What is Buerger's disease in Ayurveda?

Buerger’s disease, also known as Thromboangiitis obliterans (TAO) or Winiwarter-Buerger’s disease, is a recurring, progressive inflammation and thrombosis of small and medium arteries and veins. The sight of infestation is the hands and feet.

In this condition,

Peripheral pulses are absent
Due to impaired circulation, sensitivity to cold is increased
There is a change in skin colour, ranging from cyanotic blue to reddish blue
Skin becomes thin and shiny
Hair growth is reduced
Ulcerations and gangrene in the affected area

The major cause of Buerger’s disease is the consumption of tobacco and smoking. As tobacco triggers an immune response, it unmasks a clotting defect, which leads to an inflammatory reaction of the vessel wall. The listed symptoms can be correlated to an imbalance in the vata and pitta doshas in Ayurveda. It can also be classified under “Vatarakta” or “Raktavaha Srotas Dushti” due to conditions like impaired circulation, inflammation, and pain being involved.

Let’s understand the concepts more clearly.

Ayurvedic understanding of Buerger's disease

1. Vatarakta and Buerger's disease

Vatarakta is an Ayurvedic condition characterized by the vitiation of vata and rakta (blood). It often causes pain in the joints, inflammation, and circulation problems, which are comparable to the symptoms of Buerger’s disease (Thromboangiitis obliterans). Here’s how Vatarakta relates to Buerger’s disease.

A. Understanding Vatarakta

It is considered a condition that involves the simultaneous vitiation of vata dosha and rakta dhatu. It primarily affects the extremities, causing symptoms like:

Severe pain
Swelling and inflammation
Redness
Restricted blood flow
Ulcerations

B. Symptoms overlap with Buerger's disease

The symptoms seen in Buerger’s disease are:

Pain and tenderness in limbs, often triggered by exercise or cold
Inflammation of blood vessels
Reduced blood flow leading to ischemia
Skin changes and ulcerations in advanced stages

2. Raktavaha Srotas Dushti and Buerger's disease

In Ayurveda, Raktavaha Srotas refers to the channels that carry Rakta (blood) throughout the body. Raktavaha Srotas Dushti implies an abnormality or dysfunction in these blood-carrying pathways. Buerger’s disease (Thromboangiitis obliterans), which causes inflammation and thrombosis of small and medium-sized blood vessels, is similar to Raktavaha Srotas Dushti in terms of symptoms and pathophysiology.

A. Understanding Raktavaha srotas dushti

Raktavaha Srotas Dushti involves the vitiation or obstruction of the blood-carrying channels, leading to:

Impaired blood flow
Inflammation of blood vessels
Formation of blood clots
Tissue ischemia and necrosis

B. Symptoms overlap with Buerger's disease

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Pain and tenderness due to reduced blood flow and ischemia.
Inflammation of the blood vessels leads to swelling and redness.
Claudication: Pain in the limbs during exercise due to poor circulation.
Ulcerations and gangrene in severe cases are due to prolonged ischemia and tissue death.

Here’s a small summary of clinical features (in terms of Ayurveda) and their presence in Buerger’s disease.

Clinical Features	In Vatarakta	In Buerger’s disease
Asweda (anhydrosis)	Present	Present
Karshnata (blackish discoloration)	Present	Present
Sparshaghnatwa (parasthesia)	Present	Present
Kshate ati ruk (tenderness)	Present	Present
Supti (numbness)	Present	Present
Sheetalata (coldness in limbs)	Present	Present
Daha (burning sensation)	Present	Present
Khanjathwa (lameness)	Present	Present
Dhamani anguli sandhu sankocha (constriction of vessels and fingers)	Present	Present
Sheeta pradwesha (aversion towards cold)	Present	Present
Parshosha (atrophy)	Present	Present
Mamsakotha (gangrene) as acomplication	Present	Present

Manifestation of Buerger's disease in Ayurveda

Dosha involvement

1. Vata dosha

Vata is responsible for movement and circulation in the body. When vitiated, it can obstruct the blood vessels, leading to poor circulation and pain.
Symptoms include severe pain, coldness in extremities, and cramping.

2. Pitta dosha

Pitta governs metabolism and transformation. Its vitiation can lead to inflammation and blood-related disorders.
Symptoms include inflammation, redness, burning sensations, and ulceration.

Srotas involvement

1. Raktavaha srotas

These channels are responsible for the circulation of blood. When there is dysfunction or obstruction (Dushti) in these channels, it can lead to impaired blood flow and the manifestation of symptoms similar to Buerger’s disease.
Raktavaha Srotas Dushti can manifest as inflammation, thrombosis, and ischemia (lack of blood supply).

Symptoms of Buerger's disease in Ayurveda

Symptom	Ayurvedic explanation
Pain and claudication	Similar to intermittent claudication in modern medicine. This symptom can be associated with vitiation of the vata dosha, causing severe pain and cramps in the limbs during physical activities.
Cold sensation and discolouration	Fingers or toes may turn white or blue in response to cold and stress, a phenomenon that can be linked to vata and pitta imbalances affecting peripheral circulation.
Inflammation and thrombosis	Inflammation of blood vessels leading to clot formation can be linked to Pitta vitiation, causing inflammatory processes, and Raktavaha Srotas Dushti.
Ulceration and gangrene	Severe cases can lead to ulcerations and gangrene due to prolonged ischemia and tissue death, which can be correlated with an advanced Vata-Pitta imbalance.

Ayurvedic treatment approach for Buerger’s disease

1. Purification therapies (Shodhana)

Virechana (therapeutic purgation): It helps in cleansing the pitta dosha and reducing inflammation.
Basti (medicated enema): It helps balance the vata dosha and improves circulation in the lower limbs.

2. Palliative treatments (Shamana)

Herbal formulations: It involves the usage of herbs like Guggulu, Shallaki, and Ashwagandha to reduce inflammation and improve circulation.
Dietary changes: This emphasizes a diet that pacifies the effects of vata and pitta dosha. This includes avoiding spicy, sour, and pungent foods.

3. External therapies

Abhyanga (oil massage): It includes the use of medicated oils like Dhanvantaram taila to improve circulation and reduce Vata imbalance.
Swedana (sudation): It involves the application of heat therapies to improve blood flow.

4. Lifestyle modifications

Regular Exercise: Gentle exercises and yoga enhance blood flow and maintain vascular health.
Avoidance of Tobacco: Since smoking is a major risk factor, complete cessation of tobacco use is crucial.

5. Specific Ayurvedic Treatments

Raktamokshana (Bloodletting): In some cases, leech therapy may be used to remove impure blood and improve circulation.
Lepa (Medicated Pastes): Application of herbal pastes to affected areas to reduce inflammation and pain.

Conclusion

While Buerger’s disease is a modern medical condition, Ayurveda addresses similar pathologies under Vatarakta and Raktavaha srotas dushti. The focus is on balancing the doshas, detoxifying the body, improving circulation, and reducing inflammation through a combination of internal and external therapies, dietary modifications, and lifestyle changes. Consulting with a qualified Ayurvedic practitioner is essential for personalized treatment and effective management.