Charaka Urusthambha Chikitsa – 27th Chapter

27th Chapter of Charaka Samhita deals with Urusthambha Chikitsa – a rather rare medical condition correlated with thigh stiffness or spasticity of thigh.
Now, we shall expound the chapter on the “treatment of Urustambha (Spasticity of the thigh)” Thus, said Lord Atreya [1-2]

Prologue

Once, Agnivesha asked Lord Punarvasu, who was endowed with both of brahminic knowledge as well as elegance, who was like the Mt. Sumeru flanked by the sun and the moon, and who also the above of wisdom, memory, mundane knowledge, spiritual knowledge, frame and forgiveness, the following questions. [3-4]

Agnivesha’s question

Agnivesha’s question: Which is the disease contra indicated for Panchakarma?
Oh! Lord, all the 5 purification therapies (Pancha Karma) are described in many instances of disease treatment. Is there any curable disease caused by doshas for the alleviation of which these 5 elimination therapies (Pancha- Karma) are contra- indicated. [5-6]

Dialogue:
To the above query of Agnivesha replied, “there is such a disease for which PanchaKarma is contra-indicated and it is called Urustambha (spasticity of the thighs)”.
Agnivesha again enquired about the etiology, symptomatology and treatment of this aliment. The preceptor again replied as follows. [7]

Urustambha nidana, samprapti

Urustambha (spasticity of the thighs) is caused by the following factors:
Intake of Snigdha (unctuous), Ushna (hot),Laghu(light) and Shita (cold) ingredients when the ingested food is partially digested and partially undigested
Intake of Drava(liquid) and Sushka(dry) ingredients
Intake of Dadhi(yogurt), Kshira (milk) and meat of animals who are Gramya (domesticated animals), Anupa (animals inhabiting marshy land) and Audaka (aquatic animals)
Intake of Pistanna(pastries) and Madya(alcohol)
Divaswapna – Excessive sleep during the day time and
Prajagrah – dreaming awake at night for a long time
Langhana (Fasting) or Adhyashana (taking food while the previous meal is not digested)
Aayasa (Overexertion) and Bhaya – exposure to fearful situations; and
Vega vidharana – Suppression of the manifested natural urges.

Pathology of Urusthamba:
Because of unctuousness, the Ama (a product of altered digestion and metabolism) located in the gastro-intestinal tract, along with fat causes obstruction to the movement of Vata, etc. Because of heaviness, it immediately reaches the thighs through the downward moving vessels. Etc and being provoked by the powerful fat, these Doshas (morbid material) fill up the lower limbs including the thighs and calf regions to cause involuntary spasms and immobility in these parts. [8-11]

Simile of Pond:
As in a pond which is large, deep and full, the after remains motionless, stable and unagitated, similarly the Kapha shifted to the things remains motionless, stable and unagitated [in Urustambha] [12]

Complications

Further complications:
This ailment (urustambha or spasticity of the thighs) thereafter, gets associated with
Gaura – heaviness
Aayasa – fatigue
Sankocha – contracture
Daha – burning sensation
Ruk – pain
Supti – numbness
Kampana – tremor and
Bheda – breaking,
Sphurana – itching and
Bheda – pricking types of pain leading to the death of the patient [13]

Nirukti

Definition of Urustambha:
Kapha associated with Medas affects Vata and Pitta to cause spasticity (Stambha) of the thighs (uru) characterized by their stiffness and coldness because of which the ailment is called Uru- Stambha (Spasticity of the things) [14]

Purvaroopa

Urustamba Purvaroopa: Premonitory Signs and Symptoms:
The premonitory signs and symptoms of Urustambha (spasticity of the thighs):
Dhyana – Fixed Gaze
Ati nidra – excessive sleep
Staimitya – excessive indolence
Aruchi – anorexia
Jwara – fever
Loma harsha – horripilation
Chardi – vomiting and
Jangha uru sadana – Asthenia of the calf region as well as thighs [15]

Mistaken identity:
Mistaking it as an ailment caused by aggravated Vata Dosha, because of ignorance, if oleation therapy is administered, then these results in asthenia as well as numbness of the legs, and the lifting of the legs becomes difficult. [16]

Lakshana

Signs and symptoms of Urustambha:
Jangha uru glani – Excessive fatigue of the calf muscles and thighs
Daha vedana – Constant pain with slight burning sensation
Feeling of pain while putting the feet on the ground
Sheetam sparsham na vetti cha – Insensitivity to cold touch
Lack of control over the functions like standing, pressing the feet on the ground, walking and movement of the lower limbs and
Feeling as if limbs are propelled by someone else (not by himself) and as if these are broken [17-18]

Prognosis

If the patient is further afflicted with burning sensation, pain and tremors, then this disease Urustambha (spasticity of the thighs) leads to his death i.e he is incurable. If such signs and symptoms are absent, and if the ailment is of recent origin, then such a patient is treated, i.e he is curable. [19]

Contraindication of Panchakarma

Why Panchakarma is not indicated in Urustambha:
The reason for which Snehakarma, Vamana, Virechana and Basti are contra-indicated in the treatment of Urustambha is being explained.
Snehana and Basti therapies aggravate Kapha. Purgation therapy is also too ineffective to remove Kapha localized in the thighs).
Kapha located in its own place (i.e Amashaya or stomach), and pitta can be easily removed by emesis. Both of these, viz, Kapha and Pitta, located in the Amashaya or stomach can be eliminated by purgation. When located in Pakvashaya (Colon) all the 3 Doshas, viz, Vata Dosha, Pitta and Kapha can be rooted out by enema therapy. But when associated with Ama (product of improper digestion) and fat, and especially when these are firmly located in the thighs, it is impossible to eliminate them by the above mentioned therapies.
Since the Ama and Medas are lodged in the abode of Vayu which is cold by nature and since these are firmly localized there, it is not easy to eliminate them just as it is difficult to lift water located at a lower level. [20-24]

Line of treatment

Since Kapha and Ama (product of improper digestion) are predominant in the pathogenesis of Urustambha, the physician should constantly administer appropriate alleviation therapies for their
Kshapana (complete extraction) and
Shoshana (Absorption / drying of the liquid fraction) [25]

Foods, drinks

Food and Vegetables:
The patient of Urustambha is constantly given ununctuous regimes, So, Yava – Barley (Hordeum vulgare) (barley), Syamaka (Millet) and Kodrava along with Vegetables cooked with water and oil without adding salt. Leaves of Sunisannaka, Nimba – Neem (Azadirachta indica), Aragvadha (Cassia fistula), Vayasi (Kakamachi – Solanum nigrum), Vastuka – Chenopodium murale and bitter Vegetables like Kulaka (karavellaka – Momordica charantia) are useful for the patient. [26-27]

Drinks:
Administration of Alkali preparations, Arista (medicated wines), Haritaki—Terminalia chebula, after added with honey and Pippali – Long pepper cures Urustambha. [28]

Samangadi Yoga

The patient suffering from Urustambha should take
Samanga – Rubia cordifolia,
Shalmali – Salmalia malabarica (Gum- resin) and
along with honey. [1/2 29]

Srivestakadi Yoga

The patient may also be given
Srivestaka
Udicya – Andropogan vetiveria,
Devadaru (Cedrus deodara),
Nata (Valeriana wallici),
Chandana (Sandalwood – Santalum album),
Dhataki – Woodfordia fruticosa,
Kushta – Saussurea lappa,
Talisa – Taxus baccata and
Nalada – Nordastachys jatamamsi along with honey [29 ½ – ½ 30]

Kalka, Churna Yoga

Kalkas (recipes in the form of Paste):
The following 5 recipes cure Urustambha (spasticity of thighs):
Musta (Cyperus rotundus), Haritaki – Terminalia chebula, Lodhra (Symplocos racemosa), Padmaka – Prunus puddum and Tikta- Katukarohini – Picrorhiza kurroa
Devadaru – Cedrus deodara, Haridra (turmeric – Curcuma longa), Daru-Haridra – Berberis aristata, Vacha (Acorus calamus Linn.) And Katuka- Katukarohini – Picrorhiza kurroa
Pippali – Long pepper fruit – Piper longum, Pippali Mula, Sarala and Deva-Daru – Cedrus deodara
Chavya – Piper retrofractum, root of Chitraka – Plumbago zeylanica, Deva- Daru – Cedrus deodara and Haritaki – Terminalia chebula and
Bhallataka (Semecarpus anacardium Linn.), Pippali Mula and Pippali – Long pepper fruit – Piper longum.
All the above mentioned recipes in the form of paste are to be taken along with honey. [30 ½ – ½ 33]

Churna Yoga:
The patient suffering from Urustambha should take the following recipes:
Sarngestadi Yoga: All these ingredients taken in equal quantities is made to a powder:
Sarngesta (Gunja) – Abrus precatorius
Madana – Randia dumetorum
Danti – Baliospermum montanum
Fruits (seeds) of Vatsaka (Holarrhena antidysenterica Wall.),
Vacha (Acorus calamus Linn.),
Murva – Marsdenia tenacissima
Aragvadha (Cassia fistula),
Patha – Cissampelos parriera
Karnja – Pongamia glabra and
Kulaka (Karavellaka – Momordica chirantia).
Adjuvant: honey added with water or with honey and whey

Murvadi Yoga:
In the above mentioned manner the powder of
Murva – Marsdenia tenacissima
Ativisa – Aconitum heterophyllum
Kushta – Saussurea lappa,
Chitraka – Leadword – Plumbago zeylanica and
Katu-Katukarohini – Picrorhiza kurroa may be taken.
Guggulu – Commiphora mukul is soaked overnight in cow’s urine and taken.
Svarnaksiryadi Yoga: The powder of
Svarna-Ksiri – Panicum sumatrense
Ativisa – Aconitum heterophyllum
Musta (Cyperus rotundus)
Tejovati – Zanthoxylum alatum
Vacha (Acorus calamus Linn.
Surahva
Chitraka – Leadword – Plumbago zeylanica,
Kushta – Saussurea lappa
Patha – Cissampelos parriera and
Katuka- Katukarohini – Picrorhiza kurroa is made by adding honey.
Alternatively, the powder may be mixed with water and honey, and taken.
The Powder of Phali (Nyagrodha – Ficus bengalensis), Vyaghra-Nakha – Capparis zeylanica and Hema (Mesua ferrea) (Naga-Kesara) may be taken by the patient.
The powder of Triphala (Haritaki – Terminalia chebula, Vibhitaka – Terminalia bellerica and Amalaki – Phyllanthus emblica), Pippali – Long pepper fruit – Piper longum, Musta (Cyperus rotundus),Cavya and Katuka- Katukarohini – Picrorhiza kurroa may be made to a Linctus, and taken. [ 33 ½ – ½ 39]

Nourishing, oleation, fomentation therapies

Nourishing Therapy:
If the diseases Urustambha is caused by Apatarpana (depletion of tissues), then the patient is appropriately given Santarpana (nourishing) therapy consisting of the meat of animals inhabiting Jangala Desha (the land with shrubs and small tress) and old Shali rice. [39 ½ – ½ 40]

Oleation and Fomentation Therapies
If because [of excessive use] of ununctuous therapies, Vata Dosha gets aggravated causing thereby insomnia and pain, then the patient is given oleation and fomentation therapies for the alleviation of the aliments caused by Vata Dosha. [40 ½ – ½ 41]

Piluparnyadi Taila
Oil is cooked by adding
Piluparni (Morata – Chonemorpha fragrans)
Payasya – Impomoea paniculata,
Rasna (Vanda roxburghi / Pluchea lanceolata),
Goksuraka – Tribulus terrestris
Vacha (Acorus calamus Linn.),
Sarala,
Aguru – Aquallaria agallocha and
Patha – Cissampelos parriera
Adjuvant: 1 Prasta or 1 Anjali of this medicated oil is taken by adding honey (1/4th in quantity of the medicated oil). [41 ½ – 42]

Kusthadya Taila:
Mustard oil is cooked by adding
Kushta – Saussurea lappa
Srivestaka
Udicya – Andropogan vetiveria
Sarala,
Devadaru (Cedrus deodara),
Kesara,
Ajagandha (Ajamoda – Ajowan (fruit) – Trachyspermum roxburghianum) and
Ashwagandha – Winter Cherry / Indian ginseng (root) – Withania somnifera
The patient suffering from Urustambha (spasticity should take this medicated oil in appropriate quantity by adding honey. This recipe makes the patient free from ununctuousness leading to the cure of Urustambha [43-44]

Saindhavadya Taila:
1 Prastha of oil is cooked by adding 2 Palas of Saindhava, 5 palas of Sunthi – Zingiber officinale, 2 Palas of Granthika, 2 Palas of Chitraka – Leadword – Plumbago zeylanica, 20 fruits of Bhallataka (Semecarpus anacardium Linn.) And 2 Adhakas of Aranala (sour vinegar) intake of this medicated oil helps in the procreation of offspring.
It cures
Grdhrasi – sciatica,
Urugraha (spasticity of the thighs),
Arshas – Piles,
Arti – pain and
Sarva vata vikara – all types of diseases causes by the aggravated Vayu. [45-46]

Astakatvara Taila

1 Prastha of oil is cooked by adding 2 Palas of Pipali-Mula and Nagara (Zingiber officinale) taken together, 8 Prasthas of Katvara (takra or butter- milk) and 1 Prastha of yogurt. This medicated oil cures sciatica and Urustambha (spasticity of thighs).
Thus, ends the description of Astakatvara Taila. [47

External Therapy:
In the above mentioned verses (nos. 25-47), the recipes to be used internally for the cure of Urustambha are described in brief .Hereafter, recipes to be administered externally for the diminution of kapha will be described which you (addressed to Agnivesha by the preceptor) may hear.

Valmika- Mrttikadyutsasana:
The mud of Ant-hill, the root, fruits and barks of Karanja (Pongamia pinnata), and bricks is made to a powder. This is used for Utsadana (dry rubbing) frequently.
Alternatively, the physician should administer this, Utsadana therapy with the help of the root of Ashwagandha – Winter Cherry / Indian ginseng (root) – Withania somnifera, Arka – Calotropis gigantea, Picumarda (Nimba – Neem (Azadirachta indica)) or Devadaru (Cedrus deodara). Any one of these drugs may be mixed with honey, Sarshapa – Brassica campestris and mud of ant-hill before being used as thick Utsadana(dry rubbing or massage) or Pralepana (external application).
A wise physician may also apply the paste of Danti – Baliospermum montanum, Dravanti (a variety of Danti), Surasa – Cinnamonum zeylanica and Sarshapa – Brassica campestris for the cure of Urustambha (Spasticity of the thighs).
The warm decoction prepared by boiling water with the leaves, roots and fruits of Tarkari (Jayanti – Sesbania egyptica), Sigru – Moringa oliefera, Surasa – Cinnamonum zeylanica, Visva, Vatsaka (Holarrhena antidysenterica Wall.) And Nimba – Neem (Azadirachta indica) may be sprinkled over the affected part.
Mustard is made to a paste by triturating with cow’s urine kept overnight and used for external application.
Vatsakadi Pralepa:
Vatsaka (Holarrhena antidysenterica Wall.), Surasa ( Cinnamonum zeylanica), Kushta – Saussurea lappa, aromatic drugs (like Aguru – Aquallaria agallocha), Tumburu –( Zanthoxylum alatum), Sigru –( Moringa oleifera), Himsra – Nordastachys jatamamsi, Root of Arka – Calotropis gigantea, mud of ant- hill and Kutheraka (Parnasa – Ocimum basilicum) is made to a paste by adding Yogurt and Rock-salt a physician conversant with the line of treatment should administer this paste for eternal application for the cure of Urustambha (Spasticity of the thighs).

Shyonakadi Pariseka Pralepa:
Shyonaka – Orchis mascula, Khadira (Acacia catechu), Bilva – Aegle marmelos, Brihati – Solanum indicum, Kantakari – Solanum xanthocarpum, Sarala, Asana – Pterocarpus marsupium, Sobhanjana, Tarkari – Sesbania aegyptica, Svadamstra – Tribulus terrestris, Surasa – Cinnamonum zeylanica, Arjaka, Agnimantha – Premna integrifolia and Karanja (Pongamia pinnata) is boiled in water. This decoction is used for sprinkling over the affected part.
The above mentioned drugs may be made into a paste by triturating them with cow’s urine, and applied eternally for the cure of Urustambha (spasticity of the thighs).
To alleviate Kapha, the able bodied patients are engaged in physical exercise, and they is made to walk over the ground covered with gravels and sand in the morning.
The Patient is made to swim frequently against the current of a river with cold water but harmless (free from dangerous aquatic animals). He may also be advised swimming frequently in a pond having clean cold and stable water. [48- ½ 60]

Line of treatment

Urustambha – Line of treatment:
All the therapeutic measures which alleviate Kapha but do not aggravate Vata should always be employed for the treatment of Urustambha these therapeutic measures should however, be administered to the patient while protecting his physical strength and Agni (power of digestion and metabolism) [60 ½ – 61]

Summary

In this chapter on the treatment of Urustambha (spasticity of the thighs), the following topics are discussed:
Etiology of the disease
Premonitory signs and symptoms of the disease
Signs and symptoms of the disease
Unsuitable therapeutic measures, and the reason for their unsuitability and
To categories of therapeutic measures(viz, internal and external therapies) [62]

Thus, ends the 27th chapter with the treatment of Urustambha in the section on treatment of diseases (Chikitsa-Sthana) of Agnivesha’s work as redacted by Charaka and supplemented by Dridhabala.