Ayurvedic management of Vatarakta w . s . r . to gout-A case study

The disease which is caused by aggravated Vata and vitiated Rakta is called Vatarakta. It is better correlated with ”gout” in the modern science. Vatarakta is a metabolic disorder where pain is predominant symptom, which disturbs day to day life of persons. Gouty arthritis is a disorder of Purine metabolism and is an inflammatory response to the MSUM(monosodium urate monohydrate) crystals, formed to secondary hyperuricaemia. The disease is known as ‘the King’s disease’ or ‘rich man’s disease’. In the present case study “Simhasyadi kwath mentioned in Bhaishajyaratnavali used in acute and chronic conditions. The results are significant with reduced acute attacks, decrease in the symptoms and hyperuricaemia. Further clinical trials can be conducted to prove the efficacy of the drugs statistically.


INTRODUCTION
The word vatarakta is made of two words Vaata and rakta. The Vata is the chief (King) without which no disease may take place, the Rakta is also a very important dhatu which gives nutrition to each & every body tissues & maintains them normal by eliminating toxins-malas (waste products) through the natural orifices of the body. It is a disorder of Vata associated with Rakta. The chief complaints are severe joint pain with onset at Hasta, Pada, Mulaagata sandhi and then migrates to other joints in a way similar to Akhuvisha(rat poison). The other symptoms are burning penetrating sensation, itching, ache, pricking pain, throbbing sensation & contraction. The skin becomes brownish black, red or coppery in colour. Vatarakta is also known as-Khuda roga, Vata-balasa & Adhya vata. Gout is metabolic disorder having the incidence of 0.2 to 2.5 per 1000 with an overall prevalence of 2-26 per 1000. Gout is rare in children and pre-menopausal females in India. Out of the affected population

२८/५९
Vataprakop is either due to obstruction of srotas or excessive depletion of Dhatus. The common cause of vitiating Rakta Dhatu are similar with Pitta. Impaired Rasa and Rakta Dhatu causes impaired Dhatuposhan. So there is also increase in the malaroopa kapha because of impaired Rasadhatvagni. Due to srotorodha and depletion of shleshak kapha (karmatah kshaya) sandhishaithilya occurs. As the disease progresses, involvement of all the Dhatus takes places gradually leading to deterioration of the tissue and organs. At this stage toxic substances produced from interaction of Vata, Rakta and Kapha are freely circulates throughout the body causing impaired Dhatuposhan.
Vataprakop, Dhatukshaya and involvement of further dhatus results in "Gambhir" type of Vatarakta.
The line of treatment in the modern medicine is NSAIDs/ Colchicine/ Glucocorticoid which failed to modify the course of the disease or unable to treat the disease completely and frequently meet with the ill effects. In Ayurveda a detailed Patient was suffering from the symptoms since 4 months. Pain was rapid in onset reaching maximum severity in just 2-6 hrs The joint affected initially was the left metatarsophalengeal joint. The pain was severe in early morning specially while walking. There was burning sensation and tenderness and marked swelling with overlying red shiny skin on the affected joint.
Associated symptoms were loss of appetite, constipation, pain all over the body.
Drink plenty of fluids, particularly water Apathya (advised to avoid) 1) Masha, kuluttha, brinjal, dadhi, ikshu, panasa 2) Sleep during day time(diwaswap) 3) Exposure to heat 4) alcohol and meat On every follow up patient was assessed on signs and symptoms. Criteria: Patient was investigated for Serum uric acid, before and after completion of treatment on 28 th day. CBC(Complete Blood count) with ESR Urine Routine examination ( Micro / Macroscopy) were also done before and after 28 days.

Observations and Results:
Assessment of the signs and symptoms of the patient was done during each follow up and results are as follows. Goksur with madhur rasa madhur vipak and sheet veerya acts as shothghna and kledaghna also pittashamak and vataghna Brihat pamchmula is having the property of kapha vatahara. It has analgesic, antiinflammatory, anti-arthritic activity. Brihat panchmool acts as vataghna, shothagna and vedanasthapan with the help of saindhav as sukshmasrotogami

CONCLUSION
Hence, it can be concluded that shodhana with eranda taila nitya virechana and shaman aushadis with simhasyadi kwath is effective in the treatment of Gouty arthritis particularly in reducing the signs and symptoms. Also it works not only at symptom level but also at Samprapti. Simhasyaadi kwath acts as dahashamak, vatanashak, shoolagna, shothaghna, raktadoshahar, anulomak. This present study also highlighted the effectiveness of simhasyadi kwath. Further research can be done in the form of clinical trials to establish the efficacy of simhasyaadi kwath