Vertigo or positional giddyness is a very common condition. Ayurveda has a better treatment option for Vertigo. This is how we treat our vertigo patients at Ukkiandas Ayurveda.

1. Vertigo- Bhrama
By
Dr Jayagovinda Ukkinadka

2. Introduction
• Bhrama or Vertigo is a common condition seen in
general population.
• Very common in elderly
• Major cause of fall in elderly in above 60 age
group.
• Vertigo indicates a disease of ear- labrynth or of
Brain- Cerebellum, or Vertibro Basillar artery
insuffeciency.
• Vertigo can also be due to postural hypotension.

3. Vertigo in Ayurveda
• Explained under the heading Bhrama.
• But positional and non positional pattern is
not explained.
• Relation ship of Bhrama with ear pathology
was not known to our ancients.
• But treatment for bhrama on the basis of
doshik involvement is explained in our texts
which holds good even in todays practice for
vertigo induced due to different causes.

4. Vertigo in Ayurveda
• Rajoguna when joins with vitiated Pitta and
Vata results in Bhrama roga.
• No much elaboration is seen.
• Here Labrynth fluid, various infectious causes
represent Pitta and Cerebellum, VBI cause
represents Vata. Rajo guna one of the feature
is moving here and there, where most of
vertigo is due to non homogenous distribution
of debris in Labrynth, which is also influenced
by external movement. AVARANA is the
another pathophysiology to be considered.

5. Need of specific therapy
• In current medical practice none of the system
claims better treatment for vertigo induced
due to any cause. Present treatment in
modern medicine is symptomatic in most of
the conditions.
• Knowing the different causes of vertigo we
can develop specific treatment for vertigo of
different origin or vertigo produced due to
different NIDANA.

6. It is also said that

7. Means

8. Relationship between Doshas and
ROGA - Susrutha
• Susrutha while discussing about the relationship
between Doshas and Disease clearly says that
there is no intimate relation or bond between
dosha and diseases, if it is the case all living
creatures would be a NITYAROGI.
• He further says that many believe that Tridoshas
are the root cause for the disease but it is not
true, but a disease can not happen without the
involvement of dosha is the correct statement.

9. How doshas and Diseases are related?
• In the sky(dosha) one can see lightening(disease)
etc, if any one says that because of sky there is a
lightening, the statement is wrong but the truth is
sky is must for lightening to occur, but it happens
because of specific cause or NIMITTA. Hence for
all the disease Nimitta or NIDANA is the
important factor, but can understand the process
through different symptoms having specific
dosha, adhistana, sthananthara, nature of
damage considering the Hetu. Hence though we
don’t have much elaboration we can plan the
treatment to different BHRAMA having different
etiology and pathophysiology.

10. It is also said that

11. Treating diseases with no name
• Susrutha in another context though says that
dosha is a factor to understand the disease,
Nimitta is important, while explaining the
treatment of unexplained diseases mentions
of only dosha and symptom, but Vagbhata
corrects his version including the all factors of
etiology, pathophysiology as the consideration
for planning the treatment.

12. Hence the advantage is
• Now a days we know the pathophysiology of
many diseases causing Bhrama, i.e VIKARA
Prkarithi and Ashraya sthana and also we
know the etiology of many diseases causing
Bhrama. Eg- Vertigo induced by chronic otitis
media, over accumulation of endolymph in
cochlear duct, Ear wax accumulation etc with
the etiology.

13. TWO FORMS OF VERTIGO
• Peripheral – Pathology will be in middle, inner
ear or labrynth
• Central – pathology will be cerebellum, brain
stem or 8th cranial nerve.
• VBI where symptoms of both peripheral and
central vertigo is seen, because all are
supplied by vertebro basilar artery.

14. IDENTIFYING THE CENTRAL VERTIGO
• Gradual onset
• Less intense
• Associated other neurological signs- may be cerebro
vascular accident, motor ataxia of hand, leg or gait
ataxia, imbalance on walking, occipital headache,
speech difficulty may co exist.
• Nystamus when iduced* usually starts suddenly and
is vertical and by gazing at one point usually
precipitated.
• Pattern of nystagmus changes by changing gazing
pattern-vertical nystagmus to rotatory and horizontal
and sometimes zigzag.
* Nystagmus is induced by Dix-Hallpike maneuver

15. IDENTIFYING THE PERIPHERAL VERTIGO
• Presence of nausea and vomiting
• Abrupt onset
• Nystagmus when induced* will be usually
horizontal or rotatory, sometimes absent, when
done on the affected side-straight, left or right.
• Nystagmus usually starts after few seconds
when induced and lasts for less than one
minute.
• Pattern of nystagmus does not change by
changing the direction of gaze.
• Absence of neurological signs like imbalance,
absent motor ataxia of limbs and hands,
absence of gait ataxia etc.

16. Dix-Hallpik
maneuver

17. DIFFERENT CAUSES FOR VERTIGO IN
PERCENTAGE.
• Idiopathic pathology (including BPPV) - 39%
• Trauma - 21%
• Ear diseases - 29% (Otitis media - 9% , Vestibular
neuritis - 7%, Ménière disease - 7%, Otosclerosis -
4%, Sudden sensorineural hearing loss - 2%)
• CNS disease - 11%
• Vertebral basilar insufficiency - 9%
• Acoustic neuroma - 2%
• Cervical vertigo - 2%
• Other than these, ingestion of toxic substances,
drugs like alcohol intake, insomnia also induces
vertigo.

18. BENIGN POSITIONAL PARAXISMAL
VERTIGO
• Exact cause is not known, but non homogenous
distribution of debris in fluid in inner ear which
maintains body balance is the cause for giddiness,
but exactly which causes this condition is not well
understood.
• Main clinical features are-
• Positional vertigo-always induced by change in
position
• Lasts only for 10-20 seconds. But may start
abruptly and frequently
• Usually seen in elders

19. MÉNIÈRE DISEASE
• No single entity is known to be responsible for
Ménière's disease. It is currently thought to be due to
overaccumulation of endolymph in the cochlear duct.
Ménière's disease is defined as
• recurrent, spontaneous episodic vertigo - Acute attacks
may be accompanied with sudden falls without loss of
consciousness. These are termed as drop attacks
• hearing loss;
• aural fullness;
• tinnitus.
Either tinnitus or aural fullness (or both) must be present
on the affected side to make the diagnosis.

20. How we treat Bhrama in UA
• BPPV
• Gasinil of Ukkinadkas Ayurveda 25ml twice daily
• T. Kamadudha Ras for symptomatic improvement 1
tablet TID or BID
• T. Lashunadi Vati 1 tablet twice daily
• Gandhaka rasayana 1 tablet three times daily(must in
case of otitis media, otomycosis and labrynthitis)
• Otoclean ear drop a product of Ukkinadkas Ayurveda
with very good action in otomycosis, hardened ear
wax, and in BPPV, but contraindicated in otitis media.
• Course: from 1.5 to 3 months.
• We also advise specific neck exercises - Epley
maneuver.

21. Epley
maneuver

22. MÉNIÈRE DISEASE
• Varunadi Gana kwatha and Nimbamrithadi
kwatha with concentration of 25g kwatha
churna per day gives tremendous result.
• T Chandraprabha Vati 250mg tablet three times
daily
• T Kaishora Guggulu 1g tablet three times daily
• T Gandhaka Rasayana250mg, 1 tablet three
times daily.
• otoclean ear drop 2 drops twice daily.

23. OTITIS MEDIA
• 1. Varunadi gana kwatha -25g per day.
• 2. Gandhaka rasayana tablet- 1 tid
• 3. Kaishora guggulu 1 tid
• 4. Naradiya laxmi vilasa ras 40mg tid
• 5. sprinkle 1-2 pinch of Tankana bhasma to ear
or use antibiotics if necessary to control otitis
media.
• If Allergic rhinitis is the cause for this condition,
then treat both condition to avoid recurrence.

24. OTOMYCOSIS
• 1. Varunadi gana kwatha 25 g per day
• 2. Gandhaka rasayana 1 tid
• 3. Naradiya laxmi vilasa ras 40mg tid
• 4. oto clean ear drop 2 drops twice daily
• It is very important to ask the patient to plug
the ear with cotton, soaked and squeezed in
castor oil before taking head bath for next 3
to 6 months to avoid water entry to ear. This
should be followed in otitis media also.

25. Vertebro Basilar artery insufficiency
• Saraswatharista 25 ml bid
• Cholestonorm capsule 1 tid (a special product from
Sahasraksha vaidya shala used as blood thinning agent.
This can not be used along with Aspirin, if used induces
gastric bleeding or haematuria. We are using this capsule
in ischemic strokes in our hospital since more than 6
years, we don’t use any of the modern blood thinning
agents since last 6 years. We have done clinical research in
clinic level (bleeding time, clotting time and prothrombine
time) with satisfactory findings. We have replaced
clopidogrel and aspirin in hundreds of patients with
ischemic stroke, and in patients with mitral regurgitation
with positive result)
• …Contd

26. • T. Hemoclean (a product of SVS, Ukkinadka, used in
atherosclerosis and any fibrosis condition as
supportive remedy to rebuild the tissues, the main
ingredient is Patola, Ashwatha, Karanja, Putikaranja,
Nimba etc.)(can also be used in piles, atopic eczema
and urticaria)
• Arjunarista 15 ml bid to improve blood circulation by
enhancing the pumping ability of heart. It is always
advisable to use Arjunarista in any ischemic condition
to get fast result. We have observed such result in
many cases.
• This should be continued for very long time.
Cholestonorm is for life time in this case.
• Ask the patient to quit smoking, alcohol, excess intake
of red or white meat to avoid progression of
pathology.

27. • CNS causes like cerebellar lesions, cerebellar
ischemic strokes(postero inferior cerebellar
artery ischemia), mid brain ischemia.
• Here the condition should be treated as if we
treat ischemic stroke.

28. Conclusion
• Bhrama or vertigo is a very common condition
among the elderly people. Considering the
treatment options in Ayurveda, we can
improve the treatment technique still better.
• In our experience we have successfully treated
hundreds of vertigo including BPPV, Menier’s
disease etc, where many of them came after
failure with modern medicine.

29. … Conclusion
• Even in case of vertigo due to chronic otitis
media where the common triggering cause is
allergic rhinitis, we have better treatment
option in comparison with the modern
medicine.
• In case of central vertigo we have to consider
Avarana, Srothorodha, sthana, Nidana etc
while planning the treatment.

30. THANK YOU