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Neurological diseases (view source)
Revision as of 07:46, 30 September 2021
, 07:46, 30 September 2021no edit summary
|title=Neurological diseases
|title=Neurological diseases
|titlemode=append
|titlemode=append
|keywords= Principles, diagnosis, management, Neurological diseases,vata vyadhi, vata, pakshaghata, ardita, avarana, cerebrovascular accident, transient ischaemic attack, Ayurveda, treatment interventions, medical system healthcare, symbiohealth, charak samhita, caraka samhita, Indian system of medicine, pathogenesis of disease
|keywords= Principles, diagnosis, management, Neurological diseases, vata vyadhi, vata, pakshaghata, ardita, avarana, cerebrovascular accident, transient ischemic attack, stroke, Ayurveda, treatment interventions, medical system healthcare, symbiohealth, charak samhita, caraka samhita, Indian system of medicine, pathogenesis of disease, alternative medicine, complementary medicine
|description= Principles of diagnosis and management of neurological diseases in Ayurveda are described.
|description= Principles of diagnosis and management of neurological diseases in Ayurveda are described.
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
}}
}}
'''Diagnosis and Management of Neurological Diseases in Ayurveda'''
'''Diagnosis and Management of Neurological Diseases in Ayurveda'''
This article is based on the lecture delivered by Prof. (Dr.) S.H. Acharya in Prof. M. S. Baghel Memorial Lecture Series on July 09, 2021.
This article is based on the lecture delivered by Prof. (Dr.) S.H. Acharya in Prof. M. S. Baghel Memorial Lecture Series on July 09, 2021.The video lecture can be accessed on the link of [https://fb.watch/8l9a6DVmz6/ facebook page.]
</div>
</div>
{{Infobox
{{Infobox
|label5 = Affiliations
|label5 = Affiliations
|data5 = <sup>1</sup>Distingushed Professor, All India Institute of Ayurveda, New Delhi.
|data5 = <sup>1</sup>Distinguished Professor, All India Institute of Ayurveda, New Delhi.
<sup>2</sup>[[Charak Samhita Research, Training and Development Centre]], I.T.& R.A., Jamnagar, Gujarat, India
<sup>2</sup>[[Charak Samhita Research, Training and Development Centre]], I.T.& R.A., Jamnagar, Gujarat, India
|data8 = Under process
|data8 = Under process
}}
}}
== [[Vata]] and Neurological Diseases==
== [[Vata]] and Neurological Diseases==
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<div style="text-align:justify;">
Neurological diseases are generally considered under the umbrella of diseases of [[vata]] [[dosha]] (vata vyadhi). However, diseases of [[Vata]] does not limit to neurological disorders. Similarly, certain neuropathological conditions are beyond the limits of pure [[vata]] disorders.
Neurological diseases are generally considered under the umbrella of diseases of [[vata]] [[dosha]] (vata vyadhi). However, diseases of [[vata]] does not limit to neurological disorders. Similarly, certain neuropathological conditions are beyond the limits of pure [[vata]] disorders.
</div>
</div>
===Physiological boundaries of [[Vata]] ===
===Physiological boundaries of [[vata]] ===
<div style="text-align:justify;">
<div style="text-align:justify;">
[[Vata]] is an essential factor for the sustenance of life and cognitive functions. [Cha. Sa. [[Sutra Sthana ] 25/40]. [[Vata]] is responsible for all activities in living beings, and its derangement can result in many diseases and even fatality. [Cha. Sa. [[Sutra Sthana]] 17/ 118]
[[Vata]] is an essential factor for the sustenance of life and cognitive functions. [Cha. Sa. [[Sutra Sthana ] 25/40]. [[Vata]] is responsible for all activities in living beings, and its derangement can result in many diseases and even fatality. [Cha. Sa. [[Sutra Sthana]] 17/ 118]
All voluntary and involuntary body movements, including natural physiological impulses (somatic & psychosomatic), are executed by neural pathways. These activities with cranial nerve impulses are outcomes of activities of [[vata]]. Respiratory functions, cardiac and circulatory activities are invariably done by [[vata]]. All somatic systems and their regulatory functions and integration are governed or maintained by [[vata]].[ Cha. Sa. [[Sutra Sthana]] 12/ 8] It also controls and regulates the activities of the mind ([[manas]]). [ Cha. Sa. [[Sutra Sthana]] 12/ 8] The perception, cognition, and thought process is under the control of [[vata]].
All voluntary and involuntary body movements, including natural physiological impulses (somatic & psychosomatic), are executed by neural pathways. These activities with cranial nerve impulses are outcomes of activities of [[vata]]. Respiratory functions, cardiac and circulatory activities are invariably done by [[vata]]. All somatic systems and their regulatory functions and integration are governed or maintained by [[vata]].[ Cha. Sa. [[Sutra Sthana]] 12/ 8] It also controls and regulates the activities of the mind ([[manas]]). [Cha. Sa. [[Sutra Sthana]] 12/8] The perception, cognition, and thought process is under the control of [[vata]].
So, the vegetative nervous system, central nervous system or higher nervous system, brain behavior, and mental functions are all governed by [[Vata]] itself.
So, the vegetative nervous system, central nervous system or higher nervous system, brain-behavior, and mental functions are all governed by [[vata]] itself.
The physiology of [[vata]] cannot be limited to neurophysiology. Instead, it can be extended to molecular biology in addition to the neuronal or cellular functions.
The physiology of [[vata]] cannot be limited to neurophysiology. Instead, it can be extended to molecular biology in addition to the neuronal or cellular functions.
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The terms like sira (blood vessels), snayu (tendons) and kandara (ligaments) describe the pathology of seizures (akshepaka, dandaka) and palsies (ardita, pakshaghata). Their description in vata vyadhi confirms the connection of vata dosha disorders with the nervous system.
The terms like sira (blood vessels), snayu (tendons) and kandara (ligaments) describe the pathology of seizures (akshepaka, dandaka) and palsies (ardita, pakshaghata). Their description in vata vyadhi confirms the connection of vata dosha disorders with the nervous system.
===Head (shiras) :===
===Head (shiras) ===
The head is the most vital organ in the body (uttamanga). The roots of all the sensory and motor organs ([[indriya]]) are located in the head. [Cha. Sa. [[Sutra Sthana]] 17/12]
The head is the most vital organ in the body (uttamanga). The roots of all the sensory and motor organs ([[indriya]]) are located in the head. [Cha. Sa. [[Sutra Sthana]] 17/12]
The location of mind is described as between the top of the skull and palate by Acharya Bhela. It is precisely where the cortex and limbic system, i.e., the higher nervous system related to the functions of the mind is located.
The location of mind is described as between the top of the skull and palate by Acharya Bhela. It is precisely where the cortex and limbic system, i.e., the higher nervous system related to the functions of the mind is located.
In Ayurveda, more importance is given to functional aspects than the neuro-anatomical structures.
In [[Ayurveda]], more importance is given to functional aspects than the neuro-anatomical structures.
== Ayurvedic terminologies resembling neurological diseases ==
== Ayurvedic terminologies resembling neurological diseases ==
* Vepathu (Tremors)
* Vepathu (Tremors)
===Neuropsychotic conditions:===
===Neuropsychotic conditions ===
* Vishada (Depression)
* Vishada (Depression)
* Anavasthitha Chitta (fleeting thoughts)
* Anavasthitha Chitta (fleeting thoughts)
===Radiculopathies:===
===Radiculopathies===
It includes Gridhrasi (Sciatica), Khalli (twisting pain in
It includes Gridhrasi (Sciatica), Khalli (twisting pain in
the extremities), Vishwachi (shoulder pain), Apabahuka (frozen shoulder), Ansa shosha (atrophy of scapular muscles)
the extremities), Vishwachi (shoulder pain), Apabahuka (frozen shoulder), Ansa shosha (atrophy of scapular muscles)
== Diagnostic and Therapeutic approach in Ayurveda ==
== Diagnostic and Therapeutic approach in Ayurveda ==
[[File:Cva-_pic1.PNG|400px|'''Image 1:''' '''Cerebrovascular accident Ayurvedic perspective'''|thumb]]
=== Cerebrovascular accidents ===
=== Cerebrovascular accidents ===
<div style="text-align:justify;">
<div style="text-align:justify;">
==== Incomplete stroke ====
==== Incomplete stroke ====
<div style="text-align:justify;">
<div style="text-align:justify;">
The clinical manifestation of ‘ardita’ is described as either half of the entire body or half of the face affected by aggravated [[vata]] [[dosha]].[Cha. Sa.[[Chikitsa Sthana]] 28/42] So, ardita has a very similar clinical picture as that of pakshaghata (hemiplegia). However, a group of illnesses noted along with ‘ardita’ manifest in episodic form (vega). When the episodic event seizes, the patient is almost in normal state. Thus, a differential diagnosis between ardita and pakshaghata is chiefly relying on the transient nature of ardita [Chakrapani commentary, Cha. Sa. [[Chikitsa Sthana]] 28/38-42]
The clinical manifestation of ‘ardita’ is described as either half of the entire body or half of the face affected by aggravated [[vata]] [[dosha]].[Cha. Sa.[[Chikitsa Sthana]] 28/42]
So, ardita has a very similar clinical picture as that of pakshaghata (hemiplegia). However, a group of illnesses noted along with ‘ardita’ manifest in episodic form (vega). When the episodic event seizes, the patient is almost in normal state. Thus, a differential diagnosis between ardita and pakshaghata is chiefly relying on the transient nature of ardita [Chakrapani commentary, Cha. Sa. [[Chikitsa Sthana]] 28/38-42]
Thus, ardita simulates a transient ischemic attack or incomplete stroke, and pakshaghata simulates the condition of complete stroke. The difference in line of treatment for ardita and pakshaghata apparantly reflect the difference in their etiopathological context.
'''Management of incomplete stroke'''
'''Management of incomplete stroke'''
[[Nasya]] therapy, if performed judicially in accordance with the classical procedure can produce noticeable results in ischaemic conditions. The position of the head shall be lowered from the table. Person in a supine sleeping position with hyper extended neck and head slightly hanging downward (head low position)]
[[Nasya]] therapy, if performed judicially in accordance with the classical procedure can produce noticeable results in ischaemic conditions. The position of the head shall be lowered from the table. Person in a supine sleeping position with hyper extended neck and head slightly hanging downward (head low position)]
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====Complete stroke====
====Complete stroke====
<div style="text-align:justify;">
<div style="text-align:justify;">
When the hemorrhage happens at the area of mostly ner internal capsules, near the circle of Willis, huge edema develops around the area in the brain which is usually referred as peri -hemorrhagic edema. Furthermore, when oedema recedes, there will be some improvements in the signs and symptoms of a stroke. So, at this stage of edema, [[virechana]] works well. It was found to contribute significantly in reducing peri-hemorrhage edema.
When the hemorrhage happens at the area of mostly ner internal capsules, near the circle of Willis, huge edema develops around the area in the brain which is usually referred as peri -hemorrhagic edema. Furthermore, when oedema recedes, there will be some improvements in the signs and symptoms of a stroke. So, at this stage of edema, [[virechana]] works well. It was found to contribute significantly in reducing peri-hemorrhage edema.
[[File:Virechana_-cva.PNG|300px|'''Image 2:''' '''Virechana in stroke'''|thumb]]
The recent research on the management of stroke reveals that due to rapid onset, the primary injury of ICH is challenging to treat. Primary injury is followed by secondary injury in the peri hemorrhagic region over several days to weeks and provides a longer treatment window than the primary injury. It is important to minimize the direct effect of clot-related hydrostatic pressure. Clot removal and/or hyperosmolar therapy by mannitol etc. is indicated for the purpose.
The recent research on the management of stroke reveals that due to rapid onset, the primary injury of ICH is challenging to treat. Primary injury is followed by secondary injury in the peri hemorrhagic region over several days to weeks and provides a longer treatment window than the primary injury. It is important to minimize the direct effect of clot-related hydrostatic pressure. Clot removal and/or hyperosmolar therapy by mannitol etc. is indicated for the purpose.
A collection of molecules called the ‘complement system’ plays a crucial role in the body’s frontline defense against pathogens. But after a stroke, this system can trigger harmful inflammatory processes that damage the brain. Recent investigations in mice reveal that better outcomes can be achieved by addressing the immune response. It can be done by inhibiting its harmful effects immediately after stroke or promoting its ability to aid recovery.
A collection of molecules called the ‘complement system’ plays a crucial role in the body’s frontline defense against pathogens. But after a stroke, this system can trigger harmful inflammatory processes that damage the brain. Recent investigations in mice reveal that better outcomes can be achieved by addressing the immune response. It can be done by inhibiting its harmful effects immediately after stroke or promoting its ability to aid recovery.<ref>New therapeutic approaches directed at the post-stroke immune response show promise in mice
By Diana Kwon on June 13, 2018 - NEUROSCIENCE</ref> <ref>Intracerebral Haemorrhage: Perihemorrhagic Edema and Secondary Hematoma Expansion: From Bench Work
So, [[Virechana]] could be a better supplement in Ayurveda clinics for steroids and diuretics to deal with cerebral inflammation. In addition, the mechanism of purification therapies(shodhana) could flush out untoward oxidant molecules generated during the phenomenon of stroke. This can set the immune mechanism to normalcy.
to Ongoing Controversies.By Manoj K. Mittal1,* and Aaron LacKamp 2016; 7: 210. FRONTIERS IN NEUROLOGY.</ref>
So, [[virechana]] could be a better supplement in Ayurveda clinics for steroids and diuretics to deal with cerebral inflammation. In addition, the mechanism of purification therapies(shodhana) could flush out untoward oxidant molecules generated during the phenomenon of stroke. This can set the immune mechanism to normalcy.
When it is established that there is infarction and complete death of the nerve cells in complete stroke, it is usually treated as incurable. However, several patients with hemorrhagic stroke have got complete improvement in symptoms after Ayurvedic treatment. The slow auto-healing of neighboring tissues of infarcted focal area, the concept of neuronal plasticity, sensory-motor integration in the brain etc., can be the reasons behind these recoveries.
When it is established that there is infarction and complete death of the nerve cells in complete stroke, it is usually treated as incurable. However, several patients with hemorrhagic stroke have got complete improvement in symptoms after Ayurvedic treatment. The slow auto-healing of neighboring tissues of infarcted focal area, the concept of neuronal plasticity, sensory-motor integration in the brain etc., can be the reasons behind these recoveries.
“Avarana” pathologies are complex conditions having progressive nature and are difficult to diagnose and manage. Most of the progressive degenerative conditions of the brain do fall under the different kinds of Avarana.
“Avarana” pathologies are complex conditions having progressive nature and are difficult to diagnose and manage. Most of the progressive degenerative conditions of the brain do fall under the different kinds of Avarana.
E.g. 1: '''Parkinsonism''' can be considered as “kapha-avruta –vyana”. The main symptoms are bradykinesia (gati sanga) and tremor. [Cha.Sa. [[Chikitsa Sthana]] 28/]
E.g. 1: '''Parkinsonism''' can be considered as “[[kapha]]-avruta –vyana”. The main symptoms are bradykinesia (gati sanga) and tremor. [Cha.Sa. [[Chikitsa Sthana]] 28]
Two intrinsic factors are leading to vitiation of [[vata]]
Two intrinsic factors are leading to vitiation of [[vata]]
E.g. 2: '''Multiple sclerosis or myelopathy:''' It cannot be considered under any condition as pure vata vyadhi. The principles of urustambha or medo-avruta vata works well in this condition.
E.g. 2: '''Multiple sclerosis or myelopathy:''' It cannot be considered under any condition as pure vata vyadhi. The principles of urustambha or medo-avruta vata works well in this condition.
Some of the presentations of multiple sclerosis or myelopathy are clearly described as the features of urustambha.
Some of the presentations of multiple sclerosis or myelopathy are clearly described as the features of urustambha.
They are:
They are:
Simple methods like dietary modifications as daily use of millets like barley(yava), raw vegetables without adding salt can produce [[rukshana]] in the body.[Cha. Sa.[[Chikitsa Sthana]] 27/25-26]. Excessive [[rukshana]] will lead to aggravation of [[vata]] leading to the symptoms like loss of sleep, increased pain etc; then one can shift to the line of treatment to oleation ([[snehana]]), sudation([[swedana]])etc.[Cha. Sa. [[Chikitsa Sthana]] 27/40-41]
Simple methods like dietary modifications as daily use of millets like barley(yava), raw vegetables without adding salt can produce [[rukshana]] in the body.[Cha. Sa.[[Chikitsa Sthana]] 27/25-26]. Excessive [[rukshana]] will lead to aggravation of [[vata]] leading to the symptoms like loss of sleep, increased pain etc; then one can shift to the line of treatment to oleation ([[snehana]]), sudation([[swedana]])etc.[Cha. Sa. [[Chikitsa Sthana]] 27/40-41]
Drastic purification ([[shodhana]]) procedures are to be avoided, and the treatment should be planned according to the strength (bala)of the patient. Rejuvenating therapy ([[rasayana]]) also have a great role, especially in dealing with neurodegenerative conditions. [Cha. Sa. [[Chikitsa Sthana]] 28/239-241]
Drastic purification ([[shodhana]]) procedures are to be avoided, and the treatment should be planned according to the strength (bala)of the patient. Rejuvenating therapy ([[rasayana]]) also have a great role, especially in dealing with neurodegenerative conditions. [Cha. Sa. [[Chikitsa Sthana]] 28/239-241]
==Conclusion==
==Conclusion==
<div style="text-align:justify;">
While dealing with diagnosed neurological diseases, an Ayurveda practitioner should analyze its pathology and manifestations based on Ayurvedic principles. All neurological cases cannot be invariably included under Vata vyadhi context. The diseases should be further investigated on the basis of etiopathogenesis (samprapti) under four main categories.
While dealing with diagnosed neurological diseases, an Ayurveda practitioner should analyze its pathology and manifestations based on Ayurvedic principles. All neurological cases cannot be invariably included under Vata vyadhi context. The diseases should be further investigated on the basis of etiopathogenesis (samprapti) under four main categories.
D. Avritattva ([[vata]] activities / movements hampered / obstructed by others / within).
D. Avritattva ([[vata]] activities / movements hampered / obstructed by others / within).
The nature of Ayurvedic management can vary based upon the above pathological conditions (avastha).
The nature of Ayurvedic management can vary based upon the above pathological conditions (avastha).
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==Interactive Session==
==Interactive Session==
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<div style="text-align:justify;">
1) Which is the best, effective, and safe Ayurvedic medicine for virechana in acute cerebrovascular stroke? Please share your experiences.
'''1) Which is the best, effective, and safe Ayurvedic medicine for [[virechana]] in acute cerebrovascular stroke? Please share your experiences.'''
Sneha yukta virechana (therapeutic purgation with unctuous substance) is mainline of treatment. Medicines like eranda taila (castor oil) or castor seeds (eranda beeja) processed in milk with a small amount of cow’s urine (gomutra) for virechana in stroke patients. We can select the formulations for virechana according to the pathogenesis (samprapti) also. But, the strength (bala) of the patient should be considered with prime importance.
Sneha yukta [[virechana]] (therapeutic purgation with unctuous substance) is mainline of treatment. Medicines like eranda taila (castor oil) or castor seeds (eranda beeja) processed in milk with a small amount of cow’s urine (gomutra) for [[virechana]] in stroke patients. We can select the formulations for [[virechana]] according to the pathogenesis (samprapti) also. But, the strength (bala) of the patient should be considered with prime importance.
2) What can be a standard research protocol for the management of neurological disorders because the conditions are highly person specific?
'''2) What can be a standard research protocol for the management of neurological disorders because the conditions are highly person-specific?'''
Ans: It is tough to answer the question because we have to develop such a protocol purely based on Ayurvedic principles. We have to re-modify the trials which had been conducted in pharmacological laboratories with modern standards. We have to re-design the clinical trials by keeping the essence of Ayurveda in it. At present, we cannot give such a single protocol. However, the development of such an Ayurvedic research protocol incorporating the necessary modern parameters also is under progress. In precise, it cannot be just clinical Drug Trial protocol but to bring the holistic concept of Ayurveda approach in research also.
Ans: It is tough to answer the question because we have to develop such a protocol purely based on Ayurvedic principles. We have to re-modify the trials which had been conducted in pharmacological laboratories with modern standards. We have to re-design the clinical trials by keeping the essence of [[Ayurveda]] in it. At present, we cannot give such a single protocol. However, the development of such an Ayurvedic research protocol incorporating the necessary modern parameters also is under progress. In precise, it cannot be just clinical Drug Trial protocol but to bring the holistic concept of [[Ayurveda]] approach in research also.
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