Vāta vyādhi
All vyādhi can be classified into:
1. Sāmānyaja : The vyādhi that are formed when 2 or more doṣa take part in samprāpti and contribute to vyādhi formation like jwara etc.
2. Nānātmaja : Na-anātmajaḥ - the vyādhi that are formed from a single doṣa. Vary rarely these single doṣaja vyādhi do have anubandha (affiliation) of another doṣa but can occur without any anubandha as well. Meaning that another doṣa may rarely be affiliated but it is not an essential part of the saṃprāpti.
a. Ākṣepaka (convulsions), ārdita (facial palsy/paralysis) etc. are vātaja
b. Oṣa (burning), coṣa (sucked dry by heat/inflammation) are pittaj
c. Gurūgātratā (heaviness) is kaphaja.
There are a total of 80 nānātmaja vāta vyādhi, 40 nānātmaja pittaja vyādhi, 20 nanātmaja kaphaja vyādhi.
Of all these, vāta being the driving force, being unpredictable and being very āśu (fast), the vyādhi that it creates are of a more serious and harsh nature than nānātmaja pittaja or kaphaja vyādhi. Depending upon the various dūṣya (dhātu/organs) locations they form up 80 different vyādhi that need special mention and individually different cikitsā.
Prākṛt vāyu : nature, functions.
Prākṛt or normal vāta is responsible for the utpatti (formation), dhāraṇa (holding or preservation) and vināśā (death)… all of these being a part of the normal life cycle. This vāta bcoming vikṛta can cause multiple abnormalities in the body and the life cycle.
It is formed as mala at the time of sthūla pacana, as a kiṭṭa (mala). It is excreted out of the body after its contribution to the ‘metabolism’ in the body.
Pañcātmā vāyu koṣṭhe prādurbhavati…
All five sub-types viz. prāṇa, udāna, vyāna, samāna, apāna find themselves ‘nutrited’/supported by this koṣṭhastha vāta – the apāna vāyu.
Synonyms for vāta: maruta, mārutaḥ, anila, pavana, samīra, prabhañjana, śwasana.
Mahābhūta involvement:
Vayvākāśa dhātubhyaṃ vāyoḥ… A.S.Su.20.
Guṇa:
Tatra rukṣo laghuḥ śītaḥ kharaḥ sūkṣmascalo anilaḥ…
A.H.Su.1
Other guṇa: Dāruṇa (harsh/severe/cruel), bahu-śighra, rajo-bahula, an-avasthitatva (constantly moving).
Vātaguṇeśu sarvam raukṣam pradhānam…
· Rukṣa guṇa most dominant guṇa…
Yogavāhaḥ param vāyuḥ saṃyogād ubhayārthakṛt
Dāhakṛt tejasā yuktaḥ śītakṛt somasaṅsrayāt…
Ca.cikitsā.3
· Yogavāhi
Vātaḥ rajoguṇabahulaḥ…
· Rajo guṇa dominant
Karma:
· Vāyustantra (doctrine/system) yantra (instrument/machine) dharāḥ (manifestation)…
· prānodāna-samāna-vyāna-apānātmā
· pravartakaś cesṭānām uccāvacānām
· niyantā praṇeta ca manasaḥ
· sarvendriyāṇām udyojakaḥ
· sarvendriyarthānām abhivoḍhā
· sarva śarīra dhātu vyūhakarāḥ
· sandhānakaraḥ śarīrasya
· pravartako vacaḥ prakṛtiḥ sparśa śabdayoḥ
· śrotra sparśanayormūlam harṣotsāhayoryoniḥ
· samiraṇo agneḥ
· doṣa saṃśoṣaṇāḥ
· kṣeptā bahirmalānām
· sthūlāṇu srotasām bhettā
· kartā garbhākṛtīnām
· āyuṣo anuvṛtti pratyayabhūto (gives the assurance/conviction of life through its various actions) … bhavati akūpitaḥ… Caraka sūtrasthāna 12
Sthāna:
Pakvāśaya kaṭī sakthi śrotrāsthi sparśanendriyaṃ
Sthānam vātasya tatrāpi pakvādhānam viśeṣataḥ… A.H.Su.12
Lower part of body, lower part of koṣṭha, prāyaḥ fag end of any process…
Types based on sthāna and karma bheda. Each sub-type has its specified location and karma and will act as per specific guṇa expected in that location/ function.
Eg. Samāna in jaṭḥara, samiraṇo agneḥ…
Apāna in pakvāśaya, mala-mutra-garbha niśkramaṇaḥ kriya...
Prāṇa:
Sthānam prāṇasya śīrṣo uraḥkaṇṭha jihvāsya nāsikā… Ca.Ci.28
Prāṇo atra mūrdhagaḥ
Uraḥ kaṇṭha caro buddhi hṛdayendriya citta dhṛuk
Ṣṭhīvana kṣavathūdgāra niśwāsānna praveśakṛt… A.H.Su.12
Here ṣṭhīvana and kṣavathū although outward directed are aimed at keeping the swasana and anna marga clear and helping proper movement of prāṇa and so fall under the action of prāna (& not udāna).
Grahaṇa of śwāsa, food, water, sensations…
Hṛdaya-site of mānas – indriya-buddhi therefore in the process of jñāna-grahaṇa…
Hence yoga (breathing, not only postures) helps to control the senses… yogascittavṛtti nirodhaḥ… mainly making available ākāśa (space).
Udāna:
Udāno nāma yastūrdhwamupaiti pavanottamaḥ… Su.Nidāna.1
Uraḥsthānam udānasya nāsā-nābhi-galaṅscaret
Vākpravṛtti prayatna ūrjā bala varṇa smṛti kriyāh… A.H.Su.12/6
Karma:
Vākpravṛtti starts from the nabhi and is expressed through the jihvā.
Smṛti – bringing back from the storage to the mind and then expression.
Samāna :
Samāno agni samīpasthaḥ koṣṭhe carati sarvataḥ
Annaṃ gṛhṇāti pacati vivecayati muñcati… A.H.Su.12
Swedasrotāmbu vāhīni samādhiṣṭitaḥ
Antaragnesca pārśwasthaḥ samāno agnibalapradā… Ca.Ci.28
Since it is the vāyu directly connected to pacana, it is the vāyu that aids the various dhatuagni also…
Vyāna:
Vyāno hṛdisthitaḥ kṛtsna-deha-cāri mahajavāḥ
Gati apakṣepaṇa-utkṣepaṇa unmeṣa-nimeṣadikāḥ
Prāyaḥ sarvāḥ kriyāḥ tasmin pratibaddhāḥ śarīriṇām… A.H.Su.12
Transfer of prāna and nutrition to all dhātu…
All different movements of various organs and structures in the body…
Apāna:
Apāno apānagaḥ śroni basti meḍhra ūru gocaraḥ
Śukrārtava śakṛun mūtra garbha niṣkramaṇakriyāḥ... A.H.Su.12
The supporter or ‘provider’ of all other vāta types.
The word apāna also means guda/anus.
Important to understand the different sites, functions and direction of normal movement of vāta so that any change in these that can lead to disease can be identified and corrected whenever and wherever possible.
· Since kapha and pitta are pangu (invalid) without vāta, it is most important of all doṣa
· It is responsible for state of health or disease…
· Āyu - life is a movement in time… vāta.
All the guṇa of vāta viz. rukṣa, laghu, śīta, khara, sukṣma, cala are present in all the sub types… they are an indivisible or ir-reducible properties of vāta. But thinking of these comparatively, in terms of their tara-tama bhāva…
Sukṣma, cala, śīta, rukṣa, khara are respectively specific to prāṇa, vyāna, udāna, samāna and apana…
Hetu:
Rukṣa sīta alpa laghu anna vyvāya ati prajāgaraiḥ
Viṣamād upacārāsca doṣa asṛga sravaṇād api
Langhana plavan ati-adhwa vyāyāmāt ativiceṣṭitaiḥ
Dhātunāṃ saṇ-ksayāt cintā-śoka-rogāti karṣaṇāt
Dukha-śayyāsanāt krodhāt divāswapnāt bhayādapi
Vega-saṇdhāraṇād āmād abhighātād abhojanāt
Marmāghātād gaja-oṣtra-aśwa śīghra yānavatansanāt… Caraka cikitsā 28.
From the above list it is obvious that the hetu can be categorised into 2 main categories:
1. hetu responsible for dhātu kṣaya
2. hetu responsible for marga avarodha.
Vāyoḥ dhātukṣayāt kopo margasyāvaranen vā… Ca.Ci. 28
Mārgavarodha janya – also called upastambhit (blocked by a pillar)…
Dhātukṣaya janya – also called nir-upastambhita.
Treatment of these 2 types is nearly opposite in nature. Therefore understanding these 2 types distinctly is important.
Saṃprāpti – Upastambhita vāta vyādhi:
Mandāgni à āma OR vāta prakopa hetu à prakūpita vāta (esp with śīta guṇa) blocking srotas à movement of vāta blocked à vāta vimargaga à ama/vāyu making sthāna-saṇsraya in weak srotas à vāta vyādhi.
Saṃprāpti – Nir upastambhita vāta vyādhi:
Hetu like poor nutrition etc. or āghāta etc (traumatic/ debilitating/ degenerative) hetu that reduces the strength of dhātu causing rikta (empty) sthāna à vāta prakopa à increase in rukṣa (dry), paruṣa (harsh, stiff) and khara (rough) guṇa à vāyu pūraṇa in rikta sthāna à increased dhātu kṣaya à vāta vyādhi.
Pūrvarūpa:
ṣaṇa for vāta vyādhi.
Ātmarūpam tu yad vyaktam apāyo laghutā punaḥ… Ca.ci.28
According to any vyādhi the signs/symptoms that are obvious and clear are called rūpa or lakṣaṇa. When they are expressed very weakly they are called pūrvarūpa. As the nature of vāta is aniyamita or anischita (uncontrollable/unpredictable), the lakṣaṇa or rūpa are exhibited when the vāta vyādhi is in vega avasthā and diminish when in avegāvasthā. So one sees diminished or weak exhibition of symptoms is pūrva rūpa.
Since these diminish in avegāvasthā… and increase in vegāvasthā… having vega and avega – avasthā is a sāmanya lakṣaṇa of vāta vyādhi.
Samānya rūpa or lakṣaṇa (common symptoms of all vāta vyādhi):
· sañkoca parvaṇām stambho
· bhedo asthnām parvaṇām api
· lomaharṣaḥ
· pralāp
· pāṇi pṛṣṭhaḥ sirograhaḥ
· khañja (limp) pāngulya (disabled) kubjatvam (hump back/ crooked)
· śoṣo añgānām anidratā
· garbha śukra rajo nāśaaḥ
· spandanam gātrasūptatā
· śiro-nāsā-akṣi-jatruṇām grīvayaschāpi huṇḍanam/ vakratā
· bheda toda ārdita ākṣepo moha āyāsa eva ca
· evam vividhāni rūpāṇi karti kūpito anilaḥ… hetu-sthāna viśeṣāscha bhaved roga viśeṣakṛta… Ca.Ci.28
Cikitsā:
Vātasya upakramaḥ snehaḥ swedaḥ saṃśodhanaṃ mṛdu
Swādu amla lavaṇoṣṇāni bhojyani, abhyanga mardanam
Veṣṭanam trāsanam seko madyam paiṣṭikagaudikam
Snigdhoṣṇā bastayo bastiniyamaḥ sukhaśīlatā
Dīpanaiḥ pācanaiḥ siddhaḥ-snehasca-aneka-yonayaḥ
Viśeṣān medhya piśita-rasa tailānuvāsanam… A.H.Sutra 13.
Vāgbhaṭa in Aṣṭānga Hṛdaya gives the various cikitsa for vāta and one sees that there are cikitsā types that seem to be quite opposite in nature. Eg.–
veṣṭana-trāsana vs. sukhaśīlatā
saṃśodhanaṃ vs. anuvāsanam
This implies 2 kinds of vāta vyādhi. So one would need to make a precise diagnosis about the patients condition, whether it is a upastambhita or dhātu-kṣaya-janya saṃprāpti before deciding on the cikitsā.
Cikitsā to remove avarodha / Cikitsā that is dhātu-vṛddhikara
Kaṭu, tikta rasa / Madhura, amla, lavaṇa rasa
Kaṭu vipaki, Uṣṇa vīrya / Madhura vipāki, sometimes even śīta-vīryatmak
Laghu, srotas śodhan / Guru, balya
Rukṣa dravya āsthāpan basti / Anuvāsan basti
Many a times, in practice one notices, that the vyādhi starts with a margavarodhjanya saṃprāpti. Obviously it has to be treated as such. Once the avarodha has been removed, one has to make sure that the avarodha does not occur again. Simultaneously, if the avarodha has been for a long time, there is bound to be udarka of dhātu-kṣaya origin. All these have to be treated and this part of the treatment, is really testing… and brings out the best in the vaidya.
Cikitsā for dhātu kṣaya janya vāta vyādhi (nirupastambhita vāyu):
· Snehan cikitsā most important; snehan by various ways – abhyantara, bāhya – abhyanga, snehapāna, śirobasti/dhāra/picu, anuvāsan basti…
· Any sneha in this dhāu kṣaya condition does not act directly on the vāta. It acts on the site of kha-vaigunya. There is an increased rukṣa (dry), paruṣa (harsh, stiff) and khara (rough) guṇa leading to vāyu pūraṇa in rikta sthāna. Snehan causes snigdhatā, slkṣṇatā and mṛdutā in the dhātu. Obviously the vāta that has come to ‘reside’ in the rikta srotas leaves the place and becomes anuloma.
· Depending on the vyādhi – sneha can be selected from the 4 sneha – ghṛta, taila, vasā, majjā.
· Choice of herbs/dravya for siddhi of this sneha will also depend on vyādhi eg. Lākṣā, udid, māmsa rasa for māmsa gata conditions etc.
Generally,
· Taila – (Sesame oil by default) – is best for vāta – excellent vātaghna. Its sroto-gāmitva may need to be increased for its ‘percolating’ to the gambhira dhātu. For this, taila siddhi with related herbs once or multiple times as per requirement.
· Diet of dugdha, māmsa rasa, yuṣa, ‘khichadi’ with ghṛta etc to be given.
· Then swedan to be given using nādi bāṣpa and other means.
· Snehan swedan helps restore the various dhātu to their original condition; reducing their dryness and restoring saṃhanan and bala (strength); improves bala, agni, prāna and overall the dhāraṇā shakti.
· Anuvāsan basti with balā taila, nārayaṇ taila, dugdha / siddha kṣīra basti, māmsa rasa basti etc fruitful.
· Dravya preferably madhura, amla, lavaṇa rasa, guru, balya, even śita vīrya.. eg. Bala, aśwagandhā, śatāvari, māṣa, kuṣmāṇḍa…
· Abhrak, loha, rajat, suvarṇa bhasma containing meds like mahāyogaraj guggulu, vasant kusumākar, hemagarbha pottali rasa etc with anupān of ghṛta+sītā (candy sugar) or milk.
· Sukhaśīlatā – patient should be made to relax the patient, reduce stress, anxiety; avoiding vyavāya; generally follow hemanta ṛtucarya.
Cikitsā for mārgāvarodh janya vāta vyādhi (upastambhita vāyu)
· Cikitsā that reduces srotorodha.
· Dīpana, pācana, rukṣa, an-abhiṣyandi, lekhan, ūṣṇa dravya.
· Kaṭu – tikta rasātmak, kaṭu vipāki.
· Snehan to be avoided. Snehan with kaṭu vīpaki substances is rarely used.
· Swedana is important cikitsā – preferably rūkṣa sweda which reduces the avarodha, making vāta anuloma.
· Mṛdu anuloman.
· Various nirūha basti.
· Guggulu kalpanā important. Guggulu itself kaṭu-tikta, kaṭu, ūṣṇa, lekhana; yogavāhi.
· Eg. Triphalā guggulu, triphala+trikaṭu guggulu, yogaraj guggulu, rāsnādi guggulu, sinhanāda guggulu, kaiśora guggulu…
· Rāsnā, guḍuci, eranḍa-mūla, rason, hingu, kāraskara, daśa-mūla, bhallātaka…
· Maharāsnādi kwāth, daśamūla kwāth, daśamūlāriśṭa, bhallātakāsava, laśūnādi vaṭi, āmapācak vāti, ekānga-vīra rasa…
· Rare snehana with viṣa-garbha taila, sahacara taila… taila which is siddha with ūṣṇa, tīkṣṇa, viṣa (vyavāyi-vikāsi) dravya…
· Anupāna of hot water or honey… yogavāhi, lekhana, srotośodhana…
· Laghu āhāra, preferably drava (liquid), ūṣṇa; cooked with dīpana-pācana dravya like laśūna, ārdraka, jīraka, hingu…
· Vyāyama (exercise)…
Above was sāmānya (generalised) line of treatment for different types of vāta vyādhi…
Depending on sthāna saṃśraya, taking into account the different sub-type of vāta that is affected, specific cikitsā is decided.
· Udānam yojayet ūrdhwam… vamana, nasya
· Apānam cānulomayet… basti, virecana
· Samānam śamayet ca eva… śamana meds
· Tridhā vyānam tu yojayet… all above as per requirement
· Prāṇo rakṣaḥ caturbhyao api… protect prāṇa even at the cost of overlooking other vāyu
· Sthāne hi asya sthitiḥ dhruvā swa-sthānam gamayed evam vṛtānetān vimārgagān… understanding the location treat so that the vāyu goes back to its normal state/location. … Ca.Ci.28
Koṣṭhagata vāta
Tatra koṣṭhāśrite duṣṭe nigraho mutra varcarsoḥ
Bradhna hṛdroga gulma arṣaḥ pārśwaśulaṃ ca mārute…
Koṣṭha would mean area of grahani.
Tīvra udaraśūla, ādhmāna, mala-mūtra saṇga
Hṛdroga, gulma, arśa, pārśwa śūla as upadrava
Cikitsā:
Anuloman with erand sneha and śuṇthi fāṇṭa
Anuvāsan
Snehan swedan or udara pradeśa
Hingu lepa on udara
Śankhavaṭi, laśūnādi vaṭi…
Māmsa/medogata vāta
Gurvangaṃ tudyate atyarthaṃ daṇḍa-muṣṭi hatam yathā
Sa-ruk śwasitam atyartham māmsa-medo gate anile…
Sarvānga gaurav, feeling of being hit by sticks or being boxed…
All movements painful…
Sarvānga marda…
Similar lakṣaṇa in māṃsa and medo gata vāta… weakness, heaviness more in medogata; pain more in māmsagata
Cikitsā:
Swedan, vātānuloman…
Māmsagata – snehan, swedan, mṛdu virecana…
Viṣagarbha taila snehan with tāpa sweda…
Āmapācak vaṭi, daśamūlāriṣṭa, triphalā guggulu…
Medogata – Śilājatu, guggul kalpa
Chandraprabha, triphalā guggulu, daśamūlāriṣṭa…
Gṛdhrasī
Sphikpūrvākaṭi-pṛṣṭho rujānu jañghā padam kramāt
Gṛdhrasīḥ stambha ruk todaiḥ gṛhṇāti spandate muhuḥ
Vātād vāta-kaphād tandrā gaurava arocakānvitā… Ca.Ci.28
· Patient walks with more pressure on one foot… like a gṛdhra (vulture)…
· Vāta prakopa à sthāna saṃśraya in sphika, kaṭi… that advances to lower back, thighs, pinḍikā and eventually till the foot…