The Gerson Institute of Ayurvedic Medicine

Scott Gerson, M.D., Ph.D. (Ayurveda) Medical Director, Jupiter Medical Center Dept. of Integrative Medicine Division of Education and Research

Jupiter Medical Center at The Calcagnini Center for Mindfulness
1210 S. Old Dixie Highway, Jupiter, Florida 33458, Suite M-117.2

 

Lake Mary Clinic and Panchakarma Facility: at 635 Primera Blvd. Lake Mary, Florida 32746

 

 Telephone: (561) 263-MIND (6463); option #2 or (561) 510-3833

The Ayurvedic Approach to Bhrama (Vertigo)

Bhrama originally was not considered a separate entity but rather a symptom of many other diseases. Today in modern Ayurveda we recognize that bhrama can occur as a discreet disease which manifests as a consequence of prakopa (aggravation) of Vata and Pitta doshas and Rajas guna. Today in Western medicine we give the name vertigo to that disease (from Latin: vertere, to turn).

Paribhasha (Definition):

"Chakravath bhramato gatram bhoomou potati sarvadaa Bhrama roga iti gneyo"

"Bhrama is defined as a spinning sensation experienced by a patient causing one to lose balance and fall to the ground."

In bhrama like many diseases, the doshas initially undergo increase as a result of aggravating factors (diet, life-style, exercise, climate, emotional stress, seasons, etc.). Each dosha initially accumulates in areas of the body which are their respective normal sites (i.e. Vata = colon, mind, heart; Pitta = small intestines, blood, liver, skin; Kapha = stomach, lungs, joints.) If the body cannot eliminate the increasing dosha(s) and maintain homeostasis, it will begin to accumulate (Stage 1: Sanchaya) slowly and in small quantity. The usual reason that accumulation begins is that agni becomes low (mandagni) or irregular (vishagni) and ama begins to form in the body.

Ama causes the metabolism to become inefficient and also creates an obstruction of the srotas (channels). This interferes with the normal processes of elimination of the doshas and initiates the sancaya stage. This is the earliest stage of vikriti.

If no measures are taken to correct the situation, the process continues into the next stage, prakopa, in which the accumulated doshas provoke and irritate the local tissues. During this stage the doshas not only increase and become abnormal in quantity, but also with regard to quality, as vitiation begins. During prakopa, the aggravated doshas remain in their usual and normal sites and have not yet spread. There are subtle physical and mental pre-symptoms but no recognizable features of any specific disease, and this is a fully reversible stage.

Vata Prakopa:

  • an increase in intensity of sancaya signs, plus:
  • stiffness in one or more areas of the body
  • occasional tingling of the hands or feet
  • talking excessively; talking too fast; interrupting others
  • tenseness of the facial muscles
  • increased sensitivity to sound
  • aversion toward cold drinks and foods
  • gurgling or uneasiness in the epigastric (stomach) region
  • pain occurring in sites of old injuries
  • bone or muscle pain which is fleeting in nature
  • bowel movements: less frequent, smaller pieces, darker in
  • color, formed with many cracks, harder than usual, drier than usual (any of these signs)

Pitta Prakopa:

  • an increase in intensity of sancaya signs, plus:
  • sour taste in the mouth
  • sour fragrance of the perspiration
  • increased dryness causing increased thirst
  • slight burning in the throat, stomach, esophagus
  • mind turning to business matters after 10:00 pm
  • obsession with completing tasks which are not high priority
  • speech which is judgmental, criticizing of others, angry
  • slight burning during urination
  • yellowing of the eyes (sclerae) and/or skin
  • increased desire for alcoholic beverages/cold beverages

Nidana (Cause of Disease)

Nidana consists of five considerations: nidana (etiology), purvarupa (prodromal signs), rupa (main symptoms), upashayanupashaya (therapeutics), and samprapti (course). Nidana can be understood as four aspects—aharaja, viharaja, panchakarmajanya, and anyaja.

Vata Prakopaka Nidana

Aharaja

  • Teekshna, laghu, ruksha, sheeta guna aharas can cause vata prakopa
  • Anashana, adyashana, vishamashana, vishamopacharam, vruddahara, sevana can also cause vata prakopa
  • Sushkashaka, vallura, varakoddalaka, koradoosha, shyamaka, neevara, mudgara, masura, adhaki, harenu, kalaya, nishpava

Vihara

  • Ativyayama, vegasandharana (suppression of BM),vyayava, jagarana,
  • Bharaharana (over-exertion)
  • Gataturagaradha, padhaticharya (standing), prapatana (flying), bhagnam (amorous pleasure)

Panchakarmajanya

  • Atiyoga of vamana, virechana, shirovirechana
  • Doshatisravanam
  • Raktati sravanam (srava=flow)

Anyaja

  • Abhighata, unmada, shoka, vishama, sharirasya
  • Chinta, rogatikarshana
  • Marma gatam (gatam=related)
  • Gajashva shigrayam
  • Atitrasaka (tras=moving)
  • Kama shoka bhayam (kama=desire; bhaya=fear)

The particular causative factors responsible for the Vata component of bhrama are: speaking too much or too loudly, lack of sleep, indulgence in alcoholic beverages, exposure to cold winds especially from the north, suppression of the natural urges, fasting, excessive sexual activities, head trauma, carrying heavy loads, excessive or inappropriate emesis or purgation, continuous weeping, fear, anxiety, grief, excessive running or exertion.

Pitta Prakopa Karanas

Aharaja

  • Ushna, amla, lavana, kshara, katu rasa,
  • Ajirna bhojana, atisevitha bhojana
  • Tila, atasi, dadhi (kurds), sura, aranaala, kuluttha
  • Dushtannam
  • Vidahi padartha sevana (sevana- indulgence in, resorting to; indulging, being near fire)
  • Ahara vidahikala (overcooked food)
  • Ksharam (alkalai, ash)

Viharaja

  • Teekshan atapa sevana, agni santapa
  • Shrama, krodham (anger)

Panchakarmajanya

  • Vamana, virechana, nasya atiyogam
  • Doshati, rakati sravanam

Anyaja

  • Sharad ritu, varsha ritu
  • Madyahanam
  • Stri prasangam
  • Bhayam
  • Krodham
  • Ashudda lohas

The particular causative factors responsible for the Pitta component of bhrama are: excessive intake of sour, pungent, salty, or alkaline foods, alcoholic beverages, excessive exposure to sun and fire, excessive competitiveness, judgment, jealousy, and covetousness.

Purvarupa

Purvarupa are “pre-symptoms” which precede the appearance of a recognized disease entity. They are of two types: Samanya purvarupa – indicates the disease but not the doshic imbalance Vishishta purvarupa – indicates both the disease and the doshic imbalance

Bhrama itself is not always a discreet disease according to Ayurveda. It is also considered a possible purvarupa for the following diseases: Jvara, apasmara, arsha, raktapitta, grahani, kustha, masurika.

Rupam

Rupa refers to a collection of symptoms which are recognized as a discrete disease (synonyms: lakshanam, samstanam). They too can be either the samanya or vishishta type.

Bhrama is mentioned as a rupa of many diseases including various forms of jvaras, udavartha, murcha, chardi, arsha, kundalika, udara, pandu, halimakam, vishagni vyadi, krimi, marmagat, masurika, Rakta pradaram, and many others.

Samprapti

Due to uncorrected exposure for a period of time to the causative forces described above, the doshas can become aggravated and begin a sequence of pathological steps culminating in the creation of a disease state. The term "samprapti" refers to this sequence of doshic-related pathology triggered by one or more nidana (cause). Before we describe this sequence in detail let us consider a brief explanation of this sequence.

First, one or more doshas begins to accumulate somewhere in the body and soon becomes vitiated (aggravated). Next, the aggravated dosha spills over and begins to spread. When it reaches a vulnerable or somewhat weakened area or organ of the body, it will stagnate there and begin to mix with and disturb the structure and function of the local tissues. The tissues of the body, when spoken of in their healthy state are of course called the dhatus; however when we speak of these same tissues with regard to their mixing with vitiated doshas, we always refer to the tissues as dushyas.

This dosha-dusyas sammurcchana is the actual disease process (sammurcchana means "interaction"). The interaction of the doshas and dushyas, together with the specific effect from the site or organ involved (adhisthana) leads to the development first of specific prodromal features, and then of the main symptomatology, of a disease. Left untreated the disease will evolve its unique set of complications and reach a stage where it is no longer curable by any means.

Ayurveda, in one of its seminal contributions to medical thought, precisely describes this sequence of pathogenesis in terms of six specific stages. This has become known as the satkriyakala. Literally, this translates to "six times for action" but is also more commonly referred to as "the six stages of disease". Either translation is suitable.

The satkriyakala gives a view of the entire natural course of the disease from its early, reversible, pre-organic stages through its stage of manifestation and symptoms, to its late advanced stage with its irreversible complications. Knowledge of which stage of the satkriyakala a particular disease is in guides us toward the appropriate therapeutic intervention for that stage. The legacy left behind by this brilliant and profound set of observations into the nature of the disease process is the vital importance and practical relevance of the early identification of the incipient disease process, so that the disease can be precluded while in one of its early stages.

Satkriyakala (The Six Stages of Disease)

  • Sancaya (Accumulation)
  • Prakopa (Aggravation)
  • Prashama (Remission)
  • Prasara (Spread)
  • Sthanasamshraya (Localization)
  • Vyakti (Manifestation)
  • Bheda (Permanent Change and Complications)

With regard to Bhrama, the Vata (teekshna, laghu, ruksha, sheeta gunas) and Pitta (ushna, amla, lavana, kshara, katu gunas) ahara viharas are commonly the principal cause of the sanchayam of Vata and Pitta. This is because inappropriate diet leads to agnidushti and consumed foods, no matter how healthy, are not properly digested and ama is created. If left untreated at this stage, especially in each dosha’s respective season (Vata: varsha; Pitta: sharad), sanchaya or accumulation proceeds to prakopa or aggravation. Here is when the doshas combine with the ama which has formed and samadosha is produced. This is followed by prasara if no corrective actions are taken or possibly prashama if they are or if natural immunity is strong. However the dramatic crescendo and core event of the satkriyakala is sthanasamshraya (localization) also known as “dosha dushya sammurchanana” – interaction between the vitiated dosha and the tissues. Due to either or nidana sevana (indulgences) or sahaja karana (congenital actions), samadosha kha vaigunya occurs (lit: “the entrance through defects in the tissues of ama and dosha which causes exhaustion of the qualities of that tissue”). This is the stage (vastha) when the purvarupas of the disease appear in mild but recognizable forms.

Again with specific regard to bhrama, dosha dushya sammurchana occurs in rasa, rakta, mamsa, asthi, and majja dhatus as well as manas. As a result there is also derangement of the rasavaha, raktavaha, mamsavaha, asthivaha, majjavaha, and manovaha srotas (channels).

After sthana samsrayavastha is established there is progression to the fifth stage vyakti, where the disease is manifest, but efforts to remove the nidana karanas and doshic imbalances can still be effective. If left untreated, the disease becomes asadhya (incurable) and efforts shift to managing the symptoms only.

To summarize the Ayurvedic view and understanding of the entire disease process in bhrama (vertigo) here is a useful review:

Samprapti Features of Bhrama (Vertigo)

Dosha: Vata (prana, vyana, apana) Pitta (sadhaka, pachaka) Kapha (tarpaka) Guna: Rajas Dushya: Rasa, Rakta, Mamsa, Asthi, Majja Adhistana: Inner ear, central and peripheral nervous system Agni/Ama: Jataragnimandajanya, Dhatwagnimandajanya Srotas: Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha, Manovaha Srotodushti prakara: Atipravritti Rogamarga: Madhyama, Bahya

Prana Vata subdosha exerts direct and simultaneous control over nerve function, brain processes, manas, buddhi, smirti and all other higher cognitive functions. Additionally, prana vata possesses an indriya dharana capacity, meaning that it controls and stabilizes the five senses. This is illustrated beautifully in the metaphorical

Description in the hatha yoga pradipika which uses the image of five powerful horses (senses) being controlled by reins (manas) held by the driver (buddhi) of a sturdy chariot (body). Thus, it can be seen that pranavata has a three-faceted control over functions directly related to bhrama: mind, senses, and nervous tissue. Another important aspect of the action of prana vata is that it has a nutritive, accumulative effect as it directs energy, oxygen and nutrients inward and toward the deepest tissues of the body. Conversely, both apana and vyana vata move elements and substances out and away from the body. Vyana is responsible for the release of sveda while apana that of mutra and stool. Prana vata carries sensory information from the body and environment towards the brain; apana and vyana vata are understood to carry and disseminate information from the brain to the body. Thus the two (prana vs. apana and vyana) have opposite effects which work in harmony. When that harmony between the vata subdoshas is disturbed, the bhrama samprapti can be initiated.

Treatment (ref: CS, Sutra, 20, 11; 28, 17; SS Sarira, 4, 56)

1. Description of Individual Herbs Used in the Treatment of Bhrama

Latin: Tinospora cordifolia (Willd.) Miers

Family: Menispermaceae

Vernacular names: Sanskrit, Guduchi, Amrita; Hindi, Gurach, Gilo, Gulancha; English, Guduchi;Unani, Gilo; Malayalam, Amritu, Cittamritu; Bengali, Gulancha; Gurach; Punjabi, Gilo-Gularich; Marathi, Gula-veli, Guloe; Tamil, Sindil, Shindil; Japanese, Ibonashitsu zurabuji; Chinese, Kuan-chu-hsing

Description: A large, succulent climbing shrub with grayish-white bark with a spiral cleft; leaves cordate, 6 to 10 x 4 to 5 cm., long-petioled, acuminate at apex; Produces filiform aerial roots (similar to the banyan tree); flowers green in dioecious spikes, petals 6; fruit is a drupe, red, 4 to 5 mm in diameter.

Distribution and Habitat: Found throughout the tropical regions of India, Pakistan, Bangladesh, and Sri Lanka from the Himalayas to southern regions in deciduous forests and among other shrubs and bushes.

Part Used: stems, roots, aerial roots

Ayurvedic Energetics: Rasa: sweet, bitter, astringent Veerya: heating Vipak: sweet Gunas: unctuous, heavy, soft Doshas: VPK – (tridoshashamaka)

Pharmacological actions (Karma): alterative, diuretic, tonic, anti-inflammatory, hypoglycemic, hepatoprotective, febrifuge, digestive, dahaprashamana, medhohara

Clinical Research: Several animal and human clinical trials have established the antiinflammatory potency of the aqueous extract of Tinospora cordifolia in arthritis.1,2 The same extract has been shown to inhibit phase I and phase II in adjuvant-induced arthritis.3,4,5 The antiinflammatory effect of this plant is similar to that of the non-steroidal inflammatory agents with one important difference--the lack of adverse gastrointestinal side effects. This extract also shows weak antipyretic and morphine-potentiating activities. The hypoglycemic action of guduchi has been extensively studied. Again, the aqueous extract when administered to alloxan-induced hyperglycemic rats and rabbits in a dose of 400 mg/kg body weight induced a significant reduction in blood glucose levels.6 A similar reduction in blood sugar with guduchi has been demonstrated in adrenaline (epinephrine)-induced hyperglycemic rats.7,8 In addition the aqueous extract of the stems of the plant has been shown to antagonize the effects of seratonin, histamine, bradykinin, and prostaglandins E1 and E2 on rabbit smooth muscle.9287 It relaxes the smooth muscle of the small intestine and uterus and inhibits the contraction response to acetylcholine and histamine. The aqueous extract also demonstrated a reduction in blood urea nitrogen (BUN) levels in uremic dogs and humans and had a diuretic effect.10 One study conducted by Mhaiskar, et.al. found the aqueous extract of the stems to be an effective treatment for amavata (the closest Western equivalent is gout) and sandhigata, another form of joint affliction.11 The hepatoprotective action of Tinospora cordifolia has been studied in rats with liver damage induced with carbon tetrachloride. Interestingly, acute damage was actually somewhat increased with pre-administration of the aqueous extract, it was very effective in preventing liver fibrosis and in stimu

Lating subsequent tissue regeneration.12 There are also reports in the literature of Tinospora cordifolia used theraputically to treat rheumatoid arthritis13,14, jaundice15, and diabetes mellitus16. It has been shown to be nontoxic in acute toxicity studies.

Traditional Uses: One of the myths surrounding guduchi is that during a great war in which Rama defeated the demon Ravana, some of Rama’s brave monkey warriors were killed. Lord Indra showered nectar (amrita) from heaven to resurrect them. Some drops of this nectar fell onto the earth and created guduchi.17 Guduchi is regarded as a general tonic and rejuvenator. The water extract is used in joint diseases, urinary tract infections, vertigo, skin diseases, jaundice, diabetes, amavata, and liver disease. Guduchi is also especially useful for fevers and burning sensations anywhere in the body; it is also regarded as an aphrodisiac. The fresh plant is more effective than the dried plant. The juice of the fresh plant is administered in gonorrhea, vertigo, chronic cough, and certain forms of fever in doses of 2-4 oz tid. The plant is used externally to treat rheumatic pains. Preparations in which it is a major constituent include amritarishtam, dhanvantaram tailam, and guduchi sattva.

Indications: general weakness, fever, liver disease, gout, joint disease

Formulation and Dosage: powder : 2-3 g. bid/tid decoction : 2-4 oz. bid/tid fresh juice : 5-20 ml. bid

Latin: Asparagus racemosus

Family:Liliaceae

Vernacular names: Sanskrit, Shatavati; Hindi, Satavari; English, Asparagus; Gujarat, Ekalkanto; Bengali, Satmuli

Description: A thorny, tall, erect climbing plant with particularly fleshy, tuberous and fasciculated roots. These roots tend to be thicker in the middle portion and taper towards the base; they are whitish in color. It is the only species among the seventeen known species of Asparagus regarded as “rasayana” (general tonic) in the Ayurvedic literature.

Distribution and Habitat: Throughout the entire Indian subcontinent, especially in the north and in the low jungle regions; also commonly cultivated in home gardens.

Part Used: leaves, roots

Ayurvedic Energetics: Rasa: sweet, bitter Veerya: cooling Vipaka: sweet Guna: heavy, unctuous Doshas: VP- ; K+

Pharmacological actions (Karma): galactogogic (stanyajananam), antispasmodic, antidiarrhetic, demulcent, refrigerant, diuretic, aphrodisiac (vrishya), tonic (rasayana), antibacterial, antiparasitic, antitumor

Clinical Research: There are saponins in the roots of A. racemosus collected throughout India.18 There are several reports of galactogogic activity. One study showed that A. racemosus increased the weight of mammary tissue and milk yield in estrogen-primed rats.19 Other studies report antioxytoxic and anti-ADH activity in these saponin fractions isolated from the roots.20 Another study measuring growth promotion indicated an anabolic action of the plant. No studies to date are available which evaluate the effect of Shatavari on serum prolactin levels but several groups are currently preparing such investigations. Aqueous extracts of the roots were reported to have lipase and amylase activities.21

Traditional Uses: diarrhea, dysentery, inflammatory bowel conditions, blood purification, biliousness, edema, dyspepsia, rheumatic joint pains, gonorrhea, galactogogue, nervousness, fever, hemmorhoids

Indications: to increase milk production, nervousness, gastritis, diarrhea, female aphrodisiac, general nutritive tonic, spastic colon, fever

Formulation and Dosage: infusion, decoction, milk decoction (with ghee, pippali, and honey), powder (with honey) : 1-3 grams bid

Latin: Nardostachys jatamansi DC.

Family: Valerianaceae

Vernacular names: Sanskrit, Jatamansi, Bhytajata; Hindi, Jatamashi, Balchir; English, Indian Spikenard, Musk root; Unani, Balchar; Malayalam, Jatamanchi; Gujarati, Jatamasi; Persian, Sunbuluttib; German, Indische Narde; French, Nard Indien

Description: An erect herb with paired leaves 3.0 to 7.0 cm. long, sessile, oblong; flowers pinkish white with 1 to 3 heads, pubescent bracts; fruit covered with ovate, dentate calyx teeth with white hairs; rhizome fragrant, long, thick and woody covered with fine reddish brown fibers.

Distribution and Habitat: Grows in the Eastern Himalayas, Nepal, and Bhutan up to heights of 5000 meters.

Part Used:rhizome Ayurvedic Energetics: Rasa: sweet, bitter, astringent Veerya: cooling Vipaka: pungent Gunas: light, unctuous, sharp Doshas: VPK- (tridoshashamaka) Pharmacological actions: nervine sedative, antispasmodic, diuretic, emmenogogic, carminative, deobstruent, hypotensive, refrigerant, medhya rasayana, balya.

Clinical Research: Govindachari, et al.22 isolated a sesquiterpene component called jatamansone from the rhizome, which has been reported subsequently to produce tranquillizing effects in mice and monkeys.23 Amin, et al. demonstrated the sedative effect in humans of the root powder.24 The alkaloidal fraction obtained from the rhizome showed a significant and prolonged hypotensive action in dogs.25 In another clinical study, the antiarrhythmic activity of jatamansi was compared with quinidine sulfate and jatamansi was found to produce less prolongation of the refractory period and less slowing of conduction than quinidine. This suggests a possible use for this herb in treating certain types of cardiac arrhythmias. More research is warranted.

Traditional Uses: Jatamansi is used as a root infusion in the treatment of spasmodic conditions such as migraine headaches and irritible bowel discomfort, as well as for heart palpitations especially when associated with states of mild to moderate hysteria. It is said to also be useful in perimenopausal emotional disturbances and other nervous disorders. Sushruta recommends its us in epilepsy combined with dasamularista, Crotolaria juncea, barley, ghee, and goat's urine.26 Its oil is mixed with sesame oil and rubbed on the head as a sedative; it is usually combined with a small amount of camphor for this purpose. As an infusion with Cinnamomom tamala (Tejpatra) anise, ginger, and jaggery it is a useful remedy for flatulence, colic pain, and indigestion. It is also found in many preparations used as general tonics, respiratory conditions, leprosy, jaundice, and other liver diseases.

Indications: nervousness, anxiety, spastic conditions of the gastrointestinal tract and respiratory system.

Formulation and Dosage: rhizome decoction : 1-2 oz tid rhizome infusion : 1-2 oz tid rhizome powder : 0.5-2 g. bid rhizome extract : 14-28 ml. bid

Latin: Gossypium herbaceum Linn.

Family: Verbenaceae (syn. Gossypium indicum Lam.)

Vernacular names: Sanskrit, Gambhari, Karpas; Hindi, Karpas; English, Indian Cotton; Unani, Kambhari; Tamil, Kumizhnaram, Bengali, Gamari

Description: An erect, subglabrous shrub one meter in height with 3 to 5-lobed cordate leaves, lobes broadly ovate-acuminate; flowers axillary, yellow with purple centers, solitary; 3 to 5 celled capsules with pointed apices; ovoid seeds, covered by white cotton.

Distribution and Habitat: Cultivated throughout India, Pakaistan, North America, China and throughout the world.

Part Used: seeds, root bark

Ayurvedic Energetics: Rasa: sweet, astringent (root bark); pungent (seeds) Veerya: heating Vipaka: pungent Guna: light (root bark); unctuous, sharp (seeds) Doshas: V- ; PK+

Pharmacological actions (Karma): demulcent, expectorant, laxative, emmenagogue, galactagogue

Clinical Research: Chemical constituents include gossypol (seeds), hemigossypol (roots), limonene (leaves) and pinene (leaves)

Traditional Uses: The root bark is an effective emmenogogue (to stimulate delayed menstruation) and is sometimes used as an abortifacient. The seeds are laxative as well as a nervine tonic used in Vata-type headache and cognitive disorders. They are given as powder in warm milk. The seed poultice is applied to burns. The fresh leaf juice is used in diarrhea and dysentery, as is the leaf infusion. The leaves and roots are decocted an used in a bath for uterine pain. The roots of gossypium and sugarcane are ground together and used as a galactagogue. Cotton seed oil is used as an emollient in rheumatic joint disease and as a remedy for headaches.

Indications: delayed menstruation, vataja headache, vertigo, burns, diarrhea.

Formulation and Dosage: root powder : 1-3 g bid infusion, decoction : 1-2 oz bid fresh leaf juice : 5-10 ml. bid

Cow’s Ghee Ghee is obtained by bringing unsalted butter made from cow milk to a boil which causes the water within it to evaporate leaving the anhydrous milk fat residue in clarified form. Cow milk ghee becomes a light golden yellow color due to the presence of various carotenoids.

Ayurvedic Energetics: Rasa: sweet Veerya: cooling Vipaka: sweet Guna: heavy Doshas: V,P- ; K+

Pharmacological actions (Karma): general tonic, strengthening, medaja, mild laxative

Clinical Research: Ghee consists of a mixture of glycerides, free fatty acids, phospholipids, sterols, sterol esters, fat soluble vitamins (A, D, and E primarily), carotenoids, casein alkalai, and traces of calcium, phosphorus and iron. Its moisture content is 0.3% or less and its total cholesterol content is between 0.5 and 1%. Cow’s ghee can adsorb to lipid-soluable constituents in any herb and facilitate its crossing into cells through the lipid-based cell walls.

Indications: As an anupanam for Vata and Pitta shamaka aushadis.

Latin: Hyoscyamus niger Linn.

Family: Solanaceae

Vernacular names: Sanskrit, Yavani; Hindi, Khurasani-ajvayan; English, Henbane; Unani, Ajwan-e-khurasani; Chinese, Lao lang hoa; Japanese, Hiyosu; Tamil, Korusanai; German, Bilsenkraut, French, Jusquiame noire

Description: A foul-smelling annual or biennial erect, hairy herb covered with many glandular hairs. Stems grow to 1 meter in length; leaves are oblong-ovoid, 10 to 25 by 6 to 10 cm.; flowers are pale greenish yellow, veined, with deep purple centers, 2 to 3 cm. in diameter.

Distribution and Habitat: Native to the western Himalayas and Kashmir to altitudes of 3500 meters

Part Used: leaves, seeds

Ayurvedic Energetics: Rasa: pungent, bitter, astringent Veerya: heating Vipaka: pungent Gunas: heavy, dry Doshas: KV - ; P+

Pharmacological actions (Karma): Leaves are sedative, hypnotic, antispasmodic, mydriatic, anodyne; seeds are narcotic, anodyne, digestive, anthelminthic

Clinical Research: The leaves contain hyoscyamine (an isomer of atropine), hyoscine (an isomer of scopolamine), and scopolamine. Much of its therapeutic effects are attributable to the anti-muscarinic cholinergic actions of these belladonna alkaloids. Muravev used it effectively in a smoke-inhalation preparation to treat bronchial asthma.27 Over-dosage can produce delirium, coma, and even death.28

Traditional Uses: Yavani leaves are commonly used in the treatment of states of mental agitation, hysteria, epilepsy, insomnia, central nervous system diseases associated with uncontrollable movements, palpitations, asthma, vertigo, cough, and pain disorders. The leaves have a sedative effect found to be effective in bronchospasm, irritible bowel, and cystitis. The seeds are sometimes added to purgatives to prevent griping pain. The fresh juice of the leaves and whole plant is especially sedative; its over-dosage can produce delirium, coma, and even death. This juice is combined with barley flour and the poultice applied to inflammations. The seeds are also used as an anthelminthic.

Indications: mental agitation, vertigo, bronchospasm, irritible bowel symptoms, insomnia

Formulation and Dosage: leaf powder : 2-7 grams bid fresh juice : 3-5 ml bid whole plant extract : 3-5 ml bid seeds : 100 mg mixed with purgatives

2. Diet and Regimen

Foods which are easily digestible and which do not produce intestinal gas are recommended. The main tastes to be favored are sweet, sour, and slightly salty and foods should in addition be warm and unctuous whenever possible. Oils, including those found in seeds and nuts, are an important part of the diet. Vegetable juices and warm soups are good choices. Fresh juices of carrot, beet root and cucumber is also vatahara. Small portions of green salad with a dressing of olive oil, lemon juice and a little salt is perfectly fine but not in excess. Fruits like ripe apples, oranges, peaches, grapes, mango and papaya can be taken. Cooked vegetables like sweet potato, onion, spinach, squash, zucchini and pumpkin are good. The best spices and condiments for reducing Vata dosha include black pepper, anise, oregano, tamarind, cumin, coriander, ginger, vanilla, asafetida, garlic, fennel and turmeric.

Avoid eating hot, spicy and fried foods, sweets, wind forming foods like cabbage, cauliflower, eggplant, broccoli, mushrooms and potatoes should be prohibited. Relative contra

Indications include drinking excessive tea, coffee, alcohol, chocolate or cocoa; absolute contra

Indications are white sugar, smoking, day time sleep, and night vigil (staying up late). Efforts should be made to reduce worry, anxiety, fear, stress and grief. Regular but moderate intensity physical exercise and daily massage with oil, once or twice a week, is recommended as part of the daily routine.

In bhrama all three doshas have become aggravated and "overflowed" beyond of its natural site where it has become lodged in some peripheral tissue. In addition to its role as a primary cause of disease, the excess Vata dosha also provides the moving force for this spread of the aggravated doshas (including Vata itself). It is the quality of pressure inherent in Vata dosha which pushes the vitiated dosha towards the periphery and into the tissues. After some critical time, the dosha becomes firmly adherent and stagnant in its new location. In addition, the channel (srota) through which the dosha has moved from its original (central) site to its new (peripheral) site also becomes vitiated and obstructed. This obstruction of the channel prevents the easy return of the vitiated dosha to its original (central) site in the alimentary canal (kostha).

3. Poorvakarma

The general purpose of the poorvakarma therapies, i.e. internal and external snehana and fomentation or swedana, is to begin to loosen, liquefy, and move the vitiated doshas from their abnormal sites in peripheral tissues to the appropriate central site within the alimentary canal where they can be completely eliminated through pradhanakarma (main) procedures.

The word "Sneha" is derived from the root word "Sniha" which is a masculine word meaning love, tenderness, oil, unctuous. The defining property of an unctuous substance is that it binds together even the most minute particles of the body together; we might say it promotes cohesion at both the gross and subtle levels. "Snehana" specifically means "anointing the body with oil". Charaka tells us: "That which causes unctuousness, fluidity, softness, and moisture is called oleation therapy" (Ch. Su. 22/11). There are two types of Snehana Karma: Internal and External.

Internal Snehana (Oleation)

Patients must take the appropriate unctuous substance early in the morning within 1530 minutes of sunrise. For bhrama, the substance used is ghee. This should be preceded by the recitation of a mantra or other auspicious prayer. The treatment should begin on "Day 0" with a test dose of one ounce. The patient is then observed that day for signs of nausea, vomiting, fatigue, headache, confusion, salivation, or weakness. If none of these signs of intolerance are present, then the therapy proceeds according to the following schedule.

  • DAY "0" 1 ounce
  • DAY 1 2 ounces
  • DAY 2 3 ounces
  • DAY 3 4 ounces
  • DAY 4 6 ounces
  • DAY 5 8 ounces
  • DAY 6 10 ounces
  • DAY 7 12 ounces

The duration of the therapy can be either 3 days, 46 days, or the full 7 days according to the digestive strength of the patient as determined by the physician. Vagbhatta opines that the treatment can be less than three or more than seven days depending upon how much time is needed for the patient to manifest the signs of proper oleation. In clinical practice, the average duration of snehana is 47 days.

Sneha Abhyanga Of the many methods that are described in Ayurveda for externally oiling the body, the one that is used for this purpose in Poorvakarma is known as Sneha Abhyanga. Abhyanga is derived from the root ang meaning "movement" and the prefix abhi meaning "into" or "toward". Thus the word "abhyanga" has the meaning of moving energy into the body or, alternatively, moving toxins towards the alimentary canal for elimination. The massage is generally given for a total of 5060 minutes and the oils used can include: narayana, sesame, dhanvantari, or ksheerbala. The positioning of the patient and details of the massage strokes to the various regions of the body is addressed in a separate paper.

Swedana

The word swedana is derived from the Sanskrit root word swid meaning "to sweat, perspire; foment; soften". The word sweda refers to the "internal excreta of the body" which is a byproduct of meda or fat tissue (CS Ci.15/18). Swedana Karma is simply the group of procedures used to induce sweating. Charaka eloquently tells us that swedana is "whatever relieves stiffness, heaviness, and cold in the body and produces sweat" (CS Su.22/11). There are 29 methods of swedana enumerated by Charaka and Sushruta. The procedures used in bhrama include:

  • Avagaaha The patient takes a hot bath in a tub filled with an herbal decoction, oil, meat juice, ghee, or milk for a specified period of time.
  • Ushna sweda – The patient enters a specially constructed steam room or steam box either unprotected or protected by cloths.

4. Panchakarma Chikitsa (Radical Detoxification Procedures)

Virechana

The word virechana derives from the root reech which means "to empty, evacuate, discharge; release; leave behind" and the prefix vi which means "in two parts; division". In Ayurveda, Virechana implies the removal of malas and doshas from the Adhobhaaga (anal orifice) by administration of a purgative (laxative). Virechana causes the release of vitiated doshas from the stomach, small intestine, liver, and gallbladder and their eventual expulsion from the body via the rectum and anus.

Virechana Karma is a simple therapy to execute, involving only the administration of an appropriate purgative substance (virechana dravya). The single most important factor is that a proper course of Purvakarma (Snehana and Swedana) be completed prior to the purgation.

There are many, many medicines which can be used for virechana karma. A very common recipe for patients being treated for bhrama:

  • Draksha (Vitis vinifera)--------------- 10 gm.
  • Aragvadha (Cassia fistula)------------ l0 gm.
  • Haritaki (Terminalia chebula)------- -l0 gm.
  • Katuki (Picrorhiza kurroa)------------- 5 gm.

Boil these four ingredients in one cup (240 ml.) of water until reduced to 1/4 the original volume. Administer 40 ml of the decoction together with 25 mI. of Eranda Sneha (Castor Oil). This dosage is for promoting Madhya (medium) intensity of virechana. For minimum or maximum virechana, increase or decrease dosage by 30 %.

Shirobasti

Shirobasti is a special procedure in which a special cylindrical leather cap is fitted on the shaved head and sealed all round with a paste of black gram powder to prevent leakage of medicine. The patient’s head is shaven prior to the treatment. The patients are seated comfortably on a chair. Two-and-a-half liters of Dhanvantaram tailam heated in a water bath to 95-100°F is cautiously poured into the cap and onto the scalp. As the oil cools, it is removed and replaced with fresh warm oil. The same process is repeated over a 45-minute period, maintaining the temperature of the oil constantly between 95-100. Duration of the treatment is 45 minutes daily, for 8-14 days.

This treatment is based on the fact that each hair root on the head, as it sinks below the scalp, is connected to a tiny nerve. There are thousands and thousands of nerves lying just beneath the scalp--as many nerves as there are hairs on the head. Shirobasti bathes these tiny nerves in warm, herbalized oils which has a profoundly Vata decreasing and calming effect on the entire body.

The weight and pressure of the oil which remains on the head and scalp for 45 minutes is what eventually pushes it down along the hair shaft below the scalp line where it contacts the tiny nerve ending supplying each hair root.

Basti Karma

Basti Karma is universally regarded as the most important panchakarma procedure. The reason for this is that Basti Karma results in the removal of excess Vata dosha from the entire body. The term "Basti" indicates the procedure by which medicines are introduced into the pakvashaya (colon) via the guda-marga (anus). In modern terms, this would appear to be similar to enema therapy or colonic therapy. But these modern procedures are nothing more than bowel cleansing or nutritive therapies; the scope of Ayurvedic Basti Chikitsa is far more significant and hence cannot be remotely compared with contemporary enemata.

The exact meaning of the term "Basti" is urinary bladder. In ancient days, the urinary bladders of buffalos, goats, oxen, etc. were utilized as the enema bag and so this therapy acquired its unusual name.

Although useful in a wide variety of clinical circumstances, Basti Karma is most of all a specific treatment for Vata disorders (AH Su 1/25). In fact, the ancient vaidyas considered Basti to be half of the treatment for any disease and sometimes the entire treatment (CS Si 1/40-41).

Anuvasana Bastis are basically enemas with herbalized oils. To prepare these oils this general formula can be followed:

  • Herb ----------------1/4 cup (1 part)
  • Oil (or ghee ) ------- 1 cup (4 parts)
  • Water ----------------4 cups (16 parts)

The procedure is to combine these three ingredients in a small pot and bring to a boil. Then reduce the heat to maintain a gently rolling boil until all the water boils off. Strain and disgard the residual herbal residue. The oil which remains is now herbalized. It is allowed to cool until warm and then administered as Anuvasana Basti.

Herbs Which Are Used In Anuvasana Basti

The physician, guided by his know ledge of these and other herbs, can combine these medicines for the purpose of eradicating Vata dosha and addressing bhrama nidana directly.

  • Bala (Sida cordifolia)
  • Guduchi (Tinospora cordifolia)
  • Gokshura (Tribulus terrestris)
  • Haritaki (Terminalia chebula)
  • Ashwagandha (Withania somnifera)
  • Dasamoola (a group of ten roots used individually as well as together):
  • Bilwa (aegle marmelos)
  • Agnimantha (Premna mucronata)
  • Syonaka (Oroxylum indicum)
  • Gambhari (Gmelina arborea)
  • Patola (Trichsanthus dioica)
  • Salaparni (Desmodium gangeticum)
  • Prisniparni (Uraria picta)
  • Brihati (Solanum indicum)
  • Kantakari (Solanum surattense)
  • Eranda (Ricinus communis)
  • Amalaki (Emblica officinalis)
  • Shatapushpi (Evolvulus alsinoides)
  • Mandukparni (Centella asiatica)
  • Shatavari (Asparagus racemosus)
  • Yastimadhu (Glycyrrhiza glabra)
  • Vidari (Ipomoea digitata)
  • Kapikachchha (Mucuna pruriens )
  • Brahmi (Bacopa monniera)

Animal bladders are no longer used as the vessel to deliver Bastis. Today, the best instrument for this purpose is the adult-size enema bulb, which holds approximately 450 ml. It consists of a rubber squeeze bulb attached to a removable teflon nozzle (Basti-netra). It is available in any pharmacy. The method of administering basti is described in another paper.

Nasya

Nasya is the procedure in which medications are administered through the nostril in order to purify the head and neck region. Nasya means "of benefit to the nostrils". Shirovirechana, meaning "elimination from the head" is a word often used as a synonym for nasya. The medicines which are sometimes used include oils, pastes, powders, plant juices, decoctions, infusions, and smoke. In bhrama, generally herbalized oils and milks are utilized.

An often quoted sloka regarding nasya from the Astanga Hridayam reads: Nasyahi Siraso Dvaaram, "The nose is the doorway to the to the head." (AH Su.20/1). Being the gateway to the head, Nasya is considered to be a specific and effective treatment for diseases of the head including those involving the five senses (indriyas). Substances properly administered via this route will undoubtedly influence all the doshas which are located in the head and neck. Remember that the head is said to be the seat of the ten dhamanis (ten great vessels), the seat of the five senses, and the real location of the hridaya (heart). Most obviously of all, the nose is intimately connected to the flow of prana, the vital energy. Pure, warm sesame oil is one of the best nasya medicines used for bhrama. Arm Taila, Sadavindu Taila, and Vacha Taila are oils also utilized. Dosages are determined by the physician are detailed below.

Dosage in Drops (Bindus)

Mild Moderate Strong
(Hraswa) (Madhyama) (Uttama)
4 6 8

Nasya should not be administered directly following a meal, a bath, an alcoholic drink, sex, or exercise; nor should it be given to anyone who is pregnant, menstruating, or in an agitated state of mind.

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