AYURVEDIC MEDICINE for Cluster Headache

Natural treatment option with potential cure or significant relief for Cluster
Headache

Ossi Viljakainen

Introduction
Ayurveda is an ancient medical science and health care tradition having its earliest origins
some 7000 years ago, and that has been practiced in its present form in India for at least
5,000 years. The word Ayurveda comes from the Sanskrit terms ayur (life) and veda
(knowledge).

Though Ayurveda or Ayurvedic

medicine was documented in
the sacred historical texts known
as the Vedas thousands of years
ago, Ayurveda has significantly
evolved over the years, and new
discoveries and additions to its
system are done regularly.

Ayurveda is widely practiced on

the Indian subcontinent more
than 90 percent of Indians use
some form of Ayurvedic medicine
as means for better health,
improved immunity, balance of
mind and basic healthcare.

Principles of Ayurveda
Health care is a highly individualized practice under Ayurvedic principles, which state that
everyone has a specific constitution, or prakruti, that determines his or her physical,
physiological and mental character and disease vulnerability, explains Dr. Bala Manyam, a
neurologist and professor emeritus at Southern Illinois University School of Medicine.

According to Ayurveda, ones bodily constitution, or Prakruti is determined by three "bodily

energies" called doshas. These three doshas, namely, Vata, Pitta and Kapha function in the
physical body and give it its unique qualities. Though everyone has some features of each,
most people have one or two that predominate.

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The theory of Ayurveda considers that factors such as stress, unhealthy diet, weather and
strained relationships can all influence the balance that exists between a person's biological
energies. These unbalanced energies in turn leave individuals more susceptible to disease.

Ayurveda and Science

Ayurveda as a medical system has a strong in-built emphasis on research and validation of
its principles. In the modern world, Ayurveda is by and large considered to showcase
traditional health care. The fusion of science and Ayurveda is well perceived by Ayurvedic
physicians in India, and in the Ayurveda colleges, universities and research institutes.
Ayurvedic schools in India consistently urge for research to scientifically verify the validity of
the Ayurvedic principles2) mentioned in the classical texts.

Global dissemination of Ayurveda has required its scientific presentation, and during the past
two decades A vast amount of research has been completed, while an increasing amount of
broader research is currently in progress. Several among the new genre of Ayurvedic
doctors and scholars have prompted to sense this reality and stand up as intermediaries,
speaking in a mutually understandable language and retrieving the link of Ayurveda to
science while keeping its original flavor intact.

Scientific research on Ayurveda

Many researchers who study Ayurveda have seen that understanding patient's biological
energies (doshas) and in turn his or her body constitution (prakruti) can help determine
that patient's risk of developing certain diseases or health conditions. In a study published in
2013 in the Journal of Alternative and Complementary Medicine, Dr. Manyam used the
principles of Ayurvedic medicine to identify populations that may be at higher risk of
developing Parkinson's disease. The study found that the incidence of Parkinson's disease
was highest in those with a vata prakruti (those whose dominant dosha is vata).

Such studies can be helpful not only in identifying vulnerable populations for diseases but
also in delaying the onset of symptoms and slowing the progression of the disease,
according to Manyam.

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Disturbances in any of the three major doshas are addressed by a range of Ayurvedic
treatments, including herbal remedies, dietary restrictions, massage, yoga therapy,

meditation for stress relief, and breathing exercises called pranayama.

So far the effectiveness of these therapies has not been widely studied in clinical trials by
practitioners of Western medicine. Therefore, some western doctors and other health care
professionals consider Ayurveda a risky adjunct to conventional medicine, but this is mainly
due to the lack of well documented research.

Organizations such as the Ayurvedic Trust are now endeavoring to back up claims about the
efficacy of Ayurvedic treatments with peer-reviewed studies and articles, which are published
in the organization's two journals, Ancient Science of Life (ASL) and ASL-Musculoskeletal
Diseases.

Cluster headaches in Ayurveda

In the traditional medical texts of Ayurveda, headache is known as
Shiro Roga, which literally means head disease. Ayurveda
mentions various types of pain related head diseases, from mild to
severe and to unbearable. The classical Ayurveda texts mention 11
types of headache disorders in total. Thus in Ayurveda, headache is
not a single symptom or just a particular type of disorder, but it is
understood as a group of diseases, with various symptoms,
causative factors and etymological origins contributing to the
development of these conditions.

During the modern time, efforts have been taken by the scholars and
doctors of ayurveda to correlate these 11 types listed in the classical
texts with the descriptions used in the modern medicine. This has
been challenging at times, as the classical descriptions are quite
brief. However, in the recent literature reviews some progress has
been made, specially by the scholars AK Sharma et al. In their
research they were able to correlate cluster headache with the disease named as
ardhavabhedaka (half-head disorder) in the classical ayurveda texts. The disease

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corresponds very clearly with the symptoms of cluster headache, while the other two severe
types of headache seem to correlate with tension type headache and migraine.

The three more serious types are listed below:

Anantavata (tension headache)

"Strong pain in the back of the neck, reflecting specially to the area of the eyes, eyebrows,
and temples, localizing there and producing twisting to the sides of the cheeks, locked jaw
and several eye diseases. Such is described the head disease named Anantavata, caused
by the three forces together."

Suryavarta (migraine)
"Pain starting as mild from the area of the eyes and eyebrows (usually) with the rising sun (in
the morning), increasing gradually and reaching its peak and increasing in intensity with the
increase of light, and then finally subsiding with the setting sun (towards the evening), and
which can sometimes be subdued with cold measures and sometimes with warm measures.
Such is described suryavarta-head disease, caused by the three forces together, and which
is extremely disturbing."

Ardhavabhedaka (cluster headache)

"Person having a severe, tearing, exploding, prickingly penetrating, twisting pain in the head
limited to half of the head, and where the attacks tend to come every two weeks, ten days, or
suddenly (irregularly), is said to be suffering from head disease called 'Ardhavabhedaka'. Its
origin are the three forces together. "

Apart from these, there are many other factors, such as fever, metabolic disorders and
diseases of the eyes, ears and nose which can functions as contributing factors, or as a
cause for headaches, sinus headaches, migraines and cluster headaches. Other causes and
contributing factors are trauma, encephalitis, brain abscess, hypertension, cerebral
hemorrhage, vasodilator drugs, alcohol hangover, and tension of any kind. Any of these can
effectively be cured by Ayurvedic system of medicine.

Classical references:
Ayurveda literature consists of voluminous works written in Sanskrit language, the classical
language of India, in the same way as Latin language is the classical language of Europe.
These books describe thousands of diseases in detail, their symptoms, identification,
causes, progression and treatment. Ayurveda emphasizes the complete cure of diseases,
instead of simply managing symptoms. The classic texts mention clearly whether the
disease is curable, manageable or completely incurable.

In case of cluster headaches, Ayurveda does not indicate that the condition is incurable, and
not even, that it is difficult to cure, except when the condition has progressed further causing

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other complications, such as damage to the eye or ear. Even in these conditions, there can
be significant improvement, if not a full cure through Ayurvedic treatment modalities.

The Ayurveda book Yoga Ratnakara3) (approx. 1600 AD) a collection containing literature
quotations from various sources, many of them written around 300 BC and some dating
back to 1500 BC, contains the following verse:

rkandadhyaantprgvtvaya maithunaih
vegsadhranryasa vymaih kupito'nilh 17
kevalah sakapho v'rdha gr hitv irasou bal
many bhrakha karn ksilalt ardhesu vedanm18
astrani nibha kuryttibra so'rdhvabhedakh
nayana v'thav rotramativr ddho vinayet 19

Yoga Ratnkar, roroga 17-19.

The meaning of the above stanza is:

Coarse and dry diet, eating up in heavy quantities, taking on the easterly wind in
enormous measures, getting drenched up in dew, excessive in sexual activities,
keeping the call of nature on hold, the wind (vata) getting furious (aggravated) by dint
of exercise and labor; becoming stronger alone or in combination with cough, takes
into its grip half portion of the head, producing such a terrible pain in the parts as if
somebody is slashing the head with a very sharp edged weapon or somebody is
churning the head from inside within with a thorny churner. This unbearable and
excruciating pain is known as cluster headache or ardhvabhedaka. (translation by
Dr. Poonam Mishra)

Alternate translation:

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 Because of excessive indulgence in factors like eating dry foods, over eating,
exposure to air, intake of cold items, sexual acts, suppression of natural urges,
overworking etc, Vta gets aggravated, alone or in association with kapha dosa
spreads in half of the siras (head) and causes severe pain over many (back of the
neck), bhr (eyebrows), akha (skull), karna (ears), netra (eyes), half of lalt a
(forehead) regions. The pain is like cutting with sharp instrument or diamond, such
type of siroroga is known as ardhvabhedaka, if it aggravates, causes loss of vision
and hearing. (translation by Dr. S. Suresh Babu)

It seems the above verse is originating from an earlier Ayurveda text, Caraka Sahit4)
(approx. 300 BC) an authoritative Ayurvedic textbook containing detailed descriptions of
hundreds of diseases, and their treatments, contains the following verses:

rkstyadhyaant prvavtvayyamaithunaih
vegasam dhranysavyymaih kupitonilah74
kevalah sakapho v ardham gr htv irasastatah
manybhrakhakarnksilalt rdhotivedanm75
astrraninibhm kuryttvrm so ardhvabhedakah
nayanam v athav rotramativr ddho vinayet76

Caraka Samhita 8.9.74-76

Translation of the above verses:

The vyu (vata-dosha) gets aggravated by the intake of un-unctuous ingredients,
food in excess quantity, intake of food before the previous meal is digested, exposure
to the easterly wind as well as fog, excessive sexual indulgence, suppression of the
manifested natural urges, fatigue and physical work. This vyu, alone or in
association with kapha causes seizure of half of the head thereby causing

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 excruciating pain in the sternomastoid region, eyebrows, temples, ears, eyes and
forehead of that half side. The patient experiences excruciating pain as if caused by
the injury of a weapon or arani ([a specific] churning rod used for producing sacrificial
fire) i.e. by the fire itself. This ailment is called ardhvabhedaka (hemicrania). If
exceedingly aggravated, this ailment may even destroy the eyes and ears of the
patient.
Caraka Samhita Siddhi Sthna 74-76
(Translation by Prof. Dr. R.K. Sharma & Vd. Bhagwan Dash)

Alternate translation:
Adhyashana (irregular patterns of eating, and also eating again prior to digestion of
previous meals), Vega-dharana (suppression of natural urges sneezing, urination,
etc.), Ayaas (excessive exertion overwork, too heavy exercise), Atimaithuna
(excess in sexual activities, or excessive masturbation) and roaming around in cold
air and wind without protecting the body (and head) may be few reasons for the
vitiation of the Tridosha, which may cause Ardhavabhedaka (Cha. Si. 9. 74-76).

Additionally, a third Ayurveda text, Suruta Samhit5) (approx 500 BC), mainly dealing with
ayurvedic surgery, contains the following verse describing a cluster headache:

Yastottamgrghamatva jantoh sambhedatodabhramalajust am15

paksddahdathav-pyakasmttasyrdhabhedam tritaydvyavasyet

Sushruta Samhita Utt. 25.15b-16a

Translation:
The person who has a severe headache of bursting, pricking and spinning types
confined to half of the head only and the attacks tend to come every fortnight, ten
days or suddenly (irregularly), is said to have a rdhavabheda type of (periodical)
headache. It is supposed to be sanniptaja in origin. (translation: Prof. G.D. Singhal
& colleagues)

Ayurvedic procedural treatments specific for cluster

headache
In general, there are two classes or types of treatments in Ayurvedic medicine.

1. Palliative care (Shamana Chikitsa) aiming at reducing the symptoms and managing
the disease by taking Ayurvedic medicines and following a diet plan at home, and
2. Procedural therapies, also known as purificatory treatments (Pancha Karma), with
the aim of completely curing the condition by eliminating metabolic wastes and toxins

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 from the deep tissues of the body, followed by nourishing therapies to re-vitalize the
affected tissues and organs, and finally balancing the body and mind.

The first type of treatment generally starts with a visit to an Ayurvedic consulting doctor for
diagnosis, interviewing the patient for case history, assessment of the individual body type
and the development of the pathology, followed by prescription of Ayurvedic herbal
medications, self-care treatments, diet plan and lifestyle coaching. But considering the
severity of cluster headaches, the Ayurvedic text books do not recommend this line of
treatment for cluster headaches, as it is not sufficient, and may give only minor, if any
improvement of the condition.

The second type of treatment, known as Pancha Karma treatment, aims at completely curing
the condition. This is has to be carried out at an Ayurvedic clinic, in a in-house treatment
facility. The treatment is always planned individually to suit the patients body type, strength,
body condition, severity of the disease and other associated diseases. The duration of the
treatment is typically three to four weeks (21-28 days), depending on the severity of the
condition. Shorter treatments are not advisable, as full 21 day procedure is required for
successful relief from disease as severe as cluster headache.

The treatment consists of various treatment modalities, such as herbal medicines,

administration of medicinal substances to the body via oil massages, steam baths, herbal
baths, eye treatments, ear treatments, nasal administration of medicines and medicated
enemas, along with special diet and withdrawal from use of sensory organs by remaining in
peaceful environment including refraining from the use of telephone, Internet, laptop, etc
distractive activities during the entire course of the treatment.

The treatment is given under strict supervision of the doctor, based on the individualized
treatment plan. Each morning the patient is examined by the doctor and the progress of the
treatment is assessed, and the treatments re-adjusted as per the needs of the patient. After
doctors consultation, the patient will receive the daily treatments and therapy, typically
lasting from 1,5 to 2,5 hours. After completing the daily treatments, the patient is asked to
take full rest for some time.

Treatment:

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catuhsnehottammtr irahkyavirecanam
ndsvedo ghr tam jrnam bastikarmnuvsanam77
upanhah irobastirdahanam ctra asyate
pratiyye iroroge yaccoddist am cikitsitam78

Caraka Samhita 8.9.74-76

For the treatment of this ailment the therapies to be use are as follows:
1. Catuh -sneha (four types of fat, viz., oil, ghee, muscle-fat and bone-marrow), to
be taken in heavy dose;
2. iro-virechana (inhalation therapy for the elimination of morbid matter from the
head);
3. Kya-virechana (emesis and purgation therapy for the elimination of morbid
matter from the body);
4. Ndi-sveda (a type of fomentation therapy vide Stra 14:43)
5. Jrna-ghrta (ten years old ghee)
6. Nirha and anuvsana types of medicated enema;
7. Upanha (application of hot poultice);
8. iro-basti (keeping medicated oil over the head with the help of a cap with
open ends);
9. Dahana (cauterization); and
10. Therapies prescribed for pratiyya and iro-roga (head-diseases)
Caraka Samhita Siddhi Sthna 77-78
(Translation by Prof. Dr. R.K. Sharma & Vd. Bhagwan Dash)

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In further chapters, the text describes the full treatment protocol of this disease.

Ayurvedic medicines for cluster headaches

Ayurvedic pharmacopoeia covers over two thousand herbs and dozens of minerals and
metals. The range of herbal and mineral medical preparations is very vast, consisting of tens
of thousands of classical and modern Ayurvedic formulations.

Several medicines are mentioned in various texts for the treatment of cluster headache, and
many texts emphasize the use of licorice root among other roots, pippali, camphor, calamus,
honey, sandalwood and several others.

Treatment procedures in the classical texts

Snuff and other therapies should be employed for the treatment of sryvarta
and the diet should mainly consist of meat of the wild animals, preparations of milk
and grains and ghr ta (ghee clarified butter). [30b-31a]

The above mentioned procedures should also be employed for the treatment
of ardhavabhedaka (cluster headache). The specific measures for this disease
should also be carried out. [31b]

+ +

Snuffing therapy with the juices of the roots and fruits of irsa or with the root
of vam sa mixed with camphor or with vca (Acorus calamus) and pippali (Piper
longum) or with mahuyast i (Glycyrrhiza glabra licorice root) and honey or with
manahil alone or with honey and candana (sandalwood) is beneficial and should
be employed. At the end of all these avapda therapies snuffing with mrv and ghr t a
is useful. A pasty application prepared from sriv, utpala, kust ha and madhuyast i
pasted with sour gruel and mixed with ghr t a and oil gives relief in both these
conditions. These measures should also be employed in kaphaja diseases of the
head. [32-36a]

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For the treatment of the disease of the head originating due to a combined
action of the dosas, the measures counteracting all the three dosas are beneficial.
The draughts of ghr ta, particularly of the old one, are also recommended.[24]

+




+

+

For the treatment of vtaja disease of the head, the measures described for
(the amelioration of) vtavyadhi should be undertaken. Ghr t a or oil should be taken
(orally) along with milk. Mudga (mung-dal), kalattha and msa should be used
exclusively as diet at night. Warm milk should also be taken after taking ghr t a with
acrid and warm substances moderately.
Alternatively, the person should take (tila) oil or the (tila) paste along with milk.
Irrigations with luke warm milk processed with the vta suppressive drugs should be
employed; or else lukewarm pyasa prepared from this milk, should be pasted over
the scalp. Alternatively, anointing the scalp may also be done with cooked flesh of
fishes or with kr s ar containing rock salt or with fine paste of candana (sandalwood),
utpala, kust ha and pippal. The oil processed with the juice of (the meat of) kulra
should be employed as a snuff after administration of oleation therapies.
Milk should be mixed with half the quantity of water and cooked with the
powdered drugs of varundi group till the (original) quantity of the milk proper is left
after which it should be cooled down and churned in order to obtain ghr t a out of it.
his ghr t a, reprocessed with the madhura group of drugs, is recommended for
snuffing. Ghr ta draughts should be taken along with this milk (processed with the
varundi group) with sugar added to it. Oily fumigation should be employed at the
proper time by the physician.
The wise should employ trivr t taila or bla taila orally and in the forms of
massage, snuff, enemas and irrigation therapies and should prescribe the oily juices
or else the properly processed milk as diet. [3-11]

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The diseases if the head arising from pitta and rakta should be treated by
anointing the scalp with the drugs mixed with ghr ta and by irrigating with cold fluids
containing milk, sugarcane juice, sour gruel, mastu, honey and sugar water.
Anointing of the scalp with nala, vetasa, lotus, candana, utpala, and padmaka along
with vam a, aivla, madhuyast i, musta and kamala, mixed with ghr t a may also be
done. The madhura drugs mentioned for the treatment of visarpa should be used for
anointing the face and also as snuffs. sthpana, purging and oily enemas (also) are
beneficial for the purpose.
Snuffing with ghr ta freshly prepared from milk or else with the fats of wild
animals and sthpana with milk boiled with utpala and other drugs are beneficial.
Feeding with meat juices of wild animals, anuvsana with ghr ta and oleation with
freshly obtained ghr ta processed with madhura groups of drugs and with sugar and
also other measures which are said to pacify pitta and rakta are useful in these
conditions. [12-18a]

Disease of the head arising due to (vitiated) kapha should be remedied by the
kapha-suppressive measures, cleaning errhines, (therapeutic) vomiting and holding
of potent drugs in the anal cavity. Later on, a few draughts of clear ghr ta should be
given to swallow and sudation therapy should be employed again and again.
The physician should cleanse (purge) the head with errhines consisting of
madhkasra, bark of igudi or that of mesaringi after administration of oleation
therapy. Sticks prepared from the barks of igudi and mesaringi should be used for
smoking and smelling of the powder of kat phala and holding of the kapha-
suppressive drugs in the anal cavity should also be carried out.
Saral, kust ha, rgest , devadru and rohisa; all these drugs powdered
and pasted with alkaline water and rock salt should be anointed over the scalp in a
lukewarm state.
The food prepared from barley and ast i (rice) and combined with trikat u and
ksra, should be given to (the patient) with pat o la, mudga-pulse (mung), kulattha
and meat juice in a reasonable quantity. [18b-23]

In his recent review article6) Sharma AK et al presented the following list.

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A) Medicines
1. Herbomineral preparations (Rasa yoga):
a. Shirashooladi Vajra Rasa
b. Shirvajra Rasa
c. Chandrakanta Rasa
d. Mahalaxmi Vilas Rasa
in dose of 125 mg to 250 mg, with honey and lukewarm water.

2. Decoctions (Kwatha):
a. Pathyadi Kwatha
b. Dashmoola Kwatha
In dose of 20 ml, with warm water.

3. Pastes applied on the head and scalp (Shirolepa):

a. Kumkum Ghrita Lepa
b. Sarvadi Lepa
c. Suryavartabeeja Lepa
d. Satavaryadi Lepa

4. Medicated oils for application on the head and scalp (Shiroabhyanga):

a. Dashmoola taila
b. Mahamayura ghrita

5. Nasally administered medications (Nasya Karma):

a. Shadbindu Taila
b. Anu Taila
c. Dashmoola Taila
d. Gunja Taila
e. Kumkuma Ghrita
f. Go Ghrita
g. Shirishaya Avapida
h. Dashmoola Kwatha
i. Bhringraja Swarasa
j. Goat Milk
Dose: Oils & Ghrita 68 drops in each nostril; Juice & Kwatha 2-5 ml in each
nostril.

B) Diet & Lifestyle (Ahara Vihara)

Along with the above mentioned therapies, the patient is usually prescribed lifestyle
modifications and diet restrictions, with the aim of bringing the body and mind back to
balance and harmony. Specific restrictions for cluster headache patients have been listed in
Ayurvedic texts. The following protocol is to be followed by those undergoing the Ayurvedic
treatment regimen, and will not give other than small symptomatic relief if the full procedural
treatment protocol is not carried out.

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1. Advisable (Compatible to be followed daily)
The diet should consist of warm, oily, and nourishing foods, added with plenty of
ghee (clarified butter) for lubrication of the deep tissues of body. Whole milk products
and milk cream are advisable.
Use of Ghee (clarified butter) in large quantities
Use of oil in cooking and oily food
Meat broth, bone broth
Organic whole milk with sugar
Use of cream and cream dishes
Coconut water
Buttermilk
Kanji (rice gruel / type of rice porridge)
Patola (ridge gourd, also known as luffa) - a type of gourd similar to zucchini
Amalaki (Indian gooseberry, also known as amla)
Sweet dishes like milk pudding, made with full milk and cream

2. Unadvisable (Incompatible to be strictly avoided)

Skipping meals & fasting
Eating during indigestion
Overeating
Suppression of natural urges (urination, defecation, sneezing, yawning etc)
Excessive sexual activity (in general, sexual activity should be minimized)
Sleeping in the daytime (between 7 am and 7 pm)
Direct exposure to bright sun
Direct exposure of the body (specially the head and neck area) to cold wind
and draft
Stimulating and dehydrating drinks like coffee and cola drinks
Carbonated drinks
Ice cold drinks
Frozen food
Junk food, fast food, industrially prepared packed food, canned food,
preservatives
Excessive use of cacao and chocolate

3. Therapeutic Yoga
Yoga Nidra -deep relaxation (available on Soundcloud & Youtube)
Daily meditation (preferably twice daily)
Pranayama (anuloma-viloma)
Light yoga postures (asanas) without straining

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Opportunities for clinical research on ayurvedic
treatments for cluster headaches
There are numerous possibilities to carry out research project on
CH patients under a research program, and there is a lot of interest
into this kind of research project among the Ayurvedic scientists and
doctors. This can be arranged either in private research institutes,
or in government university hospitals. For initial study, most suitable
would be a private clinic, since this can be accomplished in a quick
manner and with flexibility. Also the patient facilities at private
research institutes are of higher standard and more suited for
western patients than at the government sector.

Once the results of the initial group become available, a further

study with a larger client base can be arranged, at a government
university hospital. Being a government body, such research
requires good planning, involvement of team of researchers, and
official approvals from the ministry of health, department of AYUSH,
national board of medicine & council of scientific research.
Obtaining the required approvals will take considerable time. Also
finding a suitable government hospital with providing quality
facilities suitable for international patients may require some
research.

Author: Ossi Viljakainen Ayurvedic practitioner, E-mail: ossi.viljakainen (at) iki.fi

______________________
References
1. Marc Lallanilla: Ayurveda: Facts About Ayurvedic Medicine, Live Science, January 06, 2015
2. Sanjeev Rastogi: Building bridges between Ayurveda and Modern Science
3. Yoga Ratnkara, Vol 2. Dr. Mdham Shetty Suresh Babu, Chowkhamba Sanskrit Series Office, Varanasi 2011
4. Caraka Sahita, Vol. VI, Dr. R.K. Sharma & Bhagwan Dash, Chowkhamba Sanskrit Series Office, Varanasi 2013
5. Suruta Sam hit, Vol 3, Prof. G.D. Singhal & Colleagues, Shaukhambha Sanskrit Pratishthan 2007
6. Sharma AK, Sharma AK (2013) A Critical Appraisal of Headache vis--vis Shiro Roga. J Homeop Ayurv Med 2: 131.
doi:10.4172/2167- 1206.1000131
7. Sanskrit texts: Sarit Search and Retrieval of Indic Texts

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