Ayurveda primarily focusses on two aspects, viz. promotion of health of a healthy person and curing the disease in the diseased person. Disease cure through Ayurveda considers not only symptomatic relief rather it aims at bringing about an overall change in the diet and lifestyle along with medicines and therapies so that the disease is treated at its root thereby minimizing the chances of recurrence or at least ensures a better quality of life with disease under control.

Health according to Ayurveda is basically a balanced state of tridoshas (the three humors) namely Vata, Pitta and Kapha; the seven dhatus (bodily tissues) namely Rasa (lymph), Rakta (blood), Mamsa (muscle), Medas (fat tissue), Asthi (bones), Majja (bone marrow), and Sukra (the sperm/ovum); and the trimalas (the three major metabolic by-products) namely Vit (fecal matter), Mutra (Urine) and Sweda (Sweat). Once in a state of balance they reflect an appropriate functioning of all the physiological systems in the body, thus, ensures the state of health. Disease, on the contrary, is a state of imbalance, a relative increase or decrease of primarily the tridoshas which influences the dhatus and the malas.

Among the tridoshas, Vata is the controlling factor which basically initiates all the movements in the body and also regulates all the physiological activities. Pitta is responsible for the metabolism and Kapha for the growth and nourishment.

Pain is a very common clinical symptom associated in most of the ailments. The conventional management of pain includes prescribing analgesics or anti-inflammatory drugs including NSAIDs which give a symptomatic relief while the underlying cause of pain often is left unaddressed only to resurge again. According to Ayurveda, Pain is primarily attributed to an abnormal functioning of Vata dosha, this means that wherever the pain manifests there is a definite involvement of Vata. Depending on the nature and severity, a pain spectrum has been explained in Ayurveda as follows which can be used as a reference to diagnose the type of pain.

• Vyadha- pain as if pricked with needles
• Ruk- pain as if pricked with a trishul; pain is continuous in nature
• Toda- piercing pain
• Bhedana- splitting pain

Further, depending on the site of localization of Vata in the course of disease the characteristic of pain varies, for example,

Thus, pain can be a presentation of varied causes. Therefore, Ayurveda visualizes each pain as different and the approach of Ayurveda towards pain management primary focusses on three aspects, as follows:

1. Normalizing the Vata which is the primary factor
2. Considering the site of Vata localization
3. Considering Pitta or Kapha which may be associated.

General principles for controlling Vata includes:

• Avoiding the factors which can vitiate Vata like
  • indulgence in food predominant in bitter, pungent or astringent tastes, for example excessive use of chilies or masalas, excessive use of sauces etc.;
  • consuming dry foods which includes deep fried foods also as the natural moisture content will be lost
  • Eating too less not sufficient to nourish the body appropriately- undernourishment
  • Eating too late- not eating when feeling hungry, postponing the meals
  • Willful suppression or initiation of natural urges
  • Keeping awake late in night
  • Speaking loudly
  • Emotional disturbances like fear, grief, worry or anxiety
  • Excessive indulgence in physical exercises and sexual activity
• Adopting the therapies and regimes which normalizes Vata like
  • Use of Oleation (like oil massage etc) and Sudation therapies (like steam etc) followed by purificatory therapies especially therapeutic enema.
  • Procedures like Banding or wrapping and seka (bathing the body with herbal decoctions or oils)
  • Diet predominant in Sweet, Sour and salt tastes
  • Medicated Oil and ghee preparations and medicines which will stimulate the metabolism
• Considering the site of Vata localization
  • Large intestine- therapeutic enema with herbal decoctions and medicated oils
  • Blood- external application of drugs with are soothing in nature, purgation and blood letting
  • Muscle and fat- purgation and therapeutic enema
  • Marrow & Bone- external application and internal administration of oils and other fats
• Considering Pitta or Kapha which may be associated- the associated Pitta or Kapha will be managed as per the protocols for subsiding them respectively.

Ayurveda offers a wide range of therapies for pain management including both external as well as internal therapies.

External therapies:

1. Snehanam : This refers to the oleation therapy and primarily includes massage. Generally, massage is done with warm medicated oil, however, in special conditions other fats like ghee etc may be used. The massage is done in long strokes in the direction of hair follicles, i.e., in the direction away from the heart.
2. Swedanam : This refers to the practice of Sudation. The aim of the therapy is to induce perspiration. This therapy is applied in various modes depending upon the condition.
   1. Bashpa Sweda: Refers to steam bath which may be administered locally on the affected part or the whole body.
   2. Pottala Sweda : Commonly known as kizhi, this includes massage using the medicated bolus wrapped in a cloth and applying by heating either over a dry pan or by dipping in warm oil. The medicated bolus may be comprising of herbal powders (podi kizhi), leaves fried in medicated oil (ela kizhi), njavara rice cooked in special decoctions (njavara kizhi) etc decided based on the condition.
   3. Seka: In this therapy warm herbal decoction or medicated oil is poured over the affected part or the whole body for a specified period of time.
   4. Avagaha: This includes immersing the affected part or the whole body in warm decoction for a specified period of time.
   5. Upanaha: Applying the medicated paste over the affected part and wrapping with cloth.
   6. Bandhana: Bandaging with a cloth after application of oil over the affected part.
3. Agnikarma & Siravedha: These are the unique para-surgical procedures in Ayurveda done in the mode of cautery and blood letting respectively. These procedure gives an instantaneous relief in pain.

  Purificatory therapies:

1. Virechanam : Refers to inducing mild purgation using herbal purgatives.
2. Vasthi: Refers to enema therapy which is considered as the best for all Vata related conditions. Generally, enema is administered as a combination of decoction enema (Niruha vasthi) and oil enema (anuvasana vasthi) for a specified period of 8, 15 or 30 days depending on the duration and intensity and chronicity of pain.

  Internal medications:

1. Snehanam : Internal administration of medicated oil, ghee or other forms of fat.
2. Use of herbal decoctions, tablets, powders, asava/arishtas etc
3. Rasayanam: The rejuvenation therapy administered in the form of special formulations, usually as the last part of the course of treatment. This helps to ensure the strengthening of the body as well as minimizes the chances of recurrence.

Besides, as per the seasonal regime, which is a unique contribution of Ayurveda, the Vata undergoes an increase in Rainy season due to the various environmental changes taking place. Therefore, in Rainy season, generally, pain, especially arthritic pain, is observed to increase. Thus, it is advisable for those experiencing such aggravation of pain to undergo the special monsoon treatment regimens including oleation (oil massage), sudation (steaming), various kizhi treatments depending on the condition, enema therapies along with prescribed diet and medicaments. Undergoing this special kind of monsoon care can also help in preventing the Vata related diseases especially in those who have a Vatika body constitution (prakruthi).

Thus, irrespective of the nature or site, according to Ayurveda there is an inevitable involvement of Vata in pain. A systematic administration of above mentioned therapies and medicaments can ensure satisfactory pain management. For the best results, it is advised to consult a certifies Ayurveda practitioner and undergo scientific treatment.

By: Dr Deepty Nair, Professor & HOD, Dept of Swasthavritta & Yoga, Ayurvedic College & Hospital, RK University Rajkot, Gujarat