Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

Buerger’s Disease

Buerger’s Disease is the inflammation of small and medium sized blood vessels mainly occurring in the blood vessels of arms / hands and or feet / legs. The blood vessels swell. Due to this, the blood vessels get blocked with thrombi (clots). As a result the blood flow will be hampered. This would lead to pain and tissue damage along with a wide array of symptoms. This condition is also called TAO – Thrombo Anginitis Obliterens.

Related Reading – ‘Buerger’s Disease – causes, symptoms, prevention, treatment’

In this article we shall try to understand Buerger’s Disease from Ayurveda Perspective.

Buerger’s Disease – Through Ayurveda Lens

Buerger’s Disease vs Vatarakta

Many similarities put understanding Buerger’s Disease into the bracket of ‘Vatarakta’.

From the pathogenesis Viewpoint

The basic pathogenesis of Vatarakta explains it as a condition caused by the blockage of pathways of vata by aggravated rakta – blood. So, basically vatarakta is a ‘raktavrita vata’ condition i.e. blood blocking the pathways of vata. Vata, we know, is the principle behind many or almost functions in the body. When vata is blocked, its functions are hampered. In other words, many functions of the body come to a halt. The body is deprived of its nutrition and oxygenation. Same thing is explained in the pathogenesis of Buerger’s Disease wherein there is blockage of blood flow due to the inflammation or swelling of blood vessels.

‘Vayuh Pravruddho, Vruddhena Raktena Avaritah Pathi…’ – The aggravated vata gets enveloped (obstructed) by aggravated and abnormally increased Rakta – blood. This is an important event which leads to the causation of vatarakta.

This mirrors the explanation of formation of thrombi / clot caused by blockage of blood vessels as explained in the pathogenesis of ‘Buerger’s Disease’.

From the ‘location of the disease’ viewpoint

Buerger’s Disease can involve blood vessels in any part of the body, but it mainly occurs involving the blood vessels in the hands / arms and or feet / legs. The symptoms too are mainly seen in the upper and lower limbs though the disease may manifest with a wide array of signs and symptoms of systemic involvement.

‘…tat cha srastam dushtam padayoh cheeyate tu| (Su.Ni.1)

Master Sushruta tells – ‘The aggravated blood moves downward and accumulates around the feet. Therein it gets mixed with vata aggravated by its own causative factors. Vatarakta is formed due to this vicious association of vata and rakta and hence called as vatarakta’. We can clearly see the mention of ‘pada – foot / feet’ in this context and similarity in the mention of ‘location of disease’.

More reference from Ayurveda –

In the context of Purvarupas of Vatarakta, Master Charaka has mentioned different sites of the body wherein the symptoms of the disease like eruptions, looseness of joints, pricking, pulsating and splitting pain, numbness, itching and discoloration manifest. The sites mentioned include – janu (knee joints), jangha (legs and joints of legs), uru (thighs and joints of thighs), kati (pelvis, hip), amsa (scapula), and hasta pada anga sandhi (joints of hands, legs and the entire body).

Here too we can notice that both upper and lower limbs and the joints therein have been clearly mentioned as the seats of vatarakta, which is also the same as explained in the context of Buerger’s Disease.

From the ‘causative factors’ viewpoint

The causes of Vatarakta are biphasic. Vata is aggravated by its own causative factors. On the other hand, rakta too gets aggravated by its own etiological factors. Both tend to contaminate each other. Vatarakta is caused when the easy movements and actions of this vata are blocked and choked by the aggressively increased blood.

Modern medicine has mentioned and marked ‘smoking’ and consumption of any form of tobacco as a single etiological factor or risk factor for causation or worsening of Buerger’s Disease. Ayurveda might have not mentioned that, but foods and activities which bring about aggravation of rakta and vata, basically the foods which are hot, pungent, deep penetrating and corrosive have been mentioned.

From ‘dosha’ viewpoint – Basic dosha connection in Buerger’s Disease

Since there is swelling and inflammation occurring in the blood vessels in this condition, the involvement of pitta is evident. Pitta resides in Rakta, and both have similar properties. The aggravation of rakta in raktapitta also implies the aggravation of pitta located within rakta. Even individually, both rakta and pitta can cause inflammation of blood vessels, or in fact anywhere in the body.

Since the clots are formed, kapha too is involved.

Since there is obstruction to the flow of blood, vata too is involved (since vata is responsible for the flow). It is the same vata which has been blocked and the symptoms are those of the struggle between vata and rakta.

From ‘dhatu’ viewpoint – Dhatu connection in Buerger’s disease

Since the blood tissue is involved in the disease, rakta dhatu is considered in the pathogenesis.

Since the skin is involved, rasa dhatu too is involved.

Since the gangrene affects the muscle tissue, mamsa dhatu involvement shall be considered.

From the ‘srotas’ viewpoint

Raktavaha Srotas – channels responsible for conveying blood from the roots (seats of production) to all parts of the body are the main srotas involved in the causation of Buerger’s Disease. Sira – the term used to describe blood vessels in general, including veins and arteries – are the upadhatus (sub-tissues) of rakta – the blood tissue.

On the other hand, Rasavaha Srotas are involved since the prominent symptoms are manifested on the skin. Skin is an upadhatu of Mamsa i.e. muscle tissue and symptoms of Buerger’s disease also involves muscles and hence Mamsavaha Srotas too is involved.

Bones and joints are involved in Buerger’s disease. Meda, i.e., fat and Jhagana – hip bones – are the roots of Asthivaha Srotas – channels responsible for transportation of bone tissue. Likewise, Asthi – bones and Sandhi – joints are the upadhatus of Meda i.e. fat tissue. Thus, asthivaha and medovaha srotas are involved in the pathogenesis of Buerger’s disease.

Majjavaha Srotas – channels of conveyance of bone marrow too are involved in Buerger’s Disease. The roots of these channels are asthi and sandhi (bones and joints). ‘Ruk Parvanam’ i.e. pain in the small joints of hands and feet are one of the symptoms of contamination of majjavaha srotas, which is also the main symptom of Buerger’s Disease.

From the perspective of signs and symptoms of Buerger’s Disease

Pain

Pain is the main symptom of Buerger’s disease. It may be continuous or intermittent but is more focused in hands / arms and or feet / legs. Pain happens due to blocks caused by blood / blood clots and normal functions of vata being hampered. Here, rakta and vata – both contribute towards causation of pain.

Vata predominance

When the pain is caused by predominance of vata in the vatarakta, it will be of the nature of shula – colicky or stabbing with sharp weapon, sphurana – pulsating and bhanjana – crushing. The word ‘vriddhi hanayah’ indicates that the pain keeps coming and going, the same feature of pain and claudication as explained in the context of Buerger’s disease.

Dhamani Anguli Sandhinam Sankocha – There will be constriction in arteries (indicates that the blood is not flowing easily) and constriction and limitation in movements of small joints of fingers and toes.

Anga graha – i.e. stiffness or catching pain in the body parts and Ati ruk – severe pain are characteristic.

Stambha – stiffness, Vepathu – tremors, Supti – numbness are also present.

Shita Dwesha Anupashaya – the person will have an aversion towards cold foods, things and comforts and anything cold will aggravate the symptoms of the disease. This probably explains the Raynaud’s Phenomenon explained in Buerger’s Disease.

Rakta Predominance

Shotha – presence of painful swelling which is red in color is a notable feature. Pricking pain and tingling sensation are predominant.

Anupashaya – The swelling or pain are not relieved with dry or unctuous comforts.

Kandu Kleda Samanvita – Swelling is associated with itching and discharge (more fluidity).

Pitta Predominance

There will be Ruk – pain associated with Vidaha – presence of severe burning sensation is a prominent feature. Along with this, there is Shotha – swelling along with Raga – reddish discoloration, Paka – suppuration / formation of pus and Sparsha Asahatva – tenderness / intolerance to touch.

The associated features include –

–        Sammoha – loss of consciousness / debility of sense organs
–        Sweda – sweating
–        Murcha – fainting
–        Mada – intoxication
–        Trt – extreme thirst
–        Bhrusha ushmata – severe raise in temperature  

Kapha Predominance

The swelling in this condition will be associated with –

–        Staimitya – feeling as if the region is covered with wet cloth / leather
–        Supti – numbness
–        Snigdhatva – unctuous / oily
–        Shitata – increased coldness
–        Guru – heaviness
–        Manda kandu – mild itching

Symptoms of two doshas or three doshas can be collectively present worsening the condition.

Other symptoms of Buerger’s Disease and Dosha relationship

From the perspective of complications of Buerger’s Disease

Gangrene is the worst and most important complication of Buerger’s Disease. It is the death of skin and tissues in the toes and fingers. It is caused due to cessation or stoppage of blood flow to the toes and fingers. These toes and fingers become numb or turn black or blue in color. There is also loss of sensation and foul smell from the affected part / parts.

In vata predominant cases of Vatarakta – ‘shothasya krishnatvam and shyavatvam’ has been mentioned. This means blackish or bluish coloration of the swelling or skin in the disease.

Kleda in the context of vatarakta caused by predominant aggravation of rakta (blood) may reflect foul smelling discharges occurring in gangrene.

Shothah Pakah – in the context of pitta predominant vatarakta explains the suppuration in the tissues of fingers and toes occurring in gangrene.

While explaining the prognosis of vatarakta, Master Sushruta mentions in the context of ‘ajanu sphutitam’….that when vatarakta cracks open from toe to knee joints, the skin therein gets fissured or broken, decayed and exhibits foul discharges and associated with complications like deterioration of strength and destruction of muscles (gangrene?), the condition becomes incurable.

Mamsakotha – decaying of muscles vis-à-vis gangrene has also been counted amongst the complications of vatarakta.

Other complications of Vatarakta which indicate bad prognosis are – insomnia, anorexia, dyspnea, tightness in the head, fainting, intoxication, pain, thirst, fever, confusion, tremors, hiccough, lameness, herpes, suppuration, pricking pain, dizziness, tiredness, crookedness of the fingers and toes, boils, burning sensation, affliction of vital organs and tissues and tumors.

Ayurveda Treatment Principles of Buerger’s Disease

Nidana Parivarjana

Avoidance of causative factors is the key principle for treating or preventing the recurrences of Buerger’s Disease vis-à-vis vatarakta. Herein the etiological factors including foods, lifestyle activities, habits and seasons which might aggravate vata, rakta or both shall be kept away.

Buerger’s Disease should be treated on the principles of treating the below mentioned conditions –

–        Vatarakta
–        Raktavaha Srotodushti
–        Mamsavaha Srotodushti
–        Medovaha Srotodushti
–        Asthivaha Srotodushti
–        Majjavaha Srotodushti
–        Shotha – inflammatory and non-inflammatory swellings

Panchakarma therapies for Buerger’s Disease

Raktamokshana vis-à-vis bloodletting is the first and foremost intervention for the treatment of vatarakta. The same principle is applicable for the treatment of Buerger’s Disease. This will help in removing the obstruction in the blood vessels and make the blood flow easy.

Vasti – medicated enema – is the most comprehensive treatment for vatarakta vis-à-vis Buerger’s Disease. Enema takes care of pain and other disturbing symptoms by balancing vata, which is the main dosha in the disease pathogenesis.

Virechana – medicated purgation – helps in controlling inflammation, by expelling and balancing aggravated pitta and rakta.

Useful external therapies in Buerger’s Disease

Dhara – showering of medicated fluids over the lesions. For this purpose, the below mentioned formulations can be used –

–        Pinda Taila
–        Dashamula Siddha Ksheera – milk medicated with / prepared with Dashamula decoction
–        Dashamula-Laksha Siddha Ksheera – milk medicated with / prepared with Dashamula Decoction and Laksha (lac)

Useful formulations in the treatment of Buerger’s Disease

–        Guluchyadi Kashayam
–        Bala Guluchyadi Kashayam
–        Kokilaksham Kashayam
–        Manjishtadi Kashayam
–        Gandharvahastadi Kashayam
–        Kaishora Guggulu
–        Trivrit Leham
–        Pinda Tailam (external)