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Line 22: − − ==[[Chikitsa Sthana]] Chapter 27, Chapter on the Management of Urustambha (Disorders of thigh and hip)== − − === Abstract === − − The chapter deals with the management of ''urustambha'' which literally means stiffness of thighs. Patients present with pain and inability to move pelvis and lower extremities. This is the only disease in which [[Panchakarma]] are contraindicated. It can be misdiagnosed as ''vata'' dominant disorder due to its clinical presentation, however, ''kapha'' and ''meda'' are main culprits in the pathogenesis. Etiological factors, pathogenesis, clinical presentation, prognosis and treatment of ''urustambha'' are described in this chapter. − − '''Keywords''': ''Viruddha, ama-visha, tridosha dushti, Saama-tridosha, Asthigata kapha, medahkaphaavrita-vata, Sneha-Shaitya-Sthairya'' in ''Uru, Rukshana, Kapha-meda-vaatahara'' treatment. Line 772:
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<big>'''[[Chikitsa Sthana]] Chapter 27. Management of Urustambha (Disorders of thigh and hip) </big>'''
<big>'''Abstract </big>'''
The chapter deals with the management of ''urustambha'' which literally means stiffness of thighs. Patients present with pain and inability to move pelvis and lower extremities. This is the only disease in which [[Panchakarma]] are contraindicated. It can be misdiagnosed as ''vata'' dominant disorder due to its clinical presentation, however, ''kapha'' and ''meda'' are main culprits in the pathogenesis. Etiological factors, pathogenesis, clinical presentation, prognosis and treatment of ''urustambha'' are described in this chapter.
'''Keywords''': ''Viruddha, ama-visha, tridosha dushti, Saama-tridosha, Asthigata kapha, medahkaphaavrita-vata, Sneha-Shaitya-Sthairya'' in ''Uru, Rukshana, Kapha-meda-vaatahara'' treatment.
{{Infobox
{{Infobox
|title = Urusthambha Chikitsa
|title = Urusthambha Chikitsa
}}
}}
=== Introduction ===
=== Introduction ===
Thus ends the chapter on management of ''urustambha'' written by Agnivesha, redacted by Charaka and completed by Dridhabala.
Thus ends the chapter on management of ''urustambha'' written by Agnivesha, redacted by Charaka and completed by Dridhabala.
=== ''Tattva Vimarsha'' ===
=== ''Tattva Vimarsha'' / Fundamental Principles===
*''Urustambha'' occurs due to consumption of diet and lifestyle having mutual contradictory properties like hot and cold, unctuous and dry etc.
*''Urustambha'' occurs due to consumption of diet and lifestyle having mutual contradictory properties like hot and cold, unctuous and dry etc.
*All the therapeutic measures which alleviate ''kapha'' but do not aggravate vata should always be employed for the treatment of ''urustambha''. These therapeutic measures should be administered while protecting the subject’s physical strength and power of metabolism.
*All the therapeutic measures which alleviate ''kapha'' but do not aggravate vata should always be employed for the treatment of ''urustambha''. These therapeutic measures should be administered while protecting the subject’s physical strength and power of metabolism.
=== ''Vidhi Vimarsha'' ===
=== ''Vidhi Vimarsha'' / Applied Inferences===
''Urustambha'' resembles ''vata'' disorder because of clinical picture of painful weakness of pelvic girdle and lower extremities muscles. However, it should not be treated as ''vatic'' disorder as basically it is caused by vitiation of ''kapha'' and ''ama'' formation leading to obstruction of ''vata''.
''Urustambha'' resembles ''vata'' disorder because of clinical picture of painful weakness of pelvic girdle and lower extremities muscles. However, it should not be treated as ''vatic'' disorder as basically it is caused by vitiation of ''kapha'' and ''ama'' formation leading to obstruction of ''vata''.
==== Etiological factors ====
==== Etiological factors ====
''Tridosha prakopa nidana'' mentioned by Vagbhata comprises of ''sankirna, ajirna, vishama, viruddha, adhyashana, vyapanna-madya, putishushkakrishaamisha'' etc. (Ashtangahridaya Nidanasthana 1/19, 20). Consuming foods having different ''gunas'' altogether (''sankirna''), practice of food and regimen which are antagonistic to the body’s state and stage (''viruddha''), consuming food before the previous one gets digested (adhyashana) and repeated development of indigestion (ajirna) explained in the aetiology are direct causes for tridosha prakopa. Regular habituation of Viruddha, adhyashana and ajirna causes accumulation of toxic metabolites in rasa dhatu. These toxic metabolites avert proper utilization of rasadhatu and elicit tridosha prakopa, which carry untransformed rasadhatu to amashaya. This rasadhatu, which is having attributes of kapha is taken to amashaya to get metabolized (digested) by kaphagni present there. Thus ama rasadhatu is a condition of koshtha. If amarasadhatu fails to get digested, it interacts and combines with elicited tridosha to become one which is designated as saama(tri)dosha. Thus tridosha prakopa occurs indirectly also by the toxic metabolites developing due to incompatible practices. As fat predominant circumstance paves for the initiation of pathogenesis of this disease, kapha gains more strength than the other two doshas. Kapha or saamakapha subdues pitta (Abhibhuya itaram dosham uru cet pratipadyate – Ashtangahridaya Nidana 15/48). In medodushtija conditions all the channels will be obstructed by medas (Sushruta Sutra 15/32). If the subject happens to indulge in overexertion, jerks, day-time sleep or awakening in night, the pathogenic factor (saama-kapha-vata) along with medas from koshdha (rasa-dhatu) moves to lower limbs and affects sakthi (lower limbs). Causes for the movement of doshas from koshdha to other rogamargas include overexertion, uncontrolled digestive or metabolic activity, unwholesome practice or vyana hyperactivity. Aavarana (obstruction of the movement of vata) pathogenesis also takes place at the siras supplying lowerlimbs. Prakupita dosha (dosha which gets aggravated by extrinsic causes and are not innately present in the body) is regarded as vata and innate intrinsic dosha is regarded as vayu (prana-udana-vyana-samana-apana) in Classics. Though both vata and vayu can get avarana, here medasaavrita vata (obstruction to vata which got aggravated by extrinsic causes by vitiated medas) takes place. Hence urusthambha has a synonym aadhyavata (Ashtangahridaya Nidana 15), which actually is a synonym of medasaavrita-vata (aadhyavata iti jneyassa kricchro medasaavrite – Madhav Nidan). The movement of vata as well as the active movement of lower limbs (performed by vyana vayu) will be obstructed by the medas and also made motionlessness (mudha-vata) by saamata. Hence the disease got the name by the samsthaana (sign), immobility of uru (urusthambha) caused by medas and ama.
''Tridosha prakopa nidana'' mentioned by Vagbhata comprises of ''sankirna, ajirna, vishama, viruddha, adhyashana, vyapanna-madya, putishushkakrishaamisha'' etc. (Ashtangahridaya Nidanasthana 1/19, 20). Consuming foods having different ''gunas'' altogether (''sankirna''), practice of food and regimen which are antagonistic to the body’s state and stage (''viruddha''), consuming food before the previous one gets digested (''adhyashana'') and repeated development of indigestion (''ajirna'') explained in the aetiology are direct causes for ''tridosha prakopa''. Regular habituation of ''viruddha, adhyashana'' and ''ajirna'' causes accumulation of toxic metabolites in ''rasa dhatu''. These toxic metabolites avert proper utilization of ''rasadhatu'' and elicit ''tridosha prakopa'', which carry untransformed ''rasadhatu'' to ''amashaya''. This ''rasadhatu'', which is having attributes of ''kapha'' is taken to ''amashaya'' to get metabolized (digested) by ''kaphagni'' present there. Thus ''ama rasadhatu'' is a condition of ''koshtha''. If ''amarasadhatu'' fails to get digested, it interacts and combines with elicited ''tridosha'' to become one which is designated as ''saama(tri)dosha''. Thus ''tridosha prakopa'' occurs indirectly also by the toxic metabolites developing due to incompatible practices. As fat predominant circumstance paves for the initiation of pathogenesis of this disease, kapha gains more strength than the other two doshas. Kapha or saamakapha subdues pitta (Abhibhuya itaram dosham uru cet pratipadyate – Ashtangahridaya Nidana 15/48). In medodushtija conditions all the channels will be obstructed by medas (Sushruta Sutra 15/32). If the subject happens to indulge in overexertion, jerks, day-time sleep or awakening in night, the pathogenic factor (saama-kapha-vata) along with medas from koshdha (rasa-dhatu) moves to lower limbs and affects sakthi (lower limbs). Causes for the movement of doshas from koshdha to other rogamargas include overexertion, uncontrolled digestive or metabolic activity, unwholesome practice or vyana hyperactivity. Aavarana (obstruction of the movement of vata) pathogenesis also takes place at the siras supplying lowerlimbs. Prakupita dosha (dosha which gets aggravated by extrinsic causes and are not innately present in the body) is regarded as vata and innate intrinsic dosha is regarded as vayu (prana-udana-vyana-samana-apana) in Classics. Though both vata and vayu can get avarana, here medasaavrita vata (obstruction to vata which got aggravated by extrinsic causes by vitiated medas) takes place. Hence urusthambha has a synonym aadhyavata (Ashtangahridaya Nidana 15), which actually is a synonym of medasaavrita-vata (aadhyavata iti jneyassa kricchro medasaavrite – Madhav Nidan). The movement of vata as well as the active movement of lower limbs (performed by vyana vayu) will be obstructed by the medas and also made motionlessness (mudha-vata) by saamata. Hence the disease got the name by the samsthaana (sign), immobility of uru (urusthambha) caused by medas and ama.
Table 1: Pathological factors involved in urustambha
Table 1: Pathological factors involved in urustambha