Gout & Ayurveda
Gout is the most common form of inflammatory arthritis, with a prevalence of 1–2% in developed countries. It is a disorder of purine metabolism associated with increase level of serum uric acid (serum uric acid >6. 8 mg/dL) , crystallizes in the form of monosodium urate, deposit in joints, tendons and in the surrounding tissues , manifested as a sudden burning pain, swelling, redness and tenderness in joints. Initially, hyperuricemic persons have no prominent symptoms and they remain asymptomatic for long time and gout develop only in about 10% of these people. Gout is the common cause of arthritis in men aged over the fifty. Incidence of gout in men is more than women because before menopause, estrogen promotes urate wasting in the urine. Gout has both modifiable (diet, alcohol, medications, co-morbidities, body mass index, physical fitness) and non-modifiable (genetics, age and gender) risk factors. As the level of uric acid [in men (≤ 7 mg/dl) and women (≤ 6 mg/dl)] crosses its saturation thresholds in physiological fluids, urate crystals precipitation started in the joints and other tissues. Non steroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids, xanthine oxidase inhibitor (like allopurinol, febuxostat) and uricosurics drugs (like probenecid) are used in the treatment of gout. These drugs have some side effects such as gastric ulcer, hypersensitivity; acute kidney injury and possibility of drug interaction with other prescribed drug such as erythromycin restrict their uses. The major objectives in chronic gout management are to keep the serum uric acid level towards normal, prevent joint damage due to hyperuricemiaand and further occurrence as well as to promote the dissolution of existing uric acid crystals as well as prevent new crystal formation. Some non pharmacological measures includes restricted protein diet, life style modification, weight loss, low alcohol consumption and ensuring sufficient fluid intake.
Tridoshas (three basic biological humors of body or Bio energy Principles), vata (the Air or Nervous System Humor), pitta (the biological fire) and kapha (The Water Humor or protective humors) are three physiological basic of the human body. Vata being predominant has the potential to cause more serious and long term diseases than the Pitta and Kapha. It gets aggravated due to either Avarana (hindrance in the path) or dhatukshaya (deficiency of body tissue). Vatarakta is one of the unique disorders among the Vatavyadhi (a group of nervous disorder) which is the result of avarana of morbid vata dosha by vitiated rakta (blood) dhatu (tissue). This causes the derangement of Rakta dhatu resulting in Vatashonita. In addition to this, Vatarakta is also produced by the Margavarana of Vayu by Kapha and Medas. In Shabda kalpa druma definition of Vatarakta is given as “Vata dushtiam raktam yatra roga vishesha”, i.e. it is caused due to the vitiation of Rakta initiated by the morbid Vata is called Vatarakta. It is of two types. When there is involvement of Twak (skin) and Mamsa (muscle) dhatus only, it is known as Uttana Vatarakta (uncomplicated gout). This type of vatarakta has Akunchana (Contraction), Ayama (Dilatation of Vessels), Beda (Splitting type of Pain), Daha (Burning Sensation), Gourava (Heaviness), Kandu (Itching), Rakta twak (Reddish coloration of the skin), Ruja (Pain), Shayava twak (Cyanosis of the skin), Sphurana (Trembling or throbbing sensation), Suptata (Numbness), Toda (Pricking pain). On the other hand, when symptoms like Swayatu grathita (Hard swelling), Paka (Suppuration), Daha (Burning sensation), Kanjatwa (Lameness), Shyavatha (Cyanosis or pallor), Pangutwa (Paraplegia), Bhrisharthi (Excruciating deep pain), Vidaha (Internal burning sensation), Tamra twak (Coppery discoloration), Ruja (Pain), Sphurana (Throbbing sensation), Adhika purvaruk (Increased pain), Toda (Pricking type of pain), Vatasya sarva Shareera charana (Vitiated vata moves all over the body), Angasya vakrikarana
(Disfigurement of the parts), Vatasya sandyasthi Majjasu chindanniva (Aggravated vayu while causing pain-burning sensation constantly moves with high speed through the Sandhi, Asthi and Majja) along with discoloration and hardening of skin are the features of Gambhira Vatarakta (complicated gout).
After one year vatarakta becomes Yapya (difficult to cure)
Principle of Ayurvedic management
In classics of Ayurveada both Shodhana and Shamana chikitsa are described for vatarakta. According to Acharya Charaka, Raktadhika vatarakta has to be treated with, Virechana (therapeutic purgation), Ghrita ksheera pana (intake of medicated ghee or milk), Seka (pouring of medicated decoctions over body), Vasti (medicated enema) and Sita nirvapana (application of pastes for cooling). Since Gambhira vatarakta falls into the category of Madyama rogamarga (intermediate path)), no other treatment is better parallel vasti in treating the disease. In case of Vatarakta, developed due to margavarana in the Rakta vaha srotas by morbid Kapha dosha and Medo dhatu, the line of treatment in the initial stage is different, snehana karma is not recommended, the main purpose in this context is to remove the Avarana and to clear the srotas (body channels) in order to monmalized the movement of vata. To achieve this goal Kapha-medo shamaka / Rukshana chikitsa is adopted first
A. Shodhana Chikitsa (purification treatment) Shodhana treatment includes Raktamoksana (bloodletting by leech or other method), Langhana (methods for effecting leanness, reduction of body bulk or resulting in lightness), Vamana (therapeutic emesis), Virechana, Asthapana vasti (decoction enema), Snehapana (intake of medicated oils or ghee)
B. Shamana (pacifying treatment) a. External application It includes various treatment modalities like Alepana (application of medicated pastes), Abhyanga (massage), Parisheka (pouring of medicated decoction over body) and Upanaha (application of hot poultice). Following drugs are used for external application