A UNIDIMENSIONAL APPRAISAL OF THE PRAGMATIC APPLICATION OF JALAPRATARAṆA AS A HETU-VYADHI VIPAREETARTHAKARI VIHARA UPASHAYA IN URUSTHAMBHA W.S.R. TO THERAPEUTIC IMPACT OF SWIMMING IN THE MANAGEMENT OF LIPID MYOPATHIES

Roga pareeksha and Rogi pareeksha constitute the two primary diagnostic components of Ayurveda. Nidana panchaka—comprising Hetu, Purvaroopa, Roopa, Upashaya-Anupashaya & Samprapti - serves as a comprehensive diagnostic framework for understanding the modalities of roga pareeksha. Among these, Upashaya and Anupashaya exemplify a trial-and-error approach applied prior to definitive diagnosis and treatment selection. The Upashaya method is particularly valuable when clinical symptoms overlap, aiding in differential diagnosis through therapeutic testing. Administration of Ahara, Vihara, or Aushadha that acts contrary to the Hetu, Vyadhi, or Hetu-Vyadhi is termed Vipareeta upashaya, whereas the approach that aligns with them is known as Vipareetartakari upashaya. Though the concept of vipareetarthakari upashaya appears complex, our Acharyas have provided clear rationales to justify its therapeutic relevance. A classical example is the advocacy of jalapratarana in urusthambha, an application of hetu-vyadhi vipareetarthakari vihara upashaya. Urusthambha is a disorder best managed through Ayurvedic shamana aushadhis. However, jalachankramana chikitsa as described by Acharya Charaka proves particularly effective by facilitating the vilayana of accumulated meda dhatu in the uru pradesha, thereby restoring the normal function of avruta vata. Pathologically, Urusthambha can be correlated with lipid myopathies, wherein adiponectin and endothelin-1 play crucial roles. Adiponectin exerts a protective effect by promoting fatty acid oxidation and reducing lipid accumulation in muscle cells, suggesting its potential as a novel therapeutic target for myopathies. Interestingly, studies indicate that cold-water swimming elevates adiponectin levels, thereby imparting beneficial effects on the musculoskeletal system. Moreover, combined interventions such as whole-body cryotherapy and cold-water swimming are known to elevate HDL levels while reducing LDL and total cholesterol. Experimental studies on animal models further support the beneficial effects of swimming exercise in mitigating myopathies via reducing ET-1, enhancing vascular function and decreasing ET-1 mediated vasoconstrictor tone.