World Journal of Pharmaceutical Research

Porselvi et al. SJIF Impact

World Journal of Pharmaceutical Factor 7.523
Research
Volume 6, Issue 10, 1486-1496. Research Article ISSN 2277– 7105

MANAGEMENT OF CHOTTU NEER (URINARY INCONTINENCE)

WITH VARMAM THERAPY

T. Porselvi*, G. Saraswathi, M. Mahalakshmi, M. Kodeeswaran and N. Shunmugom

Thirumoolar Varmam Therapy & Research Institute, Coimbatore, Tamilnadu, India.

Article Received on ABSTRACT

20 July 2017, Urinary incontinence (aconuresis) is any involuntary leakage of urine
Revised on 10 August 2017,
Accepted on 30 August 2017 causing social stigma. According to Siddha literatures Urinary
DOI: 10.20959/wjpr201710-9477 incontinence is termed “chottu neer or chottu muthiram”. The
causative factors, symptoms and medicinal remedies for Urinary
*Corresponding Author incontinence were explained detailed in the Siddha literature. Varmam
T. Porselvi therapy is the drugless theraphy and a special medicine of Siddha
Thirumoolar Varmam
medical System contributed by the siddhars for promoting the human
Therapy & Research
health. Subtle energy that functions in the body is known as Varmam.
Institute, Coimbatore,
Tamilnadu, India. Those places where this energy resides and activates both body and life
are varma points. In this clinical study we stimulated therapeutically
varmam therapy for the management of urinary incontinence. For this clinical study we
selected 65 patients (17 male, 29 female and 19 children) in the age group 5-80 years.
Therapy was given twice a week, from four week to one year. After the treatment we
concluded that treatment was found effective against stress incontinence, urge incontinence,
overflow incontinence, functional incontinance and bed wetting and it gave 93.85% excellent
results.

KEYWORDS: Urinary incontinence, Siddha, Varmam therapy, Literature, clinical study.

INTRODUCTION
Urinary incontinence (UI) is any involuntary leakage of urine, affecting male, female
including children. The urine leakage may range from leaking of a small amount to having
very strong urges to urinate that are difficult to controll. Women experience it twice as often
as men. Nocturnal enuresis (Bed wetting) involuntary urination while asleep after the age at
which bladder control usually occurs. As per Siddha literatures Urinary incontinence is
termed “chottu neer or chottu muthiram”. The word chottu means drops, muthiram means

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urine in Tamil language. According to Siddha literature ‘Siddha Maruthavam’ by Dr.

Kupusamy Mudaliyar (1987), explained the causative factors, symptoms and medicinal
remedies for Urinary incontinence.[1] According to the oldest siddha text Theran karisal
explained that the affected person had inability to control urination, urine passes
involuntarily. UI divided into two types one is adult Urinary incontinence other one is
children Urinary incontinence. Siddha system has explained that footcause of all the diseases
are the three humour of vatham, pitham and kapam, Vatham imbalance is for the UI. It is due
to Urethral stenosis, Emotional expressions like Fear, Anxiety and Panic, Urinary Tract
Infections, intestinal worms, wheezing, polyuria and Oliguria. The author Kuppusamy 1987
explained that UI in adult is due to Chronic diabetes, hemiplegia, parkinson’sdisease and
Nervous disorder.[1]

In modern medicine UI’s causes are Weak pelvic floor muscles, Urinary tract infections,
Spinal cord injuries, Emotions, Endocrine disorders, Stool impaction, Restricted mobility,
Chronic diabetes, Stroke, parkinson’sdisease, Benign prostate hypertrophy-only for males,
Child birth-only for femal, Aetiology in children, Neurological developmental delay, Genitics
and Insufficient production of anti diuretic hormone.[2,3] Clinical studyarious causes for UI
include idiopathic causes blader cancer, prior urethral or bladder or pelvic surgery, trauma
due to surgical or obsteric procedures and congenital.[4] In allopathic medical system divided
into many types base on symptoms. They are Stress Urinary Incontinence, Urge Urinary
Incontinence, Over flow Incontinence, Over Active Bladder, Functional Incontinence and
nocturnal enuresis (bed wetting).

Varmam therapy is the drugless theraphy and a special medicine of Siddha medical System
contributed by the siddhars for promoting the human health. Subtle energy that functions in
the body is known as Varmam. Varmam is the manifestation of the subtle energy (pranic
energy) of the five elements (Pancha bootha of Space, Air, Fire, Water and Earth), Gases,
Naadis, Vaasi and Kundalini. Those places where this energy resides and activates both body
and life are varma points. These points are located in nerves and naadis, muscles and bones.
Those places where this energy resides and activates both body and life are varma points. The
text titled “Varma Vilvisai” mentions 8000 varma points in the body5. The author
Thiyagarajan mentioned in his book “Siddha maruthuva sirappu” in 108 points6. By
stimulating the varma points the flow of pranic energy can be restored which will inturn
restores the normal function of the body (Sivaranjani, 2016).[7]

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Another article discribed about varma is Siddha system of medicine emphazise various
modalities of treatment, Among them drugless therapy is considered to be supremo and
Varma therapy comes under this category (Natarajan S et.al, 2012).[8] As the geriatric patients
suffer with a multiple of diseases, no new drug has been discovered so far, for the total
geriatric healthcare. This makes the patients to take specific drugs for each disease which
lead them to frustrate over its adverse effects. So they prefer to have a drugless therapy as
Varma therapy plays a unique role in it. Chelvi et al. 2016 explained that Varmam is the
unique therapy of Siddha System used to treat multiple ailments, especially related to
musculoskeletal and neurological deficits. This helps the affecting persions either acting by
locally or regulating the three humors of Vali, Azhal and Iyam.[9] Varmam therapy can also
be used along with internal medications and external applications as well. Varmam is the
points wherever the energy (pranan) is stored and when particular area or organ is affected,
the energy will spread to that area and make that organ function perfectly. This treatment
methodology is educated by the guru-disciple method (Gurukulam). The guru who coached
varmam is called as “Varmani” or “Aasan.” According to Siddha principles, the movements
of the body are mainly controlled by Vali. Hence, the varmam points were also classified as
Vali, Azhal and Iyam varmam points.[10] This theraphy is very effective in UI of aged
peoples.

Berghmans et al, 2000 was previously explained that their randomized clinical trials of urge
urinary incontinence in women the physical theraphyies were very effective (Berghmans
L.C.M et al, 2000).[11] In the present study was to evaluate the effect of varmam therapy on
Urinary incontinence management. The result of the clinical trial study may help in the
betterment of disease management.

MATERIALS AND METHODS

Study Design and subjects
A tottal of 65 subjects with complaints of urinary incondinence attending the Art Research
Institute (ARI), Coimbatore, Tamilnadu. For this clinical study we selected 65 patients (17
male, 29 female and 19 children) in the age group 5-80 years. Therapy was given twice a
week, from four week to one year. Both inclusion and exclusion criteria of the patients were
mentioned below.

Inclusion criteria
Both sexes

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Age groups 5 to 80 years

Exclusion criteria
Age below 5 and above 80 years
Urinary Stones
Tumors that block the urinary tract
Carcinoma of Prostate and Bladder
Cystocele
Benign prostate hypertrophy
Patients who have failed to appear for the treatment less than 5 sittings were not considered
for summing up results.

Therapeutic schedule
The following varmam points were stimulated one time per day for consecutive 5 sittings in
2weeks. The pressure was mentioned in Varmam literatures.[4] (Table No.1).

Table No. 1: Varma points for the treatment of UI.[4]

S.No Varmam points[4] Location[4] Function[4]
Middle line near to the Connects Gross Body With Subtle
1. Kondaikolli Varmam[12]
cranial vertex. Body
Outer surface of the occipital Regulates the function of higher centers
2. Pin kannadi kaalam[13] bone just below the occipital for micturition and enhances the
protuberance. function of spinalcord
Right flank zone (lumbar)
Regulates the functions and tonicity of
3. Muthira kaalam[12] and Left flank zone (lumbar)
bladder and ureters.
of abdomen regeion
Right side articulation of Control the flow of urine, gives streanth
4. Idamburi kaalam[14]
sacro iliac bones. to urethral sphincter muscles.
Left side articulation of Control the flow of urine, gives streanth
5. Valamburi kaalam[14]
sacro iliac bones. to urethral sphincter muscles
Inferior ramus of the ischium
Improve the tone and function of the
6. Nairuppu kalam[13]
(ascending ramus) pelvic floor muscles.
Upper portion of Suprapubic Increase the stranth and activities of
7. Kallidai kalam[15]
zone of lower abdomen baldder and urethra.
Strengthen The Nerves Of Bone
8. Adimootu varmam[16] Middle Of The Cubital Fossa
Marrow

Clinical observations
70 patients were observed. Treatment ranged from 4 weeks to 1 year as required. Varma
points were stimulated twice a week. Diet advices & exercises were taught to them. Most of
the patients got immediate response for their problem they were able to control their urgency

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until they reach the bathroom. Once the points were given continuously, the results were
good.

Few patients got response only after 8 to 9 times giving the varma points. In Children the
response was very good. They were able to wakeup when the bladder is full.

Response to varmam treatment

Good Response – 24%
Moderate Response – 34%
Mild response – 17%
Poor response – 5%
20% patients did not follow regularly.

RESULTS AND DISCUSSIONS

A tottal of 65patients was considered for this study. Of them 46 were adults (17 males and 29
females) and 19 were children (13 boys and 6 girls). Out of 17 males patients 4- got mild
response, 11-had moderate response and 2- got good response. Out of 29 females patients,
only 3 had poor response, 6 had mild response, 8 had moderate response and 12 showed good
response. (Table No.2).

Table No. 2: Response of Varmam Therapy to UI in Adult patients.

Age No.
Category Poor Mild Moderate Good
groups Observed
30-50 4 - 1 2 1
Adult
50 - 80 13 - 3 9 1
Male
Tottal 17 - 4 11 2
15 - 30 2 - - - 2
Adult 30 - 50 16 2 2 5 7
Female 50 - 80 11 1 4 3 3
Tottal 29 3 6 8 12

Out of the 13 boys, only one had mild response and all the other had good response. Among
the 6 girls one showed poor response, another showed mild response and all the other showed
good response.

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Table. 3: Response of Varmam Therapy to UI in Child patients.

Age No. Poo Mil
Category Moderate Good
groups Observed r d
5 - 10 9 - 1 - 8
Male child 10 - 15 4 - - - 4
Tottal 13 - 1 - 12
5 - 10 5 1 1 - 3
Female
10 - 15 1 - - - 1
child
Tottal 6 1 1 - 4

Table No. 4: Response of different categories of UI to varma therapy.

Category of urinary incontinence number responded /
Type of number treated
Total
patients Bedwetting
SUI UI OFT OAB FI
Boys Girls
Male - 2/2 15/15 - - - - 17/17
Female 20/20 4/5 - 0/1 2/3 - - 26/29
Children - - - - - 13/13 5/6 18/19
Total 20/20 6/7 15/15 0/1 2/3 13/13 5/6 61/65

SUI: Stress Urinary Incontinence; UUI: Urge Urinary Incontinence; OFI Overflow
Incontinence; OAB: Over Active Bladder; FI: Functional Incontinence.

Fig.No. 1. Response of UI in different age groups to Varmam therapy.

The response of different categories of UI is presented in Table. No.4. Out of 17 male

patients 2 belonged to urge Urinary Incontinence and 15 to overflow Urinary Incontinence.
Out of 29 female patients 20 belong to stress Urinary Incontinence, 5 urge Urinary
Incontinence, 1 over active bladder and 3functional Urinary Incontinence.

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All the 9 children (13 boys and girls) came under bedwetting category. Stress Urinary
Incontinence was found only among adult females and all of them responded to varmam
therapy (3 mild, 6 moderate and 11 good responses).

Out of 7UUI (2 male and 5 female) mild response was observed in male and female patients
whereas one female responded good and another moderately. One female patient responded
poor.

All the fifteen patients belonging to overflow Urinary Incontinence were mala and all of them
responded to varmam therapy (3 mild, 10 moderate and 2 good response). One female patient
affected with overactive bladder responded poorly to varmam treatment. Three female
patients were affected with functional Urinary Incontinence. They had osteo arthritis of both
knee joints with Urinary Incontinence. Out of these one each showed poor, mild and
moderate response.

Bedwetting
Boys (13) are more than girls (6) in this category. Out of 13boys one had mild response while
good response was observed in all the other 12.Out of 6 girls one showed mild response, 4
good response and one poor response.

Fig. No. 2. Overall response of UI patients to varma therapy.

Urinary Incontinence is caused by various neurological and myogenic factors mentioned

above. Varmam therapy has literary evidence for treating diseases or conditions. The
following verses in varma kaandam and varma soothiram explain how Urinary Incontinences
occur. First we will see what varma kaandam has to say about this. As per the tamil varmam

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manuscripts “varma kaandam” the following points are used to controled the UI. First one is
Kondai kolli varmam, locates in Middle line near to the cranial vertex. Stimulation of this
point regulates the functions of core substance of inthriyaas. By inthriyaas we refer to both
gnanenthiriyangal of skin, tongue, eye, ear and nose also normalize the kanmenthiriyangal of
arm, leg, mouth, anys and genitals.[12] Second one is Pin kannadi kaalam, it situate in outer
surface of the occipital bone just below the occipital protuberance. Apply this varmam point
regulates the function of higher centers for micturition and enhances the function of
spinalcord.[13] Third one is Muthira kaalam, it placed in both side lower regions of the Right
flank zone (lumbar) and Left flank zone (lumbar) of abdomen area. Put these varmam points
regulates the functions and tonicity of bladder and ureters.[12] Fourth & fifth points are
Idamburi kaalam and Valamburi kaalam, these are located in right and left side articulation
of sacro iliac bones. Pertain these points control the flow of urine, gives streanth to urethral
sphincter muscles.[14] Sixth one is Nairuppu kalam, it placed in both side of Inferior ramus of
the ischium (ascending ramus). It improve the tone and function of the pelvic floor
muscles.[13] Seventh point is Kallidai kalam, it located in upper portion of Suprapubic zone of
lower abdomen. It is used to increase the stranth and activities of baldder and urethra.[15] The
last point is Adimootu varmam placed in middle of the cubital fossa. It gives strengthen to
the nerves of bone marrow.[16]

Locations Varma points

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Abdomen area divides into 9 zones. They are Right hypochondrium -RH, Epigastrium - E,
Left hypochondrium - LH, Right flank (lumbar) - RF, Umbilical -U, Left flank (lumbar) -LF,
Right iliac fossa (inguinal) - RIF, Suprapubic - SP, Left iliac fossa (inguinal) – LIF.[17]

CONCLUSION
Age and sex the response between the age group of 10 and 30 (G2 and G3) to varmam
therapy was 100% while 7.14%, 10% and 4.17% in age groups G1, G4 and G5 responded
poorly (Fig.1). Among males all the 17 responded to treatment while 26 out of 29 female

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patients (89.66%) are responded. Over all varmam therapy produced 46.15% good response
29.23% was moderate response, 18.46% had mild response and 6.15% poor response.

As on date to our knowledge there is no permanent cure for this condition in other medical
treatment methods. From the results it could be arrived at that varmam therapy is an effective
method for the management of all types of UI. Further the tratment method is simple, non-
invasive and less time consuming without any side effects.

REFERENCES
1. Kuppusamymudaliyar, K.N. 1987. Siddha Maruthuvam, Second Edition, Published by
Siddha Medical Wing, Govt. of Tamilnadu.
2. Das P.C., Text Book of Medicine. 3rd edition, 2nd reprint, 1991, Current books
International, 60, Lenin saranee, Calcutta.
3. Streers WD. Physiology and pharmacology of the bladder and urethra. 1998. Vol 1,7th
edition. WB Saunders company, london. 26th chapter. 870-915.
4. Jerry G. Blaivas, LJ Romanzi, Heritz DM. Urinary incontinence: Pathophysiology,
evaluation, treatmentoverview and non-surgical management. 1998. Vol 1,7th edition. WB
Saunders company, London. 30th chapter. 1007- 1043.
5. Shunmugom, Abdul azees N, Shailaja R, Sugunthan S. The Foot Prints of Medical
Varmalogy (An Ancient Indian Medical System). Art Research Institute (ARI),
Coimbatore, Tamilnadu. 2012.
6. Thiyagarajan R, Siddha maruthuva sirappu, 2nd edition, Director of Indian Medicine and
Homeopathy, Arumbakkam, Madras., 1995; P.No.14.
7. Sivaranjani. Varma therapy for musculoskeletal disorders. European Journal of
Pharmaceutical and Medical Research. 2016; 3(10): 131-135.
8. Natarajan S, Nagarajan T, Sathiyarajeswaran P, Kannan M. The Role Of Varma Therapy
In Cakana Vatam. Webmed Central INDIAN MEDICINE, 2012; 3(9): WMC002906.
9. Maanickha chelvi KS, Rajesh kumar, Rajendra kumar A. Role of varmam therapy in
kumbavatham management. Asian J Pharm Clin Res, 2016; 9(2): 298-300.
10. T.V. Sambasivam Pillai, Tamil Dictionary Vol.1-5. Fourth edition, Tamilnadu Siddha
Medical Council, Chennai. 1994.
11. Berghmans L.C.M, H.J.M. Hendriks, R.A. DE BIE,{E.S.C. van waalwijk van doorn, k. bé
{& ph.e.v. van kerrebroeck. Conservative treatment of urge urinary incontinence in

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women: a systematic review of randomized clinical trials. BJU International, 2000; 85:
254±263.
12. Anonymus Manuscript of Varma kaandam, Thirumoolar Varma Therapy centre, Art
Research Institute (ARI), Coimbatore, Tamilnadu, India. Verse, 625.
13. Anonymus Manuscript of Varma Sootcham. Thirumoolar Varma Therapy centre, Art
Research Institute (ARI), Coimbatore, Tamilnadu, India. Verse, 1103-1104.
14. Anonymus Manuscript of Narambarai 108. Thirumoolar Varma Therapy centre, Art
Research Institute (ARI), Coimbatore, Tamilnadu, India. Verse 26.
15. Anonymus Manuscript of Varma Choodamani. Thirumoolar Varma Therapy centre, Art
Research Institute (ARI), Coimbatore, Tamilnadu, India. Verse, 628.
16. Vedhasathi ennum varmamkalai, Thirumoolar Varmam Therapy & Research Institute,
Coimbatore, Tamilnadu, India, 2012.
17. Clayton L.Thomas. Taber’s cyclopedic Medical Dictionary. Jaypee brothers, Medical
publishers (p) ltd, New Delhi, India. 18th edition. 1998.

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