Professional Documents
Culture Documents
Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH)
Government of India
AYUSH BHAWAN
B Block, GPO Complex, INA
New Delhi-110023
India
Telefax: 011-24651964
Website: www.ayush.gov.in
© Copyright 2017, Ministry of AYUSH, Government of India. Any part of this document may be
reproduced, copied or adapted to meet local needs, without permission from Ministry of AYUSH,
provided that the parts reproduced are not tinkered and are distributed free of charge or at no
cost – not for profit.
Executive Editor
Vaidya Manoj Nesari
Adviser (Ay)
Ministry of AYUSH
AYUSH BHAWAN
B Block, GPO Complex, INA
New Delhi-110023, India
Collaborative Institutes
Institute for Postgraduate Teaching &
Research in Ayurveda, Jamnagar
and
National Institute of Ayurveda, Jaipur
Executive Editor
Vaidya Manoj Nesari,
Adviser (Ay)
Ministry of AYUSH
Govt. of India, New Delhi
Editors
Professor M. S. Baghel
Former Director, Institute for Post Graduate Teaching & Research in Ayurveda, Jamnagar
Professor Anup Thakar
Director, Institute for Post Graduate Teaching & Research in Ayurveda, Jamnagar
Dr. S. K. Khandel
Former Head, Dept. of Roga Nidan, National Institute of Ayurveda, Jaipur
Dr. Pawan Godatwar
Professor, Dept. of Roga Nidan, National Institute of Ayurveda, Jaipur
Dr. Prakash Mangalasseri
Associate Professor, Dept. of Kayachikitsa, VPSV Ayurveda College,
Edarikkode, Kottakal, Kerala
Coordinator
Dr. Mandip Goyal
Associate Professor, Dept. of Kayachikitsa,
Institute for Post Graduate Teaching & Research in Ayurveda, Jamnagar
8. Professor Meeta Kotecha, Head, Dept. 19. Dr. Srinivas Acharya, Professor &
of Dravyaguna, National Institute of Head – Dept. of Kayachikitsa, Sri
Ayuveda, Jaipur Dharmasthala Manjunatheshwara
College of Ayurveda, P. O. Kuthpady,
9. Professor Mahesh Chandra Sharma,
Udupi, Karnataka
Former Director, National Institute of
Ayuveda, Jaipur 20. Vd. Tapan Vaidya, Associate Professor
Dept. of Kayachikitsa, J.S. Ayurveda
10. Dr. Haridra Dave, Head, Dept. of
College, Nadiad – Gujarat
Shalakya Tantra, J. S. Ayurveda College,
Nadiad - Gujarat 21. Professor Manda Ghorpade, Professor,
Head, Dept. of Stree Roga Prasutitantra,
11. Dr. B. M. Singh, Dept. of Kaumarbhritya, Sumatibhai Shalu Ayurved
Faculty of Ayurveda, Banaras Hindu Mahavidyalaya Hadapsar, Pune,
University, Varanasi Maharashtra
12. Dr. Ved Prakash Vyas, Dept. of Bal 22. Dr. Jayant Deopujari, Consultant,
Roga, Govt. Dhanwantri Ayurved Shrinidhi Ayurveda Panchakarma
College, Ujjain Chikitsalaya, Nagpur, Maharashtra
13. Dr. Eswar Sarma, Principal, VPSV 23. Dr. Manoj A. K., Professor, Dept. of
Ayurveda College, Edarikkode, Panchakarma, VPSV Ayurveda College,
Kottakal, Kerala Edarikkode, Kottakal, Kerala.
14. Dr. P. Rammanohar, Research Director, 24. Professor Umesh Shukla, Principal,
Amrita Center for Advanced Research Pt. Khushilal Sharma Government
in Ayurveda, Amritapuri, Kerala Ayurveda College, Bhopal
15. Professor A. K. Tripathi, Vice Chancellor, 25. Dr. B. L. Mehra, Head, Dept. of
Ayurved and Unani Services, Dehradun, Kayachikitsa, R.G. Govt. Ayurvedic
Uttarakhand College, Paprola, Kangra (H.P.)
16. Dr. M. M. Padhi, Deputy Director, 26. Dr. Rakesh Sharma, Reader, Dept of Bala
Central Council for Research in Roga PG Section, R.G. Govt. Ayurvedic
Ayurvedic Sciences, New Delhi College, Paprola, Kangra (H.P.)
27. Dr. Sasikumar, Chief Physician, Nechiyil
17. Dr. D. K. Dwivedi, Medical
Ayurveda Vaidyasala and Nursing
Superintendent, S. R. M. Government
Home, Karalmana, Palakkad, Kerala
Ayurveda College and Hospital,
Bareilly, Uttar Pradesh 28. Professor Y. K. Sharma, Principal cum
Dean & Head, Dept. of Kayachikitsa,
18. Dr. Kishor Sinh Chudasama, Former
Rajiv Gandhi Govt Ayurvedic College,
Principal, Sheth J. P. Govt. College,
Paprola, Distt. – Kangra, Himachal
Bhavnagar, Gujarat
Pradesh
29. Dr V. N. K. Usha, Professor, Dept. of 38. Dr. Neru Nathani, Assistant Prof., Dept.
Stree Roga and Prasutitantra, SDM of Swasthavritta and Yoga, Faculty of
college of Ayurveda, P.O. Kuthpady, Ayurveda, Institute of Medical Sciences,
Udupi, Karnataka Banaras Hindu University, Varanasi
30. Dr A. R. V. Murthy, Dean & Medical 39. Dr. Dinesh K S, Assistant Prof., Dept.
Superintendent, Atreya Ayurvedic of Kaumar Bhritya, VPSV Ayurveda
Medical College, Hospital & Research College, Edarikkode, Kottakal, Kerala
Center, Doddaballapura, Bangalore
40. Dr. A. R. Trivedi, Former, Head, Dept. of
31. Dr. Vijay Chaudhary, Reader, Dept.
Kaumarbhritya, Shri Gulab Kunverba
of Kayachikitsa, Rajiv Gandhi Govt
Ayurved Mahavidyalaya, Jamnagar,
Ayurvedic College, Paprola, Distt. –
Gujarat
Kangra, Himanchal Pradash
41. Dr. Girish K.J., Reader, Dept. of
32. Dr. Mukund Sabnis, Consultant,
Jeevan Rekha Ayurved Chikitsalaya Kayachikitsa, SDM College of
and Research Center, Aurangabad, Ayurveda, BM Road, Thanniruhalla,
Maharashtra Hassan, Karnataka
33. Dr. Bharti, Assistant Director-In-Charge, 42. Dr. Govind Reddy, Research officer
Central Ayurveda Research Institute (Ayu), In-charge, R.R.A. Podar, Central
for Cardiovascular Diseases, Central Ayurveda Research institute for Cancer,
Council for Research in Ayurvedic Mumbai.
Sciences, New Delhi
43. Dr. Manohar Gundeti, Research officer
34. Dr. Renu Singh, Research Officer (Ayu) R.R.A. Podar, Central Ayurveda
(Ayu), Central Council for Research in Research institute for cancer, Mumbai
Ayurvedic Sciences, New Delhi
44. Dr. Bhavana Prasher, Ayurved Scientist,
35. Professor Ena Sharma, Head, Dept. of
Institute of Genomics & Integrative
PTSR, Rajiv Gandhi Govt. Ayurveda
Biology, New Delhi
College, Paprola, Distt. – Kangra,
Himachal Pradesh 45. Dr. Rakhi Mehra, Former Assistant
36. Dr. Prashantha A. S., Professor, Dept. of Director-In-charge, Central Ayurveda
Kayachikitsa, Ayurved Mahavidyalaya Research Institute for Cardiovascular
and Hospital, Hubli, Karnataka Diseases, Central Council for Research
in Ayurvedic Sciences, New Delhi
37. Professor Bishnu Prasad Sharma,
Head, Dept. of Kayachikitsa, Govern-
ment Ayurvedic college and Hospital,
Guwahati
3. Professor Dhiman K., Director General, 13. Dr. Hitesh Vyas, Associate Prof., Dept.
Central Council for Research in of Basic Principles, Institute for Post
Ayurvedic Sciences, New Delhi Graduate Teaching & Research in
Ayurveda, Jamnagar, Gujarat
4. Professor Sanjay Gupta, Head, Dept. of
14. Dr. Galib, Associate Prof., Dept. of
Shalya, All India Institute of Ayurveda,
Rasashastra & Bhaishjya Kalpana, All
New Delhi
India Institute of Ayurveda, New Delhi
5. Professor L. P. Dei, Incharge Director,
15. Dr. T. S. Dudhamal, Incharge Head,
& Head, Dept. of Stree Roga and
Associate Prof., Dept. of Shalya, Institute
Prasutitantra, Institute for Post Graduate
for Post Graduate Teaching & Research
Teaching & Research in Ayurveda,
in Ayurveda, Jamnagar
Jamnagar, Gujarat
16. Dr. D. B. Vaghela, Incharge Head,
6. Professor Manjusha Rajgopala, Head,
Associate Prof., Dept. of Shalakya,
Dept. of Shalakya, All India Institute of
Institute for Post Graduate Teaching &
Ayurveda, New Delhi
Research in Ayurveda, Jamnagar
7. Professor K. S. Nisteshwar, Ex Head,
17. Dr. Rajgopala S, Associate Prof., Dept.
Dept. of Dravyaguna, Institute for
of Kaumarabhitya, All India Institute of
Post Graduate Teaching & Research in
Ayurveda, New Delhi
Ayurveda, Jamnagar, Gujarat
18. Dr. Shilpa Donga, Associate Prof., Dept.
8. Professor S. H. Acharya, Dept. of
of Stree Roga and Prasutitanta, Institute
Pachakarma, Institute for Post Graduate
for Post Graduate Teaching & Research
Teaching & Research in Ayurveda,
in Ayurveda, Jamnagar, Gujarat
Jamnagar, Gujarat
19. Dr A R Dave, Incharge Head, Associate
9. Professor M. K. Vyas, Head, Dept. of
Prof., Dept. of Kayachikitsa, Institute for
Basic Principles, All India Institute of
Post Graduate Teaching & Research in
Ayurveda, New Delhi
Ayurveda, Jamnagar, Gujarat
10. Professor R. N. Acharya, Head, Dept. of
20. Dr. Darshana Pandya, Assistant Prof.,
Dravyaguna, Institute for Post Graduate
Dept. of Roga Nidan, Institute for Post
Teaching & Research in Ayurveda,
Graduate Teaching & Research in
Jamnagar, Gujarat
Ayurveda, Jamnagar, Gujarat
In last twenty years or so Ayurveda sector has witnessed an upsurge globally. The personalized
medicine approach of Ayurveda and the huge diversity in Ayurvedic formulations have always
been glorified by supporters of Ayurveda including practitioners and scientists. At the same
time the same strengths have been used by others as impediments for its wider implementation
at public health. The National Health Policy 2017 of India has strongly recommended for
integrating Ayurveda in main health care delivery. The health policy has focussed on attaining
Sustainable Development Goals 3 (SDG 3) identified by United Nations (UN). The Ministry
of AYUSH, Government of India in an effort to streamline the implementation of Ayurveda
services, has developed Ayurvedic Essential Drug List (EDL). The issue of quality of Ayurvedic
drugs is also being addressed by developing Ayurvedic Pharmacopoeia of India. Development
of Ayurvedic Standard Treatment Guidelines is the next step in standardising the Ayurveda
services and their mainstreaming in Public Health.
The work of developing this document has been going on for over two years. It has gone
through wider consultation involving experts of different Ayurvedic subjects across the country.
Ayurveda practices in different parts of country have lot of diversity owing to availability of
local natural resources as well as local Vaidya traditions. The major challenge faced was to
arrive at consensus on Ayurvedic formulations to be prescribed for different disease conditions
with respect to available Clinical Infrastructure i.e. PHC/CHC/ DH. There were also issues
in identifying nearest correlation between Ayurvedic understandings of various disease
conditions with their allopathy counterpart. The scientists and experts having understanding
of both systems would understand easily the difficulties underlying.
The guidelines are neither prescriptive nor restrictive but are more facilitative in nature. The
guidelines doesn’t restrict Ayurveda practitioners for using various formulations as per their
wisdom, knowledge of Ayurveda and experience. This is a maiden effort to extract the wider
scope of Ayurveda practices and accommodate them in to a relatively restrictive format. For
this purpose 38 most common disease conditions commonly found in general practice have
been shortlisted. The format has been developed considering the available infrastructure and
resources at Primary Health Center (PHC) where only OPD facility is available, Community
Health Center (CHC) having 20 beds and District Hospital (DH) which has 50 beds and
good diagnostic labs. While developing this document, efforts have been made to explain
the case and treatment on Ayurvedic principles and thereby to retain the soul of Ayurveda.
At the same time conventional terminology has been used so that the document should be
easy to understand for every stakeholder. The introduction and case definition explained
at the beginning of every disease condition narrates the clinical condition making it easy to
understand to all stake holders. The references in support of treatment recommended have
been listed in scientific manner at the end of every chapter. Thus, an effort has been made to
make these guidelines more scientific and practical for implementation. The document will be
useful not only to young Ayurveda graduates but also could be useful to supporting staff and
non-Ayurveda practitioners so as to reach to the last person in the society to realize the dream
and intention of “Health for All” of the Government. The document, first of its kind would also
be useful to policy makers in future policy making, to regulators for promoting good Ayurveda
services as well as to Insurance sector to provide wider coverage to Ayurveda treatment and
services. The document would also be useful in Government’s drive for promoting Ayurveda
based Medical and Wellness Tourism.
The document has undergone nearly six reviews to eliminate any kind of discrepancy. However,
Ministry would welcome suggestions or further improvements, which in consultation with
experts and after authentication could be accommodated in next edition.
Ayurveda is the most ancient system of medicine of Indian origin and is equally relevant in
modern times. It is the knowledge base of life which, in addition to description of clinical profile
of diseases, various etiological factors – primary or secondary, the etio-pathogenesis, different
stages of disease progression, stage wise medical intervention, the prognosis and all such other
clinical details; has also described in detail the dietary substances, various physical and mental
activities, role of various epigenetic factors, methods for promotion of health, Community and
social medicine etc. Ayurveda has also emphasised on social and spiritual wellbeing. The beauty
of Ayurveda lies in the flexibility it has provided to clinicians in application part i.e. choice of
medicinal plants, drug formulations, dosage forms etc. which may vary depending upon the
availability of raw material according to geo-climatic conditions without compromising with
the fundamental principles.
India is bestowed with rich bio-diversity. The Himalayan ranges, North east India, Western
Ghats from Gujarat and extending up to southern tip of India in Kerala are bio-diversity
hotspots. Around 6000 plant varieties are found in India, out of which 600 are commonly
used. But that doesn’t mean that other are not used at all. Certain varieties are used in
certain pockets depending upon the traditions. Some medicinal plants entered in to main
stream Ayurvedic practice through folklore practices are also within the ambit of Ayurvedic
principles. According to Ayurveda principles every substance available on earth has some or
the other medicinal property. At the same time, Ayurveda has also described the mechanism
of adopting various natural resources in to main stream practice. Many Vaidya traditions have
some unique specialties of practices those have traversed through generations in their family.
Most of them have come from their long standing observations, understanding and experience.
Often, a medicinal plant or part thereof has many medicinal uses; out of those some could be
popular where as some may not. Apparently, one may find strange the unpopular use, but
may find their mention in ancient classical text. For e.g. plant parts like leaf, bark, stem, roots
are commonly used in Ayurvedic medicines. However, flowers are not frequently used. This is
because, they are season specific and perishable and also difficult to store.
In India, Ayurveda education and clinical practices are regulated under Indian Medicine
Central Council Act, 1970 whereas; Ayurveda drugs are regulated under Drugs & Cosmetics
Act, 1940 and Rules 1945. Enrolment of Ayurveda Clinical practitioners in State Register is
regulated under State (Provincial) Ayurveda Practitioners Acts of relevant States. Uniformity
of curricula and syllabi of graduation level degree course and Post Graduate degree courses in
various specialties has been maintained throughout the country. However, there is also wide
diversity observed in the prescriptions of Vaidyas in different parts of the country, which is
within the broad frame work of Ayurveda practices recognized under different legislative
provisions in force.
As per the market trends, currently Ayurveda practices are gradually shifting on pharma based
products readily available in market. Nevertheless, few Vaidyas continue to prepare classical
medicines on their own and also have their own formulations. This is very much legal as per
the provisions under Drugs and Cosmetics Act, 1940.
Ayurveda practices are not only the prescriptions of medicines but also include various
procedures. They include Panchakarma procedures, Marma Therapy, Viddha Karma, Agni Karma,
Upakalpana, dietary preparations etc.
With the onset of National Health Mission (NHM) in the year 2005, Ayurveda received major
boost towards mainstreaming in public health through which, Ayurveda services are being
made available at Primary Health Centres as well as at District Hospitals. In the year 2014, the
then Department of AYUSH under Ministry of Health and family Welfare was elevated to a
separate Ministry making clear that Ayurveda is one of the thrust area identified by Government
towards major reforms in the developing New India. This started a new era for major upsurge
for Ayurveda nationwide. These efforts are further augmented by the Ministry of AYUSH
with the implementation of National AYUSH Mission (NAM). Presently, Ayurveda services
are available in nearly 40% of PHCs throughout the country. At the same time, there is also rise
of Ayurveda infrastructure in private sector. The Ministry of AYUSH has also encouraged for
development of tertiary care through Ayurveda. Development All India Institute of Ayurveda
at New Delhi is a major milestone in this regard. Ministry of AYUSH, Government of India
has also encouraged private sector to develop tertiary care services through Ayurveda. As a
result, few Ayurveda specialty hospitals have come up in private sector in recent past. There is
increasing trend in well reputed allopathy corporate hospitals to start Ayurveda wing.
With this background, it was felt necessary to develop an authentic document which could
provide some basic guidelines about Ayurvedic practices. The present document would be
useful not only to Ayurveda practitioners but also to regulators, policy makers as well as to
International community in supporting Ayurveda practices.
Developing the Ayurvedic Standard Treatment Guidelines was a stiff task considering
the diversity in the choice of medicines and the regional variation and also considering that all
of them are scientific and are based on Ayurvedic principles. Therefore, the task was primarily
assigned to “Institute of Post Graduate Teaching and Research in Ayurveda”, (IPGT&RA)
Jamnagar and “National Institute of Ayurveda”, (NIA) Jaipur. Both these are top-notch
premier institutes of Ayurveda having international repute. I am highly indebted to Directors
and faculty of these institutes for whole heartedly supporting in this endeavour. This being the
maiden document, took long time for completion. The initial phase was more crucial wherein
the template and skeletal content were to be framed. It involved lot of energy. This could be
achieved because of dynamic leadership of Prof. M.S. Baghel, the then Director of IPGT&RA,
Jamnagar and strongly supported by Vaidya Rajesh Kotecha, the then Vice Chancellor of
Gujarat Ayurveda University and presently Secretary to Government of India, Ministry of
AYUSH. I am also thankful to Prof. Sanjeev Sharma, the present Director of NIA Jaipur, for
his support in the last and final phase of completing this document. The coordination of the
project was skilfully handled by Dr. Mandip Goyal, Associate Prof. of Kayachikitsa, IPGT & RA
Jamnagar. Dr. Prakash Mangalasseri, Associate Prof. Kayachikitsa, Ayurveda College Kottakal
had always been resourceful and supportive for getting the job completed.
Senior faculty from nearly 32 Ayurveda Institutes including All India Institute of
Ayurveda, New Delhi; Faculty of Ayurveda, Banaras Hindu University; Ayurveda College,
Kottakal; Ch. Brahm Prakash Ayurved Charak Sansthan New Delhi; Rajiv Gandhi Government
Post-Graduate Ayurvedic College, Paprola; SDM Ayurveda College, Hassan & Udupi; Central
Council for Research in Ayurvedic Sciences etc. were involved in developing this document.
Their names and specialty has been listed under list of contributors. The responsibility of
designing, proof checking etc. and getting the printed this document was assigned to Rashtriya
Ayurveda Vidyapeeth, New Delhi. Mr. N. Ramakrishnan, A.O. RAV and Dr. Varun Gupta
efficiently handled this responsibility to complete the task in time bound manner.
Most importantly I am grateful to Sh. Shripad Naik, Hon’ble Minister of State,
Independent Charge for Ministry of AYUSH, Government of India for his vision, guidance
and continuous support.
Tab Tablet
TB Tuberculosis
TIA Transient Ischaemic Attack
TLC Total Leucocyte Counts
TRUS Trans Rectal Ultra Sonography
TSH Thyroid-Stimulating Hormone
tsp teaspoon
U/Lit Unit per Litre
USG Ultra Sonography
UTI Urinary Tract Infection
VDRL test Venereal Disease Research Laboratory test
Vol. Volume
17. Artavavaha Srotas The channel that carries menstrual fluid and ovum; consists
of female reproductive system i.e. fallopian tubes, ovaries,
uterus and vaginal canal
18. Bala Strength
19. Balya An energizer that gives strength to the body
20. Bhasma Substance obtained by calcination
21. Basti It refers to the enema therapy under Panchakarma. Basti is
the most effective treatment of Vata disorder. In Ayurveda
Basti involves the introduction of herbal solution and oil
preparations in the rectum.
22. Chakhyushya Substances that are good for eyes
23. Churna Powder
24. Chikitsa Treatment, a therapy to retain balance of Doshas, practice or
science of medicine.
25. Dhatu Basic structural and nutritional body factor that supports or
nourishes the seven body tissues. These seven tissues of our
body includes the rasa, Rakta, Mamsa, Meda, Asthi, Majja and
Shukra.
26. Deepaniya Natural substances that kindle the gastric fire and augment
the appetite
27. Dinacharya Daily routine to be followed in day to day practice
28. Dushti Unhappiness, imbalanced, improper functioning
29. Ghrita (Ghee) Clarified butter made by heating unsalted butter from cow
especially
30. Hina yoga Insufficient, deficient
31. Jala Water
32. Jalauka Leech
33. Jathara Stomach, belly or abdomen
34. Jatharagni Fire located in stomach, digestive fire, gastric juices,
digestive enzymes
35. Kala Time, period, season
36. Kalka Paste of herbs to be used for medicinal purposes
37. Kapha It is one of the three Doshas i.e. the water humour, the
intracellular fluid and the extra cellular fluid that plays
significant role in the nutrition and existence of body cells
and tissues
38. Kashaya Astringent taste or flavour; sometimes use for decoction of
herbs
39. Katu Pungent taste or flavour
40. Kaumarabhrtya The branch of Ayurveda that deals with child health
(Paediatrics)
41. Kayachikitsa Internal Medicine, treatment of body diseases,
42. Kshara Alkali preparations of herbs
43. Kriyakalpa Medical procedures used in eye treatment
44. Laghu Light, small, minute
45. Langhana Depletion therapy, slimming therapy makes body thin and
light
46. Lavana Salty taste of flavour
47. Lekhaniya Substances that have scraping actions on body tissues
48. Madhu Honey
49. Majja Bone marrow
50. Mala Waste products that are to be excreted out of the body. It
primarily includes urine, faeces and sweat
51. Mana Mind
52. Manovaha Srotas The channel that carries thought, feelings and emotions;
refers to the entire mind
53. Meda It is the fat tissue supported by Mamsa Dhatu
54. Madhura Sweet taste of flavour, pleasant, charming, delightful
55. Mamsa Muscles and related systems in body
56. Mamsavaha Srotas Channels transporting to the muscles and related tissues
57. Medhya That which enhances wisdom, mental power and intelligence
58. Medovaha Srotas Channels transporting to fat and related tissues
59. Mithyaayoga Wrong use, wrong employment
80 Table 25.4: Medicines at level 3 for Kashtaartava with heavy bleeding 167
81 Table 25.5: Medicines at level 3 for Kashtaartava with scanty bleeding 167
INTRODUCTION 1
15 Bhagandara 104
16 Krimi 109
17 Parikartika 113
VATA VYADHI
27 Avabahuka 177
28 Katigraha 182
29 Gridhrasi 189
30 Pakshaghata 196
31 Sandhigata Vata 215
32 Vatarakta 220
NETRAGATA ROGA
33 Abhishyanda 227
34 Adhimantha 237
APPENDIX -
Atura Pariksha Patrak 277
Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH)
Government of India
AYUSH BHAWAN
B Block, GPO Complex,
INA, New Delhi-110023, India
Telefax: 011-24651964
Website: www.ayush.gov.in
© Copyright 2017, ministry of ayush, government of india. Any part of this document may be
reproduced, copied or adapted to meet local needs, without permission from ministry of ayush,
provided that the parts reproduced are not tinkered and are distributed free of charge or at no
cost – not for profit.
Executive Editor
Vaidya Manoj Nesari
Adviser (Ay)
Ministry of AYUSH
AYUSH BHAWAN
B Block, GPO Complex,
INA, New Delhi-110023, India
Collaborative Institutes
Institute for Postgraduate Teaching &
Research in Ayurveda, Jamnagar
and
National Institute of Ayurveda, Jaipur
Executive Editor
Vaidya Manoj Nesari,
Adviser (Ay)
Ministry of AYUSH, Govt of India, New Delhi
Editors
Professor M. S. Baghel
Former Director, IPGT&RA, Jamnagar
Professor Anup Thakar
Director, IPGT&RA, Jamnagar
Dr. S. K. Khandel
Former Head, Dept. of Roga Nidan, NIA, Jaipur
Dr. Pawan Godatwar
Professor, Dept. of Roga Nidan, NIA, Jaipur
Dr. Prakash Mangalasseri
Associate Professor, Dept. of Kayachikitsa, VPSV Ayurveda College,
Edarikkode, Kottakal, Kerala
Coordinator
Dr. Mandip Goyal
Associate Professor, Dept. of Kayachikitsa, IPGT&RA, Jamnagar
Peer Reviewers:
1. Professor Gurdip Singh, Former 6. Dr. S. N. Gupta, Head, Dept. of
Director, IPGT&RA, Jamnagar Kayachikitsa, J. S. Ayurveda College,
2. Professor R. H. Singh, Professor Nadiad –Gujarat
Emeritus, Faculty of Ayurveda BHU, 7. Professor Tanuja Nesari, Head, Dept. of
Varanasi Dravyaguna, AIIA, New Delhi
3. Professor R. B. Dwivedi, Former Director
8. Professor Meeta Kotecha, Head, Dept. of
& Head, Dept. of Basic Principles,
Dravyaguna, NIA, Jaipur
IPGT&RA, Jamnagar
9. Professor Mahesh Chandra Sharma,
4. Professor Abhimanyu Kumar, Director,
Former Director, NIA, Jaipur
AIIA, New Delhi
5. Professor H. M. Chandola, Former 10. Dr. Haridra Dave, Head, Dept. of
Director/ Principal, CBPACS, Najafgarh, Shalakya Tantra, J. S. Ayurveda College,
New Delhi Nadiad -Gujarat
11. Dr. B. M. Singh, Dept. of Kaumarbhritya, 22. Dr. Jayant Deopujari, Consultant,
Faculty of Ayurveda, BHU, Varanasi Shrinidhi Ayurveda Panchakarma
Chikitsalaya, Nagpur, Maharashtra
12. Dr. Ved Prakash Vyas, Dept. of Bal
Roga, Govt. Dhanwantri Ayurved 23. Dr. Manoj A. K., Professor, Dept. of
College, Ujjain Panchakarma, VPSV Ayurveda College,
Edarikkode, Kottakal, Kerala.
13. Dr. Eswar Sarma, Principal, VPSV
Ayurveda College, Edarikkode, 24. Professor Umesh Shukla, Principal,
Kottakal, Kerala Pt. Khushilal Sharma Government
Ayurveda College, Bhopal
14. Dr. P. Rammanohar, Research Director,
25. Dr. B. L. Mehra, HOD Kayachikitsa,
Amrita Center for Advanced Research
R.G. Govt. Ayurvedic College, Paprola,
in Ayurveda, Amritapuri, Kerala
Kangra (H.P.)
15. Professor A. K. Tripathi, Director,
26. Dr. Rakesh Sharma, Reader, Dept
Ayurved and Unani Services, Dehradun,
of Balaroga PG Section, R.G. Govt.
Uttarakhand
Ayurvedic College, Paprola, Kangra
16. Dr. M. M. Padhi, Deputy Director, (H.P.)
CCRAS, New Delhi
27. Dr. Sasikumar, Nechiyil Ayurveda
17. Dr. D. K. Dwivedi, S. R. M. Government Vaidyasala and Nursing Home,
Ayurveda College and Hospital, Bareilly Karalmana, Palakkad, Kerala
Dept. of Surgery Uttar Pradesh 28. Professor Y. K. Sharma, Principal cum
18. Dr. Kishor Sinh Chudasama, Former Dean & HOD – Kayachikitsa, Rajiv
Principal, Sheth J. P. Govt. College, Gandhi Govt Ayurvedic College,
Bhavnagar, Gujarat Paprola, Distt. – Kangra, Himachal
Pradesh
19. Dr. Srinivas Acharya, Professor &
Head – Dept. of Kayachikitsa, Sri 29. Dr VNK Usha, Dept. of Dtree roga and
Dharmasthala Manjunatheshwara Prasuti tantra, SDM college of Ayurveda,
College of Ayurveda, P. O. Kuthpady, P.O. Kuthpady, Udupi, Karnataka
Udupi, Karnataka 30. Dr A R V Murthy, Dean & Medical
20. Vd. Tapan Vaidya, Associate Professor Superintendent, Atreya Ayurvedic
Dept. of Kayachikitsa, J.S. Ayurveda Medical College, Hospital & Research
College, Nadiad – Gujarat Center, Doddaballapura, Bangalore
21. Professor Manda Ghorpade, Professor, 31. Dr. Vijay Chaudhary, Reader –
H.O.D. Streeroga Prasutitantra Kayachikitsa, Rajiv Gandhi Govt
Dept, Sumatibhai Shalu Ayurved Ayurvedic College, Paprola, Distt. –
Mahavidyalaya Hadapsar, Pune, Kangra, Himanchal Pradash
Maharashtra
32. Dr. Mukund Sabnis, Consultant, 39. Dr. Dinesh K S, Asst. Professor, Dept.
Jeevan Rekha Ayurved Chikitsalaya of Kaumar Bhritya, VPSV Ayurveda
and Research Center, Aurangabad, College, Edarikkode, Kottakal, Kerala
Maharashtra
40. Dr. A. R. Trivedi, Former, HOD,
33. Dr. Bharti, Assistant Director-In-Charge, Kaumarbhritya, Shri Gulab Kunverba
Central Ayurveda Research Institute for Ayurved Mahavidyalaya, Jamnagar,
Cardiovascular Diseases, CCRAS, New
Gujarat
Delhi
41. Dr. Girish K.J., Reader, Dept. of
34. Dr. Renu Singh, Research Officer (Ayu),
Kayachikitsa, SDM College of
CCRAS, New Delhi
Ayurveda, BM Road, Thanniruhalla,
35. Professor Ena Sharma, Head, Dept. of
Hassan, Karnataka
PTSR, Rajiv Gandhi Govt. Ayurveda
College, Paprola, Distt. – Kangra, 42. Dr. Govind Reddy, Research officer
Himachal Pradesh (Ayu), In-charge, R.R.A. Podar, Central
Ayurveda Research institute for Cancer,
36. Dr. Prashantha A. S., Professor, Ayurved
Mahavidyalaya and Hospital, Hubli, Mumbai.
Karnataka 43. Dr. Manohar Gundeti, Research officer
37. Professor Vishnuprasad Sharma, (Ayu) R.R.A. Podar, Central Ayurveda
Department of Kayachikitsa, Govern- Research institute for cancer, Mumbai
ment Ayurvedic college and Hospital, 44. Dr. Bhavana Prasher, Ayurved Scientist,
Guwahati
IGIB, New Delhi
38. Dr. Neru Nathani, Assistant Professor,
45. Dr. Rakhi Mehra, Former Assistant
Department of Swasthavritta and Yoga,
Director-In-charge, Central Ayurveda
Faculty of Ayurveda, Institute of Medical
Research Institute for Cardiovascular
Sciences, Banaras Hindu University,
Varanasi Diseases, CCRAS, New Delhi
In last twenty years or so Ayurveda sector has witnessed gradual upsurge globally.
The personalized medicine approach of Ayurveda and the huge diversity in Ayurvedic
formulations have always been glorified by supporters of Ayurveda including practitioners
and scientists. At the same time the same strengths have been used by others as impediments
for its wider implementation at public health. The National Health Policy 2017 of India has
strongly recommended for integrating Ayurveda in main health care delivery. The health
policy has focussed on attaining sustainable development goals 3 (SDG 3) identified by United
Nations (UN). The Ministry of AYUSH, Government of India in an effort to streamline the
implementation of Ayurveda services, has developed Ayurvedic Essential Drug List (EDL).
The issue of quality of Ayurvedic drugs is also being addressed by developing Ayurvedic
Pharmacopoeia of India. Development of Ayurvedic Standard Treatment Guidelines is the
next step in standardising the Ayurveda services and their mainstreaming in Public Health.
The work of developing this document has been going on for over two years. It has gone
through wider consultation involving experts of different Ayurvedic subjects across the country.
Ayurveda practices in different part of country have lot of diversity owing to availability of
local natural resources as well as local Vaidya traditions. The major challenge faced was to
arrive at consensus on Ayurvedic formulations to be prescribed for different disease conditions
with respect to available Clinical Infrastructure i.e. PHC/CHC/ DH. There were also issues
in identifying nearest correlation between Ayurvedic understandings of various disease
conditions with their allopathy counterpart. The scientists and experts having understanding
of both systems would understand easily the difficulties underlying.
The guidelines are neither prescriptive nor restrictive but are more facilitative in nature. The
guidelines doesn’t restrict Ayurveda practitioners for using various formulations as per their
wisdom, knowledge of Ayurveda and experience. This is a maiden effort to extract the wider
scope of Ayurveda practices and accommodate them in to a relatively restrictive format. For
this purpose 40 most common disease conditions commonly found in general practice have
been shortlisted. The format have been developed considering the available infrastructure and
resources at primary health center (PHC) where only OPD facility is available, Community
health Center (CHC) having 20 beds and District Hospital (DH) which has 50 beds and good
diagnostic labs. While developing this document efforts have been made to explain the case
and treatment on Ayurvedic principles and thereby to retain the soul of Ayurveda. At the same
time conventional terminology has been used so that the document should be easy understand
for every stakeholder. The introduction and case definition explained at the beginning of every
disease condition narrates the clinical condition making it easy to understand to all stake
holders. The references in support of treatment recommended have been listed in scientific
manner at the end of every chapter. Thus, an effort has been made to make these guidelines
more scientific and practical for implementation. The document will be useful not only to
young Ayurveda graduates but also could be useful to supporting staff and non-Ayurveda
practitioners so as to reach to the last person in the society to realize the dream and intention
of ‘Health for All” of the Government. The document, first of its kind would also be useful to
policy makers in future policy making, to regulators for promoting good Ayurveda services as
well as to Insurance sector to provide wider coverage to Ayurveda treatment and services. The
document would also be useful in Government’s drive for promoting Ayurveda based Medical
and Wellness Tourism.
The document has undergone nearly six reviews to eliminate any kind of discrepancy. However,
Ministry would welcome suggestions or further improvements, which in consultation with
experts and after authentication could be accommodated in next edition.
Ayurveda is the most ancient system of medicine of Indian origin and is equally relevant in
modern times. It is the knowledge base of life which, in addition to description of clinical profile
of diseases, various etiological factors – primary or secondary, the etio-pathogenesis, different
stages of disease progression, stage wise medical intervention, the prognosis and all such other
clinical details; has also described in detail the dietary substances, various physical and mental
activities, role of various epigenetic factors, methods for promotion of health, Community and
social medicine etc. Ayurveda has also emphasised on social and spiritual wellbeing. The beauty
of Ayurveda lies in the flexibility it has provided to clinicians in application part i.e. choice of
medicinal plants, drug formulations, dosage forms etc. which may vary depending upon the
availability of raw material according to geo-climatic conditions without compromising with
the fundamental principles.
India is bestowed with rich bio-diversity. The Himalayan ranges, North east India, Western
Ghats from Gujarat and extending up to southern tip of India in Kerala are bio-diversity
hotspots. Around 6000 plant varieties are found in India, out of which 600 are commonly
used. But that doesn’t mean that other are not used at all. Certain varieties are used in
certain pockets depending upon the traditions. Some medicinal plants entered in to main
stream Ayurvedic practice through folklore practices are also within the ambit of Ayurvedic
principles. According to Ayurveda principles every substance available on earth has some or
the other medicinal property. At the same time, Ayurveda has also described the mechanism
of adopting various natural resources in to main stream practice. Many Vaidya traditions have
some unique specialties of practices those have traversed through generations in their family.
Most of them have come from their long standing observations, understanding and experience.
Often, a medicinal plant or part thereof has many medicinal uses; out of those some could be
popular where as some may not. Apparently, one may find strange the unpopular use, but
may find their mention in ancient classical text. For e.g. plant parts like leaf, bark, stem, roots
are commonly used in Ayurvedic medicines. However, flowers are not frequently used. This is
because, they are season specific and perishable and also difficult to store.
In India, Ayurveda education and clinical practices are regulated under Indian Medicine
Central Council Act, 1970 whereas; Ayurveda drugs are regulated under Drugs & Cosmetics
Act, 1940 and Rules 1945. Enrolment of Ayurveda Clinical practitioners in State Register is
regulated under State (Provincial) Ayurveda Practitioners Acts of relevant States. Uniformity
of curricula and syllabi of graduation level degree course and Post Graduate degree courses in
various specialties has been maintained throughout the country. However, there is also wide
diversity observed in the prescriptions of Vaidyas in different parts of the country, which is
within the broad frame work of Ayurveda practices recognized under different legislative
provisions in force.
As per the market trends, currently Ayurveda practices are gradually shifting on pharma based
products readily available in market. Nevertheless, few Vaidyas continue to prepare classical
medicines on their own and also have their own formulations. This is very much legal as per
the provisions under Drugs and Cosmetics Act, 1940.
Ayurveda practices are not only the prescriptions of medicines but also include various
procedures. They include Panchakarma procedures, Marma Therapy, Viddha Karma, Agni Karma,
Upakalpana, dietary preparations etc.
With the onset of National Health Mission (NHM) in the year 2005, Ayurveda received major
boost towards mainstreaming in public health through which, Ayurveda services are being
made available at Primary Health Centres as well as at District Hospitals. In the year 2014, the
then Department of AYUSH under Ministry of Health and family Welfare was elevated to a
separate Ministry making clear that Ayurveda is one of the thrust area identified by Government
towards major reforms in the developing New India. This started a new era for major upsurge
for Ayurveda nationwide. These efforts are further augmented by the Ministry of AYUSH
with the implementation of National AYUSH Mission (NAM). Presently, Ayurveda services
are available in nearly 40% of PHCs throughout the country. At the same time, there is also rise
of Ayurveda infrastructure in private sector. The Ministry of AYUSH has also encouraged for
development of tertiary care through Ayurveda. Development All India Institute of Ayurveda
at New Delhi is a major milestone in this regard. Ministry of AYUSH, Government of India
has also encouraged private sector to develop tertiary care services through Ayurveda. As a
result, few Ayurveda specialty hospitals have come up in private sector in recent past. There is
increasing trend in well reputed allopathy corporate hospitals to start Ayurveda wing.
With this background, it was felt necessary to develop an authentic document which could
provide some basic guidelines about Ayurvedic practices. The present document would be
useful not only to Ayurveda practitioners but also to regulators, policy makers as well as to
International community in supporting Ayurveda practices.
Developing the Ayurvedic Standard Treatment Guidelines was a stiff task considering
the diversity in the choice of medicines and the regional variation and also considering that
all of them are scientific and are based on Ayurvedic principles. Therefore, the task was
primarily assigned to “Institute of Post Graduate Teaching and Research in Ayurveda”,
(IPGT&RA) Jamnagar and “National Institute of Ayurveda”, (NIA) Jaipur. Both these are top-
notch premier institutes of Ayurveda having international repute. I am highly indebted to
Directors and faculty of these institutes for whole heartedly supporting in this endeavour.
This being the maiden document, took long time for completion. The initial phase was more
crucial wherein the template and skeletal content were to be framed. It involved lot of energy.
This could have been possible because of dynamic leadership of Prof. M.S. Baghel, the then
Director of IPGT&RA, Jamnagar and strongly supported by Vaidya Rajesh Kotecha, the then
Vice Chancellor of Gujarat Ayurveda University and presently Secretary to Government of
India, Ministry of AYUSH. I am also thankful to Prof. Sanjeev Sharma, the current Director
of NIA Jaipur, for his support in the last and final phase of completing this document. The
coordination of the project was skilfully handled by Dr. Mandip Goyal, Associate Prof. of
Kayachikitsa, IPGT & RA Jamnagar. Dr. Prakash Mangalasseri, Associate Prof. Kayachikitsa,
Ayurveda College Kottakal had always been resourceful and supportive for getting the job
completed.
Senior faculty from nearly 32 Ayurveda Institutes including Faculty of Ayurveda,
Banaras Hindu University; Ayurveda College, Kottakal; Ch. Brahm Prakash Ayurved Charak
Sansthan New Delhi; Tilak Ayurveda College; Pune; R. R. A.Podar,Central Ayurveda Research
Institute for Cancer, Mumbai; SDM Ayurveda College, Hassan; SDM Ayurveda College
Udupi; Ayurveda College Belgaum etc. were involved in developing this document. Their
names and specialty has been listed under list of contributors. The responsibility of designing,
proof checking etc. and getting the printed this document was assigned to Rashtriya Ayurveda
Vidyapeeth, New Delhi. Mr. N. Ramakrishnan, A.O. RAV and Dr. Varun Gupta efficiently
handled this responsibility to complete the task in time bound manner.
Most importantly I am grateful to Sh. Shripad Naik, Hon’ble Minister of State,
Independent Charge for Ministry of AYUSH, Government of India for his vision, guidance
and continuous support.
Tab Tablet
TB Tuberculosis
TIA Transient Ischaemic Attack
TLC Total Leucocyte Counts
TRUS Trans Rectal Ultra Sonography
TSH Thyroid-Stimulating Hormone
tsp teaspoon
U/Lit Unit per Litre
USG Ultra Sonography
UTI Urinary Tract Infection
VDRL test Venereal Disease Research Laboratory test
Vol. Volume
17. Artavavaha Srotas The channel that carries menstrual fluid and ovum; consists
of female reproductive system i.e. fallopian tubes, ovaries,
uterus and vaginal canal
18. Bala Strength
19. Balya An energizer that gives strength to the body
20. Bhasma Substance obtained by calcination
21. Basti It refers to the enema therapy under Panchakarma. Basti is
the most effective treatment of Vata disorder. In Ayurveda
Basti involves the introduction of herbal solution and oil
preparations in the rectum.
22. Chakhyushya Substances that are good for eyes
23. Churna Powder
24. Chikitsa Treatment, a therapy to retain balance of Doshas, practice or
science of medicine.
25. Dhatu Basic structural and nutritional body factor that supports or
nourishes the seven body tissues. These seven tissues of our
body includes the rasa, Rakta, Mamsa, Meda, Asthi, Majja and
Shukra.
26. Deepaniya Natural substances that kindle the gastric fire and augment
the appetite
27. Dinacharya Daily routine to be followed in day to day practice
28. Dushti Unhappiness, imbalanced, improper functioning
29. Ghrita (Ghee) Clarified butter made by heating unsalted butter from cow
especially
30. Hina yoga Insufficient, deficient
31. Jala Water
32. Jalauka Leech
33. Jathara Stomach, belly or abdomen
34. Jatharagni Fire located in stomach, digestive fire, gastric juices,
digestive enzymes
35. Kala Time, period, season
36. Kalka Paste of herbs to be used for medicinal purposes
37. Kapha It is one of the three Doshas i.e. the water humour, the
intracellular fluid and the extra cellular fluid that plays
significant role in the nutrition and existence of body cells
and tissues
38. Kashaya Astringent taste or flavour; sometimes use for decoction of
herbs
39. Katu Pungent taste or flavour
40. Kaumarabhrtya The branch of Ayurveda that deals with child health
(Paediatrics)
41. Kayachikitsa Internal Medicine, treatment of body diseases,
42. Kshara Alkali preparations of herbs
43. Kriyakalpa Medical procedures used in eye treatment
44. Laghu Light, small, minute
45. Langhana Depletion therapy, slimming therapy makes body thin and
light
46. Lavana Salty taste of flavour
47. Lekhaniya Substances that have scraping actions on body tissues
48. Madhu Honey
49. Majja Bone marrow
50. Mala Waste products that are to be excreted out of the body. It
primarily includes urine, faeces and sweat
51. Mana Mind
52. Manovaha Srotas The channel that carries thought, feelings and emotions;
refers to the entire mind
53. Meda It is the fat tissue supported by Mamsa Dhatu
54. Madhura Sweet taste of flavour, pleasant, charming, delightful
55. Mamsa Muscles and related systems in body
56. Mamsavaha Srotas Channels transporting to the muscles and related tissues
57. Medhya That which enhances wisdom, mental power and intelligence
58. Medovaha Srotas Channels transporting to fat and related tissues
59. Mithyaayoga Wrong use, wrong employment
80 Table 25.4: Medicines at level 3 for Kashtaartava with heavy bleeding 167
81 Table 25.5: Medicines at level 3 for Kashtaartava with scanty bleeding 167
INTRODUCTION 1
15 Bhagandara 104
16 Krimi 109
17 Parikartika 113
VATA VYADHI
27 Avabahuka 177
28 Katigraha 182
29 Gridhrasi 189
30 Pakshaghata 196
31 Sandhigata Vata 215
32 Vatarakta 220
NETRAGATA ROGA
33 Abhishyanda 227
34 Adhimantha 237
APPENDIX -
Atura Pariksha Patrak 277
The classical texts of Ayurveda i.e. ‘Samhita’ were structured thousands of year ago. The Samhita
have a set pattern in which first part is narrative of entire text followed by principles, Ayurvedic
biology, Diagnosis, treatment, therapies etc. This is probably the most relevant pattern to learn
Ayurveda in depth. However, in recent times, practitioners need ready reckoners. This trend
might have started since last 3-4 centuries. The texts like Bhaishajya Ratnavali have described
disease wise formulation. In the present era, medicines are mostly prepared by Ayurveda
Pharma-companies. The diagnosis is largely laboratory based. Often allopathic method of
diagnosis is used in clinical practice followed by Ayurvedic formulations as treatment.
The Insurance coverage is getting more and more importance because of rising trend of lab
investigations, which has also become a part of evidence to support the claim submitted by
the beneficiary. As a matter of fact, typical Ayurvedic terminology is also being replaced by
contemporary words. Though it might have facilitated non Ayurveda people to understand
the prescription, it has also led to loss of specific knowledge behind the terminology.
In the above mentioned circumstances, disease conditions most frequently observed in general
practice have been chosen for preparing this document.The diseases have been categorized on
the basis of Ayurvedic method of classification i.e. according the main Srotas involved. It was
decided to stick to Ayurvedic nomenclature and put nearest allopathy term in bracket for easy
understanding of end user. Often, both the terms cannot be equated. Therefore, to clarify the
meaning, case definition is given in each chapter. This is followed by presentation of disease,
cardinal symptoms etc. to give weightage to clinical diagnosis. At the same time essential lab
investigations have been mentioned wherever felt necessary. Types subtypes based on Dosha
have been described. Efforts are made to describe the treatment according to Doshik type of
disease. It is not merely a compilation of references from classical text, but lot of brain storming
have undergone while preparing the document. The treatment described is evidence based as
well as experience based. Various formulations mentioned are indicative and not exclusive.
Number of drugs has been listed for each of the disease condition. The treating physician shall
have liberty to use any one or more medicines and formulations of his/her choice.
It is expected that an Ayurveda Vaidya working at Primary Health Center may have limited
resources. Therefore referral criteria have been mentioned. It must be kept in mind, especially
by fresher that successful doctors are those who know when to refer the patient.
Diet has major role to play in management of diseases. Therefore, emphasis has been given
on specific medicinal properties of dietary substances mentioned in classical texts or have
been scientifically established, while elaborating specific diet. Dietary substances known to
aggravate disease condition have been specifically contraindicated. Entire part related to diet
is purely based on Ayurvedic concept and non Ayurvedic reader might feel it contradictory at
times to conventional understanding of diet.
Every aspect of this document have been thoroughly discussed by experts of that particular
subject, e.g. Diet was discussed by experts of Swasthavritta, single plants were discussed by
experts of Dravyaguna and so on.
At the end of the document, classical Ayurvedic case record form based on Dashavidha Pariksha
pattern of Ayurveda integrated with some relevant conventional method of case recording has
been given for convenience for those working in hospital set-up.
Efforts have been made to develop the document as per the international standards and could
be useful not only in India but also to international community. It is expected that this effort
would introduce uniform pattern of clinical record keeping that would facilitate data exchange
and collate the data from different centers for academic purpose.
Brief Introduction of the disease: Kasa has Case definition:- Prana Vayu obstructed in
been described as an independent disorder the respiratory tract due to various reasons,
as well as a symptom of many diseases attains upward direction and comes out
like Tamaka Swasa (Bronchial Asthma), with force making specific sound is called as
Rajayakshma etc. Kasa (Cough) is the disease Kasa.
or symptom of respiratory tract occurring
due to obstruction of Vata Dosha and its Various Presentation of Kasa
reverse movement. When occurring as an
• Common clinical features: Kasa
independent disease, it has mainly 5 different
Pravriti - Shushka or Sakapha.
presentations as described in classical texts.
(coughing – either dry or produc-
The characteristic sound and pain of cough
tive)
produced will be different according to causes
of Dosha vitiation & nature of obstruction to Kasa depending upon its presentation is of
the forceful movement of the Vata Dosha. five types-
Feeling of hollowness
fullness in chest,
of chest &
heaviness of
body
Systemic Anorexia, Fever, Thirst, Diminished Fever, Fever,
features Giddiness, Anorexia, Pandu appetite, Arthralgia, sudden
Weakness, Giddiness, Anorexia Dyspnoea, desire for
Unconsciousness Unconsciousness Thirst hot & cold,
glossy &
clear skin,
consumes
excessive
food; but
weak and
emaciated,
unformed/
hard stool.
Vataja Kasa- The treatment should be started prepared with Vataghna drugs, Abhyanga,
with Snehana with ghee, Peya/Yusha/Kshira Parisheka, Snigdha Sveda.
Kshataja Kasa
Eladi Gutika53 Tab 2 tab Thrice daily 2-3 weeks –
Kushmand Avaleha54 Avaleha 10g Twice daily 2-3 weeks Warm milk
Kshayaj Kasa
Draksharishta55 Arisht- 10-20 ml Twice daily 2-3 weeks with same
Liquid quantity of
water
Shwasakuthara Rasa Tablet 125-250 3-4 times a 2-3 weeks with honey
mg day
Malla Sindura Powder 30 mg Twice daily 1 week With Vyaghri
Haritaki / honey
Shringarabhra Rasa Powder 125-250 Twice daily 2-3 weeks Sitopaladi with
mg honey
Shwaskaschintamani Powder 125-250 Twice daily 2-3 weeks Sitopaladi with
Rasa56 mg honey
Referral criteria:
LEVEL 3: AYURVEDA
• If patients not responding to above HOSPITALS AT INSTITUTIONAL
therapy. LEVEL OR DISTRICT HOSPITAL/
INTEGRATED AYURVEDIC
• Koch’s lesion or pleural effusion HOSPITALS
found in chest x-ray.
If patient is not responding to level-2 treat-
• In the cases where complications
ment, following radiological investigations
arise.
should be carried out.
• If further investigations are
• CT scan- for further confirmation of
needed.
diagnosis.
• Sputum Culture.
• 2D Echo
Treatment: Treatment given in level -2 may In Paitika Kasa with Ghana Kapha – Tikta
be continued. Dravya Samyukta Trivrit Virechana.
REFERENCES
14 Charaka, Charaka Samhita, Chikitsa Sthana 25 Sri Govinda Dasa, Bhaishajya Ratnavali
18/35, In: Yadavji Trikamji Acharya, Kasachikitsa 15/28, In: Ambikadutta Shastri,
Reprint, Varanasi: Chaukamba Sanskrit Chaukhamba Prakashan Varanasi, 2009
Sansthan; 2007. 26 Anonymous, The Ayurvedic Formulary
15 Charaka, Charaka Samhita, Chikitsa Sthana of India, Ministry of Health and Family
18/36-38, In: Yadavji Trikamji Acharya, Welfare, Govt. of India, Part 1 (7:34)
Reprint, Varanasi: Chaukamba Sanskrit 27 Anonymous, The Ayurvedic Pharmacopoeia
Sansthan; 2007. of India, Ministry of Health and Family
16 Charaka, Charaka Samhita, Chikitsa Sthana Welfare, Govt. of India, Part 1 Vol. 3 (13)
18/43-46, In: Yadavji Trikamji Acharya, 28 Anonymous, The Ayurvedic Pharmacopoeia
Reprint, Varanasi: Chaukamba Sanskrit of India, Ministry of Health and Family
Sansthan; 2007. Welfare, Govt. of India, Part 1 Vol. 4 (42)
17 Charaka, Charaka Samhita, Chikitsa Sthana 29 Anonymous, The Ayurvedic Pharmacopoeia
8/145-148, In: Yadavji Trikamji Acharya, of India, Ministry of Health and Family
Reprint, Varanasi: Chaukamba Sanskrit Welfare, Govt. of India, Part 1 Vol. 4 (59)
Sansthan; 2007. 30 Anonymous, The Ayurvedic Pharmaco-
18 Anonymous, The Ayurvedic Formulary poeia of India, Ministry of Health and
of India, Ministry of Health and Family Family Welfare, Govt. of India, Part 1
Welfare, Govt. of India, Part 1 (4:10) Vol. 4 (12)
31 Anonymous, The Ayurvedic Pharmaco-
19 Charaka, Charaka Samhita, Chikitsa Sthana
poeia of India, Ministry of Health and
18/57-62, In: Yadavji Trikamji Acharya,
Family Welfare, Govt. of India, Part 1 Vol. 1
Reprint, Varanasi: Chaukamba Sanskrit
(31)
Sansthan; 2007.
32 Anonymous, The Ayurvedic Pharmaco-
20 Anonymous, The Ayurvedic Pharmaco-
poeia of India, Ministry of Health and
poeia of India, Ministry of Health and
Family Welfare, Govt. of India, Part 1
Family Welfare, Govt. of India, Part 1
Vol. 3 (59)
Vol. 1 (76)
33 Anonymous, The Ayurvedic Pharmacopoeia
21 Anonymous, The Ayurvedic Pharmacopoeia
of India, Ministry of Health and Family
of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol 4 (42)
Welfare, Govt. of India, Part 1 Vol. 4 (42)
34 Anonymous, The Ayurvedic Pharmaco-
22 Anonymous, The Ayurvedic Pharmacopoeia poeia of India, Ministry of Health and
of India, Ministry of Health and Family Family Welfare, Govt. of India, Part 1
Welfare, Govt. of India, Part 1 Vol. 3 (21) Vol.1 (65)
23 Anonymous, The Ayurvedic Formulary 35 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 2 (4:7) Welfare, Govt. of India, Part 1 (20:16)
24 Sri Govinda Dasa, Bhaishajya Ratnavali 36 Anonymous, The Ayurvedic Formulary
Kasachikitsa 15/6, In: Ambikadutta Shastri, of India, Ministry of Health and Family
Chaukhamba Prakashan Varanasi, 2009 Welfare, Govt. of India, Part 2 (4:7)
INTRODUCTION g. Kasa
h. Urahkshata
Tamaka Swasa is one among the five types of
Swasa (dyspnoea) mentioned in Ayurveda.
It can be compared to bronchial asthma in
Line of management
modern medical science. Tamaka Swasa as a Type 1 – Kaphadhika – Shodhana / Kapha
diagnostic terminology encompasses various Nissaraka / Dhuma followed with Shamana
stages of asthma including atopic (allergic) treatment, Kutipraveshika Rasayana.7
asthma to chronic obstructive pulmonary
disorders. The Tamaka Swasa of recent onset Type 2 – Vatadhika – Tarpana / Shamana and
is curable; however it becomes incurable after Bhrimhana, Vatatapika Rasayana.8
attaining the chronicity.1 So early diagnosis
and therapeutic intervention is important.
LEVEL 1: AT SOLO AYURVEDIC
Case definition:
PHYSICIAN’S CLINIC/ PHC
Pathya-apathya (diet and life style): (Kulatha), goat milk, green leafy
vegetables like Patola, Shigru, brin-
All such food items alleviating Kapha and
jal, garlic, cardamom, cinnamon,
Vata, Ushna in property should be taken.
pepper, ginger, honey, crab soup,
And all such food items increasing Vata are
Krita and Akrita Mamsa Rasa. Luke
contraindicated. Care should be taken to
warm water for drinking26
improve the strength of the patient without
aggravating Kapha. • Regimen (Vihara): Fomentation,
hot water bath, moderate sun bath,
Do’s (Pathya)– warm clothes etc. and staying in
• Food (Ahara): All dietary articles fresh and ventilated places. Doing
should be easily digestible and light exercises and maintaining
served warm. Unpolished rice, daily routine.
wheat, green gram, horse gram
Type 2 Vatadhika variant: Same line of over the chest and mild massage. Debilitated
management in Level 2 during Vegavastha. patients may be planned for Sarvanga
Patient can also be supported with application Abhyanga with Dhanwantaram Taila49 and
of 20-30 drops of Ksheerabala (101) Avrita48 Shashtika Pinda Sweda as IPD.
REFERENCES
1 Charaka, Charaka Samhita, Chikitsa Sthana 6 Charaka, Charaka Samhita, Chikitsa Sthana
17/62, In: Yadavji Trikamji Acharya, 17/49-51, In: Yadavji Trikamji Acharya,
Reprint, Varanasi: Chaukhamba Sanskrit Reprint, Varanasi: Chaukhamba Sanskrit
Sansthan; 2009. p. 516 Sansthan; 2009. p. 515
2 Charaka, Charaka Samhita, Chikitsa Sthana 7 Charaka, Charaka Samhita, Chikitsa Sthana
17/62, In: Yadavji Trikamji Acharya, 17/89, In: Yadavji Trikamji Acharya,
Reprint, Varanasi: Chaukhamba Sanskrit Reprint, Varanasi: Chaukhamba Sanskrit
Sansthan; 2009. p. 516 Sansthan; 2009. p. 521
3 Charaka, Charaka Samhita, Chikitsa Sthana 8 Charaka, Charaka Samhita, Chikitsa Sthana
17/65-67, In: Yadavji Trikamji Acharya, 17/90, In: Yadavji Trikamji Acharya,
Reprint, Varanasi: Chaukhamba Sanskrit Reprint, Varanasi: Chaukhamba Sanskrit
Sansthan; 2009. p. 518 Sansthan; 2009. p. 521
4 Charaka, Charaka Samhita, Chikitsa Sthana 9 Charaka, Charaka Samhita, Chikitsa Sthana
17/52-54, In: Yadavji Trikamji Acharya, 17/71, In: Yadavji Trikamji Acharya,
Reprint, Varanasi: Chaukhamba Sanskrit Reprint, Varanasi: Chaukhamba Sanskrit
Sansthan; 2009. p. 516 Sansthan; 2009. p. 518
5 Charaka, Charaka Samhita, Chikitsa Sthana 10 Anonymous, The Ayurvedic Formulary
17/46-48, In: Yadavji Trikamji Acharya, of India, Ministry of Health and Family
Reprint, Varanasi: Chaukhamba Sanskrit Welfare, Govt. of India, Part I (20:49), 2000,
Sansthan; 2009. p. 515 p. 373
Welfare, Govt. of India, Part I (7:13), 2000, Sanskrit Prathisthan; 2001, p. 255
p. 321 22 Anonymous, The Ayurvedic Formulary
12 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Ministry of Health and Family Welfare, Govt. of India, Part I (12:14), 2000,
Welfare, Govt. of India, Part I (7:34), 2000, p. 518
p. 348
23 Anonymous, The Ayurvedic Formulary
13 Charaka, Charaka Samhita, Chikitsa Sthana of India, Ministry of Health and Family
17/123-124, In: Yadavji Trikamji Acharya, Welfare, Govt. of India, Part I (4:14), 2000,
Reprint, Varanasi: Chaukhamba Sanskrit p. 180
Sansthan; 2009. p. 526
24 Charaka, Charaka Samhita, Chikitsa Sthana
14 Anonymous, The Ayurvedic Formulary 18/125-128, In: Yadavji Trikamji Acharya,
of India, Ministry of Health and Family Reprint, Varanasi: Chaukhamba Sanskrit
Welfare, Govt. of India, Part I (4:10), 2000, Sansthan; 2009. p. 547
p.176
25 Anonymous, The Ayurvedic Formulary
15 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Ministry of Health and Family Welfare, Govt. of India, Part I (6:41), 2000,
Welfare, Govt. of India, Part I (4:25), 2000, p. 297
p. 192
26 Sri Govindacharya, Bhaishajya Ratnavali,
16 Anonymous, The Ayurvedic Formulary Hikka-Swasa Chikitsa Adhyaya 16/137-
of India, Ministry of Health and Family 139, p. 509
Welfare, Govt. of India, Part II (4:7), 2000,
27 Charaka, Charaka Samhita, Chikitsa Sthana
p. 41
17/14-16, In: Yadavji Trikamji Acharya,
17 Anonymous, The Ayurvedic Formulary
Reprint, Varanasi: Chaukhamba Sanskrit
of India, Ministry of Health and Family
Sansthan; 2009. p. 510
Welfare, Govt. of India, Part I (3:26), 2000,
p. 153 28 Rajkumar, Food allergy in bronchial asthma:
Diagonostic modalities; Indian Journal of
18 Anonymous, The Ayurvedic Formulary
Allergy, Asthma and Immunology; July-
of India, Ministry of Health and Family
Dec 2013, Vol. 27, Issue 2
Welfare, Govt. of India, Part I (3:14), 2000,
p. 135 29 Raj Kumar, Nirupam Sharan, Manoj
Kumar, Indu Bisht, S. N. Gaur, Pattern of
19 Anonymous, The Ayurvedic Formulary
skin sensitivity to various aeroallergens in
of India, Ministry of Health and Family
patients of bronchial asthma and/or allergic
Welfare, Govt. of India, Part I (3:1), 2000,
rhinitis in India; Indian Journal of Allergy,
p. 111
Asthma and Immunology Jul-Dec 2012,
20 Anonymous, The Ayurvedic Formulary Volume 26, Issue 2
of India, Ministry of Health and Family
30 Sushruta, Sushruta Samhita, Uttara Tantra
Welfare, Govt. of India, Part I (4:31), 2000,
50/3-5, In: Ambikadutta Shastri, Reprint,
p. 199
50 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (18:1), 2000,
of India, Ministry of Health and Family p. 591
Welfare, Govt. of India, Part I (15:3), 2000,
53 Anonymous, The Ayurvedic Formulary
p. 567
of India, Ministry of Health and Family
51 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (18:19), 2000,
of India, Ministry of Health and Family p. 642
Welfare, Govt. of India, Part I (18:7), 2000,
54 Sri Govinda Dasa, Bhaishajya Ratnavali
p. 609
33/40-41, In: Ambikadutta Shastri,
52 Anonymous, The Ayurvedic Formulary
Chaukhamba Prakashan Varanasi, 2009
of India, Ministry of Health and Family
• Pittaja Gulma
INTRODUCTION
• Pittashmari
Amlapitta is a disease of Annavaha Srotas with
• Annadravashoola
main characteristics like Urodaha, Avipaka,
Tikta Amla Udgara etc. The chronic conditions • Parinamashoola
may cause Kotha, Kandu, Mandala, etc. The • Udara Poorvarupa
condition may be co-related with Acid Peptic
Disorders. Line of Treatment
Kapardika Bhasma Churna 125-500 mg / Before meal 1-2 weeks Warm water
day / Takra
Patoladi Kwatha Kwatha 10-15 ml Empty stomach 1-2 weeks -
Kalyanaka Kshara Churna 2-3 gms Before meals 1-2 weeks Warm water
REFERENCES
In addition to these, patients may be advised e.g. Yavagu, Yusha, Tilanala Kshara
to maintain input-output chart for fluid or Palasha Kshara, Vartaka Kshara,
regulation, and record of abdominal girth. Swarjika Kshara etc. semi liquids are
advised. Yava along with Vastuka
Pathya - Apathya (Diet and life style): (Bathua leaves), Karela (Karavellaka)
are advised.
Do’s -
• Vihara: Timely meals, relaxation
• Ahara: Only milk diet is advised. techniques
Goat / camel / cow / buffalo
milk, buttermilk, Peya – Jangala Don’ts -
Mamsa Rasa, Khichadi prepared
with seasoned rice and Moong Daal, • Ahara: Salt and water intake should
Shigru, fresh vegetables soup. Diet be restricted, heavy food, green
with Deepana (digestive) property peas, black eyed beans, lentils,
and Laghu (light to digest) property yellow gram, raw vegetables and
Abhaya Vati12 Vati 1-2 Vati After meal / 2-3 Lukewarm water
thrice a day weeks
Clinical Diagnosis: Same as level 1 for a Pathya - Apathya (Diet and life style): Same
fresh case reporting directly as level 1
REFERENCES
1. Govind Das Sen, Bhaishajya Ratnavali, 10. Anonymous, The Ayurvedic Formulary
Jwara Rogadhikar, Adhyaya 5/172 edited by of India, Ministry of Health and Family
Brahma Shankara Mishra. 11th ed. Varanasi: Welfare, Govt. of India, PART-I (7:19).
Chaukhambha Sanskrit Sansthan; 1993. 11. Anonymous, The Ayurvedic Formulary
2. Govind Das Sen, Bhaishajya Ratnavali, of India, Ministry of Health and Family
Udara Rogadhikar, Adhyaya 40/36 edited Welfare, Govt. of India, PART-I ( 1:12).
by Brahma Shankara Mishra. 11th ed. 12. Govind Das Sen, Bhaishajya Ratnavali,
Varanasi: Chaukhambha Sanskrit Sansthan; Udara Rogadhikar, Adhyaya 40/87-90
1993. edited by Brahma Shankara Mishra. 11th ed.
3. Govind Das Sen, Bhaishajya Ratnavali, Varanasi: Chaukhambha Sanskrit Sansthan;
Chardi Rogadhikar, Adhyaya 19/9 edited 1993.
by Brahma Shankara Mishra. 11th ed. 13. Govind Das Sen, Bhaishajya Ratnavali,
Varanasi: Chaukhambha Sanskrit Sansthan; Udara Rogadhikar, Adhyaya 40/60 edited
1993. by Brahma Shankara Mishra. 11th ed.
4. Govind Das Sen, Bhaishajya Ratnavali, Varanasi: Chaukhambha Sanskrit Sansthan;
Ashmari Rogadhikar, Adhyaya 36/22 1993.
edited by Brahma Shankara Mishra. 11th 14. Govind Das Sen, Bhaishajya Ratnavali,
ed. Varanasi: Chaukhambha Sanskrit Udara Rogadhikar, Adhyaya 40/139 edited
Sansthan; 1993. by Brahma Shankara Mishra. 11th ed.
5. Anonymous, The Ayurvedic Formulary Varanasi: Chaukhambha Sanskrit Sansthan;
of India, Ministry of Health and Family 1993.
Welfare, Govt. of India, PART-I (4:22) 15. Anonymous, The Ayurvedic Formulary
6. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Ministry of Health and Family Welfare, Govt. of India, Part-II ( 16:19)
Welfare, Govt. of India, PART-I (4:16). 16. Anonymous, The Ayurvedic Formulary
7. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Ministry of Health and Family Welfare, Govt. of India, PART-I ( 20:4)
Welfare, Govt. of India, PART-II (4:15). 17. Govind Das Sen, Bhaishajya Ratnavali,
8. Anonymous, The Ayurvedic Formulary Udara Rogadhikar, Adhyaya 40/65-66,
of India, Ministry of Health and Family edited by Brahma Shankara Mishra. 11th
Welfare, Govt. of India, PART-I (7:8). ed. Varanasi: Chaukhambha Sanskrit
9. Anonymous, The Ayurvedic Formulary Sansthan; 1993.
of India, Ministry of Health and Family
Welfare, Govt. of India, PART-I (7:8).
Line of Treatment
INTRODUCTION:
• Nidana Parivarjana should be the
Amavata is a condition described in Ayurveda
first line of treatment.
involving multiple joints, including sacroiliac
joints with severe pain swelling and stiffness. • Shodhana Chikitsa – Virechana, Basti,
General symptoms like fever, loss of appetite Raktamokshana
etc may also be associated. The disease • Shamana Chikitsa - Langhana,
conditions like Rheumatoid Arthritis, many Swedana, Rukshana, Pachana, Deepana
other forms of connective tissue disorders
like Polymyositis, Polyarthritis in elderly • External applications - Lepa,
like Polymayalgia Rheumatica and common Upanaha
infective Arthritis in children like Rhueumatic • Rasayana Chikitsa for Rasa
Fever, Chikungunya Arthritis, Myofascial
Pain Syndromes may be considered under • Treatment according to Doshik
the umbrella of Amavata. involvement
REFERENCES
Pathya - Apathya (Diet and life style): ed water or food, sprouts, cold food
and beverages, junk foods, fried
Do’s - food, bakery items.
• Ahara: Shadanga Paniya (medicated • Vihara: Physical and mental exer-
water prepared by Musta, Parpataka, tion like physical exercises, expo-
Ushira, Chandana, Nagara, Udichya), sure to cold, breeze, suppression of
Tarpana prepared of the Laja Saktu natural urges, taking bath with cold
(Churna of perched paddy) mixed water etc.
with honey, sugar and juices of Referral Criteria: Patient not responding to
fruits, Mudga Yusha. Yavagu (gruel), above management, patient presenting with
odana (boiled rice) and Laja (popped signs of high grade fever, delirium, severe
or perched paddy), Peya prepared vomiting, posing danger of dehydration or
with Laja / Yava added with Nagar, any such other complications like bleeding,
Pippalimula, Amalaki, Mrudvika, anuria etc. shall be directly referred to
vegetables like Patola, Karavellaka, Level 3 or higher centers for emergency
Karkotaka. management.
• Vihara: complete bed rest, staying in
well ventilated room with hygienic
LEVEL 2: CHC’S OR SMALL
conditions
HOSPITALS WITH BASIC
Don’ts – FACILITIES
• Ahara: Heavy food, curd, green Clinical Diagnosis: The case referred from
peas, black eyed beans, lentils, Level 1 or newly diagnosed case must be
yellow gram, black gram, raw vege- evaluated thoroughly. At this level, line of
tables and salads, refined foods such treatment to be planned considering Doshika
as white flour (Maida), contaminat- involvement and cause of the Jwara.
Sl No Dhatu Management
Kalpas Panchakarma
1 Rasa Rasa Pachaka, (Kalinga, Patola Patra, Kutaki) Vamana, Upavasa
2 Rakta Rakta Pachaka (Patola, Sariva, Musta, Patha, Kutki) Seka, Pradeha,
Samshaman
3 Mamsa Nimba, Patol, Triphala, Draksha, Musta, Kutaja Vireka, Upavasa
Investigations 1. Virus isolation 1. Peripheral smear To precise the type of flu like
in cultures by PCR for malarial parasite swine flu (H1N1) or bird flu
(Polymerase Chain 2. Rapid slide method (H5N1) below mentioned
Reaction) - Day 1st to (Antigen based investigations are carried out:
5th diagnosis) to confirm 1. Polymerase chain reaction
2. Viral antigen malaria and its type. (PCR)
detection (such as for 3. Urine -Routine, 2. Viral culture from nasal,
NS1) – Day 1st to 7th Microscope, Bile pharyngeal, or throat
3. Serological tests: salt & Pigment – to aspirates.
IgM &, IgG (2nd ) – rule out presence of 3. Serology
Day 4th onwards black water fever and
IgG (1st) – Day 7th on presence of jaundice
wards
LFT, RFT and EEG
may be done to assess
the status of organs.
Treatment On the line of On the line of On the line of Vatashlaismika
Vata-Pittaja Jwara Sannipatika Jwara Jwara
considering
Dhatugatavasta
REFERENCES
8 Sri Govinda Dasa, Bhaishajya Ratnavali 18 Astanga Hridaya Sutra 15/15: Comm.
Jwaradhikara, 5/372, In: Ambikadutta By Sarvangasundara by Arunadatta and
Shastri, Chaukhamba Prakashan Varanasi, Ayurveda Rasayana of Hemadri annotated
2009 by Dr, Anna Moreswar Kunte and Krishna
9 Sri Govinda Dasa, Bhaishajya Ratnavali Ramachandra Sastri Avre, edited by Pt. Hari
Jwaradhikara, 5/374, In: Ambikadutta Sadashiva Sastri Paradakara, Chaukhambha
Shastri, Chaukhamba Prakashan Varanasi, Surabharati Prakashan, Varanasi.
2009 19 Anonymous, The Ayurvedic Formulary
10 Sri Govinda Dasa, Bhaishajya Ratnavali of India, Ministry of Health and Family
Jwaradhikara, 5/376, In: Ambikadutta Welfare, Govt. of India, Part II (4/8), 2000
Shastri, Chaukhamba Prakashan Varanasi, 20 Anonymous, The Ayurvedic Formulary
2009 of India, Ministry of Health and Family
11 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part II (13/1), 2000
of India, Ministry of Health and Family 21 Sri Govinda Dasa, Bhaishajya Ratnavali
Welfare, Govt. of India, Part I (12/35), Jwaradhikara, In: Ambikadutta Shastri,
2000 Chaukhamba Prakashan Varanasi, 2009
12 Anonymous, The Ayurvedic Formulary 22 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (4/1), 2000 Welfare, Govt. of India, Part I (7/35), 2000
13 Anonymous, The Ayurvedic Formulary 23 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (1/2), 2000 Welfare, Govt. of India, Part I (20/20), 2000
14 Anonymous, The Ayurvedic Formulary 24 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (20/20), 2000 Welfare, Govt. of India, Part I (20/39),
15 Anonymous, The Ayurvedic Formulary 2000
of India, Ministry of Health and Family
25 Anonymous, The Ayurvedic Formulary
Welfare, Govt. of India, Part I (20/3), 2000
of India, Ministry of Health and Family
16 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (10/15),
of India, Ministry of Health and Family 2000
Welfare, Govt. of India, Part II (16/61),
2000 26 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family
17 Astanga Hridaya Chikitsa 1/48-50: Comm.
Welfare, Govt. of India, Part I (7/13),
By Sarvangasundara by Arunadatta and
2000
Ayurveda Rasayana of Hemadri annotated
by Dr, Anna Moreswar Kunte and Krishna 27 Anonymous, The Ayurvedic Formulary
Ramachandra Sastriavre, edited by Pt. Hari of India, Ministry of Health and Family
Sadashiva Sastri Paradakara, Chaukhambha Welfare, Govt. of India, Part I (20/16),
Surabharati Prakashan, Varanasi. 2000
2. Kamala
INTRODUCTION AND
CASE DEFINITION: 3. Jwara – Vishama Jwara
4. Rajayakshma
Pandu is a disease classification involving
mainly the Rasa Dhatu with Panduta (pallor) 5. Grahani Roga
as the presenting cardinal symptom. Other
6. Udara Roga
associated symptoms are fatigue, malaise,
fever, weight loss, night sweats, palpitation, 7. Shotha – Kaphaja
dyspnoea on mild exertion. Various disease 8. Arsha
conditions affecting formation of hemoglobin
falls under the umbrella of Pandu Roga. 9. Asrigdara
10. Shosha
Clinical signs and symptoms of Pandu
11. Raktapitta
(Anemia):
12. Other nutritional deficiencies - folic acid,
Pandu is a disease of Pittaja dominance with
Vit B12, Vit. C, protein, copper etc.
following presenting signs and symptoms
1. Depleted functions of Dhatus in which
Pitta is vitiated LEVEL 1: AT SOLO AYURVEDA
2. Kshaya of Varna, Bala, Sneha and other
PHYSICIAN CLINIC/PHC
properties of Oja
Clinical Diagnosis: On the basis of history
3. Raktalpata and clinical presentation, patient can be
4. Alpa Meda diagnosed provisionally as case of Pandu
5. Debility of relevant Karmendriya and Investigations: Though much can be
Jnanendriya diagnosed based on the clinical signs and
6. Discoloration symptoms, laboratory investigations help
the clinician to confirm the diagnosis and
Classification of Pandu Roga: rule out other conditions
Treatment:
Table 7.1: Medicines at level 1 for Pandu
Gomutra Haritaki6 Churna/ 2-3 gm/1-2 Before meal/twice 2-3 weeks Luke warm
Vati tabs daily water
Navayasa Lauha7 Vati / 250-500 mg After meal/ thrice 2-3 weeks Madhu
Churna daily
Vidangadi Lauha8 Churna 250-500 mg After / thrice 2-3 weeks Luke warm
daily meal water
As per the status of the patient, Mrudu Investigation: Same as level 1 and 2. In
Virechana/Koshtha Shuddhi with Avipattikara addition
Churna 5-10 gm with Phalatrikadi Kashaya may • Bone marrow cytology
be done for the first few days of the treatment.
Pathya-Apathya (Diet and life style): Same Treatment: In addition to the management
as Level 1 of Level 1 and Level 2, if needed Panchakarma
procedures indicated for Pandu can be
Referral criteria: performed.
LEVEL 3: AYURVEDA
• Rasayana Chikitsa:
HOSPITALS AT INSTITUTIONAL
LEVEL OR DISTRICT • Vardhamana Pippali Rasayana
HOSPITAL/ INTEGRATED • Swarna Malini Vasant Rasa
AYURVEDIC HOSPITALS
Pathya-Apathya (Diet and life style): Same
Clinical Diagnosis: Same as Level 1for a as level 1
fresh case reporting directly
REFERENCES
Line of Treatment
INTRODUCTION
• Nidana Parivarjana should be the
Ekakushtha is one among eleven Kshudra
first line of treatment.
Kushta with the dominance of Vata and Kapha,
which is characterized by silvery plaques like • Shodhana Chikitsa – Vamana,
fish scales may be associated with itching Virechana, Rakta Mokshana,
and with tendency to spread all over the • Shamana Chikitsa – Pachana,
body. It can be correlated with psoriasis like Raktashodhana, external applications
diseases. Along with faulty dietary habits, (Lepa, Taila and Dhara Chikitsa)
psychogenic stress also plays important role
• Rasayana Chikitsa for Rasa – Rakta
in the pathogenesis of Ekakushtha.
Prasadana.
• Treatment according to Doshik
Case Definition:
involvement
A patient presenting with dry scaling
• General line of treatment prescribed
erythematous / maculopapulous patches,
for Kushtha
covered with adherent silvery white scales
which may or may not be associated with
itching. LEVEL 1: AT SOLO AYURVEDIC
PHYSICIAN CLINIC / PHC
Differential Diagnosis
Investigations: Nothing specific.
1. Sidhma: White colored shiny patches
Treatment: In the initial stage when the
associated with or without itching along
patient is having mild features of Ekakushta,
with exfoliation in the form of dust.
along with diet restriction, two or more of
2. Dadru: Circular patches with elevated following drugs may be given as per Doshic
periphery associated with severe itching predominance:
REFERENCES
Pathya-apathya (diet and life style Referral criteria: Patient not responding to
education): above mentioned management and showing
signs of deep Jaundice; severe vomiting, pos-
Do’s –
ing danger of dehydration, signs of hepatic
• Ahara: Khichadi prepared from encephalopathy etc.
old rice (Purana Shali), green
gram, fruits like Draksha (dried
grapes), sugarcane juice, Shritashita LEVEL 2: CHC’S OR SMALL
Jala (boiled and cooled water), HOSPITALS WITH BASIC
vegeVatiles like Patola (Trichosanthes FACILITIES
dioica), gourd, Haridra, Ardrak.
• Vihara: Complete rest Clinical diagnosis: Same as level 1 for a fresh
case reporting directly.
Don’ts -
• Ahara: Heavy food, fried food Investigation: Same as level 1. In addition
articles, pungent food articles like
• HBsAg positive
chilli, alcohol
• Vihara: Excessive physical exercise, • LFT - Elevated amino transferase-
day sleep, ALT/AST > 45U/lit, disturbed
Mridu Virechana: As per the status of the 4. Not able to take anything orally due to
patient, Mridu Virechana/Koshtha Shuddhi vomiting and nausea
with Avipattikara Churna 5-10 gm with
Drakhshadi Kashaya may be done for 3-5 days LEVEL 3: AYURVEDA
before treatment. HOSPITALS AT INSTITUTIONAL
Pathya-Apathya (Diet and life style
LEVEL OR DISTRICT
education): Same as level 1
HOSPITAL/ INTEGRATED
AYURVEDIC HOSPITALS
Referral criteria:
Clinical Diagnosis: Same as level 1 for a
1. Cases not responding to above fresh case reporting directly
mentioned therapy.
Investigation:
2. Patients having increased levels of
bilirubin with mental confusion and • Immuno assay for infective hepatitis
altered sensorium • Liver biopsy
3. Severe persistent vomiting • CT Scan
Vata-Pitta presentation of Kamala - Avipattikara Nimba - 3-6 gms with water for one month
Churna, Manibhadra Leha, Aragwadha Phala Pathya-Apathya (Diet and life style
Majja, Draksha Kwatha education): Same as level 1
REFERENCES
Differential Diagnosis-
LEVEL 1: AT SOLO AYURVEDA
Hypothyroidism needs to be differentiated PHYSICIAN’S CLINIC/PHC
from Obesity, PCOS in women, thyroid
lymphoma, addison disease, goiter and Investigations: Though it can be clinically
thyroid carcinoma. However, following diagnosed based on the signs and symp-
clinical conditions similar to Shopha described toms, Laboratory investigations are essential
in Ayurveda need to be differentiated. to confirm the diagnosis and rule out other
• Kaphaja Pandu: Gaurava (heaviness conditions
in body), Tandra (sleepiness), • CBC
Panduta (pallor), Klama (fatigue),
• Serum T3, T4, TSH
Svasa (dyspnea on exertion), Aalasya
(lethargy), Aruchi (loss of appetite), Treatment: In the initial stage when the pa-
Svaragraha (hoarseness of voice), tient is suspected to have hypothyroidism-
Ushnakamita are the symptoms of some of the following advice may be given
Kaphaja Pandu.2 along with diet restrictions:
HYPOTHYROIDISM
Pathya - Apathya (Diet and life style • Vihara: Sedentary life style, day
education): sleep, munching.
• Bhallataka Rasayana10
REFERENCES
Do’s-
• Ahara: Use of Purana Dhanya are recommended. Bitter leafy
(grains harvested 1 year back), vegetables like fenugreek, Atasi
Bharjit Dhanya (roasted grains), (Flaxseed), Sarshapa (mustard) are
Yava (Barley), Mudga (Green recommended; roasted meat of dry
grams) and Kulattha (Horse grams), habitats animals
Adhaki, Masura (Lentils), Makushtha
Pathya-Apathya (Diet and life style of management for better recovery should
education): Same as level 1 be treated at this level. All patients of Krisha
Pramehi / Vata / Durbala should be treated
Referral Criteria: Patients’ blood sugar not
at this level. Patients having HbA1c above 9
well under control and having associated
should be treated at this level.
conditions like Macrovascular complications
like Ischemic heart disease, microvascular Clinical Diagnosis: Same as level 1 for a
complications like diabetic kidney disease, fresh case reporting directly
retinopathy, neuropathy etc may be referred
to the next level. Investigation:
1. Serum electrolytes
LEVEL 3: HOSPITALS WITH
INDOOR FACILITIES LIKE 2. Blood urea and serum creatinine
PANCHAKARMA, KSHARASUTRA 3. Urine for Micro albumin
ETC. AND HAVE
INTEGRATIVE FACILITIES 4. ECG
5. Fundus examination
All patients referred from level 2 should be
treated at this level. All patients come under Treatment: In addition to the management of
Sthula Pramehi / Balavan / Kapha / Pitta Level 1 and Level -2, if needed Panchakarma
Pramehi and willing to undergo Shodhana line procedures can be performed.
REFERENCES
9. Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, 2nd Revised English
of India, Ministry of Health and Family ed. Part I (20/4), 2003, pg 258.
Welfare, Govt. of India, 2nd Revised English 11. Anonymous, The Ayurvedic Formulary
ed. Part I (20/42), 2003, pg 273. of India, Ministry of Health and Family
10. Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, 2nd Revised English
of India, Ministry of Health and Family ed. Part I (12/10), 2003, pg 185.
Note: selection of above drugs depends upon the status of obesity, e.g.
• Patients having overweight i.e. powder or Triphala Guggulu Vati or
BMI between 25 and 30 and have Gomutra Haritaki Vati along with
no other associated conditions like strict diet and life style modification.
hypothyroidism or positive family • Patients having BMI between 30 and
history of obesity, may be given 35, may be given above mentioned
drugs like Triphala powder, Haritaki drugs with Anupana of Phalatrikadi
REFERENCES
Associated Colicky, pricking Burning sensation, Thick & long standing Loss of strength
Features pain, twitching, itching, pricking swelling, excessive & valour, senses
tingling pain and tendency itching become weaker,
to suppuration Immunity
decreases
Differential Diagnosis:
LEVEL 1: AT SOLO AYURVEDA
• Rectal prolapse (Gudabhramsa) PHYSICIAN’S CLINIC/PHC
• Fissure-in-ano (Parikartika)
Clinical Diagnosis: On the basis of history
• Ulcerative colitis and Crohn’s
and clinical presentations, patient can be
disease
diagnosed provisionally as case of Arsha.
• Condyloma Acuminata
Investigations: At this level, no specific test
• Proctitis
is needed to be performed.
• Ano-rectal warts
Treatment: In the initial stage, when the
• Ano-rectal abscess patient is having mild features of Arsha,
• Rectal polyp along with diet restriction, two or more of
• Malignant tumours (Arbuda) following drugs may be given:
Aragvadha4 Churna 2-4 gm Empty stomach / bed 1-2 weeks Luke warm
time or early morning water
Castor oil5 Oil 10-20 ml Empty stomach / bed 1-2 weeks Luke
time or early morning warm water
Piplayadi Ghrita7 Ghrita 5 gm Twice daily before 1-2 weeks Luke warm
meals water
Takrarishta8 Arishta 10 -20 ml Twice daily after meals 1-2 weeks Equal quantity
of water
Abhayarishta9 Arishta 10 -20 ml Twice daily after meals 1-2 weeks Equal quantity
of water
Surana Vataka10 Vataka 500 mg Twice daily after meals 1-2 weeks Luke warm
water
Eranda Bhristha Churna 3-5 gm Empty stomach / bed 2-5 days Luke warm
Haritaki time or early morning water
sitting for long durations on hard fresh case must be evaluated thoroughly for
seats, continuous cycling or bike any complication.
riding etc.
Examination:
Referral criteria: • Per rectal examination
1. Cases not responding to the therapy • Proctoscopic examination
2. All case of moderate to severe bleeding Investigations:
per rectum
• CBC
3. Cases with complications • Special investigations like ECG,
Chest X-Ray may also be required
for surgical fitness of patients who
LEVEL 2: CHC’S OR SMALL
requires operation.
HOSPITALS WITH BASIC
FACILITIES Treatment: Treatment given in level-1
may be continued. Following medicines
Clinical diagnosis: The diagnosis is made on may be added; patient may be kept under
the basis of criteria mentioned in level-1 for observation while prescribing these kinds of
fresh cases. The case referred from level-1 or medicines.
Arogyvardhini Vati18 Vati 1-2 Vati At bed time or early 1-2 weeks Luke warm
morning empty water
stomach
Arshakuthara Rasa19 Vati 1-2 Vati At bed time or early 1-2 weeks Luke warm
morning empty water
stomach
Kankayana Vati20 Vati 1-2 Vati At bed time or early 1-2 weeks Luke warm
morning empty water
stomach
REFERENCES
Prakashana, Reprint 2011. Chikitsasthana, Family Welfare, Govt. of India, Part 1 Vol. 1,
Arsha Chikitsa Adhyaya (14/72-75), pg. pg. 6.
505. 16. Anonymous, The Ayurvedic Pharmaco-
9. Anonymous, The Ayurvedic Formulary poeia of India, Ministry of Health and
of India, Ministry of Health and Family Family Welfare, Govt. of India, Part 1 Vol. 6,
Welfare, Govt. of India, Part 1 Vol.1, pg. 1. pg. 62.
10. Anonymous, The Ayurvedic Formulary 17. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol.12, pg. Welfare, Govt. of India, Part 1 Vol.8,
34). pg. 17.
11. Anonymous, The Ayurvedic Pharmaco- 18. Anonymous, The Ayurvedic Formulary
poeia of India, Ministry of Health and of India, Ministry of Health and Family
Family Welfare, Govt. of India, Part 1 Vol. 1, Welfare, Govt. of India, Part 1 Vol.20, pg. 4.
pg. 6. 19. Anonymous, The Ayurvedic Formulary
12. Anonymous, The Ayurvedic Pharmaco- of India, Ministry of Health and Family
poeia of India, Ministry of Health and Welfare, Govt. of India, Part 2 Vol.16, pg. 2.
Family Welfare, Govt. of India, Part 1 Vol 3, 20. Anonymous, The Ayurvedic Formulary
pg. 23. of India, Ministry of Health and Family
13. Anonymous, The Ayurvedic Pharmaco- Welfare, Govt. of India, Part 1 Vol.12, pg. 5.
poeia of India, Ministry of Health and Fam- 21. Anonymous, The Ayurvedic Formulary
ily Welfare, Govt. of India, Part 1 Volume of India, Ministry of Health and Family
3 (15). Welfare, Govt. of India, Part 2 Vol.4,
14. Anonymous, The Ayurvedic Formulary pg. 16.
of India, Ministry of Health and Family 22. Anonymous, The Ayurvedic Pharmaco-
Welfare, Govt. of India, Part 1 Vol.7, pg. 15. poeia of India, Ministry of Health and
15. Anonymous, The Ayurvedic Pharmaco- Family Welfare, Govt. of India, Part 1 Vol. 3,
poeia of India, Ministry of Health and pg. 23.
Types Symptoms
Aamatisara Unformed stool with excessive mucus with foul odour, usually associated with
features of Ama like flatulence, heaviness in abdomen or body, loss of appetite,
lethargy.
Pakvatisara Stool which is contrasting to characteristics and symptoms of Amatisara.
Vataja Patient frequently passes small quantity of liquid stool with flatus or froth, with
discomfort or pain in abdomen, anus, thigh or sacral region, associated with
horripilation, increased respiration, dryness of mouth, weakness
Pittaja Patient passes stool with yellow, green, black tinge which may contain blood with
exceedingly foetid smell. Associated features may include increased thirst, burning
sensation, sweating, fainting, colic pain, inflammation and suppuration in anus
Kaphaja Patient passes stool as unctuous, white, slimy, foetid smell mixed with mucus, with
frequent colic pain, or tenesmus. Associated complains may include heaviness in
abdomen, anus, pelvis and groin, horripilation, nausea, lassitude and aversion to food.
Sannipataja Mixed symptoms of Tridoshaja (incurable)
Bhayaja The presentation of this variety is similar as Vataja Atisara. But in addition to it,
and Shokaja psychological factors can be traced in the induction of loose stool
Don’ts - Investigations:
• Ahara: Heavy Food, sweets and • Serum electrolytes
cold items, milk and milk products
• RFT
except buttermilk
• Vihara: Overeating, daytime sleep, Treatment: In addition to the management
night wakening, physical & mental mentioned in Level 1, few of the following
stress drugs may be added
Referral criteria:
1. Cases not responding to above therapy.
Bruhat Gangadhara11 Churna 500 mg-2 gm After meal / Till symptom Water / fresh
thrice daily subsides butter milk
Hingvastaka Churna12 Churna 2-3 gm After meal / Till symptom With water
thrice daily subsides
Shankha Vati15 Vati 1-2 Vati After meal / Till symptom Water
thrice daily subsides
REFERENCES
1. Acharya Sushruta, Sushruta Samhita with Uttartantra 40/6, edited By Vd. Jadavaji
Dalhana Commentary - Nibandhasangraha, Trikamji Acharya & Narayana Ram Acharya,
and Gayadas Acharya commentary - Chaukhamba Surbharti Prakashana,
Nyayachandrika Panjika on Nidanasthana, Varanasi, 2008.
Case Definition:
INTRODUCTION
Bhagandara is a Marmaasrita Vyadhi which One or more than one external opening
affects Bhaga, Guda & Basti, characterized present anywhere around the anus i.e. in
by the tract formation, tearing & multiple peri-anal area as an elevation of granulation
openings in the perineal region (Bhaga tissue with discharge of pus and associated
Pradesha) around anus & urethra, through with pain and itching.
which discharge of pus, urine, feces, semen,
flatus etc. may occurs. It is a disease of Various Presentations:
Madhyama Rogamarga which lists under
Due to predominance of particular Dosha,
Ashta Mahagada. It is a Krichrasadhya Vyadhi.
various kinds of presentations my found.
According to Dosha predominance, 8 types
Types described by Sushruta Acharya are as
of Bhagandara are described by different
follows:
Acharyas. It can be compared to Fistula-in-
ano in terms of Modern Science.
Three more types are mentioned by Vagbhata Acharya which comes under Dosha Samsargaja
variety.
REFERENCES
19. Anonymous, The Ayurvedic Formulary 21. Anonymous, The Ayurvedic Pharmacopoeia
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (5: 11). Welfare, Govt. of India, Part 1 Volume 1
20. Anonymous, The Ayurvedic Pharmacopoeia (63).
of India, Ministry of Health and Family 22. Anonymous, The Ayurvedic Pharmacopoeia
Welfare, Govt. of India, Part 1 Volume 1 of India, Ministry of Health and Family
(30). Welfare, Govt. of India, Part 1 Volume 1 (6).
Treatment: In the initial stage when the two or more of following drugs may be
patient is having mild features of Krimi, given
Dont’s–
LEVEL 2: CHC’S OR SMALL
• Ahara: Fish, Tila, milk, sour food,
HOSPITALS WITH BASIC
green leafy vegetables, Amla Phala
FACILITIES
(citrus fruits) Dadhi, buffalo milk,
jaggery, sweets, Pishtanna (items Clinical Diagnosis: Same as Level 1 for a
prepared with white flour). fresh case reporting directly.
Paribhadra (Erythrina Juice 10-30 ml Once in the morning One week Honey
indica) Patra Swarasa empty stomach
Pootikaranja Swarasa Juice 10-30 ml Once in the morning One week Honey
empty stomach
Haridra Khanda Granules 5-10 gm Twice daily after food 1 month Warm
water
REFERENCES
2) Intestinal Tuberculosis
INTRODUCTION
3) Carcinoma of large bowel
Parikarthika is not mentioned as a separate 4) Pruritis Ani of varied etiology
disease entity in any of the Brihattrayi or
Laghuthrayi. Acharya Charaka described it
LEVEL 1: AT SOLO AYURVEDA
as one among the Dasha Virechana Vyapat.
PHYSICIAN’S CLINIC/PHC
Athiyoga of Virechana, Atisara, constipation
etc. are the predisposing factors of Parikartika. Clinical Diagnosis: On the basis of history
In modern science, it is correlated with and clinical presentation, patient can
fissure-in–ano/painful defecation. be diagnosed provisionally as a case of
Case Definition: Parikartika.
Feeling of sharp cutting pain in anal orifice Investigations: At this level, no specific test
during and or after defecation associated is needed to be performed
with fresh bleeding usually in the form of a Treatment: Chikitsa should aim at Anulomana,
streak on passing of hard feces, with itching Ropana & Sulahara, deworming.
or burning in anal region.
In the initial stage when the patient is having
mild features of Parikartika such as hard stool
Differential Diagnosis:
mass with painful defecation, along with diet
1) Lower bowel inflammatory diseases like restriction, two or more of following drugs
ulcerative colitis may be given, in addition to local treatment.
Castor oil5 Oil 10-20 ml At bed time or early 1-2 weeks Luke warm
morning empty stomach water
Avipattikara Churna 5-10 gm At bed time or early 2-5 days Water
Churna6 morning empty stomach
Takrarishta Arishta 10-20 ml Twice daily after meals 1-2 weeks Equal quantity
of water
Abhayarishta7 Arishta 10-20 ml Twice daily after meals 1-2 weeks Equal quantity
of water
Surana Vatak 500 mg Twice daily after meals 1-2 weeks Luke warm
Vataka8 water
Arogyvardhini Vati 1-2 Vati at bed time or early 1-2 weeks Luke warm
Vati 17 morning empty stomach water
Kankayana Vati18 Vati 1-2 Vati at bed time or early 1-2 weeks Luke warm
morning empty stomach water
REFERENCES
Line of Treatment
INTRODUCTION
• Nidana Parivarjana should be the
Anidra is the sleep disorder caused by
first line of treatment.
aggravated Vata and Pitta. It is characterized
by difficulty in falling asleep at bedtime, • Shodhana Chikitsa – Virechana, Nasya
waking up at night and having difficulty
• Shamana Chikitsa - Snehana,
going back to sleep leading to daytime
Murdhataila, Shirolepa, Dhara
fatigue and loss of concentration.
• Medhya Rasayana
Case definition:
• Treatment according to Doshik
Patients complaining of insufficient sleep,
involvement
either due to delayed onset of sleep, or due
to frequent awakening at night or early
awakening and thus suffering from poor LEVEL 1: AT SOLO AYUVEDIC
concentration, headache, fatigue can be PHYSICIAN’S CLINIC / PHC
diagnosed as a case of insomnia.
Clinical diagnosis: On the basis of history
Differential Diagnosis: and clinical presentation
• Nidanarthkara Anidra due to any Investigations: Nothing Specific
disease conditions – Muscle fatigue,
Treatment: In the initial stage when the
restlessness, Diabetes, Asthma,
patient is having mild features of Anidra,
Arthritis etc.
two or more of following drugs may be
• Vataja Madatyaya given:
• Drug induced Insomnia
Counselling must be done for insomnia due • Vihara: Day sleep, mental and
to stress or psychological reasons. Sarvanga physical excitement before bed,
Abhyanga in day time and Shiro Abhyanga, suppression of natural urges.
Padaabhyanga, and Karnapoorana before sleep
should be advised. Referral Criteria: Refer to level 2
Pathya - Apathya (Diet and life style Cases that are not responding to above
education): management
Do’s -
• Ahara: Mamsarasa, Shali, ghee, curd, LEVEL 2: CHCS OR SMALL
milk, wheat, sugarcane, sweets, HOSPITALS WITH BASIC
grapes, sugar, black gram, sesame, FACILITIES
Khaskhas
Clinical diagnosis: The diagnosis is
• Vihara: Comfortable room and bed, made on the basis of criteria mentioned in
regular bath, timely sleep, listening level-1
light music, Yoga and meditation
Investigations: Nothing specific
Dont’s -
Treatment: Treatment given in level-1 may
• Ahara: Excessive use of spicy food, be continued. Following medicines may be
stimulants like coffee, tea, tobacco added.
etc
Nidrodaya Rasa6 Vati 1-2 tab (each After meal 15 – 30 days Milk
250 mg) twice a day
REFERENCES
Manasmitra Vati11 Vati 1-2 Vati Empty stomach 15 days to Warm water
(each 500 mg) twice a day one month
Pathya - Apathya (Diet and life style Treatment: In addition to the treatment
education): Same as Level 1 prescribed in level-1 and 2, following
procedures can be done.
Referral Criteria: The cases those are not
responding to above mentioned therapy 1. Vamana Karma
2. Virechana Karma
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL 3. Yapana Basti
LEVEL OR DISTRICT
4. Nasya
HOSPITAL / INTEGRATED
AYURVEDIC HOSPITALS 5. Rasayana Therapy
Suvarna Brahmi Vati Vati 100 mg Empty stomach 15 days to one Brahmi
twice a day month Swarasa
REFERENCES
Differential diagnosis:
INTRODUCTION
• Kaphaja Unmada
Vishaada is one of the Vatananatmaja Vikaras1
and is an important aggravating factor for • Anidra
most of diseases.2 It is a condition originating
from apprehension of failure leading to lack Line of management:
of initiation for any activity.3 The above Sattvavajaya Chikitsa - Ashwashana,
presentation is comparable with anxiety Harshana etc. along with imparting Jnana
with depression. (personal awareness), Vijnana (proved
sciences), Dhairya (assurance), Smriti
Case Definition
(experience sharing), Samadhi (helping to
The diagnosis will be made on the basis of divert the mind from causative factors and
sign and symptoms of Vishaada like; establishing self control)
REFERENCES
Gokshura Churna Churna 3-6 gm After meal / 2-3 weeks With water
thrice a day
Punarnava Churna Churna 2-3 gm After meal / 2-3 weeks With water
thrice a day
Guduchi Churna Churna 3-6 gm After meal / 2-3 weeks With water
thrice a day
Pashanbheda Churna Churna 3-6 gm After meal / 2-3 weeks With water
thrice a day
Rasayana Churna Churna 3-6 gm After meal / 2-3 weeks With water
thrice a day
Gokshuradi Guggulu1 Vati 1-2 Vati After meal / 2-3 weeks With water
thrice a day
Chandraprabha Vati5 Vati 1-2 Tab After meal / twice or 2-3 weeks Warm water
thrice a day
For the complains like pain, Vedana Shamaka substances heavy to digest, excess
drugs like Triphala Guggulu, Sarjika Kshara or amount of milk products, Rhubarb,
Ajamodadi Churna etc. can be given. strawberries, plums, spinach,
asparagus, Kapittha Phala, Jambu
Pathya - Apathya (Diet and life style): Phala, dried dates, astringent foods
articles, brinjal, beans, lady finger,
Do’s -
capsicum, tomato, cucumber,
• Ahara (food articles): Intake of spinach, black grapes, kiwi,
excess fluid, dietary items having strawberries, chickoo, pear, refined
Vataanulomana and Mutrala wheat flour (Maida), papaya, garlic,
properties like Yava (barley), yogurt, cashew nut, dried food
Kulattha (Horse gram), Purana Shali items.
(old rice), Mudga (green gram),
• Vihara: Excessive exercise/ physical
puffed rice, Rajma, vegetables
work, over eating, healthy foods
like carrot, bitter guard, potatoes,
mixed with unhealthy, suppression
reddish, pumpkin, fruits like
of natural urges
banana, lemons, apricot, plums,
apple, almonds, coconut water,
lemon juice, Aloe vera juice, corn Referral criteria:
silk, pineapple juice, butter milk, 1. Cases not responding to above
spices like ginger etc. can be used. conservative therapy.
• Vihara: Sitz bath
2. Development of complications
Don’ts - 3. Haematuria
• Ahara (food articles): Cold food 4. Need for further investigations.
and drinks, fatty foods, food
Laboratory investigation:
LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC • Complete Haemogram,
FACILITIES • Serum uric acid,
• Serum calcium.
Clinical diagnosis: The diagnosis is made
• Renal function test.
on the basis of criteria mentioned in level-1
• Urine analysis, culture.
for fresh cases. The case referred from level-1
or fresh case must be evaluated according • X-Ray KUB (Kidney, Ureter,
to the Doshic involvement. The obstruction Bladder)
in the urinary system and stage of infection Treatment: The prime aim at this level is
should be ruled out. The clinical examination to confirm the diagnosis and assess the
should be done thoroughly for detecting prognosis.
complications. Mild to moderate symptoms: The line of
management is same as level-1 for fresh case.
Investigations: In this level-2 Laboratory and
Patient must be evaluated for conditions
radiological investigations should be done to
where surgical or any other special procedure
confirm the diagnosis.
is required.
Chandraprabha Vati9 Vati 1-2 Vati After meal / 2-3 weeks Water
thrice daily
Varunadi Ghrita10 Ghrita 5-10 gm After meal / 2-3 weeks Luke warm water
thrice daily
REFERENCES
Gokshura Churna1 Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily
Punarnava Churna2 Powder 2-3 gm After meal/ 2-3 weeks with water
thrice daily
Guduchi Churna3 Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily
Shatavari Churna4 Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily
Rasayana Churna5 Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily
Bhumyamalaki Churna Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily
Gokushuradi Guggulu6 Vati 1-2 Vati After meal/ 2-3 weeks with water
thrice daily
Shilajityadi Vati10 Vati 1-2 Vati After meal/ 2-3 weeks with water
thrice daily
In addition to these, patients may be advised 2. Patients having persistent raised Blood
to maintain input-output chart for fluid Urea and serum creatinine levels with or
regulation. without oedema
REFERENCES
1 Govind Das Sen, Bhaishajya Ratnavali, 8 Govind Das Sen, Bhaishajya Ratnavali,
Ashmari Rogadhikar, Adhyaya 36/20 Ashmari Rogadhikar, Adhyaya 36/18-20
edited by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
2 Govind Das Sen, Bhaishajya Ratnavali, 9 Govind Das Sen, Bhaishajya Ratnavali,
Udara Rogadhikar, Adhyaya 40/36 edited Ashmari Rogadhikar, Adhyaya 36/7 edited
by Brahma Shankara Mishra. 11th ed. by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
3 Govind Das Sen, Bhaishajya Ratnavali, 10 Govind Das Sen, Bhaishajya Ratnavali,
Vatarakta Rogadhikara, Adhyaya 27/10 Mutraghata Rogadhikar, Adhyaya 35/15
edited by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
4 Sharangadhara, Sharangadhara Samhita
11 Anonymous, The Ayurvedic Formulary
Madhyama Khanda 6/155; Pt. Parashuram
of India, Ministry of Health and Family
Shastri Vidyasagar. 1st ed, Chaukhambha
Welfare, Govt. of India, Part II (4:8)
Surbharati Prakashan, Varanasi.
12 Govind Das Sen, Bhaishajya Ratnavali,
5 Astanga Hridaya Rasayana: Comm. By
Mutraghata Rogadhikar, Adhyaya 35/15
Sarvangasundara by Arunadatta and
edited by Brahma Shankara Mishra. 11th ed.
Ayurveda Rasayana of Hemadri annotated
Varanasi: Chaukhambha Sanskrit Sansthan;
by Dr. Anna Moreswar Kunte and Krishna
1993.
Ramachandra Sastri Avre, edited by
Pt. HariSadashiva Sastri Paradakara, 13 Anonymous, The Ayurvedic Formulary
Chaukhambha Surabharati Prakashan, of India, Ministry of Health and Family
Varanasi. Welfare, Govt. of India, Part I (6 : 40)
Rectal mucosa The rectal mucosa moves The rectal mucosa is adherent
freely over the enlarged and cannot be moved over enlarged
prostate prostate
MUTRASHTiLA (BENIGN PROSTATIC HYPERPLASIA)
Kanchanara Guggulu7 Vati 1-2 Vati After meal/thrice 2-3 weeks Water
daily
Punaravashtaka Decoction 20-40 ml After meal / 2-3 weeks -
Kwatha8 thrice daily
Varuna Kwatha9 Decoction 20-40 ml After meal / 2-3 weeks -
thrice daily
For the complaints like pain, Vedanashamaka • Vihara: Excessive exercise / physical
drugs like Triphala Guggulu, Sarjikakshara or work, over eating, suppression of
Ajamodadi Churna etc. can be given. natural urges.
Palasha Kshara Churna 250-500 mg After meal/ thrice 2-3 weeks Water
daily
Varunadi Ghrita13 Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
daily
Ushirasava14 Asava 10-20 ml after meal/twice 2-3 weeks Mixed with equal
daily quantity of water
Chandanasava15 Asava 10-20 ml after meal/twice 2-3 weeks Mixed with equal
daily quantity of water
Sarivadyasava16 Asava 10-20 ml after meal/twice 2-3 weeks Mixed with equal
daily quantity of water
Hingavadi Churna17 Churna 3-6 gm After meal/ thrice 2-3 weeks Water
daily
Mustaka Churna18 Churna 3-6 gm After meal/ thrice 2-3 weeks Water
daily
Gokshuradi Ghrita Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
daily
Pashanabhedadi Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
Ghrita19 daily
Sthiradi Ghrita20 Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
daily
Changeri Ghrita21 Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
daily
REFERENCES
1 Govind Das Sen, Bhaishajya Ratnavali, 9 Govind Das Sen, Bhaishajya Ratnavali,
Ashmari Rogadhikar, Adhyaya 36/20 Ashmari Rogadhikar, Adhyaya 36/18-20
edited by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
2 Govind Das Sen, Bhaishajya Ratnavali, 10 Govind Das Sen, Bhaishajya Ratnavali,
Udara Rogadhikar, Adhyaya 40/36 edited Mootraghata Rogadhikar, Adhyaya 35/15
by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
3 Govind Das Sen, Bhaishajya Ratnavali, 11 Sharangadhara, Sharangadhara Samhita
Vatarakta Rogadhikar, Adhyaya 27/10 Madhyama Khand 2/109; Pt. Parashuram
edited by Brahma Shankara Mishra. 11th ed. Shastri Vidyasagar. 1st ed, Chaukhambha
Varanasi: Chaukhambha Sanskrit Sansthan; Surbharati Prakashan, Varanasi 2006
1993
12 Anonymous, The Ayurvedic Formulary
4 Sharangadhara, Sharangadhara Samhita of India, Ministry of Health and Family
Madhyama Khand 4/7; Pt. Parashuram Welfare, Govt. of India, Part I (12 : 10)
Shastri Vidyasagar. 1st ed, Chaukhambha
Surbharati Prakashan, Varanasi 2006 13 Govind Das Sen, Bhaishajya Ratnavali,
Ashmari Rogadhikar, Adhyaya 36/53
5 Astanga Hridaya Rasayana: Comm. By edited by Brahma Shankara Mishra. 11th ed.
Sarvangasundara by Arunadatta and Varanasi: Chaukhambha Sanskrit Sansthan;
Ayurveda Rasayana of Hemadri annotated 1993.
by Dr, Anna Moreswar Kunte and Krishna
Ramachandra Sastri Avre, edited by Pt. Hari 14 Anonymous, The Ayurvedic Formulary
Sadashiva Sastri Paradakara, Chaukhambha of India, Ministry of Health and Family
Surabharati Prakashan, Varanasi. Welfare, Govt. of India, Part I (1 :8)
18 Govind Das Sen, Bhaishajya Ratnavali, 20 Govind Das Sen, Bhaishajya Ratnavali,
Shoola Rogadhikara, Adhyaya 30/40 edited Udavartanaha Rogadhikar, Adhyaya 31/50
by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993 1993.
19 Govind Das Sen, Bhaishajya Ratnavali, 21 Anonymous, The Ayurvedic Formulary
Ashmari Rogadhikar, Adhyaya 36/57-60 of India, Ministry of Health and Family
edited by Brahma Shankara Mishra. 11th ed. Welfare, Govt. of India, Part I (6:9)
Varanasi: Chaukhambha Sanskrit Sansthan;
1993.
Cyclical bleeding at normal interval; the Table 24.2: Differential diagnosis of Asrigdara
bleeding is either excessive in amount (>80 Pittaja Yonivyapad Excessive bleeding only at
ml) or duration (>5 days) or both. Sometimes the time of menstruation,
there is short cycle (<21 days) with heavy cervical erosion etc
and prolonged menses or acyclic bleeding Asruja Yonivyapad Excessive Bleeding only at
the time of menstruation
from the uterus. All types of Asrugdara are
associated with infertility,
associated with body ache and pain.
feverishness and burning.
Pathya - Apathya (Diet and life style bitter, sweet or astringent in taste,
education): milk, wheat, seasoned rice, green
gram, bitter guard, bottle gourd,
Do’s -
cucumber, beet root, pomegranate,
• Ahara: Shadangapaneeya, Tanduloda- grapes etc. Yusha, Yavagu mixed
ka, Laja / Lajamanda, food articles of with Ghrita, Madhura Aushadhi
Siddha Ghrita and meat soup. Pa- • Chronic patients with complications
tient should have freshly prepared like moderate to severe Anaemia,
food only. Stale and re-heated food severe Dysmenorrhoea, irregular
should not be taken at all. bleeding per vagina.
• Vihara: Maintain local hygiene,
take rest. LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Don’ts - FACILITIES
• Ahara: Articles made with Maida,
sour curd, bakery items like bread, Clinical diagnosis: Same as level 1: for a
biscuits, fermented food, spicy fresh case reporting directly.
and salty food, fried food, pickles, However, at this level, persistence of
Kshara etc. symptoms along with moderate to severe
• Vihara: Avoid day sleeping, excess anaemia, mild to moderate fever due to pelvic
exposure to heat, sexual intercourse, infections etc. should also be considered.
night awaking, suppression of Investigation: Additional to the examina-
natural urges, strenuous physical tions described in Level 1 following investi-
exercise, excess of fasting, fear, grief gations also may be carried out.
and anger.
• CBC and PBS
Referral criteria: • BT, CT
• If the vitals are not stable.
• Ultrasonography
• If the blood loss is severe
Treatment: In addition to the management
• Patients not responding to level 1 mentioned in Level 1, the following drugs
management may also be tried out.
Pathya - Apathya (Diet and life style bleeding per vagina with other systemic
education): Same as level 1. diseases like diabetes, obesity, hypertension,
severe anemia etc. should also be considered
Referral criteria: Investigation: All investigations mentioned
• Patients not responding to two to in Level 2. In addition to that the following
three cycles of treatment investigations also may be carried out.
Dhatri Lauha Vati 500 mg Morning and 2-3 months Guda Ghrita
evening
Tapyadi Lauha Vati 500 mg Morning and 2-3 months Guda Ghrita
evening
Patients with other systemic diseases can be Pathya - Apathya (Diet and life style
referred to their respective departments. education): Same as level 1.
REFERENCES
Clinical diagnosis: Painful menstruation; Treatment: During the initial phase of the
pain begins just few hours before disease, one or more drugs from the table can
menstruation. The pain is spasmodic or dull be selected as per the status of the patient.
Referral criteria: Patients not responding discomfort starting before a few days of
to level 1 management should be referred to menses etc. should be considered.
higher centre.
Investigation: Same as Level 1. In addition
to that, the following investigations may also
LEVEL 2: CHC’S OR SMALL be carried out.
HOSPITALS WITH BASIC
FACILITIES • Ultrasonography to detect pelvic
pathology
Clinical diagnosis: Same as level 1: For a
fresh case reporting directly. • CBC, ESR,
Patients having symptoms like dull lower Treatment: In addition to the drugs men-
abdominal pain situated in back and front tioned in Level 1, the following drugs may
without any radiation; lower abdominal also be given.
Rajahpravartani Tablet 1-2 tablet After meal / twice From Luke warm
Vati9 of 250 mg daily 15thday of water / Tila
the cycle Kashaya /
till onset of Kulatta Kashaya
menses
Yogaraja Guggulu Vati 2-4 tab of After meal / twice 7days Luke warm
250 mg daily water /
Dashamula
Kwatha
Basti (one of the Panchakarma procedures), Vata Dosha. Basti should be administered
in which medicated oils and decoction are during inter menstrual period.
administered as enema, is regarded as the Basti is given as per cited in classics with
best procedure to treat diseases caused by following Niruha and Anuvasana Basti
Trivrita Taila14 – –
Tila Taila15 – –
Mahanarayana Taila16 – –
In Kashtartava with Scanty bleeding, following medicines can be given as per complaints.
REFERENCES
1 The Ayurvedic Pharmacopoeia Of India, Welfare, Department of I.S.M. & H., New
Part 1, Volume 1, Ed 1st, Government of Delhi, 2003:118
India, Ministry of health and family welfare, 3 Anonymous, The Ayurvedic Formulary
Department of AYUSH:63 of India, Part 1, Volume 1, Ed. 2nd, Govt.
2 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Part 1, Volume 1, Ed. 2nd, Govt. Welfare, Department of I.S.M. & H., New
of India, Ministry of Health and Family Delhi, 2003:194
Local treatment: Douche with Sphatika Jala / general disease condition such as to
Triphala Kwatha / Panchavalkala Kwatha / avoid sweets etc. in diabetics, stale
Nimba Patra Kwatha - twice a day for 5-7 days. food etc.
Pichu with Dhatkyadi Taila / Karanja Taila / • Vihara: Over eating, intercourse,
Neem Taila. day sleeping, mental stress, sup-
pression of natural urges, use of
Pathya-Apathya (diet and life style synthetic under garments
education):
Referral criteria:
Do’s (Pathya) • Patients not responding to level 1
• Ahara: Fresh vegetables, fruits, management
milk, Mudga / Mamsa Rasa Yusha • Chronic patients
and easily digestible food. Patient • Symptoms like purulent, offensive
should take freshly prepared food irritant blood stained discharge
only. with mild to severe pruritus vulva
• Vihara: Maintain local hygiene,
celibacy, LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Don’ts: FACILITIES
• Ahara: Dietary restrictions may Clinical diagnosis: Same as level 1: For a
be followed as per the prevailing fresh case reporting directly.
Examination: Per speculum and per vaginal • Pap smear - To detect pelvic
examination should be done to find out infection
vaginitis or cervical pathology. • VDRL, HIV - To detect sexually
Investigation: Following investigations may transmitting diseases
be carried out: • USG to rule out growth
• Heamogram Treatment: Drugs for external or local
• BSL use
Oral Medications – All drugs mentioned in Level 1. In addition to that the following drugs
may also be tried.
• Colposcopy
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL • Punch biopsy or Cone biopsy
LEVEL OR DISTRICT (Cervix) or endometrial Biopsy to
HOSPITAL/ INTEGRATED rule out cervical malignancy.
AYURVEDIC HOSPITALS Treatment: In addition to the treatment
mentioned in levels 1 & 2, following therapies
Clinical diagnosis: Same as level 1: For a
can be performed in Level 3 with due care.
fresh case reporting directly
• Local Agni Karma (cauterization) in
Investigation: In addition to the investiga-
premalignant lesions of cervix
tions mentioned at Level 2, following inves-
tigations may also be carried out. • Kshara Karma
• Microscopic examination of vaginal In case of suspected malignancy, patient
discharge (wet vaginal smear test) must be referred for advanced management.
• Fungal and aerobic culture of Pathya-Apathya (Diet and life style
vaginal discharge education): Same as level 1
REFERENCES
Govt. of India, Ministry of Health and Welfare, Department of I.S.M. & H., New
Family Welfare, Department of I.S.M. & H., Delhi, 2003:113
New Delhi, 2003 11 Anonymous, The Ayurvedic Formulary
of India, Part 1, Volume 1, Ed. 2nd, Govt.
9 Anonymous, The Ayurvedic Pharmaco-
of India, Ministry of Health and Family
poeia of India, Part 1, Vol. 1, Ed. 1st, Gov-
Welfare, Department of I.S.M. & H., New
ernment of India, Ministry of Health and
Delhi, 2003:135
Family Welfare, Department of AYUSH:
131 12 Anonymous, The Ayurvedic Formulary
of India, Part 1, Volume 1, Ed. 2nd, Govt.
10 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Part 1, Volume 1, Ed. 2nd, Govt. Welfare, Department of I.S.M. & H., New
of India, Ministry of Health and Family Delhi, 2003:67
Line of Management
INTRODUCTION
• Nidana Parivarjana should be the
Avabahuka is a Vatavyadhi caused by vitiation
first line of treatment.
of Vata at ‘Amsamoola’ (shoulder) leading to
restriction of shoulder movement. Amsashosha • Shodhana Chikitsa - Nasya
(wasting around the muscles of shoulder • Shamana Chikitsa - Pachana, Deepana,
joint) is a typical feature of Avabahuka in long Snehana, Swedana,
run. Patient experiences difficulty in lifting
• External applications - Lepa,
the shoulder with or without pain. Clinical
Upanaha
conditions like frozen shoulder, brachial
neuralgia etc. are similar with Avabahuka. • Rasayana Chikitsa for Mamsadhatu
• Treatment according to Doshik
Case definition:
involvement
Restricted shoulder movement and difficulty • General line of treatment prescribed
in lifting the arm associated with or without for Vatavyadhi
pain, begins gradually and worsen over time
leading to atrophy in shoulder muscles is
defined as Avabahuka. LEVEL 1: AT SOLO AYURVEDA
PHYSICIAN’S CLINIC/PHC
Differential Diagnosis:
Clinical diagnosis: On the basis of history
a. Manyasthambha and clinical presentation
b. Viswachi
Investigations: Nil
c. Amavata and such other diseases of
Shoulder joint – Treatment: See table 27.1
Rasna Churna Churna 3-5 gm Twice a day 2-4 weeks Luke warm
water
Yogaraja Vati 1-2 tab Twice day 2-4 weeks With warm
Guggulu1 water
Local Abhyanga and Nadi Sweda, Snigdha Pathya - Apathya (Diet and life style): Same
Churna Pinda Sweda, Patrapinda Sweda, as level 1
Jambeera Pinda Sweda and Shashtika Pinda
Referral Criteria: Cases not responding to
Sweda etc can be according to the condition.
above therapy.
REFERENCES
Rasna Churna Powder 3-5 gm Twice daily 1-2 weeks Luke warm
water
Shunthi Churna Powder 3-5 gm Twice daily 1-2 weeks Luke warm
water
Saptasaram Kashaya2 Decoction 12-24 ml Empty stomach / 1-2 weeks Luke warm
6 am & 6 pm water
Erandamoola Kashaya Decoction 12-24 ml Empty stomach /6 1-2 weeks Luke warm
am & 6 pm water
Dashamoola Kashaya3 Decoction 12-24 ml Empty stomach /6 1-2 weeks Luke warm
am & 6 pm water
Yogaraja Guggulu4 Vati 1-2 Tab Twice daily 1-2 weeks With warm
water
Simhanada Guggulu5 Vati 1-2 Tab Twice daily 1-2 weeks With warm
water
Eranda Taila, Oil 15-50 ml In early morning As per With hot water
Gandharwahastadi in empty stomach need or milk
Eranda Taila, or at bed time
Nimbamritadi Eranda
Taila
Murivenna/ Sahachardi Taila/ Kuzhampu, Karpasasthydi Taila / Kuzhampu, Dhanwntharam Taila /
Kuzhampu, Nirgundyadi Taila, Bala Taila etc For External application
• USG abdomen & pelvis – to rule Treatment: In addition to the Shamana man-
out any visceral pathology and agement mentioned in Level 1, few of the
Gynecological issues related to following drugs may be added as per the
uterus and adnexa and PID leading requirement and status of the patient. Inten-
to low back pain. sive combination therapies of Rasaushadhi
and Kashthoushadhi (herbo-mineral drugs) or
• USG – KUB – To rule out renal calculi
herbal drugs containing potentially harm-
and obstructive lower urinary tract
ful ingredients can also be used cautiously
symptoms.
at this level. Patient may be kept under
• CT Scan– For better assessment of observation while prescribing these kinds of
bony canal medicines.
Sanjivani Vati Vati 125-250 mg Twice daily 1-2 weeks Warm water
Agnitundi Vati Vati 125-250 mg Twice daily 1-2 weeks Warm water
Soubhagya Shunthi Paka Avaleha 5 gm Twice daily 1-2 weeks Warm water
Gugguluthikthaka Ghrita7 Ghee 15-30 ml Once or twice 1-2 weeks Before food
daily on appetite
REFERENCES
Trayodashanga Vati 1-2 tab Twice daily 1-2 weeks Warm water
Guggulu4
Plain & various Taila 15-50 ml Empty stomach As per Hot water or
types of processed -early morning or need milk
Eranda Taila at bed time
Bala Taila, Mahanarayana Taila, Nirgundyadi Taila, Sahachardi Taila, Vishagarbha Taila, Prasaranyadi
Taila, Murivenna / Kuzhampu, Karpasasthydi Taila / Kuzhampu, Dhanwntaram Taila / Kuzhampu, etc. for
Abhyanga and Sweda
Pathya - Apathya (Diet and life style 2. Chronic cases of Gridhrasi with full-
education): fledged symptoms or associated
morbidities like foot drop, muscle
Do’s -
wasting etc which require well planned
• Ahara: Advice light Vatanuloman In - Patient Panchakarma treatment.
diet like Shigru Shaka (drumstick),
3. Acute cases of Gridhrasi with severe pain
brinjal, Methi, Jeerak, Hingu,
which require strict bed rest and traction
Saindhava, Yoosha, Mamsarasa etc.
massages etc.
may be given.
• Vihara: Correct postures while
sitting or lifting the weight, regular LEVEL 2: CHC’S OR SMALL
suitable Yogasana and Abhyanga, HOSPITALS WITH BASIC
hot water bath, fomentation, FACILITIES
comfortable seats and bed should
be used. Bowel and bladder urges Clinical Diagnosis: Same as level 1 for a
should be attended timely. fresh case reporting directly.
Dont’s -
Investigations: Same as level 1, in addition
• Ahara: Vata aggravating diet like
pulses, peas, wafers, biscuits etc, • X ray of the lumbo sacral spine
cold food and cold drinks, stale
Treatment: In addition to the Shamana
food, excessive use of chilly.
management mentioned in Level 1, some
• Vihara: Exposure to cold, heavy of the following drugs may be added
physical work, spongy mattresses as per the requirement and status of the
and easy chairs. patient. Intensive combination therapies
of Rasaushadhi and Kashthoushadhi (herbo-
Referral Criteria:
mineral drugs) can also be used.
1. Cases not responding to above line of
Shamana management.
Dhanwantharm Taila (101) Taila 10-15 drops Once or twice a day for Sahachardi
Avarti 1-2 weeks Kashaya
Sahacharadi Taila10 Taila 10-15 drops Once or twice a day for Sahachardi
(Madhyama Paka) 1-2 weeks Kashaya
• Snigdha Churna Pinda Sweda, Pathya - Apathya (Diet and life style
Patrapinda Sweda, and Jambeera education): Same as level 1
Pinda Sweda and Shashtika Pinda Referral Criteria: Cases not responding to
Sweda may be tried. above therapy
REFERENCES
Diagnostic criteria and various presentation/phases of the disease are tabulated below:
Table 30.1: Differential diagnosis of Pakshaghat with various presentations of the diseases
Ekanga Vata CVA leading to Either one upper or lower limb Only one limb
monoplegia (Bahu or Sakthi) affected affected
Sarvanga Vata CVA leading to Sarvakayashrita Pakshaghata All the four limbs
quadriplegia affected
B. Prognostic Classification
Shuddha Vata Late effects of CVA With symptoms predominantly Upashaya with
(Krichra Sadhyatama) - spastic paralysis / of Vata – Stabdha / Sankocha / Snigdha / Ushna /
contractures / Sosha / Kaarshnya / Ushnakamitwa / Brimhana line of
disuse atrophy - Kampa / Anaha / Shakritgraha / treatment
usually chronic in Shoola etc
nature
Kaphasamshrishta Early effects of CVA With symptoms predominantly Upashaya with
(Kriccha Sadhya) flaccid paralysis / of Kapha – Gourava/ Shopha/ Rooksha / Ushna /
localized swelling Sheeta/ Supta/ Shlathangata Langhana line of
– usually initial few treatment
weeks
Murcchha Stupor stage related Murcchha/ Tama Pravesha / visual Not exclusively
to CVA hallucinations due to any
substance abuse
Pathya-apathya (diet and life style and balanced food. Khichadi made
education): with rice and green gram added
Please also refer diet contributing to hyper- with pure little amount of clarified
tension and dyslipidaemia and diabetes. ghee, cream removed milk is good.
Non Constipating diet as fiber rich
Since the disease is caused by diet and
food like leafy vegetables, green
activities contributing to obesity, vitiation of
salads, fruits, barley etc should be
Vata Rakta, specific advices should be given
encouraged. Vata alleviating food
to avoid all these. The whole life style of
articles prepared with ghee or any
the patient should be changed especially in
suitable oil, Udada (black gram),
prophylactic cases of TIA or RIND to prevent
Shigru Shaka (drumstick), brinjal
recurrences.
etc may be given. Patola, Rasona,
Dadima, Parushaka, Badara, Draksha,
Do’s–
may be advised by the patient. Shali,
• Ahara: The patient should be Shashtik, Kulattha, wheat products
provided easily digesting, nutritional are suitable.
Specific Line of Management and differential diagnosis) in different stages and Doshic
permutations, the medicines / procedures enlisted here
• Pakshaghata - Snehana, Swedana,
are indicated generally. Specific indications are highlighted
Snehayuktavirechana + Mastishkya,
where ever necessary.
Upanaha
• Ardita - Navana, Moordhnitaila,
Karnapoorana, Akshi Tarpana
Combinations / Preparations
Suvarna muktadi Gutika Vati 1-2 Twice With Coconut Giddiness, BPPV
Vati daily water
Clinical Diagnosis: Same as level 1 for a Shodhana: (This include the list of Karma in
fresh case reporting directly chronological order with complete details
of procedures along with choice of drugs,
Investigation: Same as level 2 indication and contra indications)
REFERENCES
• Vatarakta
INTRODUCTION
• Katigraha
Sandhigata Vata is the type of pathogenesis
involved in various disease conditions affect- • Gridhrasi
ing the joints, e.g. osteoarthritis, rheumatoid • Ansashoola
arthritis, etc. and causing pain in affected
• Krostrukshirsha
joints.1
• Ankylosing spondylitis
Case Definition:
Amrita Bhallataka Avaleha 5-10 gm Once daily One month With milk
REFERENCES
Line of Treatment
INTRODUCTION
Vatarakta is a disease of vitiated Vata External application, Abhyanga, Parisheka and
and Rakta. Most of the collagen vascular Upanaha are advised in Uttana Vatarakta and
disorders / connective tissue disorders come Virechana, Asthapan and Snehapan are given
under the broad umbrella of Vatarakta. in Gambhira Vatarakta.
Case Definition:
Often it is presented clinically in the form of LEVEL 1: AT SOLO AYUVEDIC
painful joints, parasthesia, eruption, swelling, PHYSICIAN’S CLINIC/PHC
redness etc. Vatarakta is of two types – Uttana
Clinical Diagnosis: On the basis of
when pathology is confined to Twak and
history and clinical presentation patient
Mamsa and Gambhira when deeper tissues
can be diagnosed provisionally as case of
and organs are involved in the pathogenesis.
Vatarakta.
Differential diagnosis: Investigations: Nothing specific
1. Amavata
Treatment: In the initial stage when the
2. Kushtha
patient is having mild features of Vatarakta,
3. Visarpa along with diet restriction, two or more of
4. Arbuda following drugs may be given:
Punarnava Vati 1-2 Vati After meal/ 2-3 weeks Warm Water
Guggulu3 (500 mg) thrice a day
Simhanada Vati 1-2 Vati After meal/ 2-3 weeks Warm water
Guggulu4 (500 mg) thrice a day
Nimbadi Churna 1-3 gm After meal/ 2-3 weeks Guduchi
Churna5 thrice a day Kwatha,
Warm water
Triphala Decoction 20-40ml Before meal/ 2-3 weeks Madhu
Kwatha thrice a day
Amrutadi Decoction 20-40ml Before meal/ 2-3 weeks
Kwatha6 thrice a day
Pinda Taila7, Taila Q.S. Once daily 1 month External
application
Ksheerabala Taila Q.S. Once daily 1 month External
Taila8 application
REFERENCES
Pathya - Apathya (Diet and life style): Same • Fluorescein and Rose Bengal
as level 1. Staining
Referral criteria: Refer to level 3
Treatment:
1. Cases not responding to above therapy.
• In addition to the management of
2. Patients with severe conjunctivitis,
Level 1 and Level -2,
infection spread on cornea and blurring
of vision. • Treatment can be done according to
predomince of Dosha.
3. Patient is indicated for Panchakarma
therapy. a. Chikitsa Sutra of Vataja
Abhishyanda19 – The patient
should be treated with old ghee
LEVEL 3: AYURVEDIC
(clarified butter). The part of
HOSPITALS AT INSTITUTIONAL
the forehead adjoining the eye
LEVEL OR DISTRICT
and not the eye itself should be
HOSPITAL / INTEGRATED
fomented and local venesection
AYURVEDIC HOSPITALS.
resorted to. Then after having
Clinical Diagnosis: Same as level-1 effected full purging with the
help of a Sneha-Basti (oleaginous
Investigation: enema), such measures as
Tarpana, Putapaka, fumigation,
• Culture and Sensitivity test Aschyotana (sprinklings), Nasya
Table 33.4: Shodhana Chikitsa and other Kriyakalpas at level 3 for Abhishyanda
Parisheka Drugs used in Aschyotana can be used for Parisheka in respective Doshas.
Anjana Pashupata Yoga34 Pashupata Yoga35 Fruits of Shigru and Equal parts of
Karanja, Patala, Arjuna,
fruits and flowers of Sriparni,
Brihati36 Bilwa, Dhataki,
Manjishtha,
Amalaki pasted
with honey.37
Siramoksha Snehana, Swedana Snehana, Swedana Snehana, Swedana Bloodletting by
followed by followed by followed by Leech.41
bloodletting Siravyadhana39 Bloodletting by
with Shrunga38 Alabu or through
Siravyadha40
Dhoomapan Snaihika Dhoomapana with
Dhumapana with Trikatu, Haridra,
Agaru, Guggulu - Sarshapa, Nimba,
and Ghee etc42 Guggaluetc Kaphahara
Dravya43
Virechana Snehapana: plain Gau Ghrita, Mahatriphala Ghrita44 / Mahatiktaka Ghrita45 / Patola
Ghrita46
As per the status of the patient,
Virechana: Mridu Virechana / Koshtha Shuddhi with Avipattikara Churna47 5-10 gm with
Drakhshadi Kashaya48 (50-100 ml).
Tilwaka Ghrita (5-10 gm) with Tilwaka Kashaya (50-100 ml) may be done for early few
days of the treatment49
REFERENCES
Welfare, Govt. of India, 2000, Part II (4:16), 17. Anonymous, The Ayurvedic Formulary
2000. of India, Ministry of Health and Family
7. Vrindamadhava or Siddhayoga, 61/71.72 Welfare, Govt. of India, Part I (20:8), 2000.
edited and translated by Premvati Tiwari, 18. Anonymous, The Ayurvedic Formulary
Chaukhambha Vishvabharati, Varanasi, of India, Ministry of Health and Family
2007. Welfare, Govt. of India, Part I (20:45), 2000.
42. Vrddha Vagbhata, Ashtanga Samgraha - 48. Anonymous, The Ayurvedic Formulary
Sasilekha commentary Indu, Uttartantra, of India, Ministry of Health and Family
19/11 Chaukhambha Krishna Das Academy, Welfare, Govt. of India, Part I (4:13), 2000.
Varanasi, 2000. 49. Vrddha Vagbhata, Ashtanga Samgraha -
43. Shri Dalhana Acharya, Sushruta, Sushruta Sasilekha Comm. Indu, Uttartantra, 19/10
Samhita with Nibandhasamgraha Chaukhambha Krishna Das Academy,
commentary, Uttaratantra 11/3-5 edited Varanasi, 2000.
• Acute conjunctivitis
Treatment:
• Ocular hypertension
POAG: (Vataja & Kaphaja Adhimantha)
• Physiological cupping of optic disc
• Mootrala (diuretics) drugs
• Secondary glaucoma for reducing IOP such as
Punarnavashtaka Kwatha, Gokshuradi
LEVEL 1: AT SOLO AYUVEDIC Guggulu, Chandraprabha Vati orally
PHYSICIAN’S CLINIC / PHC etc.
• Ashchyotana (mentioned below)
Clinical Diagnosis: On the basis of history
and clinical presentation patient can be • Chakshushya & Rasayana drugs
suspected provisionally as a fresh case (mentioned below)
Pathya-Apathya (Diet and life style (eye wash), Mukhalepa (face pack
education) with herbal medicines), wearing
head gear, always wearing shoes
Diet education and preventive measures: are also beneficial for the eyes.
Do’s -
Dont’s -
• Ahara:19,20,21 Regular intake of
Yava (Hordeum vulgare), Godhuma • Ahara: Excessive and regular intake
(Triticum aestivum Linn), Lohita of Horse gram and Black gram
Shali (Oryza sativa Linn), Mudga pulses, Virudhadhanya (sprouts),
(Phaseolus radiatus), Shatavari chillies and spices, sour and
(Asparagus racemosus), Patola fermented foods like pickles, idali,
(Trichosanthes dioica), Kustumburu dosa etc, heavy foods like cheese,
(Coriander sativum), Surana (Phallus paneer, deep fried items etc, Junk
campanulatus), unripe banana foods and fast foods, Dadhi (curd),
(Musa spp.), cooked vegetables Matsya (fish), meat of animals
of Jeevanti (Leptadenia reticulata), belonging to damp areas (Anoopa
Sunishannaka (Marsilea minuta), Mamsa), Phanita, Pinyaka (oil cake)
Tanduleeya (Amaranthus aspera), Aranala (sour gruel), excess water
Vastuka (Chenopodium album), intake, excess alcohol intake, betel
Karkotaka (Momordica dioica), leaf chewing (Tambula)
Karavellaka (Momordia charantia),
• Vihara: life style factors like
Shigru (Moringa oleifera), Agastya
anger, grief, excessive coitus;
(Sesbania grandiflorum), Punarnava
suppression of natural urges
(Boerrrhavia diffusa), brinjal, carrot,
like defecation, micturition,
spinach, cow ghee, cow milk, one
lacrimation, hunger, thirst etc.;
year old preserved Ghrita, meat of
looking at minute objects, excessive
birds and wild animals, Amalaki
weeping, excessive vomiting and
(Embelica officinalis), Draksha (Vitis
suppression of vomiting, daytime
vinifera) dried and fresh both,
sleep and awakening at night, shift
Dadim (Punica granatum), Almond,
duties, working on computer for
Saindhava (rock salt), Sita (sugar
continuous and longer duration and
candy), Kshaudra (honey) and
watching television for long time,
Amalaki Payasa, Shatavari Payasa are
sudden changes of temperatures,
beneficial for the eyes.
exposure to frequent change
• Vihara: Withdrawing the mind of hot and cold temperatures,
from objects of senses, Padabhyanga exposure to dust and fumes,
(Foot massage), Shiroabhyanga (scalp excessive sunlight exposure and
massage with oil), Netraprakshalana smoking.
2. Nasya:
Table 34.2: Uses of Nasyas in various type of Adhimantha
Vataja Adhimantha: Snehana Nasya: Oil processed with Rasna, Dashmoola, Bala, milk and drugs of
Madhura Gana are beneficial.34
Pittaja Ksheersarpi (equal quantity of milk & ghee) Nasya in every 3-3 days
Adhimantha: Ghee processed with Pittahara drugs Shali, Durva, Daruharidra.35
3. Tarpana:
Table 34.3: Uses of Tarpana in various type of Adhimantha
Vataja Adhimantha Panchamula, Jivaniya and the flesh of Kukkuta should be cooked with milk
and this processed milk is used for Tarpana.38
Pittaja Adhimantha Shankha, Shukti, Madhu, Draksha, Yashti and Kataka should be cooked with
milk and this processed milk is used for Tarpana.39
Kaphaja Adhimantha The milk is cooked with goat’s liver, Agaru, Priyangu, Devadaru and it
should be churned to obtain butter and ghee should be obtained after
cooking it.40
4. Ashchyotana
Table 34.4: Uses of Ashchyotana & Parisheka in various type of Adhimantha
7. Anjana
Table 34.5: Uses of Anjana in various type of Adhimantha
8. Siramokshana:
Table 34.6: Uses of Siramokshana in various type of Adhimantha
9. Dhoomapana:
Table 34.7: Uses of Dhumapana in various type of Adhimantha
REFERENCES
21. Vrddha Vagbhata, Ashtanga Samgraha 28. Anonymous, The Ayurvedic Formulary
- Sasilekha Comm. Indu; Uttartantra, 56, of India, Ministry of Health and Family
Chaukhambha Krishna Das Academy, Welfare, Govt. of India, Part I (6:35), 2000.
Varanasi, 2000. 29. Anonymous, The Ayurvedic Formulary
22. Shri Dalhana Acharya Sushruta, Sushruta of India, Ministry of Health and Family
Samhita with Nibandhasamgraha Welfare, Govt. of India, Part I (6:34), 2000.
commentary, Uttaratantra 9/3-4, edited 30. Anonymous, The Ayurvedic Formulary
by Vaidya Jadavji Trikamji Acharya, of India, Ministry of Health and Family
Chaukhamba Surabharati Prakashan Welfare, Govt. of India, Part I (6:28),
Varanasi, 2008. 2000.
23. Shri Dalhana Acharya, Sushruta, Sushruta 31. Anonymous, The Ayurvedic Formulary
Samhita with Nibandhasamgraha of India, Ministry of Health and Family
commentary, Uttaratantra 10/3 edited Welfare, Govt. of India, Part I (7:2), 2000.
by Vaidya Jadavji Trikamji Acharya,
32. Anonymous, The Ayurvedic Formulary
Chaukhamba Surabharati Prakashan
of India, Ministry of Health and Family
Varanasi, 2008.
Welfare, Govt. of India, Part I (4:13),
24. Shri Dalhana Acharya, Sushruta, Sushruta 2000.
Samhita with Nibandhasamgraha 33. Vrddha Vagbhata, Ashtanga Samgraha -
commentary, Uttaratantra 11/2-3, edited Sasilekha Comm. Indu; Uttartantra, 19/10,
by Vaidya Jadavji Trikamji Acharya, Chaukhambha Krishna Das Academy,
Chaukhamba Surabharati Prakashan Varanasi, 2000.
Varanasi, 2008.
34. Shri Dalhana Acharya, Sushruta, Sushruta
25. Shri Dalhana Acharya, Sushruta, Sushruta Samhita with Nibandhasamgraha
Samhita with Nibandhasamgraha commentary, Uttaratantra 9/10-11, edited
commentary, Uttaratantra 12/2-3, edited by Vaidya Jadavji Trikamji Acharya,
by Vaidya Jadavji Trikamji Acharya, Chaukhamba Surabharati Prakashan
Chaukhamba Surabharati Prakashan Varanasi, 2008.
Varanasi, 2008.
35. Shri Dalhana Acharya, Sushruta, Sushruta
26. Vagabhata, Ashtanga Hridaya with Samhita with Nibandhasamgraha
the commentaries Sarvangasundara of commentary Uttaratantra 10/5, edited
Arundatta and Ayurveda Rasayana of by Vaidya Jadavji Trikamji Acharya,
Hemadri, Uttaratantra 16/21, edited by Chaukhamba Surabharati Prakashan
Pandit Hari Sadasiva Sastri Paradakara Varanasi, 2008.
Bhisagacarya; Chaukhambha Orientalia, 36. Shri Dalhana Acharya, Sushruta, Sushruta
Varanasi, Reprint 2011. Samhita with Nibandhasamgraha
27. Vrddha Vagbhata, Ashtanga Samgraha - commentary Uttaratantra 11/3-5, edited
Sasilekha Comm. Indu; Uttartantra, 19/22, by Vaidya Jadavji Trikamji Acharya,
Chaukhambha Krishna Das Academy, Chaukhamba Surabharati Prakashan
Varanasi, 2000. Varanasi, 2008.
38. Vrddha Vagbhata, Ashtanga Samgraha - 46. Vagbhata, Ashtanga Hridaya with
Sasilekha Comm. Indu; Uttartantra, 19/12, the commentaries Sarvangasundaraof
Chaukhambha Krishna Das Academy, Arundatta and Ayurveda Rasayana of
Varanasi, 2000. Hemadri: Uttaratantra, 16/9, edited by
Pandit HariSadasiva Sastri Paradakara
39. Shri Dalhana Acharya, Sushruta, Sushruta
Bhisagacarya; Chaukhamba Orientalia,
Samhita with Nibandhasamgraha
Varanasi, Reprint 2011.
commentary, Uttaratantra, 12/35-36;
edited by Vaidya Jadavji Trikamji Acharya, 47. Anonymous, The Ayurvedic Formulary
Chaukhamba Surabharati Prakashan of India, Ministry of Health and Family
Varanasi, 2008. Welfare, Govt. of India, Part II (4:9), 2000.
40. Vrddha Vagbhata, Ashtanga Samgraha - 48. Vagbhata, Ashtanga Hridaya with the
Sasilekha Comm. Indu; Uttartantra, 19/33, commentaries Sarvangasundara of
Chaukhambha Krishna Das Academy, Arundatta and Ayurveda Rasayana of
Varanasi, 2000. Hemadri, : Uttaratantra 16/25-27, edited
by Pandit Hari Sadasiva Sastri Paradakara
41. Shri Dalhana Acharya, Sushruta, Sushruta
Bhisagacarya; Chaukhambha Orientalia,
Samhita with Nibandhasamgraha
Varanasi, Reprint 2011.
commentary Uttaratantra 9/13-14, edited
by Vaidya Jadavji Trikamji Acharya, 49. Vagbhata, Ashtanga Hridaya with the
Chaukhamba Surabharati Prakashan commentaries Sarvangasundara of
Varanasi, 2008. Arundatta and Ayurveda Rasayana of
Hemadri, Uttaratantra 16/25-27, edited
42. Sharangdharacharya. Sharangdhara
by Pandit Hari Sadasiva Sastri Paradakara
Samhita Uttarakhanda 13/8, Tra. Himsagar
Bhisagacarya; Chaukhamba Orientalia,
Chandra Murty, Chaukhamba Surabharati
Varanasi, Reprint 2011.
series. Varanasi; 2007.
50. Shri Dalhana Acharya, Sushruta, Sushruta
43. Sharangdharacharya. Sharangdhara Samhita with Nibandhasamgraha
Samhita Uttarakhanda 13/8, Tra. Himsagar commentary, Uttaratantra 11/6-9, edited
Chandra Murty, Chaukhamba Surabharati by Vaidya Jadavji Trikamji Acharya,
series. Varanasi; 2007. Chaukhamba Surabharati Prakashan
44. Vagbhata, Ashtanga Hridaya with the Varanasi, 2008.
commentaries Sarvangasundara of 51. Shri Dalhana Acharya, Sushruta, Sushruta
Arundatta and Ayurveda Rasayana of Samhita with Nibandhasamgraha
Hemadri, Uttaratantra, 16/17 edited by commentary, Uttaratantra 12/11-12 edited
Pandit Hari Sadasiva Sastri Paradakara by Vaidya Jadavji Trikamji Acharya,
Bhisagacarya; Chaukhambha Orientalia, Chaukhamba Surabharati Prakashan
Varanasi, Reprint 2011. Varanasi, 2008.
52. Vrddha Vagbhata, Ashtanga Samgraha - 55. Shri Dalhana Acharya, Sushruta, Sushruta
Sasilekha Comm. Indu, Uttartantra, 19/10, Samhita with Nibandhasamgraha
Chaukhambha Krishna Das Academy, commentary, Uttaratantra 12/8, edited
Varanasi, 2000. by Vaidya Jadavji Trikamji Acharya,
53. Shri Dalhana Acharya, Sushruta, Sushruta Chaukhamba Surabharati Prakashan
Samhita with Nibandhasamgraha Varanasi, 2008.
commentary, Uttaratantra 10/3 edited 56. Vrddha Vagbhata, Ashtanga Samgraha -
by Vaidya Jadavji Trikamji Acharya, Sasilekha Comm. Indu; Uttartantra, 19/11
Chaukhamba Surabharati Prakashan Chaukhambha Krishna Das Academy,
Varanasi, 2008. Varanasi, 2000.
54. Shri Dalhana Acharya, Sushruta, Sushruta 57. Shri Dalhana Acharya, Sushruta, Sushruta
Samhita with Nibandhasamgraha Samhita with Nibandhasamgraha
commentary, Uttaratantra 19/30; edited commentary Uttaratantra 11/3-5, edited
by Vaidya Jadavji Trikamji Acharya, by Vaidya Jadavji Trikamji Acharya,
Chaukhamba Surabharati Prakashan Chaukhamba Surabharati Prakashan
Varanasi, 2008. Varanasi, 2008.
Pathya - Apathya (Diet and life style & other foods which is heavy too
education): i.e. milk, curd, dry & hard foods.
• Vihara: over brushing, sleeping in
Do’s -
prone posture, day sleep
• Ahara: Freshly cooked, easily
Referral Criteria: If patient is not responding
digestible diet such as barley, green
to above mentioned management within 5 or
gram, bitter guard, other bitter
7 days and if signs and symptoms observed
foods, ghee, luke warm water etc.
other than above mentioned signs and
should be taken.
symptoms should be referred to higher level.
• Vihara: Regular mouth washes with
normal water, luke warm water, LEVEL 2: CHC’S OR SMALL
camphor water, fomentation, betel HOSPITALS WITH BASIC
leaf chewing, Dhoomapana. FACILITIES
Pathya - Apathya (Diet and life style days or signs and symptoms become more
education): Same as level 1 acute and required for Panchkarma therapy
should be refer to higher level
Referral criteria: If patient is not responding
to above mentioned management within 10
REFERENCES
1. Sushruta, Sushruta Samhita, Nidana Sthana 4. Sushruta, Sushruta Samhita, Chikitsa Sthana
16/8, In: Ambikadutta Shastri, Reprint, 16/23-24, In: Ambikadutta Shastri, Reprint,
Varanasi: Chaukamba Sanskrit Sansthan; Varanasi: Chaukamba Sanskrit Sansthan;
2008, p. 296. 2008, p. 296.
2. Sushruta, Sushruta Samhita, Chikitsa Sthana 5. Yoga Ratnakara. Samasta Dantaveshta
16/15-16, In: Ambikadutta Shastri, Reprint, Chikitsa 1-3, In: Vidyotani Hindi
Varanasi: Chaukamba Sanskrit Sansthan; Commentary, Reprint, Varanasi:
2008, p. 295. Chaukamba Prakashana, 2013, p. 218.
3. Sushruta, Sushruta Samhita, Chikitsa Sthana 6. Sushruta, Sushruta Samhita, Chikitsa Sthana
16/17, In: Ambikadutta Shastri, Reprint, 22/17, In: Ambikadutta Shastri, Reprint,
Varanasi: Chaukamba Sanskrit Sansthan; Varanasi: Chaukamba Sanskrit Sansthan;
2008, p. 296. 2008, p. 68.
7. Sushruta, Sushruta Samhita, Chikitsa Sthana Welfare, Govt. of India, Part I (8:2), 2000,
22/17, In: Ambikadutta Shastri, Reprint, p.366.
Varanasi: Chaukamba Sanskrit Sansthan; 13. Anonymous, The Ayurvedic Formulary
2008, p. 68. of India, Ministry of Health and Family
8. Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (12:6), 2000,
of India, Ministry of Health and Family p.505.
Welfare, Govt. of India, Part II (7:6), 2000, 14. Anonymous, The Ayurvedic Formulary
p. 83. of India, Ministry of Health and Family
9. Charaka, Charaka Samhita, Chikitsa Sthana Welfare, Govt. of India, Part I (5:5), 2000,
26/195, In: Yadavji Trikamji Acharya, p. 212.
Reprint, Varanasi: Chaukamba Sanskrit 15. Sushruta, Sushruta Samhita, Chikitsa Sthana
Sansthan; 2009. p. 752. 22/17, In: Ambikadutta Shastri, Reprint,
10. Charaka, Charaka Samhita, Chikitsa Sthana Varanasi: Chaukamba Sanskrit Sansthan;
26/197, In: Yadavji Trikamji Acharya, 2008, p. 68.
Reprint, Varanasi: Chaukamba Sanskrit 16. Sushruta, Sushruta Samhita, Chikitsa Sthana
Sansthan; 2009. p. 753. 22/16, In: Ambikadutta Shastri, Reprint,
11. Sushruta, Sushruta Samhita, Chikitsa Sthana Varanasi: Chaukamba Sanskrit Sansthan;
22/42, In: Ambikadutta Shastri, Reprint, 2008, p. 68.
Varanasi: Chaukamba Sanskrit Sansthan; 17. Sushruta, Sushruta Samhita, Chikitsa Sthana
2008, p. 100. 22/15, In: Ambikaduttashastri, Reprint,
12. Anonymous, The Ayurvedic Formulary Varanasi: Chaukamba Sanskrit Sansthan;
of India, Ministry of Health and Family 2008, p. 68.
Pathya-Apathya (Diet and life style Ikshuwika Rasa i.e. sugar, sugar-
education): cane juice, jaggery; food articles
which is heavy to digest like meat,
Do’s – cheese, Paneer, milk and dry & hard
• Ahara: Freshly cooked, easily foods.12
digestible diet such as barley, green • Vihara: Over brushing, sleeping in
gram, bitter guard, other bitter prone posture, day sleep13
foods, ghee, lukewarm water etc.
Referral Criteria: If patient is not responding
should be taken.
to above mentioned management within
• Vihara: Regular mouth washes with 5 or 7 days, he should be refer to higher
normal water or lukewarm water or level.
camphor water, betel leaf chewing,
Dhumapana.11
LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Don’ts (Apathya):
FACILITIES
• Ahara: Spicy and sour food, curd,
Clinical Diagnosis: Same as level 1
butter milk, Masha soup (soup of
black beans), any preparations of Investigation: Same as level 1
Note: Anupana - In Pittaja Mukhapaka medicine should be taken with Ghrita and in Vata and Kaphaja Mukhapaka
medicine should be taken with honey.
REFERENCES
1 Sushruta, Sushruta Samhita, Nidana Sthana 4 Sushruta, Sushruta Samhita, Chikitsa Sthana
16/3, In: Ambikadutta Shastri, Reprint, 22/5, In: Ambikadutta Shastri, Reprint,
Varanasi: Chaukhamba Sanskrit Sansthan; Varanasi: Chaukhamba Sanskrit Sansthan;
2008, p. 294 2008, p. 68
2 Yogaratnakara Samasta Mukharoga Nidana 5 Sushruta, Sushruta Samhita, Chikitsa Sthana
1, In: Vidyotani Hindi Commentary, Reprint, 22/67, In: Ambikadutta shastri, Reprint,
Varanasi: Chaukhamba Prakashana, 2013, Varanasi: Chaukhamba Sanskrit Sansthan;
p. 296 2008, p. 102
3 Yogaratnakara Mukharoga Chikitsa 2-3, 6 Yogaratanakara. Mukharoga Chikitsa 7,
In: Vidyotani Hindi Commentary, Reprint, In: Vidyotani Hindi Commentary, Reprint,
Varanasi: Chaukhamba Prakashana, 2013, Varanasi: Chaukamba Prakashana, 2013,
p. 307 p. 307
Mishra and Shri Rupalalaji Vaishya, 1/146, 27 Sushruta, Sushruta Samhita, Chikitsa Sthana
10th edition, Chaukhambha Publications, 22/69, In: Ambikadutta Shastri, Reprint,
Varanasi, 2002 Varanasi: Chaukamba Sanskrit Sansthan;
26 Vagbhatta, Ashtanga Hrudyam with 2008, p. 102
Vidhyotani Hindi commentary U. 22/75 28 Anonymous, The Ayurvedic Formulary
Ed. by Vaidya Yadunandana Upahaya, of India, Ministry of Health and Family
Chaukhambha Sanskrita Series Office, Welfare, Govt. of India, Part II (8:6), 2000,
Varanasi, Reprint 2006. p. 109.
Along with it some procedures can be carried Pathya-Apathya (Diet and life style
out like steam inhalation with sowa seeds, education):
eucalyptus oil, camphor etc.
Do’s –
Whenever needed symptomatic treatment
of associated conditions can also been done • Ahara: Patient is advised to take
e.g. if patients complains of fever, Sudarshana old Shali and Sathi rice, wheat,
Ghana Vati 1-2 tablet after meal twice or thrice barley, green gram, brinjal, drum
daily can also be added. sticks, bitter gourd, ginger, black
piper, long pippali, cow milk, cow Referral criteria: Patient not responding to
ghee, jaggery, indian gooseberry, above mentioned management and show
pomegranate, grapes, oranges etc.; symptoms of rhinitis like excessive discharge,
Drink lukewarm water, cow milk foul smelling and altered discharge from
with ginger and jiggery. nose, increased nasal blockage, headache,
• Vihara: Patient should take fever etc. patient should refer to level 2.
complete rest, cover the head with
warm clothes, take steam inhalation. LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Don’ts–
FACILITIES
• Ahara: Patient should not take
Clinical diagnosis: Same as level 1
heavy food articles and preparation
like cheese, paneer, sweets etc, Investigation:
refined foods such as white flour,
1. Anterior rhinoscopy:
bread, pizza, noodles etc. He should
avoid cold drinks, ice-creams, 2. Discharge in nose, congestion, deviation
chilled water, sweets and fermented of nasal septum etc
food items like bread, Idali, Dosa, 3. Oropharynx examination:
Khamana, etc. He must avoid 4. Post nasal discharge
Vishamashana (irregular dietary
5. Blood for Hb, TLC (leucocytosis), ESR
habits)27
6. X-ray PNS
• Vihara: Patient should avoid head
bath with cold water, direct wind Treatment: In addition to the management
and air condition exposure, dust mentioned in Level 1, few of the following
and pollen exposure, excessive drugs may be added as per the requirement
liquid intake after taking meal.28 and status of the patient.
Abhraka Bhasma32 125- 250 mg Bhasma Twice a day/ Honey 2-3 weeks
after meal
Shringyadi 2- 3 gm Churna Twice a day/after Goat meat/ 2-3 weeks
Churna33 meal luke warm
water
Pushkarmula 750 – 1250 Churna Twice a day/after Honey 2-3 weeks
Churna mg meal
Swasa Kuthara 625 mg Churna / Twice a day/after Ushnodaka, 2-3 weeks
Rasa34 Vati meal Kshudra
(Kantakari)
Kwath
Kushmanda 20 gm Avaleha Before meal/ Milk / 1 month
Rasayana35 twice daily lukewarm
water
Vyaghriharitaki36 5-15 gm Avaleha Before meal/ Milk / 1 month
twice daily lukewarm
water
Eladi Churna37 5 gm Churna Before meal/ Honey/ sugar 2-3weeks
twice daily
Marichadi Gutika38 1 tab Vati Frequently/ 4-5 2-3 weeks
daily
REFERENCES
1 Vataja Shiroroga Tivra Ruja in Shira (acute pain in head and aggravates at night)
- Gets relieved by applying bandage and fomentation around
the head
2 Pittaja Shiroroga - Ushnam Angararachitam (acute burning sensation in head)
- Dhoomavat Shira and Nasa (feeling of smoke in head and
nostrils)
- Gets relieved at night due to cold atmosphere
3 Kaphaja Shiroroga - Kaphopadigdhatvam in Shira and Gala (feeling of coating of sticky
mucus in head and throat)
- Feeling of Guruta in Shira (heaviness in head)
- Pratistabdhata in Shira (feeling of stiffness in the head)
- Shunakshikootavadanama (swelling on lower eye lid and face)
4 Tridoshaja Shiroroga Mixed clinical features seen
5 Raktaja Shiroroga All the signs and symptoms of Pittaja Shiroroga with acute
tenderness
6 Kshayaja Shiroroga Very acute headache, not controlled by any primary treatment
modality
7 Krimija Shiroroga Acute headache, insect biting sensation, bleeding from nose with
water and worms or maggots
8 Suryavarta Severe headache, pain increases with sunrise and decreases with
sunset
9 Ardhavabhedaka Sudden and acute onset of pricking pain in head
10 Anantavata Acute pain in neck, eye, eyebrow, temporal region, tremors, lock
jaw
11 Shankhaka Acute pain in head and temporal region
SHIRASHOOLA (HEADACHE)
No Type of Treatment
Shiroroga Kriyakalpa Drug Dose Duration
1 Vataja Shiroroga Shirodhara Luke warm cow milk 2 litre 21 days
prepared with Vata
pacifying medicines
Upanaha Krishara As per 21 days
Sweda requirement
Marsha Nasya Tila Taila prepared with 8 drops in 7 days
Vata pacifying medicines each nostril
i.e. Bala Taila,7 Mayura
Ghrita, Rasnadi Taila
2 Pittaja Shiroroga Shirodhara Cold milk, sugarcane juice, 2 litres 21 days
Madhu Jala, Mastu
Lepa on fore Pittaghna Aushadha Sidhdha As per 7 days
head Ghrita i.e. Kakolyadi Ghrita, requirement
Utpaladi Ghrita
Marsh Nasya Pitta pacifying Aushadha 8 drops in 7 days
Sidhdha Ghrita i.e. Kshira each nostril
Sarpi, Jeevaniya Ghrita
Virechana Trivrita Avaleha or Ghrita 20 gm One day
3 Kaphaj Shiroroga Pradhaman Katphala Churna8 1-2 gm Once in a three
Nasya day
Shirolepa Trivrittadi Lepa As per 7-21 days
requirement
Fomentation Water As per 7 days
requirement
4 Tridoshaja - Above mentioned treatment as per predominant Dosha
Shiroroga - To drink old Ghrita is especially advocated.
5 Raktajashiroroga - As per Pittaja Shiroroga
6 Kshayaja Ghritapana Ghrita prepared from 5 gm in morning 7 days– 21 days,
Shiroroga milk processed with give gap of 5-7
meat of sweet taste days and again
i.e. birds (sparrow, Ghritapana
Lava etc), or animals should be
(deer, crab etc)9 started
REFERENCES
1 Shri Dalhana Acharya on, Sushruta Samhita 3 Anonymous, The Ayurvedic Formulary
with Nibandha Samgraha commentary, of India, Ministry of Health and Family
Uttaratantra 25/3-18, edited by Vaidya Welfare, Govt. of India, Part II (4:15), 2000
Jadavji Trikamji Acharya, Chaukhamba 4 Anonymous, The Ayurvedic Formulary
Surbharati Prakashan Varanasi, 2008 of India, Ministry of Health and Family
Welfare, Govt. of India, Part II (16:59), 2000
2 Shri Govindacharya, Bhaisajya Ratnavali
with Vidyotini hindi commentary by Sri 5 Anonymous, The Ayurvedic Formulary
Kaviraja Ambikadutta Shastri, edited by of India, Ministry of Health and Family
Acharya Rajeshwaradutta Shastri, 65/172, Welfare, Govt. of India, Part I (8:60), 2000
18th edition, Chaukhambha Publications, 6 Anonymous, The Ayurvedic Formulary
Varanasi, 2007 of India, Ministry of Health and Family
Welfare, Govt. of India, Part II (8:6), 2000
7 Anonymous, The Ayurvedic Formulary 11 Shri Dalhana Acharya on, Sushruta Samhita
of India, Ministry of Health and Family with Nibandha Samgraha commentary,
Welfare, Govt. of India, Part I (8:33), 2000 Uttaratantra 26/31-33, edited by Vaidya
8 Anonymous, The Ayurvedic Formulary Jadavji Trikamji Acharya, Chaukhamba
of India, Ministry of Health and Family Surbharati Prakashan Varanasi, 2008
Welfare, Govt. of India, Part I (7:4), 2000 12 Anonymous, The Ayurvedic Formulary
9 Shri Dalhana Acharya on, Sushruta Samhita of India, Ministry of Health and Family
with Nibandha Samgraha commentary, Welfare, Govt. of India, Part I (6:16),
Uttaratantra 26/26, edited by Vaidya 2000
Acharya Jadavji Trikamji Acharya, 13 Shri Dalhana Acharya on, Sushruta Samhita
Chaukhamba Surbharati Prakashan with Nibandha Samgraha commentary,
Varanasi, 2008 Uttaratantra 26/39, edited by Vaidya Jadavji
10 Anonymous, The Ayurvedic Formulary Trikamji Acharya, Chaukhamba Surbharati
of India, Ministry of Health and Family Prakashan Varanasi, 2008
Welfare, Govt. of India, part 2 (8:6), 2000
1)
2)
3)
4)
5)
1. AHARAJA :
2. VIHAARAJA:
1) Prakriti:
a) Shaarira: V / P / K / VP /VK / PK / VPK
b) Maanasika: S / R /T
2) Saara: P / M / A
3) Samhanana: P / M / A
4) Pramaana : Height___cms. Weight__kgs BMI___ P / M / A
5) Satva: P / M / A
Satva(Emot.make-up): Prakrita / Utsahita / Udrikta / Khinna / Avasadita /
Bhavanatmaka / Bhawaheena
6) Saatmya: P / M / A
7) Vyaayaama Shakti: P/M/A
8) Agni Pareeksha: P/M/A
Shabda:
Sparsha:
Drika:
Akriti:
Lipid profile
BMI / Body Wt.
Vapavahana,
Ganda, Sphika,
Kati, Vrikka,
ECG, X- Ray, USG
OJAS:
GYANENDRIYA
PARIKSHA
Karna-
Nasa-
Netra-
Jihva-
Tvacha
Manas Karma Pariksha
Buddhi Pariksha
Nervous System Examination,
CNS,
Motor & Sensory
EEG, MRI, CT SCAN, Nerve conduction Test
ROGA PARIKSHA:
SAMPRAPTHI GHATAKA
1) DOSHA:
2) DOOSHYA:
Dhatu: Rasa / Rakta / Mansa / Meda / Asthi / Majja / Shukra
7) VYAKTISTHANA: .........................................
8) KRIYAKALA: ...............................
NIDAANA:
UPASHAYA:
ANUPASHAYA:
SAMPRAAPTI (Pathogenesis):
SAMBHAVITHA VYADHI:
ROGAVINISCHAYA (Diagnosis):
VYADHI AVASTHA: SAAMA/NIRAAMA, UTTHANA/GAMBHIRA
SAADHYAASAADHYATAA (Prognosis): Saadhya/Krichchhrasaadhya/Yaapya/
Pratyaakheya
UPADRAVA (Complication):
NIDANA (Etiology):
Signature of Vaidya