Chapter CLXVII - The Nidanam of Vata Raktam

Dhanvantari said:—Now hear me, O Sushruta, discourse on the Nidanam of Vata-raktam. The blood and the bodily Vayu of a person, enraged and aggravated through ingestion of incompatible articles of fare, or through indulgence in day sleep or extreme irascibility, or through excessive night keeping, produces the disease known as Vata Raktam. Persons of soft or delicate physical temperament, as well as fat men and persons of luxurious living are extremely susceptible to an attack of Vata-Raktam. Similarly, a blow or an injury to any part of the body, may lead to vitiation of blood, and the bodily Vayu, deranged through ingestion of extremely cold, phlegmagoguic articles of fare, follows a wrong path; or on the other hand the Vayu obstructed in its course by the blood, vitiated through aforesaid causes, first produces its own specific symptoms. The disease is so named from the fact that the bodily Vayu is first deranged. Profuse perspiration (in most cases), emaciation of the body, anæsthesia, or an excruciating pain in a pre-existing ulcar, looseness of the joints, lassitude with a gone feeling in the limbs, pustular eruptions with an aching, breaking, piercing, throbbing pain in the thighs, knee-joints, and calves of legs, and about the sacrum and joints of the extremities, heaviness and loss of sensation in the foregoing parts and numbness of the body, itching sensation in the affected localities, heaviness of the limbs, pain in (the affected parts) which vanishes at intervals, discolouration of the skin and appearance of circular patches on the skin are the symptoms which mark the premonitory stage of Vata-Raktam.

In the Vataja type of this disease the patient suffers from an extremely excruciating pain in the affected parts, which become further characterized by an aching, throbbing pain. The swelling is felt rough to the touch and assumes a black or reddish-brown hue, spontaneously increasing or decreasing at intervals. The body seems numbed and extremely painful, the joints and vessels of fingers become contracted, and the patient evinces a repugnance for cold which fails to give any relief whatsoever. The numbness of the body becomes prominent, and the patient suffers from rigour and a complete anaesthesia in the affected parts.

In the type marked by predominant action of the enraged and vitiated blood, the swelling is marked by a greater aching pain, and becomes copper coloured. The disease does not yield to emulsive or parchifying measures (such as fomentation etc.,) and is marked by a tingling sensation. The patient feels an irresistible tendency to scratch the patches which exude a slimy discharge. In the Pittaja type of Vata-Raktam, perspiration with a burning sensation in the body, vertigo, epileptic fits, thirst and distraction of the mind are the symptoms which manifest themselves. The swelling can not bear the least touch, becomes red and hot, and is ultimately found to suppurate.

In the Kaphaja type of Vata-Raktam, heaviness, coldness, and anaesthesia of the affected parts become manifest. The swelling looks glossy, is marked by a slight pain and an itching sensation, and seems as if it has been tied with a wet compress. Types of Vata-Raktam, which are connected with the action of any two of the Doshas (morbific principles of Vayu, Pittam and Kaphah), exhibit symptoms which are respectively peculiar to types brought about through their several actions, while the type, which is due to the concerted action of all the three Doshas, combinedly develop the symptoms, severally belonging to the Vataja, Pittaja and Kaphaja types of Vata-Raktam.

The virus, like the poison of a mouse, first affects the lower parts of the legs, or is seen to invade the extremities of hands in certain instances, and thenceforth spreads over the whole organism. A case of Vata-Raktam, which has extended upward to the thighs, and in which the skin of the affected part breaks and exudes a discharge, and in which the patient suffers from loss of strength and flesh, or which is complicated with a host of other distressing symptoms, should be regarded as incurable, while palliation is the only treatment in a case of more than a year’s standing. Similarly, cases of Vata-Raktam marked by such supervening distresses as, insomnia with a non-relish for food, dyspnœa, sloughing of flesh, hemicrania, epileptic, fits, vertigo, pain, thirst, fever, loss of consciousness, rigour, hiccough, maimedness of gait, erysipelas, suppuration (of the affected parts), langour, curvature of the fingers, crops of pustular eruptions with a burning sensation in the body, and tumours with a catching pain at any of the nerve-unions, bone-unions, or vein-unions, as well as the one which is accompanied by epileptic fits alone, should be understood as incurable. Cases of Vata-Raktam, uncomplicated with any distressing, supervening symptoms, are curable, while those attended with a few concomitants admit only of palliative treatment. Cases of Vata-Raktam originated through the action of a single Dosha (morbific principle) are curable, while those of recent origin, and at the root of which only two Doshas lie, admit of palliative treatment. Cases of Vata-Raktam of which the three Doshas conjointly act as the exciting factors, as well as those which are connected with a host of other complications, should be regarded as incurable.