| Line 1,845: |
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| | The udāna should be regulated upwards and the apāna downwards. The samāna should be alleviated and the vyāna should be treated by all the three methods. Even more carefully than the other four types of vāta, the prāna should be maintained, because life depends on the proper maintenance of it in its habitat. | | The udāna should be regulated upwards and the apāna downwards. The samāna should be alleviated and the vyāna should be treated by all the three methods. Even more carefully than the other four types of vāta, the prāna should be maintained, because life depends on the proper maintenance of it in its habitat. |
| | Thus the physician should regulate and establish types of vāta in their normal habitats, which have been occluded and misdirected. (219-220½) | | Thus the physician should regulate and establish types of vāta in their normal habitats, which have been occluded and misdirected. (219-220½) |
| − | Types of vata occluded by dosha: | + | |
| | + | ==== Types of vata occluded by dosha ==== |
| | + | |
| | मूर्च्छा दाहो भ्रमः शूलं विदाहः शीतकामिता ||२२१|| | | मूर्च्छा दाहो भ्रमः शूलं विदाहः शीतकामिता ||२२१|| |
| | छर्दनं च विदग्धस्य प्राणे पित्तसमावृते | | | छर्दनं च विदग्धस्य प्राणे पित्तसमावृते | |
| Line 1,917: |
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| | In condition of occlusion of apāna by pitta, there occur symptoms such as yellowish discolouration of urine and feces, sensation of heat in the rectum and penis and excessive flow of the menses. (229-229½) | | In condition of occlusion of apāna by pitta, there occur symptoms such as yellowish discolouration of urine and feces, sensation of heat in the rectum and penis and excessive flow of the menses. (229-229½) |
| | In condition of occlusion of apāna by kapha, there occur stools that are loose, heavy and mixed with undigested matter and mucus and kapha dominated prameha. (230-230½) | | In condition of occlusion of apāna by kapha, there occur stools that are loose, heavy and mixed with undigested matter and mucus and kapha dominated prameha. (230-230½) |
| − | Guidelines for diagnosis of conditions: | + | |
| | + | ==== Guidelines for diagnosis of conditions ==== |
| | + | |
| | लक्षणानां तु मिश्रत्वं पित्तस्य च कफस्य च ||२३१|| | | लक्षणानां तु मिश्रत्वं पित्तस्य च कफस्य च ||२३१|| |
| | उपलक्ष्य भिषग्विद्वान् मिश्रमावरणं वदेत् | | | उपलक्ष्य भिषग्विद्वान् मिश्रमावरणं वदेत् | |
| Line 1,931: |
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| | upalakShya bhiShagvidvAn mishramĀvaranaM vadet | | | upalakShya bhiShagvidvAn mishramĀvaranaM vadet | |
| | yadyasya vAyornirdiShTaM sthānaM tatretarau sthitau ||232|| | | yadyasya vAyornirdiShTaM sthānaM tatretarau sthitau ||232|| |
| − | dōṣau bahuvidhAn vyAdhIn darshayetAM yathAnijAn |
| + | dōṣau bahuvidhAn vyAdhIn darshayetAM yathAnijAn | |
| | AvRutaM shleShmapittAbhyAM prānaM codAnameva ca ||233|| | | AvRutaM shleShmapittAbhyAM prānaM codAnameva ca ||233|| |
| | garIyastvena pashyanti bhiShajaH shAstracakShuShaH | | | garIyastvena pashyanti bhiShajaH shAstracakShuShaH | |
| Line 1,937: |
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| | syAttayoH pIDanAddhAnirAyuShashca balasya ca | | | syAttayoH pIDanAddhAnirAyuShashca balasya ca | |
| | sarve~apyete~aparij~jAtAH parisaMvatsarAstathA ||235|| | | sarve~apyete~aparij~jAtAH parisaMvatsarAstathA ||235|| |
| − | upekShaNAdasAdhyAH syurathavA durupakramAH [1] |236| lakṣaṇānāṁ tu miśratvaṁ pittasya ca kaphasya ca||231|| | + | upekShaNAdasAdhyAH syurathavA durupakramAH [1] |236| |
| | + | lakṣaṇānāṁ tu miśratvaṁ pittasya ca kaphasya ca||231|| |
| | upalakṣya bhiṣagvidvān miśramāvaraṇaṁ vadēt| | | upalakṣya bhiṣagvidvān miśramāvaraṇaṁ vadēt| |
| | yadyasya vāyōrnirdiṣṭaṁ sthānaṁ tatrētarau sthitau||232|| | | yadyasya vāyōrnirdiṣṭaṁ sthānaṁ tatrētarau sthitau||232|| |
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| | Medical authorities regard, as most serious, the condition of occlusion of prāna or udāna by kapha and pitta combined, because life is particularly dependent on prāna, and strength on udāna; and occlusion of them, will result in loss of life and vitality. (233-234½) | | Medical authorities regard, as most serious, the condition of occlusion of prāna or udāna by kapha and pitta combined, because life is particularly dependent on prāna, and strength on udāna; and occlusion of them, will result in loss of life and vitality. (233-234½) |
| | If all these conditions are either undiagnosed or neglected for longer than a year, they become either incurable or extreme difficult to cure. (235-235½) | | If all these conditions are either undiagnosed or neglected for longer than a year, they become either incurable or extreme difficult to cure. (235-235½) |
| − | Complications and management: | + | |
| | + | ==== Complications and management ==== |
| | + | |
| | हृद्रोगो विद्रधिः प्लीहा गुल्मोऽतीसार एव च ||२३६|| | | हृद्रोगो विद्रधिः प्लीहा गुल्मोऽतीसार एव च ||२३६|| |
| | भवन्त्युपद्रवास्तेषामावृतानामुपेक्षणात् | | | भवन्त्युपद्रवास्तेषामावृतानामुपेक्षणात् | |
| Line 2,033: |
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| | In a condition of occlusion of vāta by pitta, the physician should administer medications curative of pitta and not antagonistic to vāta. | | In a condition of occlusion of vāta by pitta, the physician should administer medications curative of pitta and not antagonistic to vāta. |
| | In a condition of occlusion of vāta by kapha, medications curative of kapha and vāta anulomana should be given. (245) | | In a condition of occlusion of vāta by kapha, medications curative of kapha and vāta anulomana should be given. (245) |
| − | Similarity in macro-cosm and micro-cosm: | + | |
| | + | ==== Similarity in macro-cosm and micro-cosm ==== |
| | + | |
| | लोके वाय्वर्कसोमानां दुर्विज्ञेया यथा गतिः | | | लोके वाय्वर्कसोमानां दुर्विज्ञेया यथा गतिः | |
| | तथा शरीरे वातस्य पित्तस्य च कफस्य च ||२४६|| | | तथा शरीरे वातस्य पित्तस्य च कफस्य च ||२४६|| |
| Line 2,040: |
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| | lōkē vāyvarkasōmānāṁ durvijñēyā yathā gatiḥ| | | lōkē vāyvarkasōmānāṁ durvijñēyā yathā gatiḥ| |
| | tathā śarīrē vātasya pittasya ca kaphasya ca||246|| | | tathā śarīrē vātasya pittasya ca kaphasya ca||246|| |
| − | Just as in the universe the courses of the air, the sun and the moon are difficult to comprehend, even so are the forces of vāta, pitta and kapha in the body. (246) | + | Just as in the universe the courses of the air, the sun and the moon are difficult to comprehend, even so are the forces of vāta, pitta and kapha in the body.(246) |
| − | Four states of dosha: | + | |
| | + | ==== Four states of dosha ==== |
| | + | |
| | क्षयं वृद्धिं समत्वं च तथैवावरणं भिषक् | | | क्षयं वृद्धिं समत्वं च तथैवावरणं भिषक् | |
| | विज्ञाय पवनादीनां न प्रमुह्यति कर्मसु ||२४७|| | | विज्ञाय पवनादीनां न प्रमुह्यति कर्मसु ||२४७|| |
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| | vijñāya pavanādīnāṁ na pramuhyati karmasu||247|| | | vijñāya pavanādīnāṁ na pramuhyati karmasu||247|| |
| | The physician who understand the condition of decrease, increase, normality and occlusion of vāta and other dosha, is not deluded with regard to treatment.(247) | | The physician who understand the condition of decrease, increase, normality and occlusion of vāta and other dosha, is not deluded with regard to treatment.(247) |
| − | Summary: | + | |
| | + | ==== Summary ==== |
| | + | |
| | तत्र श्लोकौ- | | तत्र श्लोकौ- |
| | पञ्चात्मनः स्थानवशाच्छरीरे स्थानानि कर्माणि च देहधातोः | | | पञ्चात्मनः स्थानवशाच्छरीरे स्थानानि कर्माणि च देहधातोः | |
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| | 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 Agnivēśa and revised by Caraka, the twenty-eighth chapter entitled ‘The therapeutics of vāta diseases’ not being available, the same as restored by Dr̥ḍhabala, is completed.[28] | + | Thus, in the section on ‘Therapeutics’, in the treatise compiled by Agnivēśa and revised by Charaka, the twenty-eighth chapter entitled ‘The therapeutics of vāta diseases’ not being available, the same as restored by Dr̥ḍhabala, is completed.[28] |
| | | | |
| − | Tattva | + | === ''Tattva Vimarsha'' === |
| | | | |
| | • Vāyu/vata is responsible for life, strength and functioning of living organisms. | | • Vāyu/vata is responsible for life, strength and functioning of living organisms. |
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| | • Just as in the universe the courses of the air, the sun and the moon are difficult to comprehend, even so are the forces of vāta, pitta and kapha in the body. The first three are responsible for all functions in macro-cosm, whereas the latter three are for functions in micro-cosm. | | • Just as in the universe the courses of the air, the sun and the moon are difficult to comprehend, even so are the forces of vāta, pitta and kapha in the body. The first three are responsible for all functions in macro-cosm, whereas the latter three are for functions in micro-cosm. |
| | • There are four conditions viz. decrease, increase, normality and occlusion of vāta and other dosha. | | • There are four conditions viz. decrease, increase, normality and occlusion of vāta and other dosha. |
| − | Vidhi Vimarsha:
| |
| − | Importance of vata dosha in overall health and disease:
| |
| − | This text highlights the grandness of vāta as a humor. Vāta is equated to ‘āyu’. Life is sustained by vāyu only. Even though ‘āyu’ is previously defined as conglomeration of sharira (physical body), indriya (sensorium), satva (mind) and atmā (soul), 4 here it is mentioned equivalent to vāyu. The sense organs, mind and soul in physical body are manifested through the function of vāyu only. The strength of the individual is also provided by vāyu. These two usages of āyu and bala in this verse are later explained as, prāna is life and udāna is strength. (verse 3)
| |
| − | Form of vayu:
| |
| − | Vāta performs all its activity for a healthy long life subject to status of its three functions. They are ‘akupita’(not increased, decreased or vitiated), ‘sthānastha’ (located in its own place) and ‘avyāhatagati’(nothing is interfering with its movement or gati). ‘Gati’ is a characteristic feature of vāta. Gati is nothing other than directional aspect of ‘chala’ property. Prāna is located in vertex and has a gati towards thorax, trachea, tongue and nose. If anything obstructs gati it leads to disease. These three characteristics of vāta imply three possible modes of pathogenesis in vāta diseases. These are svātantra dushti (..), gata vāta (increased movement of vata) and āvarana (obstruction to movement of vata). This can be further analysed as follows; due to the following three important properties of vāta, it is regarded entirely different from other dōsha5.
| |
| − | 1. Asamghāta (Incorporeal)
| |
| − | 2. Anavasthita (Unstable)
| |
| − | 3. Anāsādhya (Inaccessible)
| |
| − | Pitta and kapha have appendages and are relatively compact. On the contrary vāta is incorporeal (avayavasamghātarahita). It can be termed as rarified in nature. The vāta is anavasthita (unstable) too. These two properties are due to its panchbhautik composition. Vāta is formed by akāsa and vāyu predominantly6 which are incorporeal (amurta). Chalatva (mobility) and apratighāta (unobstructability) are characteristics of vāyu and akāsha perceptible by the tactile sense organ7. According to Tarka Samgraha, vāyu is devoid of shape (ruparahita) and posesses sensibility to touch (sparśavān). The biological vāta (which is present in the living being) is self originated (svayambhu), subtle (sukshma) and all pervasive (sarvagata). It is not sensible (avyakta) but its activities are patent or manifest (vyaktakarma).8
| |
| − | Anavasthita (unstable) is due to chala property of vāta. This continuous moving nature of vāta is explained with other terminologies also like sheeghravāt9 (swift movement), āsukāri (instantaneous action), muhushchāri (rhythmic movement).10 It abounds in the fundamental quality of rāja (the principle of cohesion and action). The predominance of rāja is responsible for the instability of vāta. The quality of chalatva is directional in nature, which is explained by the term gati. Vāta convenes all bodily activities by this important feature.
| |
| − | Owing to its incorporeal nature and instability vāta is anāsādhya (inaccessible) also. The inaccessibility is characterized in regard to its functional and physical attributes but more relevant regarding the therapeutic aspect. Above explained cardinal features make vāta achintya veerya (inconceivable prowess) and dōshanām netā (propeller of all functional elements in the body).11
| |
| − | Properties of vata:
| |
| − | In chapter vātakalākalīya (Cha.Su.12), questions have been raised about exciting and alleviating factors regarding qualities of vāta. Rūkṣa, laghu, shītā, dāruna, khara and vishada have been explained as qualities of vāta. Repeated use of substances with these qualities and actions of such similar qualities causes vridhi and excitation of vāta and is alleviated by use of substances possessing contrary qualities. This brings out the phenomenon of two mutually interrelated and inseparable of sharira vāyu viz. (1) that, the sharira vāyu is a biophysical force and (2) that it is closely associated with material substances which form part of the structure of the body for example, nervousness. It is a chemical reaction sequence which occurs during the course of life. This chemical reaction –sequence, can be accelerated (excited) or inhibited by substances with similar properties (dravya sāmānya), qualities (guna sāmānya) and actions (karma sāmānya) and inhibited by substances with opposite properties. In other words, it may be concluded that the bio – physical force – the sharira vāyu – is closely linked with some material structural factors like āhara and aushada – similars increase and opposite decrease.
| |
| − | Sodium, Potassium, Calcium, Chloride, ions are continuously moving around [Brownian movement] which is the result of its ionic state [swabhāva / swayambhu guna]. The ionic inflow and outflow within the cell causes depolarization and repolarization or in other words impulse is generated. Hyper or hypo state of these ions is the cause for disease condition which may present in the form of seizures, palpitations, muscle cramps, lethargy, altered sensorium, coma and death.
| |
| − | Therefore, the biological energy produced by this ionic movement is the cause for sharira vāyu and as per modern science too their concentration depends on āhara and vihara.
| |
| − | The continuous, controlled movement of the ions is responsible for cell activity which together at the level of cells contributes to tissue activity which together contributes to the organ, system and in turn whole body. (verse 4)
| |
| − | Types of vata dosha:The five sub types of vāta are described. In Vedic literature, as a medical system, the important five types of vāta are explained with their locations and functions. The word ‘tantrayate’ is used to explain the functional format of vāta than its structural format. The sharira (physical body) is yantra and the mode of functioning is tantra. Prāna is the supreme vāta and occupies vertex, thorax etc. Its natural flow is downwards, from vertex. Udāna is located in nābhi, uras etc. As per Ashtanga Samgraha the main location of udāna is thorax and nāsika is one among other locations. Prayatna (..) in functions of udāna is described as ‘manaprayatna’ by Gayādāsa in Sushruta Samhita12. The relationship of Samāna with sweda and ambuvaha srotas is mentioned by Charaka only. The agnimāndhya leading to jwara and absence of sweating while jwara etc can be better explained with this verse. Vyāna is located all over the body. As per Ashtanga Samgraha it is mainly located at Hridaya.
| |
| − | The vāta dōsha on basis of its functions is classified into five types. They reside in the sharira at the level of sharira parmānu (cell) and also at gross level. Five types of vāta work together in a synchronized manner for the normal functioning of the sharira (vāyu tantrayantra dhara). In this context upamāna pramāna (..) of people with different profession like mālākāra (..), kumbakār (..) stay together under one roof . (verse 5-11)
| |
| − | General etiological factors and basic pathogenesis of vāta disorders:
| |
| − | Dosha sravana here means vamana, virechana etc. The whole etiological factors can be divided into two a) which cause direct vāta vitiation and b) which cause indirect vāta vitiation. Daysleep (Divāswapna) do not directly lead to vitiation of vata. However, it leads to formation of ama and cause vāta vitiation indirectly by obstructing vāta. Vegasandharana (suppression of natural urges) and marmābhighata (trauma to vital organs) etc. are examples of direct vitiation. The pathogenesis is also bi-fold. The initial pathology is aggravation of vāta and diminution of dhātus and vice versa. One augments the other. This ultimately causes emptiness in channels and rarity in tissues which gives more space for movements of vāta. The second pathology is by increase in dhātus leading to excessive filling in channels to cause their clogging and blocking vāta. (verse 15-19)
| |
| − | Premonitory signs and symptoms:
| |
| − | Clinical manifestations may not be apparent because of vague manifestation of symptoms (Avyaktaṁ lakṣaṇam). This occurs in two situations, either the pathogenesis is extremely slow or it is abrupt. In the initial case, it is unable to appreciate the prodromal symptoms and presenting complaints separately. If it is an abrupt pathology the clinical presentation immediately follows the prodromal symptoms without appricable gap. This is because of the fact that normal process of dhātukṣaya is very slow and insidious. The same way abrupt vitiation of vāta is possible because of its ashukāritva (sudden). (verse 19-20)
| |
| − | Clinical features:The clinical presentations vary according to the specificity of hetu (cause) and sthāna (location). The treatment options also vary accordingly. For example if vāta prakopa takes place due to rūkṣa vriddhi in pakvāśaya it may lead to habitual constipation in which snigdha, uṣṇā and tikshna aushadha like mishraka snēha may be a good treatment option. If the same vāta get vitiated in āmāshaya due to snigdha vriddhi, leading to gastro-esophageal reflux disease (GERD), rūkṣa uṣṇā and tikshna like gomūtra bhavita shaddharana is the ideal treatment option. If Anuvasana is the ideal panchkarma in the initial condition, vamana is the next second best option respectively. (verse 20-24)
| |
| − | Pathogenesis of various conditions:
| |
| − | All the verses explain a specific type of samprapti like Kōṣṭhagata vāta, āmāshayagata vāta 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 dōṣa may occupy any particular site or area and lead to diseases. The description of pitta and kapha occupying in different dusya are explained in Ashtanga Samgraha of Vāgbhata in Sutrasthāna13. In that context the description of vāta in different dusya is not explained and suggested to refer nidanasthāna (anagata apeksha). This also signifies the importance of vāta in generating certain syndromic presentations. This type of pathology of vāta is called as gatavāta. Normally in all gatavāta, the affected dushya will be kshina (depleted) and affected srotas will be rikta (empty). The concept of gatavāta can be further explored physiologically. Dhātu are classified into two types’ asthāyi (temporary) dhātu and sthāyi (permanent) dhātu. Asthāyi dhātu are the ones which are dravaswarupa(…) and undergoing conversion (parinām āpadyamānanām) and they are being vikshepita (..) from their mulasthān (..) throughout the sharir (abhivahan) for the purpose of poshana (..) of the sthāyi dhātu. This parinaman (conversion) and abhivahan prakriya(transportation) takes place in mārga (channel) which are known as srotas; hence mārga is one of the synonym used for srotas alongwith sirā, dhamani, rasāyani, rasavāhini, nādi, panthāna, sharir chhidra, samvrita-asamvritāni, sthāna, āshaya, niketa, sharirdhātu avakāsha.
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| − | Prakupita(vitiated) dosha have the capacity to further vitiate both sthānasta dhātu (fixed tissue element) as well as margagata(circulating tissue elements) of sharir dhātu. When prakupita vāta vitiates the dhātu it is called as gatavāta, means vāta prakopa with specific nidān occurs as initiative factor to interplay with specific dhātu or vitiated itself in specific sthāna (āmashaya gatavāta etc.). In this context specific nidān 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 functions like dusya.
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| − | Koshthagata vata: Vāta getting vitiated in the whole kōṣṭha is explained as koshthagata vata. kōṣṭha should be understood as antha kōṣṭha or elimentary tract.
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| − | Pakwashayagata vata: In Vāgbhata and Sushruta Pakvāśayagata vāta is explained in parallel. Bradhna is a disease of debatable details.It is considered as inguinal hernia or scrotal swelling as per opinion of some scholars.
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| − | Sarvangagata vata:In sarvānga gatavāta, ākshepana and kampa is additionally explained in Vāgbhata.
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| − | Gudagata vata: In gudagata vāta, the symptomatology is similar to pakvāśayagata vāta in other classics except the symptoms present in lower limbs.
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| − | It can also be explained that gudagata vāta and pakvāśayagata vāta are different clinical entities. In gudagata vāta, vitamūtra vātanam graha (..) is observed whereas in pakvāśayagata vāta it is krichata of mūtra purisha with āntrakujan, ātopa and ānāha has been mentioned. Ashma sarkara exclusively present in gudagata vāta and rōga and shosha in jangā, uru, trika, pāda and prusta. This can be compared with lumbo-sacral plexopathy. It may be understood as; pakvāśaya gatavāta wherein proximal part of large intestine alongwith ascending, transverse and descending colon is involved whereas in gudagata vāta involvement of sigmoid colon, rectum, anus and their nerve supply.
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| − | Amashayagata vata: This is a typical presentation of anyasthānagata dōṣa. Here the sthānik dōṣa is considered as important as it is more virulent than the aganthu dōṣa. The lakshana mentioned are clinical entities which are āmashaya samutha. So when vitiated vāta enters in āmashaya manifest these diseases specifically, as told in shwas; pitta sthan samudbhava wherein pittasthān is āmashaya (Ca.Ci.17/8 Chakrapāni). When vāta enters in āmashaya will increase emptiness of stomach leading to indigestion or āma pradōṣaja vikār like visuchika etc.
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| − | This is the typical example of swasthāna kupita vāta. Exclusive vāta shaman / shodhana approaches are mandatory here.
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| − | Indriyagata vata:Indriyagata vāta is applicable to any indriya. Indriya vadha may be interpreted as complete, partial or minimal loss of sensation. ‘Shrotra’(..) has specific importance among other indriya, in which inherent dosha of shrotra is vāta itself. So vāta prakopa in shrotra is more impacting. It is worthy to remember the notion in vātakalākaleeya that vāta is ‘sarvendriyānām udyojakā’(..).
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| − | Twakgata vata: Tvak (skin) is referred as somatic organ even though it is a sensory organ. Supti and tōda here are not symptoms specific to tvakindriya. Here tvak represents ‘rasa dhātu’. Rasa does not have cellular pattern and hence not included in shakha. The tvak is the derivative of rasa and is included in shakha. Tvakindriya gatavāta should be understood under indriyagatavāta.
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| − | There are some opinions that suptatā is affecting tvak as sensory organ also. Suptatā is mentioned as purvarupa of kustha. Suptavāta suptāni is mentioned as one of the features of kapāla kustha in Ca. Ni 5/7, as per Chakrapāni “Suptavāta suptāni iti artha asparsha gyan iti artha” (anaesthesia). This description shows that suptatā is manifestation of sparshanendriya i.e. tvak. Dermopathy, arthropathy and myopathy coexist in Systemic Lupus Erythamatoses. In tvakgata vāta; tvak rūkṣa, sphutita, supta, krisha, krishna, tudyate ātanyate sarāga indicates dermopathy while parva rupa can be seen as part off arthropathy.
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| − | Mamsa-medogata vata:
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| − | Māṁsa and meda are explained together. Both come under kapha varga and the vitiation is concurrent.
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| − | Shukragata vata:
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| − | Certain symptoms are exactly opposite to one is explained. Premature ejaculation and anejaculation seems to be opposite. This is not possible in a single patient. The term ‘vā’ is more specific here in which either of one will be present. Variant features are seen in diseases. Śukragata vāta is one such example.
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| − | Snayugata vata:
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| − | Snāyugata vāta may lead to āyāma, khalli and kubjatā the vitiation may be generalized or localized.
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| − | Siragata vata:
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| − | When vāta afflict sirā it may broaden or narrow the sirā. Widening may lead to śōpha and narrowing may lead to shosha or vice versa as per the site of affliction. Ācharya have mentioned two different condition of vascular diseases i.e. aneurysym (mahat) and atherosclerosis / venous thrombosis (tanu).
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| − | Sandhigata vata:Vāta pūrṇa dr̥ti sparśa (..) and śōtha are referred in different other areas like udara etc. This is a peculiar type of śōtha which cannot be considered as either pitting or non pitting. Ballooning like swelling is mentioned here. Vāta pūrṇa dr̥ti sparśa is present due to periarticular soft tissue swelling. It may be due to bursitis also. Prasāraṇa ākuñcana pravr̥ttiśca savēdanā is either due to mild inflammation of joints or due to compression of underline neuron by osteophytes formed at margin of cartilage or both. Śōtha is due to mild inflammation of joint. Here there is no rest pain present which excludes active inflammatory presentations.(verse 24-38)
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| − | 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)
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| − | Antarayama and bahirayama: Here the disease antarāyama is explained as a disease caused by vāta making stambha to manyā. In Sushruta Samhita manyāstambha is a different disease caused by day sleep especially in irregular seats, or awkward neck positioning etc which may be compared to cervical disc diseases. According to Sushruta this condition is exclusively kaphavātaja. But the initiation of samprapti of antarāyama as manyāstambha is a highly vāta predominant condition. (verse 43-45)
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| − | In bahirayama a similar pathology of above is involved with external sira/nadi. Further bahirāyāma is considered to be more serious than the other one. There are different types of convulsive disorders explained in Ayurvedic classics. They are dealt under apatānaka or apatantraka. When convulsion affect spine it is called as dhanustambha. It is of two type antarāyama and bahirāyāma. (verse 45-48)
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| − | Hanugraha:Hanugraha is normally an orthopaedic condition. But in certain individuals this happens as recurrent. As this disease is explained in midst of various convulsive disorders it also should be understood as an episodic condition.(verse 49)
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| − | Dandaka:
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| − | Daṇḍaka is a condition in which the muscles are hypertonic but without convulsions. A similar disorder is explained in the context of ajeerna in which ajeerna may lead to alasaka (unexpelled and suspended toxicity) and further lead to tonic spasm called daṇḍalasaka. When it further manifests as tonic clonic convulsions it is referred as daṇḍa akshepaka. (verse 51)
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| − | Episodic nature:The above mentioned disorders from ardita onwards, all are vegavān (episodic). All vegavān disorders have two phases, vega and vegāntara. Vegāntara is the symptom free period and is considered as right time for medication. (verse 52)
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| − | Pakshaghata: Here three diseases namely pakṣāvadha / pakṣāghāta, ekāngarōga and sarvāngarōga are explained. In Ashtanga Hridaya ekāngarōga is explained as synonym of pakṣāghāta. Here ekāngarōga affect either one upper or lower limb. In pakṣāghāta no painful symptoms are explained. But ekāngarōga and sarvāngarōga are presented with painful symptoms and contracture. Sarvāngavāta is different from sarvāngarōga. Sirā and snāyu are considered as dushya in ekāngarōga and sarvāngarōga. Sirā is the upadhātu of rakta and snāyu is the upadhātu of meda. Both meda and rakta has vital role in pathogenesis of these diseases.(verse 53-55)
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| − | Gridhrasi: Gr̥dhrasī is a snāyugata rōga. Gr̥dhrasī is typically related to kateegraha. As gr̥dhrasī, kateegraha is also of two types viz vāta and vāta kapha. The word gr̥dhrasī is derived from ghridhra, which means vulture, the typical gait of the disease is highlighted by the name. Khalli is the term given to severe painful conditions. In Vagbhata viswāchi and gr̥dhrasī is explained as khalli when they are manifested as tivrārujā (severe pain).(verse 56-57)
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| − | Nomenclature of diseases: All the vāta disorders are unable to be named or explained. They should be understood on the basis of site of affliction. The shloka is read as sthāna and nāma anurupa also. Then the meaning is disorders should be understood according to site as well as nomenclature.(verse 58)
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| − | Pathogenensis: The basic samprapti of vāta rōga is further highlighted. It is of two types’ dhātukṣaya and margāvarana which is previously explained. Dhātukṣaya leads to more rarity in tissues and more space for vāta to move. This leads to gatavāta phenomenon. The ongoing verses are to explain āvarana of vāta by other dōṣa or dhātu. So the differences between āvarana and gatavāta should be understood.
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| − | Āvarana is special pathological condition of vāta characterized by an obstruction in the ‘gati’ (movement) of vāta, paralyzing it in performing its activities and lead to different disorders. The gatatva and āvr̥tatva are entirely different phenomenom. Here an attempt is being made to differentiate the both physio-pathologies.[16]
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| − | 1. In Āvarana, generally the vitiation of vāta is passive. When vitiated dosha or any other thing obstructs the pathway of vāta, āvarana happens. Normal state of vāta gets vitiated as āvarana progresses. The substance which obstructs the pathway of vāta is called as ‘āvaraka’ and the dosha (vāta in general or its components) affected by āvarana is called as āvariya or āvr̥ta. Normally the āvarana is caused by the etiological factors for the vitiation of āvaraka. Etiological factors for the vitiation of vāta (sva nidāna) will be absent.
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| − | In case of gatavāta the vitiation of vāta will be active. Here its own etiological factors are operating in the vitiation of vāta in the pathogenesis and the vitiated vāta adopts specific pathway and abnormally localizes at a particular sites.
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| − | 2. In the process of āvarana ‘chala’ property of vāta is diminished due to obstruction. Other properties are not involved in the process of obstruction. But in case of gatatva the vitiation of vāta takes place by involvement of other properties like rūkṣa, laghu, khara, vishada etc along with chala.
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| − | 3. In āvarana the ‘gati’ of vāta is obstructed partially or fully. Once gets obstructed the vāta may simply get lodged there (baddha mārga, mārgarodha), try to nullify the obstruction, may get covered by the obstructing substance (āvr̥ta), adopt an opposite direction (pratiloma) or alter the direction (viloma). The different terminologies have been used to denote āvarana in different contexts according to the nature of āvarana and the state of vāta and mārga (passage). In case of gatatva the gati of vitiated vāta aggrevated and starts moving abnormally leading to localization at particular sites.
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| − | 4. Āvarana is caused by purnata (filling) of other dosha in the srotas/mārga (passage) of vāta. In gatatva the srotas or sites of occupation of vāta are rikta (unfilled or spacious) and the aggrevated vāta fills the srotas/site.
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| − | 5. In āvarana of vāta, swakarma vriddhi (exaggerated activities) of āvaraka (..) is manifested. The āvr̥ta (i.e. vāta) will show swakarma hāni (diminished activity). This is the general feature of āvarana. Here the excessively increased strong āvaraka suppresses the normal action of āvr̥ta (i.e. vāta). Therefore, when the obstruction is complete it may lead to the prakopa of vāta resulting in the presentation of vāta vitiated symptoms as well as its disorders14.
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| − | In case of gatatva the symptomatology will be predominantly of vāta vitiation and pain is a common and chief complaint in all the conditions of gatatva.
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| − | 6. Āvarana is possible by other dosha (pitta and kapha), Dhātus, anna, mala, and individual components of vāta. Āvarana is not described by upadhātus and causation of āvarana by āshaya or avayava are not thinkable. Gatatva of vāta is happening in dhātu, upadhātu, āshaya and avayava. Gatatva of vāta in other dosha or non-bodily substances like anna and mala and in between the individual components vāta is not possible.
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| − | 7. In āvarana due to the dhātu, the dhātu will be in a vriddha state or in sāma avastha generally so that they produce purnatā in srotas and are capable of obstructing vāta. In dhātugata vāta the excellency of dhātu will be diminished (dhātu daurbalya) so that they produce riktatā in srotas and the vāta gets enough space for abnormal gati. Accordingly, the symptomatology of dhātuāvr̥ta vāta will be vriddha or sāmadhātu lakshana associated with diminished activities of vāta and of dhātugata vāta will be dhātu daurbalya lakshana associated with vitiated vāta lakshana. Obviously, exceptions are possible according to the complexities of process of āvarana or gatatva.
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| − | 8. In case of āvarana of vāta, the āvaraka gets importance in treatment since the vitiation of vāta is passive. When āvarana is removed vitiated vāta gets pacified. But in cases of gatatva the vitiated vāta has to be treated first along with correction of adhisthāna.
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| − | 9. Diagnosis of āvarana is made with the help of upasaya–anupasaya (trial and error) method. Diagnosis of gatatva is made according to the rupa (symptomatology).
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| − | 10. Complications of āvarana are explained in case of improper diagnosis and delayed treatment like hr̥drōga, vidradhi, kamala etc. No complication explained in gatatva.
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| − | 11. Āvarana of vāta may cause affliction of nutrition to dhātu (dhātugata sāma) leading successive diminition of rasādi dhātu (rasādimsca upasosayet).15 No such reference available in case of gatatva.
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| − | The above discussed points are briefly enlisted in the table below.
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| − | Āvr̥ta (obstructed)vāta Gata (excess movement)vāta
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| − | 1. Vitiation of vāta is passive 1. Vitiation of vāta is active
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| − | 2. Normally svanidana(..) of vāta are not responsible 2. Vitiation of vāta by svanidana
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| − | 3. Only chala property of vāta is involved and it is diminished in the phenomenon 3. Other properties of vāta are also involved and the chala property aggravated in the phenomenon
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| − | 4. Gati of vāta is obstructed 4. Gati of vāta is agrravated
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| − | 5. Purnata (fullness) in srotas/ mārga 5. Riktata (emptiness) in srotas
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| − | 6. Vāta shows svakarma hani 6. Vāta shows svakarma vriddhi
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| − | 7. Dhātu are in vriddha or sāma 7. Dhātu daurbalya present
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| − | 8. Āvarana possible with other dosha/anna/mala/individual components of vāta 8. Not possible
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| − | 9. Āvarana by avayava or āshaya not possible 9. Gatatva in āshaya and avayava explained.
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| − | 10. Āvaraka gets importance in treatment 10. Vāta gets importance in treatment
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| − | 11. Diagnosis made with upasaya anupashaya 11. Diagnosis with rupa
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| − | 12. Complications of āvarana possible 12. Not explained
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| − | 13. Successive diminuation of rasadi dhātu possible 13. Not explained.
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| | | | |
| − | 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.
| + | === ''Vidhi Vimarsha'' === |
| − | The concept of Āvarana can be be further elaborated literally. It is derived from ‘Aa’ upasargapurvak, ‘Vru’ dhatwatmak and ‘Lyut’ pratayatmak. Shabdakalpadrum explains vyutpati of Āvarana shabda from ‘Vru’ sanskirt dhātu which means valayita, veshtita, ruddha and samvita.
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| − | According to Ayurvediya Shabdakōsha the word Āvarana means avarōdha gatinirōdha i.e. obstruction or resistance or friction to the normal gati of vāta. Vāta dosha is the gatyatmak dravya within the sharira. Hence its normal gati is hampered or vitiated thus vāta becomes Āvr̥ta. Shabdakoshakar says that balwan dosha due to its vitiation impedes the durbala dosha and hampers the normal gati of the āvr̥ta dosha. Vaidyak Shabdasindhu says āvaraka means āchhadaka while āvr̥ta means āchhadita. Charaka in context of madhumeha has used the word āvr̥ta gati; Chakrapāni explains it to be ruddhagati. In context of Kāsa; Chakrapāni says pratighat means āvarana while in context of śōtha says badhamārga means āvr̥ta mārga. Thus the word āvarana can be understood as; āchhadana, Avaruddha gati, Sanga, Pidhana, Samvarana, Ākirya, Prachadana, Vestana, Valayana, Prāvr̥ta and Samvrita.(verse 59-60)
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| − | Pathology of avarana: In dosha āvarana, the symptomatology will be predominant as per the āvaraka dōṣa. The symptoms of vāta also will be there even though minimal compared to other dōṣa. Samsarga of dōṣa and āvarana of dōṣa with vāta seems to be similar. Practically this is true. But theoretically trace differences can be suggested. In samsarga the etiology and symptomatology of both vāta and associated dōṣa will be nearly of equal weightage. In Āvarana, the major culprit is the dōṣa causing āvarana, and as āvarana advances vāta also get vitiated and show symptoms.
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| − | In āvarana due to dhātu, the vriddha or sāma lakshana of dhātu are available. In gatavāta māṁsa and meda as well as asthi and majja are explained together. But in āvarana all these four are explained separately. Raktāvr̥ta vāta is approximate to uttana vātarakta. Medasāvr̥ta vāta is approximate to urustambha. Śukragatavāta and Śukrāvr̥ta vāta are similar in symptomatology since śukra and vāta, both are sarvadehaga. (verse 61-71)
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| − | Prognosis:The seriousness as well as poor prognosis of exclusive vāta disorders is highlighted. The symptoms / diseases explained here manifest when vitiated vāta affect vital parts. The therapeutic approaches should be cautious and extra effort becomes 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.(verse 72-74)
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| − | General principles of management:The general line of management of Vātavyādhi is applicable to absolute vāta vitiation only. If there is any association or obstruction of other dōṣa in Vātavyādhi, the treatment will be different. So the terms like ‘kevalam’ means without āvarana and ‘nirupasthambha’ meant without samsarga is important and should be considered as conditional always.
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| − | As in alone vātaja disease the major gunavriddhi is rūkṣa which leads to riktatā in srotas and dhātu and more avakāsa for vāta; Snēhana is essential and ideal. Various methods for snēhana has been mentioned here, which depends on avastha (stage), sthāna (site) and bala (strength) of the diseases and as well as patient.
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| − | Following snēhana, swedana is also mandatory. Here the uṣṇā guna operates to control śītā. Repeated snēhana and swedana imparts high grade of flexibility. The reduction of harsha etc. is immediate but transient as swedana is applied. So repeatedly swedana should be done.
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| − | Snēha is a good medium to control vāta as well as vātapitta. Generally this line of treatment can be counted as a part and parcel of brimhana.(verse 75-83)
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| − | Repeated Snēhana and swedana control vāta well. But there are still chances for residual dōṣa, which should be eliminated out. So samshodana lines of treatments are explained. As shodhana has a definite chance for causation of vāta prakopa, the approach should be cautious, so mridu samshodana is explained. Snēha virēchana is established by tilwaka ghrita or erand taila etc. In trimarmeeya chapter Eraṇḍataila is further explained as ultimate to cure vāta prakopa due to udāvarta. If virēchana is not possible anulomana diets should be adviced. If the patient is extremely weak niruha is the better option. Even during or after these practice of shodana; recurrent application of Snēhana and swedana are essential.(verse 83-88)
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| − | Management of vata at different sites:
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| − | The line of treatment of disorders of vāta when it is located in various particular sites is explained. All these explanations are supporting the general principle of treatment in Ayurveda in which the habitat (sthāna) is more or equally important in comparison to the invaded (āgantu) dōṣa. In Kōṣṭhagata vāta, Kōṣṭha is given preference in treatment, and so kshara which is responsible for pācana is used. But when vāta is located in pakvāśaya or guda which is particularly vātasthāna itself, udāvartahara treatment, which is nothing other than vāta anulomana, basti, varti etc are selected. In āmashayagata vāta shodhana is explained. According to Vagbhata, Vamana is indicated specifically in this condition. Hridaya anna is typically indicated in tvakgata vāta because, rūkṣatā in tvak is a resultant of rasakṣaya caused by ‘chintyanām ca atichintanāt (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. In śukrakṣaya harsha annapāna is very useful. According to Vagbhata Vrishya āhara make instantly śukra as a result of Prabhava18. Here bāhusheersha should be understood as Amsamula and this reference is equal to the treatment of apabāhuka. Avapeedaka is aspecial type of Snēhana in which uttam mātra is taken and divided into two unequal portions in which one portion is given as before food and the other portion after digestion of that Snēha and food.
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| − | Management of ardita:
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| − | The line of treatment of ardita aims mastishkya (brain). That is why directly nasya is indicated. Nasya is explained to be the direct entrance to the cranial vault. Nasya may be shodhana, Samānaa 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 mastishkya and is of four types viz. abhyanga, seka, pichu and shirobasti. Tarpana is akshitarpana and shrotratarpana. Nadisweda is very specific in ardita and ksheeradhooma is an exclusive variety in the same disease. Ānupamāṁsa upanāha is brimhana. According to Vagbhata in Ardita, vamana is indicated when there is associated śōpha and raktamokshana is indicated when associated with dāha and rāga.
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| − | In Pakṣāghāta snēhasaṁyukta swedana and snēhasaṁyukta virechana 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 in which the only and effective choice is adhoshodhana. Further the involvement of sirā as upadhātu (rakta as dhātu), further evidenced by description of sirāgraha as the morbidity prior to pakṣāghāta by Vagbhata also support this view.
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| − | Gr̥dhrasī is a snāyugata vikāra and shastra, kshara, agnikarma are explained as major line of treatment. That is why sirāvyadha and dāhakarma is explained. Basti is also a good choice since pakvāśayagata vāta leads to kateegraha and gr̥dhrasī. In hanusramsa the standard reduction procedure of temperomandibular dislocation is detailed.
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| − | 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)
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| − | Importance of site of affliction in treatment:
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| − | 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)
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| − | Treatment of vata vitiation: The treatment of only vāta vitiation (without involvement of other dosha) is Brimhana. If associated dōṣa is present specific measures after referring treatment strategies of urusthambha etc should be adopted.(verse 105)
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| − | Balā is excellent for alone vitiated vāta . The head of goat is indicated on the basis of the principle ‘sāmānyam vridhikārānam’. These also explain the awareness of utilization of brain of goat in degenerative brain lesions. Lavana relieves stambha and samghata. Upanāha is also prepared with such well fomented flesh and added with different oils, salts etc. Such upanāha are brimhana. (verse 106-108)
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| − | Avagaha sweda:
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| − | Avagāha is typically indicated in apāna vāigunya. Further it can be taken as a variety of drava sweda. Nādisweda is also an excellent option for all types of vātarōga. Further poultices (upanāha) of different varieties are explained here. In upanāha self generated heat causes swedana. It is by virtue of various dhanya and kinwa (yeast) available in it. (verse 109-118)
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| − | Different formulations:
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| − | Different medicated ghrita, vasā, majjā and mahāSnēha are explained in these verses. These are indicated for various purposes like ingestion, inhalation, enema and external application etc. MahāSnēha is very guru and ultimately indicated in madhyam rōga mārgāshrita Vātavyādhi especially like convulsions, tremor etc. (verse 119-136)
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| − | Pinyaka taila is an interesting preparation in which rūkṣa guna is imparted to taila and is highly useful in kapha associated Vātavyādhi. (verse 136-137)
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| − | Importance of oil in treatment of vata:By virtue of vyavāyi guna it reaches the different interior parts of the body without any metabolic changes. By processing taila can adopt any type of qualitative changes. The importance of āvartita taila is also highlighted here. Drugs like ksheerbalā (101 āvartita), dhanwatharam (21 āvartita) etc are worth mentioning here. This approach of samskāra makes Snēha as suksma Snēha.(verse 181-182)
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| − | Management of avrita vata:
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| − | These verses highlight the āvr̥ta vāta chikitsā. 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.
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| − | 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’.
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| − | In Kaphāvr̥tē vāta; tīkṣṇā sweda, niruha and vaman which reduces kapha has to be carried out followed by virechana which does vāta anulomana and also useful for kapha.
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| − | Jirna/purāna sarpi (old ghee) which has kaphaghna quality has to be used; tila and sarṣapa which are kapha vātagna are to be used. Warm drinks of yava, jāṇgala mānsa rasa which gives bala to the patient without increasing kapha are to be administered.(verse 183-188)
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| − | In āmāshaya gata vāta vamana is advised taking into account of sthāna. Here vāta is agantuk dōṣa. In Vagbhata and Sushruta famous shaddharana yoga is indicated in āmashayagata vāta. In pakvāśaya gata pitta and sarvashariragata vātapitta, virechana is the option. Basti is an ideal option for shodana in vāta associated with other dōṣa especially when located in pakvāśaya. Kshara Basti (Gomūtrayukta Basti) in case of Kapha-vāta and Ksheer Basti in pitta-vāta is recommended. Once associated dōṣa is eliminated out, then alone vāta cikitsā may be ideal. In pakvāshaya gatavāta where prokinetic movement is hampered is regularized by virechan. Further in pakvāshaya if there is associated kapha, virechana will help to remove it along with vāta anulomana.
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| − | Raktāvr̥ta vāta is equal to uttānavātarakta and treatment is accordingly same. Rakta āvr̥ta vāta is one of the phases of vātarakta. Thus raktamokshan and basti cikitsā which is useful in vātarakta is also helpful in rakta āvr̥ta vāta. Āmavāta is referred here as a distinct disorder, probably because of a nearest clinical entity with vātarakta as joint pathology is associated in both. But there are clarifications like āmavāta should be read as ādhyavāta and it is refered as medasāvr̥ta vāta. The order of description is missed in that way.
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| − | Prameha samprapti mentioned in Sutrasthān 17th chapter explains kapha, pitta, meda and mānsa which when increased causes āvarana of vāta. Therefore pramehagna cikitsā is helpful in meda āvr̥ta vāta and also in mansāvr̥ta vāta. Hence in mansāvr̥ta vāta the pipilika iva sanchar reduces if prameha is treated. Similarly in sthaulya, medasāvr̥ta vāta (Ca.Su. 21/5) and meda and mānsa ativridhi [Ca.Su.21/9] is observed. Therefore pramehagna, medagna followed by vātagna cikitsā is useful in medasāvr̥ta vāta and also in mānsa āvr̥ta vāta.
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| − | In anna āvr̥ta vāta, anna obstructs gati of vāta therefore vamana which helps in emptying stomach by removing anna help to regulate the gati of vāta. Pācana and deepan helps in digestion and also pacifies vāta.
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| − | Hot foementation reduces urethral pressure. Study done by Shafik A [www.ncbi.nim.nlh.gov/pubmed/8506593] showed that sitting in warm water helps in micturition which seems to be initiated by reflex internal urethral sphincter relaxation. A thermo sphincter reflex is likely to be involved.
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| − | Uttar basti effect is similar to catheterization. Further depending on the medicines used for uttar basti, tridōṣa shamāna can be done.
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| − | The lines of treatment of raktagatavāta and raktvritavāta as well as śukragatavāta and shukrāvr̥ta vāta are one and the same irrespective difference in samprapti as gatavāta or āvr̥ta vāta. It is because of the fact that rakta and śukra are mobile and comparatively pervaded all over the body like vāta so gatavāta and āvr̥ta vāta are mutually complimentary here.
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| − | Finally the treatment strategies of anyasthānagata vāta are explained. The importance is given to sthānastha dōṣa.(189-199)
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| − | Movements of vata and concept of anyonyavarana:As discussed earlier avyāhatagati is a cardinal feature of vāta to perform normally. In āvarana certain obstacles like dōṣa, dhātu or anna etc which are immobile occupy the pathway of mobile vāta. It is not mandatory that such immobile articles only cause obstruction to vāta. If the individual sub types of vāta are considered prāna, udāna, vyāna, samāna and apāna are mobile and has some specific direction for their gati. For example prāna has movement from murdha to downwards. Udāna has movement from uras to upwards. Vyāna moves upward downward and sidewards like rasa. Samāna moves around jatharāgni. Apāna move downwards from pakvāśaya. This can be further analysed as follows. Udāna possess upward movement (urdhvabhagam anayati jeevayati ityudāna, udāna urdhvavritti). Likewise ‘apāna’ is possessing downward direction (ap-adhasthat aniti prānaiti, gacchati ity apāna, adhonayatyāpana stu). Vyāna Vāyu possesses horizontal direction (vyāpanat vyāna uccyate) along with upward and downward directions as rasa samvahana is concerned.[19]Samāna is also having such qualities (samānah samam sarveshu angeshu yah annarasam nayati). Prāna is also possessing multi directional gati if the functions are analyzed. So the movements of individual subtypes of vāta are directional in nature. When these meet in opposite direction it makes anyonyāvarana. For example prāna and udāna meet opposite and interfere with mutual normal movements leads to difficulty in inspiration as well as expiration which is comparatively irreversible. This concept is called anyonyāvarana. It is of 20 types taking into account of 5 diiferent types making 4 particular combinations. Anyonyāvarana are comparatively difficult situations. In the coming verses the symptomatology of selected anyonyāvarana and their line of management are explained.(verses 199-206)
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| − | Anyonyāvarana is characterised by Svakarma hani or vriddhi which depends on the nature and site of anyonyāvarana. For example prānaāvr̥ta udāna may lead to difficulty in respiration, followed with cardiac symptoms, aphasia or dysarthria and some times upper respiratory symptoms. This presentation is comparatively acute in onset and. Here the functions of udāna are masked by prāna. But in in udānaāvr̥ta prāna the symptoms will be; loss of motor power, immunity and complexion leading to death. Here the functions of prāna are seriously hampered. This symptom may be acute or chronic in nature. When apāna got āvarana by udāna the normal peristalsis is hampared and anulomana is the line of treatment. In apāna āvarana to udāna increased bowel motility can be seen grāhi is the line of treatment which should be adopted here.
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| − | Chakrapāni in context of anukta āvaran says; Eshām svakarmānām hānih vriddhih vā āvarane matā i.e. symptoms may be presented as hāni (loss) or vridhi (increase) in lakshana of āvaraka; Ācharya Chakrapāni further coments ; Atra āvaryānām baleeyasā āvaranāt sva karma hānih bhavati, āvarakasya tu utsargatah sva karma vriddhih bhavati , tathaa āvaranena cha āvāryah prakupito bhavati tadā sva karmanām vriddhih bhavati iti vyavasthā; Anye tu āvaraneeyasya sva karma haanih, āvarakasya tu utsargato vriddhih bhavati iti vyavasthām āhuh for e.g. in vyānāvrita prāna atisveda is vyānasya sva karma vriddhi , and in udānaāvrita vyāna asveda is vyānasya sva karma hāni. Parikartikā in vyānaāvrita apāna is due to "āvaranena āvaryah prakupito bhavati tadā svakarmanām vriddhi bhavati iti vyavasthā'. Here in anyonya āvarana the clinical syndromes appear due to interplay between both āvaraka and āvarya depending upon site and hetvādi. In udānaāvrita prāna, karma ojo bala varnānām nāsho mrityuh athāpi vā. (Ca. Ci. 28/ 208 Chakrapāni); here symptoms are concerned with both, not due to one whereas in vyānaāvrita apāna and in udānaāvrita apāna chhardi is one common clinical condition, only due to urdhva gati of apāna induced by vyāna and udāna respectively. It therefore explains interplay between vāta prakāra, vāyoh vāyu antarena gati hanana roopam āvarana upapānanām eva cha.(verse 206-217)
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| − | Rehabilitation of vata:Chakrapāni coments that verse 219-221 are for vikr̥tavātānāṁ prakr̥tisthāpanamāha. Prakr̥tisthāpanam means in its own pathway (sva mārgaga)/ or in its own place (sva sthāna gamayed enam). Therefore for udāna vāyu vamanādi line of treatment should be administered to regulate the normal functional status of udāna vāyu. Apāna has adhogati therefore anuloman cikitsā should be done thereby regularizing the urdhva apāna bhava of Apāna vāyu. Samāna should be line of treatment for samāna vāyu, Chakrapāni coments deha madhyasta sthita i.e. vāta gati should be maintained in Madhya i.e. agni uttejana (empower digestive power) should be done. Samāna being agni samipastha proper digestion and absorption of essential elements will be observed. Proper electrolyte balance will be maintained thereby maintaining the pH of body fluids. As discussed previously vyāna has all the three gati i.e. urdhva, adho and madhya gati it is the same reference of shabdha archi jala santanvāta nyāya explain by Sushruta by which rasa dhātu traverses full body with help of vyān vāyu. Gati, prasāran, akshepa, nimesādi kriya are regularized. Lastly when udāna, samāna, vyāna and apāna get regularized it helps to bring back prāna in its normal sthān. Here the general line of treatment of anyonyāvarana is discussed. As already stated in anyonyāvarana the gati of individual vāta are affected. So the normalcy of gati of respective vāta should be maintained. (verse 219-221)
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| − | Importance of udana and prana vata:
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| − | Among various āvarana, the involvement of udāna and prāna are very important. As explained in the introductory comments, prāna is life and udāna is strength. These are very vital issues as far as āvarana is concerned. Improper management or avoidance of treatments may lead to permanant disabilities in Āvarana. (verse 231-236)
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| − | Complications of āvarana:
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| − | This includes hr̥drōga, vidradhi, plīhā, gulma, a'tīsāra. Hr̥drōga is a common complication of ill treated āvarana of prāna and udāna. Vidradhi and plīhā are caused by wrongly managed āvarana of vyāna. Gulma and a’tīsāra are common complications of āvarana of samāna and apāna.
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| − | Srotoshodana is an important line of management in Āvarana. It ensures avyahatagati of vāta. All abhishyandi food causes srotorōdha. 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 shilajathu rasāyana is ideal for many clinical conditions of āvarana.
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| − | Physiological events to understand functional status of vata:The functional status of Vāta with its sub units can be better understood by analyzing certain physiological events. The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to, and stimulate, the cardiac muscle (myocardium). The myocardium contracts after stimulation. It is the ordered, rhythmic stimulation of the myocardium during the cardiac cycle that allows efficient contraction of the heart, thereby allowing blood to be pumped throughout the body. Signals arising in the SA node (located in the right atrium) stimulate the atria to contract and travel to the AV node, which is located in the interatrial septum. After a delay, the stimulus diverges and is conducted through the left and right Bundle of His to the respective Purkinje fibers for each side of the heart, as well as to the endocardium at the apex of the heart, then finally to the ventricular epicardium.
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| − | On the microscopic level, the wave of depolarization propagates to adjacent cells via gap junctions located on the intercalated disk. The heart is a functional syncytium (not to be confused with a true "syncytium" in which all the cells are fused together, sharing the same plasma membrane as in skeletal muscle). In a functional syncytium, electrical impulses propagate freely between cells in every direction, so that the myocardium functions as a single contractile unit. This is the avyāhata gati of vāta which is necessary for the rapid, synchronous depolarization of the myocardium. Conduction from SA to AV to bundles and Purkinje fiber is the aparityakta swa mārga of vāta. This rhythmical and conductive system of the heart is susceptible to damage by heart disease, especially by ischemia of the heart tissues resulting from poor coronary blood flow. The result is often a bizarre heart rhythm or abnormal sequence of contraction of the heart chambers, and the pumping effectiveness of the heart often is affected severely, even to the extent of causing death. This explains the vyāhata gati of vāta which is the cause of death.
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| − | The circulatory system is the main method for blood transportation within body. This system is a complex highway of vessels, and its main purpose is to move blood and nutrients throughout body. The circulatory system is also responsible for exchanging gases and removing waste products from body. Unlike an open circulatory system, a closed circulatory system is more structured and controlled. The blood of a closed system always flows inside vessels. These vessels make up the plumbing circuit of the body and can be found throughout the entire body. This plumbing circuit can be broken down into three different types of vessels, or tubes that transport blood throughout the body: arteries, capillaries and veins. Thus a continuous flow of blood from Left ventricles to the aorta to arteries all over the body than to arterioles into capillaries into venules into veins and back to the right atrium than right ventricle via pulmonary artery to the lungs and via pulmonary veins to the left atrium and back to left ventricle. This is how blood is propagated from heart to the periphery and back to the heart. The modern explanation resembles Caraka explanation as mentioned in Ca. Ci. 15/36
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| − | This function of vāta is swa sthānastha which helps to maintain the homeostasis or swāsthya but when avarodh to this gati takes place may be due to any reason the swa mārgāsthita vāta gets vimārga gata as explained in samprapti of śōtha (Ca. Ci. 12/8).
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| − | Various edemas are either due to excessive secretion (apāna vāyu) or reduced absorption (prāna vāyu) as understood in samprapti of udara. Disturbed concentration of solutes and solvents causes changes in pressure (vyāna vāyu) either intravascular or extra vascular. The electrolyte balance is brought about by sweda dōṣa ambu srotas sthāyi vāyu i.e. samāna vāyu.
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| − | Prakruti sthita vāta is the one which is akshina vridha:
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| − | Reduced respiratory rate due to depressed respiratory centre explains kshina prāna vāyu whereas vridha prāna vāyu may be one of the causes for increased ventilation.
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| − | Prayatna, urjā are functions of udāna vāyu. Excessive excitation of cell due to excess action potential explains the vridha udāna vāyu whereas inhibition of cell activity due to reduced action potential is due to kshina udāna vāyu.
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| − | Excessive stimulation of agni (atyagni) causes increased appetite one reason being vridha samāna vāta whereas agnimāndya, grahani etc may be caused by decrease stimulation of agni by samāna vāta.
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| − | Normal pulse rate ranges from 60-80/min. Excessive pulse rate explains the repeated contraction of heart one of the cause being excessive ākunchan prasārana karma of vyāna vridhi whereas one of the cause of bradycardia may be kshina vyāna vāyu.
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| − | Increased peristalsis is the cause for increased frequency of stools one of the reason being vridha apāna vāta whereas reduced peristalsis causes constipation one reason being kshina apāna vāta.
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| − | VERSE 5-11
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| − | Modern anatomical or functional correlation of subtypes of vāta is attempted here for a rough and overall understanding for beginners. Prāna Vāyu is concerned with consciousness, arousal, heartbeat, vomiting, breathing, cough, hiccup etc. The modern functional analogue may be compared with brain stem and reticular formation which directly control cardiovascular / respiratory systems, pain sensitivity, alertness, awareness, and consciousness. Udāna is concerned with language, learning, mood, initiation, judgment, intellect, recall information etc. The prefrontal cortex, sub cortical areas and parts of limbic system along with association areas may be understood as functional areas of Udāna. Vyāna is concerned with control of skeletal muscle activities, control of hemodynamics, sweating etc. Post-lateral and dorso-medial hypothalamus - sympathetic stimulator, primary motor area, basal ganglia, extra pyramidal tract and autonomous nervous system are part and parcel of vyāna vāta. Samāna and Apāna can be considered together. Gastro Intestinal Tract based enteric nervous system (2nd brain), (brain- gut axis - more than 100 million neurons), celiac plexus, sacral plexus etc may be analogue for apāna and samāna.
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| − | The functioning of panch vāta prakār can be also understood by understanding the physiology of sensation. In its broadest definition, sensation is the conscious or subconscious awareness of changes in the external or internal environment. The nature of the sensation and the type of reaction generated vary according to the ultimate destination of nerve impulses that convey sensory information to the CNS. Sensory impulses that reach the spinal cord may serve as input for spinal reflexes, such as the stretch reflex, sensory impulses that reach the lower brain stem elicit more complex reflexes, such as changes in heart rate or breathing rate. When sensory impulses reach the cerebral cortex, person become consciously aware of the sensory stimuli and can precisely locate and identify specific sensations such as touch, pain, hearing, or taste. Perception is the conscious awareness and interpretation of sensations and is primarily a function of the cerebral cortex. Person may have no perception of some sensory information because it never reaches the cerebral cortex. For example, certain sensory receptors constantly monitor the pressure of blood in blood vessels. Because the nerve impulses conveying blood pressure information propagate to the cardiovascular center in the medulla oblongata rather than to the cerebral cortex, blood pressure is not consciously perceived. Thus some functions may involve all the panch prakāra vāta and in some their permutation and combination.
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| − | Process of sensation
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| − | An appropriate stimulus must occur within the sensory receptor’s receptive field, that is, the body region where stimulation activates the receptor and produces a response.
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| − | A sensory receptor transduces (converts) energy in a stimulus into a graded potential. Conversion of energy from one form to another i.e. transformation is the function of agni but the one which stimulates the agni is the samāna vāyu (agni samipasta and swedavaha (at the level of tvak) āshrayi vāta prakar). For example, odorant molecules in the air stimulate olfactory (smell) receptors in the nose, which transduces the molecules’ chemical energy into electrical energy in the form of a graded potential.
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| − | When a graded potential in a sensory neuron reaches threshold, it triggers one or more nerve impulses, which then propagate toward the CNS. It explains the sarvasrotogata vyāna vāta action to take the nerve impulse towards the CNS. A particular region of the CNS receives and integrates the sensory nerve impulses. Conscious sensations or perceptions are integrated in the cerebral cortex. Integration is the role of antahkarana but carried out by niyanta ca manasā i.e. vāta especially the prāna vāyu in this case.
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| − | A characteristic of most sensory receptors is adaptation, in which the generator potential or receptor potential decreases in amplitude during a maintained, constant stimulus. Because of adaptation, the perception of a sensation may fade or disappear even though the stimulus persists. For example, when you first step into a hot shower, the water may feel very hot, but soon the sensation decreases to one of comfortable warmth even though the stimulus (the high temperature of the water) does not change. This is the smriti kriya exhibited by the antahkaran but now with the help of udāna vāyu.
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| − | Many somatic motor neurons are regulated by the brain. When activated, somatic motor neurons convey motor output in the form of nerve impulses along their axons, which sequentially pass through the anterior gray horn and anterior root to enter the spinal nerve. From the spinal nerve, axons of somatic motor neurons extend to skeletal muscles of the body. This is again the function of vyāna. Thus afferent conduction of nerve impulse is the urdhwagati of vyāna, conduction from motor neurons to the skeletal muscle is the adhogati of vyāna and the autonomic nervous stimulation is the tiryaka gati of vyāna vāyu. This is the reason why Caraka in context of treatment of vāyu prakār has told “tridha vyānam tu yojayet” it explains vyāna has all the three gati which need to be regularize during the treatment.
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| − | The part of the body that responds to the motor nerve impulse, such as a muscle or gland, is the effector. Its action is called a reflex. If the effectors are skeletal muscle, the reflex is a somatic reflex. If the effectors are smooth muscle, cardiac muscle, or a gland, the reflex is an autonomic (visceral) reflex.
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| − | Depending on the resultant action function of vāta prakāra have been explained i.e. ṣṭhīvana, kṣavathū, anna pravesh, udgār, niswasa karma is seen that it is due to prāna vāyu.
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| − | Vākpravr̥tti, prayatna, urjā, bala varna smriti are karma of udāna vāyu.
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| − | Anna vivechan, agni bala prada karma is due to samāna vāyu whereas ākuncan prasāran is due to vyāna vāyu and garbha, mūtra, purisa niskraman is due to apāna vāyu.
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| − | Thus the classification done is on the gross level of functioning. Similarly at cellular level too one can understand the existence of panch prakar vāta.
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| − | The selective permeability of the plasma membrane allows a living cell to maintain different concentrations of certain substances on either side of the plasma membrane. A concentration gradient is a difference in the concentration of a chemical from one place to another, such as from the inside to the outside of the plasma membrane. Many ions and molecules are more con- centrated in either the cytosol or the extracellular fluid. For instance, oxygen molecules and sodium ions (Na) are more concentrated in the extracellular fluid than in the cytosol; the opposite is true of carbon dioxide molecules and potassium ions (K). The plasma membrane also creates a difference in the distribution of positively and negatively charged ions between the two sides of the plasma membrane. Typically, the inner surface of the plasma membrane is more negatively charged and the outer surface is more positively charged. A difference in electrical charges between two regions constitutes an electrical gradient. Because it occurs across the plasma membrane, this charge difference is termed the membrane potential. In many cases a substance will move across a plasma membrane down its concentration gradient. That is to say, a substance will move “downhill,” from where it is more concentrated to where it is less concentrated, to reach equilibrium. Similarly, a positively charged substance will tend to move toward a negatively charged area, and a negatively charged substance will tend to move toward a positively charged area. The combined influence of the concentration gradient and the electrical gradient on movement of a particular ion is referred to as its electrochemical gradient.
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| − | Transport of materials across the plasma membrane is essential to the life of a cell. (āyu is one of the paryāya of vāyu). Certain substances must move into the cell to support metabolic reactions (pravesakrita karma of prāna vāyu). Other substances that have been produced by the cell for export or as cellular waste product (niskramana karma of apāna vāyu) must move out of the cell.
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| − | The concentration gradient which is maintained is essential for cellular activity. Resting membrane potential and active membrane potential are maintained at specific levels. For e.g. Charges of -90 mv is the resting charge which reaches to +35 mv when depolarized in cardiac cell thus this knowledge of potential gradient is due to budhi dharan karma of prāna which cause the pumping of Na/K pump to activate. Thus knowledge of concentration gradient is karma of prāna vāyu. Further prāna means prinana ādāna karma i.e. helping entry/ facilitation of such ions, essential requirements within cell which will do prinan /poshan is also due to prāna. Thus process that initiates endocytosis is prāna vāyu.
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| − | Substances generally move across cellular membranes via transport processes that can be classified as passive or active, depending on whether they require cellular energy. In passive processes, a substance moves down its concentration or electrical gradient to cross the membrane using only its own kinetic energy. The continuous movement resembles the cala guna, a common quality of all the types of vāta. Modern describes it as the Brownian movement of the ions. Kinetic energy is intrinsic to the particles that are moving. There is no input of energy from the cell. An example is simple diffusion.
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| − | In active processes, cellular energy is used to drive the substance “uphill” against its concentration or electrical gradient. The cellular energy used is usually in the form of ATP. It explains the prayatna karma of udāna vāyu which is responsible for the activity. An example is active transport. Active transport is considered an active process because energy is required for carrier proteins to move solutes across the membrane against a concentration gradient. Two sources of cellular energy can be used to drive active transport: (1) Energy obtained from hydrolysis of adenosine triphosphate (ATP) is the source in primary active transport; (2) energy stored in an ionic concentration gradient is the source in secondary active transport. Like carrier-mediated facilitated diffusion, active transport processes exhibit a transport.
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| − | Many of the infolding of the inner membrane form shelves on which oxidative enzymes are attached. In addition, the inner cavity of the mitochondrion is filled with a matrix that contains large quantities of dissolved enzymes that are necessary for extracting energy from nutrients. These enzymes operate in association with the oxidative enzymes on the shelves to cause oxidation of the nutrients, thereby forming carbon dioxide and water and at the same time releasing energy. The liberated energy is used to synthesize a “high-energy” substance called adenosine triphosphate (ATP). ATP is then transported out of the mitochondrion, and it diffuses throughout the cell to release its own energy wherever it is needed for performing cellular functions. Thus the phenomenon which triggers the oxidative process is the samāna vāyu which stimulates the oxidation i.e. role of agni.
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| − | The intracellular movement of proteins, ATP transfer, and vesicle transportation can be understood as the vyāpan/ vyuhan karma of vyāna vāyu.
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| − | The end metabolites formed within the cell are removed through the process of exocytosis. The process is initiated by apāna vāyu which helps in excretion, mokshan, munchan karma at the level of cell.
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| − | The endocrine system as like nervous system controls body activities by releasing mediators, called hormones. The term hormone, derived from a Greek phrase meaning “to set in motion,” aptly describes the dynamic actions of hormones as they elicit cellular responses and regulate physiologic processes through feedback mechanisms.
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| − | Hemadri defines cala guna as ‘prerane cala’ i.e. to set in motion. Cala guna is present in vāta dōṣa therefore considering the nirukti of the word hormone it resembles to one of the quality of vāta. One can compare hormone to a vāta dharmiya dravya.
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| − | Hormones have the following effects on the body:
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| − | • Stimulation or inhibition of growth (vāyu tantra yantra dhara/ pravartaka cestānām).
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| − | • Wake-sleep cycle and other circadian rhythms (Santāna gati vidhanam).
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| − | • Mood Swings (niyantā prānaetaca manasā/ harsa utsāho yoni).
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| − | • Induction or suppression of apoptosis (programmed cell death), (āyusyo anuvritti pratyaya bhuta) (bhava abhavakara).
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| − | • Regulation of metabolism (samirano agne).
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| − | • Preparation of the body for mating, fighting, fleeing, and other activity (pravartaka cestānām ucchavacānām).
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| − | • Control of the reproductive cycle (udbhedanām ca udbhedanam)
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| − | • Hunger cravings (samirano agne)
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| − | • Sexual Arousal (apāna karma)
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| − | • A hormone may also regulate the production and release of other hormones/ (prānodāna samāna vyāna apānanām).
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| − | • Hormone signals control the internal environment of the body through homeostasis/ (āyusyo anuvritti pratyaya bhuta/ yantra tantra dharā)
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| − | Hormones are chemical messengers released from endocrine glands that coordinate the activities of many different cells. Coordination is of multiple organs and systems (srotas) from Central Nervous System to Excretory System. Srotas has been defined as channels in which parinaman and abhivahan takes place. Three factors present in srotas viz: anupahat dhatushma, anupahat mārut and anupahat srotas help to maintain sukha ayu, bala varna etc. The coordination between the srotas is brought about by nervous system and endocrine system. Both have the capacity to initiate and inhibit the action thus maintaining the coordination. Nervous system coordinates with help of nerve impulse whereas the endocrine coordinates with the help of hormones which are secreted within the interstitial fluid surrounding the secretory cells which through blood vessels reach the target organs where they carry-out the initiatory or inhibitory action.
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| − | Hormone release in the hypothalamus and pituitary is regulated by numerous stimuli and through feedback control by hormones produced by the target glands (thyroid, adrenal cortex and gonads). These integrated endocrine systems are called ‘axes.’ Caraka has explained integration (deham tantrayate samyak) with the help of vāta and its five types. Although mulasthan of 5 types of vāta have been explained at different sites in the body all are interrelated i.e. the reason why paraspara āvaran has been mentioned.
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| − | A stressor is a chemical or biological agent, environmental condition, external stimulus or an event that causes stress to an organism. Stressors have physical, chemical and mental responses inside of the body. Physical stressors produce mechanical stresses on skin, bones, ligaments, tendons, muscles and nerves that cause tissue deformation and in extreme cases tissue failure. Chemical stresses also produce biomechanical responses associated with metabolism and tissue repair. Stressor stimulates the hypothalamus. Astangsangrahakar has mention dhi, dhriti, smriti, mano bhodhan as karma of udāna i.e. to analyze the situation, for eg. If snake is far away from the body there is no fight or flight situation whereas if it is next to the body there is sudden fight or flight condition. It means udāna vāyu helps mana to get avabhodhan of the surrounding. It can be compared with analyzing the feedback signal received from various body organs and systems. The situation is analyzed and signal is sent to hypothalamus where prāna vāyu takes the decision for inhibitory or initiative action to be taken this is understood by the dharan karma of budhi and chitta i.e. mana. Hypothalamus secretes the corticotropin release factor (crf) which stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH). Udāna vāyu by its prayatna and urjā karma helps in the secretion. The release factor "ACTH" is taken to adrenal cortex with the help of vyāna vāyu. Vyāna vāyu is said to be shigrakari or fast acting i.e. within fraction of seconds ACTH reaches the adrenal cortex. Adrenal Cortex secretes various stress hormones which is stimulated by samāna vāyu. Mulasthan of samāna vāyu is in sweda, dōṣa, ambhuvaha srotas, it signals for the samāna anayati karma i.e. to maintain homeostasis thereby releasing the hormones in blood stream. The stress hormone released in blood is again taken by vyāna vāyu to various organs like heart, intestine etc. to cause the flight-or-fight response. After the response the apāna vāyu comes into action to excrete the hormones and neutralized the effect.
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| − | Between this flow there is an alternate path that can be taken after the stressor is transferred to the hypothalamus (udāna and prāna karma), which leads to the sympathetic nervous system (vyāna vāyu). After which, the adrenal medulla secretes epinephrine (samāna vāyu) in blood and with the help of vyāna vāyu spreads throughout the body to cause the flight or fight response.
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| − | VERSE 15-19
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| − | Most of the etiological factors explained here are responsible for singular vāta prakopa mediated through dhātu kṣaya. Exceptions are less in the said group. But now days etiological factors causing āvarana or samsarga vāta prakopa are mostly found. This is because of increased standard of living. The so called neuro degenerative diseases like Parkinsonism Disease, Alzheimers Disease etc even now days considered as aftereffects of metabolic dysfunctions rather than under nutrition or overuse. Even diseases like Alzheimiers dementia is conceptualised recently as type 3 Diabetes Mellitus.[20]
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| − | So a reassessment of etiological factors of contemporary importance is valid. Here an attempt is made to analyse the properties causing vāta vitiation with some modern explanations.
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| − | Rūkṣa, śītā, alpa, laghu anna, abhojana:
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| − | As any other organ, the brain is elaborated from substances present in the diet (sometimes exclusively, for vitamins, minerals, essential amino acids and essential fatty acids, including omega-3 polyunsaturated fatty acids). Most micronutrients (vitamins and trace elements) have been directly evaluated in the setting of cerebral functioning for e.g. vitamin B1 modulates cognitive performance especially in elderly. Vitamin B9 preserves brain during its development and memory during ageing. Vitamin B6 is used in treating premenstrual depression. Vitamin B6 and B12, among others, are directly involved in the synthesis of some neurotransmitters. Vitamin B12 delays the onset of signs of dementia. Supplementation of Cobalamin improves cerebral and cognitive functions in the elderly. In the brain, the nerve endings contain the highest concentration of vitamin C in the human body (after the supra renal glands). Vitamin D (or certain of its analogues) could be of interest in the prevention of various aspects of neurodegenerative or neuro-immune diseases. Iron is necessary to ensure oxygenation and to produce energy in the cerebral parenchyma and for the synthesis of neurotransmitters and myelin. An unbalanced copper metabolism homeostasis (due to dietary deficiency) could be linked to Alzheimer’s disease. Among many mechanisms manganese, copper and zinc participate in enzymatic mechanisms that protect against free radicals, toxic derivatives of oxygen. Indeed, nutrient composition and meal pattern can exert either immediate or long term effects beneficial or adverse.
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| − | From the above discussion it is observed that rūkṣa, alpa, laghu anna are apatarpankar hetu. Thus nutritional deficiency causes disorders of nervous system.
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| − | Similarly snigdha guna is essential to traverse the lipid soluble essential elements across the cell membrane. Rūkṣa guna in excess reduces the transfer of essential elements into the cells thus causing immediate or late effects.
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| | Further diets that are rich in saturated fats and sugar decrease levels of Brain derived neurotrophic factor [BDNF]. BDNF is a neurotrophin considered generally beneficial for maintaining neuronal function and for promoting recovery after neurologic insult. Reduced BDNF leads to poorer neuronal performance. Results of a study have shown that rats fed on a diet high in saturated fats and refined sugars (similar in content to the “junk food” that has become popular in western society) for a period of 1 -2 months performed significantly worse on the spatial learning water maze test. Even more alarming is that the high fat diet consumption exacerbated the effects of experimental brain injury. The effects of this high caloric diet seem to be related to elevated levels of oxidative stress and reduced synaptic plasticity which can reversed by antioxidant treatment or exercise. High caloric intake also is perceived as risk factor for Alzheimer’s disease. Concept of atibhojana, snigdha etc. leads to āma utpatti, a cause for Vātavyādhi. Research results show that noninvasive approaches such as diet and exercise can have profound consequences for increasing resilience of the CNS to injuries and for maintaining cognitive abilities. Diet and exercise are 2 very important parts of lifestyle and daily routine each can influence the capability of the brain to fight disease and to react to challenges. Physical activity can benefit neuronal function and plasticity by enhancing synaptic plasticity and reducing oxidative stress. Physical exercise can have direct effects on the brain and spinal cord by supporting the maintenance of the synaptic structure, axonal elongation and neurogenesis in the adult brain whereas excessive exertion (ativyāyāma) is hold to cause degenerative changes. | | Further diets that are rich in saturated fats and sugar decrease levels of Brain derived neurotrophic factor [BDNF]. BDNF is a neurotrophin considered generally beneficial for maintaining neuronal function and for promoting recovery after neurologic insult. Reduced BDNF leads to poorer neuronal performance. Results of a study have shown that rats fed on a diet high in saturated fats and refined sugars (similar in content to the “junk food” that has become popular in western society) for a period of 1 -2 months performed significantly worse on the spatial learning water maze test. Even more alarming is that the high fat diet consumption exacerbated the effects of experimental brain injury. The effects of this high caloric diet seem to be related to elevated levels of oxidative stress and reduced synaptic plasticity which can reversed by antioxidant treatment or exercise. High caloric intake also is perceived as risk factor for Alzheimer’s disease. Concept of atibhojana, snigdha etc. leads to āma utpatti, a cause for Vātavyādhi. Research results show that noninvasive approaches such as diet and exercise can have profound consequences for increasing resilience of the CNS to injuries and for maintaining cognitive abilities. Diet and exercise are 2 very important parts of lifestyle and daily routine each can influence the capability of the brain to fight disease and to react to challenges. Physical activity can benefit neuronal function and plasticity by enhancing synaptic plasticity and reducing oxidative stress. Physical exercise can have direct effects on the brain and spinal cord by supporting the maintenance of the synaptic structure, axonal elongation and neurogenesis in the adult brain whereas excessive exertion (ativyāyāma) is hold to cause degenerative changes. |
| | Stress is unpleasant, even when it is transient. A stressful situation–whether something environmental or psychological can trigger a cascade of stress hormones that produce well orchestrated physiological changes. Fight and flee are the 2 response which the body is accustomed too. Repeated stress leads to hormonal and neuro-adaptive changes which may be the cause for damage. All krodha (fight response) and bhaya (flight response) described by Ācharyas explain the similar effects on the body. | | Stress is unpleasant, even when it is transient. A stressful situation–whether something environmental or psychological can trigger a cascade of stress hormones that produce well orchestrated physiological changes. Fight and flee are the 2 response which the body is accustomed too. Repeated stress leads to hormonal and neuro-adaptive changes which may be the cause for damage. All krodha (fight response) and bhaya (flight response) described by Ācharyas explain the similar effects on the body. |