e Book Ayurvision 2010

1

CME IN AYURVEDA ON

“CURRENT UNDERRSTANDING AND MANAGEMENT OF ARDHAVABHEDAKA WITH AN UPDATE ON MIGRAINE”

26th and 27th November 2010

SOUVENIRSOUVENIR

Exploring the new frontiers in academic and

scientific Ayurveda

Dept. of Ayurveda,Kasturba Medical College,

Manipal University, Manipal

2

CME IN AYURVEDA ON

“CURRENT UNDERSTANDING AND MANAGEMENT OF

ARDHAVABHEDAKA WITH AN UPDATE ON MIGRAINE”

ORGANIZED BY:-

DEPT. OF AYURVEDA Kasturba Medical College

Manipal University Manipal

3

From the desk of H. O. D……….

Ayurvision A MISSION WITH A VISION

Before the days of modern medicine, societies around the world had their own ways

of preventing and treating illness. These were based on local beliefs, religion and

culture. Ayurveda, is one such system. It started in India thousands of years ago with

roots in the Indian culture and religion. Roughly translated, "Ayurveda" means "the

science of life."

“It needed a scientific age for the world to appreciate the full dignity of Ayurveda

as a holistic system of perfect health. Now it has become clear to the world of

science that every thing in the universe has its basis in the „unified field‟ and

everything can be successfully handled from this one area. It is this that has

authenticated Ayurveda‟s holistic approach to perfect health for both individual

and society. Ayurveda today stands as the technology of the „unified field‟ for

perfect health of the individual of the nation, and of the world as a whole”

- Maharishi Mahesh Yogi

India has a large infrastructure for teaching and clinical care training under Indian

systems of Medicine and teaching and training has been availed of according to the

curriculum set up by the Central Council of Indian Medicine. The diagnosis and

treatment of various ailments, use of drugs and Ayuvedic profession as a whole has

its basis to the education based on authoritative texts recognized for these systems,

but, the scientific validation of the treatment has not been done on a wide scale. The

off take and output from these institutions has so far been limited and has not been

able to meet the standards for scientific enquiry. In the present era of globalization

and development of a world market for Ayurveda as a whole (education, research and

medical care delivery), research and development is needed.

4

Ayurvision is a step towards standardizing Ayurvedic Clinical practice, based on

which depends the quality and standards of research. Ayurveda is Intellectual

Property of we Indians. Every Indian has the right to protect it.

Today, Too much emphasis is laid on modern medicine at the level of Ayurvedic

education thereby neglecting Ayurvedic tradition and practice. Ayurvedic profession

is looked down by the public greatly because graduates of Ayurveda sideline their

science and resort to unethical practice of Modern Medicine, truly a sort of quackery.

Emphasis needed to improve the quality and standards of Ayurvedic Education,

accountability of the Profession and standardization of Ayurvedic medicines.

It is unfortunate that Graduates of Modern medicine are deprived of any knowledge

of this science during their education. If an effort is made to expose students of

modern medicine to the principles and practice of Ayurveda, either during their

graduation level training or during their Internship period, we can hope for a better

interaction among these practitioners in future. Medical Council of India, IMA and

Central Council Of Indian Medicine should come to single platform and discuss this

issue, as to how to implement this.

Evidence based Ayurveda

While talking of searching and applying evidence base to Ayurveda, we need to

understand that in conventional sense, the term is primarily coined to help in clinical

decision making in the light of best among overwhelmingly available evidences

within modern medicine. Conventional modus operandi of applying evidence base to

medical practice therefore is limited to screening of best evidences that help in

decision making. Thereby, defining the best evidence and finding them pragmatically

in a clinical setting are the only real challenges.

Referring to Ayurveda, however, the issue of applying evidence base needs to be

redefined in reference to its unique propositions. There is a ubiquitous agreement

upon the traditional evidences of Ayurveda of which experience, long-term use, and

textual classical references form a large sum.

The issue of evidence base in Ayurveda therefore requires to be dealt at various levels

like documentation of existing evidences, designing diagnostic and clinical

parameters which can act as evidence to help in decision making and generating more

evidences in reference to the safety and efficacy pertinent to Ayurvedic practice. This

is the time when we need to understand that bringing evidence base to the practice of

Ayurveda is mandatory if it is thought to be raised as a medical system where

predictability and dependability are featured as key components.

5

Ayurvedic Industry and Academia

Ayurveda need more academic backup and evidence. I call upon Ayurveda Industry

to strengthen and support academic research and clinical documentation of their

products and standardizing the products to International standards, instead of simply

adopting unconventional methods like advertising the products in lay magazines and

news papers with unscientific methods and evidence less, false claims. These

practices may lead to people start looking at Ayurveda with a commercial angle and

ultimately losing their faith and trust on the science itself. We need to build up

Ayurvedic academic centers at par with Oxford or Cambridge University type of

Institutions in India or abroad in future.

" The future belongs to those who fuse intelligence with faith and who, with

courage and determination, grope their way forward from chance to choice, from

blind adaptation to creative evolution" - Charles Merriam

Through this Ayuvision we propose to explore the new frontiers in academic and

scientific Ayurveda.

Dr. M. S. Kamath MD (Ayu.)

Additional Professor & Head

Department of Ayurveda

KMC, Manipal.

Manipal University

Tel. 0820 29 22105

mail : [email protected]

6

Program Schedule

Day 1. 26th November 2010 Morning Session:

Sl. No Time Events 1. 08.00 – 09.00 Registration

2. 09.00 – 10.00 Inauguration

3. 10.00 – 10.30 High Tea

4. 10.30 – 11.30 Management of Headache past, present and future by Prof. B. M. Hegde

5. 11.30 – 12.30 Current Understanding and Management of Migraine by Dr. Vasudeva

Acharya, Associate Professor, Dept. of Medicine, KMC Manipal.

6. 12.30 – 02.00 Lunch Break

Afternoon Session:

Sl. No Time Events

1. 02.00 – 03.00 Analysis of Nidana Panchaka of Ardhavabhedaka by Dr. Zenica, HOD, Dept. of

P.G. Studies in Panchakarma, Alva’s Ayurveda Medical College, Moodbidri.

2. 03.00 – 04.00 Free Paper Session (By Delegates – 6 minutes for each paper)

3. 04.00 – 04.30 Tea Break

4. 04.30 – 05.30 Poster Presentation (Competition for Delegates – Size of Poster 30”X40”)

Day 2. 27th November 2010 Morning Session:

Sl. No Time Events 1. 09.00 – 10.00 Differential Diagnosis of Ardhavabhedaka by Dr. Srilatha, Assistant

Professor, Dept. of P.G. Studies in Kayachikitsa, S.D.M. Ayurvedic College, Udupi, Karnataka.

2. 10.00 – 10.30 Tea Break

3. 10.30 – 11.30 Current Understanding of Ardhavabhedaka with Modern Prospective by Dr. U. Indulal, Deputy Director, Technical, The Arya Vaidya Chikitsalayam &

Research Institute, 136 – 137, Ramanathapuram. PO. Coimbatore, Tamilnadu.

4. 11.30 – 12.30 Management of Ardhavabhedaka by Shamanoushadhis by Dr. Prasanth, Professor, Dept. of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli, Karnataka.

5. 12.30 – 02.00 Lunch Break

Afternoon Session:

Sl. No Time Events

1. 02.00 – 03.00 Management of Ardhavabhedaka by Panchakarma by Vd. M. Prasad, Ayurveda

Vachaspati, Director, Sunethri Ayurvedashram and Research Centre, Trikkur, Trissur, Phone: 09446229370

2. 03.00 – 03.30 Break

3. 03.30 – 04.30 Panel Discussion

4. 04.30 – 05.00 Valedictory Function Followed by High Tea

7

AYURVISION – 2010

CME ON CURRENT UNDERSTANDING AND MANAGEMENT OF

ARDHAVABHEDAKA WITH AN UPDATE ON MIGRAINE

26th

& 27th

November 2010

Chair person : Dr. Sripathi R Rao

Dean, KMC, Manipal.

Co- Chair person : Dr. M.S. Kamath HOD

Dept. of Ayurveda, KMC, Manipal.

Organizing Secretary:

Dr. Basavaraj – Associate Professor

Reception committee:

Chairmen – Dr. Kamath Madhusudhan

Dr. Soumya

Dr. Suprabha

Dr. Prasanna Rao

Mrs. Laxmi

Mrs. Bharathi

Mr. Ganesh

Miss. Sumangala

Miss. Sahana

Mr. Mahesh

Transport Committee & Accommodation

Chairmen – Dr. Shripathi Adiga

Dr. Preetam

Dr. Harish

Dr. Sumashri

Mr. Chandrashekar

Mr. Anul

Mrs. Vani. C

Food & Catering Committee:

Chairmen – Dr. Kamath Madhusudhan

Dr. Nagaraj

Dr. Deepak

Dr. Sapna

Miss. Revathi

Mrs. Geetha

Miss. Anusha

Mr. Vasanth

Miss. Sumangala

Miss. Sahana

Mrs. Sumathi

Scientific Committee:

Chairmen – Dr. K.J. Malagi

Dr. Kamath Madhusudhana

Dr. Anupama Nayak

Dr. Preetam

Mr. Md. Asif

Ayurvision e-book:

Chief Editor – Dr. Kamath Madhusudhana

Master of Ceremony: Dr. Anupama Nayak

8

Contents:

01. Management of Headache past, present and future by Prof. B.M. Hegde……… …………………………………………………………. 09 02. Current Understanding and Management of Migraine by Dr. Vasudeva Acharya……… ………………………………………………………….. 11

03. Analysis of Nidana Panchaka of Ardhavabhedaka by Dr. Zenica D’souza………… ……………………………………………………………. 14

04. Differential Diagnosis of Ardhavabhedaka by Dr. Srilatha ……………….. …………………………………………………………. 19

05. Management of Ardhavabhedaka by Shamanoushadhis by Dr. Prasanth………………. …………………………………………………………. 28 06. Management of Ardhavabhedaka by Panchakarma by Vd. M. Prasad………………. …………………………………………………………… 33

07. Current Understanding of Ardhavabhedaka with Modern Prospective by Dr. U. Indulal………………. ………………………………………………………… 37

08. Abstract …………………………………………………………. 47

9

Headache Professor BM Hegde,

[email protected]

“The ultimate lesson all of us have to learn is unconditional love, which includes not only

others but ourselves as well.”

Elisabeth Kubler-Ross

Pain has been human kind‘s greatest enemy from ―times out of mind‖; is the most important curse

even today and shall remain the same for all times to come. Doctors of all hues, ranging from the

mother of all healing wisdoms Ayurveda to the most modern hi-tech ultra specialty medicine, have

only been fighting this menace without much success to date. Pain of all kinds brings man to a

doctor for relief and it is our primary obligation to ―cure rarely, comfort mostly but, to console‖ him

always. ―Knowledge‖ wrote Karl Popper, a great thinker of England, ―advances not by repeating

known facts but by REFUTING false dogmas.‖ The world will never progress unless people can

think out of the box. History of medicine is replete with experiences of human suffering due to our

NOT THINKING but, only following false myths in medicine. Progress needs to be encouraged.

Change is life and stasis is death. Knowledge should change to evolve. Let us THINK together

about this enigma called headache.

When a patient with headache confronts you either in your office or hospital; first think of him/her

as a headache. One does not get a headache. On the contrary, most of the time, one becomes a

headache for himself and his doctor! This takes us to the crux of the headache dilemma that most, if

not all, primary headaches are in the human mind. There are three basic types of primary headaches-

migraine, tension headache and, cluster headaches (also called suicide headaches as the pain and its

frequent clustering could become unbearable to the patient). There are umpteen other known causes

of headaches ranging from common cold to cancer, which fall outside the purview of this write up,

together classed as secondary headaches.

The problem for mankind has been the unravelling the secrets of human mind which is at the root of

all headaches. Where is the mind? Never mind! What is the mind? Is it matter? If it is matter, where

is it? Finally what is matter? Mind is everywhere and, if one thinks of it as matter, it is nowhere

because there is no matter. Hans Peter Durr, the present President of the Max Planck Institute of

Physics in Munich, the greatest living physicist at 86 years, had shown that ―matter is not made up

of matter.‖ Matter and energy are the two faces of the same coin. The mind, otherwise called

individual consciousness, is only a part of the universal consciousness. We are all interconnected

although looking solid and distinct for out word appearances. The non duality of mind and matter is

called a-duality by Hans Peter Durr, who admits that he is ―only a child playing on the sands of the

beach while the vast sea of Indian wisdom of yore stares at me‖. They had called it as ―advaitha‖

thousands of years ago.

Another great German physicist, Fritz Albert Popp, had elegantly shown that every human atom

inside every cell emits photon lights which he has been able to record. Even if he applied a small

amount of ointment on his palm the photon lights in his brain and leg also changed simultaneously.

This synchrony is what is called health. When our cells are not in sync, we get illnesses-headache is

one such illness. Be that as it may, Popp also showed that our photons vibrate with the photons of

others when we interact with them. We are all parts of the same whole:

mailto:[email protected]

http://www.brainyquote.com/quotes/quotes/e/elisabethk145619.html

10

(Om poornamadhah poornamidham, poornath poornamudhachyathe.

Poornasya poornamadhay, poornamevaavshishyathe.)

Now you will be able to understand what I said in my first sentence that the patient IS a headache

when he says s/he HAS a headache. Tension headaches, cluster headaches, as also, the syndrome of

migraine, initially get born in the human mind. Our efforts at making them tranquil by the

conventional methods, many times, do not work since we follow the reductionist idea of relaxation

which is relaxation of the body to relieve muscle tension etc. That has its limited role but, the

relaxation of the mind goes much farther than all that yoga asanaas and praanaayama of the

commercial variety. You need to go deep into your ―praana‖, the real spirit, the essence of the

human being. Even the heart has its mind! The only way to be truly relaxed is to have genuine

―universal compassion, including compassion for one‘s own self.‖ To be truly compassionate it is as

important to forgive others as it is to forgive oneself for the past deeds good or bad, as otherwise, in

the deep recesses of the mind, the past keeps haunting you. The new definition of health, therefore,

is ―enthusiasm to work and enthusiasm to be compassionate.‖ In the correct sense of the word that is

true health. One could have any disease and still be healthy. Sharing and caring is the meaning of

genuine spirituality. Spirituality, thus defined, has very little to do with ritualistic religion.

Modern medicine‘s concept of organ-based diseases has come to an end. In her beautiful paper

entitled The end of the disease era, published in the American Medical Journal (2004; 116: 179) Dr.

Mary Tinnetti writes: ―

“The time has come to abandon disease as the focus of medical care. The changed spectrum of

health, the complex interplay of biological and non-biological factors, the ageing population, and

the inter-individual variability in health priorities render medical care that is centered on the

diagnosis and treatment of individual diseases at best out of date and at worst harmful. A primary

focus on disease may inadvertently lead to under-treatment, overtreatment, or mistreatment.”

Pain killers of all kinds are dangerous. They are one of the leading killers among the 2.5 million that

die annually in the US alone of Adverse Drug Reactions. Nearly 2 lakhs die due to gastric bleeding

alone according to Late Glen Gordon. Local ointments (in the US patches) of analgesics are

available for all pains including headaches. For the poor man the best I have found is an ointment

made up of black pepper made into a paste with curds. When applied on the forehead this does

wonders for the pain along with the doctors‘ empathy works wonders at the immune system level, in

addition. Rich patients can go for the US patches of capsaicin which is the same that black pepper

has. The mainstay of all headache treatments boils down to making the patients‘ mind truly tranquil,

if one could! Washing out hatred, greed, jealousy, super ego and pent up anger is not an easy job,

but is doable if one tries hard. With that kind of cleaning one develops universal compassion that

soothes all aches and pains in the mind: consequently, in the body as well.

“If you want others to be happy, practice compassion. If you want to be happy, practice

compassion."

The Dalai Lama

11

Migraine : Pathophysiology and Management

Dr VasudevaAcharya MD, DNB

Associate Professor

Department of Medicine

KMC Manipal

Email: [email protected]

Introduction

Headache is among the most common reasons that patients seek medical attention. Migraine is the

second most common cause of primary headache. Migraine afflicts approximately 15% of women

6% of men. Migraine is described as a syndrome of benign episodic headache associated with

certain features such as sensitivity to light, sound etc., often accompanied by symptoms of

neurologic dysfunction like nausea, vomiting , photophobia, vertigo, confusion and visual

disturbances.

Pathogenesis.

The sensory sensitivity that is characteristic of migraine is probably due to dysfunction of

monoaminergic sensory control systems located in the brainstem and thalamus.

There is considerable evidence that intracranial vasodilatation, long thought to be causal, in fact

occurs in response to the neurologic events of migraine. The most widely accepted theory proposes

that early in an attack, vasoactive peptides (particularly calcitonin gene-related peptide) are released

from the primary sensory nerve terminals that innervate meningeal blood vessels. These peptides

activate perivascular trigeminal nerves and cause dilatation of arteries as well as perivascular

inflammation and extravasation of proteins. First-order neurons terminate in the trigeminal nucleus

caudalis in the brainstem. They activate second-order neurons that ascend to the thalamus, and from

there third-order neurons project to higher cortical centers. If uninterrupted, this process causes pain

and can lead to hyperalgesia.

Pharmacologic and other data point to the involvement of the neurotransmitter 5-hydroxytryptamine

(also known as serotonin). The antimigraine effects of triptans relate to their ability to stimulate 5-

HT1B and 5-HT 1D receptors, which are located on both blood vessels and nerve terminals.

Data also support a role for dopamine in the pathophysiology of certain subtypes of migraine. There

is dopamine receptor hypersensitivity in migraineurs which is proved by the fact that dopamine

receptor antagonists are effective therapeutic agents in migraine.

Migraine genes identified by studying families with familial hemiplegic migraine reveal

involvement of ion channels, suggesting that alterations in membrane excitability can predispose to

migraine.

Activation of sympathetic nervous system is the likely cause of nausea, vomiting and other

autonomic symptoms. Sensitivity to light, sound and smell is theorized to result from abnormal

brain-stem modulation of sensory information. The aura is postulated to cortical spreading

depression which is most easily triggered in the occipital cortex.

12

Management

Once a diagnosis of migraine has been established, it is important to assess the extent of a patient‘s

disease and disability. Patient education is an important aspect of migraine management. A patient

should understand that migraine can be modified and controlled by lifestyle adjustments and

medications, but it cannot be eradicated. At the same time patient also should understand that

migraine is usually not a life-threatening illness.

Nonpharmacologic management

The specific triggers should be identified and avoided. A healthy diet, regular exercise, regular sleep

patterns, avoidance of excess caffeine and alcohol would be helpful. Since the stresses of everyday

living cannot be eliminated, lessening one‘s response to stress by various techniques is beneficial in

many patients. These may include yoga, hypnosis and conditioning techniques such as biofeedback.

Therapy for acute attack of migraine

The mainstay of therapy is the judicious use of one or more of the many drugs that are effective in

migraine. The selection of the optimal regimen for a given patient depends on a number of factors,

the most important being the severity of attack. Mild attacks are managed by oral drugs with

efficacy rate of 50-70%, while severe attacks warrant parenteral therapy.Nonsteroidal anti-

inflammatory agents, 5HT receptor agonists and dopamine receptor antagonists constitute three

major classes of drugs used in treatment of acute attack of migraine.

1. NSAIDs : Both severity and duration of a migraine attack can be reduced by NSAIDs.

However effect of these agents is less than optimal in severe attacks.

2. 5-HT1 agonists: Ergotamine and dihydroergotamine are nonselective receptor agonists,

while the triptans are selective 5-HT1B/1D receptor agonists.Sumatriptan, Rizatriptan and

zolmitriptan are commonly available triptans. Side effects are common but often mild and transient.

They are contraindicated in individuals with history of cardiovascular or cerebrovascular disease.

Nasal formulations of zolmitriptan is also available. Parenteral dihydroergotamine or sumatriptan

relieves symptoms rapidly in 70-90% of patients.

3. Dopamine antagonists: Oral dopamine antagonists like Metoclopramide enhances the gastric

absorption of triptans and hence should be considered as adjunctive therapy in migraine.

Preventive treatment for migraine:

Migraine prophylaxis is indicated in following situations:

1. Attacks more than 2 per week

2. Duration of each attack >48 hours

3. Attacks of extreme severity

4. Attacks accompanied by prolonged aura

5. Presence of contraindications for acute treatment

13

6. Symptoms substantially interfering daily routine despite acute treatment

7. Special situations like hemiplegic migraine

The exact mode of action of these drugs is unclear. Patients are usually started on a low dose of

chosen treatment, the dose is then gradually increased, up to a reasonable maximum to achieve

clinical benefit. Drug must be taken daily and there is usually a lag of at least 2-12 weeks before

effect is seen. The following drugs are used in prevention of migraine.

1.Betablokers : Propranolol (40-120mg)

2.Tricyclics : Amitriptyline (10-75mg)

3. Anticonvulsants :Sodium valproate (400-600mg), Topiramate (25-200mg)

4. Serotonergic drugs :Flunarizine (5-15mg)

The probability of success with any one of antimigraine drug is 50-70%. Many patients are able to

discontinue medication and experience fewer and milder attacks for long periods, suggesting that

these drugs may alter the natural history of migraine.

14

ANALYSIS ON THE NIDANA PANCHAKA OF

ARDHAVABHEDAKA Dr. Zenica D‟souza

Asst Prof & I/C HOD.

Postgraduate dept of Panchakarma.

Alva‟s Ayurveda Medical College,

Moodabedri.

mÉëÉhÉÉÈ mÉëÉhÉpÉ×iÉÉÇ rÉ§ÉÉÍ´ÉiÉÉÈ xÉuÉåïÎlSìrÉÉÍhÉ cÉ|

rÉSÒ¨ÉqÉÉ…¡qÉ…¡ÉlÉÉÇ ÍvÉUxiÉSÍpÉkÉÏrÉiÉå || -cÉ. xÉÔ 17/12

Ayurveda has given prime importance to Shirah, considering it as one of the three vital organs of

the body where the Prana resides. Charaka has considered Shirah as the supreme structure of the

body which is known as the Uttamanga. This Uttamanga is the abode for Jnanendriyas. It is one

among the Jeevitha Dhama and is also the Moola of the Shareera.

Shirashoola is a common manifestation of this vital organ Shiras experienced by almost

everyone in their life time at some time or other. ‗Ardhavabhedaka‘ is clinically an important type

of shirashoola because it is one among the commonly encountered headaches by individuals that

drags them to clinicians very often. Presenting itself as an episodic paroxysmal headache, this

manifestation adversely influences productivity and routine life style of sufferer thereby

representing a substantial health care burden both clinically and economically. These reasons make

it essential for us to understand and analyse about this particular disease ‗Ardhavabhedaka‘ and then

venture into its treatment.

UÉåaÉqÉÉSÉæ mÉUÏ¤ÉåiÉ iÉiÉÉå AlÉliÉUÇ AÉæwÉkÉÇ|

iÉiÉÈ MüqÉï ÍpÉwÉMç mÉ¶ÉÉiÉç ¥ÉÉlÉ mÉÔuÉïÇ xÉqÉÉcÉUåiÉç|| - cÉ.xÉÔ 20/20

The tools for understanding and diagnosing a disease in Ayurveda are the Nidana Panchaka. In

this paper, an analysis on the Nidana Panchaka of the disease ‗Ardhavabhedaka‘ is attempted.

Even though Charaka explains about Shirorogas in Sutra Stana and Chikitsa stana, a detailed

description of the disease ‗Ardhavabhedaka‘ is seen in Siddhi Stana along with three other varieties

of Shiro Vikaras. He mentions and explains about five types of Shiro Rogas namely Vataja, Pittaja,

Kaphaja, Sannipataja and Krimija Shiro Roga in Sutra and Chikitsa stana. Later he adds the

description of Ardhavabhedaka, Shankhaka, Suryavarta and Anantavata in Siddhi Stana. In

Astodareeya chapter, while numbering Shiro Roga, the Sankhya samprapti is Pancha. However,

Ardhavabhedaka finds a mentioning in Sutra Stana 7th

chapter in the context of kshavatu vega

dharana and 17th chapter while giving examples for Shiro Roga.

The term ‗Shiro Roga‘ stands for a group of diseases related to the Shiras which present with the

cardinal feature pain. Charaka mentions Shiro Ruk as one among the Nanatmaja Vata vikara.

ÍvÉUÉå UÉåaÉ vÉoSålÉ ÍvÉUÉåaÉiÉvÉÔsÉ ÃmÉÉ ÂeÉ AÍpÉSÏrÉiÉå - qÉkÉÑMüÉåvÉ

ÍvÉUÉå UÉåaÉ vÉoSxrÉ vÉÔsÉ LuÉ ÂeÉÉMüUå uÉë¨ÉiuÉÉiÉç| - cÉ¢ümÉÉÍhÉ

15

‗Ardhavabedhaka‘is a Shoola Pradhana Shiro roga pertaining to half of the head. Bheda is

described as - ÍvÉÉU¶É pÉåS: ÍvÉUÉåÌuÉSÉUhÉqÉÏuÉ uÉåSlÉÉ |

Being a Vyadhi involving the Shiras, the term ‗ava‘ stands for bad prognosis.Thus literal

meaning of Ardhavabhedaka is perforating or bursting out like pain in one half of the head either

right or left. Chakrapani makes it clear by saying

- AkÉÉïuÉpÉåSÈ AkÉïqÉxiÉMüuÉåSlÉÉ| (cÉ¢ümÉÉÍhÉ. cÉ. xÉÔ 7/16)

In modern parlance the term Migraine is derived from Greekword ‗hemicrania‘ which means

half of head; it means a headache which effects half of head.

Nidanas

Charaka mentions specific nidanas for Ardhavabhedaka . Almost all other Acharyas mention

samanya nidanas of Shiro Roga.

AkÉÉïuÉpÉåkÉMü ÌlÉSÉlÉ

Â¤ÉÉirÉkrÉvÉlÉÉiÉç mÉÔuÉïuÉÉiÉÉuÉvrÉÉrÉqÉæjÉÑlÉæÈ| uÉåaÉxÉÇkÉÉUhÉÉrÉÉxÉ urÉÉrÉÉqÉæÈ MÑÌmÉiÉÉå AÌlÉsÉÈ|| - cÉ.ÍxÉ 9/74

Ruksha Ashana

This is a Vata prakopaka cause related to food. Even though major surveys are yet not conducted on

the prevalence of Migraine in India, anecdotal evidence suggest that Indian food habit of not having

breakfast and frequent fasting for religious causes are common triggers for Migraine. These food habits

contribute rukshata and laghuta. Intake of Caffeine in the form of tea coffee and cola may put a migraine

patient at risk for rebound headache. Habitual daily intake of 4 to 6 cups of tea, coffee and cola are

indicative of growing prevalence of Migraine in India. These products are Vata Pitta prakopaka and Rakta

dushaka.

Ati /Adhyashana

These causes contribute to Kapha prakopa, Agni mandhya and Ama utpatti which associates Vata

Dosha. Consumption of rich, heavy diet fermented and preserved food products like cheese, butter,

chocolates are again common triggers of migraine.

Purva Vata / Avashyaya

These are Vata prakopaka karanas by virtue of their sita guna. Consumption of refrigerated

foods, ice creams and drinks, living in air conditioned enviornment can be considered under this

cause in the present days.

Ati maithuna

16

Excess sexual intercourse causes Vata prakopa.(cha.ni.1/19). A dull headache commonly

bilateral felt on the back of the head (occipital area) occurs as sexual excitement mounts. It is

probably related to excessive contraction of head and neck muscles since it can be prevented or

relieved by deliberate relaxation of those muscle groups (Paulson and Kalwans 1974).

The second type of headache, more severe and expulsive in onset, appears immediately before

or at the moment of orgasm, presumably caused by the increase in blood pressure at that

time.(Adam 1939). Apart from this menstrual cycle, contraceptive pills, hormone therapy can trigger

attacks of migraine.

Vega Sandharana

UÉåaÉÉÈ xÉuÉåï AÌmÉ eÉÉrÉliÉå uÉåaÉÉåÌ®UhÉkÉÉUhÉæÈ| -A.¾û.xÉÔ 4/21

Vegoddhirana and Dharana play a vital role in the causation of many diseases including

Ardhavabhedaka. These causes are strong Vata prakopa and udavarta karanas. Charaka mentions the

manifestation of Ardhavabhedaka due to suppression of kshavathu vega. Furthermore shira shoola is

a manifestation due to Pureesha vega dharana. Bashpa nigraha is mentioned as a samanya karana for

Shira Shoola. These references strongly support the role of vega dharana in the manifestation of

Ardhavabhedaka.

Manasika vegas are dharaneeya vega. Extreme emotions cause vitiation of shareerika and manasika

doshas. Anger is enlisted as one among the causes of Sonita dusti. Furthermore headache is caused

due to sonita dusti. (Cha.su.24/13). Quite parallel to this, Shira Shoola is regarded as a symptom of

sonata dusti.(Cha.su.17/11).

Ayasa/Vyayama

Ati Vyayama and ayasa again are predominant Vata prakopaka and rakta dushaka karanas.

Isometric exercises that cause strain to the body can precipitate headache. Stress due to time

constaint, sustained exhertion, major hassles or losses, travelling, too much, too little or interrupted

sleeps are triggers for Migraine among individuals. When psychological stress is involved, the

migraine attack often occurs after the period of strain so that some patients tend to have attacks at

weekends or at the beginning of a holiday.

xÉÉqÉÉlrÉ ÌlÉSÉlÉ

xÉÇkÉÉUhÉÉiÉç ÌSuÉÉxuÉmlÉÉiÉç UÉ§ÉÉæ eÉÉaÉUhÉÉlqÉSÉiÉç | EccÉæpÉÉïwrÉÉSuÉvrÉÉrÉÉiÉç mÉëÉauÉÉiÉÉiÉç AÌiÉ qÉæjÉÑlÉÉiÉç ||

aÉlkÉÉSxÉÉiqrÉÉSÉbÉëÉiÉÉiÉç UeÉÉå kÉÔqÉ ÌWûqÉ AÉiÉmÉÉiÉç | aÉÑÂ AqsÉ WûËUiÉSÉlÉÉSÌiÉ vÉÏiÉÉqoÉÑxÉåAlÉÉiÉç ||

ÍvÉUÉåÍpÉbÉÉiÉÉiÉç SÒ¹ÉqÉÉSìÉåSlÉÉiÉç oÉÉwmÉÌlÉaÉëWûÉiÉç | qÉåbÉÉaÉqÉÉlqÉlÉxiÉÉmÉÉ SåvÉMüÉsÉÌuÉmÉrÉïrÉÉiÉç || - cÉ.xÉÔ 17/8

Apart from the specific nidanas mentioned by Charaka, the samanya nidanas also are to be

considered in the manifestation of the disease. Majority of the causes are Vata prakopaka. Pitta and

Kapha prakopaka karana as well as rakta dushaka karanas are observed.

Samprapti

- MÑÌmÉiÉÉå AÌlÉsÉÈ || MåüuÉsÉÈ xÉMüTüÉå uÉÉ AkÉïÇ aÉëWûÏiuÉÉ ÍvÉUxÉxiÉiÉÈ| - cÉ.ÍxÉ 9/74

uÉÉiÉÉSrÉÈ mÉëMÑümrÉÎliÉ ÍvÉUÍxÉ AxÉëÇ cÉ SÒwrÉÌiÉ | iÉiÉÈ ÍvÉUÍxÉ eÉÉrÉliÉå UÉåaÉÉ ÌuÉÌuÉkÉ sÉ¤ÉhÉÉÈ || -cÉ. xÉÔ 17/11

17

All Acharyas invariably accept the involvement of Vata dosha in the samprapti of

Ardhavabhedaka. This is justified by the cardinal feature pain.

vÉÔsÉÇ lÉiÉåï AÌlÉsÉÉiÉç...... A.¾û.xÉÔ 29/6

Vata is the arambhaka dosha in the samprapti. Charaka & Madhava attribute Kapha dosha

involvement at times along with Vata, while Sushrutha considers Tridosha involvement in the

manifestation of this condition. Vagbhata attributes Vata dosha.

The invariable involvement of Rakta as a dushya in Shiroroga is mentioned by Charaka. He

has included ‗Shiro-Ruk‘ in Shonitaja Roga. (Ch. Su. 24/13) Moreover, it has been clearly stated by

Charaka that the vitiated doshas after reaching Shirah vitiates Rakta in that stana to produce Shiro

Roga. Thus Rakta is the main dushya in Ardhavabhedaka. As Rakta dhatu is involved, the srotas

which carries the dhatu is also vitiated. The stana involved is dakshina or vama ardha shira.

The role of Vata probably represents a spreading front of excitation followed by depression

(kapha) of activity of cortical cells. The headache is caused by an in co-ordinated circulatory

response resulting in a sequence of vasoconstriction and vasodilatation of extracranial vessels and a

non specific effect of intracranial metabolic disturbance. This explains the role of Rakta along with

Vata in the manifestation.

Purvarupa

No specific Purvarupas are mentioned in the Samhitas for Ardhavabhedaka Shiroroga. But one

reference regarding Purvarupa of Shiroroga is available in Vaidya Vinod.

qÉlrÉÉaÉëWû aÉÑÂiÉÉ mÉÔuÉï iÉåwÉÉÇ mÉëeÉÉrÉiÉå

Laxana

.... uÉÉ AkÉïÇ aÉWûÏiuÉÉ ÍvÉUxÉxiÉiÉÈ | qÉlrÉÉ pÉëÔ vÉÇZÉ MühÉÉïÍ¤ÉsÉsÉÉOû AkÉåï AÌiÉ uÉåSlÉÉqÉç ||

vÉx§É AUÍhÉÌlÉpÉÉÇ MÑürÉÉïiÉç iÉÏuÉëÉÇ xÉÉå AkÉÉïuÉpÉåSMüÈ | lÉrÉlÉÇ uÉÉ AjÉuÉÉ ´ÉÉå§ÉqÉÌiÉuÉë®Éå ÌuÉlÉÉvÉrÉåiÉç|| cÉ.ÍxÉ 9/75-76

rÉxrÉÉå¨qÉÉÇaÉÉkÉïqÉiÉÏuÉ eÉliÉÉå: xÉÇpÉåS iÉÉåS pÉëqÉ vÉÔsÉeÉÑ¹qÉç||

mÉ¤ÉÉ¬vÉÉWûÉSjÉuÉÉÅmrÉMüxqÉÉ¨ÉxrÉÉkÉïpÉåSÇ Ì§ÉiÉrÉÉ½uÉxrÉåiÉç|| xÉÑ.E. 25/15

AkÉåï iÉÑ qÉÔklÉïÈ xÉÉå AkÉÉïuÉpÉåSMçÈ ||

mÉ¤ÉÉiÉç MÑümrÉÌiÉ qÉÉxÉÉ²É xuÉrÉqÉåuÉ cÉ vÉÉqrÉÌiÉ | AÌiÉ uÉ×®xiÉÑ lÉrÉlÉÇ ´ÉuÉhÉÇ uÉÉ ÌuÉlÉÉvÉrÉåiÉç || A.¾.E 23/7

Pain

Pain is the characterising feature in Ardhavabhedaka. It is a severe pain of perforating or bursting

type just like injury by weapon experienced in half of shiras covering the manya, bhru, shankha,

lalata, karna and akshi. Sushrutha describes the pain as shoola, bheda and toda. This laxana

contributed by Vata dosha and rakta dusti is given a lot of importance by Acharyas by explaining

the nature and type of pains; the anatomical sites involved, the severerity as well as the episodic

paroxysmal occurrence of the headache.

18

Migraine is a triad of paroxysmal headache, vomiting and focal neurological events. Patients with

all three are said to have classical migraine. Those with just paroxysmal headache with or without

vomiting and no focal neurological features are said to have common migraine. The headache may

persist for several days as a severe throbbing hemi cranial headache.

Bhrama

UeÉÈ ÌmÉ¨ÉÉÌlÉsÉÉiÉç pÉëqÉ qÉÉ.ÌlÉ 17/

This laxana is mentioned by Sushrutha for Ardhavabhedaka. It is contributed by Vata, Pitta

and rajas and involves the raktavaha srotas.

Typically, a classical migraine attack starts with a non specific prodroma of malaise and

irritability followed by an ‗aura‘ of a focal neurological event associated with a severe throbbing

pain.

Nayana shravana vinasha

These features are mentioned by Charaka and Vagbhata. They are seen in the advanced stage of

the illness.The aura of migraine is most often in the form of ‗fortification spectra‘, shimmering

silvery zigzag lines which march across the visual field over a short period, sometimes leaving a

trail of visual field loss. In some there is aphasia when the dominant side is involved. Photophobia

and vomiting is commonly involved.

Upashaya / anupashaya

All vyanjaka hetus of Ardhavabhedaka are anupashaya. Rest, calm environment, moderate climate,

fresh and easily digestable shad rasa ahara in right kala and pramana are a few upashayas in

Ardhavabhedaka.

An analysis on the vyadhi bodhaka nidanas of Ardhavabhedaka convey that it is a pain

predominant manifestation of half part of the head which is caused by predominantly prakupitha

prana and vyana vayu and rakta dusti. This understanding enables us to treat the disease better.

19

DIFFERENTIAL DIAGNOSIS OF ARDHAVABHEDAKA

Dr. Shrilatha Kamath

Assistant professor

PG Department of Kayachikitsa

SDMCA, Udupi.

Shalakya tantra is one such branch which has been uniquely named when classifying the

ashtangas of Ayurveda under which even the important branches like prasuti tantra, panchakarma,

etc. have not been separately mentioned. In general all the different types of diseases and treatment

occuring in any part of the body or in any age have been included under a common heading of

kayachikitsa. In specific terms, diseases of the whole body except urdhwanga and diseases occuring

in any age except baalya will be included in the heading of kayachikitsa. This suggests the

uniqueness of shalakya tantra.

In conventional allopathic medicine, among the different specialisations there is no branch as

diseases of head separately. Even the others like diseases of eyes, nose, throat, ear and scalp have

been dealt as separate branches. Only in our science all these have been grouped up and named

together as shalakya tantra. Their close vicinity, physiological and pathological relationships will

explain the cause for this. In general, shiroroga term has been used for a disease which presents

predominently with the symptom of shirashula. Though shirorogas have to include the diseases of

eyes etc. as they are present in the shiras only, they are excluded and defined.

ÍvÉUÉåaÉiÉiuÉålÉ lÉÉxÉÉÌSUÉåaÉåwuÉÌmÉ mÉëÉmiÉåwÉÑ iÉÉlÉç ÌuÉWûÉrÉæuÉÉ¹ÉåSUÏrÉå mÉëÉå£üÉÇUiÉÉlÉåuÉ ÍvÉUÈvÉÔsÉsÉ¤ÉhÉÉlÉç UÉåaÉÉlÉç mÉëmÉccÉålÉ uÉ£ÑüqÉÉWû-

mÉ×jÉÌaÉirÉÉÌS | Cha.Su.17

Shiras consists of prana along with the other indriyas in its abode. Classics have mentioned

that diseases which affect the shiras have to be treated early, as shiras is considered as a pradhana

marma and marma paripalana is a must for maintaining health.

mÉëÉhÉÉÈ mÉëÉhÉpÉ×iÉÉÇ rÉ§É Í¤ÉiÉÉÈ xÉuÉåïÎlSìrÉÉÍhÉ cÉ |

rÉSÒ¨ÉqÉÉlaÉqÉlaÉÉlÉÇ ÍvÉUxiÉSÍpÉkÉÏrÉiÉå || Cha.Su.17/12||

½ÑSrÉå qÉÔÎlkÉï oÉxiÉÉæ cÉ lÉ×hÉÉÇ mÉëÉhÉÉÈ mÉëÌiÉÌ¸iÉÉÈ |

iÉxqÉÉ¨ÉåwÉÉÇ xÉSÉ rÉ¦ÉÇ MÑüÌuÉïiÉ mÉËUmÉÉsÉlÉå || 9 ||

AÉoÉÉkÉuÉeÉïlÉÇ ÌlÉirÉÇ xuÉxjÉuÉ×¨ÉÉlÉÑuÉiÉïlÉqÉç |

EimÉ³ÉÉÌiÉïÌuÉkÉÉiÉ¶É qÉqÉÉïhÉÉÇ mÉËUmÉÉsÉlÉqÉç || 10 || Cha. Si. 9/9-10

As is well known, when the roots of a tree gets diseased or destructed the whole tree gets

destroyed, similarly when the shiras (refered as mula of sharira) gets diseased, it produces a serious

malady in the whole body. So early and effective treatment for shirorogas is compulsary.

ÍqÉjrÉÉSØ¹É ÌuÉMüÉUÉ ÌWû SÒUÉZrÉÉiÉÉå iÉjÉæuÉ cÉ |

iÉjÉÉ SÒwmÉËUqÉ×wOûÉ¶É qÉÉåWûrÉårÉÑÈ ÍcÉÌMüixÉMÇ |(xÉÑ.xÉÔ.10/6)

Sushruta refers that if a disease is not properly examined, interpreted and diagnosed the

physician will be confused regarding the treatment. So diagnosis should always be perfect. It should

20

be done only after a absolute differential diagnosis. Only then a proper suitable target oriented

treatment is possible in the disease.

In numbering of the shirorogas though there is a bit of difference of opinion as charaka says

only 5, Sushruta, Madhavakara, bhavamishra 11 and Vagbhata says 19, ultimate opinion about the

shirogata rogas is the same, i.e. disease having headache as the cardinal feature.

Ardhavabhedaka or ardhabheda is a type of shiroroga where severe headache in the half

portion of the head is a presenting cardinal feature. The disease is produced due to vata kapha

pradhana tridoshas.

Among the total 11 shirorogas mentioned, 5 are doshaja and the others are kshayaja, krimija,

ardhavabhedaka, anantavata, suryavarta and shankhaka. Thus when diagnosing the disease

ardhavabhedaka the other diseases which present with the symptom headache have to be excluded

using the clinical manifestations and investigations.

For a proper, systematic and easy differentiation of the diseases, they can be categorised into,

1) Disorders which can be differentiated easily.

2) Disorders coming in the way of diagnosis.

Among the 11 diseases, pittaja, kaphaja, raktaja, kshayaja, krimija and shankhaka fall under

the first category and the other diseases like anantavata, vataja shiroroga, sannipataja shiroroga and

suryavarta can be included in the second group.

To have a clear picture of the disease migraine viz-a-viz ardhavabhedaka, the same should be

elaborately understood first. Later the other diseases which need differentiation will be discussed.

Though in the list of 11 shiro (gata)rogas mentioned by sushruta, vataja is the first one and for

differentiation purposes it will be considered later. The easily differentiated disorders will be taken

into consideration first for exclusion.

ARDHAVABHEDAKA

Nidana:

Â¤ÉÉirÉkrÉvÉlÉÉiÉç mÉÔuÉïuÉÉiÉÉuÉvrÉÉrÉqÉæjÉÑlÉæÈ |

uÉåaÉxÉÇkÉÉUhÉÉrÉÉxÉurÉÉrÉÉqÉæÈ MÑüÌmÉiÉÉåÅÌlÉsÉÈ || 74 ||

MåüuÉsÉÈ xÉMüTüÉå uÉÉÅkÉïÇ aÉ×WûÏiuÉÉ ÍvÉUxÉxiÉiÉÈ | Cha.Si.9/74-75|

Even other nidanas which increase vata and kapha can be taken here to produce this disease.

This disease is of two types vata and vatakaphaja. Based on the presentation the migraine gets

included in vataja ardhavabhedaka and when there is unilateral sinusitis it is considered as

vatakaphaja ardhavabhedaka. This is supported by the fact that sushruta refers this disease as

tridoshaja and charaka explains the usage of pratishyaya chikitsa in ardhavabhedaka.

Clinical fatures:

Character of pain- Severe pain, Friction type (shastra arani nibha), bheda, toda, Pain in half of neck,

brows,temporal, ears, eyes and forehead. Time factor which is quoted as once in 10, 15, 30 days or

suddenly is the unique feature helping in diagnosis.

-

Aggravating & relieving factors

21

Disease has a sudden onset which begins without reason and it also subsides by itself.

Associated symptoms-

Giddiness, Eye disease and Ear disease(naasha-if disease aggravates) are mentioned.

qÉlrÉÉpÉëÔvÉXçZÉMühÉÉïYvÉçÈCsÉsÉÉOûÉkÉåïÅÌiÉuÉåSlÉÉqÉç || 75 ||

vÉx§ÉÉUÍhÉÌlÉpÉÉÇ MÑürÉÉï¨ÉÏuÉëÉÇ xÉÉåÅkÉÉïuÉpÉåSMüÈ |

lÉrÉlÉÇ uÉÉÅjÉuÉÉ ´ÉÉå§ÉqÉÌiÉuÉ×®Éå ÌuÉlÉÉvÉrÉåiÉç | Cha.Si.9/75-76|

Diseases considered here-

Different types of migraine

Cluster headache

Unilateral sinusitis.

PITTAJA SHIROROGA-

Nidana:

MüOèuÉqsÉsÉuÉhÉ¤ÉÉUqÉ±¢üÉåkÉÉiÉmÉÉlÉsÉæÈ |

ÌmÉ¨ÉÇ ÍvÉUÍxÉ xÉÇSÒ¹Ç ÍvÉUÉåUÉåaÉÉrÉ MüsmÉiÉå ||22|| Cha.Su.17/22|

qÉlÉxiÉÉmÉÉ…. Cha.Su.17/10

The different etiological factors like usage of katu, amla, lavana foods, madya, exposure to

anger or any other manastapa indicate the vitiation of the annavaha srotas along with pitta dushti.

Headache thus produced due to disorders of gastrium are included. Exposure to atapa increases the

headache of acute maxillary sinusitis

.

Clinical features:

Character of pain- Severe burning sensation with pain, feeling as though the burning coal covers the

body, and smoky sensation from the head are the diagnostic features of pittaja shiroroga.

Relieving factors (upashaya anupashaya)- Sheeta prayoga (exposing to cold foods and cold climate)

and night time relieve the symptoms. The severe burning sensation and the relief by cold articles

indicate the underlying inflammatory process of either acute sinusitis or gastritis producing the

symptom of headache

.

Associated symptoms- Burning in nose and eyes, Giddiness, Sweating, Fever, Altered consciousness

and Thirst indicate the diseases like Tumours of trigimenal nerve and Post herpetic neuralgia

S½iÉå ÃerÉiÉå iÉålÉ ÍvÉUÈ vÉÏiÉÇ xÉÑwÉÔrÉiÉå |

S½åiÉå cÉ¤ÉÑwÉÏ iÉ×whÉÉ pÉëqÉÈ xuÉåS¶É eÉÉrÉiÉå ||23||

vÉÏiÉÇ xÉÑwÉÔrÉiÉå vÉÏiÉÍqÉcNûÌiÉ || Cha.Su.17/23-24||


22

Acute sinusitis

APD related headache

Tumours of trigimenal nerve

Post herpetic neuralgia

KAPHAJA SHIROROGA:

Nidana:

AÉxrÉÉxÉÑZÉæÈ xuÉlmÉxÉÑZÉæaÉÑïÃÎxlÉakÉÉÌiÉpÉÉåeÉlÉæÈ |

¤sÉåwqÉÉ ÍvÉUÍxÉ xÉÇSÒ¹È ÍvÉUÉåUÉåaÉÉrÉ MüsmÉiÉå || Cha.Su.17/24||

……..ÉSuÉvrÉÉrÉÉiÉç mÉëÉauÉÉiÉÉSÌiÉqÉæjÉÑlÉÉiÉç ||8||

aÉlkÉÉSxÉÉiqrÉÉSÉbÉëÉiÉÉSìeÉÉåkÉÔqÉÌWûqÉÉiÉmÉÉiÉç |

aÉÑuÉïqsÉWûËUiÉÉSÉlÉÉSÌiÉ vÉÏiÉÉqoÉÑxÉåuÉlÉÉiÉç ||

…….qÉÉSìÉåSlÉÉSÕ|wmÉÌlÉaÉëWûÉiÉç |

qÉåbÉÉaÉqÉÉlqÉlÉxiÉÉmÉÉWåûvÉMüÉsÉÌuÉmÉrÉïrÉÉiÉç || Cha.Su.17/8-10||

Consuming food articles like guru, snigdha, sheet jala, getting exposed to avashyaya, vata,

gandha, raja, dhuma, hima etc. will lead to or aggravate the symptoms of sinusitis due to nasal

allergy as is well known pratishyaya is a nidanarthakra vyadhi to shiroroga. Sedentary life style and

lazing down is also a cause to increase both the allergic manifestations or even chronic sinusitis. The

nidana ama includes the headache induced due to indigestion.

Clinical fatures:

Character of pain- Mild dull headache, Heaviness of the head, Stiffness, Coldness and Dozing are

the diagnostic features of kaphaja shiroroga.

Aggravating & relieving factors- It Aggravates as the night progresses and subsides by opposite

qualities of kapha like ushna laghu etc.

Associated symptoms- Secretions in shira and throat, Reduced pulsations, Swelling in orbit and face,

Drowsiness, Laziness, Loss of taste, Vomiting and Itching in the ears.

The dull ache includes chronic sinusitis and also the ache of intra cranial tumors. Heaviness

and stiffness are the two features seen as a consequence of filled up sinuses as movement will

aggravate pain. Frontal sinusitis presents with dozy and lazy feeling. Early morning pain and

vomiting are unique to sinus affliction. Increased secretions suggest posterior sinus disease. Orbit

and facial swelling suggest ethmoidal and maxillary sinus involvement.

ÍvÉUÉå qÉlSÃeÉÇ iÉålÉ xÉÑmiÉÇ ÎxiÉÍqÉiÉpÉËUMüqÉç |

pÉuÉirÉÑimÉ±iÉå iÉlSìÉ iÉjÉÉÅÅsÉxrÉqÉUÉåcÉMü || Cha.Su.17/25||


Chronic sinusitis

Acute rhinitis

Intra cranial tumor

23

RAKTAJA SHIROROGA-

Nidana:

All pittakara nidanas are responsible for rakta dushti.

Clinical fatures:

Character of pain- Tenderness is considered to be the cardinal feature of the disease along with the

association of pittaja symptoms like burning, fever etc.

Aggravating & relieving factors- Sheeta and ratri kala

Localised tenderness associated with burning pain is only seen when there is a palpable

inflammation. Cranial arteritis is a condition which afflicts more of the superficial temporal artery

and sometimes all the arteries of the cranium. Here the arteries will be thick, palpable tender and

non pulsatile

.

KSHAYAJA SHIROROGA-

Nidana:

x§ÉÏ mÉëxÉÇaÉÉiÉç ApÉÏbÉÉiÉÉiÉç AjÉuÉÉ SãWûMüqÉïhÉÉ |

Í¤ÉmÉëÇ xÉÇeÉÉrÉiÉã M×ücNíûÈ ÍvÉUÉãUÉãaÉÈ ¤ÉrÉÉiqÉMüÈ || ÌuÉSãWû

The nidanas mentioned in this disease refer to the different causes of vatavridhi and

dhatukshaya which in turn can give rise to pakshaghata, pandu like diseases

.

Clinical fatures:

Character of pain- Sudden onset, Severe pain and Pricking type of pain are diagnostic.

Aggravating & relieving factors- Sweda, Vamana, Dhuma, Raktamokshana and nasya aggravate the

symptoms as they worsen the kshaya which is the cause of the disease. Vatahara measures like

bruhmana help.

Associated symptoms- Emptiness, Giddiness, Restless eyes, Unconsciousness and Fatigue and also

other vata pitta symptoms

uÉÉiÉÌmÉ¨ÉÉiqÉMü ÍsÉaXÇ urÉÉÍqÉ´ÉÇ iÉ§É sÉ¤ÉrÉãiÉç |

pÉëqÉÌiÉ iÉÑ±iÉã vÉÔlrÉÇ ÍvÉUÉãÌuÉpÉëÉliÉlÉã§ÉiÉÉ|

qÉÔcNûÉï aÉÉ§ÉÉuÉxÉÉS¶É ÍvÉUÉãUÉãaÉã ¤ÉrÉÉiqÉMãü || ÌuÉSãWû

uÉxÉÉ oÉsÉÉxÉ¤ÉiÉxÉÇpÉuÉÉlÉÉÇ ÍvÉUÉãaÉiÉÉlÉÉÍqÉWû xÉÇ¤ÉrÉãiÉç |

¤ÉrÉmÉëuÉ×iÉÈ ÍvÉUxÉÉãÍpÉiÉÉmÉÈ Mü¹ÉãpÉuÉãiÉç EaÉëÂeÉÉã AÌiÉqÉÉ§ÉqÉç ||

xÉÇxuÉãSlÉcNûSïlÉ kÉÔqÉlÉxrÉæÈ AxÉ×ÎauÉqÉÉã¤Éæ¶É ÌuÉuÉ×Ì®qÉãÌiÉ | xÉÑ. E. 25


24

Severe headache seen in the prodromal phase of stroke(in 1/3rd

of the cases in cerebral

infarction or ischemia) indicate ekadesha raktakshaya. Anemia and Hypoglycemia as a cause of

headache is also produced due to the kshaya pathogenesis.

KRIMIJA SHIRIROGA-

Nidana:

ÌiÉsÉ¤ÉÏUaÉÑQûÉeÉÏhÉïmÉÔÌiÉxÉÎQèMühÉïpÉÉåeÉlÉÉiÉç |

YsÉåSÉåÅxÉ×YMüTüqÉÉÇxÉÉlÉÉÇ SÉåwÉsÉxrÉÉåmÉeÉÉrÉiÉå ||27||

iÉiÉÈ ÍvÉUÍxÉ xÉÇYsÉåSÉiÉç Ì¢üqÉrÉÈ mÉÉmÉMüqÉïhÉÈ |

eÉlÉrÉÎliÉ ÍvÉUÉåUÉåaÉÇ eÉÉiÉÉ oÉÏpÉixÉsÉ¤ÉhÉqÉç || Cha.Su.17/27-28||

Clinical fatures:

Character of pain- Severe pain, Pricking type of pain, Destructive(eaten up), Incising or excising

type and Burning pain with other samanya krimi lakshanas.

Associated symptoms- Blood stained watery nasal discharge, Itching, Swelling, Foul smell, Itching

in palate, Cough, Tinnitus, Delerium, Fever and Reduced strength are the other symptoms of the

disease. The last three symptoms indicate the affliction of cranium and according to the area

afflicted the symptoms like delerium etc. are seen. Intracranial abscess, encephalitis and meningitis

produced usually due to the bacterial infection can be considered here.

urÉ±cNåûSÃeÉÉMühQÕûvÉÉåTüSÉæaÉïirÉSÒÈÎZÉiÉqÉç |

Ì¢üÍqÉUÉåaÉÉiÉÑUÇ ÌuÉ±ÉiÉç Ì¢üqÉÏhÉÉÇ SvÉïlÉålÉ cÉ || Cha.Su.17/29||

ANANTAVATA-

Nidana:

SÒ¹É SÉåwÉÉx§ÉrÉÉå……….. Cha.Si.9/84-86

Clinical fatures:

Character of pain- Severe pain, Pain in eyes, brows, temporal, manya and ghata(lower neck) and

Sudden onset pain is diagnostic.

Associated symptoms- Temporal pulsations, Eye diseases and Lock jaw are the important associated

features which are necessary for the diagnosis which are seen depending on the affliction of the

branches of the trigeminal nerve.

….qÉlrÉÉmÉ¶ÉÉ®ÉOûÉxÉÑ uÉåSlÉÉqÉç || 84 ||

iÉÏuÉëÉÇ MÑüuÉïÎliÉ xÉÉ cÉÉÍ¤ÉpÉëÔvÉXçZÉåwuÉuÉÌiÉ¸iÉå |

25

xmÉlSlÉÇ aÉhQûmÉÉµÉïxrÉ lÉå§ÉUÉåaÉÇ WûlÉÑaÉëWûqÉç || 85 ||

xÉÉåÅlÉliÉuÉÉiÉxiÉ……… | Cha.Si.9/84-86


Trigeminal neuralgia

SHANKHAKA-

Nidana:

U£üÌmÉ¨ÉÉÌlÉsÉÉ SÒ¹ÉÈ……….. Cha.Si.9/71

Clinical fatures:

Character of pain- Severe pain, Burning, Toda and Cutting type of pain are seen in the disease.

Associated symptoms- Redness, Swelling (daruna shopha) in shankha, later spreads to gala and

obstructs the gala associated with trushna, murcha, jwara, pralapa and bhrama are observed in this

disease.

……..vÉXçZÉSåvÉå ÌuÉqÉÔÎcNïûiÉÉÈ |

ÌiÉuÉëÂaSÉWûUÉaÉÇ ÌWû vÉÉåTüÇ MÑüuÉïÎliÉ SÉÂhÉqÉç || 71 ||

xÉ ÍvÉUÉå ÌuÉwÉuÉ²åaÉÏ ÌlÉÂkrÉÉvÉÑ aÉsÉÇ iÉjÉÉ |

Ì§ÉUÉ§ÉÉeeÉÏÌuÉiÉÇ WûÎliÉ vÉXçZÉMüÉå lÉÉqÉ lÉÉqÉiÉÈ || 72 ||

mÉUÇ §rÉWûÉeeÉÏuÉÌiÉ cÉåiÉç mÉëirÉÉZrÉÉrÉÉcÉUåiÉç Ì¢ürÉÉqÉç | Cha.Si.9/71-72|


SANNIPATAJA SHIROROGA-

Nidana:

Factors mentioned in ekadoshaja types of shiroroga.

Clinical fatures:

Character of pain- Severe pain, Burning sensation and Heaviness indicate tridosha involvement.

Aggravating & relieving factors- Vata hara measures help as it is the inevitable dosha in shirashula.

Associated symptoms- Giddiness, Tremors, Intoxication, Thirst and Drowsiness

uÉÉiÉÉcNÕûsÉÇ pÉëqÉÈ MüqmÉÈ ÌmÉ¨ÉÉWûÉWûÉå qÉSxiÉ×wÉÉ|

MüTüÉWÒûÃiuÉÇ iÉlSìÉ cÉ ÍvÉUÉåUÉåaÉå Ì§ÉSÉåwÉeÉå || Cha.Su.17/26||

26


Subacute sinusitis

SURYAVARTA

-

Nidana:

xÉlkÉÉUhÉÉSeÉÏhÉÉï±æqÉïÎxiÉwMüÇ U£üqÉÉÂiÉÉæ |

SÒ¹Éæ SÕwÉrÉiÉxiÉccÉ SÒ¹Ç iÉÉprÉÉÇ ÌuÉqÉÔÎcNïûiÉqÉç | Cha.Si.9/79

Any vata or pitta vitiating factors other than these can also produce the disease. The term

mastishka quoted here which gets vitiated and liquified due to the nidanas and the santapa, is not

applying to the brain as is literally taken. But it refers to the area in the shiras where the doshas get

collected and gets liquified in the disease. Though charaka has not identified kapha dosha sushruta

mentions tridosha and also nimi says clearly in the samprapti about the involvement of tama and

kapha. In the ratrikala tama and kapha increases, produces srotorodha, in turn increases vata and

causes ruja. Due to suryasantapa in noon kapha vilayana occurs and later pain gradually reduces.

Clinical fatures:

Character of pain- Severe pain, Pain in eyes, brows, temporal and forehead and also typical diurnal

variation increasing in mid day

Aggravating & relieving factors- Pain will be mild in the morning, Aggravates in noon and Subsides

in evening. Also alternative relief by cold or hot articles is observed in patients.

xÉÔrÉÉåïSrÉåÇÅvÉÑxÉÇiÉÉmÉÉSèSìuÉÇ ÌuÉwrÉlSiÉå vÉlÉæÈ |

iÉiÉÉå ÌSlÉå ÍvÉUÈvÉÔsÉÇ ÌSlÉuÉ×k±É ÌuÉuÉkÉïiÉå || 80 ||

ÌSlÉ¤ÉrÉå iÉiÉÈ xirÉÉlÉå qÉÎxiÉwMåü xÉÇmÉëvÉÉqrÉÌiÉ |

xÉÔrÉÉïuÉiÉïÈ xÉ………| Cha.Si.9/80-81|


Frontal sinusitis

VATAJA SHIROROGA-

Nidana:…..

EccÉæpÉÉïwrÉÉprÉÉÇ iÉÏ¤hÉmÉÉlÉÉiÉç mÉëeÉÉaÉUÉiÉç |

vÉÏiÉqÉÉÃiÉxÉÇxmÉvÉÉïfrÉuÉÉrÉÉ²åaÉÌlÉaÉëWûÉiÉç ||16||

EmÉuÉÉxÉÉSpÉÏ±ÉiÉÉÌ²UåMüÉ²qÉlÉÉSÌiÉ |

oÉÉwmÉvÉÉåMüpÉrÉ§ÉÉxÉÉ°ÉUqÉÉaÉÉïÌiÉMüvÉïlÉÉiÉç ||17||

ÍvÉUÉåaÉiÉÉÈ ÍxÉUÉ uÉ×²Éå uÉÉrÉÑUÉÌuÉvrÉMÑümrÉÌiÉ |

iÉiÉÈ vÉÔsÉÇ qÉWû¨xrÉ uÉÉiÉÉiÉç xÉqÉÑmÉeÉÉrÉiÉå || cha.su.17/16-18||

27

Headache produced due to excessive exhertion like speaking in high pitch, night awakening,

exposure to cold breeze, controlling urges, hunger and emotions is included here. Stress is a initiator

and also a precipitator of headache in types of migraine.

Clinical fatures:

Character of pain- Intermittent pain, Severe pain, Pricking, cutting, burning type of pain and Pain in

temporal, neck, forehead are diagnostic of vataja type.

Aggravating & relieving factors-Subsides and occurs without identified reason.Night time

aggravates the symptom. Tying, fomentation, massage and oleation subsides the condition.

Associated symptoms- Giddiness, Increased pulsations, Eye pain, Photophobia, Tinnitus, Neck

stiffness, Lock jaw and nasal discharge are also noticed.

ÌlÉxiÉÑ±åiÉå pÉ×vÉÇ vÉaÉÉæ bÉÉOûÉ xÉÇÍpÉ±iÉå iÉjÉÉ |

xÉpÉëÔqÉkrÉÇ sÉsÉÉOûÇ cÉ iÉmÉiÉÏuÉÉÌiÉuÉåSlÉqÉç ||19||

uÉkrÉåiÉå xuÉlÉiÉÈ ´ÉÉå§Éå ÌlÉwM×üwrÉåiÉå CuÉÉÍ¤ÉhÉÏ |

bÉÔhÉïiÉÏuÉ ÍvÉUÈ xÉuÉï xÉÇÍkÉprÉ CuÉ qÉÑcrÉiÉå ||20||

xTÑüUirÉÌiÉ ÍxÉUÉeÉÉsÉÇ xiÉprÉiÉå cÉ ÍvÉUÉåkÉUÉ |

ÎxlÉakÉÉåwhÉqÉÑmÉvÉåiÉå cÉ ÍvÉUÉåUÉåaÉåÅÌlÉsÉÉqÉïMåü || Cha.Su.17/19-21||

The increased pulsations indicate the condition of migraine. This is the reason why

vagbhata has mentioned ardhavabhedaka as a type of vataja shiroroga. So when diagnosing

ardhavabhedaka it is not possible to exclude vataja type. Ardhabheda is a special type of vataja

shiroroga. To conclude when migraine is seen in half of the head as a typical presentataion, the

diagnosis will be ardhavabheda and when migraine is seen in whole head, it is vataja shiroroga.


All diseases which present with the severe globalised pain and which is not localised to one

region of head gets included here.

It can include-

Neuralgia- Trigeminal, temperomandibular and glossopharyngeal

Vascular headache (Migraine, Hypertension, S.A. hemorrhage, Aneurysm, Alcohol,

Thrombosis, Giant cell arteritis)

Referred headache (Eyes-Refractive errors, glaucoma, iritis; Ears-Otitis, mastoiditis, E.T.blockage,

8th

nerve lesions, furunculosis, tumors; Teeth- Infected sockets & dental roots; Paranasal sinus

disease; Neck- cervical disease

Metabolic causes (hypoglycemia, alkalosis, acidosis. )

Functional headache(Benign)

28

“MANAGEMENT OF ARDHAVABHEDAKA BY

SHAMANOUSHADHI”

DR.A.S.PRASHANTH

Professor

Department of Post Graduate Studies

Ayurveda Maha Vidyalaya

Hubli, Karnataka – 580024

Telephone: 0836-2335575

Mob: +91-94481-35575

Mail: [email protected]

Introduction:

Ardhavabhedaka named because of its classical symptom i.e. severe pain in the half of the

frontal region and due to various similarities in the clinical features it is usually compared with

Migraine headache. Ardhavabhedaka as described in Ayurvedic texts, under the context of

Shirorogas by many Acharayas. Acharya charaka considered this disease is because of vitiation of

vata or vatakapha. Acharya vagbhata opines that this disease is due to the vitiation of vata alone.

Whereas Acharya sushruta considered this disease due to the vitiation of tridosha.It is one such

shool producing disease, which is characterized by severe headache and episodic in nature.

Samprapti: (Pathogenesis)

The pathogenesis of disease starts from aggravation of dosha and it is consequent to

indulgence in etiological factors. Hence, renunciation of etiological factors is the first code of

treatment. In pathogenesis, Nidana is the efficient cause, dosha are the material cause and dosha

dushya sammurchchana is the essential cause.

The habitual use of substances having identical properties aggravates the dosha. Regarding

vitiation of doshas, the etiological factors of Ardhavabhedaka are mainly of vata kaphaja (as per

charaka) and tridoshaja (as per sushruta).

Simultaneously some of the Nidanas also cause khavaigunya in Srotas, Which is necessary

for Sthanasamshraya of dosha (4th

stage of samprapti kriyakala). Etiological factors mentioned in

classics for the vitiation of channels (Srotodushti) should be considered for Khavaigunya too. All

these factors viz. dosha dushti, khavaigunya, dushyadushti and agnimandhya are of profound

importance in pathogenesis of a disease.

Symptoms:

o Severe pain in half of the head, there by causing excruciating pain in the sternomastoid region,

eyebrows, temples, ears, eyes and forehead of that half side

o Piercing pain suddenly after a fortnight or ten days

o If exceedingly aggravated, this ailment may even destroy the eyes and the ears of the patient

o Giddiness


29

General line of treatment for Ardhavabhedaka:

For treatment of this ailment, the therapies to be used are as follows:-

1. Catuh-sneha (four types of Sneha – Taila, Ghrita, Vasa, Majja) to be taken in heavy dose.

2. Siro-virechana (inhalation therapy for the elimination of morbid matter from the head)

3. Kaya-virechana (emesis and purgation therapy for the elimination of morbid matter from the

body).

4. Nadi-sweda.

5. Jirna ghrita (10 yrs old ghee).

6. Niruha and Anuvasana types of medicated enema.

7. Upanaha.

8. Shirobati.

9. Dahan (cauterization).

10. Therapies prescribed for pratishaya and shiro roga.

11. Lepa, Jangal mamsa, Ksheeranna bhojana, Ghrita sevana are indicated.

12. Siraveda is also indicated by Acharya Sushruta.

SPECIFIC SHAMANOUSHADHI‟S IN ARDHAVABHEDAKA:

Kashayam:

1. Pathyakshadhatryadi / Pathya Shadangam Kashayam: (Sharangadhara Samhita)

Ingredients: Hareetaki, Vibheetaki, Amalaki, Bhunimba, Nimbha, Nisha and Guduchi.

Indications: Shirashoola, Ardhavabhedaka, Suryavartha, Sankhaka etc

Usage: Internal

Dosage: 60ml twice daily on empty stomach.

2. Varanadi Kashayam: (Ashtanga Hrudaya)

Ingredients: Varana, Sairyaka, Dhana, Morata, Vilva, Vishanika, Karanja etc

Indications: Shirashula, Gulma, Vidradhu, Medoroga etc

Usage: Internal


3. Drakshadi Kashayam: (Ashtanga Hrudaya)

Ingredients: Draksha, Madhooka, Lodhra, Madhuka, Kashmarya, Sariba, Mushta etc

Indications: Jwara, Madatyaya, Chardi, Bhrama etc

Usage: Internal


4. Kalyanakam Kashayam: (Ashtanga Hrudaya)

Ingredients: Sariba, Nishadwaya, Parnidwaya, Manjishta, Nagakesara, Ela etc

Indications: Unmada, Apasmara, Visha, Pandu etc

Usage: Internal


5. Vidaryadi Kashayam: (Ashtanga Hrudaya)

Ingredients: Vidari, Panchangula, Vrishchikali, Vrishchiva, Devahwa etc

Indications: Kshaya, Gulma, Shoola, Vata Pitta Vikaras

Usage: Internal


Arishtam:

1. Abhayarishtam: (Bhaishajya Ratnavali)

30

Ingredients: Abhaya, Draksha, Vidanga, Madhuka pushpa, Guda etc

Indications: Arshas, Kshaya, Pandu, Jwara, Visha etc

Usage: Internal


2. Dasamoolarishtam : (Bhaishajya Ratnavali)

Ingredients: Dasamoola, Chitraka, Pushkaramoola, Lodhra, Guduchi, Dhatri etc

Indications: Kshaya, Shoola, Kasa, Swasa, Mutra vikaras etc

Usage: Internal


Rasoushadhi:

1. Shirashooladi Vajra Rasa :

Ingredients: Parada, Gandhaka, Lohabhasma, Tamrabhasma, Guggulu, Triphala, Kushta, Madhuka,

Gokshura, Vidanga, Dashamula etc

Indications: Suryavarta, Anantavata, Sankhaka, Ardhavabhedaka

Usage: Internal

Dosage:125 to 250mg

2. Svarna Soota Sekhara Rasa :

Ingredients: Svarna Bhasma, Parada, Gandhaka, Tankana, Vatsanabhi, Tamra Bhasma, Trikatu,

Dhattura Bija, Caturjataka, Bilva Phala Majja, Sankha Bhasma, Kacura, Bhringaraja Svarasa

Bhavanartha etc

Indications: Amlapitta, Chardi, Hikka, Sitapitta, Hrllasa

Usage: Internal

Dosage:125 to 250 mg b.i.d/t.i.d

3. Vata Vidwamsa Rasa:

Ingredients: Rasa, Gandhaka, Naga Bhasma, Vanga Bhasma, Loha Bhasma, Tamra Bhasma,

Nischandra Vyoma Bhasma, Kana, Tankana, Sunthi, Maricha , Pippali, Nagara, Vatsanabha,

Vyosha, Vara, Citraka, Markava, Kushta, Nirgundi, Bhanu Dugdha, Mahi Dhatrika Nira, Chandrika

Nira, Nimbu Nira etc

Indications: Vataja Sula, Vataja Grahani, Kapha Roga, Sutika Vata

Usage: Internal

Dosage:250mg

4. Ekangaveera Rasa:

Ingredients: Sudha Gandhaka, Mrta Suta, Kanta Lauha Bhasma, Vanga Bhasma, Naga Bhasma,

Tamra Bhasma, Abhra Bhasma, Tikshana Bhasma, Nagara, Maricha, Kana, Vara Drava, Vyosha

Drava, Nirgundi Drava, Vahni Drava, Markavaja Drava, Sigru Drava, Kushta Drava, Dhatri Drava,

Visa Musti Rasa, Arka Rasa, Hata Rasa,Ardraka Rasa etc

Indications: Ardita, Dhanurvata, Avabahuka, Vataroga

Usage: Internal

Dosage:125mg

4. Brihat Soota Sekhara Rasa:[SUTA SHEKHARA RASA]

Ingredients: Suddha Suta, Tankana, Vatsa Nagaka, Sunthi, Marica, Unmatta Bija, Pippali,

Gandhaka, Tamra Bhasma, Ela, Tvak, Patra, Nagakesara, Sankha Bhasma, Bilva Majja, Kacoraka,

Bringa Raja Rasa etc

Indications: Amla Pitta, Chardi, Gulma, Kasa, Grahani, Tridoshaja Atisara

31

Usage: Internal

Dosage:125mg

6. Manasamitra Vati Gulika: (Sahasrayoga)

Ingredients: Bala, Nagabala, Vilva, Sankhapushpi, Pushkara, Vacha etc

Indications: Manasa vikaras

Usage: Internal

Dosage: 500mg tablets twice daily after food.

Ghrita:

1. Mayura Ghrita: (Charaka)

Ingredients: Dasamoola, Bala, Rasna, Triphala, Madhuka, Mayura pakshi etc

Indications: Shiroroga, Ardita, Urdhwajatru Rogas etc

Usage: Internal

2. Mahamayura Ghrita : (Charaka)

Ingredients: Same like Mayura Ghrita, Added more Kalka like Triphala, Jeevaniya gana etc

Indications: Shiroroga, Kasa, Swasa, Shosha etc

Usage: Nasya, Paana, Abhyanga, Vasti prayoga

3. Varanadi Ghrita : (Ashtanga Hrudaya)

Ingredients: Varana, Sairyaka, Dhana, Morata, Vilva, Vishanika, Karanja etc

Indications: Shirashula, Gulma, Vidradhu, Medoroga etc

Usage: Internal

Taila:

1. Kumkumadi Taila: (Yogaratnakara)

Ingredients: Kumkuma, Chandana, Lodhra, Raktacandana, Ushira, Manjishta etc

Indications: Mukha roga, Twak vikaras

Usage: External application

2. Bala Hathadi Taila : (Sahasrayoga)

Ingredients: Bala, Amalaki, Guduchi, Mudga, Masha etc

Indications: Shiroruja

Usage: External application over the head

3. Asana Vilwadi Taila : (Sahasrayoga)

Ingredients: Asana, Vilva, Bala, Guduchi etc

Indications: Shiroroga, Karnaroga


4. Bala Dhatryadi Taila : (Sahasrayoga)

Ingredients: Bala, Amalaki, Guduchi, Ushira, Hrivera, Chandana, Yasti etc

Indications: Shiroroga, Netraroga, Pitta Vata Vikaras


5. Rasnadi Taila : (Charaka)

Ingredients: Rasna, Shaliparni, Prishniparni, Brihati, Kantakari, Gokshura etc

Indications: Shiroroga

32

Usage: Nasya

6. Baladya Taila : (Charaka)

Ingredients: Bala, Madhooka, Yashtyahva, Vidari, Chandana etc

Indications: Shiroroga, Urdhwagata rogas, Pitta Vikaras

Usage: Nasya

Choorna:

1. Krishnadi Vati : (Sahasrayoga)

Ingredients: Kundurushkam, Sahasravedi, Sanninayakam etc

Indications: Shirashoola

Usage: External application over the forehead as paste with rose water

2. Rasnadi Choorna: (Sahasrayoga)

Ingredients: Sugandhavacha, Devadaru, Sanninayaka, Ashwagandha, Vacha etc

Indications: Shirashoola, Timira, Kapha vikaras etc

Usage: External application over the forehead as paste with rose water / ginger juice

3. Kachooradi Choorna: (Sahasrayoga)

Ingredients: Yashti, Bala, Dhatri, Chandana, manjishta, Ushira etc

Indications: Shirashoola, Daha, Bhrama etc

Usage: External application over the forehead as paste with rose water

Single Drugs:

1. Rasna:

Usage: Internal / Externally as Lepa can be applied

2. Tila:

Usage: Tila mixed with milk and made into paste and applied over forehead

Pathya & Apathya in Ardhavabhedaka:

Pathya:

1. Kriyakala: Swedana (Heating), Nasya Dhumpana, Virechana, Lepa, Vamana, Langhana,

Shirobasti, Raktamokshana, Dahan (cauttery) on frontal and supra orbital region, Upanaha.

2. Diet: Consuming old Ghrita, Shali, Shashtikshali, Yusha, Soup, Milk, Dhanvamansa,

Madhumusta, Sanyab, Ghritapura.

3. Vegetables: Patolam, Shigru, Vastuka, Karvellaka.

4. Fruits: Mango, Aamlaki, Dadima, Matulunga, Lemon, Grapes, Coconut.

5. Liquid Diet: Milk, Oil, Coconut water, Kanji, Takra.

6. Medicines: Pathya, Kushta, Bhringaraj, Kumari, Musta, Ushira, Karpura.

Apathya:

1. Holding of the natural urges like Sneezing, Yawning, Micturation, Sleep, Lacrimation, Stool

excretion.

2. Diet: Consuming cooked and uncooked food, Impure water, Curd, Lassi, Cold drinks, Water

of the rivers of Sahyadri, Vindhyas, kapha producing diet.

3. Activities: Teeth brushing, (dhantadhavana); Day sleeping (divaswapana).

33

Management of Ardhavabhedaka by Panchakarma

Vd.M.Prasad

Ayurveda vachaspathi.

Director

Sunethri Ayurvedashram and Research centre

Trikkur

Trissur

Cell:09446229370

Opening

This paper is not prepared on the basis of a theoretical platform. Rather, these are a clinician‘s

views. Ardhavabhedakam is basically a vatha-predominant condition and it is apparent that

sodhanachikitsa is of minimal significance in its management. But there are many clinical situations

where shamanachikitsa alone will not be sufficient. These points are discussed here. Situations

where patient cannot be managed in the OPD are also included for the sake of completion of the

subject. A case in which Shamana snehapana was seen very effective is included as on opening

note.

A case study

45 year old lady presented with severe episodic head ache for 2 years. Each episode lasted for 5

to 8 minutes, with at least one weekly episode. Attack starts as right-sided head ache, followed by

severe right-sided facial pain, which made her unconscious each time. No connection was elicitable

between the attacks and some other activity of daily living, like exertion, stress, food or so. She was

a widow, with medium physical built, otherwise healthy. No history of any other systemic ailments,

and was working as a storekeeper with negligible mental stress. They had tried all options of

medicines and all routine investigations were conducted. Analgesics showed short-term remissions,

but no cure. The case was evaluated in the OPD and later in the IPD. Based on the spectrum of

presentation, it was a case of ardhavabhedakam with vatha preponderance. No element of kapha or

pitha was evident. She was put on a mruduvirechanam with erandathylam in milk and then posted

for a samanasnehapanam with Kallyanaka Ghrtham. 30 ml of Ghrtham was given at bedtime

followed by one sip of warm milk. This continued for 15 day. The symptoms subsided completely

and the status is maintained for the last 4 years. She is on a regular use of some murdhathylam

(ksheerabala, if I am right) and no medicines are on the list.

Ardhavabhedakam

Like any other headache, ardhavabhedakam is a headache to the doctor as well as the person

who suffers it. It is more so than other regular headaches for its unpredictable onset, severity and

mysterious style of presentations. It is basically a type of vathika sirassoola, with case-specific

association of kapha, and almost-always dissociation of pitha.

In the textbooks it can be seen divided into two types, kevalavathika and kaphavathika. (Ref:

Caraka Samhitha). The causative factors identified are:-

34

1. dietary irregularities (rukshasana, atyasana, and adhyasana)

2. climatic exposures (wind from the east, fog)

3. sexual intercourse

4. withholding natural urges

5. stress (mental – ayasa)

6. physical strain (vyayama)

So these factors suggest chances of vathakopa, vatha pratilomya (udavarthajanya), and

agnidushti. Basically all these conditions of samprapthi are to be managed by samanachikitsa. But

there are situations which demand sodhanachikitsa. They are:-

1. Chronic course of the disease where the dosha/s become leena and does not yield to samana

chikitsa.

2. role of udavartha is very strong

3. Kapha has significant role in the samprapthi as shown clinically by shirogurutwam, sakapha-

vamanam and prasekam.

Ardhavabhedakam as upadrava

There are certain clinical conditions which precipitate ardhavabhedakam.

1. cervical conditions: manyasthambham

2. eye disorders: adhimantham

3. Sinus problems: acute exacerbations of chronic sinusitis

Treatment approach

The following approaches are adopted as and when needed.

1. kevalavatha chikitsa – vathika sirassoola.

2. sakapha vathika chikitsa

3. udavarthachikitsa

4. management of primary causes in secondary ardhavabhedakam

5. rasayana

Kevalavatha chikitsa

Samanayamchikitsa

snehanam: shamana snehapanam

swedanam:

mrudushodhanam: virechanam

Visheshachikitsa: based on sthana samsraya

snehanam: murdhathylam

swedanam

nasyam: shamanam and/or brumhanam.

The commonly used medicines for nasya are anuthylam, varanadi ksheeraghrtham and

ghrthamandam

virechanam (mrudusodhanam) in ardhavabhedakam- vathika

- erandathylam is used generally

- may be used with ksheeram, or as mixture with jambeeraswarasa, ardrakaswarasa

and saindhava

35

murdhathylams in ardhavabhedakam - shirodhara

- shiropichu

- shirovasthi

Commonly used snehas include

- ksheerabala

- dhanwantharam

- balaswagandhadi

- baladhathryadi

- chandanadi

- vathasani

- vidaryadi yamakam

After a course of snehana it is ideal to do nasya for a few days.

Jatrurdhwa swedanam

Eventhough swedanam is contraindicated in jatrurdhwa, rational use of swedanam is practised

in kevala vatha. Murdhathyla done in a controlled temperature is a practical method for this

purpose.

More specifically, nadisweda is done here. Simple bashpasweda and ksheera bashpa sweda are the

commonly practised methods. In the latter, boiling mixture of balamula and ksheera are used.

Jatrurdhwa is subjected to abhyanga before this.

sakapha vathika chikitsa

Control of kapha is the first target. samanachikitsa is the rule here. Sodhana is indicated when the

level of kapha is prabhootha. The tools are

1. vamanam

2. shodhana nasyam

The commonly used medicines for nasyam are shadbinduthylam and anuthylam.

Udavarthajanya ardhavabhedakam

Vegadharana and the resultant udavartha lead to the manifestation of ardhavabhedakam. This

is a very common clinical situation. The most common vegas involved are mala, mutra, kshavathu

and nidra. Of these the first two are of specific clinical importance. Care should be taken in the

prasnapareeksha to get valid information about these habits. And once diagnosed the management

should be planned accordingly. Snehavasthi, (may be mathravasthi), kashayavasthi, phalavarthi,

and avapeetakasnehapanam are the treatments of choice here. Without addressing the udavartham

no medicine will work in such cases. Pippallyadi anuvasanathylam, dhanwantharam thylam, and

sukumaraghrtham are used for the snehavasthi. Simple madhuthylika vasthi is done as nirooha. A

course of yogavasthi is seen to give excellent results.

Ardhavabhedakam as upadrava

In situations where udavartham is precipitated as an upadrava of a pre-existing condition, that

should be managed first and then proper management is to be adopted for ardhavabhedakam.

Situations like chronic sinusitis needs proper shodhanachikitsa. All adhimanthas tend to precipitate

ardhavabhedakam. They should be managed properly. Degenerative problems of cervical spine are

to be managed independently and then focus should be shifted to ardhavabhedakam.

36

Ardhavabhedakam of „obscure‟ nidana

Many times ardhavabhedaka can be seen precipitating without any specific cause. But in such

cases, an observation made by Acharya Vagbhata in Ashtangasamgraha (chapter Roganutpadaneeya

of Sutrastana) may give very important clue. He comments that sirassoola can be manifested (along

with other many other disorders) in those individuals who do not care for ruthusodhanam. It is true

that all individuals who do not practice ruthusodhanam do not develop ardhavabhedakam. But in a

given case where the nidana is a near non-entity, this may open up a straight-forward path for an

effective management.

37

CURRENT UNDERSTANDING OF ARDHAAVABHEDAKA WITH

MODERN

PERSPECTIVE

INTRODUCTION

Dr. U. Indulal

The Arya Vaidya Chikitsalayam & Research Institute

136 – 137, Trichy Road,

Ramanathapuram. P. O,

Coimbatore – 641 045 Tamilnadu

[email protected]

Headache is the most frequent ailment tormenting mankind since time immemorial and it is now

considered to be the most common neurologic disorder. Under the broad heading of headache

comes a wide range of conditions, from benign exertional headache to more serious

conditions like a trigeminal neuralgia or the one induced by an intracranial neoplasm. It

is essential to make a correct differential diagnosis for the best benefit of the sufferer. Migraine

is the most common one among the multitude number of headaches. Despite this high

incidence and increased frequency of visits for medical care, Migraine continues to be an

enigma many times, as it is poorly understood, recognized and hence inadequately managed. It

is self limiting in nature and yet each attack may be accompanied by serious symptoms urging

the need to have accurate interpretation and apt care so as to reduce the burden of the patients.

There are clinical, social, political and economic barriers preventing an effective understanding

and management of migraine to happen. The medicines commonly available for migraine

are actually invented for other diseases and when taken causes moderate to serious side

effects. Thus it is natural that patients with migraine, being dissatisfied with conventional

medicine, look for alternative approaches like Ayurveda.

In the absence of any tests to confirm the diagnosis, a condition like Migraine can pose a

serious challenge to an Ayurveda physician and thus create chances of clinical pitfalls. For us,

head is of prime importance and anything affecting the head needs to be managed effectively

and immediately1. Siroroga chapters in classical texts, like that of Vagbhata, explain

everything affecting head including dandruff and premature greying.

Ardhaavabhedaka, the condition explained in classical treatises and that which is usually

correlated with migraine, has serious consequences like neurologic deficits if left

ineffectively treated2. In such a situation it is essential for the physician to whet his/her

diagnostic skills and to perfect his therapeutic competence. Though the conventional

management of migraine have its own scope and limitations, the modern understanding of

migraine helps us greatly, especially in diagnosis. We need to know when we can treat a

headache and when we cannot.

This paper/presentation is to quickly revise the classical concepts of ardhaavabhedaka, to

approach the modern understanding of migraine from that perspective and to use the

outcome of that approach for the following purposes:


38

1

Ashtangahridaya. Uttarasthana. 24. 58 - 59 2

Ashtangahridaya. Uttarasthana. 23. 9; Charakasamhita. Siddhisthana. 9. 76

1. To increase the accuracy of diagnosis

2. To develop a system for assessment of headache based on history and functional

impairment.

3. To develop a system for results of this assessment to be used for identification of

treatment options/recommendations

4. To develop systems that allow for consistent documentation and monitoring

5. To develop system for follow-up assessment that identifies success in management of

headache in primary care setting.

6. To develop a process that will remove barriers to referral to a specialist if indicated.

ARDHAAVABHEDAKA /

MIGRAINE

Susruta considers it to be a three dosha dominant condition3. Charaka considers it as a Vata-

Kapha dominant one4. Vagbhata e plains it as a mere Vata condition and places it along with

vataja sirastapa5. But when we look at the symptoms of Migraine, with our

understanding of these e planations, we find the role of all the three doshas in varying

intensities. Before doing that comparison let us quickly look at the details of Migraine.

Migraine has various definitions, each helping us to understand the condition in a better way:

§ It is a benign and recurring syndrome of headache, nausea, vomiting and/or other

symptoms of neurologic dysfunction in varying admi tures6.

§ It is a common, chronic, incapacitating neurovascular disorder characterized by

attacks of severe headache, autonomic nervous system dysfunction and in some

patients, an aura involving neurologic symptom7.

§ It is a familial disorder characterized by recurrent attacks of headache widely

variable in intensity, frequency and duration8.

PATHOGENESIS

The hypotheses behind the cause of migraine were initially vascular and later neurologic. The

vascular theory considered the headache phase of migraine attacks as that caused by e tracranial

vasodilatation and the neurological symptoms produced by intracranial vasoconstriction.

It was later proved that simple vasoconstriction and vasodilatation are

unlikely causes for the abnormalities in migraine. Though cerebral blood flow is altered in

3

Susrutasamhita. Uttaratantra. 25. 26 4

Charakasamhita. Siddhisthana. 9. 75 5

Ashtangahridaya. Uttarasthana. 23.7 6

Harrison‘s Principles of Internal Medicine, 16th

Edition; p85 7

Migraine — Current Understanding and Treatment. Peter J. Goadsby, M.D., D.Sc., Richard B. Lipton, M.D.,

and Michel D. Ferrari, M.D., Ph.D. N Engl J Med 2002; 346:257-270 8

World Federation of Neurology

39

certain migraine attacks, all the clinical syndrome of this disease cannot be explained by that.

The neurologic theory suggests that neuronal abnormalities could be the cause of migraine

attack. Fortification spectrum is a migraine aura characterized by a slowly

enlarging visual scotoma with luminous edges. It is believed to result from spreading

depression, a slowly moving (2 or 3 mm/min), potassium liberating depression of cortical

activity, preceded by a wavefront of increased metabolic activity.

TRIGGERING FACTORS

40

o Bright lights or glare

o Noise

o Head or neck injury

o Weather changes

o Motion

o Odours

o High altitude

o Physical strain

• Lifestyle:

o Chronic levels of stress

o Skipping meals / Poor diet

o Disturbed sleeping pattern

o Smoking and drinking

• Hormonal

o Puberty

o Menopause

o Menstruation

o Pregnancy

• Emotional

o Anxiety

o Depression

o Anger

o Excitement

o ―let-down‖ approach

• Medications:

o Nitroglycerin

o Nifedipine

o Oral contraceptives

oHRT

• Dietary

FREQUENCY AND DURATION OF MIGRAINE

ATTACKS:

The frequency and duration varies from patient to patient. However the pattern of

occurrence could be depicted thus, from the available statistics:

i. Victims on an average have 1 or 2 daylong attacks every month

ii. 10 % of them get it every week

iii. 20 % experience them for 2 – 3 days

iv. 14 % have them for more than 15 days a month.

41

FOUR PHASES OF

MIGRAINE

There are four phases of Migraine – prodromal, aura, headache and postdrome9. This is

quite unlike most headaches. All migraine patients do not go through these phases either.

Prodromal phase:

Among them prodromal phase is experienced by 60% of the patients. The typical features of

this phase are difficulty in concentrating, yawning, fatigue and sensitivity to light and noise.

The duration of this phase would be a few hours to few days.

Aura

Phase:

30% of the patients undergo this phase. The typical features of this phase are visual illusions

of sparks and lights, often followed by blind or dark spots in the same configuration as the

earlier bright hallucinations. The duration of this phase would be 20 – 60 minutes.

Headache

Phase:

All patients, except those experiencing migraine variants, undergo this phase. Typical

features include excruciating pain accompanied by sensitivity to light and sound, nausea and

vomiting. The duration is usually 4 to 72 hours.

There are two major types of migraine - Migraine with aura is known as Classic Migraine and

Migraine without aura is known as Common Migraine. In Migraine without Aura, no focal

neurologic disturbance precedes the recurrent headaches. It is the most frequent type of

headache. In Migraine with Aura, premonitory sensory, motor or visual symptoms are

present. Focal neurologic symptoms are more common during the headache attacks than as

prodromal symptoms.

9 David W. Dodick, J Jay Gargus; Why Migraine Strike; Scientific American. August 2008. P 34 - 41

42

Severity Levels of

headache:

Mild: Patient is aware of a headache but is able to continue daily routine with

minimal alteration.

Moderate: The headache inhibits daily activities but is not incapacitating.

Severe: The headache is incapacitating.

Status: A severe headache that lasted more than 72 hours.

Postdromal Phase:

70% of the patients undergo this phase. It is characterized by persistence of sensitivity to

light and movement, as well as lethargy, fatigue and difficulty focusing. The duration of this

phase is a few hours to a few days.

MIGRAINE VARIANTS AND WARNING SIGNS

Migraine Variant is a migraine that exhibits in a form other than headache. It is

characterized by history of prolonged visual auras; atypical sensory, motor, or visual aura;

confusion, dysarthria; focal neurologic deficits; gastrointestinal manifestations; or other

constitutional symptoms with or without a headache. The diagnosis is determined by history

of paroxysmal signs and symptoms with or without cephalgia, a prior history of migraine

with aura, in the absence of other medical disorders that may contribute to the symptoms.

Many of these patients have a family history of migraine.

As we are dealing only with ardhaavabhedaka, we will not discuss these variants here.

However the causes for concern must be evaluated irrespective of the patient‘s past history of

headache. Warning signs of possible disorder other than primary headache are:

• Subacute and/or progressive headaches that worsen over time (months)

• A new or different headache or a statement by a headache patient

that "this is the worst headache ever."

• Any headache of maximum severity at onset.

• Headaches of new onset after the age of 50 years old.

• Persistent headache precipitated by a Valsalva maneuver

• Evidence such as fever, hypertension, myalgias, weight loss or scalp

tenderness suggesting a systemic disorder.

• Neurological signs that may suggest a secondary cause.

• Seizures.

43

DIAGNOSIS OF

MIGRAINE

There are no tests that confirm the diagnosis of primary headache. Greater experience on

the part of the clinician allows for a higher level of confidence in diagnosis. International

Classification of Headache Disorders (ICHD-II) criteria depend largely on a detailed

headache history and the exclusion of secondary cause for headache through a

physical and neurological examination.

I. POUNDing Migraine Screening and Scoring System10

P = Pulstaing quality

O = hOurs of duration 4 – 72

U = Unilateral location

N = Nausea or vomiting

D = Disabling intensity

Number of ―yes‖ answers to the above questions:

5 Migraine likely

3 – 4 Migraine possible

1 – 2 Migraine unlikely

II. The diagnostic criteria for Migraine are11

:

A. At least 2 of 1 – 4, plus 1 of 5 or 6:

1. Unilateral location

2. Pulsating/throbbing quality

3. Moderate or severe intensity

4. Aggravation by routine activity

5. Nausea and/or vomiting

6. Photophobia and phonophobia

B. Aura criteria

1. One of more fully reversible aura symptoms

2. At least one aura symptom develops over more than 4 minutes or two or

more symptoms occur in a succession

10Detsky ME, McDonald DR, Baerlocher MO, et al. Does this patient with headache have a migraine or need

neuroimaging? JAMA 2006;296:1274-83.

11 Diagnosis and Treatment of Headache, Institute of Clinical Systems Improvement; Modified from the

International Classification of Headache Disorders (ICHD – II)

44

3. Symptoms do not last more than 60 minutes

4. Attack follows within 60 minutes

C. Previous similar attacks

D. Organic disorder is ruled out by the initial evaluation or by diagnostic studies.

If another disorder is present, the headaches should not have started in close temporal

relationship to the disorder.

III. Chronic migraine

Chronic daily headache is not a diagnosis but a category that may be due to disorders

representing primary and secondary headaches. Headache (tension-type and/or migraine) on

greater than or equal to 15 days per month for at least three months is considered to be

chronic.

ASSESSMENT TOOLS

Two commonly used assessment tools are:

1. Migraine Disability Assessment Questionnaire (MIDAS)

2. Headache Impact Test (HIT – 6)

These tools are simple and help the physician and the patient to quantify the impact and the response to

adopted treatments or medicines. Both the questionnaires are attached.

With this available and essential information we will work on the diagnostic algorithm for

Migraine, as attached.

45

DIAGNOSTIC ALGORITHM

Patient presents with complaints of a Head ache

Critical First Steps:

• Detailed History

• Focused Physical Examination

• Focused Neurologic Examination

Causes for Concern Yes Consider Secondary

headache disorder

No

Meets criteria for Primary Headache disorder Specialty consultation

indicated

Yes Yes

Evaluate type of Primary Headache Refer to a specialist

Migraine

Categorise according to severity

Mild Moderate Severe Status

Treatments

Acute Prophylactic

Successful No Specialty consultation indicated

46

MIGRAINE DISABILITY ASSESSMENT QUESTIONNAIRE (MIDAS)

Instructions: Please answer the following questions about ALL the headaches you have had over the last 3 months. Write

your answer in the box next to each question. Write zero if you did not do the activity in the last 3 months.

1. Lost days from work How many days in the last 3 months did you miss work or school because of your headaches? (If you do not attend work or school enter zero in the box.)

2. Lost productivity days at work or school How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? (Do not include days you counted in question 1 where you missed work or school. If you do not attend work or school enter zero in the box.)

3. Lost household workdays On how many days in the last 3 months did you not do household work because of your headaches?

4. Lost productivity days at home How many days in the last 3 months was your productivity in household work reduced by half or more because of your headaches? (Do not include days you counted in question 3 where you did not do household work.)

5. Lost social days On how many days in the last three months did you miss family, social, or leisure activities because of your headaches?

(Questions 1-5) Total: _______________________ Days

A. On how many days in the last 3 months did you

have a headache? (If a headache lasted more than 1 day, count each day.)

B. On a scale of 0-10, on average how painful were

these headaches? (Where 0 = no pain at all, and 10 = pain as bad as it can be.)

After you have filled out this questionnaire, add the total number of days from questions 1 to 5 (ignore A and B).

Grade Definition Score

I Minimal or infrequent disability 0-5

II Mild or infrequent disability 6-10

III Moderate disability 11-20

IV Severe disability 21+ If your MIDAS score is 6 or more, please discuss this with your doctor.

Days

Days

Days

Days

Days

Days

Days

47

Abstracts.

48

A CASE PRESENTATION OF ARDHAVABHEDAKA

Dr. Hari.G*,DrPrashanth.A.S**

ABSTRACT

It is regarding a case presentation of a patient attended in the Kayachikitsa OPD of Ayurveda

mahavidyalaya hospital, hubli. On 11th

April 2010, a Hindu female patient of 35 years presented with

complaints of headache more severe in right side suffering since last 5 years.

The case was diagnosed as ardhavabhedaka and treatment was started. The patient got admitted in

the IPD on 22/04/10. She underwent therapies like nasya and shirodhara along with oral medication.

The patient was discharged on 28/04/10 after getting relieved of the complaints. She was advised to

continue oral medications.

The full details of the case will be presented.

*2nd

Year Post Graduate Scholar, PG Dept of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli.

** Professor & HOD, PG Dept of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli.

49

Ardhavabhedaka in the present era.

Chaitra.S *

ABSTRACT.

Ardhavabedaka is jatrurdvagata vikara explained under Shiroroga by all the texts of Ayurveda. It presents

with excruciating bursting, pricking pain and piercing pain in one half of the head affecting eyebrows, ear,

eyes, forehead in affected half. When not treated in time will aggrevate further and causes impairment in the

sensory functions. All the authors have given importance to the involvement of Vata dosha as prime factor

in the pathology. Yet some opined association of Pitta and Kapha dosha. So various treatment modalities

have been explained like nasya, Snehana, shiribasti etc. In the present era Migraine is the condition which is

in par excellence with Ardhavabhedaka. It is a neurological syndrome characterized by unilateral, pulsating,

severe pain along with nausea, photophobia, phonophobia which indicates the involvement of eyes, ears and

sensory manifestations like Ardhavabhedaka. Even further the patients presents with different phases like

prodrome, aura, pain and postdrome phase which supports the ideas of ancient texts of Ayurveda regarding

the manifestation of this grave condition. The management of migraine is mostly symptomatic treatment. So

understanding of these conditions will help to adopt a apt treatment protocol.

Key words : Ardhavabhedaka, Migraine, Pain, Vata,Shiroroga, Jatrurdvagata vikara.

*Final year PG, dept of Kayachikitsa, SDMCA, Udupi.

50

“ RAKTA MOKSHANA IN ARDHAVABHEDAKA”

Dr.PRASANTH.D*, Dr.ZENICAA D‟ SOUZA**.

Being a time tested remedy Panchakarma, the unique contribution of Ayurveda has its special

advantage over other treatment protocols. Raktamokshana among them, even though a beneficial procedure

is very rarely practiced among routine chikista karmas due to the various risk factors associated with it.

Especially when it comes to diseases like Ardhavabhedaka, which is classified among the shirorogas the

practical application of Raktamokshana is still far behind in clinical practices.

Acharyas have varying opinions in the concept of doshic involvement on Ardhavabhedaka, but

taking a due consideration of samprapti we can understand that Raktamokshana can be a beneficial

treatment modality that can be practiced easily. Even in the modern parallels Ardhavabhedaka is considered

to be equivalent to Migraine which accepts the vascular theory as one of its pathophysiology.

Here in my paper , iam making a humble attempt to revive the practice of Raktamokshana through a

conceptual evalution in scientific lines that can prove beneficial in the treatment of Ardhavabhedaka after a due

exploration and consideration with various samhitas and contemporary paralells.

* Second year PG scholar, Department of Panchakarma, Alva‟s Ayuverdic Medical College,

Moodbidri.

**HOD and Assistant professor, Department of Panchakarma, AAMC, Moodbidri.

51

A CLINICAL MANAGEMENT OF MIGRAINE (ARDHAVABHEDAKA)

THROUGH

NASYA AND SHIRODHARA

Dr.D.Ragavendran* , Dr.Twinkle Gupta** , Dr.P.G.Subbanagouda***

ABSTRACT

BACKGROUND AND OBJECTIVES:

Migraine (Ardhavabhedaka) is one of the commonest Neurological disorders and is a chronic

condition of recurrent attacks, widely variable in intensity, frequency and duration. It is usually associated

with nausea, vomiting and visual disturbances. About 10-20% of the population is estimated to suffer from

it. 15% women and 6% of men are usually affected as it is more commonly seen in females and middle age

persons. Treatment of migraine available in modern science is having serious side effects. To tackle such

disease entities, Ayurveda, the ancient system of medicines, introduced a variety of effective natural

medications, which gives a befitting answer to it.

The objectives were to evaluate the efficacy of Navana Nasya and Shirodhara in Migraine

(Ardhavabhedaka) and to formulate a comprehensive therapy for Migraine (Ardhavabhedaka).

METHODS:

In the present study, 2 groups were made. Group A received Navana Nasya with Anutaila, Suvarna

Sutsekhara rasa with Pathyadi Kashaya as anupana. Group B received Shirodhara with Ksheerabala taila,

Suvarna sutsekhara rasa with Pathyadi kashaya. The duration for both the groups was 70-75 days with

follow up of 3 months.

RESULTS:

Both the groups, Group A and Group B provided highly significant results in all the parameters of

assessment. The comparative analysis of both the group showed statistically insignificant.

INTERPRETATION AND CONCLUSION:

Navana Nasya, Shirodhara along with Suvarna Sutsekhara rasa with Pathyadi Kashaya as Anupana

have showed better effect in the patients.

The life style modifications including Dietary habits too, counseling, drugs and relaxation techniques

which calms the mind will definitely going to help Migraine (Ardhavabhedaka).

KEY WORDS:

Migraine, Ardhavabhedaka; Navana Nasya; Anutaila; Shirodhara; Ksheerabala taila; Suvarana

Sutsekhara rasa; Pathyadi Kashya.

* 2nd

Year Post Graduate Scholar, Dept of PG studies in Kayachikitsa, Ayurveda Mahavidyalaya,

Hubli.

** Alumni, MD (Ayu) in Kayachikitsa, Ayurveda Mahavidyalaya, Hubli

*** Professor & HOD, Dept of PG studies in Kayachikitsa, Ayurveda Mahavidyalaya, Hubli.

52

MANAGEMENT OF ARDHAVABEDHAKA

DR.ARUN J WILSON*, DR.JEAN GEORGE*, DR.ZANICA**.

ABSTRACT

Ardhavabhedaka means ― Ardha Mastaka Vedhana”

Ardhavabedhaka can be correlated with Migraine due to its cardinal feature ―half sided headache”.

Migraine is one of the common cause of recurrent headache, which constitutes 16% of the primary

headache and affect 10-20% of the general population, which is more prevalent among 35-40years old and

become 60% higher in lower income individuals. This illness affects their ability to work and to attend

institutions for higher learning, there by not getting higher paying jobs.

The modern drugs are not acceptable due to their drawbacks such as drug dependence, drug withdrawal

symptoms, relapse of headache within hours and chance of getting chronic headache.

Based on Ayurveda, Chikitsa is classified into two. ie, Shodhana and Shamana. In this poster

presentation, a humble attempt is made to highlight the different types of management told under Shodhana

eg-Dashamoola Kwatha Nasya, Shamana eg-Pathyadi Kwatha in classics. Rest of the things are discussed in

poster presentation


Moodbidri.


53

„„A clinical study to evaluate the efficacy of Shigruvadi Taila

Nasyakarma in Ardhavabhedaka‟‟

DR.PRIYA CHANDRAN* , DR.ZENICA D‟SOUZA**.

ABSTRACT.

Ardhavabhedaka is a condition in which pain is felt in the nape of the neck, eye brows, temporal

region, ears, eyes, half portion of the frontal region resembling paroxysmal unilateral headache associated

with vertigo and pain of varying intensity Very similar in line with the Migraine.

The term "migraine" refers to a syndrome of vascular spasms of the cranial blood vessels.

Symptoms of a migraine attack may include heightened sensitivity to light and sound (sonophotophobia),

nausea, auras, difficulty in speech and intense pain predominant on one side of the head. It is classified with

or without auras (seeing bright "spots" or "stars").

Migraine is one of the common causes of recurrent headache. It is three times more common in women

than men. More than 2/3rd of Migraine sufferers either have never consulted a doctor or have stopped doing

so. It is quite undiagnosed and undertreated, hence WHO ranks Migraine one among the World‘s disabling

medical illness.

Objective of the study is ‗To evaluate the efficacy of Shigruvadi Taila (Chikitsamanjari) Nasyakarma in the

management of Ardhavabhedaka‘.

The study is Single blind clinical study, comprising of 30 patients. Selection of patients is based on

diagnostic and a inclusion criteria with a special proforma with systemic history taking, physical

examination and investigations.

Nasyakarma is performed for 7 days with 8 drops of Shigruvadi Taila.

The results are assessed on statistical findings based on the parameters and statistically significant results

were found.

* Third year PG scholar, Department of Panchakarma, Alva‟s Ayuverdic Medical College,

Moodbidri.

**HOD, Department of Panchakarma, AAMC, Moodbidri.

54

Innovative Ayurvedic Practices in Ardhavabhedaka

Dr.Prasanth.D* ,Dr.K.N.Rajasekhar**.

Abstract.

Ayurveda- the science of life deals with a lot of pathological concepts for the diagnosis of a disease and its

treatment principles to combat a disease

Ardhavabhedaka is a condition of vata characterized by an obstruction in the gati of vata paralyzing it in

performing its activities by Kapha and thereby leading to various clinical symptoms .As per.the varied

opinions of Acharyas, it comes under Tridoshaja and Vata Kapha Pradhana Doshaja classification of

Vyadhi. Irrespective of the Doshic involvement, there are certain treatment principles that are explained in

Ardhavabhedaka which are not commonly practiced in day to day practice such as Agni karma,

Raktamokshana, Dhoomapana, Lepa, Paadaghaata etc ,Which can be practiced according to yukthi which

can provide very fruitfull results.

In this Poster a humble attempt is made, how to Innovately deal with a case of Ardhavabhedaka with

those procedures which are not commonly practiced in clinical practice today , but with those which have a

base in the treatment principles explained according to different treatises of Ayurveda in par with the

modern co – relate Migraine, which can provide fruitfull results.


Moodbidri.


55

Snehana in Ardhavabhedaka

Ravikanth K *

ABSTRACT:

Ardhavabhedaka is condition caused due to Shiro Marmabhighata with a typical presentation of severe

headache in one half of the head with the involvement of eyes, ears, temporal region, forehead and

eyebrows, it has been mentioned as serious ailment that can even destroy the physiological functioning of

eyes, ears etc. All the authors have accepted the involvement of Vata as main culprit in this condition and so

the controlling the Vata itself becomes the major part in the treatment. Migraine is the condition which is a

near correlation to Ardhavabhedaka with its typical presentation of one sided headache and different stages

like prodrome phase, aura phase, headache phase and postdrome phase with symptoms like nausea,

vomiting, photophobia, and visual, auditory and other sensory abnormalities. Even though there are

different treatment modalities mentioned Snehana had a major role in combating Vata dosha and also

Snehana causes tarpana and there by Marmaparipalana. This snehana can be done in various as snehapana,

bahya sneha, nasya etc. So only there is every need to understand the scope of Snehana in the treatment of

Ardhavabhedaka.

Keywords: Ardhavabhedaka, Migraine, Headache, Snehana, Shiromarma, Nasya.

*Final year PG, dept of Kayachikitsa, SDMCA, Udupi.

56

A Critical Review on Diagnosis and Treatment of Ardhavabhedak w.s.r to

Migraine.

Shweta.A.H1, Zenica D‟souza

2, Vasant.Patil

3.

Abstract

Migraine is one of the common causes of recurrent headache. It has troubled mankind from dawn of

civilization. Migraine symptoms correlate with Ardhavabhedaka. Neurovascular headaches are the second

most common primary headaches, which includes migraines and cluster headaches.

Migraine or severe headache is a risk factor for stroke in both men and women, especially before age

50. Migraine can be a challenging disease to diagnose because its clinical diagnosis based on symptoms that

are subjective and verifiable only by the patient. Many medications have been tried and a lot are still in

research work also, but these modern drugs are not acceptable due to their side effects. Also they cause drug

dependence, drug withdrawal syndrome, relapse of headache within few hours. Some drugs cannot be

prescribed in migraine associated with other medical illness.

Acharyas have given brief description of causes, symptoms and treatment of Ardhavabhedaka, but

still there are controversies in Dosha involvement. Precise diagnosis is the key for radical relief of

Ardhavabhedaka. The line of treatment told according to the stage of disease is not clearly mentioned. Here

an attempt is made to critically analyze the Nidana Panchaka, diagnosis and treatment based on Avastha.

.

1 Second year PG scholar, Department of Panchakarma, Alva‘s Ayuverdic Medical College, Moodbidri. 2 HOD and Assistant professor, Department of Panchakarma, AAMC, Moodbidri. 3 Lecturer, Department of Panchakarma, AAMC, , Moodbidri.

57

“A critical review of the, doshic predominance and its utility in

diagnosis and management of Ardhavabhedaka”

Dr. Preetham Krishanaji Lamani*,Dr.Shripathi Adiga H ;

Abstract

The desire of leading a happy, healthy and utile life and the deeds facilitating the same

have always rendered man susceptible to pain and pleasure. With the same validatory view,

Ayurveda, the science of life has described various methods of preventing as well as

combating the numerous diseases. According to International Headache Society, which

works with the purport of 'Advancing headache science, education and management and

promoting headache awareness worldwide' , about 10 – 20 % of the general population

experience headache which demands medical attention at one or the other point of their life.

Ardhavabhedaka is one among the Shirorogas described in the Ayurvedic classics. In spite

of the fact that all the three doshas are responsible for the manifestation of the disease

Ardhavabhedaka, based on the predominance of each dosha, it can be understood to be of

individual doshic variety besides its combination. The thorough understanding of nidana

and samprapti also establish this view. The classics have given wide range of treatment

modalities in managing shirorogas. They also explicate exclusive principles such as

avapeedana nasya, agni karma, rakta mokshana...etc., Thus, the proper understanding of

Ardhavabhedaka with emphasis on its doshic predominance, will aid us in selecting the

appropriate treatment modality at the earliest.

Key words: headache, tridosha,ardhavabhedaka, chikitsa

*PG Scholar, Department of Ayurveda, KMC, Manipal

**Assisstant Professor, Department of Ayurveda, KMC, Manipal

58

Delegates List for Ayurvision 2010 Sl. No. Name Place

1. Dr. V. Prem Anand Kanya Kumari

2. Dr. Prathibha. B.P. Mangalore

3. Ms. Agamya. S. Udupi

4. Dr. Hariprasad Suvarna Belthangady

5. Dr. Prathibha Puranika. K. Kundapura

6. Dr. D. Ragavendran Thanjavur

7. Dr. Hari. G. Thiruvananthapuram

8. Dr. Rajesh Ballaya Mangalore

9. Dr. Amrutha Bantwal

10. Dr. Jayanthi Hyderabad

11. Dr. Nayana. S. Pai. Moodbidri

12. Dr. Priya Chandran Kannur

13. Dr. Kasturi. R. Adiga. Manipal

14. Dr. Jean George Kozhikode

15. Dr. Raiby. P. Paul Moodbidri

16. Dr. Prasanth. D. Kollam

17. Dr. Arun. J. Wilson Tamil Nadu

18. Dr. Susha John Moodbidri

19. Dr. Raviprasad Hegde Hebri

20. Dr. Maneesh Ladhava Gadag

21. Dr. Raghavendrachar. H.M. Gadag

22. Dr. Jagadeesh. L Davangere

23. Dr. Vijayraj. M Gadag

24. Dr. Sapna Shetty (PGCPK Manipal) Mangalore

25. Dr. Sumashri. T. (PGCPK Manipal) Raichur

26. Dr. Preetam. K. Lamani. (PGCPK Manipal) Bagalkot

27. Dr. Roopak Nagaraj. (PGCPK Manipal) Udupi

28. Dr. Harish. L. (PGCPK Manipal) Davangere

29. Dr. Suprabha Shetty. (PGCPK Manipal) Udupi

30. Dr. Prasanna. A. Rao. (PGCPK Manipal) Udupi

31. Dr. Soumya Kumari. (PGCPK Manipal) Mangalore

32. Dr. Deepak. (PGCPK Manipal) Udupi

33. Dr. Shweta. A. Honnungar Bijapur

34. Dr. Anjali Raichur Bangalore

35. Dr. Vidyoth Kumar. P.V. Kannur

36. Dr. Prema Chandran Kanjangad

37. Dr. Vivekanandan Annamala Kannur

38. Dr. K.V. Narayanan Kasargod

39. Dr. K. Ravikanth Visakhapatnam

40. Dr. Chaitra. S. Bengaluru

41. Dr. Shrilatha. A. Udupi

42. Dr. Annette Sahana Soans Udupi

43. Dr. Riyaz Ernakulam

44. Dr. Manu. K Parli Palaghat

45. Mr. Gururaj Desai Udupi

46. Dr. Rachana. K Surathkal

47. Dr. Clifford Misquith Surathkal

59

DHANWANTARI DAY CELEBRATIONS -2010

60

Authorised Dealer,

Kottakkal Arya Vaidya Sala,

Opp. Corporation Bank, Manipal

61

Documents

e Book Ayurvision 2010