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Vatarakta Chikitsa.pptx

A comparitive study on vatarakta chikitsam wsr to Bruhattrayee

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WELCOME
To Seminar Presentation
1
TOPIC
Comparative study on Chikitsa of Vatarakta w.s.r to Brihatrayi
2
Presenter
Dr. Roopa M.R
Final Year PG Scholar
Department of Ayurveda Samhita and Siddhanta
Government Ayurveda Medical College and Hospital , Mysore
3
Underthe Guidanceof
Dr. Vasudev A Chate Dr Shreevathsa
Associate Professor Professor and HOD
Department of Ayurveda Samhita and Siddhanta
Government Ayurveda Medical College and Hospital. Mysore
4
CONTENTS
1.Review part
Introduction
References of Vatarakta
Definition of Chikitsa
Chikitsa acc to Charaka Samhita
Chikitsa acc to Sushruta Samhita
5
Chikitsa acc to Ashtanga Hrudaya
Pathya-Apathya of Vatarakta Vyadhi
2. Discussion part
Discussion on treatment principles of Charaka Samhita
Discussion on treatment principles of Sushruta Samhita
Discussion on treatment principles of Ashtanga Hrudaya
6

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Vatarakta Chikitsa.pptx

  • 2. TOPIC Comparative study on Chikitsa of Vatarakta w.s.r to Brihatrayi 2
  • 3. Presenter Dr. Roopa M.R Final Year PG Scholar Department of Ayurveda Samhita and Siddhanta Government Ayurveda Medical College and Hospital , Mysore 3
  • 4. Underthe Guidanceof Dr. Vasudev A Chate Dr Shreevathsa Associate Professor Professor and HOD Department of Ayurveda Samhita and Siddhanta Government Ayurveda Medical College and Hospital. Mysore 4
  • 5. CONTENTS 1.Review part Introduction References of Vatarakta Definition of Chikitsa Chikitsa acc to Charaka Samhita Chikitsa acc to Sushruta Samhita 5
  • 6. Chikitsa acc to Ashtanga Hrudaya Pathya-Apathya of Vatarakta Vyadhi 2. Discussion part Discussion on treatment principles of Charaka Samhita Discussion on treatment principles of Sushruta Samhita Discussion on treatment principles of Ashtanga Hrudaya 6
  • 7. Discussion on Vatarakta, Raktagatavata & Raktavruta Vata Summary of the Chikitsa. 3. Conclusion 4. Bibliography 7
  • 8. 1.REVIEW PART Introduction- Ayurveda speaks about comprehensive approach for both Swastha and Atura. As Trisutra is mandatory for both Swastha and Atura. Among Trisutra, Oushadha placed in 3 position and success of the treatment is based on presence and absence of Chikitsa Chatushpada. Oushadha is placed in second place in Chikitsa Chatushpada. 8
  • 9. Though Vaidya and Rogi is there but without Oushadha, Chikitsa is not possible. This shows that importance & significance of Oushadha/Chikitsa in both Swastha and Atura. 9
  • 10. Reference of Vatarakta in Brihatrayi Sl No Samhita Name of the Chapter Reference A Charaka Samhita Vatashonita Chikitsita Adhyaya Cha Chi 29 B Sushruta Samhita Vatavyadhi Nidana Adhyaya Su Ni 1 Maha Vatavyadhi Chikitsa Adhyaya Su Chi 5 C Ashtanga Hrudaya Vatashonita Nidana Adhyaya A .H Ni 16 Vatashonita Chikitsa Adhyaya A.H Chi 22 10
  • 11. Definition of Chikitsa- याभ िः भियाभ र्ाायन्ते शरीरे धातविः समािः| सा भिभित्सा भविाराणाां िमा तभिषर्ाां स्मृतम्||३४|| (Cha Su 16/34) Whatever the Kriyas which brings the normalcy of Dhatus (Dosha, Dhatu , Mala) are Known as Chikitsa. This in fact is the duty of the physician. 11
  • 12. CHIKITSA OF VATARAKTAACC TO CHARAKA SAMHITA Nidana Parivarjana- Nidana should be avoided, as it is the prime line of treatment for every Vyadhi. 12
  • 13. Base for Chikitsa of Vatarakta बुद्््वा स्थानभवशेषाांश्च द्ोषाणाां ि बलाबलम्| भिभिभत्सतभमद्ां ि ु यााद्ूहापोहभविल्पभवत्||१५५|| (Cha Chi 29/155) After considering specific Sthana and Bala of Vitiated Dosha, the physician who is well conversant in reasoning and variation should apply proper treatment. After considering the Avastha (Stage of disease) involved Dosha one should select proper line of treatment. 13
  • 14. Raktamokshana- Atyayika Chikitsa रक्तमार्गं भनहन्त्याशु शाखासभन्धषु मारुतिः| भनभवश्यान्योन्यमावाया वेद्नाभ हारेद्सून्||३५|| (Cha Chi 29/35) Vitiated Vata having reached the joints of extremities obstruct the way of the Rakta and vitiated Rakta obstruct the way of Vata, Thus causes the unbearable pain as similar to leading to death. 14
  • 15. तत्र मुञ्िेद्सृि ् शृङ ् र्गर्लौििःसूच्यलाबुभ िः| प्रच्छनैवाा भसराभ वाा यथाद्ोषां यथाबलम्||३६|| (Cha Chi 29/36) In this condition, Rakta Moskshana should be done with Shrunga, Jalauka, Suchi, Alabu, Prachhana or Siravyadha depending on Dosha and Bala of the Rogi 15
  • 16. रुग्द्ाहशूलतोद्ातााद्सृि ् स्राव्यां र्लौिसा| शृङ ् र्गैस्तुम्बैहारेत् सुभििण्डूभिभमभिमायनात्||३७|| (Cha Chi 29/37) Rakta Mokshana should be done with Jalauka in case of suffering from Ruk, Daha , Shoola and Thoda. If the Rogi is suffering from Supti, Kandu and Chimichimayana Rakta Mokshana should be done with Shrunga or Alabu. 16
  • 17. द्ेशाद्देशां व्रर्त् स्राव्यां भसराभ िः प्रच्छनेन वा| (Cha Chi 29 ) If the Lakshanas like Daha, Thoda etc are not localized to specific part rather of fleeting nature, Rakta Mokshana should done with Siravyadha or by Prachhanna. Contraindication of Rakta Mokshana अङ ् र्गग्लानौ न तु स्राव्यां रूक्षे वातोत्तरे ि यत् ||३८|| (Cha Chi 29/ 38) In case of Angaglani, Rukshata and other symptoms of Vata Dosha (Vata Pradhana) Rakta Mokshana should not be done. 17
  • 18. Other Shodhana in Vatarakta भवरेच्यिः स्नेहभयत्वाऽऽद्ौ स्नेहयुक्त ै भवारेिनैिः| रूक्षैवाा मृद्ुभ िः शस्तमसि ृ द्वभस्तिमा ि||४१|| सेकाभ्यङ ् गप्रदेहान्नस्नेहााः प्रायोऽविदावहनाः| िातरक्त े प्रशस्यन्त ...|४२| (Cha Chi 29/ 41-42) After proper Snehana, Vatarakta Rogi should be treated with Mrudu Sneha Virechana or with Mrudu Rooksha Virechana. After Mrudu Virechana, give frequent Basti including Anuvasana and Niruha Basti. besides Seka, Abhyanga , Pradeha, Anna and Sneha be given which should not cause Vidaha. 18
  • 19. Importance of Virechana योर्गैश्च िल्पभवभहतैरसि ृ त्तां भवरेियेत्| मृद्ुभ िः स्नेहसांयुक्त ै र्ज्ाात्वा वातां मलावृतम्||८७|(Cha Chi 29/87) In case of Vata Avruta with Mala, Mrudu Virechana is indicated. The drugs mentioned in Kalpa Sthana along with Sneha is beneficial. 19
  • 20. क्षीरेणैरण्डतैलां ि प्रयोर्गेण भपबेन्नरिः| बहुद्ोषो भवरेिाथे र्ीणे क्षीरौद्नाशनिः||83|| (Cha Chi 29/83) If Bahu Dosha is there in Vatarakta, in that condition Virechana should be given with Ksheera mixed with Eranda Taila . After digestion Kshira Oudhana (Rice mixed with milk) is given as food. 20
  • 21. Importance of Basti भनहारेद्वा मलां तस्य सघृतैिः क्षीरबभस्तभ िः| न भह बभस्तसमां भिभञ्िद्वातरक्तभिभिभत्सतम्||८८|| (Cha Chi 29/88) Mala in Vatarakta should be eliminated by administrating Kshirabasti,.There is no treatment efficient as Basti. 21
  • 22. Vishesha Chikitsa based on Sthana भवशेषां तु भनबोध मे||४२|| बाह्यमालेपनाभ्यङ ् र्गपररषेिोपनाहनैिः| भवरेिास्थापनस्नेहपानैर्गाम् ीरमािरेत्||४३|| (Cha Chi 29/43) Uttana Vatarakta treated with Alepa, Abhyanga , Parisheka and Upanaha Gambhira Vatarakta treated with Virechana, Asthapana Basti and Snehapana 22
  • 23. Gambira Vatarakta Chikitsa र्गम् ीरे रक्तमािान्तां स्याच्िेत्तद्वातवज्र्येत्| पश्चाद्वाते भियाां ि ु यााद्वातरक्तप्रसाद्नीम्||१६०|| (Cha Chi 29/160) In Gambhira Vatarakta if Rakta is vitiated strongly (severely) thus treated first at the beginning like Vataroga and there after steps should be taken to pacify the Vata in Vatarakta 23
  • 24. Vishesha Avastha (Vataprakopa due to Avarana) क ु विते मागगसंरोधान्मेदसो िा कफस्य िा| अवतिृद््याऽवनले नाद्ौ शस्तां स्नेहनबृांहणम्||१५६|| (Cha Chi 29/156) व्यायामशोधनाररष्टमूत्रिानैविगरेचनैाः| तक्राभयाप्रयोगैश्च क्षपयेत् िफमेद्सी||१५७|| (Cha Chi 29/157) If the Vata is vitiated due to obstruction either by excessive aggravated Meda or Kapha, one should not apply Sneha or Brumhana drugs in the beginning. Instead, Kapha and Meda are to be subside with Vyayama, Shodhana, Mutrapaana, Virechana, intake of Arishta and Takra with Abhaya 24
  • 25. Chikitsa of Pakwavastha of Vatarakta रक्तभपत्ताभतवृद्््या तु पािमाशु भनयच्छभत| भ न्नां स्रवभत वा रक्त ां भवद्ग्धां पूयमेव वा||१६१|| (Cha Chi 29/161) तयोिः भिया भवधातव्या ेद्शोधनरोपणैिः [१] | ि ु यााद्ुपद्रवाणाां ि भियाां स्वाां स्वाभच्िभिभत्सतात्||१६२|| (Cha Chi 29/162) The disease manifested due to excessive aggravation of Rakta and Pitta get inflamed and exhibits the features of Bhinna Srava (discharging blood) or Vidagdha Puya (Pus with property of burning sensation) should be treated with Bhedana, Shodhana and Ropana. Complications should be managed according to their respective treatment. 25
  • 26. CHIKITSA OF VATARAKTA ACC TO SUSHRUTA SAMHITA General consideration for treatment तत्रप्राणमाांसक्षयभपपासाज्वरमूच्छााश्वासिासस्तम् ारोििाभवपािभवसरणसङ ् िोिनैरनुपद्रुतां बलवन्तमात्मवन्तमुपिरणवन्तां िोपिमेत् ||६|| (Su Chi 5/ 6) In this disease, a patient can be taken up for treatment , If he is Balavanta, Atmavanta and Upakaranavanta, and devoid of complications like Pranakshaya, Mamsakshaya and also afflicted with Pipasa, Murcha, Jwara, Shwasa, Kasa Sthamba, Arochaka, Avipaka Visarana and Sankocahana (Flaccidity or Spasticity of limbs) 26
  • 27. Vataja Vatarakta Chikitsa तत्, आद्ावेव बहुवातरूक्षम्लानाङ ् र्गादृते मार्गाावरणाद्दुष्टशोभणतमसि ृ द्ल्पाल्पमवभसञ्िेद्वातिोप यात् | ततो वमनाभद्भ रुपिमैरुपपाद्य प्रभतसांसृष्ट क्त ां वातप्रबले पुराणघृतां पाययेत् | (Su Chi 5) In this disease, first of all vitiated Rakta resulting from obstruction to the channels, should be let out from the patients repeatedly in small quantity so as to forestall excessive aggravation of Vaata, except from those whose limb have becomes dry and withered due to excess Vata. 27
  • 28. There after , the patient should be subjected to the procedures of emesis, etc followed by the administration of restricted dietary regimen ( such as Samsarjana Krama), If the patient has predominance of Vata one should give Purana Gritha as Shamana Oushadhi. Parisheka with Shatapaaka Bala Taila Pradeha , Upanaha, Purana Grutha 28
  • 29. Pittaja Vatarakta Chikitsa शाभलषभष्टिनलवञ्र्ुलतालीसशृङ ् र्गाटिर्गलोड्यर्गौरीर्गैररिशैवलपद्मिपद्मपत्रप्र ृभतभ धाा न्याम्लभपष्टैिः प्रद्ेहो घृतभमश्रिः, ||८|| (Su Chi 5/8) After Shodhana, Pittahara Shamana Oushadhi (Sarpi), Pittaja-Jwarahara Oushadhi should be given. Parisheka with Pittahara Kashaya Abhyanga with Sarpi Shatadauta Grutha, Grutha Mishrita Pradeha 29
  • 30. Rakta- Prabala Vatarakta रक्तप्रबलेऽप्येवां, बहुशश्च शोभणतमवसेियेत्, शीततमाश्च प्रद्ेहािः िायाा इभत ||९|| (Su Chi 5/9) In Rakta- Prabala Vatarakta repeated Raktamokshana should be done Sheeta Tama Pradeha should be applied 30
  • 31. Kaphaja Vatarakta Chikitsa After Shodhna, Kaphahara Kashaya should be given as Shamana Oushadhi, Gudaharitaki should be given with Mutra or Jala Parisheka with Kaphahara Kashaya Sukoshna Panchapradeha with Ksharodaka 31
  • 32. Sannipataja Vatarakta Chikitsa सांसर्गे सभन्नपाते ि भियापथमुक्त ां भमश्रां ि ु याात् ||११| (Su Chi 5/11) In case of Samsargaja and Sannipataja Vaatarakta. Combined treatment for Doshas involved, as mentioned for earlier should be carried out. 32
  • 33. Samanya Chikitsa Yogas of Vatarakta Guda Haritaki In all types of Vatarakta, Gudaharitaki should be administered Vardhamana Pippali Yoga Pippali in increasing order of Five or 10 every day, pasted in milk or water, should be given to drink , while the patient is living on milk and rice diet for 10 days and then similarly decreased until five or ten. 33
  • 34. Conclusion of Vatarakta Chikitsa एवमाद्यैिः भियायोर्गैरभिरोत्पभततां सुखम् | वातासृि ् सा्यते वैद्यैयााप्यते तु भिरोभत्थतम् ||१४|| (Su Chi 5/14 ) By the above mentioned treatment protocol physician cures Vatarakta of recent origin easily and alleviates the chronic one. 34
  • 35. CHIKITSA OF VATARAKTA ACC TO ASHTNAGA HRUDAYA िातशोविवतनो रक्त ं वस्नग्धस्य बहुशो हरेत्| अल्पाल्पां पालयन् वायुां यथाद्ोषां यथाबलम्||१|| (A H Chi 22/1) रुग्रागतोददाहेषु जलौकोवभविगवनहगरेत्| शृङ ् गतुम्बैवश्चवमवचमाकण्डूरुग्दूयनावन्ितम्||२|| (A H Chi 22/2) प्रच्छानेन वसरावभिाग देशाद्देशान्तरं व्रजत्| --------------------------------------------|३| (A H Chi 22/3) विरेच्याः स्नेहवयत्िा तु स्नेहयुक्त ै विगरेचनैाः| --------------------------------------------|५| (A H Chi 22/5) 35
  • 36. िातोत्तरे िातरक्त े िुरािं िाययेद्घृतम्| --------------------------------------------||५|| (A H Chi 22/5) क्षीरेिैरण्डतैलं च प्रयोगेि विबेन्नराः| बहुदोषो विरेकार्थे जीिे क्षीरौदनाशनाः||११|| (A H Chi 22/11) वनहगरेद्वा मलां तस्य सघृतैिः क्षीरबभस्तभ िः| न वह बवस्तसमं वकवचचद्वातरक्तवचवकवत्सतम्||१३|| विशेषात््युिार्श्वोरुििागवस्र्थजठरावतगषु| --------------------------------------------|१४| (A H Chi 22/ 13-14) 36
  • 37. Bahya Chikitsa उत्तानं लेिनाभ्यङ ् गिररषेकािगाहनैाः| विरेकास्र्थािनस्नेहिानैगगम्भीरमाचरेत्||३८|| (A H Chi 22/ 38) AvasthikaChikitsa क ु विते मागगसंरोधान्मेदसो िा कफस्य िा| अवतिृद््याऽवनले शस्तं नादौ स्नेहनबृंहिम्||४७|| कृ त्िा तत्राढ् यिातोक्त ं िातशोविवतक ं तताः| भेषजं स्नेहनं क ु यागद्यच्च रक्तप्रसादनम्||४८|| (A H Chi 22/ 47-48) Acharya Vagbhata, explained treatment for Vatarakta, same as like Acharya Charaka without any change. 37
  • 38. PATYA-APATHYA OF VATARAKTA Pathya is also a part of the Chikitsa, all the three Acharyas are explained both Aharaja & Viharaja Pathya and Apathy for Vatarakta Vyadhi, but Sushruta explained more about Viharaja Pathya like Manohara Gruha, Mrudu Gandopadana, Sukha Shayana, Mrudu Samvahana. 38
  • 39. Table showing the PATHYA and APATHYA of Vatarakta acc to Brihatrayi Pathya Apathya Puranayava, Godhuma, Nivara, Shashtika Shali Vishkira, Pratuda Mamsa Katu, Amla, Lavana Adhaka, Chanaka, Mudga, Masura, Makushtaka Ushna Sunishannaka, Vetragra, Kakamachi,Shatavari, Vastuka, Upodika, Sourchala Guru, Abhishyandi Ahara, Dadhi Gavya, Mahisha and Ajakshira Sukta, Khsara Manohara Gruha, Mrudu Gandopadana, Sukha Shayana, Mrudu Samvahana Santapa, Divaswapna, Vyayama, Maithuna 39
  • 40. 2. DISCUSSION PART DISCUSSION ON TREATMENT PRINCIPLES OF VATARAKTA ACC TO CAHRAKA SAMHITA Q no-1: Why Nidana Parivarjana is needed? सङ ् क्षेपतिः भियायोर्गो भनद्ानपररवर्ानम् | (Su Ut 1/25 ) भनद्ानानाां द्ोषिारिहेतूनाां रोर्गिारिहेतूनाां ि सवातो वर्ानम्. Nidanaparivarjana is the brief and prime treatment for all Vyadhi. 40
  • 41. त्यार्गाभद्वषमहेतूनाां समानाां िोपसेवनात्| भवषमा नानुब्नभन्त र्ायन्ते धातविः समािः||३६|| (Cha Su 16/36 ) By avoiding the unwholesome causative factors and by adopting wholesome factors normalcy of Dhatus takes place naturally. Though Nidana Parivarjana is not mentioned directly, with help of Hetwarta Tantrayukti, one should consider this, this is the prime line of treatment in all Vyadhi 41
  • 42. Here Analysis of Nidana reveals that, both Aharaja and Viharas like Haya Yana, Ushtra Yana, Ambu Kreeda, Plavana are contributing much and Adhishtana of Vyadhi is primarily seen in Hasta Or Paada Mula so, one must avoid the Nidana here Nidana Parivarja plays very important role in stopping the further vitiation of Dhatu. 42
  • 43. Q no-2: Is it possible to get Vatarakta Vyadhi other than Swatantra Hetu Janya Vataprakopa? Yes, It is possible. Because Kaphavruta and Medavruta Vata , may also leads to Vatarakta (Paratantra Hetu Janya Vata Prakopa) 43
  • 44. Q no-3: Why should consider Sthana Bala-Abala etc of Vatarakta Rogi ? The physician who is well-versed about knowledge of prognosis proceeds to treat a patient will certainly get success in his endeavor. परीक्ष्यिाररणो भह ि ु शला वभन्त (Cha su 10/5) On the other hand who treats incurable disease without having the knowledge of the prognosis will certainly loose prosperity, wisdom and reputation 44
  • 45. सा्यासा्यभव ार्गर्ज्ो र्ज्ानपूवं भिभित्सििः| िाले िार ते िमा यत्तत् साधयभत ध्रुवम्||७|| अथाभवद्यायशोहाभनमुपिोशमसङ ् रहम् | प्राप्नुयाभन्नयतां वैद्यो योऽसा्यां समुपािरेत्||८|| (Cha Su 10/7-8) 45
  • 46. भ षर्ा प्राि ् परीक्ष्यैवां भविाराणाां स्वलक्षणम्| पश्चात्िमासमारम् िः िायािः सा्येषु धीमता||२१|| सा्यासा्यभव ार्गर्ज्ो यिः सम्यक्प्प्रभतपभत्तमान्| (Cha Su 10/21) An intelligent physician should examine the distinctive features of the disease i.e. whether it can be curable or not curable? and then proceed to treat the curable diseases only, one who is well versed about the diseases and their treatment modalities will never commit a mistake. 46
  • 47. This principle is specifically highlighted in the Vatarakta Chikitsa, because here Vata Prakopa will takes by two ways one is by Vatavruddikara Nidana (Swatantra Hetu) and in other condition Vataprakopa will takes place because of Avarana (Kapha and Medha) in both the condition treatment modalities will be different. 47
  • 48. Q no-4: Why Raktamokshna is given importance?  Vatarakta is Shonitaja Vyadhi and also Rakta Pradoshaja Vyadhi  Margavarodha by Rakta leads to further Vata Prakopa (to remove Avarana)  Alpa Alpa Rakta Harana - to avoid Vata Prakopa  Different types like Shringa, Jalauka Suchi, Alabu, Siravyadha are explained based on Dosha involvement and Bala of the Roga and Rogi 48
  • 49. त्वग्द्ोषा रन्थयिः शोफा रोर्गािः शोभणतर्ाश्च ये | रक्तमोक्षणशीलानाां न वभन्त िद्ािन ||३४|| (Su su 14/34) By undergoing Raktamokshana, skin diseases, Granthi , Shopha and other Shonitaja Rogas will never occur  Helps specially in Uttana Vatarakta. 49
  • 50. Q no-5: Why Mrudu Shodhana is indicated?  Because, in Vatasyopakrama, Mrudu Shodhana is indicated (It may be Virechana or Basti) मृद्ूभन ि सांशोधनाभन (Cha Vi 6/16)  This is the Vatapradhana Vyadhi, Teeskhna Shodhana will again leads Vataprakopa This Vyadhi mostly occur in Sukumara (Prayaha Sukumaranam) so these persons are not fit for Teekshna Shodhana 50
  • 51. Q no-6: Why Basti is considered as best treatment for Vatarakta ?  As Vatarakta is mentioned in Vataja Nanatmaja Vyadhi, without the involvement of Vata , Vatarakta Vyadhi will not manifest and Basti is said the best treatment for Vata Dosha बभस्तवाातहराणाां (Cha su 25 ).  Pakwashaya is considered as Vishesha Sthana of Vata, In Marmaasthi Sandhigata Vyadhi (Madhya Roga Marga) Basti is indicated, as Vatarakta is Madhyama Roga Marga Vyadhi. शाखार्गतािः िोष्ठर्गताश्च रोर्गा ममो्वासवाावयवाङ ् र्गर्ाश्च|( Cha Si 1/ 38)  Avarana of Vata by Mala is removed by Basti. 51
  • 52. Q no-7: Why Kshira- Basti is indicated?  Kshira is Vatapittashamaka, Raktaprasadaka, Kshiram Jeevaniyanam Shreshtam क्षीरां र्ीवनीयानाां, Q No-8: Why Virechana is mentioned in Vatarakta ?  As in Vatarakta, Rakta Dushti is there and in Shonitaja Vyadhi, Vircechana is also a one line of treatment to pacify the Rakta. 52
  • 53. ि ु यााच्छोभणतरोर्गेषु रक्तभपत्तहरीं भियाम्| भवरेिमुपवासां ि स्रावणां शोभणतस्य ि||१८|| (Cha su 24/18)  As in Vataja Vyadhi Samanya Chikitsa, Mrudu Shodhana is mentioned it also includes Mrudhu Virechana. So Virechana helps in Nirharana of Dushita Vata and Dushita Rakta.  Virechana will do the Avarana Hara action, where in Vata get Avruta by Mala. 53
  • 54. यद्यनेन सद्ोषत्वात् िमाणा न प्रशाम्यभत||८३|| मृद्ुभ िः स्नेहसांयुक्त ै रौषधैस्तां भवशोधयेत्| (Cha Chi 28/83)  Snehayukta Mrudhu Virechana is directly indicated in Vatavyadhi Chikitsa 54
  • 55. Q no-9: What is the importance of explaining the Chikitsa based on Sthana though all Vatarakta are produced because of Vata, Rakta & Tridosha ?  One should eliminate the Vitatied Doshas by their nearest Marga (Route) यद्ीरयेद्वभहद्ोषान् पञ्िधा शोधनां ि तत्| भनरूहो वमनां िायभशरोरेिोऽस्रभवस्रुभतिः||५|| (A H Su 14/5) 55
  • 56. Here in Uttana Vatarakta, vitiated Doshas will get Sthanasamsharya in between Twak Mamsa so here Bahir-Parimarjana Chikitsa will place major role to pacify the vitiated Dosha as compared to other Chikitsa. In Gambhira Vatarakta, vitiated Doshas will get Sthanasamsharya in Gambhira Dhatus like Meda, Asthi and Majja , here it needs Abhyantra Shodhana Chikitsa so Virechana, Basti etc are indicated. 56
  • 57. Q no-10: What exactly Nirharana of Mala in Vatarakta? Here one has to consider both Dushita Dosha and Dhushita Mala, Q no-11: What is Sneha Virechana and Rooksha Virechana? In Apla Snigdha condition, Virechana should be given with Sneha Drvaya (Eranda Taila+ Ksheera), In Ati Snigdha condition, Virechana should be given with Rooksha Dravya like Trivrut, Triphala etc 57
  • 58. Q no-12: What is Bahudosha ? Bahu Dosha means quantitative and qualitative increase of vitiated Dosha, with the help of Ateetavekshana & Prasanga Tantrayukti one has to consider Bahudosha Lakshanas also. अभवपािोऽरुभििः स्थौल्यां पाण्डुता र्गौरवां क्प्लमिः| भपडिािोठिण्डूनाां सम् वोऽरभतरेव ि||१३|| 58
  • 59. Shloka Cont….., आलस्यश्रमद्ौबाल्यां द्ौर्गान््यमवसाद्ििः| श्लेष्मभपत्तसमुत्क्प्लेशो भनद्रानाशोऽभतभनद्रता||१४|| तन्द्रा क्प्लैब्यमबुभित्वमशस्तस्वप्नद्शानम्| बलवणाप्रणाशश्च तृप्यतो बृांहणैरभप||१५|| बहुद्ोषस्य भलङ ् र्गाभन तस्मै सांशोधनां भहतम्| ऊ्वं िैवानुलोमां ि यथाद्ोषां यथाबलम्||१६|| (Cha Su 16) 59
  • 60. Q no-13: What is Kshapana Chikitsa in Kaphamedavruta Vata? Here Kshapana means Chedana of Kapha & Meda क्षपणां सवाथोच्छेद्ेन (Cha Chi 27/25) Q no-14:As Upanaha is one among the Niragni Sweda, why it is considered in Bahirparimarjana Chikitsa ?  Though Upanaha is one among the Niragni Sweda, it is specifically indicated in Kaphapradha Vatarakta. 60
  • 61. Q no-15: Why Eranda Taila Prayoga in Vatarakta ? In the indication of Eranda Taila, Gambhira and Kaphamedavruta Vatarakta is mentioned. (र्गुल्मोद्रब्र्नाशािःप्लीहोद्ावतायोभनशुिर्गद्े [१] | मेद्िःिफसांसृष्टे मारुतरक्त े ऽवर्गाढे ि||२७|| र्गृध्रभसपक्षवधाभद्षु भवरेिनाहेषु वातरोर्गेषु| वाते भवबिमार्गे मेद्िःिफभपत्तरक्त े न||२८|| 61
  • 62. Sholka Cont…, पयसा माांसरसैवाा भत्रफलारसयूषमूत्रमभद्राभ िः| द्ोषानुबन्धयोर्गात् प्रशस्तमेरण्डर्ां तैलम्||२९|| तद्वातनुत्स्व ावात् सांयोर्गवशाभद्वरेिनाच्ि र्येत्| मेद्ोसृभक्प्पत्तिफोभन्मश्राभनलरोर्गभर्त्तस्मात्||३०|| बलिोष्ठव्याभधवशाद्ापञ्िपला वेन्मात्रा| मृद्ुिोष्ठाल्पबलानाां सह ोज्यां तत्प्रयोज्यां स्यत्)||३१|| इत्युद्ावताभिभित्सा| 62
  • 63. DISCUSSION ON TREATMENT PRINICIPLES OF VATARAKTA ACC TO SUSHRUTA SAMHITA Here Acharya Sushruta mentioned the general guidelines for consideration of Vatarakta Rogi for treatment is explained. आयुष्मान् सत्त्ववान् सा्यो द्रव्यवानात्मवानभप ||२१|| आभस्तिो वैद्यवाक्प्यस्थो व्याभधतिः पाद् उच्यते |२२| (Su Su 34/22) 63
  • 64. The Lakshana of Rogi in Chikitsa Chatushpada, mentioned by Acharya Sushruta is like this, Rogi should be आयुष्मान् द्ीघाायुिः| सत्त्ववान् क्प्लेशसभहष्णुिः| सा्यिः सा्यव्याभधयुक्त | वैद्यवाक्प्यस्थो वैद्यविनिर This type of Roga and Rogi are eligible for treatment and with help of Viparyaya Tantrayukti, the Rogi which has afflicted with Upadrava like Pipasa, Jwara etc and Bala Kshaya Mamsa Kshaya etc should not be treated. Here also basic principle is highlighted by Acharya Sushruta. 64
  • 65.  Acharya Sushruta is not explained in detail about Shodhana, but also given importance to Shodhana.  Given importance to Rakta Mokshana because Acharya considered Margashodhana/ Marga Avaranahara is the prime treatment.  Here Acharya accepted that after Shodhana (based on Dosha) one should go for Shamana Oushadi specially Purana Grutha and specific Doshahara Siddha Grutha. 65
  • 66.  As Acharya Sushruta not Accepted Uttana and Gambhira as separate types, so based on Dosha involvement and Sthana Samshraya of Dosha, both Bahirparimarja ( like Parisheka, Pradeha, Abhyanga and Upanaha )and Abhyantara Chikitsa is explained.  In Rakta Prabala Vatarakta, repeated Rakta Mokshana and Sheeta Tama Pradeha is mentioned because here the patient is having severe Daha Raga Shoola and Paaka. 66
  • 67. Q no-16: What is the Karmukata of Guda Haritaki ? सपुराणोऽभधिर्गुणो र्गुडिः पथ्यतमिः स्मृतिः ||१६१|| (Su Su 45/161) Purana गुडः should be used, as (like Madhu Grutha Vidanga, Guda also be used in old form) Purana गुडः is Patyatama. हरीतिी क्ष्यमाणा नार्गरेण र्गुडेन वा | सैन्धवोपभहता वाऽभप सातत्येनाभग्नद्ीपनी ||६८|| वातानुलोमनी वृष्या िेभन्द्रयाणाां प्रसाद्नी | सन्तपाणि ृ तान् रोर्गान् प्रायो हभन्त हरीतिी ||६९|| (Su Su 44/68-69) 67
  • 68. When Haritaki is consumed with Nagara or Haritaki with Guda or Haritaki with Saindhava for long long time it will do the Agnideepana, Vatanulomana, Indriya Prasadana, cures the Santarpana Janya Rogas 68
  • 69. Vatarakta is Santarpana (Nidana Sevana Janya) Vyadhi ( Prayaha Sukumaranam, Sthulya Mishtanna Bhoji), here Agni Mandya, Vata and Rakta Dushti will be there, So Gudaharitaki will do all the actions like Agnideepana, Vatanulomana, Rakta Prasadana which will do the Indriya Prasadana. As Indriya Prasadana is the one of the Vishuddha Rakta Lakshana प्रसन्नवणेभन्द्रयभमभन्द्रयाथााभनच्छन्तमव्याहतपक्त ृ वेर्गम्| सुखाभन्वतां तु(पु)भष्टबलोपपन्नां भवशुिरक्त ां पुरुषां वद्भन्त||२४|| (Cha Su 24/24) 69
  • 70. DISCUSSION ON TREATMENT PRINICIPLES OF VATARAKTA ACC TO ASHTANGA HRUDAYA. Acharya Vagbhata followed same treatment principles of Acharya Charaka without any change. 70
  • 71. DISCUSSION ON PATHYA –APTHYA Q no-17: Why Pathya is important ? कावठन्यादूनभािाद्वा दोषोऽन्ताः क ु वितो महान्||३२९|| िथ्यैमृगद्वल्ितां नीतो मृदुदोषकरो भिेत्| (Cha Chi 30/329) िाभठन्याभद्भत द्ोषियरूपसांहतत्वात्| ऊन ावात् अियप्रिोपात्;, मृद्ुद्ोषिर इभत अल्पभविारिरिः 71
  • 72. What are the similarities and dissimilarities between Acharya Charaka’s view and Acharya Sushruta’s view in Vatarakta Chikitsa?  Both Acharya’s advised Raktamoskhana as prime and first line of treatment because to remove the Avarana caused by Rakta to the Vata.  Though Acharya Sushruta is not accepted Uttana and Gambhira Vatarakta as separate types, but considered Gambhira Vatarakta has succeeding stage of Uttana Avastha, so Acharya Sushruta also explained Bahirparimarjana Chikitsa like Alepa, Abyanga Seka, Upanaha etc…. as like Acharya Charaka 72
  • 73.  Acharya Sushruta not explained in detail about Shodhana like Basti and Virechana in Vatarakta like Acharya Charaka  Acharya Sushruta has given much importance for Bahirarimarjana, Raktamokshana and Shamana Oushadis like Purana Sarpi Paana in Vata Pradhana Vatarakta and other Sarpi Paana based on Dosha involvement.  Vardhamana Pippali Yoga and Guda Haritaki are the special formulations explained by Acharya Sushruta 73
  • 74. Param eter Vatarakta Raktagatavata Raktavruta Vata Dosha Both Vata and Rakta are vitiated by their Swakarana (Swatantra Hetu) Only Vata get vitiated by its Hetu but Rakta is not vitiated initially Here vitiated Rakta will cause the Avarana to Parkruta Vata Laksh ana कण्डूदाहरुगायामतोदस्फ ु रिक ु चचनैाः| अवन्िता श्यािरक्ता त्िग्बाह्ये ताम्रा तर्थेष्यते||२०|| गम्भीरे र्श्वयर्थुाः स्तब्धाः कवठनोऽन्तभृगशावतगमान्| श्यािस्ताम्रोऽर्थिा दाहतोदस्फ ु रििाकिान्||२१|| रुवग्िदाहावन्ितोऽभीक्ष्िं िायुाः सन््यवस्र्थमज्जसु| वछन्दवन्नि चरत्यन्तिगक्रीक ु िंश्च िेगिान्||२२|| करोवत खचजं िङ ् गुं िा शरीरे सिगतश्चरन्| सिैवलगङ ् गैश्च विज्ञेयं िातासृगुभया्रययम्||२३|| रुजस्तीव्रााः ससन्तािा िैिण्यं कृ शताऽरुवचाः| गात्रे चार ं वष भुक्तस्य स्तम्भश्चासृग्गतेऽवनले||३१|| रक्तािृते सदाहावतगस्त्िङ्ांसान्तरजो भृशम्||६३|| भिेत् सरागाः र्श्वयर्थुजागयन्ते मण्डलावन च| Chikit sa As mentioned above शीतााः प्रदेहा रक्तस्र्थे विरेको रक्तमोक्षिम्||९२|| Vatashonita Chikitsa 74
  • 75. Raktamokshana Antah parimarjana Bahi-Parimarjana Shringa Mrudu Vamana Parisheka Jalauka Mrudu Virechana Pradeha Suchi Basti Abhyanga Alabu Upanaha Siravyadha To sum up- Chikitsa of Vatarakta in brief 75
  • 76. Vishesha Chikitsa Uttana Vatarakta Gambhira Vatarakta Alepa Virechana Abyanga Asthapana Parisheka Snehapana Upanaha 76
  • 77. Avastha Chikitsa Kapha-Meda Avarana janya Vatarakta Chikitsa of Urusthamba first (Kshapana) Raktavrita Vata Vata Rakta Chikitsa Avasthika Chikitsa 77
  • 78. 3.CONCLUSION-  For manifestation of Vatarakta Vyadhi, vitiation of both Rakta and Vata is mandatory, so Vatarakta is mentioned in Vataja Nanatmaja Vyadhi and in Shonitadushti Janya Vyadhi (Charaka Samhita) & in Sushruta it is considered under Raktapradoshaja Vyadhi. 78
  • 79.  In Vatarakta, Nidana Parivarjana must be consider along with other Chikitsa  Samprapthi Vishesha -Paraspara Avarana of Vata & Rakta getting Sthana Samshraya in Parvasthi Sandhis it leads Atyarta Dussaha Vedanas in all Sandhis so to do Avaranahara Raktamokshana is mentioned by all Acharya as the prime treatment 79
  • 80. • In Uttana Vatarakta – most of the time, as compared to Vata, Rakta vitiation will be more so different types of Raktamoksha based on Dosha involvement as mentioned and Bahiparimarjana Chikitsa (Bahya Shamana ) is focused more • In Gamabhira Vatarakta- most of the time Vata involvement will be more as compared to Rakta, So Antah Parimarjana (Shodhana and Shamana) is specified more by all the Acharyas. 80
  • 81. • Though separate Nidana is mentioned for the vitiation of Vata and Rakta (Swatantra Hetu), Sometime in Vatarakta, vitiation of Vata will takes place by Avarana (by Kapha & Medha) in that condition, one should not go for general line of treatment, one should do the Avaranahara Chikitsa.  In Sushruta Samhita this Vyadhi is explained under Vatavyadhi Adhyaya, but while explaining Chikitsa it is explained under Mahavatavyadhi Adhyaya because of Chikitsa Vishesha. 81
  • 82.  Consideration of Pathya must be mandatory in the Chikitsa of Vatarakta.  By seeing all this, one can say that though all the three Acharya explained the Chikitsa for Vatarakta, Acharya Charaka has given in detail explanation about Chikitsa of Vatarakta 82
  • 83. 4.BIBILIOGRAPHY  Charaka Samhita with Chakrapani Commentary, Edited by Acharyayadavjitrikamaji, Chaukhamba Orientalia, Varanasi; Reprint 2011  Sushruta Samhita with Dalhana Commentary, Acharyayadavjitrikamji, Chaukhamba Sanskrit Samstan, Varanasi; Reprint 2013  Ashtanga Hrudaya with Arunadatta and Hemadri commentary , Pt, Hari sadashiva Shastri paradakara (Editor) Chaukhambha Sanskrit Sansthan, Varanasi; Reprint 2009.  Charaka Samhita with English Translation by Dr Shashireka.  Sushruta Smahita with English translation by Prof G.D Singhal and Collegues. 83