Changes

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''.

Fine powders of shirovirechana medicines can clear obstructive pathology faster and hence are preferred. Maricha which is pramathi i.e., with its potency drags the doshas out of srotasas (channels) and removes them from the system. Other medicines shigrubija, vidanga are known for their shirovirechana activity.

Fine powders of ''shirovirechana'' medicines can clear obstructive pathology faster and hence are preferred. ''Maricha'' which is ''pramathi'' i.e., with its potency drags the ''doshas'' out of ''srotasas'' (channels) and removes them from the system. Other medicines ''shigrubija, vidanga'' are known for their ''shirovirechana'' activity.

Vata and kapha are both considered as causative factors for the onset of tandra. Vata agitates kapha, which in turn occupies hridaya. The knowledge process gets blocked leading to tandra. Treatment aims at eliminating and pacifying kapha. Vyayama and diet of pungent and bitter tastes which acts against kapha are suitable. The unusual reference of blood letting can be attributed to involvement of hridaya, which is an organ made up of purest form of rakta.

''Vata'' and ''kapha'' are both considered as causative factors for the onset of ''tandra''. ''Vata'' agitates ''kapha'', which in turn occupies ''hridaya''. The knowledge process gets blocked leading to ''tandra''. Treatment aims at eliminating and pacifying ''kapha''. ''Vyayama'' and diet of pungent and bitter tastes which acts against ''kapha'' are suitable. The unusual reference of blood letting can be attributed to involvement of ''hridaya'', which is an organ made up of purest form of ''rakta''.

The factors that bring about physical and mental exertion with foods that prolong the digestion or are heavy for digestion bring about an aggravation of kapha with vata and tamo guna thereby producing tandra (drowsiness). Hence, all medicines that help to clear the avarana of manas by these doshas may be employed, especially so teekshna pradhamana nasya.

The factors that bring about physical and mental exertion with foods that prolong the digestion or are heavy for digestion bring about an aggravation of ''kapha'' with ''vata'' and ''tamo guna'' thereby producing ''tandra'' (drowsiness). Hence, all medicines that help to clear the ''avarana'' of ''manas'' by these ''doshas'' may be employed, especially so ''teekshna pradhamana nasya''.

The mutravaha srotovikaras have been broadly classified into mutra atipravrittija (excess urination) and mutra apravrittija (less urination) vikaras by Vagbhata (A.H.Ni.9/40). The former includes twenty varities of prameha and the latter includes two categories of disorders – 8 types of mutrakrcchra (dysuria) and 12 types mutraghata (urinary disorders), though both the set of disorders are described under the title mutraghata. Under mutraghata, bastikundala (circular distension of bladder) is not described.  

 

The ''mutravaha srotovikaras'' have been broadly classified into ''mutra atipravrittija'' (excess urination) and ''mutra apravrittija'' (less urination) ''vikaras'' by Vagbhata (A.H.Ni.9/40). The former includes twenty varieties of ''prameha'' and the latter includes two categories of disorders – 8 types of ''mutrakrichchra'' (dysuria) and 12 types ''mutraghata'' (urinary disorders), though both the set of disorders are described under the title ''mutraghata''. Under ''mutraghata, bastikundala'' (circular distension of bladder) is not described.

 

 

 

 

 

Susruta describes ''pittaja'' and ''kaphaja'' types of ''mutraukasada'' (dense urine) as two different conditions. In ''pittaja mutraukasada'' he describes that on drying, the urine resembles ''gorochana churna'' (powder of a stone or 'bezoar' found in cattle) and in case of ''kaphaja'' variety, on drying the urine becomes like ''shankha churna'' (powder of conch shell).  

Due to holding of natural urges, obstruction to the downward movement of vata makes vata gati in to upward and circular, manifesting in to severe condition called mutrajathara (accumulation of urine in abdominal cavity). Along with symptoms like retention of urine and stool, indigestion is also one of the symptoms.

Due to holding of natural urges, obstruction to the downward movement of vata makes vata gati in to upward and circular, manifesting in to severe condition called mutrajathara (accumulation of urine in abdominal cavity). Along with symptoms like retention of urine and stool, indigestion is also one of the symptoms.

Based on the descriptions, the condition seems to be a neurological disturbance of bladder function due to repeated withholding the urge of micturition.

Based on the descriptions, the condition seems to be a neurological disturbance of bladder function due to repeated withholding the urge of micturition.

All the above mentioned mutradoshas are in accordance with the nidanas described under Ca.Vi.5/20 ie, drinking water, consuming food, indulging in sexual intercourse when one feels the urge to micturate and withholding the urge of micturition especially in an emaciated or traumatized individual.   

All the above mentioned mutradoshas are in accordance with the nidanas described under Ca.Vi.5/20 ie, drinking water, consuming food, indulging in sexual intercourse when one feels the urge to micturate and withholding the urge of micturition especially in an emaciated or traumatized individual.   

The condition mutratita seems to be a physiological atony of bladder owing to prolonged withholding the urge to micturate, thereby the bladder contractions wean away and paves the way for atony. Recurrent withholding the urge may result in pathological atony as well as neurological disturbances in bladder function due to disturbances in the balance between symapathetic and parasympathetic functions. This concept may be practically found in patients of diabetes mellitus with recurrent urinary tract infections (cystitis), wherein USG reveals significant residual urine in bladder due to bladder atony. Such patients are immensely benefited by toilet training ie, developing a habit of regular micturition at timely intervals which in due course reduces the incidence of recurrent urinary tract infections  and in due course significantly reduces the residual urine, possibly improving the bladder tone and nervous integrity.

The condition mutratita seems to be a physiological atony of bladder owing to prolonged withholding the urge to micturate, thereby the bladder contractions wean away and paves the way for atony. Recurrent withholding the urge may result in pathological atony as well as neurological disturbances in bladder function due to disturbances in the balance between symapathetic and parasympathetic functions. This concept may be practically found in patients of diabetes mellitus with recurrent urinary tract infections (cystitis), wherein USG reveals significant residual urine in bladder due to bladder atony. Such patients are immensely benefited by toilet training ie, developing a habit of regular micturition at timely intervals which in due course reduces the incidence of recurrent urinary tract infections  and in due course significantly reduces the residual urine, possibly improving the bladder tone and nervous integrity.

The role of basti chikitsa and specifically uttarabasti in the management of apana vata vikrti and also sthana dushti (local vitiation) has been highlighted in the classical texts.

The role of basti chikitsa and specifically uttarabasti in the management of apana vata vikrti and also sthana dushti (local vitiation) has been highlighted in the classical texts.

The drugs having mutrala (mutravirecaneeya and mutravirajaneeya) actions are all useful in the above mentioned mutradoshas. The mutravirajaneeya, mutravirecaneeya gana dravyas(Ca.Su.4/15 ) are very helpful.   

The drugs having mutrala (mutravirecaneeya and mutravirajaneeya) actions are all useful in the above mentioned mutradoshas. The mutravirajaneeya, mutravirecaneeya gana dravyas(Ca.Su.4/15 ) are very helpful.   

The descriptions of the procedure with materials or equipments used thereby are clearly stated in the texts. Gold and silver are metals considered to be soft and malleable. The uttarabasti nozzle prepared out of these are specially suited for introducing into urethra as it is extremely vulnerable to trauma during the procedure which can be minimized by these metals. Primarily the chance of injury is due to the fact that male urethra is curved (‘S’ shaped) and straightened slightly when the penis is erect. Nevertheless, when fully straight there is a increased chance of trauma. Further these metals have a protective effect on the body.

The descriptions of the procedure with materials or equipments used thereby are clearly stated in the texts. Gold and silver are metals considered to be soft and malleable. The uttarabasti nozzle prepared out of these are specially suited for introducing into urethra as it is extremely vulnerable to trauma during the procedure which can be minimized by these metals. Primarily the chance of injury is due to the fact that male urethra is curved (‘S’ shaped) and straightened slightly when the penis is erect. Nevertheless, when fully straight there is a increased chance of trauma. Further these metals have a protective effect on the body.

In clinical practice, simple rubber catheters no. 6 or 7 may be used for the procedure after sterilization by autoclaving and so should be the medicine used for uttarabasti. With due aseptic precautions, the procedure should be carried out in a fumigated room preferably like an O.T. procedure which reduces the likely chances of U.T.I. Nevertheless, in the outcome the chances of asymptomatic pyuria or abacteriuric pyuria are always there. These possibly can be minimized with the use of filtered medicaments (so as to ensure no particles), priorly autoclaved and administered with nozzle of gold or silver. Though the classical position of the patient is seating, lying down position is equally easy and the patient may be made to feel more comfortable. An hour after the procedure, the patient should be instructed to consume plenty of oral fluids to maintain a high urine output. The patients comfortably retain the medicament for 2-4 hours. The procedure may be done daily for 8 days after an initial gudagata asthapana basti. The procedure is done after asking the patient to evacuate the bladder and bowel.  

In clinical practice, simple rubber catheters no. 6 or 7 may be used for the procedure after sterilization by autoclaving and so should be the medicine used for uttarabasti. With due aseptic precautions, the procedure should be carried out in a fumigated room preferably like an O.T. procedure which reduces the likely chances of U.T.I. Nevertheless, in the outcome the chances of asymptomatic pyuria or abacteriuric pyuria are always there. These possibly can be minimized with the use of filtered medicaments (so as to ensure no particles), priorly autoclaved and administered with nozzle of gold or silver. Though the classical position of the patient is seating, lying down position is equally easy and the patient may be made to feel more comfortable. An hour after the procedure, the patient should be instructed to consume plenty of oral fluids to maintain a high urine output. The patients comfortably retain the medicament for 2-4 hours. The procedure may be done daily for 8 days after an initial gudagata asthapana basti. The procedure is done after asking the patient to evacuate the bladder and bowel.  

The drugs described are mostly ushna veerya, vatanulomana and hence are highly beneficial in clearing the avarodha(obstruction) of aushadha.

The drugs described are mostly ushna veerya, vatanulomana and hence are highly beneficial in clearing the avarodha(obstruction) of aushadha.

The indication of administration of varti into gudamarga as well, probably indicates that some reflex mechanisms are involved in the evacuation of bladder in case of retained medicament. This in the classical description may be explained as causing apanavatanulomana.

The indication of administration of varti into gudamarga as well, probably indicates that some reflex mechanisms are involved in the evacuation of bladder in case of retained medicament. This in the classical description may be explained as causing apanavatanulomana.

From the descriptions, it appears that this condition could possibly be Migraine. The possible triggering factors such as sleep deprivation, physical exhaustion, mental factors such as anxiety, stress etc, may all be understood under the nidanas described in the classics. The location of pain is also similar. The severity of pain and the disturbances of vision and audition are all classical being found in the stage of aura and may even associate with the proper stage.   

From the descriptions, it appears that this condition could possibly be Migraine. The possible triggering factors such as sleep deprivation, physical exhaustion, mental factors such as anxiety, stress etc, may all be understood under the nidanas described in the classics. The location of pain is also similar. The severity of pain and the disturbances of vision and audition are all classical being found in the stage of aura and may even associate with the proper stage.   

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 brumhana (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 brumhana (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.

 

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.  

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''.

As the condition is purely vata dominant, all the treatments described for suryavarta such as ghritapana, ghrita nasya, siropicu, sirobasti are all beneficial. If the condition is associated with raktavrita vata, siravyadha is utmost beneficial. This condition may be possibly correlated with Trigeminal neuralgia, based on the location of pain. Siravyadha at the temporal area is of utmost benefit in neuralgic headaches.  

 

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

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''.  

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 fibres of olfactory nerve. The second most agreeable hypothesis is the receptor theory, which believes stimulation of certain brain centres 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, medicaments may be made to act on the brain.

 

As the condition is purely ''vata'' dominant, all the treatments described for ''suryavarta'' such as ''ghritapana, ghrita nasya, siropichu, sirobasti'' are all beneficial. If the condition is associated with ''raktavrita vata, siravyadha'' is utmost beneficial. This condition may be possibly correlated with Trigeminal neuralgia, based on the location of pain. ''Siravyadha'' at the temporal area is of utmost benefit in neuralgic headaches.  

 

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 fibres of olfactory nerve. The second most agreeable hypothesis is the receptor theory, which believes stimulation of certain brain centres 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, medicaments 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.