Purishaja Anaha Disease Review

Transcription

1 Purishaja Anaha Disease Review Ethymological Derivation Purishaja Anaha term consists of two words Purishaja and Anaha. Ja pratyaya means originatiing from; so word purishaja means caused by, originated from purisha. Anaha : Word Anaha is derived from verbal root nah with aa upasrga. Nah dhatu belongs to 4 th gana and operates in both parasmai pada as well aatmane pada. - + () = Important meanings of word Naha are 1.! 2. #$% $&' ( 3. *+,$ 4../ Aa upasarga has various meanings important among them are 1. 0$ % 3.. In this case considering meaning of Aa as asamantat word anaha gives meaning as Meaning of word Anaha In Ayurveda : 0$ / :;$3< / / =>?@ 0&0Ạ 03. B/DEE Word aadi (etc) includes obstruction due to adhovata (flatus) and any other factors which may cause obstruction for normal passage of urine, faecal matter and flatus. Purishaja Anaha 157

2 Thus the meaning of phrase Purishaja anaha is obstruction caused to excretion of malas or distension of abdomen caused by accumulation of faecal matter leading to difficulty for normal excretion of urine, flatus and faecal matter from human body. Thus depending on this anaha can be primarily of three types in which causes for normal movement of excretory products outside human body may be urine, flatus and faecal matter. Exceptional condotions where other pathological reasons may be responsible for it include ama, gulma, mudhagarbha, arsha and so on. How so ever in case of mutra, purisha and adhovata their excretion is carried out. Apana vata and vitiation in any of these leads to similar effect on remaining two. One example of each of these types from classics is given bellow. 1. $3<F (In context of mutra vega rodha ) #.0Ạ03E/G 2. $F (In context of visuchika chikitsa ) 0&.0Ạ.2ABG HI-HD 3. &.JF (In context of visuchika chikitsa ) 0&.0Ạ 2ABG HI-HD 4. :K/ (In context of listing nanatmaja vatavyadhi ) #.0Ạ03HI/DD Thus there can be inumerous types of anaha dependng on factor causing obstruction. Anaha a Vriddhi or a Sanga? Word anaha has two important meanings 1. Vriddhi 2. Sanga Prima facially it may seem that these are different and in Ayurveda both of them are accepted by different acharyas. For example Sushruta Samhita explains that nichaya (sanga) of purisha or ama leads to anaha whereas Charaka Samhita explains it under ekadeshiya shotha which is nothing but vriddhi. If carefully studied it is evident that both these phenomena are interrelated and not distinct; but it is just the contexts in which these are explained has made this apperent difference. Charaka samhita explains it under eka deshiya shotha in Trishophiya adhyaya. L :2/ &.2/ &.M$.N.2O.2 98 PF.2 Q3R%$SL F2 # 0A03DT/UH Purishaja Anaha 158

3 Anaha a Disease or a Symptom? Anaha can manifest as a symptom associated with some other diseases as well as separate independent disease. If it is a symptom then at some stage of samprapti in main disease obstruction is caused to normal flow of mala, mutra & adhovata. In most of cases when it manifests as symptom; it does not need separate chikitsa upakrama and treatment of pradhana vyadhi itself pacifies anaha. In some diseases anaha can also be manifested as purvarupa in this case it can be a warning symptom as well as initial stage of samprapti which hints of sanga and vimargagamana in koshtha. Let us consider one example V3A2L WX@= YZJ8[.2/ / \%8/ ]3^A :_LA:L # 0&0A 2ABD/G Anaha as Purvarupa : In shwasa vyadhi it is vigunata and vimargagamana (urdhwagamana/pratilomata) of vayu which is cause for manifestation of Anaha as purvarupa as mentioned in shwasa samprapti..: `.2A:&/ 8[a b0a&2/ \03R%8 3c 2A\0A.#M2 0&0A 2ABD / - -8 :&/, `.2A.:.:&8 3ca%/, er%8 3c 2a b0a&2/ 0 \ =>?@ Anaha as Upadrava : Anaha may also manifest as upadrava or arishta lakshana. One example for Anaha as upadrava is Wf8A\0$A $8A # Fg`]$ # 0A.# U/DT If vamana is given to a patient in avastha of anupasthita dosha then these upadravas are seen. Unless and untill upadrava is balawana and causes threat to life it does not need any specific treatment. It pacifies on treatment of pradhana vyadhi. Anaha as Arishta: Anaha is mentioned in many arishta conditions also, but in most of conditions it is a part of a big group of symptoms which require different perhaps opposite treatment modalities (viruddha upakrama) which is reason for asadhyata. h.20h $2+ i %^A $ # 0A5Ȧ G/T Purishaja Anaha 159

4 Purishaja Anaha : $A]`Z..#2Aj$ 38.: (A.:&.^ :2%$A ak$a.:$$&.1 0&0A 2ABD/HI-HD 5l.:03.#2&,.#..m2c.Z03.#8f:cn&Y$Q$- $.$. ]`2 &@JA,..#2A :`.(2A,.: ($ 7:(A,.:&.^ o%:&, :2%$.$.2 9/:2%$.$a%/, aka a$%.$a%/;..#2a ]`.:&.^.: (A 02 k$q[:2%$a ]`Z r:s32$a.:$&1@.2.;=a%/.#$.$.2 ]`.Z]JA $t1; 2u, 0$2v $QL.]%2c2 =>?@ Excessive deposition/accumulation of faecal matter which is obstructed because of vimargaga vata (which changes its normal course of anulomana/downward direction to pratiloma/upward direction) disturbing its normal process of excretion of purisha. Some authors say that word ama is adjective of purisha but it is not accepted by Dalhana and he says that these are two different types of anaha. One caused due to ama and other caused due to purisha. Further to support his claim excerptions from other texts are also quoted. Lakshanas of Purishaja anaha : Ss/?@Ò&@J$3<]3^8[a $3w%0 ]`Z$n \0h x]f :.1.^y. #<^08g:. 0&0A 2ABD/HH-HU &@JF^M$- Ss 5. Ss]z/ {.. $3%<1_/ 0 A 0 42 ]3^8[Q< {.}: 0 &J/ x]f 5a%/ $/ j8].1 5.2:i#2 x]]z< &@J$. 2A, 7a #, x] :.2.#2 x]fx]* 5.2 ƒ.1 2# x]8g32 / &@Jg:.2 52@w.1; 2a[. 0 3: Y r:.b.^2a%/ =>?@ Lakshanas of purishaja anaha are as follows 1. Kati stambha 2. Kati shula 3. Prishtha shula 4. Prishtha Stambha 5. Sashula mutra pravritti 6. Sashula mala pravritti 7. Murcchha Purishaja Anaha 160

5 8. Shwasa 9. Purisha gandhi vamana And other symptoms of alasaka such as Lakshanas of Alasaka : &.M2[a 2.2.:3F.2.(8 $2h. &M+.:.9:.2 :2:#.89h &M+ L `]A :2 2L^0$# 2`ˆ8 :89+ 0&0A 2ABD/E-T 7^0^M$- &.M.. &.M/ $ 2Š&Y8 :.2 7a%$.2]Aa 2a 2.2 2$.0.:]2@:.:3F.2 7 Y]zA8.2.:.9:.2.:]J 0$1 w.2 1. Abdominal distension 2. Tama pravesha 3. Obstruction to normal flow of adhovata 4. Rumbling noise (in the intestines), and the upward coursing of the vata 5. Feeling of movements of flatus in abdomen 6. Absolute suppression of stool and flatus, 7. Excessive pain in and stuffiness of the abdomen, 8. Vayu incarcerated in the abdomen making a croaking rumbling 9. Obstructed Hiccoughs 10. Obstructed Eructations Sadhyasadhyatva : S&]`Z$ L $A F2, 2a 004c..2 :/ =>?@ =>?@ Patients having vamana of shakrit are asadhya and hence should not be treated. Practically vamana of faecal matter is an extreme condition and vomitus of having colour or smell of faecal matter is to be considered under asadhya category. Chikitsa of Purishaja Anaha : 7a2A 8 ]`Z$ $$AF2 k#_h 0&0A 2ABD/H 'k#@_/' 5< #.2%&;=/ 'k a.:9a' 5.2.Žc ƒ.2- k k.c, 0%^82 09&; a.:9.$.2.:;$3<&^8$.:9 Two important upakramas explained by Acharyas are =>?@ 1. Swedana 2. Pachana Purishaja Anaha 161

6 Dalhana comment on this as anulomana is to be included in the treatment of anaha. Swedana and pachana are explained as upakramas but one thing to be noted that this shloka is in continuation of amaja anaha chikitsa. A school of thought also opines that this is second stage in chikitsa of amaja anaha. It is well known that amaja anaha will invariably have agni dushti at initial stage of samprapti whereas in purishaja anaha it will be on a later stage. Thus treatment of purishaja anaha first should aim at expulsion of purisha, mutra etc which are very cause of anaha and then side by side should also correct agni vitiation if present any. Thus swedana may provide sadya/quick relief but it will not be enough for complete cure. Samprapti vighatana must be done in light of the causative factors. Breaking the bonds of mala which are formed in with intestinal walls is the first line of treatment. Expelling the accumulated purisha, mutradi is second line of treatment. Increasing the agni so as to break continuation of samprapti by virtue of increasing digestion is third step necessary for apunarbhava. Considering the definition of anulomana, it becomes evident that it is the treatment modality which suits best for management of purishaja anaha. Anulomana Karma : Anulomana karma has been defined as `c A $^A.gc!$98 2 2n&^8$A ].0Ạ3.'Ạ/ Actions coming under anulomana are 1. Paka of malas 2. Bandha bhedana 3. Adho nayana of malas Paka of malas : One point which needs to be understood in proper is Sharangadhara has used the word malas in plural and not in singular. It should include mala, mutra and adho vata all the three then and then use of plural can be justified. Paka of mala is well formation in other words it is proper sara kitta vibhajana. Kitta remains in brihad antra where as sara is absorbed in sharira which is called as vivechana of malas. It is karma of katu avasthapaka in sharira. Shoshana is karma associated with ruksha and ushna gunas. Paka invariably will be associated with ushna guna. Purishaja Anaha 162

7 Bandha bhedana: Sneha amsha of mala when increases its normal proportion then it causes bandha between koshtha and malas, because of these bandhas normal anuloma gati of malas is obstructed, they accumulate in intestines. To break these bonds again opposite guna of snigdha is to be administered. This snigdha guna will be associated with increased jala mahabhuta which will be reduced by ushna guna. Kashaya rasa will be a good option in this treatment as it will be leading to katu vipaka. Picchila guna which is present in avipakva mala leads to adhesions between antra and mala. Samyak paka of mala removes excess snigdha guna, brings its normal consistency, gandha and varna. Adho nayana of malas: Anulomana gati of vata dosha is responsible for expulsion of malas which has been explained as M.$%^$ ---- #. 0Ạ 03. DH/T Among the types of vata dosha, this area comes under apana karya kshetra. Thus apana vaigunya is mainly responsible for this obstruction to normal gati of malas. Drug which has vatanulomana and vata shamana effect will useful in this condition. In contemporary system of modern medicine, Gastro - intestinal physiology is in divided in three main phases which are digestion, fluid mechanics and motility which is also taken in consideration and all of them can be corrected as explained in definition of anulomana by Sharangadhara. Haritaki has been explained as example of anulomana. It has been also quoted as the best pathya drug. Thus taking these points in mind anulomana was selected as treatment modality and Haritaki was selected as trial drug. Purishaja Anaha 163