Trimarmiya Siddhi

Siddhi Sthana Chapter 9. Management of diseases of three vital organs

Trimarmiya Siddhi

Section/Chapter	Siddhi Sthana Chapter 9
Preceding Chapter	Prasrita Yogiyam Siddhi
Succeeding Chapter	Basti Siddhi
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana
Translator and commentator	Shenoy R.
Reviewer	Panse A.
Editors	Thakar A. B., Mangalasseri P., Deole Y.S., Basisht G.
Year of publication	2020
Publisher	Charak Samhita Research, Training and Skill Development Centre
DOI	10.47468/CSNE.2020.e01.s08.010

Abstract

This chapter describes importance of three vital organs viz. hridaya (heart), shiras (head) and basti (urinary bladder) during purification procedures. The etio-pathogenesis of marma disorders are elaborated in detail with their management. The diseases include apatantraka (Opisthotomus), tandra (drowsiness) related to hridaya involvement, thirteen types of mutra dosha (diseases caused due to vitiation of urine), and diseases related to head viz. shankhaka (acute temporal headache ), ardhavabhedaka (one sided headache or migraine), suryavarta (headache that increases with sun rise) and anantavata (headache that starts from an area and then gradually involves the entire head and face). Uttara basti (per urethral and per vaginal drug delivery) as a treatment modality, its procedure of administration and dimensions of netra (nozzle) are discussed in detail for the management of urinary and reproductive systemic disorders. Nasya therapy (nasal errhines) is described for the management of disorders of head. The chapter emphasizes on importance of sustaining health of marma by following preventive measures and timely treatment.
Keywords: Marma (vital points), Diseases of head and nervous system, Heart and cardiovascular system, bladder, kidney and urinary system, Apatantraka, Ardhavabhedaka, Basti, Hridaya, Mutradosha, Nasya, Shiromarma, Suravarta, Tandra, Trimarma, Udavarta,Uttara basti, per vaginal drug delivery, per urethral drug delivery.

Introduction

Panchakarma and basti in particular can cause complications pertaining to marmas especially to the three vital points (trimarma-hridaya, shiras and basti) and successful treatment entails the proper administration of basti. All marmas fall under the madhyama rogamarga (disease pathways including internal systems) [ Cha.Sa.Sutra Sthana 11/48], and their diseases are difficult to manage. Vata dosha is important in etio-pathology of any disease, because the it is responsible for movement of vitiated doshas to other sites of disease (roga marga). Basti is the best treatment to alleviate vata and manage these diseases [Cha.Sa Siddhi Sthana 1/38-39]. Some diseases described in this chapter are not mentioned in the Trimarmiya Chikitsa chapter [Cha. Sa.Chikitsa Sthana 26] described earlier.

Uttara basti (per urethral and per vaginal drug delivery) is the third type of basti in the management of shukravaha srotas (reproductive system) and mutravaha srotas (urinary systems). This treatment modality to deliver drug in bladder in case of urinary system disorders and in uterus in case of uterine and reproductive system disorders is explained in detail. Nasya therapy (nasal errhines), its types and its importance in management of disorders of head is described further. Thus, the present chapter encompasses etio-pathology and medical management of all disorders related to heart, head and urinary system.

Sanskrit text, Transliteration and English Translation

अथातस्त्रिमर्मीयां सिद्धिं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātastrimarmīyāṁ siddhiṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAtastrimarmIyAM siddhiM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter "Trimarmiya Siddhi" (Management of diseases of three vital organs). Thus said Lord Atreya [1-2]

Description of marma (vital points and organs)

सप्तोत्तरं मर्मशतमस्मिञ्छरीरे स्कन्धशाखासमाश्रितमग्निवेश!|

तेषामन्यतमपीडायां समधिका पीडा भवति, चेतनानिबन्धवैशेष्यात्|

तत्र शाखाश्रितेभ्यो मर्मभ्यः स्कन्धाश्रितानि गरीयांसि, शाखानां तदाश्रितत्वात्; स्कन्धाश्रितेभ्योऽपि हृद्वस्तिशिरांसि, तन्मूलत्वाच्छरीरस्य||३||

saptōttaraṁ marmaśatamasmiñcharīrē skandhaśākhāsamāśritamagnivēśa!|

tēṣāmanyatamapīḍāyāṁ samadhikā pīḍā bhavati, cētanānibandhavaiśēṣyāt|

tatra śākhāśritēbhyō marmabhyaḥ skandhāśritāni garīyāṁsi, śākhānāṁ tadāśritatvāt; skandhāśritēbhyō'pi hr̥dvastiśirāṁsi, tanmūlatvāccharīrasya||3||

saptottaraM marmashatamasmi~jcharIre skandhashAkhAsamAshritamagnivesha!|

teShAmanyatamapIDAyAM samadhikA pIDA bhavati, cetanAnibandhavaisheShyAt|

tatra shAkhAshritebhyo marmabhyaH skandhAshritAni garIyAMsi, shAkhAnAM tadAshritatvAt; skandhAshritebhyo~api hRudvastishirAMsi, tanmUlatvAccharIrasya||3||

Hey Agnivesha! There are 107 marmas in this sharira situated in the skandha (trunk) and shakha (extremities or limbs). Trauma or pain occurring in these areas is much more intense as compared to other parts because of chetana (life) is bound to these sites.

The marmas related to skandha are more important than those situated in the shakha because the shakha is attached to the skandha and more so among the skandha situated marmas, hrid, basti and shiras are important owing to the fact that they are the root cause of body (on them depends the existence or otherwise of the body).[3]

Description of three vital organs

तत्र हृदये दश धमन्यः प्राणापानौ मनो बुद्धिश्चेतना महाभूतानि च नाभ्यामरा इव प्रतिष्ठितानि, शिरसि इन्द्रियाणि इन्द्रियप्राणवहानि च स्रोतांसि सूर्यमिव गभस्तयः संश्रितानि, बस्तिस्तु स्थूलगुदमुष्कसेवनीशुक्रमूत्रवाहिनीनां नाडी(ली)नां मध्ये मूत्रधारोऽम्बुवहानां सर्वस्रोतसामुदधिरिवापगानां प्रतिष्ठा, बहुभिश्च तन्मूलैर्मर्मसञ्ज्ञकैः स्रोतोभिर्गगनमिव दिनकरकरैर्व्याप्तमिदं शरीरम्||४||

तेषां त्रयाणामन्यतमस्यापि भेदादाश्वेव शरीरभेदः स्यात्, आश्रयनाशादाश्रितस्यापि विनाशः; तदुपघातात्तु घोरतरव्याधिप्रादुर्भावः; तस्मादेतानि विशेषेण रक्ष्याणि बाह्याभिघाद्वातादिभ्यश्च||५||

tatra hr̥dayē daśa dhamanyaḥ prāṇāpānau manō buddhiścētanā mahābhūtāni ca nābhyāmarā iva pratiṣṭhitāni, śirasi indriyāṇi indriyaprāṇavahāni ca srōtāṁsi sūryamiva gabhastayaḥ saṁśritāni, bastistu sthūlagudamuṣkasēvanīśukramūtravāhinīnāṁ nāḍī(lī)nāṁ m adhyē mūtradhārō'mbuvahānāṁ sarvasrōtasāmudadhirivāpagānāṁ pratiṣṭhā, bahubhiśca tanmūlairmarmasañjñakaiḥ srōtōbhirgaganamiva dinakarakarairvyāptamidaṁ śarīram||4||

tēṣāṁ trayāṇāmanyatamasyāpi bhēdādāśvēva śarīrabhēdaḥ syāt, āśrayanāśādāśritasyāpi vināśaḥ; tadupaghātāttu ghōrataravyādhiprādurbhāvaḥ; tasmādētāni viśēṣēṇa rakṣyāṇi bāhyābhighādvātādibhyaśca||5||

tatra hRudaye dasha dhamanyaH prANApAnau mano buddhishcetanA mahAbhUtAni ca nAbhyAmarA iva pratiShThitAni, shirasi indriyANi indriyaprANavahAni casrotAMsi sUryamiva gabhastayaH saMshritAni, bastistu sthUlagudamuShkasevanIshukramUtravAhinInAM nADI(lI)nAM madhye mUtradhAro~ambuvahAnAMsarvasrotasAmudadhirivApagAnAM pratiShThA , bahubhishca tanmUlairmarmasa~jj~jakaiH srotobhirgaganamiva dinakarakarairvyAptamidaM sharIram||4||

teShAM trayANAmanyatamasyApi bhedAdAshveva sharIrabhedaH syAt, AshrayanAshAdAshritasyApi vinAshaH; tadupaghAtAttu ghorataravyAdhiprAdurbhAvaH;tasmAdetAni visheSheNa rakShyANi bAhyAbhighAdvAtAdibhyashca||5||

In the hridaya (heart), are situated the ten dhamani (ten great vessels arising from the heart), prana, apana, manas (mind), buddhi (intellect), chetana (life), mahabhutas (5 fundamental elements) just like spokes to the axle in the center of a wheel.

In the shiras (head) are situated the indriyas (the seat of special senses), the srotas (channels) pertaining to the conduction of indriya and prana like the radiating spicules of the rays of sunlight.

The basti (bladder) situated in the midst of sthula guda (rectum), mushka (scrotum), sevani (perineal raphe), nadis carrying mutra (urine) and shukra (semen) is the mutradhara (reservoir of urine) in to which drain all the ambuvaha srotas, similar to the udadhi (sea/ ocean) into which drain all the rivers. Hence, the body may be described to be pervaded by innumerable srotas nourishing marmas similar to the sky which is pervaded by the rays of sunlight.

Among all the marmas, bheda (injury) to these 3 marmas (hridaya, shiras and basti) leads to sudden loss to the body. The destruction of substance (ashraya) leads to the destruction of the substrate. Its injury leads to severe disease manifestation. Hence, these should be especially protected against external injury and vatadi doshas.[5]

Clinical signs of injury to three marmas

तत्र हृद्यभिहते कासश्वासबलक्षयकण्ठशोषक्लोमाकर्षणजिह्वानिर्गममुखतालुशोषापस्मारोन्मादप्रलापचित्तनाशादयः स्युः; शिरस्यभिहते मन्यास्तम्भार्दितचक्षुर्विभ्रममोहोद्वेष्टनचेष्टानाशकासश्वासहनुग्रहमूकगद्गदत्वाक्षिनिमीलन- गण्डस्पन्दनजृम्भणलालास्रावस्वरहानिवदनजिह्मत्वादीनि, बस्तौ तु वातमूत्रवर्चोनिग्रहवङ्क्षणमेहनबस्तिशूलकुण्डलोदावर्तगुल्मानिलाष्ठीलोपस्तम्भनाभिकुक्षिगुदश्रोणिग्रहादयः; वाताद्युपसृष्टानां त्वेषां लिङ्गानि चिकित्सिते सक्रियाविधीन्युक्तानि||६||

tatra hr̥dyabhihatē kāsaśvāsabalakṣayakaṇṭhaśōṣaklōmākarṣaṇajihvānirgamamukhatāluśōṣāpasmārōnmādapralāpacittanāśādayaḥ syuḥ; śirasyabhihatē manyāstambhārditacakṣurvibhramamōhōdvēṣṭanacēṣṭānāśakāsaśvāsahanugrahamūkagadgadatvākṣinimīlana- gaṇḍaspandanajr̥mbhaṇalālāsrāvasvarahānivadanajihmatvādīni, bastau tu vātamūtravarcōnigrahavaṅkṣaṇamēhanabastiśūlakuṇḍalōdāvartagulmānilāṣṭhīlōpastambhanābhikukṣigudaśrōṇigrahādayaḥ ; vātādyupasr̥ṣṭānāṁ tvēṣāṁ liṅgāni cikitsitē sakriyāvidhīnyuktāni||6||

tatra hRudyabhihate kAsashvAsabalakShayakaNThashoShaklomAkarShaNajihvAnirgamamukhatAlushoShApasmAronmAdapralApacittanAshAdayaH syuH; shirasyabhihate manyAstambhArditacakShurvibhramamohodveShTanaceShTAnAshakAsashvAsahanugrahamUkagadgadatvAkShinimIlana- gaNDaspandanajRumbhaNalAlAsrAvasvarahAnivadanajihmatvAdIni, bastau tu vAtamUtravarconigrahava~gkShaNamehanabastishUlakuNDalodAvartagulmAnilAShThIlopastambhanAbhikukShigudashroNigrahAdayaH; vAtAdyupasRuShTAnAM tveShAM li~ggAni cikitsite sakriyAvidhInyuktAni||6||

Injury to the hridaya leads to kasa (cough), shwasa (breathlessness), balakshaya (weakness), kantashosha (dryness of throat), klomakarshana (a form of severe chest pain), jihvanirgama (prolapse of tongue), mukhashosha (dryness of mouth), talushosha (dryness of palate), apasmara (epilepsy), unmada (psychosis), pralapa (irrelevant speech), chittanahsa (loss of mental integrity) etc.

Injury to the shiras leads to manyastambha (stiffness of neck), ardita (hemiplegia with facial palsy), chakshuvibhrama (improper movements of eyeball/lesions in sight), moha (a state of confusion), udveshtana (twisting pain in the head), cheshtanasha (loss of body functions), kasa (cough), shwasa (breathlessness), hanugraha (stiffness of jaw), muka (dumbness), gadgada (hoarseness of voice), akshinimilana (ptosis), gandaspandana (twitching in cheek), jrambhana (excessive yawning), lalasrava (dribbling of saliva), svarahani (aphonia), vadana jihmatva (deviation of face) etc.

Affliction of basti causes vata- mutra- varcha nigraha (retention of flatus, urine and stools), vankshana- mehana- basti shula (pain in groin, genitals and bladder region), kundala (retrogressive movement of vata or mutra), udavarta (reflux of vata or mutra), gulma (abdominal lumps ), anila asthila (a solid mass due to aggravated vata), upastambha (obstruction or retention of urine), nabhi- kukshi- guda- shroni graha (stiffness in umbilicus, epigastrium, rectum and pelvis) etc.

These mentioned symptoms due to affliction by vatadi doshas have been explained in Chikitsa Sthana with their management. [6]

Importance of vata dosha and basti therapy

किन्त्वेतानि विशेषतोऽनिलाद्रक्ष्याणि, अनिलो हि पित्तकफसमुदीरणे हेतुः प्राणमूलं च, स बस्तिकर्मसाध्यतमः, तस्मान्न बस्तिसमं किञ्चित् कर्म मर्मपरिपालनमस्ति| तत्र षडास्थापनस्कन्धान् विमाने द्वौ चानुवासनस्कन्धाविह च विहितान् बस्तीन् बुद्ध्या विचार्य महामर्मपरिपालनार्थं प्रयोजयेद्वातव्याधिचिकित्सां च||७||

kintvētāni viśēṣatō'nilādrakṣyāṇi, anilō hi pittakaphasamudīraṇē hētuḥ prāṇamūlaṁ ca, sa bastikarmasādhyatamaḥ, tasmānna bastisamaṁ kiñcit karma marmaparipālanamasti| tatra ṣaḍāsthāpanaskandhān vimānē dvau cānuvāsanaskandhāviha ca vihitān bastīn buddhyā vicārya mahāmarmaparipālanārthaṁ prayōjayēdvātavyādhicikitsāṁ ca||7||

kintvetAni visheShato~anilAdrakShyANi, anilo hi pittakaphasamudIraNe hetuH prANamUlaM ca, sa bastikarmasAdhyatamaH, tasmAnna bastisamaM ki~jcit karma marmaparipAlanamasti| tatra ShaDAsthApanaskandhAn vimAne dvau cAnuvAsanaskandhAviha ca vihitAn bastIn buddhyA vicArya mahAmarmaparipAlanArthaM prayojayedvAtavyAdhicikitsAM ca||7||

However, these marmas have to be protected especially from anila (vata), as vata is the prime factor or cause for the aggravation of pitta and kapha and also it is the cause of prana (life) and is best palliable by basti. Hence, there is no treatment better than basti to maintain the marma. Hereby, the six asthapana skandhas (decoction enemas) and also the two anuvasana skandhas described in Vimana Sthana, as well as the bastis described in Siddhi Sthana with the treatment of vatavyadhi chikitsa may be rationally employed in the protection and restoration of the maha marmas (three great marmas).[7]

Management of marma disorders

भूयश्च हृद्युपसृष्टे हिङ्गुचूर्णं लवणानामन्यतमचूर्णसंयुक्तं मातुलुङ्गस्य रसेनान्येन वाऽम्लेन हृद्येन वा पाययेत्, स्थिरादिपञ्चमूलीरसः सशर्करः पानार्थं, बिल्वादिपञ्चमूलरससिद्धा च यवागूः, हृद्रोगविहितं च कर्म; मूर्ध्नि तु वातोपसृष्टेऽभ्यङ्गस्वेदनोपनाहस्नेहपाननस्तःकर्मावपीडनधूमादीनि; बस्तौ तु कुम्भीस्वेदः, वर्तयः, श्यामादिभिर्गोमूत्रसिद्धो निरूहः, बिल्वादिभिश्च सुरासिद्धः, शरकाशेक्षुदर्भगोक्षुरकमूलशृतक्षीरैश्च त्रपुसैर्वारुखराश्वाबीजयवर्षभकवृद्धिकल्कितो निरूहः, पीतदारुसिद्धतैलेनानुवासनं, तैल्वकं च सर्पिर्विरेकार्थं, शतावरीगोक्षुरकबृहतीकण्टकारिकागुडूचीपुनर्नवोशीरमधुकद्विसारिवालोध्रश्रेयसीकुशकाशमूलकषायक्षीरचतुर्गुणं बलावृषर्षभकखराश्वोपकुञ्चिकावत्सकत्रपुसैर्वारुबीजशितिवारकमधुकवचाशतपुष्पाश्मभेदकवर्षाभूमदनफलकल्कसिद्धं तैलमुत्तरबस्तिर्निरूहो वा शुद्धस्निग्धस्विन्नस्य बस्तिशूलमूत्रविकारहर इति||८||

bhūyaśca hr̥dyupasr̥ṣṭē hiṅgucūrṇaṁ lavaṇānāmanyatamacūrṇasaṁyuktaṁ mātuluṅgasya rasēnānyēna vā'mlēna hr̥dyēna vā pāyayēt, sthirādipañcamūlīrasaḥ saśarkaraḥ pānārthaṁ, bilvādipañcamūlarasasiddhā ca yavāgūḥ, hr̥drōgavihitaṁ ca karma; mūrdhni tu vātōpasr̥ṣṭē'bhyaṅgasvēdanōpanāhasnēhapānanastaḥkarmāvapīḍanadhūmādīni; bastau tu kumbhīsvēdaḥ, vartayaḥ, śyāmādibhirgōmūtrasiddhō nirūhaḥ, bilvādibhiśca surāsiddhaḥ, śarakāśēkṣudarbhagōkṣurakamūlaśr̥takṣīraiśca trapusairvārukharāśvābījayavarṣabhakavr̥ddhikalkitō nirūhaḥ, pītadārusiddhatailēnānuvāsanaṁ, tailvakaṁ ca sarpirvirēkārthaṁ, śatāvarīgōkṣurakabr̥hatīkaṇṭakārikāguḍūcīpunarnavōśīramadhukadvisārivālōdhraśrēyasīkuśakāśamūlakaṣāyakṣīracaturguṇaṁ balāvr̥ṣarṣabhakakharāśvōpakuñcikāvatsakatrapusairvārubījaśitivārakamadhukavacāśatapuṣpāśmabhēdakavarṣābhūmadanaphalakalkasiddhaṁ tailamuttarabastirnirūhō vā śuddhasnigdhasvinnasya bastiśūlamūtravikārahara iti||8||

bhUyashca hRudyupasRuShTe hi~ggucUrNaM lavaNAnAmanyatamacUrNasaMyuktaM mAtulu~ggasya rasenAnyena vA~amlena hRudyena vA pAyayet, sthirAdipa~jcamUlIrasaH sasharkaraH pAnArthaM, bilvAdipa~jcamUlarasasiddhA ca yavAgUH, hRudrogavihitaM ca karma; mUrdhni tu vAtopasRuShTe~abhya~ggasvedanopanAhasnehapAnanastaHkarmAvapIDanadhUmAdIni; bastau tu kumbhIsvedaH, vartayaH, shyAmAdibhirgomUtrasiddho nirUhaH, bilvAdibhishca surAsiddhaH, sharakAshekShudarbhagokShurakamUlashRutakShIraishca trapusairvArukharAshvAbIjayavarShabhakavRuddhikalkito nirUhaH, pItadArusiddhatailenAnuvAsanaM, tailvakaM ca sarpirvirekArthaM, shatAvarIgokShurakabRuhatIkaNTakArikAguDUcIpunarnavoshIramadhukadvisArivAlodhrashreyasIkushakAshamUlakaShAyakShIracaturguNaM balAvRuSharShabhakakharAshvopaku~jcikAvatsakatrapusairvArubIjashitivArakamadhukavacAshatapuShpAshmabhedakavarShAbhUmadanaphalakalkasiddhaM tailamuttarabastirnirUho vA shuddhasnigdhasvinnasya bastishUlamUtravikArahara iti||8||

When the hridaya is predominantly affected, one should consume powdered hingu (asafetida) with lavana (rock salt) (primary base, in a powdered form) admixed with juice of matulunga (Citrus indica) or any other juice which is predominantly sour in taste and liked by the individual. Sthiradi panchamula (Five roots comprising sthira/ salaparni- Desmodium gangeticum, Prishniparni- Uraria picta, brihati- Solanum indicum, kantakari- Solanum surattense/ xanthocarpum, gokshura- Tribulus terrestris) rasa with sugar for drinking, yavagu (porridge) prepared out of bilvadi panchamula (five great roots comprising bilva- Aegle marmelos, agnimantha- Clerodendrum phlomides, syonaka- Oroxylum indicum , patala- Stereospermum tetragonum , Gambhari- Gmelina arborea) rasa, treatment modalities described under hridroga.

When murdhni (shiras ) is afflicted by vata, abhyanga (oil massage), sweda (fomentation), upanaha (poultice), snehapana (internal oleation), nastah ( nasal drug aministration errhines) such as avapidana (with churnas), dhuma (smoke) should be employed.

In disorders of basti, kumbhisweda ( a type of mahasweda described in [Cha.Sa.Sutra Sthana 14/56-58], varti prayoga (urethral suppository), niruha basti (decoction enema) prepared of shyamadi (Operculina turpethum etc) drugs with gomutra (Cows Urine) or bilvadi (Aegle marmelos etc) drugs with sura (fermented liquid), or with sara (Saccharum munja), kasa (Saccharum spontaneum), ikshu (Saccharum officinarum), darbha (Eragrostis cynosuroides/ Desmostachya bipinnata), gokshura (Tribulus terrestris), mulaka (Raphanus sativus) kvatha mixed with milk and paste of trapusa ( Cucumis sativus), ervaruka (Cucumis sativus- bitter), kharasvabija (Ajamoda- Apium graveolens), yava (Hordeum vulgare), rishabhaka (Microstylis muscifera Ridley ), vriddhi ((Habenaria intermedia D.Don syn. Habenaria arietina H.f.) ); anuvasana (Oil enema) with taila prepared from pitadaru (Berberis aristata), ghee prepared out of tilvaka (Symplocos racemosa or Viburnum sp.) for virechana (purgation); oil prepared out of kashaya (decoction) of shatavari (Asparagus racemosus), gokshura (Tribulus terrestris), brahati (Solanum indicum), kantakari (Solanum xanthocarpum), guduchi (Tinospora cordifolia), punarnava (Boerhavia diffusa), usira (Vetiveria zizanoides), madhuka (Glycyrrhiza glabra), 2 sariva(sveta sariva- Hemidesmus indicus and krishna sariva- Cryptolepis buchanana), lodhra (Symplocos racemosa), shreyasi (Cavya-Piper chaba), kusha (Desmostachys bipinnata), kasha (Saccharum spontaneum) roots, with 4 times kshira (milk), kalka(paste) made of bala (Sida cordifolia), vrisha (Adhatoda vasica), rishabhaka (Microstylis muscifera Ridley ), kharashva (Ajamoda- Apium graveolens), upakunchika (Elatteria cardomum), vatsaka (Holarrhena antidysenterica), trapusha (Cucumis sativus), ervarubija (Cucumis sativus seeds), shitivaraka (Sunishannaka- Marsilea quadrifida), madhuka (Glycyrrhiza glabra), vacha (Acorus calamus), shatapushpa (Peucedanum graveolens/ Anethum graveolens), asmabhedaka (Bergenia ligulata), varshabhu (Trianthema monogyna/ crystallina), madanaphala (Randia spinosa) should be used for uttara basti (enema into urethral route), and niruha (decoction enema) after shodhana (purification) , in an individual who is snigdha svinna (who is properly oleated and fomented) alleviates basti shula (pain in basti) and mutra vikara (urinary disorders). [8]

भवन्ति चात्र श्लोकाः-

हृदये मूर्ध्नि बस्तौ च नृणां प्राणाः प्रतिष्ठिताः|
तस्मात्तेषां सदा यत्नं कुर्वीत परिपालने||९||

आबाधवर्जनं नित्यं स्वस्थवृत्तानुवर्तनम्|
उत्पन्नार्तिविघातश्च मर्मणां परिपालनम्||१०||

bhavanti cātra ślōkāḥ-

hr̥dayē mūrdhni bastau ca nr̥ṇāṁ prāṇāḥ pratiṣṭhitāḥ|
tasmāttēṣāṁ sadā yatnaṁ kurvīta paripālanē||9||

ābādhavarjanaṁ nityaṁ svasthavr̥ttānuvartanam|
utpannārtivighātaśca marmaṇāṁ paripālanam||10||

bhavanti cAtra shlokAH-

hRudaye mUrdhni bastau ca nRuNAM prANAH pratiShThitAH|
tasmAtteShAM sadA yatnaM kurvIta paripAlane||9||

AbAdhavarjanaM nityaM svasthavRuttAnuvartanam|
utpannArtivighAtashca marmaNAM paripAlanam||10||

Thereby concluding the Slokha-

In the hridaya, murdhna (head) and basti of individuals is situated the prana (life element) and hence attempts should be made to maintain paripalana (maintain normalcy) them. Abadhavarjana (avoidance of factors that cause affliction to marmas), svasthavrittanuvartana (following the healthy regimen), utpannarti vighata (management of the existing conditions) ensures maintenance of marmas (marma paripalana).[9-10]

अत उर्ध्वं विकारा ये त्रिमर्मीये चिकित्सिते|
न प्रोक्ता मर्मजास्तेषां कांश्चिद्वक्ष्यामि सौषधान्||११||

ata urdhvaṁ vikārā yē trimarmīyē cikitsitē|
na prōktā marmajāstēṣāṁ kāṁścidvakṣyāmi sauṣadhān||11||

ata urdhvaM vikArA ye trimarmIye cikitsite|
na proktA marmajAsteShAM kAMshcidvakShyAmi sauShadhAn||11||

Hence forward, will be described some of the diseases related to marma that have not been described in the chapter Trimarmiya Chikitsa, alongwith their treatment.[11]

Etiopathology of apatantraka (Opisthtomus)

क्रुद्धः स्वैः कोपनैर्वायुः स्थानादूर्ध्वं प्रपद्यते|
पीडयन् हृदयं गत्वा शिरः शङ्खौ च पीडयन्||१२||

धनुर्वन्नमयेद्गात्राण्याक्षिपेन्मोहयेत्तथा|
(नमयेच्चाक्षिपेच्चाङ्गान्युच्छ्वासं निरुणद्धि च)|
कृच्छ्रेण चाप्युच्छ्वसिति स्तब्धाक्षोऽथ निमीलकः ||१३||

कपोत इव कूजेच्च निःसञ्ज्ञः सोऽपतन्त्रकः|
दृष्टिं संस्तम्भ्य सञ्ज्ञां च हत्वा कण्ठेन कूजति||१४||

हृदि मुक्ते नरः स्वास्थ्यं याति मोहं वृते पुनः|
वायुना दारुणं प्राहुरेके तमपतानकम्||१५||

kruddhaḥ svaiḥ kōpanairvāyuḥ sthānādūrdhvaṁ prapadyatē|
pīḍayan hr̥dayaṁ gatvā śiraḥ śaṅkhau ca pīḍayan||12||

dhanurvannamayēdgātrāṇyākṣipēnmōhayēttathā|
(namayēccākṣipēccāṅgānyucchvāsaṁ niruṇaddhi ca)|
kr̥cchrēṇa cāpyucchvasiti stabdhākṣō'tha nimīlakaḥ ||13||

kapōta iva kūjēcca niḥsañjñaḥ sō'patantrakaḥ|
dr̥ṣṭiṁ saṁstambhya sañjñāṁ ca hatvā kaṇṭhēna kūjati||14||

hr̥di muktē naraḥ svāsthyaṁ yāti mōhaṁ vr̥tē punaḥ|
vāyunā dāruṇaṁ prāhurēkē tamapatānakam||15||

kruddhaH svaiH kopanairvAyuH sthAnAdUrdhvaM prapadyate|
pIDayan hRudayaM gatvA shiraH sha~gkhau ca pIDayan||12||

dhanurvannamayedgAtrANyAkShipenmohayettathA|
(namayeccAkShipeccA~ggAnyucchvAsaM niruNaddhi ca)|
kRucchreNa cApyucchvasiti stabdhAkSho~atha nimIlakaH ||13||

kapota iva kUjecca niHsa~jj~jaH so~apatantrakaH|
dRuShTiM saMstambhya sa~jj~jAM ca hatvA kaNThena kUjati||14||

hRudi mukte naraH svAsthyaM yAti mohaM vRute punaH|
vAyunA dAruNaM prAhureke tamapatAnakam||15||

Vata aggaravated by its own causative factors moves upwards from its sthana (site), reaching the hridaya produces pain or discomfort in hridaya (heart) and also in shira (head) and shankha (temporal area). It causes a bow-like bending of the body, akshipet (involuntary jerks) and mohayet (altered consciousness). (It causes involuntary bending or contractures and jerky movements and also obstruction to breathing). The person breathes out with difficulty, has spasm of eye movements or drooping, makes cooing sounds like a dove, becomes unconscious. The condition is called apatantraka. Some authors call a variant of this condition as apatanaka, in which there is fixity of eyes (gaze fixed) and grunting sounds from throat. When hridaya is free of doshas the person becomes healthy and becomes unconscious again when gets afflicted with doshas and is due to severe aggravation of vata. [12-15]

Management of apatantraka (opisthotomus)

श्वसनं कफवाताभ्यां रुद्धं तस्य विमोक्षयेत्|
तीक्ष्णैः प्रधमनैः सञ्ज्ञां तासु मुक्तासु विन्दति||१६||

मरिचं शिग्रुबीजानि विडङ्गं च फणिज्झकम्|
एतानि सूक्ष्मचूर्णानि दद्याच्छीर्षविरेचनम्||१७||

तुम्बुरूण्यभया हिङ्गु पौष्करं लवणत्रयम्|
यवक्वाथाम्बुना पेयं हृद्ग्रहे चापतन्त्रके ||१८||

हिङ्ग्वम्लवेतसं शुण्ठीं ससौवर्चलदाडिमम्|
पिबेद्वातकफघ्नं च कर्म हृद्रोगनुद्धितम्||१९||

शोधना बस्तयस्तीक्ष्णा न हितास्तस्य कृत्स्नशः|
सौवर्चलाभयाव्योषैः सिद्धं तस्मै घृतं हितम्||२०||

śvasanaṁ kaphavātābhyāṁ ruddhaṁ tasya vimōkṣayēt|
tīkṣṇaiḥ pradhamanaiḥ sañjñāṁ tāsu muktāsu vindati||16||

maricaṁ śigrubījāni viḍaṅgaṁ ca phaṇijjhakam|
ētāni sūkṣmacūrṇāni dadyācchīrṣavirēcanam||17||

tumburūṇyabhayā hiṅgu pauṣkaraṁ lavaṇatrayam|
yavakvāthāmbunā pēyaṁ hr̥dgrahē cāpatantrakē ||18||

hiṅgvamlavētasaṁ śuṇṭhīṁ sasauvarcaladāḍimam|
pibēdvātakaphaghnaṁ ca karma hr̥drōganuddhitam||19||

śōdhanā bastayastīkṣṇā na hitāstasya kr̥tsnaśaḥ|
sauvarcalābhayāvyōṣaiḥ siddhaṁ tasmai ghr̥taṁ hitam||20||

shvasanaM kaphavAtAbhyAM ruddhaM tasya vimokShayet|
tIkShNaiH pradhamanaiH sa~jj~jAM tAsu muktAsu vindati||16||

maricaM shigrubIjAni viDa~ggaM ca phaNijjhakam|
etAni sUkShmacUrNAni dadyAcchIrShavirecanam||17||

tumburUNyabhayA hi~ggu pauShkaraM lavaNatrayam|
yavakvAthAmbunA peyaM hRudgrahe cApatantrake ||18||

hi~ggvamlavetasaM shuNThIM sasauvarcaladADimam|
pibedvAtakaphaghnaM ca karma hRudroganuddhitam||19||

shodhanA bastayastIkShNA na hitAstasya kRutsnashaH|
sauvarcalAbhayAvyoShaiH siddhaM tasmai ghRutaM hitam||20||

The aggravated kapha vata doshas cause obstruction to shvasana (breathing) which should be cleared by tikshna pradhamana nasya (powder blowing into nostrils). This restores the sanjna (consciousness). Sirsha virechana (purification of head) should be given using very fine powder of maricha (black peper/Piper indicum), shigrubija (seeds of Moringa olifera), vidanga (Embelia ribes) and phaninjjaka (Marubaka- Origanum majorana). In hridgraha (stiffness or tightness in Heart) and apatantraka one should consume tumburu (Zanthoxylum alatum), abhaya (Terminalia chebula fruit), hingu (Asafoetida), pushkara (Inula racemosa), three types of lavana (saindhava, sauvarcala and bida lavana) with decoction of yava (Hordeum vulgare). Consume hingu (Asafoetida), amlavetasa (Garcinia pedunculata), sunthi (Zingiber officinale), with sauvarchala (sorchal salt) and dadima (juice of pomergranate/ Punica granatum) and employ treatment that alleviates vata kapha doshas and which cures hridroga (cardiac disorders). Tikshna shodhana basti (strong purificatory enemas) is totally unsuitable. Ghrita prepared by sauvarchala salt, abhaya (Terminalia chebula), vyosha (pippali, maricha, sunthi i.e., Piper longum, Piper indicum and Zingiber officinale) is suitable. [16-20]

Etiopathology and treatment of tandra (drowsiness)

मधुरस्निग्धगुर्वन्नसेवनाच्चिन्तनाच्छ्रमात् |
शोकाद्व्याध्यनुषङ्गाच्च वायुनोदीरितः कफः||२१||

यदाऽसौ समवस्कन्द्य हृदयं हृदयाश्रयान्|
समावृणोति ज्ञानादींस्तदा तन्द्रोपजायते||२२||

हृदये व्याकुलीभावो वाक्चेष्टेन्द्रियगौरवम्|
मनोबुद्ध्यप्रसादश्च तन्द्राया लक्षणं मतम्||२३||

कफघ्नं तत्र कर्तव्यं शोधनं शमनानि च|
व्यायामो रक्तमोक्षश्च भोज्यं च कटुतिक्तकम्||२४||

madhurasnigdhagurvannasēvanāccintanācchramāt |
śōkādvyādhyanuṣaṅgācca vāyunōdīritaḥ kaphaḥ||21||

yadā'sau samavaskandya hr̥dayaṁ hr̥dayāśrayān|
samāvr̥ṇōti jñānādīṁstadā tandrōpajāyatē||22||

hr̥dayē vyākulībhāvō vākcēṣṭēndriyagauravam|
manōbuddhyaprasādaśca tandrāyā lakṣaṇaṁ matam||23||

kaphaghnaṁ tatra kartavyaṁ śōdhanaṁ śamanāni ca|
vyāyāmō raktamōkṣaśca bhōjyaṁ ca kaṭutiktakam||24||

madhurasnigdhagurvannasevanAccintanAcchramAt |
shokAdvyAdhyanuSha~ggAcca vAyunodIritaH kaphaH||21||

yadA~asau samavaskandya hRudayaM hRudayAshrayAn|
samAvRuNoti j~jAnAdIMstadA tandropajAyate||22||

hRudaye vyAkulIbhAvo vAkceShTendriyagauravam|
manobuddhyaprasAdashca tandrAyA lakShaNaM matam||23||

kaphaghnaM tatra kartavyaM shodhanaM shamanAni ca|
vyAyAmo raktamokShashca bhojyaM ca kaTutiktakam||24||

Due to consumption of anna (foods) that are madhura (sweet), snigdha (unctuous), guru (heavy to digest), chintana (excessive thinking), shrama (exertion), shoka (grief), vyadhyanushanga (chronicity of diseases), kapha aggravated by vata in association when gets lodged in hridaya, obscures the process of jnana, tandra (drowsiness) occurs. The symptoms of tandra are hridaye vyakulibhava (uneasiness or discomfort in the region of heart), sluggishness of speech and physical activity, decreased acuity of the sense organs, clouding of mind and intellect. This condition should be managed by shodhana and shamana measures that are kaphahara, vyayama (exercise), raktamokshana (blood letting) and intake of foods that are predominantly katu (pungent) and tikta (bitter).[21-24]

Thirteen types of urinary disorders

मूत्रौकसादो जठरं कृच्छ्रमुत्सङ्गसङ्क्षयौ|
मूत्रातीतोऽनिलाष्ठीला वातबस्त्युष्णमारुतौ||२५||

वातकुण्डलिका ग्रन्थिर्विड्घातो बस्तिकुण्डलम्|
त्रयोदशैते मूत्रस्य दोषास्ताँल्लिङ्गतः शृणु||२६||

mūtraukasādō jaṭharaṁ kr̥cchramutsaṅgasaṅkṣayau|
mūtrātītō'nilāṣṭhīlā vātabastyuṣṇamārutau||25||

vātakuṇḍalikā granthirviḍghātō bastikuṇḍalam|
trayōdaśaitē mūtrasya dōṣāstāmँlliṅgataḥ śr̥ṇu||26||

mUtraukasAdo jaTharaM kRucchramutsa~ggasa~gkShayau|
mUtrAtIto~anilAShThIlA vAtabastyuShNamArutau||25||

vAtakuNDalikA granthirviDghAto bastikuNDalam|
trayodashaite mUtrasya doShAstA@mlli~ggataH shRuNu||26||

Mutraukasada(dense urine), mutrajathara (accumulation of urine in abdominal cavity), mutrakrichchra (dysuria), mutrotsanga (residual urination), mutrasamkshaya (suppression of urine formation), mutratita (delayed micturition), vatashthila (hard globular swelling like tumor), vatabasti (vata affection of bladder), ushnavata (vata-pitta vitiation of urine/burning micturition), vatakundalika (scanty and painful flow of urine), granthi (cyst at the neck of bladder), vidghata (feces coming through urine) and bastikundala (circular distension of bladder) are the thirteen varieties of mutra dosha (urinary disorders) and listen to them with their symptoms.[25-26]

Mutraukasada (dense urine)

पित्तं कफो द्वावपि वा बस्तौ संहन्यते यदा|
मारुतेन तदा मूत्रं रक्तं पीतं घनं सृजेत्||२७||

सदाहं श्वेतसान्द्रं वा सर्वैर्वा लक्षणैर्युतम्|
मूत्रौकसादं तं विद्यात् पित्तश्लेष्महरैर्जयेत्||२८||

pittaṁ kaphō dvāvapi vā bastau saṁhanyatē yadā|
mārutēna tadā mūtraṁ raktaṁ pītaṁ ghanaṁ sr̥jēt||27||

sadāhaṁ śvētasāndraṁ vā sarvairvā lakṣaṇairyutam|
mūtraukasādaṁ taṁ vidyāt pittaślēṣmaharairjayēt||28||

pittaM kapho dvAvapi vA bastau saMhanyate yadA|
mArutena tadA mUtraM raktaM pItaM ghanaM sRujet||27||

sadAhaM shvetasAndraM vA sarvairvA lakShaNairyutam|
mUtraukasAdaM taM vidyAt pittashleShmaharairjayet||28||

Pitta, kapha both or singly getting aggravated with vata, when reach into the basti cause reddish, yellowish, thick urine to flow, with burning, or whitish, thick or with all the symptoms. The condition is called mutraukasada and should be treated with pitta kaphahara measures.[27-28]

Mutra jathara (accumulation of urine in abdominal cavity)

विधारणात् प्रतिहतं वातोदावर्तितं यदा|
पूरयत्युदरं मूत्रं तदा तदनिमित्तरुक्||२९||

अपक्तिमूत्रविट्सङ्गैस्तन्मूत्रजठरं वदेत्|
मूत्रवैरेचनीं तत्र चिकित्सां सम्प्रयोजयेत्||३०||

हिङ्गुद्विरुत्तरं चूर्णं त्रिमर्मीये प्रकीर्तितम्|
हन्यान्मूत्रोदरानाहमाध्मानं गुदमेढ्रयोः||३१||

vidhāraṇāt pratihataṁ vātōdāvartitaṁ yadā|
pūrayatyudaraṁ mūtraṁ tadā tadanimittaruk||29||

apaktimūtraviṭsaṅgaistanmūtrajaṭharaṁ vadēt|
mūtravairēcanīṁ tatra cikitsāṁ samprayōjayēt||30||

hiṅgudviruttaraṁ cūrṇaṁ trimarmīyē prakīrtitam|
hanyānmūtrōdarānāhamādhmānaṁ gudamēḍhrayōḥ||31||

vidhAraNAt pratihataM vAtodAvartitaM yadA|
pUrayatyudaraM mUtraM tadA tadanimittaruk||29||

apaktimUtraviTsa~ggaistanmUtrajaTharaM vadet|
mUtravairecanIM tatra cikitsAM samprayojayet||30||

hi~ggudviruttaraM cUrNaM trimarmIye prakIrtitam|
hanyAnmUtrodarAnAhamAdhmAnaM gudameDhrayoH||31||

Withholding the urge to urinate, causes vata to get obstructed in its normal pathway which causes udavarta (reversal of movements) and thereby the mutra fills up in the udara producing inconsistent pain, sense of indigestion, obstruction to the flow of mutra and vid. This is called mutra jathara. Mutra virechana chikitsa (diuresis) should be employed in this condition. Hingu dvirittara churna clears mutrodara (distension of abdomen due to urinary retention), anaha (simple distension due to indigestion or constipation), adhmana (distension with pain) of guda (anus) and medhra (phallum). [29-31]

Mutra krichchra (dysuria)

मूत्रितस्य व्यवायात्तु रेतो वातोद्धतं च्युतम्|
पूर्वं मूत्रस्य पश्चाद्वा स्रवेत् कृच्छ्रं तदुच्यते||३२||

mūtritasya vyavāyāttu rētō vātōddhataṁ cyutam|
pūrvaṁ mūtrasya paścādvā sravēt kr̥cchraṁ taducyatē||32||

mUtritasya vyavAyAttu reto vAtoddhataM cyutam|
pUrvaM mUtrasya pashcAdvA sravet kRucchraM taducyate||32||

Indulgence in sexual intercourse by a person with active urge to micturate causes affliction of the dislodged shukra (seminal secretions) which flows either before or after the urine stream and this is called mutra krichchra.[32]

Mutrotsanga (residual urination)

खवैगुण्यानिलाक्षेपैः किञ्चिन्मूत्रं च तिष्ठति|
मणिसन्धौ स्रवेत् पश्चात्तदरुग्वाऽथ चातिरुक्||३३||

मूत्रोत्सङ्गः स विच्छिन्नमुच्छेषगुरुशेफसः |

khavaiguṇyānilākṣēpaiḥ kiñcinmūtraṁ ca tiṣṭhati|
maṇisandhau sravēt paścāttadarugvā'tha cātiruk||33||

mūtrōtsaṅgaḥ sa vicchinnamucchēṣaguruśēphasaḥ|

khavaiguNyAnilAkShepaiH ki~jcinmUtraM ca tiShThati|
maNisandhau sravet pashcAttadarugvA~atha cAtiruk||33||

mUtrotsa~ggaH sa vicchinnamuccheShagurushephasaH |

Due to khavaigunya (structural deformity) in the mutravaha srotas, severe vata aggravation, some urine remains in the manisandhi (base of penis) and discharges sometime later either without pain or with severe pain. Mutra passes in vichchinna (split form) and uchchesha (with some residual urine in the enlarged or engorged penis) from the guru shepha (enlarged penis due to accumulation of excess urine in the penis). This is mutrotsanga. [33-33½]

Mutra samkshaya (suppression of urine formation)

वाताकृतिर्भवेद्वातान्मूत्रे शुष्यति सङ्क्षयः||३४||

vātākr̥tirbhavēdvātānmūtrē śuṣyati saṅkṣayaḥ||34||

vAtAkRutirbhavedvAtAnmUtre shuShyati sa~gkShayaH||34||

Due to aggravation of vata, the urine gets decreased with manifestation of vatakriti (symptoms of aggravated vata). The condition is mutra kshaya. [34]

Mutratita (delayed micturition)

चिरं धारयतो मूत्रं त्वरया न प्रवर्तते|
मेहमानस्य मन्दं वा मूत्रातीतः स उच्यते||३५||

ciraṁ dhārayatō mūtraṁ tvarayā na pravartatē|
mēhamānasya mandaṁ vā mūtrātītaḥ sa ucyatē||35||

ciraM dhArayato mUtraM tvarayA na pravartate|
mehamAnasya mandaM vA mUtrAtItaH sa ucyate||35||

In a person withholding for long, the urge to urinate, the urine does not flow instantly or flows with mild stream. This is called mutratita.[35]

Ashthila (hard globular swelling like tumor)

आध्मापयन् बस्तिगुदं रुद्ध्वा वायुश्चलोन्नताम्|
कुर्यात्तीव्रार्तिमष्ठीलां मूत्रविण्मार्गरोधिनीम्||३६||

ādhmāpayan bastigudaṁ ruddhvā vāyuścalōnnatām|
kuryāttīvrārtimaṣṭhīlāṁ mūtraviṇmārgarōdhinīm||36||

AdhmApayan bastigudaM ruddhvA vAyushcalonnatAm|
kuryAttIvrArtimaShThIlAM mUtraviNmArgarodhinIm||36||

When vata obstructs the path of mutra, it causes adhmana (distension) of basti (bladder area) and guda (rectal area) producing ashthila (stone like hard mass or swelling) which is chala (freely mobile), unnata (elevated) which causes tivra arti (severe pain) and vinmutrarodhini (obstruction to stools and urine). [36]

Vatabasti (vata affliction of bladder)

मूत्रं धारयतो बस्तौ वायुः क्रुद्धो विधारणात्|
मूत्ररोधार्तिकण्डूभिर्वातबस्तिः स उच्यते||३७||

mūtraṁ dhārayatō bastau vāyuḥ kruddhō vidhāraṇāt|
mūtrarōdhārtikaṇḍūbhirvātabastiḥ sa ucyatē||37||

mUtraM dhArayato bastau vAyuH kruddho vidhAraNAt|
mUtrarodhArtikaNDUbhirvAtabastiH sa ucyate||37||

Withholding the urine in the basti causes vata to aggravate which causes mutrarodha (urinary obstruction), arti (pain), kandu (itching) and this is called vatabasti. [37]

Ushnavata ((vata-pitta affliction of urine/burning micturition)

उष्मणा सोष्मकं मूत्रं शोषयन् रक्तपीतकम्|
उष्णवातः सृजेत् कृच्छ्राद्बस्त्युपस्थार्तिदाहवान्||३८||

uṣmaṇā sōṣmakaṁ mūtraṁ śōṣayan raktapītakam|
uṣṇavātaḥ sr̥jēt kr̥cchrādbastyupasthārtidāhavān||38||

uShmaNA soShmakaM mUtraM shoShayan raktapItakam|
uShNavAtaH sRujet kRucchrAdbastyupasthArtidAhavAn||38||

Due to indulgence in ushma (factors that increase the heat in the body), there will be mutra shosha (decrease in mutra), raktapita mutra (reddish or yellowish urine), passed with difficulty (krichchrat), causing arti (pain) and daha (burning) in basti (urinary bladder) and upastha (genitalia). This is ushnavata. [38]

Vatakundalika (scanty and painful flow of urine)

गतिसङ्गादुदावृत्तः स मूत्रस्थानमार्गयोः|
मूत्रस्य विगुणो वायुर्भग्नव्याविद्धकुण्डली||३९||

मूत्रं विहन्ति संस्तम्भभङ्गगौरववेष्टनैः|
तीव्ररुङ्मूत्रविट्सङ्गैर्वातकुण्डलिकेति सा||४०||

gatisaṅgādudāvr̥ttaḥ sa mūtrasthānamārgayōḥ|
mūtrasya viguṇō vāyurbhagnavyāviddhakuṇḍalī||39||

mūtraṁ vihanti saṁstambhabhaṅgagauravavēṣṭanaiḥ|
tīvraruṅmūtraviṭsaṅgairvātakuṇḍalikēti sā||40||

gatisa~ggAdudAvRuttaH sa mUtrasthAnamArgayoH|
mUtrasya viguNo vAyurbhagnavyAviddhakuNDalI||39||

mUtraM vihanti saMstambhabha~ggagauravaveShTanaiH|
tIvraru~gmUtraviTsa~ggairvAtakuNDaliketi sA||40||

Due to gatisanga (obstruction in the pathway) of mutra in the mutrasthana (mutrasaya) and mutramarga (mutravaha srotas), the viguna vayu (aggravated vata) becomes udavratta (reflux or moves in opposite direction) and thereby bhagna (broken), vyaviddha (zigzag) or kundali (rotatory) in its pathway. It then affects the mutra with samstambha (stiffness or rigidity), bhanga (breaking pain), gaurava (heaviness), veshtana (twisting pain), tivraruk (severe pain) and mutravitsanga (retention of urine and feces). The condition is called vata kundalika. [39-40]

Raktagranthi (nodular swelling in bladder)

रक्तं वातकफाद्दुष्टं बस्तिद्वारे सुदारुणम्|
ग्रन्थिं कुर्यात् स कृच्छ्रेण सृजेन्मूत्रं तदावृतम्||४१||

अश्मरीसमशूलं तं रक्तग्रन्थिं प्रचक्षते|

raktaṁ vātakaphādduṣṭaṁ bastidvārē sudāruṇam|
granthiṁ kuryāt sa kr̥cchrēṇa sr̥jēnmūtraṁ tadāvr̥tam||41||

aśmarīsamaśūlaṁ taṁ raktagranthiṁ pracakṣatē|

raktaM vAtakaphAdduShTaM bastidvAre sudAruNam|
granthiM kuryAt sa kRucchreNa sRujenmUtraM tadAvRutam||41||

ashmarIsamashUlaM taM raktagranthiM pracakShate|

Rakta getting vitiated by vata and kapha, produces a grievous nodular swelling (granthi) which obstructs the mutra and as a result the mutra is eliminated with difficulty and pain similar to urinary calculus. The condition is called raktagranthi. [41-41½]

Vid vighata (feces coming through urine)

रूक्षदुर्बलयोर्वातेनोदावृत्तं शकृद्यदा||४२||

मूत्रस्रोतः प्रपद्येत विट्संसृष्टं तदा नरः|
विड्गन्धं मूत्रयेत् कृच्छ्राद्विड्विघातं विनिर्दिशेत्||४३||

rūkṣadurbalayōrvātēnōdāvr̥ttaṁ śakr̥dyadā||42||

mūtrasrōtaḥ prapadyēta viṭsaṁsr̥ṣṭaṁ tadā naraḥ|
viḍgandhaṁ mūtrayēt kr̥cchrādviḍvighātaṁ vinirdiśēt||43||

rUkShadurbalayorvAtenodAvRuttaM shakRudyadA||42||

mUtrasrotaH prapadyeta viTsaMsRuShTaM tadA naraH|
viDgandhaM mUtrayet kRucchrAdviDvighAtaM vinirdishet||43||

In a ruksha (emaciated) and durbala (weak) person, due to aggravated vata when shakrita (stool matter) becomes udavarta (moves into other pathway) and enters the channels of mutra, the person passes mutra admixed with stool matter bearing a fecal odor with difficulty. The condition is called vidvighata.[42-43]

Basti kundala (circular distension of bladder)

द्रुताध्वलङ्घनायासादभिघातात् प्रपीडनात्|
स्वस्थानाद्वस्तिरुद्वृत्तः स्थूलस्तिष्ठति गर्भवत्||४४||

शूलस्पन्दनदाहार्तो बिन्दुं बिन्दुं स्रवत्यपि|
पीडितस्तु सृजेद्धारां संस्तम्भोद्वेष्टनार्तिमान्||४५||

बस्तिकुण्डलमाहुस्तं घोरं शस्त्रविषोपमम्|
पवनप्रबलं प्रायो दुर्निवारमबुद्धिभिः||४६||

तस्मिन् पित्तान्विते दाहः शूलं मूत्रविवर्णता|
श्लेष्मणा गौरवं शोफः स्निग्धं मूत्रं घनं सितम्||४७||

श्लेष्मरुद्धबिलो बस्तिः पित्तोदीर्णो न सिध्यति|
अविभ्रान्तबिलः साध्यो न तु यः कुण्डलीकृतः||४८||

स्याद्वस्तौ कुण्डलीभूते हृन्मोहः श्वास एव च|४९|

drutādhvalaṅghanāyāsādabhighātāt prapīḍanāt|
svasthānādvastirudvr̥ttaḥ sthūlastiṣṭhati garbhavat||44||

śūlaspandanadāhārtō binduṁ binduṁ sravatyapi|
pīḍitastu sr̥jēddhārāṁ saṁstambhōdvēṣṭanārtimān||45||

bastikuṇḍalamāhustaṁ ghōraṁ śastraviṣōpamam|
pavanaprabalaṁ prāyō durnivāramabuddhibhiḥ||46||

tasmin pittānvitē dāhaḥ śūlaṁ mūtravivarṇatā|
ślēṣmaṇā gauravaṁ śōphaḥ snigdhaṁ mūtraṁ ghanaṁ sitam||47||

ślēṣmaruddhabilō bastiḥ pittōdīrṇō na sidhyati|
avibhrāntabilaḥ sādhyō na tu yaḥ kuṇḍalīkr̥taḥ||48||

syādvastau kuṇḍalībhūtē hr̥nmōhaḥ śvāsa ēva ca|49||

drutAdhvala~gghanAyAsAdabhighAtAt prapIDanAt|
svasthAnAdvastirudvRuttaH sthUlastiShThati garbhavat||44||

shUlaspandanadAhArto binduM binduM sravatyapi|
pIDitastu sRujeddhArAM saMstambhodveShTanArtimAn||45||

bastikuNDalamAhustaM ghoraM shastraviShopamam|
pavanaprabalaM prAyo durnivAramabuddhibhiH||46||

tasmin pittAnvite dAhaH shUlaM mUtravivarNatA|
shleShmaNA gauravaM shophaH snigdhaM mUtraM ghanaM sitam||47||

shleShmaruddhabilo bastiH pittodIrNo na sidhyati|
avibhrAntabilaH sAdhyo na tu yaH kuNDalIkRutaH||48||

syAdvastau kuNDalIbhUte hRunmohaH shvAsa eva ca|49|

Due to factors such as fast walking, fasting, exhaustion, injury and compression, the basti is displaced upwards giving the appearance of distended gravid uterus. The patient manifests with shula (severe pain), spandana (involuntary contractions or spasms) and daha (burning) and passes urine drop by drop. On straining there is streamed urine with samstambha (griping pain), udvestana (twisting pain) or arti (simple pain). The condition is called basti kundala and is similar to shastra (sharp weapon), visha (poison) in its action. The condition is dominant of vata and is incurable by the unintelligent.

When vata is associated with pitta, there occurs daha (burning), shula (colicky pain) and discoloration of urine.

Association with kapha causes gaurava (heaviness), shopha (swelling), and the mutra is snigdha (unctuous), ghana (thick) and sita (whitish).

When kapha obstructs the bladder neck or when pitta is severely aggravated it is incurable. If bladder neck is unobstructed, it is curable but not when there is circumgyration. When there is circumgyration in bladder it causes hrid moha (altered consciousness) and breathlessness. [44-48½]

Management of urinary disorders

दोषाधिक्यमवेक्ष्यैतान् मूत्रकृच्छ्रहरैर्जयेत्॥४९॥

बस्तिमुत्तरबस्तिं च सर्वेषामेव दापयेत् |

dōṣādhikyamavēkṣyaitān mūtrakr̥cchraharairjayēt||49||

bastimuttarabastiṁ ca sarvēṣāmēva dāpayēt|50|

doShAdhikyamavekShyaitAn mUtrakRucchraharairjayet||49||

bastimuttarabastiM ca sarveShAmeva dApayet|50|

These conditions should be examined in terms of dominance of dosha and treated by measures that relieve mutrakrichchra (dysuria). Basti (rectal enemas) and uttara basti (Bladder enemas) should be administered in all these conditions. [49-49½]

Description of uttara basti (urethral/per vaginal drug administration)

पुष्पनेत्रं तु हैमं स्याच्छ्लक्ष्णमौत्तरबस्तिकम्||५०||

जात्यश्वहनवृन्तेन समं गोपुच्छसंस्थितम्|
रौप्यं वा सर्षपच्छिद्रं द्विकर्णं द्वादशाङ्गुलम्||५१||

तेनाजबस्तियुक्तेन स्नेहस्यार्धपलं नयेत्|
यथावयोविशेषेण स्नेहमात्रां विकल्प्य वा||५२||

स्नातस्य भुक्तभक्तस्य रसेन पयसाऽपि वा|
सृष्टविण्मूत्रवेगस्य पीठे जानुसमे मृदौ||५३||

ऋजोः सुखोपविष्टस्य हृष्टे मेढ्रे घृताक्तया|
शलाकयाऽन्विष्य गतिं यद्यप्रतिहता व्रजेत्||५४||

ततः शेफःप्रमाणेन पुष्पनेत्रं प्रवेशयेत्|
गुदवन्मूत्रमार्गेण प्रणयेदनु सेवनीम्||५५||

हिंस्यादतिगतं बस्तिमूने स्नेहो न गच्छति|
सुखं प्रपीड्य निष्कम्पं निष्कर्षेन्नेत्रमेव च||५६||

प्रत्यागते द्वितीयं च तृतीयं च प्रदापयेत्|
अनागच्छन्नुपेक्ष्यस्तु रजनीव्युषितस्य च||५७||

puṣpanētraṁ tu haimaṁ syācchlakṣṇamauttarabastikam||50||

jātyaśvahanavr̥ntēna samaṁ gōpucchasaṁsthitam|
raupyaṁ vā sarṣapacchidraṁ dvikarṇaṁ dvādaśāṅgulam||51||

tēnājabastiyuktēna snēhasyārdhapalaṁ nayēt|
yathāvayōviśēṣēṇa snēhamātrāṁ vikalpya vā||52||

snātasya bhuktabhaktasya rasēna payasā'pi vā|
sr̥ṣṭaviṇmūtravēgasya pīṭhē jānusamē mr̥dau||53||

r̥jōḥ sukhōpaviṣṭasya hr̥ṣṭē mēḍhrē ghr̥tāktayā|
śalākayā'nviṣya gatiṁ yadyapratihatā vrajēt||54||

tataḥ śēphaḥpramāṇēna puṣpanētraṁ pravēśayēt|
gudavanmūtramārgēṇa praṇayēdanu sēvanīm||55||

hiṁsyādatigataṁ bastimūnē snēhō na gacchati|
sukhaṁ prapīḍya niṣkampaṁ niṣkarṣēnnētramēva ca||56||

pratyāgatē dvitīyaṁ ca tr̥tīyaṁ ca pradāpayēt|
anāgacchannupēkṣyastu rajanīvyuṣitasya ca||57||

puShpanetraM tu haimaM syAcchlakShNamauttarabastikam||50||

jAtyashvahanavRuntena samaM gopucchasaMsthitam|
raupyaM vA sarShapacchidraM dvikarNaM dvAdashA~ggulam||51||

tenAjabastiyuktena snehasyArdhapalaM nayet|
yathAvayovisheSheNa snehamAtrAM vikalpya vA||52||

snAtasya bhuktabhaktasya rasena payasA~api vA|
sRuShTaviNmUtravegasya pIThe jAnusame mRudau||53||

RujoH sukhopaviShTasya hRuShTe meDhre ghRutAktayA|
shalAkayA~anviShya gatiM yadyapratihatA vrajet||54||

tataH shephaHpramANena puShpanetraM praveshayet|
gudavanmUtramArgeNa praNayedanu sevanIm||55||

hiMsyAdatigataM bastimUne sneho na gacchati|
sukhaM prapIDya niShkampaM niShkarShennetrameva ca||56||

pratyAgate dvitIyaM ca tRutIyaM ca pradApayet|
rajanIvyuShitasya ca||57||

Pushpanetra (uttara basti nozzle) used for uttara basti should be made of gold or silver, smooth, be similar to stalk of jati (Jasminum officinale), or asvahana (Karavira- Nerium odorum/ indicum) and like cow’s tail (tapering). It should be 12 angulas long, have two ridges (dvikarna) and sarshapachidra (permitting the passage of mustard seed). It fitted on to goats bladder, half pala (25ml) of sneha should be taken or the quantity of sneha should be judiciously calculated in consideration of the patient’s age.

The patient having bathed, taken food with mamsarasa or milk, after clearing the urges of urine and feces, seated erect comfortably on a soft seat of knee height, the erect penis probed with a shalaka (metallic probe) duly lubricated with ghee and if found to be unobstructed, then in accordance with the size of penis the enema nozzle should be introduced as per the procedure of gudabasti i.e., along the direction of perineal raphe. If it is excessively introduced it causes pain and if insufficiently introduced the snehana does not occur. After compressing the basti yantra (douche bag) without shaking and comfortably (without causing discomfort to the patient) the basti netra should be removed. In case, the basti medicine comes out, a second and even a third enema may be given. If it does not come out then it can be ignored for a night. [50-57]

Pippalyadi varti (medicated wick/suppository)

पिप्पलीलवणागारधूमापामार्गसर्षपैः|
वार्ताकुरसनिर्गुण्डीशम्पाकैः ससहाचरैः||५८||

मूत्राम्लपिष्टैः सगुडैर्वर्तिं कृत्वा प्रवेशयेत्|
अग्रे तु सर्षपाकारां पश्चार्धे माषसम्मिताम्||५९||

नेत्रदीर्घां घृताभ्यक्तां सुकुमारामभङ्गुराम्|
नेत्रवन्मूत्रनाड्यां तु पायौ चाङ्गुष्ठसम्मिताम्||६०||

स्नेहे प्रत्यागते ताभ्यामानुवासनिको विधिः|
परिहारश्च सव्यापत् ससम्यग्दत्तलक्षणः||६१||

pippalīlavaṇāgāradhūmāpāmārgasarṣapaiḥ|
vārtākurasanirguṇḍīśampākaiḥ sasahācaraiḥ||58||

mūtrāmlapiṣṭaiḥ saguḍairvartiṁ kr̥tvā pravēśayēt|
agrē tu sarṣapākārāṁ paścārdhē māṣasammitām||59||

nētradīrghāṁ ghr̥tābhyaktāṁ sukumārāmabhaṅgurām|
nētravanmūtranāḍyāṁ tu pāyau cāṅguṣṭhasammitām||60||

snēhē pratyāgatē tābhyāmānuvāsanikō vidhiḥ|
parihāraśca savyāpat sasamyagdattalakṣaṇaḥ||61||

pippalIlavaNAgAradhUmApAmArgasarShapaiH|
vArtAkurasanirguNDIshampAkaiH sasahAcaraiH||58||

mUtrAmlapiShTaiH saguDairvartiM kRutvA praveshayet|
agre tu sarShapAkArAM pashcArdhe mAShasammitAm||59||

netradIrghAM ghRutAbhyaktAM sukumArAmabha~ggurAm|
netravanmUtranADyAM tu pAyau cA~gguShThasammitAm||60||

snehe pratyAgate tAbhyAmAnuvAsaniko vidhiH|
parihArashca savyApat sasamyagdattalakShaNaH||61||

Varti (suppository) prepared out of pippali (Piper longum), lavana (rock salt), agaradhuma (house soot), apamarga (Achyranthus aspera), sarshapa (Brassica campestris), vartaku (Solanum melongena), nirgundi juice (juice of Vitex negundo), shampaka (Cassia fistula), sahachara (Barleria prionitis), mutra (Urine of cattle etc. 8 animals), amla (amlavarga dravyas like nimbuka etc) with gud (jaggery) all pounded together and varti prepared which is introduced into the urinary passage. The tip of varti should be of the size of sarshapa (seed of Brassica campestris) and the other end resembling masha (Phaseolus radiatus). In the mutranadi (urinary passage), it should be introduced like the bastinetra and in the payu (anal orifice) it should be of thickness upto 1 angushta. When the sneha comes out, it should be followed by anuvasana basti vidhi (procedures mentioned in the after care of anuvasana basti). The vyapat (complications), their management and symptoms of proper administration are also similar to anuvasana basti procedure.[58-61]

Time of administration of uttara basti

स्त्रीणामार्तवकाले तु प्रतिकर्म तदाचरेत्|
गर्भासना सुखं स्नेहं तदाऽऽदत्ते ह्यपावृता||६२||

गर्भं योनिस्तदा शीघ्रं जिते गृह्णाति मारुते|
बस्तिजेषु विकारेषु योनिविभ्रंशजेषु च||६३||

योनिशूलेषु तीव्रेषु योनिव्यापत्स्वसृग्दरे|
अप्रस्रवति मूत्रे च बिन्दुं बिन्दुं स्रवत्यपि||६४||

विदध्यादुत्तरं बस्तिं यथास्वौषधसंस्कृतम् |६५|

strīṇāmārtavakālē tu pratikarma tadācarēt|
garbhāsanā sukhaṁ snēhaṁ tadādattē hyapāvr̥tā||62||

garbhaṁ [1] yōnistadā śīghraṁ jitē gr̥hṇāti mārutē|
bastijēṣu vikārēṣu yōnivibhraṁśajēṣu ca||63||

yōniśūlēṣu tīvrēṣu yōnivyāpatsvasr̥gdarē|
aprasravati mūtrē ca binduṁ binduṁ sravatyapi||64||

vidadhyāduttaraṁ bastiṁ yathāsvauṣadhasaṁskr̥tam [2] |65|

strINAmArtavakAle tu pratikarma tadAcaret|
garbhAsanA sukhaM snehaM tadA~a~adatte hyapAvRutA||62||

garbhaM [1] yonistadA shIghraM jite gRuhNAti mArute|
bastijeShu vikAreShu yonivibhraMshajeShu ca||63||

yonishUleShu tIvreShu yonivyApatsvasRugdare|
aprasravati mUtre ca binduM binduM sravatyapi||64||

vidadhyAduttaraM bastiM yathAsvauShadhasaMskRutam [2] |65|

In women, uttarabasti should be administered during the menses as the vagina is then open and easily receives the sneha administered, thereby the vata being subdued it easily becomes impregnable. Uttarabasti with appropriate medicines should be administered in disorders of basti (Urinary bladder), prolapse of uterus, severe pain related to uterus, 20 diseases of uterus and vagina (described in [Cha.Sa.Chikitsa Sthana 30th chapter], menorrhagia-metrorrhagia conditions, retention of urine and dribbling incontinence.[62-64½]

Dimensions of nozzle for uttara basti and its procedure

पुष्पनेत्रप्रमाणं तु प्रमदानां दशाङ्गुलम्||६५||

मूत्रस्रोतःपरीणाहं मुद्गस्रोतोऽनुवाहि च|
अपत्यमार्गे नारीणां विधेयं चतुरङ्गुलम्||६६||

द्व्यङ्गुलं मूत्रमार्गे तु बालायास्त्वेकमङ्गुलम्|
उत्तानायाः शयानायाः सम्यक् सङ्कोच्य सक्थिनी||६७||

अथास्याः प्रणयेन्नेत्रमनुवंशगतं सुखम्|
द्विस्त्रिश्चतुरिति स्नेहानहोरात्रेण योजयेत्||६८||

बस्तौ, बस्तौ प्रणीते च वर्तिः पीनतरा भवेत्|
त्रिरात्रं कर्म कुर्वीत स्नेहमात्रां विवर्धयेत्||६९||

अनेनैव विधानेन कर्म कुर्यात् पुनस्त्र्यहात्|७०|

puṣpanētrapramāṇaṁ tu pramadānāṁ daśāṅgulam||65||

mūtrasrōtaḥparīṇāhaṁ mudgasrōtō'nuvāhi ca|
apatyamārgē nārīṇāṁ vidhēyaṁ caturaṅgulam||66||

dvyaṅgulaṁ mūtramārgē tu bālāyāstvēkamaṅgulam|
uttānāyāḥ śayānāyāḥ samyak saṅkōcya sakthinī||67||

athāsyāḥ praṇayēnnētramanuvaṁśagataṁ sukham|
dvistriścaturiti snēhānahōrātrēṇa yōjayēt||68||

bastau, bastau praṇītē ca vartiḥ pīnatarā bhavēt|
trirātraṁ karma kurvīta snēhamātrāṁ vivardhayēt||69||

anēnaiva vidhānēna karma kuryāt punastryahāt|70|

puShpanetrapramANaM tu pramadAnAM dashA~ggulam||65||

mUtrasrotaHparINAhaM mudgasroto~anuvAhi ca|
apatyamArge nArINAM vidheyaM catura~ggulam||66||

dvya~ggulaM mUtramArge tu bAlAyAstvekama~ggulam|
uttAnAyAH shayAnAyAH samyak sa~gkocya sakthinI||67||

athAsyAH praNayennetramanuvaMshagataM sukham|
dvistrishcaturiti snehAnahorAtreNa yojayet||68||

bastau, bastau praNIte ca vartiH pInatarA bhavet|
trirAtraM karma kurvIta snehamAtrAM vivardhayet||69||

anenaiva vidhAnena karma kuryAt punastryahAt|70|

The uttarabasti nozzle for females should be 10 angulas in length, circumference as equal to that of urethra and its inner lumen permitting a seed of mudga (whole green gram/ phaseolus mungo). It should be introduced to a length of 4 angulas in the genital tract and 2 angulas into urinary tract for adult females and 1 angula for bala (unmarried below 16 years of age). The lady lying down supine with thighs folded upon itself, should be introduced the nozzle comfortably in the direction parallel to the spine. Two, three or four unctuous enemas may be administered in a span of 24 hours. The varti (suppository) to be administered for elimination of basti medicament should be thicker than the enema nozzle. This uttarabasti should be done for three consecutive nights with gradual increase in the dose of unctuous medicament. The procedure should be likewise repeated after 3 days.[65-69½]

Etiopathology and management of diseases of Head

Shankhaka (temporal headache)

अतः शिरोविकाराणां कश्चिद्भेदः प्रवक्ष्यते||७०||

रक्तपित्तानिला दुष्टाः शङ्खदेशे विमूर्च्छिताः|
तीव्ररुग्दाहरागं हि शोफं कुर्वन्ति दारुणम्||७१||

स शिरो विषवद्वेगी निरुध्याशु गलं तथा|
त्रिरात्राज्जीवितं हन्ति शङ्खको नाम नामतः||७२||

परं त्र्यहाज्जीवति चेत् प्रत्याख्यायाचरेत् क्रियाम्|
शिरोविरेकसेकादि सर्वं वीसर्पनुच्च यत्||७३||

ataḥ śirōvikārāṇāṁ kaścidbhēdaḥ pravakṣyatē||70||

raktapittānilā duṣṭāḥ śaṅkhadēśē vimūrcchitāḥ|
tīvrarugdāharāgaṁ hi śōphaṁ kurvanti dāruṇam||71||

sa śirō viṣavadvēgī nirudhyāśu galaṁ tathā|
trirātrājjīvitaṁ hanti śaṅkhakō nāma nāmataḥ||72||

paraṁ tryahājjīvati cēt pratyākhyāyācarēt kriyām|
śirōvirēkasēkādi sarvaṁ vīsarpanucca yat||73||

ataH shirovikArANAM kashcidbhedaH pravakShyate||70||

raktapittAnilA duShTAH sha~gkhadeshe vimUrcchitAH|
tIvrarugdAharAgaM hi shophaM kurvanti dAruNam||71||

sa shiro viShavadvegI nirudhyAshu galaM tathA|
trirAtrAjjIvitaM hanti sha~gkhako nAma nAmataH||72||

paraM tryahAjjIvati cet pratyAkhyAyAcaret kriyAm|
shirovirekasekAdi sarvaM vIsarpanucca yat||73||

Here after shall be elaborated certain diseases of the head. The aggravated rakta, pitta and vata getting lodged in the shankhadesha (temporal area) produce a severe painful swelling with redness. It is acute in manifestation like poison and obstructs the channels of the head and neck, killing the patient in 3 nights. If the patient survives beyond these 3 days, then considering the condition as pratyakhyeya (incurable but manageable) one should administer treatment modalities such as shirovirecha (errhines), seka (affusions) etc., which are curative of visarpa (erysipelas like lesions).[70-73]

Ardhavabhedaka (migraine affecting one side of head)

रूक्षात्यध्यशनात् पूर्ववातावश्यायमैथुनैः|
वेगसन्धारणायासव्यायामैः कुपितोऽनिलः||७४||

केवलः सकफो वाऽर्धं गृहीत्वा शिरसस्ततः|
मन्याभ्रूशङ्खकर्णाक्षिललाटार्धेऽतिवेदनाम्||७५||

शस्त्रारणिनिभां कुर्यात्तीव्रां सोऽर्धावभेदकः|
नयनं वाऽथवा श्रोत्रमतिवृद्धो विनाशयेत्||७६||

चतुःस्नेहोत्तमा मात्रा शिरःकायविरेचनम्|
नाडीस्वेदो घृतं जीर्णं बस्तिकर्मानुवासनम्||७७||

उपनाहः शिरोबस्तिर्दहनं चात्र शस्यते|
प्रतिश्याये शिरोरोगे यच्चोद्दिष्टं चिकित्सितम्||७८||

rūkṣātyadhyaśanāt pūrvavātāvaśyāyamaithunaiḥ|
vēgasandhāraṇāyāsavyāyāmaiḥ kupitō'nilaḥ||74||

kēvalaḥ sakaphō vā'rdhaṁ gr̥hītvā śirasastataḥ|
manyābhrūśaṅkhakarṇākṣilalāṭārdhē'tivēdanām||75||

śastrāraṇinibhāṁ kuryāttīvrāṁ sō'rdhāvabhēdakaḥ|
nayanaṁ vā'thavā śrōtramativr̥ddhō vināśayēt||76||

catuḥsnēhōttamā mātrā śiraḥkāyavirēcanam|
nāḍīsvēdō ghr̥taṁ jīrṇaṁ bastikarmānuvāsanam||77||

upanāhaḥ śirōbastirdahanaṁ cātra śasyatē|
pratiśyāyē śirōrōgē yaccōddiṣṭaṁ cikitsitam||78||

rUkShAtyadhyashanAt pUrvavAtAvashyAyamaithunaiH|
vegasandhAraNAyAsavyAyAmaiH kupito~anilaH||74||

kevalaH sakapho vA~ardhaM gRuhItvA shirasastataH|
manyAbhrUsha~gkhakarNAkShilalATArdhe~ativedanAm||75||

shastrAraNinibhAM kuryAttIvrAM so~ardhAvabhedakaH|
nayanaM vA~athavA shrotramativRuddho vinAshayet||76||

catuHsnehottamA mAtrA shiraHkAyavirecanam|
nADIsvedo ghRutaM jIrNaM bastikarmAnuvAsanam||77||

upanAhaH shirobastirdahanaM cAtra shasyate|
pratishyAye shiroroge yaccoddiShTaM cikitsitam||78||

Vata aggravated due to consumption of ruksha (dry/ ununctuous) substances, excessive quantity or frequent intake (adhyashana), easterly breeze, dew/snow, sexual intercourse, withholding of urges, exhaustion and exercise, either singly or along with kapha, affecting either half of the head produces severe pain in neck, eyebrow, temples, ear, eye, forehead of one side. The condition is acutely severe like a sharp weapon or fire-log and is called ardhavabhedaka. The condition when severe may impair the functions of an eye or an ear. The 4 snehas (taila, ghrita, vasa and majja) in the maximum dose, kayavirechana (purgation), sirovirechana (purificatory errhines), nadisweda, 10 year old ghee, oil enemas, poultices, shirobasti, cautery are advocated here. The management told for pratishyaya (rhinitis) and headaches as mentioned should also be employed appropriately. [74-78]

Suryavarta (headache increasing after sun-rise and in noon)

सन्धारणादजीर्णाद्यैर्मस्तिष्कं रक्तमारुतौ|
दुष्टौ दूषयतस्तच्च दुष्टं ताभ्यां विमूर्च्छितम्||७९||

सूर्योदयेंऽशुसन्तापाद्द्रवं विष्यन्दते शनैः|
ततो दिने शिरःशूलं दिनवृद्ध्या विवर्धते||८०||

दिनक्षये ततः स्त्याने मस्तिष्के सम्प्रशाम्यति|
सूर्यावर्तः स तत्र स्यात् सर्पिरौत्तरभक्तिकम्||८१||

शिरःकायविरेकौ च मूर्ध्ना त्रिस्नेहधारणम् |
जाङ्गलैरुपनाहश्च घृतक्षीरैश्च सेचनम् ||८२||

बर्हितित्तिरिलावादिशृतक्षीरोत्थितं घृतम्|
स्यान्नावनं जीवनीयक्षीराष्टगुणसाधितम्||८३||

sandhāraṇādajīrṇādyairmastiṣkaṁ raktamārutau|
duṣṭau dūṣayatastacca duṣṭaṁ tābhyāṁ vimūrcchitam||79||

sūryōdayēṁ'śusantāpāddravaṁ viṣyandatē śanaiḥ|
tatō dinē śiraḥśūlaṁ dinavr̥ddhyā vivardhatē||80||

dinakṣayē tataḥ styānē mastiṣkē sampraśāmyati|
sūryāvartaḥ sa tatra syāt sarpirauttarabhaktikam||81||

śiraḥkāyavirēkau ca mūrdhnā trisnēhadhāraṇam |
jāṅgalairupanāhaśca ghr̥takṣīraiśca sēcanam ||82||

barhitittirilāvādiśr̥takṣīrōtthitaṁ ghr̥tam|
syānnāvanaṁ jīvanīyakṣīrāṣṭaguṇasādhitam||83||

sandhAraNAdajIrNAdyairmastiShkaM raktamArutau|
duShTau dUShayatastacca duShTaM tAbhyAM vimUrcchitam||79||

sUryodayeM~ashusantApAddravaM viShyandate shanaiH|
tato dine shiraHshUlaM dinavRuddhyA vivardhate||80||

dinakShaye tataH styAne mastiShke samprashAmyati|
sUryAvartaH sa tatra syAt sarpirauttarabhaktikam||81||

shiraHkAyavirekau ca mUrdhnA trisnehadhAraNam |
jA~ggalairupanAhashca ghRutakShIraishca secanam ||82||

barhitittirilAvAdishRutakShIrotthitaM ghRutam|
syAnnAvanaM jIvanIyakShIrAShTaguNasAdhitam||83||

Witholding the urges, indigestion etc. leads to the vitiation of rakta and vata which in turn vitiate the mastishka (brain). Thus, affected by the vitiated rakta and vata, at sunrise due to the heat of sunrays these slowly liquefy and thereby during the day there is headache which increases with the day. At the end of the day as they solidify, the headache subsides. The condition is called suryavarta and is managed by post-prandial ghee consumption, shirovireka (purificatory errhines), kayavireka (purgation), shiropichu (holding a gauze or piece of cotton soaked in medicated oil over the vertex) or shirobasti (holding medicated oil in a circular tank like formation over the head) with trisnehas, poultices prepared with jangala mamsa (meat of animals living in dry lands), affusions with ghee and milk, ghee (nasya) errhines prepared out of ksheerapaka of barhi, tittiri, lava (birds that live on land) etc. and navana (unctuous errhines) with ghee processed with 8 parts milk and jeevaniya drugs (jeevaka, jeevanti- Leptadenia reticulata, rishabhaka, kakoli, kshirakakoli etc.).[79-83]

Anantavata (pulsating headache involving all areas of head)

(उपवासातिशोकातिरूक्षशीताल्पभोजनैः)|
दुष्टा दोषास्त्रयो मन्यापश्चाद्घाटासु वेदनाम्||८४||

तीव्रां कुर्वन्ति सा चाक्षिभ्रूशङ्खेष्ववतिष्ठते|
स्पन्दनं गण्डपार्श्वस्य नेत्ररोगं हनुग्रहम्||८५||

सोऽनन्तवातस्तं हन्यात् सिरार्कावर्तनाशनैः|
वातो रूक्षादिभिः क्रुद्धः शिरःकम्पमुदीरयेत्||८६||

तत्रामृताबलारास्नामहाश्वेताश्वगन्धकैः|
स्नेहस्वेदादि वातघ्नं शस्तं नस्यं च तर्पणम्||८७||

(upavāsātiśōkātirūkṣaśītālpabhōjanaiḥ)|
duṣṭā dōṣāstrayō manyāpaścādghāṭāsu vēdanām||84||

tīvrāṁ kurvanti sā cākṣibhrūśaṅkhēṣvavatiṣṭhatē|
spandanaṁ gaṇḍapārśvasya nētrarōgaṁ hanugraham||85||

sō'nantavātastaṁ hanyāt sirārkāvartanāśanaiḥ|
vātō rūkṣādibhiḥ kruddhaḥ śiraḥkampamudīrayēt||86||

tatrāmr̥tābalārāsnāmahāśvētāśvagandhakaiḥ|
snēhasvēdādi vātaghnaṁ śastaṁ nasyaṁ ca tarpaṇam||87||

(upavAsAtishokAtirUkShashItAlpabhojanaiH)|
duShTA doShAstrayo manyApashcAdghATAsu vedanAm||84||

tIvrAM kurvanti sA cAkShibhrUsha~gkheShvavatiShThate|
spandanaM gaNDapArshvasya netrarogaM hanugraham||85||

so~anantavAtastaM hanyAt sirArkAvartanAshanaiH|
vAto rUkShAdibhiH kruddhaH shiraHkampamudIrayet||86||

tatrAmRutAbalArAsnAmahAshvetAshvagandhakaiH|
snehasvedAdi vAtaghnaM shastaM nasyaM ca tarpaNam||87||

The three doshas aggravated due to fasting, severe grief, consumption of food which is ununctuous, cold and less in quantity, producing severe pain in manya (antero lateral part of neck) and then ghata (posterior part of neck). Later the pain localizes to the eye, eyebrow and temples, causes twitching in the cheek, diseases of the eye and stiffness of the jaw. The condition is called anantavata. It is treated by siravyadha (venesection) and medicines that cure suryavarta. The vata aggravated by ruksha etc factors produces tremors of the head. In this condition amrita (Tinospora cordifolia), bala (Sida cordifolia), rasna (Pluchea lanceolata), mahashveta (Clitoria ternatea Linn.), ashvagandha (Withania sommifera) which are alleviators of vata should be used for oleation, fomentation and tarpana nasya (nourishing errhines) should be employed.[84-87]

नस्तःकर्म च कुर्वीत शिरोरोगेषु शास्त्रविद्|
द्वारं हि शिरसो नासा तेन तद् व्याप्य हन्ति तान्||८८||

nastaḥkarma ca kurvīta śirōrōgēṣu śāstravid|
dvāraṁ hi śirasō nāsā tēna tad vyāpya hanti tān||88||

nastaHkarma ca kurvIta shirorogeShu shAstravid|
dvAraM hi shiraso nAsA tena tad vyApya hanti tAn||88||

A physician proficient in the Ayurveda scriptures should employ nasya karma (errhines) in diseases of the head as the nose being the gateway of head, the medicines administered thereby pervades into the head and cures diseases pertaining to the head.[88]

Types of nasya (nasal drug delivery therapy)

नावनं चावपीडश्च ध्मापनं धूम एव च|
प्रतिमर्शश्च विज्ञेयं नस्तःकर्म तु पञ्चधा||८९||

स्नेहनं शोधनं चैव द्विविधं नावनं स्मृतम्|
शोधनः स्तम्भनश्च स्यादवपीडो द्विधा मतः ||९०||

चूर्णस्याध्मापनं तद्धि देहस्रोतोविशोधनम् |
विज्ञेयस्त्रिविधो धूमः प्रागुक्तः शमनादिकः||९१||

प्रतिमर्शो भवेत् स्नेहो निर्दोष उभयार्थकृत्|
एवं तद्रेचनं कर्म तर्पणं शमनं त्रिधा||९२||

nāvanaṁ cāvapīḍaśca dhmāpanaṁ dhūma ēva ca|
pratimarśaśca vijñēyaṁ nastaḥkarma tu pañcadhā||89||

snēhanaṁ śōdhanaṁ caiva dvividhaṁ nāvanaṁ smr̥tam|
śōdhanaḥ stambhanaśca syādavapīḍō dvidhā mataḥ ||90||

cūrṇasyādhmāpanaṁ taddhi dēhasrōtōviśōdhanam |
vijñēyastrividhō dhūmaḥ prāguktaḥ śamanādikaḥ||91||

pratimarśō bhavēt snēhō nirdōṣa ubhayārthakr̥t|
ēvaṁ tadrēcanaṁ karma tarpaṇaṁ śamanaṁ tridhā||92||

nAvanaM cAvapIDashca dhmApanaM dhUma eva ca|
pratimarshashca vij~jeyaM nastaHkarma tu pa~jcadhA||89||

snehanaM shodhanaM caiva dvividhaM nAvanaM smRutam|
shodhanaH stambhanashca syAdavapIDo dvidhA mataH ||90||

cUrNasyAdhmApanaM taddhi dehasrotovishodhanam |
vij~jeyastrividho dhUmaH prAguktaH shamanAdikaH||91||

pratimarsho bhavet sneho nirdoSha ubhayArthakRut|
evaM tadrecanaM karma tarpaNaM shamanaM tridhA||92||

Nasya karma is said to be of 5 types- navana (unctuous errhines), avapida (expressed errhines), dhmapana (powder errhines), dhuma (smoke inhalation) and pratimarsha (low dose unctuous errhines). Navana (unctuous errhines) is of two types viz, snehana (oleating) and shodhana (purificatory). Avapida (Expressed errhine) is of two types-shodhana (purificatory) and stambhana (astringent). Blowing of churna (powder errhine) is said to cleanse the body passages. Dhuma (smoke inhalation) is said to be of three types ie, shamana etc (palliative, oleating and purificatory) as mentioned before. Pratimarsha is an oleative type of errhine without any adverse effects whatsoever and serves both (oleation and purification). Hence, the above mentioned 5 types of errhines fall into 3 categories – rechana (purificatory), tarpana (nourishing) and samana (palliative). [89-92]

स्तम्भसुप्तिगुरुत्वाद्याः श्लैष्मिका ये शिरोगदाः|
शिरोविरेचनं तेषु नस्तःकर्म प्रशस्यते||९३||

ये च वातात्मका रोगाः शिरःकम्पार्दितादयः|
शिरसस्तर्पणं तेषु नस्तःकर्म प्रशस्यते ||९४||

रक्तपित्तादिरोगेषु शमनं नस्यमिष्यते|
ध्मापनं धूमपानं च तथा योग्येषु शस्यते ||९५||

(दोषादिकं समीक्ष्यैव भिषक् सम्यक् च कारयेत्)|९६|

stambhasuptigurutvādyāḥ ślaiṣmikā yē śirōgadāḥ|
śirōvirēcanaṁ tēṣu nastaḥkarma praśasyatē||93||

yē ca vātātmakā rōgāḥ śiraḥkampārditādayaḥ|
śirasastarpaṇaṁ tēṣu nastaḥkarma praśasyatē ||94||

raktapittādirōgēṣu śamanaṁ nasyamiṣyatē|
dhmāpanaṁ dhūmapānaṁ ca tathā yōgyēṣu śasyatē ||95||

(dōṣādikaṁ samīkṣyaiva bhiṣak samyak ca kārayēt)|96|

stambhasuptigurutvAdyAH shlaiShmikA ye shirogadAH|
shirovirecanaM teShu nastaHkarma prashasyate||93||

ye ca vAtAtmakA rogAH shiraHkampArditAdayaH|
shirasastarpaNaM teShu nastaHkarma prashasyate ||94||

raktapittAdirogeShu shamanaM nasyamiShyate|
dhmApanaM dhUmapAnaM ca tathA yogyeShu shasyate ||95||

(doShAdikaM samIkShyaiva bhiShak samyak ca kArayet)|96|

In kaphaja shirorogas characterized by stiffness, numbness, heaviness etc. Nasta karma(nasal errhines) especially purificatory type is beneficial. Those diseases of head which are due to vata such as tremors of the head, facial palsy etc in them nastakarma in the form of tarpana is most suited. In diseases like raktapitta (bleeding dyscrasias) palliative errhines are indicated. Powder errhines and smoke inhalation are indicated for appropriate ones (treatment should be carried out by the physician after duly considering the dosha etc factors).[93-95½]

फलादिभेषजं प्रोक्तं शिरसो यद्विरेचनम्||९६||

तच्चूर्णं कल्पयेत्तेन पचेत् स्नेहं विरेचनम्|
यदुक्तं मधुरस्कन्धे भेषजं तेन तर्पणम्||९७||

साधयित्वा भिषक् स्नेहं नस्तः कुर्याद्विधानवित्|९८|

phalādibhēṣajaṁ prōktaṁ śirasō yadvirēcanam||96||

taccūrṇaṁ kalpayēttēna pacēt snēhaṁ virēcanam|
yaduktaṁ madhuraskandhē bhēṣajaṁ tēna tarpaṇam||97||

sādhayitvā bhiṣak snēhaṁ nastaḥ kuryādvidhānavit|98|

phalAdibheShajaM proktaM shiraso yadvirecanam||96||

taccUrNaM kalpayettena pacet snehaM virecanam|
yaduktaM madhuraskandhe bheShajaM tena tarpaNam||97||

sAdhayitvA bhiShak snehaM nastaH kuryAdvidhAnavit|98|

The fruit etc. seven categories of medications suitable as errhines for purification of head mentioned in Rogabhishagjitiya Vimana may be used as powder and in oil base for purification. The drugs of sweet category mentioned in the that chapter may be used for tarpana (nourishing). With these mentioned drugs the sneha should be prepared and used by the physician who is skillful in the errhine therapy.[96-97½]

Procedure of nasya therapy

प्राक्सूर्ये मध्यसूर्ये वा प्राक्कृतावश्यकस्य च||९८||

उत्तानस्य शयानस्य शयने स्वास्तृते सुखम्|
प्रलम्बशिरसः किञ्चित् किञ्चित् पादोन्नतस्य च||९९||

दद्यान्नासापुटे स्नेहं तर्पणं बुद्धिमान् भिषक्|
अनवाक्शिरसो नस्यं न शिरः प्रतिपद्यते||१००||

अत्यवाक्शिरसो नस्यं मस्तुलुङ्गेऽवतिष्ठति|
अत एवंशयानस्य शुद्ध्यर्थं स्वेदयेच्छिरः||१०१||

संस्वेद्य नासामुन्नम्य वामेनाङ्गुष्ठपर्वणा|
हस्तेन दक्षिणेनाथ कुर्यादुभयतः समम्||१०२||

प्रणाड्या पिचुना वाऽपि नस्तःस्नेहं यथाविधि|
कृते च स्वेदयेद्भूय आकर्षेच्च पुनः पुनः||१०३||

तं स्नेहं श्लेष्मणा साकं तथा स्नेहो न तिष्ठति|

prāksūryē madhyasūryē vā prākkr̥tāvaśyakasya ca||98||

uttānasya śayānasya śayanē svāstr̥tē sukham|
pralambaśirasaḥ kiñcit kiñcit pādōnnatasya ca||99||

dadyānnāsāpuṭē snēhaṁ tarpaṇaṁ buddhimān bhiṣak|
anavākśirasō nasyaṁ na śiraḥ pratipadyatē||100||

atyavākśirasō nasyaṁ mastuluṅgē'vatiṣṭhati|
ata ēvaṁśayānasya śuddhyarthaṁ svēdayēcchiraḥ||101||

saṁsvēdya nāsāmunnamya vāmēnāṅguṣṭhaparvaṇā|
hastēna dakṣiṇēnātha kuryādubhayataḥ samam||102||

praṇāḍyā picunā vā'pi nastaḥsnēhaṁ yathāvidhi|
kr̥tē ca svēdayēdbhūya ākarṣēcca punaḥ punaḥ||103||

taṁ snēhaṁ ślēṣmaṇā sākaṁ tathā snēhō na tiṣṭhati|
prAksUrye madhyasUrye vA prAkkRutAvashyakasya ca||98||

uttAnasya shayAnasya shayane svAstRute sukham|
pralambashirasaH ki~jcit ki~jcit pAdonnatasya ca||99||

dadyAnnAsApuTe snehaM tarpaNaM buddhimAn bhiShak|
anavAkshiraso nasyaM na shiraH pratipadyate||100||

atyavAkshiraso nasyaM mastulu~gge~avatiShThati|
ata evaMshayAnasya shuddhyarthaM svedayecchiraH||101||

saMsvedya nAsAmunnamya vAmenA~gguShThaparvaNA|
hastena dakShiNenAtha kuryAdubhayataH samam||102||

praNADyA picunA vA~api nastaHsnehaM yathAvidhi|
kRute ca svedayedbhUya AkarShecca punaH punaH||103||

taM snehaM shleShmaNA sAkaM [1] tathA sneho na tiShThati|

Tarpana sneha nasya should be administered into the nostrils of a patient in the early morning or mid noon, who has attended to his ablutions lying down supine comfortably on a well spread couch, with head extended and the foot slightly raised. If the head is not lowered at all, the medication does not reach the head. If the head is excessively lowered the nasya medication may reach into the brain. Hence, a reclining patient for proper purification should be administered fomentation to the head. After proper fomentation, the tip of nose elevated with the thumb of left hand and with the right hand the unctuous errhine should be dropped into the nostril through a tube or gauze, equally into both the nostrils. After having done this, the head should be duly fomented and the instilled medicine should be repeatedly extracted along with the phlegmmatous discharge so that no medicine remains. (98-103½)

Dhumapana (medicated smoking) and post nasya therapy

स्वेदेनोत्क्लेशितः श्लेष्मा नस्तःकर्मण्युपस्थितः ||१०४||

भूयः स्नेहस्य शैत्येन शिरसि स्त्यायते ततः|
श्रोत्रमन्यागलाद्येषु विकाराय स कल्पते||१०५||

ततो नस्तःकृते धूमं पिबेत् कफविनाशनम् |
हितान्नभुङ्निवातोष्णसेवी स्यान्नियतेन्द्रियः||१०६||

विधिरेषोऽवपीडस्य कार्यः प्रध्मापनस्य तु|
तत् षडङ्गुलया नाड्या धमेच्चूर्णं मुखेन तु||१०७||

विरिक्तशिरसं तूष्णं पाययित्वाऽम्बु भोजयेत्|
लघु त्रिष्वविरुद्धं च निवातस्थमतन्द्रितः||१०८||

विरेकशुद्धो दोषस्य कोपनं यस्य सेवते|
स दोषो विचरंस्तत्र करोति स्वान् गदान् बहून्||१०९||

यथास्वं विहितां तेषु क्रियां कुर्याद्विचक्षणः|
अकालकृतजातानां रोगाणामनुरूपतः||११०||

svēdēnōtklēśitaḥ ślēṣmā nastaḥkarmaṇyupasthitaḥ ||104||

bhūyaḥ snēhasya śaityēna śirasi styāyatē tataḥ|
śrōtramanyāgalādyēṣu vikārāya sa kalpatē||105||

tatō nastaḥkr̥tē dhūmaṁ pibēt kaphavināśanam |
hitānnabhuṅnivātōṣṇasēvī syānniyatēndriyaḥ||106||

vidhirēṣō'vapīḍasya kāryaḥ pradhmāpanasya tu|
tat ṣaḍaṅgulayā nāḍyā dhamēccūrṇaṁ mukhēna tu||107||

viriktaśirasaṁ tūṣṇaṁ pāyayitvā'mbu bhōjayēt|
laghu triṣvaviruddhaṁ ca nivātasthamatandritaḥ||108||

virēkaśuddhō dōṣasya kōpanaṁ yasya sēvatē|
sa dōṣō vicaraṁstatra karōti svān gadān bahūn||109||

yathāsvaṁ vihitāṁ tēṣu kriyāṁ kuryādvicakṣaṇaḥ|
akālakr̥tajātānāṁ rōgāṇāmanurūpataḥ||110||

svedenotkleshitaH shleShmA nastaHkarmaNyupasthitaH ||104||

bhUyaH snehasya shaityena shirasi styAyate tataH|
shrotramanyAgalAdyeShu vikArAya sa kalpate||105||

tato nastaHkRute dhUmaM pibet kaphavinAshanam |
hitAnnabhu~gnivAtoShNasevI syAnniyatendriyaH||106||

vidhireSho~avapIDasya kAryaH pradhmApanasya tu|
tat ShaDa~ggulayA nADyA dhameccUrNaM mukhena tu||107||

viriktashirasaM tUShNaM pAyayitvA~ambu bhojayet|
laghu triShvaviruddhaM ca nivAtasthamatandritaH||108||

virekashuddho doShasya kopanaM yasya sevate|
sa doSho vicaraMstatra karoti svAn gadAn bahUn||109||

yathAsvaM vihitAM teShu kriyAM kuryAdvicakShaNaH|
akAlakRutajAtAnAM rogANAmanurUpataH||110||

The mucus liquefied by the sudation, accumulated by the administration of errhine will get condensed back in the head due to the inherent coldness of the unctuous errhine which leads to diseases of ears, neck and throat. Hence, after the errhine therapy, one should take smoking which eliminates kapha, consume wholesome diet, resort to breezeless, warm residence and observe self restraint.

The same procedure should be employed for administration of avapida nasya (expressed errhine). As regards pradhmapana (powder inhalation), the medicinal powder should be blown by mouth through a 6 Angula long tube. After purification of the head he should be made to drink hot water followed by predominant fluid diet which is light and not against the three doshas, and then made to reside in a breezeless place by vigilant physician. One who is purified off the doshas if indulges in factors which cause dosha aggravation, the doshas getting provoked move about in the body producing many diseases due to them. In these the wise physician should carry out treatments as mentioned and as appropriate for diseases arising due to untimely administration of errhine therapy. [104-110]

The treatment of vitiated doshas after nasya

अजीर्णे भोजने भुक्ते तोये पीतेऽथ दुर्दिने|
प्रतिश्याये नवे स्नाते स्नेहपानेऽनुवासने||१११||

नावनं स्नेहनं रोगान् करोति श्लैष्मिकान् बहून्|
तत्र श्लेष्महरः सर्वस्तीक्ष्णोष्णादिर्विधिर्हितः||११२||

क्षामे विरेचिते गर्भे व्यायामाभिहते तृषि|
वातो रूक्षेण नस्येन क्रुद्धः स्वाञ्जनयेद्गदान्||११३||

तत्र वातहरः सर्वो विधिः स्नेहनबृंहणः|
स्वेदादिः, स्याद्घृतं क्षीरं गर्भिण्यास्तु विशेषतः||११४||

ज्वरशोकातितप्तानां तिमिरं मद्यपस्य तु|
रूक्षैः शीताञ्जनैर्लेपैः पुटपाकैश्च साधयेत् ||११५||

ajīrṇē bhōjanē bhuktē tōyē pītē'tha durdinē|
pratiśyāyē navē snātē snēhapānē'nuvāsanē||111||

nāvanaṁ snēhanaṁ rōgān karōti ślaiṣmikān bahūn|
tatra ślēṣmaharaḥ sarvastīkṣṇōṣṇādirvidhirhitaḥ||112||

kṣāmē virēcitē garbhē vyāyāmābhihatē tr̥ṣi|
vātō rūkṣēṇa nasyēna kruddhaḥ svāñjanayēdgadān||113||

tatra vātaharaḥ sarvō vidhiḥ snēhanabr̥ṁhaṇaḥ|
svēdādiḥ, syādghr̥taṁ kṣīraṁ garbhiṇyāstu viśēṣataḥ||114||

jvaraśōkātitaptānāṁ timiraṁ madyapasya tu|
rūkṣaiḥ śītāñjanairlēpaiḥ puṭapākaiśca sādhayēt ||115||

ajIrNe bhojane bhukte toye pIte~atha durdine|
pratishyAye nave snAte snehapAne~anuvAsane||111||

nAvanaM snehanaM rogAn karoti shlaiShmikAn bahUn|
tatra shleShmaharaH sarvastIkShNoShNAdirvidhirhitaH||112||

kShAme virecite garbhe vyAyAmAbhihate tRuShi|
vAto rUkSheNa nasyena kruddhaH svA~jjanayedgadAn||113||

tatra vAtaharaH sarvo vidhiH snehanabRuMhaNaH|
svedAdiH, syAdghRutaM kShIraM garbhiNyAstu visheShataH||114||

jvarashokAtitaptAnAM timiraM madyapasya tu|
rUkShaiH shItA~jjanairlepaiH puTapAkaishca sAdhayet ||115||

Unctuous errhine administered in patients of indigestion, soon after major food, water consumption, on an unsuitable (cloudy) day, in case of acute rhinitis, after bath, internal oleation, oil enema gives rise to many diseases of kapha. In these conditions all measures that alleviate kapha such as penetrating, hot etc are beneficial.

Ununctuous or dry errhines in persons who are emaciated, after purgation, pregnant, exhausted due to severe exercise, thirsty, leads to aggravation of vata and produce diseases due to it. In such conditions all vata alleviating measures such as oleation, nourishing therapy, sudation etc should be done. In case of pregnant especially, ghee and milk should be administered. Unctuous errhine administered in those afflicted by severe fever, grief and alcoholics causes dimness of vision. It should be managed by collyrium and applications to the eye and instillation of medicine prepared by putapaka method which are un-unctuous and cold. [111-115]

Types of navana (unctuous errhines)

स्नेहनं शोधनं चैव द्विविधं नावनं मतम्|
प्रतिमर्शस्तु नस्यार्थं करोति न च दोषावान्||११६||

नस्तः स्नेहाङ्गुलिं दद्यात् प्रातर्निशि च सर्वदा|
न चोच्छिङ्घेदरोगाणां प्रतिमर्शः स दार्ढ्यकृत्||११७||

snēhanaṁ śōdhanaṁ caiva dvividhaṁ nāvanaṁ matam|
pratimarśastu nasyārthaṁ karōti na ca dōṣāvān||116||

nastaḥ snēhāṅguliṁ dadyāt prātarniśi ca sarvadā|
na cōcchiṅghēdarōgāṇāṁ pratimarśaḥ sa dārḍhyakr̥t||117||

snehanaM shodhanaM caiva dvividhaM nAvanaM matam|
pratimarshastu nasyArthaM karoti na ca doShAvAn||116||

nastaH snehA~gguliM dadyAt prAtarnishi ca sarvadA|
na cocchi~gghedarogANAM pratimarshaH sa dArDhyakRut||117||

Unctuous errhine (all errhines for that matter) is of two types- oleating and purificatory. Pratimarsha (low dose unctuous errhine) serves both the purpose and does not produce any ill effects. In the morning, night and at all times, one should use an oleated finger for pratimarsha. It should not be inhaled deeply. It is suitable for healthy and serves to strengthen the head.[116-117]

Summary

तत्र श्लोकौ

त्रीणि यस्मात् प्रधानानि मर्माण्यभिहतेषु च|
तेषु लिङ्गं चिकित्सां च रोगभेदाश्च सौषधाः||११८||

विधिरुत्तरबस्तेश्च नस्तःकर्मविधिस्तथा|
सव्यापद्भेषजं सिद्धौ मर्माख्यायां प्रकीर्तितम्||११९||

tatra ślōkau

trīṇi yasmāt pradhānāni marmāṇyabhihatēṣu ca|
tēṣu liṅgaṁ cikitsāṁ ca rōgabhēdāśca sauṣadhāḥ||118||

vidhiruttarabastēśca nastaḥkarmavidhistathā|
savyāpadbhēṣajaṁ siddhau marmākhyāyāṁ prakīrtitam||119||

tatra shlokau

trINi yasmAt pradhAnAni marmANyabhihateShu ca|
teShu li~ggaM cikitsAM ca rogabhedAshca sauShadhAH||118||

vidhiruttarabasteshca nastaHkarmavidhistathA|
savyApadbheShajaM siddhau marmAkhyAyAM prakIrtitam||119||

To conclude the verses-

The 3 most important among the marmas, signs and symptoms due to their injury, their treatment, diseases affecting these marmas with their management, uttarabasti procedure, procedure of nasyakarma, their complications with management have all been described in the chapter on siddhi related to three marmas.[118-119]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते सिद्धिस्थाने त्रिमर्मीयसिद्धिर्नाम नवमोऽध्यायः||९||

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē siddhisthānē trimarmīyasiddhirnāma navamō'dhyāyaḥ||9||

ityagniveshakRute tantre carakapratisaMskRute~aprApte dRuDhabalasampUrite siddhisthAne trimarmIyasiddhirnAma navamo~adhyAyaH||9||

Hence, the 9th chapter of Siddhi Sthana named Trimarmiya Siddhi, which was unavailable and hence, completed by Dridhabala in Agnivesha’s compendium redacted by Charaka.

Tattva Vimarsha (Fundamental Principles)

• Marmas are the vital junctions and organs in the body.
• Marmas are the site of chetana (vital power of life). Therefore, their diseases/injuries are more severe and need immediate attention in treatment.
• The vital organs in trunk and abdomen are more important that those in extremities or at superficial level.
• Hridaya (heart including cardio-vascular system), basti (Urinary bladder including urinary system and kidneys) and shiras (head including sensory-motor nervous system) are important owing to the fact that they are the roots of body and the existence of life depends on them.
• Hridaya (heart) is the center for receiving the ten dhamani (ten great vessels arising from the heart), prana, apana, manas (mind), buddhi (intellect), chetana (life), mahabhutas (5 fundamental elements) just like spokes to the axle in the center of a wheel.
• Shiras (head) is the centre for the indriyas (the seat of special senses), the srotas (channels) pertaining to the conduction of indriya and prana like the radiating spicules of the rays of sunlight.
• The basti (bladder) is center that is related with the functions of sthula guda (rectum), mushka (scrotum), sevani (perineal raphe), urinary channels and shukra (semen). It is also the mutradhara (reservoir of urine) in to all the water carrying channels in the body drain, similar to all the rivers drain into the udadhi (sea/ ocean).
• Injury to these three marmas (hridaya, shiras and basti) leads to sudden loss to the life. Therefore these should be especially protected against external injury and vatadi doshas.
• Vata is the prime factor or cause for the aggravation of pitta and kapha and also it is the cause of prana (life) and is best managed by basti.
• Prana (life) is situated at hridaya (heart), murdhna (head) and basti (bladder and urinary system). Hence attempts should be made to maintain paripalana (maintain normalcy) them. Abadhavarjana (avoidance of factors that cause affliction to marmas), svasthavrittanuvartana (following the healthy regimen), utpannarti vighata (management of the existing conditions) ensures maintenance of marmas (marma paripalana).
• Apatantraka (opisthotomus) disease is caused by kapha-vata dominance and it shall be managed by kapha-vata pacifying measures including tikshna pradhamana nasya (powder blowing into nostrils). Strong purification enemas are contraindicated in the treatment of apatantraka.
• Tandra (drowsiness) is caused due to vitiation of vata and kapha dosha. This condition should be managed by shodhana and shamana measures that are kaphahara, vyayama (exercise), raktamokshana (bloodletting) and intake of foods that are predominantly katu (pungent) and tikta (bitter).
• The urinary disorder occur mainly due to suppression of urine urge, vitiation of doshas in urine. These conditions should be treated based on dominance of dosha and by measures that relieve mutrakrichchra (dysuria), basti ( per rectal enemas) and uttara basti (per urethral enemas).
• Improper diet and lifestyle habits are causative factors for various types of headaches. The doshas with rakta are involved in the etio-pathology of head diseases.
• Administration of four snehas (taila, ghrita, vasa and majja) in the maximum dose, Kayavirechana (purgation), shirovirechana (purificatory errhines), nadisweda ( fomentation), 10 year old ghee, oil enemas, poultices, shirobasti, cautery are advocated in the management of head diseases.
• The disorders of head and organs in the supra-clavicular region can be managed by nasya karma (errhines). Nasal drug administration is the gateway of head, the medicines administered thereby pervade into the head and cures diseases pertaining to the head.
• In kapha dominant diseases of head with obstructive pathology, nasya (nasal errhines) of purificatory type are advised.
• In vata dominant diseases of head with degenerative pathology, nasya (nasal errhines) of nourishing type are advised.
• In pitta dominant diseases of head with hemorrhagic pathology, nasya (nasal errhines) of palliative type are advised.

Vidhi Vimarsha (Applied Inferences )

The concept of marma described in Ayurveda texts differs with those described in Keraliya Marma Chikitsa (Kalari Marma) and the Tamilian marma concept. The numbers and positions also vary greatly. The Keraliyan marma concept seems to be more related to warfare medicine and the management of trauma while the tamilian marma concept is more so as described in Ayurveda related to kshata as well well as doshaja aghata. Ayurveda believes that suppression of urges, over enthusiastic activities, strainful activities, faulty treatment practices can actually cause doshaja marmaghata.

Clinical conditions like paralysis, paresis, paraplegia, quadriplegia, haemorrhage can be understood on Ayurvedic lines by taking clue from here. When it takes place at shirasthana above mentioned conditions can manifest. They need to be treated on the lines of treatment of marmaghata rather than only treating them as vatavyadhi.

The clinical presentations described to occur under the affection of three marmas are almost practically found in relation to dosha aggravations affecting the marmas and also in case of their injury. Some symptoms are due to direct organ damage and others due to reflex neurological or hormonal disturbances.

Vata is considered to be cause of provocation of pitta and kapha. In the process of disease formation direct reference of involvement of vata as early as in the stage of prasara (third out of six stages of disease formation) vata is also said to be cause of life to underline its importance as well as the need to address it urgently. Amongst all the treatments of vata, basti is the best purely on its merits to take care of vata disorders of all the systems throughout the body.

Hridaya when gets affected, is managed by juices which are amla (sour) in taste ,as it is best among hridya dravyas. The drug hingu (asafoetida) has been found to be effective as a vatanulomaka, pachana, amahara, and sulaghna. It is also widely used in udavarta conditions, to relieve functional spasms of smooth muscles as in intestinal colic. Hingu vachadi churna is specifically used for such conditions. Clinical conditions related to Trimarma are alarmingly high today. By effecting subtle changes in life style in accordance with classical guidelines will help to reduce life risk to great extent. Preventing the injury to vital organs and timely appropriate management in case of diseases is the key to prevention of diseases and promotion of health.

Apatantraka(opisthotomus) is due to obstruction of kapha to vata, apatanaka(status epilepticus) is only due to vata.

Based on the descriptions of the condition involving the heart which is the manasa sthana and the involvement of head as well, with clinical manifestations like unconsciousness with flexion spasms or bending of the body, which is temporary, this condition may be considered as a form of syncope.

Treatment schedule for apatantraka starts with tikshna pradhamana as prana vilomatva has to be corrected to maintain the life of the patient. Second in line is shirovirechana, as vitiated vata creates pain in sirah and shankha by taking upward course. Then treatment for pacification of vata kapha in hridroga is applied to take care of hridaya, as vata also occupies hridaya when does upward direction. Further basti would have been an ideal option to take vata into its own site and pacify it, but it should not be strong, it is to be given in lesser quantity. Involvement of hridaya in pathogenesis might have prompted this thought, as strong basti might cause dehydration due to excess elimination leading to fatal condition of hridaya.

Fine powders of shirovirechana medicines can clear obstructive pathology faster and hence are preferred. Maricha which is pramathi i.e., with its potency drags the doshas out of srotasas (channels) and removes them from the system. Other medicines shigrubija, vidanga are known for their shirovirechana activity.

Vata and kapha are both considered as causative factors for the onset of tandra. Vata agitates kapha, which in turn occupies hridaya. The knowledge process gets blocked leading to tandra. Treatment aims at eliminating and pacifying kapha. Vyayama and diet of pungent and bitter tastes which acts against kapha are suitable. The unusual reference of blood letting can be attributed to involvement of hridaya, which is an organ made up of purest form of rakta.

The factors that bring about physical and mental exertion with foods that prolong the digestion or are heavy for digestion bring about an aggravation of kapha with vata and tamo guna thereby producing tandra (drowsiness). Hence, all medicines that help to clear the avarana of manas by these doshas] may be employed, especially so teekshna pradhamana nasya.

The mutravaha srotovikaras have been broadly classified into mutra atipravrittija (excess urination) and mutra apravrittija (less urination) vikaras by Vagbhata (A.H.Ni.9/40). The former includes twenty varieties of prameha and the latter includes two categories of disorders – 8 types of mutrakrichchra (dysuria) and 12 types mutraghata (urinary disorders), though both the set of disorders are described under the title mutraghata. Under mutraghata, bastikundala (circular distension of bladder) is not described.

In general terms though we find that mutraghata is described as condition with suppression or less production of urine and mutrakrichchra as dysuria, not all conditions described under mutraghata are characterized by oliguria or reduced output.

Most of the conditions seem to occur predominantly by retention of urine or bladder distension. Mutrasaada, mutraukasaada and ushnavata may be considered as scanty urination or oliguria; Mutrakshaya may be equated to oliguria or anuria.

Mutrakrichchra is a condition of dysuria due to spermorrhoea. Others like vatabasti, mutratita, mutrajathara seem to occur due to voluntary withholding of the urge of micturition resulting in physiological bladder atony as in mutratita or retention with pain as in vatabasti and atonied distended bladder in mutrajathara all progressive conditions of the same pathological process.

Bastikundala also seems to be a condition of bladder atony but with superadded cystitis due to severe physical stress and states of dehydration. In vatashthila and mutragranthi there seems to be an obvious anatomical growth which causes obstruction to the urine pathway which may be considered as prostatomegaly and vesicle tumors respectively. The condition of vatakundalika, though from the Nidana seems to be similar to the conditions of withholding the urge of urination, due to the symptoms seems more or less like urethral stricture. Mutrotsanga seems to be a condition of acute urethritis or cystitis where there is stranguary, dysuria, hesitancy and sometimes blood in urine. Mutrakshaya more or less seems like anuria or oliguria due to dehydration. Vidvighata clearly seems a case of recto vesicle or rectourethral fistula.

Susruta describes pittaja and kaphaja types of mutraukasada (dense urine) as two different conditions. In pittaja mutraukasada he describes that on drying, the urine resembles gorochana churna (powder of a stone or 'bezoar' found in cattle) and in case of kaphaja variety, on drying the urine becomes like shankha churna (powder of conch shell).

Due to holding of natural urges, obstruction to the downward movement of vata makes vata gati in to upward and circular, manifesting in to severe condition called mutrajathara (accumulation of urine in abdominal cavity). Along with symptoms like retention of urine and stool, indigestion is also one of the symptoms.

Based on the descriptions, the condition seems to be a neurological disturbance of bladder function due to repeated withholding the urge of micturition.

All the above mentioned mutradoshas are in accordance with the nidanas described under Ca.Vi.5/20 ie, drinking water, consuming food, indulging in sexual intercourse when one feels the urge to micturate and withholding the urge of micturition especially in an emaciated or traumatized individual.

The condition mutratita seems to be a physiological atony of bladder owing to prolonged withholding the urge to micturate, thereby the bladder contractions wean away and paves the way for atony. Recurrent withholding the urge may result in pathological atony as well as neurological disturbances in bladder function due to disturbances in the balance between sympathetic and parasympathetic functions. This concept may be practically found in patients of diabetes mellitus with recurrent urinary tract infections (cystitis), wherein USG reveals significant residual urine in bladder due to bladder atony. Such patients are immensely benefited by toilet training ie, developing a habit of regular micturition at timely intervals which in due course reduces the incidence of recurrent urinary tract infections and in due course significantly reduces the residual urine, possibly improving the bladder tone and nervous integrity.

The role of basti chikitsa and specifically uttarabasti in the management of apana vata vikriti and also sthana dushti (local vitiation) has been highlighted in the classical texts.

The drugs having mutrala (mutravirecaneeya and mutravirajaneeya) actions are all useful in the above mentioned mutradoshas. The mutravirajaneeya, mutravirechaneeya gana dravyas[Cha.Sa.Sutra Sthana 4/15] are very helpful.

The descriptions of the procedure with materials or equipment used thereby are clearly stated in the texts. Gold and silver are metals considered to be soft and malleable. The uttarabasti nozzle prepared out of these are specially suited for introducing into urethra as it is extremely vulnerable to trauma during the procedure which can be minimized by these metals. Primarily the chance of injury is due to the fact that male urethra is curved (‘S’ shaped) and straightened slightly when the penis is erect. Nevertheless, when fully straight there is a increased chance of trauma. Further these metals have a protective effect on the body.

In clinical practice, simple rubber catheters no. 6 or 7 may be used for the procedure after sterilization by autoclaving and so should be the medicine used for uttarabasti. With due aseptic precautions, the procedure should be carried out in a fumigated room preferably like an O.T. procedure which reduces the likely chances of U.T.I. Nevertheless, in the outcome the chances of asymptomatic pyuria or abacteriuric pyuria are always there. These possibly can be minimized with the use of filtered medicament (so as to ensure no particles), pre-autoclaved and administered with nozzle of gold or silver. Though the classical position of the patient is seating, lying down position is equally easy and the patient may be made to feel more comfortable. An hour after the procedure, the patient should be instructed to consume plenty of oral fluids to maintain a high urine output. The patients comfortably retain the medicament for 2-4 hours. The procedure may be done daily for 8 days after an initial gudagata asthapana basti. The procedure is done after asking the patient to evacuate the bladder and bowel.

The drugs described are mostly ushna veerya, vatanulomana and hence are highly beneficial in clearing the avarodha(obstruction) of aushadha.

The indication of administration of varti into gudamarga as well, probably indicates that some reflex mechanisms are involved in the evacuation of bladder in case of retained medicament. This in the classical description may be explained as causing apanavatanulomana.

The modern gynecological texts describe per vaginal investigative procedures to be carried out soon after the menses after the stoppage of bleeding. In practice, it’s the ideal time for the uttarabasti as it’s the time wherein this is naturally open to shed the endometrium which almost closes by the period of ovulation. Further, not only do the medicament enter the uterus with ease but also it acts at a time ideal for it to receive the sperms as well as provides a conducive environment for implantation of fertilized ovum maximizing the chances to conceive.

Vitiated rakta, pitta and vata takes course of shirah(head), especially shankha (temporal region), a marma of the type sadyahpranahara (acute life threatening), making the condition incurable. Involvement of rakta dhatu in diseases of shirah is appreciated by Charaka in [Cha.Sa.Sutra Sthana 17/11] Pitta dominating symptoms like daha (burning sensation), raga (redness) and vitiation of rakta dhatu brings in treatment of visarpa in to picture, as it also has both these entities vitiated.

The consideration of shankhaka as pratyakhyeya vyadhi and the initiation of treatment in case of survival probably indicates the fact that there could be residual symptoms needing effective management and also that there is a likely chance of recurrence.

Pathogenesis of the disease indicates two different ways of vitiation of dosha, vata and vatakapha. Further treatment can also be understood on this basis. Use of Chatusneha (all four snehas ghrita, taila, vasa, majja), procedures like shirobasti, anuvasanabasti, aimed at pacifying vata while more aggresive treatments like shirovirechana, virechana, use of 10 year old ghee, upanaha (poultice), dahana (cautery) are useful in vatakapha dominating condition.

From the descriptions, it appears that this condition could possibly be migraine. The possible triggering factors such as sleep deprivation, physical exhaustion, mental factors such as anxiety, stress etc, may all be understood under the nidanas described in the classics. The location of pain is also similar. The severity of pain and the disturbances of vision and audition are all classical being found in the stage of aura and may even associate with the proper stage.

Treatment is aimed at elimination of dosha initially followed by pacification of them by various means. Three sneha viz, taila, ghrita, vasa to be used in murdha taila form (holding these materials on head). Here majja is excluded as it is gurutara (most heavy amongst snehas). Seka(effusion) in the form of ghrita, milk will help in pacifying vata by acting as brimhana (nourishment), at the same time raktaprasadana (pacifying the impurities in blood) is achieved. Nasya with jeevaniya ghrita is also to pacify vata and to account for raktaprasadana.

In Bhavaprakasa Nighantu, due to non availability, pratinidhi (substitutes) have been described for ashtha varga (group of eight vitalizer herbs) drugs like vidarikanda (Pueraria tuberosa) for jeevaka and rshabhaka, ashvagandha (Withania somnifera) for kakoli and kshirakakoli, varahikanda (Dioscorea bulbifera) for riddhi and vriddhi, shatavari (Asparagus racemosus) for meda and mahameda.

The description of the incidence and timing of the symptoms point to the condition of frontal sinusitis which usually starts as a dull headache in the morning that increases in severity as the day progresses. Occasionally it may be relieved by sleep or sometimes not which depends on the relative dominance of rakta and vata.

As the condition is purely vata dominant, all the treatments described for suryavarta such as ghritapana, ghrita nasya, siropichu, sirobasti are all beneficial. If the condition is associated with raktavrita vata, siravyadha is utmost beneficial. This condition may be possibly correlated with Trigeminal neuralgia, based on the location of pain. Siravyadha at the temporal area is of utmost benefit in neuralgic headaches.

It is uncontroversial that nose is the gateway of head as all the authors of brihattrayis and laghutrayis have shared the importance of nasyakarma in shirorogas.

Though the exact mode of action of nasya is not studied some hypotheses have been put forward by the scholars of Ayurveda. One of them is that the medicament directly penetrates into the brain, as fat soluble substances can easily diffuse through the cribriform plate of ethmoid bone (which forms the roof of the nasal cavity) which is porous and owing to the location of olfactory bulbs the medicament can percolate along the fibers of olfactory nerve. The second most agreeable hypothesis is the receptor theory, which believes stimulation of certain brain centers through specific receptors situated in the nasal cavity. The administration of posterior pituitary extract into nostrils by means of sprays, practically and successfully followed in diabetes insipidus is a proof sufficient that through suitable formulation, medicament may be made to act on the brain.

It is clearly described that sneha nasya should be done in vata aggravation and ruksha nasya should be done in kaphaja diseases. If this indication is ignored the complications that may follow and the measures to tackle them is described in the above verses.

In Ashtanga Hridaya, ten specific timings suitable for administration of pratimarsha have been described.

In practice, especially in conditions of migraine, allergic rhinitis and atopic rhinitis we advise patients to smear medicated oil or ghee into the nostrils using an oleated finger. This may be considered a form of pratimarsha itself.

Related Chapters

• Kiyanta Shiraseeya Adhyaya
• Trimarmiya Chikitsa

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