Vatavyadhi Chikitsa

Vatavyadhi Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 28
Preceding Chapter	Urusthambha Chikitsa
Succeeding Chapter	Vatarakta Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 28, Chapter on disorders caused by vata dosha)

Abstract

Vatavyadhi Chikitsa deals with disorders particularly caused by vata dosha. It is an important chapter as it encompasses a large spectrum of disorders especially concerned with neurological system, musculoskeletal system, reticulo-endothelial system and further pervades to all other systems in the body. The chapter highlights the five sub classifications of vata, their habitat and functions. The etiological factors of vatavyadhi are enlisted and two major pathology viz, dhatukshaya and avarana are detailed. In dhatukshaya, vitiated vata assumes the status of gatavata (increased movement of vata) and occupies various sites leading to dhatugata (affecting tissues) vata, ashayagata (affecting various sites) vata and avayava (organs) gatavata. Avarana (obstruction by covering) is a distinct pathology of vata in which the free mobility of vata is hampered. Accordingly, avarana may happen either due to two other dosha, dhatu (rakta, etc.) or mala (waste). Avarana may also happen in between two subtypes of vata as the direction of movement of various types of vata differ. This is called anyonyavarana. The symptomatology, pathology and management strategies of avarana as well as gatavata are detailed in the chapter. The most common neurological disorders like pakshaghata (stroke), ardita (facial palsy), gridhrasi (sciatica), avabahuka (frozen shoulder), viswachi (cervico brachial neuralgia) etc. are described. Various formulations including medicated oils and ghee etc. are also included in the chapter. The chapter confirms the difficulty in curability of chronic vatavyadhi affecting debilitated individuals.

Keywords: Aksepaka, Anyonyvarana, Apana, Ardita, Avabahuka, Avarana, Ayurveda, Convulsive disorders, Dhatukshaya, Facial palsy, Gatavata, General Line of treatment of Vatavyadhi, Gridhrasi, Neurological disorders, Paksaghata, Praana, Samana, Sciatica, Specific treatments of Vatavyadhi, Stroke, Udana, Viswachi, Vyana.

Introduction

Vatavyadhi Chikitsa exclusively deals with certain common disorders where the specific vitiation of vata takes place. Before entering the chapter, let us consider the etymological derivations of the term vata. The technical term vata is derived from Sanskrit root verb va which means gati gandhanayoh (movement and continued efforts/enthusiasm.) or by the application of kta to the root verb va which again means the same as above, vatiti vata, the term vata is derived. As all ancient Indian scientific treatise observe strict rules regarding formation of a word, for the brevity and secrecy of expressions, it should be analyzed in detail for better understanding. The meaning of gati is to acquire; and jnana is to get aware or to sense. The term gandhana means to enthuse, to excite or to stimulate. Considering the different meanings of gati, and gandhana it is understood that the term vata itself conveys its role as a receptor as well as stimulator. Hence it can be said that vata is the biological force which recognizes and stimulates all the activities in the body.

Vata is the prime dosha. Owing to its incorporeal nature and instability it is inaccessible in comparison to other two dosha. The inaccessibility is characterized in regard to its functional and physical attributes but is more relevant regarding the therapeutic aspect. Vata is also explained as achintyaveerya (inconceivable prowess) and doshaanaam netah (propeller of all functional elements in the body).1

Before discussing the importance and implications of vata, the references on vata and neurological elements in vedic literature is to be highlighted. In vedic science two terminologies namely prana and pranaja were used to denote nerve impulses. Prana is kriyashakti (power for action) and may be compared with motor impulse. Pranaja is also same as prana but conveys sensation of taste, smell, vision, sound, coitus, reproduction, pleasure and pain. It can be compared with sensory afferent impulse. Both prana and pranaja leave body at death. The entire neural axis is explained as sushumna (spinal cord) and it extends from the mid-perineum to inside of cranium runing through the middle of the spine to reach the cerebrum, 12 fingers breadth from nose. The shape of sushumna is compared with flower of datura alba with two dilatations at thoracic and lumbar areas. The cross section of spinal column is compared with the letter Aum in which grey matter and white matter is identified as chitrini (name for grey matter) and vajra (name for white matter). The neural net works are compared with luta tantu (spider web)2. Ten subtypes of vata are explained and dhananjaya (the tenth and last subtype) does not leave the body even after death. This is responsible for tissue transplantation after death. The description of shadchakra (six chakras) is also very striking with latest functional modern neurology. The difference between vedic and ayurvedic neurology is that vedic science used it to attain higher level of consciousness through control of one’s nerve impulses. Ayurvedic science is meant for academic advancement or therapeutics. In Ayurveda it can be seen that practical utilization of vedic knowledge for therapeutic purpose by modification through experiments and experiences is done. Detailed descriptions of features of vata are available in various chapters of Charaka Samhita including Deerghanjiviteeya Adhyaya, Vatakalakaliya Adhyaya and Rogabhishagjitiya Vimana, etc. The pathology and therapeutic aspects of vata is explained in this chapter. There is no separate chapter for diseases of pitta and kapha dosha. Vatavyadhi Chikitsa is an exclusive chapter dealing with vata janita vishesha vyadhi (diseases caused by vata vitiation). It is because of the supremacy of vata. The chapter is kept just after Urusthambha Chikitsa since in that particular disease ama, kapha, meda, etc. are associated to cause vataprakopa and urustambha. On application of strenuous rukshana chikitsa in urustambha, vataprakopa alone may also happen. Even though in nanatmaja (single dosha) vatavyadhi the presence of other dosha can be traced, the disease cannot manifest without the vitiation of vata.

Vata as explained earlier is the biological force present in the body which recognizes and stimulates all the activities. Instability of vata makes it inaccessible. It is characterized by an increase in the chala (motion) property, which is favored and contributed by other properties also. The chala guna is directional in nature and termed as gati. Gati is the distinct quality of vata, very important on physiological and pathological aspects. The gati of individual components of vata is to be analyzed according to the intensity, direction and area; depending upon the particular function it is carrying out. When the gati is aggravated (gatatva) or obstructed (avarana) the functional normality’s of vata are impaired. The gati or gatatva have two implications, one subjected to activity (to move, carry out or reach-gata) and the second subjected to abode of activity (pathway). Gatatva is an essential part of any vataja samprapti (pathogenesis). Gatatva of vata is possible in dhatu, upadhatu, asaya (sites or hollow cavities of organs), avayava (part or organ), etc. Consumption of ahara of relatively higher kittansa (waste products) leads to diminution of dhatu and aggravation of vata3. It leads to riktata (emptiness) and more avakasa (space) in dhatu, makes the engorgement and hyper movement of aggravated vata in the site. Dhatugatavata and dhatuavrita vata are also distinct pathologies as in avarana the vitiation of vata is passive and the gati is obstructed.

The chapter begins with praising of powerful vata followed with five subtypes of vata. After these descriptions, the etiopathological and therapeutic aspects of vata are explained. In the present chapter the two distinct pathology of vata is explained with possible causative factors. In the context of gatavata, the pathology is related to the various dhatu, ashaya or avayava involved in gatatva. The same way different avarana of vata by other two dosha, dhatu, mala, anna, etc. are explained. Since different subtypes of vata possess different gati mutual avarana among subtypes are also possible. The chapter also explains various disorders like pakshaghata, ardita, akshepaka, avabahuka etc. The general line of treatment of absolute vata vitiation is detailed in the chapter by giving importance to snehana, swedana, samshodana, etc. An ample amount of medications including various taila yoga, ghr̥ita yoga, etc. are also given in the chapter. The specific treatment approaches in exclusive conditions are also explained.

Vatavyadhi are group of disorders which are very commonly encountered by ayurvedic physicians. In many diseases like pakshaghata, ardita, gridhrasi, kateegraha, etc. ayurvedic physicians are claiming better results and it is widely accepted also. Critical understandings of pathology, types, prognostic factors etc. are very important for academic and clinical success. Thus, thorough understanding of vata roga is essential for every treating physician.

Sanskrit Text, Transliteration and English Translation

अथातो वातव्याधिचिकित्सितं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

athAto VātavyādhicikitśītāM vyAkhyAsyAmaH ||1||

iti ha smAha bhagavAnAtreyaH ||2||

athātō vātavyādhicikitśītāṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

Now we shall expound the chapter on “the therapeutics for vatavyadhi", thus said by the Lord Atreya.[1-2]

Significance of vayu

वायुरायुर्बलं वायुर्वायुर्धाता शरीरिणाम् | वायुर्विश्वमिदं सर्वं प्रभुर्वायुश्च कीर्तितः ||३||

Vāyur AyurbalaM Vāyur VāyurdhAtA sharIriNAm | Vāyur vishvamidaM sarvaM prabhurVāyushcakIrtitaH ||3||

Vāyurāyurbalaṁ vāyurvāyurdhātā śarīriṇām| vāyurviśvamidaṁ sarvaṁ prabhurvāyuśca kīrtitaḥ||3||

Vayu is life, vayu is strength, vayu mainstays living organism, the same vayu is verily the universe, and hence the Lord Vayu is praised. [3]

Important role of vayu in health

अव्याहतगतिर्यस्य स्थानस्थः प्रकृतौ स्थितः | वायुः स्यात्सोऽधिकं जीवेद्वीतरोगः समाः शतम् ||४||

avyAhatagatiryasya sthānasthaH prakRutau sthitaH | VāyuHsyAtso~adhikaM jIvedvItarōgaH samAH shatam ||4||

avyāhatagatiryasya sthānasthaḥ prakr̥tau sthitaḥ| vāyuḥ syātsō'dhikaṁ jīvēdvītarōgaḥ samāḥ śatam||4||

When normal (non vitiated) vayu is at its abode with unobstructed (free) movement, is responsible for long lifespan of hundred years devoid of diseases.[4]

Types of vayu and their functions

प्राणोदानसमानाख्यव्यानापानैः स पञ्चधा | देहं तन्त्रयते सम्यक् स्थानेष्वव्याहतश्चरन् ||५||

स्थानं प्राणस्य मूर्धोरःकण्ठजिह्वास्यनासिकाः [१] | ष्ठीवनक्षवथूद्गारश्वासाहारादि कर्म च ||६||

उदानस्य पुनः स्थानं नाभ्युरः कण्ठ एव च | वाक्प्रवृत्तिः प्रयत्नौर्जोबलवर्णादि कर्म च ||७||

स्वेददोषाम्बुवाहीनि स्रोतांसि समधिष्ठितः | अन्तरग्नेश्च पार्श्वस्थः समानोऽग्निबलप्रदः ||८||

देहं व्याप्नोति सर्वं तु व्यानः शीघ्रगतिर्नृणाम् | गतिप्रसारणाक्षेपनिमेषादिक्रियः सदा ||९||

वृषणौ बस्तिमेढ्रं च नाम्भूरू वङ्क्षणौ गुदम् | अपानस्थानमन्त्रस्थः शुक्रमूत्रशकृन्ति [२] च ||१०||

सृजत्यार्तवगर्भौ च युक्ताः स्थानस्थिताश्च ते | स्वकर्म कुर्वते देहो धार्यते तैरनामयः ||११||

prānaodAnasamānakhya vyānapānaiH sa pa~jcadhA | dehaM tantrayate samyak sthAneShvavyAhatashcaran ||5||

sthānaM prānasya mUrdhoraHkaNThajihvAsyanAsikAH [1] | ShThIvanakṣavathūdgArashvAsAhArAdi karma ca ||6||

udānasya punaH sthānaM nAbhyuraH kaNTha eva ca | vAkpravRuttiH prayatnaurjobalavarNAdi karma ca ||7||

sveda dōṣambuvAhIni srotAMsi samadhiShThitaH | antaragneshca pArshvasthaH Samānao~agnibalapradaH ||8||

dehaM vyApnoti sarvaM tu vyānaH shIghragatirnRuNAm | gatiprasAraNAkShepanimeShAdikriyaH sadA ||9||

vRuShaNau bastimeDhraM ca nAmbhUrU va~gkShaNau gudam | apāna sthānamantrasthaH śukramūtrashakRunti [2] ca ||10||

sRujatyArtavagarbhau ca yuktAH sthānasthitAshca te | svakarma kurvate deho dhAryate tairanAmayaH ||11||

prāṇōdānasamānākhyavyānapāna iḥ sa pañcadhā| dēhaṁ tantrayatē samyak sthānēṣvavyāhataścaran||5||

sthānaṁ prāṇasya mūrdhōraḥkaṇṭhajihvāsyanāsikāḥ [1] | ṣṭhīvanakṣavathūdgāraśvāsāhārādi karma ca||6||

udānasya punaḥ sthānaṁ nābhyuraḥ kaṇṭha ēva ca| vākpravr̥ttiḥ prayatnaurjōbalavarṇādi karma ca||7||

svēdadōṣāmbuvāhīni srōtāṁsi samadhiṣṭhitaḥ| antaragnēśca pārśvasthaḥ samānō'gnibalapradaḥ||8||

dēhaṁ vyāpnōti sarvaṁ tu vyānaḥ śīghragatirnr̥ṇām| gatiprasāraṇākṣēpanimēṣādikriyaḥ sadā||9||

vr̥ṣaṇau bastimēḍhraṁ ca nābhyūrū vaṅkṣaṇau gudam| apānasthānamantrasthaḥ śukramūtraśakr̥nti [2] ca||10||

sr̥jatyārtavagarbhau ca yuktāḥ sthānasthitāśca tē| svakarma kurvatē dēhō dhāryatē tairanāmayaḥ||11||

Vayu is of five types namely prana, udana, samana, vyana and apana and they mechanize the body optimally occupying their sites without any irregular movement.

The location of prana is vertex, thorax, trachea, tongue, mouth and nose and it performs functions of spitting, sneezing, eructation, respiration, deglutition etc.

The site of udana is umbilicus, thorax and trachea and is responsible for vocalization, drive, energy, strength, complexion etc. Samana is located in channels of sweat, humors and water and lateral to the seat of agni (digestive enzymes (agni) and yield strength to the digestive fire.

Vyana has swift movement and spreads all over the body and is responsible for gait, flexion, extension, twinkling etc. Apana is told to be located in testicles, urinary bladder, penis, umbilicus, thighs, inguinal region and anus and performs ejaculation, micturition, defecation, expulsion of menstrual blood and fetus.

When these five are located in respective sites optimally, perform their functions, supports life without any morbidity. [5-11]

Role of vata/vayu in causing diseases

विमार्गस्था ह्ययुक्ता वा रोगैः स्वस्थानकर्मजैः | शरीरं पीडयन्त्येते प्राणानाशु हरन्ति च ||१२||

सङ्ख्यामप्यतिवृत्तानां तज्जानां हि प्रधानतः | अशीतिर्नखभेदाद्या रोगाः सूत्रे निदर्शिताः ||१३||

तानुच्यमानान् पर्यायैः सहेतूपक्रमाञ्छृणु | केवलं वायुमुद्दिश्य स्थानभेदात्तथाऽऽवृतम् ||१४||

vimArgasthA hyayuktA vA rōgaiH svasthānakarmajaiH | sharIraM pIDayantyete prānanAshu haranti ca ||12||

sa~gkhyAmapyativRuttAnAM tajjAnAM hi pradhAnataH | ashItirnakhabhedAdyA rōgaH sUtre nidarshitAH ||13||

tAnucyamAnAn paryAyaiH sahetUpakramA~jchRuNu | kevalaM Vāyu muddishya sthānabhedAttathA~a~avRutam ||14||

vimārgasthā hyayuktā vā rōgaiḥ svasthānakarmajaiḥ| śarīraṁ pīḍayantyētē prāṇānāśu haranti ca||12||

saṅkhyāmapyativr̥ttānāṁ tajjānāṁ hi pradhānataḥ| aśītirnakhabhēdādyā rōgāḥ sūtrē nidarśitāḥ||13||

tānucyamānān paryāyaiḥ sahētūpakramāñchr̥ṇu| kēvalaṁ vāyumuddiśya sthānabhēdāttathāvr̥tam||14||

When dislodged or impaired, dosha harm the body by diseases according to their respective site and function, and may even lead to instantaneous death.

Even though the diseases caused by them are innumerable, starting from nakhabheda (nail splitting), the major eighty diseases enlisted in Sutra Sthana are important.

Now the aforesaid synonymous diseases with etiology and therapeutics are about to explain here, the absolute vata as per different locations as well as that got obstructed. [12-14]

Etiopathology

रूक्षशीताल्पलघ्वन्नव्यवायातिप्रजागरैः | विषमादुपचाराच्च दोषासृक्स्रवणादति ||१५||

लङ्घनप्लवनात्यध्वव्यायामातिविचेष्टितैः | धातूनां सङ्क्षयाच्चिन्ताशोकरोगातिकर्षणात् ||१६||

दुःखशय्यासनात् क्रोधाद्दिवास्वप्नाद्भयादपि | वेगसन्धारणादामादभिघातादभोजनात् ||१७||

मर्माघाताद्गजोष्ट्राश्वशीघ्रयानापतंसनात् | देहे स्रोतांसि रिक्तानि पूरयित्वाऽनिलो बली ||१८||

करोति विविधान् व्याधीन् सर्वाङ्गैकाङ्गसंश्रितान् |१९|

rūkṣashItAlpalaghvannavyavAyAtiprajAgaraiH | viShamAdupacArAcca dōṣasRuksravaNAdati ||15||

la~gghanaplavanAtyadhvavyAyAmAtiviceShTitaiH | dhātunAM sa~gkṣayaccintAshokarōgatikarShaNAt ||16||

duHkhashayyAsanAt krodhAddivAsvapnAdbhayAdapi | vegasandhAraNAdAmAdabhighAtAdabhojanAt ||17||

marmAghAtAdgajoShTrAshvashIghrayAnApataMsanAt | dehe srotAMsi riktAni pUrayitvA~anilo balI ||18||

karoti vividhAn vyAdhIn sarvA~ggaikA~ggasaMshritAn |19|

rūkṣaśītālpalaghvannavyavāyātiprajāgaraiḥ| viṣamādupacārācca dōṣāsr̥ksravaṇādati||15||

laṅghanaplavanātyadhvavyāyāmātivicēṣṭitaiḥ| dhātūnāṁ saṅkṣayāccintāśōkarōgātikarṣaṇāt||16||

duḥkhaśayyāsanāt krōdhāddivāsvapnādbhayādapi| vēgasandhāraṇādāmādabhighātādabhōjanāt||17||

marmāghātādgajōṣṭrāśvaśīghrayānāpataṁsanāt| dēhē srōtāṁsi riktāni pūrayitvā'nilō balī||18||

karōti vividhān vyādhīn sarvāṅgaikāṅgasaṁśritān|19|

Due to intake of dry, cold, deficient and light food; excessive sex and sleeplessness; improper treatments; expelling of dosha or blood letting; by excessive fasting, swimming, walking, exercising, and physical activity; depletion of tissue elements; worrying, grief, debilitating diseases; usage of uncomfortable beds or seats; anger, day sleep or even with fright; suppression of natural urges, indigestion, trauma, abstaining from food; injury to vital areas, falling from swift moving elephant, camel or horse etc. vata is aggravated. This gets filled in the vacuous channels in the body and leads to various generalized or localized disorders. [15-19]

Premonitory symptoms

अव्यक्तं लक्षणं तेषां पूर्वरूपमिति स्मृतम् ||१९||

आत्मरूपं तु तद्व्यक्तमपायो लघुता पुनः |२०|

avyaktaM lakShaNaM teShAM pUrvarUpamiti smRutam ||19||

AtmarUpaM tu tadvyaktamapAyo laghutA punaH |20|

avyaktaṁ lakṣaṇaṁ tēṣāṁ pūrvarūpamiti smr̥tam||19||

ātmarūpaṁ tu tadvyaktamapāyō laghutā punaḥ|20|

Indistinct manifestation of the diseases are considered as prodromal symptoms.When the cardinal feature is clearly manifested, it is called as symptom, while the lessening of features are indicative of cure. [19-20]

General signs and symptoms of vata vitiation

सङ्कोचः पर्वणां स्तम्भो भेदोऽस्थ्नां पर्वणामपि ||२०||

लोमहर्षः प्रलापश्च पाणिपृष्ठशिरोग्रहः | खाञ्ज्यपाङ्गुल्यकुब्जत्वं शोषोऽङ्गानामनिद्रता ||२१||

गर्भशुक्ररजोनाशः स्पन्दनं गात्रसुप्तता | शिरोनासाक्षिजत्रूणां ग्रीवायाश्चापि हुण्डनम् ||२२||

भेदस्तोदार्तिराक्षेपो मोहश्चायास एव च | एवंविधानि रूपाणि करोति कुपितोऽनिलः ||२३||

हेतुस्थानविशेषाच्च भवेद्रोगविशेषकृत् |२४|

sa~gkocaH parvaNAM stambho bhedo~asthnAM parvaNAmapi ||20||

lomaharShaH pralApashca pANipRuShThashirograhaH | khA~jjyapA~ggulyakubjatvaM shoSho~a~ggAnAmanidratA ||21||

garbhaśukrarajonāśaH spandanaM gAtrasuptatA | shironAsAkShijatrUNAM grIvAyAshcApi huNDanam ||22||

bhedastodArtirAkShepo mohashcAyAsa eva ca | evaMvidhAni rUpANi karoti kupito~anilaH ||23||

hetusthānavisheShAcca bhavedrōgavisheShakRut |24|

Saṅkōcaḥ parvaṇāṁ stambhō bhēdō'sthnāṁ parvaṇāmapi||20||

lōmaharṣaḥ pralāpaśca pāṇipr̥ṣṭhaśirōgrahaḥ| khāñjyapāṅgulyakubjatvaṁ śōṣō'ṅgānāmanidratā||21||

garbhaśukrarajōnāśaḥ spandanaṁ gātrasuptatā| śirōnāsākṣijatrūṇāṁ grīvāyāścāpi huṇḍanam||22||

bhēdastōdārtirākṣēpō mōhaścāyāsa ēva ca| ēvaṁvidhāni rūpāṇi karōti kupitō'nilaḥ||23||

hētusthānaviśēṣācca bhavēdrōgaviśēṣakr̥t|24|

Vitiated vata causes various symptoms like contractures, joint stiffness, splitting of bones and joints, horripilation, delirium, spasticity of hands, back and neck; limping, paraplegia, hunch back; organ atrophy, insomnia, intrauterine death of embryo and fetus, diminishing sperms and menstruation fasciculation, generalized numbness, twitches of head, nose, eyes, supraclavicular part and neck; splitting, pricking or aching type of pains; convulsions, loss of consciousness, fatigue etc. Different specific diseases of vata are caused by specificity in etiological factors and site of affliction. [20-24]

Clinical features of vitiation of vata at different sites

Koshthashirta vata (vitiation at gastrointestinal tract)

तत्र कोष्ठाश्रिते दुष्टे निग्रहो मूत्रवर्चसोः ||२४||

ब्रध्नहृद्रोगगुल्मार्शःपार्श्वशूलं च मारुते |

tatra kōṣṭhashrite duShTe nigraho mūtravarcasoH ||24||

bradhnahRudrōgagulmArshaHpArshvashUlaM ca mArute |

tatra kōṣṭhāśritē duṣṭē nigrahō mūtravarcasōḥ||24||

bradhnahr̥drōgagulmārśaḥpārśvaśūlaṁ ca mārutē|

When vitiated vata is located in gastrointestinal tract or in abdomen it leads to urinary retention and constipation, intestinal and epigastric discomforts, gulma, piles and pain in flanks.[24]

Sarvanga kupita vata (vitiation all over body)

सर्वाङ्गुकुपिते वाते गात्रस्फुरणभञ्जने ||२५||

वेदनाभिः परीतश्च स्फुटन्तीवास्य सन्धयः |

sarvA~ggukupite vAte gAtrasphuraNabha~jjane ||25||

vedanAbhiH parItashca sphuTantIvAsya sandhayaH |

sarvāṅgakupitē vātē gātrasphuraṇabhañjanē||25||

vēdanābhiḥ parītaśca sphuṭantīvāsya sandhayaḥ|

When vitiated vata is located all over the body, it produces generalized fasciculation and breaking pain; different types of pain and the generalized joint crepitus. [25]

Guda sthita vata (vitiation at anus)

ग्रहो विण्मूत्रवातानां शूलाध्मानाश्मशर्कराः ||२६||

जङ्घोरुत्रिकपात्पृष्ठरोगशोषौ गुदस्थिते |

graho viNmūtravātanAM shUlAdhmAnAshmasharkarAH ||26||

ja~gghorutrikapAtpRuShTharōgashoShau [1] gudasthite | grahō viṇmūtravātānāṁ śūlādhmānāśmaśarkarāḥ||26||

jaṅghōrutrikapātpr̥ṣṭharōgaśōṣau [1] gudasthitē|

When vitiated vata is located in anus, it leads to retention of feces, urine and flatus; colicky pain, flatulence, renal calculi, micro-calculi; diseases with atrophy in calf, thigh, pelvis, and the back.[26]

Amashaya sthita vata (vitiation at stomach)

हृन्नाभिपार्श्वोदररुक्तृष्णोद्गारविसूचिकाः ||२७|| कासः कण्ठास्यशोषश्च श्वासश्चामाशयस्थिते | hRunnAbhipArshvodararuktRuShNodgAravisUcikAH ||27|| kAsaH kaNThAsyashoShashca shvAsashcĀmashayasthite | hr̥nnābhipārśvōdararuktr̥ṣṇōdgāravisūcikāḥ||27|| kāsaḥ kaṇṭhāsyaśōṣaśca śvāsaścāmāśayasthitē| When vitiated vāta is located in stomach, symptoms manifest as pain in epigastrium, umbilicus, flanks and abdomen; morbid thirst, eructation, acute gastroenteritis, cough, dryness of throat and mouth and breathing difficulty.(27)

Pakwashaya sthita vata (vitiation at colon)

पक्वाशयस्थोऽन्त्रकूजं शूलाटोपौ करोति च ||२८|| कृच्छ्रमूत्रपुरीषत्वमानाहं त्रिकवेदनाम् | pakvAshayastho~antrakUjaM shUlATopau karoti ca ||28|| kRucchramūtrapurIShatvamAnAhaM trikavedanAm | pakvāśayasthō'ntrakūjaṁ śūlāṭōpau karōti ca||28|| kr̥cchramūtrapurīṣatvamānāhaṁ trikavēdanām|

When vitiated vāta is located in colon it causes gurgling, colicky pain, tympanites, difficulty in defecation and urination, flatulence and lumbar/ sacroiliac pain. (28)

Indriya gata vata (vitiation in sense organs)

श्रोत्रादिष्विन्द्रियवधं कुर्याद्दुष्टसमीरणः ||२९|| shrotrAdiShvindriyavadhaM kuryAdduShTasamIraNaH ||29|| śrōtrādiṣvindriyavadhaṁ kuryādduṣṭasamīraṇaḥ||29|| When vitiated vāta is located in ear like sense organs leads to sensorial loss in the respective organs. (29)

Twaksthita vata (vitiation at skin)

त्वग्रूक्षा स्फुटिता सुप्ता कृशा कृष्णा च तुद्यते | आतन्यते सरागा च पर्वरुक् त्वक्स्थितेऽनिले ||३०|| tvagrūkṣa sphuTitA suptA kRushA kRuShNA ca tudyate | Atanyate sarAgA ca parvaruk tvaksthite~anile ||30|| tvagrūkṣā sphuṭitā suptā kr̥śā kr̥ṣṇā ca tudyatē| ātanyatē sarāgā ca parvaruk tvaksthitē'nilē||30|| When vitiated vāta is located in skin it becomes dry, fissured, numb, thin, blackish. It causes pain along with erythema and strech and leads to pain in distal end of bones.(30)

Raktagata vata (vitiation at blood)

रुजस्तीव्राः ससन्तापा वैवर्ण्यं कृशताऽरुचिः | गात्रे चारूंषि भुक्तस्य स्तम्भश्चासृग्गतेऽनिले ||३१|| rujastIvrAH sasantApA vaivarNyaM kRushatA~aruciH | gAtre cArUMShi bhuktasya stambhashcAsRuggate~anile ||31|| rujastīvrāḥ sasantāpā vaivarṇyaṁ kr̥śatā'ruciḥ| gātrē cārūṁṣi bhuktasya stambhaścāsr̥ggatē'nilē||31|| When vitiated vāta is located in blood it manifests as severe pain with warmth and discoloration; weight loss, anorexia, specific raised rashes in body and esophageal spasm.(31)

Mamsa medogata vata (vitiation in muscles and fats)

गुर्वङ्गं तुद्यतेऽत्यर्थं दण्डमुष्टिहतं तथा | सरुक् श्रमितमत्यर्थं [२] मांसमेदोगतेऽनिले ||३२|| gurva~ggaM tudyate~atyarthaM daNDamuShTihataM tathA | saruk shramitamatyarthaM [2] māṁsamedogate~anile ||32|| gurvaṅgaṁ tudyatē'tyarthaṁ daṇḍamuṣṭihataṁ tathā| saruk śramitamatyarthaṁ [2] māṁsamēdōgatē'nilē||32|| When vitiated vāta is located in muscles and fat, it manifest as heaviness of body, pricking pain and as if beaten by a strong rod or fist cuff and painful severe fatigue.(32)

Majja-asthigata vata (vitiation in bones and marrow)

भेदोऽस्थिपर्वणां सन्धिशूलं मांसबलक्षयः | अस्वप्नः सन्तता रुक् च मज्जास्थिकुपितेऽनिले ||३३|| bhedo~asthiparvaNAM sandhishUlaM māṁsabalakṣayaH | asvapnaH santatA ruk ca majjAsthikupite~anile ||33|| bhēdō'sthiparvaṇāṁ sandhiśūlaṁ māṁsabalakṣayaḥ| asvapnaḥ santatā ruk ca majjāsthikupitē'nilē||33|| When vitiated vāta is located in bones and marrow it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia and continuous pain.(33)

Shukra gata vata (vitiation in semen)

क्षिप्रं मुञ्चति बध्नाति शुक्रं गर्भमथापि वा | विकृतिं जनयेच्चापि शुक्रस्थः कुपितोऽनिलः ||३४|| kShipraM mu~jcati badhnAti śukraM garbhamathApi vA | vikRutiM janayeccApi śukrasthaH kupito~anilaH ||34|| kṣipraṁ muñcati badhnāti śukraṁ garbhamathāpi vā| vikr̥tiṁ janayēccāpi śukrasthaḥ kupitō'nilaḥ||34|| When vitiated vāta is located in semen, it causes premature ejaculation or anejaculation. It may also lead to preterm or delayed labor. It may also cause deformity in fetus. (34)

Snayugata vata (vitiation in tendons)

बाह्याभ्यन्तरमायामं खल्लिं कुब्जत्वमेव च | सर्वाङ्गैकाङ्गरोगांश्च कुर्यात् स्नायुगतोऽनिलः ||३५|| bAhyAbhyantaramAyAmaM khalliM kubjatvameva ca | sarvA~ggaikA~ggarōgaMshca kuryAt snAyugato~anilaH ||35|| bāhyābhyantaramāyāmaṁ khalliṁ kubjatvamēva ca| sarvāṅgaikāṅgarōgāṁśca kuryāt snāyugatō'nilaḥ||35|| When vitiated vāta is located in neural tissue or tendons, it leads to ophisthotonus or emprosthotonus, radiculopathy,? kyphosis, quadriplegia or hemiplegia. (35)

Siragata vata (vitiation in vascular tissue)

शरीरं मन्दरुक्शोफं शुष्यति स्पन्दते तथा | सुप्तास्तन्व्यो महत्यो वा सिरा वाते सिरागते ||३६|| sharIraM mandarukśōphaM shuShyati spandate tathA | suptAstanvyo mahatyo vA sirā vAte sirāgate ||36|| śarīraṁ mandarukśōphaṁ śuṣyati spandatē tathā| suptāstanvyō mahatyō vā sirā vātē sirāgatē||36|| When vitiated vāta is located in vascular tissue it leads to mildly painful edema in the body, emaciation, twitching, loss of pulsation along with dilation or coarctation of vessels. (36)

Sandhigata vata (vitiation in joints)

वातपूर्णदृतिस्पर्शः शोथः सन्धिगतेऽनिले | प्रसारणाकुञ्चनयोः प्रवृत्तिश्च [३] सवेदना ||३७|| (इत्युक्तं [४] स्थानभेदेन वायोर्लक्षणमेव च) |३८| vātapUrNadRutisparshaH śōthaH sandhigate~anile | prasAraNAku~jcanayoH pravRuttishca [3] savedanA ||37|| (ityuktaM [4] sthānabhedena vAyorlakShaNameva ca) |38| vātapūrṇadr̥tisparśaḥ śōthaḥ sandhigatē'nilē| prasāraṇākuñcanayōḥ pravr̥ttiśca [3] savēdanā||37|| (ityuktaṁ [4] sthānabhēdēna vāyōrlakṣaṇamēva ca)|38| When vitiated vāta is located in joints, it leads to palpatory feeling of air in joints(crepitus), swelling along with painful flexion and extension.(38)

Thus the symptomatology of vāta according to various site are explained. (38)

Ardita (facial paralysis)

अतिवृद्धः शरीरार्धमेकं वायुः प्रपद्यते | यदा तदोपशोष्यासृग्बाहुं पादं च जानु च ||३८|| तस्मिन् सङ्कोचयत्यर्धे मुखं जिह्मं करोति च | वक्रीकरोति नासाभूललाटाक्षिहनूस्तथा ||३९|| ततो वक्रं व्रजत्यास्ये भोजनं वक्रनासिकम् [१] | स्तब्धं नेत्रं कथयतः क्षवथुश्च निगृह्यते ||४०|| दीना जिह्मा समुत्क्षिप्ता कला [२] सज्जति चास्य वाक् | दन्ताश्चलन्ति बाध्येते श्रवणौ भिद्यते स्वरः ||४१|| पादहस्ताक्षिजङ्घोरुशङ्खश्रवणगण्डरुक् [३] | अर्धे तस्मिन्मुखार्धे वा केवले स्यात्तदर्दितम् ||४२|| ativRuddhaH sharIrArdhamekaM Vāyu H prapadyate | yadA tadopashoShyAsRugbAhuM pAdaM ca jAnu ca ||38|| tasmin sa~gkocayatyardhe mukhaM jihmaM karoti ca | vakrIkaroti nAsAbhUlalATAkShihanUstathA ||39|| tato vakraM vrajatyAsye bhojanaM vakranAsikam [1] | stabdhaM netraM kathayataH kṣavathūshca nigRuhyate ||40|| dInA jihmA samutkShiptA kalA [2] sajjati cAsya vAk | dantAshcalanti bAdhyete shravaNau bhidyate svaraH ||41|| pAdahastAkShija~gghorusha~gkhashravaNagaNDaruk [3] | ardhe tasminmukhArdhe vA kevale syAttadarditam ||42|| ativr̥ddhaḥ śarīrārdhamēkaṁ vāyuḥ prapadyatē| yadā tadōpaśōṣyāsr̥gbāhuṁ pādaṁ ca jānu ca||38|| tasmin saṅkōcayatyardhē mukhaṁ jihmaṁ karōti ca| vakrīkarōti nāsābhrūlalāṭākṣihanūstathā||39|| tatō vakraṁ vrajatyāsyē bhōjanaṁ vakranāsikam [1] | stabdhaṁ nētraṁ kathayataḥ kṣavathuśca nigr̥hyatē||40|| dīnā jihmā samutkṣiptā kalā [2] sajjati cāsya vāk| dantāścalanti bādhyētē śravaṇau bhidyatē svaraḥ||41|| pādahastākṣijaṅghōruśaṅkhaśravaṇagaṇḍaruk [3] | ardhē tasminmukhārdhē vā kēvalē syāttadarditam||42|| If the excessively increased vāta affects one half of the body, as it diminishes the blood there, leads to contracture of arm, leg and knee of the affected half, and causes distortion of one side of the face and produces asymmetry of the nose, eye brow, fore head, eye and jaw. The food goes into one side of the mouth; while speaking the nose gets curved, the eye remains rigid and without blink; the sneeze gets suppressed. His speech is feeble, distorted, strenuous and indistinct. His teeth get rickety, hearing affected and voice is hoarse. There is pain in his feet, hand, eyes, calves, thighs, temples, ears and cheek. This condition, may affect half the body or half of the face only, is called ardita (facial paralysis). (38-42)

Antarayama (Emprosthotonous)

मन्ये संश्रित्य वातोऽन्तर्यदा नाडीः प्रपद्यते | मन्यास्तम्भं तदा कुर्यादन्तरायामसञ्ज्ञितम् ||४३|| अन्तरायम्यते ग्रीवा मन्या च स्तभ्यते भृशम् | दन्तानां दंशनं लाला पृष्ठायामः [१] शिरोग्रहः ||४४|| जृम्भा वदनसङ्गश्चाप्यन्तरायामलक्षणम् | (इत्युक्तस्त्वन्तरायामो [२] ... |४५| manye saMshritya vAto~antaryadA nADIH prapadyate | manyAstambhaM tadA kuryAdantarAyAmasa~jj~jitam ||43|| antarAyamyate grIvA manyA ca stabhyate bhRusham | dantAnAM daMshanaM lAlA pRuShThAyAmaH [1] shirograhaH ||44|| jRumbhA vadanasa~ggashcApyantarAyAmalakShaNam | (ityuktastvantarAyAmo [2] ... |45 manyē saṁśritya vātō'ntaryadā nāḍīḥ prapadyatē| manyāstambhaṁ tadā kuryādantarāyāmasañjñitam||43|| antarāyamyatē grīvā manyā ca stabhyatē bhr̥śam| dantānāṁ daṁśanaṁ lālā pr̥ṣṭhāyāmaḥ [1] śirōgrahaḥ||44|| jr̥mbhā vadanasaṅgaścāpyantarāyāmalakṣaṇam| (ityuktastvantarāyāmō [2] ...|45| When vāta get localised in the ‘manyā’(neck), lateral aspect of the neck and gets spread into the internal vessels, it causes manyāstambha otherwise named as antarāyam (Emprosthotonus). So the neck becomes convulsed inward and the lateral aspect becomes very stiff, the teeth get clenched with salivation, contraction of the back muscles and the head is stiff; yawning and lock jaw; these are the symptoms of antarāyam. Thus antarāyam is explained. (43-45)

Bahirayama(ophisthotonous)

...बहिरायाम उच्यते) ||४५|| पृष्ठमन्याश्रिता बाह्याः शोषयित्वा सिरा बली | वायुः कुर्याद्धनुस्तम्भं बहिरायामसञ्ज्ञकम् ||४६|| चापवन्नाम्यमानस्य पृष्ठतो नीयते शिरः | उर उत्क्षिप्यते मन्या स्तब्धा ग्रीवाऽवमृद्यते ||४७|| दन्तानां दशनं जृम्भा लालास्रावश्च वाग्ग्रहः | जातवेगो निहन्त्येष वैकल्यं वा प्रयच्छति ||४८|| ...bahirAyAma ucyate) ||45|| pRuShThamanyAshritA bAhyAH shoShayitvA sirā balI | Vāyu H kuryAddhanustambhaM bahirAyAmasa~jj~jakam ||46|| cApavannAmyamAnasya pRuShThato nIyate shiraH | ura utkShipyate manyA stabdhA grIvA~avamRudyate ||47|| dantAnAM dashanaM jRumbhA lAlAsrAvashca vAggrahaH | jAtavego nihantyeSha vaikalyaM vA prayacchati ||48|| ...bahirāyāma ucyatē)||45|| pr̥ṣṭhamanyāśritā bāhyāḥ śōṣayitvā sirā balī| vāyuḥ kuryāddhanustambhaṁ bahirāyāmasañjñakam||46|| cāpavannāmyamānasya pr̥ṣṭhatō nīyatē śiraḥ| ura utkṣipyatē manyā stabdhā grīvā'vamr̥dyatē||47|| dantānāṁ daśanaṁ jr̥mbhā lālāsrāvaśca vāggrahaḥ| jātavēgō nihantyēṣa vaikalyaṁ vā prayacchati||48||

Bahirāyāma, will now be described. The potently provoked vāta, on getting localized in the posterior and lateral of the neck and constricting external vessels, causes bow leg like rigidity of the body which is called as bahirāyāma (ophisthotonous). As the body being bent like a bow, the head gets retracted almost touching his back and his chest is thrown forward, the sides of the neck become rigid and the neck in total get compressed along with clenching of teeth, salivation and aphasia. The attack may lead to death of the patient or deformity.(46-48)

Hanugraha (lock jaw)

हनुमूले स्थितो बन्धात् संस्रयत्यनिलो हनू | विवृतास्यत्वमथवा कुर्यात् [१] स्तब्धमवेदनम् ||४९|| हनुग्रहं च संस्तभ्य हनुं(नू)संवृतवक्रताम् |५०| hanumUle sthito bandhAt saMsrayatyanilo hanU | vivRutAsyatvamathavA kuryAt [1] stabdhamavedanam ||49|| hanugrahaM ca saMstabhya hanuM(nU)saMvRutavakratAm |50| hanumūlē sthitō bandhāt saṁsrayatyanilō hanū| vivr̥tāsyatvamathavā kuryāt [1] stabdhamavēdanam||49|| hanugrahaṁ ca saṁstabhya hanuṁ(nū)saṁvr̥tavakratām|50| When the vāta gets localized at the root of the jaws causes dislocation of the jaws and produces either a condition of stiff gaping of mouth without any pain; or by causing spasticity of the jaw, the mouth becomes fixed and cannot be opened. This is called as hanugraha (lock jaw)

Aakshepaka (episodic contractions)

मुहुराक्षिपति क्रुद्धो गात्राण्याक्षेपकोऽनिलः ||५०|| पाणिपादं च संशोष्य सिराः सस्नायुकण्डराः |५१| muhurAkShipati kruddho gAtrANyAkShepako~anilaH ||50|| pANipAdaM ca saMshoShya sirāH sasnAyukaNDarAH |51| muhurākṣipati kruddhō gātrāṇyākṣēpakō'nilaḥ||50|| pāṇipādaṁ ca saṁśōṣya sirāḥ sasnāyukaṇḍarāḥ|51| In ākṣēpaka (..), the provoked vāta dimnuate/contracts vessels, tendons and ligaments of the hands and feet cause episodic contraction in different parts of the body. (50-51)

Dandaka (stiffness of body)

पाणिपादशिरःपृष्ठश्रोणीः स्तभ्नाति मारुतः ||५१|| दण्डवत्स्तब्धगात्रस्य दण्डकः सोऽनुपक्रमः |५२| pANipAdashiraHpRuShThashroNIH stabhnAti mArutaH ||51|| daNDavatstabdhagAtrasya daNDakaH so~anupakramaH |52| pāṇipādaśiraḥpr̥ṣṭhaśrōṇīḥ stabhnāti mārutaḥ||51|| daṇḍavatstabdhagātrasya daṇḍakaḥ sō'nupakramaḥ|52| When vāta causes rigidity of muscles of the hands, feet, head, back and hips, so that the body becomes stiff as a stick, is called as daṇḍaka, the condition is irremediable. (51-52)

Episodic nature of vata disorders

स्वस्थः स्यादर्दितादीनां मुहुर्वेगे [१] गतेऽगते ||५२|| पीड्यते पीडनैस्तैस्तैर्भिषगेतान् विवर्जयेत् |५३| svasthaH syAdarditAdInAM muhurvege [1] gate~agate ||52|| pIDyate pIDanaistaistairbhiShagetAn vivarjayet |53| svasthaḥ syādarditādīnāṁ muhurvēgē [1] gatē'gatē||52|| pīḍyatē pīḍanaistaistairbhiṣagētān vivarjayēt|53| In diseases like ardita etc. when the episodic convulsions are gone, the patient returns to normal. Later as the episodes return the patient gets severely afflicted with characteristic features; the physicians should regard this condition as incurable. (52-53)

Pakshaghata (paralysis)

हत्वैकं मारुतः पक्षं दक्षिणं वाममेव वा ||५३|| कुर्याच्चेष्टानिवृत्तिं हि रुजं वाक्स्तमभमेव [१] च | गृहीत्वाऽर्धं शरीरस्य सिराः स्नायूर्विशोष्य च ||५४|| पादं सङ्कोचयत्येकं हस्तं वा तोदशूलकृत् | एकाङ्गरोगं तं विद्यात् सर्वाङ्गं [२] सर्वदेहजम् ||५५|| hatvaikaM mArutaH pakShaM dakShiNaM vAmameva vA ||53|| kuryAcceShTAnivRuttiM hi rujaM vAkstamabhameva [1] ca | gRuhItvA~ardhaM sharIrasya sirāH snAyUrvishoShya ca ||54|| pAdaM sa~gkocayatyekaM hastaM vA todashUlakRut | ekA~ggarōgaM taM vidyAt sarvA~ggaM [2] sarvadehajam ||55|| hatvaikaṁ mārutaḥ pakṣaṁ dakṣiṇaṁ vāmamēva vā||53|| kuryāccēṣṭānivr̥ttiṁ hi rujaṁ vākstambhamēva [1] ca| gr̥hītvā'rdhaṁ śarīrasya sirāḥ snāyūrviśōṣya ca||54|| pādaṁ saṅkōcayatyēkaṁ hastaṁ vā tōdaśūlakr̥t| ēkāṅgarōgaṁ taṁ vidyāt sarvāṅgaṁ [2] sarvadēhajam||55|| When vāta paralyze one side of the body either right or left, leads to motor deficit, pain and aphasia on the affected side. [This is called as pakṣāghata (hemiplegia)]. By afflicting one side of the body, vāta causes diminution of the vessels and nerves lead to contraction of either one leg or one arm with aching and piercing pain. That condition is to be known ekāṅgarōga (monoplegia). If it affects whole body it is called sarvāṅgarōga (quadriplegia).(53-55)

Gridhrasi (sciatica) and khalli (radiculopathy)

स्फिक्पूर्वा कटिपृष्ठोरुजानुजङ्घापदं क्रमात् | गृध्रसी स्तम्भरुक्तोदैर्गृह्णाति स्पन्दते मुहुः ||५६|| वाताद्वातकफात्तन्द्रागौरवारोचकान्विता | खल्ली तु पादजङ्घोरुकरमूलावमोटनी ||५७|| sphikpUrvA kaTipRuShThorujAnuja~gghApadaM kramAt | gRudhrasI stambharuktodairgRuhNAti spandate muhuH ||56|| vātadvātakaphAttandrAgauravArocakAnvitA | khallI tu pAdaja~gghorukaramUlAvamoTanI ||57|| sphikpūrvā kaṭi pr̥ṣṭh ōrujānujaṅghāpadaṁ kramāt| gr̥dhrasī stambharuktōdairgr̥hṇāti spandatē muhuḥ||56|| vātādvātakaphāttandrāgauravārōcakānvitā| khallī tu pādajaṅghōrukaramūlāvamōṭanī||57|| Gr̥dhrasī due to vāta is manifested as; stiffness, ache and pricking pain in the course of gluteal region, hip and posterior aspect of thigh, knee, calf and soles and twitching infrequently. If it is due to combined vāta and kapha, there will be additional symptoms of listlessness, heaviness and anorexia. The condition is known as khallī where there is kneading pain referable to feet, calf, thigh and shoulder. (56-57)

Other local disorders

स्थानानामनुरूपैश्च लिङ्गैः शेषान् विनिर्दिशेत् |५८| sthānanAmanurUpaishca li~ggaiH sheShAn vinirdishet |58| sthānānāmanurūpaiśca liṅgaiḥ śēṣān vinirdiśēt|58| The rest of the disorders should be diagnosed according to the symptoms characteristic of the seat of affection. (58)

Pathological factors

सर्वेष्वेतेषु संसर्गं पित्ताद्यैरुपलक्षयेत् ||५८|| वायोर्धातुक्षयात् कोपो मार्गस्यावरणेन च (वा) | वातपित्तकफा देहे सर्वस्रोतोऽनुसारिणः ||५९|| वायुरेव हि सूक्ष्मत्वाद्द्वयोस्तत्राप्युदीरणः [१] | कुपितस्तौ समुद्धूय तत्र तत्र क्षिपन् गदान् ||६०|| करोत्यावृतमार्गत्वाद्रसादींश्चोपशोषयेत् |६१| sarveShveteShu saMsargaM pittAdyairupalakṣayaet ||58|| vAyordhātukṣayat kopo mArgasyĀvaranaena ca (vA) | vātapittakaphA dehe sarvasroto~anusAriNaH ||59|| Vāyu reva hi sUkShmatvAddvayostatrApyudIraNaH [1] | kupitastau samuddhUya tatra tatra kShipan gadAn ||60|| karotyAvRutamArgatvAdrasAdIMshcopashoShayet |61| sarvēṣvētēṣu saṁsargaṁ pittādyairupalakṣayēt||58|| vāyōrdhātukṣayāt kōpō mārgasyāvaraṇēna ca (vā)| vātapittakaphā dēhē sarvasrōtō'nusāriṇaḥ||59|| vāyurēva hi sūkṣmatvāddvayōstatrāpyudīraṇaḥ [1] | kupitastau samuddhūya tatra tatra kṣipan gadān||60|| karōtyāvr̥tamārgatvādrasādīṁścōpaśōṣayēt|61| In all these disorders, the association of other dōṣha like pitta etc. is to be considered. The provocation of vāta is either due to ‘dhātukṣaya’, means diminution of tissue elements and/ or due to ‘āvarana’ means obstruction to its pathway. The vāta, pitta and kapha, always circulate through all the body channels. The vāta, owing to its quality of subtleness is really the impeller of the other two. When the vāta is provoked, it propels the other two doshas and dislodges them about here and there, causing various diseases. Due to ‘āvarana’ (obstruction in its path), it further causes diminution of the body nutrient fluid and other body elements. (59-61)

Avrita vata (conditions due to obstructed vata)

लिङ्गं पित्तावृते दाहस्तृष्णा शूलं भ्रमस्तमः [१] ||६१|| कट्वम्ललवणोष्णैश्च विदाहः शीतकामिता | शैत्यगौरवशूलानि कट्वाद्युपशयोऽधिकम् ||६२|| लङ्घनायासरूक्षोष्णकामिता च कफावृते | रक्तावृते सदाहार्तिस्त्वङ्मांसान्तरजो भृशम् ||६३|| भवेत् सरागः श्वयथुर्जायन्ते मण्डलानि च | कठिनाश्च विवर्णाश्च पिडकाः श्वयथुस्तथा ||६४|| हर्षः पिपीलिकानां च सञ्चार इव मांसगे | चलः स्निग्धो मृदुः शीतः शोफोऽङ्गेष्वरुचिस्तथा ||६५|| आढ्यवात इति ज्ञेयः स कृच्छ्रो मेदसाऽऽवृतः | स्पर्शमस्थ्नाऽऽवृते तूष्णं पीडनं चाभिनन्दति ||६६|| सम्भज्यते सीदति च सूचीभिरिव तुद्यते | मज्जावृते विनामः [२] स्याज्जृम्भणं परिवेष्टनम् ||६७|| शूलं तु पीड्यमाने च पाणिभ्यां लभते सुखम् | शुक्रावेगोऽतिवेगो वा निष्फलत्वं च शुक्रगे ||६८|| भुक्ते कुक्षौ च रुग्जीर्णे शाम्यत्यन्नावृतेऽनिले | मूत्राप्रवृत्तिराध्मानं बस्तौ मूत्रावृतेऽनिले ||६९|| वर्चसोऽतिविबन्धोऽधः स्वे स्थाने परिकृन्तति | व्रजत्याशु जरां स्नेहो भुक्ते चानह्यते नरः ||७०|| चिरात् पीडितमन्नेन दुःखं शुष्कं शकृत् सृजेत् | श्रोणीवङ्क्षणपृष्ठेषु रुग्विलोमश्च मारुतः ||७१|| अस्वस्थं हृदयं चैव वर्चसा त्वावृतेऽनिले |७२| li~ggaM pittAvRute dAhastRuShNA shUlaM bhramastamaH [1] ||61|| kaTvamlalavaNoShNaishca vidAhaH shItakAmitA | shaityagauravashUlAni kaTvAdyupashayo~adhikam ||62|| la~gghanAyAsarUkShoShNakAmitA ca kaphAvRute | raktAvRute sadAhArtistva~gmāṁsantarajo bhRusham ||63|| bhavet sarAgaH shvayathurjAyante maNDalAni ca | kaThinAshca vivarNAshca piDakAH shvayathustathA ||64|| harShaH pipIlikAnAM ca sa~jcAra iva māṁsage | calaH snigdho mRuduH shItaH shopho~a~ggeShvarucistathA ||65|| ADhyavāta iti j~jeyaH sa kRucchro medasA~a~avRutaH | sparshamasthnA~a~avRute tUShNaM pIDanaM cAbhinandati ||66|| sambhajyate sIdati ca sUcIbhiriva tudyate | majjAvRute vinAmaH [2] syAjjRumbhaNaM pariveShTanam ||67|| shUlaM tu pIDyamAne ca pANibhyAM labhate sukham | śukravego~ativego vA niShphalatvaM ca śukrage ||68|| bhukte kukShau ca rugjIrNe shAmyatyannAvRute~anile | mūtrapravRuttirAdhmAnaM bastau mūtravRute~anile ||69|| varcaso~ativibandho~adhaH sve sthAne parikRuntati | vrajatyAshu jarAM sneho bhukte cAnahyate naraH ||70|| cirAt pIDitamannena duHkhaM shuShkaM shakRut sRujet | shroNIva~gkShaNapRuShTheShu rugvilomashca mArutaH ||71|| asvasthaM hRudayaM caiva varcasA tvAvRute~anile |72| liṅgaṁ pittāvr̥tē dāhastr̥ṣṇā śūlaṁ bhramastamaḥ [1] ||61|| kaṭvamlalavaṇōṣṇaiśca vidāhaḥ śītakāmitā| śaityagauravaśūlāni kaṭvādyupaśayō'dhikam||62|| laṅghanāyāsarūkṣōṣṇakāmitā ca kaphāvr̥tē| raktāvr̥tē sadāhārtistvaṅmāṁsāntarajō bhr̥śam||63|| bhavēt sarāgaḥ śvayathurjāyantē maṇḍalāni ca| kaṭhināśca vivarṇāśca piḍakāḥ śvayathustathā||64|| harṣaḥ pipīlikānāṁ ca sañcāra iva māṁsagē| calaḥ snigdhō mr̥duḥ śītaḥ śōphō'ṅgēṣvarucistathā||65|| āḍhyavāta iti jñēyaḥ sa kr̥cchrō mēdasāvr̥taḥ| sparśamasthnāvr̥tē tūṣṇaṁ pīḍanaṁ cābhinandati||66|| sambhajyatē sīdati ca sūcībhiriva tudyatē| majjāvr̥tē vināmaḥ [2] syājjr̥mbhaṇaṁ parivēṣṭanam||67|| śūlaṁ tu pīḍyamānē ca pāṇibhyāṁ labhatē sukham| śukrāvēgō'tivēgō vā niṣphalatvaṁ ca śukragē||68|| bhuktē kukṣau ca rugjīrṇē śāmyatyannāvr̥tē'nilē| mūtrāpravr̥ttirādhmānaṁ bastau mūtrāvr̥tē'nilē||69|| varcasō'tivibandhō'dhaḥ svē sthānē parikr̥ntati| vrajatyāśu jarāṁ snēhō bhuktē cānahyatē naraḥ||70|| cirāt pīḍitamannēna duḥkhaṁ śuṣkaṁ śakr̥t sr̥jēt| śrōṇīvaṅkṣaṇapr̥ṣṭhēṣu rugvilōmaśca mārutaḥ||71|| asvasthaṁ hr̥dayaṁ caiva varcasā tvāvr̥tē'nilē|72| Vata occluded by pitta: The symptoms of vāta occluded by pitta are burning sensation, morbid thirst, colic, giddiness, darkness of vision; heart burn on eating pungent, sour, salt and hot things and craving for cold things.(61) Vata occluded by kapha: If the vāta is occluded by kapha, there will be excess feeling of cold, heaviness, pain, pacification by pungent and similar other articles, craving for fasting, exertion, dry and hot things.(62) Vata occluded by blood:When it is occluded by the blood, there will be severe burning pain in the area between the skin and the flesh, along with edema and reddish tinge and round patches.(63) Vata occluded by mamsa: In the flesh, it causes hard, discoloured boils, and swellings, horripilation and tingling.(64) Vata occluded by meda:When the vāta is occluded in the adipose tissue, it causes movable, smooth, soft and cold swellings in the body, as well as anorexia. This condition is known as āḍhyavāta and is difficult to cure. (65) Vata occluded by asthi:When the vāta is occluded in the osseous tissue, the patient likes hot touch (local sudation) and pressing . He has splitting pain and feels as though his body is being pricked with needles.(66) Vata occluded by majja: When the vāta is occluded in the marrow, there will be flexure/bending/curving of the body, /pandiculation (stretching and stiffening of the trunk and extremities), excess yawning, twisting and colicky pain. The patient gets relief on pressing with the hand (gentle massage). (67). Vata occluded by shukra: If the vāta is occluded in semen, it results anejaculation or premature ejaculation or sterility.(68) Vata occluded by food: If the vāta is occluded by food, there will be pain in the stomach on ingestion of food and disappearance of pain after digestion.(68) Vata occluded by urine: If the vāta is occluded by urine leads to urinary retention and distension of bladder.(69) Vata occluded by feces: If the vāta is occluded by the fecal matter; it leads to obstinate constipation, scissoring type pain in anal region, all unctuous matter ingested is immediately digested (due to excess dryness in colon), after food intake the person suffers from increased distension of abdomen and owing to the pressure of the food ingested the patient passes dry feces with difficulty and after long delay. He is afflicted with pain in the hips, groins and back; as the vāta moves in a reverse direction causes epigastric discomfort. (70-71)

Prognosis

सन्धिच्युतिर्हनुस्तम्भः [१] कुञ्चनं कुब्जताऽर्दितः ||७२|| पक्षाघातोऽङ्गसंशोषः [२] पङ्गुत्वं खुडवातता | स्तम्भनं चाढ्यवातश्च रोगा मज्जास्थिगाश्च ये ||७३|| एते स्थानस्य गाम्भीर्याद्यत्नात् सिध्यन्ति वा न वा | नवान् बलवतस्त्वेतान् साधयेन्निरुपद्रवान् ||७४|| sandhicyutirhanustambhaH [1] ku~jcanaM kubjatA~arditaH ||72|| pakShAghAto~a~ggasaMshoShaH [2] pa~ggutvaM khuDavātatA | stambhanaM cADhyavātashca rōga majjAsthigAshca ye ||73|| ete sthānasya gAmbhIryAdyatnAt sidhyanti vA na vA | navAn balavātastvetAn sAdhayennirupadravAn ||74|| sandhicyutirhanustambhaḥ [1] kuñcanaṁ kubjatā'rditaḥ||72|| pakṣāghātō'ṅgasaṁśōṣaḥ [2] paṅgutvaṁ khuḍavātatā| stambhanaṁ cāḍhyavātaśca rōgā majjāsthigāśca yē||73|| ētē sthānasya gāmbhīryādyatnāt sidhyanti vā na vā| navān balavātastvētān sādhayēnnirupadravān||74|| Joint dislocation, lock jaw, contracture, hunch back(kyphosis), facial paralysis, hemiplegia, atrophy of a part, paraplegia, arthritis, stiffness, rheumatic conditions and disorders due to affliction of vāta in the marrow; all these on account of their seriousness of the seat affected , may or may not be cured even after deliberate treatment. These can be cured when they are of recent origin in strong patient and without any complications. (72-74)

General management of vata disorders

Importance of snehana (oleation therapy) and swedana(sudation therapy)

क्रियामतः परं सिद्धां वातरोगापहां शृणु | केवलं निरुपस्तम्भमादौ स्नेहैरुपाचरेत् ||७५|| वायुं सर्पिर्वसातैलमज्जपानैर्नरं ततः | स्नेहक्लान्तं समाश्वास्य पयोभिः स्नेहयेत् पुनः ||७६|| यूषैर्ग्राम्याम्बुजानूपरसैर्वा स्नेहसंयुतैः | पायसैः कृशरैः साम्ललवणैरनुवासनैः ||७७|| नावनैस्तर्पणैश्चान्नैः [१] सुस्निग्धं स्वेदयेत्ततः | स्वभ्यक्तं स्नेहसंयुक्तैर्नाडीप्रस्तरसङ्करैः ||७८|| तथाऽन्यैर्विविधैः स्वेदैर्यथायोगमुपाचरेत् | स्नेहाक्तं [२] स्विन्नमङ्गं तु वक्रं स्तब्धमथापि वा ||७९|| शनैर्नामयितुं शक्यं यथेष्टं शुष्कदारुवत् | हर्षतोदरुगायामशोथस्तम्भग्रहादयः ||८०|| स्विन्नस्याशु प्रशाम्यन्ति मार्दवं चोपजायते | स्नेहश्च धातून्संशुष्कान् पुष्णात्याशु प्रयोजितः ||८१|| बलमग्निबलं पुष्टिं प्राणांश्चाप्यभिवर्धयेत् | असकृत्तं पुनः स्नेहैः स्वेदैश्चाप्युपपादयेत् ||८२|| तथा स्नेहमृदौ कोष्ठे न तिष्ठन्त्यनिलामयाः |८३| kriyAmataH paraM siddhAM vātarōgapahAM shRuNu | kevalaM nirupastambhamAdau SnēhairupAcaret ||75|| Vāyu M sarpirvasAtailamajjapāna irnaraM tataH | SnēhaklAntaM samAshvAsya payobhiH Snēhayet punaH ||76|| yUShairgrAmyAmbujAnUparasairvA SnēhasaMyutaiH | pAyasaiH kRusharaiH sAmlalavaNairanuvAsanaiH ||77|| nAvanaistarpaNaishcAnnaiH [1] susnigdhaM svedayettataH | svabhyaktaM SnēhasaMyuktairnADIprastarasa~gkaraiH ||78|| tathA~anyairvividhaiH svedairyathAyogamupAcaret | SnēhaktaM [2] svinnama~ggaM tu vakraM stabdhamathApi vA ||79|| shanairnAmayituM shakyaM yatheShTaM shuShkadAruvat | harShatodarugAyAmaśōthastambhagrahAdayaH ||80|| svinnasyAshu prashAmyanti mArdavaM copajAyate | Snēhashca dhātunsaMshuShkAn puShNAtyAshu prayojitaH ||81|| balamagnibalaM puShTiM prānaMshcApyabhivardhayet | asakRuttaM punaH SnēhaiH svedaishcApyupapAdayet ||82|| tathA SnēhamRudau koShThe na tiShThantyanilAmayAH |83| kriyāmataḥ paraṁ siddhāṁ vātarōgāpahāṁ śr̥ṇu| kēvalaṁ nirupastambhamādau snēhairupācarēt||75|| vāyuṁ sarpirvasātailamajjapānairnaraṁ tataḥ| snēhaklāntaṁ samāśvāsya payōbhiḥ snēhayēt punaḥ||76|| yūṣairgrāmyāmbujānūparasairvā snēhasaṁyutaiḥ| pāyasaiḥ kr̥śaraiḥ sāmlalavaṇairanuvāsanaiḥ||77|| nāvanaistarpaṇaiścānnaiḥ [1] susnigdhaṁ svēdayēttataḥ| svabhyaktaṁ snēhasaṁyuktairnāḍīprastarasaṅkaraiḥ||78|| tathā'nyairvividhaiḥ svēdairyathāyōgamupācarēt| snēhāktaṁ [2] svinnamaṅgaṁ tu vakraṁ stabdhamathāpi vā||79|| śanairnāmayituṁ śakyaṁ yathēṣṭaṁ śuṣkadāruvat| harṣatōdarugāyāmaśōthastambhagrahādayaḥ||80|| svinnasyāśu praśāmyanti mārdavaṁ cōpajāyatē| snēhaśca dhātūnsaṁśuṣkān puṣṇātyāśu prayōjitaḥ||81|| balamagnibalaṁ puṣṭiṁ prāṇāṁścāpyabhivardhayēt| asakr̥ttaṁ punaḥ snēhaiḥ svēdaiścāpyupapādayēt||82|| tathā snēhamr̥dau kōṣṭhē na tiṣṭhantyanilāmayāḥ|83| Now listen to the effective line of treatment for the cure of diseases due to vāta. If there is absolute vitiation of vāta without any kind of association(obstruction), it should be treated at first with oleation therapy, such as internal administration of ghee, fat, oil and marrow. Then as the person, when saturated by the oleation, should be eased by consolation and should again be oleated with unctuous articles added milk; thin gruel of cereals and pulses or meat juice of domestic, wet-land and aquatic animals, milk or meat without bones mixed with sour and salt articles; followed with unctuous enema, nasal medications and nutritive food. (75-77) When he is well oleated, he should be subjected to sudation therapy, for which oil is applied externally, and then fomentation is done through tubular, mattress or bolus method or different other types suitable to the situation. (78) By application of oleation and sudation, even a deformed stiffened limb can be slowly brought back to normality, just as it possible to bend as desired even a dried piece of wood by such measures. (79) Tingling numbness, pricking pain, aches, convulsions, swelling, stiffness and spasticity and similar other conditions can be quickly cured and the softness of the part restored by means of sudation. (80) The oleation therapy when applied quickly replenishes the diminished body elements and increases the strength, power of the digestive mechanism, robustness and the vitality. (81) The oleation and sudation procedures should be repeatedly administered so that the disorders of vāta may not stay in the viscera softened by oleation procedure. (82)

Mridu samshodhana (Mild purgation)

यद्यनेन सदोषत्वात् कर्मणा न प्रशाम्यति ||८३|| मृदुभिः स्नेहसंयुक्तैरौषधैस्तं विशोधयेत् | घृतं तिल्वकसिद्धं वा सातलासिद्धमेव वा ||८४|| पयसैरण्डतैलं वा पिबेद्दोषहरं शिवम् | स्निग्धाम्ललवणोष्णाद्यैराहारैर्हि मलश्चितः ||८५|| स्रोतो बद्ध्वाऽनिलं रुन्ध्यात्तस्मात्तमनुलोमयेत् [१] | दुर्बलो योऽविरेच्यः स्यात्तं निरूहैरुपाचरेत् ||८६|| पाचनैर्दीपनीयैर्वा भोजनैस्तद्युतैर्नरम् | संशुद्धस्योत्थिते चाग्नौ स्नेहस्वेदौ पुनर्हितौ ||८७|| स्वाद्वम्ललवणस्निग्धैराहारैः सततं पुनः | नावनैर्धूमपानैश्च सर्वानेवोपपादयेत् ||८८|| इति सामान्यतः प्रोक्तं वातरोगचिकित्सितम् |८९| yadyanena sa dōṣatvAt karmaNA na prashAmyati ||83|| mRudubhiH SnēhasaMyuktairauShadhaistaM vishodhayet | ghRutaM tilvakasiddhaM vA sAtalAsiddhameva vA ||84|| payasairaNDatailaM vA pibed dōṣaharaM shivam | snigdhAmlalavaNoShNAdyairAhArairhi malashcitaH ||85|| sroto baddhvA~anilaM rundhyAttasmAttamanulomayet [1] | durbalo yo~avirecyaH syAttaM nirUhairupAcaret ||86|| pācanairdIpanIyairvA bhojanaistadyutairnaram | saMshuddhasyotthite cAgnau Snēhasvedau punarhitau ||87|| svAdvamlalavaNasnigdhairAhAraiH satataM punaH | nAvanairdhUmapāna ishca sarvAnevopapAdayet ||88|| iti SamānayataH proktaM vātarōgacikitśītām |89| yadyanēna sadōṣatvāt karmaṇā na praśāmyati||83|| mr̥dubhiḥ snēhasaṁyuktairauṣadhaistaṁ viśōdhayēt| ghr̥taṁ tilvakasiddhaṁ vā sātalāsiddhamēva vā||84|| payasairaṇḍatailaṁ vā pibēddōṣaharaṁ śivam| snigdhāmlalavaṇōṣṇādyairāhārairhi malaścitaḥ||85|| srōtō baddhvā'nilaṁ rundhyāttasmāttamanulōmayēt [1] | durbalō yō'virēcyaḥ syāttaṁ nirūhairupācarēt||86|| pācanairdīpanīyairvā bhōjanaistadyutairnaram| saṁśuddhasyōtthitē cāgnau snēhasvēdau punarhitau||87|| svādvamlalavaṇasnigdhairāhāraiḥ satataṁ punaḥ| nāvanairdhūmapānaiśca sarvānēvōpapādayēt||88|| iti sāmānyataḥ prōktaṁ vātarōgacikitśītām|89| If due to residual morbidity, the symptoms did not subside with the above procedures, then the patient should be cleansed by means of mild drugs mixed with unctuous articles. (83)

For this purpose the patient may take the medicated ghee prepared with tilvaka or sātala, or castor oil with milk; all of these are auspicious and expel the morbid humors. (84) By excessive use of unctuous, sour, salty and hot articles of diet, the excretory matter gets accumulated and occluding the alimentary passage, obstructs the vāta, hence anulomana of vāta should be done. (85) Debilitated patients, in whom purgation is contraindicated, should be given evacuative enema followed by a diet consisting of, or mixed with, the drugs of the digestive and appetizer groups. (86) Sudation and oleation procedures, repeated again, are beneficial for those whose digestive mechanism has been stimulated as a result of the purificatory procedure. (87) All diseases due to vāta vitiation are always to be continually treated with sweet, sour, salty and unctuous articles of diet and nasal medication and inhalations. Thus the treatment of diseases due to vāta provocation has been expounded in general. (88)

Specific treatment of various conditions

विशेषतस्तु कोष्ठस्थे वाते क्षारं [१] पिबेन्नरः ||८९|| पाचनैर्दीपनैर्युक्तैरम्लैर्वा [२] पाचयेन्मलान् | गुदपक्वाशयस्थे तु कर्मोदावर्तनुद्धितम् ||९०|| आमाशयस्थे शुद्धस्य यथादोषहरीः क्रियाः | सर्वाङ्गकुपितेऽभ्यङ्गो बस्तयः सानुवासनाः ||९१|| स्वेदाभ्यङ्गावगाहाश्च हृद्यं चान्नं त्वगाश्रिते | शीताः प्रदेहा रक्तस्थे विरेको रक्तमोक्षणम् ||९२|| विरेको मांसमेदःस्थे निरूहाः शमनानि च | बाह्याभ्यन्तरतः स्नेहैरस्थिमज्जगतं जयेत् ||९३|| हर्षोऽन्नपानं शुक्रस्थे बलशुक्रकरं हितम् | विबद्धमार्गं दृष्ट्वा वा शुक्रं दद्याद्विरेचनम् ||९४|| विरिक्तप्रतिभुक्तस्य पूर्वोक्तां कारयेत् क्रियाम् | गर्भे शुष्के तु वातेन बालानां चापि शुष्यताम् ||९५|| सिताकाश्मर्यमधुकैर्हितमुत्थापने पयः | हृदि प्रकुपिते सिद्धमंशुमत्या पयो हितम् ||९६|| मत्स्यान्नाभिप्रदेशस्थे सिद्धान् बिल्वशलाटुभिः | वायुना वेष्ट्यमाने तु गात्रे स्यादुपनाहनम् ||९७|| तैलं सङ्कुचितेऽभ्यङ्गो माषसैन्धवसाधितम् | बाहुशीर्षगते नस्यं पानं चौत्तरभक्तिकम् ||९८|| बस्तिकर्म त्वधो नाभेः शस्यते चावपीडकः |९९| visheShatastu kōṣṭhasthe vAte kShAraM [1] pibennaraH ||89|| pācanairdIpanairyuktairamlairvA [2] pAcayenmalAn | gudapakvAshayasthe tu karmodAvartanuddhitam ||90|| Āmashayasthe shuddhasya yathA dōṣaharIH kriyAH | sarvA~ggakupite~abhya~ggo bastayaH sAnuvAsanAH ||91|| svedAbhya~ggAvagAhAshca hRudyaM cAnnaM tvagAshrite | shItAH pradehA raktasthe vireko raktamokShaNam ||92|| vireko māṁsamedaHsthe nirUhAH shamanAni ca | bAhyAbhyantarataH SnēhairasthimajjagataM jayet ||93|| harSho~annapāna M śukrasthe balaśukrakaraM hitam | vibaddhamArgaM dRuShTvA vA śukraM dadyAdvirēcanam ||94|| viriktapratibhuktasya pUrvoktAM kArayet kriyAm | garbhe shuShke tu vAtena bAlAnAM cApi shuShyatAm ||95|| śītākAshmaryamadhukairhitamutthApānae payaH | hRudi prakupite siddhamaMshumatyA payo hitam ||96|| matsyAnnAbhipradeshasthe siddhAn bilvashalATubhiH | Vāyu nA veShTyamAne tu gAtre syAdupanAhanam ||97|| tailaM sa~gkucite~abhya~ggo mAShasaindhavasAdhitam | bAhushIrShagate nasyaM pAnaM cauttarabhaktikam ||98|| bastikarma tvadho nAbheH shasyate cAvapIDakaH |99| viśēṣatastu kōṣṭhasthē vātē kṣāraṁ [1] pibēnnaraḥ||89|| pācanairdīpanairyuktairamlairvā [2] pācayēnmalān| gudapakvāśayasthē tu karmōdāvartanuddhitam||90|| āmāśayasthē śuddhasya yathādōṣaharīḥ kriyāḥ| sarvāṅgakupitē'bhyaṅgō bastayaḥ sānuvāsanāḥ||91|| svēdābhyaṅgāvagāhāśca hr̥dyaṁ cānnaṁ tvagāśritē| śītāḥ pradēhā raktasthē virēkō raktamōkṣaṇam||92|| virēkō māṁsamēdaḥsthē nirūhāḥ śamanāni ca| bāhyābhyantarataḥ snēhairasthimajjagataṁ jayēt||93|| harṣō'nnapānaṁ śukrasthē balaśukrakaraṁ hitam| vibaddhamārgaṁ dr̥ṣṭvā vā śukraṁ dadyādvirēcanam||94|| viriktapratibhuktasya pūrvōktāṁ kārayēt kriyām| garbhē śuṣkē tu vātēna bālānāṁ cāpi śuṣyatām||95|| sitākāśmaryamadhukairhitamutthāpanē payaḥ| hr̥di prakupitē siddhamaṁśumatyā payō hitam||96|| matsyānnābhipradēśasthē siddhān bilvaśalāṭubhiḥ| vāyunā vēṣṭyamānē tu gātrē syādupanāhanam||97|| tailaṁ saṅkucitē'bhyaṅgō māṣasaindhavasādhitam| bāhuśīrṣagatē nasyaṁ pānaṁ cauttarabhaktikam||98|| bastikarma tvadhō nābhēḥ śasyatē cāvapīḍakaḥ|99| Treatment of vata located in alimentary tract: Now to be specific; in the condition of morbid vāta lodged in the alimentary tract, the patient should drink alkaline drugs or digestion of humors is to be done with digestive and appetizer groups of drugs.(89) Treatment of vata located in colon: In condition of morbid vāta lodged in the rectum or the colon, the treatment of udāvarta should be given. (90) Treatment of vata located in stomach: If it is lodged in the stomach, after the purificatory process, specific treatment as per the dōṣha should be given. Treatment of vata located in entire body:When the vāta is provoked in the entire body, oil massage, evacuative enema and unctuous enema should be given. (91) Treatment of vata located in skin: When the skin is affected, sudation, oil application, hot immersion bath and cordial food should be given. Treatment of vata located in blood:When the blood is affected, thick and cold external applications, purgation and blood letting are to be done. (92) Treatment of vata located in muscle flesh and fat: As the flesh and fat is affected purgation, evacuative enema and palliative measures should be administered. Treatment of vata located in osseous tissue and bone marrow:The osseous tissues and bone-marrow affliction should be corrected with internal and external oleation therapy.(93) Treatment of vata located in semen and intrauterine growth retardation: If the semen is affected, virility enhancing food and drinks which promote strength and semen are beneficial. If the passage of semen is found to be occluded, purgation should be administered. Only after purgation and consumption of diet, the previously mentioned line of treatment should be carried out.(94) When vāta causes intrauterine growth retardation or new born is emaciated, then milk prepared with sugar, kāśmarya and madhuka is beneficial for restoration.(95) Treatment of vata located in cardiac region: If the provoked vāta is located in the cardiac region, the milk prepared of aṁśumati is beneficial. Treatment of vata located in umbilicus: If it is located in the umbilicus, fish processed with unripe bilva fruits should be given.(97) Treatment of vata located in parts of body: If there are cramps in any part of the body, poultice should be applied. In contractures of body parts, external massage with the medicated oil prepared with black gram and rock salt should be prescribed. If there is vāta provocation in the shoulders nasal medication and ghee should be administered after food. When the morbid vāta is localized below the umbilical region, enema and avapīḍaka snēha are recommended.(98)

Treatment of vata disorders affecting tendon, ligaments and vessels

अर्दिते नावनं मूर्ध्नि तैलं तर्पणमेव च ||९९|| नाडीस्वेदोपनाहाश्चाप्यानूपपिशितैर्हिताः | स्वेदनं स्नेहसंयुक्तं पक्षाघाते विरेचनम् ||१००|| अन्तराकण्डरागुल्फं सिरा बस्त्यग्निकर्म च | गृध्रसीषु प्रयुञ्जीत खल्ल्यां तूष्णोपनाहनम् ||१०१|| पायसैः कृशरैर्मांसैः शस्तं तैलघृतान्वितैः | व्यात्तानने हनुं स्विन्नामङ्गुष्ठाभ्यां प्रपीड्य च ||१०२|| प्रदेशिनीभ्यां चोन्नाभ्य चिबुकोन्नामनं हितम् | स्रस्तं स्वं गमयेत्स्थानं स्तब्धं स्विन्नं विनामयेत् ||१०३|| ardite nAvanaM mUrdhni tailaM tarpaNameva ca ||99|| nADIsvedopanAhAshcApyAnUpapishitairhitAH | svedanaM SnēhasaMyuktaM pakShAghAte virēcanam ||100|| antarAkaNDarAgulphaM [1] sirā bastyagnikarma ca | gRudhrasIShu prayu~jjIta khallyAM tUShNopanAhanam ||101|| pAyasaiH kRusharairmāṁsaiH shastaM tailaghRutAnvitaiH | vyAttAnane [2] hanuM svinnAma~gguShThAbhyAM prapIDya ca ||102|| pradeshinIbhyAM connAbhya cibukonnAmanaM hitam | srastaM svaM gamayetsthānaM stabdhaM svinnaM vinAmayet ||103|| arditē nāvanaṁ mūrdhni tailaṁ tarpaṇamēva ca||99|| nāḍīsvēdōpanāhāścāpyānūpapiśitairhitāḥ| svēdanaṁ snēhasaṁyuktaṁ pakṣāghātē virēcanam||100|| antarākaṇḍarāgulphaṁ [1] sirā bastyagnikarma ca| gr̥dhrasīṣu prayuñjīta khallyāṁ tūṣṇōpanāhanam||101|| pāyasaiḥ kr̥śarairmāṁsaiḥ śastaṁ tailaghr̥tānvitaiḥ| vyāttānanē [2] hanuṁ svinnāmaṅguṣṭhābhyāṁ prapīḍya ca||102|| pradēśinībhyāṁ cōnnābhya cibukōnnāmanaṁ hitam| srastaṁ svaṁ gamayētsthānaṁ stabdhaṁ svinnaṁ vināmayēt||103|| In facial paralysis, nasal medication, overhead application of oil, tarpaṇa, tubular fomentation and poultices prepared of the flesh of aquatic animals are beneficial.(99) In hemiplegia, sudation with unctuous preparations and purgation are beneficial. In sciatica venesection of the vein situated between medially situated tendon (kaṇḍarā) and gulpha, enema and cauterization should be resorted.(100) In khalli, hot poultices prepared with milk pudding or kr̥śara or flesh mixed with oil and ghee are beneficial.(101) In lock jaw; in case of opened fixed mouth, the jaw should be subjected to sudation procedure first and then it should be pressed downwards by the thumbs (inserting in the mouth and pressing on the molar teeth) and pushed upwards by fingers (which are placed externally below the chin) is beneficial. So the subluxated part will reach its proper position. In stiffness it should be subjected to sudation procedure and flexed. (102-103)

Specific treatment as per site and dushya

प्रत्येकं स्थानदूष्यादिक्रियावैशेष्यमाचरेत् [१] |१०४| pratyekaM sthānadUShyAdikriyAvaisheShyamAcaret [1] |104| pratyēkaṁ sthānadūṣyādikriyāvaiśēṣyamācarēt [1] |104| Specific line of treatment should be adopted in specific condition depending on site of affliction and the vitiated tissue involved.(104) Brimhana (nourishment) treatment: सर्पिस्तैलवसामज्जसेकाभ्यञ्जनबस्तयः [१] ||१०४|| स्निग्धाः स्वेदा निवातं च स्थानं प्रावरणानि च | रसाः पयांसि भोज्यानि स्वाद्वम्ललवणानि च ||१०५|| बृंहणं यच्च तत् सर्वं प्रशस्तं वातरोगिणाम् |१०६| sarpistailavasAmajjasekAbhya~jjanabastayaH [1] ||104|| snigdhAH svedA nivātaM ca sthānaM prĀvaranani ca | rasAH payAMsi bhojyAni svAdvamlalavaNAni ca ||105|| bRuMhaNaM yacca tat sarvaM prashastaM vātarogiNAm |106| sarpistailavasāmajjasēkābhyañjanabastayaḥ [1] ||104|| snigdhāḥ svēdā nivātaṁ ca sthānaṁ prāvaraṇāni ca| rasāḥ payāṁsi bhōjyāni svādvamlalavaṇāni ca||105|| br̥ṁhaṇaṁ yacca tat sarvaṁ praśastaṁ vātarōgiṇām|106| Ghee, oil, fat, marrow, affusion, massage, enema, unctuous sudation, staying at calm places (without strong wind), covering with blankets, meat soups, various milks, articles of diet of sweet, sour and salt tastes and whatever is nourishing are beneficial for disorders due to vāta.(104-106)

Various formulations

बलायाः पञ्चमूलस्य दशमूलस्य वा रसे ||१०६|| अजशीर्षाम्बुजानूपमांसादपिशितैः पृथक् | साधयित्वा रसान् स्निग्धान्दध्यम्लव्योषसंस्कृतान् ||१०७|| भोजयेद्वातरोगार्तं तैर्व्यक्तलवणैर्नरम् | एतैरेवोपनाहांश्च पिशितैः सम्प्रकल्पयेत् ||१०८| | balAyAH pa~jcamUlasya dashamUlasya vA rase ||106|| ajashIrShAmbujAnUpamāṁsadapishitaiH pRuthak | sAdhayitvA rasAn snigdhAndadhyamlavyoShasaMskRutAn ||107|| bhojayedvātarōgartaM tairvyaktalavaNairnaram | etairevopanAhAMshca pishitaiH samprakalpayet ||108|| balāyāḥ pañcamūlasya daśamūlasya vā rasē||106|| ajaśīrṣāmbujānūpamāṁsādapiśitaiḥ pr̥thak| sādhayitvā rasān snigdhāndadhyamlavyōṣasaṁskr̥tān||107|| bhōjayēdvātarōgārtaṁ tairvyaktalavaṇairnaram| ētairēvōpanāhāṁśca piśitaiḥ samprakalpayēt||108||

The patient afflicted with vāta disorders should be given meat soup of the flesh of the head of the goat, or of the aquatic, wet land or carnivorous animals prepared separately in the decoction of sida species, pañchamūla and dashamūla seasoned with unctuous articles, sour curds and trikatu which is salted liberally.( 106-107) Poultices should be prepared from the same fleshe as mixed with ghee, oil and sour articles, with the boneless flesh well crushed and steamed. (108)

घृततैलयुतैः साम्लैः क्षुण्णस्विन्नैरनस्थिभिः | पत्रोत्क्वाथपयस्तैलद्रोण्यः स्युरवगाहने ||१०९|| स्वभ्यक्तानां प्रशस्यन्ते सेकाश्चानिलरोगिणाम् | आनूपौदकमांसानि दशमूलं शतावरीम् ||११०|| कुलत्थान् बदरान्माषांस्तिलान्रास्नां यवान् बलाम् | वसादध्यारनालाम्लैः सह कुम्भ्यां विपाचयेत् ||१११|| नाडीस्वेदं प्रयुञ्जीत पिष्टैश्चाप्युपनाहनम् | तैश्च सिद्धं घृतं तैलमभ्यङ्गं पानमेव च ||११२|| मुस्तं किण्वं तिलाः कुष्ठं सुराह्वं लवणं नतम् | दधिक्षीरचतुःस्नेहैः सिद्धं स्यादुपनाहनम् ||११३|| उत्कारिकावेसवारक्षीरमाषतिलौदनैः | एरण्डबीजगोधूमयवकोलस्थिरादिभिः ||११४|| सस्नेहैः सरुजं गात्रमालिप्य बहलं भिषक् | एरण्डपत्रैर्बध्नीयाद्रात्रौ कल्यं विमोक्षयेत् ||११५|| क्षीराम्बुना ततः सिक्तं पुनश्चैवोपनाहितम् | मुञ्चेद्रात्रौ दिवाबद्धं चर्मभिश्च सलोमभिः ||११६|| फलानां तैलयोनीनामम्लपिष्टान् सुशीतलान् | प्रदेहानुपनाहांश्च गन्धैर्वातहरैरपि ||११७|| पायसैः कृशरैश्चैव कारयेत् स्नेहसंयुतैः |११८| रूक्षशुद्धानिलार्तानामतः स्नेहान् प्रचक्ष्महे||११८|| विविधान् विविधव्याधिप्रशमायामृतोपमान्|

ghRutatailayutaiH sAmlaiH kShuNNasvinnairanasthibhiH | patrotkvAthapayastailadroNyaH syuravagAhane ||109|| svabhyaktAnAM prashasyante sekAshcAnilarogiNAm | AnUpaudakamāṁsani dashamUlaM shatAvarIm ||110|| kulatthAn badarAnmAShAMstilAnrāsnāM yavAn balAm | vasAdadhyAranAlAmlaiH saha kumbhyAM vipAcayet ||111|| nADIsvedaM prayu~jjIta piShTaishcApyupanAhanam | taishca siddhaM ghRutaM tailamabhya~ggaM pAnameva ca ||112|| mustaM kiNvaM tilAH kuṣṭhaM surAhvaM lavaNaM natam | dadhikShIracatuHSnēhaiH siddhaM syAdupanAhanam ||113|| utkArikAvesavArakShIramAŚaṭīlaudānaiH | eraṇḍabIjagodhUmayavakōlasthirAdibhiH ||114|| saSnēhaiH sarujaM gAtramAlipya bahalaM bhiShak | eraṇḍapatrairbadhnIyAdrAtrau kalyaM vimokṣayaet ||115|| kShIrAmbunA tataH siktaM punashcaivopanAhitam | mu~jcedrAtrau divAbaddhaM carmabhishca salomabhiH ||116|| phalAnAM tailayonInAmamlapiShTAn sushItalAn | pradehAnupanAhAMshca gandhairvātaharairapi ||117|| pAyasaiH kRusharaishcaiva kArayet SnēhasaMyutaiH |118| rūkṣashuddhAnilArtAnAmataH Snēhan pracakShmahe ||118|| vividhAn vividhavyAdhiprashamAyAmRutopamAn |

ghr̥tatailayutaiḥ sāmlaiḥ kṣuṇṇasvinnairanasthibhiḥ| patrōtkvāthapayastailadrōṇyaḥ syuravagāhanē||109|| svabhyaktānāṁ praśasyantē sēkāścānilarōgiṇām| ānūpaudakamāṁsāni daśamūlaṁ śatāvarīm||110|| kulatthān badarānmāṣāṁstilānrāsnāṁ yavān balām| vasādadhyāranālāmlaiḥ saha kumbhyāṁ vipācayēt||111|| nāḍīsvēdaṁ prayuñjīta piṣṭaiścāpyupanāhanam| taiśca siddhaṁ ghr̥taṁ tailamabhyaṅgaṁ pānamēva ca||112|| mustaṁ kiṇvaṁ tilāḥ kuṣṭhaṁ surāhvaṁ lavaṇaṁ natam| dadhikṣīracatuḥsnēhaiḥ siddhaṁ syādupanāhanam||113|| utkārikāvēsavārakṣīramāṣatilaudānaiḥ| ēraṇḍabījagōdhūmayavakōlasthirādibhiḥ||114|| sasnēhaiḥ sarujaṁ gātramālipya bahalaṁ bhiṣak| ēraṇḍapatrairbadhnīyādrātrau kalyaṁ vimōkṣayēt||115|| kṣīrāmbunā tataḥ siktaṁ punaścaivōpanāhitam| muñcēdrātrau divābaddhaṁ carmabhiśca salōmabhiḥ||116|| phalānāṁ tailayōnīnāmamlapiṣṭān suśītalān| pradēhānupanāhāṁśca gandhairvātaharairapi||117|| pāyasaiḥ kr̥śaraiścaiva kārayēt snēhasaṁyutaiḥ|118| rūkṣaśuddhānilārtānāmataḥ snēhān pracakṣmahē||118|| vividhān vividhavyādhipraśamāyāmr̥tōpamān|

For immersion bath, vessel should be filled with the decoction of the leaves curative of vāta or with medicated milk or oil. Affusion is recommended after a good oil massage to the patient suffering from vāta disorder. (109) Cook in a pot the flesh of wetland and aquatic creatures, dashamūla, asparagus, horse-gram, jujube, black gram, sesame, rāsnā, barley and sida along with fat, curds, acetic acid and sour articles and administer this in the form of kettle sudation. This in the form of paste may also be used as poultice. And medicated ghee and oil prepared with this may be used for external massage as well as internal administration. (110-112)

The preparations made of mustā, yeast, sesame, kuṣṭha, devadāru, rock salt and nata, along with curds milk and the four varieties of unctuous articles should be used as poultice. (113)

The physician should give on the painful part, a thick application prepared of pancakes, vēsavāra preparation, milk, black gram, sesame, boiled rice, castor seeds, wheat, barley, badara, and sthirā etc mixed with unctuous articles. This application should be at night and bandaged with caster leaves, and the bandage should be removed the next morning. Then the part should be poured with milk added with water and again poultice. The bandage which is applied during the day must be of leather with fur, and it should be removed at night. (114-116)

Thick applications can be made of oleiferous fruits well pasted with sour articles and be applied after it gets cool. And poultices can be made of the fragrant group of drugs curative of vāta, milk pudding or kr̥śara mixed with unctuous articles be used. (117)

We shall describe the various unctuous preparations which are comparable to nectar and are curative of disorders in those who are afflicted with dryness after purification and vāta provocation. (118)

द्रोणेऽम्भसः पचेद्भागान् दशमूलाच्चतुष्पलान्||११९|| यवकोलकुलत्थानां भागैः प्रस्थोन्मितैः सह| पादशेषे रसे पिष्टैर्जीवनीयैः सशर्करैः||१२०|| तथा खर्जूरकाश्मर्यद्राक्षाबदरफल्गुभिः| सक्षीरैः सर्पिषः प्रस्थः सिद्धः केवलवातनुत्||१२१|| निरत्ययः प्रयोक्तव्यः पानाभ्यञ्जनबस्तिषु| चित्रकं नागरं रास्नां पौष्करं पिप्पलीं शटीम्||१२२|| पिष्ट्वा विपाचयेत् सर्पिर्वातरोगहरं परम्| बलाबिल्वशृते क्षीरे घृतमण्डं विपाचयेत्||१२३|| तस्य शुक्तिः प्रकुञ्चो वा नस्यं मूर्धगतेऽनिले| ग्राम्यानूपौदकानां तु भित्वाऽस्थीनि पचेज्जले||१२४|| तं स्नेहं दशमूलस्य कषायेण पुनः पचेत्| जीवकर्षभकास्फोताविदारीकपिकच्छुभिः||१२५|| वातघ्नैर्जीवनीयैश्च कल्कैर्द्विक्षीरभागिकम्| तत्सिद्धं नावनाभ्यङ्गात्तथा पानानुवासनात्||१२६|| सिरापर्वास्थिकोष्ठस्थं प्रणुदत्याशु मारुतम्| ये स्युः प्रक्षीणमज्जानः क्षीणशुक्रौजसश्च ये||१२७|| बलपुष्टिकरं तेषामेतत् स्यादमृतोपमम्| तद्वत्सिद्धा वसा नक्रमत्स्यकूर्मचुलूकजा||१२८|| प्रत्यग्रा विधिनाऽनेन नस्यपानेषु शस्यते| प्रस्थः स्यात्त्रिफलायास्तु कुलत्थकुडवद्वयम्||१२९|| कृष्णगन्धात्वगाढक्योः पृथक् पञ्चपलं भवेत्| रास्नाचित्रकयोर्द्वे द्वे दशमूलं पलोन्मितम्||१३०|| जलद्रोणे पचेत् पादशेषे प्रस्थोन्मितं पृथक्| सुरारनालदध्यम्लसौवीरकतुषोदकम्||१३१|| कोलदाडिमवृक्षाम्लरसं तैलं वसां घृतम्| मज्जानं च पयश्चैव जीवनीयपलानि षट्||१३२|| कल्कं दत्त्वा महास्नेहं सम्यगेनं विपाचयेत्| सिरामज्जास्थिगे वाते सर्वाङ्गैकाङ्गरोगिषु||१३३|| वेपनाक्षेपशूलेषु तदभ्यङ्गे प्रयोजयेत्| निर्गुण्ड्या मूलपत्राभ्यां गृहीत्वा स्वरसं ततः||१३४|| तेन सिद्धं समं तैलं नाडीकुष्ठानिलार्तिषु| हितं पामापचीनां च पानाभ्यञ्जनपूरणम्||१३५|| कार्पासास्थिकुलत्थानां रसे सिद्धं च वातनुत्|१३६| droNe~ambhasaH pacedbhAgAn dashamUlAccatuShpalAn ||119|| yavakōlakulatthAnAM bhAgaiH prasthonmitaiH saha | pAdasheShe rase piShTairjIvanIyaiH sasharkaraiH ||120|| tathA kharjUrakAshmaryadrAkShAbadaraphalgubhiH | sakShIraiH sarpiShaH prasthaH siddhaH kevalavātanut ||121|| niratyayaH prayoktavyaH pAnAbhya~jjanabastiShu | citrakaM nAgaraM rāsnāM pauShkaraM pippalIM śaṭīm ||122|| piShTvA vipAcayet sarpirvātarōgaharaM param | balAbilvashRute kShIre ghRutamaNDaM vipAcayet ||123|| tasya shuktiH praku~jco vA nasyaM mUrdhagate~anile | grAmyAnUpaudakAnAM tu bhitvA~asthIni pacejjale ||124|| taM SnēhaM dashamUlasya kaShAyeNa punaH pacet | jIvakarShabhakAsphotAvidArIkapikacchubhiH ||125|| vātaghnairjIvanIyaishca kalkairdvikShIrabhAgikam | tatsiddhaM nAvanAbhya~ggAttathA pAnAnuvAsanAt ||126|| sirāparvAsthikōṣṭhasthaM prānaudatyAshu mArutam | ye syuH prakShINamajjAnaH kShINaśukraujasashca ye ||127|| balapuShTikaraM teShAmetat syAdamRutopamam | tadvatsiddhA vasA nakramatsyakUrmaculUkajA ||128|| pratyagrA vidhinA~anena nasYāpanaeShu shasyate | prasthaH syAttriphalAyAstu kulatthakuDavadvayam ||129|| kRuShNagandhAtvagADhakyoH pRuthak pa~jcapalaM bhavet | rāsnācitrakayordve dve dashamUlaM palonmitam ||130|| jaladroNe pacet pAdasheShe prasthonmitaM pRuthak | surAranAladadhyamlasauvIrakatuShodakam ||131|| kōladADimavRūkṣamlarasaM tailaM vasAM ghRutam | majjAnaM ca payashcaiva jIvanIyapalAni ShaT ||132|| kalkaM dattvA mahASnēhaM samyagenaM vipAcayet | sirāmajjAsthige vAte sarvA~ggaikA~ggarogiShu ||133|| vepanAkShepashUleShu tadabhya~gge prayojayet | nirguNDyA mUlapatrAbhyAM gRuhItvA svarasaM tataH ||134|| tena siddhaM samaM tailaM nADIkuṣṭhanilArtiShu | hitaM pAmApacInAM ca pAnAbhya~jjanapUraNam ||135|| kArpAsAsthikulatthAnAM rase siddhaM ca vātanut |136| drōṇē'mbhasaḥ pacēdbhāgān daśamūlāccatuṣpalān||119|| yavakōlakulatthānāṁ bhāgaiḥ prasthōnmitaiḥ saha| pādaśēṣē rasē piṣṭairjīvanīyaiḥ saśarkaraiḥ||120|| tathā kharjūrakāśmaryadrākṣābadaraphalgubhiḥ| sakṣīraiḥ sarpiṣaḥ prasthaḥ siddhaḥ kēvalavātanut||121|| niratyayaḥ prayōktavyaḥ pānābhyañjanabastiṣu| citrakaṁ nāgaraṁ rāsnāṁ pauṣkaraṁ pippalīṁ śaṭīm||122|| piṣṭvā vipācayēt sarpirvātarōgaharaṁ param| balābilvaśr̥tē kṣīrē ghr̥tamaṇḍaṁ vipācayēt||123|| tasya śuktiḥ prakuñcō vā nasyaṁ mūrdhagatē'nilē| grāmyānūpaudakānāṁ tu bhitvā'sthīni pacējjalē||124|| taṁ snēhaṁ daśamūlasya kaṣāyēṇa punaḥ pacēt| jīvakarṣabhakāsphōtāvidārīkapikacchubhiḥ||125|| vātaghnairjīvanīyaiśca kalkairdvikṣīrabhāgikam| tatsiddhaṁ nāvanābhyaṅgāttathā pānānuvāsanāt||126|| sirāparvāsthikōṣṭhasthaṁ praṇudatyāśu mārutam| yē syuḥ prakṣīṇamajjānaḥ kṣīṇaśukraujasaśca yē||127|| balapuṣṭikaraṁ tēṣāmētat syādamr̥tōpamam| tadvatsiddhā vasā nakramatsyakūrmaculūkajā||128|| pratyagrā vidhinā'nēna nasyapānēṣu śasyatē| prasthaḥ syāttriphalāyāstu kulatthakuḍavadvayam||129|| kr̥ṣṇagandhātvagāḍhakyōḥ pr̥thak pañcapalaṁ bhavēt| rāsnācitrakayōrdvē dvē daśamūlaṁ palōnmitam||130|| jaladrōṇē pacēt pādaśēṣē prasthōnmitaṁ pr̥thak| surāranāladadhyamlasauvīrakatuṣōdakam||131|| kōladāḍimavr̥kṣāmlarasaṁ tailaṁ vasāṁ ghr̥tam| majjānaṁ ca payaścaiva jīvanīyapalāni ṣaṭ||132|| kalkaṁ dattvā mahāsnēhaṁ samyagēnaṁ vipācayēt| sirāmajjāsthigē vātē sarvāṅgaikāṅgarōgiṣu||133|| vēpanākṣēpaśūlēṣu tadabhyaṅgē prayōjayēt| nirguṇḍyā mūlapatrābhyāṁ gr̥hītvā svarasaṁ tataḥ||134|| tēna siddhaṁ samaṁ tailaṁ nāḍīkuṣṭhānilārtiṣu| hitaṁ pāmāpacīnāṁ ca pānābhyañjanapūraṇam||135|| kārpāsāsthikulatthānāṁ rasē siddhaṁ ca vātanut|136| Four pala (192 gm) of dashamūla should be decocted in one drōṇē’ of water adding 64 tolas (768 gm) of barley, badara and horse gram. When it is reduced to ¼th quantity, prepare a medicated ghee in this decoction by taking 16 pala (768 gm) of ghee and adding milk, the paste of the jīvanīya drugs, sugar, dates, white teak, grape, badara and fig. This ghee is curative of disorders due to absolute vāta. This preparation is harmless and should be used for internal administration, external massage and enema. (119-121) Medicated ghee, prepared with the paste of chitraka, dry-ginger, rāsnā, pushkara, long pepper and śaṭī is excellent to cure vāta-disorders. (122) The supernatant part of ghee should be prepared with the milk boiled with sida and bilva. Two or four tolas (48 gm) of this should be used as nasal medication in condition of morbid vāta affecting the head. (123) The bones of the domestic, wet -land and aquatic animals should be broken into bits and cooked in water. The unctuous fluid obtained should again be cooked in the decoction of the dashamūla, adding the paste of rṣabhakā, sphōtā, vidārī and kapikacchu and of vāta -curative drugs or jīvanīya group of drugs and double the quantity of milk. By the use of this preparation as nasal medication, massage, internal administration and unctuous enema, the morbid vāta affecting the vessels, joints, bones and in kuṣṭha gets quickly cured. For those suffering from loss of marrow as well as those who suffer from loss of semen and vital essence, this imparts strength and robustness and acts like nectar. (124-127) The fresh fat of the alligator, fish, tortoise or the porpoise prepared similarly as described above is recommended as nasal medication and for internal administration. (128) Take 64 tolas (768 gm) of the triphalā, 32 tolas (384 gm) of horse gram, 20 tolas (240 gm) each of the bark of the kr̥ṣṇagandhā and āḍhaki, 8 tolas (96 gm) each of rāsnā, citraka and four tolas (48 gm) of each of the dashamūla and decoct them in 1 drōṇē (12.288 l) of water, reduced to one fourth of its quantity. Than add 64 tolas (768 gm) each of surā, aranāla, sour curds, sauvīraka, tuṣōdakam, the decoction of small badara, pomegranate, tamarind, butter, oil, fat, ghee, marrow, milk and 24 tolas (288gm) of the paste of the jīvanīya group of drugs, and prepare the mahāsnēha preparation in the due manner. (129-132)

This should be used as inunction in morbid vāta affecting the vessels. Marrow and bones as well as is conditions of tremors contractions and colic, and vāta disorder affecting the entire body or only a part of the body. (133)

The expressed juice of the root and leaves of nirgundi should be cooked with an equal quantity of oil. This oil can be used for internal administration, external massage and ear-fill; it is beneficial in sinuses or fistula -in -ano, dermatosis and other vāta disorders as well as in scabies and scrofula. The oil prepared with the decoction of cotton seeds and horse gram is also curative of vāta. (134-135)

मूलकस्वरसे क्षीरसमे स्थाप्यं त्र्यहं दधि||१३६|| तस्याम्लस्य त्रिभिः प्रस्थैस्तैलप्रस्थं विपाचयेत् | यष्ट्याह्वशर्करारास्नालवणार्द्रकनागरैः ||१३७|| सुपिष्टैः पलिकैः पानात्तदभ्यङ्गाच्च वातनुत् |१३८| mUlakasvarase kShIrasame sthApyaM tryahaM dadhi ||136|| tasyAmlasya tribhiH prasthaistailaprasthaM vipAcayet | yaShTyAhvasharkarArāsnālavaNArdrakanAgaraiH ||137|| supiShTaiH palikaiH pAnAttadabhya~ggAcca vātanut |138| mūlakasvarasē kṣīrasamē sthāpyaṁ tryahaṁ dadhi||136|| tasyāmlasya tribhiḥ prasthaistailaprasthaṁ vipācayēt| yaṣṭyāhvaśarkarārāsnālavaṇārdrakanāgaraiḥ||137|| supiṣṭaiḥ palikaiḥ pānāttadabhyaṅgācca vātanut|138| Curds should be kept for three days in a mixture of equal measures of the expressed juice of radish and milk. Prepare medicated oil by taking 64 tolas (768 gm) of oil and triple the quantity of this sour preparation adding the paste of 4 tolas (48 gm) each of liquorice, sugar, rāsnā, rock salt and green ginger. This oil can be used for internal administration and external application as curative of vāta. (136-137)

पञ्चमूलकषायेण पिण्याकं बहुवार्षिकम् ||१३८|| पक्त्वा तस्य रसं पूत्वा तैलप्रस्थं विपाचयेत् | पयसाऽष्टगुणेनैतत् सर्ववातविकारनुत् ||१३९|| संसृष्टे श्लेष्मणा चैतद्वाते शस्तं विशेषतः | यवकोलकुलत्थानां श्रेयस्याः शुष्कमूलकात् ||१४०|| बिल्वाच्चाञ्जलिमेकैकं द्रवैरम्लैर्विपाचयेत् | तेन तैलं कषायेण फलाम्लैः कटुभिस्तथा ||१४१|| पिष्टैः सिद्धं महावातैरार्तः शीते प्रयोजयेत् |१४२| pa~jcamUlakaShAyeNa piNyAkaM bahuvArShikam ||138|| paktvA tasya rasaM pUtvA [1] tailaprasthaM vipAcayet | payasA~aShTaguNenaitat sarvavātavikAranut ||139|| saMsRuShTe shleShmaNA caitadvAte shastaM visheShataH | yavakōlakulatthAnAM shreyasyAH shuShkamUlakAt ||140|| bilvAccA~jjalimekaikaM dravairamlairvipAcayet | tena tailaM kaShAyeNa phalAmlaiH kaTubhistathA ||141|| piShTaiH siddhaM mahAvātairArtaH shIte prayojayet |142| pañcamūlakaṣāyēṇa piṇyākaṁ bahuvārṣikam||138|| paktvā tasya rasaṁ pūtvā [1] tailaprasthaṁ vipācayēt| payasā'ṣṭaguṇēnaitat sarvavātavikāranut||139|| saṁsr̥ṣṭē ślēṣmaṇā caitadvātē śastaṁ viśēṣataḥ| yavakōlakulatthānāṁ śrēyasyāḥ śuṣkamūlakāt||140|| bilvāccāñjalimēkaikaṁ dravairamlairvipācayēt| tēna tailaṁ kaṣāyēṇa phalāmlaiḥ kaṭubhistathā||141|| piṣṭaiḥ siddhaṁ mahāvātairārtaḥ śītē prayōjayēt|142| pañcamūlakaṣāyēṇa piṇyākaṁ bahuvārṣikam||138|| paktvā tasya rasaṁ pūtvā [1] tailaprasthaṁ vipācayēt| payasā'ṣṭaguṇēnaitat sarvavātavikāranut||139|| saṁsr̥ṣṭē ślēṣmaṇā caitadvātē śastaṁ viśēṣataḥ| yavakōlakulatthānāṁ śrēyasyāḥ śuṣkamūlakāt||140|| bilvāccāñjalimēkaikaṁ dravairamlairvipācayēt| tēna tailaṁ kaṣāyēṇa phalāmlaiḥ kaṭubhistathā||141|| piṣṭaiḥ siddhaṁ mahāvātairārtaḥ śītē prayōjayēt|142|

Cook very old oil-cake in the decoction of dashamūla; strain the solution and prepare a medicated oil in this solution by taking 64 tolas (768 gm) of oil and eight times the quantity of milk.This oil is curative of all disorders of vāta.This is specially recommended in conditions of vāta associated with kapha.(138-139)

Take 16 tolas (192 gm) each of barley, kōla, horse gram, śrēyasi, dry radish and bilva and cook them in a sour solution. The medicated oil prepared with this decoction along with sour fruit and the paste of pungent spices, should be used by the patient suffering from severe disorders of vāta, in the cold season. (140-141)

Sahachara taila and baladi taila

सर्ववातविकाराणां तैलान्यन्यान्यतः शृणु ||१४२|| चतुष्प्रयोगाण्यायुष्यबलवर्णकराणि च | रजःशुक्रप्रदोषघ्नान्यपत्यजननानि च ||१४३|| निरत्ययानि सिद्धानि सर्वदोषहराणि च | सहाचरतुलायाश्च रसे तैलाढकं पचेत् ||१४४|| मूलकल्काद्दशपलं पयो दत्त्वा चतुर्गुणम् | सिद्धेऽस्मिञ्छर्कराचूर्णादष्टादशपलं भिषक् ||१४५|| विनीय दारुणेष्वेतद्वातव्याधिषु योजयेत् | श्वदंष्ट्रास्वरसप्रस्थौ द्वौ समौ पयसा सह ||१४६|| षट्पलं शृङ्गवेरस्य गुडस्याष्टपलं तथा | तैलप्रस्थं विपक्वं तैर्दद्यात् सर्वानिलार्तिषु ||१४७|| जीर्णे तैले च दुग्धेन पेयाकल्पः प्रशस्यते | बलाशतं गुडूच्याश्च पादं रास्नाष्टभागिकम् ||१४८|| जलाढकशते पक्त्वा दशभागस्थिते रसे | दधिमस्त्विक्षुनिर्यासशुक्तैस्तैलाढकं समैः ||१४९|| पचेत् साजपयोऽर्धांशैः कल्कैरेभिः पलोन्मितैः | शटीसरलदार्वेलामञ्जिष्ठागुरुचन्दनैः ||१५०|| पद्मकातिविषामुस्तसूर्पपर्णीहरेणुभिः | यष्ट्याह्वसुरसव्याघ्रनखर्षभकजीवकैः ||१५१|| पलाशरसकस्तूरीनलिकाजातिकोषकैः | स्पृक्काकुङ्कुमशैलेयजातीकटुफलाम्बुभिः ||१५२|| त्वचाकुन्दुरुकर्पूरतुरुष्कश्रीनिवासकैः [१] | लवङ्गनखकक्कोलकुष्ठमांसीप्रियङ्गुभिः ||१५३|| स्थौणेयतगरध्यामवचामदनपल्लवैः | सनागकेशरैः सिद्धे क्षिपेच्चात्रावतारिते ||१५४|| पत्रकल्कं ततः पूतं विधिना तत् प्रयोजयेत् | श्वासं कासं ज्वरं हिक्कां [२] छर्दिं गुल्मान् क्षतं क्षयम् ||१५५|| प्लीहशोषावपस्मारमलक्ष्मीं च प्रणाशयेत् | बलातैलमिदं श्रेष्ठं वातव्याधिविनाशनम् ||१५६|| (अग्निवेशाय गुरुणा कृष्णात्रेयेण भाषितम्) | इति बलातैलम् | sarvavātavikArANAM tailAnyanyAnyataH shRuNu ||142|| catuShprayogANyAyuShyabalavarNakarANi ca | rajaHśukrapra dōṣaghnAnyapatyajananAni ca ||143|| niratyayAni siddhAni sarva dōṣaharANi ca | sahAcaratulAyAshca rase tailADhakaM pacet ||144|| mUlakalkAddashapalaM payo dattvA caturguNam | siddhe~asmi~jcharkarAcUrNAdaShTAdashapalaM bhiShak ||145|| vinIya dAruNeShvetadVātavyādhiShu yojayet | shvadaMShTrAsvarasaprasthau dvau samau payasA saha ||146|| ShaTpalaM shRu~ggaverasya guDasyAShTapalaM tathA | tailaprasthaM vipakvaM tairdadyAt sarvAnilArtiShu ||147|| jIrNe taile ca dugdhena peyAkalpaH prashasyate | balAshataM guDUcyAshca pAdaM rāsnāShTabhAgikam ||148|| jalADhakashate paktvA dashabhAgasthite rase | dadhimastvikShuniryAsashuktaistailADhakaM samaiH ||149|| pacet sAjapayo~ardhAMshaiH kalkairebhiH palonmitaiH | śaṭīsaraladArvelAma~jjiShThAgurucandanaiH ||150|| padmakAtiviṣāmustasUrpaparNIhareNubhiH | yaShTyAhvasurasavyAghranakharShabhakajIvakaiH ||151|| palAsharasakastUrInalikAjAtikoShakaiH | spRukkAku~gkumashaileyajAtIkaTuphalAmbubhiH ||152|| tvacAkundurukarpUraturuShkashrInivAsakaiH [1] | lava~gganakhakakkōlakuṣṭhamAMsIpriya~ggubhiH ||153|| sthauNeyatagaradhyAmavacAmadanapallavaiH | sanAgakesharaiH siddhe kShipeccAtrAvātarite ||154|| patrakalkaM tataH pUtaM vidhinA tat prayojayet | shvAsaM kAsaM jvaraM hikkAM [2] chardiM gulmAn kShataM kṣayam ||155|| plIhashoShAvapasmAramalakShmIM ca prānāśayet | balAtailamidaM shreShThaM Vātavyādhivināśanam ||156|| (agniveshAya guruNA kRuShNAtreyeNa bhAShitam) | iti balAtailam |

sarvavātavikārāṇāṁ tailānyanyānyataḥ śr̥ṇu||142|| 

catuṣprayōgāṇyāyuṣyabalavarṇakarāṇi ca| rajaḥśukrapradōṣaghnānyapatyajananāni ca||143|| niratyayāni siddhāni sarvadōṣaharāṇi ca| sahācaratulāyāśca rasē tailāḍhakaṁ pacēt||144|| mūlakalkāddaśapalaṁ payō dattvā caturguṇam| siddhē'smiñcharkarācūrṇādaṣṭādaśapalaṁ bhiṣak||145|| vinīya dāruṇēṣvētadvātavyādhiṣu yōjayēt| śvadaṁṣṭrāsvarasaprasthau dvau samau payasā saha||146|| ṣaṭpalaṁ śr̥ṅgavērasya guḍasyāṣṭapalaṁ tathā| tailaprasthaṁ vipakvaṁ tairdadyāt sarvānilārtiṣu||147|| jīrṇē tailē ca dugdhēna pēyākalpaḥ praśasyatē| balāśataṁ guḍūcyāśca pādaṁ rāsnāṣṭabhāgikam||148|| jalāḍhakaśatē paktvā daśabhāgasthitē rasē| dadhimastvikṣuniryāsaśuktaistailāḍhakaṁ samaiḥ||149|| pacēt sājapayō'rdhāṁśaiḥ kalkairēbhiḥ palōnmitaiḥ| śaṭīsaraladārvēlāmañjiṣṭhāgurucandanaiḥ||150|| padmakātiviṣāmustasūrpaparṇīharēṇubhiḥ| yaṣṭyāhvasurasavyāghranakharṣabhakajīvakaiḥ||151|| palāśarasakastūrīnalikājātikōṣakaiḥ| spr̥kkākuṅkumaśailēyajātīkaṭuphalāmbubhiḥ||152|| tvacākundurukarpūraturuṣkaśrīnivāsakaiḥ [1] | lavaṅganakhakakkōlakuṣṭhamāṁsīpriyaṅgubhiḥ||153|| sthauṇēyatagaradhyāmavacāmadanapallavaiḥ| sanāgakēśaraiḥ siddhē kṣipēccātrāvatāritē||154|| patrakalkaṁ tataḥ pūtaṁ vidhinā tat prayōjayēt| śvāsaṁ kāsaṁ jvaraṁ hikkāṁ [2] chardiṁ gulmān kṣataṁ kṣayam||155|| plīhaśōṣāvapasmāramalakṣmīṁ ca praṇāśayēt| balātailamidaṁ śrēṣṭhaṁ vātavyādhivināśanam||156|| (agnivēśāya guruṇā kr̥ṣṇātrēyēṇa bhāṣitam)| iti balātailam| Listen now to the description of other preparations of oils for all types of diseases of vāta that can be used in all the four therapeutic modes; that are promotive of longivity, strength and complexion; that are curative of menstrual and seminal disorders; which are inductive of progeny; and which are free from harmful effects and are generally curative of all kinds of morbidity. (142-143)

Prepare medicated oil in 400 tolas (4.8 l) of the decoction of sahācara, by using 256 tolas (3.072 l) of oil and adding 40 tolas (480 gm) of the paste of radish and four times the quantity milk is added.The physician should use this oil mixed with 72 tolas (864 gm) of powdered sugar, in severe types of vāta disorder. (144-145)

Prepare medicated oil by taking 64 tolas (768 ml) of oil along with 128 tolas (1.536 l) of the expressed juice of śvadaṁṣṭrā, equal quantity of milk, 24 tolas (288 gm) of dry ginger and 32 tolas (384 gm) of jaggery. This should be administered in all kinds of disorders of vāta. After the dose of oil has been digested the regimen of thin gruel along with milk is recommended. (146-147)

Take 400 tolas (4.8 kg) of balā, ¼th part of guḍūchi and one eighth quantity of rāsnā and cook in 1 āḍhaka (307.2 l) of water till it is reduced to one tenth of the quantity. Prepare 256 tolas (3.072 l) of oil with this decoction adding equal quantities of whey, sugarcane juice and vinegar along with half the quantity of goat’s milk and the paste of four tolas (48 gm) of the leaves of each of the following drugs:- śaṭī, sarala, dārvi, ēlā, mañjiṣṭhā, agaru, candana, padmaka, ativiṣā, musta, sūrpaparṇī, harēṇu, yaṣṭimadhu, surasa, vyāghranakha, rṣabhaka, jīvakaiḥ, juice of palāśa, kastūrī, nalikā, buds of jasmine, spr̥kkā, kuṅkuma, śailēya, jātī phala, kaṭuphala, ambu, tvak, kunduru, karpūra, aturuṣka, śrīnivāsa, lavaṅga, nakha, kakkōli, kuṣṭha, māṁsī, priyaṅgu, sthauṇēya, tagara, dhyāma, vacā, leaves of madana and nagakesar. This should then be strained and the paste of fragrant drugs are added to it and administered duly. This excellent balā oil is curative of vāta disorders in general. It can be used in dyspnoea, cough, fever, hiccup, vomiting, gulma, pectoral lesions, cachexia, splenic disorders, emaciation, epilepsy and lack of lusture. (148-154)

Amritadi tailam

अमृतायास्तुलाः पञ्च द्रोणेष्वष्टस्वपां पचेत् ||१५७|| पादशेषे समक्षीरं तैलस्य द्व्याढकं पचेत् | एलामांसीनतोशीरसारिवाकुष्ठचन्दनैः ||१५८|| बलातामलकीमेदाशतपुष्पर्धिजीवकैः [१] | काकोलीक्षीरकाकोलीश्रावण्यतिबलानखैः ||१५९|| महाश्रावणिजीवन्तीविदारीकपिकच्छुभिः | शतावरीमहामेदाकर्कटाख्याहरेणुभिः ||१६०|| वचागोक्षुरकैरण्डरास्नाकालासहाचरैः | वीराशल्लकिमुस्तत्वक्पत्रर्षभकबालकैः ||१६१|| सहैलाकुङ्कुमस्पृक्कात्रिदशाह्वैश्च कार्षिकैः | मञ्जिष्ठायास्त्रिकर्षेण मधुकाष्टपलेन च ||१६२|| कल्कैस्तत् क्षीणवीर्याग्निबलसम्मूढचेतसः | उन्मादारत्यपस्मारैरार्तांश्च प्रकृतिं नयेत् ||१६३|| वातव्याधिहरं श्रेष्ठं तैलाग्र्यममृताह्वयम् | (कृष्णात्रेयेण [२] गुरुणा भाषितं वैद्यपूजितम्) ||१६४|| इत्यमृताद्यं तैलम् | amRutAyAstulAH pa~jca droNeShvaShTasvapAM pacet ||157|| pAdasheShe samakShIraM tailasya dvyADhakaM pacet | elAmAMsInatoshIrasArivAkuṣṭhacandanaiH ||158|| balAtAmalakImedAshatapuShpardhijIvakaiH [1] | kAkolIkShIrakAkolIshrAvaNyatibalAnakhaiH ||159|| mahAshrAvaNijIvantIvidArIkapikacchubhiH | shatAvarImahAmedAkarkaTAkhyAhareNubhiH ||160|| vacAgokShurakairaNDarāsnākAlAsahAcaraiH | vIrAshallakimustatvakpatrarShabhakabAlakaiH ||161|| sahailAku~gkumaspRukkAtridashAhvaishca kArShikaiH | ma~jjiShThAyAstrikarSheNa madhukAShTapalena ca ||162|| kalkaistat kShINavIryAgnibalasammUDhacetasaH | unmAdAratyapasmArairArtAMshca prakRutiM nayet ||163|| VātavyādhiharaM shreShThaM tailAgryamamRutAhvayam | (kRuShNAtreyeNa [2] guruNA bhAShitaM vaidyapUjitam) ||164|| ityamRutAdyaM tailam | amr̥tāyāstulāḥ pañca drōṇēṣvaṣṭasvapāṁ pacēt||157|| pādaśēṣē samakṣīraṁ tailasya dvyāḍhakaṁ pacēt| ēlāmāṁsīnatōśīrasārivākuṣṭhacandanaiḥ||158|| balātāmalakīmēdāśatapuṣpardhijīvakaiḥ [1] | kākōlīkṣīrakākōlīśrāvaṇyatibalānakhaiḥ||159|| mahāśrāvaṇijīvantīvidārīkapikacchubhiḥ| śatāvarīmahāmēdākarkaṭākhyāharēṇubhiḥ||160|| vacāgōkṣurakairaṇḍarāsnākālāsahācaraiḥ| vīrāśallakimustatvakpatrarṣabhakabālakaiḥ||161|| sahailākuṅkumaspr̥kkātridaśāhvaiśca kārṣikaiḥ| mañjiṣṭhāyāstrikarṣēṇa madhukāṣṭapalēna ca||162|| kalkaistat kṣīṇavīryāgnibalasammūḍhacētasaḥ| unmādāratyapasmārairārtāṁśca prakr̥tiṁ nayēt||163|| vātavyādhiharaṁ śrēṣṭhaṁ tailāgryamamr̥tāhvayam| (kr̥ṣṇātrēyēṇa [2] guruṇā bhāṣitaṁ vaidyapūjitam)||164|| ityamr̥tādyaṁ tailam

Prepare decoction of 2000 tolas (24 kg) of guḍūchi in 5 drōṇē (98.304 l) of water by reducing to ¼th its quantity. Later add 512 tolas (60144 l) of sesame oil and equal quantity of milk in this decoction, along with paste of 1 tola (12 gm) each of cardamom, ēlā, māṁsī, nata, uśīra, sārivā, kuṣṭha, candana, balā, tāmalakī, mēdā, śatapuṣpa, ridhi, jīvaka, kākōlī, kṣīrakākōlī, śrāvaṇy, atibalā, nakha, mahāśrāvaṇi, jīvantī,vidārī, kapikacchu, śatāvarī, mahāmēdā, karkaṭā, harēṇu, , vacā, gōkṣura, eraṇḍa, rāsnā, kālā, sahācara, bāla, vīrā, śallaki, musta, tvak, patra, rṣabhaka, balaka, elā, kuṅkuma, spr̥kkā and three tolas (36 gm) of mañjiṣṭhā and 32 tolas (384 gm) of yashtimadhu. It restores the health of those affected with reduced semen, digestive power and vitality. Normalises individuals with insanity and epilepsy and is excellent to cure vāta disorder. This is the amr̥tādya taila propounded by preceptor Kr̥ṣṇātrēya who was respected by reverent physicians. (157- 164)

Rasna taila

रास्नासहस्रनिर्यूहे तैलद्रोणं विपाचयेत् | गन्धैर्हैमवतैः पिष्टैरेलाद्यैश्चानिलार्तिनुत् ||१६५|| कल्पोऽयमश्वगन्धायां प्रसारण्यां बलाद्वये | क्वाथकल्कपयोभिर्वा बलादीनां पचेत् पृथक् ||१६६|| इति रास्नातैलम् | rāsnāsahasraniryUhe tailadroNaM vipAcayet | gandhairhaimavātaiH piShTairelAdyaishcAnilArtinut ||165|| kalpo~ayamashvagandhAyAM prasAraNyAM balAdvaye | kvAthakalkapayobhirvA balAdInAM pacet pRuthak ||166|| iti rāsnātailam | rāsnāsahasraniryūhē tailadrōṇaṁ vipācayēt| gandhairhaimavātaiḥ piṣṭairēlādyaiścānilārtinut||165|| kalpō'yamaśvagandhāyāṁ prasāraṇyāṁ balādvayē| kvāthakalkapayōbhirvā balādīnāṁ pacēt pr̥thak||166|| iti rāsnātailam The medicated oil is prepared by taking 1024 tolas (12.288 l) of oil and cooking it in 4000 tolas (48 l) of the decoction of rāsnā along with the paste of the fragrant groups of drugs grown in the Himalayas, as well as the cardamom group of drugs. This oil is curative of vāta. A similar preparation of aśvagandhā and prasāraṇi and the two varieties of sida or the medicated oil of sida and other drugs may be prepared using these drugs individually in the form of decoction, paste or milk. Thus, rāsnā taila has been explained. (165 – 166)

Mulakadya taila and vrishmuladi taila

मूलकस्वरसं क्षीरं तैलं दध्यम्लकाञ्जिकम् | तुल्यं विपाचयेत् कल्कैर्बलाचित्रकसैन्धवैः ||१६७|| पिप्पल्यतिविषारास्नाचविकागुरुशिग्रुकैः | भल्लातकवचाकुष्ठश्वदंष्ट्राविश्वभेषजैः ||१६८|| पुष्कराह्वशटीबिल्वशताह्वानतदारुभिः | तत्सिद्धं पीतमत्युग्रान् हन्ति वातात्मकान् गदान् ||१६९|| इति मूलकाद्यं तैलम् | वृषमूलगुडूच्योश्च द्विशतस्य शतस्य च | चित्रकात् साश्वगन्धाच्च क्वाथे तैलाढकं पचेत् ||१७०|| सक्षीरं वायुना भग्ने दद्याज्जर्जरिते तथा | प्राक्तैलावापसिद्धं च भवेदेतद्गुणोत्तरम् ||१७१|| इति वृषमूलादितैलम् | mUlakasvarasaM kShIraM tailaM dadhyamlakA~jjikam | tulyaM vipAcayet kalkairbalAcitrakasaindhavaiH ||167|| pippalyativiṣārāsnācavikAgurushigrukaiH | bhallAtakavacAkuṣṭhashvadaMShTrAvishvabheShajaiH ||168|| puShkarAhvaśaṭībilvashatAhvAnatadArubhiH | tatsiddhaM pItamatyugrAn hanti vātatmakAn gadAn ||169|| iti mUlakAdyaM tailam | vRuShamUlaguDUcyoshca dvishatasya shatasya ca | citrakAt sAshvagandhAcca kvAthe tailADhakaM pacet ||170|| sakShIraM Vāyu nA bhagne dadyAjjarjarite tathA | prAktailAvApasiddhaM ca bhavedetadguNottaram ||171|| iti vRuShamUlAditailam | mūlakasvarasaṁ kṣīraṁ tailaṁ dadhyamlakāñjikam| tulyaṁ vipācayēt kalkairbalācitrakasaindhavaiḥ||167|| pippalyativiṣārāsnācavikāguruśigrukaiḥ| bhallātakavacākuṣṭhaśvadaṁṣṭrāviśvabhēṣajaiḥ||168|| puṣkarāhvaśaṭībilvaśatāhvānatadārubhiḥ| tatsiddhaṁ pītamatyugrān hanti vātātmakān gadān||169|| iti mūlakādyaṁ tailam| vr̥ṣamūlaguḍūcyōśca dviśatasya śatasya ca| citrakāt sāśvagandhācca kvāthē tailāḍhakaṁ pacēt||170|| sakṣīraṁ vāyunā bhagnē dadyājjarjaritē tathā| prāktailāvāpasiddhaṁ ca bhavēdētadguṇōttaram||171|| iti vr̥ṣamūlāditailam|

Medicated oil is prepared by taking 64 tolas (768 gm) of oil and cooking it in equal quantities of radish juice, milk, sour curds, and sour kanji, the paste of sida, chitraka, rock salt, pippali, ativiṣā, rāsnā, cavika, agaru, śigru, bhallātaka, vacā, kuṣṭha, śvadaṁṣṭrā, viśvabhēṣaja, puṣkara, śaṭī, bilwa, śatāhvā, nata, and devadāru. This mūlakādya taila, when taken internally, cures even very severe types of vāta disorders. (167-169) 256 tolas (3.072 l) of sesame oil are cooked in 800 tolas (9.6 l) of the decoction of vr̥ṣa roots and guḍūci, and 400 tolas (4.8 l) of the decoction of Chitraka, aśvagandhā and milk. This medicated oil should be prescribed in fractured or serious conditions of bone due to vāta. It becomes exceedingly effective if prepared with the paste mentioned in earlier oils. (170-171)

Mulaka taila

रास्नाशिरीषयष्ट्याह्वशुण्ठीसहचरामृताः ||१७२|| स्योनाकदारुशम्पाकहयगन्धात्रिकण्टकाः | एषां दशपलान् भागान् कषायमुपकल्पयेत् ||१७३|| ततस्तेन कषायेण सर्वगन्धैश्च कार्षिकैः | दध्यारनालमाषाम्बुमूलकेक्षुरसैः [१] शुभैः ||१७४|| पृथक् प्रस्थोन्मितैः सार्धं तैलप्रस्थं विपाचयेत् | प्लीहमूत्रग्रहश्वासकासमारुतरोगनुत् [२] ||१७५|| एतन्मूलकतैलाख्यं [३] वर्णायुर्बलवर्धनम् | इति मूलकतैलम् | यवकोलकुलत्थानां मत्स्यानां शिग्रुबिल्वयोः | रसेन मूलकानां च तैलं दधिपयोन्वितम् ||१७६|| साधयित्वा भिषग्दद्यात् सर्ववातामयापहम् | लशुनस्वरसे सिद्धं तैलमेभिश्च वातनुत् ||१७७|| तैलान्येतान्यृतुस्नातामङ्गनां पाययेत च | पीत्वाऽन्यतममेषां हि वन्ध्याऽपि जनयेत् सुतम् ||१७८|| यच्च शीतज्वरे तैलमगुर्वाद्यमुदाहृतम् | अनेकशतशस्तच्च सिद्धं स्याद्वातरोगनुत् ||१७९|| वक्ष्यन्ते यानि तैलानि वातशोणितकेऽपि च | तानि चानिलशान्त्यर्थं सिद्धिकामः प्रयोजयेत् ||१८०|| नास्ति तैलात् परं किञ्चिदौषधं मारुतापहम् | व्यवाय्युष्णगुरुस्नेहात् संस्काराद्वलवत्तरम् ||१८१|| गणैर्वातहरैस्तस्माच्छतशोऽथं सहस्रशः | सिद्धं क्षिप्रतरं हन्ति सूक्ष्ममार्गस्थितान् गदान् ||१८२|| rāsnāshirIShayaShTyAhvashuNThIsahacarAmRutAH ||172|| syonAkadArushampAkahayagandhAtrikaNTakAH | eShAM dashapalAn bhAgAn kaShAyamupakalpayet ||173|| tatastena kaShAyeNa sarvagandhaishca kArShikaiH | dadhyAranAlamAShAmbumUlakekShurasaiH [1] shubhaiH ||174|| pRuthak prasthonmitaiH sArdhaM tailaprasthaM vipAcayet | plIhamūtragrahashvAsakAsamArutarōganut [2] ||175|| etanmUlakatailAkhyaM [3] varNAyurbalavardhanam | iti mUlakatailam | yavakōlakulatthAnAM matsyAnAM shigrubilvayoH | rasena mUlakAnAM ca tailaM dadhipayonvitam ||176|| sAdhayitvA bhiShagdadyAt sarvavātamayApaham | lashunasvarase siddhaM tailamebhishca vātanut ||177|| tailAnyetAnyRutuṣṇā tAma~gganAM pAyayeta ca | pItvA~anyatamameShAM hi vandhyA~api janayet sutam ||178|| yacca shItajvare tailamagurvAdyamudAhRutam | anekashatashastacca siddhaM syAdvātarōganut ||179|| vakShyante yAni tailAni vātashoNitake~api ca | tAni cAnilashAntyarthaM siddhikAmaH prayojayet ||180|| nAsti tailAt paraM ki~jcidauShadhaM mArutApaham | vyavAyyuShNaguruSnēhat saMskArAdvalavattaram ||181|| gaNairvātaharaistasmAcchatasho~athaM sahasrashaH | siddhaM kShiprataraM hanti sUkShmamArgasthitAn gadAn ||182|| rāsnāśirīṣayaṣṭyāhvaśuṇṭhīsahacarāmr̥tāḥ||172|| syōnākadāruśampākahayagandhātrikaṇṭakāḥ| ēṣāṁ daśapalān bhāgān kaṣāyamupakalpayēt||173|| tatastēna kaṣāyēṇa sarvagandhaiśca kārṣikaiḥ| dadhyāranālamāṣāmbumūlakēkṣurasaiḥ [1] śubhaiḥ||174|| pr̥thak prasthōnmitaiḥ sārdhaṁ tailaprasthaṁ vipācayēt| plīhamūtragrahaśvāsakāsamārutarōganut [2] ||175|| ētanmūlakatailākhyaṁ [3] varṇāyurbalavardhanamiti mūlakatailamyavakōlakulatthānāṁ matsyānāṁśigrubilvayōḥ| rasēna mūlakānāṁ ca tailaṁ dadhipayōnvitam||176|| sādhayitvā bhiṣagdadyāt sarvavātāmayāpaham| laśunasvarasē siddhaṁ tailamēbhiśca vātanut||177|| tailānyētānyr̥tusnātāmaṅganāṁ pāyayēta ca| pītvā'nyatamamēṣāṁ hi vandhyā'pi janayēt sutam||178|| yacca śītajvarē tailamagurvādyamudāhr̥tam| anēkaśataśastacca siddhaṁ syādvātarōganut||179|| vakṣyantē yāni tailāni vātaśōṇitakē'pi ca| tāni cānilaśāntyarthaṁ siddhikāmaḥ prayōjayēt||180|| nāsti tailāt paraṁ kiñcidauṣadhaṁ mārutāpaham| vyavāyyuṣṇagurusnēhāt saṁskārādvalavattaram||181|| gaṇairvātaharaistasmācchataśō'tha sahasraśaḥ| siddhaṁ kṣiprataraṁ hanti sūkṣmamārgasthitān gadān||182||

Prepare a decoction by taking 40 tolas (48 gm) of each of rāsnā, śirīṣa, liquorice, dry ginger, sahācara, guḍūci, syōnāka, devadāru, śampāka, aśvagandhā and goksura. Then oil is prepared by taking 64 tolas (768 ml) of sesame oil and cooking it in the above said decoction along with 64 tolas (768 ml) each of curds, aranāla, decoction of black gram, juices of good quality of radish, and sugar cane, adding one tola (12 gm) of the paste of each of the gandhavarga drugs. This mūlaka oil is curative of splenic disorders, retention of urine, dyspnoea, cough and other vāta disorders. It is also promotive of complexion, life and vitality. Thus mūlaka taila is explained. (172-173) Medicated oil is prepared by taking sesame oil and cooking it in the decoction of barley, kōla, horse gram, fish, drumstick, bael, radish, curds and milk. This is curative of all vāta disorders. The medicated oil prepared in the expressed juice of garlic and the drugs mentioned above, is curative of vāta rōga. These different oils may be given as potion to a woman who has just taken her purificatory bath on the cessation of menses. By taking any of this medicated oil as pana, even a sterile woman will become fertile.

The agurvādya oil, which has been described in the treatment of śīta jvara, if processed again many hundred times, becomes curative of vāta disorders. And the medicated oils, which will be described in the therapeutics of rheumatic conditions, may be prescribed for the alleviation of vāta disorders, by the physician desirous of success in treatment. (176-180) There exists no medication superior to oil as a remedy for vāta, due to its quality of extreme spreadability, hot in potency, heaviness, unctuousness and by virtue of becoming more powerful on being medicated with the vāta curative group of drugs. Being also capable of further intensification of potency, by being processed again for hundreds or thousands of times, taila very quickly cures the diseases which are located into even the minutest part of the body. (181- 182)

Management of avrita vata conditions

क्रिया साधारणी सर्वा संसृष्टे चापि शस्यते | वाते पित्तादिभिः स्रोतःस्वावृतेषु विशेषतः ||१८३|| पित्तावृते विशेषेण शीतामुष्णां तथा क्रियाम् | व्यत्यासात् कारयेत् सर्पिर्जीवनीयं च शस्यते ||१८४|| धन्वमांसं यवाः शालिर्यापनाः क्षीरबस्तयः | विरेकः क्षीरपानं च पञ्चमूलीबलाशृतम् ||१८५|| मधुयष्टिबलातैलघृतक्षीरैश्च सेचनम् | पञ्चमूलकषायेण कुर्याद्वा शीतवारिणा ||१८६|| कफावृते यवान्नानि जाङ्गला मृगपक्षिणः | स्वेदास्तीक्ष्णा निरूहाश्च वमनं सविरेचनम् ||१८७|| जीर्णं सर्पिस्तथा तैलं तिलसर्षपजं हितम् | संसृष्टे कफपित्ताभ्यां पित्तमादौ विनिर्जयेत् ||१८८|| kriyA sAdhAraNI sarvA saMsRuShTe cApi shasyate | vAte pittAdibhiH srotaHsvAvRuteShu visheShataH ||183|| pittAvRute visheSheNa shItAmuShNAM tathA kriyAm | vyatyAsAt kArayet sarpirjIvanIyaM ca shasyate ||184|| dhanvamāṁsaM yavAH shAlirYāpana H kShIrabastayaH | virekaH kShIrapāna M ca pa~jcamUlIbalAshRutam ||185|| madhuyaShTibalAtailaghRutakShIraishca secanam | pa~jcamUlakaShAyeNa kuryAdvA shItavAriNA ||186|| kaphAvRute yavAnnAni jA~ggalA mRugapakShiNaH | svedAstIkShNA nirUhAshca vamanaM savirēcanam ||187|| jIrNaM sarpistathA tailaM tilasarShapajaM hitam | saMsRuShTe kaphapittAbhyAM pittamAdau vinirjayet ||188|| kriyā sādhāraṇī sarvā saṁsr̥ṣṭē cāpi śasyatē| vātē pittādibhiḥ srōtaḥsvāvr̥tēṣu viśēṣataḥ||183|| pittāvr̥tē viśēṣēṇa śītāmuṣṇāṁ tathā kriyām| vyatyāsāt kārayēt sarpirjīvanīyaṁ ca śasyatē||184|| dhanvamāṁsaṁ yavāḥ śāliryāpanāḥ kṣīrabastayaḥ| virēkaḥ kṣīrapānaṁ ca pañcamūlībalāśr̥tam||185|| madhuyaṣṭibalātailaghr̥takṣīraiśca sēcanam| pañcamūlakaṣāyēṇa kuryādvā śītavāriṇā||186|| kaphāvr̥tē yavānnāni jāṅgalā mr̥gapakṣiṇaḥ| svēdāstīkṣṇā nirūhāśca vamanaṁ savirēcanam||187|| jīrṇaṁ sarpistathā tailaṁ tilasarṣapajaṁ hitam| saṁsr̥ṣṭē kaphapittābhyāṁ pittamādau vinirjayēt||188|| This general line of treatment is also recommended in conditions of association with morbidity of other humors, but especially when the body channels have been occluded by pitta and kapha in vāta disorders. (183) Management of pittavrita vata: In condition of occlusion of pitta, the physician should administer cold and hot lins of treatment in alternation. Here, ghee prepared of Jīvanīya gana is recommended. Diet which contains flesh of jāṇgala animals, barley and sāli rice, Yāpana enema, milk enema, purgation, drinking of milk, decoction of pañchamūla and sida is also beneficial.(184-185) The patient should be given dhārā with medicated oil or ghee or milk prepared with liquorice and sida, or with the decoction of pañchamūla or with cold water. (186) In conditions of occlusion by kapha articles made of barley, the flesh of animals and birds of jāṇgala area as diet is effective along with strong sudation, evacuative enema and emesis and purgation. Old ghee, sesame oil and mustard oil are also beneficial. (187-187 ½) In the condition of occlusion by both kapha and pitta, pitta must be subdued first. (188)

Management of various condition of vata located in other sites

आमाशयगतं मत्वा कफं वमनमाचरेत् ||१८९|| पक्वाशये विरेकं तु पित्ते सर्वत्रगे तथा | स्वेदैर्विष्यन्दितः श्लेष्मा यदा पक्वाशये स्थितः ||१९०|| पित्तं वा दर्शयेल्लिङ्गं बस्तिभिस्तौ विनिर्हरेत् | श्लेष्मणाऽनुगतं वातमुष्णैर्गोमूत्रसंयुतैः ||१९१|| निरूहैः पित्तसंसृष्टं निर्हरेत् क्षीरसंयुतैः | मधुरौषधसिद्धैश्च तैलैस्तमनुवासयेत् ||१९२|| शिरोगते तु सकफे धूमनस्यादि कारयेत् | हृते पित्ते कफे यः स्यादुरःस्रोतोऽनुगोऽनिलः ||१९३|| सशेषः स्यात् क्रिया तत्र कार्या केवलवातिकी | शोणितेनावृते कुर्याद्वातशोणितकीं क्रियाम् ||१९४|| प्रमेहवातमेदोघ्नीमामवाते [३] प्रयोजयेत् | स्वेदाभ्यङ्गरसक्षीरस्नेहा मांसावृते हिताः ||१९५|| महास्नेहोऽस्थिमज्जस्थे पूर्ववद्रेतसाऽऽवृते | अन्नावृते तदुल्लेखः [४] पाचनं दीपनं लघु ||१९६|| मूत्रलानि तु मूत्रेण स्वेदाः सोत्तरबस्तयः | शकृता तैलमैरण्डं स्निग्धोदावर्तवत्क्रिया [५] ||१९७|| स्वस्थानस्थो बली दोषः प्राक् तं स्वैरौषधैर्जयेत् | वमनैर्वा विरेकैर्वा बस्तिभिः शमनेन वा ||१९८|| (इत्युक्तमावृते वाते पित्तादिभिर्यथायथम् [६] ) |१९९| ĀmashayagataM matvA [1] kaphaM vamanamAcaret ||189|| pakvAshaye virekaM tu pitte sarvatrage tathA | svedairviShyanditaH shleShmA yadA pakvAshaye sthitaH ||190|| pittaM vA darshayelli~ggaM bastibhistau vinirharet | shleShmaNA~anugataM vātamuShNairgomūtrasaMyutaiH ||191|| nirUhaiH pittasaMsRuShTaM nirharet kShIrasaMyutaiH | madhurauShadhasiddhaishca tailaistamanuvAsayet ||192|| shirōgate tu sakaphe dhUmanasyAdi kArayet | hRute pitte kaphe yaH syAduraHsroto~anugo~anilaH ||193|| sasheShaH [2] syAt kriyA tatra kAryA kevalavAtikI | shoNitenAvRute kuryAdvātashoNitakIM kriyAm ||194|| pramehavātamedoghnImAmavAte [3] prayojayet | svedAbhya~ggarasakShIraSnēha māṁsavRute hitAH ||195|| mahAsneho~asthimajjasthe pUrvavadretasA~a~avRute | annAvRute tadullekhaH [4] pācanaM dIpanaM laghu ||196|| mūtralAni tu mUtreNa svedAH sottarabastayaH | shakRutA tailamairaNDaM snigdhodAvartavatkriyA [5] ||197|| svasthānastho balI dōṣaH prAk taM svairauShadhairjayet | vamanairvA virekairvA bastibhiH shamanena vA ||198|| (ityuktamAvRute vAte pittAdibhiryathAyatham [6] ) |199| āmāśayagataṁ matvā [1] kaphaṁ vamanamācarēt||189|| pakvāśayē virēkaṁ tu pittē sarvatragē tathā| svēdairviṣyanditaḥ ślēṣmā yadā pakvāśayē sthitaḥ||190|| pittaṁ vā darśayēlliṅgaṁ bastibhistau vinirharēt| ślēṣmaṇā'nugataṁ vātamuṣṇairgōmūtrasaṁyutaiḥ||191|| nirūhaiḥ pittasaṁsr̥ṣṭaṁ nirharēt kṣīrasaṁyutaiḥ| madhurauṣadhasiddhaiśca tailaistamanuvāsayēt||192|| śirōgatē tu sakaphē dhūmanasyādi kārayēt| hr̥tē pittē kaphē yaḥ syāduraḥsrōtō'nugō'nilaḥ||193|| saśēṣaḥ [2] syāt kriyā tatra kāryā kēvalavātikī| śōṇitēnāvr̥tē kuryādvātaśōṇitakīṁ kriyām||194|| pramēhavātamēdōghnīmāmavātē [3] prayōjayēt| svēdābhyaṅgarasakṣīrasnēhā māṁsāvr̥tē hitāḥ||195|| mahāsnēhō'sthimajjasthē pūrvavadrētasāvr̥tē| annāvr̥tē tadullēkhaḥ [4] pācanaṁ dīpanaṁ laghu||196|| mūtralāni tu mūtrēṇa svēdāḥ sōttarabastayaḥ| śakr̥tā tailamairaṇḍaṁ snigdhōdāvartavatkriyā [5] ||197|| svasthānasthō balī dōṣaḥ prāk taṁ svairauṣadhairjayēt| vamanairvā virēkairvā bastibhiḥ śamanēna vā||198|| (ityuktamāvr̥tē vātē pittādibhiryathāyatham [6] )|199| On finding that kapha is located in the stomach (āmāśaya), emesis should be given and if it is located in the colon (pakvāśaya), the treatment of choice is purgation. If pitta has pervaded all over the body, again the same (purgation) should be given. (189-189 ½)

As kapha or pitta gets liquefied by sudation, and gets accumulated in the colon and the symptoms of pitta manifest, both of these should be eliminated by the use of enema. (190-190 ½)

If vāta is associated with kapha, it should be eliminated by warm evacuative enema mixed with cow’s urine. If vāta is associated with pitta, it should be eliminated by evacuative enema mixed with milk. Then the patient should be given unctuous enema prepared with the madhura rasa group of drugs. (191-192) In condition of vāta located in the head and associated with kapha, inhalation and nasal medication should be given. (192 ½)

If after the elimination of pitta and kapha, there remains a residual morbidity of vāta in the channels of the chest region, the treatment indicated in absolute vāta should be given. (193- 193 ½) If vāta is occluded by blood, the line of treatment should be the same as indicated in vātashonita.( 194)

In āmavāta, treatment curative of prameha, vāta and meda, should be given. (194 ½) If vāta is occluded by the flesh, than sudation, massage, meat juices, milk and unctuous medications are recommended. (195) If vāta is occluded by the osseous tissue or the marrow, mahāsnēha should be given. If occluded in the semen, the treatment has already been described. (195 ½)

If vāta is occluded by food, then emesis, digestives, carminatives and light diet are recommended. (196)

If occluded by urine, diuretics, sudation and trans-urethral enema are recommended. If vāta is occluded by fecal matter, the remedies are castor oil and unctuous therapy as indicated in udāvarta. (197) A morbid humor, while in its natural habitat, and when more powerful; it should be first subdued by its own suitable medications such as emesis, purgation, enema or sudation. (198) Thus has been described the treatment of conditions of occlusion of vāta by pitta etc. (198 ½)

Mutual occlusions by types of vata and their management

मारुतानां हि पञ्चानामन्योन्यावरणे शृणु ||१९९|| लिङ्गं व्याससमासाभ्यामुच्यमानं मयाऽनघ! | प्राणो वृणोत्युदानादीन् प्राणं वृण्वन्ति तेऽपि च ||२००|| उदानाद्यास्तथाऽन्योन्यं सर्व एव यथाक्रमम् | विंशतिर्वरणान्येतान्युल्बणानां [१] परस्परम् ||२०१|| मारुतानां हि पञ्चानां तानि सम्यक् प्रतर्कयेत् | सर्वेन्द्रियाणां शून्यत्वं ज्ञात्वा स्मृतिबलक्षयम् ||२०२|| व्याने प्राणावृते लिङ्गं कर्म तत्रोर्ध्वजत्रुकम् | स्वेदोऽत्यर्थं लोमहर्षस्त्वग्दोषः सुप्तगात्रता ||२०३|| प्राणे व्यानावृते तत्र स्नेहयुक्तं विरेचनम् | प्राणावृते समाने स्युर्जडगद्गदमूकताः ||२०४|| चतुष्प्रयोगाः शस्यन्ते स्नेहास्तत्र सयापनाः | समानेनावृतेऽपाने [२] ग्रहणीपार्श्वहृद्गदाः ||२०५|| शूलं चामाशये तत्र दीपनं सर्पिरिष्यते |२०६| mArutAnAM hi pa~jcAnAmanyonyĀvaranae shRuNu ||199|| li~ggaM vyAsasamAsAbhyAmucyamAnaM mayA~anagha! | prānao vRuNotyudānadIn prānaM vRuNvanti te~api ca ||200|| udānadyAstathA~anyonyaM sarva eva yathAkramam | viMśaṭīrvaraNAnyetAnyulbaNAnAM [1] parasparam ||201|| mArutAnAM hi pa~jcAnAM tAni samyak pratarkayet | sarvendriyANAM shUnyatvaM j~jAtvA smRutibalakṣayam ||202|| vyānae prānavRute li~ggaM karma tatrordhvajatrukam | svedo~atyarthaM lomaharShastvag dōṣaH suptagAtratA ||203|| prānae vyānavRute tatra SnēhayuktaM virēcanam | prānavRute Samānae syurjaDagadgadamUkatAH ||204|| catuShprayogAH shasyante Snēhastatra saYāpana H | SamānaenAvRute~apānae [2] grahaNIpArshvahRudgadAH ||205|| shUlaM cAmAshaye tatra dIpanaM sarpiriShyate |206| mārutānāṁ hi pañcānāmanyōnyāvaraṇē śr̥ṇu||199|| liṅgaṁ vyāsasamāsābhyāmucyamānaṁ mayā'nagha!| prāṇō vr̥ṇōtyudānādīn prāṇaṁ vr̥ṇvanti tē'pi ca||200|| udānādyāstathā'nyōnyaṁ sarva ēva yathākramam| viṁśatirvaraṇānyētānyulbaṇānāṁ [7] parasparam||201|| mārutānāṁ hi pañcānāṁ tāni samyak pratarkayēt| sarvēndriyāṇāṁ śūnyatvaṁ jñātvā smr̥tibalakṣayam||202|| vyānē prāṇāvr̥tē liṅgaṁ karma tatrōrdhvajatrukam| svēdō'tyarthaṁ lōmaharṣastvagdōṣaḥ suptagātratā||203|| prāṇē vyānāvr̥tē tatra snēhayuktaṁ virēcanam| prāṇāvr̥tē samānē syurjaḍagadgadamūkatāḥ||204|| catuṣprayōgāḥ śasyantē snēhāstatra sayāpanāḥ| samānēnāvr̥tē'pānē [8] grahaṇīpārśvahr̥dgadāḥ||205|| śūlaṁ cāmāśayē tatra dīpanaṁ sarpiriṣyatē|206| Oh, sinless dear, I shall next describe the mutual obstruction between the five types of vāta in detailed and concised manner. (199 - 199 ½) The prāna vāta occludes the udāna and other types of vāta while they too may occlude the prāna. (200)

Udāna and all other types of vāta may occlude one another in the same manner. There occur twenty conditions of occlusion caused by mutual obstruction of these five types of provoked vāta. These should be properly debated. (201-201½) On observing the loss of function of all the sense organs, and loss of memory and strength, it should be diagnosed as the condition of the occlusion of vyāna by prāna. Here the therapeutic approaches above the supra-clavicular region of the body are to be done. (202-202½) When prāna gets occluded by vyāna excessive perspiration, horripilation, skin diseases, and numbness of limbs is manifested. The treatment is purgation combined with unctuous articles. (203-203½) In condition of occlusion of samāna by prāna, the speech will be scanty, slurred or even muteness can occur. All the four modes of unctuous therapy along with yāpana enema are recommended as treatment. (204-204½) In condition of occlusion of apāna by samāna, grahaṇī, pain in pārśva, heart diseases and colicky pain of the stomach manifest where treatment indicated is the ghee medicated with digestive stimulants. (205-205½) शिरोग्रहः प्रतिश्यायो निःश्वासोच्छ्वाससङ्ग्रहः ||२०६|| हृद्रोगो मुखशोषश्चाप्युदाने प्राणसंवृते | तत्रोर्ध्वभागिकं कर्म कार्यमाश्वासनं तथा ||२०७|| कर्मौजोबलवर्णानां नाशो मृत्युरथापि वा | उदानेनावृते प्राणे तं शनैः शीतवारिणा ||२०८|| सिञ्चेदाश्वासयेच्चैनं सुखं चैवोपपादयेत् | उर्ध्वगेनावृतेऽपाने छर्दिश्वासादयो गदाः ||२०९|| स्युर्वाते तत्र बस्त्यादि भोज्यं चैवानुलोमनम् | मोहोऽल्पोऽग्निरतीसार ऊर्ध्वगेऽपानसंवृते ||२१०|| वाते स्याद्वमनं तत्र दीपनं ग्राहि चाशनम् | वम्याध्मानमुदावर्तगुल्मार्तिपरिकर्तिकाः ||२११|| लिङ्गं व्यानावृतेऽपाने तं स्निग्धैरनुलोमयेत् | अपानेनावृते व्याने भवेद्विण्मूत्ररेतसाम् ||२१२|| अतिप्रवृत्तिस्तत्रापि सर्वं सङ्ग्रहणं मतम् | मूर्च्छा तन्द्रा प्रलापोऽङ्गसादोऽग्न्योजोबलक्षयः ||२१३|| समानेनावृते व्याने व्यायामो लघुभोजनम् | स्तब्धताऽल्पाग्निताऽस्वेदश्चेष्टाहानिर्निमीलनम् ||२१४|| उदानेनावृते व्याने तत्र पथ्यं मितं लघु | पञ्चान्योन्यावृतानेवं वातान् बुध्येत लक्षणैः ||२१५|| एषां स्वकर्मणां हानिर्वृद्धिर्वाऽऽवरणे मता | यथास्थूलं समुद्दिष्टमेतदावरणेऽष्टकम् ||२१६|| सलिङ्गभेषजं सम्यग्बुधानां बुद्धिवृद्धये |२१७| shirograhaH pratishyAyo niHshvAsocchvAsasa~ggrahaH ||206|| hRudrogo mukhashoShashcApyudānae prānasaMvRute | tatrordhvabhAgikaM karma kAryamAshvAsanaM tathA ||207|| karmaujobalavarNAnAM nAsho mRutyurathApi vA | udānaenAvRute prānae taM shanaiH shItavAriNA ||208|| si~jcedAshvAsayeccainaM sukhaM caivopapAdayet | urdhvagenAvRute~apānae chardishvAsAdayo gadAH ||209|| syurvAte tatra bastyAdi bhojyaM caivAnulomanam | moho~alpo~agnira’tīsāra Urdhvage~apāna saMvRute ||210|| vAte syAdvamanaM tatra dIpanaM grAhi cAshanam | vamyAdhmAnamudAvartagulmArtiparikartikAH ||211|| li~ggaM vyānavRute~apānae taM snigdhairanulomayet | apānaenAvRute vyānae bhavedviNmūtraretasAm ||212|| atipravRuttistatrApi sarvaM sa~ggrahaNaM matam | mUrcchA tandrA pralApo~a~ggasAdo~agnyojobalakṣayaH ||213|| SamānaenAvRute vyānae vyAyAmo laghubhojanam | stabdhatA~alpAgnitA~asvedashceShTAhAnirnimIlanam ||214|| udānaenAvRute vyānae tatra pathyaM mitaM laghu | pa~jcAnyonyAvRutAnevaM vātan budhyeta lakShaNaiH ||215|| eShAM svakarmaNAM hAnirvRuddhirvA~a~āvaranae matA | yathAsthUlaM samuddiShTametadĀvaranae~aShTakam ||216|| sali~ggabheShajaM samyagbudhAnAM buddhivRuddhaye |217| śirōgrahaḥ pratiśyāyō niḥśvāsōcchvāsasaṅgrahaḥ||206|| hr̥drōgō mukhaśōṣaścāpyudānē prāṇasaṁvr̥tē| tatrōrdhvabhāgikaṁ karma kāryamāśvāsanaṁ tathā||207|| karmaujōbalavarṇānāṁ nāśō mr̥tyurathāpi vā| udānēnāvr̥tē prāṇē taṁ śanaiḥ śītavāriṇā||208|| siñcēdāśvāsayēccainaṁ sukhaṁ caivōpapādayēt| urdhvagēnāvr̥tē'pānē chardiśvāsādayō gadāḥ||209|| syurvātē tatra bastyādi bhōjyaṁ caivānulōmanam| mōhō'lpō'gniratīsāra ūrdhvagē'pānasaṁvr̥tē||210|| vātē syādvamanaṁ tatra dīpanaṁ grāhi cāśanam| vamyādhmānamudāvartagulmārtiparikartikāḥ||211|| liṅgaṁ vyānāvr̥tē'pānē taṁ snigdhairanulōmayēt| apānēnāvr̥tē vyānē bhavēdviṇmūtrarētasām||212|| atipravr̥ttistatrāpi sarvaṁ saṅgrahaṇaṁ matam| mūrcchā tandrā pralāpō'ṅgasādō'gnyōjōbalakṣayaḥ||213|| samānēnāvr̥tē vyānē vyāyāmō laghubhōjanam| stabdhatā'lpāgnitā'svēdaścēṣṭāhānirnimīlanam||214|| udānēnāvr̥tē vyānē tatra pathyaṁ mitaṁ laghu| pañcānyōnyāvr̥tānēvaṁ vātān budhyēta lakṣaṇaiḥ||215|| ēṣāṁ svakarmaṇāṁ hānirvr̥ddhirvāvaraṇē matā| yathāsthūlaṁ samuddiṣṭamētadāvaraṇē'ṣṭakam||216|| saliṅgabhēṣajaṁ samyagbudhānāṁ buddhivr̥ddhayē|217| In conditions of occlusion of udāna by prāna, there is neck rigidity, coryza, impediment to inspiration and expiration, cardiac disorders and dryness of the mouth. Here the treatment is as indicated in diseases of the parts above the supra clavicular region and consolation. (206-207) In condition of occlusion of prāna by udāna, there will be loss of function, vital essence, strength and complexion or it may even lead to death. This condition should be treated by gradual pouring with cold water and comforting measures in such a way that the patient may be restored to health. (208-208½) In condition of the occlusion of apāna by udāna, there will be vomiting, dyspnoea, and similar other disorders. The treatment is enema and similar measures, and diet inducing vāta anulomana. (209-209½) In condition of the occlusion of udāna by apāna, there occur stupor, reduced digestive mechanism and diarrhoea. The treatment measures are emesis and diet that is digestive, stimulant and grāhi. (210-210½) In condition of occlusion of apāna by vyāna, there occur the symptoms of vomiting, distension of abdomen, udāvarta, gulma, colic and griping pain. This condition should be treated by anulomana by means of unctuous medications. (211-211½) In condition of occlusion of vyāna by apāna, there occurs excessive discharge of feces, urine and semen. Here the treatment indicated is saṅgrahaṇa therapy. (212-212½) In condition of occlusion of vyāna by samāna, there occurs fainting, stupor, garrulousness, asthenia of the limbs, reduced digestive mechanism, vital essence and strength. Exercise and light diet are indicated as treatment for this condition. (213-213½) In condition of occlusion of vyāna by udāna, there occurs rigidity, decreased gastro-intestinal enzymes activity, anhidrosis, and loss of movement and absence of winking. The treatment is wholesome, measured and light diet. (214-214½)

By the symptoms one should diagnose the condition of mutual occlusion of these five types of vāta, and it has been laid down that there will occurs either the increase or decrease of its functions as the particular type of vāta is affected. (215-215½) Thus have been described in general this eight conditions of mutual occlusion alongwith their symptoms and treatment, in order to aid the understanding of intelligent physicians. (216-216½)

General guidelines for management

स्थानान्यवेक्ष्य वातानां वृद्धिं हानिं च कर्मणाम् ||२१७|| द्वादशावरणान्यन्यान्यभिलक्ष्य भिषग्जितम् | कुर्यादभ्यञ्जनस्नेहपानबस्त्यादि [१] सर्वशः ||२१८|| क्रममुष्णमनुष्णं वा व्यत्यासादवचारयेत् |२१९| sthānanyavekShya vātanAM vRuddhiM hAniM ca karmaNAm ||217|| dvAdashĀvarananyanyAnyabhilakShya bhiShagjitam | kuryAdabhya~jjanaSnēhapāna bastyAdi [1] sarvashaH ||218|| kramamuShNamanuShNaM vA vyatyAsAdavacArayet |219| sthānānyavēkṣya vātānāṁ vr̥ddhiṁ hāniṁ ca karmaṇām||217|| dvādaśāvaraṇānyanyānyabhilakṣya bhiṣagjitam| kuryādabhyañjanasnēhapānabastyādi [1] sarvaśaḥ||218|| kramamuṣṇamanuṣṇaṁ vā vyatyāsādavacārayēt|219| On investigating the habitat of each type of vāta, as well as the signs of increase or decrease of its functions, the physician should diagnose the remaining twelve conditions of mutual occlusions and should treat them by means of external application, unctuous internal administration, enema and all other procedures, or he may be alternatively given cold and hot measures. (217-218½)

Specific principles of management

उदानं योजयेदूर्ध्वमपानं चानुलोमयेत् ||२१९|| समानं शमयेच्चैव त्रिधा व्यानं तु योजयेत् | प्राणो रक्ष्यश्चतुर्भ्योऽपि स्थाने ह्यस्य स्थितिर्ध्रुवा ||२२०|| स्वं स्थानं गमयेदेवं वृतानेतान् विमार्गगान् |२२१| udānaM yojayedUrdhvamapāna M cAnulomayet ||219|| samānaM shamayeccaiva tridhA vyānaM tu yojayet | prānao rakShyashcaturbhyo~api sthAne hyasya sthitirdhruvA ||220|| svaM sthānaM gamayedevaM vRutAnetAn vimArgagAn |221| udānaṁ yōjayēdūrdhvamapānaṁ cānulōmayēt||219|| samānaṁ śamayēccaiva tridhā vyānaṁ tu yōjayēt| prāṇō rakṣyaścaturbhyō'pi sthānē hyasya sthitirdhruvā||220|| svaṁ sthānaṁ gamayēdēvaṁ vr̥tānētān vimārgagān|221| The udāna should be regulated upwards and the apāna downwards. The samāna should be alleviated and the vyāna should be treated by all the three methods. Even more carefully than the other four types of vāta, the prāna should be maintained, because life depends on the proper maintenance of it in its habitat. Thus the physician should regulate and establish types of vāta in their normal habitats, which have been occluded and misdirected. (219-220½) Types of vata occluded by dosha: मूर्च्छा दाहो भ्रमः शूलं विदाहः शीतकामिता ||२२१|| छर्दनं च विदग्धस्य प्राणे पित्तसमावृते | ष्ठीवनं क्षवथूद्गारनिःश्वासोच्छ्वाससङ्ग्रहः ||२२२|| प्राणे कफावृते रूपाण्यरुचिश्छर्दिरेव च | मूर्च्छाद्यानि च रूपाणि दाहो नाभ्युरसः क्लमः ||२२३|| ओजोभ्रंशश्च सादश्चाप्युदाने पित्तसंवृते | आवृते श्लेष्मणोदाने वैवर्ण्यं वाक्स्वरग्रहः ||२२४|| दौर्बल्यं गुरुगात्रत्वमरुचिश्चोपजायते | अतिस्वेदस्तृषा दाहो मूर्च्छा चारुचिरेव [१] च ||२२५|| पित्तावृते समाने स्यादुपघातस्तथोष्मणः | अस्वेदो वह्निमान्द्यं च लोमहर्षस्तथैव च ||२२६|| कफावृते समाने स्याद्गात्राणां चातिशीतता | व्याने पित्तावृते तु स्याद्दाहः सर्वाङ्गगः क्लमः ||२२७|| गात्रविक्षेपसङ्गश्च ससन्तापः सवेदनः | गुरुता सर्वगात्राणां सर्वसन्ध्यस्थिजा रुजः ||२२८|| व्याने कफावृते लिङ्गं गतिसङ्गस्तथाऽधिकः [२] | हारिद्रमूत्रवर्चस्त्वं तापश्च गुदमेढ्रयोः ||२२९|| लिङ्गं पित्तावृतेऽपाने रजसश्चातिवर्तनम् | भिन्नामश्लेष्मसंसृष्टगुरुवर्चःप्रवर्तनम् ||२३०|| श्लेष्मणा संवृतेऽपाने कफमेहस्य चागमः |२३१| mUrcchA dAho bhramaH shUlaM vidAhaH shItakAmitA ||221|| chardanaM ca vidagdhasya prānae pittasamAvRute | ShThIvanaM kṣavathūdgAraniHshvAsocchvAsasa~ggrahaH ||222|| prānae kaphAvRute rUpANyarucishchardireva ca | mUrcchAdyAni ca rUpANi dAho nAbhyurasaH klamaH ||223|| ojobhraMshashca sAdashcApyudānae pittasaMvRute | AvRute shleShmaNodAne vaivarNyaM vAksvaragrahaH ||224|| daurbalyaM gurugAtratvamarucishcopajAyate | atisvedastRuShA dAho mUrcchA cArucireva [1] ca ||225|| pittAvRute Samānae syAdupaghAtastathoShmaNaH | asvedo vahnimAndyaM ca lomaharShastathaiva ca ||226|| kaphAvRute Samānae syAdgAtrANAM cAtishItatA | vyānae pittAvRute tu syAddAhaH sarvA~ggagaH klamaH ||227|| gAtravikShepasa~ggashca sasantApaH savedanaH | gurutA sarvagAtrANAM sarvasandhyasthijA rujaH ||228|| vyānae kaphAvRute li~ggaM gatisa~ggastathA~adhikaH [2] | hAridramūtravarcastvaM tApashca gudameDhrayoH ||229|| li~ggaM pittAvRute~apānae rajasashcAtivartanam | bhinnAmashleShmasaMsRuShTaguruvarcaHpravartanam ||230|| shleShmaNA saMvRute~apānae kaphamehasya cAgamaH |231| mūrcchā dāhō bhramaḥ śūlaṁ vidāhaḥ śītakāmitā||221|| chardanaṁ ca vidagdhasya prāṇē pittasamāvr̥tē| ṣṭhīvanaṁ kṣavathūdgāraniḥśvāsōcchvāsasaṅgrahaḥ||222|| prāṇē kaphāvr̥tē rūpāṇyaruciśchardirēva ca| mūrcchādyāni ca rūpāṇi dāhō nābhyurasaḥ klamaḥ||223|| ōjōbhraṁśaśca sādaścāpyudānē pittasaṁvr̥tē| āvr̥tē ślēṣmaṇōdānē vaivarṇyaṁ vāksvaragrahaḥ||224|| daurbalyaṁ gurugātratvamaruciścōpajāyatē| atisvēdastr̥ṣā dāhō mūrcchā cārucirēva [11] ca||225|| pittāvr̥tē samānē syādupaghātastathōṣmaṇaḥ| asvēdō vahnimāndyaṁ ca lōmaharṣastathaiva ca||226|| kaphāvr̥tē samānē syādgātrāṇāṁ cātiśītatā| vyānē pittāvr̥tē tu syāddāhaḥ sarvāṅgagaḥ klamaḥ||227|| gātravikṣēpasaṅgaśca sasantāpaḥ savēdanaḥ| gurutā sarvagātrāṇāṁ sarvasandhyasthijā rujaḥ||228|| vyānē kaphāvr̥tē liṅgaṁ gatisaṅgastathā'dhikaḥ [12] | hāridramūtravarcastvaṁ tāpaśca gudamēḍhrayōḥ||229|| liṅgaṁ pittāvr̥tē'pānē rajasaścātivartanam| bhinnāmaślēṣmasaṁsr̥ṣṭaguruvarcaḥpravartanam||230|| ślēṣmaṇā saṁvr̥tē'pānē kaphamēhasya cāgamaḥ|231| In occlusion of prāna by pitta fainting, giddiness, colic, burning sensation, craving for cold things and vomiting of acidic gastric material are seen as symptoms. (221-221½) In occlusion of prāna by kapha, there occur symptoms such as frequent spitting, sneezing, eructation, impediment to the inspiration and expiration, anorexia and vomiting. (222-222½) In condition of occlusion of udāna by pitta, there occur symptoms such as fainting etc and burning in the umbilical region and chest, exhaustion, loss of vital essence and asthenia. (223-223½) In occlusion of udāna by kapha, there occur discolourations, aphasia and dysarthria, debility, heaviness of the body and anorexia. (224-224½) In condition of occlusion of samāna by pitta, there occur hyperhidrosis, thirst, burning, fainting, anorexia, derangement of appetite and decreased gastro-intestinal enzyme activity. (225-225½) In condition of occlusion of the samāna by kapha, there occur anhidrosis, reduced gastro-intestinal enzyme activity, horripilation and excessive coldness of the limbs. (226-226½)

In condition of occlusion of vyāna by pitta, there occur burning all over the body, exhaustion, chorea or poverty of movements accompanied with temperature and pain. (227-227½) In condition of occlusion of vyāna by kapha, there occur symptoms such as heaviness of the limbs, pain in all the bones and joints, and impaired gait. (228-228½) In condition of occlusion of apāna by pitta, there occur symptoms such as yellowish discolouration of urine and feces, sensation of heat in the rectum and penis and excessive flow of the menses. (229-229½) In condition of occlusion of apāna by kapha, there occur stools that are loose, heavy and mixed with undigested matter and mucus and kapha dominated prameha. (230-230½) Guidelines for diagnosis of conditions: लक्षणानां तु मिश्रत्वं पित्तस्य च कफस्य च ||२३१|| उपलक्ष्य भिषग्विद्वान् मिश्रमावरणं वदेत् | यद्यस्य वायोर्निर्दिष्टं स्थानं तत्रेतरौ स्थितौ ||२३२|| दोषौ बहुविधान् व्याधीन् दर्शयेतां यथानिजान् | आवृतं श्लेष्मपित्ताभ्यां प्राणं चोदानमेव च ||२३३|| गरीयस्त्वेन पश्यन्ति भिषजः शास्त्रचक्षुषः | विशेषाज्जीवितं प्राणे उदाने संश्रितं बलम् ||२३४|| स्यात्तयोः पीडनाद्धानिरायुषश्च बलस्य च | सर्वेऽप्येतेऽपरिज्ञाताः परिसंवत्सरास्तथा ||२३५|| उपेक्षणादसाध्याः स्युरथवा दुरुपक्रमाः [१] |२३६| lakShaNAnAM tu mishratvaM pittasya ca kaphasya ca ||231|| upalakShya bhiShagvidvAn mishramĀvaranaM vadet | yadyasya vAyornirdiShTaM sthānaM tatretarau sthitau ||232||

dōṣau bahuvidhAn vyAdhIn darshayetAM yathAnijAn | 

AvRutaM shleShmapittAbhyAM prānaM codAnameva ca ||233|| garIyastvena pashyanti bhiShajaH shAstracakShuShaH | visheShAjjIvitaM prānae udānae saMshritaM balam ||234|| syAttayoH pIDanAddhAnirAyuShashca balasya ca | sarve~apyete~aparij~jAtAH parisaMvatsarAstathA ||235|| upekShaNAdasAdhyAH syurathavA durupakramAH [1] |236| lakṣaṇānāṁ tu miśratvaṁ pittasya ca kaphasya ca||231|| upalakṣya bhiṣagvidvān miśramāvaraṇaṁ vadēt| yadyasya vāyōrnirdiṣṭaṁ sthānaṁ tatrētarau sthitau||232|| dōṣau bahuvidhān vyādhīn darśayētāṁ yathānijān| āvr̥taṁ ślēṣmapittābhyāṁ prāṇaṁ cōdānamēva ca||233|| garīyastvēna paśyanti bhiṣajaḥ śāstracakṣuṣaḥ| viśēṣājjīvitaṁ prāṇē udānē saṁśritaṁ balam||234|| syāttayōḥ pīḍanāddhānirāyuṣaśca balasya ca| sarvē'pyētē'parijñātāḥ parisaṁvatsarāstathā||235|| upēkṣaṇādasādhyāḥ syurathavā durupakramāḥ [13] |236| lakṣaṇānāṁ tu miśratvaṁ pittasya ca kaphasya ca||231|| upalakṣya bhiṣagvidvān miśramāvaraṇaṁ vadēt| yadyasya vāyōrnirdiṣṭaṁ sthānaṁ tatrētarau sthitau||232|| dōṣau bahuvidhān vyādhīn darśayētāṁ yathānijān| āvr̥taṁ ślēṣmapittābhyāṁ prāṇaṁ cōdānamēva ca||233|| garīyastvēna paśyanti bhiṣajaḥ śāstracakṣuṣaḥ| viśēṣājjīvitaṁ prāṇē udānē saṁśritaṁ balam||234|| syāttayōḥ pīḍanāddhānirāyuṣaśca balasya ca| sarvē'pyētē'parijñātāḥ parisaṁvatsarāstathā||235|| upēkṣaṇādasādhyāḥ syurathavā durupakramāḥ [1] |236| On observing the mixed symptoms of pitta and kapha, the learned physician should diagnose it as a condition of combined occlusion. (231-231½) If the two other doshas get located in the places described as the habitat of vāta, they manifest various symptoms of disorders characteristic to each of them. (232-232½) Medical authorities regard, as most serious, the condition of occlusion of prāna or udāna by kapha and pitta combined, because life is particularly dependent on prāna, and strength on udāna; and occlusion of them, will result in loss of life and vitality. (233-234½) If all these conditions are either undiagnosed or neglected for longer than a year, they become either incurable or extreme difficult to cure. (235-235½) Complications and management: हृद्रोगो विद्रधिः प्लीहा गुल्मोऽतीसार एव च ||२३६|| भवन्त्युपद्रवास्तेषामावृतानामुपेक्षणात् | तस्मादावरणं वैद्यः पवनस्योपलक्षयेत् ||२३७|| पञ्चात्मकस्य वातेन पित्तेन श्लेष्मणाऽपि वा | भिषग्जितमतः सम्यगुपलक्ष्य समाचरेत् ||२३८|| अनभिष्यन्दिभिः स्निग्धैः स्रोतसां शुद्धिकारकैः | कफपित्ताविरुद्धं यद्यच्च वातानुलोमनम् ||२३९|| सर्वस्थानावृतेऽप्याशु तत् कार्यं मारुते हितम् | यापना बस्तयः प्रायो मधुराः सानुवासनाः ||२४०|| प्रसमीक्ष्य बलाधिक्यं मृदु वा स्रंसनं हितम् | रसायनानां सर्वेषामुपयोगः प्रशस्यते ||२४१|| शैलस्य जतुनोऽत्यर्थं पयसा गुग्गुलोस्तथा | लेहं वा भार्गवप्रोक्तमभ्यसेत् क्षीरभुङ्नरः ||२४२|| अभयामलकीयोक्तमेकादशसिताशतम् [१] | अपानेनावृते सर्वं दीपनं ग्राहि भेषजम् ||२४३|| वातानुलोमनं यच्च पक्वाशयविशोधनम् | इति सङ्क्षेपतः प्रोक्तमावृतानां चिकित्सितम् ||२४४|| प्राणादीनां भिषक् कुर्याद्वितर्क्य स्वयमेव तत् | पित्तावृते तु पित्तघ्नैर्मारुतस्याविरोधिभिः | कफावृते कफघ्नैस्तु मारुतस्यानुलोमनैः ||२४५|| hRudrogo vidradhiH plIhA gulmo~a’tīsāra eva ca ||236|| bhavantyupadravAsteShAmAvRutAnAmupekShaNAt | tasmAdĀvaranaM vaidyaH pavanasyopalakṣayaet ||237|| pa~jcAtmakasya vAtena pittena shleShmaNA~api vA | bhiShagjitamataH samyagupalakShya samAcaret ||238|| anabhiShyandibhiH snigdhaiH srotasAM shuddhikArakaiH | kaphapittAviruddhaM yadyacca vātanulomanam ||239|| sarvasthānavRute~apyAshu tat kAryaM mArute hitam | Yāpana bastayaH prAyo madhurAH sAnuvAsanAH ||240|| prasamIkShya balAdhikyaM mRudu vA sraMsanaM hitam | rasāyananAM sarveShAmupayogaH prashasyate ||241|| shailasya jatuno~atyarthaM payasA guggulostathA | lehaM vA bhArgavaproktamabhyaset kShIrabhu~gnaraH ||242|| abhayAmalakIyoktamekAdashaśītāshatam [1] | apānaenAvRute sarvaM dIpanaM grAhi bheShajam ||243|| vātanulomanaM yacca pakvAshayavishodhanam | iti sa~gkShepataH proktamAvRutAnAM cikitśītām ||244|| prānadInAM bhiShak kuryAdvitarkya svayameva tat | pittAvRute tu pittaghnairmArutasyAvirodhibhiH | kaphAvRute kaphaghnaistu mArutasyAnulomanaiH ||245|| hr̥drōgō vidradhiḥ plīhā gulmō'tīsāra ēva ca||236|| bhavantyupadravāstēṣāmāvr̥tānāmupēkṣaṇāt| tasmādāvaraṇaṁ vaidyaḥ pavanasyōpalakṣayēt||237|| pañcātmakasya vātēna pittēna ślēṣmaṇā'pi vā| bhiṣagjitamataḥ samyagupalakṣya samācarēt||238|| anabhiṣyandibhiḥ snigdhaiḥ srōtasāṁ śuddhikārakaiḥ| kaphapittāviruddhaṁ yadyacca vātānulōmanam||239|| sarvasthānāvr̥tē'pyāśu tat kāryaṁ mārutē hitam| yāpanā bastayaḥ prāyō madhurāḥ sānuvāsanāḥ||240|| prasamīkṣya balādhikyaṁ mr̥du vā sraṁsanaṁ hitam| rasāyanānāṁ sarvēṣāmupayōgaḥ praśasyatē||241|| śailasya jatunō'tyarthaṁ payasā guggulōstathā| lēhaṁ vā bhārgavaprōktamabhyasēt kṣīrabhuṅnaraḥ||242|| abhayāmalakīyōktamēkādaśasitāśatam [14] | apānēnāvr̥tē sarvaṁ dīpanaṁ grāhi bhēṣajam||243|| vātānulōmanaṁ yacca pakvāśayaviśōdhanam| iti saṅkṣēpataḥ prōktamāvr̥tānāṁ cikitśītām||244|| prāṇādīnāṁ bhiṣak kuryādvitarkya svayamēva tat| pittāvr̥tē tu pittaghnairmārutasyāvirōdhibhiḥ| kaphāvr̥tē kaphaghnaistu mārutasyānulōmanaiḥ||245|| As a result of neglecting these conditions of occlusions, there occur complications such as cardiac disorders, abscesses, splenic disorders, gulma and diarrhoea. (236-236½) Therefore, the physician should diagnose the condition of occlusion of the five types of vāta, by vāta, pitta, or kapha. (237-237½) After having well thought about the proper medications, the physician should treat the patient by measures which are non-abhiṣyandi, unctuous and depurative of body channels. (238-238½) In condition of occlusion of vāta in all its habitats, taking prompt measures which are vāta anulomana and at the same time not antagonistic to kapha and pitta is beneficial. (239-239½) The yāpana enema as well as the sweet unctuous enema is generally beneficial, and if the patient found to be sufficiently strong mild laxatives may be used. (240-240½) The use of all kinds of rasāyana is highly recommended. A course of shilājatu and a course of guggulu with milk are especially beneficial. (241-241½) The patient living on milk diet, may take a course of rasāyana told by Bhārgava explained in ‘abhayāmalakī pāda’ containing 4400 tolas (52.8 kg) of sugar. (242-242½) In condition of occlusion by apāna, all measures that are dīpana, grāhi, vāta anuloman and which cleanse pakvāśaya constitute the treatment. (243-243½) Thus has been described in brief the line of treatment in conditions of occlusion of prāna and other types of vāta; the physician should use his own discretion and give the proper treatment. (244-244½) In a condition of occlusion of vāta by pitta, the physician should administer medications curative of pitta and not antagonistic to vāta. In a condition of occlusion of vāta by kapha, medications curative of kapha and vāta anulomana should be given. (245) Similarity in macro-cosm and micro-cosm: लोके वाय्वर्कसोमानां दुर्विज्ञेया यथा गतिः | तथा शरीरे वातस्य पित्तस्य च कफस्य च ||२४६|| loke vAyvarkasomAnAM durvij~jeyA yathA gatiH | tathA sharIre vātasya pittasya ca kaphasya ca ||246|| lōkē vāyvarkasōmānāṁ durvijñēyā yathā gatiḥ| tathā śarīrē vātasya pittasya ca kaphasya ca||246|| Just as in the universe the courses of the air, the sun and the moon are difficult to comprehend, even so are the forces of vāta, pitta and kapha in the body. (246) Four states of dosha: क्षयं वृद्धिं समत्वं च तथैवावरणं भिषक् | विज्ञाय पवनादीनां न प्रमुह्यति कर्मसु ||२४७|| kṣayaM vRuddhiM samatvaM ca tathaivĀvaranaM bhiShak | vij~jAya pavanAdInAM na pramuhyati karmasu ||247|| kṣayaṁ vr̥ddhiṁ samatvaṁ ca tathaivāvaraṇaṁ bhiṣak| vijñāya pavanādīnāṁ na pramuhyati karmasu||247|| The physician who understand the condition of decrease, increase, normality and occlusion of vāta and other dosha, is not deluded with regard to treatment.(247) Summary: तत्र श्लोकौ- पञ्चात्मनः स्थानवशाच्छरीरे स्थानानि कर्माणि च देहधातोः | प्रकोपहेतुः कुपितश्च रोगान् स्थानेषु चान्येषु वृतोऽवृतश्च ||२४८|| प्राणेश्वरः प्राणभृतां करोति क्रिया च तेषामखिला निरुक्ता | तां देशसात्म्यर्तुबलान्यवेक्ष्य प्रयोजयेच्छास्त्रमतानुसारी ||२४९|| tatra shlokau- pa~jcAtmanaH sthānavashAccharIre sthānani karmANi ca dehadhAtoH | prakopahetuH kupitashca rōgan sthAneShu cAnyeShu vRuto~avRutashca ||248|| prānaeshvaraH prānabhRutAM karoti kriyA ca teShAmakhilA niruktA | tAM deshasAtmyartubalAnyavekShya prayojayecchAstramatAnusArI ||249|| tatra ślōkau- pañcātmanaḥ sthānavaśāccharīrē sthānāni karmāṇi ca dēhadhātōḥ| prakōpahētuḥ kupitaśca rōgān sthānēṣu cānyēṣu vr̥tō'vr̥taśca||248|| prāṇēśvaraḥ prāṇabhr̥tāṁ karōti kriyā ca tēṣāmakhilā niruktā| tāṁ dēśasātmyartubalānyavēkṣya prayōjayēcchāstramatānusārī||249|| The vāta being the subject of this chapter, the habitats and functions of the five-fold body sustaining element vāta, have been dealt with here. The causes of provocation, the diseases which this life controlling principle of vāta gives rise to in the persons, when provoked, both in its own habitat and in other places, both in conditions of occlusion and in no occlusion, and the treatment of all those disease have been fully expounded here. The physician guided by the directions of the science, should administer the treatment, giving full consideration to factors of place, similarity, season and strength. (248-249) इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने वातव्याधिचिकित्सितं नामाष्टाविंशोऽध्यायः ||२८|| Ity agniveshakRute tantre carakapratisaMskRute~aprApte dRuDhabalasampUrite cikitsāsthAne VātavyādhicikitśītāM nAmAShTAviMsho~adhyAyaH ||28|| ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē vātavyādhicikitśītāṁnāmāṣṭāviṁśō'dhyāyaḥ||28||

Thus, in the section on ‘Therapeutics’, in the treatise compiled by Agnivēśa and revised by Caraka, the twenty-eighth chapter entitled ‘The therapeutics of vāta diseases’ not being available, the same as restored by Dr̥ḍhabala, is completed.[28]

Tattva

• Vāyu/vata is responsible for life, strength and functioning of living organisms. • Normal (non vitiated) vāyu/vata with unobstructed (free) movement and location at its natural site, is responsible for long healthy lifespan. • Vāyu/vata is of five types namely prāna, udāna, samāna, vyāna and apāna and they mechanize the body optimally occupying their sites without any irregular movement. • The location of prāna is vertex, thorax, trachea, tongue, mouth and nose and it performs functions of spitting, sneezing, eructation, respiration, deglutition etc. • The site of udāna is umbilicus, thorax and trachea and is responsible for vocalization, drive, energy, strength, complexion etc. • Samāna is located in channels of sweat, humors and water and lateral to the seat of agni (digestive enzymes (agni) and yield strength to the digestive fire. • Vyāna has swift movement and spreads all over the body and is responsible for gait, flexion, extension, twinkling etc. • Apāna is located in testicles, urinary bladder, penis, umbilicus, thighs, inguinal region and anus and performs ejaculation, micturition, defecation, expulsion of menstrual blood and fetus. • When these five are located in respective sites optimally, they perform their functions and support life without any morbidity. • Due to various vata provoking factors, vata is vitiated and it fills the empty channels and leads to various disorders at that particular site. • The onset of vata disorders is generally sudden without any premonitory signs. • The diagnosis of vata disorders is based upon the symptoms characteristic of the seat of affliction. • In all vata disorders, the association of other dōsha like pitta etc. is to be considered. • The provocation of vāta is either due to ‘dhātukṣaya’, means diminution of tissue elements and/ or due to ‘āvarana’ means obstruction to its pathway. The vāta, pitta and kapha always circulate through all the body channels. • The vāta, owing to its quality of subtleness is really the impeller of the other two dosha. • When the vāta is provoked, it propels the other two doshas and dislodges them about here and there, causing various diseases. Due to ‘āvarana’ (obstruction in its path), it further causes diminution of the body nutrient fluid and other body elements. • In case of avarana (occlusion of vata), the clinical presentation includes the increased signs of dosha which is occluding vata. • In pure vitiation of vata, without any association or obstruction by other dosha, snehana and swedan therapy are first principles of treatment. • Mild cleansing with unctuous drugs shall be given to remove the residual morbidity. • By excessive use of unctuous, sour, salty and hot articles of diet, the excretory matter gets accumulated, occluding the alimentary passage, obstructs the vāta, hence anulomana of vāta should be done. • Specific line of treatment should be adopted in specific condition depending on site of affliction and the vitiated tissue involved. • Ghee, oil, fat, marrow, affusion, massage, enema, unctuous sudation, staying at calm places (without strong wind), covering with blankets, meat soups, various milks, articles of diet of sweet, sour and salty taste and whatever is nourishing are beneficial for disorders due to vāta. • Pitta and kapha dosha occlude vata dosha at their sites and result in disorders. The clinical features are dominated by the vitiated dosha. The functions of obstructed dosha are decreased in these conditions. • The various types of vata dosha can mutually occlude each other’s pathways and result in disorders. There are increased signs of obstructing types of vata and decreased functions of obstructed type of vata dosha. • The udāna should be regulated with therapies leading to its upward movement. The apāna should be regulated with therapies leading to its downwards movement. The samāna should be alleviated and the vyāna should be treated by all the three methods. Prāna should be maintained even more carefully than the other four types of vāta, because life depends on the proper maintenance of it in its habitat. Thus, the treatment is intended to regulate and establish types of vāta in their normal habitats, which have been occluded and misdirected. • Life and vitality is particularly dependent on prāna, and strength on udāna; and occlusion of them, will result in loss of life and vitality. • In a condition of occlusion of vāta by pitta, the treatment is done with medications curative of pitta and not antagonistic to vāta. • In a condition of occlusion of vāta by kapha, medications curative of kapha and vāta anulomana should be given. • Just as in the universe the courses of the air, the sun and the moon are difficult to comprehend, even so are the forces of vāta, pitta and kapha in the body. The first three are responsible for all functions in macro-cosm, whereas the latter three are for functions in micro-cosm. • There are four conditions viz. decrease, increase, normality and occlusion of vāta and other dosha. Vidhi Vimarsha: Importance of vata dosha in overall health and disease: This text highlights the grandness of vāta as a humor. Vāta is equated to ‘āyu’. Life is sustained by vāyu only. Even though ‘āyu’ is previously defined as conglomeration of sharira (physical body), indriya (sensorium), satva (mind) and atmā (soul), 4 here it is mentioned equivalent to vāyu. The sense organs, mind and soul in physical body are manifested through the function of vāyu only. The strength of the individual is also provided by vāyu. These two usages of āyu and bala in this verse are later explained as, prāna is life and udāna is strength. (verse 3)

Form of vayu:

Vāta performs all its activity for a healthy long life subject to status of its three functions. They are ‘akupita’(not increased, decreased or vitiated), ‘sthānastha’ (located in its own place) and ‘avyāhatagati’(nothing is interfering with its movement or gati). ‘Gati’ is a characteristic feature of vāta. Gati is nothing other than directional aspect of ‘chala’ property. Prāna is located in vertex and has a gati towards thorax, trachea, tongue and nose. If anything obstructs gati it leads to disease. These three characteristics of vāta imply three possible modes of pathogenesis in vāta diseases. These are svātantra dushti (..), gata vāta (increased movement of vata) and āvarana (obstruction to movement of vata). This can be further analysed as follows; due to the following three important properties of vāta, it is regarded entirely different from other dōsha5. 1. Asamghāta (Incorporeal) 2. Anavasthita (Unstable) 3. Anāsādhya (Inaccessible) Pitta and kapha have appendages and are relatively compact. On the contrary vāta is incorporeal (avayavasamghātarahita). It can be termed as rarified in nature. The vāta is anavasthita (unstable) too. These two properties are due to its panchbhautik composition. Vāta is formed by akāsa and vāyu predominantly6 which are incorporeal (amurta). Chalatva (mobility) and apratighāta (unobstructability) are characteristics of vāyu and akāsha perceptible by the tactile sense organ7. According to Tarka Samgraha, vāyu is devoid of shape (ruparahita) and posesses sensibility to touch (sparśavān). The biological vāta (which is present in the living being) is self originated (svayambhu), subtle (sukshma) and all pervasive (sarvagata). It is not sensible (avyakta) but its activities are patent or manifest (vyaktakarma).8 Anavasthita (unstable) is due to chala property of vāta. This continuous moving nature of vāta is explained with other terminologies also like sheeghravāt9 (swift movement), āsukāri (instantaneous action), muhushchāri (rhythmic movement).10 It abounds in the fundamental quality of rāja (the principle of cohesion and action). The predominance of rāja is responsible for the instability of vāta. The quality of chalatva is directional in nature, which is explained by the term gati. Vāta convenes all bodily activities by this important feature. Owing to its incorporeal nature and instability vāta is anāsādhya (inaccessible) also. The inaccessibility is characterized in regard to its functional and physical attributes but more relevant regarding the therapeutic aspect. Above explained cardinal features make vāta achintya veerya (inconceivable prowess) and dōshanām netā (propeller of all functional elements in the body).11 Properties of vata: In chapter vātakalākalīya (Cha.Su.12), questions have been raised about exciting and alleviating factors regarding qualities of vāta. Rūkṣa, laghu, shītā, dāruna, khara and vishada have been explained as qualities of vāta. Repeated use of substances with these qualities and actions of such similar qualities causes vridhi and excitation of vāta and is alleviated by use of substances possessing contrary qualities. This brings out the phenomenon of two mutually interrelated and inseparable of sharira vāyu viz. (1) that, the sharira vāyu is a biophysical force and (2) that it is closely associated with material substances which form part of the structure of the body for example, nervousness. It is a chemical reaction sequence which occurs during the course of life. This chemical reaction –sequence, can be accelerated (excited) or inhibited by substances with similar properties (dravya sāmānya), qualities (guna sāmānya) and actions (karma sāmānya) and inhibited by substances with opposite properties. In other words, it may be concluded that the bio – physical force – the sharira vāyu – is closely linked with some material structural factors like āhara and aushada – similars increase and opposite decrease. Sodium, Potassium, Calcium, Chloride, ions are continuously moving around [Brownian movement] which is the result of its ionic state [swabhāva / swayambhu guna]. The ionic inflow and outflow within the cell causes depolarization and repolarization or in other words impulse is generated. Hyper or hypo state of these ions is the cause for disease condition which may present in the form of seizures, palpitations, muscle cramps, lethargy, altered sensorium, coma and death. Therefore, the biological energy produced by this ionic movement is the cause for sharira vāyu and as per modern science too their concentration depends on āhara and vihara. The continuous, controlled movement of the ions is responsible for cell activity which together at the level of cells contributes to tissue activity which together contributes to the organ, system and in turn whole body. (verse 4) Types of vata dosha:The five sub types of vāta are described. In Vedic literature, as a medical system, the important five types of vāta are explained with their locations and functions. The word ‘tantrayate’ is used to explain the functional format of vāta than its structural format. The sharira (physical body) is yantra and the mode of functioning is tantra. Prāna is the supreme vāta and occupies vertex, thorax etc. Its natural flow is downwards, from vertex. Udāna is located in nābhi, uras etc. As per Ashtanga Samgraha the main location of udāna is thorax and nāsika is one among other locations. Prayatna (..) in functions of udāna is described as ‘manaprayatna’ by Gayādāsa in Sushruta Samhita12. The relationship of Samāna with sweda and ambuvaha srotas is mentioned by Charaka only. The agnimāndhya leading to jwara and absence of sweating while jwara etc can be better explained with this verse. Vyāna is located all over the body. As per Ashtanga Samgraha it is mainly located at Hridaya. The vāta dōsha on basis of its functions is classified into five types. They reside in the sharira at the level of sharira parmānu (cell) and also at gross level. Five types of vāta work together in a synchronized manner for the normal functioning of the sharira (vāyu tantrayantra dhara). In this context upamāna pramāna (..) of people with different profession like mālākāra (..), kumbakār (..) stay together under one roof . (verse 5-11) General etiological factors and basic pathogenesis of vāta disorders: Dosha sravana here means vamana, virechana etc. The whole etiological factors can be divided into two a) which cause direct vāta vitiation and b) which cause indirect vāta vitiation. Daysleep (Divāswapna) do not directly lead to vitiation of vata. However, it leads to formation of ama and cause vāta vitiation indirectly by obstructing vāta. Vegasandharana (suppression of natural urges) and marmābhighata (trauma to vital organs) etc. are examples of direct vitiation. The pathogenesis is also bi-fold. The initial pathology is aggravation of vāta and diminution of dhātus and vice versa. One augments the other. This ultimately causes emptiness in channels and rarity in tissues which gives more space for movements of vāta. The second pathology is by increase in dhātus leading to excessive filling in channels to cause their clogging and blocking vāta. (verse 15-19) Premonitory signs and symptoms: Clinical manifestations may not be apparent because of vague manifestation of symptoms (Avyaktaṁ lakṣaṇam). This occurs in two situations, either the pathogenesis is extremely slow or it is abrupt. In the initial case, it is unable to appreciate the prodromal symptoms and presenting complaints separately. If it is an abrupt pathology the clinical presentation immediately follows the prodromal symptoms without appricable gap. This is because of the fact that normal process of dhātukṣaya is very slow and insidious. The same way abrupt vitiation of vāta is possible because of its ashukāritva (sudden). (verse 19-20) Clinical features:The clinical presentations vary according to the specificity of hetu (cause) and sthāna (location). The treatment options also vary accordingly. For example if vāta prakopa takes place due to rūkṣa vriddhi in pakvāśaya it may lead to habitual constipation in which snigdha, uṣṇā and tikshna aushadha like mishraka snēha may be a good treatment option. If the same vāta get vitiated in āmāshaya due to snigdha vriddhi, leading to gastro-esophageal reflux disease (GERD), rūkṣa uṣṇā and tikshna like gomūtra bhavita shaddharana is the ideal treatment option. If Anuvasana is the ideal panchkarma in the initial condition, vamana is the next second best option respectively. (verse 20-24) Pathogenesis of various conditions: All the verses explain a specific type of samprapti like Kōṣṭhagata vāta, āmāshayagata vāta etc. They are not to be considered as a single disease. These specific diseases may lead to many disease presentations in which the treatment strategies can be generalized. Any dōṣa may occupy any particular site or area and lead to diseases. The description of pitta and kapha occupying in different dusya are explained in Ashtanga Samgraha of Vāgbhata in Sutrasthāna13. In that context the description of vāta in different dusya is not explained and suggested to refer nidanasthāna (anagata apeksha). This also signifies the importance of vāta in generating certain syndromic presentations. This type of pathology of vāta is called as gatavāta. Normally in all gatavāta, the affected dushya will be kshina (depleted) and affected srotas will be rikta (empty). The concept of gatavāta can be further explored physiologically. Dhātu are classified into two types’ asthāyi (temporary) dhātu and sthāyi (permanent) dhātu. Asthāyi dhātu are the ones which are dravaswarupa(…) and undergoing conversion (parinām āpadyamānanām) and they are being vikshepita (..) from their mulasthān (..) throughout the sharir (abhivahan) for the purpose of poshana (..) of the sthāyi dhātu. This parinaman (conversion) and abhivahan prakriya(transportation) takes place in mārga (channel) which are known as srotas; hence mārga is one of the synonym used for srotas alongwith sirā, dhamani, rasāyani, rasavāhini, nādi, panthāna, sharir chhidra, samvrita-asamvritāni, sthāna, āshaya, niketa, sharirdhātu avakāsha. Prakupita(vitiated) dosha have the capacity to further vitiate both sthānasta dhātu (fixed tissue element) as well as margagata(circulating tissue elements) of sharir dhātu. When prakupita vāta vitiates the dhātu it is called as gatavāta, means vāta prakopa with specific nidān occurs as initiative factor to interplay with specific dhātu or vitiated itself in specific sthāna (āmashaya gatavāta etc.). In this context specific nidān for each and every gata vāta related diseases must be observed to clarify why vitiated vāta goes to specific part of the body or to specific dhātu to develop kosthagata vāta, raktagata vāta etc., in this condition dhātu functions like dusya. Koshthagata vata: Vāta getting vitiated in the whole kōṣṭha is explained as koshthagata vata. kōṣṭha should be understood as antha kōṣṭha or elimentary tract. Pakwashayagata vata: In Vāgbhata and Sushruta Pakvāśayagata vāta is explained in parallel. Bradhna is a disease of debatable details.It is considered as inguinal hernia or scrotal swelling as per opinion of some scholars. Sarvangagata vata:In sarvānga gatavāta, ākshepana and kampa is additionally explained in Vāgbhata.

Gudagata vata: In gudagata vāta, the symptomatology is similar to pakvāśayagata vāta in other classics except the symptoms present in lower limbs. 

It can also be explained that gudagata vāta and pakvāśayagata vāta are different clinical entities. In gudagata vāta, vitamūtra vātanam graha (..) is observed whereas in pakvāśayagata vāta it is krichata of mūtra purisha with āntrakujan, ātopa and ānāha has been mentioned. Ashma sarkara exclusively present in gudagata vāta and rōga and shosha in jangā, uru, trika, pāda and prusta. This can be compared with lumbo-sacral plexopathy. It may be understood as; pakvāśaya gatavāta wherein proximal part of large intestine alongwith ascending, transverse and descending colon is involved whereas in gudagata vāta involvement of sigmoid colon, rectum, anus and their nerve supply.

Amashayagata vata: This is a typical presentation of anyasthānagata dōṣa. Here the sthānik dōṣa is considered as important as it is more virulent than the aganthu dōṣa. The lakshana mentioned are clinical entities which are āmashaya samutha. So when vitiated vāta enters in āmashaya manifest these diseases specifically, as told in shwas; pitta sthan samudbhava wherein pittasthān is āmashaya (Ca.Ci.17/8 Chakrapāni). When vāta enters in āmashaya will increase emptiness of stomach leading to indigestion or āma pradōṣaja vikār like visuchika etc.

This is the typical example of swasthāna kupita vāta. Exclusive vāta shaman / shodhana approaches are mandatory here. Indriyagata vata:Indriyagata vāta is applicable to any indriya. Indriya vadha may be interpreted as complete, partial or minimal loss of sensation. ‘Shrotra’(..) has specific importance among other indriya, in which inherent dosha of shrotra is vāta itself. So vāta prakopa in shrotra is more impacting. It is worthy to remember the notion in vātakalākaleeya that vāta is ‘sarvendriyānām udyojakā’(..). Twakgata vata: Tvak (skin) is referred as somatic organ even though it is a sensory organ. Supti and tōda here are not symptoms specific to tvakindriya. Here tvak represents ‘rasa dhātu’. Rasa does not have cellular pattern and hence not included in shakha. The tvak is the derivative of rasa and is included in shakha. Tvakindriya gatavāta should be understood under indriyagatavāta. There are some opinions that suptatā is affecting tvak as sensory organ also. Suptatā is mentioned as purvarupa of kustha. Suptavāta suptāni is mentioned as one of the features of kapāla kustha in Ca. Ni 5/7, as per Chakrapāni “Suptavāta suptāni iti artha asparsha gyan iti artha” (anaesthesia). This description shows that suptatā is manifestation of sparshanendriya i.e. tvak. Dermopathy, arthropathy and myopathy coexist in Systemic Lupus Erythamatoses. In tvakgata vāta; tvak rūkṣa, sphutita, supta, krisha, krishna, tudyate ātanyate sarāga indicates dermopathy while parva rupa can be seen as part off arthropathy. Mamsa-medogata vata: Māṁsa and meda are explained together. Both come under kapha varga and the vitiation is concurrent. Shukragata vata: Certain symptoms are exactly opposite to one is explained. Premature ejaculation and anejaculation seems to be opposite. This is not possible in a single patient. The term ‘vā’ is more specific here in which either of one will be present. Variant features are seen in diseases. Śukragata vāta is one such example. Snayugata vata: Snāyugata vāta may lead to āyāma, khalli and kubjatā the vitiation may be generalized or localized. Siragata vata: When vāta afflict sirā it may broaden or narrow the sirā. Widening may lead to śōpha and narrowing may lead to shosha or vice versa as per the site of affliction. Ācharya have mentioned two different condition of vascular diseases i.e. aneurysym (mahat) and atherosclerosis / venous thrombosis (tanu). Sandhigata vata:Vāta pūrṇa dr̥ti sparśa (..) and śōtha are referred in different other areas like udara etc. This is a peculiar type of śōtha which cannot be considered as either pitting or non pitting. Ballooning like swelling is mentioned here. Vāta pūrṇa dr̥ti sparśa is present due to periarticular soft tissue swelling. It may be due to bursitis also. Prasāraṇa ākuñcana pravr̥ttiśca savēdanā is either due to mild inflammation of joints or due to compression of underline neuron by osteophytes formed at margin of cartilage or both. Śōtha is due to mild inflammation of joint. Here there is no rest pain present which excludes active inflammatory presentations.(verse 24-38) Ardita: Ardita is a disease of episodic origin. It may lead to facial paralysis or hemiplegia or both. In other classics ardita is explained as facial paralysis only.(verse 38-42) Antarayama and bahirayama: Here the disease antarāyama is explained as a disease caused by vāta making stambha to manyā. In Sushruta Samhita manyāstambha is a different disease caused by day sleep especially in irregular seats, or awkward neck positioning etc which may be compared to cervical disc diseases. According to Sushruta this condition is exclusively kaphavātaja. But the initiation of samprapti of antarāyama as manyāstambha is a highly vāta predominant condition. (verse 43-45) In bahirayama a similar pathology of above is involved with external sira/nadi. Further bahirāyāma is considered to be more serious than the other one. There are different types of convulsive disorders explained in Ayurvedic classics. They are dealt under apatānaka or apatantraka. When convulsion affect spine it is called as dhanustambha. It is of two type antarāyama and bahirāyāma. (verse 45-48) Hanugraha:Hanugraha is normally an orthopaedic condition. But in certain individuals this happens as recurrent. As this disease is explained in midst of various convulsive disorders it also should be understood as an episodic condition.(verse 49) Dandaka: Daṇḍaka is a condition in which the muscles are hypertonic but without convulsions. A similar disorder is explained in the context of ajeerna in which ajeerna may lead to alasaka (unexpelled and suspended toxicity) and further lead to tonic spasm called daṇḍalasaka. When it further manifests as tonic clonic convulsions it is referred as daṇḍa akshepaka. (verse 51) Episodic nature:The above mentioned disorders from ardita onwards, all are vegavān (episodic). All vegavān disorders have two phases, vega and vegāntara. Vegāntara is the symptom free period and is considered as right time for medication. (verse 52) Pakshaghata: Here three diseases namely pakṣāvadha / pakṣāghāta, ekāngarōga and sarvāngarōga are explained. In Ashtanga Hridaya ekāngarōga is explained as synonym of pakṣāghāta. Here ekāngarōga affect either one upper or lower limb. In pakṣāghāta no painful symptoms are explained. But ekāngarōga and sarvāngarōga are presented with painful symptoms and contracture. Sarvāngavāta is different from sarvāngarōga. Sirā and snāyu are considered as dushya in ekāngarōga and sarvāngarōga. Sirā is the upadhātu of rakta and snāyu is the upadhātu of meda. Both meda and rakta has vital role in pathogenesis of these diseases.(verse 53-55) Gridhrasi: Gr̥dhrasī is a snāyugata rōga. Gr̥dhrasī is typically related to kateegraha. As gr̥dhrasī, kateegraha is also of two types viz vāta and vāta kapha. The word gr̥dhrasī is derived from ghridhra, which means vulture, the typical gait of the disease is highlighted by the name. Khalli is the term given to severe painful conditions. In Vagbhata viswāchi and gr̥dhrasī is explained as khalli when they are manifested as tivrārujā (severe pain).(verse 56-57) Nomenclature of diseases: All the vāta disorders are unable to be named or explained. They should be understood on the basis of site of affliction. The shloka is read as sthāna and nāma anurupa also. Then the meaning is disorders should be understood according to site as well as nomenclature.(verse 58) Pathogenensis: The basic samprapti of vāta rōga is further highlighted. It is of two types’ dhātukṣaya and margāvarana which is previously explained. Dhātukṣaya leads to more rarity in tissues and more space for vāta to move. This leads to gatavāta phenomenon. The ongoing verses are to explain āvarana of vāta by other dōṣa or dhātu. So the differences between āvarana and gatavāta should be understood. Āvarana is special pathological condition of vāta characterized by an obstruction in the ‘gati’ (movement) of vāta, paralyzing it in performing its activities and lead to different disorders. The gatatva and āvr̥tatva are entirely different phenomenom. Here an attempt is being made to differentiate the both physio-pathologies.[16] 1. In Āvarana, generally the vitiation of vāta is passive. When vitiated dosha or any other thing obstructs the pathway of vāta, āvarana happens. Normal state of vāta gets vitiated as āvarana progresses. The substance which obstructs the pathway of vāta is called as ‘āvaraka’ and the dosha (vāta in general or its components) affected by āvarana is called as āvariya or āvr̥ta. Normally the āvarana is caused by the etiological factors for the vitiation of āvaraka. Etiological factors for the vitiation of vāta (sva nidāna) will be absent. In case of gatavāta the vitiation of vāta will be active. Here its own etiological factors are operating in the vitiation of vāta in the pathogenesis and the vitiated vāta adopts specific pathway and abnormally localizes at a particular sites. 2. In the process of āvarana ‘chala’ property of vāta is diminished due to obstruction. Other properties are not involved in the process of obstruction. But in case of gatatva the vitiation of vāta takes place by involvement of other properties like rūkṣa, laghu, khara, vishada etc along with chala. 3. In āvarana the ‘gati’ of vāta is obstructed partially or fully. Once gets obstructed the vāta may simply get lodged there (baddha mārga, mārgarodha), try to nullify the obstruction, may get covered by the obstructing substance (āvr̥ta), adopt an opposite direction (pratiloma) or alter the direction (viloma). The different terminologies have been used to denote āvarana in different contexts according to the nature of āvarana and the state of vāta and mārga (passage). In case of gatatva the gati of vitiated vāta aggrevated and starts moving abnormally leading to localization at particular sites. 4. Āvarana is caused by purnata (filling) of other dosha in the srotas/mārga (passage) of vāta. In gatatva the srotas or sites of occupation of vāta are rikta (unfilled or spacious) and the aggrevated vāta fills the srotas/site. 5. In āvarana of vāta, swakarma vriddhi (exaggerated activities) of āvaraka (..) is manifested. The āvr̥ta (i.e. vāta) will show swakarma hāni (diminished activity). This is the general feature of āvarana. Here the excessively increased strong āvaraka suppresses the normal action of āvr̥ta (i.e. vāta). Therefore, when the obstruction is complete it may lead to the prakopa of vāta resulting in the presentation of vāta vitiated symptoms as well as its disorders14. In case of gatatva the symptomatology will be predominantly of vāta vitiation and pain is a common and chief complaint in all the conditions of gatatva. 6. Āvarana is possible by other dosha (pitta and kapha), Dhātus, anna, mala, and individual components of vāta. Āvarana is not described by upadhātus and causation of āvarana by āshaya or avayava are not thinkable. Gatatva of vāta is happening in dhātu, upadhātu, āshaya and avayava. Gatatva of vāta in other dosha or non-bodily substances like anna and mala and in between the individual components vāta is not possible. 7. In āvarana due to the dhātu, the dhātu will be in a vriddha state or in sāma avastha generally so that they produce purnatā in srotas and are capable of obstructing vāta. In dhātugata vāta the excellency of dhātu will be diminished (dhātu daurbalya) so that they produce riktatā in srotas and the vāta gets enough space for abnormal gati. Accordingly, the symptomatology of dhātuāvr̥ta vāta will be vriddha or sāmadhātu lakshana associated with diminished activities of vāta and of dhātugata vāta will be dhātu daurbalya lakshana associated with vitiated vāta lakshana. Obviously, exceptions are possible according to the complexities of process of āvarana or gatatva. 8. In case of āvarana of vāta, the āvaraka gets importance in treatment since the vitiation of vāta is passive. When āvarana is removed vitiated vāta gets pacified. But in cases of gatatva the vitiated vāta has to be treated first along with correction of adhisthāna. 9. Diagnosis of āvarana is made with the help of upasaya–anupasaya (trial and error) method. Diagnosis of gatatva is made according to the rupa (symptomatology). 10. Complications of āvarana are explained in case of improper diagnosis and delayed treatment like hr̥drōga, vidradhi, kamala etc. No complication explained in gatatva. 11. Āvarana of vāta may cause affliction of nutrition to dhātu (dhātugata sāma) leading successive diminition of rasādi dhātu (rasādimsca upasosayet).15 No such reference available in case of gatatva. The above discussed points are briefly enlisted in the table below. Āvr̥ta (obstructed)vāta Gata (excess movement)vāta 1. Vitiation of vāta is passive 1. Vitiation of vāta is active 2. Normally svanidana(..) of vāta are not responsible 2. Vitiation of vāta by svanidana 3. Only chala property of vāta is involved and it is diminished in the phenomenon 3. Other properties of vāta are also involved and the chala property aggravated in the phenomenon 4. Gati of vāta is obstructed 4. Gati of vāta is agrravated 5. Purnata (fullness) in srotas/ mārga 5. Riktata (emptiness) in srotas 6. Vāta shows svakarma hani 6. Vāta shows svakarma vriddhi 7. Dhātu are in vriddha or sāma 7. Dhātu daurbalya present 8. Āvarana possible with other dosha/anna/mala/individual components of vāta 8. Not possible 9. Āvarana by avayava or āshaya not possible 9. Gatatva in āshaya and avayava explained. 10. Āvaraka gets importance in treatment 10. Vāta gets importance in treatment 11. Diagnosis made with upasaya anupashaya 11. Diagnosis with rupa 12. Complications of āvarana possible 12. Not explained 13. Successive diminuation of rasadi dhātu possible 13. Not explained.

As āvarana proceeds it may end up in dhātukṣaya as the āvr̥ta will block rasadhātu which give nourishment. This is commonly observed. This is possible in many other disorders also. The best example is rajayakshma. The concept of Āvarana can be be further elaborated literally. It is derived from ‘Aa’ upasargapurvak, ‘Vru’ dhatwatmak and ‘Lyut’ pratayatmak. Shabdakalpadrum explains vyutpati of Āvarana shabda from ‘Vru’ sanskirt dhātu which means valayita, veshtita, ruddha and samvita. According to Ayurvediya Shabdakōsha the word Āvarana means avarōdha gatinirōdha i.e. obstruction or resistance or friction to the normal gati of vāta. Vāta dosha is the gatyatmak dravya within the sharira. Hence its normal gati is hampered or vitiated thus vāta becomes Āvr̥ta. Shabdakoshakar says that balwan dosha due to its vitiation impedes the durbala dosha and hampers the normal gati of the āvr̥ta dosha. Vaidyak Shabdasindhu says āvaraka means āchhadaka while āvr̥ta means āchhadita. Charaka in context of madhumeha has used the word āvr̥ta gati; Chakrapāni explains it to be ruddhagati. In context of Kāsa; Chakrapāni says pratighat means āvarana while in context of śōtha says badhamārga means āvr̥ta mārga. Thus the word āvarana can be understood as; āchhadana, Avaruddha gati, Sanga, Pidhana, Samvarana, Ākirya, Prachadana, Vestana, Valayana, Prāvr̥ta and Samvrita.(verse 59-60)

Pathology of avarana: In dosha āvarana, the symptomatology will be predominant as per the āvaraka dōṣa. The symptoms of vāta also will be there even though minimal compared to other dōṣa. Samsarga of dōṣa and āvarana of dōṣa with vāta seems to be similar. Practically this is true. But theoretically trace differences can be suggested. In samsarga the etiology and symptomatology of both vāta and associated dōṣa will be nearly of equal weightage. In Āvarana, the major culprit is the dōṣa causing āvarana, and as āvarana advances vāta also get vitiated and show symptoms.

In āvarana due to dhātu, the vriddha or sāma lakshana of dhātu are available. In gatavāta māṁsa and meda as well as asthi and majja are explained together. But in āvarana all these four are explained separately. Raktāvr̥ta vāta is approximate to uttana vātarakta. Medasāvr̥ta vāta is approximate to urustambha. Śukragatavāta and Śukrāvr̥ta vāta are similar in symptomatology since śukra and vāta, both are sarvadehaga. (verse 61-71) Prognosis:The seriousness as well as poor prognosis of exclusive vāta disorders is highlighted. The symptoms / diseases explained here manifest when vitiated vāta affect vital parts. The therapeutic approaches should be cautious and extra effort becomes essential for a better recovery. As the disease becomes chronic the curability rate drastically declines. The physical strength of the patient is also very important.(verse 72-74) General principles of management:The general line of management of Vātavyādhi is applicable to absolute vāta vitiation only. If there is any association or obstruction of other dōṣa in Vātavyādhi, the treatment will be different. So the terms like ‘kevalam’ means without āvarana and ‘nirupasthambha’ meant without samsarga is important and should be considered as conditional always. As in alone vātaja disease the major gunavriddhi is rūkṣa which leads to riktatā in srotas and dhātu and more avakāsa for vāta; Snēhana is essential and ideal. Various methods for snēhana has been mentioned here, which depends on avastha (stage), sthāna (site) and bala (strength) of the diseases and as well as patient. Following snēhana, swedana is also mandatory. Here the uṣṇā guna operates to control śītā. Repeated snēhana and swedana imparts high grade of flexibility. The reduction of harsha etc. is immediate but transient as swedana is applied. So repeatedly swedana should be done. Snēha is a good medium to control vāta as well as vātapitta. Generally this line of treatment can be counted as a part and parcel of brimhana.(verse 75-83) Repeated Snēhana and swedana control vāta well. But there are still chances for residual dōṣa, which should be eliminated out. So samshodana lines of treatments are explained. As shodhana has a definite chance for causation of vāta prakopa, the approach should be cautious, so mridu samshodana is explained. Snēha virēchana is established by tilwaka ghrita or erand taila etc. In trimarmeeya chapter Eraṇḍataila is further explained as ultimate to cure vāta prakopa due to udāvarta. If virēchana is not possible anulomana diets should be adviced. If the patient is extremely weak niruha is the better option. Even during or after these practice of shodana; recurrent application of Snēhana and swedana are essential.(verse 83-88)

Management of vata at different sites:

The line of treatment of disorders of vāta when it is located in various particular sites is explained. All these explanations are supporting the general principle of treatment in Ayurveda in which the habitat (sthāna) is more or equally important in comparison to the invaded (āgantu) dōṣa. In Kōṣṭhagata vāta, Kōṣṭha is given preference in treatment, and so kshara which is responsible for pācana is used. But when vāta is located in pakvāśaya or guda which is particularly vātasthāna itself, udāvartahara treatment, which is nothing other than vāta anulomana, basti, varti etc are selected. In āmashayagata vāta shodhana is explained. According to Vagbhata, Vamana is indicated specifically in this condition. Hridaya anna is typically indicated in tvakgata vāta because, rūkṣatā in tvak is a resultant of rasakṣaya caused by ‘chintyanām ca atichintanāt (overworrying).17 Bahya Snēhana in the form of abhyanga or dharā etc are very effective in asthi and majjāgata vāta. Ābhyantara Snēhana replenishes meda dhātu and subsequently asthi and meda. It is worthy to note the utility of tikta ghrita in asthikṣaya. In śukrakṣaya harsha annapāna is very useful. According to Vagbhata Vrishya āhara make instantly śukra as a result of Prabhava18. Here bāhusheersha should be understood as Amsamula and this reference is equal to the treatment of apabāhuka. Avapeedaka is aspecial type of Snēhana in which uttam mātra is taken and divided into two unequal portions in which one portion is given as before food and the other portion after digestion of that Snēha and food. Management of ardita: The line of treatment of ardita aims mastishkya (brain). That is why directly nasya is indicated. Nasya is explained to be the direct entrance to the cranial vault. Nasya may be shodhana, Samānaa or brimhana as the case may be. But there is opinion that since the word nāvana is used it means snaihika nasya. Mūrdhni taila is absolutely mastishkya and is of four types viz. abhyanga, seka, pichu and shirobasti. Tarpana is akshitarpana and shrotratarpana. Nadisweda is very specific in ardita and ksheeradhooma is an exclusive variety in the same disease. Ānupamāṁsa upanāha is brimhana. According to Vagbhata in Ardita, vamana is indicated when there is associated śōpha and raktamokshana is indicated when associated with dāha and rāga. In Pakṣāghāta snēhasaṁyukta swedana and snēhasaṁyukta virechana is indicated. Virechana is the line of treatment in pakṣāghāta and outweighs Basti which is said to be ideal for vātakopa. Pakṣāghāta may be understood as a concealed urdhwaga raktapitta in which the only and effective choice is adhoshodhana. Further the involvement of sirā as upadhātu (rakta as dhātu), further evidenced by description of sirāgraha as the morbidity prior to pakṣāghāta by Vagbhata also support this view. Gr̥dhrasī is a snāyugata vikāra and shastra, kshara, agnikarma are explained as major line of treatment. That is why sirāvyadha and dāhakarma is explained. Basti is also a good choice since pakvāśayagata vāta leads to kateegraha and gr̥dhrasī. In hanusramsa the standard reduction procedure of temperomandibular dislocation is detailed. Agnikarma and sirāvyadha are the two line of treatment which are useful in acute phase to relieve the pain in Gr̥dhrasī and also in Khalli. Agnikarma relieves muscle spasm thereby reducing pain whereas sirāvyadha 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: 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) Treatment of vata vitiation: The treatment of only vāta vitiation (without involvement of other dosha) is Brimhana. If associated dōṣa is present specific measures after referring treatment strategies of urusthambha etc should be adopted.(verse 105) Balā is excellent for alone vitiated vāta . The head of goat is indicated on the basis of the principle ‘sāmānyam vridhikārānam’. These also explain the awareness of utilization of brain of goat in degenerative brain lesions. Lavana relieves stambha and samghata. Upanāha is also prepared with such well fomented flesh and added with different oils, salts etc. Such upanāha are brimhana. (verse 106-108) Avagaha sweda: Avagāha is typically indicated in apāna vāigunya. Further it can be taken as a variety of drava sweda. Nādisweda is also an excellent option for all types of vātarōga. Further poultices (upanāha) of different varieties are explained here. In upanāha self generated heat causes swedana. It is by virtue of various dhanya and kinwa (yeast) available in it. (verse 109-118) Different formulations: Different medicated ghrita, vasā, majjā and mahāSnēha are explained in these verses. These are indicated for various purposes like ingestion, inhalation, enema and external application etc. MahāSnēha is very guru and ultimately indicated in madhyam rōga mārgāshrita Vātavyādhi especially like convulsions, tremor etc. (verse 119-136) Pinyaka taila is an interesting preparation in which rūkṣa guna is imparted to taila and is highly useful in kapha associated Vātavyādhi. (verse 136-137) Importance of oil in treatment of vata:By virtue of vyavāyi guna it reaches the different interior parts of the body without any metabolic changes. By processing taila can adopt any type of qualitative changes. The importance of āvartita taila is also highlighted here. Drugs like ksheerbalā (101 āvartita), dhanwatharam (21 āvartita) etc are worth mentioning here. This approach of samskāra makes Snēha as suksma Snēha.(verse 181-182) Management of avrita vata: These verses highlight the āvr̥ta vāta chikitsā. 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 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’. In Kaphāvr̥tē vāta; tīkṣṇā sweda, niruha and vaman which reduces kapha has to be carried out followed by virechana which does vāta 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 vātagna are to be used. Warm drinks of yava, jāṇgala mānsa rasa which gives bala to the patient without increasing kapha are to be administered.(verse 183-188) In āmāshaya gata vāta vamana is advised taking into account of sthāna. Here vāta is agantuk dōṣa. In Vagbhata and Sushruta famous shaddharana yoga is indicated in āmashayagata vāta. In pakvāśaya gata pitta and sarvashariragata vātapitta, virechana is the option. Basti is an ideal option for shodana in vāta associated with other dōṣa especially when located in pakvāśaya. Kshara Basti (Gomūtrayukta Basti) in case of Kapha-vāta and Ksheer Basti in pitta-vāta is recommended. Once associated dōṣa is eliminated out, then alone vāta cikitsā may be ideal. In pakvāshaya gatavāta where prokinetic movement is hampered is regularized by virechan. Further in pakvāshaya if there is associated kapha, virechana will help to remove it along with vāta anulomana. Raktāvr̥ta vāta is equal to uttānavātarakta 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. Āmavāta is referred here as a distinct disorder, probably because of a nearest clinical entity with vātarakta as joint pathology is associated in both. But there are clarifications like āmavāta should be read as ādhyavāta and it is refered as medasāvr̥ta vāta. The order of description is missed in that way. Prameha samprapti mentioned in Sutrasthān 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 reduces if prameha is treated. Similarly in sthaulya, medasāvr̥ta vāta (Ca.Su. 21/5) and meda and mānsa ativridhi [Ca.Su.21/9] is observed. Therefore pramehagna, medagna followed by vātagna cikitsā is useful in medasāvr̥ta vāta and also in mānsa āvr̥ta vāta. In anna āvr̥ta vāta, anna obstructs gati of vāta therefore vamana which helps in emptying stomach by removing anna help to regulate the gati of vāta. Pācana and deepan helps in digestion and also pacifies vāta. Hot foementation reduces urethral pressure. Study done by Shafik A [www.ncbi.nim.nlh.gov/pubmed/8506593] 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. Uttar basti effect is similar to catheterization. Further depending on the medicines used for uttar basti, tridōṣa shamāna 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. Finally the treatment strategies of anyasthānagata vāta are explained. The importance is given to sthānastha dōṣa.(189-199) Movements of vata and concept of anyonyavarana:As discussed earlier avyāhatagati is a cardinal feature of vāta to perform normally. In āvarana certain obstacles like dōṣa, 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 to downwards. Udāna has movement from uras 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 (urdhvabhagam anayati jeevayati ityudāna, udāna urdhvavritti). Likewise ‘apāna’ is possessing downward direction (ap-adhasthat aniti prānaiti, gacchati ity apāna, adhonayatyāpana stu). Vyāna Vāyu possesses horizontal direction (vyāpanat vyāna uccyate) along with upward and downward directions as rasa samvahana is concerned.[19]Samāna is also having such qualities (samānah samam sarveshu angeshu yah annarasam nayati). Prāna is also possessing multi directional gati if the functions are analyzed. 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. In the coming verses the symptomatology of selected anyonyāvarana and their line of management are explained.(verses 199-206) Anyonyāvarana is characterised by Svakarma hani or vriddhi which depends on the nature and site of anyonyāvarana. 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 in udānaāvr̥ta prāna the symptoms will be; 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. Chakrapāni in context of anukta āvaran says; Eshām svakarmānām hānih vriddhih vā āvarane matā i.e. symptoms may be presented as hāni (loss) or vridhi (increase) in lakshana of āvaraka; Ācharya Chakrapāni further coments ; Atra āvaryānām baleeyasā āvaranāt sva karma hānih bhavati, āvarakasya tu utsargatah sva karma vriddhih bhavati , tathaa āvaranena cha āvāryah prakupito bhavati tadā sva karmanām vriddhih bhavati iti vyavasthā; Anye tu āvaraneeyasya sva karma haanih, āvarakasya tu utsargato vriddhih bhavati iti vyavasthām āhuh for e.g. in vyānāvrita prāna atisveda is vyānasya sva karma vriddhi , and in udānaāvrita vyāna asveda is vyānasya sva karma hāni. Parikartikā in vyānaāvrita apāna is due to "āvaranena āvaryah prakupito bhavati tadā svakarmanām vriddhi bhavati iti vyavasthā'. Here in anyonya āvarana the clinical syndromes appear due to interplay between both āvaraka and āvarya depending upon site and hetvādi. In udānaāvrita prāna, karma ojo bala varnānām nāsho mrityuh athāpi vā. (Ca. Ci. 28/ 208 Chakrapāni); here symptoms are concerned with both, not due to one whereas in vyānaāvrita apāna and in udānaāvrita apāna chhardi is one common clinical condition, only due to urdhva gati of apāna induced by vyāna and udāna respectively. It therefore explains interplay between vāta prakāra, vāyoh vāyu antarena gati hanana roopam āvarana upapānanām eva cha.(verse 206-217) Rehabilitation of vata:Chakrapāni coments that verse 219-221 are for vikr̥tavātānāṁ prakr̥tisthāpanamāha. Prakr̥tisthāpanam means in its own pathway (sva mārgaga)/ or in its own place (sva sthāna gamayed enam). Therefore for udāna vāyu vamanādi line of treatment should be administered to regulate the normal functional status of udāna vāyu. Apāna has adhogati therefore anuloman cikitsā should be done thereby regularizing the urdhva apāna bhava of Apāna vāyu. Samāna should be line of treatment for samāna vāyu, Chakrapāni coments deha madhyasta sthita i.e. vāta gati should be maintained in Madhya i.e. agni uttejana (empower digestive power) should be done. Samāna being agni samipastha 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 it is the same reference of shabdha archi jala santanvāta nyāya explain by Sushruta by which rasa dhātu traverses full body with help of vyān vāyu. Gati, prasāran, akshepa, nimesādi kriya are regularized. Lastly when udāna, samāna, vyāna and apāna get regularized it helps to bring back prāna in its normal sthān. Here the general line of treatment of anyonyāvarana is discussed. As already stated in anyonyāvarana the gati of individual vāta are affected. So the normalcy of gati of respective vāta should be maintained. (verse 219-221) 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) Complications of āvarana: 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 a’tīsāra are common complications of āvarana of samāna and apāna. Srotoshodana is an important line of management in Āvarana. It ensures avyahatagati of vāta. All abhishyandi food causes srotorōdha. 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 shilajathu rasāyana is ideal for many clinical conditions of āvarana.

Physiological events to understand functional status of vata:The functional status of Vāta with its sub units can be better understood by analyzing certain physiological events. The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to, and stimulate, the cardiac muscle (myocardium). The myocardium contracts after stimulation. It is the ordered, rhythmic stimulation of the myocardium during the cardiac cycle that allows efficient contraction of the heart, thereby allowing blood to be pumped throughout the body. Signals arising in the SA node (located in the right atrium) stimulate the atria to contract and travel to the AV node, which is located in the interatrial septum. After a delay, the stimulus diverges and is conducted through the left and right Bundle of His to the respective Purkinje fibers for each side of the heart, as well as to the endocardium at the apex of the heart, then finally to the ventricular epicardium. On the microscopic level, the wave of depolarization propagates to adjacent cells via gap junctions located on the intercalated disk. The heart is a functional syncytium (not to be confused with a true "syncytium" in which all the cells are fused together, sharing the same plasma membrane as in skeletal muscle). In a functional syncytium, electrical impulses propagate freely between cells in every direction, so that the myocardium functions as a single contractile unit. This is the avyāhata gati of vāta which is necessary for the rapid, synchronous depolarization of the myocardium. Conduction from SA to AV to bundles and Purkinje fiber is the aparityakta swa mārga of vāta. This rhythmical and conductive system of the heart is susceptible to damage by heart disease, especially by ischemia of the heart tissues resulting from poor coronary blood flow. The result is often a bizarre heart rhythm or abnormal sequence of contraction of the heart chambers, and the pumping effectiveness of the heart often is affected severely, even to the extent of causing death. This explains the vyāhata gati of vāta which is the cause of death. The circulatory system is the main method for blood transportation within body. This system is a complex highway of vessels, and its main purpose is to move blood and nutrients throughout body. The circulatory system is also responsible for exchanging gases and removing waste products from body. Unlike an open circulatory system, a closed circulatory system is more structured and controlled. The blood of a closed system always flows inside vessels. These vessels make up the plumbing circuit of the body and can be found throughout the entire body. This plumbing circuit can be broken down into three different types of vessels, or tubes that transport blood throughout the body: arteries, capillaries and veins. Thus a continuous flow of blood from Left ventricles to the aorta to arteries all over the body than to arterioles into capillaries into venules into veins and back to the right atrium than right ventricle via pulmonary artery to the lungs and via pulmonary veins to the left atrium and back to left ventricle. This is how blood is propagated from heart to the periphery and back to the heart. The modern explanation resembles Caraka explanation as mentioned in Ca. Ci. 15/36 This function of vāta is swa sthānastha which helps to maintain the homeostasis or swāsthya but when avarodh to this gati takes place may be due to any reason the swa mārgāsthita vāta gets vimārga gata as explained in samprapti of śōtha (Ca. Ci. 12/8). Various edemas are either due to excessive secretion (apāna vāyu) or reduced absorption (prāna vāyu) as understood in samprapti of udara. Disturbed concentration of solutes and solvents causes changes in pressure (vyāna vāyu) either intravascular or extra vascular. The electrolyte balance is brought about by sweda dōṣa ambu srotas sthāyi vāyu i.e. samāna vāyu. Prakruti sthita vāta is the one which is akshina vridha: Reduced respiratory rate due to depressed respiratory centre explains kshina prāna vāyu whereas vridha prāna vāyu may be one of the causes for increased ventilation. Prayatna, urjā are functions of udāna vāyu. Excessive excitation of cell due to excess action potential explains the vridha udāna vāyu whereas inhibition of cell activity due to reduced action potential is due to kshina udāna vāyu. Excessive stimulation of agni (atyagni) causes increased appetite one reason being vridha samāna vāta whereas agnimāndya, grahani etc may be caused by decrease stimulation of agni by samāna vāta. Normal pulse rate ranges from 60-80/min. Excessive pulse rate explains the repeated contraction of heart one of the cause being excessive ākunchan prasārana karma of vyāna vridhi whereas one of the cause of bradycardia may be kshina vyāna vāyu. Increased peristalsis is the cause for increased frequency of stools one of the reason being vridha apāna vāta whereas reduced peristalsis causes constipation one reason being kshina apāna vāta. VERSE 5-11 Modern anatomical or functional correlation of subtypes of vāta is attempted here for a rough and overall understanding for beginners. Prāna Vāyu is concerned with consciousness, arousal, heartbeat, vomiting, breathing, cough, hiccup etc. The modern functional analogue may be compared with brain stem and reticular formation which directly control cardiovascular / respiratory systems, pain sensitivity, alertness, awareness, and consciousness. Udāna is concerned with language, learning, mood, initiation, judgment, intellect, recall information etc. The prefrontal cortex, sub cortical areas and parts of limbic system along with association areas may be understood as functional areas of Udāna. Vyāna is concerned with control of skeletal muscle activities, control of hemodynamics, sweating etc. Post-lateral and dorso-medial hypothalamus - sympathetic stimulator, primary motor area, basal ganglia, extra pyramidal tract and autonomous nervous system are part and parcel of vyāna vāta. Samāna and Apāna can be considered together. Gastro Intestinal Tract based enteric nervous system (2nd brain), (brain- gut axis - more than 100 million neurons), celiac plexus, sacral plexus etc may be analogue for apāna and samāna. The functioning of panch vāta prakār can be also understood by understanding the physiology of sensation. In its broadest definition, sensation is the conscious or subconscious awareness of changes in the external or internal environment. The nature of the sensation and the type of reaction generated vary according to the ultimate destination of nerve impulses that convey sensory information to the CNS. Sensory impulses that reach the spinal cord may serve as input for spinal reflexes, such as the stretch reflex, sensory impulses that reach the lower brain stem elicit more complex reflexes, such as changes in heart rate or breathing rate. When sensory impulses reach the cerebral cortex, person become consciously aware of the sensory stimuli and can precisely locate and identify specific sensations such as touch, pain, hearing, or taste. Perception is the conscious awareness and interpretation of sensations and is primarily a function of the cerebral cortex. Person may have no perception of some sensory information because it never reaches the cerebral cortex. For example, certain sensory receptors constantly monitor the pressure of blood in blood vessels. Because the nerve impulses conveying blood pressure information propagate to the cardiovascular center in the medulla oblongata rather than to the cerebral cortex, blood pressure is not consciously perceived. Thus some functions may involve all the panch prakāra vāta and in some their permutation and combination. Process of sensation An appropriate stimulus must occur within the sensory receptor’s receptive field, that is, the body region where stimulation activates the receptor and produces a response. A sensory receptor transduces (converts) energy in a stimulus into a graded potential. Conversion of energy from one form to another i.e. transformation is the function of agni but the one which stimulates the agni is the samāna vāyu (agni samipasta and swedavaha (at the level of tvak) āshrayi vāta prakar). For example, odorant molecules in the air stimulate olfactory (smell) receptors in the nose, which transduces the molecules’ chemical energy into electrical energy in the form of a graded potential. When a graded potential in a sensory neuron reaches threshold, it triggers one or more nerve impulses, which then propagate toward the CNS. It explains the sarvasrotogata vyāna vāta action to take the nerve impulse towards the CNS. A particular region of the CNS receives and integrates the sensory nerve impulses. Conscious sensations or perceptions are integrated in the cerebral cortex. Integration is the role of antahkarana but carried out by niyanta ca manasā i.e. vāta especially the prāna vāyu in this case. A characteristic of most sensory receptors is adaptation, in which the generator potential or receptor potential decreases in amplitude during a maintained, constant stimulus. Because of adaptation, the perception of a sensation may fade or disappear even though the stimulus persists. For example, when you first step into a hot shower, the water may feel very hot, but soon the sensation decreases to one of comfortable warmth even though the stimulus (the high temperature of the water) does not change. This is the smriti kriya exhibited by the antahkaran but now with the help of udāna vāyu. Many somatic motor neurons are regulated by the brain. When activated, somatic motor neurons convey motor output in the form of nerve impulses along their axons, which sequentially pass through the anterior gray horn and anterior root to enter the spinal nerve. From the spinal nerve, axons of somatic motor neurons extend to skeletal muscles of the body. This is again the function of vyāna. Thus afferent conduction of nerve impulse is the urdhwagati of vyāna, conduction from motor neurons to the skeletal muscle is the adhogati of vyāna and the autonomic nervous stimulation is the tiryaka gati of vyāna vāyu. This is the reason why Caraka in context of treatment of vāyu prakār has told “tridha vyānam tu yojayet” it explains vyāna has all the three gati which need to be regularize during the treatment. The part of the body that responds to the motor nerve impulse, such as a muscle or gland, is the effector. Its action is called a reflex. If the effectors are skeletal muscle, the reflex is a somatic reflex. If the effectors are smooth muscle, cardiac muscle, or a gland, the reflex is an autonomic (visceral) reflex. Depending on the resultant action function of vāta prakāra have been explained i.e. ṣṭhīvana, kṣavathū, anna pravesh, udgār, niswasa karma is seen that it is due to prāna vāyu. Vākpravr̥tti, prayatna, urjā, bala varna smriti are karma of udāna vāyu. Anna vivechan, agni bala prada karma is due to samāna vāyu whereas ākuncan prasāran is due to vyāna vāyu and garbha, mūtra, purisa niskraman is due to apāna vāyu. Thus the classification done is on the gross level of functioning. Similarly at cellular level too one can understand the existence of panch prakar vāta. The selective permeability of the plasma membrane allows a living cell to maintain different concentrations of certain substances on either side of the plasma membrane. A concentration gradient is a difference in the concentration of a chemical from one place to another, such as from the inside to the outside of the plasma membrane. Many ions and molecules are more con- centrated in either the cytosol or the extracellular fluid. For instance, oxygen molecules and sodium ions (Na) are more concentrated in the extracellular fluid than in the cytosol; the opposite is true of carbon dioxide molecules and potassium ions (K). The plasma membrane also creates a difference in the distribution of positively and negatively charged ions between the two sides of the plasma membrane. Typically, the inner surface of the plasma membrane is more negatively charged and the outer surface is more positively charged. A difference in electrical charges between two regions constitutes an electrical gradient. Because it occurs across the plasma membrane, this charge difference is termed the membrane potential. In many cases a substance will move across a plasma membrane down its concentration gradient. That is to say, a substance will move “downhill,” from where it is more concentrated to where it is less concentrated, to reach equilibrium. Similarly, a positively charged substance will tend to move toward a negatively charged area, and a negatively charged substance will tend to move toward a positively charged area. The combined influence of the concentration gradient and the electrical gradient on movement of a particular ion is referred to as its electrochemical gradient. Transport of materials across the plasma membrane is essential to the life of a cell. (āyu is one of the paryāya of vāyu). Certain substances must move into the cell to support metabolic reactions (pravesakrita karma of prāna vāyu). Other substances that have been produced by the cell for export or as cellular waste product (niskramana karma of apāna vāyu) must move out of the cell. The concentration gradient which is maintained is essential for cellular activity. Resting membrane potential and active membrane potential are maintained at specific levels. For e.g. Charges of -90 mv is the resting charge which reaches to +35 mv when depolarized in cardiac cell thus this knowledge of potential gradient is due to budhi dharan karma of prāna which cause the pumping of Na/K pump to activate. Thus knowledge of concentration gradient is karma of prāna vāyu. Further prāna means prinana ādāna karma i.e. helping entry/ facilitation of such ions, essential requirements within cell which will do prinan /poshan is also due to prāna. Thus process that initiates endocytosis is prāna vāyu. Substances generally move across cellular membranes via transport processes that can be classified as passive or active, depending on whether they require cellular energy. In passive processes, a substance moves down its concentration or electrical gradient to cross the membrane using only its own kinetic energy. The continuous movement resembles the cala guna, a common quality of all the types of vāta. Modern describes it as the Brownian movement of the ions. Kinetic energy is intrinsic to the particles that are moving. There is no input of energy from the cell. An example is simple diffusion. In active processes, cellular energy is used to drive the substance “uphill” against its concentration or electrical gradient. The cellular energy used is usually in the form of ATP. It explains the prayatna karma of udāna vāyu which is responsible for the activity. An example is active transport. Active transport is considered an active process because energy is required for carrier proteins to move solutes across the membrane against a concentration gradient. Two sources of cellular energy can be used to drive active transport: (1) Energy obtained from hydrolysis of adenosine triphosphate (ATP) is the source in primary active transport; (2) energy stored in an ionic concentration gradient is the source in secondary active transport. Like carrier-mediated facilitated diffusion, active transport processes exhibit a transport. Many of the infolding of the inner membrane form shelves on which oxidative enzymes are attached. In addition, the inner cavity of the mitochondrion is filled with a matrix that contains large quantities of dissolved enzymes that are necessary for extracting energy from nutrients. These enzymes operate in association with the oxidative enzymes on the shelves to cause oxidation of the nutrients, thereby forming carbon dioxide and water and at the same time releasing energy. The liberated energy is used to synthesize a “high-energy” substance called adenosine triphosphate (ATP). ATP is then transported out of the mitochondrion, and it diffuses throughout the cell to release its own energy wherever it is needed for performing cellular functions. Thus the phenomenon which triggers the oxidative process is the samāna vāyu which stimulates the oxidation i.e. role of agni. The intracellular movement of proteins, ATP transfer, and vesicle transportation can be understood as the vyāpan/ vyuhan karma of vyāna vāyu. The end metabolites formed within the cell are removed through the process of exocytosis. The process is initiated by apāna vāyu which helps in excretion, mokshan, munchan karma at the level of cell.

The endocrine system as like nervous system controls body activities by releasing mediators, called hormones. The term hormone, derived from a Greek phrase meaning “to set in motion,” aptly describes the dynamic actions of hormones as they elicit cellular responses and regulate physiologic processes through feedback mechanisms. Hemadri defines cala guna as ‘prerane cala’ i.e. to set in motion. Cala guna is present in vāta dōṣa therefore considering the nirukti of the word hormone it resembles to one of the quality of vāta. One can compare hormone to a vāta dharmiya dravya. Hormones have the following effects on the body: • Stimulation or inhibition of growth (vāyu tantra yantra dhara/ pravartaka cestānām). • Wake-sleep cycle and other circadian rhythms (Santāna gati vidhanam). • Mood Swings (niyantā prānaetaca manasā/ harsa utsāho yoni). • Induction or suppression of apoptosis (programmed cell death), (āyusyo anuvritti pratyaya bhuta) (bhava abhavakara). • Regulation of metabolism (samirano agne). • Preparation of the body for mating, fighting, fleeing, and other activity (pravartaka cestānām ucchavacānām). • Control of the reproductive cycle (udbhedanām ca udbhedanam) • Hunger cravings (samirano agne) • Sexual Arousal (apāna karma) • A hormone may also regulate the production and release of other hormones/ (prānodāna samāna vyāna apānanām). • Hormone signals control the internal environment of the body through homeostasis/ (āyusyo anuvritti pratyaya bhuta/ yantra tantra dharā) Hormones are chemical messengers released from endocrine glands that coordinate the activities of many different cells. Coordination is of multiple organs and systems (srotas) from Central Nervous System to Excretory System. Srotas has been defined as channels in which parinaman and abhivahan takes place. Three factors present in srotas viz: anupahat dhatushma, anupahat mārut and anupahat srotas help to maintain sukha ayu, bala varna etc. The coordination between the srotas is brought about by nervous system and endocrine system. Both have the capacity to initiate and inhibit the action thus maintaining the coordination. Nervous system coordinates with help of nerve impulse whereas the endocrine coordinates with the help of hormones which are secreted within the interstitial fluid surrounding the secretory cells which through blood vessels reach the target organs where they carry-out the initiatory or inhibitory action. Hormone release in the hypothalamus and pituitary is regulated by numerous stimuli and through feedback control by hormones produced by the target glands (thyroid, adrenal cortex and gonads). These integrated endocrine systems are called ‘axes.’ Caraka has explained integration (deham tantrayate samyak) with the help of vāta and its five types. Although mulasthan of 5 types of vāta have been explained at different sites in the body all are interrelated i.e. the reason why paraspara āvaran has been mentioned. A stressor is a chemical or biological agent, environmental condition, external stimulus or an event that causes stress to an organism. Stressors have physical, chemical and mental responses inside of the body. Physical stressors produce mechanical stresses on skin, bones, ligaments, tendons, muscles and nerves that cause tissue deformation and in extreme cases tissue failure. Chemical stresses also produce biomechanical responses associated with metabolism and tissue repair. Stressor stimulates the hypothalamus. Astangsangrahakar has mention dhi, dhriti, smriti, mano bhodhan as karma of udāna i.e. to analyze the situation, for eg. If snake is far away from the body there is no fight or flight situation whereas if it is next to the body there is sudden fight or flight condition. It means udāna vāyu helps mana to get avabhodhan of the surrounding. It can be compared with analyzing the feedback signal received from various body organs and systems. The situation is analyzed and signal is sent to hypothalamus where prāna vāyu takes the decision for inhibitory or initiative action to be taken this is understood by the dharan karma of budhi and chitta i.e. mana. Hypothalamus secretes the corticotropin release factor (crf) which stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH). Udāna vāyu by its prayatna and urjā karma helps in the secretion. The release factor "ACTH" is taken to adrenal cortex with the help of vyāna vāyu. Vyāna vāyu is said to be shigrakari or fast acting i.e. within fraction of seconds ACTH reaches the adrenal cortex. Adrenal Cortex secretes various stress hormones which is stimulated by samāna vāyu. Mulasthan of samāna vāyu is in sweda, dōṣa, ambhuvaha srotas, it signals for the samāna anayati karma i.e. to maintain homeostasis thereby releasing the hormones in blood stream. The stress hormone released in blood is again taken by vyāna vāyu to various organs like heart, intestine etc. to cause the flight-or-fight response. After the response the apāna vāyu comes into action to excrete the hormones and neutralized the effect. Between this flow there is an alternate path that can be taken after the stressor is transferred to the hypothalamus (udāna and prāna karma), which leads to the sympathetic nervous system (vyāna vāyu). After which, the adrenal medulla secretes epinephrine (samāna vāyu) in blood and with the help of vyāna vāyu spreads throughout the body to cause the flight or fight response. VERSE 15-19 Most of the etiological factors explained here are responsible for singular vāta prakopa mediated through dhātu kṣaya. Exceptions are less in the said group. But now days etiological factors causing āvarana or samsarga vāta prakopa are mostly found. This is because of increased standard of living. The so called neuro degenerative diseases like Parkinsonism Disease, Alzheimers Disease etc even now days considered as aftereffects of metabolic dysfunctions rather than under nutrition or overuse. Even diseases like Alzheimiers dementia is conceptualised recently as type 3 Diabetes Mellitus.[20]

So a reassessment of etiological factors of contemporary importance is valid. Here an attempt is made to analyse the properties causing vāta vitiation with some modern explanations.

Rūkṣa, śītā, alpa, laghu anna, abhojana: As any other organ, the brain is elaborated from substances present in the diet (sometimes exclusively, for vitamins, minerals, essential amino acids and essential fatty acids, including omega-3 polyunsaturated fatty acids). Most micronutrients (vitamins and trace elements) have been directly evaluated in the setting of cerebral functioning for e.g. vitamin B1 modulates cognitive performance especially in elderly. Vitamin B9 preserves brain during its development and memory during ageing. Vitamin B6 is used in treating premenstrual depression. Vitamin B6 and B12, among others, are directly involved in the synthesis of some neurotransmitters. Vitamin B12 delays the onset of signs of dementia. Supplementation of Cobalamin improves cerebral and cognitive functions in the elderly. In the brain, the nerve endings contain the highest concentration of vitamin C in the human body (after the supra renal glands). Vitamin D (or certain of its analogues) could be of interest in the prevention of various aspects of neurodegenerative or neuro-immune diseases. Iron is necessary to ensure oxygenation and to produce energy in the cerebral parenchyma and for the synthesis of neurotransmitters and myelin. An unbalanced copper metabolism homeostasis (due to dietary deficiency) could be linked to Alzheimer’s disease. Among many mechanisms manganese, copper and zinc participate in enzymatic mechanisms that protect against free radicals, toxic derivatives of oxygen. Indeed, nutrient composition and meal pattern can exert either immediate or long term effects beneficial or adverse. From the above discussion it is observed that rūkṣa, alpa, laghu anna are apatarpankar hetu. Thus nutritional deficiency causes disorders of nervous system. Similarly snigdha guna is essential to traverse the lipid soluble essential elements across the cell membrane. Rūkṣa guna in excess reduces the transfer of essential elements into the cells thus causing immediate or late effects. Further diets that are rich in saturated fats and sugar decrease levels of Brain derived neurotrophic factor [BDNF]. BDNF is a neurotrophin considered generally beneficial for maintaining neuronal function and for promoting recovery after neurologic insult. Reduced BDNF leads to poorer neuronal performance. Results of a study have shown that rats fed on a diet high in saturated fats and refined sugars (similar in content to the “junk food” that has become popular in western society) for a period of 1 -2 months performed significantly worse on the spatial learning water maze test. Even more alarming is that the high fat diet consumption exacerbated the effects of experimental brain injury. The effects of this high caloric diet seem to be related to elevated levels of oxidative stress and reduced synaptic plasticity which can reversed by antioxidant treatment or exercise. High caloric intake also is perceived as risk factor for Alzheimer’s disease. Concept of atibhojana, snigdha etc. leads to āma utpatti, a cause for Vātavyādhi. Research results show that noninvasive approaches such as diet and exercise can have profound consequences for increasing resilience of the CNS to injuries and for maintaining cognitive abilities. Diet and exercise are 2 very important parts of lifestyle and daily routine each can influence the capability of the brain to fight disease and to react to challenges. Physical activity can benefit neuronal function and plasticity by enhancing synaptic plasticity and reducing oxidative stress. Physical exercise can have direct effects on the brain and spinal cord by supporting the maintenance of the synaptic structure, axonal elongation and neurogenesis in the adult brain whereas excessive exertion (ativyāyāma) is hold to cause degenerative changes. Stress is unpleasant, even when it is transient. A stressful situation–whether something environmental or psychological can trigger a cascade of stress hormones that produce well orchestrated physiological changes. Fight and flee are the 2 response which the body is accustomed too. Repeated stress leads to hormonal and neuro-adaptive changes which may be the cause for damage. All krodha (fight response) and bhaya (flight response) described by Ācharyas explain the similar effects on the body. Śītā guna- Prolonged exposure to the cold causes the body to slow blood circulation to the periphery. The reduced blood flow can intensify neuropathy symptoms and potentially cause further damage to already affected peripheral nerves. Research is essential to rule out effects of śītā guna on cryoglobulinemia; a condition of cold antibody in blood which cause vasculitis and neuropathy as well. Increase cryoglobulinemia increases viscosity leading to reduced blood flow thereby causing neuropathy. Ativyavāya – Donald L Hilton and others in their research paper on pornography addiction: A neuroscience perspective, were of the opinion that compulsive sexuality can indeed be addictive. It concludes for the first time that a sexual compulsion can cause physical, anatomic change in the brain, the hallmark of brain addiction. A preliminary study showed frontal dysfunction specifically in patients unable to control their sexual behavior. The study used diffusion MRI to evaluate function of nerve transmission through white matter. It demonstrated abnormality in the superior frontal region, an area associated with compulsivity. Hormonal changes similar to overeating induced obesity were also observed. Ati plavana, atiadva, ati vyāyāma, ati vichesta: Normal exercise has a good neurobiological impact. It increases the secretion of positive hormones and also helps in neurogenesis whereas over exercising can lead to an increased resting heart rate, a cause for increased cardiac output leading to hypertension, risk factor for stroke. Unexplained weight loss and decreased appetite is another factor. Further decreased of essential elements leads to neurological deficits as discussed before. Further cortisol and stress hormones levels tend to increase with decrease in testosterone levels. Emotions are intimately linked with organic life. They either result is an, “abnormal excitation of the nervous network, which induces changes in heart rate and secretions, or interrupts the normal relationship between the peripheral nervous system and brain.” Cerebral activity is focused on the source of emotions; voluntary muscles may become paralyzed and sensory perceptions may be altered including the feeling of physical pain. The idea of emotions involves specific areas of brain and activation of these areas is associated with increase blood supply. VERSE 19-20 In all disorders of Vāta dōṣa the purvarupa may not be registered separately. For example the textual presentation of Ardita (Vegavāna) may be a purvarupa of pakṣāghāta just like Transient Ischemic Attack are considered as warning signs of stroke. In abrupt onsets, purvarupa cannot be distinguished from rupa as in the case of manyasthambha in Apatanaka. Acute convulsive disorders manifest abruptly without any premonitory symptoms. In diseases of very insidious onset also premonitory signs are not appreciated sepertely. In most of the mayopathies this happens. VERSE -24-38 Various gatavāta are seen in general practice. Pakvāśaya gatavāta is a syndromic presentation in which habitual constipation is associated with obstructive uropathy symptoms, LBA, inguinal hernia etc symptoms.

Āmāshaya gatavāta is GERD like presentations with features of lax esophageal sphincter, hiatus hernia or simply non ulcer dyspepsia.
Tvakgatavāta is icthyosis of various presentations. 

In raktagata vāta, rakta dhātu gets vitiated by vāta dōṣa leading to shoshan of rakta dhātu; thus raktadhātu is unable to carry-out its normal function of jeevana, varnaprasādana, mānsa poshan etc. Vaivarnya is caused due to loss of varnaprasādana karma, due to depletion of mānsa poshana, krishata and tivra ruja (Ischaemic pain) is observed. CREST syndrome can also be understood on the basis of rakta gatavāta. Mānsa meda dhātu have similar characteristic both being snigdha, guru, sthira guna pradhan which gets vitiated by rūkṣa, laghu and cala guna of vāta leading to disorder called mānsamedogata vāta. Various myopathies can be included under mānsamedogata vāta specially Carnitine palmitoyltransferase deficiency in which severe pain with fatigueness is seen. Myasthenia gravis can also be considered in mānsamedogata vāta. Asthigata vāta is multiple clinical conditions in which osteoporosity are a marked feature and majjāgata vāta is the same associated with marked synovitis. Due to external injury or due to pressure the asthi and majjā dhātu gets deranged leading to pain mainly at asthi parva or at the level of joints. The pain is continuous and it may later on show periarticular muscular atrophy as its late complication. It can be collectively understood under osteoarthritis where in focal loss of articular hyaline cartilage is seen with simultaneous proliferation of new bone with remodelling of joint contour (sclerosis). Śukragata vāta may be either premature ejaculation, anejaculation os seminal abnormalities. In śukragata vāta, śukra are formed but either the count is less or there is some anomaly with its structure. Hence along with early ejaculation there is also abnormality in the foetus. Anomalies caused by extra sex chromosomes or less sex chromosomes can be included under this group (Aneploidy or polyploidy). In śukragata vāta sperms are formed but the count may be reduced as in Viral Orchitis, Tuberculosis, Sexually Transmitted Diseases, Chemotherapy, Ionizing radiation and drugs in which testosterone levels remain normal. It may cause premature or delayed ejaculations and also may cause abnormality in the foetus. Snāyugata vāta is characterized with radiculopathy (Sciatica), convulsions (Hemifacial spasm) or deformities (Torticolism). Sandhigatavāta is classical osteoarthritis. In Sirāgata vāta, Ācharya have used two words mahati sirā and tanu sirā which resembles the two conditions related to vessels viz. aneurysm and narrowing of vessels. Aneurysms are a result of a weakened blood vessel wall. The repeated trauma of blood flowing through the vessel may contribute to degeneration of the vessel wall. Bleeding through the aneurysym may cause edema (śōpha). Pulsation (spandate) may be felt. Narrowing of vessels mainly in the periphery is to be considered. Peripheral artery disease wherein there is no pulsation (suptā iti nispandā) and pain is observed. Intermittant Claudication, rest pain is the symptoms observed. Further due to reduced blood supply tissue loss (susyati) is also seen. Muscular atrophy manifests as sequel of Peripheral Arterial Disease. VERSE 38-42 Ardita may be understood as many clinical conditions. Normally it is diagnosed as Bell’s palsy. The facial paralysis may be either of Upper Motor Neuron (UMN) or Lower Motor Neuron (LMN) origin. The etiological factors explained in Ashtanga Hridaya like bearing weight over head, over exertion activities to temporomandibular joint etc may lead to local causes to form LMN pathology. Here as Ardita is explained as vegavān disease clinical conditions like Transient Ischaemic Attack (TIA) and Reversible Ischaemic Neurological Disease (RIND) etc also may be understood in terms of Ardita. Further Hemifacial spasm, synkynesis etc has an after effect of poor managed or unresolved facial palsy is aso understood as ardita. Caraka from shlok no. 38 onwards has classified the disease on basis of presenting symptoms. Since even in modern classification one may find neurological deficits become difficult to classify on basis of disease because for example facial presentation may be due to Trigeminal nerve, facial nerve, infective as in herpes, tumour like brain lesion, infarct or hemorrhagic in origin. Irrelevant of aetiological factors one needs give importance to the symptoms. In context of facial palsy may be / may not be associated with involvement of other parts of the body. A complete interruption of the facial nerve at the stylo-mastoid foramen paralyzes all muscles of facial expression. The corner of mouth droops, the creases and skin-fold are effaced, the forehead is unfurrowed and the eyelids will not closed [stabdhaṁ nētraṁ]. Upon attempted closure of the lids, the eye on the paralyzed side rolls upward (Bells phenomenon), food collects between the teeth and lips and saliva may dribble from the corner of the mouth [vakraṁ vrajatyāsyē bhōjanaṁ]. If the nerve to the stapedius is interrupted, there is hyperacusis (sensitivity to loud sounds). Lesions in the internal auditory meatus may affect the adjacent auditory and vestibular nerves, causing deafness, tinnitus or dizziness (bādhyētē śravaṇau). Chakrapāni has explained it to be prabhav but today after complete anatomical study above explanation for hearing deficit may be proved. If the peripheral facial paralysis has existed for some time and recovery of motor function is incomplete, a continuous diffuse contraction of facial muscles may appear. Further other than Bells palsy facial palsy may be seen unilaterally or bilaterally in Lymes Disease. The Ramsay Hunt Syndrome caused by reactivation of Herpes zoster in the geniculate ganglion. Facial palsy that is often bilateral occurs in sarcoidosis and in Guillain Barre Syndrome, Leprosy, Diabetes mellitus, connective tissue diseases including Sjogren’s syndrome and Amyloidosis. The rare Melkersson Rossential Syndrome consists of recurrent facial paralysis and tumors of temporal bone. In supranauclear lesion there may be a dissociation of emotional and voluntary facial movements and often some degree of paralysis of arm or leg or aphasia. Further in corticobular involvement, weakness is usually observed only in the lower face and tongue; extra ocular, upper facial pharyngeal and few muscles are almost always spared. With bilateral corticobulbar lesions, pseudobulbar palsy often develops: dysarthria, dysphagia, dysphonia and emotional labiality accompany bilateral facial weakness and a brisk jaw jerk. A “pure motor” hemiparesis of the face, arm or leg is often due to a small, discrete lesion in the posterior limb of the internal capsule, cerebral peduncle or upper pons. Some brainstem lesion produces “crossed paralysis” consisting of ipsilateral cranial nerve signs and contralateral hemiparesis. From above discussion one can understand various presentation of facial palsy which may / may not be associated with involvement of other parts of the body. Misdirection of food, resulting in nasal regurgitation and laryngeal and pulmonary aspiration during swallowing is characteristic of oropharyngeal dysphagia [bhōjanaṁ vakranāsikam]. Vakraṁ vrajatyāsyē, Chakrapāni comments, nā samam mukhena khādati kintu vakra ekadeshena explains the weakness of oral muscle due to which patient is unable to chew and swallow equally from both the sides. Dinā jihya samutkshipta kalā sajjati ca āsya vāka explains the language disturbances (aphasia) seen in such patients. Aphasia should be diagnosed only when there are deficits in the formal aspects of language such as naming, word choice, comprehension, spelling and syntax. The neural substrate of language is composed of a distributed network centered in the perisylvian region of the left hemisphere. The posterior pole located at temporoparietal junctior and includes region known as Wernicke’s area and the anterior pole of language network is known as Broca’s area. Both this area are interconnected with each other with additional perisylvian, temporal, prefrontal and posterior parietal regions making up a neural network sub serving the various aspects of language function. Anomia – deficit of naming Paraphasia – Name the object with wrong word or fail to come up with appropriate word, may provide a circum-locutious description of the object. Semantic paraphasia – If patient offers an incorrect but legitimate word (pen for pencil) the naming error is semantic paraphasia. Phoenemic paraphasia – word approximates correct answer but is phonetically inaccurate (plentil for pencil). Spontaneous speech [samutshipta atitvarita] is described as “fluent” if it maintains appropriate output volume, phrase length and melody or as “non fluent” if it is sparse, halting and overage utterance length below four words [kaleti avyaktā] Alexia describes an inability to either read aloud or comprehend single words and simple sentences. VERSE 43-51 Emprosthotonus and opisthotonus are two grave situations. These are also vegavāna – episodic in nature. These come generally considered under Ākshepaka vikāra (convulsions). Ākshepaka may be sārvadehika (generalized) or sthānika (local). These are caused when upadhātu like sirā, snāyu and kandarā are involved. Convulsions have two phases called tonic and clonic. If the patient posses tonic spasms without convulsive movements it is known as Dandaka. It can be compared with Botulism. These ākshepaka vyādhi is found to be very difficult to cure. So Ācharya advice here that, in diseases starting from ardita etc to consider these as pratyākhyeya or vivarjya as they possess frequent paroxyms. But it seems that, the description and treatment of Hanugraha does not fit to this category since it is a reducible orthopedic condition. In Ashtanga Hridaya other than these explained ākshepaka vikāra there are vranāyāma (tetanus), garbapata samutpanna ākshepaka (eclampsia?) etc are also explained. Antarāyama and bahirāyama are state of severe hyperflexion and hyperextension respectively alongwith spasticity in which an individual’s head, neck and spinal column enter into a complete bridging or arching position. Bahirāyāma also known as opisthotonus the abnormal posturing is an extra- pyramidal effect and is caused by spasm of the axial muscles along the spinal column. It is seen in some cases of severe cerebral palsy and traumatic brain injury or as a result of the severe muscular spasm associated with tetanus. It can be feature of severe acute hydrocephalus. In neonate it may be symptom of meningitis, tetanus and severe kernicterus or the rare Maple Syrup Urine Disease. This marked extensor tone can cause infants to “rear backwards” and stiffen out as the mother or nurse attempts to hold or feed them. It is sometimes seen in lithium intoxication, strychnine poisoning. Involvement of sirā is seen in bahirāyama and antarāyama. Chakrapāni explains it to be sirāgata vāta. Depending on nerve impulse agonist and antagonist muscle both either extend or flexed. Locked jaw (hanustambha), teeth biting (dantanām dashana), salivation (lālā srāva), jrumbā (yawning) are common ‘symptoms for bahirāyama and antarāyama.’ Manyāstambha can be compared with spasmodic torticolis which is an extremely painful chronic neurological movement disorder is causing the neck to involuntarily turn into left, right, upward and / or downward. The condition is also referred as cervical dystonia. Other symptoms include muscle hypertrophy, neck pain, dysarthria and tremor. It may be secondary too cerebrovascular diseases, peripheral or central trauma, toxins, metabolic, drug induced, paraneoplastic syndromes, CNS tumour, kernicterus etc. Hanustambha or Trismus or lock jaw refers to reduced opening of the jaws caused by spasm of the muscles of mastication, or may generally refer to all causes of limited mouth opening. Historically and commonly, the term lock jaw was sometimes used as a synonym for both trismus and tetanus. Common Causes – Pericoronitis – inflammation of soft tissue around impacted third molar. – Inflammation of muscles of mastication. It is frequent sequel to surgical removal of mandibular third molar (lower wisdom tooth). – Peritonsillar abscess – Temporomandibular joint dysfunction – Submucous fibrosis – Fracture of the zygomatic arch Other Causes – Acute osteomyelitis – Ankylosis of Temporomandibular joint – Mumps – Seizure – Stroke – Malignant hyperthermia – Malignant otitis externa – Local anesthesia – Needle prick to medial pterygoid muscle. Verse 50 The explanation given in shlok 50 resembles some of the hyperkinetic movement disorders; they are characterized by the presence of a variety of different involuntary movements. Athetosis – slow, distal, writhing, involuntary movements with prosperity to affect the arms and hands. Chorea – Rapid, semi purposeful, graceful, dancelike, nonpaterned involuntary movements involving distal or proximal muscle groups. Dystonia – Involuntary patterned sustained or repeated muscle contraction, often leading to twisting movements and abnormal posture. Myoclonus – Sudden, brief (<100ms), shocklike, arrhythmic muscle twitches Tics – Brief, repeated, stereotyped muscle contractions that are often suppressible. Can be simple and involve a single muscle group or complex and affect a range of motor activities. Tremor – Rhythmic oscillation of a body part due to intermittent muscle contractions Focal Dystonias – There are most common forms of dystonia. They typically present in the fourth to sixth decades and affect women more than men. The major types are: 1) Blepharospasm – Dystonic contractions of eyelids with increased blinking that can interfere with reading, watching TV and driving. 2) Oromandibular Dystonia (OMD) – contractions of muscles of the lower face lips, tongue and jaw (opening or closing) 3) Cervical Dystonia – Dystonic contraction of neck muscle. 4) Limb Dystonia – these can be present in either arms or legs and are often brought out by task specific activities such as handwriting playing a musical instrument Ca.Si.9/12-15 explains apatānaka and apatantraka vyādhi. It is in continuation of marmagata vyādhi. This is symptoms of typical meningeal irritation caused after trauma, subarachnoid hemorrhage or inactive encephalitis. Non epileptic convulsions are to be considered in these cases. Aseptic meningitis, encephalitis (herpes simplex, arboviruses, rabies) post infectious encephalomyelitis may also be considered. Verse 51 The explanation given for dandaka resembles self limiting acute paralysis as seen in Guillian Barre syndrome. VERSE 53-55 In these verses Ācharya Caraka explains three paralytic disorders namely monoplegia (ekāngarōga), hemiplegia (pakṣavadha) and quadriplegia (sarvāngarōga). In Ashtanga Hridaya ekāngarōga and pakṣavadha are explained as synonyms. According to Caraka ekāngarōga is monoplegia which is associated with toda and shoola which seems to be peripheral radiculopathy with motor deficit or focal brain lesions. In pakṣavadha paralysis, aphasia and sensory symptoms may co exist. Paralysis is loss of muscle function for one or more muscles. It may be accompanied by a sensory loss. Causes – Stroke – a) Hemorrhagic b) Ischemic – Trauma with nerve injury – Cerebral palsy – Poliomyelitis – Cerebral palsy – Peripheral neuropathy – Parkinson’s disease – Spina bifida – Multiple sclerosis – Amyotrophic Lateral Sclerosis – Botulism – Guillain Barre Syndrome Hatvaikaṁ: – explains loss of voluntary movement either in one part /or whole body. It usually refers to the limbs either mono i.e. one leg or one arm [ekāngarōga] or para i.e. both legs, hemi i.e. one arm and one leg on either side of the body [dakṣiṇaṁ vāmam ēva vā] and quadri i.e. all four limbs (sarvāṅga rōga]. Cēṣṭā nivr̥ttiṁ is seen due to loss of muscle power and tone. Rujā /pain are due to reduced venous return leading to increase lactic acid within the muscle causing the pain. Thus physiotherapy helps to reduce pain. Sirāḥ Snāyūrviśōṣya – explains atrophy i.e. partial or complete wasting of a part of the body. Poor nourishment, poor circulation, loss of nerve supply and disuse or lack of exercise is the cause. Pādaṁ saṅkōcayatyēkaṁ hastaṁ vā: Damage to the pyramidal tract and its accompanying para pyramidal (cortico-reticulospinal) fibers give rise to UMN syndrome including positive and negative features. Impaired ability of damaged motor neurons to regulate descending pathways gives rise to disordered spinal reflexes, increased excitability of muscle spindles and decreased synaptic inhibition. This results in increased muscle tone of symptomatic muscle. The increased muscle tone may further lead to contractures. Stroke symptoms typically start suddenly, over seconds to minute and in most cases do not progress further. The more extensive area of brain affected, more functions are likely to be lost. Symptoms as per affected area: A) CNS pathways – Spinothalamic tract, corticospinal tract and dorsal column – Hemiplegia and muscle weakness of face – Numbness – Reduction in sensory or vibratory sensation – Initial flaccidity (reduced muscle tone), replaced by spasticity (increased muscle tone), excessive reflexes and obligatory synergy. B) If Brainstem which gives rise to cranial nerve gets involved, than – altered smell, taste, hearing or vision – drooping of eyelid (ptosis) and weakness of ocular muscle – decreased reflexes: gag, swallow, pupil reactivity to light – decreased sensation and muscle weakness of the face – balance problems and nystagmus – altered breathing and heart rate

         – weakness in sternocleidomastoid muscle with inability to turn head on one side
         – weakness in tongue

C) Cerebral cortex – aphasia – dysarthria – apraxia – visual field defect – memory deficit – disorganized thinking, confusion, hypersexual gestures (frontal lobe) D) Cerebellum – altered walking gait – altered movement coordination – vertigo and or disequlibrium

VERSE 56-57 Gr̥dhrasī can be correlated to Lumbo sacral radiculopathy, especially sciatica. There are opinions that the term pr̥ṣṭha used just after kati and prior to uru is misinterpreted as spinal column. The meaning as “posterior aspect” seems to be more apropriate in this context. But Chakrapāni specifically clarifies that Gr̥dhrasī manifest initially as catch in the gluteal region associated with spasm, ache and pain followed with catch spreading to hip, spine, thigh etc. The two types of gr̥dhrasī can be roughly correlated to Lumbar Degenerative Disc Disease as Vātika which is more prevalent in older age group and Intervertebral Disc Herniation as Vātakapha which is more prevalent in younger age group. The previous one is manifested as dehydrated disc and the later as bulged nucleus pulposus. The radiographic findings cannot be considered as ultimate for treatment strategies, which is specifically designed according to symptomatology and upashaya. Gr̥dhrasī / sciatica is a set of symptoms including pain caused by general compression or irritation of one of five spinal nerve roots of each sciatic nerve. Sciatica is a relatively common form of lower back and leg pain. Sciatica is a set of symptoms rather than diagnosis; its cause being irritation at the root of nerve; in other words radiculopathy similarly Ācharya has mentioned khalli disease which is again a type of radiculopathy when brachial and lumbo sacral radiculopathy coexist. Radix means root; thus as set of conditions in which one or more nerves roots are affected shortly after exit from spinal cord. It may be secondary to degenerative disease, osteoarthritis, facet joint degeneration, ligamentous hypertrophy and spondylolisthesis. More rare cause may include radiation, diabetes mellitus, neoplastic disease or any meningeal based disease process. Depending on dermatome of the nerve supply pains are seen. Therefore Caraka mentions symptoms of upper & lower extremity. Khalli can also be considered as limb dystonia such as writer’s cramp, musician cramps. VERSE 58-61 Samsarga dōṣa should be identified in all above discussed presentations. For example in case of pakṣāghāta, pitta anubanda features are very commonly seen in certain Thalamic infarctions. Eventhough swedana is a primary line of treatment in pakṣāghāta, it is not useful in thalamic infarctions which is otherwise called as sensory stroke. Further it responds to śītā sthambana treatments like takradhara. VERSE 61-71 In case of Pitta āvr̥ta vāta due to intake of pittakara hetu quantitative vridhi of pitta takes place. It starts accumulating and now opposes the gati of vāta which is unable to get rid off the pitta dōṣa so pitta vridhi lakshana are observed. Symptoms like dāha etc are observed. The symptoms can be compared with heat stroke where the failure of heat regulating mechanism takes place. Giddiness, syncope may be observed, heat cramps may occur due to loss of sodium, potassium, chlorides in the blood. Hyperthermia reduces blood flow to brain causing giddiness. In case of Kaphāvr̥ta vāta effect of cold stress should be considered. Muscular weakness is observed along with hypothermia. Symptoms may also arise in morning hours of cold seasons and rainy season. Working in air-conditioned rooms for longer hours can also create such symptoms. Even in common cold without pyrexia such symptoms may be produced. Raktāvr̥ta vāta are near to some connective tissue disorders manifested with myalgia, insidious arthralgia, talengectacia and soft tissue inflammations. Hetu explained in vidhishonitiya adhyaya are responsible for quantitative increase of rakta dhātu which impedes the gati of vāta dōṣa hence normal parivahana is hampered and stagnation takes place leading to sanga this is the reason why in rakta āvr̥ta vāta, rāga yukta śōtha, mandala, local dāha and vedāna have been explained. It can be compared with urticaria or vasculitis wherein there are rashes, burning sensation, pain, wheel and flare like presentation. Mānsa dhātu is formed when vāyu, ambu, teja and rakta usma together bring sthirata to the mānsaposakansa. Sthira, kathina are the guna of mānsa while lepana is the karma of mānsa dhātu. Such mānsa when opposes the gati of vāta, kathina pidakā and śōtha is formed. Nodules and tumours are defined as the solid, raised and firm growth. Mānsāvr̥ta vāta looks like thrombophlebitis, deep vein thrombosis or lymphangitis etc with acute inflammatory symptoms.

Medasāvr̥ta vāta is otherwise called as ādyavāta or urusthamba. When ambu, snigdha guna along with the dhātusma acts on poshakansa a soft, snigdha meda dhātu is formed. When such medadhātu will obstruct the gati of vāta dōṣa it leads to origin of snigdha, mridu, ambulatory śōtha. Lipoma bullae can also be understood in context of medasāvr̥ta vāta.

Mānsa meda āvr̥ta vāta may also be a complication of prameha since mānsa and meda are the āvaraka along with kapha and pitta to develop āvr̥ta vāta in basti and in turn leading to madhumeha as explained in Ca.Su.17. It indicates when mānsa and meda become more vitiated and cause more kleda genesis or become kledānvita; they lead to different micro and macro angiopathy related complication. Meda-āvr̥ta vāta can be compared with Diabetic nephropathy. Pipīlikānāṁ ca sañcāra are the abnormal sensory positive phenomenon or it may be the late complication of microangiopathy. In asthyāvr̥ta vāta a relative asthi vriddhi in the form of osteophytes is observed (compensatory to decrease bone density) increasing the symptoms of pain along with chances of fracture. Eka sthāna vridhi and anya sthāna kṣaya is another principle which explain the concept of osteophytes. Osteophytes may compress the nerves root causing tingling or suchivāta vedana (entrapment or compressive neuropathy). In Asthyāvr̥ta vāta asthi is vitiated and leading to āvarana of vātasya mārga. When osteophytes are formed in osteoarthritis, spondylosis, it compresses underlying nerve fibres and manifest severe pain while joint movement in osteoarthritis and compressive neuropathy in spondylosis. Posterior incroachment can lead to spinal cord compression and related features like pseudo intermittent claudication. In majjāvr̥ta vāta the majja dhātu impedes the gati of vāta (nerve conduction) leading to the symptoms like vināma; pain etc. Diffuse bulging of cord may be considered as well spinal canal stenosis. In śukrāvr̥ta vāta immature sperms are formed which lose their forward movement activity. Ciliary dyskinesia (Kartagener Syndrome) can be included in this group. Since motility is reduced it leads to infertility. Y chromosomes microdeletions and POLG variants are increasingly recognised as a cause of azoospermia or oligospermia. Primary gonadal deficiency with low-testesterone and decreased spermatogenesis are the reason for infertility. Patients with normal hormonal levels and low sperm count may be found in obstructive anomaly of vas deferens and epididymus. Annāvr̥ta Vāta: Āhar when taken in excess the prokinetic movement is reduced and the āhar is not propelled forward leading to strech reflex. The pain of obstruction of hollow abdominal viscera is classically described as intermittent food related abdominal pain followed by remission. Mūtra-āvr̥ta vāta: These symptoms are seen in mūtravega dharan. Normal urine formation takes place but the patient does not evacuate it timely leads to the avarodha of vāta gati. Vāta is unable to contract the detrusor muscle thus there is mūtra apravriti and inturn bladder distension. This condition may also arise in neurogenic bladder. Atonic bladder – Micturition reflex contraction cannot occur if the sensory nerve fibres from the bladder to the spinal cord are destroyed, thereby preventing transmission of strech signals from the bladder. When this happens, a person loses bladder control, despite intact efferent fibers from the cord to the bladder and despite intact neurogenic connections within the brain. Instead of emptying periodically the bladder fills to capacity and overflows a few drops at a time through the urethra. This is called overflow incontinence. Crush injury is the common cause. Purishāvr̥ta Vāta: Dietary fibres adsorb water and this increases the bulk of stools and helps reducing the tendency to constipation by encouraging bowel propulsive movements. Diet low in fibres content reduces the healthy bowel movements. Stools are formed but due to slow transit there is hard and pelty stool formation which finds it difficult to pass out. Malavega dharan may also cause the above symptoms. In Diabetes mellitus whenever there is neurogenic involvement, peristalsis are reduced creating the above symptom. Spastic colon may also be considered. VERSE 72-74 The different symptoms or clinical presentations explained in these verses suggestive of involvement of CNS as well as chronic degenerative nature. These disease presentations manifest in madhyama rōga mārga. If the diseases are diagnosed earlier the prognostic factors are good. In chronic conditions even after cure, chances of permanent deficits / deformities exist. Vātarōga with complications like hr̥drōga, vidradhi etc also should be seriously considered. VERSE 75-82 The line of treatment of absolute vāta vitiation is explained here. It excludes all possible association of other dōṣa. Majority of such clinical conditions are degenerative in nature. It is further charecterised with tissue depletion. Supportive measures are more important than eliminative procedures. Snēhana is the primary line of treatment explained. Various types of articles and medications are highlighted here. All of them are falling under the category of phospholipids. Lipid metabolism and involvement of neural membrane phospholipids in neurodegeneration of human brain etc are found to be recently as significant. Breakdown of cellular membranes is a characteristic feature of neuronal degeneration in acute (stroke) and chronic (senile dementia) neurological disorders. A review by J Klein summarizes recent experimental and clinical work which concentrated on changes of choline-containing phospholipids as indicators of neuronal membrane breakdown. Experimental studies identified glutamate release, calcium influx, and activation of cellular phospholipase A2 (PLA2) as important steps initiating membrane breakdown in cultured neurons or brain slices under hypoxic or ischemic conditions. Proton NMR studies have shown an elevation of choline-containing compounds in the brain of Alzheimer patients while neurochemical studies in post mortem-brain demonstrated increase of the catabolic metabolite, glycerophosphocholine, an indicator of PLA2 activation. In contrast, studies of cerebrospinal fluid, phosphorus NMR studies, and measurements of phospholipases in post mortem Alzheimer brain gave ambiguous results which may be explained by methodical limitations. The finding that, in experimental studies, choline was a rate-limiting factor for phospholipid biosynthesis has stimulated clinical studies aimed at counteracting phospholipid breakdown, e.g. by combinations of choline and cytidine. Future experimental approaches should clarify whether loss of membrane phospholipids is cause or consequence of the neurodegenerative disease process.[21] Probably loss of memebrane phospholipids is cause or consequence of the neurodegenerative disease process. Ayurveda advocates usage of various Snēhana in perview of the statement ‘Snēhasāro āyām purusah prānasca Snēhabhuyishta”. Swedana is also very important in management of vāta rōga. It is ideally indicated in Vāta and vāta kapha conditions. On continuous application of snigdha property, gradually there exists an association of kapha. Sweda effectively eliminate stiffness, pain and coldness and imparts better flexibility, improvement in peripheral circulation and relieves oedema. VERSE 83-88 Here the term ‘sā dōṣatva’ is of some controversy. It is generally understood as having associated dōṣa. But the specific treatment explained here is for vāta alone. So it is argued that there is no chance for a newer associated dōṣa. Chakrapāni clarifies that ‘sā dōṣatvam’ should be understood in relation to different karma done already. If any procedural fault is there it should be corrected with shodana karma to be explained here. But it can also be understood in a different way. ‘Sā dōṣatvam’ happens in singular vātaj diseases as the initial treatment procedures are going on. For example continuous Snēhana therapy may lead to association āma and kapha which is to be managed by deepana and pācana as explained. The same way continuous administration of swedana may impart involvement pitta prakopa which should be managed with mridu virēcana like eraṇḍataila with milk. ‘Sā dōṣatva’ can also be interpreted as residual dōṣa which normally not amenable to Snēha and sweda alone or together. In such conditions mridu samsodana is explained. In all these circumstances bala should be considered as in vāta prakopa alone. Bala of the patient is normally reduced and further gets compromised by continuous treatment. VERSE 96

     Aortic stenosis (AS) [Hridaya pradesh sthān dusti]

Constant production of pressure required to Overcome the pressure gradient caused by AS

                    Left Ventricular hypertrophy

Thickened muscular layer but the arteries that-

                                            Supply muscles do not get significantly longer or bigger

               Blood supply to meet oxygen demand

Ischaemia [Apatarpan]

Dhātukṣaya

Vātaprakopa

Angina Hrudayagata Vāta Study done by Kurin G A & oths [www.ndoi.n&m.nih.gov./pubmed 18380926) showed that Desmodium gangeticum posses the ability to scavange the free radicals generated during ischaemia and ischaemia reperfusion and thereby preserves the mitochondrial respiratory enzymes that eventually lead to cardioprotection. Bahusirsa gata vāta is the clinical condition resembling frozen shoulder. VERSE 99-103 The line of treatment of Ardita is explained here. It focuses disease above cervical seventh vertebra (urdhwajatru). As per modern science facial paralysis is almost a disease of auto recovery still some residual paralysis remains on the affected side. A well executed timely ayurvedic treatment make absolute cure without any evidence of facial deviation. In Ashtanga Hridaya vamana and raktamokshana are also explained in the treatment strategy of ardita. Vamana is useful in certain middle ear associated facial nerve symptoms (for eg. hyperacusis) seen along with recurrent upper or and lower respiratory tract infections. The same way raktamokshana is indicated in facial herpes infection. Virēcana is the direct line of treatment for pakṣaghata. Virēcana was considered as an excellent option to relieve intracranial oedema. Further it ignites majjadhatwagni and boost intellect. It is worthy to observe that virēcana is the pratiloma sodhana in urdhwaga raktapitta and cerebrovascular accidents may be understood as concealed urdhwaga raktapitta.

Gr̥dhrasī is practically better controlled by parasurgical procedures explained in Ayurveda. Classical Basti practice also yield good outcome.

Verse 134 Vitex nigunto has good anti-inflammatory and analgesic activity. Leaf extracts have shown to reduce oxidative stress. Roots extracts have enzyme inhibitory activity. VERSE 184 In Pittāvr̥tē vāta a balance of śītā and uṣṇā cikitsā has to be followed because extensive śītā cikitsā reduce pitta but increases vāta therefore a balance has to be maintained therefore the word ‘vyatyāsāt kārayēt’. Even in heat stroke management, the goal of treatment is to reduce temperature by at least 0.20c/min to approximately 390C. Active external cooling generally is halted at 390C to prevent overshooting, which can result in iatrogenic hypothermia. Ice water immersing is generally followed but the disadvantage it causes subcutaneous vasoconstriction, preventing the transfer of heat via conduction. Ice water may also increases shivering, which inturn increases heat production. Therefore śītā uṣṇā cikitsā has been mentioned. Sēcanam of takra, ghrita and kshira has been mentioned. Yamaka Snēha of ghr̥ta and taila helps to balance pitta and vāta further kshira sēcana also improves bala of patient by process of dermal absorption. VERSE 189 ‘Sthānam jayet purvam’ is a basic cikitsā sutra. Āmāshaya is among the main seat of kapha and if kapha is associated with āmāshaya gata vāta then first treat kapha by administrating vaman. Vaman helps in removing excessive mucus in stomach lining. Further, symptoms such as visucika etc explain āmavisha present in āmāshaya which can be removed by vaman. Verse 197 Study on rat shows, the omega 3 deficient rats had significantly reduced DHA content in both brain regions. In the hippocampus, DHA deficient rats had 72% higher acetylcholine. Thus study is necessary if Snēha virēcana has omega 3 fatty acids. Further role of laxation and its anticholinergic effect should be studied. Verse 202- 206 Prāna Āvr̥ta Vyāna Prāna vāyu acts like a controller. It is responsible for the ādāna karma. Gyanendriya perceive their objects with the help of prāna vāyu. Vyāna vāyu is responsible for gati or conduction. Hence vyāna vāyu plays a significant role in rasa vikshepan. Conduction is not only related to cardiac cycle but all types of neural conduction should be considered. Whenever the controller prāna will restrict the gati of conducting vyāna vāyu the indriya will not be able to perceive its subject (vishaya). It may happen in one indriya (homonymous) or in all indriya (heteronymous) together. If it happens in all indriya it can be compared with the vegetative stage or deep coma. Rasarakta vikshepan is karma of vyāna vāyu. In case of eye; vascular disease related to retina / optic disc causes visual loss. Alzheimers Disease may also be considered. Macroscopically, the brain is atrophic, particularly the cerebral cortex and hippocampus. Many different neurotransmitter abnormalities have been described; particularly impairment of cholinergic transmission through noradrenaline, 5 H-T, glutamate and substance P is also involved. Inability to retrieve information (smriti kṣaya) is the symptom. Later apraxia, visuo spatial impairment and aphasia are seen.

Vyāna Āvr̥ta Prāna

Sweda sravan is normal function of vyāna vāyu thus whenever vyāna gets vitiated it causes sweda atipravriti. It explains sympathetic overactivity or cholinergic effect. Sweat glands secrete large quantities of sweat when sympathetic nerves get stimulated. Visha is one of the hetu of vyāna prakopa. Perception is the function of prāna vāyu when it gets āvr̥ta its perception function is reduced. It is negative sensory feeling caused in disorders like diabetes mellitus. Excessive sweating may cause tvak vikār due to dehydration. Treatment Snēha yuktaṁ virēcanam: Snēha helps to reduce vyāna and virēcana helps in bringing anuloma gati to prāna vāyu. Prāna Āvr̥ta Samāna Pānini has explained that ātmā alongwith budhi activates the mana with the help of prāna. Mana stimulates the kāyāgni with the help of samāna vāyu and gives prerna to vāyu in upward direction which depending on ashta sthān produces various sounds. Thus vitiation of prāna or samāna leads to symptoms like gadgada and mūkatā. Dysarthria, Mutism is associated with perisylvian region of left hemisphere. Posterior pole being Wernickes area and anterior pole of language is known as Brocas area. An essential function of this area is to transform neural word representation into their articulatory sequences so that words can be uttered in the form of spoken language. Both the poles are interconnected with each other and with additional perisylvian, temporal, prefrontal & posterior parietal regions making up a neural network subserving the various aspects of language function. Damage to any one of these components or to their interconnections can give rise to language disturbances (aphasia). Treatment Catuṣprayōgā snēhā – gives bala to samāna Yāpana – gives bala to prāna. Verse 204 Omega 3 fatty acids play a crucial role in brain function, as well as normal growth and development. Snēha is similar to meda and asthigata meda is majjā. Therefore Snēha helps in bruhan of majjā and also does regularization of vāta. Verse 205 Samāna Āvr̥ta Apāna Samāna vāyu helps in agni sandukshan also it has role in anna dharan, pacāna, virecana and taking kitta downward. Samāna vāyu is agni-samipasta vāta prakār. Grahani avayava helps in apakwa āhār dharan and pakwa āhār is pushed forward in pārshwabhag. In Samāna āvr̥ta Apāna, vridha Samāna does not help in dharan of apakwa āhār. Grahani vyādhi is so called because grahani is unable to do dharan of āhār. As apakwa āhār moves forward parshwa shool begins. Due to vitiated Samāna the number of intermediate metabolites increases and it obstruct gati of āpāna causing ischemia causing hr̥drōga. Treatment Agnideepaka ghrita Deepan sarpi is to be administered in Samāna āvr̥ta apāna. Deepan karma helps to improve the enzymatic effect reducing the intermediate metabolites. Further Snēha regularizes vāta and thereby obstruction of āpāna is removed. Omega 3 fatty acids supplementation greater than one gram daily for at least one year may be protective against cardiac death, sudden death and myocardial infarction in people. Omega 3 fatty acids reduce blood triglyceride levels. It also has anti-inflammatory effect. Deepan sarpi helps in agnivardhan and does anuloman. It helps in āma pācana and reduces inflammation and has healing effect therefore useful in grahani. VERSE 206-217 Prāna Āvr̥ta Udāna Role of udāna vāyu is to give urjā, bala, increase prayatna, srotas preenan etc. They get hampered when prāna does āvarana over udāna vāyu. The prāna vāyu has adhogati while udāna vāyu has urdhwagati does mismatching takes place leading to sangraha of niḥśvās and ucchvāsa. Failure of control over the immune system leads to autoimmune disorder. The above condition can be seen in rheumatic heart disease and also in allergic rhinitis. Treatment Urdhvabhāgikaṁ karma means Snēha, nasya etc. Nasya has its local effect on nose improving the local immune response as well as on respiratory centre. Nasya has good effect on allergic rhinitis. Role of vaman needed to be studied. Āśvāsan cikitsā can be related to maintenance of patient. Because it is also seen clinically that most of patients of allergic situations can be maintained but not cured. Similarly patient who have developed stenosis of mitral valve are too maintained. Modern science opts for operative in late cases. Udāna Āvr̥ta Prāna Bala, varna, oja, prayatna depend on Udāna vāyu while controller and assimilator is prāna vāyu. In udāna āvr̥ta prāna the prāna gati is restricted does perceiverance and control is lost while udāna vāyu being prakopita oja, varna, bala nāśa is seen. The above symptoms are seen in terminally ill patient in which fatigueness and weakness is commonly seen associated with psychological symptoms like hopelessness, meaninglessness, confusion, delirium which are similar to oja nāśa. Underlying various disorders reduce the energy store. It occurs due to disease induced factors such as TNF, cytokines and from secondary factors such as cachexia, dehydration, anemia, infection hypothyroidism and Diabetic Ketoacidosis (DKA). Changes in muscle enzymes also play an important role. RAS system may get involve later on causing semicoma followed by coma and lastly death. Treatment Āśvāsan cikitsā over here again means maintaining the patient. As discussed in symptoms it is underlying process in various dangerous diseases. Even modern science in emergencies maintains the basic criteria i.e. BP, Heart rate, Urine output, electrolyte balance etc. Sukhaṁ caivōpapādayēt i.e. no shodhan or karshan should be done. Ācharya have cautioned by explaining that emergency caused due to shodhan cikitsā are more dangerous than bruhan cikitsā. In Udāna āvr̥ta prāna there is oja nāśa therefore avoid karshan in any form. Sinchet śītavāriṇā explain that rugna prabodhan should be done repeatedly. Udāna Āvr̥ta Apāna In above condition one needs to emphasize on gati of vāta prakār. Udāna has its urdhwagati while apāna vāyu has anuloma gati. In udāna āvr̥ta apāna; the later changes its gati and now becomes udāna bhava āpana as commented by Chakrapāni ‘Urdhwagati swabhava āpana’. Thus urdhwagati is increased causing symptoms like chardi, shwas etc. Cigarette smoking often results in mucous gland enlargement and goblet cell hyperplasia. Goblet cells increase in number but in extent through the bronchial tree. Bronchi undergoes squamous metaplasia which disrrupts mucociliary clearence leading to COPD. Antiperistalsis means peristalsis up the digestive tract rather than downward. This may begin as far down in the intestinal tract as the ileum. It can push the contents upto duodenum and stomach leading to their over distention which becomes the exciting factor that initiates the actual vomiting act. Basti and anuloman cikitsā helps in regularizing the peristalsis. The reverse movement of prostration is diverted downward. Due to anuloman, urdhwa gati of udāna is also pacified and regularized, further over distention of abdomen is reduced. Apāna Āvr̥ta Udāna Apāna has adogati and is responsible for kitta utsarjan while udāna vāyu is responsible for urja and has urdhwagati. Apāna when resist udāna the udāna vāyu becomes apāna bhava āpāna. As udāna vāyu gets āvr̥ta, urja or agni is reduced causing agnimāndya. The increase kitta and reduced urja gives rise to moha and alpāgni. Uraemia may be understood in the above condition where the concentration of blood urea (kitta bhag) increases in blood. Treatment As understood in Raktapitta cikitsā ‘Pratimargam ca haret’ is the cikitsā siddhant; vaman should be administered if there is excessive atisār. Vaman has urdhwagati which gives bala to udāna vāyu. Deepan karma which will give bala to agni and inturn bala to udāna. Grāhi aushada reduces the hyperperistalsis seen in apāna vridhi and also helps in absorption of electrolytes fluid thereby reduces quantity and frequency of stool. Vyāna Āvr̥ta Apāna Apāna vāyu has its own anuloma gati and its role is to eliminate the faecal matter, urine etc. In this āvarana, vyāna opposes the gati of apāna thus anuloman does not take place. Features resemble adhovāta vegadharan vyādhi like ādmān, udawarta, gulma and vedana. When the person stresses while passing motions the hard stools cause painful condition called the fissure. Gastro-Intestine has its own intrinsic set of nerves known as intramural plexus or the intestinal enteric nervous system located on the walls of gut. Both parasympathetic and sympathetic stimulation originating in the brain can affect gastro intestinal activity mainly by increasing or decreasing specific actions in the gastrointestinal intramural plexuses. Strong sympathetic stimulation inhibits peristalsis and increases the tone of sphinctures. Net results in slow propulsion of food through tract sometimes decrease the secretion as well even to the extent of constipation. As the peristalsis is reduced the food remains in stomach or early part of small intestine which send the strech impulse to vomiting centre causing the vomiting. Anuloman gives bala to apāna vāyu reducing the ādmān. Snigdha anuloman gives softness the stools thereby reducing pain and fissure. Snigdha anuloman is cikitsā for udavarta and Gulma. Apāna Āvr̥ta Vyāna Function of apāna vāyu is excretion of fecal matter, urine, menstrual blood and sperm at a specific interval. Apāna when gets vridha and restricts the gati of vyāna the utsarga vriti of āvaraka is seen. Thus atipravriti of purisha, mūtra and retasa is seen. There is interplay between gati of apāna with gati of vyāna. The srijan karma and gati karma of apāna vāyu vitiates vyāna vāyu which becomes āvr̥ta and thus rasa vikshepan karma is reduced. Diarrhoea causes dehydration leading to reduced ventricular filling pressure. Modulation comes into play causing increase heart rate and peripheral vasoconstriction but if the dehydration continues the cardiac output is reduced thus leading to reduced rasa vikshepan causing hypovolaemic shock. Symptoms explain apāna ati pravritti therefore sangrahan cikitsā has been mentioned. Sangrahan drugs are jaliyansa shoshaka by their usna guna except for some drugs like musta which are grahi although śītā gunatmak. Sangrahan maintains the fluid volume thereby maintaining the cardiac output and electrolyte imbalance. Sangrahan karma reduces the utsarjan karma of apāna and improves the dharan karma of apāna. Samāna Āvr̥ta Vyāna Many systemic metabolic abnormalities cause altered sensorium by interrupting the delivery of energy substrates. Almost all instance of diminished alertness can be traced to widespread abnormalities of the cerebral hemisphere or to reduced activity of a special thalamocortical alerting system termed the reticular activating system (RAS). Suppression of RAS and cerebral function can take place incase of metabolic derangement such as hypoglycaemia or hepatic failure leading to stage of reduced comprehension, coherence and capacity to reason. Irrelevant talk, lack of appreciation of spatial relation of self or external environment (agnosia) may also occur. Exercise improves the vyāna bala and vyāna activates Samāna to stimulate the agni uttejaka bhava. Whereas laghu bhojan prevents the excessive load on agni thereby reducing the intermediate metabolites. Activity of agni uttejaka bhava (Samāna vāyu) is reduced. Thereby pacifying Samāna vāyu and giving bala to vyāna. Udāna Āvr̥ta Vyāna Vyāna vāyu is responsible for gati, vikshepan, sweda sravan, nimesha, unmesha etc. but whenever it gets āvr̥ta swa karma hāni occurs and if it gets āvr̥ta by udāna the one responsible for bala, prayatna, urjā causes symptoms like stabdhata, alpāgni, asweda, chestahāni and nirmilan. Continuous generalized electrical discharges of the cortex are associated with coma even in the absence of epileptic motor activity. The self limited coma that follows seizures termed the postictal state may be due to exhaustion of energy resources or effects of locally toxic molecules that are byproduct of seizures. Alpa, mita and laghu bhojan helps to empowerise agni. Laghu āhār gets easily digested and absorbed and comes into circulation. This gives bala to vyāna which provides nutrition by its rasa vikshepa karma thereby pacifying the udāna. ANUKTA ĀVARANA Vyāna Āvr̥ta Udāna Vyāna is associated with gati and prakshepan while udāna is associated with bala prayatna and urjā. Vikrut vyāna has impaired gati which when impedes udāna will reduce the bala, prayatna ādi karma of udāna. Sympathetic fibres originate in the hypothalamus, pass down the brain stem and cervical spinal cord to emerge at T1 level, return back up to the eye in association with the internal carotid artery and supply the dilator pupillae. Lesion in the sympathetic pathway cause Horner’s syndrome. The reason may be central (at the level of Hypothalamus / brain stem) or at the periphery (at the level of lung apex, carotid artery) or may be idiopathic. Vyāna āvr̥ta udāna can also be considered in paroxysmal tachycardia. Abnormalities in different portions of the heart including the atria, the Purkinje system, or the ventricles, can occasionally cause rapid rhythmical discharge of impulses that spread in directions throughout the heart. This is believed to be caused most frequently by re-entrant circus movement feedback pathways that set up local repeated self re-excitation. The above process occurs unless considerable ischemic damage and may lead to ventricular fibrillation. Thus there is never a coordinate contraction of all the ventricular muscle at once which is required for cardiac pumping. Patient may complaint of palpitation or symptoms such as dizziness, dyspnoea, fatiguebility i.e. bala, prayatna are reduced. Apāna Āvr̥ta Samāna Apāna is responsible for srijan karma. Vikrita Apāna increases the nishkraman prakriya. Increase Hustration reflex causes excessive propulsion movement. Excess motility causes reduced absorption. The body in unable to reabsorb bicarbonate ions i.e. Samāna karma is reduced. Loss of bicarbonate causes rise of H+. Body compensates the process by increased ventilation. The PaCO2 is reduced secondarily by hyperventilation which mitigates the rise in H+ leading to metabolic acidosis. Diarrhea associated with passage of more than 200g of stool with urgency of defaecation and faecal incontinence. This may lead to malabsorption leading to hypoalbuminaemia, hypocalcaemia and vitamin D deficiency, hypomagnesaemia, phosphate, zinc and weight loss. Prāna Āvr̥ta Apāna Prāna vāyu function is associated with controlling system of the body, as said by Nyāyachandrikākār. Prāna vāyu helps in assimilation and maintain homeostasis. Apāna is responsible for elimination. Considering pakvāshaya it may be compared with srijan of purisa mūtra etc. and at cellular level function of apāna is removal of cellular products within the cell. In this particular condition of prāna āvr̥ta apāna the vikrita prāna obstructs the gati of apāna and it is unable to release the cellular products. This can be understood in condition of Brainstem lesion where in the control over CO2 expiration is lost. Depletion of CO2 expiration leads to increase in concentration of CO2 in blood resulting in respiratory failure of Type II origin i.e. severe respiratory acidosis. A simple sleep apnoea / hypopnoea syndrome may also be considered. Udāna Āvr̥ta Samāna In this particular condition as udāna vikriti takes place anabolism increase reducing the catabolism. This is observed in Hypothyroidism where in weight gain is seen with decreased appetite. Leptin is secreted by adipose cells and acts primarily through the Hypothalamus. Its level of production provides an index of adipose energy stores. High leptin levels decrease food intake and increase energy expenditure. The OB gene is present in humans and expressed in fats. The obesity in these individuals begins shortly after birth, is severe and is accompainied by neuroendocrine abnormalities. Role of central hypothyroidism has been understood in mouse model.

  Leptin                           Leptin Receptor Signal                                    Proopiomelanocortin
                                                                                                         (POMC) Expression

                                                                                                                 Alpha MSH
                                                                                                   Melanocortin & Receptor Signal
                                                                                                                Appetite

Another condition may be considered where increased acetylcholine stimulates increased ATP (-urjā) which further increases excessive secretion of fluids and electrolytes in addition to normal viscid alkaline mucus which further increases gastrointestinal activity causing reduced absorption (annasoshan, vivechan karma) leading to malabsorption diarrhea. Vyāna Āvr̥ta Samāna There is interplay between gati of vyāna with gati of Samāna. Therefore when rasa vikshepan karma of vyāna related to Samāna vāyu is vitiated, the later becomes āvr̥ta and in turn annapācana, vivechan and munchan karma of Samāna are inhibited or decreased. Sympathetic nerves have dual action in some cases; it increases secretion but if parasympathetic is already causing copious secretion than sympathetic usually reduces the secretion mainly by vasoconstriction reducing the blood supply. Although Enteric Nervous System (ENS) can function autonomously; Autonomic Nervous System (ANS) connects ENS centrally. When ANS activity is increased it has its impact on gastrointestinal tract. Sympathetic overstimulation causes vasoconstriction which reduces secretion of gastric juices and pancreas exocrine secretion. Their insufficiency can cause malabsorption syndrome in which predominant feature is steatorrhoea, deficiency of fat soluble vitamins, protein and carbohydrate deficiency related features. As compensatory mechanism vasodilatation in skin leads to excessive sweating and skin related features. Samāna Āvr̥ta Prāna Role of Samāna along with agnideepan is to help in pācana and sāra kitta vibhajan. Thus along with pitta, Samāna plays its major role in metabolism. If Samāna gets vitiated then sāra kitta vibhajan does not takes place properly and kitta bhaga gets upashoshit along with sāra bhaga. Thus kitta munchan prakriyā does not take place. This condition may be noted in metabolic acidosis, hypercalcemia and uraemia. The kitta bhaga now alters the gati of prāna or in other words neuronal excitability. It may show symptoms like confusion seizures, coma and death. It may also depress the respiratory centre causing hyperventilation or Kussmaul breathing.

Samāna Āvr̥ta Udāna

The same kitta bhāg depending on sthān obstructs the gati of udāna. The bala, prayatna, urjā ādi karma are reduced. Conditions can be observed in hepatic coma where in increase levels of ammonia (kitta bhāg) interfere with cerebral energy metabolism and with Na+, K+, ATPase pump. Number and size of astrocytes are increased. They alter the nerve cell function and causes symptoms of fatiguebility, altered sensorium and coma. (prayatna nāśa). Similarly Hyperthyroidism may also be considered. Samāna is said to be agnibala pradha, it leads to increase in catabolism. Energy gets exhausted with increase catabolism reducing the bala prayatna which is the role of udāna vāyu as seen in thyrotoxicosis. Apāna Āvr̥ta Prāna Interplay exists between apāna the eliminator and prāna the controller of the body system. Mismatching between apāna and prāna karma leads to various disorders. If the srijan karma and gati of apāna related to ādān karma of prāna gets vitiated the prāna vāyu gets āvr̥ta and in turn causing difficulty in breathing, confusion, coma and death. Loss of Na+, Cl-, H+ and extra cellular fluid depletion occurs in excessive administration of diuretics or in congenital chlorodiarrhoea. It leads to increase concentration of plasma HCO3 which leads to condition such as apathy, confusion and drowsiness. In anxiety induced hyperventilation excessive loss of CO2 takes place. PaCO2 andH+ falls. The low PaCO2 results in reduced renal Na+/H+ exchange due to which patient feels short of oxygen. VERSE 221 Pitta Āvr̥ta Prāna Prāna vāyu is said to be controller, it helps in assimilation of āhār etc. In pittāvr̥ta prāna there is quantitative increase of pitta and it opposes the gati of prāna, hence ingested food is vomitted out and since the āhār is not completely digested it comes out in the vidagda form, as pitta has increased there are symptoms of dāha, vidāha, murchha, bhrama and śītā kamana Whenever food is ingested it stimulates the pharyngeal sensory receptors which send the impulse to the swallowing centre from where the motor impulses are sent with the help of 5th, 9th, 10th, 12th, cranial nerves to the pharynx and upper esophagus similarly sensory signals that initiate vomitting originate mainly from the pharynx, esophagus, stomach and upper portion of small intestine. The impulse traverses by both vagal and sympathetic afferent nerve fibres to the vomitting centre from where motor impulse that cause vomitting are transmitted by way of 5th, 7th, 9th, 10th & 12th cranial nerves to the upper GIT causing vomitting. Thus vomitting may be initiated by nervous signals arising in the brain. Stimulation of the floor of 4th ventricle called chemoreceptor trigger zone with the help of administration of certain drugs initiate vomitting. If the gastric contents are incompletely digested are vomited out with a burning sensation associated with abdominal pain, vertigo, etc. Viral encephalitis may also be considered which is associated with high grade fever, focal neurological signs and seizures. These emergencies are difficult to treat so as said by Caraka that pitta and kapha āvr̥ta prāna are difficult to treat.

Kapha Āvr̥ta Prāna

Vridha kapha opposes the gati of controller prāna hence inspiration and expiration functions are hampered at the same time chardi, ṣṭhīvana and kṣavathū symptom increases in frequency. Depression of respiratory centre in the medulla should be considered. Abnormal ventilation may be considered as in case of COPD where in mucus plugs prevent the gases exchange. The mucus accumulated in nasal and throat cavity obstructs the gati of prāna causing irritation, the afferent impulses passes to the medulla where the reflex of kṣavathū and ṣṭhīvana is triggered the same impulse also stimulates the vomitting centre causing chardi.

Pitta Āvr̥ta Udāna

Karma of udāna vāyu is to generate urjā, it is vāka pravriti mulak, prayatna bala, varna, kārak along with srotas prinan, dhi dhriti smriti mano bodhana are the karma of udāna. The pitta which has increased quantitatively along with its tiksna, uṣṇā etc guna is responsible for āvarana of udāna vāyu. Thus prayatna, bala, varna nāśa take place similar to the ojo bhransa explained by Sushruta, body gets fatigue as there is reduced energy and burning sensation between nābhi and ura along with murchha, dāha bhrama ādi vridha pitta lakshana. As ATP production is hampered (Urjā hāni) metabolism gets hampered leading to GERD (Gastro Eosophageal Reflux Disease) causing heart burn and associated symptoms like fatigueness vertigo etc.

Kapha Āvr̥ta Udāna

Śītā, guru, manda guna yukta vridha kapha has qualities opposite of vāta. Especially when vitiated kapha impedes udāna vāyu, vāka pravriti, bala, varna, utsāha are loss thus creating the above symptoms. Pānini has explained swarotpatti in which he says ātmā and budhi come together and they give prerana to the mana which further stimulates vāyu and it moves upward through the thorax cavity and with the help of astasthān helps in shabdhotpati. Vāyu prakār which is moving in thorax cavity in upward direction should be understood as udāna. Kapha obstructs this particular gati causing vākswargraha, thus muscular movement in larynx mouth and respiratory system does not occur in succession causing dysarthria. As ATP is unable to generate energy, daurbalya and guru gātratā symptoms are enhanced. Pitta āvr̥ta Samāna Pitta gives āshraya for agni while Samāna is said to be agni uttejaka bhava. When āvarana of Samāna takes place abhāva of agni uttejana occurs but it takes with the help of pitta hence there are generalised symptoms of pittavridhi with usma upaghāt. Hence excessive sweating leading to trishna associated with dāha murcha aruchi which are pittavridhi samānya lakshana. Zollinger Ellison Syndrome may be understood in this case wherein gastrinoma secretes large amount of gastrin which stimulate the parietal cells of stomach to secrete acid to their maximal capacity. Increase aldosteronism may also be considered under pitta āvr̥ta samāna. Kapha āvr̥ta Samāna In Kapha āvr̥ta Samāna the śītā , manda guru guna obstructs gati of Samāna. Thus agni uttejaka abhavta is seen leading to agnimandya. Difference between the pitta and kapha āvr̥ta samāna is the excessive drava gunatmaka vridhi which prevents agnivridhi in case of pittāvr̥ta samāna while incase of kaphāvr̥ta samāna the enzymes are absent and there is no conversion of ATP. Pitta āvr̥ta vyāna Vyāna vāyu is responsible for all gati, prasarana, ākuncana, utshepa, avakshepa, nimesha unmesha ādi kriya. Whenever āvarana of vyāna vāyu takes place sanga or restriction of sarvānga gātra takes place and dāha, santāpa are the sāmānya lakshana of vridha pitta. Inflammatory myopathies may be considered under pitta āvr̥ta vyāna. Systemic features like fever and fatigue are common. Other systemic autoimmune disease such as SLE (Systemic lupas erythomatosis) or vasculitis can also cause myositis. Polymyalgia rheumatica may also be considered where in muscular pain and stiffness is present. There is no true vasculitis but there is close association with giant cell arteritis, fatigueness, fever and depression. Kapha āvr̥ta vyāna In case of kapha āvr̥ta vyāna gurutā ādi are samānya lakshana of vridha kapha. Fibromyalgia may be considered in kapha āvr̥ta vyāna. In this disorder there is no structural, inflammatory or endocrine abnormality. Marked fatigability, pain along with signs of osteoarthritis is observed. Pitta āvr̥ta apāna The quantitatively increased pitta offers resistance to the gati of apāna. Role of apāna is dharana of the sharir. Mala bhāg is excreted out with the help of apāna vāyu, raja pravartan, garbha nishkraman are also functions of apāna. The vridha pitta imparts its haridra peeta varna to mūtra and purisa. Due to its usna and tikshna guna santāpa is felt at guda or medra sthāna. Pitta is mala bhāg of rakta and rakta helps in poshan of raja dhātu. Both pitta and raja have samāna gunadharma hence pitta vridhi also leads to raja vridhi causing raja atidarshan. This condition may be compared with infective inflammatory changes in urethra, anorectum and vagina. HSV (Herpes simplex virus) increases vaginal discharge along with vulval pain and dysuria. In trichomoniasis infection there is vulva and vaginal inflammation along with froathy yellow / green discharge. HSV and trichomoniasis may also be responsible for proctitis and urethritis. Kapha āvr̥ta apāna The snigdha, guru, pichchhila, drava guna yukta kapha has its resemblance similar to meda and kleda does the bahudrava kapha when gets basti prabhava and along with meda and kleda reach the mūtravaha srotas and get settle at glomerulus (āsādya pratirudyate gatwā awatistate) leading to utpatti of kaphaj prameha. This condition can be compared with alimentary glycosuria, a rapid but transitory rise of blood glucose following a meal. The concentration exceeds the normal renal threshold; during this time glucose will be present in the urine. Vridha kapha by its snigdha, pichchhil, āma swaroop, guna changes the consistency and physical appearance of the mala converting it into bhinna, āma, kapha sansrista guru varca. Prognosis of Pitta and Kapha Āvr̥ta vāta Prakār - Ācharyas beleive āvarana of prāna and udāna vāyu by both kapha, pitta are a serious condition. - Anabhisyandhi, snigdha and sroto shodhak dravya should be selected. - Yāpana basti with madhur rasa pradhan dravya. - Anuvāsan basti - If patient is balwan mrudu anuloman is useful - Rasāyana cikitsā to be followed - Shilajeet and guggulu should be administered along with milk. - Use of Lasuna, guggulu, shilajeeta rasāyana are mentioned here specificaly, shows their importance in breaking mārgasya āvarana/avarodha. - Chyavanprasa and Abhayaamalaki rasayan should be given. - If apāna vāyu does the āvarana then deepana, grāhi, vāta anulomaka and pakvashaya shodhana dravya should be selected. - In āvarana due to pitta, therapy which alleviates pitta but does not work against vāyu should be given. - If kapha does the āvarana then therapies which reduce kapha and which do anuloma of vāta should be selected. Reference 1. Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/8; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 2. B C Joshy, Neurology in Ancient India – some evidences, Indian journal of History of science, 19(4):366-396(1984) 3. Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Sutrasthānam 28/4; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000. 4. Ibid 1/42 5. Ibid 12/3 6. Vagbhata Vridha, Astangasamgraham with Sasilekha Commentary Sutrasthāna20/2; Sreekumari Amma (eds.) 1st ed. Trivandrum: Publication Division; Ayurveda College, 2000. 7. Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Shareerasthāna; 1/29-30; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000. 8. Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/5; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 9. Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Vimanasthāna; 8/98; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000. 10. Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/9; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 11. Ibid 1/8 and Dal. on above. 12. Sushruta. Sushrutasamhita with Nyayachandrika Commentary, Nidanasthānam 1/14; Vd. Yadavji Trikmji Ācharya (eds), Reprint, Choukhamba Krishnadas Academy, 2004, Gayadasa on above. 13. Vagbhata Vridha, Astangasamgraham with Sasilekha Commentary Sutrasthāna22/18; Sreekumari Amma (eds.) 1st ed. Trivandrum: Publication Division; Ayurveda College, 2000. 14. Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Chikitsasthāna; 28/215; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000; Chakrapāni on above 15. Ibid 28/61 16. Prakash Mangalasseri, Baghel MS, Anup Thakar, Skandhan KP et al; A Clinical Study on Śukragatavāta with special reference to Premature Ejaculation and its management by Akarakarabhadiyoga and Yāpanavasti 17. Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Vimanasthāna; 5/13; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000. 18. Vagbhata, Astangahrdayam; Shareerasthānam 5/67; BhishagĀcharya Harisastri Paradikara Vaidya (eds.) 9th ed. Varanasi: Chaukhambha Orientalia; 2005. P798 19. Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Sutrasthāna 14/5; Vd. Yadavji Trikmji Ācharya (eds), Reprint, Choukhamba Krishnadas Academy, 2004 20. Suzanne M. de la Monte, M.D., M.P.H and Jack R. Wands, M.D et al; Alzheimer's Disease is Type 3 Diabetes–Evidence Reviewed; J Diabetes Sci Technol. Nov 2008; 2(6): 1101–1113. Published online Nov 2008. 21. J. Klein, Membrane breakdown in acute and chronic neurodegeneration: focus on choline-containing phospholipids, Journal of Neural Transmission, August 2000, Volume 107, Issue 8-9, pp 1027-1063 (abstract accessed online at http://link.springer.com/article/10.1007 /s007020070051on 29.07. 2014)