अथातो वातशोणितनिदानं व्याख्यास्यामः ।
इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound Vatasonita nidanam-diagnosis of gout; thus said atreya and other great sages.
Vatarakta Nidana – causes of Gout
विदाह्यन्नं विरुद्धं च तत्तच्चासृक्प्रदूषणम् । भजतां विधिहीनं च स्वप्नजागरमैथुनम् ॥ १ ॥
प्रायेण सुकुमाराणामचङ्क्रमणशीलिनाम् । अभिघातादशुद्धेश्च नृणामसृजि दूषिते ॥ २ ॥
वातलैः शीतलैर्वायुर्वृद्धः क्रुद्धो विमार्गगः | ताद्दशैवासृजा रुद्धः प्राक्तदेव प्रदूषयेत् ॥ ३ ॥
आढ्यरोगं खुडं वातबलासं वातशोणितम् । तदाहुर्नामभिः तच्च पूर्वं पादौ प्रधावति ॥ ४ ॥ विशेषाद्यानयानाद्यैः प्रलम्बौ
taking of foods which causes burning sensation during digestion, which are incompatable; which cause vitiation of blood, indulgence in sleep, keeping awake without sleep and sexual intercourse in improper ways, trauma, not resorting to purificatory therapies and, exposure to cold breeze; these bring about vitiation of both vata and sonita (blood). Vata getting aggravated moving in wrong directions being obstructed (in its normal direction) by the aggravated blood, vitiates it (the blood) first and gives rise to the disease called by names such as adhyaroga, khuda, vatabalasa and vatasonita (vatarakta) – usually in persons of tender construction and who are not habituated to walking, it first affects the legs especially of those who keep them hanging when riding on animals etc. 1-5a.
Vatarakta Purva rupa – premonitory symptoms of gout
तस्य लक्षणम् । भविष्यतः कुष्ठसमं तथा सादः श्लथाङ्गता ॥ ५ ॥
जानुजङ्घोरुकट्यंसहस्तपादाङ्गसन्धिषु कण्डूस्फुरणनिस्तोदभेदगौरवसुप्तताः । ॥६॥
भूत्वा भूत्वा प्रणश्यन्ति मुहुराविर्भवन्ति च ।
Its premonitory symptoms are similar to those of kustha (leprosy) and also, debility, looseness of the body, itching, throbbing, intermittent and splitting types of pain in the bony joints of the forelegs, calves, thigh, waist, shoulders, hands, feet and other joints of the body; feeling of heavyness, loss of tactile sensation – these appearing and disappearing often and on. 5b-7a.
Vatarakta Rupa – clinical features of gout
पादयोर्मूलमास्थाय कदाचिद्धस्तयोरपि ॥७॥
आखोरिव विषं क्रुद्धं कृत्स्नं देहं विधावति । त्वड्मांसाश्रयमुत्तानं तत्पूर्वं जायते ततः ॥ ८ ॥
कालान्तरेण गम्भीरं सर्वान् धातूनभिद्रवत् । कण्डादिसंयुतोत्ताने त्वक्ताम्रा श्यावलोहिता ॥ ९ ॥
सायामा भृशदाहोषा गम्भीरेऽधिकपूर्वरुक् । श्वयथुर्ग्रथितः पाकी वायुः सन्ध्यस्थिमज्जसु ॥ १० ॥
छिन्दन्निव चरत्यन्तर्वक्रीकुर्वंश्च वेगवान् । करोति खचं पङ्कं वा शरीरे सर्वतश्चरन् ॥ ११ ॥
It makes its root (site of onset) in the feet or sometimes in the hands also, then spreads to the entire body like the poison of rat bite, (slowly and steadily over long periods of time).
Residing in the skin and muscles, it starts first as uttana type and then, in course of time, it becomes gambhira type, spreading to all the tissues. In the uttana type, the skin has itching etc. (different kinds of pain) colours such as coppery, black or red, stretchin, severe burning sensation and heat. In the gambhira type, swelling, appears preceded by severe pain, is hard and having ulcers; vata moving with great spread in the joints, bones and marrow produces cutting pain and curvatures (of bones and joints) and then moving all over the body makes the person lame by one leg or by both the legs. 7b-11.
वातेऽधिकेऽधिकं तत्र शूलस्फुरणतोदनम् । शोफस्य रौक्ष्यकृष्णत्वश्यावतावृद्धिहानयः ॥ १२॥
धमन्यङ्गुलिसन्धीनां सङ्कोचोऽङ्गग्रहोऽतिरुक् । शीतद्वेषानुपशयौ स्तम्भवेपथुसुप्तयः ॥ १३ ॥
रक्ते शोफोऽतिरुक्तोदस्ताम्रश्चिमिचिमायते । स्त्रिग्धरूक्षैः शमं नैति कण्ड्रक्लेदसमन्वितः ॥ १४ ॥
पित्ते विदाहः सम्मोहः स्वेदो मूर्च्छा मदः सतृट् । स्पर्शाक्षमत्वं रुग्रागः शोफः पाको भृशोष्मता ॥ १५ ॥
कफे स्तैमित्यगुरुतासुप्तिस्निग्धत्वशीतताः । कण्डूर्मन्दा च रुक् द्वन्द्वसर्वलिङ्गं च सङ्करे ॥ १६ ॥
If vata is predominant, there is more of pain, throbbing and pricking, swelling is dry, black or blue, increasing and decreasing (at periods of time related to vata) costriction of the dhamanis ( arteries, tendons) of the joints of the fingers (or toes),catching pain in the body, severe pain (in the joints etc.), hatredness towards cold which leads to discomfort, stiffness, shivering (tremors) and loss of tactile sensation.
If rakta (blood) is predominat, there is swelling with severe pain, pricking, coppery colour, tingling sensation, not subsiding with the application of either unctuous or dry things, accompanied with itching exudation.
If pitta is predominant, there is burning sensation in the body, delusion, perspiration, fainting, toxicity, thirst, inability to bear the touch (tenderness ), pain, redness, swelling, ulceration and great heat.
If kapha is predominant, there is inactivity, heavyness, loss of tactile sensation, unctuousness and cold ( of the skin), mild itching and pain.
In case of two or all the dosas being predominant the related symptoms will be present simultaneously. 11 A.H.II 12-16.
Sadhyasadhayata – prognosis of gout
एकदोषानुगं साध्यं नवं, याप्यं द्विदोषजम् । त्रिदोषजं त्यजेत्स्त्रावि स्तब्धमर्बुदकारि च ॥१७॥
That arising from any one dosa and of recent onset is curable; that arising from two dosas is controllable but presisting; that arising from the three dosas, which is exudative, static (immovable) and that leading to arbuda ( malignant nodules/ trophies) are to be rejected.
Avarana vata nidanam
रक्तमार्गं निहत्याशु शाखासन्धिषु मारुतः । निविश्यान्योन्यमावार्य वेदनाभिर्हरत्यसून् ॥ १८ ॥
Maruta (vata) spreading quickly into the channels of the blood in the joints of the extremities, get enveloped (impounded, prevented from functioning normally) by one another, produce different kinds of pain and takes away the life. 18.
वायौ पञ्चात्मके प्राणो रौक्ष्यव्यायामलङ्घनैः । अत्याहाराभिघाताध्ववेगोदीरणधारणैः कुपितश्चक्षुरादीनामुपघातं ॥१प्रवर्तयेत् ।९॥
पीनसार्दिततृट्कासश्वासादींश्चामयान्बहून् ॥ २० ॥
Among the divisions of vata, the prana division getting aggravated by dryness (absence of fat), too much of exercise fasting, consuming large quality of food, trauma, long distance walk, and premature initiation or suppression of the urges of the body, produces disorders of the eyes etc. (sense organs), nasal catarrh, facial palsy, thirst, cough, dyspnoea and many other diseases. 19-20.
उदान: क्षवथूगारच्छर्दिनिद्राविधारणैः । गुरुभारातिरुदितहास्याद्यैर्विकृतो कण्ठरोधमनोभ्रंशच्छर्द्यरोचकपीनसान् गदान् ॥ २१ ॥
कुर्याच्च गलगण्डादींस्तांस्तान् जत्रूर्ध्वसंश्रयान् ॥ २२ ॥
Udana vata getting aggravated by suppression of sneezing, belching, vomitting and sleep, carrying heavy load on the head, excess indulgence in weeping, laughing etc., produces obstruction of the throat, disorders of the mind, vomitting loss of taste / appetite, nasal catarrh, enlargement of glands of the neck and other diseases of organs above the 21-22. shoulders.
व्यानोऽतिगमनध्यानक्रीडाविषमचेष्टितैः विरोधिरूक्षभीहर्षविषादाद्यैश्च । दूषितः ॥ २३ ॥
पुंस्त्वोत्साहबलभ्रंशशोफचित्तोत्प्लवज्वरान् । सर्वाङ्गरोगनिस्तोदरोमहर्षाङ्गसुप्तताः कुष्ठं विसर्पमन्यांश्च कुर्यात्सर्वाङ्गगान् गदान् । ॥ २४॥
Vyana vata getting aggravated by excess of walking or sexual intercourse, worry, exercise improper activities, intake of food which are in compatable and dry ( fatless); fear, joy, sorrow etc. produces diminition of masculine power, enthusi asm and strength, swelling (of the body), disorders of the mind, fever, paralysis of the whole body, intermittant pain, horripilation, loss of tactile sensation, kustha (leprosy and other skin diseases), visarpa, ( herpes) and other diseases affecting the whole body. 23-25a.
समानो विषमाजीर्णशीतसङ्कीर्णभोजनैः ॥ २५ ॥
करोत्यकालशयनजागराद्यैश्च दूषितः । शूलगुल्मग्रहण्यादीन् पक्कामाशयजान् गदान् ॥ २६ ॥
Samana vata getting aggravated by improper foods, uncooked foods, ( or foods causing indigestion ), cold and mixed (of healthy and unhealthy), sleeping or keeping awake at improper time etc. gives rise to abdominal pain, tumors of the abdomen, diseases of the duodenum and other diseases arising in the intestine and stomach (alimentary tract).
अपानो रूक्षगुर्वन्नवेगाघातातिवाहनैः ।
यानयानासनस्थानचङ्क्रमैश्चातिसेवितैः कुपितः कुरुते रोगान् कृच्छ्रान् पक्वाशयाश्रयान्। मूत्रशुक्रप्रदोषार्शोगुदभ्रंशादिकान् ॥२७॥ बहून् ॥ २८ ॥
Apana vata getting aggravated by indigestion of dry and heavy foods, suppression of the urges or too much of their premature initiation, excess indulgence in riding on animals, vehicles, sitting and walking gives rise to many difficult diseases of the large intestines, disorders of urine and semenpiles, prolapse of the rectum etc. 27-28
सर्वं च मारुतं सामं तन्द्रास्तैमित्यगौरवैः । स्निग्धत्वारोचकालस्यशैत्यशोफाग्निहानिभिः ॥ २९ ॥
कटुरूक्षाभिलाषेण तद्विधोपशयेन च। युक्तं विद्यान्निरामं तु तन्द्रादीनां विपर्ययात् ॥ ३० ॥
Maruta (vata) which is Sama ( associated with ama ) should be recognised by the presence of stupor, inactiveness, feeling of heavyness, and unctuousness (of the body), loss of digestion power, loss of taste / appetite, lassitude, cold, swelling, desire for things of pungent dry and deriving comfort from such things. Nirama state ( not associated with undigested material) of vata should be recognised by ( the presence of) symptoms opposite of stupor etc. 29-30.
वायोरावरणं चातो बहुभेदं प्रवक्ष्यते ।
Next, shall be described the various kinds of avarana (covering/obstruction ) to vayu (vata). 31a.
Anya dosavarana – obstruction by the other dosas
लिङ्गं पित्तावृत्ते दाहस्तृष्णा शूलं भ्रमस्तमः ॥ ३१ ॥ कटुकोष्णाम्ललवणैर्विदाहः शीतकामता ।
Symptoms when it is covered (obstructed in its functioning) by pitta are-burning sensation, thirst, pain, dizziness, blindness, (momentary), burning sensation inside the alimentary canal by foods which are pungent, hot ( heat producing), sour, salt, and desire for cold things. 31b-32a.
शैत्यगौरवशूलानि कट्वाद्युपशयोऽधिकम् ॥ ३२ ॥ लङ्घनायासरूक्षोष्णकामता च कफावृते ।
Cold, feeling of heavyness, pain, finding great comfort by foods which are pungent etc. ( hot, sour and salt) desire for fasting, exertion ( exercise), foods which are dry (moisture free, fat free) and hot (heat producing) are the symptoms when obstructed by kapha. 32b-33a.
Dhatu avarana – obstruction by tissues
रक्तावृत्ते सदाहाऽर्तिस्त्वङ्मांसान्तरजा भृशम् ॥ ३३ ॥ भवेच्च रागी श्वयथुर्जायन्ते मण्डलानि च ।
When obstructed by blood, there is burning sensation, severe pain inside the skin and muscles, appearance of red swelling and red patch on the skin. 33b-34a.
मांसेन कठिनः शोफो विवर्ण: पिटिकास्तथा ॥ ३४ ॥ हर्षः पिपीलिकानां च सञ्चार इव जायते ।
When obstructed by muscle, there is hard swelling and eruptions of various colours, horripilations and feeling of ants crawling on the body. 34b-35a.
चलः स्निग्धो मृदुः शीतः शोफो गात्रेष्वरोचकः ॥ ३५ ॥ आढ्यवात इति ज्ञेयः स कृच्छ्रो मेदसाऽऽवृते ।
Swelling on the body which is movable, unctuous, soft and cold, loss of taste/appetite are the symptoms when covered by fat. This condition is known as Adhyavata and is difficult to cure. 35b-36a.
स्पर्शमस्थ्यावृतेऽत्युष्णं पीडनं चाभिनन्दति ॥ ३६ ॥ सूच्येव तुद्यतेऽत्यर्थमङ्गं सीदति शूल्यते ।
When obstructed by bone tissue, the body is very hot to touch, finds comfort by squeezing (massaging, pressing), feels as though being pricked by needles severely, weak and painful. 36b-37a.
मज्जावृते विनमनं जृम्भणं परिवेष्टनम् ॥ ३७॥ शूलं च पीड्यमानेन पाणिभ्यां लभते सुखम् ।
When obstructed by the marrow, there is bending of the body parts, more of yawning (feeling of ) encircling the body (by rope, cloth etc. ) and pain, which subsides by pressing with the hands. 37b-38a.
शुक्रावृतेऽतिवेगो वा न वा निष्फलताऽपि वा ॥ ३८ ॥
When obstructed by the semen, the ejaculation (of se men) occurs with great force or not at all, or it may become fruitless (not producing the embryo). 38b.
भुक्ते कुक्षौ रुजा जीर्ण शाम्यत्यन्नावृतेऽनिले ।
When anila (vata ) is obstructed by the food, there is pain in the abdomen soon after consuming food, subsiding after digestion. 39a.
मूत्राप्रवृत्तिराध्मानं बस्तेर्मूत्रावृते भवेत् ॥ ३९ ॥
विडावृते विबन्धोऽधः स्वस्थाने परिकृन्तति । व्रजत्याशु जरां स्नेहो भुक्ते चानह्यते नरः ॥ ४० ॥
शकृत्पीडितमन्नेन दुःखं शुष्कं चिरात्सृजेत् ।
When obstructed by the urine, there is no elimination of urine, but distention of the urinary bladder; when obstructed by the faeces there is obstruction down below (constipation) and so faeces there is obstruction down below (constipation) and so causes cutting pain in its own place (in the large intestine and rectum), fat (administered by mouth as part of oleation therapy) gets digested quickly, the person develops flatulence by partaking food, the faeces thus troubled by food, is expelled with difficulty in dry condition (scabellous) and after long periods. 39b-41a.
सर्वधात्वावृते वायौ श्रोणिवड्ङ्क्षणपृष्ठरुक् ॥ ४१ ॥
विलोमो मारुतोऽस्वस्थं हृदयं पीड्यतेऽति च ।
When vata is obstructed by all the tissues, there is pain in the pelvis, groins and back; it gins to move in wrong directions, causes illhealth and severe pain in the heart.
भ्रमो मूर्च्छा रुजा दाहः पित्तेन प्राण आवृते ॥ ४२ ॥
विदग्धेऽन्ने च वमनम् उदानेऽपि भ्रमादयः । दाहोऽन्तरूर्जाभ्रंशश्च दाहो व्याने च सर्वगः ॥ ४३ ॥
क्लमोऽङ्गचेष्टासङ्गश्च ससन्तापः सवेदनः । समान ऊष्मोपहतिरतिस्वेदोऽरतिः सतृट् ॥ ४४ ॥
दाहश्च स्यात् अपाने तु मले हारिद्रवर्णता । रजोतिवृत्तिस्तापश्च योनिमेहनपायुषु ॥ ४५ ॥
When prana (division of vata) is obstructed by pitta there is dizziness, fainting, pain, burning sensation and vomitting when the food is undergoing digestion; similarly; dizziness etc. appear. When udana vata is obstructed (by pitta) in addition to burning sensation internally, and loss of strength. When vyana vata (is obstructed by pitta) there is burning sensation everywhere, exhaustion, hinderance to movement of the body parts, associated with tiredness and pain; when samana vata is obstructed (by pitta) there is disturbances of body temperature, profuse perspiration, restlessness, thirst and burning sensation. When apana vata is obstructed (by pitta) there is yellow colour of the faeces (and also urine) more of menstrual bleeding (in women) or discomfort by increased temperature in the vagina, penis and 42b-45. rectum.
श्लेष्मणा त्वावृते प्राणे सादस्तन्द्राऽरुचिर्वमिः । क्षवथूद्गारनिःश्वासोच्छ्वाससङ्ग्रहः ॥ ४६ ॥
उदाने गुरुगात्रत्वमरुचिर्वाक्स्वरग्रहः । बलवर्णप्रणाशश्च व्याने पर्वास्थिवाग्ग्रहः ॥ ४७ ॥
गुरुताऽङ्गेषु सर्वषु स्खलितं च गतौ भृशम् । समानेऽतिहिमाङ्गत्वमस्वेदो मन्दवह्निता ॥ ४८ ॥
अपाने सकफं मूत्रशकृतः स्यात्प्रवर्तनम् ।
When prana is obstructed by slesma (kapha) there is debility, stupor, loss of taste/appetite, vomitting, expectoration of sputum, more of sneezing and belching, obstruction to inspiration and expiration. When udana is obstructed by kapha there is feeling of heavyness of the body, loss of taste/appetite, hinderence to speak and of voice and loss of strength and colour/complexion. When vyana is obstructed, there is catching pain in the joints, bones and of speaking, heavyness of all the parts of the body, and great impairement in walking (gait). When samana is obstructed, there is profound coldness of the body, absence of sweating and weakness of digestive activity. When apana is obstructed by kapha, there is elimination of urine and faeces mixed with kapha. 46-49a.
इति द्वाविंशतिविधं वायोरावरणं विदुः ॥ ४९ ।।
Thus, these are the twenty two kinds of avarana of vata, known (to the ancient authorites). 49b.
प्राणादयस्तथाऽन्योन्यमावृण्वन्ति यथाक्रमम् ।
सर्वेऽपि विंशतिविधं विद्यादावरणं च तत् ॥ ५० ॥
Prana and others (divisions of vata) get obstructed by themselves mutually, and in respective order, or all together; they are known to be of twenty kinds. 50.
निःश्वासोच्छ्वाससंरोधः प्रतिश्यायः शिरोग्रहः। हृद्रोगो मुखशोषश्च प्राणेनोदान आवृते ॥ ५१ ॥
उदानेनावृते प्राणे वर्णोजोबलसङ्क्षयः । दिशाऽनया व विभजेत्सर्वमावरणं भिषक् ॥ ५२ ॥
स्थानान्यवेक्ष्य वातानां वृद्धिं हानि च कर्मणाम् ।
Hinderance to inspiration and expiration, nasal catarrh, catching pain in the head, disease (pain) of the heart, and dryness of the mouth appears when udana is obstructed by prana. When prana is obstructed by udana there is loss of colour/complexion, enthusiasm and strength.
In this manner, the physician should classify all other kinds of avarana of vata by noting the places and the increase and decrease of the functions. 51-53a.
प्राणादीनां च पञ्चानां मिश्रमावरणं मिथः ॥ ५३ ॥
पित्तादिभिर्द्वादशभिर्मिश्राणां मिश्रितैश्च तैः । मिश्रैः पित्तादिभिस्तद्वन्मिश्रणाभिरनेकधा ॥ ५४ ॥
तारतम्यविकल्पाच्च यात्यावृतिरसङ्ख्यताम्। तां लक्षयेदवहितो यथास्वं लक्षणोदयात् ॥ ५५ ॥
शनैः शनैश्चोपशयाद्गूढामपि मुहुर्मुहुः ।
The avarana of the prana and other five divisions of vata, mixed along with the twelve kinds by pitta etc, mixed with each other and seperately ( become innumerable); similarly so when mixed with pitta etc. it becomes many and with more and most (premutations of combinations) it becomes innumerable; these should be recognised intently (repeatedly, of ten) by noting the onset of symptoms and even those symptoms which are not well manifest by diagnostic tests which give comfort to the patient. 53b-56a.
विशेषाज्जीवितं प्राण उदानो बलमुच्यते ॥ ५६ ॥ स्यात्तयोः पीडनाद्धानिरायुषश्च बलस्य च ।
Prana vata is chiefly responsible, especially for ( existence) of life and udana is spoken of as responsible for strength. Hence, their disorder causes loss of life and strength respectively. 56b-57a.
आवृता वायवोऽज्ञाता वा वत्सरं स्थिताः ॥ ५७॥ प्रयत्नेनापि दुःसाध्या भवेयुर्वाऽनुपक्रमाः । विद्रधिप्लीहहृद्रोगगुल्माग्निसदनादयः ।। ५८ ॥ भवन्त्युपद्रवास्तेषामावृतानामुपेक्षणात् ॥ ५८ ॥
Avarana of vata which are not known and those known and which have persisted for more than a year, are either difficult to cure or impossible to treat, in spite of all efforts.
By neglecting the ( different kinds of ) avarana ( of vata) complications/secondary diseases arise such as abscesses, enlargement of spleen, heart disease, abdominal tumors, weak digestion etc.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थाने वातशोणितनिदानं नाम
षोडशोऽध्यायः ॥ १६ ॥
Thus ends the chapter-Vatasonita nidana-the sixteenth in of Astangahrdaya samhita, composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
( समाप्तं चेदं तृतीयं निदानस्थानम्) Thus ends nidana sthana-the third section.