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parasympathetic impulses are at peak level, the reflex center of the spinal cord ... ischiocavernosus and bulbocavernosus muscles that compress the bases of ...
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A critical review of Apana Vayu in modern perspective Pritam Moharana1, Neha Rawat2, Rakesh Roushan3* P.G Scholar, P.G Department of Kriya Sharir, CBPACS, New Delhi, India 1 P.G Scholar, P.G Department of Kriya Sharir, CBPACS, New Delhi, India 2 Assistant Professor, P.G Department of Kriya Sharir, CBPACS, New Delhi, India 3*

Abstract:

Human need is infinite. As time increases, demand and needs of human also increases. Their first and foremost need is to live a long life. It is possible when we have a healthy lifestyle. Ayurveda a traditional Indian system of medicine, main aim is to maintain the health of healthy and cure the disease of diseased. That’s why people all around the world are looking towards India since ancient times. In Ayurveda health is a state where the dosha, agni, dhaatu, mala, all the physiological process are in homeostatic state and soul, sense organ and mind are in a state of total wellbeing. Vata dosha is the most important among Tridosha which is responsible to control all type of movements. After the digestion of food by agni with the help of samana vayu, aahara is converted into saara and kitta portion. Kitta portion of food is eliminated by apana vayu with the harmonization of other Prana and Vyana vayu. Apana vayu is located in pakvadhana and traversed though sroni (pelvis), basti (urinary bladder), medhra (external genital apparatus of each sex) and uru (thighs). It helps in elimination samirana (flatus), sakrit (faeces), mutra (urine), sukra (semen), garbha (fetus), artava (menstrual fluid). All the functions of Apana vayu can be compared with contemporary modern medical science. Very few works have been accomplished on conceptual features of vata. In this article an attempt has been made to correlate the physiological activity of Apana vayu with modern medical science. For this study, the basic materials have been collected from the Ayurvedic classics with the available commentaries, as well as text books of contemporary modern medical science have been referred for better understanding of the concept and its comparison with contemporary science. Key words: Apana vayu, Prana Vayu, Saman Vayu, Vyana vayu. Introduction:

Ayurveda, the science of life is based on the fundamental theory called the tridosha theory. The tridosha is derived from the Sanskrit word tri and dosha that means three pollutant or vitiated factors. These pollutant factors play a significant role in maintenance of health or well being and disease or illness. These three doshas do their function at various levels such as cellular, single system, organization level. Out of these three doshas, vata has the supremacy of all these three doshas as it initiate and control all the functions. It is also responsible for all type of movement 1. Pitta, Kapha, all dhatus and malas are inactive like lame individual. It becomes mobile when vata becomes active. The active vata carried them away from its location just like the clouds being carried away by the wind 2. Vata dosha is the controller and impellor of all mental functions, and the employer of all sensory 897

Received: 8 August Revised: 15 August Accepted: 20 August Index in Cosmos

September 2018 Volume 8 Number 9 UGC Approved Journal

International journal of basic and applied research

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faculties. Vata joins the body tissues and brings compactness to the body, promotes speech, origin of sound and touch sensation. Vata dosha is the root cause of auditory and tactile sense faculties, Vata is the causative factor of pleasure and courage, stimulates the digestive fire, and helps in the absorption of the dośhas and ejection of the excretory products. Vata travels through all gross and subtle channels, gives the shape of embryo and is the indicator of continuity of life 3. Vata dosha has been divided into five types namely prana, udana, samana, vyana, apana. Among these apana vata has an important role in expulsion of samirana (flatus), sakrit (faeces), mutra (urine), sukra (semen), garbha (fetus), artava (menstrual fluid). It performs its function by the help of other three vayu. They do these functions by proper coordination and cooperation. It cannot be represented by one structure at all the time. Ayurveda is the science based on the concept of functional understanding. There is no specific correlation of Apana vayu mentioned any ancient literature. It seems to be a problem found in student life, particularly first year of Bachelor of Ayurvedic Medicine and Surgery to understand about the concept of Apana vayu. Increased demand of Ayurveda science in the present society is required to understand the depth of Ayurvedic principles on criterion of modern medical science in an easy mode. In this review we are trying to identify anatomical structures based on its physiological functions retrospectively described under the function of Apana vayu. Site and Functions Of Apana Vayu By Different Acharya:

Sthana (Location)

Karma (Function)

898

Charak Samhita4

Sushrut Samhita5

Astanga Hridaya6

Vrishana (testicles), Vasti (urinary bladder), Medhra (penis), Nabhi(umbilicus), Uru (thighs), Vakshyana (inguinal region) and Guda(anus) Ejaculation, Micturition, defecation, expulsion of menstrual blood and fetus.

Pakvadhana (Large intestine)

apana desha (perineal region) and it traverses along sroni (pelvis), vasti (urinary bladder), medhra (external genital apparatus of each sex) and uru (thighs)

Elimination samirana (flatus), sakrit (faeces), mutra (urine), sukra (semen), garbha (fetus), artava (menstrual fluid)

Expulsion of sukra (semen), artava (menstrual blood), sakrit (faeces), mutra (urine), and garbha (the product of conception that is fetus and placenta)

Received: 8 August Revised: 15 August Accepted: 20 August Index in Cosmos

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Astanga Sangraha7 Rectum, moves along the urinary bladder, pelvis, penis, scrotum, and groin

Elimination of faeces, urine, semen, menstrual fluid and foetus

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Modern Aspects: Sukra Niskramana: Erection and ejaculation is the culmination of male sexual act. Sukra niskraman means the ejaculation of semen. Penile erection is the first effect of male sexual stimulation. It is caused by parasympathetic impulses that pass from sacral region of spinal cord through pelvic nerve to penis. Ejaculation is the end result of the male sexual act. When the sexual stimulus becomes extremely intense means parasympathetic impulses are at peak level, the reflex center of the spinal cord emit sympathetic impulses that leave the cord at T12 to L2 and pass to the genital organs through the hypogastric and pelvic sympathetic nerve plexuses to initiate emission. Emission begins with contraction of vas deferens and the ampulla to cause expulsion of sperms into the internal urethra. Contraction of prostate gland and seminal vesicles expels prostatic and seminal fluid into the urethra. All these fluid is mixed in internal urethra with mucus to form semen. After the filling of semen in internal urethra it elicits sensory signals that are transmitted through pudendal nerve to the sacral region of the spinal cord. These sensory signals also excite rhythmic contraction of internal genital organs and cause ischiocavernosus and bulbocavernosus muscles that compress the bases of penile erectile tissue. These effects together cause increase in pressure in both erectile tissue of penis, genital ducts and urethra. It causes ejaculation of semen to exterior8. Mutra Niskramana: It means act of micturition. Micturition reflex is initiated by stretch reflex. When bladder begins to fill urine at higher pressure, sensory stretch receptors in the bladder wall are stimulated and send signals to the sacral segment of cord through pelvic nerve. Then it reflexively back again to bladder through motor parasympathetic nerve fibers to causes micturition. It involves coordination between central, autonomic and somatic nervous system. Micturition reflex is an autonomic spinal cord reflex but it can be inhibited and facilitated by centers in the brain. It includes pons and several centers in cerebral cortex. The smooth muscle of bladder (detrusor) and trigone are innervated by both sympathetic nerve fibers from the lumbar spinal cord and parasympathetic fibers from the sacral spinal cord. Stimulation of sympathetic fiber causes contraction of trigone and relaxation of detrusor muscle. Stimulation of parasympathetic fiber causes contraction of detrusor muscle and relaxation of trigone. Urethral sphincter is innervated by somatic pudendal nerve. These nerves coordinative help in micturition9. Mala Niskramana: It means act of defecation. When a mass movement forces feces into rectum, desire for defecation occurs immediately. Two type of reflex is seen. One is an intrinsic reflex which is mediated by local ENS in the rectal wall. When feces enter into the rectum, there is distention of rectal wall. Sensory signals are initiated through myentric plexus and causes peristalsis from descending colon to sigmoid and rectum. These waves cause the relaxation of internal sphincter. At the same time if the external anal sphincter is open defecation occurs. The other defecation reflex is initiated by 899

Received: 8 August Revised: 15 August Accepted: 20 August Index in Cosmos

September 2018 Volume 8 Number 9 UGC Approved Journal

International journal of basic and applied research

www.pragatipublication.com ISSN 2249-3352 (P) 2278-0505 (E) Cosmos Impact Factor-5.86

parasympathetic nervous system. After entering of fecal matter into the rectum, the nerve endings in the rectum are stimulated then signal transmitted to the spinal cord through afferent nerve fiber. Reflex signal via pelvic nerve goes to descending colon, sigmoid and rectum. These parasympathetic signals travel in the pelvic nerve and greatly intensify peristalsis and relax the internal anal sphincter. At the same time if external anal sphincter is voluntarily relaxed defecation occurs. Sympathetic fibers from the superior rectal and hypogastric plexuses stimulate and maintain the internal anal sphincter contraction. External anal sphincter is innervated by somatic pudendal nerve 10. Artava Niskramana: It means the menstruation. The cyclic events that take place during the reproductive period of a woman’s life is called menstrual cycle. After ovulation if fertilization occurs the ovum becomes zygote and it gets implanted on the uterine wall leading to pregnancy. If the ovum is not fertilized two days before the onset of sexual cycle bleeding starts because of sudden reduction in the release of estrogen and progesterone from ovary. Decreased level of these two hormones causes sudden involution of endometrium of the uterus. It leads to reduction in the thickness of endometrium up to 65 % of original thickness. During the next 24 hours the tortuous blood vessels in the endometrium undergo severe constriction. It is due to three reasons. 1. The involution of endometrium 2. The action of vasoconstrictor substance like prostaglandin released from tissues of involved endometrium. 3. Sudden lack of estrogen and progesterone. The vasoconstriction leads to hypoxia which results in necrosis of endometrium. Due to necrosis, the blood vessels of endometrium start rupturing and blood oozes out. The outer layer of the necrotic endometrium is separated and passes out along with blood. The process is continued for about 24-36 hour. Within 48 hours after the reduction in the estrogen and progesterone, the superficial layers of endometrium are completely desquamated. The desquamated tissues and the blood in the endometrial cavity initiate the contraction of uterus. Uterine contractions expel the blood along with desquamated uterine tissues to the exterior through vagina11. Garbha Nishkramana: The term Garbha nishkramana is meant for parturition which means birth of baby. In the end of pregnancy the uterus develops strong rhythmic contraction that the baby is expelled. There are two factors that cause uterine contraction. A. Hormonal factor B. Mechanical factor. Increased estrogen to progesterone ratio towards the end of the pregnancy is partly responsible for the increased contractility of the uterus. Stimulation of paraventricular nuclei of hypothalamus causes neurohypophysis to secrete oxytocin hormone which causes uterine contraction. The fetus’s pituitary 900

Received: 8 August Revised: 15 August Accepted: 20 August Index in Cosmos

September 2018 Volume 8 Number 9 UGC Approved Journal

International journal of basic and applied research

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gland secretes oxytocin which plays an important role in uterine excitation. Fetus’s adrenal gland secretes large quantity of cortisol which helps in stimulation of uterus. Fetal membrane release prostaglandin which increases intensity of uterine contraction. Stretching of smooth muscle organs increases their contractility. Intermittent stretch due to fetal movement can also elicit smooth muscle contraction. Stretching or irritation of the nerves in the uterine cervix initiate reflex to the body of uterus which causes uterine contraction. Uterine contraction becomes stronger toward the end of pregnancy. It causes stretching of the cervix and later forces the baby through the birth canal causing parturition. After birth of the baby for about 10-45 minutes the uterus continues to contract to a smaller size which causes removal of placenta from the walls of the uterus thus causing separation of placenta from its implantation site12. Samirana Niskramana: It means expulsion of flatus through anus. Flatus can enter the gastrointestinal tract from three sources: 1. Swallowed air 2. Gases formed in the gut as a result of bacterial action. 3. Gases that diffuse from the blood into gastrointestinal tract. Colon bacilli the bacteria are present in the absorbing colon. Average 7-10 lit of gases are entering in the large intestine each day whereas average 0.6 lit are expelled through anus. The remainder is absorbed through intestinal mucosa to blood and expelled through lungs. Due to bacterial activity vitamin k, vitamin B12, thiamine, riboflavin, and various gases like carbon dioxide, hydrogen gas, methane that contribute to flatus are produced13. Excess expulsion of gas results from irritation of the large intestine, which promotes rapid peristaltic expulsion of gases through anus before they can be absorbed. Due to the gastrointestinal motility flatus is eliminated through anus. This gastrointestinal motility is functioning by the help of myentric plexus which is stimulated greatly by sympathetic and parasympathetic nervous system14. The actual odor in the flatus is due to presence of gases like indole, skatole, mercaptans, and hydrogen sulphide. Discussion:

Ejaculation is followed by erection. It is the distal second set of male sexual act, which is achieved by the sympathetic discharge from thoraco-lumbar outflow after intense parasympathetic action. Sukra niskramana is one of the functions of apan vayu and this function is under the control of synchronized action of both para-sympathetic and sympathetic action. Parasympathetic stimulation causes erection of genital organ and sympathetic stimulation causes ejaculation. Without erection, ejaculation is not possible. During intense sexual stimulation means at the peak level of parasympathetic stimulation, sympathetic stimulation begins to discharge sympathetic outflow and outflow is terminated after ejaculation. So, mainly sympathetic part of autonomic nervous system is responsible for ejaculation and may be compared with the function of apana vayu. Artava niskramana is one of the functions of Apana Vayu. Artava niskramana or menstruation occurs due to decreased level of estrogen and progesterone. Involution of corpus luteum ceases the secretions of estrogen and progesterone. Decreased level of hormones prevents the stimulation of endometrial cells cause reduction of endometrial thickness and leads to severe constriction in 901

Received: 8 August Revised: 15 August Accepted: 20 August Index in Cosmos

September 2018 Volume 8 Number 9 UGC Approved Journal

International journal of basic and applied research

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endometrial vessels. Prostaglandin helps in constriction of vessels of endometrium. Uterine contraction is executed by Vyana vayu. Artava niskramana function of apana vayu may be compared with the decreased secretion of estrogen and progesterone due to involution of corpus luteum. The desquamated tissue and the blood in endometrial cavity are expelled out by the gravitational force. Mutra niskramana and Sakrit niskramana like functions are performed by the collaboration of Samana vayu, Prana vayu, Vyana vayu and Apana Vayu. Mutra and Mala are separated by Samana Vayu and excreted out by the coordinative function of Prana (pontine centre for micturition), Vyana (autonomic functions of vyana vayu) and Apana Vayu (parasympathetic action originated from sacral origin). The sensory information for micturition, is sent to brain stem and cortex through ascending tract which is the function of vayu (sarvendrinaamudhyojaka and sarvendriyarthaambhivodha). Vyana Vayu performs its function by the contraction of muscle for the movement of waste material and finally Apana Vayu eliminates the feces, urine. Micturition and defecation reflex is performed by central integrating center in the sacral spinal cord. Influence of higher center like brain stem and cortex can be considered as the function of prana vayu. Parasympathetic action from sacral region may be compared with Mutra niskramana and Sakrit niskramana functions of apana vayu. Parturition is performed by the coordinative function of Prana, Vyana, and Apana vayu. Oxytocin hormone which is secreted from posterior pituitary is under the control of Prana vayu which causes contraction of uterus. This contraction of uterus is executed by Vyana Vayu. When the estrogen to progesterone ratio is increased towards the end of pregnancy Apana Vayu executes its function and helps in elimination of fetus and placenta. Oxytocine and increased estrogen to progesterone ratio during last trimester may be compared with the function of apana vayu. About 7-10 litres of gases are formed in 24 hours and about 600 ml of flatus elimination is carried out by Apana vayu with coordination of Samana and Vyana Vayu. Rest of the gases is absorbed. It is performed by gastrointestinal motility which is the coordinative function Samana and Vyana Vayu. Excess of gas causes irritation of the large intestine which promotes rapid peristaltic expulsion of gases. The gastrointestinal motility is caused by contraction of muscle under the influence of myentric plexus. The contraction and relaxation of muscle is executed by Vyana Vayu. Flatus elimination is coordinatively performed by Apana, Prana, Samana and Vyana Vayu. Irritation of large intestine and stimulation of myentric plexus may be compared with the Samiran niskramana function of apana vayu. Conclusion:

Vata dosha is involved in all type of systemic activity. Among five vata doshas, apana vayu is responsible for eliminations of waste products as well as fetus. Excretion is the process by which all the waste products are eliminated. It is very important in our life as it helps to promote homeostasis. These functions are regulated mainly by apana vayu with the coordination of samana, prana and vyana vayu. It can be concluded that apana vata may be correlated with sympathetic part of autonomic nervous system, decreased secretion of estrogen and progesterone due to involution of corpus luteum, Parasympathetic action from sacral region, Oxytocine hormone, increased estrogen to progesterone ratio during last trimester, Irritation of large intestine and stimulation of myentric 902

Received: 8 August Revised: 15 August Accepted: 20 August Index in Cosmos

September 2018 Volume 8 Number 9 UGC Approved Journal

International journal of basic and applied research

www.pragatipublication.com ISSN 2249-3352 (P) 2278-0505 (E) Cosmos Impact Factor-5.86

plexus. There is a need of further research to evaluate in detail of all other vata dosha, kshaya, vriddhi and avarana for the betterment of mankind. References:

1. Pritam Moharana & Rakesh Roushan: (2018). “A Critical Review of Prana Vayu in the Modern Perspective,1(9), 446-457. 2. Tripathy B.N: Kaladikakhyana- Shariram, Purva Khanda, Sarngadhara Samhita, Varanasi, India: Chaukhamba Surabharati Prakashana.2011: 65. 3. Pritam Moharana & Rakesh Roushan: Effect Of Prana And Vyana Vayu In Ncds W.S.R. to Cardiovascular System. International Ayurvedic Medical Journal {online} 2018 {cited May, 2018}. 4. Pandey K, Chaturvedi G, eds. Vatavyadhi Chikitsa Adhyaya, Charaka Samhita. Varanasi, India: Chaukambha Bharati Academy; 2015: 775 Reprint. 5. Shastri A.D. eds ,Vatavyadhi Nidana Adhyaya, Ayurveda Tatwa Sandipika Hindi Commentary, Susruta Samhita, Varanasi(India): Chaukhamba Sanskrit Sansthan;Edition-2014.page no-296. 6. Tripathy B.N. Eds, Doshabhediya Adhyaya, Astanga Hridaya, Varanasi, India: Chaukambha Sanskrit Pratisthan; 2012: 171 Reprint. 7. Gupta A.D. Eds, Doshabhediya Adhyaya, Astanga Sangraha, Varanasi, India: Chaukambha Krishnadas Academy; 2012: 160 Reprint. 8. Hall. E, Guyton. C. (2016), Reproductive physiology, Textbook of medical physiology, New Delhi (India), Elseveir; 2016: 680. 9. Hall. E, Guyton. C. (2016), Renal physiology, Textbook of medical physiology, New Delhi (India), Elseveir; 2016: 549. 10. Hall. E, Guyton. C. (2016), Gastrointestinal physiology, Textbook of medical physiology, New Delhi (India), Elseveir; 2016: 472. 11. Hall. E, Guyton. C. (2016), Reproductive physiology, Textbook of medical physiology, New Delhi (India), Elseveir; 2016: 665. 12. Hall. E, Guyton. C. (2016), Reproductive physiology, Textbook of medical physiology, New Delhi (India), Elseveir; 2016: 691. 13. Hall. E, Guyton. C. (2016), Gastrointestinal physiology, Textbook of medical physiology, New Delhi (India), Elseveir; 2016: 462. 14. Hall. E, Guyton. C. (2016), Gastrointestinal physiology, Textbook of medical physiology, New Delhi (India), Elseveir; 2016: 418. 903

Received: 8 August Revised: 15 August Accepted: 20 August Index in Cosmos

September 2018 Volume 8 Number 9 UGC Approved Journal