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    Charaka Urusthambha Chikitsa – 27th Chapter

    27th Chapter of Charaka Samhita deals with Urusthambha Chikitsa ̵ a rather rare medical condition corelated with thigh stifnes or spasticity of thigh.
    Now, we shal expound the chapter on the “treatment of Urustambha (Spasticity of the thigh)” Thus, said Lord Atreya [1-2]
    Table of Contents
    Prologue
    Agnivesha’s question
    Urustambha nidana, samprapti
    Complications
    Nirukti
    Purvaropa
    Lakshana
    Prognosis
    Contraindication of Panchakarma
    Line of treatment
    Fods, drinks
    Samangadi Yoga
    Srivestakadi Yoga
    Kalka, Churna Yoga
    Nourishing, oleation, fomentation therapies
    Astakatvara Taila
    Line of treatment
    Sumary
    Prologue
    Once, Agnivesha asked Lord Punarvasu, who was endowed with both of brahminic knowledge as wel as elegance, who was love the Mt. Sumeru flanked by the sun and the mon, and who also the above of wisdom, memory, mundane knowledge, spiritual knowledge, frame and forgivenes, the consequent questions. [3-4]
    Agnivesha’s question
    Agnivesha’s questi on: Which is the disease contra indicated for Panchakarma?
    Oh! Lord, al the 5 purification therapies (Pancha Karma) are described in many instances of disease treatment. Is there any curable disease caused by doshas for the aleviation of which these 5 elimination therapies (Pancha- Karma) are contra- indicated. [5-6]
    Dialogue:
    To the above interogate of Agnivesha replied, “there is such a disease for which PanchaKarma is contra-indicated and it is caled Urustambha (spasticity of the thighs)̵.
    Agnivesha again enquired about the etiology, symptomatology and treatment of this aliment. The preceptor again replied as folows. [7]
    Urustambha nidana, samprapti
    Urustambha (spasticity of the thighs) is caused by the consequent factors:
    Intake of Snigdha (unctuous), Ushna (hot),Laghu(light) and Shita (co ld) ingredients when the ingested fod is partialy digested and partialy undigested
    Intake of Drava(liquid) and Sushka(dry) ingredients
    Intake of Dadhi(yogurt), Kshira (milk) and meat of animals who are Gramya (domesticated animals), Anupa (animals inhabiting marshy land) and Audaka (aquatic animals)
    Intake of Pistana(pastries) and Madya(alcohol)
    Divaswapna ̵ abundant slep during the day time and
    Prajagrah ̵ dreaming awake at night for a long time
    Langhana (Fasting) or Adhyashana (taking fod while the previous meal is not digested)
    Aayasa (Overexertion) and Bhaya ̵ exposure to unerved situations; and
    Vega vidharana ̵ Supresion of the manifested natural urges.
    Pathology of Urusthamba:
    Because of unctuousnes, the Ama (a product of altered digestion and metabolism) located in the gastro-intestinal tract, along with fat causes obstruction to the movement of Vata, etc. Because of heavines, it imediately reache s the thighs through the downward moving vesels. Etc and being provoked by the powerful stout, these Doshas (morbid material) fil up the lower limbs including the thighs and calf regions to cause involuntary spasms and imobility in these parts. [8-1]
    Simile of Pond:
    As in a pond which is large, dep and ful, the after remains stagnant, stable and unagitated, similarly the Kapha shifted to the things remains moribund, stable and unagitated [in Urustambha] [12]
    Complications
    Further complications:
    This ailment (urustambha or spasticity of the thighs) thereafter, gets asociated with
    Gaura ̵ heavines
    Aayasa ̵ fatigue
    Sankocha ̵ contracture
    Daha ̵ burning sensation
    Ruk ̵ pain
    Supti ̵ numbnes
    Kampana ̵ tremor and
    Bheda ̵ breaking,
    Sphurana ̵ itching and
    Bhed a ̵ pricking types of pain leading to the death of the patient [13]
    Nirukti
    Definition of Urustambha:
    Kapha asociated with Medas afects Vata and Pita to cause spasticity (Stambha) of the thighs (uru) characterized by their stifnes and coldnes because of which the ailment is caled Uru- Stambha (Spasticity of the things) [14]
    Purvaropa
    Urustamba Purvaropa: Premonitory Signs and Symptoms:
    The premonitory signs and symptoms of Urustambha (spasticity of the thighs):
    Dhyana ̵ Fixed Gaze
    Ati nidra ̵ abundant slep
    Staimitya ̵ abundant indolence
    Aruchi ̵ anorexia
    Jwara ̵ fever
    Loma harsha ̵ horipilation
    Chardi ̵ vomiting and
    Jangha uru sadana ̵ Asthenia of the calf plan as wel as thighs [15]
    Mistaken identity:
    Mistaking it as an ailment caused by agravated Vata Dosha, because of ignorance, if oleation therapy is administered, then these results in asthenia as wel as numbnes of the legs, and the lifting of the legs becomes chalenging. [16]
    Lakshana
    Signs and symptoms of Urustambha:
    Jangha uru glani ̵ abundant fatigue of the calf muscles and thighs
    Daha vedana ̵ Constant damage with slight burning sensation
    Feling of hurt while puting the fet on the ground
    Shetam sparsham na veti cha ̵ Insensitivity to frigid touch
    Lack of control over the functions like standing, presing the fet on the ground, walking and movement of the lower limbs and
    Feling as if limbs are propeled by someone else (not by himself) and as if these are broken [17-18]
    Prognosis
    If the patient is further aflicted with burning sensation, pain and tremors, then this disease Urustambha (spasticity of the thighs) leads to his death i.e he is incurable. If such signs and symptoms are absent, and if the ailment is of curent origin, then such a patient is treated, i.e he is curable. [19]
    Contraindication of Panchakarma
    Why Panchakarma is not indicated in Urustambha:
    The bounds for which Snehakarma, Vamana, Virechana and Basti are contra-indicated in the treatment of Urustambha is being explained.
    Snehana and Basti therapies agravate Kapha. Purgation therapy is also to inefective to waive Kapha localized in the thighs).
    Kapha located in its own area (i.e Amashaya or stomach), and pita can be easily removed by emesis. Both of these, viz, Kapha and Pita, located in the Amashaya or stomach can be eliminated by purgation. When located in Pakvashaya (Colon) al the 3 Doshas, viz, Vata Dosha, Pita and Kapha can be roted out by enema therapy. But when asociated with Ama (product of gros digestion) and paunchy, and especialy when these are firmly located in the thighs, it is imposible to eliminate them by the above mentioned therapies.
    Since the Ama and Medas are lodged in the abode of Vayu which is cold by nature and since these are firmly localized there, it is not easy to eliminate them unbiased as it is chalenging to lift water located at a lower level. [20-24]
    Line of treatment
    Since Kapha and Ama (product of gros digestion) are predominant in the pathogenesis of Urustambha, the physician should constantly administer apropriate aleviation therapies for their
    Kshapana (complete extraction) and
    Shoshana (Absorption / drying of the liquid fraction) [25]
    Fods, drinks
    Fod and Vegetables:
    The patient of Urustambha is constantly given ununctuous regimes, So, Yava ̵ Barley (Hordeum vulgare) (barley), Syamaka (Milet) and Kodrava along with Vegetables coked with water and oil without ading salt. Leaves of Sunisanaka, Nimba ̵ Nem (Azadirachta indica), Aragvadha (Casia fistula), Vayasi (Kakamachi – Solanum nigrum), Vastuka – Chenopodium murale and biter Vegetables like Kulaka (karavelaka – Momordica charantia) are useful for the patient. [26-27]
    Drinks:
    Administration of Alkali preparations, Arista (medicated wines), Haritaki–Terminalia chebula, after adjunct with honey and Pipali – Long peper cures Urustambha. [28]
    Samangadi Yoga
    The patient sufering from Urustambha should take
    Samanga ̵ Rubia cordifolia,
    Shalmali – Salmalia malabarica (Gum- resin) and
    along with honey. [1/2 29]
    Srivestakadi Yoga
    The patient may also be given
    Srivestaka
    Udicya – Andropogan vetiveria,
    Devadaru (Cedrus deodara),
    Nata (Valeriana walici),
    Chandana (Sandalwod ̵ Santalum album),
    Dhataki ̵ Wodfordia fruticosa,
    Kushta – Sausurea lapa,
    Talisa – Taxus bacata and
    N alada – Nordastachys jatamamsi along with honey [29 1/2 ̵ 1/2 30]
    Kalka, Churna Yoga
    Kalkas (recipes in the form of Paste):
    The consequent 5 recipes cure Urustambha (spasticity of thighs):
    Musta (Cyperus rotundus), Haritaki – Terminalia chebula, Lodhra (Symplocos racemosa), Padmaka – Prunus pudum and Tikta- Katukarohini ̵ Picrorhiza kuroa
    Devadaru – Cedrus deodara, Haridra (turmeric ̵ Curcuma longa), Daru-Haridra – Berberis aristata, Vacha (Acorus calamus Lin.) And Katuka- Katukarohini ̵ Picrorhiza kuroa
    Pipali – Long peper fruit – Piper longum, Pipali Mula, Sarala and Deva-Daru – Cedrus deodara
    Chavya – Piper retrofractum, rot of Chitraka – Plumbago zeylanica, Deva- Daru – Cedrus deodara and Haritaki – Terminalia chebula and
    Bhalataka (Semecarpus anacardium Lin.), Pipali Mula and Pipali – Long peper fruit – Piper longum.
    Al the above mentioned recipes in the form of paste are to be taken along with honey. [30 1/2 ̵ 1/2 3]
    Churna Yoga:
    The patient sufering from Urustambha should take the folowing recipes:
    Sarngestadi Yoga: Al these ingredients taken in equal quantities is made to a powder:
    Sarngesta (Gunja) – Abrus precatorius
    Madana – Randia dumetorum
    Danti – Baliospermum montanum
    Fruits (seds) of Vatsaka (Holarhena antidysenterica Wal.),
    Vacha (Acorus calamus Lin.),
    Murva – Marsdenia tenacisima
    Aragvadha (Casia fistula),
    Patha – Cisampelos pariera
    Karnja – Pongamia glabra and
    Kulaka (Karavelaka – Momordica chirantia).
    Adjuvant: honey joined with water or with honey and whey
    Murvadi Yoga:
    In the above mentioned maner the powder of
    Murva ̵ Marsdenia tenacisima
    Ativisa – Aconitum heterophylum
    Kushta – Sausurea lapa,
    Chitraka &#8 21; Leadword ̵ Plumbago zeylanica and
    Katu-Katukarohini ̵ Picrorhiza kuroa may be taken.
    Gugulu – Comiphora mukul is soaked overnight in cow’s urine and taken.
    Svarnaksiryadi Yoga: The powder of
    Svarna-Ksiri – Panicum sumatrense
    Ativisa – Aconitum heterophylum
    Musta (Cyperus rotundus)
    Tejovati – Zanthoxylum alatum
    Vacha (Acorus calamus Lin.
    Surahva
    Chitraka ̵ Leadword ̵ Plumbago zeylanica,
    Kushta – Sausurea lapa
    Patha – Cisampelos pariera and
    Katuka- Katukarohini ̵ Picrorhiza kuroa is made by ading honey.
    Alternatively, the powder may be mixed with water and honey, and taken.
    The Powder of Phali (Nyagrodha – Ficus bengalensis), Vyaghra-Nakha – Caparis zeylanica and Hema (Mesua ferea) (Naga-Kesara) may be taken by the patient.
    The powder of Triphala (Haritaki – Terminalia chebula, Vibhitaka – Terminalia belerica and Amalaki – Phylanthus emblica), Pipali – Long peper fruit – Piper longum, Musta (Cyperus rotundus),Cavya and Katuka- Katukarohini ̵ Picrorhiza kuroa may be made to a Linctus, and taken. [ 3 1/2 ̵ 1/2 39]
    Nourishing, oleation, fomentation therapies
    Nourishing Therapy:
    If the diseases Urustambha is caused by Apatarpana (depletion of tisues), then the patient is apropriately given Santarpana (nourishing) therapy consisting of the meat of animals inhabiting Jangala Desha (the land with shrubs and smal tres) and aged Shali rice. [39 1/2 ̵ 1/2 40]
    Oleation and Fomentation Therapies
    If because [of excesive use] of ununctuous therapies, Vata Dosha gets agravated causing thereby insomnia and damage, then the patient is given oleation and fomentation therapies for the aleviation of the aliments caused by Vata Dosha. [40 1/2 ̵ 1/2 41]
    Pilupar nyadi Taila
    Oil is coked by ading
    Piluparni (Morata – Chonemorpha fragrans)
    Payasya ̵ Impomoea paniculata,
    Rasna (Vanda roxburghi / Pluchea lanceolata),
    Goksuraka – Tribulus terestris
    Vacha (Acorus calamus Lin.),
    Sarala,
    Aguru – Aqualaria agalocha and
    Patha – Cisampelos pariera
    Adjuvant: 1 Prasta or 1 Anjali of this medicated oil is taken by ading honey (1/4th in quantity of the medicated oil). [41 1/2 ̵ 42]
    Kusthadya Taila:
    Mustard oil is coked by ading
    Kushta – Sausurea lapa
    Srivestaka
    Udicya – Andropogan vetiveria
    Sarala,
    Devadaru (Cedrus deodara),
    Kesara,
    Ajagandha (Ajamoda – Ajowan (fruit) – Trachyspermum roxburghianum) and
    Ashwagandha ̵ Winter Chery / Indian ginseng (rot) ̵ Withania somnifera
    The patient sufering from Urustambha (spasticity should hold this medicated oil in apropriate quantity by ading honey. This recipe makes the patie nt fre from ununctuousnes leading to the cure of Urustambha [43-4]
    Saindhavadya Taila:
    1 Prastha of oil is coked by ading 2 Palas of Saindhava, 5 palas of Sunthi – Zingiber oficinale, 2 Palas of Granthika, 2 Palas of Chitraka ̵ Leadword ̵ Plumbago zeylanica, 20 fruits of Bhalataka (Semecarpus anacardium Lin.) And 2 Adhakas of Aranala (sour vinegar) intake of this medicated oil helps in the procreation of ofspring.
    It cures
    Grdhrasi ̵ sciatica,
    Urugraha (spasticity of the thighs),
    Arshas ̵ Piles,
    Arti ̵ damage and
    Sarva vata vikara ̵ al types of diseases causes by the agravated Vayu. [45-46]
    Astakatvara Taila
    1 Prastha of oil is coked by ading 2 Palas of Pipali-Mula and Nagara (Zingiber oficinale) taken together, 8 Prasthas of Katvara (takra or buter- milk) an d 1 Prastha of yogurt. This medicated oil cures sciatica and Urustambha (spasticity of thighs).
    Thus, ends the description of Astakatvara Taila. [47
    External Therapy:
    In the above mentioned verses (nos. 25-47), the recipes to be old internaly for the cure of Urustambha are described in brief .Hereafter, recipes to be administered externaly for the diminution of kapha wil be described which you (adresed to Agnivesha by the preceptor) may hear.
    Valmika- Mrtikadyutsasana:
    The mud of Ant-hil, the rot, fruits and barks of Karanja (Pongamia pinata), and bricks is made to a powder. This is used for Utsadana (dry rubing) frequently.
    Alternatively, the physician should administer this, Utsadana therapy with the asist of the rot of Ashwagandha ̵ Winter Chery / Indian ginseng (rot) ̵ Withania somnifera, Arka ̵ Calotropis gigantea, Picumarda (Nimba ̵ Nem (Azadirachta indica) or Devadaru (Cedrus deodara). Any one of these drugs may be mixed with honey, Sarshapa – Brasica campestris and mud of ant-hil before being dilapidated as thick Utsadana(dry rubing or masage) or Pralepana (external aplication).
    A wise physician may also aply the paste of Danti – Baliospermum montanum, Dravanti (a variety of Danti), Surasa – Cinamonum zeylanica and Sarshapa – Brasica campestris for the cure of Urustambha (Spasticity of the thighs).
    The warm decoction prepared by boiling water with the leaves, rots and fruits of Tarkari (Jayanti – Sesbania egyptica), Sigru – Moringa oliefera, Surasa – Cinamonum zeylanica, Visva, Vatsaka (Holarhena antidysenterica Wal.) And Nimba ̵ Nem (Azadirachta indica) may be sprinkled over the afected part.
    Mustard is made to a paste by triturating with cow’s urine kept overnight and dilapidated for external aplication.
    Vatsakadi Pralepa:
    Vatsaka (Holarhena antidysenterica Wal.), Surasa ( Cinamonum zeylanica), Kushta – Sausurea lapa, arom atic drugs (like Aguru – Aqualaria agalocha), Tumburu -( Zanthoxylum alatum), Sigru -( Moringa oleifera), Himsra – Nordastachys jatamamsi, Rot of Arka ̵ Calotropis gigantea, mud of ant- hil and Kutheraka (Parnasa – Ocimum basilicum) is made to a paste by ading Yogurt and Rock-salt a physician conversant with the line of treatment should administer this paste for eternal aplication for the cure of Urustambha (Spasticity of the thighs).
    Shyonakadi Pariseka Pralepa:
    Shyonaka – Orchis mascula, Khadira (Acacia catechu), Bilva – Aegle marmelos, Brihati ̵ Solanum indicum, Kantakari ̵ Solanum xanthocarpum, Sarala, Asana – Pterocarpus marsupium, Sobhanjana, Tarkari – Sesbania aegyptica, Svadamstra – Tribulus terestris, Surasa ̵ Cinamonum zeylanica, Arjaka, Agnimantha – Premna integrifolia and Karanja (Pongamia pinata) is boiled in water. This decoction is old for sprinkling over the afected part.
    The above mentio ned drugs may be made into a paste by triturating them with cow’s urine, and aplied eternaly for the cure of Urustambha (spasticity of the thighs).
    To abate Kapha, the able bodied patients are active in physical exercise, and they is made to walk over the ground covered with gravels and sand in the morning.
    The Patient is made to swim frequently against the modern of a river with cold water but harmles (fre from hazardous aquatic animals). He may also be advised swiming frequently in a pond having clean col and stable water. [48- 1/2 60]
    Line of treatment
    Urustambha ̵ Line of treatment:
    Al the therapeutic measures which relieve Kapha but do not agravate Vata should always be employed for the treatment of Urustambha these therapeutic measures should however, be administered to the patient while protecting his physical strength and Ag ni (power of digestion and metabolism) [60 1/2 ̵ 61]
    Sumary
    In this chapter on the treatment of Urustambha (spasticity of the thighs), the folowing topics are discused:
    Etiology of the disease
    Premonitory signs and symptoms of the disease
    Signs and symptoms of the disease
    Unsuitable therapeutic measures, and the reason for their unsuitability and
    To categories of therapeutic measures(viz, internal and external therapies) [62]
    Thus, ends the 27th chapter with the treatment of Urustambha in the section on treatment of diseases (Chikitsa-Sthana) of Agnivesha’s work as redacted by Charaka and suplemented by Dridhabala.
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