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 [[Vatavyadhi Chikitsa]] 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.

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

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

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

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

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

 

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

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

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

 

Management of ardita (facial palsy):

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

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

   

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

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

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

 

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

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

Importance of site of affliction in treatment:

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

 

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

 

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

 

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

 

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

 

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

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

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

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

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

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

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

Avagaha (immersion) sweda:

Avagaha (immersion) sweda:

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

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

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

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

Management of avrita vata:

 

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

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

 

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

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

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

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

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

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

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

=== Reference ===

=== Related Chapter ===

 

=== References ===

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