Whats App Discussion series 33: ''NABHI-CHALAN'' by Vd. Ranga prashad Bhat, Dr. Ghanshyam Vatsa, Dr. Pawan madan, Prof. D S Mishra and others

[2/27, 14:08] Ghanshyam Vatsa KC MD:

नाब डिग जाना । 

धरण होना ।

नाभि हिल जाना ।

ये क्या होता है ?

ये कैसे ठीक होता है ?

ये आयुर्वेद में कहाँ वर्णित हैं ?

आधुनिक चिकित्सा में इसकी तुलना किससे करेंगे ?

कृपया गुरुजन इस पर प्रकाश डालने का कष्ट करें 

[2/27, 14:09] Ravneet Kaur Ras: 

Sir it is dislocation of aorta wn it bifurcates at umbilicus

[2/27, 14:09] Ravneet Kaur Ras: Modern

[2/27, 14:25] Ghanshyam Vatsa KC MD: आयुर्वेद  में ?

[2/27, 14:39] J K Pandey Dr. Lukhnau:

धन्यवाद सर यह प्रश्नउठाने के लिये ।

मैं भी इस विषय में विद्वान वैद्यों का मत जानना चाहूँगा ।

[2/27, 15:00] Vd. Dhanvantari Pancholi MD: 

Exploration Stick.... 

बहुत अच्छी बात है यह बात लगभग सभी के अनुभव में आई है 

इस में आगे बढ़ने का तरीका यह हो सकता है...... कि

 जहां जहां पर यह समस्या उत्पन्न होती है उस समस्या से संबंधित अन्य लक्षण भी इकट्ठे किए जाएं 

तब अंगुली रखी जा सकती है कि 

 इस समस्या के साथ यह यह चार पांच प्रकार के लक्षण या उपद्रव मिलते हैं 

उनके आधार पर यह निर्णय हो सकेगा कि यह क्या है और इसे क्या कहते हैं और इसकी क्या चिकित्सा है

यथा कोष्ठबद्धता यथा अतिसार यथा मूत्र संबंधी विकार यथा अग्निमांद्यता, छर्दी, etc. 

[2/27, 15:02] Vd. Dhanvantari Pancholi MD:

 As much as data (sample size) more precision, narrowing.

[2/27, 15:18] Pankaj Chhayani dr ndyad:

 Respected Ranga sir explained these in past...

[2/27, 17:04] pawan madan Dr: 

Ji..

Naabhi..

There can be many explanations for this. 

Anatomically Bhatt sir explained once but still patients refer Naabhi to various complaints.

Its a thing which moat probably have been coined by some vaidyas to make understand the pts their symptoms related to abdomen.

ऐसा लगता है के तब से ये शब्द रूढि हो गया व जनमानस मे प्रचलित हो गया.

[2/27, 17:05] Vd. Dhanvantari Pancholi MD:

 Any Ayurvedic explanation Sir 

[2/27, 17:10] pawan madan Dr:

 मुझे लगता है के ये वात कर्म दुष्टि जन्य लक्षण ही है. 

ये वात कर्म दुष्टि स्व हेतु जन्य या अन्य दोश हेतु जन्य भी हो सकती है. 

ये सीधे तैर पर वात दोष प्रकोप भी हो सकता है या आवरणजन्य भी.

[2/27, 17:12] pawan madan Dr:

 बहुत सारे ऐसे रोगिओ मे जिन मे नाधि दोष परिलक्षित किया गया था (रोगी के द्वारा ही या किसी अन्य चिकित्सक द्वारा) उनमे मैने जब वात अनुलोमन चिकित्सा की तो उपश्या पाया.

[2/27, 17:13] Vd Ranga Prasad Ji Chennai: 

*पार्श्व-पृष्ठ-कटी ग्रह* !?

[2/27, 17:14] pawan madan Dr:

 सर इसमे लक्षण तो सारे कोष्ठ सम्बधित मिलते है..

[2/27, 17:14] Vd. Dhanvantari Pancholi MD:

Points to be considered. 

अपानवायु से संबंधित सभी अवयव और सभी रोगों पर विचार किया जाए

Referred pain from all the concerned organs? 

Intestinal anomalies. 

Colics.

[2/27, 17:15] Bhushan bhakad Vd. Nasik:

 Atisar, Gulm can be taken in consideration in d.d. as per symptoms

[2/27, 17:15] pawan madan Dr: 

[2/27, 17:15] Vd. Dhanvantari Pancholi MD: 

*अपानवायु से संबंधित सभी अवयव और सभी रोगों पर विचार किया जाए*

[2/27, 17:18] Vd Ranga Prasad Ji Chennai: 

जी । बिलकुल ।। उसमें (नाभि हिलना) में भी वही ही प्रस्तुत होता हैं ।।

शूल, आनाह, आध्मान, आटोप, अतिसार , ये सब कण्ट्रोल नहीं हुआ तो (अप्रतिकार से) छर्दि से end होता हैं ।।

[2/27, 17:20] pawan madan Dr: 

फिर पार्श्व प्रौष्ठ कटि ग्रह कैसे..?

[2/27, 17:31] Vd Ranga Prasad Ji Chennai: 

Abdominal Core muscle का sprain (ग्रह) होने से, उसका तात्पर्य होने वाले structures (insertion और origin की वजे से) जैसे ribs, kati, vertebra, पार्श्व संधि वगेरा वगेरा स्थान पर, नाभि हिलना की अवस्थाओं में 2+ से 3+ असह्यता को elicit किया जा सकते ( in origin and insertion points of stressed areas of Transversus abdominis muscle). 

Unless one elicits the tenderness at the different points of origin and insertion of the Above core muscle mentioned in such cases clinically, my this observation *will never be accepted* and *will always be debated on and off* when ever one presents the doubt over the *nabhi hilna*.

*The benefit of doubt* points to the core muscle.

In one female case - nabhi hilna was observed. Cause of it - postural discomfort felt during *transvaginal sonography*.

One orthopedic doc presented the same features, soon after the day of his hectic schedule handling 5 cases of *manual reduction of fracture of leg*. 

In other cases too such factors causing sprain of T.A.muscle was observed like in one peculiar case *post vyavaya* done with compromised posture for extra sensual pleasure.!

In all these cases, I was just concentrating on T.A. muscle and trying to relax it to provide relief to them, through non interventional therapeutic methods I adopt in my Marma practice.

Result was instant with remedial relief.

Only hence, I am stressing the learned to consider the involvement of the core muscle and the concept of the graha in the afore said nidana presented.

[2/27, 17:32] Vd Ranga Prasad Ji Chennai: 

Read below. ( *1st Para mein iska hint hein*).

[2/27, 17:35] Vd Ranga Prasad Ji Chennai: 

How do we need to understand the pain or graha in ribs, parshva and kati in a case of prabhuta ascites ?

How does the vata in those local sites gets aggravated ? 

The logic is simple :. THE ABDOMEN BLOATS - The Skin stretches - the underlying core muscle stretches - attachment and insertion point gets stressed - pain or graha manifests. 

[2/27, 17:37] Vd Ranga Prasad Ji Chennai:

 https://www.google.co.in/search?q=transverse+abdoninis+origin+and+insertion+points&oq=transverse+abdoninis+origin+and+insertion+points&aqs=chrome..69i57.15924j0j4&client=ms-android-ktouch&sourceid=chrome-mobile&ie=UTF-8

[2/27, 17:37] Vd Ranga Prasad Ji Chennai:

 https://www.google.co.in/search?q=transverse+abdominis+origin+and+insertion+points&client=ms-android-ktouch&prmd=ivn&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjsmcXMnrDSAhVIS7wKHRKyBgAQ_AUIBygB&biw=360&bih=559

[2/27, 17:38] Vd Ranga Prasad Ji Chennai:

  Analysis with above inputs may give the idea over the clinical thought process explained from my end.

[2/27, 18:17] pawan madan Dr:

 

[2/27, 20:00] Ghanshyam Vatsa KC MD: 

दस्त, कब्ज़, पेटदर्द इत्यादि के अलावा इसमें एक लक्षण ख़ास तौर पर दिखाई देता है । नाभि में जो धड़कन होती है वह ऊपर या नीचे, दांय अथवा बांये चली जाती है ।

इसी से ही पता चलता है कि नाभि हिल गयी है और फिर उसे पिंडलियाँ मसल कर या फिर नाभि पर वैक्यूम पैदा करके वापिस उसी स्थान पर लाया जाता है तो मरीज़ को आराम आ जाता है । किंतु कभी कभी वह नाभि की धड़कन वापिस चली जाती है । और मरीज़ को कोई दिक्कत ( लक्षण ) भी नहीं होती । 

यदि हम माने की ये मसल्स में खिंचाव की वजह से है तो नाभि की धड़कन ( abdominal aorta की pulsation ) ऊपर नीचे कैसे चली जाती है । कहीं इसमें कुछ हाथ omentum का तो नहीं है ?

[2/27, 20:14] Vd. Dhanvantari Pancholi MD:

 Only answer 

Detailed observations by Ayurvedic experts. 

Significantly high number of such cases. 

Documentation. 

Analysis 

Correlations. 

Interpretation. 

My humble approach. 

[2/27, 20:52] Daya Shnkrji Sir: 

नाभिभ्रन्स में अंगुली नाभी में डालने पर pulsation महसूस होता है।

कभी यह दांयें ककया बायें महसूस होता है तो सब लक्षण मिलते है।

   चिकित्सा के लिए रोगी को खाली पेट सीधे लिटाकर दोनो पैरों को उपर उठाए 90 डिग्री तक तथा धीरे-धीरे वापस लायें ऐसा तीन बार करें

[2/27, 20:54] Vd Ranga Prasad Ji Chennai: 

My understanding of Hindi is not up to the mark, especially when not much of Sanskrit word is getting mixed and the text is almost 100% in Hindi. 

Still, I try to understand that, Sir you're querying regarding how the pulsation is felt displaced from underneath the NAbhi...?

The fact sir, lies with the *linea alba* (present in the center median plane of abdomen).

Please note that the medial end of the fibres of the Transversus abdominis muscle is inserted into linea alba.

When the muscle gets sprained, the trigger point pulls the muscle towards the force of sprained area.

Hence the linea alba where in the umbilicus too is attached gets deviated to the side of muscle pull giving an appearance as if the umbilicus is displaced independently, but which is not the case.

Having said that, the abdominal aorta which is present in the midline starts getting directed to left at the level of 4th Lumbar vertebra to get branched into two common iliac arteries.

Which means there Aorta will not be in the median plane at the level of 4th vertebral body.

Having said that, let me also bring to your notice that *The umbilicus is at the level of the fibrocartilage between the _third and fourth lumbar vertebrae_*

This 4th lumbar vertebra, technical factor is what gets unnoticed by many physicians. And with a *general notion* that the abdominal aorta lies in the center of the abdomen, tentatively gets confused that the abdomen gets displaced , and when it gets displaced pulsation is either felt or seen underneath the umbilicus. 

*But, sir, the actual fact is* the umbilicus ofcourse is deviated, but not the Aorta.

Because the Aorta remains in its natural place little bit deviated to left at the point of 4th Lumbar Vertebra.

To conclude, it is a mithya jnAn, that only because of displaced umbilicus, pulsation occurs in that area.

Nope, even other wise one could feel the pulsation in that area (slightly left to the normal placement of umbilicus).

[2/27, 21:02] Vd Ranga Prasad Ji Chennai: 

And when one places the vacuum creating apparatus, the muscle pull gets negated due to continuous suction effect over the region of the transverse abdominis, thereby the pulling muscle fibres start giving up the resistance and gets relaxed.

When the T.A. muscle gets relaxed, the umbilicus comes to its normal position.

When it comes to normal position, one will not feel the pulsation over the umbilicus. *It is sheerly because, lemme once again stress the fact, that the Abdominal Aorta is naturally present little bit on the left side of the umbilicus*.

*Mithya jnAn due to Pratyaksha anupalabdhi factor* is the cause for the confusion that the umbilicus deviation is the cause for the cough, adhmana, atop, atisar, vaman etc symptoms. And we tentatively stress the effect (nabhi hilna) as the reason for the symptoms by overlooking the cause (muscle sprain). 

Hope, I have tried my level best sensibly to make the observations observed clinically from over my end. 

[2/27, 21:25] Ghanshyam Vatsa KC MD:

 

Sorry for writing in hindi.

Thanks a lot. Now things are much clear in my mind. 

We test the difference of umbilicus from both nipples ( in case of males ) & from both great toes ( in case of females) and always find a difference, which is corrected and patient gets relief.

By the way omentum ( lesser or greater ) have any kind of role in this pulsation feeling ?

[2/27, 21:45] Vd Ranga Prasad Ji Chennai: 

Nope sir. If omentum gets involved, probably it should get involved over at the level of pathology of adhesions to cause this much of clinical symptoms.

And in that case, the presentation would be an emergency situation due to AvaraNa.

And simple measures like cupping or creating vacuum would not provide immediate relief.

As of my observation all the symptoms starting from cough to atisara (from throat/ chest to lower abdomen) are due to *increased intra abdominal pressure* occurring as an event in the above case resulting in a panicking situation of *ghabrahat in the udara region*.

[2/27, 22:01] Vd. Dhanvantari Pancholi MD:

 2

Not many people knew in detail about such stalwart of Ayurved. 

Sad I missed such great soul. 

I always dreamed to have a 

pan-Indian (forget world) platform for Ayurvedists' exchange. 

So we could come near and know better each others and don't miss the Gems.

[2/27, 22:05] Vd. Dhanvantari Pancholi MD:

 3

And thank you Dr Bhatt for your deep analysis of Nabhi Chalan (displacement). 

Hope we Ayurvedists shall enhance our analytical skills too. 

Nice, satisfactory and enhancing experience in the last. 

We need more involvement of Dr Bhatt and his insight inputs. 

[2/27, 22:49] Vd Ranga Prasad Ji Chennai: 

Sir, I already am active in discussions. 

Being a *mutant in thought process,* ~_ I restrict my presence of participation to times in need of my mutant thoughts._~ 

_Rest of the time, remaining silent and watching the ongoing discussions to collect the pros from the discussions and leave the cons from the same discussion,  for gyan vardhan._

Having been affiliated to constructive side of discussions, I tentatively keep quite during destructive criticisms. 

Having said that, I'm always at an approaching distance to the community and family of Ayurveda gathered over here in this prestigious dias created by our brother Surendra Soni bhai. 

[2/27, 23:03] S A Soni: 

नमो नमः ।

Respected Ranga Guru !!

[2/28, 12:41] S A Soni: 

                           

Respected Ranga Sir !!

Great interpretation done by you regarding nabhi chalan.

Thanks again to you.

I m agree with you but I feel that there may be a possibility of intraluminal or extraluminal positional cause especially of small intestines related (a type of displacement/changes in normal position- don't know exact anatomical/pathological term) and it is responsible for different types of clinical manifestations. 

Usually the condition arises after the strange 'Vihar' like jumping from hight or heavyweight lifting in odd positions.

This may also responsible for shift of pulsation at certain level because muscles usually superficial.

Is it possible ??

[2/28, 13:26] Vd Ranga Prasad Ji Chennai: 

1. I still stand by view sir. 

2. The possibility of involvement of intestines explained by you gets ruled out. 

Reason is over a simple clinical logic brother. 

Though the symptoms of atisar, cchardhi, aadhmaan, atop gives us an logical idea to think about the involvement of the intestinal structures..., *Remember the nature of Shula is not COLIC*. The patient experiences *stretching pain / electrified pain due to nerve stretching or nerve pinching*. 

When colic is not present, it means intestinal motility is not the cause for pain. And the benefit of doubt gets passed on to extra abdominal structures.

Who else the culprit might be other than the core muscle !? 

[2/28, 13:43] S A Soni: 

Thanks Sir !!

Position of A Aorta is deeper and muscles are superficial that's why I raised the question. Possibility of preexisting milder intraluminal silent pathogenesises might be triggered by muscle stretching.

Thanks.

[2/28, 13:45] Vd Ranga Prasad Ji Chennai:

 Possibilities might be sir. But so far so now, I've not got one such presentation. 

[2/28, 14:19] pawan madan Dr: 

Ranga sir...

[2/28, 14:06] S A Soni:

Perfect explanations.

Only one question....if it is due to muscles only....Is it possible that some muscle relaxant medicines couod be able to correct this Naabhi Chaalan??

[2/28, 14:31] Vd Ranga Prasad Ji Chennai:

 Good question raised, Pawan ji. 

The point is, unlike in other sprains where in the epicentre of the muscle pull will be in the center of the muscle mass, over here the sprain and strain are over the insertion and origin point of the core muscle.

That having said, the constant bucket handle movement of the  ribs along with the voluntary movements of the hip bone while walking (one never takes bed rest but moves hitherto), the muscle is under continua stress at both ends. 

Hence external application of muscle relaxants when applied provides only a temporary yield of painless experience from 15 mts yo half an hour. 

To be frank, I've not prescribed any modern muscle relaxants in such cases (since I don't prescribe modem medicines) and the necessity was not arising to use Rx beyond Ajamodadi, since I'm well equipped with my NCMT procedure (non conventional marma taping) getting developed from over my end. 

But, it sure will work and provide quicker relief when I/V inj gets administered rather than in oral form.

[2/28, 14:43] Anju Nvle Dr: 

Sir thanks alot for the knowledge. Sir do u have any video of NCMT procedure,where we can also have d opportunity to see and learn.

[2/28, 15:05] Vd Ranga Prasad Ji Chennai: 

Nope ji.   

************************************************************************************

Above discussion held on 'Kaysampraday" a Famous WhatsApp group  of  well known Vaidyas from all over the India. 

Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

Email: surendraasoni@gmail.com

Mobile No. +91 9408441150