SHRI K. MISHRA

University of Southern California,Los Angeles

Neuromuscular disorders in"Ayurveda": an ancientmedical treatise of India

Various types of neurological and neuro-muscular disorders are described in theAyurveda which is one of the oldest medicaltraditions in the world. The pathogenesis ofneurological and neuromuscular disordersare due to the deranged humour (vat) whichenters the dhatu tissues such as muscles[mans) and ligaments (snayu) to producesymptoms. Among approximately 80 neuro-logical and neuromuscular disorders de-scribed in the Ayurveda are tetanus (hanug-rah), brachial plexopathy (bahushosh), para-plegia (pangu), peripheral neuropathy (paddah), facial paralysis (ardit), and lathyrism(kalay khanj), the latter being of great interestto modern neurotoxicologists. The rela-tionship of lathyrism to eating the legumeLathyris sativus was well described bySushruta (Shastri & Guru, 1953). Ayurvedaprovides a good description of a number ofmuscles and ligaments in the body as well asinherited and acquired disorders includingmuscle atrophy, hypertrophy, weakness,pain and cramps. The basic principles oftreatment include balancing vata. Treatmentis of two types, preventative and symptoma-tic. In spite of Ayurveda being an ancienttherapeutic discipline there are still manyareas which need further investigation in thelight of the scientific advances of modernmedicine. Ayurveda should not be consi-dered as a historical and obsolete medicaldiscipline.

INTRODUCTION

Ayurveda is both the basic treatise ofIndian medicine and one of the

oldest medical disciplines in the world.Ayurveda originated from the AtharvaVeda, one of the four great epics ofIndo-Aryan Hindus. The Atharva Veda

is said to have been written approx-imately 3000 years ago, though its exactdates are not known. Ayurveda is notonly a medical discipline but an art andscience of life. The literal meaning ofAyurveda is treatise on age (ayuh). Age,according to Charak Samhita (Pandey &Charurvedi, 1968), is defined as "theunion between body, senses, mind andsoul". The definition of Ayurveda isvery broad, being the science of humanlife and a discipline which describes thefactors, good and harmful, for life. Italso includes the diagnosis and treat-ment of mental and physical disorders.According to Ayurveda the humanbody is the seat (anchor) of religion(dharma), wealth (artha), passion (kam)and salvation (moksha). The variousillnesses to be described interfere withthe ultimate achievement of life, there-fore objectives of perfect health areessential for the fulfilment of thosegoals.

What is the definition of health?According to Sushruta Samhita (Shastri& Guru, 1953) ideal health is defined as"balanced humours (vat, pitta and kafa,vat or vayu signifying the electricalactivities of peripheral nerves, pittasignifying metabolic activities includingthose of the digestive system, kafasignifying phlegm, synovial fluids etc)balanced digestive system and all excre-tory systems of the body with happi-ness of soul, mind and all senses". Sincethe original description of Ayurveda inthe Atharva Veda, many original booksand narratives have been written, suchas the famous Charak Samhita, a medic-

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al treatise, and Sushrut Samhita, thegreat surgical treatise. These books dateback to 700 to 1200 years BC. Since then,many other books have been writtenand many have been translated intoPersian, German, and English, as wellas other languages.

SUBSPECIALITIES OF AYURVEDA

Ayurveda is also called Ashtang andconsists of eight parts: kaya chikitsa(internal medicine, including neurolo-gy), shalakya (ophthalmology, ENT anddentistry), shalya (surgery), agad tantra(toxicology), bhoot vidya (psychologyand psychiatry), komar bhritya (paediat-rics), rasyayan (science of rejuvenation,gerontology) and bajikarnn (sexology,aphrodisiacs).

Aetiology

Aetiological factors in Ayurveda havebeen divided into endogenous andexogenous groups. The endogenousfactors include derangement of tridoshn(humours); derangement of seven dhatu(tissues), blood, fat, muscle, bone, etc;and derangement of mental factors, rajaand tama. The exogenous factors in-clude physical and biological factors andthe effects of stars, zodiac and manyother external forces.

The endogenous disorders can causeillness in seven different ways: (1) byinheritance from either parent, as incases of leucoderma and piles; (2) due tocongenital factors in utero or duringbirth, as in the cases of dwarfism andblindness; (3) due to dietary habitsand/or excessive physical activities; (4)due to external trauma; (5) due toenvironmental factors such as weatherand soil; (6) due to infectious agents or acurse; (7) due to abnormal daily habitssuch as sleep deprivation, excessiveeating, and routine substance abuse(Sashtri & Guru, 1953).

Diseases are classified into mental(psychological) and physical (somatic)categories. The mansik (mental) diseasesinclude anger, jealousy, pride, anxiety,

and fear, and are caused by alterationsof raja and tama. The sharirik (bodily)diseases are caused by alteration of thehumors, vat, pitta and kafa and theirinteraction with the seven differentdhatu (tissues) which consist of rasa(extracellular fluid lymph), rakta(blood), mans (muscle), meda (fat), asthi(bone), majjd (bone marrow) and shukra(semen).

AETIOPATHOGENESIS OFNEUROLOGICAL-NEUROMUSCULARDISORDERS IN AYURVEDA

Humour (vat) is responsible for theperception of sensation, such as touch,hearing, vision, taste and smell tovarious organs — eyes, ear, tongue,nostrils. It is also responsible forspeech, hands, feet and the excretorysystem. It performs breathing, digestionand other activities in the body. The vataare responsible for all bodily activities.

There are five types of vata withspecific location and neuroanatomicalsubstrates. The first, pran, is responsiblefor sustaining life. Udan is responsiblefor speech, including singing, etc. Sa-man controls digestion in the upper GItract. Byan is responsible for circulation,especially in the chest area. Finally, apancontrols the pelvic region, includingurinary and faecal functions and thesespecific functions and sites can becompared to respiratory centers andvarious autonomie plexuses.

The neurological symptomatology isproduced by the derangement of vat indifferent tissues (dhatu), for example,skin manifestations characterized bydryness or hyperaesthesia. Musclesymptomatology included musclecramps, weakness and atrophy.

The descriptions of neurological andneuromuscular disorders, includingcentral and peripheral nervous systemand muscle, come under the heading ofvat, vyadhi. Therefore the primaryaetiological factor is the derangement ofhumour vata. As described earlier, thereare many types of vata, depending on

the location. The neurological disordersare produced due to abnormality ofparticular subtype of vata. The derangediwta enters in the different tissues(dhatu) of the body, ie muscle, skin, fat,where it produces symptoms such asmyalgia, twitching, numbness, andtingling.

The derangement of vata is due toexogenous or endogenous causes, andaetiological factors include diet, weath-er, trauma, and excessive bleeding.Eighty types of neurological and neuro-muscular disorders have been de-scribed. Neurological disorders includeshiro vedana (headaches) and ardhavbheda (migraines), murchcha (syncope),nidra (sleep), bhram (confusion), sanyas(coma), madyadhikar (excessive drink-ing), unmadadhikar (encephalopathy),apasmar (seizures), shiro bhram (giddi-ness), pachcha-ghat (hemiplegia), andurustambh (quadriplegia), gadgadminminmukam (dysarthria and aphasia) andpralap (delirium).

Neuromuscular disorders includehanugraph (lock jaw trismus), jihvastambh (tongue paralysis), rasa abhav(loss of taste), twak shunyata (numb-ness), daha dhikar (burning sensation),ardit (facial paralysis), manyastambh (tor-ticolis), bahu shosh, ap bahuk shosh (brac-hial plexopathy), bishwachi (monople-gia), gridhrasi (sciatica), khanj (monople-gia), pangu (paraplegia), kalaya khanj(spastic paraplegia) due to eating kalay(Lathyris sativas and Vica sativus), vatkantak (neuralgia), pad, dah (burning offeet), padharsh (tingling of feet), dandapa-tanak (orthotonos and opistohtonos),dhanustambh (tetanus), and kubjak (kyph-osis). There are many other neuro-muscular disorders which are referredto in the texts (Mishra, 1987), accordingto which muscular disorders are pro-duced due to dearranged humour, vat.The symptoms described include mus-cle pain, stiffness, atrophy and weak-

ness (ashtang hridayam) (Upadhyaya.1979). Sushruta Samhita has given <igood anatomical description of musdi.(mans) and their ligaments in the chapter on anatomy (sharirsthan). There an500 muscles and 900 tendons (ligaments) in the body and there are cleaicut descriptions of types and sizes 01muscles. Many neuromuscular disorders described in Ayurveda hav>.detailed clinical symptomatology inspite of lack of modern scientific factsThe observations of Ayurvedic Vaidyn-deserve due historical recognition, conditions like 7th nerve palsy (Bell's palsyand lathyrism being described Ion;.before the usual prior claims.

TREATMENT

There are two principles of treatment uneurological disorders: prophylaci¡and symptomatic. Prophylactic trealment includes avoidance of weathetfood and physical exercise responsibifor derangement of humour, vainSymptomatic treatment includes lot.treatment, oil and massage for examphand oral use of compounds whic!decrease the vata. These compounds arusually herbal but on occasion variouforms of purified metal preparationhave been used.

REFERENCES

Mishra, S.K. (1987): Concept of neuiologu .disorders. In: Ayurveda, ancient Indi.imedical treatise. Neurology 37, (Suppl.240.

Pandey, G.S. & Chaturvedi, G.N. (196«Charak Samhita Sharir and Chikitsa. Var,nasi: Chaukhamba Sanskrit Sansthan.

Shastri, A.D. & Guru, L.V. (1953): SushnSamhita, Shrir Nidam and Chikilsa. Var.nasi: Chaukamba Sanskrit Sansthan.

Upadhyaya, Y.N. (1979): Asthang Hidayam. Varanasi: Chaukhamba SanskiSansthan.

Neuroscience across the centuries, ed. F.C. Rose, (C) Smith-Gordon,