Unit 31. Sāmānya Cikitsā of Śiroroga

Unit 31. Śiroroga—Sāmānya Cikitsā

(Sūryāvarta, Anantavāta, Ardhāvabhedaka; Uttamāṅgatva, Pathya–Apathya, General Treatment)

A) Sūryāvarta, Anantavāta, Ardhāvabhedaka (with migraine differentials)

1) Sūryāvarta — Definition, Features, Management

Classical marker (Aṣṭāṅgahṛdaya, Uttaratantra 23/18–20):
“पित्तानुबद्धः शङ्खाक्षि–भ्रूललाटेषु मारुतः,
रुजं सस्पन्दनां कुर्याद् अनुसूर्योदय–उदयाम्।
आ मध्याह्नं विवर्धिष्णुः क्षुद्वतः सा विशेषतः,
अव्यवस्थितशीतोष्णसुखा शान्त्यतः परम्।
सूर्यावर्तः स इत्युक्तः …”

Gist for study: Pain begins after sunrise, throbs around śaṅkha–akṣi–bhrū–lalāṭa, peaks near midday, worsens with hunger, and settles with cooling and stable temperature.

Sāmānya Cikitsā (doṣa-guided):

• Ārambha (acute phase): quiet/dark room; śīta-pichu on forehead/temples; gentle bandhana to damp pulsations.
• Pitta-śamana: tikta–madhura–śīta regimen; śatadhouta-ghṛta lepa; internal ghṛta judiciously; mṛdu-virecana when pitta–rakta signs are clear.
• Nasya: Prātimarśa with ghṛta/śītala taila between attacks; avoid strong nasya during burning phase.
• Pathya: drākṣā, dhātrī (āmalakī), dhānyaka-jīraka-jala, laja-māṇḍa; regular meals (avoid fasting).
• Apathya: intense sun/heat, dehydration, amla–lavaṇa–kaṭu diet, alcohol, late nights.
• ICHD-3 differential: Often aligns with migraine without aura; distinguish from sinusitis (purulent discharge, bend-forward pain) and from TACs (short attacks with autonomic signs).

2) Anantavāta — Clinical Idea, Features, Management

(Vāta-pradhāna cervico-temporo-orbital radiation; texts describe pain arising at manyā/ghaṭā (nape/neck) radiating to śaṅkha–akṣi/kapola, sometimes with jaw/eye dysfunction.)

Vāta pain phenotype (A.H. Uttara 23/3–7 excerpts):
“… निस्तुद्येते भृशं शङ्खौ, घाटा संविद्यते तथा;
भ्रुवोर्मध्यं ललाटं च पततीवाति वेदनम्।
… घूर्णतीव शिरः सर्वं … स्फुरत्यति सिराजालम् …
… प्रकाशासहता …
… मार्दवं मर्दन–स्नेह–स्वेद–बन्धैश्च जायते।”

Gist: Pricking/splitting pain with temporal focus, neck involvement, photophobia, vascular throbbing; mardana–sneha–sveda–bandha give relief.

Sāmānya Cikitsā:

• Vāta-śamana: mūrdhni-taila, mild abhyanga–svedana, uṣṇa-pichu to nape/temple; warm, unctuous diet; regular sleep.
• If kapha āvaraṇa (stuffiness/heaviness): prior dīpana-pācana, gentle śiro-dhūma, steam inhalation; then prātimarśa nasya.
• If pitta association (burn/blood shot eyes): prefer śīta-upakrama; avoid strong heat/svedana.
• Ergonomics: avoid prolonged downward gaze; micro-breaks; cervical mobility; light mārdava over jaw/temple.
• Differential (ICHD-3): Cervicogenic headache, occipital neuralgia, TMJ dysfunction, ocular causes; compared with migraine, aura and severe nausea may be less prominent, posture-trigger is clearer.

3) Ardhāvabhedaka — Definition, Features, Management (Migraine-like)

Classical definition (A.H. Uttara 23/7–8):
“अर्धे तु मूर्ध्नः सोऽर्धावभेदकः; पक्षात् कुप्यति,
मासाद्वा स्वयमेव च शाम्यति;
अतिवृद्धस्तु नयनं श्रवणं वा विनाशयेत्।”

Gist: Recurrent hemicrania with periodicity (pakṣika cycles), severe splitting pain; chronic severe cases may impair eye/ear functions.

Sāmānya Cikitsā:

• If āmā signs (nausea, coated tongue): start with dīpana-pācana (śuṇṭhī–pippalī–marica, jīraka) before heavy snehana.
• During attack: quiet/dark room; śīta (pitta) or uṣṇa (vāta/kapha) pichu; gentle head bandhana; minimal aromatics.
• Interictal: Prātimarśa nasya (ghṛta-yukta or vāta-pitta śāmaka taila) morning/evening; sleep regularisation; hydration.
• Śodhana (selected): mṛdu-virecana in pitta-rakta dominance; vamana only after pācana in clear kapha-utkleśa (chronic rhino-sinus patterns).
• Rasāyana: medhya-ghṛta yogas (brahmī, śaṅkhapuṣpī), gentle mindfulness/breathwork.
• ICHD-3 differential grid:
  • Migraine (± aura): unilateral, throbbing, moderate–severe, aggravated by activity, nausea/photophobia.
  • Tension-type: bilateral, pressing/tightening, no nausea, not aggravated by activity.
  • TACs: shorter, circadian clusters with autonomic signs (lacrimation, nasal congestion).
  • Red flags: first/worst thunderclap, fever/neck stiffness, focal deficit, age >50 new onset—require urgent referral.

B) Śirasaḥ Uttamāṅgatvam, Pathya–Apathya & Sāmānya Cikitsā of Śiroroga

1) Śirasaḥ Uttamāṅgatvam & Nasya-mukhyatā

Nasya principle (A.H. Sūtrasthāna 20/1):
“नासा हि शिरसः द्वारं तेन तद्भेषजं हितम्।”
Meaning: The nose is the doorway to the head; hence medicines delivered through the nose are beneficial for ūrdhvajatru-gata disorders.

Implication: In most śirorogas, correctly chosen nasya (especially prātimarśa) between attacks is foundational.

2) Pathya–Apathya (General Regimen)

Hetu-avoidance (A.H. Uttara 23/1–3):
“धूमातपतुषाराम्बु-क्रीडातिस्वप्नजागरैः,
उत्स्वेदाधिपुरोवात-बाष्पनिग्रह-रोदनैः।
अत्यम्बुमद्यपानेन कृमिभिर्वेगधारणैः,
उपधानमृजाभ्यङ्ग-द्वेषादधः-प्रतिक्षणैः।
असात्म्यगन्ध-दुष्टामभोज्याद्यैश्च शिरोगताः
जनयन्त्यामयान् दोषाः …”

Pathya (doṣa-wise):

• Vāta-pradhāna: warm, lightly unctuous foods (godhūma, mūg-yūṣa with ghṛta); regular meals; warm water sips; gentle mūrdhni-taila; early sleep.
• Pitta-pradhāna: śīta-prāya diet (drākṣā, dhātrī, godhūma, laja-māṇḍa); avoid sun/heat; cool compress when needed.
• Kapha-pradhāna: uṣṇa-laghu meals (yava, mudga), dīpana-pācana spices (trikaṭu, ajamodā), morning steam inhalation if stuffy.

Apathya: alcohol, amla-lavaṇa-kaṭu overloads, day sleep (kapha), night vigil (vāta-pitta), head-wetting in cold wind, prolonged screen-glare, tight headgear during attacks.

3) Sāmānya Cikitsā — Staged Plan

(i) Nidāna-parivarjana: Strictly remove A.H. 23/1–3 hetus above.

(ii) Āma-pācana (when indicated): laghu dīpana-pācana; do not begin with heavy snehana if āmā is clear.

(iii) Doṣa-śamana & Śiras-mukha Upakrama:

• Vātaja trends (relief cues supported in A.H. 23/7):
  “… मर्दन–स्नेह–स्वेद–बन्धैश्च …”
  Gentle abhyanga–svedana, bandhana, warm mūrdhni-taila, prātimarśa nasya with vāta-hara taila/ghṛta.
• Pittaja trends (A.H. 23/9):
  “… स्वेदोऽक्षिदहनं मूर्च्छा, निशि शीतैश्च मार्दवम्।”
  Śīta-upakrama, śatadhouta-ghṛta lepa, mṛdu-virecana in pitta–rakta dominance; protect eyes from glare.
• Kaphaja trends (A.H. 23/10–11):
  “अरुचिः कफजे मूर्ध्नो गुरु-स्तिमित-शीतता … तन्द्रा …”
  Uṣṇa-sveda, dīpana-pācana, śiro-dhūma, nasya with kaṭu-tikta-uṣṇa dravyas; vamana in selected chronic sinus-kapha states post-pācana.

(iv) Śodhana (selected, patient-centric): mṛdu-virecana (pitta), vamana (kapha chronicity) after proper preparation; raktamokṣa in raktānubandha where appropriate and supervised.

(v) Rasāyana & Satvavajaya: medhya-ghṛta (brahmī/śaṅkhapuṣpī), hydration & sleep discipline, mild breath-work; graded physical activity avoiding triggers.

4) Prognostic Hints within Cikitsā Planning

• Sukha-sādhya: mono-doṣa, recent onset, good bala, quick upaśaya.
• Kṛcchra/Yāpya: tridoṣa, chronic recurrence, sinus-kapha background, ardhāvabhedaka with frequent bouts.
• Guarded: śaṅkhaka (rapid, prāṇāntika if neglected), kṛmija with deep tissue involvement, raktānubandha with ocular danger.

(For śaṅkhaka emergency colour, A.H. U. 23/16–17 describes rapid decline if untreated for three nights.)

Assessment

Long Essay (10 marks — attempt any 1)

1. Write Sāmānya Cikitsā of Śiroroga including Nasya-mukhyatā, staged plan (āma-pācana → doṣa-śamana → śodhana), and Pathya–Apathya. Substantiate with A.H. S. 20/1 and A.H. U. 23/1–3, 7, 9–11.
2. Discuss Ardhāvabhedaka under definition (with A.H. U. 23/7–8), lakṣaṇa, cikitsā during attack vs interictal, and ICHD-3 differentials with red-flag list.

Short Essays (5 marks — attempt any 3)

1. Sūryāvarta: quote A.H. U. 23/18–20; write triggers and pitta-śamana measures.
2. Anantavāta: pain pathway, vāta-śamana tools, ergonomics, and differentials.
3. Explain “नासा हि शिरसः द्वारं”—applications of prātimarśa nasya.
4. Doṣa-wise Pathya–Apathya for recurrent head pain.

Short Answers (2 marks — attempt any 6)

• Two hetus from A.H. U. 23/1–3 to avoid.
• One vāta relief line from A.H. U. 23/7 (any phrase).
• One pitta relief cue from A.H. U. 23/9.
• Two kapha features from A.H. U. 23/10–11.
• Define Sūryāvarta in one line with its midday pattern.
• Name two red flags warranting urgent referral.

MCQs (10 × 1)

1. “अनुसूर्योदय–उदयाम् … आ मध्याह्नं विवर्धिष्णुः” describes:
   a) Anantavāta b) Sūryāvarta c) Ardhāvabhedaka d) TAC
2. “नासा हि शिरसः द्वारं …” supports:
   a) Vamana b) Virecana c) Nasya d) Raktamokṣa
3. Vāta relief specifically praised in A.H. 23/7:
   a) Tikta-ghṛta b) Mardana–Sneha–Sveda–Bandha c) Divā-svapna d) Ati-vyāyāma
4. Kapha phenotype per A.H. 23/10–11 includes:
   a) Photophobia b) Gurutā, Tandrā c) Burning d) Mania
5. Ardhāvabhedaka periodicity term:
   a) Nitya b) Pakṣika c) Varṣika d) Sāptāhika
6. Migraine vs TTH: nausea/photophobia typical of:
   a) Migraine b) TTH c) Cluster d) Neuralgia
7. First-line in kapha-āvaraṇa before nasya:
   a) Heavy snehapāna b) Dīpana-pācana c) Śīta-lepa d) Day sleep
8. Red flag requiring referral:
   a) Hunger b) Focal neurologic deficit c) Photophobia d) Mild nausea
9. Interictal scheduling best for prātimarśa nasya:
   a) During emesis b) High fever c) Daily morning/evening d) Thunderclap onset
10. Pitta–rakta dominance cleansing:
    a) Mṛdu-virecana b) Vamana c) Basti only d) Rasāyana alone

Answer key: 1-b, 2-c, 3-b, 4-b, 5-b, 6-a, 7-b, 8-b, 9-c, 10-a.

End of Unit 31.