Changes

=== Management of ''ardita'' (facial palsy) ===

=== Management of ''ardita'' (facial palsy) ===

The line of treatment of ''ardita'' aims at ''mastishkya'' (brain), therefore, ''nasya'' is indicated. ''Nasya'' is explained to be the direct entrance to the cranial vault. ''Nasya'' may be ''shodhana, shamana'' or ''brimhana'' as the case may be. But there is an opinion that since the word ''navana'' is used, it means ''snaihika nasya''. ''Murdhni taila'' is absolutely meant for treatment in head region and is of four types viz. ''abhyanga'' ( head massage), ''seka'' (pouring liquid on head), ''pichu'' ( therapeutic unctuous swab on head) and ''shirobasti''. ''Tarpana'' (nourishment therapy) is ''akshitarpana'' (nourishing eyes) and ''shrotratarpana'' (nourishing ears). ''Nadisweda'' is very specific in ''ardita'' and ''ksheeradhooma'' (medicated fumes of milk).

The line of treatment of ''ardita'' aims at ''mastishkya'' (brain), therefore, [[nasya]] is indicated. [[Nasya]] is explained to be the direct entrance to the cranial vault. [[Nasya]] may be ''shodhana, shamana'' or [[brimhana]] as the case may be. But there is an opinion that since the word ''navana'' is used, it means snaihika [[nasya]]. ''Murdhni taila'' is absolutely meant for treatment in head region and is of four types viz. ''abhyanga'' ( head massage), ''seka'' (pouring liquid on head), ''pichu'' ( therapeutic unctuous swab on head) and ''shirobasti''. ''Tarpana'' (nourishment therapy) is ''akshitarpana'' (nourishing eyes) and ''shrotratarpana'' (nourishing ears). ''Nadisweda'' is very specific in ''ardita'' and ''ksheeradhooma'' (medicated fumes of milk).

Poultice prepared from flesh of marshy animals is used for ''brimhana'' in atrophy of muscles. ''Vamana'' is indicated in ''ardita'', when it is associated with ''shopha'' and ''raktamokshana'' is indicated when associated with ''daha'' (burning) and ''raga'' (redness).

Poultice prepared from flesh of marshy animals is used for [[brimhana]] in atrophy of muscles. [[Vamana]] is indicated in ''ardita'', when it is associated with ''shopha'' and ''raktamokshana'' is indicated when associated with ''daha'' (burning) and ''raga'' (redness).

In ''pakshaghata, swedana,'' fomentation mixed with unctuous material and ''virechana'' or purgation therapy with unctuous substance is indicated. ''Virechana'' is the line of treatment in ''pakshaghata'' and outweighs ''basti'' which is said to be ideal for ''vatakopa''. ''Pakshaghata'' may be understood as a concealed ''urdhwaga raktapitta'' (bleeding from upper orifices of body) in which the only and effective choice is ''adho-shodhana'' (purgation). ''Gridhrasi'' is a tendon and ligament disorder and ''shastra, kshara,'' and ''agnikarma'' are the main line of treatment. Therefore ''siravyadha'' (blood letting) and ''dahakarma'' (cauterization) is advised. ''Basti'' is also a good choice since ''pakvashayagata vata'' leads to ''kateegraha'' and ''gridhrasi''.  

In ''pakshaghata, [[swedana]], fomentation mixed with unctuous material and [[virechana]] or purgation therapy with unctuous substance is indicated. [[Virechana]] is the line of treatment in ''pakshaghata'' and outweighs [[basti]] which is said to be ideal for [[vata]]kopa. ''Pakshaghata'' may be understood as a concealed ''urdhwaga raktapitta'' (bleeding from upper orifices of body) in which the only and effective choice is ''adho-shodhana'' (purgation). ''Gridhrasi'' is a tendon and ligament disorder and ''shastra, kshara,'' and ''agnikarma'' are the main line of treatment. Therefore ''siravyadha'' (blood letting) and ''dahakarma'' (cauterization) is advised. [[Basti]] is also a good choice since pakvashayagata [[vata]] leads to ''kateegraha'' and ''gridhrasi''.  

''Agnikarma'' and ''siravyadha'' are the two line of treatment which are useful in acute phase to relieve the pain in ''gridhrasi'' and also in ''khalli''. ''Agnikarma'' relieves muscle spasm thereby reducing pain whereas ''siravyadha'' may be helpful by reducing the blood stasis. Improved circulation removes cytokines and other inflammatory factors thereby reducing pain. (99-103)

''Agnikarma'' and ''siravyadha'' are the two line of treatment which are useful in acute phase to relieve the pain in ''gridhrasi'' and also in ''khalli''. ''Agnikarma'' relieves muscle spasm thereby reducing pain whereas ''siravyadha'' may be helpful by reducing the blood stasis. Improved circulation removes cytokines and other inflammatory factors thereby reducing pain. (99-103)

=== Importance of site of affliction in treatment ===

=== Importance of site of affliction in treatment ===

The specificity of treatment depends on the site of affliction and the associated morbid tissues. For example masthishkya is very specific for ardita, pakṣāghāta, indriyagatavāta etc. Even though vamana is kaphahara, it is exclusively indicated in āmashayagata vāta taking into account of site of affliction. (verse 104)

The specificity of treatment depends on the site of affliction and the associated morbid tissues. For example masthishkya is very specific for ardita, pakshaghata, indriyagatavata etc. Even though [[vamana]] is [[kapha]]hara, it is exclusively indicated in āmashayagata vāta taking into account of site of affliction. (verse 104)

Brimhana treatment of vata vitiation: The treatment of exclusive vāta vitiation (without involvement of other dosha) is brimhana. If associated dosha is present, they shall be treated first. (verse 105)

[[Brimhana]] treatment of [[vata]] vitiation: The treatment of exclusive [[vata]] vitiation (without involvement of other [[dosha]]) is [[brimhana]]. If associated [[dosha]] is present, they shall be treated first. (verse 105)

Balā is excellent for lone vitiated vāta. The head of goat is indicated on the basis of the principle ‘sāmānyam vridhikārānam’(like increases like). These also explain the awareness of utilization of brain of goat in degenerative brain lesions. Lavana relieves stambha (stiffness) and samghata (conglomeration). Upanāha is also prepared with such well fomented flesh and added with different oils, salts etc. Such upanāha are brimhana. (verse 106-108)

Bala is excellent for lone vitiated [[vata]]. The head of goat is indicated on the basis of the principle ‘samanyam vridhikaranam’(like increases like). These also explain the awareness of utilization of brain of goat in degenerative brain lesions. Lavana relieves stambha (stiffness) and samghata (conglomeration). Upanaha is also prepared with such well fomented flesh and added with different oils, salts etc. Such upanāha are brimhana. (verse 106-108)

Avagaha (immersion) sweda:

Avagaha (immersion) sweda:

Avagāha is typically indicated in apāna vāigunya (defects due to apana vata vitiation), it is a type of drava sweda (liquid fomentation). Nādisweda is also an excellent option for all types of vātarōga. Poultices (upanāha) of different types  provide self generated heat to cause swedana. It is by virtue of various dhanya (cereals) and kinwa (yeast) available in it.  (verse 109-118)

Avagāha is typically indicated in apana vaigunya (defects due to apana [[vata]] vitiation), it is a type of drava sweda (liquid fomentation). Nādisweda is also an excellent option for all types of vātarōga. Poultices (upanāha) of different types  provide self generated heat to cause swedana. It is by virtue of various dhanya (cereals) and kinwa (yeast) available in it.  (verse 109-118)

Different formulations:

Different formulations:

Different medicated ghrita,taila, vasā, majjā and mahā snēha ( combination of all four sneha) are indicated for various conditions in the form of oral ingestion, inhalation, enema and external application etc. Mahā snēha is guru (heavy to digest) and ultimately indicated in disorders like convulsions, tremor etc. (verse 119-136)

Different medicated ghrita,taila, vasa, majja and maha sneha ( combination of all four sneha) are indicated for various conditions in the form of oral ingestion, inhalation, enema and external application etc. Maha sneha is guru (heavy to digest) and ultimately indicated in disorders like convulsions, tremor etc. (verse 119-136)

Pinyaka taila is a preparation in which rūkṣa guna is imparted to taila and is highly useful in kapha associated Vātavyādhi. (verse 136-137)

Pinyaka taila is a preparation in which ruksha [[guna]] is imparted to taila and is highly useful in [[kapha]] associated [[Vata]]vyadhi. (verse 136-137)

Importance of oil in treatment of vata: By virtue of vyavāyi guna (pervading/diffusive), it reaches the different interior parts of the body without any metabolic changes. By processing taila can adopt any type of qualitative changes.  The drugs are potentiated by repeated processing in its own media. Drugs like ksheerbalā (101 āvartita), dhanwatharam (21 āvartita) etc. are worth mentioning here. This approach of samskāra makes snēha as sukshma snēha (with better bio-availability and penetration) .(verse 181-182)

Importance of oil in treatment of [[vata]]: By virtue of vyavayi [[guna]] (pervading/diffusive), it reaches the different interior parts of the body without any metabolic changes. By processing taila can adopt any type of qualitative changes.  The drugs are potentiated by repeated processing in its own media. Drugs like ksheerbalā (101 āvartita), dhanwatharam (21 āvartita) etc. are worth mentioning here. This approach of samskāra makes snēha as sukshma snēha (with better bio-availability and penetration) .(verse 181-182)

=== Management of ''avrita vata'' ===

=== Management of avrita [[vata]] ===

In pittāvr̥ta vāta, hot and cold should be applied alternately.  Jīvanīya sarpi is also very brimhana. Brimhana is the ideal pacifying line of treatment for vāta and vātapitta.   

In [[pitta]]vr̥ta [[vata]], hot and cold should be applied alternately.  Jīvanīya sarpi is also very [[brimhana]]. [[Brimhana]] is the ideal pacifying line of treatment for [[vata]] and [[vata]]-[[pitta]].   

In kaphāvr̥ta vāta, rūkṣa is given importance. In association of kapha along with pitta in vātarōga, pitta should be given importance in management. It is because of the fact that pitta makes the disease process as ‘ashukāri’(instantaneous).  

In [[kapha]]vr̥ta [[vata]], ruksha is given importance. In association of [[kapha]] along with [[pitta]] in [[vata]]roga, [[pitta]] should be given importance in management. It is because of the fact that [[pitta]] makes the disease process as ‘ashukāri’(instantaneous).  

In Kaphāvr̥ta vāta; tīkṣṇā sweda, niruha and vamana which reduces kapha is indicated followed by virechana intended for vāta anulomana and also useful for kapha.

In [[Kapha]]vr̥ta [[vata]]; tīkṣṇā sweda, niruha and [[vamana]] which reduces [[kapha]] is indicated followed by [[virechana]] intended for [[vata]] anulomana and also useful for [[kapha]].

Jirna/purāna sarpi (old ghee) which has kaphaghna quality has to be used; tila and sarṣapa which are kapha vātaghna are to be used. Warm drinks of yava, jāṇgala mānsa rasa which gives strength to the patient without increasing kapha are to be administered. (verse 183-188)

Jirna/purāna sarpi (old ghee) which has [[kapha]]ghna quality has to be used; tila and sarshapa which are [[kapha]] [[vata]]ghna are to be used. Warm drinks of yava, jāṇgala mānsa rasa which gives strength to the patient without increasing kapha are to be administered. (verse 183-188)

Kshara basti (gomūtrayukta basti) in case of kapha-vāta and ksheera basti in pitta-vāta is recommended. Raktāvr̥ta vāta is similar to uttāna-vātarakta and treatment is accordingly same. Rakta āvr̥ta vāta is one of the phases of vātarakta. Thus raktamokshan and basti cikitsā which is useful in vātarakta is also helpful in rakta āvr̥ta vāta.  

Kshara [[basti]] (gomūtrayukta [[basti]]) in case of [[kapha]]-[[vata]] and ksheera [[basti]] in [[pitta]]-[[vata]] is recommended. [[Rakta]]vruta [[vata]] is similar to uttana-vatarakta and treatment is accordingly same. [[Rakta]] avruta [[vata]] is one of the phases of vatarakta. Thus [[raktamokshana]] and basti cikitsā which is useful in vātarakta is also helpful in rakta avruta [[vata]].  

Prameha samprapti mentioned in Sutra sthana 17th chapter explains kapha, pitta, meda and mānsa which when increased causes āvarana of vāta. Therefore, pramehagna cikitsā is helpful in meda āvr̥ta vāta and also in mansāvr̥ta vāta. Hence in mansāvr̥ta vāta the pipilika iva sanchar (tingling sensation) reduces, if prameha is treated. Similarly, in obesity, medasāvr̥ta vāta (vata obstructed by excess meda) [Cha.Sa.[[Sutra Sthana]] 21/5] and meda and mānsa ativridhi [Cha.Sa.[[Sutra Sthana]] 21/9] is observed.  These conditions are best treated on the principles of management of prameha, sthaulya associated with vitiated vata. Therapeutic emesis to expel out the intoxicated food in stomach is advised in condition of annavrita vata ( vata obstructed by food). Pāchana and deepan helps in digestion and also pacifies vāta.

Prameha samprapti mentioned in Sutra sthana 17th chapter explains [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa dhatu]] which when increased causes avarana of [[vata]]. Therefore, pramehagna cikitsa is helpful in meda avruta [[vata]] and also in mamsavruta [[vata]]. Hence in mamsavruta [[vata]] the pipilika iva sanchara (tingling sensation) reduces, if prameha is treated. Similarly, in obesity, medasavruta [[vata]] ([[vata]] obstructed by excess meda) [Cha.Sa.[[Sutra Sthana]] 21/5] and meda and mamsa ativridhi [Cha.Sa.[[Sutra Sthana]] 21/9] is observed.  These conditions are best treated on the principles of management of prameha, sthaulya associated with vitiated [[vata]]. Therapeutic emesis to expel out the intoxicated food in stomach is advised in condition of annavrita [[vata]] ( [[vata]] obstructed by food). [[Pachana]] and [[deepana]] helps in digestion and also pacifies [[vata]].

Hot foementation reduces urethral pressure. A study done by Shafik A.  showed that sitting in warm water helps in micturition which seems to be initiated by reflex internal urethral sphincter relaxation. A thermo sphincter reflex is likely to be involved.

Hot fomentation reduces urethral pressure. A study done by Shafik A.  showed that sitting in warm water helps in micturition which seems to be initiated by reflex internal urethral sphincter relaxation. A thermo sphincter reflex is likely to be involved.

Uttara basti effect is similar to catheterization. Further depending on the medicines used for uttara basti, tridōṣa shamāna can be done.  

Uttara basti effect is similar to catheterization. Further depending on the medicines used for uttara basti, tri[[dosha]] shamana can be done.  

The lines of treatment of raktagatavāta and raktvritavāta as well as śukragatavāta and shukrāvr̥ta vāta are one and the same irrespective difference in samprapti as gatavāta or āvr̥ta vāta. It is because of the fact that rakta and śukra are mobile and comparatively pervaded all over the body like vāta so gatavāta and āvr̥ta vāta are mutually complimentary here.  

The lines of treatment of [[rakta]]gata [[vata]] and raktvrita [[vata]] as well as [[shukra]]gata [[vata]] and shukrāavruta [[vata]] are one and the same irrespective difference in samprapti as gata [[vata]] or avruta [[vata]]. It is because of the fact that [[rakta]] and [[shukra]] are mobile and comparatively pervaded all over the body like [[vata]] so gata[[vata]] and avruta [[vata]] are mutually complimentary here.  

Finally, the treatment strategies of anyasthānagata(in other sites) vata are explained. The importance is given to sthanastha dosha (in own sites).(189-199)

Finally, the treatment strategies of anyasthanagata(in other sites) [[vata]] are explained. The importance is given to sthanastha [[dosha]] (in own sites).(189-199)

Movements of vata and concept of anyonyavarana:As discussed earlier avyāhatagati (free movement) is a cardinal feature of vāta to perform normally. In āvarana certain obstacles like dosha, dhātu or anna etc which are immobile, occupy the pathway of mobile vāta. It is not mandatory that such immobile articles only cause obstruction to vāta. If the individual sub types of vāta are considered prāna, udāna, vyāna, samāna and apāna are mobile and has some specific direction for their gati. For example, prāna has movement from murdha (head) to downwards. Udāna has movement from uras(chest) to upwards.  Vyāna moves upward downward and sidewards like rasa. Samāna moves around jatharāgni. Apāna move downwards from pakvāśaya. This can be further analysed as follows.  Udāna possess upward movement.  Likewise ‘apāna’ has downward direction.  Vyāna vāyu moves in horizontal direction (vyāpanat vyāna uccyate) along with upward and downward directions as rasa samvahana (circulation) is concerned.[19]Samāna is also having such qualities to equally distribute the nutrients through out the body.  Prāna has multi directional gati. So, the movements of individual subtypes of vāta are directional in nature. When these meet in opposite direction it makes anyonyāvarana. For example prāna and udāna meet opposite and interfere with mutual normal movements leads to difficulty in inspiration as well as expiration which is comparatively irreversible. This concept is called anyonyāvarana. It is of 20 types taking into account of 5 diiferent types making 4 particular combinations. Anyonyāvarana are comparatively difficult situations. (verses 199-206)

Movements of [[vata]] and concept of anyonyavarana:As discussed earlier avyahatagati (free movement) is a cardinal feature of [[vata]] to perform normally. In [[avarana]] certain obstacles like [[dosha]], [[dhatu]] or anna etc which are immobile, occupy the pathway of mobile [[vata]. It is not mandatory that such immobile articles only cause obstruction to [[vata]]. If the individual sub types of [[vata]] are considered prana, udana, vyana, samana and apana are mobile and has some specific direction for their gati. For example, prana has movement from murdha (head) to downwards. Udana has movement from uras(chest) to upwards.  Vyana moves upward downward and sidewards like rasa. Samana moves around jatharagni. Apana move downwards from pakvashaya. This can be further analysed as follows.  Udana possess upward movement.  Likewise ‘apana’ has downward direction.  Vyana [[vayu]] moves in horizontal direction (vyāpanat vyāna uccyate) along with upward and downward directions as rasa samvahana (circulation) is concerned.[19]Samāna is also having such qualities to equally distribute the nutrients through out the body.  Prana has multi directional gati. So, the movements of individual subtypes of vāta are directional in nature. When these meet in opposite direction it makes anyonyāvarana. For example prāna and udāna meet opposite and interfere with mutual normal movements leads to difficulty in inspiration as well as expiration which is comparatively irreversible. This concept is called anyonyāvarana. It is of 20 types taking into account of 5 diiferent types making 4 particular combinations. Anyonyāvarana are comparatively difficult situations. (verses 199-206)

Anyonyāvarana is characterised by Svakarma hani or vriddhi (either increase or decrease in functions) which depends on the nature and site of anyonyāvarana (mutual covering). For example prānaāvr̥ta udāna may lead to difficulty in respiration, followed with cardiac symptoms, aphasia or dysarthria and some times upper respiratory symptoms. This presentation is comparatively acute in onset and. Here the functions of udāna are masked by prāna. But in  udānaāvr̥ta prāna the symptoms are loss of motor power, immunity and complexion leading to death. Here the functions of prāna are seriously hampered. This symptom may be acute or chronic in nature. When apāna got āvarana by udāna the normal peristalsis is hampared and anulomana is the line of treatment. In apāna āvarana to udāna increased bowel motility can be seen grāhi is the line of treatment which should be adopted here.

Anyonya avarana is characterised by Svakarma hani or vriddhi (either increase or decrease in functions) which depends on the nature and site of anyonyāvarana (mutual covering). For example prana avruta udana may lead to difficulty in respiration, followed with cardiac symptoms, aphasia or dysarthria and some times upper respiratory symptoms. This presentation is comparatively acute in onset and. Here the functions of udāna are masked by prana. But in  udana avruta prana the symptoms are loss of motor power, immunity and complexion leading to death. Here the functions of prana are seriously hampered. This symptom may be acute or chronic in nature. When apana got avarana by udana the normal peristalsis is hampared and anulomana is the line of treatment. In apana avarana to udana increased bowel motility can be seen grāhi is the line of treatment which should be adopted here.

Rehabilitation of vata: Prakr̥tisthāpanam means re-establishment in its own pathway (sva mārgaga)/ or in its own place (sva sthāna gamayed enam). Therefore for udāna vāyu, vamana etc. treatment should be administered to regulate the normal functional status of udāna vāyu. Apāna has adhogati, therefore anulomana chikitsā should be done, thereby regularizing the urdhva apāna bhava of Apāna vāyu. Shamāna should be line of treatment for samāna vāyu. Empowering digestive power should be done. Samāna being sited near agni, proper digestion and absorption of essential elements will be observed. Proper electrolyte balance will be maintained, thereby maintaining the pH of body fluids. As discussed previously vyāna has all the three gati i.e. urdhva, adho and madhya gati. Here the general line of treatment of anyonyāvarana is discussed. (verse 219-221)

Rehabilitation of [[vata]]: Prakrutisthapanam means re-establishment in its own pathway (sva margaga)/ or in its own place (sva sthana gamayed enam). Therefore for udana [[vayu]], [[vamana]] etc. treatment should be administered to regulate the normal functional status of udana [[vayu]]. Apana has adhogati, therefore anulomana chikitsā should be done, thereby regularizing the urdhva apana bhava of Apana [[vayu]]. Shamana should be line of treatment for samana [[vayu]]. Empowering digestive power should be done. Samana being sited near [[agni]], proper digestion and absorption of essential elements will be observed. Proper electrolyte balance will be maintained, thereby maintaining the pH of body fluids. As discussed previously vyāna has all the three gati i.e. urdhva, adho and madhya gati. Here the general line of treatment of anyonyavarana is discussed. (verse 219-221)

Importance of udana and prana vata:

Importance of udana and prana vata:

Among various āvarana, the involvement of udāna and prāna are very important. As explained in the introductory comments, prāna is life and udāna is strength. These are very vital issues as far as āvarana is concerned. Improper management or avoidance of treatments may lead to permanant disabilities in Āvarana.  (verse 231-236)

Among various avarana, the involvement of udana and prana are very important. As explained in the introductory comments, prana is life and udana is strength. These are very vital issues as far as avarana is concerned. Improper management or avoidance of treatments may lead to permanant disabilities in avarana.  (verse 231-236)

Complications of āvarana:  

Complications of Avarana:  

This includes hr̥drōga, vidradhi, plīhā, gulma, a'tīsāra. Hr̥drōga is a common complication of ill treated āvarana of prāna and udāna. Vidradhi and plīhā are caused by wrongly managed āvarana of vyāna. Gulma and atīsāra are common complications of āvarana of samāna and apāna.  

This includes hrudroga, vidradhi, plīhā, gulma, atisara. Hrudroga is a common complication of ill treated avarana of prana and udana. Vidradhi and pliha are caused by wrongly managed avarana of vyana. Gulma and atisara are common complications of avarana of samana and apana.  

Srotoshodana is an important line of management in Āvarana. It ensures unobstructed movement of vāta. All abhishyandi(..) food causes srotorōdha (obstruction of channels). Yāpana Basti is ideal for all age group and safe to severe clinical presentations. It protects all marma points. As it is neither lekhana (..), nor brimhana, it is useful for managing vāta as well as āvaraka kapha or pitta. Guggulu rasāyana and shilajatu rasāyana is ideal for many clinical conditions of āvarana.

Srotoshodana is an important line of management in Avarana. It ensures unobstructed movement of [[vata]]. All abhishyandi(..) food causes srotorodha (obstruction of channels). Yapana [[Basti]] is ideal for all age group and safe to severe clinical presentations. It protects all marma points. As it is neither lekhana (..), nor brimhana, it is useful for managing [[vata]] as well as avaraka [[kapha]] or [[pitta]]. Guggulu rasāyana and shilajatu rasāyana is ideal for many clinical conditions of avarana.

=== Related Chapter ===

=== Related Chapter ===

* [[Vatakalakaliya Adhyaya]]

* [[Vatakalakaliya Adhyaya]]

== References ==

== References ==