Abstract
Viudha aahar and vihar aggravate the vata and rakta, when aggravated Vata is obstructed by the vitiated Rakta, the excessively aggravated vayu vitiates the entire Rakta. The disease thus is called Vatarakta. The disease Gout can be presented very similar to Vatarakta. Vatarakta is commonest among chronic inflammatory joint disease in which mainly small joints becomes swollen, tender, painful and stiff. The metatarsal–phalangeal joint at the base of the big toe is the most commonly affected.

Today various medications from various pathies are available for treatment of Vatarakta. Definitely allopathic system of medicine has got an important role to play in overcoming agony of pain, restricted movement and disability caused by the articular diseases, but the use of such medicines comes with tremendous side effects. Hence the management of this disease is merely insufficient in other systems of medicine and patients are continuously looking with a hope towards Ayurveda to overcome this challenge, that’s where Ayurvedic treatment has proved its upper hand.

Bhavprakash samhita has described the efficacy of Trivritadi kwatha in the management of Vatarakta. Trivritadi kwatha ghana vati has Vataghna, Pittaghna and Raktashamak Prperties hence it is useful in management of Vatarkta.

Key words- Vatarakta, Trivritadi kwatha ghana vati

Introduction

In present busy and fast life, one can’t follow the rules of ‘Dinacharya’ and ‘Ritucharya’ described in Ayurveda. Due to urbanization, high industrial growth and deforestation at extreme speed our life style has been drastically changed. To cope with this situation everybody have to face hectic, competitive and stressful life. People cannot pay attention to their physical and mental health. Irregular food habits, suppression of natural urges, lack of proper sleep and less time for relaxation are being part of our life, which enhances incidences of many diseases and disorders.

When aggravated Vata is obstructed by the vitiated Rakta, the excessively aggravated vayu vitiates the entire Rakta. The disease thus is called Vatarakta. Vatarakta is commonest among chronic inflammatory joint disease in which mainly small joints becomes swollen, tender, painful and stiff. The metatarsal–phalangeal joint at the base of the big toe is the most commonly affected. Therefore, it has taken the foremost place among the joint disorders.

Bhavprakash samhita has described the efficacy of Trivritadi kwatha in the management of Vatarakta. Vata and Pitta are the main pathological factors of Vatarakta. Trivritadi kwatha ghana vati has Vata-pittaghna properties , hence selected for study

Aim and Objectives

Aim:- To study the efficacy of Trivritadi Kwatha Ghana Vati in the management of Vatarakta.

Objectives:- To observe its adverse effects if any (If reported during trial).

Material and Methods

Materials-
Pre-diagnosed 30 patients of Vatarakta
Drug- Trivritadi kwatha ghana vati (Trivrita, Vidari, Gokshur)

Methods-
This was an exploratory study- open randomized two months, clinical study conducted in Department of Kayachikitsa .
Total of 30 uncomplicated clinically diagnosed cases of Vatarkta were studied during this research work.
Inclusion criteria-

1. Patient having textual signs and symptoms of vatarakta were randomly selected.
2. Patients between age group 25 to 70 years.

Exclusion criteria:-

1. Patients of age below 25 years and above 70 years of either gender.
2. Amavata, Sandhigatavata, Psoriatic arthritis.
3. Gambhir vatarakta (Kotha and Paka yukta).
4. Any other major illness.
5. Hypersensitivity reaction to any drug.

Therapy:-

Route of administration – Oral
Dose – 500mg Twice a day
Bheshaj kala (time)- Vyana and Udana kala (After lunch and dinner)
Duration – 2 Months.
Anupan – Koshnajala (Luke warm water).
Follow up – After every 15 days.

Criteria for Assessment

1. Joint Score: -

Score 3            :           More than 5 joints.
Score 2            :           Joints between 3-5.
Score 1            :           At least 2 joints.
Score 0            :           Less than 2 joints.

1. Duration of Numbness:-

Score 3            :           Above 60 min.
Score 2            :           For 30-59 min.
Score 1            :           For 0-29 min.
Score 0            :           No numbness.

1. Severity of Pain :-(by VAS)

Score 3            :           Severe.
Score 2            :           Moderate.
Score 1            :           Mild.
Score 0            :           Nil.

1. Tenderness :-

Score 3            :           Severe.
Score 2            :           Moderate.
Score 1            :           Mild.
Score 0            :           Nil.

1. Swelling :-

Score 3            :           Severely present.
Score 2            :           Markedly present.
Score 1            :           Slightly present.
Score 0            :           Absent.

1. Local Temperature of affected joints:-

Score 3            :           Severe.
Score 2            :           Moderate.
Score 1            :           Mild.
Score 0            :           If Normal.

1. Grip Strength:-

Score 3            :           Poor (below 48 mm of Hg)
Score 2            :           Moderate (50-148 mm of Hg)
Score 1            :           Mild (150-198 mm of Hg)
Score 0            :           Normal (above 200 mm of Hg)

8. Functional Score:-

Score 3            :           Unable to do.
Score 2            :           With the help of other person or device.
Score 1            :           Able to do with difficulty.
Score 0            :           Able to do without any difficulty.


Relief of Symptoms:-
Good Results           :   Above 75%
Moderate Results     :   50% - 74.9%
Mild Results             :   25% - 49.9%
No Results               :   Below 25%

Investigation- 1. Uric acid   2. E.S.R.

Observations and Results-

Observations Before and After treatment-

Relief of Symptoms:-

Investigation

Uric acid

E.S.R.

Discussion
Discussion in the effect of therapy on symptoms-

Pain in joints :- Trivritadi kwatha Ghana Vati showed on an average 52.3% relief in pain which is statistically highly significant (P<0.001). This proves the significant effect of Trivritadi Kwatha Ghana Vati on joint pain.

Pain is the classical feature of vata dosha. Ushna virya and anulomaka properties of Trivrita and madhur rasa and vipaka, snigdha propeties of Vidari and Gokshur pacifies Vata and Rakta. Removal of obstruction from the way of vata resulting in to Vatanulomana, thus pain in Vatarakta might have been relived.

Swelling :- Trivritadi kwatha Ghana vati showed on an average 56.3% relief in swelling (sandhi shotha) which is statistically highly significant (P<0.001). This proves the significant effect of Trivritadi Kwatha Ghana Vati on swelling.

When vitiated rakta obstruct the sukshma srotasas of body, it causes accumulation of malabhavas i.e. kleda which leads to symptoms sandhi shotha (Swelling over joint). Due to tikta, katu rasa, ushna virya of Trivrita and mutral, Kledaghna and anulomaka properties of Gokshur and Vidari, kleda is excreted out of the body. The factor which causes swelling is excreted out of the body, thus swelling might have been relived.

Numbness :- Trivritadi Kwatha Ghana Vati showed 37.7% effect on reducing numbness, i.e. significant (P<0.001) this might be seen due to Vatashamaka, Vatanulomaka, Dahaprashamak, Balya and Rasayana properties of contents.

Tenderness:- The trial drug also showed significant effect on reducing Tenderness (sparshasahatva) i.e. 46.9% (P<0.001), which was found statistically highly significant. This proves the significant effect of Trivritadi Kwatha Ghana Vati on tenderness.
Tenderness is mainly due to painful inflammatory condition of the affected joints capsule. Trivritadi Kwatha Ghana Vati reduces the inflammation due to vatashamak and anulomaka properties of Trivrita and mutral, anulomaka, vata-pitta shamak properties of Gokshur and Vidari. Once the kleda is excreted out of the body reduces the inflammation thus tenderness might have been reduced.

Local temperature :- Trivritadi Kwatha Ghana Vati showed  50.7%  effect on reducing local temperature of joints i.e highly significant (P<0.001), this might be seen due to madhur rasa and vipaka, sheeta virya, Rakta-Pittashamaka and dahaprashamak properties of Vidari and mutral properties of  Gokshur.

Grip strength :- Trivritadi Kwatha Ghana Vati also showed 42.4% effect on improving of grip strength i.e. Highly significant (P<0.001) , this effect might be due to vedanasthapak, shothaghna, dahaprashamak, balya, rasayan,  vata-pitta shamaka properties of Trivrita, Vidari and Gokshur. It gives strength to the snayu and kandara. Pain in joint, sweeling, warmthness (Local temperature) was reduced therefore grip strength improved.

Effect on Functional capacity :-  The effect of therapy on the functional capacity was assessed. An average improvement of 44.3% was observed. That means drug is highly significant (P<0.001). This proves the significant effect of Trivritadi Kwatha Ghana Vati on functional capacity.

Trivritadi Kwatha Ghana vati reduces pain, swelling, tenderness, local temperature due to their properties so functional capacity significantly improved.

This might be due to Shothahara, Vedanasthapaka, Dahaprashamaka, Balya, Rasayan, Shonitsthapan,Raktaprasadak, Vata-Pitta shamaka properties of Trivritadi Kwatha Ghana Vati as well as nourishment of dhatus by balya, pushtikar, bruhana, snigdha properties of Vidari and Gokshur.

Investigations-

• Comparing the value of Sr.uric acid before and after treatment Trivritadi kwatha Ghana Vati is effective in reducing Sr.Uric acid level as mean before treatment was 8.30 and after treatment was 7.81 which is statistically significant (P<0.001).
• Comparing the value of E.S.R before and after the treatment, it is observed that Trivritadi Kwatha Ghana Vati is effective in reducing E.S.R. level as mean before treatment was 21.96  and after treatment was 16.66  which is statistically significant (P<0.001).

Probable action of Drug:-
Trivritadi Kwatha Ghana Vati-
Trivrita, Vidari, Gokshur are the three ingredients of this formulation.

Trivrita:-  Trivrita is having tikta, katu rasa, katu vipaka, ushna virya, laghu, ruksha, tikshna guna and Anulomaka, Virechaka, Shothahara Shoolahara properties.  Vata and Rakta are the main factors in the Samprapti of Vatarakta. Trivrita is the best known as Sukha-virechaka dravya. Acharya Charaka states that Virechana is the best treatment for Pitta dosha and Rakta is having Ashrayashrayi bhava with Pitta (A.h.su.11/26, Sarvanagasundar Tika) so it pacifies Pitta and Rakta also. Ushna virya and anulomaka properties of Trivrita are also pacifies Vata. Hence Trivrita plays important role in Samprapti bhang.

Vidari:-  Vidari is having madhur rasa, vipaka, sheeta virya, guru, snigdha guna and Vata-Pitta shamaka, Shonitasthapana, Kledaghana, Mutral, Dahaprashamak, Shothaghna and Varnya properties. By above mentioned properties it pacifies Vata, Pitta and Rakta (Rakta is having ashrayashrayi bhava with Pitta, A.h.su.11/26, Sarvanagasundar Tika). Hence vidari takes part in samprapti bhanga of Vatarakta. Vidari is also having Rasayana and Balya properties hence gives strength to the srotas and it is also helpful for apunarbhava chikitsa.

Gokshur:- Gokshur is having Madhur Rasa, Vipaka, Sheeta Virya, Guru, Snigdha guna. Due to these properties Gokshur possess Vata-Pitta Shamaka, Shothahara, Vednasthapak, Mutral, Kledaghna and Anulomaka properties.  By above mentioned properties it pacifies Vata, Pitta and Rakta (Rakta is having Ashrayashrayi bhava with Pitta, A.h.su.11/26, Sarvanagasundar Tika) and takes major part in Samprapti bhanga.

Thus the trial drug Trivritadi Kwatha Ghana vati is effectively acts on Vatarakta.

Conclusion

• Trivritadi Kwatha Ghana Vati is effective in the management of Vatarakta.
• No any adverse effect / No untoward effects was seen in the patients during clinical trial.
• On the basis of observations of the studies, Administration of Trivritadi Kwatha Ghana Vati can be recommended in the management of Vatarakta.

References

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