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IMPORTANCE OF ROGMARGA IN CHIKITSA KAMAL KISHORE 1 st yr P.G.SCHOLAR DEPT OF PG STUDIES IN KAYACHIKITSA SKAMCH&RC

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1. IMPORTANCE OF ROGMARGA IN CHIKITSA KAMAL KISHORE 1st yr P.G.SCHOLAR DEPT OF PG STUDIES IN KAYACHIKITSA SKAMCH&RC 2. Acknowledgement Im very much thankful to my master H.H Sri Sri Ravishankar for the infinite love. Im also grateful to my Guide Dr. Byresh A. under whose valuable inputs this ppt could come out in a easy and understandable form. Last and most important to my parents. 2 3. Feel free to copy , understand , copy etc U can reach me at Kamal.kishore [email protected] 3 4. CONTENTS Introduction Classification of Roga marga Koshta Shakha gati Shakha Koshta gati Diseases in Bahya Roga marga Diseases in Madhyama Roga marga Diseases in Abhyantra Roga marga Dosh gati 4 Koshta Shakha gati Shakha Koshta gati Roga marga and Dosh Gati Roga marga and Samprapti Anatomical Aspect of Roga marga Prime line of treatment Significance of understanding Rogamarga Conclusion 5. Roga marga 5 6. Roga Marga is an unique contribution of Ayurveda. It is being explained in Nirdesha Chatuska in Tisraisaniya Adhyaya of Charaka Samhita. After explaining the trini ayatanani and tryoroga , tryorogamarga is explained which indicates its importance. Ua + qa = Uaqa raogaaNaaM maaga-: raogamaaga-: | (Hemadri on A.H. Su. 12/45) 6 7. 7 8. ROGA ei Ci Ua:| Which causes pain is called as roga. MARGA Marga means pathway The pathway of disease is considered to be as Rogamarga. Marga Srotoparyaya Sroto, Sira, Damani, Rasayani & Nadi. 8 9. r Uaqa Ci SZ qqxjxlkr Mr |( c.su.11/48) r Uahq qa: o qkrprliU: ||( a.sa.su22/90) 9 Acc to Charaka 1. SaaKaa 2. kxaoYz 3. mamaa- isqa sainQa Acc to Vagbhata 1. baa+ 2. AaByaantar 3. maQyama 10. 10 Sauk` 11. Charaka iSaZUSrkiu:iuM cxoUaqa||(c.su11/48) Vagbhata ioUSkiuxiuMc| xml:SZZr:||(A.Sa.Su 22/91) 11 Sauk` 12. Charaka qqhmluxiWSrqkSl,Axjxlkr AxjxqraximloxlrMhDU, xqkrqUaqa|(C.su.11/48) Vagbhata SUWSruxirSqqhrxjlqc xlkr| xUxlrMhOUqkrq||(A..x.12/47,48) 12 13. Charaka MmlcriqWxiSaUqkrqWlqlqqmYuSrimrrSa oSxil, xUaqaAprliU|(c.x. 11/48) Vagbhata AprliUqWxiSaUUqkrqqWlqlqSrW MAliUi mrr:|(A.x.x22/18) 13 14. Charaka i, ahQmQMsermccqMskqqxqwkxkuxYzurXaSruMU oWqa uxmrqasqSuSkrSrSZlxUhpuliUa||(c.x.11/49) Vagbhata iSrahQmQMsermccqMsoSkqqxqurXaSr oWmaaSTSasquxmuSkrSr||(A.x.x 22/18) 14 15. Charaka mukaWmilMSiSaaoYaUerqxjxlkSsaSpM SSr SUWxiUaSrqkrqqalxUhpuli Ua|(c.x.11/49) Vagbhata Uaqa:xjixirqamukSi:| qkSUaxlkrxjMSsaWSr||(A..x.12/47,48) 15 16. Charaka jvaraitasaarcC- lasakxivasaUicakxakxasaSvaasaih@kxanaahaodrplaIhadyaa o#ntamaa-gajaa: ca ivasapa-SvayaqaugaulmaaSaao- ivad`Qyaadya: kxaoYzanausaairNaao Bavainta raogaa: ||(ca.saU.11/49) Vagbhata iSreuUixUNsxMuwcMxMxW@kxakqlWSU msWSrAliSWSTSuSkasqSr||(A.x.x:22/96)16 17. yaqaa duYTona daoYaoNa yaqaa caanauivasapa-taa | (A.h`.ina.1/8) For the disease to take place, Dosha has to do Visarpana after getting vitiated. The Trividha Gati of the Dosha is explained by Acharya Charaka. They are :- 1) Kshaya, Sthana and Vrddhi. 2) Urdhwa, Adhah and Tiryak. 3) Shakha, Koshta and Marmasthi Sandhi. 17 18. Charaka urrqSwqhxihrkSixrlucUhi| McNZqsrliSiiulqixrc||(c.x.28/31) Vagbhata urrqSwqhxihrSWicUhSmMcNZxjqqh Siiulqixrc| Swrli |(A..x.16) 18 19. Due to the following factors the vitiated doshas may go into bahya as well as madhyama roga marga. 1.) Vyayama (Exercise): Exercise produces ushma, kshobha in the body and shrama (A.Su.13/17 + com.). Which leads to vaata vriddhi this vaata tends to take the doshas from koshta to shaakha or marmaasthi sandhii or both. 19 20. 2.) Ushmanah taikshnyath :- Ushmanah and taikshnyath leads to srotomukha vivrutti and vilayata of consolidated doshas i.e. prasara . While passing they encounter at a certain place an obstruction/hindrance (khavaigunyat). Thus remaining there, a specific pathogenesis is formed and a particular disease is formed. 20 21. 3.) Ahita Acharana : Acharana is action, behavior or conduct. Ahita means which is not helpful or beneficial. Those things, which are not only useless but are troublesome too. 21 22. 4.) Drutatvat Marutasya Maruta is called Vata and Drutatva terms for the property of movement. Because of the subtleness of Vayu, and its rapidity, Dosha are taken to the other Roga Marga from Koshta . Vagbhatta has added Asthi-Marmani while Charaka has only mentioned Shakha. Here, the Shakha word implies to both the Roga-Marga (Madhyama and Bahya), because from Kostha it can go in to both of these Margas. 22 23. gaita pa`kxarao#vasqaa vaa |(ca.saU.12/7 par cak`xpaaiNa) Thus, in pathological backgrounds, the travel of Dosha from Kostha to Shakha can be related with three stages of Chaya, Prakopa and Prasara avastha. The Chaya takes place by Ahita acharanat, which helps in the increase of concentration of Doshas. Vyayamat & Ushmanah Taikshnyat creates the liquefaction (vilayana) which is Prakopa. Prasara takes place by Drutatvat Marutasya and hence Dosha travels from Koshta to Shakha. 23 24. e.g. of dosh gati from koshta shaakha 1.) Shaakhaashrita Kaamala r}XaSaItagaur]svaaduvyaayaamaOvao- gainaga`hO: | kxfxsaMmaUicC-taao vaayau: sqaanaata ipattaM kxfxhrOja-yaota ||(ca.ica. 16/125) 2.) Aamavaata : isnagQaM Bau@tavataao +nnaM24 25. Charaka uSkruwrlSlimMi xiqZuSakli| SZqYiuqsMrliurlaWi||(c.x.28/31,33) Vagbhata ijiprxiqZuSkli | ukrpwrlSlimMiMqurlaWi||(A.W.x.13/18) 25 26. Due to the following factors the shaakhagata doshas may go into koshta. 1.) Vriddhi : When the Dosha (pitta and kapha) are excess i.e. when the Dosha, which have travelled from Koshta to other Rogamarga, are excess, and if the Srotas of these Rogamarga are completely filled up, then Dosha travel towards Koshta. This increase brings back the Dosha to Koshta. 26 27. 2) Vishyandanat : This term means excess of the secretions. It is nothing but liquefaction/ vilayanaat (chakrapaani on C.Su.29/32) . Vagbhata use the term Abhishyandana instead of Vishyandana, the Sarvanga Sundara Tika says, that Abhisyandana may take place either from the drugs with ushna, tikshna properties. 27 28. 3) Pakaat : Paka reduces the pichillita of Dosha, which are seated in shakha and hence their tendency to get accumulated there and getting absorbed/adsorbed is reduced, thereby directing their flow towards Kostha. paakxaidita paakxjainatalaaGavaata pa@vaao ih daoYaao laGau sana kxaoYzM yaaita | (iSavadasa saona) 28 29. 4) Srotomukha Vishodhana : Vagbhata places this factor very first while Charaka places it after vriddhi, vishyandana & paka. Some times the strotas are unable to convey their substance through them, because their internal space becomes full of some unwanted substances like Ama. Vitiated Dosha become stagnant there. Such a situation is said to be Srotomukhavarodha. The process of their expulsion is called Srotas Shuddhi or Srotomukha Vishodhana. 29 30. 5) Vayoscha Nigrahat : Vayu is the prime factor for any movement. Pressure of Vata helps the spread of Dosha from the central tract (Koshta) to the Shakha. But when this pressure of the central tract is released, vitiated Dosha has no other way, but to come back to alimentary channel from side ward shelters i.e. the periphery system. Thus, they return to their normal abode. 30 31. e.g. of dosh gati from shaakha koshta 1.) Shaakhaashrit Kaamla maataulaugaM rsaM XaaOd` ipappalaImaircaainvatama sanaagarM ipabaota ipattaM taqaa#syaoita svamaaSayama | (ca.ica 16/129) 31 Trikatu because of its ushna, teekshna and laghu guna makes pitta vruddhi in shaakha. Maatulunga swarasa due to its amlarasa, amlavipaka, ushnaveerya does vatashamana. Trikatu due to its katurasa and rooksha guna, does kaphashamana. 32. 2.) Vaitarana basti for Aamvaat (Chakradatta niruhaadhikaara. Chapter76) 32 chincha by amlarasa and guru guna does the vriddhi. guda by its agnivardhaka property and madhura rasa does the paaka and vayu nigraha. gomootra by its teekshna, katu, tikta, laghu does srotomukhvishodhana. saindhava by vishyandana, vilayan, kledanam. (ca.k`. 1/15) (ca.saU.26/42) taila is G {ttamama 33. urrqSwqhxihrkSixrlucUhi | McNZ qs rliSiiulqixrc || ta~aasqaa: ca ivalambantao kxdaicanna samaIirtaa: | naadoSakxalao kuxpyainta BaUyaao hotaupa`taIiXaNa: |(c.x/28/33) ij iprxiqZuSkli | ukrpwrlSlimMiMq ur laWi|| ta~aasqaa: ca ivalambaorona BaUyaao hotaupa`taIiXaNa: |(A.W.x.13/18) 33 34. Thus the word tatrastha in Charakas parlance gives the meaning of shakhastha while in Vagbhatas parlance it means koshtastha. Charaka explains that when doshas have approached the shakha and madhyama rogamarga, it lingers silently waiting for its sameerana and when the favourable condition (desha, kaala) appears, it gets flared up and cause the disease. Chakrapani also clarifies that weak dosha doesnot succeed to cause the disease. 34 35. According to Vagbhata , tatrastha implies dosha which have been brought back to koshta. At this point of time they are not in the sanchayavastha. Released from shakhadi marga, systematically, they dont create any disease in koshta. If at this stage they are neglected, then factors like desha, kaala etc gives them strength and thereby producing the new disease. It is therefore necessary to drive them out of body by the nearest way. Example : in the line of treatment of amavata after achieving the niraamaavastha , shodhana should be done. 35 36. yaqaaduYTona daoYaoNa yaqaa caanauivasapa- taa | inavaR-ittaramayasyaasaaO sampa`aiptajaa- itaraagaita: ||(A.h`.ina.1/8) pa`itaraogaimaita k`uxQaa raogaaiQaYzanagaaimaina: | rsaayanaI: pa`paVaSau daoYaa doho ivakuxva-tao |(A.h`.ina.1/23) 36 37. In the healthy state, there will be no Rogamarga of any kind reserved to the travel of the vitiated Doshas. Marga is created actually when Khavaigunya takes place. The vitiated doshas moving in the body will take advantage of this Khavaigunya, and it is than the manifestation of a disease takes place through dosh dushya sammorchana. The Srotasas, which are vitiated, behave as Roga marga Or the Marga for the Roga. As a result of this, Roga becomes clear and virulent. Thus, the term Roga marga. It can be understood as the weak part of the Srotas responsible for the Samprapti occurrence and also spreading of a disease. 37 38. Healthy state No rogamarga Prakupita dosha Takes sthaanasamshraya where there is khavaigunyata Srotas which are vitiated behave as rogamarga Manifestation of disease 39. 1.) Shaakha / Bahya Rogamarga :- SaaKaa AiBaQaoyaanaaM baa+tva &aapanaaqaM- |(cak`xpaaina ca.saU. 11/48 par) Thus, to show the remoteness of these structures, they have been termed as Shakha/Bahya Rogamarga. Rasa, Rakta, Mamsa, Meda, Majja pertaining to the internal structures like Yakrit, pliha, etc. should not come under Bahya Roga Marga. For example, Yakrta Gata Rakta should come under Abhyantara Roga Marga. The accessory appendages of skin like hairs, nails, tactile cells, sebaceous glands etc. Mammary glands, ext. ear, tonsils, adenoids should be considered under Bahya Rogamarga. Thus, looking to the structures and diseases allotted to Bahya Rogamarga it is evident that this Marga is in direct contact to the external stimulus and these diseases are such that it can be visualized and/or palpable i.e., Pratyaksagamya. 39 40. 2.) Madhyama rogamarga The structures of Madhyama rogamarga are not closely linked with each other anatomically. They perform some vital functions of the body and any damage to them will give rise to serious consequences. 3.) Abhyantara Roga Marga This Roga Marga is termed as Koshta. Hence, all the Koshtangas may be included under this Roga-Marga except Basti & Hrdaya. But the reason for not considering these organs under Kostha may be that the structural disorders of any of these organs may influence the material flowing through them but not the organs of Mahasrotas. 40 41. 41 Disease Vaman Virechana Basti Nasya Raktmokshana Pakshwadha + + Pakshgraha + Apatanak + Ardita + + Shosha + Rajyakshama + + Asthisandhi shoola + Guda bhransa Shiro roga + + + + + Hridya roga + + + Basti roga + + + 42. Diseases Vamana Virechana Basti Nasya Rakt mokshana Arsa + Vrana + + Vidradhi + + Kustha + + + + Pama + Visarpa + + + Granthi + + Slipada + + + Ganda + + + + Arbuda + + + Apachi + + + Ksudra roga + Masurika + Romantika + Granthi + + + Vyanga + + + Nilika + + Palitya + + Arumsika + Mukha dusika + Switra + Bhagandara + + 42 43. 43 Disease Vaman Virechana Basti Nasya Raktmokshana Jwara + + + + Atisara + Chardi + + Alasaka + Visuchika + Kasa + + Swasa + + Hikka + Anaha + Udara + + + + Pliha Vriddhi + + Visarpa Swayathu + + Gulma + + + Arsa + + Vidradhi + + 44. Vaman & Virechana Antah Parimarjan Nasya & Basti Shaman chikitsa Shodhana chikitsa ( Rakt mokshana, kshara, agni) Bahi parimarjan 44 Abhyantara Rogmarga Bahya Rogmarga Madhyama Rogmarga tasmaata na baistasamaM ikxicaMta kxma- mama-pairpaalanamaista |(ca.isa.9/7) 45. Gugullu and Shilajatu are widely used in the disease affecting the Sandhis, Basti, Hridaya and also in diseases concerned with Sandhi nibaddha Sira, Snayu, Kandara and Snayupratana. In the same way, Gandhaka, Bhallataka, Manjistha, Khadira, Bakuchi happens to be the most used drugs in the majority of the diseases of Bahya Rogmarga. Likewise, medicated Ghrita and other Dipaniya drugs are extensively used in the diseases of Abhyantara rogmarga. 45 46. 46 raogamaaga-sya &aanama icaikxtsaa Baodaqa-ma |(maQaukxaoYa) According to Madhukosha the knowledge of this movement of doshas is in the formulation of treatment protocols. sauKasaaQyatvaaid &aanaaqa-ma |(cak`xpaaiNa) According to Chakrapaani it is helpful in predicting Saadhyaasadhyata. snaohi@lannaa: kxaoYzgaa Qaataugaa vaa sa`aotaaolaInaa yao ca SaaKaaisqasaMsqaa: | daoYaa: svaodOstao d`vaIkRxtya kxaoYzM naItaa: samyak SauiwiBaina- hyantao |(A.=.saU.17/30) According to Vagbhata the vitiated doshas from all rog marga are brought back to kostha and are taken out of body through samshodhana. 47. saaQyaasaaQyaivaBaaga&aao &aanapaUva-M icai@tasakx:|(ca.saU.10/7) Disease caused by single dosha afflicting one of the rogamargas with chatushpaad is a sign of good prognosis(sukhasaadhya). Disease occuring in two roga margas is also krichsaadhya even though it is new. When doshas are seated in the deeper dhatus like meda etc..involving the dhatus and marmasthi sandhis it is an indication of palliability (yaapya). If a disease is manifested by involving all the margas it clearly indicates the incurability(prathyakhyeya). 47 48. The knowledge of roga margas helps to understand the dosha gati, there by in understanding the disease process and its treatment module. Eg: Doshas in kosthagatha Vaman & Virechana. There are some disease like Arsha which occurs in two rogamarga like Bhahya and Abhyantra depends on doshagathi and vyadhimarga further chikitsa is planed . e.g. Arsha in Bahya marga twak aashrit Arsha in Abhyantra marga koshta aashrit 48 49. Both Charaka and Vagbhata considered disease like Visarpa, Vidradhi, Arsha, Gulma, Svayathu in both Bahyagatha and Abhyantra roga marga. Some scholars have corelated the roga margas with germ layers, the clinical utility of which is still unexplored. Sushruta has not explained the roga marga as a separate entity but has included it while explaining diseases. e.g. Kustha - tasya ipattaSlaoYmaaNaaO pa`kuxipataaO pairgaR=ainala: pa`vaRwistaya-ggaa: | isara: sampa`ipta paV samauwUya baa+M 49 50. Rogamarga in classics is not suggestive of any anatomical entities i.e., rachanatmaka or avakashavachaka or srotas or dhamanivachaka. The literal meaning of word rogamarga signifies not the physiological turn over but rather related to vikara or roga. The description of Roga Marga is a special type of classification that helps us to understand the disease process and management. Such a classification is unique in comparison to Moderns systemic classification of disease, as the modern systemic classification does not give any contribution in the field of prognosis and management whereas it is not so in the case of classification of diseases in terms of Roga Marga. 50 51. A study of the diseases related to Abhyantara rogmarga reveals that Agnimandya be the main factor in those diseases. Agnimandya gives rise to Ama, which in turn creates Srotorodha. Nearly all the diseases of Madhyam rogmarga are originated due to Pratihata Vayu (obstructed) and hence mostly they are Pakwasayotha. In the diseases of Bahya Rogmarga, Dhatwagnimandya will be prominent. Ama will be in the dhatus in these cases. 51 52. Extra slides 53 53. Bernoulis principle 54 54. EXPECTORANTS (Mucokinetics) These drugs believed to increase bronchial secretions and mucocilliary function or reduce its viscosity , facilitating its removal by coughing. eg-: sodium and potassium citrate (salt action) Plants like VASAKA (Adatoda vasica) - Increases bronchial secretions (vruddhyaath) - Increases mucocilliary functions (srotomukha vishodhanaath) - Decreases viscosity of bronchial secretions (vishyandaath) 55 55. Explanations GUDABHRANSH Out of all the above diseases, gudabhransh(rectal prolapse) involving pelvic organ consists of sushirsnayu(sphincter) situated at the end of rectum. So even if it is a kosthanga, due to non functioning of snayu it is included in the middle pathway. The diseases like Shosha & Rajyaksma( both caused by depleting dhatus) involve musculoskeletal system. Hence despite of involvement of dhatus, they are considered under this route & not the outer route. Also the guda is a sadyopranhar marma So thats why madhyam rog marga 56 56. Rajayakshma is manifested by the vitiation of Vata and Kapha Pradana Tri-dosha. Madhyama Roga Marga constitutes the Head, Heart, Bladder and such other Marma Sthana, Asti Sandi etc. Vata and Kapha Dosha gets aggravated with Pitta dosha and spreads all over the joints of the body and other Marma Sthana, Urdwa, Adha and Tiryak Bhaga and obstruct the Srotas thus leading to an improper Dhatu- paka. So there is Dhatu Kshaya found in Shosha disease. In Madhyama Rogamarga vyadhi the disease affected in Hridaya, Basti, Shira Pradesha, Marma and Asti. In Shosha, these sites affected simultane- ously, so this Rajayakshma is the best example for Madhyama Roga Marga. Agnivesha, Charaka, Dridhabala, Charaka samhita, Nidana sthana , Ra- jayakshma Chikitsa Adhyaya, 8/31-32, edited by Vaidya Jadavaji Trikamji Aacharya, Reprint ed. Chaukhambha Surabharati Prakashana, Varanasi, 2005; - 460 57 RAJYAKSHAMA 57. 58 58. 59 59. 60 60. 61 61. 62 62. 63 63. 64