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By
K.S. ASWINI DEV.
Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences,Karnataka, Bangalore.
In partial fulfillment of the requirements for the degree of
AYURVEDA VACHASPATHI M.D. (PANCHAKARMA)
In
PANCHAKARMA
Under the guidance of
Dr. G. PURUSHOTHAMACHARYULU M.D. (Ayu)
Under the co-guidance of
Dr. SANTOSH . N. BELAVADI M.D. (Ayu)
Post graduate department of Panchakarma. Shri D. G. Melmalagi Ayurvedic Medical College.
Gadag – 582103.
2006.
CLINICAL STUDY ON “ROOKSHASWEDASTHADHACLINICAL STUDY ON “ROOKSHASWEDASTHADHACLINICAL STUDY ON “ROOKSHASWEDASTHADHACLINICAL STUDY ON “ROOKSHASWEDASTHADHACLINICAL STUDY ON “ROOKSHASWEDASTHADHA
NASYAM” IN THE MANAGEMENT OFNASYAM” IN THE MANAGEMENT OFNASYAM” IN THE MANAGEMENT OFNASYAM” IN THE MANAGEMENT OFNASYAM” IN THE MANAGEMENT OF
MANYASTHAMBHA (CERVICAL SPONDYLITIS)MANYASTHAMBHA (CERVICAL SPONDYLITIS)MANYASTHAMBHA (CERVICAL SPONDYLITIS)MANYASTHAMBHA (CERVICAL SPONDYLITIS)MANYASTHAMBHA (CERVICAL SPONDYLITIS)
Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.
DECLARATION BY THE CANDIDATE
hereby declare that this dissertation / thesis entitled
“Clinical Study On “Rookshaswedasthadha Nasyam” in the Manage-
ment of Manyasthambha (Cervical Spondylitis).” is a bonafide and
genuine research work carried out by me under the guidance of Dr. G.
Purushothamacharyulu, M.D.(Ayu), Professor & H.O.D, Post gradu-
ate department of Panchakarma and co-guidance of Dr. Santosh.N.
Belavadi M.D.(Ayu), Lecturer, Post graduate department of Panchakarma.
Date:Place: Gadag.
I
K.S. Aswini Dev
CERTIFICATE BY THE CO- GUIDE
This is to certify that the dissertation entitled “Clinical Study On
“Rookshaswedasthadha Nasyam” in the Management of Manyasthambha
(Cervical Spondylitis).” is a bonafide research work done by
K.S. Aswini Dev. in partial fulfillment of the requirement for the degree of
Ayurveda Vachaspathi. M.D (Panchakarma).
Date:
Place:Gadag. Dr. Santosh. N. Belavadi. M.D. (Ayu).
Lecturer,
Post graduate Department of Panchakarma.
ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF
THE INSTITUTION
This is to certify that the dissertation entitled “Clinical Study On
Rookshaswedasthadha Nasyam in the Management of Manyasthambha
(Cervical Spondylitis)” is a bonafide research work done by K.S. Aswini Dev
under the guidance of Dr. G. Purushothamacharyulu, M.D. (Ayu). Professor &
H.O.D, Postgraduate department of Panchakarma and co-guidance of
Dr. Santosh.N. Belavadi M.D. (Ayu), Lecturer, Post graduate department
of Panchakarma.
Dr. G. Purushothamacharyulu, M.D. (Ayu). Dr. G. B. Patil.
Professor & H.O.D. Principal.
Post graduate department of Panchakarma.
SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,POST GRADUATE DEPARTMENT OF PANCHAKARMA.
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “Clinical Study On
Rookshaswedasthadha Nasyam in the Management of Manyasthambha
(Cervical Spondylitis)” is a bonafide research work done by
K.S. Aswini Dev in partial fulfillment of the requirement for the degree of
Ayurveda Vachaspathi. M.D (Panchakarma).
Date:
Place:Gadag. Dr. G. Purushothamacharyulu. M.D. (Ayu).
Professor & H.O.D.
Post graduate Department of Panchakarma.
SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,POST GRADUATE DEPARTMENT OF PANCHAKARMA.
COPYRIGHT
Declaration by the candidate
I hereby declare that the Rajiv Gandhi University of Health
Sciences, Karnataka shall have the rights to preserve, use and
disseminate this dissertation / thesis in print or electronic format for
academic / research purpose.
Date:
Place:Gadag.
© Rajiv Gandhi University of Health Sciences, Karnataka.
K.S. Aswini Dev.
I
ACKNOWLEDGMENT By the god’s grace and blessing of elders, I would like to express my gratitude towards the personalities who helped me during my course of study. I express my obligation to my honourable guide Dr. G. Purushothamacharylu M.D. (Ayu) H.O.D. PG Department of panchakarma, for his critical suggestions and expert guidance for the completion of this work. I am extremely grateful and obliged to my Co-Guide Dr. Santosh. N. Belavadi, Lecturer, for his guidance and encouragement at every step of this work. I express my deep gratitude to Dr. G.B. Patil, Principal D.G.M.A.M.C, Gadag, for his encouragement as well as providing all necessary facilities for this research work. I express my sincere gratitude to Dr. P. Shivaramadu M.D. (Ayu), Professor and Dr. Shashidhar.H. Doddamani M.D. (Ayu), for their sincere advices and assistance. I express my gratitude to Dr. R.V. Shettar M.D. (Ayu), Dr. Samudri M.D.(Ayu) for their encouragement as well as suggestions for this research work. I express my sincere gratitude to Dr. Varadacharylu M.D. (Ayu), Dr. M.C. Patil M.D. Dr. Mulagund M.D. Dr. K.S.R. Prasad M.D. Dr. Dilipkumar M.D. Dr. Kuber sankh M.D. Dr. G. Danappa gowda M.D. Dr. U.V. Purad M.D. Dr. B.G. Swami M.D. Dr. J. Mitti M.D. Dr. Nidugundi M.D. and other P.G. Staff for their constant encouragement. I am thank full to Sri M.V. Mundinamani (Librarian) Sri Tippana gowda (Lab-Technician) Basavaraj (X-Ray Technician), Sri Chaitrakumar (Computer operator) for their help during my course of study. I express my sincere thanks to my colleagues and friends Dr. Udaykumar, Dr. Lingareddy Biradar, Dr. Krishnakumar, Dr. Chandramouliswaran. Dr. Ratnakumar, Dr. Prasanakumar, Dr. Ashok, Dr. Vijay Hiremath, Dr. Manjunath Akki, Dr. Suresh Akkandi, Dr. Subin Vaidyamadom, Dr. Satheesh Varrier, Dr. Febin .K. Dr. Ranjith, Dr. Shajil, Dr. Shyju ollakode, Dr. V.M. Hugar, Dr. Venka reddy, Dr. Kalmat, Dr. Jayraj Basarigidad, Dr. Kendadamath, Dr. Madhushree, Dr. Shiba, Dr. Payappagouder, Dr. Budi, Dr. Nataraj, Dr. Adarsh, Dr. Uday Ganesh, Dr. Kumbar, Dr. Mukta.H. and other P.G Scholars for their support. I lay my deep respects to my grand parents Late: Sri Kuttan Pillai, Sumathi kutty Amma, Late: Raghavan Pillai and Ponnamma for their elderly blessings upon me. I also thankful to my uncles Mohanan. Devananthan, Suresh kumar, Madhukunar, Mohana krishan, Dr. Harikrishnan and aunts chandrika, Geetha, smitha, Sheeja, Suja, Sindhu, Prameela for their moral support. I pray homage to my dearest uncle Late Shri Bhankara Pillai for his love affection.
II
I would like to put the support and inspiration provided by Dr. M.N Raveendran Nair (Retd. Principal) Dr. M.S. Suseelappan (Retd. Principal) Dr. Sukumaran Nair (Rtd. Principal), Dr. Keshavadas M.D. (Ayu), Dr. P.S. Gopi Rtd. D.M.O (is M Kerala), Brahmasree Astavaidyan Vaidyamadam cheriya Narayana Nambudiri, Dr. Rajukutty, Dr. Sahadevan, Dr. Mathew’s Vempilly, Dr. Mustattakamal, Dr. A. Satyanarayana, Smt. P.B Pankaja, Dr. Krisha Kutty Nair (Rtd. Superdient of Panchakarma, Dr. Rajini sunel. I also acknowledge the support and inspiration provided by my teachers Dr. Vasadeva Redder, Dr. Brahma, Dr. S. Swaminatan, I also thank Sri Habib Katib and family for the support and acknowledgment provided during my stay at Gadag. I acknowledgment my parents for their whole hearted consent to participate in his clinical trial. I express my thanks to all the persons who have helped me directly and indirectly with apology for my inability to identify then individually. Finally I express my deep love and affection to my respected parents Sri Dr. R. Sasidharan Pillai (Retd. Govt: Medical Officer) and Smt. Girija S. Pillai who are the prime reasons for all my success.
(K.S. Aswini Dev)
III
LIST OF ABBREVIATIONS
⇒ A. H. – Ashtanga Hridaya.
⇒ B. P. – Bhavaprakasha
⇒ C. S. – Charaka Samhita.
⇒ G. R. – Good response.
⇒ M. R. – Moderate response.
⇒ N. R. – No response.
⇒ P. R. – Poor response.
⇒ S. S. – Sushruta Samhita.
III
LIST OF ABBREVIATIONS
⇒ A. H. – Ashtanga Hridaya.
⇒ B. P. – Bhavaprakasha
⇒ C. S. – Charaka Samhita.
⇒ G. R. – Good response.
⇒ M. R. – Moderate response.
⇒ N. R. – No response.
⇒ P. R. – Poor response.
⇒ S. S. – Sushruta Samhita.
IV
ABSTRACT
The present study and clinical study on the Rookshaswedasthadha Nasyam in the
management of Manyasthambha is focused on the techniques of pinda sweda and
additive effect of Nasya and a common disorder of Manyasthambha. Rookshasweda and
Nasya is believe to have a note worthy role in the management of such inflammatory and
degenerative condition by imparting strength to the cervical spine, its related structures
and nervous system.
The objective of the study are 1) To evaluate the efficacy of Rooksha sweda in the
management of Manyasthambha. (Cervical spondylitis) 2) To evaluate the efficacy of
Rooksha sweda and Nasya in the management of Manyasthambha (Cervical spondylitis).
3) To evaluate the comparative efficacy of both these treatment groups in the
management of Manyasthambha (Cervical spondylitis)
The aim of the study was to find out the effect of Rooksha sweda and Nasya in
the management of Manyasthambha and to check the advantage of Nasya over Rooksha
sweda in Managing the same disease therefore two groups were made. The study design
selected for the present study was prospective comparative clinical trial.
The result of the study confirmed that Rookshasweda has highly significant in
Ruk, Graha, Extension and Lateral flexion of neck in group A. In group A Muscle
strength and Rotation showed no significant Result.
In group B muscle strength showed no significant result, and rest of the
parameters showed highly significant results. This increased significance of the
parameters is may be due to the additive effect of Nasya along with Rooksha sweda.
V
In the classic, the Treatment is told as Rooksha sweda and Nasya where we
consider Manyastambha in the doshic level as vata and kapha are the two main factors
involved in the pathogenesis of Manyasthambha. Here the pain and stiffness are two
symptoms present in the disease which can be attributed the vata and kapha dosha
lakshna Rooksha sweda is told for srotoshodhana ther by subside the vitiated kapha
which is in the Manya predesha and for this purpose, Rooksha sweda by Kolakulathadi
choorna is done which relieves the pain and stambatwa.
Manyasthambha being one of the urdwajatru gatha vikara and especially dhatu
kshayajanya vata roga hence Brumhana type of nasyakarma is more beneficial.
Brumhana Nasya karma has been selected for the study become the disease
Manyasthambha is inflammatory and degenerative in origin and Urdwajatagata vata
vyadhi. Hence nasyakarma with Mahamasha thaila is best advisible to palliate the
disease which helps to set right the disease as it being santarpana type of chikitsa which
prepared with vatahara drugs.
Key words: Rooksha sweda, Kolakulathadi Choorna, Manyasthambha, Cervical
spondylitis, Nasya, Mahamasha taila, etc.
Table of Contents Chapter Page No.
1 Introduction 1-4
2 Objectives 5-7
3 Review of literature 8-103
4 Methods 104-131
5 Results 132-170
6 Discussion 171-182
7 Conclusion 183-184
8 Summary 185
9 Bibliographic References
10 Annexure
i
LIST OF TABLES LIST OF TABLES Page No.1. Table Showing Classification of Nasya according to Various Acharya 11 2. Table Showing the dosage schedule for sneha nasya is as below 16 3. Table Showing dosage schedule according to Sushruta. 17 4. Table Showing indications of Nasya according to season 18 5. Table Showing the time schedule of Navana Nasya 18 6. Table Showing dose of Shirovirechana 20 7. Table Showing the indication of avapida Nasya 20 8. Table Showing the length of dhuma yantra nadi 22 9. Table Showing drugs used fo Dhuma nasya 22 10. Table Showing various Timings for Pratimarsha Nasya 24 11. Table Showing the contra Indications of Nasya mentioned in
Brihattrayi 29
12. Table Showing time schedule in different seasons 31 13. Table Showing time schedule in Doshaja Vikara 31 14. Table Showing the Course of Nasya karma 32 15.
Table Showing The Dosage of Nasya Karma 33
16. Table Showing Nasya Yantra
35
17. Table Showing Samyaka Yoga Lakshana
38
18. Table Showing ayoga Lakshana 39 19. Table Showing atiyoga Lakshan 40 20. Table Showing the properties, action and predominance of
mahabhootas of swedana dravyas 46
21. Table Showing the persons and diseases that are fit for swedana. 47
22. TableShowing the persons and diseases those are unfit for Swedakarma.
48
23. Table Showing the lakshanas to be observed on the patient 50
24. Table Showing the Atiswinna lakshanas on the patient 51
25. Table Showing types of sweda 53
26. Table Showing the different layers of twak 73 27. Table Showing the incidence of Nidana of Manyasthambha according
to different Acharyas 89
28. Table Showing Level of disc herniation 99 29. Table Showing the Pathyaapathyas in Vatavyadhi 101
30. Table Showing chikitsa of Manyasthamba according to different Acharyas
102
31. Table Showing the Rasa, guna, veerya, vipaka, and dosha karma of kolakulathadi choorna.
111
32. Table Showing the Table of Mahamasha taila 112 33. Table Showing distributions of patients by age Groups. 133 34. Table Showing distributions of patients by sex 134 35. Table Showing distributions of patients by Religion 135 36. Table Showing distributions of patients by Occupation 136 37. Table Showing distributions of patients by Economical status 137
ii
38. Table Showing distributions of patients Dietary habit 138 39. Table Showing distributions of patients by Agni 139 40 Table Showing distributions of patients by Koshta 140 41 Table Showing distributions of patients by Nidra 141 42 Table Showing distributions of patients by Vyasana 142 43
Table Showing distributions of patients by Deha-prakriti 143
44 Table Showing distributions of patients by Satmya 144 45 Table Showing distributions of patients according to chronicity of the
disease. 145
46 Table Showing distributions of patients by Ahara Nidana: 146 47 Table Showing distributions of patients by Vihara Nidana: 147 48 Table Showing distributions of patients by Manasika Lakshana: 148 49 Table Showing Distributions of patients by different grades of RUK 149 50
Table Showing response of patients by different grades of RUK 150
51 Table Showing distributions of patients by Different grades of Graha 151 52 Table Showing response of patients by different grades of Graha 152 53 Table Showing distributions of patients by different grades of (Passive
neck flexion) 153
54 Table Showing response of patients of patient by different grades of (Passive neck flexion)
154
55 Table Showing distributions of patients by different grades of muscle strength
155
56 Table Showing the over all treatment Response in patient of different grades of Muscle strength in both the treatment Groups (A&B):
156
57 Table Showing distributions of patients by different grades of Mobility gradings (flexion)
157
58 Table Showing the over all treatment Response in patient of different grades of Mobility grading (flexion)
158
59 Table Showing distributions of patients by different grades of Mobility extension
159
60 Table Showing the over all Response in patient of different grades of Extension
160
61 Table Showing distributions of patients by different grades of Lateral flexion
160
62 Table Showing the over all Response in patient of different grades of Lateral flexion
161
63 Table Showing distributions of patients by different grades of Rotation in both the treatment Groups (A&B):
161
64 Table Showing the over all Response in patient of different grades of Rotation
162
65 Table Showing distributions of patients by different grades to Over all Response
162
66 Table Showing Overall response of each parameter 163 67 Table Master Chart of Subjective and Objective Parameters. 164 68 Table Showing Statatical analysis of Group A 165 69
Table Showing Statatical analysis of Group B 165
70 Table Showing Comparative statistical analysis of both Groups (A & B).
166
iii
71 Table Showing the response of Nasyakarmukata in Group A. 167 72 Table Showing the response of Nasyakarmukata in Group B. 168 73 Table Showing Statatical analysis of Nasyakarmukata in Group A 168 74 Table Showing Statatical analysis of Nasyakarmukata in Group B 168 75 Table Showing the response of Swedakarmukata in Group-A. 169 76 Table Showing the response of Swedakarmukata in Group-B. 169 77 Table Showing the study of Sweda kaarmukata parameters of Group-A. 170 78 Table Showing the study of Sweda kaarmukata parameters of
Group-B. 170
LIST OF FIGURES PHOTOGRAPHS AND GRAPHS
LIST OF TABLES Page No.1. Figure Showing section of skin 75 2. Figure Showing Cervical vertebrae (C1-C4) Postrio-superior view 80 3. Figure Showing Cervical vertebrae (C2-T1) Right lateral view 81 4. Figure Showing the Ingredients of Kolakulathadi choorna 104 5. Figure Showing the treatment procedures of Nasya and Rookshasweda 123 6 Graph Showing distributions of patients by age Groups. 133 7 Graph Showing distributions of patients by sex 134 8 Graph Showing distributions of patients by Religion 135 9 Graph Showing distributions of patients by Occupation 136 10 Graph Showing distributions of patients by Economical status 137 11 Graph Showing distributions of patients Dietary habit 138 12 Graph Showing distributions of patients by Agni 139 13 Graph Showing distributions of patients by Koshta 140 14 Graph Showing distributions of patients by Nidra 141 15 Graph Showing distributions of patients by Vyasana 142 16
Graph Showing distributions of patients by Deha-prakriti 143
17 Graph Showing distributions of patients by Satmya 144 18 Graph Showing distributions of patients according to chronicity of the
disease. 145
19 Graph Showing distributions of patients by Ahara Nidana: 146 20 Graph Showing distributions of patients by Vihara Nidana: 147 21 Graph Showing distributions of patients by Manasika Lakshana: 148 22 Graph Showing Distributions of patients by different grades of RUK 149 23 Graph Showing distributions of patients by Different grades of Graha 151 24 Graph Showing distributions of patients by different grades of (Passive
neck flexion) 153
25 Graph Showing distributions of patients by different grades of muscle strength
155
26 Graph Showing distributions of patients by different grades of Mobility gradings (flexion)
157
27 Graph Showing distributions of patients by different grades of Mobility extension
159
28 Graph Showing distributions of patients by different grades of Lateral flexion
160
29 Graph Showing distributions of patients by different grades of Rotation in both the treatment Groups (A&B):
161
30 Graph Showing distributions of patients by different grades to Over all Response
162
iv
Introduction
There are many marvels created by the human being but the greatest marvel is
the human being itself. Human, being superior out of four kinds of living beings
Swedaja, Andaja, Audbhija and Jarayuja, is the conglomeration of the five basic
entities i.e., Panchamahabhutas and is the subject of the treatment as he is associated
with miseries.
Body is formed by three Dosha viz. Vata, Pitta and Kapha. They are present in
three phases, as the establishment, existence and extinction. These Doshas
respectively prop up the body like Anila (air), Surya (sun or fire ) and Soma (moon or
water), which support the cosmic functions like Visarga (releasing the energy),
Aadana (drawing strength) and vikshepa (by diffusing). The body connot survive
without Kapha, Pitta and Vata. The Tridoshas eternally present and support the body
as vital forces in their normalcy, import development strength, complexion and
cheerfulness to the body.
Ayurveda is the rich storehouse of time-tested and effective recipes for the
treatment of several obstinate and otherwise incurable diseases. More important than
these recipes are the specialized therapies, which while curing such diseases
strengthen the immune system in the body and help in the preservation of positive
health. These specialized therapies in Ayurveda are called as Panchakarmas. It is no
wonder that the scientists and physicians in India and abroad are evincing deep
interest in the classical form of Ayurvedic treatment. Panchakarma therapy primarily
aims at cleansing the body of its accumulated impurities and nourishing the tissues.
Once this is achieved, it becomes very easy to rejuvenate the tissues and prevent the
process of ageing. This helps the individual to lead a disease free old age and he/she
1
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Introduction
becomes capable of serving the society with his/her accumulated experience without
any mental disability and physical decay.
The term ‘Panchakarma’ literally means five-fold therapy. The word ‘Pancha’
has a meaning ‘Vistara’ (elaborate) also. Thus, it implies the meaning elaborate
procedures. Both the meanings are really true in their sense. The therapies that are
included under this collective term are Vamana karma, Virechana karma, Nirooha
basti, Anuvasana basti and Nasya karma. Sushruta’s school, which deals with surgery
primarily, includes Rakthamokshana in the place of Anuvasana basti.
It is necessary at this state to make it clear that these Panchakarmas do not
imply simple administration of emesis, purgation, enema or nasal drops as is
conventionally understood. Elaborate methods are described for the preparation of
these therapies, their administration, preparation of the individual prior to the
administration of these and the management of the patient after the therapy is
administered.
Nasya is an important therapeutic procedure as many of the courses of
Ayurvedic treatment1. It comes under the Panchashodhanakarmas2. It is more or less
essential in all Urdhwa jathru vikaras3. Nasya is effective not only for inducing
immediate results but also serves as a permanent cure.
Nasya is described as having a significant role among Panchakarmas as it
does. The important action of Shirah shodhana4 (clearing the channels of head) by
clearing the doshasamghata deep rooted in the channels of indiriyas situated in the
Shiras.
2
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Introduction
During the course of time, some therapies have been developed in Ayurveda.
Apart from curing some of the obstinate and otherwise incurable diseases, these
special therapies help in rejuvenating the body. If used periodically, they prevent the
ageing process while simultaneously preventing the manifestation of diseases. Thus
these therapies, apart from their utility as preparatory measures for the Panchakarmas
are specialized therapies in their own merit.
Among these modified therapies, choorna Pinda sweda is the most important
technique of rooksha sweda. For this rooksha sweda, a compound called
kolakulathadi choorna which is mentioned by charka is used and prepared by
pounding all the drugs and made into a pottali for swedana purpose. A successfully
employed rooksha sweda is believed to help to a great extent, the patients suffering
from different neuromuscular disorders and also several systemic diseases.
Manyastambha is a vataja nanatmaja vyadhi the symptoms may include Ruk
& Sthamba. The most common symptom is pain in the neck, worsening with exertion
and relieved, in the early stages, by rest. This pain often radiates down to the hand,
with the fingers becoming numb due to compression of the nerves that innervate the
upper extremity. The brachial plexus is affected. The trapezius area becomes tender
and painful. A nodule can form in the muscle due to chronic pressure. The symptoms
of cervical cord compression can sometimes be severe. The pain radiates down the
right or left arm to the fingers, to the chest and shoulder blades depending on which
side the nerve root is involved. It can become continuous, making movements painful
and limited. If the cervical vertebrae become unstable, the danger of cord
3
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Introduction
compression is imminent and, in some cases, fusion of the bones may be warranted.
But this is rare7.
Vata disorders are dealt by Acharyas as Vata Vyadhi includes the above-
discussed spinal originative problems, especially cervical Spondylitis as
“Manyastambha”. Truly, the Manyasthambha is one of the Vatajananatmaja Vyadhi,
a disease referred to the Siras in the neck region. Even though Manyasthambha is a
condition pertaining to the veins of the neck (greevagata siras) with its signs and
symptoms resembles the cervical Spondylitis.
Vatavyadhi in general & manyastambha in particular is treated with swedana.
The chapter on the treatment of manyastambha specifically emphasizes on the
adoption of rooksha sweda and nasya8abc. It is because in the initial stages of
Manyasthambha there is vata avarana by Kapha which in later turns out to be a kevala
Vataja vayadhi so in order to relieve the obstructing Kaphadosha rooksha sweda is
done with kolakulathadi choorna9.
As Nasya is stated to be the best for Urdhwajathrugatavikaras and
manyasthambha being one among them is practiced here. So Rookasweda and Nasya
is believed to have a note worthy role in relieving the inflammatory a condition and
stambatwa with in the cardinal feature of manyastambha. Therefore, this study has
been undertaken as an attempt to help the patients suffering from manyastambha in
our society and also to evaluate the efficacy of these treatment modalities.
4
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Objectives
5
Need for the study:
In Manyastambha, in the initial stages there in vata avarana by kapha. So inorder
to relieve the avarana, rooksha sweda is done. For this purpose, kolakulathadi choorna is
used which relieves the pain & stambhatwa.
Nasya is an another treatment modality explained by our acharyas in the
management of Manyasthambha. Nasya is stated as the best remedial measure for the
treatment of the diseases of Urdwajatru and manyastambha being one among them. So
for the purpose of Nasya Mahamasha taila mentioned by chakradatta is taken for the
study10.
Manyasthambha (cervical spondylitis) is explained as one of the vataja nanatmaja
vyadhi5. This diseasse is having a prevalence of 0.1 –1% of the general population with a
male to female ratio of 3:1 & more commonly affects population in the productive period
of life6.
In this contemporary system of medicine either conservative or surgical treatment
is done. Treatment usually is conservative, with nonsteroidal anti-inflammatory drugs,
physical modalities,
Ayurveda the age-old Indian system of medicine advocates a reliable management
for the diseases with due consideration to protect the normal health based on Tridosha
theory, treating the disease with highly efficacious and easily available drugs.
Anti inflammatory, Ama Dosha and disease modifying anti rheumatic drugs are
the drugs of choice in contemporary system of medicine. Fortunately all the analgesics
are liable to many side effects particularly in prolonged use.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Objectives
6
Ayurvedic approach to the Manyasthambha is to retard the inflammatory and
degeneration process and strengthening the Dhatus. Pacifying the Vata Dosha has special
importance in the management of any degenerative phenomenon.
Nasya is described as a significant Shodhana therapy as it has the important action
i.e. clearing the channels of head (Shirah Shodhana) by cleansing the Dosha which is
deep rooted in the channels.
In recent and past, Ayurvedic scientists at various centers with an aim to study the
Manyasthambha and to evolve safer and economical medicaments for it, have carried out
several experimental and clinical studies. The works are successful to some extent to
relieve pain and stiffness, common complaints of this condition.
• In 1992, S. Hebbar from G.A.M.C. Mysore, worked on Manyastambha with
special reference to its management by Nasya.
• In 1994, Vijaya Lakshmi from G.A.M.C. Mysore, worked on Medical
management of cervical Spondylitis.
Only few works were carried out related to the present topic .In the classics the
line of treatment was told as Rooksha Sweda and Nasya. Much of Inflammation is seen
only at the initial stage and not at the later stage .The later stages can be named as
degenerative phases. Rooksha Sweda11 is applicable only in the inflammatory stage,
whereas in the degenerative phase Brumhana Nasya and Vata pacifying drugs are more
effective12.
Rooksha sweda and Nasya are the simple techniques and ingredients are easily
available & economical. Also these are indicated in the management of Manyasthambha
and have no proven adverse effects. This study was intended to assess the efficacy of the
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Objectives
7
Rooksha sweda and Nasya techniques in the management of this disease and to compare
the efficacy of Rooksha sweda with that of Nasya. So the present study, Clinical Study
on “Rookshaswedasthadha Nasyam” In the management of Manyasthambha
(Cervical Spondylitis) was taken.
Objectives of the study
To evaluate the efficacy of Rooksha sweda and Nasya in the management of
Manyasthambha. (Cervical Spondylitis)
To evaluate the efficacy of Rooksha sweda in the management of
Manyasthambha (Cervical Spondylitis).
To evaluate the comparative efficacy of both these treatment groups in the
Management of Manyasthambha (Cervical Spondylitis).
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Historical review of Nasya
HISTORICAL BACKGROUND OF NASYA KARMA
Seeds of knowledge are imbibed in Veda. Veda’s are ancient source of
knowledge. There is description of health and disease related topics in a patchy form in
all Veda but proportion of such topics is significant in Atharvaveda. Hence Ayurveda is
considered as a subset of Atharvaveda. It is natural that accumulation of knowledge of
any topic occurs gradually and same is the case with Nasya karma, which has developed
since Vedic era to Modern era. Before the historical review of Nasya that of Nasa through
which it is given would be handy.
DESCRIPTION OF NASA IN VEDA
Rigveda : There is indication of a word Nasa in a Mantra
“Yen Ygnasta yala sapla …………..”
Yajurveda : While describing the Indriyas, there is mention of two Netra, two Karna,
two Nasika Chhidra and Jihva.
Atharvaveda : Nasa is described among nine chhidras and Indriya.
“Ashtachakra, Navadwara…….”
“Shirshaklima shirshamayana ………..”
Bhagvad Gita : While describing Indriyas, the Nasa is mentioned.
“Navadvara Purva dehi neva …….”
DESCRIPTION OF NASYA IN ANCIENT TEXTS
Rigveda : There is a mantra in Rigveda in which eradication of Roga is mentioned by
routes of Nasa (Nostrils), Chibuka (Chin), Shira (Head), Karna (Ear), and Rasna
(Tongue). This can be considered as a primitive picture of Nasya Karma.
Krishna Yajurveda, Shatpatha Brahmana, Upanishad: In these texts, the term Nasya
karma has been used frequently. 8
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Historical review of Nasya
Ramayana : In Valmiki Ramayana, when Laxman became unconscious by the blow of
Meghanada, Vaidya Sushena administered the juice of Sanjivani through nasal route
bringing him to consciousness instantaneously.
Bauddha Kala : “Jeevaka” the famous Vaidya of Bauddha kala had utilized Nasya
karma in many cases such as
1) In Shirahshoola, he prescribed Nasya of medicated ghrita to the wife of Shreshthi
of Saketa Nagar.
2) Once, when Jeevak wanted to give Virechana to Lord Buddha, he gave him
aushadhi by nasya for Virechana.
Vinaya Pitika : In this book, it is mentioned that one utpala hasta of Nasya has potency
to induce 10 vegas of Virechana.
Samhita Kala : Literature written during this period is the heart of ayurvedic literature.
In all the Samhita, Nasya karma has been elaborately described especially in Charaka
Samhita, Sushruta Samhita and Ashtanga Samgraha. The research conducted on this
therapy was at such a height that it was used to achieve expected sex of foetus. Nasya
karma is utilized in treatment of many diseases in Brihattrayi such as in Charaka, in
chikitsa of Jwara, Raktapitta, Kustha, Rajyakshama, Unmada, Apasmara, Shwayathu,
Hikka, Shvasa, Kasa, Visha, Trimarmiya, Vata vyadhi, Trimarmiya siddhi etc,. In
Sushruta Samhita, in Chiktisa of Dwivraniya, Sadyovrana, Bhagandar, Vata Vyadhi,
Mahavata Vyadhi, Kustha, Udara, Granthi, Apachi, Arbuda ganda, Vriddhi, Upadamsha,
Shlipada, Kshudra Roga, Mukha Roga etc, . In Ashtanga Hridaya, in Chikitsa of Jwara,
Raktapitta, Shvasa Hikka, Rajyakshama, Chhardi, Hridaroga, Trishna, Madatyaya,
Shvitra, Krimi, Vata Vyadhi etc,.
9“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
10
Etymology of Nasya Karma
In Sanskrit language each word is derived from a specific dhatu and each dhatu
bears an inherent meaning which is the crux of the word. The derivation of the word
Nasya is from “Nasa” dhatu. It conveys the sense of Gati – motion. Vyapti bears the
meaning pervasion. Here, the Nasa dhatu is inferred in sense of nose. According to
Vachaspatyam word “Nasata” means beneficial for nose.
In context of Ayurveda, the word Nasya suggests the nasal route for
administration of various drugs. As per Acharya Sushruta, administration of medicine or
medicated oils through the nose is known as Nasya13. Arunadatta and Bhavaprakasha
opines that all drugs that are administered through the nasal passage are called Nasya14.
Sharangadhara and Vagbhatta15 also hold the same view.
Synonyms :
• Prachchardana
• Shirovirechana
• Shirovireka
• Murdhavirechana
• Navana
• Nastaha Karma
Amongst the various synonyms of Nasya karma Shirovirechana, Shirovireka and
Murdhavirechana are suggestive of elimination of Doshas from the Shira or parts situated
above the clavicle i.e. Prachchardana, whereas the terms Nastaha and Navana indicates
site of administration.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
11
CLASSIFICATION OF NASYA KARMA :
Nasya is classified in various ways by different Acharya. Each classification has
its own salient features and each is done with different angles. Classification according to
various Acharya is described in a tabular form as below.
Table No.1 Showing Classification of Nasya according to Various Acharya
No Name of Acharya Classification
1 Charaka According to mode of action - Rechana, Tarpana, Shamana
According to the method of administration –
Navana, Avapidana, Dhmapana, Dhuma, Pratimarsha
According to various parts of drugs utilized –
Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twaka
2 Sushruta Shirovirechana, Pradhamana, Avapida, Nasya, Pratimarsha
3 Vagbhatta Virechana, Brimhana,
Shamana
4 Kashyapa Brimhana, Karshana
5 Sharangadhara Rechana, Snehana
6 Bhoja Prayogika, Snaihika
7 Videha Sangya Prabodhaka,
Stambhana,
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
12
CHARAKA’S CLASSIFICATION OF NASYA :
According to Charaka the Nasya is of five types viz. Navana, Avapidana,
Dhmapana, Dhuma and Pratimarsha16.
Navana is further divided in to Snehana and Shodhana, Avapidana into Shodhana
and Stambhana, Dhuma into Prayogika, Vairechanika and Snaihika while Pratimarsha is
divided into Snehana and Virechana.
The above-mentioned five types of Nasya are regrouped according to their
pharmacological action into three groups viz. – Rechana, Tarpana and Shamana17.
Charaka has also mentioned 7 types of Nasya according to parts of the drugs to be used
in Nasya karma viz. – Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twak18.
Nasya
According to the action of Nasya therapy
Navana Avapidana Dhmapana Dhuma Pratimarsha
Snehana Shodhana Prayogika Snaihika Vairechanika
Shodhana Stambhana Snehana Virechana
Shamana Tarpana Rechana
According to various parts of the drugs utilized in Nasya therapy
Phala Patra Mula Kanda Pushpa Niryasa Twaka
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
13
CLASSIFICATION OF NASYA ACCORDING TO SUSHRUTA
According to Sushruta, Nasya is of 5 types viz. Nasya, Avapida, Pradhamana,
Shirovirechana and Pratimarsha. These 5 types of Nasya are further classified according
to their functions into two groups viz. Shirovirechana and Snehana19.
Shirovirechana, Avapida and Pradhamana are used for Shirovirechana purpose.
i.e. for the elemination of morbid Dosha from Shira while Pratimarsha and Nasya may
be used for Snehana20.
Nasya
Shirovirechana Snehana
Shirovirechana Pradhmana Avapida Nasya Pratimarsha
VAGBHATTA’S CLASSIFICATION OF NASYA
Ashtanga Samgraha has mainly classified Nasya according to its effect viz.
Virechana, Brimhana and Shamana21. Snehana and Brimhana Nasya have been further
subdivided according to the doses into two groups i.e. Marsha and Pratimarsha22.
Avapida nasya may be given for both Virechana and Shamana while Pradhamana
Nasya is given only for Shirovirechana.
Ashtanga Hridaya has mainly classified Nasya in 3 types viz. Rechana, Brimhana
and Shamana23.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
14
Nasya
KASHYAPA’S CLASSIFICATION OF NASYA
According to Kashyapa Samhita, Nasya has been classified into two groups i.e.
Brimhana and Karshana. These two types are also known as Shodhana and Purana
Nasya24ab.
Virechana Brimhana Shamana
Sneha Nasya According to Dose
Murdha Virechana
Pradhamana
Avapida Pratimarsha Marsha
Nasya
Brimhana Karshana (Shodhana) (Purana)
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
15
SHARANGADHARA’S CLASSIFICATION OF NASYA
Sharangdhara has also classified Nasya according to their functions into two
groups viz. Rechana and Snehana. Rechana Nasya is further subdivied into Avapida and
Pradhamana while Snehana Nasya is subdivided into Marsha and Pratimarsha25abc.
Nasya
Rechana Snehana
Pradhmana Marsha Avapida Pratimarsha
VIDEHA’S CLASSIFICATION OF NASYA
Videha has stated two types i.e. Sanjyaprabodhaka and Stamabhana26
Nasya
Sanjya Prabodhaka Stambhana
It is clear from the above discription that two types of classification of Nasya Karma
are available in Ayurvedic literature. One is based on the pharmacological actions viz.
Rechana, Tarpana etc. Other is based on the preparation of drug and the method of its
application e.g. Dhmapana (Powder is blowed) Avapida (Extracted Juice is used) Dhuma
(Smoking through nose).
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
16
Apart from classification on above basis other criteria are also described as follows :
♦ Classification according to preparation e.g. Avapida nasya which indicates the use
of expressed juice:
♦ Classification according to the dose to be dropped into the nostrils e.g. marsha
and pratimarsha described by Acharya Vagbhatta.Considering by par the
classification of Charaka as gold standard we will have detailed description of
each type.
NAVANA NASYA
Navana is one of the important and well applicable type of Nasya karma.
Method : In Navana, the drops of medicated oil or ghee are administered.
Instrument : For administration of Sneha in nostrils, use of Pranadi (Pipette or dropper)
is described by Acharya Charaka.
Classification : It is classified in to two types. Snehana Nasya, hodhana Nasya
Snehana Nasya : It enhances the strength of all dhatus and is used as dhatu poshaka i.e.
nutritive for dhatu.
Table No.2. The dosage schedule for sneha nasya is as below27
1 Hina matra 8 drops in each nostril
2 Madhyama matra 16 drops in each nostril (Shukti Pramana)
3 Uttama matra 32 drops in each nostril (Panishukti Pramana)
According to Bhoja, Matra of Prayogika sneha nasya is 8 drops, while matra of
Snahika Nasya 16 drops. According to Doshabala quantity can be doubled or tripled.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
17
Benefits of Sneha Nasya :
It is used for the Snehana in the complaint of feeling of head lightness. It gives
strength to neck, shoulder and chest and improves eyesight.
Indications of Sneha Nasya :
Sneha Nasya can be given in the following conditions :
Vatika Shirahshula, Keshapata, Dantapata, Shmashrupata, Tivrakarnashula,
Timira, Nasaroga, Mukhashosha, Avabahuka, Akalaja Valita, Akalaja Palita,
Darunaprabodha and Vatapittaja Mukharoga28.
Shodhana Nasya
Sushruta’s Shirovirechana type is included in Shodhana type of Navana Nasya. It
eliminates the vitiated Doshas.
Drugs :
In this type of Nasya, oil prepared by Shirovirechana Dravya like Pippali,
Vidanga, Shigru etc. are selected29.
Dose :
Table No. 3. It can be given in following dosage schedule according to Sushruta30.
1 Uttama 8 drops 2 Madhyama 6 drops 3 Hina 4 drops
Indications :
It can be used in the following conditions; Kaphapurna Talu and Shira, Aruchi,
Shirogaurava, Shula, Pinasa, Ardhavabhedaka, Krimi, Pratishyaya, Apasmara,
Gandhagyananasha and Urdhvajatrugata Kapharogas31 and Urdhvajatrugata Shopha, Praseka,
Arbuda and Kotha.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
18
In healthy persons Navana Nasya should be given according to the following
seasonal schedule32.
Table No. 4 Indications of Nasya according to season
Sl.No Season Nasya to be given at
1 Shita Kala Noon
2 Sharada and Vasanta Morning
3 Grishma Rutu Evening
4 Varsha Rutu Only when sun is visible
Time Schedule :
Table No.5. Navana Nasya should be administered according to the following time
schedule33.
Sl.No Roga Nasya to be given at
1 In Kaphaja Roga Fore noon
2 In Pittaja Roga Noon
3 In Vataja Roga After Noon
Avapida Nasya
This Nasya can be utilized for both Shodhana and Shamana purpose depending
upon the drug utilized.
Definition:
In Avapida Nasya, juice is expressed from paste or kalka of a drug. The word
Avapida means it is expressed juice of leaves or paste (kalka) of required medicine34.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
19
Method :
The paste (kalka) of required medicine is placed in a white and clean cloth and
thereafter it is squeezed to obtain the required quantity of juice, directly in the nostrils of
the patients. The administration of the drug in this way is known as Avapida nasya35.
This type of nasya may also be given with kalka (paste) etc.
It may also be given by dipping the swab (pichu) into the Kwatha (decoction) or
Sheeta (cold infusion) or Swarasa (juice) of the required drug. Though Acharya Sushruta
has categorized this under Shirovirechana, Avapida has also been used for Stambhana
purpose in treatment of Raktapitta where Sharkara and Ikshu rasa are utilized for the
same36.
Charaka has described two types of Avapida Nasya.
1) Stambhana Nasya : For this type ikshu rasa, milk etc. are used.
2) Shodhana Nasya : For this type Saindhava, Pippali etc. are used.
According to Chakrapani, Avapida nasya is of three types .
1) Shodhana
2) Stambhana
3) Shamana
Videha has mentioned two types of Avapida Nasya.
1) Sangya prabodhana : It is one type of shodhana nasya.
2) Stambhana : It is one type of shamana nasya.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
20
Table No.6. Dose of Shirovirechana, Avapida Nasya should be given as follows:
1 Hina Matra 4 drops
2 Madhyama Matra 6 drops
3 Uttama Matra 8 drops
Indications :
Table No.7. Avapida Nasya is indicated in the following conditions37.
Manasaroga Apasmara Shirovedana
Apatantraka Moha Mada
Murchha Sanyasa Bhaya
Krodha Bhiru Sukumara
Krisharogi Stri Raktapitta
Vishabhighata Chitta vyakulavastha
Sharangdhara recommends the Avapida Nasya for the patients suffering from Galaroga,
Vishamajwara Manovikara and Krimi38.
DHMAPANA NASYA
It is a specific Shodhana Nasya.
Synonym : Pradhmana Nasya
Definition : This type of nasya is instilled with Churna specifically for Shirovirechana.
This nasya is mentioned as Dhmapana in Charaka Samhita and as Pradhamana in
Sushruta Samhita.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
21
Instrument : In this type, fine powder of drug is administered through nasal passage. For
this purpose specific Nadi yantra, A tube like instrument with length of 6 angulas and
with open ends is utilized.
Method : Fine powder of required drug is kept at one end and air is blown from the other
end, so that the medicine gets puffed into the nostrils. Videha has advocated a different
procedure in this context according to him, fine powder is kept in a pottali of thin cloth
and then patient is asked to inhale deeply, so that the subtle particles of medicine enter
into nostrils.
Dose: According to Videha,
Three Muchuti (3 pinches) for method with Shadangula nadi.
Two tolas i.e. 20 gms for pottali method.
Drugs specifically mentioned for Pradhmana nasya.
Rock salt, garlic, guggulu, maricha, vidanga etc.
Here we observe that the drugs used in Pradhmana nasya are Tikshna (irritative)
and it would be safe to remain cautious while executing this Nasya.
Indications: According to Charaka, its indications are as under –
a) Shiroroga b) Nasaroga c) Akshiroga
DHUMA NASYA
Inhalation of medicated Dhuma by nasal route and elimination of dosha by oral
route is called Dhuma Nasya. Acharya Sushruta has remained aloof from description of
this Nasya.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
22
Types and Instrument: Acharya Charaka has mentioned special Dhuma Nadi for
Dhuma Nasya. The length of the Nadi depends upon the type of the Dhuma Nasya,
details of which are as under:
Table No.8 Showing the length of dhuma yantra nadi39
Sl.No Type of Dhuma Nasya Length of Nadi
1 Prayogika 36 angula
2 Vairechanika 24 angula
3 Snaihika 32 angula
Breadth of the nadi should be as per measurement of ones own angula.
Dose:
Two puffs are to be taken for Prayogika Dhuma.
3 to 4 puffs are to be taken for Vairechanika Dhuma.
A single puff is advised for snaihika Dhuma.
Table No.9. Drugs used fo Dhuma nasya:
1 Prayogika Dhuma Priyangu, Ushira, etc.
2 Vairechanika Dhuma Aparajita, Apamarga etc
3 Snaihika Dhuma Vasa, Ghrita etc
Indication of Dhuma Nasya40:
It is indicated for treatment of Shiroroga, Nasaroga and Akshiroga.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
23
MARSHA – PRATIMARSHA NASYA
The methods shared by both these types are common but the variation occurs in
context of dose. In Pratimarsha Nasya 1 – 2 drops are administered while in Marsha the
dose is of 6 to 10 drops.
Pratimarsha Nasya : Following method is employed for Pratimarsha Nasya. A
finger is dipped in the appropriate sneha up to 2 phalanges and then oil is allowed
to drop from it in both nostrils. Patient is advised to expel out the sneha, which
comes in oral cavity.
Dose – 2 drops, morning as well as in evening hours41.
The sneha should be in such an amount that it reaches from nose to gullet but
should not be enough to produce secretions in gullet
Indications42 :
♦ Pratimarsha can be given in
♦ Any age
♦ Any season
♦ Even in not suitable time and season i.e. in Varsha and Durdina
♦ Bala - Vriddha
♦ Bhiru - Sukumara
♦ Weak patients - Kshtakshama
♦ Trishna Pidita - Mukhashosha
♦ Valita and Palita
Contraindications
It is contraindicated in
♦ Dushta Pratishyaya - Krimija Shiroroga
♦ Badhirya (deafness) - Bahudosha
Madhyapi (drunkers –habitual) ♦
♦ Utklishta Doshas.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
24
It is contraindicated in such persons because the Sneha Matra is quite insufficient to
eliminate Doshas or Kriminasha and already aggravated Doshas may get vitiated
further43. Sushruta and Sharangadhara have described 14 suitable times for Pratimarsha
Nasya, while Vagbhatta has mentioned fifteen Kala.
Table No.10. Various Timings for Pratimarsha Nasya
No Time for Pratimarsha Nasya Su. As. H. Sha.
1 After leaving the bed in morning + + +
2 After cleaning the teeth (with Dantadhavana) + + +
3 Before going outside + - +
4 After exercise + + +
5 After sexual intercourse + + +
6 After walking + + +
7 After urination + + +
8 After passing Apanavayu + - -
9 After Kavala + + +
10 After Anjana + + +
11 After meal + + +
12 After sneezing + - -
13 After sleeping in the noon + + +
14 In the evening + + +
15 After vomiting - + +
16 After Shirobhyanga - + -
17 After defaecation - + +
18 After laughing - + -
Pratimarsha in Nasya is a very innocent procedure, it never produces any
complication and by its virtue checks any disease process44.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
25
Marsha Nasya
The method of administration of Marsha Nasya resembles that of Pratimarsha but
as said earlier the dose varies.
Dose – In Marsha Nasya, 6 to 10 drops of Sneha are administered.
Drugs – Though all Sneha dravya like oil, ghee, etc. can be utilized but use of oil is
advisable because Shira is the place of Kapha and oil is inherently opposite to Kapha in
properties.
Marsha Nasya is quickly effective and more beneficial than its counterpart i.e.
pratimarsha45.
CLASSIFICATION OF NASYA ACCORDING TO KARMA
This type of classification is given in Charaka Samhita as well as Ashtanga
Hridaya46ab.
Chart No.7 Classification According to Karma (Pharmacological Action)
Rechana Brimhana Shaman
Sangyaprabodhana (Shodhana)
Krimighna Stambhana Karshana
Raktastambhan Doshastambhan
The types Rechana, Tarpana and Shamana are described by Acharya Charaka and
Vagbhatta. Sushruta has not described the Shamana Nasya. He has given only two types
viz. Shirovirechana and Snehana.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
26
Kashyapa has mentioned Brimhana and Karshana types of Nasya karma i.e.
Sangya Prabodhana and Stambhana, according to their pharmacological action.
All these types can be included into the classification of Charaka, as in previous
pages. Details of each type of Nasya according to the Karma, is as under.
a) RECHANA NASYA
The Nasya, which eliminates vitiated Doshas of Shira through the nasal route is
also called Rechana Nasya47. It is also termed as Karshana Nasya.
Drugs : Apamarga, Pippali, Maricha etc. are drugs of choice that can be used for
Rechana Nasya. Kwatha, Swarasa or Tikshna sneha of above drugs may also be utilized
for the same.
Indications :
Stambha, Supti, Gaurava, Shiroroga etc.
According to Sushruta and Vagbhatta, it is used in Shleshma abhivypta like
Talukantaka, Shirokrimi, Arochaka, Pinasa, Pratishyaya48. Urdhvajatrugata Shopha,
Praseka, Vairasya, Arbuda, Dadru and Kotha49.
If Rechana Nasya is to be given in patients of weak will power then Sneha
preparation of Rechana dravya is applied.
b) TARPANA NASYA
Tarpana is that type of Nasya, which is specially indicated in a Dhatukshaya
(degeneration). Tarpana Nasya resembles Snehana Nasya described by Sushruta and
Sharangadhara and Brimhana Nasya mentioned by Acharya Vagbhatta in its properties
and actions.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
27
Drugs :
Drugs of Madhura skandha and Sneha prepared with Vata-Pittahara drugs are
used for above type50. Exudation of certain trees, meat soups and blood may also be
administered.
Indications :
Vatika Shiroroga, Dantapata, Keshapata, Darunaka and other Vata-Pittaja roga.
Sushruta advises Sneha Nasya for increasing general strength and to improve the vision
power and its acquity. It is also used for curing the Shirah kampa and Ardita51.
c) SHAMANA NASYA
It is described by Charaka as well as Vagbhatta and Pratimarsha and Stambhana
Nasya can be co-related with it.
Definition :
The type of Nasya which is used for alleviation of Dosha of Shira is called
Shamana Nasya.
Drugs :
Usually drugs beneficial for particular diseases are chosen for this type and the
carrier is a Sneha dravya.
Indication :
It is indicated to check the bleeding occurring in the course of Raktapitta.
It is also indicated in Vali, Palita, Khalitya, Darunaka, Raktaraji, Vyanga and
Nilika.
It can also be used to improve the power of eyes, ears and nose.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
28
INDICATIONS OF NASYA
Nasya therapy may be given in all diseases except in the conditions mentioned
earlier. The specific indications of Tarpana Nasya, Shodhana Nasya, Shamana Nasya,
Shirovirechana, Navana, Avapida, Dhmapana and Dhuma Nasya etc. have already been
discussed in the classification of Nasya, but Charaka has described the following general
indications, where Nasya therapy should be used.
Shirostambha Gadgadatva
Ardhavabhedaka Vaggraha
Shirahshula Grivaroga
Akshishula Swarabheda
Shukra Roga-Netragata Galashundika
Raji Galashaluka
Timira Galaganda
Vartmaroga Upajihvika
Pinasa Manyastambha
Nasa Shula Ardita
Danta Stambha Apatantraka
Danta Shula Apatanaka
Danta Harsha Karnashula
Danta Chala Arbuda
Hanugraha Skandharoga
Mukharoga Ansashula
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
29
According to Ashtanga Samgraha if the Nasya is to be given as a part of
performing the complete Panchakarma then, it should be given after Basti karma.
CONTRAINDICATION OF NASYA
In our classics - Brihattrayi some special conditions have been mentioned where
Nasya should not be administered, otherwise various complications may occur. In
general, in all patients Nasya should not be administered on Durdina (Rainy day) or in
Anrutu (Viparita Kala).
Table No.11. Contra Indications of Nasya mentioned in Brihattrayi have been
tabulated below :
Sr. Anasyarha Charaka Sushruta Vagbhatta
1 Bhuktabhakta + + +
2 Ajirni + + -
3 Pitta Sneha + + +
4 Pitta Mad + + +
5 Pitta Toya + + +
6 Snehadi Patukamah + - +
7 Snatah Shirah + - +
8 Snatukamah + + +
9 Kshudharta + - +
10 Shramarta + + -
11 Matta + - -
12 Murcchita + - -
13 Shastradandahrita + - -
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
30
14 Vyavayaklanta + - -
15 Vyayamaklanta + +(Shranta) -
16 Panaklanta + - -
17 Navajwara Pidita + - -
18 Shokabhitapta + - -
19 Virikta + - +(Shuddha)
20 Anuvasita + +(Datta Basti) +(Datta Basti)
21 Garbhini + + +
22 Navapratishyayarta + - -
23 Apatarpita - + +(Shuddha)
24 Pittadravah - + +
25 Trishnarta + + -
26 Gararta - + +
27 Kruddha - + -
28 Bala - + -
29 Vriddha - + -
30 Vegavarodhitah - + + (Vegarta)
31 Raktasravita - - +
32 Sutika - - +
33 Shvasapidita - - +
34 Kasapidita - - +
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
31
SUITABLE TIME FOR GIVING NASYA
According to Charaka generally Nasya should be given in Pravrita, Sharada and
Vasant Rutu. However in emergency it can be given in any season by providing artificial
conditions of the above mentioned seasons, for example in summer, Nasya can be given
in cold places and in cold season, it can be given in hot places.
Table No. 12. Time schedule in different seasons should be as below52.
SL.No Rutu Nasya to be given at
1 Grishma Rutu Morning
2 Shita Rutu Noon
3 Varsha Rutu When day is clear
4 Sharada + Vasanta Morning
5 Shishira + Hemanta Noon
6 Grishma + Varsha Evening
According to Sushruta in normal condition Nasya should be given on empty
stomach.
Table No. 13. Time schedule in Doshaja Vikara should be as below53.
SL.No Doshaja Vikara Nasya to be given at
1 Kaphaja Vikara Morning
2 Pittaja Vikara Noon
3 Vataja Vikara Evening
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
32
Vagbhatta has prescribed same timings as Sushruta has mentioned. According to
Doshaja Vikara he has suggested some more important points.
Nasya should be given daily in morning and evening in Vataja Shiroroga, Hikka,
Apatanaka, Manyastambha and Swarabhramsha.
Sharangadhara has described same time schedule for different seasons as Sushruta
has mentioned. He further states that – Nasya can be given in night, if the patient is
suffering from Lalasrava, Supti, Pralapa, Putimukha, Ardita, Karnanadi, Trishna,
Shiroroga and such conditions like excessive vitiated Doshas54.
TABLE No. 14. COURSE OF NASYA KARMA
No. Name of Acharaya Days
1 Sushruta 1,2,7,21
2 Bhoja 9
3 Vagbhatta 3,5,7,8
Vagbhatta
Nasya Karma may be given for seven consecutive days. In conditions like Vata
Dosha in head, hiccough, loss of voice, Manyasthamba, Apatanaka etc. it may be done
twice a day (in morning and evening)55.
Nasya should be given for 3 days, 5 days, 7 days and 8 days or till the patient
shows the symptoms of Samyaka Nasya as stated in Ashtanga Samgraha56.
Bhoja
Bhoja says that if Nasya is given continuously beyond nine days then it becomes
Satmya to patients and if given further, it neither benefits nor harms the patients.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
33
Sushruta
According to Sushruta, Nasya may be given repeatedly at the interval of 1, 2, 7 or
21 days depending upon the condition of the patient and the disease he suffer57.
Charaka
Charaka has not mentioned specific duration of the Nasya therapy, but instead
suggested to give it according to the severity of disease.
DOSE OF NASYA
The dose of Nasya drug depends upon the drug utilized for it and the variety of
the therapy. Charaka has not prescribed the dose of the Nasya. Sushruta and Vagbhatta
have mentioned the dose in form of Bindu (drops), here one Bindu means the drop which
smears after dipping the two phalanges of Pradeshini (index) finger in oil58.
Table. No.15. Showing The Dosage of Nasya Karma
Drops in each Nostril
No.
Type of Nasya Hrasva
Matra
Madhyama
Matra
Uttam
Matra
1 Shamana Nasya 8 16 32
2 Shodhana Nasya 4 6 8
3 Marsha Nasya 6 8 10
4 Avapida Nasya (Kalka Nasya) 4 6 8
5. Pratimarsha Nasya 2 2 2
Dose According to Videha :
The common dose for Pradhamana Nasya is 3 Muchuti (here one Muchuti = the
quantity of Churna which may come in between index finger and thumb = 2.4 Ratti.)
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
34
Dose According to Sharangadhara59 :
Sharangadhara has described the following dosage schedule for Nasya Karma
depending upon the variety of material used.
Tikshnaushadhi Churna - 1 Shana (4 Masha)/(24 Ratti)
Hingu – 1 Yava (½ Ratti)
Saindhava – 1 Masha (6 Ratti)
Dugdha – 8 Shana (64 Drops)
Jala (Aushadha Siddha) – 3 Karsha (3 Tola)
Madhura Dravya – 1 Karsha (1 Tola)
If the Nasya is given in less quantity than the prescribed dose then it does not
eliminate the Doshas completely and cause heaviness, loss of appetite, cough, salivation,
coryza, vomiting and disorders of the throat etc. If the Snehana Nasya is administered in
the excessive dose it may produce the symptoms of Atiyoga
Nasyavidhi
The procedure of Nasya karma may be classified under following headings :
Purva Karma (Pre-measures)
Pradhana Karma (Chief measure)
Pashchata Karma (Post-measures)
Purva Karma (Pre-measure) : It is advisable that all materials, drugs and
equipments like napkin, utensils necessary for Nasya karma are collected in sufficient
quantity prior to Nasya karma.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
35
Patient should be prepared for Nasya karma. It can be described in detail as under.
Special room for Nasya should be prepared which should be free from atmospheric
effects like direct blow of air or dust and it should be lighted properly60.
Nasya Asana : It should be placed in Nasya room. It consists of -
A chair for sitting purpose
A cot for lying purpose
Nasya Aushadhi : Drug required for Nasya karma in the form of Kalka, Churna,
Kwatha, Kshira, Udaka, Sneha, Asava etc. should be collected in sufficient quantity.
Drug for counter acting any complications during or after the nasya should also be
kept ready.
Table No. 16. Nasya Yantra : It should be collected according to the types of Nasya
such as :
A dropper or Pichu For Snehana, Avapida, Marsha and Pratimarsha Nasya.
Shadangula Nadi For Pradhmana Nasya Dhuma Yantra For Dhuma Nasya
Besides it is also necessary that a stove, bowl, napkins, spitting pits and an
efficient assistant are kept handy.
Selection of The Patient : The patient should be selected according to the indications
and contra-indications of Nasya described in classics.
Preparation of The Patient : To prepare the patient for the Nasya karma following
matter should be considered according to Acharya Sushruta.
Patient should have passed his natural urges like urine and stool. He should have
completed his routine activities. Light breakfast prior (1 hour) to Nasya karma is advised.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
36
After preparation of patient by above said regimens, snehana and swedana should
be done. Here, Snehana means, Mridu Abhyanga. It should be done on scalp, forehead
and neck for 3 to 5 minutes by medicated oil like Bala taila61 etc.
After Abhyanga, Mridu Swedana should be done on Shira, Mukha, Nasa, Manya,
Griva and Kantha. Though according to Ayurvedic texts, Swedana should not be done on
the head, but for the purpose of elimination and liquification of dosha Mridu Swedana
can be done as Purva karma of Nasya.
Pradhana Karma (Chief measure) : The procedure to be adopted for the Nasya karma
is described here as per the statements of Charaka, Vagbhata and susrutha62abc.
Posture of The Patient :
Patient should lye down in supine position on Nasya table. The head of the patient
should be lowered (Pravilambita). The position of head should not be excessively
extended. After covering of eyes with a clean cloth, the tip of patients nose should be
drawn upward by the left thumb of the Vaidya. At the same time with the right hand
Vaidya should instill lukewarm medicine in both the nostrils, alternately, with the help of
proper instrument like pichu, dropper, shadangula nadi etc. according the type of Nasya.
The drug should be proper in dose and temperature.
The patients should remain relaxed at the time of administration of nasya and he
should avoid speech, anger, sneezing, laughing and shaking his head65.
Pashchata Karma (Post-measure) : According to Acharya Charaka66 Acharya
Sushruta67 and Acharya Vagbhatta following regimen should be followed after
administration of Nasya. Patient in lying position is asked to count up to 100 matra i.e.
approximately 2 minutes. After administration of Nasya feet, shoulders, palms and ears
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
37
should be massaged. Again mild fomentation should be done on forehead, cheeks and
neck. For pacifying Vata dosha, Rasna churna is rubbed on head.
The patient is asked to expel out the drug which comes in oropharynx. Care
should be taken that no portion of medicated oil is left behind.
Medicated Dhumpana and Gandusha are advocated to expel out the residue
mucous lodged in Kantha. Patient should be advised to stay in a windless place. A light
meal and lukewarm water are advised. One should avoid dust, smoke, sunshine, hot bath,
anger, riding, excessive intake fat and liquid diet68.
Acharya Charaka further says that the patient should avoid day sleep and should
not use cold water for any purpose like pana, snana, etc.
SAMYAK YOGA, AYOGA AND ATIYOGA OF NASYA KARMA
After Nasya karma the symptoms of its Samyaka yoga, Ayoga and Atiyoga
should be observed, which are being described here as under.
Samyak Yoga :
The symptoms of adequate, Nasya according to Charaka are Urah-shiro-laghava
(Feeling of lightness in chest and head). Indriyavishuddhi (sensorial proficiency) and
Srotovishuddhi (cleansing of channels). In addition, Sushruta has described
Sukhaswapna-prabodhana (good sleep and awakening), Chitta-Indriya-prasannata
(mental and sensorial happiness) and Vikaropashama (Improvement). Besides these
proper respiration and sneezing have been described by Vagbhatta as general symptoms
of Samyaka Yoga of Nasya Karma.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
38
Table.No.17. Showing Samyaka Yoga Lakshana
Symptoms Ch. Su. As. H. Sha. B. P. Ka.
Urah Laghuta + - - - + -
Shiro Laghuta + + - - - -
Netra Laghuta - + + - +
Laghuta - - - + -
Srotovishuddhi + + - + + +
Swaravishuddhi - + - - -
Vaktravishuddhi - + - - -
Indriyaachchta-prasada + + - + + +
Netrateja Vriddhi - + - - +
Chitta Prasada - + - + + +
Vikaropashama - + - + + -
Sukha Svapna Prabodha - + + - - -
Sukhachchvasa - + - - - -
Arati - - - - - -
Medha - - - - - -
Bala - - - - - -
Ayoga :
If Nasya is not given in proper way or the dose is less, features of inadequate
Nasya arise which are Shirogaurava (heaviness in head), Galopalepa (throat coated with
mucus) and Nishthivana (excessive spitting69). According to Sushruta, Kandu (Itching),
Upadeha (feeling of wetness), Guruta (heaviness), Srotasam Kapha Srava (excess mucus
secretion in channels) are the symptoms of Hina Shuddhi70. Vitiation of Vata, dryness in
Indriya, no relief in the symptoms of the disease71, dryness in mouth and nose are other
symptoms of Ayoga of Nasya karma.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
39
Table No. 18. Ayoga Lakshana72
Sl.No Symptoms Ch. Su. As. H. Sha. B.P. Ka.
1 Shirogaurava and Dehagaurava + - - + + +
2 Galopalepa + - - - - -
3 Nishthivana + - - - - -
4 Kandu - + + + + -
5 Kaphapraseka - - - - - -
6 Upadeha + - + + - -
7 Rukshata + - - + + +
8 Vata Vaigunya + - - - - -
9 Srotoriktata - - - - + -
10 Srotasamkaphasrava + - - + + +
11 Nasashosha - + - - - -
12 Asyashosha - + - - - -
13 Akshistabdhata - + - - - -
14 Shiroshunyata - + - - - -
15 Vyadhi Vridhdhi - - - - - +
Atiyoga :
According to Charaka, the general features of excessive Nasya are, feeling of
Arati (uneasiness) and Toda (pricking like pain in the head, eyes, temporal region and
ears)73. Kapha Srava (Salivation), Shirahshula (headache) and Indriya Vibhrama
(confusion) are the symptoms of Atiyoga of Nasya74. Mastulungagama, Vatavriddhi,
Indriyavibhrama and Shiroshunyata (emptiness of head) are also the symptoms of Atiyoga of
Shirovirechana.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
40
Table No. 19. Atiyoga Lakshana
Symptoms Ch. Su. As. H. Sha. B.P. Ka. Shirogaurava - + + + + - Shiroshunyata - + - + + - Shirovedana + - - - - + Netra Vedana + - - - - - Shankhavedana + - - - - - Suchitodavata Pida + - - - - - Indriya Vibhrama - + - + + + Mastulungagama - + - - - - Snehapurna Srotasa - - - - + - Karna Talu Upadeha - - - - - - Vata Vriddhi + - - - - + Kandu - + - - - - Praseka - + + + - - Pinasa - + - - - - Aruchi - - + - - - Deha Daurbalya - - - - - + Unmada - - - - - - Pitta Vriddhi - - - - - - Hridaya Shula - - - - - - Suryavarta Roga - - - - - - Atripti - - - - - -
Vyapada :
Vyapada (complication) after administration of nasya occurs in following conditions.
♦ If patient breaches the protocol to be followed after Nasya karma.
♦ On administration of Nasya in any contra-indicated condition.
♦ Due to technical failure by any means.
The complications occur through following two modes.
Doshotklesha : This should be managed by Shodhana and Shamana chikitsa.
Doshakshaya : This should be managed by Brimhana chikitsa75.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
41
Details about the complication along with the reasoning for their occurrence and
treatment are as under :
If nasya is given in contraindicated conditions than many Vyapada can occur such as :
When Nasya is administered to the patient just after lunch or who is suffering
from indigestion than diseases like Kasa, Shvasa, Chhardi, Pratishyaya etc. may occur
due to obstruction of channels situated in upper part of body.
If Nasya is given in season in which it is contra-indicated for e.g. cloudy
atmosphere, then there is possibility of occurrence of Kapha roga like asthma.
Treatment : In above-mentioned conditions treatment should be done with Kapha
Nashaka Upchara like use of Ushna, Tikshna Aushadha and Kapha Nashaka karma.
If Nasya is given in Krisha, Kshina (emaciated), Virikta (patient who had taken
virechana} Aatura (anxious), Garbhini (pregnant lady), Vyayam klant (exhausted with
exercise) and a thirsty person then vitiation of Vata dosha takes place which may produce
vata-vikara.
In this condition, Vatanashaka treatment like snehana, swedana, brimhana should
be specially done, pregnant lady should be treated with ghrita and milk76.
If Nasya is administered in a madya pitta, person having fever and in
shokabhitapta then timir roga may occur.
Treatment : Ruksha, Sheeta, Lepa and Putpaka should be applied.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
42
Vyapada Due To Technical Failure
This can occur in following conditions -
If the drug used for Nasya is very hot or cold. The dose is not proper i.e. very less
or in excess quantity. If the posture is not proper i.e. patient has lowered his head more
during Nasya. In such conditions complications like Trishna and Udgara occur.
Treatment should be done according to the disease. If the patient faints at the time of
Nasya he should be treated with sprinkling of water on Lalata and Mukha77.
BENEFITS OF NASYA
Patient who regularly observes Nasya Karma does not become victim of diseases
of eyes, ears and nose. His hair and beard does not turn gray. His hair doesn’t falls but
instead grows fast. Diseases like common cold, migraine, headache, facial paralysis, etc.
can be alleviated. The joints, sinus, tendons and bones of his cranium acquires great
strength. His face becomes cheerful and plump and his voice becomes mallow, firm and
stentorian. Strength of all sense organs increases greatly. There will be no sudden
invasion of disease in the upper parts (Urdhvajatrugata) of the body. He experiences the
symptoms of old age later.
Disease of the supra clavicular region are cured in the person who practices
Nasya. He gets clarity of senses, good smell of mouth and the strength of jaw, teeth,
arms, chest, etc. He never suffers from the premature appearance of wrinkles, premature
hair falling and Vyanga.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Nasya karma
43
Mode of action of Nasya karma
In Ayurvedic classics, the mode of action of Nasya karma is explained indirectly.
According to Charaka Samhita, the drug administered through the nose enters in the
Uttamanga and eliminates the morbid doshas residing there.
According to Vrudda Vagbhata :
Drug administered through nose -the doorway to sheera
Reaches the Shringataka marma of Head (Sheera), which is a sira marma and formed by
the siras of nose, eyes, kantha and shrotra
The drug spreads by the same route
Scratches the morbid Doshas of Urdhwajatru and extracts them from the Uttamanga78
Indu, the commentator of Ashtanga Sangraha, opined that Shringataka is the inner
side of middle part of head i.e. “Shiraso Antar Madhyam”.
In this context Sushruta has clarified that Shringataka marma is a Siramarma
formed by the union of Siras (blood vessels) supplying to nose, ear, eye and tongue. Thus
we can say that drug administered through Nasya may enter the above sira and purifies
them79. Under the complications of Nasya karma, Sushruta80 has mentioned that
excessive eliminative errhine may cause Mastulunga Strava (flow of cerebrospinal fluid
out to the nose). which suggest the direct relation of Nasal pathway to brain.
All ancient Acharyas have said considered Nasa as the gate way of Sheera. It does
not mean that any channel directly connects brain and nose, but it may be suggestive of
any connection through blood vessels, lymphatics and nerve.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Historical review of sweda karma
44
HISTORICAL BACKGROUND OF SWEDA KARMA
It is customary, on the part of researchers belonging to various fields of
knowledge, to search the Vedas, as they are the prime sources of ancient wisdom. Such a
search of Vedas for references regarding Panchakarmas, Swedana in particular was not
fruitful.
The works during and after the samhitakala provide ample description on
Panchakarmas and their Poorvakarmas i.e. Snehana and Swedana. Among the
samhitagranthas, Charaka samhita (1000B.C.)81 was the first to describe Swedakarma
under the Shadupakramas. In this text, one can find definition, classification, indications,
contra-indications and benefits of Swedana. Bhela82, considered contemporary to
Charaka, had also described Swedana in detail in the Sweda adhyaya of sutrasthana.
Kashyapa samhita83, written by Vriddha Jeevaka (600B.C.) did mention Swedakarma and
descriptions are found with minor differences from Charaka samhita. The next book that
provides equal details is Sushruta samhita84 written in 2nd century A.D. Ashtanga
samgraha85 and Ashtanga hridaya86 had also allotted separate chapters for Sweda
karma87abcdef.
Various literary works belonging to the Classical Age of Indian Literature (320
AD – 740 AD88) had also mentioned the usefulness of Swedakarma. Later textbooks on
Ayurveda such as Sharangadhara samhita89 and Chakradatta90 had described Swedana
karma under a separate chapter, while texts such as Bhavaprakasha91,
Bhaishajyaratnavali92 and Yogaratnakara93 had mentioned the utility of Swedakarma in
various diseases.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Historical review of sweda karma
45
Sweda94: - Sweda is a word of masculine gender. Sweda word is coined by the
combination of “Swit” dhathu and “Dhanj” pratyaya. Sweda is a shareeramala, which is
associated with body heat mechanism.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Sweda karma
46
Sweda karma
The process which relieves stambha (stiffness), gourava (heaviness), sheeta
(coldness) and which induce sweda (sweating) is known as Sweda karma95. In general,
Sweda karma represents the therapy by which a person is made to sweat. Swedana will
cure Vata, Kapha and Vatakaphaja disorders96. But, it is not recommended in disorders
due to excitement of Pitta.
Even though, swedana is poorva karma, it has its own entity as pradhana karma in
some diseases. Charaka included Sweda karma in Shadupakramas and he has treated it as
main therapy97. For samshodhana purpose, it is considered as poorva karma. In sweda
sadhya diseases it acts as main therapy.
Properties of Swedana drugs98
Generally guru, teekshna and ushna dravyas induce sweating. Drugs with the sara,
snigdha, rooksha, sukshma, drava and sthira gunas are also utilized in Sweda karma.
Table No. 20. Showing the properties, action and predominance of mahabhootas of
swedana dravyas:
Sl. Properties Main actions Mahabhuta 1 Ushna Anutsaha, moorchakrit, swedakrit and dahakrit Agni 2 Teekshna Daha-pakakara, shodhananga, sraavana Agni 3 Snigdha Snehakrit, mardavakrit, bala-varnakrit Apa and Prithwi 4 Rooksha Opposite to snigdha and stambhakara, khara Vayu and Agni 5 Sara Anulomana, prerakata and pravrittisheela Vayu and Agni 6 Sthira Chirakaritha, sthairyakara and stambhakara Prithwi 7 Sookshma Sookshmachidrapraveshayogyata,vivarana sheelata Akasha, Vayu and Agni 8 Guru Sada, upalepa, tarpanakrit and brimhanakrit Prithwi and Jala 9 Drava Kledana, alodana, syandanakaraka Jala
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Sweda karma
47
Swedayogyas (Swedarhas99,100,101)
Table No.21. Showing the persons and diseases that are fit for swedana.
Sl. Vyadhi C.S. S.S. A.H. Sl. Vyadhi C.S. S.S. A.H.1 Pratishyaya + - + 30 Uru ruk / graha + - + 2 Kasa + - + 31 Jangha ruk / graha + - + 3 Hikka + - + 32 Kshavathu + - - 4 Swasa + - + 33 Khalli + - + 5 Alaghava + - - 34 Ayama + - + 6 Karna shoola + - - 35 Sheeta + - - 7 Manyasthamba + - - 36 Vepathu + - + 8 Shira shoola + - - 37 Vatakantaka + - + 9 Swara bheda + - + 38 Sankocha + - +
10 Gala graha + - - 39 Ayamashoola + - + 11 Ardita + - + 40 Stambha + - + 12 Ekanga roga + - + 41 Gourava + - + 13 Pakshaghata + - + 42 Supti + - + 14 Ardita + - + 43 Nasyarha + + + 15 Vinamaka + - + 44 Bastyarha + + + 16 Koshtanaha + - + 45 Shodhaneeya + + + 17 Vibandha + - + 46 Aahritashalya - + - 18 Mutraghata + - - 47 Anupadrava
moodhagarbha - + -
19 Vijrimbhaka + - + 48 Samyak prajata - + - 20 Parshwagraha + - + 49 Bhagandara - + - 21 Prishtagraha + - + 50 Arsha - + - 22 Kateegraha + - + 51 Ashmari - + - 23 Kukshigraha + - + 52 Shleshma roga - - + 24 Gridhrasi + - + 53 Amaroga - - + 25 Mutrakrichra + - + 54 Hanugraha - - + 26 Vriddhi + - + 55 Arbuda - - + 27. Angamarda + - + 56 Granthi - - + 28 Pada ruk / graha + - + 57 Shukraghata - - + 29 Janu ruk / graha + - + 58 Adhyamaruta
(Urustambha) - - +
Sushrutha had specified that those who are fit for Nasya, Basthi and Shodhana are
Poorvam Swedyas ; Ahritashalya, Moodhagarbha and Samyak prajata are Paschat
Swedyas ; and Bhangandara and Arsha are Poorvam Cha Paschat cha Swedyas102.
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We can conclude that, in general, there are three categories of diseases wherein
swedana is indicated – a) Vatapradhana rogas, b) Kaphapradhana rogas and c)
Shodhaneeya and Shadyakarmayogyas.
Sweda ayogyas (Sweda anarhas)103,104,105
Table No. 22. Showing the persons and diseases those are unfit for Swedakarma.
Sl. Vyadhi C.S. S.S. A.H. Sl. Vyadhi C.S. S.S. A.H.1 Kashayanitya + - - 24 Adhyaroga
(Vataraktha) + - +
2 Madyanitya + + - 25 Durbala + + + 3 Garbhini + + + 26 Ativisushka + - - 4 Rakthapitha + + - 27 Ksheenaoja + - - 5 Pithakopa + - + 28 Timira + - + 6 Atisara + + - 29 Pandu - + + 7 Rooksha + - - 30 Kshaya - + + 8 Madhumeha + + + 31 Kshama - + + 9 Vidagdhabradhna + - + 32 Ajeerna - + - 10 Bhrashtabhradna + - + 33 Chardi - + - 11 Visha + + - 34 Moorcha - - + 12 Madyavikara + - + 35 Stambhaneeya - - + 13 Shrantha + - - 36 Visarpa - - + 14 Nashtasamjna + - - 37 Kushta - - + 15 Sthoola + - + 38 Peeta dugdha - - + 16 Pithameha + - - 39 Peeta sneha - - + 17 Trishna + + + 40 Peeta dadhi - - + 18 Kshut + - + 41 Peeta madhu - - + 19 Krodha + - + 42 Krita virechana - - + 20 Shoka + - + 43 Glani - - + 21 Kamala + - + 44 Bhaya - - + 22 Udara + + + 45 Pushpitha - - + 23 Kshatha + - + 46 Sootha - - +
Reasons for the exemption of these diseases from swedana have been
explained by various acharyas. Sushrutha stated that in these conditions, which are
contra-indicated for swedana, if swedana is performed either the body gets destroyed, or
the diseases progress to incurable stage. He also permits the performance of swedana in
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durbala and ajeernabhaktha, if their vikaras are curable only by swedana106. Chakrapani,
commenting on the verses of Charaka, says that kashayanityas become rookshas and
atistabdha gatras; hence, the swedana if performed causes parvabheda. Also persons
suffering from rakthapitha, pithameha, kamala etc. and pittaprakriti persons are
exempted from swedana even prior to shodhana as it may cause further pittakopa.
Madhumeha persons develop shareera shaithilya and in such a condition, swedana is
contra indicated. He also adds that if the condition of the patient is Sweda eka sadhya,
then the sweda be permitted107.
Arunadatha, commenting on the verses in Ashtangahridaya, states that swedana
if done to an atisthoola person causes medovilayana resulting in shareera kshobha. For
rooksha, durbala, kshataksheena, kshama etc. The swedana may cause extreme
emaciation. A person having good appetite if undergoes swedana suffers from dehaglani.
In kamala and pandu rogas, the Swedakarma causes pitta vidradhi resulting in roga
vridhi. In garbhini, the swedana induces gabrha vyapat. For pushpitha ladies, it causes
excessive bleeding. For sootha, it causes emaciation108.
As Vagbhata109 had stated if these conditions are atyayika, then mridu sweda can
be stated, Arunadatha110 too supports this view. Hemadri111 further states that even if a
condition/disease is aswedya, the stage being atyayika (due to the inevitability of
swedana) mridu sweda can be performed.
In general, we can conclude that Swedakarma is contra-indicated in four
conditions: – (1) pitta, (2) raktha, (3) durbala avastha and (4) sweda asaha. Also it is to
be noted that swedana can be performed in mridu mode if these conditions are sweda eka
sadhya.
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Samyak swinnalakshanas112
Table No.23. Showing the lakshanas to be observed on the patient.
Sl. Lakshana C.S. S.S. A.H. 1 Seetha vyuparama + - + 2 Shoola vyuparama + - + 3 Sthambhanigraha + - - 4 Gouravanigraha + - - 5 Sanjathamardava + + + 6 Swedasrava - + - 7 Vyadhihani - + - 8 Laghutva - + - 9 Seetharthiva - + -
Among these shoola vyuparama, sthambhanigraha, gourvanigraha, laghutva,
mardava and vyadhihani are not evident immediately after swedakarma every day, but
manifest after the total course of proper swedana. Sheeta vyuparama, swedasrava and
seetharthitva are to be observed daily at the end of swedakarma daily.
Aswinnalakshanas
If the swedana performed is not sufficient or proper, then the lakshanas opposite
to the samyak swinnalakshanas occur. Dalhana adds that heaviness of the body,
ushnabhilasha and hardness of the body also occur. He has stated that mithya swinna
means both alpa swinna and mithya swinna (improper sudation) and that vyadhi vridhi
also occurs113.
Atiswinnalakshanas114,115,116.
If the swedana performed is in excess, it leads to many complications.
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Table No. 24. Showing the Atiswinna lakshanas on the patient.
Sl.no Lakshana C.S S.S A.H 1 Pitta prakopa + + + 2 Murcha + + + 3 Shareerasadana + - - 4 Trishna + + + 5 Daha + + - 6 Swaradourbalya + - + 7 Angadourbalya + - + 8 Sandhipeeda - + + 9 Sphototpathi - + - 10 Rakthaprakopa - + - 11 Bhranthi - + - 12 Vidaha - + - 13 Klama - + - 14 Bhrama - - + 15 Jwara - - + 16 Syava-raktha mandaladarshana - - + 17 Chardi - - +
Management of Atiswinna
Charaka117 advises the adoption of greeshma ritu charya along with consumption
of madhura-snigdha-seetha aharas and to follow snigdha-seetha upacharas. This includes
consumption of sasharkara mantha, jangala mriga-pakshimamsa, ghee, milk and
shashtikashali. Madya should be avoided. Ahara dravyas with lavana, amla, katu and
ushna properties and viharas such as vyayama should be avoided. Patient should live in
seethagriha during the day and in the room cooled by moon rays in the night.
Seethadravyas like chandana can be applied over the body. Mukthamani dharana also
can be done. Patient can also be taken to cool forests and ponds. He/She should not
indulge in intercourse118. Sushruta says that all kinds of seetha upachara should be
performed immediately119.
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Vagbhata had advised the adoption of stambhana chikitsa in case of atiswinna120.
Drugs, which are having the properties of laghu, manda, seetha, slakshna, rooksha,
sookshma, sura and drava and having tiktha-kashaya-madhura rasas, are stambhana
oushadhas. These are to be administered internally and externally to prevent further
complications of the patients.
Classification of Sweda
Several types of classification of Sweda are made with different points of view.
A) According to agni bheda121.
a) Sagni (Thermal) b) Niragni (Non-thermal).
B) According to guna bheda122.
a) Rooksha (Dry) b) Snigdha (Unctuous).
C) According to sthana bheda123. a) Ekanga (Local) b) Sarvanga (Total).
D) According to rogi bala and roga bala124 a) Mrudu (Gentle), b) Madhyama
(Medium) c) Mahan (Maximum).
E) According to the source of heat125,126. a) Tapa (Direct heat), b) Ushma (Steam), c)
Upanaha (Poultice) d) Drava (Warm liquid).
F) According to the method of sudation127. a) Sankara (Mixed), b) Prastara (hot bed),
c) Nadi (Steam kettle), d) Parisheka (Affusion), e) Avagaha (Bath), f) Jentaka
(Sudatorium), g) Asmaghna (Stone bed), h) Karshu (Trench), i) Kuti (Cabin), j) Bhu
(Ground bed), k) Kumbhi (Pitcher bed), l) Kupa (Pit sudation) and m) Holaka (Under
bed).
G) According to the usefulness in the Chikitsa, Samshamaneeya and
Samshodhanangabhoota128.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Table No. 25. TYPES OF SWEDA
01. Snigdha 02. Rooksha
01. Ekanga 02.Sarvanga
01. Samshamaneeya 02. Samshodhaneeya
01. Mridu 02. Madhyama 03. Mahan
01. Sagni 02. Niragni
Tapa Upanaha Ushma Drava
Pani Pradeha Pinda Parisheka
Kamsya Bandhana Samstara Avagaha
Phala Sankara Nadi
Valuka Ghanashma
Vastra Kumbhi
Ghatika Kupa
Kuti
Jentaka
01. Vyayama 02.Ushnasadana 03. Gurupravarana 04. Kshudha
05. Bahupana 06. Krodha 07. Bhaya 08. Upanaha
09. Aahava 10. Aatapa
53
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54
H) According to the route of application. Bahya and Abhyantara129
On the basis of applicability in children. Hasta, Pradeha, Nadi, Prastara, Sankara,
Upanaha, Avagaha and Parisheka130.
Niragni Sweda is further classified into ten types, viz., vyayama (exercise), ushna
sadana (warm rooms), guru pravarana (heavy blankets), kshudha (hunger), bahupana
(excessive drinking), bhaya (fear), krodha (anger), upanaha (plasters), ahava (war) and
atapa (sun bath)131.
Dalhana had said that jentaka, karshu, kuti, kupa and holaka are tapa swedas ;
sankara, prastara, ashmaghna, nadi, kumbhi and bhu are ushma swedas132.
Bashpasweda and Shahtikashalipindasweda belong to the Ushma type of
Swedana. Dalhana has defined Ushma sweda as “Ushma bashpaha”. He has opined that
all the techniques of ushma sweda can be collectively called as bashpa sweda133.
Nadi sweda
This is done with the steam coming from the vessel full of boiled
mamsarasa, milk, curd, dhanyamla or vataharapatrabhanga kwatha. The top of the vessel
is to be covered with kambala etc. for the prevention of excessive heat affecting the
patient134. Otherwise, the mouth of another vessel, which has a hole in its side, should
cover the top of this vessel. Sandhibandhana is done on the mukhas of the vessels. To the
hole of the upper vessel, a nadi (tube) resembling hastishunda (trunk of an elephant) of
one or ½ vyama (hand) length, having three folds and made of trina, kasha etc. is
connected. Before performing nadi sweda, the patient should be done abhyanga and
covered with a thick blanket. This is a very good method of swedana where all the angas
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are done proper sudation without any difficulty135. The Bashpasweda used in this study is
a modification of this classical technique.
Sankara sweda136
The process of thermal sudation by means of a bolus containing tila, masha etc.
with or without wrapping cloth is known as sankara sweda or pinda sweda. It is of two
types viz., Snigdha andRuksha.
Sudation is done with the boluses of the seeds of tila, masha, kulatha mixed with
amla dravya, ghee, taila, mamsa, odana, payasa and krishara is called as Snigdha pinda
sweda. It is specially indicated in Vata rogas.
Sudation with the excreta of various animals like cow, ass, camel, pig etc. and
other substances such as satushayava, sand, powder, stones, dry cow dung cake, iron
powder etc. is called as ruksha pinda sweda, which is indicated in Kapha rogas.
According to Sushruta and Vagbhata, Upanaha type of sweda is considered as one
among saagni swedas. At the same time, Charaka and Vagbhata have considered this as a
niragni sweda also. Chakrapani, commenting on Charaka samhita, stated that upanaha is
of two types – Sagni and Niragni137. The sagni upanaha is nothing but sankara sweda
itself. An example for it is the Kolakulathadi yoga explained in Charaka samhita
Suthrasthana.
All the Pindaswedas are based on the principle of Sankarasweda138.
Pinda swedas
As this study is on a major technique of pinda sweda, it will be relevant to
describe in brief other techniques of pinda sweda too.
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Pinda sweda is a process by which the whole body or a specific part of the body is
made to perspire by the application of certain heated medicinal puddings applied
externally in the form of pinda or boluses tied up in square pieces of cloths. The
technique is a combination of snehana (oelation), mardana (massage) and swedana
(fomentation). Pinda Sweda will come under sankara sweda of Charaka and Kashyapa
and ushma sweda of Sushruta and Vagbhata.
The following pinda swedas are being practiced commonly.
1) Shashtikashalipindasweda
2) Patrapotalipindasweda
3) Choornapindasweda
4) Valukasweda
5) Tushapindasweda
6) Jambeerapindasweda
7) Mamsapindasweda
8) Kukkutandapindasweda
9) Mashapindasweda
10) Godhumapindasweda
11) Dhanyapindasweda
12) Haridradi pindasweda
1. Shashtikashalipindasweda139
Details of this process will be discussed in the methodology chapter as this study
deals specially about Shashtikashalipindasweda.
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Effects Of Shashtikashalipindasweda - The effects of this treatment, if
properly done, are many. It cures powerful Vatarogas affecting all parts of the body;
diseases due to Rakthaprakopa; diseases which are very difficult to treat and diseases
which are affecting the strength (or immunity) of the body. In addition to these,
Shashtikashalipindasweda cures all types of diseases of the nervous system, chronic
rheumatism, pain in the joints, emaciation of the limbs and diseases born of vitiated
blood. This karma makes the body strong and sturdy with well-developed musculature. It
maintains the metabolism in a healthy condition from every point of view. This treatment
is found to be efficacious in subjects suffering from blood pressure and in certain kinds of
skin diseases resulting from impurity of the blood. This may also be resorted to once a
year, by healthy persons to keep up perfect health during old age and to prevent
premature aging.
2. Patrapotalipindasweda140
Also known as “Ila kizhi” or “Pachakkizhi” (common names), this type of pinda
sweda uses cut Vataharapatras in the form of pottali. Patras of arka, eranda, shigru,
nirgundi, karanja, chincha etc. are taken in equal quantity and cut into small pieces.
Coconut scrapings and citrus fruit can also be mixed together with the patras. This
mixture should be roasted in suitable taila (e.g. Bala taila, Masha taila, Nimba taila etc.)
fit for disease. After proper frying, the mixture should be tied as two boluses in clean,
square clothes.
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These pindas are again heated in suitable taila and applied to the body in
comfortable heat. Out of the two pindas, one pinda should be in the vessel over gentle fire
while the other pinda is used for massage. Bolus should be taken by the right hand and
the intensity of heat is tested by the outer surface of the left hand before starting the
procedure. The patient should be well massaged with vatahara taila or taila suitable to
disease in prior. As soon as the bolus, which is in use losses the heat, it should be
replaced by the bolus, which is kept over the fire. Left hand of the attender should do the
light massage in the direction of the bolus.
The process has to be done without any interruption for a minimum time of 30
minutes on the first day. Application should be done by asking the patient to position in
all the seven postures. If the physician decides to perform the therapy for 7 days, the
duration should be increased by five minutes each day, thus reaching 45 minutes on the
fourth day. From there it is reduced by five minutes per day to reach the original duration
(30 minutes) on the seventh day.
If the therapy is for 14 days, the increase in the duration is the same reaching the
maximum of one hour on the seventh day. Sometimes is the duration on eighth day also
and from there, the duration is reduced. These are subject to the individual rationality of
the physician.
After the prescribed duration, the oil is wiped off the body with a dry towel.
Patient should be protected from immediate exposure to cold, sun, wind etc. and allows
to take rest for a few minutes. Then he is advised to take bath in water boiled with
vataharapatras.
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The drava in which the bolus is heated may be dhanyamla, gomutra,
vataharakashaya etc. The bolus of the contents should be changed daily or at least once in
three days. Two attendants are needed for the karma – one to perform the pinda sweda
and other to heat the bolus. Indications are prasupthi, kampa, angamarda, pakshaghata,
askhepaka, gridhrasi, sandhigatavata, kateeshoola etc.
3. Choornapindasweda141
This is performed with boluses of medicinal powders and is also known as
‘Podikkizhi’ (common name). Powders of rasa, ashwagandha, sarala, shunti, vacha,
shigru, devadaru, sarshapa, kola, kulatha, masha, godhuma, mudga, tila etc has to be
taken and added saindhava lavana. Each has to be taken 10 gms and 30 gms of coconut
scrapings and 2 or 3 pieces of citrus fruits can also be added. These powders and other
items well mixed are to be fried in suitable oils and made into two boluses.
The procedure and duration are same as the patrapottali sweda. This procedure is
the snigdha variety of choorna pinda sweda. The rooksha variety of choorna pinda sweda
is also common. Powders of kulatha, tusha etc are fried in iron pan along with saindhava
lavana without oil and then made into bolus.
Snigdha choornapindasweda is indicated in Vatarogas like apabahuka, gridhrasi
etc. and rooksha choornapindasweda is indicated in saama-kaphanubandha Vatarogas like
amavata.
4.Valuka sweda142
In this the bolus is prepared of sand. This is a typical rooksha sweda indicated in
amavata, vatarakta, urustambha etc. Here, the sand can be fried in dhanyamla along with
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saindhava lavana. Much care should be taken in testing the heat of the bolus and only
moderate heat should be applied.
5.Tushapindasweda143
It is a process by which the bolus is prepared by the husk of the paddy. Husk of
the wheat also can be used. It is a household practice in our country in swasa and kasa.
6. Jambeerapindasweda144
Drugs used in this are jambeeraphala, saindhava lavana, and fried powders of
methika, kulatha, haridra and shatapushpi. 10 citrus fruits of big size should be cut into
the small pieces and 30 gms of haridra choorna and 5 gms of saindhava is added and fried
in suitable oil and made into bolus. It is beneficial in pakshaghata, apabahuka, sandhi
gatavata, bhagna etc.
7. Mamsapindasweda145
It is similar to Shashtikashalipindasweda. If mamsa is alone made into bolus, the
drava dravya for cooking and heating is mamsa rasa. If mamsa is used along with
shashtikashali, balamoola kwatha along with ksheera are the drava dravyas for cooking
the mamsa and shali and also for heating the bolus. Meat of goats, hen, pig, peacock etc.
are generally used.
It is mainly indicated in emaciation (Shosha) prominent conditions such as
atrophy, dystrophy, myopathy, pakshaghata, balavata etc. It arrest the premature aging,
promotes the growth, tonicity and strength of muscles.
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8. Kukkutandapindasweda146
Egg yolk of hen is used for this technique. Two lemon fruits are taken and cut into
pieces. It is mixed with three boiled egg yolks and fried in suitable oils and made into
bolus. It is beneficial in ardita, greevagraha, hanugraha, apabahuka etc.
9. Mashapindasweda147
Here, instead of Shashtikashali, masha (Phaseolus radiatus) is used and the
procedure, duration and indications are similar to Shashtikashalipindaswedakarma.
10. Godhumapindasweda
Here, instead of Shashtikashali, godhuma (wheat) is used and the procedure,
duration and indications are similar to Shashtikashalipindasweda.
11. Haridradi pindasweda148
This is specially indicated in Kshata (Trauma). Here, haridra choorna and laja
choorna are taken in more quantity and sarja choorna, jeeraka choorna and manjishta
choorna in less quantity. The white part of two boiled eggs is mixed thoroughly with
these powders and the end product is used as a bolus.
12. Dhanyapindasweda149
Fried powders of masha, mudga, tila, sarshapa, shashtikashali, kulatha, methika,
shatapushpa and eranda beeja are made into bolus. Also, these can be cooked in milk
squeezed from coconut scrapings and made into bolus and used instead of
shashtikashalipinda.
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Swedakarmas and Karmukata
Swedakarma has four major actions over the body –
(a) stambhaghnata, (b) gouravaghnata, (c) seethaghnata and (d) swedakarakata.
a. Stambhaghnata
Stambha means stiffness. This attribute is a resultant of excess seetha guna and
also influence of factors such as samanavata, sleshakakapha, ama, mamsa, vasa and
medas is contributory to the production of stambha. Samanavata is rooksha gunapradhana
and hence if vitiated does excessive shoshana of shareera there by producing contractures
and stiffness. Sleshakakapha is snigdha and pichila and hence if decreased (kshaya)
results in less lubrication of joints causing stiffness.
Swedakarma being snigdha and ushna corrects both these deranged dosha
ghatakas and relieves stiffness. Chakrapani had stated that stambha also means
obstruction or block. Therefore, swedana not only relieves stiffness, but also clears
blocking of passages (srotorodha). Srotas as a structural entity is Kaphapradhana. Ayana
or transport is the most important function of srotas. This is under the control of Vata.
There by it is evident that there is a predominant influence of Vata and Kapha over the
srotas. Vitiation of these two hampers the structural and functional aspects of the srotas.
We know that swedana has the opposite qualities to that of Vata and Kapha,
thereby producing a palliative effect on them and the srotas is becoming normal. It is
well known that unless there is a srotodushti there is no disease. Thus, it is evident that
swedana clears the srotodushti or sanga.
In other words, by contact of bearable warmth, the area in contact gets more
circulation. The lumina of the contracted body architecture get smoother and wider. This
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rendering a stiff entity smooth relieves variety of obstructions. Widening of the core and
simultaneous liquefaction of the solid or semi-solid material makes the flow easier.
Widening of the tract and fluid character of the material inside makes the obstructions
released slowly.
b. Gouravaghnata
Heaviness of the body is being relieved by Swedana. By means of swedana, the
fluids in the body are being excreted through the sweda (sweat) and hence the feeling of
lightness in the body. Swedana stimulates the nerve endings and promotes muscle
strength.
c. Seethaghnatha
Seethaghnatha has to be understood as the patient is relieved of the coldness
existing prior (the ushna guna pradhana sweda karma is performed). In fact, by the
excretion of sweat, the heat in the body is being transferred out.
d. Swedakarakata
Swedana produces perspiration. This is a mala (excretory product). In this, the
wastes of all the layers of skin, muscles, nerves, rasa, raktha, meda etc. are mixed.
Therefore, it is a mechanism of excreting the metabolic wastes in the body tissues.
Apart from these major actions, Swedana also produces the following effects.
1. Doshadraveekarana
Snehana performed prior to swedana makes the doshas mridu and
eradicates the mala sanga. The swedana penetrates to each and every channel in the body
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and liquefies the doshas. These liquefied doshas has to be eliminated from the body
means of shodhana karma.
2. Vata shamana
Snehapoorvayukthasweda pacifies the Vata dosha, thereby curing the
pureesha-mutra-shukra sanga. By its properties opposite to that of Vata, it pacifies the
Vata. Sweda is also one of the upakramas of Vata.
3. Gatra vinamana
Charaka says that by application of oil and heat, even dry wood can be
bent then what is the wonder about shareera. It cures harsha, ruk, ayama, shopha,
stambha and graha and produces mardava, thereby permitting normal flexible body
movements.
4. Agnideepana
As swedana is ushna guna pradhana, it does the ama pachana there by
promoting the agni in the body.
5. Twak mardava and Prasadana
Perspiration is dependent on skin, where in the hair follicles which are the
moolas of swedavaha srotas are situated. Due to sweating and excretion of wastes, the
skin becomes soft and pleasant.
6. Bhakthasradha
As the swedana promotes agni, more interest on food consumption is
resulting.
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7. Srotosuddhi
The mechanism of making srotosuddhi has been explained under the
action stambhaghnata.
8. Nidra-Tandra nasha
Swedana pacifies Vata. Vata is responsible for the functions of indriyas
wherein nidra and tandra are affecting. Sweda also pacifies Kapha thereby making the
body light, and providing relaxation. Thus it prevents excessive sleep and drowsiness.
9. Sandhicheshtakara
Swedana relieves stambha and graha thereby promoting the sandhicheshta.
10. Dosha shodhana
The doshas situated in the dhathus, koshta and sakha-asthi and those leena
in the srotas gets kledana by snehana and gets liquefied by the swedana and comes to the
koshta and get ready for elimination by means of shodhanakarma.
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NASYA ACCORDING TO MODERN VIEW
There is no direct pharmacological correlation between nose and brain. However
the olfactory area is the only place in the whole human body where there is direct contact
between the outer surface and Central Nervous System. It is known that blood brain
barrier is a strict security system due to which many drugs cannot reach in the brain.
However the effect of drug on the brain, administered through the nasal pathway
can be seen in followed examples.
The nose is used as a route of administration for inhalation of anaesthetic drugs.
The importance of Nasal route is indicated by the fact that Dr D. N. Rao of
AIIMS delivered antigenic peptide related to the AIDS virus by packaging them in
porous polymer microsphere and aerosolizing them in rats (The Hindu).
Ethanol suspension of Insulin sprayed through nebulizer gave excellent results in
rats without producing any allergy. Certain agents are used as decongestants in the
treatment of paranasal sinusitis. In modern medicine system, anterior pituitary hormones,
in the form of Nasal spray are being used since a long time. In the same way Vasopressin
is already in market in the form of Nasal therapy.
In some researches, it is found that Nasal administration of leutinizing hormone
and calcitonin are equally effective in maintaining blood concentration as in Intra-venous
effusions. ( Fink G. et al 1973; Pontrioli E. A. et al 1983)
The studies show that perspired scent that has been painted on upper lips has
caused synchronization of the menstrual cycle in Female volunteers by contact smelling
(Michael Russel, 1977).
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Nasal administration of an LRH antagonist for 3-6 months was found to be
effective in inhibiting ovulation as a contraceptive measure (Berauist et al 1979) In this
case absorption of drugs is believed through nasal and pharyngeal mucosa. Kumar Anand
(1979) has attempted contraceptive drug administration through Nasal route and opined
that the route is beneficial than systemic administration. It was also found that
concentration of the drug in C.S.F. was very high to that when administered
intravenously. An experimental study, carried out by fragrance inhalation method, to
observe the lactation inhibiting effect of Jasmine flowers, proved beneficial on rats. The
findings also showed reduction of gland activity and decrease in serum prolactin
(Abraham 1979).
Hypoglycaemic effect of Insulin and hyperglycaemic effect of Glucagon
hormones are confirmed by intra-nasal administration in normal and diabetic patients.
- Pontrioli E. A. et al. 1983 Cryptorchid boys (having undescended testis) have been
treated by intranasal GTRH (Gonadotropin Releasing Hormone) to stimulate leutinizing
hormone secretion. - Raifer J. et al 1985
It is proved by scientist of Institute of Medical Science, Delhi that the drug
administered through nose shows effective action on brain. By above-mentioned
examples it can be said that there is very close relation between brain and nose.
Thus to understand the action of Nasya drug on central nervous system it is
necessary to know the probable pathways of action of Nasya dravya. On the basis of
fractional stage of Nasya karma procedures, we can draw certain rational issues that are
as follow :
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Effect on Neuro-vascular Junction
Specific posture during Nasya karma, like the lowering of the head, fomentation
of face seems to have an impact on blood circulation of the head and face. The efferent
vasodilator nerves are spread out on the superficial surface of face. They receive
stimulation by fomentation and this may increase the blood flow to the brain i.e.
momentary hyperemia. According to Chatterjee, approximately 22% of total dilatation of
cerebral capillaries, caused by facial efferent stimulation will lead to 150% blood in flow.
– Chatterjee 1980
It is also possible that the fall of arterial pressure due to vasodilation may induce
the Cushing’s reaction.
Due to this reaction a “Slush” is created in intra-cranial space, which probably
forces more transfusion of fluid in brain tissue which may lead to make possible the drug
action in the brain.
This can be explained by the example of drug like benzyl penicillin. The drug
does not attain therapeutic level in the brain in normal conditions. But it is found to be
effective during the meningitis (the inflammatory condition of meninges). (Gillman and
Goodman 1980).
Absorption and transportation of the drug administered by nasal pathway :
Keeping the head in lowering position and retention of medicine in nasopharynx
help in providing sufficient time for local drug absorption. Any liquid soluble substance
has greater chance for passive absorption through the cell of lining membrane.
The drug absorption can also be enhanced by massage and local fomentation.
Fingl 1980
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The absorption of drug, promoted by massage and local fomentation can occur in
two ways : By systemic circulation Direct pooling into the intra-cranial region The
second way is of more interest. It can occur in two ways
a) By vascular path
b) By lymphatic path
Transportation By Vascular Path :
Pooling of the blood of nasal vein and of opthalmic vein occurs in facial vein
naturally. It is interesting that both facial and opthalmic veins have no venial valve in
between. As a result the blood may drain on either side. It means blood from facial vein
can enter in cavernous venous sinus of the brain in reverse direction. Such a pooling of
blood in the brain is more possible in head lowered position due to gravity. Thus the
absorption of drug in meninges and related intra-cranial organ is considerable point.
In the support of this hypothesis it is described in modern medicine also that the
infective thrombosis of facial vein may lead to infection of meninges easily, through this
path.– William et al. 1971 Pooling of the blood from paranasal sinuses is also possible in
the same manner.
Shringataka marma, mentioned by Acharya Vagbhatta can also be explained by
above description.
Drug Transportation By Lymphatic Path :
Through this pathway drug can reach directly into the C.S.F. Along with olfactory
nerve, the arachnoid matter sleeve is extended to sub-mucosal area of the nose.
Correlation between them is understood by the fact that dye injected to arachnoid matter
causes colouration of nasal mucosa within seconds and viceversa also.
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Preliminary studies reported from AIIMS Laboratory’s shows that when steroids
are administered through nasal pathway, they enter rapidly in C.S.F. Their level in C.S.F.
was found to be much higher as compared with systemic injections.
Here it is important to remind the statement of Sushruta that the excessive
administration of Virechana Nasya (eliminative errhine) may cause oozing of mastulunga
(C.S.F.) into the nose.
Thus we can say that the ancient scholars of Ayurveda had some knowledge of
lymphatic path and functional relation between nose and brain.
Importance of Post Nasya Massage :
The absorption and transportation of drug administered through nasal route is
explained in previous pages. Post Nasya massage, recommended by ancient Acharya is
as important as the massage before Nasya.
Post Nasya massage on the frontal, temporal, maxillary, mastoid and manya
region may help to subside the irritation of the somatic constriction due to heat
stimulation. It may also help in removing the slush created in these regions.
According to Sushruta, manya is a marma existing in neck on either side of
trachea150. Which likely corresponds to the carotid sinus of neck on the bifurcation of
common carotid artery. The receptors called baroreceptors are situated here and
manipulation on it may have a buffering action on cerebral arterial pressure.
– Best and Taylor, 1988
Pressure applied on the baroreceptors is also found to normalize the deranged
cerebral arterial pressure. – Hejmadi S. 1985
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On the basis of this fact, we can understand that procedures, postures and
conducts explained for Nasya karma have a great importance in drug absorption and
transportation.
Thus it can be stated that there is a definite effect of Nasya karma on the diseases
of nervous system, endocrine system and psychiatric disturbances.
In this way, procedure of Nasya is beneficial in various diseases and for
maintenance of healthy condition too.
How does the drugs enter into the brain can be discussed below. The absorption
of the drugs are carried out in three media. They are:
By general blood circulation, after absorption through mucous membrane. The
direct pooling into venous sinuses of brain via inferior ophthalmic veins. Absorption
directly into the cerebrospinal fluid.
Apart from the smallemmisary veins entering cavernous sinuses of the brain, a
pair of venous branch emberiging from alaenasi will drain into facial vein. Just almost in
the opposite direction inferior ophthalmic veins also enter the facial vein. These
opthalmies in other hand also drain into cavernous sinuses of the meninges and in
addition nither the facial vein not the ophthalmic veins have any veinal valves. So there
are more chances of blood draining from facial vein into the cavernous sinus in the
lowered head position.
The nasal cavity directly opens with the frontal maxillary and sphenoidal air
sinuses epithelial layer is also continuous throughout them. The momentary retention of
drug in nasopharynx and suction causes oozing of drug material into air sinuses. These
sites are rich with blood vessels entering the brain and meninges through the existing
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foramins in the bones. Therefore, there are better chances of drug transportation in this
path. The shringhataka marma has been explained by recent authors as ‘middle cephalic
fossa of the skull consisting paranasal sinuses and meningial vessels and nerves. One can
see into the truth of narration made by Vagbhata here. The drug administered enters the
paranasal sinuses especially frontal and sphenoidal sinuses i.e, shringhataka where the
ophthalmic veins and the other veins spread out. The sphenoidal sinuses are in close
relation with intracranial structures. Thus there may be a so far undetected route between
air sinuses and cavernous sinuses enabling the transudation of fluids. As a whole, the
mentioning of the shringhataka in this context seems to be more reasonable.
ABSORPTION OF DRUG
The drug may be absorbed initially by ‘passive process’ across the cell wall. Any
lipid soluble substance has greater chance for passive absorption directly through the
lining of cell membrane. Then the later transversion may be carried through capillaries
and veins. Usually the Nasya consists of Snehadravya, as strongly recommended by the
Ayurvedic texts. Modern science states that the greater the lipid water coefficient, the
concentration of drug in the membrane and the faster is its diffusion. The partion
coefficient is also dependent upon the temperature of the moment of administration.
Hence, the rised temperataure due to hot fermentation may help in this active process.
In the conclusion it may be stated that, the nose is the doorway to the brain and it
is also path to consciousness. Pran of life energy enters the body through the breath taken
in, through the nose, Nasal administration helps to correct the disorders of prana affecting
the higher cerebral, sensory and motor functions. The brief study of mechanism of
Nasyakarma can be summed up in a single statement made in the Ayurvedic classics
‘Nasahi Shirasodwaram’. I.e, nose is the pharmacological passage into the head.
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Twak shareera
Ayurveda has recognized twak as an upadhatu of mamsa151. The twak is a
modification of mamsadhatu in its developmental state i.e. during intrauterine life152.
Sushruta described the seven layers of twak and the diseases arising from the twak153.
The following table shows the thickness of the seven layers of twak and the
diseases arising from them.
Table No. 26. Showing the different layers of twak
Sl. Layer of twak Size Diseases arising from each layer
1 Avabhasini 1/18 Vrihi Sidhma, Padma, Kantaka
2 Lohitha 1/16 Vrihi Tilakalaka, Nyaccha, Vyanga
3 Swetha 1/12 Vrihi Charmadala, Ajagalli, Mashaka
4 Tamra 1/8 Vrihi Kilasa, Kushta
5 Vedinee 1/5 Vrihi Kushta, Visarpa
6 Rohinee 1 Vrihi Granthi, Apachi,
Arbuda, Shlipada, Galaganda
7 Mamsadhara 2 Vrihi Bhagandara, Vidradhi, Arshas
According to Sushruta, these seven layers of twak are formed, as the
cream is formed layer after layer in the boiling milk.
Charaka slightly differs from Sushruta and had described only six layers
of twak without naming them154. Order of these six layers is 1) udakadhara, 2) asrigdhara,
3) sidhma-kilasa sambhavadhishthana, 4) dadrukushta sambhavadhishthana, 5) alaji-
vidradhi sambhavadhishthana and 6) arumshika adhishthana. Among these if, the
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innermost layer i.e. arumshika adhishthana is injured the patient goes into shock and
develops a very serious skin disease called arumshika, a type of boils on the phalanges
and elbow joint.
Bhrajakapitta, one among the panchavidha Pittas, is located in the twak. It is this
bhrajakapitta that takes up and metabolizes the drugs applied in the form of abhyanga,
parisheka, avagaha, alepa155 etc.
Modern View
Most of the modern scientists recognize the possibilities of considering skin as a
Large, Highly Complex Organ and as a Structuraly Integrated Organ System. The
components of the integumentary system are the cutaneous membrane or skin and the
associated hairs, nails and exocrine glands. The system accounts for about 16% of ones
body weight156.
Cutaneous membrane has two components – the superficial epithelium or
epidermis and the underlying connective tissues of the dermis. The associated or
accessory structures are located in the dermis and protrude through the epidermis to the
skin surface. Function of the skin is supported by an extensive network of blood vessel
branches (through the dermis) and sensory receptors that monitor touch, pressure,
temperature and pain. The loose connective tissue of the subcutaneous layer or superficial
fascia or the hypodermis which lies beneath the dermis separates the integument from the
deep fascia around the other organs such is muscles and bones.
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General functions of the skin
• Protection of underlying tissues and organs.
• Excretion of salts, water and organic wastes.
• Maintenance of normal body temperature.
• Synthesis of a steroid, vitamin D3 that is subsequently converted to the hormone
calcitriol, important to normal calcium metabolism.
• Storage of nutrients.
• Detection of touch, pressure, pain and temperature stimuli and the relay of that
information to the nervous system.
Sweda and Swedavahasrotas
Sweda is produced from medodhathu as a mala during dhathuparinama157.
When the body becomes hot, the udaka that comes out from the romakupas is called
sweda158. Sweda is an apyadravya159. Sweda is brought to the surface of the skin through
the swedavaha srotases by the action of vyanavata160. The excretion of the sweda
bestows moisture and delicate nature to the skin161. According to Hemadri, the hair on
the skin is supported by the sweda162.
Medas and romakupa are the moolas of swedavaha srotas163. They get vitiated due
to ativyayama, atisantapa, indiscriminate indulgence in cold and heat, krodha, shoka and
bhaya164. Their vitiation produces the following lakshanas- aswedana (anhydrosis),
atiswedana (hyperhydrosis), parushya (roughness of the body), atislakshnata (excessive
smoothness of the body), paridaha (general burning sensation) and lomaharsha
(horripulations)165.
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HISTORICAL BACKGROUND OF MANYASTHAMBHA
The disease references are much available in Vedas and Samhita as only Vata
vikara. It is evidential that there is no direct reference of the disease as Manyasthambha is
available from vedic literature, but can definitely find indirect references here and there.
In the Rigveda and Atharvana Veda we can see the details of Vata bheda, Sleshmaka
Kapha166. Sandhi Vyadhi and medicines used in Vata Vyadhi. The references are found
from Bhruhatrayes and Laghu trayees many more about the disease Manyasthambha.
Manyasthambha is highlighted in early 20th century and even they have mentioned the
Shodhana and Shamana line of managements.
Charaka Thrimarmeeya chapter of Siddhi Sthana167, he explained
Manyasthambha is because of head injury i.e. shiro abigatham and considered
“Antharayama” as Manyasthambha. Similarly Vagbhata168 also refer Manyasthambha is a
symptom of “Antharayama”. In further while explaining the Nasya vidhi, he has
indicated Nasya especially Brumhana Nasya for Manyasthambha169.
Susruta Samhita dealt Manyasthambha as the prodromal symptom of Apathanaka,
a Vata Vyadhi. But Gayadasa, commentator of Susruta, considers Manyasthambha as
individual disease entities because of its causative factors are discussed separately as a
disease170,171.
Later texts of Ayurveda Madhava Nidana172, Bhavaprakasha173 and
Sharangadhara174 Samhita dealt Manyasthambha as individual disease by discussing its
detailed pathology along with its specific line of treatment. Chakradutta175, Vangasena176
and Bhaishajaya Ratnavali177 also discussed Nidana and treatment for Manyasthambha as
an individual entity of disease.
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At the present day of context, the contemporary science explains elaborated
description of cervical Spondylitis, which is a inflammatory and degenerative disease,
has been studied under a separate branch named as Rheumatology linked with the bonny
lesions178.
Etymology of Manyasthambha
The Manyasthambha comprised of two meaningful words, Manya and sthambha,
which makes the meaning of stiffness of the neck muscles. It clearly states the
pathogenesis of the neck and its contents. The derivation of the Manyasthambha is as
follows179.
“Manya” means the back of the neck or the part below the head, manya and
Greeva are synonyms.
“Sthambha” relays the meaning of stopping or retarding the functions of the neck
i.e. inability of neck movements
With the above stated definitions and derivations we can draw a conclusion as
such the disease Manyasthambha is a disease of the neck where the movements are
restricted or disturbed because of the underlying pathology. The pathology is either
inflammatory, degeneration or due to local pathological entities, either because of the
internal humoral vitiation or exogenic factors180.
Paribasha181
Vata is vitiated either because of Avarana or Dhatu kshaya. When Vata covered
by Kapha or Dosha accumulation makes Manyasthambha. Even though Manyasthambha
is told as a vataja nanatmaja Vata Vyadhi Kapha Dosha associations are also inscribed in
the Samprapti.
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This is because the Vata is vitiated and lodging in the Kapha sthana so the Kapha
involvement can occur. When any disease is not treated properly at the initial stage it may
lead to further deterioration. Such activity is happening even in Manyasthambha too. At
the initial stage of the disease the Kapha Anubandhatwam is acknowledged. When it
becomes chronic, it becomes as a total Vata disorder, which is degenerative condition in
nature.
Surface Anatomy of the disease concern
Vertebral column182,183,184
The total numbers of bone present in the body are together called as skeleton. The
main division of skeleton is into axial and appendicular. The axial skeleton includes
vertebral column, sternum, ribs, and skull. The appendicular skeleton includes these
bones of the upper and lower limbs and girdle bones. The vertebral column extends from
the base of the skull through the whole length of the neck and trunk. It consists of thirty
three separate irregular bones called vertebra placed in series and connected together by
ligaments and discs of fibro-cartilage to form a flexible curved support for the trunk.
The vertebral column varies length but it is about 70cm in man and 60cm in
women. Th vertebra is named according to region in which they lie. They are 7 cervical,
12 thoracic, 5 lumbar, 5 sacral, 5 coccygeal.
With the exception of the first two cervical vertebrae all other vertebra consists of
a large anterior weight bearing body and a posterior placed vertebral arch. The arch
springs from the postero-lateral aspects of the body and with its surrounds large hole,
vertebral foramina. When the vertebra are placed in series these foramina together with
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the ligamenta flava, that unite the adjacent laminae form the vertebral canal which lodges
the spinal chord with its meaning and blood vessels.
Atlas (first cervical) vertebra
The first cervical vertebra is called the atlas it looks very different from a typical cervical
vertebra as it has no body and no spine. It consists of two lateral masses joint anteriorly
by a short anterior arch, and posteriorly by a much longer posterior arch. The arches give
the atlas a ring like appearance. The large transverse process pierced by a foramen
transversarium, projects latterly from the lateral mass. The superior aspects of each lateral
mass shows an elongated concave facet, which articulates with the corresponding condyle
of the occipital bone.
Cervical vertebrae (C1-4) Postrio-superior view
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The axis (second cervical) vertebra
The most conspicuous feature of the axis, which distinguishes it from all
othervertebra, is the presence of a thick finger like projection arising from the upper part
of the body. This projection is called the densor odontoid process. The anterior aspect of
the dens bears a convex oval facet for articulation with the anterior arch. Its posterior
aspect shows a transverse grove for the transverse ligament. The pedicles, laminae and
spine are the thick and strong, the inferior articular facets are placed below the junction of
the pedicles and the laminae.
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Cervical vertebrae (C2-T1) Right-Lateral view
The seventh cervical vertebra
The seventh cervical vertebra differs from a typical vertebra in having a long thick spinus
process, which ends in a single tubercle. The tip of the process forms a prominent surface
landmark. Because of this fact this vertebra is referred to as the vertebra prominence.
The transverse processes are also large and have prominent posterior tubercles. In
this vertebra the vertebral artery and vein do not transverse the foramen transversarium of
this vertebrae an accessory vertebral vein passes through the foramen.
Anatomy of inter vertebral joints
All vertebrae from 2nd cervical to 7th cervical vertebrae articulate by cartilaginous
joints between their bodies, synovial joints between their articular process
(Zygapophysical) and fibrous joints between their laminae and also between their
transverse and spinous process.
Inter-vertebral disc
It is a fibro-cartilagenous disc, which bends the two adjacent vertebral bodies,
except the axis. Morphologically it is a segmental structure as opposed to the vertebral
body, which is inter-segmental.
Inter-vertebral discs Shape: The shape of the inter-vertebral disc corresponds to that of
the vertebral bodies between which it is placed.
Inter-vertebral discs Thickness: It varies in different region of the column and in
different parts of the same disc. In cervical region the disc are thicker in front than
behind.
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Structure of inter-vertebral disc: Each disc is made up of three parts, viz., Nucleus
pulposes, annulus fibrosus and cartilaginous plate. The individual component description
is as follows.
Nucleus pulposus: It is the central part of the disc, which is soft and gelatinous at birth.
Its water content is 90% in newborn and 70% in old age. It is kept under tension and acts
as a hydraulic shock absorber. It represents the remains of the notochord and contains
few multi nucleated notochordal cells during the first decade of life. After which there is
a gradual replacement of the mucord material by fibro cartilage derived mainly from the
cells of annulus fibrosus and partly from the cartilaginous plates covering the upper and
lower surfaces of the vertebrae. Thus with advancing age the disc becomes amorphous
and difficult to differentiate from the annulus. Its water binding capacity and the elasticity
are reduced.
Annulus fibrousus: It is the peripheral part of the disc made up of a narrower outer zone
of collagenous fibres and a wider inner zone of fibro cartilage. The laminae form
incomplete collars, which are convex downwards and re corrected by strong fibrous
bands. They overlap into one another at obtuse angles. The outer collagenous fibers bend
with anterior and posterior longitudinal ligaments.
Cartilaginous plate: Two cartilaginous plates lie one above the other below the nucleus
pulposes. Disc gains its nourishment from the vertebrae by diffusion through these plates.
Function of inter-vertebral discs: Inter-vertebral discs give shape to the vertebral
column. They act as a vertebral series of shock absorbers or buffers. Each disc may be
linked to a coiled up spring.
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Movements of the cervical column: Range of movements between vertebrae is
restricted by the limited deformities of inter-vertebral discs. Whose greater thickness at
cervical column increases individual range. It is also limited by the topography of the
zygophysial joints and by concomitant changes in tension of the ligamentous
syndesmoses. Thus the total range of vertebral movement includes flexion, extension,
lateral flexion rotation.
Flexion: In flexion the anterior longitudinal ligaments become relaxed and the anterior
part of inter-vertebral discs are composed. While at its limit the posterior longitudinal
ligament ligamentum flora, inter-spinous and supra-spinous ligaments and posterior
fibres of intervertebral discs are tensed.
Extension: In extension the opposite event of flexion occurs. Tension of the anterior
longitudinal ligament, Anterior disc fibres and approximation of spines, zygopophyses
and compression of posterior disc fibres, limits extension.
Lateral flexion: Here the inter-vertebral discs are laterally compressed and contra-
laterally tensed and lengthened motion being limited by tension of antagonist muscles
and ligaments. It is always combined with rotation, lateral movements occur in any part
of the column but are greatest in cervical and lumbar region.
Rotation: Rotation involves twisting of vertebrae relative to each other, with torsional
deformation of intervening discs. Movement is slight at cervical level.
Neuro anatomy
Cervical plexus185,186
The cervical plexus is formed by the vertebral rami of the upper four cervical
nervous. The rami emerge between the anterior and posterior tubercles of the cervical
transverse processes, grooving the costo transverse bars. The four roots are with one
another to form three loops.
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The plexus is related posteriorly to the muscles, which arise from the posterior
tubercles of the transverse process i.e., the Levator scapulae and the scanlenus medius.
Anteriorly to the pre-vertebral facia, the interior jugular vein and sterno mastoid.
Branches
A) Superficial cutaneous branches
Lesser occipital (c2)
Greater auricular(c2,c3)
Transverse (anterior) cutaneous nerve of the neck (c2,c3)
Supra clavicular (c3,c4)
B) Deep branches
Communicating branches
Muscular branches
o rectus capitis anterior from c1
o rectus captis lateratus from c1,c2
o longus capitis from c1,c2,c3
o lower root of anasa cervicalis c2c3
Muscles supplied by cervical branches
Stermomastoid – c2 and accessory nerve
Trapezius – c3-c4
Lavetor scapularis – c3c4c5
Phrenic nerve c3c4c5
Longus colli c3-8
Scalenus medius c3-8
Scalenus anterior c4-6
Scalenus posterior c6-8
Phrenic nerve
This is a mixed nerve and carrying motor fibres to the diaphragm and sensory
fibres from the diaphragm, the pleura, the pericardium, and part of the peritoneum.
Origin: It arises chiefly from the 4th cervical nerve but receives contributions from c5
may come directly from the root or indirectly through the nerve to the subclavius.
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Nidana – the aetiology of Manyasthambha
Nidana is defined as ‘Vyadhi Uttpatti hettu nidanam” This is the main cause for
the occurance of a disease. This makes us to ascertain the diagnosis, helps to provide
proper treatment and Nidana Parivarjna is one of the important measures in chikitsa.
As the Manyasthambha is a Vata Vyadhi, the Vata Vyadhi Nidana has to be
considered here. Manyasthambha is one among the eighty types of Vata disorders. There
is no much difference in the causative factors of Vata diseases. Only due to Samprapti
Vishesha of vitiated Vata will leads to variety of Vata disorder like Ardhita, Pakshagata,
Manyasthambha etc., the factors which causes vitiation of Vata are classified under the
following sub headings.
Swaprakopaka Nidana
Margavarodhaka Nidana
Marmaghatakara Nidana
Dhatukshayakaraka Nidana
The etiological factors having some properties of Vata causes increase of Vata.
According to Samanya Vishesha Siddhanta, the principle of the doctrine is the
combination of similar brings about vrudhi and the dissimilar to kshaya187. Further
excessive and constant consumption of the same etiological factors results in to
provocation of Vata. Apart from these the factors which favours the provocation of Vata
are also to be considered here. These etiological factors are classified as follows.
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Swaprakopaka Nidana
Ahara (dietetic factors)
Excessive and continuos in take of diet possessing the properties of ruksha,
Sheeta Laghu, and rasas like Katu, Tikta, Kashaya, irregular food habits, in sufficient
diet, intake of dried leafy vegetables, dried food articles, cereals like varaka, kodrava,
pulses like syamaka, mudga, kalaya, chanaka, harenu.
Vihara188
Ratri jagarana, excessive walking, excessive swimming, excessive riding on
horses and vehicles, ativyavaya, prapatane (talking) adhyasana, bharavahana (weight
lifting) ativyayama (excessive exercise) balavat vigraha, (fighting with persons of
superior strength).
Seasonal factors and Vayah
Rainy season and part of the summer season. End part of the day, night, digestion
are the seasonal which makes Vata prokopa in the old age Vata Dosha is dominant makes
Dhatu kshaya (degenerative changes)
Mithyo pachara of Pancha karma189
Improper doing of Vamana, Virechana, Vasti etc., the term denotes has atiyoga as
well as heena yoga. The wrongly carried out methods cause vitiation of Vata Dosha.
Psychological factors190
Due to worry, grief, anger, fear, anxiety, the body becomes emaciation causes
Vata vitiation.
Margavarodhaka Nidana
The etiological factors which causes obstruction in the normal movement of Vata
results in the prakopa of Vata.
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Vegha dharana and udheerane191
Suppression of natural urges and inducing the urges forcefully causes Vata
prokopa.In Manyasthambha these factors causes prakopa of Vyanavata, a sthanika Dosha
may aggravate the condition. Example : Due to the suppression of sneezing, headache,
debility of the sence organs , stiffness of the Neck (Manyasthambha) and facial paralysis
occur.
Ama
Due to hypo functioning of Agni, the food that is not completely digested, yields
immature Rasa in Amashaya, obstructs the Vatavaha Srotas, causes the vitiation of Vata
and moves around in different directions to produce a Vata Vyadhi.
Other Doshas
Manyasthambha is told as Vata kaphaja even though it is included in Vataja
nanatmaka Vyadhi. Here Kapha Dosha involvement is present. The Kapha prokopa ahara
nidanas causes the obstruction of Vata makes sthanika disease.
Kapha prokopa factors
Ahara: Excessive and continuous usage of sweet, acidic, salty, cold and heavy food
articles like yavaka, black gram, curd, milk, nava danyas. Anupa mamsa etc.,
Vihara: Day sleep, excessive sleep, suppression of vomiting
Marmabhigata: Injury to neck causes Vata prakopa resulting kshata of the manya siras
and asthi bramsa, hence it results in to the loss or restriction of neck movements. The
etiological factors such as carrying heavy weight over head, sleeping in irregular surface,
etc, can cause the marmagata in the neck region192,193.
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Dhatu kshaya kara Nidana
The Dhatu kshya can arise due to various etiological factors. The Dhatu kshya
causes increase of rukshata thus prakopa of Vata. Dhatukshaya occurs usually during
vardakya, because at this stage dhatus are in hriyamana stage, deterioration of dhatus
vitiates vatadosha which inturn leads to manya stamba. Here datukshaya can
beinterpreted interms of degenarative changes found at the site of disease manification,
which are primarily due to ageing process. In old age due to the degeneration of the discs
increases pressure on nerve roots by which nerve roots of the vertebra is compressed and
the compression of vertebra is causing Manyasthambha. Excessive indulgence in exercise
or sex causing Dhatu kshaya is also a cause of Vata prakaopa leads to Manyasthambha.
Comparison of Manyasthambha Lakshana.
After viewing general nidanas of vatavyadhi in short, we will switch onto specific
etiological factors of Manyasthambha. As described by different authors of causes of
Manyasthambha are listed in the table.
Table No. 27. Showing the incidence of Nidana of Manyasthambha according to
different Acharyas.
SN Nidana Sushruth Madava nidana Bhavaprakash Yogaratnakar
1 Diwaswapna + + + +
2 Asanasthana vikruthi + - + +
3 Urdwanireekshana + - + +
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Divaswapnam
“ Diwaswapanam ithi rathrijagaranam”
As it is defined by Bhavaprakasha ‘ one who does rathrijagarana day sleep during
day time’ but at this juncture it would be better to specify how does it become an
etiological factor for manyasthambha. as we all known Divaswapnam causes Kapha
prakopa, which is involved in early stages of the disease to be more specific. It can be
interpreted in terms of sleeping in bad postures. Which causes minor trauma to the
cervical spine and leads Manyasthambha.
Asanasthana Vikruthi194,195,196,197
“Asanam Upaveshanam, sthanam urdvibhavanam”.
“Asanena sthanena va-athishayena vikrutham greeva-adi vikrutha.”
Here Asana as upaveshanam and sthana as urddwa vibhavanam, which means the
postural disturbances specifically with reference to sitting. Persons sitting or even lying
down in bad postures, which in turn leads to improper positioning of cervical vertebrae,
this puts uneven pressure over the spinal nerve roots producing different signs and
symptoms. We know that when a person sits or sleeps in improper head positions, if that
person is of middle age or old aged as he has already developed degenerative changes in
the cervical vertebrae. Which is due to ageing process, hence a wrong posture cause
minor trauma accelerates the pathology of degeneration leading to set of clinical features.
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Urdwa Nireekshana198,199,200,201
Vivrutha urdwa neereekshanaihi vakramargavolokanaihi
Dalhana clarifies that by looking upwards continuously is vakra position of
manya leads to minor trauma and precipitates the symptoms. In Charaka Samhita
abigathwam of siras has told one of the reason for Manyasthambha.
Aetiology of Cervical spondylitis
In addition to age and possibly gender, several risk factors have been proposed for
cervical Spondylitis. Repeated occupational trauma (e.g., carrying axial loads,
professional dancing, and gymnastics) may contribute. Familial cases have been reported;
a genetic cause is possible. Smoking also may be a risk factor. Conditions that contribute
to segmental instability and excessive segmental motion (e.g., congenitally fused spine,
and cerebral palsy, Down syndrome) may be risk factors for spondylotic disease. Very
stiff muscles in the cervical region can, over the years, cause a kinking of the cervical
spine to the front. Bad posture and lack of exercise to the cervical region are the key
factors which are responsible in a majority of the patients.
Lying in bed with several pillows propping up the neck into an unnatural position
can affect the alignment of the cervical column, causing a forward inclination. Reclining
on sofas with the spine hunched and the neck pushed forward is bad for cervical
alignment. Hunching over the computer for many hours, occupational hazards such as
those of a writer, an illustrator or a painter, all cause the spine to be bent forward all the
time. Positioning the body to the same side during sleep, with the shoulder muscles and
the neck compressed, also develops faulty alignment in the cervical spine.
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In due course the spine is bent, the front surface of the bones and disc are
excessively pressurised and damage occurs. The so-called executive chairs are ill-
designed and push the neck out of alignment. No chair should reach over the head. The
level should be up to the shoulder blades so that the chest can stretch over the edge
keeping the body upright.
In India, railway porters carry heavy loads on their heads but they do not suffer
from cervical pain (as one would expect) from the heavy load they carry every day. Only
in the group of people who never exercise their bodies does this occur most frequently.
In the modern science they described severe trauma such as suddenly turning the
head, continuously looking upwards, repeated movements of cervical vertebrae, desk
work, clinical work, weight lifting etc., causes for cervical Spondylitis. Apart from the
above age is obviously the most important predisposing factor. Etiological factors
according to modern202
1) Postural causes
Drooping shoulder
Condition in the muscles fascia, ligaments and glands
Trauma
Occupational strain
2) Condition of the cervical spine
Inter vertebral disc prolapse
Lesions in the vertebral bodies
Trauma: old fractures, dislocation, subluxations
Tuberculosis
Tumour deposits
Ankylosing Spondylitis
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3) Intra-spinal conditions
Cord tumours
Syringomyelia
Extradural tumours
Shoulder lesions
Peri-arthritis
Supra spinatus tendnitas
Sub deltoid bursitis
4) Reffered pain
Cardiac ischemia can cause left sided brachial neuralgea
Sub-diaphragmatic lesions like gall bladder lesions cause right sided pain
5) Systematic cause
Diabetic neuropathy
Manyasthambha Samprapti
The study of samprapthi is the most important aspect of understanding the
disease. It explains the complete disease process which starts immediately after nidana
sevana. It includes the explanation about the dearrangement of Doshas and the
pathological changes that takes place in a person leading to the formation of the diseases
and also the mode of manifestation of clinical features. Further more it aids the treatment
too.
In our classic it’s samprapti is explained as follows: Due to nidana sevana vata
gets vitiated and gets avrutha by kapha which interms does sthabdatha of 14 manya shiras
situated in the back of neck and results in Manyasthambha.
Samprapti is a series of pathological changes takes place in the body from day of
development of the disease till to complete manifestation and establishment of the disease
with its complications. The knowledge of Samprapti is very much essential from Chikitsa
point of view and it also helps to understand complete pathogenesis of a disease, as it has
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told by our Acharyas. “Samprapti vightanameva Chikitsa”, which means systemic
breaking of Samprapti is called Chikitsa hence a proper knowledge of Samprapti along
with its ghatakas is very much essential. An elaborate description of Samprapti of
Manyasthambha is not available in the classics.
The Vata Dosha along with Kapha Dosha get vitiated and take asraya at manya
pradesha affecting the manya siras causing sthambana and ruja of neck. Bhavamishra
explained the pathogenesis of Manyasthambha elaborately but he did not describe the
pathological structural changes in the articular cartilage disc and vertebrae. Vata prakopa
Nidanas mentioned like datukshya, which mainly occur during the mid and later decades
of life time can be interpreted in terms of degenerative changes found in the cervical
spine and disc which is the resultant of ageing process mentioned in the ailed science.
Second one is due to margavarodha. The Nidanas like adhyaashana, vishamasana
(Urdhwa Nireekshana, asmasthama sayanam) and other Ama kara Nidanas vitiated first
Agni leading to manda Agni and production of Ama causing margkavarodha in this way
all the above Nidanas will causes Vataprakopa either by datukshya or margavarodha.
While describing Samprapti of Manyasthambha (cervical Spondylitis) it should be under
stood in this manner.
When we go though the pathological changes found at cervical spine, the change
in the ligamentum flavum, which is indicative of early stages of disease. Here at this
initial stage we can expect the involvement of Kapha.
In the latter stage it involves nerves roots and even spinal cord, which is attributed
solely to Vata vitiation. In some patients we can find shotha localised part and in the
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allied science they claim that swelling is found in early stages i.e., cervical Spondylitis,
which is suggestive of vitiation of Kapha.
When the due course all diseases are not treated properly it leads to Vatic in
nature. In the initial stage we can accept the involvement of Kapha in Manyasthambha
(Cervical Spondylitis) but the latter stage, we find the compression of nerve root due to
ostyophytes changes producing different signs and symptoms which are collectively
termed as Manyasthambha (Cervical Spondylitis). It can be attribute the role of Vata
Dosha and there is minimal or no involvement of Kapha.
Samprapti Ghatakas
Showing the schematic Representation of Manyasthambha Samprapti
Vaya and Nidanas
Diwaswapna, Asanasthana sayanam Vata prakaopa
Urdhwanireekshana
Sleshmavarana
Stana samshraya in manya siras
Kupitha Vata
Manyasthambha
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The knowledge of Samprapti gataka is very much essential while treating a
disease because systematic breaking of pathogenesis as Samprapti is known as treatment
of a particular disease
♦ Dosha : Vata- Vyanavata
♦ Kapha : sleshma Kapha
♦ Dushya : asthi, majja, sanyu, mamsa,
♦ Agni : jatara Agni mandya janya Ama,
asthi dhatuagni mandya janya Ama
♦ Srotas : asthi vaha Srotas
♦ Sroto dusthti : sanga
♦ Udhbhara sthama : pakwasaya
♦ Sanchar sthana : rasayani
♦ Roga marga : madhayama rogamarga
♦ Adhishtanam : manya pradesha
♦ Vyaktha sthana : manya pradesha
Purvaroopa203
Poorva rupa are the premonitory symptoms, which occur before the complete
manifestation of a disease. Commonly all disease will show some premonitory symptoms
before the disease develops but there are no such premonitory symptoms of
Manyasthambha are mentioned in the classics but In general before manifestation of
Manyasthambha vitiated Vata will show its symptoms in the body. This includes mild
pain in the neck and also stiffness of neck.
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Roopa204
The term roopa implies both signs and symptoms, which plays a very important
role in the diagnosis and management of the disease. The lakshana develops after the
poorvaroopa as the Samprapti (pathology) advances from sthana samshraya avastha to
vyaktha vastha. At this stage, the Dosha- dushya sammurchana becomes continuous and
the total signs and symptoms are observed. In this stage of Sammurchita Dosha ruk (pain)
and Stambha (stiffness) becomes the only signs and symptoms told in the classics as
Lakshana pertaining to the Manyasthambha is visualized. These can be classified in
association with the other symptoms as under with different headings, which we don’t
find in the classics. They are -
1 Asymptomatic
2 symptomatic
Symptomatic stage can be classified in to -
1. Pain restricted to only manya pradesha
2. Pain radiating down to the arm, fore arm, hand and fingers
Asymptomatic stage
In the classics, Asymptomatic stage is described as the vrudhvastha. The dhatus
will becomes ksheena, which is a quite natural process in which the Dhatus becomes
degenerated as age progresses. Occasionally, few people in spite of appearing these
changes will not show any significant signs and symptoms related to the stage of
Asymptomatic, as there is no involvement of the nerve root. In modern science they
explained as follows the vertebra of most people past 50 years of age shows some
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evidence of a degenerate changes. It is important to realise that such finding may be
Asymptomatic and of no clinical significance.
Symptomatic stage
It can be classified as a localised pain in manyapradesha and radiating pain down
the arm, fore arm, hand, and fingertip according to the site of the pain. This classification
is made on the basis of Manyasthambha pathology involved with the signs and
symptoms. Pain is the symptom produced due to involvement of different anatomical
structures in the disease process. Hence minimal involvement reflects with pain restricted
only to manya pradesha and in the advanced cases, it even involves special nerves, which
causes the radiation of pain down to the arms depending upon the involvement of nerve
root segments.
Here the presenting symptom will be stiffness of neck i.e., sthamba of manya. The
sthamba is the resultant of spasticity of neck muscles, which stretches and make neck
stiff. Vedana in manya pradesha are manya shoola, this is outstanding clinical symptoms
in all most of all patients.
Symptoms205
The most common symptom is pain in the neck, worsening with exertion and
relieved, in the early stages, by rest. This pain often radiates down to the hand, with the
fingers becoming numb due to compression of the nerves that innervate the upper
extremity. The brachial plexus is affected. The trapezius area becomes tender and painful.
A nodule can form in the muscle due to chronic pressure.
The symptoms of cervical cord compression can sometimes be severe. The pain
radiates down the right or left arm to the fingers, to the chest and shoulder blades
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depending on which side the nerve root is involved. It can become continuous, making
movements painful and limited. If the cervical vertebrae become unstable, the danger of
cord compression is imminent and, in some cases, fusion of the bones may be warranted.
But this is rare.
Clinical aspects206
The signs and symptoms produced are the results of nerve root compression, spinal cord
compression, or both. The most common complaint is neck pain, which limits its motion
and is aggravated by neck extension. Pain also may radiate in one arm in a pattern
Characteristic of the particular root involved.
Table No.28. Level of disc herniation
Manifestation C4-C5 C5-C6 C6-C7 C7-T1 Root Compressed
C4 C5 C6 C7
Weakness Deltoid Biceps Triceps, wrist, Extension
Hand Intrinsic wrist flexion
Sensory loss Lateral shoulder
Lateral arm forearm, thumb, lateral aspect of finger
Middle finger Ring and little Finger
Reflex involvement
Deltoid pectoralis
Biceps Triceps Finger flexion
Vyavachedaka Nidana
Sapeksha nidana or differential diagnosis plays a prime role in arriving at a exact
decision between diseases presenting a similar clinical feature which helps for the
pinpoint diagnosis and treatment.
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This disease can be differentiated from following diseases.
Vishwachi
Avabhahuka
Acharya Sushruta explains viswachi as that which causes karmakshaya of bahu
due to the dusti of kandara which runs from bahu prista towards talabhaga of hasta and
angulies. Vitated vata when gets lodged in bahushira causes Apabhahuka described by
Acharya Bhava prakasha.
Upashaya and Anupashaya
In the process of investigating the disease Upashaya methods that is therapeutic
trails with certain diet, drug activities are also considered as a tool in some cases. As
there is no Upashaya and Anupashaya for Manyasthambha mentioned in the classics. But
we can select the Vata Vyadhi Upashaya.
Manyasthambha comes under the Vata Vyadhi some of the observations done
during clinical trials are listed as cold breezes, continuos work morning hours, weight
lifting as Anupashaya for Manyasthambha. Abhyanga, sweda, rest, avoiding pillows are
considered as Upashaya. Even in the contemporary science they have described the hot
massage relieves the pain which is as Upashaya.
Upadravas, Arista Lakshana and Sadyasadhyata
When we go through the classics there is no mentioning of above factors in the
context of Manyasthambha. Hence we can consider the description which is available in
vatavyadi in general.
In allied science complications of Cervical Spondylitis has been explained that is
“If the spinal canal is markedely narrowed by osteophytes the spinal cord may be
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damaged, with progressive upper motor neurone disturbance affecting all the fourlimbs
and possibly the bladder. The complication is serious but uncommon.
Pathya-Apathya
Pathya is defined as ‘Pathona Petham Pathyam’,
Pathya is one which is suitable to the body, mind and to all Srotase’s in healthy as
well as diseased condition.
There is no special Pathya and Apathyas mentioned for Manyasthambha. As it is
mentioned in the list of Vata Vyadhi, general regimen of diet and other habits mentioned
under this can be adopted in Manyasthambha and they are as follows:
Table No. 29. Showing the Pathyaapathyas in Vatavyadhi:
Factors Pathyas Apathyas Sneha and others Sarpi, vasa, taila, majja, gritha,
dugdha, kilata, dadhikurchika -
Harita, Shakha, Shimbhi and phala varga
Kulatha, Masha, godhuma, Raktishli, patola, vartaka, dadima, parushaka, badara, Iashuna and draksha.
Chanaka, kalaya, shyamaka, karuvinda, nivara, kangu, mudga, rajamasha, guda, jambuka, kramuka, Mirnala, nishpava, Taalaphala, asthimajja shimbi, shaka, udumbara.
Mamsa varga Chataka, kukkuta, tittira, shilindhra, nakra, gargars, khudisha, Bileshaya
All jangala mamsa varga.
Rasa Pradhana Madhura, Amla, Lavana Kashaya, Katu, Tikta Mansika Sukha Chinta, Prajagara Vihara Snehana, swedana, snehapana, snana,
Abhyanga, Rechana, Mardana, basti, Avagahana, Samvahana, Samshamana, Agni karma, Upanaha, Tailadroni, Shirobasti, shamana, Nasya, santarpana and Brimhana
Vyavaya, Ativyayama, Basti, Ashva yana, Chankramana, Vegadharana, chardhi, Shrama, anashnata, Gurunadi sheetalam.
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Ayurvedic line of management
Susruta says Nidana parivarjana is Chikitsa. But Charaka has further amplified the scope
of Chikitsa by saying, Chikitsa aims not only the less exposure to the causative factors of
the disease, but also at the restoration of Doshic equilibrium. Manyasthambha being
Vataja Vyadhi, treatment of Vata Vyadhi can be adopted. But, specific line of treatment
is described for Manyasthambha.
Chikitsa sutra of Manyasthambha
The steps and procedures to be adopted in the management of the Manyasthambha are
as follows.
1. Rooksha Sweda
2. Panchamoolakwatha or dasamoolakwatha sevana
3. Nasya karma
Table No.30. Chikitsa of Manyasthambha according to different Acharyas are
depicted as under.
CHIKITSA Bhava Prakasha
Yoga Ratnakara
Susruta Samhita
Bhaishajya Ratnavali
Chakradutta
Sneham + - + - - Swedam + + - - - Nasyakarma + + + + - Nasapanam - + - + +
Bhava Mishra mentions that the Abhyanga with thaila or grutha should be done in
Manyasthambha. Bhavaparakasha and Yogaratnakara indicate Rooksha Sweda and
Nasya. Bhaishajyaratnavali and also Chakradutta indicate Mahamasha yoga Taila
Nasapanam (Nasya) in Manyasthambha. Mahamasha Taila even can be used as pana i.e.
internal medication, which is the present dissertation topic. Apart from the above
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mentioned specific management, as the disease is a Vata Vyadhi Vata Chikitsa sutra and
methodologies of the pacifying measures of Vata are also adaptable.
Management of cervical Spondylitis in contemporary science
Medical science accepts cervical spondylitis as a normal degenerative aging
change. Painkillers are prescribed. In order to prevent the symptoms of vascular
insufficiency, anti-platelet drugs are given to maintain cerebral blood flow. This makes
the platelets less sticky, the blood thinner and helps better flow. But this is illogical. The
essential change is of a mechanical nature.
If the cervical spine could be realigned and the intervertebral spaces widened, a
normal state of blood flow would be restored. Physiotherapy can, at best, only offer
marginal relief. sometimes the condition may even be aggravated. It is better avoided.
In situations where the patient suffers acute giddiness, it is useful to restrict the
movement of the neck with a soft collar. Sudden neck movements cause the spur to
impinge on the cervical nerves and blood vessels and reduce the blood to the brain. This
creates a situation where the patient, sometimes becomes afraid of moving the neck. In
the long run, of course, a collar is to be avoided as it stiffens the neck muscles and pushes
the neck out of alignment.
The problem is worsened, as, for health, the muscles and bones have to be aligned
and stretched rather than made stiff. Cervical traction, where the skull is lifted up, has its
value in a few cases. But, in due course, the weight of the skull makes it settle down on
the cervical column and the symptoms recur. Though, obviously, the osteo-phytes cannot
be removed, one can adjust and realign the spine so that compression of the vertebral
arteries and cervical nerves does not occur.
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Drug review
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DRUG REVIEW
INGREDIENTS OF KOLAKULATHADI CHOORNA:
Kola208:
Botonical Name: Zizyphus sativus.
Family Name : Rhamnus.
Sanskrit Name : Karkandhu, Badari, Kola, Kuval, Visham.
Rasa : Amla, Madhura, Kashyaya.
Veerya : Seetha.
Vipaka : Madhura.
Guna : Guru, Snigdha, Pichila.
Doshaghnata : Vata pitta shyamak.
Botanical Description
There are three main verities namely Rajbadar, Badar, Kshudrabadar. It is a
medium sized tree with spikes. Bark-grey and thorn, Rajbadar variety is used in
medicine,
Kulatha209
Botonical Name: Dolichos biflorus Linn.
Family Name : Leguminoseae
Sanskrit Name : Kulatha, Tamrabeeja, Shweta beeja
Rasa : Kashaya
Veerya : Ushna
Vipaka : Amala
Guna : Laghu, Rooksha, Tikshna
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
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Doshaghnata : Kapha, Vata, Shyamak.
Parts used : Seeds
External uses
Powder of kulatha if applied whole body reduce excessive perspiration.
Devadaru210:
Botonical Name : Cedrus Deodara.
Family Name : Conifereae.
Sanskrit Name :
Rasa : Tiktha.
Veerya : Ushna.
Vipaka : Katu.
Guna : Laghu Snigdha.
Pradhana karma : Vedana Stapana gana.
It contains dark coloured oil and resin, internally usefull in all rukpradana vyadhis
in Aruchi and Krimi, in Raktadushya and Kaphajakasa. External uses – inflammation is
relieved by its local application, its local application and oil is used in arthritis.
Masha211 a,b
Botonical Name : Phascolus mungo
Family Name : Fabaceae.
Sanskrit Name : Uddulu, Masha.
Rasa : Madhura.
Veerya : Ushna.
Vipaka : Madhura.
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Guna : Guru Snigdha.
Dosha Karma : Vatashamak.
Chemical Composition
Contains Melissa oil, citrol, ionone, and vit. A.
Parts used
Roots and seeds.
Atasi212
Botonical Name : Linum Usitaissimum Linn.
Family Name : Linaceae.
Sanskrit Name : Pichila, Medaganda, Hemavati, Rudraneela.
Rasa : Madhura, Tiktha.
Veerya : Ushna.
Vipaka : Katu.
Guna : Guru Snigdha.
Dosha Karma : Vatashamak, Kaphapitta vardhak.
Chemical Composition
Seeds have 37 to 44% oil, white seeds have more oil, fresh oil is more viscous and
colourless but in fresh air gets solidified.
External uses
The poulitice of the flour of Atasi is used to assimilate inflammation, this external
application of its oil i.e., abhyanga in Vatashyamak.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
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Tila213 a,b,c
Botonical Name : Sesamum indicum Linn.
Family Name : Pedalianeae.
Sanskrit Name : Tila, Homadhanya, Pavitra, Pitrutarpan.
Rasa : Madhura.
Veerya : Sheeta.
Vipaka : Madhura.
Guna : Guru Snigdha.
Dosha Karma : Vatashamak, Kaphapitta vardhak.
Chemical Composition
It contains oil 50-60%, Proteins 22%. It is an excellent snehan and analegesic and is very
useful for wound healing. It is very useful in dry skin and body ache by acting a
Vatashamak. Among all the varieties of taila, tila taila is considered to be the best for
nourishing all the seven dhatus of the body.
Kushtam214
Botonical Name : Saussurea luppa
Family Name : Compositae
Sanskrit Name : Padmatertha, Punyasagar, Brahnatertha
Rasa : Tikta katu madhura.
Veerya : Ushna.
Vipaka : Katu.
Guna : Laghu Rooksha, Tikshna.
Dosha Karma : Kapha vata haram.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
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Chemical Composition
Roots contain 1.5% aromatic oil, Glucoside, Saussurinsalt, Resin, Tannin, Insulin 18%
stable oil, Nitrate, Glucose etc,. Leaves do not contain aromatic oil on incinerating, roots
yield 3.5% Ash. It contains large quantity of manganese.
Vacha215
Botonical Name : Acorus calamus Linn
Family Name : Araceae
Sanskrit Name : Ugroganda, Shadgrantha, Shataparvika
Rasa : Tikta katu.
Veerya : Ushna.
Vipaka : Katu.
Guna : Laghu, Tikshna, Sara.
Dosha Karma : Kapha vata haram.
Chemical Composition
Rhizome bark has 1.5 to 3.5% volatile oil which contains an asaryaldehyde. Besides, it
contains Acorine, Engenal, Asarone, Caffeine and little Astrigent.
External uses
Being analegesic and Anti inflammatory its paste is useful in Rhematoid Artharitis,
Osteoartharitis and hemiplegia.
Satahwa216a,b
Botonical Name : Anethum sawa.
Family Name : Umbeliferae.
Sanskrit Name : Shatapatrika, Shata pushpika
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Rasa : Katu Tikhta.
Veerya : Ushna.
Vipaka : Katu.
Guna : Laghu, Rooksha, Tikshna.
Dosha Karma : Kapha vata haram.
Chemical Composition
Dried ripe fruit contains a volatile oil 3-4% which is composed of anethine,
Phellanndriene, and di-limonene, Apiol, also contain carvotie and Hydrocarbone.
Yava217
Botonical Name : Trachi spermum Lini
Family Name : Umbeliferae.
Sanskrit Name : Yava
Rasa : Katu Tikhta.
Veerya : Ushna.
Vipaka : Katu.
Guna : Laghu, Rooksha.
Dosha Karma : Kapha vata haram by tikshna and ushna, pitta vardaka, used
in kapha vata disease.
Parts used : Seeds
Chemical composition
Aromatic oil is present in the seeds which solidifies on cooling and is called
thymol cyst.
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External uses
Being analgesis, anti-inflammatory, laxative, antibacterial, complexion enhancer
and antidote its external application reduces oedema and pain, skin diseases, scorpion
bite.
Rasna218
Botonical Name : Pluchealanceolata
Family Name : Compositeae
Sanskrit Name : Atirasa, Elaparni, Gandhanakuli
Rasa : Tikhta.
Veerya : Ushna.
Vipaka : Katu.
Guna : Guru.
Dosha Karma : Kapha vata haram.
Parts used : Bark
Uses:
Rheumatoid Arthitis, vata disorders, tuberculosis. It is and antipyrectic and is useful in
skin diseases like itching, ringworms, ecezema. Rasana has a specific action in
Rheumatoid arthritis.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Table No. 31 Showing the Rasa, guna, veerya, vipaka, and dosha karma of kolakulathadi choorna.
Botanical Name Family Synonyms Rasa Veerya Vipaka Guna Dosha karma Zizyphus sativus Rhamnus Badari, visham, kola Amla madhura
kashaya Sheetha Madhura Guru
snigdha pichila
Vata pitta shyamak
Dolichos biflorus Linn
Leguminoseae Kulatha Tamrabeeja Shweta beeja
Kashaya Ushna Amala Laghu Rooksha Tikshna
Kapha Vata Shyamak
Cedrus deodara Roxb.
Conifereae Devadaru Suradaru
Tiktha Ushna Katu Laghu snigdha
Vedhana stapana gana
Pluchea lanceolata
Compositae Rasna Tiktha Ushna Katu Guru Vata haram vishagnam
Phaseolous Mungo Fabaceae Uddulu Masha
Madhura Ushna Madhura Guru snigdha
Vata shaman
Linum usitassimum Linn.
Linaceae Medagnda Hemavati Atasi
Madhura Tiktha
Ushna Katu Guru snigdha
Vata shamak kapha pitta vardak
Sesamum indicum Linn.
Pedalianeae Tila Homadhanya Pavitra
Madhura Sheetha Madhura Guru snigdha
Vata shamak kapha pitta vardak
Saussurea luppa Compositae Padmatertha Punyasagar Brahnatertha
Tiktha Katu Madhura
Ushna Katu Laghu Rooksha Tikshna
Vata kapha haram
Acorus calamus Linn
Araceae Ugroganda Shadgrantha Shataparvika
Tiktha Katu
Ushna Katu Laghu Tikshna Sara
Kapha Vata Haram
Anethum sawa Umbeliferae Shatapatrika Shata pushpika
Katu Tiktha
Ushna Katu Laghu Rooksha Tikshna
Kapha Vata Haram
Trachi spermum Lini
Umbellifere Yava Katu Tikta Ushna Katu Rooksha Laghu
Kapha vata shamaka
Table no. 32. Showing the Table of Mahamasha taila
Sl.No
Name Latin Name Rasa Guna Veerya Vipaka Parts used Doshaghnata Karmukata
1 Bilwa219 Aele Marmeolos corr
Katu, Tikta, Kashaya
Laghu Rooksha
Ushna Katu Moola Vatakapha Shamaka pitta Vardhaka
Deepana pachana, Grahi, balya
2 Agnimantha220 Premna mucronuta
Tikta, katu, kashaya, madhura
Rooksha laghu
Ushna Katu Moola Kaphavata Shamaka
Deepana, pachana, Vedana Shamaka, Anulomaka
3 Shyonaka221 Oroxylum indicum
Madhura, Tikta Kashaya
Laghu Rooksha
Ushna Katu Moola Khapavata Shamaka
Shothahara, Vedhana, Shamaka, Deepaka, Pachaka, Rochaka.
4 Patala222 Stereospermum Surveolens
Tikta, Kashaya
Laghu Rooksha
Ushna Katu Moola Tridosha Shamaka
Vedana Shamaka, Shotahara, Deepaka, Pachaka, Rochak
5 Kashmarya223 Gmelinza arborex
Tikta, Kashaya, Madhura
Guru Ushna Katu Moola Tridosha Shamaka
Anulomaka, Shothara, Vrishya, Balya.
6 Shalaparni224 Desmodium ganqeticum
Madhura, Tikta
Guru Snigdha
Ushna Madhura Moola Tridosha Shamaka
Shotahara, Anulomana.Virshya.
7 Prsniparni225 Uraria picta Madhura, Tikta
Laghu Singdha
Ushna Madhura Moola Tridosha Shamaka
Vedana Shamaka, Shotahara
8 Brahathi226 Solanum indicum
Katu, Tikta
Laghu Rooksha, Teekshna
Ushna Katu Moola Kaphavata Shamaka
Vedana Shamaka, Shotahara
9 Kantakari227 Solanum surateense burn
Tikta, Katu
Laghu Rooksha, Teekshna
Ushna Katu Moola Kaphavata Shamaka
Vedana Shamaka, Shotahara
10 Gokshura228 Tribulus terristris
Madhura Guru, Snigdha
Sheeta Madhura Moola Vatapitta Shamaka
Vedana Shamaka, Anulomana, Shothara
11 Masha229 Phaseotus mungo leguminosal
Guru srigdha
Madhura Ushna Madhura Phala beeja Vatashamak pitta & kapha vardhaku
Vatayadhi, sandivata nadidourbalya
12 Kapikachu231 (atmaguptha)
Muchuna prurita leguminosae
Guru srigda
Madhura tikta
Ushna Madhura Beeja moola roma
Tridoshagna Vatavyadhi, nadidourbalya krisha
13 Shati232 Hedychium spicatium zingiberaceae
Laghu thikshna
Katu Tikta Kashaya
Ushna Katu Kandha Kaphavatagna Vedanasthapana, Shoolaprashamana deepana grahi
14 Devadaru Cedriusdeodarapinaceae
Laghu snigdha
Tikta Ushna Katu Kandasara Taila
Kaphavatagna Shothavedanapradhana rogas sandivasa etc. vatavyadhya
15 Bala Sida cordifolia Madura Laghu, snigdha
Picchila Madhura Moola Vata pitta hara
Balya, Bramhana, Vrshya
16 Rasna233 Pluchea lanceolata compositae
Guru Tikta Ushna Katu Patra Kaphavatagna Vednashamaka, shothaX shoolapradhana vikras, sandishoola
17 Prasarini Leptadenia sperlum Asclepiadacea
Guru Tikta Kashaya
Guru sara
Katu Moola Vata kapha Shamaka
Vedanasthapana, Shoolaprashamana deepana grahi
18 Kushta Saussurealappa compositae
Laghu rooksha tikshna
Tikta katu madhura
Ushna Katu Moola Kaphavatagna Shoolaprashamana, vedanasthapana, deepana, pachana
19 Parushaka Grewia asiatica Madhura, Amla, Kashaya
Laghu, Snigdha
Sheeta Katu Vata pitta shamaka
Vatavyadhi, vedanapradhana vikaras, nadidourbalya
20 Bharangi Uerodendrum serratum
Tikta katu Laghu Rooksha
Ushna Katu Moola Vata kapha shamaka
Vatahara, Shothahara,
21 Punarnava234 Boerhavia diffusa
Madhura tikta
Laghu Rooksha
Ushna Madhura Moola Vayasthaapana, vata kaphara
Rasayana, vishagna, Kasahara
22 Mathulunga Litrus acido medica
Madhura, Amla
Laghu snigdha
Anushna Madhura Tvak Vata, pitta, kapha hara
Vata, pitta, kapha hara, hrydhya
23 Jeeraka235 Cuminum cuminumcyminum Umbeliferacea
Katu Laghu Rooksha
Ushna Katu Beeja Kaphavatanga vatahara, Pittavardhaka
Deepaka, pachaka
24 Hingu Ferula narthex Katu Laghu snigdha
Ushna Katu Niriyasa Kapha, Vata shamaka
Shula prashamana, deepana, Vajikarna
25 Shatavari236 Asparagu racimosum
Tikta Madhura
Guru, snigdha
Sheeta Madhura Kanda Tridosha shamaka
Vedanasthapaka, Shulahara
26 Goksura237 Tribulus terrestris zygophyllaceae
Guru snigdha
Madhura Sheetha Madhura Phara moola Vatapittagna Vatavyadhi, vedanapradhana vikaras, nadidourbalya
27 Pippali Moola238
Piperlongum piperaceae
Laghu Snigdha Tikshna
Katu Anushna sheeta
Madhura Phalamoola Kaphavatagna Shotha, vatayadhi, aruchi, ajeerna
28 Chitraka239 Plumbago zeylamica plumbaginaceae
Laghu Rooksha Tikshna
Katu Ushna Katu Moolatwak Kaphavatagna Vatavyadhi nadidourbalya deepana pachana
29 Mudgaparni240 Phaseolus Trilobus (leguminosae)
Lagu Rooksha
Madhura Tikta
Sheetha Madhura Panchangamoola
Vatapittagna Vatahara, roga, deepana and grahi
30 Mashaparni241 Teramnuslabialis Leguminosae
Laghu Snigdha
Madhura Tikta
Sheetha Madhura Panchangamoola
Vatapittagna Vatanulomana, snehana, deepana, shothahara
31 Jeevanthi242 Leptadenia Reticulata Asclepiadaecae
Laghu snigdha
Madhura Sheetha Madhura Panchangamoola
Vatapittagna Snehana, anulomana, grahibalya, rasayana
32 Madhuka243 Glycyrhiza Glabra leguminosae
Guru snigdha
Madhura Sheetha Madhura Panchangamoola
Vatapittagna Vatanulomana, nadidourbalya
33 Saindhava lavana
Rock salt
Madhura, Lavana
Sheeta
Madhura Laghu, Snigdha, Sukshma
- Tridosha Shamaka
Deepana,Pachana,Rechana,Ruchikara, Hridya, Chakshushya
34 Ksheera (Cow’s milk) 229
Madhura Sheeta Madhura Guru Snigdha, sheetha
Tridosha Shamaka
Brimhanam, Vrishya, Balya, Vata roga, Swasa and Kasa
35 Tila thaila230 Sesamum indicum
Madhura katu tiktha
Ushana Madhura Guru Seeds Vata nashaka Vata vyadhi, Medoroga, Vrana, shotha
Clinical study
116
CLINICAL STUDY
Methodological approach is the backbone of research. Utmost care is
taken in designing a methodology for conducting a research. Clinical research involves
the experimentation of a drug/therapy on a population and recording the feedback based
on which postulations are made regarding the usefulness of the drug/therapy in the
disease. Hence, in this section, the researchers put forward the systemic procedures,
which are followed by the researchers right from the identification of the problem to the
final conclusion.
Research Approach
In this clinical study, the objective was to “evaluate the efficacy of
Rookshasweda and Nasya in the management of Manyasthamba (Cervical
spondylitis)”. The efficacy of this was determined by finding of base line data of the
parameters before and after the treatment data was compared with only Rookshasweda to
study the added effect of Nasya karma.
Study Design
It is a comparative clinical study. Total patients were made in to two Groups A
and B. Group A will receive only ruksha sweda and Group B will receive Rooksha sweda
with nasya karma.
Source of Data
Patients suffering from Manyasthambha will be selected from Dept. of
Panchakarma P.G.S. & R (Panchakarma) O.P.D. & I.P.D. of Shri D..G. Melmalgi
Ayurvedic College Hospital.
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Sample Size & Grouping
A minimum of 30 Patients equally distributed in each groups.
Group A - Rooksha sweda with Kolakulathadi choorna pinda around the cervical region
and shoulders.
Group B – Local Rooksha sweda with Kolakulathadi choorna pinda around the cervical
region and shoulders followed by Nasya with Mahamasha thaila.
Selection criteria
The cases were selected strictly as per the pre-set inclusion and exclusion of
criteria.
Inclusion Criteria
• All cases of clinical and radiological evidence of Manyastambha (Cervical
spondylitis)
• Without any discrimination of chronicity and severity of the diseases.
• Patients of both sex
• Patients of Manysthambha falling in the age group of 18-65 years.
• Patients fit for Nasya karma.
Exclusion Criteria
• Patients below 15 and above 65 years of the age.
• Preganant women and lactating Mothers.
• Any other systemic disorders other than of Manyasthambha.
• Any other degenerative diseases associated.
• Patients unfits for Nasya karma
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Duration of the study
In both groups, initially 7 days of treatment followed by 7 days of rest. Then,
treatment repeated for 7 days again followed by 7 days of rest. The total study duration is
28 days.
Data Collection
Patients were thoroughly examined both subjectively and objectively. Detailed
history pertaining to the mode of onset, previous ailment, previous treatment history,
family history, habits, ashtavidhapareeksha and dashavidhapareeksha and physical
examination findings were noted. Routine investigations were done to exclude other
pathologies. Radiological features also were investigated.
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Examination
History
The most common symptom is pain in the neck, worsening with exertion and
relieved, in the early stages, by rest. This pain often radiates down to the hand, with the
fingers becoming numb due to compression of the nerves that innervate the upper
extremity. The brachial plexus is affected. The trapezius area becomes tender and painful.
A nodule can form in the muscle due to chronic pressure. The symptoms of cervical cord
compression can sometimes be severe. The pain radiates down the right or left arm to the
fingers, to the chest and shoulder blades depending on which side the nerve root is
involved. It can become continuous, making movements painful and limited. If the
cervical vertebrae become unstable, the danger of cord compression is imminent and, in
some cases, fusion of the bones may be warranted. But this is rare.
Examination of the Cervical spine
This is always associated with a dearth of objective findings. Physical
examination includes.
1. Inspection
2. Palpation
3. Movements
1) Inspection
Although the deformity of the cervical spine is unusual in cervical spondylitis is
always at the head on the neck as a whole before palpating assessing the movements.
Patient with cervical spondylitis for eg:- They may have a pokeneck. Check also that the
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
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patient can support the head without difficulty instability of the cervical spondylitis can
be easily missed in recumbency position.
2) Palpation
Midline, tenderness over the supra spinous ligament is found after an injury to the
neck such as sprain / whiplash injury. Tenderness and spasm of the paraspinal muscles
extending down to the trapezius are found in cervical spondylitis.
3) Movements
The neck movements includes flexion, extension, lateral rotation, and lateral
flexion. Neurological examination is normal provided the disease cervical spondylitis not
associated with complaints.
Types of Pain
Patient experiences different types of pain depending on underlined pathology
1. Aching type of pain
2. Grippling pain
3. Vague, ill defined and ill localized pain
4. Throbbing pain
5. Shooting pain
6. Pricking pain
The neck pain may be chronic or episodic, with long period of remission. Usually
pain is more frequent in the upper limb then in the neck, although it is present
frequently in both the areas. A case of cervical spondylitis may exactly mimic the
cardiac pain by radiating the left arm and chest so if a patient is a known case of
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cervical spondylitis, when he gets a real heart attack, pain is attributed to spondylitis,
and the diagnosis is missed.
Mobility grading of Cervical spine
Flexion
Is examined by asking the patient to touch the chin to chest full forward flexion is
present. When the chin touches the chest. It is graded as four. If the flexion is 75% of
total movement then it is graded as three. 50% of the movement is graded as two. 25% of
total movement is graded as one and no movements is graded as zero.
Extension
Of at least 30 degrees beyond the horizontal is only possible.
It is graded as four it the extension is 75 degree of total movement then it is graded as
three. 50 degree of the movement is graded as two. 25 degree of movement is one and
zero as no movement.
Lateral flexion
Lateral flexion should be at least 40 degree to each side. Starting from the neutral
position of the head is tilted first to one side and then the other. Grading is done on
above.
Rotation
Cervical plexus
The cervical plexus is formed by the vertebral rami of the upper four cervical
nervous. The rami emerge between the anterior and posterior tubercles of the cervical
transverse processes, grooving the costo transverse bars. The four roots are with one
another to form three loops.
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The plexus is related posteriorly to the muscles, which arise from the posterior
tubercles of the transverse process i.e., the Levator scapulae and the scanlenus medius.
Anteriorly to the pre-vertebral facia, the interior jugular vein and sterno mastoid.
Branches
A) Superficial cutaneous branches
1. Lesser occipital
2. Greater auricular
3. Transverse (anterior) cutaneous nerve of the neck (c2,c3)
4. Supra clavicular (c3,c4)
B) Deep branches
1. Communicating branches
2. Muscular branches
(a) rectus capitis anterior from c1
(b) rectus captis lateratus from c1,c2
(c) longus capitis from c1,c2,c3
(d) lower root of anasa cervicalis c2c3
Muscles supplied by cervical branches
1. Stermomastoid – c2 and accessory nerve
2. Trapezius – c3-c4
3. Lavetor scapularis – c3c4c5
4. Phrenic nerve c3c4c5
5. Longus colli c3-8
6. Scalenus medius c3-8
7. Scalenus anterior c4-6
8. Scalenus posterior c6-8
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Treatment Schedule
Group A – Rookshaswedam with Kolakulathadi choorna pinda.
Ingredients
Kola, Kulatha, Devadaru, Rasna, Masha, Atasi, Tila, Vacha, Satahwa, Yava.
Preparation
Medicine Kolakulathadi choorna, the above said ingredients were taken in raw
form after removing the impurities. There then individually were pulverized to get fine
powder after obtaining the fine powder they were mixed to get uniform mixture.
Pottali
2 Pottali were prepared each containing 200 gms of Kolakulathadi choorna they
were tied properly and kept for ready for the treatment .
Patient
Patient were selected after fulfilling the criterias. The patient were briefed about
the intended procedure. Patients were asked to sit comfortably over a stool of knee
height.
Procedure
Two pottalis were heated up to a sustainable heat and were used alternatively to
give the swedana over the cervical region and on both shoulders. This procedure is done
by pressing, rubbing & keeping over the said body parts. The whole procedure was
repeated for about 15-20 min depending on the response of the individual patient.
Paschat Karma
Patient is asked to rest for 15-20 minutes in the comfortable position.
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Pathya during treatment period & pariharakala
The pathyacharana is an important factor which was followed for 28days
including the treatment period & pathyacharana. Patients were advised to take katu-
tiktha-kashaya-rooksha varjitha aharadravyas in light quantity. Rice gruel with little milk
was advised as the ideal food. Patient was advised to drink hot water only. Patient was
advised to avoid sexual intercourse, blocking of natural urges, traveling, exercise, over-
speech, uneven sitting & lying postures, exposure to wind, cold, heat and dust, anger and
grief.
Group B- Rookshasweda along with Nasya
1) Rookshasweda
Is performed as explained before.
2) Method of preparation of Mahamasha thaila
Masha and dasamula are prepared in to yavakuta curna and dissolved in
mentioned quantity of water in a kashaya patra and kept as it is for one night and next day
these contents are reduced into 1/4th quantity over madhyamagni according to kwatha
vidhi. Kwatha is filtered and kept ready.. Murchita tila taila is taken in a sneha patra and
heated over madhyamagni then already prepared kwatha is added and mixed well, after
that cows –milk is added. While adding kwatha etc. dravadravyas. Kalka of above
mentioned drugs are to be added and mixed well, then taila is prepared according to
tailapaka vidhi. After attaining paka pariksa, sneha patra has to be taken out from the fire
& taila is filtered immediately and obtained taila is preserved.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
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3) Nasya
Special room for Nasya should be prepared which should be free from
atmospheric effects like direct blow of air or dust and it should be lighted properly.
a) A chair for sitting purpose
b) A cot for lying purpose
To prepare the patient for the Nasya karma following matter should be considered
Patient should have passed his natural urges like urine and stool.
He should have completed his routine activities.
Light breakfast prior (1 hour) to Nasya karma is advised.
After preparation of patient by above said regimens, snehana and swedana should
be done. Here, Snehana means, Mridu Abhyanga. It should be done on scalp, forehead
and neck for 3 to 5 minutes by medicated oil like Bala taila etc.
After Abhyanga, Mrudu Swedana should be done on Shira, Mukha, Nasa, Manya,
Greeva and Kantha. Swedana should not be done on the head, but for the purpose of
elimination and liquification of dosha Mridu Swedana can be done as Purva karma of
Nasya.
Pradhana Karma
Posture of The Patient :
Patient should lye down in supine position on Nasya table. The head of the patient
should be lowered (Pravilambita). The position of head should not be excessively
extended. After covering of eyes with a clean cloth, the tip of patients nose should be
drawn upward by the left thumb of the Vaidya. At the same time with the right hand
Vaidya should instill 8 drop of lukewarm oil (Mahamasha Taila) in both the nostrils,
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Clinical study
126
alternately, with the help of proper instrument like pichu, dropper, The drug should be
proper in dose and temperature. The patients should remain relaxed at the time of
administration of nasya and he should avoid speech, anger, sneezing, laughing and
shaking his head.
Pashchat Karma
Patient in lying position is asked to count up to 100 matra i.e. approximately 2
minutes. After administration of Nasya feet, shoulders, palms and ears should be
massaged. Again mild fomentation should be done on forehead, cheeks and neck. For
pacifying Vata dosha, Rasna churna is rubbed on head. The patient is asked to expel out
the drug which comes in oropharynx. Care should be taken that no portion of medicated
oil is left behind. Medicated Dhumpana and Gandusha are advocated to expel out the
residue mucous lodged in Kanta.
Pathya during treatment period & pariharakala
Patient should be advised to stay in a windless place. A light meal and lukewarm
water are advised. One should avoid dust, smoke, sunshine, hot bath, anger, riding,
excessive intake fat and liquid diet the patient should avoid day sleep and should not use
cold water for any purpose like pana, snana, etc.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Clinical study
127
Methods of Assessment of clinical response
Clinical parameters and functional parameters, were made out to assess the
clinical response in both the groups.
I. Subjective
(Ruk) Pain 0 – No pain
1 mild – pain present positionally does not require
Medications
2 Moderate - Pain present irrespective of posture
relieves by hot fomentation
3 M severe - Pain present relives by oral medication.
4 severe - Pain does not relived by medication
present persistently.
II. Graha
(Stiffness) Grade 0 - No movement
Grade 1 - Up to 25% of total movement
Grade 2 - Up to 50% of total movement
Grade 3 - Up to 75% of movement
Grade 4 - Full range.
Objective
Mobility (Flexion) Grade 0 - No movement
Grade 1 - Restricted movement
Grade 2 - Full range
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Clinical study
128
Extension Grade 0 - No movement
Grade 1 - Restricted movement
Grade 2 - Full range
Lateral flexion Grade 0 - No movement
Grade 1 - Restricted movement
Grade 2 - Full range
Rotation Grade 0 - No movement
Grade 1 - Restricted movement
Grade 2 - Full range
Passive neck flexion Grade 0 - With any difficulty
Grade 1 - With some difficulty
Grade 2 - With much difficulty
Grade 3 - Unable to do
Muscle strength
Grade 0 - Complete paralysis
Grade 1 - A flicker of contraction
Grade 2 - Power detectable only when gravity is
excluded by appropriate postural
adjustment.
Grade 3 - The limp can be held in the force of gravity
but not the examiners resistance.
Grade 4 - There is some degree of weakness, usually
described as poor, severe or moderate
strength.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Clinical study
129
Assessment of Nasyakarmukatha
This was done to ascertain the efficacy of Nasya karmas in inducing the
benefits of Nasya in the group B. the following parameters were designed basing on the
samyak Nasya lakshana explained by vagbhatta.
Sukhouchvasam Grade 0 - No change
Grade 1 - Slight improvement.
Grade 2 - Marked improvement.
Sukhaswapnam Grade 0 - No change
Grade 1 - Slight improvement.
Grade 2 - Marked improvement.
Sukhabodha Grade 0 - No change
Grade 1 - Slight improvement.
Grade 2 - Marked improvement.
Akshipadavam Grade 0 - No change
Grade 1 - Slight improvement.
Grade 2 - Marked improvement.
Assessment Of Swedakarmukatha
This was done to ascertain the efficacy of both the Karmas in inducing the
benefits of Swedana in the individual groups. The following parameters were designed
basing on the Shamana-Sweda gunas explained by Sushrutha.
• Agnideepti :- Grade 0 – No change/Absent
Grade 1 – Slight improvement/Present
Grade 2 – Good improvement
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Clinical study
130
• Maardava :- Grade 0 – No change/Absent
Grade 1 – Slight improvement/Present
Grade 2 – Good improvement
• Tvakprasada :- Grade 0 – No change/Absent
Grade 1 – Slight improvement/Present
Grade 2 – Good improvement
• Tandrahaani :- Grade 0 – Absent
Grade 1 – Present
• Bhakthasradha :- Grade 0 – Absent
Grade 1 – Present
• Sandhicheshta :- Grade 0 – No movement
Grade 1 –Up to 50% of the full range of joint
motion
Grade 2 – 50-75% of the full range of joint
motion
Grade 3 – >75% & <full range
Grade 4 – Full Range of joint Motion
• Srothonirmalatva :- Grade 1 – Very satisfied
Grade 2 – Somewhat Satisfied
Grade 3 – Neither satisfied nor dissatisfied
Grade 4 – Somewhat dissatisfied
Grade 5 – Very dissatisfied
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Clinical study
131
Overall Assessment Of Clinical Response
• Good Response : >60% improvement in clinical and functional
parameters
• Moderate Response : 31-60% improvement in clinical and functional
parameters
• Poor Response : 1-30% improvement in clinical and functional
parameters
• No Response : 0 % or No improvement in clinical and functional
parameters
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
132
33 patients were registered for the present study. Out of this, 3 patients were
excluded hence, their data has not been included here. The remaining 30 patients of
Manyasthamba fulfilling the criteria for diagnosis, were treated in the following two
groups –
Group A – Rooksha sweda – 15 patients.
Group B – Rooksha sweda and Nasya – 15 patients.
All the patients were examined before and after the treatment according to the
case sheet format given in the appendix. Both the subjective and objective changes were
recorded along with the assessment of Nasyakarmukata and Swedakaarmukata. The data
recorded are presented under the following heading –
1) Demographic data
2) Data related to the disease
3) Data related to over all response to the treatment
4) Statistical analysis of the clinical and functional parameters and inter group
comparison.
5) Statistical analysis of Nasyakarmukata
6) Statistical analysis of swedakarmukata
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
133
I. DEMOGRAPHIC DATA
Table No. 33. Showing distributions of patients by age Groups.
Age Group Group A % Group B % Total Total % 21-30 3 20% 1 6.66% 4 13.33% 31-40 6 40% 4 26.66% 10 33.33% 41-50 4 26.66% 4 26.66% 8 26.66% 51-60 1 6.66% 5 33.33% 6 20% 61-70 1 6.66% 1 6.66% 2 6.66%
Among the 15 patients in the group A maximum number of patients fell in the age
group 31-40 i.e. 6 patients (40%), where as 4 patients (26.66%) fell in the age group 41-
50 and only 3 patient (20%) fell in the age group 21-30. and 60-70 one patient (6.66%)
and only one patient fell in the age group 51-60 Among the 15 patients in the group B,
maximum number of patients, fell in the age group 51-60 i.e 5. (33.33%) where as 4
patients (26.66%) fell in the age group 31-40. 4 patients (26.66%) fell in the age group
41-50. 1 patient (6.66%) fell in the age group 21-30 (6.66%) 1 patient fell in the age
group 61-70 (6.66%) In the study as a whole (30 patients), maximum numbers of
patients, fell in the age group 31-40 i.e. 10 (33.33%), where as 8 patients (26.66%) fell in
the age group 41-50 and 6 patient fell in the age group 51-60 (20%) and 4 patients fell in
the age group 21-30 (13.33%) and 2 patients fell in the age group 61-70 (6.66%)
Showing distributions of patients by age Groups.
31
46
4
10
4 4
8
1
56
1 12
02468
1012
Group A Group B Total
21-3031-4041-5051-6061-70
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
134
Table No. 34 Showing distributions of patients by sex
Sex Group A % Group B % Total %
Male 10 66.66% 9 60% 19 63.33%
Female 5 33.33% 6 40% 11 36.66%
Among the 15 patients in the group A, 10 patients were males (66.66%) and 5
patients were females (33.33%). Among the 15 patients in the group B, 9 patients were
males (60%) and 6 patients were females (40%). In the study as a whole (30 patients), 19
patients were males (63.66%) and 11 patients were females (36.33 %).
10
5
96
19
11
0
5
10
15
20
Group-A Group-B Total
Showing the incidence of sex
Male
Female
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
135
Table No.35 Showing distributions of patients by Religion
Religion Group A % Group B % Total %
Hindu 12 80% 12 80% 24 80%
Muslim 3 20% 3 20% 6 20%
Christian 0 0% 0 0% 0 0%
Among the 15 patients in group A, 12 patients were Hindus (80%), 3 patients
were Muslims (20%). Among the 15 patients in group B, 12 patients were Hindus (80%)
and 3 patients were Muslims (20%). In the study as a whole (30 patients), 24 patients
were Hindus (80%), 6 patients were Muslims (20%).
Showing distributions of patients by Religion
12 12
24
3 36
0 0 00
5
10
15
20
25
30
Group A Group B Total
HinduMuslimChristian
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
136
Table No.36 Showing distributions of patients by Occupation
Occupation Group A % Group B % Total %
Sedentary 2 13.33% 7 46.66% 9 30%
Active 7 46.66% 6 40.00% 13 43.33%
Labour 6 40.10% 2 13.33% 8 26.66%
Others 0 0% 0 0% 0 0%
Among the 15 patients in the group A, 2 patients (13.33%) were of sedentary, 7
patients (46.66%) were active and 6 patients (40.10%) were labours. Among the 15
patients in the Group B, 7 patients (46.66%) were sedentary, 6 patients (40%) were active
and 2 patients (13.33%) were labours. In the study as a whole (30 Patients), 9 patients
(30%) were sedentary, 13 patients (43.33%) were active and 8 patients (26.66%) were
labours.
Showing distributions of patients by Occupation
2
79
76
13
6
2
8
0 0 002468
101214
Group A Group B Total
SedentaryActive LabourOthers
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
137
Table No.37 Showing distributions of patients by Economical status
Economical
status
Group A % Group B % Total %
Poor 1 6.66% 1 6.66% 2 6.66%
Lower
middle
7 46.66% 6 40.00% 13 43.33%
Upper
middle
5 33.33% 8 53.33% 13 43.33%
Rich 2 13.33% 0 0% 2 6.66%
Among the 15 patients in group A, 1 patient were poor (6.66%), 7 patients were
of the Lower middle class (46.66%) and 5 patients were Upper middle (33.33%). and 2
patients were rich (13.33%) Among the 15 patients in the group B, 1 patients were poor
(6.66%), 6 patients were of Lower middle class (40 %) and 8 patient was Upper middle
class (53.33%). In the study as a whole (30 Patients), 2 patients were poor (6.66%), 13
patients were of the lower middle class (43.33%) and 13 patients were upper middle class
(43.33%). 2 patients were rich (6.66%).
Showing distributions of patients by Economical status
1 12
76
13
5
8
13
20
2
02468
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Group A Group B Total
PoorLower middleUpper middleRich
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
138
Table No. 38 Showing distributions of patients Dietary habit
Dietary
habit
Group A % Group B % Total %
Vegetarian 3 20% 5 33.33% 8 26.66%
Mixed 12 80% 10 66.66% 22 73.33%
Among the 15 patients in group A, 3 patients were vegetarians (20%) and 12
patients were having mixed dietary habits (80%). Among the 15 patients in group B, 5
patients were vegetarians (33.33%) and 22 patients were having mixed dietary habits
(73.33%). In this study as a whole (30 patients), 8 patients were vegetarians (26.66%) and
22 patients were having mixed dietary habits (73.33%).
Showing distributions of patients Dietary habit
35
8
1210
22
0
5
10
15
20
25
Group A Group B Total
VegetarianMixed
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
139
Table No. 39 Showing distributions of patients by Agni
Agni Group A % Group B % Total %
Manda 8 53.33% 7 46.66% 15 50%
Teekshna - - - - - -
Vishama 3 20% 5 33.33% 8 26.66%
Sama 4 26.66% 3 20% 7 23.33%
Among the 15 patients in group A, 8 patients were having Manda agni (53.33%),
3 patients were having vishama agni (20%) and 4 patients were having sama agni (20%).
Among the 15 patients in group B, 7 patients were having Manda agni (46.66%), 5
patients were having vishama agni (33.33%) and 3 patients were having sama agni
(20%). In the study as a whole, 15 patients were having manda agni (50%). 8 patients
were having vishama agni (33.33%) and 7 patients were having sama agni (23.33%). No
patients reported with Teekshna agni in this study.
Showing distributions of patients by Agni
8 7
15
0 0 0
35
8
4 3
7
02468
10121416
Group A Group B Total
MandaTeekshnaVishamaSama
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
140
Table No. 40 Showing distributions of patients by Koshta
Koshta Group A % Group B % Total %
Madhya 9 60% 11 73.33% 19 63.33%
Mrdu 1 6.66% 1 6.66% 2 6.66%
Krura 5 33.33% 3 20% 8 26.66%
Among the 15 patients in group A, 9 patients were having Madhya koshta (60%),
1 patient was having Mridu koshta (6.66%) and 5 patients were having Krura koshta
(33.33%). Among the 15 patients in group B, 11 patients were having Madhya koshta
(73.33%), one patient was having Mridu koshta (6.66%) and 3 patients were having
Krura koshta (20%). In the study as a whole (30 patients), 19 patients were having
Madhya koshta (63.33%), 2 patients were having Mridu koshta (6.66%), and 8 patients
were having Krura koshta (26.66%).
Showing distributions of patients by Koshta
911
19
1 1 25
3
8
0
5
10
15
20
Group A Group B Total
MadhyaMrduKrura
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
141
Table No.41 Showing distributions of patients by Nidra
Nidra Group A % Group B % Total %
Sukha 2 13.33% 2 13.33% 4 26.66%
Alpa 5 33.33% 8 53.33% 13 43.33%
Ati 2 13.33% 2 13.33% 4 13.33%
Vishama 6 40.00% 3 20% 9 30%
Among the 15 patients in group A, 5 patients had alpa nidra (33.33%) and 6
patients had vishama nidra (40%). 2 patients had sukha nidra (13.33%) and 2 patients had
alpa nidra (33.33%) Among the 15 patients in group B, 8 patients had alpa nidra
(53.33%), 2 patient had ati nidra (13.33%) and 3 patients had vishama nidra (20%). 2
patients had sukha nidra (13.33%) In the study as a whole (30 patients), 13 patients had
alpa nidra (43.33%), 4 patients had ati nidra (13.33%) and 9 patients had vishana nidra
(30%). 4 patients had sukha nidra. (26.66%).
Showing distributions of patients by Nidra
2 24
5
8
13
2 24
6
3
9
02468
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Group A Gruoup B Total
SukhaAlpaAtiVishama
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Observation and Results
142
Table No. 42 Showing distributions of patients by Vyasana
Vyasana Group A % Group B % Total %
Smoking 3 20% 1 6.66% 4 13.33%
Tobacco 8 53.33% 9 60% 17 56.66%
Alcohol 3 20% 4 26.66% 7 23.33%
Others - 0% - - -
None 1 6.66% 1 6.66% 2 6.66%
Among the 15 Patients in group A, 3 patients had smoking habit (20%), 8 patients
had tobacco habit (53.33%), 3 patients had alcohol habit (20%) and 1 patient had no
habits (6.66%). Among the 15 patients in group B, 1 patient had smoking habit (6.66%),
9 patients had tobacco habit (60%), 4 patients had alcohol habit (26.66%) and 1 patients
had no habits (6.66%). In the study as a whole, 4 patients had smoking habit (13.33%),
17 patients had tobacco habit (56.66%), 7 patients had alcohol habit (23.33%) and 2
patients had no habits (6.66%). No patient reported in this study had any other habits.
Showing distributions of patients by Vyasana
31
14
8 9
17
3 47
0 0 01 1 2
0
5
10
15
20
Group A Group B Total
SmokingTobaccoAlcoholOthersNone
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
143
Table No.43 Showing distributions of patients by Deha-prakriti
Deha Prakriti Group A % Group B % Total %
Vata pitta 7 46.66% 8 60% 15 50%
Vata kapha 5 33.33% 4 26.66% 9 30%
Pitta kapha 3 20% 3 20% 6 20%
Among the 15 patients in group A, 7 patients were of Vata pitta prakriti (46.66%),
5 patient of Vata Kapha prakriti (33.33 %), 3 patients of Pitta Kapha (20%), Among the
15 patients in group B, 8 patients were of Vata Pitta prakriti (60%), 4 patients of Vata
kapha prakriti (26.66%), 3 patients of Pitta kapha (20%). In the study as a whole (30
patients), 15 patients were of Vata pitta prakriti (50%), 30 patient of Vata Kapha prakriti
(30%), 6 patients of Pitta kapha prakriti (20%).
Showing distributions of patients by Deha-prakriti
78
15
54
9
3 3
6
02468
10121416
Group A Group B Total
Vata pittaVata kaphaPitta kapha
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
144
Table No.44 Showing distributions of patients by Satmya
Satmya Group A % Group B % Total %
Rooksha 13 86.66% 15 100% 28 93.33%
Snigdha 2 13.33% - - 2 6.66%
Among the 15 patients in group A, 13 patients were of rooksha satmya (86.66%)
and 2 patients were of snigdha satmya (13.33%). All the patients of group B, were of
rooksha satmya. In the study as a whole (30 patients), 28 patients were of rooksha satmya
(6.66%) and 2 patients were of snigdha satmya.
Showing distributions of patients by Satmya
1315
28
20
2
0
5
10
15
20
25
30
Group A Group B Total
RookshaSnigdha
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
145
Table No.45 Showing distributions of patients according to chronicity of the disease.
Duration Group A % Group B % Total %
Less than 6 3 20% 2 13.33% 5 16.66%
6M – 1yr 8 53.33% 6 40% 14 46.66%
1–11/2 yrs 4 26.66% 7 46.66% 11 36.66%
Among 15 patients in group A, 3 patients falls under below 6 months (20%) 8
patients falls under 6M – 1 year (53.33%) 4 patients falls under 1yrs-11/2 yrs (26.66%)
among 15 patients in group B, 2 patients falls under below 6 months (13.33%) 6 patients
falls under 6M – 1 yrs (40%) 7 patients falls under 1yrs-11/2 yrs (46.66%) In the study as
a whole (30 patients) 5 patients falls under below 6 months (16.66%) 14 patients falls
under 6M-1yrs (46.66%) 11 patients falls under 1yrs-11/2 yrs (36.66%).
Showing distributions of patients according to chronicity of the disease.
3 2
5
86
14
4
7
11
02468
10121416
Group A Group B Total
Less than 66M - 1yr1- 11/2yr
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
146
Table No.46 Showing distributions of patients by Ahara Nidana:
Rasa Group A % Group B % Total % Katu Rasa 5 33.33% 6 40% 11 36.66% Tikta Rasa 1 6.66% 1 6.66% 2 13.33% Kasaya Rasa 1 6.66% 1 6.66% 2 13.33% Ati sheeta 3 20% 2 13.33% 5 16.33% Ati Rooksha 4 26.66% 5 33.33% 9 30.00% Alpa ahara 1 6.66% - 1 6.66%
Among 15 patients in group A, 1 patients had tikta rasa atisevana (6.66%), 1
patients had kashaya rasa atisevana (6.66%), 5 patients had katu rasa atisevana (33.33%),
1 patients had alpa bhojana (6.66%), 3 patients had Ati sheeta bhojana (20%) and 4
patients had rooksha bhojana (26.66%). Among 15 patients in group B, 1 patient had
tikta rasa atisevana (6.66%), 1 patients had kashaya rasa atisevana (6.66%), 6 patients
had katu rasa atisevana (40%), 2 patients had Ati sheeta bhojana (13.33%), 5 patients had
rooksha bhojana (33.33%). In the study as a whole (30 patients), 2 patients had tikta rasa
atisevana (13.33%), 2 patients had kashaya rasa atisevana (13.33%), 11 patients had katu
rasa atisevana (36.66%), 1 patients had alpa bhojana (6.66%), 5 patients had Ati sheeta
bhojana (30%) and 9 patients had rooksha bhojana (30%).
Showing distributions of patients by Ahara Nidana
56
11
1 12
1 12
32
54
5
9
10
1
02468
1012
Group A Group B Total
Katu RasaTikta RasaKasaya RasaAti sheetaAti RookshaAlpa ahara
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
147
Table No. 47 Showing distributions of patients by Vihara Nidana:
Vihara GroupA % GroupB % Total % Asamasthana syanam
4 26.66% 5 33.33% 9 30.33%
Urdwa Nireekshanam
4 26.66% 1 6.66% 5 16.66%
Diva swapnam 3 20% 1 6.66% 4 13.33% Vyayama 3 20% 3 20% 6 20% Langhana - - - - - - Plavana - - - - - - Adwaganama 2 13.33 2 13.33 4 13.33 Yana - - 2 13.33% 2 6.66%
Among 15 patients in group A, 4 patients had Asamasthana syanam (26.66%), 4
patients had Urdwa Nireekshanam (26.66%), 3 patients had Diva swapnam (20%), 3
patients had Vyayama (20%), 2 patients had Adwaganama (13.33%) and No patients
were absorbed having Langhana, Plavana and Yana. Among 15 patients in group B, 5
patient had Asamasthana syanam (33.33%), 1 patients had Urdwa Nireekshanam
(6.66%), 1 patients had Diva swapnam (6.66%), 2 patients had Adwaganama (13.33%), 2
patients had Yana (13.33%). No patients were absorbed having Langhana and Plavana. In
the study as a whole (30 patients), 9 patients had Asamasthana syanam (30.33%), 5
patients had Urdwa Nireekshanam (16.66%), 4 patients had Diva swapnam (13.33%), 6
patients had Vyayama (20%), 4 patients had Adwaganama (13.33%) 2 patients had yana
(6.66%) No patients were absorbed having Langhana and Plavana.
Showing distributions of patients by Vihara Nidana
4 5
9
4
1
53
1
43 3
6
0 0 00 0 02 2
4
02 2
02468
10
Group A Group B Total
AsamasthanasyanamUrdwaNireekshanamDiva swapnam
Vyayama
Langhana
Phavana
Adwaganama
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Observation and Results
148
Table No.48 Showing distributions of patients by Manasika Lakshana:
Manasika Group A % Group B % Total %
Chinta 8 53.33% 7 46.66% 15 50%
Shoka 4 26.66% 4 26.66% 8 26.66%
Bhaya 3 20% 4 26.66% 7 23.33%
Among 15 patients in group A, 8 patients had Chinta (53.33%), 4 patients had
Shoka (26.66%), 3 patients had Bhaya (20%), Among 15 patients in group B, 7 patient
had Chinta (46.66%), 4 patients had Shoka (26.66%), 4 patients had Bhaya (26.66%), In
the study as a whole (30 patients), 15 patients had Chinta (50%), 8 patients had Shoka
(26.66%), 7 patients had Bhaya (23.33%),
Showing distributions of patients by Manasika Lakshana
8 7
15
4 4
8
3 4
7
02468
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Group A Group B Total
ChintaShokaBhaya
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Observation and Results
149
II. DATA RELATED TO THE DISEASE Table No. 49 Distributions of patients by different grades of RUK
RUK Group A % Group B % Total %
Grade 0 0 - - - - -
Grade 1 0 - - - - -
Grade 2 3 20% 4 26.66% 7 23.33%
Grade 3 10 66.66% 9 60% 19 63.33%
Grade 4 2 13.33% 2 13.33% 4 13.33%
Among 15 patients in group A, 3 patients had Grade 2 (20%), 10 patients had
Grade 3 (66.66%), 2 patients had Grade 4 Pain (13.33%), and No patients were having
Ruk in Grade 0 and Grade 1. Among 15 patients in group B, 4 patients had Grade 2
(26.66%), 9 patients had Grade 3 (60%), 2 patients had Grade 4 (13.33%) In the study as
a whole (30 patients), 7 patients had Grade 2 (23.33%), 19 patients had Grade 3
(63.33%), 4 patients had Grade 4 (13.33%), and No patients were having Ruk in Grade 0
and Grade 1.
Distributions of patients by different grades of RUK
0 0 00 0 03 4
710 9
19
2 24
0
5
10
15
20
Group A Group B Total
Grade 0Grade 1Grade 2Grade 3Grade 4
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Observation and Results
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Table No. 50 Showing response of patients by different grades of RUK
RUK Group A Group B Total
NR PR MR GR NR PR MR GR NR PR MR GR
Grade 0 - - - - - - - - - - - -
Grade 1 - - - - - - - - - - - -
Grade 2 - 2 1 - - 3 1 - - 5 2 -
Grade 3 - 10 - - 2 5 2 - 2 15 2 -
Grade 4 1 0 1 0 - 2 - - 1 2 1 -
Among 15 patients in group A, 2 patients of Grade 2 had Poor response and 1
patient of Grade 2 had Moderate response. 10 patients of Grade 3 had poor response, 1
patient had no response and 1 patient had Moderate response in Grade 4. In group B 3
patients of Grade 2 were having Poor response and 1 patient had Moderate response. 2
patients had no response while 5 patients are having poor response and 2 patients having
moderate response are seen in Grade 3. 2 patients of Grade 4 are having poor response.
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Table No.51 Showing distributions of patients by Different grades of Graha
Graha Group A % Group B % Total %
Grade 0 - - - - - -
Grade 1 - - - - - -
Grade 2 4 26.66% 2 13.33% 6 20%
Grade 3 11 73.33% 13 86.66% 24 80%
Grade 4 - - - - - -
Among 15 patients in group A, 4 patients had Grade 2 (26.66%) while 11 patients
had Grade 3 (73.33%), and no patients were observed in Grade 0 ,1 and 4 Among 15
patients in group B, 2 patients had Grade 2 (13.33%), and 13 patients had Grade 3
(86.66%), and No patients were having Graha in Grade 0,1 and 4.
Showing distributions of patients by Different grades of Graha
0 0 00 0 04
26
1113
24
0 0 00
5
10
15
20
25
30
Group A Group B Total
Grade 0Grade 1Grade 2Grade 3Grade 4
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Table No. 52 Showing response of patients by different grades of Graha Graha Group A Group B Total
NR PR MR GR NR PR MR GR NR PR MR GR
Grade 0 - - - - - - - - - - - -
Grade 1 - - - - - - - - - - - -
Grade 2 - 3 1 - - 2 1 - - 5 1 -
Grade 3 - 10 1 - 2 9 2 - 2 19 3 -
Grade 4 - - - - - - - - - - - -
Among 15 patients in group A, 3 patients of Grade 2 had Poor response and 1
patient of Grade 2 had Moderate response. 10 patients of Grade 3 had poor response, 1
patient of Grade 3 had Moderate response. In group B 2 patients of Grade 2 were having
Poor response and 1 patient had Moderate response. 2 patients of Grade 3 had no
response while 9 patients are having poor response and 2 patients having moderate
response.
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Table No.53 Showing distributions of patients by different grades of (Passive neck flexion)
Passive neck
flexion
Group A % Group B % Total %
Grade 0 - - - - - -
Grade 1 - - - - - -
Grade 2 10 66.66 % 12 80 % 22 73.33 %
Grade 3 5 33.33 % 3 20 % 8 26.66 %
Among 15 patients in group A, 10 patients had Grade 2 (66.66%) while 5 patients
had Grade 3 (33.33%), and no patients were observed in Grade 0 and 1 Among 15
patients in group B, 12 patients had Grade 2 (80%), and 3 patients had Grade 3 (20%),
and No patients were in Grade 0 and 1.
Showing distributions of patients by different grades of (Passive neck flexion)
0 0 00 0 0
1012
22
53
8
0
5
10
15
20
25
Group A Group B Total
Grade 0Grade 1Grade 2Grade 3
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Table No. 54 Showing response of patients of patient by different grades of (Passive neck flexion) Passive
neck
flexion
Group A Group B Total
NR PR MR GR NR PR MR GR NR PR MR GR
Grade 0 - - - - - - - - - - - -
Grade 1 - - - - - - - - - - - -
Grade 2 - 10 - - 2 8 2 - 2 18 2 -
Grade 3 - 3 2 - - 3 - - - 6 2 -
Among 15 patients in group A, 10 patients of Grade 2 had Poor response. 3
patients of Grade 3 had Poor response and 2 patients had moderate response. In group B
2 patients of Grade 2 were having No response, 8 patients had poor response and 2
patients had Moderate response. 3 patients of Grade 3 had poor response.
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Table No. 55 Showing distributions of patients by different grades of muscle strength Muscle system Group A % Group B % Total %
Grade 0 - - - - - -
Grade 1 - - - - - -
Grade 2 - - - - - -
Grade 3 - - - - - -
Grade 4 11 73.33% 11 73.33% 22 73.33%
Grade 5 4 26.66% 4 26.66% 8 26.66%
Among 15 patients in group A, 11 patients had Grade 4 (73.33%) while 4 patients
had Grade 5 (26.66%), and no patients were observed in Grade 0,1,2 and 3 Among 15
patients in group B, 11 patients had Grade 4 (73.33%), and 4 patients had Grade 5
(26.66%), and No patients were in Grade 0,1,2 and 3.
Showing distributions of patients by different grades of muscle strength
0 0 00 0 00 0 00 0 0
11 11
22
4 48
0
5
10
15
20
25
Group A Group B Total
Grade 0Grade 1Grade2Grade 3Grade 4Grade 5
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Table No.56 Showing the over all treatment Response in patient of different grades of Muscle strength in both the treatment Groups (A&B): Muscle
strength
Group A Group B Total
NR PR MR GR NR PR MR GR NR PR MR GR
Grade 0 - - - - - - - - - - - -
Grade 1 - - - - - - - - - - - -
Grade 2 - - - - - - - - - - - -
Grade 3 - - - - - - - - - - - -
Grade 4 - 9 2 - - 9 2 - - 18 4 -
Grade 5 - 4 - - 1 2 1 - 1 6 1 -
Among 15 patients in group A, 9 patients of Grade 4 had Poor response, 2
patients of Grade 4 had Moderate response. 4 patients of Grade 5 had Poor response. In
group B 9 patients of Grade 4 were having Poor response, 2 patients of Grade 4 had
Moderate response. 1 patient of Grade 5 had No response, 2 patients had poor response
and 1patient had moderate response.
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Table No.57 Showing distributions of patients by different grades of Mobility gradings (flexion)
Mobility
gradings
(flexion)
Group A % Group B % Total %
Grade 0 5 33.33% 4 26.66% 9 30%
Grade 1 10 66.66% 11 73.33% 21 70%
Among 15 patients in group A, 5 patients had Grade 0 (33.33%) while 10 patients
had Grade 1 (66.66%). Among 15 patients in group B, 4 patients had Grade 0 (26.66%),
and 11 patients had Grade 1 (73.33%).
Showing distributions of patients by different grades of Mobility gradings (flexion)
5 4
910 11
21
0
5
10
15
20
25
Group A Group B Total
Grade 0Grade 10
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Table No.58 Showing the over all treatment Response in patient of different grades of Mobility grading (flexion)
Group A Group B Total Mobility
grading
(flexion)
NR PR MR GR NR PR MR GR NR PR MR GR
Grade 0 - 4 1 - 1 3 - - 1 7 1 -
Grade 1 - 9 1 - 1 7 3 - 1 16 4 -
Grade 2 - - - - - - - - - - - -
Among 15 patients in group A, 4 patients of Grade 0 had Poor response and 1
patient of Grade 0 had Moderate response. 9 patients of Grade 1 had Poor response and 1
patient of Grade 1 had moderate response. In group B 1 patient of Grade 0 is having No
response, 3 patients were having Poor response. 1 patients of Grade 1 had No response,
while 7 patients of Grade 1 had Poor response and 3 patients had Moderate response.
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Observation and Results
159
Table No.59 Showing distributions of patients by different grades of Mobility extension
Extension Group A % Group B % Total %
Grade 0 4 26.66% 4 26.66% 8 26.66%
Grade 1 11 73.33% 11 73.33% 22 73.33%
Grade 2 - - - - - -
Among 15 patients in group A, 4 patients had Grade 0 (26.66%) while 11 patients
had Grade 1 (73.33%). Among 15 patients in group B, 4 patients had Grade 0 (26.66%),
and 11 patients had Grade 1 (73.33%).
Showing distributions of patients by different grades of Mobility extension
4 48
11 11
22
0 0 00
5
10
15
20
25
Group A Group B Total
Grade 0Grade 1Grade 2
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Table No.60 Showing the over all Response in patient of different grades of Extension
Group A Group B Total Extension NR PR MR GR NR PR MR GR NR PR MR GR
Grade 0 - 3 1 - 1 3 - - 1 6 1 - Grade 1 - 10 1 - 1 7 3 - 1 17 4 - Grade 2 - - - - - - - - - - - -
Among 15 patients in group A, 3 patients of Grade 0 had Poor response and 1
patient of Grade 0 had Moderate response. 10 patients of Grade 1 had Poor response and
1 patient of Grade 1 had moderate response. In group B 1 patient of Grade 0 is having No
response, 3 patients were having Poor response. 1 patients of Grade 1 had No response,
while 7 patients of Grade 1 had Poor response and 3 patients had Moderate response.
Table No.61 Showing distributions of patients by different grades of Lateral flexion
Lateral flexion
Group A % Group B % Total %
Grade 0 5 33.33% 3 20 8 26.66% Grade 1 10 66.66% 12 80 22 73.33% Grade 2 - - - - - -
Among 15 patients in group A, 5 patients had Grade 0 (33.33%) while 10 patients
had Grade 1 (66.66%). Among 15 patients in group B, 3 patients had Grade 0 (20 %), and
12 patients had Grade 1 (80 %).
Showing distributions of patients by different grades of Lateral flexion
5 3810 12
22
0 0 005
10152025
Group A Group B Total
Grade 0Grade 1Grade 2
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Table No.62 Showing the over all Response in patient of different grades of Lateral flexion
Group A Group B Total Lateral flexion NR PR MR GR NR PR MR GR NR PR MR GR Grade 0 - 3 2 - 2 1 1 - 2 4 3 - Grade 1 - 10 - - - 8 3 - - 18 3 - Grade 2 - - - - - - - - - - - -
Among 15 patients in group A, 3 patients of Grade 0 had Poor response and 2
patients of Grade 0 had Moderate response. 10 patients of Grade 1 had Poor response. In
group B 2 patients of Grade 0 is having No response, 1 patient is having Poor response, 1
patient of Grade 0 had Moderate response. 8 patients of Grade 1 had Poor response and 3
patients had Moderate response.
Table No.63 Showing distributions of patients by different grades of Rotation in both the treatment Groups (A&B):
Rotation Group A % Group B % Total % Grade 0 1 6.66% 1 6.66% 2 6.66% Grade 1 14 93.33% 14 93.33% 28 93.33% Grade 2 - - - - - -
Among 15 patients in group A, 1 patient had Grade 0 (6.66%) while 14 patients
had Grade 1 (93.33%). Among 15 patients in group B, 1 patient had Grade 0 (6.66 %),
and 14 patients had Grade 1 (93.33 %).
Showing distributions of patients by different grades of Rotation in both the treatment Groups
(A&B):
1 1 2
14 14
28
0 0 00
10
20
30
Group A Group Total
Grade 0Grade 1Grade 2
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Observation and Results
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Table No.64 Showing the over all Response in patient of different grades of Rotation
Group A Group B Total Rotation NR PR MR GR NR PR MR GR NR PR MR GR
Grade 0 - 1 - - 1 - - - 2 - - - Grade 1 - 12 2 - - 12 2 - - 24 4 - Grade 2 - - - - - - - - - - - - Among 15 patients in group A, 1 patient of Grade 0 had Poor response. 12 patients of
Grade 1 had Poor response. 2 patients of Grade 1 had moderate response. In group B 1
patient of Grade 0 is having No response, 12 patient is having Poor response, 2 patient of
Grade 1 had Moderate response.
III. Data Related to Overall Responses to the Treatment Table No.65 Showing distributions of patients by different grades to Over all Response
Response Group A % Group B % Total % Good - - - - - - Moderate 2 13.33% 3 20% 5 16.66% Poor 13 86.66% 10 66.66% 23 76.66% No response - - 2 13.33% 2 6.66%
Among 15 patients in group A, 2 patients had Moderate response (13.33%) while 13
patients had Poor response (86.66%). Among 15 patients in group B, 3 patients had
Moderate response (20 %), and 10 patients had Poor response (66.66 %) and 2 patients
had no response (13.33 %) No patient is having good response in both the Groups.
Showing distributions of patients by different grades to Over all Response
0 0 02 3 5
1310
23
0 2 205
10152025
Group A Group B TOTAL
GoodModeratePoorNo response
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Table No. 66 Showing Overall response of each parameter
Parameter Group % Remarks A Ruk B
53.88 Moderate Response
A Graha B 53.325 Moderate Response
A Passive neck flexion
B 52.22 Moderate Response
A Muscle strength B 3.33 Poor Response
A F B 23.33 Poor Response
A E B 14.995 Poor Response
A Lf B 14.995 Poor Response
A
Mobility grading
R B
13.33 Poor Response
The parameters Ruk, Graha and passive neck flexion showed moderate response in
overall assessment, while Mobility and Muscle strength showed poor response in overall
assessment.
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Observation and Results
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Table No. 67 Master Chart of Subjective and Objective Parameters. Opp
Num
RUK Graha Passive
neck
flexion
Mobility Muscle
strength
Remarks
Flexion Extension L.F R
B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T
2610 3 1 3 2 2 1 0 1 1 1 1 1 1 1 4 4 PR
2310 3 2 2 1 2 1 1 1 1 1 1 1 1 1 4 4 PR
2267 3 1 3 2 2 1 0 1 1 1 1 1 1 1 5 5 PR
2214 3 2 3 1 2 1 1 1 0 1 0 1 1 1 4 3 PR
2482 2 0 2 1 2 1 1 1 0 1 1 2 1 1 4 4 PR
3399 3 1 3 2 2 1 1 2 1 1 1 1 1 1 4 4 PR
3704 4 3 3 2 3 2 1 1 0 1 0 1 0 1 5 5 PR
3701 3 2 2 1 3 2 0 1 1 1 1 1 1 1 5 5 PR
3635 3 1 3 2 2 1 1 1 1 2 1 1 1 1 4 4 PR
4238 3 2 3 1 2 1 0 1 1 1 1 1 1 1 4 4 PR
4277 3 1 3 2 3 2 1 1 1 1 1 1 1 1 4 4 PR
4735 2 1 3 0 3 2 1 1 1 1 0 1 1 1 5 5 MR
4721 3 2 3 1 2 1 1 1 1 1 1 1 1 2 4 4 PR
925 2 1 3 2 2 1 1 1 1 1 0 1 1 1 4 3 PR
4144 4 3 2 1 3 2 0 0 0 1 0 0 1 1 4 4 MR
1195 2 1 3 1 2 1 1 1 1 1 1 1 1 1 4 4 PR
2382 2 0 3 1 2 1 1 1 1 1 1 1 1 1 4 3 MR
1644 3 2 3 1 2 0 1 1 1 1 1 1 1 2 4 4 PR
2305 3 1 3 0 2 1 1 2 1 2 1 0 1 0 5 5 MR
1443 3 1 3 1 2 1 1 1 1 1 0 0 1 0 4 5 MR
1035 3 1 3 2 2 1 1 1 1 1 1 1 1 2 5 5 PR
2638 2 1 3 2 2 1 0 1 0 1 1 1 1 1 5 5 PR
4729 3 1 2 1 3 2 1 2 1 2 1 1 1 1 4 4 PR
2539 4 2 3 1 3 1 0 1 0 1 1 1 1 2 5 5 PR
3916 3 2 3 1 2 1 0 1 0 1 0 1 1 2 5 5 NR
3779 4 2 3 1 3 1 0 1 0 1 1 2 1 1 4 5 PR
3807 3 1 3 1 2 1 1 2 1 2 1 2 1 2 4 4 PR
4271 3 2 3 2 2 1 1 2 1 2 0 1 0 1 4 4 NR
4730 2 0 3 2 2 1 1 1 1 1 1 1 1 1 4 4 PR
278 3 2 2 1 2 1 1 2 1 2 1 1 1 2 4 3 PR
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IV. Statistical analysis of the clinical and functional parameters and intergroup comparison.
Table No.68 Showing Statatical analysis of Group A
Parameter Mean S.D S.E t-Value P -Value Remarks
Ruk 1.4 0.507 0.130 10.76 < 0.001 H.S
Graha 1.333 0.617 0.159 8.38 <0.001 H.S
Passive neck
flexion
1.00 0.00 - - - -
Muscle
strength
0.133 0.351 0.09 1.48 >0.05 N.S
F 0.266 6.457 0.118 2.25 <0.05 H.S
E 0.333 0.487 0.125 2.664 <0.02 H.S
Lf 0.266 0.457 0.118 2.254 <0.05 H.S
Mobility
Grading
R 0.133 0.351 0.09 1.477 >0.05 N.S
Table No. 69 Showing Statatical analysis of Group B Parameter Mean S.D S.E t-Value p-Value Remarks
Ruk 1.6 0.507 0.131 12.21 <0.001 H.S
Graha 1.666 0.617 0.159 10.477 <0.001 H.S
Passive neck
flexion
1.266 0.457 0.118 10.728 <0.001 H.S
Muscle
strength
0.2 0.414 0.106 1.886 >0.05 N.S
F 0.6 0.507 0.130 4.615 <0.001 H.S
E 0.333 0.487 0.125 2.664 <0.002 H.S
Lf 0.266 0.457 0.118 2.254 <0.05 H.S
Mobility
Grading
R 0.6 0.507 0.131 4.58 <0.001 H.S
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Observation and Results
166
Table No.70 Showing Comparative statistical analysis of both Groups (A & B).
Sl.No Parameters Group Mean S.D S.E P.S.E t- value
P - value
Remarks
A 1.533 0.833 0.215 1 Ruk
B 1.266 0.703 0.181
0.281 0.95 >0.05 N.S
A 1.4 0.632 0.163 2 Graha
B 1.2 0.560 0.144
0.217 0.921 >0.05 N.S
A 1.333 0.487 0.125 3 Passive neck flexion B 1.00 0.377 0.097
0.158 2.107 <0.05 H.S
A 4.4 0.507 0.131 4 Muscle strength
B 4.533 0.516 0.133
0.186 0.715 >0.05 N.S
A 1.00 0.377 0.097 F B 1.333 0.487 0.125
0.159 2.094 <0.05 H.S
A 1.066 0.258 0.066 E B 1.00 0.53 0.138
0.152 0.434 >0.05 N.S
A 0.933 0.457 0.118 Lf
B 1.2 0.414 0.106
0.159 1.679 >0.05 N.S
A 1.066 0.258 0.066 0.1933 1.034 >0.05 N.S
5 Mobility grading
R B 1.266 0.703 0.181
Conclusion
To compare the mean effect of two groups the statatical analysis is done by using
unpaired ‘t’ test. Assuming that the mean effect in the two groups in all the parameters is
same after the treatment.
From the analysis the parameter mobility grading flexion and passive neck flexion
shows highly significance ( as ‘P’ is less than 0.05). The parameter passive neck flexion
is most significient than other parameters (By comparing ‘t’ values).
The parameter muscle strength, the mean effect is more and the passive neck
flexion is less in a Group B after the treatment and there is a much variation in the
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Observation and Results
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parameter of ‘Ruk’ of Group A after the treatment (By comparing mean and standard
deviation)
To compare effect of drug within the Group this statatical analysis is using by
paired ‘t’ test by assuming that the drug is not responsible for the changes in the
observation before and after the treatment. From the analagesic, in Group B the
parameters Ruk, Graha, and passive neck flexion shows more highly significance than the
Group A (By comparing ‘t’ values).
The parameter muscle strength shows not significant both the Groups (A& B).
The mobility grading in Group B of parameter flexion, Rotation, shows more
highly significant. The parameter extention and lateral flexion shows equal highly
significant in both the Groups. But the Rotation in Group A shows not significant. (By
comparing ‘P’ Value and ‘t’ Value)
V. Statistical analysis of Nasyakarmukata Table No.71 Showing the response of Nasyakarmukata in Group A.
Opp Num
Sukauchvasam Sukhaswapnam Sukha Bodha
Aksha padavam
B.T A.T B.T B.T A.T A.T B.T A.T 2610 0 2 0 2 0 2 1 2 2310 0 1 0 2 0 2 0 2 2267 0 2 1 2 0 1 1 2 2214 0 1 1 1 1 2 1 2 2482 0 2 1 2 1 2 0 2 3399 0 1 0 2 1 1 1 2 3704 0 2 0 1 0 2 0 2 3701 0 1 1 2 0 2 1 2 3635 0 2 1 2 0 2 1 2 4238 0 1 1 2 0 2 1 1 4277 0 2 1 1 0 2 0 1 4735 0 1 1 1 1 1 1 1 4721 0 2 0 2 1 0 0 2 925 0 2 0 2 1 0 1 2 4144 0 1 0 2 0 2 1 2
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168
Table No.72 Showing the response of Nasyakarmukata in Group B.
Opp Num
Sukauchvasam Sukhaswapnam Sukha Bodha
Aksha padavam
B.T A.T B.T B.T A.T A.T B.T A.T 1195 0 2 0 1 0 2 1 2 2382 0 2 0 2 1 2 0 2 1644 1 1 1 2 1 1 1 2 2305 1 1 1 1 1 1 1 2 1443 1 1 1 2 0 1 0 2 1035 0 1 0 2 0 2 1 2 2638 0 1 1 2 1 2 0 1 4729 0 1 1 2 0 2 1 2 2539 0 1 1 2 0 2 0 1 3916 0 1 0 2 0 2 1 2 3779 0 1 1 2 0 2 0 2 3807 0 1 0 2 1 2 1 1 4271 0 2 0 2 1 2 1 1 4730 0 1 0 1 1 1 1 1 278 0 2 1 2 1 2 1 2
Table No. 73 Showing Statatical analysis of Nasyakarmukata in Group A
Parameter Mean S.D S.E t-Value P -
Value
Remarks
Sukhauchvasam 1.066 0.703 0.181 5.889 <0.001 H.S
Sukha
swapanam
1.333 0.617 0.159 8.383 <0.001 H.S
Sukha Bodha 1.2 0.774 0.2 6.00 <0.001 H.S
Akshipadavam 1.00 0.654 0.169 5.917 <0.001 H.S
Table No.74 Showing Statatical analysis of Nasyakarmukata in Group B
Parameter Mean S.D S.E t-Value P -Value
Remarks
Sukhauchvasam 1.533 0.516 0.133 11.526 <0.001 H.S Sukha swapanam
1.733 0.457 0.118 14.686 <0.001 H.S
Sukha Bodha 1.133 0.743 0.191 5.93 <0.001 H.S Akshipadavam 1.133 0.639 0.165 6.866 <0.001 H.S
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VI. Statistical analysis of Swedakarmukata
Table No.75 Showing the response of Swedakarmukata in Group-A.
Agnideepti Bhakta shraddha
Tandra hani
Sandhi cheshta
Sroto nirmalatwa
Mardava Twak prasada
Sl. No.
B A B A B A B A B A B A B A 01. 0 2 0 1 0 1 1 3 3 1 0 1 0 2 02. 0 2 0 1 0 1 1 3 3 1 0 2 0 2 03. 0 2 1 1 0 1 1 2 3 2 1 2 1 2 04. 1 2 1 1 0 1 1 2 4 3 0 2 0 2 05. 1 2 1 1 0 1 1 2 4 2 1 2 1 2 06. 1 2 1 1 0 1 1 2 3 2 1 2 0 1 07. 0 2 0 1 1 1 2 3 4 2 1 2 1 2 08. 1 2 1 1 0 1 2 2 4 2 0 1 0 1 09. 0 1 0 1 0 1 2 3 3 2 0 1 0 1 10. 1 2 0 1 0 1 1 2 3 1 0 1 0 1 11. 0 2 0 1 0 1 1 2 3 2 0 1 0 0 12. 1 2 1 1 0 1 1 3 3 2 0 1 0 1 13. 0 1 0 1 0 1 2 3 3 2 0 1 0 1 14. 1 2 1 1 0 1 1 3 4 2 1 2 1 1 15. 0 2 0 1 0 1 1 2 3 2 0 1 0 1 Table No.76 Showing the response of Swedakarmukata in Group-B.
Agnideepti Bhakta shraddha
Tandra hani
Sandhi cheshta
Sroto nirmalatwa
Mardava Twak prasada
Sl. No.
B A B A B A B A B A B A B A 16. 0 1 0 1 0 1 2 3 3 3 0 0 0 0 17. 0 1 0 1 0 1 1 2 4 2 1 1 1 2 18. 0 1 0 1 0 1 1 3 4 2 1 1 1 2 19. 0 1 0 1 0 1 1 3 3 2 0 1 0 2 20. 1 1 1 1 0 1 1 2 3 2 0 1 0 0 21. 0 1 0 1 0 1 1 2 3 2 1 1 1 2 22. 0 1 0 1 0 1 1 2 3 3 0 1 0 1 23. 0 1 0 1 0 1 1 2 3 2 0 1 0 1 24. 0 1 0 1 0 1 2 3 3 3 0 0 0 1 25. 0 2 0 1 0 1 2 3 3 2 0 1 0 1 26. 0 1 0 1 0 0 2 3 3 3 0 0 0 1 27. 0 1 0 1 0 1 2 3 4 3 0 1 0 1 28. 0 1 0 1 0 1 2 3 3 3 0 1 0 1 29. 0 1 0 1 0 1 2 3 3 3 0 0 0 1 30. 0 1 1 1 0 1 2 3 3 2 0 1 0 0
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Table No.77 Showing the study of Sweda kaarmukata parameters of Group-A. Parameters Mean S.D S.E t-value p-value Remarks Agnideepti 1.866 0.351 0.0908 10.664 <0.001 H.S. Bhakta shraddha 0.533 0.516 0.133 4.00 <0.01 H.S. Tandrahani 0.933 0.258 0.066 14.13 <0.001 H.S. Sandhi cheshta 1.133 0.1516 0.133 8.518 <0.001 H.S. Srotonirmalatva 1.866 0.516 0.133 14.03 <0.001 H.S. Mardava 1.466 0.516 0.133 11.02 <0.001 H.S. Twak prasada 1.33 0.617 0.159 8.383 <0.001 H.S. Table No.78 Showing the study of Sweda kaarmukata parameters of Group-B. Parameters Mean S.D S.E t-
value p-value
Remarks
Agnideepti 1.066 0.256 0.066 16.00 <0.001 H.S. Bhakta shraddha
0.866 0.351 0.0903 9.537 <0.001 H.S.
Tandrahani 0.866 0.351 0.0908 9.537 <0.001 H.S. Sandhi cheshta 2.26 0.351 0.0908 12.47 <0.001 H.S. Srotonirmalatva 2.466 0.516 0.133 18.54 <0.001 H.S. Mardava 0.733 0.457 0.118 6.211 <0.001 H.S. Twak prasada 1.066 0.153 0.153 6.967 <0.001 H.S. To know the Swedakaarmukata in both the groups the parameters were analyzed.
In group-A the parameter Agni deepti showed more significance than the other
parameters and also it differs from the group-B, by comparing the t-values. The
parameter Agni deepti had uniform effect in group-A but in group-B the parameter
Srotonirmamatva had uniform effect. The mean effect of the parameter Sandhi cheshta in
group-A and the parameter Tandra haani was more and same in both the groups. The
variation in Sandhi chesta in group-A was more whereas the parameters Srotonirmalatva
and Mardava had the same mean effect. The parameter Twak prasada in group-B had
more variation whereas the parameters Tandra haani and Mardava had the same
variations.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
171
Any hypothesis or principle, if to be proved must be discussed thoroughly from
all angles, which has been clearly stated by Charaka long back. After the formation of a
hypothesis, it has to be tested and observed by various methods and eventually the results
are obtained. All these should be well supported by proper reasoning or logic and finally
concluded. A hypothesis gets established as a principle if the reasoning given is
satisfactory, otherwise it remains as it is. Charka has very precisely said that, even the
truth may not be accepted, as it is without the logical interpretation.
Discussion improves the knowledge and discussion with science becomes base
establishment of the concept. Thus discussion is the most essential phase of any research
work. Keeping this in view, the facts which have emerged from the study can be studied
in 4 main headings.
1) Discussion on Manyasthambha
2) Discussion on Karmas.
3) Discussion on clinical study.
Discussion on demographic data.
Discussion on disease data.
4) Discussion on results.
1. Discussion on Manyasthambha
These are osteo-arthritis of spinal joints of cervical and lumbar regions. Here the
straightening of the two curved regions of spine causes entrapment of the nerve roots
emerging out of spinal canal. This gives neurological symptoms depending on the type of
nerve.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
172
Cervical spondylitis causes sensory / motor symptoms of posterior head and neck,
shoulders, upper limb regions as pain, numbness, burning, weakness etc. Giddiness on
neck movements and inter vertebral prolapse are later complications.
The most common symptom is pain in the neck, worsening with exertion and
relieved, in the early stages, by rest. This pain often radiates down to the hand, with the
fingers becoming numb due to compression of the nerves that innervate the upper
extremity the brachial plexus is affected. The trapezius area becomes tender and painful.
A nodule can form in the muscle due to chronic pressure. The symptoms of cervical cord
compression can sometimes be severe. The pain radiates down the right or left arm to the
fingers, to the chest and shoulder blades depending on which side the nerve root is
involved. It can become continuous, making movements painful and limited. If the
cervical vertebrae become unstable, the danger of cord compression is imminent and, in
some cases, fusion of the bones may be warranted. But this is rare.
Causes of Manyasthambha
Considering the reference of Manyasthambha to cervical Spondylitis the better
comparison can be made from the Nidana. The main Nidana can be considered fewer
than 4 headings.
1. Swaprakopa Nidana – including Ahara Nidana
2. Margavarodhaka Nidana – causing obstruction to Vata
3. Marmaghata kara Nidana – injury/trauma
4. Dhatukshayaka Nidana – depletion of Dhatu
Though these are considered different Nidana bhavas ultimately they are inter
related. But to know the exact cause for the onset of disease such a classification has been
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
173
made. The swaprakopa nidanas, marmabigata and margavarodhaka nidanas eventually
leads to Dhatukshaya and there by provoke the vata. Spondylotic changes often are
observed in the ageing population. However, only a small percentage of patients with
radiographic evidence of cervical Spondylitis are observed.
Stress and long working hours in front of computers can lead to cervical pain as
well as pathological abnormalities. The commonest cause for cervical Spondylitis or such
type of diseases is the Inflammatory and degenerative changes effected in the cervical
region. Anti inflammatory, analgesic and disease modifying anti rheumatic drugs are the
drugs of choice in contemporary system of medicine.
In take of excessive and heavy fatty meals were observed to lead to accelerated
Inflammatory and degenerative process and can be considered as Kapha provocative diet.
The posture of work i.e., looking upward direction lying on irregular surface etc. are
considered as the cause for cervical Spondylitis. The psychological factors Shoka, Bhaya,
chinta etc. lead to provocation of vata and intern leads to degenerative diseases. So all
these factors can be considered as the swaprokopa Nidana factors in Ayurveda.
Trauma is observed to be the next causative factor for the disc prolapse. Trauma
or abigatha to the marmas are considered here. Almost all the patients of cervical
Spondylitis have a history of trauma or bad postures which in turn leads to improper
positioning of cervical vertebrae, this puts uneven pressure over the spinal nerve roots
producing different signs and symptoms.
It is observed that when a person sleeps with improper head position, especially in
middle aged or old aged, develop Inflammatory and degenerative processes in the
cervical vertebrae, and may lead to Manyasthambha. Spondylitis is due to ageing process
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
174
or with wrong postures causing minor trauma, which can accelerate the pathology of
Manyasthambha and further degeneration leading to set a clinical features.
The Ahara and vidhara as elucidated in the Nidana induces reduction of sneha
bhavas and simultaneously Vata prakopa i.e., Vyanavata that normally controls all the
movements of the body due to Dhatu kshaya. Reduction of sleshmaka Kapha, which
normally align the joints, causes the vitiated Vata to settle in the joints.
2) Discussion on Karmas.
Manyastambha is a vatavyadhi by its nature. The condition manyastamba is
affecting the neck region with the symptoms such as pain and stiffness. Vata is vitiated
either because of Avarana or Dhathukshya when vata covered by kapha or Dosha
accumilation makes Manyastambha. In initial stage of the disease the kapha anubandam
is acknowledge. Ayurveda advocates a reliable management of this condition through
highly efficiencies and easily available drugs based on doshic theory. Ayurvedic
approach to the disease management of Manyastambha is to retard the inflammation and
degeneration and to strengthen the dhathus and passifing the vata dosha which has a
special importance in the management.
In the classic, the treatment is told as Rooksha sweda and Nasya where we
consider manyastambha in the doshic level as vata and kapha are the two main factors
involved in the pathogenesis of Manyasthambha. Here the pain and stiffness are two
symptoms present in the disease which can be attributed the vata and kapha dosha
lakshna Rooksha sweda is told for srotoshodhana there by subside the vitiated kapha
which is in the Manyapredesha and for this purpose, Kolakulathadi choorna is used
which relieves the pain and stambatwa. By swedana we can get the effects like twak
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
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mruduta, twakprasada, srotoshodhana, stabdhatwa in the sandhis are relieved and
becomes easy for chesta.
Charaka while explaining the effects of swedana he says it is best in sankocha,
ayama, shoola, sthambha etc. all the vikaras of sarvanga and ekanga.
Kolakulathadi Choorna
Most of the ingredients of kola kulatthadi churna are having Laghu ushna snigdha
gunas and kapha vata hara properties. Manyasthambha being a vataja vyadhi with kapha
avarana gets regressed by the usage of this choorna as Rooksha sweda.
Nasya karma is the first line of management explained in the classic for
urdwajatru gata vatavyadhi, Manyasthambha being one of the urdwajatru gatha vikara
and especially dhatu kshayajanya vata roga hence Brahmana type of nasyakarma is more
beneficial. Brahmana nasya karma has been selected for the study because the disease
Manyasthambha is degenerative in orgin and Urdwajatagata vata vyadhi. Hence
nasyakarma with Mahamasha thaila is best advisible to palliate the disease which helps to
set right the disease as it being santarpana type of chikitsa which prepared with vatahara
drugs. As per the Bruhmana Nasya karma mechanism is concerned it could be
hypothesized that it acts on local as well as systemic levels by the direct contact with the
nerve terminals and also uptake of the drugs by nasal mucosa. Hence Nasyakarma not
only acts as curative but also acts on prevantive measure.
Nasya dravya reaches the shringataka marma of head (sheera) which is a sira
marma and formed by the siras of nose, eyes, kanta, and shrotra. The drugs spreads by the
same route and scratches the morbid doshas of urdhajatru and excreate them from the
uttamaga.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
176
Indu, commentator of Asthanga sangraha, opined that shringataka is the inner side
of middle part of head “shiraso antar madhyam.”
In this contex susruta, clarified the shringataka marma is a siramarma forced by
the union of sira (blood vessels) supplying to nose, ear, eye and tongue thus we can enter
the above sira and purities them.
Mahamasha Thaila
By virtue of its qualities like guru, snigdha teekshna, madhurvipaka, ushna veerya
is vata shamaka property, vedana sthapaka, shoola hara, nadidourbalyahara, balyam
Bruhmana, shodhaharam, anulomana rasayanam acts on dathukshaya most of the
ingredients are antagonistic to nadi dourbalyam and reinstaling it to normalcy.
Mode of action of Nasya
The absorption of the drugs is carried out in three media they are by general blood
circulation, after absorption through mucous membrane. The direct pooling into Venus
sinus of brain via inferior ophthalmic veins and next one absorption directly in to the
cerebra spinal fluid. Apart from the small emissary veins entering cavernous sinuses of
the brain, a pair of venous branch emerging from alliance will drain into facial vein. Just
almost in the opposite direction inferior ophthalmic in other hand also drain into
cavernous sinus of the menages. And in addition neither the facial vein nor the
ophthalmic veins have any venial values so there are more chances of blood draining
from facial vein into the cavernous sinus in the lowered head position.
The nasal cavity directly opens with the frontal maxillary and sphenoidal air sinus
epithelial layer is also continuous through out then the momentary retention of drug in
naso pharynx. Medicine causes oozing as drug material enters into air sinus, which are
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
177
rich with blood vessels entering the brain and remaining through the existing foramens in
the bones there are better chances of drug transportation in this path. Recent authors as
middle cephalic fosse of the skull consisting para-nasal sinus and meningial vessels and
nerves one can see in to the truth of narration made have explained the shringataka
marma by Vagbhata here. The drug administered enters the para nasal sinus especially
frontal and sphenoid sinus i.e., shringataka where the ophthalmic veins and the other
veins spread the sphenoid sinus are in close relation with intra-cranial structures. Thus
there may be a so far undetected route between air sinuses and cavernous sinuses
enabling the transudation of fluids. As a whole, the mentioning of the shringataka in this
context seems to be more reasonable.
3) Discussion on Clinical study
Discussion on Demographic data:
All the cases were reported to D.G.M Ayurvedic medical college hospital, post
graduation department. Special medical camps were also conducted in the college
for selecting the patient. 33 cases were registered and from that 30 cases were
selected for the study. Observed features in the patients during the study were
recorded in the case sheets and these observations were analyzed and tabulated
after completion of clinical study. These observations findings are discussed
below.
♦ Age
Risk of cervical spondylitis as age advances because of increase in the
inflammatory and degenerative conditions in the cervical spin and its
surroundings structure, especially after 35 years of age. It is also recorded fact
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
178
that cervical spondylitis occurs frequently in 35-40 years of age. In this study
above factors where proved as the maximum number of patients between 30-40
years of age (33.33%)
♦ Sex
It is said that males are more affected in comparison to females in
Manifestation of cervical spondylities and ratio is given as 3:1 for male to female
ratio. In this study the above said statement is having a significance as number of
male patients are more that is 19 patients (63.33%) out of 30 females being only
11 (36.66%).
♦ Food habits
In the manifestation of vata vyadhi food habits place a pivotal role. If we
check the nidana aspects we can see the importance of food habits in the present
study. Only 8 patients were registered as vegetarians and remaining 22 patients
were seen as mixed diet consumer. This condradictory observations may be due to
the small sample size and study limited to a particular area.
♦ Religion
In the present study majority of the patients where Hindus i.e. 22 patients
(80%). But does not mean that Hindus are more prone to the disease. This may be
due to the area involved as majority of population are hindus.
♦ Occupation
Maximum number of patients are with active life style 13 (43.33%) and
labours are registered only 8 in number (26.66%) it is said that cervical
spondylitis frequently occurs in the patients who are weight lifters doing heavy
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
179
exercises etc. The low incidence of labourers in comparision to active and
sedentary people may be due to the small sample size and random selection of
patients.
♦ Social economical status
In the present study the maximum number of patients were found in
middle class that is 26 patients this may be due to the small sample size and
randomly selection of patients.
Discussion on disease data
• Deha prakruthi
In the present study the majority of the patients were of vata pitta
prakruthi 15 patients (50%) and next dominent prakruthi is vata kapha which are
9 in number least are pitta kapha patients with 6 in numbers (20%) the
significance of increased number of vata pitta prakruthi is may be due to the
geographical area were the study is conducted.
• Agni
In the present study the majority of the patients were of mandagni 15
patients (50%) and next dominent Vishama which are 8 (26.66%) in numbers
least are Samaagni patients with 7 in numbers (23.33%) the significance of
increased number of Mandagni is may be due to the geographical area were the
study is conducted.
It is explained that Ama which may characterstic feature due to mandagni
acts as a strong nidana for manifectation of vata vyadhi and Manyasthambha in
particular because in the initial stages of Manyasthambha there will be vata
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
180
avarana by kapha which can be assumed as a resultant of increased amathva in the
body.
• Koshta
In the present study the majority of the patients were of madyama 19
patients (63.33%) and next dominent Koshta is Krura which are 8 in numbers
least are Mrudu koshta patients with 2 in numbers (6.66%) the significance of
increased number of madyama koshta is may be due to the geographical area were
the study is conducted.
• Nidra
In the present study the maximum patients were having Alpa nidra that is
13 in number (43.33) and the next dominent type of Nidra is Vishama nidra were
9 patients are seen. High incidence of Alpa and vishama Nidra is may be due to
the increased pain and inturn disturbing the sleep.
• Nidanam
Most of the Nidanas mentioned in the classics were elicited in the study,
among the ahara nidana all the patients where in the habit of taking vata
vriddhikara ahara. In the vihara group the prominent nidanas were found as urdwa
nireekshanam, Asamastana sayanam, Vyayamam from these we can say that this
Nidanas had key role in the pathogenesis of Manyasthambha.
• Chronicity
Here in this study, the maximum number of patients were having
chronicity ranging from 6 months to 1 year 14 Next highest number of patients
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
181
were found having the chronicity of 1 year to 1½ year 11 patients. This
observation is due to the radomised clinical study.
4) Discussion on Results
All the cases were reported to D.G.M Ayurvedic medical college hospital,
post graduation department. Special medical camps were also conducted in the
college for selecting the patient. 33 cases were registered and from that 30 cases
were selected for the study. Observed features in the patients during the study
were recorded in the case sheets and these observations were analyzed and
tabulated after completion of clinical study. These observations findings are
discussed below.
The result of the study confirmed that Rookshasweda has highly
significant in Ruk Graha extension and lateral flexion of neck in group A.In group
A muscle strength and Rotation did not showed no significant result.
In group B muscle strength showed no significant result, and rest of
parameters showed highly significant results. This increased significance of the
parameters is may be due to the additive effect of Nasya along with sweda.
The muscle strength is having no significance and it is due to the very
small study duration of 14 days. So we cannot expect any significant result by
Nasya and swedana. More patients are not having any change in the muscle
strength because majority of the patients having normal muscle strength. Very
few patients shown the muscle weakness during the study it was unchanged.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Discussion
182
To compare the mean effect of two groups the statatical analysis is done
by using unpaired ‘t’ test. Assuming that the mean effect in the two groups in all
the parameters is same after the treatment.
From the analysis the parameter mobility grading flexion and passive neck
flexion shows high significance ( as ‘P’ is less than 0.05). The parameter passive
neck flexion is most significient than other parameters (By comparing ‘t’ values).
The parameter muscle strength, mean effect is more and the passive neck
flexion is less in Group B after the treatment and there is a much variation in the
parameter of ‘Ruk’ of Group A after the treatment (By comparing mean and
standard deviation)
To compare effect of drug within the Group this statatical analysis is using
by paired ‘t’ test by assuming that the drug is not responsible for the changes in
the observation before and after the treatment. From the analagesic, in Group B
the parameters Ruk, Graha, and passive neck flexion shows more highly
significance than the Group A (By comparing ‘t’ values). The parameter muscle
strength shows not significant both the Groups (A& B). The mobility grading in
Group B of parameter flexion, Rotation, shows more highly significant. The
parameter extention and lateral flexion shows equal highly significant in both the
Groups. But the Rotation in Group A shows not significant. (By comparing ‘P’
Value and ‘t’ Value)
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Conclusion
183
The following conclusions are drawn on the basis of the research undertaken with
the Rookshaswedasthada Nasyam at D.G.M. Ayurvedic medical college and Hospital,
Gadag.
• The disease Manyasthambha and cervical Spondylitis are similar in their etiology,
sign and symptoms.
• The Dosha entities included in this disease are Vyanavata and Sleshmaka Kapha.
• Manyasthambha is one of the Vataja Nanatmaja vyadhis.
• The initial stages the vata avarana by kapha is seen leading to Stambatwa, Gaurava,
and Ruk.
• Males and aged people are more affected than females.
• Inflammatory and degenerative joint changes being progressive and irreversible
treatment is aimed at the relief of the symptoms and to check the disease process, to
induce regeneration if possible.
• Rooksha sweda karma is a modification of the sankara sweda (or sagni upanaha)
that comes under ushma type of swedana.
• No complications of sweda (atiyoga, ayoga and mitya yoga) were absorbed in this
study.
• No complications of Nasya (atiyoga, ayoga and mitya yoga) were absorbed in this
study.
• During the follow up period (after the 28th day) the results attained seemed to wear
out in the Rooksha sweda group, but results lasted throughout the follow up period
in the Rooksha sweda along with Nasya group.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Conclusion
184
• In group B, the parameters (Ruk) Graha and passive neck flexion shares more
highly significant then the group A (By comparing t valuves) the parameter muscle
strength shows not significant in both the groups.
• In group B values shows more highly significant when compare to group A, and
this may be due to the addictive effect of Nasya karma.
Suggestions for the future study
1) Study on large sample.
2) Studying on repeated application of these treatment procedure may be conducted
and progress studied.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
Summary
185
The dissertation work entitled “The clinical study on Rooksha swedasthada
Nasyam in the management of Manyastambha (Cervical spondylitis)” consists of
seven parts. They are
• Introduction
• Objectives
• Review of Literature
• Methodology
• Results
• Discussion
• Conclusion
The Introduction highlights on Rooksha sweda, Nasya and Manyasthamba. The
objectives part describes the need for the study, previous studies on Manyasthambha, title
of the present study and the objectives of the present study Review of literature part
covers the historical view on Nasya, sweda an Manyasthambha, Nirukthi and paribhasa
of Rookshasweda, Nasya and Manyasthambha shareera of Twak description of
swedakarma and Rooksha sweda in particular and description of Manyasthambha.
Methodology part contains review of properties and chemical composition of the drugs
used, Methodology of the clinical study, procedures of Rooksha sweda and Nasya and the
parameters for clinical and functional assessment and the Nasya Karmukatha and
swedakarmukatha parameter. Discussion part consists of the headings, Discussion on
Manyasthambha, Discussion on Karma, Discussion on clinical study, Discussion on
results. Conclusion part contains the conclusions of the present study and suggestion for
the future study.
“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha
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152) Rao Ramasundara M, Sarira rachana vijnana chapter 4. Vijayawada: Susruta opticals;2003.p. 565. 153) Sushrutha, Sushruthasamhitha Shareerasthana chapter 4 sloka 4. Varanasi: Krishnadas Academy; 1980. p. 355. (Krishnadas Ayurveda series 51). 154) Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 4. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 337 . (Kasi Sanskrit series 228). 155) Sushrutha, Sushruthasamhitha Suthrasthana chapter 21 sloka 10. Varanasi: Krishnadas Academy; 1980. p. 101. (Krishnadas Ayurveda series 51). 156) Martini.F.H, Fundamentals of Anatomy and Physiology chapter 5. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 148. 157) Agnivesa, Charakasamhitha Chikitsasthana chapter 15 sloka 18. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 515 . (Kasi Sanskrit series 228). 158) Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 15. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 339 . (Kasi Sanskrit series 228). 159) Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 16. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 339 . (Kasi Sanskrit series 228). 160) Vaghbhata, Ashtangasangraha with Sashilekha teeka Suthrasthana chapter 20 sloka 3. Rudraparasava editor. Trichur: Mangalodayam publication; 1913. p. 147. 161) Sushrutha, Sushruthasamhitha Suthrasthana chapter 15 sloka 2. Varanasi: Krishnadas Academy; 1980. p. 68. (Krishnadas Ayurveda series 51). 162) Vagbhata, Ashtangahridaya Suthrasthana chapter 11 sloka 5. Varanasi: Krishnadas Academy; 1982. p.173. (Krishnadas Academic series 4). 163) Agnivesa, Charakasamhitha Vimanasthana chapter 5 sloka 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 251 . (Kasi Sanskrit series 228). 164) Agnivesa, Charakasamhitha Vimanasthana chapter 5 sloka 22. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 252 . (Kasi Sanskrit series 228). 165) Agnivesa, Charakasamhitha Vimanasthana chapter 5 sloka 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 251 . (Kasi Sanskrit series 228). 166) Shastri ramagopal, Vedom main Ayurved, Delhi:Madanmohanlal Ayurveda anusthana trust;1956. p. 63. 167) Agnivesa, Charakasamhitha Siddhisthana chapter 9 sloka 6. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 717 (Kasi Sanskrit series 228)).
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181) Vagbhata, Ashtangahridaya Nidanasthana chapter 16 –sloka 47 Varanasi: Krishnadas Academy; 1982. p. 539 (Krishnadas Academic series 4). 182) B.D Chaurasia Human Anatomy 3rd ed. Vol-3 1995.CBS publishers and distributors New Delhi p. 59. 183) Martini.F.H, Fundamentals of Anatomy and Physiology chapter 7. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 218 184) Peter. L. Williams Grays Anatomy Chapter 6. 38 th ed. Philadelphia: Churchill Living Stone; 2000. p. 429-40 185) B.D Chaurasia Human Anatomy 3rd ed. Vol-3 1995.CBS publishers and distributors New Delhi p. 59. 186) Martini.F.H, Fundamentals of Anatomy and Physiology chapter 7 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 219. 187) Ashtangasangraha Suthrasthana chapter 1 sloka 32 Prof.K.R.Srikhantamurthy editor. Varanasi: Chaukhambha Orientalia; 1996. p. 10. (Jaikrishnadas Ayurvedic series 79). 188) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p .616,617. (Kasi Sanskrit series 228)). 189) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 7. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p .615. (Kasi Sanskrit series 228)). 190) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 616,617. (Kasi Sanskrit series 228). 191) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 616,617. (Kasi Sanskrit series 228). 192) Sushrutha, Sushruthasamhitha Shareerasthana chapter 6 sloka 19. Varanasi: Krishnadas Academy; 1980. p . 370-375. (Krishnadas Ayurveda series 51). 193) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 616,617. (Kasi Sanskrit series 228). 194) Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 67. Varanasi: Krishnadas Academy; 1980. p.267. (Krishnadas Ayurveda series 51). 195) Madhavakara, Madhavanidana chapter 22 sloka 51-52. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 436. (Chaukhambha Ayurvijnana Granthamala 46).
196) Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24 sloka 74-75 5th ed. Varanasi: Chaukhambha Orientalia; 1988. p. 235. (Chaukhambha Sanskrit series 130). 197) Yogaratnakara –Vatavyadhi chikitsa sloka 63 Vaidya Lakshmipatisastry, editor. Varanasi Chaukhambha Sanskrit Sansthan; 1988. p 403. (Kasi Sanskrit series 160). 198) Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 67. Varanasi: Krishnadas Academy; 1980. p. 267. (Krishnadas Ayurveda series 51). 199) Madhavakara, Madhavanidana chapter 22 sloka 51. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 436. (Chaukhambha Ayurvijnana Granthamala 46). 200) Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24 sloka 74-75. 5th ed. Varanasi: Chaukhambha Orientalia; 1988. p. 235. (Chaukhambha Sanskrit series 130). 201) Yogaratnakara – Vatavyadhi chikitsa sloka 63 Vaidya Lakshmipatisastry, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 403. (Kasi Sanskrit series 160). 202) G.S Sainani A.P.I textbook of medicine section XVII Rheumatology. 6th ed. Mumbai:Association of Physicians of India. p. 829. 203) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 616,617. (Kasi Sanskrit series 228) 204) Madhavakara, Madhavanidana chapter 1 sloka 7. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 39. (Chaukhambha Ayurvijnana Granthamala 46). 205) www.spineuniverse.com accessed on 18/08/2004 206) http: // emuguidemaps.homesstad.com 207) www.fontynmedical.be/scripts/deatails 208) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 673. 209) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 584. 210) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 248. 211) a) Shastry J.L.N Dravyaguna Vijanam vol 2 Ist edition Varanasi, Chaukhamba Orientalia, 2004 pg. 705.
b) Nadkarni K.M Dr, Indian Meteria Medica Vol 1 3rd edition Bombay, Popular prakashan 1976. pg 939. 212) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 525. 213) a) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 629-630. b) Dr. Gyanendra pandey, Dravya guna vijana part 3. 2nd ed. Varanasi: Chaukhamba Krishnadas academy 2002 p. 621-623. c) Nadkarni K.M Dr, Indian Meteria Medica Vol 1 3rd edition Bombay, Popular prakashan 1976. p. 1126-1127. 214) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 350. 215) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 479. 216) a) Dr. Gyanendra pandey, Dravya guna vijana part 3. 2nd ed. Varanasi: Chaukhamba Krishnadas academy 2002 p. 428-429. b) Nadkarni K.M Dr, Indian Meteria Medica Vol 1 3rd edition Bombay, Popular prakashan 1976. p. 935-936. 217) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 468. 218) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 706. 219) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 455. (Varanasi Ayurveda series). 220) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 221. (Varanasi Ayurveda series). 221) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 469. (Varanasi Ayurveda series). 222) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 223. (Varanasi Ayurveda series). 223) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 225. (Varanasi Ayurveda series).
224) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 820. (Varanasi Ayurveda series). 225) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 822. (Varanasi Ayurveda series). 226) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 822. (Varanasi Ayurveda series). 227) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 283. (Varanasi Ayurveda series). 228) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 632. (Varanasi Ayurveda series). 229) Vagbhatta, Ashtangasangraha Suthrasthana chapter 6 sloka (94-96). Prof.K.R.Srikhantamurthy editor. Varanasi: Chaukhambha Orientalia; 1996. (Jaikrishnadas Ayurvedic series 79). 230) Vagbhatta, Ashtangasangraha Suthrasthana chapter 6 sloka (52-53). Prof.K.R.Srikhantamurthy editor. Varanasi: Chaukhambha Orientalia; 1996. (Jaikrishnadas Ayurvedic series 79). 231) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 569. (Varanasi Ayurveda series). 232) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 292. (Varanasi Ayurveda series). 233) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 39. (Varanasi Ayurveda series). 234) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 202. (Varanasi Ayurveda series). 235) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 365. (Varanasi Ayurveda series). 236) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 562. (Varanasi Ayurveda series). 237) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 632. (Varanasi Ayurveda series). 238) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 275. (Varanasi Ayurveda series).
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SPECIAL CASE SHEET FOR MANYASTHAMBA Post Graduate Research And Studies Center (Panchakarma)
Shree DGM Ayurvedic Medical College, Gadag. Guide: Dr. G.Purushothamacharyulu, PGScholar:K.S.AswiniDev. MD (Ayu). Co- Guide:Dr.S.N.Belawadi. MD (Ayu). 1. Name of the patient : Sl. No : 2. Father’s / Husband’s Name : OPD No : 3. Age : IPD No : 4. Sex : Bed No : 5. Religion : 6. Occupation : 7. Economical Status : 8. Address :_____________________________ Phone No : ____________________________ Email ID : _____________________________ 9. Type of treatment : Group A Group B
10.Date of Schedule Initiation :
M F
Poor Middle Aristocrat
Hindu Muslim Christian Others
Sedentary Active Labor Others
Date of Schedule Completion : 11. Result: 12. Consent: I here by agree that, I have been fully educated with the disease and
Good Response
Moderate Response
Poor Response
No Response
treatment, here by satisfied whole heartedly, and accept the medical trial over
me.
Investigator’s Signature Patient’s
Signature
2
I. Main Complaints Duration
a) Ruk
b) Sthamba
II. Associated Complaints Duration
a) Numbness and Arms ( ) Hands ( ) Fingers ( ) Tingling Sensation
b) Muscle weakness and Shoulder ( ) Arms ( ) Hands ( ) Fingers ( )
Deterioration
c) Headache 1-2 times per month
1-2 times per week Daily but intermittent pain
Continuous pain
d) Crunching sounds Movement of the neck
Movement of the Shoulder muscles
Flexion ( ) Bending
Extension ( ) Rt. Lateral Lt.
Lateral
III. HISTORY OF PRESENT ILLNESS:
Mode of onset Chronic ( ) Insidious ( ) Acute ( ) Traumatic ( )
Nature of pain Pricking ( ) Aching ( ) Generalized ( )
Tearing ( ) Burning ( )
Variation of pain Increased on use ( ) Increased on disuse ( ) Nocturnal ( )
Routine activities affected Yes ( ) No ( )
IV. HISTORY OF PAST ILLNESS:
V. TREATMENT HISTORY:
Modern Medicine ( ) Ayurveda Medicine/Therapy ( )
Other Systems ( ) Relief with previous treatment ( )
VI. FAMILY HISTORY RELEVANT:
If Yes, specify the relation
3
VI. Vayaktika vruttanta : 1 Ahāra Vegetarian ( ) Non Vegetarian ( ) 2 Vihāra Nature of work : Hard ( ) Moderate ( ) Sedentary ( ) 3 Agni Samāgni ( ) Mandāgni ( ) Teekshāgni ( ) vishamāgni ( ) 4 Kostha Mrudu ( ) Madhyama ( ) Krura ( ) 5 Nidra Prākruta ( ) Alpa ( ) Ati ( ) Diwāswapna ( ) 6 Vyasana None ( ) Tobacco ( ) Smoking ( ) Alcohol ( ) 7 Artava Regular ( ) Irregular ( ) Menopause ( )
Samanya Pareeksha
A. Asta sthāna Pareeksha : B. Vital examination
VII. Dasha vidha Pareekshā :
1 Nadi /Min 2 Mala 3 Mootra 4 Jihwa 5 Shabda 6 Sparsha 7 Druk 8 Akruti
1 Heart Rate /min 2 Resp. rate /min 3 Blood Pressure mm of Hg4 Body Temp / F5 Body weight Kgs.
1 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Sama ( )
2 Sāra Pravara. ( ) Madhyama. ( ) Avara ( )
3 Samhanana Pravara ( ) Madhyama. ( ) Avara ( )
4 Pramana Pravara ( ) Madhyama. ( ) Avara ( )
5 Sātmya Ekarasa. ( ) Sarva rasa ( ) Vyamishra ( )
Rooksha satmya ( ) Snigda satmya ( )
6 Satva Pravara ( ) Madhyama ( ) Avara ( )
7 Ahara Shakti a) Abhyavaharana shakti P ( ) M ( ) A ( )
b) Jarana shakti P ( ) M ( ) A ( )
8 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )
9 Vaya Bala ( ) Yuva ( ) Vrudda ( )
4
VIII. SROTOPAREEKSHA
Srotas Observed Lakshana
Pranavaha
Annavaha
Udakavaha
Rasavaha
Rakthavaha
Mamsavaha
Medovaha
Asthivaha
Majjavaha
Sukravaha
Pureeshavaha
Muthravaha
Swedovaha
Aarthavavaha
IX. NIDAANAPAREEKSHA a. Aahaara
Tiktharasa Athyupayoga Kashayarasa Athyupayoga Katurasa Athyupayoga
Alpa Bhojana Pramitha Bhojana Rooksha Bhojana
b. Vihaara
Vega Dhaarana Vegoodeerana Ativyavaya
Nisaajaagarana Atyucha Bhaashana Ativyaayama
c. Maanasika
Atibhaya Atishoka Atichintha
d. Occupational
e. Chikitsa Aparaadhaja
Shodhanakarma Atiyogaja Yes No
5
2. Poorvarupa :
3. Upashaya/Anupashaya :
Ushna Seetha
Rooksha Snigdha
4. Rupa :
5. Samprapthi :
X SAADHYAASAADHYATA: XI NIDANA
AAHARA VIHARA MANASIKA
Katu Rasa Asamasthana sayanam Chinta
Tikta Rasa Urdhwa Nireekshanam Shoka
Kashaya Rasa Diva swapnam Bhaya
Ati Sheeta Vyayama VYASANA
Ati Rooksha Langhana Madhya Pana
Alph Ahara Plavana Dhooma Pana
Laghu Ahara Adhvagamana Tobacco Chewing
NIDRA Yanam
Vishama Upachara
Prajagara
XII SPECIAL EXAMINATION
A. Pain a). Onset Sudden ( )
Gradual ( ) b). Site Cervical ( )
Cervico thoracic ( ) Shoulder ( ) c). Nature of pain Localised ( )
Radiated ( ) Vague ( )
c) MOBILITY OF CERVICAL
JOINT
Before After
Flexion
Extension
Rt. Lateral
Bending Lt. Lateral
Rotation Intermittent ( ) Continues ( )
6
d). Duration Since e). Severity
1 2 3 4 5 Grade (Grade 0: No pain, Grade 1: Mild pain, Grade 2: More than mild pain but
tolerable, Grade 3: Moderately severe pain , Grade 4: Severe pain, Grade 5: Intolerable, perhaps suicidal pain)
f). Aggravating Movement ( ) Rest ( ) g). Relieving factor Rest ( ) Pain relievers ( ) Tranquillizes ( ) Pressure
( )
0 1 2 3 II). Stiffness of neck III) Tenderness 1 2 3 (Huckstep tender triad)
IV. Dizziness; while
a) DARSANA Before After
Swelling
Redness
Muscle waisting
b) SPARSANA
Warmth over joint (t0)
Tenderness
Bony component palpable
INVESTIGATIONS X-RAY FINDINGS
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TREATMENT PROTOCOL
I Group A :- Choorna pinda swedam Day Time Duration Observation Advise 1 2 3 4 5 6 7 I Group B :- (Choorna pinda swedam followed by Nasyam) Day Time Duration Observation Advise 1 2 3 4 5 6 7 III Nasyam :- Day Matra 8 Bindu Time of
Performance Observation Advise
1 2 3 4 5 6 7
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XII. ASSESSMENT OF RESULTS
A. SUBJECTIVE PARAMETERS
Parameters Before Treatment After Treatment
Ruk (Pain)
Graha (Stiffness)
OBJECTIVE PARAMETERS
PARAMETER B. T. A. T.
Pain Grade
Stiffness
Numbness
Flexion
Extension
Rt. Lateral
Mobility
of
cervical
spine Lt Lateral
Passive neck flexion
Muscle strength
B. NASYAKAARMUKATA PARAMATERS. Parameters Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Sukhauchvasam
Sukha
swapanam
Sukha Bodha
Akshipadavam
Sukhauchvasam
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C. SWEDAKAARMUKATA PARAMETERS
Parameters Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Agnideepthi
Bhakthasradha
Tandraahaani
Sandhicheshta
Srotonirmalatva
Parameters Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Maardava
Tvak Prasada
INVESTIGATOR’S NOTE:
SIGNATURE OF GUIDE SIGNATURE OF THE SCHOLAR
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1) Pain grade : 1) Grade O: No Pain, 1: Mild Pain, 2) More than Mild Pain but tolerable 3) Moderately sever pain 4) Sever pain S: Intolerable perhaps suicidal pain 2) Stiffness grade : (No Movement =0, Upto 50% =1 50 – 70% =2, > 70% ad full range =3 Full range =4) 3) Mobility grade : No Movement =0, Upto 50%=1, 50-70%=2, >70%, and full range=3, Flexion:-0, No movement, Full range – up to chin Touches (300) Extension –0, No movement, Full range -300,
Lateral flexion :-0 No movement, Full range -400, Rotation: 0, No movement, Full range - 700 to 900