A Systemic Review on Chittodvega and its Management

[Find the meaning and references behind the names: Raja, Chitta, Class, Vata, Scholar, Send, Ram, Joshi, Manas, Mind, Show, Harish, Citta, Data, Gad, Kishor, Back, Tama, Agrawal, Due, Mob, Pitta, Author, Strong, Roga, Edge, Jan, Common]

Volume- 3, Issue- 1 IRJAY 1 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 Abstract- Chittodvega is manas roga and develops due to vitiation of raja and tama along with vata and pitta. It can be defined as a chitta (mind) + udvega (anxiety) i.e. „Anxious status of a mind”. It can be correlated with generalized anxiety disorder on the basis of etymology of chittodvega, type of psychological disorder and symptomology. Generalized anxiety disorder (GAD) is a chronic anxiety disorder and characterized by persistent, excessive, and/or unrealistic worry associated with muscle tension, impaired concentration, autonomic arousal, feeling "on edge" or restless, and insomnia. As any separate description of chittodvega is not clearly mentioned in Ayurvedic classics so common etiological factors i.e. asatmyendriyarthasamyoga, pragyaparadha and parinama Volume- 3, Issue- 1 Review Article A Systemic Review on Chittodvega and its Management Dr. Shriti Agrawal * Dr. Harish Bhakuni 1 Prof. Ram Kishor Joshi 2 * M.D.Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Email id shriti 2490@gmail.com, Mob No. 8318737642. 1 Assistant Professor, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur. 2 H.O.D. and Professor, Department of Kayachikitsa , National Institute of Ayurveda, Jaipur . Article received on- 2 Jan. Article send to reviewer- 3 Jan. Article send back to author- 5 Jan. Article again received after correction- 13 jan. Corresponding author - Dr. Shriti Agrawal, M.D.Scholar, Department of Kayachikitsa, Email id shriti 2490@gmail.com

[Find the meaning and references behind the names: Buddhi, Dosha, Modern, Human, Divine, Life, Speedy, Body, Long, Deals, Present, Memory, Ayu, Development, Main, Salvation, Sleep, Under, Seat, Knowledge, Study, Good, Mental]

Volume- 3, Issue- 1 IRJAY 2 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 can be considered as nidana of chittodvega . Poorvarupa of unmada can be considered as the lakshana of chittodvega which are shirah shoonyata , udvega, dhyana , hridgraha, ayasa, unmattchittatvam, which is similar to excessive anxiety and worry, restlessness, being easily fatigued, difficulty in concentration, irritability, sleep disturbance etc found in GAD.Clinical trials have shown that anxiolytic drugs alone have limited long-term efficacy. Moreover, they often have adverse side effects including dependency, drowsiness, impaired cognition and memory and sexual dysfunction. The treatment procedure described are daivavyapasraya (divine therapy), yuktivyapasraya ( rational therapy) and sattvavajaya (mental therapy) etc. So the present study deals with systemic review of chittodvega from all the classics of Ayurveda and its management. KEYWORDS- Chittodvega , Generalized anxiety disorder (GAD), Poorvarupa , Unmada, Lakshana. INTRODUCTION With the advancement in modern science, human life becomes very speedy and more stressful. So psychiatric disorders are broadening its sphere today, out of which anxiety disorders are most common. Manas is very important in Ayurveda as it is an essential component of ayu , tridanda , process of knowledge, site for disease development, good health and salvation. The main seat of manas is hridaya and it performs its function by moving in whole body through srotas along with vata , pitta and kapha . Raja and tama are two manasika doshas which vitiates the hridaya , the seat of buddhi and then obstruct the manovaha srotas and produce various types of psychological disorders like chittodvega etc. A group of psychiatric disorders described in Ayurveda under the heading of unmada , strikingly resembles with psychosis. “ Chittodvega ” as it is not mentioned in classics, but it is described as a prodormal symptom of unmada. Various texts have also described many terms related to mental status i.e. chittavibhramsha 1 (mental decadence), chittavibhrama 2 (mental perturbation), anavasthita chitta 3 (unstable mind), chittaviparyaya 4 (misapprehension of mind), unmatchitta 5 (furoreous mind), etc. Chittodvega can be defined as a Chitta (mind) + Udvega (anxiety) i.e. „Anxious status of a mind”. Chittodvega is manas roga and develops due to vitiation of raja and tama along with vata and pitta. It includes symptoms like shirah shoonyata , udvega, dhyana , hridgraha, ayasa, unmattchittatvam, which is similar to excessive anxiety and worry, restlessness, being easily fatigued, difficulty in concentration, irritability, sleep disturbance etc found in GAD. Chittodvega seems to be nearest term for anxiety disorders on the basis of etymology , type of psychological

[Find the meaning and references behind the names: Four, India, Fix, Care, Chosen, Kta, Urban, Males, Cure, Acharya, Cit, Steady, Root, Lack, Age, Vin, State, Fear, Chit, Factor, Line, Veda, Need]

Volume- 3, Issue- 1 IRJAY 3 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 disorder and symptomology described by Acharya Caraka. Generalized anxiety disorder (GAD) is a chronic anxiety disorder characterized by persistent, excessive, and/or unrealistic worry associated with muscle tension, impaired concentration, autonomic arousal, feeling "on edge" or restless, and insomnia. Among the anxiety disorders, GAD is one of the most common anxiety disorders in late life, with a prevalence of 7% in the community 6 In India, the overall weighted prevalence of GAD was 0.6% for current experience and also the rates for females (0.8 %) were higher as compared to those for males (0.4%). Similarly, the rates for the 40-49 age group(0.8 %) and the rates for urban metro residents (1.3%) were higher as compared to their respective counterparts 7 The Ayurvedic approach toward the treatment of chittodvega is the need of our as no system is successful in providing the complete cure to this disease, so chittodvega is a challenging and a burning problem of medical science. Due to wide spectrum of disease, much prevalence in the society and lack of effective medicine, the disease had been chosen for the study. HISTORICAL REVIEW Many descriptions about mental disorders and their treatment are available in four vedas and in charaka , sushruta and vagbhatta samhita . But there is no any separate description of chittodvega is clearly mentioned in Ayurvedic classics. However It has been described as poorvarupa of unmanda. So the anxious state of mind or chittodvega can be considered as a separate disorder or symptom of other medical and psychological disorders. ETYMOLOGY The term chittodvega comprises of two words i.e. chitta and udvega . Chitta is derived from root “ chit ” which means: to perceive, fix the mind upon, attend to, intend, to be anxious about, care for, to resolve, to understand, comprehend, know, make attentive, remind of 8 Addition of “ kta ” Pratyaya to chit i.e. Cit + Kta leads to Chitta , which means observed, perceived, considered, reflected or meditated upon, resolved, intended, wished, desired, visible, perceptible 9 Simiarly udvega is derived from root “ Ud ” which means: upwards, upon, anxiety, liberation 8 Addition of “ Vin ” Pratyaya to “ Ud ” i.e. Ud + Vin leads to Udvega , which means: steady, composed, tranquil ,agitation, anxiety, regret, fear, distress, astonishment 10 DEFINITION Chittodvega is a manas roga and develops due to vitiation of raja and tama along with vata and pitta. It can be defined as – chitta (mind) + udvega (anxiety) i..e. chittodvega (anxious state of mind). NIDANA Nidana is most important as the avoidance of etiological factor forms the first and foremost line of treatment. There is no separate description of chittodvega is mentioned in Ayurvedic classics so as the

[Find the meaning and references behind the names: Moha, Harsha, Man, Wisdom, Dhi, Malina, Kama, Basic, Ever, Senses, Tamas, Pragya, Smriti, Bhaya, Rajas, Chinta, Living, Non, Wrong, General]

Volume- 3, Issue- 1 IRJAY 4 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 nidana of it. But in general for all manasika vikaras basic pathogenic factors are rajas & tamas The factors which vitiates these two can be considered as nidana of chittodvega . In general, common etiological factors of all sharirika & manasika rogas 11 has been stated as followsa) Asatmyendriyarthasamyoga (deficient, excessive or perverted use of senses) Indriyartha samyoga are the cognitive processes through which a man becomes aware of both external and internal environment. Sensory perceptions which are not congenial with sensory organs called asatmendriyarthasamyoga i.e. unwholesome contact with the objects may be in the form of atiyoga (excessive or overutilization), ayoga (hypo utilization or non-utilization) and mithyayoga (non-judicial or wrong utilization). In present conditions, human beings are living in the state of ever increasing stressful situations leads to imbalance of sharirika and manasika doshas causing psychological disorders like anxiety disorder. b) Pragyaparadha (volitional transgression) The discrimination and judgment capacity of human is related to wisdom, intelligence or understanding which is known as pragya . An action carried out with non-justifiable understanding due to dhivibramsa (impairment of intellect), dhritivibramsa (impairment of will) and smritivibramsa (impairment of memory) is termed as pragyaparadha 12 . Chart No. 1 Dhi Dhriti Smriti (Intellect) (Will) (Memory) Vibhramsha (Impaired) Visamavigyanam [Improper perception] Visamapravartanam [improper action] * Vegadharanam *Not follow good deeds described in Sadvritta * ManasikaNidanas - Kama,Krodha,Bhaya,Lobha,Harsha,Chinta,Udvega,Moha,Ayasa etc * Aharaja Nidanas- Virudha ahara,Dushta ahara,Asuchi ahara,Malina ahara. DISEASE

[Find the meaning and references behind the names: Stage, Force, Vegas, Vega, Time, Six, Shoka, Part, Anger, Person, Plays, Play, Given, Role, Kala, Lust]

Volume- 3, Issue- 1 IRJAY 5 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 c) Parinama (deficient, excessive or perverted incidence of seasons) Affections resulted by influences of seasonal variation called parinama . Acharya Caraka has explained advent of maturity of the time ( kala ) 13 and it is considered as the causative factor for mental disorders Various descriptions are given in the classical texts describing the affect of parinama which are as follows:  Acharya Chakrapani states that the presence of chronic physical illness may also cause manas roga and even one manasroga may cause another manasroga in its bhedavastha or chronicity.  Relation of various manas bhava like kama (passion), shoka (grief), bhaya (fear) etc. have their effect on vata , krodha has its effect on pitta 14  All sharirika and manasikarogas occur due to initiation of the controllable vegas ( dharaniyavegas ) like kama (lust), krodha (anger) , udvega (exhaustion) and suppression of the adharaniya vegas (urges which should not be suppressed) 15 The etiological factors show their influence according to the individual‟s personality and the circumstances. SAMPRAPTI In Ayurvedic methodology, samprapti is most important part in defining a disease. Since there is no direct explanation of samprapti of chittodvega in Ayurvedic texts, although it is included under manovikara . So considering above knowledge about manas , samprapti of chittodvega may be traced out by considering the general principles and multifactorial causative factor of manovikara. Therefore with the available literature an attempt has been made to explain samprapti of chittodvega through shadvidha kriyakala (six occasions for treatment) 16 1. Sanchayavastha (stage of accumulation of dosha ) There are several predisposing factors that play an important role in person‟s vulnerability to chittodvega e.g vatika and pattika sharirika prakriti ; rajasika manas prakriti individual and persons with avara satva appear to be more frequently vulnerable to mental disorder and also the attitude and behavior of expectant mother reflects on emotional status of the offspring etc. Due to these factors the person exhibits an exaggerated response to emotional disturbance disposing factors indulges in pragyaparadha or asatmendriarthasamyoga or in under stress, it initiates the disease process by resulting in imbalance of manodoshas - rajas . 2. Prakopavastha (stage of aggravation of dosha ) If sanchayavastha i.e. imbalance of the manodoshas is not encountered with treatment and nidana is continued the disease lands in the next stage that is prakopavastha of chittodvega . Among the two manasika doshas , rajas plays an important role as it is the driving force behind all emotions. At this stage psychic symptoms like chinta (anxiety), bhaya (fear) , krodha (grief)and shoka (anger) may develop. 3. Prasaravastha (stage of expansion of dosha )

[Find the meaning and references behind the names: Start, Pain, Major, Agni, Kampa, Table, Rupa, Shiro]

Volume- 3, Issue- 1 IRJAY 6 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 When these psychic symptoms continue for a longer time and override the limit they start influencing the sharirika doshas predominantly vata gets vitiated as it is controller of mind and produces symptoms mainly related to aggravation of it. Sadhaka pitta also declines due to depletion of satva resulting in the symptoms such as excitement, fear, anger, confusion etc and derangement of tarpaka kapha results in undernourishment of indriyas (senses). 4. Sthanasamshrayavastha (stage of localization of dosha ) The vitiated manodosha and sharirika doshas vitiates hridaya which ultimately vitiate manas due to ashraya - ashrayi bhava and if persists for longer period results in ojokshaya. Also vitiated vatadi doshas vitiate jatharagni which results vitiation in dhatu and their strotas resulting in the psychosomatic presentation of the disease, which can be considered as the sthanasamshrayavastha of chittodvega . 5. Vyaktavastha (stage of manifestation of disease) When multiple dhatus and their strotas are involved and the disease is expressed clearly, the disease enters into the stage of vyaktavastha . All psychosomatic symptoms like excessive thoughts, sleep disturbance, abdominal pain, difficulties in concentration etc occur in this stage. 6. Bhedavastha (chronicity) When the disease is not treated properly or promptly and the causative factors continue, attains chronicity becomes krichrasadhya leading to major psychiatric illness like unmada (insanity). Table No. 1 Samprapti ghataka (substance for pathogenesis) of Chittodvega Dosha Manas - Rajas, Tamas ( Specially Rajas) Sharira - Vata, Pitta ( Specially Vata) Dushya Manas,Sarvadhatu Srotas Manovaha Srotas( Specifically ), Sarvastrotodushti Agni Jatharagni, Dhatvagni Udbhavasthaana Manas(Hridaya) Adhisthaana Hridaya(Shiro-hridaya) Vyaktisthaana Manas,Sarvasharira Rupa Udvega, Bhaya, Kampa, Atisweda etc Rogamarga Madhyam Sadhyasadhyata Kriccha Sadhya Upadrava Unmadadi Manovikara, Sarva Shariravikara

[Find the meaning and references behind the names: Manasa, Blank, Mere, Mild, Mano, Eyes, Heart, Flow]

Volume- 3, Issue- 1 IRJAY 7 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 Flow Chart of Manifestations: Chart No.2 Asatmyendriyarthasamyoga Pragyaparadha Parinama Vitiation of Sharirika Dosha Vitiation of Manasika Dosha ( Mainly Vata Pitta ) ( Raja & Tama) Mild Vitiation of the seat of intellect ( Hridaya ) Mano Dushti Agni Vikriti Rasadi Dhatu Vikriti Manovaha Srotodushti Sarva Srotodushti Manasa Lakshana Uttapatti Sharira Lakshana Uttapatti LAKSHANA There is no separate description of chittodvega . So the poorvarupa of unmada 17 can be considered as the lakshana of chittodvega which are as follows- Shirahshoonyata - Mind becoming blank Chakshushorakulta - Dilatation of eyes Ucchawasasyadhikyam -Increased respiration Udvega - Palpitation Dhyana - Apprehension Hridgraha - Feeling of tightness in heart region Unmattchittatvam - Inability to concentrate Anannabhilasa - Anorexia Sammoha - Illusion Swanokarnayo - Tinnitus Avipaka - Impaired digestion CHIKITSA Mental health is not mere absence of mental illness. Good mental health is the Nidana Sevana Chittodvega

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Volume- 3, Issue- 1 IRJAY 8 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 ability to respond to the experience of life with flexibility and a sense of purpose. Preventive measures: Ayurveda believes that prevention of diseases is better than cure hence following measures described in classics as follows: 1. Sadvritta (Good conduct) 18 : According to Ancient texts , on practicing of sadvritta , the satvaguna prevails over rajas and tamas , thus preserves good mental health. Acharya Caraka has prescribed a long list of good conduct e.g. should not be impatient or over exhilarated, do things at right time and should devoted to knowledge, charity, friendship, compassion, cheerfulness, indifference and calmness etc. 2. Achara Rasayana (Moral and Behavioral conduct) 19 : Acharya Caraka stated a schedule of good conduct to be followed by the man for longevity, immunity and promotion of mental health which is called the achara rasayana e.g. satya vadinam (truthful), akrodha (free from anger), ahimsaka (do not indulge in violence) etc. It is claimed that the practicing of achara rasayana yields in an individual all benefits of rasayana , may it be biological or psychological. 3. Dharaniya vega vidharana (Urges which should be controlled) 20 : Dharaniya vegas such as lobha (greed) , shoka (grief) , bhaya (fear) etc . must be restrained as they induce a variety of mental conflicts at the level of individual psyche causing mental ill health of the individual besides their untoward impact on the society including the family and relatives. Curative measures : Chittodvega can be treated on the basis of these three basic modalities of treatment 21 which are as follows- 1. Daivavyapashrayachikitsa (Divine therapy): It deals with methods of treatment such as mantra , mani , mangala, bali , upahara etc. It creates confidence in the patients by removing the fear and negative tendencies indirectly helping the person in gathering confidence and help in the management of manovikara . 2. Yuktivypashrayachikitsa (Rational therapy): It deals with uses of ahara , vihara and aushadha to cure the disease. Importance of ahara (dietetic regimen) and vihara (behavioral regimen) : Food has a direct and intimate connection with the mind and plays a vital part in the make-up of the mind e.g. satvic diet calms the mind; excessive intake of pungent, spicy, sour, hot, dry etc. food items increase rajas manas dosha which excites the mind; cold tasteless, foul smelling, leftover food increase tamasa manas dosha etc. Vihara like vishamachesta i.e. abnormal motor activities like abnormal posture, excessive exercise and violation of good conduct can also be considered as the etiological factors of manas roga . Aaushadha Chikitsa (management through drug) : There are two types of yuktivyapashraya chikitsa :

[Find the meaning and references behind the names: New, Work, Nasya, Laid, Fruit, Maha, Brahmi, Rasa, Gram, Bahi, Wheat, Patience, Fixed, Basti, Cow, Green, Milk, Samana, White]

Volume- 3, Issue- 1 IRJAY 9 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 1.Antah Parimarjana Chikitsa: It can be further classified as: a) Shodhana: It includes virechana , brihmana basti , brihmana nasya. b) Shamana: It includes the following: TABLE No. 2 Ekmoolika Prayoga Shankhapushpi , brahmi , yastimadhu , mandukparni , jatamansi , ashwagandha , amalaki , guduchi Ghrita Prayoga Brahmi ghrita, maha kalyanaka ghrita, maha paishachika ghrita, lahsunadya ghrita, kushmanda ghrita. Rasyana Prayoga Brahmi rasayana . Rasousdhi Smritisagara rasa, krishnachaturbhuja rasa. Arishta Ashwagandharishta, sarasvatarishta. Panak Shankhapushpi Panak 2.Bahi Parimarjana Chikitsa: It can be further classified as: a) Abhyanga: Mahnarayna taila b) Swedana Chikitsa: Nadisweda, Vashpasweda c) Shirodhara: Kshiradhara with Godugdha, Tailadhara with Brahmi taila, ksheerbala taila. In chittodvega both sharirika and manasika doshas are vitiated. Shodhana (purificatory) measures are advocated to do the cleansing of the vitiated dosha and removes avarana of manas dosha . When the shodhana is properly done, shamana and rasayana therapies are suggested. 3)Satvavajaya Chikitsa (Mental therapy) 22 : It contains spiritual and scriptural knowledge, patience, memory and meditation so it is specified for the management of mental disorder. The line of treatment of mental diseases is based on the theory of normalizing the manasika doshas . Acharya Caraka defines sattvavajaya as a „mind control therapy‟ in which stress has been laid on restraining the mind from unwholesome arthas (subjects of senses). PATHYA AND APATHYA Following pathya and apathya should be followed to prevent and cure chittodvega : Pathya :- Ahara – Wheat, green gram, cow milk, shatadhouta ghrita , old and new ghrita , old white kushmanda fruit, brahmi leaves, grapes etc. Vihara – Meditation, fixed sleeping time (only in night), God worship, proper programming of any work etc. Apathya :- Ahara – Alcohol, oily and spicy food etc.

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Volume- 3, Issue- 1 IRJAY 10 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 Vihara – Suppress the urges of thrust, hunger, sleep etc, day sleeps etc. REFERENCES 1 Paradkar HS, editor. Astanga Hridaya of Vagbhatta with Sarvangasundra commentary of Arunadatta & Ayurvedarasayana of Hemadri, Nidana Sthana. Ch.05, Ver. 49, 6 th ed., Varansi: Chaukhambha Surbharati Prakashan;2014. pp.483. 2 Shivprasad Sharma, editor. Astanga Samgraha of Vriddha Vagbhatta with Sasilekha Sanskrit commentary of Indu, Nidana Sthana. Ch. 06, Ver. 15, 3 rd ed., Varanasi:Chaukhambha Krushnadasa academy; 2012. PP.380 3 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Sutra Sthana. Ch. 20, Ver.11, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.113 4 Acharya jadavaji Trikamaji, editor. Sushruta Samhita of Sushruta with Nibandhsangraha Commentry of Dalhana Acharya,, Uttaratantra. 3 rd ed., Ch.57, Ver.3. Varanasi: Chaukhambha Surbharati Prakashan; 2014. pp-764 5 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Nidana Sthana. Ch. 07, Ver.6, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.223 6 Beekman, A .T., B remmer, M. A., Deeg, D. J., et al. ( 1998 ). Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. International Journal of Geriatric Psychiatry ,13 , 717 –726 7 Generalized Anxiety Disorder, National Institute of Mental Health and Neuro Sciences Bengaluru, National Mental Health Survey of India, 2015-2016 8 Sir Monier Monier –Williams (1956), A sanskrit-english dictionary, 3 rd ed., The university press Oxford, Pp-395 9 P.K. Gode & CG Karv (1958), Sanskrit English dictionary-part II, Prasa Prakashana Puna, pp-707 10 P.K. Gode & CG Karv (1957), Sanskrit English dictionary-part I, Prasa Prakashana Puna, pp-417 11 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Vimana Sthana. Ch. 06, Ver.06, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.258 12 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Sharira Sthana. Ch. 01, Ver.102, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.297 13 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Sutra Sthana. Ch.11, Ver.42, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.76 14 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Chikitsa Sthana. Ch. 03, Ver.115, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.407

Volume- 3, Issue- 1 IRJAY 11 IRJAY, vol- 3, issue-1, Jan.:2020; 1-11 15 Shivprasad Sharma, editor. Astanga Samgraha of Vriddha Vagbhatta with Sasilekha Sanskrit commentary of Indu, Sutrasthana. Ch. 04, Ver. 21, 3 rd ed., Varanasi:Chaukhambha Krushnadasa academy; 2012. PP.56 16 Acharya jadavaji Trikamaji, N M Acharya, editor. Sushruta Samhita of Sushruta with Nibandhsangraha Commentry of Dalhana Acharya , Sutrasthana. 3 rd ed., Ch.21, Ver.37. Varanasi: Chaukhambha Surbharati Prakashan; 2014. pp-106 17 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Nidana Sthana. Ch. 07, Ver.04, Reprint edition. Varanasi:Chaukhambha Prakashan;2011 18 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Sutra Sthana. Ch. 08,Ver.17, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.58 19 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Chikitsa Sthana. Ch. 01/4,Ver.30-35, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.58 20 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Sutra sthana. Ch. 07/,Ver.26, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.50 21 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Sutra sthana. Ch. 11/,Ver.26, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.77 Acharya Jadavji Trikamji, editor. Charak Samhita of Agnivesha with Ayurveda Dipika commentary of Chakrapanidatta, Sutra sthana. Ch. 11/,Ver.54, Reprint edition. Varanasi:Chaukhambha Prakashan;2011. pp.7

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