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बुधवार, 17 फ़रवरी 2016

Etiopathogenesis of vaata vyaadhi

Etiopathogenesis of vaata vyaadhi , 

my approach to Ch.Chi.28/ 15-19 . 
     Most of the etiological factors explained here are responsible for kevala vāta prakopa mediated through dhātu kṣaya. Exceptions are less in the said group. But now days etiological factors causing āvarana or samsarga vāta prakopa are mostly found. This is because of increased standard of living. The so called neuro degenerative diseases like Parkinsonism Disease, Alzheimers Disease etc even now days considered as aftereffects of metabolic dysfunctions rather than under nutrition or overuse. Even diseases like Alzheimiers dementia is conceptualised recently as type 3 Diabetes Mellitus.[20]
So a reassessment of etiological factors of contemporary importance is valid. Here an attempt is made to analyse the properties causing vāta vitiation with some modern explanations.
Rūkṣa, śītā, alpa, laghu anna, abhojana: 
As any other organ, the brain is elaborated from substances present in the diet (sometimes exclusively, for vitamins, minerals, essential amino acids and essential fatty acids, including omega-3 polyunsaturated fatty acids). Most micronutrients (vitamins and trace elements) have been directly evaluated in the setting of cerebral functioning for e.g. vitamin B1 modulates cognitive performance especially in elderly. Vitamin B9 preserves brain during its development and memory during ageing. Vitamin B6 is used in treating premenstrual depression. Vitamin B6 and B12, among others, are directly involved in the synthesis of some neurotransmitters. Vitamin B12 delays the onset of signs of dementia. Supplementation of Cobalamin improves cerebral and cognitive functions in the elderly. In the brain, the nerve endings contain the highest concentration of vitamin C in the human body (after the supra renal glands). Vitamin D (or certain of its analogues) could be of interest in the prevention of various aspects of neurodegenerative or neuro-immune diseases. Iron is necessary to ensure oxygenation and to produce energy in the cerebral parenchyma and for the synthesis of neurotransmitters and myelin. An unbalanced copper metabolism homeostasis (due to dietary deficiency) could be linked to Alzheimer’s disease. Among many mechanisms manganese, copper and zinc participate in enzymatic mechanisms that protect against free radicals, toxic derivatives of oxygen. Indeed, nutrient composition and meal pattern can exert either immediate or long term effects beneficial or adverse.
       From the above discussion it is observed that rūkṣa, alpa, laghu anna are apatarpankar hetu. Thus nutritional deficiency causes disorders of nervous system.
Similarly snigdha guna is essential to traverse the lipid soluble essential elements across the cell membrane. Rūkṣa guna in excess reduces the transfer of essential elements into the cells thus causing immediate or late effects.
         Further diets that are rich in saturated fats and sugar decrease levels of Brain derived neurotrophic factor [BDNF]. BDNF is a neurotrophin considered generally beneficial for maintaining neuronal function and for promoting recovery after neurologic insult. Reduced BDNF leads to poorer neuronal performance. Results of a study have shown that rats fed on a diet high in saturated fats and refined sugars (similar in content to the “junk food” that has become popular in western society) for a period of 1 -2 months performed significantly worse on the spatial learning water maze test. Even more alarming is that the high fat diet consumption exacerbated the effects of experimental brain injury. The effects of this high caloric diet seem to be related to elevated levels of oxidative stress and reduced synaptic plasticity which can reversed by antioxidant treatment or exercise. High caloric intake also is perceived as risk factor for Alzheimer’s disease. Concept of atibhojana, snigdha etc. leads to āma utpatti, a cause for Vātavyādhi. Research results show that noninvasive approaches such as diet and exercise can have profound consequences for increasing resilience of the CNS to injuries and for maintaining cognitive abilities. Diet and exercise are 2 very important parts of lifestyle and daily routine each can influence the capability of the brain to fight disease and to react to challenges. Physical activity can benefit neuronal function and plasticity by enhancing synaptic plasticity and reducing oxidative stress. Physical exercise can have direct effects on the brain and spinal cord by supporting the maintenance of the synaptic structure, axonal elongation and neurogenesis in the adult brain whereas excessive exertion (ativyāyāma) is hold to cause degenerative changes.
           Stress is unpleasant, even when it is transient. A stressful situation–whether something environmental or psychological can trigger a cascade of stress hormones that produce well orchestrated physiological changes. Fight and flee are the 2 response which the body is accustomed too. Repeated stress leads to hormonal and neuro-adaptive changes which may be the cause for damage. All krodha (fight response) and bhaya (flight response) described by Ācharyas explain the similar effects on the body.
Śītā guna- Prolonged exposure to the cold causes the body to slow blood circulation to the periphery. The reduced blood flow can intensify neuropathy symptoms and potentially cause further damage to already affected peripheral nerves.
         Research is essential to rule out effects of śītā guna on cryoglobulinemia; a condition of cold antibody in blood which cause vasculitis and neuropathy as well. Increase cryoglobulinemia increases viscosity leading to reduced blood flow thereby causing neuropathy.
Ativyavāya – Donald L Hilton and others in their research paper on pornography addiction: A neuroscience perspective, were of the opinion that compulsive sexuality can indeed be addictive. It concludes for the first time that a sexual compulsion can cause physical, anatomic change in the brain, the hallmark of brain addiction. A preliminary study showed frontal dysfunction specifically in patients unable to control their sexual behavior. The study used diffusion MRI to evaluate function of nerve transmission through white matter. It demonstrated abnormality in the superior frontal region, an area associated with compulsivity. Hormonal changes similar to overeating induced obesity were also observed.
Ati plavana, atiadva, ati vyāyāma, ati vichesta: Normal exercise has a good neurobiological impact. It increases the secretion of positive hormones and also helps in neurogenesis whereas over exercising can lead to an increased resting heart rate, a cause for increased cardiac output leading to hypertension, risk factor for stroke. Unexplained weight loss and decreased appetite is another factor. Further decreased of essential elements leads to neurological deficits as discussed before.
           Further cortisol and stress hormones levels tend to increase with decrease in testosterone levels.
Emotions are intimately linked with organic life. They either result is an, “abnormal excitation of the nervous network, which induces changes in heart rate and secretions, or interrupts the normal relationship between the peripheral nervous system and brain.” Cerebral activity is focused on the source of emotions; voluntary muscles may become paralyzed and sensory perceptions may be altered including the feeling of physical pain. The idea of emotions involves specific areas of brain and activation of these areas is associated with increase blood supply.
VERSE 19-20
       In all disorders of Vāta dōṣa the purvarupa may not be registered separately. For example the textual presentation of Ardita (Vegavāna) may be a purvarupa of pakṣāghāta just like Transient Ischemic Attack are considered as warning signs of stroke. In abrupt onsets, purvarupa cannot be distinguished from rupa as in the case of manyasthambha in Apatanaka. Acute convulsive disorders manifest abruptly without any premonitory symptoms. In diseases of very insidious onset also premonitory signs are not appreciated sepertely. In most of the mayopathies this happens.Prof. Dr. Satyendra Narayan Ojha ,
 MD (KC), Ph.D. 
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
 Kodoli ,Panhala , Kolhapur.. 
drsnojha@rediffmail. com

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