Ayurvedic perspective of vasculitis
Vasculitis is defined as an inflammatory condition of blood vessels. The pathology is usually deep and affects the walls of blood vessels causing structural and functional changes. Mainly it changes the thickness of the walls of vessels that carry blood. Thickening of the walls is usually observed, which causes restricted or obstructed blood flow to the affected area and further. It can lead to damage of tissues and in some cases, a complete organ can be damaged.
Vasculitis is not a common disease. It develops in many forms and many come under a rare group of diseases. It can affect any person irrespective of gender age or race yet some types are more commonly seen in specific age groups. It may affect a tissue, a group of tissues, or an organ either partly or completely. Whether it is cured in a short while or it stands with you for a long time depends upon many factors like the type of the disease and the area affected etc. Some cases resolve on their own and do not even need treatment. But most types are managed with medications to control inflammation, especially during flare-ups.
Speaking of vasculitis, there are many types and many syndromes are coming under this group. For eg. Wegner Granulomatosis, Behcet’s disease, Buerger’s disease, Churg-Strauss syndrome, Takayasu’s arteritis, Kawasaki disease etc. Each one of them is considered, diagnosed and managed as a separate disease in most cases. We can not find a very common line of treatment for all types of vasculitis. Considering signs and symptoms, some common manifestations are developed in almost all types of vasculitis. As all of them share a common pathology involving inflammation of blood vessels, they present with fever, severe fatigue, headaches, weight loss, and generalised or shifting types of aches and pains. Not all but some of these will be present in every case of vasculitis. Other signs and symptoms depend upon the type of disease and the area of the body affected. For example, you may develop a sudden breathing disorder when your lungs are affected by vasculitis.
The exact cause of vasculitis is not completely known yet. Experts say genetic and environmental factors play important roles as many vasculitis syndromes are considered autoimmune diseases. Deranged immunity can also trigger inflammation. Many vasculitis syndromes are diagnosed by direct consultation. But a biopsy of the blood vessels of the affected organ or area only gives a confirmation. Though the diagnosis is possible, treatment options are very few. Symptomatic and conservative management is done in most cases. In flare-ups, drugs like prednisone are used to control the inflammation. As it is a corticosteroid, there are potential adverse effects. It should not be used for the long term.
Depending on the type and severity, vasculitis can cause many complications including tissue damage, Organ failure, Blood clots, aneurysms, Vision problems including blindness, and many other infections.
The main diseases coming under vasculitis are:
- Behcet’s disease – considered to be an autoimmune disease with flare-ups and normal periods in severe cases. It involves inflammation of blood vessels all over the body, and manifestation and severity dependent upon the area affected more. Mouth ulcerations, acne-like blisters, redness, pain & swelling in joints etc. are seen in most people. When it affects the eyes, uveitis develops.
- Buerger’s disease – It is also called thrombo-angitis obliterans (TAO). The blood vessels, mainly of hands and feet become inflamed and swollen. They are also blocked with blood clots called thrombi. Tingling sensation and numbness in the hands and feet are seen. Pain, especially claudication pain, inflamed veins under the skin, are some other observations. In some cases, Raynaud’s phenomenon is also associated with TAO. Sores and ulcerations develop, more in extremities. As the circulation is compromised, the tissue gets damaged, the area gets infected and eventually, gangrene may develop. Most cases are seen in tobacco users mainly smokers.
- Wegener’s disease –is also called granulomatosis with polyangiitis. It is characterised by harmful inflammatory tissue masses (granulomas). It is an inflammatory condition of blood vessels and can affect any tissue or organ which get damaged by the reduced blood flow. But it mainly affects the ears, nose & throat, lungs and kidneys. Main presentations are confined to respiratory and renal systems but varied presentations are possible. Main signs include pain in the sinuses, fatigue, cough, shortness of breath, fever, joint pain, blood in urine and hearing loss. Confirmatory diagnosis is biopsy and treatment options include immunosuppressants and steroids.
- Systemic Lupus erythematosus or SLE – Also called simply lupus, this is the most familiar among vasculitis. An inflammatory disease of autoimmune nature, in which the immune system attacks its healthy tissues by mistake. It can affect many organs and systems in the body including the skin, joints, heart, brain and kidneys. Symptoms vary widely according to each person. But mostly severe tiredness, fever, joint pains and skin rashes are seen. Although all the discomforts may not be manifested in each person, there are numerous signs & symptoms elaborated as per the area and severity of pathology affected, like severe pain in muscles, chest pain, anaemia, blood in the urine, hair loss, mouth ulcers, swelling and weight loss. There can be anxiety or depression present. There can be flare-ups and periods of normalcy followed. There is no permanent cure for SLE, only symptomatic management to control flare-ups are available. It includes lifestyle management, anti-inflammatory drugs and steroids.
Ayurvedic perspective of vasculitis and its management
Ayurvedic way of understanding diseases is different from the familiar modern way. Ayurveda explains Doshas or humours as the functional units in the body, which bless the body with positive health when they are in a balanced state. The same doshas, when imbalanced, cause all the diseases in the body and they also afflict the mind in various disease conditions. Doshas are three in number, Vaata the air component, Pitta the fire component and Kapha, the water component. Together they bless each other in quantity and quality to work as a team for stable metabolism a healthy person.
As doshas are the functional components, there are structural components called the dhatus. They comprise almost all the body tissues and they are seven types. As structural units, growth and development depend upon dhatus. Rakta is the second dhatu, including the circulatory system. It is produced from rasadhatu by the action of bhutagni and dhaatwagni. Teja(fire) and jala (water) mahabhootas are dominant in rakta. The role of raktadhaatu in the human body is jeevanam or maintaining life itself. Raktadhatu is produced in yakrt and pleeha mainly and get circulated through raktavahasrotas or channels which carry rakta. In vasculitis conditions, the channels which carry raktadhatu get damaged in structure and thereby function of raktadhaatu is affected. Due to asraya-asrayi bandha, Pitta dosha gets vitiated in diseases where raktadhatu is involved.
Many disease conditions in Ayurveda involve presentations similar to vasculitis. Kushtha (deep-rooted skin diseases), Vaatarakta (inflammatory joint disease), Visarpa (inflammatory and fast-spreading blisters like in herpes), share many stages of clinical manifestation of vasculitis. There is no directly named correlation for vasculitis in Ayurveda. But clinically most cases can be compared with Vaatarakta considering both the nidana, poorvarupa and lakshana. Ayurveda treats patients only, not the disease. So there is no need to name a disease, but a Vaidya should understand the condition in Ayurvedic terms.
Main nidana or causative factors for Vaatarakta are:
- Food which is Vidaahi (causing indigestion&acidity), viruddham (opposite in potency) & asrkpradooshanam (that which vitiates Raktadhatu)
- Unwholesome habits of sleep & waking up,
- Unhealthy regimens and acts of sex
- Intolerant personality
- Sedentary lifestyle
- Injury or stress including physical and mental trauma
- Absence of timely cleaning of the body through Sodhanakriya (panchakarma)
- Rakta-vitiating factors with the usage of Vaata-vitiating factors and cold diet & regimen
Poorvaroopa or prodromal symptoms are similar to Kushtha (severe skin disease affecting deeper dhatus). Due to nidaana or causative factors, vitiated Vaata & Rakta travel through an abnormal path in the body. They get obstructed at sites where structural or functional anomalies are present in channels and the disease gets manifested. There are many signs and symptoms of Vaatarakta described in Ayurvedic classics including Saada (fatigue), Slathangatha (feeling of loose joints & body), Kandu(itching), Sphurana(throbbing), nisthoda (pricking pain), bheda (piercing pain), gaurava(heaviness), suptata(numbness) of joints especially jaanu(knee), jangha(calf), ooru(thigh), kati(sacrum), amsa(shoulder), hasta(arms), paada(legs) and angasandhishu (in joints of the body).
Vaatarakta is a disease with chronic pathology. It can be cured only if the disease pathology is of less than one year. After one year, the disease gets Yaapya or manageable with medicines and therapies. The treatment depends upon the stage in pathogenesis, whether it is in uttanam (affecting superficial layers and dhatus) or gambheeram(affecting the deeper layers and dhatus).
As the vitiated Raktadhatu circulates all over the body with a fastly acting pathogenesis, ayurvedic treatment for vasculitis starts with bringing back to the excess & vitiated Rakta by raktamoksha (bloodletting) in suitable patients. It is done either after using Sneha therapy or as an emergency procedure where the inflammation is severe. Raktamoksha should be done with letting out blood in small quantities, intermittently, considering the strength of the patient.
Other therapies are also performed according to the clinical presentation. Lepanam or external application of herbal pastes help reduce swelling and inflammation, thereby help relieve pain and improve mobility of the area, especially in joints. Dasamoolam, a combination of roots of ten herbal trees are used for this purpose. It is also used in the form of Parishekam or pouring warm decoction over the area for one hour or till the pain subsides. As vasculitis involves Raktadhatu, it needs alternate use of Heat and cold to get relief. Excess heat or cold will worsen the condition. Mild therapeutic sweating with various kinds of pindasweda(poultices), or upanaha(warm herbal paste with a bandage covering) can help, especially in the early stages to reduce the thickening of vessel walls and to restore the blood flow. But when done too much, this can lead to haemorrhage.
Virechana or therapeutic purgation is the most advised Panchakarma procedure to balance Pitta, thereby Rakta here. It is done as an in-house procedure under medical supervision with prescribed pre-and post-operative procedures. Also, daily intake of medicines for a mild laxative effect like small doses of Avipattichoornam is beneficial. Basti procedures added with manjishtha, padma and ksheera are also done in many cases, considering the manifestations in joints and locomotor system. In patients with respiratory discomforts, vamana or therapeutic emesis will be helpful. Commonly used internal medicines include Manjishthadi kashayam, mahamanjishthadi kashayam, guduchyadi kashayam, drakshadi kashayam, guduchisattwam, kokilakshakam kwatham and avipatti choornam. Proper diet, exercise and a healthy lifestyle are very important. Yoga or any other exercises are not advised during a painful flare up with severe inflammation. Regular stretching and mild cardio exercises are advised in the normal period. Yogacharya including naadisuddhi pranayama, sookshmasandhivyayama, suryanamaskaara is recommended to maintain balance.
Ayurveda does not suggest a this-medicine for a this-disease type of management for any condition. It involves a holistic methodology to correct the structural or functional anomaly by removing the causative factors that led to the disease and balancing the metabolism. Everything you eat, you speak or even you think matters on a subtle level that contributes to your health. It starts with getting up early, following a proper daily routine is a part of healthy healing. Avoiding anything bad for health, leading a healthy life with proper diet, exercise, daily routine, seasonal regimen and cleaning the body from time-to-time etc are part of it. Vasculitis conditions can be managed well by choosing to live the ayurvedic way.