Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Hanu means lower jaw / mandible
Graha means tightness, catch, rigidity, lock, arrest
Hanugraha is a condition explained in the context of Vatavyadhi – special vata disorders of ‘only vata origin’. It is marked by tightness of the jaw or at the joint of the lower jaw which makes opening and closing the mouth difficult.
It is also called as ‘Hanustambha’ by some experts, which also means the same. Stambha also means tightness or stiffness or rigidity.
Causative Factors of Hanugraha
General etiological factors
Since Hanugraha has been explained in the context of Vatavyadhi, all etiological factors of vatavyadhi and all those factors which cause aggravation of vata including foods, activities, behaviours and seasonal changes would also serve as etiological factors for Hanugraha.
Specific etiological factors
जिह्वानिर्लेखनाच्छुष्कभक्षणादभिघाततः।(वा.नि.अ.१५)
Master Vagbhata enlists specific etiological factors for Hanustambha and they are as mentioned below –
Jihva nirlekhana – tongue scraping – Opening the mouth in excess and for prolonged periods of time while putting the tongue out, for the purpose of scraping / cleaning the tongue and teeth with the help of tongue cleaners and brushes respectively would put pressure on the jaws and excessive related movements will cause aggravation of vata.
Shushka Bhakshanat – Excessive eating of dry and hard foods. This needs a lot of effort for chewing the food and there is lot of jaw activity involved in it. Dry foods also cause vata aggravation.
Abhighata – Injury to the jaw, joints and other structures of the jaw is yet another important etiological factor for stiffness to occur in the jaw and cause hanugraha / hanustambha. Abhighata is an important causative factor for aggravation of vata.
Samprapti: Pathogenesis
कुपितोहनुमूलस्थःसंसयित्वाऽनिलोहनुम्।।४९।।(वा.नि.अ.१५)
According to Master Vagbhata –
Due to the above said etiological factors, the vata located in the hanumula i.e., root of the jaw gets aggravated and causes looseness and dislocation of the joints of the jaw. This condition is called hanugraha.
हनुमूले स्थितो बन्धात् संस्रयत्यनिलो हनू|
विवृतास्यत्वमथवा कुर्यात् स्तब्धमवेदनम् ||४९||
हनुग्रहं च संस्तभ्य हनुं(नू)संवृत वक्रताम् |५०| च.चि.२८/४९-५०॥
According to Master Charaka –
The aggravated vata located at the hanumula i.e. root of the jaw causes loosening of the structures which hold the jaw joint in position and causes dislocation of jaw bones. This leads to a condition wherein the mouth of the patient constantly remains opened along with stiffness. There will be less pain. It may also cause lockjaw. This would occur because of the stiffness of the joints of the jaw when the mouth remains closed. Here the patient would feel difficulty in opening the mouth. This condition is called Hanugraha.
Symptoms of Hanugraha
करोतिविवृतास्यत्वमथवासंवृतास्यताम्।
हनुग्रहःसतेनस्यात्कृच्छाच्चर्वणभाषणम्।।५०।।(वा.नि.अ.१५)
Below mentioned are the symptoms of Hanugraha
– The mouth of the person would either remain open or closed at all times
– Due to the mouth being shut or open constantly at all times, it would cause difficulty in chewing the food
– The same mechanism of pathogenesis would cause difficulty in speaking
Master Charaka too has mentioned the same symptoms. Apart from mentioning the stiffness of the jaw and tightness of the joints of the jaw, he has also mentioned that Hanugraha will be associated with less pain. So, stiffness is a predominant complaint in Hanugraha while pain is not. It is only associated with symptoms which are also mild in nature.
Prognosis of Hanugraha
सन्धि च्युति र्हनुस्तम्भः कुञ्चनं कुब्जताऽर्दितः||७२||
……………………………………………………….
एते स्थानस्य गाम्भीर्याद्यत्नात् सिध्यन्ति वा न वा|
नवान् बलवतस्त्वेतान् साधयेन्निरुपद्रवान्||७४|| च.चि.२८/७२-७४॥
While discussing the prognosis of Vata Vyadhis, some diseases have been mentioned which can be cured only after administering careful and timely treatment. If treatment is not provided at proper time and if not managed properly, these diseases cannot be cured at all i.e. they would become incurable because of their deep-seated and chronic nature. They can also be cured when they are newly manifested and in strong patients and when not associated with complications. Hanustambha too has been mentioned amongst these diseases.
So, Hanustambha or Hanugraha can be cured if –
– addressed early with proper interventions, when the disease is acute and newly manifested,
– the patient is strong enough
– proper treatment is given at proper time,
– it is not associated with complications
On the other hand, if neglected or if the disease gets chronic or mis-managed, it would become incurable.
Treatment of Hanustambha / Hanugraha
General line of treatment
सर्पिस्तैल वसा मज्ज सेकाभ्यञ्जन बस्तयः ||१०४||
स्निग्धाः स्वेदा निवातं च स्थानं प्रावरणानि च|
रसाः पयांसि भोज्यानि स्वाद्वम्ल लवणानि च||१०५||
बृंहणं यच्च तत् सर्वं प्रशस्तं वात रोगिणाम्|१०६| च.चि.२८/१०४-१०५||
Since Hanugraha is a Vata Vyadhi, general line of treatment of vata vyadhis will also be applicable for treating this condition. This includes medicines, treatments, lifestyle changes, behaviours and diet which are good for vata i.e. which helps in mitigating aggravated vata and balancing it.
They include –
– Snehana – use of ghee, oil, muscle fat, bone marrow
– Swedana – sudation
– Abhyanga – herbal oil massage
– Basti / Vasti – medicated enemas – decoction and oil (unctuous) enemas
– Nivatam cha sthanam – living in places devoid of wind
– Pravarani cha – covering the body with blankets and shielding from cold
– Rasah – consumption of meat soups
– Payamsi – consumption of different types of milk
– Bhojyani svadu amla lavanani cha – consumption of foods which are predominantly sweet, sour and salty / saline in taste, which are vata-mitigating and balancing tastes
– Brmhanam yat cha – any other measures which are nourishing in nature
– And all other effective anti-vata remedies like vasti etc
Specific line of treatment
व्यात्तानने हनुं स्विन्नामङ्गुष्ठाभ्यां प्रपीड्य च||१०२||
प्रदेशिनीभ्यां चोन्नाभ्य चिबुकोन्नामनं हितम्|
स्रस्तं स्वं गमयेत्स्थानं स्तब्धं स्विन्नं विनामयेत्||१०३||
प्रत्येकं स्थानदूष्यादि क्रिया वैशेष्यमाचरेत् |१०४| च.चि.२८/१०२-१०४
In Hanugraha, if the mouth remains open, swedana – fomentation is given to the jaw and jaw joints (mandibular joints). After giving swedana, the jaw joints are pressed with the help of thumbs inserted into the mouth. At the same time, the lower jaw (mandible) and chin are elevated with the help of index fingers kept outside. With this manoeuvre, the jaw bone (mandible) which has been dislocated will slide back into its normal position. If there is increased stiffness of the jaw joint, it should be given with fomentation. Following this, it is pressed downwards to ensure mobility of the joint. But care should be taken to give specific therapies for each patient depending on the location of vata, the dhatus affected by vitiated vata and factors like avarana i.e. obstruction or occlusion of vata etc.
Important Therapies
– Abhyanga with Mahamasha Taila or Ksheerabala Taila
– Swedana – with milk processed with Dashamula
– Nasya – with Anu Taila or Mahamasha Taila
– Gandusha – with Ksheerabala Taila or Tila Taila
– Vasti – in complicated conditions not responding to conventional therapies and medicines
Important Formulations
– Pathyakshadhatryadi Kashayam
– Maharasnadi Kashayam
– Balarishta
– Ashwagandharishta
– Triphala Guggulu
– Panchamrita Loha Guggulu
– Vatavidhwamsini Ras
– Ekangavira Ras
Other considerations
Hanugraha shall also be treated on the lines of –
– Ekanga Roga
– Pakshavadha
– Ardita
Modern perspective
Hanugraha is correlated to a condition called ‘lockjaw’ or ‘jaw stiffness’ or ‘jaw tightness’ explained in modern medicine. The disease has similar symptoms to those of Hanugraha or Hanustambha.
‘Related Reading – Jaw Tightness or Locked Jaw’
