A A M J Anveshana Ayurveda Medical Journal

Transcription

1 A A M J Anveshana Ayurveda Medical Journal ISSN: Review Article Concept Analysis : Swedana in Manyāstambha Soumya Jacob 1 Anandaraman P.V 2 Parameswaran Namboothiri 3 Prathibha C.K 4 A b s t r a c t Manyāstambha (Stiff Neck) is a Vātavyādhi where neck movements are restricted. The other Lakśanas of this disease includes Ruk, Stambha, Śopha and Cheśtastambha. It can occur as a result of Dhātu Kśaya and as due to Āvaranaja. The line of treatment of both these conditions is different. The main treatment includes Snehana and Swedana. Swedana therapy has a special role in this disease. Swedana which has Tīkśna and Uśna property has its main action like Stambaghna, Gauravaghna, Śītaghna which are quite opposite to the Lakśanas of this disease. Snigdha Sweda can be done in Dhātu Kśayaja Manyāstambha whereas in Āvaranaja Vikāra, Rūkśa Sweda is done. Key words: Manyāstambha, Rūkśa Sweda, Snigdha Sweda, Āvarana, Cervical Spondylitis. 1 PG Scholar, 2, 3 & 4 Associate Professor, Department of PG Studies in Panchakarma, Amrita School of Ayurveda, Kollam. CORRESPONDING AUTHOR Dr. PRATHIBHA C.K Associate Professor, Department of PG Studies in Panchakarma, Amrita School of Ayurveda, Kollam, Kerala. drprathibhack@gmail.com AAMJ / Vol. 2 / Issue 3 / May June 2016

2 INTRODUCTION In the current era, human beings are prone to get many neck related problems because of unwholesome lifestyles, food habits, due to stress and nature of work. Improper sitting postures and continuous work create undue pressure and stress that causes injury to cervical spine which may play an important role in producing diseases like cervical spondylosis, cervical radiculopathy, cervical spondylitis etc. The signs and symptoms seen in these diseases i.e. pain and stiffness in the neck can be correlated to the disease Manyāstambha explained in Ayurvedic classics. MANYĀSTAMBHA Manyāstambha is derived from two words- Manyā and Stambha. Manyā means back of the neck i. Stambha relays the meaning of stopping or retarding the function ii. It is one of the Vātaja Nānātmaja Vikāra, where neck movements are restricted iii. It can also occur due to Kaphāvarana iv. CAUSATIVE FACTORS As the Manyāstambha is a Vāta predominant Vyādhi, the general Vātavyādhi Nidāna v can be considered here. Āhāraja Nidānas include excessive and continuous intake of food having Rūkśa, Śīta property, excessive intake of food processing pungent, astringent and bitter taste, Irregular food habits, after digestion of food. Viharaja Nidānas include Rātri jāgarana, excessive walking, excessive swimming, excessive riding on horses and vehicles, excessive coitus, weight lifting, excessive exercises and suppression of urges. Other Kapha Prakopa factors which may contribute to the Āvarana pathology are excessive and continuous usage of Sweet, acidic, salty, cold and heavy food articles, soon after taking food, Day sleep, excessive sleep, suppression of Vomiting and Sitting for long periods. The specific Nidānas which are mentioned in classics is sleeping at daytime, sitting on irregular postures, constantly gazing upwards vi etc. The disease Manyāstambha can occur as a symptom and also as a disease. As a symptom, it can occur as a result of Śiro Abhighāta vii, as a symptom of Antarāyāma viii, due to Pīnasa Vegadhārana ix and as a symptom of Ardita x. SIGNS AND SYMPTOMS One of the Pratyātma Lakśana of Manyāstambha is Stambha xi. It is a Urdhwajatrugata Vikāra in which Vāta gets Āvrutha by Kapha xii. As no specific Lakśana are mentioned in classics, Kaphāvruta Vāta Lakśanas can be adopted here. The Kaphāvrutha Vāta Lakśanas include Śītata, Śopha, Gaurava, Ruk and Cheśthastambha xiii. PATHOLOGY Manyāstambha being the Vāta predominant diseases, its pathology can be represented in two ways, Dhātu Kśayaja and Āvaranaja In Dhātu Kśayaja condition, due to Vāta aggravating factors, Vāta gets vitiated and get localized in Manyā Pradeśa (back of the neck) affecting the Manyā Siras and produces symptoms. In Āvaranaja Vikāra, due to the Vāta Prakopa and Kapha Prakopa Nidānas, Vāta Dośa along with Kapha Dośa gets vitiated and takes Asraya at Sira and Snayu of Manyā Pradeśa and produces Lakśanas. Cervical Pathologies and Manyāstambha In many research papers, the disease Manyāstambha is compared with conditions like cervical spondylosis, cervical spondylitis, Torticollis and stiff neck. In cervical spondylosis, aching pain, Neck stiffness, and limitation of movements are the signs and symptoms seen which are compared to symptoms of Manyāstambha as Ruk, Stambha, and Cheśta Stambha xiv. In cervical Spondylitis, neck pain, neck stiffness, swelling are seen which are compared with the Lakśanas of Manyāstambha xv. Spasmodic torticollis xvi in which the head becomes persistently turned to one side, associated with muscle spasm xvii is also taken as Manyāstambha which is presented with Stambha and cheśta Hani. Due to its predominant symptom Stiff neck is also compared as Manyāstambha. xviii MANAGEMENT The general line of treatment of Manyāstambha is intake of Panchamūla or Daśamūla Kwatha, administration of Rukśa Sweda and Nasya xix. Sushrutacharya mentions Vamana karma as a major treatment procedure to be adopted here xx. Among these therapeutic procedures, Swedana has the main role in treating this disease. AAMJ / Vol. 2 / Issue 3 / May June

3 Based on the pathology explained earlier, the line of treatment of the disease needs to be differentiated. Role of Swedana in Manyāstambha Swedana is one among Śadupakrama and Langhana therapy xxi. Swedana Karma is indicated in Vātaja and Vāta Kaphaja disorders; hence, it is an apt treatment in Manyāsthambha. In Vātaja Manyāstambha, Snigdha Sweda is adopted. In Vāta Kaphaja Manyāstambha, to break Kaphāvarana Rūkśa Sweda is to be adopted in case of symptoms like heaviness and swelling in the neck region. Later when the condition becomes purely Vāta one can adopt Snehana. Snigdha Sweda Śaśtika Śāli Pinda Sweda, Patrapotali Sweda, Jambīra Pinda Sweda, Manyā Basti are some of the commonly used Snigdha Sweda in practice as treatments in Manyā Stambha. Snigdha varieties of Sweda have a special effect in managing the Vāta Pradhana and DhātuKśayajanya Manyāstambha. Śaśtika Śāli Pinda Sweda Śaśtika rice is Guru, Śīta, Snigdha and Brhmana in property and its Sweda relieves Stambha, Sankocha and Śūla of Manyā region. It is also a unique procedure which may improve the strength of fibrous tissue, increase movement and flexibility of the joint and relieves the pain. Śaśtik Śāli Pinda Sweda can provide a long lasting effect in relieving the stiffness and spasm of muscles and can increase the lateral bending of the cervical spine xxii. Patrapotali Sweda Here medicinal leaves used for Patrapotali Sweda are of Vāta hara in property, which relieves Sūla, Stambha of the neck. Patrapotali Sweda does provide improvements in stiffness, pain, tenderness in cervical spondylosis, but its role in improving the neurological deficits are limited xxiii. Manyā Basti It is a kind of Bāhya Sneha Swedana procedure. Snehana mainly acts against Rukśa Guna caused by Vāta and Swedana mainly act against Śīta Guna. Wadhwa Ritu et. al. opine that this procedure can cause a reduction in inflammation and spasm, thus reducing the pain and stiffness of the neck xxiv. Rukśa Sweda Rukśa Sweda is done in Āvaranaja Manyāstambha. Rukśana is an ideal treatment to break Kaphāvarana xxv. It is mainly done in Vāta Kapha Predominant condition. Common Rukśa Swedas adopted are Rukśa Chūrna Pinda Sweda, Valuka Sweda, Nadi Sweda, Tuśa Pinda Sweda etc. Rukśa Chūrna Pinda Sweda The drugs used in this Sweda include Gokhara, Karīśa, Yava, Kulatha, Daśamūla xxvi etc. which has Vāta Kaphahara property. A clinical study conducted on Rūkśa Sweda done with Kolakulathadi Chūrna reported that it could relieve pain, stiffness, extension and lateral flexion of the neck in Manyāstambha xxvii. Study conducted to evaluate the effect of Kārpāsabījadi Chūrnapinda Sweda in cervical spondylosis, has shown betterment in pain, stiffness, headache, numbness, movements of the neck after 7 days of treatment xxviii. Nādi Sweda Most of the drugs used in Nādi Sweda are VātaKaphahara and Śulanāśaka. Bharti, Shveta Katyal et.al conducted a study on clinical observations on Grīvāstambha Chikitsa. The objective of this study was to observe the effect of Nādi Sweda along with MahāYogarja Guggulu and Panchaguna Taila. Here Nādi Sweda was with Daśamūla Kwātha. The results showed that by giving steam, the spasm of the muscle and pain in the neck relieves. They concluded that reduction in inflammation and spasm facilitates better blood supply and improved nerve conduction xxix. DISCUSSION MODE OF ACTION OF SWEDANA Sedative effect The sedative effect produced relieves the pain in the area. This may be because of the increased blood supply which produces removal of waste products hence getting good nourishment xxx. Heat is also a counter-irritant i.e. the thermal stimulus may affect the pain sensation as explained in pain gate theory of Melzack and Wall xxxi. This explains the effect of heat applied on the nerves. Vāta is the responsible factor for inducing pain xxxii in the body and the properties of Vāta and Swedana are exactly the opposite. Hence, the heat can cause reduction in pain by reducing the swelling, removing the coldness at the site and causing perspiration xxxiii. AAMJ / Vol. 2 / Issue 3 / May June

4 Relieves Stiffness (Stambha) Stiffness is a resultant of excess Śīta Guna. Vayu by Rukśa Guna absorbs Snigdhata which results in Stambha. Swedana by its Snigdha and Uśna property relieves Stambha xxxiv. Uśna Guna of Swedana does Srotośuddhi and Āmapāchana and relieves stiffness. The rise in temperature induces muscle relaxation and increases the efficiency of muscle action, as the increased blood supply ensure the optimum conditions for muscle contraction xxxv. Relieves Coldness This is mainly due to Uśna Guna of Sweda. As a result of the increased metabolism, the output of waste products from the cells is increased. These include metabolites, which act on the walls of capillaries and arterioles causing dilation of these vessels. In addition, the heat has a direct effect on the blood vessels, causing vasodilatation, particularly in the superficial tissues where the heat is more. Stimulation of superficial nerve endings can also cause a reflex dilatation of the arterioles. As a result of the vasodilatation, there is an increased flow of blood through the area so that the coldness of body gets removed xxxvi. CONCLUSION Manyāstambha being the Vātaja Nānātmaja Vikāra there is a major role of Swedana in the treatment. There is a wide range of Sweda modalities which are present in practice comprising both Rukśa and Snigdha Sweda. A thorough assessment of Dośa and the Pathology will guide us to reach the selection of apt Sweda modality which can break the Samprāpti of the disease. By the application of oil and Sudation therapy, a dry stick becomes soft and elastic; similarly the same effect will be in alive human being xxxviii. ΛΛΛΛ Relieves heaviness By means of Swedana, the fluids sustained in the body are being excreted through the Sweda and hence the feeling of lightness occurs in the body xxxvii. Stimulation of sweat glands Swedana promotes sweating. There is reflex stimulation of the sweat glands in the area exposed to the heat, resulting from the effect of the heat on the sensory nerve endings. As the heated blood circulates throughout the body it affects the centers concerned with the regulation of temperature and there is increased activity of the sweat glands throughout the body xxxviii. AAMJ / Vol. 2 / Issue 3 / May June

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