Introduction:

Gout is known as the king of disease or the rich man’s disease. According to ayurved it is known as aadhya-vata or vata-rakta (disease due to vitiation of blood and vata dosha) which strongly support the role of sedentary lifestyle and dietary habits in gout. Prevalence of gout has approximately doubled between 1990 and 2010. This rise is believed to be due to increasing life expectancy. Changes in diet and an increase in disease associated with gout, such as metabolic syndrome and high blood pressure. In men over the age of 30 and women over the age of 50 prevalence is 2%.

In humans uric acid is the final oxidation product of purine metabolism and is excreted in urine. When the level of uric acid increases in blood more than normal levels i.e. 6mg/dl (female) and 7mg/dl (male) the uric acid forms microscopic crystals in joints lead to inflammation of joints.

According to ayurveda, gout is a result of the imbalance of vata dosha which upsets the blood circulation of the body and the best way to treat it is by rebalancing the dosha.

Causes of gout:

1. Sedentary work
2. Obesity
3. Lack of sleep
4. Virudhha aahar sevan (consuming opposite food)
5. Alcohol
6. Indigestion
7. Excess of consumption of salty, hot, spicy, oily foods.

Signs and symptoms:

• Most usual symptom is a recurrent attack of acute inflammatory arthritis.
• Big toe is most affected often.
• Other joints, such as heels, knees, wrists and fingers may also be affected.
• Other symptoms may include fatigue and fever, tingling sensation, hyper aesthesia, numbness, appearance of rashes and patches on skin.
• Long standing hyperuricemia may result in other symptoms, including hard, painless diposits of uric acid crystals known as tophi. Extensive tophi may lead to chronic arthritis due to bone erosion.

Ayurvedic management:

Management of gout varies from patient to patient and depends upon the individuals physical and psychological constitution (doshaj prakruti). Management can be summarized under following headings:

1. Diet and Lifestyle Changes
2. Panchakarma Therapy
3. Yoga and Exercise
4. Medication

Diet and lifestyle changes that are effective include reducing intake of food such as meat and seafood, consuming adequate vitamin C, limiting alcohol consumption and avoiding obesity. Vitamin C intake of 1500mg/day decreases the risk of gout by 45% compared to 250mg/day. Coffee but not tea consumption is associate with lower risk of gout.

Diet: Every eatable that aids in uric acid production should be avoidable. Such foods normally belongs to purine rich category and include:

1. Yeast
2. Legumes
3. Fish and meat
4. Chocolate, cocoa
5. Organ meat

Recommended food which may be beneficial to people with gout include:

• Plenty of water to flush out the toxins from the blood and to make kidney work properly.
• A vegan diet is considered beneficial in ayurveda for the treatment of gout.
• Celery is one of the most beneficial items that help in treatment of gout. Celery helps in reducing the acidic content of the body.
• Fruits, nuts, berries may be consumed in liberal amounts so that urine is neutral or near alkaline.

Panchakarma Therapy

Detoxification therapy like medicated enema and purgation along with oil massage decrease the concentration of plasma uric acid level and its inflammatory stages in both acute and chronic condition.

Yoga and Exercise

• A person with gout should do exercise for at least 30 minutes a day.
• Surya namaskar along with stretching exercise can loosen up the muscles.
• In addition to regular exercise be sure to strive to live a balanced life.

Medication

A number of herbs and their compound formulations are used for pain removal to reduce the uric acid level and other disturbing features of the disease.

Some of the herbs include:

1. Guduchi/ Tinospora cordifolia
2. Punarnava/ Boerhavia diffusa
3. Manjishtha/ Rubia cordifolia
4. Yashtimadhu/ Glycerryza glabra
5. Ashwagandha/ Withania somnifera
6. Shunthi/ Zinziber officinale

Kaishore guggul is the drug of choice for the treatment of this condition.

Trifala is an effective ayurvedic herbal product prepared with herbs such as amalaki, haritaki, bibhitak, which have antigout power. Navkarshik churna is an herbal formula mentioned in Chakradutta. He prepared a mixture of nine herbs, used as an excellent Ayurvedic treatment for gout to purify blood.