The 1st chapter of Nidanasthana of Sushruta Samhita is named as Vata Vyadhi Nidanam Adhyaya. This chapter deals with Diseases of the Nervous System.

अथातो वातव्यधिनिदानं व्याख्यास्यामः ॥१॥
यथोवाच भगवान धन्वन्तरिः॥२॥
Now, we will expound the diagnosis of Vata Vyadhi (diseases caused by aggravated Vata, Vis-à-vis diseases of nervous system); as revealed by the venerable Dhanvantari.

धन्वन्तरिं धर्मभृतां वरिष्ठममृतोद्भवम ॥
चरनावुपसंगृह्य सुश्रुतः परिपृच्छति ॥३॥
वायोः प्रकृतिभूतस्य व्यापन्नस्य च कोपनैः ॥
स्थानं कर्म च रोगांश्च वद मे वदतां वर ॥४॥
Sushruta bowed down to the feet of Master Dhanvantari who was known to be the chief among those who followed and maintained Dharma – righteous way of living or moral code of living and who was born with Amrta – nectar. After offering his respects to his master, he requested – ‘Sir, you being the best among the expounders, please let me know about the seats and functions of Vata, both – in its normal and abnormal states. Also enumerate the causes for its abnormality and diseases produced by it’.

Nature and qualities of Vata

तस्य तद्वचनं श्रुत्वा प्राब्रवीद्भिषजां वरः ॥
स्वयंभूरेष भगवान् वायुरित्यभिशब्दितः ॥५॥
स्वातन्त्र्यान्निभावाच्च सर्वगत्वात्तथैव च ॥
सर्वेषामेव सर्वात्मा सर्वलोकनमस्कृतः ॥६॥
स्थित्युत्पत्तिविनाशेषु भूतानामेष कारणम ॥
अव्यक्तो व्यक्तकर्मा च रूक्षः शीतो लघुः खरः ॥७॥
तिर्यग्गो द्विगुणश्चैव रजोबहुल एव च ॥
अचिन्त्यवीर्यो दोषाणां नेता रोगसमूहराट् ॥८॥
आशुकारी मुहुश्चारी पक्वाधानगुदालयः ॥
After having heard the words of request from Sushruta, the best physician, revered Lord Dhanvantari began explaining thus –
‘Bhagavan (God) Vayu is Swayambhu – is a self-born divinity. This vayu is independent and everlasting. It is an all-pervading and functional entity in all living and nonliving things. Vayu is highly respected and worshiped by the entire world and all the world. Vayu is the cause for maintenance, birth and death of all living beings. In spite of it being invisible, vayu is knowable through its actions. It is dry, cold, light, rough and moves in all the directions. Vayu has two qualities i.e. sabda – sound and Sparsha – touch. Being predominant in Rajo Guna, Vayu is highly powerful. It is the leader of doshas and also spreads them. Vayu is also the king of groups of diseases. It is quick acting, moves constantly and mainly dwells in Pakvadana – large intestine and Guda – rectum.

Functions of Anila (Vata)

देहे विचरतस्तस्य लक्षणानि निबोध मे ॥९॥
दोषधात्वग्रिसमतां संप्राप्तिं विषयेषु च ।
क्रियाणामानुलोम्यं च करोंत्यकुपितोऽनिलः ॥
Now listen to the functions of Vata.
It pervades the entire body.
In a state of its balance and when not aggravated, this Vayu renders the below mentioned beneficial functions –

• Maintains normalcy of doshas, dhatus and agni
• Helps the sense organs to perceive their respective sense objects
• Initiates the functions of the body, mind and speech
  Pancha Vata-five divisions of vata
  यथाऽग्रिः पञ्चधा भिन्नो नामस्थानक्रियामयैः ॥
  भिन्नोऽनिलस्तस्था ह्येको नामस्थानक्रियामयैः ॥११॥
  Just like the agni i.e. pitta is of five types in respect of its names, seats, functions and diseases that it causes, Vata too, in spite of being only one, is divided into five kinds in respect of its names, seats, functions and the diseases it produces.

Five kinds of Vata

Prana Vata

यो वायुर्वक्रसंचारी स प्राणो नाम देहधृक॥
सोऽन्नं प्रवेशयत्यन्तः प्राणांश्चाप्यवलम्बते ॥१३॥
प्रायशः कुरुते दृष्टो हिक्काश्वासादिकान् गदान् ॥
Prana is that kind of vayu which moves in the mouth.
This vayu

• supports the body
• helps in moving the ingested food inside the alimentary tract
• maintains and supports the Prana – life, and its functions
  When the same Prana Vata gets aggravated, it generally causes diseases like hiccups, dyspnea etc.

Udana Vata

उदानो नाम यस्तूर्ध्वमुपैति पवनोत्तमः ॥१४॥
तेन भाषितगीतादिविशेषोऽभिप्रवर्तते॥
ऊर्ध्वजत्रुगतान् रोगान् करोति च विशेषतः ॥१५॥
Udana is that vayu which moves in an upward direction.
Udana Vayu helps in achieving the actions of singing, speaking and such others. When the same Udana Vayu gets aggravated, it produces diseases of the organs above the shoulders.

Samana Vata

आमपक्वाशयचरः समानो वह्निसङ्गतः ॥
सोऽत्रं पचति तज्जांश्च विशेषान्विविनक्ति हि ॥१६॥
गुल्माग्रिसादातीसारप्रभृतीन कुरुते गदान् ॥
Samana is that Vayu which moves in the amasaya – stomach and small intestine and Pakvasaya – colon (large intestine)
This Samana Vayu after getting associated with Agni – the digestive fire, cooks (digests) the food properly and separates the essence and waste products from the digested food.
The same Samana Vayu, when aggravated, causes diseases like abdominal tumors, weakness of digestion, diarrhea etc.

Vyana Vata

कृत्स्नदेहचरो व्यानो रससंवहनोद्येतः ॥१७॥
स्वेदासृकस्त्रावणश्चापि पञ्चाधा चेष्टयत्यपि ॥
कुद्धश्च कुरुते रोगान् प्रायशःसर्वदेहगान् ॥१८॥
Vyana is Vayu which travels all over the body.
This Vyana Vayu –

• circulates the rasa
• eliminates sweat and
• helps proper flow of blood,
• performs five kinds of action – expansion, contraction, upward, downwards and sideward movements
  The same Vyana Vata, when aggravated, generally produces diseases affecting the whole body.

Apana Vata

पक्वाधानालयोऽपानः काले कर्षति काले कर्षति चाप्यधः ॥
समीरणः शकृन्मुत्रं शुक्रगर्भार्तवानि च ॥।१९॥
कुद्धश्च कुरुते रोगान् घोरान् बस्तिगुदाश्रयान् ॥
Apana is that Vayu which resides in Pakvadana – large intestine.
Apana Vayu eliminates –

flatus,
feces,
urine,
semen,
fetus and
menstrual fluid

The same Apana Vayu when aggravated gives rise to dreadful diseases of urinary bladder and rectum.

शुक्रदोषप्रमेहस्तु व्यानापानप्रकोपजाः ॥२०॥
युगपत् कुपिताश्चापि देहं भिन्द्युरसंशयम्॥
When Vyana Vayu and Apana Vayu are simultaneously aggravated, diseases of semen and diabetes are caused. When all types of Vata get aggravated simultaneously, they will undoubtedly destroy the whole body.

Asayagata vata vikara: Abnormalities in the viscera caused by Vata

अत ऊर्ध्वं प्रवक्ष्यामि नानास्थानान्तराश्रितः ||२१||
बहुशः कुपितो वायुर्विकारान् कुरुते हि यान् |
वायुरामाशये क्रुद्धश्छर्द्यादीन् कुरुते गदान् ||२२||
मोहं मूर्च्छां पिपासां च हृद्ग्रहं पार्श्ववेदनाम् |
पक्वाशयस्थोऽन्त्रकूजं शूलं [२] नाभौ करोति च ||२३||
कृच्छ्रमूत्रपुरीषत्वमानाहं त्रिकवेदनाम् |
श्रोत्रादिष्विन्द्रियवधं कुर्यात् क्रुद्धः समीरणः ||२४||
After this, the abnormalities produced by aggravated vata in different places of the body will be described.

Ashaya in which aggravated vata is seated Symptoms
Amashaya Gata Vata – Vata aggravated in stomach (and small intestines) Diseases like vomiting etc.
Delusion
Fainting
Thirst
Severe catching / gripping pain in the region of heart
Pain in flanks
Pakvashaya Gata Vata – Aggravated vata seated in large intestine or aggravation of vata in large intestine Gurgling noise in the abdomen
Pain around the navel region
Difficulty in voiding urine and feces
Flatulence
Low back / sacral pain
Shrotradishu Gata Vata – Aggravated vata localized in ears etc. (sense organs) Loss of sensory perception of the related indriya / indriyas wherein vata gets aggravated

Dhatugata Vata Vikara: Abnormalities of vata in the tissues

वैवर्ण्यं स्फुरणं रौक्ष्यं सुप्तिं चुमुचुमायनम् |
त्वक्स्थो निस्तोदनं कुर्यात् त्वग्भेदं परिपोटनम् ||२५||
व्रणांश्च रक्तगो, ग्रन्थीन् सशूलान् मांससंश्रितः |
तथा मेदःश्रितः कुर्याद्ग्रन्थीन्मन्दरुजोऽव्रणान् ||२६||
कुर्यात् सिरागतः शूलं सिराकुञ्चनपूरणम् |
स्नायुप्राप्तः स्तम्भकम्पौ शूलमाक्षेपणं तथा ||२७||
हन्ति सन्धिगतः सन्धीन् शूलशोफौ करोति च |
अस्थिशोषं प्रभेदं च कुर्याच्छूलं च तच्छ्रितः ||२८||
तथा मज्जगते रुक् च न कदाचित् प्रशाम्यति |
अप्रवृत्तिः प्रवृत्तिर्वा विकृता शुक्रगेऽनिले ||२९||

Tissues and structures in which aggravated vata is localized Symptoms
Tvakstha Vata – Aggravated vata residing in skin (rasa dhatu) Appearance of abnormal colors in the skin
Throbbing sensation
Roughness
Loss of sensation / loss of consciousness
Tingling sensation
Continuous pricking pain
Cracks / fissures in the skin, all over the body
Peeling off of the skin
Raktagata Vata – aggravated vata localized in the blood Ulcers are formed
Mamsagata Vata – aggravated vata localized in muscles Painful cystic swellings / tumors
Medogata Vata – aggravated vata localized in fat Cystic swellings / tumors which have mild pain and are non-ulcerating
Siragata Vata – aggravated vata localized in veins (blood vessels) Pain
Contraction of veins / blood vessels
Fullness of veins / blood vessels
Snayugata Vata – aggravated vata localized in ligaments Stiffness
Tremors
Pain
Convulsions
Sandhigata Vata – aggravated vata localized in bony joints Destroys the actions of the joints
Pain in joints
Swelling in joints
Asthigata Vata – aggravated vata localized in the bones Dryness of the bones
Fractures
Pain in the bones
Majjagata Vata – aggravated vata localized in bone marrow Dryness
Pain which does not subside at all
Shukragata Vata – aggravated vata localized in semen tissue Excessive elimination or improper elimination of semen

Movement of abnormal vata in the body

हस्तपादशिरोधातूंस्तथा संचरति क्रमात् ॥
व्याप्रुयाद्वाऽखिलं देहं वायुःसर्वगतो नृणाम् ॥३०॥
स्तम्भनाक्षेपणस्वापशोफशूलानि सर्वगः ॥
Sarvagata Vata
The aggravated vata successively affects the hands, feet, head and tissues one after the other. It also affects the entire body when all the tissues of the body are invaded by the aggravated vata.
The aggravated vata moving and pervading the entire body produces the below mentioned symptoms –

loss of movements
convulsions
loss of sensation
swelling and
pain

Association of vata with other doshas and its localization in various organs

स्थानेषूक्तेषु संमिश्रः संमिश्राः कुरुते रुजः ॥३१॥
कुर्यादवयवप्राप्तो मारुतस्त्वमित्न् गदान् ॥
When associated with other doshas i.e. pitta and kapha, the aggravated vata gives rise to mixed kinds of pains and symptoms in the places of the body mentioned above.
The aggravated vata produces innumerable diseases when localized in various organs.

Avarana Vata: Vata covered / obstructed by other Doshas

दाहसंतापमूर्च्छाः स्युर्वायौ पित्तसमन्विते ॥३२॥
शैत्यशोफगुरुत्वानि तस्मिन्नेव कफावृते ॥
सूचीभिरिव निस्तोदः स्पर्शद्वेषः प्रसुप्तता॥३३॥
शेषाः पित्ताविकाराः स्युर्मारुते शोणितान्विते ॥
प्राणे पित्तावृते छर्दिर्दाहश्चैवोपजायते ॥३४॥
दौर्बल्यंसदनं तन्द्रा वैवर्न्यं च कफावृते ॥
उदाने पित्तसंयुक्ते मूर्च्छदाहभ्रमक्लमाः ॥३५॥
अस्वेदहर्षौ मन्दोऽग्रिः शीतस्तम्भौ कफावृते॥३६॥
कफाधिकं च विण्मूत्रं रोमहर्षः कफवृते ॥
अपाने पित्तसंयिक्ते दाहौष्णये स्यादसृग्दरः ॥३७॥
अधःकायगुरुत्वं च तस्मिन्नेव कफावृते॥
व्याने पित्तावृते दाहो गात्रविक्षेपणं क्लमः ॥३८॥
गुरुणि सर्वगात्राणि स्तम्भनं चास्थिपर्वणाम् ॥
लिङ्गं कफावृते व्याने चेष्टास्तम्भस्तथैव च ।३९॥
Vata enveloped / mixed with pitta gives rise to –

burning sensation,
increase of body temperature
fainting
Vata enveloped by Kapha produces the below mentioned symptoms –
coldness
swelling
heaviness
Vata enveloped by Rakta – blood will cause –
pain as if pricked by needles
aversion to touch
numbness – loss of sensation
other symptoms of pitta aggravation
Prana Vata enveloped by pitta causes –
vomiting
burning sensation
Prana Vata enveloped by kapha causes –
weakness
fatigue
drowsiness / stupor
discoloration
Udana Vata enveloped by Pitta causes –
fainting
burning sensation
giddiness
exhaustion
Udana Vata enveloped by Kapha causes –
absence of sweating
horripilations
weak digestion
coldness
stiffness / loss of movement
Samana Vata enveloped by Pitta causes –
sweating
burning sensation
increased heat
fainting
Samana Vata enveloped by Kapha causes –
increase of kapha
excessive formation of feces and urine
horripilation
Apana Vata enveloped by Pitta produces –
burning sensation
excessive heat
menorrhagia
Apana Vata enveloped by Kapha causes –
heaviness in the lower portion of the body
Vyana Vata enveloped by pitta causes –
burning sensation
irregular movements of the body parts
exhaustion
Vyana Vata covered by Kapha causes –
heaviness of the body
stiffness of the bony joints – mainly interphalangeal joints and
loss of movements or stiffness of limbs and other parts of the body

Notes: – Avarana means enveloping or covering. Functionally it means hindering or obstruction of movements or functions of vata. Vata can be enveloped by other doshas i.e. pitta or kapha or by dhatus or by its own subtypes. As a rule, it is only vata or subtype of vata that is enveloped. The obstructed vata is called avruta. That which envelopes vata or subtype of vata and hampers its functions and actions is called avaraka. The mechanism in which an Avaraka envelopes Avruta and interferes with its functions is called Avarana. The symptoms of Avaraka are generally more powerful.

Vatarakta Vyadhi: Gout

प्रायशः सुकुमाराणां मिथ्याऽऽहारविहारिणम् ॥
रोगाध्वप्रमदामद्यव्यायामैश्चातिपिडनात् ॥४०॥
ऋतुदात्म्यविपर्यासात्स्नेहादीनां च विभ्रमात् ॥
अव्यवाये तथा स्थूले वातरक्तं प्रकुप्यति॥४१॥
हस्त्यश्वोष्ट्रैर्गच्छतोऽन्यैश्च वायुः कोपं यातः कारणैः सेवितैः स्वैः ॥
तीक्ष्णोष्णाम्लक्षारशाकादिभोज्यैः संतापाद्यैर्भूयसा सेवितैश्च ॥४२॥
क्षिप्रं रक्तं दुष्टिमायति तच्च वायोर्मार्गं संरुणद्धचाशु यातः ॥।
कुद्धोऽत्यर्थं मार्गरोधात् स वायुरत्युद्रिकं दूषयेद्रक्तमाशु ॥४३॥
तत् संपृक्तं वायुना दूषितेन तत्प्राबल्यादुच्यते वातरक्तम् ॥
तद्वत् पित्तं दूषितेनासृजाऽऽक्तं श्लेष्मा दुष्टो दूषितेनासृजाऽऽक्तः ॥४४॥
Etiological factors of Vatarakta – Generally, Vatarakta arises in the below mentioned persons / in below mentioned conditions –

in those of tender constitution (physique)
in those who excessively indulge in unhealthy foods and activities
in those severely exhausted due to the effects of long-standing diseases
in those who are accustomed to long distance walking and sexual indulgence
in those who drink wine or other alcoholic beverages in excess
in those who excessively indulge in physical activities
in those who indulge in foods and activities which are opposite to the nature of the seasons and accustomed ones (foods and activities)
those who have been administered with improper oleation and other therapies
in those who abstain from copulation and
in those who are obese
Pathogenesis of Vatarakta –
Vayu gets excessively aggravated due to the below mentioned causes –
regularly and excessively riding on elephant, horse, camel etc. for long periods of time and such other causes
excessive indulgence in vegetables / foods having penetrating quality, hot potency, sour and alkaline taste
exhaustion by heat etc.

The vata thus aggravated quickly causes vitiation of rakta. This rakta in turn obstructs the path of vata. The vata undergoing great aggravation due to its path being obstructed by blood, causes great vitiation of the blood. In this disease, the vitiated rakta is combined with greatly aggravated vata wherein vata is very predominant. Therefore, this disease is called Vatarakta.
Similarly, when aggravated pitta combines with vitiated blood it will be known as pittarakta. Also, the aggravated kapha combined with vitiated blood will cause a condition called kapharakta.

Symptoms of Vatarakta caused by association of vata with various aggravated doshas

स्पर्शोद्विग्रौ तोदभेप्रशोषस्वापोपेतौ वातरक्तेन पादौ ॥
पित्तासृग्भ्यामुग्रदाहौ भवेतामत्यर्थोष्णौ रक्तशोफौ मृदू च ॥४५॥
कण्डूमन्तौ श्वेतशीतौ सशोफौ पीनस्तब्धौ श्लेष्मदुष्टे तु रक्ते॥
सर्वैर्दुष्टे शोणिते चापि दोषाः स्वं स्वं रूपं पादयोर्दर्शयन्ति ॥४६॥
Below mentioned are the symptoms of Vatarakta caused by predominance of aggravated Vata and Rakta –

• intolerance towards touch in the feet
• pricking and cutting types of pain
• severe dryness
• loss of sensation

Below mentioned are the symptoms of Vatarakta caused by predominance of aggravated Pitta and Rakta –

• severe burning sensation
• excessive heat
• redness
• swelling
• softness of the swelling

Below mentioned are the symptoms of Vararakta caused by predominance of aggravated Kapha and Rakta –

• itching
• whitish discoloration
• feeling of coldness on touch
• swelling bulged up
• immobility of feet

Below mentioned are the symptoms of Vatarakta caused by predominance of all doshas (aggravated) associated with aggravated rakta (blood) –

symptoms of respective doshas involved in the pathogenesis are manifested in the legs Purvarupa:

Premonitory symptoms

प्राग्रूपे शिथिलौ स्विन्नौ शीतलौ सविपर्ययौ |
वैवर्ण्यतोदसुप्तत्वगुरुत्वौषसमन्वितौ ।।४७ ।।
Below mentioned symptoms can be seen in the feet during the premonitory stage of Vatarakta –

Spread of the disease

पादयोर्मूलमास्थाय कदाचिद्धस्तयोरपि ।।
आखोर्विषमिव क्रुद्धं तद्देहमनुसर्पति ।।४८ ।।
Vatarakta remains rooted in the feet and sometimes even in the hands. When it gets increased, the disease spreads all over the body. The spread of the disease to all parts of the body has been compared to the spread of rat poison, which also spreads in quick time.

Prognosis of Vatarakta

आजानुस्फुटितं यच्च प्रभिन्नं प्रत्रुतं च यत् ।।
उपद्रवैश्च यज्जुष्टं प्राणमांसक्षयादिभिः ।।४९ ।।
शोणितं तदसाध्यं स्याद्याप्यं संवत्सरोत्थितम् ।।
The prognosis is bad and vatarakta is incurable in presence of the below mentioned signs and symptoms –

• cracks and fissures spread out from feet to the knee joints
• skin is broken
• exudation of fluids
• presence of complications like loss of prana – the vital life energy or strength and muscles etc.
  On the other hand, vatarakta which persists for more than a year is considered to be manageable but cannot be completely cured (i.e. it persists to stay).

Akshepaka: Convulsions

यदा तु धमनीः सर्वाः कुपितोऽभ्येति मारुतः ||५०||
तदाक्षिपत्याशु मुहुर्मुहुर्देहं मुहुश्चरः |
मुहुर्मुहुस्तदाक्षेपादाक्षेपक इति स्मृतः ||५१||
The aggravated vata invades all the dhamanis i.e. nerves of the body. Doing so, the aggravated vata would quickly cause vigorous movements of the body. These movements occur repeatedly. This disease is called as Akshepaka because the vigorous movements of the body parts occur repeatedly.

Apatanaka

सोऽपतानकसंज्ञो यः पातयत्यन्तगऽन्तरा ।।
कफान्वितो भृशं वायुस्तास्वेव यदि तिष्ठति ।।५२ ।।
स दण्डवत् स्तम्भयति कृच्छ्रो दण्डापतानकः ।।
हनुग्रहस्तदाऽत्यर्थ सोऽन्नं कृच्छ्रान्निषेवते ।।५३ ।।
धनुस्तुल्यं नमेद्यस्तु स धनुःस्तम्भसंज्ञकः ।।
अङ्गुलीगुल्फजठरहद्वक्षोगलसंश्रितः ।।५४ ।।
स्नायुप्रतानमनिलो यदाऽऽक्षिपति वेगवान् ।।
विष्टब्धाक्षः स्तब्धहनुर्भग्नपार्श्वः कर्फ वमन् ।।५५ ।।
अभ्यन्तरं धनुरिव यदा नमति मानवः ।।
तदाऽस्याभ्यन्तरायामं कुरुते मारुतो बली ।।५६ ।।
बाह्यस्नायुप्रतानस्थो बाह्यायामं करोति च ।।
तमसाध्यं बुधाः प्राहुर्वक्षःकट्यूरुभञ्जनम् ।।५७ ।।
कफपित्तान्वितो वायुर्वायुरेव च केवलः ।।
कुर्यादाक्षेपकं त्वन्यं चतुर्थमभिघातजम् ।।५८ ।।
Apatanaka – The condition of Akshepaka in which the person falls on the ground in between the bouts of convulsions is known as Apatanaka.

Dandapatanaka – Vatawould get greatly aggravated and on finding the association with kapha would reside in the same dhamanis mentioned above. Following this, the vata in association with kapha would make the body stiff, like a log of wood. This disease is called Dandapatanaka, which is said to be difficult to cure.

Hanugraha – A condition caused by vata in which the person eats the food with great difficulty is called Hanugraha, which means rigidity or stiffness of the lower jaw (lock-jaw).

Dhanustambha – Dhanustambha is a condition in which the body is bent like a bow. This bending of the body is caused by Aksepaka.

Abhyantarayama – It is a condition caused by vata which has got localized in the network of ligaments of the toes, ankle, abdomen, heart, chest and throat, producing powerful movements. Herein, the aggravated vata bends the body of the person inwards, like a bow and hence called Abhyantarayama. Below mentioned are the symptoms of this condition –

• powerful movements of the body parts
• convulsions occur in bouts
• bulging of eyes
• rigidity
• loss of movement of the lower jaw
• curvature (fracture or distortion) of the flanks
• vomiting of kapha

Bahyayama – Bahyayama is a condition caused when aggravated Vata gets localized in the external network of snayu (ligaments, nerves) and bends the body outwards. Wise people consider this condition as incurable when it is associated with distortion of chest, waist and thighs.

Vāta produces aksepaka – convulsions all by itself or when associated with either kapha or pitta. The fourth kind of aksepaka is produced by trauma.

Prognosis of Apatanaka

गर्भपातनिमित्तश्च शोणितातित्रवाच्च यः ।।
अभिघातनिमित्तश्च न सिध्यत्यपतानकः ।।५९ ।।
Apatānaka does not get cured when –

• it is caused by abortion,
• it is caused due to severe hemorrhage and
• it is caused due to trauma

Paksāghāta: Hemiplegia

अधोगमाः सतिर्यग्गा धमनीरूर्ध्वदेहगाः |
यदा प्रकुपितोऽत्यर्थं मातरिश्वा प्रपद्यते ||६०||
तदाऽन्यतरपक्षस्य सन्धिबन्धान् विमोक्षयन् ।।
हन्ति पक्षं तमाहुर्हि पक्षाघातं भिषग्वराः ।।६१ ।।
यस्य कृत्स्नं शरीरार्धमकर्मण्यमचेतनम् ।।
ततः पतत्यसून् वाऽपि त्यजत्यनिलपीडितः ।।६२ ।।
शुद्धवातहतं पक्षं कृच्छ्रसाध्यतमं विदुः ।।
साध्यमन्येन संसृष्टमसाध्यं क्षयहेतुकम् ।।६३ ।।
Pathogenesis –
Severely aggravated vata
↓
Invades the dhamanis (nerves, ligaments) located in the downward, sideward and upward directions / parts of the body
↓
And causes loosening of the bindings of the joints and
↓
Destroys one half of the body
↓
This condition is called as Pakshaghata by the best physicians

Symptoms –

• half of the afflicted body becomes incapable of any work or activity i.e. there will be no movements or actions in the afflicted part of the body
• the person becomes unconscious (alt – loss of sensation to touch on the affected side) or
• the person may even die
  If the destruction of half of the body is caused by vata alone, it will become very difficult to cure. On the other hand, if vata is associated with other doshas i.e. pitta or kapha, the disease becomes curable. The disease becomes incurable when it causes decrease or loss of tissues.

Apatantraka: Tetanus

वायुरूर्ध्वं व्रजेत् स्थानात् कुपितो हृदयं शिरः |
शङ्खौ च पीडयत्यङ्गान्याक्षिपेन्नमयेच्च सः ||६४||
निमीलिताक्षो निश्चेष्टः स्तब्धाक्षो वाऽपि कूजति |
निरुच्छ्वासोऽथवा कृच्छ्रादुच्छ्वस्यान्नष्टचेतनः ||६५||
स्वस्थः स्याद्धृदये मुक्ते ह्यावृते तु प्रमुह्यति |
कफान्वितेन वातेन ज्ञेय एषोऽपतन्त्रकः ||६६||
Pathogenesis –
The aggravated vata moves upwards from its place (normal seat)
↓
and invades the regions of heart, head and temples and
↓
produces pain, convulsions and bending of the body
↓
this disease is produced by vata in association with kapha
↓
and is called as Apatantraka

Symptoms of Apatantraka –

• pains
• convulsions
• bending of body
• eyes are closed, inactive and there is loss of movements of the eyes
• moaning i.e. mild sounds of suffering is heard as coming from the throat
• no breathing or breathing with difficulty

The person becomes normal and healthy when his heart becomes free and becomes unconscious when his heart gets enveloped.

Mañyā sthambha: Stiff neck / wry neck

मन्यास्तम्भं प्रकुरुते स एव श्लेष्मणाऽऽवृतः ।।६७ ।।
Causes –

• excessive sleeping during day time
• improper way of sitting or standing (improper posture)
• excessive gazing upwards
  Pathogenesis – Due to the above said causes, vata gets aggravated and enveloped by kapha, producing Manyastambha.
  Symptoms – rigidity or loss or movement of the neck and shoulders

Ardita: Facial paralysis

गर्भिणीसूतिकाबालवृद्धक्षीणेष्वसृक्क्षये ।
उच्चैया॑हरतोऽत्यर्थं खादतः कठिनानि वा ।।
हसतो जृम्भतो भाराद्विषमाच्छयनादपि ।।६८ ।।
शिरोनासौष्ठचिबुकललाटेक्षणसन्धिगः ।।
अर्दयित्वाऽनिलो वक्त्रमर्दितं जनयत्यतः ।।६९ ।।
वक्रीभवति वक्त्रार्धं ग्रीवा चाप्यपवर्तते ।।
शिरश्चलति वाक्सङ्गो नेत्रादीनां च वैकृतम् ।।७० ।।
ग्रीवाचिबुकदन्तानां तस्मिन् पार्श्वे तु वेदना ।।
यस्याग्रजो रोमहर्षी वेपथुनॆत्रमाविलम् ।।७१ ।।
वायुरूर्ध्वं त्वचि स्वापस्तोदो मन्याहनुग्रहः ।।
तमर्दितमिति प्राहुाधिं व्याधिविशारदाः ।।७२ ।।
क्षीणस्यानिमिषाक्षस्य प्रसक्तं सक्तभाषिणः ।।
न सिध्यत्यर्दितं बाढं त्रिवर्षं वेपनस्य च ।।७३ ।।
Causative factors – Below mentioned are the etiological factors of ardita –

• loss of blood in the pregnant women, woman after delivery, children, old persons, the debilitated persons and others
• shouting loudly,
• eating hard foods or things,
• laughing out loudly,
• yawning excessively,
• carrying heavy weights on the head,
• adopting improper postures in sleeping etc,
  Pathogenesis – In these persons Vata gets (aggravated and) localized in places such as the head, nose, lips, chin, forehead and eyes, produces pain in these and gives rise to Ardita.
  Symptoms – In this,
• half the face becomes distorted (irregular) so also the neck;
• there is shaking of the head,
• obstruction to speaking, disorders of the eye etc,
• pain in the neck, chin and teeth of that side
  Premonitory symptoms – include –
• horripilations,
• tremors,
• dirtiness of the eyes / tear filled in the eyes,
• vayu moving in upward directions (and causing belching etc conditions)
• numbness of the skin,
• pricking pain,
• stiffness / rigidity of nape of the neck / shoulders and lower jaw
  This disease is called Ardita, by experts of diseases.

Ardita is incurable –

• in weak persons
• in those who do not wink their eyes
• in those whose speech is constantly obstructed
• when it persists for more than three years
• when it is associated with shaking of head

Gridhrasi: Sciatica

पार्ष्णिप्रत्यङ्गुलीनां तु कण्डरा याऽनिलार्दिता |
सक्थ्नः क्षेपं निगृह्णीयाद्गृध्रसीति हि सा स्मृता ||७४||
Gridhrasi is a condition caused by the aggravated vata invading the kandaras i.e. ligaments and tendons of the ankles and toes, thereby producing kshepa i.e. pain and inability to extend in the thighs.

Viśāvacī: Monoplegia of arms

तलप्रत्यङ्गुलीनां तु कण्डरा बाहुपृष्ठतः ।।
बाह्वोः कर्मक्षयकरी विश्वाचीति हि सा स्मृता ।।७५ ।।
Visvachi is a disease caused when aggravated vata invades the kandara i.e. ligaments or tendons of the back of the arms and also extends up to and affecting the palm and fingers, thereby producing loss of functions (movements) of the arms.

Kroșțuka śīrşa , Swelling of the knee joints

वातशोणितजः शोफो जानुमध्ये महारुजः ।।
शिरः क्रोष्टकपूर्वं तु स्थूलः क्रोष्टकमूर्धवत् ।।७६ ।।
Krostuka Sirsaka is a disease presenting with a swelling which resembles the head of krostuka i.e. jackal in shape. It is caused when vata associated with rakta i.e. blood produces swelling at the middle of the knee joint, accompanied by severe pain.

Khañja – Pañgu- Lameness

वायुः कट्यां स्थितः सक्थ्नः कण्डरामाक्षिपेद्यदा |
खञ्जस्तदा भवेज्जन्तुः, पङ्गुः सक्थ्नोर्द्वयोर्वधात् ||७७||
Khanja is a disease in which the person has difficulty in walking. It is caused when the aggravated vata gets localized in the waist of the person and constricts the ligaments of the thighs. In this condition, only one leg is destroyed. The same condition is called Pangu when both legs are destroyed, being afflicted by vata.

Kalāya khañja: Lathyrism

प्रक्रामन् वेपते यस्तु खञ्जन्निव च गच्छति |
कलायखञ्जं तं विद्यान्मुक्तसन्धिप्रबन्धनम् ||७८||
A disease in which there is shaking of the legs at the commencement of walking itself and the person walking like a man lame by one leg and the binding of the joints become weak is known as Kalaya Khanja.

Vata kantaka: Sprain of the ankle

न्यस्ते तु विषमं पादे रुजः कुर्यात् समीरणः ।।
वातकण्टक इत्येष विज्ञेयः खुडुकाश्रितः ।।७९ ।।
Vata localized in the ankle gets aggravated and produces pain in those who keep their feet irregularly on the ground. This condition is called Vatakantaka.

Pādadāha: Burning feet

पादयोः कुरुते दाहं पित्तासृक्सहितोऽनिलः ।।
विशेषतश्चङ्क्रमणात् पाददाहं तमादिशेत् ।।८० ।।
Vata getting aggravated along with pitta and rakta i.e. blood causes burning sensation of the feet in those who walk too much. This condition is called as padadaha.

Padaharsa: Sensitive feet

हृष्यतश्चरणौ यस्य भवतश्च प्रसुप्तवत् ।।
पादहर्षः स विज्ञेयः कफवातप्रकोपजः ।।८१ ।।
The disease caused by aggravation of kapha and vata presenting with horripilations (pins and needles) and absence of tactile sensation (numbness) in the feet is called as Padaharsa.

Apabāhuka: Wasting / emaciation of arms

अंसदेशस्थितो वायुः शोषयित्वांऽसबन्धनम् ।।
सिराश्चाकुञ्य तत्रस्थो जनयत्यवबाहुकम् ।।८२ ।।
Apabahuka is a condition which afflicts the shoulders, caused when vata localized in the region of the shoulder gets aggravated and dries up the bindings i.e. ligaments of the shoulders and constricts the siras – veins located therein.

Badhirya: Deafness

यदा शब्दवहं स्रोतो वायुरावृत्य तिष्ठति ।।
शुद्धः श्लेष्मान्वितो वाऽपि बाधिर्यं तेन जायते ।।८३ ।।
Badhirya means deafness. It is caused when the aggravated vata either alone or in association with kapha gets localized in the channels of sound i.e. inside the ears and damages them.

Karnasula: Earache

हनुशङ्खशिरोग्रीवं यस्य भिन्दन्निवानिलः ।।
कर्णयोः कुरुते शूलं कर्णशूलं तदुच्यते ।।८४ ।।
Karna sula means pain in the ears. This is caused when the aggravated vata gets localized in the lower jaw, temples, head and neck and gives rise to splitting or bursting pain in the ears.

Muka – minmina – gadgada- Dumbness – nasal – voice – and stammering

आवृत्य सकफो वायुर्धमनी : शब्दवाहिनीः ।।
नरान् करोत्यक्रियकान्मूकमिन्मिणगद्गदान् ।।८५ ।।
The person either becomes muka – dumb or minmina – of nasal talk or gadgada – stammering when the channels of sound (voice) are covered and blocked by vata aggravated along with kapha.

Tuni-pratituni: Bladder pains

अधो या वेदना याति वर्चोमूत्राशयोत्थिता |
भिन्दतीव गुदोपस्थं सा तूनीत्यभिधीयते ।।८६ ।।
गुदोपस्थोत्थिता सैव प्रतिलोमविसर्पिणी ।।
वेगैः पक्वाशयं याति प्रतितूनीति सा स्मृता ।।८७ ।।
Tuni is a condition caused by aggravated vata getting localized in the seats of feces i.e. rectum and of urine i.e. urinary bladder, giving rise to cutting pain in the rectum and penis which moves downwards.
Pratituni is a similar kind of pain, as in Tuni, which moves upwards and reaches pakvashhaya i.e. large intestines, in bouts.

Ādhmāna – pratyādhmāna: Flatulence

साटोपमत्युग्ररुजमाध्मातमुदरं भृशम् ।।
आध्मानमिति जानीयाद्धोरं वातनिरोधजम् ।।८८ ।।
विमुक्तपार्श्वहृदयं तदेवामाशयोत्थितम् ।।
प्रत्याध्मानं विजानीयात् कफव्याकुलितानिलम् ।।८९ ।
Adhmana is a condition which is marked by great distension of the abdomen associated with movement of sound and severe pain. This condition is caused by habitual suppression of fart (flatus) and is said to be dreadful.
The same adhmana commencing in the amasaya – stomach, sparing the flanks and heart (region of heart) is known as Pratyadhmana. This condition is caused by vata associated with kapha.

Asthila-pratyasthila: Enlarged prostate

अष्ठीलावद्घनं ग्रन्थिमूर्ध्वमायतमुन्नतम् |
वाताष्ठीलां विजानीयाद्बहिर्मार्गावरोधिनीम् [१] ||९०||
एनामेव रुजायुक्तां वातविण्मूत्ररोधिनीम् |
प्रत्यष्ठीलामिति वदेज्जठरे तिर्यगुत्थिताम् ||९१||
A tumor produced by aggravated vata which has the below mentioned features is called as Asthila –

• hard like asthila – iron anvil
• elevated upwards and
• obstructing the anal orifice
  The same asthila is called pratyasthila when it is accompanied with pain, situated slightly obliquely inside the abdomen and obstructing the passages of fart, feces and urine.

इति श्रीसुश्रुतसंहितायां निदानस्थाने वातव्याधिनिदानं नाम प्रथमोऽध्यायः ।।१ ।।
Thus ends the first chapter by name Vātavyādhi nidānam , in Nidāna
sthāna of Suśruta samhita .