SHRI K.

MISHRA University of Southern California, Los Angeles

Neuromuscular disorders in "Ayurveda": an ancient medical treatise of India

Various types of neurological and neuromuscular disorders are described in the Ayurveda which is one of the oldest medical traditions in the world. The pathogenesis of neurological and neuromuscular disorders are due to the deranged humour (vat) which enters the dhatu tissues such as muscles (mans) and ligaments (snayu) to produce symptoms. Among approximately 80 neurological and neuromuscular disorders described in the Ayurveda are tetanus (hnnugrah), brachial plexopathy (bahushosh), paraplegia (pangu), peripheral neuropathy (pad dah), facial paralysis (ardii), and lathyrism (kalay khanj), the latter being of great interest to modern neurotoxicologists. The relationship of lathyrism to eating the legume Lnthyris sativus was well described by Sushruta (Shastri & Guru, 1953). Ayurveda provides a good description of a number of muscles and ligaments in the body as well as inherited and acquired disorders including muscle atrophy, hypertrophy, weakness, pain and cramps. The basic principles of treatment include balancing vata. Treatment is of two types, preventative and symptomatic. In spite of Ayurveda being an ancient therapeutic discipline there are still many areas which need further investigation in the light of the scientific advances of modern medicine. Ayurveda should not be considered as a historical and obsolete medical discipline.

is said to have been written approximately 3000 years ago, though its exact dates are not known. Ayurveda is not only a medical discipline but an art and science of life. The literal meaning of Ayurveda is treatise on age (ayuh). Age, according to Charak Samhita (Pandey & Charurvedi, 1968), is defined as "the union between body, senses, mind and soul". The definition of Ayurveda is very broad, being the science of human life and a discipline which describes the factors, good and harmful, for life. It also includes the diagnosis and treatment of mental and physical disorders. According to Ayurveda the human body is the seat (anchor) of religion
(dharma), wealth (artha), passion (kam)

INTRODUCTION

yurveda is both the basic treatise of Indian medicine and one of the oldest medical disciplines in the world. Ayurveda originated from the Atharva Veda, one of the four great epics of Indo-Aryan Hindus. The Atharva Veda

and salvation (moksha). The various illnesses to be described interfere with the ultimate achievement of life, therefore objectives of perfect health are essential for the fulfilment of those goals. What is the definition of health? According to Sushruta Samhita (Shastri & Guru, 1953) ideal health is defined as "balanced humours {vat, pitta and kafa, vat or vayu signifying the electrical activities of peripheral nerves, pitta signifying metabolic activities including those of the digestive system, kafa signifying phlegm, synovial fluids etc) balanced digestive system and all excretory systems of the body with happiness of soul, mind and all senses". Since the original description of Ayurveda in the Atharva Veda, many original books and narratives have been written, such as the famous Charak Samhita, a medic205

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S. K. MISHRA and fear, and are caused by alterations of raja and tama. The sharirik (bodily) diseases are caused by alteration of the humors, vat, pitta and kafa and their interaction with the seven different dhatu (tissues) which consist of rasa (extracellular fluid lymph), rakta (blood), mans (muscle), ineda (fat), aslhi (bone), niajja (bone marrow) and shukra (semen).
AETIOPATHOGENESIS or
NEUROLOGICAI.-NEUROMUSCULAR DISORDERS IN AYURVEDA

S. K. MISHRA

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al treatise, and Sushrut Samhita, the great surgical treatise. These books date back to 700 to 1200 years BC. Since then, many other books have been written and many have been translated into Persian, German, and English, as well as other languages.
SUUSPECIALITIES OF AYURVEDA

Ayurveda is also called Ashtang and consists of eight parts: kaya chikitsa (internal medicine, including neurology), shalakya (ophthalmology, ENT and dentistry), shahjn (surgery), agad tantra (toxicology), bhoot vidya (psychology and psychiatry), komar bhritya (paediatrics), rasyayan (science of rejuvenation, gerontology) and bajikaran (sexology, aphrodisiacs).
Aetiology

Aetiological factors in Ayurveda have been divided into endogenous and exogenous groups. The endogenous factors include derangement of tridoshn (humours); derangement of seven dtiatu (tissues), blood, fat, muscle, bone, etc; and derangement of mental factors, raja and tania. The exogenous factors include physical and biological factors and the effects of stars, zodiac and many other external forces. The endogenous disorders can cause illness in seven different ways: (1) by inheritance from either parent, as in cases of leucoderma and piles; (2) due to congenital factors in utero or during birth, as in the cases of dwarfism and blindness; (3) due to dietary habits and/or excessive physical activities; (4) due to external trauma; (5) due to environmental factors such as weather and soil; (6) due to infectious agents or a curse; (7) due to abnormal daily habits such as sleep deprivation, excessive eating, and routine substance abuse (Sashtri & Guru, 1953). Diseases are classified into mental (psychological) and physical (somatic) categories. The mansik (mental) diseases include anger, jealousy, pride, anxiety,

Humour (vat) is responsible for the perception of sensation, such as touch, hearing, vision, taste and smell to various organs eyes, ear, tongue, nostrils. It is also responsible for speech, hands, feet and the excretory system. It performs breathing, digestion and other activities in the body. The vata are responsible for all bodily activities. There are five types of vata with specific location and neuroanatomical substrates. The first, pran, is responsible for sustaining life. Udan is responsible for speech, including singing-, etc. Saman controls digestion in the upper GI tract. Byan is responsible for circulation, especially in the chest area. Finally, apan controls the pelvic region, including urinary and faecal functions and these specific functions and sites can be compared to respiratory centers and various autonomic plexuses. The neurological symptomatology is produced by the derangement of vat in different tissues (dhatu), for example, skin manifestations characterized by dryness or hyperaesthesia. Muscle symptomatology included muscle cramps, weakness and atrophy. The descriptions of neurological and neuromuscular disorders, including central and peripheral nervous system and muscle, come under the heading of vat, vya'dhi. Therefore the primary aetiological factor is the derangement of humour vata. As described earlier, there are many types of vata, depending on

the location. The neurological disorders are produced due to abnormality of particular subtype of vata. The deranged vata enters in the different tissues (dhatu) of the body, ie muscle, skin, fat, where it produces symptoms such as myalgia, twitching, numbness, and tingling. The derangement of vata is due to exogenous or endogenous causes, and aetiological factors include diet, weather, trauma, and excessive bleeding. Eighty types of neurological and neuromuscular disorders have been described. Neurological disorders include shiro vcdana (headaches) and ardhav bheda (migraines), murchcha (syncope), nidra (sleep), bliram (confusion), sanyas (coma), madyadhikar (excessive drinking), unmadadhikar (encephalopathy), apasmar (seizures), shiro bliram (giddiness), pachcha-ghat (hemiplegia), and unistaiiibli (quadriplegia), gadgadwinniiii mukam (dysarthria and aphasia) and pralap (delirium). Neuromuscular disorders include hanugraph (lock jaw trismus), jihva stambh (tongue paralysis), rasa abhav (loss of taste), twak shunyata (numbness), dalia dliikar (burning sensation), ardit (facial paralysis), manyasiambh (torticolis), balm shosli, ap balmk shosh (brac-

ness (ashtnng hiidiu/tiw) (Upadhyaya, . 1979). Sushruta Samhita has given < i good anatomical description ol musck1: (mans) and their ligaments in the chap ter on anatomy (sharirstlinii). There an 500 muscles and 900 tendons (ligaments) in the body and then; are cleoi cut descriptions of types and sizes ol muscles. Many neurtnnuscular dis orders described in Ayurveda havi detailed clinical symptomatology in spite of lack of modern scientific tacts The observations of Ayurvedic Vaiilya: deserve due historical recognition, con ditions like 7th nerve palsy (Bell's palsy and lathyrism being described Ion; before the usual prior claims.
TREATMENT

hial plexopathy), bishwachi (monoplegia), gridhrasi (sciatica), klianj (monoplegia), paiigu (paraplegia), kalaya klianj (spastic paraplegia) due to eating kalay (Lathyris sativus and Vica sativus), vat knntak (neuralgia), pad, dah (burning of feet), padharsh (tingling of feet), dandapatanak (orthotonos and opistohtonos), dhanustambh (tetanus), and kubjak (kyphosis). There are many other neuromuscular disorders which are referred to in the texts (Mishra, 1987), according to which muscular disorders are produced due to dearranged humour, vat. The symptoms described include muscle pain, stiffness, atrophy and weak-

There are two principles of treatment u neurological disorders: prophylaai and symptomatic. Prophylactic treat ment includes avoidance of weathei food and physical exercise responsibi for derangement of humour, vain Symptomatic treatment includes lor, treatment, oil and massage for example, and oral use of compounds whic! decrease the vata. These compounds ar usually herbal but on occasion variou forms of purified metal preparation have been used.

REFERENCES

Mishra, S.K. (1987): Concept of neurologic. disorders. In: Ayurveda, ancient Indi.i medical treatise. Neurology 37, (Suppl. 240. Pandey, G.S. & Chaturvedi, G.N. (196K Charak Samhita Sharir and Chikitsa. Var. nasi: Chaukhamba Sanskrit Sansthan. Shastri, A.D. & Guru, L.V. (1953): Sushn Samhita, Slirir Nidam and Chikitsa. Var. nasi: Chaukamba Sanskrit Sansthan. Upadhyaya, Y.N. (1979): Asthang Hi dayam. Varanasi: Chaukhamba Sanski Sansthan.

Neuroscience across the centuries, e d. F.C. Rose, Smith-Gordon, 198*7