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- The Diagnosis of Vatarakta (Gout)

[*]Chapter Twenty-three
[ The Diagnosis of Vatarakta (Gout)]
Aetiology [23 1-3]
(Excessive) inrake of salty, sour, pungent, alkaline, fatty and hot rood, taking meals while one is having indigestion, curried or tried preparations of meat of aquatic or swampy animals, dried (meat and cereal) ball preparations, radishes, kulattha 1 masa 2 nispava 3 different varieties of leafy vegetables and meat, sugarcane and yoghurt, aranala 4, sauvira 5, sukta 6, butter-milk 1, wine 8 and asava 9, eating incompatible articles of diet, eating before the previous meal has been digested 10, anger, day sleep and keeping awake at night : the above aetiological factors aggravate vayu and rakta usually in those who are delicate, obese, lead a life of comfort and indulge in unsalutary diet and regimen.
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1.    Dolichos biflorus Linn.
2.    Phaseolus mungo Linn.
3.    Dolichos lablab Linn. 1-3. Various pulses]
4.    Kanji or sour fermented rice water.
5.    Sour fermented barley water (S. S. I. 44, 35-40/1).
6.    Vinegar.
7.       Takra.
8.    Sura.
9.    Medicated spirit. [4-9. Fermented alcoholic and non-alcoholic preparations.)
10.  Too frequent eating

Diagnosis ofVatarakta (Gout)
Pathogenesis [23.4]
     Riding on an elephant, a horse or a camel and  an intake of heart-burn producing articles of diet causes improper digestion of food leading quickly to vitiation  of   blood. which then gravitates and accumulates in the feet.
     Thereafter, it (the blood) gets saturated with the deranged , vayu on account of the predominance of which it is called vatarakta (gout).       
             
Prodromal features [23.5-7]
      The (general) prodromal symptoms and signs of vatarakta are profuse perspiration or anhidrosis, blackish discolouration, loss of the sense of touch, severe pain on (even mildest) trauma, slackness of the joints, indolence and malaise; (the local) appearance of eruptions on the knees, legs, thighs, loins, shoulders, hands, feet and the joints of the body, severe pricking type of pain, twitchings tearing pain, heaviness, numbness and an itching sensation, pain in the joints which comes and goes again and again (1), local discolouration and circumscribed patches (also occur).
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1.  Periods of exacerbation and remission.

Vatarakta with predominance of vata [23.8,9]                                       

       With the predominance of vata, there is excessive pain, twitchings and splitting sensation in the lesions. The (inflammatory) swelling is dry, blackor blackish, and increases or decreases at times. The arteries and the joints of the fingers (and toes) become narrow, and movements ot the part (local joints) are restricted and severely painful. There is an aversion and intolerance to cold as well as rigidity, tremors and numbness in the limbs.

Vaiarakra with predominance of rakta [23.10]
       With the predominance of rakta, there is severe pain as well as pricking and tingling sensations in the (inflammatory) swelling which is coppery red and is associated with an itching sensation and a moist discharge it subsides neither with fatty nor with drv medicaments.

Vatarakta with predominance of pitta [23,11]
     With the predominance of pitta, one suffers from heart-burn, mental confusion, perspiration, fainting, intoxication and thirst; there is hyperaesthesia, severe pain, redness, excessive heat and suppuration in the (inflammatory) swelling.

Vatarakta with predominance of kapha [23,12]
With the kapha predominance, the body is felt as if covered with wet clothes, heavy, insensitive to touch, oily and cold. There is an itching sensation and  mild pain (locally). With ihe predominance of two dosas or of all the dosas, mixed features (of the concerned dosas) are present.

Spread [23.13]
        The disease spreads all over the body like a virulent rat poison beginning from the root(1) of (the toes of) the feet or sometimes from the hands.

Prognosis [23.14-18]
That vatarakta in which exfoliation occurs upto the knee, which cracks and oozes, which is associated with complications, and in which loss of vitality and emaciation are present is incurable; that which is of one year's duration is relievable only.
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1. Metatarso-phalangeal joint region.

           A case of vatarakta should not be taken up for treatment if complications  like insomnia, anorexia, dyspnoea, sloughing, fixity (1) of the head (at the joints of the neck), fainting, pain, thirst, fever, mental confusion, tremors, hiccough, inability to walk, spreading cellulitis, suppuration, pricking pain, dizziness, tiredness, digital (2) deformities, appearance of blisters,
burning sensation, affection of the vital organs (3) and tumours have  supervened, or else if mental confusion (4) alone has developed.

       If all the complications have not appeared, the condition is relievablewhereas if there are no complications at all it is curable.
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      Vatarakta with the predominance of one dosa alone and of recent origin is curable; with the predominance of two dosas, it becomes relievable only. On the contrary, if there is a predominance of all the three dosas and if it is associated with the complications it becomes incurable.
           Thus ends (the twenty-third chapter entitled) "The Diagnosis of Vatarakta (Gout)" of Madhava Nidana, as compiled by Sri Madhavakara
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1 Cervical spondylosis.
2 Toes and fingers.
3 Such as the brain, the heart and the kidneys.
4 Involvment of the C.N.S

Summary
     This chapter deal, with the diagnosis of gout.

Actio-pathogencsis (1-4)
          Unsalutary diets and habits arc given which aggravate vata and rakta in thу delicate, obese and sedentary persons (1-3); exessive riding on elephants, ets and consumption of heart-burn producing food gravitates the vitiated rakta (blood) to the  feet and it getting saturated there with the deranged vayu produces vatarakta (gout) (4).

Clinical Features (5-13)
       Sensory, disturbances, transient pains in the joints of the extremities and sweat disorders, etc. are mentioned as the prodromal features (5-7). A vivid description of rhe local lesion along with rhe general signs and symptoms due to the predominance of the various humours are given (8-12). The disease starts from the base of the toes (metatarso-phalangeal joint region) or sometimes from ,he hands and spreads all over the body like a virulent rat poison (13)

Prognosis (14-18)
The features of incurability include chronicity of more than a year with emaciation, general complications like mental confusion, hiccough etc, local complications as toe deformities, .skin exfoliation, cracks and oozing, suppuration and tumour formation, etc., and a predominance of all the humours; milder features and predominance of two humours indicate the disease to be still relievable;
whereas an early lesion, without any complication and with the predominance of one humour only is considered curable.

Suggested Research Problems

1. All good History of Medicine books and chapters should be corrected to include the references of gout as given in this chapter.
2. A  historical and comparative research into the various conceptual aspects of gout and allied disorders a.s mentioned in this chapter is indicated.
3. A clinical study to correlate the various conditions described in this chapter in terms of modern terminology could be done.
4. Clinical and experimental studies could be planned to find the role of the actiological factors (1-4) of gout and related joint disorders.[/*]