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A CLINICAL STUDY TO EVALUATE THE EFFECT OF

NIYTA VIRECANA IN ESSENTIAL HYPERTENSION

/SHONITA DUSTI

A CONCEPTUAL STUDY:
HISTORICAL REVIEW

The Vedas are considered


to be the oldest documented source of knowledge.

VEDAS:
There are many references regarding the term Vata
or Vayu, but the word Pakshaghata was not used. In
Rigveda, Vayu has been worshipped as god and
Vayu chikitsa has
also been mentioned. Shukla Yajurveda also quotes
the word Vayavya for Vayu In Atharvaveda the word
Vataja has been used for Vata and five types of Vata
are mentioned. Location of Vata in upper part of
Mastiska is mentioned. The word Vatakrita has also
been used in the context of description of vata. Vayu
chikitsa has also been mentioned in Atharvaveda.
Here Pippali and Vishanika has been claimed as
Vatakrita Bheshaji and Vatakrita Nashini
respectively. Viskandha is described as maharoga
of vata. Samskandha, Jambha, Visara, and
Abhishochana are some other diseases of Vata

UPANISHADS:

Among Upanishads Taitariya Upanishad has


explained the Swaroopa, Sthana, and Karya of five
types of Vata. In Chandogya Upanishad the word
Tejobanna is referred for
Sharira, which comprises of Teja+ Apa+Anna,
where Anna refers to Pranavata. The chala
property of vata and its close relation with bodily
activities and movements have been
highlighted here. Prashnopanishad mentions
Udana Vayu moves to and fro from foot and legs
to head.
Importance of Vyana vayu regarding movements
and Samana vayu towards circulation is
mentioned. In Ramayana the pathological effects
caused by aggravated vayu are allegorically
described as deformities in the body. The
importance of vayu in maintainance of health and
life has been stated.
In Agni Purana a food regimen is explained for
vatavyadhi as Godhuma, Jangala, Mamsa Rasa,
Udga, Amalaki. Badara, Kharjura, Madhu, Ghrita
etc.

In Garuda purana the Vata prakopaka nidana like


Katu Tikta Amla, Ruksha sevana, Chinta,
Vyayama, Bhaya, Shoka, Ratri jagarana etc have
been explained.
Vishnu Purana has given properties of vata as
Laghu, Sheeta, Ati ruksha .It causes drying or
emaciation of body and is unbearable to it.

REVIEW OF SAMHITAS:

CHARAKA SAMHITA:

Acharya charaka, while mentioning about the


diseases, which occur in the Madhyama roga
marga, included Pakshaghata under Eighty types
of Vata Vikara he has included Pakshavadha.
He has mentioned that Tikta rasa ati sevana
causes Pakshaghata.
In Chikitsa sthana, Pakshaghata is mentioned as
Upadrava of Vrana.
Samanya nidana of Vata vyadhi, Purvarupa,
Rupa, Samprapti, Sadhyasadyatva and chikitsa
has also been mentioned in chikitsa sthana 28th
chapter.

SUSHRUTA SAMHITA:

In Sushruta Samhita while explaining about Ati


Rakta srava due to Sira vyadha he says that if Sira
vyadha is performed during ati ushna kala in ati
swinna, ati vriddha and Performed by ignorant
person, leads to pakshaghata.
In Shareera sthana, Marma Nirdesha Adhyaya,
Acharya sushruta explained that Pakshaghata is
caused by Puncturing of Kakshadhara and
Lohitaksha marma.22 while explaining indications
and contra indications of sira vyadha he said that
patients suffering from Pakshaghata are
considered as contra indicated for Sira vyadha.

Sushruta has explained Nidana, Poorvarupa,


Rupa, Samprapti, Sadyasadyatva in Nidana
sthana. He
explained doshanubandha but lakshanas are not
explained. Has dealt about chikitsa in Chikitsa
sthana. Mentioned Ati Maithuna as a specific
Nidana for Pakshaghata.

BHELA SAMHITA:

The clinical features of Pakshaghata is not mentioned


in the present available Bhela Samhita. In sutra
sthana he has explained Vata prakopaka nidana,
Kupita vata janita
vikara where he has mentioned the Pakshanga roga.
Bhela has classified vata vyadhi in to two main
groups.
a) Sarvanga roga. b) Ekanga roga.
He has enumerated only the name of Paksha graha
and the description regarding the vata vyadhi
chikitsa is given in twenty sixth chapter of chikitsa
sthana.

HARITA SAMHITA:

Harita has explained etiological factors of vata


prakopa, classification of vata vyadhi, and five types
of vata dosha and sixteen disorders of each type of
vata. Brief Samprapti of Pakshaghata is also
explained.

KASHYAPA SAMHITA:

In Kashyapa samhita there is no specific adhyaya for


Vatavyadhi. Regarding Vata and its causative factors
are explained in Sutra sthana. He has enumerated
only the name of Pakshaghata under Nanatmaja
Vatavyadhi.

ASHTANGA SANGRAHA AND ASHTANGA HRIDAYA:


Ashtanga sangraha and Ashtanga hridaya give both
views of charaka and sushruta.

He has given whole description regarding vata.


In Ashtanga Hridaya sutra sthana,Pakshavadha is
explained under Marmashakasthisandhi Roga.
Detail description regarding samanya vatavyadhi
Nidana, Purvarupa, Rupa, Samprapti,
Sadhyasadhyatva is given in Ashtanga Sangraha
16th chapter and 15th chapter
of Nidana sthana in Ashtanga Hridaya. Further,
Treatment is also explained in Ashtanga hridaya and
Ashtanga sangraha.

MIDEVIAL PERIOD:

MADHAVA NIDANA:

General Nidana of Vatavyadhi along with signs and


symptoms of Pakshaghata are described in 22nd
chapter. Contribution of this text is the description
of two types of
Pakshaghata- Pittanubandha and Kaphanubandha.
CHAKRADUTTA:

The author has explained Vatavyadhi chikitsa.


Description shows that he has adopted both
Acharya Charaka and Acharya Sushrutas view.

SHARANGADHARA SAMHITA:

The author mentioned Pakshaghata under Vataja


roga . Adhamalla while commenting on this has
given the same description as Madhavakara.

BHAVAPRAKASH:

He included this disease among 80 types of Vata


vikaras .He described in detail Samprapti and
sadhyasadhyatva of Pakshaghata. A number of
yogas have been mentioned in this text for
treating Vatavyadhi and Pakshaghata in
particular.

The other Midevial period texts like Gada


nigraha, Vangasena, Rasa ratna sammuchaya
Yogaratnakara have followed the opinion of
Sushrutha.
VYUTPATTI AND PARIBASHA:

On screening different Ayurvedic classics for the


word Pakshaghata, two words are seen
commonly. They are Pakshaghata and
Pakshavadha. The word Paksha is common in
both. The word paksha has different meanings
according to the context.
Paksha Dehangam = Part
Paksha Panchadasha ahoratra = 15 days
Paksha Parshva = Flank or side
Paksha Dehardha = Half of body
Paksha Dehanga bheda = Member of body
So the word paksha means Flank or Side or Half
of anything.
Here it means a Limb or Member of body.

Acharya Charaka has used the word Paksha in


different context.
It has been used for describing 15 days.
Feather of bird
One side of body
Acharya sushrutha while explaining about
Pakshaghata, has used the word Paksha.
Dalhana commented on this by saying it as
Shareerardham.
Ashtanga sangraha and Ashtanga hridaya also used
the word Paksha which gives the same meaning as
mentioned by Sushruta.
Vijaya rakshita, commentator of Madhava nidana
explains the meaning of paksha as
Ardanarishwaravat. Sharangadhara samhita,
Bhavaprakasha, Yogaratnakara have used the word
Paksha with the meaning as half of the body.
Considering all the above references we can
conclude that the word Paksha refers to:
One Side of body.

AGHATA:

The word Aghata is derived from the word


An+Han+Ghan
Han+Vich+Bhave+Lyut
The word Ghata depicts different meanings. Some
are as follows
Ghata Vadha = Killing
Ghata Hanana = Destruction
Ghata Prahara = A Blow
So the word Ghata means Killing,Blow,Injury
In ayurveda the word Ghata have been quoted in
various contexts like Marmaghata,
Mutraghata etc. It shows reduced activities.

VADHA:

Hananam iti
Han+ap, vadha desha
Vadha Ghata
Vadha Hanana
Vadha Prana viyoga phalaka vyapara
So the word vadha means killing, destruction,
blow. From above description it shows
that Ghata and Vadha has same meaning. So
Pakshaghata and Pakshavadha are having same
meaning. Thus the Etymology of Pakshaghata
remains as Pakshasya dehangasya ghatam
vinasham yasyat yat wa
Pakshasya aghata iti Pakshaghata
Pakhasya ghataha iti Pakshaghata
Pakshasya vadah iti Pakshaghata
From the above descriptions it is evident that the
meaning of word Pakshaghata is loss of
function of one half of the body.

HEMIPLEGIA:
ETYMOLOGY:
The word hemiplegia is derieved from two words,
Hemi and Plegia.
Meaning of these terms are
Hemi Half
Plege Stroke
Means Loss of strength or voluntary movements on
either side of body.
SYNONYMS:
Paralysis Para = Beyond Lyien = to loosen Lysis =
death
Stroke, Cardio Vascular Accident.
HEMIPLEGIA:
A unilateral brain lesion producing paralysis of
contralateral side of Body including
Face, trunk and limbs.

DIPLEGIA:
A bilateral cerebral or a high cervical lesion
produces Diplegia. The limbs of both
sides are affected.

MONOPLEGIA:
Paralysis of single limb resulting from a cerebral
lesion is termed cerebral monoplegia.
Spinal or peripheral monoplegia is less common.
PARAPLEGIA:
Paralysis of limbs resulting from a lesion of spinal
cord, usually affecting both legs
alone. It is differentiated from cerebral diplegia in
which the face is also affected.
Clinically most common condition is hemiplegia. If
the condition is in milder form then it
is known as Hemiparesis, characterized by
weakness on either side of body.
Considering the Etymology of word Pakshaghata and
hemiplegia, it shows both have
same meaning. Hemiparesis can be explained in
terms of words like Paksha daurbalya.
Diplegia and Monoplegia can be considered as
variants of Sarvangavata and Ekangavata
respectively.

NIDANA
In Ayurvedic classics the word Nidana has been used
in two ways:
(1)Causative Factor (2) Diagnosis. The Causative
factors explained in the classics may be divided into
many groups but for the sake of convenience, these
can be grouped
into two types viz.: (1) General (2) Specific

TABLE NUMBER 1:
(A) Aaharaja (Dietetic Causes):

II.Gunatah + + + + +

Rukshaanna (ununctous diet)


Laghvanna (light diet) - + + - -
Gurva anna (heavy diet) - - + + -
Sheetanna (cold diet) + - + - -

III.Rasatah - + + + +

Kashaayaanna (astringent taste)


Katvanna (acidic taste) - + + + +
Tiktaanna (Bitter taste) - + + + +

IV.Karmatah

Vishtambhi (constipative diet) - - + - -


V. Veeryatah

Sheeta (cold) - - - - +

VI.Maatratah

Abhojana (fasting) + + - - +
Alpashana (dieting) + - + + -
Vishmashana (Taking unequal food) - + - - -

VII. Kaalatah

Adhyashana (eating before digestion of previous - + - - -

meal)
Jeernanta (After digestion) - + + + +
Pramitashana (Taking food in improper time) - - + + +

(B) Vihaaraja (Behavior):

1. Karmatah

1.Mithyayogatah - - + - -

Ashmabhramana (Whirling stone)


Ashmachalana (Shaking of stone) - - + - -
Ashmavikshepa (Throwing of stone) - - + - -
Ashmotkshepa (pulling down stone) - - + - -
Balavat vigraha (wrestling with superior healthy - + + - -

one )
Damyagaja nigraha (subduing unteameable - - + - -

elephant) cow and horse


Divasvapna (day sleep) + + - - -
Dukha asana (uncomfortable sitting) + - - - -
Dukha shayya (uncomfortable sleeping) + - - - -
Ghadhotsadana (strong rubbing) - - + - -
Kashtachalana (shaking of wood) - - + - -
Kashta vikshepa (throwing of wood) - - + - -
Kashtotkshepa (pulling down wood) - - + - -
Lohabhramana (whirling of metal) - - + - -
Lohachalana (shaking of metal) - - + - -
Lohavikshepa (Throwing of metal) - - + - -
Lohotkshepa (pulling down metal) - - + - -
Paragatana (strike with others) - - + - -
Shilabhtamana (Whirling of rock) - - + - -
Shilachalan (Shaking of rock) - - + - -
Shilavikshepa (Throwing of rock) - - + - -
Shilotkshepa (Pulling down rock) - - + - -
Bhaaraharana (Head loading) - + + - -
Vegadharana (Voluntary suppression of natural + + + + +

urges)
Vegodeerana (Forceful drive of natural urges) - - + + -
Vishamopachara (Abnormal gestures) + - - - -

2. Atiyogatah

Atigamana (excessive walking) + - + - -


Atihaasya (Loud laughing) - + + + -
Atijrumbha (Loud yawning) - + - - -
Atikharacapakarshana (Violent stretching of the - - + + -

bow)
Atilanghana (Leaping over ditch) + + + - -
Atiplavana (Excessive bounding) + + - - -
Atiprabhashana (Continous talking) - - + + -
Atipradhavana (Excessive running) + + - - -
Atiprajagarana (Excessive awakening) + + + + +
Atiprapatana (Leaping from height) - + - - -
Atiprapidana (Violent pressing blow) - + - - -
Atipratarana (Excessive swimming) - + + - -
Atiraktamokshana (Excessive Blood letting) - - - - +
Atishrama (Over exertion) - - - - +
AtiSthaana (Standing for a long period) - + - - -
Ativyayama (Violent exercise) + + + + +
Ativyavaya (excessive sexual intercourse) + + + + +
Atiadhyayana (excessive study) - + + - -
Adyashana (sitting for a long period) - + - - -
Atyuchabhashana (speaking loudly) - - - + -
Gajaticharya (excessive riding on elephant) - - + + -
Kriyaatiyoga (excessive purification therapy) - - + + +
Padaticharya (walking long distances) - + - - -
Ratha aticharya (excessive riding on chariot) - + - - -
Turangaticharya (excessive riding on horse) - + - - -

(C) Aagantuja (External factors):

Abhighata (trauma) + - - - -
Gaja, Ushtra, Ashvasighrayanapatamsana + - - - -

(Falling from speedy, running elephant, camel

and horse)

(D) Manasika (Mental factors):

Bhaya (fear) + - + + +
Chinta (worry) + - + - -
Krodha (Anger) + - - - -
Mada (Intoxication) - - - - +
Shoka (Grief) + - + + +
Utkantha (Anxiety) - - + - -

(E) Kalaja (Seasonal factors):

Abhra (cloudy season) - + - - -


Aparahnna (evening) - + + + +
Aparatra (the end of the night) - - + + -
Greeshma (summer season) - - + - -
Pravaata (windy day) - + + - -
Sishira (winter day) - - - - +
Sheetakala (early winter) - + - - +
Varsha (rainy season) - + + - +

(F) Anya Hetuja (Miscellaneous causes):

Aama (undigested article) + - - - -


Asrikshaya (loss of blood) + + + - -
Dhatukshaya (loss of body elements) + - - - -
Doshakshaya (depletion of Dosha) + - - - -
Rogatikarshana (emaciation due to disease) + - - - -
Gadakruta mamskshaya (wasting due to disease) - - - - +

1. Aharaja (Dietic factors):

Excessive consumption of Tikta, Katu, Kashaya Rasa leads to


vitiation of Vata.
Substance having Sheeta, Ruksha, Laghu Gunas, Vistambi Dravyas
and Sheeta Virya Dravyas and other food substances like Adhaki,
Chanaka, Kalaya, Mudga may lead to
Vata vitiation and Alpa Bhojana, Alpashana, Vishamashana are
also considered as factors, which leads to Vata Prakopa and
Dhatukshaya.
2. Viharaja (Habit and regimens):

It includes habits and regimen related to body. The factors like


Vegadharana, Ratrijagarana, Asamyak Shodhana, unwanted
strain by bodily exercise, excessive travelling, uncomfortable
sitting and sleeping postures are considered as the viharatah
factors for Vata Prakopa. Also excessive indulgence in walking,
talking, swimming, excessive sexual intercourse and the
excessive indulgence in the Nidanas described above may finally
land up in Dhatukshaya and hence Vata Prakopa.

3. Agantuja factors (External factors):


The external factors like Marmaaghata, Abhighata, Bhagna are also
considered under Agantuja factors.
4. Manasika (Mental factors):

The Manasika factors like Bhaya, Chinta, Krodha, Shoka,


Utkantha will also result in Vata Prakopa.

5. Kalatah (Seasonal factors):


Over exposure to air, cold climate, varshakala, summer season,
cloudy atmosphere may also cause Vata prakopa.

6. Anya Hetu (Miscellaneous causes):


All the other Nidanas that cannot be included in any of the above
groups comprises this group factors like excessive haemorrhage
(Asrikshaya), Rogatikarshana, Visha, Dhatukshaya, Ama and
Margavarodha may land up in VataPrakopa.