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{{#seo:

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|title=Urustambha Chikitsa

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|titlemode=append

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|keywords=Viruddha, ama-visha, tridosha dushti, Saama-tridosha, Asthigata kapha, medahkaphaavrita-vata, Sneha-Shaitya-Sthairya in Uru, Rukshana, Kapha-meda-vaatahara treatment,Ayurveda, Indian system of medicine, charak samhita.

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|description=Chikitsa Sthana Chapter 27. Management of Urustambha (Diseases of thigh and hip)

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|image_alt=charak samhita

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|type=article

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}}

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<big>'''[[Chikitsa Sthana]] Chapter 27. Management of Urustambha (Diseases of thigh and hip) </big>'''

{{Infobox

|title = Urusthambha Chikitsa

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|label5 = Other Sections

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|~~header3~~ =

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|data6 = Rajkumar, [[Yogesh Deole|Deole Y. S.]]

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|label7 = Reviewer

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|data7 = Rastogi S.

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|label8 = Editors

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|data8 = Ojha S.N., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.028 10.47468/CSNE.2020.e01.s06.028]

}}

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<big>'''Abstract </big>'''

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<p style="text-align:justify;">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 dhatu]] are main culprits in the pathogenesis. Etiological factors, pathogenesis, clinical presentation, prognosis and treatment of ''urustambha'' are described in this chapter.

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<br/>

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'''Keywords''': Viruddha, ama-visha, tridosha dushti, Saama-tridosha, Asthigata [[kapha]], medahkaphaavrita-[[vata]], Sneha-Shaitya-Sthairya in Uru, [[Rukshana]], [[Kapha]]-meda-[[vata]]hara treatment.

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</p>

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==~~[[Chikitsa Sthana]] Chapter 27, Chapter on the Management of Urustambha (Disorders of thigh and hip)~~==

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== Introduction ==

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=~~== Abstract ===~~

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''Urustambha'' is placed in a sequence after management of disorders of three ''marma'' and before management of [[vata]] disorders. The sequence indicates that it is as hazardous as ''trimarma'' disorder and resembles [[vata]] disorders. Though the clinical presentation of ''urustambha'' resembles [[vata]] dominant diseases, the management is focused on main culprits like [[kapha]] and [[meda dhatu]]'. The two obstruct the vessels flowing downwards in the thigh region causing stiffness and immobility of thighs.

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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.

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~~'''Keywords'''~~: ~~''Viruddha, ama-visha, tridosha dushti, Saama-tridosha, Asthigata kapha, medahkaphaavrita-vata, Sneha-Shaitya-Sthairya'' in ''Uru, Rukshana, Kapha-meda-vaatahara'' treatment.~~

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~~=== Introduction ===~~

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''Urustambha'' is placed in a sequence after management of disorders of three ''marma'' and before management of ''vata'' disorders. The sequence indicates that it is as hazardous as ''trimarma'' disorder and resembles ''vata'' disorders. Though the clinical presentation of ''urustambha'' resembles ''vata'' dominant diseases, the management is focused on main culprits like ''kapha'' and ~~''medas'~~'. The two obstruct the vessels flowing downwards in the thigh region causing stiffness and immobility of thighs.

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''Urustambha'' evokes ~~''tridosha''~~ response which tries to metabolize ''rasa'' by directing it to digestive organs, where it is regarded as improperly transformed substance called ''ama rasa-dhatu''. Disproportionate fat causes susceptibility by directing the ''sama-~~tridosha''~~ (united ~~''tridosha''~~ and ''ama rasa-dhatu'') to the lower limbs. Combined with fat, ''kapha dosha'' having similar qualities gets more strength and fills up the bones of lower limbs. Simultaneously ''vata'' gets obstructed by fat resulting in the development of cardinal feature like- excessive fatigue of calf muscles and thighs, constant pain with slight burning sensation. Pain in feet on stepping on the ground, cold to touch, loss of sensation, inability to stand because of lack of muscle strength, unable to move the upper and lower parts of the lower limbs due to the feeling as if they are fractured.

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''Urustambha'' evokes tri[[dosha]] response which tries to metabolize ''rasa'' by directing it to digestive organs, where it is regarded as improperly transformed substance called ama [[rasa dhatu]]. Disproportionate fat causes susceptibility by directing the sama-tri[[dosha]] (united tri[[dosha]] and ama [[rasa dhatu]]) to the lower limbs. Combined with fat, [[kapha]] [[dosha]] having similar qualities gets more strength and fills up the bones of lower limbs. Simultaneously [[vata]] gets obstructed by fat resulting in the development of cardinal feature like- excessive fatigue of calf muscles and thighs, constant pain with slight burning sensation. Pain in feet on stepping on the ground, cold to touch, loss of sensation, inability to stand because of lack of muscle strength, unable to move the upper and lower parts of the lower limbs due to the feeling as if they are fractured.

If the patient develops burning sensation, pricking pain and tremors, ''urusthambha'' is fatal. If such symptoms are absent and is of recent origin, then it is curable.

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The treatment principle of ''urusthambha'' is ''rukshana'' (facilitating consumption and absorption of liquid metabolites in circulation and tissues) and ''pachana'' (increasing metabolism) by neutralizing toxic metabolites along with alleviation of ''vata''. Medicines should be alkaline medicines, medicated alcoholic preparations, cow’s urine, diaphoresis and massage with paste of herbs to remove fat and other liquid metabolites. After ''rukshana-pachana,'' oleation for restoring ''vata''- could be done internally, which would subside ''kapha-~~medas~~-vata'' due to the peculiarity of medicated oils. Along with external ''rukshana'' the patient should be made to exercise according to his strength. This disease could be cured only with careful diligence as it is situated in deeper tissues like bones and all three ~~''doshas''~~ are involved simultaneously.

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The treatment principle of ''urusthambha'' is [[rukshana]](facilitating consumption and absorption of liquid metabolites in circulation and tissues) and [[pachana]] (increasing metabolism) by neutralizing toxic metabolites along with alleviation of [[vata]]. Medicines should be alkaline medicines, medicated alcoholic preparations, cow’s urine, diaphoresis and massage with paste of herbs to remove fat and other liquid metabolites. After [[rukshana]]-[[pachana]], oleation for restoring [[vata]]- could be done internally, which would subside [[kapha]]-[[meda dhatu]]-[[vata]] due to the peculiarity of medicated oils. Along with external [[rukshana]] the patient should be made to exercise according to his strength. This disease could be cured only with careful diligence as it is situated in deeper tissues like bones and all three [[dosha]] are involved simultaneously.

''Urusthambha'' is a disease, not well understood and researched. It requires further study and scientific exploration.

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=== Sanskrit Text, Transliteration and English Translation ===

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== Sanskrit Text, Transliteration and English Translation ==

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अथात ऊरुस्तम्भचिकित्सितं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

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athāta ūrustambhacikitsitaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH ||2||

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</div></div>

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Now we shall expound the chapter "Urustambha chiktsa (Management of diseases of thigh and hip). Thus said Lord Atreya.[1-2]

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~~We shall now expound the chapter on the management of ''urusthambha'' (~~immobility of ~~thighs), thus said Lord Atreya~~.~~[1-2]~~

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Note: The word "Urustambha" literally means immobility of thigh.

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==== Agnivesha’s query ====

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=== Agnivesha’s query ===

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श्रिया परमया ब्राह्मया परया च तपःश्रिया |

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अहीनं चन्द्रसूर्याभ्यां सुमेरुमिव पर्वतम् ||३||

धीधृतिस्मृतिविज्ञानज्ञानकीर्तिक्षमालयम् |

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अग्निवेशो गुरुं काले संशयं परिपृष्टवान् ||४||

भगवन् पञ्च कर्माणि समस्तानि पृथक् तथा |

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निर्दिष्टान्यामयनां हि सर्वेषामेव भेषजम् ||५||

दोषजोऽस्त्यामयः कश्चिद्यस्य तानि भिषग्वर! |

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न स्युः शक्तानि शमने साध्यस्य क्रियया सतः ||६||

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shriyA paramayA brAhmayA parayA ca tapaHshriyA |

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ahInaM candrasUryAbhyAM sumerumiva parvatam ||3||

dhIdhRutismRutivij~jAnaj~jAnakIrtikShamAlayam |

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agnivesho guruM kAle saMshayaM paripRuShTavAn ||4||

bhagavan pa~jca karmANi samastAni pRuthak tathA |

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nirdiShTAnyAmayanAM hi sarveShAmeva bheShajam ||5||

doShajo~astyAmayaH kashcidyasya tAni bhiShagvara! |

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na syuH shaktAni shamane sAdhyasya kriyayA sataH ||6||

śriyā paramayā brāhmayā parayā ca tapaḥśriyā|

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ahīnaṁ candrasūryābhyāṁ sumērumiva parvatam||3||

dhīdhr̥tismr̥tivijñānajñānakīrtikṣamālayam|

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agnivēśō guruṁ kālē saṁśayaṁ paripr̥ṣṭavān||4||

bhagavan pañca karmāṇi samastāni pr̥thak tathā|

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nirdiṣṭānyāmayanāṁ hi sarvēṣāmēva bhēṣajam||5||

dōṣajō'styāmayaḥ kaścidyasya tāni bhiṣagvara!|

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na syuḥ śaktāni śamanē sādhyasya kriyayā sataḥ||6||

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</div></div>

Once Agnivesha asked about a doubt to the mentor Lord Punarvasu, who was having infallible intellect of true knowledge and penance, who was like the Sumeru mountain with unblemished like sun and moon and was abode of wisdom, self realization, memory, glory and patience.

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“Oh Lord, all the five therapies ([[Panchakarma]]) are explained together as well as separately as therapeutic measure for all the diseases. Is there any curable disease caused by ~~''doshas''~~ for the cure of which these five therapies are contraindicated?” [3-6]

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“Oh Lord, all the five therapies ([[Panchakarma]]) are explained together as well as separately as therapeutic measure for all the diseases. Is there any curable disease caused by [[dosha]] for the cure of which these five therapies are contraindicated?” [3-6]

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==== Atreya’s ~~answer~~ ====

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=== Atreya’s reply ===

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अस्त्यूरुस्तम्भ इत्युक्ते गुरुणा तस्य कारणम् |

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सलिङ्गभेषजं भूयः पृष्टस्तेनाब्रवीद्गुरुः ||७||

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astyūrustambha ityuktē guruṇā tasya kāraṇam|

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saliṅgabhēṣajaṁ bhūyaḥ pr̥ṣṭastēnābravīdguruḥ||7||

astyUrustambha ityukte guruNA tasya kAraNam |

sali~ggabheShajaM bhUyaH pRuShTastenAbravIdguruH ||7||

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</div></div>

To the above mentioned doubt of Agnivesha, the preceptor replied “The disease named ''urusthambha'' is there for which [[Panchakarma]] is contraindicated. Agnivesha again enquired about the etiology, symptoms and treatment of this ailment. The Preceptor again replied. [7]

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==== Etiopathology ====

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=== Etiopathology ===

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स्निग्धोष्णलघुशीतानि जीर्णाजीर्णे समश्नतः |

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स्निग्धोष्णलघुशीतानि जीर्णाजीर्णे समश्नतः | <br />

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द्रवशुष्कदधिक्षीरग्राम्यानूपौदकामिषैः ||८||

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द्रवशुष्कदधिक्षीरग्राम्यानूपौदकामिषैः ||८|| <br />

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पिष्टव्यापन्नमद्यातिदिवास्वप्नप्रजागरैः |

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पिष्टव्यापन्नमद्यातिदिवास्वप्नप्रजागरैः | <br />

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लङ्घनाध्यशनायासभयवेगविधारणैः ||९||

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लङ्घनाध्यशनायासभयवेगविधारणैः ||९|| <br />

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स्नेहाच्चामं चितं कोष्ठे वातादीन्मेदसा सह |

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स्नेहाच्चामं चितं कोष्ठे वातादीन्मेदसा सह | <br />

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रुद्ध्वाऽऽशु गौरवादूरू यात्यधोगैः सिरादिभिः ||१०||

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रुद्ध्वाऽऽशु गौरवादूरू यात्यधोगैः सिरादिभिः ||१०|| <br />

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पूरयन् सक्थिजङ्घोरु दोषो मेदोबलोत्कटः |

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पूरयन् सक्थिजङ्घोरु दोषो मेदोबलोत्कटः | <br />

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अविधेयपरिस्पन्दं जनयत्यल्पविक्रमम् ||११||

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अविधेयपरिस्पन्दं जनयत्यल्पविक्रमम् ||११|| <br />

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महासरसि गम्भीरे पूर्णेऽम्बु स्तिमितं यथा |

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महासरसि गम्भीरे पूर्णेऽम्बु स्तिमितं यथा | <br />

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तिष्ठति स्थिरमक्षोभ्यं तद्वदूरुगतः कफः ||१२||

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तिष्ठति स्थिरमक्षोभ्यं तद्वदूरुगतः कफः ||१२||<br />

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गौरवायाससङ्कोचदाहरुक्सुप्तिकम्पनैः |

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गौरवायाससङ्कोचदाहरुक्सुप्तिकम्पनैः | <br />

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भेदस्फुरणतोदैश्च युक्तो देहं निहन्त्यसून् ||१३||

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भेदस्फुरणतोदैश्च युक्तो देहं निहन्त्यसून् ||१३|| <br />

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ऊरू श्लेष्मा समेदस्को वातपित्तेऽभिभूय तु |

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ऊरू श्लेष्मा समेदस्को वातपित्तेऽभिभूय तु | <br />

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स्तम्भयेत्स्थैर्यशैत्याभ्यामूरुस्तम्भस्ततस्तु सः ||१४||

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स्तम्भयेत्स्थैर्यशैत्याभ्यामूरुस्तम्भस्ततस्तु सः ||१४|| <br />

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snigdhōṣṇalaghuśītāni jīrṇājīrṇē samaśnataḥ|

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snigdhōṣṇalaghuśītāni jīrṇājīrṇē samaśnataḥ| <br />

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dravaśuṣkadadhikṣīragrāmyānūpaudakāmiṣaiḥ||8||

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dravaśuṣkadadhikṣīragrāmyānūpaudakāmiṣaiḥ||8|| <br />

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piṣṭavyāpannamadyātidivāsvapnaprajāgaraiḥ|

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piṣṭavyāpannamadyātidivāsvapnaprajāgaraiḥ| <br />

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laṅghanādhyaśanāyāsabhayavēgavidhāraṇaiḥ||9||

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laṅghanādhyaśanāyāsabhayavēgavidhāraṇaiḥ||9|| <br />

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snēhāccāmaṁ citaṁ kōṣṭhē vātādīnmēdasā saha|

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snēhāccāmaṁ citaṁ kōṣṭhē vātādīnmēdasā saha| <br />

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ruddhvā''śu gauravādūrū yātyadhōgaiḥ sirādibhiḥ||10||

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ruddhvā''śu gauravādūrū yātyadhōgaiḥ sirādibhiḥ||10|| <br />

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pūrayan sakthijaṅghōru dōṣō mēdōbalōtkaṭaḥ|

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pūrayan sakthijaṅghōru dōṣō mēdōbalōtkaṭaḥ| <br />

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avidhēyaparispandaṁ janayatyalpavikramam||11||

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avidhēyaparispandaṁ janayatyalpavikramam||11|| <br />

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mahāsarasi gambhīrē pūrṇē'mbu stimitaṁ yathā|

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mahāsarasi gambhīrē pūrṇē'mbu stimitaṁ yathā| <br />

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tiṣṭhati sthiramakṣōbhyaṁ tadvadūrugataḥ kaphaḥ||12||

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tiṣṭhati sthiramakṣōbhyaṁ tadvadūrugataḥ kaphaḥ||12|| <br />

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gauravāyāsasaṅkōcadāharuksuptikampanaiḥ |

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gauravāyāsasaṅkōcadāharuksuptikampanaiḥ | <br />

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bhēdasphuraṇatōdaiśca yuktō dēhaṁ nihantyasūn||13||

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bhēdasphuraṇatōdaiśca yuktō dēhaṁ nihantyasūn||13|| <br />

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ūrū ślēṣmā samēdaskō vātapittē'bhibhūya tu|

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ūrū ślēṣmā samēdaskō vātapittē'bhibhūya tu| <br />

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stambhayētsthairyaśaityābhyāmūrustambhastatastu saḥ||14||

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stambhayētsthairyaśaityābhyāmūrustambhastatastu saḥ||14|| <br />

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snigdhoShNalaghushItAni [3] jIrNAjIrNe samashnataH |

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snigdhoShNalaghushItAni [3] jIrNAjIrNe samashnataH | <br />

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dravashuShkadadhikShIragrAmyAnUpaudakAmiShaiH ||8||

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dravashuShkadadhikShIragrAmyAnUpaudakAmiShaiH ||8|| <br />

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piShTavyApannamadyAtidivAsvapnaprajAgaraiH |

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piShTavyApannamadyAtidivAsvapnaprajAgaraiH | <br />

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la~gghanAdhyashanAyAsabhayavegavidhAraNaiH ||9||

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la~gghanAdhyashanAyAsabhayavegavidhAraNaiH ||9|| <br />

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snehAccAmaM citaM koShThe vAtAdInmedasA saha |

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snehAccAmaM citaM koShThe vAtAdInmedasA saha | <br />

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ruddhvA~a~ashu gauravAdUrU yAtyadhogaiH sirAdibhiH ||10||

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ruddhvA~a~ashu gauravAdUrU yAtyadhogaiH sirAdibhiH ||10|| <br />

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pUrayan sakthija~gghoru doSho medobalotkaTaH |

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pUrayan sakthija~gghoru doSho medobalotkaTaH | <br />

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avidheyaparispandaM janayatyalpavikramam ||11||

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avidheyaparispandaM janayatyalpavikramam ||11|| <br />

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mahAsarasi gambhIre pUrNe~ambu stimitaM yathA |

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mahAsarasi gambhIre pUrNe~ambu stimitaM yathA | <br />

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tiShThati sthiramakShobhyaM tadvadUrugataH kaphaH ||12||

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tiShThati sthiramakShobhyaM tadvadUrugataH kaphaH ||12|| <br />

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gauravAyAsasa~gkocadAharuksuptikampanaiH |

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gauravAyAsasa~gkocadAharuksuptikampanaiH | <br />

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bhedasphuraNatodaishca yukto dehaM nihantyasUn ||13||

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bhedasphuraNatodaishca yukto dehaM nihantyasUn ||13|| <br />

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UrU shleShmA samedasko vAtapitte~abhibhUya tu |

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UrU shleShmA samedasko vAtapitte~abhibhUya tu | <br />

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stambhayetsthairyashaityAbhyAmUrustambhastatastu saH ||14||

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stambhayetsthairyashaityAbhyAmUrustambhastatastu saH ||14|| <br />

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</div></div>

*Intake of foods of contradictory properties like ''snigdha''(unctuous), ''ushna''(hot), ''laghu''(light to digest), ''sheeta''(cold), ''drava''(liquid), ''shushka''(dry) food (altogether or alternating) when the previous food is partially digested only or completely digested.

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*Over exertion, continuous fear, suppression of urges

*Due to excess unctuousness, accumulation of ''ama'' in ''koshtha'' takes place.

−

*Due to above mentioned causes and due to ''ama'', vitiation of ~~''tridosha''~~ takes place.

+

*Due to above mentioned causes and due to ''ama'', vitiation of tri[[dosha]] takes place.

−

*''Ama'' with deranged ''medas'' obstructs ''prakupita ~~tridosha''~~ and due to heaviness, they move downward through ''siras'' to reach lower limbs. ~~''Doshas''~~, get accentuated by the strength of the ~~''medas''~~ to fill calves and thighs of the lower limbs causing involuntary movements and immobility.

+

*''Ama'' with deranged ''medas'' obstructs ''prakupita tri[[dosha]] and due to heaviness, they move downward through ''siras'' to reach lower limbs. [[Dosha]], get accentuated by the strength of the[[meda dhatu]] to fill calves and thighs of the lower limbs causing involuntary movements and immobility.

−

The ''kapha'' filled lower limbs become like a lake which is large, deep and fully filled with water which remains, still, stable and undisturbed.

+

The [[kapha]] filled lower limbs become like a lake which is large, deep and fully filled with water which remains, still, stable and undisturbed.

This disease when gets associated with heaviness, strain, contracture, burning sensation, pain, numbness, tremor, splitting, twitching and pricking types of pain, then it becomes lethal.

−

''Kapha'' with its ''sthira''(stable) and ''sheeta'' (cold) properties associated with ~~''medas''~~ subdues ''vata'' and ''pitta'' and causes immobility of ''uru'' (thighs). Hence the disease is termed as ''urusthambha''. [8-14]

+

[[Kapha]] with its ''sthira''(stable) and ''sheeta'' (cold) properties associated with [[meda dhatu]]subdues [[vata]] and [[pitta]] and causes immobility of ''uru'' (thighs). Hence the disease is termed as ''urusthambha''. [8-14]

−

==== Prodromal symptoms ====

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=== Prodromal symptoms ===

+

−

प्राग्रूपं ध्याननिद्रातिस्तैमित्यारोचकज्वराः |

+

प्राग्रूपं ध्याननिद्रातिस्तैमित्यारोचकज्वराः | <br />

−

लोमहर्षश्च छर्दिश्च जङ्घोर्वोः सदनं तथा ||१५||

+

लोमहर्षश्च छर्दिश्च जङ्घोर्वोः सदनं तथा ||१५||<br />

+

−

prāgrūpaṁ dhyānanidrātistaimityārōcakajvarāḥ|

+

prāgrūpaṁ dhyānanidrātistaimityārōcakajvarāḥ| <br />

−

lōmaharṣaśca chardiśca jaṅghōrvōḥ sadanaṁ tathā||15||

+

lōmaharṣaśca chardiśca jaṅghōrvōḥ sadanaṁ tathā||15||<br />

−

prAgrUpaM dhyAnanidrAtistaimityArocakajvarAH |

+

prAgrUpaM dhyAnanidrAtistaimityArocakajvarAH | <br />

−

lomaharShashca chardishca ja~gghorvoH sadanaM tathA ||15||

+

lomaharShashca chardishca ja~gghorvoH sadanaM tathA ||15||<br />

+

</div></div>

Thinking or concentrating on something, excessive sleep, indolence (decreased emotion), anorexia, fever, horripilation, vomiting and reduced movements of calves and thighs (due to loss of strength) are the prodromal symptoms of ''urusthambha''.[15]

−

==== Contraindication of ''snehana'' (oleation therapy)====

+

=== Contraindication of [[snehana]] (oleation therapy)===

+

−

वातशङ्किभिरज्ञानात्तस्य स्यात् स्नेहनात् पुनः |

+

वातशङ्किभिरज्ञानात्तस्य स्यात् स्नेहनात् पुनः | <br />

−

पादयोः सदनं सुप्तिः कृच्छ्रादुद्धरणं तथा ||१६||

+

पादयोः सदनं सुप्तिः कृच्छ्रादुद्धरणं तथा ||१६||<br />

+

−

vātaśaṅkibhirajñānāttasya syāt snēhanāt punaḥ|

+

vātaśaṅkibhirajñānāttasya syāt snēhanāt punaḥ| <br />

−

pādayōḥ sadanaṁ suptiḥ kr̥cchrāduddharaṇaṁ tathā||16||

+

pādayōḥ sadanaṁ suptiḥ kr̥cchrāduddharaṇaṁ tathā||16|| <br />

−

vAtasha~gkibhiraj~jAnAttasya syAt snehanAt punaH |

+

vAtasha~gkibhiraj~jAnAttasya syAt snehanAt punaH | <br />

−

pAdayoH sadanaM suptiH kRucchrAduddharaNaM tathA ||16||

+

pAdayoH sadanaM suptiH kRucchrAduddharaNaM tathA ||16||<br />

+

</div></div>

−

If oleation therapy is administered due to misunderstanding, that this disease as ''vata'' disorder or due to ignorance, it results in loss of strength in legs, loss of sensation in the legs and difficulty in raising the legs.[16]

+

If oleation therapy is administered due to misunderstanding, that this disease as [[vata]] disorder or due to ignorance, it results in loss of strength in legs, loss of sensation in the legs and difficulty in raising the legs.[16]

−

==== Clinical features ====

+

=== Clinical features ===

+

−

जङ्घोरुग्लानिरत्यर्थं शश्वच्चादाहवेदना |

+

जङ्घोरुग्लानिरत्यर्थं शश्वच्चादाहवेदना | <br />

−

पदं च व्यथते न्यस्तं शीतस्पर्शं न वेत्ति च ||१७||

+

पदं च व्यथते न्यस्तं शीतस्पर्शं न वेत्ति च ||१७|| <br />

−

संस्थाने पीडने गत्यां चालने चाप्यनीश्वरः |

+

संस्थाने पीडने गत्यां चालने चाप्यनीश्वरः | <br />

−

अन्यनेयौ हि सम्भग्नावूरू पादौ च मन्यते ||१८||

+

अन्यनेयौ हि सम्भग्नावूरू पादौ च मन्यते ||१८|| <br />

+

−

jaṅghōruglāniratyarthaṁ śaśvaccādāhavēdanā|

+

jaṅghōruglāniratyarthaṁ śaśvaccādāhavēdanā| <br />

−

padaṁ ca vyathatē nyastaṁ śītasparśaṁ na vētti ca||17||

+

padaṁ ca vyathatē nyastaṁ śītasparśaṁ na vētti ca||17|| <br />

−

saṁsthānē pīḍanē gatyāṁ cālanē cāpyanīśvaraḥ|

+

saṁsthānē pīḍanē gatyāṁ cālanē cāpyanīśvaraḥ| <br />

−

anyanēyau hi sambhagnāvūrū pādau ca manyatē||18||

+

anyanēyau hi sambhagnāvūrū pādau ca manyatē||18|| <br />

−

ja~gghoruglAniratyarthaM shashvaccAdAhavedanA |

+

ja~gghoruglAniratyarthaM shashvaccAdAhavedanA | <br />

−

padaM ca vyathate nyastaM shItasparshaM na vetti ca ||17||

+

padaM ca vyathate nyastaM shItasparshaM na vetti ca ||17|| <br />

−

saMsthAne pIDane gatyAM cAlane cApyanIshvaraH |

+

saMsthAne pIDane gatyAM cAlane cApyanIshvaraH | <br />

−

anyaneyau hi sambhagnAvUrU pAdau ca manyate ||18||

+

anyaneyau hi sambhagnAvUrU pAdau ca manyate ||18|| <br />

+

</div></div>

*Excessive fatigue of calf muscles and thighs,

Line 238: Line 293:

*Unable to move the upper and lower parts of the lower limbs due to the feeling that they are fractured.[17-18]

−

==== Prognosis ====

+

=== Prognosis ===

+

−

यदा दाहार्तितोदार्तो वेपनः पुरुषो भवेत् |

+

यदा दाहार्तितोदार्तो वेपनः पुरुषो भवेत् | <br />

−

ऊरुस्तम्भस्तदा हन्यात् साधयेदन्यथा नवम् ||१९||

+

ऊरुस्तम्भस्तदा हन्यात् साधयेदन्यथा नवम् ||१९|| <br />

+

−

yadā dāhārtitōdārtō vēpanaḥ puruṣō bhavēt|

+

yadā dāhārtitōdārtō vēpanaḥ puruṣō bhavēt| <br />

−

ūrustambhastadā hanyāt sādhayēdanyathā navam||19||

+

ūrustambhastadā hanyāt sādhayēdanyathā navam||19|| <br />

−

yadA dAhArtitodArto vepanaH puruSho bhavet |

+

yadA dAhArtitodArto vepanaH puruSho bhavet | <br />

−

UrustambhastadA hanyAt sAdhayedanyathA navam ||19||

+

UrustambhastadA hanyAt sAdhayedanyathA navam ||19||<br />

+

</div></div>

If the patient develops burning sensation, pricking pain and tremors, ''urusthambha'' is fatal. If such symptoms are absent and is of recent origin, then it is curable.[19]

−

==== Contraindications of [[Panchakarma]] ====

+

=== Contraindications of [[Panchakarma]] ===

+

−

तस्य न स्नेहनं कार्यं न बस्तिर्न विरेचनम् |

+

तस्य न स्नेहनं कार्यं न बस्तिर्न विरेचनम् | <br />

−

न चैव वमनं यस्मात्तन्निबोधत कारणम् ||२०||

+

न चैव वमनं यस्मात्तन्निबोधत कारणम् ||२०|| <br />

−

वृद्धये श्लेष्मणो नित्यं स्नेहनं बस्तिकर्म च |

+

वृद्धये श्लेष्मणो नित्यं स्नेहनं बस्तिकर्म च | <br />

−

तत्स्थस्योद्धरणे चैव न समर्थं विरेचनम् ||२१||

+

तत्स्थस्योद्धरणे चैव न समर्थं विरेचनम् ||२१|| <br />

−

कफं कफस्थानगतं पित्तं च वमनात् सुखम् |

+

कफं कफस्थानगतं पित्तं च वमनात् सुखम् | <br />

−

हर्तुमामाशयस्थौ च स्रंसनात्तावुभावपि ||२२||

+

हर्तुमामाशयस्थौ च स्रंसनात्तावुभावपि ||२२|| <br />

−

पक्वाशयस्थाः सर्वेऽपि बस्तिभिर्मूलनिर्जयात् |

+

पक्वाशयस्थाः सर्वेऽपि बस्तिभिर्मूलनिर्जयात् | <br />

−

शक्या न त्वाममेदोभ्यां स्तब्धा जङ्घोरुसंस्थिता ||२३||

+

शक्या न त्वाममेदोभ्यां स्तब्धा जङ्घोरुसंस्थिता ||२३|| <br />

−

वातस्थाने हि तच्छैत्याद्द्वयोः स्तम्भाच्च तद्गताः |

+

वातस्थाने हि तच्छैत्याद्द्वयोः स्तम्भाच्च तद्गताः | <br />

−

न शक्याः सुखमुद्धर्तुं जलं निम्नादिव स्थलात् ||२४||

+

न शक्याः सुखमुद्धर्तुं जलं निम्नादिव स्थलात् ||२४|| <br />

+

−

tasya na snēhanaṁ kāryaṁ na bastirna virēcanam|

+

tasya na snēhanaṁ kāryaṁ na bastirna virēcanam| <br />

−

na caiva vamanaṁ yasmāttannibōdhata kāraṇam||20||

+

na caiva vamanaṁ yasmāttannibōdhata kāraṇam||20|| <br />

−

vr̥ddhayē ślēṣmaṇō nityaṁ snēhanaṁ bastikarma ca|

+

vr̥ddhayē ślēṣmaṇō nityaṁ snēhanaṁ bastikarma ca| <br />

−

tatsthasyōddharaṇē caiva na samarthaṁ virēcanam||21||

+

tatsthasyōddharaṇē caiva na samarthaṁ virēcanam||21|| <br />

−

kaphaṁ kaphasthānagataṁ pittaṁ ca vamanāt sukham|

+

kaphaṁ kaphasthānagataṁ pittaṁ ca vamanāt sukham| <br />

−

hartumāmāśayasthau ca sraṁsanāttāvubhāvapi||22||

+

hartumāmāśayasthau ca sraṁsanāttāvubhāvapi||22|| <br />

−

pakvāśayasthāḥ sarvē'pi bastibhirmūlanirjayāt|

+

pakvāśayasthāḥ sarvē'pi bastibhirmūlanirjayāt| <br />

−

śakyā na tvāmamēdōbhyāṁ stabdhā jaṅghōrusaṁsthitāḥ||23||

+

śakyā na tvāmamēdōbhyāṁ stabdhā jaṅghōrusaṁsthitāḥ||23|| <br />

−

vātasthānē hi tacchaityāddvayōḥ stambhācca tadgatāḥ|

+

vātasthānē hi tacchaityāddvayōḥ stambhācca tadgatāḥ| <br />

−

na śakyāḥ sukhamuddhartuṁ jalaṁ nimnādiva sthalāt||24||

+

na śakyāḥ sukhamuddhartuṁ jalaṁ nimnādiva sthalāt||24|| <br />

−

tasya na snehanaM kAryaM na bastirna virecanam |

+

tasya na snehanaM kAryaM na bastirna virecanam | <br />

−

na caiva vamanaM yasmAttannibodhata kAraNam ||20||

+

na caiva vamanaM yasmAttannibodhata kAraNam ||20|| <br />

−

vRuddhaye shleShmaNo nityaM snehanaM bastikarma ca |

+

vRuddhaye shleShmaNo nityaM snehanaM bastikarma ca | <br />

−

tatsthasyoddharaNe caiva na samarthaM virecanam ||21||

+

tatsthasyoddharaNe caiva na samarthaM virecanam ||21|| <br />

−

kaphaM kaphasthAnagataM pittaM ca vamanAt sukham |

+

kaphaM kaphasthAnagataM pittaM ca vamanAt sukham | <br />

−

hartumAmAshayasthau ca sraMsanAttAvubhAvapi ||22||

+

hartumAmAshayasthau ca sraMsanAttAvubhAvapi ||22|| <br />

−

pakvAshayasthAH sarve~api bastibhirmUlanirjayAt |

+

pakvAshayasthAH sarve~api bastibhirmUlanirjayAt | <br />

−

shakyA na tvAmamedobhyAM stabdhA ja~gghorusaMsthitA ||23||

+

shakyA na tvAmamedobhyAM stabdhA ja~gghorusaMsthitA ||23|| <br />

−

vAtasthAne hi tacchaityAddvayoH stambhAcca tadgatAH |

+

vAtasthAne hi tacchaityAddvayoH stambhAcca tadgatAH | <br />

−

na shakyAH sukhamuddhartuM jalaM nimnAdiva sthalAt ||24||

+

na shakyAH sukhamuddhartuM jalaM nimnAdiva sthalAt ||24||<br />

+

</div></div>

The reason for which oleation, enema, purgation and emesis are contraindicated in ''urusthambha'' is being explained for your understanding.

−

Oleation and enema therapies always aggravate ''kapha''. Purgation is ineffective to remove ''kapha'' localized there (in the thighs). ''Kapha'' reaching its own place (''amashaya'') and ''pitta'' can be easily removed by emesis. Both these ~~''doshas''~~ lodged in ''amashaya'' can be eliminated by purgation. When lodged in ''pakvashaya'', all the three ~~''doshas''~~ could be fully removed by enema therapy. But in ''urusthambha'' since pathognomonic ''doshas'' are stagnant due to ''amatva'' (metabolic defect) and obstructed by fat, since ''kapha'' is lodged in the abode of ''vata'', which is of ''sheeta guna'' and since ''vata'' and ''kapha'' are immobile, it is not easy to remove them just as it is difficult to remove stagnant water from a ditch.[20-24]

+

Oleation and enema therapies always aggravate [[kapha]]. Purgation is ineffective to remove [[kapha]] localized there (in the thighs). [[Kapha]] reaching its own place (''amashaya'') and [[pitta]] can be easily removed by emesis. Both these [[dosha]] lodged in ''amashaya'' can be eliminated by purgation. When lodged in ''pakvashaya'', all the three [[dosha]] could be fully removed by enema therapy. But in ''urusthambha'' since pathognomonic [[doshas]] are stagnant due to ''amatva'' (metabolic defect) and obstructed by fat, since [[kapha]] is lodged in the abode of [[vata]], which is of ''sheeta guna'' and since [[vata]] and [[kapha]] are immobile, it is not easy to remove them just as it is difficult to remove stagnant water from a ditch.[20-24]

−

==== Principles of management ====

+

=== Principles of management ===

+

−

तस्य संशमनं नित्यं क्षपणं शोषणं तथा |

+

तस्य संशमनं नित्यं क्षपणं शोषणं तथा | <br />

−

युक्त्यपेक्षी भिषक् कुर्यादधिकत्वात्कफामयोः ||२५||

+

युक्त्यपेक्षी भिषक् कुर्यादधिकत्वात्कफामयोः ||२५|| <br />

−

सदा रूक्षोपचाराय यवश्यामाककोद्रवान् |

+

सदा रूक्षोपचाराय यवश्यामाककोद्रवान् | <br />

−

शाकैरलवणैर्दद्याज्जलतैलोपसाधितैः ||२६||

+

शाकैरलवणैर्दद्याज्जलतैलोपसाधितैः ||२६|| <br />

−

सुनिषण्णकनिम्बार्कवेत्रारग्वधपल्लवैः |

+

सुनिषण्णकनिम्बार्कवेत्रारग्वधपल्लवैः | <br />

−

वायसीवास्तुकैरन्यैस्तिक्तैश्च कुलकादिभिः ||२७||

+

वायसीवास्तुकैरन्यैस्तिक्तैश्च कुलकादिभिः ||२७|| <br />

−

क्षारारिष्टप्रयोगाश्च हरीतक्यास्तथैव च |

+

क्षारारिष्टप्रयोगाश्च हरीतक्यास्तथैव च | <br />

−

मधूदकस्य पिप्पल्या ऊरुस्तम्भविनाशनाः ||२८||

+

मधूदकस्य पिप्पल्या ऊरुस्तम्भविनाशनाः ||२८|| <br />

+

−

tasya saṁśamanaṁ nityaṁ kṣapaṇaṁ śōṣaṇaṁ tathā|

+

tasya saṁśamanaṁ nityaṁ kṣapaṇaṁ śōṣaṇaṁ tathā| <br />

−

yuktyapēkṣī [1] bhiṣak kuryādadhikatvātkaphāmayōḥ||25||

+

yuktyapēkṣī [1] bhiṣak kuryādadhikatvātkaphāmayōḥ||25|| <br />

−

sadā rūkṣōpacārāya yavaśyāmākakōdravān|

+

sadā rūkṣōpacārāya yavaśyāmākakōdravān| <br />

−

śākairalavaṇairdadyājjalatailōpasādhitaiḥ||26||

+

śākairalavaṇairdadyājjalatailōpasādhitaiḥ||26|| <br />

−

suniṣaṇṇakanimbārkavētrāragvadhapallavaiḥ|

+

suniṣaṇṇakanimbārkavētrāragvadhapallavaiḥ| <br />

−

vāyasīvāstukairanyaistiktaiśca kulakādibhiḥ||27||

+

vāyasīvāstukairanyaistiktaiśca kulakādibhiḥ||27|| <br />

−

kṣārāriṣṭaprayōgāśca harītakyāstathaiva ca|

+

kṣārāriṣṭaprayōgāśca harītakyāstathaiva ca| <br />

−

madhūdakasya pippalyā ūrustambhavināśanāḥ||28||

+

madhūdakasya pippalyā ūrustambhavināśanāḥ||28|| <br />

−

tasya saMshamanaM nityaM kShapaNaM shoShaNaM tathA |

+

tasya saMshamanaM nityaM kShapaNaM shoShaNaM tathA | <br />

−

yuktyapekShI bhiShak kuryAdadhikatvAtkaphAmayoH ||25||

+

yuktyapekShI bhiShak kuryAdadhikatvAtkaphAmayoH ||25|| <br />

−

sadA rUkShopacArAya yavashyAmAkakodravAn |

+

sadA rUkShopacArAya yavashyAmAkakodravAn | <br />

−

shAkairalavaNairdadyAjjalatailopasAdhitaiH ||26||

+

shAkairalavaNairdadyAjjalatailopasAdhitaiH ||26|| <br />

−

suniShaNNakanimbArkavetrAragvadhapallavaiH |

+

suniShaNNakanimbArkavetrAragvadhapallavaiH | <br />

−

vAyasIvAstukairanyaistiktaishca kulakAdibhiH ||27||

+

vAyasIvAstukairanyaistiktaishca kulakAdibhiH ||27|| <br />

−

kShArAriShTaprayogAshca harItakyAstathaiva ca |

+

kShArAriShTaprayogAshca harItakyAstathaiva ca | <br />

−

madhUdakasya pippalyA UrustambhavinAshanAH ||28||

+

madhUdakasya pippalyA UrustambhavinAshanAH ||28||<br />

+

</div></div>

−

Since ''kapha'' and ''ama'' are conspicuous in the pathogenesis of ''urustambha'', the physician should constantly judiciously administer therapies for their ''samshamana'' (pacification), ''kshapana'' (reduction) and ''shoshana''(drying up by absorption).

+

Since [[kapha]] and ''ama'' are conspicuous in the pathogenesis of ''urustambha'', the physician should constantly judiciously administer therapies for their ''samshamana'' (pacification), ''kshapana'' (reduction) and ''shoshana''(drying up by absorption).

−

The patient of ''urustambha'' should be constantly given ''rukshana'' (drying up therapies to facilitate absorption of liquid metabolites from circulation and tissues) with ''yava'' (barley), ''shyamaka'' (millet), and ''kodrava'' along with vegetables cooked with water and oil, but without adding salt. Leaves of ''sunishannaka, nimba, arka, vetra, aragwadha, vaayasi, vaastuka'' and bitter vegetables like ''kulaka'' (''karavellaka'') aid ''rukshana''.

+

The patient of ''urustambha'' should be constantly given [[rukshana]] (drying up therapies to facilitate absorption of liquid metabolites from circulation and tissues) with ''yava'' (barley), ''shyamaka'' (millet), and ''kodrava'' along with vegetables cooked with water and oil, but without adding salt. Leaves of ''sunishannaka, nimba, arka, vetra, aragwadha, vaayasi, vaastuka'' and bitter vegetables like ''kulaka'' (''karavellaka'') aid [[rukshana]].

Administration of alkali (''kshaara'') preparations, ''arishta'' (medicated wines), ''haritaki'', water added with honey and ''pippali'' cures ''urustambha'' (immobility of thighs). [25-28]

−

==== Various formulations ====

+

=== Various formulations ===

+

−

समङ्गां शाल्मलीं बिल्वं मधुना सह ना पिबेत् |

+

समङ्गां शाल्मलीं बिल्वं मधुना सह ना पिबेत् | <br />

−

तथा श्रीवेष्टकोदीच्यदेवदारुनतान्यपि ||२९||

+

तथा श्रीवेष्टकोदीच्यदेवदारुनतान्यपि ||२९|| <br />

−

चन्दनं धातकीं कुष्ठं तालीसं नलदं तथा |३०|

+

चन्दनं धातकीं कुष्ठं तालीसं नलदं तथा |३०|<br />

+

−

samaṅgāṁ śālmalīṁ bilvaṁ madhunā saha nā pibēt|

+

samaṅgāṁ śālmalīṁ bilvaṁ madhunā saha nā pibēt| <br />

−

tathā śrīvēṣṭakōdīcyadēvadārunatānyapi||29||

+

tathā śrīvēṣṭakōdīcyadēvadārunatānyapi||29|| <br />

−

candanaṁ dhātakīṁ kuṣṭhaṁ tālīsaṁ naladaṁ tathā|30|

+

candanaṁ dhātakīṁ kuṣṭhaṁ tālīsaṁ naladaṁ tathā|30| <br />

−

sama~ggAM shAlmalIM bilvaM madhunA saha nA pibet |

+

sama~ggAM shAlmalIM bilvaM madhunA saha nA pibet | <br />

−

tathA shrIveShTakodIcyadevadArunatAnyapi ||29||

+

tathA shrIveShTakodIcyadevadArunatAnyapi ||29|| <br />

−

candanaM dhAtakIM kuShThaM tAlIsaM naladaM tathA |30|

+

candanaM dhAtakIM kuShThaM tAlIsaM naladaM tathA |30| <br />

+

</div></div>

The patient suffering from ''urusthambha'' should take ''samanga, shalmali'' and ''bilwa'' along with honey.

The patient may also be given ''shriveshtaka, udichya, devadaru, nata, chandana, dhataki, kushtha, talisa, nalada'' (along with honey). [29-30]

+

−

मुस्तं हरीतकीं लोध्रं पद्मकं तिक्तरोहिणीम् ||३०||

+

मुस्तं हरीतकीं लोध्रं पद्मकं तिक्तरोहिणीम् ||३०|| <br />

−

देवदारु हरिद्रे द्वे वचां कटुकरोहिणीम् |

+

देवदारु हरिद्रे द्वे वचां कटुकरोहिणीम् | <br />

−

पिप्पलीं पिप्पलीमूलं सरलं देवदारु च ||३१||

+

पिप्पलीं पिप्पलीमूलं सरलं देवदारु च ||३१|| <br />

−

चव्यं चित्रकमूलानि देवदारु हरीतकीम् |

+

चव्यं चित्रकमूलानि देवदारु हरीतकीम् | <br />

−

भल्लातकं समूलां च पिप्पलीं पञ्च तान् पिबेत् ||३२||

+

भल्लातकं समूलां च पिप्पलीं पञ्च तान् पिबेत् ||३२|| <br />

−

सक्षौद्रानर्धश्लोकोक्तान् कल्कानूरुग्रहापहान् |३३|

+

सक्षौद्रानर्धश्लोकोक्तान् कल्कानूरुग्रहापहान् |३३|<br />

+

−

mustaṁ harītakīṁ lōdhraṁ padmakaṁ tiktarōhiṇīm||30||

+

mustaṁ harītakīṁ lōdhraṁ padmakaṁ tiktarōhiṇīm||30|| <br />

−

dēvadāru haridrē dvē vacāṁ kaṭukarōhiṇīm|

+

dēvadāru haridrē dvē vacāṁ kaṭukarōhiṇīm| <br />

−

pippalīṁ pippalīmūlaṁ saralaṁ dēvadāru ca||31||

+

pippalīṁ pippalīmūlaṁ saralaṁ dēvadāru ca||31|| <br />

−

cavyaṁ citrakamūlāni dēvadāru harītakīm|

+

cavyaṁ citrakamūlāni dēvadāru harītakīm| <br />

−

bhallātakaṁ samūlāṁ ca pippalīṁ pañca tān pibēt||32||

+

bhallātakaṁ samūlāṁ ca pippalīṁ pañca tān pibēt||32|| <br />

−

sakṣaudrānardhaślōkōktān kalkānūrugrahāpahān|33|

+

sakṣaudrānardhaślōkōktān kalkānūrugrahāpahān|33|<br />

−

mustaM harItakIM lodhraM padmakaM tiktarohiNIm ||30||

+

mustaM harItakIM lodhraM padmakaM tiktarohiNIm ||30|| <br />

−

devadAru haridre dve vacAM kaTukarohiNIm |

+

devadAru haridre dve vacAM kaTukarohiNIm | <br />

−

pippalIM pippalImUlaM saralaM devadAru ca ||31||

+

pippalIM pippalImUlaM saralaM devadAru ca ||31|| <br />

−

cavyaM citrakamUlAni devadAru harItakIm |

+

cavyaM citrakamUlAni devadAru harItakIm | <br />

−

bhallAtakaM samUlAM ca pippalIM pa~jca tAn pibet ||32||

+

bhallAtakaM samUlAM ca pippalIM pa~jca tAn pibet ||32|| <br />

−

sakShaudrAnardhashlokoktAn kalkAnUrugrahApahAn |33|

+

sakShaudrAnardhashlokoktAn kalkAnUrugrahApahAn |33|<br />

+

</div></div>

The following five recipes cure ''urusthambha'' (immobility of thighs):

Line 406: Line 476:

All the above mentioned recipes in the form of a paste (''kalkaas'') are to be taken along with honey.[30 ½ - 33 ½]

−

==== Powder formulations ====

+

=== Powder formulations ===

+

−

शार्ङ्गेष्टां मदनं दन्तीं वत्सकस्य फलं वचाम् ||३३||

+

शार्ङ्गेष्टां मदनं दन्तीं वत्सकस्य फलं वचाम् ||३३|| <br />

−

मूर्वामारग्वधं पाठां करञ्जं कुलकं तथा |

+

मूर्वामारग्वधं पाठां करञ्जं कुलकं तथा | <br />

−

पिबेन्मधुयुतं तुल्यं चूर्णं वा वारिणाऽऽप्लुतम् ||३४||

+

पिबेन्मधुयुतं तुल्यं चूर्णं वा वारिणाऽऽप्लुतम् ||३४|| <br />

−

सक्षौद्रं दधिमण्डैर्वाऽप्यूरुस्तम्भविनाशनम् |

+

सक्षौद्रं दधिमण्डैर्वाऽप्यूरुस्तम्भविनाशनम् | <br />

−

मूर्वामतिविषां कुष्ठं चित्रकं कटुरोहिणीम् ||३५||

+

मूर्वामतिविषां कुष्ठं चित्रकं कटुरोहिणीम् ||३५|| <br />

−

पूर्ववद्गुग्गुलुं मूत्रे रात्रिस्थितमथापि वा |

+

पूर्ववद्गुग्गुलुं मूत्रे रात्रिस्थितमथापि वा | <br />

−

स्वर्णक्षीरीमतिविषां मुस्तं तेजोवतीं वचाम् ||३६||

+

स्वर्णक्षीरीमतिविषां मुस्तं तेजोवतीं वचाम् ||३६|| <br />

−

सुराह्वं चित्रकं कुष्ठं पाठां कटुकरोहिणीम् |

+

सुराह्वं चित्रकं कुष्ठं पाठां कटुकरोहिणीम् | <br />

−

लेहयेन्मधुना चूर्णं सक्षौद्रं वा जलाप्लुतम् ||३७||

+

लेहयेन्मधुना चूर्णं सक्षौद्रं वा जलाप्लुतम् ||३७|| <br />

−

फलीं व्याघ्रनखं हेम पिबेद्वा मधुसंयुतम् |

+

फलीं व्याघ्रनखं हेम पिबेद्वा मधुसंयुतम् | <br />

−

त्रिफलां पिप्पलीं मुस्तं चव्यं कटुकरोहिणीम् ||३८||

+

त्रिफलां पिप्पलीं मुस्तं चव्यं कटुकरोहिणीम् ||३८|| <br />

−

लिह्याद्वा मधुना चूर्णमूरुस्तम्भार्दितो नरः |३९|

+

लिह्याद्वा मधुना चूर्णमूरुस्तम्भार्दितो नरः |३९|<br />

+

−

śārṅgēṣṭāṁ madanaṁ dantīṁ vatsakasya phalaṁ vacām [1] ||33||

+

śārṅgēṣṭāṁ madanaṁ dantīṁ vatsakasya phalaṁ vacām [1] ||33|| <br />

−

mūrvāmāragvadhaṁ pāṭhāṁ karañjaṁ kulakaṁ tathā|

+

mūrvāmāragvadhaṁ pāṭhāṁ karañjaṁ kulakaṁ tathā| <br />

−

pibēnmadhuyutaṁ tulyaṁ cūrṇaṁ vā vāriṇā''plutam||34||

+

pibēnmadhuyutaṁ tulyaṁ cūrṇaṁ vā vāriṇā''plutam||34|| <br />

−

sakṣaudraṁ dadhimaṇḍairvā'pyūrustambhavināśanam|

+

sakṣaudraṁ dadhimaṇḍairvā'pyūrustambhavināśanam| <br />

−

mūrvāmativiṣāṁ kuṣṭhaṁ citrakaṁ kaṭurōhiṇīm||35||

+

mūrvāmativiṣāṁ kuṣṭhaṁ citrakaṁ kaṭurōhiṇīm||35|| <br />

−

pūrvavadgugguluṁ [2] mūtrē rātristhitamathāpi vā|

+

pūrvavadgugguluṁ [2] mūtrē rātristhitamathāpi vā| <br />

−

svarṇakṣīrīmativiṣāṁ mustaṁ tējōvatīṁ vacām||36||

+

svarṇakṣīrīmativiṣāṁ mustaṁ tējōvatīṁ vacām||36|| <br />

−

surāhvaṁ citrakaṁ [3] kuṣṭhaṁ pāṭhāṁ kaṭukarōhiṇīm|

+

surāhvaṁ citrakaṁ [3] kuṣṭhaṁ pāṭhāṁ kaṭukarōhiṇīm| <br />

−

lēhayēnmadhunā cūrṇaṁ sakṣaudraṁ vā jalāplutam||37||

+

lēhayēnmadhunā cūrṇaṁ sakṣaudraṁ vā jalāplutam||37|| <br />

−

phalīṁ vyāghranakhaṁ hēma pibēdvā madhusaṁyutam|

+

phalīṁ vyāghranakhaṁ hēma pibēdvā madhusaṁyutam| <br />

−

triphalāṁ pippalīṁ mustaṁ cavyaṁ kaṭukarōhiṇīm||38||

+

triphalāṁ pippalīṁ mustaṁ cavyaṁ kaṭukarōhiṇīm||38|| <br />

−

lihyādvā madhunā cūrṇamūrustambhārditō naraḥ|39|

+

lihyādvā madhunā cūrṇamūrustambhārditō naraḥ|39| <br />

−

shAr~ggeShTAM madanaM dantIM vatsakasya phalaM vacAm [1] ||33||

+

shAr~ggeShTAM madanaM dantIM vatsakasya phalaM vacAm [1] ||33|| <br />

−

mUrvAmAragvadhaM pAThAM kara~jjaM kulakaM tathA |

+

mUrvAmAragvadhaM pAThAM kara~jjaM kulakaM tathA | <br />

−

pibenmadhuyutaM tulyaM cUrNaM vA vAriNA~a~aplutam ||34||

+

pibenmadhuyutaM tulyaM cUrNaM vA vAriNA~a~aplutam ||34|| <br />

−

sakShaudraM dadhimaNDairvA~apyUrustambhavinAshanam |

+

sakShaudraM dadhimaNDairvA~apyUrustambhavinAshanam | <br />

−

mUrvAmativiShAM kuShThaM citrakaM kaTurohiNIm ||35||

+

mUrvAmativiShAM kuShThaM citrakaM kaTurohiNIm ||35|| <br />

−

pUrvavadgugguluM [2] mUtre rAtristhitamathApi vA |

+

pUrvavadgugguluM [2] mUtre rAtristhitamathApi vA | <br />

−

svarNakShIrImativiShAM mustaM tejovatIM vacAm ||36||

+

svarNakShIrImativiShAM mustaM tejovatIM vacAm ||36|| <br />

−

surAhvaM citrakaM [3] kuShThaM pAThAM kaTukarohiNIm |

+

surAhvaM citrakaM [3] kuShThaM pAThAM kaTukarohiNIm | <br />

−

lehayenmadhunA cUrNaM sakShaudraM vA jalAplutam ||37||

+

lehayenmadhunA cUrNaM sakShaudraM vA jalAplutam ||37|| <br />

−

phalIM vyAghranakhaM hema pibedvA madhusaMyutam |

+

phalIM vyAghranakhaM hema pibedvA madhusaMyutam | <br />

−

triphalAM pippalIM mustaM cavyaM kaTukarohiNIm ||38||

+

triphalAM pippalIM mustaM cavyaM kaTukarohiNIm ||38|| <br />

−

lihyAdvA madhunA cUrNamUrustambhArdito naraH |39|

+

lihyAdvA madhunA cUrNamUrustambhArdito naraH |39| <br />

+

</div></div>

The patient suffering from urusthambha should take the following recipes.

Line 473: Line 546:

#The powder of ''triphala, pippali, musta, chavya'' and ''katuka-rohini'' may be made to a linctus and taken.[33 ½ - 39 ½]

−

==== Treatment of consequence of ''apatarpana'' ====

+

=== Treatment of consequence of ''apatarpana'' ===

+

−

अपतर्पणजश्चेत् स्याद्दोषः सन्तर्पयेद्धि तम् ||३९||

+

अपतर्पणजश्चेत् स्याद्दोषः सन्तर्पयेद्धि तम् ||३९|| <br />

−

युक्त्या जाङ्गलजैर्मांसैः पुराणैश्चैव शालिभिः |

+

युक्त्या जाङ्गलजैर्मांसैः पुराणैश्चैव शालिभिः | <br />

−

रूक्षणाद्वातकोपश्चेन्निद्रानाशार्तिपूर्वकः ||४०||

+

रूक्षणाद्वातकोपश्चेन्निद्रानाशार्तिपूर्वकः ||४०|| <br />

−

स्नेहस्वेदक्रमस्तत्र कार्यो वातामयापहः |

+

स्नेहस्वेदक्रमस्तत्र कार्यो वातामयापहः | <br />

+

−

apatarpaṇajaścēt syāddōṣaḥ santarpayēddhi tam||39||

+

apatarpaṇajaścēt syāddōṣaḥ santarpayēddhi tam||39|| <br />

−

yuktyā jāṅgalajairmāṁsaiḥ purāṇaiścaiva śālibhiḥ|

+

yuktyā jāṅgalajairmāṁsaiḥ purāṇaiścaiva śālibhiḥ| <br />

−

rūkṣaṇādvātakōpaścēnnidrānāśārtipūrvakaḥ||40||

+

rūkṣaṇādvātakōpaścēnnidrānāśārtipūrvakaḥ||40|| <br />

−

snēhasvēdakramastatra kāryō vātāmayāpahaḥ|

+

snēhasvēdakramastatra kāryō vātāmayāpahaḥ| <br />

−

apatarpaNajashcet syAddoShaH santarpayeddhi tam ||39||

+

apatarpaNajashcet syAddoShaH santarpayeddhi tam ||39|| <br />

−

yuktyA jA~ggalajairmAMsaiH purANaishcaiva shAlibhiH |

+

yuktyA jA~ggalajairmAMsaiH purANaishcaiva shAlibhiH | <br />

−

rUkShaNAdvAtakopashcennidrAnAshArtipUrvakaH ||40||

+

rUkShaNAdvAtakopashcennidrAnAshArtipUrvakaH ||40|| <br />

−

snehasvedakramastatra kAryo vAtAmayApahaH |

+

snehasvedakramastatra kAryo vAtAmayApahaH |<br />

+

</div></div>

If the disease ''urusthambha'' is caused by ''apatarpana'', then the patient should be appropriately given ''santarpana'' therapy consisting of the meat of animals inhabiting in ''jangala desha'' (The land with shrubs and small trees) and old shali rice.

−

If because (of excessive use) of ''rukshana'' therapies, ''vata'' gets aggravated causing insomnia and pain, then the patient should be given oleation and fomentation therapies for the alleviation of the ailments caused by ''vata''. [39 ½ - 41 ½]

+

If because (of excessive use) of [[rukshana]] therapies, [[vata]] gets aggravated causing insomnia and pain, then the patient should be given oleation and fomentation therapies for the alleviation of the ailments caused by [[vata]]. [39 ½ - 41 ½]

−

==== ''Piluparnyadi taila'' ====

+

=== ''Piluparnyadi taila'' ===

+

−

पीलुपर्णी पयस्या च रास्ना गोक्षुरको वचा ||४१||

+

पीलुपर्णी पयस्या च रास्ना गोक्षुरको वचा ||४१|| <br />

−

सरलागुरुपाठाश्च तैलमेभिर्विपाचयेत् |

+

सरलागुरुपाठाश्च तैलमेभिर्विपाचयेत् | <br />

−

सक्षौद्रं प्रसृतं तस्मादञ्जलिं वाऽपि ना पिबेत् ||४२||

+

सक्षौद्रं प्रसृतं तस्मादञ्जलिं वाऽपि ना पिबेत् ||४२|| <br />

+

−

pīluparṇī payasyā ca rāsnā gōkṣurakō vacā||41||

+

pīluparṇī payasyā ca rāsnā gōkṣurakō vacā||41|| <br />

−

saralāgurupāṭhāśca tailamēbhirvipācayēt|

+

saralāgurupāṭhāśca tailamēbhirvipācayēt| <br />

−

sakṣaudraṁ prasr̥taṁ tasmādañjaliṁ vā'pi nā pibēt||42||

+

sakṣaudraṁ prasr̥taṁ tasmādañjaliṁ vā'pi nā pibēt||42|| <br />

−

pIluparNI payasyA ca rAsnA gokShurako vacA ||41||

+

pIluparNI payasyA ca rAsnA gokShurako vacA ||41|| <br />

−

saralAgurupAThAshca tailamebhirvipAcayet |

+

saralAgurupAThAshca tailamebhirvipAcayet | <br />

−

sakShaudraM prasRutaM tasmAda~jjaliM vA~api nA pibet ||42||

+

sakShaudraM prasRutaM tasmAda~jjaliM vA~api nA pibet ||42||<br />

+

</div></div>

Oil should be cooked by adding ''piluparni, payasya, raasna, gokshuraka, vacha, sarala, agaru'' and ''paadha''. One ''prasarta'' or one ''anjali'' of this medicated oil should be taken by adding honey (One fourth in quantity of the medicated oil). [41 ½ - 42]

−

==== ''Kushthadi taila'' ====

+

=== ''Kushthadi taila'' ===

+

−

कुष्ठश्रीवेष्टकोदीच्यसरलं दारु केशरम् |

+

कुष्ठश्रीवेष्टकोदीच्यसरलं दारु केशरम् | <br />

−

अजगन्धाऽश्वगन्धा च तैलं तैः सार्षपं पचेत् ||४३||

+

अजगन्धाऽश्वगन्धा च तैलं तैः सार्षपं पचेत् ||४३|| <br />

−

सक्षौद्रं मात्रया तच्चाप्यूरुस्तम्भार्दितः पिबेत् |

+

सक्षौद्रं मात्रया तच्चाप्यूरुस्तम्भार्दितः पिबेत् | <br />

−

(रौक्ष्यान्मुक्त ऊरुस्तम्भात्ततश्च स विमुच्यते ) ||४४||

+

(रौक्ष्यान्मुक्त ऊरुस्तम्भात्ततश्च स विमुच्यते ) ||४४|| <br />

+

−

kuṣṭhaśrīvēṣṭakōdīcyasaralaṁ dāru kēśaram|

+

kuṣṭhaśrīvēṣṭakōdīcyasaralaṁ dāru kēśaram| <br />

−

ajagandhā'śvagandhā ca tailaṁ taiḥ sārṣapaṁ pacēt||43||

+

ajagandhā'śvagandhā ca tailaṁ taiḥ sārṣapaṁ pacēt||43|| <br />

−

sakṣaudraṁ mātrayā taccāpyūrustambhārditaḥ pibēt|

+

sakṣaudraṁ mātrayā taccāpyūrustambhārditaḥ pibēt| <br />

−

(raukṣyānmukta ūrustambhāttataśca sa vimucyatē [1] )||44||

+

(raukṣyānmukta ūrustambhāttataśca sa vimucyatē [1] )||44|| <br />

−

kuShThashrIveShTakodIcyasaralaM dAru kesharam |

+

kuShThashrIveShTakodIcyasaralaM dAru kesharam | <br />

−

ajagandhA~ashvagandhA ca tailaM taiH sArShapaM pacet ||43||

+

ajagandhA~ashvagandhA ca tailaM taiH sArShapaM pacet ||43|| <br />

−

sakShaudraM mAtrayA taccApyUrustambhArditaH pibet |

+

sakShaudraM mAtrayA taccApyUrustambhArditaH pibet | <br />

−

(raukShyAnmukta UrustambhAttatashca sa vimucyate [1] ) ||44||

+

(raukShyAnmukta UrustambhAttatashca sa vimucyate [1] ) ||44||<br />

+

</div></div>

−

Mustard oil should be cooked by adding ''kushtha, shreeveshtaka, udichya, sarala, devadaru, kesara, ajagandha'' and ''ashwagandha''. The patient suffering from ''urusthambha'' should take this medicated oil in appropriate quantity by adding honey. This recipe makes the patient free from ''rukshana'' (''kevala-vata prakopaja'' symptoms) leading to the cure of ''urusthambha''. [43-44]

+

Mustard oil should be cooked by adding ''kushtha, shreeveshtaka, udichya, sarala, devadaru, kesara, ajagandha'' and ''ashwagandha''. The patient suffering from ''urusthambha'' should take this medicated oil in appropriate quantity by adding honey. This recipe makes the patient free from [[rukshana]] (''kevala-vata prakopaja'' symptoms) leading to the cure of ''urusthambha''. [43-44]

−

==== ''Saindhavadi taila'' ====

+

=== ''Saindhavadi taila'' ===

+

−

द्वे पले सैन्धवात् पञ्च शुण्ठ्या ग्रन्थिकचित्रकात् |

+

द्वे पले सैन्धवात् पञ्च शुण्ठ्या ग्रन्थिकचित्रकात् | <br />

−

द्वे द्वे भल्लातकास्थीनि विंशतिर्द्वे तथाऽऽढके ||४५||

+

द्वे द्वे भल्लातकास्थीनि विंशतिर्द्वे तथाऽऽढके ||४५|| <br />

−

आरनालात् पचेत् प्रस्थं तैलस्यैतैरपत्यदम् |

+

आरनालात् पचेत् प्रस्थं तैलस्यैतैरपत्यदम् | <br />

−

गृध्रस्यूरुग्रहार्शोर्तिसर्ववातविकारनुत् ||४६||

+

गृध्रस्यूरुग्रहार्शोर्तिसर्ववातविकारनुत् ||४६||<br />

+

−

dvē palē saindhavāt pañca śuṇṭhyā granthikacitrakāt|

+

dvē palē saindhavāt pañca śuṇṭhyā granthikacitrakāt| <br />

−

dvē dvē bhallātakāsthīni viṁśatirdvē tathā''ḍhakē||45||

+

dvē dvē bhallātakāsthīni viṁśatirdvē tathā''ḍhakē||45|| <br />

−

āranālāt pacēt prasthaṁ tailasyaitairapatyadam|

+

āranālāt pacēt prasthaṁ tailasyaitairapatyadam| <br />

−

gr̥dhrasyūrugrahārśōrtisarvavātavikāranut||46||

+

gr̥dhrasyūrugrahārśōrtisarvavātavikāranut||46|| <br />

−

dve pale saindhavAt pa~jca shuNThyA granthikacitrakAt |

+

dve pale saindhavAt pa~jca shuNThyA granthikacitrakAt | <br />

−

dve dve bhallAtakAsthIni viMshatirdve tathA~a~aDhake ||45||

+

dve dve bhallAtakAsthIni viMshatirdve tathA~a~aDhake ||45|| <br />

−

AranAlAt pacet prasthaM tailasyaitairapatyadam |

+

AranAlAt pacet prasthaM tailasyaitairapatyadam | <br />

−

gRudhrasyUrugrahArshortisarvavAtavikAranut ||46||

+

gRudhrasyUrugrahArshortisarvavAtavikAranut ||46||<br />

+

</div></div>

−

One ''prastha'' (768 grams) of oil should be cooked by adding two ''palas'' (one ''pala'' = 48 grams) of ''saindhava'', five ''palas'' of ''shunthi'', two ''palas'' of ''granthika'', two ''palas'' of ''chitraka'', 20 fruits of ''bhallahaka'' and two ''adhakas'' of ''aranala''. Intake of this medicated oil helps in the conception of the offspring. It cures ''gridhrasi, urugraha, arshas,'' pain and all types of diseases caused by the aggravated vata. [45-46]

+

One ''prastha'' (768 grams) of oil should be cooked by adding two ''palas'' (one ''pala'' = 48 grams) of ''saindhava'', five ''palas'' of ''shunthi'', two ''palas'' of ''granthika'', two ''palas'' of ''chitraka'', 20 fruits of ''bhallahaka'' and two ''adhakas'' of ''aranala''. Intake of this medicated oil helps in the conception of the offspring. It cures ''gridhrasi, urugraha, arshas,'' pain and all types of diseases caused by the aggravated [[vata]]. [45-46]

+

−

पलाभ्यां पिप्पलीमूलनागरादष्टकट्वरः |

+

पलाभ्यां पिप्पलीमूलनागरादष्टकट्वरः | <br />

−

तैलप्रस्थः समो दध्ना गृध्रस्यूरुग्रहापहः ||४७||

+

तैलप्रस्थः समो दध्ना गृध्रस्यूरुग्रहापहः ||४७|| <br />

−

इत्यष्टकट्वरतैलम् |

+

इत्यष्टकट्वरतैलम् |<br />

−

इत्याभ्यन्तरमुद्दिष्टमूरुस्तम्भस्य भेषजम् |

+

इत्याभ्यन्तरमुद्दिष्टमूरुस्तम्भस्य भेषजम् | <br />

+

−

palābhyāṁ pippalīmūlanāgarādaṣṭakaṭvaraḥ|

+

palābhyāṁ pippalīmūlanāgarādaṣṭakaṭvaraḥ| <br />

−

tailaprasthaḥ samō dadhnā gr̥dhrasyūrugrahāpahaḥ||47||

+

tailaprasthaḥ samō dadhnā gr̥dhrasyūrugrahāpahaḥ||47|| <br />

−

ityaṣṭakaṭvaratailam|

+

ityaṣṭakaṭvaratailam| <br />

−

ityābhyantaramuddiṣṭamūrustambhasya bhēṣajam|

+

ityābhyantaramuddiṣṭamūrustambhasya bhēṣajam| <br />

−

palAbhyAM pippalImUlanAgarAdaShTakaTvaraH |

+

palAbhyAM pippalImUlanAgarAdaShTakaTvaraH | <br />

−

tailaprasthaH samo dadhnA gRudhrasyUrugrahApahaH ||47||

+

tailaprasthaH samo dadhnA gRudhrasyUrugrahApahaH ||47|| <br />

−

ityaShTakaTvaratailam |

+

ityaShTakaTvaratailam |<br />

−

ityAbhyantaramuddiShTamUrustambhasya bheShajam |

+

ityAbhyantaramuddiShTamUrustambhasya bheShajam |<br />

+

</div></div>

One ''prastha'' of oil (768 grams) should be cooked by adding two ''palas'' (96 grams) of ''pippalimoola'' and ''nagara'' taken together, 8 ''prasthas'' of ''katvara'' (butter milk) and one ''prastha'' of yogurt. This medicated oil cures ''gridhrasi'' (sciatica) and ''urustambha''. [47]

−

==== External applications ====

+

=== External applications ===

+

−

श्लेष्मणः क्षपणं त्वन्यद्बाह्यं शृणु चिकित्सितम् ||४८||

+

श्लेष्मणः क्षपणं त्वन्यद्बाह्यं शृणु चिकित्सितम् ||४८|| <br />

−

वल्मीकमृत्तिका मूलं करञ्जस्य फलं त्वचम् |

+

वल्मीकमृत्तिका मूलं करञ्जस्य फलं त्वचम् | <br />

−

इष्टकानां ततश्चूर्णैः कुर्यादुत्सादनं भृशम् ||४९||

+

इष्टकानां ततश्चूर्णैः कुर्यादुत्सादनं भृशम् ||४९|| <br />

−

मूलैर्वाऽप्यश्वगन्धाया मूलैरर्कस्य वा भिषक् |

+

मूलैर्वाऽप्यश्वगन्धाया मूलैरर्कस्य वा भिषक् | <br />

−

पिचुमर्दस्य वा मूलैरथवा देवदारुणाः ||५०||

+

पिचुमर्दस्य वा मूलैरथवा देवदारुणाः ||५०|| <br />

−

क्षौद्रसर्षपवल्मीकमृत्तिकासंयुतैर्भिषक् |

+

क्षौद्रसर्षपवल्मीकमृत्तिकासंयुतैर्भिषक् | <br />

−

गाढमुत्सादनं कुर्यादूरुस्तम्भे प्रलेपनम् ||५१||

+

गाढमुत्सादनं कुर्यादूरुस्तम्भे प्रलेपनम् ||५१|| <br />

−

दन्तीद्रवन्तीसुरसासर्षपैश्चापि बुद्धिमान् |

+

दन्तीद्रवन्तीसुरसासर्षपैश्चापि बुद्धिमान् | <br />

−

तर्कारीशिग्रुसुरसाविश्ववत्सकनिम्बजैः ||५२||

+

तर्कारीशिग्रुसुरसाविश्ववत्सकनिम्बजैः ||५२|| <br />

−

पत्रमूलफलैस्तोयं शृतमुष्णं च सेचनम् |

+

पत्रमूलफलैस्तोयं शृतमुष्णं च सेचनम् | <br />

−

पिष्टं तु सर्षपं मूत्रेऽध्युषितं स्यात् प्रलेपनम् ||५३||

+

पिष्टं तु सर्षपं मूत्रेऽध्युषितं स्यात् प्रलेपनम् ||५३|| <br />

−

वत्सकः सुरसं कुष्ठं गन्धास्तुम्बुरुशिग्रुकौ |

+

वत्सकः सुरसं कुष्ठं गन्धास्तुम्बुरुशिग्रुकौ | <br />

−

हिंस्रार्कमूलवल्मीकमृत्तिकाः सकुठेरकाः ||५४||

+

हिंस्रार्कमूलवल्मीकमृत्तिकाः सकुठेरकाः ||५४|| <br />

−

दधिसैन्धवसंयुक्तं कार्यमेतैः प्रलेपनम् |

+

दधिसैन्धवसंयुक्तं कार्यमेतैः प्रलेपनम् | <br />

−

(ऊरुस्तम्भविनाशाय भिषजा जानता क्रमम्) ||५५||

+

(ऊरुस्तम्भविनाशाय भिषजा जानता क्रमम्) ||५५|| <br />

−

श्योनाकं खदिरं बिल्वं बृहत्यौ सरलासनौ |

+

श्योनाकं खदिरं बिल्वं बृहत्यौ सरलासनौ | <br />

−

शोभाञ्जनकतर्कारीश्वदंष्ट्रासुरसार्जकान् ||५६||

+

शोभाञ्जनकतर्कारीश्वदंष्ट्रासुरसार्जकान् ||५६|| <br />

−

अग्निमन्थकरञ्जौ च जलेनोत्क्वाथ्य सेचयेत् |

+

अग्निमन्थकरञ्जौ च जलेनोत्क्वाथ्य सेचयेत् | <br />

−

प्रलेपो मूत्रपिष्टैर्वाऽप्यूरुस्तम्भनिवारणः ||५७||

+

प्रलेपो मूत्रपिष्टैर्वाऽप्यूरुस्तम्भनिवारणः ||५७|| <br />

+

−

ślēṣmaṇaḥ kṣapaṇaṁ tvanyadbāhyaṁ śr̥ṇu cikitsitam||48||

+

ślēṣmaṇaḥ kṣapaṇaṁ tvanyadbāhyaṁ śr̥ṇu cikitsitam||48|| <br />

−

valmīkamr̥ttikā mūlaṁ karañjasya phalaṁ tvacam|

+

valmīkamr̥ttikā mūlaṁ karañjasya phalaṁ tvacam| <br />

−

iṣṭakānāṁ tataścūrṇaiḥ kuryādutsādanaṁ bhr̥śam||49||

+

iṣṭakānāṁ tataścūrṇaiḥ kuryādutsādanaṁ bhr̥śam||49|| <br />

−

mūlairvā'pyaśvagandhāyā mūlairarkasya vā bhiṣak|

+

mūlairvā'pyaśvagandhāyā mūlairarkasya vā bhiṣak| <br />

−

picumardasya vā mūlairathavā dēvadāruṇaḥ||50||

+

picumardasya vā mūlairathavā dēvadāruṇaḥ||50|| <br />

−

kṣaudrasarṣapavalmīkamr̥ttikāsaṁyutairbhiṣak|

+

kṣaudrasarṣapavalmīkamr̥ttikāsaṁyutairbhiṣak| <br />

−

gāḍhamutsādanaṁ kuryādūrustambhē pralēpanam||51||

+

gāḍhamutsādanaṁ kuryādūrustambhē pralēpanam||51|| <br />

−

dantīdravantīsurasāsarṣapaiścāpi buddhimān|

+

dantīdravantīsurasāsarṣapaiścāpi buddhimān| <br />

−

tarkārīśigrusurasāviśvavatsakanimbajaiḥ||52||

+

tarkārīśigrusurasāviśvavatsakanimbajaiḥ||52|| <br />

−

patramūlaphalaistōyaṁ śr̥tamuṣṇaṁ ca sēcanam|

+

patramūlaphalaistōyaṁ śr̥tamuṣṇaṁ ca sēcanam| <br />

−

piṣṭaṁ tu sarṣapaṁ mūtrē'dhyuṣitaṁ syāt pralēpanam||53||

+

piṣṭaṁ tu sarṣapaṁ mūtrē'dhyuṣitaṁ syāt pralēpanam||53|| <br />

−

vatsakaḥ surasaṁ kuṣṭhaṁ gandhāstumburuśigrukau|

+

vatsakaḥ surasaṁ kuṣṭhaṁ gandhāstumburuśigrukau| <br />

−

hiṁsrārkamūlavalmīkamr̥ttikāḥ [1] sakuṭhērakāḥ||54||

+

hiṁsrārkamūlavalmīkamr̥ttikāḥ [1] sakuṭhērakāḥ||54|| <br />

−

dadhisaindhavasaṁyuktaṁ kāryamētaiḥ pralēpanam|

+

dadhisaindhavasaṁyuktaṁ kāryamētaiḥ pralēpanam| <br />

−

(ūrustambhavināśāya [2] bhiṣajā jānatā kramam)||55||

+

(ūrustambhavināśāya [2] bhiṣajā jānatā kramam)||55|| <br />

−

śyōnākaṁ khadiraṁ bilvaṁ br̥hatyau saralāsanau|

+

śyōnākaṁ khadiraṁ bilvaṁ br̥hatyau saralāsanau| <br />

−

śōbhāñjanakatarkārīśvadaṁṣṭrāsurasārjakān||56||

+

śōbhāñjanakatarkārīśvadaṁṣṭrāsurasārjakān||56|| <br />

−

agnimanthakarañjau ca jalēnōtkvāthya sēcayēt|

+

agnimanthakarañjau ca jalēnōtkvāthya sēcayēt| <br />

−

pralēpō mūtrapiṣṭairvā'pyūrustambhanivāraṇaḥ||57||

+

pralēpō mūtrapiṣṭairvā'pyūrustambhanivāraṇaḥ||57|| <br />

−

shleShmaNaH kShapaNaM tvanyadbAhyaM shRuNu cikitsitam ||48||

+

shleShmaNaH kShapaNaM tvanyadbAhyaM shRuNu cikitsitam ||48|| <br />

−

valmIkamRuttikA mUlaM kara~jjasya phalaM tvacam |

+

valmIkamRuttikA mUlaM kara~jjasya phalaM tvacam | <br />

−

iShTakAnAM tatashcUrNaiH kuryAdutsAdanaM bhRusham ||49||

+

iShTakAnAM tatashcUrNaiH kuryAdutsAdanaM bhRusham ||49|| <br />

−

mUlairvA~apyashvagandhAyA mUlairarkasya vA bhiShak |

+

mUlairvA~apyashvagandhAyA mUlairarkasya vA bhiShak | <br />

−

picumardasya vA mUlairathavA devadAruNAH ||50||

+

picumardasya vA mUlairathavA devadAruNAH ||50|| <br />

−

kShaudrasarShapavalmIkamRuttikAsaMyutairbhiShak |

+

kShaudrasarShapavalmIkamRuttikAsaMyutairbhiShak | <br />

−

gADhamutsAdanaM kuryAdUrustambhe pralepanam ||51||

+

gADhamutsAdanaM kuryAdUrustambhe pralepanam ||51|| <br />

−

dantIdravantIsurasAsarShapaishcApi buddhimAn |

+

dantIdravantIsurasAsarShapaishcApi buddhimAn | <br />

−

tarkArIshigrusurasAvishvavatsakanimbajaiH ||52||

+

tarkArIshigrusurasAvishvavatsakanimbajaiH ||52|| <br />

−

patramUlaphalaistoyaM shRutamuShNaM ca secanam |

+

patramUlaphalaistoyaM shRutamuShNaM ca secanam | <br />

−

piShTaM tu sarShapaM mUtre~adhyuShitaM syAt pralepanam ||53||

+

piShTaM tu sarShapaM mUtre~adhyuShitaM syAt pralepanam ||53|| <br />

−

vatsakaH surasaM kuShThaM gandhAstumburushigrukau |

+

vatsakaH surasaM kuShThaM gandhAstumburushigrukau | <br />

−

hiMsrArkamUlavalmIkamRuttikAH [1] sakuTherakAH ||54||

+

hiMsrArkamUlavalmIkamRuttikAH [1] sakuTherakAH ||54|| <br />

−

dadhisaindhavasaMyuktaM kAryametaiH pralepanam |

+

dadhisaindhavasaMyuktaM kAryametaiH pralepanam | <br />

−

(UrustambhavinAshAya [2] bhiShajA jAnatA kramam) ||55||

+

(UrustambhavinAshAya [2] bhiShajA jAnatA kramam) ||55|| <br />

−

shyonAkaM khadiraM bilvaM bRuhatyau saralAsanau |

+

shyonAkaM khadiraM bilvaM bRuhatyau saralAsanau | <br />

−

shobhA~jjanakatarkArIshvadaMShTrAsurasArjakAn ||56||

+

shobhA~jjanakatarkArIshvadaMShTrAsurasArjakAn ||56|| <br />

−

agnimanthakara~jjau ca jalenotkvAthya secayet |

+

agnimanthakara~jjau ca jalenotkvAthya secayet | <br />

−

pralepo mUtrapiShTairvA~apyUrustambhanivAraNaH ||57||

+

pralepo mUtrapiShTairvA~apyUrustambhanivAraNaH ||57||<br />

+

</div></div>

In the above mentioned verses (no.s 25-47), the recipes to be used internally for the cure of ''urusthambha'' are briefly described.

−

Hereafter recipes to be administered externally for the diminution of ''kapha'' will be described which you may hear.

+

Hereafter recipes to be administered externally for the diminution of [[kapha]]' will be described which you may hear.

*The mud of ant-hill, the root, fruits and barks of ''karanja'' and bricks should be made to a powder. This should be used for ''utsaadana'' (therapeutic massage with mixture of powder and unctuous substance) frequently.

*Alternatively, the physician should administer this ''utsaadana'' therapy with the help of the root of ''ashwagandha, arka, pichumarda'' or ''devadaru''. Any one of these drugs may be mixed with honey, ''sarshapa'' and mud of ant-hill before being used as thick ''utsaadana'' or ''pralepana''.

Line 685: Line 776:

*The above mentioned drugs may be made into a paste by triturating them with cow’s urine and applied externally for the cure of ''urusthambha'' .[48-57]

−

==== Beneficial diet and lifestyle in ''kapha'' vitiation ====

+

=== Beneficial diet and lifestyle in [[kapha]] vitiation ===

+

−

कफक्षयार्थं शक्येषु व्यायामेष्वनुयोजयेत् |

+

कफक्षयार्थं शक्येषु व्यायामेष्वनुयोजयेत् | <br />

−

स्थलान्याक्रामयेत् कल्यं शर्कराः सिकतास्तथा ||५८||

+

स्थलान्याक्रामयेत् कल्यं शर्कराः सिकतास्तथा ||५८|| <br />

−

प्रतारयेत् प्रतिस्रोतो नदीं शीतजलां शिवाम् |

+

प्रतारयेत् प्रतिस्रोतो नदीं शीतजलां शिवाम् | <br />

−

सरश्च विमलं शीतं स्थिरतोयं पुनः पुनः ||५९||

+

सरश्च विमलं शीतं स्थिरतोयं पुनः पुनः ||५९|| <br />

−

तथा विशुष्केऽस्य कफे शान्तिमूरुग्रहो व्रजेत् |६०|

+

तथा विशुष्केऽस्य कफे शान्तिमूरुग्रहो व्रजेत् |६०|<br />

+

−

kaphakṣayārthaṁ śakyēṣu vyāyāmēṣvanuyōjayēt|

+

kaphakṣayārthaṁ śakyēṣu vyāyāmēṣvanuyōjayēt| <br />

−

sthalānyākrāmayēt kalyaṁ śarkarāḥ sikatāstathā||58||

+

sthalānyākrāmayēt kalyaṁ śarkarāḥ sikatāstathā||58|| <br />

−

pratārayēt pratisrōtō nadīṁ śītajalāṁ śivām|

+

pratārayēt pratisrōtō nadīṁ śītajalāṁ śivām| <br />

−

saraśca vimalaṁ śītaṁ sthiratōyaṁ punaḥ punaḥ||59||

+

saraśca vimalaṁ śītaṁ sthiratōyaṁ punaḥ punaḥ||59|| <br />

−

tathā viśuṣkē'sya kaphē śāntimūrugrahō vrajēt|60|

+

tathā viśuṣkē'sya kaphē śāntimūrugrahō vrajēt|60| <br />

−

kaphakShayArthaM shakyeShu vyAyAmeShvanuyojayet |

+

kaphakShayArthaM shakyeShu vyAyAmeShvanuyojayet | <br />

−

sthalAnyAkrAmayet kalyaM sharkarAH sikatAstathA ||58||

+

sthalAnyAkrAmayet kalyaM sharkarAH sikatAstathA ||58|| <br />

−

pratArayet pratisroto nadIM shItajalAM shivAm |

+

pratArayet pratisroto nadIM shItajalAM shivAm | <br />

−

sarashca vimalaM shItaM sthiratoyaM punaH punaH ||59||

+

sarashca vimalaM shItaM sthiratoyaM punaH punaH ||59|| <br />

−

tathA vishuShke~asya kaphe shAntimUrugraho vrajet |60|

+

tathA vishuShke~asya kaphe shAntimUrugraho vrajet |60| <br />

+

</div></div>

−

*To alleviate ''kapha'', the able-bodied patients should be engaged in physical exercise and they should be made to walk over the ground covered with gravels and sand in the morning.

+

*To alleviate [[kapha]], the able-bodied patients should be engaged in physical exercise and they should be made to walk over the ground covered with gravels and sand in the morning.

*The patient should be made to swim often against the current of river with cold water but harmless. He may also be advised swimming frequently in a pond having clean, cold and stable water.[58-60]

+

−

श्लेष्मणः क्षपणं यत् स्यान्न च मारुतमावहेत् ||६०||

+

श्लेष्मणः क्षपणं यत् स्यान्न च मारुतमावहेत् ||६०|| <br />

−

तत् सर्वं सर्वदा कार्यमूरुस्तम्भस्य भेषजम् |

+

तत् सर्वं सर्वदा कार्यमूरुस्तम्भस्य भेषजम् | <br />

−

शरीरं बलमग्निं च कार्यैषा रक्षता क्रिया ||६१||

+

शरीरं बलमग्निं च कार्यैषा रक्षता क्रिया ||६१||<br />

+

−

ślēṣmaṇaḥ kṣapaṇaṁ yat syānna ca mārutamāvahēt ||60||

+

ślēṣmaṇaḥ kṣapaṇaṁ yat syānna ca mārutamāvahēt ||60|| <br />

−

tat sarvaṁ sarvadā kāryamūrustambhasya bhēṣajam|

+

tat sarvaṁ sarvadā kāryamūrustambhasya bhēṣajam| <br />

−

śarīraṁ balamagniṁ ca kāryaiṣā rakṣatā kriyā||61||

+

śarīraṁ balamagniṁ ca kāryaiṣā rakṣatā kriyā||61|| <br />

−

shleShmaNaH kShapaNaM yat syAnna ca mArutamAvahet ||60||

+

shleShmaNaH kShapaNaM yat syAnna ca mArutamAvahet ||60|| <br />

−

tat sarvaM sarvadA kAryamUrustambhasya bheShajam |

+

tat sarvaM sarvadA kAryamUrustambhasya bheShajam | <br />

−

sharIraM balamagniM ca kAryaiShA rakShatA kriyA ||61||

+

sharIraM balamagniM ca kAryaiShA rakShatA kriyA ||61|| <br />

+

</div></div>

−

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.[60-61]

+

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.[60-61]

−

==== Summary ====

+

=== Summary ===

+

तत्र श्लोकः-

−

हेतुः प्राग्रूपलिङ्गानि कर्मायोग्यत्वकारणम् |

+

हेतुः प्राग्रूपलिङ्गानि कर्मायोग्यत्वकारणम् | <br />

−

द्विविधं भेषजं चोक्तमूरुस्तम्भचिकित्सिते ||६२||

+

द्विविधं भेषजं चोक्तमूरुस्तम्भचिकित्सिते ||६२||<br />

+

tatra ślōkaḥ-

−

hētuḥ prāgrūpaliṅgāni karmāyōgyatvakāraṇam|

+

hētuḥ prāgrūpaliṅgāni karmāyōgyatvakāraṇam| <br />

−

dvividhaṁ bhēṣajaṁ cōktamūrustambhacikitsitē||62||

+

dvividhaṁ bhēṣajaṁ cōktamūrustambhacikitsitē||62|| <br />

tatra shlokaH-

−

hetuH prAgrUpali~ggAni karmAyogyatvakAraNam |

+

hetuH prAgrUpali~ggAni karmAyogyatvakAraNam | <br />

−

dvividhaM bheShajaM coktamUrustambhacikitsite ||62||

+

dvividhaM bheShajaM coktamUrustambhacikitsite ||62||<br />

+

</div></div>

In this chapter on the treatment of ''urustambha'', the following topics are discussed. Etiology, premonitory signs and symptoms, signs and symptoms, therapeutic measures which are ineffective and causes to substantiate their futility and two categories of therapeutic measures (viz. internal and external).[62]

+

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने ऊरुस्तम्भचिकित्सितं नाम सप्तविंशोऽध्यायः ||२७||

+

ityagniveshakRute tantre carakapratisaMskRute~aprApte dRuDhabalasampUrite cikitsAsthAne UrustambhacikitsitaM nAma saptaviMsho~adhyAyaH ||27||

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē ūrustambhacikitsitaṁnāma saptaviṁśō'dhyāyaḥ||27||

+

</div></div>

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.

−

*Inadequate digestion leading to vitiation of all ''dosha'' causes the basic pathogenesis.

+

*Inadequate digestion leading to vitiation of all [[dosha]] causes the basic pathogenesis.

−

*''Kapha'' is the main dosha and ''meda'' is ''dushya''. ''Avarodha'' (blockage) by excess fat and lipids in the vessels going downwards in thigh region is the type of pathogenesis.

+

*[[Kapha]] is the main [[dosha]] and [[meda dhatu]] is ''dushya''. ''Avarodha'' (blockage) by excess fat and lipids in the vessels going downwards in thigh region is the type of pathogenesis.

*Oleation and [[Panchakarma]] therapy is contraindicated in ''urustambha''.

−

*Constant administration of therapies for ''samshamana'' (pacification), ''kshapana'' (reduction) and ''shoshana'' (drying up by absorption) of ''kapha'' and ''ama'' are indicated in ''urustambha''.

+

*Constant administration of therapies for ''samshamana'' (pacification), ''kshapana'' (reduction) and ''shoshana'' (drying up by absorption) of [[kapha]] and ''ama'' are indicated in ''urustambha''.

−

*''Rukshana'' (drying up) therapies with diet, lifestyle and medicinesis administered to absorb morbid ''dosha'' causing obstruction.

+

*[[Rukshana]] (drying up) therapies with diet, lifestyle and medicinesis administered to absorb morbid [[dosha]] causing obstruction.

*The treatment includes internal administration of ''kshara, arishta'' and ''haritaki'' as well as the drugs having abovementioned actions. External application in the form of ''utsadana''( massage with mixture of powder and unctuous substance) is prescribed.

−

*The strong patients shall be advised exercise which can reduce ''kapha'' and ''meda'' like walking on sand or swimming against the stream. The objective of exercise it to remove blockage from circulation.

+

*The strong patients shall be advised exercise which can reduce [[kapha]] and [[meda dhatu]] like walking on sand or swimming against the stream. The objective of exercise it to remove blockage from circulation.

−

*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 (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]].

+

It is caused by poor lifestyle and diet with excess fat and inadequate digestion leading to ''ama'' and vitiation of three [[dosha]] of which [[kapha]] is predominant. ''Ama'', vitiated three [[dosha]] and deranged [[meda dhatu]] (fat) get deposited in the muscles of lower extremities and strangulate them.

+

Since it is ''tridoshic'' disorder with increased ama, [[Panchakarma]] is contraindicated.

+

Specific treatment is internal and external [[rukshana]] (consumption therapies) consisting of:

+

*Consumption of the ''amadosha'',

+

*Releasing the ''medas'' which is strangulating/ deposited / adhered with the muscles

+

*First pacify only [[kapha]] by consumption

+

*Swimming against the flow of water.

+

*[[Pachana]], digestion regularization for the [[pitta]] [[dosha]].

+

*Aggressive physiotherapy.

+

*All the myopathies should be treated as per line of treatment mentioned in ''urustambha''.

+

*Differential diagnosis between urustambha, mamsa-medogata [[vata]] (disorder due to vitiated [[vata]] located in [[mamsa dhatu]] and [[meda dhatu]]), [[pitta]]vrita vyana (''vyana'' covered by vitiated [[pitta]]) and [[kapha]] avrita vyana ([[vyana]] covered by vitiated [[kapha]]) is necessary. These sets of disorders refer to genetic and acquired muscular disorders (inflammatory and degenerative disorders).

+

=== Etiological factors ===

+

Tri[[dosha]] prakopa nidana mentioned by Vagbhata comprises of ''sankirna, ajirna, vishama, viruddha, adhyashana, vyapanna-madya, putishushkakrishaamisha'' etc. <ref>Vagbhata. Nidana Sthana, Cha.1 Sarvaroga Nidana Adhyaya verse 19,20. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>. Consuming foods having different [[guna]] 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 tri[[dosha]] prakopa. Regular habituation of ''viruddha, adhyashana'' and ''ajirna'' causes accumulation of toxic metabolites in [[rasa dhatu]]. These toxic metabolites avert proper utilization of [[rasa dhatu]] and elicit tri[[dosha]] prakopa, which carry untransformed [[rasa dhatu]] to ''amashaya''. This [[rasa dhatu]], which is having attributes of [[kapha]] is taken to ''amashaya'' to get metabolized (digested) by [[kapha]]gni present there. Thus ama [[rasa dhatu]] is a condition of ''koshtha''. If ''amarasadhatu'' fails to get digested, it interacts and combines with elicited tri[[dosha]] to become one which is designated as saama(tri)[[dosha]]. Thus tri[[dosha]] 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 [[dosha]]. [[Kapha]] or saama[[kapha]] subdues [[pitta]].<ref>Vagbhata. Nidana Sthana, Cha.15, Vatavyadhi Nidana Adhyaya verse 48. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref> In medodushtija conditions all the channels will be obstructed by medas . <ref>Sushruta. Sutra Sthana, Cha.15 Doshadhatumalakshayavruddhivijnaneeyam Adhyaya verse 32. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>. 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 [[dosha]] 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<ref>Vagbhata.Nidana Sthana, Cha.15 Vatavyadhi Nidanam In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>, 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'''

+

{| class="wikitable"

+

|-

+

! Vitiated [[dosha]] !! Dushya [[Dhatu]] !! Srotas !! [[Prakriti]] (Sthanik [[dosha]]) !! Desha (Rogamarga) !! Kaala (stage of the disease)

+

|-

+

| Vitiated [[Kapha]] (Gourava,Sthairya, Shaitya, Snigdha) - [[Vata]] (Laaghava & Vaishadya) || [[Rasa dhatu]](+), [[Asthi dhatu]](+) ||Rasavaha-srotas (+) Majjavaha-srotas (+) || Avalambaka [[Kapha]] (+),Paachaka [[pitta]] (-),Samaana (+), Vyaana (+) || Antar-roga maarga (+), Madhyama roga maarga (+) ||Saama [[kapha]] (+), Avrita-[[vata]], Acute (+)

+

|-

+

|}

+

Note: (+)=Identical with vitiated [[dosha]],(-)= not identical with vitiated [[dosha]], Samprapti Bala: 11/12 (Pravara)

+

=== Reason of limitation of panchakarma in management ===

+

The reason why [[panchakarma]] therapies are ineffective in urusthambha is due to four reasons. The tri[[dosha]] which is getting vitiated due to visharupa ama (toxic metabolites in [[rasa dhatu]]) become saama[[dosha]] on interaction with ama [[rasa dhatu]]. This saamadosha will be directed to lower limbs by fat. So the two reasons being the adherence (paicchilyam) produced by ama and obstruction by medas. Due to these causes, the [[dosha]] are unable to move out of uru. The third reason is [[asthi]] is site of [[vata]] which is inherently shita (cold leading to stiffness) predominant. [[Kapha]] has cold properties leading to obstruction and stiffness. The fourth reason is mudha-vatata ([[vata]] in [[asthi dhatu]] is devoid of movement) due to ama and avarana and hence movement of [[kapha]] outwards is not facilitated. Moreover [[kapha]] is immobile.

+

[[Panchakarma]] therapy is prescribed only when [[dosha]] are in a state of getting expelled out from nearest external orifices. In urusthambha due to adhering nature of [[dosha]], obstruction by fat, decreased metabolic activity in [[asthi dhatu]] and also due to immobile [[kapha]]-[[vata]], srotashodhana (clearing channels), abhishyandana (flowing nature of doshas) or paaka (proper metabolic activity) do not take place. This shows the inadequacy to facilitate mobility and koshtha gati (movement of dosha towards GIT) of [[dosha]]. Hence panchakarma therapy is not advisable in this circumstance.

+

=== Importance of rukshana ===

+

The biological functions performed by ruksha guna are those opposite to sneha guna. Snehaguna imparts softness, unctuousness, increases strength and improves the complexion. Ruksha removes kleda (water elementary principle) from cells or tissues and causes hardening and eventually roughening takes place. Fat predominance in structures makes them soft while protein in excess makes them hard. Sneha-kleda vriddhi in excess in tissues makes them flaccid and soft. As the sneha-kleda vriddhi cannot be expelled from [[asthi dhatu]] and brought to koshdha, the treatment principle which is to be applied is either increasing the mobility of kleda and make it move outwards or drying up of kleda by absorption. [[Rukshana]] is performed not only by ruksha guna, but also by many gunas which directly or indirectly augment the absorption of kleda. Kashaya-katu-tikta tastes are successively more powerful rukshana rasas.

+

Vyadhiviparita treatment encompasses reinstalling the functions of samana [[vayu]], vyana [[vayu]] and avalambaka [[kapha]]. Hetuviparita treatment is Saama[[dosha]] management and [[kapha]]avrita [[vata]] treatment.

+

=== Beneficial diet ===

+

Congenial (pathya or roga-saatmya) food should be changed to shyaamaaka, kodrava, uddaala and shaali which are puraana (stored for a long period like one year or more). Shaali though is madhura, puraana will subside [[kapha]] and medas. Yusha of shushka moolaka or patola, Jaangala maamsa and other vegetables without ghee and salt <ref> Sushruta. Chikitsa Sthana, Cha.5 Mahavatavyadhi Chikitsitam verse 38. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1. </ref>

+

=== Medicines ===

+

The best drug of choice is guggulu <ref>Sushruta. Chikitsa Sthana, Cha.5 Mhavatavyadhi Chikitsitam Adhyaya verse 40-45. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>. With its (guggulu’s) prabhaava (special attribute), it does rukshana (vaishadyakara) as well as vata-anulomana (ushna-virya) simultaneously.

+

The best formulation of choice is shaddharana churna which metabolises saama [[kapha]] and also medas along with [[vata]]-anulomana. Other chief drugs that could be used according to the status are triphala, trikatu, shilajit, karanjaphala, sarshapa etc. Choice of medicine is to be done according to the state and stage of the disease and diseased.

+

Nourishment in vitiation of [[vata]]:If Urusthambha develops in emaciated (Apatarpanotha), santarpana of [[rasa dhatu]] has to be done with jaangala maamsa, puraana shaali etc. All the foresaid measures could be done in niraama stage only. The food, regimen and medicine should always be [[kapha]]-[[vata]]hara.

+

The treatment should be always [[kapha]]hara ([[rukshana]]) along with [[vata]]hara (anulomana for laghu, vishada [[guna]]). [[Laaghava]] (decline of anulomana, effortless execution of activities) Aatma-rupa of [[vata]] causes symptoms in vyakti stage. Roukshya (degenerative changes) Aatma-rupa of [[vata]] causes symptoms of insomnia and pain (alarm to prevent necrosis) as upadrava due to careless application of [[rukshana]].

+

=== Medicated oils ===

+

Medicated oils are to be applied only in niraama-[[dosha]] as well as [[kapha]] and medas have decreased (aavarana lakshanas disappear) considerably. Medicated oils can alleviate roukshya, vaishadya and laghava without affecting or along with the decline of [[kapha]] and [[meda dhatu]].

+

=== Management of ama [[dosha]] ===

+

All these therapeutics are to be administered after metabolizing saama [[dosha]]. As ama is of toxic nature, treatment principle of ama-[[vata]] ([[Langhana]]m [[swedana]]m tikto [[deepana]]ani katuni ca) has to be applied initially. Then [[rukshana]] treatment principle without aggravating [[vata]] is explained. The foresaid food, recipes (medicine) and regimen help to achieve [[rukshana]]. Katu, tikta and kashaya rasaas are antagonistic to [[kapha]], but aggravates [[vata]]. Dravyas which differ from the above principle are shunthi, pippali, rasona (katu dravyaas), guduchi, patola (tikta dravyas) and haritaki (kashaya dravya) will not aggravate vata. The patient should be made to walk on irregular surface will cause strain to lower limbs which is a treatment principle of [[kapha]]<ref>Vagbhata. Sutra Sthana, Cha.13 Doshopakramaneeya Adhyaya verse 12. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4. </ref>. Swimming in cool water would increase the internal temperature which counters the shita guna of [[kapha]] which is strongly embedded in shita [[asthi-dhatu]]. This would favour [[kapha]] kshapana from [[asthi]] and its mitigation.

+

=== Current clinical practices ===

+

==== Principles of management ====

+

#Kshapana of [[kapha]] and [[meda dhatu]] ( reduction of [[kapha]] and [[meda dhatu]])

+

#[[Rukshana]] and shoshana (drying and absorbing excess fat and lipids)

+

#External application 4. Exercise in the form of swimming against the flow

+

==== Important medicines ====

+

1. Bhallataka 2. Guggulu

+

'''Table 2: Medicines used to treat Urustambha'''

+

{| class="wikitable"

+

|-

+

! Name !! Dose !! Time !! Anupana (vehicle)

+

|-

+

|Bhallatakadi decoction || 20 to 40 ml || Early morning and before sleep two times || --

+

|-

+

|Triphala guggulu || 250 -500 mg || Early morning and before sleep two times ||Bhallatakadi decoction

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|-

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|Chandraprabha || 250 -500 mg || Early morning and before sleep two times ||Vardhamana pippali formulation

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|}

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Revision as of 10:27, 23 February 2024