Vatavyadhi Chikitsa
Chikitsa Sthana Chapter 28.Management of diseases caused by vata dosha
| Section/Chapter | Chikitsa Sthana Chapter 28 |
|---|---|
| Preceding Chapter | Urustambha Chikitsa |
| Succeeding Chapter | Vatarakta Chikitsa |
| Other Sections | Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana |
| Translator and commentator | Mangalasseri P. |
| Reviewer | Ojha S.N. |
| Editors | Ojha S.N., Deole Y.S., Basisht G. |
| Year of publication | 2020 |
| Publisher | Charak Samhita Research, Training and Skill Development Centre |
| DOI | 10.47468/CSNE.2020.e01.s06.029 |
Abstract
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.
Introduction
Vatavyadhi Chikitsa exclusively deals with certain common disorders where the specific vitiation of vata takes place. Before entering the chapter, let us consider the etymological derivations of the term vata. The technical term vata is derived from Sanskrit root verb va which means gati gandhanayoh (movement and continued efforts/enthusiasm.) or by the application of kta to the root verb va which again means the same as above, vatiti vata, the term vata is derived. As all ancient Indian scientific treatise observe strict rules regarding formation of a word, for the brevity and secrecy of expressions, it should be analyzed in detail for better understanding. The meaning of gati is to acquire; and jnana is to get aware or to sense. The term gandhana means to enthuse, to excite or to stimulate. Considering the different meanings of gati, and gandhana it is understood that the term vata itself conveys its role as a receptor as well as stimulator. Hence it can be said that vata is the biological force which recognizes and stimulates all the activities in the body.
Vata is the prime dosha. Owing to its incorporeal nature and instability it is inaccessible in comparison to other two dosha. The inaccessibility is characterized in regard to its functional and physical attributes but is more relevant regarding the therapeutic aspect. Vata is also explained as achintyaveerya (inconceivable prowess) and doshaanaam netah (propeller of all functional elements in the body).[1]
Before discussing the importance and implications of vata, the references on vata and neurological elements in vedic literature is to be highlighted. In vedic science two terminologies namely prana and pranaja were used to denote nerve impulses. Prana is kriyashakti (power for action) and may be compared with motor impulse. Pranaja is also same as prana but conveys sensation of taste, smell, vision, sound, coitus, reproduction, pleasure and pain. It can be compared with sensory afferent impulse. Both prana and pranaja leave body at death. The entire neural axis is explained as sushumna (spinal cord) and it extends from the mid-perineum to inside of cranium runing through the middle of the spine to reach the cerebrum, twelve fingers breadth from nose. The shape of sushumna is compared with flower of datura alba with two dilatations at thoracic and lumbar areas. The cross section of spinal column is compared with the letter Aum in which grey matter and white matter is identified as chitrini (name for grey matter) and vajra (name for white matter). The neural net works are compared with luta tantu (spider web)[2]. Ten subtypes of vata are explained and dhananjaya (the tenth and last subtype) does not leave the body even after death. This is responsible for tissue transplantation after death. The description of shadchakra (six chakras) is also very striking with latest functional modern neurology. The difference between vedic and ayurvedic neurology is that vedic science used it to attain higher level of consciousness through control of one’s nerve impulses. Ayurvedic science is meant for academic advancement or therapeutics. In Ayurveda it can be seen that practical utilization of vedic knowledge for therapeutic purpose by modification through experiments and experiences is done. Detailed descriptions of features of vata are available in various chapters of Charak Samhita including Deerghanjiviteeya Adhyaya, Vatakalakaliya Adhyaya and Rogabhishagjitiya Vimana, etc. The pathology and therapeutic aspects of vata is explained in this chapter. There is no separate chapter for diseases of pitta and kapha dosha. Vatavyadhi Chikitsa is an exclusive chapter dealing with vata janita vishesha vyadhi (diseases caused by vata vitiation). It is because of the supremacy of vata. The chapter is kept just after Urustambha Chikitsa since in that particular disease ama, kapha, meda, etc. are associated to cause vataprakopa and urustambha. On application of strenuous rukshana chikitsa in urustambha, vataprakopa alone may also happen. Even though in nanatmaja (single dosha) vatavyadhi the presence of other dosha can be traced, the disease cannot manifest without the vitiation of vata.
Vata as explained earlier is the biological force present in the body which recognizes and stimulates all the activities. Instability of vata makes it inaccessible. It is characterized by an increase in the chala (motion) property, which is favored and contributed by other properties also. The chala guna is directional in nature and termed as gati. Gati is the distinct quality of vata, very important on physiological and pathological aspects. The gati of individual components of vata is to be analyzed according to the intensity, direction and area; depending upon the particular function it is carrying out. When the gati is aggravated (gatatva) or obstructed (avarana) the functional normality’s of vata are impaired. The gati or gatatva have two implications, one subjected to activity (to move, carry out or reach-gata) and the second subjected to abode of activity (pathway). Gatatva is an essential part of any vataja samprapti (pathogenesis). Gatatva of vata is possible in dhatu, upadhatu, asaya (sites or hollow cavities of organs), avayava (part or organ), etc. Consumption of ahara of relatively higher kittansa (waste products) leads to diminution of dhatu and aggravation of vata[ Cha. Sa. Sutra Sthana 28/4]. It leads to riktata (emptiness) and more avakasa (space) in dhatu, makes the engorgement and hyper movement of aggravated vata in the site. Dhatugatavata and dhatuavrita vata are also distinct pathologies as in avarana the vitiation of vata is passive and the gati is obstructed.
The chapter begins with praising of powerful vata followed with five subtypes of vata. After these descriptions, the etiopathological and therapeutic aspects of vata are explained. In the present chapter the two distinct pathology of vata is explained with possible causative factors. In the context of gatavata, the pathology is related to the various dhatu, ashaya or avayava involved in gatatva. The same way different avarana of vata by other two dosha, dhatu, mala, anna, etc. are explained. Since different subtypes of vata possess different gati mutual avarana among subtypes are also possible. The chapter also explains various disorders like pakshaghata, ardita, akshepaka, avabahuka etc. The general line of treatment of absolute vata vitiation is detailed in the chapter by giving importance to snehana, swedana, samshodhana, etc. An ample amount of medications including various taila yoga, ghr̥ita yoga, etc. are also given in the chapter. The specific treatment approaches in exclusive conditions are also explained.
Vata vyadhi 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.
Sanskrit Text, Transliteration and English Translation
Now we shall expound the chapter Vata vyadhi chikitsa (Management of diseases caused by vata dosha). Thus said Lord Atreya.[1-2]
Significance of vayu
वायुरायुर्बलं वायुर्वायुर्धाता शरीरिणाम् |
वायुर्विश्वमिदं सर्वं प्रभुर्वायुश्च कीर्तितः ||३||
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]
Important role of vayu in health
अव्याहतगतिर्यस्य स्थानस्थः प्रकृतौ स्थितः |
वायुः स्यात्सोऽधिकं जीवेद्वीतरोगः समाः शतम् ||४||
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]
Types of vayu and their functions
प्राणोदानसमानाख्यव्यानापानैः स पञ्चधा |
देहं तन्त्रयते सम्यक् स्थानेष्वव्याहतश्चरन् ||५||
स्थानं प्राणस्य मूर्धोरःकण्ठजिह्वास्यनासिकाः [१] |
ष्ठीवनक्षवथूद्गारश्वासाहारादि कर्म च ||६||
उदानस्य पुनः स्थानं नाभ्युरः कण्ठ एव च |
वाक्प्रवृत्तिः प्रयत्नौर्जोबलवर्णादि कर्म च ||७||
स्वेददोषाम्बुवाहीनि स्रोतांसि समधिष्ठितः |
अन्तरग्नेश्च पार्श्वस्थः समानोऽग्निबलप्रदः ||८||
देहं व्याप्नोति सर्वं तु व्यानः शीघ्रगतिर्नृणाम् |
गतिप्रसारणाक्षेपनिमेषादिक्रियः सदा ||९||
वृषणौ बस्तिमेढ्रं च नाम्भूरू वङ्क्षणौ गुदम् |
अपानस्थानमन्त्रस्थः शुक्रमूत्रशकृन्ति [२] च ||१०||
सृजत्यार्तवगर्भौ च युक्ताः स्थानस्थिताश्च ते |
स्वकर्म कुर्वते देहो धार्यते तैरनामयः ||११||
Vayu is of five types namely prana, udana, samana, vyana and apana and they mechanize the body optimally occupying their sites without any irregular movement.
The location of prana is vertex, thorax, trachea, tongue, mouth and nose and it performs functions of spitting, sneezing, eructation, respiration, deglutition etc.
The site of udana is umbilicus, thorax and trachea and is responsible for vocalization, drive, energy, strength, complexion etc. Samana is located in channels of sweat, humors and water and lateral to the seat of agni (digestive enzymes (agni) and yield strength to the digestive fire.
Vyana has swift movement and spreads all over the body and is responsible for gait, flexion, extension, twinkling etc. Apana is told to be located in testicles, urinary bladder, penis, umbilicus, thighs, inguinal region and anus and performs ejaculation, micturition, defecation, expulsion of menstrual blood and fetus.
When these five are located in respective sites optimally, perform their functions, supports life without any morbidity. [5-11]
Role of vata/vayu in causing diseases
विमार्गस्था ह्ययुक्ता वा रोगैः स्वस्थानकर्मजैः |
शरीरं पीडयन्त्येते प्राणानाशु हरन्ति च ||१२||
सङ्ख्यामप्यतिवृत्तानां तज्जानां हि प्रधानतः |
अशीतिर्नखभेदाद्या रोगाः सूत्रे निदर्शिताः ||१३||
तानुच्यमानान् पर्यायैः सहेतूपक्रमाञ्छृणु |
केवलं वायुमुद्दिश्य स्थानभेदात्तथाऽऽवृतम् ||१४||
When dislodged or impaired, dosha harm the body by diseases according to their respective site and function, and may even lead to instantaneous death.
Even though the diseases caused by them are innumerable, starting from nakhabheda (nail splitting), the major eighty diseases enlisted in Sutra Sthana are important.
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]
Etiopathology
रूक्षशीताल्पलघ्वन्नव्यवायातिप्रजागरैः |
विषमादुपचाराच्च दोषासृक्स्रवणादति ||१५||
लङ्घनप्लवनात्यध्वव्यायामातिविचेष्टितैः |
धातूनां सङ्क्षयाच्चिन्ताशोकरोगातिकर्षणात् ||१६||
दुःखशय्यासनात् क्रोधाद्दिवास्वप्नाद्भयादपि |
वेगसन्धारणादामादभिघातादभोजनात् ||१७||
मर्माघाताद्गजोष्ट्राश्वशीघ्रयानापतंसनात् |
देहे स्रोतांसि रिक्तानि पूरयित्वाऽनिलो बली ||१८||
करोति विविधान् व्याधीन् सर्वाङ्गैकाङ्गसंश्रितान् |१९|
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]
Premonitory symptoms
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]
General signs and symptoms of vata vitiation
सङ्कोचः पर्वणां स्तम्भो भेदोऽस्थ्नां पर्वणामपि ||२०||
लोमहर्षः प्रलापश्च पाणिपृष्ठशिरोग्रहः |
खाञ्ज्यपाङ्गुल्यकुब्जत्वं शोषोऽङ्गानामनिद्रता ||२१||
गर्भशुक्ररजोनाशः स्पन्दनं गात्रसुप्तता |
शिरोनासाक्षिजत्रूणां ग्रीवायाश्चापि हुण्डनम् ||२२||
भेदस्तोदार्तिराक्षेपो मोहश्चायास एव च |
एवंविधानि रूपाणि करोति कुपितोऽनिलः ||२३||
हेतुस्थानविशेषाच्च भवेद्रोगविशेषकृत् |२४|
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, benumbing or paralysis of muscles 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]
Clinical features of vitiation of vata at different sites
Koshthashrita vata (vitiation at gastrointestinal tract)
तत्र कोष्ठाश्रिते दुष्टे निग्रहो मूत्रवर्चसोः ||२४||
ब्रध्नहृद्रोगगुल्मार्शःपार्श्वशूलं च मारुते |
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]
Sarvanga kupita vata (vitiation all over body)
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]
Guda sthita vata (vitiation at anus)
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]
Amashaya sthita vata (vitiation at stomach)
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]
Pakwashaya sthita vata (vitiation at colon)
When vitiated vata is located in colon it causes gurgling, colicky pain, tympanites, difficulty in defecation and urination, flatulence and lumbar/ sacroiliac pain. [28]
Indriya gata vata (vitiation in sense organs)
श्रोत्रादिष्विन्द्रियवधं कुर्याद्दुष्टसमीरणः ||२९||
When vitiated vata is located in ear like sense organs leads to sensorial loss in the respective organs. [29]
Twaksthita vata (vitiation at skin)
त्वग्रूक्षा स्फुटिता सुप्ता कृशा कृष्णा च तुद्यते |
आतन्यते सरागा च पर्वरुक् त्वक्स्थितेऽनिले ||३०||
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]
Raktagata vata(vitiation at blood)
रुजस्तीव्राः ससन्तापा वैवर्ण्यं कृशताऽरुचिः |
गात्रे चारूंषि भुक्तस्य स्तम्भश्चासृग्गतेऽनिले ||३१||
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]
Mamsa medogata vata (vitiation in muscles and fats)
गुर्वङ्गं तुद्यतेऽत्यर्थं दण्डमुष्टिहतं तथा |
सरुक् श्रमितमत्यर्थं [२] मांसमेदोगतेऽनिले ||३२||
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]
Majja-asthigata vata (vitiation in bones and marrow)
भेदोऽस्थिपर्वणां सन्धिशूलं मांसबलक्षयः |
अस्वप्नः सन्तता रुक् च मज्जास्थिकुपितेऽनिले ||३३||
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]
Shukra gata vata (vitiation in semen)
क्षिप्रं मुञ्चति बध्नाति शुक्रं गर्भमथापि वा |
विकृतिं जनयेच्चापि शुक्रस्थः कुपितोऽनिलः ||३४||
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]
Snayugata vata (vitiation in tendons)
बाह्याभ्यन्तरमायामं खल्लिं कुब्जत्वमेव च |
सर्वाङ्गैकाङ्गरोगांश्च कुर्यात् स्नायुगतोऽनिलः ||३५||
When vitiated vata is located in neural tissue or tendons, it leads to ophisthotonus or emprosthotonus, radiculopathy, kyphosis, quadriplegia or hemiplegia. [35]
Siragata vata (vitiation in vascular tissue)
शरीरं मन्दरुक्शोफं शुष्यति स्पन्दते तथा |
सुप्तास्तन्व्यो महत्यो वा सिरा वाते सिरागते ||३६||
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]
Sandhigata vata (vitiation in joints)
वातपूर्णदृतिस्पर्शः शोथः सन्धिगतेऽनिले |
प्रसारणाकुञ्चनयोः प्रवृत्तिश्च [३] सवेदना ||३७||
(इत्युक्तं [४] स्थानभेदेन वायोर्लक्षणमेव च) |३८|
When vitiated vata is located in joints, it leads to palpatory feeling of air in joints(crepitus), swelling along with painful flexion and extension.[38]
Thus the symptomatology of vata according to various site are explained. [38]
Ardita (facial paralysis)
अतिवृद्धः शरीरार्धमेकं वायुः प्रपद्यते |
यदा तदोपशोष्यासृग्बाहुं पादं च जानु च ||३८||
तस्मिन् सङ्कोचयत्यर्धे मुखं जिह्मं करोति च |
वक्रीकरोति नासाभूललाटाक्षिहनूस्तथा ||३९||
ततो वक्रं व्रजत्यास्ये भोजनं वक्रनासिकम् [१] |
स्तब्धं नेत्रं कथयतः क्षवथुश्च निगृह्यते ||४०||
दीना जिह्मा समुत्क्षिप्ता कला [२] सज्जति चास्य वाक् |
दन्ताश्चलन्ति बाध्येते श्रवणौ भिद्यते स्वरः ||४१||
पादहस्ताक्षिजङ्घोरुशङ्खश्रवणगण्डरुक् [३] |
अर्धे तस्मिन्मुखार्धे वा केवले स्यात्तदर्दितम् ||४२||
If the excessively increased vata affects one half of the body, as it diminishes the blood there, leads to contracture of arm, leg and knee of the affected half, and causes distortion of one side of the face and produces asymmetry of the nose, eye brow, fore head, eye and jaw.
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]
Antarayama (Emprosthotonous)
मन्ये संश्रित्य वातोऽन्तर्यदा नाडीः प्रपद्यते |
मन्यास्तम्भं तदा कुर्यादन्तरायामसञ्ज्ञितम् ||४३||
अन्तरायम्यते ग्रीवा मन्या च स्तभ्यते भृशम् |
दन्तानां दंशनं लाला पृष्ठायामः [१] शिरोग्रहः ||४४||
जृम्भा वदनसङ्गश्चाप्यन्तरायामलक्षणम् |
(इत्युक्तस्त्वन्तरायामो [२] ... |४५|
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]
Bahirayama(ophisthotonous)
...बहिरायाम उच्यते) ||४५||
पृष्ठमन्याश्रिता बाह्याः शोषयित्वा सिरा बली |
वायुः कुर्याद्धनुस्तम्भं बहिरायामसञ्ज्ञकम् ||४६||
चापवन्नाम्यमानस्य पृष्ठतो नीयते शिरः |
उर उत्क्षिप्यते मन्या स्तब्धा ग्रीवाऽवमृद्यते ||४७||
दन्तानां दशनं जृम्भा लालास्रावश्च वाग्ग्रहः |
जातवेगो निहन्त्येष वैकल्यं वा प्रयच्छति ||४८||
Bahirayama, will now be described. The potently provoked vata, on getting localized in the posterior and lateral of the neck and constricting external vessels, causes bow leg like rigidity of the body which is called as bahirayama (ophisthotonous).
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]
Hanugraha (lock jaw)
हनुमूले स्थितो बन्धात् संस्रयत्यनिलो हनू |
विवृतास्यत्वमथवा कुर्यात् [१] स्तब्धमवेदनम् ||४९||
हनुग्रहं च संस्तभ्य हनुं(नू)संवृतवक्रताम् |५०|
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)
Aakshepaka (episodic contractions)
मुहुराक्षिपति क्रुद्धो गात्राण्याक्षेपकोऽनिलः ||५०||
पाणिपादं च संशोष्य सिराः सस्नायुकण्डराः |५१|
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]
Dandaka (stiffness of body)
पाणिपादशिरःपृष्ठश्रोणीः स्तभ्नाति मारुतः ||५१||
दण्डवत्स्तब्धगात्रस्य दण्डकः सोऽनुपक्रमः |५२|
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]
Episodic nature of vata disorders
स्वस्थः स्यादर्दितादीनां मुहुर्वेगे [१] गतेऽगते ||५२||
पीड्यते पीडनैस्तैस्तैर्भिषगेतान् विवर्जयेत् |५३|
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]
Pakshaghata (paralysis)
हत्वैकं मारुतः पक्षं दक्षिणं वाममेव वा ||५३||
कुर्याच्चेष्टानिवृत्तिं हि रुजं वाक्स्तमभमेव [१] च |
गृहीत्वाऽर्धं शरीरस्य सिराः स्नायूर्विशोष्य च ||५४||
पादं सङ्कोचयत्येकं हस्तं वा तोदशूलकृत् |
एकाङ्गरोगं तं विद्यात् सर्वाङ्गं [२] सर्वदेहजम् ||५५||
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]
Gridhrasi (sciatica) and khalli (radiculopathy)
स्फिक्पूर्वा कटिपृष्ठोरुजानुजङ्घापदं क्रमात् |
गृध्रसी स्तम्भरुक्तोदैर्गृह्णाति स्पन्दते मुहुः ||५६||
वाताद्वातकफात्तन्द्रागौरवारोचकान्विता |
खल्ली तु पादजङ्घोरुकरमूलावमोटनी ||५७||
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]
Other local disorders
स्थानानामनुरूपैश्च लिङ्गैः शेषान् विनिर्दिशेत् |५८|
The rest of the disorders should be diagnosed according to the symptoms characteristic of the seat of affection. [58]
Pathological factors
सर्वेष्वेतेषु संसर्गं पित्ताद्यैरुपलक्षयेत् ||५८||
वायोर्धातुक्षयात् कोपो मार्गस्यावरणेन च (वा) |
वातपित्तकफा देहे सर्वस्रोतोऽनुसारिणः ||५९||
वायुरेव हि सूक्ष्मत्वाद्द्वयोस्तत्राप्युदीरणः [१] |
कुपितस्तौ समुद्धूय तत्र तत्र क्षिपन् गदान् ||६०||
करोत्यावृतमार्गत्वाद्रसादींश्चोपशोषयेत् |६१|
In all these disorders, the association of other dosha like pitta etc. is to be considered.
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 dosha 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]
Avrita vata (conditions due to obstructed vata)
लिङ्गं पित्तावृते दाहस्तृष्णा शूलं भ्रमस्तमः [१] ||६१||
कट्वम्ललवणोष्णैश्च विदाहः शीतकामिता |
शैत्यगौरवशूलानि कट्वाद्युपशयोऽधिकम् ||६२||
लङ्घनायासरूक्षोष्णकामिता च कफावृते |
रक्तावृते सदाहार्तिस्त्वङ्मांसान्तरजो भृशम् ||६३||
भवेत् सरागः श्वयथुर्जायन्ते मण्डलानि च |
कठिनाश्च विवर्णाश्च पिडकाः श्वयथुस्तथा ||६४||
हर्षः पिपीलिकानां च सञ्चार इव मांसगे |
चलः स्निग्धो मृदुः शीतः शोफोऽङ्गेष्वरुचिस्तथा ||६५||
आढ्यवात इति ज्ञेयः स कृच्छ्रो मेदसाऽऽवृतः |
स्पर्शमस्थ्नाऽऽवृते तूष्णं पीडनं चाभिनन्दति ||६६||
सम्भज्यते सीदति च सूचीभिरिव तुद्यते |
मज्जावृते विनामः [२] स्याज्जृम्भणं परिवेष्टनम् ||६७||
शूलं तु पीड्यमाने च पाणिभ्यां लभते सुखम् |
शुक्रावेगोऽतिवेगो वा निष्फलत्वं च शुक्रगे ||६८||
भुक्ते कुक्षौ च रुग्जीर्णे शाम्यत्यन्नावृतेऽनिले |
मूत्राप्रवृत्तिराध्मानं बस्तौ मूत्रावृतेऽनिले ||६९||
वर्चसोऽतिविबन्धोऽधः स्वे स्थाने परिकृन्तति |
व्रजत्याशु जरां स्नेहो भुक्ते चानह्यते नरः ||७०||
चिरात् पीडितमन्नेन दुःखं शुष्कं शकृत् सृजेत् |
श्रोणीवङ्क्षणपृष्ठेषु रुग्विलोमश्च मारुतः ||७१||
अस्वस्थं हृदयं चैव वर्चसा त्वावृतेऽनिले |७२|
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]
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]
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]
Vata occluded by mamsa dhatu
In the flesh, it causes hard, discolored boils, and swellings, horripilation and tingling.[64]
Vata occluded by meda dhatu
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]
Vata occluded by asthi dhatu
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]
Vata occluded by majja dhatu
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]
Vata occluded by shukra dhatu
If the vata is occluded in semen, it results in ejaculation or premature ejaculation or sterility.[68]
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]
Vata occluded by urine
If the vata is occluded by urine leads to urinary retention and distension of bladder.[69]
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]
Prognosis
सन्धिच्युतिर्हनुस्तम्भः [१] कुञ्चनं कुब्जताऽर्दितः ||७२||
पक्षाघातोऽङ्गसंशोषः [२] पङ्गुत्वं खुडवातता |
स्तम्भनं चाढ्यवातश्च रोगा मज्जास्थिगाश्च ये ||७३||
एते स्थानस्य गाम्भीर्याद्यत्नात् सिध्यन्ति वा न वा |
नवान् बलवतस्त्वेतान् साधयेन्निरुपद्रवान् ||७४||
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]
General management of vata disorders
Importance of snehana (oleation therapy) and swedana(sudation therapy)
क्रियामतः परं सिद्धां वातरोगापहां शृणु |
केवलं निरुपस्तम्भमादौ स्नेहैरुपाचरेत् ||७५||
वायुं सर्पिर्वसातैलमज्जपानैर्नरं ततः |
स्नेहक्लान्तं समाश्वास्य पयोभिः स्नेहयेत् पुनः ||७६||
यूषैर्ग्राम्याम्बुजानूपरसैर्वा स्नेहसंयुतैः |
पायसैः कृशरैः साम्ललवणैरनुवासनैः ||७७||
नावनैस्तर्पणैश्चान्नैः [१] सुस्निग्धं स्वेदयेत्ततः |
स्वभ्यक्तं स्नेहसंयुक्तैर्नाडीप्रस्तरसङ्करैः ||७८||
तथाऽन्यैर्विविधैः स्वेदैर्यथायोगमुपाचरेत् |
स्नेहाक्तं [२] स्विन्नमङ्गं तु वक्रं स्तब्धमथापि वा ||७९||
शनैर्नामयितुं शक्यं यथेष्टं शुष्कदारुवत् |
हर्षतोदरुगायामशोथस्तम्भग्रहादयः ||८०||
स्विन्नस्याशु प्रशाम्यन्ति मार्दवं चोपजायते |
स्नेहश्च धातून्संशुष्कान् पुष्णात्याशु प्रयोजितः ||८१||
बलमग्निबलं पुष्टिं प्राणांश्चाप्यभिवर्धयेत् |
असकृत्तं पुनः स्नेहैः स्वेदैश्चाप्युपपादयेत् ||८२||
तथा स्नेहमृदौ कोष्ठे न तिष्ठन्त्यनिलामयाः |८३|
Now listen to the effective line of treatment for the cure of diseases due to vata. If there is absolute vitiation of vata without any kind of association(obstruction), it should be treated at first with oleation therapy, such as internal administration of ghee, fat, oil and marrow. Then as the person, when saturated by the oleation, should be eased by consolation and should again be oleated with unctuous articles added milk; thin gruel of cereals and pulses or meat juice of domestic, wet-land and aquatic animals, milk or meat without bones mixed with sour and salt articles; followed with unctuous enema, nasal medications and nutritive food. [75-77]
When he is well oleated, he should be subjected to sudation therapy, for which oil is applied externally, and then fomentation is done through tubular, mattress or bolus method or different other types suitable to the situation. [78]
By application of oleation and sudation, even a deformed stiffened limb can be slowly brought back to normality, just as it possible to bend as desired even a dried piece of wood by such measures. [79]
Tingling numbness, pricking pain, aches, convulsions, swelling, stiffness and spasticity and similar other conditions can be quickly cured and the softness of the part restored by means of sudation. [80]
The oleation therapy when applied quickly replenishes the diminished body elements and increases the strength, power of the digestive mechanism, robustness and the vitality. [81]
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]
Mridu samshodhana (Mild purgation)
यद्यनेन सदोषत्वात् कर्मणा न प्रशाम्यति ||८३||
मृदुभिः स्नेहसंयुक्तैरौषधैस्तं विशोधयेत् |
घृतं तिल्वकसिद्धं वा सातलासिद्धमेव वा ||८४||
पयसैरण्डतैलं वा पिबेद्दोषहरं शिवम् |
स्निग्धाम्ललवणोष्णाद्यैराहारैर्हि मलश्चितः ||८५||
स्रोतो बद्ध्वाऽनिलं रुन्ध्यात्तस्मात्तमनुलोमयेत् [१] |
दुर्बलो योऽविरेच्यः स्यात्तं निरूहैरुपाचरेत् ||८६||
पाचनैर्दीपनीयैर्वा भोजनैस्तद्युतैर्नरम् |
संशुद्धस्योत्थिते चाग्नौ स्नेहस्वेदौ पुनर्हितौ ||८७||
स्वाद्वम्ललवणस्निग्धैराहारैः सततं पुनः |
नावनैर्धूमपानैश्च सर्वानेवोपपादयेत् ||८८||
इति सामान्यतः प्रोक्तं वातरोगचिकित्सितम् |८९|
If due to residual morbidity, the symptoms did not subside with the above procedures, then the patient should be cleansed by means of mild drugs mixed with unctuous articles. [83]
For this purpose the patient may take the medicated ghee prepared with tilvaka or satala, or castor oil with milk; all of these are auspicious and expel the morbid humors. [84]
By excessive use of unctuous, sour, salty and hot articles of diet, the excretory matter gets accumulated and occluding the alimentary passage, obstructs the vata, hence anulomana of vata should be done. [85]
Debilitated patients, in whom purgation is contraindicated, should be given evacuative enema followed by a diet consisting of, or mixed with, the drugs of the digestive and appetizer groups. [86]
Sudation and oleation procedures, repeated again, are beneficial for those whose digestive mechanism has been stimulated as a result of the purificatory procedure. [87]
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]
Specific treatment of various conditions
विशेषतस्तु कोष्ठस्थे वाते क्षारं [१] पिबेन्नरः ||८९||
पाचनैर्दीपनैर्युक्तैरम्लैर्वा [२] पाचयेन्मलान् |
गुदपक्वाशयस्थे तु कर्मोदावर्तनुद्धितम् ||९०||
आमाशयस्थे शुद्धस्य यथादोषहरीः क्रियाः |
सर्वाङ्गकुपितेऽभ्यङ्गो बस्तयः सानुवासनाः ||९१||
स्वेदाभ्यङ्गावगाहाश्च हृद्यं चान्नं त्वगाश्रिते |
शीताः प्रदेहा रक्तस्थे विरेको रक्तमोक्षणम् ||९२||
विरेको मांसमेदःस्थे निरूहाः शमनानि च |
बाह्याभ्यन्तरतः स्नेहैरस्थिमज्जगतं जयेत् ||९३||
हर्षोऽन्नपानं शुक्रस्थे बलशुक्रकरं हितम् |
विबद्धमार्गं दृष्ट्वा वा शुक्रं दद्याद्विरेचनम् ||९४||
विरिक्तप्रतिभुक्तस्य पूर्वोक्तां कारयेत् क्रियाम् |
गर्भे शुष्के तु वातेन बालानां चापि शुष्यताम् ||९५||
सिताकाश्मर्यमधुकैर्हितमुत्थापने पयः |
हृदि प्रकुपिते सिद्धमंशुमत्या पयो हितम् ||९६||
मत्स्यान्नाभिप्रदेशस्थे सिद्धान् बिल्वशलाटुभिः |
वायुना वेष्ट्यमाने तु गात्रे स्यादुपनाहनम् ||९७||
तैलं सङ्कुचितेऽभ्यङ्गो माषसैन्धवसाधितम् |
बाहुशीर्षगते नस्यं पानं चौत्तरभक्तिकम् ||९८||
बस्तिकर्म त्वधो नाभेः शस्यते चावपीडकः |९९|
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]
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]
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.
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]
Treatment of vata located in skin
When the skin is affected, sudation, oil application, hot immersion bath and cordial food should be given.
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]
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.
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]
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]
When vata causes intrauterine growth retardation or new born is emaciated, then milk prepared with sugar, kashmarya and madhuka is beneficial for restoration.[95]
Treatment of vata located in cardiac region
If the provoked vata is located in the cardiac region, the milk prepared of aṁśumati is beneficial.
Treatment of vata located in umbilicus
If it is located in the umbilicus, fish processed with unripe bilva fruits should be given.[97]
Treatment of vata located in parts of body
If there are cramps in any part of the body, poultice should be applied.
In contractures of body parts, external massage with the medicated oil prepared with black gram and rock salt should be prescribed.
If there is vata provocation in the shoulders nasal medication and ghee should be administered after food.
When the morbid vata is localized below the umbilical region, enema and avapidhaka sneha are recommended.[98]
Treatment of vata disorders affecting tendon, ligaments and vessels
अर्दिते नावनं मूर्ध्नि तैलं तर्पणमेव च ||९९||
नाडीस्वेदोपनाहाश्चाप्यानूपपिशितैर्हिताः |
स्वेदनं स्नेहसंयुक्तं पक्षाघाते विरेचनम् ||१००||
अन्तराकण्डरागुल्फं सिरा बस्त्यग्निकर्म च |
गृध्रसीषु प्रयुञ्जीत खल्ल्यां तूष्णोपनाहनम् ||१०१||
पायसैः कृशरैर्मांसैः शस्तं तैलघृतान्वितैः |
व्यात्तानने हनुं स्विन्नामङ्गुष्ठाभ्यां प्रपीड्य च ||१०२||
प्रदेशिनीभ्यां चोन्नाभ्य चिबुकोन्नामनं हितम् |
स्रस्तं स्वं गमयेत्स्थानं स्तब्धं स्विन्नं विनामयेत् ||१०३||
In facial paralysis, nasal medication, overhead application of oil, tarpaṇa, tubular fomentation and poultices prepared of the flesh of aquatic animals are beneficial.[99]
In hemiplegia, sudation with unctuous preparations and purgation are beneficial.
In sciatica, venesection of the vein situated between medially situated tendon (kandhara) and gulpha, enema and cauterization should be resorted.[100]
In khalli, hot poultices prepared with milk pudding or krishara or flesh mixed with oil and ghee are beneficial.[101]
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]
Specific treatment as per site and dushya
प्रत्येकं स्थानदूष्यादिक्रियावैशेष्यमाचरेत् [१] |१०४|
Specific line of treatment should be adopted in specific condition depending on site of affliction and the vitiated tissue involved.[104]
Brimhana (nourishment) treatment
सर्पिस्तैलवसामज्जसेकाभ्यञ्जनबस्तयः [१] ||१०४||
स्निग्धाः स्वेदा निवातं च स्थानं प्रावरणानि च |
रसाः पयांसि भोज्यानि स्वाद्वम्ललवणानि च ||१०५||
बृंहणं यच्च तत् सर्वं प्रशस्तं वातरोगिणाम् |१०६|
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]
Various formulations
बलायाः पञ्चमूलस्य दशमूलस्य वा रसे ||१०६||
अजशीर्षाम्बुजानूपमांसादपिशितैः पृथक् |
साधयित्वा रसान् स्निग्धान्दध्यम्लव्योषसंस्कृतान् ||१०७||
भोजयेद्वातरोगार्तं तैर्व्यक्तलवणैर्नरम् |
एतैरेवोपनाहांश्च पिशितैः सम्प्रकल्पयेत् ||१०८||
The patient afflicted with vata disorders should be given meat soup of the flesh of the head of the goat, or of the aquatic, wet land or carnivorous animals prepared separately in the decoction of sida species, panchamoola and dashamoola seasoned with unctuous articles, sour curds and trikatu which is salted liberally.[106-107]
Poultices should be prepared from the same flesh as mixed with ghee, oil and sour articles, with the boneless flesh well crushed and steamed. [108]
घृततैलयुतैः साम्लैः क्षुण्णस्विन्नैरनस्थिभिः |
पत्रोत्क्वाथपयस्तैलद्रोण्यः स्युरवगाहने ||१०९||
स्वभ्यक्तानां प्रशस्यन्ते सेकाश्चानिलरोगिणाम् |
आनूपौदकमांसानि दशमूलं शतावरीम् ||११०||
कुलत्थान् बदरान्माषांस्तिलान्रास्नां यवान् बलाम् |
वसादध्यारनालाम्लैः सह कुम्भ्यां विपाचयेत् ||१११||
नाडीस्वेदं प्रयुञ्जीत पिष्टैश्चाप्युपनाहनम् |
तैश्च सिद्धं घृतं तैलमभ्यङ्गं पानमेव च ||११२||
मुस्तं किण्वं तिलाः कुष्ठं सुराह्वं लवणं नतम् |
दधिक्षीरचतुःस्नेहैः सिद्धं स्यादुपनाहनम् ||११३||
उत्कारिकावेसवारक्षीरमाषतिलौदनैः |
एरण्डबीजगोधूमयवकोलस्थिरादिभिः ||११४||
सस्नेहैः सरुजं गात्रमालिप्य बहलं भिषक् |
एरण्डपत्रैर्बध्नीयाद्रात्रौ कल्यं विमोक्षयेत् ||११५||
क्षीराम्बुना ततः सिक्तं पुनश्चैवोपनाहितम् |
मुञ्चेद्रात्रौ दिवाबद्धं चर्मभिश्च सलोमभिः ||११६||
फलानां तैलयोनीनामम्लपिष्टान् सुशीतलान् |
प्रदेहानुपनाहांश्च गन्धैर्वातहरैरपि ||११७||
पायसैः कृशरैश्चैव कारयेत् स्नेहसंयुतैः |११८|
रूक्षशुद्धानिलार्तानामतः स्नेहान् प्रचक्ष्महे||११८||
विविधान् विविधव्याधिप्रशमायामृतोपमान्|
For immersion bath, vessel should be filled with the decoction of the leaves curative of vata or with medicated milk or oil.
Affusion is recommended after a good oil massage to the patient suffering from vata disorder. [109]
Cook in a pot the flesh of wetland and aquatic creatures, dashamoola, asparagus, horse-gram, jujube, black gram, sesame, rasna, barley and sida along with fat, curds, acetic acid and sour articles and administer this in the form of kettle sudation. This in the form of paste may also be used as poultice. And medicated ghee and oil prepared with this may be used for external massage as well as internal administration. [110-112]
The preparations made of musta, yeast, sesame, kushtha, devadaru, rock salt and nata, along with curds milk and the four varieties of unctuous articles should be used as poultice. [113]
The physician should give on the painful part, a thick application prepared of pancakes, vesavara preparation, milk, black gram, sesame, boiled rice, castor seeds, wheat, barley, badara, and sthira etc mixed with unctuous articles. This application should be at night and bandaged with caster leaves, and the bandage should be removed the next morning. Then the part should be poured with milk added with water and again poultice. The bandage which is applied during the day must be of leather with fur, and it should be removed at night. [114-116]
Thick applications can be made of oleiferous fruits well pasted with sour articles and be applied after it gets cool. And poultices can be made of the fragrant group of drugs curative of vata, milk pudding or krishara mixed with unctuous articles be used. [117]
We shall describe the various unctuous preparations which are comparable to nectar and are curative of disorders in those who are afflicted with dryness after purification and vata provocation. [118]
द्रोणेऽम्भसः पचेद्भागान् दशमूलाच्चतुष्पलान्||११९||
यवकोलकुलत्थानां भागैः प्रस्थोन्मितैः सह|
पादशेषे रसे पिष्टैर्जीवनीयैः सशर्करैः||१२०||
तथा खर्जूरकाश्मर्यद्राक्षाबदरफल्गुभिः|
सक्षीरैः सर्पिषः प्रस्थः सिद्धः केवलवातनुत्||१२१||
निरत्ययः प्रयोक्तव्यः पानाभ्यञ्जनबस्तिषु|
चित्रकं नागरं रास्नां पौष्करं पिप्पलीं शटीम्||१२२||
पिष्ट्वा विपाचयेत् सर्पिर्वातरोगहरं परम्|
बलाबिल्वशृते क्षीरे घृतमण्डं विपाचयेत्||१२३||
तस्य शुक्तिः प्रकुञ्चो वा नस्यं मूर्धगतेऽनिले|
ग्राम्यानूपौदकानां तु भित्वाऽस्थीनि पचेज्जले||१२४||
तं स्नेहं दशमूलस्य कषायेण पुनः पचेत्|
जीवकर्षभकास्फोताविदारीकपिकच्छुभिः||१२५||
वातघ्नैर्जीवनीयैश्च कल्कैर्द्विक्षीरभागिकम्|
तत्सिद्धं नावनाभ्यङ्गात्तथा पानानुवासनात्||१२६||
सिरापर्वास्थिकोष्ठस्थं प्रणुदत्याशु मारुतम्|
ये स्युः प्रक्षीणमज्जानः क्षीणशुक्रौजसश्च ये||१२७||
बलपुष्टिकरं तेषामेतत् स्यादमृतोपमम्|
तद्वत्सिद्धा वसा नक्रमत्स्यकूर्मचुलूकजा||१२८||
प्रत्यग्रा विधिनाऽनेन नस्यपानेषु शस्यते|
प्रस्थः स्यात्त्रिफलायास्तु कुलत्थकुडवद्वयम्||१२९||
कृष्णगन्धात्वगाढक्योः पृथक् पञ्चपलं भवेत्|
रास्नाचित्रकयोर्द्वे द्वे दशमूलं पलोन्मितम्||१३०||
जलद्रोणे पचेत् पादशेषे प्रस्थोन्मितं पृथक्|
सुरारनालदध्यम्लसौवीरकतुषोदकम्||१३१||
कोलदाडिमवृक्षाम्लरसं तैलं वसां घृतम्|
मज्जानं च पयश्चैव जीवनीयपलानि षट्||१३२||
कल्कं दत्त्वा महास्नेहं सम्यगेनं विपाचयेत्|
सिरामज्जास्थिगे वाते सर्वाङ्गैकाङ्गरोगिषु||१३३||
वेपनाक्षेपशूलेषु तदभ्यङ्गे प्रयोजयेत्|
निर्गुण्ड्या मूलपत्राभ्यां गृहीत्वा स्वरसं ततः||१३४||
तेन सिद्धं समं तैलं नाडीकुष्ठानिलार्तिषु|
हितं पामापचीनां च पानाभ्यञ्जनपूरणम्||१३५||
कार्पासास्थिकुलत्थानां रसे सिद्धं च वातनुत्|१३६|
Four pala (192 gm) of dashamoola should be decocted in one drone of water adding 64 tolas (768 gm) of barley, badara and horse gram. When it is reduced to one fourth quantity, prepare a medicated ghee in this decoction by taking 16 pala (768 gm) of ghee and adding milk, the paste of the jeevaniya drugs, sugar, dates, white teak, grape, badara and fig. This ghee is curative of disorders due to absolute vata. This preparation is harmless and should be used for internal administration, external massage and enema. [119-121]
Medicated ghee, prepared with the paste of chitraka, dry-ginger, rasna, pushkara, long pepper and shathi is excellent to cure vata-disorders. [122]
The supernatant part of ghee should be prepared with the milk boiled with sida and bilva. Two or four tolas (48 gm) of this should be used as nasal medication in condition of morbid vata affecting the head. [123]
The bones of the domestic, wet-land and aquatic animals should be broken into bits and cooked in water. The unctuous fluid obtained should again be cooked in the decoction of the dashamoola, adding the paste of rishabhaka, sphota, vidari and kapikachchu and of vata-curative drugs or jeevaniya group of drugs and double the quantity of milk. By the use of this preparation as nasal medication, massage, internal administration and unctuous enema, the morbid vata affecting the vessels, joints, bones and in kushtha gets quickly cured. For those suffering from loss of marrow as well as those who suffer from loss of semen and vital essence, this imparts strength and robustness and acts like nectar. [124-127]
The fresh fat of the alligator, fish, tortoise or the porpoise prepared similarly as described above is recommended as nasal medication and for internal administration. [128]
Take 64 tolas (768 gm) of the triphala, 32 tolas (384 gm) of horse gram, 20 tolas (240 gm) each of the bark of the krishnagandha and adhaki, 8 tolas (96 gm) each of rasna, chitraka and four tolas (48 gm) of each of the dashamoola and decoct them in 1 drone (12.288 l) of water, reduced to one fourth of its quantity. Than add 64 tolas (768 gm) each of sura, aranala, sour curds, sauveeraka, tushodakam, the decoction of small badara, pomegranate, tamarind, butter, oil, fat, ghee, marrow, milk and 24 tolas (288gm) of the paste of the jeevaniya group of drugs, and prepare the mahasneha preparation in the due manner. [129-132]
This should be used as inunction in morbid vata affecting the vessels. Marrow and bones as well as is conditions of tremors contractions and colic, and vata disorder affecting the entire body or only a part of the body. [133]
The expressed juice of the root and leaves of nirgundi should be cooked with an equal quantity of oil. This oil can be used for internal administration, external massage and ear-fill; it is beneficial in sinuses or fistula -in -ano, dermatosis and other vata disorders as well as in scabies and scrofula. The oil prepared with the decoction of cotton seeds and horse gram is also curative of vata. [134-135]
मूलकस्वरसे क्षीरसमे स्थाप्यं त्र्यहं दधि||१३६||
तस्याम्लस्य त्रिभिः प्रस्थैस्तैलप्रस्थं विपाचयेत् |
यष्ट्याह्वशर्करारास्नालवणार्द्रकनागरैः ||१३७||
सुपिष्टैः पलिकैः पानात्तदभ्यङ्गाच्च वातनुत् |१३८|
Curds should be kept for three days in a mixture of equal measures of the expressed juice of radish and milk. Prepare medicated oil by taking 64 tolas (768 gm) of oil and triple the quantity of this sour preparation adding the paste of 4 tolas (48 gm) each of liquorice, sugar, rasna, rock salt and green ginger. This oil can be used for internal administration and external application as curative of vata. [136-137]
पञ्चमूलकषायेण पिण्याकं बहुवार्षिकम् ||१३८||
पक्त्वा तस्य रसं पूत्वा तैलप्रस्थं विपाचयेत् |
पयसाऽष्टगुणेनैतत् सर्ववातविकारनुत् ||१३९||
संसृष्टे श्लेष्मणा चैतद्वाते शस्तं विशेषतः |
यवकोलकुलत्थानां श्रेयस्याः शुष्कमूलकात् ||१४०||
बिल्वाच्चाञ्जलिमेकैकं द्रवैरम्लैर्विपाचयेत् |
तेन तैलं कषायेण फलाम्लैः कटुभिस्तथा ||१४१||
पिष्टैः सिद्धं महावातैरार्तः शीते प्रयोजयेत् |१४२|
Cook very old oil-cake in the decoction of dashamūla; strain the solution and prepare a medicated oil in this solution by taking 64 tolas (768 gm) of oil and eight times the quantity of milk. This oil is curative of all disorders of vata. This is specially recommended in conditions of vata associated with kapha.[138-139]
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]
Sahachara taila and baladi taila
सर्ववातविकाराणां तैलान्यन्यान्यतः शृणु ||१४२||
चतुष्प्रयोगाण्यायुष्यबलवर्णकराणि च |
रजःशुक्रप्रदोषघ्नान्यपत्यजननानि च ||१४३||
निरत्ययानि सिद्धानि सर्वदोषहराणि च |
सहाचरतुलायाश्च रसे तैलाढकं पचेत् ||१४४||
मूलकल्काद्दशपलं पयो दत्त्वा चतुर्गुणम् |
सिद्धेऽस्मिञ्छर्कराचूर्णादष्टादशपलं भिषक् ||१४५||
विनीय दारुणेष्वेतद्वातव्याधिषु योजयेत् |
श्वदंष्ट्रास्वरसप्रस्थौ द्वौ समौ पयसा सह ||१४६||
षट्पलं शृङ्गवेरस्य गुडस्याष्टपलं तथा |
तैलप्रस्थं विपक्वं तैर्दद्यात् सर्वानिलार्तिषु ||१४७||
जीर्णे तैले च दुग्धेन पेयाकल्पः प्रशस्यते |
बलाशतं गुडूच्याश्च पादं रास्नाष्टभागिकम् ||१४८||
जलाढकशते पक्त्वा दशभागस्थिते रसे |
दधिमस्त्विक्षुनिर्यासशुक्तैस्तैलाढकं समैः ||१४९||
पचेत् साजपयोऽर्धांशैः कल्कैरेभिः पलोन्मितैः |
शटीसरलदार्वेलामञ्जिष्ठागुरुचन्दनैः ||१५०||
पद्मकातिविषामुस्तसूर्पपर्णीहरेणुभिः |
यष्ट्याह्वसुरसव्याघ्रनखर्षभकजीवकैः ||१५१||
पलाशरसकस्तूरीनलिकाजातिकोषकैः |
स्पृक्काकुङ्कुमशैलेयजातीकटुफलाम्बुभिः ||१५२||
त्वचाकुन्दुरुकर्पूरतुरुष्कश्रीनिवासकैः [१] |
लवङ्गनखकक्कोलकुष्ठमांसीप्रियङ्गुभिः ||१५३||
स्थौणेयतगरध्यामवचामदनपल्लवैः |
सनागकेशरैः सिद्धे क्षिपेच्चात्रावतारिते ||१५४||
पत्रकल्कं ततः पूतं विधिना तत् प्रयोजयेत् |
श्वासं कासं ज्वरं हिक्कां [२] छर्दिं गुल्मान् क्षतं क्षयम् ||१५५||
प्लीहशोषावपस्मारमलक्ष्मीं च प्रणाशयेत् |
बलातैलमिदं श्रेष्ठं वातव्याधिविनाशनम् ||१५६||
(अग्निवेशाय गुरुणा कृष्णात्रेयेण भाषितम्) |
इति बलातैलम् |
Listen now to the description of other preparations of oils for all types of diseases of vata that can be used in all the four therapeutic modes; that are promotive of longevity, strength and complexion; that are curative of menstrual and seminal disorders; which are inductive of progeny; and which are free from harmful effects and are generally curative of all kinds of morbidity. [142-143]
Prepare medicated oil in 400 tolas (4.8 l) of the decoction of sahachara, by using 256 tolas (3.072 liters) of oil and adding 40 tolas (480 gm) of the paste of radish and four times the quantity milk is added.The physician should use this oil mixed with 72 tolas (864 gm) of powdered sugar, in severe types of vata disorder. [144-145]
Prepare medicated oil by taking 64 tolas (768 ml) of oil along with 128 tolas (1.536 liters) of the expressed juice of shvadamshthra, equal quantity of milk, 24 tolas (288 gm) of dry ginger and 32 tolas (384 gm) of jaggery. This should be administered in all kinds of disorders of vata. After the dose of oil has been digested the regimen of thin gruel along with milk is recommended. [146-147]
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]
Amritadi tailam
अमृतायास्तुलाः पञ्च द्रोणेष्वष्टस्वपां पचेत् ||१५७||
पादशेषे समक्षीरं तैलस्य द्व्याढकं पचेत् |
एलामांसीनतोशीरसारिवाकुष्ठचन्दनैः ||१५८||
बलातामलकीमेदाशतपुष्पर्धिजीवकैः [१] |
काकोलीक्षीरकाकोलीश्रावण्यतिबलानखैः ||१५९||
महाश्रावणिजीवन्तीविदारीकपिकच्छुभिः |
शतावरीमहामेदाकर्कटाख्याहरेणुभिः ||१६०||
वचागोक्षुरकैरण्डरास्नाकालासहाचरैः |
वीराशल्लकिमुस्तत्वक्पत्रर्षभकबालकैः ||१६१||
सहैलाकुङ्कुमस्पृक्कात्रिदशाह्वैश्च कार्षिकैः |
मञ्जिष्ठायास्त्रिकर्षेण मधुकाष्टपलेन च ||१६२||
कल्कैस्तत् क्षीणवीर्याग्निबलसम्मूढचेतसः |
उन्मादारत्यपस्मारैरार्तांश्च प्रकृतिं नयेत् ||१६३||
वातव्याधिहरं श्रेष्ठं तैलाग्र्यममृताह्वयम् |
(कृष्णात्रेयेण [२] गुरुणा भाषितं वैद्यपूजितम्) ||१६४||
इत्यमृताद्यं तैलम् |
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]
Rasna taila
रास्नासहस्रनिर्यूहे तैलद्रोणं विपाचयेत् |
गन्धैर्हैमवतैः पिष्टैरेलाद्यैश्चानिलार्तिनुत् ||१६५||
कल्पोऽयमश्वगन्धायां प्रसारण्यां बलाद्वये |
क्वाथकल्कपयोभिर्वा बलादीनां पचेत् पृथक् ||१६६||
इति रास्नातैलम् |
The medicated oil is prepared by taking 1024 tolas (12.288 l) of oil and cooking it in 4000 tolas (48 l) of the decoction of rasna along with the paste of the fragrant groups of drugs grown in the Himalayas, as well as the cardamom group of drugs. This oil is curative of vata. A similar preparation of ashvagandha and prasarani and the two varieties of sida or the medicated oil of sida and other drugs may be prepared using these drugs individually in the form of decoction, paste or milk.
Thus, rasna taila has been explained. [165–166]
Mulakadya taila and vrishmuladi taila
मूलकस्वरसं क्षीरं तैलं दध्यम्लकाञ्जिकम् |
तुल्यं विपाचयेत् कल्कैर्बलाचित्रकसैन्धवैः ||१६७||
पिप्पल्यतिविषारास्नाचविकागुरुशिग्रुकैः |
भल्लातकवचाकुष्ठश्वदंष्ट्राविश्वभेषजैः ||१६८||
पुष्कराह्वशटीबिल्वशताह्वानतदारुभिः |
तत्सिद्धं पीतमत्युग्रान् हन्ति वातात्मकान् गदान् ||१६९||
इति मूलकाद्यं तैलम् |
वृषमूलगुडूच्योश्च द्विशतस्य शतस्य च |
चित्रकात् साश्वगन्धाच्च क्वाथे तैलाढकं पचेत् ||१७०||
सक्षीरं वायुना भग्ने दद्याज्जर्जरिते तथा |
प्राक्तैलावापसिद्धं च भवेदेतद्गुणोत्तरम् ||१७१||
इति वृषमूलादितैलम् |
Medicated oil is prepared by taking 64 tolas (768 gm) of oil and cooking it in equal quantities of radish juice, milk, sour curds, and sour kanji, the paste of sida, chitraka, rock salt, pippali, ativisha, rasna, chavika, agaru, shigru, bhallataka, vacha, kushtha, shvadamishtra, vishvabheshaja, pushkara, shati, bilwa, shatahva, nata, and devadaru. This mulakadya taila, when taken internally, cures even very severe types of vata disorders. [167-169]
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]
Mulaka taila
रास्नाशिरीषयष्ट्याह्वशुण्ठीसहचरामृताः ||१७२||
स्योनाकदारुशम्पाकहयगन्धात्रिकण्टकाः |
एषां दशपलान् भागान् कषायमुपकल्पयेत् ||१७३||
ततस्तेन कषायेण सर्वगन्धैश्च कार्षिकैः |
दध्यारनालमाषाम्बुमूलकेक्षुरसैः [१] शुभैः ||१७४||
पृथक् प्रस्थोन्मितैः सार्धं तैलप्रस्थं विपाचयेत् |
प्लीहमूत्रग्रहश्वासकासमारुतरोगनुत् [२] ||१७५||
एतन्मूलकतैलाख्यं [३] वर्णायुर्बलवर्धनम् |
इति मूलकतैलम् |
यवकोलकुलत्थानां मत्स्यानां शिग्रुबिल्वयोः |
रसेन मूलकानां च तैलं दधिपयोन्वितम् ||१७६||
साधयित्वा भिषग्दद्यात् सर्ववातामयापहम् |
लशुनस्वरसे सिद्धं तैलमेभिश्च वातनुत् ||१७७||
तैलान्येतान्यृतुस्नातामङ्गनां पाययेत च |
पीत्वाऽन्यतममेषां हि वन्ध्याऽपि जनयेत् सुतम् ||१७८||
यच्च शीतज्वरे तैलमगुर्वाद्यमुदाहृतम् |
अनेकशतशस्तच्च सिद्धं स्याद्वातरोगनुत् ||१७९||
वक्ष्यन्ते यानि तैलानि वातशोणितकेऽपि च |
तानि चानिलशान्त्यर्थं सिद्धिकामः प्रयोजयेत् ||१८०||
नास्ति तैलात् परं किञ्चिदौषधं मारुतापहम् |
व्यवाय्युष्णगुरुस्नेहात् संस्काराद्वलवत्तरम् ||१८१||
गणैर्वातहरैस्तस्माच्छतशोऽथं सहस्रशः |
सिद्धं क्षिप्रतरं हन्ति सूक्ष्ममार्गस्थितान् गदान् ||१८२||
Prepare a decoction by taking 40 tolas (48 gm) of each of rasna, shirisha, liquorice, dry ginger, sahachara, guduchi, syonaka, devadaru, shampaka, ashvagandha and gokshura. Then oil is prepared by taking 64 tolas (768 ml) of sesame oil and cooking it in the above said decoction along with 64 tolas (768 ml) each of curds, aranala, decoction of black gram, juices of good quality of radish, and sugar cane, adding one tola (12 gm) of the paste of each of the gandhavarga drugs. This mūlaka oil is curative of splenic disorders, retention of urine, dyspnoea, cough and other vata disorders. It is also promotive of complexion, life and vitality. Thus mūlaka taila is explained. [172-173]
Medicated oil is prepared by taking sesame oil and cooking it in the decoction of barley, kola, horse gram, fish, drumstick, bael, radish, curds and milk. This is curative of all vata disorders. The medicated oil prepared in the expressed juice of garlic and the drugs mentioned above, is curative of vata roga. These different oils may be given as potion to a woman who has just taken her purificatory bath on the cessation of menses. By taking any of this medicated oil as pana, even a sterile woman will become fertile.
The agurvadya oil, which has been described in the treatment of shita jwara, if processed again many hundred times, becomes curative of vata disorders. And the medicated oils, which will be described in the therapeutics of rheumatic conditions, may be prescribed for the alleviation of vāta disorders, by the physician desirous of success in treatment. [176-180]
There exists no medication superior to oil as a remedy for vata, due to its quality of extreme spreadability, hot in potency, heaviness, unctuousness and by virtue of becoming more powerful on being medicated with the vata curative group of drugs.
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]
Management of avrita vata conditions
क्रिया साधारणी सर्वा संसृष्टे चापि शस्यते |
वाते पित्तादिभिः स्रोतःस्वावृतेषु विशेषतः ||१८३||
पित्तावृते विशेषेण शीतामुष्णां तथा क्रियाम् |
व्यत्यासात् कारयेत् सर्पिर्जीवनीयं च शस्यते ||१८४||
धन्वमांसं यवाः शालिर्यापनाः क्षीरबस्तयः |
विरेकः क्षीरपानं च पञ्चमूलीबलाशृतम् ||१८५||
मधुयष्टिबलातैलघृतक्षीरैश्च सेचनम् |
पञ्चमूलकषायेण कुर्याद्वा शीतवारिणा ||१८६||
कफावृते यवान्नानि जाङ्गला मृगपक्षिणः |
स्वेदास्तीक्ष्णा निरूहाश्च वमनं सविरेचनम् ||१८७||
जीर्णं सर्पिस्तथा तैलं तिलसर्षपजं हितम् |
संसृष्टे कफपित्ताभ्यां पित्तमादौ विनिर्जयेत् ||१८८||
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]
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.
Diet which contains flesh of jaṇgala animals, barley and shali rice, yapana enema, milk enema, purgation, drinking of milk, decoction of panchamula and sida is also beneficial.[184-185]
The patient should be given dharā with medicated oil or ghee or milk prepared with liquorice and sida, or with the decoction of panchamūla or with cold water. [186]
In conditions of occlusion by kapha articles made of barley, the flesh of animals and birds of jangala area as diet is effective along with strong sudation, evacuative enema and emesis and purgation. Old ghee, sesame oil and mustard oil are also beneficial. [187-187 ½]
In the condition of occlusion by both kapha and pitta, pitta must be subdued first. [188]
Management of various condition of vata located in other sites
आमाशयगतं मत्वा कफं वमनमाचरेत् ||१८९||
पक्वाशये विरेकं तु पित्ते सर्वत्रगे तथा |
स्वेदैर्विष्यन्दितः श्लेष्मा यदा पक्वाशये स्थितः ||१९०||
पित्तं वा दर्शयेल्लिङ्गं बस्तिभिस्तौ विनिर्हरेत् |
श्लेष्मणाऽनुगतं वातमुष्णैर्गोमूत्रसंयुतैः ||१९१||
निरूहैः पित्तसंसृष्टं निर्हरेत् क्षीरसंयुतैः |
मधुरौषधसिद्धैश्च तैलैस्तमनुवासयेत् ||१९२||
शिरोगते तु सकफे धूमनस्यादि कारयेत् |
हृते पित्ते कफे यः स्यादुरःस्रोतोऽनुगोऽनिलः ||१९३||
सशेषः स्यात् क्रिया तत्र कार्या केवलवातिकी |
शोणितेनावृते कुर्याद्वातशोणितकीं क्रियाम् ||१९४||
प्रमेहवातमेदोघ्नीमामवाते [३] प्रयोजयेत् |
स्वेदाभ्यङ्गरसक्षीरस्नेहा मांसावृते हिताः ||१९५||
महास्नेहोऽस्थिमज्जस्थे पूर्ववद्रेतसाऽऽवृते |
अन्नावृते तदुल्लेखः [४] पाचनं दीपनं लघु ||१९६||
मूत्रलानि तु मूत्रेण स्वेदाः सोत्तरबस्तयः |
शकृता तैलमैरण्डं स्निग्धोदावर्तवत्क्रिया [५] ||१९७||
स्वस्थानस्थो बली दोषः प्राक् तं स्वैरौषधैर्जयेत् |
वमनैर्वा विरेकैर्वा बस्तिभिः शमनेन वा ||१९८||
(इत्युक्तमावृते वाते पित्तादिभिर्यथायथम् [६] ) |१९९|
On finding that kapha is located in the stomach (amashaya), emesis should be given and if it is located in the colon (pakvashaya), the treatment of choice is purgation. If pitta has pervaded all over the body, again the same (purgation) should be given. [189-189 ½]
As kapha or pitta gets liquefied by sudation, and gets accumulated in the colon and the symptoms of pitta manifest, both of these should be eliminated by the use of enema. [190-190 ½]
If vata is associated with kapha, it should be eliminated by warm evacuative enema mixed with cow’s urine. If vata is associated with pitta, it should be eliminated by evacuative enema mixed with milk. Then the patient should be given unctuous enema prepared with the madhura rasa group of drugs. [191-192]
In condition of vata located in the head and associated with kapha, inhalation and nasal medication should be given. [192 ½]
If after the elimination of pitta and kapha, there remains a residual morbidity of vata in the channels of the chest region, the treatment indicated in absolute vata should be given. [193- 193 ½]
If vata is occluded by blood, the line of treatment should be the same as indicated in vatashonita.[194]
In ama vata, treatment curative of prameha, vata and meda, should be given. [194 ½]
If vata is occluded by the flesh, than sudation, massage, meat juices, milk and unctuous medications are recommended. [195]
If vata is occluded by the osseous tissue or the marrow, mahasneha should be given. If occluded in the semen, the treatment has already been described. [195 ½]
If vata is occluded by food, then emesis, digestives, carminatives and light diet are recommended. [196]
If occluded by urine, diuretics, sudation and trans-urethral enema are recommended. If vata is occluded by fecal matter, the remedies are castor oil and unctuous therapy as indicated in udavarta. [197]
A morbid humor, while in its natural habitat, and when more powerful; it should be first subdued by its own suitable medications such as emesis, purgation, enema or sudation. [198]
Thus has been described the treatment of conditions of occlusion of vata by pitta, etc. [198 ½]
Mutual occlusions by types of vata and their management
मारुतानां हि पञ्चानामन्योन्यावरणे शृणु ||१९९||
लिङ्गं व्याससमासाभ्यामुच्यमानं मयाऽनघ! |
प्राणो वृणोत्युदानादीन् प्राणं वृण्वन्ति तेऽपि च ||२००||
उदानाद्यास्तथाऽन्योन्यं सर्व एव यथाक्रमम् |
विंशतिर्वरणान्येतान्युल्बणानां [१] परस्परम् ||२०१||
मारुतानां हि पञ्चानां तानि सम्यक् प्रतर्कयेत् |
सर्वेन्द्रियाणां शून्यत्वं ज्ञात्वा स्मृतिबलक्षयम् ||२०२||
व्याने प्राणावृते लिङ्गं कर्म तत्रोर्ध्वजत्रुकम् |
स्वेदोऽत्यर्थं लोमहर्षस्त्वग्दोषः सुप्तगात्रता ||२०३||
प्राणे व्यानावृते तत्र स्नेहयुक्तं विरेचनम् |
प्राणावृते समाने स्युर्जडगद्गदमूकताः ||२०४||
चतुष्प्रयोगाः शस्यन्ते स्नेहास्तत्र सयापनाः |
समानेनावृतेऽपाने [२] ग्रहणीपार्श्वहृद्गदाः ||२०५||
शूलं चामाशये तत्र दीपनं सर्पिरिष्यते |२०६|
Oh Sinless Dear! I shall next describe the mutual obstruction between the five types of vata in detailed and concised manner. [199-199 ½]
The prana vata occludes the udana and other types of vata while they too may occlude the prana. [200]
Udana and all other types of vāta may occlude one another in the same manner. There occur twenty conditions of occlusion caused by mutual obstruction of these five types of provoked vata. These should be properly debated. [201-201½]
On observing the loss of function of all the sense organs, and loss of memory and strength, it should be diagnosed as the condition of the occlusion of vyana by prana.
Here the therapeutic approaches above the supra-clavicular region of the body are to be done. [202-202½]
When prana gets occluded by vyana excessive perspiration, horripilation, skin diseases, and numbness of limbs is manifested. The treatment is purgation combined with unctuous articles. [203-203½]
In condition of occlusion of samana by prana, the speech will be scanty, slurred or even muteness can occur. All the four modes of unctuous therapy along with yapana enema are recommended as treatment. [204-204½]
In condition of occlusion of apana by samana, grahani, pain in parshva, heart diseases and colicky pain of the stomach manifest where treatment indicated is the ghee medicated with digestive stimulants. [205-205½]
शिरोग्रहः प्रतिश्यायो निःश्वासोच्छ्वाससङ्ग्रहः ||२०६||
हृद्रोगो मुखशोषश्चाप्युदाने प्राणसंवृते |
तत्रोर्ध्वभागिकं कर्म कार्यमाश्वासनं तथा ||२०७||
कर्मौजोबलवर्णानां नाशो मृत्युरथापि वा |
उदानेनावृते प्राणे तं शनैः शीतवारिणा ||२०८||
सिञ्चेदाश्वासयेच्चैनं सुखं चैवोपपादयेत् |
उर्ध्वगेनावृतेऽपाने छर्दिश्वासादयो गदाः ||२०९||
स्युर्वाते तत्र बस्त्यादि भोज्यं चैवानुलोमनम् |
मोहोऽल्पोऽग्निरतीसार ऊर्ध्वगेऽपानसंवृते ||२१०||
वाते स्याद्वमनं तत्र दीपनं ग्राहि चाशनम् |
वम्याध्मानमुदावर्तगुल्मार्तिपरिकर्तिकाः ||२११||
लिङ्गं व्यानावृतेऽपाने तं स्निग्धैरनुलोमयेत् |
अपानेनावृते व्याने भवेद्विण्मूत्ररेतसाम् ||२१२||
अतिप्रवृत्तिस्तत्रापि सर्वं सङ्ग्रहणं मतम् |
मूर्च्छा तन्द्रा प्रलापोऽङ्गसादोऽग्न्योजोबलक्षयः ||२१३||
समानेनावृते व्याने व्यायामो लघुभोजनम् |
स्तब्धताऽल्पाग्निताऽस्वेदश्चेष्टाहानिर्निमीलनम् ||२१४||
उदानेनावृते व्याने तत्र पथ्यं मितं लघु |
पञ्चान्योन्यावृतानेवं वातान् बुध्येत लक्षणैः ||२१५||
एषां स्वकर्मणां हानिर्वृद्धिर्वाऽऽवरणे मता |
यथास्थूलं समुद्दिष्टमेतदावरणेऽष्टकम् ||२१६||
सलिङ्गभेषजं सम्यग्बुधानां बुद्धिवृद्धये |२१७|
In conditions of occlusion of udana by prana, there is neck rigidity, coryza, impediment to inspiration and expiration, cardiac disorders and dryness of the mouth.
Here the treatment is as indicated in diseases of the parts above the supra-clavicular region and consolation. [206-207]
In condition of occlusion of prana by udana, there will be loss of function, vital essence, strength and complexion or it may even lead to death.
This condition should be treated by gradual pouring with cold water and comforting measures in such a way that the patient may be restored to health. [208-208½]
In condition of the occlusion of apana by udana, there will be vomiting, dyspnea, and similar other disorders. The treatment is enema and similar measures, and diet inducing vata anulomana. [209-209½]
In condition of the occlusion of udana by apana, there occur stupor, reduced digestive mechanism and diarrhea. The treatment measures are emesis and diet that is digestive, stimulant and grahi. [210-210½]
In condition of occlusion of apana by vyana, there occur the symptoms of vomiting, distension of abdomen, udavarta, gulma, colic and griping pain. This condition should be treated by anulomana by means of unctuous medications. [211-211½]
In condition of occlusion of vyana by apana, there occurs excessive discharge of feces, urine and semen. Here the treatment indicated is sangrahana therapy. [212-212½]
In condition of occlusion of vyana by samana, there occurs fainting, stupor, garrulousness, asthenia of the limbs, reduced digestive mechanism, vital essence and strength. Exercise and light diet are indicated as treatment for this condition. [213-213½]
In condition of occlusion of vyana by udana, there occurs rigidity, decreased gastro-intestinal enzymes activity, anhidrosis, and loss of movement and absence of winking. The treatment is wholesome, measured and light diet. [214-214½]
By the symptoms one should diagnose the condition of mutual occlusion of these five types of vata, and it has been laid down that there will occurs either the increase or decrease of its functions as the particular type of vata is affected. [215-215½]
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]
General guidelines for management
स्थानान्यवेक्ष्य वातानां वृद्धिं हानिं च कर्मणाम् ||२१७||
द्वादशावरणान्यन्यान्यभिलक्ष्य भिषग्जितम् |
कुर्यादभ्यञ्जनस्नेहपानबस्त्यादि [१] सर्वशः ||२१८||
क्रममुष्णमनुष्णं वा व्यत्यासादवचारयेत् |२१९|
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]
Specific principles of management
उदानं योजयेदूर्ध्वमपानं चानुलोमयेत् ||२१९||
समानं शमयेच्चैव त्रिधा व्यानं तु योजयेत् |
प्राणो रक्ष्यश्चतुर्भ्योऽपि स्थाने ह्यस्य स्थितिर्ध्रुवा ||२२०||
स्वं स्थानं गमयेदेवं वृतानेतान् विमार्गगान् |२२१|
The udana should be regulated upwards and the apana downwards. The samana should be alleviated and the vyana should be treated by all the three methods. Even more carefully than the other four types of vata, the prana should be maintained, because life depends on the proper maintenance of it in its habitat.
Thus the physician should regulate and establish types of vata in their normal habitats, which have been occluded and misdirected. [219-220½]
Types of vata occluded by dosha
मूर्च्छा दाहो भ्रमः शूलं विदाहः शीतकामिता ||२२१||
छर्दनं च विदग्धस्य प्राणे पित्तसमावृते |
ष्ठीवनं क्षवथूद्गारनिःश्वासोच्छ्वाससङ्ग्रहः ||२२२||
प्राणे कफावृते रूपाण्यरुचिश्छर्दिरेव च |
मूर्च्छाद्यानि च रूपाणि दाहो नाभ्युरसः क्लमः ||२२३||
ओजोभ्रंशश्च सादश्चाप्युदाने पित्तसंवृते |
आवृते श्लेष्मणोदाने वैवर्ण्यं वाक्स्वरग्रहः ||२२४||
दौर्बल्यं गुरुगात्रत्वमरुचिश्चोपजायते |
अतिस्वेदस्तृषा दाहो मूर्च्छा चारुचिरेव [१] च ||२२५||
पित्तावृते समाने स्यादुपघातस्तथोष्मणः |
अस्वेदो वह्निमान्द्यं च लोमहर्षस्तथैव च ||२२६||
कफावृते समाने स्याद्गात्राणां चातिशीतता |
व्याने पित्तावृते तु स्याद्दाहः सर्वाङ्गगः क्लमः ||२२७||
गात्रविक्षेपसङ्गश्च ससन्तापः सवेदनः |
गुरुता सर्वगात्राणां सर्वसन्ध्यस्थिजा रुजः ||२२८||
व्याने कफावृते लिङ्गं गतिसङ्गस्तथाऽधिकः [२] |
हारिद्रमूत्रवर्चस्त्वं तापश्च गुदमेढ्रयोः ||२२९||
लिङ्गं पित्तावृतेऽपाने रजसश्चातिवर्तनम् |
भिन्नामश्लेष्मसंसृष्टगुरुवर्चःप्रवर्तनम् ||२३०||
श्लेष्मणा संवृतेऽपाने कफमेहस्य चागमः |२३१|
In occlusion of prana by pitta fainting, giddiness, colic, burning sensation, craving for cold things and vomiting of acidic gastric material are seen as symptoms. [221-221½]
In occlusion of prana by kapha, there occur symptoms such as frequent spitting, sneezing, eructation, impediment to the inspiration and expiration, anorexia and vomiting. [222-222½]
In condition of occlusion of udana by pitta, there occur symptoms such as fainting etc and burning in the umbilical region and chest, exhaustion, loss of vital essence and asthenia. [223-223½]
In occlusion of udana by kapha, there occur discolorations, aphasia and dysarthria, debility, heaviness of the body and anorexia. [224-224½]
In condition of occlusion of samana by pitta, there occur hyperhidrosis, thirst, burning, fainting, anorexia, derangement of appetite and decreased gastro-intestinal enzyme activity. [225-225½]
In condition of occlusion of the samana by kapha, there occur anhidrosis, reduced gastro-intestinal enzyme activity, horripilation and excessive coldness of the limbs. [226-226½]
In condition of occlusion of vyana by pitta, there occur burning all over the body, exhaustion, chorea or poverty of movements accompanied with temperature and pain. [227-227½]
In condition of occlusion of vyana by kapha, there occur symptoms such as heaviness of the limbs, pain in all the bones and joints, and impaired gait. [228-228½]
In condition of occlusion of apana by pitta, there occur symptoms such as yellowish discoloration 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 apana 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
लक्षणानां तु मिश्रत्वं पित्तस्य च कफस्य च ||२३१||
उपलक्ष्य भिषग्विद्वान् मिश्रमावरणं वदेत् |
यद्यस्य वायोर्निर्दिष्टं स्थानं तत्रेतरौ स्थितौ ||२३२||
दोषौ बहुविधान् व्याधीन् दर्शयेतां यथानिजान् |
आवृतं श्लेष्मपित्ताभ्यां प्राणं चोदानमेव च ||२३३||
गरीयस्त्वेन पश्यन्ति भिषजः शास्त्रचक्षुषः |
विशेषाज्जीवितं प्राणे उदाने संश्रितं बलम् ||२३४||
स्यात्तयोः पीडनाद्धानिरायुषश्च बलस्य च |
सर्वेऽप्येतेऽपरिज्ञाताः परिसंवत्सरास्तथा ||२३५||
उपेक्षणादसाध्याः स्युरथवा दुरुपक्रमाः [१] |२३६|
On observing the mixed symptoms of pitta and kapha, the learned physician should diagnose it as a condition of combined occlusion. [231-231½]
If the two other dosha get located in the places described as the habitat of vata, they manifest various symptoms of disorders characteristic to each of them. [232-232½]
Medical authorities regard, as most serious, the condition of occlusion of prana or udana by kapha and pitta combined, because life is particularly dependent on prana, and strength on udana; 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]
Complications and management
हृद्रोगो विद्रधिः प्लीहा गुल्मोऽतीसार एव च ||२३६||
भवन्त्युपद्रवास्तेषामावृतानामुपेक्षणात् |
तस्मादावरणं वैद्यः पवनस्योपलक्षयेत् ||२३७||
पञ्चात्मकस्य वातेन पित्तेन श्लेष्मणाऽपि वा |
भिषग्जितमतः सम्यगुपलक्ष्य समाचरेत् ||२३८||
अनभिष्यन्दिभिः स्निग्धैः स्रोतसां शुद्धिकारकैः |
कफपित्ताविरुद्धं यद्यच्च वातानुलोमनम् ||२३९||
सर्वस्थानावृतेऽप्याशु तत् कार्यं मारुते हितम् |
यापना बस्तयः प्रायो मधुराः सानुवासनाः ||२४०||
प्रसमीक्ष्य बलाधिक्यं मृदु वा स्रंसनं हितम् |
रसायनानां सर्वेषामुपयोगः प्रशस्यते ||२४१||
शैलस्य जतुनोऽत्यर्थं पयसा गुग्गुलोस्तथा |
लेहं वा भार्गवप्रोक्तमभ्यसेत् क्षीरभुङ्नरः ||२४२||
अभयामलकीयोक्तमेकादशसिताशतम् [१] |
अपानेनावृते सर्वं दीपनं ग्राहि भेषजम् ||२४३||
वातानुलोमनं यच्च पक्वाशयविशोधनम् |
इति सङ्क्षेपतः प्रोक्तमावृतानां चिकित्सितम् ||२४४||
प्राणादीनां भिषक् कुर्याद्वितर्क्य स्वयमेव तत् |
पित्तावृते तु पित्तघ्नैर्मारुतस्याविरोधिभिः |
कफावृते कफघ्नैस्तु मारुतस्यानुलोमनैः ||२४५||
As a result of neglecting these conditions of occlusions, there occur complications such as cardiac disorders, abscesses, splenic disorders, gulma and diarrhea. [236-236½]
Therefore, the physician should diagnose the condition of occlusion of the five types of vata, by vata, pitta, or kapha. [237-237½]
After having well thought about the proper medications, the physician should treat the patient by measures which are non-abhishyandi, unctuous and depurative of body channels. [238-238½]
In condition of occlusion of vata in all its habitats, taking prompt measures which are vata anulomana and at the same time not antagonistic to kapha and pitta is beneficial. [239-239½]
The yapana enema as well as the sweet unctuous enema is generally beneficial, and if the patient found to be sufficiently strong mild laxatives may be used. [240-240½]
The use of all kinds of rasayana is highly recommended. A course of shilajatu and a course of guggulu with milk are especially beneficial. [241-241½]
The patient living on milk diet, may take a course of rasayana (told by Bhargava explained in Abhayamalaki Pada) containing 4400 tolas (52.8 kg) of sugar. (242-242½)
In condition of occlusion by apana, all measures that are deepana, grahi, vata anulomana and which cleanse pakvashaya constitute the treatment. [243-243½]
Thus has been described in brief the line of treatment in conditions of occlusion of prana and other types of vata; the physician should use his own discretion and give the proper treatment. [244-244½]
In a condition of occlusion of vata by pitta, the physician should administer medications curative of pitta and not antagonistic to vata.
In a condition of occlusion of vata by kapha, medications curative of kapha and vata anulomana should be given. [245]
Similarity in macrocosm and microcosm
लोके वाय्वर्कसोमानां दुर्विज्ञेया यथा गतिः |
तथा शरीरे वातस्य पित्तस्य च कफस्य च ||२४६||
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]
Four states of dosha
क्षयं वृद्धिं समत्वं च तथैवावरणं भिषक् |
विज्ञाय पवनादीनां न प्रमुह्यति कर्मसु ||२४७||
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]
Summary
तत्र श्लोकौ-
पञ्चात्मनः स्थानवशाच्छरीरे स्थानानि कर्माणि च देहधातोः |
प्रकोपहेतुः कुपितश्च रोगान् स्थानेषु चान्येषु वृतोऽवृतश्च ||२४८||
प्राणेश्वरः प्राणभृतां करोति क्रिया च तेषामखिला निरुक्ता |
तां देशसात्म्यर्तुबलान्यवेक्ष्य प्रयोजयेच्छास्त्रमतानुसारी ||२४९||
The vata being the subject of this chapter, the habitats and functions of the five-fold body sustaining element vata, have been dealt with here. The causes of provocation, the diseases which this life controlling principle of vata gives rise to in the persons, when provoked, both in its own habitat and in other places, both in conditions of occlusion and in no occlusion, and the treatment of all those disease have been fully expounded here. The physician guided by the directions of the science, should administer the treatment, giving full consideration to factors of place, similarity, season and strength. [248-249]
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने वातव्याधिचिकित्सितं नामाष्टाविंशोऽध्यायः ||२८||
Thus, in the section on ‘Therapeutics’, in the treatise compiled by Agnivesha and revised by Charak, the twenty-eighth chapter entitled Vatavyadhi Chikitsa not being available, the same as restored by Dridhabala, is completed.[28]
Tattva Vimarsha (Fundamental Principles)
- Vayu/vata is responsible for life, strength and functioning of living organisms.
- Normal (non vitiated) vayu/vata with unobstructed (free) movement and location at its natural site, is responsible for long healthy lifespan.
- Vayu/vata is of five types namely prana, udāna, samana, vyana and apana and they mechanize the body optimally occupying their sites without any irregular movement.
- The location of prana is vertex, thorax, trachea, tongue, mouth and nose and it performs functions of spitting, sneezing, eructation, respiration, deglutition etc.
- The site of udana is umbilicus, thorax and trachea and is responsible for vocalization, drive, energy, strength, complexion etc.
- Samana is located in channels of sweat, humors and water and lateral to the seat of agni (digestive enzymes (agni) and yield strength to the digestive fire.
- Vyana has swift movement and spreads all over the body and is responsible for gait, flexion, extension, twinkling etc.
- Apana is located in testicles, urinary bladder, penis, umbilicus, thighs, inguinal region and anus and performs ejaculation, micturition, defecation, expulsion of menstrual blood and fetus.
- When these five are located in respective sites optimally, they perform their functions and support life without any morbidity.
- Due to various vata provoking factors, vata is vitiated and it fills the empty channels and leads to various disorders at that particular site.
- The onset of vata disorders is generally sudden without any premonitory signs.
- The diagnosis of vata disorders is based upon the symptoms characteristic of the seat of affliction.
- In all vata disorders, the association of other dosha like pitta etc. is to be considered.
- 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 quality of subtleness is really the impeller of the other two dosha.
- When the vata is provoked, it propels the other two dosha 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.
- In case of avarana (occlusion of vata), the clinical presentation includes the increased signs of dosha which is occluding vata.
- In pure vitiation of vata, without any association or obstruction by other dosha, snehana and swedana therapy are first principles of treatment.
- Mild cleansing with unctuous drugs shall be given to remove the residual morbidity.
- By excessive use of unctuous, sour, salty and hot articles of diet, the excretory matter gets accumulated, occluding the alimentary passage, obstructs the vata, hence anulomana of vata should be done.
- Specific line of treatment should be adopted in specific condition depending on site of affliction and the vitiated tissue involved.
- 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 salty taste and whatever is nourishing are beneficial for disorders due to vata.
- Pitta and kapha dosha occlude vata dosha at their sites and result in disorders. The clinical features are dominated by the vitiated dosha. The functions of obstructed dosha are decreased in these conditions.
- The various types of vata dosha can mutually occlude each other’s pathways and result in disorders. There are increased signs of obstructing types of vata and decreased functions of obstructed type of vata dosha.
- The udana should be regulated with therapies leading to its upward movement. The apana should be regulated with therapies leading to its downwards movement. The samana should be alleviated and the vyana should be treated by all the three methods. Prana should be maintained even more carefully than the other four types of vata, because life depends on the proper maintenance of it in its habitat. Thus, the treatment is intended to regulate and establish types of vāta in their normal habitats, which have been occluded and misdirected.
- Life and vitality is particularly dependent on prana, and strength on udana; and occlusion of them, will result in loss of life and vitality.
- In a condition of occlusion of vata by pitta, the treatment is done with medications curative of pitta and not antagonistic to vata.
- In a condition of occlusion of vata by kapha, medications curative of kapha and vata anulomana should be given.
- 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. The first three are responsible for all functions in macrocosm, whereas the latter three are for functions in microcosm.
- There are four conditions viz. decrease, increase, normality and occlusion of vata and other dosha.
Vidhi Vimarsha (Applied Inferences )
Importance of vata dosha in overall health and disease
This text highlights the grandness of vata dosha. 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), sattva (mind) and atma (soul). [Cha. Sa. Sutra Sthana 1/42] 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]
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).
Nature of vata
Pitta and kapha are relatively compact and in corporeal form. On the contrary vata is incorporeal (avayavasamghatarahita). 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[3] which are incorporeal (amurta). Chalatva (mobility) and apratighata (unobstructability) are characteristics of vayu and akasha perceptible by the tactile sense organ. [Cha. Sa. Sharira Sthana 1/29-30] 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).[4]
Anavasthita (unstable) is due to chala property of vata. This continuous moving nature of vata is explained with other terminologies also like sheeghravata(swift movement)[Cha. Sa. Vimana Sthana 8/98], ashukari (instantaneous action), muhushchari (rhythmic movement).[5]. It abounds in the fundamental quality of raja (the principle of cohesion and action). The predominance of raja is responsible for the instability of vata. The quality of chalatva is directional in nature, which is explained by the term gati. Vata convenes all bodily activities by this important feature.
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).[Cha. Sa. Sutra Sthana 1/8]
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.
- that, the sharira vayu is a biophysical force and
- that it is closely associated with material substances which form part of the structure of the body for example, functions of nervous system. 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 samanya), qualities (guna samanya) and actions (karma samanya) and inhibited by substances with opposite properties. In other words, it may be concluded that the bio – physical force – the sharira vayu – is closely linked with some material structural factors. These can be influenced by diet and medicine on the basis of similar increase and opposite decrease.
Sodium, potassium, calcium, and chloride ions are continuously moving around (brownian movement) which is the result of their ionic state (swabhava / 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 vayu and as per modern science too their concentration depends on ahara 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
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 paramanu (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]
General etiological factors and basic pathogenesis of vata disorders
The etiological factors can be divided into two:
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 dhatu 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 dhatu leading to excessive filling in channels to cause their clogging and blocking vata. [verse 15-19]
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]
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.
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]
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[Cha. Sa. Sutra Sthana 12/3]
- Asamghata (Incorporeal)
- Anavasthita (Unstable)
- Anasadhya (Inaccessible)
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).
Prakupita(vitiated) dosha have the capacity to further vitiate both sthanastha dhatu (fixed tissue element) as well as margagata (circulating tissue elements) sharira dhatu. When prakupita vata vitiates the dhatu, it is called as gatavata. In this condition, vitiated vata affects the specific site due to specific etiological factors. While designing treatment protocol, in this context specific etiological factors for each and every gatavata related diseases must be observed to clarify why vitiated vata goes to specific part of the body or to specific dhatu to develop kosthagata vata, raktagata vata etc. In this condition, dhatu is dushya (getting vitiated).
Koshthagata vata:
Vata getting vitiated in the koshtha(alimentary tract) is explained as koshthagata vata.
Gudagata vata:
It can also be explained that gudagata vata and pakvashayagata vata are different clinical entities. In gudagata vata, obstruction of stool, urine and flatus is observed, whereas in pakvashayagata vata there is painful defecation, micturition with antrakujana (gurgling sound), atopa (distension) and anaha (constipation). Ashma sarkara (urolith) is exclusively present in gudagata vata with pain and atrophy in calf muscles, thighs, sacram, feet and back. This can be compared with lumbo-sacral plexopathy. It may be understood as in case of pakvashaya gatavata, proximal part of large intestine along with ascending, transverse and descending colon is involved; whereas in gudagata vata, involvement of sigmoid colon, rectum, anus and their nerve supply.
Amashayagata vata:
This is a typical presentation of vata leaving its own site and vitiating other site. Here the local dosha is considered important because it is more virulent than the external dosha coming from other sites. The clinical entities originating from amashaya (stomach) are caused due to vitiated vata entering into amashaya. It increases emptiness of stomach leading to indigestion or ama pradoshaja vikara like visuchika (diarrhea) etc.
Indriyagata vata:
Indriyagata vata is applicable to any sense organ. Indriya vadha may be interpreted as complete, partial or minimal loss of sensation. Shrotra(ears) has specific importance among other indriya, in which inherent dosha of shrotra is vata itself. So vata prakopa in shrotra is more impacting. It is worthy to remember the notion in vatakalakaleeya that vata is sarvendriyanam udyojaka (motivating factors for all sense organs).
Twakgata vata:
Tvak (skin) is referred as somatic organ even though it is a sensory organ. Supti (numbness) and toda (pricking sensation) are not symptoms specific to tvakindriya. Here tvak represents rasa dhatu. Rasa does not have cellular pattern and hence not included in shakha. The tvak is derivative of rasa and is included in shakha. Tvakindriya gatavata should be understood under indriyagatavata.
Siragata vata:
When vata afflicts sira (blood vessel) it may broaden or narrow the sirā. Widening may lead to shopha and narrowing may lead to shosha or vice versa as per the site of affliction. Two different conditions of vascular diseases i.e. aneurysym (mahat) and atherosclerosis / venous thrombosis (tanu) are examples.
Sandhigata vata (osteoarthritis):
There is depletion of periarticular and articular tissue by vitiated vata in sandhigata vata/osteoarthritis, empty spaces are occupied by vata which is felt as crepitus on palpation. Vata also causes hypertrophic tissue in the form of osteophytes and causes painful flexion and extension movements. This is the characteristic feature of swelling in sandhigata vata.
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]
Antarayama (emprosthotonous) and bahirayama(ophisthotonous):
These diseases are tetany like conditions in which the body is sharply bent forward and backward respectively. [verse 43-48]
Hanugraha:
It is a lockjaw like condition that may be persistent or intermittent or recurrent due to vitiation of vata affecting the mandibular joint. [verse 49]
Dandaka:
Dandaka is a condition in which the muscles are hypertonic but without convulsions. When it further manifests as tonic clonic convulsions it is referred as danda akshepaka. This condition is caused due to vitiation of vata simultaneously in muscle groups. [verse 51]
Episodic nature of various vata disorders
The disorders mentioned from ardita onwards are vegavana (episodic). All vegavana disorders have two phases, vega and vegantara. Vegantara is the symptom free period and is considered as right time for medication. [verse 52]
Pakshaghata:
Three diseases namely pakshaghata(hemiplegia), ekangaroga (monoplegia) and sarvangaroga (quadriplegia) are explained. In pakshaghata no painful symptoms are explained. Sira and snayu are considered as dushya in ekangaroga and sarvangaroga. Sira is the upadhatu of rakta and snayu is the upadhatu of meda, therefore meda and rakta have vital role in pathogenesis of these diseases. [verse 53-55]
Gridhrasi:
Gridhrasi is a snayugata (affecting tendon) roga. The word gridhrasi is derived from ghridhra, which means vulture, the typical gait of the disease is highlighted by the name. The patient’s gait is changed like a vulture due to affected tendons by vitiated vata.
Khalli is the term given to severe painful twisting conditions of tendons. [verse 56-57]
Nomenclature of diseases:
All the vata disorders cannot be named or explained. They should be understood on the basis of site of affliction as well as nomenclature. [verse 58]
Diagnosis of dhatukshaya (degenerative pathology) and avarana (obstructive pathology) induced vitiation of vata:
Vata can be vitiated due to dhatukshaya and margavarana types of pathogenesis. Dhatukshaya leads to depletion of tissues and more space for vata to move. This leads to gatavata phenomenon. Avarana of vata can be caused by other dosha or dhatu. So the differences between avarana and gatavata should be understood.
The word, avarana means obstruction or resistance or friction to the normal gati of vata. Hence when its normal movement is hampered or vitiated, it becomes avrita and leads to different disorders. The gatatva and avritatva are entirely different phenomenon. Here an attempt is being made to differentiate the both physio-pathologies. [16]
- In avarana, generally the vitiation of vata is passive. When vitiated dosha or any other thing obstructs the pathway of vata, avarana happens. Normal state of vata gets vitiated as avarana progresses. The substance which obstructs the pathway of vata is called as avaraka and the dosha (vata in general or its components) affected by avarana is called as avariya or avrita. Normally the avarana is caused by the etiological factors for the vitiation of avaraka. Etiological factors for the vitiation of vata (sva nidana) will be absent. In case of gatavata the vitiation of vata will be active. Here its own etiological factors are operating in the vitiation of vata in the pathogenesis and the vitiated vata adopts specific pathway and abnormally localizes at particular sites.
- In the process of avarana chala property of vata is diminished due to obstruction. Other properties are not involved in the process of obstruction. But in case of gatatva the vitiation of vata takes place by involvement of other properties like ruksha, laghu, khara, vishada etc along with chala.
- In avarana the gati of vata is obstructed partially or fully. Once gets obstructed the vata may simply get lodged there (baddha marga, margarodha), try to nullify the obstruction, may get covered by the obstructing substance (avrita), adopt an opposite direction (pratiloma) or alter the direction (viloma). The different terminologies have been used to denote avarana in different contexts according to the nature of avarana and the state of vata and marga (passage). In case of gatatva the gati of vitiated vata aggravated and starts moving abnormally leading to localization at particular sites.Avarana is caused by purnata (filling) of other dosha in the srotas/marga (passage) of vata. In gatatva the srotas or sites of occupation of vata are rikta (unfilled or spacious) and the aggravated vata fills the srotas/site.
- In avarana of vata, swakarma vriddhi (exaggerated activities) of avaraka (covering dosha) is manifested. The avrita (i.e. vata) will show swakarma hani (diminished activity). This is the general feature of avarana. Here the excessively increased strong avaraka suppresses the normal action of avrita (i.e.vata). Therefore, when the obstruction is complete it may lead to the prakopa of vata resulting in the presentation of vata vitiated symptoms as well as its disorders[ Cha. Sa. Chikitsa Sthana 28/215, Chakrapani]. In case of gatatva the symptomatology will be predominantly of vata vitiation and pain is a common and chief complaint in all the conditions of gatatva.
- Obstruction or covering of vata is possible by body components like dosha (pitta and kapha),tissues,food, excretory products or mutual affliction of vata types. Gatatva of vata (affection) is happening in empty spaces or hollow cavities of tissues, their elements, organs and other body parts. In avarana, the body component is in increased state causing fullness in respected channels, while in gatatva pathology, the body components are in depleted state casusing emptiness in the respected channels. Dhatugata vata will be presented with decreased quality of tissues associated with signs of vitiated vata. Obviously, exceptions are possible according to the complexities of process of avarana or gatatva.
- In case of avarana of vata, the avaraka is important for treatment since vitiation of vata is passive. When avarana is removed vitiated vata gets pacified. But in cases of gatatva, the vitiated vata has to be treated first along with correction of adhisthana.
- Diagnosis of avarana is made with the help of upashaya–anupashaya (pacifying and aggravating factors) method. Diagnosis of gatatva is made according to the rupa (symptomatology).
- Complications of avarana are explained in case of improper diagnosis and delayed treatment like hridroga, vidradhi, kamala etc. No known complication occur in gatatva.
- Avarana of vata may cause depletion of nutrition to dhatu (dhatugata sama) leading to successive diminition of rasadi dhatu(rasadimscha upasosayet).[Cha. sa. Sutra Sthana 28/61] No such reference is available in case of gatatva.
The discussed points are briefly enlisted in the table below:
| Avrita(obstructed) vata | Gata (excess movement) vata |
|---|---|
| Vitiation of vata is passive | Vitiation of vata is active |
| Normally svanidana(specific causes for vitiation) of vata are not responsible | Vitiation of vata by svanidana |
| Only chala property of vata is involved and it is diminished in the phenomenon | Other properties of vata are also involved and the chala property aggravated in the phenomenon |
| Gati of vata is obstructed | Gati of vata is aggravated |
| Purnata(fullness) in srotas/marga | Riktaka(emptiness) in srotas |
| Vata shows svakarma hani (decreased function) | Vata shows svakarma vriddhi (increased function) |
| Dhatu are in vriddhi (increase) or saama | Dhatu daurbalya (decrease) present |
| Avarana possible with other dosha/anna/mala/individual components of vata | Not possible |
| Avarana by avayava(body part) or ashaya(organ) not possible | Gatatva in ashaya and avayava explained |
| Avaraka gets importance in treatment | Vata gets importance in treatment |
| Diagnosis made with upashaya anupashaya (hit and trial) | Diagnosis with rupa |
| Complications of avarana possible | None |
| Successive diminution of rasadi dhatu possible | None |
As avarana proceeds it may end up in dhatukshaya as the avrita will block rasa dhatu which give nourishment. This is commonly observed. This is possible in many other disorders also. The best example is rajayakshma.
Prognosis:
Exclusive vata disorders are serious and have poor prognosis. The symptoms / diseases explained manifest when vitiated vata affects vital parts. The therapeutic approaches should be cautious and extra efforts are essential for a better recovery. As the disease becomes chronic the curability rate drastically declines. The physical strength of the patient is also very important in determining prognosis. [verse 72-74]
General principles of management:
The general line of management of vatavyadhi applies to absolute vata vitiation only. If there is any association or obstruction of other dosha in vatavyadhi, the treatment will be different. Kevalam term indicates pathology of vitiation of exclusive vata. Nirupastambha is condition without any association of other dosha. This pathology shall be primarily treated with oleation therapy.
As in exclusive vataja disease the major gunavriddhi is ruksha which leads to riktata in srotas and dhatu and more avakasha (space) for vata; snehana is essential and ideal. Various methods for snehana are employed depending on avastha (stage), sthana (site) and bala (strength) of the diseases and as well as patient.
Following snehana, swedana is also mandatory. Here the ushna guna (hot property) operates to control sheeta (cold). Repeated snehana and swedana imparts high grade of flexibility.
Sneha is a good medium to control vata as well as vata-pitta. Generally, this line of treatment can be counted as a part of brimhana. [verse 75-83]
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]
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.
Hridaya anna (favourite food) is typically indicated in tvakgata vata because, rūkṣatā in tvak is a result of rasakṣaya caused by overworrying.[Cha. Sa. Vimana Sthana 5/13]
Bahya snehana in the form of abhyanga or dhara, etc are very effective in asthi dhatugata and majja dhatugata vata. Abhyantara snehana replenishes meda dhatu and subsequently asthi dhatu and majja dhatu. It is worthy to note the utility of tikta ghrita in asthi dhatu kshaya.
In shukrakshaya (depletion of shukra), harshana (pleasure) and vrishya annapana (aphorodisiac diet) is very useful. [6]
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).
Poultice prepared from flesh of marshy animals is used for brimhana in atrophy of muscles. Vamana is indicated in ardita, when it is associated with shopha and raktamokshana is indicated when associated with daha (burning) and raga (redness).
In pakshaghata, swedana, fomentation mixed with unctuous material and virechana or purgation therapy with unctuous substance is indicated. Virechana is the line of treatment in pakshaghata and outweighs basti which is said to be ideal for vatakopa. Pakshaghata may be understood as a concealed urdhwaga raktapitta (bleeding from upper orifices of body) in which the only and effective choice is adho-shodhana (purgation). Gridhrasi is a tendon and ligament disorder and shastra, kshara, and agnikarma are the main line of treatment. Therefore siravyadha (blood letting) and dahakarma (cauterization) is advised. Basti is also a good choice since pakvashayagata vata leads to kateegraha and gridhrasi.
Agnikarma and siravyadha are the two line of treatment which are useful in acute phase to relieve the pain in gridhrasi and also in khalli. Agnikarma relieves muscle spasm thereby reducing pain whereas siravyadha may be helpful by reducing the blood stasis. Improved circulation removes cytokines and other inflammatory factors thereby reducing pain. (99-103)
Agnikarma is a para surgical procedure in which a metallic thin pointed rod called shalaka is heated and applied to specific points of pain for relief. It is commonly used as efficient pain reducing therapy in musculoskeletal disorders.
Importance of site of affliction in treatment
The specificity of treatment depends on the site of affliction and the associated morbid tissues. For example masthishkya is very specific for ardita, pakshaghata, indriyagatavata 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 vata vitiation (without involvement of other dosha) is brimhana. If associated dosha is present, they shall be treated first. [verse 105]
Bala is excellent for lone vitiated vata. The head of goat is indicated on the basis of the principle ‘samanyam vridhikaranam’(like increases like). These also explain the awareness of utilization of brain of goat in degenerative brain lesions. Lavana relieves stambha (stiffness) and samghata (conglomeration). Upanaha is also prepared with such well fomented flesh and added with different oils, salts etc. Such upanāha are brimhana. [verse 106-108]
Avagaha (immersion) sweda
Avagaha is typically indicated in apana vaigunya (defects due to apana vata vitiation), it is a type of drava sweda (liquid fomentation). Nadisweda is also an excellent option for all types of vataroga. Poultices (upanaha) of different types provide self generated heat to cause swedana. It is by virtue of various dhanya (cereals) and kinwa (yeast) available in it. [verse 109-118]
Different formulations
Different medicated ghrita, taila, vasa, majja and maha sneha (combination of all four sneha) are indicated for various conditions in the form of oral ingestion, inhalation, enema and external application etc. Maha sneha is guru (heavy to digest) and ultimately indicated in disorders like convulsions, tremor etc. [verse 119-136]
Pinyaka taila is a preparation in which ruksha guna is imparted to taila and is highly useful in kapha associated Vata vyadhi. [verse 136-137]
Importance of oil in treatment of vata
By virtue of vyavayi 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 ksheerbala (101 avartita), dhanwatharam (21 avartita) etc. are worth mentioning here. This approach of samskara makes sneha as sukshma sneha (with better bio-availability and penetration). [verse 181-182]
Management of avrita vata
In pittavritta vata, hot and cold should be applied alternately. Jivaniya sarpi is also very brimhana. Brimhana is the ideal pacifying line of treatment for vata and vata-pitta.
In kaphavritta vata, ruksha is given importance. In association of kapha along with pitta in vataroga, pitta should be given importance in management. It is because of the fact that pitta makes the disease process as ‘ashukari’(instantaneous).
In Kaphavritta vata; tikshna sweda, niruha and vamana which reduces kapha is indicated followed by virechana intended for vata anulomana and also useful for kapha.
Jirna/purana sarpi (old ghee) which has kaphaghna quality has to be used; tila and sarshapa which are kapha vataghna are to be used. Warm drinks of yava, jangala mamsa rasa which gives strength to the patient without increasing kapha are to be administered. [verse 183-188]
Kshara basti (gomutrayukta basti) in case of kapha-vata and ksheera basti in pitta-vata is recommended. Raktavruta vata is similar to uttana-vatarakta and treatment is accordingly same. Rakta avruta vata is one of the phases of vatarakta. Thus raktamokshana and basti chikitsa which is useful in vatarakta is also helpful in rakta avruta vata.
Prameha samprapti mentioned in Sutra sthana 17th chapter explains kapha, pitta, meda dhatu and mamsa dhatu which when increased causes avarana of vata. Therefore, pramehagna cikitsa is helpful in meda avruta vata and also in mamsavrutta vata. Hence in mamsavrutta vata the pipilika iva sanchara (tingling sensation) reduces, if prameha is treated. Similarly, in obesity, medasavruta vata (vata obstructed by excess meda) [Cha.Sa.Sutra Sthana 21/5] and meda and mamsa ativridhi [Cha.Sa.Sutra Sthana 21/9] is observed. These conditions are best treated on the principles of management of prameha, sthaulya associated with vitiated vata. Therapeutic emesis to expel out the intoxicated food in stomach is advised in condition of annavrita vata ( vata obstructed by food). Pachana and deepana helps in digestion and also pacifies vata.
Hot fomentation reduces urethral pressure. A study done by Shafik A. 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.
Uttara basti effect is similar to catheterization. Further depending on the medicines used for uttara basti, tridosha shamana can be done.
The lines of treatment of raktagata vata and raktvrita vata as well as shukragata vata and shukrāavruta vata are one and the same irrespective difference in samprapti as gata vata or avruta vata. It is because of the fact that rakta and shukra are mobile and comparatively pervaded all over the body like vata so gatavata and avruta vata are mutually complimentary here. Finally, the treatment strategies of anyasthanagata(in other sites) vata are explained. The importance is given to sthanastha dosha (in own sites).[Verse 189-199]
Movements of vata and concept of anyonyavarana:As discussed earlier avyahatagati (free movement) is a cardinal feature of vata to perform normally. In avarana certain obstacles like dosha, dhatu or anna etc which are immobile, occupy the pathway of mobile [[vata]. It is not mandatory that such immobile articles only cause obstruction to vata. If the individual sub types of vata are considered prana, udana, vyana, samana and apana are mobile and has some specific direction for their gati. For example, prana has movement from murdha (head) to downwards. Udana has movement from uras(chest) to upwards. Vyana moves upward downward and sidewards like rasa. Samana moves around jatharagni. Apana move downwards from pakvashaya. This can be further analysed as follows. Udana possess upward movement. Likewise ‘apana’ has downward direction. Vyana vayu moves in horizontal direction (vyāpanat vyāna uccyate) along with upward and downward directions as rasa samvahana (circulation) is concerned.[19]Samana is also having such qualities to equally distribute the nutrients through out the body. Prana has multi directional gati. So, the movements of individual subtypes of vāta are directional in nature. When these meet in opposite direction it makes anyonyavarana. 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 different types making 4 particular combinations. Anyonyāvarana are comparatively difficult situations. [verses 199-206]
Anyonya avarana is characterized by Svakarma hani or vriddhi (either increase or decrease in functions) which depends on the nature and site of anyonyāvarana (mutual covering). For example prana avruta udana 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 prana. But in udana avruta prana the symptoms are loss of motor power, immunity and complexion leading to death. Here the functions of prana are seriously hampered. This symptom may be acute or chronic in nature. When apana got avarana by udana the normal peristalsis is hampared and anulomana is the line of treatment. In apana avarana to udana increased bowel motility can be seen grāhi is the line of treatment which should be adopted here.
Rehabilitation of vata
Prakrutisthapanam means re-establishment in its own pathway (sva margaga)/ or in its own place (sva sthana gamayed enam). Therefore for udana vayu, vamana etc. treatment should be administered to regulate the normal functional status of udana vayu. Apana has adhogati, therefore anulomana chikitsā should be done, thereby regularizing the urdhva apana bhava of Apana vayu. Shamana should be line of treatment for samana vayu. Empowering digestive power should be done. Samana being sited near agni, 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. Here the general line of treatment of anyonyavarana is discussed. [verse 219-221]
Importance of udana and prana vata
Among various avarana, the involvement of udana and prana are very important. As explained in the introductory comments, prana is life and udana is strength. These are very vital issues as far as avarana is concerned. Improper management or avoidance of treatments may lead to permanant disabilities in avarana. [verse 231-236]
Complications of Avarana
This includes hrudroga, vidradhi, plīhā, gulma, atisara. Hrudroga is a common complication of ill treated avarana of prana and udana. Vidradhi and pliha are caused by wrongly managed avarana of vyana. Gulma and atisara are common complications of avarana of samana and apana.
Srotoshodhana is an important line of management in Avarana. It ensures unobstructed movement of vata. All abhishyandi(increasing discharges in body) food causes srotorodha (obstruction of channels). Yapana Basti is ideal for all age group and safe to severe clinical presentations. It protects all marma points. As it is neither lekhana (reducing body components), nor brimhana, it is useful for managing vata as well as avaraka kapha or pitta. Guggulu rasāyana and shilajatu rasāyana is ideal for many clinical conditions of avarana.
Related chapters
Vatakalakaliya Adhyaya, Basti, Snehana, Panchakarma
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References
- ↑ Dalhana, Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Nidana Adhyaya verse 8. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
- ↑ B C Joshy, Neurology in Ancient India – some evidences, Indian journal of History of science, 19(4):366-396(1984)
- ↑ Indu, Vagbhata, Sutra sthana Chap 20 Doshabhediya Verse 2, In: Sreekumari Amma (eds.) 1st ed. Trivandrum: Publication Division; Ayurveda College, 2000.
- ↑ Dalhana, Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Nidana Adhyaya verse 5. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
- ↑ Dalhana, Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Nidana Adhyaya verse 9. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.
- ↑ Vagbhata, Sharira Sthana Chap 5 , Angavibhaga Adhyaya, Verse 67. In: Bhishagacharya Harisastri Paradikara Vaidya (eds.) 9th ed. Varanasi: Chaukhambha Orientalia; 2005. P798