Changes

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' ===

The concept of ''marma'' described in Ayurveda texts differs with those described in ''Keraliya Marma Chikitsa'' (''Kalari Marma'') and the Tamilian ''marma'' concept. The numbers and positions also vary greatly. The Keraliyan ''marma'' concept seems to be more related to warfare medicine and the management of trauma while the tamilian ''marma'' concept is more so as described in Ayurveda related to kshata as well well as ''doshaja aghata''. Ayurveda believes that suppression of urges, over enthusiastic activities, strainful activities, faulty treatment practices can actually cause ''doshaja marmaghata''.

The concept of ''marma'' described in Ayurveda texts differs with those described in ''Keraliya Marma Chikitsa'' (''Kalari Marma'') and the Tamilian ''marma'' concept. The numbers and positions also vary greatly. The Keraliyan ''marma'' concept seems to be more related to warfare medicine and the management of trauma while the tamilian ''marma'' concept is more so as described in Ayurveda related to ''kshata'' as well well as ''doshaja aghata''. Ayurveda believes that suppression of urges, over enthusiastic activities, strainful activities, faulty treatment practices can actually cause ''doshaja marmaghata''.

Clinical conditions like paralysis, paresis, paraplegia, quadriplegia, haemorrhage can be understood on Ayurvedic lines by taking clue from here. When it takes place at ''shirasthana'' above mentioned conditions can manifest. They need to be treated on the lines of treatment of ''marmaghata'' rather than only treating them as ''vatavyadhi''.  

Clinical conditions like paralysis, paresis, paraplegia, quadriplegia, haemorrhage can be understood on Ayurvedic lines by taking clue from here. When it takes place at ''shirasthana'' above mentioned conditions can manifest. They need to be treated on the lines of treatment of ''marmaghata'' rather than only treating them as ''vatavyadhi''.  

''Apatantraka''(opisthotomus) is due to obstruction of ''kapha'' to ''vata'', ''apatanaka''(status epilepticus) is only due to ''vata''.

''Apatantraka''(opisthotomus) is due to obstruction of ''kapha'' to ''vata'', ''apatanaka''(status epilepticus) is only due to ''vata''.

Based on the descriptions of the condition involving the heart which is the ''manasa sthana'' and the involvement of head as well, with clinical manifestations like unconsciousness with flexion spasms or bending of the body, which is temporary, this condition may be considered as a form of Syncope.

Based on the descriptions of the condition involving the heart which is the ''manasa sthana'' and the involvement of head as well, with clinical manifestations like unconsciousness with flexion spasms or bending of the body, which is temporary, this condition may be considered as a form of syncope.

Treatment schedule for ''apatantraka'' starts with ''tikshna pradhamana'' as ''prana vilomatva'' has to be corrected to maintain the life of the patient. Second in line is ''shirovirechana'', as vitiated ''vata'' creates pain in ''sirah'' and ''shankha'' by taking upward course. Then treatment for pacification of ''vata kapha'' in ''hridroga'' is applied to take care of ''hridaya'', as ''vata'' also occupies ''hridaya'' when does upward direction. Further ''basti'' would have been an ideal option to take ''vata'' into its own site and pacify it, but it should not be strong, it is to be given in lesser quantity. Involvement of ''hridaya'' in pathogenesis might have prompted this thought, as strong ''basti'' might cause dehydration due to excess elimination leading to fatal condition of ''hridaya''.

Treatment schedule for ''apatantraka'' starts with ''tikshna pradhamana'' as ''prana vilomatva'' has to be corrected to maintain the life of the patient. Second in line is ''shirovirechana'', as vitiated ''vata'' creates pain in ''sirah'' and ''shankha'' by taking upward course. Then treatment for pacification of ''vata kapha'' in ''hridroga'' is applied to take care of ''hridaya'', as ''vata'' also occupies ''hridaya'' when does upward direction. Further ''basti'' would have been an ideal option to take ''vata'' into its own site and pacify it, but it should not be strong, it is to be given in lesser quantity. Involvement of ''hridaya'' in pathogenesis might have prompted this thought, as strong ''basti'' might cause dehydration due to excess elimination leading to fatal condition of ''hridaya''.

Treatment is aimed at elimination of ''dosha'' initially followed by pacification of them by various means. Three ''sneha'' viz, ''taila, ghrita, vasa'' to be used in ''murdha taila'' form (holding these materials on head). Here ''majja'' is excluded as it is ''gurutara'' (most heavy amongst ''snehas''). ''Seka''(effusion) in the form of ''ghrita'', milk will help in pacifying ''vata'' by acting as ''brimhana'' (nourishment), at the same time ''raktaprasadana'' (pacifying the impurities in blood) is achieved. ''Nasya'' with ''jeevaniya ghrita'' is also to pacify ''vata'' and to account for ''raktaprasadana''.  

Treatment is aimed at elimination of ''dosha'' initially followed by pacification of them by various means. Three ''sneha'' viz, ''taila, ghrita, vasa'' to be used in ''murdha taila'' form (holding these materials on head). Here ''majja'' is excluded as it is ''gurutara'' (most heavy amongst ''snehas''). ''Seka''(effusion) in the form of ''ghrita'', milk will help in pacifying ''vata'' by acting as ''brimhana'' (nourishment), at the same time ''raktaprasadana'' (pacifying the impurities in blood) is achieved. ''Nasya'' with ''jeevaniya ghrita'' is also to pacify ''vata'' and to account for ''raktaprasadana''.  

In Bhavaprakasa Nighantu, due to non availability ''pratinidhi'' (substitutes) are described for ''ashtha varga'' (group of eight vitalizer herbs) drugs like ''vidarikanda'' (Pueraria tuberosa) for ''jeevaka'' and ''rshabhaka, ashvagandha'' (Withania somnifera) for ''kakoli'' and ''kshirakakoli, varahikanda'' (Dioscorea bulbifera) for ''riddhi'' and ''vriddhi, shatavari'' (Asparagus racemosus) for ''meda'' and ''mahameda''.

In Bhavaprakasa Nighantu, due to non availability, ''pratinidhi'' (substitutes) have been described for ''ashtha varga'' (group of eight vitalizer herbs) drugs like ''vidarikanda'' (Pueraria tuberosa) for ''jeevaka'' and ''rshabhaka, ashvagandha'' (Withania somnifera) for ''kakoli'' and ''kshirakakoli, varahikanda'' (Dioscorea bulbifera) for ''riddhi'' and ''vriddhi, shatavari'' (Asparagus racemosus) for ''meda'' and ''mahameda''.

The description of the incidence and timing of the symptoms point to the condition of frontal sinusitis which usually starts as a dull headache in the morning that increases in severity as the day progresses. Occasionally it may be relieved by sleep or sometimes not which depends on the relative dominance of ''rakta'' and ''vata''.  

The description of the incidence and timing of the symptoms point to the condition of frontal sinusitis which usually starts as a dull headache in the morning that increases in severity as the day progresses. Occasionally it may be relieved by sleep or sometimes not which depends on the relative dominance of ''rakta'' and ''vata''.  

It is uncontroversial that nose is the gateway of head as all the authors of ''brihattrayis'' and ''laghutrayis'' have shared the importance of ''nasyakarma'' in ''shirorogas''.

It is uncontroversial that nose is the gateway of head as all the authors of ''brihattrayis'' and ''laghutrayis'' have shared the importance of ''nasyakarma'' in ''shirorogas''.

Though the exact mode of action of ''nasya'' is not studied some hypotheses have been put forward by the scholars of Ayurveda. One of them is that the medicament directly penetrates into the brain, as fat soluble substances can easily diffuse through the cribriform plate of ethmoid bone (which forms the roof of the nasal cavity) which is porous and owing to the location of olfactory bulbs the medicament can percolate along the fibers of olfactory nerve. The second most agreeable hypothesis is the receptor theory, which believes stimulation of certain brain centers through specific receptors situated in the nasal cavity. The administration of Posterior pituitary extract into nostrils by means of sprays, practically and successfully followed in diabetes insipidus is a proof sufficient that through suitable formulation, medicament may be made to act on the brain.

Though the exact mode of action of ''nasya'' is not studied some hypotheses have been put forward by the scholars of Ayurveda. One of them is that the medicament directly penetrates into the brain, as fat soluble substances can easily diffuse through the cribriform plate of ethmoid bone (which forms the roof of the nasal cavity) which is porous and owing to the location of olfactory bulbs the medicament can percolate along the fibers of olfactory nerve. The second most agreeable hypothesis is the receptor theory, which believes stimulation of certain brain centers through specific receptors situated in the nasal cavity. The administration of posterior pituitary extract into nostrils by means of sprays, practically and successfully followed in diabetes insipidus is a proof sufficient that through suitable formulation, medicament may be made to act on the brain.

It is clearly described that ''sneha nasya'' should be done in ''vata'' aggravation and ''ruksha nasya'' should be done in ''kaphaja'' diseases. If this indication is ignored the complications that may follow and the measures to tackle them is described in the above verses.

It is clearly described that ''sneha nasya'' should be done in ''vata'' aggravation and ''ruksha nasya'' should be done in ''kaphaja'' diseases. If this indication is ignored the complications that may follow and the measures to tackle them is described in the above verses.

In Ashtanga Hridaya, ten specific timings  suitable for administration of ''pratimarsha'' are described.

In Ashtanga Hridaya, ten specific timings  suitable for administration of ''pratimarsha'' have been described.

In practice, especially in conditions of migraine, allergic rhinitis and atopic rhinitis we advise patients to smear medicated oil or ghee into the nostrils using an oleated finger. This may be considered a form of ''pratimarsha'' itself.

In practice, especially in conditions of migraine, allergic rhinitis and atopic rhinitis we advise patients to smear medicated oil or ghee into the nostrils using an oleated finger. This may be considered a form of ''pratimarsha'' itself.