ayurveda,

  • About Ayurveda

    About Ayurveda

     

    Content

    History

    Why Ayurveda Originated ?

    Eight Branches In Ayurveda

    Basic Principles of Ayurveda

    Tridosha

    Pancha Maha-bootha concept

    Ayurvedic Approach to Health and Wellness

    About Ayurveda Treatments (Upakrama)

    Panchakarma

    Ayurvedic Text Books- Tantra

    Types Of Medicine In Ayurveda

     

                       The word Ayurveda is a Sanskrit word (आयुर्वेद) that evolves from combination of two words, "Ayush" (आयुस्) meaning life and "veda" (वेदः) meaning knowledge. Ayurveda means "Knowledge about Life" Ayurveda is a 3000 year old science that originated in India. Present region of North Indian, Pakistan, Nepal, Barma, Tibet and East-Northern places of Bangladesh. The components and concept of Ayurveda is rooted in Vedas. Ayurveda considered as the one of the Upveda of ‘Adharva veda’.

      History

                               Ayurveda is an ancient medical science which was developed in India thousands of years ago. Believed to have been passed on to humans from the Gods themselves.God ‘Dhwanathiri’ considered as the god who gives ayurveda to mankind for his health. In ayurveda literature it says that ayurveda not created, it sates ‘BRAMHA SMRITHWA AYURVEDA ‘. ie God Brahma recollected or compiled ayurveda science. It is believed that early a samhita named ‘Bramha Samhita’ was present. All other samhita’s used content Bramha samhita to write new samhita for easy understanding and usage.

     

     

             Ayurvedic Medicine is the world's oldest comprehensive health care system and is indigenous to India where it is widely practiced. "This ancient art of healing asserts that the science, philosophy and spirituality are all necessary aspects of healthy living." Thus Ayurveda is not only a comprehensive medical system but also a way of living and the very concept of "mind, body and spirit" originates from Ayurveda.

                  Ayurveda originated in vedic time, ancient universities like was ‘Nalantha’ and ‘Takshashila’ was the main hub off education in ‘Hindustan’. They promoted ayurveda. Due to ‘Buddhism’ and ‘Jainism’  ayurveda spred all over the world, ‘Buddhist’  saints spread the ayurveda to South India, Srilanka, Indonesia etc. But I want to mention one thing that due to principle in ‘Ahimsa’ in ‘Buddhism’, surgical information in the Ayurveda almost lost they give more impotents to herbal and treatment procedure. Still we can see the influence of Buddhism in ayurveda classical text book.

     Why Ayurveda Originated ?

                    In vedic time people are preferred ‘yaga’ or ‘Homa’ for a purpose like to get blessing from god, nature etc. To get cure from a disease, ‘Yaga’ is prescribed. Sir, you can simply guess what will be the cost  for a ‘yaga’ like procedure, naturally that will not affordable by people, many families became poor due to this. Also more important thing is there, in ancient time ‘Chatur Varnya’ based community life style is adapted. All are not rich to involve in Yaga and all are not allowed. This situation lead a necessary situation to design a treatment protocol like ayurveda which is effective also cost effective system, even ordinary people can use.

                 Our ‘Acharya’ are considered as ‘Apta’, which simply means they free from all the negative energy from the earth, no intention to cheat others, not want to get any profit from anyone. They saw all the people as one, not based on community system. I believe that due to this Ayurveda is still exists, due to their kindness and truthfulness in heart, not me and any of other ayurveda doctors.

     Eight Branches In Ayurveda

       The Branches in Ayurveda are derived from classical Sanskrit literature, in which Ayurveda was called "the science of eight branches" (Sanskritaṣṭāṅga अष्टांग). The components are:

     1.Kayachikitsa (general medicine): "cure of diseases affecting the body".

     2.Kaumāra-bhṛtya and Bala Roga: deals with the treatment of children.

     3.Shalya tantra deals with surgical techniques.

     4.Śālākya-tantra - deals with diseases of the teeth, eye, nose, ear etc.

     5.Bhuta-vidya deals with the causes, which are not directly visible and not directly  explained by tridosha ,pertaining to micro-organisms or spirits.

     6.Agada-tantra deals with antidotes to poison.

     7.Rasayana-tantra (Geriatrics)/(Anti Agings) : deals with rejuvenation.

     8.Vajikarana tantra (aphrodisiacs) deals with healthy and desired progeny.

     

     Basic Principles of Ayurveda

               

    Tridosha, Pancha Maha-bootha , Saptha dathu , Agni, concept of  Srothos

     

    Tridosha

     

    ·         Vata pertains to air and ether elements. This energy is generally seen as the force, which directs nerve impulses, circulation, respiration, and elimination.

    ·         Kapha pertains to water and earth elements. Kapha is responsible for growth and protection. The mucousal lining of the stomach, and the cerebral-spinal fluid that protects the brain and spinal column are examples of kapha.

    ·         Pitta pertains to fire and water elements. This dosha governs metabolism, e.g., the transformation of foods into nutrients. Pitta is also responsible for metabolism in the organ and tissue systems.

     

    Tridosha - Vata, Pitta and kapha

     

    vāyu: pittaṃ kaphaśceti trayo doṣā: samāsata: || vikṛtā’vikṛtā dehaṃ ghnanti te varttayanti ca | (A.H)

    Vayu – Vata, Pitta and kapha are the three Doshas of the body. Perfect balance of three Doshas

    leads to health, imbalance in Tridosha leads to diseases.

     

    te vyāpino’pi hṛnnābhyoradhomadhyordhva saṃśrayā: ||

    vayo’horātribhuktānāṃ te’ntamadhyādigā: kramāt | (A.H.)

     

    The Tridosha are present all over the body, but their presence is especially seen in particular

    parts. If you divide the body into three parts, the top part upto chest is dominated by Kapha

    Dosha, between chest and umbilicus is dominated by Pitta, below umbilicus part is dominated by

    Vata.

    Similarly, in a person’s life, day and in night (separately), the first part is dominated by Kapha,

    second part is dominated by Pitta and third part is dominated by Vata. While eating and during

     

    digestion, the first, second and third part are dominated by Kapha, Pitta and Vata respectively.

     

    Qualities of Vata

    tatra rūkṣo laghu: śīta: khara: sūkṣmaścalo’nila: || (A.H.)

    Rooksha – dryness, Laghu – Lightness, Sheeta – coldness, Khara – roughness, Sookshma –

    minuteness, Chala – movement These are the qualities of Vata.

     

    Qualities of Pitta

    pittaṃ sasneha tīkṣṇoṣṇaṃ laghu visraṃ saraṃ dravam |(A.H.)

     

    Sasneha – slightly oily, unctuous, Teekshna – piercing, entering into deep tissues, Ushna –

    hotness, Laghu – lightness, Visram – bad smell, sara – having fluidity, movement, drava –

    liquidity are the qualities of Pitta.

     

    Qualities of Kapha

     

    snigdha: śīto gururmanda: ślakṣṇo mṛtsna: sthira: kapha: || (A.H)

    Snigdhna – oily, unctuous, Sheeta – cold, Guru – heavy, Manda – mild, viscous, shlakshna –

    smooth, clear, Mrutsna – slimy, jely, sthira – stability, immobility are the qualities of Kapha.

     

    The increase, decrease of individual Doshas, or imbalance of couple of these Doshas is called as

    Samsarga. And imbalance of all the three Doshas together is called as Sannipata.

     

     

     

    Pancha Maha-bootha concept

     Ayurveda is based on the premise that the universe is made up of five elements:

     

    1.Pradvi – earth

    2.Aap – water

    3.Tejus – Fire

    4.Vayu – Air

    5.Akash – Space  

     

                These elements are represented in humans by three "doshas", or energies: Vata, Pitta and Kapha. When any of the doshas accumulate in the body beyond the desirable limit, the body loses its balance. Every individual has a distinct balance, and our health and well-being depend on getting a right balance of the three doshas ("tridoshas"). Ayurveda suggests specific lifestyle and nutritional guidelines to help individuals reduce the excess dosha.

    Ayurvedic Approach to Health and Wellness

    To maintain the health of a healthy person  (swastha vritha) and cure the disease of a diseased.

    Preventive Medicine – Creates and maintains health and longevity of an individual by maintaining balance of a person's prakturi (or constitution) by creating daily and periodic regimens. These health routines focus on diet and exercise, herbals, massage, meditation, and social behavior and positive relationships.

    Curative Medicine – Treatments to cure the disease by one or combination of the following approaches:

         · Internal measures, including shodhana (detoxification) and shamana (methods used to improve quality of life via palliative care).

         · External measures, including snehana (oil treatments), svedana (steam therapy using herbal steam), and use of herbal pastes.

         · Surgical methods, including removal of tissues, organs, and harmful growths.

         · Mental and spiritual therapies or daivya chikitsa.

         · Herbal therapy, including astute pharmacology.

     About Ayurveda Treatments (Upakrama)

    Two types of  Treatments (Upakrama)

    1.Langhana

    2. Brimhna

    Langhana Therapy further divided in two

    1.Sodhana

    2.Samana



    Saman therapy further divided in to

    1.pachana

    2.Dipana

    3.khuth

    4. Vyayama

    5. Thritt

    6.Athapha

    7.Maarutha

     

     Sothana Therapy (Pancha Karma ) Divided in to –

    According to susrutha



    1.Vaman (Therapeutic vomiting or emesis)

    2.Virechan (Purgation)

    3.Basti (Enema using medicine)

    4.Nasya ( Application of medicine in Nose)

    5.Rakta moksha (Bloodletting or detoxification of the blood)

     

    According To Charaka

     

    1.Vaman (Therapeutic vomiting or emesis)

    2.Virechan (Purgation)

    3.Nasya ( Application of medicine in Nose)

    4.Matra Vasthi (Enema Using tail / Gritam)

    5.Kashaya Vasthi (Enema using Kashaya / decotion)

    More about Pancha Karma

    Panchakarma

     

                Ayurveda recognizes that all living and non-living things are composed of panchamahabhut or five basic elements of the entire creation. One branch of Indian philosophy—Sankhya, states that there are 24 elements in all, of which five are the foundation of the gross world: earth, water, fire, air and ether. According to ayurveda these five elements in different combinations constitute the three body types/doshas—vata (air and space), pitta (fire) and kapha (earth and water). These two theories are the guiding factors of ayurveda as a therapeutic science.

    Ayurveda advises undergoing panchakarma at the seasonal changes to both keep the metabolism strong and keep toxins from accumulating in the body as well as the mind. The process finds the way to the root cause of the problem and corrects the essential balance of mind, body, and emotions. It is considered extremely effective to go through the process of panchakarma prior to any rejuvenation treatment (rasayana/herbal medicines), for it cleanses the body, improves the digestion, the metabolic processes of the body and cleanse the thought process as well.
    Basically, panchakarma is meant to make an individual most receptive to the curative process of ayurveda by removing accumulated waste in body and mind.

    Vamana (Emesis)

    It is a process of therapeutic vomiting (induced), which helps eliminate the toxic or waste matters from the stomach and thoracic cavity. Kapha dominant diseases like severe skin diseases (psoriasis, urticaria); bronchial asthma, mental disorders etc. are selected for this treatment procedure. This process is not suggested for expecting mothers. Normally eight bouts of emesis are followed. The vomiting is stopped when yellow coloration is seen. Then, dhoomapana—inhalation of medicated fumes—is done through a special process. Finally, certain rules have to be followed called paschatkarma that basically implies strict diet regimen.

    The entire treatment takes 15 days, and requires good attention as well as skilled assistance.

    Virechana (Purgation)

    This eliminates the toxic or waste matters from the intestine. It also cures pitta or pitta-dominated diseases. Poorvakarma or initial process of cleansing like vamana is suggested here. About 20 purges may be seen in this process depending on the patient's health.
    A mild form of virechana without the poorvakarma, is an integral part of ayurvedic therapy. It is also used for prevention of diseases.

    Basti (Enema using medicine)

    The process of vasti or therapeutic enema is resorted to eliminate toxins from colon, and strengthens the tissues. Two kinds of vastis are followed in ayurveda. Snehavasti is the vasti where medicated oils are used. This is not advised in patients suffering from diabetes, anemia, diarrhea, and obesity. Poorvakarma is required here.For kashaya vasti, honey, rock salt, sneham (oils), paste of medicines are required and mixed one by one in the above order. This concoction is taken in an empty stomach. After the process the patient is allowed to take a bath.

    Diseases like hemiplegia, and disease due to vata are treated by this process. Medicines are selected as per disease and stage.

    Nasya (Nasal Application of Herbal Medicines)

    Nasya is instillation of medicine through nose. It is an important procedure of ayurveda for the treatment of sirorogas or diseases affecting head area. Nasya helps cleanse the head and sinuses. The process is contraindicated in various psychological diseases, asthma and cough.
    Here, the patient is to inhale lightly warmed oil. Warmed oil is massaged in the patient's neck, shoulder, palm, face and sole before and after the process of nasya. Different timings are indicated for different dosha types. Morning time is prescribed for kapha diseases, noon in pitta diseases and evening in vata diseases.

    Raktamoksha (Blood-Letting)

    Susruta gave stress to Raktamoksha (blood-letting) as one of the panchakarma, taking two of the vastis as a single karma (here, procedure). The process of letting out the vitiated blood is termed raktamoksha. In this procedure localized impurity or poison from the blood is removed through various methods. Often leech is used to suck out the impure blood from the affected area. Blood-letting is also done to eliminate toxins from the blood stream causing various chronic skin disorders like urticaria, eczema, scabies and leucoderma etc. The method was also effectively used to cure enlarged liver and spleen.

                The sodhana treatment / chikitsa known as pancha karma therapy. Most of the Ayurveda therapy centre give imports only for pancha karma therapy, But according to ayurveda sodhana and samana both have equal important.  So I  never say pancha karma is a superior treatment. I think most of time that is not good, because according to literature in ayurveda so many people and disease condition not recommend for pancha treatments. Unfortunately treatment centers want to promote it because it is more profitable business. For preparing a person for pancha karma, a lot of other procedure are need to be do. Like  application of oil in different ways like massage , Dhara etc. You must remembered that our Acharyas I mentioned who is considered as ‘Apta’ not prescribed any oil massage therapy. I always feel bad thiking about that.  One of the intentions to write this article that now a day’s most of people thought that it is only an ‘Oil Massage’ therapy not a science.

    Major Ayurvedic Text Books- Tantra (Brhattrayi)

    Charak Samhita


    Charak Samhita, which dates back to approximately 800 BC, is a major compendium of Ayurvedic medical theory and practice that Charaka, an internist at the University of Taxila, compiled in Sanskrit. Presented as poetry, Samhita contains more than 8,400 verses in its 120 chapters.

    Actual content in the Charaka samhita wrote by Acharya Agnivesha. But Acharya Charaka modified it. Some missing chapters are added by Acharya ‘ Dridabala’.

    Sushruta Samhita by Sushruta 


    This surgical text, which dates back to approximately 700 BC, contains seminal content such as the Ayurvedic definition of health, information on blood, and the description of five sub-doshas of Pitta and the marma points. This volume also includes pioneering techniques in skin grafting and reconstructive surgery.

    Ashtanga Sangraha and Ashtanga Hridaya by Vagbhata


    Ashtanga Sangraha and Ashtanga Hridayam, dating back to approximately 400 BC, were written by an Ayurvedic physician from the Sindh region of India. The Sangraha is primarily written in prose, while The Hridayam is presented as poetry. These texts define the five subdoshas of Kapha and emphasize the material value of life. The Hridaya is still highly regarded as a primary Ayurvedic medical text book.

     

    Minor Ayurvedic Classics (Lghutrayi)

    Sarangadhar Samhita by Sharngadhara 


    This text was written in the 13th century AD, and is valued for its explanation of the Ayurvedic concept of materia medica, as well as for its pharmacological formulations. It is also considered the foremost text on pulse diagnosis.

    Bhav Prakash Nighantu by Bhavamisra


    This 16th century text contains approximately 10,278 verses of varying meters and focuses on herbal descriptions, food, the therapeutic use of trace metals, and rejuvenation therapies. Information on sexually transmitted diseases, particularly syphilis, is also included.

     

    Madhava Nidan by Madhava Kara


    This text was written between 700 AD and 1100 AD, and is valued for its precise classification of diseases and disease etiology, particularly in the fields of pediatrics and toxicology. Madhava Nidan is considered the Bible for Ayurvedic clinical diagnosis.

    Types Of Medicine In Ayurveda

    According to origin

    1.  Herbal Medicine – Medicine prepared using medicinal Plants

    2.  Mineral Medicine– Medicine prepared using heavy metals like mercury, arsenic, sulphur, siver,gold etc.

    3.  Herbo-mineral combined medicine

    According to Preparation

    1.  Kashaya

    2.  Arishta

    3.  Asava

    4.  Churna

    5.  Lehya

    6.  Gritha

    7.  Gulika

    8.  Arka

    9.  Basma / kshara

    10.            Malahara – Lepana

     

     

     

  • AyurvedicTreatment of Rheumatoid Arthrtitis (Amavata)

     

    AyurvedicTreatment of Rheumatoid Arthrtitis (Amavata)

     

    DISEASES OF THE JOINTS

     

    Diseases like arthritis have been known to exist since times immemorial. Charaka Samhita, the Ayurvedic treatise on medicine, deals more effectively with the reason, symptoms, clinical-diagnosis and the possible treatment of arthritis. Prognosis of arthritis, as described by the Ayurvedic physicians, remains unaltered largely.According to Ayurveda, in order to treat various types of arthritis, we need to need to stimulateagni and suppress the ama.Ayurveda distinguishes three categories of arthritis (depending upon the predominance of the biological humour), vataja, paittaka and kaphaja.

    Diseases of the joints are better known as rheumatic diseases. Rheumatoid arthritis, osteoarthritis, and gouty-arthritis are common varieties of arthritis encountered in clinical practice. Rheumatism is widely used for inflammation or injury to the soft tissues.Cervical-spondylosis, lumbar-spondylosis, and sciatica are other significant diseases included in this segment.

    Rheumatoid arthritis is an autoimmune disorder in which rheumatoid factor is found to be positive. Gout is characterisedby high levels of uric acid in the serum...hyperuricemia. Psoriasis, a skin disorder, is associated with arthritis (psoriatic arthritis).

    Pain, inflammation-swelling, fever, morning stiffness and loss of function, are major clinical features of arthritis. Depending on the involvement of the joint, character of the pain and laboratory investigations, the final diagnosis is done. Some form of arthritis like rheumatic-arthritis, involves other organs,including heart and muscles.

     

    AYURVEDIC MANAGEMENT OFRHEUMATIC DISEASES

     

    Inflammatory diseases, including arthritis and rheumatism are a major group of prevalent diseases.Most of the available pain-killers drugs are effective in inflammatory conditions of the joints, but have a major side-effect of gastric irritation and even, ulceration.Active-principleshaving potent anti-inflammatory effect has been isolated from medicinal plants used in Ayurvedic system of medicine.

    The management of a joint disease requires a rational approach. In patients suffering from obesity, weight management hasgreatimpact. Ayurvedic system of medicineconsiders malfunctioning of the digestive system responsible for diseases like arthritis and rheumatism. Effective herbs are available for treating arthritis but at the same time side effects caused by the synthetic drugs are alarming.

     

    AMAVATA (RHEUMATOID ARTHRITIS)

     

    Cause: Ama (substance produced by malfunctioning of the digestive system) is considered to be the root cause of Amavata (rheumatoid arthritis) in Ayurveda.Ama circulates in the blood and finally accumulateswithin the joint cavity,resultingin pain and loss of function. Rheumatoid arthritis accounts for fifteen% of the total rheumatic disorders. The incidence is more common in women as compared to men. Further, rheumatoid arthritis is more prevalent in damp and cold conditions.

    Signs and Symptoms: Rheumatoid arthritis is a chronic form of arthritis characterized by pain and inflammation of many joints. Rheumatoid arthritis commonly affectsthe small joints of the hands.Rheumatoid arthritis has symmetrical pattern which is not found in osteoarthritis. Rheumatoid arthritis affects finger joints adversely. Z-shaped deformity of the thumb and deviation of the hand are features characteristic to rheumatoid arthritis.

    Rheumatoid factor is found to be positive in 80 per cent of the patients. Erythrocytic sedimentation rate is on the higher side in acute cases. Total leukocyte count and differential leukocyte count are also high. In rare cases,anaemia is found. The effect of rheumatoid arthritis is not only confined to joints, but it has extra-articular effects also (as it attacks heart, muscle and eye).

    Remedies:Practitioners of Ayurveda use formulations for anti-inflammatory, analgesic and anti-arthritic action with considerable success

    Ø Mahayograjaguggul is a traditional remedy for treating rheumatoid arthritis.Two tablets of Mahayograjaguggul, twice a day, are recommended with lukewarm-water.

    Ø Triphala Guggul and Yograja Guggul have immunomodulator and cartilage-protective activities.

    Ø Maharasnadiquatha, six teaspoonfuls, with water should be consumed twice a day, for better effects.

    Ø aDashmoola (combination of roots of ten plants) is standard Ayurvedic remedy for inflammatory diseases like arthritis.

    Ø Trikatu powder is recommended for improving digestion. This drug is very effective in detoxifying amain rheumatoid arthritis patients. One teaspoonful, with warm water not only corrects digestion, but stimulates appetite also.

    Ø Commiphora mukul, traditionally known as guggul, has figured high in the treatment of arthritis. Animal models have demonstrated anti-inflammatory activity of crude drug and standardized extract containing guggulsterones. Clinical studies have reported utility of the drug in the treatment of rheumatoid arthritis and osteoarthritis

    Ø Vishagarbhataila is used for local application twice a day. Hot fomentation after light massage is helpful in reducing the stiffness of the joints.

     

    PRECAUTIONS AND DIET

     

    Ø The patient should ensure consumption of fresh vegetables, garlic and black pepper.

    Ø Exposure to cold and damp conditions should be avoided.

    Ø Use of the curd should be avoided at night.

    Ø Soybean, potato, white grams, pea, potato, and bathing with cold water should be avoided.

    Ø Wheat, ginger, ghee, garlic, punarnava, mango, grape, pomegranate, are beneficial in rheumatoid arthritis.

     

    CONCLUSION

    Rheumatoid arthritis can be kept under control by a blend of regular exercise, strict diet-regimen and proper medication.

     

    AUTHOR BIO:

    Dr.Vikram Chauhan (MD-AYURVEDA) is an Ayurvedic practitioner based in Mohali, India. He is spreading the knowledge of ancient healing treatment of Ayurveda not only in India but also abroad. He has researched age old formulas from ancient Ayurvedic text books to restore health and save human beings from the worst side-effects of chemical based treatments. Dr.Vikram Chauhan is also the author of 'Ayurveda- God's Manual For Healing', an informative book for people interested in learning basics of Ayurveda, diet and principles of healing according to Ayurveda system of medicine. He is CEO and Founder of Planet Ayurveda Products, Planet Ayurveda Clinic and Krishna Herbal Company.

    Website – www.planetayurveda.com

     

    Contact:

    DR.VIKAS DUBEY, B.A.M.S(M.D)AYU B.V.D.U COLLEGE OF AYURVED                    MOB-9479427096 ,8237250287    E-MAIL ; This email address is being protected from spambots. You need JavaScript enabled to view it.,

  • Prameha: Classification, Aetiology and Pathogenesis according to ayurveda

     ‘‘Prameha:Classification, Aetiology and Pathogenesis’’

    DR.VIKAS DUBEY, B.A.M.S(M.D)AYU B.V.D.U COLLEGE OF AYURVED                    MOB-9479427096 ,8237250287    E-MAIL ; This email address is being protected from spambots. You need JavaScript enabled to view it.,

     

     Abstract:

     The classical texts of Ayurvedahas described Pramehaas a group of disorders of the urinary system( Vasti) this is also part of Trimarma. Each sub type of Pramehahas been defined on specific characteristics of abnormal urine. Classification of Prameha is based on different perspectives such as Genetics, Environmental Factors, Behavioural Changes and Food Habits. Nosology of diseases has been made on the basis of   pathophysiology, manifestation of clinical features, and characteristics of thea bnormal urine. Each sub type is, therefore, not identical with the conditions mentioned in the classification of diseases in Modern Medicine. For instance, theview of many scholars that the Diabetes Mellitus as Madhumeha,is an incorrect interpretation because Madhumehadoes not represent entire clinical course of Diabetes Mellitus. Madhumehais a fatal condition, which represents a particular stage of Diabetes Mellitus and other diseases of the Kidney. The pathogenesis of prameha is described on the basis of Dosa - Dhatu - MalaTheory. Early stage ofthe disease manifests clinically due to the vitiation of Kaphapredominantly. Gradualdevelopment of the disease may occur manifesting the features of vitiated Pittaand VStaon the influence of aggravating factors and inadequate attention in themanagement.

    KEY WORDS:- Pameha,Trimarma,Hrdaya,Sirsa,Vasti(Urinary system)

    ·        Introduction

      Ayurveda mentions three major vital places of the body as Trimarma, which includes Hrdaya,

    Sirsaand Vasti. Prameha,which is a group ofdiseases of Vasti(Urinary System) is

    characterized by excessive passing of turbid urine.The term "Prameha"is derived from the root of Sanskrit language "Mih - Ksarane",whichmeans passing of urine. The prefix "Pra"stands

    for excessiveness. Therefore, the term"Prameha"literally stands for excessive passing

    of urine1 1 . Excessive passing of urine - PrabhQtamutratS''and the Turbidity of urine - "Avilamu

    tratS" aremain characteristic features of"Prameha".Therefore, the condition "Prameha"

    can be basically defined as "a group ofdiseases of any cause, which manifests

    "excessive passing of urine with or withoutturbidity of urine".

    The Classification of PramehaPramehais included in the category of ‘Maharoga’,which consists of the most fatal conditionsthat are incurable - (Su.Ci.14.11)

    Classification of Pramehahas been made onthe basis of quantitative and qualitative analysis

    of urine. The classical texts of Ayurveda,Carakasamhita, Susrutasamhitaand As (hastangahrdayasamhits mention the 20 sub - typesof Pramehaand different technical terms have

    been used in the nosology of few conditions -(CS.Ni.4.38 , CS.Ci.6.61 , SS.Ni.6.262 , AS Ni

    10.83).On the aetiological basis, Pramehaisdivided into two categories as Congenital

    {Prakrtija)and Acquired {Svakfta)9.Thecongenital type of Pramehais caused byhereditary and nonhereditary defects of the ovumand sperm -(SS.Ci.11.037).On the basis of pathophysiology, all types ofPramehaare the results of vitiation of tridosa and they are categorized into three groupsnamely Kaphajaprameha, Pittajapramehaand VStajapramehaaccording to the predominant dOsa- (CS.Ni.4.38, SS.Ni.67) and each categoryis divided into sub types on the basis of the characteristics of urine. been replaced by Raktameha,a synonym of Sorjitamehain addition to theother types of PittajapramehainCarakasamhita. Asthahgahrdayasarhhitahasfollowed the Carakasamhitain classifying the Vataja Prameha.

    .Kaphaja Prameha

     Kaphajaprameha,which includes ten types ofPramehanamely Udakameha, IksubSlikSrasameha(Iksumeha), SSndrameha, SSndr -aprasSdameha, Suklameha, Sukrameha,S\itameha , Sanairmeha, SikatSmeha ,andLdlSmeha- (CS.Su.19.3.91 , CS.Ni.4.102).Susrutarefers to the terms Pistameha ,SurSmeha, Lavanamehaand Phenameha -(SS.Ni. 6.102-7) instead of Sandraprasadameha,

    Suklameha, SJtameha, AlaiamehaofCarakasamhitawhile AsthSrigahrdayasarii hitsrefers to Udakameha, Iksumeha,SSndrameha, Sukrameha, SJtameha,Sanairmeha,SikatSmeha, Pistameha, Suramehaand Lalameha -(AHS.Ni.10.8-133).

    Pittaja Prameha

    Pittaja Prameha,which includes six types ofPrameha,namely KsSrameha, Kaiameha,

    Nllameha, Lohitameha, MSnjistamehaandHaridrameha- (CS.Su.19.121 3 . CS.Ni.4.2513).

    Susrutarefers to the terms AmlamehaandSorjitameha(SS.Ni.6.112 7 ) instead of KSIamehaand Lohitamehaof Carakasamhita,while AsthSngahrdayasarhhitShas followed themCarakasamhitabut Lohitamehahas beenreplaced by Sorjitamehaof Susrutasamhita -(AHS.Ni.10.14-153).

     VatajaPrameha                                                                                                          Carakasamhitaincludes four types of VatajaPrameha,namely VasSmeha, MajjSmeha,

    Hastimehaand Madhumeha -(CS.Su.19.121,CS.Ni.4.91, CS.Ci.6.71. Susrutasamhitarefers

    to the terms Sarpirmehaand Ksaudrameha -(SS.Ni.6.122-7 ) instead of Majjamehaand

    Madhumehaof Carakasamhitawhile AsthShgahrdayasarnhitahas followed Carakasamhita(AHS Ni 10.16 -183)

    Aetiology of Prameha

    Origination of Pramehais symbolically expressed in Carakasamhitaas it occured dueto excessive drinking of Ghee (Havisa)when the Lord Daksawas destroying the sacrifice -(CS.Ni.8.111 8 ) . The aetiological factors mentioned in classical texts are common forall types of Prameha.Aetiological factors can be classified according to the nature of effecton the kidney. Susrutasamhitahas emphasized

    two categories: Hereditary and Acquired.Hereditary causes include the defects of Bija (Sperm or Ovum). Acquired causes of Pramehainclude inappropriate food and life style -(SS.Ci.11.032).

    Genetic Factors

    Susrutasamhitahas identified the geneticinvolvement in pathogenesis of Prameha -

    SS.Ci.11.032). Carakasamhitamentions that, indescribing the prognosis of Prameha,genetic

    involvement of the disease is a cause of poorprognosis. Further Cakrapanidatta,the great

    commentator of Carakasamhita,also elaboratesthat the Pramehamay be hereditary or

    congenital due to defects of Bija(Sperm orOvum)-(CS.Ci.6.578).

    Carakasamhitastates that congenital type ofdiseases can occur due to defect in bija,

    bijabhSgaor bfjabhSgSvayavS(CS.Sa.4.308).The bija, bijabhSgaand bijabhSgSvayavacan

    be compared with Ovum and Sperm,Chromosomes and Genes respectively.

    Cakrapanidattacomments that this defect isdue to the indulgence in inappropriate foods at

    the time of pregnancy. Carakasamhitafurtherstates that excessive use of sweet taste during

    pregnancy may cause birth to a child affectedwith Pramehaand obesity (CS.Sa.8.218).

    Genetic influence and factors that affect thefoetal nutrition are the primary causes of

    Prameha.In comparison to the modernmedicine, Diabetes Mellitus is a leading

    disease, which shows abnormalities in the urineand causes renal damage. Genetics involvement

    is accepted as a significant aetiolgical factor -Level "A" evidence4 Monogenic forms and

    susceptibility genes have also been identifiedin both forms of Diabetes Mellitus Type 1 and

    Type 2.

    Non • Genetic Factors

    Nutrition:

    Epidemiological studies have reported a higherincidence of Type 2 Diabetes Mellitus in

    subjects with a low birth weight. The hypothesisthat nutrition of the mother can profoundly affect

    the metabolic outcome of the offspring has beenconfirmed by elegant mechanistic animal

    studies. Low birth weight is accepted as asignificant aetiological factor - Level "A"

    evidence. Poor nourishment of the foetusincreases the risk of metabolic syndrome and

    Type 2 Diabetes Mellitus and postnatal over -nutrition may aggravate the syndrome4.

    Food Habits

    Excessive utility of foods that increases bodyweight, fat content of the body (CS.Ni.4.141)

    and foods that are acid, salt - (CS.Su.17.381)and sweet - (SS.Ni.6.37) in taste are main

    causes of Prameha.Excessive utility of food that possesses the

    properties such as Sitaand Snigdha -(SS.Ni.6.37) and rice prepared from recent

    harvest, water obtained from recent rain, leadto increase the constituents such as Slesma,

    Pitta, Medasand Mamsa -(CS.Su.17.381).These conditions affect the proper function of

    vata.The vitiated vataattracts djaand propelsit into vasti,which causes Madhumeha

    (CS.Su.17.381, CS.Su.17.78-821), which is themost difficult to cure and is the fatal state of

    the clinical course of Prameha.Excessive use of food that are sweet in taste,

    excessive use of rice obtained from recentharvest, recently prepared alcohol, meats

    obtained from terrestrial animals (Anupa)andaquatic animals (Audaka)and diary products,

    sweets prepared from Jaggery and Pisfaka(foods prepared from flour) etc are the causes

    of over nutrition (CS.Su.23.21).According to the modern research, which

    confirms the facts mentioned in ancientAyurvedic texts, high frequency of intake of

    foods rich in carbohydrate, protein ornitrosamine compounds too will increase the

    risk of insulin dependant diabetes in human6.Proteins from cows' milk may trigger the

    autoimmune response that destroys Beta cellsof pancrease in laboratory rats. It has been

    suggested that proteins in cows' milk are alsorisk factors for human diabetes1 2 . Children who

    develop diabetes are often breast fed for ashorter period1

    Behaviour:-

    Excessive sleeping, desire for sleeping duringthe day time, indulgence in long-term sitting,

    lack of exercise (sedentary life style) -(CS.Ni.4.141), lack of thinking, lack of

    m e d i c i n a l p u r i f i c a t i o n s , d e s i r e forPrameha Pidaka- (CS.Su.17.3-41,

    CS.Su.17.381 , CS.Su.23.21 , SS.Ni.6.37). inaddition to, Kota, Kandu, Pandu, Jvara,

    Kustha, Visucikaderived from Ama, Mutrakrcchra, Arocaka, Tandra, Dvajabhahga,

    Atistulata(Obesity), Lasyness, Heaviness ofthe body, Indriyasand Srotasfilled with Mala,

    Difficulty in concentration of mind, Thoughtfulness, Oedema and other related

    conditions - (CS.Su.23.21).

    Secondary Causes of Prameha

    Obesity

    Obesity can act as a secondary cause in thegenesis of Prameha- (CS.Ni.4.14'). Obesity

    and Leanness depend on the state of Rasa(Nutrients).Excessive use of food that cause

    the increase of Kapha,excessive repetition ofintake of meal, absence of exercises and

    sleeping during the day time are the reasons ofobesity, which leads to serious complications

    such as Prameha, Vidradhi, Pidaka, SvasaandVatavyadhietc - (SS.Su.15.387).

    Modern investigations show that there is globalepidemic of obesity affecting all ages and is

    associated with insulin resistance, impairedglucose tolerance and cardiovascular diseases.

    Physical inactivity is independently associatedwith increased insulin resistance. Lifestyle

    changes in subjects with impaired glucosetolarence decreases progression to Diabetes

     

    Mellitus. Physical inactivity has also been accepted as a significant aetiological factor -

    Level "A" evidence.

    Functional and Organic Defects of Urinary System

    The retroward action of Vatadue to the functional and organic defects of urinary system (Vasti)

    leading to urinary retention cause Prameha ,Mutradosa(abmormalities of urine), Sukradosa

    (abnormalities of seman and seminal fluid),Mutraghata(obstructions of the urinary system)

    - (SS.Ni.3.272). Asmarf(urinary calculi) too isone of the leading causes of Pramehaspecially

    Sikatameha , SarkaramehaandBhasmakhyameha(SS.Ni.3.13-152).

    Stress

    Evidences from animal studies and mechanisticstudies suggest a relationship between stress

    and insulin resistance with predisposition toType 2 Diabetes Mellitus and it has been

    accepted as an aetiological factor - Level "B"evidence (Partial acceptance subject to

    confirmation.

    Iatrogenic Causes of Prameha

    Administration of medical procedures and medicines, which are liable to cause renal

    damage may produce Prameha.Indication ofDharaka Ausadha(Antidiarrhoeal Drugs) is an

    example - (Su.Ut.40.29 - 302). According tomodern investigations, many chemicals, which

    are administered as medicine, are identified ascauses of renal damage.

    Aetiology of Slesmaja Prameha

    Carakasamhitarefers to the specific aetiologyin respect to the major categories of Prameha.

    Food and changes in lifestyle are the predominantcauses of Kaphaja Prameha,in which

    Iksumehais included. According toCarakasamhita,aetiology of Slesmaja

    Pramehaincludes;Excessive utility of cereals such asHayanaka, Yavaka, Cinaka, Uddalaka,

    Naisada , Itkata , Mukundaka ,Mahavrrhi, PramodakaandSugandhaka(CS.Ni.4.58).Excessive utility of food prepared fromHarenuobtained from recent harvest,Juice of Masawith Ghee, meats

    obtained from domestic animals,aquatic animals and animals ofmarshy lands, saka,food preparedfrom gingelly and flour (Pi$taka),Diary products, Kusara,Vilepi,foodprepared from sugar cane, curd which

    is not prepared properly, liquids andsweets etc - (CS.Ni.4.5B).Absence from physical exercise and

    massages, excessive sleeping, longterm sitting and others, whichincrease Medaand urine -(CS.Ni.4.58).

    These factors play a major role in the pathogenesisof Iksumehaand modern investigations

    also accept the sedantory life style as anaetiological factor of Diabetes Mellitus Type 2.

    Aetiology of Pittaja Prameha

    Aetiology of Pittaja Pramehaincludes Excessive use of material, whichpossess the qualities such as U$na,Amla , Lavana, Ksara, KafukaandTik$na,Use of inappropriately prepared food or food that are liable to inappropriatedigestion; use of incompatible food,which cause the aggravation of pitta

    Excessive exposure to sunlight and heat; excessive exertion and anger -(CS.Ni.4.71).

    These aetiological factors may cause damagesof the kidney directly or indirectly.

    Aetiolgy of Vataja Prameha

    Aetiology of Vataja Pramehaincludes;Excessive use of material, whichpossess the qualities such as kasayakatu, tikta, ruksa, laghu, sita; Excessive indulgence of sexuality and exertion, excessive exposure tosunlight, uncontrolled feelings, sorrow,keeping awake at night, inappropriatepostures of the body, refrains fromnatural urges and trauma; Excessive administration of Emesis, Purgation,Asthapanatype of enema andSirovirecana,fasting, and excessivebloodletting;These factors will aggravate the Vata -

    (CS.Ni.4.91 ) especially Vyanaand Apana,causing Pramehaand Sukradosa-(SS.Ni.1.207).

    Pathogenesis

    The aetiological factors mentioned above lead to increase the body constituents such asSlesma, Pitta, Medaand Mamsa,which willmake the person fatty, weight gained andincrease the viscosity of body - (CS.Su.17.381,CS.Su.23.21 , SS.Ni.6.37). The vitiated dosa produces diseases according to the places,

    where they deposit and the Pramehaoccursdue to the deposition of vitiated dosain Vasti -

    (SS.Su.21.337).

    Pathogenesis of Slesmaja Prameha

    Increased s)esmadue to the influence ofrespective aetiological factors (Nidana)willvitiate dosaand affect the dusya(Tissues). Thevitiated Slesmawill disseminate throughout the body arid amalgamate with Meda, KledaandMamsa,which lead to generate gangrenes {Putimamsaja Pidaka)such as Saravika,

    Kacchapikaetc. The contaminated Kleda isconverted into urine, which consists of thecharacteristics of vitiated Slesma.VitiatedMedaand Kledaaffect the urinary systemobstructing the channels. Slesmaja Pramehaincludes ten sub-types classified on the basis of characteristics of urine.The characteristics, which are similar to thoseof Slesma,includes whiteness, coldness,hardness, viscousness, clearness,

    smoothness, heaviness, sweetness, ability toseparate into two layers as condensed and clear and the unpleasant smell of urine -(CS.Ni.4.51). At the initial stage of the disease, dosawill not be properly metabolized. Theunmetabolized dosaamalgamate with Meda -(SS.Ni.6.47)and propel into the channels

    carrying urine, which flow downward to excrete through the opening of Vasti(SS.Ni.6.47). Any

    type of Kaphaja Pramehacan arise at this stage.Generally all the three dosa, which involve in

    genesis of Prameha,affect the constituentssuch as Meda, Rakta, Sukra, Ambu, Vasa,

    Lasika, Majja, Rasa,Qfa,and Mansaof Vasti-(CS.Ci.6.6, CS.Ci.6.81). Dosa,which enters the

    vasti,contaminates urine and produces Prameha -(CS.Ci.6.41). Predominance of vitiated dosain Kaphaja Pramehasis Kapha and the mainly affected dusyais Meda.All subtypes of Kaphaja Pramehaoccur due to the amalgamation of vitiated Kapha, Vataand Pitta with Meda-(Su.Ni.6.97).

    Pathogenesis of Pittaja Prameha

    This is the second stage of Prameha,where the paths are obstructed by Medacausing the

    impairment of proper functions of vata,whichincreases the function of Agni (TTksnagni)and

     results in dryness of food and swift digestion -(CS.Su.21.5-7, CS.Ni.4.71). Pittaja Prameha

    occurs due to the amalgamation of vitiated pitta,vataand kaphawith dusyasuch as blood -

    (SS.Ni.6.97,CS.Su.24.51)and Meda -(SS.Ni.6.97). Pittaja Pramehaincludes the six

    sub-types on the basis of characteristics ofurine, which are similar to those of pittasuch

    as alkalinity, acidity, salty, pungentness, usna,and smell of raw flesh (CS.Ni.4.71).

    Pathogenesis of Vataja Prameha

    This is the tertiary stage of the Prameha.The person, who has excessive fat, will be broken

    down as fire burns forest, causing various typesof complications - (CS.Su.21.5-71).

    In comparison to Diabetes Mellitus, breakdownof fat occurs at this stage causing diabetic

    ketoacidosis. The vitiated vata,disseminatedthrough out the body bringing the lymph into

    the channels of urine, produces Vasameha.When vatabrings Majja, Lasika(Tissue fluids)

    and Ojainto urine, it produces Majjameha,Hastimehaand Madhumeharespectively

    (CS.Ni.4.91).Hastimehawill excrete excessive volume Hastimehawill excrete excessive volume of

     urine very slowly but it remains residual of urine in the bladder because of vitiated Vata -

    (CS.Ni.4.91). Probably it may be due to thedefects of neurogenic control on bladder.

    Fatal conditions such as Jvara, Pidakaand Bhagandaraoccur in the case of excessive

    growth of fat due to the influence of vitiated vata and Vataja Pramehaalso arises - (CS.Su.21.5-

    71). Vataja Pramehaoccurs due to the  amalgamation of vitiated vata, kaphaand pitta

    with Vasa, Majjaand Meda -(SS.Ni.6.97). Thevitiated vataalso attracts ojaand propels it into

    vasti,which causes Madhumeha,the final and the most serious stage, which is difficult to cure

    - (CS.Su.17.381). All types of Pramehalead to Madhumehadue to lack of management

     Conclusion

    Slesmaja, Pittaja,and Vataja Prameharepresent three clinical stages of renal damage. Slesmaja Pramehais the initial stage,where the function of kidney is impaired mildly.Pittaja Prameha,the second clinical stage of Prameha,shows moderately impaired renalfunctions and at the third stage, the VatajaPrameha,renal functions are affected severely.In comparison, Diabetes Mellitus passes thesethree clinical stages during its clinical course.

    The stage of impaired glucose tolerance, whichmay show polyuria without sugars in urine, can

    be included in Udakameha.The stage of impaired glucose tolerance, which showspolyuria and glycosuria, are included in Iksumeha.The stage of impaired glucose

    tolerance, which shows polyuria, glycosuria and albuminuria are included in Sandramehaand

    so forth.

    . References:

    1. Buddhadasa R, Eds. 1960. Carakasamhita,Department of State Languages, Colombo.

    2. Buddhaddsa R, Eds. 1962. Susrtasamhita,Department of State Languages, Colombo.

    3. Buddhadasa, R., Ed. 1964. Asthangahrdayasamhita, 1" Edi, Department of State Languages,        Colombo.

    4. Diabetes Association of Sri Lanka, 2002. Diabetesin Asia 2002;4 m international conference.   Colombo.

    5. Elliot, R.B., Martin. J.M.. 1984. Dietary protein: atrigger of insulin dependent diabetes in the BB rat.Diabetolodia26: 297-299.

    6. Gisela G Dahlquist., Leif G Blom., Lars Ake

    7. Jadavji Trikamji Acarya, Eds. 1931. Susrtasamhita,Nirnayasagar Press, Bombay.

    8. Jadavji Trikamji Acarya, Eds. 1994. Carakasamhita- 4'" edi, CaukhambhaSamskrit Samsthan, Varanasi.

    9. Krishnamurthy, K.H.; Sharma, P.V., 2000. BhelansamhitSr.Chapter VI. 155-157. Chaukhamba

    Visvabharathi, Varanasi.

    10. Patterson, C.C., Thorogood, M., Smith, P.G.,Heasman, M.A., Clarke, I.A., Mann, J.I., 1983.

    Epidemiology of Type 1 (insulin dependant) diabetes in Scotland 1968-1976: evidence of an increasingincidence. Diabetologia24: 238-243.

    11. Radhakantadeva. Eds. 1813. Sabdakalpadruma

    Vol III: 285. Calcuta.

    12. Scott, F.W., Daneman, D., Martin, J.M., 1983.Evidence of a critical role of diet in the developmentof insulin dependant diabetes mellitus. DiabetesRes:1 5 3 - 157.

    13.Sharma, R.K., Das, B., 1998. Agnivesa's

     

    AUTHOR BIO:

    Dr.Vikram Chauhan (MD-AYURVEDA) is an Ayurvedic practitioner based in Mohali, India. He is spreading the knowledge of ancient healing treatment of Ayurveda not only in India but also abroad. He has researched age old formulas from ancient Ayurvedic text books to restore health and save human beings from the worst side-effects of chemical based treatments. Dr.Vikram Chauhan is also the author of 'Ayurveda- God's Manual For Healing', an informative book for people interested in learning basics of Ayurveda, diet and principles of healing according to Ayurveda system of medicine. He is CEO and Founder of Planet Ayurveda Products, Planet Ayurveda Clinic and Krishna Herbal Company.

    Website – www.planetayurveda.com

     

    Contact:

    DR.VIKAS DUBEY, B.A.M.S(M.D)AYU B.V.D.U COLLEGE OF AYURVED                    MOB-9479427096 ,8237250287    E-MAIL ; This email address is being protected from spambots. You need JavaScript enabled to view it.,

     

     

  • ROLE OF TILNILOTPAL GANDUSHA IN MANAGEMENT OF MUKHAPAKA / Apthous ulcer

      “ROLE OF TILNILOTPAL GANDUSHA IN  MANAGEMENT OF MUKHAPAKA”

     

    Dr. Dubey Vikas

    M.D. (Scholar)

    Bharti Vidyapeeth AyurvedaCollege,

    Dhankawadi, pune 411043

    E-mailAddress-This email address is being protected from spambots. You need JavaScript enabled to view it.,

    Phone no. – 08237250287, 09479427096

     

    Second Author-

     Dr.PATWARDHAN. R.P

    M.D. (AYU)

    PROFESSOR SWASTHAVRITTA

    Bharti Vidyapeeth AyurvedaCollege, Dhankawadi, pune 411043

    Phone no.- 09422522723

     

    ABSTRACT:-

     

    Now a day lifestyle is drastically changed. Due to increased pollution,Fast life style, junk food habit and addictions  problems of oral health are arising progressively. Therefore there are increased problems regarding bad oral hygiene.Among various Mukharogas, Mukhapaka is Pittaja Nanatmaja and Rakta Pradoshaja Vikara, characterized by VedanayuktaVrana in the Mukhaguha. The lakshanas of Mukhapaka can be co-related with apthous ulcer (recurrent ulcerative stomatitis) explained in modern medical science.

    In Ayurveda,  non-practice of  gandusha etc. are  said to be major cause for mukhapaka.Indirectly  it infers  the  importance of  gandusha  because the  physical,  thermal and  chemical causes  of injury  to  oral cavity  (due to  exposure  to various  risk factors)  can  be  better  counteracted  by  practicing  gandusha  daily.  Clinical trial on a single group of 60 patients having mukhapaka,was carried out.

    Patients was given Tilnilotpaladi  kwatha Gandusha for period of 7 days in every morning empty stomach.

    60 patients studied, maximum number of patients(51.66) belonged to the age group of 20-30 years,Male sex (65%), and upper middle socio economics status (41.6%),mixed diet (61.66),addicted to smoking(38.33%),occupation (20% ) IT professionals.

    32% individuals have shown good response,53% sown moderate Response,and 15% shown mild response.

    KEYWORDS:Mukhapak, Tilnilotpaladi Yoga, Apthous ulcer.

    INTRODUCTION-:

    -: Mukha Swasthya (oral hygiene) has gained importance now a day, because mukha is such anga, which is exposed to many risk factors in day-to-day life.

    ØDue to increased pollution, junk food habits and addictions like tobacco-guthaka chewing, smoking, soft drinks; problems are arising progressively.

    ØTherefore, problems regarding bad oral hygiene are progressively increased.

    ØIn Ayurvedic text, Aphthous ulcer is denoted as ‘Sarvasar rog’ or ‘Mukhapaka’ due to its spread in the complete oral cavity (mukha) [2, 3, 4].

    ØMukhapaka is Pittaja Nanatmaja & rakta Pradoshaja Vikara, characterized by Vedanayukta Vrana in the Mukha guha.

    ØThe lakshanas of Mukhapaka can be co-related with Apthous ulcer; explained in modern medical science

    AIM:-

    — Management of Mukhapaka by Tilnilotpaladi Gandusha.

     OBJECTIVES :-

    — To study the role of Gandusha as an Upakrama of Dinacharya.

    — To assess the role of Tilnelotpaladi Gandusha in the prevention of recurrent Mukhapaka.

    — To study in detail about Mukhapaka. (Apthous ulcer).

    This section includes following headings.

    1. Ayurvedic review

    a.  Mukha Shareera

    b. Mukhapaka

    c.  Gandusha

    2. Modern review

    a.  Anatomy of oral cavity

    b. Pathology related to Apthous ulcer.

    MUKHAPAKA

    Ø Mukhapaka is a condition characterized by vedana & shopha yukta vrana in the mukha guha pratyangas.

    ØMukhapaka can be correlated with a disease entity ulcerative stomatitis, in which apthous ulcers are very common with recurrent episodes.

    Types –Acc. to Charak, Sushrut & Madhav nidan

    1. Vataja Mukhapaka

    2. Pittaja Mukhapaka

    3. Kaphaja Mukhapaka

    Vaghbata - Raktaja and Sannipataja mukhapaka.

     GANDUSHA

    ØThe word Gandusha is formed by Gadi + Gandescha which mean mukha purnam i.e. filling the mouth.

    Gandusha is the procedure of holding any liquid in the mouth to its full capacity without any movement inside. It is usually done with drava (liquid

    TYPES

    Based on doshagnata and karmukata Gandusha is classified mainly into four types. They are - 

    Snaihika (lubricating) – indicated in diseases of vata

    Shamana (matigating) – indicated in diseases of pitta

    Shodhana (purificatory) - indicated in diseases of kapha

    Ropana (healing) – indicated in ulcerations of mukha

    Anatomy of Mouth

    ØA mucosa lined cavity is also called the oral cavity or Buccal (bucca-cheeks) cavity.

    ØIt is formed by cheeks laterally, soft and hard palate superiorly.

    ØAnterior opening is oral orifice & posteriorly it is continuous with the oropharynx.

    REVIEW OF STOMATITIS :

    Definition:General term for diffuse inflammation of the mouth.

    Apthous ulcer (recurrent ulcerative stomatitis) :

    ØThis is a commonest recurrent condition of unknown etiology characterized by painful superficial ulcers in movable mucosa of the mouth.

    ØGenerally these ulcers are seen in buccal mucosa, lips, tongue, floor of the mouth, soft palate & oro-pharynx.

    ETIOLOGY :-

    ØThe cause is obscure.

    ØSome probable causative factors are emotional stress, viral infections, endocrine disorders psycho-somatic factors, habitual constipation, auto-immune reaction.

     

    TYPES :-

    There are three main clinical types

    1. Minor apthae

    2. Major apthae

    3. Herpetiform apthae

    MATERIALS AND METHODS:

    Title of study:-

            “Role of Tilnilotpaladi Gandusha in Management of Mukhapaka”

    Place of study:-

            OPD and IPD of  B.V.D.U. Ayurved Hospital, Pune ,Maharashtra (India).

    Sample Size:- Clinical trial on a single group of 60 persons having mukhapaka, was carriedout.

    Drug & Duration of Therapy:-

    Selection of Upakram :-

    Upakrama  :- Gandusha

    Time          :- In Morning (After Dantadhavana)

    Form         :- Kashaya (Decoction)

    Quantity     :-80-120 ml (As per oral liquid  holding capacity  of the patients)

    Drug Ingredients-

     Tilnilotpaladi yoga:- 

     1.Tila (Sesamum Indicum)

    2.Nilotpal (Nymphaea stella)

    3.Ghee       

    4.Sugar,

    5.Milk

    6.Honey. (5,10)

     

    Procedure  :-

    ØThe patient asked to sit in erect posture.

    ØThe neck, cheeks and the forehead of the patient to be treated with Gandusha, massaged and fomented.

    ØGandush has been so long held in the mouth by the patient till the aggravated dosha accumulated in regions of the cheeks or secreted through the nostrils & the eyes.

    Inclusion Criteria :-

    ØPatient complaining of recurrent Mukhapaka.

    ØPatients between age group of 20-50 years.

    ØPatients of both sex included in the study.

    Exclusion Criteria :-

    As per Bhavaprakasha Purvakhanda, patient contraindicated for Gandusha excluded –

    ØGandusha is contraindicated in unconscious, poisoned, weak, krisha person, patient suffering from bleeding disorders and conjunctivitis.

    ØPatient having chronic or carcinogenic ulcers in oral cavity.

    ØMukhapaka due to any other disorders e.g. Syphilis, AIDS, Dengue Haemorrhagic Fever etc.

    ØPatients suffering from any other systemic disorders.

     

    ASSESMENT CRITERIA

    Efficacy of  the therapy  was assessed in  the signs  and symptoms before  and after the course of Gandusha.

    It was assessed on the basis of self-formulated scoring scale to signs and symptoms of Mukhapaka as follows.

     

    Assessment of parameters for Mukhapaka:

    1. Ruja (pain) using VAS scale for pain Assessment

     

    No pain

    0

    Mild-pain during churning of food

    1

    Moderate-pain during talking and

    gets relief by topical anesthetics

    2

     

    Severe- pain even during rest,

    No relief by topical anesthetics

    3

     

     

    2.  Daha (burning sensation)

    No daha

    0

    Mild-tolerable, no need of cooling agents Likeglycerin or cold juice

    1

     

    Moderate-intolerable,Gets relief by cooling agents

    2

     

    Severe- intolerable, no relief by cooling agents

    3

     

     

    3.   Raktavarnata (Reddness)

    No redness

    0

    Dull red or pink red

    1

    Colour of mazanta

    2

    Bright red

    3

     

    4.  Size of the vrana

    Size of the vrana 0 mm

    0

    Size of the vrana between 0—5 mm

    1

    Size of the vrana between 6—10 mm

    2

    Size of the vrana more than 10 mm

    3

     

    5.  No of Vrana

    No Vrana

    0

    Number of Vrana  0  - 1

    1

    Number of Vrana  1  - 3

    2

    Number of Vrana more than  3

    3

     

     

    Assessment of Parameter for mukhaswasthya

    1.  Frequency of attack:-

     

    No relapse up to 2 Months

    0

    One attack every 2 Months

    1

    One attack every Months.

    2

    Two or more attacks in a months

    3

     

     

    FOLLOW UP

     

    Follow up will be done periodically for total duration of 21 days.

    — 1st follow up :-  3th day

    — 2nd follow up:- 7th day

    — 3rd follow up :- 14st day (Post Treatment)

    — 4th  follow up:- 21th day (Post Treatment) 

     

    Observation and results

    1.Age wise distribution :-There were maximum no. of patients i.e.51.67 % in age group 20-30 and 38.33% in age group 30-40 also minimum no. of patients i.e.10% in age group 40-50.

     

     

    2.Sex wise distribution

    Sex

    No of Patients

    Percentage

    Female

    21

    35.00%

    Male

    39

    65.00%

         Total

    60

           100%

         

     

     

    There were Maximum no. of patients i.e. 65 % were males and 35% were females.This indicated its more incidence rate in males.

    3.Dietary Habitat wise distribution

    There were Maximum no. of patients i.e. 61.67% were mixed and minimum i.e.38.33% were vegetarian. The ancient Ayurvedic physicians were aware of the ‘Apathyakara Ahara and Vihara' (unsalutary life style and food habits) as the most important causative agent [6, 7, 8].

    Diet

    No of Patients

    Percentage

    mixed

    37

    61.67%

    vegetarian

    23

    38.33%

    Total

    60

    100.00%

     

    4.Marital status wise distribution

    Marital status

    No of Patients

    Percentage

    married

    39

    65.00%

    unmarried

    21

    35.00%

    Total

    60

    100.00%

    It was found that maximum number of patients i.e. 65% were married, While 35 % Patients were unmarried.

     

    5.Occupation wise distribution

    Occupation

    No of Patients

    Percentage

    Bank Emp

    9

    15.00%

    BPO

    3

    5.00%

    Driver

    11

    18.33%

    Govt job

    2

    3.33%

    IT

    12

    20.00%

    Police

    6

    10.00%

    S/G( security guard)

    5

    8.33%

    Student

    7

    11.67%

    Teacher

    5

    8.33%

    Total

    60

    100.00%

     

    On considering the nature of occupation, it was found that maximum i.e.20% no. of patients were IT professionals while minimum i.e.3.33% no of patients having government job.

     

    6.Vyasanawise distribution:-

    Vyasana

    No of Patients

    Percentage

    Alcohol

    12

    20.00%

    Smoking

    23

    38.33%

    Tea

    22

    36.67%

    Tobaco

    3

    5.00%

    Total

    60

    100.00%

     

    This showed that maximum i.e. 38% patients were having smoking vyasan and mimimum no. of patients  i.e.5% having alcohol tobacco vyasan .

    7. vihara  wise distribution:-

    vihara

    No of Patients

    Percentage

    Divaswapna

    10

    16.67%

    No

    14

    23.33%

    R.Jagarana

    36

    60.00%

    Total

    60

    100.00%

    Patients  with  history  of ratrijagrana  were 60% and  16.67% had history  of Diwaswapa.

     

    8.Socio economic condition wise distribution

    The classification of patients based on their economic status indicates that people of high socio economic status were more susceptible (41.67%) to mukhapaka.

     

    Socio eco cond

    No of Patients

    Percentage

    Upper middle class

    25

    41.67%

    middle class

    23

    38.33%

    Lower class

    12

    20.00%

    Total

    60

    100.00%

         

     

    9.Family History wise distribution

     

    Family Histroy

    No of Patients

    Percentage

    no

    35

    58.33%

    yes

    25

    41.67%

    Total

    60

    100.00%

     

       

    Here, it was found that maximum numbers of patients i.e. 58.33% were having family history while 41.67% were not having family history.

     

    10.Prakriti  Family History

    Prakruti

    No of Patients

    Percentage

    kapha- vata

    1

    1.67%

    pitta- kapha

    28

    46.67%

    pitta-vataj

    1

    1.67%

    vata-kapha

    17

    28.33%

    vata-pitta

    13

    21.67%

    Total

    60

    100.00%

    It was found that  maximum no. of patients i.e. 46 .67% were belonged to pitta- kaphaPrakriti,, and minimum no. of patients i.e. 1.67% kapha –vataPrakriti.

    RESULTS:-

     

    1.Effect of Tilnilotpaladi Yogaon Rujain the management of Mukhapaka

    Ruja (Pain) :-

     

    Grade

    BT

    AT

    No. of patients

    BT

    No. of patients

    AT

    No Pain

    4

    6.66%

    32

    53.33%

    Mild Pain

    36

    60%

    21

    35%

    Moderate pain

    20

    33.33%

    7

    11.66%

    Sever pain

    0

    0%

    0

    0%

    Total

    60

    100%

    60

    100%

     

    Parameter

    N

    Mean

    Std Deviation

    Positive rank

    Negative rank

    Tie

    Z value

    P value

    Interpretation

    BT

    AT

    BT

    AT

    Ruja

    60

    0.766

    0.253

    0.721

    0.536

    10

    17

    24

    -0.652

    0

    S

    Here P value was >0.05 hence accept Hi.e.

    On associated symptoms of Mukhapaka, the improvement observed on Ruja (66.97%) was statistically significant.

    2.Effect of Tilnilotpaladi YogaonDaha in the management of Mukhapaka

    Daha (Burning Sensation) :-

    Grade

    BT

    AT

    No. of patients

    BT

    No. of patients

    AT

    No Daha

    0

    0%

    32

    53.33%

    Mild Daha

    34

    56.66%

    28

    46.66%

    Moderate Daha

    26

    43.33%

    0

    0%

    Sever Daha

    00

    0%

    0

    0%

    Total

    60

    100%

    60

    100%

    Parameter

    N

    Mean

    Std Deviation

    Positive rank

    Negative rank

    Tie

    Z value

    P value

    Interpretation

    BT

    AT

    BT

    AT

    Daha

    60

    2.6

    0.466

    0.616

    0.503

    0

    59

    1

    0.679

    0

    S

    Here P value was <0.05 hence reject Hi.e.

    On associated symptoms of Mukhapaka, the improvement observed (82%)on Daha was statistically significant.

    3.Effect ofTilnilotpaladi Yogaon RaktaVarnata of vranain the management of Mukhapaka

    Rakta Varnata of vrana[ Redness] :-

     

    Grade

    BT

    AT

    No. of patients

    BT

    No. of patients

    AT

    No Redness

    0

    0%

    14

    23%

    Dull Red (or) pink red

    33

    55%

    44

    73%

    Color of Magenta

    22

    37%

    2

    3%

    Bright Red

    5

    8%

    0

    0%

    Total

    60

    100%

    60

    100%

     

    Parameter

    N

    Mean

    Std Deviation

    Positive rank

    Negative rank

    Tie

    Z value

    P value

    Interpretation

    BT

    AT

    BT

    AT

    Rd.ofVran

    60

    1.533

    0.8

    0.65

    0.48

    0

    38

    22

    -5.809

    0

    S

    Here P value was <0.05 hence reject Hi.e.

    On associated symptoms of Mukhapaka, the improvement observed (91%)on RaktaVarnata of vrana was ethically significant.

    4.Effect of Tilnilotpaladi  YogaonNo. Of  Vrana in the management of Mukhapaka

    Parameter

    N

    Mean

    X

    % of relief

    SD

    Std error

    Z value

    p value

    BT

    AT

    BT

    AT

    BT

    AT

    No.OfVrana

    60

    1.116

    0.433

    0.683

    61.20%

    0.666

    0.499

    0.086

    0.065

    7.827

    0.00003

     

     

    Before treatment the mean score of No.Of Vrana was 1.116 which was reduced to 0.433 after treatment with 61.20% relief also p value is <0.05 hence it is statistically significant .

     

    5.Effect of Tilnilotpaladi YogaonSize of Vrana in the management of Mukhapaka

    Parameter

    N

    Mean

    X

    % of relief

    SD

    Std error

    Z value

    p value

    BT

    AT

    BT

    AT

    BT

    AT

    Size of Vrana

    60

    0.726

    0.266

    0.134

    63.36%

    0.616

    0.445

    0.079

    0.058

    6.823

    0.003

     

    Before treatment the mean score of Size of Vrana was 0.726 which was reduced to 0.266 after treatment with 63.36 % relief  but p value is <0.05 hence it is statistically significant.

     

    6.Effect ofTilnilotpaladi Yogaonfrequency of attack in the management of Mukhapaka:-

     

    Parameter

    N

    Mean

    X

    % of relief

    SD

    Std error

    Z value

    p value

    BT

    AT

    BT

    AT

    BT

    AT

    Freq attack

    60

    0.867

    0.3

    0.5667

    65.39%

    0.5956

    0.462

    0.076

    0.059

    6.082

    0.000032

     

    Before treatment the mean score of Freq attack was 0.867which was reduced to 0.3 after treatment with 65.39% relief also p value is <0.05 hence it is statistically significant .

    7.OVERALL IMPROVEMENT

     

    improvement

    No. of patients

    percentage

    Marked improvement

    19

    32%

    moderate improvement

    32

    53%

    Mild improvement

    9

    15%

    No improvement

    0

    0%

    Total

    60

    100%

     

    The above graph showed  that  there were 32 % patients  have  shown  good  response,  53%  shown  moderate while only 15% patients have shown mild response

     

    8.Study of Recurrence:-

    Grade

    No. of Patients

    %

      Recurrence

    53

    88.33

     

    Mild Recurrence

    04

    6.66

     

    Moderate Recurrence

    03

    5

     

    Sever Recurrence

    00

    0

               

     

    -88.33% Patient had no. recurrence after 21 days follow up study.

    -6.66% patients had recurrence of mild intencity.

    -5% patients had moderate degree of recurrence.

     

      

     

     Conclusion

           The conclusions drawn on the basis of this study are as follows.

    1. Among various mukharogas ,mukhapaka is considered as pittaja Nanatmaja and raktapradoshaja vikara ,characterized by vedana Yuktavrana inside the mukhakuhara.Nearly 60% of the population is suffering with this problem.

    2. The lakshanas of mukhapaka can be correlated to a clinical entity“Apthous ulcer” (recurrent ulcerative stomatities) explained in the contemporary medical science,which is also characterized by painful Superficial ulcers in the movable mucosa of the mouth with recurrent  episodes.

    3. Gandusha upakrama of dinacharya on of the important methods Mentioned in Ayurveda for maintenance of oral hygiene.

    4. Out of 60 patients studied, maximum number of patients (51.666%)  belonged to the age group of 20-30 years, Male sex (65%), and upper middle socio economic status (41.66%), mixed diet (61.66%), addicted to smokinge (38.33%).occupation ( 20%  ) IT professionals.

    5. Most of the patients were of pitta kaphaprakriti (46.33%), with positive history of ratrijagarana (60%).

    6. 32% individuals have shown good response,53% shown moderate Response, and 15% shown mild response.

    7. As Tilnilotpaladi Gandusha having madhur,kashyarasa,shetavirya and kaphahe-pittaghnaproperties,It removes aggravated kaph and pitta Guna from oral cavity.

    8. Hence from the study it is concluded that,Tilnilotpaladi Gandusha is an important upakrama of Dincharya mentioned in Samhitas which should befolled regularly,in order to prevent Mukharogas and  maintain  oral  hygine.

     

    References:-

     

    1.  [1] A Short Textbook of ENT- edited by K.B. Bhargava, S.K. Bhargava & T.M. Shah, 7th Edition-2005, Usha Publication, Mumbai, India, 228-229.

     

    2. [2] Vagbhatta’s Ashtanga Hridayam, Vol. 3 (Uttar sthan), translated by Prof. K.R. Srikanth Murthy, Edition Reprint-2006, and published by Chaukhamba Krishnadas Academy, Varanasi, U.P. India, Chapter 22, 184-197.

     

    3. [3] Illustrated Susruta Samhita of Sushruta, Vol. 1 & 2, translated by Prof. K.R. Srikanth Murthy, Edition Second-2004, published by Chaukhamba Orientalia Publication, Varanasi, U.P. India, Nidansthan Chapter 16-Page no. 563 & Chikitsasthan Chapter 22- Page no. 204-215.

     

    4. [4] Agnivesh’s Charak Samhita (Based on Chakrapani Datta’s Ayurved Dipika), Vol. 4, translated by Dr. Ram Karan Sharma & Vaidya Bhagwan Dash, Edition Reprint-2007, published by Chaukhamba Sanskrit series office, Varanasi, U.P. India, Chikista Sthan- Chapter 26-Page no. 505.

     

    5. [5] Dravyaguna Vigyan, Vol. 2, by Prof. P.V. Sharma, Edition Reprint-2006, published by Chaukambha Bharati Academy, Varanasi, U.P., India, Page no.882 & 585.

     

    6. [6] Bhavprakash of Bhavamisra (Uttarardha Madhyamkhanda), Part 2, 8th Edition-2003, edited with the Vidyotini Hindi Commentary by Pandiat Sri Brahmashankara Mishra published by Chaukhamba Sanskrit Sansthan, Varanasi, U.P., India, Chikistadhikar; Mukharogadhikar, Chapter 66-Page no. 720.

     

    7. [7] Bhaisajya Ratnavali-Vidyotini Hindi Vyakhya Vimarsh Parisishta Samhita-commentary by Shri Ambika Datta Shastri, edited by Kaviraj Rajeshwardatta Shastri, 16th Edition-2002, published by Chaukamba Sanskrit Sanshtan Varanasi, U.P., India, Page no. 676-677.

     

    8. [8] Yogaratnakar (Uttarardha), Vidyitini tika, by Vaidya Shri Lakshmipati Shastri, Edited by Bhishagratna Shri Brahmashankar Shastri, 7th Edition-2002, published by Chaukhamba Sanskrit Sansthan, Varanasi, U.P., India, Mukharoga Nidan/Chikitsa, Page no.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            296-97.

    9. [9] Dravyaguna Vigyan, Vol. 2, by Prof.Mansi Deshpanday, Edition Reprint-2015, published by Chaukambha Bharati Academy, Varanasi, U.P., India, Page no.457,644,648.

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