Changes

|data1 = [[Chikitsa Sthana]] Chapter 28

|data1 = [[Chikitsa Sthana]] Chapter 28

|label2 = Preceding Chapter

|label2 = Preceding Chapter

|data2 = [[Urusthambha Chikitsa]]

|data2 = [[Urustambha Chikitsa]]

|label3= Succeeding Chapter

|label3= Succeeding Chapter

}}

}}

==([[Chikitsa Sthana]] Chapter 28, Chapter on disorders caused by ''vata dosha'')==

==[[Chikitsa Sthana]] Chapter 28, Chapter on disorders caused by ''vata dosha''==

=== Abstract ===

=== 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.  

[[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.''

'''Keywords''': ''Akshepaka, Anyonyavarana, Apana, Ardita, Avabahuka, Avarana,'' Ayurveda, Convulsive disorders, ''Dhatukshaya,'' Facial palsy, ''Gatavata,'' General Line of treatment of ''Vatavyadhi, Gridhrasi,'' Neurological disorders, ''Pakshaghata, Prana, Samana,'' Sciatica, Specific treatments of ''Vatavyadhi'', Stroke, ''Udana, Vishwachi, Vyana.''

=== Introduction ===

=== Introduction ===

''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).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/8; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

''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).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/8; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

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)<ref>B C Joshy, Neurology in Ancient India – some evidences, Indian journal of History of science, 19(4):366-396(1984)</ref>. 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''.  

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, twelve 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)<ref>B C Joshy, Neurology in Ancient India – some evidences, Indian journal of History of science, 19(4):366-396(1984)</ref>. 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 [[Charak 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 ''vata''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Sutrasthānam 28/4; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref>. 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.

''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 ''vata''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Sutrasthānam 28/4; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref>. 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.

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.

==== Clinical features of vitiation of ''vata'' at different sites ====

==== Clinical features of vitiation of ''vata'' at different sites ====

===== ''Koshthashirta vata'' (vitiation at gastrointestinal tract) =====

===== ''Koshthashrita vata'' (vitiation at gastrointestinal tract) =====

तत्र कोष्ठाश्रिते दुष्टे निग्रहो मूत्रवर्चसोः ||२४||  

तत्र कोष्ठाश्रिते दुष्टे निग्रहो मूत्रवर्चसोः ||२४||  

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē vātavyādhicikitśītāṁnāmāṣṭāviṁśō'dhyāyaḥ||28||  

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē vātavyādhicikitśītāṁnāmāṣṭāviṁśō'dhyāyaḥ||28||  

Thus, in the section on ‘Therapeutics’, in the treatise compiled by Agnivesha and revised by Charaka, the twenty-eighth chapter entitled ‘The therapeutics of ''vata'' diseases’ not being available, the same as restored by Dridhabala, is completed.[28]

Thus, in the section on ‘Therapeutics’, in the treatise compiled by Agnivesha and revised by Charak, the twenty-eighth chapter entitled [[Vatavyadhi Chikitsa]] not being available, the same as restored by Dridhabala, is completed.[28]

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

==== Nature of ''vata'' ====

==== Nature of ''vata'' ====

''Pitta'' and ''kapha'' are relatively compact and in corporeal form. On the contrary ''vata'' is incorporeal (''avayavasamghātarahita''). It can be termed as rarified in nature. The ''vata'' is ''anavasthita'' (unstable) too. These two properties are due to its composition formed by ''akasha'' and ''vayu'' predominantly<ref> Vagbhata Vridha, Astangasamgraham with Sasilekha Commentary Sutrasthāna20/2; Sreekumari Amma (eds.) 1st ed. Trivandrum: Publication Division; Ayurveda College, 2000.</ref>  which are incorporeal (''amurta''). ''Chalatva'' (mobility) and ''apratighata'' (unobstructability) are characteristics of ''vayu'' and ''akasha'' perceptible by the tactile sense organ<ref> Agnivesha, ''Charaka Samhita'' with Ayurveda Dipika commentary Shareerasthana; 1/29-30; Dr.Gangasahay pandey (eds.) 6th  ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000 </ref>. The biological ''vata'' (which is present in the living being) is self originated (''svayambhu''), subtle (''sukshma'') and all pervasive (''sarvagata''). It is invisible (''avyakta'') but its activities are patent or manifest (''vyaktakarma'').<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/5; Vd. Yadavji Trikamji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

''Pitta'' and ''kapha'' are relatively compact and in corporeal form. On the contrary ''vata'' is incorporeal (''avayavasamghātarahita''). It can be termed as rarified in nature. The ''vata'' is ''anavasthita'' (unstable) too. These two properties are due to its composition formed by ''akasha'' and ''vayu'' predominantly<ref> Vagbhata Vridha, Astangasamgraham with Sasilekha Commentary Sutrasthāna20/2; Sreekumari Amma (eds.) 1st ed. Trivandrum: Publication Division; Ayurveda College, 2000.</ref>  which are incorporeal (''amurta''). ''Chalatva'' (mobility) and ''apratighata'' (unobstructability) are characteristics of ''vayu'' and ''akasha'' perceptible by the tactile sense organ<ref> Agnivesha, ''Charak Samhita'' with Ayurveda Dipika commentary Shareerasthana; 1/29-30; Dr.Gangasahay pandey (eds.) 6th  ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000 </ref>. The biological ''vata'' (which is present in the living being) is self originated (''svayambhu''), subtle (''sukshma'') and all pervasive (''sarvagata''). It is invisible (''avyakta'') but its activities are patent or manifest (''vyaktakarma'').<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/5; Vd. Yadavji Trikamji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

Anavasthita (unstable) is due to chala property of ''vata''.  This continuous moving nature of ''vata'' is explained with other terminologies also like ''sheeghravata''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Vimanasthāna; 8/98; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref> (swift movement), ''ashukari'' (instantaneous action), ''muhushchari'' (rhythmic movement).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/9; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004</ref>. It abounds in the fundamental quality of ''raja'' (the principle of cohesion and action). The predominance of ''raja'' is responsible for the instability of ''vata''. The quality of ''chalatva'' is directional in nature, which is explained by the term ''gati''. ''Vata'' convenes all bodily activities by this important feature.

Anavasthita (unstable) is due to chala property of ''vata''.  This continuous moving nature of ''vata'' is explained with other terminologies also like ''sheeghravata''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Vimanasthāna; 8/98; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref> (swift movement), ''ashukari'' (instantaneous action), ''muhushchari'' (rhythmic movement).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/9; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004</ref>. It abounds in the fundamental quality of ''raja'' (the principle of cohesion and action). The predominance of ''raja'' is responsible for the instability of ''vata''. The quality of ''chalatva'' is directional in nature, which is explained by the term ''gati''. ''Vata'' convenes all bodily activities by this important feature.

==== Properties of ''vata'' ====

==== Properties of ''vata'' ====

In chapter vātakalākalīya (Cha.Su.12), questions have been raised about exciting and alleviating factors regarding qualities of vāta. Rūkṣa(dry), laghu(light ), shītā(cool), dāruna (dreadful), khara (rough) and vishada (clean) have been explained as qualities of vāta. Repeated use of substances with these qualities and actions of such similar qualities causes aggravation 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, functions of nervous system. 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. These can be influenced by diet and medicine on the basis of similar increase and opposite decrease. .

In [[Vatakalakaliya Adhyaya]], questions have been raised about exciting and alleviating factors regarding qualities of ''vata''. ''Ruksha''(dry), ''laghu''(light), ''sheeta''(cool), ''daruna'' (dreadful), ''khara'' (rough) and ''vishada'' (clean) have been explained as qualities of ''vata''. Repeated use of substances with these qualities and actions of such similar qualities causes aggravation and excitation of ''vata'' and is alleviated by use of substances possessing contrary qualities. This brings out the phenomenon of two mutually interrelated and inseparable of ''sharira vayu'' viz.  

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.

#that, the ''sharira vayu'' is a biophysical force and  

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.

#that it is closely associated with material substances which form part of the structure of the body for example, functions of nervous system. 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 samanya''), qualities (''guna samanya'') and actions (''karma samanya'') and inhibited by substances with opposite properties. In other words, it may be concluded that the bio – physical force – the ''sharira vayu'' – is closely linked with some material structural factors. These can be influenced by diet and medicine on the basis of similar increase and opposite decrease.

 

Sodium, potassium, calcium, and chloride ions are continuously moving around (brownian movement) which is the result of their ionic state (''swabhava / 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 vayu'' and as per modern science too their concentration depends on ''ahara'' 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)

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: 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 quality of vāta and sharira (physical body) is yantra for functioning of tantra. 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). (verse 5-11)   

 

General etiological factors and basic pathogenesis of vāta disorders: 

===== Types of ''vata dosha'' =====

 

In Vedic literature, as a medical system, the important five types of ''vata'' are explained with their locations and functions. The word ''tantrayate'' is used to explain the functional quality of ''vata'' and ''sharira'' (physical body) is ''yantra'' for functioning of ''tantra''. The ''vata dosha'' on basis of its functions is classified into five types. They reside in the ''sharira'' at the level of ''sharira parmanu'' (cell) and also at gross level. Five types of ''vata'' work together in a synchronized manner for the normal functioning of the ''sharira'' (''vayu tantrayantra dhara''). (verse 5-11)  

   

==== General etiological factors and basic pathogenesis of ''vata'' disorders ====

The etiological factors can be divided into two:

The etiological factors can be divided into two:

a) which cause direct vāta vitiation and  

#which cause direct ''vata'' vitiation and  

b) which cause indirect vāta vitiation.  

#which cause indirect ''vata'' 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:

Daysleep (''divaswapna'') do not directly lead to vitiation of ''vata''. However, it leads to formation of ''ama'' and cause ''vata'' vitiation indirectly by obstructing ''vata''. ''Vegasandharana'' (suppression of natural urges) and ''marmabhighata'' (trauma to vital organs) etc. are examples of direct vitiation. The pathogenesis is also bi-fold. The initial pathology is aggravation of ''vata'' and diminution of ''dhatus'' and vice versa. One augments the other. This ultimately causes emptiness in channels and rarity in tissues which gives more space for movements of ''vata''. The second pathology is by increase in ''dhatus'' leading to excessive filling in channels to cause their clogging and blocking ''vata''. (verse 15-19)

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 appreciable gap. (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, ushṇā  and tikshna aushadha like mishraka snēha may be a good treatment option. If the same vāta gets vitiated in āmāshaya due to snigdha vriddhi, it leads to gastro-esophageal reflux disease (GERD), rūkṣa uṣṇā and tikshna like gomūtra bhavita shaddharana is the ideal treatment option. Anuvasana is the ideal therapy in vata vitiated in pakwashaya, whereas vamana is the best therapy in vata vitiated in amashaya. (verse 20-24)

===== Premonitory signs and symptoms =====

Three modes of pathogenesis of vata diseases:

 

The three characteristics of vāta vitiation viz. svātantra dushti (vitiation due to independent specific causes), gata vāta (increased movement of vata) and āvarana (obstruction to movement of vata). imply three possible modes of pathogenesis in vāta diseases. These can be further analysed as follows; due to the following three important properties of vāta, it is regarded entirely different from other dōsha5.

Clinical manifestations may not be apparent because of vague manifestation of symptoms (''Avyaktam lakshanam''). 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 appreciable gap. (verse 19-20)

1. Asamghāta (Incorporeal)

 

2. Anavasthita (Unstable)

===== Clinical features =====

3. Anāsādhya (Inaccessible)

 

Pathogenesis of various conditions:

The clinical presentations vary according to the specificity of ''hetu'' (cause) and ''sthana'' (location). The treatment options also vary accordingly. For example if ''vata prakopa'' takes place due to ''ruksha vriddhi'' in ''pakvashaya'' it may lead to habitual constipation in which ''snigdha, ushna'' and ''tikshna aushadha'' like ''mishraka sneha'' may be a good treatment option.  

All the verses explain a specific type of samprapti (pathogenesis) like Kōṣṭhagata vāta (vata affecting alimentaty tract), āmāshayagata vāta (vata affecting stomach.) 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 dosha may occupy any particular site or area and lead to diseases. This type of pathology of vitiated vāta is called as gatavāta.  Normally in all gatavāta, the affected dushya(vitiated body components) 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 (liquid state) and undergoing conversion (parinām āpadyamānanām) and they are being vikshepita (circulated) from their mulasthān (origin) throughout the sharir (abhivahan) for the purpose of poshana (nourishment) 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 (vein), dhamani (artery), rasāyani (capillary), rasavāhini (channels carrying nutrient fluid), nādi (nerve), panthāna (pathway), sharir chhidra (perforated channel), samvrita-asamvritāni (covered or uncovered), sthāna (site), āshaya (organ), niketa (habitat), sharirdhātu avakāsha (hollow space in body tissues).

 

Prakupita(vitiated) dosha have the capacity to further vitiate both sthānastha dhātu (fixed tissue element) as well as margagata (circulating tissue elements) sharir dhātu. When prakupita vāta vitiates the dhātu, it is called as gatavāta. In this condition, vitiated vata affects the specific site due to specific etiological factors. While designing treatment protocol, in this context specific etiological factors 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 is dushya (getting vitiated).

If the same ''vata'' gets vitiated in ''amashaya'' due to ''snigdha vriddhi'', it leads to gastro-esophageal reflux disease (GERD), ''ruksha ushna'' and ''tikshna'' like ''gomutra bhavita shaddharana'' is the ideal treatment option. ''Anuvasana'' is the ideal therapy in ''vata'' vitiated in ''pakwashaya'', whereas ''vamana'' is the best therapy in ''vata'' vitiated in ''amashaya''. (verse 20-24)

Koshthagata vata: Vāta getting vitiated in the kōṣṭha (elimentary tract) is explained as koshthagata vata.  

 

Gudagata vata: It can also be explained that gudagata vāta and pakvāśayagata vāta are different clinical entities. In gudagata vāta, obstruction of stool, urine and flatus is observed, whereas in pakvāśayagata vāta there ispainful defecation, micturition with āntrakujan (gurgling sound), ātopa (distension) and ānāha (constipation). Ashma sarkara (urolith) is exclusively present in gudagata vāta with pain and atrophy in calf muscles, thighs, sacram, feet and back. This can be compared with lumbo-sacral plexopathy. It may be understood as in case of pakvāśaya gatavāta, 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.

===== Three modes of pathogenesis of ''vata'' diseases =====

Amashayagata vata: This is a typical presentation of vata leaving its own site and vitiating other site. Here the local dosha is considered important because it is more virulent than the external dosha coming from other sites. The clinical entities originating from āmashaya (stomach) are caused due to vitiated vāta entering into āmashaya. It increases emptiness of stomach leading to indigestion or āma pradōṣaja vikāra like visuchika (diarrhea) etc.

 

Indriyagata vata: Indriyagata vāta is applicable to any sense organ. Indriya vadha may be interpreted as complete, partial or minimal loss of sensation. ‘Shrotra’(ears) 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’ (motivating factors for all sense organs).

The three characteristics of ''vata'' vitiation viz. ''svatantra dushti'' (vitiation due to independent specific causes), ''gata vata'' (increased movement of ''vata'') and ''avarana'' (obstruction to movement of ''vata''). imply three possible modes of pathogenesis in ''vata'' diseases. These can be further analyzed as follows; due to the following three important properties of ''vata'', it is regarded entirely different from other ''dosha''<ref>Ibid 12/3</ref>.

Twakgata vata: Tvak (skin) is referred as somatic organ even though it is a sensory organ. Supti (numbness) and tōda (pricking sensation) 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 derivative of rasa and is included in shakha. Tvakindriya gatavāta should be understood under indriyagatavāta.

#''Asamghāta'' (Incorporeal)

Siragata vata:

#''Anavasthita'' (Unstable)

When vāta afflicts sirā (blood vessel) 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. Two different conditions of vascular diseases i.e. aneurysym (mahat) and atherosclerosis / venous thrombosis (tanu) are examples.

#''Anāsādhya'' (Inaccessible)

 

==== Pathogenesis of various conditions ====

 

All the verses explain a specific type of ''samprapti'' (pathogenesis) like ''koshthagata vata'' (''vata'' affecting alimentary tract), ''amashayagata vata'' (''vata'' affecting stomach.) 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 ''dosha'' may occupy any particular site or area and lead to diseases. This type of pathology of vitiated ''vata'' is called as ''gatavata''.  Normally in all ''gatavata'', the affected ''dushya''(vitiated body components) will be ''kshina'' (depleted) and affected ''srotas'' will be ''rikta'' (empty). The concept of ''gatavata'' can be further explored physiologically. ''Dhatu'' are classified into two types’ ''asthayi'' (temporary) ''dhatu'' and ''sthayi'' (permanent) ''dhatu''. ''Asthayi dhatu'' are the ones which are ''dravaswarupa'' (liquid state) and undergoing conversion (''parinam apadyamananam'') and they are being ''vikshepita'' (circulated) from their ''mulasthana'' (origin) throughout the ''sharira'' (''abhivahana'') for the purpose of ''poshana'' (nourishment) of the ''sthayi dhatu''. This ''parinamana'' (conversion) and ''abhivahana prakriya''(transportation) takes place in ''marga'' (channel) which are known as ''srotas''; hence ''marga'' is one of the synonym used for ''srotas'' along with ''sira'' (vein), ''dhamani'' (artery), ''rasayani'' (capillary), ''rasavahini'' (channels carrying nutrient fluid), ''nadi'' (nerve), ''panthana'' (pathway), ''sharira chhidra'' (perforated channel), ''samvrita-asamvritani'' (covered or uncovered), ''sthana'' (site), ''ashaya'' (organ), ''niketa'' (habitat), ''shariradhatu avakasha'' (hollow space in body tissues).

 

''Prakupita''(vitiated) ''dosha'' have the capacity to further vitiate both ''sthanastha dhatu'' (fixed tissue element) as well as ''margagata'' (circulating tissue elements) ''sharira dhatu''. When ''prakupita vata'' vitiates the ''dhatu'', it is called as ''gatavata''. In this condition, vitiated ''vata'' affects the specific site due to specific etiological factors. While designing treatment protocol, in this context specific etiological factors for each and every ''gatavata'' related diseases must be observed to clarify why vitiated ''vata'' goes to specific part of the body or to specific ''dhatu'' to develop ''kosthagata vata, raktagata vāta'' etc. In this condition, ''dhatu'' is ''dushya'' (getting vitiated).

 

''Koshthagata vata'': ''Vata'' getting vitiated in the ''koshtha'' (alimentary tract) is explained as ''koshthagata vata''.  

 

''Gudagata vata:'' It can also be explained that ''gudagata vata'' and ''pakvashayagata vata'' are different clinical entities. In ''gudagata vata'', obstruction of stool, urine and flatus is observed, whereas in ''pakvashayagata vata'' there is painful defecation, micturition with ''antrakujana'' (gurgling sound), ''atopa'' (distension) and ''anaha'' (constipation). ''Ashma sarkara'' (urolith) is exclusively present in ''gudagata vata'' with pain and atrophy in calf muscles, thighs, sacram, feet and back. This can be compared with lumbo-sacral plexopathy. It may be understood as in case of ''pakvashaya gatavata'', proximal part of large intestine along with ascending, transverse and descending colon is involved; whereas in ''gudagata vata'', involvement of sigmoid colon, rectum, anus and their nerve supply.

 

'''Amashayagata vata''': This is a typical presentation of ''vata'' leaving its own site and vitiating other site. Here the local ''dosha'' is considered important because it is more virulent than the external ''dosha'' coming from other sites. The clinical entities originating from ''amashaya'' (stomach) are caused due to vitiated ''vata'' entering into ''amashaya''. It increases emptiness of stomach leading to indigestion or ''ama pradoshaja vikara'' like ''visuchika'' (diarrhea) etc.

 

''Indriyagata vata'': ''Indriyagata vata'' is applicable to any sense organ. ''Indriya vadha'' may be interpreted as complete, partial or minimal loss of sensation. ''Shrotra''(ears) has specific importance among other ''indriya'', in which inherent ''dosha'' of ''shrotra'' is ''vata'' itself. So ''vata prakopa'' in ''shrotra'' is more impacting. It is worthy to remember the notion in ''vatakalakaleeya'' that ''vata'' is ''sarvendriyanam udyojaka'' (motivating factors for all sense organs).

 

''Twakgata vata'': ''Tvak'' (skin) is referred as somatic organ even though it is a sensory organ. ''Supti'' (numbness) and ''toda'' (pricking sensation) are not symptoms specific to ''tvakindriya.'' Here ''tvak'' represents ''rasa dhatu''. ''Rasa'' does not have cellular pattern and hence not included in ''shakha''. The ''tvak'' is derivative of ''rasa'' and is included in ''shakha''. ''Tvakindriya gatavata'' should be understood under ''indriyagatavata.''

 

''Siragata vata'': When ''vata'' afflicts ''sira'' (blood vessel) it may broaden or narrow the sirā. Widening may lead to ''shopha'' and narrowing may lead to ''shosha'' or vice versa as per the site of affliction. Two different conditions of vascular diseases i.e. aneurysym (''mahat'') and atherosclerosis / venous thrombosis (''tanu'') are examples.

13. Successive diminuation of rasadi dhātu possible 14. None.

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.  

''Sandhigata vata'' (osteoarthritis): There is depletion of periarticular and articular tissue by vitiated ''vata'' in ''sandhigata vata''/osteoarthritis, empty spaces are occupied by ''vata'' which is felt as crepitus on palpation. ''Vata'' also causes hypertrophic tissue in the form of osteophytes and causes painful flexion and extension movements. This is the characteristic feature of swelling in ''sandhigata vata''.  

Prognosis: Exclusive vata disorders are serious and have poor prognosis. The symptoms / diseases explained manifest when vitiated vāta affects vital parts. The therapeutic approaches should be cautious and extra efforts are 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 in determining prognosis. (verse 72-74)  

General principles of management: The general line of management of Vātavyādhi applies to absolute vāta vitiation only. If there is any association or obstruction of other dosha in Vātavyādhi, the treatment will be different. Kevalam term indicates pathology of vitiation of exclusive vata. Nirupastambha is condition without any association of other dosha. This pathology shall be primarily treated with oleation therapy.

 

As in exclusive vātaja disease the major gunavriddhi is rūkṣa which leads to riktatā in srotas and dhātu and more avakāsha (space) for vāta; Snēhana is essential and ideal. Various methods for snēhana are employed depending on avastha (stage), sthāna (site) and bala (strength) of the diseases and as well as patient.

Following snēhana, swedana is also mandatory. Here the ushṇā  guna (hot property) operates to control śītā (cold).  Repeated snēhana and swedana imparts high grade of flexibility.  

 

Snēha is a good medium to control vāta as well as vāta-pitta. Generally, this line of treatment can be counted as a part of brimhana. (verse 75-83)

Repeated snēhana and swedana therapies can control vāta well. However, samshodhana (purification) therapies are executed to remove the residual dosha. As shodhana has a definite chance for causation of vāta prakopa, the approach should be cautious, so mridu samshodana (mild purification) is done. Snēha virēchana is done by tilwaka ghrita or erand taila etc. Eraṇḍataila is very effective in treating vāta prakopa due to udāvarta. If virēchana is not possible, anulomana diet should be adviced. If the patient is extremely weak niruha is better option. Even after shodhana; recurrent application of snēhana and swedana are essential.(verse 83-88)  

 

Management of vata at different sites:

Treatment of disorders of vāta, when located in different sites, habitat (sthāna) is more important in comparison to the invaded (āgantu) dosha e.g in kōṣṭhagata vāta, kōṣṭha is given preference in treatment, and so kshara is used which helps in digestion (pāchana). But when vāta is located in pakvāśaya or guda which is vātasthāna, udāvartahara treatment is selected, which includes vāta anulomana, basti, varti etc. In āmashayagata vāta, shodhana in the form of vamana is done.  

 

Hridya anna (favourite food) is typically indicated in tvakgata vāta because, rūkṣatā in tvak is a result of rasakṣaya caused by 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 (depletion of shukra), harshana (pleasure) and vrishya annapāna (aphorodisiac diet) is very useful. 18

Management of ardita (facial palsy):

 

The line of treatment of ardita aims at mastishkya (brain), therefore, nasya is indicated. Nasya is explained to be the direct entrance to the cranial vault. Nasya may be shodhana, shamāna 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 meant for treatment in head region and is of four types viz. abhyanga ( head massage), seka (pouring liquid on head), pichu ( therapeutic unctuous swab on head) and shirobasti. Tarpana (nourishment therapy ) is akshitarpana ( nourishing eyes) and shrotratarpana (nourishing ears). Nadisweda is very specific in ardita and ksheeradhooma (medicated fumes of milk). Poultice prepared from flesh of marshy animals is used for brimhana in atrophy of muscles. Vamana is indicated in ardita, when it is associated with śōpha and raktamokshana is indicated when associated with dāha (burning) and raga (redness).

In Pakṣāghāta, swedana, fomentation mixed with unctuous material and virechana or purgation therapy with unctuous substance 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 (bleeding from upper orifices of body) in which the only and effective choice is adho-shodhana (purgation). Gr̥dhrasī is a tendon and ligament disorder and shastra, kshara, agnikarma are the main line of treatment. Therefore sirāvyadha (blood letting) and dāhakarma (cauterization) is advised. Basti is also a good choice since pakvāśayagata vāta leads to kateegraha and gr̥dhrasī.  

 

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)

Agni karma :  Agnikarma is a para surgical procedure in which a metallic thin pointed rod called shalaka is heated. Then the hot shalaka is touched to specific points of pain for relieving. It is commonly used as efficient pain reducing therapy in musculoskeletal disorders.  

 

Importance of site of affliction in treatment:

 

 

 

 

 

 

'''Prognosis''': Exclusive ''vata'' disorders are serious and have poor prognosis. The symptoms / diseases explained manifest when vitiated ''vata'' affects vital parts. The therapeutic approaches should be cautious and extra efforts are 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 in determining prognosis. (verse 72-74)

'''General principles of management''': The general line of management of ''vatavyadhi'' applies to absolute ''vata'' vitiation only. If there is any association or obstruction of other dosha in ''vatavyadhi'', the treatment will be different. ''Kevalam'' term indicates pathology of vitiation of exclusive ''vata''. ''Nirupastambha'' is condition without any association of other ''dosha''. This pathology shall be primarily treated with oleation therapy.

As in exclusive ''vataja'' disease the major ''gunavriddhi'' is ''ruksha'' which leads to ''riktata'' in ''srotas'' and ''dhatu'' and more ''avakasha'' (space) for ''vata''; ''snehana'' is essential and ideal. Various methods for ''snehana'' are employed depending on ''avastha'' (stage), ''sthana'' (site) and ''bala'' (strength) of the diseases and as well as patient.

 

Following ''snehana, swedana'' is also mandatory. Here the ''ushna guna'' (hot property) operates to control ''sheeta'' (cold).  Repeated ''snehana'' and ''swedana'' imparts high grade of flexibility.  

 

''Sneha'' is a good medium to control ''vata'' as well as ''vata-pitta''. Generally, this line of treatment can be counted as a part of ''brimhana''. (verse 75-83)

 

Repeated ''snehana'' and ''swedana'' therapies can control ''vata'' well. However, ''samshodhana'' (purification) therapies are executed to remove the residual ''dosha''. As ''shodhana'' has a definite chance for causation of ''vata prakopa'', the approach should be cautious, so ''mridu samshodana'' (mild purification) is done. ''Sneha virechana'' is done by ''tilwaka ghrita'' or ''eranda taila'', etc. ''Eranda taila'' is very effective in treating ''vata prakopa'' due to ''udavarta''. If ''virechana'' is not possible, ''anulomana'' diet should be adviced. If the patient is extremely weak ''niruha'' is better option. Even after ''shodhana''; recurrent application of ''snehana'' and ''swedana'' are essential.(verse 83-88)  

 

===== Management of ''vata'' at different sites =====

Treatment of disorders of ''vata'', when located in different sites, habitat (''sthana'') is more important in comparison to the invaded (''agantu'') '''dosha''' e.g in ''koshthagata vata, koshtha'' is given preference in treatment, and so ''kshara'' is used which helps in digestion (''pachana''). But when ''vata'' is located in ''pakvashaya'' or ''guda'' which is ''vatasthana, udavartahara'' treatment is selected, which includes ''vata anulomana, basti, varti'' etc. In ''amashayagata vata, shodhana'' in the form of ''vamana'' is done.  

 

''Hridaya anna'' (favourite food) is typically indicated in ''tvakgata vata'' because, rūkṣatā in tvak is a result of rasakṣaya caused by overworrying.<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Vimanasthāna; 5/13; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref>

 

''Bahya snehana'' in the form of ''abhyanga'' or ''dhara'', etc are very effective in ''asthi'' and ''majjagata vata''. ''Abhyantara snehana'' replenishes ''meda dhatu'' and subsequently ''asthi'' and ''meda''. It is worthy to note the utility of ''tikta ghrita'' in ''asthikshaya''.  

   

In ''shukrakshaya'' (depletion of ''shukra''), ''harshana'' (pleasure) and ''vrishya annapana'' (aphorodisiac diet) is very useful. <ref>Vagbhata, Astangahrdayam; Shareerasthānam 5/67; BhishagĀcharya Harisastri Paradikara Vaidya (eds.) 9th ed. Varanasi: Chaukhambha Orientalia; 2005. P798</ref>

 

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

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

 

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

 

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

 

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

 

''Agnikarma'' is a para surgical procedure in which a metallic thin pointed rod called ''shalaka'' is heated and applied to specific points of pain for relief. It is commonly used as efficient pain reducing therapy in musculoskeletal disorders.

 

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

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

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

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

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

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

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

Avagaha (immersion) sweda:

Avagaha (immersion) sweda:

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

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

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

Management of avrita vata:

 

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

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

 

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

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

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

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

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

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

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

=== Reference ===

=== Related Chapter ===

 

=== References ===

<div id="BackToTop"  class="noprint" style="background-color:#DDEFDD; position:fixed;

<div id="BackToTop"  class="noprint" style="background-color:#DDEFDD; position:fixed;

  bottom:32px; left:2%; z-index:9999; padding:0; margin:0;"><span style="color:blue;

  bottom:32px; left:2%; z-index:9999; padding:0; margin:0;"><span style="color:blue;