Vatarakta: An Etiological Appreciation

Introduction

Lifestyle is stated as the physiognomies of people of a region in special time and place. It comprises of day to day behaviours and actions of individuals in job, activities, fun and diet. Lifestyle has a significant influence on physical and mental health of human being. Unhealthy lifestyle in current situation is resulting in various metabolic, endocrinological, and systemic disorders. Ayurveda: The way of living life, has mainly focussed on lifestyle of individuals by adopting Dinacharya (daily regimens), Rutucharya (seasonal regimens), Nidra Vidhi (sleep) and Ahara Vidhi (diet) as mentioned in classics. Impairment of these factors results in various Vyadhi (disease); one such Vyadhi is Vatarakta.

Vatarakta is a special type of Vatavyadhi which is explained under both Vataja Nanatmaja Vikara1 and Rakta Pradoshaja Vikara2 which signifies the involvement and importance of Vata and Rakta in manifestation of the disease. Vatarakta is a best illustration which is known for its two-tier mechanism of Avarana pathology. Prakupita (aggravated) Vata gets Avarana (obstruction) by Dustha (vitiated) Rakta, aggravates extensively and in turn vitiates and obstructs Dushita Rakta resulting in Raktamargavarana and further vitiation of Dustha Rakta.3 In these cases, both Vata and Rakta gets vitiated by consumption of their respective Nidana. Santarpana (over nutrition) set of etiological factors also contribute to exhibition of Vatarakta. Various Aaharaja, Viharaja and Manasika Hetu are enumerated in classics, in detail. Classification and conception of those is very much essential in understanding Vatarakta.

Classification and Conception of Vatarakta Hetu (Nidana)

The word Nidana has been employed in two different views. Vyadhi Janaka also called as Hetu, gives the complete knowledge about causative factors of the disease and another is Vyadhi Bodhaka which means comprehensive knowledge about the disease and it includes Nidana Panchaka.4 Yet Nidana and Hetu words are used interchangeably. As Vata and Rakta are involved in producing Vatarakta, to produce this specific pathology, two separate set of etiological factors are responsible. These factors cause an independent vitiation of Vata and Rakta or together they may vitiate both.

The above listed Aharaja, Viharaja, Manasika and other numerous contributory factors of Vatarakta can be classified and studied under different subheadings of Hetu as follows:

I. a.Abhyantara Hetu

Dosha and Dooshya are said to be Abhyantara Hetu5 (internal cause) for any disease. Dosha Dooshya Sammurchana is well-described as Samavayi Karana (inseparable cause) in manifestation of the disease and in Vatarakta, Vata Dosha and Rakta Dhatu can be considered as Abhyantara Hetu.

b. Bahya Hetu

Bahya Hetu (external cause) is Ahara, Vihara and Kala5 which can be further divided into Samanya and Vishesha Hetu. This kind of classification of Vyadhi Nidana helps in complete understanding of the disease.

i. Samanya Hetu

Nidana which causes Vata Dosha Prakopa (aggravation) and Rakta Dhatu Dushti are considered as Samanya Nidana in the present context. Thus Aahara, Vihara and Manasika Bhava mentioned in the context of Vatarakta are segregated into Vata prakopakara and Rakta Dushaka Nidana as follows.

Aharaja Hetu for Vata Prakopa comprises of excess intake of Katu (pungent), Kshara (alakaline), Shushkamamsa (dry meat), Viruddhashana (intake of mutually contradictory food) etc. Viharaja Bhava like Prajagara (remaining awake at night), Vyayama (excessive physical exercise), riding over Haya (horse), Ushtra (camel) etc, Atiplavana (excessive swimming), Jalakrida (aquatic games), and Langhana (fasting) causes aggravation of Vata Dosha. Manasika Bhava like Krodha (anger) also causes Vata Prakopa. Other causes like Vega Dharana (suppression of natural urges), Abhighata (injury) also helps in manifestation of Vatavyadhi by provoking Vata Dosha.6

For Rakta Dhatu Dushti, Aharaja Hetu can be considered as excess intake of Lavana (salt), Amla (sour), Snigdha (unctous), Ushna Bhojana (hot food), Klinna (putrefied) and Anupamamsa (meat of marshy land), Kulattha (hoarse gram), Masha (black gram), Pinyaka (oil cake), Dadhi (curd), Takra (buttermilk) Aranala (gruel), Souvira (sour preparation of dehusked barley), Shukta (vinegar) and Madya Varga (alcoholic beverages) like Sura (alcohol), Asava (wine), Adhyashana (intake of food before the digestion of previous meal) etc. Viharaja Karana like excessive walking in hot weather etc. Krodha as Manasika Karana also causes Rakta Dushti.6 Nidana which are explained in Vidhishonitiya Adhyaya show much similarities with Vatarakta Nidana by which one can consider few more additional Nidana like intake of green leafy vegetables, Chardi Vega Dharana (suppression of urge of vomiting), and association of Sharat Rutu in manifestation of Shighrakari Vyadhi Vatarakta.7

Misthanna Bhojina (indulgence of sweet food), Sukha Bhojina (leisurely eating), Achankramanasheelata (absence habit of walking), Rutu Viparyasa (improper execution of diet and conduct of particular season), Satmya Viparyasa (usage of food articles which are not congenial to one’s own temperament), Avyavaya (lack of sexual activity), Snehadi Chikitsa Vibhramana (improper purification therapies) etc factors also play a greater role in appearance of the disease.8

ii. Vishesha Hetu

Vishesha Hetu are those which are specific to the disease. In this context, Sukumara (delicate person), Ushne Cha Atyadhwam (travelling in hot weather after intake of Ushna Aahara) can be considered as Vishesha Nidana. Bija Dushti can also be considered under this category. As per Acharya Sushruta, Sthoulyata is one of the cause for Vatarakta8 and Bija Dushti is the cause for Sthoola.9

Ashtamahadoshkara Bhava (eight factors to be avoided by patient during and after Panchakarma) like Rathakshobha (travelling on any vehicles), Atichankramana (excessive walking) and Atyasana (excessive sitting) provokes Vata Dosha and results in Sandhi Shithilyata (weakness of joints), Sandhi Shoola (pain in joints), Toda (pricking sensation) in Adha Shakha (lower limbs), Sira Dhamani Harsha (dilatation of veins and arteries), thereby contributing to Vatarakta Nidana.10

II. a. Sannikristha Hetu

The word meaning of Sannikrishta is nearer/ adjacent/close. It means one which is nearer is the main cause of the disease. This Hetu do not depend on any other Hetu to cause the disease.5 In current context, the vitiation of Vata and Rakta can be considered as Sannikrishta Nidana. b. Viprakristha Hetu Viprakristha means distant/remote cause which demands prolonged indulgence, but it may not directly influence the manifestation of the disease.5 In case of Vatarakta, continuous intake of Nidana which are Vatakara and Rakta Dhatu Dusthikara are considered as Viprakristha Nidana.

c. Vyabhichari Hetu

In Vyabhichari Hetu, Nidana, Dosha and Dooshya will not be capable of producing disease or they may not co-ordinate each other to produce the disease. In this context, Hetu may not produce the disease completely or it will produce the disease with Alpa Lakshanas (less symptoms).5 Excessive travelling and other similar factors that predispose the illness in patient suffering from Vatarakta are suggestive of Vyabhichari nature of causative factors.

d. Pradhanika Hetu

The Hetu which produces immediate effect like Visha (poison) is called as Pradhanika Hetu.5 Visha by its Ruksha Guna aggravates Vata Dosha, by Ushna Guna aggravates Pitta Dosha, vitiates Rakta by Sukshma Guna, spreads all over the body immediately by Vyavayi Guna, and takes life by Vikasi Guna.11 Depending upon Dosha Sthana and Prakruti of person, Visha produces severe other complications and even death. Among various classifications of Visha, constant exposure to Dushita Desha (place), Kala (time), Anna (food) and Diwaswapna for a longer time causes vitiation of Dhatu which is termed as Dushi Visha (type of artificial poison).12 Dushi Visha vitiates Rakta and produces Kitibha (psoriasis), Kotha (urticaria)13 and also causes Moorcha (fainting), Pipasa (excess thirst), Atisara (diarrhea) and Dhatugata Roga14 etc. Thus Abhighata (external injury) which is very instant in nature can be considered as Pradhanika Hetu for Vatarakta. And remaining Hetu like Diwaswapna, Ratrijagarana etc on long term exposure act as Dushi Visha.

III a. Utpadaka Hetu

Acharya Sushruta has broadly classified Vyadhi into three types namely Aadhyatmika, Aadhidaivika and Adhibhoutika which are further sub classified into seven types. They are Adibala Pravrutta, Janmabala Pravrutta, Doshabala Pravrutta, Sanghatabala Pravrutta, Kalabala Pravrutta, Daivabala Pravrutta and Svabhavabala Pravrutta.15 These set of Hetu may be studied under Utpadaka Hetu. Utpadaka Hetu are those which causes accumulation of Dosha and thus initiate the disease process.5

i. Adibala Pravrutta

Adibala Pravrutta Karana is an inherent defect in Shukra (sperm) or/and Shonita (ovum). i.e., Beeja (sperm or ovum), Beeja Bhaga (gene) and Beeja Bhaga Avayava (chromosome) Dusthi.16 Adibala Pravrutta Karana for Vatarakta was not mentioned in the classics but it can be understood that Sthoulya is one of the cause for Vatarakta and Stoulya is also an Adibala Pravrutta Vikara. It can also be assumed that Vikruti in Raktavaha Dhamani during development of Garbha may cause Vatarakta.

ii. Doshabala Pravrutta

The diseases which are formed due to the vitiation of Shareerika Dosha Vata, Pitta and Kapha, Manasika Dosha Raja and Tama are termed as Doshabala Pravrutta Vyadhi.16 So Nidana which causes vitiation of Vata Dosha will fall under the category of Doshabala Pravrutta Nidana.

iii. Janmabala Pravrutta

Janmabala Pravrutta Vyadhi arises due to improper conduct by the Garbhini (pregnant woman) during gestation, such as intake of Guru, Ushna, Tikshna Ahara, Madya sevana, Mamsa sevana, Yana (ride) over rough surface.16 These set of Nidana are also seen in Vatarakta. Thus, Grabhini when involved in these Nidana may get progeny with congenital Vatarakta.

iv. Sanghatabala Pravrutta

Sanghatabala Pravrutta or Adhibhoutika type of diseases are caused by an external injury.17 Thus Abhighata can be taken as Sanghatabala Pravrutta Karana of Vatarakta.

v. Kalabala Pravrutta

Kalabala Pravrutta diseases are brought about by the variation in Rutu (season) which are again classified into two types - Vyapana Rutu and Avyapanna Rutu. Vyapanna Rutu Kruta are due to abnormal seasonal variations. Avyapanna Rutu Kruta are due to disturbances of Dosha in normal season; when increased or decreased Dosha are not balanced by suitable diet and lifestyle, it may lead to various diseases.18 Thus, Rutusatyma Viparyasa i.e, improper execution of Ahara (diet) and Satmya (conduct) of particular season can be considered as Kalabala Pruvrutta Nidana of Avyapanna Rutu Kruta variety for Vatarakta.

vi. Daivabala Pravrutta

Daivabala Pravrutta Vyadhi are caused by the curse given by Deva (gods), Guru (teachers), Vipra (brahmins) etc. They are further divided into Sasmsargaja (direct contact from the people who are suffering from disease due to curse by Deva, Guru etc) and Akasmika (cause is not known and manifest suddenly).18 Thus, even Akasmika (Idiopathic) Karana may be the cause for Vatarakta.

b. Vyanjaka Hetu

Vyanjaka Hetu is the Preraka (triggering/ aggravating factor).5 Here Vata Prakopaka Karana like Yana (excess travelling) and Rakta Dushaka Nidana like Atapa Sevana (excessive exposure to sunlight) are considered as Vyanjaka Hetu as they worsen the condition of Vatarakta.

IV a. Asatmya Indriyartha

Samyoga Asatmendriyartha Samyoga (Improper use of sense organs) is the Atiyoaga (excessive usage), Ayoga (absence or less usage) and Mithyayoga (perverted or abnormal usage) of Jnanendria (sensory organs), Karmendriya (motor organs), and Manas (mind).5 Karmendriya Atiyoaga like Haya Ushtra Yana, Ambukrida, Plavana, Atyadhwa Karmendriya Ayoga like Achankramanasheelata Karmendriya Mithyayoga like Vega Dharana Jnanendria Atiyoaga like Ati Amla, Lavana, Ruksha Aahara Sevana Jnanendria Ayoga like Abhojana Jnanendria Mithyayoga like intake of Klinna, Shushka Mamsa Manas Mithyayoga like Krodha are considered as Asatmendriyartha Samyoga Nidana for Vatrakta.

b. Prajnaparadha

Prajnaparadha is the Nidana where person does mistakes knowingly due to loss of Dhee (ability to comprehend), Dhriti (controlling power) and Smrithi (power to recall memories) which are said to be Sarvadosha Prakopaka.19 Santarpanottha Nidana like Ati Dadhi Sevana and Madya Sevana, activities like Diwaswapna, Ratrijagaran and Vegavarodha etc are Prajnaparadhajanya Nidana of Vatarakta.

c. Parinama

Parinama or Kala is again Ayoga, Atiyoga or Mithyayoga of Sheeta (cold season), Ushna (summer season) and Varsha (rainy season).5 It plays a very important role in manifestation of the disease as Vata Sanchaya Kala is the Greeshma and Prakopa Kala is Varsha, whereas Rakta Dushti results in Pitta Dosha Prakopa owing to their Ashrayaashrayee Bhava and it is a well-known fact that Sharad Rutu is Pitta Prakopaka Kala (Rakta Dushti) and Lakshana of Vatarakta may get aggravated in Sharad Rutu.

V. a. Dosha Hetu

Madhuradi Rasa produced in Rutu are responsible for Dosha Chaya (accumulation), Prakopa (aggravation), Prashama (alleviation).5 In this case, the Nidana like Kashaya, Ruksha, and Katu Rasa Aahara Sevana may be considered as Dosha Hetu, which is responsible for the Sanchaya and Prakopa of the Vata Dosha.

b. Vyadhi Hetu

Hetu which is specific in causing particular disease is Vyadhi Hetu.5 In this condition, Vatarakta Arambhaka Beeja Dusthi can be considered as Vyadhi Hetu and excessive travelling after intake of Vidahi Aahara Sevana can be included under the same.

c. Ubhaya Hetu

Ubhaya Hetu is the combination of Dosha Hetu and Vyadhi Hetu.5 Riding over Hasti (elephant), Ashwa (horse), Usthra (camel) after intake of Vidahi Ahara aggravates Vata Dosha and causes Vatarakta.

VI. a. Anubandhya Hetu

Anubandhya also denoted as Swatantra (independent) vyadhi, gets manifested by its respective causes.5 Analysis of Vatarakta Nidana and Samprapti denotes the Pradhyanata of Vata Dosha, whereas according to the clinical course of the disease and principles of treatment, both Kapha and Pitta are seemed to be involved. Hence Vata holds prime importance in the etiopathogenesis of Vatarakta and acts as Anubandhya Hetu.

b. Anubandha Hetu

Anubandha Hetu is Paratantra (dependent).5 Pitta and Kapha are said to be Anubandha i.e., Paratantra Dosha in the appearance of the disease Vatarakta.

Discussion

• Samprapti of Vatarakta is a mutual vicious cycle between Prakupita Vata Dosha and Dusthita Rakta Dhatu which are intensified by their respective Nidana where Margavarana of Vata Dosha by Dusthita Rakta Dhatu and Dustha Rakta Margavarana by Kruddha Vata Dosha is the primary phenomenon in causing the illness.
• Depending upon the involvement of Dhatu, Vatarakta is classified mainly into two typesUtthana (superficial) and Gambheera (deep). Ubhaya (superficial and deep) Vatarakta explanation is also available in the texts.
• When the Samprapti of Vatarakta is restricted to Twak, Rakta and Mamsa Dhatu, it is regarded as Utthana Vatarakta. Involvement of deeper dhatu like Asthi, Majja and Sandhi signifies the Gambheera Vatarakta. In an additional variety i.e., Ubhayashrita Vatarakta, both the superficial as well as deeper Dhatu gets affected.20
• Contrary to this, in other variety of Vatarakta, the etiological factors like Santarpana Ahara, Madya sevana, Diwaswapna, Avyavyaya, Sthoulya etc., leads to aggravation of Kapha Dosha and vitiation of Medo Dhatu which further results in accumulation of Kapha Dosha and Medo Dhatu in the Raktamarga, thereby causing Dhamani Pratichaya (atherosclerosis) and contributing to principal pathology of Raktamargavarana and finally manifesting as Vatarakta.21

Conclusion

• Improper and unhealthy lifestyle is the main causative factor for Vatarakta.
• In Ayurveda, lifestyle means all the things that produce effect over Shareera (body), Indriya (sense organs), Satwa (mind) and Atma (soul).
• The way of thinking, eating, living, indulging in different activities etc. are the most important part of lifestyle because these have greater impact on a person.
• Hetu is the foremost among Nidana Panchaka and thus understanding of different types of Hetu is necessary as Nidana Parivarjana i.e. avoidance of causative factors is one of the principal treatment of any Vyadhi.

Conflicts of Interest

Declared.