Download urdhwaga dhamani and its importance

Ayurvedic aspects of urdhwagami dhamani and its involvement in stroke
*Dr. Bhan Pratap Yadaw
**Prof. H. H. Awasthi
*S.R. & Ph.D Scholar, Deptt. of Rachana Sharir, Faculty of Ayurveda, IMS, BHU.
**Professor & Head, Deptt. of Rachana Sharir, Faculty of Ayurveda, IMS, BHU.
Abstract- Thorough structural scientific knowledge of the life was recommended by ancient
Acharyas. Ayurvedic acharyas has used an anatomical term dhamani, which is one of the
controversial terms (structure), used to represents tubular structure, to carry sabda, sparsa, rupa,
rasa and gandha and it is one of the synonyms of srotas. Many times controversies or differences
in opinions had been raised due to the two types of commentators. One who had performed the
dissection and seen the structures and having profound knowledge then commented the terms, they
had not left any chance for controversies. Others who had not performed the dissection but
commented the terms on the basis of knowledge of Sanskrita and other literature and using the
synonyms of the terms. They had left many chances for controversies. The term dhamani is used to
describe arteries and nerves specially urdhwagami dhamanis which supplies to head and neck
regions of the body. According to susruta, dhamani originate in the embryonic life from nabhi and
they spread upward, downward and in oblique fashion from nabhi. By the urdhwaga dhamani,
parts of the body above the umbilicus, such as the abdomen, flanks, back, chest, shoulders, neck,
head etc are supported and maintained. The upward dhamani perform all these functions always
(throughout life). Two arterial systems supply the brain with blood: the internal carotid and basilar.
The internal carotids and basilar arteries are connected via the circle of Willis, which allows blood
to pass from one system to another in the event of blockage. Stroke is the third leading cause of
death in the world with millions people affected annually. Survivors of stroke have varying degrees
of disability, from dementia to total incapacity.
Keywords- urdhwaga, dhamani, ayurveda, sushruta samhita, pakshaghat, artery, nerve, stroke.
Urdhwaga dhamani – arteries spreading upward- In S.Sha.9/5, it is said that, those arteries
spreading upward, support (maintain) the body by attending to functions such as receiving
sensation of sabda (sound), sparsha (touch), rupa (sight), rasha (taste) and gandha (smell);
praswas (inspiration), ucchwas (expiration), jrimbha (yawning), kshavathu (sneezing), hasita
(laughing), kathita (talking), ghosita (shouting) and such other functions. These after reaching the
hridaya (heart) each one divides into three, thus becoming thirty. Out of these, two each carry vata,
pitta, kapha, sonita and rasa - thus ten. Two each carry sensation of sabda (sound), rupa (sight),
rasha (taste) and gandha (smell); – thus eight. Two attend to kathita (speaking in words), two
attend to ghosita (shouting or loud sound without words), two attend to swapiti (sleep), and two to
pratibudhi (waking), two carry ashru (tears in the eyes), two carry stanya (breast milk) in the
breasts of women, these only carry sukra (semen) from the breast in men – thus twelve. Thus total
thirty urdhvaga dhamanis are described by their division.
Vagbhata (A.S.Sha.6/11) says that, each one of those spreading upwards, after reaching the
hridaya (heart), divides into three (branches); thus becomes thirty, out of this thirty, two each carry
vata, pitta, kapha, rasa and rakta; from eight of them, sabda (sound), rupa (sight), rasa (taste) and
gandha (smell) will be understood, bhashana (speaking), ghosakara (shouting), swapiti (sleeping)
and pratibudhyate (awakening) are done by two each, two ashruvahan (bring out the tears), two
stanyashrita (located in the breasts carry the production and elimination of breast-milk in women)
and sukra (semen) in men.
Pakshaghata (Hemiplegia) (S.Ni.1/60), When the greatly aggravated matarisva (vata) invades the
downward, sideward and upward dhamanis (ligaments or nerves in this context), then it causes
loosening of the bindings of the joints and destroys any one half of the body. The term paksha
means half of the body and ghat means loss of function of paksha is seen in Pakshaghata. It is
mainly a vata vyadhi and pitta and kapha doshas also associate vata in the causation of the disease.
Charaka observes that sira snayu vishoshana (arteries and ligaments degeneration) leads to
pakshaghata, but sushruta notes the involvement of dhamani in the pathogenesis of Pakshaghata.
Chakrapani says that without understanding the prakriti (physiology) correct knowledge of vikriti
(pathology) is not possible. The implications of sira, dhamani and srotas are very essential to
understand the pathogeness of pakshaghata. A critical and careful study of Ayurvedic classics
confirms that the structures like sira and dhamani convey vascular structures of the body. Acharya
charaka says that (Ch.chi.28/53,54,55), when the aggravated vayu paralyzing one side of the body
either right or left causes immobility of that side in association with pain and loss of speech, the
ailment is called pakshavadha.
Discussion - Dr. ghanekar and gangadher shastri both have submitted controversial and
confusing statements in reference to the above couplet. Dr. ghanekar preferred to label some of
these vessels as internal auditory artery for voice carrying vessels, central retinal artery for sense of
vision, lingual artery for sense of taste, sphenopalatine branch of internal maxillary artery for the
sense of smell, laryngeal artery for the sense of sound, sublingual artery for the sense of speech,
lacrimal artery for the sense of lacrimation, mammary artery for the sense of lactation. Pandit
gangadher shastry has labeled all these vessels as nerve in the following order. Auditory nerves,
optic nerves, nerves of taste i.e. branches from glassopharyngeal and lingual nerves, olfactory
nerves, inferior laryngeal nerves, hypoglossal nerves, lacrimal nerves. Dalhana also commented on
the lines of sushruta.
Table of Urdhwagami dhamanis
S.
No.
Name
of No.
Functions of Dhamani
Dhamani
Expected name Expected name
of Nerve in
of Artery in
anatomy
anatomy
1.
Vatavaha
2
Transportation of Vata
2.
Pittavaha
2
Transportation of Pitta
3.
Kaphavaha
2
Transportation of Kapha
4.
Rasavaha
2
Transportation of Rasa
from heart to target part of
body
5.
Raktavaha
2
Transportation of Rakta
from heart to target part of
body
6.
Sabdavaha
2
Receiving
of
sensation by ear
7.
Rupavaha
2
sense of vision by eyes
8.
Rasavaha
2
Receiving
of
taste Branches of 7th,9th Lingual artery
sensation by tongue
& 10th cranial
nerve
9.
Gandhavaha
2
Receiving
of
sensation by nose
10.
Ghosakara
2
attend to shouting (loud Inferior laryngeal Laryngeal artery
sound without words)
nerve
11.
Bhasanakara
2
the sense
delivery
12.
Ashruvahi
2
carry tears (in the eyes)
13.
Stanyavahi
2
carry breast milk in the
breasts of women/ carry
sukra from the breast in
of
sound Vestibulocochlear nerve
Optic nerve
smell Olfactory nerve
speech Hypoglosal nerve
Lacrimal nerve
Internal auditory
artery
Central
artery
retinal
Sphenopalatine
branch of internal
maxillary
Sublingual artery
Lacrima artery
Mammary artery
men
14.
Swapnakara
2
Attend to sleep
15.
Jagrankara
2
Attend to waking from Sympathetic
sleep
nerves
Total dhamani
Parasympathetic
nerves
30- these, (dhamani) above the umbilicus, such as the abdomen, flanks,
back, chest, shoulders, neck, arms etc are supported and maintained. The
upward dhamani perform all these functions throughout life.
Blood Supply to the Brain- The consequences of pakshaghata (stroke) depend upon which
areas of the brain are affected by ischemia, hemorrhage, hematoma or aneurysm. Therefore, it is
important to understand the organization of the cerebral blood supply system. Two arterial
systems supply the brain with blood: the internal carotid and basilar. The internal carotids and
basilar arteries are connected via the circle of Willis, which allows blood to pass from one
system to another in the event of blockage. In addition, the middle cerebral arteries provide most
of the blood supply to the corpus striatum. The striatas, which are arterial branches of the middle
cerebral arteries, are known as the arteries of stroke as they are the main source of blood for the
internal capsule. A rupture of the lenticulo-striate artery results in bleeding usually in the region
of the internal capsule (Steadman, 1997). When one of these arteries is damaged, the bottleneck
of fibers within the internal capsule, including the pyramidal tract, can be affected, causing many
disabilities. The striatas have relatively thin walls and pressure within them is high. For this
reason, they are more vulnerable to hemorrhages than to blockages.
The Circle of Willis- The Circle of Willis or the Circulus Arteriosus is the main arterial
anastomatic trunk of the brain. According to Bhatnagar and Andy (1995), anastomosis occurs
when vessels bring blood to one spot and then redistribute it. The two internal carotid arteries
and the basilar arteries feed into the Circle of Willis. The blood is then redistributed by the
anterior, middle and posterior cerebral arteries. Thus, the ends of the internal carotids and the
basilar artery enter the Circle while the three cerebral arteries arise and exit from it. (Neither the
internal carotids nor the basilar arteries can be considered "cerebral" arteries since they do not
begin within the brain).
In the Circle of Willis the two internal carotids are joined together by the anterior
communicating artery while the posterior communicating artery links the internal carotid system
with the basilar artery. These connections make collateral circulation, which Love and Webb
(1992) define as "the flow of blood through an alternate route," possible. This is a safety
mechanism, allowing brain areas to continue receiving adequate blood supply even when there is
a blockage somewhere in an arterial system. When all arteries are functioning normally, their
blood supplies will not mix where they meet in the Circle because the pressure of their streams
will be equal. As long as the Circle of Willis can maintain blood pressure at fifty percent of its
normal level, no infarction or death of tissue will occur in an area where a blockage exists. If
collateral circulation is good, sometimes a blockage will have no permanent effects. Sometimes,
an adjustment time is required before collateral circulation can reach a level that supports normal
functioning; the communicating arteries will enlarge as blood flow through them increases. In
such cases, a transient ischemic attack may occur, meaning that parts of the brain are temporarily
deprived of oxygen.
Causes- The causes of stroke are classified into two broad groups: ischemic (about 85 percent of
strokes) and hemorrhagic (about 15 percent of strokes). Ischemic strokes are further broken
down into four categories: 1.Thrombotic: Blood flow to the brain is blocked by a blood clot, or
thrombus, in a large carotid artery previously damaged by atherosclerosis, or hardening of the
arteries. In atherosclerosis, calcium and cholesterol accumulate on the inside of a blood vessel,
and this plaque narrows or blocks the artery. Blood clots form readily along the rough surface of
the plaque, obstructing the already limited blood flow. About 60 percent of strokes are the result
of restriction of oxygenated blood to the brain. 2.Embolic: Blood flow is blocked by a clot that
formed elsewhere in the cardiovascular system, usually the heart. A piece of loose plaque called
an embolus is carried through the bloodstream and lodges in a small artery, causing a stroke.
3.Lacunar: A tiny artery in the brain is completely blocked by plaque. While the area of damage
may be very small, the severity of the stroke could be significant, depending on which part of the
brain is injured. 4.Blood clotting abnormality: Abnormalities in the chemistry of the blood and
blood cells result in increased clot formation. This condition rarely causes a stroke.
In a hemorrhagic stroke, a weakened blood vessel ruptures and blood escapes into the brain. This
mass of blood presses on the normal brain tissue, destroying a portion of it in the process.
Uncontrolled high blood pressure is usually the cause.
According to ayurveda, it is mainly a vata vyadhi and pitta and kapha doshas also associate vata
in the causation of the disease. Charaka observes that sira snayu vishoshana( arteries and
ligaments degeneration) leads to pakshaghata, but sushruta notes the involvement of dhamani
(veins)in the pathogenesis of Pakshaghata. Chakrapani says that without understanding the
prakruti (physiology) correct knowledge of vikruti (pathology) is not possible. The implications
of sira, dhamani and srotas are very essential to understand the pathogeness of pakshaghata.
ConclusionBy the urdhwaga dhamani, parts of the body above the umbilicus, such as the abdomen, flanks,
back, chest, shoulders, neck, head etc are supported and maintained. The upward dhamani
perform all these functions always (throughout life). Apparent similarity between the functions
of dhamanis i.e. arteries and nerves is because these functions are interdependent and
supplementary to one another. Functions of nerves will not be effective in any part of the body if
that part is not supplied with blood by the arteries.
The nervous tissue, more than any other tissue of the body, depends for its normal functioning on
the continuous supply of arterial blood. Whenever, the volume of blood circulating in the brain is
reduced for even a short time unconsciousness results. The nerve cells suffer irreversible damage
if the blood flow remains insufficient for too long. Consequently disturbance in the blood supply
of brain tissue and the lesions resulting there from constitute a large part of the pathology of the
brain. In a tissue whose activity depends so much upon its blood supply, the micro-anatomical
relations between the cells and the blood vessels are of particular interest.
Stroke, or brain attack, is a type of cardiovascular disease. A stroke occurs when a blood vessel
that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that
happens, part of the brain cannot get the blood and oxygen it needs, so it starts to die.
REFERENCES:
1. Sushruta Samhita Commentry by B.G. Ghanekar and English Commentry by K.R. Sri Kantha Murthy.
2. GRAY’S Anatomy fourtieth edition
3. Agnivsha . Charaka, Charaka Samhita, text with English translation and Critical exposition based on
Chakrapanidatta's Ayurveda Dipika by Sharma R.K. and Bhagwan Dash. Varanasi: Chaukhambha Sanskrit Series
Office; 2002.
4. Vagbhata . In: Ashtangasangrah, sharirsthana, 6/11. Reprint. Pt. Harishastri Paradakar Bhishgacharya., editor.
Varanasi: Chaukhamba Surbharati Prakashana; 2002.
5. Sushruta . In: Sushruta Samhita, Sharisthana, dhamanivyakaran. Reprint. Vaidya Jadavaji Trikamaji Acharya,
Narayana Rama Aachrya., editors. Varanasi: Chaukhambha Surbharati Prakashana; 2003.
6. Dalhana . Commentator, Sushruta Samhita, Sharirsthana, dhamanivyakaran. Reprint. Varanasi: Chaukhambha
Surbharati Prakashana; 2003.
7. Guyton AC, Hall JE. Textbook of Medical Physiology. 11th ed. Philadelphia, Pennsylvania: Elsevier Inc.
8. Susruta, SusrutaSamhita with Nibandhasan-graha Commentary of Sri Dalhanacharya - Edited by
VaidyaYadavjiTrikamjiAcharya; ChowkhambaKrishnadas Academy, Varanasi – 2004