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शुक्रवार, 19 फ़रवरी 2016

Rakta Avrita Vata

Rakta Avrita Vata

       Vata dosha alongwith ruksha, laghu, shita, khara, suksma guna possesses cala guna.
Yasya prerane shakti sa cala .Va.Su.1/40 (Arundatta)
Cala guna is essential for avyahatgati of vata dosha and also for the pravartan (stimulation), chesta (movement), vyuhakar (organizing), ksepta (excretion), santan gati (sinus rhythym), pumping and pulsation. Thus whenever cala guna will be affected vikshepa, samvahana, parivahana, chavan, pargaman, sravan, visyandana karma will be hampered.
          As understood in grahani adhyaya yugpat, sarvatra, continuous vikshepa of rasa rupa dhatu is by vyanvayu which is responsible for nutrition of sthyayi dhatu. Whenever due to kha vaigunya the vikshepita rasa gets obstructed/ stagnated, pathogenesis takes place. Thus for avyahatgati of vata normalcy of marga and margastha dhatu is essential.
          Marga means various channels, srotas, sira, dhamani, rasayani, rasavahini, nadi, pantha, sharirchidra, aashaya, niketa etc. whereas margastha dhatu means drava rupa asthayi raktadi dhatu.
Specific ratio of pancamahabhut maintains the dravatva of dhatu. More the viscosity slow is the flow of the drava rupa dhatu. Viscosity will increase whenever parthivata will increase in proportion in margastha dhatu. Change in specific proportion is primarily due to agni. It may be at level of jatharagni, dhatvagni or bhutagni. Secondly, anupahat agni is responsible for maintaining of normalcy of dhatus. Agnimandya leads to apachit dhatu vridhi. Such apachit dhatu are nothing but aam which may act as antigen. Vyadhi vighatkar bhava comes in action to prevent adherence of aam with specific dhatu.
Thus presence of aam and vyadhi vigatkar bhava changes the specific ratio of dravatva leading to reduction of flow (Saratva) or capillary perfusion and increase in organ congestion and syndromes of hyperviscosity.
          Therefore upahata agni causes variation in dravata leading to obstruction or aavaran of vata dosha causing aavrita vata.
Secondly anupahat srotas is necessary for dhatu poshan. Srotas over here means marga or channels. If the patency of channels is hampered it disturbs the flow of drava rupa dhatu. Patency of channels depends on bija (genetic), environmental factors (external factors) and internal environment within the channels.
           It is important to understand the significance why Kush Sankrityayana while explaining 6 qualities did not explain cala as quality of vata whereas he explained daruna as quality of Vata. Secondly answer given to question of Kankayan Rishi on how asanghata or amurta vata gets prakopita or prashaman by murta dravya.
           Acharya Badish Dharmargava has explained that ruksa, laghu, shita, khara, vishada, sushira and daruna guna acts on sharir and as vayu takes ashraya of sharir for its activity prakopa of vayu takes place whereas snigdha, guru, ushna, slakshna, mridu, picchila guna when increase in sharir they do prashaman of ashrayi vata dosha. Therefore darunata i.e. hardness of marga causes prakopa of vata. Specific hardness of channels is essential for normal flow. If such darunata is lost it causes aneurysm leading to impaired flow of drava rupi dhatu as understood in siragata vata whereas hardness when increased the flow is obstructed causing vataprakopa.
      Thus one can conclude from above discussion that for normalcy of vatagati following entities are essential.
1) Specific ratio of drava rupa dhatu ( Viscosity)
2) Marga ( Channels)
Apakva aahar rasa
Dhatusma (Upahata ushma)
Sama dhatu [asthayi / dravarupa]
Vikara vighata bhava if vighatkara bhava Vyadhiutpatti without aavaran
are unable to regularize
Specific ratio of dravata is altered / bija dusti and/or environmental factors
Viscosity rheological forces Loss of patency of channels
Yatra sanga kha vaigunya (upahat srotas)
Vyadhiutpatti without aavaran
Avarodha to avyahat gati Inflammation of channels
Aavrita vata [upahat srotasgata vayu]
Vyadhi utpatti with aavaran
Rakta Avrita Vata
Raktavrite sa daha arti tvak mansa antarya bhrisam |
Bhavet sa raga swayathu jayante mandalani cha ||
Ca.Ci.28 / 215
         In rakta avrita vata there is either quantitative and /or qualitative increase in rakta dhatu which obstructs the gati of vata dosha leading to aavrita vata.
In Vidhishonitiya adhyaya Caraka has explained rakta dustikara hetu which are cause for qualitative and quantitative impairment of rakta dhatu.
Ati lavan rasa sevan causes quantitative increase of rakta ( Raktam Vardhayati)
Kshar causes pachana, daran of the srotas.
Amla rasa does pachana, mansa vidaha ( lepana karma is of mansa and vessels are made up of muscle fibers) and swayathu utpadayati. Rakta dusti, causes inflammation.
Katu rasa reduces bala and has quality to irritate the mucosal lining.
Kulatha has ushna virya and amla vipak. It causes amlapitta and thereby after vitiating pitta causes rakta dusti. Kulatha is mentioned hetu in raktapitta where there is quantitative increase of rakta.
Masha although balya, when taken in excess quantity causes mala vridhi and is ushna in nature.
Tila taila, mulaka, pindalu, jalaja and anup mansa by their ushna guna causes raktadusti.
Sura, souvirak, sukta are ushna and are raktadustikara.
Virudha, upaklinna anna, puti anna, diva swap are agnimandyakar and have low nutritional values.
Aatap and anala sanyog are external factors which directly affect the small blood vessels and are cause for local pathogenesis. Similarly abhighata/ injury also causes raktadusti as seen in case of superficial venous thrombosis after catheterization.
One thing is common that all the above ahariya dravyas are vatashamaka therefore when taken in excess will hamper gati of vatadosha.
           The quantitative increase of rakta causes increase in viscosity and thereby hampering the gati of vata as seen in cases of polycythaemia rubra vera.
POLYCYTHAEMIA RUBRA VERA (PRV)is a myeloproliferative disorder wherein there is an abnormally high number of red blood cells with or without abnormally high number of platelets and WBC, because of the circulation of extra number of blood cells , blood becomes thicker or more sludgy than normal causing blood to flow slowly and giving rise to certain symptoms and also increasing risk of thrombosis.
Over 19 in 20 people with PRV have an abnormality (called a mutation ) in a protein called the JAK2 protein. The JAK2 protein normally helps to regulate and control the productions of blood cells.
The sludgy blood flow means oxygen cannot get to the tissues leading to various symptoms like headache, chest pain, pain in calf muscles (arti tvak mansa antarjo bhrisam ), tiredness, dizziness, tinnitus, blurring of vision.
          Further 4 out of 10 patients release histamine causing itching and urticarial rash ( sa raga swayathu jayante mandalanicha). Complexion is a bit more ruddy than normal due to increase number of RBC.
           Some patients may present with bruising, epistaxis, gastrointestinal blood. This presentation should be understood under raktapitta. Also about 1 in 10 people with PRV develop gout wherein concept of vatarakta should be considered.
          This also signifies the common hetus in raktapitta, vatarakta and raktadusti.
Venesection is one among the treatment for PRV which removes the extra red blood cells and make blood less viscous so that it circulates better. Regular venesection is preffered. Acharyas have explained raktamokshana in vatarakta and treatment of raktavritta vata is similar to vatarakta.
Apparent erythrocytosis where RBC are more concentrated can be caused by many things such as obesity ( recollect the jalaj, anup, mansa, masha etc are cause for sthaulya and raktadusti), alcohol (sura sauvira), stress ( krodhadi), smoking ( tikshna ushna dravya), less fluid, diuretics, high blood pressure, kidney disease etc. The presentation is similar to PRV.
Hyperviscosity Syndrome; it is a group of symptoms triggered by increase in the viscosity of the blood
Type of hyper viscosity syndrome vary by pathology,
1) Serum hyperviscosity which may cause neurologic or ocular disease.
2) Polycythemic hyperviscosity which results in reduced blood flow or capillary perfusion and increased organ congestion.
3) Syndrome of hyperviscosity caused by reduced deformability of RBC often evident in sickle cell anaemia ( note pinyaka, harita shaka etc have low nutritional value ( vit B12) are explained as rakta dustikar hetu)
           Blood viscosity is a measure of the resistance to the flow of blood. This biophysical property makes it a critical determinant of friction against the vessel walls, the rate of venous return, the work required for the heart to pump blood and how much oxygen is transported to tissues and organs. These functions of the cardiovascular system are directly related to vascular resistance, preload, afterload and perfusion respectively.
           The primary determinants of blood viscosity are haematocrit, RBC deformability, RBC aggregation and plasma viscosity. Plasma viscosity is determined by water content and macromolecular components, so the factors that affect blood viscosity are the plasma protein concentration and types of proteins in the plasma. Elevation of plasma viscosity correlates to the progression of coronary and peripheral vascular diseases. Many conventional cardiovascular risk factors and outcomes have been independently correlated with whole blood viscosity. Hypertension, total cholesterol, LDL, VLDL, triglycerides, diabetes, metabolic syndrome, obesity, male gender, aging, cigarette smoking have all been positively linked to whole blood viscosity.
            PHLEBITIS is the inflammation of vein. It most commonly occurs in superficial veins. Phlebitis often occurs in conjunction with thrombosis and is then called as thrombophlebitis.
Phlebitis is typically caused by local trauma (abhighata to the vein). Phlebitis can also result from certain medications and drugs that irritate the veins i.e. vascular irritant (tiksna, ushna, kshara katu dravya). These causes are directly affecting the marga or the channels / siras. Immune factors (Vikar vighatkar bhava) come into play at the site of injury, if they are strong enough no inflammation occurs but if there is faulty response inflammation occurs at the site of injury (kha vaigunya). Inflamed endothelium now leads to coagulopathy. Thrombus signs does formed causes obstruction to the flow of blood leading to symptoms like localized redness and swelling (sa raga swayathu mandala), pain or burning along the length of the vein ( sa daha arti tvak mansa antarja bhrusam) and veins become hard and cord like ( darunta).
           ERYTHROMELALGIA  is a rare neurovascular peripheral pain disorder (arti) in which blood vessels, usually in the lower extremity or hands are episodically blocked frequently (on and off daily) then become hyperemic and inflame (rasa, swayathu). The attacks are produced and are commonly triggered by heat, pressure, mild activity, exertion, insomnia or stress.
             It is classified into two primary and secondary. The primary type resembles the second phase of vatarakta wherein vitiated vata dosha impedes gati of rakta whereas in secondary erythromelagia very specially caused due to essential thrombocytosis resemble rakta avrita vata.
Conclusion: Rakta avritta vata is a process of pathogenesis wherein raktavriddhi (quantitative increase of rakta) impedes the gati of vata which leads to symptoms like pain, redness, burning sensation and localized inflammation. The symptoms can be observed in various diseases like erythromelalgia, phlebitis, PRV and apparent erythrocytosis. Thus raktavritta vata is not a single disease but initial factor of pathology.
          Raktamokshana reduces quantitative increase of blood. Virechan is the best shodhan procedure for raktadusti. Fluid loss due to virechan also has impact on intravascular quantity of fluid plasma does reducing the avarodh.
           Shita pradeha mainly medicines like dashanga lepa, kamala, ushira, yastimadhu, sariva, chandan, padmak, darbha etc drugs helps to reduce local inflammatory response. Anti thrombotic effect of darbha, kamala also reduces the avarodh to the gati of vata.
Medicines which reduces avarodh of rakta and quantitative increase of rakta alongwith which reduces inflammation of siras is helpful in rakta avrita vata.
Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com

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