- - 87 - -

o p

o p

C E R T I F I C A T E

This is to certify that Shettar R.V.Shettar R.V.Shettar R.V.Shettar R.V.Shettar R.V. Scholar of

M.D.(Ay.)M.D.(Ay.)M.D.(Ay.)M.D.(Ay.)M.D.(Ay.) Kayachikitsa has worked for his thesis on the

topic entitled "Role of Nasya Karma in Ardita with special

reference to Ksheerabala Taila (Shatavartita).

This work is done under my supervision and guidance.

This thesis makes a distinct advance on scientific lines

in the above subject and the findings are immensely valuable

and have considerably contributed to the present knowledge

of the subject

I am fully satisfied with his original work and

hereby forward the thesis for the evaluation of adjudicators.

Guide :

DR. V.V.SUBRAHMANYA SASTRYG.C.I.M.(Madras), D.Ay.M(B.H.U.)Head of Department of K.C.P.G.studies and research centreD.G.M. Ay. Medical CollegeGadag - 582 101.

- - 88 - -

ACKNOWLEDGEMENT

I express my deep sense of gratitude to my respected guide

Dr.V.V.Subrahmanya Sastry. Head of Department of K.C.Post graduation

& Research Centre. D.G.M. Ayurvedic medical college Gadag. It was

very pleasant to work under his guidance. He gave moral Support,

encouragement throughout my work. Without his in time guidance it

was not possible.

I am also greatful to the Asst. Professor Dr.K.S.R. Prasad and

lecturer Dr. A.K.Padnda for their advices throughout the work and

also help in clinical work.

I am thankful to my U.G. lecturer Dr. C.M. Sarangamath for his

kind co-operation. He helped me in clinical work and provided many

patients for the present trial and encouraged throughout the work.

I express my thanks to Dr. S. S.Hiremath and Dr. C. S. Hiremath

for their help in the project work. My sincere thanks to Dr.U. V. Purad

incharge pathology department, and to Dr. S. A. Patil who helped

me and advised to join the course.

I express sincere thanks to my uncle Dr. A. M. Anegundi for

his advices and encouragement. He provided many refferences of modern

science and helped me a lot throughout the course.

- - 89 - -

It was very pleasant to express my deep sense of gratitude to

my principal Dr. G. B. Patil who permitted me to do the present work.

He provided all facilities intime and supported in every step throughout

the course.

I am thankful to our librarian Mr. Mundinamani and to all college

teaching and non teaching staff for their support.

I am also thankful to Mr.Krishna Fattepur and Mr. Habib for their

neat job work in the preparation of this thesis.

Finally I express my sincere thanks to all my colleagues, friends,

and family members and those who helped directly and indirectly.

SHETTAR. R. V.

INTRODUCTION

Those alone are wise who act after investigation.

Eventhough the detailed subject of Ayurveda is written as explained

by the sages, the necessity of investigation with regard to the etiopathology

diagnosis and treatment are essential for the progress of Ayurveda.

The primary aim of the Auyrvedic science are two : 1. To

maintain the health of a swastha and 2. To cure the disease of an

unhealthy person. A swastha is a person whose doshas are in a state

of equilibrium, his digestive capacity is normal, with the normal functions

of dhatus and malas accompanied by the lucid states of Atma, indriyas

and manas. Indriyas are of two types : 1. Jnanendriyas - Sense organs

and 2. Karmendriyas - the conative organs. The verbal expression is

the function of one of the Karmendriyas, and it is the God's gift to

human beings.

Arditavata is a disease in which some of the jnanendriyas

and karmendriyas, located in the siras are affected, particularly in their

function. Therefore the most important characteristics of a human being

viz: facial expression and verbal expression are lost, in a way the patient

U@mdZkAùkl@Okkv lc Anù#k\kk Xk̂ kùTPù Charak

- - 2 - -

loses the essential human characteristic. The incidence of this disease

is sufficiently high to warrant an effective treatment.

The most important and effective treatment recommended in

Ayurveda for the Arditavata is Nasya Karma. The application of this

kind of treatment is also easily without any distress to the patient.

Therefore this method of treatment is selected in this trial. The medecine

selected is also easy available and it is one of the effective vatahara

medecines. The use of Ksheerabala taila (101) has been recommended

in the treatment of vatarogas by almost all Ayurvedic scholars. The

herbal ingredients that are used in the praparation of Ksheerabala taila

are nontoxic, easily available and non-controversial. Therefore the administration

of Ksheerabala Taila (101) has been used in the treatment of Arditavata.

A total of 30 cases have been selected in this study and

these cases have been grouped into three types with different methods

of treatment. It has been found that the Nasya Karma with the Ksheerabala

taila(101) to be more effective. But this trial can be visualised as only

a pilot study and a further extensive work is necessary to establish

the definate curative effect of Ksheerabala taila(101) nasya karma on

the patients of Arditavata.

*****

- - 3 - -

NIRUKTI PARYAYA

The word Ardita generally indicates a person afflicted or distressed.

But in Ayurveda it explains a specific disease afflicting the Urdhavanga particularly

the face.

Charaka has mentioned Ardita as a separate disease in the 80

vatarogas(Ch.Su.20/11). But in chikitsa sthana the description of Ardita has

been combined with pakshghata (Ch.Chi.28/38 to 42) and they are separated

while discussing the treatment (Ch.Chi 28-99, 100)

Sushruta and later authors have clearly separated both these diseases

and discussed their Nidana and treatments.

DEFINITIONS :

All most all authors indicated that the face is the afflicted part in

Ardita Vataroga.

Charaka states that this disease is localised in half of the body(Ch.Chi

28/42). According to Sushruta, the vata vitiated by it's own causes, afflicts

the half of the mouth(and other regions of the head) (Su.Ni.2/69) Gayadasa

states that the vata located in mukha is vitiated. Vagbhata agrees with the

opinion of Sushruta, that half of the vaktra is afflicted by the vitiated vata

causing a curling in that region (AH.Ni.-25/34). Arunadatta is more clear. He

states that the upper portion of the body particularly the half of the Vaktra

is afflicted. Madhavakara has followed Sushruta (Ma.Ni22/46) while commenting

- - 4 - -

on Sharangadhara Samhita Pradhana Khanda (Chapter-7-106) Adhamalla has

clearly stated that Ardita is a disease afflicting one half of the face.

SYNONYMS :

(1) Ekayama : According to some authorities this disease is also

known as Ekayama. This word is used by Vagbhata in Astanga Hridaya (Nidana

25/37) and Arumadatta Commentory on same.

(2) Ardita Vata : It is also known as Facial paralysis or Facial haemiplegia

indicating the paralysis of the muscles of one side of the face with the rest

of the body not being afflicted.

The word "paralysis" indicates an abnormal condition characterized

by the loss of muscle functions or the loss of sensation or both.

- - 5 - -

SHAREERA

It is clear that this disease Ardita afflicts the face and other closely

associated organs. All authorities mentioned that the afflicted region is the half

of the face.

'Vaktram', 'Asyam', 'Vadanam', 'Tundam', 'Ananam', 'Lepanam',

and 'Mukham' , a re the synonyms o f t he face and a l so the mou th

(Amarakosha 2 chapter 349).

Bhavamishra states that shiras is the "Adyamangam" indicating that

it is the first organ and also an important one. Mastulunga(brain) is inside

it. The following are the upangas of shiras (Bha.Pra.Poorva 2-71 to 74)

1) Lalata (forehead)

2) Bhruyugma (two eye brows)

3) Netradvayam (two eyes)

4) Shankham (the temporal region)

5) karnam (ear)

6) Kapola (Cheeks)

7) Nasika (Nose)

8) ostha (lips)

9) Srikvinyam (two corners of the mouth)

10) Mukha (mouth)

11) Talu (Palate)

12) Hanu dvayam (two jaws)

9) Srikvinyam

10) Mukha (mouth)

11) Talu (Palate)

12) Hanu dvayam (two jaws)

13) Danta (teeth)

- - 6 - -

14) Dantaveshtha (gums)

15) Rasana (Tongue)

16) Chibuka (Chin)

17) Gala (Throat)

Most of these sub-organs are afflicted in the Arditavata and therefore

some relevant information regarding some of these organs/sub organs is mentioned

here.

The above stated organs/sub-organs of the shiras have different functions.

Majority of them join to reflect the facial expression through the action of different

muscles. There are four sense organs viz., Netra, Karna, Nasika and Jihwa.

Of these the actual perception of Shabda, Roopa and Gandha belong to different

cranial nerves, whereas the Rasa pereception is closely associated with the

facial nerve. Which also controls themovements of the muscles of the face.

All most all the organs/sub-organs of the face have their own separate/

specific functions and also muscles to execute those functions.The following

table indicates the muscles:

Sl.

No. Upanga Muscles Cranial Nerve

1. Lalata Occipito frantlis (Epicranius) Facial Nerve

- - 7 - -

2. Bhruyugma Corrugator supercili Facial Nerve

Procerus Facial Nerve

3. Netradvayam Orbicularis oculi Facial Nerve

Lavator palpebrae superioris Occulomotor

4. Shankham Temporalis Trigeminal

5. Karnam Stapedius Facial

Auricularis anterior Facial

Auricularis Posterior Facial

Auricularis Superior Facial

6. Kopola Buccinator Facial

7. Nasika Procerus Facial

Nasalis Facial

Dilator naris Facial

Depressor Septi Facial

Compressor naris Facial

- - 8 - -

8. Ostha, Orbicularis oris Facial

Srikvinyam Depressor angularis Facial

Mukha Depressor labii inferioris Facial

Levator angularis Facial

Levator labii superioris Facial

Risorius Facial

Zygomaticus major Facial

Zygomaticus minor Facial

9. Talu Tensor veli palatini Trigeminal

10. Hanu Masseter Trigeminal

Pterygoid medialis Trigeminal

Pterygoid lateralis Trigeminal

Temporalis Trigeminal

Platysma Facial

11. Danta (No muscels) Only sensation Trigeminal

Dantavestha

- - 9 - -

12. Jihwa Hypoglossus Hypoglossal

Stylohyoidus Facial

Platysma Facial

13. Chibuka Mentalis "

14. Gala Platysma "

It may be noticed from the above tabular statement that the affliction

of the facial nerve is capable of paralysing many muscles of the face.

VATA AND RELATED SROTASES

In view of the movements of the facial muscles for expression and

other important functions, it is necessary to understand the importance of vata.

It is clear that the definition of the word Vata explains its involvement

in the movement and sensation (Su.Su.21-5). The movement in the body is

expressed by the contraction and relaxations of the muscles are controlled by

vata.

According to Susruta, vata in its normal state and coursing through

its specific channels (siras) helps to proper discharge of its specific functions

viz. expansion and contraction speech etc. and also produces the clear-

ness and non-illusiveness of Buddhi (intellect) and the cognitive organs (Su.Sarira.7-

8). It is also stated that the functions are

- - 10 - -

conducted without any obstruction. Charaka has also stated that for the maintenance

of its physiological functions, vata should have movement without any obstruction

(Ch.Chi 28-4) indicating that an obstruction to its movement will lead to pathological

state (Ch.Chi.28-59)

In order to conduct, the two main functions of "Gati" (motor) and

"Gandha" (sensory), the vata has to move through the srotases throughout

the body. These vata-vaha srotases can be divided into two varieties depending

upon the motor or sensory function.

i) Chestavaha srotases which conduct the motor function. The

specific direction for the requisite motor function is transmitted

from the Buddhi only, in close association of the "Manas"

(Ch.Sarira.1-23). Therefore these cheshtavaha srotases originate

in Buddhi (higher cortical centres) and with a relay in the mind,

terminate in the conative organ or other muscles.

ii) Samjnavaha srotases which conduct the sensory function. These

originate in the respective cognitive organs and after relaying

in the region of manas, terminate in the connected Indriya

buddhi.

The vatavaha srotases are of two types based on their structure:

i) Samvrita : Well covered or concealed. These are the myelinated

nerve fibres.

- - 11 - -

ii) Asamvrita : not covered or open. These are the nonmyelinated

variety.

The relevant vata vaha srotas/nadi in the present context of Ardita

vata which afflicts the muscles of the face is the seventh cranial nerve i.e.

Facial nerve.

FACIAL NERVE

The 7th cranial nerve supplies the structures derived from the second

pharyangeal(brachial) arch of the embryo. It is predominantly an efferent nerve(1)

to the muscles of facial expression, also to the posterior belly of diagastric,

the stylohyoid and the stepedius muscles, and (2) to many of the glands of

the head. It also contains a few afferent fibres which originate in the cells

of its genicular ganglion and are predominantly concerned with taste sensations

from the anterior2/3 of the tongue and the palate.

The facial nerve arises by two roots from the lateral part of the

pantomeduallary sulcus immediately anterior to the vestibulocochlear (8th cranial)

nerve. The roots are the large, motor, facial nerve anterior to the small nervus

intermidus which transmits sensory and preganglionic parasympathetic nerve

fibres. They pass laterally with the 8th nerve into the internal acoustic meatus,

surrounded by a sheath of the meningis. Here the branches of the nervus intermedius

join the 7th and 8th nerves, though all its fibres probably enter the 7th nerve

distally. The facial nerve pierces the meninges at the lateral end of the internal

acoustic meatus and continues lateraly in the bony facial canal lying above

and between the cochlea and vestibule. At the hiatus for the greater genicular

- - 12 - -

ganglion and gives off(1) the greater petrosal nerve (2) a branch to the tympanic

plexus and (3) a branch to the sympathetic plexus on the middle meningial

artery. The facial nerve now turns abruptly backwards in the bone of the upper

part of medial(labyrinthine) wall of the middle ear cavity, superior to the fenestra

vestibuli and then inferior to the prominence caused by the lateral semicircular

canal in the aditus to the mastoid antrum. Medial to the aditus the nerve turns

verticially downwords in the bony septum which separates the middle ear from

the mastoid antrum and aircells, and gives off first the nerve to stapedius,

than the chorda tympani, and the finally a communicating branch to the auricular

branch of the vagus. The last arises immediately before the nerve emerages

from the stylomastoid foramen.

The facial nerve emerges from the stylomastoid foramen under cover

of the mastoid process. The nerve passes anterolaterally between the styloid

process and the posterior belly of digastric, and gives off(1) one or two descending

branches which supply the posterior belly of the digastric nerve. The facial

nerve then enters the posterior medial to the external carotid artery and the

crossing superficial vein, breaks into number of branches which emergus separately

from the gland and passes to supply the muscles of the facial expression on

their deep surfaces.

BRANCHES

I. From the geniculum of the facial nerve.

1. The greater petrosal nerve

- - 13 - -

2. A small branch passes through temporal bone to join the

tympanic plexus of the glossopharyngeal nerve.

3. A minute, inconstant branch to the sympathetic plexus on the

middle meningeal artery.

II. In the descending part of the canal

1. The small stapedial nerve passes fowards to supply the stapedus

muscle.

2. The chorda tympani

3. Auricular branch of the vagus.

III. In the neck

1. Decending digastric branch

2. Posterior auricular nerve

IV. In the parotid gland

1. Temporal branches

2. Zygomatic branches

3. Buccal branches

4. marginal mandibular branch

- - 14 - -

5. Cervical branches

The most important functions of the organs/sub-organs of Shiras enlisted

above are :

1) Facial Expression : Due to emotions like happiness, fear, dislike

etc.

2) Closure and opening of the eyes.

3) The movement of the pinnae of the ears which are not very

evident in the human beings.

4) Respiratory Act : inhalatiion and expiration through the nose.

5) Deglutition of the food after proper mastication, prevention of

the food falling out of the mouth.

6) Various stages of laughter.

7) Verbal expression through the movements of tongue, lips, cheeks

etc.

To conduct all these functions different groups of muscles play

an articulated part.

The facial expression is dependent on the mood of the mind which

acts in two different ways.

- - 15 - -

i) In association with the sense organs depending on the

information received from them.

ii) Without association of the sense organs. (Chakrapani on Ch.Sh.1-21)

The vata is stated to control the mind (Ch.Su.12-8) and also the

Arthas (objects) of the mind. Manas is the cause of different modes of functions

of Buddhi (Bhe. Chi 8-4). Therefore it is understood that the Manas is capable

of modifying the instruction of Buddhi for an action. There are two sub-divisions

of vata which can modify the function of Manas.

1) Prana vata (AH.Su.12-4)

2) Udana Vata (Ch.Chi.28-7)

A critical analysis of the functions of both Pranavata and Udanavata

indicates the following areas in CNS, related to them.

PRANAVATA :

Reticular formation from the brain stem to medulla oblangata with

connection to higher centres.

UDANAVATA :

Reticular formation from the lower part of the pons to the spinal

cord up to C3, C4, C5, T2 to T6. The motor nuclei of the cranial nerves 7,9,10,11

and 12 are included.

- - 16 - -

MUKHA : This word has two meanings.

1) Face and

2) Mouth

The face has many upangas which are stated already. The vaktra

or mouth is the upper opening of the Annavaha srotas, which compromises

of two Asayas i.e. Amasaya and Pakvasaya. The mouth is therefore the entrance

to the koshtha. The food ingested is chewed well for mixing with the saliva

and also for softening and passes through the gala (throat) and annanadi (oesophagus)

into the amasaya for the process of digestion.

OSHTHA : (LIPS)

The lips are made up of muscles covered by skin. They prevent

the food from falling out of the mouth. They also take part in two important

functions.

1) Verbal expression and

2) Facial expression

They also protect the teeth and gums.

JIHVA : (TONGUE)

Tongue is a muscular structure and it is voluntary. It is placed on

- - 17 - -

the floor of the mouth with a front portion free. Inside the mouth it is capable

of all types of movements. The "Rasanendriya" is located in the epithelium

covering it. The sensation of the taste is carried by the chorda tympani branch

of the facial nerve (anterior two third of the tongue) and the posterior one

third by the glossopharyngeal nerve. The muscles of tongue are supplied by

the hypoglossal nerve.

The tongue serves the following functions :

1) Mastication : it helps in the act of chewing

2) Deglutition

3) Taste

4) Speech

5) Secretion of mucous and of serous fluid with which it keeps

moist.

- - 18 - -

NIDANA

The Nidana is characterised as the ground of production of a disease,

together with the way in which this action is necessarily brought about. (Vijayarakshita

on Ma.Ni.1-5). The term Nidana relates both to etiology as well as diagnosis

of disease. The etiology helps in ascertaining the causative factors of a disease

(Chakrapani on Ch.Ni.1-1) Nidana also helps in deciding the Sadhyasadhyatva

of the disease.

Charaka has included Ardita in the 80 vataja rogas i.e. vata nanatmaja

rogas and also in the diseases caused by the vitiated vata in the head (Ch.Si.9-

9). The following are the general causes of sirorogas (Cha.Su.17-8 to 11)

1) Sandharana - Suppression of natural urges

2) Diwaswapna - Sleep during the day time

3) Ratrijagarana - Vigil during night

4) Mada - Intoxication

5) Uchha bhashana - Speaking loudly

6) Exposure to frost and easterly wind

7) Atimaidhuna - excessive sex

8) Asatmya gandha - Inhalation of undesirable smell

- - 19 - -

9) Rajodhumahima atatpa - exposure to the dust, smoke,

snowfall and sun.

10) Ati seeta-Ambusevana - excessive intake of cold water

11) Abhighata to siras - injury to head

12) Dushta ama - vitiation by ama

13) Rodana - lamentation

14) Bashpa nigraha - Supression of tears

15) Manastapa - anxiety and other mental stresses

16) Doshakala viparyaya - Adopting regimen countraryto those prescribed for the localityand season.

17) Excessive intake of guru, amla and harita diets.

Due to the above causes, the doshas get aggravated resulting in

the vitiation of raktadhatu in the head. This causes diseases of various symptoms

in the head.

The above stated causes are relevant to all diseases that afflict the

head, where Ardita is also included. In the causation of the diseases of head,

it should be noted that not only the doshas but raktadhatu also are the participant

in the disease process.

- - 20 - -

Both Sushruta and Vagbhata have enumerated the causes of

Ardita (Su.Ni.1-68 AH.Ni.-15-32-33; Ma Ni.22-44.45).

1) Speaking louldy

2) Chruning hard food stuffs.

3) Excessive laughter, yawning and also sneezing

4) Carrying heavy loads on head

5) Sudden movement of head and neck

6) Sleeping in an uncomfortable posture.

7) Use of pillows in wrong posture.

Susruta adds that in the event of Raktakshaya to the following they

will be afflicted by Ardita :

1) Pregnant lady

2) Recently delivered lady

3) Children

4) Old people

5) Emaciated persons

- - 21 - -

Vaghata has stated that Ardita is a disease caused by the vitiation

of Pranavata (AH.Ni.16-20). The cause of the vitiation of Pravanata are the

following :

1) Excessive indulgence in the Ruksha ahara and vihara

2) Excessive physical exercise

3) Fasting

4) Over eating

5) Trauma

6) Excesive indulgence of walking

7) Suppression of natural urges

8) Trying to stimulate the natural urges when they are not ready

for excretion.

In Yogaratnakara some more causes are added (Y.R.Ma.Khanda)

1) Sitting on an uneven place.

2) Excessive use of tongue cleaning

3) Injury to the cheeks

4) Wrong use of Siravyadhana (in the head)

- - 22 - -

5) Injury to the marma (in the head)

6) Excessive rubbing of the eyes, ears and nose.

All the causes stated above may be catagorised into different groups.

I. AGE AND SEX :

Children, Old people, pregnant and delivered women.

II. DIET :

1) Excessive intake of Ruksha, guru, amla and harita diets.

2) Chewing hard food stuffs

3) Over eating

4) Amadosha

5) Fasting

6) Excessive intake of alcoholic drinks.

III. BEHAVIOR :

1) Speaking loudly

2) Excessive laughter, yawning and also sneezing

3) Excessive physical exercise

- - 23 - -

4) Excessive indulgence in walking

5) Sitting or sleeping on uneven places.

6) Use of uncomfortable pillows

7) Sudden movement of head and neck

8) Carrying heavy loads on head

9) Suppression of natural urges or forceful stimulation

10) Excessive use of tongue scraping

11) Wrong use of Siravyadha and Nasya

12) Exposure to frost, dust, smoke etc.

IV. INJURY

1) Injury to head

2) Injury to cheeks

3) Injury to marma (in the head)

Ardita vata roga clearly indicates the paralysis of the facial muslces.

This may be due to :

1) Lesion of the fibres of the upper motor neurons concerned with

voluntary movement.

- - 24 - -

2) Lesion of the fibres of upper motor neurons conerned with emotional

expression.

3) Lesion of the lower motor neurons.

The causes indicated for the development of the paralysis of the

facial muscles lead to the affliction of the facial nerve. But they are clearly

indicative of the causation of Bell's palsy only.

1) Exposure to cold

2) Neuritis

a) Allergic

b) Infective

3) Middle ear disease

4) Injury to the nerve.

- - 25 - -

SAMPRAPTI

The vata vitiated by the earlier stated causative factors, settles in

the regions of head, nose, chin, forehead and the eyes and produces the disease

called Ardita vata (Ma.Ni.22-45:Su.Ni.1-69). The symptom of vaksanga indicates

that the vitiated vata affects the tongue also (Ch.Chi. 28-41; Su.Ni.1-70; AH.Ni.-

15-34: Ma.Ni.22-47) Vagbhata has indicated the affliction of the ear on the

affected side (AH.Ni.15-35).

Charaka states that the vitiated vata while settling in the above stated

regions in the head, causes the "Soshana" of the "Rakta" dhatu resulting in

Ardita vataroga (Ch.Chi-28-38). Here the soshana may be understood as a

reduced supply of rakta to that particular region affecting the jeevanakriya.

According to Vagbhata Ardita roga due to the vitiation of Pranavata

(AH.Ni.16-20) and one of the functions of the pranavata is "Dhamani dhrik"

i.e. sustaining and protecting the dhamanis (arteries) (AH.Su.12-4) The location

of pranavata is the head. Therefore the raktashoshana or reduction in the blood

supply may be due to vitiation of pranavata.

The dhamanis may also be affected by the disease dhamani prartichaya

(atherosclerosis) which is one of the important causes of Rakta Soshana to

the region in the head, which controls the voluntary movements of the facial

muscles.

- - 26 - -

POORVAROOPA

Poorvaroopa or premonitory symptoms are the unmifested form

of symptoms. (Chakrapani on Ch.Ni.1-28) A poorvaroopa is that by which

a specific impending illness is known but not the specific entity. It is an

undeveloped symptom on account of the alpata of the illness (Ma.Ni.1-

5, 6) A poorvarupa is a charectristic that indicates the production of an

illness (Bha.Pra.Poorva Khanda 7-34). The poorvarupa indicates the state

of sthana samsraya of Kriyakalas (as explained by Susruta). In this stage

the excited or vitiated doshas become localised and it marks the begining

of specific disease pertaining to those structures. Dalhana explains this

stage sthanasamshraya as one in which the prakupita dosha having extended

and spread over to parts other than their own due to srotovaigunya or

pathological involvement of related srotas - by implication to dosha dushya

summurchana i.e. interaction between the doshas and dushyas or the process

of the pathogenesis.

The poorvarupa of Arditavata has been described by Sushruta

(Su.Ni.1-71,72).

1) Romaharsha (horripilation)

2) Vepanam (Trembling)

3) Avila Netrata (eye not being clear)

4) Vayuroordhwa (upward movement of vata)

- - 27 - -

5) Twachi swapa (loss of sensation of skin)

6) Toda (pain)

7) Manya sthamba (stiffness of the neck)

8) Hanugraha (stiffness of the jaw)

All the symptoms of Ardita vata in a mild from also can be considered

as poorvarupa.

- - 28 - -

ROOPA

Roopa of a disease is the stage of Vyakta in the Kriyakalas and

manifests the full fledged disease. The following is the list of sign and symptoms

mentioned in different Ayurvedic classics (Su.Ni.1-69; AH.Ni.15-34; Ma.Ni.22-

46.47; Bha.Pra.Madhy 2-63,64; Y. R. Madhya vatavyadhi nidana 56-57).

1) Distortion of the affected side of the face(the mouth is drawn

over to the opposite side)

2) If the patient tried to laugh, the mouth is drawn to the normal

side.

3) There is also pulling of neck toward normal side.

4) Shaking of the head and also teeth.

5) Rigid and winkless of the eyes, closing of the affected eye is

difficult.

6) Vikriti of the nose

7) Difficulty in speech and hoarseness

8) Loss of hearing and smell sensation and pain in the ear also.

9) The spitting is effected to one side only.

10) Sneeze gets suppressed

- - 29 - -

11) Severe pain in neck, chin, teeth, on the affected side

12) Fear in sleep also

13) Loss of memory.

Since Charaka described a combined state of Ardita and

pakshaghata, only those symptoms expressed due to the Ardita are given below

(Ch.Chi 28-40,41)

1) The food instead of going straight, goes into one side of the mouth.

2) While speaking nose gets curved

3) The eye remains rigid and winkless

4) The sneeze gets suppressed.

5) Speech is faint, distorted, stuttery, indistinct and thick and hoarseness

of voice.

6) Teeth get shaking.

7) Pain in the gums.

8) There is distoration/asymmetry of the nose, eyebrows, forehead,

eye and jaw.

Bhavamishra has classified the Ardita roga into three types, according

to the predominence of the doshas

- - 30 - -

I) Vataja Type

1) Excessive salviation

2) pain

3) Shaking of the head.

4) Throbbing pain

5) Stiffness of the neck and jaws.

6) Difficulty in speech.

7) Oedema of the lips.

II) PITTAJA TYPE

1) Fever

2) Thirst

3) Loss of consciousness

4) Burning sensation.

III) KAPHAJA TYPE

1) Oedema of the cheek, neck etc.

2) Stiffness of the above regions or paralysis.

- - 31 - -

Going through all informations about Ardita explained by different

scholars conviace that Ardita overall resembles the facial paralysis in modera

texts. Paralysis is meant an incapacity to move or feel due to the damage

to the nervous system. Such incapacity occuring facial muscles can be

stated as facial paralysis which movements. As explained earlier the facial

muscles are controlled by 7th cranial nerve i.e. facial nerve.

Facial paralysis can occur by two kind of lesions viz. Supranuclear

and infranuclear type. The signs and symptoms vary according to the nature

of the fibre paths involved.

Facial weakness/paralysis may be due to :

1. A supranuclear lesion involving the corticospinal fibres concerned

in voluentary facial movements;

2. A supranuclear lesion involving the fibres concerned in emotional

movement of the face - mimic paralysis.

3. Nuclear and infranuclear lesions involving the lower motor neurones;

and

4. Primary degeneration or disorder of function of facial muscles.

1. Facial paralysis due to a supranuclear corticospinal lesion is distinguished

by the fact that movements of the lower face are affected more

severily than those of the upper.

2. A pathway controlling emotional movements as distinct from

- - 32 - -

voluntary movement of the opposite side of the face, The most

important originates in the frontal lobe. A lesion,

above the internal capsule may paralyse voluntary movement

of the lower face on the opposite side. Leaving emotional

movement, as in spontaneous smiling intact. Very rarely,

a frontal or thalamic lesion may aboilish contralateral emo-

tional movement leaving voluntary movement unimpaired

(Mimic Paralysis).

3. Lesions involving the lower motor neurones destroy the

final common path, affect equally all forms of facial movements.

The facial lower motor neurones may be involved by a lesion:

a) Pontine lesion (within the pons)

Lesions in this region, facial paralysis is usually associated

with conjugate occular deviation, often with paralysis of the ipsilateral jaw

muscles and some times with the contralateral hemiplegia. Involvment of

trigeminal nucleus may lead to sensory loss also. Bilateral facial paralysis

occasionally occurs as a congenital abnormality (Mobius' Syndrome).

b) Lesion within the posterior fossa, between the pons and the internal

acoustic meatus may cause deafness and loss of taste in the anterior

two third of the tongue as well as facial paralysis. The commonest of such

lesions are acoustic neuroma.

- - 33 - -

c) Within the temporal bone the facial nerve may be involved

in skull fracture or be involved in infections of the middle ear and mastoid.

Herpes zoster of the geniculate ganglion usually causes facial paralysis

through secondary involvement of the motor fibres of the nerve, so called

Ramsay - Hunt syndrome. Lesions within the middle ear is usualy associated

with loss of taste in the anterior two third of the tongue, due to interruption

of the fibres of the chorda tympani.

d) After emergence of the nerve from the skull the fibres of the

facial nerve may be involved in many inflammatory or malignant processes

causing unilateral or bilateral facial palsy. Facial palsy of bilateral or unilateral

with recurrent episodes of facial ocdema occur in patients with deeply

furrowed tongue i.e. Melkersson's syndrome.

4. Primary disfunction of the facial muscles is seen in mysthenia gravis,

muscular dystrophy and dystrophy mytonica.

Among the above terms of lower motor neuron lesions, Bell's

palsy is a commest form of facial paralysis.

Bell's Palsy :

Bell's palsy is defined as the facial paralysis of accute onset

presumed to be due to non-suppurative inflammation of the facial nerve

within its canal above the stylomastoid foramen.

- - 34 - -

The features of Bell's palsy are :

1. Usually unilateral, rarely bilateral.

2. pain within ear or mastoid region or arround the angle of jaw.

3. Onset is sudden - often patient awaken to find the face paralysed.

4. Paralysis of the muscles of facial expression. The upper and

lower facial muscles are equally affected and voluntary emotional

& associated movements are involved.

5. Eyebrow droops, wrinkles smoothed out, frowning and rising

of eyebrow is impossible.

6. The palpebral fissure becomes wider on affected side and

closure of the eye is impossible.

7. When the patient attempts to close the eye, the globe rolls

upwords and slightly inwards - Bell's phenomenon.

8. Eversion of the lower lid impairs absorption of tears, tends

to overflow.

9. Nasolabial fold is smoothed out.

10. Mouth becomes drawn to sound side and the patient cannot

retract the angle of the mouth or purse the lips as in whistling.

11. Paralysis of the buccinator causes cheek a puffed out appearence

in respiration.

12. Food accumulates between the cheek and the teeth.

13. The tongue deviates to the sound side when protruded.

14. Loss of taste in anterior 2/3 of the tongue may occur when

the inflammatory process extends to the chorda tympani.

- - 35 - -

15. The patient may complaing of hypercusis, an intensification

of loud noises in the affected ear, when the branches to the

stapedius is involved.

By the above modern explanation, we are convinced that the

facial paralysis varies in its fetures according to the site of lesion involve

in the pathogenisis. One can also observe the signs and symptoms of

Ardita explained in different Ayurvedic classics closely resemble the above

mentioned facial palsy.

- - 36 - -

SADHYASADHYATA

The following are the Asadhya lakshanas according to Sushruta and

Bhavamishra(Su.Ni.-1-73 : Bha. Pra. Vatavyadhi)

1) Extreme emaciation

2) Inability to close the afflicted eye

3) Difficulty in speech.

4) Duration more than three years.

5) Severe shaking or trembling of the head.

The inability to close the afflicted eye may be the loss of conjunctival

reflex.

Vijayarakshita's commentory states that excessive secretion from mouth

(salivation), nose and eye is considered as an Asadhya lakshana. by some

authorities. (Vijayarakshita on Ma.Ni.22-48)

- - 37 - -

CHIKITSA

There are slight differences in the treatment advocated by the Bruhatrayee

I. Charaka Samhita (Ch.Chi.28-99,100)

1) Tailabhyanaga to the head

2) Nasyakarma

3) Tarpana Kriya with medicated oil to the eyes and ears.

4) Nadi Sweda

5) Upanaha Sweda

Both these swedana kriyas are to be administered with the flesh

of aquatic animals.

II. Susruta Samhita (Su.Chi-5-22)

If the patient is sufficiently strong and capable of arranging all upakramas,

he should be treated as mentioned for vatavyadhi.

He should be specifically treated as follows :

1) Mastishkyam : Application of sneha or kalka with sneha etc.

on the vertex of the head.

2) Shirovasti

- - 38 - -

3) Nasyakarma

4) Dhoomapana

5) Upanaha Sweda

6) Snehana-according to the dosha

7) Nadisweda.

III. Vagbhata (AH.Chi.21-43) He followed Chakra.

1) Nasya Karma

2) Application of oil to head

3) Tarpana Kriya with medicated oil to eyes and ears.

In addition he recommended two more methods of treatments based

on the accompanying dosha.

1) kapha - If there is oedema, vamana Kriya has to be administered.

2) Pitta - if there is redness and burning sensation, sirvyadha

is recommended.

IV) Bhavamishra (Bha. Pra. Madhayam 2-vatayadhi)

1) Snehapana according to dosha

- - 39 - -

2) Nasya karma

3) Upanaha Sweda

4) Shirovasti

5) Diet with the articles which alleviate vata.

It may be noticed from the above that all authorities recommended

Nasyakarma in the treatment of Arditavata. It has been claimed by Vagbhata

that Ardita is one of the prana vayu dustita roga. It has been said in the principles

of treating vata vyadhis that prana should be always guarded at first (AH.Chi.22-

69). Nasya karma can act directly on murdha and murdha is the seat of prana

vayu therefore nasyakrma may be therepy of choice in this disorder scholars

have noted.

- - 40 - -

ANatomY OF THE NOSE

The external nose is a structure composed of bone and cartilage.

The bony part is formed mainly by the nasal bone on each side, and

the frontal process of the maxillary bone. The cartilaginous portion

is formed by several cartilages which support and give shape to the

nares. Attached to the cartilages are the muscles for dilating the

narea.

The nose is a cavity within the skull having its axis at right

angles to the face. It is important to remember this fact in examination

of the nose, since it is a common misconception that the nasal axis

is parallel to the line of the external nasal structure. The nasal cavity

is divided by the nasal septum into two parts which have similar anatomical

structure but may be asymmetrical.

The septum is a structure composed partly of cartilage and

partly of bone. Anteriorly, the septum is formed by the quadrilateral

cartilage. Posterior to this is the vertical plate of the ethmoid while

behind that again, the rostrum of the sphenoid bone helps to form

the partition. Below, the quadrilateral cartilage articulates with the

maxillary sphine and with the vomer, while along the lower edge are

found two other strips of cartilage which are known as the vomeronasal

cartilages.

- - 41 - -

The septum is covered with perichondruim where there is cartilage,

with periosteum where there is bone, and outside this with mucous

memberane.

On the lateral wall there is a system of ridges known as

the conchae, or turbinates, each of which overhangs a groove known

as a meatus.

The conchae or turbinates are three in number - the inferior

concha, the middle concha and the superior concha. The inferior concha

forms a bone by itself, attached in the laterial wall of the nose. The

middle concha and the superior concha are part of the ethmoid bone.

The conchae (Turbinates) are covered with mucous memberane which

is, the most part, columnar ciliated epithelium.

Underlying the mucous membrane there is erectile tissue which

is found chiefly at the anterior and posterior ends of the inferior conchae,

in their lower borders, and at the anterior ends of the middle concha.

The meatus of the nose are of importance since they are the drainage

channels of the accessory air sinuses. The appearance of pus in one

of the meatus is of diagnositic importance in affections of the nose

and accessory air sinuses.

Into the superior meatus and spheno-ethmodial recess drain

the posterior group of nasal accessory sinuses. Into the middle meatus

drain the anterior group, while into the inferior meatus drains the nasolachrymal

duct. It should be noted that while the inferior and middle meatus

- - 42 - -

are open at both ends the superior meatus is closed at the anterior

end. This means that pus from the posterior group of sinuses will

be seen on posterior rhinoscopy.

In the normal nose these parts can rarely be seen from the

front. Between these two enlargements is a groove which is known

as the hiatus semilunaris, into which the ostium eminence, the bulla

ethmoidiais, which is due to the protrusion into the meatus of one of

the air cells of the ethmodial labyrinth.

The middle meatus contains several structurs of importance.

An enlargements is found at the anterior end of the middle meatus,

which is part of the ethmoid bone, known as the uncinate process.

A little further back can be seen another of the maxillary air sinus

opens. The hiatus semilunaris, when followed upwards, leads to

narrowings called the infundibulum. In many cases the infundibulum

continues upwards, becoming the fronto-nasal duct. Owing, however

to the irregularity of the development of the frontal sinus and the anterior

ethmoid cells, it is possible that the fronto-nasal duct may open from

an anterior ethmoidial cell.

BOUNDARIES OF THE NASAL CAVITY :

Inferiorly the floor of the nasal cavity is formed by the maxilla

and by the palatine bones. The roof of the nasal cavity is formed,

in front, by the lateral nasal bones. Behind is the cribrifrom plate.

- - 43 - -

This is a bony lamina of the ethmoid bone, which is perforated to

permit the passage of the filaments of the olfactory nerves. Posteriorily

the sphenoid bone forms part of the roof.

THE NERVE-SUPPLY :

The sensory nerve-supply is mainly by the sphenopalatine nerves,

the fibres of which pass through the sphenopalatine ganglion to join

the maxillary nerve. This ganglion is the centre for sensory function

in the large portion of the nose. The anterior and upper part, however

is supplied by the anterior ethmodial nerves, which are branches from

the nasociliary branches of the ophthalmic division of the fifth nerve.

These find entrance to the nasal cavity at the enterior end of the cribriform

plate and finally ramify on the outer surface of the nose as the external

nasal nerves. The limitation of the centres of nasal sensation to

these points renders block or regional anasthesia easy and effective.

The sympathetic supply to the nose is distributed also from

the sphenopalatine ganglion, which it reaches by means of the deep

petrosal nerve from the carotid plexus. The secretomotor supply is

obtained from the geniculate ganglion.

NERVE OF SPECIAL SENSATION :

The olfactory nerves enter the nose through the cribriform

plate in the roof and are distributed to the upper part of the nasal

septum and the medial wall of the superior concha.

- - 44 - -

ARTERIAL SUPPLY :

The upper part of the nasal cavity is supplied by the anterior

and posterior ethmodial arteries which are branches of the opthalmic

artery in the nearby orbit. The opthalmic arises from the internal carotid

artery.

The lower part of the nose is supplied by branches derived

from the maxillary artery, the most important being the sphenopalatine

arteries and the termination of the greater palatine. Smaller contributions

enter from the face.

These internal and external carotid sources anastomose freely

in the nose. An aggregation of poorly supported vessels on the anterior

part of the septum just behind the skin margin is known as Little's

area and is a frequent source of bleeding.

The lymphatic vessels drain posteriorly to the superior deep cervical

group.

NASAL ACCESSORY SINUSES :

The nasal accesory sinuses are air spaces which are developed

in the bones of the skull and have communication with the nasal cavity.

They are divided into two groups - the anterior group and the posterior

group. The anterior group comprises the frontal air sinus, the maxillary

air sinus and the anterior ethmoidal air cells. The posterior group

- - 45 - -

comprises the posterior ethmodial air cells and the sphenoidal sinus.

This grouping of the sinuses is arranged more from the point of view

of drainage than from actual anatomical distribution. The sinuises vary

so widely in their positions during development that the distinction between

'anterior' and 'posterior' might be completely misleading. The anterior

group of sinuses drains into the middle meatus, and the posterior group

drains into the superior meatus and the spheno-ethmoidal recess.

THE MAXILLARY AIR SINUS :

At birth this sinus is represented by a small space on the

lateral wall of the nose, high up in the middle meatus, and communicates

with the nasal cavity. As growth proceeds the space enlarges by a

process of pneumatization of the maxillary bone. There is a double

process of pneumatization of the maxillary bone at work. In the young

child the second dentition lies in the upper part of the maxillary bone,

a very short distance below the orbit, and the lescent of the dentition

is brough about by the laying down of new bone. This bone, as it

is laid down, becomes pneumatized, forming the maxillary air sinus.

Development proceeds downwards and forwards until at the age of,

approximately, nine years, the floor of the maxillary air sinus is on

the same level as the floor of the nose. From this time development

proceeds until the antrum is finally completed by the descent of the

third molar tooth. This take place betwen the twenty-thrid and twenty-

fifth years.

- - 46 - -

The fully developed maxillary air sinus should extend from the

first premolar to the third molar tooth. The sinus reaches up to the

floor of the orbit and thus occupies practically the whole body of the

maxillary bone. Its medial boundary is the laterla nasal wall with the

attachment of the inferior concha, while the upper posterior part of

the medial wall frequently shows a bony dehiscence which is closed

by memberane. This is known as the membranous part of the middle

meatus, and the ostium lies in this part of the wall. In addition to

the normal ostium there is sometimes a small accessory ostium below

and in front of it. It is important to remember that the infra-orbital

nerve traverses the roof of the maxillary air sinus and appears at the

infraorbital foramen in the upper part of the anterior maxillary wall.

In the floor of the sinus runs the superior alveolar nerve, and

the roots of the teeth not infreqently project into the maxillary air sinus.

They may be covered with only a thin plate of bone, in which case

the reson for infection of the maxillary air sinus in apical tooth abscess

becomes obvious. Extraction of such a poorly covered tooth can result

in an abnormal communication between mouth and antrum. This is

known as oro-antral fistula. In the upper wall of the antrum anteriorly

is a hollow bounded medially by the canine ridge. This depression

is known as the canine fossa, and within the bone of the anterior wall

run twigs from the infra-orbital nerve to the teeth of the upper jaw.

The hard plate forms a large portion of the floor of the maxillary

air sinus. The pterygoid fossa with the spheno palatine fissure at

- - 47 - -

its inner of medial end is posterior. The maxillary air sinus may consist

of one whole cavity or it may be divided by septa into two or more

cavities which may or may not communicate with one another. The

shape of maxilary air sinus varies with different types of facies. In

persons with projecting face bones it will be found that the anterior

and medial angle of the sinus is narrow with the nasal wall bulging

into the sinus.

The maxillary air sinus is lined by ciliated columnar epithelium.

It is richly provided with glands, which are situated chiefly around the

ostium.

THE FRONTAL SINUS :

The frontal sinus occupies the space in the frontal bone between

the inner and the outer tables. The sinus is not present at birth but

becomes the frontal sinus about the age of five when the air cells

extend above the level of the supraorbital ridge. The frontal sinus

is developed from a recess in the anterior part of the nose. One

or both sinuses may remain rudimentary, but when pneumatization extends

into the frontal bone proper, it enlarges in every direction. The fully

developed frontal sinus may extend to the outer orbital angle and upwards

into the frontal bone for a distance of severla centimeteres.

The frontal sinuses are rarely symmetrical and they are seperated

by a thin plate of bone. The roof of the orbit forms the floor of

the frontal sinus, containing towards the inner angle the supra-orbital

- - 48 - -

nerve and having attached to it, more medially, the trochlea of the

superior oblique muscle. The frontal sinus is lined with columnar epithelium.

The cilia of the frontal sinus, according to some authorities, are generally

found around the opeining of the fronto-nasal duct. Between the frontal

sinus and the orbit are frequently found narrow cells which are known

as the orbito-ethmodial cells, and these may or may not communicate

with the frontal sinus. They may have their own opeinings into the

nose.

THE ETHMODIAL CELLS :

The ethmoidal air cells, although divided into two groups, must

be regarded as one from the point of view of development and treatment.

To explain this division of the ethmoidal cells properly, it is necessary

to go back to their development. In the primary nasal cartilage, grooves

and ridges appear on the laterial wall, the ridges becoming conchae,

and in the embryonic nose may number five ethmoconchae. As development

proceeds adhesions form on these ridges, parts of the grooves being

cut off and thereby forming cells. Eventually one of these ethmo-conchae

becomes more prominent than the others and forms the middle concha.

This appears to be a more or less arbitary process, and therefore

all cells above this ridge become posterior ethmoid, while all those

below it become anterior ethmoid, drainage being respectively above

and below the middle concha, so that an anterior ethmodial cell might

quite well behind , anatomically speaking, a posterior ethmoidal cell.

In contrast to the other sinuses the ethmoid consist of very many small

air cells without regular disposition, symmetary or fixed number. They

- - 49 - -

lie in the upper part of the laterial wall of the nose. Laterally is the

orbital periosteum. Below is part of the maxillary air sinus and above

the cells meet at an apex, though in the anterior part the frontal sinus

might be said to bear a superior relationship. The lining of these

cells is similar to that of the other sinuses, drainage, as before, being

effected by ciliary mucous membrane.

THE SPHENOIDAL SINUS :

The sphenoidal sinus occupies the body of the sphenoid bone.

At birth the sphenoidal sinus is seen as a small depression at the

posterior end of the nasal cartilage. As development proceeds the

depression deepens and in effect the posterior end of the nasal cartilage

becomes constricted the point of constriction becoming the ostium of

the sphenoidal sinus. At the age of nine to twelve years the sphenoidal

sinus does not encroach upon the sphenoidal bone, and is still confined

to cartilage, but after this period pneumatization of the sphenoidal

bone begins, and may extend down into the pterygoid process of the

sphenoid. The sphenoidal sinuses are capable of wide variation in

shap and position. They may be of unequal size and one may be

almost on top of the other.

Abnormal pneumatization accounts for certain unusual complications

of sphenoidal sinusitis. In most skulls pneumatization extends inferiorly

below the pituitary fossa which bulges into the sinus. The transphenoidal

route to the pitutary takes advantage of this, so that the sphenoidal

sinus now provides the usual means of access for hypophysectomy.

- - 50 - -

At the outer part of the roof the Gasserian ganglion may form a superior

relationship, while at the outer anterior angle, where the roof and the

lateral wall meet, the optic foramen, containing the optic nerve, is in

close apposition to the sphenoidal sinus. The lateral wall is in contact

with the cavernous sinus , with the nerves and vascular structures which

it contains. In the floor there is one important strcture, the vidian

nerve or the nerve of the pterygoid canal. As a rule this nerve is

in the substance of the bone, but it may be lightly covered on the

floor of the sinus and may even be carried in a bony arch across

it.

The ostium of the sphenoidal sinus is, as has already been

pointed out, high up in the anterior wall. The lining of the sphenoidal

sinus similar to that of the other sinuses and the nasal cavity.

It will be seen that the accessory sinuses form a system into

which the nasal lining is continued unbroken and which therefore must

share in some degree, the pathological changes which the infection

is likely to produce in the nasal cavity.

PHYSIOLOGY OF THE NOSE :

The Chief Functions of the nose are

1) Smell

2) Filtration

3) Humidification and warming of the air passing to the lungs.

There are other functions, such as vocal resonance, self-cleansing

and provision of moisture for protection of the mucous membrane.

- - 51 - -

The functions depend upon the mucous membrane with its underlying

tissues. In certain areas such as the conchae (turbinates) this is a

complicated structure of ciliary mucous membrane, glands, blood spaces

and connecting tissues based upon bone, and is under the control of

the autonomic nervous system. In this way the conchae act as a valve

mechanism enlarging or narrowing the air channels and so determining

the directions of the air stream. The path of the air column in the

nose during inspiration is upwards and backwards towards the middle

concha, thence in a curve towards the posterior nares. This can be

demonstrated by the inhalation of a small quantity of coloured powder.

In expiration such a definate path is not followed, but there

is a more general diffusion of the air column throughout the nose, with

an eddy round the middle concha.

SMELL : Smell as a function may be influenced in various ways. For

example obstruction from inflammation or vasomotor changes may prevent

air reaching the olfactory area. Sometimes toxic or infective conditions

or head injury destroy the nerve endings and the sense of smell.

Filteration is effected by the adhesion to the mucous film of

dust, bacteria and other practicles. These are removed by ciliary action

into the pharynx and swallowed with the secretions.

- - 52 - -

THE SENSE OF SMELL :

The olfactory membrane lies in the superior part of each nostril.

The receptor cells for the smell sensation are the olfactory cells, which

are actually bipolar nerve cells derived originally from the C.N.S itself.

These cells are interspread among the sustentacular cells. The mucosal

end of the olfactory cell, form a knob from which the olfactory haire

or cilia project into the mucos tract coats the inner surface of the

nasal cavity. These cilia react to odour in the air and then stimulats

the olfactory cells. Spaced among the olfactory cells in the olfactory

membrane are many small glands of Bowman tract secrete mucus into

the surface of the olfactory membrane.

The olfactory cells react to olfactory stimuli by depolarizing

the cell and thus creating a receptor potential. This in turn initiates

nerve impulse in the olfactory nerve fibre. The oxan of the olfactory

receptor neurons pierce the cribriform plate of the ethamoid bone and

enter the olfactory bulb. In the olfactory bulbs the oxan terminate

among the dendrites of the mitral and tufted cells in the olfactory glomeruli.

The axons of the mitral and tufted cells pass posteriorly through the

olfactory tract and terminate either primarily or after relay nerve in

two principal areas of the brain called the medial olfactory are a and

the lateral olfactory area respectively. The medial olfactory area is

composed of a group of nuclei located in the midportion of the brain

includes the olfactory nucleus the olfactory tubercle, parts of the hypothalamus

and other adjecent areas.

- - 53 - -

The lateral olfactory area is composed mainly of the prepyriform

and pyriform cortex and part of the amyglaliod nuclei. The secondary

olfactory tract pass from both the medial and lateral olfactory area

into many other portion of the system and into associated regions of

the thalamus and brain stem nuclie.

HUMIDIFICATION :

The moistening and warming of the air passing to the lungs is

one of the chief functions. Air reaches the lungs at about 30oC and

at 75-95 per cent relative humidity. When, during cold weather, the

air in a room is heated, the humidity may fall from the optimum 40

per cent to as low as 5 to 10 per cent. To increase this humidity

to the level necessary for comfort may cause a severe strain on the

nasal mechanism. Unless the mucous membrane is very efficient extreme

discomfort may result. Similarly changes in the mucous membrane

of the nose caused by disease or trauma may produce symptoms. These

are due to the inability of the glands and blood spaces to provide

the warmth and moisture demanded by the atmospheric conditions.

Ciliary action is the means by which the mucous membrane cleanses

itself and removes unwanted material. By the movement of the cilia

which fringe the surface cells, a constant streaming of mucus is produced

antero posteriorily. Any interference with normal action causes unpleasant

symptoms. Overaction of the cilia may mean copious nasal secretions

and impaired action leads to accumulation of secretion of even to the

formation of crusts which cause obstruction by clogging the nose.

- - 54 - -

The post-nasal discharge, so often a cause of complaint, is an expression

of the inability of the ciliary mechanism to deal with thickened mucus

which slowly finds its way into the pharynx where it acumulates. The

conditions necessary for efficient ciliary action are mucus of the correct

consistency and adequate aeration. Conditions inimical to ciliary action

are excessive drying, inflammation, thick secretions and unsuitable drugs.

The nose plays an important part in giving resonance to the

voice. Malformations of the nasopharynx and obstructions in the nose

itself may alter the tone of the voice, making it flat and uninteresting.

In the same manner, by interfering with the nasal air column, rigidity

or fibrosis of the soft palate may deprive the voice of timbre. For

this reason nasal operations upon singers must be approached with

great caution and considerable experience is required to judge the probable

effects on voice of treatments causing alternation of the nasal structure.

- - 55 - -

INTRODUCTION

Those alone are wise who act after investigation. Eventhough

the detailed subject of Ayurveda is written as explained by the

sages, the necessity of investigation with regard to the etiopathology

diagnotis and treatment are essential for the progress of Ayurveda.

The primary aim of the Auyrvedic science are two : 1.

To maintain the health of a swastha and 2. To cure the disease

of an unhealthy person. A swastha is a person whose doshas

are in a state of equilibrium, his digestive capacity is normal,

with the normal functions of dhatus and malas accompanied by

the lucid states of Ama, indriyas and manas. Indriyas are of two

types : 1. Janendriyas - Sense organs and 2. Karmendriyas -

The conative organs. The verbal expression is the function of one

of the Karmendriyas, and it is the God's gift to human beings.

Arditavata is a disease in which some of the jnanendriyas

and karmendriyas, located in the siras are affected, particularly

in their function. Therefore the most important characteristics of

a human being viz: facial expression and verbal expression are

lost, in away the patient loses the essential human characteristic.

- - 56 - -

The incidence of this disease is sufficiently high to warrant an

effective treatment.

The most important and effective treatment recommended

in Ayurveda for the Arditavata is Nasya Karma. The application

of this kind of treatment is also easy without any distress to the

patient. Therefore this method of treatment is selected in this trial.

The medecine selected is also easy available and it is one of

the effective vatahara medecines. The use of Ksheerabala taila

(101) has been recommended in the treatment of vatarogas by

almost all Ayurvedic scholars. The herbal ingredients that are used

in the praparation of Ksheerabala taila are nontoxic, easily available

and non-controversial. Therefore the administration of Ksheerabala

Taila (101) has been used in the treatment of Arditavata.

A total of 30 cases have been selected in this study

and these cases have been grouped into three types with different

methods of treatment. It has been found that the Nasya Karma

with the Ksheerabala taila(101) to be more effective. But this trial

can be visualised as only a pilot study and a further extensive

work is necessary to establish the definate curative effect of Ksheerabala

taila(101) nasya karma on the patients of Arditavata.

*****

- - 2 - -

- - 57 - -

Table No.1 Sex

������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������

���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������

��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������

��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������

��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������

6

������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������

������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������

Female

Male

40%60%

- - 58 - -

0

234567

Table No.2 Age and Sex incidence

15-20 21-30 31-40 41-50 51-60

7

6

5

4

3

2

1

0

Male

Female

- - 59 - -

Table No. 4 Occupationalwise

EmpHW

AWStud

others

S1

0

2

4

6

8

10

12

Note :

Emp - Employees

HW - House Wives

AW - Agricultural Workers

Stud - Students

Others - Others

- - 60 - -

Table No.5 Occupation Sex wise

Note :

Emp - Employees

HW - House Wives

AW - Agricultural Workers

Stud - Students

Others - Others

EmpHW

AWStud

Others

Male

Female

0

1

2

3

4

5

6

7

8

9

0

- - 61 - -

X1X2

X3

S0

2

4

6

8

10

12

14

16

18

X1=Exposure to frost, dust, cold smoke etc.X2=Middle ear InfectionX3=Recently delivered women

Table No.6 Causitive Factors

- - 62 - -

X1X2

X3X4

X5

S1

0

2

4

6

8

10

12

X1 = Below one weekX2 = 8-14 daysX3 = 15-30 DaysX4 = 31-90 DaysX5 = above 90 Days

Table No.7 Duration

- - 63 - -

Table No.8.1 Comparative Table of Completely Relieved

Gp-A Gp-B Bp-C

7 Days

14 Days

012345

Table No.8.2 Comparative Table of Partially Relieved

Gp-AGp-B

Bp-C

7 Days

14 Days

0

0.5

1

1.5

2

2.5

3

Gp-A Gp-B Bp-C

7 Days

14 Days

0

2

4

6

8

Table No.8.3 Comparative Table of Non-responsive

ROLE OF NASYAKARMA IN ARDITAWITH SPECIAL REFERENCE TO

KSHEERABALA TAILA (AVARTITA)

Thesis submitted in partial fulfilment for theaward of post graduate degree of

Doctor of Medicine (Ayurveda)

M. D. (Ayurveda)

BySHETTAR RAGHAVENDRA VENKATESH

Under the guidance ofDR. V. V. SUBRAHMANYA SASTRY

G.C.I.M. (Madras) D. Ay. M. (B.H.U)

POST GRADUATION AND RESEARCH CENTRE

D. G. M. AYURVEDIC MEDICAL COLLEGE

GADAG

RAJIV GANDHI UNIVERSITY OFHEALTH SCIENCES

BANGALORE1999

- - 65 - -

Going through all informations about Ardita explained by

different scholars conviace that Ardita overall resembles the facial

paralysis in modera texts. Paralysis is meant an incapacity to move

or feel due to the damage to the nervous system. Such incapacity

occuring facial muscles can be stated as facial paralysis which

movements. As explained earlier the facial muscles are controlled

by 7th cranial nerve i.e. facial nerve.

Facial paralysis can occur by two kind of lesions viz.

Supranuclear and infranuclear type. The signs and symptoms vary

according to the nature of the fibre paths involved.

Facial weakness/paralysis may be due to :

1. A supranuclear lesion involving the corticospinal fibres concerned

in voluentary facial movements;

2. A supranuclear lesion involving the fibres concerned in emotional

movement of the face - mimic paralysis.

3. Nuclear and infranuclear lesions involving the lower motor neurones;

and

4. Primary degeneration or disorder of function of facial muscles.

1. Facial paralysis due to a supranuclear corticospinal lesion

is distinguished by the fact that movements of the lower

face are affected more severily than those of the upper.

2. A pathway controlling emotional movements as distinct

- - 66 - -

from voluntary movement of the opposite side of the face,

The most important originates in the frontal lobe. A lesion,

above the internal capsule may paralyse voluntary movement

of the lower face on the opposite side. Leaving emotional

movement, as in spontaneous smiling intact. Very rarely, a

frontal or thalamic lesion may aboilish contralateral emotional

movement leaving voluntary movement unimpaired (Mimic Paralysis).

3. Lesions involving the lower motor neurones destroy the

final common path, affect equally all forms of facial movements.

The facial lower motor neurones may be involved by a lesion:

a) Pontine lesion (within the pons)

Lesions in this region, facial paralysis is usually associated

with conjugate occular deviation, often with paralysis of the ipsilateral

jaw muscles and some times with the contralateral hemiplegia. Involvment

of trigeminal nucleus may lead to sensory loss also. Bilateral facial

paralysis occasionally occurs as a congenital abnormality (Mobius'

Syndrome).

b) Lesion within the posterior fossa, between the pons and the

internal acoustic meatus may cause deafness and loss of taste

in the anterior two third of the tongue as well as facial paralysis.

- - 67 - -

The commonest of such lesions are acoustic neuroma.

c) Within the temporal bone the facial nerve may be involved

in skull fracture or be involved in infections of the middle ear and

mastoid. Herpes zoster of the geniculate ganglion usually causes

facial paralysis through secondary involvement of the motor fibres

of the nerve, so called Ramsay - Hunt syndrome. Lesions within

the middle ear is usualy associated with loss of taste in the anterior

two third of the tongue, due to interruption of the fibres of the

chorda tympani.

d) After emergence of the nerve from the skull the fibres of the

facial nerve may be involved in many inflammatory or malignant

processes causing unilateral or bilateral facial palsy. Facial palsy

of bilateral or unilateral with recurrent episodes of facial ocdema

occur in patients with deeply furrowed tongue i.e. Melkersson's

syndrome.

4. Primary disfunction of the facial muscles is seen in mysthenia

gravis, muscular dystrophy and dystrophy mytonica.

Among the above terms of lower motor neuron lesions,

Bell's palsy is a commest form of facial paralysis.

Bell's Palsy :

Bell's palsy is defined as the facial paralysis of accute

onset presumed to be due to non-suppurative inflammation of the

- - 68 - -

facial nerve within its canal above the stylomastoid foramen.

The features of Bell's palsy are :

1. Usually unilatera, rarely bilteral.

2. pain within ear or mastoid region or arround the angle of jaw.

3. Onset is sudden - after patient awaken to find the face paralysed.

4. Paralysis of the muscles of facial expression. The upper and

lower facial muscles are equally affected and voluntary emotional

& associated movements are involved.

5. Eyebrow droops, wrinkles smoothed out, frowning and rising

of eyebrow is impossible.

6. The palpebral fissure becomes wider on affected side and

closure of the eye is impossible.

7. When the patient attempts to close the eye, the globe rolls

upwords and slightly inwards - Bell's phenomenon.

8. Eversion of the lower lid impairs absorption of tears, tends

to overflow.

9. Nasolabial fold is smoothed out.

10. Mouth becomes drawn to sound side and the patient cannot

retract the angle of the mouth or purse the lips as in whistling.

11. Paralysis of the buccinator causes cheek a puffed out appearence

in respiration.

12. Food accumulates between the cheek and the teeth.

13. The tongue deviates to the sound side when protruded.

- - 69 - -

14. Los of taste in anterior 2/3 of the tongue may occur when

the inflammatory process expends to the chorda tympani.

15. The patient may complaing of hypercusis, an intensification

of loud noises in the affected ear, when the branches to the

stapedius is involved.

By the above modern explanation, we are convinced that

the facial paralysis varies in its fetures according to the site of

lesion involve in the pathogenisis. One can also observe the signs

and symptoms of Ardita explained in different Ayurvedic classics

closely resemble the above mentioned facial palsy.

- - 70 - -

MODE OF ACTION OF NASYA

Drug administered to a person has to be absorbed into

the system. Its action on the particular system of the body depends

on absorption and disposal of the drug. The absorption of the

drug will be mainly depends on the route of administration, physiology

of the drug solubility and absorption surface.

The main channel of administration of Nasyadravya is nose

which is explained as the dwara of shiras. Nasya dravya administered

through nose reach the upper portion of the nose, and there the

absorption takes place. Drugs used in this therapy may be water

soluble or highly lipid soluble. These substances are capable to

stimulate the olfactory epithelium and nerve path.

Modern science explains that, it has been found that the

cilia of the body of the olfactory cell contain relatively large quantities

of lipoid materials, this could explain why a substance must be

lipid soluble to cause marked stimulation of an olfactory cell.

In Astanga Sangaraha an idea is given about the absorption

of nasyadravya. The drug administered through nose reaches the

sringatakamarma, spreads there and shows its action & cures the

- - 71 - -

disease.

The sleshmika kala of the nose is highly vascular & good

absorbing surface. Due to its vascularity the drug will be mainly

absorbed through the raktayanis and stimulates the olfactory nerve.

Through the rasayanis (Venules) drug will reach the vaktra sira

(Facial vein), and few communitates with the siras of antahkaroti

pradesha. Like this nasyadrvya reaches moordha and shows its

action on the affected part.

- - 72 - -

SUMMARY

Arditavata is disease, which come across oftenly. Non-

availability of satisfactory treatment made patient to approach Ayurvedic

physicians for a better reults.

Arditavata is a disease of Shiras and facial nerve is

the affected part. So the anatomical discription and physiological

impairement has been described.

Before going to clinical trial, knowledge of causative factors

and pathophysiological aspects are very important. So brief description

of causative factors and disease process has been eloborated.

In Ardivata pranavata and raktavaha srotodusti are the

main pathological aspects. Importance of vata particulary prana

and udana and their pathological changes along with the Raktavaha

Srotodusti discussed separately.

Signs and symptoms, explained by different scholars are

described.

- - 73 - -

Line of a treatment for Ardita mentioned by a different

Scholars has been followed. Major classics mentioned nasya karma

is the line of treatment for Arditavata. The regimen prescribed

was followed strictly.

Results obtained are presented in tabular form.

The detail description of drug taken for trial i.e. Ksheerabala

Taila (101) has been described. Chemical constituents, pharmacological

and analytical description narrated separately.

- - 74 - -

SPECIAL CASE SHEET OF ARDITAVATA

Name of the patient Case No.

Age Yrs. O.P.No.

Sex M F I.P.No:

Caste Hindu Ward No.

Muslim

Christean Bed No:

OthersDate of Admission / /

Occupation Date of Discharge / /

Employee

House-wives Result

Agricultural workers Completely relieved

Student Partially relieved

Others Non responsive

Address :

Pin :

D.G.M. Ayurvedic Medical CollegePost-Graduation and Research Centre

GADAGDept. Kaya - Chikitsa

Guide : Dr. V.V.S.Sastry D.Ay.M.(BHU) Scholor : Shettar. R.V.

- - 75 - -

Economical Status :

Annual Income

Income from other sources

Total

(Chief Complaints with duration) Duration

1. Deviation of the mouth angle

2. Inability to close the eye on affected side

3. Vak Sanga

4. Excessive Salivation

5. Bhojanasamardhata

6. Mukha parswa Vedana

7. Adhika Asru Srava

8. Karnavedana

9. Jihwa Vatrata

10. Lalata Valinasha

History of Present illness :Mode of on set sudden Gradual

Side affected Right Left

Associated Symptoms

Duration

1. Sira Kampa

2. Greeva Vedana

3. Danta Vedana

4. Chibuka Vedana

5. Sparashasahatva

- - 76 - -

Associated diseases if any1. Diabetus

2. Hemiplegia

3. Head injury

4. Syphilis

Family History :

G.Father G.Mother G.Father G.Mother

Father Mother

Brother Sister Patient Brother Sister

Brother Sister

Wife/Husband

Father in law Mother in law

Personal HistoryHabits

Alcohol

Smoking

Tobacco Chewing

Drug addiction

Diet Factors1. Vegiterian

2. Mixed

Marital status Married Unmarried

- - 77 - -

Menstrual History (in females)

Pregnant Women Y N

Recently delivered Y N

Previous cycles Regular irregular

General Examinations

Pulse /min

B.P mm of Hg

Body Temp oF

Respiration rate /min

Body Weight kg

Prakrityadi Pareeksha

1. Prakruti

Vataja Pittaja Kaphaja Dwandawaja Sannipataja

Vatapitta Vatakapha Pitta-Kapha

Pareeksha Bhava1. Shareera (body as a whole)

Vataja Pittaja Kaphaja

Deeragha, Krasha Alpa Madhyama Hraswa, Samhata

Apachita, Ruksha Nati Stabda Mahat, Upachita

Seeta, Durbhaga Natiruksha Snigdha, Sheeta

Dull face Sukumara Subhaga

Bahu Sira pratana Piplu. tila. Vyanga

- - 78 - -

2. Twak (Skin)

Ruksha, Sphutita Tanu Asputana Snigdha, Asputana

Khara, Dhusara Atimrudu, gaura Mrudu, Avadata

Tamra (Red or pink) (Yellowish) Sweta

3. Netra (eye)

Alpa, Ruksha, Tanu Tanu Pingala(yellowish) Vishala, Snigdha

Dhusara Ashuranjanasheela pruthu, Sheetapriya

4. Jihwa (Tongue)

Tanu, Alpa Ruksha Madhyama, Madhyama pruthu, Mahat

Sphutita Anavasthita Tamra, Rakta Slakshna Ardra

LalataAlpa Valiyukta Mahat

Sandhi

Tanu, Alpa, Ruksha Madhyama Pruthu, Mahat

Shabdagamini Mrudu Upachita

Tamra(pinkish)

Bala

Alpa,Shighra trasa Madhyama Balavan

2. Sara

i) Rasa Sara ii) Rakta Sara

iii) Mamsa Sara iv) Meda Sara

v) Asthi Sara vi) Majja Sara

vii) Sukra Sara viii) Satwa Sara

- - 79 - -

3. Samhanat

Pravara Madhyama Avara

4. Satwa

Pravara Madhyama Avara

5. Satmya

i) Food addiction

ii) Alcohol

iii) Tobacco-chewing

iv) Drug addiction

6. Desha

Janma desha

Vruddha desha

Vyadhita desha

Sroto pareeksha

1. Rasavaha sroto pareeksha

i) Hridaya

Inspection

Percussion

Auscultation

ii) Sirajala

iii) Dhamanijala

iv) Rasayanijala

- - 80 - -

2. Raktavaha Sroto pareeksha

i) Yakrit - palpation

Percussion

ii) Pleeha - palpation

Percussion

iii) Lasikagranthi

iv) Conjunctiva

3. Mamsavaha Srotopariksha

1. Prominance of temporal Muscle

1 3 7 11 14 After treatment

2. Prominance of Massater Muscle

1 3 7 11 14 After treatment

C.N.S EXAMINATION

State of Consciousness

Appearence & behaviour

EXAMINATION OF AFFECTED CRANIAL NERVES

1. Trigeminal nerve

1. Prominence of tempora Muscle

1 3 7 11 14 After treatment

- - 81 - -

2. Prominence of Massater Muscle

1 3 7 11 14 After treatment

3. Deviation of Jaw on affected side (In cms)

1 3 7 11 14 After treatment

4. Corneal reflex

1 3 7 11 14 After treatment

2. Facial nerve1. In ability of closing eye on affected side (in cms)

1 3 7 11 14 After treatment

2. In ability of eye brow rising (Presence of wrinkles on forehead)

1 3 7 11 14 After treatment

3. Mouth inflation test

1 3 7 11 14 After treatment

4. Whistling

1 3 7 11 14 After treatment

5. Mouth angle diviation ( In cms)

1 3 7 11 14 After treatment

- - 82 - -

6. Sense of taste in anterior 2/3 of the tongue

1 3 7 11 14 After treatment

Solution : 1. Sugar

2 . Salt

3 . Citricacid

4 . Quinnine

3. Auditory Nerve1) Power of hearing

2) Abnormal sensation

3) Vertigo

4. Glasso - pharyngeal nerve1) Sense of taste in posteror 1/3 of the tongue

5. Hypoglossal1) Tongue protrusion

2) Tongue movements

3) Deviation

4) Atrophy

5) Tremor

Nidana Panchaka1. Hetu

Aetiological factors

i. Exposure to cold, dust, frsot and smoke etc.

ii. Middle ear infection

iii. Recently delevered women

iv. Carrying heavy load on head

v. Speaking loudly

- - 83 - -

vi. Excessive laughter

vii. Excessive yawning and sneezing

viii. Sudden movements of head and neck

ix. Wrong use of Siravyadha

x. Suppression of natural urges

xi. Head injury

xii. Excessive haemorrhage

2. Samprapti Ghatakas

1. Dosha

2. Dooshya

3. Srotas

4. Srotodusti prakara

5. Agni

6. Ama

7. Udhava sthana

8. Sanchara sthana

9. Adisthana

10. Rogamarga

3. Lakshnas

1 3 7 11 14 A.Treatment

1. Mukhavakrata

2. Akshinimeshasmarthata

3. Vak Sang

4. Sira Kampa

5. Bhara Heenata

6. Adhika Asrusrava

7. Greeva vedana

8. Mukhaparshwa Vedana

- - 84 - -

9. Danta Vedana

10. Chibuka Vedana

11. Karna Vedana

12. Badhirya

13. Sparshasahatva

14. Adhika lalasrava

15. Jihwa Vakrata

16. Suptata

17. Bhojanasamardha

18. Lalata Valinasha

4. Poorvarupa

1 3 7 11 13 A.treatment

1. Horipilation

2. Vepanam

3. Avila Netrata

4. Vayuroordhwa

5. Twachi Swapa

6. Toda

7. Manyasthamba

8. Hanugraha

5. Sadhyasadhyata

Asadhya Laxana

1. Extreme emaciation

2. Inability to close the afflicted eye

3. Difficulty in speach

4. Duration more than 3 years

5. Serve shaking or

trembling of the head

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LAB INVESTIGATION

1. HB% gm%

2. T.C.

D.C

3. ESR mm/hr

4. RBS

SAPEKHA NIDANA

Diagnosis

Signature

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INTRODUCTION

Those alone are wise who act after investigation.

Eventhough the detailed subject of Ayurveda is written as explained

by the sages, the necessity of investigation with regard to the etiopathology

diagnosis and treatment are essential for the progress of Ayurveda.

The primary aim of the Auyrvedic science are two : 1. To maintain

the health of a swastha and 2. To cure the disease of an unhealthy person.

A swastha is a person whose doshas are in a state of equilibrium, his

digestive capacity is normal, with the normal functions of dhatus and malas

accompanied by the lucid states of Atma, indriyas and manas. Indriyas

are of two types : 1. Jnanendriyas - Sense organs and 2. Karmendriyas

- the conative organs. The verbal expression is the function of one of the

Karmendriyas, and it is the God's gift to human beings.

Arditavata is a disease in which some of the jnanendriyas

and karmendriyas, located in the siras are affected, particularly in their

function. Therefore the most important characteristics of a human being

viz: facial expression and verbal expression are lost, in a way the patient

loses the essential human characteristic. The incidence of this disease

is sufficiently high to warrant an effective treatment.

The most important and effective treatment recommended in

Ayurveda for the Arditavata is Nasya Karma. The application of this kind

of treatment is also easily without any distress to the patient. Therefore

this method of treatment is selected in this trial. The medecine selected

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o p

o p

C E R T I F I C A T E

This is to certify that Shettar R.V.Shettar R.V.Shettar R.V.Shettar R.V.Shettar R.V. Scholar of

M.D.(Ay.)M.D.(Ay.)M.D.(Ay.)M.D.(Ay.)M.D.(Ay.) Kayachikitsa has worked for his thesis on the

topic entitled "Role of Nasya Karma in Ardita with special

reference to Ksheerabala Taila (Shatavartita).

This work is done under my supervision and guidance.

This thesis makes a distinct advance on scientific lines

in the above subject and the findings are immensely valuable

and have considerably contributed to the present knowledge

of the subject

I am fully satisfied with his original work and

hereby forward the thesis for the evaluation of adjudicators.

Guide :

DR. V.V.SUBRAHMANYA SASTRYG.C.I.M.(Madras), D.Ay.M(B.H.U.)Head of Department of K.C.P.G.studies and research centreD.G.M. Ay. Medical CollegeGadag - 582 101.

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ACKNOWLEDGEMENT

I express my deep sense of gratitude to my respected guide

Dr.V.V.Subrahmanya Sastry. Head of Department of K.C.Post graduation

& Research Centre. D.G.M. Ayurvedic medical college Gadag. It was

very pleasant to work under his guidance. He gave moral Support,

encouragement throughout my work. Without his in time guidance it

was not possible.

I am also greatful to the Asst. Professor Dr.K.S.R. Prasad and

lecturer Dr. A.K.Padnda for their advices throughout the work and

also help in clinical work.

I am thankful to my U.G. lecturer Dr. C.M. Sarangamath for his

kind co-operation. He helped me in clinical work and provided many

patients for the present trial and encouraged throughout the work.

I express my thanks to Dr. S. S.Hiremath and Dr. C. S. Hiremath

for their help in the project work. My sincere thanks to Dr.U. V. Purad

incharge pathology department, and to Dr. S. A. Patil who helped

me and advised to join the course.

I express sincere thanks to my uncle Dr. A. M. Anegundi for

his advices and encouragement. He provided many refferences of modern

science and helped me a lot throughout the course.

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It was very pleasant to express my deep sense of gratitude to

my principal Dr. G. B. Patil who permitted me to do the present work.

He provided all facilities intime and supported in every step throughout

the course.

I am thankful to our librarian Mr. Mundinamani and to all college

teaching and non teaching staff for their support.

I am also thankful to Mr.Krishna Fattepur and Mr. Habib for their

neat job work in the preparation of this thesis.

Finally I express my sincere thanks to all my colleagues, friends,

and family members and those who helped directly and indirectly.

SHETTAR. R. V.

B i b l i o g r a p h y

1. Amarakosha :

2. Astanga Hridaya : Arunadatta & Hemadri Commentory

3. Astanga Sangraha : Indu commentory

4. Baishajyaratnavali :

5. Bhavaprakasha : Bhavamishra

6. Bhela Samhita :

7. Brain's Diseases of the : John WaltonNervous system

8. Charak Samhita : Chakrapani commentory

9. Chakra Datta : Chakrapani

10. Dhanwantari Nighantu :

11. Gadanigraha :

12. Grey's Textbook of Anatomy :

13. Harita Samhita :

14. Harrison's Principles of :Internal Medicine

15. Hutchison's Clinical Methods :

16. Inian materia medica : Dr. K. M. Nadkarni

17. Introduction to Kaya Chikitsa : Dr. C. Dwarakanath

18. Kashyapa Samhita :

19. Madhava Nidana : Madhukosha cmmentory

20. Nutritive values of Indian : C. Gopalan & B.V.Ramasastryfoods

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21. Panchakarma Vignana : Sreedhara Kasture

22. Principles & Practice of : Davidsonmedecine

23. Pratyaksha Shareera : Gananatha Sen

24. Sahasrayoga :

25. Savil's Clinical medecine :

26. Shabdastomamahanidhi :

27. Shabdakalpadruma :

28. Sharangadhara Samhita : Adhamalla commentory

29. Susruta Samhita : Dalhana, Jejjata commentory

30. Text book of physiology : Gayton

31. The chemical constituents : T. P. Hilditchof natural foods & P. N. Williams

32. Tridosha Theory : Dr. V. V. S. Sastry

33. Vangasena :

34. Yogaratnakar :

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loudly

Excessive

Comprises 16

Poorvaroopa or premonitory symptoms are the unmenifested form 26

form 27

Roopa of a disease is the stage of Vyakta in the Kriyakalas and manifests

Salivation 30

Going through all informations about Ardita explained by different

scholars conviace that Ardita overall resembles the facial paralysis

in modern texts. Paralysis is meant an incapacity to move or feel

due to the damage to the nervous system. Such incapacity occuring

facial muscles can be stated as facial paralysis. As explained earlier

the facial muscles are controlled by 7th cranial nerve i.e. facial

nerve.

abolish 32

Charaka 38

structure 40

quadrilateral 40

spheno-ethmoidal

ethmoidal 42

ethmoidalis, which is due to the protrusion into the meatus of one of

ethmoidal 42

ethmoidal 43 anterior - 43 ethmoidal 44

ethmoidal 45 lateral - 46 membrane 46

several 47 ethmoidal 48 lateral 48

ethmoidal 48 shape and position 49

lateral 49 pitutary 49 particles. 51

or cilia project into the mucuos tract coats the inner surface of the

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