E-ISSN:2456-3110

Case Report

Ardhavabhedaka (Migraine)

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 1 January
Publisherwww.maharshicharaka.in

Role of Marma Chikitsa in the management of Ardhavabhedaka (Migraine) - A Single Case Study

Raje Singh V.1*, Marwaha R.2, Gupta P.3, Kumar Chourasiya S.4, Sharma S.5
DOI:

1* Vandna Raje Singh, Post Graduate Scholar, P.G. Department of Rachna Sharir, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.

2 Rita Marwaha, HOD, Prof. & Co-guide, P.G. Department of Rachna Sharir, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.

3 Pankaj Gupta, Reader & Guide, P.G. Department of Rachna Sharir, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.

4 Swatantra Kumar Chourasiya, Lecturer & Co-guide, P.G. Department of Rachna Sharir, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.

5 Shraddha Sharma, Lecturer & Co-guide, Department of Kayachikitsa, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.

Main objective of Ayurveda is to maintain the health of healthy person and to cure the disease of ill-person. With the exploration of Marma Science, the whole scenario of Indian surgery may change in multidimensional approaches. Marmas are the vital points in the body where Prana exist. According to Ayurvedic texts the Marmas are the Sthana, when injured may be life threatening. If this Marma Sthana is properly stimulated than many physical and mental disorders like Migraine, Stress, Anxiety can be treated. Acharya has described Shiroroga with his etiology, symptoms, complication and treatment. Ardhavabhedaka is one of them. According to Acharyas, there will be severe pain in half side of the head, affecting particularly Manya, Bhru, Shankha, Karna, Akshi and Lalaat. The nature of pain is like Shastra Arani Nibham. In modern, Migraine is throbbing unilateral headache preceded by an aura associated with vomiting and visual disturbance. In modern Era, Marma Chikitsa plays an important role in the management of Ardhavabhedaka (Migraine). As Pain is the major symptom which affects the person’s day to day activities, so pain is the major target in the management of Ardhavabhedaka. Therefore, Marma Chikitsa can be a non-medicinal and non-invasive approach in the management of Ardhavabhedaka (Migraine). Shiromarma can be used effectively in the management of Ardhavabhedaka (Migraine). This abstract elaborates the role Marma Chikitsa in Ardhavabhedaka (Migraine).

Keywords: Ardhavabhedaka, Migraine, Shiromarma, Marma, Ayurveda, Marma Chikitsa

Corresponding Author How to Cite this Article To Browse
Vandna Raje Singh, Post Graduate Scholar, P.G. Department of Rachna Sharir, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.
Email: 		Vandna Raje Singh, Rita Marwaha, Pankaj Gupta, Swatantra Kumar Chourasiya, Shraddha Sharma, Role of Marma Chikitsa in the management of Ardhavabhedaka (Migraine) - A Single Case Study. J Ayu Int Med Sci. 2023;8(1):219-223.
Available From
https://jaims.in/jaims/article/view/2242

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-26 2022-11-29 2022-12-06 2022-12-13 2022-12-20
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Vandna Raje Singh, Rita Marwaha, Pankaj Gupta, Swatantra Kumar Chourasiya, Shraddha Sharmaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Singh V et al: Role of Marma Chikitsa in the management of Ardhavabhedaka (Migraine)

Introduction

Ayurveda is an ancient science of life in which knowledge of Sharir is described vividly. Marmas are the vital points in the body which prove to be fatal when subjected to trauma.[1] If these Marma points are used carefully in treatment, the diseases can also be cured. Marma Chikitsa is the oldest treasure of Indian surgery from the Vedic period.[2]

All authorities of Ayurveda have described Shiroroga in which Shirahshool is the common symptom. Ardhavabhedaka is one of them in which pain occurs in head unilaterally. According to Acharya Charak, there will be severe pain in half side of the head, affecting particularly Manya, Bhru, Shankha, Karna, Akshi and Lalaat. The nature of pain is like Shastra Arani Nibham.[3]

Marma science is permanent, natural, non-invasive way of healing today, because it succeeds in conserving many of the highest moral values of its adherents. It promotes calmness, self-control, self-healing, realization and happiness and thus much to prevent suffering and sorrow.[4]

As Pain is the major symptom which affects the person’s day to day activities, so pain is the major target in the management of Ardhavabhedaka. Therefore, Marma Chikitsa can be a non-medicinal and non-invasive approach in the management of Ardhavabhedaka (Migraine). Shiromarma can be used effectively in the management of Ardhavabhedaka (Migraine).

Migraine is an episodic headache disorder usually characterized by pain involving either half of the head. Migraine is the most common type of headache in young adults. Migraine headaches often being with various prodromal sensations, such as nausea, loss of vision in part of the field of vision, visual aura, and other types of sensory hallucinations. Here in, we report a rare case of migraine without aura presenting with the relevant investigations.

Marma: Marma is defined as an Anatomical site where muscles, veins, ligaments, bones, and joints meet together. They are also the sites where not only Tridosh are present but their subtle forms like Prana, Ojas, and Teja are also present with Sattva, Raja and Tama.[5] Marma is the point on the body where the blockage of energy is felt. It is the junction between physiology and consciousness,

and by touching it changes the body’s biochemistry and can unfold radical and alchemical change in one’s makeup.[6] Stimulation of these inner pharmacy pathways signals the body to produce exactly what it needs including hormones and neurochemicals that heal the body, mind and consciousness.[7]

Marma Chikitsa: The basics of Marma Chikitsa can be considered as Angirasi Chikitsa. In Angirasi Chikitsa, Rasa refer to the executive elements that controls and carries out various function of the body. Marma therapy contributes to increase or recharge physical, mental and spiritual energies. On the physical level it helps to revitalize or re-energize the body tissues; at cellular level, it improves the vital functions like digestion, respiration, blood circulation and excretion. On the psychological level it improves the mental faculty by directing it in the positive direction.

Marma points being used for Marma Chikitsa are - Vidhura, Apanga, Avarta, Sthapani, Simanta, Shringataka and Adhipati Marma.

Ardhavabhedaka (Migraine): While describing Shiroroga, many Acharya counted Ardhavabhedaka in Shiroroga. Acharya Charak has stated that there will be severe pain in half side of the head, affecting particularly Manya, Bhru, Shankha, Karna, Akshi and Lalaat. The pain is like Shastra Arani Nibham.

According to Acharya Sushrut there will be severe tearing and pricking pain in one half of the head associated with giddiness. These features appear every fortnightly or ten days or any time.[8]

A useful definition of migraine is a benign and recurring syndrome of headache, nausea, vomiting and/or other symptoms of neurologic dysfunction in varying admixtures. Migraine can be recognized by its activators (red wine, menses, hunger, lack of sleep, glare, estrogen, worry, perfumes, let down periods) and its deactivators (sleep, pregnancy, exhilaration, triptans).

Instrumentation

Severity of Headache

0 = No headache.

1 = Mild headache, patient is aware only if he/she pays attention to it.

2 = Moderate headache, can ignore at times.


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Singh V et al: Role of Marma Chikitsa in the management of Ardhavabhedaka (Migraine)

3 = Severe headache, can’t ignore but he/she can do his/her usual activities.

4 = Excruciating headache, can’t do anything.

Frequency of Headache

Assessed in term of (frequency in days)

0 = Nil 1 = ≥ 20 days

2 = 15 days

3 = 10 days

4 = ≤ 5 days

Duration of Headache

(Assessed in term of hours/day)

0 = Nil

1 = 1-3 hours/day

2 = 3-6 hours/day

3 = 6-12 hours/day

4 = More than 12 hours/day

Nausea

0 = Nil

1 = Occasionally

2 = Moderate, however does not disturb the routine work

3 = Severe, disturbing routine work

4 = Severe enough, small amount of fluid regurgitating from mouth

Vomiting

0 = Nil

1 = Only if headache does not subside

2 = Vomiting 1-2 times

3 = Vomiting 2-3 times

4 = Forced to take medicine to stop vomiting

Gradation for associated symptoms

0 = No symptoms

1 = Mild (can do his/her work)

2 = Moderate (forced to stop work)

3 = Severe (forced to take rest)

 4 = Excruciating (force to take medicine)

Case Report

A 25 year old male patient OPD NO. Is 46483 presented with complaints of headache, nausea and vomiting for the past 1 year. No history of illness or accidents in the past five years and not taking any medication for any illness/disorder. He has continuous, unilateral headache in frontal, parietal lobe in left side sometimes right side. The nature of pain was moderate to severe associated with nausea and sometimes vomiting. Family history was not contributory. He has to take allopathic medicine for pain.

Examination

1. Duration of headache - 1 year

2. Frequency of attacks - 10 days

3. Severity of headache - Moderate to severe

4. Duration of each attack - 6 to 12 hours/day

5. Site - Unilateral (Frontal & parietal)

6. Location – character - Changing

7. Nature of pain - Severe

8. Associated symptoms - Nausea/vomiting

9. Quality - Pulsatile & heaviness

10. Past history - No

11. Family history - Noncontributory

12. Stress of life - Occupation

13. Treatment history - Analgesic oral pills

Physical examination

  • Body weight: 63 kg
  • Heart Rate: 97/min
  • Respiration Rate: 24/min
  • Blood pressure: 140/80 mmHg

Investigation

  • HB - 13.4 gm%
  • TLC - 7800 cumm.
  • DLC - Neutrophils-58 Lymphocytes-36 Monocytes-3 Basophil-0 Eosinophil-3
  • ESR - 11 mm/hr
  • RBS - 110 mg/dl

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Singh V et al: Role of Marma Chikitsa in the management of Ardhavabhedaka (Migraine)
  • T. Scan of head - Normal study.

Protocol of Treatment

SN Marma point Stimulation time  Sittings of Marma Chikitsa Total time period
1. Vidhura 0.8 sec. Two time per day 30 days
2. Apanga 0.8 sec. Two time per day 30 days
3. Avarta 0.8 sec. Two time per day 30 days
4. Sthapani 0.8 sec. Two time per day 30 days
5. Simanta 0.8 sec. Two time per day 30 days
6. Shrngataka 0.8 sec. Two time per day 30 days
7. Adhipati 0.8 sec. Two time per day 30 days

Results

Before and after completion of 30 days treatment clinical assessments were made from the interrogation and gradation of scoring pattern. There was a drastic change in the parameters as:

Sign & Symptom  B.T. 1st Week 2nd Week 3rd Week 4th Week
Severity of Headache 3 3 2 2 1
Frequency of Headache 3 3 3 2 1
Duration of Headache 3 3 3 2 1
Nausea 3 3 2 1 0
Vomiting 2 2 2 1 0

1st Follow up: after 30th day patient came to Marma OPD with low frequency and duration of migraine. He was advised to continue the same for 1 month.

Discussion

The Ayurveda explains the episodic nature of Ardhavabhedaka (Migriane). Pain is the major symptom in the Ardhavabhedaka which affects the person’s activities. Marma is the seat of vital energy i.e. Prana. Prana in Ayurveda are directly related to Vata. As per Ayurveda damage to Marma Structures, Vata gets vitiated and causes pain. Severity of pain depends on the amount of injury, type of injury, area of that Marma involved in injury and composition of Marma.

The Marma point harmonizes the nervous and endocrine system and normalize different pathology in the body through vital power itself, with proper stimulation, manipulation. These techniques are known as Marma Chikitsa. It includes gentle massage over the Marma points. There are many theories in modern science regarding pain control by various methods like acupuncture, acupressure, etc.

In gate control theory of pain nerves from all over the body run to the spinal cord, which is the first main meeting point for the nervous system. In the spinal cord, you might imagine a series of gates into which messages about pain arrive from all over the body. These gates can sometimes be much more open than at other times. This is important because it is through these gates that messages from your body pass towards your brain. If the gates are more open, then a lot of pain messages pass through to the brain and you are likely to experience a high level of pain. If the gates are more closed, then fewer messages get through and you are likely to experience less pain.

Several opiates like substances found at the various level of the nervous system that is responsible for pain suppression. These substances include beta-endorphin, met-enkephalin, leu-enkephalin etc.

So, in the management of Ardhavabhedaka (Migraine), to get out of this problem we need a non-medicinal approach. Marma Chikitsa is one of the emerging applied aspects of Marma. Marma Chikitsa is a non-invasive, easy to apply, with maximum benefits if applied properly. While performing Marma Chikitsa proper knowledge of Marma is mandatory. It can be a milestone in the field of medical science.


Conclusion

Ardhavabhedaka is correlated with Migraine in modern science. Migraine is an episodic headache which specially occur in head unilaterally. It includes recurring attacks of varying degree and the frequency of attack is different. Acharya Sushrut has explained 107 Marma Points and their importance.

The role of Marma Chikitsa is to maintain health and to cure disease. Marma Chikitsa is a non-invasive and non-pharmacological process, so we have used as a management for Ardhavabhedaka. Vidhura, Apanga, Avarta, Sthapani, Simanta, Shringataka and Adhipati Marma are the points which we have stimulated during our Marma Chikitsa. We have given Marma Chikitsa twice a day for 30 days.

In above summary we have concluded that the patient gets relief in the severity, frequency and duration of Migraine by Marma Chikitsa.


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Reference

1. Debasis Kundu. Essence of Marma, Varanasi, Chaukhambha prakashan, 2022:2.

2. Sunil Kumar Joshi. Marma Science and Principles of Marma Therapy, New Delhi, Vani Publications, 2019;33.

3. Shastri Kashinath, Gorakhanath Vidyotini Commentary on Charak Samhita Varanasi, Chaukhambha Bharti Academy, 2009;1: Sutra Sthan 29/3:576

4. Sunil Kumar Joshi. Marma Science and Principles of Marma Therapy, New Delhi, Vani Publications, 2019;9

5. Sushruta: Sushruta Samhita, edited with Ayurveda Tatva Sandeepika Hindi commentary by Shastri Kaviraj Ambika Dutta. Varanasi India: Chaukhambha Sanskrit Sansthan; part-1;2014; Shareera Sthana 6/37:77.

6. Lele Avinash, Ranade Subash and Frawley David: Secrets of Marma: The lost secrets of Ayurveda, a comprehensive text book of Ayurvedic vital points. Delhi India: Chaukhambha Sanskrit Pratishthan, 1999; 4: 13

7. Ranade Subhash and Lele Avinash. Ayurveda and Marma therapy by Frawley David, Lotus Press. PO Box 325, Twin Lakes, WI 53181. 2003.

8. Shastri Ambika dutta, Sushrut Samhita, Ayurveda Tattva Sandipika, Varanasi Chaukhambha Sanskrit Sansthan Varanasi, 2012; 2: Uttartantra. Chap., 25/15: 166.


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