Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Context of Vilambika disorder
Vilambika is a gastrointestinal disorder. Vilambika has been explained in Sushruta Samhita Uttara Sthana Section, Chapter 56. Master Sushruta has quoted a verse of two lines describing this context in a chapter meant for detailed explanation of another digestive disorder Visuchika.
The same condition has also been explained in Madhava Nidana treatise in the context of (chapter of) Agnimadyadi Nidanam i.e. chapter dealing with Agnimandya – sluggish digestive fire and other diseases. Here too, the author has copy pasted the same references from Sushruta Samhita.
Relation to context
The condition called Vilambika has been explained along with Visuchika and Alasaka immediately after the explanation of agnimandya – low digestive fire, ajeerna – indigestion and types of ajeerna.
Master Sushruta says that the ama, vistabdha and vidagdha types of ajirna are responsible for manifestation of gastrointestinal disorders like Visuchika, Alasaka and Vilambika.
In short – Ajirna vis-à-vis indigestion is the foundation (cause) for vilambika and similar conditions.
Nidana: Causative factors
Vilambika is caused by Ajirna – indigestion. So, logically anything and everything which causes ajirna might cause Vilambika. All types of ajirna and all causes of all these types are also the causes of vilambika. The causes of vitiation of annavaha srotas – channels carrying / conveying food shall also be considered.
The causative factors of formation of ama also should be considered as causal of vilambika.
Samprapti: Pathogenesis
दुष्टं तु भुक्तं कफमारुताभ्यां प्रवर्तते नोर्ध्वमधश्च यस्य ।।
विलम्बिकां तां भृशदुश्चिकित्स्यामाचक्षते शास्त्रविदः पुराणाः ।। ९ ।।
Food getting vitiated by kapha and vāta, does not come out either from upward or from downward paths (and stays inside the abdomen for a long time). This disease, which is difficult to treat, is called by the ancient physicians as Vilambikā.
The consumed food comes into the stomach wherein there is abnormal increase of kapha and vata
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Kapha and Pitta would vitiate the consumed food by getting mixed with it
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The food contaminated by kapha and pitta neither moves upwards or downwards
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There occurs stagnation of food in the stomach
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Due to this stagnation and very slow movement (vilamba) of food, the condition is called as Vilambika
Lakshana: Symptoms
The main symptom of Vilambika is ‘the food not being able to move upwards or downwards and getting stagnated in the stomach’.
The below mentioned symptoms are not mentioned in the treatise but need to be assumed based on the nature of the disease.
– Ajirna – chronic indigestion will be another main complaint in the backdrop. All symptoms associated with indigestion of food will also be present in this condition.
– Generalized symptoms of kapha and vata aggravation may also be seen.
– Since the food is stagnated and not digested properly, ama is formed and the rasa is not formed. Since ahara rasa is not formed, the tissues are also not formed. This leads to depletion of tissues, low strength and immunity.
Srotas Affected & Mode of Affliction
We can see that the annavaha srotas – food conveying channels are mainly involved in this disease Vilambika. The srotodushti i.e. affliction of srotas will be of ‘sanga – obstruction’ type. The obstruction takes place in the amashaya – stomach and annavahi dhamanis i.e. oesophagus above and duodenum / small intestine below. Therefore, the food cannot move upwards or downwards. Amashaya and Annavahi Dhamanis are the roots of annavaha srotas.
The afflicted thing is ‘anna’ i.e. food. The doshas which would afflict the food are kapha and vata, as already mentioned.
Excessive consumption of the food, untimely consumption of food, consumption of unwholesome foods and disturbance or vitiation of agni – digestive fire located in the stomach and intestine are the chief causes of contamination / vitiation of annavaha srotas. The same are the causes of Vilambika.
Relationship with Alasaka
By description and pathogenesis, alasaka and vilambika appear to be the explanation of similar conditions. In both conditions, the food affected by kapha and vata neither moves upwards nor downwards. Then what is the difference between these two conditions?
In alasaka it is said that the food being afflicted by kapha and vata will get stagnated in the stomach like a shalya i.e. foreign body. Though there is no diarrhoea or vomiting, this condition is marked by severe pain in the abdomen. Thirst and belching are predominantly present.
The other symptoms of alasaka are distension of abdomen, fainting, sounds from abdomen, upward movement of vata, and obstruction of faeces and fart / flatus.
The difference between these two conditions is that Alasaka is an acute condition whereas Vilambika appears like a chronic manifestation and a progressive state of Alasaka.
Master Sushruta has specified that vilambika is very much difficult to treat whereas bad prognosis has not been mentioned in the context of alasaka.
Master Charaka has not mentioned Vilambika. He has mentioned more dreadful and incurable state of alasaka as Dandalasaka. Charaka’s Dandalasaka can be said to be a similar condition as that of Sushruta’s Vilambika.
Relation to Vidagdhajirna
This condition vilambika is said to develop from a state of probably a chronic indigestion and compromised stomach and gastrointestinal tract caused due to predominant vitiation of pitta which probably has caused severe inflammation and damage in the intestinal tract i.e. vidagdhajirana.
Prognosis of Vilambika
The word ‘dushchikitsyam’ in the description of Vilambika indicates that it is very difficult to treat vilambika and hence carries a bad prognosis.
Immediately after explaining vilambika, Master Sushruta Samhita gives two more immediate verses and they seem to be applicable to vilambika. They are –
यत्रस्थमामं विरुजेत्तमेव देशं विशेषेण विकारजातैः ।।
दोषेण येनावततं स्वलिङ्गैस्तं लक्षयेदामसमुद्भवैश्च ।। १० ।।
This explains ‘the place in the body wherein there is ama will give rise to pain and that place itself should be considered as a seat of origin of diseases caused by doshas. This shall be determined by the presence of symptoms of ama at that place.’ This verse is actually applicable for all conditions arising from ama and also to vilambika.
This also shows the presence of ama in vilambika and the reason it might be a painful condition.
यः श्यावदन्तौष्ठनखोऽल्पसंज्ञश्छर्घर्दितोऽभ्यन्तरयातनेत्रः ।।
क्षामस्वरः सर्वविमुक्तसन्धिर्यायान्नरः सोऽपुनरागमाय ।।११।।
The patient of vilambika walks away never to return (i.e. he dies) if he has the below mentioned signs (and symptoms) associated with the disease –
– Shyava danta oshta nakha – bluish discoloration of teeth (gums), lips and nails
– Alpa Sanjna – has only little consciousness
– Chardi – severe vomiting,
– Abhyantara yata netrah – sunken eyes (eyes gone deep inside the sockets)
– Kshama svarah – has developed feeble voice
– Sarva vimukta sandhi – looseness / laxity of all the joints of the body
These signs show severe deficit of oxygen, hydration and nutrition to the cells and development of severe cyanosis which might lead to death.
These signs of bad prognosis may also be applicable for visuchika and alasaka explained by Master Sushruta in the same context, but the bad prognosis itself has not been mentioned in the description of these conditions.
So, by default they are applicable only for vilambika. It also makes sense because they are explained immediately after the description of vilambika.
Treatment Principles of Vilambika
We can see that Master Sushruta has not explained the treatment of Vilambika, and neither does other treatises. This clearly explains that the acharyas had seriously regarded this condition as incurable. So, it is important to see that this problem does not develop.
Below mentioned are the important precautions to be taken so as to keep vilambika away from manifesting.
Preventive measures –
– Avoiding the etiological factors which could cause agnimandya
– Avoiding the etiological factors of pitta aggravation
– Avoiding the etiological factors which would cause ajirna, mainly vidagdhajirna
– Avoiding the etiological factors of ama
– Avoiding the etiological factors of contamination and vitiation of annavaha srotas – channels of transportation of foods and liquids and purishavaha srotas – channels responsible for formation and expulsion of faeces – in total, the gastrointestinal tract including stomach, small intestines and colon
Curative measures – Since vilambika cannot be cured, it is important to cure the ajirna and ama in its backdrop promptly. The below mentioned principles shall be considered –
– Prompt and timely treatment of agnimandya
– Promptly keeping pitta in a state of balance always
– Prompt and timely treatment of ajirna, mainly vidagdhajirna
– Prompt and timely treatment of ama – ama pachana measures
– Prompt and timely treatment of annavaha and purishavaha sroto dushti
– Prompt treatment of other gastrointnestinal diseases like atisara, grahani, pravahika, anaha, adhmana, alasaka etc
Also, the below mentioned are also the key factors which should be considered –
– Following the principles laid by Ayurveda towards taking of healthy and timely foods hitting qualitative and quantitative balance, as per the body’s needs applying the mind and senses i.e. conscious eating habits, like following ahara vidhi vishesha ayatana principles.
– Knowing the right and wrong diets for oneself in consultation with Ayurveda or diet specialists and preparing a customized dietetic protocol which would suit oneself.
– Following disciplined etiquettes as related to food consumption.
– Keeping a check on gastrointestinal health, importantly on chronic and stubborn subtleties like loss of appetite, aversion from food, indigestion, constipation, flatulence, dyspepsia, distension of abdomen, noises from abdomen, changed patterns of appetite or bowel evacuation etc and taking quick opinions and seeking quick remedies for the same.
– Keeping well hydrated, taking balanced foods, following proper bowel habits, following time of eating foods and sleep
– Keeping away from undue stress and making peace with food.
– Properly following the dinacharya and rutucharya as explained in Ayurveda.
