Clinical Effect of Raktamokshan W.S.R. to Shiravedha in Vatakantaka: A Case Report

Introduction

The word Vata denotes the movement and it is the main cause for action. Kantaka means the point of the needle like thorn which is troublesome and produces sharp stinging pain. Similarly Vatakantaka is one of the clinical condition which is considered as a Vatavyadhi by Acharya Sushruta [1] and Acharya Vagbhata [1]. It is mainly caused due vitiation of Vata Dosha occurring due to improper placement of heel while walking, running etc or by frequently walking on uneven surfaced. Due to which aggravated Vata gets seated in Gulfa Sandhi which causes pricking pain [2].

Plantar Fasciitis has similar pathology and clinical presentation like Vatakantaka. It is a chronic inflammation of plantar fascia caused by collagen degeneration associated with repetitive micro trauma to the plantar fascia [1]. The development of these painful disorders occurs in people who have a sedentary life style, wear high heeled shoes, have unusually high or low arches in the feet or have tight calf muscles or tight Achilles tendon (the tendon that attaches the calf muscles to the heel). People whose occupation involve long standing and walking on hard surface are more prone to develop plantar fasciitis. It is also common among runners and dancers.

Patients suffering from plantar fasciitis feel a great deal of pain, often while placing weight on the foot after waking up in the morning which eventually gets worsened on walking or running and after period of rest. Pain is radiating in nature from bottom to the heel towards the toes. Some people even have burning pain along the inside border of sole while walking. As a part of treatment physical therapy and splinting at night are employed which helps to stretch the calf muscles and fascia during bed rest. Non invasive measures include use of adhesive strapping or arch supporting warps, cold and ice pack massages, use of non steroidal anti-inflammatory drugs (NSAIDs) and frequent corticosteroid injections. Now a day’s extracorporeal pulse activation therapy (EPAT) is been used for the treatment in which pressure waves of sound are applied on heel which stimulates the blood circulation and helps in healing [1]. Plantar Fasciotomy Surgery is reserved for chronic Sufferers [2, 3].

Acharya Bhavmishra has advice Raktamokshan, Eranda Taila Pana and Agnikarma for Vatakantaka [1] Raktamokshan is one among five Karma described for purification of the body which includes various methods but among them Shiravedh and Jalaukavacharna are commonly practice. Raktamokshan is indicated specially when Rakta is mainly involved as Dushya in Samprapti Ghataka [1]. According to the reports presented pain gets relieved locally immediately after the Raktamokshan and gives long term effect. Therefore Ayurveda provides better promising treatment for the absolute relief of pain.

Vatakantaka (Planter Fasciitis) is a common cause of heel pain which is caused due to vitiation of Vatadosh. Vata is vitiated due to walking on irregular or uneven surface, excessive strain on heels and get accumulated in Khudukapradesha (Ankle joint) and causes pain as if pricked by a thorn [4].

Planter Fasciitis is one of the most common conditions of painful heel. Almost 80 percent patients of heel pain are diagnosed as planter fasciitis [5] the clinical features of Vatakantaka can be correlated with the symptoms of Calcaneal spur where there is involvement of Kaphavruta Vayu [6]. Vatakantaka caused mainly due to the vitiation of Vata Dosha occurring due to walking on an uneven ground frequently, placing the feet improperly [7]. As the reference of Acharya Sushruta suggests the disease chronic plantar fasciitis can be correlated with Vatakantaka. Vatakantaka is Snayu Asthi Sandhi Aashrita [8].

Observation and Results

minutes. Then medial side of left foot was cleaned thoroughly with antiseptic solution to maintain hygiene.

Pradhana Karma: B.P. cuff was tied just above the ankle to maintain the pressure. The most tender or painful point on the medial side of the heel was marked and with help of 20 no needle vein was punctured and 10ml of blood was expelled out (Figure 2).

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Paschat Karma: With help of cotton manual pressure was given on the side of puncture to stop the bleeding. After 5 minutes blood was stopped, bandaging was done and patient was asked to walk around. • Second sitting was scheduled after 5 days at morning.

Results

On Observation of sign and symptoms pain, Tenderness, Swelling, Burning sensation, Redness are significantly reduced to from score 3, 2 to 01, and 00. On first seating and second sitting respectively (Tables 3 & 4 and Figure 3).

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Discussion

Vatakantaka is one of the common happening conditions of foot. It can be clinically correlated with plantar fasciitis [9]. Here a single case study was been done in which 2 sittings of Raktamokshan were done with the help of Shiravedh method. On the 1st sitting showed significant relief in pain and burning sensation and gradual relief in tenderness, redness and swelling as shown in Table 1, and Table 2. During 2nd sitting patient had negligible pain and burning sensation and similar results were seen with associated symptoms? Here in the Samprapti of Vatakantaka, Sotha and Araktavarnata clearly mentions the obstructions in the channels of Rakta due to which Snayu and Rakta Dushti takes place which causes pain, tenderness, redness etc symptoms. The severe pain in the morning hours soon after walking up suggest the association of Kapha or Ama Dosha with Vayu and Rakta. Samprapti due to Vataprakopaka Nidana and Samprapti due to Dhatukshayakara Nidana [10].

This pathogenesis is broken by Raktamokshan [11].

Abhyanga and Swedana before Raktmokshan does Vilayan of Dushit Doshas due to which during Shiravedha Doshas easily follows out. Through Shiravedh Dushit Rakta is expelled out due to which obstruction is released. Dushit Rakta along with Ama follows out and Prakrut Vayu and Rakta gains normalcy and starts proper circulation, in results pain along with other symptoms is relieved. As the Vatakantaka is associated with Ama, Eranda Taila Pana and Kaishore Guggulu are selected for oral medications as shown in Figure 3.

Therefore it can be safely concluded that this modality helps in reducing pain, tenderness and burning sensation. It provides resulting relief in the symptoms but sometimes symptoms may reappear for which more regular sittings of Raktmokshan should be done [11]. Raktamokshan is gaining popularity across the globe. Siravedhana Karma physician can demolish the pathogenesis of Vatarakta and should manage the disease [12].

Conclusion

Vatakantaka is a disease which comes under Vatavyadhi Vikar. Pathogenesis and management as per the classics treatment was planned accordingly and case was successfully managed with Ayurvedic treatment. Therefore this demonstrates that this modality in Ayurveda has ability to deal with painful condition without NSAIDs and surgery. Management of pain and tenderness was reduced after the treatment by Raktamokshana [13], Raktamokshana is a treatment modality which helps to treat Vatakantaka, hence a successful attempt was made to incorporate Raktamokshana in the form of Cupping Therapy was adopted in this case [14].