Friday, 2 December 2011

ATM: December Issue


AN OVERVIEW ON ‘AGNIKARM CHIKITSA’
- A MINIMAL INVASSIVE PROCEDURE
Author:
*Dr.Amar P. Dwivedi   
*Associate Professor, Shalya tantra Dept.,Dr.D.Y.Patil College of Ayurved,
 Navi Mumbai.
 
   Definition:
In Ayurveda, treatment with heat burns is called as ‘Agni Karma’, It is also called as ‘Dahan Karma’. In modern terminology, ‘Agni Karma’ therapy can be termed as ‘Intentional Heat Burn Therapy’.
   Material used for Agni karma (as per disease)-
Depending upon the Disease & its predominant  Doshas, different material (Probes) and its temperature is selected for the treatment.
      1) Twakadagdha - Pippali, Ajasakrida,  Godanta, Shara, Shalaka
      2) Mamsadagdha - Jambhavsta Shalakla and Other Metals
      3 )Sira, Snayu, Sandhi -Asthidagdha - Madhu, Jaggery and Sneha
 In brief, in catabolic or degenerative diseases Gold or Silver probe should be used, similarly in anabolic and hyper growth conditions Pancha dhatu or iron probe can be used.
However, practically  material required for ‘Agnikarm’ are: Spirit lamp as heat source, sterile water, cotton swabs, gauze pieces, Yastimadhu Ghrita etc for post Agnikarma dressing.

Heat generated by different materials:
Heat generated by shalaka’s on heating(red hot) are as follows -
     Types of shalakas                                Temperatures
          Gold                                        62oC
          Silver                                          350oC
          Copper                                      212 oC
          Iron                                            228o C
          Pippali                                        57 oC
          Aja sakrit                                  45-55 oC

Types of Agni karma according to different shapes:
Valaya

3
Bindu

2
  Vilekha 
      
1
Pratisaran

4
Ardha Chandra

5
Swastik

6
Ashtapad

7




Site of Heat Burns as per diseases -
In shirorog
(Headache, Migraine, Adhimantha etc.)

Between two eyebrow & 
Frontal and temporal area

In Painful conditions & Vataja disease like-
       Heal pain & Calcaneal Spur
       Sandhitgat vata & Ama vata,
       Frozen shoulder, sciatica
       Cervical spondylosis etc



At the site of maximum pain.

Cyst, Mass, Warts, Tumor, Piles, Fistula, Bleeding disorders etc

After excision, at the bed of wound
In Incomplete  Inguinal hernia

-On the first toe of leg of opposite side  of the body &
-At superficial inguinal ring
In disease of eye lids (Entropion etc.)

Roots of eye lashes

Effects of Agni Karma:
Theory – 1 
Agni karma


Ushan guna( Hot properties)


Qualities against Vata & Kapha dosha


Pacifies vata & reduces kapha


Reduces pain

Theory – 2
Agni karma


Ushan guna( Hot properties)



Increase in the Dhatvagni (Tissue fire)



Manda Dhatvagni gets pacified





Enhances nourishment                            Also performs Ama Pachan
- formation good newer tissues              & removal of accumulated toxins

Procedure of ‘ Agnikarm’
For simplifying or understanding the procedure of ‘ Agnikarm’, it can be described as per ‘Trividh Karm’ i.e. Poorvakarm, Pradhankarm & Pasachatkarm.
Procedure of ‘ Agnikarm’
·        Patients consent to undergo Agni karma treatment
·        Routine blood investigations like CBC, Blood Sugar etc
·        Inj. T.T. IM (Prophylectically)
·        Confirmation of site of Agni Karma and marked
·        Patient is taken in confidence

Note:
During the procedure the patient may feel pain so he should be taken in confidence and assistance may be required to hold them so that heat burns can be performed at appropriate site.
·        The selected site is cleaned with ‘Triphala quath’ or ‘Normal saline’ & the area is covered with sterile drape ( Hole towel). In any condition sprit should not be applied for cleansing the part.

·        Avoid ‘Agnikarm’ in ‘ Sharad & Grishm’ Ritu if possible.

Main procedure –
·        Two different ‘Agnikarm’ techniques are practiced. 
1.     Intermittent, Multiple Heat Burns- In this ‘Agnikarm’ is done by giving intermittent, multiple Heat burns over the desired site.  
2.     Continuous Heating Method- In this method, tip of the  ‘Agnikarm’ shalaka is kept in touch with desired site, whereas continuous heating is given on the other end by a candle or any other light source. 
·        According to disease superficial burns i.e “Twaka Dagda” for disease receding superficially and deep heat burns i.e.; Mansa Dagda’ is done for deep seated diseases.
·        Depending on the nature of the  disease ,the predominance of doshas and its site 10-12 heat burns are done with appropriate  shalakas.
·        In chronic disease for 3-4 sittings of agni karma is required in interval of 15 days.

 

qq
 






Post- Operative-
·        Yashti madhu ghrita, Rakta chandan siddha ghrita or lepa of ghrita mixed with honey can also be applied prior to Dressing.
These medicines help to reduces the burning sensation and pain caused by heat burns , also they help in healing procedure.
·        The site of Agni karma is done is prevented from contact with water (thus it will prevent it from infections)
·        Sukshama triphala vati or Triphala guggul internally is advised.
·        If pain is unbearable then modern medicines like anti-inflammatory, analgesic and anti biotic to prevent secondary infection can given.
Note:
Some people experience Severe pain after heat burn therapy but it subsides on its own in due course of time, in the same way, as after other surgeries patients have to bear the pain at the site of operation for few time.
General Signs of Adequate heat burns
·        The patients pain is immediately relived after heat burns
·        The effected parts gets lighter
·        The patient is relived from disease

 Mechanism  of action of ‘Agni Karma therapy’ 
Effect on Metabolism
          The place where Agnikarma is performed,the local tissue metabolism is improved & various metabolic and rejuvenating changes takes places  which leads to increased demand of oxygen and nutrient of the tissues at that site.Similarly, it  also excretes the unwanted metabolites and toxins..

Effect on pain
Due to increased  local metabolism, the waste products (metabolites) which are produced gets excreted, which normalize the blood circulation & releases the pressure on end nerves,  thus resulting in reduction in intensity of pain.

Effect of heat on Muscles Tissues
Rise in temperature induces relaxation of muscles & increase the efficiency of their  action.

Friday, 4 November 2011

Wishing all ATM readers ‘A Happy and Safe Diwali!’


Dr. Amarprakash P. Dwivedi
M.S. (Ayu.), Ph. D. (Sch.)Asso.Professor & I/C, Shalya TantraEMail: dramar_d@yahoo.co.inMobile: 09323097013/09757445151

Happy Healthy Diwali


‘Deepawali’ or ‘Diwali’ is one of the most popular festivals in India. It comes in the Hindu month of ‘Ashwin’ as per the lunar calendar and corresponds roughly with either October or November depending upon the movement of the Sun & the Moon and their relative positions in the space and the time.
Meaning and significance: Deepawali means, a row of lights. Symbolically, it represents our divine nature and reminds us of our primary responsibility to pursue the path of light and find the divine.
The great Goddess Mahalaxmi, who symbolizes all the positive forces of light and the divine nature of wealth,is the principal deity of this  remarkably unique festival. Just as she represents health, wealth, happiness, victory,harmony, joy and enlightenment, Diwali represents the brilliance of life in its full glory. Many Hindu consider Diwali as the beginning of a new year.
It is also believed that the festival of Diwali commemorates the return of Lord Ram to Ayodhya after spendind 14 years of extradition.
As far Ayurveda is concerned, it is believed that on the first day of Diwali festival  i.e. on Dhantrayodashi ‘Lord Dhanvantari’ emerged from the ocean holding the knowledge of spiritual medicines of Ayurved, to help the mankind fight against sickness, disease and death.


Diwali Health Mantra
Sweets and Festivals go hand in hand. And when it comes to Indian festivals, especially the grand Diwali, sweets are many, along with all kinds of rich dishes. If you tend to gain weight more easily, it is suggested to keep your taste buds in some control otherwise all your weight loss strategy will go waste. Here are some tips on adopting healthy ways of eating this Diwali.

         Moderation is the mantra to enjoy festive food. Eat fatty foods, sweets and other fried snacks in little amounts. It’s good to go on Ayurvedic diets (Light easily digestible meals like Kichadi. Soups, Fruits & fruit juices, Coconut water etc. along with drinking Luke warm water) before the big day comes so that your body gets detoxified beforehand. After relishing the festive food, again go on Ayurvedic diets!

         If you are making sweets yourself, use low fat ingredients- like low fat milk and other dairy products. Use natural sweeteners like honey and dates to make sweets and avoid using refined sugar or artificial sweeteners.

         Before eating snacks, remember to drink water to bring in the feeling of fullness.

         Instead of loading your plate to the brim with sweets, just take a few, may be one or two, items and eat them slowly and gradually.

         If someone serves fruits along with sweets, try to take more of them in your plate.

         A couple of sweets are OK but don't let yourself have more of carbonated cold drinks. Instead, have some natural refreshing drink like lemon juice, coconut water, or some other fruit juice.

         Don't try to eat away all your gifted chocolates at once. Keep them in fridge. Eat them in moderation over a few days. They don't get spoiled so soon. There are much better options than this too. Give these chocolates to the young ones in the family, neighborhood or even to the children in the nearby orphanage! Enjoy happiness while sharing and keep yourself away from worries of weight gain at the same time.

The low-calorie guide to festive cooking:
         Use skimmed milk to prepare dishes like shrikhand, rice puddings like kheer phrini, Bengali sweets, fruit custards, etc.
         Make salted munchies such as mathris, shakarpalis, chaklis, kachoris, etc, using high-fibre flour such as finger millet or bajra, ragi or soya flour along with wheat flour.
         Add green leafy vegetables such as methi (fenugreek), palak (spinach), kothmir (coriander) or mint to salted snacks.
         Bake salted snacks instead of frying them. Bake cutlets or kebabs instead of frying them.
Serve roasted papads.Decorate biryanis with baked onions instead of fried ones.
         Serve meals with rotis or pulkas or steamed pulao instead of puris or parathas or biryani.
         Eat dry roasted nuts and dry fruits in their natural form instead of fried, salted or sugared.
Sweets, puddings, chocolates, ice cream and soft drinks are made with sugar that only contain empty calories.  

         Many sweets are also rich in ghee or mava, making them calorie dense. Instead of buying commercial ones, make sweets at home using less sugar and ghee.
         For instance gajar ka halwa can be made at home using condensed milk instead of khoya or mava.
         Have rasgollas instead of gulab jamuns. Other less fattening Diwali sweets include sandesh and pedas.

Tips for maintaining the calorie count:
Diwali is a time full of celebrations. Holidays, shopping, partying, eating, fun and fare are all part of it. This is the time when you are most susceptible to put on weight. It is very difficult to resist those tempting dishes beautifully adorned on your table. Restraining yourself from not eating these yummy recipes is out of question. So here are some very simple daily activities which will help you to loose some calories, and you can very easily fit these in your holiday schedule…
·         Get off the bus one stop early.
·         Walk to a bus stop a few blocks away.
·         Walk briskly instead of strolling .
·         Walk around the house while you talk on a cordless phone or mobile.
·         Climb stairs instead of taking an escalator or elevator.
·         Do a squat every time you pick something up. This forces you to use your leg muscles and will build strength
·         Take a 10-minute activity break every hour while you read or watch TV.
·         Take your dog out for a walk.
Also...
         Make it a point to sit down and eat, as this will help you think about the amount of food you are consuming.
         Eat slowly and chew your food well, and you will find you end up eating less.
         Drink a 12-ounce glass of water before eating as it will take up room in your stomach and make you feel less hungry.
         Quit smoking as it is injurious to health.
   Avoid excessive drinking as excessive drinking can cause health problems like liver and kidney diseases.
     Limit your coffee/ caffeine intake as studies shows that it raises the blood pressure.
These are some very simple activities which will help you in maintaining your calorie count. Good eating habits form the basis for maintaining strong health. To get robust in the right way, you may require changing your eating habits along with various other routine practices. Thirty minutes of moderate-to-vigorous physical activity (such as a brisk walk), at least 4 days every week, greatly helps in reducing blood pressure, cholesterol and weight.
…Wishing all ATM readers ‘A Happy and Safe Diwali!’ 

Vata Dosha..............


                                       Vata Dosha Revisited
Dr.H.S.Palep
M.D., D.G.O., D.F.P., F.I.C.O.G., G.F.A.M.
Prabhadevi, Mumbai


            Vayuh tantra yantra dharah , prana udana saman vyanapana, atma pravartaka
Iveshtanam. Uccha vachanam, niyanta pranetacha manasah, sarvendriyarthanam udyojakah sarvendriyarthanamabhivodha, sarva sharer dhatu vyuhakarah, shrotra sparshanayo moolam, harshotsahyo yonih, samirano agnih dosha sasoshanah, kshepta bahi malanam, sthoolanam srotasam bheta, karta garbhakritinam, ayusho anuvritt pratya bhooto bhavati akupita.      (Charak)

Vayu is described as a beholder of yantra and also the tantra. (yantra tantra dharah)
Yantra is the whole body machine. Tantra is the controlling mechanism of whole body organization comprising of seventy trillion cells. In its physiological state it is comprised of five types, viz., prana, udana, samana, vyana and apana. Prana denotes very life. It also means motion. Udana refers to its location in upper pat of the body. Saman vayu (samam anayati iti) is the one that homogenizes with body the food eaten, digested and absorbed.
Vyan vayu ( vi + an spandate) or visheshena spandate.   
It means that it has specialized quality actions of being pulsatile and vibrating. It is responsible for all the peristalitic actions in GI tract and pulsatile action of blood vessels. It is also described as maha java. It moves with very high speed. It is responsible for all neuronal and endocrine functions in the body. It is all body pervasive unlike other types of vayus.
Apana vayu (apa nayati , apa sarati) : It carries with it all metabolic waste and helps to excrete them. It is responsible for evacuation of bladder, bowel and delivery of fetus from utero. It also controls menstrual and seminal flow. It also programs the fetal growth. (karta garbhakritinam)
Other functions of vayu in the physiological state:
It is described as atma pravartakah.
What is atma? How does vayu regulate all the bodily functions?
Atma denotes self awareness or consciousness and intellect. Atma expresses through vayu. It controls and inspires mind. (Nayantah pranetecha manasah). Atma, the Self / Purush/ the conscious element/ agent / doer along with 24 constituents of Prakruti form the Human embodiment (Chikitsa purusha/ treatable human entity). This conglomeration alone experiences the entire worldly phenomenon. Since self has no attributes, by it self or through any indications or signs, it is not inferable. Since it is knower or the cause of all the awareness, it is called as the knower of the field. Consciousness is awareness, an ability to perceive one’s relationship with his environment. It is the capacity to receive, store, recognize the information and it also enables an individual to process the information in to knowledge and use this knowledge to organize or program all his activities. Thus an individual is a unique unit of experiences, activity and interactions that drive them along their developmental trajectories. (pravartakah cheshtanam ucchaavachanam).
Current sciences are exploring the field of human consciousness as never before. Andrade in 1999 described semiotic agency as information gathering and using systems. Zurek extended these properties to living entities. Semiotic agency merges and transforms the internal and external flows of energy.
The Avyakta prakriti is the field, the un manifest primordial material source of entire creation. The first step in creation of life systems is the union of Purush/self with Prakruti. Next in the order is the creation of intelligent thinking systems, i.e., Mahat or ocean of cosmic consciousness. It is born out of self. Intellect is the rational thinking principle of mind. Intelligent is the one, who is endowed with the faculty of reasoning. The next in the order of creation is Ahankar/ ego, which is the ID of self. Next in line is Mind. Mind is not conscious, but when yoked to self, it is impelled by self in to activity. Mind has the faculties of dhee(reception/ understanding), dhriti (retention/ fortitude/ will power), smriti (recall/ memory), chintan (thinking) and buddhi (judgement/ intelligence). With the mind thinking systems develop. Mind is an instrument (upadhi). Objects of mind are thoughts, comprehension, contemplation, imagination, hypothesizing and determination (sankalp) and initiation of actions. The two qualities of mind are Ekatwam (single) and anutwam (subtle/ atomic). It is the basis for joy and enthusiasm (harsha utsahor yoni). Next in order are five tanmatras/ subtle qualities of sound, touch, vision, taste and aroma. (shrotra sparshanoyoh moolam). These qualities belong to five gross elements ether/space, air, fire, water and earth respectively. These five qualities can be perceived by mind through five organs of cognition, viz. ear, skin, eyes, taste buds of tongue and nose respectively (prakrutayo shabda sparshayo). Mind acts through five organs volition or conation, viz. tongue (speech) (pravartakayo vacha), hands, feet, excretory and genital organs (Kshepta bahirmalanam). (sarvendriyanam udyojaka – sarvendriyanamabhi vodha= It carries with it the impulses and initiates all sensory motor functions). It organizes all the tissues of the body (sarva sharer dhatu vyuha kara). It integrates the whole body. (sandhana karah sharirasya). It is responsible for metabolic fire (Sameeraner agneer dosha samsoshanah). It is also the basis for ones life span when in the physiological state. (Ayusho pratyabhuto bhavati akupita)    

Vayu thus regulates and integrates all the sensory and motor functions of the body. A gas regulating all the biological functions in the body was unthinkable for any modern scientist before the invention of NO. Most of them believed in neuro hormonal actions based on adrenaline or acetyl choline as neuro transmitters. 

Awarding of Nobel Prize in 1980 to Furschgot and Zawadski for the discovery of NO gas has completely changed the understanding of the role of neuro transmitters for maintaining normal vascular tone. NO is a gas produced by the endothelial cells of the vascular system and many other tissues of the body, viz., brain, CNS and nerves. Nitric oxide is a bi-atomic gas produced by the action of the enzyme nitric oxide synthase on the amino acid L-arginine. The by-product of this is another amino acid, L-citrulline, whose presence in tissue can be measured as a marker of nitric oxide synthase activity. Nitric oxide synthase is found in the endothelium, brain and central nervous system. Nitric oxide itself lasts only milliseconds in the circulation; it is rapidly degraded to nitrite and nitrate then excreted. L-arginine, a semi essential aminoacid and is a substrate for the NO generation. It is synthesized by the action of different nitricoxide synthases in different tissues of the body. In the nervous system it is nNOS. It is called Geneproduct-1. It generates NO in neurons and glial tissues. It regulates the cerebro vascular tone and regulates the learning and memory (Prana and Udana vayu functions). The Second Nitric oxide synthase is Inducible iNOS which is called Gene product –2. It generates NO in monocytes, macrophages, smoothmuscle cells, cardiomyocytes, hepatocytes and mega-karyocytes etc. It plays great role in maintaining the general immunity and inflammatory reactions of the body (vyana and samana vayufunctions). eNOS is the third Gene product which responsible for generation of NO in the vascular endothelial cells (vyana vayu). It determines the cerebral blood flow. NO reacts with guanyl cyclase resulting in cGMP, which is the relaxant of all the smooth muscles including the sphincters in GI tract (Saman vayu function). It causes vaso dilatation. This action of NO is responsible for penile erection, which is the basis for the action of sildenafil (viagra) –Apana vayu function. NO also functions as a neurotransmitter in non adrenergic and non cholinergic pathways of myocardial contractility, GI tract motility. It prevents adhesion and aggregation of leucocytes and platelets thus maintaining the integrity of the vascular system. It is different from other neurotransmitters since it has two way actions on both afferent and efferent nerves, as well on pre and post synaptic neurons.
Pathological effects of NO:
Defficiency or depletion or excessive of NO can lead to number of pathological conditions, e.g., hypertension, athero-sclerosis, and diabetese. Free radicals and advanced glycosylation end products inactivate NOs resulting in to various pathologies. Similarly vitiated Vayu can cause all different types of diseases enumerated above.
Prostagladins are local hormones produced in almost all the tissues and body fluids in response to diverse stimuli, mechanical, thermal, chemical, bacterial and hormonal etc. They are chiefly responsible for the pain sensation and inflammation. Prostaglandin synthesis and their metabolism are dependent on NO. Vitiated Vata is the cause of pain according to Ayurvedic conceptualization. Just as with Vayu, the spectrum of actions of NO and Prostaglandins encompass wide range of biological processes. Arachidonic acid (AA) is the precursor for all the different PGs (prostaglandins). AA is produced from the metabolism of dietary linoleic acid. Action of enzyme cyclooxegenase on AA result in PGs. Lipooxegenase action on AA results in leukotriens. Lukotriens are also the mediators of inflammation. They have profound effect on microvasculature causing exudation of plasma. They cause release of histamine from basophils, also cause chemotaxis of leucocytes. PGEs and PGA release erythropoietin from the renal cortex.
Prostaglandins have wide range of actions on all systems of the body. Some PG s e.g. PGE, PGI and PGA act as vasodilators, where as PGF and TXA (Thromboxane) are vasoconstrictors. They exert great effect on the blood cells. TXA causes platelet aggregation. PGE causes smooth muscle relaxation in bronchial tree, uterus and GI tract etc.
Gastric hydrochloric acid and other secretions are reduced where as the secretion of mucin is increased by PGA, PGI2 and PGE. PGs cause luteolysis.
PGs are responsible for the pyrogen induced fever. They also amplify the pain sensation in all the inflammatory processes. They also exert profound influence on carbohydrate metabolism by insulin like action and cause inhibition of lypolysis.
PGs regulate synthesis of cAMP by activating or inhibiting adenylate cyclase in the membrane bound receptors. Thus PGs functions can be compared to the action of various vayus in health and as well the disease.    

If vayu is equated to only neurotransmission and hormonal functions, the whole idea of Tantra yantra dhara description of Charak falls flat. It falls short very badly and can not explain all the functions or actions envisaged for Vayu. Neurohormonal basis only explains the Yantra part of the whole Tantra yantra dhara. Tantra relates to whole organization of the body where seventy trillion cells perform under one unified command. Therefore Vata concept probably also relates to genome. Brilliant discovery in 1953 of double helix structure of Deoxy ribo nucleicacid (DNA) as the basic stucture of genome has laid the foundation for the understanding of the basis for molecular biology. Now that there is need to rediscover Vata, Pitta and Kapha as the concepts of molecular biology. Nuceicacids are also proteins. All the proteins have Nitrogen as a benchmark. Vayu is the mixture mainly of Nitrogen, Oxygen and other minor gasses. Various biomolecules, that include gene proteins and small gas molecules e.g. NO,CO act on surface receptors of the cells to form ligand receptor complex resulting in  to specified action depending on the type of the cell. Ligand receptor complex results in to series of intracellular events. They include the formation of messenger RNA (m RNA) in Ribosomes (transcription), formation of new protein (translation). This newly formed protein causes replication of a cell and also repairs the damaged DNA of a cell. One of the most important regulatory gene discovered is P53. It is also known as molecular policeman. It regulates the repair and the programmed death of the cell, (apoptosis). Mutation of this gene can cause cancer. Gene proteins or regulatory proteins act through endocrine, paracrine and autocrine mechanisms. Therefore regulating proteins also participate in the umbrella functions of vayu that can satisfy the description of Tantra yantra action of Vayu.
Another interesting description of vayu is, it being Rajo pradhan. Raja is signified by motivated action.  In the experiment with Hydrocarbon polymer in solution of sea water, it is seen that particles in the solution in the beginning move in Brownian fashion. This solution when exposed to ultraviolet irradiation in presence of atmospheric air, these particle start moving rapidly. This change in the type of particle motion can be compared to Rajas. When the ultra sound is introduced in to this solution the particles are observed to be organizing themselves in to cell layers. This organizational ability is derived from the Satwa quality of Akash. The biological Vayu (vata dosha) is the result of combination both Vayu and Akash. Because of this Vata is responsible for both structure and function of the body correctly fitting in to the theme of Tantra yantra description of Charak. Structural and functional enzyme proteins are regulated by gene proteins. Self assembly is the property of all the biomolecules. They possess the capacity to replicate, multiplicate and perpetuate. This phenomenon is aided by Ahankar.
Ayurveda attributed volitional aggression (pragnyaparadh), incompatible environment, food and activities as the etiological causes for the increase or decrease of all doshas including vata leading to their imbalance, there by creating pathology. Excessive (atiyoga), Negative (hina yoga) and perverse (mithya yoga) interactions with the agents of environment, and as well the chemical and physical agents can cause damage to DNA. Thus Yantra tantra dhara concept of Vayu can now be understood in terms of NO and regulatory genes.

References: Ayurveda and Modern Medicine  -  Dr. R.D.Lele
                    Tridosha – Madhu Jeevan – Vaidya Nanal Ramesh
                    Scientific Foundation of Ayurveda- Dr. H.S.Palep
                    Nitric Oxide Donors – Christopher Lee