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Understanding Gout (Vatarakta)

Dr. Vikram Dev Singh

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Diagnosis
Diagnosis is established by: -

1. Demonstration of needle shaped urate crystals in synovial fluid with greatly elevated neutrophils under polarized light;

2. Raised serum uric acid;

3. Raised ESR; and

4. Radiographs – May be normal in early stage of the disease but may show soft tissue swelling with patchy calcification, punched out erosions and secondary degenerative changes.

Ayurvedic Approach
Except few examples, in majority of cases there is no one to one compare of an ayurvedic disease with a modern disease. Likewise Vatarakta in total, as described in different ancient ayurvedic texts, covers signs, symptoms and pathology of gout, cellulitis, SLE, polyarteritis nodosa, peripheral vascular disorders, psoriatic arthritis and arthritis due to metabolic disturbances.

According to Sushruta, in Vatarakta both Vata and Rakta get aggravated following their own respective etiological factors and start circulating in the body. After some time the localization takes place in the big toe of the foot (Padyormulam) or seldom in the thumb of the hand (Kadachiddhastyorapi). Afterwards the disease spreads all over the body like a virulent rat poison. These features bear a resemblance to gout to a great extent. The existence of local erosion of the skin or any other dermatose also resembles the desquamation of the skin, as mentioned in modern medicine, in case of untreated gout.

In superficial stage (Uttanavastha) of Vatarakta, causative doshas (pathogeny) are located in Tvak and Mamsa (Skin & superficial muscles) manifesting with deep brownish red or coppery overlying skin, itching, burning and piercing pain. While deeper or severe form (Gambhiravastha) further vitiates deeper tissues exhibiting swelling with stiffness and rigidity, inflammatory changes, distress, severe pain and pulsations in the affected parts. The symptoms are more prominent in bones, nerves and muscles.

Management
Since the disease spreads through vitiated Rakta, raktamokshana (Blood letting) is the treatment of choice. Depending upon the site and stage of the disease and taking into consideration the strength of the patient, after appropriate oleation (Snehana) of the patient, so as to pacify Vata, one can carry out raktamokshana by venesection or by applying leeches. Blood letting should be done in smaller installments as profuse blood loss may severely aggravate Vata which may prove fatal.

Specific Formulations
Amrita guggulu, Kaishor Guggulu, Triphala guggulu, Gokshuradi guggulu, Panchamrita rasa, Arogyavardhini vati, Tala sindura, Mahatarakeshwara rasa, Vishveshwara rasa, Vataraktantaka rasa, Mahamanjishthadi kwatha, sarivadyasava, Vasa kwatha, etc.

Dos & Don’ts
1. Person suffering from gout should drink 8-10 glasses of water a day. Being overweight increases your risk for gout hence it is advised to control your weight. A diet that is low in fat may help lose weight. But avoid fasting or very low-calorie diets as very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack.

2. Limit meat and seafood. Diets high in meat and seafood (high-purine foods) can raise uric acid levels. It is recommended for the person wanting to heal from gout to be on a totally vegetarian diet. This meatless diet will help clean out the colon and reduce toxic buildup in the muscles.

3. Foods high in certain fatty acids (such as omega 3), for example, olive oil, flax oil, and certain nuts should be consumed. These fatty acids contain important anti-inflammatory properties that help to ease inflammation in the joints.

4. Limit alcohol, especially beer. Alcohol can reduce the release of uric acid by the kidneys into urine, causing an increase of uric acid in your body. Beer being rich in purines appears to be worse than some other beverages that contain alcohol.

5. A person with gout should exercise for at least 30 minutes daily. Stretching exercises can loosen up the muscles. But strenuous exercises must be avoided.

6. A patient suffering from Gout must not take cold baths. Avoid getting exposed to rain or cold wind.

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