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Comparetive Study of Shambukadya Gutika and Nrupavallabha Taila Navana Nasya in the Management of Ardhavabhedaka W.S.R.T Migraine, By NEERAJ KUMAR, Department of Kayachikitsa, Post graduate studies ...

Comparetive Study of Shambukadya Gutika and Nrupavallabha Taila Navana Nasya in the Management of Ardhavabhedaka W.S.R.T Migraine, By NEERAJ KUMAR, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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  • “Comparetive Study of Shambukadya Gutika and Nrupavallabha Taila Navana Nasya in the Management of Ardhavabhedaka W.S.R.T Migraine” By NEERAJ KUMAR Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Kayachikitsa Under the Guidance of Dr. Raghavendra V. Shettar M.D. (Ayu), Asst. Professor in Kayachikitsa Department of Kayachikitsa Post Graduate Studies & Research Center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2006-2009
  • D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 This is to certify that the dissertation “Comparetive study of Shambukadya Gutika and Nrupavallabha Taila Navana Nasya in the management of Ardhavabhedaka w.s.r.t Migraine” is a bonafide research work done by Neeraj Kumar in partial fulfillment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University of Health Sciences, Bangalore, and Karnataka.Date: GuidePlace: Dr. Raghavendra V. Shettar, M.D. (Ayu), Asst. Professor. Dept. of Kayachikitsa DGMAMC, PGS&RC, Gadag
  • J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 Endorsement by the H.O.D, principal/ head of the institution This is to certify that the dissertation entitled “Comparetive study ofShambukadya Gutika and Nrupavallabha Taila Navana Nasya in themanagement of Ardhavabhedaka w.s.r.t Migraine” is a bonafide research workdone by Neeraj Kumar under the guidance of Dr. Raghavendra V. Shettar, M.D.(Ayu), Asst. Professor, Dept. of Kayachikitsa in partial fulfillment of the requirement for thepost graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under RajivGandhi University of Health Sciences, Bangalore, Karnataka.. Professor & HOD (Dr. G. B. Patil) Dept. of Kayachikitsa Principal, PGS&RC DGM Ayurvedic Medical College, Date: Gadag Place: Gadag Date: Place:Gadag
  • Declaration by the candidate I here by declare that this dissertation / thesis entitled “Comparetive study ofShambukadya Gutika and Nrupavallabha Taila Navana Nasya in themanagement of Ardhavabhedaka w.s.r.t Migraine” is a bonafide and genuineresearch work carried out by me under the guidance of Dr. Raghavendra V. Shettar,M.D. (Ayu), Asst. Professor, Dept. of Kayachikitsa, DGMAMC, PGS&RC, Gadag.Date:Place: Neeraj Kumar
  • Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation/ thesis in print orelectronic format for the academic / research purpose.Date:Place: Neeraj Kumar© Rajiv Gandhi University of Health Sciences, Karnataka
  • Acknowledgement On this solemn occasion of successful accomplishment of my work, I offer mysalutations to the Almighty for having bestowed in me the ability to discharge my dutiesthoroughly in this endeavor. It is next to impossible to express my profound love and gratitude to myaffectionate parents Dr. Parkash Chand & Mrs. Jogindari Devi who have always stoodby me during each step of life. I wish to express my deepest gratitude first to my guide Dr. RaghavendraV.Shettar, M.D. (Ayu), Asst. Prof. for his timely advises and encouragement during thisresearch work and for his inspirational clinical knowledge. I express my gratefulness to my professor Dr. V. Varadacharyulu, M.D. (Ayu),who was former H.O.D. of the department I express my gratitude to Prof. Dr. K. Shiva Rama Prasad, M.D. (Ay), M.A.(Jyo) Ph.D. (Jy), for his timely advises and encouragement during the course of thisresearch work. I express my thankfulness to my beloved principal Dr. G. B. Patil for hisencouragement and support by providing all necessary facilities for this research work I extend my gratitude Dr.Mulki Patil, Dr.Shankaragouda, Dr.P.Shivaramudu,Dr.G.Purushottamacharyulu, Dr.M.C.Patil, Dr. G.Danappagoudar, Dr.S.N.Belawadi,Dr.Nedugundi, Dr.Samudri, Dr.Kuber sankh. Dr.Mulgund, Dr.J.Mitti, Dr.Yasmin A.P. andall my U.G. Lecturers for time-to-time help offered by them I express my immense gratitude to my statistician Nandakumar, librarian V.B.Mundinamani and assistant Shavi & Kerur for facilitating me in collection and productionof my thesis.
  • At this memorable moment, I am overwhelmed to express my heartfelt gratitudeto my wife Dr.Ratika, whose love, inspiration and understanding was the driving forcebehind the successful completion of this work. I express my heartfelt gratitude to my brother, Dr. Raman for constant help andencouragement to move ahead. On this occasion, I express my gratitude to my father in-law Late Shri PremKumar Chopra, mother in-law Mrs. Manorma Chopra who have always inspired andboosted my efforts by their incessant love throughout this work. I would like to sharethese moments with my brother in-law Mr. Rohit Chopra for their kind co-operation I take this moment to express my thanks to all my Post graduate colleagues, Dr.Ashok M.G., Dr.Kamalaxi, Dr.Sulochana, Dr.Shivaleela Kalyani, Dr.Prasann Joshi, Dr.Sanjeev Choudhary (Babu Ji), Dr.Vijayalakshmi B, Dr.Anupama Bijjal, Dr.Trupti Itagi,Dr.Ishwar Patil, Dr.Bodke, Dr.Kanthi, Dr.Praveen, Dr Bhagesh, Dr.Suraj, Dr. VijeyMahantesh, Dr.Vinod, Dr. Baba Saheb. Last, but not least, I take this opportunity to express my gratitude for my sweet,cute daughter ROOPAASHI whose immense love, support and inspiration have been ofprime importance in successful completion of this work. Finally I am thankful to all those who helped directly or indirectly for thecompletion of this work. (Neeraj Kumar.)
  • Abstract of “Comparative study of Shambukadya gutika andNrupavallabha taila navana nasya in the management ofArdhavabhedaka w.s.r.t. Migraine”Key words: Ardhavabhedaka, Shirah shula, Kaphapradhana shiroroga, Migraine, IHS Criteria, Shambukadya gutika, Nrupavallabha taila Ardhavabhedaka is one among the 11 types of shirorogas considered by ouracharyas. Acharya Charaka has described five types of Shirahshoola, Acharya Vagbhataexplaine ten types of shiroroga and Sharangadhara has described 11 types of Shirahroga.The variants are Vataja, Pittaja, Kaphaja, Sannipataja, Raktaja, Krimija, Kshayaja,Suryavarta, Ardhavabhedaka, Shankhaka and Anantvata. Among these Ardhavabheda isfound to be the most common complaint after Vatika Shirahshoola. It is a troublesomevariety of shirashula and most commonly found nowadays. The causes ofardhavabhedaka are excessive intake of Ruksha ahara, adhyashana, purovayu sevana,atapa sevana, vegadharna, athivyayama in which pain is substantial in one half of theshiras, manya, bhru, akshi, lalata, karma pradesha. The attacks of ardhavabhedaka will beonce in three days, once in fifteen days and once in a month as per classics. Thesefeatures of the disease ardhavabhedaka are comparable with the signs, symptoms andfrequency of attacks of migraine headache, since one side headache and attacks occurringonce a week, once a fortnight or once a month with great regularity is also appreciable inmigraine. According to Acharya Charaka if the disease ardhavabhedaka is left untreatedit destroy the normal function of eyes and ears. Ingredients of the trial drug are collected form local area and prepared underGMP conditions, weighing about 125mg tablet for internaland, 8 drops of taila in eachnostril for nasya. Patients of Ardhavabhedaka fulfilling the IHS criteria of diagnosis wereselected in the present study. The female and male ratio in the study is approximately 2:4
  • patients, and in the present study out of 28 patients 21(75%) patients were recorded withRuksha and 7(25%) snigdha ahara. In the present study 8(28.57%) patients had familyhistory. Apart from the symptoms the Subjective and Objective Parameter of both theGroup (A & B) shows high significance result in the study. The mean result of the keyparameters i.e Subjective and Objective Parameter of Group- A for Nrupavallabha Tailais 84% i.e Good response and the mean result of the key parameters i.e Subjective andObjective Parameter of Group- B for Shambukadya gutika is 81% i.e Good response.This is strong evidence to state that Nasya is an effective remedy for Ardhavabhedaka.
  • ContentsS.NO Contents Page Number1 Introduction 1- 32 Objective 4-53 Literary Review 6 - 964 Drug Review 97 – 1014 Material And Methodology 102 – 1125 Observation And Result 113- 1616 Discussion 162- 1977 Conclusion 198- 2008 Summary 201- 2039 Bibliography I- XIII10 Annexure I-X
  • TablesS.N Title of Table Page1 Table no 1 showing Samanya shiroroga nidanas 14- 152 Table no 2 showing Vishista nidanas of ardhavabhedaka 153 Table no 3 showing Laxanas of ardhavabhedaka 16-174 Table no 4 showing dosha involvement in samprapti ghatakas 225 Table no 5 showing Sapekshata of Ardhavabhedaka 246 Table no 6 showing Marmas in Shiras 317 Table no 7 showing types of shiroroga according to different 31- 32 acharyas8 Table no 8 showing Pathya for shiroroga 359 Table no 9showing Apathya for shiroroga 3510 Table no 10 showing suitable time for Pratimarsha Nasya 5111 Table no 11 showing Yogya of nasya karma 5412 Table no 12 showing Contraindication of nasya 55-5613 Table no 13 showing the dosage in Nasya Karma 5714 Table no 14 showing Samaka yoga laxanas Acc to different 58 Acharyas15 Table no 15 showing Ayoga laxanas Acc to different Acharyas 5916 Table no 16 showing Atiyoga laxanas Acc to different Acharyas 59- 6017 Table no 17 showing Genetic Basis of Migraine 7318 Table no 18 showing factors common with ardhavabhedaka and 91-92 migraine19 Table no 19 showing Differential Diagnosis of Migraine 92- 9320 Table No 20 Showing the Nrupavallabha Taila ingredients 10021 Table No 21 Showing the Shambukadya Gutika Ingredients 10122 Table No 22 Showing the Grading for objective parameter for 107-108 both shamana & shodhana aushadies23 Table No 23 Showing the Assessment chart for shaman aushadhi 108 (Subjective Parameters)
  • 24 Table No 24 Showing the Assessment chart for shaman aushadhi 108 (Objective Parameters)25 Table No 25 Showing the Assessment chart for navana nasya 109 (Subjective Parameters)26 Table No 26 Showing the Assessment chart for navana nasya 109 (Objective Parameters)27 Table No 27 Showing the Distribution of patients by Age in 113 Groups-A & B28 Table No 28 showing the incidence of Gender in Groups-A & B 11429 Table No 29 Showing the Incidence of Ardhavabhedaka in 114 different religions in Groups - A&B30 Table No 30 Showing the Incidence of Ardhavabhedaka in 115 different occupation in Groups -A & B31 Table No 31 Showing the Incidence of Ardhavabhedaka acc. to 116 marital status in Groups-A & B32 Table No 32 Showing the Showing Incidence of 117 Ardhavabhedaka acc. to Socio-Economic status in Groups-A&B33 Table No 33 Showing the Incidence of Family History status in 117 Groups-A & B34 Table No 34 Showing the Incidence of distribution of patients 118 diet pattern35 Table No 35 showing the distribution of patients by Rasa 119 predominance:36 Table No 36 showing the distribution of patients by Agni: 12037 Table No 37 showing the distribution of patients by koshta: 12138 Table No 38 Showing the distribution of patients by pureesha 122 pravruti:39 Table No 39 showing the distribution of patients by chronicity of 123 chief complaints:40 Table No 40 Showing the distribution of patients by Vyasana 125
  • 41 Table No 41 showing the distribution of patients by Nidra 12542 Table No 42 Showing the distribution of patients by Menstrual 126 History43 Table No 43 Showing the Incidence by Precipitating Factors: 12744 Table No 44 Showing the Incidence by Relieving Factors: 12845 Table No 45 showing the distribution of patients by previous 129 treatment history46 Table No 46 showing the distribution of patients having Stress 12947 Table No 47 showing the distribution of patients by Chief 130 Complaints48 Table No 48 Showing the distribution of patients by Associated 131 Complaints49 Table No 49 showing the distribution of patients by Location of 132 pain50 Table No 50 showing the distribution of patients by Nature of 133 pain51 Table No 51 showing the distribution of patients by Time 134 Intensity of pain52 Table No 52 showing the distribution of patients by Onset 13453 Table No 53 showing the distribution of patients by Duration of 135 pain54 Table No 54 showing the distribution of patients by Frequency 136 of attack55 Table No 55 showing the distribution of patients according to 137 Aharaja Nidana56 Table No 56 showing the distribution of patients according to 138 Viharaja Nidana57 Table No 57 showing the distribution of patients according to 139 Manasika Hetu58 Table No 58 showing the distribution of patients according to 139
  • Intensity of pain during Menstruation59 Table No 59 showing the distribution of patients according to 140 Roopa60 Table No 60 showing the distribution of patients according to 141 Prakruti61 Table No 61 showing the distribution of patients according to 142 Sara62 Table No 62 showing the distribution of patients according to 143 Samahanana63 Table No 63 showing the distribution of patients according to 143 Satmya64 Table No 64 showing the distribution of patients according to 144 Satwa65 Table No 65 showing the distribution of patients according to 145 Abhyavaharana Shakti66 Table No 66 showing the distribution of patients according to 146 Jarana Shakti67 Table No 67 showing the distribution of patients according to 146 Vyayama Shakti68 Table No 68 showing the distribution of patients according to 147 Vaya69 Table no 69 showing the result of Severity of Pain 14870 Table no 70 showing the result of Duration of Pain 14871 Table no showing 71 the result of Frequency of Pain 14872 Table no 72 showing the result of IHS Criteria 14873 Table no 73 showing the result of Shirashoola 14974 Table no 74 showing the result of Shankha Shoola 14975 Table no showing 75 the result of Manya,Bhru,Akshi,Lalata 149 Shoola76 Table no 76 showing the result of Bhrama 150
  • 77 Table no 77 showing the Net result of Subjective & Objective 150 Parameter (Group- A)78 Table no 78 showing the result of Sevirety of Pain 15079 Table no showing 79 the result of Duration of Pain 15180 Table no 80 showing the result of Frequency of Pain 15181 Table no 81 showing the result of IHS Criteria 15182 Table no 82 showing the result of Shirashoola 15283 Table no 83 showing the result of Shankha Shoola 15284 Table no 84 showing the result of Manya,Bhru,Akshi,Lalata 152 Shoola85 Table no 85 showing the result of Bhrama 15386 Table no 86 showing the Net result of Subjective & Objective 153 Parameter (Group- B)87 Table no 87 showing the Statestical Result of Gp- A &Gp- B 153-15888 Table no 88 Showing the overall result of Single Patient wise 159 Gp- A89 Table No 89 Showing Overall Result of Single Patient wise of 160 Gp- B
  • FiguresS.N Title of Figures Page1 Graph No 1 Showing the Distribution of patients by Age in Groups-A 113 &B2 Graph No 2 showing the incidence of Gender in Groups-A & B 1143 Graph No 3 Showing the Incidence of Ardhavabhedaka in different 115 religions in Groups - A&B4 Graph No 4 Showing the Incidence of Ardhavabhedaka in different 116 occupation in Groups -A & B5 Graph No 5 Showing the Incidence of Ardhavabhedaka acc. to marital 116 status in Groups-A & B6 Graph No 6 Showing the Showing Incidence of Ardhavabhedaka acc. 117 to Socio-Economic status in Groups-A & B7 Graph No 7 Showing the Incidence of Family History status in 118 Groups-A & B8 Graph No 8 Showing the Incidence of distribution of patients diet 119 pattern9 Graph No 9 showing the distribution of patients by Rasa 120 predominance:10 Graph No 10 showing the distribution of patients by Agni: 12111 Graph No 11 showing the distribution of patients by koshta: 12112 Graph No 12 showing the distribution of patients by pureesha pravruti: 12213 GraphNo13 Showing distribution of patientsby Chronicity of Chief 124 Complaints(GroupA)14 GraphNo14 Showing distribution of patientsby Chronicity of Chief 124 Complaints(GroupA)15 Graph No 15 Showing the distribution of patients by Vyasana 12516 Graph No 16 showing the distribution of patients by Nidra 12617 Graph No 17 Showing the distribution of patients by Menstrual 127 History18 Graph No 18 Showing the Incidence by Precipitating Factors: 12819 Graph No 19 Showing the Incidence by Relieving Factors: 12820 Graph No 20 showing the distribution of patients by previous 129 treatment history:21 Graph No 21 showing the distribution of patients having Stress 13022 Graph No 22 showing the distribution of patients by Chief Complaints 13023 Graph No 23 Showing the distribution of patients by Associated 131 Complaints24 Graph No 24 showing the distribution of patients by Location of pain 13225 Graph No 25 showing the distribution of patients by Nature of pain 133
  • 26 Graph No 26 showing the distribution of patients by Time Intensity of 134 pain27 Graph No 27 showing the distribution of patients by Onset 13528 Graph No 28 showing the distribution of patients by Duration of pain 13629 Graph No 29 showing the distribution of patients by Frequency of 137 attack30 Graph No 30 showing the distribution of patients according to Aharaja 137 Nidana31 Graph No 31 showing the distribution of patients according to Viharaja 138 Nidana32 Graph No 32 showing the distribution of patients according to 139 Manasika Hetu33 Graph No 33 showing the distribution of patients according to 140 Intensity of pain during Menstruation34 Graph No 34 showing the distribution of patients according to Roopa 14135 Graph No 35 showing the distribution of patients according to Prakruti 14236 Graph No 36 showing the distribution of patients according to Sara 14237 Graph No 37 showing the distribution of patients according to 143 Samahanana38 Graph No 38 showing the distribution of patients according to Satmya 14439 Graph No 39 showing the distribution of patients according to Satwa 14540 Graph No 40 showing the distribution of patients according to 145 Abhyavaharana Shakti41 Graph No 41 showing the distribution of patients according to Jarana 146 Shakti42 Graph No 42 showing the distribution of patients according to 147 Vyayama Shakti43 Graph No 43 showing the distribution of patients according to Vaya 14744 Graph No 44 Showing the overall result of Single Patient wise Gp- A 15945 Graph No 45 Showing the overall result of Single Patient wise Gp- B 160
  • Introduction Headache is the term used by patient to describe a variety of head pains anddiscomforts. Pain, it has been said; it is one of nature’s earliest signs of morbidity. Itstands pre-eminent among all the sensory experiences by which humans judge theexistence of disease within themselves. Headache in general is one of the commonestcomplaints of the people seeking professional help. Only few of us are spared theexperience of headache. As many as 90% of the individual have at least one headacheper year and 10 to 20% of the population go to physician with headache as theirprimary complaint, It is also a major cause of absenteeism from work and ofavoidance of social and personal activities. It is a benign symptom, which may be ofprimary etiopathic type or may be manifestation of a wide range of organic diseasessuch as brain tumour, subarachnoid hemorrhage, meningitis or giant cell arteritis. Itmay be psychosomatic like migraine, tension headache or may be psychogenic inorigin e.g. Anxiety, Depression, hypochondrial and delusional headache. Ardhavabhedaka is a vata and kapha pradhana shiroroga is one such diseasewhere pathology lies in uttamanga. The symptom complex of Ardhavabhedaka verymuch correlates to that of Migraine. The disease Migraine is characterized by periodicheadache, which is typically unilateral & often associated with visual disturbance &vomiting. The attacks occur at intervals, which vary from a few days to severalmonths. Migraine is seen more often in women where it affects approximately one infifth compared with men where the incidence is near one in 16. The prevalence ofrecurrent headache was found to be 18% in boys (males) and 21% in girls(female).Migraine can be associated with the Menstrual Cycle and about 2/3 ofmigraine disappear at the Menopause. 1
  • Based on the sign and symptoms, the condition Ardhavabhedaka may beconsidered with that of Migraine explained in modern science. Though theetiopathogenesis of Migraine is not clear but it is believed to be due to disturbance inthe carotid or vertebro basilar vascular tree by the sudden contraction and dilatation ofthe vessels. First vasoconstriction causes ischaemic symptoms & followedvasodilation exerts pressure on the nerve endings to vessels of intra or extracranialarteries, causes secondary muscular contractions. Ardhavabhedaka is the common problem encountered by the generalpractitioners. Severe headache causes discomfort to the patient. There is no specifictreatment for migraine in modern medicine. Most of the patients require costly andlong term psychotherapy like ergot, phenobarbitol, propranol etc. Even after long-term use of these drugs, the complaints in these patients are not completely curable.To overcome this problem many researches had done but still no effective drugs arefound. Current drugs, which are available, are specially analgesics and narcotics,which have many complication or adverse effect like Stroke, Coma, Hypertension,and Loss of senses. So it becomes necessary to study Ayurvedic Shodhana therapy likeNasyakarma and Shamana therapy, for the management of shiroroga. In this regardAyurvedic system of medicine provides effective management to Ardhavbhedaka(Migraine) The Ayurvedic compound chosen for the present clinical studyShambukadya Gutika internally and Nrupavallabha Taila nasya will route outardhavbhedaka (Migraine). The oushadhi dravyas administred through Nasa directly enters in to Shirasand cures Shirorogas, so in this study for 14 patients Nasya with Nrupavallabha Taila 2
  • is administered. This taila mainly contains Vatashamaka and kaphaghna dravyas,which are the main culprit to cause Ardhavabhedaka. Shambukadya Gutika which contains Kaphaghana, Vatashamaka andShoolaghana dravyas which are helpful to break down the samprapti ofArdhavabhedaka So, Comparative study of Shambukadya Gutika and Nrupavallabha TailaNavana Nasya in the management of Ardhavabhedaka W.S.R.T Migraine isundertaken to compare the efficacy of Nasya and Shamana oushadhi. 3
  • Objectives Ayurvedic science, a boon in today’s world, describes swastha parayanata,which means maintenance of health in the one hand and treatment of disease on theother. It has been described in Ayurveda that it is not rational treatment where themedicine modifies one disease; on the other hand it provokes new complications. Sohere, we are putting our step forward to find safe and effective remedy for nature’searliest sign of morbidity i.e. headache. Headache in general is one of the commonest complaints of the people seekingprofessional help. As many as 90% of the individuals have at least one headache peryear and 10-20% of the population go to physician with headache as their primarycomplaint It is a benign symptom, which may be of primary etiopathic or may bemanifestation of a wide range of organic diseases. Migraine headache is a severe head pain often unilateral and frequentlydescribed as throbbing in nature. Migraine attacks may include nausea and vomiting,photophobia and phonophobia. It is usually recurrent and episodes last any wherebetween four hours and three days. Ardhavabhedaka is a vata and kapha pradhanashiroroga is one such disease where pathology lies in uttamanga. The symptomcomplex of ardhavabhedaka very much correlates to that of migraine. There is no specific medicine for migraine in the contemporary science. Mostof the patients need costly and long term psychotherapy. Current drugs which areavailable are specially analgesics and narcotics, which have many complications oradverse effects like stroke, coma, HTN, and loss of senses. In this regard the objectives proposed in the study are -Objectives:1) To evaluate the effect of Shambukadya vati in Ardhavabhedaka. 4
  • 2) To evaluate the effect of Nrupavallabha taila in Ardhavabhedaka.3) To evaluate the effect of nasya in Ardhavabhedaka.4) To assess the comparative efficacy of Shambukadya vati and Nrupavallabha taila Navana nasya in Ardhavabhedaka The Ayurvedic compound choosen for the present clinical studyShambukadya gutika internally and Nrupavallabha taila nasya will route outardhavabhedaka. As the ardhavabhedaka has its root in the uttamanga i.e. shiras and nasa is theshirodwara, hence nasya dravya directly enters into shiras and cures shiroroga. Thenasya dravya selected mainly contains vatashamaka and kaphaghna dravyas which arethe main culprits to cause ardhavabhedaka. Shambukadya gutika which contains kaphaghna, vatashamaka andshoolaghna dravyas are helpful to break down the samprapti of Ardhavabhedaka. So, the comparative study of Shambukadya gutika and Nrupavallabhataila navana nasya in the management of Ardhavabhedaka W.S.R.T. migraine isundertaken to compare the efficacy of nasya and shamana aoushadhi. 5
  • Historical review The meaning of historical review is to trace out a continuous chain ofknowledge and by that come to know that where at present. The history of medicine isas old as human civilization. Plenty of disorders have been found referred in theancient literatures of Vedic period, either directly naming the disease itself or byhinting the nature of the disorder. In historical period disease ardhavabhedaka is notexplained in the form of detailed chapters. The acharyas were attempted to study the disease on doshas and broadlynamed this disease as shiroroga. The various references started from Vedic period aregiven below.Vedic period: In Rigveda and atharvaveda the term “Shirashakti” is mentioned whichrepresents all Shirorogas and the term “Shirashamya” which has taken as diseaseoccurring in shiras1.Samhita kala The references regarding shirorogas are available in different samhitaslike, Charaka samhita, Sushruta samhita, Bhel samhita, and Hareeta samhita.Charaka samhita: Nasya is indicated for this disease2. Vegadharana is considerd as one of thehetus for ardhavabhedaka3. The Nidana, bheda, roopa, samprapti, laxanas areexplaind4Sushruta samhita: Acharya sushruta has explained the samanya & vishesha chikitsa of diseaseardhavabhedaka5. 6
  • Bhel samhita: In the Bhel samhita Vishesha nidana, samprapti, lakshanas, and chikitsa ofdisease ardhavabhedaka are explained6Hareeta samhita: In Hareeta samhita a separate chapter for shiroroga are explained in whichardhashiroruja is mentioned7Sangraha kala: (500 BC-800 BC) In this kala also several books were written like Astanga sangraha, Astangahrydam and Madhava nidana which dealt about disease ardhavabhedaka.Astanga sangraha: Nirukti, Samanya nidana, and complications are explained8Chikitsa of ardhavabhedaka is explained in detail9Astanga hrydam: Nirukti, Samanya nidana, and complications are explained10Samanya and vishesha Chikitsa of ardhavabhedaka explained in detail11Madhava nidana: Vishesha nidana, bheda, sites of pain and nature of pain is described in detail12Gada nigraha: A compiled book was written by acharya Shodala having detailed descriptionabout vishesha nidana, samprapti, bhedas, and sites and nature of pain13.Adhunika kala: In Bhavaprakasha, vishesha nidana, samprapti, and bheda, sites and nature ofpain are explained in detail14 7
  • Chakra dutta: In this text only particular aushadie yogas for the treatment for ardhavbhedakais mentioned15Yogaratanakara: Vishesha nidana, bheda, sites and nature of pain is described in detail16Review of previous research works- Many researches are carried on ardhavabhedaka. During the present studysome researches are taken for the reference, those are enlisted below.1) Vijaylaxmi- comparative study on the role of Gunja Taila nasya and pathyadikwatha in ardhavabhedaka- A clinical study, 2000, G A M C Bangalore.2) Lalitha B R- Experimental evalution of vedana sthapaka action of Mundi(Spherathus Indicus) W.S.R to ardhavabhedaka,, 2000, G A M C Bangalore.3) Dai Nirmala jyothi k- Management of ardhavabhedaka with maricha bhringarajalepa with and without shadbindu nasya, 2004, Dr B K R R G A M C, A P university,vijeyawada.4) Arun B S- The study on the role of nasya karma in the management ofardhavabhedaka, 1987, I P G T & R A Gujarat Ayurveda University.5) Arya s- Ardhavabhedaka chikitsa main pathyadi kwatha evam kumkuma nasya kakarmatmaka adhyayana 1993, National Institute of ayurveda, Jaipur.6) Bajaj Harshita- To compare clinical efficacy of shirah shooladi vajra rasa herbaland without classical kajjali in patients of ardhavabhedaka W S R T , Migraine, 2002,State ayurvedic college, Lucknow.7) Sheshadri B V- Ardhavabhedaka and its management, 1987, G A M C, Mysore.8) Geetha s- Clinical study on the effect of Brimhana nasya and shamana aushadha inardhavabhedaka W S R T Migraine, 1998, G A M C, Mysore. 8
  • 9) Thakur Y D- Avapeedana nasya ka ardhavabhedaka, sooryavarta par prayogikaadhyana, 2002, Shri ayurveda mahavidyalya Nagpur.10) Gharde S G- Ardhavabhedaka shiroroga par dashmoola taila kshara nasyaprayoga, 1998, Shri ayurveda mahavidyalya Nagpur.11) Lalitha -Concept of nasya karma in shiro roga W S R T ardhavabhedaka and itsmanagement, 1999, university of pune.12) Kavitha S- Pharmaceutical development of shirashooladi vajra rasa W S R T itsefficacy on ardhavabhedaka, 1996, G A M C Kerala University, Thiruvanantapuram.13) Bhaswati J- Astudy on preventive and curative aspects of ardhavabhedaka(migraine) with yoga and selected ayurvedic modalities 1999, G A M C KeralaUniversity Trivendrum.14) Madan Sandeep- Pharmaceutical preparation and standerisation of anu taila(Dasha- Avartila) and kapha ketu rasa W S R T their comparative study onardhavabhedaka, 2003, M M M G A M C Rajesthan University, Udaipur (Jaipure)15) Sharma M C- Jyotishmati ka vanaspatika adhyayan evam ardhavabhedaka parkarmukta 1988, M M M G A M C Rajesthan University, Udaipur (Jaipure). 9
  • Review of the literature Nirukti: The word ardhavabhedaka is made up of two words i.eArdha +Bhedaka= Ardhavabhedaka(yan sandhi)Ardha17 means half, half part, halved or farming half. (William 1973)Bhedaka 18- means breakinginto, piercing, perforatimg. (William 1973) Totally the word meaning of ardhavabhedaka is a piercing type or breakingtype of pain in half partDefinition: Ardhatu moordham soardhavabhedaka19 Ardhatu shirasaha ardhabhedaka ucchataeArdhavabhedaka means piercing type or breaking type of pain in half portion of theShiras or moordha is known as ardhavabhedaka. If one half of the head develops severe tearing and pricking pain, giddiness and piercing pain suddenly after a fortnight or ten days. This should be diagnosed as Ardhavabhedaka20 Pain in half side of head is considered as Ardhavabhedaka21 Ardhavabhedaka is one type of shirah shoola where arani manthanavat shoola is experienced in half part of the head involving bhru, akshi, lalata etc. caused by vata alone or in association with kaph22Paryaya: Ardha sheersha vikara Ardha bheda Ardha shiro ruja 10
  • All these paryayavachi pada’s carry the same meaning that shoola is present inhalf portion of the Shiras.Bhedas: When we look through the classification of Ardhavabhedaka it is clear that itis of doshaja variety. According to Acharya Sushrutha the disease Ardhavabhedaka isTridoshaja. Acharya charaka considers Ardhavabhedaka as vataja, vatakaphaja.According to Acharya madhavakara in madhava nidana, acharya bhava prakasha andin nimitantra disease ardhavabhedaka is vataj or vatakaphaj. Only acharya vaghbhatatold disease ardhavabhedaka as vataj only. So, Ardhavabhedaka is a tridoshajavyadhi, but vata and kapha are the pradhana dosha. The classification of ardhavabhedaka according to different acharyas asfollows, Acc. to acharya charaka23- vataj or vata kaphaj. Acc. to acharya shusruta24- Tridoshaj. Acc. to madhavakara25 - vataj or vata kaphaj. Acc .to Bhava Prakash26 –vataj or kaphaj Nidana Nidana plays an important role in manifestation of disease. In classics nidanais defined as, the factors, which lead to the disease by deranging the equilibrium ofthe doshas in the body. The knowledge of the nidana is necessary to know thesamprapti and sadhyasadhyata of disease. Prevention is very essential by nidanaparivarjana, which acts as the first line of treatment. As ardhavabhedaka is enumerated under types of shiroroga, and we get thereferences of samanya nidana of shiroroga separately hence it is also considered. In 11
  • the context of the disease ardhavabhedaka specific causative factors of the disease arementioned. For the purpose of easy understanding the nidanas of ardhavabhedaka can beclassified under following headings.Samanya nidana – which can be again classified as Aharaja Viharaja Manasika AgantujaVishista nidanas - This can be again classified as. Aharaja Viharaja Mansika Other than these causative factors improper usage of certain treatmentprocedures are mentioned as causative factors of ardhavabhedaka.Samanya nidana of Shiroroga27, 28, 29 Adhyashana: Intake of food before the digestion of previous meals. Ati amla sevana: Excessive intake of sour food items. Ati sheetambu sevana: Excessive intake of cold water. Athi Madya pana: Excessive intake of alcohol. Ati teekshna and ushna aharasevana: Excessive intake of teekshna and hot foods. Athi guru ahra sevana: Excessive Intake of food, which is heavy for digestion. Harithadana: Intake of spicy foods like pippali etc. Abhyanga dwesha: Ambukreeda: Excessive playing in water or swimming 12
  • Asathmya gandha grahana: Inhalation of Incongenious odourAtapa sevana: Excessive exposure to sunlight.Ati maithuna: Excessive indulgence in sexual act.Ati shaityata: Excessive exposure to cold.Atibharavahana: Carrying of heavy items excessively.Avashyaya/ Tushara sevana: Excessive exposure to mist.Bhashpa nigraha: Doing of ashru vegadharana.Desha viparyaya: The desha is of three types: anupa, jangala and sadharana. If aperson moves from one desha to another he will be exposed to sudden change inenvironment.Dhooma sevana: Excessive inhalation of dhooma.Divaswapna: Sleeping during daytime.Kalaviparyaya: Means mithyayoga of kala.Megagama: Presence of excessive clouds.Mruja dwesha: Hating of cleanliness by snana, jiwha nirlekhana, dantha dhavana,gandusha etc.Adhaprathathekshana: Continuous strenuous looking in down ward direction.Purovata sevana: Expoture to cold breeze from eastern direction.Raja sevana: Excessive exposure to dust.Ratri jagarana: Awakening during night.Ucchhirabhashana: Excessive loud speech.Upadhana: Using of high pillow during sleep.Uthsweda: Excessive sudation to upper part of the body.Vegadharana: Supression of natural urges.Manasanthapa: Vaichitya, arathi and glani are manasanthapa lakshanas. 13
  • Rodhana: Excessive weeping.Vishishta nidana30, 31, 32, Adhyashana: Intake of food before the digestion of previous meals. Athyashana: Consumption of food in excessive quantity. Rookshana: Excessive consumption of food having rooksha guna. Ayasa: Excessive physical strain. Chardhi nigraha: Supression of chardi Vega. Kshavathu nigraha: Supression of kshavathu Vega. Vyayama: Excessive excersize.Table no 1 showing Samanya shiroroga nidanasNidanas CS AH AS HS YRAdhyashana – + + – –Ati amla sevana + – – – –Atisheetambu sevana – + + – +Athi Madhya pana – – – + +Atiteekshna and ushna aharasevana – – – + –Athi guru ahra sevana + – – – –Harithadana + – – – –Abhyanga dwesha – + + + –Ambukreeda + + + – +Asathmya gandha grahana + + + – +Atapa sevana + + + + +Ati maithuna + + + – +Ati shaithyata – – – + –Athibharavahana – – – + –Avashyaya/ Tushara sevana + + + – +Bhashpa nigraha + + + – +Desha viparyaya + – – – –Dhooma sevana + + + – + 14
  • Divaswapna + – – – –Kalaviparyaya + – – – –Megagama + – – – –Mruja dwesha – + + – +Adhaprathathekshana – + + – +Purovata sevana + + + – +Raja sevana + – – – –Ratri jagarana + + + – +Ucchairbhashana + + + – +Upadhana – + + – +Uthsweda – + + – +Vegadharana + + + – +Manasanthapa + – – – –Rodhana + + + – +Table no 2 showing Vishista nidanas of ardhavabhedaka33, 34, 35, 36Nidana CS BS MN BP YR GN VSRookshana + – + + + + +Adhyashana + – + + + + +Athyashana + – + + + + +Ayasa + – + + + + +Chardhi nigraha – + – – – – –Kshavathu nigraha – + – – – – –Vyayama + – + + + + +Purovata + – + + + + +Avashyaya + – + + + + +Maithuna + – + + + + +Vegasandharana + – + + + + +Diwaswapana – + – – – – –Abhigata – + – – – – –Pratapa – + – – – – – 15
  • Poorvaroopa: Poorva roopa of disease ardhavabhedaka have not been mentioned specificallyin the text either shirashoola in general or ardhavabhedaka in specific. So, in generalthe poorva roopa can be assumed Alpa and avyakta laxanas.Roopa: When the disease manifests itself through some of the laxanas, that stage istermed as rupa. It is the vyaktavastha of the kriyakala. The rupa of a disease may bevery specific of it which is termed as pratyatma laxana. Roopa are the symptoms,which denotes a disease that has manifest. The knowledge of roopa is very essentialfor diagnosis, prognosis and for the purpose of proper management. AcharyaVagbhata explains the laxanas of vataja shirashoola and he mentions that if theselaxanas are seen in half portion of the head, then it is known as Ardhavabhedaka37 andthe chikitsa of ardhavabhedaka is as same as vataja shirashoola mention in AstangaSangrahaBased on the above references, an attempt is made to consider the laxanas of vatajashiroroga under the heading of Ardhavabhedaka.Table no 3 showing Laxanas of ardhavabhedaka:Laxanas CS SS AH BS GN MN YR BP ASArdha shirashoola + – – – + + + + –Manya shoola + – – – + + + + –Bhru shoola + – – – + + + + –Shankha shoola + – – – + + + + –Karna shoola + – – – + + + + –Akshi shoola + – – – + + + + –Lalata shoola + – – – + + + + –Shastra arani nibham + – – – – + – – –Akasmat Kupyati – + – – – – – – – 16
  • Bhrama – + – – – – – – –Bhrumadhya shoola – – + – – – – – +Chakshu shvyathu – – – + – – – – –Dwadashat kupyati – + – – – – – – –Dwitiyat kupyati – + – – – – – – –Ganda shvyathu – – – + – – – – –Gharana srava – – + – – – – – +Hanu graha – – + – – – – – +Masat kupyati – + – – – – – – +Pakshat Kupyati – + – – – – – – +Prakasha santrasa – – + – – – – – +Sambheda – + – – – – – – –Swayamevashamyati – – + – – – – – +Sirajala spurana – – + – – – – – +Skandha graha – – + – – – – – +Toda – + – – – – – – –Trayat kupyati – + – – – – – – –Samprapti: Nidanas are the first & foremost requirement in the course / development ofvyadhi. The process which explains how the dushita doshas travel in the body andcauses dhatu dusti & roga utpatti is termed as Samprapti38. By knowing the sampraptiwe can express what are the doshas, dhatus, srotas, rogamarga involved in thatparticular disease. So, specific samprapti of Ardhavabhedaka as well as samanyasamprapti explained for shiroroga has been considered. Samprapthi is one among the nidana panchaka, which is essential for theproper knowledge of the disease. Acharya Charaka explains the samanya shirorogasamprapti in the sutrasthana that, the dosha prakopaka nidanas will result in prakopa 17
  • of single dosha or tridosha, then cause dooshana of rakta and leads toArdhavabhedaka39 The nidana explain in the visesha samprapti of Ardhavabhedaka does prakopaof vata alone or along with kapha, seated in half portion of shiras & causeArdhavabhedaka40. In the ardhavabhedaka kevala vatajanya or vatakaphajanya doshas arepredominant... In both the varieties i.e. kevala vatajanya and vata kapha janya, vataplays the key role, while in the latter variety kapha plays the role of anubandhi dosha.So, the dosha and dushya become vitiated and take place in different shatkriya kalaleads to ardhavabhedaka.Sanchaya Nidana, such as ruksha ahara, purvayu, shoka, ratri jagarana, vegavarodhacause the sanchaya of vata in its udbhava sthana. If the above nidanas are alsoassociated with kaphakara nidanas such as guru bhojana, sambhojana, adhyashanasheetambupana, there is sanchaya of kapha along with vata in amashaya.Prakopa If nidana parivarjana is not done in the sanchya stage, continued associationwith the nidana leads on to the prakopa of vata either alone or along with kapha.Prasara In this stage, specific nidanas such as vyayama, ushna, teekshna ahara &vegadharana cause the prasara of the doshas from kosta to shakha, marmasthi sandhi.During this avastha the vitiated doshas circulating and does dooshana of the rasadhidhatus which are already durbala due to nidanas such as madhyapana, amla rasasevana, pratapa. 18
  • Sthana Sanshraya There will be khavaigunyata in Shiras with specific location such as akshi,bhru, lalata, shankha, manya etc. Hence the dosha which are in prasaravastha attainsthanasamshraya in Shiras.Vyakta When the dosha & dooshyas seated in specific srotas, the disease ismanifested. Since vata affects the siras of shirah and it attains shaithilya & there isakunchana and purana. On the basis of nidana it is obvious that the vitiated Doshas,particularly Vata or Vata-kapha reach the head which in turn vitiate Rakta andRaktavaha Srotas situated there leading to manifestation of signs and symptoms ofArdhavabhedaka in this fifth stage of Samprapti. Also there is rakta dusti hence the vascular disturbance manifest in the formof shoola in ardha parshwa of Shiras. The episodic nature of Ardhavabhedaka is resultant of the effect of vyanjakahetus such as manasantapa, amla rasa, and pratapa. Because of they do immediatevata prakopa and kapha vilayana. However, it is difficult to explain the reason behind only the half part of theShiras being affected during the episode. It is probably due to vyadhi swabhava.Bheda The ativridda doshas affect the indriyas at this juncture due to impropertreatment and result in upadravas like shrotra & nayana vinasha.Samanya samprapti: Due to the different kind of samanya shiroroga nidana indulgence in above-mentioned Doshas, viz. Vata, Pitta & Kapha get aggravated. Resulting in the vitiationof Rakta in the head, resulting in the disease Shirahshoola 19
  • Vishista samprapti: The Nidana factors vitiate either vata alone or associated with kapha invadesthe half portion of the head and causes ardhvabheadaka41, 42.Samanya shiroroga samprapthi: Nidana Sevana Aggravated Vatadi & Rajadi Dosha Vitiation of Rakta in head Shiroroga with various symptoms 20
  • Vishishta Samprapti of Ardhavabhedaka: Aharaja, Nidana Sevana Viharaja, Manasika Dosha prakopa Agnimandya Kha-vaigunya Sroto DushtiVata Kapha Raja tamaDominating Prakopa Amotpatti Tridosha Prakopa Rasa Rakta Kha-vaigunya in Dushti Rasavaha and Raktavaha Srotas Prasara Sthana samshrya Ardhashirah Ardhavabhedaka 21
  • Samprapthi ghatakas:Doshik involvementAccording to different Acharyas different type of dosha involvement is there in thesamprapti charkaTable no 4 showing dosha involvement in samprapti ghatakasDosha S.S C.S Dalhana M.N A.H H.S Y.RVata - + + + + + +Pitta - - + - - + -Kapha - + - + - - +Tridosha + - - - - - -Dhushya: RakthaAgni: JatharagniAma: JatharagnimandyaUdbhava sthana: AmapakwashayaSrothas: RakthaSrothodusti prakara: vimargagamana, SangaAdhistana: ShirasVyaktha stana: Ardha ShirasRogamarga: MadhyamaUpashaya & anupashaya: Upashaya & anupashaya helps to the vaidya when diagnosis becomes difficultdue to guda linga. And with the Upashaya & anupashaya use of in order to decidepathya-apathya. No references are available in any of texts which deal with upashayaand anupashaya of Ardhavabhedaka. 22
  • The onset is sudden with regular intervals and it gets reduced by itself i.e.swayamiva shamyathi without any proper medication. It is also mentioned that thenature of onset is akasmat that is the onset is sudden43Upadrava After knowing in detailed about the nidana, poorvaroopa, roopa, sampraptione should also be kept in mind while treating the patient i.e. upadrava. Becauseupadravas are the resultant by which we can diagnose the patient correctly. In Ardhavabhedaka, Acharyas have listed only two upadravas44, 45, 46 whichcan occur independently or together. These upadravas manifest when doshas becomeativridda. Nayana vinasha (destruction or loss of visual capacity) Shrotra vinasha (destruction or loss of hearing capacity)Sadhya sadhyatha: After diagnosis the disease, by using the factors like poorvaroopa, roopa,upadrava then all these factors help to decide the sadhyasadhyatha. This not onlyhelps the physician to achieve success in treatment but also minimize the risk forpatient. By Knowing the sadhyasadhyatha lead us in a direction to give appropriatetreatment. Regarding Ardhavabhedaka.In Bhela Samhita is of the opinion that it is‘Sudustara’47, literally which means ‘Attidukhena taraneeyaha’. Hence it can beconsidered as kastasadhya vyadhi. In male after the age of 50 and in Female after the menopause, pain ofardhavabhedaka will disappears. 23
  • Arishta: The arishta laxanas of disease ardhavabhedaka is not mention in the texts butthere is a reference of arishta laxanas of Shiroroga in Harita Samhita that if occursearly in the morning then that patient’s life span is supposed to be short.Sapeksha/ Vyavachedaka Nidana To pinpoint the diagnosis and to adopt best modality of the treatment for thecondition, sapeksha nidana is very essential. It is essential to rule out other possiblediseases, which are having the similar symptoms. The cardinal feature ofardhavabhedaka as mentioned in rupa is also present in other urdhvajatrugatadisorders but they do not form the cardinal features of those diseases. The diseasesconsidered for vyavachedaka nidana are as follows.Table no 5 showing Sapekshata of ArdhavabhedakaSl. No. Vyadhi Laxana1 Anantavata48 Manya shoola, teevra ruja in akshi, bhru, kampa in ganda parshwa, hanugraha, netra roga.2 Vataja Aranimanthanavat shoola in netra, toda, bheda, avilata Adhimanta49 of netra, vyatha in half portion of head.3 Anyatovata50 Shoola in greeva, karna, shiras, hanu, manya, bhru, akshi4 Vataja Shirashoola, toda, stambha, harsha and srava from Abhishyanda akshi5 Shankaka51 Raga and sopha at shanka pradesha, pralapa, jwara, trut, bramha, tiktasya and peetavadana 526 Suryavartha Spandana at gandaparshva, netraroga and hanugraha7 Ardita53 Vedana in greeva, chibuka, danta parshwa Vakrata of ardha bhaga of mukha, vak sangha 24
  • All the above vikaras of uttamanga are differentiated from Ardhavabhedaka on thebasis of episodic nature, associated symptoms such as shabdhasahishnutha,prakashasantrasa, bhrama etc.Chikitsa:Acharya Sushrutha opines that:“Doshaha ksheena brumhayitavyaha, kupitaha prashamitavyaha,Vridda nirharitavyaha, samsha paripalya iti siddhantaha54” Chikitsa is done in order to bring the vitiated doshas into samyavastha in theshareera and to maintain swasthya of the shareera by doing the different types ofchikitsa like Shodhana, shamana, brimhana, langhana etc. The treatment principal of disease ardhavabhedaka according to differentacharyas is mention as follows.Acc. to acharya Charaka55: Chatursneha (ghruta, taila, vasa, majja) in uttama matra and also purana ghruta for pana. Shirovirechana and kayavirechana. Nadi sweda Basti prayoga—Nirhoo vasti and anuvasana vasti Upanaha, shirovasti, Agni karma are the best treatment for ardhavabhedaka.Acc. to acharya shusruta56: Avapeedana nasya yoga— Nasya with shirisha moola and phala Nasya with vamsha moola and karpoora Nasya with vacha and pippali churna Nasya with yastimadhu churna and madhu Nasya with madhu, chandana, manashila churna 25
  • Ghruta prayoga— Madhura aushadies (kakolayadi gana) siddha kalka and kwatha siddha ghruta nasyaLepa prayoga— Sariva (anantamoola), nilakamala, kootha, yastimadhu mix with kanji and add ghruta and taila and apply on headAcc. to astanga sangraha57: Nasya prayoga Nirgundi patra swarasa , ghruta and saindhava Shirisha moola and phalaLepa prayoga— Sariva kalka, utpala, kushta, vacha, madhuka, pippali then add oil and swarasa of amla dravya and apply on headAcc. to Astanga Hrydam58: Nasya prayoga Shirisha beeja, apamarga moola, vida lavana choorna Sthira swarasa nasyaLepa prayoga— Prapunnata kala mix with amla dravya swarasa and apply over headAcc. To yogaratanakara59: Snehana and swedana should be given this is the best aushadhi Shodhana should be done by giving virechana and after that dhoomapana should be done and after that snigdha and ushna bhojana should be given vidanga and black tila lepa Girikarni (aparajita) phala and moola, jala kalka nasya Girikarni (aparajita) moola tied with ear does the shamana of pain Maricha and bhangre swarasa nasya or lepa 26
  • Maricha and tandulodaka (shalidhanya) nasya or lepa Madanphala, mishri, godugdha nasya Narikela jala, moorchita goghruta siddha ghruta nasya Sariva, kushta, madhuka, vacha, pippali, nilakamala add kanji and ghruta and apply over head Maricha and tandulodaka (shalidhanya) nasya or lepa Shunthi and jala lepaKsheerapana— Sharkara and godugdha pana Narikela jala pana Sheetala jala panaAcc. to Gada Nigraha60: Nasya prayoga Nasya with kumkuma (kesar) fried in ghee and mix sugar Nasya with masha moola, sweta aparajita and rasona kalka Gunja moola navana nasya Patha moola choorna nasya Shirisha, moolaka, madanphala kalka, rasa avapeedana nasya Vacha, pipppali kalka rasa avapeedana nasya Shaliparni rasa nasya Shunti, rasona, tulsi beeja, vacha, pippal kalka rasa avapeedana nasyaLepa prayoga— Chakramarda beeja mix with kanji and apply lepa over headAcc. to chakradata61: Brhajjivakadya taila nasya Kumkumadi taila nasya 27
  • Dashmooladi kwatha nasya Jangala mamsa upanaha Sarivadi lepaAcc. to bhaishajya ratnavali62: Sarivadi lepa Hurhur beeja churna and swarasa of the same patra lepa apply over the head Dashmoola aushadhi kwatha, ghruta and saindhava lavana nasya Dugdha pana with sharkara Narikela jala pana with sharkara Only sheetala jala Chatursneha nasya Black tilla, jatamamsi churna, saindhava lavana and madhu lepa apply over lalata and head Vidanga, Krishna tilaand add jala and take swarasa and nasya should be given Dagdha choolika mritika churna, black maricha churna mix with each other and give nasya for ardhavabhedaka patient 28
  • Shiroroga:Sirah (head) The shirah is the supreme of all the organs because in a living being, the headis the substratum of ‘elan vital’ and all the sense faculties. So it occupies the firstplace amongst the vital organs of the body63. In the head are set, as rays in the sun, thesense organs and the channels carrying the sensory and vital impulses64. As regardsthe vital organs situated in the trunk, Shirah is considered as one of the threeimportant vital organs i.e. since the existence of the body is dependent upon them.Injury to Shirah may lead to death of the patientor it may lead to Rigidity of the sidesof the neck, facial paralysis, agitation of the eyes, stupefaction, and constricting painin the head, loss of movement, cough, dyspnoea, tinismus, dumbness, stutteringspeech, closed condition of the eye-lids, twitching of the cheeks, yawning fits,ptyalism, aphasia and facial asymetrySynonyms of shiroroga: Shiroabhitapa Shirapeeda Shirovedana ShiroshoolaDefinition of shirahshoola: Shirahshoola is also mentioned as synonym of Shiroroga. Charaka hasmentioned Shiroruk (Shoola) as separate disease among eighty types of vata-vyadhis65.The term shirahshula is limited only to the pain developed in the head.Though khalitya, palitya etc. occur in the head region they are not included in theshiroroga. Dalhana, the commentator of Sushruta samhita has also opined the same 29
  • and he says that shiroroga is limited only up to headache66. Hence, khalitya etc. arenot considered under shiroroga. Chakrapani Datta has also opined the same as that of Charaka and SushrutaBhaishajya Ratnavali considers shirahshula as the ruja developed in the head.Importance of shirah (head): Charaka has considered shirah as the supreme, important and major part of thebody, which is known as utthamanga for existing vital organs like prana, indriya,prana vaha srotas, sadyo pranahara marma, pranavata, sadaka pitta, aalochaka pitta,tarpaka sleshama and it is the seat for all samgnyavaha (sensory) and chestavaha(motor) prayatna etc.. Shirah has been compared with the Sun. Charaka explains thatall the sense organs and the channels carrying the sensory and vital impulses from theshirah are like the rays from the Sun67. Among the doshas pranavaha is situated inShiras Vagabhatta has compared human being with a tree, with roots at the top andbranches at the bottom and defined head as a site where all sense organs along withthe prana resides. Thus, being the site of conscience it is the supreme of all organs,which requires prime protection68. Vagbhatta has described ten “Jivita Dham” which are shira, rasanabandhana,kantha, asrak, hridaya, nabhi, basti, shukra, ojas, and guda69. He also considered thatshirah (head) is the root of the body and consciousness resides in head. Thus shirah isthe supreme amongst all the organs.Marmas of jatrurdhwa: There are 107 Marmas (vital parts) in the human body and the pradhanamarma is shirah. It is a sadyopranahara Marma. According to Sushruta among 107marmas 37 are situated in jatrurdhwa bhaga70 30
  • The total number of sadhyopranahara marma enumerated by sushrutha is 19,among which 15 are situated in shiras71Table no 6 showing Marmas in ShirasMarma Number Type Type SizeNeela 2 Vaikalyakara Sira marma 4 anguliManya 2 Vaikalyakara Sira marma 4 anguliSiramatruka 8 Sadhyopranahara Sira marma 4 anguliPhana 2 Vaikalyakara Sira marma ½ anguliApanga 2 Vaikalyakara Sira marma ½ anguliVidhura 2 Vaikalyakara Snayu marma ½ anguliKrukatika 2 Vaikalyakara Sandhi marma ½ anguliShankha 2 Sadhyopranahara Asthi marma ½ anguliUthkshepa 2 Vishalyagna Snayu marma ½ anguliAvartha 2 Vaikalyakara Sandhi marma ½ anguliShrungataka 4 Sadhyopranahara Sira marma 4 anguliAdhipathi 1 Sadhyopranahara Sandhi marma ½ anguliSthapani 2 Vishalyagna Sira marma ½ anguliSeemantha 5 Kalantharapranahara Sandhi marma 4 anguliTypes of shiroroga according to different acharyas: Acc. to Acharya Sushruta72: 11 types. Acc. to Acharya Charka73: 5 types Acc.to Bhava prakasha74: 11 types Acc.to Yogaratanakara75: 11 types Acc.to Madhava nidana 76: 11 typesTable no 7 showing types of shiroroga according to different acharyasS. NO DISEASE S.S C.S B.P Y.R M.N1 Vataj + + + + +2 Pittaj + + + + +3 Kaphaj + + + + + 31
  • 4 Tridoshaj + + + + +5 Raktaja + – + + +6 Kshyaja + – + + +7 Krimija + + + + +8 Suryavarta + – + + +9 Anantavata + – + + +10 Ardhavabheda + – + + +11 Shankhaka + – + + +Vataj shiroroga77: Nidana: By loud and excessive speech, pungent drinks, contact with coldwind, sexual indulgence, suppression of natural urges, excessive fasting, trauma,excessive virechana and vamana, excessive weeping, grief, caring heavy load,walking for long distance and emaciation in excess. Laxanas: There is pain in the temporal region and cracking sensation in thenape (The back side of the neck). The head and central part of eyebrows haveexcessive pain and burning sensation. There is pain and noise in the ear, there is afeeling as if eyes are coming out, giddiness, there is excessive throbbing of the veinsand the neck is stiffened etc.Pittaj shiroroga78: Nidana: By the intake of substances having katu, amla, lavana, kshara,Madhya, by anger, by expose to sun and fire. Laxanas: Burning and aching sensation in the head, patient develops a likingfor cold substances, burning sensation in the eyes and patient is subjected to thirst,giddiness. 32
  • Kaphaj shiroroga79: Nidana: By sedentary habits, sleep during day time, excessive intake of heavyand unctuous food, head get vitiated and cause shiroroga.Laxanas: There is heaviness in head along with dull pain and numbness in head.There isa feeling of the head being covered with a wet cloth and stiffness.Drowsiness,haziness and anorexia are associated symptoms in Kaphaja headache. Due topredominance of Kapha, sticky mucus secretion in throat, swelling of face and eyessockets. Vagbhatta enumerates additional symptoms as vomiting, dull pain duringdaytime and severe pain at night along with Shirah-nispandata and karnapida.Tridoshaj80: Head disease being caused by nidana all the three doshas, there is pain,giddiness, shaking of the head due to morbid vata, burning sensation, intoxication andthirst due to morbid pitta and heaviness and drowsiness due to morbid kapha.Raktaj shiroroga81: This type of Shirah shoola has been described by Sushruta only, starting thatwhen Rakta is vitiated there is Raktaja Shirah Shoola with presenting feature ofPittaja Shirah Shoola along with hyperasthesia of the head.Kshayaja shiroroga82: Shiroroga developes due to loss of vasa and kapha of the head and by injury.Itis difficult to cure and has very severe pain, pain increase by Snehana (sudation),Vamana, Dhumpana, Pradhamana and Siravedha theripes. 33
  • Krimija shiroroga83: Eating during indigestion, excess intake of tila, milk, jaggery, putrefied andwholesome food – all these vitiate Rakta, Kapha and Mamsa and result in stickinessproviding favorable condition for propagation of pathogenic organism leads to severepain in the head, worms eat away the interior of the head, persons feels as though hishead is exploding, watery fluid mix with blood flows out from the noseSuryavarta84: Due to suppression of natural urges, indigestion etc Rakta and Vayu getsvitiated and then affects the brain which thus affected is gradually liquefied aftersunrise due to heat of sunrays and headache increase as the day advances and getsubsided at the end of the day when the brain matter is solidified. According to Sushruta, pain starts mildly in the region of the eyes andeyebrow with sunrise, gradually gaining momentum by midday and finally subsidesas the sunsets. The condition is relieved sometime by cold measures and sometime byhot measures. It is Sannipataja and very difficult to treat.Anantavata85: Due to indulgence in fasting, grief, rooksha ahara, atisheeta ahara and alpabhojana, all the three doshas get vitiated and cause intense pain in manya (carotidregion) and back of the neck and pain is referred to eyebrows and temple region. Itcan cause twitching near the cheeks, eyes disease and lock jaw.Ardhavabhedaka86: Vayu vitiated due to intake of rough food, over eating, eating duringindigestion, easterly winds, excessive sexual indulgence, suppression of natural urges,strains or over exertion, either alone or in combination with Kapha – vitiated Vataseize half of the head and cause severe pain like cutting and churning in half of the 34
  • carotid region neck, eyebrow, temple ear, eye or forehead of the one side of head. Thepain is very internees and agonizing. If condition is aggravated there is impairment ofeye and ear functions. It has been elucidated by Vagbhatta that this type of headachedevelops either at the intervals of fortnight or a month and subsides of its own accord.Shankhaka87: When Rakta, Pitta and Vata are vitiated simultaneously and reside inhead specifically the temporal region – this cause severe swelling with intense pain,burning sensation and redness and swelling. This condition is poorly prognosticatedas the manifestations leads to obstruction in head and throat and kills the patientwithin three days. Vagbhatta adds to the above description, delirium, fever, thirst,giddiness, bitter taste in mouth and yellow colored face. This type of headache is verysevere and difficult to manage even by the joint advice of thousands of physicians andis regarded to be dangerous as death itself.Pathya- Apathya88:Table no 8 showing Pathya for shiroroga1 Kriyakrama Swedana, Nasya, Dhumpana Virechana, Lepa, Vamana, Langhana, Shirobasti, Raktamokshana, upanaha.2 Aahara Purana Ghrita, Shali, Shashtikashali, Saathi chawal, Yusha, dugdha, jangala mamsa,3 Shakhavarga Parvalla, sahijana, , karvellaka, tarkari, shigru.4 Phalavarga Amra, Amalaki, Dadima, Matulunga, nimbu, Draksha, Narikela.5 Drava ahara Milk, Oil, narikelambu, Kanji, Takra, dadhi, jeernavari.6 Aushadis Kushta, Bhringaraj, Kumari, Musta, Ushira, Karpura,Table no 9showing Apathya for shiroroga1 Vihara Kshvayathu, jrumba, mutra, nidra, mala vegadharana, krodha, divaswapna, jalamajjana, dantakasta.2 Ahara Viruddha bhojana, , unboiled ksheera3 Jala Himajala, dhushita jala, sahya and vindhya parvata jala. 35
  • Nasa Shareera“Aushadham aushadha sneho va naasikabhyama deeyate iti nasayam siddhama89” Aushadhi or aushadhi siddha sneha administered through nasa marga is knownas Nasya karma. It is a special and important therapy in which the medicine isadministered through the nose either in the form of churna, kalka, sneha or dhoomaetc that is known as nasya and the process is known as nasya karma. “NaasahiShirasoodwaaram90” Nose is the gateway of the head. Nasya is very useful in thediseases of the upper part of the neck. Nasa acts as a barrier to spread the infection.The medicine administered through the nose reach the shiras and eliminate thevitiated doshas from the head. In Sushruta samhita the word shirovirechana is used fora type of nasya. Charaka has also used the word that nastha prachardana, andprachardana means vamana and this can be done with the help of nasya. ButChakrapani91 is of the view that Nastha Prachhardana also meant as Shirovirechana. In Ayurvedic samhitas the detailed description of Nasa Shareera is notavailable. Ghranendriya is one among Pancha Gynanendrias. It develops in the fetusin the 3rd month of intrauterine period92.Synonyms: Nasa, ghrana, nasika .Pramana: Nasa puta pramana is 2 anguli93. Nose contain tarunasthi (cartilage) and three bones94 (Ghonaasthi,Nasaakshisandhi, Nasavivara). Nasa is one type of srotas95 having 2 peshi96 and 2marmas called phana marma97 they are sira marma having ardha angula pramana andif the injury occurred it leads to destroy the sense of gandha. Nose having 24 siras98out of that 6 are vata vahini, 6 are pitta vahini, 6 are kapha vaha and 6 are raktha vahasiras99. Nose having two dhamini which dose the function of gandha ghrana.100Anatomy of nose101: 36
  • External nose:It is a pyramidal in shape with its root up and the base directed downward. Nasalpyramid consists of osteocartilaginous framework covered by muscles and skin.Osteocartilaginous framework:Bony part:Upper one- third of the external nose is bony while lower two – third arecartilaginous. The bony part consists of two nasal bones which meet in the mid lineand rest on the upper part of the nasal process of the frontal bone and are themselvesheld between frontal processes of the maxillae.Cartilaginous part: It consists ofUpper lateral cartilages:They extend from under surface of nasal bones above, to the alar cartilages below.They fuse with each other and upper border of the septal cartilage in the midlineanteriorly. The lower free edge of upper lateral cartilage is seen intranasally as limenvestibule.Lower lateral cartilages: (alar cartilage)Each alar cartilage is u- shaped.It has lateral crus which form the ala and medial crus which run in the columella.Lateral crus overlap lower edge of upper lateral cartilage on each side.Lesser alar cartilages:Two or more in number, they lie above and lateral to alar cartilages.Septal cartilage:Its anterosuperior border runs from under the nasal bone to the nasal tip. It supportsthe dorsum or cartilaginous part of nose.Nasal musculature: 37
  • Osteocartilaginous framework of nose is covered by muscles which bringabout movement of nasal tip, ala and the overlying skin. They are the procerus,nasalis, levator labii superioris alaque nasi, anterior and posterior dilator nares, anddepressor septi.Nasal skin: The skin over the nasal bones and upper lateral cartilages is thin and freelymobile while that covering the alar cartilages is thick and adherent, and contains manysebaceous glands.Internal nose: It is divided into right and left nasal cavities by nasal septum. Each nasalcavity communicates with the exterior through the naris or nostril and with thenasopharynx through posterior nasal aperture or the choana. Each nasal cavityconsists of skin lined portion- the vestibule and the mucosa- lined portion, the nasalcavity proper.Vestibule of nose: Anterior and inferior part of nasal cavity is called vestibule. It is lined by skinand contained sebaceous glands, hair follicles and hairs called vibrissae. Its upperlimit on the lateral wall is marked by limen nasi (nasal valve) which is formed bycaudal margin of upper lateral cartilage. Its medial wall is formed by columella andlower part of the nasal septum up to its muco cutaneous junction.Nasal cavity proper: Each nasal cavity has a lateral wall, a medial wall, a roof and a floor.Lateral wall: It is marked by three scrolls like bony projection called turbinates orconchae. From below upwards they are inferior, middle and superior sometimes a 38
  • forth turbinate, concha suorema, is also present below and lateral to each turbinate isthe corresponding meatus. Inferior meatus Middle meatus Superior meatus Sphenoethmoidal recessMedial wall: Nasal septum forms the medial wallRoof: Anterior sloping part of the roof formed by nasal bones, posterior sloping part,by the body of sphenoid bone, and the middle horizontal part, by the cribriform plateof ethmoid through which olfactory nerve enter the nasal cavity.Floor: It is formed by palatine process of the maxilla in its anterior three- fourths andhorizontal part of the palatine bone in its posterior one- fourth.Nerve supply of nasal cavity: Olfactory nerves- they carry sense of smell and supply olfactory region of nose. Nerves of common sensation- o Anterior ethmoidal nerve o Branches of sphenopalatine ganglion o Branches of infra- orbital nerve Autonomic nerves 39
  • Blood supply:Both the internal (Anterior ethmoid artery, posterior ethmoid artery) and externalcarotid systems (Sphenopalatine artery, septal branch of superior labial artery) supplythe noseNasal septum: Internal carotid systems: Anterior ethmoidal artery Posterior ethmoidal arteryExternal carotid systems: sphenopalatine artery septal branch of greater palatine artery septal branch of superior labial arteryLateral wall: Internal carotid systems: Anterior ethmoidal Posterior ethmoidalExternal carotid systems: Posterior lateral nasal branches Greater palatine artery Nasal branch of anterior superior dental Branches of facial artery to nasal vestibulePhysiology of nose102:Function of the nose as classified as: Respiration: Inspired air passes upward in a narrow stream medial to the middle turbinateand then downwards and backwards in the form of an arc, mouth breathing is anacquired lesion due to the nasal obstruction. 40
  • Olfaction: The olfactory mucosa is located in roof of the nasal cavity adjacent area tosuperior turbinate and upper part of septum. Olfactory cells are distributed in theolfactory mucosa. The odoriferous material reaches the olfactory area by diffusion;the olfactory cells are stimulated and carry the smell sensation to the olfactory bulb ofthe brain. Purification of inspired air carried out by vibrissae of nasal vestibule, cilia and by lysozyme enzyme of nasal mucosa. Warming and moistening of cold and dry inspired air before reaching the lungs by the highly vasculared nasal mucosa, if not causes damaged to the respiratory tract. Resonance is added to the voice by the nasal cavity and paranasal sinuses and there are also responsible for pronouncing the nasal consonants like M and N. The nose act as the out let for Para nasal sinuses and lachrymal apparatus. Nose act as ventilating shaft for the Eustachian tube for the equalization of pressure of air between the external atmosphere and the middle ear cavity through the Eustachian tube. Reflexes like sneezing have a protective function on exposer to irritants the respiration may be stopped temporarily to protect the respiratory tract 41
  • Review of NasyaNirukti of Nasya: “Nasyam tatkathyate dheerernasagrahayam yadoshadam Navanam nasyakarmeti tasye naamdwayam matam” The administration of medicines through the nose is called nasya. It is alsoknown as navana and nasya karma.Etymology and definition of nasya karma: Each word is derived from specific dhatu and each dhatu bears a naturalmeaning like that the word Nasya is derived from ‘Nasa’ Dhatu. It conveys the senseof Gati – motion (Nasa Gatau) and Vyapti means pervasion (Nasa Vyaptau). InAyurvedic texts, Nasa Dhatu is used in sense of Nose (Nasa Nasikayam). Accordingto Vachaspatyam the literal meaning of the word Nasya is being in the nose or thethings beneficial to the nose. According to Monier Williams the meaning of Nasya is belonging to nose orbeing in the nose. Thus the beneficial things pertaining to nose is to administer themedicated drugs through nose is known as “Nasya”. In Ayurveda, the word Nasya has been taken specifically to mention the rootof administration of the drugs. As stated by Sushruta103 medicines or medicated oiladministered through the nose is known as Nasya and according to Arundatta,bhavaprakasha104, sharangadhara and vaghabhata105 opines that all the drugs either inthe churna, kalka, sneha form administered through the nasal passage are calledNasya. Synonyms: Shirovirechana Shirovireka Moordhavirechana 42
  • Navana Prachchardana Nastha karma Virechana means elimination of the doshas from the body and the AcharyaSushruta in Sushruta samhita106 mention shirovirechana a particular variety of nasyakarma. So, above mention synonyms like shirovirechana, shirivireka andmoordhavirechana means elimination of the vitiated doshas of the urdhavajatrugatavikaras. Acharya Charaka has also used the word that nastha prachardana, andprachardana means vamana or shodhana and this can be done with the help of nasyakarma whereas the word navana and nastha means site of administration. On the basisof the foregoing it means that administration of medicines through the nasal passageto eliminate the vitiated doshas of the urdhavajatrugata vikaras is known as nasyakarma.Classification of nasya: All the Acharyas have classified Nasya in various ways. Nasya may beclassified according to its function and use of preparation e.g. Churna, Sneha, kalkaand juice etc. The classification according to various Acharya like Charaka, Sushrutaand Vagbhatta are as follows –Classification of Nasya According to Acharya Charaka:According to Charaka107, the Nasya is of five type’s viz. Navana, Avapida,Dhamapana, Dhuma and Pratimarasa. Navana nasya is further divided in to Snehana and Shodhana and Avapidananasya is divided into Shodhana and Stambhana, and Dhuma nasya is divided intoPrayogika, Vairechaniaka and Snaihika while Pratimarsha nasya is divided intoSnehana and Shodhana. 43
  • The above mentioned five types of Nasya are regrouped according to theirpharmacological action function into three groups108 – Rechana, Tarpana andShamana. Acharya Charaka109 has also mentioned 7 types of Nasya according to partsof the drugs to be used in Nasyakarma i.e Phala, Patra, Mula, Kanda, Pushpa, Niryasa,Twaka.Classification of Nasya According to Acharya Sushruta: According to Acharya Sushruta110 Nasya is of 5 type’s i.e Nasya, Avapida,Pradhamana, Shirovirechana and Pratimarsha. These 5 types of Nasya are furtherclassified according to their functions into two group’s i.e Shirovirechana and snehana Shirovirechana, Avapida and Pradhamana are used for Shirovirechana i.e. forthe elimination of Dosha from the urdhavajatrugata and Pratimarsha and Nasya usedfor Snehana.Classification of Nasya According to Acharya Vagbhatta: Ashtanga Sangraha111 has mainly classified Nasya according to the functioni.e Virechana, Brimhana and Shamana. Snehana and Brimhana Nasya have beenfurther subdivided according to the doses into two groups i.e. Marsha andPratimarsha. Avapida nasya may be given for both Virechana and Shamana whilePradhamana Nasya is given only for Shirovirechana. Ashtanga Hridaya has mainly classified Nasya in 3 type’s i.e Rechana,Brimhana and Shamana112.Classification of Nasya According to Kashyapa: According to Kashyapa Samhita113 Nasya has classified into two groups i.e.Brimhana and Karshana. These two types are also known as Shodhana and PuranaNasya. 44
  • Classification of Nasya According to Sharangadhara: Sharangadhara114, 115, 116 has classified Nasya according to their function intotwo group’s i.e.Rechana and Snehana. Rechana Nasya is further subdivided intoAvapida and Pradhamana nasya and Snehana Nasya is subdivided into Marsha andPratimarsha. Bhoja has classified two types of Nasya i.e Prayogika and Snehika and Videhahas stated two types i.e. Sangyaprabodhaka and Stambhana. It is clear from the above description that two types of classification of NasyaKarma are available in Ayurvedic literature. One is based on the pharmacologicalactions i.e Rechana, Tarpana and the other is based on the preparation of drug and themethod of its application i.e. Dhmapana, Avapida and Dhuma.Navana Nasya: Navana nasya is one of the most important nasya which can be easilyadminstrable and more beneficial. It is a process in which the medicated oil isdropped into nose with the help of cotton (pichu) or pranadi (pippet or dropper)describe by Acharya charaka. It can be mainly classified into two types Snehana andShodhana Nasya.Snehana Nasya Snehana Nasya gives strength to all the Dhatus and is used as Dhatuposhaka i.e.nutritive for dhatu.Dose117: Hina matra - 8 drops in each nostril Madhyama matra - Shukti Pramana – 16 drops in each nostril Uttama matra - Panishukti Pramana – 32 in each nostril 45
  • Benefits of Sneha Nasya: It is used for the snehana purpose and does thefeeling of head lightness. It gives strength to neck, shoulder and chest and increaseseye sight.Indications of Sneha Nasya118: Vataj shiroroga, Keshapata, Dantapata, Shamashrupata, Tivrakarnashoola,Timira, Nasaroga, Mukhashosha, Avabahuka, Akalaja Valita, Akalaja Palita,Darunaprabodha and Vatapittaja Mukharoga, darunaka, ardita vata etc.Shodhana Nasya119In the shodhana type of nasya Acharya Sushruta include shirovirechana type.In thistype of Nasya, oil prepared by Shirovirechana. Dravyas like Pippali, Shigru, vidanga,apamarga etc. can be selected.Dosage schedule for snehana nasya120: Uttama - 8 drops Madhyama - 6 drops Hina - 4 dropsIndications121: Kaphapurna Talu and Shira, Aruchi, Shirogaurava, Shirahshoola, Pinasa,Ardhavabhedaka, Krimi, Pratishyaya, Apasmara, Gandhagyananasha andUrdhvajatrugata Kapharogas and Urdhvajatrugata Shopha, Praseka, Arbuda andKotha. Navana Nasya122 should be given according to the following seasonal schedulein the healthy person. Shita Kala - Noon (madhyana) Sharada and Vasanta - Morning (poorvaha) Grishma Ritu - Evening(aparahna) 46
  • Varsha Ritu - Only when sun is visible or non cloudy day.Time Schedule123:Navana Nasya should be administered according to the following time schedule. In Kaphaja Roga - Before noon In Pittaja Roga - Noon In Vataja Roga - After noonAvapeedana nasya:In Avapeedana nasya, medicated drops extracted from aushada kalka and is instilledinto nose is called avapeedana nasya124.Types:It is of two types125 Shodhana nasya- ikshu rasa, milk are used Stambhana nasya- saindhava, pippali are used Chakrapani has mentioned 3 types of Avapida Nasya i.e. Shodhana, Stambhana and Shamana. Videha has mentioned two types of Avapida Nasya Sangyaprabodhana – It is one type of shodhana nasya Stambhana- It is one type of shamana nasyaDose: Hina - 4 drops Madhyama matra - 6 drops Uttama matra - 8 dropsIndications: Avapida Nasya is indicated in the following conditions according toDalhana126. 47
  • Vishabhighata, Sanyasa, Murccha, Moha, Apatantraka, Mada, Apasmara,Shirovedana, Krodha, Bhaya, Manasaroga, Chittavyakulavastha, Krisharogi, Bhiru,Sukumara, Stri, Raktapitta and similar states. Sharangadhara127 recommends theAvapida Nasya for the patient suffering from throat, sannipata jwara, atinidra,vishama jwara, manovikara and krimi etc.Dhamapana Nasya or pradhamana nasya: Dhamapana or Pradhamana is a specific Shodhana Nasya. In which medicatedpowder is blowed in the nose with the help of Nadi Yantra (Shadangula Nadi bothside open ended). The Churna of required drug is kept at one end, and air is blownfrom the other end, so that the medicine may enter into the nostrils. This nasya ismention as Dhmaoana in charaka samhita and Pradhamana in Sushruta samhita. Videha has described another method for Pradhamana. In which fine powderof drug kept in a Pottali made by a thin cloth is used to inhale, so that smallestparticles of the medicine enter into the nostrils.Dose: According to Videha, the dose of Dhamapana Nasya is three Muchuti (3pinch). For the Pottali method Churna should be at least 2 Tolas i.e. 20 gms.Saindhava, vacha, maricha, pippali, kankola, lashuna, puram and katphala are goodpradhmana nasya and all theas drugs are tikshana dravyas128Indications:According to Acharya Charaka129 Shiro Roga (Disease of the Head) Nasa Roga (Disease of the Nose) Akshi Roga (Disease of Eye) 48
  • According to Acharya Sushruta130 Krimi Visha roga Mansika vikar Dhuma nasya: Dhuma nasya is the procedure of inhalation or taking the medicated smokethrough nostril and elimination of doshas from oral root is known as dhuma nasya.Dhuma Nasya is of the following types131:(i) Prayogika (ii) Snehika (iii) Virechanic Charaka has mentioned special Dhumanadi for dhuma nasya. The length of thenadi depends upon the type of the dhuma nasya.The measurement is for Virechanatype of dhuma nasya is 24 Angula length and for Snehika type of Dhuma nasya is 32Angula and length of Prayogika type of Dhuma nasya is 36 advocated.Dose: Prayogika dhuma nasya- Two puffs are to be taken Snehika dhuma nasya- 3 to 4 puffs are to be taken Virechanic dhuma nasya- A single puff is advise For Prayogika Dhuma drugs like Priyangu, Ushira etc. should be used. ForSnehika Dhuma Vasa, Ghrita etc. and for Virechanic Dhuma, drugs like Aparajita,Apamarga etc. should be used.Indication132:Dhuma Nasya is indicated in Shiroroga, Nasaroga and AkshirogMarsha – Pratimarsha Nasya: Marsha and Pratimarsha type of nasya are well tolerated and is very muchconvenient procedure. Pratimarsha and Marsha nasya having the same procedure, but 49
  • the main difference between them is of dose. In Pratimarsha Nasya 1-2 drops aregiven. In Marsha Nasya the dose is 6 to 10 drops.Pratimarsha Nasya133: Pratimarsha Nasya can be given by dipping the finger in the Sneha and thendropping it in the both nostrils. The patient should be advised not to expel out theSneha given in the form of Nasya and comes to oral cavity. Pratimarsha Nasya can begiven daily and even in all the seasons at morning and evening.Dose134: The dose of pratimarsha nasya is 2 drops i.e morning and evening hour and thesneha should at least reach from nose to throat, but it should not be too much that canproduce secretion in throat.Indications135: Pratimarsha can be given in any age, any season and even in Akala mean notsuitable time and season i.e. in Varsha and Durdina. It can be given to Bala, Vriddha,Bhiru, Sukumara and weak patients, Kshatakshama, Trishna Pidita, Mukhashosha,Valita and Palita.Contraindications: Dushta Pratishyaya Bahudosha Krimija Shiroroga Medhyapi Badhirya Persons having Utklishta Doshas Persons having these type of disease the pratimarsha nasya should not givenbecause the Sneha Matra is quite insufficient to eliminate doshas or kriminasha andalready aggravated doshas may get vitiated further136. 50
  • Fourteen suitable times has been mention by Acharya Sushruta137 and Sharangadhara138 for Pratimarsha Nasya, while Acharya Vagbhatta139 has mentioned fifteen Kala Table no 10 showing suitable time for Pratimarsha Nasya Time for Pratimarsha Nasya Su. Va. Sha. After leaving the bed in morning + + + After cleaning the teeth (with Dantadhavana) + + + Before going outside + - + After exercise + + + After sexual intercourse + + + After walking + + + After urination + + + After passing apanavayu + - - After Kavala + + +. After meal + + +. After sneezing + - -. After sleeping in the noon + + +. In the evening + + +. After vomiting - + +. After Shirobhyanga - + -. After defecation - + +. After laughing - + -. After Anjana + + + Marsha: Marsha nasya is also as same as like pratimarsha nasya that dropping the sneha into the nostril with finger but there is dose difference in pratimarsha and marsha nasya, According to Acharya Vagbhatta only 6 to 10 drops dropping into nostril is known as Marsha. According to Vagbhatta Marsha Nasya gives more side effects 51
  • (Vyapada) but again he suggested that it gives quick result and it is more effectivethan Pratimarsha Nasya140. Drugs used for Marsha nasya are oil and ghruta etc but useof oil is indicated because shira is the place of kapha and oil is opposite to kaphadosha in properties.Classification of Nasya according to their karma or pharmacological action: Acharya Charaka141 and Vagbhatta142 have classified Nasya according to theirpharmacological actions or karma into three groups: Rechana Tarpana Shamana Acharya Sushruta and Sharangadhara has not explained about Shamana fromthis classification and divided Nasya karma into only two groups, Shirovirechana andSnehana. In Kashyapa samhita, kashyapa explained about the Brimhana and Karshanatypes of Nasya and Acharya Videha described two types of Nasya karma according totheir pharmacological action i.e. Sangyaprabodhana and Stambhana. All these typescan be included into the classification of Charaka.Rechana Nasya (Virechana Nasya) The Rechana Nasya143 elimination the vitiated Doshas from Urdhvajatrugataor the shira part of the body is known as Rechana nasya. About the drugs of Rechana nasya Churna or sneha of these Apamarga,Pippali, Maricha and alsoTikshna, Sneha, Kwatha or Svarasa of these drugs mix withMadhu, Saindhava, Asava, Pitta and Mutra may be utiilized144Indications: Shiroroga like Stambha, Supti Shleshma Abhivyapata in Talukantha andShirokrimi, Arochaka, Shoola, Shirogaurava, Pinasa, Pratishyaya, Urdhvajatrugata 52
  • Kaphaja Vikara145.And Urdhvajatrugata Shopha, Praseka, Vairasya, Arbuda, Dadruand Kotha146.Kaphaja type of and Guruta of Shirah.Patient of Galaroga, Sannipataja Jvara, Atinidra, Manovikara, Abhishyanda,Sarpadansha and Murchha Shirovirechana Nasya with Kalka, Churna and Svarasashould be given and instant result is required, then Churna should be used.Tarpana Nasya: Tarpana Nasya, sneha nasya and brimhana nasya are explained by AcharyaCharaka, Sushruta, Sharangdhara and Acharya vaghbata may be considered as thesynonyms of each other. Madhura skandha drugs147 and sneha prepared withVatapittahara drugs148 should be used.Indications149: Vatika Shiroroga, ardita, Shirakampa. Snehana Nasya promoting the strengthand increasing the vision power according as per Acharya shusruta.Shamana Nasya: Shamana Nasya is used for the mitigation of Dosha situated in the Shirah isknown as shamana nasya. Acharya Charaka and Vagbhatta have explained ShamanaNasya and correlated with Snehana and Marsha-Pratimarsha. The Sneha preparedwith the beneficial drugs for particular disease may be used for Shamana Nasya.Indications: It helps in Raktapitta150 bleeding. It is also indicated in Akala Valita, Palitaand Khalitya, Darunaka, Raktaraji, Vyanga and Nilika. Anutaila Nasya administeredin Pravrita, Sharada and Vasant Ritu promotes the functions of eyes, ears and noseand other diseases like Manyastambha, Shirahshoola, Ardita, Hanustambha, Pinasa,and Ardhavabhedaka etc 53
  • Yogya of nasya karma151 Nasya therapy may be given in all diseases except in the conditions mentioned earlier. The particular indications of Navana, Tarpana Nasya, Shodhana Nasya, Shamana Nasya, Shirovirechana, Avapida, Dhamapana and Dhuma Nasya etc. have already been discussed in the classification of Nasya. But Acharya Charaka had described the following general indications where Nasya therapy should be used. Table no 11 showing Yogya of nasya karma Shirostambha Mukharoga Manyastambha Karnashoola Danta stambha Nasa shoola Danta shoola Akshishoola Hanugraha . Shirahshoola. Pinasa . Ardita. Galashundika . Apatantraka. Galashaluka . Apatanaka. Shukra Roga-Netragata . Galaganda. Timira . Danta Harsha. Vartmaroga . Danta chala. Vyanga . Raji-Netra Roga. Upajihvika . Arbuda. Ardhavabhedaka . Svarabheda. Grivaroga . Veggraha. Skandharoga . Gadgadatva Suitable time for giving Nasya152 According to Charaka, generally Nasya should be given in pravrita, Sharada and Vasant Ritu. However, in urgent situation it can be given in any season by providing artificial conditions of the above mentioned seasons. 54
  • Time schedule in different seasons: Grishma Ritu- Before noon (morning) Shita Ritu- Noon Varsha Ritu- Day should be clear Sharda and vasanta- Morning Shishira and hemanta- Noon Grishma and vasanta- EveningTime schedule acc. to Doshaja Vikara153 Kaphaja Vikara- Morning Pittaja Vikara- Noon Vataja Vikara- Evening Sharangadhara154 has described same time schedule for different seasons asSushruta has mentioned. He further states that – Nasya can be given in night, if thepatient is suffering from Lalasrava, Supti, Pralapa, Putimukha, Ardita, Karnanadi,Trishna, and Shiroroga and in excessive vitiated Doshas.Contraindication of nasya155, 156, 157: Acharya Charaka, Sushruta, Vaghabhata has mention some special conditionwhere nasya procedure should not be administered otherwise various complicationmay occur.Table no 12 showing Contraindication of nasya Nasyaanarha Charaka Sushruta Vaghbata1 Ajirna + + –2 Pitta sneha + + +3 Pitta mad + + +4 Pitta toya + + +5 Snatah shira + – + 55
  • 6 Snatukamah + + +7 Kshudharta + – +8 Shramarta + + –9 Murchitta + - -10 Shastradandaahrita + - -11 Vyavayaklanta + - -12 Panaklanta + - -13 Navajwara pidita + - -14 Shokaabhitapa + - -15 Virikta + - +16 Anuvasita + + +17 Garbhini + + +18 Nava pratishyartha + - -19 Apatarpita - + +20 Pittadravha - + +21 Trishnartha + + -22 Kruddha - + -23 Bala - + -24 Vriddha - + -25 vegavarodhitah - + -26 Raktasravita - - +27 Sutika - - +28 Kasapidita - - +29 Swasapidita – – +30 Gararata – + +31 Vyayamaklanta + + –32 Mattaha + – –33 Bhukta bhakata + + +Courses of Nasya Karma: According to the Acharya Vaghabhata158 Nasya Karma may be given for 7consecutive days and if the Vata Dosha causes problem in shira or head, hiccough, 56
  • torticolitis, loss of voice etc then twice a day nasya karma should be done (in morning and evening). The use of Nasya on 3rd. 5th, 7th and 8th day or till the patient shows Samyak159 laxanas of Nasya. Bhoja neither says that if Nasya is given continuously beyond 9 days then it becomes Satmya to patients and if given further, it neither benefits nor harm to the patients. According to Acharya Sushruta160, Nasya may be given repeatedly at the interval of 1, 2, 7 and 21 days depending upon the condition of the patient. Acharya Charaka has not mentioned specific duration of the Nasya therapy, but suggested to give according to the severity of disease. Dose of Nasya Karma: Charaka has not prescribed the dose of the Nasya. Sushruta and Vagbhatta161 have mentioned the dose in form of Bindus here one Bindu means the drop which is formed after dipping the two phalanges of Pradeshini finger Table no 13 showing the dosage in Nasya Karma Drops in each nostrilSl.no Type of Nasya Hrasva Madhya Uttam1 Shamana Nasya 8 16 322 Shodhana Nasya 4 6 83 Marsha Nasya 6 8 104 Avapida Nasya (Kalka Nasya) 2 2 25 Pratimarsha Nasya 2 2 2 According to Videha The common dose for Pradhamana Nasya is 3 Muchuti (here one Muchuti = The Churna which may come in between Index finger and thumb = 2.4 Ratti). 57
  • Sharangdhara162 described the dosage schedule for Nasya Karma: Tikshna aushadhi Churna – 1 shana (4 masha) (24 Ratti) Hingu – 1 Yava (½ Ratti) Saindhava – 1 Masha (6 Ratti) Dugdha – 8 Shana (64 Drops) Jala (Aushadha Siddha) – 3 Karsha (3 Tola) Madhura Dravya – 1 Karsha (1 Tola) If the dose of nasya drug is given in less quantity rather than the prescribeddose then it may leads to so many complication like heaviness, loss of appetite,cough, salivaion, coryza, vomiting and disorders of the throat etc and if the dose ofnasya drug is administered in the excessive it may leads to symptoms of Atiyoga. SoMadhyama to Uttama Matra i.e. 16-32 drops is selected for Snehana (Shamana)Nasya according to Acharya Sushruta.Samaka yoga, ayogya and atiyoga of nasya karma:Table no 14 showing Samaka yoga laxanas Acc to different AcharyasSr No Symptoms CS SS AH SHAR BP KA S1 Uraha laghuta + - - - + -2 Shiro laghuta + + - - - -3 Netra laghuta - - + + - -4 Laghuta - - - - + -5 Srotovishudhi + + - + + +6 Swaravishudhi - - + - - -7 Vaktravishudhi - - + - - -8 Indriyaachchta + + - + + + prasada9 Netraja vriddhi - - + + - +10 Chitta prasada - + - + + +11 Vikaripashama - + - + + -12 Sukhachchvasa - + - - - - 58
  • Table no 15 showing Ayoga laxanas163 Acc to different AcharyasSr No Symptoms CS SS AH SHAR BP KA S1 Shirogourava + - - + + +2 Galoplepa + - - - - -3 Nishtivana + - - - - -4 Kaphapraseka - - - - - -5 Upadeha + - + + - -6 Rukshata + - - + + +7 Vata vaigunya + - - - - -8 Srotoriktata - - - - + -9 Nashashosha - + - - - -10 Asyashosha - + - - - -11 Akshistabdhata - + - - - -12 Shiroshuniata - + - - - -13 Vyadhi vriddhi - - - - - +Table no 16 showing Atiyoga laxanas Acc to different AcharyasSr No Symptoms CS SS AH SHAR BP KA S1 Shirogourava - + + + + -2 Shiroshunyata - + - + + -3 Shirivedana + - - - - +4 Netra vedana + - - - - -5 Shankhavedana + - - - - -6 Indriya bhrima - + - + + +7 Mastulungagama - + - - - -8 Karnataluupadeha - - - - - -9 Vata vriddhi + - - - - +10 Kandu - + - - - -11 Praseka - + + + - -12 Pinasa - + - - - - 59
  • 13 Aruchi - - + - - -14 Deha dourbalya - - - - - +Vyapada164 and pratikara: Nasya vyapats are of two kinds- By dosha utklesha (Increase) and doshakshaya (Decrease). Those due to Utaklesha of dosha should be treated by Shodhanaand Shamana therapies and those due to dosha kshaya should be treatedby bruhmanatherapy. Several kaphaja type of ailments are manifested if Snehana type ofnasya karma is administered in such like condition- During indigestion, after theintake of food, after drinking water, in a cloudy day, after bath, after the intake ofsneha and anuvasana vasti the Kasa, swasa, peenasa, agnimandya disease mayproduced. For the treatment of such ailment all the kapha- alleviating therapeuticmeasures containing ingredient s which is having Teekshana, ushna properties.In thekrusha person, garbhini, vyayama klanta ( person afflicted with hard work), trishnarthseveral vatikka type of ailments are manifested. For the treatment of these ailments allthe snehana, brihmana, swedana and such other therapies which allivates vayu areuseful.In case of garbhini, ghee and milk should be specially given.The sneha given toa patient who is exceedingily afflicted with jwara, shoka, madya peeta gives rise toTimira roga. For the treatment of this timira roga patient should be given rookshasitanjana, lepa, puta paka. And if the patient becomes faint or moorchita then coldwater sprinkled over him avoiding the head165. 60
  • Headache:Definition of Headache: Headache166 is one of the most common medical complaints of civilizedhumans, yet severe and chronic headaches are only infrequently caused by organicdisease. In the United States, in 1 year, most of the population will have a headacheand over 5% will seek medical aid; over 1% of physicians office visits andemergency department visits are primarily for headache (Silberstein and Silberstein,1990). Most recurrent headaches are symptoms of a chronic primary headachedisorder, but ophthalmologic problems, sinusitis, dental disorders, infection, braintumor, cerebral hemorrhage, and meningitis may all present with headache. Headachepain of benign origin may be intense; headache pain of malignant origin may be mild.Many patients fear that their headache is secondary to a serious medical problem andseek not only pain relief but also reassurance that they do not have a brain tumor orother life-threatening problem. For these reasons, every physician must beknowledgeable in the diagnosis and treatment of headache.Headache has troubled mankind from dawn of civilization. A headache is anunpleasant thing because it attacks the seat of reason. It is a common humanexperience, diverse in its expressions, complex in its manifestations and difficult tounderstand in any simple mechanistic way. It may thus be inferred that for the mostpart headache represents an inability of individual to deal in some measure with theuncertainties of life. Headache can be classified into two groups primary headache secondary headache 61
  • Primary headache: primary headache are those benign headaches where clinicalexamination and investigations are normal, but still the patient continues to sufferExamples of primary headache are commonly seen in practice are migraine, tensiontype headache & cluster headache. Approximately 90% of headaches are seen inpractice is primary headache.Secondary headache: secondary headaches are secondary to an underlyingstructural, vascular, metabolic or infective cause that can be detected on clinicalexamination or by appropriate investigation Headache167 is a frequently encountered neurological symptom but is seldomassociated with significant neurological disease unless accompanied by othersymptoms or neurological signs. Nevertheless, patients suffering from headachesusually fear serious brain disease. In order to manage them effectively, it is importantto be aware of this mismatch between fear of disease and its actual likelihood. Carefulclinical assessment usually identifies one of a limited number of headaches. Aftertaking a careful history and performing the appropriate neurological examination, it isoften not necessary to perform further investigations. The patient can be reassured andprovided with symptomatic treatment.Important points in the headache history: The overall pattern (intermittent or continuous) The tempo of onset The time of day of onset of maximal pain The effect of posture, coughing and straining The location of the pain Any associated symptoms 62
  • Mode of production of headache168: All the tissue covering the cranium is sensitive to pain, especially the arteries butalso the muscles and pericranium. The skull bone itself is insensitive. Within thecranium, the venous sinusus and their tributaries, the dura mater and cerebral arteriesand the fifth, ninth, tenth cranial nerves are the chief pain sensitive. The main factorscausing headache (Lance 1981) Inflammation involving pain sensitive structure of the head. Referred pain. Meningeal irritation. Traction on, or dilatation of blood vessels Pressure upon or distortion of pain sensitive structure caused by tumors or other lesion. Psychological causes ( when the pain in some instances may be due to tension in the muscles of the scalp and neck)Physiology of headache: Pain usually occurred when peripheral nociceptors are stimulated in responseto tissue injury, visceral distention. In such situation, pain perception is a normalphysiologic response mediated by a healthy nervous system. Pain can also result whenpain producing pathways of the peripheral or central nervous system (CNS) aredamaged or activated in appropriately. Headache may originate from either or bothmechanism. Relatively few cranial structures are pain producing; these include thescalp, middle meningeal artery, dural sinuses, falx ceribri, and proximal segment ofthe large pail arteries. The ventricular epindyma, choroids plexus, pail veins, andmuch of the brain parenchyma are not pain producing.The key structure involve in primary headache appear to be 63
  • The large intracranial vessels and dura mater. The peripheral terminals of the trigeminal nerve that innervate these structures. The caudal portion of the trigeminal nucleus, which extends into the dorsal horn of the upper cervical spinal cord and receives input from the first and second cervical nerve root (the trigeminocervical complex) The pain modulator system in the brain that receives input from trigeminal nociceptors.Etiopathogenesis of Headache: Headache is manifested by – Distention, traction or dilation of intra-cranial or extra-cranial arteries. Traction or displacement of large intra-cranial veins or their dural envelope. Compression, traction or inflammation of cranial or spinal nerves. Spasm, inflammation or trauma to cranial and cervical muscles. Meningeal irritation and raised intra-cranial pressure.Mechanism of headache:It has been well established now that headache may be generated centrally andinvolves the serotonergic and adrenergic pain modulating systems where serotonergicsystem’s 5HT interacts with encephalic neurons whereas in the adrenergic systemnor-epinephrine uses GABA containing interneurons. There is also involvement ofprimary sensory neuron containing encephalin receptors and uses the substance P andthe polypeptide as a neurotransmitter, which inhibit neuronal transmission, preventingpropagation of pain impulses from the periphery to CNS.Sensory stimuli from head are conveyed to the CNS via trigeminal nerves, forstructures above the tentorium in the anterior and middle fossa of skull via the first 64
  • three cervical nerves for those in the posterior fossa and the inferior surface oftentorium. The ninth and tenth cranial nerves supply a part of the posterior fossa. Sometimes tension headaches can make one feel sick or nauseous andbecause of the way that neck muscles go in spasm; it can affect the blood supply tothe upper part of the spinal cord, making the patient feel dizzy, woolly-headed, andoff-balance. The changes in tension headache are often pounding, in time with theheartbeat. Typically, straining or exercising exacerbates the headache, as the bloodpressure rises even more during these activities. Thus the brain is thought to be an insensitive organ with a pain sensitivecapsule which can refer pain through a number of neural pathways. Pain perception isfurther modified in caudal nucleus of trigeminal nerve, where the nociceptiveimpulses are met by both inhibitory and facilitator impulse which descends fromhigher structure within the cortex and the brain stem. 65
  • MigraineDefinition of migraine: A useful definition of migraine169 is a benign and recurring syndrome ofheadache, nausea, vomiting, and/or other symptoms of neurological dysfunction invarying admixtures. Migraine can often be recognized by its activators(red wine,menses, hunger, lack of sleep, glare, estrogen, worry, perfumes, let-down periods) andits deactivators (sleep, pregnancy, exhilaration, trip tans). Severe headache attacks,regardless of cause, are more likely to be described as throbbing and associated withvomiting and scalp tenderness. Milder headaches tend to be nondescript—tight, bandlike discomfort often involving the entire head—the profile of tension-type headache. Migraine170 is a common episodic headache disorder with a 1-year prevalenceof approximately 18% in women, 6% in men, and 4% in children. It is characterizedby attacks consisting of various combinations of headache and neurologic,gastrointestinal and autonomic symptoms. Most patients develop migraine in the firstthree decades of life, but in some it develops in the fourth or even the fifth decade Theterm migraine is derived from the Greek word hemicrania, introduced by Galen inapproximately 200 A.D. (Critchley, 1967). Recent studies show some most likely cause of headaches171. First, there is nosuch thing as a “regular headache.” Studies have shown that 90% of all chronic,recurring headaches are either migraine or tension-type headache, and we thus woulddo well to understand the nature of those disorders. There are literally hundreds ofother causes for chronic, recurring headache, but only10% of cases involves one ofthese causes. Most of these other causes are either secondary headaches or other rarerprimary headache disorders, such as cluster. Studies show that patients try nearly 5treatment options before finding one that works, and spend, on average, 3 1⁄2 years to 66
  • find that successful treatment. One reason is that often the correct diagnosis is notmade. While tension-type headache is more prevalent in the general population,migraine is the most important primary headache disorder and the most commoncause of headache in patients presenting to a clinic or ED with the chief complaint ofhead pain. In the past, we divided migraine into two types, classic and common, basedon the presence or absence of aura symptoms; those terms now have been replaced bymigraine with aura and migraine without aura. Although outdated few synonyms were used in previous days to describeMigraine headache. Hemicrania Sick Headache Bilious Headache Blind HeadacheClassification of migraine172: Most migraine descriptions stress three features: the unilateral distribution ofthe headache; the presence of a warning (often visual); and nausea or vomiting TheAd Hoc Committee on Classification of Headache (Friedman et al., 1962) describedvascular headache of migraine type as follows. Recurrent attacks of headache widely varied in intensity, frequency, andduration. The attacks are commonly unilateral in onset; are usually associated withanorexia and sometimes with nausea and vomiting; in some are proceeded by, orassociated with, conspicuous sensory, motor, and mood disturbances; and are oftenfamilial. In an attempt to increase precision, the International Headache Society (IHS)proposed and published its classification of headache disorders (Headache 67
  • Classification Committee of the International Headache Society, 1988). The new IHSclassification system has raised many areas of dispute. Some believe it to be toocomplex and arbitrary. Others believe that it is not useful in primary-care settings andfails to adequately address chronic daily headache. Nonetheless, it has served toprovide a highly uniform tool for conducting clinical trials (Solomon and Lipton,1991; Rapport, 1992). The IHS criteria attempt to diagnose headache types rather thanheadache syndromes yet require a number of attacks over a period of time before adiagnosis can be made. They are currently undergoing revision. Migraine headaches were formerly divided into two varieties: classic andcommon (Silberstein, 1984). The IHS calls the common type migraine without auraand the classic type migraine with aura the aura being the complex of focalneurological symptoms that precedes or accompanies an attack (HeadacheClassification Committee of the International Headache Society, 1988). At most,only30% of migraine headaches classics. The same patient may have migraine headachewithout aura, migraine headache with aura, and migraine aura without headache. To establish a diagnosis of migraine under the IHS classification, certainclinical features must be present and organic disease must be excluded To diagnosismigraine without aura five attacks are needed, each lasting 4 to 72 hours and havingtwo of the following four characteristics: unilateral location, pulsating quality,moderate to severe intensity, and aggravation by routine physical activity. In addition,the attacks must have at least one of the following: nausea and/or vomiting and/orphotophobia and phonophobia using these criteria, no single associated feature ismandatory for diagnosing migraine, although recurrent episodic attacks must bedocumented. A patient who has pulsatile pain aggravated by routine activity,photophobia, and phonophobia meets the criteria, as does the more typical patient 68
  • with unilateral throbbing pain and nausea (Headache Classification Committee of theInternational Headache Society, 1988). If one of the criteria is missing, the headacheis called migraines. A migraine attack usually lasts less than a day; when it persists for more than3 days, the term status migraines are applied. Although migraine often begins in themorning, sometimes awakening the patient from sleep at dawn, it can begin at anytime of the day or night. The frequency of attacks is extremely variable, from a few ina lifetime to several a weeks. The median frequency is 1.5 attacks per month; 10% ofmigraine has one attack per week (Stewart et al., 1994b). To diagnose IHS migraine with aura at least two attacks with three of thefollowing four features are required: one or more fully reversible aura symptoms, auradeveloping over more than 4 minutes, aura lasting less than 60 minutes, and headachefollowing the aura with a free interval of less than 60 minutes. Migraine with aura issubdivided into migraine with typical auraInternational Headache Society migraine classification: Migraine Migraine without aura Migraine with aura Migraine with typical aura Migraine with prolonged aura Familial hemiplegic migraine Basilar migraine Migraine aura without headache Migraine with acute onset aura Ophthalmoplegic migraine 69
  • Retinal migraine Childhood periodic syndromes that may be precursors to or associated with migraine Benign paroxysmal vertigo of childhood Alternating hemiplegia of childhood Complications of migraine Status migrainosus Migrainous infarction Migrainous disorder not fulfilling above criteriaMigraine with aura (classic migraine):Migraine without aura:Diagnostic criteria: Previously used terms: common migraine, hemicrania simplex. At least 5 attacks fulfilling B-D Headache lasting 4 to 72 hours (untreated or unsuccessfully treated) Headache has at least 2 of the following characteristics: Unilateral location Pulsating quality Moderate or severe intensity (inhibits or prohibits daily activities) Aggravation by walking stairs or similar routine physical activityDuring headache at least 1 of the following: Nausea and/or vomiting Photophobia and phonophobia No evidence of organic disease 70
  • Migraine with aura (classic migraine):Diagnostic criteria: At least 2 attacks fulfilling B At least 3 of the following characteristics: One or more fully reversible aura symptoms indicating brain dysfunction At least 1 aura symptom develops gradually over more than 4 minutes or 2 or more symptoms occur in succession No single aura symptom lasts more than 60 minutes Headache follows aura with a free interval of less than 60 minutes (it may also begin before or simultaneously with the aura) History, physical examination, and, where appropriate, diagnostic testsexclude a secondary causeEpidemiology173: It frequently comes as quite a surprise to patients when they are told themhave migraine. Studies have shown that there are more than 21 million migrainesufferers in the United States, but only 11 million have been diagnosed; thus slightlyless than half of all migraine wander about ignorant as to the source of their recurrentheadaches and are either practicing benign neglect, popping medications for “sinusheadache,” buying new eyeglasses or terrified they have a brain tumor. Perhapsreflecting the “machismo” under pinning of our culture, the misconception that mendo not get migraine or some other unidentified variable, men are less likely to bediagnosed than women are. Regardless, the failure to secure an accurate diagnosisoften results in failure to find effective treatment and thus, unnecessary suffering.Migraine headaches most typically begin in childhood or the teenage years, oftenworsening until around age 40 or 50 before they begin to improve. 71
  • These patterns vary different from most other physical afflictions, which tendto increase as one advance to the senior years. Migraine is especially prevalent duringthe years that people ordinarily are most productive in their careers and are activelyraising their families. As a consequence, the disability imposed by migraine is costly.As we read these words, over one million Americans are suffering from an acutemigraine attack that is inhibiting or prohibiting their usual activities. Of these acuteattacks, over 60% will last 3 to 12 hours, and 12% will last longer than a day. Inaddition to the personal suffering experienced by the millions of Americans withmigraine and their families, migraine provokes more than 6 billion lost working daysand 74 million days of restricted activity yearly. Americans spend 3 million days permonth bed ridden due to acute migraine. All of this translates to $17 billion annually in lost income and productivityand if patient include the cost of caring for these attacks and their related healthproblems, the economic burden for society soars to almost $50 billion annually. It isexpensive to have migraine. Patient missed workdays or impaired functioning duringan attack mean that he may be perceived as a less desirable employee. Statistics onlost working days do not describe for show migraine affects the quality of life (QoL)of those afflicted. Experts now have tools to measure QoL data and have applied it tothe migraine population. The results are astounding (Affect with wonder). The qualityof life for those with migraines poor even when compared to individuals with otherchronic medical disorders that at first glance would seem more devastating; QoLscores are lower for migraine than for depression, chronic back problems, recent heartattack, and congestive heart failure. 72
  • Pathogenesis of migraine174: The exact mechanism is not completely understood, migraine is believed to becaused by a bio-chemical imbalance in the brain that sets off a chain reactioninvolving the nerves and blood vessels of the face and head. The most common typeof migraine involves the trigeminal nerve. It carries nerve impulses from the head andface to the brain. In response to biochemical changes in the brain, the trigeminal nerve releasespeptides, which cause blood vessels in the brain to dilate. The swollen blood vessels,in turn, stimulate the nerves around them to release chemicals, which produceinflammation. When the blood passes through these inflamed and dilated bloodvessels, surrounding nerves transmit impulses to the brain that are interpreted asthrobbing or pulsating pain. In response, more peptides are released and the cycle mayrepeat itself for several hours or up to a week. The chemicals known to be importantin this process are Serotonin, 5-HT and DopamineGenetic Basis of Migraine Migraine has a definite genetic predisposition. Specific mutations leading torare causes of vascular headache have been identifying: Table no 17 showing Genetic Basis of Migraine Gene (Locus) Function of Gene Clinical Comment Syndrome1 tRNALeu(UUR) Unknown MELAS Extremely rare (mitochondrial) syndrome syndrome2 CACNL1A4 P/Q calcium channel Familial Mutations (19p13) regulating hemiplegics account for neurotransmitter migraine approximately release (FHM) 50% of FHM cases3 DRD2 (11q23) G protein–coupled D2 Migraine Positive receptor for dopamine association reported. In two independent laboratories 73
  • Clinical Syndromes Related to Migraine Genetics: Melas syndrome It consists of mitochondrial encephalomyopathy, lactic acidosis and stroke- like episodes. It is caused by A G point mutation in the in the mitochondrial gene encoding for tRNALeu (UUR) at nucleotide position 3243. Episodic migraine- like headaches are another common clinical feature of this syndrome, especially early in the course of the disease. The genetic pattern of mitochondrial disorders is unique, since only mothers transmit mitochondrial DNA. Thus, all the children of mothers with MELAS syndrome are affected with the disorder. Familial Hemiplegic Migraine (FHM) It is characterized by episodes of recurrent hemiparesis or hemiplegia during the aura phase of the migraine headache. Other associated symptoms include – Hemianesthesia or paresthesia Hemianopic visual field disturbances Dysphasia Variable degrees of drowsiness Confusion and/or coma In severe attacks, these symptoms can be quite long and persists for days orweeks, but characteristically they last for only 30 to 60 min. and are followed by aunilateral throbbing headache. Approximately 50% of the cases of FHM appear to be caused by mutationswithin the CACNL1A4 gene on chromosome 19, which encodes a P/Q type calciumchannel sub-unit expressed only in the central nervous system. 74
  • The function of CACNL1A4 gene remains unknown but it is likely to playrole in calcium induced neurotransmitter release and/or contraction of smoothmuscles. Migraine has a definite genetic predisposition. Specific mutations leading torare causes of vascular headache have been identified (Table 14-6). For example, theMELAS syndrome consists of a mitochondrial encephalomyopathy, lactic acidosis,and stroke-like episodes and is caused by an A: G point mutation in the mitochondrialgene encoding for trialed (UUR) at nucleotide position 3243. Episodic migraine-likeheadaches are another common clinical feature of this syndrome, especially early inthe course of the disease. The genetic pattern of mitochondrial disorders is unique,since only mothers transmit mitochondrial DNA. Thus, all children of mothers withMELAS syndrome are affected with the disorder. Familial hemiplegics migraine(FHM) is characterized by episodes of recurrent hemi paresis or hemiplegia during theaura phase of a migraine headache. Other associated symptoms may include hemianesthesia or parenthesis; hemianopic visual field disturbances; dysphasia; andvariable degrees of drowsiness, confusion, and/or coma. In severe attacks, thesesymptoms can be quite prolonged and persist for days or weeks, but characteristicallythey last for only 30 to 60 min and are followed by a unilateral throbbing headache.Approximately 50% of cases of FHM appear to be caused by mutations within theCACNL1A4 gene on chromosome 19, which encodes P/Q type calcium channelsubunit expressed only in the central nervous system. The gene is very large (_300 kbin length) and consists of 47 axons. Four distinct point mutations have been identifiedwithin the gene (in five different families) that co segregate with the clinical diagnosisof FHM. Analysis of heliotypes in the two families 75
  • With the same mutation suggest that each mutation arose independently ratherthan representing founder effect. CACNL1A4 is likely to playa role in calcium-induced neurotransmitter release and/or contraction of smooth muscle. Differentmutations within this gene are the cause of two other neuro genetic disorders, spinocerebellar ataxia type 6 and episodic ataxia type 2 (Chap. 352). In a genetic association study, a NICO polymorphism in the gene encoding theD2 dopamine receptor (DRD2) was overrepresented in population of patients withmigraine with aura compared to a control group of non migraine, suggesting thatsusceptibility to migraine with aura is modified by certain DRD2 alleles. In aSardinian population, an association between different DRD2 alleles and migraine hasalso been demonstrated. These initial studies suggest that variations in dopaminereceptor regulation and/or function may alter susceptibility to migraine sincemolecular variations within the DRD2gene have been associated with variations indopaminergic function. However, since not all individuals with the implicatedDRD2genotypes suffer from migraine with aura, additional genes or factors must also beinvolved. Migraine is likely to be a complex disorder with polygenic inheritance andstrong environmental component.The vascular theory of migraine: It was widely held for many years that the headache phase of migrainousattacks was caused by extra cranial vasodilatation and that the neurologist symptomswere produced by intracranial vasoconstriction (i.e., the “vascular” hypothesis ofmigraine). Migraine).Regional cerebral blood flow studies have shown that in patientswith classic migraine there is, during attacks, a modest cortical hypo perfusion thatbegins in the visual cortex and spreads forward at rate of 2 to 3 mm/min. The decreasein blood flow averages 25 to30% (insufficient to explain symptoms on the basis of 76
  • ischemia) and progresses anteriorly in a wavelike fashion independent of thetopography of cerebral arteries. The wave of hypo perfusion persists for 4 to6 h,appears to follow the convolutions of the cortex, and does notcross the central orlateral sulcus, progressing to the frontal lobe via the insula. Perfusion of sub corticalstructures is normal. Contra lateral neurologic symptoms appear duringtemporoparietal hypo perfusion; attires, hypo perfusion persists in these regions aftersymptoms cease. More often, frontal spread continues as the headache phase begins. A fewpatients with classic migraine show no flow abnormalities; an occasional patient hasdeveloped focal ischemia sufficient to cause symptoms. However, focal ischemia doesnot appear to be necessary for focal symptoms to occur. The ability of these changesto induce the symptoms of migraine has been questioned. Specifically, the decrease inblood flow that is observed does not appear to be significant enough to cause focalneurological symptoms. Second, the increase in blood flow per se is not painful, andvasodilatation alone cannot account for the local edema and focal tenderness oftenobserved in migraine. Moreover, in migraine without aura, no flow abnormalities areusually seen. Thus, it’s unlikely that simple vasoconstriction and vasodilatation arethe fundamental Pathophysiology abnormalities in migraine. However, it is clear thatcerebral blood flow is altered during certain migraine attacks, and these changes mayexplain some, but clearly not all, of the clinical syndrome of migraine.The neuronal theory of migraine: Fortification spectrum is a migraine aura characterized by a slowly enlargingvisual scotoma with luminous edges (see below). It is believed to result fromspreading depression, a slowly moving (2 to 3 mm/min), potassium-liberatingdepression of cortical activity, preceded by a wave front of increased metabolic 77
  • activity. Spreading depression can be produced by a variety of experimental stimuli,including hypoxia, mechanical trauma, and the topical application of potassium.These observations suggest that neuronal abnormalities could be the cause of amigraine attack. Physiologically, electrical stimulation near dorsal raphe neurons inthe upper brainstem can result in migraine-like headaches. Blood flowing the ponesand midbrain increases focally during migraine headache episodes; this alterationprobably results from increased activity of cells in the dorsal raphe and locuscoeruleus. There are projections from the dorsal raphe that terminate on cerebralarteries and alter cerebral blood flow. There are also major projections from the dorsalraphe to important visual centers, including the lateral geniculation body, superiorcolliculus, retina, and visual cortex. These various serotonergic projections mayrepresent the neural substrate for the circulatory and visual characteristics of migraine. The dorsal raphe cells stop firing during deep sleep, and sleep is known toameliorate migraine; the anti migraine prophylactic drugs also inhibit activity of thedorsal raphe cells through a direct or indirect agonist effect. Positron emissiontomography (PET) scan studies have demonstrated that midbrain structures near thedorsal raphe areactivated during a migraine attack. In one study of acute migraine, aninjection of Samaritan relieved the headache but did not alter the brainstem changesnoted on thePET scan. These data suggest that a “brainstem generator” may be thecause of migraine and that certain anti migraine medications may not interfere withthe underlying pathologic processing migraine.The trigeminovascular system in migraine: Activation of cells in the trigeminal nucleus caudal is in the medulla (a pain-processing center forth head and face region) results in the release of vocativeneuropathies, including substance P and calcitonin gene–related peptide, at vascular 78
  • terminations of the trigeminal nerve. These peptide neurotransmitters have beenproposed to induce a sterile inflammation that activates trigeminal nociceptiveafferents originating on the vessel wall, further contributing to the production of pain.This provides potential mechanism for the soft tissue swelling and tenderness of bloodvessels that accompany migraine attacks. However, numerous pharmacologic agentsthat are effective in preventing or reducing inflammation in this animal model (e.g.,selective 5-HT1D agonists, NK-1 antagonists, endothelia antagonists) have failed todemonstrate any clinical efficacy in migraine trials.5-hydroxytryptamine in migraine: Pharmacological and other data point to the involvement of the neurontransmitter, 5-hydroxytryptamine (5-HT also known as serotonin) in migraine.Approximately 40 years ago, methysergide was found to antagonize certain peripheralactions of 5-HT and was introduced as the first drug capable of preventing migraineattacks. Subsequently, it was found that platelet levels of 5-HT fall consistently at theonset of headache and that drugs that cause 5-HTto be released may trigger migrainesepisodes. Such changes in circulating5-HT levels proved to be pharmacologicallytrivial, however, and interest in the humeral role of 5-HT in migraine declined. Morerecently, interest in the role of 5-HT in migraine has been renewed due to theintroduction of the trip tan class of anti migraine drugs. The trip tans are designed tostimulate selectively a particular subpopulation of 5-HT receptors. At least,14specific, 5-HT receptor exists in humans. The triptans (e.g., naratriptan, rizatriptan,sumatriptan, and zolmitriptan) are potent agonists of 5-HT1B, 5-HT1D, and 5-HT1Freceptors and are less potent at 5-HT1A and 5-HT1E receptors. Growing body of dataindicates that the ant migraine efficacy of the triptans relates to their ability tostimulate 5-HT1B receptors, which are located on both blood vessels and nerve 79
  • terminals. Selective 5-HT1Deceptor agonists have, thus far, failed to demonstrateclinical efficacy in migraine. Triptans that are weak 5-HT1F agonists are alsoeffective in migraine; however, only 5-HT1B efficacy is currently thought to beessential for ant migraine efficacy.Dopamine in migraine: Growing body of biologic, pharmacologic, and genetic data supports a role fordopamine in the Pathophysiology of certain subtypes of migraine. Most migrainesymptoms can be induced by dopaminergic stimulation. Moreover, there is dopaminereceptor hypersensitivity in migraine, as demonstrated by the induction of yawning,nausea, vomiting, hypotension, and other symptoms of migraine attack bydopaminergic agonists at doses that do not affection migraine. Conversely, dopaminereceptor antagonists are effective therapeutic agents in migraine, especially whengiven parent rally or concurrently with other ant migraine agents. As noted above,genetic data also suggest that molecular variations within dopamine receptor genesplay a modifying role in the Pathophysiology of migraine with aura. Therefore,modulation of dopaminergic neurotransmission should be considered in thetherapeutic management of migraine.The sympathetic nervous system in migraine: Alterations occur within the sympathetic nervous system (SNS) of migrainebefore, during, and between migraine attacks. Factors that activate the SNS are alltriggers for migraine. Specific examples include environmental changes (e.g., stress,sleep patterns, hormonal shifts, hypoglycemia) and agents cause release and asecondary depletion of peripheral catecholamine (e.g., tyramine, phenylethylamine,fenfluramine, m-chlorophenylpiperazine,and reserpine). By contrast, effectivetherapeutic approaches to migraine share a neither ability to mimic and/or enhance the 80
  • effects of nor epinephrine in the peripheral SNS. For example, nor epinephrine itself,sympathomimetics (e.g.,isometheptene), monoamine oxidize inhibitors (MAOIs), andreuptake blockers alleviate migraine. Dopamine antagonists, prostaglandin synthesisinhibitors, and adenosine antagonists are pharmacologic agents effective in the acutetreatment of migraine. These drugs block the negative feedback inhibition or norepinephrine release induced by endogenous dopamine, prostaglandins, and adenosine.Therefore, migraine susceptibility may relate to genetically based variations in theability to maintain adequate concentrations of certain neurotransmitters withinpostganglionic sympathetic nerve terminals. This hypothesis has been called theempty neuron theory of migraine.Etiology of migraine175: The primary cause of Migraine still eludes us. Hereditary cause is probablyimportant. But the mode of transmission is uncertain; an autosomal dominant traitwith incomplete penetrance cannot be excluded. Some factors trigger the migraineheadache.Common Migraine Triggers:Foods: Aged cheese Alcohol (particularly red wine and champagne) Monosodium glutamate (contained in seasonings and processed foods) Chocolate Nuts, oranges, and tomatoes Caffeinated beverages Nitrates and nitrites (hot dogs, sausages, luncheon meats) Avocado 81
  • Smoked or pickled fish or meats Onions Aspartame (dietary sweetener) Yeast or protein extracts (brewer’s yeast, marmite)Medications: Vasodilators (nitroglycerin, isosorbide dinitrate) Hormones (oral contraceptives, estrogens, clomiphene, danazol) Anti-hypertensives (nifedipine, captopril, prazosin, reserpine, minoxidil) Histamine .2 blockers (cimetidine, ranitidine) Antibiotics (trimethoprim-sulfa, griseofulvin) Selective Serotonin Reuptake InhibitorsLifestyle: Fasting or skipping meals Sleep (too little or too much, changes in patterns, e.g., jet lag, shift changes) Letdown following stess (weekends, vacations, after exams) Caffeine withdrawalOthers: Weather changes High altitude (air travel, mountain climbing)Hormonal change176: Menstruation, ovulation, pregnancy.Visual stimuli: Bright light and glare.Auditory stimuli: Loud noise and music. 82
  • Olfactory stimuli: Perfumes and certain odour.Other factors, which cause migraine, are:1. Reduced magnesium levels Researchers have also noted a drop in magnesium levels before or during amigraine attack. Magnesium plays a role in nerve cell function; reduced levels couldbe a destabilizing factor, causing the nerves in the brain to misfire, possibly evenaccounting for the auras that many sufferers experience.2. Female hormones The female hormones progesterone and estrogen appear to play some role butit appears that it is their fluctuation, not their presence that is associated withmigraines.3. Hypotension Some migraine headache may get precipitated by a sudden drop in bloodpressure (hypotension) this was suggested by a study.Diagnosis of Migraine177: The recognition of migraine has been enhanced by the introduction ofdiagnostic criteria for both migraine wit hand without aura (formerly known as“classic” and “common” migraine, respectively) by the International HeadacheSociety (IHS). These contain features distinguishing migraine from the other twomost common headache disorders, tension and cluster. Particularly salient diagnosticfeatures, as well as additional clinical pearls, include: migraine headaches are notnecessarily unilateral; the patient’s activity during the headache is particularly helpfuldiagnostically(migraine lie still, patients with cluster headache pace or rock back and 83
  • forth, and the activity of those with tension headaches is largely unaffected);individuals may experience more than one variety of migraine, or even differentheadache disorders (typically migraine and tension);many patients with a history ofmotion sickness(especially carsickness during childhood) are migraine headachesassociated with nausea +/- vomiting after minor head trauma are probably migraines(so-called “footballers migraine”) and migraine frequently manifests initially inchildhood with cyclic vomiting and abdominal pain, carsickness, “footballersmigraine” or combinations thereof. A meticulous history is essential in assessing anyheadache patient. The following headache information should be elicited: • Age of onset • Family history site or sites of pain • Duration • Character • Intensity • Mode of onset • Time between onsets to peak pain • Temporal profile • Aggravating or precipitating factors • alleviating factors • associated neurological, ophthalmologic and autonomic Features • Prior and current medication use, including dosage, schedule, and efficacy(inquiry into use of over-the counter (OTC) medications, as well as prescribed ones, isvital) • Caffeine use • History of head trauma 84
  • • Results of prior neuro imaging studies • A complete review of systems; and • Why the patient is currently seeking medical attention .Although mostheadaches are benign, one should be vigilant in searching for “red flags,” potentiallyindicating more ominous etiologies, including • Abrupt onset of a new, severe headache (“worst headache of my life”) • A progressive headache course • Onset with exertion, including sexual intercourse Onset of headache duringor after middle age • Headache associated with a decreased level of consciousness • Headache associated with meningeal signs, fever, indurate temporal arteriesor other significant physical findings • clear postural features of the headache, especially exacerbation supine andrelief standing • Significant worsening of headache with Valsalva maneuver Failure to fit a“benign” headache profile and any headache in a patient with a known, serious,medical condition, such as cancer, immune compromise or infection. A patient without any “red flags,” whose presentation conforms to one of thecommon headache disorders, and with a normal physical examination, does notnecessarily need any ancillary tests. For an in-depth discussion of further evaluationand treatment of headaches associated with “red flags,” which may representdangerous conditions such as subarachnoid hemorrhage; infectious or carcinomatousmeningitis or encephalitis; raised intracranial pressure secondary to neoplasm, abscessor intracranial hemorrhage, temporal arteritis or other vasculitides 85
  • International Headache Society Criteria for Migraine without AuraA. At least 5 attacks that fulfill criteria in B, C, D, and EB. Headache attacks that last 4 to 72 hrs (untreated orUnsuccessfully treated)C. Headache has at least 2 of the following characteristics: Unilateral site Pulsating quality Moderate to severe intensity Aggravation by walking stairs or similar routine physical activityD. During headache, at least 1 of the following symptoms: Nausea or vomiting (or both) Photophobia and phonophobiaE. No evidence of related organic disease.International Headache Society Criteria for Migraine with AuraA. At least 2 attacks that fulfill criteria in B and CB. At least 3 of the following 4 characteristics: One or more completely reversible aura symptoms that indicate focal cerebral cortical or brain-stem dysfunction (or both) At least one aura symptom develops gradually over >4 min or two or more symptoms occur in succession No aura symptom lasts >60 min Headache follows aura in <1 hrC. No evidence of related organic disease 86
  • Clinical Features of Migraine178: Migraine should always be thought of as complex systemic disorder withheadache being one of the most common presenting features. The typical attack ofmigraine consists of a sequence of event which blau has divided into four phase. The prodrome phase The aura The headache The postdromeThe prodrome: A number of migraineurs experience a variety of subtle systemic, mental orpsychological premonitory symptoms which precedes the aura and the headache byseveral hours or days.The aura: Visual aura is most common, but an aura consists of virtually any neurologicalsymptoms. During the aura phase, 10% to 20% of migraine sufferers experience a 10-to-20-minute aura that usually, but not necessarily, is visual. The visual aura assumesmany variations, including silver streaks, white lights, double vision, blind spots, anddistortion of all linear objects.The headache: Headache is the most consistent and debilitating symptom of migraine. Thereis some misconception regarding the migraine headache which needs to be set right.The pain of migraine need not always be throbbing in nature. The pain may affect anyregion of the head, face and is unilateral in only 50 – 70% of patient, and the pain mayeven radiate to the neck. The headache is usually accompanied by nausea, vomiting, 87
  • photophobia or photophobia, and the head pain is increased with movement. Manymigraineurs get relief by lying down in a darken room.The postrome: A majority of migraine patient give a history of a drained out, exhausted,depression feeling after the headache and this is labeled as the prodrome. Recognitionof this phase confirms the diagnosis.Clinical features of migraine179:Migraine without aura (common migraine): In this syndrome no focal neurological disturbance precedes the recurrentheadaches. Migraine without aura is by far the more frequent type of vascularheadache. The International Headache Society criteria for migraine include moderateto severe head pain, pulsating quality, unilateral location, aggravation by walkingstairs or similar routine activity, attendant nausea and/or vomiting, photophobia andphonophobia, and multiple attacks, each lasting 4 to 72 h.Migraine with aura (classic migraine): In this syndrome headache is associated with characteristic premonitorysensory, motor, or visual symptoms. Focal neurologic disturbances are more commonduring headache attacks than as prodromal symptoms. Focal neurologic disturbanceswithout headache or vomiting have come to be known as migraine equivalents ormigraine accompaniments and appear to occur more commonly in patients betweenthe ages of 40 and 70 years. The term complicated migraine has generally been usedto describe migraine with dramatic transient focal neurologic features or a migraineattack that leaves a persisting residual neurologic deficit. The most commonpremonitory symptoms reported by migraineurs are visual, arising from dysfunctionof occipital lobe neurons. Scotomas and/or hallucinations occur in about one-third of 88
  • migraineurs and usually appear in the central portions of the visual fields. A highlycharacteristic syndrome occurs in about 10% of patients; it usually begins as a smallparacentral scotoma, which slowly expands into a “C” shape. Luminous angles appearat the enlarging outer edge, becoming colored as the scintillating scotoma expandsand moves toward the periphery of the involved half of the visual field, eventuallydisappearing over the horizon of peripheral vision. The entire process lasts 20 to 25min. This phenomenon is pathognomonic for migraine and has never been describedin association with a cerebral structural anomaly. It is commonly referred to as afortification spectrum because the serrated edges of the hallucinated “C” seemed toresemble a fortified town with bastions around it; spectrum is used in the sense of anapparition or specter.Basilar migraine: Symptoms referable to a disturbance in brainstem function, such as vertigo,dysarthria, or diplopia, occur as the only neurologic symptoms of the attack in about25% of patients. Adramatic form of basilar migraine (Bickerstaff’s migraine) occursprimarily in adolescent females. Episodes begin with total blindness accompanied orfollowed by admixtures of vertigo, ataxia, dysarthria, tinnitus, and distal and perioralparesthesias. In about one-quarter of patients, a confusion state supervenes. Theneurological symptoms usually persist for 20 to 30 min and are generally followed bya throbbing occipital headache. This basilar migraine syndrome is now known also tooccur in children and in adults over age 50. An altered sensoriumN may persist for aslong as 5 days and may take the form of confusional states superficially resemblingpsychotic reactions. Full recovery after the episode is the rule. 89
  • Carotidynia: The carotidynia syndrome, sometimes called lower-half headache or facialmigraine, is most common among older patients, with the incidence peaking in thefourth through sixth decades. Pain is usually located at the jaw or neck, althoughsometimes periorbital or maxillary pain occurs; it may be continuous, deep, dull, andaching, and it becomes pounding or throbbing episodically. There are oftensuperimposed sharp, ice pick–like jabs. Attacks occur one to several times per week,each lasting several minutes to hours. Tenderness and prominent pulsations of thecervical carotid artery and soft tissue swelling overlying the carotid are usuallypresent ipsilateral to the pain; many patients also report throbbing ipsilateral headacheconcurrent with carotidynia attacks as well as between attacks. Dental trauma is acommon precipitant of this syndrome. Carotid artery involvement also appears to becommon in the more traditional forms of migraine; over 50% of patients with frequentmigraine attacks are found to have carotid tenderness at several points on the sidemost often involved during hemicranial migraine attacks.Hemiplegic migraine180: This type of migraine can occur in families. Headache is followed by contralateral hemiperesis or hemiplegia which may last up to 10 days. Patient may haveseveral attacks affecting one side of the body; whereas the next attacks may affect theopposite side.Opthalmoplegic migraine: Headache is commonly around the eyes and is accompanied by weakness ofmovement of one eye which may outlast the headache by some days. Children aremore commonly affected. 90
  • Retinal Migraine: Retinal vascular lesions in migraine are fortunately rare. Thrombosis of the central retinal artery and of single branches may occur and recurrent attacks of retinal ischaemia may lead to bilateral optic atrophy due to ischaemic papillopathy. Retinal and vitreous hemorrhages may also occur. Childhood periodic syndrome: Childhood periodic syndrome may be precursors to or may be associated with migraine. These are benign proximal vertigo of childhood and altering hemiplegia of childhood. Complications of migraine181 Status Migrainosus- Headache lasts for more than 72 hrs. inspite of treatment. Headache is either continous or interrupted with headache free intervals of less than 4 hours Migranous Infarction- Here the typical neurological deficits are not completely reversible within 7 days. Neuro imaging demonstrates ischaemic infarction in relevant areas. Table no 18 showing factors common with ardhavabhedaka and migraine Ardhavabhedaka Migraine1. Unilateral pain of head Usually unilateral some times bilateral head pain2. Pakshat, dwadashat, Periodical attack of pain trayat, masat kupyanthi3. Swayamiva shamyathi Spontaneous relief4. Akasmath kupyanthi No consistant antiduct causes to onset5. Thoda in shanka, bru, Pain in the regions of temporal, ear, lalata, akshi, karna occipita, perital, peri orbital 91
  • 6. Sirajala spuranam Dilatation and torture of extra cranial vessels7. Application of pressure Mardhanam, mardhavam sneha, by tight bandage lowers lepayai the intensity of pain Prognosis of Migraine182 For many people, migrainers eventually go into remission and sometimes disappear completely, particularly as their age; estrogen decline after menopause may be responsible for remission in some older women. One study reported that the following people with migrainers have a better chance of remission if they have- A family history of migraine with aura. Migrainers that are not triggered by light. No other primary headache According to another study, a history of head trauma or oral contraceptives use predicted a power long term outlook. Table no 19 showing Differential Diagnosis of Migraine Sl. Tension Cluster Trigeminal Temporal Characters Migraine No. Headache Headache Neuralgia Arteritis Location of Both Temporal 1 One/both One One Pain sides 2 Duration 9-72 hrs 2hrs-days 30-90 min Few sec Constant Mild/mod/ Mild- 3 Severity Excruciating Severe Severe Severe Mod Nausea 4 Photophobia Common - - - - Phonophobia Lacrimation 5 Sometimes - Yes - - Redness of 92
  • eyes Systemic6 Present - - SymptomsManagement of migraine183:Pharmaco therapycal treatment:(A)During attack: Analgesics- NSAIDs e.g diclofenac can be given PO or IM and is particularly useful when severe vomiting is a feature. Ergotamine- Most important drugs for severe attack i.e. (a) Ergotamine tartrate 0.25 to 0.5 mg. IM. Or orally 1-2 mg. tablet preferably in combination with 100 mg. caffeine- 2 tablets are given at onset followed by 1 tablet after 30 min. if necessary. (B) Diahydroergotamine 1 mg. IM or 1-2 mg orally. Whichever preparation is used, a high dose often causes nausea and vomiting. These may prevented by giving cycligine 50 mg. or chloropromogine 25 mg. contraindication to ergotamine – septic or infectious states, peripheral vascular disease , coronary disease, pregnancy, thyrotoxicosis. Sumatriptan 6 mg s.c gives relief from headache in 60 min, with corresponding improvement in nausea, vomiting and photophobia. Oral dose of 100 mg provides relief within 2 hrs. Headache recures within 48 hrs in little less than half the patients. Contraindication – IHD, prinzmetal’s angina and arrhythmias. Drug Rizatriptan, given orally acts faster than the Sumatriptan. Rizatriptan wafers may be helpful in case of nausea with migraine, as they can be taken without fluids, reducing the likelihood of vomiting. Side effects include chest pain and paraesthesia. 93
  • General- Lying in dark room and quit room, and ice pack to the head may help.B) Reducing frequency and severity of subsequent attacks- Elimination of trigger factors- sleeping late, irregular and hurried meals, certains food especially chocklate and fried food, or missing of meal, psychological stress, contraceptives pills and treatment of cervical spondolosis. Relaxation exercise- which may include biofeedback from a temporalis electromyogram. Drugs: Sedatives- Amitryptaline 100 to 150 mg noct. Promethazine 10-25 mg. as nocturnal sedative helpful in children. Serotinine (5- HT) inhibitors- Calcium antagonists- such as Flunarizine 4 mg / Cyproheptadine 4 mg t.d.s can cause sedative and wt. gain. Pizotifin 0.5 mg t.d.s or 1.5 mg noct. Propranolol- 20 mg BD increased to 20 mg q.d.s may be helpful in some. Clonidine- 25-50 mcg BD or t.d.s sometimes effectives. Tricyclic agents- e.g imipramine 25 mg t.d.s may be effective irrespective of the presence of depression. Hormones- progesterone given for last eight days may be useful for migraine occurring in the immediate premenstrual period or at the beginning of catamania. When migraine begins or becomes worse at the time of menopause, oestrin, given in small doses as continous therapy sometimes helpful. 94
  • Other drugs- phenilizine, carbamezipine, valproate and gabapentine may be of some benifite.Non pharmacologuical treatment: Psychological phenomena can play an important role in the genesis andmaintenance of migraine headache. In order to deal with such factors, a number ofself regulating, noninvasive, behavioral techniques such as biofeedback therapy,relaxation therapy and hypnosis have been employed. In women with migraine, thereare special situations that warrant a modified line of management.Migraine in pregnancy184 Some women experience freedom from attack during pregnancy while otherexperience exacerbation during the early months of pregnancy most drugs used forprophylaxis and treatment of acute attack should be avoided during pregnancy andlactation. Biofeedback is one non pharmacological technique which will help inpregnancy. If at all a prophylactic must be used then propranolol and the tricyclicantidepressant may be recommended but it should be remembered that the effect ofthese drugs in pregnant migrainers have not been adequately investigated. Asprin,ergots and most prophylactic drugs are contraindicated.Menstrual migraine: Approximately 60%of women give a history of an association betweenmenstruation and their migraine attacks .They need abortive therapy prior to theirperiods. Antiemetics, NSAIDS, analgesic and ergotamine are helpful. If simplermethods fail, then hormonal therapy may be required. Migraine is also frequent inmenopausal and post-menopausal women. Hormonal replacement therapy given topostmenopausal women may worsen migraine headaches. Estrogen implants and 95
  • transdermal patches may keep the concentration of estrogen more uniform and thismay be beneficial in reducing the frequency of headache. 96
  • Drug reviewNrupavallabha taila 185,186,187,188,189,190,191,192,193,194,195,196,197,198,199,200,201 Nrupavallabha taila mention especially for disease ardhavabhedaka inChakradatta, Chikista Sthana, and chapter 59/191-197. In this taila Vidarikanda,Shatavari, Draksha, Shaliparani, Kantakari, Brahati, Madhuka, Bala, Vidanga,Manjishta, Rasana, Nilothpala, Gokshura, Propaundarika, Punarnava, Pippali andSaindhava Lavana are the main ingredients which are mainly contains Vatashamakaand kaphaghna dravyas, which are the main culprit to cause Ardhavabhedaka.Thedetailes of all these ingredients are mention in the table mention below.Shambukadya Gutika:1) Shanka bhasma202: Vargas- sudha verge. Name: Sanskrit- Shankha. Hindi- shankha English-counch shell Chemical formula- Caco3 Synonym- Shankha,shankhak,kambbu,samudraj,sunaad,dhiragnaad. Properties: Guna- Laghu, sheeta. Rasa- Katu,kashaya,ksharyea. Virya- sheetaKarma- Ghrahi, balya, lekhana, agnideepaka, tridoshaghana, ghradosha, kshaya,netra roga.Indication: Amla pitta,ghrani,atisara,parinamashoola,shwasa.Matra- 2 rati.Anupana- Nimbu swarasa,ushna jala.2) Loha bhasma203: Name: Sanskrit- Loh (ayasa). Hindi- Loha. English-Iron Chemical formula- Fe Synonym- Ayas,aayas,kaalayas,shastra loha,teekshana loha,sara loha. 97
  • Properties: Guna-Sara,guru,rooksha.. Rasa- Tikta,madhura,kashya.. Virya- sheetaKarma- Lekhana, balya, vrushya, vayastambhaka, medhya, caksooshya, yogavahi,raktavardhaka, vajikar, veeryavardhaka.Indication: Shotha, shoola,arsha,pandu,pleeha roga,medo roga,jara vyadhi,kushtaroga,raktaj roga,gulma,udara,kaphaj roga, shwasa,kasa,jwara,amavatMatra -1|4 rati - 2 rati.Anupana- Triphala,madhu,ghee,dugdha,shilajatu,buuter.3) Mandura bhasma204Name: Sanskrit –ManduraHindi- Mandura Loha kitta.English-Iron oxideSynonym- Mandura,kitta,lohabhav,lohamala.Properties: Guna-sheeta Rasa-kashya.. Virya- sheetaKarma- Pittashamaka,vrushya,ruchikaraka,agnideepaka,uttama rakta vardhaka.Indication: Pandu,kamala,shosha,shotha,halimaka,pleeha roga.Matra- 1|4 rati - 2 rati.Anupana- Madhu4) Rasota (Rasanjana)205:Lattin :Extraction.BerberisHindi- Rasota,rasavata.Bengali-rasanjana.Kannada-rasanjanMarathi-rasavat,rasanjan.Gujarati-rasavatiTelagu-rasajanyu.Punjabi-rasoot..Properties: Guna-Katu Rasa-Katu,tikta. Virya- Ushna.Karma- Kapha nashaka,visha,netra vikara,rasayana,chedaka. 98
  • Indication: Jwarahara, arshoghana, shothaghana, raktashodhaka, netra vikarahara.Matra- 1|4 rati - 2 rati.5) Madhu206, 207:Rasa - Madhura, KashayaGuna -Guru, Ruksha, yogavahi(samananukari dravyaprabhodhita shakt(Ch.su.27/249Su.Su.45/142)Veerya - Sheeta.Properties - Grahi, vilekhana, srotoshodhaka, chakshushya, deepana, etcIndication - kushta, Arsha, Kasa, Meha, Krimi, Meda, shwas 99
  • Table No 20 Showing the Nrupavallabha Taila IngredientsSI NAME GUNA RASA VIPAKA VEERYA DOSHAKARMA KARMUKTANO1 Vidarikanda Snigdha Madhura Madhura Sheeta Vata pitta shamaka valya, bhrumna ,Rasayana kashya, shosha,daha etc2 Shatavari Gura,snigdha Madhura,tikta Madhura Sheeta Vata pitta hara stanya, kshya, artava kshya, rakta pitta, arshas, atisara, grahani, kshya, gulma.3 Draksha Guru, snigdha, madhura. madhura sheeta vata pita shamaka jwara,raktapitta,kamala,rajayaksma,daha, mrudu. trsna4 Shaliparni Guru, snigdha madhura, tikta madhura ushna. Tridosha hara sotha,kasa-swasa,jwara,atisara,chardi,krimi.5 Kantakari Laghu,ruksha,t Katu, tikta katu ushna Kapha-vata hara Kasa,swasa,sotha, hikka,ashmari,pratisyaya eekshna6 Brahti Laghu,ruksha Katu, tikta katu ushna Kapha-vata hara Svasa, hrdroga, sula, jwara, chardi, kushta, kandu, krimi7 Madhuka Guru,snigdha Madhura. Madhura shita. Tridoshahara vrana shotha, chardi, trushna, visaroga, kshya, daha, raktapitta, hrdroga, vrana8 Bala Laghu,snigdha Madhura Madhura shita vata pitta hara Raktapitta, vatavyadhi, prameha, ksaya. ,picchila9 Vidanga Laghu,rooksha Katu,kashaya Katu. ushna kapha vata hara. krimi, udara, adhmana,shoola,kushta. ,tikshna10 Manjishta Guru,rooksha Madhura,tikta Katu. ushna kapha pitta hara Jwara,mootrakricchra,prameha,kushta,netra . roga,sotha12 Nilotphala Laghu,snigdha Tikta,madhur Madhura Sheeta kapha pitta shamaka Mastishaka ,pichilla a,kashaya daurbalya,anidra,balya,vishaghana13 Gokshura Guru,snigdha Madhura Madhura Sheeta. Vata pitta hara Mutrakricchara,ashmari,prameha,hrdroga,ars as,svasakasa,klaibya..14 Propaundarika Laghu, Tikta Katu Sheeta Kapha pitta hara. Netra rooksha ,kashaya roga,visphota,kandu,arsas,visaroga,shoola15 Punarnava Laghu, Madhura,tikta Katu ushna. Kapha vata hara Sotha,pandu,raktapitta,udara,hrdroga,swasa. rooksha , kashya16 Pippali Laghu, Katu Madhura ushna(ardr Kapha kapha hara udara,plihodara,jwara,kushta,prameha,gulma snigdha a seeta) ,arshas,shoola17 Saindhava Laghu, Sheeta Tridoshahara Netra roga,agnideepaka,vrushya,vata snigdha anulomaka,vrana ropana,vranashodhaka.18 Sarkara Laghu Madhura Sheeta Vata pitta hara Rakta vikara,daha,moorcha,jwara. 100
  • Table No 21 Showing the Shambukadya Gutika IngredientsSI NAME GUNA RASA VEERYA DOSHAKARMA KARMUKTANO Drug Guna Rasa Veerya Doshagnata Indication1 Shankha bhasma Laghu,sheeta Katu,kashaya,ks sheeta Tridoshaghana Amla pitta, ghrani, atisara, haryea parinamashoola, shwasa2 Loha bhasma Sara,guru, Tikta,madhura, sheeta Pittashamaka Shotha,shoola,arsha,pandu,pleeharoga,me rooksha kashya doroga,jaravyadhi, kushtaroga,raktajroga,gulma, udara,kaphaja jwara,3 Mandura bhasma Guna-sheeta kashya sheeta Pittashamaka Pandu,kamala,shosha,shotha,halimaka,ple eha roga.4 Rasota Katu Katu, Tikta Ushana Vata & Kaphashamaka Kapha nashaka,visha, netra vikara,rasayana,chedaka.5 Sarkara Laghu Madhura Sheeta vatapittahara Rakta vikara,daha,moorcha,jwara.6 Madhu Guru, rooksha Madhura, sheeta vatapittahara kushta, Arsha, Kasa, Meha, Krimi, Kashaya Meda, shwas 101
  • MethodologyMaterials and method: It is necessary to describe the procedure adopted in the study. As the presentclinical study was aimed at treating Ardhavabhedaka w.s.r.t migraine, this part dealswith the outcome of the procedures carried out in the studyObjectives of the study: The present study named comparative study of Shambukadya gutika &Nrupavallabha taila navana nasya in the management of ardhavabhedaka w.s.r.tmigraine was carried out with following objectives. To evaluate the efficacy of Shambukadya Gutika in Ardhavbhedaka. To evaluate the efficacy of Nrupavallabh Taila Navan nasya in Ardhavbhedaka.Materials for the study:Source of data: Patients will be selected from O.P.D of D.G.M.A M.C. & H. after fulfillingthe inclusion and exclusion criteria. Required literary information for the intended study will be procured fromboth the Ayurvedic and Modern textbooks and updated with recent journals of boththe faculties.The material used for the study was: Shambukadya gutika for internally Nrupavallabha taila for navana nasya . 102
  • Preparation of the medicine:Shambukadya gutika for internally: The 6 ingredient of the Shambukadya gutika having shanka bhasma, lohabhasma, rasota, mandura bhasma, sugar and honey and the tablets are prepared withgood manufacturing practice.Nrupavallabha taila for navana nasya: The 18 ingredient of the Nrupavallabha taila having Vidarikanda, Shatavari,Draksha, Shaliparni, Kantakari, Brahti, Madhuka, Bala, Vidanga, Manjistha, Rasna,Nilotphala, Gokshura, Propaundarika, Punarnava, Pippali, Saindhava, Sarkara etc andthe taila are prepared according to the reference of Sharangadhara samhita in ourcollege pharmacy.METHODS:Type of study:The study was standered comparetive clinical study of Shambukadya gutika forinternally and Nrupavallabha taila for navana nasya Ardhavabhedaka wsrt migraine.Source of data: the minimum 30 number of patients included for the study.Patient of either sex were selected O.P.D of D.G.M.A M.C. & H. after fulfilling theinclusion and exclusion criteria.Selection of patients:A minimum of 30 patients equally distributed in two groups Group A: 15 patients will receive Shambukadya Gutika internally. Group B: 15 patients will receive Navan Nasya with Nrupavallabh Taila.Inclusion criteria: Patient above 12 years and below 60 years of age group irrespective of sex. 103
  • Patient with clinical features of Ardhavbhedaka as well as Migraine explained in classics. Patient fit for nasya karmaExclusion criteria: Brain Tumour Subarchnoid Hemorrhage Meningitis Glaucoma Purulent Sinusitis Arterial Hypertension Under the age of 12 yearsDiagnostic criteria: The clinical features of Ardhavbhedaka as well as Migraine mentioned in textswill be the basis of diagnosis.Diagnostic criteria for ardhavabhedaka: Shirashula Bhrama Toda Chardi Prakasha santrasa Shabdaasahishnuta Karna kshweda Aura 104
  • Diagnostic criteria for migraine:International Headache Society criteria for primary headache disordersMigraine with aura (classic migraine):Diagnostic criteria: At least 2 attacks fulfilling B At least 3 of the following characteristics: One or more fully reversible aura symptoms indicating brain dysfunction At least 1 aura symptom develops gradually over more than 4 minutes or 2 or more symptoms occur in succession No single aura symptom lasts more than 60 minutes Headache follows aura with a free interval of less than 60 minutes (it may also begin before or simultaneously with the aura)C) History, physical examination, and, where appropriate, diagnostic tests exclude asecondary causeMigraine with aura (classic migraine):Migraine without aura:Diagnostic criteria:Previously used terms: common migraine, hemicrania simplex. At least 5 attacks fulfilling B-D Headache lasting 4 to 72 hours (untreated or unsuccessfully treated) Headache has at least 2 of the following characteristics: o Unilateral location o Pulsating quality o Moderate or severe intensity (inhibits or prohibits daily activities) o Aggravation by walking stairs or similar routine physical activity 105
  • D) During headache at least 1 of the following: Nausea and/or vomiting Photophobia and phonophobiaE) No evidence of organic diseasePosology: Internal: Shambukadya Gutika –125 mg three times per day for 45 days study duration with 45 days follow up period. External: Navana nasya with Nrupavallabh Taila 8-8 drops in each nostril for 14 days study duration with 30 days follow up period.InvestigationsDiagnostic and exclusion Hemoglobin percentage. Random blood Sugar Erythrocyte sedimentation rate Total WBC count Differential count.Assessment of results: The subjective and objective parameters of base line data to pre andpost medication will be compared for assessment of the results. All the result will beanalyzed statistically for “p” value using student‘t’ test Paired t- test for effect ofindividual group and un-paired t-test for comparative study of the mean of two groups.Non –parametric gain if it is necessary. 106
  • Assessment chart for shamana aushadhi:Subjective parameter:Shiraha shoola, shankha shoola, manya, bhru, akshi, lalata shoola and shastra araninibham vedana were set as subjective parameter. The grading were as followTable No 22 Showing the Grading for objective parameter for both shamana &shodhana aushadies S.No Symptoms Grading 1 Severity of pain Intolerable pain 4 Disturbs the normal work 3 Not disturb the normal work 2 Pain Tolerable 1 No pain 0 2 Duration of pain Over 24 hours or continuous 4 12 to 24 hours 3 3 to 12 hours 2 0 to 3 hours 1 No pain 0 3 Frequency of attack Continuous 4 Once in a week 3 Once in a 15 days 2 Once in a month 1 No attack 0 4 IHS Criteria More than 7 4 Presenting 5-6 criteria 3 107
  • Presenting 4-5 criteria 2 Symptom less than 3 1 Absence of symptoms 0Table No 23 Showing the Assessment chart for shaman aushadhi (SubjectiveParameters)S.No Assessment Criteria BT 15th 30th AT Follow-up Day Day 15 30 451 Shiraha Shoola2 Shankha Shoola3 Manya,bhru,akshi,lalata Shoola4 Shastra arani nibham vedanaTable No 24 Showing the Assessment chart for shaman aushadhi (ObjectiveParameters)S.No Assessment Criteria BT 15th 30th AT Follow-up Day Day 15 30 451 Severity of Pain2 Duration of Pain3 Frequency of PainIHS Criteria1 Unilateral location2 Pulsating quality3 Moderate intensity4 Severe intensity5 Aggravated by walking stairs6 Phonophobia7 Photophobia8 Nausea9 Vomiting 108
  • Table No 25 Showing the Assessment chart for navana nasya (SubjectiveParameters)S.No Assessment Criteria BT 7th 14th Follow-up Day Day 15 301 Shiraha Shoola2 Shankha Shoola3 Manya,bhru,akshi,lalata Shoola4 Shastra arani nibham vedanaTable No 26 Showing the Assessment chart for navana nasya (OjectiveParameters)S.No Assessment Criteria BT 7th 14th Follow-up Day Day 15 301 Severity of Pain2 Duration of Pain3 Frequency of PainIHS Criteria1 Unilateral location2 Pulsating quality3 Moderate intensity4 Severe intensity5 Aggravated by walking stairs6 Phonophobia7 Photophobia8 Nausea9 Vomiting 109
  • Nasya vidhi:Preparation of patient for nasya vidhi:The method of administration of Nasya of nasya may be classified under followingheadings. Poorva Karma. Pradhaana Karma. Paschaat Karma.Poorva Karma:Nasya karma is an important therapy among panchakarma, for the management of thedisease and other systemic disorders like vata vyadhi. Before going to start the nasyakarma it is very much important for the arrangement of the materials, drugs andequipments which is very much necessary for nasya karma. Special room for nasyakarma “ Nasya bhavana” which is free from atmospheric effects that which is directlyfree from direct blow of air , dust, and lighted properly.Nasya asana:A chair for sitting purposeA cot for lying purposeNasya Yantra:Nasya yantra should be used according to the type of nasya.For snehana, Marsha, pratimarsha and avapida nasya a dropper (Gokarana) or pichu isused and for pradhamana nasya shadangula nadi yantra should be used and fordhooma nasya dhooma yantra is used. 110
  • Equipment:Massage table, Spitting Pitts, two Bowl, Napkins, Dropper, cotton, gas stove,Saindhava, one big vessel, one steel glass, two attendants etc.Nasya aushadhi: Morchita tila taila was used in sufficient quantity for localabhyanga, and then Nrupavallabha taila was used for nasya in the quantity of 8 dropsin each nostril.Selection of the Patient - The patient should be selected according to the indicationsand contraindictions of Nasya mention in the inclusion and exclusion criteria.Preparation of the patient: According to the Acharya Sushruta following type of regimens are given tothe patient to prepare the patient for nasya karma. Diet should be given to the patient who has passed his natural urges like urine,stool, etc. after some time toothbrush and other routine daily activities should be done.Light breakfast before one hour to nasya karma is advised. Now snehana (mrudhuabhyanga) and swedana should be done. Snehana and swedana should be done onscalp, forhead and neck for 3- 5 minutes with medicated oil. After doing the abhyangato the patient mruda swedana should be done on shira, mukha, nasa, manya greevaand kantha. But according to the classics, sweda on the head is a contraindication. Itis adopted for elimination of Doshas and liquification of doshas. After swedana,mrudu mardana on kantha, mukha, shira manya must be done.Pradhana karma:The procedure for nasya karma is described here according to Acharya Charaka,Sushruta and vaghbata. After completion of the poorva karma with snehana andswedana the nasya karma should be adopted to that patient. Patient should lie down insupine position on the nasya shaiyya. The shira of the patient should be lowered i.e. 111
  • Pravilambita and foot part is slightly raised. The eyes of the patient must be closedwith the help of a wet cloth or cotton, the physician should raise the tip of thepatient’s nose with his left thumb and the right hand the 8-8 drops of the lukewarmmedicine should be dropped in both the nostrils alternately with the help of nasyayantra used for sneha nasya properly. Be remembering that the dose should not be lessor more in quantity and not too hot and too cold. The patient should remain relaxed atthe time of administration of Nasya and the patient should avoid speech, anger,sneezing, laughing and head shaking during Nasya Karma.Pashchata karma: According to the Acharya Charaka, Sushruta and Vaghabhata after completionof pradhana karma following regimen should be followed. After completion karma, inthe supine position ask the patient to count up to 100 matra approximately up to 2minute. After this massaged should be done to feets, shoulders, palms and ears. Thenagain mrudhu swedana should be done on head, cheek and neck. Now ask the patientto spit out the medicated drug which comes in oropharynx and no portion of medicineis left inside. After this medicated kavala, gandoosha and dhoomapana are advocatedto expel out the kapha lodged in the kantha. Now advice the patient to stay inwindless place and laghu ahara and lukewarm water is advised. Patient should avoiddust, smoke, and brightness, hot bath, anger riding excessive intake liquid diet.Acharya charaka further advise that the patient should avoid day sleep and should notuse cold water for pana and snana. 112
  • Observations of Demographic Data and Results Totally 30 patients are enrolled in the present study among them 28 werecompleted the treatment and 2 discontinued. All patients were closely observed duringthe treatment and documented the changes in specially made case sheet. These dataobtained from the clinical trial are well documented and observed data are tabulatedin systematic manner.Table No 27 Showing the Distribution of patients by Age in Groups-A & BAge Group -A Group -B Total No. No. No. % % %20-30 3 21.42 1 7.14 4 14.2830-40 6 42.85 8 57.14 14 5040-50 4 28.57 3 21.42 7 2550-60 1 7.14 2 14.28 3 10.71 In group-A 3(21.42%) patients belongs to 20-30 age group, 6(42.85%)patients belong to 30-40 age group, 4(28.57%) patients belongs to 40-50 age group,1(7.14%) patient belongs to 50-60 age group and in Group- B 1(7.14%) patientbelongs to 20-30 age group, 8(57.14%) patients belong to 30-40 age group, 3(21.42%)patients belongs to 40-50 age group, 2(14.28%) patients belongs to 50-60 age groupand overall out of 28 patients, 4(14.28%) patients belongs to 20-30 age group,14(50%)) patients belongs to 30-40 age group, 7(25%) patients belongs to 40-50 agegroup, 3(10.71%) patients belongs to 50-60 age group.Graph No 1 Showing the Distribution of patients by Age in Groups-A & B 14 12 10 8 Group A 6 Group B Total 4 2 0 20-30 31-40 41-50 51-60 113
  • Table No 28 showing the incidence of Gender in Groups-A & B Male % Female %Group -A 3 21.42 11 78.57Group -B 4 28.57 10 71.42Total 7 25 21 75 In Group-A among 14 patients 3(21.42%) were males and 11(78.57%) werefemales and in Group-B among 14 patients 4(28.57%) were males and 10(71.42%)were females and overall out of 28 patients 7(25%) were male and 21(75%) werefemales.Graph No 2 showing the incidence of Gender in Groups-A & B 25 20 15 Group-A Group-B 10 Total 5 0 Male FemaleTable No 29 Showing the Incidence of Ardhavabhedaka in different religions inGroups - A&BReligion Hindu % Muslim % Christian %Group -A 9 64.28 5 35.71 - -Group -B 13 92.85 1 7.14 - -Total 22 78.57 6 21.42 - - In Group-A among 14 patients 9(64.28%) were Hindus and 5(35.71%) wereMuslims and none were Christian and others and in Group-B among 14 patients13(92.85%) were Hindus and 1(7.14%) were Muslims and none were Christian and 114
  • others and out of 28 patients 22(78.57%) were Hindus and 6(21.42%) were Muslimsand none were Christian.Graph No 3 Showing the Incidence of Ardhavabhedaka in different religions inGroups - A&B 25 20 15 Group A Group B 10 Total 5 0 Hindu Muslim ChristianTable No 30 Showing the Incidence of Ardhavabhedaka in different occupationin Groups -A & BOccupation Sedentary % Active % Labor %Group –A 9 64.28 4 28.57 1 7.14Group –B 5 35.71 3 21.42 6 42.85Total 14 50 7 25 7 25 In Group-A among 14 patients 9(64.28%) were Sedentary and 4(28.57%) wereActive and 1(7.14%) were Labor and in Group-B among 14 patients 5(35.71%) wereSedentary and 3(21.42%) were Active and 6(42.85%) were Labor and in total out of28 patients 14(50%) were Sedentary and 7(25%) were Active and 7(25%) wereLabor. 115
  • Graph No 4 Showing the Incidence of Ardhavabhedaka in different occupationin Groups -A & B 14 12 10 8 Group A Group B 6 Total 4 2 0 Sedentary Active LabourTable No 31 Showing the Incidence of Ardhavabhedaka acc. to marital status inGroups-A & BMarital status Married % Unmarried %Group -A 11 78.57 3 21.42Group -B 13 92.85 1 7.14Total 24 85.71 4 14.28 In Group-A among 14 patients 11(78.57%) were Married persons and3(21.42%) were Unmarried and in Group-B among 14 patients 13(92.85%) wereMarried persons and 1(7.14%) were Unmarried and in total out of 28 patients24(85.71%) Married persons and 4(14.28%) were Unmarried.Graph No 5 Showing the Incidence of Ardhavabhedaka acc. to marital status inGroups-A & B 25 20 15 Group a 10 Group B Total 5 0 Married Unmarried 116
  • Table No 32 Showing the Showing Incidence of Ardhavabhedaka acc. to Socio-Economic status in Groups-A & BEconomic Poor % Middle % Higher % Higher %status middle classGroup -A 2 14.28 6 42.85 6 42.85 - -Group -B 7 50 5 35.71 2 14.28 - -Total 9 32.14 11 39.28 8 28.57 - - In Group-A among 14 patients 2(14.28%) from Poor class and 6(42.85%)from Middle class, 6(42.85%) from Higher middle class and none from Higher classIn Group-B among 14 patients 7(50%) from Poor class and 5(35.71%) from Middleclass, 2(14.28%) from Higher middle class and none from Higher class and out of 28patients 9(32.14%) from Poor class and 11(39.28%) from Middle class, 8(28.57%)from Higher middle class and none from Higher class.Graph No 6 Showing the Showing Incidence of Ardhavabhedaka acc. to Socio-Economic status in Groups-A & B 12 10 8 Group A 6 Group B 4 Total 2 0 Poor Middle Higher Higher class MiddleTable No 33 Showing the Incidence of Family History status in Groups-A & BFamily History Present % Absent %Group -A 3 21.42 11 78.57Group -B 5 35.71 9 64.28Total 8 28.57 20 71.42 117
  • In Group-A among 14 patients 3(21.42%) patients shows the Family Historyand Family History in11 (78.57%) patients was Absent, In Group-B among 14patients 5(35.71%) patients shows the Family History and Family History in 9(78.57%) patients was Absent and out of 28 patients 8(28.57%) patients shows theFamily History and Family History in 20 (71.42%) patients was Absent.Graph No 7 Showing the Incidence of Family History status in Groups-A & B 20 15 Group A 10 Group B Total 5 0 Present AbsentTable No 34 Showing the Incidence of distribution of patients diet patternType of diet Vegetarian % Mix Veg %Group -A 5 35.71 9 64.28Group -B 7 50 7 50Total 12 42.85 16 57.14 In Group-A among 14 patients 5(35.71%) were Vegetarian persons and9(64.28%) were Mixed Vegetarian and in Group-B among 14 patients 7(50%) wereVegetarian persons and 7(50%) were Mixed Vegetarian and in total out of 28 patients12(42.85%) were Vegetarian persons and 16(57.14%) were Mixed Vegetarian. 118
  • Graph No 8 Showing the Incidence of distribution of patients diet pattern 16 14 12 10 Group A 8 Group B 6 Total 4 2 0 Vegetarian Mixed VegTable No 35 showing the distribution of patients by Rasa predominance: Group-A % Group-B % Total %Madhura 4 28.57 5 35.71 9 32.14Amla 10 71.42 10 71.42 20 71.42Lavana 7 50 11 78.57 18 64.28Katu 14 100 11 78.57 25 89.28Tikta 2 14.28 0 0 2 7.14Kashaya 0 0 0 0 0 0 In Group-A among 14 patients 4(28.57%) patients preferred madhura rasa,10(71.42%) patients preferred amla rasa, 7(50%) patients preferred lavana rasa,14(100%) patients preferred katu rasa, 2(14.28%) patients preferred tikta rasa andnone of patients preferred kashaya rasa In Group-B among 14 patients 5(35.71%)patients preferred madhura rasa, 10(71.42%) patients preferred amla rasa, 11(78.57%)patients preferred lavana rasa, 11(78.57%) patients preferred katu rasa, and none ofpatients preferred tikta rasa and kashaya rasa and out of 28 patients 9(32.14%)patients preferred madhura rasa, 20(71.42%) patients preferred amla rasa, 18(64.28%)patients preferred lavana rasa, 25(89.28%) patients preferred katu rasa, 2(7.14%)patients preferred tikta rasa and none of patients preferred kashaya rasa . 119
  • Graph No 9 showing the distribution of patients by Rasa predominance: 25 Group A 20 Group B Total 15 10 5 0 Madhura Amla Lavana Katu Tikta KashayaTable No 36 showing the distribution of patients by Agni: Sama % Vishma % Manda % Teekshna %Group-A 1 7.14 5 35.71 7 50.00 1 7.14Group-B 0 0 2 14.28 11 78.57 1 7.14Total 1 3.57 7 25 18 64.28 2 7.14 In Group-A among 14 patients 1(7.14%) of the patients had sama agni,5(35.71%) of the patients had vishma agni, 7(50.0%) of the patients had manda agni,1(7.14%) of the patients had teekshna agni and In Group-B among 14 patients none ofthe patients had sama agni, 2(14.28%) of the patients had vishma agni, 11(78.57%) ofthe patients had manda agni, 1(7.14%) of the patients had teekshna agni and out of 28patients 1(3.57%) of the patients had sama agni, 7(25%) of the patients had vishmaagni, 18(64.28%) of the patients had manda agni, 2(7.14%) of the patients hadteekshna agni. 120
  • Graph No 10 showing the distribution of patients by Agni: 18 16 14 12 10 Group A 8 Group B 6 Total 4 2 0 Sama Vishma Manda TeekshnaTable No 37 showing the distribution of patients by koshta: Mrudu % Madhyama % Krura %Group-A 1 7.14 8 57.14 5 35.71Group-B 2 14.28 10 71.42 2 14.28Total 3 10.71 18 64.28 7 25 In Group-A among 14 patients 1(7.14%) of the patients had mrudu koshta,8(57.14%) of the patients had madhyama koshta, 5(35.71%) of the patients had krurakoshta and In Group-B among 14 patients 2(14.28%) patients had mrudu koshta,10(71.42%) of the patients had madhyama koshta, 2(14.28%) of the patients had krurakoshta and out of 28 patients 3(10.71%) of the patients had mrudu koshta, 18(64.28%)of the patients had madhyama koshta, 7(25%) of the patients had krura koshta. Graph No 11 showing the distribution of patients by koshta: 20 15 Gr - A Gr - B 10 Total 5 0 mrudu madhya krura 121
  • Table No 38 Showing the distribution of patients by pureesha pravruti: Prakruta % Vitvivandha % Dravavit %Group-A 2 14.28 11 78.57 1 7.14Group-B 4 28.57 9 64.28 1 7.14Total 6 21.42 20 71.42 2 7.14 In Group-A among 14 patients 2(14.28%) of the patients having prakrutapureesha pravruti, 11(78.57%) of the patients having vitvivandha pureesha pravruti,1(7.14%) of the patients having dravavit pureesha pravruti and In Group-B among 144(28.57%) of the patients having prakruta pureesha pravruti, 9(64.28%) of the patientshaving vitvivandha pureesha pravruti, 1(7.14%) of the patients having dravavitpureesha pravruti and out of 28 patients 6(21.42%) of the patients having prakrutapureesha pravruti, 20(71.42%) of the patients having vitvivandha pureesha pravruti,2(7.14%) of the patients having dravavit pureesha pravrutiGraph No 12 showing the distribution of patients by pureesha pravruti: 20 18 16 14 12 Group A 10 Group B 8 Total 6 4 2 0 Prakruta Vitbivandha Dravavit 122
  • Table No 39 showing the distribution of patients by chronicity of chiefcomplaints: Group-A % Group-B % Total % Fresh 0 0 1 7.14 1 3.57Shirashoola <1 yrs 5 35.71 3 21.42 8 28.57 <5 yrs 3 21.42 5 35.71 8 28.57 >5 yrs 6 42.85 5 35.71 11 39.28 Fresh 0 0 0 0 0 0 <1 yrs 1 7.14 4 28.57 5 17.85Bhrama <5 yrs 2 14.28 2 14.28 4 14.28 >5 yrs 3 21.42 1 7.14 4 14.28 Fresh 0 0 0 0 0 0 <1 yrs 1 7.14 0 0 1 3.57Toda <5 yrs 1 7.14 2 14.28 3 10.71 >5 yrs 2 14.28 2 14.28 4 14.28 In Group-A among 14 patients none of the patients having fresh shirashoola,5(35.71%) patients having shirashoola from last one year, 3(21.42%) patients havingshirashoola from last five years, 6(42.85%) patients having shirashoola from morethen five years and In Group-B among 14 patients none of the patients having freshbhrama, 1(7.14%) patients having bhrama from last one year, 2(14.28%) patientshaving bhrama from last five years, 3(21.42%) patients having bhrama from morethen five years and out of 28 patients none of the patients having fresh toda, 1(7.14%)patients having toda from last one year, 1(7.14%) patients having toda from last fiveyears, 2(14.28%) patients having toda from more then five years. 123
  • GraphNo13(GroupA) 7 6 5 4 Shirashoola Bhrama 3 Toda 2 1 0 fresh < 1yr <5yr > 5yrGraph No 14 Group B: 7 6 5 4 Shirashoola Bhrama 3 Toda 2 1 0 fresh < 1yr <5yr > 5yr 124
  • Table No 40 Showing the distribution of patients by VyasanaVyasana Gr- A % Gr- B % Total %Alcohol 1 7.14 2 14.28 3 10.71Smoking 2 14.28 4 28.57 6 21.42Tobacco chewing 9 64.28 7 50 16 57.14 In Group-A among 14 patients 1(7.14%) patient were Addicted with alcohol,2(14.28%) patients were Addicted with smoking and 9(64.28%) patient wereAddicted with tobacco chewing and in Group-B among 14 patients 2(14.28%) patientwere Addicted with alcohol, 4(28.57%) patients were Addicted with smoking and7(50%) patient were Addicted with tobacco chewing and out of 28 patients 3(10.71%)patient were Addicted with alcohol, 6(21.42%) patients were Addicted with smokingand 16(57.14%) patient were Addicted with tobacco chewing. Graph No 15 Showing the distribution of patients by Vyasana 16 14 12 10 Group A 8 Group B 6 Total 4 2 0 Alcohol Smoking Tobacco ChewingTable No 41 showing the distribution of patients by Nidra Day % Night % Sound % Disturbed % SleepGroup -A 3 21.42 1 7.14 2 14.28 8 57.14Group -B 4 28.57 2 14.28 2 14.28 6 42.85Total 7 25 3 10.71 4 14.28 14 50 125
  • In Group- A out of fourteen patient 3(21.42%) patients sleep at day time,1(7.14%) patients sleep at night time, 2(14.28%) patients having sound sleep and8(57.14%) patients having disturbed sleep while in Group- B out of fourteen patient4(28.57%) patients sleep at day time, 2(14.28%) patients sleep at night time,2(14.28%) patients having sound sleep and 6(42.85%) patients having disturbed sleepand out of 28 patients 7(25%) patients sleep at day time, 3(10.71%) patients sleep atnight time, 4(14.28%) patients having sound sleep, 14(50%) patients having disturbedsleep.Graph No 16 showing the distribution of patients by Nidra 14 12 10 8 Group A 6 Group B Total 4 2 0 Day Night Sleep DisturbedTable No 42 Showing the distribution of patients by Menstrual History Regular % Irregular % Menopause %Group -A 4 36.36 4 36.36 3 27.27Group -B 3 30 3 30 4 40Total 7 33.33 7 33.33 7 33.33 In Group- A out of 11 patient 4(36.36%) patients shows Regular Menstrualhistory, 4(36.36%) patients shows Irregular Menstrual history and 3(27.27%) patientsare in menopause stage and in Group- B out of 10 patient 3(30%) patients showsRegular Menstrual history, 3(30%) patients shows Irregular Menstrual history and4(40%) patients are in menopause stage out of 21 patients 7(33.33%) patients shows 126
  • Regular Menstrual history, 7(33.33%) patients shows Irregular menstrual History and7(33.33%) patients are in menopause stage.Graph No 17 Showing the distribution of patients by Menstrual History 7 Group A 6 Group B 5 Total 4 3 2 1 0 Regular Irregular MenopouseTable No 43 Showing the Incidence by Precipitating Factors: Group- A % Group- B % Total %Snigdha ahara 2 14.28 5 35.71 7 25Diwaswapa 2 14.28 5 35.71 7 25Ratrijagrana 7 50 6 42.85 13 46.42Ayasa 1 7.14 3 21.42 4 14.28Chinta 10 71.42 9 64.28 19 67.85Vegadharana 10 71.42 13 92.85 23 82.14Atapasevana 12 85.71 9 64.28 21 75Rookshaahara 12 85.71 9 64.28 21 75Purvayu 8 57.14 7 50 15 53.57Menstrual cycle 7 50 7 50 14 100 The incidence of Precipitating factors found in 28 patients i.e Group- A &Group- B revealed that Ratrijagrana 13(46.42%), Chinta 19(67.85%), Vegadharana23(82.14%), Atapasevana 21(75%), Rooksha ahara 21(75%) and Purvayu 15(53.57%)was found as a main precipitating factor in all the patients followed by Snigdha ahara 127
  • 7(25%), Diwaswapa 5(17.85%), and Menstrual cycle 14(100%) of patients, Ayasa4(14.28%).Graph No 18 Showing the Incidence by Precipitating Factors: 25 20 15 Group A 10 Group B Total 5 0Table No 44 Showing the Incidence by Relieving Factors: Group- A % Group- B % Total %Vomiting 4 28.57 6 42.85 10 35.71Head Bending 5 35.71 7 50 12 42.85Tranquilizers 12 85.71 10 71.42 22 78.57Taking Rest 14 100 10 71.42 24 85.71 The incidence of Relieving factors found in 28 patients revealed thatTranquilizers 22(78.57%) and Taking rest 24(65.71%), Vomiting 10(35.71%) andHead Bending 12(42.85%) were found as the main Relieving factors in the patients.Graph No 19 Showing the Incidence by Relieving Factors: 25 20 15 Group A 10 Group B 5 Total 0 Vomiting Head Bending Tranquilizers Taking Rest 128
  • Table No 45 showing the distribution of patients by previous treatment history: Gr- A % Gr- B % Total %Started but discontinued 6 42.85 7 50 13 46.42Taking only during attack 8 57.14 7 50 15 53.57 In Group- A out of fourteen patient 6(42.85%) patients started the medicinesbut discontinued and 8(57.14%) patients taking medicines during attack time and InGroup- B out of fourteen patient 7(50%) %) patients started the medicines butdiscontinued and 7(50%) patients taking medicines during attack time and out of 28patients 13(46.42%) patients started the medicines but discontinued and 15(53.57%)patients taking medicines during attack time.Graph No 20 showing the distribution of patients by previous treatment history: 16 14 12 10 Gr - A 8 Gr - B 6 Total 4 2 0 Started but discontinued Taking only during attackTable No 46 showing the distribution of patients having Stress Present % Absent %Group -A 7 50 7 50Group -B 10 71.42 4 28.57Total 17 60.71 11 39.28 In Group- A out of fourteen patient 7(50%) patients having stress and in7(50%) patients stress were absent and in Group- B out of fourteen patient10(71.42%) patients having stress and in 4(28.57%) patients stress were absent and in 129
  • total out of 28 patients 17(60.71%) patients having stress and in 11(39.28%) patientsstress were absentGraph No 21 showing the distribution of patients having Stress 18 16 14 12 Group A 10 8 Group B 6 Total 4 2 0 Present AbsentTable No 47 showing the distribution of patients by Chief Complaints Shirashoola % Bhrama % Toda %Group -A 14 100 6 42.85 4 28.57Group -B 14 100 7 50 5 35.71Total 28 100 13 46.42 9 32.14 In Group- A out of fourteen patient 14(100%) patients having Shirashoola,6(42.85%) patients having Bhrama, 4(28.57%) patients having Toda and In Group- Bout of fourteen patient 14(100%) patients having Shirashoola, 7(50%) patients havingBhrama, 5(35.71%) patients having Toda and in total out of 28 patients 28(100%)patients having Shirashoola, 13(46.42%) patients having Bhrama, and 9(32.14%)having Toda.Graph No 22 showing the distribution of patients by Chief Complaints 30 25 20 Group A 15 Group B 10 Total 5 0 E Shirashoola Bhrama Toda 130
  • Table No 48 Showing the distribution of patients by Associated Complaints Group -A % Group -B % Total %Chardi 12 85.71 10 71.42 22 78.57Prakasha 12 85.71 11 78.57 23 82.14SantrasaShabda 4 28.57 8 57.14 12 42.85AsahiuntaKarna 0 - 1 7.14 1 71.42KshwedaAura 2 14.28 0 - 2 78.57 In Group- A out of 14 patient 12(85.71%) patients having Chardi, 12(85.71%)patients having Prakasha Santrasa, 4(28.57%) patients having Shabda Asahiunta andnone of patients having Karna Kshweda and 2(14.28%) patients having Aura InGroup- B out of 14 patient 10(71.42%) patients having Chardi, 11(78.57%) patientshaving Prakasha Santrasa, 8(57.14%) patients having Shabda Asahiunta and 1(7.14%)patients having Karna Kshweda and none of patients having Aura and out of 28patients 22(78.57%) patients having Chardi, 23(82.14%) patients having PrakashaSantrasa, 12(42.85%) patients having Shabda Asahiunta and 1(71.42%)patientshaving Karna Kshweda and 2(78.57%) patients having Aura.Graph No 23 Showing the distribution of patients by Associated Complaints 25 20 15 Group A 10 Group B Total 5 0 Chardi Prakasha Asahishuna Kshweda Aura Santras Karna Shabda 131
  • Table No 49 showing the distribution of patients by Location of pain Group -A % Group -B % Total %Right 8 57.14 6 42.85 14 50Left 6 42.85 8 57.14 14 50Frontal 11 78.57 10 71.42 21 75Temporal 14 100 14 100 28 100Occipital 4 28.57 6 42.85 10 35.71Jaw 3 21.42 1 7.14 4 14.28 In Group- A out of 14 patient 8(57.14%) patients having pain in the Rightside, 6(42.85%) patients having pain in the Left side, 11(78.57%) patients having painin the Frontal side, 14(100%) patients having pain in the Temporal side, 4(28.57%)patients having pain in the Occipital side, 3(21.42%) patients having pain in the Jawregion and In Group- B out of 14 patient 6(42.85%) patients having pain in the Rightside, 8(57.14%) patients having pain in the Left side, 10(71.42%) patients having painin the Frontal side, 14(100%) patients having pain in the Temporal side, 6(42.85%)patients having pain in the Occipital side, 1(7.14%) patients having pain in the Jawregion and out of 28 patients 14(50%) patients having pain in the Right side, 14(50%)patients having pain in the Left side, 21(75%) patients having pain in the Frontal side,28(100%) patients having pain in the Temporal side, 10(35.71%) patients having painin the Occipital side, 4(14.28%) patients having pain in the Jaw region.Graph No 24 showing the distribution of patients by Location of pain Group A 30 Group B 25 Total 20 15 10 5 0 Right Left Frontal Temporal Occipital Jaw 132
  • Table No 50 showing the distribution of patients by Nature of pain Group –A % Group -B % Total %Throbbing 14 100 14 100 28 100Pricking 11 78.57 11 78.57 22 78.57Churning 0 - 0 - 0 -Cutting 2 14.28 3 21.42 5 17.85Pulsating 0 - 0 - 0 - In Group- A out of 14 patient 14(100%) patients having Throbbing type ofpain, 11(78.57%) patients having Pricking type of pain, 2(14.28%) patients havingCutting type of pain and none of patients having Churning and Pulsating type of painand In Group- B out of 14 patient 14(100%) patients having Throbbing type of pain,11(78.57%) patients having Pricking type of pain, 3(21.42%) patients having Cuttingtype of pain and none of patients having Churning and Pulsating type of pain and outof 28 patients 28(100%) patients having Throbbing type of pain, 22(78.57%) patientshaving Pricking type of pain, 5(17.85%) patients having Cutting type of pain andnone of patients having Churning and Pulsating type of painGraph No 25 showing the distribution of patients by Nature of pain 30 25 20 Group A 15 Group B Total 10 5 0 Thrbbing Pricking Churning Cutting Pulsating 133
  • Table No 51 showing the distribution of patients by Time Intensity of pain Morning % Noon % Evening % Night %Gr -A 8 57.14 3 21.42 8 57.14 1 7.14Gr -B 6 42.85 5 35.71 12 85.71 2 14.28Total 14 50 8 28.57 20 71.42 3 10.71 In Group- A out of 14 patient 8 (57.14%) patients having pain at Morningtime, 3(21.42%) patients having pain at Afternoon time, 8(57.14%) patients havingpain at Evening time, 1(7.14%) patients having pain at Night time and In Group- Bout of 14 patient 6(42.85%) patients having pain at Morning time, 5(35.71%) patientshaving pain at Afternoon time, 12(85.71%) patients having pain at Evening time,2(14.28%) patients having pain at Night time and out of 28 patients 14(50%) patientshaving pain at Morning time, 8(28.57%) patients having pain at Afternoon time,20(71.42%) patients having pain at Evening time, 3(10.71%) patients having pain atNight time.Graph No 26 showing the distribution of patients by Time Intensity of pain 20 15 Group A 10 Group B Total 5 0 Morning Noon Evening NightTable No 52 showing the distribution of patients by Onset Insidious % Acute % Chronic %Group -A 3 21.42 4 28.57 9 64.28Group -B 1 7.14 3 21.42 8 57.14Total 4 14.28 7 25 17 60.71 In Group- A out of fourteen patient 3(21.42%) patients having InsidiousOnset, 4(28.57%) patients having Acute Onset, 9(64.28%) patient having chronic 134
  • onset of pain and In Group- B out of fourteen patient 1(7.14%) patients havingInsidious Onset, 3(21.42%) patients having Acute Onset, 8(57.14%) patient havingchronic onset of pain and out of 28 patients 4(14.28%) patients having InsidiousOnset, 7(25%) patients having Acute Onset, 17(60.71%) patient having chronic onsetof pain.Graph No 27 showing the distribution of patients by Onset 20 15 Group A 10 Group B Total 5 0 Insidious Acute ChronicTable No 53 showing the distribution of patients by Duration of pain 1–5Hours % 5–10Hours %Group -A 6 42.85 8 57.14Group -B 10 71.42 4 28.57Total 16 57.14 12 42.85 In Group- A out of fourteen patients It was observed that the pain duration of6(42.85%) patients are in between 1-5 hours, and the pain duration of 8(57.14%)patients are in between 5-10hours and In Group- B out of fourteen patients It wasobserved that the pain duration of 10(71%) patients are in between 1-5 hours, and thepain duration of 4(28.57%) patients are in between 5-10hours and out of 28 patients Itwas observed that the pain duration of 16(57.14%) patients are in between 1-5 hours,and the pain duration of 12(42.85%) patients are in between 5-10h 135
  • Graph No 28 showing the distribution of patients by Duration of pain 16 14 12 10 Group A 8 Group B 6 Total 4 2 0 1-5Hours 5-10HoursTable No 54 showing the distribution of patients by Frequency of attack 1-5 % 5-10 % 10-15 % Continu % Days Days Days ousGroup -A 2 14.28 4 28.57 5 35.71 3 21.42Group -B 2 14.28 5 35.71 6 42.85 1 7.14Total 4 14.28 9 32.14 11 39.28 4 14.28 In Group- A out of fourteen patients It was observed that the Frequency ofattack of 2(14.28%) patients are in between 1-5 days, the Frequency of attack of4(28.57%) patients are in between 5-10 days, and the Frequency of attack of5(35.71%) patients are in between 10-15 days and 3(21.42%) patients havingcontinuous Frequency of attack and In Group- B out of fourteen patients It wasobserved that the Frequency of attack of 2(14.28%) patients are in between 1-5 days,the Frequency of attack of 5(35.71%) patients are in between 5-10 days, and theFrequency of attack of 6(42.85%) patients are in between 10-15 days and 1(7.14%)patients having continuous Frequency of attack and out of 28 patients It was observedthat the Frequency of attack of 4(14.28%) patients are in between 1-5 days, theFrequency of attack of 9(32.14%) patients are in between 5-10 days, and theFrequency of attack of 11(39.28%) patients are in between 10-15 days and 4(14.28%)patients having continuous Frequency of attack. 136
  • Graph No 29 showing the distribution of patients by Frequency of attack 12 10 8 Group A 6 Group B 4 Total 2 0 1 - 5 days 5-10days 10-15days ContineousTable No 55 showing the distribution of patients according to Aharaja Nidana Ruksha % Snigdha %Group -A 12 85.71 2 14.28Group -B 9 64.28 5 35.71Total 21 75 7 25 In Group- A out of fourteen patients, 12(85.71%) patients preferred RookshaAhara, 2(14.28%) patients preffered Snigdha Ahara and In Group- B out of fourteenpatients 9(64.28%) patients preffered Rooksha Ahara, 5(35.71%) patients prefferedSnigdha Ahara and out of total 28 patients 21(75%) patients preffered RookshaAhara, 7(25%) patients preffered Snigdha Ahara.Graph No 30 showing the distribution of patients according to Aharaja Nidana 25 20 15 Group A Group B 10 Total 5 0 Ruksha Snigdha 137
  • Table No 56 showing the distribution of patients according to Viharaja Nidana Group -A % Group -B % Total %Vega 10 71.42 13 92.85 23 82.14dharanaRatri 7 50 6 42.85 13 46.42jagaranaAtapa 12 85.71 9 64.28 21 75sevanaDiwa 2 14.28 5 35.71 7 25swapaAtyasana 4 28.57 3 21.42 7 25Ayasa 1 7.14 3 21.42 4 14.28Purvayu 8 57.14 7 50 15 53.57 In Group- A out of fourteen patients 10(71.42%) patients adaptedVegadharana, 7(50%) patients adapted Ratrijagrana, 12(85.71%) patients adaptedAtapa Sevana, 2(14.28%) patients adapted Diwaswapa, 4(28.57%) patients adaptedAtayashana, 1(7.14%) patients adapted Ayasa, 8(57.14%) patients adapted Purvayuand In Group- B out of fourteen patients 13(92.85%) patients adapted Vegadharana,6(42.85%) patients adapted Ratrijagrana, 9(64.28%) patients adapted Atapa Sevana,5(35.71%) patients adapted Diwaswapa, 3(21.42%) patients adapted Atayashana,3(21.42%)patients adapted Ayasa, 7(50%) patients adapted Purvayu and totally out of28 patients 23(82.14%) patients adapted Vegadharana, 13(46.42%) patients adaptedRatrijagrana, 21(75%) patients adapted Atapa Sevana, 7(25%) patients adaptedDiwaswapa, 7(75%) patients adapted Atayashana, 4(14.28%) patients adapted Ayasa,15(53.57%) patients adapted Purvayu.Graph No 31 showing the distribution of patients according to Viharaja Nidana 25 20 15 Group A Group B 10 Total 5 0 Vegadharana Atapa sevan Atyashana Purva vayu 138
  • Table No 57 showing the distribution of patients according to Manasika Hetu Bhaya % Shoka % Chinta %Group -A 2 14.28 0 - 10 71.42Group -B 1 7.14 0 - 9 64.28Total 3 10.71 0 - 19 67.85 In Group- A out of fourteen patients 2(14.28%) patients had Bhaya and10(71.42%) patients Chinta as manasika hetus. Group- B out of fourteen patients1(7.14%) patient had Bhaya and 9(64.28%) patients Chinta as the causative factors.Totally out of 28 patients, 3(17.85%) patients had Bhaya and 19(67.85%) patients hadChinta as predisposing factors.Graph No 32 showing the distribution of patients according to Manasika Hetu 20 18 16 14 12 Group A 10 Group B 8 6 Total 4 2 0 Bhaya Shoka ChintaTable No 58 showing the distribution of patients according to Intensity of painduring Menstruation Menstruation % Group -A 7 50 Group -B 7 50 In Group- A out of 7 patients 7(50%) patients shows the Menstruationproblem and in Group-B out of 7 patients 7(50%) patients shows the Menstruationproblem. 139
  • Graph No 33 showing the distribution of patients according to Intensity of painduring Menstruation 8 6 Group A 4 Group B 2 0 MenstruationTable No 59 showing the distribution of patients according to Roopa Gr -A % Gr -B % Total %Ardha 14 100 14 100 28 100shirashoolaManya 9 64.28 10 71.42 19 67.85ShoolaBhru 11 78.57 10 71.42 21 75ShoolaShankaha 12 85.71 14 100 26 92.85shoolaAkshi 3 21.42 3 21.42 6 21.42ShoolaLalata shoola 7 50 6 42.85 13 46.42 In Group- A out of fourteen patients in 14(100%) patients having Ardha shirashoola,9(64.28%) patients having Manya shoola, 11(78.57%) patients having Bhrushoola, 12(85.71%) patients having Shankaha shoola, 3(21.42%) patients havingAkshi shoola, 7(50%) patients having Lalata shoola, and In Group- A out of fourteenpatients in 14(100%) patients having Ardha shira shoola,10(71.42%) patients havingManya shoola, 10(71.42%) patients having Bhru shoola, 14(100%) patients havingShankaha shoola, 3(21.42%) patients having Akshi shoola, 6(42.85%) patients havingLalata shoola, and totally out of 28 patients 28(100%) patients having Ardha shirashoola,19(67.85%) patients having Manya shoola, 21(75%) patients having Bhrushoola, 26(92.85%) patients having Shankaha shoola, 6(21.42%) patients havingAkshi shoola, 13(46.42%) patients having Lalata shoola. 140
  • Graph No 34 showing the distribution of patients according to Roopa 30 25 20 15 Group A Group B 10 Total 5 0 Ardhashirashoola shankahashoola sastra arani nibham vedanaTable No 60 showing the distribution of patients according to Prakruti V % VP % VK %Group -A 8 57.14 4 28.57 2 14.28Group -B 6 42.85 3 21.42 5 35.71Total 14 50 7 25 7 25 In Group- A out of fourteen patients 8(57.14%) patients having Vata prakruti,4(28.57%) patients having Vata Pitta prakruti, 2(14.28%) patients having Vata Kaphaprakruti and In Group- B out of fourteen patients 6(42.85%) patients having Vataprakruti, 3(21.42%) patients having Vata Pitta prakruti, 5(35.71%) patients havingVata Kapha prakruti and out of 28 patients 14(50%) patients having Vata prakruti,7(25%) patients having Vata Pitta prakruti, 7(25%) patients having Vata Kaphaprakruti. 141
  • Graph No 35 showing the distribution of patients according to Prakruti 14 12 10 8 Group-A Group-B 6 Total 4 2 0 Vata Vata pitta Vata kaphaTable No 61 showing the distribution of patients according to Sara Pravara % Madhyama % Avara %Group -A 3 21.42 3 21.42 8 57.14Group -B 2 14.28 1 7.14 11 78.57Total 5 17.85 4 14.28 19 67.85 In Group- A out of fourteen patients 3(21.42%) patients having Pravara sara,3(21.42%) patients having Avara sara, 8(57.14%) patients having Madhyama sara andIn Group- B out of fourteen patients 2(14.28%) patients having Pravara sara,1(7.14%) patients having Avara sara, 11(78.57%) patients having Madhyama sara andout of 28 patients 5(17.85%) patients having Pravara sara, 4(14.28%) patients havingmadhyama sara, 19(67.85%) patients having avara sara.Graph No 36 showing the distribution of patients according to Sara 20 18 16 14 12 Group-A 10 Group-B 8 Total 6 4 2 0 Pravara madhyama avara 142
  • Table No 62 showing the distribution of patients according to Samahanana Asamhita % Susamhita % Madyyama % SamhitaGroup -A 14 100 - - - -Group -B 11 78.57 3 21.42 - -Total 25 89.28 3 10.71 - - In Group- A out of fourteen patients 14(100%) patients having asamhitaSamahanana, none of patient having susamhita Samahanana and MadhyamaSamahanana and In Group- B out of fourteen patients 11(78.57%) patients havingasamhita Samahanana, 3(21.42%) having susamhita Samahanana none of patienthaving Madhyama Samahanana and out of 28 patient 25(89.28%) patients havingasamhita Samahanana, 3(10.71%) having susamhita Samahanana none of patienthaving Madhyama Samahanana.Graph No 37 showing the distribution of patients according to Samahanana 25 20 15 Group-A Group-B 10 Total 5 0 Asamhita Susamhita Madhyama samhitaTable No 63 showing the distribution of patients according to Satmya Ruksha % Snigdha %Group -A 12 85.71 2 14.28Group -B 9 64.28 5 35.71Total 21 75 7 25 In Group- A out of fourteen patients 12(85.71%) patients having Satmaya ofRooksha Ahara, 2(14.28%) patients having Satmaya of Snigdha Ahara, and In Group-B out of fourteen patients 9(64.28%) patients having Satmaya of Rooksha Ahara, 143
  • 5(35.71%) patients having Satmaya of Snigdha Ahara, and out of 28 patients 21(75%)patients having Satmaya of Rooksha Ahara, 7(25%) patients having Satmaya ofSnigdha Ahara,.Graph No 38 showing the distribution of patients according to Satmya 25 20 15 Group-A Group-B 10 Total 5 0 Rooksha SnigdhaTable No 64 showing the distribution of patients according to Satwa Pravara % Madhyama % Avara %Group -A 3 21.42 4 28.57 7 50Group -B 1 7.14 - - 13 92.85 Total 4 14.28 4 14.28 20 71.42 In Group- A out of fourteen patients 3(21.42%) patients having Pravara Satwa,4(28.57%) patients having madhyama Satwa, 7(50%) patients having avara Satwa andIn Group- B out of fourteen patients 1(7.14%) patients having Pravara Satwa, None ofpatients having madhyama Satwa, 13(92.85%) patients having avara Satwa and out of28 patients 4(14.28%) patients having Pravara Satwa, 4(14.28%) patients havingmadhyama Satwa, 20(71.42%) patients having avara Satwa 144
  • Graph No 39 showing the distribution of patients according to Satwa 20 15 Group-A 10 Group-B 5 Total 0 Pravara Madhyama AvaraTable No 65 showing the distribution of patients according to AbhyavaharanaShakti Pravara % Madhyama % Avara % Group -A - - 13 92.85 1 7.14 Group -B - - 13 92.85 1 7.14 Total - - 26 92.85 2 7.14 In Group- A out of fourteen patients 13(92.85%) patients having MadhyamaAbhyaharana Shakti, 1(7.14%) patients having Avara Abhyaharana Shakti, None ofpatients having Pravara Abhyaharana Shakti and In Group- B out of fourteen patients13(92.85%) patients having Madhyama Abhyaharana Shakti, 1(7.14%) patientshaving Avara Abhyaharana Shakti, None of patients having Pravara AbhyaharanaShakti and out of 28 patients 26(92.85%) patients having Madhyama AbhyaharanaShakti, 2(7.14%) patients having Avara Abhyaharana Shakti, None of patients havingPravara Abhyaharana ShaktiGraph No 40 showing the distribution of patients according to AbhyavaharanaShakti 30 25 20 Group-A 15 Group-B 10 Total 5 0 Pravara Avara Madhyama 145
  • Table No 66 showing the distribution of patients according to Jarana Shakti Pravara % Madhyama % Avara %Group -A - - 11 78.57 3 21.42Group -B 1 7.14 8 57.14 5 35.71 Total 1 3.57 19 67.85 8 28.57 In Group- A out of fourteen patients 11(78.57%) patients having MadhyamaJarana Shakti, 3(21.42%) patients having Avara Jarana Shakti, None of patientshaving Pravara Jarana Shakti and In Group- B out of fourteen patients 1(7.14%)patients having Pravara Jarana Shakti, 8(57.14%) patients having Madhyama JaranaShakti, 5(35.71%) patients having Avara Jarana Shakti and out of 28 patients1(3.57%) patients having Pravara Jarana Shakti, 19(67.85%) patients havingMadhyama Jarana Shakti, 8(28.57%) patients having Avara Jarana Shakti.Graph No 41 showing the distribution of patients according to Jarana Shakti 20 18 16 14 12 Group-A 10 Group-B 8 Total 6 4 2 0 Pravara Avara MadhyamaTable No 67 showing the distribution of patients according to Vyayama Shakti Pravara % Madhyama % Avara %Group -A 8 57.14 2 14.28 4 28.57Group -B 6 42.85 4 28.57 4 28.57 Total 14 50 6 21.42 8 28.57 In Group- A out of fourteen patients 8(57.14%) patients having PravaraVyayama Shakti, 2(14.28%) patients having Madhyama Vyayama Shakti, 4(28.57%)patients having Avara Vyayama Shakti, In Group- A out of fourteen patients6(42.85%) patients having Pravara Vyayama Shakti, 4(28.57%) patients having 146
  • Madhyama Vyayama Shakti, 4(28.57%) patients having Avara Vyayama Shakti andout of 28 patients 14(50%) patients having Pravara Vyayama Shakti, 6(21.42%)patients having Madhyama Vyayama Shakti, 8(28.57%) patients having AvaraVyayama Shakti.Graph No 42 showing the distribution of patients according to Vyayama Shakti 14 12 10 8 Group-A Group-B 6 T otal 4 2 0 Pravara Madhyama AvaraTable No 68 showing the distribution of patients according to Vaya Balya % Yauvana % Vrydhaka %Group -A 1 7.14 10 71.42 3 21.42Group -B - - 9 64.28 5 35.71 Total 1 3.57 19 67.85 8 28.57 In Group- A out of fourteen patients 1(7.14%) patients is Balya, 10(71.42%)patients are Yauvana, 3(21.42%) patients are Vrydhaka, In Group- B out of fourteenpatients none of patients is Balya, 9(64.28%) patients are Yauvana, 5(35.71%)patients are Vrydhaka and out of 28 patients 1(3.57%) patients is Balya, 19(67.85%)patients are Yauvana, 8(28.57%) patients are Vrydhaka.Graph No 43 showing the distribution of patients according to Vaya 20 15 Group A 10 Group B Total 5 0 Balya Yauvana Vrudha 147
  • Results Results of Subjective and Objective Parameter (Group- A)Objective Statistical Result of Nrupavallabha TailaTable no 69 showing the result of Severity of Pain Severity of Score Percentage Net result Response pain (BT - AT) BT 52 100% AT 04 8% 92% Good response. The present study revealed that 52 score was found before the treatmentwhereas 04 score was found after the treatment. This study illustrated that the effectof Nrupavallabha Taila on Severity of pain gives 92% result i.e. Good response. Table no 70 showing the result of Duration of Pain Duration of Score Percentage Net result Response pain (BT - AT) BT 35 100% AT 08 23% 77% Good response. The present study revealed that 35 score was found before the treatmentwhereas 08 score was found after the treatment. This study illustrated that the effectof Nrupavallabha Taila on Duration of pain gives 77% result i.e. Good response. Table no showing 71 the result of Frequency of PainFrequency of Score Percentage Net result Response pain (BT - AT) BT 36 100% AT 04 11% 89% Good response. The present study revealed that 36 score was found before the treatmentwhereas 04 score was found after the treatment. This study illustrated that the effectof Nrupavallabha Taila on Frequency of pain gives 89% result i.e. Good response. Table no 72 showing the result of IHS Criteria IHS criteria Score Percentage Net result Response (BT - AT) BT 38 100% AT 12 32% 68% Moderate response. 148
  • The present study revealed that 38 score was found before the treatmentwhereas 12 score was found after the treatment. This study illustrated that the effectof Nrupavallabha Taila on IHS criteria gives 68% result i.e. Moderate response Subjective Statistical Result of Nrupavallabha TailaTable no 73 showing the result of Shirashoola Shirashoola Score Percentage Net result Response (BT - AT) BT 52 100% AT 04 08% 92% Good response. The present study revealed that 52 score was found before the treatmentwhereas 04 score was found after the treatment. This study illustrated that the effectof Nrupavallabha Taila on Shirashoola gives 92% result i.e. Good responseTable no 74 showing the result of Shankha Shoola Shankha Score Percentage Net result Response shoola (BT - AT) BT 52 100% AT 06 12% 88% Good response. The present study revealed that 52 score was found before the treatmentwhereas 06 score was found after the treatment. This study illustrated that the effectof Nrupavallabha Taila on Shankha shoola gives 88% result i.e. Good responseTable no showing 75 the result of Manya,Bhru,Akshi,Lalata Shoola Manya,Bhru,Akshi,Lalata Score Percentage Net result Response Shoola (BT - AT) BT 41 100% Good AT 05 12% 88% response. The present study revealed that 41 score was found before the treatmentwhereas 05 score was found after the treatment. This study illustrated that the effectof Nrupavallabha Taila on Manya,Bhru,Akshi,Lalata Shoola gives 88% resulti.e.Good response 149
  • Table no 76 showing the result of Bhrama Bhrama Score Percentage Net result Response (BT - AT) BT 14 100% AT 03 21% 79% Good response. The present study revealed that 14 score was found before the treatmentwhereas 03 score was found after the treatment. This study illustrated that the effectof Nrupavallabha Taila on Bhrama gives 79% result i.e. Good responseTable no 77 showing the Net result of Subjective & Objective Parameter (Group-A) Net Result Percentage Net results of all Response therapies (X/N) Severity of pain 92% Duration of pain 77% Frequency of pain 89% IHS criteria 68% 84% Good Shirashoola 92% response. Shankha shoola 88% Manya,Bhru,Akshi,Lalata 88% Shoola Bhrama 79% N=8 X = 673 Net mean results of the therapies (All subjective and objective parameter ofGroup-A in to the consideration) = 84% i.e. Good response.Results of Subjective and Objective Parameter (Group- B) Objective Statistical Result of Shambukadya GutikaTable no 78 showing the result of Sevirety of Pain Severity of Score Percentage Net result Response pain (BT - AT) BT 50 100% AT 07 14% 86% Good response. 150
  • The present study revealed that 50 score was found before the treatmentwhereas 07 score was found after the treatment. This study illustrated that the effectof Shambukadya Gutika on Severity of pain gives 86% result i.e. Good responseTable no showing 79 the result of Duration of Pain Duration of Score Percentage Net result Response pain (BT - AT) BT 28 100% AT 10 36% 64% Moderate response. The present study revealed that 28 score was found before the treatmentwhereas 10 score was found after the treatment. This study illustrated that the effectof Shambukadya Gutika on Duration of pain gives 64% result i.e. Moderate responseTable no 80 showing the result of Frequency of PainFrequency of Score Percentage Net result Response pain (BT - AT) BT 35 100% AT 07 20% 80% Good response. The present study revealed that 35 score was found before the treatmentwhereas 07 score was found after the treatment. This study illustrated that the effectof Shambukadya Gutika on Frequency of pain gives 80% result i.e. Good responseTable no 81 showing the result of IHS Criteria IHS criteria Score Percentage Net result Response (BT - AT) BT 43 100% AT 14 33% 67% Moderate response. The present study revealed that 43 score was found before the treatmentwhereas 14 score was found after the treatment. This study illustrated that the effectof Shambukadya Gutika on IHS criteria gives 67% result i.e. Moderate response 151
  • Subjective Statistical Result of Shambukadya GutikaTable no 82 showing the result of Shirashoola Shirashoola Score Percentage Net result Response (BT - AT) BT 50 100% AT 07 14% 86% Good response. The present study revealed that 50 score was found before the treatmentwhereas 07 score was found after the treatment. This study illustrated that the effectof Shambukadya Gutika on Shirashoola gives 86% result i.e. Good responseTable no 83 showing the result of Shankha Shoola Shankha Score Percentage Net result Response shoola (BT - AT) BT 51 100% AT 09 18% 82% Good response. The present study revealed that 51score was found before the treatmentwhereas 09 score was found after the treatment. This study illustrated that the effectof Shambukadya Gutika on Shankha shoola gives 82% result i.e. Good responseTable no 84 showing the result of Manya,Bhru,Akshi,Lalata Shoola Manya,Bhru,Akshi,Lalata Score Percentage Net result Response Shoola (BT - AT) BT 37 100% AT 03 8% 92% Good response. The present study revealed that 37score was found before the treatmentwhereas 03 score was found after the treatment. This study illustrated that the effectof Shambukadya Gutika on Manya,Bhru,Akshi,Lalata Shoola gives 92% result i.e.Good response 152
  • Table no 85 showing the result of Bhrama Bhrama Score Percentage Net result Response (BT - AT) BT 16 100% AT 01 6% 94% Good response. The present study revealed that 16 score was found before the treatmentwhereas 01 score was found after the treatment. This study illustrated that the effectof Shambukadya Gutika on Bhrama gives 94% result i.e. Good responseTable no 86 showing the Net result of Subjective & Objective Parameter (Group-B) Net Result Percentage Net results of Response all therapies (X/N) Severity of pain 86% Duration of pain 64% Frequency of pain 80% IHS criteria 67% 81% Good response. Shirashoola 86% Shankha shoola 82% Manya,Bhru,Akshi,Lalata 92% Shoola Bhrama 94% N=8 X = 651 Net mean results of the therapies (All subjective and objective parameter ofGroup-B in to the consideration) = 81% i.e. Good response.Table no 87 showing the Statestical Result of Gp- A &Gp- BStatastical Result: Results on Objective parameter:Param Treat Du Mean±SD Mean±SE DF T- P- Re eter ment rati Value Value mar Group on ks BT 3.714 0.468 - - - - -Severit A AT 0.285 0.468 3.428 0.172 13 19.93 <0.001 HS y of B BT 3.571 0.5 - - Pain AT 0.513 0.518 3.071 0.164 18.72 <0.001 HS 153
  • In order to assess the pain the patients of each group were examined accordingto the clinical findings and the results were analyses from the statistical analysis. Theparameter severity of pain in group A Mean ±SD before was 3.714 ±0.468 and afterthe treatment it is reduced to 0.285 ±0.468, with Mean difference 3.428 and standardof mean 0.172 and test shows more highly significant in group A as P<0.001. Ingroup B Mean ±SD before was 3.571 ±0.5 and after the treatment it is reduced to0.513 ±0.468 with Mean difference 3.071and standard of mean 0.164 and test showsmore highly significant in group B as P<0.001.The parameter severity of pain is having more effect in group A than group B (ByComparing t-values).Para Treatm Durati Mean±SD Mean±SE DF T- P- Remarksmete ent on Value Value r GroupDura BT 2. 0.759 - - - - -tion A 5 of AT 0. 0.513 1.928 0.245 13 7.860 <0.001 HSPain 57 1 B BT 2. 0.392 - - - - - 0 AT 0. 0.468 1.285 0.125 10.28 <0.001 HS 71 4 The parameter Duration of pain in group A Mean ±SD before was 2.5±0.759 and after the treatment it is reduced to 0.571 ±0.513, with Mean difference1.928 and standard of mean 0.245 and test shows more highly significant in group Aas P<0.001. In group B Mean ±SD before was 2.0 ±0.392 and after the treatment itis reduced to 0.714 ±0.468 with Mean difference 1.285 and standard of mean 0.125and test shows more highly significant in group B as P<0.001. 154
  • The parameter Duration of pain is having more effect in group B than group A (ByComparing t-values). Paramet Treatm Dura Mean±SD Mean±SE DF T- P- Remarks er ent tion Value Value Group Frequen BT 2.571 0.851 - - - - - cy of A AT 0.285 0.468 2.285 0.220 13 10.386 <0.001 HS pain B BT 2.5 0.65 - - - - - AT 0.5 0.518 2.0 0.209 9.569 <0.001 HS The parameter frequency of pain in group A Mean ±SD before was 2.571±0.851 and after the treatment it is reduced to 0.285 ±0.468, with Mean difference2.285 and standard of mean 0.22 and test shows more highly significant in group Aas P<0.001. In group B Mean ±SD before was 2.5 ±0.65 and after the treatment it isreduced to 0.5 ±0.518 with Mean difference 2.00and standard of mean 0.209 and testshows more highly significant in group B as P<0.001.The parameter frequency of pain is having more effect in A than group B (ByComparing t-values). Paramet Grou Durati Mean±SD Mean±SE DF T- P- Remar er p on Value Value ks BT 2.714 0.611 - - - - - IHS A AT 0.857 0.363 1.857 0.142 13 13.077 <0.001 HS criteria B BT 3.071 0.615 - - - - - AT 1.0 0.0 2.0714 0.164 12.63 <0.001 HS The parameter IHS Criteria in group A Mean ±SD before was 2.714 ±0.611and after the treatment it is reduced to 0.857 ±0.363, with Mean difference 1.857 andstandard of mean 0.142 and test shows more highly significant in group A asP<0.001. In group B Mean ±SD before was 3.071 ±0.615 and after the treatment itis reduced to 1.0 ±0.0 with Mean difference 2.0714 and standard of mean 0.164 andtest shows more highly significant in group B as P<0.001. 155
  • The parameter severity of pain is having more effect in group A than group B (ByComparing t-values). Results on Subjective parameter:Paramete Group Duratio Mean±SD Mean±SE DF T- P- Re r n Value Value mar ks Ardha BT 3.714 0.468 - - - - - Shira A AT 0.285 0.468 3.4 0.172 13 19.93 <0.001 HS Shoola 28 B BT 3.571 0.513 - - - - - AT 0.5 0.518 3.0 0.614 5.00 <0.001 HS 71 The parameter Shira Shoola in group A Mean ±SD before was 3.714±0.468 and after the treatment it is reduced to 0.285 ±0.468, with Mean difference3.428 and standard of mean 0.172 and test shows more highly significant in group Aas P<0.001. In group B Mean ±SD before was 3.571 ±0.513 and after the treatmentit is reduced to 0.5 ±0.518 with Mean difference 3.071and standard of mean 0.164and test shows more highly significant in group B as P<0.001.The parameter Shira Shoola is having more effect in group A than group B (ByComparing t-values)Parameter Treatme Dura Mean±SD Mean±SE D T- P- Rem nt tion F Val Value arks Group ue Shankha BT 3.71 0.46 - - - - - Shoola A 4 8 13 AT 0.42 0.51 3.28 0.163 20. <0.001 HS 8 3 5 3 11 B BT 3.64 0.64 - - - - - 2 2 AT 0.64 0.49 3.0 0.148 20. <0.001 HS 2 7 27 The parameter Shanka Shoola in group A Mean ±SD before was 3.714±0.468 and after the treatment it is reduced to 0.428 ±0.513, with Mean difference 156
  • 3.285 and standard of mean 0.1633 and test shows more highly significant in group Aas P<0.001. In group B Mean ±SD before was 3.642 ±0.642 and after the treatmentit is reduced to 0.642 ±0.497 with Mean difference 3.0 and standard of mean 0.148and test shows more highly significant in group B as P<0.001.The parameter Shanka Shoola is having equal effect in both groups (By comparing t-values).Param Treatme Durati Mean±SD Mean±SE DF T- P- Re eter nt on Value Value ma Group rksManya BT 2.928 0.997 - - - - -, Bhru A AT 0.357 0.633 2.571 0.271 13 9.48Akshi, B BT 2.642 0.841 - - - - - lalata AT 0.214 0.425 2.428 0.202 12.01 <0.001 HSShoola The parameter in Manya, Bahu, Akshi, lalata Shoola group A Mean ±SDbefore was 2.928 ±0.997and after the treatment it is reduced to 0.357 ±0.663, withMean difference 2.571 and standard of mean 0.271 and test shows more highlysignificant in group A as P<0.001. In group B Mean ±SD before was 2.642 ±0.841and after the treatment it is reduced to 0.214 ±0.425 with Mean difference 2.428 andstandard of mean 0.202 and test shows more highly significant in group B asP<0.001.The parameter Manya, Bahu, Akshi, lalata Shoola is having more effect in B thangroup A ( By Comparing t-values).Parameter Treatme Duration Mean±SD Mean±SE DF T- P- Remar nt Valu Valu ks Group e e Shastra BT 0.0 0.0 - - - - - arani A AT 0.0 0.0 0.0 0.0 - - - nibhama B BT 0.0 0.0 - -- - - - vedana AT 0.0 0.0 0.0 0.0 - - - 157
  • The parameter Shastra arani nibhama Vedana is not having symptom before and aftertreatment. Para Treat Duratio Mean±SD Mean±SE DF T- P- Rem mete ment n Value Value arks r Group Bhra BT 1.0 1.24 - - - - - ma A AT 0.21 0.42 0.78 0.28 13 2.803 <0.02 HS 4 5 5 0 B BT 1.14 1.35 - - - - - 2 AT 0.07 0.26 1.07 0.35 3.016 <0.01 HS 14 7 1 5 The parameter in Bhrama group A Mean ±SD before was 1.0 ±1.24 andafter the treatment it is reduced to 0.214 ±0.425, with Mean difference 0.785 andstandard of mean 0.280 and test shows more highly significant in group A as P<0.02.In group B Mean ±SD before was 1.142 ±1.35 and after the treatment it is reducedto 0.0714 ±0.267 with Mean difference 1.071 and standard of mean 0.355 and testshows more highly significant in group B as P<0.01.The parameter Bhrama is having more effect in B than group A (By Comparing t-values). Overall in Group A the parameter Severity of Pain, frequency of Pain, IHSCriteria and Shira shoola are more effective, Where as in Group B Duration of pain,Manya Bahu Akshi lalata Shoola and Bhrama are more effective. 158
  • Overall result of Group – ATable no 88 Showing the overall result of Single Patient wise Gp- AS.NO OPD SP+OP SP+OP BT AT Net Remarks NO (BT) (AT) (%) (%) Response 1 5433 18 2 100 11 89% GR 2 6162 18 0 100 00 100% GR 3 6366 22 6 100 27 73% MR 4 6475 24 0 100 00 100% GR 5 88 23 4 100 17 83% GR 6 149 27 7 100 26 74% MR 7 6175 23 1 100 4 96% GR 8 265 23 3 100 13 87% GR 9 295 25 1 100 4 96% GR 10 234 27 8 100 30 70% MR 11 325 23 4 100 17 83% GR 12 1072 24 7 100 29 71% MR 13 1293 22 2 100 9 91% GR 14 1535 21 1 100 5 95% GRSP- Subjective Parameter, OP- Objective Parameter, BT- Before Treatment,AT- After Treatment, GR- Good Response, MR- Moderate Response, GoodResponse- 10, Moderate Response- 4 Graph No 44 Showing the overall result of Single Patient wise Gp- A Good response Mod response 159
  • Overall result of Group – BTable No 89 Showing Overall Result of SINGLE Patient wise of Gp- BS.NO OPD SP+OP SP+OP BT AT Net Remarks NO (%) (%) Response 1 4917 20 6 100 30 70% MR 2 4983 27 7 100 26 74% MR 3 5014 23 6 100 26 74% MR 4 5091 26 7 100 27 73% MR 5 5115 19 1 100 5 95% GR 6 5645 23 1 100 4 96% GR 7 5777 18 1 100 6 94% GR 8 6348 21 6 100 29 71% MR 9 6457 21 4 100 19 81% GR 10 08 22 5 100 23 77% GR 11 06 24 2 100 8 92% GR 12 84 24 3 100 13 87% GR 13 929 20 4 100 20 80% GR 14 1154 22 5 100 23 77% GRSP- Subjective Parameter, OP- Objective Parameter, BT- Before Treatment,AT- After Treatment, GR- Good Response, MR- Moderate Response, GoodResponse- 9, Moderate Response- 5 Graph No 45 Showing the overall result of Single Patient wise Gp- B Good response Mod response 160
  • Over all Result of Subjective and Objective Parameter of Group-A & Group-B: Overall in almost all Subjective and Objective Parameter of Group-A &Group-B the Shamana and Shodhana drug shows highly significant after thetreatment. Comparative results of both Gr-A and Gr-B shows that Nasya (Gr-A) isbetter treatment than that of Shamana (Gr-B) in the management ofArdhavabheadaka. 161
  • Discussion: The Shareera is divided into six parts i.e. head, two upper extremities, trunkand two lower extremities. Amongst these six parts Shirah is a most important organof the Shareera, as the Shirah regulates all the vital psychosomatic functions andShirah is the seat or sthana for all the five Gyanendriyas. Therefore, any functional orpathological abnormality affecting in the Shirah causes disturbance to human being. Ardhavabhedaka is one among the 11 types of shirorogas considered by ouracharyas. Acharya Charaka has described five types of Shirahshoola, AcharyaVagbhata explained ten types of shiroroga and Sharangadhara has described 11 typesof Shirahroga. The variants are Vataja, Pittaja, Kaphaja, Sannipataja, Raktaja,Krimija, Kshayaja, Suryavarta, Ardhavabhedaka, Shankhaka and Anantvata. Amongthese Ardhavabheda is found to be the most common complaint after VatikaShirahshoola. It is a troublesome variety of shirashula and most commonly foundnowadays. The causes of ardhavabhedaka are excessive intake of Ruksha ahara,adhyashana, purovayu sevana, atapa sevana, vegadharna, ativyayama in which pain issubstantial in one half of the shiras, manya, bhru, akshi, lalata, karna pradesha. Theattacks of ardhavabhedaka will be once in three days, once in fifteen days and once ina month as per classics. These features of the disease ardhavabhedaka are comparablewith the signs, symptoms and frequency of attacks of migraine headache, since oneside headache and attacks occurring once a week, once a fortnight or once a monthwith great regularity is also appreciable in migraine. According to Acharya Charaka ifthe disease ardhavabhedaka is left untreated it destroy the normal function of eyes andears. A most common complaint regarding Shiroroga is Shirahshoola. The diseaseArdhavabhedaka is characterized by paroxysmal and unilateral headache, which may 162
  • be severe in nature. In this disease all the three doshas are involved in the sampraptibut the more predominance doshas are Vata or Vatakapha. The diseaseardhavabhedaka may not be fatal but if not treated properly then it may destroy thenormal function of eyes and ears. Based on critical studies it has been found thatArdhavabhedaka, as much similar to migraine. It is generally accepted that Migrainesymptoms are the result of changes that occur in blood vessels within and around thebrain. Migraine is seen more often in women where it affects approximately one infifth compared with men where the incidence is near one in 16. The prevalence ofrecurrent headache was found to be 18% in boys (males) and 21% in girls (female).Migraine can be associated with the Menstrual Cycle and about 2/3 of migrainedisappear at the menopause. Acharya Charaka has quoted very well that ‘Nasaa Hi Shiroso Dwaram’ Noseis the only gateway for administering the medicines and goes into the shirah and expelthe vitiated doshas. In our classics Acharyas explained about the nasya therapy whichis very much helpful for urdhavajatrugata vyadies. Acharya Charaka has mention Chatu-Sneha orally as well as in the form ofNasya in the management of Shiroroga. Hence considering the Shambukadya Gutikaand Nrupavallabh Taila both are vatahara drugs and Shirogata vyadhis are best treatedby Nasya karma, so the present clinical study is undertaken to evaluate the efficacy ofShambukadya Gutika and Nrupavallabh Taila Navana nasya in Ardhavbhedaka(Migraine). The clinical part of the study covered the observation made from 30 patientsof Ardhavabhedaka registered after exclusionary criteria to evaluate the diseaseincidence and its clinical profile. The therapeutic trial has been done on 28 patients,where 2 patients are discontinued the medication during the trail period. These 163
  • patients were divided into two groups i.e. Nrupavallabha taila Navana Nasya for 15patients in Group A and Shambukadya Gutika for 15 patients in Group B. The discussion is done in the following headings; Discussion on the disease Ardhavabhedaka with special reference to Migraine. Discussion on clinical study. Discussions on the observation of the patients of ardhavabhedaka. Discussions on observations made during the trial work under two subheadings as Group A and Group B. Discussion on results. Probable mode of action of the therapy and drug respectively in both groups.1) Discussion on the disease Ardhavabhedaka with special reference to MigraineDiscussion on Disease: As there is difference of opinion regarding the dosha involvement in theproduction of Ardhavabhedaka as Sushruta mentioned involvement of tridoshawhereas Vagbhata mentioned as it is kevala vataja but Acharya Charka, Madhava,Bhavaprakasha specified the importance of either vata, kapha or vata kaphaja. Most ofthe symptoms of Ardhavabhedaka mimics to that of migraine such as Toda- pricking,Manthanavata- churning, Tearing and Piercing type of pain. In Ayurveda mentionedthat shirashoola is felt in either of the sides, in the modern parlance migraine willaffect unilateral side of the head.Nidana:Aharaja: Among the 28 patients of both the group (Group-a & Group-B) 21(75%)patients were taking Rooksha Ahara like chilly, jawara roti and other spicy dominantfood and remaining 7(25%) patients were taking Snigdha pradhana Aharas like all oil 164
  • fried things majority along with other foods. Because of the continuous intake ofRooksha ahara there will be aggravation in vata dosha leading to the ardhavabhedakaand those patients were taking snigdha pradhana aharas, in them prakupita kaphadosha gets lodged in the shiras leading to the production of ardhavabhedaka. Amongthe present study few patients have the habit of in taking alcohol (Red Wine as one ofthe causative agent in the production of migraine mention in contemporary system ofmedicine) which is having the properties like laghu, rooksha, ashukari etc leading toincrease in the rooksha guna of shareera resulting in vata prakopa.Viharaja: In Group- A out of fourteen patients 10(71.42%) patients had pureeshaVegadharana, 7(50%) patients had Ratrijagrana, 12(85.71%) patients had AtapaSevana, 2(14.28%) patients had Diwaswapa, 4(28.57%) patients had Atayashana,1(7.14%) patients a had Ayasa, 8(57.14%) patients had Purvayu and In Group- B outof fourteen patients 13(92.85%) patients had pureesha Vegadharana, 6(42.85%)patients had Ratrijagrana, 9(64.28%) patients had Atapa Sevana, 5(35.71%) patientshad Diwaswapa, 3(21.42%) patients had Atayashana, 3(21.42%)patients had Ayasa,7(50%) patients had Purvayu and totally out of 28 patients 23(82.14%) patients hadpureesha Vegadharana, 13(46.42%) patients had Ratrijagrana, 21(75%) patients hadAtapa Sevana, 7(25%) patients had Diwaswapa, 7(75%) patients had Atayashana,4(14.28%) patients had Ayasa, 15(53.57%) patients had Purvayu. Among the viharahetus greater part pureesha vega dharana is observed in 23(82.14%) patients of boththe groups shows that vata might have aggravated in them because of it (vagbhatamentioned in Rogaanuthpadneeya Adhyaya) that pureesha vega dharana will lead toshirashoola. Among the 28 patients 13(46.43%) patients had Ratrijagrana as one ofthe viharaja nidana, as Charka in Sutrasthana mentioned that “Ratroujagranam 165
  • Rooksham” means Ratrijagrana (Lack of sleep mentioned as causative factor formigraine also) will lead to Rooksha guna vriddhi, which is the guna of vata (vriddhisamanaih sarvesham) leading to vata vriddhi and results in Ardhavabhedaka.Remaining viharaja nidanas, like Diwaswapna leadings to kapha vriddhi (SnigdhamPraswapatam Diva). Atapa sevana, Ayasa and exposure to purvayu lead to vataprakopa results in Ardhavabhedaka.Manasika: In Group- A out of fourteen patients in 2(14.28%) patients Bhaya wasobserved, Shoka was not observed in any patients, 10(71.42%) patients Chinta wasobserved and In Group- B out of fourteen patients in 1(7.14%) patient Bhaya wasobserved, Shoka was not observed in any patients, 9(64.28%) patients Chinta wasobserved and totally out of 28 patients in 3(17.85%) patients Bhaya was observed,Shoka was not observed in any patients, 19(67.85%) patients Chinta was observed .Excessive Chinta (Stress, Worry mentioned in etiology of migraine) and Bhayaleading to vata prakopa and also at the same time Charka mentioned in VimanaSthana that if a person having Chinta, Shoka, Bhaya etc then even if he consumesproper quantity of ahara Won’t digest resulting in the production of the disease.Psychological stress always play major role in Migraine.Anya (Intensity of pain during Menstruation): In Group – A out of eleven female patients 7(63.33%) patients shown themenstrual problem and in Group-B out of 10 female patients 7(70%) patients shownthe menstrual problem. From the above data it is evident that due to Hormonal(Estrogen) disturbances during menstrual period may lead to excessive headache. 166
  • Poorvaroopa: In Ayurvedic classics no one Acharyas will explain about poorvaroopa ofardhavabhedaka.Roopa: In the present study total 100% patients having Ardha shira shoola,19(67.85%) patients having Manya shoola, 21(75%) patients having Bhru shoola,26(92.85%) patients having Shankaha shoola, 13(46.42%) patients having Lalatashoola. Ardha shirashoola manya, bhru, shankha and lalata were the sthana ofshirashoola experienced by maximum number of patients. Manya is the portion inurdhavajatru on either side of the neck. The vata which is predominant dosha getsaggravated causes sankocha of the siras which manifests in the form of shoola inmanya pradesha. Bhru is close to mastishaka here ophthalmic artery of internalcarotid artery and facial artery involved to produce pain. Here dushita rakta getsblocked in the sookshama siras due to sira akunchana with the help of vitiated vataand in shankha pradesha vata dosha alone or along with kapha dosha causescontraction in temporal and parietal vessels producing sanga and causes pain their anddue to the vitiated avarodhajanya vata shoola in lalata takes place and also due toconstriction and later dilatation of anterior cerebral artery pain is exhibited in the forhead.Samprapti: By the intake of Rookshadi aharaja nidanas, pureesha vegadharanam,Ratrijagranajanya viharaja nidanas along with chinta , bhayadi mansika nidanasleading to improper digestion of whatever food consumed resulting in Ama of thesame, because of this vata, kapha along with rakta gets vitiated circulates all over thebody makes its sthana samshraya in the uttamanga (Shiras) result in the vyadhi 167
  • Ardhavabhedaka. Hence, all these four factors i.e. Dosha Prakopa, Agnimandya, Kha-vaigunyam and Srotodushti ultimately lead to Sthana Sanshraya in Shirah and causesevere pain in half side of head and its appendages like Manya , Bhru , Shankha ,Karna, Akshi, and Lalata etc can be considered as Vyakti sthana of Ardhavabhedaka8.On the basis of the above mentioned factors it is clear that the vitiated Doshas,particularly Vata or Vatakapha reach the head which in turn vitiate Rakta andRaktavaha Srotas situated there leading to manifestation of symptomatology ofArdhavabhedaka.Pathogenesis of Migraine as per Modern science: The metabolic changes are implicated in pathogenesis of migraine whichchanges the Intra and Extra Cranial blood flow as well as more subtle alteration in theneuronal activity which leads to headache. The cranial vascular system may thusregard as the most conspicuous end organ of migrainous process. Blood is shuntedaway from the periphery giving rise to pallor in case of extracranial vascular tree andfocal neurological symptoms from the cortical ischemia in the case of intracranialvessels. Migraine has been presented as a heightened neurovascular reaction to anyrapid change in the internal or external environment, possibility by a distortedprotective response to any real imagined threat to integrity of brain. So, on looking into the pathogenesis aspect of migraine, similarity is seenamong the two system of medicine pertaining to production of pain, insufficientsupply of blood to brain tissue. The difference found is that modern systememphasizes on hereditary neurovascular instability whereas Ayurveda givesimportance to the vitiation of vata dosha. 168
  • The comparison between modern science and Ayurveda is that in modernscience there is interaction between neural and vascular factors whereas according toour acharyas there is dosha dooshya sammurchana takes place i.e. vata dosha andrakta dooshya.2) Discussions on the materials and methods:Drugs used in the trial work were-1) Shambukadya Gutika2) Nrupavallabha tailaIngredients of Shambukadya Gutika-1. Shankha Bhasma: As shoola is predominant laxana of Ardhavabhedaka the Shankha Bhasma helps in the management of shirashoola. It is mainly indicated in the disease like Amlapitta etc which indicates its action on pitta dosha also.2. Loha Bhasma: By the Tikta and Kashya rasa it acts on kapha dosha which is another important dosha involved in the samprapti of ardhavabhedaka. As shotha and shoola are observed in different parts of the body in ardhavabhedaka patients loha bhasma helps in regulating the shoola and reduces the shotha. Rakta is another factor influenced in migraine. Loha is an ideal medicine in Rakta pradosha.3. Mandura Bhasma: By its Kashaya rasa and sheeta veerya it acts on pitta dosha and counteract with the laxanas like Bhrama in the ardhavabhedaka. Same as in case of loha, mandoora is also help in correcting Rakta.4. Rasota (Rasanjana): By its katu,tikta rasa & ushna veerya acts on kapha dosha which is an important doshas involved in ardhavabhedaka after vata.5. Madhu (Honey): By its Kashaya rasa and Rooksha guna it does kapha shamana and by its Yogavahi guna it enhances the action of others drugs. 169
  • 6. Sharakara: By its madhura rasa it does shamana of pitta dosha by which severity of laxanas like Chardi decreases.Ingredients of Nrupavallabha taila- In Nrupavallabha taila, ushna guna of Shaliparni, Kantakari, Bhrati, Vidanga,Manjishta, Punarnava and Pippali etc acts over vata and kapha which are the mainculprits to cause ardhavabhedaka. Madhura rasa Madhura vipaka and Snigdha guna ofthe dravyas like Vidarikanda, Shatavari, Draksha, Shaliparni etc acts on vata doshathereby the shamana of shoola occurs. Katu rasa and Rooksha guna of Kantakari,Bhrati, Vidanga acts over kapha dosha thereby shamana of laxanas likeGhrana Srava,Hanu Graha occurs. As the dravyas like Vidarikanda and Shatavari and Pippali arehaving Rasyana gunas, so as a rasayana they cause vata shamana. According toAcharyas Charaka, Yastimadhu is one among the Medhya rasayana so; if theardhavabhedaka disease is due to stress and strain then also their yoga may give reliefto the patients. As Punarnava is mainly shothaghana so it helps to reduce the shotha inthe different parts of the shiras and in the later stage of ardhavabhedaka as theupadravas Nayana Vinasha occurs so the drugs like Manjishta and Propaundarikawhich having the action on netra are useful.3) Discussion on clinical study: Inclusion of the patients in the study was in accordance with the criteria set asinclusion and exclusion criteria.Inclusion criteria: Patients irrespective of the sex from 12 to 60 year of age were included. Thisis because at the onset of menstruation (Menarche) usually their will be onset ofmigraine in females. However males are out of this preview. From the earlierresearches it was noted that the migraine disappear or decreases on its own without 170
  • any medical advises after 6 decades. Hence the inclusion criteria were fixed before 60yrs irrespective of the sex.Exclusion criteria: Patients who are under the age of 12 years, patients having brain tumor,subarchnoid hemorrhage, meningitis, glaucoma, purulent sinusitis were excludedfrom the study because of to avoid interference in the action of the treatment and alsoto avoid complications. These conditions can not be managed by medical interventionrather surgical intervention is the choice of treatment. For Group-A Nrupavallabha taila was used for navana nasya and the studyduration was 14days. In Group- B Shambukadya Gutika was given to the patients andthe study duration was 45 days. Totally 30 patients got registered out of which 2discontinued the trial, one each of two groups. 28 Patients were divided randomly intotwo groups.Laboratory investigations: Though there is no significance of the laboratory investigations in theardhavabhedaka disease routine blood investigations like Hb%, T.C., D.C. and E.S.R.were done to assess the general condition of the patient and to exclude the othersystemic diseases. When medicines are given to the patients there is chances ofreaction or adverse effects on normal homeostasis of the body, the only method toassess adverse reactions is by assessing the blood picture. In the present study nosignificant changes were noticed apart decimal variations in the readings before andafter the treatment. The safety of the drug is proved with the help of blood picture. 171
  • 4) Discussions on the observation of the patients of ardhavabhedaka whounderwent the trial The observations were made in the patients of Group-A and Group-Bexcluding the dropouts. Thus, these observations were based on the clinical trials on28 patients registered in the study. The data were colleted in the case sheet andanalyzed after the completion of the study.Drop outs: For the present study total 30 patients selected into two groups and out of 30patient’s two patients were dropout during various stages of the study. 1 case fromgroup A and 1 case from group B. and both the patients were male. These patientsdiscontinued the treatment because they are coming from long distance.5) Discussion on observation made on results during the trial work under twosubheadings as Group-A &Group-B The observations were made in the patients of both groups excluding dropouts.Thus, these observations were based on the clinical trials on 28 patients registered inthe study. The data were colleted in the case sheet and were analysed after thecompletion of the study.Incidence of Age: 50% of the patients in the present study are in there 4th decade (30-40 yrs) ofthe life span. In this 50% patients were females. During this age females usually attainmenopause, where in huge variation in hormones are seen. It is stated earlier in thecontext of migraine in the literary review that the hormonal imbalance during themenopausal age is a primary cause for migraine. This observation supports the earlierresearches. 172
  • Incidence of Sex: 75% of the cases in the study were females. The possible reason may besimilar to the explanation given earlier. The prevalence in females may also due toclose relationship between ovarian hormones and migraine.Incidence of religion: Among 28 patients 22 were Hindu’s. No relevant explanation or notion can bedrawn as the relation between religion and Ardhavabhedaka (Migraine). Also thisstudy was small sample study to draw any conclusion.Incidence of occupation: In the present study people who are having the occupation history as sedentarytype were more seen there housewives were included under this category who areactually having psychological disturbances as well as hormonal imbalance. Howeversuch intervention is difficult to draw.Incidence of marital status: In the present study 86% of the patients who are married, when analysed mostof them having certain stressful factors which might have resulted in the manifestationof Ardhavabhedaka in them.Incidence of socio economic status: Most number of patients in the study were of poor and middle class they areworking in the field during the time they might have suppressed the pureesha andmootradi vegas, excessive atapa sevana and more work load might have resulted inardhavabhedaka(Migraine). Financial insecurity (stress) may be the region for highincidence. 173
  • Incidence of family history: Out of 28 patients 8(28.57%) patients show the family history and 20(71.42%)patients do not show family history. This study contains of small group but accordingto the classics the disease ardhavabhedaka (migraine) having hereditary prevalence.So, this study does not disallow the significance of family history.Incidence of diet: In the present study and out of 28 patients 12(42.85%) were Vegetarianpersons and 16(57.14%) were Mixed Vegetarian. As per the modern texts it suggeststhat non- vegetarians are more prone to migraine as preserved meat is one of thetriggering factors for migraine.Incidence of agni: In this clinical trial more number of patients had history of either mandagnii.e. 18(64.28%) and vishmagni 7(25%), mandagni is caused by kapha vriddhi andvishmagni is causes by vata prakopa. These two doshas are mainly related withdisease ardhavabhedaka. Hence the influence of vruddha dosha are seen to impact onagniIncidence of koshta: In this research work 18 (64.28%) patients has madhyama kostha and 7(25%)patients having krura kostha. As madhyama kostha is related with kapha dosha andkrura kostha with vata dosha which indicates predominance of vata and kapha doshain this disorder.Incidence of vyasana: Among the 28 patients, 3(10.71%) patients had the habit of consuming thealcohol; it is one of the triggering factors for the migraine (Red Wine as one of thecausative agent in the production of migraine mention in contemporary system of 174
  • medicine). At the same time in Ayurveda it is mentioned that madyapana is one of thenidana for the shiroshoola. As ardhavabheaka is shoola pradhana shiroroga as madyais having properties like laghu, rooksha, ashukaari and amla etc which will aggravatevata along with rakta leading to the manifestation of ardhavabhedaka. In the present study 6(21.42%) patients had the habit of smoking, which is oneof the nidana for shiroroga mention by Acharya Charaka. Here by excessive smokethere will be vruddhi in rooksha guna leading to vata prakopa. This vitiated vatavitiates rakta and gets lodged in Ardha bhagha of shira result in manifestation ofardhavabhedaka. In the present study among the 28 patients 16(57.14%) patients were addictedwith tobacco chewing, provably because of this increased rooksha guna in the bodyleading to vata vruddhi and ultimately end in the manifestation of ardhavabhedaka.Incidence of nidra: In the present study more then 50% patients having disturbed sleep which isthe one of the triggering factor of ardhavabhedaka i.e. Ratrijagrana. Disturbances ofsleep cause strain to the mind and cause pain in the head.Incidence of menstrual history: The irregularity of the Menstruation period is the main triggering factor whichcauses stress and strain to the mind due to the hormonal imbalance and ultimatelyleads to ardhavabhedaka(migraine) in females. In the present study 7(33.33%) femalepatients having menstrual problem and due this patient is suffering withardhavabhedaka (migraine)Incidence of Precipitating Factors: Among the 28 patients of both the group (Group-A & Group-B) 21(75%)patients were taking Rooksha Ahara like chilly, jawara roti and other spicy dominant 175
  • food and remaining 7(25%) patients were taking Snigdha pradhana Aharas like all oilfried things mostly along with other foods. Because of the continuous intake ofRooksha ahara there will be aggravation in vata dosha leading to the ardhavabhedakaand those patients were taking snigdha pradhana aharas, in them prakupita kaphadosha gets lodged in the shiras leading to the production of ardhavabhedaka. In Group- A out of fourteen patients 10(71.42%) patients had pureeshaVegadharana, 7(50%) patients had Ratrijagrana, 12(85.71%) patients had AtapaSevana, 2(14.28%) patients had Diwaswapa, 1(7.14%) patients a had Ayasa,8(57.14%) patients had Purvayu and In Group- B out of fourteen patients 13(92.85%)patients had pureesha Vegadharana, 6(42.85%) patients had Ratrijagrana, 9(64.28%)patients had Atapa Sevana, 5(35.71%) patients had Diwaswapa, 3(21.42%)patientshad Ayasa, 7(50%) patients had Purvayu and totally out of 28 patients 23(82.14%)patients had pureesha Vegadharana, 13(46.42%) patients had Ratrijagrana, 21(75%)patients had Atapa Sevana, 7(25%) patients had Diwaswapa, 7(75%) patients hadAtayashana, 4(14.28%) patients had Ayasa, 15(53.57%) patients had Purvayu. Amongthe vihara hetus majorly pureesha vega dharana is ovserved in 23(82.14%) patients ofboth the groups shows that vata might have aggravated in them because of it(vagbhata mentioned in Rogaanuthpadneeya Adhyaya that pureesha vega dharana willlead to shirashoola) Among the 28 patients 13(46.43%) patients had Ratrijagrana asone of the viharaja nidana, as Charka in Sutra sthana mentioned that “RatroujagranamRooksham” means Ratrijagrana (Lack of sleep mentioned as causative factor formigraine also) will lead to Rooksha guna vriddhi, which is the guna of vata (vriddhisamanaih sarvesham) leading to vata vriddhi and results in Ardhavabhedaka. In Group- A out of fourteen patients in 10(71.42%) patients Chinta wasobserved and In Group- B out of fourteen patients 9(64.28%) patients Chinta was 176
  • observed and totally out of 28 patients 19(67.85%) patients Chinta was observed.Excessive Chinta (Stress, Worry mentioned in etiology of migraine) and also at thesame time Charka mentioned in Vimana Sthana that if a person having Chinta, Shoka,Bhaya etc then even if he consumes proper quantity of ahara won’t digest resulting inthe production of the disease. In Group - A out of 11 patients 7(33.33%) patients had irregular menses and inGroup-B out of 10 patients 7(33.33%) patients. From the above data it is evident thatdue to Hormonal (Estrogen) disturbances during menstrual period leads to excessiveheadacheIncidence of Relieving Factors:Vomiting:Among 28 patients, 10(35.71%) patients got relief from the symptoms by voming.This may be because of srotoshodhana in siras, by which patients got the relief fromthe symptoms of ardhavabhedaka.. (While explaning samyaka vamana laxanas atCharaka Siddhi sthana 1 chapter, Hrudya stitha, Shira stitha and Indriya stitha srothoshuddhi are mentioned, the same principle can be applied here.Head bending downward: In the present study 12(42.85%) patients get relievedfrom the symptom when they bend the head downward. This might have result in lackof circulation to the head leading to reduction in tension resulting in relieving fromthe symptoms for a while.Tranquilizers: Tranquilizers are the drugs that produce a calming effect, relievinganxiety and tension. Here migraine resulted as a cause of stress and strain will getrelieved by the use of tranquilizers. In the present study 22(78.57%) patients relievedby the use of tranquilizers. 177
  • Taking Rest: If stress and strain are the triggering factors for migraine, then usually patientsget relief by taking the rest. In the present study around 24(85.71%) patients had gotrelief from the symptoms when they have taken the rest.Incidence of Previous treatment History: Among 28 patients 13(46.42%) patients started the medicines but discontinuedonce gets subsided, the remaining 15(53.57%) patients were taking medicines onlyduring the attack because of this improper and discontinuity of medicines might havetriggered the situation and resulted in the severity of the disease.Incidence of stress: Out of 28 patients, 60% of patients have positive sign of stress because, stressis one of the most important psychological factor involved in Ardhavabhedaka(Migraine).Incidence of chief complaints: Regarding the chief complaints 100% patients were having shirahshoola(headache), 14(50%) patients having Bhrama and 9(32.14%) having Toda as chiefcomplaints which are the classical symptoms of Ardhavabhedaka(migraine).Incidence of associated complaints: In the present study out of 28 patients 22(78.57%) patients have Chardi,23(82.14%) patients having Prakasha Santrasa, 12(42.85%) patients having ShabdaAsahiunta and 1(71.42%)patients having Karna Kshweda and 2(78.57%) patientshaving Aura. These all are classical laxanas of ardhavabhedaka(migraine) Theseassociated symptoms are also the outcome of stress responses. 178
  • Incidence of location, nature of pain, intensity, onset, duration, frequency: Regarding the location of pain, Maximum 28(100%) patients were having painin half side of the head i.e. temporal region and regarding the nature of pain 28(100%)patients having throbbing type of pain and 22(78.57%) patient having pricking type ofpain,. The intensity of pain in 14(50%) patients at morning time were more due to thekapha vriddhi karana at morning time and 20(71.42%) patients at evening time due tovata vriddhi karana at evening time, Maximum patients i.e. 60% were having Chroniconset of pain might be because of the extra cranial vasodilatation and vata vyadhi dueto dhatu kashya are chronic in nature and 25% of the patients having Acute onsetwhen vata become vitiated and does the kapha abrodha then vydhi become acute innature and 16(57.14%) patients having pain duration in between 1-5 hours and12(42.85%) patients having pain duration in between 5-10 hours but according to thetextual maximum duration was 4-72 hours but in this study more then 50% of patientshaving pain duration up to 5 Hours and 42% of patients having pain duration up to 10Hours and frequency of the pain is more then 10-15 days in 11(39.28%) patients andthen 5-10days in 9(32.14%) patients .Incidence of aharaja nidana: The incidence of ahara nidana shows that out of 28 patients 75% of thepatients shows the history of rooksha ahara which is the main cause for vata vitiationand according to Acharya Charaka the disease ardhavabhedaka is vataja predominantvyadhi and only 25% of the patients shows the history of snigdha ahara which is themain cause for kapha vitiation and according to Acharya Charaka the diseaseardhavabhedaka is vataja-kaphaj predominant vyadhi. 179
  • Incidence of viharaja nidana: The incidence shows the maximum number of patients shows vatapredominant viharaja nidana i.e Ratrijagrana, Vegadharana, Atyasana, Purvayu etcwhich is the main dosha either alone or with kapha dosha causes the ardhavabhedakaaccording to Acharya Charaka.Incidence of mansika: 60% of the patients having positive sign of Chinta (tension) which cause theardhavabhedaka (migraine) because stress is one of the most important psychologicalfactors involved in Migraine which clearly shows the effect of psychological factorsin the etiopathogenesis of shirahshoola and Ardhavabhedaka.Incidence of roopa: In the present study total 100% patients having Ardha shira shoola,19(67.85)patients having Manya shoola, 21(75) patients having Bhru shoola, 26(92.85) patientshaving Shankaha shoola, 13(46.42) patients having Lalata shoola. Ardha shirashoolamanya, bhru, shankha and lalata were the sthana of shirashoola experienced bymaximum number of patients. Manya is the portion in urdhavajatru on either side ofthe neck. The vata which is predominant dosha gets aggravated causes sankocha ofthe siras which manifests in the form of shoola in manya pradesha. Bhru is close tomastishaka here ophthalmic artery of internal carotid artery and fascial arteryinvolved to produce pain. Here dooshita rakta gets blocked in the sookshama siras dueto sira akunchana with the help of vitiated vata and in shankha pradesha vata doshaalone or along with kapha dosha causes contraction in temporal and parietal vesselsproducing sanga and causes pain their and due to the vitiated avarodhajanya vatashoola in lalata shoola takes place and also due to constriction and later dilatation ofanterior cerebral artery pain is exhibited in the forhead. 180
  • Incidence of vaya: In this study 19(67.85%) patients included in the study were of middle age i.eyauvana usually who have the work burdon and who lead the family with lots ofstress and strain and which is the most importany physcological factors to cause theardhavabhedaka. Hence the age influence in causing the ardhavabhedaka.Discussion on Parameter:Subjective Parameter of Group- A & Group- B: In Group- A subjective parameter like Shirashoola, Shankaha shoola, Manya,Bhru, Akshi, Lalata shoola have shown good response with the Nrupavallabha Tailanasya {Sarveshu shooleshu praayen pavanaha prabhu). It means that in all kind ofshoola or pain vata is the responsible dosha. All these shoola or pain is felt in theurdhavajatrugata pradesha (Differents part of Shiras) is the sthana of kapha, hence inthese condition predominantly vata along with anubandha dosha i.e kapha is involved.In Astanga Sangraha sutrasthana he mentioned that (Shareerajanaam doshanaamkramen parmoushadam vasteervireko vamnam tatha tailam, ghrutam madhu) taila isthe best remedy for vata, the dravyas processed in Nrupavallabha Taila likevidarikanda, shatavari, draksha, shaliparni etc does the vata shamana there by shoolashamana occurs. Nasya is the nearest root for eliminating the urdhavajatrugata doshas.Even nasya is the best measure for for kapha dosha. Above mentioned drugs havingmadhura rasa, madhura vipaka, does the shamana of rakta, because rakta is thepradhana dushya in ardhavabhedaka. Remaining drugs of Nrupavallabha Taila like,vidanga, bhrati, kantakari, punarnava and pippali acts over both vata and kapha doshawhich are the main culprits of ardhavabhedaka. Some other drugs like yastimadhu isone of the medhya rasayana helps to relieve stress and strain even manjishta also dosethe vitiated rakta dhatu shamana and prasadana. 181
  • In Group- A subjective parameter like bhrama shown good response becauseof the presence of drugs in the taila like manjishta, shatavari, draksha, vidarikanda etcwill does both rakta shamana and prasadana thereby the pitta shamana also occurs.Pitta and rakta having ashrya- ashryee sambandha, pitta is the main responsible doshainvolved in bhrama laxana utpatti, in Madhava nidana he mention that Chakravatabhumoutpatti sarvadaha bhrama roga itigyeneyo rajaha pittaanilaatamaka. Theabove mention drugs having the properties like madhura rasa, madhura vipaka andsheeta veerya helps in the shamana of both rakta as well as pitta dosha. In Group- B parameter like bhrama has shown good result then Group- A. InGroup- B Shambukadya Gutika is used having ingredients like shankaha bhasmawhich is showing good response in the pitta pradhana condition. Sharkara is the oneof the ingredient presenting in this yoga does the shamana of pitta dosha. Even lohabhasma will have kashaya rasa does the shamana of pitta dosha. Other shoola likeShankaha shoola, Manya, Bhru, Akshi, Lalata shoola have shown better result inGroup- B then Group- A, it is because of the ingredients like loha bhasma, mandurabhasma, rasanjana. Loha bhasma not only does the shamana of kapha dosha but alsodoes the shoola shamana. Madhu (Honey) is the one of the ingredient of shambukadyagutika which is having kashaya rasa and rooksha guna does the kapha shamana and byits yogavahi property it enhances the action of other drugs. Here sthanika dosha iskapha gets shamana by this preparation. Here main ingredient is shankaha bhasmawhich is the best shoolaghana dravya hence this might have shown good response inparameter like Shankaha shoola, Manya, Bhru, Akshi, Lalata pradesha then Group- A.The parameter shankaha shoola has shown equal effect in both groups. 182
  • Results on Subjective parameter:Ardha Shirashoola: The parameter Shira Shoola in group A Mean ±SD before was 3.714±0.468 and after the treatment it is reduced to 0.285 ±0.468, with Mean difference3.428 and standard of mean 0.172 and test shows more highly significant in group Aas P<0.001. In group B Mean ±SD before was 3.571 ±0.513 and after the treatmentit is reduced to 0.5 ±0.518 with Mean difference 3.071and standard of mean 0.164and test shows more highly significant in group B as P<0.001.The parameter Shira Shoola is having more effect in group A than group B (ByComparing t-values).Shankha Shoola: The parameter Shanka Shoola in group A Mean ±SD before was 3.714±0.468 and after the treatment it is reduced to 0.428 ±0.513, with Mean difference3.285 and standard of mean 0.1633 and test shows more highly significant in group Aas P<0.001. In group B Mean ±SD before was 3.642 ±0.642 and after the treatmentit is reduced to 0.642 ±0.497 with Mean difference 3.0 and standard of mean 0.148and test shows more highly significant in group B as P<0.001.The parameter Shanka Shoola is having equal effect in both groups (By comparing t-values).Manya, Bhru, Akshi, Lalata Shoola: The parameter in Manya, Bahu, Akshi, lalata Shoola group A Mean ±SDbefore was 2.928 ±0.997and after the treatment it is reduced to 0.357 ±0.663, withMean difference 2.571 and standard of mean 0.271 and test shows more highlysignificant in group A as P<0.001. In group B Mean ±SD before was 2.642 ±0.841and after the treatment it is reduced to 0.214 ±0.425 with Mean difference 2.428 and 183
  • standard of mean 0.202 and test shows more highly significant in group B asP<0.001.The parameter Manya, Bahu, Akshi, lalata Shoola is having more effect in B thangroup A ( By Comparing t-values).Shastra Arani Nibham Vedana:The parameter Shastra arani nibhama Vedana is not having symptom before and aftertreatment.Bhrama: The parameter in Bhrama group A Mean ±SD before was 1.0 ±1.24 andafter the treatment it is reduced to 0.214 ±0.425, with Mean difference 0.785 andstandard of mean 0.280 and test shows more highly significant in group A as P<0.02.In group B Mean ±SD before was 1.142 ±1.35 and after the treatment it is reducedto 0.0714 ±0.267 with Mean difference 1.071 and standard of mean 0.355 and testshows more highly significant in group B as P<0.01.The parameter Bhrama is having more effect in B than group A (By Comparing t-values).Overall in Group A the parameter Severity of Pain, frequency of Pain, IHS Criteriaand Shira shoola are more effective, Where as in Group B Duration of pain, ManyaBahu Akshi lalata Shoola and Bhrama are more effective.Discussion on results:Statistical Result and discussion of Objective parameter:Severity of Pain- In order to assess the pain the patients of each group were examined accordingto the clinical findings and the results were analyses from the statistical analysis. Theparameter severity of pain in group A Mean ±SD before was 3.714 ±0.468 and after 184
  • the treatment it is reduced to 0.285 ±0.468, with Mean difference 3.428 and standardof mean 0.172 and test shows more highly significant in group A as P<0.001. Ingroup B Mean ±SD before was 3.571 ±0.5 and after the treatment it is reduced to0.513 ±0.468 with Mean difference 3.071and standard of mean 0.164 and test showsmore highly significant in group B as P<0.001. The parameter severity of pain is having more effect in group A than group B(By Comparing t-values). Pain is Vata pradhana lakshana and nasya is the besttreatment for shoola. Thereby in Gr-A results are shown good response.Duration of Pain: The parameter Duration of pain in group A Mean ±SD before was 2.5±0.759 and after the treatment it is reduced to 0.571 ±0.513, with Mean difference1.928 and standard of mean 0.245 and test shows more highly significant in group Aas P<0.001. In group B Mean ±SD before was 2.0 ±0.392 and after the treatment itis reduced to 0.714 ±0.468 with Mean difference 1.285 and standard of mean 0.125and test shows more highly significant in group B as P<0.001. The parameter Duration of pain is having more effect in group B than group A(By Comparing t-values). Shodhana treatment eliminates dosha from the body. Dhatuposhana is also necessary for the maintenance of equilibrium of the body. In thisregard Rasayan are the choice of medicines. Shambukadi Gutika possesses Rasayanaproperty shows good result in Gr-B.Frequency of Pain: The parameter frequency of pain in group A Mean ±SD before was 2.571±0.851 and after the treatment it is reduced to 0.285 ±0.468, with Mean difference2.285 and standard of mean 0.22 and test shows more highly significant in group Aas P<0.001. In group B Mean ±SD before was 2.5 ±0.65 and after the treatment it is 185
  • reduced to 0.5 ±0.518 with Mean difference 2.00and standard of mean 0.209 and testshows more highly significant in group B as P<0.001. The parameter frequency of pain is having more effect in A than group B (ByComparing t-values). Nasya is the treatment of Shodhana. Repeated shodhana alwaysreduces the reoccurrence of dosha prakopa. Thereby nasya controls the frequency ofpain by removing dosha from the shiras.IHS Criteria: The parameter IHS Criteria in group A Mean ±SD before was 2.714 ±0.611and after the treatment it is reduced to 0.857 ±0.363, with Mean difference 1.857 andstandard of mean 0.142 and test shows more highly significant in group A asP<0.001. In group B Mean ±SD before was 3.071 ±0.615 and after the treatment itis reduced to 1.0 ±0.0 with Mean difference 2.0714 and standard of mean 0.164 andtest shows more highly significant in group B as P<0.001. The parameter IHS criteria are having more effect in group A than group B(By Comparing t-values). Overall effect of the treatment in the present study showedgood response by nasya therapy.Over all Result of Subjective and Objective Parameter of Group-A & Group-B: Overall in almost all Subjective and Objective Parameter of Group-A &Group-B the Shamana and Shodhana drug shows highly significant after thetreatment.7) Probable mode of action of the Nasya in ArdhavabhedakaMode of action of nasya karma:Ayurvedic point of view:In Ayurvedic classics, the mode of action of Nasya karma is explained indirectly. According to Charaka Samhita, the drug administered through the nose entersin the Uttamanga and eliminates the morbid doshas residing there (Ch. Si. 2/22). 186
  • According to Ashtanga Samgraha: Drug administered through nose -the doorway to sheeraReaches the Shringataka marma of Head (Sheera), which is a sira marma and formedby the siras of nose, eyes, kantha and shrotraThe drug spreads by the same routeScratches the morbid Doshas of Urdhwajatru and extracts them from the Uttamanga(A. S. 29/2). Indu, the commentator of Ashtanga Samgraha, opined that Shringataka is theinner side of middle part of head i.e. “Shiraso Antar Madhyam”. In this context Sushruta has clarified that Shringataka marma is a Siramarmaformed by the union of Siras (blood vessels) supplying to nose, ear, eye and tongue.Thus we can say that drug administered through Nasya may enter the above sira andpurifies them. (Su. Sha. 6/27). Under the complications of Nasya karma, Sushruta has mentioned thatexcessive eliminative errhine may cause Mastulunga Srava (flow of cerebrospinalfluid out to the nose). Su. Chi. 40/40, which suggest the direct relation of Nasalpathway to brain. All ancient Acharyas have said considered Nasa as the gate way of Sheera. Itdoes not mean that any channel directly connects brain and nose, but it may besuggestive of any connection through blood vessels, lymphatic and nerves. It is an experimentally proven fact that where any type of irritation takes placein any part of the body, the local blood circulation is always increased. This is theresult of natural protection function of the body. Something happens whenprovocation of Doshas takes place in Shirah due to irritating effect of administered 187
  • drug, resulting an increase of the blood circulation of brain. So extra accumulatedmorbid Doshas are expelled out from small blood vessels and ultimately these morbidDoshas are thrown out by the nasal discharge, tears and by salivation. The anatomical point of view there is no such direct pharmacodynamicconsiderations between nose and cranial organs. Moreover, blood brain barrier is astrict security system that human brain has. The nose is used as a route of drugadministration for inhalation of anaesthetic materials and certain decongestants forparanasal sinusitis. Anterior pituitary hormone nasal sprays are in practice withmodern medical system. Nasal administrations of leutinising hormone (Fink G. et al1973) and calcitonin (Pontrioli E.A. et al, 1983) are found to be equally effective asintravenous infusions in maintaining blood concentrations. Michael Russel (1977) hasobserved that perspired scent that has been painted on the upper lips has caused thesynchronization of the menstrual cycle in female volunteers by contact smelling. AnLRH agonist nasal administration for 3-6 months was observed effective in inhibitingovulation as a contraceptive measure (Berauist et al, 1979). The drugs are mostlybelieved in these cases to be absorbed through nasal and pharyngeal mucosa. Anand(1979) has also attempted contraceptive opined that the route is beneficial thansystemic administration. It was claimed that the concentration of drug in C.S.F. wasvery high to that when administered intravenously. An experimental study on theinhibiting effect of Jasmine flowers on lactation was also carried out by fragranceinhalation method proving beneficial on rats (Abraham 1979). Reduction in glandactivity and reduction in serum prolactin was also noted. Hypoglycemic effects ofinsulin and hyperglycemic effects of glucagons hormone are confirmed by intranasaladministration in normal and in diabetic patients (Pontrioli E.A. et al, 1983).Intranasal gonadotropin hormone releasing hormone has been therapeutically 188
  • recommended in stimulating leutinising hormone secretion in cryptorchid boys i.e.having undescended testis (Raifer J. et al, 1985). Scientist of the institute of medicalsciences Delhi have proved after experiments that the drug administered through noseshows effective action on the brain, so it can be said that there is very close relationbetween Shirah an Nasa (nose). According to modern point of view: • There is no direct pharmacological correlation between nose and brain. • However the olfactory area is the only place in the whole human body where there is direct contact between the outer surface and Central Nervous System. • It is known that blood brain barrier is a strict security system due to which many drugs cannot reach in the brain. • However the effect of drug on the brain, administered through the nasal pathway can be seen in followed examples. • The nose is used as a route of administration for inhalation of anaesthetic drugs. • The importance of Nasal route is indicated by the fact that Dr D. N. Rao of AIIMS delivered antigenic peptide related to the AIDS virus by packaging them in porous polymer microsphere and aerosolizing them in rats (The Hindu). • Ethanol suspension of Insulin sprayed through nebulizer gave excellent results in rats without producing any allergy. • Certain agents are used as decongestants in the treatment of paranasal sinusitis. • In modern medicine system, anterior pituitary hormones, in the form of Nasal spray are being used since a long time. 189
  • • In the same way Vasopressin is already in market in the form of Nasal therapy.• In some researches, it is found that Nasal administration of leutinizing hormone and calcitonin are equally effective in maintaining blood concentration as in Intra-venous effusions. o Fink G. et al 1973; Pontrioli E. A. et al 1983• The studies show that perspired scent that has been painted on upper lips has caused synchronization of the menstrual cycle in Female volunteers by contact smelling (Michael Russel, 1977).• Nasal administration of an LRH antagonist for 3-6 months was found to be effective in inhibiting ovulation as a contraceptive measure (Berauist et al 1979). o In this case absorption of drugs is believed through nasal and pharyngeal mucosa.• Kumar Anand (1979) has attempted contraceptive drug administration through Nasal route and opined that the route is beneficial than systemic administration. o It was also found that concentration of the drug in C.S.F. was very high to that when administered intravenously.• An experimental study, carried out by fragrance inhalation method, to observe the lactation inhibiting effect of Jasmine flowers, proved beneficial on rats. o The findings also showed reduction of gland activity and decrease in serum prolactin (Abraham 1979). 190
  • • Hypoglycaemic effect of Insulin and hyperglycaemic effect of Glucagon hormones are confirmed by intra-nasal administration in normal and diabetic patients. o Pontrioli E. A. et al. 1983 • Cryptorchid boys (having undescended testis) have been treated by intranasal GTRH (Gonadotropin Releasing Hormone) to stimulate leutinizing hormone secretion. o Raifer J. et al 1985 It is proved by scientist of Institute of Medical Science; Delhi that the drugadministered through nose shows effective action on brain. By above-mentioned examples it can be said that there is very close relationbetween brain and nose. Thus to understand the action of Nasya drug on central nervous system it isnecessary to know the probable pathways of action of Nasya dravya. On the basis of fractional stage of Nasya karma procedures, we can drawcertain rational issues that are as follow:Effect on Neuro-vascular Junction • Specific posture during Nasya karma, like the lowering of the head, fomentation of face seems to have an impact on blood circulation of the head and face. • The efferent vasodilator nerves are spread out on the superficial surface of face. • They receive stimulation by fomentation and this may increase the blood flow to the brain i.e. momentary hyperemia. 191
  • • According to Chatterjee, approximately 22% of total dilatation of cerebral capillaries, caused by facial efferent stimulation will lead to 150% blood in flow. Chatterjee 1980 • It is also possible that the fall of arterial pressure due to vasodilation may induce the Cushing’s reaction. • In this reaction when the ratio between C.S.F. pressure and cerebral arterial pressure decreases, the increased C.S.F. pressure tends to compress the arteries in brain which causes transient Ischaemia in the brain. By this the aroused Ischaemic response subsequently the arterial pressure rises. Cushing • Due to this reaction“Slush” is created in intra-cranial space, which probably forces more transfusion of fluid in brain tissue which may lead to make possible the drug action in the brain. • This can be explained by the example of drug like benzyl penicillin. The drug does not attain therapeutic level in the brain in normal conditions. But it is found to be effective during the meningitis (the inflammatory condition of meninges). Gillman and Goodman 1980. Thus, we can say that the pre-procedures of the Nasya karma are likely tolower the blood brain barrier, which makes possible the absorption of certain drugs inthe brain tissue.Effect at Neuro-endocrinal Level • The peripheral olfactory nerves are chemoreceptor in nature. This olfactory nerve differs from other cranial nerves, except optic nerve in it’s nature, and it 192
  • is phytogenetically closely related to brain. It can be considered as the fiber tract of brain itself. Brobeck 1980.• There are adjacent nerves called terminal nerves which run along the olfactory nerves though their functions are unknown. Hamilton 1966.• It is well-known that these nerves are connected with limbic system of the brain including hypothalamus, which is having control over endocrinal secretions.• Hypothalamus is also responsible for integrating the function of the endocrine system and nervous system.• Hypothalamus is directly connected with posterior lobe of pituitary by nerve fibers.• Hypothalamus is having connections with anterior lobe of pituitary through portal vessels and it is capable of inducing secretions of the anterior pituitary through these vessels.• It is also believed that product of such hypothalamic stimulation are drained by the portal vessels into the anterior lobe.• The experimental stimulation of olfactory nerves caused stimulation in certain cell of hypothalamus and amygdaloid complex, but the nature of the effects is not properly understood. Tonabe 1975.• A study shows that just like primitive mammals, man also responds to the language of smell in the environment. B.S.M. 1980 193
  • • Abraham and colleagues (1979) in their experimental studies, have observed that more exposure to smell of the Jasmine flower reduces the activity of the mammary gland. This may be acting through impulses travelling through olfactory pathways influencing hypothalamus, which causes the inhibitory effect of LH (Leutinizing Hormone) through the pituitary. Abraham et al 1979.• Russel 1977 observed in his studies that certain chemical pheromones have effect on menstrual cycle also.• The drugs used for pumsavana in Ayurveda to get the expected sex of child, may be considered to be acting through above-mentioned pathway i.e. Hypothalamo pituitary pathway.Effect at Neuro Psychological Level:• It is discussed previously that the terminal nerves running along the olfactory are connected with limbic system of brain including hypothalamus. Hamilton 1966• The limbic system is also concerned with behavioral aspects of human beings, besides control over endocrine secretions.• Thus certain drug administered through nose may have an impact on immediate psychological behaviour by acting on limbic system through olfactory nerves.• Cowley 1975 has also highlighted such phenomena in his study which was carried out on the effect of exposing people to known pheromone for a short time period. 194
  • • The result showed subjects reacting differently, in assessing men and women, in comparision with the control state; the judgement of people can also be influenced by exposure to andosterol and a mixture of short chain fatty acids. • Above-mentioned observations support the indication of Nasya in Ayurveda to treat the mental disorders like Apasmara and Unmada. Absorption and transportation of the drug administered by nasal pathway: • Keeping the head in lowering position and retention of medicine in nasopharynx help in providing sufficient time for local drug absorption. • Any liquid soluble substance has greater chance for passive absorption through the cell of lining membrane. • The drug absorption can also be enhanced by massage and local fomentation. Fingl 1980 The absorption of drug, promoted by massage and local fomentation can occur in two ways: i) By systemic circulation ii) Direct pooling into the intra-cranial region The second way is of more interest. It can occur in two ways a) By vascular path b) By lymphatic patha) Transportation By Vascular Path : Shringataka marma, mentioned by Acharya Vagbhatta can also be explainedby above description.b) Drug Transportation By Lymphatic Path : • Through this pathway drug can reach directly into the C.S.F. 195
  • • Along with olfactory nerve, the arachnoid matter sleeve is extended to sub- mucosal area of the nose. Correlation between them is understood by the fact that dye injected to arachnoid matter causes colouration of nasal mucosa within seconds and viceversa also. • Preliminary studies reported from AIIMS Laboratory’s shows that when steroids are administered through nasal pathway, they enter rapidly in C.S.F. Their level in C.S.F. was found to be much higher as compared with systemic injections. • Here it is important to remind the statement of Sushruta that the excessive administration of Virechana Nasya (eliminative errhine) may cause oozing of mastulunga (C.S.F.) into the nose. Thus we can say that the ancient scholars of Ayurveda had some knowledge oflymphatic path and functional relation between nose and brain. Importance of Post Nasya Massage: • The absorption and transportation of drug administered through nasal route is explained in previous pages. • Post Nasya massage, recommended by ancient Acharya is as important as the massage before Nasya. • Post Nasya massage on the frontal, temporal, maxillary, mastoid and manya region may help to subside the irritation of the somatic constriction due to heat stimulation. • It may also help in removing the slush created in these regions. • According to Sushruta, manya is a marma existing in neck on either side of trachea (Su. Sha. 6/29). Which likely corresponds to the carotid sinus of neck on the bifurcation of common carotid artery? The receptors called 196
  • baroreceptors are situated here and manipulation on it may have a buffering action on cerebral arterial pressure. • Best and Taylor, 1988 • Pressure applied on the baroreceptors is also found to normalize the deranged • Cerebral arterial pressure. – Hejmadi S. 1985 • On the basis of this fact, we can understand that procedures, postures and conducts explained for Nasya karma have a great importance in drug absorption and transportation. • Thus it can be stated that there is a definite effect of Nasya karma on the diseases of nervous system, endocrine system and psychiatric disturbances. • In this way, procedure of Nasya is beneficial in various diseases and for maintenance of healthy condition too.Recommendation for future study: A. Separate study should be carried in large sample with less then one year duration, 1-5 yrs duration, 5-10 yrs duration etc to assess its efficacy with respect of chronicity. B. Dhara karma also essential followed by nasya as there is strong involvement of psychological factors as a causative factor. C. It is essential to give Shamnoushadhi followed by nasya. D. Both the procedures can be adopted in same group. E. Other nasya yogas can be studied. 197
  • ConclusionHeadache in general is one of the commonest complaints of the people seekingprofessional help.As many as 90% of the individuals have at least one headache per year and10-20% of the population go to physician with headache as their primarycomplaint.Migraine is seen more often in women where it affects approximately one infifth compared with men where the incidence is near one in 16. Theprevalence of recurrent headache was found to be 18% in boys (males) and21% in girls (female). Migraine can be associated with the Menstrual Cycleand about 2/3 of migraine disappear at the Menopause.It is a benign symptom, which may be of primary, idiopathic or manifestationof a wide range of organic diseases.Ardhavabhedaka is one among the 11 types of shirorogas.The variants are Vataja, Pittaja, Kaphaja, Sannipataja, Raktaja, Krimija,Kshayaja, Suryavarta, Ardhavabhedaka, Shankhaka and Anantvata.Ardhavabheda is found to be the most common complaint after VatikaShirahshoola.Ardhavabhedaka is a vata and kapha pradhana shiroroga is one such diseasewhere pathology lies in uttamanga.It is a troublesome variety of shirashula and most commonly found nowadays.The causes of ardhavabhedaka are excessive intake of Ruksha ahara,adhyashana, purovayu sevana, atapa sevana, vegadharna, athivyayama inwhich pain is substantial in one half of the shiras, manya, bhru, akshi, lalata,karma pradesha. 198
  • The attacks of ardhavabhedaka will be once in three days, once in fifteen daysand once in a month as per classics.These features of the disease ardhavabhedaka are comparable with the signs,symptoms and frequency of attacks of migraine headache, since one sideheadache and attacks occurring once a week, once a fortnight or once a monthwith great regularity is also appreciable in migraine.According to Acharya Charaka if the disease ardhavabhedaka is left untreatedit destroy the normal function of eyes and ears.Migraine headache is a severe head pain often unilateral and frequentlydescribed as throbbing in nature.Migraine attacks may include nausea and vomiting, photophobia andphonophobia.It is usually recurrent and episodes last any where between four hours andthree days.There is direct reference for Nrupavallabha taila mention especially for diseaseardhavabhedaka in Chakradatta, Chikista Sthana, and chapter 59/191-197. Soin this study for 14 patients Nasya with Nrupavallabha Taila is administered.This taila mainly contains Vatashamaka and kaphaghna dravyas, which are themain culprit to cause Ardhavabhedaka.There is direct reference for Shambukadya gutika mention especially fordisease ardhavabhedaka in Gada Nigraha Vol-1 prayogika khanda gutikaadhikara, chapter 4/36. So in this study for 14 patients are treated withShambukadya Gutika, contains Kaphaghana, Vatashamaka and Shoolaghanadravyas which are helpful to break down the samprapti of Ardhavabhedaka. 199
  • In the present study there are 23 patients had the viharaja nidana like pureesha vegadharana, it is in maximum noted. Among the manasika nidana chinta is noted in 19 patients in the present study suggests that there is strong involvement of psychological factors in the manifestation of migraine. In the present study Ardha shoola is noticed in all 28 patients suggests that is one of the important laxana of the ardhavabhedaka. Shankha shoola is observed in 26 patients of the present study suggestive of after ardha shoola, shankha shoola is the second major laxana of the ardhavabhedaka. Net mean results of the therapies (All subjective and objective parameter of Group-A in to the consideration) = 84% i.e. Good response. Net mean results of the therapies (All subjective and objective parameter of Group-B in to the consideration) = 81% i.e. Good response.Recommendation for future study: Separate study should be carried in large sample with less then one year duration, 1-5 yrs duration, 5-10 yrs duration etc to assess its efficacy with respect of chronicity. Dhara karma also essential followed by nasya as there is strong involvement of psychological factors as a causative factor. It is essential to give Shamnoushadhi followed by nasya. Both the procedures can be adopted in same group. Other nasya yogas can be studied. 200
  • Summary: The thesis entitled “Comparetive Study of Shambukadya Gutika andNrupavallabha Taila Navana Nasya in the management ofArdhavabhedakaW.S.R.T Migraine” Ardhavabhedka is one of the shoola pradhana shiroroga mentioned in variousAyurvedic texts. It is vatakapha pradhana vyadhi, which co-relates with that ofMigraine, in specific Migraine without Aura. Migraine is a type of paroxysmalheadache occurring due to multiple factors which include dietary factors,environmental, hereditary etc. Exact cause is not known. It is more common betweenthe age group of 12-60 years and is rare after the age 60.Thesis comprises following parts.1. Introduction2. Objectives of the study3. Review of literature4. Methodology5. Observation and results6. Discussion7. Interpretation and Conclusion1. Introduction: Ardhavabhedka is one of the 11 type of the shiroroga mentioned in ourclassics by different Acharyas It is vatakapha pradhana vyadhi, which co-relates withthat of Migraine. Ardhavabhedaka (Migraine) is more common between the age groupof 12-60 years and is rare after the age 60. Ardhavabhedaka along with their modernexplanation were given in detail. Definition and Synonyms of ardhavabhedaka,nidanas, roopa, samprapti, upashaya- anuapshaya, sadhya- asadhyata, chikithsa, 201
  • pathya-apathya and definition of shiraroga, type of shiroroga, Samprapti of Shiroroga,chikithsa of shiroroga etc are explained. Definition of headache, pain sensitivestructure of the head, International headache society classification of headache,etiopathogenesis of headache, headache diagnosis, definition of migraine, prevalenceof migraine, pathogenesis of migraine etc are explained. And the general aspects ofNasya under the headings of etymological derivation and definition of Nasya, itssynonyms, classification, indications, contraindication, course, dose, administrationand mode of action of Nasya karma.2. Objectives of the study:1) To evaluate the effect of Shambukadya Gutika in Ardhavabhedaka.2) To evaluate the effect of Nrupavallabha taila in Ardhavabhedaka.3) To evaluate the effect of nasya in Ardhavabhedaka.4) To assess the comparative efficacy of Shambukadya vati and Nrupavallabha taila Navana nasya in Ardhavabhedaka3. Review of literature: This part includes historical review, review of previous research works,Review of Shirashoola, Ardhavabhedaka, Migraine and Headache and descriptionregarding nidana, lakshanas, roopa, samprapti, upashaya-anupashaya, sadya-asadyata,pathya-apathya etc., Definition, classification, differential diagnosis and treatmentsetc. In the drug review description concerning about the guna, karma, indication,chemical composition etc and preparation of Yoga.4. Methodology: This includes the selection criteria, study design, sample size and grouping,exclusion and inclusion criteria, diagnostic criteria, posology i.e total drops of taila fornavana nasya (shodhana therepy} and for shamana aushadi, study duration, follow up 202
  • period, Assessment of the results by analyzed statistically for “P” value using student‘t’ test Paired t-test for individual group and unpaired t-test for comparative study ofthe mean of the two group. Subjective and objective parameters, routine Investigationand preparation of drug. In this series, 28 patients of Ardhavabhedaka were selectedand randomly divided into two groups viz. 15 in Shambukadya Gutika group, 15 inNrupavallabha taila Nasya group. One patient in each group have discontinued theirtreatment.5. Observation and result: It includes observation on all demographic datas with their percentage andgraphical representation, regarding the observation nidanas, poorvaroopas, lakshanasand results of individual symptoms followed overall response of the treatment.6. Discussion:1. Discussion on the disease Ardhavabhedaka with special reference to Migraine.2. Discussion on clinical study.3. Discussions on the observation of the patients of ardhavabhedaka who underwent the trial.4. Discussions on observations made on results during the trial work under two subheadings as Group A and Group B.5. Discussion on results.6. Probable mode of action of the therapy and drug respectively in both groups.Interpretation and Conclusion In both the groups’ Good response was recorded but slightly Group- A showedbetter result then Group B. It indicates the efficacy of nasya karma over shamanatherapy. 203
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  • 142. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka 2, 3rd edition by Vaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 pp287.143. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 58, reprint 2005. Edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambhasurabharathi Prakashanam 2005 pp720.144. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 58, reprint 2005. Edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 pp720.145. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 23. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 pp555146. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka5, Rudra parasava 1st Edition 2006 Varanasi Chaukhamba Krishnadas Academy. pp 223.147. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 96-97, reprint 2005. Edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 pp990148. Agnivesa, Charaka samhitha, vimanasthana, chapter 8, sloka 139, 8th edition 2004, by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam , pp681149. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 94, reprint 2005. Edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 pp722.150. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 95, 8th edition 2004, by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005, pp989.151. Agnivesa, Charaka samhitha, Siddhisthana chapter 2, sloka 22, 8th edition 2004, by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005, pp 904152. Agnivesa, Charaka samhitha, Siddhisthana chapter 2, sloka 23, reprint 2005.edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 pp690.153. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 24. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 pp555.154. Sharangadhara, Sharangadhara samhita Utharakhanda Chapter 8, sloka 3, 6thed. Varanasi: Chowakambha Orientalia 2005 P.339. (Jai. Krishnadas Ayurveda series) X
  • 155. Agnivesa, Charaka samhitha, Siddhisthana chapter 2, sloka 20, 8th edition 2004, by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005, pp 902156. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 47. reprint 2005 by vaidya P.V. Sharma, Chowakambha Sanskrit samsthan varanasi , pp 154157. Vagabhatta , Astanga hrydaya, sustrastana chapter 20 sloka 211-13, 3rd edition, by Vaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 pp287.158. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka 15-16, 8th ed. EditedbyVaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 pp290.159. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka16, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy.pp 225160. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 42. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 pp556.161. Vagabhatta, Astanga hrydaya sustrastana chapter 20 sloka 9, 8th ed. Edited byVaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 pp289.162. Sharangadhara, Sharangadhara samhita Utharakhanda Chapter 8, sloka 21, 6th ed. Varanasi: Chowakambha Orientalia 2005 P.342. (Jai. Krishnadas Ayurveda series)163. Vagabhatta, Astanga hrydaya sustrastana chapter 20 sloka 23-24, 8th ed. Edited byVaidya Bhisagacharya Harishastri Paradaka .Varanasi: Chowkambha Orientalia 1998 pp.292.164. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 49. 3rd edition, 1996 by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 pp557.165. Vagabhatta, Astanga hrydaya sustrastana chapter 20 sloka 21, 3rd edition, 1996 byVaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 pp292.166. Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J.7th Edition, Overview, Diagnosis, and Classification of Headache 2nd chapter, 2001 Oxford University Press, pp6167. Nicholas A. Boon, Davidsons principal and practice of medicines, 20th edition, Churchil Livingstone, 26th chapter, pp1160168. John Walton, Brains diseases of the Nervous system, 20th edition, 3rd chapter, oxford medical publication, pp127 XI
  • 169. Anthony S. Fauci, MD, Harrisons, Principal of internal medicines, volume- 1, 16th edition, Headache 14th chapter, Mc Graw Hill Medical New York170. Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J. Title: Wolffs Headache and Other Head Pain, 7th Edition, 9th chapter, 2001 Oxford University Press, pp 122171. Mark W Green, MD, Managing your Headache, 2nd edition, 3rd chapter, The primary Headache syndrome, printed in united states of Americha, pp 46172. Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J. Title: Wolffs Headache and Other Head Pain, 7th Edition, 9th chapter, 2001 Oxford University Press, pp 122-123173. Mark W Green, MD, Managing your Headache, 2nd edition, 3rd chapter, The primary Headache syndrome, printed in united states of Americha, pp 47-48174. Anthony S. Fauci, MD, Harrisons, Principal of internal medicines, volume- 1, 16th edition, Headache 14th chapter, Mc Graw Hill Medical New York175. Jay A. Van Gerpan, MD, Stephan Hicky, MD, and David JCapobianco, MD, Migraine Diagnosis, Prevention and treatment,April 2000,Jacksonville medicine,pp 3176. Siddharth N. Shah, API textbook of medicines, 7th edition, Neurology, Headache 4th chapter, published by the association of physicians of India, Mumbai, pp749(Migraine the triggers)177. Jay A. Van Gerpan, MD, Stephan Hicky, MD, and David J Capobianco, MD, Migraine Diagnosis, Prevention and treatment, April 2000, Jacksonville medicine, pp 1-2178. Siddharth N. Shah, API textbook of medicines, 7th edition, Neurology, Headache 4th chapter, published by the association of physicians of India, Mumbai, pp750179. Anthony S. Fauci, MD, Harrisons, Principal of internal medicines, volume- 1, 16th edition, Headache 14th chapter, Mc Graw Hill Medical New York180. Aspi F. Golwalla, MD, Medicines for student, 20th edition, Neurological, Headache 10th chapter, printed by Neel graphics, pp497-498181. Bs Singhal, API textbook of medicines, 6th edition, Neurology, Headache 5th chapter, pp 704182. http://health.mytimes.com/health/guide/disease/migraine/prognosis.html183. Aspi F. Golwalla, MD, Medicines for student, 20th edition, Neurological, Headache 10th chapter, printed by Neel graphics, pp498-499184. Siddharth N. Shah, API textbook of medicines, 7th edition, Neurology, Headache 4th chapter, published by the association of physicians of India, Mumbai, pp751185. Priyavrat sharma, Dravyaguna vijnana, part-2, 7th edition 1983, chaukhamba bharati academy, pp 738-740 XII
  • 186. Ibid pp 562-564187. Ibid pp 133-135188. Ibid pp 820-821189. Ibid pp 280-282190. Ibid pp 282-284191. Ibid pp 253-256192. Ibid pp 734-736193. Ibid pp 503-506194. Ibid pp 800-802195. Ibid pp 39-41196. Ibid pp 585-586197. Ibid pp 632-634198. Ibid pp 94-95199. Ibid pp 630-631200. Ibid pp 275-279201. kaviraj Ambika Datta Shastri, Edited, Sushruta Samhita, Sutrasthana, 46/315, edition reprint 2007, publication Chaukhamba Samskrit Samsthan, pp209202. Prof. Siddhinanda Mishra, Ayurveda Rasashastra, 14th edition 2004, Suddha Varga, Shankha prakarana, chaukhamba orientella, pp685-689203. Ibid, pp 543-560204. Dr. Chadrabhushana jha, Ayurveda Rasashastra, reprint 2006, lohadi- dhatu- upadhatu prakarana ,chaukhamba surbharati prakashana, pp356- 359205. Prof. Siddhinanda Mishra, Ayurveda Rasashastra, 14th edition 2004, anjana prakarana, chaukhamba orientella, pp 455-461206. Dr. Bhramananda Tripathi, edited, Charaka Samhita, Sutrasthana, 27/249, edition reprint, 2007, publication Chaukhamba Surbharati Prakashana, pp531207. Ibid 45/142, PP531 XIII
  • Master Chart (Group-A&B) Data showing Demographic Data & Personal History for Group-A & Group- B Sl OPD Age Sex Rel. E.S. M.S. Occ. Diet TF Agni Kostha Ni. Pureesha FH MH Pravsutti 01. 5433 38 F H HM M S V AK M KR DI VI P IR 02. 6162 60 F H P M S V MLK V M SS P A - 03. 6366 26 F M HM UN A MX AK M M SI VI P IR 04. 6475 25 M H HM UN A MX AK M M DI VI A - 05. 88 36 F M HM M S MX AK T MR DI DR A IR 06. 149 45 F H M M S V LK M KR D VI A - 07. 6175 44 M H HM M A V MAK M KR N VI A - 08. 265 36 F M M M A MX AK V KR DI VI P R 09. 295 26 F H HM M S MX MAK V M D P A R 10. 234 32 F H M M S MX MLK V M D VI A IR 11. 325 37 F M M M S MX LK V M SS VI A R 12. 1072 50 F H M M S V LK S M DI VI A - 13. 1293 30 M H P UN L MX LTK M M DI VI A - 14. 1535 40 F M M M S MX TK M KR DI VI A - 01. 4917 30 M H P UN L V AK M M N VI A - 02. 4983 55 F H P M S V MLK V M D P A - 03. 5014 46 F H M M A MX MLK V M D P A - 04. 5091 30 F H HM M L V AK M KR DI VI A R 05. 5115 36 F H HM M A V ALK V M DI P P IR 06. 5645 32 M H P M L MX AL V M S P A - 07. 5777 34 F H M M S V ALK M M DI VI P IR 08. 6348 35 F H M M A MX LK V KR DI VI A IR 09. 6457 39 M H P M L V ALK V M DI VI A - 10. 08 46 M H P M L MX ALK V KR S VI A - 11. 06 48 F H P M L MX AL T M N DR P - 12. 84 37 F H M M S MX MAK M M D VI P R 13. 929 28 F M M M S MX MLK M M D VI P R 14. 1154 50 F H HM M S V MAL M KR DI VI A RI
  • Abbreviations: Sex: M- Male, F- Female, Rel-Religion: H-Hindu, M-Muslim, ES-Economical Status: P-Poor, M- Middle, Higher Middle, Occ-Occupation: S- Sedentary, A-Active, L-Labor. MS-Marital Status: M-Married, Un- Unmarried. FH- Family History: P- Present, A- Absent, Ni-Nidra:SS-Sound-Sleep, DI-Disturbed, D- Day, N- Night, Diet: V-Vegetarian, MX-Mixed veg. TF- Tast Preffered- M-Madhura, A- Amla, L- Lavana, K- Katu,T- Tikta, KA- Kashaya, Koshta- KR- Krura, M- Madhyama, MR- Mrudu, Agni- M- Manda, V- Vishma, T- Teekshna, S- Sama, Pureesha pravruti-VI- Vitbivandha, P- prakruta, DR- Dravavit, MH- Menstrual History- IR- Irregular, R- RegularII
  • Objective Assessment of Nrupavallabhadi Taila for IHS Criteria Group ASl.No OPD No Unilateral Phonopho Moderate Aggrd by Pulsating Vomiting Location Intensity intensity walking Quality Nausea phobia Severe Photo statin bia BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT 1 5433 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 2 6162 1 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 3 6366 1 1 1 0 1 1 1 0 0 0 1 0 1 1 0 0 1 0 4 6475 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 5 88 1 0 0 0 1 0 1 1 0 0 0 0 1 1 0 0 1 0 6 149 1 1 1 0 1 1 1 0 0 0 0 0 1 0 0 0 1 1 7 6175 1 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 1 0 8 265 1 0 1 0 1 0 1 1 0 0 1 0 1 1 0 0 0 0 9 295 1 0 1 0 1 0 1 0 0 0 0 0 1 0 0 0 1 1 10 234 1 1 1 0 1 1 1 0 0 0 0 0 1 1 0 0 1 0 11 325 1 0 1 1 1 1 1 0 0 0 0 0 1 0 0 0 1 0 12 1072 1 1 0 0 0 0 1 0 0 0 1 0 1 1 0 0 1 1 13 1293 1 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 14 1535 1 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 1Total 14 4 8 1 10 4 13 3 0 0 4 0 12 6 0 0 12 6Abbreviation used- BT- Before treatment AT- After treatmentIII
  • Objective Assessment of Shambukadya Gutika for IHSCriteria Group-BSl.No OPD NO l Location Moderate iIntensity Unilatera Agged by Pulsating Vomiting Phonoph Intensity working phobias Servere Quality Nausea Photo statin obia BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT 1 4917 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 2 4983 1 1 0 0 0 1 1 0 0 0 0 0 1 0 0 1 1 0 3 5014 1 1 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 4 5091 1 1 0 0 0 1 1 0 0 0 1 0 1 1 0 1 1 0 5 5115 1 0 0 0 0 1 0 0 0 0 1 0 1 1 0 1 1 1 6 5645 1 0 0 0 0 1 1 0 0 0 0 0 1 0 0 1 1 1 7 5777 1 0 1 1 0 1 0 0 0 0 1 1 0 0 0 1 1 0 8 6348 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 9 6457 1 0 1 1 0 1 1 0 0 0 1 0 0 0 0 1 1 1 10 08 1 0 1 1 1 1 1 0 0 0 0 0 1 1 0 1 1 0 11 06 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 1 0 12 84 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 13 929 1 1 1 1 0 1 1 0 0 0 1 0 1 1 0 1 1 0 14 1154 1 0 1 1 1 1 0 0 0 0 1 0 1 1 0 1 1 1Total 14 7 7 2 12 8 12 0 0 0 8 2 11 7 0 0 12 5Abbreviation used- BT- Before treatment AT- After treatmentIV
  • Data Related to disease Specific (GROUP-A)OPD Nature of Pain Site of pain Interval bet Averag Intensity Onset attack e duratio n Tension 1-5 days Contino 5-10hrs 15days 1-5hrs Acute Night Noon Tem Mor 5-10 Chu Jaw Chr Inci Cut Eve Fro Oci Pul 10- Th Pr Rt Lt us5433 + + + + + + + + +6162 + + + + + + + +6366 + + + + + + + + + + +6475 + + + + + + + + +88 + + + + + + + + + + + +149 + + + + + + + + + + + +6175 + + + + + + + + +265 + + + + + + + + + + + +295 + + + + + + + + +234 + + + + + + + + +325 + + + + + + + + + +1072 + + + + + + + + + + +V
  • 1293 + + + + + + + + + +1535 + + + + + + + + + + +Total 14 11 0 2 0 8 6 14 11 4 3 2 4 5 3 6 8 8 3 8 1 3 11 0 7Abbreviation used- TH- Throbbing, PRI- Pricking, CHU- Churning, CUT- Cutting, PUL- Pulsating RI- Right, LT- Left, TEM- Temporal, FRO-Frontal, OCCI- Occipital, Jaw CONT- Continuous, MOR- Morning, NOON- Afternoon, EVE- Evening, Night INCI- Insidious, ACU- Acute, CHR-ChroniVI
  • Data Related to disease Specific (Group-B)OPD Nature of Pain Site of pain Interval bet attack Avg. Intensity Onset duration 5-10 Chu Con Jaw Acu Chr Noo Inci Cut Eve Fro 15d 10h day day Oci Nig 5hr Pul Mo 1-5 10- Th Te Pr Rt Lt ht 1- 5- te n r s t4917 + + + + + + + + + +4983 + + + + + + + + + +5014 + + + + + + + +5091 + + + + + + + + + +5115 + + + + + + + +5645 + + + + + + + + + +5777 + + + + + + + +6348 + + + + + + + + + + + +6457 + + + + + + + + + +08 + + + + + + + + + + +06 + + + + + + + + + +84 + + + + + + + + + + +929 + + + + + + + + + + +1154 + + + + + + + + + + +Total 14 11 0 3 0 6 8 1 1 6 1 2 5 6 1 10 4 6 5 12 13 0 4 0 VII
  • Abbreviation used- TH- Throbbing, PRI- Pricking, CHU- Churning, CUT- Cutting, PUL- Pulsating RI- Right, LT- Left,TEM- Temporal, FRO- Frontal, OCCI- Occipital, Jaw CONT- Continuous, MOR- Morning, NOON- Afternoon, EVE-Evening, Night INCI- Insidious, ACU- Acute, CHR- Chronic Objective parameter statistical assessment of Nrupavallabhadi taila (Group-A) S.No O.P.D. Severity of pain Duration of pain Frequency of IHS criteria No. pain BT AT %of BT AT %of BT AT %of BT AT %of cure cure cure cure 1 5433 4 0 100 2 1 75 2 0 100 1 1 75 2 6162 3 0 100 2 0 100 2 0 100 2 0 100 3 6366 3 1 75 2 1 75 2 1 75 3 1 75 4 6475 4 0 100 2 0 100 4 0 100 2 0 100 5 88 3 0 100 2 1 75 2 0 100 3 1 75 6 149 4 1 75 2 1 75 3 1 75 3 1 75 7 6175 4 0 100 3 0 100 1 0 100 3 1 75 8 265 4 0 100 4 1 75 3 0 100 3 1 75 9 295 4 0 100 3 0 100 3 0 100 3 1 75 10 234 4 1 75 4 1 75 4 1 75 3 1 75 11 325 4 0 100 2 1 75 2 0 100 3 1 75 12 1072 4 1 75 2 1 75 3 1 75 3 1 75 13 1293 4 0 100 2 0 100 3 0 100 3 1 75 14 1535 3 0 100 3 0 100 2 0 100 3 1 75 Total 52 4 35 8 36 4 38 12VIII
  • Abbreviation used- BT- Before treatment AT- After treatment Objective parameter statistical assessment of Shambukadya gutika (Group-B) S.No O.P.D. Severity of pain Duration of pain Frequency of IHS criteria No. pain BT AT %of BT AT %of BT AT %of BT AT %of cure cure cure cure 1 4917 4 1 75 2 1 75 3 1 75 2 1 75 2 4983 4 1 75 2 1 75 2 1 75 3 1 75 3 5014 4 1 75 2 1 75 3 1 75 2 1 75 4 5091 4 1 75 2 1 75 3 1 75 4 1 75 5 5115 3 0 100 2 0 100 2 0 100 3 1 75 6 5645 4 0 100 1 0 100 2 0 100 3 1 75 7 5777 3 0 100 2 0 100 2 0 100 3 1 75 8 6348 4 1 75 2 1 75 2 1 100 3 1 75 9 6457 3 0 100 2 1 75 3 1 75 3 1 75 10 08 3 1 75 2 1 75 2 0 100 3 1 75 11 06 4 0 100 2 1 75 4 0 100 3 1 75 12 84 4 0 100 3 1 75 3 0 100 3 1 75 13 929 3 0 100 2 0 100 2 1 75 4 1 75 14 1154 3 1 75 2 1 75 2 0 100 4 1 75 Total 50 7 28 10 35 7 43 14Abbreviation used- BT- Before treatment AT- After treatmentIX
  • Subjective parameter statistical assessment of Nrupavallabhadi taila (Group-A)S.No O.P.D. Shira shoola Shankha shoola Manya,bhru, Shastra arani Bhrama No. Akshi,lalata nibhama vedana shoola BT AT %of BT AT %of BT AT %of BT AT %of BT AT %of cure cure cure cure cure 1 5433 4 0 100 4 0 100 1 0 100 0 0 0 0 0 0 2 6162 3 0 100 3 0 100 3 0 100 0 0 0 0 0 0 3 6366 3 1 75 4 0 100 3 0 100 0 0 0 2 1 75 4 6475 4 0 100 4 0 100 4 0 100 0 0 0 0 0 0 5 88 3 0 100 4 1 75 3 0 100 0 0 0 3 1 75 6 149 4 1 75 4 1 75 4 1 75 0 0 0 3 0 100 7 6175 4 0 100 4 0 100 4 0 100 0 0 0 0 0 0 8 265 4 0 100 3 1 75 2 0 100 0 0 0 0 0 0 9 295 4 0 100 4 0 100 4 0 100 0 0 0 0 0 0 10 234 4 1 75 4 1 75 4 2 50 0 0 0 0 0 0 11 325 4 0 100 3 0 100 3 1 75 0 0 0 2 1 75 12 1072 4 1 75 4 1 75 2 1 75 0 0 0 2 0 100 13 1293 4 0 100 4 1 75 2 0 100 0 0 0 0 0 0 14 1535 3 0 100 3 0 100 2 0 100 0 0 0 2 0 100Total 52 4 52 6 41 5 0 0 0 14 3 X
  • Abbreviation used- BT- Before treatment AT- After treatment Subjective parameter statistical assessment of Shambukadya gutika (Group-B)S.No O.P.D. Shira shoola Shankha shoola Manya,bhru, Shastra arani Bhrama No. Akshi,lalata nibhama vedana shoola BT AT %of BT AT %of BT AT %of BT AT %of BT AT %of cure cure cure cure cure 1 4917 4 1 75 3 1 75 2 0 100 0 0 0 0 0 0 2 4983 4 1 75 4 1 75 4 1 75 0 0 0 4 0 100 3 5014 4 1 75 4 1 75 2 0 100 0 0 0 2 0 100 4 5091 4 1 75 4 1 75 4 1 75 0 0 0 1 0 100 5 5115 3 0 100 3 0 100 3 0 100 0 0 0 0 0 0 6 5645 4 0 100 4 0 100 2 0 100 0 0 0 3 0 100 7 5777 3 0 100 3 0 100 2 0 100 0 0 0 0 0 0 8 6348 4 1 75 4 1 75 2 0 100 0 0 0 0 0 0 9 6457 3 0 100 3 1 75 2 0 100 0 0 0 2 0 0 10 08 3 1 75 3 0 100 4 0 100 0 0 0 2 1 75 11 06 4 0 100 4 0 100 3 0 100 0 0 0 0 0 0 12 84 4 0 100 4 1 75 3 0 100 0 0 0 0 0 0 13 929 3 0 100 4 1 75 2 1 75 0 0 0 0 0 0 14 1154 3 1 75 4 1 75 2 0 100 0 0 0 2 0 100 XI
  • Total 50 7 51 9 37 3 0 0 0 16 1 Abbreviation used- BT- Before treatment AT- After treatment Data related to chief & associated complaints of Group - A S.No Chief complaints 1 2 3 4 5 6 7 8 9 10 11 12 13 14 T 1 Shira shoola + + + + + + + + + + + + + + 14 2 Bhrama + + + + + + 6 3 Toda + + + + 4 Associated complaints 1 Chardi + + + + + + + + + + + + 12 2 Prakasha santrasa + + + + + + + + + + + + 12 3 Shabda asahishnua + + + + 4 4 Karma kshweda 5 Aura + + 2 Data related to chief & associated complaints of Group - B S.No Chief complaints 1 2 3 4 5 6 7 8 9 10 11 12 13 14 T 1 Shira shoola + + + + + + + + + + + + + + 14 2 Bhrama + + + + + + + 7 3 Toda + + + + + 5 XII
  • Associated complaints1 Chardi + + + + + + + + + + 102 Prakasha santrasa + + + + + + + + + + + 113 Shabda asahishnua + + + + + + + + 84 Karma kshweda + 15 Aura Data related to Roopa Group- A S.NO OPD NO Ardha Manya Bhru shoola Shankaha Akshi Lalata Shastra arani Shirashoola shoola shoola shoola shoola Nibham vedana 1 5433 + + + + + 2 6162 + + + + 3 6366 + + + + + 4 6475 + + + 5 88 + + + + + 6 149 + + + + 7 6175 + + + + 8 265 + + + 9 295 + + + 10 234 + + + + 11 325 + + + + 12 1072 + + + 13 1293 + + + + + 14 1535 + + + + Total 14 9 11 12 3 7 0 XIII
  • Data related to Roopa Group- A S.NO OPD NO Ardha Manya Bhru shoola Shankaha Akshi Lalata Shastra arani Shirashoola shoola shoola shoola shoola Nibham vedana 1 4917 + + + + 2 4983 + + + + 3 5014 + + + 4 5091 + + + + 5 5115 + + + + 6 5645 + + + + 7 5777 + + + + 8 6348 + + + + 9 6457 + + + + 10 08 + + + + 11 06 + + + + + 12 84 + + + + + 13 929 + + + + 14 1154 + + + + Total 14 10 10 14 3 6 0 Data related to Rogi Pareeksha Group- AS.NO OPD Prakruti Sara Samahana Satmya Satwa Ahara Vyayama Vaya NO shakti shakti V VP VK P A M S A M R S P A M AS JS P A M Balya Yauvana Vrdhyaka 1 5433 + + + + + + M A + + + 2 6162 + + + + + + M M + + XIV
  • 3 6366 + + + + + M M + + 4 6475 + + + + + + M M + + 5 88 + + + + + + M M + + 6 149 + + + + + M M + + + 7 6175 + + + + + + A A + + 8 265 + + + + M A + + 9 295 + + + + + M M + + 10 234 + + + M M + + 11 325 + + + + + M M + + 12 1072 + + + M M + 13 1293 + + + + + + M M + + 14 1535 + + + + + M M + Total 8 4 2 3 8 3 0 14 0 12 2 3 7 4 8 4 2 10 3 V-Vata, VP- Vata pitta, VK- Vata kapha P- Pravara, A- Avara, M- Madhyama S-Susamhita, A- Asamhita, M- Madhyama Samhita R- Rooksha, S- Snigdha P- Pravara, A- Avara, M- Madhyama AS- Abharana Shakti, JS- Jarana Shakti Data related to Rogi Pareeksha Group- BS.NO OPD Prakruti Sara Samahana Satmya Satwa Ahara Vyayama Vaya NO shakti shakti V VP VK P A M S A M R S P A M AS JS P A M Balya Yauvana Vrdhyaka 1 4917 + + + + + + M M + + 2 4983 + + + + + + M M + + 3 5014 + + + + + M M + + 4 5091 + + + + + A A + + 5 5115 + + + + + M M + + 6 5645 + + + + + + M P + + XV
  • 7 5777 + + + + + + M A + + 8 6348 + + + + + M A + + 9 6457 + + + + M A + + + 10 08 + + + + + M M + 11 06 + + + + + M M + + 12 84 + + + + + M A + + 13 929 + + + + M M + + 14 1154 + + + + M M + +Total 6 3 5 2 11 1 3 11 0 9 5 1 0 13 6 4 4 0 9 5 V-Vata, VP- Vata pitta, VK- Vata kapha P- Pravara, A- Avara, M- Madhyama S-Susamhita, A- Asamhita, M- Madhyama Samhita R- Rooksha, S- Snigdha P- Pravara, A- Avara, M- Madhyama AS- Abharana Shakti, JS- Jarana Shakti XVI
  • Data related to Nidana (Aharaja, Viharaja, Mansika, Anya) Group- AS.NO OPD Aharaja Viharaja Manasika Anya NO Ruksha Snigdha Vegad Ratri Atapa Diwa Atyasana Purva Ayasa Bhaya Shoka Chinta Menst harana jagrana sevana swapna vayu ruatio n 1 5433 + + + + + 2 6162 + + + + 3 6366 + + + + + + + 4 6475 + + + + + 5 88 + + + + + + + 6 149 + + + + 7 6175 + + + + + + 8 265 + + + + + 9 295 + + + 10 234 + + + + + + + 11 325 + + + + + + 12 1072 + + + + + 13 1293 + + + + + + 14 1535 + + + + +Tota 12 2 10 7 12 4 8 1 2 0 10 5 l XVII
  • Data related to Nidana (Aharaja, Viharaja, Mansika, Anya) Group- BS.NO OPD Aharaja Viharaja Manasika Anya NO Ruksha Snigdha Vega Ratri Atapa Diwa Atyasana Purva Ayasa Bhaya Shoka Chinta Menst dharana jagrana sevana swapna vayu ruatio n 1 4917 + + + + + + 2 4983 + + + + + 3 5014 + + + + + 4 5091 + + + + + + + 5 5115 + + + + + 6 5645 + + + 7 5777 + + + + + + + 8 6348 + + + + + + 9 6457 + + + + 10 08 + + + + + 11 06 + + + + 12 84 + + + + + 13 929 + + + + + 14 1154 + + + + + +Total 9 5 13 6 9 5 3 7 3 1 0 9 3 XVIII
  • DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA D.G.M.AYURVEDIC MEDICAL COLLEGE - GADAG SPECIAL CASE SHEET FOR COMPARATIVE STUDY OF SHAMBUKADYA GUTIKA AND NRUPAVALLABHA TAILA NAVANA NASYA IN THE MANAGEMENT OF ARDHAVABHEDAKA w.s.r.t. MIGRAINE” Guide: Dr. R.V. Shettar, M.D (Ayu), Scholar: Neeraj Kumar Asst. Professor, P.G. Dept of Kayachikitsa. 1) Name of the Patient Sl.No 2) Sex Male Female OPD No 3) Age Years IPD No 4) Religion Hindu Muslim Christian Other 5) Occupation Sedentary Active Labor 6) Economical status Poor Middle Higher middle Higher class 7) Address Contact No: Pin 8) Selection Included Excluded 9) Schedule Initiation Date Completion Date 10) Result Well responded Moderately responded Responded Not responded Discontinued 11) INFORMED CONSENT I Son/Daughter/Wife of amexercising my free will, to participate in above study as a subject. I have been informed to mysatisfaction, by the attending physician the purpose of the clinical evaluation and nature of thedrug treatment. I am also aware of my right to opt out of the treatment schedule, at any timeduring the course of the treatment.EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw ________________________________________________£À£Àß ¸ÀéEZÉÒ¬ÄAzÀ PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞwAiÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ AiÀiÁªÁUÁzÀgÀÄ aQvÉì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å«zÉ JAzÀÄw½¢gÀÄvÉÛ£É. gÉÆÃVAiÀÄ gÀÄdÄ/Patients Signature I
  • A History Taking1) Chief complaint with duration– No Complaints Before treatment Fresh <1Yrs < 5Yrs > 5Yrs 1 Shirashula 2 Bhrama 3 Toda2) Associated Features No Complaints Before treatment Fresh <1Yrs < 5Yrs > 5Yrs 1 Chardi 2 Prakasha santrasa 3 Shabdaasahishnuta 4 Karna kshweda 5 Aura3) History of Present illnessi) Repeated attack of headache Present Absent Right half Left Halfii) First attackOnset Insidious Acute ChronicNature of pain Throbbing Cutting Pricking Pulsating ChurningSite Temporal Occipital Frontal Parietal Maxillary Per orbital Jaw Neck Mastoidiii) Interval between attacksiv) Average duration of attackv) Last attack – d d d d m m m m y y y y y y y y II
  • vi) Weather related to Menstruations Yes No vi) Precipitating factors – vii) Reliving factors – viii) Intensity – Morning Afternoon Evening Night4) History of past illness if any5) Family History Paternal Maternal Parental Marriage Yes No Number of Sibling Brother Sisters Any History of Migraine Yes No6) Personal history a) Ahara Vegetarian Taste in Madhura Amla Mixed food predominance Lavana Katu Tikta Kashaya b) Vihara (Physical work) Heena Madhyama Uttama c) Kosta Krura Madhyama Mrudu d) Jatharagni bala Manda Teekshna Vishama Sama e) Pureesha pravritti Vitvibandha Dravavit Prakrita Frequency f) Mutra pravritti Frequency Day Night g)Occupational history Type of employment Working hours Nature of Work Work involving any Yes No mental strain If yes Mild Moderate Severe Vyasana Alcoholic Smoking Tobacco Chewing Whether symptoms produced during working hours Yes No Weather symptoms relieved by change of place Yes No III
  • 7) Menstrual History Menarche Yes No Age Menopause Yes No Age Regular Irregular Oral Contraceptives Pills Yes No duration8) Previous treatment history if any Anti migraine drug 1) 2) Not started Yes No Started but discontinued Yes No Started and continuing Yes No Taking only during attack Yes No9) Nidana Panchaka –Nidana:AharajaViharajaAnya10) Roopa: Ardha shirashoola Manya shoola Bhru shoola Shankaha shoola Akshi shoola Lalata shoola Shastra arani nibham vedana11) Samprapti ghataka: Dosha- Adhistana- Dushya- Srotas- Dushtiprakara- Agni-12) General Examination 1 Height Cms 2 Weight Kg 3 Pulse bpm 4 Blood pressure mm/Hg 5 Respiration rate tpm IV
  • 6 Heart rate bpm o 7 Temperature F13) ASTA STHANA PARIKSHA Nadi Dosha Mutra Pravrutti Jihwa Ardra Sushka Mala Sama Nirama Lepa Nirlepa Shabda Sparsha Sheeta Ushna Drik Akruti14) DASHVIDHA PARIKSHA Prakruti V P K VP VK PK VPK Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in (Cms) Cms Weight in (Kgs) Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya15) Systemic examination: A) CVS-B) GIT examination:Symptoms Present AbsentDysphasiaHeart burnFlatulencevomitingAbdominal pain Site DurationC) CNS examination:a) Optic nerve examination Visual activity Yes No Near vision Distant vision Visual field: Present AbsentHemianopiaBitemporal hemianopiaBinasal hemianopia V
  • Intra Ocular Pressure –b) Examination of nasal cavities – Deviated nasal septum Present Right Left Absent Polyp Present Right Left Absent Nasal Mucosa Congested Non Congested Allergic Rhinitis Present Absent Pain Present Absentc) Examination of Ear Tympanic Membrane Congested Intact Perforated Otalgia Present Absentd) Examination of Oral cavity Tonsils Inflammation Normale) Cranial Nerve ExaminationCranial Nerve Motor root Sensory root16) Laboratory Investigation 1 Heamoglobin % 2 ESR 3 RBS 4 Total WBC count 5 Differential count P L E M B % % % % % VI
  • 17) Chikitsa - 1) Internal: Shambukadya gutika – 125 mg three times a day for 45 days with 45 days follow up. 2) External: Navana nasya with Nrupavallabh taila for 14 days with 30 days follow up.18) Treatment – ASSESSMENT CHART FOR SHAMANA AUSHADHI Subjective ParametersS.No Assessment Criteria BT 15th 30th AT Follow-up Day Day 15 30 45 1 Shiraha Shoola 2 Shankha Shoola 3 Manya,bhru,akshi,lalata Shoola 4 Shastra arani nibham vedana 5 Bhrama Objective Parameters S.No Assessment Criteria BT 15th 30th AT Follow-up Day Day 15 30 45 1 Severity of Pain 2 Duration of Pain 3 Frequency of Pain IHS Criteria 1 Unilateral location 2 Pulsating quality 3 Moderate intensity 4 Severe intensity 5 Aggravated by walking stairs 6 Phonophobia 7 Photophobia 8 Nausea 9 Vomiting VII
  • 19) Treatment – ASSESSMENT CHART FOR NAVANA NASYA Subjective ParametersS.No Assessment Criteria BT 7th 14th Follow-up Day Day 15 30 1 Shiraha Shoola 2 Shankha Shoola 3 Manya,bhru,akshi,lalata Shoola 4 Shastra arani nibham vedana 5 Bhrama Objective ParametersS.No Assessment Criteria BT 7th 14th Follow-up Day Day 15 301 Severity of Pain2 Duration of Pain3 Frequency of Pain IHS Criteria1 Unilateral location2 Pulsating quality3 Moderate intensity4 Severe intensity5 Aggravated by walking stairs6 Phonophobia7 Photophobia8 Nausea9 Vomiting VIII
  • GRADING FOR SUBJECTIVE PARAMETERS.No Symptoms Grading1 Shiraha Shoola Intolerable pain 4 Disturbs the normal work 3 Not disturb the normal work 2 Pain Tolerable 1 No pain 02 Shankha Shoola Intolerable pain 4 Disturbs the normal work 3 Not disturb the normal work 2 Pain Tolerable 1 No pain 03 Manya,bhru,akshi,lalata Shoola Intolerable pain 4 Disturbs the normal work 3 Not disturb the normal work 2 Pain Tolerable 1 No pain 04 Shastra arani nibham vedana Intolerable pain 4 Disturbs the normal work 3 Not disturb the normal work 2 Pain Tolerable 1 No pain 05 Bhrama Intolerable pain 4 Disturbs the normal work 3 Not disturb the normal work 2 Pain Tolerable 1 No pain 0 IX
  • GRADING FOR OBJECTIVE PARAMETERS.No Symptoms Grading1 Severity of pain Intolerable pain 4 Disturbs the normal work 3 Not disturb the normal work 2 Pain Tolerable 1 No pain 02 Duration of pain Over 24 hours or continuous 4 12 to 24 hours 3 3 to 12 hours 2 0 to 3 hours 1 No pain 03 Frequency of attack Continuous 4 Once in a week 3 Once in a 15 days 2 Once in a month 1 No attack 04 IHS Criteria More than 7 4 Presenting 5-6 criteria 3 Presenting 4-5 criteria 2 Symptom less than 3 1 Absence of symptoms 0Signature of Guide: Signature of Scholar: (Dr.R.V. Shettar) (Dr. Neeraj Kumar) X