDALA SUPTATA KANDU K

143

Annexure

III. HISTORY OF PRESENT ILLNESS: L 1) PAIN: ONSET SUDEEN GRADUAL COURSE PROGRESSIVE INTERMITTENT CONTINOUS TYPE OF PAIN INTERMITTENT CLAUDICATION RESTPAIN AGGRAVATING FACTORS: DIURENAL - NIGHT SEASONAL – MOVEMENT WALKING K REST P Y 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 OTHERS

V. 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) RECENT OPERATION Y I) ANY COMPLAINT RELATED TO PERIPHERAL VASCULAR DISORDER

144

Annexure

VI. 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 \ IRREGULAR IX. GENRAL EXAMINATION : BUILT NOURISHMENT CYANOSIS CLUBBING LYMPHADENOPATHY TEMPERATURE PULSE RATE RYTHEM VOLUME CONDITION OF VESSEL WALL BLOOD PRESSURE RESPIRATORY RATE

145

Annexure

X. 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 HEIGHT WEIGHT 10. VAYATAH: BALA MADHYAM VRIDDHA XI. 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 VIKRITA XIII. 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

150

TRUSHNA / MADA \ BHRAMA \ RAGA \ PAK \ BHEDA / SPARSHYA AKSHAMATWA 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 \ MARMA GRAHA \ 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

TYPE MATRA NIRGAMAN

TIME VISHESHA PURVA

LAKSHANAPASCHATA 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. ]

Annexure

BASTI SAMYAKA YOGA: 1) PRASRUSTA VITKATA. 2) PRASRUSTA MUTRATA.

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