Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
‘Manyastambha’ is a condition explained in Ayurveda in the context of Vata Vyadhi – special disorders caused by aggravated vata.
Meaning of Manyastambha
The word Manyastambha is made up of two terms. They are –
– Manya = back side of the neck
– Stambha = stiffness, catch
Putting both the terms together, Manyastambha means ‘stiffness of the back of the neck region’.
Definition of Manya
Manya has been defined as ‘greeva paschad bhaga’ which means ‘posterior part of the neck – back of the neck’. Stambha means stiffness, catch or a condition wherein there is loss of movements.
Manyastambha is a vata disorder and is caused when the aggravated vata afflicts the mamsa – muscles, snayu – ligaments and nerves and soft tissues at the back of the neck.
Understanding the word Stambha
Stambha / stabdhata means stiffness. But it can be understood according to situation and context. In conditions like Manyastambha, stambha not only means stiffness but also the other conditions caused by and associated with stambha. They include loss or limitation of movements, mal-presentation and positioning of chin and head.
Stambha may be caused either by vata or kapha. We will further understand the involvement of kapha in the causation of stambha or manyastambha in the discussion of pathogenesis of the disease.
So, stambha or stiffness is caused by –
– Vata – when manyastambha is caused by only vata, as in manyastambha being one of the eighty vata nanatmaja roga
– Kapha – as per the pathogenesis of manyastambha explained by Master Sushruta wherein kapha obstructs or envelopes vata, thus hampering the vata, causing a kaphavrita vata like condition which further leads to stiffness and limitation of movements at the neck
– Vata drying up the kapha in the back of the neck and causing stiffness
Types of Manyastambha
The types of Manyastambha have not been specified in Ayurveda texts. But we can infer the types based on the explanation and references we find about the disease in the treatises.
1. Vata Pradhana Manyastambha – In this condition, manyastambha is caused by aggravation of ‘only vata’ in the region of manya. This matches with manyastambha mentioned as one among the eighty types of ‘vata nanatmaja rogas’.
2. Kapha Pradhana or Kaphavrita Vata Janya Manyastambha – This condition has been explained by Master Sushruta. In this condition, aggravated kapha blocks vata in the region of the manya and causes a regional ‘kaphavrita vata like condition’ in manya.
1. Manyastambha – a Vata Nanatmaja Vyadhi
Manyastambha is counted as one among the eighty types of vata nanatmaja vikaras i.e. specific vata disorders wherein no other dosha is involved in the pathogenesis. This also explains the role of vata in the causation of this disorder.
In this condition, aggravated vata gets lodged in the region of manya and causes stiffness, difficult movements, pain and other related symptoms. The causative factors of this condition are also the ‘vata aggravating’ ones. The interventions too will be targeted towards balancing vata.
2. Manyastambha – a Kaphavrita Vata condition
This is a variant of Manyastambha wherein aggravated kapha is also involved along with vata in the pathogenesis of the disease. Here the aggravated kapha blocks and envelopes vata. This is called as kaphavruta vata. This mechanism can happen anywhere in the body but when it happens in the manya region, it will cause manyastambha. Avarana is a vata disorder itself. But here the movements and functions of vata are hampered by kapha. The stiffness in this condition is caused by kapha. Restriction of movements and pain are caused by vata which has been blocked and trying to fight back to escape from the captivity.
Causes of Manyastambha
Below mentioned are the important causes of Manyastambha –
1. General Causative factors –
Any vata increasing, aggravating or triggering causative factors, including foods and lifestyle activities can cause or trigger manyastambha, when aggravated vata finds place and get lodged in the nape of the neck – manya. These causes can be considered as general causative factors of manyastambha.
Manyastambha caused by the below-mentioned specific causes may further be triggered or worsened by these general causative factors.
Keeping it short, generalized causative factors for vata aggravation are those which predominantly cause ‘vata nanatmaja type of manyastambha’ but may in later part of time get associated with kapha in those having kapha aggravation and might lead to avarana type of manyastambha, but not as a rule.
2. Specific Causative factors –
– Divaswapna – excessive sleeping during day time
– Asama sthana – sleeping on an uneven surface, in odd and untoward positions. It also includes uneven work places wherein one needs to work by compromising the position of the neck.
– Urdhwa nirikshanah – looking upwards / with upward gaze in excess
All these etiological factors involve abnormal positions of the neck, which on longer run can cause stiffness, pain and reduced movements at the neck – manyastambha.
These etiological factors clearly aggravate both kapha and vata. While diwaswapna aggravates kapha in excess, the other two factors are responsible for aggravation of vata.
So, these set of causative factors give rise to the type of manyastambha caused due to kaphavrita vata.
While there is no description of ‘manyastambha’ explained in the context of vata nanatmaja rogas and the causative factors mentioned above have been mentioned in the context of manyastambha involving kapha along with vata (kaphavrita vata) by Master Sushruta, these factors shall be considered as ‘specific causative factors for manyastambha’ while generalized causative factors as mentioned above are the ones which will cause the nanatmaja vata vyadhi – manyastambha.
Pathogenesis of Manyastambha
1. Vata Nanatmaja Type of Manyastambha
Due to excessive consumption of or exposure to vata aggravating etiological factors, the vata would abnormally increase in the body. When this vata gets localized in the manya region, it will cause stiffness, restriction of movements of the neck and pain. Vata causes this by drying of kapha, and tissues in the manya including sira, snayu, mamsa and kandara.
Excessive consumption of vata aggravating etiological factors
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Aggravation of vata
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Vata gets lodged in the manya – back of the neck
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Vata dries up kapha, sira, snayu, mamsa and kandara in the region of manya
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Stiffness, pain and restriction of movements of neck
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Vata Nanatmaja Manyastambha
2. Kaphavruta Vata Type of Manyastambha
Due to excessive consumption of / exposure to the above said etiological factors, vata and kapha would undergo imbalance. Mainly kapha would get severely aggravated. This kapha would cause avarana of vata i.e. the aggravated kapha envelopes vata and blocks (interferes) with its normal functioning. This can also be considered as a state of ‘kaphavruta vata’ occurring in the region of the neck.
Excessive consumption of / exposure to the etiological factors leading to excessive aggravation of kapha and partial imbalance of vata
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The doshas move towards manya – back of the neck / nape of the neck and get lodged therein
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Kapha envelops and blocks the vata
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The normal functioning of vata is disturbed
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There occurs pain and loss of movements and tilting of neck due to the affliction of nerves, muscles, tendons and soft tissues in the nape of the neck
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This condition is called as manyastambha / Kaphavrta Vata Janya Manyastambha
Though manyastambha is a vata disorder, this condition is caused by the blockage of functions of vata by the aggravated kapha. When blocked and surrounded by kapha, vata tries hard to escape from the zone of restriction and express itself. This struggle would cause the symptoms.
Since kapha is predominant in the combo causing this disease there is increased stiffness in the nape of the neck i.e. stambha. Stambha is a characteristic feature and symptom of aggravated kapha. Pain and other symptoms are caused by the enveloped vata. Restriction of movements, if any, is caused by the mechanism of blockage of vata by kapha.
Treatment Principles of Manyastambha
Vata Pradhana (Nanatmaja) Manyastambha – This condition should be treated on the lines of Vata Vyadhi Chikitsa – all measures and medicines prescribed for treatment of Vata predominant disorders.
The main interventions include –
External interventions –
– Abhyanga – Ksheerabala Taila, Prasarinyadi Taila, Mahanarayana Taila, Mahamasha Taila, Balashwagandha Taila – can be used for soothing massage
– Griva Vasti – oil pooling on the back of the neck
– Pinda Sweda – Patrapinda Sweda and Shashtika Shali Pinda Sweda are highly beneficial
– Lepa / Upanaha – Vata alleviating herbs may be used for anointment or poultice
Internal interventions –
– Nasya – errhines with Ksheerabala Taila, Mahamasha Taila
– Vasti – medicated enemas – in chronic / stubborn / chronic conditions – Ksheerabala Taila, Prasarinyadi Taila, Guggulutiktaka Ghrta – are beneficial for enemas.
Kapha Pradhana (Kaphavrita Vata) Manyastambha – This condition should be treated on the lines of ‘Avarana Chikitsa’. Avarana is a pathological event wherein pitta, kapha, any tissue or excreta or food would envelope and obstruct vata. Herein the normal movements and functions of vata will be hampered. One subtype of vata may be enveloped and blocked by another subtype of vata also. That which envelops and causes obstruction of vata is called avaraka, vata is called avruta and the entire event is called avarana. Avruta is constant – it is always vata or a subtype of vata.
In kaphavruta vata taking place in the region of manya leading to Manyastambha, kapha is avaraka and vata is avruta. As a rule of treating avarana, first the avruta should be treated and the vata should be freed.
So, the initial interventions in this condition will be to get rid of kapha and the obstruction to vata that it has caused. Later when vata gets freed, it is still aggressive and confused and erratic since it was trying an escape route all the time. This vata should now be calmed and be brought to a state of balance.
The interventions and treatment principles for this condition includes –
External interventions –
– Abhyanga – with kapha alleviating oils like Kottamchukkadi Taila or any oil which is prepared with kapha alleviating herbs
– Swedana – study should always be done after abhyanga / snehana. Here, ruksha sweda – dry sudation / fomentation is desired. Choorna Pinda Sweda is preferable in this condition. Kottamchukkadi Churna or Rasnadi Churna may be used for this purpose.
– Lepa / Upanaha – Kapha alleviating herbs may be used for anointment or poultice
Internal interventions
– Mrudu Vamana – mild emesis should be administered to expel morbid kapha if its aggravation is severe
– Nasya – Anu Taila shall be used for errhine
Vata management
Once the kapha avarana has been removed, the vata will be exposed. This vata should now be managed on the lines of ‘vata vyadhi chikitsa’ as per the principles of treatment mentioned above.
Beneficial formulations in Manyastambha
– Maharasnadi Kashayam
– Prasarinyadi Kashayam
– Rasonadi Kashayam
– Varanadi Kashayam
– Mahayogaraja Guggul
– Rasnadi Guggulu
– Balarishta
– Ashwagandharishta
– Guggulutiktakam Ghrta
