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Vatavyadhi Chikitsa (view source)

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<big>'''[[Chikitsa Sthana]] Chapter 28.Management of ~~disorders~~ caused by [[vata]] [[dosha]] </big>'''

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<big>'''[[Chikitsa Sthana]] Chapter 28.Management of diseases caused by [[vata]] [[dosha]] </big>'''

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

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

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

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

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''Vatavyadhi'' are group of disorders which are very commonly encountered by ayurvedic physicians. In many diseases like ''pakshaghata, ardita, gridhrasi, kateegraha,'' etc. ayurvedic physicians are claiming better results and it is widely accepted also. Critical understandings of pathology, types, prognostic factors etc. are very important for academic and clinical success. Thus, thorough understanding of ''vata roga'' is essential for every treating physician.

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

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== Sanskrit Text, Transliteration and English Translation ==

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</div></div>

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Now we shall expound the chapter ~~on “the therapeutics for ''vatavyadhi''~~"~~, thus~~ said ~~by the~~ Lord Atreya.[1-2]

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Now we shall expound the chapter"Vata vyadhi chikitsa" (Management of diseases caused by [[vata]] [[dosha]]). Thus said Lord Atreya.[1-2]

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==== Significance of ''vayu'' ====

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=== Significance of ''vayu'' ===

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''Vayu'' is life, ''vayu'' is strength, ''vayu'' mainstays living organism, the same ''vayu'' is verily the universe, and hence the Lord ''Vayu'' is praised. [3]

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==== Important role of ''vayu'' in health ====

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=== Important role of ''vayu'' in health ===

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When normal (non vitiated) ''vayu'' is at its abode with unobstructed (free) movement, is responsible for long lifespan of hundred years devoid of diseases.[4]

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==== Types of ''vayu'' and their functions ====

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=== Types of ''vayu'' and their functions ===

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When these five are located in respective sites optimally, perform their functions, supports life without any morbidity. [5-11]

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==== Role of ''vata/vayu'' in causing diseases ====

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=== Role of ''vata/vayu'' in causing diseases ===

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Now the aforesaid synonymous diseases with etiology and therapeutics are about to explain here, the absolute ''vata'' as per different locations as well as that got obstructed. [12-14]

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==== Etiopathology ====

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=== Etiopathology ===

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Due to intake of dry, cold, deficient and light food; excessive sex and sleeplessness; improper treatments; expelling of ''dosha'' or blood letting; by excessive fasting, swimming, walking, exercising, and physical activity; depletion of tissue elements; worrying, grief, debilitating diseases; usage of uncomfortable beds or seats; anger, day sleep or even with fright; suppression of natural urges, indigestion, trauma, abstaining from food; injury to vital areas, falling from swift moving elephant, camel or horse etc. ''vata'' is aggravated. This gets filled in the vacuous channels in the body and leads to various generalized or localized disorders. [15-19]

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==== Premonitory symptoms ====

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=== Premonitory symptoms ===

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Indistinct manifestation of the diseases are considered as prodromal symptoms.When the cardinal feature is clearly manifested, it is called as symptom, while the lessening of features are indicative of cure. [19-20]

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==== General signs and symptoms of ''vata'' vitiation ====

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=== General signs and symptoms of ''vata'' vitiation ===

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Vitiated ''vata'' causes various symptoms like contractures, joint stiffness, splitting of bones and joints, horripilation, delirium, spasticity of hands, back and neck; limping, paraplegia, hunch back; organ atrophy, insomnia, intrauterine death of embryo and fetus, diminishing sperms and menstruation fasciculation, generalized numbness, twitches of head, nose, eyes, supraclavicular part and neck; splitting, pricking or aching type of pains; convulsions, loss of consciousness, fatigue etc. Different specific diseases of ''vata'' are caused by specificity in etiological factors and site of affliction. [20-24]

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

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

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

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

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When vitiated ''vata'' is located in gastrointestinal tract or in abdomen it leads to urinary retention and constipation, intestinal and epigastric discomforts, ''gulma'', piles and pain in flanks.[24]

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===== ''Sarvanga kupita vata'' (vitiation all over body) =====

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==== ''Sarvanga kupita vata'' (vitiation all over body) ====

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When vitiated ''vata'' is located all over the body, it produces generalized fasciculation and breaking pain; different types of pain and the generalized joint crepitus. [25]

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===== ''Guda sthita vata'' (vitiation at anus) =====

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==== ''Guda sthita vata'' (vitiation at anus) ====

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When vitiated ''vata'' is located in anus, it leads to retention of feces, urine and flatus; colicky pain, flatulence, renal calculi, micro-calculi; diseases with atrophy in calf, thigh, pelvis, and the back.[26]

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===== ''Amashaya sthita vata'' (vitiation at stomach) =====

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==== ''Amashaya sthita vata'' (vitiation at stomach) ====

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When vitiated ''vata'' is located in stomach, symptoms manifest as pain in epigastrium, umbilicus, flanks and abdomen; morbid thirst, eructation, acute gastroenteritis, cough, dryness of throat and mouth and breathing difficulty.[27]

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==== ''Pakwashaya sthita vata'' (vitiation at colon) ====

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=== ''Pakwashaya sthita vata'' (vitiation at colon) ===

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When vitiated ''vata'' is located in colon it causes gurgling, colicky pain, tympanites, difficulty in defecation and urination, flatulence and lumbar/ sacroiliac pain. [28]

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==== ''Indriya gata vata'' (vitiation in sense organs) ====

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=== ''Indriya gata vata'' (vitiation in sense organs) ===

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When vitiated ''vata'' is located in ear like sense organs leads to sensorial loss in the respective organs. [29]

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==== ''Twaksthita vata'' (vitiation at skin) ====

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=== ''Twaksthita vata'' (vitiation at skin) ===

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When vitiated ''vata'' is located in skin it becomes dry, fissured, numb, thin, blackish. It causes pain along with erythema and strain and leads to pain in distal end of bones.[30]

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==== ''Raktagata vata'' (vitiation at blood) ====

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=== ''Raktagata vata'' (vitiation at blood) ===

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When vitiated ''vata'' is located in blood it manifests as severe pain with warmth and discoloration; weight loss, anorexia, specific raised rashes in body and esophageal spasm.[31]

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==== ''Mamsa medogata vata'' (vitiation in muscles and fats) ====

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=== ''Mamsa medogata vata'' (vitiation in muscles and fats) ===

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When vitiated ''vata'' is located in muscles and fat, it manifest as heaviness of body, pricking pain and as if beaten by a strong rod or fist cuff and painful severe fatigue.[32]

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==== ''Majja-asthigata vata'' (vitiation in bones and marrow) ====

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=== ''Majja-asthigata vata'' (vitiation in bones and marrow) ===

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When vitiated ''vata'' is located in bones and marrow it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia and continuous pain.[33]

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==== ''Shukra gata vata'' (vitiation in semen) ====

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=== ''Shukra gata vata'' (vitiation in semen) ===

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When vitiated ''vata'' is located in semen, it causes premature ejaculation or anejaculation. It may also lead to preterm or delayed labor. It may also cause deformity in fetus. [34]

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==== ''Snayugata vata'' (vitiation in tendons) ====

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=== ''Snayugata vata'' (vitiation in tendons) ===

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When vitiated ''vata'' is located in neural tissue or tendons, it leads to ophisthotonus or emprosthotonus, radiculopathy, kyphosis, quadriplegia or hemiplegia. [35]

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==== ''Siragata vata'' (vitiation in vascular tissue) ====

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=== ''Siragata vata'' (vitiation in vascular tissue) ===

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When vitiated ''vata'' is located in vascular tissue it leads to mildly painful edema in the body, emaciation, twitching, loss of pulsation along with dilation or coarctation of vessels. [36]

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==== ''Sandhigata vata'' (vitiation in joints) ====

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=== ''Sandhigata vata'' (vitiation in joints) ===

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Thus the symptomatology of ''vata'' according to various site are explained. [38]

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==== ''Ardita'' (facial paralysis) ====

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=== ''Ardita'' (facial paralysis) ===

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The food goes into one side of the mouth; while speaking the nose gets curved, the eye remains rigid and without blink; the sneeze gets suppressed. His speech is feeble, distorted, strenuous and indistinct. His teeth get rickety, hearing affected and voice is hoarse. There is pain in his feet, hand, eyes, calves, thighs, temples, ears and cheek. This condition, may affect half the body or half of the face only, is called ''ardita'' (facial paralysis). [38-42]

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==== ''Antarayama'' (Emprosthotonous) ====

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=== ''Antarayama'' (Emprosthotonous) ===

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When ''vata'' get localised in the ''manya'' (neck), lateral aspect of the neck and gets spread into the internal vessels, it causes ''manyastambha'' otherwise named as ''antarayam'' (Emprosthotonus). So the neck becomes convulsed inward and the lateral aspect becomes very stiff, the teeth get clenched with salivation, contraction of the back muscles and the head is stiff; yawning and lock jaw; these are the symptoms of ''antarayam''. Thus ''antarayam'' is explained. [43-45]

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==== ''Bahirayama''(ophisthotonous) ====

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=== ''Bahirayama''(ophisthotonous) ===

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As the body being bent like a bow, the head gets retracted almost touching his back and his chest is thrown forward, the sides of the neck become rigid and the neck in total get compressed along with clenching of teeth, salivation and aphasia. The attack may lead to death of the patient or deformity.[46-48]

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==== ''Hanugraha'' (lock jaw) ====

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=== ''Hanugraha'' (lock jaw) ===

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When the ''vata'' gets localized at the root of the jaws causes dislocation of the jaws and produces either a condition of stiff gaping of mouth without any pain; or by causing spasticity of the jaw, the mouth becomes fixed and cannot be opened. This is called as ''hanugraha'' (lock jaw)

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==== ''Aakshepaka'' (episodic contractions) ====

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=== ''Aakshepaka'' (episodic contractions) ===

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In ''akshepaka'' (..), the provoked ''vata'' contracts vessels, tendons and ligaments of the hands and feet cause episodic contraction in different parts of the body. [50-51]

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==== ''Dandaka'' (stiffness of body) ====

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=== ''Dandaka'' (stiffness of body) ===

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When ''vata'' causes rigidity of muscles of the hands, feet, head, back and hips, so that the body becomes stiff as a stick, is called as ''dandaka'', the condition is irremediable. [51-52]

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==== Episodic nature of ''vata'' disorders ====

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=== Episodic nature of ''vata'' disorders ===

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In diseases like ''ardita'' etc. when the episodic convulsions are gone, the patient returns to normal. Later as the episodes return the patient gets severely afflicted with characteristic features; the physicians should regard this condition as incurable. [52-53]

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==== ''Pakshaghata'' (paralysis) ====

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=== ''Pakshaghata'' (paralysis) ===

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When ''vata'' paralyze one side of the body either right or left, leads to motor deficit, pain and aphasia on the affected side. [This is called as ''pakshaghata'' (hemiplegia)]. By afflicting one side of the body, ''vata'' causes diminution of the vessels and nerves lead to contraction of either one leg or one arm with aching and piercing pain. That condition is to be known ''ekangaroga'' (monoplegia). If it affects whole body it is called ''sarvangaroga'' (quadriplegia).[53-55]

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==== ''Gridhrasi'' (sciatica) and ''khalli'' (radiculopathy) ====

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=== ''Gridhrasi'' (sciatica) and ''khalli'' (radiculopathy) ===

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''Gridhrasi'' due to ''vata'' is manifested as; stiffness, ache and pricking pain in the course of gluteal region, hip and posterior aspect of thigh, knee, calf and soles and twitching infrequently. If it is due to combined ''vata'' and ''kapha'', there will be additional symptoms of listlessness, heaviness and anorexia. The condition is known as ''khalli'' where there is kneading pain referable to feet, calf, thigh and shoulder. [56-57]

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==== Other local disorders ====

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=== Other local disorders ===

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The rest of the disorders should be diagnosed according to the symptoms characteristic of the seat of affection. [58]

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==== Pathological factors ====

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=== Pathological factors ===

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The provocation of ''vata'' is either due to ''dhatukshaya'', means diminution of tissue elements and/ or due to ''avarana'' means obstruction to its pathway. The ''vata, pitta'' and ''kapha'', always circulate through all the body channels. The ''vata'', owing to its subtle characteristics is really the impeller of the other two. When the ''vata'' is provoked, it propels the other two ''doshas'' and dislodges them about here and there, causing various diseases. Due to ''avarana'' (obstruction in its path), it further causes diminution of the body nutrient fluid and other body elements. [59-61]

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==== ''Avrita vata'' (conditions due to obstructed ''vata'') ====

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=== ''Avrita vata'' (conditions due to obstructed ''vata'') ===

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</div></div>

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===== ''Vata'' occluded by ''pitta'' =====

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==== ''Vata'' occluded by ''pitta'' ====

The symptoms of ''vata'' occluded by ''pitta'' are burning sensation, morbid thirst, colic, giddiness, darkness of vision; heart burn on eating pungent, sour, salt and hot things and craving for cold things.[61]

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===== ''Vata'' occluded by ''kapha'' =====

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==== ''Vata'' occluded by ''kapha'' ====

If the ''vata'' is occluded by ''kapha'', there will be excess feeling of cold, heaviness, pain, pacification by pungent and similar other articles, craving for fasting, exertion, dry and hot things.[62]

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===== ''Vata'' occluded by blood =====

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==== ''Vata'' occluded by blood ====

When it is occluded by the blood, there will be severe burning pain in the area between the skin and the flesh, along with edema and reddish tinge and round patches.[63]

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===== ''Vata'' occluded by ''mamsa'' =====

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==== ''Vata'' occluded by ''mamsa'' ====

In the flesh, it causes hard, discolored boils, and swellings, horripilation and tingling.[64]

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===== ''Vata'' occluded by ''meda'' =====

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==== ''Vata'' occluded by ''meda'' ====

When the ''vata'' is occluded in the adipose tissue, it causes movable, smooth, soft and cold swellings in the body, as well as anorexia. This condition is known as ''adhyavata'' and is difficult to cure. [65]

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===== ''Vata'' occluded by ''asthi'' =====

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==== ''Vata'' occluded by ''asthi'' ====

When the ''vata'' is occluded in the osseous tissue, the patient likes hot touch (local sudation) and pressing . He has splitting pain and feels as though his body is being pricked with needles.[66]

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===== ''Vata'' occluded by ''majja'' =====

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==== ''Vata'' occluded by ''majja'' ====

When the ''vata'' is occluded in the marrow, there will be flexure/bending/curving of the body, /pandiculation (stretching and stiffening of the trunk and extremities), excess yawning, twisting and colicky pain. The patient gets relief on pressing with the hand (gentle massage). [67]

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===== ''Vata'' occluded by ''shukra'' =====

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==== ''Vata'' occluded by ''shukra'' ====

If the ''vata'' is occluded in semen, it results in ejaculation or premature ejaculation or sterility.[68]

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===== ''Vata'' occluded by food =====

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==== ''Vata'' occluded by food ====

If the ''vata'' is occluded by food, there will be pain in the stomach on ingestion of food and disappearance of pain after digestion.[68]

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===== ''Vata'' occluded by urine =====

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==== ''Vata'' occluded by urine ====

If the ''vata'' is occluded by urine leads to urinary retention and distension of bladder.[69]

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===== ''Vata'' occluded by feces =====

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==== ''Vata'' occluded by feces ====

If the ''vata'' is occluded by the fecal matter; it leads to obstinate constipation, scissoring type pain in anal region, all unctuous matter ingested is immediately digested (due to excess dryness in colon), after food intake the person suffers from increased distension of abdomen and owing to the pressure of the food ingested the patient passes dry feces with difficulty and after long delay. He is afflicted with pain in the hips, groins and back; as the ''vata'' moves in a reverse direction causes epigastric discomfort. [70-71]

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==== Prognosis ====

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=== Prognosis ===

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Joint dislocation, lock jaw, contracture, hunch back(kyphosis), facial paralysis, hemiplegia, atrophy of a part, paraplegia, arthritis, stiffness, rheumatic conditions and disorders due to affliction of vāta in the marrow; all these on account of their seriousness of the seat affected , may or may not be cured even after deliberate treatment. These can be cured when they are of recent origin in strong patient and without any complications. [72-74]

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==== General management of ''vata'' disorders ====

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=== General management of ''vata'' disorders ===

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===== Importance of ''snehana'' (oleation therapy) and ''swedana''(sudation therapy) =====

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==== Importance of ''snehana'' (oleation therapy) and ''swedana''(sudation therapy) ====

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The oleation and sudation procedures should be repeatedly administered so that the disorders of ''vata'' may not stay in the viscera softened by oleation procedure. [82]

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===== ''Mridu samshodhana'' (Mild purgation) =====

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==== ''Mridu samshodhana'' (Mild purgation) ====

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All diseases due to ''vata'' vitiation are always to be continually treated with sweet, sour, salty and unctuous articles of diet and nasal medication and inhalations. Thus the treatment of diseases due to ''vata'' provocation has been expounded in general. [88]

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===== Specific treatment of various conditions =====

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==== Specific treatment of various conditions ====

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</div></div>

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===== Treatment of ''vata'' located in alimentary tract =====

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==== Treatment of ''vata'' located in alimentary tract ====

Now to be specific; in the condition of morbid ''vata'' lodged in the alimentary tract, the patient should drink alkaline drugs or digestion of humors is to be done with digestive and appetizer groups of drugs.[89]

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===== Treatment of ''vata'' located in colon =====

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==== Treatment of ''vata'' located in colon ====

In condition of morbid ''vata'' lodged in the rectum or the colon, the treatment of ''udavarta'' should be given. [90]

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===== Treatment of ''vata'' located in stomach =====

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==== Treatment of ''vata'' located in stomach ====

If it is lodged in the stomach, after the purificatory process, specific treatment as per the ''dosha'' should be given.

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===== Treatment of ''vata'' located in entire body =====

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==== Treatment of ''vata'' located in entire body ====

When the ''vata'' is provoked in the entire body, oil massage, evacuative enema and unctuous enema should be given. [91]

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===== Treatment of ''vata'' located in skin =====

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==== Treatment of ''vata'' located in skin ====

When the skin is affected, sudation, oil application, hot immersion bath and cordial food should be given.

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===== Treatment of ''vata'' located in blood =====

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==== Treatment of ''vata'' located in blood ====

When the blood is affected, thick and cold external applications, purgation and blood letting are to be done. [92]

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===== Treatment of ''vata'' located in muscle flesh and fat =====

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==== Treatment of ''vata'' located in muscle flesh and fat ====

As the flesh and fat is affected purgation, evacuative enema and palliative measures should be administered.

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===== Treatment of ''vata'' located in osseous tissue and bone marrow =====

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==== Treatment of ''vata'' located in osseous tissue and bone marrow ====

The osseous tissues and bone-marrow affliction should be corrected with internal and external oleation therapy.[93]

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===== Treatment of ''vata'' located in semen and intrauterine growth retardation =====

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==== Treatment of ''vata'' located in semen and intrauterine growth retardation ====

If the semen is affected, virility enhancing food and drinks which promote strength and semen are beneficial. If the passage of semen is found to be occluded, purgation should be administered. Only after purgation and consumption of diet, the previously mentioned line of treatment should be carried out.[94]

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When ''vata'' causes intrauterine growth retardation or new born is emaciated, then milk prepared with sugar, ''kashmarya'' and ''madhuka'' is beneficial for restoration.[95]

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===== Treatment of ''vata'' located in cardiac region =====

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==== Treatment of ''vata'' located in cardiac region ====

If the provoked ''vata'' is located in the cardiac region, the milk prepared of aṁśumati is beneficial.

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===== Treatment of ''vata'' located in umbilicus =====

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==== Treatment of ''vata'' located in umbilicus ====

If it is located in the umbilicus, fish processed with unripe ''bilva'' fruits should be given.[97]

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===== Treatment of ''vata'' located in parts of body =====

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==== Treatment of ''vata'' located in parts of body ====

If there are cramps in any part of the body, poultice should be applied.

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When the morbid ''vata'' is localized below the umbilical region, enema and ''avapidhaka sneha'' are recommended.[98]

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==== Treatment of ''vata'' disorders affecting tendon, ligaments and vessels ====

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=== Treatment of ''vata'' disorders affecting tendon, ligaments and vessels ===

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In lock jaw; in case of opened fixed mouth, the jaw should be subjected to sudation procedure first and then it should be pressed downwards by the thumbs (inserting in the mouth and pressing on the molar teeth) and pushed upwards by fingers (which are placed externally below the chin) is beneficial. So the subluxated part will reach its proper position. In stiffness it should be subjected to sudation procedure and flexed. [102-103]

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==== Specific treatment as per site and ''dushya'' ====

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=== Specific treatment as per site and ''dushya'' ===

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Specific line of treatment should be adopted in specific condition depending on site of affliction and the vitiated tissue involved.[104]

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===== ''Brimhana'' (nourishment) treatment =====

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==== ''Brimhana'' (nourishment) treatment ====

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Ghee, oil, fat, marrow, affusion, massage, enema, unctuous sudation, staying at calm places (without strong wind), covering with blankets, meat soups, various milks, articles of diet of sweet, sour and salt tastes and whatever is nourishing are beneficial for disorders due to ''vata''.[104-106]

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==== Various formulations ====

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=== Various formulations ===

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Take 16 ''tolas'' (192 gm) each of barley, ''kola'', horse gram, ''shreyasi,'' dry radish and ''bilva'' and cook them in a sour solution. The medicated oil prepared with this decoction along with sour fruit and the paste of pungent spices, should be used by the patient suffering from severe disorders of ''vata'', in the cold season. [140-141]

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===== ''Sahachara taila'' and ''baladi taila'' =====

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==== ''Sahachara taila'' and ''baladi taila'' ====

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Take 400 ''tolas'' (4.8 kg) of ''bala'', fourth part of ''guduchi'' and one eighth quantity of ''rasna'' and cook in 1 ''adhaka'' (307.2 l) of water till it is reduced to one tenth of the quantity. Prepare 256 ''tolas'' (3.072 l) of oil with this decoction adding equal quantities of whey, sugarcane juice and vinegar along with half the quantity of goat’s milk and the paste of four ''tolas'' (48 gm) of the leaves of each of the following drugs:- ''shathi, sarala, darvi, ela, manjishtha, agaru, chandana, padmaka, ativisha, musta, surpaparni, harenu, yashthimadhu, surasa, vyaghranakha, rshabhaka, jeevakaih,'' juice of ''palasha, kastūrī, nalika,'' buds of jasmine, ''sprrikka, kunkuma, shaileya, jati phala, kathuphala, ambu, tvak, kunduru, karpura, aturushka, shrinivasa, lavanga, nakha, kakkoli, kushtha, mamsi, priyangu, sthauneya, tagara, dhyama, vacha,'' leaves of ''madana'' and ''nagakesar''. This should then be strained and the paste of fragrant drugs are added to it and administered duly. This excellent ''bala'' oil is curative of ''vata'' disorders in general. It can be used in dyspnea, cough, fever, hiccup, vomiting, ''gulma'', pectoral lesions, cachexia, splenic disorders, emaciation, epilepsy and lack of lustre. [148-154]

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===== ''Amritadi tailam'' =====

+

==== ''Amritadi tailam'' ====

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Prepare decoction of 2000 ''tolas'' (24 kg) of ''guduchi'' in 5 ''drone'' (98.304 l) of water by reducing to ¼th its quantity. Later add 512 ''tolas'' (60144 l) of sesame oil and equal quantity of milk in this decoction, along with paste of 1 ''tola'' (12 gm) each of cardamom, ''ela, mamsi, nata, ushira, sariva, kushtha, chandana, bala, tamalaki, meda, shatapushpa, riddhi, jeevaka, kakoli, ksheerakakoli, shravani, atibala, nakha, mahashravani, jeevanti,vidari, kapikacchu, shatavari, mahameda, karkata, harenu, vacha, gokshura, eranda, rasna, kala, sahachara, bala, veera, shallaki, musta, tvak, patra, rishabhaka, balaka, ela, kunkuma, sprikka'' and three ''tolas'' (36 gm) of manjishtha and 32 ''tolas'' (384 gm) of ''yashtimadhu''. It restores the health of those affected with reduced semen, digestive power and vitality. Normalizes individuals with insanity and epilepsy and is excellent to cure ''vata'' disorder. This is the ''amritadya taila'' propounded by preceptor ''krishnatreya'' who was respected by reverent physicians. [157- 164]

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===== ''Rasna taila'' =====

+

==== ''Rasna taila'' ====

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Thus, ''rasna taila'' has been explained. [165–166]

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===== ''Mulakadya taila'' and ''vrishmuladi taila'' =====

+

==== ''Mulakadya taila'' and ''vrishmuladi taila'' ====

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256 ''tolas'' (3.072 l) of sesame oil are cooked in 800 ''tolas'' (9.6 l) of the decoction of ''vrisha'' roots and guduchi, and 400 ''tolas'' (4.8 l) of the decoction of ''chitraka, ashvagandha'' and milk. This medicated oil should be prescribed in fractured or serious conditions of bone due to ''vata''. It becomes exceedingly effective if prepared with the paste mentioned in earlier oils. [170-171]

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===== ''Mulaka taila'' =====

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==== ''Mulaka taila'' ====

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Being also capable of further intensification of potency, by being processed again for hundreds or thousands of times, ''taila'' very quickly cures the diseases which are located into even the minutest part of the body. [181-182]

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

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

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This general line of treatment is also recommended in conditions of association with morbidity of other humors, but especially when the body channels have been occluded by ''pitta'' and ''kapha'' in ''vata'' disorders. [183]

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===== Management of ''pittavrita vata'' =====

+

==== Management of ''pittavrita vata'' ====

In condition of occlusion of ''pitta,'' the physician should administer cold and hot lins of treatment in alternation. Here, ghee prepared of ''jeevaniya gana'' is recommended.

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In the condition of occlusion by both ''kapha'' and ''pitta, pitta'' must be subdued first. [188]

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==== Management of various condition of ''vata'' located in other sites ====

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=== Management of various condition of ''vata'' located in other sites ===

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Thus has been described the treatment of conditions of occlusion of ''vata'' by ''pitta'', etc. [198 ½]

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==== Mutual occlusions by types of ''vata'' and their management ====

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=== Mutual occlusions by types of ''vata'' and their management ===

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Thus have been described in general this eight conditions of mutual occlusion along with their symptoms and treatment, in order to aid the understanding of intelligent physicians. [216-216½]

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==== General guidelines for management ====

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=== General guidelines for management ===

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On investigating the habitat of each type of ''vata'', as well as the signs of increase or decrease of its functions, the physician should diagnose the remaining twelve conditions of mutual occlusions and should treat them by means of external application, unctuous internal administration, enema and all other procedures, or he may be alternatively given cold and hot measures. [217-218½]

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==== Specific principles of management ====

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=== Specific principles of management ===

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Thus the physician should regulate and establish types of ''vata'' in their normal habitats, which have been occluded and misdirected. [219-220½]

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==== Types of ''vata'' occluded by ''dosha'' ====

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=== Types of ''vata'' occluded by ''dosha'' ===

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In condition of occlusion of ''apana'' by ''kapha'', there occur stools that are loose, heavy and mixed with undigested matter and mucus and ''kapha'' dominated ''prameha''. [230-230½]

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==== Guidelines for diagnosis of conditions ====

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=== Guidelines for diagnosis of conditions ===

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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]

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==== Complications and management ====

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=== Complications and management ===

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In a condition of occlusion of ''vata'' by ''kapha'', medications curative of ''kapha'' and ''vata anulomana'' should be given. [245]

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==== Similarity in macrocosm and microcosm ====

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=== Similarity in macrocosm and microcosm ===

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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 ''vata, pitta'' and ''kapha'' in the body.[246]

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==== Four states of ''dosha'' ====

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=== Four states of ''dosha'' ===

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The physician who understand the condition of decrease, increase, normality and occlusion of ''vata'' and other ''dosha'', is not deluded with regard to treatment.[247]

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==== Summary ====

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=== Summary ===

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== Vidhi Vimarsha (Applied Inferences ) ==

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==== Importance of ''vata dosha'' in overall health and disease ====

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=== Importance of ''vata dosha'' in overall health and disease ===

This text highlights the grandness of ''vata'' as a humor. ''Vata'' is equated to ''ayu''. Life is sustained by ''vayu'' only. Even though ''ayu'' is previously defined as conglomeration of ''sharira'' (physical body), ''indriya'' (sensorium), ''satva'' (mind) and ''atma'' (soul), <ref> Ibid 1/42 </ref> here it is mentioned equivalent to ''vayu''. The sense organs, mind and soul in physical body are manifested through the functions of ''vayu'' only. The strength of the individual is also provided by ''vayu''. These two usages of ''ayu'' and ''bala'' are later explained as, ''prana'' is life and ''udana'' is strength. (verse 3)

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''Vata'' performs all its activity for a healthy long life subject to status of its three functions. They are ''akupita''(not increased, decreased or vitiated), ''sthanastha'' (located in its own place) and ''avyahatagati''(nothing is interfering with its movement or ''gati'').

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

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

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

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Owing to its incorporeal nature and instability ''vata'' is ''anasadhya'' (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 ''vata achintya veerya'' (inconceivable prowess) and ''doshanam neta'' (propeller of all functional elements in the body).<ref>Ibid 1/8 </ref>

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==== Properties of ''vata'' ====

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=== Properties of ''vata'' ===

In [[Vatakalakaliya Adhyaya]], questions have been raised about exciting and alleviating factors regarding qualities of ''vata''. ''Ruksha''(dry), ''laghu''(light), ''sheeta''(cool), ''daruna'' (dreadful), ''khara'' (rough) and ''vishada'' (clean) have been explained as qualities of ''vata''. Repeated use of substances with these qualities and actions of such similar qualities causes aggravation and excitation of ''vata'' and is alleviated by use of substances possessing contrary qualities. This brings out the phenomenon of two mutually interrelated and inseparable of ''sharira vayu'' viz.

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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)

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===== Types of ''vata dosha'' =====

+

==== Types of ''vata dosha'' ====

In Vedic literature, as a medical system, the important five types of ''vata'' are explained with their locations and functions. The word ''tantrayate'' is used to explain the functional quality of ''vata'' and ''sharira'' (physical body) is ''yantra'' for functioning of ''tantra''. The ''vata dosha'' on basis of its functions is classified into five types. They reside in the ''sharira'' at the level of ''sharira parmanu'' (cell) and also at gross level. Five types of ''vata'' work together in a synchronized manner for the normal functioning of the ''sharira'' (''vayu tantrayantra dhara''). (verse 5-11)

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==== General etiological factors and basic pathogenesis of ''vata'' disorders ====

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=== General etiological factors and basic pathogenesis of ''vata'' disorders ===

The etiological factors can be divided into two:

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#which cause indirect ''vata'' vitiation.

−

~~Daysleep~~ (''divaswapna'') do not directly lead to vitiation of ''vata''. However, it leads to formation of ''ama'' and cause ''vata'' vitiation indirectly by obstructing ''vata''. ''Vegasandharana'' (suppression of natural urges) and ''marmabhighata'' (trauma to vital organs) etc. are examples of direct vitiation. The pathogenesis is also bi-fold. The initial pathology is aggravation of ''vata'' and diminution of ''dhatus'' and vice versa. One augments the other. This ultimately causes emptiness in channels and rarity in tissues which gives more space for movements of ''vata''. The second pathology is by increase in ''dhatus'' leading to excessive filling in channels to cause their clogging and blocking ''vata''. (verse 15-19)

+

Day sleep (''divaswapna'') do not directly lead to vitiation of ''vata''. However, it leads to formation of ''ama'' and cause ''vata'' vitiation indirectly by obstructing ''vata''. ''Vegasandharana'' (suppression of natural urges) and ''marmabhighata'' (trauma to vital organs) etc. are examples of direct vitiation. The pathogenesis is also bi-fold. The initial pathology is aggravation of ''vata'' and diminution of ''dhatus'' and vice versa. One augments the other. This ultimately causes emptiness in channels and rarity in tissues which gives more space for movements of ''vata''. The second pathology is by increase in ''dhatus'' leading to excessive filling in channels to cause their clogging and blocking ''vata''. (verse 15-19)

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===== Premonitory signs and symptoms =====

+

==== Premonitory signs and symptoms ====

Clinical manifestations may not be apparent because of vague manifestation of symptoms (''Avyaktam lakshanam''). 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 appreciable gap. (verse 19-20)

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===== Clinical features =====

+

==== Clinical features ====

The clinical presentations vary according to the specificity of ''hetu'' (cause) and ''sthana'' (location). The treatment options also vary accordingly. For example if ''vata prakopa'' takes place due to ''ruksha vriddhi'' in ''pakvashaya'' it may lead to habitual constipation in which ''snigdha, ushna'' and ''tikshna aushadha'' like ''mishraka sneha'' may be a good treatment option.

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If the same ''vata'' gets vitiated in ''amashaya'' due to ''snigdha vriddhi'', it leads to gastro-esophageal reflux disease (GERD), ''ruksha ushna'' and ''tikshna'' like ''gomutra bhavita shaddharana'' is the ideal treatment option. ''Anuvasana'' is the ideal therapy in ''vata'' vitiated in ''pakwashaya'', whereas ''vamana'' is the best therapy in ''vata'' vitiated in ''amashaya''. (verse 20-24)

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===== Three modes of pathogenesis of ''vata'' diseases =====

+

==== Three modes of pathogenesis of ''vata'' diseases ====

The three characteristics of ''vata'' vitiation viz. ''svatantra dushti'' (vitiation due to independent specific causes), ''gata vata'' (increased movement of ''vata'') and ''avarana'' (obstruction to movement of ''vata''). imply three possible modes of pathogenesis in ''vata'' diseases. These can be further analyzed as follows; due to the following three important properties of ''vata'', it is regarded entirely different from other ''dosha''<ref>Ibid 12/3</ref>.

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#''Anāsādhya'' (Inaccessible)

−

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

+

=== Pathogenesis of various conditions ===

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

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#''Avarana'' of ''vata'' may cause depletion of nutrition to ''dhatu'' (''dhatugata sama'') leading to successive diminition of ''rasadi dhatu'' (''rasadimscha upasosayet'').<ref>Ibid 28/61</ref> No such reference is available in case of ''gatatva''.

−

The ~~above~~ discussed points are briefly enlisted in the table below:

+

The discussed points are briefly enlisted in the table below:

{| class="wikitable"

|-

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

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

+

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

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

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

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

+

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

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

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

−

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

+

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

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

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

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

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

+

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

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

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* [[Vatakalakaliya Adhyaya]]

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=== References ===

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== References ==

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