Charaka Samhita Vatarakta Chikitsa 29th Chapter

29th chapter of Charaka Sanhita Chikitsa Sthana deals with causes, types and treatment for Vatarakta, a condition, often correlated with Gout.

We shall now expound the chapter on “the treatment of Vata Shonita. Thus, said Lord Atreya. [1-2]

Agnivesha’s Query and Atreya’s Reply

While the preceptor Atreya Punarvasu, glowing like fire, was seated in an attentive mood surrounded by saints after completing his Agnihotra (ritual of offering oblation to fire), Agnivesha requested him to explain the etiology, symptoms and treatment of the ailment caused by the simultaneous aggravation of both Vata and Rakta (blood) which is like the combination of the wind and fire. The Guru answered as below:[3-4]

Vatarakta Nidana, Samprapti

Causes and pathophysiology of Vatarakta:
Generally people of tender health who indulge in sweet food, leisurely eating and sedentary habits get afflicted by Vatarakta because of the following:
lavanamla katu kshra snigdhoshna bhojanaihi – Excessive intake of salt, sour, pungent, alkaline, unctuous, hot and uncooked food.
Intake of putrified or dry meat of aquatic (Ambuja)or marshy land (Anupa) inhabiting animals
kulattha masha nishpva kandipalalekshubhi – Excessive intake of oil-cake preparation or radish, excessive intake of Kulattha – horse gram, black gram, Nishpava, Leafy vegetables, etc. meat and sugarcane
dadhyranla sauvra ukta takra sursavai – Excessive intake of curd, Aranala(Kanji), Sauvira (sour preparation of dehusked barley), Sukta (vinegar), Buttermilk, alcohol and wine,
Virudhha ahara – Intake of mutually contradictory food.
Adhyashana – Intake of food before the previous meal is digested
Ati Krodha – Resorting to anger in excess
Divasvapna – Sleeping during day time and
Prajagara – remaining awake at night.
In a person whose blood is vitiated by the above mentioned causative factors of Vatarakta (gout), gets aggravated because of the following:
Abhighata ( injury)
Ashuddhi (skipping seasonal Panchakarma therapies)
Intake of less of food or abstinence from food
Riding over horses, camels or on vehicles drawn by them
plavana laghanai – Resorting to aquatic games, swimming and jumping
Excessive wayfaring in hot season, which disturbs the equilibrium of Vata
Ati maithuna – Indulgence in sexual intercourse and
Vega nigrahat – Suppression of the manifested natural urges.
Because of the above factors, Vata gets aggravated. Being obstructed in its course by the vitiated blood, the excessively aggravated Vata vitiates the entire blood. The disease thus, caused is called Vata-Rakta (gout).
It is also known by the synonyms like Kuddha, Vata Balasa and Adya Vata. [5-11]

Parts affected

Parts of Body Affected By Vatarakta:
The sites where Vatarakta is manifested are –
hands, feet, fingers including toes and all joints. In the beginning, the hands and feet are afflicted. From this base, it spreads to all other body parts because of the subtle (Sookshma) pervasive nature of Vata and Rakta.
Because of their fluidity (Dravatvaat) and mobility (Saratvaat), they (Vata and Rakta), while moving through the vessels; get obstructed in the joints which makes them further aggravated. Because of the tourtous nature of the course in the joints, the morbid matter gets lodged there.
Being localized in joints, they get further associated with Pitta, etc., (i.e Kapha and Vata Dosha aggravated associated with Pitta and Kapha, the disease produces different types of pain characterized by nature of these elements. Therefore, in general, the disease gives rise to pain in all these joints. These different types of pain become excessively unbearable for the patients.[12-15]

Purvaroopa

Vatarakta Poorvaroopa: Premonitory Signs and Symptoms:
Svedo atyartham na va – Excess or absence of perspiration.
Karshnyam – Black coloration of the joints
Sparsha ajnatvam – Insensibility to touch, and
Kshate ati ruk – excessive pain if there is injury to the afflicted part
Sandhi shaithilya – fragile joints
Aalasyam – indolence and
Sadanam – asthenia
Pidaka udgamah – Appearance of pimples
Janu jangha uru kati amsha hasta pada anga sandhi nistoda – Pricking pain, twitching sensation, splitting pain, heaviness and numbness in the knees, calf, thighs, umbilical region, shoulders, hands, feet and joints in the body.
Kandu – Itching
Sandhi shu ruk bhutva nashyati – Frequently, the pain while be appearing in the joints disappears[suddenly] and
Vaivarnyam – Discoloration of the skin and
Mandala utpatti – Appearance of circular patches over the body. [16-18]

Types

Types of Vatarakta:
Vatarakta is of 2 types:
Uthana Vatarakta (superficial) – located in the skin as well as muscle tissues and
Gambheera Vatarakta (deep seated) – located in deeper tissues

Uttana Vatarakta

Uttana Vatarakta Lakshana:
The superficial or external (Uthana or Bahya) varieties of Vatarakta gives rise to the following signs and symptoms:
Kandu – Itching
Daha – burning sensation
Ruk – ache
Aayama – extension
Toda – pricking pain
Sphurana – throbbing sensation and
Aakunchana – contraction and
Shyava rakta tvak – The skin becomes brownish black, red or coppery in color

Gambhira Vatarakta

Signs and Symptom of Gambhira Vatarakta:
The deep seated (gambhira) Vatarakta gives rise following signs and symptoms:
Shvayathu – Oedema
Stabdha – stiffness
Kathina – hardness and
Antar bhrusha arti – excruciating pain in the interior of the body
Shyava tamra tvak – Blackish brown or coppery coloration [of the skin] and
Daha – Burning sensation
Toda – pricking pain
Sphurana – twitching sensation and
Pakavan – suppuration of the joints.

If Vatarakta is located both in (Uthana) and interior (gambhira) of the body, then the following signs and symptoms are manifested:
Aggravated Vata while causing pain and burning sensation constantly, moves with high speed through the joints, bones and bone marrow as if cutting them to make the joints curved inwards
While moving all over the body, this aggravated Vata Dosha makes the person lame and paraplegic and all the signs and symptoms described above (in respect of Uthana and Gambhira types of Vatarakta) are manifested. [20-23]

Classification of Vatarakta:
Now listen to the signs and symptoms of Vatarakta classified on the basis of the following:
Vataja, Pittaja, Kaphaja and Raktaja.
Caused by the predominace of 2 or 3 or all of the above mentioned factors. [24]

Vataja Vatarakta

dhamanyaguli sandhn sakoco’gagraho’tiruk
kuñcana stambhane ta pradveacnile’dhike26

Symptoms of Vatarakta by aggravated Vata Dosha
Sira aayama – Dilatation of veins
Shula – Colic pain
Sphurana – throbbing pain and
Todanam – pricking pain
Karshnyam raukshyam shyavata sotha – Blackness, dryness and brownish coloration of oedema
Vriddhi haanayah sotha – Increase and decrease of the oedema
Dhamani anguli sandhinam sankocha – Contraction of vessels, fingers(including toes) and joints
Anga graha – Stiffness of the limbs
Ati ruk – Excessive pain
Sandhi kunchana stambhana – Contractures and stiffness [of joints] and
Shita pradvesha – Disliking for cold things [25-26]

Raktaja Vatarakta

Vatarakta dominated by vitiated blood is characterized by:
Shyvathu – Oedema,
Bhrsha ruk – excessive pain and
Toda – pricking pain
Tamra tvak – Coppery coloration of the skin
Chimchimayana – Tingling sensation
Snigdha ruksha shamam – Not yielding to therapies which are either unctuous or ununctuous and
Kandu – Itching and
Kleda – sloughing. [27]

Pittaja Vatarakta

Vatarakta dominated by increased Pitta causes:
Vidaha – Burning sensation
Vedana – pain
Murccha – fainting
Sweda – sweating
Trishna – morbid thirst
Mada – intoxication and
Bhrama – dizziness
Raga – Redness
Paka – suppuration and burning open of the afflicted joints and
Shosha – Emaciation of the afflicted limb [28]

Kaphaja Vatarakta

Vatarakta dominated by Kapha is characterized by the following signs and symptoms in special:
Staimitya – Indolence
Gaurava – heaviness
Sneha – unctuousness
Supti – numbness and
Manda ruk – Less of pain

Signs and symptoms of Vatarakta Dominated by 2 or 3 Doshas
Vatarakta dominated by 2 or 3 of the aggravated Doshas is characterized by the etiological factors as well as signs of 2 3 Doshas together as described above. [26 ½]

Prognosis, complications

Upashaya – Prognosis:
If Vatarakta is caused by:
Only 1 Dosha, and if it is of recent origin, then it is curable.
The combination of 2 Doshas, then it is only Palliable.
All the 3 Doshas (including the 4th one i.e Rakta vide commentary above), then it is incurable.
If the curable varieties are attended with complications (to be described hereafter), then they also become incurable. [30]

Vatarakta Upadrava – Complications:
Patients of Vatarakta having complications like these are not to be treated:
Asvapna – sleepless
Arochaka – anorexia
Shvasa – asthma
Mamsa kotha – sloughing of muscles
Shiro graha – stiffness of the head
Murccha – fainting
Mada – Intoxication
Ruk – pain
Trshna – morbid thirst
Jwara – fever
Moha – unconsciousness
Vepana – trembling
Hikka – hiccup
Pangulya – lameness
Visarpa – erysipelas
Paka – suppuration
Toda – pricking pain
Bhrama – giddiness
Klamah – mental fatigue
Anguli vakrata – curvature of fingers and toes
Sphota – pustule eruptions
Daha – burning sensation
Marma graha – affliction of vital parts and
Arbuda upadrava – tumor is not to be treated.
Even association of Moha (unconsciousness) alone as a complication renders the patient of Vatarakta incurable.
If Vata is associated with these symptoms then such patients are treated:
Srava – exudation [from the afflicted joint]
Vivarna – manifestation of opposite color of the skin
Stabdha – stiffness
Arbuda – tumor
Sankocha – contraction and
Indriyatpanam – affliction of the senses
If the ailment is associated with only some of the aforesaid complications, then the patient is palliable, and if there is none of these complications, then the patient is curable. [31-34]

Raktamokshana in Vatarakta

Need for blood-letting treatment in Vatarakta:
The aggravated Vata located in the Shakha (peripheral tissues) and joints cause obstruction to the channels of blood instantaneously. Then the Vata and blood enter into, and cause obstruction of each other giving rise to pain and even death. Therefore, depending upon the Doshas involved and the strength of the patient, blood-letting is done with the help of horn, leech, needle, and gourd or by vensection.

Jalaukavacharana

Indication for Jalauka – leech therapy for blood letting:
Ruk – pain
Daha – burning sensation
Shula – colic pain and
Toda – pricking pain

Shrunga, Pracchanna, Siravyadha

If the pain moves from one part of the body to the other, then blood-letting is by Siravyadha or Pracchana (scratching with rough surface leaves or instruments).
However, blood-letting is not to be done if there is emaciation of the limbs and if there is dryness of the body because of predominance of the aggravated Vata Dosha. Blood-letting is avoided in such cases because as a result of the depletion of blood.
The aggravated Vata gives rise to
Sotha – deep-seated oedema
Stabdhata – stiffness
Kampa – trembling
Snyu sirmay – diseases of the vessels and ligaments
Glani – Asthenia and
Sankocha – Contractures
Excessive blood- letting gives rise to
Pangulya – lameness
Vata vyadhi – diseases of Vata and
Even death
Therefore, it is done in appropriate measure only in persons having unctuousness. [35-40]

Chikitsa Sutra

Vatarakta Samanya Chikitsa Sutra:
Line of treatment in general:
In the beginning, Snehana – oleation therapy is given to the patient suffering from Vatarakta.
Thereafter, he is given
Sneha virechana – purgation therapy with unctuous ingredients (if the patient is slightly unctuous) or Rooksha Virechana – if the patient has excess oiliness.
These purgatives are of mild nature. [Sharp purgative may excessively provoke Vayu for which these are contra indicated for the treatment of patients suffering from Vatarakta].
The patient is given medicated enema therapies (both Niruha and Anuvasana) frequently.
He is given
Seka – affusion
Abhyanga – massage
Pradeha – application of thick ointments
Food and unctuous substance which do not cause burning sensation. [41- ¾ 42]

Specific Treatment:
Hereafter, specific treatment of various types of Vatarakta will be described which may be listened to. [42 ¼]
Specific Treatment of Uthana Vatarakta:
Uthana (superficial) type of Vatarakta (gout) is treated with
Alepana – application of ointments
Abyanga – Massage
Seka – affusion and
Upanaha – application of hot poultice [1/2 43]

Specific Treatment of Gambhira Vatarakta:
Gambhira (deep seated) type of Vatarakta is treated with
Vireka – purgation
Asthapana – a type of medicated enema containing decoction of drugs among others and
Snehapana – intake of unctuous potions. [43 ½]

Specific Treatment of Vatarakta Dominated by Vata:
Vatarakta caused by the predominance of aggravated Vata is treated with potions containing
Sarpi – ghee
Taila – oil
Vasa – muscle fat and
Majja – bone marrow
Abhyanga – massage
Basti – medicated enema and
Sukhoshna upanaha – application of lukewarm Upanaha (poultices). [44]

Specific Treatment of Vatarakta Dominated by Pitta and Rakta:
If Vatarakta is dominated by vitiated Rakta (blood), and aggravated Pitta, then the patient is treated with
Vireka – purgation
Kshirapana – potions containing ghee and milk
Seka – affusion
Basti – medicated enema and
Cooling Nirvapana – application of ointment for the alleviation of burning sensation [45]

Specific Treatment of Kaphaja Vatarakta:
If Vatarakta is dominated by aggravated Kapha, then the patient is treated by emetics.
He is not given Sneha and Seka in excess. He should keep fast, and lukewarm ointment – Lepa is applied over his body. [46]

Specific Management of Vatarakta Dominated by Kapha and Vayu:
If Vatarakta is caused by the dominance of Kapha and Vata, then application of cold poultice will cause Stambhana (astringent action) as a result of which there will be aggravation of
Daha – burning sensation
Sotha – oedema
Ruja – pain and
Kandu – itching sensation [47]

Precaution in treatment of Vatarakta dominated by Rakta and Pitta:
If Vata Rakta is caused by the predominance of vitiated Rakta and aggravated Pitta, then the use of heating therapies may cause
Daha – burning sensation
Kleda – softness of tissues and
Avadarana – bursting of the wounds.
Therefore, the physician should administer appropriate therapies after determining the strength (aggravated nature) of the Doshas. [48]

Prohibitions in Vatarakta

Things to be avoided by the patient suffering from Vata Rakta (gout):
Diva svapna – Sleep during day time
Santapa – exposure to heat
Vyayama – exercise
Maithuna – sexual intercourse and
intake of Katu (pungent), Ushna (hot), Guru (heavy), abhisyandi (ingredients which cause obstruction to the channels of circulation), Lavana (saline) and Amla (sour) ingredients [49]

Pathya

Pathya for Vata Rakta
Wholesome food and drinks for Gout:
Cereals like old barley, wheat, Nivara (a type of wild rice), and shali as Shashtika types of rice.
Soup of the meat of Viskira (Gallinaceous) and Pratuda (Pecker) birds
Soup of Adhaki – Cajanus cajan, Chanaka – Chickpea,
Mudga – Green gram, Masura – Lens esculenta and Makustha – Phaseolus aconitifolius added with ghee in liberal quantity
Leafy vegetables like Sunisannaka, tender branches of Vetra (Salix caprea), Kakamachi – Solanum nigrum, Shatavari – Asparagus racemosus, Vastuka – Chenopodium album, Upodika and Sauvarcala (suryavartta) sizzled with ghee and meat-soup. These are to be given to the making side dishes and Milk of cow, buffalo and goat.
Thus, the treatment of Vatarakta is described in brief. These are to be elaborated hereafter. [50-54]

Shravanyadi Ghrita

Ghee cooked by adding milk – 4 times of ghee and the paste of
Munditika (Sravani)
Ksira Kakoli – Fritillaria roylei
Jivaka – Malaxis acuminata
Rishabhaka – Manilkara hexandra and
Madhuka– Licorice – Glycyrrhiza glabra all taken in equal quantities [in total 1/4th in quantity of ghee] cures Vatarakta (gout). [55]

Bala Ghrita

A paste is prepared of:
Bala – Sida cordifolia
Atibala – Abutilon indicum
Meda – Polygonatum cirrhifolium
Atma Gupta – Mucuna pruriens
Shatavari – Asparagus racemosus
Kakoli – Fritillaria roylei
Ksheera Kakoli – Fritillaria roylei
Rasna (Vanda roxburghi / Pluchea lanceolata) and
Riddhi.
Ghee is cooked by adding milk, 4 times in quantity of ghee, and the aforesaid paste.
This medicated ghee cures
Vatarakta – gout
Hrud roga – heart disease
Pandu – anemia
Visarpa – erysipelas
Kamala – Jaundice and
Jwara – fever. [56-57]

Parushaka Ghrita

Ghee is cooked with the paste of
Trayantika – Thalictrum foliolosum
Tamalaki – Phyllanthus niruri
Kakoli – Fritillaria roylei
Kshira Kakoli – Fritillaria roylei and
Shatavari – Asparagus racemosus and the decoction of
Kaseruka (Scripus grossus) by adding the juice of
Parusaka – Grewia asiatica
Draksha – Raisin – Vitis vinifera
Kashmarya – Gmelina arborea
Sugarcane and
Vidari (Ipomoea paniculata / Pueraria tuberosa), taken in equal quantity, separately, and 4 times of milk.
This medicated ghee is taken regularly (prayogika) which cures
Vatarakta – gout
Kshata kshina – Phthisis
Visarpa – erysipelas and
Paittika jware – Paittika type of fever.
Thus ends the description of Parushaka ghrta [58-60]

Jeevaneeya Ghrita

2 Palas of each of
Bilva – Aegle marmelos
Syonaka – Orchis mascula
Gambhari – Gmelina arborea
Patali – Ficus microcarpa
Ganikarika
Shalaparni – Desmodium gangeticum
Prishniparni – Uraria picta
Brihati – Solanum indicum
Kantakari – Solanum xanthocarpum
Goksura – Tribulus terrestris
Varsabhu (white variety of Punarnava – Boerhavia diffusa)
Eranda – Ricinus communis
Mudga Parni – Phaseolus trilobus
Mahameda – Polygonatum verticillatum
Masha Parni – Teramnus labialis
Shatavari – Asparagus racemosus
Sankha Pushpi – Crotalaria juncea
Avak-Puspi (adhah-Puspi) – Trichodesma indicum
Rasna (Vanda roxburghi / Pluchea lanceolata)
Atibala – Abutilon indicum and
Bala – Country mallow (root) is added with 1 Drona of water and boiled till 1/4th of water remains.
Along with this decoction, equal quantities (1 Adhaka) of each of milk, juice of Dhatri, Sugar-cane juice and soup of the meat of goat is added to 1 Adhaka of ghee, and cooked over mild fire, this 1 Adhaka of ghee is cooked by adding the paste of
Meda – Polygonatum cirrhifolium
Mahameda- Polygonatum verticillatum
fruit of Kasmarya – Gmelina arborea
Utpala – Nymphaea alba
Tvak-Ksiri (Vamsa Locana)
Pippali – Long pepper fruit – Piper longum
Draksha – Raisin – Vitis vinifera
Seeds of lotus
Punarnava – Boerhavia diffusa
Nagara – Zingiber officinale
Kshira Kakoli – Fritillaria roylei
Padmaka – Prunus cerasoides
Brihati – Solanum indicum
Kantakari – Solanum xanthocarpum
Vira(vrddhi)
Srngataka
Bhavya – Dillenia indica
Urumana
Nikochaka – Alangium salviifolium
Kharjura – Phoenix slyvestris
Aksota – Juglans regia
Vatama – Amygdalus commonis
Munjaka and
Abhisuka (Pista)
After it is properly cooked and cooled, honey (1/4th in quantity of ghee) is added. This recipe is kept in a clean pot in a well protected place (free from wind) after performing protective rituals (Raksa Vidhi).
This medicated ghee is taken in the dose of 1 Aksa which cures
Pandu – anemia
Jwara – fever
Hikka – hiccup
Svara bheda – hoarseness of voice
Bhagandara – anal fistula
Parshva shoola – pain in the sides of the chest
Sosha – consumption
Kasa – cough
Pliha – splenic disorders
Vatarakta
Kshata – Phthsis
Karshya – emaciation
Apsmara – epilepsy
stone and sand in different parts of the body,
Paralysis of the whole body or only one part of it, and urinary obstruction.
It is an excellent promoter of strength and complexion. It destroys wrinkles and grey hair. This Jivaniya Ghrta promotes virility, and helps in the fertility of sterile woman. [61-70]

Drakshadi Ghrita

The patient suffering from Vatarakta may take the following recipes containing 4 Types of Fat
Ghee cooked by adding the juice of Draksha – Raisin – Vitis vinifera or the decoction of Madhuka– Licorice – Glycyrrhiza glabra, and added with Sitopala (sugar of big crystals);or
Milk boiled by adding the juice of Guduchi – Tinospora cordifolia, and added with sitopala. [71]

Mahasneha Yoga

Muscle fat as well as bone marrow of animals belonging to the group of dhanva (inhabiting dry land forests or deserts), Pratuda (Pecker birds) and Viskira (gallinaceous birds) whatever are available is collected.
Ghee and oil along with the aforesaid muscle fat and bone marrow is cooked by adding the decoction and paste of
Jivaka – Malaxis acuminata
Rishabhaka – Manilkara hexandra
Meda – Polygonatum cirrhifolium
Rsya Prokta (Atibala – Abutilon indicum)
Shatavari – Asparagus racemosus
Madhuka– Licorice – Glycyrrhiza glabra
Madhu Parni (Vikankata) – Flacourtia ramoutchii
Kakoli – Fritillaria roylei
Kshira Kakoli – Fritillaria roylei
Mudga Parni – Phaseolus trilobus
Masha Parni – Termnus labialis
Bilva – Aegle marmelos
Synonaka – Orchis mascula
Gambhari – Gmelina arborea
Patala – Ficus microcarpa
Ganikarika
Sala Parni
Prishniparni – Uraria picta
Brihati – Solanum indicum
Kantakari – Solanum xanthocarpum
Goksura – Tribulus terrestris
Punarnava – Boerhavia diffusa
Bala – Country mallow (root) – Sida cordifolia
Amrita – Tinospora cordifolia
Vidari (Ipomoea paniculata / Pueraria tuberosa)
Ashwagandha – Winter Cherry / Indian ginseng (root) – Withania somnifera and
Ashmabhedaka by adding milk (4 times in quantity of ghee).
This recipe of medicated fat (containing 4 types of fat) cures Vatarakta pervading the whole body, and other serious diseases caused by the aggravated Vata. [72-75]

Sthiradya Ghrita and Taila

Oil or ghee is cooked by adding the decoction of
Sthira – Desmodium gangeticum
Svadamstra – Tribulus terrestris
Brihati – Solanum indicum
Sariva – Indian Sarsaparilla – Hemidesmus indicus
Shatavari – Asparagus racemosus
Kashmarya – Gmelina arborea
Atmagupta – Mucuna pruriens
Vruscheera
Bala – Country mallow (root) – Sida cordifolia and
Maha bala – Grewia populifolia, and milk (4 times in quantity of ghee or oil) along with the paste of
Meda – Polygonatum cirrhifolium,
Shatavari – Asparagus racemosus
Yashtimadhu – Glycyhrrhiza glabra
Jivanti – Leptadenia reticulata,
Jivaka – Malaxis acuminata and
Rishabhaka
1 dose of this medicated ghee and medicated oil (both taken together according to Chakrapani) is added with 3 times in quantity of milk, and 1 ½ times in quantity of sugar. This recipe is then churned with the help of a Khaja (churning stick or hand with fingers spread out).
Intake of this recipe cures Vatarakta caused by the simultaneous aggravation of all the 3 Doshas. [76-78]

Ksheera Yoga

The patient suffering from Vatarakta is given the following recipes which alleviate Vayu:
taila paya arkar payam – Oil, milk and sugar mixed together
Milk added with ghee, oil, sugar and honey
1 Prastha of milk boiled by adding Amsumati (shala parni), and added with 2 Palas of Sugar
1 Prastha of milk boiled by adding
Pippali – Long pepper fruit – Piper longum, and
Sunthi – Zingiber officinale and added with 2 Palas of Sugar
Milk Boiled by adding
Bala – Country mallow (root) – Sida cordifolia
Shatavari – Asparagus racemosus
Rasna (Vanda roxburghi / Pluchea lanceolata)
Bilva – Aegle marmelos
Syonaka – Orchis mascula
Gambhari – Gmelina arborea
Patala – Ficus microcarpa
Ganikarika
Sala Parni
Prishniparni – Uraria picta
Brihati – Solanum indicum
Kantakari – Solanum xanthocarpum
Goksura – Tribulus terrestris and
Pilu – Salvadora persica and
Milk boiled by adding
Syama – Operculina ipomoea
Eranda – Ricinus communis and
Sthira – Desmodium gangeticum (Sala Parni). [79-81]

Virechana Yogas

The Vatarakta patient is given the following Virechana Yoga:
Milk which is Dharosna (freshly collected and still warm) is added with cow’s urine (in equal quantity), and taken which causes downward movement of morbid matter from the colon.
The powder of Trivrt – Operculina turpethum may also be taken along with Dharosna milk.
Eranda Taila (castor oil) may be taken habitually with milk for the purgation (elimination) of morbid mater. After the digestion of this potion, the patient is given rice with milk to eat
The decoction of Abhaya – Terminalia chebula sizzled with ghee
The powder of Trivrit along with grape juice; as a post-prandial drink, milk is given to the patient
The decoction of these drugs are taken after adding salt and honey for purgation:
Kashmarya – Gmelina arborea
Trivrt – Operculina turpethum
Draksha – Raisin – Vitis vinifera
Haritaki – Terminalia chebula
Vibhitaka – Terminalia bellerica
Amalaki – Phylanthus emblica and
Parusaka – Grewia asiatica
The decoction of these drugs are taken mixed with honey:
Haritaki – Terminalia chebula
Vibhitaki – Terminalia bellerica and
Amalaki – Phyllanthus emblica
Decoction of
Dhatri – Emblica officinalis
Haridra (turmeric – Curcuma longa) and
Musta (Cyperus rotundus)
The above cited 2 recipes (no. 8 & 9) are useful in the treatment of Vatarakta if it is caused by the predominance of Kapha.
The recipes to be described in Kalpa section which are mild is administered after adding fat to the patient suffering from Vatarakta frequently for purgation if Vata is occluded by feces. [82-87]

Basti Yoga

Basti Yoga: Medicated Enema
If in Vatarakta (gout), Vayu is occluded by feces, then the fecal matter is eliminated by Ksheera Basti (a recipe of medicated enema contain milk in large quantity) prepared by adding ghee. There is no therapeutic measure comparable to Basti (medicated enema) for the cure of Vatarakta (gout).
Niruha Basti (Decoction mix enema) along with Anuvasana (oil enema) is useful for pain in the urinary bladder, groin, sides of the chest, thighs, joints, bones and abdomen, and in Udavarta (upward movement of the wind in the abdomen).
For the cure of burning sensation and colic pain, a wise physician should use the medicated oils to be described hereafter, for medicated enema, inhalation, massage and affusion. [88-90]

Madhuparnyadi Taila

1 Tula of Madhu Yasti – Glycyhrrhiza glabra is boiled (by adding 1 drona of water), and reduced to 1/4th. To this (1 Adhaka) decoction, 1 Adhaka of oil and 1 Adhaka of milk is added, and cooked by adding the paste of 1 pala of each of
Shata Puspa – Anethum sowa
Shatavari – Asparagus racemosus
Murva – Marsdenia tenacissima
Payasya – Impomoea paniculata
Aguru – Aquallaria agallocha
Chandana – Santalum album
Sthira – Desmodium gangeticum
Hamsa Padi – Adiantum phillipense
Mamsi – Nordastachys jatamamsi
Meda – Polygonatum cirrhifolium
Mahameda –Polygonatum verticillatium
Madhu Parni – Glycyrrhiza glabra
Kakoli – Fritillaria roylei
Kshira Kakoli – Fritillaria roylei
Tamalaki – Phyllanthus niruri
Riddhi
Padmaka – Prunus cerasoides
Jivaka – Malaxis acuminata
Rishabhaka – Manilkara hexandra
Jivanti – Leptadenia reticulata
Tvak – Cinnamonum zeylanica
Patra – Cinnamomum tamala Nees and Eberum.,
Nakha
Balaka
Prapaundarika (Nymphaea lotus) – red variety
Manjistha – Rubia cordifolia
Sariva – Indian Sarsaparilla – Hemidesmus indicus,
Aindri – Colocynth – Citrullus colocynthis and
Vitunnaka(Dhanyaka) – Coriandrum sativum
Use of this medicated oil in 4 different ways (internal intake, Massage, medicated enema and inhalation) cures Vatarakta accompanied with complications, pain in the limbs and affliction of the whole body.
It also cures diseases caused by
Vata
Rakta (vitiated blood) and
Pitta
Daha – burning sensation
Ruja – pain and
Jvara – fever.
It promotes strength and complexion.
Thus ends the description of Madhuparnyadi Taila [91-95]

Sukumaraka Tailam

100 Palas of Madhuka– Licorice – Glycyrrhiza glabra, 1 Prastha of each of
Draksha – Raisin – Vitis vinifera
Kharjura – Phoenix slyvestris
Parusaka – Grewia asiatica
Madhuka– Licorice – Glycyrrhiza glabra,
Odana Paki (Atibala – Abutilon indicum) and
Munjataka – Orchis latifolia and
1 Adhaka of Kashmarya – Gmelina arborea is boiled remains.
The decoction is filtered.
1 Adhaka of oil is cooked by adding the aforesaid decoction, 4 Adhakas of milk, 1 Adhaka of each juice of the
Amalaki – Emblica officinalis/Phyllanthus emblica
Kashmarya – Gmelina arborea
Vidari (Ipomoea paniculata / Pueraria tuberosa) and sugar-cane, and
The paste of 1 Pala of each of
Kadamba – Anthocephlus indicus
Amalaka – Emblica officinalis/ Phyllanthus emblica
Aksota – Juglans regia
Lotus-seed
Kaseruka – Scripus grossus
Srngataka – Tectona grandis
Srngavera – Zingiber officinale
Lavana
Pippali – Long pepper fruit – Piper longum
Sita – white variety of Cynodon dactylon and
10 drugs belonging to Jivaniya group (Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda, Mahameda – Polygonatum cirrhifolium, Kakoli – Fritillaria roylei, Ksira Kakoli – Fritillaria roylei, Mudga Parni –Phaseolus trilobus, Masha Parni – Teramnus labialis, Jivanti – Leptadenia reticulata and Madhuka– Licorice – Glycyrrhiza glabra).
After the oil is properly cooked, 1 Prastha of honey is added to it.
This medicated oil is used for
Nasya (inhalation)
Abhyanga (massage)
Potion (internal intake) for Manyastambha (torticollis),
Hanu graha – lock-jaw,
Sarvanga vata – Paralysis of the whole body or one part of it,
Kshata kshina – phthisis and
Kshate jware – fever caused by phthisis.
This is called Sukumaraka Taila, and it cures Vatarakta (gout).
This medicated oil promotes
Svara – voice
Varna – complexion
Aarogya – positive health and
Bala – robustness of the body.
Thus, ends the description of Sukumaraka Taila. [96-102]

Amritadya Taila

100 Palas of each of
Guduchi – Tinospora cordifolia
Madhuka– Licorice – Glycyrrhiza glabra,
Shala Parni
Prishniparni – Uraria picta
Brihati – Solanum indicum
Kantakari – Solanum xanthocarpum
Goksura – Tribulus terrestris
Punarnava – Boerhavia diffusa
Rasna (Vanda roxburghi / Pluchea lanceolata)
Root of Eranda – Ricinus communis and
Available drugs belonging to Jivaniya group ( viz., Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Maha medha, Kakoli – Fritillaria roylei, Ksira Kakoli – Fritillaria roylei, Mudga Parni – Phaseolus trilobus, Masha Parni – Teramnus labialis, Jivanti – Leptadenia reticulata and Madhuka—Madhuca longifolia),
500 Palas of Bala – Country mallow (root) – Sida cordifolia
1 Adhaka of each of
Kola – Zizyphus jujuba
Bilva – Aegle marmelos
Yava – Barley (Hordeum vulgare),
Masha – Phaseolus mungo and
Kulattha – horse gram and
1 Drona of well dried fruits of Kasmari – Gmelina arborea is coarsely pounded and washed with water.
This coarse powder is boiled by adding 100 Dronas of water till 4 Dronas of water remain.
1 Drona of oil is cooked by adding the aforesaid decoction, 5 Dronas of milk and the paste of 3 Palas of each of
Chandana – Sandalwood – Santalum album
Ushira – Vetiver – Vetiveria zizanioides
Kesara
Patra – Cinnamomum tamala Nees and Eberum.,
Ela – Elattaria cardamum
Aguru – Aquallaria agallocha
Kushta – Saussurea lappa
Tagara – Valerian walichii and
Yashtimadhu – Glycyrrhiza glabra and
8 Palas of Manjistha – Rubia cordifolia
This medicated oil is used in the form of
Pana – Potion for internal intake
Abhyanga – massage
Nasya – inhalation and
Basti – medicated enema.
It cures
Vatarakta – gout
Kshata kshina – Phthis
Ailments caused by carrying heavy load
seminal deficiency treatment
Vepana – tremors
Aakshepa – convulsions
Bhanga – fractures
Sarvanga vata – Paralysis of the whole body or a part of it
Yoni dosha – Ailments of the female genital organs
Apasmara – epilepsy
Unmada – insanity
Pangu Khanja Lameness of hands and legs, and
Prasava roga – ailments caused during parturition.
This is an excellent recipe of medicated oil and it is called Amritadya Taila.
Thus, ends the description of Amrtadya Taila. [103- 109]

Mahapadma Taila

5 Palas of each of
Padma – Lotus (Nelumbo nucifera),
Vetasa – Salix caprea
Yastimadhu – Glycyhrrhiza glabra
Phenila (upodika) – Sapindus trifoliatus
Padmaka – Prunus cerasoides
Utpala – Nymphaea alba
Darbha – Desmostachya bipinnata
Bala – Sida cordifolia
Chandana (Sandalwood – Santalum album) and
Kimsuka – Butea monosperma is boiled by adding water.
1 Prastha of oil is cooked by adding the aforesaid decoction, 1 Prastha of Sauvira, and the paste of each of
Lodhra – Symplocos racemosa
Kaliyaka – Berberis aristata
Ushira – Vetiver – Vetiveria zizanioides
Jivaka – Malaxis acuminata
Rishabhaka – Manilkara hexandra
Kesara
Madayanti – Lawsonia alba
Lata
Patra – Cinnamomum tamala Nees and Eberum
Padma Kesara
Padmaka – Prunus cerasoides
Prapaundaraika
Kashmarya – Gmelina arborea
Mamsi – Nordastachya jatamamsi
Meda – Polygonatum cirrhifolium
Priyangu – Callicarpa macrophylla and
Kunkuma – Crocus sativus and
1 Pala of Manjistha – Rubia cordifolia.
This is called Mahapadma – taila which cures Vatarakta and fever. Thus ends the description of Mahapadma Taila. [110-113]

Khuddaka Taila

Oil is cooked by adding the decoction of
Padmaka – Prunus cerasoides
Ushira – Vetiver – Vetiveria zizanioides
Yastimadhu – Glycyrrhiza glabra and
Haridra – turmeric – Curcuma longa and the paste of
Sarja – Vateria indica
Manjistha – Rubia cordifolia
Vira – Kshira Kakoli – Fritillaria roylei and
Chandana – Sandalwood – Santalum album
This medicated oil is called Khuddaka Padmaka Taila, and
It cures
Vatarakta and
Daha – burning sensation.
Thus, ends the description of Khuddhaka Padmaka Taila. [114- ½ 115]

Madhuka Taila

100 Palas of Yastimadhu – Glycyrrhiza glabra is boiled by adding 10 times (1000 Palas) of milk (till 1/4th of milk remains). In 4 dronas of oil, the aforesaid medicated milk and 1 Pala of Madhuka – Madhuca longifolia (in paste form) is added and cooked.
Similarly, oil may be cooked by adding the decoction or juice of Madhuka – Madhuca longifolia or Kashmari – Gmelina arborea [and the paste of Madhuka– Licorice – Glycyrrhiza glabra].
These medicated oils cure Vatarakta (gout). [115 ½ – 116]

Satapaka Madhuka Taila

1 Prastha of oil is added with 4 Prasthas of milk, and 1 Pala of the Paste of MadhuParni – Indian tinospora (stem) – Tinospora cordifolia, this medicated oil is again added with 4 times of milk, and the paste of 1 Pala of MadhuParni – Indian tinospora (stem) – Tinospora cordifolia (Yashti Madhu) is repeated for 100 times in total. As a result of this repeated cooking. The paste of 100 Palas of Yastimadhu will be consumed.
This medicated oil cures
Shvasa – asthma and
Kasa – cough in Tridoshaja Vatarakta
Hrud roga – heart diseases
Pandu – anemia
Visarpa – erysipelas
Kamala – jaundice and
Daha – burning sensation.
Thus, ends the description of Satapaka Madhuka -Taila. [117-118]

Sahasrapaka, Shatapaka Bala Taila

Oil is cooked by adding the decoction of bala (4 times in quantity of oil), paste of Bala – Country mallow (root) (1/4th in quantity of oil), and milk (in equal quantity of oil) for the 1000 or 100 times.
This medicated oil cures both the rejuvenation of the body, promotion of clarity of sense perception, longevity, robustness and voice. It cures morbidities in semen and menstruation.
Thus, ends the description of Sahasra Paka bala Taila and Satapaka Bala Taila. [119-120]

Guduchyadi taila

Oil is cooked with the
Juice of Guduchi – Tinospora cordifolia and milk or
With juice of Draksha – Raisin – Vitis vinifera or
With the decoction of Madhuka– Licorice – Glycyrrhiza glabra and
The juice of Kashmari – Gmelina arborea.
These medicated oils cure Vatarakta (gout). [121]

Aranaladi taila

Oil (1 Prastha) is cooked by adding 1 Adhaka of Aranala (sour vinegar) and 1/4th of a Prastha of Sarja (Vateria indica)-Rasa. This medicated oil is then added with liberal quantity of water, and churned.
This is an excellent recipe for the cure of
Jwara – fever
Daha – burning sensation and
Arti – pain. [122]

Pinda Taila

Oil is cooked with the paste of
Madhucchista (bee’s wax),
Manjistha – Rubia cordifolia
Sarja (Vateria indica)-Rasa and
Sariva – Indian Sarsaparilla – Hemidesmus indicus [the paste is 1/4th in quantity of oil], and water which is 4 times of oil in quantity).
Massage of this oil cures pain in Vatarakta (gout).
Thus, ends the description of Pinda taila. [123]

Parisheka

Dashamoola Ksheera for Parisheka:
Milk is boiled by adding Dasha Mula (bilva – Aegle marmelos, Syonaka – Orchis mascula, Gambhari – Gmelina arborea, Patala – Ficus microcarpa, Ganikarika, Sala Parni, Prishniparni – Uraria picta, Brihati – Solanum indicum, Kantakari – Solanum xanthocarpum and Goksura – Tribulus terrestris).
Affussion with this medicated milk instantaneously cures pain [in Vatarakta or gout]. Similarly, affusion is done with luke warm cow’s ghee [for the cure of pain] in Vatarakta or gout caused by the predominance of aggravated Vata. [124]

Sneha Parisheka:
Oil, ghee,muscle fat or bone marrow is cooked by adding drugs belonging to sweet or Jivaniya group(Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Mahameda, Kakoli – Fritillaria roylei, Masha Parni – Teramnus labialis, Mudga Parni – Phaseolus trilobus, Jivanti – Leptadenia reticulata and Madhuka– Licorice – Glycyrrhiza glabra).
These recipes, when lukewarm is used for affusion if there is
Stabdha – stiffness
Aakshepaka – convulsion and
Shoola – pain in Vatarakta (Gout).
If, however, there is burning sensation, these recipes is cooled, and thereafter, used for affusion. [125]
Oil mixed with the
Milk of cow, sheep or goat or
With the decoction of drugs belonging to Jivaniya group (jivaka, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Mahameda, Kakoli – Fritillaria roylei,Ksira Kakoli – Fritillaria roylei,Masha Parni – Teramnus labialis, Mudga Parni – Phaseolus trilobus, Jivanti – Leptadenia reticulata and Madhuka– Licorice – Glycyrrhiza glabra) or
With the decoction of Pancha Mula (Bilva – Aegle marmelos, Syonaka – Orchis mascula, Gambhari – Gmelina arborea, Patala – Ficus microcarpa and Ganikarika) may similarly (lukewarm or cold) be used for affusion in the above mentioned conditions. [126]

Drakshadi Yoga for Seka:
Juice of Draksha – Raisin – Vitis vinifera, sugar-cane juice, alcohol, Dadhi Mastu (whey), sour Kanji (gruel), rice water and honey is mixed with water or sugar-solution. These recipes are useful for affusion in Vatarakta (gout). [127]

Kumuda etc for necklace:
Affusion or touch (external application) of cold water soaked with
Kumuda – Nymphaea alba
Utpala (Nymphaea alba)
Padma, etc,
Necklace of gems and
Chandana – Santalum album is beneficial for curing burning sensation [128]
The patient should lie on a bed spread over with fine silk cloth and leaves of lotus, sprinkled with water impregnated with the rays of the moon (dew water) and fanned by the cold breezes women, who speak pleasantly, whose breasts and hands are smeared with the paste of sandal wood and cold and pleasing in touch.
This regimen cures
Daha – burning sensation
Rujam – pain and
Klama – mental fatigue in Vatarakta or gout [129-130]

Raktamokshana, Lepa

If Vatarakta is associated with
Sa raga – redness,
Sa ruja -pain and
Daha – burning sensation
Then after:
Visravya – blood-letting,
Lepana (external application) is done with
The paste of
Madhuka – Madhuca longofolia
Asvattha – Ficus religiosa
Tvak – Cinnamonum zeylanica
Mamsi – Nordastachys jatamamsi
Vira (Ksira Kakoli – Fritillaria roylei)
Udumbara – Ficus racemosa
Sadvala (Durva (Cynodon dactylon) and
Kamala – Nymphaea alba or
With the paste of Barley-powder mixed with Yastimadhu – Glycyrrhiza glabra, milk and ghee.
The ghee prepared by boiling with the paste of drugs belonging to
Jivaniya group(Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Mahameda – Polygonatum cirrhifolium, Kakoli – Fritillaria roylei, Ksira Kakoloi,Mudga Parni – Phaseolus trilobus,Masha Parni – Teramnus labialis, Jivanti – Leptadenia reticulate) and
Madhuka – Madhuca longifolia may also be applied
Cures
Daha – burning sensation and
Ruja – pain in Vatarakta or gout. [131-132]

Tiladi Pralepa:
These ingredients are made to a paste by triturating with Goat’s milk:
Tila – Sesame indicum
Priyala (Buchanania lanzan)
Madhuka– Licorice – Glycyrrhiza glabra,
Bisa and
Root of Vetra – Salix caprea
Application of this paste cures
Daha – burning sensation and
Raga – redness in Vatarakta or gout. [133]

Prapaundarikadi Lepa:
Application of the paste prepared of
Prapaundarika (Nymphaea lotus) – red variety,
Manjistha – Rubia cordifolia,
Daru Haridra (berberis aristata),
Madhuka– Licorice – Glycyrrhiza glabra,
Chandana (Sandalwood – Santalum album)
Sitopala (sugar of big crystal),
Eraka (Hoggala Grass)
Saktu (roasted corn flour)
Masura
Ushira – Vetiver – Vetiveria zizanioides and
Padmaka – Prunus cerasoides
Cures
Ruja – pain
Daha – burning sensation
Visarpa – erysiples
Raga – redness and
Sopha – swelling.
The above mentioned recipes (described in verse nos. 128 – ¾ 135] are useful in Vatarakta dominated by aggravated Pitta and Vitiated Rakta (blood). [134- ¾ 135]

Vataja Vatarakta recipes

Recipes for external Use in Vatarakta Dominated by Vayu,
Now, listen to the description of lepas (poultices) for Vatarakta caused by the predominance of Vata. The pudding of Mugda (green gram) and milk is prepared by cooking with the decoction of drugs which alleviate Vata, and added with fat (oil or ghee). Application of this pudding as hot poultice (upanaha) cures pain.
Similarly, the application of the bolus of Tila – Sesame (Sesamum indicum) and Sarsapa – Brassica campestris as hot poultice cures pain. [135 ¼- 136]
Vesavaras (types of meat preparation) is made of the
Meat of animals belonging to the group of
Audaka (aquatic animals) and
Prasaha (animals and birds who eat by snatching their food) and
Anupa (animals living in marshy land).
Jivaniya group (Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Mahameda, Kakoli – Fritillaria roylei, Ksira Kakoli – Fritillaria roylei, Mugda Parni – Phaseolus trilobus, Masha Parni – Teramnus labialis, Jivanti – Leptadenia reticulata and Madhuka– Licorice – Glycyrrhiza glabra) and fat (oil or ghee).
Application of these recipes as hot poultices cures
Stambha – stiffness
Toda – pricking pain
Ruk – ache
Aayama – Stretching
Sotha – oedema and
Anga graha – immobility of limbs.
Muscle fat is cooked by adding drugs belonging to Jivaniya group, and milk. Use of this recipe as hot poultice cures the aforesaid ailments. [137- 138]
Upanaha of these drugs is done by making them into a paste by adding ghee and goat’s milk:
Root of Sahacara – Casearia esculanta and
Jivanti – Leptadenia reticulata.
Similarly, seeds of Tila – Sesame (Sesamum indicum) is roasted and immersed in goat’s milk. A paste of these seeds is prepared by triturating with the milk (earlier used for immersion).
Application of this paste as hot poultice is also useful for ailments caused by the predominance of aggravated vayu in Vatarakta. [139]
For the cure of pain caused by the predominance of Vata in Vatarakta, the physician should apply the paste of
Uma (Atasi – Linum usitatissimum),
Fruits of Eranda – Ricinus communis or
Satahva prepared by triturating with milk. [140]
Ingredients:
2 Prasthas of each of
Ghritam – ghee,
Tailam – oil,
Vasa – muscle fat and
Majja – bone marrow of animals and birds inhabiting marshy land and arid zone is cooked by adding the
Decoction of the root and tender leaves (collected form the top of the tree) of
Eranda – Ricinus communis (4 times in quantity of Fat), and
Paste prepared of one Bilva (pala) of each of the drugs belonging to
Jivaniya group (Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Mahameda – Polygonatum cirrhifolium, Kakoli – Fritillaria roylei, Ksira Kakoli – Fritillaria roylei, Mudga Parni – Phaseolus trilobus, Masha Parni – Teramnus labialis, Jivanti – Leptadenia reticulata and Madhuka– Licorice – Glycyrrhiza glabra),
Gavya kshiram – cow-milk
Aja kshiram – goat-milk
Haridra (turmeric – Curcuma longa)
Utpala (Nymphaea alba),
Kushta – Saussurea lappa,
Ela (Elettaria cardamomum Maton)
Satahva,
Leaves of asvahana(Karavira – Nerium indicum) and
Flowers of Kakubha (Arjuna (terminalia arjuna)).
After the medicated fat is cooked, the pot is taken out of the oven, and made to cool down. Thereafter, 8 Palas of Madhucchista (bee’s wax) is added, and mixed together.
This medicated fat is applied externally to cure pain in a patient because of
Ardita (facial paralysis),
Sandhi gata vata – location of the aggravated Vata in the joints,
Vatarakta (gout),
Khanja (Lameness) and
Kubja (hunch-Back). [141-144]

Kaphaja Vatarakta recipes

Abhaynga Lepa Yoga for Vatarakta Dominated by Kapha
Massage with the medicated ghee prepared by boiling with cow’s urine, Ksarodaka (alkaline solution) and alcohol is useful in Vatarakta caused by the predominace of Kapha. And when the ailment is associated with oedema, heaviness, itching etc. [145]
Ghee is boiled with the paste of
Padmaka – Prunus cerasoides,
Tvak – Cinnamonum zeylanica
Madhuka– Licorice – Glycyrrhiza glabra and
Sariva – Indian Sarsaparilla – Hemidesmus indicus and
Vinegar prepared of honey (Madhusuka).
This medicated ghee is useful for
Seka – affusion and
Abhyanga – massage in Vatarakta caused by the predominance of Kapha. [146]

Parisheka Yoga –
Kshara (Alkali prepration), oil, cow’s urine or water is boiled by adding drugs having pungent taste. These liquids are useful for affusion in Vatarakta (caused by the predominance of Kapha. [147]

Sarshapadi Lepa:
Application of the paste of
Sarsapa – Brassica campestris
Nimba – Neem (Azadirachta indica),
Arka – Calotropis gigantean,
Himsra – Nardostachys jatamamsi,
Kshira – milk and
Tila – Sesame (Sesamum indicum)
Cures: Vatarakta caused by the predominance of Kapha
Application of the poultice prepared of the bark of
Kapittha (Feronia limonia),
Ghrta – ghee,
Kshira – milk and
Saktu (roasted corn- flour) is most useful in the treatment of the aforesaid ailment [148]

Poultice – Pralepa for Vatarakta Dominated by Vayu and Kapha:
Application of the poultice prepared of
Grha Dhuma (Kitchen-soot),
Vacha (Acorus calamus Linn.),
Kushta – Saussurea lappa,
Satahva,
Haridra (turmeric – Curcuma longa) and
Daru Haridra (berberis aristata)
Cures: pain in Vatarakta caused by the Predominance of Vata and Kapha [149]

Tagaradi Lepa
Application of the poultice prepared by
Tagara – Valerian walichii,
Tvak – Cinnamonum zeylanicum,
Satahva,
Ela (Elettaria cardamomum Maton),
Kushta – Saussurea lappa,
Musta (Cyperus rotundus),
Harenuka – Amomum subulatum,
Deva Daru – Cedrus deodara and
Vyaghra Nakha – Capparis zeylanica by triturating with sour liquids (kanji etc) cures Vatarakta caused by the predominance of Vayu and Kapha. [150]

madhu shigru adi Seka:
Similarly, paste is prepared of the seeds of sweet variety of Sigru – Moringa oleifera by triturating with Dhanyamla (sour liquid prepared of cereals with husk). It is applied for some time over the affected part, and thereafter, the part is affused with sour liquids (Kanji etc) which is beneficial in Vatarakta dominated by Vata and Kapha. [151]
Recipe for Vatarakta caused by Predominance of all the 3 Doshas

Triphaladi Kalka:
Ingredients:
Triphala (Haritaki, Vibhitaki and Amalaki),
Trikatu (Ginger, pepper and long pepper fruit),
Patra – Cinnamomum tamala Nees and Eberum.,
Ela (Elettaria cardamomum Maton) ,
Tvak-Ksheeri(vamsa Locana),
Chitraka – Leadword – Plumbago zeylanica,
Vaca (Acorus calamus Linn.),
Vidanga – Embelia ribes,
Pippali -Mula,
Romasha (Kasisa),
Bark of Vatsaka (Holarrhena antidysenterica Wall.),
Riddhi,
Tamalaki – Phyllanthus niruri and
Cavya – Piper chaba is taken in equal quantities, and made to a paste.
In the morning, this paste is smeared over an iron pot, and the food kept in this pot is taken by the patient during the noon time.
The patient should avoid taking yogurt, Sukta (vinegar), Alkalies and mutually contradictory ingredients of food.
This is an excellent recipe for curing Vatarakta even when caused by the predominance of all the 3 Doshas, and is associated with excruciating pain. [152-154]

Line of Treatment:
The physician well versed in appropriate permutation and combination of therapies should apply the above mentioned therapeutic measures (for Vatarakta gout) after determinating its location and, relative strength of the Doshas responsible for the causation of the ailment. [155]
Therapy for Vatarakta caused by Occlusion because of the obstruction to their course by the aggravated Vata, the Medas and Kapha get provokes in excess in Vata Rakta (gout). In such an event, Snehana and Bruhmana should not be employed in the beginning. The provoked fat and Kapha is brought to their normal state by exercise, by elimination therapy, by the intake of wine and urine, by Virechana and by the administration of butter-milk as well as Abhaya – Terminalia chebula (Haritaki).
Intake of the decoction of Bodhi tree along with honey instantaneously cures Vatarakta (Gout), even if it is of serious nature being caused by the simultaneous aggravation of all the 3 Doshas.
Inkate of old barley or wheat, Sidhu and Arista types of wine, sura (alcohol) Asava (a type of wine), or Silajatu, Guggulu (Commifora mukul Engl.) and honey also cures Vatarakta (gout). [156-159]

Gambheera Vatarakta treatment

If in the Gambheera (Deep seated) Vatarakta blood is vitiated, then for its cure, in the beginning, Vayu is alleviated, and thereafter, the treatment for the alleviation of Vatarakta is given. [160]

Suppurated Vatarakta treatment

Treatment of Suppurated (Paka) Vatarakta
If, in Vatarakta Pitta and Rakta are vitiated in excess, then this may lead to suppuration, bursting open of the wound and discharge of putrid blood as well as pus. This condition is treated by incision, purification and therapies for the healing of the wound.
Complications of Vatarakta are treated on the lines prescribed for the respective signs and symptoms. [161-162]

Summary:
Maharsi Atreya explained to Agnivesha, in brief as well as in detail, the following topics relating to Vatarakta (gout):
Hetu – Etiology
Sthanani – Location of the diseases
Mulam – The base (root) of the disease
Kupyati roga – The reason for which the disease generally gets aggravated in the joints
Rupam – Premonitory signs and symptoms
Signs and symptoms of the 2 varieties of Vatarakta
Signs and symptoms of different types of Vatarakta
Signs and symptoms of the disease caused by the predominance of different Doshas
Complications
Curability, Palliability and incurability of the disease
Detailed treatment of curable types of the disease and
Treatment of different stages of the disease. [163-165]
Thus ends the 29th chapter of Chikitsa section dealing with the “Treatment of Vatarakta” of Agnivesha’s work as redacted by Charaka, and supplemented by Dridhabala.