Approach to Ayurveda Treatment
Prof. Muralidhar Sharma
based on the lecture available at–Approach to Ayurvedic Practice
वेपथुर्विषमो वेगः कण्ठौष्ठपरिशोषणम् |
निद्रानाशः क्षुतः स्तम्भो गात्राणां रौक्ष्यमेव च ||
शिरोहृद्गात्ररुग्वक्त्रवैरस्यं बद्धविट्कता |
जृम्भाऽऽध्मानं तथा शूलं भवत्यनिलजे ज्वरे ||
It is an area where we can have better management than contemporary medicine. Contemporary medicine often failed to resolve the conditions quickly. But I consider this as one of the varieties of the Visham Jwara. The typical feature associated with Vataja Jwara is irregular (Vishama) onset itself. An obvious clinical symptom of the pain (Shoola) is present. In this condition, my prescription would be Lakshminarayana Rasa (instead of Mritunjay Rasa), Arogyavardhini, and Amritarishta. The other restriction like rest and diet are very vital. Duration could not be specified, it could be 1-2 weeks or at the time it may be enhanced up to a month. Responses may not be uniform but still, you can manage the patient safely. Chikungunya-like conditions where you have the typical Vataja jwara can be better managed with Ayurvedic medicine than the contemporary system of medicine. Investigations are necessary for such conditions.
Investigations – Haemogram, Peripheral smear study
Gastritis /Food poisoning
तृष्णा मूर्च्छा भ्रमो दाहः स्वप्ननाशः शिरोरुजा |
कण्ठास्यदशोषो वमथू रोमहर्षोऽरुचिस्तथा ||
पर्वभेदश्च जृम्भा च वातपित्तज्वराकृतिः |
Another variant of the Jwara conditions mentioned in the Sushruta is the patients who have food poisoning after having some fast food like pizza, ice cream, and so on. Patients have often the symptoms of gastric irritation and nausea. The patient may come to you with symptoms of Jwara and Ajirna. My prescription would be Mrityunjaya Rasa, Anandabhairava Rasa, Mustakarishta /Jeerakadyarishta. If the patent has frequent loose stool then the choice would be Mustakarishta. Jeerakadyarishta would be chosen when abdominal distension is more.
रक्तनिष्ठीवनं दाहः स्वेदश्छर्दनविभ्रमौ |
प्रलापः पिटिका तृष्णा रक्तप्राप्ते ज्वरे नृणाम् |||
Another variant is exanthematous fever conditions like chickenpox. Chickenpox is one of the areas where Ayurvedic treatment has a better edge than the contemporary system. Common society people would prefer Ayurvedic treatment by choice and they may not go to the other system. In all such conditions, there is always a potential risk of sudden development of changes like meningeal irritation. Therefore be careful about these signs. We can manage this condition as Pittaja or Raktaja Jwara provided that care has been taken related to meningeal irritation signs and dietary restrictions have been followed. My prescription would be Paripathadi Kadha and Kamadudha. It is not the Parpata because Parpata found in our area may not be the same, it doesn’t have a bitter taste and a lot of differences are also present. The textual word is Parpata but I use Paripatha and it is original Marathi term used in Maharashtra.
Asadhya Lakshanas (Toxaemia)
Asadhya Lakshanas are the limits of Ayurvedic management
निद्रानाशो भ्रमः श्वासस्तन्द्रा सुप्ताङ्गताऽरुचिः |
तृष्णा मोहो मदः स्तम्भो दाहः शीतं हृदि व्यथा ||
पक्तिश्चिरेण दोषाणामुन्मादः श्यावदन्तता |
रसना परुषा कृष्णा सन्धिमूर्धास्थिजा रुजः ||
निर्भुग्ने कलुषे नेत्रे कर्णौ शब्दरुगन्वितौ |
प्रलापः स्रोतसां पाकः कूजनं चेतनाच्युतिः ||
स्वेदमूत्रपुरीषाणामल्पशः सुचिरात् स्रुतिः |
नात्युष्णशीतोऽल्पसञ्ज्ञो भ्रान्तप्रेक्षी हतस्वरः |
खरजिह्वः शुष्ककण्ठः स्वेदविण्मूत्रवर्जितः ||
सास्रो निर्भुग्नहृदयो भक्तद्वेषी हतप्रभः |
श्वसन्निपतितः शेते प्रलापोपद्रवायुतः ||
Su. Ut 39/35-41
In the case of any sort of the disease when the Asadhya Lakshanas described in the Samhitas are present then it is indicative of limitation for Ayurvedic treatment. I have tried to list those Asadhya Lakshanas in the text which we can see in the clinical practice presenting with febrile conditions.
One of them is toxemia, patients with severe toxaemic conditions and having fever. If patients have a total leukocyte count is more than 17,000, then it is a limitation for Ayurvedic treatment. It cannot be managed irrespective of the source of infection and need to have antibiotic therapy at that level. Any sort of infection may be managed if TLC is less than 17000. But if the total leucocyte counts more than 17,000, I consider it a limitation. I have added one more criterion of TLC more than 17000 to Asadhya Lakashan mentioned by Sushruta.
In every patient with a fever, it is one of the important parts of clinical examination to rule out meningeal irritation signs. If the patient has meningeal signs and convulsions then it is suggestive of Asadhya Lakashan, and also a limitation for Ayurveda treatment.
ओजो विस्रंसते यस्य पित्तानिलसमुच्छ्रयात् |
स गात्रस्तम्भशीताभ्यां शयनेप्सुरचेतनः ||
अपि जाग्रत् स्वपन् जन्तुस्तन्द्रालुश्च प्रलापवान् |
संहृष्टरोमा स्रस्ताङ्गो मन्दसन्तापवेदनः ||
ओजोनिरोधजं तस्य जानीयात् कुशलो भिषक् |
Su. Ut39/43, 44, 45
A febrile convulsion is a condition where it is difficult to manage the patient during a convulsive phase and it may not be possible to manage with Ayurvedic treatment. If body temperature rises above 103 degrees Fahrenheit is a limitation for Ayurvedic treatment where the use of some kind of antipyretic drug is needed to reduce the temperature. It may not be simple convectional practice and may need further investigations. It has to be considered as Asadhya Lakshana or considered a red alert where you have to be careful to assess and progress. If a patient has the tendency of febrile condition then to prevent febrile convulsion my prescription would be Saraswatarishta. The use of Sarasvatarishta for a prolonged period prevents the next episode of convulsion. The use of Medhya Aushadhi definitely helps in the prevention of the next episode of convulsion.
Poor general condition
Pralepak Jwara is considered a poor general condition.
तथा प्रलेपको ज्ञेय शोषिणां प्राणनाशनः |
दुश्चिकित्स्यतमो मन्दः सुकष्टो धातुशोषकृत् ||
Su. Ut. 39/54
Here I have summarized the condition and enlisted gross indications where patients cannot be managed with Ayurvedic treatment.
- WBC Count – Less than 3000 and more than 18000
If a patient has a total leukocyte count, of less than 3000 or more than 18,000 then both the conditions I would consider impossible to be managed with the Ayurvedic management or you need to have a more detailed approach. Causes could be many and you need to go into the specific cause. You may have some window of opportunity for management with Ayurvedic medicines but I would consider that as a caution sign.
- Platelet count –Less than 60000
A platelet count of less than 60,000 I consider one of the danger signs and limitations for Ayurveda management. In such conditions platelet transfusion is necessary. Without that, you may risk the life of the patient.
- Widal positive at dilution of 160
In cases of typhoid, the early stages can be managed with Laxminarayan Rasa. But if Widal is positive in more than 160, I would consider it a limitation for Ayurvedic treatment.
All these points should be considered for the selective choice of the patient.
In case of anatomical deformities like deviated nasal septum or fully-grown adenoids, it is almost not possible to have satisfactory results with Ayurvedic treatment even though symptoms are milder. Even in the contemporary system of medicine, the outcome will be poorer. Ayurvedic treatment or allopathic treatment provides almost similar results and both cannot establish a cure. So palliative treatment is possible but not a curative treatment. Most of those anatomical defects may be managed with surgical treatment better than our palliative treatment. So the decision of whether the surgery is needed or not needs more expertise and skills. It is a slightly higher-level issue. All these cases should be managed more carefully and the need for surgical intervention has to be considered.
Investigations to plan the Ayurvedic approach to treatment:
Investigations are done not only for making the present diagnosis of disease but also to help to manage the Ayurvedic line of treatment. Here examples of patients with low back aches are explained. Clinical symptoms may be similar in both cases. But radiological findings could be a degenerative change in one patient. In another patient, it could be only the inflammatory changes that can be seen as white sclerotic marks.
वायोर्धातुक्षयात् कोपो मार्गस्यावरणेन च (वा)|
वातपित्तकफा देहे सर्वस्रोतोऽनुसारिणः||
Dhatukshaya and Margavarodh can be ruled out with help of radiological investigation. Dhatukshaya canbe correlated with degenerative pathology. My treatment of choice is mentioned below
Dhatukshayajanya vatavyadhi prescription:
Chandraprabha 1 tds
Abhraka bhasma 1gm
Godanti 25 gm
Avipathikara 25 gm
In case of inflammatory pathology:
Most of the time uric acid levels may be higher or some other signs of inflammatory pathology. Most orthopedics don’t give importance to elevated uric acid levels. But when you deal with patients, you will have plenty of patients who have elevated uric acid levels and involvement in the joint. My prescription would be Kaishora Guggulu, Mrityunjaya Rasa, and Amrritarista. If necessary Agnichiktsa and Kshara Bastimay be necessary.
Serum uric acid 7.8 =Samsrushta vata