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Pain Management In Ayurveda

Pain Management In Ayurveda

Life is a journey from a pain in the form of birth to a pain in the form of death. Pain is a dear companion who walks along and tells when something is wrong. Pain is not just a complaint. The whole system of medicines, methods and money revolves around pain. In a world where everyone is looking for means and medicines to minimize and kill the pain, Ayurveda can be a ray of hope to understand and manage pain.

In Ayurveda “Shoola” is the term used for pain. The term Shoola is generally referred to pain in abdomen i.e Udara shoola. There are different varieties of pain based on the sites such as Shira shoola, Parshwa shoola,Udara shoola etc.Each type of Shoola holds a specific Samprapti what we call as the pathophysiology in ayurveda.

The prime treatment for all conditions is Nidana parivarjana i.e the removal of causative factors.Pain is invariably an indicator of imbalanced Vata dosha.As per Achaarya susruta there can be no Ruja without Vata,no Daha without Pitta and no Puya without Kapha.Vata gets vitiated by its own Nidanas.According to Aacharya Vagbhata there are specific causative factors for the vitiation of the Pancha Vata.Due to those causative factors Vata gets vitiated and brings Rukshata, Laghuva, kharatva which causes symptoms of pain. The vikalpa samprapti plays a key role in the management of shoola. It can be the resultant effect in the vruddhi of any of the gunas of vata.So for alleviating pain in different conditions, it is necessary to understand the underlying guna of vata responsible for shoola.The increase of ruksha guna results in shoola in vataja pandu. Laghu guna vruddhi leads to shoola in asthi kshaya.Sheeta guna vruddhi leads to shoola in Amavata,  Khara guna vruddhi leads to shoola in vata kantaka,Sukshma guna vruddhi in vatarakata (gout) and Chala guna vruddhi leads to shoola in Vataja atisara.

According to International Association for the Study of Pain (IASP) , it is defined as an unpleasant sensory and emotional experience associated actual or potential tissue damage. There are some characteristics attributed to pain.They are site, onset, character, radiation, associated symptoms, timing (duration, course and pattern).exacerbating and relieving factors and severity. In Ayurveda also these factors play a major role. First is the site i.e Ashraya of Shoola .If it is in Kati pradesha radiating to Sphik, Prushta, Uru, Janu and Jangha, then Gridhrasi line of management should be adopted there. If the pain is in heel region, Vata kantaka can be the possible diagnosis and its line of management like Ishtika sweda , Upanaha etc can be adopted.The second factor is the character. i.e different types of Shoola like Ruja, Toda, Bheda etc are mentioned in classics. Third factor is radiation, i.e radiating type of pain is mentioned in Gridhrasi and Viswachi and depending upon the diagnosis its specific management can be adopted to relieve the pain. The fourth factor is associated symptoms .i.e if the Shoola is associated with Swapa which is a Kaphaja bhava (numbness), Vata kaphahara line of management should be adopted. If the Shoola is associated with Daha,which is a Pittaja bhava then Vata pittahara and Rakta prasadana line of management should be adopted.Fifth factor is timing, if the pain aggreavates in morning then the condition is Kaphanubandha vataja shoola.If it aggreavates in afternoon, Pittanubandha is there and if it aggreavates at night,it will be mostly Kevala vatika in nature.Also the pattern of Shoola,i.e if the pain is intermittent or fluctuating then its Kevala vatika because Vata dosha is having Vishama vega. In such cases Kevala vatika line of management can be adopted.If the pain is acute onset and with severe intensity then its having Pittanubandha and can go for Vatapittahara chikitsa. If the pain is dull in nature,its showing Manda vega and is having Kaphanubandha. Therefor Vata kaphahara chikitsa should be adopted. Sixth factor is excacerbating and relieving factors.i.e the concept of Upashaya and Anupashaya in ayurveda. Seventh factor is severeity and in case of severe pain Atyayika chikitsa should be adopted.

 

Hence it is understood that the management of pain is mainly focused on normalizing the vitiated Vata. As there are Pancha vatas, it is mandatory to sketch out the specific Vata which is involved in the pathogenesis of pain. For example if the pain is in the abdomen (acute abdomen) and that too in the stomach,there the culprit will be Samana vata. So for tackling Samana vata the treatment modality is Shamana. Again here the Ashraya is important. Since the abode is Amashaya it can be understood as Amashaya gata vata. For Amasahaya gata vata the specific Shamana oushadhi mentioned in our classics is Shaddharanam churnam. Hingu also offers a significant relief in Koshtagata vata. Hingu containing preparations are vastly used in Udara shoola. Some of the examples are Hinguashtaka choornam, Hinguvachadi churnam etc. If the pain is in the sandhis ,the vata involved is Vyana vata. So for tackling Vyana vata , Urdhwabhaga hara chikitsa,Anulomana chikitsa and Shamana chikitsa should be adopted as told by Acharya charaka in vatavyadhi chikitsa. Shamanoushadhis that are having action over the Asthi and Sandhis can be choosen here. For example Rasna panchakam kashayam is one of the magical yoga that has its action over Sandhis. The Ashraya of Vyana vata is Hrudaya.So those drugs which are named as Hrudya can be judiciously advised in Vyana vata prokopa janya shoola. Arjuna arishtam or Dadimadi ghritam is the best choice for such conditions. If the patient complains of headache or what we called as Shirashoola in ayurveda, the treatment should be focused on normalizing the Prana vata. For Pranavata, the treatment modalities like Nasya,Moordhni taila,Shirosthalam can be judiciously opted. For Shira shoola specific shamana yogas like Pathyashadangam kashayam, Varunadi Kashayam can be wisely administered. If the patient is complaining of pain radiating from loin to groin,the diagnosis of ureteric calculi can be made. Here the involved Vata is Apana. For Apana vata anulomana line of management should be given. So for ureter calculi Pashana bheda can be wisely opted for pain management. Another painful condition contributed by Apana vata is fissure in ano and bleeding piles. Lajjalu kashayam for Avagaham can be given in this condition. As Lajjalu is a Vedanasthapaka drug it helps in alleviating the pain. If the patient come with complaint of pain in the flanks, it will be Udana vata vaaigunya.So for Parshwashoola the best drug of choice is Pushkaramoola.

The shoola prashamana mahakashaya told by Acharya charaka also is a good option for pain management in ayurveda. Those drugs are Pippali, Pippali moola, Chitraka, Chavya, Shrungavera, Maricha, Ajamoda, Aja gandha, Ajaji and Gandeera. Oushadha sevana kala equally holds a great role in pain management along with Oushadhis. For Sandhishoola, medicine can be given after food as there is involvement of Vyana vata. For abdominal colic, medicines can be given in the middle of the food as there is an involvement of Samana vata. For renal colic or any kind of calculi,there is invariably the involvement of Apana vata. So medicines are generally given before food. Due to the involvement of Prana vata in Shira shoola, it is advisable to give the medicine after food in morning. For Prashwashoola medicines are advised to be given after food in the evening time as there is involvement of Udana vata.

The Bahya chikitsas in ayurveda plays a major role in the management of pain along with Shamanoushadhis. In a case of lumbago or kati shoola, treatment modalities like Kati basthi  Kati pichu, Kati lepa and Kati upanaham can be effectively used. If there is severe pain in Lumbago sciatic syndrome or what we call in ayurveda as Gridhrasi, the best line of management is Rakta mokshanam in the form Siravyadhanam in the Gulfa pradesha. There will be significant improvement in the angle during Straight Leg Raise after the Rakta mokshanam. In conditions like Calcaneal spur or Vata kantaka, there is widespread use of Agni karma and Ishtika swedana. In acute abdomen cases, Udara veshtana with Vata hara dravyas is done so as to reduce the pain. In Shirashoola or head ache Lepa can be applied over to the Lalata pradesha for getting analgesic effect. The most commonly used drug is Rasna along with Jambheera swarasa. In OA knee or Janusandhigata vata, external therapies like Janu basthi, Janu pichu, janu lepa and Janu upanaha can be given with Vata hara drugs like Rasna, Devadaru, Shunti etc. Abhyanga along with different forms of Swedanas are used vastly in ayurveda for pain management in orthopaedic cases. Depending upon the avastha different in the form of Taila are selected for Abhyanga and Swedanas. Basthi also hold a major role in pain management in orthopaedic cases especially in Degenerative Lumbar Disc Disease and IVDP. In cases like frozen shoulder and cervical spondylotic radiculopathy, Nasya Karma with Avastha based oushadhis can be opted along with Abyanga ,Greeva basthi, Upanaha, Pichu and Lepa. Yogasanas and pranayama also helps in alleviating the pain in different conditions. Yogasana bring energy and flexibility to the body, reduces the stiffness of the joints and controls the mind. Pranayama increases the pain threshold. Regulating the breath revitalizes the body and cultivate a positive state of well being. The role of meditation in managing pain is inevitable as it reduces anxiety and mental stress thereby improving the mood of the person.

Hence management of pain in ayurveda aims at removing the causative factors for the pain. Normalising the prakupita vata is the hall mark feature of pain management in ayurveda.It can be done by different internal and external therapies. As pain is both a physical and psychological effect, normalizing the shareerika and manasika doshas helps in attaining a pain free state.

Raveendran CP
thediethub@gmail.com
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