11836048497df Rasa Raktha Vaha KC

Drone Foundation Course 2020-21
RASAVAHA AND RAKTAVAHA SROTO DUSHTI JANYA

VIKARAS -
AYURVEDA PORTION
1. ***Explain nidana, samprapthi, lakshana and chikitsa of

amavataha (10marks)
(KUHS March-2018, AMRITA July-2016 Supplementary, AMRITA Feb-2014)
2. Chikitsasootra of amavatha (5marks)
(KUHS Sep-2018, KUHS Apri-2017, AMRITA Feb-2017, AMRITA Feb-2019

Supplementary, AMRITA Aug-2018, AMRITA Aug-2018 Supplementary,
AMRITA Feb-2018, AMRITA Aug-2017,
AMRITA Feb-2016, AMRITA July-2016 Supplementary, AMRITA July-2015)
ANSWER:
 Etymology of amavatha:
The term amavatha comprises of two vital words - ama and vatha
‘Amam cha vatham cha amavatham I’ (Vijayarakshitha)

– Ama and vatha unites to form amavatha
‘Amena sahitho vatha: amavatha: I’ (Vijayarakshitha)

– Vatha associated with ama creating a disease known as amavatha.
 Amavatha, eventhough mentioned in brihatthrayi as one disease among vatavyadhi,

Madhavakara was the first acharya to elaborate this clinical syndrome in his classic-
Madhavanidana and dedicated a separate chapter for the same. There after other
authors described it in their respective texts.
 Nidana :
(Ma.Ni.25/1)
 Indulgence in incompatible food and habits
 Poor digestive fire
 Lack of physical activity
1
 Indulgence in exercise after after taking snigdhahara
 Samprapthi:
(Ma.Ni.25/ 2-5)
Ama circulates the body due to propulsive effect of vridhavatha,
Reaches various kaphasthanas in the body like sandhis, amasaya, uras, kanta, siras
Dhamani
Dushti by tridosha
Rasavahasrothas thrikasandhipravesa
Dourbalya Sandhistabdhatha
Sandhisotha
Shula
Amavatha
 Samanyalakshana
(Ma.Ni-25/6)B
 Body pain
2
 Loss of taste
 Morbid thirst
 Malaise
 Feeling of heavyness
 Fever
 Indigestion
 Oedema of body parts
 Pravrudha amavatha lakhana:
(MA.Ni-25/7-10)
 When amavatha gets exacerbated- Pravrudha amavatah, it becomes most distressing

of all diseases
 Wherever amadosha reaches, produce painful swelling , ie on

– Joints of the hands
– Feet
– Cervical region
– Knees and thighs
 The affected part is excessively painful as if it is bitten by scorpions.
 It also gives rise to
– Excessive salivation
– Decreased digestive power
– Feeling of heaviness
– Loss of the drive
– Bad taste in the mouth
– burning sensation
– Poly urea
3
– Hardness in the abdomen

– Colicky pain
– Reversal of normal sleeping habit
– Thirst,vomiting, vetigo, giddiness
– Pericardial discomfort
– Constiption
– Stiffness
– Gurgling intestinal sounds
– Other troublesome complications
 Features of doshik predominance:
Vata: Severe pain
Pitha: burning sensation and redness
Kapha: Feeling of being covered with wet clothes
Heavyness
Itching
 Classification
Doshabhedena
 Vata
 Pitha
 Kapha
 Vatapitha
 Vathakapha
 Pithakapha
 Sannipatha
 Sadhyasadhyatha:
 Ekadoshaja: Sadhya
 Dwidoshaja: Yapya
 Sannipathaja Krichrasadhya
 swelling all over the body
• Chikitsa:
Chikitsasootra:
Langhanam svedanam tiktham deepanani

katooni cha
Virechanam snehapanam vasthayaschaama
marute
Saindhavadyanuvasasya ksharavasti prasasyate
4
Amavate panchakolasidham panannamishyate

Rooksha svedo vidadavyo valuka putakaisthata..
(chakradatta- amavatadikara)
 Langhana
 Swedana-
 Use of drugs of tiktarasa, katurasa
 Deepana
 Virechana
 Snehapana
 Vasthi
 Anuvasana with saindhavadi
 Ksharavasthi
 Rookhasweda like valukasweda
 Food and drinks processed with panchakola is benficial
(Bha.Pra.Madhyamakhanda-26/14-15)
 Bhavamisra advised upanaha avoiding sneha
 Important yogas in amvatha :

Kashaya:
 Rasnadasamoola kwatha
 Rasna panchaka kwatha
 Rasna saptka kwatha
Choorna
 Amritadi choorna
 Vaiswanara choorna
 Alambushadi choorna
 Satapushpadi choornam
 Bhagothara alambushadi choorna
 Thriphala pathyadi choornam
Gudika:
 Yogaraja guggulu
 Simhanada guggulu
 Ajamodadi vatakam
5
Ghrita
 Nagara ghrita
 Mrita ghrita
 Hingwadi ghrita
 Sunteeghrita
Rasona preparations:
 Rasona pinda
 Prasarani rasona pinda
 Rasona sura
 Importance of erandataila in amavatah
(B.P.Madhyamakhanta)
 Erandataila should be given long with dasamoola kashaya or water boiled with
nagara-It is beneficial for reducing pain of kukshi, vasthi and kateepradesa.
(Chakradutta-Amavatadhikara)
 Pathyapathyas in amavatha
 Pathya
Ahara
 Vasthuka saka
 Arishta
 Punarnava
 Patola
 Lasuna
 Varthaka
 Karavellaka
 Yavannam
 Koradooshannam
 Puranasali
 Shashtika
 Lavaka mamsam
 Takram
 Yooshaprepared with kulatha, kalaya and chanka
Vihara
 Rookshana
 Swedana
 Langhana
 Chankramana
 Mridu vyayama
 Ushna vasthra
 Apathya
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ahara:
 Dadhi
 Matsya
 Guda
 Ksheeram
 Virudhahara
Vihara:
 Poorva vayu
 Vegarodha
 Nisa jagarana
 Bathing in cold water
 Ativyavaya
3. Pandusamprapti and chikitsa (10marks)

(AMRITA Feb-2016, AMRITA July-2015, AMRITA Feb-2014)
4. Line of treatment of panduroga (5marks)
(KUHS Sept-2019, KUHS Sept-2018, KUHS March-2018, AMRITA Feb-2017,
AMRITA Feb-2016, AMRITA Aug-2017 Supplementary)
ANSWER:
Charaka classified rogas according to ruja, varna, samuthana, sthana, samsthana In

this classification the disease pandu falls in the group of varna in pandu, there is some
significant change in the normal colour of the body.
 As per Vijaya rakshitha
‘Pandutwenopalakshitho roga panduroga’

A person who acquires panduvarnatwam is a pandurogi.
(Su.U-43/4)
While describing signs and symptoms of different types of panduroga, several types
of complexion like harita, syava are described, but all of these are dominated by
‘pandutha’
 Panduvarna is defined in Amarakosha as follows
‘Sita peeta samayukta panduvarna prakirtitaha’

The combination of white and yellow colour in equal proportion is called panduvarna.
 Synonyms
7
Susruthacharya explains following names as the synonym of panduroga.

Kamala, Apanaki, Kumbhakamala, Lagharaka, Alasaka
 Samanya nidana of panduroga:
(Su.U.44/3)
In persons who indulge in
 too much copulation,

 Sours, salts, wine
 Habit of eating mud
 Day sleep
 Tikshnahara.
The doshas get aggravated, vitiate blood and bring about pandubhava.
 Samprapthi:
(A.H.Ni13/1-3)
Listed nidanas
Pithapradhana tridosha aggravation
Hridisthitha pitha is forced to dasadhamanis by the powerful anila
Pitha spreads throughout the body
Vitiate tvak, rakta and mamsa
Results in Pandu
(Produce different kinds of colours such as pandu, haridra, haritha , pandu
being more
Dhathu become sithila and properties of ojas become diminished)
8
 Samanya lakshana:
( Cha.Chi.16/13-16)
 Raktalpatha
 Alpamedaska
 Nisara
 Sithilendriya
 Vaivarnya
 Karnakshweda-tinnitus
 Suppression of the power of digestion
 Weakness
 Prostration
 Repugnance against food
 Fatigue
 Giddiness
 Pain in the body
 Fever
 Dyspnoea
 Heaviness
 Norexia
 Feels as if limbs are being kneaded, squeezed and churned
 Swelling of orbital region
 Green colour complexion
 Small hair of body fall out
 Looses bodily lusture
 He become irritable
 Dislikes cold things
 Feels sleepy
 Spits in excess
9
 Alpavak
 Suffers from cramps in the calf region
 Suffers from pain and weakness in lumbar region , thighs and feet
while making efforts for climbing
Charaka ,Vagbhata (5) Susrutha (4)
 Vathaja  Vathaja
 Pithaja  Pithaja
 Kaphaja  Kaphaja
 Sannipathaja  Sannipathaja
 Mrit bhakshana janya
 Chikitsa:
Treatment principle:
(Cha.chi.16/39-43)
Yuktivyapasraya chikitsa of pandu includes the following
 Nidana parivarjana
 Snehana
 Sodhana
 Samana
Nidana parivarjana: The above mentioned nidanas of panduroga should be avoided.
Snehana:
 Snehana is the poorvakarma of sodhana chikitsa.

 Tiktaghritas are indicated in pandu as it is a pithapradhana vyadhi
 Following ghritas are mentioned for sneha karma
 Panchgavya ghritam
 Mahatiktaka ghritam
 Kalyanaka ghritam
10
 Dadimadi ghitam
 Katukurohinyadi ghrita
 Pathya ghritam
 Danthi ghritam
 Drakshaghritam
 Haridradi ghritam
As it is a a pitha pradhana vyadhi, sweda karma is contra indicated in pandu
Sodhana:
The patients suffering from panduroga should be given vamana and virechana therapies
with snigdha and tikshna drugs for cleansing the body.
In all types of pandu, hareetaki is advised for virechana
and also the following are mentioned
 Gomutrayukta dugdham
 Danthiphala rasa,
 Draksha choorna
 Gomootrahareetaki choorna in kaphaja pandu
 Trivrit choorna in pithaja pandu
 Aragwadha majja with trikatu choornam
 Phala ghritam
 Tilwaka ghritam
 Dadimadya ghritam
 Pathyaghritam
 Dandi ghritam
 Drakshadi ghritam
 Doorvyadi ghritam.
Treatment according to predominant dosha
Vathika : Sneha bhooyishta
Paithika: Thikta and seetha
Kaphaja: Katu, tikshna and ushna
Sannipathika: Mixed
Samana:
 Ayoraja
 Mandoora vatakam
 Dhatryavaleha
 Goudarishta
 Beejakarishta
 Dhatryarishta etc.
11
Panam: Sthradi gana sidha toyam
Mrit bhakshana janya pandu:
The mud which may be composed of various undigesatable and un assimilable

substances obstructs the various channels.
Thus it is necessary to remove by strong purgations. The following ghritas are

indicated
 Vyoshadi ghritam
 Nagakesaradi ghritam in the suitable dosha form.
 Pathyapathya
Pathya Apathya
 Godhuma,Saali, Yava, Shashtika,  Guru, rooksha

mudga, syamaka, ie  Katu amla rasas
 Ghrita  Vidahi padarthas
 Payas  Kaanchika
 Takra  Sura, Souveerka
 Ghrita  Beejapurka
 Ayasa  Nila
 Takra  Upodhaki
 Vasthuka  Gramya mamsa
 Sathapushpam
 Vasa
 Patola
 Parpadaka
 Shanka
5. Nidana poorvaka chikitsa of mritbhakshana janya pandu

(5marks)
(KUHS March-2019, AMRITA July-2016 Supplementary)
 Acharya Charaka and Vagbhta explain mritbhakshanajanya pandu as the fifth type
of pandu
 It is a type of panduroga which is caused by eating mud, hence the name.
 Samprapthi:
12
(Cha.Chi.16/27-30)
Because of its rookshatwa, mud causes rookshatha in ahararasa
Undigested mud, fills up and blocks srothases
Afflicts the sharpness of senses, lusture, energy and ojas
Immediately causes panduroga, which results in in the loss of strength,

complexion and agni
 Signs and symptoms:
 Oedema in the cheeks, eye-sockets and eye-bones

 Oedema in feet, umbilical region and pudendum
 Worms in koshta
 Loose stools
 Stool mixed with rakta and kapha
Habitual indulgence in eating mud aggravates one of the three doshas.
 kashaya rasa type: Aggravates vayu

 Ushara type: Aggravates pitha
 Sweet type: Aggaravates kapha.
 Chikitsa:
Line of treatment:
(Cha.chi.16/13-124)
13
Depending on the doshas aggravated, different types of treatments should be given to

the patient suffering from mritbhakshana janya pandu. Because of the specific nature
of the causative factor, this type of anemia needs special type of treatment
Treatment include
 Sodhana
 Samana
Sodhana:
The clay which may be composed of various undigestable And unassiimilable

substances obstructs the various channels. Thus it is necessary to remove it by
sodhana procedures.
 Teekshna sodhana is indicated to remove the swallowed mud from body, without
losing bala of the patient.
 When the alimentary tract becomes purified, medicated ghee recipes which bestow
strength should be administered.
(Cha.Chi.16/117-118)
Important ghrita yogas:
 Vyoshadi ghrita: Specifically indicated for mritbhakshana janya pandu. It

mitigates all the disorders produced by mud quickly.
(A.H.Chi- 16/36-38)
 Ghritha prepared by kesara, yashtayahwa, pippali, ksheera and sadvala.
Recipe for causing aversion for mud:
 If the patient is unable to give up his clay-swallowing habits, he should be given

clay impregnated with vidanga, ela, athivisha, nimbapatra, pata, varthaka,
katurohini, kutaja or murva for creating aversion to mud.
 These drugs also counteract the adverse effect of clay-swallowing.
14
6. ***Describe chikitsasootra and management of kamala (10marks)
(KUHS April-2017)
7. Describe kamala chikitsasootra (5marks)

(AMRITA Aug-2018 Supplementary, AMRITA Feb-2017), AMRITA Feb-2017
Supplementary, AMRITA Aug-2017 Supplementary, AMRITA July-2015, AMRITA
Feb-2014)
8. Sakhasritakamala and its management (5marks)
(KUHS March-2019, AMRITA July -2015)
9. Koshtasrita kamala chikitsa (5marks)
(AMRITA March-2016)
ANSWER:
 Kamala- Nirukti:
 In sabda sthoma mahanidhi, the word kamala is defined as
‘Kamam kanthim lunathi iti kamala’
 Here kamam means desire and kanthi is the lusture. Both are diminished in case of
kamala.
 So Kamala is a disease in which an individual looses interest in all aspects and gets
yellowish discolouration
 Kamala is a pitha rakta pradhana vyadhi
 Nidana:
(Cha.Chi.16/34)
(A.H.Ni-13/15)
(A.H.Ni-13/17)
15
 If a patient suffering from panduroga, excessively follows pitha vitiating diet and
regimen, the pitha so aggravated burns the rakta and the mamsa and causes
kamala.
 Vagbhata states that kamala may happen even without panduroga in a person who
have aggravation of pitha.
 Susruthacharya elaborate the nidana as follows
The person immediately at the end of the disease (panduroga) indulges in
 Amlarasa ahara
 Madya
 Apathya ahara and vihara
pitha aggravates greatly and results in kamala
 Samanya lakshana
(Cha.chi.16/35)
 Yellowishness of eyes, skin, face and nails

 Colour of Stool and urine become raktapeetavarna
 ‘Bhekavarna’-Yellowish paleness of the body like that of frog
 Indriyadourbalya
 Daha- burning sensation
 Indigestion
 Debility
 Anorexia
 Emaciation
 Classification
According to Charakacharya, kamala is basically classified into two
 Koshtasritha kamala
 Sakhasrithakamala /Rudhapatha kamala
16
 Koshatsritha kamala:
 In koshtasritha kamala,’ bahupithatha’ is the main feature and the site of

sthanasamsraya is mahasrotha or koshta itself, hence the name.
 Koshtasritha kamala exhibits signs and symptoms as described under samanya
lakshana
 Sakhasrithkamala:
Sakhasritha kamala is also known by the name ‘Rudhapatha kamala’, as the

normal rout of pitha is obstructed in this type of kamala.
 Samparapti:
Excessive intake of ruksha, sheetha, guru and madhura ahara along with
nonperforming of vyayama, suppression of vegas
Vatha aggravates along with kapha
obstructs the passage of pitha and expels pitha outside of its seat
Malaroopa pitha instead of going into koshta, reaches sakha and produce signs
and symptoms like yellowishness of eyes,skin etc.
 Lakshana:
 Haridra varna of Netra, mutra, mukha and tvak

 ‘Svetavarchas’ /Tilapishtanibha varchas – Whitish feces
 Atopa, vishtambha
 Heavyness in the region of heart
 Debility
 Alpa agni
 Parswa soola
 Hikka
 Swasa
 Anorexia
 Fever
17
Kumbha kamala:
(Cha.Chi.16/37-39)
This stage of kamala develops, when kamala continues and not treated properly,
kamala becomes deep seated (khareebhuta) and thus becomes difficult to cure.
This condition is called kumbha kamala.
 Black and yellow coloured urine and feces

 Profound swelling in the body
 Colour of eyes face becomes red
 vomitus, stool and urine become raktavarna
 Afflicted with burning sensation, anorexia, morbid thirst, constipation,
drowsiness and fainting
 Patient loose agni and consciousness
A person with this type of kumbha kamala succumbs to death quickly
 Susruthacharya consider kumbhakamala as a bheda of kamala characterised

with
 mahasopha (profound swelling) and
 parvabheda (Pain in joints)
 Lagharaka and Alasaka:
 Kamala when associated with fever, aches in body, giddiness, debility, stupor
and kshaya, it is known as lagharaka and Alasa (SU.U.44/12)
 Chikitsa
Koshtasritha kamala:
(Cha. Chi. 16/40)
18
 Patient suffering from kamala should be given virechana therapy with mild and
bitter drugs.
 After cleansing of koshta, patient should be given pathyahara
(A.H.Chi.16/40)
 Treatment which mitigate pitha and which are not opposed to panduroga should
be administered.
Sakhasritha kamala chikitsa:
(Cha.Chi. 16/124)
 A patient of kamala if passes stools of the colour of sesame paste, (Tilapishta

nibha) it denotes obstruction in the passage of pitha by kapha. Therefore, the pitha
of such patient should be won by administration of drugs which alleviates kapha.
(Cha.Chi.16/130-132)
 Katu, theekshna , ushna, lavana and extremely amla drugs should be continued till
the stool of the patient acquires the colour of pitha (yellow) and vatha gets
alleviated
 When the pitha returns to its own habitat and the stool gets coloured with pitha
and the patient is relieved of complications, then the line of treatment described
for koshtasritha kamala should be resumed.
Yogas:
Ghritayogas for virechana poorva snehana:

 Panchagavya ghrita
 Maha tiktaka ghrita
19
 Kalyanaka ghrita
 Pathyahara for koshtasritha kamala:
After cleansing koshta, kamala patient should be given pathyahara which includes the
following,
 Saali
 Yava
 Godhuma
 Yoosha of mudga, adhaki and masoora
 Jangalamamsarasa
Pathya ahara for sakhasritha kamala:
 Food with soup of the meat of barhi, tithiri, and daksha

 Sizzled with rooksha, amla and katurasa
 Vegetable soup of sushkamoolaka and kulatha
 Juice of mathulunga mixed with honey, pippali and maricha and sunti inorder to bring
the diverged pitha to its own course.
10. ***Line of treatment of Haleemaka (5marks)

(AMRITA Feb-2014)
11. Haleemaka chikitsa sootra (2marks)
(AMRITA August-2017, AMRITA Feb-2016, AMRITA July-2016 Supplementary,
AMRITA July-2015)
ANSWER:
 Haleemaka is the stage of the disease develops as serious complication of

pandu or kamala
 It is predominantly caused by the aggravation of vatha and pitha in samprapti
 Synonyms:
Lodara (Vagbhata)
Laghavaka, Alasaka (Susrutha)
 Clinical features:
20
(Cha.Chi.16/132)-134)
(A.H.Ni13/18-19)
 Colour of the patient already suffering from pandu becomes green, black or
yellow
 Diminition of bala and utsaha
 Drowsiness
 Mandagni
 Mild fever
 Lack of libido
 Malaise
 Dyspnoea
 Morbid thirst
 Anorexia
 Giddiness
 Treatment:
(Cha.Chi.16/134-138)
 Patient suffering from haleemaka should take the recipe prepared from buffalo
milk by adding juice of guduchi and milk
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 After oeation, patient should take trivrit mixed with the juice of amalaki which
causes purgation
 After purgation, he should take food and drinks which are dominated by sweet
taste and alleviators of pitha and vatha.
 He should habitually resorts to different types of yapana vasthi, ksheeravasthi and
anuvasana vasthi
Beneficial yogas:
 Drakshavaleha
 Ghee processed with madhura rasa drugs
 For agnivridhi –Mardweekarishta
 If kasa associated – abhayaleha
 Pippali, madhuka and bala along with milk depending upon dosha aggravated and
the strength of the patient
12. Kumbha kamala (5marks)
(KUHS Sept-2017 Supplementary)
ANSWER:
 The term kumbha kamala denotes the advanced stage of kamala.

 Oedema constitutes one of the most important signs of kumbhakamala.
This stage of kamala develops, when kamala continues and not treated properly,
kamala becomes deep seated (khareebhuta) and thus becomes difficult to cure. This
condition is called kumbha kamala.
(Cha.Chi.16/37-39)
 Clinical features:
 Black and yellow coloured urine and feces
22
 Profound swelling in the body

 Colour of eyes and face becomes red
 vomitus, stool and urine become raktavarna
 Afflicted with burning sensation, anorexia, morbid thirst, constipation,
drowsiness and fainting
 Patient loose agni and consciousness
A person with this type of kumbha kamala succumbs to death quickly
 Susruthacharya consider kumbhakamala as a bheda of kamala characterised

with
 mahasopha (profound swelling) and
 parvabheda (Pain in joints)
 Chikitsa:
(A.H.Ni-16/52-53)
 Silajathu or makshika dhathu or hiranyaja kitta should be mixed with cow’s urine
and consumed daily for one month
13. Define pathya and write pathyapathya of kamala (5marks)

(KUHS March- 2018)
ANSWER:
 Pathyahara for koshtasritha kamala:
After cleansing koshta by purgation therapy using mridu and tiktarasa drugs, kamala
patient should be given pathyahara which includes the following,
 Saali
 Yava
 Godhuma
 Yoosha of mudga, adhaki and masoora
 Jangalamamsarasa
 Pathya ahara for sakhasritha kamala:
Pathyahara advised for sakhasritha kamala are mainly rooksha in guna, amla and katu in
ras., This helps to clear the passage of pitha by alleviating kapha and inturn helps to bring
the diverged pitha to its own course.
23
 Food with soup of the meat of barhi, tithiri, and daksha, sizzled with rooksha,
amla and katurasa
 Vegetable soup of sushkamoolaka and kulatha
 Juice of mathulunga mixed with honey, pippali, maricha and sunti
 Apathyahara:
As pitha is already excessively aggravated, pitha vridhikara ahara and viharas are
contraindicated in koshtasritha kamala,
Which include
 Katu, Amla and Lavana pradhana ahara

 Tikshna and ushna guna pradhana ahara
 Exposure to excess heat and sun.
14. Describe chikitsasootra and management of vatarakta (10Marks)
(KUHS Sep-2019, AMRITA March-2019)
15. Type of vataraktha and its management (5Marks)
(AMRITA Aug-2018, AMRITA Aug-2018 Supplementary)
16. Line of treatment of vatarakta (3marks)
(KUHS March-2019, KUHS April-2017)
17. Chikitsasootra of vatarakta (2Marks)
(AMRITA Aug-2019 Supplementary, AMRITA Feb-2019 Supplementary, AMRITA
July-2016 Supplementary, AMRITA July-2015 , AMRITA Feb-2014 )
18. Importance of vasthi in vatarakta

(5Marks)
(AMRITA Feb-2017, AMRITA Feb-2014)
19. Rakta mokshana in vata raktha (5 marks)

(AMRITA Feb-2018)
ANSWER:
24
 Defenition:
(Cha.Chi-29/11)
Vitiated vatha and vitiated rakta cause the disease vatarakta
 Synonyms
 Khudam: “khuda desa praptya khudam; khuda sabdena

sandhiruchyate”
 Vata valasam: “vatasya avaraanena balam asti asmin sonithe iti
vatavalasah”
 Adyarogam: “aadyanam prayo bhavatiti adyarogah”
 Nidanam
(A.H.Ni-16/1-4)
25
(Cha.Chi-29/5-10)
 Aharaja nidanas:
 Vidahyannam
 Virudhamannam
Charakacharya elaborate the nidanas, which include following
 Klinna sushka ambuja aanoopa mamsam

 Palalam,ikshu,aranala
Susruthacharya includes
 Guru aharam
Rakthadushti factors
 foods having teekshna, ushna, lavana, kshara, amla katu properties

 intake of madhya, kulatha,masha, nishpava, tilathaila etc
Viharaja nidanas
 Vidhiheena swapna jagara,maidhuna
 sukumara,
 achankramana seeli
26
 abhighatha, asudhi
 viseshat yana yanadhyai:
Manasika nidanas
krodha
 Samprapthi:
Rakta kopa Vata Kopa
Avarana of vata by rakta
Vata kopa
Further vitiation of rakta
Vata & Rakta
Sarva deha vyapti
Sthana samsraya in sandhis due to vakratwa of sandhi
 Samanya lakshanam:
(A.H.Ni-16/6, 7)
 Debility
 Looseness of the body
 Itching
 Throbbing
 Intermittent and splitting type of pain in the bony joints of the forelegs,
calves, thigh, waist, shoulders, hands, feet and other joints of the body
 Feeling of heaviness
 Loss of tactile sensation
 Symptoms appears and disappears often
(A.H.Ni- 16/ 7)
27
Site of onset of vatarakta is in the feet or sometimes in the hands also and
then spreads to the entire body like the poison of rat bite, ie slowly and
steadily over long periods of time.
 Classification:
I. It has been divided into two major groups based on severity:

 Uthana
 Gambheera
II. Based on doshik predominance, divided into 4

 Vata predominant
 Rakta predominant
 Pitha predominant
 Kapha predominant
 Lakshanas
( A.H.Ni-16/ 8-11)
 Uthana
 Kandu: Itching
 Ruk: Pain
 Toda: Intermittent and splitting type of pain
 sphurana : Throbbing
 Colour of twak changes to: tamra, syava or lohitha
 Ayama
 Bhrisha daha and oosha : Severe burning sensation and heat
 Gambheera:
 Adhika ruk : Severe pain

 Gradhita and paki swayadhu : Swelling, which is hard and gets paka
 Vata moving with great spread in the joints
 Bones and marrow produces cutting pain and curvatures
 Khanja or pangu ; Vata moves all over the body makes the
person lame by one legor by both the legs
28
 Lakshanas based on dosha predominanace
Vatadhika vatarakta Raktadhika Pithadhika Kaphadhika

vatarakta vatarakta vatarakta
 Pain:  Swelling  Burning  Inactivity
 Throbbing with severe sensation in  Heaviness
 Pricking pain the body  Loss of
 Swelling:  Pricking  Delusion tactile
 Dry  Coppery  Perspiration sensation
 Black or blue colour  Fainting  Unctuousness
colour  Tingling  Toxicity  Coldness
 Increasing sensation  Thirst  Mild itching
and  Inability to  Pain
decreasing  Not bear the
 Constriction of subsiding touch
dhamanis and with the  Pain
joints of fingers application of  Redness
 Catching pain in either Swelling
the body unctuous or  Ulceration
 Severe pain dry things  Great heat
 Hatredness  Accompanied
towards cold , with itching
which leads to and
discomfort exudation
 Stiffness
 Tremors
 Loss of tactile
sensation
 Chikitsa:
Samnya chikitsasootra:
(Cha.Chi.29/41, 42)
29
(A.H.Chi.29/1-3)
Treatment of vatarakta can broadly classify into
 Anthaparimarjana chikitsa
 Bahiparimarjana chikitsa
Vata rakta chikitsa
Bahiparimarjana chikitsa Anthaparimarjana chikitsa
Lepa Seka Sneha Upanaha
Sodhana Samana
1. Rakta mokshana 1. Samana drugs
2. Mridu virechana 2. Pathya and apthya
3. Vasthi
Anthaparimarjana chikitsa
Sodhana
 Rakta mokshana:
The blood of the patient should be let out in small quantities, at many times after
snehana therapy, protecting him from vatha appropriate to the dosha and strength of
the body.
Method of raktamosha according to dosha
 Ruk, toda, daha: Jalouka

 Tingling sensation, itching, pain and burning sensation: Sringa,alabu
30
 Disease is spreading from place to place: Prachana or Siravedha

 Vasthi:
(A.H.Chi - 29/13,14)
There is nothing equal to vasthi in the treatment of vatarakta, especially when it is

associated with pain of flanks, thighs, joits, bones and abdomen.
 Virechana:
 Virechana is indicated especially in pitahdhika vatarakta

 Erandataila mixed with milk is indicated to produce purgation in the patient who
has great increase of dosha
Samana:
Ghrita:
 Puranaghritam
 Sravanyadi ghritam
 Drakshamadhuka ghritam
 Ksheeraguduchiswarasa ghritam
 Parooshaka ghritam
 Jeevaneeyaganasidha ghritam
Tailam:
 Madhuyashtyadi tailam
 Ksheerabala tailam
Ksheera:
 Balasatavaryati srita kheera
Kashaya
 Vareetiktadi kashaya
 Abhayakashaya
 Mustadraksha haridra kashayam
 Guduchi kashaya
 Kokilaksha kashaya
 Thriphala ayolepa
 Leleetaki vasa
31
Bahiparimarjana chikitsa:
 Lepa:
 Prapoundareekadi lepa- For lepana fter raktamoksha

 Grihadhoomadi lepa- Vatakaphadhika vatasonitha
 Madhusigrubeeja lepa - Vatakaphadhika vatasonitha
 Lepana of paste of kshuma, eranda or satahwa- Vatadhika vatasonitha
 Seka:
 Mootraksharasurapakvasidha ghrita with madu and sukta

 Amladravya dhara indicated after lepana in vatakaphadhika vatasonitha
 Dhara with dasamoolasritaksheera
 Madhuroushadhasidha mahasneha dhara
 Gavya,avika and chagasheera mixed with taila
 Draksharasa
 Ikshurasa
 Madya
 Dadhi
 Mastu
 Amlakanchikam
 Tandulam
 Kshoudra
 sarkarambhas
 Upanaha:
Mainly indicated in vatadhika vatasonitha

 Upanaha with vatahara dravyasidhasnigdhakrisara and mudga payasa
 Upanaha with jeevaneeya oushadha sidha oudaka , prasaha and anoopa
vesavara
 Abhyanga:
 Pindataila
 Aranalataiala
 Madhuyashtyadi taila
 Visesha chikitsa
32
Uthana and gambheera vataraktha chikitsa
(Cha.Chi.29/43)
 Uthana kind of vatarakta should be treated with lepana, abhyanga, parisheka and
avagaha
 Gambheera vatrakta should be treated by virechana, asthapana and snehapana
Vatadhika vatarakta chikitsa
(Cha.Chi. 29/44)
 Ghrita, taila, vasa and majja should be used for pana, abhyanga and anuvasana vasthi
and lukewarm poultice should be applied
Rakta and pithadhika vatarakta chikitsa
(Cha.Chi. 29/45)
 In pitha and raktha dominant type – patient should be treated by virechana,

ghritapana, ksheerapana, parisheka and anuvasana vasthi and seethala, dahasamaka
pralepa should be done
Kaphadhika vatarakta chikitsa
(Cha.Chi. 29/46)
In kapha dominant variety, mruduvamana, avoid excessive oleation, sudation and

fasting. koshna lepa is useful
 Pathyapathya;
 Pathya
Ahara: Puranannam, yava, mudga, masura, karela, patola, amalaki, dry grapes, milk
of cow and goat.
 Apathya
Ahara: Katu, ushna, guru, lavana, ushna andvidahi ahara,
33
madya, dadhi, kshara, kulatha, amla, pinyaka, abhishyandi, moolakadi,
masha, kulatha, tila
Vihara: Divaswapna, Santhapam, vyayamam, maithunam
20. **Hridrogachikitsa (5marks)

(AMRITA Feb-2017, AMRITA Aug-2017 Supplementary, AMRITA July-2016,
AMRITA July-2015, AMRITA Feb-2014)
21. Write in detail about kaphaja hridroga lakshana and traeatment
(5marks)
(AMRITA Aug-2017)
22. Vathika hridroga lakshana and and chikitsa (5 marks)
(AMRITA Feb-2017)
ANSWER:
 The term hridaya is derived from three Sanskrit roots Hri, Da and In., which
respectively mean harana, dana and ayana.ie,Receiving, giving away and moving
for the continuous activity of the first two functions.
 Hridaya is the moola of pranavaha srothas
 Hridroga –Nidana
Charakacharya explains following nidanas for hridroga
(Cha.Chi.26/70)
 Excessive exercise
 Excessive use of article having tikshna attributes
 Administration of vamana, virechana and vasthi in excess
 Excessive worry, fear and stress
 Improper treatment of diseases
 Chardi, ama and suppression of natural urges
 Emaciation
 Trauma
 Susruthacharya explains nidana and samprapthi of hridroga
34
( Su.U- 43/3-4)
Nidana:
 Suppresion of urges
 Ingestion of food of ushna and roksha guna in excess
 Virudhasanam
 Adhyasanam
 Ajeerna bhojanam
 Asatmyabhojanam
 Food in more quantity
 Samprapthi:
Nidanas cause the aggravation of dosha
Vitiate rasa present in the heart
Give rise to pain in heart, which is known as hridroga.
 Common signs and symptoms
(Cha.Chi.26/71)
 Discolouration of skin
 Fainting
 Fever
 Cough
 Hiccup
 Dyspnoeea
 Distaste in mouth
 Morbid thirst
 Unconsciousness
 Vomiting
 Nauseaain
 Anorexia
35
Classification :
Charaka Susrutha
1. Vatika hridroga 1. Vtika hridroga
2. Paithika hridroga 2. Paithika hridroga
3. Kaphaja hridroga 3. Kaphaja hridroga
4. Sannipathaja hridroga 4. Sannipathaja hridroga
5. Krimija hridroga
 Vathika hridroga – Visesha lakshana:
(Su.U. 43/6)
(Cha.Chi.26/79)
Charaka Susrutha
 Feeling of emptiness in heart Feels pain like
region  Expanding
 Hrid drava  Pricking
 Sosha  Twisting
 Pricking pain  Tearing
 Stambha  Exploding
 Unconsciousness  Splitting
Pain is the important character of vathika hridroga
 Kaphaja hridroga –Visesha lakshana:
(Cha.Chi.26/80)
(Su.U.43/8)
36
Charaka Susrutha
 Stabdhatha  Feeling of heaviness of body
 Heavyness and heart
 Timidity of heart  Kaphasrava through mouth
 Excessive salivation and nose
 Fever  Anorexia
 Cough  Stiffness of the body
 Drowsiness  Weakness of digestive power
 Sweet taste in mouth
Pathika hridroga Sannipthaja hridroga Krimija hridroga

Darkness of vision All features of three Acute pain
Giddiness doshaja hridrogas Pricking pain
Burning sensation Itching
Unconsciousness
Santrasa-feeling of distress
Heat sensation
Fever
Yellowish discoulouration
 Hridroga chikitsa:
Treatment of vatika hridroga:
 Oil, souviraka, masthu and buttermilk taken in equal quantity, added with salt.
Intake of this with lukewarm water is beneficial
 Medicated oil prepared by Punarnava devadarvyadi kashaya as dravadravya
– for pana and abhyanga
 Ghrita prepared by using paste of hareetaki, nagara, pushkara moola, vayastha,
amalaki and hingu as kalka
 Intake of kalka of pushkaramoola, root of beejapooraka, mahoushadha, sati
and hareetaki mixed withkshara, ghrita and salt cures vatika hridroga and
vikartika
 Paste of pathya, sati, pushkara moola etc. with oil and ghee
 Ghrita prepared by using sunti, pippali, maricha etc. as kalka and curd
prepared from buffalo milk as dravadravya
 Dose: 1 pala/half pala/or one pichu by adding honey
Treatmnent of kaphaja hridroga:
 Swedana, vamana and langhana is advised in kaphaja hridroga

 Intake of yava as food along with soup of kulatha and dhanyaka
37
 Drinks having teekshna attributes is advised

 Urine boiled with katphala, devadaru etc.
 Linctus prepared by adding powder of trivrit, sunti, maricha and pippali in
kashaya of udumbara, aswatha, vata etc. is advised to take with warm water
Specific rasayanas advised for kaphaja hridroga:
 Silajathu rasayana
 Chyavana prasha
 Agasthya hareetaki
 Brahma rasayana
 Amalaka rasayana:
23. Mention in detail about nidana, lakshana, sadhyasadhyatha and

line of treatment of rakta pitha
(5mark)
(KUHS Sep-2018, AMRITA Feb-2017, AMRITA March-2015, AMRITA Feb-2014
24. Chikitsasootra of raktapitha

(2marks)
(AMRITA Aug-2018 Supplementary, AMRITA Feb-2016, AMRITA July-2016
Supplementary)
ANSWER:
 Susrutha bestows importance to rakta equl to the tridoshas.

 Body is supported and maintained by rakta
‘Sonithadapi va nithyam deha ethaisthu dharyathe’
 The most important function of rakta is jeevana kriya ie, it sustains life
‘Raktam jeevayathi prananuvarthanam karothiithi’
 Raktapitha – Nirukti:
Raktascha pithascha ithi raktapitham (Susrutha)

Raktena anugatham pitham raktapitham (Ma. Ni)
( Cha. Chi.4/9)
38
Because of conjunction with, similarity in causes of vitiation, odor, colour and

origin, pitha associates or interacts with rakta, hence the disease is called rakta
pitha.
(Cha,chi 4/5)
It is said that the physician should quickly manage raktapitha as it is a dreadful
disease, having more severity and and quick-acting like fire.
 Nidana
(Cha.Chi.4/6)
Aharaja: Intake of rooksha, tikshna, sour, pungent and salty and also
vidahi substances in excess
Viharaja: Exposure to sun
 Samprapthi:
Pitha which is drava in nature and rakta which possess closer affinity get
vitiated
Mix together and assume identical qualities
Spread throughout the body
Produce Raktapitha
 Lakshana
(Cha.Chi 4/15-17)
39
(A.H.Ni-3/ 7,8)
Movement of raktapitha is directed upwards and downwards
 Urdwagaraktapitha: Through seven orifices (2 nostrils, 2akshi,
2karna, asya)
 Adhoga raktapitha: 2orifices (gudamarga and mootramarga)
 Through romakoopa(tiryak gatha) : Asanghyeyam(Innumerable)
 Classification
According to gathi
 Urdhwaga
 Adhoga
 Ubhayagatha
 Tiryak gatha
Doshabhedena:
 Vathaja
 Pithaja
 Kaphaja
 Samsargaja
 Sannipathaja
 Sadhyasadhyatha
Based on gathi
 Urdhwaga: Sadhya
 Adhoga: Yapya
 Ubhayagatha: Asadhya
 Tiryak gatha: Leads to death
Doshabhedena
(Cha.Chi4/13-14)
40
Raktapitha associated with one dosha: Sadhya
Associated with two dosha: Yapya
Associated with thridosha: Asadhya
 That which bleeds heavily, found in a person who has poor digestive power,
produced by all the three doshas and that manifesting in both the direction should
be rejected
Chikitsa:
Chikitsasootra:
(A.H.Ni.3/14)
For Raktapitha, ideal treatment is purificatory therapy opposite to the direction of

bleeding.
(A.H.Chi 2/5-8)
Raktapitha produced by santtharpana, in a strong person, caused by many dosha

should be treated by
 Virechana, if it is of upward direction

 Vamana , if it is of downward direction
or by samana and brimhana after finding out whether the patient is fit for
langhana and brimhana therapies.
For urdhwaga: samana
 Samana by the administration of drugs having tikta and kashaya rasa and
upavasa
 Drinking shadangodaka devoid of sunti
For adhoga raktapitha : Brimhana
 Use of madhurarasa drugs which is brimhana
Indication for stambhana therapy:
Ksheenamamsabalam balam vridham soshanubandhinam
41
Avamyavirechascha stambhanai samupachareth (Chakradutta)
Raktastambhana therapy should be initiated at once in patients who are

ksheena, children, aged and suffering from rajayakshma since they are not fit
for vamana or virechana therapies.
 Gudamarga raktapitha:
 Sonithavasthi is indicated
 Milk boiled with mocharasa is beneficial
 Milk boiled with shoots and tender leaves of vata or that boiled with sunti,
udichya and utpala
 Mootarmarga raktapitha:
 Milk boiled with gokantaka and of abhiruo with the parni quickly relieves
the bleeding associated with pain, especially of urinary passage
Samanoushadha:
 Vasa prayoga:
 Vasa is the paramoushadha for raktapitha

 Vasaghrita : mixed with honey is indicated for raktapitha
(A.H.Chi2/42, 43)
 Fresh juice of vasa mixed with powder of phalini, mrit, rodhra, anjana, and
makshika alleviates bleeding disorders

 Kashaya:
 Patola, malati, nimbi, the two chandana and padmaka
 Lodhra, vrisha, tanduliya, krishnamrit, and madayanthika
 Satavari, gopakanya, the two kakoliand madhuyashtika
 Lehyayogas:
 Excreta of pigeon may be licked mixing it with hone
 Ksheeraprayoga:
 After use of decoctions, when the digestive power gets increased and
42
bleeding is not mitigated, got’s milk or cow’s milk boiled with five times
of water should be consumed
 Ghria
 Vasaghrita
 Thrayaman ghrita
 Khara prayoga
In case of bleeding from the throat, the blood being slimy, mixed with kapha or
solidified, then the kshara prepared from the stalks of utpala, amboja renu, syama
or madhukaeach one separately should be licked mixed with honey and ghee.
25. Gudagatha raktapitha treatment (2Marks)
(AMRITA July-2015)
Refer Q No.23
26. Mootramarga raktapitha chikitsa

(2Marks)
(AMRITA March-2015)
Refer Q No.23
27. Write the vasaprayoga in raktapitha (2Marks)
(AMRITA Aug-2014)
Refer Q No.23
28. Chikitsasidhantha of madatyaya (5marks)
(KUHS Sept-2017 Supplementary, AMRITA Feb-2017, AMRITA July-2015,

AMRITA Feb-2014, AMRITA Aug-2018 Supplementary, AMRITA Feb-2019)
ANSWER:
Madya and visha both possess ojovipareetha attributeshence if it is cosumed

excessively, produce madatyaya roga
(Ma.Ni- 18/1)
The bad effects of madya has been described by Charaka in the chapter on madatyaya,
while Madhava nidana and Susutha described the same under panatyaya
43
 Samprapthi:
If a person who is durbala and of thamasika prakriti consumes excessive alcohol
All tridoshas get vitiated and localizes in budhi
Produce obstructions in the activities of speech, body and mind leading to vaisamya
of samjavaha and pranavaha srothas
Four stages of madatyaya:

Susrutha charaka Features
First stage mada First stage mada StageI-Stage of stimulation
Second stage mada Second stage mada StageII-Stage of

excitement
Third stage mada Madanthara StageIII- stage of delirium
Fourth stage mada Thritiy madam StageIV-Stage of coma
Stage-wise symptomatology:
 First stage:
 Pleasant and decent
 Refreshing stage of alcoholism
 Second stage:
 Ojus is afflicted, memory disturbance
 Speech and movement disturbances
 Confusion
 Incoherence in standing
 One cannot discriminate between pain and pleasure
 Third stage:
 Loses control over himself
 Insult others
 Eat things that he should not
 Expose all the secrets kept in his mind
 Fourth stage:
 Ojas is damaged severely, becomes motionless like a cutwood
 Appears like dead
 He does not perceive or identify even his friends
Thus if one consumes alcohol against the prescribed limits and procedures, the
person become addicted to it and start suffering from the symptoms of madatyaya.
 Vataja type: hiccup, dyspnoea, tremors, pain in sides, stiffnes in

bodyheadache, walking innight and frequent delirium
44
 Pithaja type: Thirsty, burning sensation, syncope, fever, sweating, fainting,

diarrhoea and giddiness
 Kaphja:Vomiting, anorexia, nausea, drowsiness, stiffness, heaviness and
feeling cold
 Sannipthika: Mixed symptoms
Susrutha:
According to Susrutha, there are three types of panatyaya
 Paramada: Identical to kaphaja type. One may feel heat and heaviness in
whole body, loss of taste, loss of appetite, head ache and joint pains.
 Panajirna: It is the stage of indigestion of consumed alcohol. Abdominal
distension , vomiting, sour eructation and burning sensation
 Panavibhrma: Ti is due to vatakopa, because of excessive drinking of
alcohol. Body pains, fainting, vomiting and burning sensation all over the
body etc. are the symptoms
If a person restarts drinking excessively he may develop any of the following

diseases:
 Dhvamsaka:
Person suffers from excessive expectoration, but dryness in throat, excessive

sleep and stupor
 Vikshaya:
Severe body ache, head ache and compression in chest, thirst, vomiting
and fever
Chikitsa:
(Cha.Chi-24/107,108)
All the types of madatyaya are caused by vitiation of all the three doshas
In the beginning, treatment should be made for the most predominant dosha. If all the
doshas are equally aggravated, then the treatment should generally be started from the
location of kapha, followed by that of pitha and lastly that of vatha.
45
 Justification of giving madya in madatyaya:
(Cha.Chi.24/112-114)
 Intake of excessive alcohol which is tikshna, ushna, amla and vidahi makes
annarasa kledayukta and vidagdha which ultimately turns kshara and causes
anthardaha, jwara, thrishna unconsciousness, giddiness and intoxication
instantaneously
 To correct these ailments alcohol should be administered because when an
alkaline substance (kshara) gets mixed up with a amla substance , the outcome
becomes madhura in taste and alcohol is the best among the aricles having
amlalarasa
 Dugdhapana in madatyaya:
(Cha.Chi.24/195-197)
 After giving up alcohol, because of langhana, pachana, doshasodhana,and

samana, kapha gets diminished and the body of the patient becomes weak as
well as light.
 For this type of a patient whose body is afflicted by alcohol and in whose
body, vatha and pitha are aggravated, milk is exceedingly wholesome like the
rain for a tree afflicted with hot summer
46
Important yogas:
 Ashtanga lavana:
 Phalatrikadi choorna
 Eladi vati
 Mahakalyanaka vati
 Srikhantasava
 Brahmi, vacha, jatamamsietc. can also be used according to the needs of the
patient
29. Describe tarpanachikitsa and importance of dugdhapana in

madatyaya (5Marks)
(KUHS March-2018)
ANSWER:
Refer Q No.28
30. Mention stages of madatyaya (2Marks)

(AMRITA July-2016 Supplementary)
ANSWER:
Refer Q No.28
31. Madyaprayoga in madatyaya (2Marks)

(AMRITA Aug-2014, AMRITA Feb-2014)
ANSWER:
Refer Q No.28
32. Describe madamoorchasanyasa lakshana and treatment (5Marks)

(AMRITA Aug-2017)
33. Define Sanyasa and write its management (5marks)
(AMRITA Feb-2017, AMRITA Feb-2019 Supplementary)
34. Write definition of mada along with its management (5marks)
(AMRITA FEB-2019)
47
35. Expalin moorchachikitsasootara (2Marks)

(AMRITA March-2015)
ANSWER:
 Samanya nidana of mada, moorcha and sanyasa:
(A.H.Ni6/24-25)
 Mada, moorcha, sanyasa each succeeding one stronger than its preceding
 Affect persons who are constantly engaged in rajas, moha and unsuitable foods.
 These arise from the obstruction of channels of rasa, asrik and chethana
 Mada
Nidana:
(A,H.Ni26)
Mada arises from the doshas separately and from all of them together, by rakta
,madya and visha
Types and symptoms:
 Vathika:
 Speech is obstructed, become fast, non syllable and unsteady
 Activities hinders in the middle
 Body becomes dry and blackish-red
 Paithika:
 Person is in anger
 Body-Reddish yellow
 Fond of quarrel
 Kaphaja
 Person speaks very less with mingling of words
 Body-yellowish white
 Always found worrying and lazy
 Sannipathaja
 All the symptoms will be found simultaneously
 Raktaja:
48
 Body is stiff
 Gaze-fixed
 Other paithika symptoms
 Madyaja:
 All the activities of speech and body are irregular
 Vishaja:
 Tremors
 Too much of sleep
 Powerful than others
(A.H.Ni-6/26-29)
 Moorcha –Types and Lakshana:
 Vathikamoorcha:
(A.H.Ni-6/30,31)
 Person sees the sky to be lighter, black or blue in colour

 Enters into darkness and wakes up soon
 Pain in the region of heart
 Tremor
 Dizziness
 Emaciation
 Blackish-red complexion
 Paithika moorcha
49
(A.H.Ni-6/32,33)
 Person sees the sky to be red and yellow
 Become unconscious and wakes up quick
 Sweating
 Burning sensation
 Thirst
 Increased heat
 Diarrhoea- feces is blue or yellow
 Eye- red or yellow
 Unsteady gaze
Kaphaja moorcha:
(A.H.Ni-6/33, 34)
 Person sees the sky to be full o clouds

 Become unconscious and wakes up after long time
 Associated with oppression in the heart
 Salivation
 Feeling of heaviness
 Restricted movements of the boy as though covered with moist hide
Sannipathaja moorcha
(A.H.Ni-6/35)
 All the symptoms will be present
 Patient appears like a patient of apasmara-falling to the ground with loss of
consciousness but without bhibhatsa cheshta
 Sanyasa nidana and lakshana:
 In case of mada and moorcha, the doshas subside by themselves without any
treatment soon after the bout pass off, but in sanyasa it does not happen so ,
without treatment.
 The malas which are very strong undergoing aggravation, together and getting
localized in the seats of life, bring about impairment of the activities of speech,
50
body and mind, because of this, the person appears like a log of wood and a dead
man. If not treated quickly, he dies soon
(A.H.Ni-6/36-39)
 Chikitsa
Treatment of mada and moorcha:
(A.H.Chi-7/100)
For mada and moorcha, the treatment should be done for the mitigation of vata
and pitha, In all of them there will be predominance of pitha, which should be
taken care of .
 cold poultice
 Wearing precious stones
 Pouring warm liquids on the body
 Fanning
 Breeze
 Sugar
 Juice of draksha, ikshu, khrjura and kasmarya, milk and meat soup
processed with drugs of sweet taste
 Soup mixed with juice of dadima, swastika, raktasali, yava
 Medicated ghrita-
 jeevaneeya ganasidha ghrita
 Kalyanaka ghrita
 Mahatiktaka ghrita
 Satpala ghrita
During the vega:

 Obstruction of mouth and nose
 Pana and nasya of breast mik
 Lehana –The paste of mrinala, bias or Krishna with honey
 Abhya, duralabha or musta with honey
 Consume the paste of maricha, marrow of kola, useera and ahikesra with
cold wter
51
 Ghee prepared with juice of dhatreephala or decoction of pathya

 Panchakarma
 Raktamoksha
 Satvavachaya chikitsa
 If severe, treatment of sanyasa may be adopted.
Sanyasa chikitsa:
(A.H.Chi-7/110-112)
In coma:
 Suteekshna nasya and anjana
 dhoomapanam
 Pradhamana nasya
 Pricking the nail beds with needles
 Plucking the hair
 Branding with fire
 Bites by insects such as scorpions
 Smearing the inside of the mouth with pungent and sour substances
 Smearing the body with kapikachu
After waking up:
 Fresh juice of Lasuna to drink
 Eat the tendrils of beejapoorakamixed with vyosha and lavana
 Easily digestable food in very liitle quantity
 Theekshna and ushna madya for srothovisodhana
After that:
 Vismapana: He should be treated with activities which cause

distraction of mind
 Samsmarana
 Hearing and seeing the things liked by him
 Heraing pleasent sound of singing and musical instruments
 Vyayama
Therapies such as
 Sramsana
 Lekhana
52
 Dhooma
 Raktamoksha
(A.H.Chi-7/115)
 He should be protected from secondary diseases and causes which produce

destraction of the mind
RASAVAHA AND RAKTAVAHA SROTO DUSHTI JANYA VIKARAS -

MODERN PORTION
1. ***Explain hypertension ( 5Marks)
(KUHS Sep-2017 Supplementary, AMRITA July-2016 Supplementary)
2. Define hypertension and clinical grading of BP (2marks)

(AMRITA Feb-2019, Supplementary)
3. Mention the cause of hypertension (2Marks)
(AMRITA July-2016, AMRITA Feb-2016 Supplementary)
4. Mention types of hypertension and its management (2Marks)
(AMRITA Aug-2018 Supplementary)
5. Ayurvedic treatment of hypertensioin (2marks)
(AMRITA July-2016, AMRITA Feb-2014)
ANSWER:
Hypertension is a long-term medical condition in which blood pressure in the

arteries is persistently elevated. It is the most prevalent treatable risk factor for stroke,
coronary artery disease and renal disease.
 Definition:
Hypertension is defined as a systolic blood pressure (SBP) of 140 mm Hg or

more, or a diastolic blood pressure (DBP) of 90 mm Hg or more
53
 Classification:
When Systolic BP & Diastolic BP fall in different categories, higher category should be
selected to classify BP status
 Determinants of BP
Systolic pressure is mainly determined by cardiac output and diastolic pressure is

determined by peripheral resistence.
 Pathophysiology
Normal blood pressure is maintained by four mechanisms.
 Renal mechanism
 Activities of autonomic nervous system
 Vascular mechanisms
 Activities of endocrine system
Alterations in any of these mechanisms may cause hypertension
 Factors influencing BP
 Age : BP increases with age

 Sex : Males have slightly higher values than females of same age
 Hereditary factors- strongest predictor
 Genetic factors
 Birth weight : low birth weight associated with higher prevalence of hypertension
and Diabetes
 Obesity : two fold risk, central obesity is the strongest predictor
 Dietary sodium & potassium intake:
 Reduction of dietary sodium by 100mmol/day leads to lowering of BP on long
term
 Higher potassium intake lowers BP
 Etiological classification of hypertension
 Primary Hypertension
54
 Secondary Hypertension
Primary hypertension
 In primary hypertension, BP gets elevated without an evident organic cause

 Characterised by increased peripheral vascular resistance
 Accounts for 90-95 % of cases
 Two types - Benign hypertension and malignant hypertension
Clinical features
 Usually asymptomatic
 Symptoms include
 Fatigue
 Dizziness
 Palpitation
 Headache (Throbbing head ache, felt in suboccipital region on waking up
after sleep )
 Anxiety
Secondary hypertension
 Produced by an identifiable cause & correction of the cause leads to regression

 Less common cause of hypertension (<5%)
Causes of secondary hypertension
I. Renal
 Renal parenchymal disease like diabetic nephropathy, chronic nephritis, acute

glomerulo nephritis, polycystic disease of kidney and Hydronephrosis
 Renovascular conditions like Renal artery stenosis and intra renal vasculitis
 Renin producing tumors
 Primary Sodium retention
II. Endocrine
 Acromegaly
 Hypothyroidism & hyperthyroidism

 Hyperparathyroidism
 Adrenal
 Cortical -Cushing’s syndrome, Primary hyperaldosteronism etc.
 Medullary – Pheochromocytoma
 Exogenous hormones (Estrogen, mineralocorticoid, glucocorticoid)
55
III. Vascular causes: Coarctation of aorta

IV. Pregnancy induced hypertension
V. Neurological disorders
 Increased intracranial pressure
 GBS
VI. Miscellaneous causes: OSA, stress, hypoglycemia, burns, alcohol withdrawal, excess
salt, obesity, drugs etc
Uncontrolled Hypertension- Complications
 Stroke
 TIA
 Left ventricular hyoertrophy
 CHD
 CHF
 Retinopathy
 Peripheral arterial disease
 Chronic kidney disease
Management
 Lifestyle modification
 Pharmacological treatment
Lifestyle modifications
 Stop smoking
 Losing weight
 Limiting alcohol consumption
 Reduced NaCl intake
 Increased Potassium intake
 Healthy dietary pattern
 Taking more exercise
 Learning to cope with stress
Pharmacologic Therapy
 Diuretics
 ACEI inhibitors
 Beta blockers
 Calcium channel blockers:
 Direct acting Vasodilators
56
 Hypertension –Ayurvedic approach
 Dosha involved: Vatapradhana tridosha
 Circulation is mainly controlled by vyana vayu and increase in cardiac output can be
considered as vyana vayu kopa
 Change in peripheral resistance can be either due to kevala vata kopa (vaso
consriction & dilation occuring due to hormonal, neural mechanisms) or due to
avarana (occlusion by atherosclerosis)
 Since it is a lifestyle disorder, it can be considered as santharpanotha vyadhi
 Chikitsa
 Nidana parivarjana – By Lifestyle modification
 Sodhana : Mridu sodhana can be done for vatanulomana
 Samana: Mainly include srotosodhana and vatanulomana

Bahya samana prayogas include Takra dhara , Siro dhara and
Thalam
 Some common yogas
Punarnavadi kashaya
Gadharva hastadi kashaya
Gandharva hastadi eranda tailam.
Dhanwantharam gudika
Siva gudika
Sarpagandha ghanavati
Abhayarishtam
6. Leukemia (5marks)
(KUHS Sep-2017 Supplementary)

7. Write briefly about leukemia (2mrks)
(AMRITA Feb-2018)
ANSWER:
• Epidemiology
 Leukemia is the 11th most common cancer worldwide
57
 Leukemia causes more deaths than any other cancer among children and young
adults under the age of 20
• Classification:
1. Acute lymphoblastic leukemia (ALL)
2. Acute myeloid leukemia (AML)
3. Chronic lymphocytic leukemia (CLL)
4. Chronic myeloid leukemia (CML)
1. Acute lymphoblastic leukemia(ALL)
 ALL is a heterogenous group of lymphoid disorders that result from a monoclonal

proliferation and expansion of immature lymphoid cells in marrow, blood and
other organs
 Most common childhood acute leukemia
 Clinical features:
 Fatigue
 Lack of energy
 Easy bruising
 Obvious bleeding
 Infections
 Fever
 night sweat
 weight loss
Treatment:
 Chemotherapy
2. Acute myeloid leukemia(AML)
 AML are clonal malignant disorders resulting from genetic alterations in

normal hematopoietic stem cells
 These alterations result in limiting their ability to differentiate into red cells,
granulocytes, platelets and proliferation of abnormal leukemic cells or blasts
 Clinical features
 Fever
 Bruising
 Bleeding
 Infections
 Hb< 12g/dl
58
 Organomegaly
 Sternal tenderness
 Retinal haemorrhage
 Infiltration of gingivae, skin, soft tissues etc
Treatment
Treatment aims at elimination of malignant clone ie marrow blast <5% and recovery
of hematopoiesis
3. Chronic lymphocytic leukemia(CLL)

 CLL is an indolent lymphoid disorder involving a clonal expansion of CD5
positive B cells
 Clinical Features:
 Fatigue
 Fever in the absence of active Infections
 Weight loss
 Night sweats
Treatment:
 Often not requiring treatment at diagnosis

 Treatment is initiated after occurrence of significant fatigue or anemia, weight
loss, fever without infection or night sweat.
4. Chronic myeloid leukemia(CML)
 CML is a pluripotent hematopoietic stem cell disorder leading to

myeloproliferation and its attendant consequences
 Hallmark of CML is ph chromosome ie reciprocal translocation between long
arms of chromosome 9&22
Treatment
 Chemotherapy and stem cell transplantation
• Ayurvedic view :
 Beejadushti
 Nidanas of pandu, rakta pitta, arbuda must be considered
 Dhatwagni mandya happens at the level of raktadhatu formation
Line of treatment:
59
Treatment aims at
 Dhatwagni correction
 Rakta prasadakam
 vata anulomanam
 Rasayana
 Jeevaneeya
 Balakara
8. Ayurvedic management of cirrhosis of liver (3 marks)
(KUHS Sept-2019, KUHS Sep-2017 Supplementary, AMRITA Feb-2017)
ANSWER:
Cirrhosis is a chronic parenchymal liver disease characterised by diffuse fibrosis and

conversion of normal architecture into structurally abnormal nodules.
 Classification:
 Alcoholic cirrhosis
 Biliary cirrhosis
 Cardiac cirrhosis
 Cryptogenic cirrhosis
 Cirrhosis due to chronic viral hepatitis
 Causes:
 Infections
 Drugs &Toxins
 Metabolic causes
 Vascular causes
 Biliary Obstruction
 Cryptogenic
 Primary immunological disorders
 Pathology of cirrhosis
Etiological Factors
Destruction of hepatocytes
Obstruction of blood flow
Activation of hepatic stellate cells
Fibrosis/Scarring
60
Cirrhosis
 Ayurvedic view:
Dosha- Tridosha (pitta pradhana)

Doosya- Rasa, Rakta, Medas
Rogamarga- Abhyantharam
 Beejadushti, bhootabhishanga and madya can be considered as causative factors

which leads to pithapradhana tridosha dushti which inturn leads to dhatukshaya,
vatavridhi and finally dhathunasa
Chikitsa should include
 Nidana parivarjana
 Correction of agnimandya
 Pithasamana
 Raktaprasadana
 Rasayanam
 Commonly used medicines
Single drugs:
 Bhoomyamalaki
 Kalamegha
 Guduchi
 Katurohini
 Bhringaraja
 Punarnava
Commonly used yogas
 Patolakaturohinyadi kashayam
 Vasaguluchyadi kashayam
 Drakshadi kashayam
 Patolamooladi kashayam
 Arogyavardhini vati
 Chandraprabha vati
61
 Avipathichoornam
9. Write investigations on hepatitis (2marks)
(AMRITA Aug-2017)
ANSWER:
Hepatitis is the inflammation of the liver.

 The condition can be self limiting or can progress to fibrosis, cirrhosis or liver cancer.
 Causes:
 Viral
 Alcohol
 Toxic and Drug induced
 Auto immune
 Non alcoholic fatty liver disease
 Types:
 Acute hepatitis
 Chronic hepatitis
Investigations
 Blood
 Biochemical tests
 Prothrombin time
 S. Bilirubin
 S. Transaminase
 S. ALP
 S.AST
 S.ALT
 Albumin
 Total protein
 GGT(Gamma –glutamyl transpeptidase)
 LD(Lactate dehydrogenasE), AFP(Alpha feto protein)
 Serological markers
 Acute hepatitis panel- may be used to help detect infection with hepatitis
virus
 Auto immune antibodies(eg: ANA,ASMA)-associated with autoimmune
hepatitis
 Liver ultrasound scan –Transient elastogrphy can show the amount of liver
damage
 Liver biopsy
62

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Drone Foundation Course 2020-21

RASAVAHA AND RAKTAVAHA SROTO DUSHTI JANYA

1. ***Explain nidana, samprapthi, lakshana and chikitsa of

(KUHS March-2018, AMRITA July-2016 Supplementary, AMRITA Feb-2014)

2. Chikitsasootra of amavatha (5marks)

(KUHS Sep-2018, KUHS Apri-2017, AMRITA Feb-2017, AMRITA Feb-2019

‘Amam cha vatham cha amavatham I’ (Vijayarakshitha)

‘Amena sahitho vatha: amavatha: I’ (Vijayarakshitha)

 Amavatha, eventhough mentioned in brihatthrayi as one disease among vatavyadhi,

 Indulgence in exercise after after taking snigdhahara

Ama circulates the body due to propulsive effect of vridhavatha,

 Pravrudha amavatha lakhana:

 When amavatha gets exacerbated- Pravrudha amavatah, it becomes most distressing

 Wherever amadosha reaches, produce painful swelling , ie on

– Hardness in the abdomen

Langhanam svedanam tiktham deepanani

Amavate panchakolasidham panannamishyate

 Important yogas in amvatha :

 Importance of erandataila in amavatah

3. Pandusamprapti and chikitsa (10marks)

Charaka classified rogas according to ruja, varna, samuthana, sthana, samsthana In

 As per Vijaya rakshitha

‘Pandutwenopalakshitho roga panduroga’

 Panduvarna is defined in Amarakosha as follows

‘Sita peeta samayukta panduvarna prakirtitaha’

Susruthacharya explains following names as the synonym of panduroga.

 Samanya nidana of panduroga:

 too much copulation,

Pithapradhana tridosha aggravation

Hridisthitha pitha is forced to dasadhamanis by the powerful anila

Pitha spreads throughout the body

Vitiate tvak, rakta and mamsa

Yuktivyapasraya chikitsa of pandu includes the following

Nidana parivarjana: The above mentioned nidanas of panduroga should be avoided.

 Snehana is the poorvakarma of sodhana chikitsa.

In all types of pandu, hareetaki is advised for virechana

and also the following are mentioned

Treatment according to predominant dosha

Vathika : Sneha bhooyishta

Paithika: Thikta and seetha

Kaphaja: Katu, tikshna and ushna

Panam: Sthradi gana sidha toyam

Mrit bhakshana janya pandu:

The mud which may be composed of various undigesatable and un assimilable

Thus it is necessary to remove by strong purgations. The following ghritas are

 Godhuma,Saali, Yava, Shashtika,  Guru, rooksha

5. Nidana poorvaka chikitsa of mritbhakshana janya pandu

(KUHS March-2019, AMRITA July-2016 Supplementary)

Because of its rookshatwa, mud causes rookshatha in ahararasa

Undigested mud, fills up and blocks srothases

Afflicts the sharpness of senses, lusture, energy and ojas

Immediately causes panduroga, which results in in the loss of strength,

 Signs and symptoms:

 Oedema in the cheeks, eye-sockets and eye-bones

Habitual indulgence in eating mud aggravates one of the three doshas.

 kashaya rasa type: Aggravates vayu

Depending on the doshas aggravated, different types of treatments should be given to

The clay which may be composed of various undigestable And unassiimilable