E-ISSN:2456-3110

Review Article

Manyastambha

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 9 SEPTEMBER
Publisherwww.maharshicharaka.in

A review article on the Ayurvedic aspects of Manyastambha

Thakur JS1*, Nayak NR2, Dass RK3
DOI:10.21760/jaims.9.9.40

1* Jyoti Singh Thakur, Post Graduate Scholar, Dept of Roga Nidana Evam Vikruti Vigyan, Shri NPA Govt Ayurved College, Raipur, Chhattisgarh, India.

2 Nikhila Ranjan Nayak, Professor and HOD, Dept of Roga Nidana Evam Vikruti Vigyan, Shri NPA Govt Ayurved College, Raipur, Chhattisgarh, India.

3 Ranjip Kumar Dass, Professor and HOD, Dept of Panchkarma, Shri NPA Govt Ayurved College, Raipur, Chhattisgarh, India.

In today’s era, because of the stressful and fast lifestyle people are suffering from various degenerative diseases. Manyastambha is one of the lifestyle disorders which have a very high prevalence at present. Manyastambha is the clinical entity in which the back of the neck becomes stiff or rigid, painful, Stambh in the cervical region, and neck movement are hampered. Manyastambha has been enumerated in eighty Vataja Nanatmja Vyadhis as well as Urdhwajatrugata Vikaras. It can be clinically co-related with cervical Spondylosis in modern medicine. Cervical Spondylosis is a degenerative condition of the cervical spine. Ruk and Stambha are the primary symptoms. It may cause pressure on nerve roots with subsequent sensory or motor disturbances if severe. The prevalence of cervical spondylosis is rising due to the increase in a busy, professional, and social life, poor sitting posture in offices, continuous work, working long hours on computers, night jobs, watching hours of television, sleeping on abnormally soft mattresses and pillows, and placing the bare minimum importance on healthy physical, mental, and dietary habits.

Keywords: Manyastambha, Cervical Spondylosis, Lifestyle Disorder

Corresponding Author How to Cite this Article To Browse
Jyoti Singh Thakur, Post Graduate Scholar, Dept of Roga Nidana Evam Vikruti Vigyan, Shri NPA Govt Ayurved College, Raipur, Chhattisgarh, India.
Email: 		Thakur JS, Nayak NR, Dass RK, A review article on the Ayurvedic aspects of Manyastambha. J Ayu Int Med Sci. 2024;9(9):248-257.
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https://jaims.in/jaims/article/view/3836

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-08-01 2024-08-12 2024-08-21 2024-08-31 2024-09-11
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© 2024by Thakur JS, Nayak NR, Dass RKand 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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Introduction

Nowadays, stress, a sedentary lifestyle, office, and computer work, long duty hours, manual labor, excess traveling, traveling on bikes, and cars for a long time, and unhealthy eating habits cause stiffness in joints, muscle stiffness, and diseases of joints and locomotor systems. Neck pain hampers the patient's day-to-day activities. The disease not only affects an individual's health but also burdens quality of life and significantly hampers daily activities.

Movement is an important characteristic of the human body. Ayurveda literature explains that Vata is the controller of all activities of the body.[1] All kinds of movements in the body are due to Vata Dosha and its de-arrangement leads to loss of body movement.

Manyastambha is one among the Naanathmaja Vatavyadhi.[2] It is considered a Urdhwajathrugata Vikara. It is a condition in which aggravated Vata lodges in the Manya region along with the involvement of Kapha leads to Sthabdhatha (restricted movements) and Shoola (pain).[3]

Manyastambha term derived from words such as “Manya” which means nape of the neck and Amarkosha describes ‘Manya’ (Neck region) as Greeva Paschat Sira (Nerves of Neck region)[4] and “Stambh” which means stiffness, rigidity.[5] In this Kaphavruta Vata takes shelter in the Sira and Snayu of Manyapradesh. It is characterized by Guruta, Stambha in Manyapradesha, Ruk, and Cheshtastambh. The clinical presentation of Manyastambha resembles the Cervical Spondylosis. It is a type of Vatavyadhi. It can occur as Nanatmaja Vikara as well as Kaphavruta Vata.

Aacharya Sushruta has mentioned in Nidan Sthan that sleeping during the day, posture deformity, and constantly looking upwards, are the reasons that aggravate Vata along with Kapha which causes Manyastambha.[6]

The signs and symptoms of Manyastambha can be correlated with Cervical Spondylosis. Cervical spondylosis is a most common musculoskeletal disorder and a major problem in modern society. According to a global burden of disease study in 2013, neck pain was one of the top 10 causes of years lived with disability globally.[7]

According to Global Burden of Disease 2015, neck pain remains the leading cause of years lived with disability and the fourth leading cause of disability-adjusted life years.[8]

In the present era, leading a sedentary lifestyle, sitting in front of computers for a long time, traveling too much on two-wheelers, lack of neck exercise, improper sitting postures, increased mental stress, etc are the main reasons for aggravation of Vata. Along with this Vata, and Kapha Dosha are also associated with causing Manyastamba.

Vata is vitiated either by Avarana or by Dhatukshaya. The vitiated Vata is lodged in Kaphastana thus involving Kapha Dosha in the pathophysiology. As in any disease, Manyastambha also if not treated in the initial stages can further deteriorate. Though the Kapha Anubhandatha is acknowledged in the initial stages of the disease, when it becomes chronic, only Vataja involvement is seen.

Aim and Objective

A review article on the Ayurvedic aspects of Manyastambh

Materials and Methods

For this study, Ayurveda Samhitas like Brihattrayi and Laghutrayi, etc., authentic publications, internet, and modern medical literature havebeenreviewed.

Review on Manyastambh

A brief description of the historical aspect of the illness was explored starting from the Vedic era to the present time and entitled as historical review. The disease Review elaborates the general description of the disease Manyastambha.

Vedic literature

In Yajurveda and Samaveda no reference is available about Manyastambha. In Rigveda and Atharva Veda there is no direct reference for the disease as Manyastambha is available, but can find indirect references. In the Rigveda and Atharva Veda, the details of Vata Bheda, Shleshmaka Kapha,[9] Sandhi Vyadhi, and medicines used in Vatavyadhi are there.


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Brihattrayi

Charak Samhita: In 20th chapter of Charak Sutrasthana “Maharogadhyaya” there are 80 types of Vataj Nanatmaja Vyadhi that have been mentioned. And among them, Manyastambha is one of them.[10] Acharya Charaka in the Trimarmeeya Adhyaya of Siddhi Sthana 12 explains Manyastambha is because of head injury i.e., Shiro Abhighatam.[11]

Sushruta Samhita:Sushruta has given a detailed description of Vatavyadhi in the first chapter of Nidana Sthana, Vatavyadhi Adhyaya.[12] Acharya Sushruta considers Manyastambha as an individual disease and also as the prodromal symptom of Apatanaka.[13] Gayadasa, a commentator on Sushruta Samhita, discussed the causative factors.[14]

Ashtanga Hridayam: In Ashtanga Hridaya Nidana Sthana chapter 15, Vatavyadhi Nidana, Vagbhatta mentions Manyastambha as a symptom of Antharayama.[15]

In Ashtang Samgrah also, Manyastambha is mentioned.[16]

Laghuttrayi

Madhav Nidana: Manyastambha is described in chapter- 22, Vatavyadhi Nidan.[17]

Bhavprakash: Aacharya Bhavprakash also described 80 types of Vataj Nanatmaja Vikara in Madhyam Kand chapter- 24, Vatavyadhi Adhikar.[18]

Sharangdhar Samhita: Aacharya Sharangdhar mentioned in Purvakand Adhyaya - 7, that there are 80 types of Vata Roga and Manyastambha is one of the Vata Rogas.[19]

Kashyap Samhita: Aacharya Kashyap has described 80 types of Vataj Nanatmaja Vikara in Sutrasthana chapter - 27 Rogadhyaya, Manyastambha is mentioned one of them.[20]

Harit Samhita: Aacharya Harit mentioned about Manyastambha in Tritiya Sthana chapter - 20 Vatavyadhi.[21]

Gadnigrah: has also described Manyastambha in Kayachikitsa Kand chapter – 19.[22]

Yogratnakar: has also mentioned about Manyastambha in Vatavyadhi Nidan.[23]

Chakradatta: has also described the treatment of Manyastambha in chapter - 22.[24]

In Bhaishajya Ratnavali chapter- 26, Vatavyadhi Rogadhikar, treatment of Manyastambha is mentioned.[25]

Vyutpatti and Nirukti

Manyastambha is mainly formed from two words, Manya and Stambh.

Manya: ग्रीवायााः पश्चात शिराः [26] (Shabdha Kalpa Drumam)
Stambha: निश्चऱीकरण (Dalhana)
Stambha: स्तम्भ इह क्रियानिरोध इनत [27] (Shabdha Kalpa Drumam)

According to Aruna Dutta the commentator of Astanga Hridaya the meaning of the word Manya is two Nadis, laterally to the Neck. Manya means the back or the nape of the neck. While the meaning of the word Stambha is Niscalikarana (Dalhana).[28] Stambha means stiffness, rigidity, making stiff or immovable.[29] Thus, Manyastambha is the clinical entity in which there is pain and restricted movements of the neck is present. The stiffness of neck is the consequence of aggravated Vata lodged in the cervical region, as Stambha is the Prakupita Vata Karma.[30] In this disease, Vata and Kapha Doshas are involved.

Paribhasha[31]

Manyastambha is coming under one of the 80 Vataja Nanatmaja Vikaras. Along with Vata, Kapha Dosha is also associated. Vata is vitiated either because of Kaphavarana or Dhatu Kshaya. Vata is vitiated and lodged in the Kapha Sthana so the Kapha involvement can occur. When any disease is not treated properly at the initial stage it may lead to further deterioration. Such activity is happening even in Manyastambha too. At the initial stage of the disease the Kapha Anubandhatwam is acknowledged. When it becomes chronic, it becomes a Vata disorder only, which is a degenerative condition in nature.

Nidana of Manyastambh

Specific Nidanas of Manyastambha have not been mentioned anywhere in the classics. Hence the factors, which are responsible for the vitiation of Vayu can be considered as the Nidana of Manyastambha also. The Vata Prakopaka Nidana described by Aacharyas, are as below:


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Aaharaj Nidana

NidanaC.SS.SA.H.H.S M.NY.RB.P
Ruksha Ahara+++++++
Sheeta Ahara++-++++
Alpa Ahara+-+-+++
Laghu Ahara+---+++
Kashaya Rasa-+++--+
Katu Rasa-+-+--+
Tikta Rasa-++---+
Masoor -+-+---
Kalaya -+-+---
Nishpava -+-+---
Rajmasha -+-+---
Neevara -+-+---
Raktashali -+-+---
Koradoosha -+-+---
Shyama -+-+---
Yavagu ---+---
Mudga -+-+---
Aadhki -+-+---
Harenu -+-+---
Kalinga ---+---
Vastuka ---+---
Palandu ---+---
Gunjana ---+---
Kandashaka ---+---
Shushkashaka ---+---
Vallura -+-----
Varaka-+-----

Viharaj Nidana

NidanaC.S.S.S.A.H.H.S.M.N.Y.R.B.P.
Diwaswapna[32][33]-+--+++
Vishamashana[32][33]++--++-
Urdhvanirikshana[32][33]-+--+++
Atibhukta ---+---
Kshara ---+---
Abhojana --+----
Langhana +----+-
Adhovatarodha -+-+---
Mutrarodha -+-+---
Pureesharodha -+-+---
Nisha Jagarana +-+++++
Ativyayama ++++++-
Ativyavaya ++++++-
Atiadhwa ++-+++-
Atibhashana --++---
Ashwayana +--+++-
Ushtrayana +--+++-
Rathayana ---+---
Gajayana +---++-
Plavana +---+++
Aticheshta +---++-
Sheeghrayana+---++-
Kshavthu Vegadharan[34]+-+----
Jrimbha Vegadharana[35]-++----
Ashru Vegadharana[36]--+----
Abhighata ++  --+++

Manasik Nidana

NidanaC.S.S.S.A.S.H.S.M.N.Y.R.B.P.
Shoka +-+-+++
Chinta +-+-+++
Dukh +------
Krodha +----+-
Bhaya +--+---

Panchkarma Apacharaja Nidana

NidanaC.S.S.S.A.H.H.S.M.N.Y.R.B.P.
Vishama Upachara +---+-+
Asamyaka Vamana Karma -----+-
Asamyaka Virechana Karma -----+-
Kriyatiyoga --+----

Kalaj Nidana

NidanaC.S.S.S.A.H.H.S.M.N.Y.R.B.P.
Sheeta ---+---
Durdina--+---
Aprahne ----+---
Varsharitu -----+-
Greeshmaritu -+-----
Jara +----+-

Anya Nidana (Other Causes)

NidanaC.S.S.S.A.H.H.S.M.N.Y.R.B.P.
Dosha Sravana+-----+
Asrika Sravana +---+++
Dhatukshaya+---+++
Marmaghata+---+-+
Amadosha+---+++
Roga Atikarshana+---+++

C.S. - Charak Samhita, S.S. - Sushruta Samhita, A.H. - Ashtang Hridaya, M.N. - Madhav Nidana, H.S. - Harit Samhita, Y.R. - Yog Ratnakar, B.P. - Bhava Prakash

Purvarupa[37]

Purvarupa indicates a disease that will happen in the future. The Purvarupa manifests in the Sthanasanshraya Avastha of Shadkriyakala. There is no separate explanation in the classics about the Purvarupa of Manyastambha.

Charaka stated that the Purvarupa of Vatavyadhi is “Avyaktam Lakshanam Tesham Purvarupam Iti Smritam”.[38] Commentator Vijayarakshita explain the word “Avyakta” as “Na Ati Abhivyakta” means the word Avyakta as the symptoms which are not manifested clearly.[39] Hence, mild occasional symptoms prior to the manifestation of Manyastambha may be taken as Purvarupa.


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Rupa

The manifested signs and symptoms of a disease are termed as the Rupa. Rupa is seen in the fifth stage i.e., Vyakti Avastha which occurs after Sthanasamsraya Avastha. Some of the general symptoms of Vata Vyadhi are similar to the sign and symptoms of Manyastambha (Cervical spondylosis).

The sign and symptoms of Manyastambha are-[41]

मन्या च स्तंभयते (stiffness of neck)
मन्याशूल (pain in neck)
अन्तरामयते ग्रीवा (straining of neck in inward direction)
शिरोग्रह (headache)
पृष्ठग्रह (pain in back)

Samprapti

The way in which the Doshas get vitiated and the course it follows for the manifestation of the disease is called Samprapti. The knowledge of Samprapti is very much essential from a treatment point of view and it also helps to understand the complete pathogenesis of a disease.

No specific Samprapti has been explained for Manyastambha. So, the general Samprapti of Vatavyadhi can be considered.

  • Acharya Charaka has mentioned that Vata Prakopa Nidana Sevana, Vata Prakopa and this Prakupita Vata gets accumulated in Rikta Srotas and gives rise to various Sarvanga and Ekang Vyadhi (Ch.Chi. 28/ 18 19).[42] Acharya Vagbhatta has also stated that vitiated Vata circulate through empty channels in body (Rikta Srotas) and fills them.[43] (AH, Ni. 15/6)
  • The vitiated Vata also causes Shleshaka Kapha Kshaya due to Ruksha and Khara Guna. Here Ruksha and Khara Guna of Vata are considered as antagonising factors for Shleshaka Kapha which eventually results in diminution of Shleshaka Kapha which is binding force between joints and ultimately leads to Kshaya in Dhatus. Because of Dhatukshaya, vitiated Vata flows out of its Ashaya to circulate in entire body and settles down in Asthi.
  • Whenever the Vyana Vayu gets vitiated, then simultaneously Khavaigunya takes place at Asthi Dhatu because of its higher affinity towards Asthidhatu due to Ashraya-Ashryee Bhava leads to Asthivaha and Majjavaha Srotodushti which results in Manyastambha.

Samprapti Ghatak

Proper knowledge of Samprapti along with its Ghatakas is very muchessential.

DoshaVyan Vayu, Shleshmak Kapha
Dushya Asthi, Majja, Snayu, Mamsa
Agni Jatharagni, Asthi-Majja Dhatwagni
Strotas Asthivaha, Majjavaha
Strotodushti Prakara Sanga
Udbhav Sthan Pakwashaya
Vyakta SthanGreeva (Manya Pradesh)
Swabhav Chirkari
Rogmarg Marmasthi-Sandhi

Upashaya

All drugs, diet, and regimens that give long-lasting relief in Manyastambha may be taken as Upashaya. E.g. - Abhyanga, Swedana, Ushna Ahara, Ushna Ritu, Avoiding pillows, etc.

Anupashaya

All drugs and regimens that exaggerate the diseases are taken as Anupashaya. E.g.- The diet having Laghu, Ruksha, Sheeta Gunas, Anashana, Alpashana, Sheeta Rutu and Evening time.

Pathya-Apathya

Specific Pathya and Apathya of Manyastambha are not mentioned. But as being a Vatavyadhi, we have to adopt the same.

Pathya Ahara in Manyastambha[44]

VargaDravya
Annavarga Godhuma, Masha, Kulattha, Raktashali
Dugdhvarga Gau-Aja Dugdha, Ghrita, Kilata
Phalavarga Draksha, Madhuka, Badara, Amra
Jalavarga Ushna Jala, Shritashita Jala
Madyavarga Sura, Surasava, Amlakanjika, Madira
Mamsavarga Kukkuta, Tittira, Nakra, Mayura,Chataka
Mutravarga Gou, Avika, Asti,Mutra,Ashva
Rasavarga Madhura, Amla, Lavana
Shakavarga Patola, Rason, Shigru, Jivanti
Snehavarga Ghrita, Taila, Vasa, Majja

Apathya Ahara in Manyastambha[45]

VargaDravya
Annavarga Yava, Kodrava, Shyamaka, Chanaka, Kalaya
Dugdhvarga Gadarbha Dugdha
Ikshuvarga Madhu
Jalavarga Nadi-Samudra, Shita Jala, Dushita Jala, Tadagasya Jalam
Madyavarga Navamadya, Atimadyapana
Mansavarga Kapota, Paravat, Kulinga, Shuka, Shushka Mamsa
Mutravarga Ajamutra
Phalavarga Jambu, Kasheruka, Kramuka, Lavali, Parpataki Phala
Rasavarga Katu, Tikta, Kasaya Rasa
Shakavarga Kumuda, Kamalanala, Palakya, Udumbara

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Chikitsa

Nirukti of Chikitsa:“Kit Rogapanayane.” The root word ‘Kit’ means removal or eradication. Kit means separating the disease or eradicating the disease from the body or controlling or destroying the disease and disease process.

Chikitsa Ruk Pratikriya[46]: Treating or eradicating pain or disease is called Chikitsa.

Chikitsa Roga Nidana Pratikare[47]: avoiding a disease's causative factor or factors is called Chikitsa.

Yaa Kriya Vyadhi Harinee Sa Chikitsa Nigadhyate[48]: any activity or approach which alleviates or destroys a disease is called Chikitsa.

Chikitsa of Manyastambh

As in Ayurveda, the first line of treatment is Nidanaparivarjanama. The first aim should be lifestyle modification, which can be achieved through dietary habits, Yoga, and Regular exercises. Bhava Mishra mentions that the Abhyanga with Taila or Ghrita should be done in Manyastambha, Bhavamishra and Yogaratnakara indicate Rooksha Sweda and Nasya.[49] As the disease is a Vatavyadhi, Vatahara Chikitsa can be adopted.

General treatment of Vatavyadhi

As Manyastambha is considered under Vatavyadhi, line of treatment of Vatavyadhi is to be adopted in Manyastambha. Samanya Vatopakramas that are explained as Vata Shamaka Ahara, Snehana, Swedana, Mrudu Samshodhana, Bahir Parimarjana and variety of Basti Upakramas are main line of treatment to pacify the Vata.

Snehana

When vitiation of Vata occurs without any Upstambha or Avarana, it should be treated at first with Sneha Dravyas like Grita, Taila, Vasa & Majja. Anuvasana Basti with Amla & Lavana Rasa, Sneha Nasyas & Brihana Ahara & Vihara also come under Snehana.

Swedana

After proper Abhyanga, the patient may be subjected to the Swedana therapy like Nadi Sveda, Sankara Sveda, Prastara Sveda etc. it is also useful in Toda (pricking pain), Harsha (tingling sensation), Ruka (ache), Shotha (oedema),

Stambha (stiffness), Anga Graham (spasticity).The Snehana and Swedana procedures should be administered repeatedly as a result of which the disorders of Vata may not get lodged in the Kostha softened by Snehana procedure.

Mridu Samshodhana (Virechana)

Mrudu Virechana must be given in Vata Vyadhies which are not subsided by the Snehana and Swedana. For this purpose the patient may take the medicated Ghee prepared with Tilvaka or Satala or oral administration of ‘Eranda Sneha’ along with Godugdha (cow milk) for the Virechana purpose. This will help in both Vata Anulomana as well as elimination of morbid Doshas.

Basti

Basti is considered to be the best treatment modality, because of its wide applicability and multidimensional therapeutic approach towards the Vata Dosha, also effective in conditions where other Doshas are involved. The Basti is termed as Ardha Chikitsa or Sampurna Chikitsa. The desired effects may be produced by modifying the basic constituents of Basti like Kashaya and Kalka drugs as per the need. Lekhana, Brimhana, Grahi, Shodhana and many other specific Bastis are mentioned. Acharya Charaka, while explaining the treatment for Asthipradoshaja Vikaras, has mentioned Panchakarma in which importance is given to Basti, containing Tikta dravyas, Ksheera and Sarpi.

Nasya Karma

Nasya Karma is one of the therapeutic procedures of Urdhvajatrugata Vikaras, wherein the drug is administered through the nasal route. According to Acharya Charaka, Nasya Karma has been indicated in all types of Vata Vyadhies.

Discussion

It covers the Ayurvedic review and other Therapeutic Procedures, recommended to manage the Vatavyadhi (Manyastambha). In the Ayurvedic review, Nidana Panchaka, Sadhya-Asadhyata, and Chikitsa of the disease have been described. As Manyastambha is not mentioned as a separate disease the Nidanas mentioned for Vata-Vyadhi and Vata Prakopa are incorporated as causative factors of Manyastambha (Cervical Spondylosis), though separate Nidanas are not mentioned.


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In Ayurvedic management, Snehan Karma produced Snigdhta, Mardavta, and Vishyandan in the neck region. The Swedan reduces Kapha and Ama that responsible for spasticity in the neck in cervical spondylosis. Vata manifestation vitiates due to Sheet Guna, in such case, Swedan showing hot potency pacifies the Vata manifestation. Manya Basti relieves stiffness and pain in the neck region. The Nasya Karma pacifies the mainly Vata Dosha and associated Kapha Dosha through its Brimhana nature and works as an effective treatment in cervical spondylosis.

Conclusion

Based on clinical manifestation, pathogenesis, and complication, cervical spondylosis can be correlated with Manyastambha. The Manyastambha comes under the eighty types of Nanatmaja Vata Vyadhies. Vata provocating factors are accepted as Nidana. Vyana Vayu and Shleshaka Kapha are essential components for the pathogenesis of Manyastambha (Cervical Spondylosis). The Ayurvedic treatment modalities can be used as an effective management of cervical spondylosis.

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