अथातो वातशोणितनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
We will now expound, Vatasonita (vatarakta) nidanam – diagnosis of Gout; thus said atreya and other great sages. (1)
Vata Sonita/Rakta Nidana – samprapti – causes, pathogenesis
विदाह्यन्नं विरुद्धं च तत्तच्चासृकप्रदूषणम् । भजतां विधिहीनं च स्वप्नजागरमैथुनम् ॥ २॥
प्रायेण सुकुमाराणामचंक्रमणशालिनाम् । अभिघातादशुद्धेश्च नृणामसृजि दूषिते ॥३॥
वातलैः शीतलैर्वायुर्वृद्धः क्रुद्धो विमार्गगः । तादृशेनासृजा रुद्धः प्राक्तदेव प्रदूषयेत् ॥४॥
आढ्यरोगं खुडं वातबलासं वातशोणितम् । तदाहुर्नामभिस्तच्च पूर्वं पादौ प्रधावति ॥ ५ ॥ विशेषाद्यानयानाद्यैः प्रलम्बौ तस्य लक्षणम् ।
By indulgence in foods which are vidahi (cause burning sensation during digestion) viruddha (incompatable) and such other factors which vitiate the blood, improper procedure regarding sleeping, keeping awake and sexual intercourse, especially by those who are of tender constitution (incapable of hard work) and those not accustomed to walking, in others, due to injury and accumilation of impurities in the body for want of purificatory measures regularly, sonita (blood) becomes vitiated. By the factors causing aggravation of vata (enumerated in chapter 2 of nidanasthana), especially by cold, vata also gets increased, begins to move in worng channels and becomes obstructed by the blood, also found in them ( worng channels) and produces the disease, known as Adhyaroga, Khuda, Vatabalasa and Vatasonita.
It commences in the legs, especially by keeping them hanging down for long hours as in riding on animals etc. (2-6a)
Vatarakta Purvarupa – prodromal symptoms
भविष्यतः कुष्ठसमं तथा सादः श्लथाङ्गता ॥६॥
जानुजङ्घोरुकट्यंसहस्तपादाङ्गसन्धिषु । कण्डूस्फुरणनिस्तोदभेदगौरवसुप्तताः ॥७॥ भूत्वा भूत्वा प्रणश्यन्ति मुहुराविर्भवन्ति च ।
Its prodromal symptoms are the same as those of kustha (leprosy), in addition there is debility, looseness of the body parts, itching, throbbing, constant pain, cutting pain, heaviness and loss of sensation, appearing disappearing and re-appearing frequently in the joints of the knee, foreleg, thighs, waist, shoulders, hands, feet and (other parts) of the body. (6b-8a )
Vata Sonita Lakshana- clinical features of Gout
पादयोर्मूलमास्थाय कदाचिद्धस्तयोरपि ॥८॥
आखोरिव विषं क्रुद्धं कृत्स्त्रं देहं प्रधावति । त्वङ्मांसाश्रयमुत्तानं तत् पूर्वं जायते ततः ॥९॥
कालान्तरेण गम्भीरं सर्वान् धातूनाभिद्रवत् । कण्ड्वादिसंयुतोत्ताने त्वक् ताम्रश्यावलोहिता ॥ १० ॥
सायामा भृशदाहोषा गम्भीरे ऽधिकपूर्वरुक् । श्वयथुर्ग्रथितः पाकी वायुः सन्ध्यस्थिमज्जसु ॥११॥
भिन्दन्निव चरत्यन्तर्वक्रीकुवश्च वेगवान् । करोति खलं पङ्गु वा शरीरे सर्वतश्चरन् ॥१२॥
Starting first in the feet, sometimes even in the hands, it quickly spreads to all other parts of the body also, similar to the spread of the poison of the rat. (8b)
First, it affects the skin and muscles only, it is known as Uttana and next, after lapse of time, it affects all the dhatus and becomes known as Gambhira. During Uttana stage, the skin has itching etc. (other kinds of pain) with coppery or bluish red hairs, is stretched and has severe burning sensation and increased local heat.
During the Gambhira stage the troubles enumerated earlier are more pronounced, swelling develops nodules and ulcers, vata moves in the joints, bones and marrow causing pain as though being excised, travelling quickly spread to the whole body, causes contractures, there by making the person lame either by one leg or both legs. (9-12)
वातेऽधिकेऽधिकं तत्र शूलस्फुरणतोदनम् । शोफस्य रौक्ष्यकृष्णत्वश्यावतावृद्धिहानयः ॥१३॥
धमन्यङ्गुलिसन्धीनां सङ्कोचोऽङ्गग्रहोऽतिरुक् । शीतद्वेषानुपशयौ स्तम्भवेपथुसुप्तयः ॥१४॥
रक्ते शोफोऽतिरुक् तोदस्ताम्रश्चिमिचिमायते । स्त्रिग्धरूक्षैः शमं नैति कण्डूक्लेदसमन्वितः ॥१५॥
पित्ते विदाहः सम्मोहः स्वेदो मूर्छा मदः सतृट् । स्पर्शाक्षमत्वं रुग्रागः शोफः पाको भृशोष्मता ॥१६॥
कफे स्तैमित्यगुरुतासुप्तिस्निग्धत्वशीतताः । कण्डूर्मन्दा च रुग्द्वन्द्वसर्वलिङ्गं च सङ्करे ॥१७॥
If vata is predominant, there is too much of pain, throbbing and pricking, roughness, black or blue colour, increase or decrease of the swelling, contractures of the dhamanis ( arteries), joints of the fingers and toes, catching pain in the body parts, severe pain (distress), dislike for cold, cold increasing his discomfort, stiffness (loss of movement) tremors (or rigors) and loss of sensation.
If rakta (blood) is predominant the swelling has severe pain, is coppery in colour, has the sensation of ants crawling, does not subside either by heat or cold, has itching and exudation.
If pitta is predominant, there is burning sensation in the hands, feet, shoulders, etc. delusion perspiration, fainting, toxicity, thirst, tenderness, pain, redness, swelling, ulceration, and severe local heat.
If kapha is predominant, there is inactivity, feeling of heaviness, loss of tactile sensation, greasiness, cold, mild itching and pain.
If there is combination of any two doshas or of all the three the symptoms of both or all of them will be present. (13-17)
Sadhyasadhyata – prognosis
एकदोषानुगं साध्यं नवं याप्यं द्विदोषजम् ।
त्रिदोषजं त्यजेत् स्त्रावि स्तब्धमर्बुदकारि च ॥ १८ ॥
That arising from one dosha and of recent origin is curable; that arising from two doshas is controllable (and persists for the rest of life), that arising from all the three doshas, which is exudative, static (motionless) and that giving rise to formation of arbuda (malignant tumors) are to be rejected. (18)
Avarana vata
रक्तमार्गं निहन्त्याशु शाखासन्धिषु मारुतः । निविश्यान्योन्यमावार्य वेदनाभिर्हरत्यसून् ॥१९॥
Vata getting localised in the joints of the extremities, obstructs the channels (passages) of the blood; thus obstructing each other, produces many distresses and kills the person. (19)
वायौ पञ्चात्मके प्राणो रौक्ष्यव्यायामलङ्घनैः । अत्याहाराभिघाताध्ववेगोदीरणधारणैः ॥ २०॥
कुपितश्चक्षुरादीनामुपघातं प्रवर्तयेत् । पीनसार्दिततृट्कासश्वासार्दीश्चामयान्बहून् ॥ २१ ॥
Among the five divisions of vata, prana gets aggravated (increased) by dry things, (excess of) exercises, fasting, over-eating injury, walking long distances and premature initiation or willful suppression of bodily urges and produces disorders of the eye and others (sense organs) and many diseases like nasal catarrah, facial palsy, thirst, cough, dyspnoea etc. (20-21)
उदानः क्षवथूद्गारच्छर्दिनिद्राविधारणैः । गुरुभारातिरुदितहास्याद्यैविकृतो गदान् ॥ २२ ॥
कण्ठरोधमनोभ्रंशच्छर्द्यरोचकपीनसान् । कुर्याच्च गलगण्डादीन्तांस्तान्जत्रूर्ध्वसंश्रयान् ॥२३॥
Udana gets aggravated by suppressing sneezing, belching, vomiting and sleep, carrying heavy loads, excess of crying, laughing, etc, and produces obstruction to the throat, disorders of the mind, vomiting anorexia, nasal catarrah, scrofula and other diseases of the parts above the shoulders. (22-23)
व्यानोऽतिगमनस्थानक्रीडाविषमचेष्टितैः । विरोधिरूक्षभीहर्षविषादाद्यैश्च दूषितः ॥ २४ ॥ ॥ २५ ॥ पुंस्त्वोत्साहबलभ्रंशशोफचित्तोत्प्लवज्वरान् । सर्वाङ्गरोगनिस्तोदरोमहर्षाङ्गसुप्तताः कुष्ठं विसर्पमन्यांश्च कुर्यात्सर्वाङ्गगान् गदान् ।
Vyana gets aggravated by excess of walking, sitting and other activities done improperly, foods which are incompatable and dry, too much of fear, pleasure, grief etc. and produces decrease of sexual vigour, enthusiasm and strength, oedema, mental disorders, fever, paralysis of the entire body, intermittant pain, horripilation loss of sensation of the body parts, leprosy, herpes and many other diseases affecting the entire body. (24-25)
समानो विषमाजीर्णशीतसङ्कीर्णभोजनैः ॥२६॥
करोत्यकालशयनजागराद्यैश्च दूषितः । शूलगुल्मग्रहण्यादीन् पक्कामाशयजान् गदान् ॥२७॥
Samana gets aggravated by intake of foods which are unsuitable uncooked, cold and mixture of many kinds, sleeping and keeping awake at improper times, etc and produces pain in the abdomen, abdominal tumors, disease of the duodenum and other diseases of pakvasaya and amasaya (gastro-intestinal tract). (26-27)
अपानो रूक्षगुर्वन्नवेगाघातातिवाहनैः । यानयानासनस्थानचंक्रमैश्चातिसेवितैः ॥ २८ ॥
कुपितः कुरुते रोगान्कृच्छ्रान्पक्वाशयाश्रयान् । मूत्रशुक्रप्रदोषार्शोगुदभ्रंशादिकान् बहून् ॥ २९ ॥
Apana gets aggravated by goods which are dry and hard to digest, suppression of the urges, excess of straining at stools, riding on vehicles, sitting, walking etc and produces many diseases of the pakvasaya (large intestine) with are difficult to cure, disorders of urine, semen (and its counterpart in the females), prolapse of the rectum and many others. (28-29)
सर्वं च मारुतं सामं तन्द्रास्तैमित्यगौरवैः । स्निग्धत्वारोचकालस्यशैत्यशोफाग्निहानिभिः ॥३०॥
कटुरूक्षाभिलाषेण तद्विधोपशयेन च । युक्तं विद्यान्निरामं तु तन्द्रादीनां विपर्ययात् ॥३१॥
All the (five) maruta ( vata) are to be recognised as Sama ( associated with endogeneous toxins) when symptoms such as stupor, inactivity, feeling of heaviness, greasiness, loss of appetite, lassitude, cold (chill), swelling, loss of digestive activity, desire for things which are pungent and dry (moistureless) and finding of comfort by such things, and recognised as Nirama (without the association of toxins) by the symptoms opposite of stupor etc (enumerated above). (30-31)
Dhatvavarana
वायोरावरणं चातो बहुभेदं प्रवक्ष्यते । लिङ्गं पित्तावृते दाहस्तृष्णा शूलं भ्रमस्तमः ॥३२॥
कटुकोष्णाम्ललवणैर्विदाहः शीतकामता । शैत्यगौरवशूलानि कट्वाद्युपशयोऽधिकम् ॥३३॥
लङ्घनायासरूक्षोष्णकामतां च कफावृते । रक्तावृते सदाहार्तिस्त्वङ्मांसान्तरजा भृशम् ॥३४॥
भवेच्च रागी श्वयथुर्जायन्ते मण्डलानि च । मांसेन कठिनः शोफो विवर्ण: पिटकास्तथा ॥३५॥
हर्षः पिपीलिकानां च सञ्चार इव जायते । चलः स्निग्धो मृदुः शीतः शोफो गात्रेष्वरोचकः ॥३६॥
आढ्यवात इति ज्ञेयः स कृच्छ्रो मेदसावृते । स्पर्शमस्थ्यावृतेऽत्युष्णं पीडनं चाभिनन्दति ॥३७॥
सूच्येव तुद्यतेऽत्यर्थमङ्गं सीदति शूल्यते । मज्जावृते विनमनं जृम्भणं परिवेष्टनम् ॥ ३८ ॥
शूलं च पीड्यमाने च पाणिभ्यां लभते सुखम् । शुक्रावृतेऽतिवेगो वा न वा निष्फलतापि वा ॥३९॥
भुक्ते कुक्षौ रुजा जीर्णे शाम्यत्यन्नावृतेऽनिले । मूत्राप्रवृत्तिराध्मानं बस्तेर्मूत्रावृते भवेत् ॥ ४० ॥
विडावृते विबन्धोऽध: स्वे स्थाने परिकृन्तति ॥४१॥
व्रजत्याशु जरां स्नेहो भुक्ते चानह्यते नरः । शकृत्पीडितमन्नेन दुःखं शुष्कं चिरात्सृजेत् ॥४२॥
सर्वधात्वावृते वायौ श्रोणिवङ्क्षणपृष्ठरुक् । विलोमो मारुतो ऽस्वास्थ्यं हृदयं पीड्यते ऽतिच ॥४३॥
Further on, will be described the many kinds of Avarana vata such as in Pittavrta vata (vata being covered/hindered/obstructed/inactivated/disturbed by pitta) symptoms such as burning sensation, thirst, pain in the abdomen, giddiness, loss of consciousness, severe burning sensation by things which are pungent, hot or heat producing sour and salt and desire for cold comforts – are the symptoms.
In Kaphavita vata (vata covered/inactivated by kapha) the symptoms are cold, heaviness, pain in the abdomen, greatreliefby things which are pungent ( hot, sour, salty) and desire for fasting, physical work, dry foods and warm comforts.
In Raktavrta vata (covered/inactivated by blood) severe pain along with burning sensation manifest in the skin and muscles, the skin becomes red, swollen and has elevated patches (erythema/rash).
In Mansavtavata (covered / inactivited by muscular tissues) there is hard swelling, discolouration, appearance of papules (petechae, pustules), horripilations and feeling as though ants are crawling on the body.
In Medasavrta vata (covered / inactivated by fat tissue) there develop swellings on the body which are moveable, fatty, soft, and cold, anorexia and the disease Adhyavata which is difficult to cure.
In Asthyavrta vata (covered/inactivated by bone tissue) the symptoms are – body very hot ot touch, desires to be squeezed (massaged severe pain as though pricked by needles, weakness (inability) and constant pain.
In Majjavrta vata (covered/inactivated by marrow) there is bending of the body, yawning, pain circulating all over, finds comfort when massaged by the hand.
In Sukravrta vata (covered/inactivated by semen) the symptoms are ejaculation with force or no ejaculation, or it becoming useless (not forming the embryo).
In Annavrta vata (covered/inactivated by food) there is pain in the abdomen after taking food which subsides after digestion.
In Mutravrta vata (covered/inactivated by urine) there is no elemination of urine, and enlargement of the urinary bladder is present.
In Vidavrta vata (covered/inactivated by faeces) there is constipation, accumilation in its own place causing cutting like pain when faeces becomes vitiated by food, the fatty materials quick digestion, the person develops distention of the abdomen, after meals and facces is eliminated with difficulty, dry and after long time.
When vata becomes covered/inactivated by all the dhatus (tissues), there is pain in the pelvis, groins and back, upward movement of vata, ill-health in and severe pain (distress) in the heart (region of the heart). (32-43)
Pittavarana
भ्रमो मूर्छा रुजा दाहः पित्तेन प्राण आवृते । विदग्धेऽन्ने च वमनमुदाने विभ्रमादयः ॥४४॥
दाहोऽन्तरूर्जाभ्रंशश्च दाहो व्याने तु सर्वगः । क्लमोऽङ्गचेष्टासङ्गश्च सन्तापः सहवेदनः ॥४५॥
समान उष्पोपहतिरतिस्वेदोऽरतिः सतृट् । दाहश्च स्यादपाने तु मले हारिद्रवर्णता ॥४६॥ रुजोऽतिवृद्धिस्तापश्च योनिमेहनपायुषु ॥४७॥
When pranavata is covered/inactivated by pitta there is giddiness, faintings, pain, burning sensation; when udana is covered (by pitta) there is burning sensation during digestion, vomiting, giddiness etc, burning sensation internally, loss of vigour (strength, vafour etc); When vyana is covered, there is burning sensation all over the body, exhaustion without work, obstruction to the movement of the body parts, distress from heat and pain; when samana is covered there is decrease of body temperature desire for warmth, perspiration, restlessness, thirst, and burnings sensation; when apana is covered there is deep yellow colour of the faeces, great increase of pain and warmth in the vagina, penis and rectum. (44-47)
Kaphavarana
श्लेष्मणा त्वावृते प्राणे सादस्तन्द्रारुचिर्वमिः । ष्ठीवनक्षवथूद्गारनिश्वासोच्छ्वाससंग्रहः ॥४८॥
उदाने गुरुगात्रत्वमरुचिर्वाक्स्वरग्रहः । बलवर्णप्रणाशश्च व्याने पर्वास्थिवाग्ग्रहः ॥४९॥
गुरुताङ्गेषु सर्वेषु स्खलितं च गतौ भृशम् । समानेऽतिहिमाङ्गत्वमस्वेदो मन्दवह्निता ॥५०॥
अपाने सकफं मूत्रशकृतोः स्यात् प्रवर्तनम् । इति द्वाविंशतिविधं वायोरावरणं विदुः ॥५१॥
When prana vata is covered/inactivated by slesma (kapha) there is debility, stupor, anorexia, vomiting, obstruction to spitting, sneezing, belching, inspiration and expiration; when udana is covered inactivated (by kapha) there is feeling of heaviness of the body, anorexia, difficulty in talking and voice, loss of strength and colour ( and complexion); when vyana is covered/inactivated there is catching of (pain) of the joints, bones, and difficulty of speech, heaviness and feeling as though all the parts of the body are going to fall off; when samana is covered/inactivated the body becomes very cold with absence of perspiration and weakness of digestion; when apana is covered inactivated the faeces and urine are elimanated mixed with kapha.
Thus twenty-two kinds of avarana vata have been described. (48-51)
Anyonyavarana
प्राणादयस्तथान्योन्यमावृण्वन्ति यथाक्रमम् । सर्वेपि विंशतिविधं विद्यादावरणं च तत् ॥५२॥
निश्वासोच्छ्ववाससंरोधः प्रतिश्यायः शिरोग्रहः । हृद्रोगो मुखशोषश्च प्राणेनोदान आवृते ॥५३॥ उदानेनावृते प्राणे वर्णौजोबलसङ्क्षयः ।
Prana and others (divisions of vata) cover/inactivate one another among themselves in the regular manner; these are of twenty kinds, to be recognised as follows –
Obstruction to inspiration and expiration, running in the nose, catching pain in the head, pain (or disease) of the heart, and dryness of the mouth are the symptoms when Udana is covered/inactivated obstructed by prana. When prana is covered by Udana, there is loss of colour ( complexion) ojas (vigour) and strenth. (52-54a)
दिशानया च विभजेत् सर्वमावरणं भिषक् ॥५४॥
स्थानान्यवेक्ष्य वातानां वृद्धिं हानिं च कर्मणाम् ।
In this way the physician should classify all the Avaranas, considering the places, symptoms, increase or decrease of functions, of vata. (54)
प्राणादीनां च पञ्चानां मिश्रमावरणं मिथः ॥५५॥
पित्तादिभिर्द्वादशभिर्मिश्राणां मिश्रितैश्चतैः । मिश्रैः पित्तादिभिस्तद्वन्मिश्रणाभिरनेकधा ॥५६॥
तारतम्यविकल्पाच्चयात्यावृतिरसङ्ख्यताम् । तां लक्षयेदवहितो यथास्वं लक्षणोदयात् ॥५७॥ शनैश्शनैश्चोपशयाद् गूढामपि मुहुर्मुहुः ।
Avarana vata become innumerable, formed by the covering/hinderance of the prana and others (five divisions of vata) among themselves (forming 20 kinds), by pitta and others in twelve ways, by their combination (in two and threes) etc. likewise by the combination with pitta and others, in combination of two’s and three’s etc. by their mild, moderate and great degrees (of combinations) of classifications etc. (thus avarana vata is innumerable); they should be recognised by symptoms which are clearly found and by adopting such measures which produce comfort slowly and frequently. (55-57)
विशेषाज्जीवितं प्राण उदानो बलमुच्यते ॥५८ ॥
स्यात्तयो: पीडनाद्धानिरायुषश्च बलस्य च ॥५९॥
Prana is specially responsible for life and Udana for strength; by their abnormalities there will be loss of life and strength respectively – so goes the saying. (58-59)
आवृता वायवो ऽज्ञाता ज्ञाता वा वत्सरं स्थिताः । प्रयत्नेनापि दुःसाध्याः भवेयुर्वानुपक्रमाः ॥६०॥
Avarana vata which are not known (recognised), those which are known but persisting for more than a year, become either curable with difficulty or incurable. (60)
विद्रधिप्लीहहृद्रोगगुल्माग्निसदनादयः । भवन्त्युपद्रवास्तेषामावृतानामुपेक्षणात् ॥६१ ॥
By neglecting (the treatment of ) these avarana vata, vidradhi (abscess) pliha (enlargement of spleen) hrdroga ( diseases of the heart ) gulma ( abdominal tumors) agnisadana (poor digestive ability ) etc. develop as upadrava (secondary diseases / complications). (61)
॥ इति षोडशोऽध्यायः ॥
Thus ends the Sixteenth chapter.
Thus ends Nidanasthana- the third section.
