Gout

GOUT

Gout is the true crystal deposition disease characterized by pain & swelling of I St Metatarsophalengeal joint initially followed by other joints with an abnormal elevation of Urate level in the body either due to over production or under excretion or sometimes both. Itcan also be defined as the pathological reaction of the joint or periarticular tissues to the presence of non sodium urate monohydrate crystals, clinically this may present as inflammatory arthritis, bursitis, tenosynovitis, cellulitis or as a nodular tophaceous crystal deposits. Although prolonged hyperuriceamia is necessary but is alone not sufficient for development of Gout.

According to Modern Concept Predisposing Factors of Gout are

1. a) Trauma to the joint
2. b) Exposure to cold
3. c) Drugs reaction
4. d) Excessive use of Alcohol
5. e) High Protein Diet
6. f) excess use of Diuretics
7. g) Chemicals like Urografin, Allopurinol, Urocosuric drugs etc.
8. h) Sometimes it is associated with changes in the atomospheric pressure.
9. i) Acute Infection.

Hyperuricaemia is a prerequisite for deposition of uric acid in synovial & other tissues. Uric acid is the end product of purine metabolism. There are two pathway involved in the purine synthesis.

The high levels of uric acid in the blood are caused by protein rich foods. Alcohol intake often causes acute attacks of gout & hereditary factors may contribute to the elevation of uric acid.

Symptoms

According to modern concept the clinical features of gout appears mostly at the age above 40, mainly 95% in males & rarely in females. It is extremely rapid onset reaching maximum severity in just 2-6 hrs. Often walking the patient in the early morning with severe pain, which is often described as the “worst pain” ever. There is extreme tenderness on accounts of which the patient is unable to wear socks.

The joint most commonly affected initially is the Ist metatarsophalengeal joint 50% other side ankle, heel, knees & hands. The hip and shoulder joints are usually not affected. There is marked swelling with over line red shiny skin on the affected joints.

During attack the joint shows the signs of marked synovitis, sometimes the attack may be accompanied by fever, specially if a large joint such as the knee is involved. When the attack subsides pruritus common.

The general features are anorexia, malaise, headache, tachycardia & fever which may come with slight chill & the involved skin is tense. The local veins are very much prominent. An attack may last for two weeks after which the joint becomes completely normal till another attack occur.

According to Ayurveda

Ayurveda consider gouty arthritis as vatarakta. The word Vatarakta is made up of two words Vata & Rakta. Vatarakta (Gout) is a variety of Vataroga (Group of diseases caused by Vayu). The disease which is caused by excessively aggravated Vayu (Vata) & vitiated blood (Rakta) is called Vatarakta. Vatarakta is also known as-Khuda roga, Vata-balasa, Vatashra & Adhya vata.

Etiology according to Ayurveda

The causative factors said by various Acharya’s may be divided into three categories as –

(A) The Factors Aggravate the Vatarakta

1. a) Tender physique.
2. b) Excessive intake of sweet food.
3. c) Sedentary habits & Leisurely eating.
4. d) Unwholesome diets & activities.
5. e) Deteriorated diseases.
6. f) Long walking.
7. g) Excessive sexual activities.
8. h) Excessive physical exercise.
9. i) Abstain of sex & Perversely sex.
10. j) Obesity.
11. k) Most oftenly fallen to sad and oftenly be angry.
12. l) To take sleep during day and remaining awake at night.
13. m) Intake of food before the previous meal is digested.
14. n) Excessively intake of saline, sour, pungent, alkaline taste.
15. o) Excessive intake of unctuous & hot potency food.
16. p) Intake of purified or dry meat of aquatic or marshyland dweller animals.
17. q) Excessive intake of sesamun indicum cake preparation.
18. r) Excessive intake of radish, kullattha, masa, nispava, leafy vegetables, meat & sugarcane.
19. s) Diet unwholesome to seasons and accustomed ones.
20. t) Intake of mutually contradictory- incompatible foods.
21. u) Improper administration of oleation & other purifactory therapies.
22. v) More intake of curd, aranala (kanji), sauvira (sour preparation of dehusked barley), shukta (Vinegar), buttermilk & Alcohol, wine.

(B) The Factors Vitiates the Rakta

1. a) Trauma
2. b) Omission of the purification of the body. i.e. omission of the use of elimination therapies which are supposed to be done in routine during different seasons.
3. c) Partaking of foods which cause burning sensation during digestion which are incompatible.

(C) The Factors Aggravates the Vata

1. a) Excessive intake of astringent, pungent, bitter & unctuous ingredients
2. b) Intake of less food or abstinence from food.
3. c) Great indulgence in vegetable which posses qualities like penetrating.
4. d) Riding over elephant, horses, camel or on vehicles drawn by them for long periods.
5. e) Resorting to aquatic games, swimming & jumping.
6. f) Exhaustion by heat due to excessive wayfaring in Hot seasons.
7. g) Indulgence in sexual intercourse
8. h) Suppression of the manifested natural urges.
9. i) Exposure to cold breeze.

Sign & Symptoms according to Ayurveda

The signs & symptoms of Uttana (superficial) Vatarakta are stated very similar by the Acharya Charak and Acharya. These are – itching, burning sensation, ache, extension, pricking pain, throbbing sensation & contraction. The skin becomes brownish black, red or coppery in colour. Burning penetrating sensation produced like Mustard oil.

The signs & symptoms of Gambhira (Deep seated) Vatarakta are stated as following – hard inflammation with stiffness, severe pain beneath oedema, blackish or coppery coloration of skin, burning sensation, piercing pain, quivering & suppuration inside the oedema.

Treatment

Acharya Charaka & others have stated the treatment of Vatarakta in very detail

1 Snehana –  Initially oleation tharepy should be applied to the patient of Vatarakta & after that if the patient is slightly unctuous should be given purgation therapy with unctuous ingredients.

Swedana –

2 Dhaara – Taila dhaara to the effected part is ideal fomentation in Vatarakta.  Dhaara with Taila that is vata hara and pitta hara should be chosen.

3 kizhi – like podi kizhi (powder poultice heat), ila kizhi (leaf poultice heat) can be given with proper precaution, and should not over do.

4 Naadi weda – steam with hollow pipe to effected part. The steam of water boiled with herbs that subside Vata doha.

5 Lepana – paste of herbs that reduce vata and pitta are applied over the effected area.

Shodhana

6 Virechanam – fter proper preparation patient should give purgation therapy with ununctous ingredients but these should be mild in nature because of the sharp purgatives may excessively provoke the Vata, which will not be useful for treatment of Vatarakta. but the

7 Vast – The Vasti is the best treatment of the Vatarakta & there is no any therapy useful in comparision to Vasti regarding the treatment of Vatarakta. Repeatedly doing Vasti therapy, both Niruha & Anuvasana will be more useful regarding the treatment of Vatarakta.

8 Raktamokshana may be done by Horn, Leech, Needle, Gourd, Scratching of the skin & Venesection.

Some Important Ayurvedic Formulations for Treatment of Vatarakta

1. Guda haritaki should be consumed regularly.
2. Pippali may be used in increasing & decreasing order. (Vardhmana pippali yoga)
3. Intake of Juice of Guduchi or powder or paste or decoction for a prolonged period.
4. Patoladi kashayam,  Decoction of Guduchi with Eranda Tail.
5. Nimbadi Churnam. .
6. Amrita guggulu, Kaishore guggulu, Punarnava guggulu Triphala guggulu, Simhanada guggulu.
7. Guduchi Ghrita, Shatavari Ghrita, Amritadya Ghrita, Bala Ghrita, Guduchi tail, Mahapinda tailam, Sukumara Taila as drink, Bala Taila as drink, Pinda taila, Madhuka tailam, Satapaka madhuka tail.

Proper food for Vatarakta (gout) According to ayurveda

For the patients suffering from Vatarakta the following are useful –

1. The cereals like the old Barley, Wheat, Nivara (a type of wild rice) & Sali as well as Shashtika types of rice.
2. Meat soup of the Vishikara (gallinaceous) as partridge, quail, lark etc. & Pratuda (Pecker) birds as peacock, hen, parrot, pigeon, sparrow etc.
3. Leafy vegetables like Sunishnaka, tender branch of Vetra, Kakamachi (Solanum nigrum), Vastuka (Chenopodium album), Upodika (Basella rubra), Souvarchala sizzled with ghrita & meat soup.
4. Vegetables like Karvellaka (Momordica Charantia), Choulai Amaranthus), Surana (amorphophallus campanulatus), Ginger (Zingiber officinale), Methika (Trigonella feonumgreacum), Patola (Trichosanthes dioica), Kushmanda (Banincusa hisipida), Punarnava (Boerhavia diffusa), Palak (Spinacia Oleracea), Chakavada (Cassia tora), Bottle gourd (Lagenaria vulgaris), Kheera (Cucumis utilisimus), Aragavadha (Cassia fistula), Guduchi (Tinosora cardifolia) etc.
5. Draksha, Currant, Butter, Large raisin, Castor oil, White variety of sugar.
6. Soup of Adhaki (Cajamus indicus), Chanaka (Cicer arietenum), Masura (Lentil), Mudga (Psoralea radiatus) added with ghrita in liberal quantity.
7. Milk of cow, buffalo, goat & sheep etc.
8. The following diet should be beneficial for a Vatarakta (Gout) patient :-
9. Limit meat, poultry and fish.
10. Cut back on fat.
11. Limit or avoid alcohol
12. Limit or avoid foods sweetened with high-fructose corn syrup
13. Choose complex carbohydrate
14. Choose low-fat or fat-free dairy products
15. Drink plenty of fluids, particularly water.

Don’ts  for Vatarakta

1) Sleep during day time

2) Exposure to heat

3) Excessive Exercise

4) Excessive sexual intercourse

5) Excessive intake of pungent, saline, sour & alkaline taste & hot heavy abhishyandi (ingredients which cause obstruction to the channels of circulation) gunas & ushna veeryas food ingredients as mash, kullatha, peas, curd, sugarcane, radish, alcohol, sesamum oil, kanji (sour liquids), saktu, jackfruit, brinjal, kundaroo etc.

6) Meat of aquatic & anoopa habitat animals.

7) Incompatible diets should be avoided by the patients suffering from Vatarakta.