CONCEPTUAL REVIEW: ON VATIKA SHIRHASHUL W.S.R TO …
Transcript of CONCEPTUAL REVIEW: ON VATIKA SHIRHASHUL W.S.R TO …
www.wjpps.com Vol 4, Issue 12, 2015.
1224
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
CONCEPTUAL REVIEW: ON VATIKA SHIRHASHUL W.S.R TO
TENTION HEADACHE
Dr. Hetal Vyas* and Dr. A. R. Dave
**
*Reader & HOD, Kayachikitsa Dept. Shree Gulab kunverba Ayurved Mahavidhyalay
Jamnagar.
**Associate Proffesor & HOD Kayachikitsa Dept. Institute for Post Graduate Teaching and
Research In Ayurveda. Gujarat Ayurveda University, Jamnagar-361008.
ABSTRACT
In 21st century competitive Yuga and stressful life worry, tension,
anxiety, fear, grief creates many psychosomatic disorders. Speed and
accuracy are the prime demands of modern era. The need of human
being is infinite but the availability is less to fulfill and our growing
needs have no end. Irregular and scrappy diet repressed hostility, anger
or frustration, long periods of study, lack of proper sleep, less time for
relaxation and suppression of natural urges are the inseparable parts of
our routine which enervate body and finally lead to the disease.
Tension headache is one of them, which can be compared with Vatika
Shirahshula described in Ayurvedic texts, as mental factors like
excessive weeping, grief, fear, terror have also been attributed in its aetiopathogenesis.
Kaplan and Sadock (1995) have reported that 82% patients are suffering from tension
headache. Nearly 80% of population will experience a tension type headache at sometime.
An estimated 1 year prevalence of 86% in women and 63% in men means that it is more
probable to have experience a tension type headache (in Denmark).
KEYWORDS: Vatika Shirahshul, Tension Type Headache (TTH), Shankhanishtoda.
INTRODUCTION
Shirah is a main control system of all bodily ailments. Alteration in the activity of the Shirah
influences all body tissues and also influenced by body tissues in an inverse order. The life
style in modern era creates so many psychological disorders. Vatika Shirahshula (TTH) is
most common among them, which makes suffer many people due to their run race. The main
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
SJIF Impact Factor 5.210
Volume 4, Issue 12, 1224-1241 Review Article ISSN 2278 – 4357
Article Received on
19 Oct 2015,
Revised on 09 Nov 2015,
Accepted on 29 Nov 2015
*Correspondence for
Author
Dr. Hetal Vyas
Reader & HOD,
Kayachikitsa Dept. Shree
Gulab kunverba Ayurved
Mahavidhyalay Jamnagar.
www.wjpps.com Vol 4, Issue 12, 2015.
1225
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
habitat of Pranavayu which supports the mind and regulates the mental activities is Shirah.[1]
(A. H. Su. 12/4) Vata is the main Dosha involved in Shula.[2]
The International Association
for the study of pain (IASP) has defined pain as „an unpleasant sensory and emotional
experience associated with actual or potential tissue damage or described in terms of such
damage. In the Samprapti (pathogenesis) of Vatika Sirahshula, Vata takes important role,
which can compare to the nerve impulse and the seat of Vata is the CNS. Therefore, Vata
Vyadhi indirectly indicates the diseases of CNS.We can correlate the Vata with tension also.
Because tension means bodily tension and mental tension. Bodily tension means muscle
tension i.e. contraction of muscle. The whole muscular system as ready for action. Nerve
having the prime role for it. Vata having the Chala Guna (mobile). Mental tension means
high thinking, while also the function of Vata. So we can correlate the Vata with tension also.
Shankhanishtoda, Ghatasambheda and loss of sleep are all symptoms of vatika shirahshul we
can correlate with Tension type of Headache.
DEFINATION
Shirahshula is described in Ayurveda not only as the symptom of many diseases but also as
an independent disease entity as Shiroroga.
ßÖÐëÐë· Ö[ÆçÈ ßÖÐë·Ä ÖâÒÐáÊÞ Ðá¼Þ¹ßÍ߸ÏÄçÞ2(Ma. Ni. –Vijayarakshita)
Shankhbheda, Lalatbheda Shiroruk.[3]
Shirahshula is also mentioned as synonym of Shiroroga. Charaka has mentioned Shiroruk
(Shula) as separate disease among eight types of Vata-vyadhis.
TENSION HEADACHE
Constant dull, band like pain, tightness or pressure around forehead or, back of the head and
neck.[4]
CAUSES OF VATIKA SHIRHASHUL[5]
Aharaja Hetu (Dietary Factors) Viharaja Hetu (Recreational Factors) Manasa Hetu
(Psychological Factors)
Tikshnna pana (Strong alcohol
consumption) Uchchairbhashya (High tone speech) Bashpa (Excessive weeping)
Ati Vireka (Excessive purgation) Atibhashana (Excessive talking) Shoka (Grief)
Ati Vamana (Excessive vomiting) Prajagara (Night waking) Bhaya (Fear)
Shitamarutasparsha (Contact of cold wind) Trasa (Terror)
Ati Vyavayi (Excessive coitus)
www.wjpps.com Vol 4, Issue 12, 2015.
1226
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
Vatika Shirahshula caused by mental factors only can be correlated with tension type
headache as excessive weeping, grief, fear and terror have also been attributed in its
pathogenesis.
CAUSES OF TENSION HEADACHE[6]
Stress (everyday hassles, family crises, heavy workloads, unpleasant work or social
situations).
Change in sleep regimen (shift work, oversleeping)
Skipping meals (a poor, scrappy diet)
Certain foods (caffeine, alcohol, cheese, chocolate)
Physical exertion
Environmental factors (sun glare, odours, smoke, ambient noise, fluorescent lighting,
sustained postures at video, terminals or while driving)
Female hormonal changes (menses, menopause, pregnancy, exogenous hormone use)
Medications used for concomitant medical conditions (nitrates, selective serotonin
reuptake inhibitors, antihypertensives).
Overuse of headache medication (analgesic and caffeine combinations butalbital
compounds, opiates, ergot)
Depression and anxiety
Vega Nigraha (Holding of natural urges of
motion & urination)
Upavasa (fasting)
Abhighata (Trauma/injury)
Vyayama (Excessive exercise)
Ati margakarshana (excessive walking)
Ati bharvahana (Heavy weight lifting)
All above mentioned causes specially
mental factors
Rasavahasrotodusti
Rasadhatukshaya due to Mental causes –
Rasadhatukshaya
Vataprakopa
Vatika Shirahshula
www.wjpps.com Vol 4, Issue 12, 2015.
1227
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
Working in awkward positions or holding one position for a long time.
Clenching or grinding teeth (functional disturbances of masticatory muscle around the
temporomendibular joint)
Stiff joints and muscles due to arthritis of the neck or inflammation of the shoulder joints
may develop TTH.
Tight band around the forehead, heavy weight on top of head.
Eye strain caused by dealing with a large amount of paper work.
Coping strategies (avoidance, self criticism, lack of use of social supports)
Excessive worry
All work – no play
Long periods of study, typing or other concentration
Perfectionism
Injuries to the spine
Repress, hostility, anger, frustration
Low blood sugar, food allergy.
SIGN & SYMPTOMS
According to Ayurveda[7]
Symptoms Ch. Ma. Ni./ Su. Sa. A.H./A.S. Ha. Sam.
Shankhanishtoda + - + -
Ghatasambheda + - + -
Bhrumadhya Tapanam + - + -
Lalata Tapanam + - + -
Shrotranishkasanavat Pida + - + -
Akshinishkasanavat Pida + - + -
Shiroghrurnanam + - + -
Sandhimokshanavat Pida + - + -
Shirostambha + - + -
Shirajalasphurana + - + -
Bhavanti Tivra Nishi - + - +
Kandhara Hanugraha - - + -
Prakashasahyata - - + -
Ghranasrava - - + -
Vrishanaruja - - - +
Sudden relieved by itself - - + -
According to modern view
SIGN & SYMPTOMS OF TTH[6]
The headache starts at the back of the head and spread.
www.wjpps.com Vol 4, Issue 12, 2015.
1228
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
Dull pressure or a squeezing pain (dull, steady, achy pain on both sides of the head) lasts
from half an hours to several hours or days).
Pain in TTH.
o Compressive - constrictive type.
o Non-pulsatile, evening time.
o Varied in intensity, frequency and duration long lasting.
o Commonly in occipital and bilateral region associated with muscle contraction.
Visual symptoms are absent.
Nausea, vomiting, anorexia, rarely present.
Photophobia, or phonophobia may be present.
Tenderness on the scalp, neck and shoulder muscles.
Insomnia.
Fatigue.
Irritability.
Difficulty concentrating.
Correlation Between The Symptoms of Vatika Shirahshula & Tention Type of
Headache.
Rupa of Vatika Shirahshula Symptoms of TTH
Shankhanistoda, Ghatasambheda etc. Typically involve entire head commonly
occipital and bilateral region.
Sayam Kala (Bhavanti Tivranishi) Moderately severe in evening time.
Prakasha Asahyata Photophobia
Shabda Asahisnuta Phonophobia
Shiroghrurnanam Giddiness
Nidra Alpata Disturbed sleep
SAMPRAPTI
The Samprapti of a disease refers to the process by which the vitiated Doshas react with
Dushyas and produces Kriyatmaka and Rachanatmaka changes in the target organ leading to
the manifestation of a disease. Otherwise the process of manifestation of disease is known as
Samprapti. In Samprapti – Nidana is the efficient cause, Dosha are the material cause and
Dosha – Dushya Sammurchana is the essential cause.
The Samprapti of Vatika Shirahshula is not mentioned by any Acharya on details in
Ayurvedic literature. But Acharya Charaka have described the Samprapti of Vatika
Sirahshula (Cha.su.17/18).
www.wjpps.com Vol 4, Issue 12, 2015.
1229
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
Dosha Prakopa
Charaka described the Vatika Shirahshula in Nanatmaja Vikara as Shiroruk (Headache),
Shankha Bheda (Temoporal headache) and Lalata Bheda (frontal headache) which are the
main symptoms of Vatika Shirahshula.
In this disease the Manasika Hetu like tension, anxiety, depression produces various types of
diseases according to the Prakriti of a person.
Bhaya, Shoka etc.
Vatika shirahshula Vata Pradhana Prakriti
Ulcerative Colitis Pitta Pradhana Prakriti
obesity Kapha Pradhana Prakriti
So in this Vatika Shirahshula, Vata is the main Dosha to causing this disease.
In some types of Vatika Shirahshula Pitta is also in Kshaya stage and Kapha Vriddhi is also
present in some cases, but it is very mild.
There are two types of vitiation of Vata seen in this disease Vatika Shirahshula.
1) Dhatukshayajanya Vata Prakopa
2) Margavarodhajanya Vata Prakopa
Dhatukshayajanya Vata Prakopa
According to Acharya Charaka, due to Nidana (mainly Manasika), Dhatukshaya occurs, first
Rasa Dhatukshaya then ultimately all Dhatukshaya and leads to Vata Prakopa; then the Vata
comes into Prasara stage and leads to Sthanasanshraya in Raktavaha Srotasa (Shirajala
Sphurana) of Shirah (head) because Kha-vaigunya is there, due to Manovaha Srotasa Dushti
(Raja, Tama vitiate) and causing Vatika Shirahshula.
In the above Sloka “Saraksayat”, Sara mean Mastishka i.e. inner part of Kapala and Kshaya
means decrease of Snehadi qualities or very minute change in the composition.
ÐØÕÞÙàßÈ Æá\ÏßKÄ ßºKHÏÞÈÞÚ ºÞßÄߺKÄÈÞÄì”” (Cha. Vi. 58/13).
Rasa Dhatu Kshaya
Rakta Dhatu kshaya
Uttarottaro Dhatu Kshaya
Chayapurvaka vata Prakopa
www.wjpps.com Vol 4, Issue 12, 2015.
1230
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
2) Margavarodhajanya Vata Prakopa
The etiological factors (Manasikabhava) like Chinta, Shoka, Bhaya etc. directly causes
(Jatharagnimandya). Due to Jatharagni-mandya, Apakva Annarasa is formed (Ama),
Sarabhuta Rasa is formed in very less amount, but Malarupi Kapha is increased in amount
and goes to circulation (Rasa-Rakta Samvahana) and also reach in head (Shirah). Their Sanga
occurs due to Khavaigunya, because this Chinta, Shoka etc. causes Khavaigunya in
Manovaha Srotasa due to Raja and Tama guna increase, which is situated in Shirah. It leads
to Vata Prakopa and causes Vatika Shirahshula.
ROLE OF MANASIKABHAVA ON AGNIMANDHYA
ÎÞqÞÏÞMÏOÏÕÙÄÚ ÄÚ ÊIÏÚ ºÞKÈ ÈÚ ¼àÏåßÄ”
ߺKÄÞÖëøÍÏøë¸Æ᣶ÖQÏÞ} Ê~¼Þ·Ðè£ • (Cha. Vi. 2/9).
It means the food eaten by one who is under anxiety grief, fear, anger, pain, having sedentary
habits, used to awaken at night will fail to be digested properly.
In Amotpatti also Manasikabhava are mentioned as a main causative factor.
øÞÎøê¸ÒêÍÎêÙæ\ÏÞåßÙÖëøÎÞÈêöç·ÍÏêÊÄMÎÈØÞ ÕÞ ÏÆKÈÞÈÎáÊáFÏÄç ÄÆMÏÎÎçÕ
ÊŒÆâÏßÄ”” (Cha. Vi. 2/8).
i.e. when the mind is afflicted with desire, anger, greed, infatuation, envy, shame, grief,
indignation, anxiety and fear will lead to Amotpatti which is the basic responsible factor
behind every disease. Because this Ama leads to Margavarodha followed by Dosha Prakopa
as mentioned in Ashtanga Hridaya. (A.H.8/4)Agnimandya leads to Amotpatti and results
Margavarodha. So this too having most important in Mārgāvarodhajanya Vataprakopa.
www.wjpps.com Vol 4, Issue 12, 2015.
1231
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
chinta, Bhaya, krodha
Vitiates
Manas (Ubhayendriya, control all sence organs)
Incapable to Swa-Swa Visaya Grahana
Incapable of Rasanendriya Karma
Imbalance in diet intake
Indigestion
Arna
Dhatu/Dushya
Rakta is the main Dushya in all types of Shiroroga. Charaka also in Sutrasthana 24th
chapter
including Shiro-ruk in Rakta Pradoshaja Vikara.
In Vatika Shirahshula also Rakta is considered as main Dushya. It has also main role in
Samprapti.
Due to Manasikabhava like Chinta, Shoka, Bhaya etc. in 2nd
Samprapti Rasa Dhatukshaya
(vitiation) is developed. After then Rakta Dhatu also Kshaya (vitiates). In other hand in 3rd
Samprapti due to Agnimandya also Sarabhuta Rasa Kshaya is there and leads to Raktakshaya
automatically. This vitiates (Kshaya) Rakta goes to the circulation and Sthanasansraya in
Shirah. Due to Kshaya of Rakta Vata will be aggravated. Chala Guna of Vata is increased in
circulation. So that Shirajalasphurana, Sirasaithilya, Rukshata etc. symptoms are seen in the
patient of Vatika Shirahshula. Mainly Raktakshaya will be seen in upper part of the body
(Urdhvabhaga).
(Cha. Su. 17/11-18) So, Rasa and Rakta both Dhatus are take part in the Samprapti of Vatika
Shirahshula.
www.wjpps.com Vol 4, Issue 12, 2015.
1232
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
Srotodushti/Khavaigunya
Acharya Charaka has mentioned the involvement of Shirogata Sira in diseases occurring in
head. He stated that the vitiated Dosha vitiate Rakta along with Shira situated in Shirah and
produce Shiroroga (Ch. Su. 17/18-22). So it means Raktavaha Srotasa Dushti occurs.
Rasavaha Srotodushti
In Charaka Vimana 5/13, Charaka also states that –
ÐØÕÞÙàßÈ Æá\ÏßKÄ ßºKHÏÞÈÞÚ ºÞßÄߺKÄÈÞÄì”” (Cha. Vi. 58/13).
Excessive indulgence of Manas in thinking can be the main vitiating factors for Rasavaha
Srotasa as mentioned in Charaka Samhita.
Raktavaha Srotasa
In view of Asrayasrayeebhava, vitiation of Pitta may lead to the vitiation of Rakta as stated in
Sushruta Sutrasthana.
øë¸ÖëøÍÏÞÏØëÊÕÞØÜÜÜÜÜÜßÊÄÚ ÊŒøëÊÎÞÊ߸Äç (Su. Su. 21/21).
ßÊkÊŒøêÊÃèÐçÕ ºÞÍàWÃÜÜÜÜÜÜÜÜÜÜÜÜÜÜ¥Øîøì ÊŒøëÊÎÞÊvÄ (Su. Su. 21/25).
Again Acharya Charaka has quoted that. (Ch. Su. 24/9-10).
Here Manasa Santapa and Krodha (anger) can be taken as mental factors.
Swedavaha Srotasa
UÕçÆÕÞÙàßÈ Æá\ÏßKÄ øë¸ÖëøÍÏèUÄÅÞ”” (Ch. Vi. 5/22).
According to Charakacharya, Krodha (anger), Shock (grief) and Bhaya (fear) can vitiate the
Swedavaha srotasa.
www.wjpps.com Vol 4, Issue 12, 2015.
1233
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
Manovaha Srotasa
Manovaha Srotasa have not been separately mentioned in Charaka Samhita. It is however,
stated that the entire body represents the abode of the Manas and therefore all Srotasa of the
body should be considered as the Manovaha Srotasa.
¥ßºKÄÈÞßÄߺKÄÈÍÏÞÈøߺKÈèÎÈë¹ßÊ ßÕøîÄÚ ÎÈëÌáßgÎßÊ ßÕøîÄÞÚ ¼ÈÏÄàßÄ ÍÞÕ£””
(Ch. Su. 8/16; Chakrapani on Ch. Vi. 5/41).
The mind gets vitiated by non-thinking, excessive thinking or even thinking of frightening
nature.
Due to Chinta, Shoka, Bhaya etc. Raja and Tama, Manasika Dosha will be aggravated. So
Manovaha Srotasa also vitiated. In this way Manovaha Srotasa can be considered in the
Samprapti of Vatika Shirahshula.
Moreover, it has clearly stated that the vitiated Doshas after reaching Shirah vitiate Rakta
along with Sira i.e. blood vessels situated there, to produce Shiroroga.
ÄÄ£ßÖÐßØ ¼ÞÏÄç Ðë·Þ£ ßÕßÕ¸ÒpÃÞ£””
ÕÞÄÞÆÏ£ ÊŒøáMÏßKÄ ßÖÐUÏUq¢ º Æá\ÏßKÄ” ( Ch. Su. 17/11-18).
Adhisthana
The seat of disease is Shirah (head), Mana (mind).
Vyaktisthana
Shirah (head) and its appendages like Manya, Bhru, Shankha, Karna, Akshi, Lalata, Ghata,
Hanu, Sirogata Sandhi can be considered as Vyaktisthana of Vatika Shirahshula.
Agni
The main Agni involved in this disease is Jatharagnimandya is less functioning of enzymes
and local hormones of the gastrointestinal tract (G.I.T.).
Roga Marga
Madhyama Roga Marga/Marmesti Sandhigata Hence all the above factors i.e. Dosha
Prakopa, Dushya Dushti, Agnimandya, Kha-vaigunya and Srotodushti ultimately leads to
Sthana Samsraya in Shirah and causes severe pain in Shankha Pradesh (Shankhanishtoda),
Ghata Pradesha.
www.wjpps.com Vol 4, Issue 12, 2015.
1234
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
Srotodushti Prakara
Sanga, Vimargagamana.
Samprapti of Vatika Shirahshula[8]
ßÖÐë·ÄÞ ßÖÐÞÕîfë ÕÞÏáÐÞßÕTÏ øáMÏßÄ”
ÄÄ£ ÖâÒ¢ ÎÙkUÏ ÕÞÄÞÄí ØÎáʼÞÏÄç”” (Ch. Su. 17/18).
As vitiated Vata Dosha effects the Shirodhamanies (nerves and blood vessels) the symptoms
due to reduce blood supply to scalp muscle and other tissues as mentioned earlier. Pain
occurring suddenly without any known cause and relieving by itself or also noted among
these cases. This can be differentiated from other Shirahshula by this specific symptom.
Pathogenesis of Teasion Headache[9]
TTH is common, the pathophysiology and likely mechanism remain unclear. Current
knowledge of the nociceptive (pain receptors) system suggests that the derivative pain of
TTH has a muscular origin. Muscular or myofascial pain tends to be dull and achy, poorly
localized and radiating, pain originating from cutaneous structures is sharp, localized and
non-radiating.
Most research has focused on a peripheral mechanism pertaining to pericranial muscle
tenderness, thus explaining the previous term muscle contraction headache. researches
who have attempted to find correlations between subjective complaints of pericranial
muscle tension and electromyographic changes during a headache have had conflicting
results.
Sustained muscles contraction from physical or emotional causes may compress
intramuscular arterioles, causing ischaemia, accumulation of noxious metabolites or both
results in localized tenderness.
Physical and emotional causes
Sustained muscles contraction
Compress intramuscular arterioles
Ischaemia
www.wjpps.com Vol 4, Issue 12, 2015.
1235
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
Accumulation of noxious metabolites
Localized tenderness in head
TTH has a purely central mechanism and that muscle tension is an epiphenomenon.
Studies that suggest a sharp disorder with TTH have found reductions in platelet or serum
serotonin, epinephrine, nor-epinephrine and dopamine levels. These findings appear to
support the idea that an alteration in serotoninergic and monoaminergic central systems
results in depressed pain suppression and activated pain pathways in TTH (Normal level
these neurotransmitters that help nerves communicate).
Emotions have biochemical effects in the body and mental stress alone elicit muscle
contraction through the limbic system.
www.wjpps.com Vol 4, Issue 12, 2015.
1236
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
Chronic TTH also may be associated with central opioid hypofunction with decreased
CSF beta endorphin levels and associated with exteroceptive suppression (ES2).
The cause of TTH is most likely multifactorial and best described by olesen‟s vascular
myogenic supraspinal model.
The convergence of multiple pain pathways – vascular, muyogenic supraspinal or all of
these that enter the caudate nucleus of the trigeminovascular system and, in combination
with other precipitating factors in a predisposed person, determine headache activation
threshold is met.
A genetic predisposition has been suggested by studies that found a threshold increased
incidence of chronic TTH in families.
Pathogenesis of TTH is complex and multifactorial with contributions that central,
peripheral, vascular, muscular, psychogenic.
Another chemical in the body that ma play a role in TTH is nitric oxide, which is
involved in the transmission of nerve impulses over production of nitric oxide has been
linked to chronic tension headache and substances that block the production of nitric
oxide have been shown to reduce the muscle lightness in TTH.
According to Jenson, extracranial myofascial nociception is one of them. Headache is not
related directly to muscle contraction and possible hypersensitivity of neurons in the
trigeminal nucleus caudalis has been suggested.
Bendtsen – described central sensitization at the level of the spinal dorsal horn/trigeminal
nucleus due to prolonged nociceptive inputs from pericranial myofascial tissue. The
central neuroplastic changes may affect regulation of peripheral mechanism and can lead
to increased pericranial muscle activity or release of neurotransmitters in myofascial
tissue. This central sensitization may be maintained even after the initial eliciting factors
have been normalized, resulting in conversion of ETTH into CTTH.
Correlation Between Samprapti of Vatika Sirahsula & Pathophysiological Mechanism
of Tension Headache
Role of Vata Nerve impulse; Tension.
In the Samprapti (pathogenesis) of Vatika Sirahshula, Vata takes important role, which
can compare to the nerve impulse and the seat of Vata is the CNS which already
described previously. Therefore, Vata Vyadhi indirectly indicates the diseases of CNS.
We can correlate the Vata with tension also. Because tension means bodily tension and
mental tension. Bodily tension means muscle tension i.e. contraction of muscle. The
www.wjpps.com Vol 4, Issue 12, 2015.
1237
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
whole muscular system as ready for action. Nerve having the prime role for it. Vata
having the Chala Guna (mobile). Mental tension means high thinking, while also the
function of Vata. So we can correlate the Vata with tension also.
Role of Rasa and Rakta
Rasa and Rakta which are having the prime role among all Dhatu in the pathogenesis
(Samprapti) of Vatika Shirahshula. But the importance of the Rasa-Rakta complex, which
has the function of Preenana (nourishment) and Jeevana (supplying Prana – oxygen) to
the nervous system should also be taken into consideration.
If the blood flow is interrupted for only ten seconds, loss of consciousness, results an
interruption of four minutes causes irreversible damage to most cerebral cells. The normal
blood flow through the brain tissue of the adult average 50–55ml/100 gm of brain per minute.
For the entire brain of the average adult, this is approximately 750 ml per minute or 15% of
the total resting cardiac output. The O2 consumption of human brain averages about
3.5ml/100 gm brain per minute or 49 ml/min for the whole brain in an adult. It represents
approximately 20% of the total resting O2 consumption.
Any disturbance in these two functions can create a disturbance in the function of Vata. In
Ayurved also Rasa and Rakta Dhatukshaya occur. So the role of Rasavaha and Raktavaha
Srotasa in Samprapti can be understood.
Role of Agnimandya And Ama
Stress, strain, anxiety leads to Agnimandya and produce Ama which disturb the digestion
process. Pakvashaya is stated as the most important seat (Vishesa Sthana) of Vata.
Snigdha Ahara Dravya (lipids) are digested in the Pakvashaya and products of such digestion
are absorbed here for utilization of the structure of Mastiska and Vatavaha Srotasa (C.N.S.).
It is already mentioned that the chief of contain of nerve tissue is lipid. Most of fat digestion
and protein digestion occur in the small intestine and the end product of both protein and fat
digestion are absorbed in the small intestine. Therefore, the materials required in the structure
of the nervous system are made available in the Pakvashaya.
Certain bacteria especially colon bacilli are present in the absorbing colon. The substances
formed as a result of bacterial activity are vitamin K, Vitamin B12, thiamine, riboflavin etc.
www.wjpps.com Vol 4, Issue 12, 2015.
1238
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
They all are essential for maintaining some of the functions of the CNS e.g. formation of
lipids from carbohydrate is in influenced by Vitamin B12.
Lots of Ayurvedic researches have established „Ama‟ as „Free radicals‟ in modern concept
with logical explanation. From the definition of free radicals that “It is an atom or molecule
which containing one or more unpaired electrons and exist in an incomplete metabolic state,
which requires neutralization by free radical scavengers”. We can be able to correlate the
concept of Ama viz. indicates undigested i.e. incomplete metabolic state in free radical forms.
When we enter into the cause of production of free radicals, it can be headed in two ways viz.
i) Exogenous factor and ii) Endogenous factors. The endogenous factor as being triggered by
the Manasikabhava like Chinta, Kama, Shoka, Bhaya etc. which ultimately lowers the
production of certain enzymes. As we know the production of enzymes regulated by neural
centers, requires healthy neural functions. Thus, deficiency of enzymes causes production of
free radicals which can be correlated with Mandagni state and production of Ama.
From the above description, it is evident that Manasikabhava are the factors in production of
Ama (free radicals).
In Ayurvedic aspect also due to Agnimandya the diet are also not properly digested. So the
digestion and absorption of protein and fat part are not done properly. It may leads to
deficiency of vitamins which is formed by bacterial activities and deficiency of such vitamins
leads to a disturbance of both structural and functional integrity of nervous system, the lipid
formation also impaired. Hence, the role of Agnimandya and Ama also taken into
consideration.
Role of Ama and free radicals in production of the disease mentioned in the tabular format.
Free Radicals Ama
Impaired action of free radical scavengers. Dhatvagni Daurbalya
Increased production of free radicals at the site. Sanchaya of Ama at the site of production.
Circulation of free radicals in the body. Prasara of Ama.
Starts reacting with the weak cell membrane. Sthanasanshraya at the site of Kha-vaigunya.
Production of disease. Production of Vyadhi.
In this way the Samprapti of Vatika Shirahshula and pathophysiological aspect of tension
headache correlates with each oth.
www.wjpps.com Vol 4, Issue 12, 2015.
1239
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
CHIKITSA
General management of Shiroroga
Commonly in all types of headache the following preventive measures should be taken.
Nidana Parivarjana
According to the treatment point of view, the etiological factors which produce headache
should be avoided. Commonly rest, countenance without stress, avoiding the holding of the
natural urges, controlling the mind are very helpful. Also other Aharaja and Viharaja Hetus
should be avoided.
Samshodhana Chikitsa
Shirovirechana – Nasyakarma has been advised as the important method of treatment in
Urdhvajatrugata Rogas. Thus repeated use of Nasya with special medicine which are
indicated for such condition is to be put into practice in headache.
Samshamana Chikitsa
Simultaneous to Nidana Parivarjana, the vitiated Doshas should be brought to their normal
state by help of drugs, based on Samanya Vishesh principles, according to predominance of
the manifesting Dosha.
Other Measures
Yoga Ratnakara has described the following measures for Shiroroga.[10]
Snehana Upanaha
Swedana Dhumapana
Lepa Langhana
Parisheka Agnikarma
Raktamokshana Shirobasti
These measures should be applied after considering the predominance of Dosha and other
general considerations of the patients.
Satvavajaya
The term Satvavajaya implies the therapeutics for mental disturbances. This is secured best
by restraining the mind from desire for unwholesome object and the cultivation of Gnana,
Vijnana, courage, memory and Samadhi (concentration).The advice of the counseling in the
present time is no more considered to be only for psychiatric disorders, but also in the
www.wjpps.com Vol 4, Issue 12, 2015.
1240
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
prevalence of disrupt psyche of a patient in need or parallel supportive therapy to alleviate his
conditions by making him able to cope up his illness with better adjustment and adaptation.
Psychological and psychodynamic methods are no more a palliative management but also a
curative treatment in those conditions, the basic approach is –
1) Assurance
2) Exchange or replacement of emotions viz. replacement of Kama, Krodha, Bhaya, Harsha,
Irshya etc. with appropriate emotions.
3) Psychoshock theory.
General Management of Shiroroga[11]
In Bhaishajya Ratnavali, general line of treatments for Shirahshula has been described which
is Swedana, Nasya, Dhumapana, Virechana, Lepa, Vamana, Langhana, Shirobasti,
Raktamokshana, Agnikarma, Upanaha, Purana Ghrita and Shashtika Shali.
MANAGEMENT OF TENSION HEADACHE[6]
Management of tension headache mainly divided into two groups viz. –
Pharmacological approach
Non-pharmacological approach.
Pharmacological
Abortive Therapy Prophylactic Therapy
Simple analgesics without caffeine NSAIDs
Simple analgesics with caffeine Tricycles antidepressants
NSAIDs Selective serotonin reuptake inhibitors
Muscle relaxants Monoamine Oxidase inhibitors
Narcotic analgesics
Barbiturate or acetaminophen compound
Non-pharmacological approach
Regulation of
Lifecycle
Psychological
counseling
Avoidance of
environmental precipitants Physical Therapy
Alternative
therapies
Maintain
regular sleep
Stress management
program Wear sunglasses Heat, ice, ultrasound Acupuncture
Take regular
meal Meditation
Avoid smoke, strong
odours, noisy area Electical nerve stimulation Acupressure
Avoid known
dietary triggers
Individual or family
psychotherapy Maintain proper posture
Stretching and
strengthening exercise for
affected musculature
Therapeutic
touch
Get regular
aerobic exercise
Behavioral
management Triggered point stretching AromaTherapy
www.wjpps.com Vol 4, Issue 12, 2015.
1241
Vyas et al. World Journal of Pharmacy and Pharmaceutical Sciences
REFERENCES
1. Astanga Hridaya Su. Ch.12/4 -Sarvangsundari commentary by Arundatta, Krishna as
Academy, Varanasi.
2. (a)Charaka Samhita Chi. Ch.3 Edited by Yadavaji Trikamji Acharya, Chaukhambha
Sanskrit Sansthana, Varanasi. Pg. No.401
(b)Madhava Nidana Ch. 26/1 – Madhukosha commentary by Vijayrakshita and Shrikanta
Datta with hindi Vidhyotini commentary by Shastri S, Chaukhambha Sandskrita
Sansthana, Varanasi. Pg.No. 464.
3. Charaka Sumhita (Su.ch. 20/11) Edited by Yadavaji Trikamji Acharya, Chaukhambha
Sanskrit Sansthana, Varanasi. Pg.No. 113.
4. www.m.webmd.com.guide.tension.
5. (a)Charaka Sumhita (Su.ch. 17/16-17) Edited by Yadavaji Trikamji Acharya,
Chaukhambha Sanskrit Sansthana, Varanasi. Pg.No.100
(b)Harita Samhita – Sastu Sahitya Vardhaka Karyalaya Bombay.
6. www. healthline. com. TTH.
www. myoclinic. com -20019295.
www. medicinenet. Com. main. mobileart.
https://en.m Wikipedia. org. wiki. Tensi.
7. (a)Charaka Sumhita (Su.ch. 17/19,20,21) Edited by Yadavaji Trikamji Acharya,
Chaukhambha Sanskrit Sansthana, Varanasi. Pg.No. 100.
(b)Madhava Nidana Ch. 60/2 – Madhukosha commentary by Vijayrakshita and Shrikanta
Datta with hindi Vidhyotini commentary by Shastri S, Chaukhambha Sandskrita
Sansthana, Varanasi. Pg.No. 334.
©Astanga Hridaya Su. Ch.12/4 -Sarvangsundari commentary by Arundatta, Krishna as
Academy, Varana.
(d)Harita Samhita – Sastu Sahitya Vardhaka Karyalaya Bombay.
8. Charaka Sumhita (Su.ch. 17/18) Edited by Yadavaji Trikamji Acharya, Chaukhambha
Sanskrit Sansthana, Varanasi. Pg. No. 100.
9. www ncbi. nlm. nih. Gov. pubmed https.//en. M Wikipedia. Org. wiki. Tensi.
10. Yoga Ratnakar with Vidyotini Hindi Commentary, Chaukhambha Sanskrit Series
Varanasi.
11. Bhaishajya Ratnavali Vidhyotini tika, Chaukhambha Sanskrit Series Varanasi. 1962.