Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Peripheral Vascular Diseases (PVD) comprises any condition, disease or disorder which affects the blood vessels / circulatory system outside of the brain and heart. It is the most common disease which affects the arteries. Atherosclerosis is a common condition which primarily causes PVD. Atherosclerosis is marked by gradual accumulation and deposition of fatty material inside the blood vessels which eventually causes blocks, narrowing or weakening of arteries.
Atherosclerosis can affect any blood vessel in the body and is often associated with arteries of the brain and heart. The arteries of the legs are most commonly affected in PVDs.
Related Reading – ‘Peripheral Vascular Diseases’
Many conditions explained in Ayurveda explain conditions similar to PVDs from the perspective of either similarity in causative factors, pathogenesis, symptoms or complications.
Related Reading – ‘Peripheral Vascular Diseases – Ayurveda Understanding’
Among these conditions, ‘VATARAKTA’ or Vatashonita seems to be a condition which closely resembles Peripheral Vascular Diseases from many perspectives i.e. aetiology, pathogenesis, symptoms and complications. The treatment principles, therapies and medicines explained in the context of Vatashonita are applicable in treating PVDs. They also have yielded good results and relief to the patients of PVDs.
In this article we shall discuss in brief, the similarities between Vatarakta and Peripheral Vascular Disorders.
Peripheral Vascular Diseases v/s Vatarakta
From the perspective of Etiological Factors & Pathogenesis
PVDs are mainly caused due to the narrowing or blockage of blood vessels, mainly due to atherosclerosis.
Vatarakta is caused due to enveloping followed by obstruction to free movements of vata by abnormally increased rakta – blood. When this happens, there is occlusion to free flow of blood in the blood vessels. This mechanism also shows narrowing or blockage occurring inside the blood vessels.
Atherosclerosis is caused due to buildup of fatty substances which accumulate in the walls of the arteries. Fat buildup can take place due to excessive consumption of fat rich foods and when fats do not digest well in the body. Though Ayurveda has not directly mentioned the occlusion of blood vessels by fat, the Acharyas have mentioned certain things in the list of aetiological factors which are contributory towards fat buildup and consequent accumulation. Snigdha bhojana – unctuous or fat rich foods, Anupa Mamsa – meat of animals living in marshy places, Mishtanna Sukhabhojana – excessive consumption of calorie rich foods and Achankramanashila – lack of physical exercises or sedentary life – have been mentioned amongst the etiological factors (nidana) which are potential enough to cause medo vriddhi i.e. pathological increase of fat in the body.
The blockage of channels of the body by increased fat is called Medo Avruta Marga. This is an important pathway which leads to depletion of other tissues of the body due to lack of nutrition. On the other side there will be an increase of ‘only fat’ at the cost of other tissues. This event leads to manifestation of many symptoms similar to those of Vatarakta and also PVDs.
The tissue depletion which takes place in this event eventually causes abnormal increase of vata in the channels, blood vessels in this context. This increased vata is responsible for pain and other symptoms in both PVD and Vatarakta.
A condition called as Sarakta Medas explained in the context of Prameha (Diabetes and related disorders) explains the event of atherosclerosis. Sarakta Medas indicate fat buildup in the blood / blood vessels. Prameha is caused due to contamination of medovaha srotas – fat transporting channels. Diabetes is also mentioned to be one of the causative factors of PVDs. Prameha, Medoroga and Vatarakta are all Santarpanottha Rogas – caused due to excessive and unwanted nutrition combined with sedentary lifestyle.
Prameha and Medoroga can lead to Vatarakta and Vatarakta will have symptoms similar to PVDs. Diabetes and Obesity are causative factors and also risk factors for PVDs.
Injury is one of the main causative factors for PVDs. Abhighata has been mentioned amongst the Nidanas of Vatarakta. Also, excessive and regular indulgence in riding the animals, swimming, jumping, long distance running and walking, have been mentioned amongst the etiological factors of Vatarakta, which can all cause injuries and cause symptoms similar to those of PVDs.
From the perspective of Symptoms of PVDs
Pain & related pathogenesis of Vatarakta
Mainly pain of PVDs are similar in nature to those of Vatarakta. The free movement of vata in the blood vessels is hampered by the aggravated rakta (blood which has increased in quantity will block the vata in the blood vessels). When these two aggravated components i.e. vata and rakta combine, they cause vatarakta. This pathogenesis is mainly responsible for all the symptoms of vatarakta including severe pain. Similar pathogenesis can be found explained in the context of PVDs, wherein increased fat deposits cause obstruction to flow of blood leading to symptoms of the disease.
Understanding the other symptoms of PVDs from Ayurveda perspective
Intermittent claudication – pain that comes and goes, typically in calves, thighs or hips, mainly occurring during activities and subsides at rest. ‘Sandhishu ruk bhutva bhutva vinashyati…’ has been mentioned in the context of premonitory symptoms of Vatarakta which means – ‘pain appears and disappears repeatedly at frequent intervals in the joints’. Though ‘joints’ has been mentioned, it can generally be understood as ‘lower limbs’. This can become worse once the disease progresses and transits from premonitory to stage of manifestation.
Pricking pain and other symptoms – Pricking pain, twitching, splitting pain, heaviness and numbness are manifested in the knees, calves, thighs, navel, shoulders, hands, feet and joints of the body. These premonitory symptoms of Vatarakta according to Ayurveda, are not just manifested in the lower limbs but are also manifested in the upper limbs, abdomen and joints of the body.
Modern medicine has mentioned butt pain, numbness (supti), tingling (chimachimayana) and weakness (daurbalya) in legs amongst the symptoms of PVDs.
Symptoms of Raktaja Vatarakta and PVDs – Bhrusha Ruk – severe pain, toda – pricking pain and chimachimayana tingling sensation are symptoms of Raktaja Vatarakta, which are also symptoms of PVDs.
Pain of ‘types of Vatarakta’ and nature of pain in PVDs – Pricking pain and throbbing sensation are also the symptoms of Uttana Vatarakta – Vatarakta present superficially and limited to skin and muscles. Severe pain is also present in Uttana, Gambhira and Vataja Vatarakta, as symptoms.
Numbness – Numbness is a symptom of PVDs and is also a symptom of Kaphaja Vatarakta.
Foot pain, Toe pain and Burning sensation in feet and toes – While burning sensation or pain in feet and toes are mentioned in PVD, Vatarakta has been explained to have its origin in the foot with pain in toes and burning sensation due to the nature of the disease. Burning sensation and pain are predominant symptoms of Uttana Vatarakta, Raktaja Vatarakta and Pittaja Vatarakta.
Burning sensation and other symptoms of Gambhira Vatarakta – Daha – burning sensation, toda – pricking sensation and sphurana – pulsative pain are characteristic of Gambhira Vatarakta – Vatarakta located in deeper tissues like fat, bones, bone marrow and semen.
Non-healing ulcers, stubborn sores, suppuration, discolouration and gangrene – Non-healing ulcers or sores on the legs or feet is characteristic of PVD. Paka – suppuration has been mentioned amongst the symptoms of Gambhira Vatarakta. Suppuration can lead to non-healing ulcers or sores.
Karshnya – blackish discolouration, roukshya – dryness and shyavata – brownish discolouration are the symptoms of Vatarakta predominantly caused by aggravated vata – Vataja Vatarakta. These types of discolouration also indicate suppuration and formation of non-healing ulcers. Suppuration is also present in Pittaja Vatarakta. Kleda which is a symptom of Raktaja Vatarakta also means sloughing which is an effect of decay of tissues following suppuration.
Mamsa kotha – sloughing of muscles and Paka – suppuration are complications of Vatarakta, so is of PVDs. Mamsa Kotha can be compared to gangrene, which has been counted amongst the complications of PVDs.
Discolouration and cold feet – Discolouration and coldness of legs or feet are the symptoms of PVD. Shyavata and Karshnyata depicting discolouration and Shita Pradvesha (aversion of cold because there is excessive coldness in the body) are the symptoms of Vataja Vatarakta. Discolouration is also a symptom of uttana, gambhira and raktaja vatarakta.
From the perspective of seats of manifestation of symptoms
PVD manifests with pain in butts, numbness, tingling or weakness in legs, burning sensation in feet or toes, non-healing sores on legs or feet, discolouration in feet. So, all symptoms manifest mainly in lower limbs. Intermittent claudication of PVDs manifest in calves, thighs or hips – lower limbs to be precise. There is also heaviness, tightness or tiredness in the legs.
In Vatarakta too, the pain starts from the padamula i.e., feet and involves the entire lower limb in due course of time.
PVD is also said to cause pain or discomfort in the upper back, neck, jaw or shoulder. It also causes sudden numbness, weakness or paralysis in the face, arm or leg. It causes difficulty in walking, loss of balance or coordination. So, the impact of the disease is beyond lower limbs.
Vatarakta too affects kara – hands, pada – feet, anguli – fingers and toes, sarva sandhi – all joints but they are said to have their origin from the roots of hands or feet and later spread to other parts of the body.
To sum up,
Peripheral Vascular Disease shows so much resemblance with the spectrum of Vatarakta. It is also found that the treatments and medicines prescribed under the context of Vatarakta give immensely good results and relief when administered to those suffering from peripheral vascular diseases. The same has been my clinical experience too.