The 23rd chapter of Madhava Nidana deals with Vata rakta nidana that is Gout. Gout is a common and complex form of arthritis that can affect anyone. It’s characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe.
Causes of Gout —
लवणाम्ल – कटु – क्षार – स्निग्धोष्णाजीर्णभोजनैः |
क्लिन्न – शुष्काम्बुजानूपमांस – पिण्याक – मूलकैः || १||
कुलत्थ – माष – निष्पाव – शाकादि – पललेक्षुभिः |
दध्यारनाल – सौवीर – शुक्त – तक्र – सुरासवैः || २ ||
विरुद्धाद्यशन- क्रोध – दिवास्वप्न – प्रजागरैः |
lavaṇāmla – kaṭu – kṣāra – snigdhōṣṇājīrṇabhōjanaiḥ |
klinna – śuṣkāmbujānūpamānsa – piṇyāka – mūlakaiḥ || 1||
kulattha – māṣa – niṣpāva – śākādi – palalēkṣubhih |
dadhyāranāla – sauvīra – śukta – takra – surāsavaiḥ || 2 ||
viruddhādyaśana- krōdha – divāsvapna – prajāgaraiḥ |
The factors that lead to gout are —
- Over indulgence in foods that are salty, sour, pungent, alkaline , fatty, fried preparations of meat of aquatic or swamp animals
- Dried (meat and cereal) ball preparations
- Oily eatables, radishes, kulattha, masha, nishpava
- Different varieties of leafy vegetables and meat
- Sugarcane and yogurt
- Aasava
- Eating incompatible articles of diet.
The Other factors instrumental in producing the ailment include —
- Eating before digestion of the meal previously taken,
- The anger
- Day sleep and keeping awake at night and
Sleeping during day, such unhealthy activities are also instrumental in producing Vatarakta. 1-2
प्रायशः सुकुमाराणां मिथ्याहार – विहारिणां |
स्थूलानां सुखिनां चापि कुप्यते वातशोणितं || ३ ||
prāyaśaḥ sukumārāṇāṁ mithyāhāra – vihāriṇāṁ |
sthūlānāṁ sukhināṁ cāpi kupyatē vātaśōṇitaṁ || 3 ||
The disease, also named Vata Shonita, affects mainly those who are delicate,obese, leading a life of comfort and who indulge in the rich diet and regimen. 3
Samprapti (pathogenesis) of Vata Rakta —
हस्त्यश्वोष्ट्रैर्गच्छतश्चाश्नतश्च विदाह्यन्नं स विदाहो अशनस्य |
कृत्स्नं रक्तं विदहत्याशु तच्च स्रस्तं दुष्टं पादयोः चीयते तु ||
तत् संपृक्तं वायुना दूषितेन तत्प्रबल्यादुच्यते वातरक्तम् ||४||
hastyaśvōṣṭrairgacchataścāśnataśca vidāhyannaṁ sa vidāhō aśanasya |
kr̥tsnaṁ raktaṁ vidahatyāśu tacca srastaṁ duṣṭaṁ pādayōḥ cīyatē tu ||
tat sampr̥ktaṁ vāyunā dūṣitēna tatprabalyāducyatē vātaraktam ||4||
Moreover, riding on elephant, horse, camel and the like animals for long durations and an intake of heart – burn producing articles of diet cause improper digestion of food. This situation leads quickly to vitiation of blood, that, subsequently gravitates and accumulates in the feet. Thereafter, the blood is saturated with the deranged Vayu, because of the predominance of that is called Vata Rakta (Gout). This disease has been called Vata Rakta because vata dosha is predominant in this disorder. 4
Purvarupa (Premonitory Symptoms) —
स्वेदो अत्यर्थं न वा कार्ष्ण्यं स्पर्शाज्ञत्वं क्षते अतिरुक् |
सन्धिशैथिल्यमालस्यं सदनं पिडकोद्गमः || ५ ||
जानु – जङ्घोरु – कट्यम्स – हस्त – पादाङ्गसन्धिषु |
निस्तोदः स्फुरणं भेदो गुरुत्वं सुप्तिरेव च || ६ ||
कण्डुः सन्धिषु रुग्भूत्वा भूत्वा नश्यति चासकृत् |
वैवर्ण्यं मण्डलोत्पत्तिर्वातासृक्पूर्वलक्षणम् || ७ ||
svēdō atyarthaṁ na vā kārṣṇyaṁ sparśājñatvaṁ kṣatē atiruk |
sandhiśaithilyamālasyaṁ sadanaṁ piḍakōdgamaḥ || 5 ||
jānu – jaṅghōru – kaṭyamsa – hasta – pādāṅgasandhiṣu |
nistōdaḥ sphuraṇaṁ bhēdō gurutvaṁ suptirēva ca || 6 ||
kaṇḍuḥ sandhiṣu rugbhūtvā bhūtvā naśyati cāsakr̥t |
vaivarṇyaṁ maṇḍalōtpattirvātāsr̥kpūrvalakṣaṇam || 7 ||
The prodormal symptoms of the Vata Rakta include the following features —
- Excessive or no perspiration
- Blackish discolouration
- Loss of tactile sensation
- Severe pain even on slight hurting
- Lack of firmness in the joints
- Lassitude
- Depression
- Appearance of blisters on the skin
- Pricking sensation
- Pulsation
- Breaking sensation
- Heaviness
- Numbness and itching sensation in the knees, calf muscles, thighs, pelvis, scapular region hands, legs and joints.
- The pain in the joints persists and disappears alternatively. There could also manifest discolouring and patches of the body. 5-7
Symptomatology of Vata Rakta, dosha wise —
वाते अधिके अधिकं तत्र शूल – स्फुरण – भञ्जनम् |
शोथस्य रौक्ष्यं कृष्णत्वं श्यावता – वृद्धि – हानयः || ८ ||
धमन्यङ्गुलिसन्धीनां सङ्कोचो अङ्गग्रहो अतिरुक् |
शीतद्वेषानुपशयौ स्तम्भ – वेपथु – सुप्तयः || ९ ||
vātē adhikē adhikaṁ tatra śūla – sphuraṇa – bhañjanam |
śōthasya raukṣyaṁ kr̥ṣṇatvaṁ śyāvatā – vr̥ddhi – hānayaḥ || 8 ||
dhamanyaṅgulisandhīnāṁ saṅkōcō aṅgagrahō atiruk |
śītadvēṣānupaśayau stambha – vēpathu – suptayaḥ || 9 ||
If vata is very predominant, pain could be pulsating, tearing and very severe. In this case, swelling of joints will appear dry, will produce black, or blue patches, increasing or decreasing often, contractures of the fingers, stiffness and severe pain. The patient would develop dislike for cold features. Moreover, there could be stiffness, tremors, and loss of sensation in other parts of the body as well. 8-9
रक्ते शोथो अतिरुक्तोदस्ताम्र चिमचिमायते |
स्निग्ध – रुक्षैः शमं नैति कण्डु – क्लेदसमन्वितः || १० ||
raktē śōthō atiruktōdastāmra cimacimāyatē |
snigdha – rukṣaiḥ śamaṁ naiti kaṇḍu – klēdasamanvitaḥ || 10 ||
If rakta is affected profoundly, the swelling could be associated with a pricking pain and tingling sensation and it would be coppery red and would remain associated with an itching sensation and a moist discharge; it subsides neither with oil or dry massage nor with dry medications. 10
पित्ते विदाहः सम्मोहः स्वेदो मूर्च्छा मदः सतृट् |
स्पर्शासहत्वं रुग्रागः शोथः पाको भृशोष्मता || ११ ||
pittē vidāhaḥ sammōhaḥ svēdō mūrcchā madaḥ satr̥ṭ |
sparśāsahatvaṁ rugrāgah śōthah pākō bhr̥śōṣmatā || 11 ||
With the predominance of pitta in this disease, there would be
- Vidaha — burning sensation in the body,
- Moha — delusion,
- Svedo — perspiration,
- Murccha — fainting,
- Mada — Toxicity
- Trut — Thirst
- Tenderness in joints
- Pain
- Red colour
- Swelling
- Formation of pus inside and great warmness. 11
कफे स्तैमित्य – गुरुता – सुप्ति – स्निग्धत्व – शीतताः |
कण्डुः मन्दा च रुग्द्वन्द्वं सर्वलिङ्गं च सङ्करात् || १२ ||
kaphē staimitya – gurutā – supti – snigdhatva – śītatāḥ |
kaṇḍuḥ mandā ca rugdvandvaṁ sarvaliṅgaṁ ca saṅkarāt || 12 ||
With the kapha in predominance,
- the body is felt as if covered with wet clothes
- Heavy
- Insensitive to touch
- Oily and
- Cold
- There is itching sensation and mild pain
With the predominance of 2 doshas or all of the doshas, mixed symptoms of the concerned doshas are present. 12
The process of spreading of Vata Rakta —
पदायोर्मूलमास्थाय कदाचिद्दस्तयोरपि |
आखोर्विषमिव क्रुद्धं तद्देहमुपसर्पति || १३ ||
padāyōrmūlamāsthāya kadāciddastayōrapi |
ākhōrviṣamiva kruddhaṁ taddēhamupasarpati || 13 ||
The pain usually starts with the legs, sometimes even from the hands and spreads to other parts of the body in a method identical to the spreading of poison of a rat bite (that is slowly).13
Prognosis of Vata rakta —
आजानु स्फुटितं यच्च प्रभिन्नं प्रस्रुतं च यत् |
उपद्रवैश्च यज्जुष्टं प्राण – मांसक्षयादिभिः || १४ ||
वातरक्तमसाध्यं स्याध्याप्यं संवत्सरोत्थितं |
ājānu sphuṭitaṁ yacca prabhinnaṁ prasrutaṁ ca yat |
upadravaiśca yajjuṣṭaṁ prāṇa – mānsakṣayādibhiḥ || 14 ||
vātaraktamasādhyaṁ syādhyāpyaṁ sanvatsarōtthitaṁ |
That case of Vata rakta is difficult to cure in which the skin is cracked up to the knee, skin is cut off and there is exudation associated with complication like emaciation of energy and muscle tissue. This condition is incurable while the case that has completed one year of duration is yapya (it can be prolonged). 14
Complications of Vata Rakta —
अस्वप्नारोचक – श्वास – मांसकोथ – शिरोग्रहाः ||१५||
संमूर्च्छा – मद – रुक् – तृष्णा – ज्वर – मोह – प्रवेपकाः |
हिक्का – पाङ्गुल्य – विसर्प – पाक – तोद – भ्रम – क्लमाः || १६ ||
अङ्गुलिवक्रता – स्फोट – दाह – मर्मग्रहार्बुदाः |
एतैरूपद्रवैर्वर्ज्यं मोहेनैकेन वा अपि यत् || १७ ||
asvapnārōcaka – śvāsa – mānsakōtha – śirōgrahāḥ ||15||
sammūrcchā – mada – ruk – tr̥ṣṇā – jvara – mōha – – pravēpakāḥ |
hikkā – pāṅgulya – visarpa – pāka – tōda – bhrama – klamāḥ || 16 ||
aṅgulivakratā – sphōṭa – dāha – – marmagrahārbudāḥ |
ētairūpadravairvarjyaṁ mōhēnaikēna vā api yat || 17 ||
The complications of Vata Rakta include —
- Lack of sleep
- Anorexia
- Dyspnea
- sloughing
- cervical spondylosis
- syncope
- Intoxication
- Pain
- thirst
- fever
- Delusion
- Trembling hiccup
- Lameness
- Erysipelas
- Ulceration
- Pricking sensation
- Giddiness
- Tiredness
- bending of the fingers
- Cracking
- Burning sensation and abscess in the vital parts.
A case with these complications should be avoided for treatment. It is to be avoided even if only the symptom of delusion is present as a complication of gout. 15-17
अक्रुत्स्नोपद्रवं याप्यं, साध्यं स्यान्निरुपद्रवं |
akrutsnōpadravaṁ yāpyaṁ, sādhyaṁ syānnirupadravaṁ |
When only some of the complications are present, the disease can be prolonged. On the other hand,a case of gout without any further complications is curable.
Curability of Vata Rakta —
एकदोषानुगं साध्यं नवं, याप्यं द्विदोषजं |
त्रिदोषजमसाध्यं स्याद्दस्य च स्युरुपद्रवाः || १८ ||
ēkadōṣānugaṁ sādhyaṁ navaṁ, yāpyaṁ dvidōṣajaṁ |
tridōṣajamasādhyaṁ syāddasya ca syurupadravāḥ || 18 ||
Likewise, that case of gout in that only one dosha is involved and that is of a recent origin is curable. If two doshas are involved in gout, the disease could persist for life. However, if all the three doshas are involved in the case and there are further complications in it, the case is impossible to cure. 18
इति श्रीमाधवकरविरचिते माधवनिदाने वातरक्तनिदानं समाप्तम् || 23 ||
iti śrīmādhavakaraviracitē mādhavanidānē vātaraktanidānaṁ samāptam ||23 ||
Thus concludes the chapter of Vatarakta.
Source —
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I’m Dr. Malini Bhat MD (Ayu); an Ayurvedic Doctor and a health blogger. Follow me on social media to get daily health tips which you can easily adapt to a healthy lifestyle.
Very good information. Very useful
Thank you Doctor 🙂