Clinical Neurology in Ayurveda

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Clinical Neurology in Ayurveda is a handy book dealing with the practical clinical methodology of patient examination with the detail description of Vatavaha Samsthana and diseases related to it. The book gives the comprehensive idea of clinical importance and practical utility of Dashavidha Pariksh with diagrammatic presentation. Well systemic examination with respective photographs is given for Nervous system examination. This book is of exclusive in nature providing Ayurvedic scholars a complete scheme of patient examination with nervous system disorder and a particular approach to make diagnosis using both Ayurvedic as well as modern tools of clinical examination. The book first time introduces the scientific correlation of Avaana and its practical utility. This monograph deals with Ayurvedic Neurology through discussion of VAta-vaha Samsathana and diseases related to it. There is collection of Ct scan and MRI images of various neural pathologies with their full description with an aim to provide an easy explanation for diagnosis of pathological conditions to the readers. It is expected that this book may prove beneficial for Ayruvedic scholar, teachers, as well as or Ayruvedic Professional who desired opt build and evident concept about Vatavaha Samsathana and its clinical examination.

Dr. Divya Kajaria is a radiant Ayurvedic scholar with an outstanding, academic career. She had been completed her graduation from State Ayurvedic College, Varansi an done her post graduation in Kaachikitsa form N.I. a., Jaipur. During her studies she is always a meritorious student getting first rank in first and final professional examinations. She had also pompously hold the all Indian Ist rank in P.G. entrance examination of N.I.A. Presently she is working as senor resident in Deptt. Of Kayachikitsa. Faculty of Ayurveda, I.M.S., B. H.U. Along with this she is also perusing her Ph. D in Kayachikitsa under the guidance of her illustrious mentor Prof. S. K. Tiwari, Prof & Head, Deptt. Of Kayachikitsa, Faculty of Ayurveda, I. M.S, B. H.U.

This monograph authored by Dr. Divya kajaria deals with the clinical and path physiology of Mental and Neurological diseases as described in Ayurveda. Considerations of Mind and Nervous system are the core of Ayurvedic Medicine. Disorders of Mind and Nervous system are usually considered intractable in conventional modern medicine while the Ayurvedic Practitioners claim effective cure for such ailments. Hence, the attempt to compile a special monograph on this important aspect of Ayurveda is really commendable.

A critical review of the Ayurvedic literature reveals that Mind has been give greater importance that Brain. Mind and Brain and essentially allied entities in conventional western thinking, but Ayurveda conceive them on different footings. Conventionally Mind is considered as the function of Brain. Brain makes Mind through interaction of the outer world with the help of certain special components of Brain and Nervous System such as the Association Areas of Brain, the Limbic System and the Autonomic Nervous System. Conventional Biosciences try to explain most of the psychological functions within the frame of the Brain and Nervous system. In this consideration Mind is not an abstract entity although it is a complex phenomenon.

Ayurveda considers Manas/Mind as an integral part of the entity of Ayu/Jiva which is considered a four dimensional process-“Sarirendriya Satvaatma Samyogao Dhari Jivitam”

Manas is also considered the constituent of Nava Dravya –“khaadinyaatma Manah Kalo Dishasca Dravya Samgra” (Caraka). Thus Manas has a primary causal role in creation. It is the product of Consciousness not of the material brain. Brain is an important part of Sthula Sarira which might be functioning as the gross apparatus helping the formation of Manas as the evolutes of Atman the consciousness. The Atman itself is an extension of Paranaatman i.e. the Brahman which is an ocean of the consciousness and is the Absolute Reality which forms the basic matrix of the creation of this world.

However, in Ayurvedic Biology Mana is also described at the level of life entity, health, well being addend disease. In this gross contact we discuss the applied aspects of Manas in the realm of Prakriti and Vikriti. Ayurvedic texts describe 16 categories of Manas Prakriti or Psychic personalities in terms of Trigunas-sattva, Raja and Tama. Ayurveda also describes a range of Manas Bhavas and Manas Dosa Vikaras encompassing the range of emotions like kama, krodha, Lobha, MOha, Harsha, Vishada etc. These emotions are prevalent among the masses in this worldly life. However if these emotions override a limit they are considered as Primary Mental disease. The texts describe a large number of other Secondary Mental diseases such as Unmada, Apasmara , Atattavabhinivesha etc. besides Agantuja Unamada, or Grahaavesha with subtle etiology and manifestations . The texts also deliberate on the Daivavyapaasraya, Yuktivyapaasraya and Sattvaavajaye cikitsa of all these ailments in great besides an entirely different field of Naisthiki Cikitsa for Moksha.

Thus Ayurvedic Psychology and psychiatry are much deeper sciences o Psyche and Psychic illness than conventional western Psychology and Psychiatry. The present monograph authored by Dr. Divya Kajaria has dealt with the concept of Manas and Manas Roga in good details. This monograph also deals with Ayurvedic Neurology through discussions on Vata system and its physiology and certain selected Vata Vyadhis, their aetiopathogenesis, clinical presentation and Ayurvedic management. Ayurvedic Biology stands on its unique the entire biophysical understanding of Human Body Mind system in distinctly different perspective than that of conventional modern biology and medicine. It is not easy to compare the two sciences without the in-depth understanding of both. Such an effort warrants intense interface of Ayurveda with science of today. Any hurried casual approach in this extremely sensitive exercise may distort the real facts.

Dr. Divya Kajaria has attempted to deal with this important topic from an applied approach. I appreciate her efforts to write on such an important topics of Ayurveda. I congratulate the author and the publisher of this book for their good work.

Ayurveda is not only a system of Medicine rather it is the science of life. It includes physical, mental and spiritual well being. The teaching approach in ancient time is totally different from that in present era. In ancient time the desired student (disciple, Shishya) reside with his teacher {Guru) and get the knowledge of various subjects. Student spends his whole time with his teacher and gets benefitted by his experiences. This teaching style is known as Guru- Shishya Parampara. All the present available Ayurvedic texts are in conversation form & the matter is compiled as a conversation between teacher & student. Thus the texts mainly comprise basic principles, fundamentals & treatment modalities lacking the details of practical clinical methodology. In ancient time teacher taught the students about clinical methods by live demonstration and the same is deliver by that student to the offspring's, thus it is not required to pile-up. But with passage of time everything changes, the Guru-Shishya Parampara is replaced by class room teaching. The ancient knowledge running in families does not remain only the property of special class and student belonging to every class get the liberty to attain the knowledge. This revolution is admirable in every aspect but the only drawback is loss of traditional teaching methods. And practical clinical knowledge. This makes a huge gap in Ayurvedic knowledge and the fundamentals become controversial and unclear because of lack of proper practical demonstration. Now it is time to refill this gap by providing good books, and trained teachers giving new generation a clear vision about Ayurveda. If Ayurveda has to be made a life science it is required that it should be taught in its own methodology and its fundamental should be made comprehensible as far as possible. Practical clinical training is an integral part of any medical science so that student can understand what he is learning about.

There are different methods for clinical examination described in Ayurveda, namely Dwividha Pramana Pariksha, Trividha Pramana Pariksha, Panchavidha Pariksha, Astavidha Pariksha, Dashavidha Pariksha, Srotasa Pariksha etc. There are two approaches for clinical examination in Ayurveda- (i) Those assessing the strength of Patient (Rogi Pariksha) (ii) Those assessing the strength of disease (Roga- Pariksha). Ayurveda gives more importance on assessing the strength of patient and says that this is key factor in determining the treatment. At this junction. Ayurveda and modern medical science different markedly. Among all above motioned clinical examinations the most useful and practically applicable is Dashavidha ariksha & Srotasa examination. DAshavidha Pariksha is the only examination that assesses the strength of patient as well as strength of disease strength/Bala Partiksha. For proper management of disease, it is required to have proper knowledge about pathogenesis of disease. According to Ayurveda no disease ever originated without the vitiation of Starotas or without the involvement of Srotasa. The vitiated doshas resides at particular dushya causes vitiation of Srotassans produce diseases. As this book mainly focus on Rogi Paariksha (examination of Patient), Srotasa Pariksha is selected to get the knowledge about Samprapti (pathogenesis) & Samprapti Ghataka, among carious other clinical examination described in text for Rogi Pariksha. Describing the diseases on the basis of Srotasa has an additional advantage for Rogi Pariksha. Describing the diseases on the Basis of Srotasa has an additional advantage for easy remembrance of large disease with a sam

e treatment methodology to be followed in every disease. In Ayurveda two types of diseases are describe (i) Samanuyaja Vyadhi,(ii) Nanatamaja Vyadhi. Samanyaja Vydhiya are those diseases that have preeminence of only one dosha. Among Nanatamaja Vyadhiya largest number of diseases comes under the umbrella of Vatika Disorders (80 diseases).

According to Ayurveda Tridosha (Vata, Pitta, Kapha) is the fundamental unite of all living things. Among these tree again, vata plays the dominant role buy regulating and influencing the other two doshas. Amazing similarity is present between the prevalence of vatika disorders and Nervous system disorder. Even today also, the maximum number of disabling diseases belongs to those that related to Nervous system. We can thus say that things remain same and only nomenclature differs in different system of medicine. Though it is too difficult to say that Vatika disorder sonly belongs to Nervous system disorders as vata is very wide term but still on the basis of its action and physiological properties it can be said that its function are much similar to that of Nervous System in body. There are two main cause for vitiation of vata namely i. Margavarana, ii. Dhatukshaya. According to modern science all the diseases related to Nervous system can be broadly divided into i. inflammatory type & those related to disturbance in various neurotransmitters or nerve impulse conduction defects, ii. Atrophy related & Degenerative type diseases. Thus here again a similarity persist between the two. There are many more reasons accounting for similarity persist between the two. There are many more reasons accounting for similarity between vata and Nervous system which will discuss elaborately in respective chapters.

Vatika disorders are detailed in Ayurvedic texts elaborately but no clear indication regarding Srotasa involvement is available. Acharya gives no clue, throwing light in this matter which remains unexplained. Vatika disorders comprise a broad spectrum of diseases from Nakhabheds to Pakshaghata. Inspite of all diversities one striking similarity exist between all these diseases that is- Pain. Pain is characteristic sign of vata. According to Ayurveda any type of knowledge (jnana) is not possible without the involvement of Man. Sukha (pleasure) or Dukha (pain) are felt only when Indrya (sensory organ) get collaborated with Atma through Mana.

Srotasa are minute channels spreading throughout body & carrying those substances after which they are named, for example Raktavaha srotasa carries Rakta dhatu froomits origin to whole body. There are seven Dhatus and seven respective channels for carrying them. But no separate channels are described in Ayurveda or carrying vata, Pittaa, kapha & Mana as these are said to be circulated in whole body thought every Srotasa continuously. This is beautifully explained by Acharaya Cakrapani While commenting on Manovaha Srotasa. Mana is said to be Sukshma (infinitesimal) and Sarvashaririavyapaka (present in whole body). Every perception after analysis gets proper response only w hen Man functions normally. Every perception after analysis gets proper response only when Man functions normally. Every minute thousand of sensory impulses though sensory organ are received analyzed and responded, according to Ayurveda this is only due to Mana. Though Mana is not a physical entity that can be carried in Srotasa, but it should have to remain in contact with all Indriyas (sensory organ) to produce knowledge, thus by Manovaha Srotasa it means that these are these channels carrying sensory and motor impulses which is according to Ayurveda govern and regulated by (va Gatiandhanayo ). Thus vitiation of Vata causes vitiation of Manovaha Srotasa and vice-versa. Modern science said that Mind is different from Bain and same is accepted by Ayurveda. Mana has two distinctive functions in body.

Vata is the active one as Rajas in Manasika Dosha. Vata has the dominance of Rajo Guna. That’s why; one can say that all the physical activities are controlled by thae Rajas. Vata domiciles in the upper portion of Mastiska and activities all works of the body which is mentioned in Aharvavedaa. I mean that both the vata and Mana having the same working field called Mastiska. Being the controller, activator, leader and carrier of action, vata is responsible for all activities of Mana.

All mental activities are imbalanced when vata become vitiated like-speech imcapavility, improper perception of taste and smell, depletion of enthusiasm etc. Again when vata increases, the manifestations are like lack of perception of taste, diminish vision, numbness, delirium, fear etc.

Vata Prakriti persons show the fluctuation of activities and quickness of rep sense to stimuli. Thus state that the predominance of vata makes the physical as well as psychological activities little exaggerated. Out of five types of vayu especially Prana, Udana and vyana have greater influence over Mana.

They are very much related to seat of Mana i.e. Hriday and Sira. Prana Vayu moves in the Urah, Sira and regulates this organs situated in these places along with the control of mental thoughts and assists better concentration.

Almost all Manasa Rogas are counted under Nanatmaja Roga of Vayu. Hence, role of Vayu is the most important as stated viz., ‘Niyanata Praneta Ca Manasaha’ in normal state, while in vitiated state it gives birth to Bhaya, Shoka, Moha etc. (Ca. Su. 12/8) considering to the different kind of vayu.

(1) Prana vayu-dhriti of Buddhi-Hridaya-Indriya-Citta.

(2) Udana Vayu- It gets vitiated with extreme happiness, grief, Harsa, Dukha and respectively causing Manobhramsa.

(3) Vyana Vayu-It get vitiated by continuous thinking i.e., by Dhyana or Chinta, Bhaya or fear. Harsa, Visada causes Sattvabhramsa, Utsahabjramsa, Cittotplava.

Thus it is now clear that there is Manovaha Srotasa involvement in Vatika disorders. And this is quite apparent that Stress, Anxiety and other psychiatric disorders produces nervous disorders such as.

From above all discussion the conclusion which we draw is quite amazing. As both Psychiatric and Nervous system disorders involves vitiation of Mnaovaha Srotas so treatment should aim to modify the exaggerated Manshika Doshaas by giving proper medicine and therapy including Medhya Rasyna in Vatika disorders but now after above discussion its rationality is proved and now we can give proper explanation for using Medhya Rasyana, Satvajaya Chikitsa & Shirodhara in Essential Hypertension by many physicians. Thus to understand Ayurveda it is very necessary to know its fundamentals without which successful management of any disease in just a dream.