HERBS

GOUT (GOUTY ARTHRITIS)

ABOUT THE DISEASE

It is a disorder caused by tissue accumulation of excessive amount of uric acid. Uric acid is formed by metabolic breakdown of the Purines. Purine is formed by breakdown of protein in body cells and also it is present in certain foods we eat.

Few examples of Purine rich foods include – Seafood, Tea, coffee, Milk products, Meat, Alcoholic beverages, Beans, Mushrooms, Spinach, Cauliflower etc.

Normal uric acid levels are 2 - 6 mg/dl in females and 3.2 – 7 mg/dl in males.

Increased uric acid level in blood is known as Hyperuricemia.

Accumulation of uric acid in the form of crystals (Mono sodium urate crystals) in joints is called as Gout. The crystalline aggregates are termed as “Tophii”.

The deposition of MSU crystals is maximum in great toe because of lowest temperature in toe.

Increased levels of uric acid in the body result from :

  • Overproduction or
  • reduced excretion of uric acid or from both.

CLINICAL FEATURES

Signs and symptoms includes:-

  • Rapid onset of pain, small joints like finger joints, toes, ankle joint, wrist joint are more commonly involved.
  • Most commonly pain starts in great toe.
  • The nature of pain is severe, often waking the patient in the early morning.
  • Some patients may complain of difficulty in wearing socks.
  • Other clinical features include tenderness in the joints, marked swelling, difficulty in movement of joints, lethargy and sometimes fever.

AYURVEDIC VIEW

In Ayurvedic literatures, the condition resembling “Gout” has been described under “Vatarakta”.

Vatarakta is a disorder in which Vata Dosha and Rakta gets aggravated independently leading to pain and swelling in the small joints of the body.

ETIOLOGICAL FACTORS

  • Excessive intake of salty, alkaline, sour, spicy, oily or dry food.
  • Excessive intake of meat products.
  • Excessive intake of fermented products like curd, alcoholic beverages, vinegar, buttermilk etc.
  • Irregular eating habits or fasting for prolonged period.
  • Eating during indigestion or overeating.
  • Excessive physical exertion.
  • Holding of natural urges.
  • Physical trauma

According to Acharyas, Vatarakta is commonly found in patients with following physical traits – Delicate, obese and comfort loving, having a sedentary life style and having calorie rich diet.

PATHOGENESIS

The intake of etiological factors mentioned earlier lead to aggravation of Vata and Rakta . The vitiated Doshas travel through the channels (srotasas or microcirculation) of the body It gets accumulated at the joints (smaller joints first) causing Vatarakta.

CLINICAL FEATURES

Acharya charak has described two types of Vatarakta which can be correlated to its stages:-

(a) Uttana Vatarakta – In this stage, Doshas are situated in Twacha and Mansa dhatu i.e. in superficial dhatus. The clinical features includes:-

  • Itching on the skin.
  • Burning sensation on the skin.
  • Pain – pricking type of pain.
  • Tingling and spasm.
  • Deformities in body parts.
  • Dark Reddish discoloration of skin in the affected part.

(b) Gambhira Vatarakta – In this stage, Doshas are situated in Asthi and Sandhi Dhatu. The clinical features includes:-

  • Stiffness and swelling in joints.
  • Pain in the affected part of body.
  • Dark or copper coloured discoloration of the skin.
  • Burning, pricking, tingling sensation or feeling of heat in the joints.

PRINCIPLE OF TREATMENT

The main line of treatment of Vatarakta includes Vata and Pitta pacifying treatment along with Raktashodhak treatment.

For Uttana Vatarakta, external treatment measures are main line of treatment which include –

Alepa - local application of medicines in paste form.
Abhyanga - local massage.
Parisheka - pouring of medicinal decoctions on the affected body part.
Upnaha - local bandaging.

In case of Gambhira Vatarakta internal administration of medicines according to the dosha involved, local administration of medicines in the joint involved and Panchkarma therapies like Raktamokshana, Virechana, Snehpana, Basti chikitsa are main treatment modalities.

MEDICINES

1. Single herbs - Sariva (Hemidesmus indicus), Gorakhmundi (sphaeranthus indicus), Giloy (Tinospora cordifolia), Manjistha (Rubia cordifolia), Pippali (Piper longum), Amalki (Phyllanthus emblica), Nimba (Azadirachta indica), Mulethi (Glycyrrhiza glabra), Haritki (Terminalia chebula), Amaltas (Cassia fistula), Shatavari (Asparagus racemosus), Gokshura (Tribulus terrestris), Patola (Trichosanthes dioca), Dhanyak (Coriandrum sativum), Kutki (Picrorhiza kurroa), Bhringraj (Eclipta alba).

2. Powders – Panchnimbadi churna, Chopchinyadi churna, Manjisthadi churna, Avipattikar churna, Giloy satva.

3. Tablets – Kaishor guggulu, Punarnava guggulu, Gokshuradi guggulu, Amritadi guggulu, Punarnava mandoor, Prawal panchamrit, Arogyavardhini vati.

4. Kwath (Herbal decoctions) - Navkarshik kashaya, Patoladi kwath, Dashmool kwath, Amritadi kwaath, Punarnavadi kwaath.

5. Asava/Arishta (alcoholic preparations) – Sarivadyasava, Khadirarishta, Manjitharishta, Amritasava, Chandanasava.

5. Asava/Arishta (alcoholic preparations) – Sarivadyasava, Khadirarishta, Manjitharishta, Amritasava, Chandanasava.

7. Lep (Paste applications) – Dashang lepa, Tiladi lepa.

HOME REMEDIES

1. Drink at least 8-10 glasses of water every day. This helps in flushing out of excess uric acid from the body.

2. Ginger and turmeric are natural anti inflammatory agents. Intake of ginger and turmeric in the form of tea or powder helps in reduction of pain and swelling in the joints.

3. Avoid purine rich foods like Seafood, Tea, coffee, milk products, meat, Alcoholic beverages, sugar, beans, mushrooms, spinach, cauliflower, etc.

4. Foods that are helpful in gout includes – Fruits like Bananas, orange, melon, coconut water, apricot, fruit berries, fish oil, Bottle gourd, wheat products etc.

5. Increase the intake of vitamin C rich food like Amla or lemon juice in your diet. This also helps in elimination of excess uric acid from body.

6. Exercise regularly - Regular mild exercise helps in improving the blood circulation of the body, improves the metabolism which help in reducing the uric acid levels.

7. Regular intake of Giloy juice helps in effective reduction of uric acid

Disclaimer

The purpose of Ayurvidya is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider regarding your medical condition or treatment and before undertaking any new health care regimen.