Urusthambha – Stiffness of thighs.
This is the only disease where panchakarma is contraindicated.
Now we shall expound the chapter “Urustambha chikitsa” (Management of diseases of thigh and hip). Thus said Lord Atreya.[1-2]
Agnivesha’s query :
Once Agnivesha asked a doubt to the mentor Lord Punarvasu, who was having infallible intellect of true knowledge and penance, who was like the semaru mountain with unblemished like sun and moon and was abode of wisdom, self realization, memory, glory and patience.
“Oh Lord, all the five therapies (panchakarma) are explained together as well as therapeutic measure for all the diseases. Is there any curable disease caused by doshas for the cure of which these five therapies are contraindicated?” [3-6]
Atreya’s reply :
To the above mentioned doubt of Agnivesha, the preceptor replied “The disease named urusthambha is there for which Panchakarma is contraindicated. Agnivesha again enquired about etiology, symptoms and treatment of this ailment. The preceptor again replied. 
- Intake of foods of contradictory properties like snigdha (unctuous), ushna (hot), laghu (light to digest), sheeta (cold), drava (liquid), Shushka (dry) food (altogether or alternatively) when the previous food is partially digested only or completely digested.
- Intake of food having opposite qualities like yoghurt and milk, meat of animals which are gramya (from urban area), anupa (marshy places) and auduka (aquatic).
- Intake of pastries and denatured alcohol.
- Excessive daytime sleep and awakening during night . Excessive fasting or taking food while the previous meal has not been digested.
- Over exertion, continuous fear, suppression of urges.
- Due to excess unctuousness, accumulation of ama in koshta takes place.
- Ama with deranged medas obstructs prakupita tridoshas and due to heaviness, they move downward through siras(blood vessels) to reach lower limbs. Doshas get accentuated by the strength of the medas to fill calves and thighs of the lower limbs causing involuntary movements and immobility.
The kapha filled lower limbs become like lake which is large, deep and fully filled with water which remains still, stable and undisturbed.
The disease when gets associated with heaviness, strain, contracture, burning sensation, pain, numbness, tremor, splitting, twitching and pricking types of pain, then it becomes lethal.
Kapha with its sthira (stable) and sheeta (cold) properties with medas subdues vata and pitta and causes immobility of uru (thighs). Hence the disease is termed as urusthambha. [8-14]
Prodromal symptoms :
Thinking or concentrating on something, excessive sleep, indolence (decreased emotion), anorexia, fever, horripilation, vomiting and reduced movements of calves and thighs (due to loss of strength) are the prodromal symptoms of Urusthambha. 
Contraindication of snehana (oleation therapy):
If oleation therapy is administered due to misunderstanding, that this disease as vata disorder or due to ignorance, it results in loss of strength in the legs, loss of sensation in the legs and difficulty in raising the legs.
Clinical features :
- Excessive fatigue of calf muscles and thighs.
- Constant pain with slight burning sensation,
- Pain in feet on stepping on the ground,
- Insensitivity to cold touch,
- Loss of muscle power on standing, resisting the movement, walking and on moving the lower limbs,
- Unable to move the upper and lower parts of the lower limbs due to the feeling that they are fractured.[17-18]
If the patient develops burning sensation, pricking pain and tremors, urusthambha is fatal. If such symptoms are absent and is recent origin, then it is curable.
Contraindication of Panchakarma :
The reason for which oleation, enema, purgation and emesis are contraindicated in urusthambha is being explained for your understanding.
Oleation and enema therapies always aggravate kapha. Purgation is ineffective to remove kapha localized there (in the thighs). Kapha reaching its own place (amashaya) and pitta can easily be removed by emesis. Both these doshas lodged in amashaya can be eliminated by purgation. When lodged in pakvashaya, all the three doshas could be fully removed by enema therapy. But in urusthambha since pathognomonic doshas are stagnant due to amatva (metabolic defect) and obstructed by meda (fat), since kapha is lodged in the abode of vata, which is of sheeta guna and since vata and kapha are immobile, it is not easy to remove them just as it is difficult to remove stagnant water from a ditch.[20-24]
Principles of Management :
तस्य संशमनं नित्यं क्षपणं शोषणं तथा | युक्त्यपेक्षि भिषक् कुर्यादधिकत्वत्कफामयो: || 25 ||
Since kapha and ama are conspicuous in the pathogenesis of urusthambha, the physician should conatantly judiciously administer therapies for their samshamana (pacification), Kshapana (reduction) and Shoshana (drying up by absorption).
The patient of urusthambha should be constantly given rukshana (drying up therapies to facilitate absorption of liquid metabolites from circulation and tissues) with yava (barley), shyamaka (millet), and kodrava along with vegetables cooked with water and oil, but without adding salt. Leaves of sunishannaka, nimba, arka, vetra, aragwadha, vaayasi, vaastuka and bitter vegetables like kulaka (karavellaka) aid rukshana.
Administration of alkali (kshara) preperations, arishta, haritako, water added with honey and pippali cures urusthambha (immobility of thighs). [25-28]
Various formulations :
The patient suffering from urusthambha should take samaga, shalmali and bilwa along with honey.
The patient may be given shriveshtaka, udichya, devadaru, nata, chandana, dhataki, kushtha, talisa, nalada (along with honey). [29-30]
The following five reipes cure urusthambha (immobility of thighs)
- Musta,haritaki,lodhra,padmaka and tikta rohini.
- Chavya,root of chitraka,devadaru and haritaki.
- Bhallataka,pippalimula and pippali
All the above mentioned recipes in the form of paste (kalkas) are to be taken along with honey. [31-33]
The patient suffering from urusthambha should take following recepies.
- Sharngestadi churna : Sharngeshta (gunja), madana, danti, fruits (seeds) of vatsaka, vacha, murva, aragwadha, patha, karanja and kulaka (karavellaka) – all these ingredients taken in equal quantiies should be made into a powder.This should be made into a powder. This should be taken along with honey added with water. Alternatively, this powder may added with honey and sour whey and taken.
- Murvadi yoga : In the above-mentioned manner, the powder of murva, ativisha, kushtha, chitraka and katurohini may be taken.
- Guggulu should be soaked overnight in cow’s urine and taken.
- Swarnakshiryadi yoga : The powder of swarnakshiri, ativisha, musta, tejovati, vacha, surahwa, chitraka, kushdha, padha and katurohini. It should be taken in the form of linctus made by adding honey. Alternatively, the powder may be mixed with water and honey and taken.
- The powder of phalli (nyagrodha), vyaghra-nagha and hema (nagakeshara) may be taken by the patient.
- The powder of triphala, pippali, musta, chavya and katuka-rohini may be made to a linctus and taken.[33-39]
Treatment of consequence of Apatarpana :
If the disease urusthambha is caused by apatarpana, then the patient should be appropriately given santarpana therapy consisiting of the meat of animals inhabitating in jangala desha (The land with shrubs and small trees) and old shali rice.
If because (of excessive use) of rukshana therapies, vata gets aggravated causing insomnia and pain, then the patient should be given oleation and fomentation therapies for the allevation of the ailments caused by vata. [39-41]
Piluparnyadi taila :
Oil should be cooked by adding piluparni, payasya, rasna, gokshuraka, vacha, sarala, agaru and paadha. One prasarta (प्रसृत) or one anjali of this medicated oil should be taken by adding honey (one fourth in quantity of the medicated oil).[41-42]
Kushthadi taila :
Mustard oil(सर्षप) should be cooked by adding kushtha, shreeveshtaka, udichya, sarala, devadaru, kesara, ajagandha and ashwagandha. The patient suffering from urusthambha should take this medicated oil in appropriate quantity by adding honey. This recipe makes the patient free from rukshana (kevala-vata prakopaja symptoms) leading to cure of urushtambha.[43-44]
Saindhavadi taila :
One prastha (768 grams) of oil should be cooked by adding two palas (1 pala = 48 grams) of saindhava, 5 palas of shunthi, 2 palas of granthika, 2 palas of chitraka, 20 fruits of bhallataka and 2 adhakas of arnala. Intake of this medicated oil helps in the conception of the offspring. It cures gridhrasi, urugraha, arshas, pain and all types of diseases caused by the aggravated vata. [45-46]
One prastha of oil (768 grams) should be cooked by adding two palas (96 grams) of pippalimoola and nagara taken together, 8 prasthas of katvara (butter milk) and one prastha of yogurt. This medicated oil cures gridhrasi (sciatica) and urusthambha. 
In the above mentioned verses (no.s 25-47), the recipes to be used internally for the cure of urusthambha are briefly described.
Hereafter recepies to be administered externally for the diminution of kapha will be described which you may hear.
- The mud of ant-hill, the root, fruits and barks of karanja and bricks should be made to a powder. This should be used for utsaadana (threapeutic massage with mixture of powder and uncuous substance) frequently.
- Alternatively, the physician should administer this utsaadana therapy with the help of the root of the ashwagandha, arka, pichumarda or devadaru. Any one of these drugs are mixed with honey, sarshapa and mud of the ant-hill before being used as thick utsaadana or pralepana.
- A wise physician may also apply the paste of danti, dravanti, surasa, vishwa, vatsaka and nimbi dhaara (pouring continuously) may be done over the affected part.
- Sarshapa should be made to a paste by triturating with cow’s urine kept overnight and used for external application.
- Vatsaka, surasa, kushtha, aromatic drugs like agaru, tumburu, shigru, himstra, root of arka, Mud of ant-hill and kudhereka should be made to a paste by adding yoghurt and rock salt. A physician conversant with the line of treatment should administer this paste as external application for the cure of urusthambha.
Shyonaka, khadura, bilwa, brihati, kantakari, sarala, asana, shobhanjana, tarkari, shwadamshtra, surasa, arjaka, agnimantha and karanja should be boiled in water.
- This decoction is to be used for dhaara (pouring continuously) on the affected part.
- The above mentioned drugs may be made into a paste by triturating them with cow’s urine and applied externally for the cure of uruthambha.[48-57]
Benefitial diet and lifestyle in kapha vitiation :
To alleviate kapha, the able-bodied patients should be engaged in physical exercise and they should be made to walk over the ground covered with gravels and sand in the morning.
The patient should be made to swim often against the current of river with cold water but harmless. He may also be advised swimming frequently in pond having clean, cold and stable water. [58-60]
All the therapeutic measures which alleviate kapha but do not aggravate vata should be employed for the treatment of urusthambha. These therapeutic measures should be administered while protecting the subject’s physical strength and power of metabolism.[60-61]
In this chapter on the treatment of urusthambha, the following topics are discussed. Etiology, premonitory signs and symptoms, signs and symptoms, therapeutic measures which are ineffective and causes to substantiate their futility and two categories of therapeutic measures (viz. internal and external).
Thus ends the chapter on management of urusthambha written by Agnivesha, redacted by charaka and completed by Dridhabala.