1 2 3 4
Dr.BeleTarun PG(Sch),Dr.BondreMithun,Dr.CardozoBasil,Dr.AvadhutSureshAiya
1PG.Scholar,PGDepartmentofKayachikitsa,GomantakAyurvedMahavidhyalaya&ResearchCentre,Shiroda,Goa,India.
2Guide&AssistantProfessor,PGDepartmentofKayachikitsa,GomantakAyurvedMahavidhyalaya&ResearchCentre,Shiroda, Goa,India.
3Co-Guide,HoD&Professor,PGDepartmentofKayachikitsa,GomantakAyurvedMahavidhyalaya&ResearchCentre,Shiroda, Goa,India.
4Co-Guide,HoD&Professor,PGDepartmentofPanchakarma,GomantakAyurvedMahavidhyalaya&ResearchCentre,Shiroda, Goa,India.
ABSTRACT
Intoday'seraduetoindisciplinelifestyle,stress,skippingmeal,irregularandfast-foodhabitsorconsumptionofalcohol&smoking;manypeoplearesufferingfrom various kinds of diseases and disorders. One of them is Manyastambha Earlier it effected elderly aged people but now it is more common in younger generation speciallyafter30yearsofage.Therearevarioustypesoftreatmentindifferentpathy'sbutInAyurvedaVaatNashakChikitsaanddifferenttypesofproceduresNasya, Manyabasti,Sekaandmorearementionedforthemanagementof Manyastambha Manyastambha isconsideredas VaatVyadhiandmanyAcharyaswerementioned aboutit.AcharyaSushrutamentionedManyastambhaasanindividualdiseaseandAcharyaCharakamentioneditasManyagatavaatbutnotasanindividualdisease. AcharyaCharakamentionedManyagatavaatundertheVaatVyadhi.
Amale patient aged 24-years came to KamakshiArogyadham (KAD) OPD with the Complaint of Manya Pradeshi Shoola, Stambha, Bhrama, Manya se Aunsa SanchariVedna(for3years)andShirograhaandPipalikaabhisarpan(for1year)withpainfulneckmovementonbothsides.AccordingtoClassicalsymptomshewas diagnosedasManyastambha ItisadegenerativediseaseofJatrugatapradeshathatisconsideredasVaatNanatmajaVyadhiinCharakaSamhita InAyurvedaNasya ismentionedasbesttreatmentfor Urdhvajatrugata Vikar and Bala (Sidacordifolia)ismentionedby Acharya Sushruta in Vata Nashaka drugs.So Bala Taila Nasya wasgiventothepatientforthemanagementofManyastambha.10drops(UttamMatra)ofBalaTailaadministeredineachnostrilofpatientmorningandeveningfor7 days.Assessmentwasdonebeforeandafterthetreatment.Theresultofthistherapeuticprotocolisveryeffectiveinthepatient.
KEYWORDS:NASYA,MANYA,STAMBHA,SHOOL,BALA.
INTRODUCTION:
Inpresenteraeverybodyisrunningforhisorherlivelihood.Thus,mostofthem cannotmanagetobalancetheirlifestyle.Duetoexcessiveworkload,travelling, undisciplinedlifestyle,eating fast food or addictionof alcohol or smoking and especiallyafter30yearsofage.About66%ofadultsexperiencemanyapradeshi 1 shoolaandstambhaand5%arehighlydisabledbyneckpain.effectsonparticularhealthandcausesdiseasesofjointsorlocomotorsystemveryoften.
ThereisaclinicaltermcalledManyastambhainwhichbackoftheneckbecomes stiff & rigid along with pain which impaired the movement of neck.Acharya sushrutamentioned Manyastambha asanindividualdiseaseandits4causesi.e., 2 diva Swapna, Vikrut urdhva nirikshana, sthana, aasana In this disease sterno 3 mastoidgetconstricted andAcharyaSushrutaalsoclassified Manyastambha in 4 tofourtypesi.e., vataja, aamvataja, janmaja, aakshepyukta .Itcanbecorelated withtorticollis.Accordingto Ayurveda vitiatedvaatdoshadecrease asthi dhatu inbodythus asthi dhatu kshaya occur Accordingto Ashraya ashrayi bhava itis inversely proportion to each otheri.e.,when vaat dosha increases asthi dhatu 5decreases
Accordingtomodernsciencewecancorelate Manyastambha withtorticollis.In modern medicines this condition is managed by NSAID'S, steroids which also 6 causes side effects but in ayurveda it is treated by panchakarma, shaman and bruhana chikitsa There are various effective procedures of panchakarma according to condition of patient and severity of disease like yog basti, manya basti and nasya karma which may be applied on patient for the treatment of Manyastambha Acharya Charaka also mentioned the effectiveness of Nasya 7 karma and dhoompaan in all types of vaat vyadhis andAcharya Charaka also mentionedthatNasyaofVaatNashakaTailashouldbegivenwhenvayuisviti8 atedinbahuorshirpradesha So,inthisstudyBalaTailaNasyawasgiventothe
patient. In India Bala (Sida Cordifolia) is one of the most Important, effective and easily available drug. Bala has a property to increase the bala or strength 9 that'swhyitisalsoknownasbalya AcharyaCharakamentionedbalainagroup 10 oftendrugswhichhasbalyaactivity andAcharyavagbhatalsomentionedBala 11 in the group of balya mahakashaya and Achrya Sushruta mentioned Bala in sanshaman gana he also mentioned that bala is one of the drug that have vaat 12 Sanshamak property Acharya Charaka mentioned Bala Taila is best for the 13 treatment of vaat vyadhi Bala also have some Chemical properties of antianalgesic&painsuppressantpropertiesduetopresenceofephedrine. AIM&OBJECTIVE:
1. Bala. 2. TilaTail.
Ÿ
Ÿ
SopofNasya:
TheprocedureofapplicationofNasyaKarmaincludes-
1. Poorvakarma
2. Pradhanakarma
3. Paschatkarma
PoorvaKarma:
Therearethreestepsmentionedinpoorvakarmathatshallbeapplied.
1) sambhar sangraha- alltherequiredmaterialswillbemadeavailableat treatmentsite.
2) rogipariksha-patientwillbeselectedasperinclusioncriteria.
3) aatursidhataa-
Eyeswillbecoveredwith Afterthese Mrudu Sterilepads. Abhyanga with TilaTailaandMruduSwedanabyNadiSwedaYantrawillbedoneatManya, Skandhas,UbhayhastaandMukhapradesha.
Ÿ PatientWillbemadetolieinsupinepositionwithhisheadtilteddownwards fromtheedgeofthetablewithnostrilspointingtotheroof.
PradhanaKarma:
Therearethreestepsin Pradhana karma thatwouldbefollowwhiledoingthe NasyaKarmaofpatients.Thesestepsare,
1. NasyaDaan(asperclinicalguidelines).
2. Nasyottarparichryaandobservation(asperclinicalguidelines).
3. Nasyavyapadandpratikaar(ifnecessary).
Ÿ Thepalmsandsoleofthepatientarerubbedwellwithhands.
10dropsofBalaTailawillbeadministerineachnostrilofpatient.
Ÿ
ditionsofspinewillbeexcludedfromthestudy
Ÿ
Ÿ
Patients undergoing other modalities of treatment for Manyastambha or othersevereillnesseswillbeexcluded.
Patientsoftheagebelow20yearsandabove60yearswillbeexcluded.
Patients suffering from Nasal polyps, urdhvagata raktapitta, tuberculosis, chronic cardiac failure, asthmatic disorders, severe anaemic patients and ischemicheartdiseasepatientsareexcluded.
Ÿ
Ÿ
NasyaAnarhaPatients.
Those patients not willing for trail and not giving written consent will be excluded.
Studydesign: Asinglelabelopenarmtrailclinicalstudyadopted.
TreatmentSchedule: Afterdiagnosisselectedpatientwastreatedwith Bala Tail Nasya 10dropseach 17 18 Nostril twiceaday(morning&evening) for7days.
Criteriaforassessment: Improvement in clinical symptoms, score and grading will be given for each symptomAccording to the severity andAngle of Movement of Neck (Flexion, st Extension,rightlateralangle&leftlateralangle)ismeasurebygoniometeron1 th dayand14 dayofstudy.
Casereport: Amalepatientaged24yearscametoKADOPDwithc/omanyapradeshishoola & stambha from past 3 years. He has c/o Manya se aunsa sanchari Vedna, Bhramaandsa-kasthakriyafrompast3yearsbutinpast2monthstheseverityof symptomsisincreased.
Historyofpresentillness: Patientwashavingpresentcomplaintsfrompast3yearsandhealsotakenmodern medicines but he did not get relief in symptoms, so patient come to KAD OPDforfurthertreatment.
15
Ÿ Patientisaskedtoremainlyinginsamepositionfor vaakshatakakala and spitoutthesecretionsreachingthemouth(ifany)andnottoswallowit.
Paschatakarma:
1. nasyopranttatkalkarniyakarma-skandhadimardana.
2. gandushwithwarmwater
3. pathyadinirdesh.
4. nasyottarkarma.
Ÿ
Patientwillbescreenedandexaminedforyoglakshanaofnasya
Ÿ Gentlemassageoverhasta,skandhadiwillbegiven.
Ÿ
Dhoompaanwithvachaandharidradhoomvarti3strokesineachnostril.
Ÿ Gandusha-Gandushawillbedonewithwarmwater
Patient is advised to avoid polluted air, bath and contraindicated food during treatment.
MATERIALANDMETHOD:
Source of data: patient of either sex diagnosed by Manyastambha from the K.A.DOPD.BalaoilispreparedinRasshastradepartmentofGAM&RC.Refer16 enceofbalaoilistakenfromGadnigrahaPrayogakhandetailadhikaraadhyay
Inclusion&exclusioncriteria:
Inclusioncriteria:
1) Patientshavingtheclassicalsignsandsymptomsof shoola and stambha in manyapradesha
2) Patientsbetweentheagegroupof20-60years.
3) Patientsofbothsexes.
4) NasyaArhapatients.
5) Patientswillingtotakenasyatreatmentandreadyforgivingwrittenconsent willbeincluded.
Exclusioncriteria:
Ÿ Patientswithmajordisordersthatistraumatic,infectiveandneoplasticcon-
Pasthistory: NohistoryofHTN/TSH/DM.
Nohistoryofanyothermajorillnessorsurgicalincidents.
Nohistoryofanytraumaoraccident.
Personalhistory: Aahara: 1) guru,Ruksha,sheeta,amlarasaPradhanaaaharaSevana.
Vihara: 1) workingoncomputerfor7to8hoursdaily., 2) YaanYaangamanadailyformorethan50km/day
Generalexamination: 1) Condition—ConsciousandAfebrile. 2) Pulserate—78/min. 3) Bloodpressure—124/80mm/hg.
Respiratoryrate—16/min.
Weight—68kg.
Height—169cm.
Systemicexamination: 1) R.S–A.E--B.E—clear
C.N.S—Consciousandoriented.
C.V.S—S1&S2Normal,Noabnormalsound. 4) P/A—Soft,liverkidney,spleen–NotPulpable.
Prakriti:Vaat-kapha
Koshta:Mradu
Agni:Sama
Satva:Pravara
Sara:RaktSaar
Ashtavidhpariksha:
1) Nadi—78/min.
2) Mala—2times/daysamyaka.
3) Mutra—5-6times/daysamyaka
4) Jivha—Sama.
5) Shabda—Clear
6) Sparsha—Ushna.
7) Druk—Sthir
8) Akruti—Madhyama.
IndriyaParikshan: 1) Dhyanendriya:Pravara 2) Karmendriya:Pravara
Strotasexamination: 1) AsthivahaStrotas—manyapradeshishoolapresent.
2) MajjavahaStrotas—tinglingsensation&numbnessinupperlimb.
Clinicalexaminationofspine: 1) Inspection—noanyabnormalitywasseen.
2) Gait—Normal. Investigation: 1) E.S.R
2) C.R.PQUANTITATIVE.
Diagnosis&assessment: Manyagatavaat was diagnosed by classical symptoms like manya pradeshi shoolaandstambha
Treatment: st th
Bala Taila nasya 10 Bindu,morningandeveningwillbegivenfrom1 to7 day th st (total7days).Then14 dayfromthestarting1 dayofnasyapatientfollow-up willbedone.
Differentialdiagnosis: 1) Cervicalspondylosis.
2) Fibromyalgia.
3) Arthritis.
Pathya-Apathya: Pathya— Shunthi,Ajmoda , mishreya, maricha, saindhava, hingu, Rasona, jeeraka,
Apathya— Virrudha anna, shushka mamsa, sem, Guru-vishtambhi padartha, sheetaljalpaan,vaatvardhakaaahara.
RESULT:
Theassessmentbeforeandafterthecompletionoftreatmentshowsthatthereis symptomatically improvement (subjective parameter) shown in table no 1 that donebyVASScaleforpainandsameasimprovementisshownintableno2that scored by grading table for stambha and range of movement is also shown in table number 3 before and after treatment by goniometry that also shows improvementaftertreatment.
1) ShoolaAssessmentTable:
2) StambhaAssessmentTable:
4) RangeofMovementScale: Rangeofmovementofneckwillberecordedbythehelpofgoniometerinstrument before and after the treatment. There 4 types of movement angles were recordedbythehelpofgoniometer
1. Cervicalflexionangle.
2. Cervicalextensionangle.
3. Rightlateralmovementofneck.
4. Leftlateralmovementofneck.
Objectiveparameter: st th ESR&CRPQUANTITATIVE--on1 &14 dayofstudy
ChangeinESR&CRPQUANTITATIVEwillbecomparebeforeandafterthe treatment.
DISCUSSIONONBALATAILANASYAINMANYASTAMBHA: 19 Nasya isbesttreatmentfor Urdhwjatrugata vyadhi Continuouslydoingwork on computer and Ruksha, Amla Ras Pradhan aahara and yaan yaan gamana dailymayalleviate vaat dosha and guru, sheet bhojan savanna andworkingon computer for long time also elevate kapha dosha and it can be interpreted in termsofsleepingin Vikrit aasana maycausetraumatothecervicalregionleading to Manyastambha In Charaka abhighata in sira also mentioned as one of causesofManyastambha
As Acharya Charaka also mentioned that Avyakta lakshana can be taken as a poorvarupa in vaatvyadhi and commentator Vijyarakshita explains the term avyakta those symptoms that are not visible or express clearly hence light or infrequentpainonneckregioncanbetakenaspoorvarupaofManyastambha
Rupa is necessary for authentic diagnosis of disease in Ayurveda classical sign andsymptomsof Manyastambha arementionedby Acharyas themainofthose sign and symptoms are manya pradeshi shoola and stambha by those classical symptoms we can diagnose it Manyastambha There are not upshaya and anupshaya ismentionedin Manyastambha byacharyas,sovaat vyadhi upshaya and anupshaya canbeconsiderin Manyastambha theknowledgeof samprapti isveryimportantforthetreatmentof Manyastambha Italsohelpstounderstand thepathogenesisofManyastambha vitiatedvaatdoshaandkaphadoshatakean aashraya in Manya pradesha and effecting on manya Shira that may cause Manyastambha.
MODEOFACTIONOFBALATAILANASYAINMANYASTAMBHA: 10 drops of Bala Taila nasya is administrated in each nostril, that Bala Taila reachedalltheregionsabovetheclaviclethroughfacialnervefrom Shringataka Marma Itnourishesthetissueofthatparticularareabytheir bruhana effectand alsopacifythevitiatedvaatdosha.BalaTailacontains Bala Panchanga and Tila Taila By analyzing the drugs of Bala Taila, it strengthens and nourishes the body, balances vaat dosha and the pacify the shoola and stambha in manya pradesha
Overalleffectoftherapy:
Duringtheentireperiodoftherapythereisnoadverseeffectseenorobservedin the patient. Patient got significant improvement statistically and symptomatically
CONCLUSION:
Asthi-MajjagatavaatisdegenerativevyadhisoShodhanaandBruhanachikitsa isutilizedinit.Inthisreview Bala Taila Nasya isutilizedfor Shodhana ofvitiated Vata and Bruhana of Asthi and Sandhi Patient shows significant relief in manifestations.
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