The Ayurveda Experience Blog
The word ‘urustambha’ consists of two words ‘uru‘ and ‘stambha‘. Uru means thighs and stambha means cramping or spasticity. This condition causes pain in the thighs or calves among other symptoms. Let’s look at Ayurvedic remedies and treatments for thigh and calf pain (urustambha).
In the classical Ayurvedic medical text Charaka Samhita’s 27th chapter – Chikitsa Sthana, the treatment modalities for ‘urustambha‘ are mentioned extensively.
An important aspect of this condition is that it is contraindicated with panchakarma procedures. Before, discussing the possible treatments and remedies in detail, let us briefly discuss the following.
- Nidana (etiology) and Samprapti (pathology) of Urustambha
- Warning Signs and Symptoms
- Signs and Symptoms of the Condition
- Clinical Correlation with Western Medicine
- Why Panchakarma is Contraindicated in Urustambha
- Line of Treatment as per Ayurveda Principles
- Evidence-Based Ayurveda/Research Studies on the Condition
Etiology And Pathology Of Urustambha
Causative Factors – Food
According to Ayurveda, the stiffness or spasticity in the thighs/calves occurs due to the consumption of food before the previous meal has been digested properly.
It is also associated with the consumption of unctuous, light, dry, liquid form, cold and stale food.
Frequent consumption of yogurt and other dairy products like milk, meat of animals residing in marshy lands, meat of aquatic animals, and fermented food and alcohol can also lead to urustambha.
Causative Factors – Lifestyle Habits
In addition to improper dietary patterns mentioned above, lifestyle habits like daytime sleeping, staying awake at night, improper fasting, excessive fear or emotional outbreaks, and suppression of natural urges also cause thigh or calf pain associated with urustambha.
The causative factors described above result in the accumulation of ama (metabolic waste/toxins) which gets associated with the medo dhathu (fat tissue) and obstruct the movement of Vata in the body.
This Vata gets accumulated in the thigh region and due to the involvement of morbid fat tissue and vitiated Kapha, it spreads further to the lower limbs including calf muscles causing involuntary spasms and immobility. (Reference 9 Cha.Chik 27/8-11)
Warning Signs And Symptoms
The renowned Ayurvedic scholar Charaka mentioned a list of symptoms as purvarupa (warning signs) to look out for.
- Fixed gaze.
- Excessive sleep.
- Fever
- Loss of taste.
- Vomiting
- Horripilation (goosebumps)
- Pain and heaviness in thighs.
He also mentioned that if urustambha is mistaken for an aggravated Vata condition and abhyanga is administered, it can cause numbness of thighs and difficulty lifting the legs.
Signs And Symptoms Of Urustambha
- Fatigued calf muscles and thighs.
- Constant pain associated with burning sensations.
- Insensitivity to cold touch.
- Lack of control over lower limbs.
- Severe pain when feet are kept on the ground.
If the condition is recent, Ayurvedic treatments can treat it. However, it is believed to be incurable in chronic conditions associated with burning sensation, pain and tremors.
Clinical Correlation With Western medicine
Till date, there is no clear understanding of urustambha and its clinical significance in western medicine. Urustambha is essentially a lifestyle disorder and is commonly seen in higher socioeconomic sections of the population.
Urustambha samprapti (pathology) resembles that of atherogenesis. Diva swapna (daytime sleep) and raatri jaagarana (staying awake at night) as explained in urustambha’s pathology may indicate conditions like obstructive sleep apnea (OSA).
The clinical presentation of urustambha may be unilateral or bilateral or even both. Charaka’s version of urustambha indicates a vascular pathology like aortoiliac occlusion with an underlying metabolic syndrome.
Sushruta’s version of urustambha indicates an inflammatory pathology of the spinal cord like acute transverse myelitis or inflammatory myelopathy or infectious myelitis.
Principles of urustambha are also applicable for the prevention and management of conditions like atherosclerosis, multiple sclerosis, OSA, aortoiliac occlusion, diabetes mellitus, obesity, cardiovascular pathology, acute myelopathy, and other ischemic and inflammatory spinal diseases.1
Ayurvedic Treatments For Urustambha
There is a predominance of Kapha dosha associated with ama (toxins/metabolic waste) in urustambha.
Therefore, treatments for the condition should also be aimed at the extraction and drying up of the liquid fraction of the vitiated doshas and ama.
In accordance with the line of treatment for urustambha, kshapana and shoshana (complete extraction and absorption of the liquid fraction) are to be done.
All the therapeutic measures which pacify Kapha but do not aggravate Vata should be employed for the treatment of urustambha taking into consideration the agni (digestive fire) and bala (strength) of the patient.
How to bring the aggravated doshas into equilibrium through food and drinks?
Include – yava (barley), syamaka (millet), cooked vegetables without salt, bitter vegetables, neem, and Cassia fistula.
Also, the administration of alkaline and medicated wines along with haritaki (Terminalia chebula).
Baluka sweda is a rooksha (dry) type of swedana. It is used in the dominance of Kapha and ama (undigested metabolites) in the body. A prior oil massage is not carried out in this type of fomentation.
This procedure includes the application of heated bolus (poultice) of sand on the body part where fomentation is required. This type of fomentation quickly reduces the Kapha and digests the ama.
Udwarthana (Ayurvedic powder massage) is indicated in urustambha as the avarodha (obstruction) due to Kapha gets cleared and there is an increase in the bhrajaka Pitta.
This leads to the destruction of Vata, vilayana of Kapha and medha. Other internal medicines include the following.
Trailokyachintamani: It is vatakaphaghna, means pacifies Kapha and Vata. Being ushna (hot) and teekshna (pungent), it vilayana (melts) and chedana (scrapes) Kapha and helps normalize the movement of Vata.
This results in better control of vyana vayu in the movements of peshi (muscles) and kandara (ligaments). It also removes the accumulated Kapha in sira (blood vessels), which is the important event in the samprapti of urustambha.
It is also agnideepana (improves digestive fire), hridya (good for the heart), sadyah ojaskara (immproves ojas), balya (improves strength), protects indriyas (sense organs) and prana and is vishaghna (removes toxins).2
Samangadi Yoga: Herbs like samanga, shalmali and bilva along with honey should be administered.
Why Is Panchakarma Contraindicated For Urustambha?
Snehana (oleation therapy) and vasti karma (medicated enema) always aggravate Kapha.
Virechana karma (therapeutic purgation) is also effective in pacifying the localized Kapha located in its own place whereas Pitta can be easily pacified by vamana.
Both Kapha and Pitta located in the amashaya (intestines) can be eliminated by virechana (therapeutic purgation). When located in pakvashaya (umbrella term for organs that are present below the umbilicus), all the three doshas can be rooted out by basti karma.
However, when associated with ama (toxins) and meda (fat tissue), especially when located in the thighs, it is impossible to eliminate with panchakarma procedures.5
Evidence-Based Ayurveda/Research Studies On Urustambha
CASE A: A 20-year-old girl suddenly developed kriyahaniand supti (loss of movements and sensations) in both legs. She was diagnosed with acute transverse myelopathy and Brown sequard syndrome with a demyelinating process at India’s Goa medical college hospital.
No improvements were observed with steroid treatment. She was then diagnosed with urustambha as per the Ayurvedic perspective.
Her treatment included Ayurvedic drugs like trailokyachintamani , suvarnasameerapannaga, and navajeevana rasa with which her movements and sensations were restored.3
CASE B: A known case of transverse myelitis was showing signs and symptoms of urustambha, as well as other Kapha-dominance symptoms.
Therefore, as per Charaka Samhita, rookshana karma (dehydrating therapy) was selected as the choice of treatment for this individual.
In the next step, vachadi yoga – consisting of equal amounts of self-prepared powders of vacha (Acorus calamus), devadaru (Cedrus deodara), pippali (Piper longum), gajapippali (Scindapsus officinalis), haritaki (Terminalia chebula), and katuki (Picrorhiza kurroa) were given in a dose of 3 grams twice a day along with honey.
Besides these medicines, kaishora guggulu in a dose of two tablets soaked in water and two tablets of chandraprabha vati along with water were started twice a day as oral medicine were also given.
All the Kapha vardhaka aahara–vihara (diet and regimen aggravating Kapha) were restricted and yava (barley) along with karvellaka (bitter gourd) were added to the diet. With this treatment, the patient started responding well.
By understanding the concept of urustamba, the disease can be easily treated by removing the avarana (obstructions).
Within 10 days the patient was able to move all the fingers of the left foot. The treatment continued as such and on the 15th day of treatment, the patient was able to dorsiflex his left foot.
On the 18th day, he was able to flex his left knee. After 2-3 days, his right foot also started moving. On the 34th day from date of admission, the patient successfully raised his hip on his feet in lying position.
He was advised with some physiotherapy and exercises afterward .4 By understanding the concept of urustamba, the disease can be easily treated by removing the avarana (obstructions).
Simultaneously, the progression of the disease into asadhya avastha or incurable state can also be prevented. Hence, it is necessary to understand the concept of urustamba for better diagnosis and management.6
Consult a qualified Ayurvedic practitioner before undergoing the procedures or trying the herbs and remedies mentioned in this article.
References
- Mamidi, Prasad & Gupta, Kshama. (2017). “Urustambha” – Aortoiliac occlusion with Metabolic syndrome?. International Journal of Green Pharmacy. 11. S 49 – S 61. 10.22377/ijgp.v11i01.873.
- Rasatantrasara Siddhaprayoga Sangraha, Swami Krishnanandji, Krishnagopal Ayurved Bhavan, Kaleda Ajmer, 1990, Vol.1, Pg.
- A CASE STUDY. Prof. Vd. Upendra Dixit M. JSAP Vol 1 May 2014
- Jindal, N., Shamkuwar, M. K., & Berry, S. (2012). Importance of Rookshana Karma (dehydrating therapy) in the management of transverse myelitis. Ayu, 33(3), 402–405. doi:10.4103/0974-8520.108852
- Sharma RK, Dash B, Urustambha Chikitsa, Caraka Samhita of Agnivesa based on Cakrapani Datta’s Ayurveda Dipika ed. Varanasi: Chaukhambha, reprinted, 2009.Vol.5.Verse -20-24.p.7.
- Dr. Akhil Sharma, Dr. A. S. Prashanth, Dr. S. G. Chavan. Role of Avarana in the etiopathogenesis of Urustambha. J Ayurveda Integr Med Sci 2018;4:91-95.
