A presentation on vata rakta chikitsa ppt

detailed descriptive information on vata rakta/gouty arthritis treatment gathered from different ayurvedic classics

1. By: D r. P . J yothi P.G. Scholar Kaya Chikitsa department Dr.BRKR Govt.Ayurvedic Medical College Hyderabad. A P resentation on V ãta R akta C hikitsa

2. I ntroduction : A chronic disease or a chronic illness is defined as a condition which develops gradually through years because of frequent and continuous exposure to abnormal dietary, lifestyle or environmental factors. Initially there may be absence of diseased symptoms but at later stages, complex manifestations involving one or more organs leading to derangement of bodily functions will be seen in chronic diseases. Vãta Rakta in Ayurveda is considered as one such chronic illness which is commonly seen affecting nearly 14-17 percent of population every year. It is caused by vitiated Vãta and Rakta . Vitiated Vãyu obstructs the path of vitiated Rakta in the beginning and then gets vitiated by Rakta further this complete process is known as Vãta- Rakta.

3. Types of Vãta Rakta mainly include Uttãna, Gambhira, Vãta Pradhãna, Pitta Pradhãna, Kapha Pradhãna, and Rakta Pradhãna. Clinical Features of Vãta Rakta ranges from mild inflammation and discoloration of skin to complete derangement of bodily organs depending up on its type and chronicity. Chronic and later stages of Vãta Rakta also cause complications like mamsa kotha, murcha, marma graham, anguli vakrata etc. Though Vãta Rakta is mentioned to be as kriccha sãdhya vyãdhi , by strictly following the protocol of Vãta Rakta chikitsa as mentioned in various Ayurvedic classics a physician can boldly treat this condition. Keeping this in view, through this presentation an effort of highlighting various important Ayurvedic treatment measures which can be used for effective management of Vãta Rakta has been made.

4. O bjectives : To review effective ayurvedic treatment measures of Vãta Rakta. To increase scope of Vãta Rakta management through various treatment modalities as mentioned in Ayurvedic classics.  

5. V ãta R akta C hikitsa S utra : Sãmãnya Chikitsa विरेच्य: स्नेहयित्वादौ स्नेह युक्तैर्विरेचनै: रूक्क्षैर्व म्रुदुभिशस्त मसक्रुद्वस्तिकर्म च || सेकाभ्यग्ङ प्रदेहान्न स्नेह: प्रायो अविदाहिन: वातरक्ते प्रश्स्यम्तु विशेषम् तु निबोध मे || (च.चि. 29/42 ) Utt ãna and Gambhiraja Chikit sa बाह्य मालेपनाभ्यन्ग्ङ् परिषेकोपनाहनै विरेकास्थापन स्नेहपानैर्गम्भीरमाचरेत् || (च.चि. 29/43 ) V ãta Pradhãnaja Chikitsa ` सर्पिस्तैल वसामज्जा पानाभ्यग्ङ वस्तिभि: सुकोष्णै रुपनाहैश्च वातोथ्तरमुपाचरेत् || (च.चि. 29/44 )

6. Pitta and Rakta Pradh ãnaja Chikitsa विरेचनैर्घ्रुतक्षीरपानै स्सेकै श्च वस्तिभि: शीतैर्निर्वापणै श्चापि रक्त पित्तोत्तरम् जयेत् || (च.चि. 29/45 ) Kapha Pradh ãnaja Chikitsa वमनम् म्रुदु नात्यर्धम् स्नेहसेका वि लग्ङनम् कोष्ण लेपाश्च शस्यम् ते वातरक्ते कफोत्तरे | | (च.चि. 29/46 )

7. V ãta r akta c hikitsa u pakrama: Treatment measures of Vãta Rakta include both Antah Parimãrjana and Bahir Parimãrjana Chikitsa as shown in the figure.

8. A NTAH P ARIM ãRJANA C HIKITSA

9. S HODANA C hikitsa: Ã ma P ã chana and Agni Deepana It is carried out Prior to Shodana chikitsa with Tikta, Katu rasa and Rũksha guna prãdhãnya drugs according to Rogi and Roga bala for a duration of 3 to 5 days. 1. Shaddarana chṹrna (Gambhira and pittaja) Dose - 3 to 6gm, bid, before food Anupãna – Honey/Ushna jala 2. Pancasama chṹrna (vãtaja) 3. Guduchyãdi or Amrutottara kvãtha (pittaja, kaphaja) Dose – 15 to 20ml, bid, before food 4. Dashamoola kvãtha (Vãtaja) Anupãna – Ushna Jala  

10. Sneha P ãna Sneha Pãna is carried out according to koshta bala and prakruti of patient and also according to predominant dosha present i.e. 1. Vãta Prãdhãna Vãta Rakta - Sadphala ghritam, Madhu yashtyãdi tailam, Ksheera balã tailam, Dhanvantari ghritam   → All these sneha dravyas does Brimhana and Vãta hara Karma 2. Pitta Prãdhãna Vãta Rakta - Mahã tiktaka ghritam → This ghrita promotes Rakta prasãdana and pitta Shãmaka karma 3 . Kapha Pradhãnya Vãta Rakta - Guggulu tiktaka ghritam - Madhu yashtyãdi tailam and Dhanvantari ghritam (Only in selected cases) → All these sneha dravyas does Ushna guna and kapha hara Karmas

11. Sneha Pãna is given in a dose of 40 to 60 ml, twice daily, before food for a duration of 5 to 7 days. Sneha P ãna is Contra indicated in medo mãrgãvarana janya Vãta Rakta. Svedana Usually Svedana is contraindicated in Vãta Rakta but just for the purpose Of Virechana we can go for “Mrudu Svedana”. Potalam and Sekam measures are followed to promote svedana in Kapha pradhãna Vãta Rakta. In few Vãta Pradhãna Vãta Rakta conditions, very mild Upan ãha Svedana is advised.   ss  

12. Vamana In Gambhira and Kapha pradhãna type of Vãta Rakta and in few Pitta Pradhãna Vãta Rakta cases associated with severe complications , “Mrudu Vamana Karma” is carried out with Madanaphala, Yashti madhu and Ksheera (Ãkantabharitha) according to koshta bala of rogi and roga avastha. Virechana In Gambhira, Pitta, Kapha and Rakta prãdhãnya Vãta Rakta “Mrudu Virechana Karma” with 25ml Eranda tail or Nimbha Amrutha Eranda tailam given with milk is carried out according to rogi and roga bala.  

13. Vasthi Specifically in Vãta Pradhãna type of Vãta Rakta and in presence of symptoms like Basti shṹla, Vankshana sh ũ la, Pãrswa sh ũ la and Udara sh ũ la, “Vasthi Karma” is considered to be as a best treatment of choice.   निर्हरेद्वा मलम् तस्य स घ्रुतै: क्षीरवस्ति भि: न हि वस्ति समम् किन्चिद्वातरक्त चिकित्सितम् || वस्ति वक्षण पार्र्श्वोरुपर्वास्थि जठरार्तिशु | (च.चि. 29/88 ) Administration of Ksheera Vasti/ Balã Gudṹcyãdi Ksheera Vasti is widely emphasized in all types of Vãta Rakta and especially in Vãta Pradhãna condition. → Ingredients of Ksheera Vasti include: Mãkshika – 100ml Sneha (mahã tiktaka ghritam and balã tailam 100ml each) – 200ml and Gudṹcyãdi Ksheera kvãtha – 200ml

14. Apart from ksheera vasti, Gudṹchyãdi yãpana vasti in Kapha Pradhãna Vãta Rakta and Pancha tiktaka vasti in Pitta Pradhãna Vãta Rakta are also preferred to some extent. → Ingredients of Gudṹchyãdi Yãpana vasti include: Mãkshika – 100ml, Lavana - 15 gm, Sneham (madhu yashtyãdi tailam and tiktaka ghritam 100ml each) – 200ml, Kalkam (satãhva) – 30gm and Kvãtham (gudṹchyãdi) – 400ml   → Ingredients of Pancha tiktaka vasthi include: Mãkshika – 100ml, Sneha (Pancha tiktaka ghritam) – 200 ml and Gudṹcyãdi Ksheera kvãtha – 200ml For Ksheera vasti, Guduchyãdi Yãpana vasti and pancha tiktaka vasti, either yoga or Kãla vasti protocol can be followed.

15. Rakta mokshana In bhrihatrayee“Rakta mokshana” was mentioned as first line of treatment to be opted for chronic Vãta Rakta condition. Prior to Rakta mokshana certain measures like snehana, mrudu virechana n vasti should be followed. Rakta mokshana according to types of Vãta Rakta 1. Uttãna – Shringi, Jalauka, Alãbu and Prãcchanna 2. Gambhira – Sirãvyadhana 3. Vãtaja – Shringi 4. Pittaja and Raktaja – Jalauka 5. Kaphaja – Alãbu   If lesions are small and if pain moves from one part of the body to the other then bloodletting should be done by pracchana.

16. S HAMANA C HIKITSA: Gudṹci is considered as Agra Oushada for Vãta Rakta. It is administered in many forms. Shamana chikitsa of Vãta Rakta include administration of drugs like

17. Shamana oushada Drugs Dose Anup ãna Rasa or Bhasma Rasa mãnikya ras- kaphaja ; Mahã tãleshwar ras; Tãla bhasma; Gandhaka bhasma - Pittaja 125-250 mg, od/bid Madhu Vati or Guggulu Ārogya vardhini vati- Tridoshaja ; Gokshṹrãdi guggulu- Vãtaja; Kaishore guggulu and Amruthãdi guggulu- Gambhira,Pittaja,Kaphaja and Raktaja ; Punarnava,Yoga raja and Simhanãda guggulu- Kaphaja 250-500 mg, bid Gudṹci kvãtha, Ushna jala

18. Shamana oushada Drugs Dose Anup ã na Chṹrna Hareetaki, Manjishtãdi, Nimbãdi, Chopchinyãdi 3-6 gm, bid Ushna jala or Madhu Āsava or Arista Sãribhyãdãsava, Manjishtyãdarishta,Amrutãrishta 20-40 ml, bid Jala Kvãtha Dashamoola- Vãtaja ; Manjishtãdi- Tridoshaja ; Amrutãdi/ Amruttotara- Gambhira, Pittaja and Raktaja ; Rãsnã saptaka and Guggulu tiktaka- Kaphaja 20-30ml,bd,before food Jala or Madhu

19. Shamana oushada Drugs Dose Anup ãna Ghrita Gudṹchyãdi- Tridoshaja ; Satãvari, Sukumãraka,Jeevaniya, Bhallataka- Kaphaja 10-20ml,bd Ksheera Taila Pinda, Madhu parnyãdi,Balã and Dhanvantari- Vãtaja ; Gudṹcyãdiand Nãrãyana- Pittaja; Kottam chukkãdi and cinchyãdi- Kaphaja Depends on mode of administration Depends on mode of administration Rasãyana Chyavana prãsa- Vãtaja and Pittaja ; Vardhamãna pippali- Kaphaja and Vãtaja; Bhallataka- Kaphaja ; Shilãjith- Tridoshaja 20gm,bd Ksheera

20. b ahir P ARIM ãRJANA C HIKITSA

21. Bahir Parim ãrjana Chikitsa is followed as general measure of treatment for all types of Vãta Rakta but it is specifically considered as a main line of treatment for Uttãna Vãta Rakta. It includes External measures like 1. Avagãhana – Nimbha patra or Gudṹci patra are used for Avagãhana karma (fumigation) 2. Lepa – Madhuchista, Dashãnga, Tagarãdi, Pra Poundarikãdi/Sata doutha ghrita,   Krishna tila etc are used for ext.application on Vãta Rakta affected joints. 3. Upanãha – Mainly advised for Utt ãna, V ãtaja and Kaphaja Vãta Rakta. - Vãtagna Snigdha upanãha and Tila pinda upanãha are advised.   4. Seka 5. Abhyanga Carried out with Pinda/Balã/Dhanvantari/Gudṹcyãdi tailam 6. Dhãra

22. S ingle d rugs Gudṹci Sãribha Guggulu Shilajith Bhallãtaka Erandamoola Patola Sunti etc

23. P ATHYA - a PATHYA Pathya Apathya Āhãraja: Shṹka dhãnya - Shashtika shãli, Yava, Lãja, Godhuma Shami dhãnya - Mudga, Kulttha, Mãsha Mãmsa varga - Grãmya mãmsa, jãngala mãmsa Jala varga - Ushna jala Ksheera varga - Goksheera, Ajã kseera Katu, Ushna, Guru, Lavana, Madhya, Dadhi, Kshãra, Kulutta, Āmla, Pinyãka,Abhishyandi, Moolikãdi Vihãraja: Abhyanga and Parishekana etc Divã swapna, Ātapa Sevana, Ati Vyãyãma, Ati Maithuna etc

24. I deal t reatment p lan :

25. 1. Nidãna Parivarjanam  2. Samsodhana Chikitsa (Yathochita) 3. Bahir Parimãrjajana Chikitsa (Yathochita) 4. Samshamana Chikitsa   Rasa mãnikya Ras – 125mg + Gudṹci Satva – 500mg + Ārogyavardhini Vati – 250mg 1- bd with Honey, before food + Chopchinyãdi Chṹrna – 2gm Kaishore guggulu : 2- bd to tid with Luke warm water , before food   Manjishtyãdarishta : 20ml- bd with equal quantity water, after food   Satãvari Ghrita : 20ml- bd with milk, after food   Pinda tailam : for external application 5.  Pathya-Apathya

26. C onclusion: Thus the descriptive presentation on Vãta Rakta chikitsa is concluded.   An attempt of presenting Vãta Rakta Chikitsa in a detailed manner is made expecting it to be beneficiary for Ayurvedic research scholars and hence providing further scope to carry out even more research on this aspect.  

27. R eferences: Charaka Samhita, Chikitsa Sthãna.29 th chap Sushruta Samhita, Chikitsa Sthãna.5 th chap Ashtãnga Hridaya, Chikitsa Sthãna.22 nd chap Bhãva Prakãsha Samhitha, 29 th chap Bhaisajya Ratnãvali, Vãta Rakta Chikitsã Prakaran Sãrangadhara Samhitha Rasendra Sãra Sangraha L. Mahadevan’s Clinical methods of Ayurveda book, vol.2 Prof. Ajay Kumar Sharma’s Hindi text of Kaya Chikitsa, vol.2

28. T h a n k Y o u . .