Changes

|data1 = [[Chikitsa Sthana]] Chapter 28

|data1 = [[Chikitsa Sthana]] Chapter 28

|label2 = Preceding Chapter

|label2 = Preceding Chapter

|data2 = [[Urusthambha Chikitsa]]

|data2 = [[Urustambha Chikitsa]]

|label3= Succeeding Chapter

|label3= Succeeding Chapter

}}

}}

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

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

=== Abstract ===

=== Abstract ===

[[Vatavyadhi Chikitsa]] deals with disorders particularly caused by ''vata dosha''. It is an important chapter as it encompasses a large spectrum of disorders especially concerned with neurological system, musculoskeletal system, reticulo-endothelial system and further pervades to all other systems in the body. The chapter highlights the five sub classifications of ''vata'', their habitat and functions. The etiological factors of ''vatavyadhi'' are enlisted and two major pathology viz, ''dhatukshaya'' and ''avarana'' are detailed. In ''dhatukshaya'', vitiated ''vata'' assumes the status of ''gatavata'' (increased movement of ''vata'') and occupies various sites leading to ''dhatugata'' (affecting tissues) ''vata, ashayagata'' (affecting various sites) ''vata'' and ''avayava'' (organs) ''gatavata''. ''Avarana'' (obstruction by covering) is a distinct pathology of ''vata'' in which the free mobility of ''vata'' is hampered. Accordingly, ''avarana'' may happen either due to two other ''dosha, dhatu'' (''rakta'', etc.) or ''mala'' (waste). ''Avarana'' may also happen in between two subtypes of ''vata'' as the direction of movement of various types of ''vata'' differ. This is called ''anyonyavarana''. The symptomatology, pathology and management strategies of ''avarana'' as well as ''gatavata'' are detailed in the chapter. The most common neurological disorders like ''pakshaghata'' (stroke), ''ardita'' (facial palsy), ''gridhrasi'' (sciatica), ''avabahuka'' (frozen shoulder), ''viswachi'' (cervico brachial neuralgia) etc. are described. Various formulations including medicated oils and ghee etc. are also included in the chapter. The chapter confirms the difficulty in curability of chronic ''vatavyadhi'' affecting debilitated individuals.  

[[Vatavyadhi Chikitsa]] deals with disorders particularly caused by ''vata dosha''. It is an important chapter as it encompasses a large spectrum of disorders especially concerned with neurological system, musculoskeletal system, reticulo-endothelial system and further pervades to all other systems in the body. The chapter highlights the five sub classifications of ''vata'', their habitat and functions. The etiological factors of ''vatavyadhi'' are enlisted and two major pathology viz, ''dhatukshaya'' and ''avarana'' are detailed. In ''dhatukshaya'', vitiated ''vata'' assumes the status of ''gatavata'' (increased movement of ''vata'') and occupies various sites leading to ''dhatugata'' (affecting tissues) ''vata, ashayagata'' (affecting various sites) ''vata'' and ''avayava'' (organs) ''gatavata''. ''Avarana'' (obstruction by covering) is a distinct pathology of ''vata'' in which the free mobility of ''vata'' is hampered. Accordingly, ''avarana'' may happen either due to two other ''dosha, dhatu'' (''rakta'', etc.) or ''mala'' (waste). ''Avarana'' may also happen in between two subtypes of ''vata'' as the direction of movement of various types of ''vata'' differ. This is called ''anyonyavarana''. The symptomatology, pathology and management strategies of ''avarana'' as well as ''gatavata'' are detailed in the chapter. The most common neurological disorders like ''pakshaghata'' (stroke), ''ardita'' (facial palsy), ''gridhrasi'' (sciatica), ''avabahuka'' (frozen shoulder), ''viswachi'' (cervico brachial neuralgia) etc. are described. Various formulations including medicated oils and ghee etc. are also included in the chapter. The chapter confirms the difficulty in curability of chronic ''vatavyadhi'' affecting debilitated individuals.  

'''Keywords''': ''Aksepaka, Anyonyvarana, Apana, Ardita, Avabahuka, Avarana,'' Ayurveda, Convulsive disorders, ''Dhatukshaya,'' Facial palsy, ''Gatavata,'' General Line of treatment of ''Vatavyadhi, Gridhrasi,'' Neurological disorders, ''Paksaghata, Praana, Samana,'' Sciatica, Specific treatments of ''Vatavyadhi'', Stroke, ''Udana, Viswachi, Vyana.''

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

=== Introduction ===

=== Introduction ===

''Vata'' is the prime ''dosha''. Owing to its incorporeal nature and instability it is inaccessible in comparison to other two ''dosha''. The inaccessibility is characterized in regard to its functional and physical attributes but is more relevant regarding the therapeutic aspect. ''Vata'' is also explained as ''achintyaveerya'' (inconceivable prowess) and ''doshaanaam netah'' (propeller of all functional elements in the body).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/8; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

''Vata'' is the prime ''dosha''. Owing to its incorporeal nature and instability it is inaccessible in comparison to other two ''dosha''. The inaccessibility is characterized in regard to its functional and physical attributes but is more relevant regarding the therapeutic aspect. ''Vata'' is also explained as ''achintyaveerya'' (inconceivable prowess) and ''doshaanaam netah'' (propeller of all functional elements in the body).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/8; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

Before discussing the importance and implications of ''vata'', the references on ''vata'' and neurological elements in vedic literature is to be highlighted. In vedic science two terminologies namely ''prana'' and ''pranaja'' were used to denote nerve impulses. ''Prana'' is ''kriyashakti'' (power for action) and may be compared with motor impulse. ''Pranaja'' is also same as ''prana'' but conveys sensation of taste, smell, vision, sound, coitus, reproduction, pleasure and pain. It can be compared with sensory afferent impulse. Both ''prana'' and ''pranaja'' leave body at death. The entire neural axis is explained as ''sushumna'' (spinal cord) and it extends from the mid-perineum to inside of cranium runing through the middle of the spine to reach the cerebrum, twelve fingers breadth from nose. The shape of ''sushumna'' is compared with flower of ''datura alba'' with two dilatations at thoracic and lumbar areas. The cross section of spinal column is compared with the letter ''Aum'' in which grey matter and white matter is identified as ''chitrini'' (name for grey matter) and ''vajra'' (name for white matter). The neural net works are compared with ''luta tantu'' (spider web)<ref>B C Joshy, Neurology in Ancient India – some evidences, Indian journal of History of science, 19(4):366-396(1984)</ref>. Ten subtypes of ''vata'' are explained and ''dhananjaya'' (the tenth and last subtype) does not leave the body even after death. This is responsible for tissue transplantation after death. The description of ''shadchakra'' (six ''chakras'') is also very striking with latest functional modern neurology. The difference between vedic and ayurvedic neurology is that vedic science used it to attain higher level of consciousness through control of one’s nerve impulses. Ayurvedic science is meant for academic advancement or therapeutics. In Ayurveda it can be seen that practical utilization of vedic knowledge for therapeutic purpose by modification through experiments and experiences is done. Detailed descriptions of features of ''vata'' are available in various chapters of [[Charaka Samhita]] including [[Deerghanjiviteeya Adhyaya]], [[Vatakalakaliya Adhyaya]] and [[Rogabhishagjitiya Vimana]], etc. The pathology and therapeutic aspects of ''vata'' is explained in this chapter. There is no separate chapter for diseases of ''pitta'' and ''kapha dosha''. [[Vatavyadhi Chikitsa]] is an exclusive chapter dealing with ''vata janita vishesha vyadhi'' (diseases caused by vata vitiation). It is because of the supremacy of ''vata''. The chapter is kept just after [[Urusthambha Chikitsa]] since in that particular disease ''ama, kapha, meda,'' etc. are associated to cause ''vataprakopa'' and ''urustambha''. On application of strenuous ''rukshana chikitsa'' in ''urustambha, vataprakopa'' alone may also happen. Even though in ''nanatmaja'' (single ''dosha'') ''vatavyadhi'' the presence of other ''dosha'' can be traced, the disease cannot manifest without the vitiation of ''vata''.  

Before discussing the importance and implications of ''vata'', the references on ''vata'' and neurological elements in vedic literature is to be highlighted. In vedic science two terminologies namely ''prana'' and ''pranaja'' were used to denote nerve impulses. ''Prana'' is ''kriyashakti'' (power for action) and may be compared with motor impulse. ''Pranaja'' is also same as ''prana'' but conveys sensation of taste, smell, vision, sound, coitus, reproduction, pleasure and pain. It can be compared with sensory afferent impulse. Both ''prana'' and ''pranaja'' leave body at death. The entire neural axis is explained as ''sushumna'' (spinal cord) and it extends from the mid-perineum to inside of cranium runing through the middle of the spine to reach the cerebrum, twelve fingers breadth from nose. The shape of ''sushumna'' is compared with flower of ''datura alba'' with two dilatations at thoracic and lumbar areas. The cross section of spinal column is compared with the letter ''Aum'' in which grey matter and white matter is identified as ''chitrini'' (name for grey matter) and ''vajra'' (name for white matter). The neural net works are compared with ''luta tantu'' (spider web)<ref>B C Joshy, Neurology in Ancient India – some evidences, Indian journal of History of science, 19(4):366-396(1984)</ref>. Ten subtypes of ''vata'' are explained and ''dhananjaya'' (the tenth and last subtype) does not leave the body even after death. This is responsible for tissue transplantation after death. The description of ''shadchakra'' (six ''chakras'') is also very striking with latest functional modern neurology. The difference between vedic and ayurvedic neurology is that vedic science used it to attain higher level of consciousness through control of one’s nerve impulses. Ayurvedic science is meant for academic advancement or therapeutics. In Ayurveda it can be seen that practical utilization of vedic knowledge for therapeutic purpose by modification through experiments and experiences is done. Detailed descriptions of features of ''vata'' are available in various chapters of [[Charak Samhita]] including [[Deerghanjiviteeya Adhyaya]], [[Vatakalakaliya Adhyaya]] and [[Rogabhishagjitiya Vimana]], etc. The pathology and therapeutic aspects of ''vata'' is explained in this chapter. There is no separate chapter for diseases of ''pitta'' and ''kapha dosha''. [[Vatavyadhi Chikitsa]] is an exclusive chapter dealing with ''vata janita vishesha vyadhi'' (diseases caused by vata vitiation). It is because of the supremacy of ''vata''. The chapter is kept just after [[Urusthambha Chikitsa]] since in that particular disease ''ama, kapha, meda,'' etc. are associated to cause ''vataprakopa'' and ''urustambha''. On application of strenuous ''rukshana chikitsa'' in ''urustambha, vataprakopa'' alone may also happen. Even though in ''nanatmaja'' (single ''dosha'') ''vatavyadhi'' the presence of other ''dosha'' can be traced, the disease cannot manifest without the vitiation of ''vata''.  

''Vata'' as explained earlier is the biological force present in the body which recognizes and stimulates all the activities. Instability of ''vata'' makes it inaccessible. It is characterized by an increase in the ''chala'' (motion) property, which is favored and contributed by other properties also. The ''chala guna'' is directional in nature and termed as ''gati''. ''Gati'' is the distinct quality of ''vata'', very important on physiological and pathological aspects. The ''gati'' of individual components of ''vata'' is to be analyzed according to the intensity, direction and area; depending upon the particular function it is carrying out. When the ''gati'' is aggravated (''gatatva'') or obstructed (''avarana'') the functional normality’s of ''vata'' are impaired. The ''gati'' or ''gatatva'' have two implications, one subjected to activity (to move, carry out or reach-gata) and the second subjected to abode of activity (pathway). ''Gatatva'' is an essential part of any ''vataja samprapti'' (pathogenesis). ''Gatatva'' of ''vata'' is possible in ''dhatu, upadhatu, asaya'' (sites or hollow cavities of organs), ''avayava'' (part or organ), etc. Consumption of ''ahara'' of relatively higher ''kittansa'' (waste products) leads to diminution of ''dhatu'' and aggravation of ''vata''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Sutrasthānam 28/4; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref>. It leads to ''riktata'' (emptiness) and more ''avakasa'' (space) in ''dhatu'', makes the engorgement and hyper movement of aggravated ''vata'' in the site. ''Dhatugatavata'' and ''dhatuavrita vata'' are also distinct pathologies as in ''avarana'' the vitiation of ''vata'' is passive and the ''gati'' is obstructed.

''Vata'' as explained earlier is the biological force present in the body which recognizes and stimulates all the activities. Instability of ''vata'' makes it inaccessible. It is characterized by an increase in the ''chala'' (motion) property, which is favored and contributed by other properties also. The ''chala guna'' is directional in nature and termed as ''gati''. ''Gati'' is the distinct quality of ''vata'', very important on physiological and pathological aspects. The ''gati'' of individual components of ''vata'' is to be analyzed according to the intensity, direction and area; depending upon the particular function it is carrying out. When the ''gati'' is aggravated (''gatatva'') or obstructed (''avarana'') the functional normality’s of ''vata'' are impaired. The ''gati'' or ''gatatva'' have two implications, one subjected to activity (to move, carry out or reach-gata) and the second subjected to abode of activity (pathway). ''Gatatva'' is an essential part of any ''vataja samprapti'' (pathogenesis). ''Gatatva'' of ''vata'' is possible in ''dhatu, upadhatu, asaya'' (sites or hollow cavities of organs), ''avayava'' (part or organ), etc. Consumption of ''ahara'' of relatively higher ''kittansa'' (waste products) leads to diminution of ''dhatu'' and aggravation of ''vata''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Sutrasthānam 28/4; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref>. It leads to ''riktata'' (emptiness) and more ''avakasa'' (space) in ''dhatu'', makes the engorgement and hyper movement of aggravated ''vata'' in the site. ''Dhatugatavata'' and ''dhatuavrita vata'' are also distinct pathologies as in ''avarana'' the vitiation of ''vata'' is passive and the ''gati'' is obstructed.

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

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

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

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

तत्र कोष्ठाश्रिते दुष्टे निग्रहो मूत्रवर्चसोः ||२४||  

तत्र कोष्ठाश्रिते दुष्टे निग्रहो मूत्रवर्चसोः ||२४||  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

All the verses explain a specific type of ''samprapti'' (pathogenesis) like ''koshthagata vata'' (''vata'' affecting alimentary tract), ''amashayagata vata'' (''vata'' affecting stomach.) etc. They are not to be considered as a single disease. These specific diseases may lead to many disease presentations in which the treatment strategies can be generalized. Any ''dosha'' may occupy any particular site or area and lead to diseases. This type of pathology of vitiated ''vata'' is called as ''gatavata''.  Normally in all ''gatavata'', the affected ''dushya''(vitiated body components) will be ''kshina'' (depleted) and affected ''srotas'' will be ''rikta'' (empty). The concept of ''gatavata'' can be further explored physiologically. ''Dhatu'' are classified into two types’ ''asthayi'' (temporary) ''dhatu'' and ''sthayi'' (permanent) ''dhatu''. ''Asthayi dhatu'' are the ones which are ''dravaswarupa'' (liquid state) and undergoing conversion (''parinam apadyamananam'') and they are being ''vikshepita'' (circulated) from their ''mulasthana'' (origin) throughout the ''sharira'' (''abhivahana'') for the purpose of ''poshana'' (nourishment) of the ''sthayi dhatu''. This ''parinamana'' (conversion) and ''abhivahana prakriya''(transportation) takes place in ''marga'' (channel) which are known as ''srotas''; hence ''marga'' is one of the synonym used for srotas alongwith sirā (vein), dhamani (artery), rasāyani (capillary), rasavāhini (channels carrying nutrient fluid), nādi (nerve), panthāna (pathway), sharir chhidra (perforated channel), samvrita-asamvritāni (covered or uncovered), sthāna (site), āshaya (organ), niketa (habitat), sharirdhātu avakāsha (hollow space in body tissues).

All the verses explain a specific type of ''samprapti'' (pathogenesis) like ''koshthagata vata'' (''vata'' affecting alimentary tract), ''amashayagata vata'' (''vata'' affecting stomach.) etc. They are not to be considered as a single disease. These specific diseases may lead to many disease presentations in which the treatment strategies can be generalized. Any ''dosha'' may occupy any particular site or area and lead to diseases. This type of pathology of vitiated ''vata'' is called as ''gatavata''.  Normally in all ''gatavata'', the affected ''dushya''(vitiated body components) will be ''kshina'' (depleted) and affected ''srotas'' will be ''rikta'' (empty). The concept of ''gatavata'' can be further explored physiologically. ''Dhatu'' are classified into two types’ ''asthayi'' (temporary) ''dhatu'' and ''sthayi'' (permanent) ''dhatu''. ''Asthayi dhatu'' are the ones which are ''dravaswarupa'' (liquid state) and undergoing conversion (''parinam apadyamananam'') and they are being ''vikshepita'' (circulated) from their ''mulasthana'' (origin) throughout the ''sharira'' (''abhivahana'') for the purpose of ''poshana'' (nourishment) of the ''sthayi dhatu''. This ''parinamana'' (conversion) and ''abhivahana prakriya''(transportation) takes place in ''marga'' (channel) which are known as ''srotas''; hence ''marga'' is one of the synonym used for ''srotas'' along with ''sira'' (vein), ''dhamani'' (artery), ''rasayani'' (capillary), ''rasavahini'' (channels carrying nutrient fluid), ''nadi'' (nerve), ''panthana'' (pathway), ''sharira chhidra'' (perforated channel), ''samvrita-asamvritani'' (covered or uncovered), ''sthana'' (site), ''ashaya'' (organ), ''niketa'' (habitat), ''shariradhatu avakasha'' (hollow space in body tissues).

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

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

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

As āvarana proceeds it may end up in dhātukṣaya as the āvr̥ta will block rasadhātu which give nourishment. This is commonly observed. This is possible in many other disorders also. The best example is rajayakshma.  

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

Prognosis: Exclusive vata disorders are serious and have poor prognosis. The symptoms / diseases explained manifest when vitiated vāta affects vital parts. The therapeutic approaches should be cautious and extra efforts are essential for a better recovery. As the disease becomes chronic the curability rate drastically declines. The physical strength of the patient is also very important in determining prognosis. (verse 72-74)

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

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

 

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

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

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

 

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

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

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

 

Management of vata at different sites:

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

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

 

Hridya anna (favourite food) is typically indicated in tvakgata vāta because, rūkṣatā in tvak is a result of rasakṣaya caused by overworrying.17

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

Bahya snēhana in the form of abhyanga or dharā etc are very effective in asthi and majjāgata vāta. Ābhyantara snēhana replenishes meda dhātu and subsequently asthi and meda. It is worthy to note the utility of tikta ghrita in asthikṣaya.

 

In śukrakṣaya (depletion of shukra), harshana (pleasure) and vrishya annapāna (aphorodisiac diet) is very useful. 18

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

Management of ardita (facial palsy):

 

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

''Ardita'': ''Ardita'' is a disease of episodic origin. It may lead to facial paralysis or hemiplegia or both. In other classics ''ardita'' is explained as facial paralysis only. (verse 38-42)

In Pakṣāghāta, swedana, fomentation mixed with unctuous material and virechana or purgation therapy with unctuous substance is indicated. Virechana is the line of treatment in pakṣāghāta and outweighs basti which is said to be ideal for vātakopa. Pakṣāghāta may be understood as a concealed urdhwaga raktapitta (bleeding from upper orifices of body) in which the only and effective choice is adho-shodhana (purgation). Gr̥dhrasī is a tendon and ligament disorder and shastra, kshara, agnikarma are the main line of treatment. Therefore sirāvyadha (blood letting) and dāhakarma (cauterization) is advised. Basti is also a good choice since pakvāśayagata vāta leads to kateegraha and gr̥dhrasī.  

 

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

''Antarayama'' (emprosthotonous) and ''bahirayama''(ophisthotonous): These diseases are tetany like conditions in which the body is sharply bent forward and backward respectively. (verse 43-48)

 

Importance of site of affliction in treatment:

''Hanugraha'': It is a lockjaw like condition that may be persistent or intermittent or recurrent due to vitiation of ''vata'' affecting the mandibular joint. (verse 49)

 

''Dandaka'':''Dandaka'' is a condition in which the muscles are hypertonic but without convulsions. When it further manifests as tonic clonic convulsions it is referred as ''danda akshepaka''. This condition is caused due to vitiation of ''vata'' simultaneously in muscle groups. (verse 51)

 

Episodic nature of various ''vata'' disorders: The disorders mentioned from ''ardita'' onwards are ''vegavana'' (episodic). All ''vegavana'' disorders have two phases, ''vega'' and ''vegantara''. ''Vegantara'' is the symptom free period and is considered as right time for medication. (verse 52)

 

''Pakshaghata'': Three diseases namely ''pakshaghata''(hemiplegia), ''ekangaroga'' (monoplegia) and ''sarvangaroga'' (quadriplegia) are explained. In ''pakshaghata'' no painful symptoms are explained. ''Sira'' and ''snayu'' are considered as ''dushya'' in ''ekangaroga'' and ''sarvangaroga''. ''Sira'' is the ''upadhatu'' of ''rakta'' and ''snayu'' is the ''upadhatu'' of meda, therefore ''meda'' and ''rakta'' have vital role in pathogenesis of these diseases. (verse 53-55)

 

''Gridhrasi'': ''Gridhrasi'' is a ''snayugata'' (affecting tendon) ''roga''. The word ''gridhrasi'' is derived from ''ghridhra'', which means vulture, the typical gait of the disease is highlighted by the name.  The patient’s gait is changed like a vulture due to affected tendons by vitiated ''vata''.

 

''Khalli'' is the term given to severe painful twisting conditions of tendons. (verse 56-57)

 

Nomenclature of diseases: All the ''vata'' disorders cannot be named or explained. They should be understood on the basis of site of affliction as well as nomenclature. (verse 58)

 

Diagnosis of ''dhatukshaya'' (degenerative pathology) and ''avarana'' (obstructive pathology) induced vitiation of ''vata'': ''Vata'' can be vitiated due to ''dhatukshaya'' and ''margavarana'' types of pathogenesis. ''Dhatukshaya'' leads to depletion of tissues and more space for ''vata'' to move. This leads to ''gatavata'' phenomenon. ''Avarana'' of ''vata'' can be caused by other ''dosha'' or ''dhatu''. So the differences between ''avarana'' and ''gatavata'' should be understood.

 

The word, ''avarana'' means obstruction or resistance or friction to the normal ''gati'' of ''vata''. Hence when its normal movement is hampered or vitiated, it becomes ''avrita'' and leads to different disorders. The ''gatatva'' and ''avritatva'' are entirely different phenomenon. Here an attempt is being made to differentiate the both physio-pathologies. [16]

 

#In ''avarana'', generally the vitiation of ''vata'' is passive. When vitiated ''dosha'' or any other thing obstructs the pathway of ''vata, avarana'' happens. Normal state of ''vata'' gets vitiated as ''avarana'' progresses. The substance which obstructs the pathway of ''vata'' is called as ''avaraka'' and the ''dosha'' (''vata'' in general or its components) affected by ''avarana'' is called as ''avariya'' or ''avrita''. Normally the ''avarana'' is caused by the etiological factors for the vitiation of ''avaraka''. Etiological factors for the vitiation of ''vata'' (''sva nidana'') will be absent. In case of ''gatavata'' the vitiation of ''vata'' will be active. Here its own etiological factors are operating in the vitiation of ''vata'' in the pathogenesis and the vitiated ''vata'' adopts specific pathway and abnormally localizes at particular sites.

#In the process of ''avarana chala'' property of ''vata'' is diminished due to obstruction. Other properties are not involved in the process of obstruction. But in case of ''gatatva'' the vitiation of ''vata'' takes place by involvement of other properties like ''ruksha, laghu, khara, vishada'' etc along with ''chala''.

#In ''avarana'' the ''gati'' of ''vata'' is obstructed partially or fully. Once gets obstructed the ''vata'' may simply get lodged there (''baddha marga, margarodha''), try to nullify the obstruction, may get covered by the obstructing substance (''avrita''), adopt an opposite direction (''pratiloma'') or alter the direction (''viloma''). The different terminologies have been used to denote ''avarana'' in different contexts according to the nature of ''avarana'' and the state of ''vata'' and ''marga'' (passage). In case of ''gatatva'' the ''gati'' of vitiated ''vata'' aggravated and starts moving abnormally leading to localization at particular sites.''Avarana'' is caused by ''purnata'' (filling) of other ''dosha'' in the ''srotas/marga'' (passage) of ''vata''. In ''gatatva'' the ''srotas'' or sites of occupation of ''vata'' are ''rikta'' (unfilled or spacious) and the aggravated ''vata'' fills the ''srotas''/site.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

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

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

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

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

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

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

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

Avagaha (immersion) sweda:

Avagaha (immersion) sweda:

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

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

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

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

Management of avrita vata:

 

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

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

 

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

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

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

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

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

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

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

=== Reference ===

=== Related Chapter ===

 

=== References ===

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