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C E R T I F I C A T E
This is to certify that Shettar R.V.Shettar R.V.Shettar R.V.Shettar R.V.Shettar R.V. Scholar of
M.D.(Ay.)M.D.(Ay.)M.D.(Ay.)M.D.(Ay.)M.D.(Ay.) Kayachikitsa has worked for his thesis on the
topic entitled "Role of Nasya Karma in Ardita with special
reference to Ksheerabala Taila (Shatavartita).
This work is done under my supervision and guidance.
This thesis makes a distinct advance on scientific lines
in the above subject and the findings are immensely valuable
and have considerably contributed to the present knowledge
of the subject
I am fully satisfied with his original work and
hereby forward the thesis for the evaluation of adjudicators.
Guide :
DR. V.V.SUBRAHMANYA SASTRYG.C.I.M.(Madras), D.Ay.M(B.H.U.)Head of Department of K.C.P.G.studies and research centreD.G.M. Ay. Medical CollegeGadag - 582 101.
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ACKNOWLEDGEMENT
I express my deep sense of gratitude to my respected guide
Dr.V.V.Subrahmanya Sastry. Head of Department of K.C.Post graduation
& Research Centre. D.G.M. Ayurvedic medical college Gadag. It was
very pleasant to work under his guidance. He gave moral Support,
encouragement throughout my work. Without his in time guidance it
was not possible.
I am also greatful to the Asst. Professor Dr.K.S.R. Prasad and
lecturer Dr. A.K.Padnda for their advices throughout the work and
also help in clinical work.
I am thankful to my U.G. lecturer Dr. C.M. Sarangamath for his
kind co-operation. He helped me in clinical work and provided many
patients for the present trial and encouraged throughout the work.
I express my thanks to Dr. S. S.Hiremath and Dr. C. S. Hiremath
for their help in the project work. My sincere thanks to Dr.U. V. Purad
incharge pathology department, and to Dr. S. A. Patil who helped
me and advised to join the course.
I express sincere thanks to my uncle Dr. A. M. Anegundi for
his advices and encouragement. He provided many refferences of modern
science and helped me a lot throughout the course.
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It was very pleasant to express my deep sense of gratitude to
my principal Dr. G. B. Patil who permitted me to do the present work.
He provided all facilities intime and supported in every step throughout
the course.
I am thankful to our librarian Mr. Mundinamani and to all college
teaching and non teaching staff for their support.
I am also thankful to Mr.Krishna Fattepur and Mr. Habib for their
neat job work in the preparation of this thesis.
Finally I express my sincere thanks to all my colleagues, friends,
and family members and those who helped directly and indirectly.
SHETTAR. R. V.
INTRODUCTION
Those alone are wise who act after investigation.
Eventhough the detailed subject of Ayurveda is written as explained
by the sages, the necessity of investigation with regard to the etiopathology
diagnosis and treatment are essential for the progress of Ayurveda.
The primary aim of the Auyrvedic science are two : 1. To
maintain the health of a swastha and 2. To cure the disease of an
unhealthy person. A swastha is a person whose doshas are in a state
of equilibrium, his digestive capacity is normal, with the normal functions
of dhatus and malas accompanied by the lucid states of Atma, indriyas
and manas. Indriyas are of two types : 1. Jnanendriyas - Sense organs
and 2. Karmendriyas - the conative organs. The verbal expression is
the function of one of the Karmendriyas, and it is the God's gift to
human beings.
Arditavata is a disease in which some of the jnanendriyas
and karmendriyas, located in the siras are affected, particularly in their
function. Therefore the most important characteristics of a human being
viz: facial expression and verbal expression are lost, in a way the patient
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loses the essential human characteristic. The incidence of this disease
is sufficiently high to warrant an effective treatment.
The most important and effective treatment recommended in
Ayurveda for the Arditavata is Nasya Karma. The application of this
kind of treatment is also easily without any distress to the patient.
Therefore this method of treatment is selected in this trial. The medecine
selected is also easy available and it is one of the effective vatahara
medecines. The use of Ksheerabala taila (101) has been recommended
in the treatment of vatarogas by almost all Ayurvedic scholars. The
herbal ingredients that are used in the praparation of Ksheerabala taila
are nontoxic, easily available and non-controversial. Therefore the administration
of Ksheerabala Taila (101) has been used in the treatment of Arditavata.
A total of 30 cases have been selected in this study and
these cases have been grouped into three types with different methods
of treatment. It has been found that the Nasya Karma with the Ksheerabala
taila(101) to be more effective. But this trial can be visualised as only
a pilot study and a further extensive work is necessary to establish
the definate curative effect of Ksheerabala taila(101) nasya karma on
the patients of Arditavata.
*****
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NIRUKTI PARYAYA
The word Ardita generally indicates a person afflicted or distressed.
But in Ayurveda it explains a specific disease afflicting the Urdhavanga particularly
the face.
Charaka has mentioned Ardita as a separate disease in the 80
vatarogas(Ch.Su.20/11). But in chikitsa sthana the description of Ardita has
been combined with pakshghata (Ch.Chi.28/38 to 42) and they are separated
while discussing the treatment (Ch.Chi 28-99, 100)
Sushruta and later authors have clearly separated both these diseases
and discussed their Nidana and treatments.
DEFINITIONS :
All most all authors indicated that the face is the afflicted part in
Ardita Vataroga.
Charaka states that this disease is localised in half of the body(Ch.Chi
28/42). According to Sushruta, the vata vitiated by it's own causes, afflicts
the half of the mouth(and other regions of the head) (Su.Ni.2/69) Gayadasa
states that the vata located in mukha is vitiated. Vagbhata agrees with the
opinion of Sushruta, that half of the vaktra is afflicted by the vitiated vata
causing a curling in that region (AH.Ni.-25/34). Arunadatta is more clear. He
states that the upper portion of the body particularly the half of the Vaktra
is afflicted. Madhavakara has followed Sushruta (Ma.Ni22/46) while commenting
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on Sharangadhara Samhita Pradhana Khanda (Chapter-7-106) Adhamalla has
clearly stated that Ardita is a disease afflicting one half of the face.
SYNONYMS :
(1) Ekayama : According to some authorities this disease is also
known as Ekayama. This word is used by Vagbhata in Astanga Hridaya (Nidana
25/37) and Arumadatta Commentory on same.
(2) Ardita Vata : It is also known as Facial paralysis or Facial haemiplegia
indicating the paralysis of the muscles of one side of the face with the rest
of the body not being afflicted.
The word "paralysis" indicates an abnormal condition characterized
by the loss of muscle functions or the loss of sensation or both.
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SHAREERA
It is clear that this disease Ardita afflicts the face and other closely
associated organs. All authorities mentioned that the afflicted region is the half
of the face.
'Vaktram', 'Asyam', 'Vadanam', 'Tundam', 'Ananam', 'Lepanam',
and 'Mukham' , a re the synonyms o f t he face and a l so the mou th
(Amarakosha 2 chapter 349).
Bhavamishra states that shiras is the "Adyamangam" indicating that
it is the first organ and also an important one. Mastulunga(brain) is inside
it. The following are the upangas of shiras (Bha.Pra.Poorva 2-71 to 74)
1) Lalata (forehead)
2) Bhruyugma (two eye brows)
3) Netradvayam (two eyes)
4) Shankham (the temporal region)
5) karnam (ear)
6) Kapola (Cheeks)
7) Nasika (Nose)
8) ostha (lips)
9) Srikvinyam (two corners of the mouth)
10) Mukha (mouth)
11) Talu (Palate)
12) Hanu dvayam (two jaws)
9) Srikvinyam
10) Mukha (mouth)
11) Talu (Palate)
12) Hanu dvayam (two jaws)
13) Danta (teeth)
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14) Dantaveshtha (gums)
15) Rasana (Tongue)
16) Chibuka (Chin)
17) Gala (Throat)
Most of these sub-organs are afflicted in the Arditavata and therefore
some relevant information regarding some of these organs/sub organs is mentioned
here.
The above stated organs/sub-organs of the shiras have different functions.
Majority of them join to reflect the facial expression through the action of different
muscles. There are four sense organs viz., Netra, Karna, Nasika and Jihwa.
Of these the actual perception of Shabda, Roopa and Gandha belong to different
cranial nerves, whereas the Rasa pereception is closely associated with the
facial nerve. Which also controls themovements of the muscles of the face.
All most all the organs/sub-organs of the face have their own separate/
specific functions and also muscles to execute those functions.The following
table indicates the muscles:
Sl.
No. Upanga Muscles Cranial Nerve
1. Lalata Occipito frantlis (Epicranius) Facial Nerve
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2. Bhruyugma Corrugator supercili Facial Nerve
Procerus Facial Nerve
3. Netradvayam Orbicularis oculi Facial Nerve
Lavator palpebrae superioris Occulomotor
4. Shankham Temporalis Trigeminal
5. Karnam Stapedius Facial
Auricularis anterior Facial
Auricularis Posterior Facial
Auricularis Superior Facial
6. Kopola Buccinator Facial
7. Nasika Procerus Facial
Nasalis Facial
Dilator naris Facial
Depressor Septi Facial
Compressor naris Facial
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8. Ostha, Orbicularis oris Facial
Srikvinyam Depressor angularis Facial
Mukha Depressor labii inferioris Facial
Levator angularis Facial
Levator labii superioris Facial
Risorius Facial
Zygomaticus major Facial
Zygomaticus minor Facial
9. Talu Tensor veli palatini Trigeminal
10. Hanu Masseter Trigeminal
Pterygoid medialis Trigeminal
Pterygoid lateralis Trigeminal
Temporalis Trigeminal
Platysma Facial
11. Danta (No muscels) Only sensation Trigeminal
Dantavestha
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12. Jihwa Hypoglossus Hypoglossal
Stylohyoidus Facial
Platysma Facial
13. Chibuka Mentalis "
14. Gala Platysma "
It may be noticed from the above tabular statement that the affliction
of the facial nerve is capable of paralysing many muscles of the face.
VATA AND RELATED SROTASES
In view of the movements of the facial muscles for expression and
other important functions, it is necessary to understand the importance of vata.
It is clear that the definition of the word Vata explains its involvement
in the movement and sensation (Su.Su.21-5). The movement in the body is
expressed by the contraction and relaxations of the muscles are controlled by
vata.
According to Susruta, vata in its normal state and coursing through
its specific channels (siras) helps to proper discharge of its specific functions
viz. expansion and contraction speech etc. and also produces the clear-
ness and non-illusiveness of Buddhi (intellect) and the cognitive organs (Su.Sarira.7-
8). It is also stated that the functions are
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conducted without any obstruction. Charaka has also stated that for the maintenance
of its physiological functions, vata should have movement without any obstruction
(Ch.Chi 28-4) indicating that an obstruction to its movement will lead to pathological
state (Ch.Chi.28-59)
In order to conduct, the two main functions of "Gati" (motor) and
"Gandha" (sensory), the vata has to move through the srotases throughout
the body. These vata-vaha srotases can be divided into two varieties depending
upon the motor or sensory function.
i) Chestavaha srotases which conduct the motor function. The
specific direction for the requisite motor function is transmitted
from the Buddhi only, in close association of the "Manas"
(Ch.Sarira.1-23). Therefore these cheshtavaha srotases originate
in Buddhi (higher cortical centres) and with a relay in the mind,
terminate in the conative organ or other muscles.
ii) Samjnavaha srotases which conduct the sensory function. These
originate in the respective cognitive organs and after relaying
in the region of manas, terminate in the connected Indriya
buddhi.
The vatavaha srotases are of two types based on their structure:
i) Samvrita : Well covered or concealed. These are the myelinated
nerve fibres.
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ii) Asamvrita : not covered or open. These are the nonmyelinated
variety.
The relevant vata vaha srotas/nadi in the present context of Ardita
vata which afflicts the muscles of the face is the seventh cranial nerve i.e.
Facial nerve.
FACIAL NERVE
The 7th cranial nerve supplies the structures derived from the second
pharyangeal(brachial) arch of the embryo. It is predominantly an efferent nerve(1)
to the muscles of facial expression, also to the posterior belly of diagastric,
the stylohyoid and the stepedius muscles, and (2) to many of the glands of
the head. It also contains a few afferent fibres which originate in the cells
of its genicular ganglion and are predominantly concerned with taste sensations
from the anterior2/3 of the tongue and the palate.
The facial nerve arises by two roots from the lateral part of the
pantomeduallary sulcus immediately anterior to the vestibulocochlear (8th cranial)
nerve. The roots are the large, motor, facial nerve anterior to the small nervus
intermidus which transmits sensory and preganglionic parasympathetic nerve
fibres. They pass laterally with the 8th nerve into the internal acoustic meatus,
surrounded by a sheath of the meningis. Here the branches of the nervus intermedius
join the 7th and 8th nerves, though all its fibres probably enter the 7th nerve
distally. The facial nerve pierces the meninges at the lateral end of the internal
acoustic meatus and continues lateraly in the bony facial canal lying above
and between the cochlea and vestibule. At the hiatus for the greater genicular
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ganglion and gives off(1) the greater petrosal nerve (2) a branch to the tympanic
plexus and (3) a branch to the sympathetic plexus on the middle meningial
artery. The facial nerve now turns abruptly backwards in the bone of the upper
part of medial(labyrinthine) wall of the middle ear cavity, superior to the fenestra
vestibuli and then inferior to the prominence caused by the lateral semicircular
canal in the aditus to the mastoid antrum. Medial to the aditus the nerve turns
verticially downwords in the bony septum which separates the middle ear from
the mastoid antrum and aircells, and gives off first the nerve to stapedius,
than the chorda tympani, and the finally a communicating branch to the auricular
branch of the vagus. The last arises immediately before the nerve emerages
from the stylomastoid foramen.
The facial nerve emerges from the stylomastoid foramen under cover
of the mastoid process. The nerve passes anterolaterally between the styloid
process and the posterior belly of digastric, and gives off(1) one or two descending
branches which supply the posterior belly of the digastric nerve. The facial
nerve then enters the posterior medial to the external carotid artery and the
crossing superficial vein, breaks into number of branches which emergus separately
from the gland and passes to supply the muscles of the facial expression on
their deep surfaces.
BRANCHES
I. From the geniculum of the facial nerve.
1. The greater petrosal nerve
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2. A small branch passes through temporal bone to join the
tympanic plexus of the glossopharyngeal nerve.
3. A minute, inconstant branch to the sympathetic plexus on the
middle meningeal artery.
II. In the descending part of the canal
1. The small stapedial nerve passes fowards to supply the stapedus
muscle.
2. The chorda tympani
3. Auricular branch of the vagus.
III. In the neck
1. Decending digastric branch
2. Posterior auricular nerve
IV. In the parotid gland
1. Temporal branches
2. Zygomatic branches
3. Buccal branches
4. marginal mandibular branch
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5. Cervical branches
The most important functions of the organs/sub-organs of Shiras enlisted
above are :
1) Facial Expression : Due to emotions like happiness, fear, dislike
etc.
2) Closure and opening of the eyes.
3) The movement of the pinnae of the ears which are not very
evident in the human beings.
4) Respiratory Act : inhalatiion and expiration through the nose.
5) Deglutition of the food after proper mastication, prevention of
the food falling out of the mouth.
6) Various stages of laughter.
7) Verbal expression through the movements of tongue, lips, cheeks
etc.
To conduct all these functions different groups of muscles play
an articulated part.
The facial expression is dependent on the mood of the mind which
acts in two different ways.
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i) In association with the sense organs depending on the
information received from them.
ii) Without association of the sense organs. (Chakrapani on Ch.Sh.1-21)
The vata is stated to control the mind (Ch.Su.12-8) and also the
Arthas (objects) of the mind. Manas is the cause of different modes of functions
of Buddhi (Bhe. Chi 8-4). Therefore it is understood that the Manas is capable
of modifying the instruction of Buddhi for an action. There are two sub-divisions
of vata which can modify the function of Manas.
1) Prana vata (AH.Su.12-4)
2) Udana Vata (Ch.Chi.28-7)
A critical analysis of the functions of both Pranavata and Udanavata
indicates the following areas in CNS, related to them.
PRANAVATA :
Reticular formation from the brain stem to medulla oblangata with
connection to higher centres.
UDANAVATA :
Reticular formation from the lower part of the pons to the spinal
cord up to C3, C4, C5, T2 to T6. The motor nuclei of the cranial nerves 7,9,10,11
and 12 are included.
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MUKHA : This word has two meanings.
1) Face and
2) Mouth
The face has many upangas which are stated already. The vaktra
or mouth is the upper opening of the Annavaha srotas, which compromises
of two Asayas i.e. Amasaya and Pakvasaya. The mouth is therefore the entrance
to the koshtha. The food ingested is chewed well for mixing with the saliva
and also for softening and passes through the gala (throat) and annanadi (oesophagus)
into the amasaya for the process of digestion.
OSHTHA : (LIPS)
The lips are made up of muscles covered by skin. They prevent
the food from falling out of the mouth. They also take part in two important
functions.
1) Verbal expression and
2) Facial expression
They also protect the teeth and gums.
JIHVA : (TONGUE)
Tongue is a muscular structure and it is voluntary. It is placed on
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the floor of the mouth with a front portion free. Inside the mouth it is capable
of all types of movements. The "Rasanendriya" is located in the epithelium
covering it. The sensation of the taste is carried by the chorda tympani branch
of the facial nerve (anterior two third of the tongue) and the posterior one
third by the glossopharyngeal nerve. The muscles of tongue are supplied by
the hypoglossal nerve.
The tongue serves the following functions :
1) Mastication : it helps in the act of chewing
2) Deglutition
3) Taste
4) Speech
5) Secretion of mucous and of serous fluid with which it keeps
moist.
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NIDANA
The Nidana is characterised as the ground of production of a disease,
together with the way in which this action is necessarily brought about. (Vijayarakshita
on Ma.Ni.1-5). The term Nidana relates both to etiology as well as diagnosis
of disease. The etiology helps in ascertaining the causative factors of a disease
(Chakrapani on Ch.Ni.1-1) Nidana also helps in deciding the Sadhyasadhyatva
of the disease.
Charaka has included Ardita in the 80 vataja rogas i.e. vata nanatmaja
rogas and also in the diseases caused by the vitiated vata in the head (Ch.Si.9-
9). The following are the general causes of sirorogas (Cha.Su.17-8 to 11)
1) Sandharana - Suppression of natural urges
2) Diwaswapna - Sleep during the day time
3) Ratrijagarana - Vigil during night
4) Mada - Intoxication
5) Uchha bhashana - Speaking loudly
6) Exposure to frost and easterly wind
7) Atimaidhuna - excessive sex
8) Asatmya gandha - Inhalation of undesirable smell
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9) Rajodhumahima atatpa - exposure to the dust, smoke,
snowfall and sun.
10) Ati seeta-Ambusevana - excessive intake of cold water
11) Abhighata to siras - injury to head
12) Dushta ama - vitiation by ama
13) Rodana - lamentation
14) Bashpa nigraha - Supression of tears
15) Manastapa - anxiety and other mental stresses
16) Doshakala viparyaya - Adopting regimen countraryto those prescribed for the localityand season.
17) Excessive intake of guru, amla and harita diets.
Due to the above causes, the doshas get aggravated resulting in
the vitiation of raktadhatu in the head. This causes diseases of various symptoms
in the head.
The above stated causes are relevant to all diseases that afflict the
head, where Ardita is also included. In the causation of the diseases of head,
it should be noted that not only the doshas but raktadhatu also are the participant
in the disease process.
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Both Sushruta and Vagbhata have enumerated the causes of
Ardita (Su.Ni.1-68 AH.Ni.-15-32-33; Ma Ni.22-44.45).
1) Speaking louldy
2) Chruning hard food stuffs.
3) Excessive laughter, yawning and also sneezing
4) Carrying heavy loads on head
5) Sudden movement of head and neck
6) Sleeping in an uncomfortable posture.
7) Use of pillows in wrong posture.
Susruta adds that in the event of Raktakshaya to the following they
will be afflicted by Ardita :
1) Pregnant lady
2) Recently delivered lady
3) Children
4) Old people
5) Emaciated persons
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Vaghata has stated that Ardita is a disease caused by the vitiation
of Pranavata (AH.Ni.16-20). The cause of the vitiation of Pravanata are the
following :
1) Excessive indulgence in the Ruksha ahara and vihara
2) Excessive physical exercise
3) Fasting
4) Over eating
5) Trauma
6) Excesive indulgence of walking
7) Suppression of natural urges
8) Trying to stimulate the natural urges when they are not ready
for excretion.
In Yogaratnakara some more causes are added (Y.R.Ma.Khanda)
1) Sitting on an uneven place.
2) Excessive use of tongue cleaning
3) Injury to the cheeks
4) Wrong use of Siravyadhana (in the head)
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5) Injury to the marma (in the head)
6) Excessive rubbing of the eyes, ears and nose.
All the causes stated above may be catagorised into different groups.
I. AGE AND SEX :
Children, Old people, pregnant and delivered women.
II. DIET :
1) Excessive intake of Ruksha, guru, amla and harita diets.
2) Chewing hard food stuffs
3) Over eating
4) Amadosha
5) Fasting
6) Excessive intake of alcoholic drinks.
III. BEHAVIOR :
1) Speaking loudly
2) Excessive laughter, yawning and also sneezing
3) Excessive physical exercise
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4) Excessive indulgence in walking
5) Sitting or sleeping on uneven places.
6) Use of uncomfortable pillows
7) Sudden movement of head and neck
8) Carrying heavy loads on head
9) Suppression of natural urges or forceful stimulation
10) Excessive use of tongue scraping
11) Wrong use of Siravyadha and Nasya
12) Exposure to frost, dust, smoke etc.
IV. INJURY
1) Injury to head
2) Injury to cheeks
3) Injury to marma (in the head)
Ardita vata roga clearly indicates the paralysis of the facial muslces.
This may be due to :
1) Lesion of the fibres of the upper motor neurons concerned with
voluntary movement.
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2) Lesion of the fibres of upper motor neurons conerned with emotional
expression.
3) Lesion of the lower motor neurons.
The causes indicated for the development of the paralysis of the
facial muscles lead to the affliction of the facial nerve. But they are clearly
indicative of the causation of Bell's palsy only.
1) Exposure to cold
2) Neuritis
a) Allergic
b) Infective
3) Middle ear disease
4) Injury to the nerve.
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SAMPRAPTI
The vata vitiated by the earlier stated causative factors, settles in
the regions of head, nose, chin, forehead and the eyes and produces the disease
called Ardita vata (Ma.Ni.22-45:Su.Ni.1-69). The symptom of vaksanga indicates
that the vitiated vata affects the tongue also (Ch.Chi. 28-41; Su.Ni.1-70; AH.Ni.-
15-34: Ma.Ni.22-47) Vagbhata has indicated the affliction of the ear on the
affected side (AH.Ni.15-35).
Charaka states that the vitiated vata while settling in the above stated
regions in the head, causes the "Soshana" of the "Rakta" dhatu resulting in
Ardita vataroga (Ch.Chi-28-38). Here the soshana may be understood as a
reduced supply of rakta to that particular region affecting the jeevanakriya.
According to Vagbhata Ardita roga due to the vitiation of Pranavata
(AH.Ni.16-20) and one of the functions of the pranavata is "Dhamani dhrik"
i.e. sustaining and protecting the dhamanis (arteries) (AH.Su.12-4) The location
of pranavata is the head. Therefore the raktashoshana or reduction in the blood
supply may be due to vitiation of pranavata.
The dhamanis may also be affected by the disease dhamani prartichaya
(atherosclerosis) which is one of the important causes of Rakta Soshana to
the region in the head, which controls the voluntary movements of the facial
muscles.
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POORVAROOPA
Poorvaroopa or premonitory symptoms are the unmifested form
of symptoms. (Chakrapani on Ch.Ni.1-28) A poorvaroopa is that by which
a specific impending illness is known but not the specific entity. It is an
undeveloped symptom on account of the alpata of the illness (Ma.Ni.1-
5, 6) A poorvarupa is a charectristic that indicates the production of an
illness (Bha.Pra.Poorva Khanda 7-34). The poorvarupa indicates the state
of sthana samsraya of Kriyakalas (as explained by Susruta). In this stage
the excited or vitiated doshas become localised and it marks the begining
of specific disease pertaining to those structures. Dalhana explains this
stage sthanasamshraya as one in which the prakupita dosha having extended
and spread over to parts other than their own due to srotovaigunya or
pathological involvement of related srotas - by implication to dosha dushya
summurchana i.e. interaction between the doshas and dushyas or the process
of the pathogenesis.
The poorvarupa of Arditavata has been described by Sushruta
(Su.Ni.1-71,72).
1) Romaharsha (horripilation)
2) Vepanam (Trembling)
3) Avila Netrata (eye not being clear)
4) Vayuroordhwa (upward movement of vata)
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5) Twachi swapa (loss of sensation of skin)
6) Toda (pain)
7) Manya sthamba (stiffness of the neck)
8) Hanugraha (stiffness of the jaw)
All the symptoms of Ardita vata in a mild from also can be considered
as poorvarupa.
- - 28 - -
ROOPA
Roopa of a disease is the stage of Vyakta in the Kriyakalas and
manifests the full fledged disease. The following is the list of sign and symptoms
mentioned in different Ayurvedic classics (Su.Ni.1-69; AH.Ni.15-34; Ma.Ni.22-
46.47; Bha.Pra.Madhy 2-63,64; Y. R. Madhya vatavyadhi nidana 56-57).
1) Distortion of the affected side of the face(the mouth is drawn
over to the opposite side)
2) If the patient tried to laugh, the mouth is drawn to the normal
side.
3) There is also pulling of neck toward normal side.
4) Shaking of the head and also teeth.
5) Rigid and winkless of the eyes, closing of the affected eye is
difficult.
6) Vikriti of the nose
7) Difficulty in speech and hoarseness
8) Loss of hearing and smell sensation and pain in the ear also.
9) The spitting is effected to one side only.
10) Sneeze gets suppressed
- - 29 - -
11) Severe pain in neck, chin, teeth, on the affected side
12) Fear in sleep also
13) Loss of memory.
Since Charaka described a combined state of Ardita and
pakshaghata, only those symptoms expressed due to the Ardita are given below
(Ch.Chi 28-40,41)
1) The food instead of going straight, goes into one side of the mouth.
2) While speaking nose gets curved
3) The eye remains rigid and winkless
4) The sneeze gets suppressed.
5) Speech is faint, distorted, stuttery, indistinct and thick and hoarseness
of voice.
6) Teeth get shaking.
7) Pain in the gums.
8) There is distoration/asymmetry of the nose, eyebrows, forehead,
eye and jaw.
Bhavamishra has classified the Ardita roga into three types, according
to the predominence of the doshas
- - 30 - -
I) Vataja Type
1) Excessive salviation
2) pain
3) Shaking of the head.
4) Throbbing pain
5) Stiffness of the neck and jaws.
6) Difficulty in speech.
7) Oedema of the lips.
II) PITTAJA TYPE
1) Fever
2) Thirst
3) Loss of consciousness
4) Burning sensation.
III) KAPHAJA TYPE
1) Oedema of the cheek, neck etc.
2) Stiffness of the above regions or paralysis.
- - 31 - -
Going through all informations about Ardita explained by different
scholars conviace that Ardita overall resembles the facial paralysis in modera
texts. Paralysis is meant an incapacity to move or feel due to the damage
to the nervous system. Such incapacity occuring facial muscles can be
stated as facial paralysis which movements. As explained earlier the facial
muscles are controlled by 7th cranial nerve i.e. facial nerve.
Facial paralysis can occur by two kind of lesions viz. Supranuclear
and infranuclear type. The signs and symptoms vary according to the nature
of the fibre paths involved.
Facial weakness/paralysis may be due to :
1. A supranuclear lesion involving the corticospinal fibres concerned
in voluentary facial movements;
2. A supranuclear lesion involving the fibres concerned in emotional
movement of the face - mimic paralysis.
3. Nuclear and infranuclear lesions involving the lower motor neurones;
and
4. Primary degeneration or disorder of function of facial muscles.
1. Facial paralysis due to a supranuclear corticospinal lesion is distinguished
by the fact that movements of the lower face are affected more
severily than those of the upper.
2. A pathway controlling emotional movements as distinct from
- - 32 - -
voluntary movement of the opposite side of the face, The most
important originates in the frontal lobe. A lesion,
above the internal capsule may paralyse voluntary movement
of the lower face on the opposite side. Leaving emotional
movement, as in spontaneous smiling intact. Very rarely,
a frontal or thalamic lesion may aboilish contralateral emo-
tional movement leaving voluntary movement unimpaired
(Mimic Paralysis).
3. Lesions involving the lower motor neurones destroy the
final common path, affect equally all forms of facial movements.
The facial lower motor neurones may be involved by a lesion:
a) Pontine lesion (within the pons)
Lesions in this region, facial paralysis is usually associated
with conjugate occular deviation, often with paralysis of the ipsilateral jaw
muscles and some times with the contralateral hemiplegia. Involvment of
trigeminal nucleus may lead to sensory loss also. Bilateral facial paralysis
occasionally occurs as a congenital abnormality (Mobius' Syndrome).
b) Lesion within the posterior fossa, between the pons and the internal
acoustic meatus may cause deafness and loss of taste in the anterior
two third of the tongue as well as facial paralysis. The commonest of such
lesions are acoustic neuroma.
- - 33 - -
c) Within the temporal bone the facial nerve may be involved
in skull fracture or be involved in infections of the middle ear and mastoid.
Herpes zoster of the geniculate ganglion usually causes facial paralysis
through secondary involvement of the motor fibres of the nerve, so called
Ramsay - Hunt syndrome. Lesions within the middle ear is usualy associated
with loss of taste in the anterior two third of the tongue, due to interruption
of the fibres of the chorda tympani.
d) After emergence of the nerve from the skull the fibres of the
facial nerve may be involved in many inflammatory or malignant processes
causing unilateral or bilateral facial palsy. Facial palsy of bilateral or unilateral
with recurrent episodes of facial ocdema occur in patients with deeply
furrowed tongue i.e. Melkersson's syndrome.
4. Primary disfunction of the facial muscles is seen in mysthenia gravis,
muscular dystrophy and dystrophy mytonica.
Among the above terms of lower motor neuron lesions, Bell's
palsy is a commest form of facial paralysis.
Bell's Palsy :
Bell's palsy is defined as the facial paralysis of accute onset
presumed to be due to non-suppurative inflammation of the facial nerve
within its canal above the stylomastoid foramen.
- - 34 - -
The features of Bell's palsy are :
1. Usually unilateral, rarely bilateral.
2. pain within ear or mastoid region or arround the angle of jaw.
3. Onset is sudden - often patient awaken to find the face paralysed.
4. Paralysis of the muscles of facial expression. The upper and
lower facial muscles are equally affected and voluntary emotional
& associated movements are involved.
5. Eyebrow droops, wrinkles smoothed out, frowning and rising
of eyebrow is impossible.
6. The palpebral fissure becomes wider on affected side and
closure of the eye is impossible.
7. When the patient attempts to close the eye, the globe rolls
upwords and slightly inwards - Bell's phenomenon.
8. Eversion of the lower lid impairs absorption of tears, tends
to overflow.
9. Nasolabial fold is smoothed out.
10. Mouth becomes drawn to sound side and the patient cannot
retract the angle of the mouth or purse the lips as in whistling.
11. Paralysis of the buccinator causes cheek a puffed out appearence
in respiration.
12. Food accumulates between the cheek and the teeth.
13. The tongue deviates to the sound side when protruded.
14. Loss of taste in anterior 2/3 of the tongue may occur when
the inflammatory process extends to the chorda tympani.
- - 35 - -
15. The patient may complaing of hypercusis, an intensification
of loud noises in the affected ear, when the branches to the
stapedius is involved.
By the above modern explanation, we are convinced that the
facial paralysis varies in its fetures according to the site of lesion involve
in the pathogenisis. One can also observe the signs and symptoms of
Ardita explained in different Ayurvedic classics closely resemble the above
mentioned facial palsy.
- - 36 - -
SADHYASADHYATA
The following are the Asadhya lakshanas according to Sushruta and
Bhavamishra(Su.Ni.-1-73 : Bha. Pra. Vatavyadhi)
1) Extreme emaciation
2) Inability to close the afflicted eye
3) Difficulty in speech.
4) Duration more than three years.
5) Severe shaking or trembling of the head.
The inability to close the afflicted eye may be the loss of conjunctival
reflex.
Vijayarakshita's commentory states that excessive secretion from mouth
(salivation), nose and eye is considered as an Asadhya lakshana. by some
authorities. (Vijayarakshita on Ma.Ni.22-48)
- - 37 - -
CHIKITSA
There are slight differences in the treatment advocated by the Bruhatrayee
I. Charaka Samhita (Ch.Chi.28-99,100)
1) Tailabhyanaga to the head
2) Nasyakarma
3) Tarpana Kriya with medicated oil to the eyes and ears.
4) Nadi Sweda
5) Upanaha Sweda
Both these swedana kriyas are to be administered with the flesh
of aquatic animals.
II. Susruta Samhita (Su.Chi-5-22)
If the patient is sufficiently strong and capable of arranging all upakramas,
he should be treated as mentioned for vatavyadhi.
He should be specifically treated as follows :
1) Mastishkyam : Application of sneha or kalka with sneha etc.
on the vertex of the head.
2) Shirovasti
- - 38 - -
3) Nasyakarma
4) Dhoomapana
5) Upanaha Sweda
6) Snehana-according to the dosha
7) Nadisweda.
III. Vagbhata (AH.Chi.21-43) He followed Chakra.
1) Nasya Karma
2) Application of oil to head
3) Tarpana Kriya with medicated oil to eyes and ears.
In addition he recommended two more methods of treatments based
on the accompanying dosha.
1) kapha - If there is oedema, vamana Kriya has to be administered.
2) Pitta - if there is redness and burning sensation, sirvyadha
is recommended.
IV) Bhavamishra (Bha. Pra. Madhayam 2-vatayadhi)
1) Snehapana according to dosha
- - 39 - -
2) Nasya karma
3) Upanaha Sweda
4) Shirovasti
5) Diet with the articles which alleviate vata.
It may be noticed from the above that all authorities recommended
Nasyakarma in the treatment of Arditavata. It has been claimed by Vagbhata
that Ardita is one of the prana vayu dustita roga. It has been said in the principles
of treating vata vyadhis that prana should be always guarded at first (AH.Chi.22-
69). Nasya karma can act directly on murdha and murdha is the seat of prana
vayu therefore nasyakrma may be therepy of choice in this disorder scholars
have noted.
- - 40 - -
ANatomY OF THE NOSE
The external nose is a structure composed of bone and cartilage.
The bony part is formed mainly by the nasal bone on each side, and
the frontal process of the maxillary bone. The cartilaginous portion
is formed by several cartilages which support and give shape to the
nares. Attached to the cartilages are the muscles for dilating the
narea.
The nose is a cavity within the skull having its axis at right
angles to the face. It is important to remember this fact in examination
of the nose, since it is a common misconception that the nasal axis
is parallel to the line of the external nasal structure. The nasal cavity
is divided by the nasal septum into two parts which have similar anatomical
structure but may be asymmetrical.
The septum is a structure composed partly of cartilage and
partly of bone. Anteriorly, the septum is formed by the quadrilateral
cartilage. Posterior to this is the vertical plate of the ethmoid while
behind that again, the rostrum of the sphenoid bone helps to form
the partition. Below, the quadrilateral cartilage articulates with the
maxillary sphine and with the vomer, while along the lower edge are
found two other strips of cartilage which are known as the vomeronasal
cartilages.
- - 41 - -
The septum is covered with perichondruim where there is cartilage,
with periosteum where there is bone, and outside this with mucous
memberane.
On the lateral wall there is a system of ridges known as
the conchae, or turbinates, each of which overhangs a groove known
as a meatus.
The conchae or turbinates are three in number - the inferior
concha, the middle concha and the superior concha. The inferior concha
forms a bone by itself, attached in the laterial wall of the nose. The
middle concha and the superior concha are part of the ethmoid bone.
The conchae (Turbinates) are covered with mucous memberane which
is, the most part, columnar ciliated epithelium.
Underlying the mucous membrane there is erectile tissue which
is found chiefly at the anterior and posterior ends of the inferior conchae,
in their lower borders, and at the anterior ends of the middle concha.
The meatus of the nose are of importance since they are the drainage
channels of the accessory air sinuses. The appearance of pus in one
of the meatus is of diagnositic importance in affections of the nose
and accessory air sinuses.
Into the superior meatus and spheno-ethmodial recess drain
the posterior group of nasal accessory sinuses. Into the middle meatus
drain the anterior group, while into the inferior meatus drains the nasolachrymal
duct. It should be noted that while the inferior and middle meatus
- - 42 - -
are open at both ends the superior meatus is closed at the anterior
end. This means that pus from the posterior group of sinuses will
be seen on posterior rhinoscopy.
In the normal nose these parts can rarely be seen from the
front. Between these two enlargements is a groove which is known
as the hiatus semilunaris, into which the ostium eminence, the bulla
ethmoidiais, which is due to the protrusion into the meatus of one of
the air cells of the ethmodial labyrinth.
The middle meatus contains several structurs of importance.
An enlargements is found at the anterior end of the middle meatus,
which is part of the ethmoid bone, known as the uncinate process.
A little further back can be seen another of the maxillary air sinus
opens. The hiatus semilunaris, when followed upwards, leads to
narrowings called the infundibulum. In many cases the infundibulum
continues upwards, becoming the fronto-nasal duct. Owing, however
to the irregularity of the development of the frontal sinus and the anterior
ethmoid cells, it is possible that the fronto-nasal duct may open from
an anterior ethmoidial cell.
BOUNDARIES OF THE NASAL CAVITY :
Inferiorly the floor of the nasal cavity is formed by the maxilla
and by the palatine bones. The roof of the nasal cavity is formed,
in front, by the lateral nasal bones. Behind is the cribrifrom plate.
- - 43 - -
This is a bony lamina of the ethmoid bone, which is perforated to
permit the passage of the filaments of the olfactory nerves. Posteriorily
the sphenoid bone forms part of the roof.
THE NERVE-SUPPLY :
The sensory nerve-supply is mainly by the sphenopalatine nerves,
the fibres of which pass through the sphenopalatine ganglion to join
the maxillary nerve. This ganglion is the centre for sensory function
in the large portion of the nose. The anterior and upper part, however
is supplied by the anterior ethmodial nerves, which are branches from
the nasociliary branches of the ophthalmic division of the fifth nerve.
These find entrance to the nasal cavity at the enterior end of the cribriform
plate and finally ramify on the outer surface of the nose as the external
nasal nerves. The limitation of the centres of nasal sensation to
these points renders block or regional anasthesia easy and effective.
The sympathetic supply to the nose is distributed also from
the sphenopalatine ganglion, which it reaches by means of the deep
petrosal nerve from the carotid plexus. The secretomotor supply is
obtained from the geniculate ganglion.
NERVE OF SPECIAL SENSATION :
The olfactory nerves enter the nose through the cribriform
plate in the roof and are distributed to the upper part of the nasal
septum and the medial wall of the superior concha.
- - 44 - -
ARTERIAL SUPPLY :
The upper part of the nasal cavity is supplied by the anterior
and posterior ethmodial arteries which are branches of the opthalmic
artery in the nearby orbit. The opthalmic arises from the internal carotid
artery.
The lower part of the nose is supplied by branches derived
from the maxillary artery, the most important being the sphenopalatine
arteries and the termination of the greater palatine. Smaller contributions
enter from the face.
These internal and external carotid sources anastomose freely
in the nose. An aggregation of poorly supported vessels on the anterior
part of the septum just behind the skin margin is known as Little's
area and is a frequent source of bleeding.
The lymphatic vessels drain posteriorly to the superior deep cervical
group.
NASAL ACCESSORY SINUSES :
The nasal accesory sinuses are air spaces which are developed
in the bones of the skull and have communication with the nasal cavity.
They are divided into two groups - the anterior group and the posterior
group. The anterior group comprises the frontal air sinus, the maxillary
air sinus and the anterior ethmoidal air cells. The posterior group
- - 45 - -
comprises the posterior ethmodial air cells and the sphenoidal sinus.
This grouping of the sinuses is arranged more from the point of view
of drainage than from actual anatomical distribution. The sinuises vary
so widely in their positions during development that the distinction between
'anterior' and 'posterior' might be completely misleading. The anterior
group of sinuses drains into the middle meatus, and the posterior group
drains into the superior meatus and the spheno-ethmoidal recess.
THE MAXILLARY AIR SINUS :
At birth this sinus is represented by a small space on the
lateral wall of the nose, high up in the middle meatus, and communicates
with the nasal cavity. As growth proceeds the space enlarges by a
process of pneumatization of the maxillary bone. There is a double
process of pneumatization of the maxillary bone at work. In the young
child the second dentition lies in the upper part of the maxillary bone,
a very short distance below the orbit, and the lescent of the dentition
is brough about by the laying down of new bone. This bone, as it
is laid down, becomes pneumatized, forming the maxillary air sinus.
Development proceeds downwards and forwards until at the age of,
approximately, nine years, the floor of the maxillary air sinus is on
the same level as the floor of the nose. From this time development
proceeds until the antrum is finally completed by the descent of the
third molar tooth. This take place betwen the twenty-thrid and twenty-
fifth years.
- - 46 - -
The fully developed maxillary air sinus should extend from the
first premolar to the third molar tooth. The sinus reaches up to the
floor of the orbit and thus occupies practically the whole body of the
maxillary bone. Its medial boundary is the laterla nasal wall with the
attachment of the inferior concha, while the upper posterior part of
the medial wall frequently shows a bony dehiscence which is closed
by memberane. This is known as the membranous part of the middle
meatus, and the ostium lies in this part of the wall. In addition to
the normal ostium there is sometimes a small accessory ostium below
and in front of it. It is important to remember that the infra-orbital
nerve traverses the roof of the maxillary air sinus and appears at the
infraorbital foramen in the upper part of the anterior maxillary wall.
In the floor of the sinus runs the superior alveolar nerve, and
the roots of the teeth not infreqently project into the maxillary air sinus.
They may be covered with only a thin plate of bone, in which case
the reson for infection of the maxillary air sinus in apical tooth abscess
becomes obvious. Extraction of such a poorly covered tooth can result
in an abnormal communication between mouth and antrum. This is
known as oro-antral fistula. In the upper wall of the antrum anteriorly
is a hollow bounded medially by the canine ridge. This depression
is known as the canine fossa, and within the bone of the anterior wall
run twigs from the infra-orbital nerve to the teeth of the upper jaw.
The hard plate forms a large portion of the floor of the maxillary
air sinus. The pterygoid fossa with the spheno palatine fissure at
- - 47 - -
its inner of medial end is posterior. The maxillary air sinus may consist
of one whole cavity or it may be divided by septa into two or more
cavities which may or may not communicate with one another. The
shape of maxilary air sinus varies with different types of facies. In
persons with projecting face bones it will be found that the anterior
and medial angle of the sinus is narrow with the nasal wall bulging
into the sinus.
The maxillary air sinus is lined by ciliated columnar epithelium.
It is richly provided with glands, which are situated chiefly around the
ostium.
THE FRONTAL SINUS :
The frontal sinus occupies the space in the frontal bone between
the inner and the outer tables. The sinus is not present at birth but
becomes the frontal sinus about the age of five when the air cells
extend above the level of the supraorbital ridge. The frontal sinus
is developed from a recess in the anterior part of the nose. One
or both sinuses may remain rudimentary, but when pneumatization extends
into the frontal bone proper, it enlarges in every direction. The fully
developed frontal sinus may extend to the outer orbital angle and upwards
into the frontal bone for a distance of severla centimeteres.
The frontal sinuses are rarely symmetrical and they are seperated
by a thin plate of bone. The roof of the orbit forms the floor of
the frontal sinus, containing towards the inner angle the supra-orbital
- - 48 - -
nerve and having attached to it, more medially, the trochlea of the
superior oblique muscle. The frontal sinus is lined with columnar epithelium.
The cilia of the frontal sinus, according to some authorities, are generally
found around the opeining of the fronto-nasal duct. Between the frontal
sinus and the orbit are frequently found narrow cells which are known
as the orbito-ethmodial cells, and these may or may not communicate
with the frontal sinus. They may have their own opeinings into the
nose.
THE ETHMODIAL CELLS :
The ethmoidal air cells, although divided into two groups, must
be regarded as one from the point of view of development and treatment.
To explain this division of the ethmoidal cells properly, it is necessary
to go back to their development. In the primary nasal cartilage, grooves
and ridges appear on the laterial wall, the ridges becoming conchae,
and in the embryonic nose may number five ethmoconchae. As development
proceeds adhesions form on these ridges, parts of the grooves being
cut off and thereby forming cells. Eventually one of these ethmo-conchae
becomes more prominent than the others and forms the middle concha.
This appears to be a more or less arbitary process, and therefore
all cells above this ridge become posterior ethmoid, while all those
below it become anterior ethmoid, drainage being respectively above
and below the middle concha, so that an anterior ethmodial cell might
quite well behind , anatomically speaking, a posterior ethmoidal cell.
In contrast to the other sinuses the ethmoid consist of very many small
air cells without regular disposition, symmetary or fixed number. They
- - 49 - -
lie in the upper part of the laterial wall of the nose. Laterally is the
orbital periosteum. Below is part of the maxillary air sinus and above
the cells meet at an apex, though in the anterior part the frontal sinus
might be said to bear a superior relationship. The lining of these
cells is similar to that of the other sinuses, drainage, as before, being
effected by ciliary mucous membrane.
THE SPHENOIDAL SINUS :
The sphenoidal sinus occupies the body of the sphenoid bone.
At birth the sphenoidal sinus is seen as a small depression at the
posterior end of the nasal cartilage. As development proceeds the
depression deepens and in effect the posterior end of the nasal cartilage
becomes constricted the point of constriction becoming the ostium of
the sphenoidal sinus. At the age of nine to twelve years the sphenoidal
sinus does not encroach upon the sphenoidal bone, and is still confined
to cartilage, but after this period pneumatization of the sphenoidal
bone begins, and may extend down into the pterygoid process of the
sphenoid. The sphenoidal sinuses are capable of wide variation in
shap and position. They may be of unequal size and one may be
almost on top of the other.
Abnormal pneumatization accounts for certain unusual complications
of sphenoidal sinusitis. In most skulls pneumatization extends inferiorly
below the pituitary fossa which bulges into the sinus. The transphenoidal
route to the pitutary takes advantage of this, so that the sphenoidal
sinus now provides the usual means of access for hypophysectomy.
- - 50 - -
At the outer part of the roof the Gasserian ganglion may form a superior
relationship, while at the outer anterior angle, where the roof and the
lateral wall meet, the optic foramen, containing the optic nerve, is in
close apposition to the sphenoidal sinus. The lateral wall is in contact
with the cavernous sinus , with the nerves and vascular structures which
it contains. In the floor there is one important strcture, the vidian
nerve or the nerve of the pterygoid canal. As a rule this nerve is
in the substance of the bone, but it may be lightly covered on the
floor of the sinus and may even be carried in a bony arch across
it.
The ostium of the sphenoidal sinus is, as has already been
pointed out, high up in the anterior wall. The lining of the sphenoidal
sinus similar to that of the other sinuses and the nasal cavity.
It will be seen that the accessory sinuses form a system into
which the nasal lining is continued unbroken and which therefore must
share in some degree, the pathological changes which the infection
is likely to produce in the nasal cavity.
PHYSIOLOGY OF THE NOSE :
The Chief Functions of the nose are
1) Smell
2) Filtration
3) Humidification and warming of the air passing to the lungs.
There are other functions, such as vocal resonance, self-cleansing
and provision of moisture for protection of the mucous membrane.
- - 51 - -
The functions depend upon the mucous membrane with its underlying
tissues. In certain areas such as the conchae (turbinates) this is a
complicated structure of ciliary mucous membrane, glands, blood spaces
and connecting tissues based upon bone, and is under the control of
the autonomic nervous system. In this way the conchae act as a valve
mechanism enlarging or narrowing the air channels and so determining
the directions of the air stream. The path of the air column in the
nose during inspiration is upwards and backwards towards the middle
concha, thence in a curve towards the posterior nares. This can be
demonstrated by the inhalation of a small quantity of coloured powder.
In expiration such a definate path is not followed, but there
is a more general diffusion of the air column throughout the nose, with
an eddy round the middle concha.
SMELL : Smell as a function may be influenced in various ways. For
example obstruction from inflammation or vasomotor changes may prevent
air reaching the olfactory area. Sometimes toxic or infective conditions
or head injury destroy the nerve endings and the sense of smell.
Filteration is effected by the adhesion to the mucous film of
dust, bacteria and other practicles. These are removed by ciliary action
into the pharynx and swallowed with the secretions.
- - 52 - -
THE SENSE OF SMELL :
The olfactory membrane lies in the superior part of each nostril.
The receptor cells for the smell sensation are the olfactory cells, which
are actually bipolar nerve cells derived originally from the C.N.S itself.
These cells are interspread among the sustentacular cells. The mucosal
end of the olfactory cell, form a knob from which the olfactory haire
or cilia project into the mucos tract coats the inner surface of the
nasal cavity. These cilia react to odour in the air and then stimulats
the olfactory cells. Spaced among the olfactory cells in the olfactory
membrane are many small glands of Bowman tract secrete mucus into
the surface of the olfactory membrane.
The olfactory cells react to olfactory stimuli by depolarizing
the cell and thus creating a receptor potential. This in turn initiates
nerve impulse in the olfactory nerve fibre. The oxan of the olfactory
receptor neurons pierce the cribriform plate of the ethamoid bone and
enter the olfactory bulb. In the olfactory bulbs the oxan terminate
among the dendrites of the mitral and tufted cells in the olfactory glomeruli.
The axons of the mitral and tufted cells pass posteriorly through the
olfactory tract and terminate either primarily or after relay nerve in
two principal areas of the brain called the medial olfactory are a and
the lateral olfactory area respectively. The medial olfactory area is
composed of a group of nuclei located in the midportion of the brain
includes the olfactory nucleus the olfactory tubercle, parts of the hypothalamus
and other adjecent areas.
- - 53 - -
The lateral olfactory area is composed mainly of the prepyriform
and pyriform cortex and part of the amyglaliod nuclei. The secondary
olfactory tract pass from both the medial and lateral olfactory area
into many other portion of the system and into associated regions of
the thalamus and brain stem nuclie.
HUMIDIFICATION :
The moistening and warming of the air passing to the lungs is
one of the chief functions. Air reaches the lungs at about 30oC and
at 75-95 per cent relative humidity. When, during cold weather, the
air in a room is heated, the humidity may fall from the optimum 40
per cent to as low as 5 to 10 per cent. To increase this humidity
to the level necessary for comfort may cause a severe strain on the
nasal mechanism. Unless the mucous membrane is very efficient extreme
discomfort may result. Similarly changes in the mucous membrane
of the nose caused by disease or trauma may produce symptoms. These
are due to the inability of the glands and blood spaces to provide
the warmth and moisture demanded by the atmospheric conditions.
Ciliary action is the means by which the mucous membrane cleanses
itself and removes unwanted material. By the movement of the cilia
which fringe the surface cells, a constant streaming of mucus is produced
antero posteriorily. Any interference with normal action causes unpleasant
symptoms. Overaction of the cilia may mean copious nasal secretions
and impaired action leads to accumulation of secretion of even to the
formation of crusts which cause obstruction by clogging the nose.
- - 54 - -
The post-nasal discharge, so often a cause of complaint, is an expression
of the inability of the ciliary mechanism to deal with thickened mucus
which slowly finds its way into the pharynx where it acumulates. The
conditions necessary for efficient ciliary action are mucus of the correct
consistency and adequate aeration. Conditions inimical to ciliary action
are excessive drying, inflammation, thick secretions and unsuitable drugs.
The nose plays an important part in giving resonance to the
voice. Malformations of the nasopharynx and obstructions in the nose
itself may alter the tone of the voice, making it flat and uninteresting.
In the same manner, by interfering with the nasal air column, rigidity
or fibrosis of the soft palate may deprive the voice of timbre. For
this reason nasal operations upon singers must be approached with
great caution and considerable experience is required to judge the probable
effects on voice of treatments causing alternation of the nasal structure.
- - 55 - -
INTRODUCTION
Those alone are wise who act after investigation. Eventhough
the detailed subject of Ayurveda is written as explained by the
sages, the necessity of investigation with regard to the etiopathology
diagnotis and treatment are essential for the progress of Ayurveda.
The primary aim of the Auyrvedic science are two : 1.
To maintain the health of a swastha and 2. To cure the disease
of an unhealthy person. A swastha is a person whose doshas
are in a state of equilibrium, his digestive capacity is normal,
with the normal functions of dhatus and malas accompanied by
the lucid states of Ama, indriyas and manas. Indriyas are of two
types : 1. Janendriyas - Sense organs and 2. Karmendriyas -
The conative organs. The verbal expression is the function of one
of the Karmendriyas, and it is the God's gift to human beings.
Arditavata is a disease in which some of the jnanendriyas
and karmendriyas, located in the siras are affected, particularly
in their function. Therefore the most important characteristics of
a human being viz: facial expression and verbal expression are
lost, in away the patient loses the essential human characteristic.
- - 56 - -
The incidence of this disease is sufficiently high to warrant an
effective treatment.
The most important and effective treatment recommended
in Ayurveda for the Arditavata is Nasya Karma. The application
of this kind of treatment is also easy without any distress to the
patient. Therefore this method of treatment is selected in this trial.
The medecine selected is also easy available and it is one of
the effective vatahara medecines. The use of Ksheerabala taila
(101) has been recommended in the treatment of vatarogas by
almost all Ayurvedic scholars. The herbal ingredients that are used
in the praparation of Ksheerabala taila are nontoxic, easily available
and non-controversial. Therefore the administration of Ksheerabala
Taila (101) has been used in the treatment of Arditavata.
A total of 30 cases have been selected in this study
and these cases have been grouped into three types with different
methods of treatment. It has been found that the Nasya Karma
with the Ksheerabala taila(101) to be more effective. But this trial
can be visualised as only a pilot study and a further extensive
work is necessary to establish the definate curative effect of Ksheerabala
taila(101) nasya karma on the patients of Arditavata.
*****
- - 2 - -
- - 57 - -
Table No.1 Sex
������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
6
������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
Female
Male
40%60%
- - 58 - -
0
234567
Table No.2 Age and Sex incidence
15-20 21-30 31-40 41-50 51-60
7
6
5
4
3
2
1
0
Male
Female
- - 59 - -
Table No. 4 Occupationalwise
EmpHW
AWStud
others
S1
0
2
4
6
8
10
12
Note :
Emp - Employees
HW - House Wives
AW - Agricultural Workers
Stud - Students
Others - Others
- - 60 - -
Table No.5 Occupation Sex wise
Note :
Emp - Employees
HW - House Wives
AW - Agricultural Workers
Stud - Students
Others - Others
EmpHW
AWStud
Others
Male
Female
0
1
2
3
4
5
6
7
8
9
0
- - 61 - -
X1X2
X3
S0
2
4
6
8
10
12
14
16
18
X1=Exposure to frost, dust, cold smoke etc.X2=Middle ear InfectionX3=Recently delivered women
Table No.6 Causitive Factors
- - 62 - -
X1X2
X3X4
X5
S1
0
2
4
6
8
10
12
X1 = Below one weekX2 = 8-14 daysX3 = 15-30 DaysX4 = 31-90 DaysX5 = above 90 Days
Table No.7 Duration
- - 63 - -
Table No.8.1 Comparative Table of Completely Relieved
Gp-A Gp-B Bp-C
7 Days
14 Days
012345
Table No.8.2 Comparative Table of Partially Relieved
Gp-AGp-B
Bp-C
7 Days
14 Days
0
0.5
1
1.5
2
2.5
3
Gp-A Gp-B Bp-C
7 Days
14 Days
0
2
4
6
8
Table No.8.3 Comparative Table of Non-responsive
ROLE OF NASYAKARMA IN ARDITAWITH SPECIAL REFERENCE TO
KSHEERABALA TAILA (AVARTITA)
Thesis submitted in partial fulfilment for theaward of post graduate degree of
Doctor of Medicine (Ayurveda)
M. D. (Ayurveda)
BySHETTAR RAGHAVENDRA VENKATESH
Under the guidance ofDR. V. V. SUBRAHMANYA SASTRY
G.C.I.M. (Madras) D. Ay. M. (B.H.U)
POST GRADUATION AND RESEARCH CENTRE
D. G. M. AYURVEDIC MEDICAL COLLEGE
GADAG
RAJIV GANDHI UNIVERSITY OFHEALTH SCIENCES
BANGALORE1999
- - 65 - -
Going through all informations about Ardita explained by
different scholars conviace that Ardita overall resembles the facial
paralysis in modera texts. Paralysis is meant an incapacity to move
or feel due to the damage to the nervous system. Such incapacity
occuring facial muscles can be stated as facial paralysis which
movements. As explained earlier the facial muscles are controlled
by 7th cranial nerve i.e. facial nerve.
Facial paralysis can occur by two kind of lesions viz.
Supranuclear and infranuclear type. The signs and symptoms vary
according to the nature of the fibre paths involved.
Facial weakness/paralysis may be due to :
1. A supranuclear lesion involving the corticospinal fibres concerned
in voluentary facial movements;
2. A supranuclear lesion involving the fibres concerned in emotional
movement of the face - mimic paralysis.
3. Nuclear and infranuclear lesions involving the lower motor neurones;
and
4. Primary degeneration or disorder of function of facial muscles.
1. Facial paralysis due to a supranuclear corticospinal lesion
is distinguished by the fact that movements of the lower
face are affected more severily than those of the upper.
2. A pathway controlling emotional movements as distinct
- - 66 - -
from voluntary movement of the opposite side of the face,
The most important originates in the frontal lobe. A lesion,
above the internal capsule may paralyse voluntary movement
of the lower face on the opposite side. Leaving emotional
movement, as in spontaneous smiling intact. Very rarely, a
frontal or thalamic lesion may aboilish contralateral emotional
movement leaving voluntary movement unimpaired (Mimic Paralysis).
3. Lesions involving the lower motor neurones destroy the
final common path, affect equally all forms of facial movements.
The facial lower motor neurones may be involved by a lesion:
a) Pontine lesion (within the pons)
Lesions in this region, facial paralysis is usually associated
with conjugate occular deviation, often with paralysis of the ipsilateral
jaw muscles and some times with the contralateral hemiplegia. Involvment
of trigeminal nucleus may lead to sensory loss also. Bilateral facial
paralysis occasionally occurs as a congenital abnormality (Mobius'
Syndrome).
b) Lesion within the posterior fossa, between the pons and the
internal acoustic meatus may cause deafness and loss of taste
in the anterior two third of the tongue as well as facial paralysis.
- - 67 - -
The commonest of such lesions are acoustic neuroma.
c) Within the temporal bone the facial nerve may be involved
in skull fracture or be involved in infections of the middle ear and
mastoid. Herpes zoster of the geniculate ganglion usually causes
facial paralysis through secondary involvement of the motor fibres
of the nerve, so called Ramsay - Hunt syndrome. Lesions within
the middle ear is usualy associated with loss of taste in the anterior
two third of the tongue, due to interruption of the fibres of the
chorda tympani.
d) After emergence of the nerve from the skull the fibres of the
facial nerve may be involved in many inflammatory or malignant
processes causing unilateral or bilateral facial palsy. Facial palsy
of bilateral or unilateral with recurrent episodes of facial ocdema
occur in patients with deeply furrowed tongue i.e. Melkersson's
syndrome.
4. Primary disfunction of the facial muscles is seen in mysthenia
gravis, muscular dystrophy and dystrophy mytonica.
Among the above terms of lower motor neuron lesions,
Bell's palsy is a commest form of facial paralysis.
Bell's Palsy :
Bell's palsy is defined as the facial paralysis of accute
onset presumed to be due to non-suppurative inflammation of the
- - 68 - -
facial nerve within its canal above the stylomastoid foramen.
The features of Bell's palsy are :
1. Usually unilatera, rarely bilteral.
2. pain within ear or mastoid region or arround the angle of jaw.
3. Onset is sudden - after patient awaken to find the face paralysed.
4. Paralysis of the muscles of facial expression. The upper and
lower facial muscles are equally affected and voluntary emotional
& associated movements are involved.
5. Eyebrow droops, wrinkles smoothed out, frowning and rising
of eyebrow is impossible.
6. The palpebral fissure becomes wider on affected side and
closure of the eye is impossible.
7. When the patient attempts to close the eye, the globe rolls
upwords and slightly inwards - Bell's phenomenon.
8. Eversion of the lower lid impairs absorption of tears, tends
to overflow.
9. Nasolabial fold is smoothed out.
10. Mouth becomes drawn to sound side and the patient cannot
retract the angle of the mouth or purse the lips as in whistling.
11. Paralysis of the buccinator causes cheek a puffed out appearence
in respiration.
12. Food accumulates between the cheek and the teeth.
13. The tongue deviates to the sound side when protruded.
- - 69 - -
14. Los of taste in anterior 2/3 of the tongue may occur when
the inflammatory process expends to the chorda tympani.
15. The patient may complaing of hypercusis, an intensification
of loud noises in the affected ear, when the branches to the
stapedius is involved.
By the above modern explanation, we are convinced that
the facial paralysis varies in its fetures according to the site of
lesion involve in the pathogenisis. One can also observe the signs
and symptoms of Ardita explained in different Ayurvedic classics
closely resemble the above mentioned facial palsy.
- - 70 - -
MODE OF ACTION OF NASYA
Drug administered to a person has to be absorbed into
the system. Its action on the particular system of the body depends
on absorption and disposal of the drug. The absorption of the
drug will be mainly depends on the route of administration, physiology
of the drug solubility and absorption surface.
The main channel of administration of Nasyadravya is nose
which is explained as the dwara of shiras. Nasya dravya administered
through nose reach the upper portion of the nose, and there the
absorption takes place. Drugs used in this therapy may be water
soluble or highly lipid soluble. These substances are capable to
stimulate the olfactory epithelium and nerve path.
Modern science explains that, it has been found that the
cilia of the body of the olfactory cell contain relatively large quantities
of lipoid materials, this could explain why a substance must be
lipid soluble to cause marked stimulation of an olfactory cell.
In Astanga Sangaraha an idea is given about the absorption
of nasyadravya. The drug administered through nose reaches the
sringatakamarma, spreads there and shows its action & cures the
- - 71 - -
disease.
The sleshmika kala of the nose is highly vascular & good
absorbing surface. Due to its vascularity the drug will be mainly
absorbed through the raktayanis and stimulates the olfactory nerve.
Through the rasayanis (Venules) drug will reach the vaktra sira
(Facial vein), and few communitates with the siras of antahkaroti
pradesha. Like this nasyadrvya reaches moordha and shows its
action on the affected part.
- - 72 - -
SUMMARY
Arditavata is disease, which come across oftenly. Non-
availability of satisfactory treatment made patient to approach Ayurvedic
physicians for a better reults.
Arditavata is a disease of Shiras and facial nerve is
the affected part. So the anatomical discription and physiological
impairement has been described.
Before going to clinical trial, knowledge of causative factors
and pathophysiological aspects are very important. So brief description
of causative factors and disease process has been eloborated.
In Ardivata pranavata and raktavaha srotodusti are the
main pathological aspects. Importance of vata particulary prana
and udana and their pathological changes along with the Raktavaha
Srotodusti discussed separately.
Signs and symptoms, explained by different scholars are
described.
- - 73 - -
Line of a treatment for Ardita mentioned by a different
Scholars has been followed. Major classics mentioned nasya karma
is the line of treatment for Arditavata. The regimen prescribed
was followed strictly.
Results obtained are presented in tabular form.
The detail description of drug taken for trial i.e. Ksheerabala
Taila (101) has been described. Chemical constituents, pharmacological
and analytical description narrated separately.
- - 74 - -
SPECIAL CASE SHEET OF ARDITAVATA
Name of the patient Case No.
Age Yrs. O.P.No.
Sex M F I.P.No:
Caste Hindu Ward No.
Muslim
Christean Bed No:
OthersDate of Admission / /
Occupation Date of Discharge / /
Employee
House-wives Result
Agricultural workers Completely relieved
Student Partially relieved
Others Non responsive
Address :
Pin :
D.G.M. Ayurvedic Medical CollegePost-Graduation and Research Centre
GADAGDept. Kaya - Chikitsa
Guide : Dr. V.V.S.Sastry D.Ay.M.(BHU) Scholor : Shettar. R.V.
- - 75 - -
Economical Status :
Annual Income
Income from other sources
Total
(Chief Complaints with duration) Duration
1. Deviation of the mouth angle
2. Inability to close the eye on affected side
3. Vak Sanga
4. Excessive Salivation
5. Bhojanasamardhata
6. Mukha parswa Vedana
7. Adhika Asru Srava
8. Karnavedana
9. Jihwa Vatrata
10. Lalata Valinasha
History of Present illness :Mode of on set sudden Gradual
Side affected Right Left
Associated Symptoms
Duration
1. Sira Kampa
2. Greeva Vedana
3. Danta Vedana
4. Chibuka Vedana
5. Sparashasahatva
- - 76 - -
Associated diseases if any1. Diabetus
2. Hemiplegia
3. Head injury
4. Syphilis
Family History :
G.Father G.Mother G.Father G.Mother
Father Mother
Brother Sister Patient Brother Sister
Brother Sister
Wife/Husband
Father in law Mother in law
Personal HistoryHabits
Alcohol
Smoking
Tobacco Chewing
Drug addiction
Diet Factors1. Vegiterian
2. Mixed
Marital status Married Unmarried
- - 77 - -
Menstrual History (in females)
Pregnant Women Y N
Recently delivered Y N
Previous cycles Regular irregular
General Examinations
Pulse /min
B.P mm of Hg
Body Temp oF
Respiration rate /min
Body Weight kg
Prakrityadi Pareeksha
1. Prakruti
Vataja Pittaja Kaphaja Dwandawaja Sannipataja
Vatapitta Vatakapha Pitta-Kapha
Pareeksha Bhava1. Shareera (body as a whole)
Vataja Pittaja Kaphaja
Deeragha, Krasha Alpa Madhyama Hraswa, Samhata
Apachita, Ruksha Nati Stabda Mahat, Upachita
Seeta, Durbhaga Natiruksha Snigdha, Sheeta
Dull face Sukumara Subhaga
Bahu Sira pratana Piplu. tila. Vyanga
- - 78 - -
2. Twak (Skin)
Ruksha, Sphutita Tanu Asputana Snigdha, Asputana
Khara, Dhusara Atimrudu, gaura Mrudu, Avadata
Tamra (Red or pink) (Yellowish) Sweta
3. Netra (eye)
Alpa, Ruksha, Tanu Tanu Pingala(yellowish) Vishala, Snigdha
Dhusara Ashuranjanasheela pruthu, Sheetapriya
4. Jihwa (Tongue)
Tanu, Alpa Ruksha Madhyama, Madhyama pruthu, Mahat
Sphutita Anavasthita Tamra, Rakta Slakshna Ardra
LalataAlpa Valiyukta Mahat
Sandhi
Tanu, Alpa, Ruksha Madhyama Pruthu, Mahat
Shabdagamini Mrudu Upachita
Tamra(pinkish)
Bala
Alpa,Shighra trasa Madhyama Balavan
2. Sara
i) Rasa Sara ii) Rakta Sara
iii) Mamsa Sara iv) Meda Sara
v) Asthi Sara vi) Majja Sara
vii) Sukra Sara viii) Satwa Sara
- - 79 - -
3. Samhanat
Pravara Madhyama Avara
4. Satwa
Pravara Madhyama Avara
5. Satmya
i) Food addiction
ii) Alcohol
iii) Tobacco-chewing
iv) Drug addiction
6. Desha
Janma desha
Vruddha desha
Vyadhita desha
Sroto pareeksha
1. Rasavaha sroto pareeksha
i) Hridaya
Inspection
Percussion
Auscultation
ii) Sirajala
iii) Dhamanijala
iv) Rasayanijala
- - 80 - -
2. Raktavaha Sroto pareeksha
i) Yakrit - palpation
Percussion
ii) Pleeha - palpation
Percussion
iii) Lasikagranthi
iv) Conjunctiva
3. Mamsavaha Srotopariksha
1. Prominance of temporal Muscle
1 3 7 11 14 After treatment
2. Prominance of Massater Muscle
1 3 7 11 14 After treatment
C.N.S EXAMINATION
State of Consciousness
Appearence & behaviour
EXAMINATION OF AFFECTED CRANIAL NERVES
1. Trigeminal nerve
1. Prominence of tempora Muscle
1 3 7 11 14 After treatment
- - 81 - -
2. Prominence of Massater Muscle
1 3 7 11 14 After treatment
3. Deviation of Jaw on affected side (In cms)
1 3 7 11 14 After treatment
4. Corneal reflex
1 3 7 11 14 After treatment
2. Facial nerve1. In ability of closing eye on affected side (in cms)
1 3 7 11 14 After treatment
2. In ability of eye brow rising (Presence of wrinkles on forehead)
1 3 7 11 14 After treatment
3. Mouth inflation test
1 3 7 11 14 After treatment
4. Whistling
1 3 7 11 14 After treatment
5. Mouth angle diviation ( In cms)
1 3 7 11 14 After treatment
- - 82 - -
6. Sense of taste in anterior 2/3 of the tongue
1 3 7 11 14 After treatment
Solution : 1. Sugar
2 . Salt
3 . Citricacid
4 . Quinnine
3. Auditory Nerve1) Power of hearing
2) Abnormal sensation
3) Vertigo
4. Glasso - pharyngeal nerve1) Sense of taste in posteror 1/3 of the tongue
5. Hypoglossal1) Tongue protrusion
2) Tongue movements
3) Deviation
4) Atrophy
5) Tremor
Nidana Panchaka1. Hetu
Aetiological factors
i. Exposure to cold, dust, frsot and smoke etc.
ii. Middle ear infection
iii. Recently delevered women
iv. Carrying heavy load on head
v. Speaking loudly
- - 83 - -
vi. Excessive laughter
vii. Excessive yawning and sneezing
viii. Sudden movements of head and neck
ix. Wrong use of Siravyadha
x. Suppression of natural urges
xi. Head injury
xii. Excessive haemorrhage
2. Samprapti Ghatakas
1. Dosha
2. Dooshya
3. Srotas
4. Srotodusti prakara
5. Agni
6. Ama
7. Udhava sthana
8. Sanchara sthana
9. Adisthana
10. Rogamarga
3. Lakshnas
1 3 7 11 14 A.Treatment
1. Mukhavakrata
2. Akshinimeshasmarthata
3. Vak Sang
4. Sira Kampa
5. Bhara Heenata
6. Adhika Asrusrava
7. Greeva vedana
8. Mukhaparshwa Vedana
- - 84 - -
9. Danta Vedana
10. Chibuka Vedana
11. Karna Vedana
12. Badhirya
13. Sparshasahatva
14. Adhika lalasrava
15. Jihwa Vakrata
16. Suptata
17. Bhojanasamardha
18. Lalata Valinasha
4. Poorvarupa
1 3 7 11 13 A.treatment
1. Horipilation
2. Vepanam
3. Avila Netrata
4. Vayuroordhwa
5. Twachi Swapa
6. Toda
7. Manyasthamba
8. Hanugraha
5. Sadhyasadhyata
Asadhya Laxana
1. Extreme emaciation
2. Inability to close the afflicted eye
3. Difficulty in speach
4. Duration more than 3 years
5. Serve shaking or
trembling of the head
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LAB INVESTIGATION
1. HB% gm%
2. T.C.
D.C
3. ESR mm/hr
4. RBS
SAPEKHA NIDANA
Diagnosis
Signature
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INTRODUCTION
Those alone are wise who act after investigation.
Eventhough the detailed subject of Ayurveda is written as explained
by the sages, the necessity of investigation with regard to the etiopathology
diagnosis and treatment are essential for the progress of Ayurveda.
The primary aim of the Auyrvedic science are two : 1. To maintain
the health of a swastha and 2. To cure the disease of an unhealthy person.
A swastha is a person whose doshas are in a state of equilibrium, his
digestive capacity is normal, with the normal functions of dhatus and malas
accompanied by the lucid states of Atma, indriyas and manas. Indriyas
are of two types : 1. Jnanendriyas - Sense organs and 2. Karmendriyas
- the conative organs. The verbal expression is the function of one of the
Karmendriyas, and it is the God's gift to human beings.
Arditavata is a disease in which some of the jnanendriyas
and karmendriyas, located in the siras are affected, particularly in their
function. Therefore the most important characteristics of a human being
viz: facial expression and verbal expression are lost, in a way the patient
loses the essential human characteristic. The incidence of this disease
is sufficiently high to warrant an effective treatment.
The most important and effective treatment recommended in
Ayurveda for the Arditavata is Nasya Karma. The application of this kind
of treatment is also easily without any distress to the patient. Therefore
this method of treatment is selected in this trial. The medecine selected
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o p
o p
C E R T I F I C A T E
This is to certify that Shettar R.V.Shettar R.V.Shettar R.V.Shettar R.V.Shettar R.V. Scholar of
M.D.(Ay.)M.D.(Ay.)M.D.(Ay.)M.D.(Ay.)M.D.(Ay.) Kayachikitsa has worked for his thesis on the
topic entitled "Role of Nasya Karma in Ardita with special
reference to Ksheerabala Taila (Shatavartita).
This work is done under my supervision and guidance.
This thesis makes a distinct advance on scientific lines
in the above subject and the findings are immensely valuable
and have considerably contributed to the present knowledge
of the subject
I am fully satisfied with his original work and
hereby forward the thesis for the evaluation of adjudicators.
Guide :
DR. V.V.SUBRAHMANYA SASTRYG.C.I.M.(Madras), D.Ay.M(B.H.U.)Head of Department of K.C.P.G.studies and research centreD.G.M. Ay. Medical CollegeGadag - 582 101.
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ACKNOWLEDGEMENT
I express my deep sense of gratitude to my respected guide
Dr.V.V.Subrahmanya Sastry. Head of Department of K.C.Post graduation
& Research Centre. D.G.M. Ayurvedic medical college Gadag. It was
very pleasant to work under his guidance. He gave moral Support,
encouragement throughout my work. Without his in time guidance it
was not possible.
I am also greatful to the Asst. Professor Dr.K.S.R. Prasad and
lecturer Dr. A.K.Padnda for their advices throughout the work and
also help in clinical work.
I am thankful to my U.G. lecturer Dr. C.M. Sarangamath for his
kind co-operation. He helped me in clinical work and provided many
patients for the present trial and encouraged throughout the work.
I express my thanks to Dr. S. S.Hiremath and Dr. C. S. Hiremath
for their help in the project work. My sincere thanks to Dr.U. V. Purad
incharge pathology department, and to Dr. S. A. Patil who helped
me and advised to join the course.
I express sincere thanks to my uncle Dr. A. M. Anegundi for
his advices and encouragement. He provided many refferences of modern
science and helped me a lot throughout the course.
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It was very pleasant to express my deep sense of gratitude to
my principal Dr. G. B. Patil who permitted me to do the present work.
He provided all facilities intime and supported in every step throughout
the course.
I am thankful to our librarian Mr. Mundinamani and to all college
teaching and non teaching staff for their support.
I am also thankful to Mr.Krishna Fattepur and Mr. Habib for their
neat job work in the preparation of this thesis.
Finally I express my sincere thanks to all my colleagues, friends,
and family members and those who helped directly and indirectly.
SHETTAR. R. V.
B i b l i o g r a p h y
1. Amarakosha :
2. Astanga Hridaya : Arunadatta & Hemadri Commentory
3. Astanga Sangraha : Indu commentory
4. Baishajyaratnavali :
5. Bhavaprakasha : Bhavamishra
6. Bhela Samhita :
7. Brain's Diseases of the : John WaltonNervous system
8. Charak Samhita : Chakrapani commentory
9. Chakra Datta : Chakrapani
10. Dhanwantari Nighantu :
11. Gadanigraha :
12. Grey's Textbook of Anatomy :
13. Harita Samhita :
14. Harrison's Principles of :Internal Medicine
15. Hutchison's Clinical Methods :
16. Inian materia medica : Dr. K. M. Nadkarni
17. Introduction to Kaya Chikitsa : Dr. C. Dwarakanath
18. Kashyapa Samhita :
19. Madhava Nidana : Madhukosha cmmentory
20. Nutritive values of Indian : C. Gopalan & B.V.Ramasastryfoods
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21. Panchakarma Vignana : Sreedhara Kasture
22. Principles & Practice of : Davidsonmedecine
23. Pratyaksha Shareera : Gananatha Sen
24. Sahasrayoga :
25. Savil's Clinical medecine :
26. Shabdastomamahanidhi :
27. Shabdakalpadruma :
28. Sharangadhara Samhita : Adhamalla commentory
29. Susruta Samhita : Dalhana, Jejjata commentory
30. Text book of physiology : Gayton
31. The chemical constituents : T. P. Hilditchof natural foods & P. N. Williams
32. Tridosha Theory : Dr. V. V. S. Sastry
33. Vangasena :
34. Yogaratnakar :
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loudly
Excessive
Comprises 16
Poorvaroopa or premonitory symptoms are the unmenifested form 26
form 27
Roopa of a disease is the stage of Vyakta in the Kriyakalas and manifests
Salivation 30
Going through all informations about Ardita explained by different
scholars conviace that Ardita overall resembles the facial paralysis
in modern texts. Paralysis is meant an incapacity to move or feel
due to the damage to the nervous system. Such incapacity occuring
facial muscles can be stated as facial paralysis. As explained earlier
the facial muscles are controlled by 7th cranial nerve i.e. facial
nerve.
abolish 32
Charaka 38
structure 40
quadrilateral 40
spheno-ethmoidal
ethmoidal 42
ethmoidalis, which is due to the protrusion into the meatus of one of
ethmoidal 42
ethmoidal 43 anterior - 43 ethmoidal 44
ethmoidal 45 lateral - 46 membrane 46
several 47 ethmoidal 48 lateral 48
ethmoidal 48 shape and position 49
lateral 49 pitutary 49 particles. 51
or cilia project into the mucuos tract coats the inner surface of the
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