URUSTAMBHA

URUSTAMBHA 

• Urustambha is a vatakaphaja nanatmaja vyadhi characterized by stiffness and heaviness of thighs.

• It is described in Charaka Samhita Chikitsa Sthana 28 under Vatavyadhi Chikitsa.

• Often compared with Poliomyositis, Myopathy, or Myositis in modern medicine due to muscular involvement.

NIDANA (ETIOLOGY)

• Use of guru (heavy), snigdha (unctuous), sheeta (cold), kapha-vardhaka ahara and vihaara.

• Avyayama (lack of exercise), divaswapna (day-sleep), and srotorodha (obstruction of channels) also play a role.

🔹 श्लोकः
गुरूणि स्निग्धमधुराण्यभिष्यन्दि च यानि च।
नित्यं सेवेत तैः स्नेहं कृत्वा दिवासुप्तिमाचरेत्॥
(Charaka Samhita, Chikitsa Sthana 28/18)

SAMPRAPTI (PATHOGENESIS)

• Due to kapha-vardhaka nidana, kapha dosha increases and accumulates in uru pradesha (thigh region).

• Simultaneously, vata dosha gets vitiated due to obstruction (avarana).

• Leads to sanga (stasis) in srotas and results in stambha (stiffness), gourava (heaviness) of thighs.

🔹 श्लोकः
वातस्य प्रवणो मार्गः कफेनाभिहतो दृढम्।
यत्र स्यात्तत्र रूक्षत्वं स्रोतसां चापि संगता॥
(Charaka Samhita, Chikitsa Sthana 28/20)

SAMPRAPTI VIGHATANA (BREAKING THE PATHOGENESIS)

• Aim is to remove kapha avarana, normalize vata dosha, and reopen obstructed srotas.

• Strategy includes:

  • Langhana (lightening therapy)

  • Swedana (sudation)

  • Virechana (purgation)

  • Snehana in later stages

  • Vatahara and Kaphahara chikitsa

CHIKITSA SUTRA (PRINCIPLES OF TREATMENT)

• Kaphavatahara chikitsa is the key principle.

• Urdhwa shodhana via vamana is avoided due to sthana of disease.

• Focus is on Deepana-Pachana, Ruksha-Upakrama, Swedana, Snehana, Basti karma, Shamana aushadhis.

🔹 श्लोकः
रूक्षं स्वेदं विरेकं च स्नेहं बस्तिं च योजयेत्।
सन्धिस्थं चातिवृद्धं च कफं वातमपि स्यात्॥
(Charaka Samhita, Chikitsa Sthana 28/34)

CHIKITSA (TREATMENT APPROACH)

1. PURVA KARMA

• Deepana-Pachana with Trikatu churna, Hingvashtaka churna.

• Langhana – upavasa or laghu bhojana in initial kapha dominance.

• Ruksha swedana – using valuka sweda (sand fomentation) to remove kapha.

2. PRADHANA KARMA

• Virechana with Trivrit Lehya or Abhayadi Modaka.

• Niruha Basti with Dashamoola Kwatha + honey + rock salt + gomutra.

• Anuvasana Basti with Eranda taila or Ksheerabala taila.

3. PASCHAT KARMA

• Samsarjana Krama after virechana.

• Dietary restrictions with kapha-vata pacifying ahara.

4. SHAMANA CHIKITSA

• Dashamoola Kwatha, Rasna Saptaka Kwatha.

• Guggulu preparations like Yogaraja Guggulu, Kaishora Guggulu.

• Eranda taila internally for vata-kapha anulomana.

• Guduchi, Haritaki, Shunthi, Pippali for Deepana and Rukshana.

IMPORTANT YOGA FORMULATIONS

• Eranda Sneha + Dashamoola

• Rasna Panchaka + Shunthi + Guggulu

• Shamana Yoga: Trayodashanga Guggulu

PATHYAPATHYA (DIET AND LIFESTYLE GUIDELINES)

Pathya:

• Light, warm, digestible food

• Kulatha yusha, Yava, Mudga

• Regular mild exercise, Abhyanga

Apathya:

• Heavy, oily, cold, sweet food

• Day sleeping, sedentary lifestyle

PROGNOSIS (SAADHYA-ASADHYA VICHAR)

• Saadhya in early stages with proper chikitsa

• Krichra sadhya or asadhya in chronic, progressive cases with muscle wasting

MODERN CORRELATION

• Polymyositis, dermatomyositis, chronic inflammatory myopathies may resemble Urustambha due to:

  • Muscle stiffness

  • Weakness in proximal limbs (thighs)

  • Difficulty in walking, climbing

Clinical Findings:

• Muscle tenderness

• Elevated CPK (creatine phosphokinase)

• EMG abnormalities

Modern Management:

• Corticosteroids (Prednisolone)

• Immunosuppressive drugs (Azathioprine, Methotrexate)

• Physiotherapy

• High-protein diet

DIFFERENTIAL DIAGNOSIS

• Sciatica

• Rheumatoid arthritis (in proximal large joints)

• Muscular dystrophy

• Hypothyroid myopathy

IMPORTANT REFERENCES

• Charaka Samhita – Chikitsa Sthana 28

• Ashtanga Hridaya – Nidana and Chikitsa Sthana

• Susruta Samhita – Chikitsa Sthana

• Davidson’s Principles and Practice of Medicine (Myopathies chapter)

• Harrison’s Internal Medicine (Neuromuscular disorders)