THERAPEUTIC EFFICACY OF VARMAM ADANGAL (SIDDHA PHYSICAL THERAPY) IN THE MANAGEMENT OF VALIPPU NOI (SEIZURE) - A REVIEW 

Vrindha.K.V¹, N.J.Muthukumar², M.V.Mahadevan ³, D.Periyasami³, V.Mahalakshmi³, P. Samundeswari⁴,

¹ PG Scholar, Dept. of Varma Maruthuam, National Institute of Siddha,Chennai

² Professor &HOD, Dept. of Sirappu Maruthuvam, National Institute of Siddha, Chennai

³ Associate Professor, Dept. of Sirappu Maruthuvam, National Institute of Siddha, Chennai

⁴ Lecturer, Dept. of Sirappu Maruthuvam, National Institute of Siddha, Chennai

Corresponding author - Vrindha.K .V, PG Scholar, Dept. of Varma Maruthuam, National Institute of Siddha,Chennai

ABSTRACT

Varma Maruthuvam (Siddha Physical Therapy) is a specialty of Siddha Medicine deals with the study of energizing points (Varmam) in the body which are used to treat various disease conditions. Varmam injury can be regulated by Adangal pullikal (retrieval points)[1]. Adangal points are nothing but Varmam points used in the management of emergency as well as disease condition.[2] Valippu noi (Seizure disorder) is one among the 4448 diseases which is occurred due to increase in the kabam humour along with vatham and pitham[3]. Management of the above condition is explained in various Siddha Varmam literatures.

Key words - Siddha Medicine, Varmam, Seizure management, Siddha Physical Therapy

INTRODUCTION

பாதாதி கேசமெங்கும் கதிதந்தோடும் வாசிநிலை வர்மம்” Varmam is the science of vaasi (the vital energy circulating inside the body)[4]. It is the regulating force of uyirthathukkal( Vaatham, Pitham and Kabam) and hence, any irregularities in this circulating energy will cause Varma diseases. Causes of varmam injury can be due to internal or external causes. External causes includes trauma, environment changes and internal causes are idiopathic. Injured Varmam can be regulated physically through Adangal pullikal (retrieval points).Adangal points are nothing but varmam points used in the management of emergency as well as disease condition “நாமென்ற நரம்புதான் பின்னிவரும் நலமான தானமதே அடங்கலாகும்”(varma sarasoothira thirvukol-36) [2]this versus defines Adangal as junction of narambukal (nerves, blood vessels). Different kinds of adangal are seen in Siddha literatures like Varma odivu murivu sarasoothiram – 1200,Varma sarasoothira thiravukol – 36, Varma laada soothiram- 300 etc. Its number also varies from literature to literature.

Epilepsy is defined as a group of disorders in which there are recurrent episodes of altered cerebral function associated with paroxysmal excessive and hypersynchronous electrical discharge of cerebral neurons. Each episode of neurologic dysfunction is called seizure, which may be convulsive or non conclusive. The estimated proportion of the general population with active epilepsy (i.e. continuing seizures or with the need for treatment) at a given time is between 4 and 10 per 1000 people. However, some studies in low- and middle-income countries suggest that the proportion is much higher, between 7 and 14 per 1000 people. Globally, an estimated 2.4 million people are diagnosed with epilepsy each year. In high-income countries, annual new cases are between 30 and 50 per 100 000 people in the general population. In low- and middle-income countries, this figure can be up to two times higher.[5]

Valippu noi mentioned in Siddha literatures can be compared to seizure. In Siddha literatures, we can see 2 group of classifications for Valippu noi . One group of classification describes 5 types of Valippu noi and the other group describes 21 types[6]. Common symptoms mentioned includes loss of awareness, involuntary movements of upperlimb and lowerlimb, frothy

saliva, deviation of mouth and eyeball¹. In Varmam based literatures certain terms likeVettal, Sanni vettu, Kai kaal virayal,vali are related withValippu noi. Etiology described is primary vitiation of the kabam humour along with vatham and pitham. It may also happen due to consequence of mega noi, physical and mental tiredness.[3]

ADANGAL

Adangal are the areas situated in the junction of (narambu) nerves. It is used for the varma treatment procedures. It can be grouped into 12, 16, 29, 36, 51, 56, 64 among this 12 adangal points are considered to be more important.[7]

“ நாமென்ற நரம்பதுதான் பின்னிவரும்

நலமான தானமதே அடங்கலாகும் ”

(Varma sarasoothira thiravukol – 36)

Several adangal used for the management of Seizure are explained below

1. Pininarambu adangal

2. Paenkuzhi adangal

3. Unthi adangal

4. Sakthikuri adangal

5. Valapinkalai adangal

1. PINI NARAMBU ADANGAL

Othername

Sevikutri adangal

Sevikkuzhi adangal

Sithambarakugai adangal

Nivirthi kalaiyadangal

Pini narambu adangal is one among the adangal point indicated forvettu (epilepsy). It is described in literature Varma laada soothiram - 300

“மயக்கமும் சன்னிவெட்டால் மறுத்துதான் முடிப்புதாளால்

கயக்கமும் கைகால்விறயல் கலக்கம் இப்படியே கண்டால்

தியக்கமும் செவிகுற்றி குழியின் திடம்பிணி நரம்படங்கல்

வியக்கவே செய்யநன்று வினையில்லை கருதிக்கொள்ளே”

(Varma laada soothiram-300)

It is located in Sevikutri kuzhi. Here it is indicated for seizure, loss of awareness, stiffness of upper and lower limb.

Figure 1 Pini Narambadangal

Manipulation method - Upward pressure at the site with tip of the ventral surface of index

and middle finger for 3 seconds then release. Repeated for 3 times[8]

Maaththirai (pressure) - ¼ maaththirai

Anatomical relations

Location - Below the tragus of both ears

Bone - Condyloid process of the mandible and zygomatic process

of the skull

Joint - Temperomandibular joint

Muscles - Masseter

Ligaments - Joint capsule, tempero mandibular ligament

Artery - Maxillary artery, superficial temporal artery

Vein - Superficial temporal vein

Nerve - Auriculotemporal nerve, Greater auricular nerve, Vagus

nerve

Sensory supply - Auricular branch of Vagus nerve

Gland - Parotid gland[9]

2. PAENKUZHI ADANGAL

Othername

Pin kuzhi adangal

Thaayadangal

Pinkuzhi adangal

It is located below the pidarikuzhi. Symptoms like involuntary movements of the body, body tiredness and delirium can be treated by the proper application of this adangal point.

“இளக்குவது இன்னுமொரு உபாயங் கேளு

இருப்பென்ற காலமதில் இசைவாய் நின்ற

தழைக்குமந்த உருளையது விலகிப் போனால்

தப்பாமல் இடக்காலில் வலுவாய் ஊன்றி

ஒழுக்கமாய்த் தான் பிடித்து பேன் குழியில்

உற்பனமாய் கீழ் அமர்த்த உருளை விழும்

பழக்கமாய் மேல் அமர்த்த அசதி தீரும்

பற்றாமல் இடம் சுழிக்க சன்னியோடும்

ஓடுமே வலம் சுழிக்க விறையலோடும்

ஓர்மையோடு உள்ளக் கருத்தின் புலன்கள் வேணும்

ஆகுமே அடங்கலது பலத்துச் செய்ய

அறிவு மிக குணங்குறிகள் சாத்தியாசாத்தியம்

தேடுமே பரகதிக்கு வழியைத் தேடு

திடுக்கமுடன் செய்யாதே தீங்கொண்ணாதே

போடுமே மாத்திரையில் பிலன் குறைந்து

புத்திக்கு அமர்ந்து முறை காணிப்பாயே”

Figure 2. Paenkuzhi Adangal

Manipulation method - Physician’s left foot is placed over subject’s left foot then place the physician’s thumb over the adangal and apply pressure over the varmam point and rotated to the left for 30 seconds.[8]

Maaththirai (pressure) - ¼ maaththirai

Anatomical landmark

Location - It is situated at the posterior aspect of neck (at the level of

C3 vetebra.)

Bone - Cervical vertebra (C3)

Muscles - Splenius capitis, trapezius

Ligaments - Interspinous ligaments, ligamentum flavum

Artery - Branches of vertebral artery

Vein - Branches of vertebral vein

Nerve - Spinal nerve

Sensory supply - Occipital nerve[11]

3. UNTHI ADANGAL

Othername

Unthipuzhai adangal

Naabi adangal

Pirai adangal

Sara adangal

Manipooraga adangal

It is located in umbilicus and it will regulate the varmam energy all over the body.

“தூண்டவே மணிபூரகம் தொந்தித்த காலத்தில் தானே

பூண்டதோருந்திப் புழைய்டங்கல் என்றறிந்து தாக்கு

கொண்டதோர் குறிக்கேடெல்லாம் கோணாமல் ஓடிப்போகும்

தண்டவே முறைகள இன்னும் தக்கதாய் வாழ்த்துவோமே”

(Varma laada soothiram-300)

Figure 3 Unthi Adangal

Manipulation method - Ventral surface of middle 3 fingers placed at the site

transversely, applied pressure for 3 seconds and release.

Repeated for 3 times [8]

Maaththirai (pressure) - ¼ maaththirai

Anatomical relations

Location - It is situated over the umbilicus

Muscles - Rectus abdominis

Ligament - Median Umblical ligament, round ligament

Artery - Superior and inferior epigastric artery

Vein - Superior and inferior epigastric vein

Nerve - T10 dermatome[10]

4. VALA PINKALAI ADANGAL

Othername

Karandai mun adangal

Ida idakalai adangal

Vala pinkalai adangal is situated anterior to the medial malleolus and it is one among the adangal point indicated for sannivettu (epilepsy). It is described in literature Varma laada soothiram - 300

“மீளவே கால் கண்ணுக்குமுன் பக்கம் கீழ்வட்ட்த்தில்

ஆளவே தானமொன்றாம் இட பிங்கலை அடங்கல்

நீளவே சன்னிவெட்டால் நிகழ்விதம் பலதுக்கெல்லாம்

வாளதாம் செய்து பார் மாறாதவர் இல்லைதானே”

(Varma laada soothiram-300)

Figure 4 Valapinkalai adangal

Manipulation method - Pulp of thumb is placed at the site and apply pressure then

release. Repeated for 3 times [8]

Maaththirai (pressure) - ¼ maaththirai

Anatomical landmark

Location - Between medial malleolus and tendon of tibialis anterior

Bone - Tibia and talus

Joint - Ankle joint

Muscles - Tibialis anterior

Ligaments - Deltoid ligament

Artery - Tibialis anterior artery

Vein - Medial marginal vein

Nerve - Deep peroneal nerve

Sensory supply - Saphenous nerve[11]

5. SAKTHIKOORADANGAL

Othername

Sakthi kuri adangal

Keezhadangal

It is located below the medial malleolus. It is indicated for the symptoms like shaking of body, sweating, rigor, fever and delirium.

“தானென்றால் கால் கண்ணுக்கு தாழ்வதில் சக்தி கூறடங்கல்

கோனென்றால் தலத்தில் குறித்து மாத்திரையில் பார்க்க

வேனென்றால் விறையல் விக்கல் வேர்வையும் சன்னி சீதமாம்

கூனென்றாலதுவும் காய்ச்சல் கோச்சல் கொழுத்தும் போமே”

(Varma laada soothiram-300)

Figure 5. Sakthi Kooradangal

Manipulation method - Physician’s thumb (ventral) placed over the site and apply

pressure for 5 sec and released. Repeated for 3 times [8]

Maaththirai (pressure) - ¼ maaththirai

Anatomical relations

Location - Below the medial malleolus

Bone - Talus

Muscles - Tibialis posterior

Ligaments - Deltoid ligament

Artery - Posterior tibial artery

Vein - Great saphenous vein

Sensory supply - Saphenous nerve[10]

Notes

· Avoid lifting heavy weight and indulging in strenuous activities immediately after treatment

• Varmam treatment should not be given immediately after meals

DISCUSSION AND CONCLUSION

Varma Maruthuvam (Siddha Physical Therapy) can be employed in both acute and chronic ailments. Seizure is a disease condition in which there are episodes of acute onset. Due to the sustained seizure episodes the patient is prone to secondary injuries. Even in modern medicine there is no absolute treatment to stop the seizure episodes. Then the way forward is to manage each episode with some form of physical intervention. Here we can utilize the scope of Varma Maruthuvam. The above mentioned five adangal are simple to adopt, easy to practice and train. A close associate of the patient could be trained by the doctor to manage the patient whenever he passes through the seizure episodes. Clinical trials can be performed to validate the effectiveness of Adangal in the management of Seizure.

REFERENCE

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9. Richard L Drake, A. Wayne Vogl, Adam W. M. Mitchell, Grace Anatomy ,39 ^th edition

10. Richard S Snell, Clinical Anatomy by Regions 8^th edition, Wolters Kluwer (India) New Delhi (P) limited, 2008.

11. Chaurasia B D, Human anatomy volume 1, 2, 3, CBS Publishers and distributors, 4^th edition 2004.