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Line 3,243: − + − aṣṭāvētē kṣīradōṣā hētulakṣaṇabhēṣajaiḥ||281|| − nirdiṣṭāḥ kṣīradōṣōtthāstathōktāḥ kēcidāmayāḥ|282| − aShTAvete kShIradoShA hetulakShaNabheShajaiH ||281|| − nirdiShTAH kShIradoShotthAstathoktAH kecidAmayAH |282| − − Thus these eight defects of breast milk have been described here with their causes, symptoms and treatment and some ailments caused by the defects of milk have also described here. (281-282) − Principles of management in pediatrics: − दोषदूष्यमलाश्चैव महतां व्याधयश्च ये ||२८२|| − त एव सर्वे [१] बालानां मात्रा त्वल्पतरा मता | − निवृत्तिर्वमनादीनां मृदुत्वं परतन्त्रताम् ||२८३|| − वाक्चेष्टयोरसामर्थ्यं वीक्ष्य बालेषु शास्त्रवित् | − भेषजं स्वल्पमात्रं तु यथाव्याधि प्रयोजयेत् ||२८४|| − मधुराणि कषायाणि क्षीरवन्ति मृदूनि च | − प्रयोजयेद्भिषग्बाले मतिमानप्रमादतः ||२८५|| − अत्यर्थस्निग्धरूक्षोष्णमम्लं कटुविपाकि च | − गुरु चौषधपानान्नमेतद्बालेषु गर्हितम् ||२८६|| − समासात् सर्वरोगाणामेतद्बालेषु भेषजम् | − निर्दिष्टं शास्त्रविद्वैद्यः प्रविविच्य [२] प्रयोजयेत् ||२८७|| − dōṣadūṣyamalāścaiva mahatāṁ vyādhayaśca yē||282|| − ta ēva sarvē [1] bālānāṁ mātrā tvalpatarā matā| − nivr̥ttirvamanādīnāṁ mr̥dutvaṁ paratantratām||283|| − vākcēṣṭayōrasāmarthyaṁ vīkṣya bālēṣu śāstravit| − bhēṣajaṁ svalpamātraṁ tu yathāvyādhi prayōjayēt||284|| − madhurāṇi kaṣāyāṇi kṣīravanti mr̥dūni ca| − prayōjayēdbhiṣagbālē matimānapramādataḥ||285|| − atyarthasnigdharūkṣōṣṇamamlaṁ kaṭuvipāki ca| − guru cauṣadhapānānnamētadbālēṣu garhitam||286|| − samāsāt sarvarōgāṇāmētadbālēṣu bhēṣajam| − nirdiṣṭaṁ śāstravidvaidyaḥ pravivicya [2] prayōjayēt||287|| − doShadUShyamalAshcaiva mahatAM vyAdhayashca ye ||282|| − ta eva sarve [1] bAlAnAM mAtrA tvalpatarA matA | − nivRuttirvamanAdInAM mRudutvaM paratantratAm ||283|| − vAkceShTayorasAmarthyaM vIkShya bAleShu shAstravit | − bheShajaM svalpamAtraM tu yathAvyAdhi prayojayet ||284|| − madhurANi kaShAyANi kShIravanti mRudUni ca | − prayojayedbhiShagbAle matimAnapramAdataH ||285|| − atyarthasnigdharUkShoShNamamlaM kaTuvipAki ca | − guru cauShadhapAnAnnametadbAleShu garhitam ||286|| − samAsAt sarvarogANAmetadbAleShu bheShajam | − nirdiShTaM shAstravidvaidyaH pravivicya [2] prayojayet ||287|| − The vitiation of dosha, body elements, mala and the diseases which affect adults also affect children similarly, but in lesser degree. − The paediatrician should not administer emesis like purification procedures in children due to tender nature, dependency, inability to fully express themselves in speech and gestures. − He should give only small doses of medicines as per the disease. Sweet decoction, medicated milk and medicines with mild potency shall be administered in children by wise pediatrician. − The medicines, food and beverages with excess unctuousness, dryness, hot potency, sour, pungent in post digestive effect, and heavy to digest property are contraindicated in children. − Thus, in brief, the directions regarding the treatment of all the diseases occurring in children, and the physician well versed in science should treat the diseases after meticulously differentiating these factors (mentioned above).(282-287) − − Importance of chikitsa sthana: − भवन्ति चात्र- − इति सर्वविकाराणामुक्तमेतच्चिकित्सितम् | − स्थानमेतद्धि तन्त्रस्य रहस्यं परमुत्तमम् [१] ||२८८|| − bhavanti cātra- − iti sarvavikārāṇāmuktamētaccikitsitam| − sthānamētaddhi tantrasya rahasyaṁ paramuttamam [1] ||288|| − − bhavanti cAtra- − iti sarvavikArANAmuktametaccikitsitam | − sthAnametaddhi tantrasya rahasyaM paramuttamam [1] ||288|| − Thus has been expounded the therapeutics of all diseases; and this section of chikitsa (management) contains the most essential part of this treatise. (288) − Contributors of the treatise: − अस्मिन् सप्तदशाध्यायाः कल्पाः सिद्धय एव च | − नासाद्यन्तेऽग्निवेशस्य तन्त्रे चरकसंस्कृते ||२८९|| − तानेतान् कापिलबलिः शेषान् दृढबलोऽकरोत् | − तन्त्रस्यास्य महार्थस्य पूरणार्थं यथातथम् ||२९०|| − asmin saptadaśādhyāyāḥ kalpāḥ siddhaya ēva ca| − nāsādyantē'gnivēśasya tantrē carakasaṁskr̥tē||289|| − tānētān kāpilabaliḥ śēṣān dr̥ḍhabalō'karōt| − tantrasyāsya mahārthasya pūraṇārthaṁ yathātatham||290|| − asmin saptadashAdhyAyAH kalpAH siddhaya eva ca | − nAsAdyante~agniveshasya tantre carakasaMskRute ||289|| − tAnetAn kApilabaliH sheShAn dRuDhabalo~akarot | − tantrasyAsya mahArthasya pUraNArthaM yathAtatham ||290|| − Seventeen chapters of chikitsa sthana, all chapters of kalpa sthana and siddhi sthana are not found in treatise composed by Agnivesha and revised by Charaka. − These chapters have been added by Dridhabala, Son of Kapilabali to fulfil the aim of completion of this great treatise. (289-290) − Guiding principles to understand anukta vyadhi (untold diseases that are not mentioned here): − रोगा येऽप्यत्र नोद्दिष्टा बहुत्वान्नामरूपतः | − तेषामप्येतदेव स्याद्दोषादीन् वीक्ष्य भेषजम् ||२९१|| − rōgā yē'pyatra nōddiṣṭā bahutvānnāmarūpataḥ| − tēṣāmapyētadēva syāddōṣādīn vīkṣya bhēṣajam||291|| − rogA ye~apyatra noddiShTA bahutvAnnAmarUpataH | − teShAmapyetadeva syAddoShAdIn vIkShya bheShajam ||291|| − The disease which are not described here due to their various names and clinical presentations shall also be treated according to the dominance of dosha etc.factors (as mentioned earlier). (291) − दोषदूष्यनिदानानां विपरीतं हितं ध्रुवम् | − उक्तानुक्तान् गदान् सर्वान् सम्यग्युक्तं नियच्छति ||२९२|| − dōṣadūṣyanidānānāṁ viparītaṁ hitaṁ dhruvam| − uktānuktān gadān sarvān samyagyuktaṁ niyacchati||292|| − doShadUShyanidAnAnAM viparItaM hitaM dhruvam | − uktAnuktAn gadAn sarvAn samyagyuktaM niyacchati ||292|| − The treatment that is opposite to dosha, dushya and nidana (causative factors) is always beneficial. The diseases that are told and untold here can be treated with proper implementation of this principle. (292) − देशकालप्रमाणानां सात्म्यासात्म्यस्य चैव हि | − सम्यग्योगोऽन्यथा ह्येषां पथ्यमप्यन्यथा भवेत् ||२९३|| − dēśakālapramāṇānāṁ sātmyāsātmyasya caiva hi| − samyagyōgō'nyathā hyēṣāṁ pathyamapyanyathā bhavēt||293|| − deshakAlapramANAnAM sAtmyAsAtmyasya caiva hi | − samyagyogo~anyathA hyeShAM pathyamapyanyathA bhavet ||293|| − The medicines shall be prescribed after due consideration of desha (habitat), kala (season), pramana (dosage), satmya (adaptability) and asatmya (non-adaptability). If this is properly considered, then it is pathya (beneficial to body systems).Otherwise it is non-beneficial. (293) − Routes of administration of medicine: − आस्यादामाशयस्थान् हि रोगान् नस्तःशिरोगतान् | − गुदात् पक्वाशयस्थांश्च हन्त्याशु [१] दत्तमौषधम् ||२९४|| − शरीरावयवोत्थेषु विसर्पपिडकादिषु | − यथादेशं [२] प्रदेहादि शमनं स्याद्विशेषतः ||२९५|| − āsyādāmāśayasthān hi rōgān nastaḥśirōgatān| − gudāt pakvāśayasthāṁśca hantyāśu [1] dattamauṣadham||294|| − śarīrāvayavōtthēṣu visarpapiḍakādiṣu| − yathādēśaṁ [2] pradēhādi śamanaṁ syādviśēṣataḥ||295|| − AsyAdAmAshayasthAn hi rogAn nastaHshirogatAn | − gudAt pakvAshayasthAMshca hantyAshu [1] dattamauShadham ||294|| − sharIrAvayavottheShu visarpapiDakAdiShu | − yathAdeshaM [2] pradehAdi shamanaM syAdvisheShataH ||295|| − If the doshas are located in stomach, then medicines shall be administered orally; if at head region, then through nose; and if at colon then medicines quickly act if given per rectum. The doshas at other body parts and diseases originated from them like visarpa, pidaka etc, shall be treated with pradeha etc. specific local pacification procedures. (294-295) − Factors to be considered for medicine administration: − दिनातुरौषधव्याधिजीर्णलिङ्गर्त्ववेक्षणम् [१] | − कालं बिद्याद्दिनावेक्षः पूर्वाह्णे वमनं यथा ||२९६|| − dināturauṣadhavyādhijīrṇaliṅgartvavēkṣaṇam [1] | − kālaṁ vidyāddināvēkṣaḥ pūrvāhṇē vamanaṁ yathā||296|| − − dinAturauShadhavyAdhijIrNali~ggartvavekShaNam [1] | − kAlaM bidyAddinAvekShaH pUrvAhNe vamanaM yathA ||296|| − Medicines must be administered taking into consideration day (time), patient, type of medicine, disease, digestive status, and season. The time of administration of medicine depends on the day like emetics should be given early in the morning. (296) − Aushadha sevana kala (time of administration of medicine): − रोग्यवेक्षो यथा प्रातर्निरन्नो बलवान् पिबेत् | − भेषजं लघुपथ्यान्नैर्युक्तमद्यात्तु दुर्बलः ||२९७|| − rōgyavēkṣō yathā prātarnirannō balavān pibēt| − bhēṣajaṁ laghupathyānnairyuktamadyāttu durbalaḥ||297|| − rogyavekSho yathA prAtarniranno balavAn pibet | − bheShajaM laghupathyAnnairyuktamadyAttu durbalaH ||297|| − The time of administration and the type of medicine must be decided as per the condition and diseased status of the patient. Patient in good condition who is strong should consume medicine early in the morning prior to morning meals and a person who is weak should take medicines along with food which is very light to get digested. (297) − Ten slots of consuming medicines: − भैषज्यकालो भुक्तादौ मध्ये पश्चान्मुहुर्मुहुः | − सामुद्गं भक्तसंयुक्तं ग्रासग्रासान्तरे दश ||२९८|| − bhaiṣajyakālō bhuktādau madhyē paścānmuhurmuhuḥ| − sāmudgaṁ bhaktasaṁyuktaṁ grāsagrāsāntarē daśa||298|| − − bhaiShajyakAlo bhuktAdau madhye pashcAnmuhurmuhuH | − sAmudgaM bhaktasaMyuktaM grAsagrAsAntare dasha ||298|| − Ten slots or times of consuming medicines are described which are as follows. Two timing which are described in previous sutra, before meals, in between meals, at end of meals, frequently, at the end of meal and again consuming meals, medicine mixed with the morsel, along with each morsel and administrating in between each morsel.(298) − Relation between time of administration and type of vitiated vata dosha: − अपाने विगुणे पूर्वं, समाने मध्यभोजनम् | − व्याने [२] तु प्रातरशितमुदाने भोजनोत्तरम् ||२९९|| − apānē viguṇē pūrvaṁ, samānē madhyabhōjanam| − vyānē [2] tu prātaraśitamudānē bhōjanōttaram||299|| − apAne viguNe pUrvaM, samAne madhyabhojanam | − vyAne [2] tu prAtarashitamudAne bhojanottaram ||299|| − In vitiation of apana vayu medicines must be consumed before food , in vitiation of samana vayu food must be consumed in between meals, in vyana vayu vitiation early morning medication is advised and in udana vayu vitiation medicine is advised after meals. (299) − − वायौ प्राणे प्रदुष्टे तु ग्रासग्रासान्तरिष्यते | − श्वासकासपिपासासु त्ववचार्यं मुहुर्मुहुः ||३००|| − vāyau prāṇē praduṣṭē tu grāsagrāsāntariṣyatē| − śvāsakāsapipāsāsu tvavacāryaṁ muhurmuhuḥ||300|| − − vAyau prANe praduShTe tu grAsagrAsAntariShyate | − shvAsakAsapipAsAsu tvavacAryaM muhurmuhuH ||300|| − When prana vayu is vitiated medicines is to be advocated along with each morsel and in between two morsel. In diseases like shwas, kasa, pippasa (thirst) frequent doses of medicines must be given. (300) − सामुद्गं हिक्किने देयं लघुनाऽन्नेन संयुतम् | − सम्भोज्यं त्वौषधं भोज्यैर्विचित्रैररुचौ हितम् ||३०१|| − sāmudgaṁ hikkinē dēyaṁ laghunā'nnēna saṁyutam| − sambhōjyaṁ tvauṣadhaṁ bhōjyairvicitrairarucau hitam||301|| − − sAmudgaM hikkine deyaM laghunA~annena saMyutam | − sambhojyaM tvauShadhaM bhojyairvicitrairarucau hitam ||301|| − − − In diseases like hikka, medicines are to be used before and after, along with light meal to get digested. In patient with anorexia, medicines are to be given with meals.(301) − ज्वरे पेयाः कषायाश्च क्षीरं सर्पिर्विरेचनम् | − षडहे षडहे देयं कालं वीक्ष्यामयस्य च ||३०२|| − jvarē pēyāḥ kaṣāyāśca kṣīraṁ sarpirvirēcanam| − ṣaḍahē ṣaḍahē dēyaṁ kālaṁ vīkṣyāmayasya ca||302|| − jvare peyAH kaShAyAshca kShIraM sarpirvirecanam | − ShaDahe ShaDahe deyaM kAlaM vIkShyAmayasya ca ||302|| − Peya , kashaya ( decoction) , kshira (medicated milk), medicated ghee and purgation must be advocated every six days taking into consideration status of the disease. (302) − Signs of complete digestion: − क्षुद्वेगमोक्षौ लघुता विशुद्धिर्जीर्णलक्षणम् | − तदा भेषजमादेयं स्याद्धि दोषवदन्यथा ||३०३|| − kṣudvēgamōkṣau laghutā viśuddhirjīrṇalakṣaṇam| − tadā bhēṣajamādēyaṁ syāddhi dōṣavadanyathā||303|| − − kShudvegamokShau laghutA vishuddhirjIrNalakShaNam | − tadA bheShajamAdeyaM syAddhi doShavadanyathA ||303|| − − Good appetite, natural passage of urges like stools and urine, lightness in the body and unobstructed vata dosha are the symptoms of jeerna (complete digestion). Above mentioned medicines are to be advocated when such symptoms arrive. If medications are given with such type of symptoms they pacify the disease and when given without such symptoms they vitiate the doshas.(303) − चयादयश्च दोषाणां वर्ज्यं सेव्यं च यत्र यत् | − ऋताववेक्ष्यं यत् कर्म पूर्वं सर्वमुदाहृतम् ||३०४|| − cayādayaśca dōṣāṇāṁ varjyaṁ sēvyaṁ ca yatra yat| − r̥tāvavēkṣyaṁ yat karma pūrvaṁ sarvamudāhr̥tam||304|| − − cayAdayashca doShANAM varjyaM sevyaM ca yatra yat | − RutAvavekShyaM yat karma pUrvaM sarvamudAhRutam ||304|| − Which dosha are vitiated in which season, i.e the pattern of vitiation of dosha as per the seasonal variation, and what are the dietary do’s and don’ts and which treatment should be administered in which season is well elaborated previously in Sutrasthana. (304) − (उपक्रमाणां [३] करणं प्रतिषेधे च कारणम् | − व्याख्यातमबलानां सविकल्पानामवेक्षणे ||३०५|| − (upakramāṇāṁ [3] karaṇaṁ pratiṣēdhē ca kāraṇam| − vyākhyātamabalānāṁ savikalpānāmavēkṣaṇē||305|| − − (upakramANAM [3] karaNaM pratiShedhe ca kAraNam | − vyAkhyAtamabalAnAM savikalpAnAmavekShaNe ||305|| − − The contraindicated treatment in certain period are explained well, as well as management of a weak patient and a strong patient is very well elaborated. (305) − मुहुर्मुहुश्च रोगाणामवस्थामातुरस्य च | − अवेक्षमाणस्तु भीषक् चिकित्सायां न मुह्यति) ||३०६|| − इत्येवं षड्विधं कालमनवेक्ष्य भिषग्जितम् | − प्रयुक्तमहिताय स्यात् सस्यस्याकालवर्षवत् ||३०७|| − muhurmuhuśca rōgāṇāmavasthāmāturasya ca| − avēkṣamāṇastu bhiṣak cikitsāyāṁ na muhyati)||306|| − ityēvaṁ ṣaḍvidhaṁ kālamanavēkṣya bhiṣagjitam| − prayuktamahitāya syāt sasyasyākālavarṣavat||307|| − − muhurmuhushca rogANAmavasthAmAturasya ca | − avekShamANastu bhIShak cikitsAyAM na muhyati) ||306|| − ityevaM ShaDvidhaM kAlamanavekShya bhiShagjitam | − prayuktamahitAya syAt sasyasyAkAlavarShavat ||307|| − That vaidya who keenly looks towards the status of the patient and status of the disease and then treats the patient never makes a mistake while managing the patient. The vaidya who does not follow the above six dosage timings of administration of medicines would not treat the disease properly and as unseasonal rain damages the crops; same way the medicines given at the wrong time damages health of patient. (306-307) − Kala (season, state and time): − व्याधीनामृत्वहोरात्रवयसां भोजनस्य च | − विशेषो भिद्यते यस्तु कालावेक्षः स उच्यते ||३०८|| − वसन्ते श्लेष्मजा रोगाः शरत्काले तु पित्तजाः | − वर्षासु वातिकाश्चैव प्रायः प्रादुर्भवन्ति हि ||३०९|| − vyādhīnāmr̥tvahōrātravayasāṁ bhōjanasya ca| − viśēṣō bhidyatē yastu kālāvēkṣaḥ sa ucyatē||308|| − vasantē ślēṣmajā rōgāḥ śaratkālē tu pittajāḥ| − varṣāsu vātikāścaiva prāyaḥ prādurbhavanti hi||309|| − − vyAdhInAmRutvahorAtravayasAM bhojanasya ca | − visheSho bhidyate yastu kAlAvekShaH sa ucyate ||308|| − vasante shleShmajA rogAH sharatkAle tu pittajAH | − varShAsu vAtikAshcaiva prAyaH prAdurbhavanti hi ||309|| − − One who classifies ritu ( season), day, night, age and time of meals depending upon time is called as kalaveksha. − In general, kaphaja disorders are manifested in vasanta ritu; pittaja disorders appear during sharada ritu and vataja disorders manifest during varsha ritu. (308-309) − Circadian rhythm of dosha disorders: − निशान्ते दिवसान्ते च वर्षान्ते वातजा गदाः | − प्रातः क्षपादौ कफजास्तयोर्मध्ये तु पित्तजाः ||३१०|| − niśāntē divasāntē ca varṣāntē vātajā gadāḥ| − prātaḥ kṣapādau kaphajāstayōrmadhyē tu pittajāḥ||310|| − nishAnte divasAnte ca varShAnte vAtajA gadAH | − prAtaH kShapAdau kaphajAstayormadhye tu pittajAH ||310|| − − End of night, end of day, end of rainy season time is prone for vataja disorders. Beginning of day, morning and evening times is susceptible for kaphaja disorders and middle time of day is prone for pittaja disorders.(310) − वयोन्तमध्यप्रथमे वातपित्तकफामयाः | − बलवन्तो भवन्त्येव स्वभावाद्वयसो नृणाम् ||३११|| − vayōntamadhyaprathamē vātapittakaphāmayāḥ| − balavantō bhavantyēva svabhāvādvayasō nr̥ṇām||311|| − − vayontamadhyaprathame vAtapittakaphAmayAH | − balavanto bhavantyeva svabhAvAdvayaso nRuNAm ||311|| − − Human age has been divided into prathama, madhya and anta age. In prathama vaya(childhood), there is predominance of kapha; in madhya vaya (youth and adulthood), there is predominance of pitta and in anta vaya (old age), there is predominance of vata dosha. These doshas have a natural predominance as per the age of the person.(311) − जीर्णान्ते वातजा रोगा जीर्यमाणे तु पित्तजाः | − श्लेष्मजा भुक्तमात्रे तु लभन्ते प्रायशो बलम् ||३१२|| − jīrṇāntē vātajā rōgā jīryamāṇē tu pittajāḥ| − ślēṣmajā bhuktamātrē tu labhantē prāyaśō balam||312|| − jIrNAnte vAtajA rogA jIryamANe tu pittajAH | − shleShmajA bhuktamAtre tu labhante prAyasho balam ||312|| − Taking into consideration the time of digestion of food, when it gets completely digested, that is at the end of food digestion vata dosha disorders occur; in middle of digestion pitta dosha disorders manifest and immediately when food is under process of digestion kapha dosha dominant disorder may appear.(312) − Importance of proper dosage: − नाल्पं हन्त्यौषधं व्याधिं यथाऽऽपोऽल्पा महानलम् | − दोषवच्चातिमात्रं स्यात्सस्यस्यात्युदकं यथा ||३१३|| − सम्प्रधार्य बलं तस्मादामयस्यौषधस्य च | − नैवातिबहु नात्यल्पं भैषज्यमवचारयेत् ||३१४|| − nālpaṁ hantyauṣadhaṁ vyādhiṁ yathā''pō'lpā mahānalam| − dōṣavaccātimātraṁ syātsasyasyātyudakaṁ yathā||313|| − sampradhārya balaṁ tasmādāmayasyauṣadhasya ca| − naivātibahu nātyalpaṁ bhaiṣajyamavacārayēt||314|| − nAlpaM hantyauShadhaM vyAdhiM yathA~a~apo~alpA mahAnalam | − doShavaccAtimAtraM syAtsasyasyAtyudakaM yathA ||313|| − sampradhArya balaM tasmAdAmayasyauShadhasya ca | − naivAtibahu nAtyalpaM bhaiShajyamavacArayet ||314|| − As very small quantity of water can’t extinguish big fire, similarly small doses (insufficient dose) of medicine can’t inhibit or treat disease. Similarly excess water in field damages crop, the same way excess of medicine damages health of a person. Hence medicine should be given as per the status of disease; neither should it be given in very higher dose nor in very smaller doses to treat disease.(313-314) − Satmya (adaptability) as per habitat: − औचित्याद्यस्य यत् सात्म्यं देशस्य पुरुषस्य च | − अपथ्यमपि नैकान्तात्तत्त्यजंल्लभते सुखम् ||३१५|| − बाह्लीकाः पह्लवाश्चीनाः शूलीका यवनाः शकाः | − मांसगोधूममाध्वीकशस्त्रवैश्वानरोचिताः ||३१६|| − मत्स्यसात्म्यास्तथा [१] प्राच्याः क्षीरसात्म्याश्च सैन्धवाः | − अश्मकावन्तिकानां [२] तु तैलाम्लं सात्म्यमुच्यते ||३१७|| − कन्दमूलफलं [३] सात्म्यं विद्यान्मलयवासिनाम् | − सात्म्यं दक्षिणतः पेया मन्थश्चोत्तरपश्चिमे [४] ||३१८|| − मध्यदेशे भवेत् सात्म्यं यवगोधूमगोरसाः | − तेषां तत्सात्म्ययुक्तानि भैषजान्यवचारयेत् ||३१९|| − सात्म्यं ह्याशु बलं धत्ते नातिदोषं च बह्वपि |३२०| − योगैरेव चिकित्सन् हि देशाद्यज्ञोऽपराध्यति ||३२०|| − aucityādyasya yat sātmyaṁ dēśasya puruṣasya ca| − apathyamapi naikāntāttattyajaṁllabhatē sukham||315|| − bāhlīkāḥ pahlavāścīnāḥ śūlīkā yavanāḥ śakāḥ| − māṁsagōdhūmamādhvīkaśastravaiśvānarōcitāḥ||316|| − matsyasātmyāstathā [1] prācyāḥ kṣīrasātmyāśca saindhavāḥ| − aśmakāvantikānāṁ [2] tu tailāmlaṁ sātmyamucyatē||317|| − kandamūlaphalaṁ [3] sātmyaṁ vidyānmalayavāsinām| − sātmyaṁ dakṣiṇataḥ pēyā manthaścōttarapaścimē [4] ||318|| − madhyadēśē bhavēt sātmyaṁ yavagōdhūmagōrasāḥ| − tēṣāṁ tatsātmyayuktāni bhaiṣajānyavacārayēt||319|| − sātmyaṁ hyāśu balaṁ dhattē nātidōṣaṁ ca bahvapi| − yōgairēva cikitsan hi dēśādyajñō'parādhyati||320|| − aucityAdyasya yat sAtmyaM deshasya puruShasya ca | − apathyamapi naikAntAttattyajaMllabhate sukham ||315|| − bAhlIkAH pahlavAshcInAH shUlIkA yavanAH shakAH | − mAMsagodhUmamAdhvIkashastravaishvAnarocitAH ||316|| − matsyasAtmyAstathA [1] prAcyAH kShIrasAtmyAshca saindhavAH | − ashmakAvantikAnAM [2] tu tailAmlaM sAtmyamucyate ||317|| − kandamUlaphalaM [3] sAtmyaM vidyAnmalayavAsinAm | − sAtmyaM dakShiNataH peyA manthashcottarapashcime [4] ||318|| − madhyadeshe bhavet sAtmyaM yavagodhUmagorasAH | − teShAM tatsAtmyayuktAni bhaiShajAnyavacArayet ||319|| − sAtmyaM hyAshu balaM dhatte nAtidoShaM ca bahvapi |320| − yogaireva cikitsan hi deshAdyaj~jo~aparAdhyati ||320|| − Any food substance which is habituated to a particular person and which are not conducive or not wholesome to body and mind is called as apathya. Any person who is consuming such type of food or who is following unwholesome behavior should not instantly hold it. If any unwholesome food is prohibited instantly the person is not benefitted from it. − Balhik means people living in balakha bukhara, shadwal, shulik, yawan and shaka are satmya to mamsa ( meat), godhuma(wheat), madhvik ( Alcoholic beverges) surgery and agnikarma (cauterization). Satmya is those daily activities and food which have become habitual to body. People from east are habituated to milk while people living in sindha desha are satmya to fish. Ashmak, and Avantika (Ujjain) residing people are satmya to oil and ghee. People from Vidyanamalaya (Malbar region ) are satmya to kanda (rhizomes , tuber) roots and fruits. People from north are satmya to peya , and people from south are satmya to mantha. People from central part are satmya to yava, godhuma and gorasa (milk). Medicines must be administered along with the food which is satmya to the patient . Medicines given with satmya food nourish the body fast and do not create much untoward effects. Medicines given without consideration of desha and kala and administered as mentioned in yoga ( formulation) may lead to wrong management. (315-320) − − Viparitarthakari chikitsa (contradictory treatment): − वयोबलशरीरादिभेदा हि बहवो मताः [१] |३२१| − तथाऽन्तःसन्धिमार्गाणां दोषाणां गूढचारिणाम् ||३२१|| − भवेत् कदाचित् कार्याऽपि विरुद्धाभिमता क्रिया | − पित्तमन्तर्गतं गूढं [१] स्वेदसेकोपनाहनैः ||३२२|| − नीयते बहिरुष्णैर्हि तथोष्णं शमयन्ति ते | − बाह्यैश्च शीतैः सेकाद्यैरूष्माऽन्तर्याति पीडितः ||३२३|| − सोऽन्तर्गूढं कफं हन्ति शीतं शीतैस्तथा जयेत् | − श्लक्ष्णपिष्टो घनो लेपश्चन्दनस्यापि दाहकृत् ||३२४|| − त्वग्गतस्योष्मणो रोधाच्छीतकृच्चान्यथाऽगुरोः | − छर्दिघ्नी मक्षिकाविष्ठा मक्षिकैव तु वामयेत् ||३२५|| − द्रव्येषु स्विन्नजग्धेषु चैव तेष्वेव विक्रिया |३२६| − − vayōbalaśarīrādibhēdā hi bahavō matāḥ [1] |321| − tathā'ntaḥsandhimārgāṇāṁ dōṣāṇāṁ gūḍhacāriṇām||321|| − bhavēt kadācit kāryā'pi viruddhābhimatā kriyā| − pittamantargataṁ gūḍhaṁ [1] svēdasēkōpanāhanaiḥ||322|| − nīyatē bahiruṣṇairhi tathōṣṇaṁ śamayanti tē| − bāhyaiśca śītaiḥ sēkādyairūṣmā'ntaryāti pīḍitaḥ||323|| − sō'ntargūḍhaṁ kaphaṁ hanti śītaṁ śītaistathā jayēt| − ślakṣṇapiṣṭō ghanō lēpaścandanasyāpi dāhakr̥t||324|| − tvaggatasyōṣmaṇō rōdhācchītakr̥ccānyathā'gurōḥ| − chardighnī makṣikāviṣṭhā makṣikaiva tu vāmayēt||325|| − dravyēṣu svinnajagdhēṣu caiva tēṣvēva vikriyā| − tasmāddōṣauṣadhādīni parīkṣya daśa tattvataḥ||326|| − vayobalasharIrAdibhedA hi bahavo matAH [1] |321| − tathA~antaHsandhimArgANAM doShANAM gUDhacAriNAm ||321|| − bhavet kadAcit kAryA~api viruddhAbhimatA kriyA | − pittamantargataM gUDhaM [1] svedasekopanAhanaiH ||322|| − nIyate bahiruShNairhi tathoShNaM shamayanti te | − bAhyaishca shItaiH sekAdyairUShmA~antaryAti pIDitaH ||323|| − so~antargUDhaM kaphaM hanti shItaM shItaistathA jayet | − shlakShNapiShTo ghano lepashcandanasyApi dAhakRut ||324|| − tvaggatasyoShmaNo rodhAcchItakRuccAnyathA~aguroH | − chardighnI makShikAviShThA makShikaiva tu vAmayet ||325|| − dravyeShu svinnajagdheShu caiva teShveva vikriyA |326| − tasmAddoShauShadhAdIni parIkShya dasha tattvataH ||326|| − − Medicines should be advised, taking into consideration the dushyas, doshas, and different types of factors related to the status of the body. The doshas which are situated in the deeper tissues are also of different types and these doshas move through the different types of channels which are connected to each other. To manage any disease which is deeply seated into the tissue, many procedures much seems to be opposite as per the classical text are to be advocated. For example pitta which is ushna (hot) in nature is treated by sheeta (cold) procedures, but in deep seated boil the pitta which is ushna in nature and vitiated is to be treated by giving hot fomentation or poultice. If cold procedures are implemented in this condition it will worsen the condition. Similarly if deep seated kapha dosha is to be treated sheeta procedures must be implemented. Lepas made out of sheeta dravyas like chandan are applied the inner heat will not be released and this heat can make cough dry. Though chandana is sheeta dravya, lepa made out of superfine powder of chandan applied on the lesion will block the heat coming out from the skin. This accumulated heat creates burning at the sight. In opposite, If lepa of agaru which is hot in nature and is applied, will impart coldness in that part. It is known that stool of fish has vomiting inhibiting activity but fish if consumed induces vomiting. Food substances if boiled or baked changes their properties. Thus it’s important for a vaidya, that he should not depend only on the properties of the yoga (formulation) but must consider all the ten factors discussed earlier along with different type of factors their classification and some exceptional rules while treating disorders. (321-326) − − निवृत्तोऽपि पुनर्व्याधिः स्वल्पेनायाति हेतुना ||३२७|| − क्षीणे मार्गीकृते देहे शेषः सूक्ष्म इवानलः | − तस्मात्तमनुबध्नीयात् प्रयोगेणानपायिना ||३२८|| − सिद्ध्यर्थं प्राक्प्रयुक्तस्य सिद्धस्याप्यौषधस्य तु |३२९| − काठिन्यादूनभावाद्वा दोषोऽन्तः कुपितो महान् ||३२९|| − पथ्यैर्मृद्वल्पतां नीतो मृदुदोषकरो भवेत् | − पथ्यमप्यश्नतस्तस्माद्यो व्याधिरुपजायते ||३३०|| − ज्ञात्वैवं वृद्धिमभ्यासमथवा तस्य कारयेत् |३३१| − सातत्यात्स्वाद्वभावाद्वा पथ्यं द्वेष्यत्वमागतम् ||३३१|| − कल्पनाविधिभिस्तैस्तैः प्रियत्वं गमयेत् पुनः | − मनसोऽर्थानुकूल्याद्धि तुष्टिरूर्जा रुचिर्बलम् ||३३२|| − सुखोपभोगता च स्याद्व्याधेश्चातो बलक्षयः | − लौल्याद्दोषक्षयाद्व्याधेर्वैधर्म्याच्चापि या रुचिः ||३३३|| − तासु पथ्योपचारः स्याद्योगेनाद्यं विकल्पयेत् |३३४| − − kuryāccikitsitaṁ prājñō na yōgairēva kēvalam| − nivr̥ttō'pi punarvyādhiḥ svalpēnāyāti hētunā||327|| − kṣīṇē mārgīkr̥tē dēhē śēṣaḥ sūkṣma ivānalaḥ| − tasmāttamanubadhnīyāt prayōgēṇānapāyinā||328|| − siddhyarthaṁ prākprayuktasya siddhasyāpyauṣadhasya tu| − kāṭhinyādūnabhāvādvā dōṣō'ntaḥ kupitō mahān||329|| − pathyairmr̥dvalpatāṁ nītō mr̥dudōṣakarō bhavēt| − pathyamapyaśnatastasmādyō vyādhirupajāyatē||330|| − jñātvaivaṁ vr̥ddhimabhyāsamathavā tasya kārayēt|331| − sātatyātsvādvabhāvādvā pathyaṁ dvēṣyatvamāgatam||331|| − kalpanāvidhibhistaistaiḥ priyatvaṁ gamayēt punaḥ| − manasō'rthānukūlyāddhi tuṣṭirūrjā rucirbalam||332|| − sukhōpabhōgatā ca syādvyādhēścātō balakṣayaḥ| − laulyāddōṣakṣayādvyādhērvaidharmyāccāpi yā ruciḥ||333|| − tāsu pathyōpacāraḥ syādyōgēnādyaṁ vikalpayēt| − kuryAccikitsitaM prAj~jo na yogaireva kevalam | − nivRutto~api punarvyAdhiH svalpenAyAti hetunA ||327|| − kShINe mArgIkRute dehe sheShaH sUkShma ivAnalaH | − tasmAttamanubadhnIyAt prayogeNAnapAyinA ||328|| − siddhyarthaM prAkprayuktasya siddhasyApyauShadhasya tu |329| − kAThinyAdUnabhAvAdvA doSho~antaH kupito mahAn ||329|| − pathyairmRudvalpatAM nIto mRududoShakaro bhavet | − pathyamapyashnatastasmAdyo vyAdhirupajAyate ||330|| − j~jAtvaivaM vRuddhimabhyAsamathavA tasya kArayet |331| − sAtatyAtsvAdvabhAvAdvA pathyaM dveShyatvamAgatam ||331|| − kalpanAvidhibhistaistaiH priyatvaM gamayet punaH | − manaso~arthAnukUlyAddhi tuShTirUrjA rucirbalam ||332|| − sukhopabhogatA ca syAdvyAdheshcAto balakShayaH | − laulyAddoShakShayAdvyAdhervaidharmyAccApi yA ruciH ||333|| − tAsu pathyopacAraH syAdyogenAdyaM vikalpayet |334| − − As a small sparkle of fire flare ups when it comes in contact with wind or wood and gets converted into huge flames of fire similarly already a weak body in which previously a disease pathology has occurred and disease has recovered, whenever gets chance may again relapse. Hence for the better results of the medicines given before to treat the disease, pathya (wholesome diet) must be followed after the disease is completely treated. − If strong or weak medicament has vitiated doshas, they can be pacified by following wholesome diet. If disease status aggravates even when followed by wholesome diet, diet pattern should be changed which can help to inhibit the disease. If patient is bored from taking the same food or does not relish the food, then food should be prepared by different methods which will be liked by the patient. − If the food and other objects are liked by patient then only he gets satisfaction, enthusiasm, energy, taste, strength and happiness which reduces the influence of disease. − Greediness in eating, due to the inactivity of doshas or wrong disease process leads to loss of taste and appetite which can be corrected by whole some diet and activity or change in the previously advised diet.(327-333) − Summary: − तत्र श्लोकाः- − विंशतिर्व्यापदो योनेर्निदानं लिङ्गमेव च ||३३४|| − चिकित्सा चापि निर्दिष्टा शिष्याणां हितकाम्यया | − शुक्रदोषास्तथा चाष्टौ निदानाकृतिभेषजैः ||३३५|| − क्लैब्यान्युक्तानि चत्वारि चत्वारः प्रदरास्तथा | − तेषां निदानं लिङ्गं च भैषज्यं चैव कीर्तितम् ||३३६|| − क्षीरदोषास्तथा चाष्टौ हेतुलिङ्गभिषग्जितैः | − रेतसो रजसश्चैव कीर्तितं शुद्धिलक्षणम् ||३३७|| − उक्तानुक्तचिकित्सा च सम्यग्योगस्तथैव च | − देशादिगुणशंसा [१] च कालः षङ्विध एव च ||३३८|| − देशे देशे च यत् सात्म्यं यथा वैद्योऽपराध्यति − चिकित्सा चापि निर्दिष्टा दोषाणां गूढचारिणाम् ||३३९|| − यो हि सम्यङ्ग जानाति शास्त्रं शास्त्रार्थमेव च | − न कुर्यात् स क्रियां चित्रमचक्षुरिव चित्रकृत् ||३४०|| − अग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते | − चिकित्सितमिदं स्थानं षष्ठं परिसमापितम् ||३४१|| − tatra ślōkāḥ- − viṁśatirvyāpadō yōnērnidānaṁ liṅgamēva ca||334|| − cikitsā cāpi nirdiṣṭā śiṣyāṇāṁ hitakāmyayā| − śukradōṣāstathā cāṣṭau nidānākr̥tibhēṣajaiḥ||335|| − klaibyānyuktāni catvāri catvāraḥ pradarāstathā| − tēṣāṁ nidānaṁ liṅgaṁ ca bhaiṣajyaṁ caiva kīrtitam||336|| − kṣīradōṣāstathā cāṣṭau hētuliṅgabhiṣagjitaiḥ| − rētasō rajasaścaiva kīrtitaṁ śuddhilakṣaṇam||337|| − uktānuktacikitsā ca samyagyōgastathaiva ca| − dēśādiguṇaśaṁsā [1] ca kālaḥ ṣaṅvidha ēva ca||338|| − dēśē dēśē ca yat sātmyaṁ yathā vaidyō'parādhyati| − cikitsā cāpi nirdiṣṭā dōṣāṇāṁ gūḍhacāriṇām||339|| − yō hi samyaṅna jānāti śāstraṁ śāstrārthamēva ca| − na kuryāt sa kriyāṁ citramacakṣuriva citrakr̥t||340|| − agnivēśakr̥tē tantrē carakapratisaṁskr̥tē| − cikitsitamidaṁ sthānaṁ ṣaṣṭhaṁ parisamāpitam||341|| − tatra shlokAH- − viMshatirvyApado yonernidAnaM li~ggameva ca ||334|| − shukradoShAstathA cAShTau nidAnAkRutibheShajaiH ||335|| − klaibyAnyuktAni catvAri catvAraH pradarAstathA | − teShAM nidAnaM li~ggaM ca bhaiShajyaM caiva kIrtitam ||336|| − kShIradoShAstathA cAShTau hetuli~ggabhiShagjitaiH | − retaso rajasashcaiva kIrtitaM shuddhilakShaNam ||337|| − uktAnuktacikitsA ca samyagyogastathaiva ca | − deshAdiguNashaMsA [1] ca kAlaH Sha~gvidha eva ca ||338|| − deshe deshe ca yat sAtmyaM yathA vaidyo~aparAdhyati | − cikitsA cApi nirdiShTA doShANAM gUDhacAriNAm ||339|| − yo hi samya~gga jAnAti shAstraM shAstrArthameva ca | − na kuryAt sa kriyAM citramacakShuriva citrakRut ||340|| − agniveshakRute tantre carakapratisaMskRute | − cikitsitamidaM sthAnaM ShaShThaM parisamApitam ||341|| − In this chapter of Yonivyapad Chikitsa twenty types of yoni roga, their causes symptoms and treatment, eight types of disorders of veerya (semen), their causes symptoms and treatment, four types of infertility and four types of pradara ( vaginal discharges) their causes symptoms and treatment, eight types of disorders of breast milk their causes symptoms and its short and detail treatment, − Symptoms of shuddha shukra (normal semen) and shudhha artav (menstrual bleeding), management of explained and unexplained diseases, importance of place and time in treatment, six type of classification regarding time in general or the period regarding day, month, season etc, satmya of people residing in different area, how vaidya can cause error in conducting any treatment or procedure and treatment of deep seated doshas. − As a blind person cannot draw a good portrait, similarly that vaidya who doesn’t understand science and its interpretation cannot treat disease in a proper manner. (334-341) − इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने योनिव्यापच्चिकित्सितं नाम त्रिंशोऽध्यायः ||३०|| − श्रीचरकसंहितायां चिकित्सितस्थानं समाप्तम् ||३१|| − ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē yōnivyāpaccikitsitaṁnāma triṁśō'dhyāyaḥ||30|| − iti carakasaṁhitāyāṁ ṣaṣṭhaṁ cikitsitasthānaṁ sampūrṇam| − ityagniveshakRute tantre carakapratisaMskRute~aprApte dRuDhabalasampUrite cikitsAsthAne yonivyApaccikitsitaM nAma triMsho~adhyAyaH ||30|| − shrIcarakasaMhitAyAM cikitsitasthAnaM samAptam ||31|| − Thus ends the thirtheeth chapter of Chikitsa sthana in the treatise by Agnivesha, revised by Charaka and redacted by Dridhabala. − Tattva vimarsha: − • The faulty lifestyle habits, vitiated menstrual blood, defects in beeja (ovum, causing hereditary or congenital defects) and the destiny are four causative factors for diseases of female genital tract. − • In addition to above, manifestation of yonivyapat (diseases of female genital tract) depends upon the vitiation of doshas due to their own causative factors. − • The manifestation of diseases of female genital tract can occur in two ways viz. structural abnormalities and functional abnormalities. This leads to defects in menstruation, difficulty in sexual intercourse, inability to conceive i.e. infertility or abortion. − • The diseases of female genital tract are influenced by various physiological factors like age, maturity, menstruation, sexual intercourse, pregnancy, labour, menopause and suppression of natural urges. − • Vata plays important role in all conditions of yonivyapat, because the genital tract is inherent seat of vata dosha. − • The genetic defects in female genital tract are mainly caused by improper diet and lifestyle of mother during pregnancy and vitiation of vata dosha. − • Assessment of dominance of dosha must be done before starting treatment of yonivyapat, because the treatment and procedures are highly specific to vitiation of dosha. − • The treatment is based upon assessment of dominance of dosha, its purification, general pacification and local procedures with dosha alleviating medicines. − • The purification procedures advocated in females shall always be mild in nature. Strong purification is contra-indicated in females. − • The local examination of female genital tract, vaginal discharge, vaginal structure (unctuousness or dryness, stiffness or flaccidity, displacement) shall always be done before designing treatment protocol. − • In rakta yoni (bleeding through the vagina), the colour of bleeding should be observed for the association of doshas and haemostatic drugs should be used according to the involvement of doshas. (86) − • When the genital tract is purified and the seeds (sperm and ovum) are normal (in their own form), undamaged, then the jivatama or consciousness wants to come into the foetus (garbha) then women conceive. (125) − • In males, the shukra (semen) gets ejaculated as a result of excitement and is the sign of masculinity. The seed as an effect of delighted coitus, has been described as shukra (semen), is the male characteristic. As the seed has capacity of reproduction in favourable conditions, the shukra possess capacity of reproduction. − • Improper diet, improper lifestyle, psychological factors and improper sexual habits impair quality and quantity of shukra dhatu. − • Fenilam (frothy), tanu (slender), ruksham (arid), vivarnam (discolored), pooti (putrid), pichhilam (slimy), afflicted with other dhatus, & precipitant are the eight shukra disorders affected by vitiated dosha. − • Retah (virile semen) that is snigdha (unctuousness), ghana (viscous), picchila (slimy), madhura (sweet), avidahi (non-blazing), looking like white crystal quartz; are characteristics of normal (semen). − • In case of diseases of semen, treatment principles with use of formulations mentioned in vajikarana (aphrodisiac), raktapitta and yonivyapada are applied. − • Impotency is caused by the beeja-upaghata (hereditary/congenital defect), dhwajopaghata (erectile dysfunction), jaraya (senility), shukrasamkshaya (diminished semen). − • The treatment mentioned for the shukra (semen) disorders as well as kshataksheena shall be applied for alleviation of impotency. Indications are basti, ksheera-sarpi (combination of milk and ghee), vrushya yoga(aphrodisiac), & rasayana prayoga (rejuvenating medicines); all together shall be administered for the treatment of impotency, caused by excess coitus, dhatu viparyaya, considering deha-bala (strength of the patient), dosha–bala (degree of dosha vitiation), agni-bala (power of agni) & bheshaj-kala (time of medicine administration). − • The vitiated dosha affect menstrual blood and increase quantity and duration of menstruation leading to pradara. The clinical manifestations of pradara depend upon dosha dominance involved in pathogenesis. − • If menstrual discharge (artava) comes after a month without stickiness (sliminess), burning sensation and pain, persists for five days, neither too little nor excess in quantity then it is considered as free from doshas or normal. In colour, artava (menstrual blood) should be red like gunja fruit, red lotus flower or mahavara or red as indragopaka insect, such artava is considered as normal menstrual blood. (225-226) − • The treatment of pradara is as per principles of management for raktatisara (diarrhoea with expulsion of blood), raktapitta (internal haemorrhage) and raktarsha (bleeding piles). − • The breast milk can be affected by vitiated dosha due to improper diet and lifestyle of mother or wet nurse. The clinical manifestation is observed in change in colour and consistency of breast milk, signs on the breast milk fed baby and mother too. The treatment of mother or wet nurse is done in order to treat the defects. − • The vitiation of dosha, body elements, mala and the diseases which affect adults also affect children similarly, but to lesser degree. − • The paediatrician should not administer emesis like purification procedures in children due to tender nature, dependency, inability to fully express themselves in speech and gestures. − He should give only small doses of medicines as per the disease. Sweet decoction, medicated milk and medicines with mild potency shall be administered in children by wise pediatrician. − The medicines, food and beverages with excess unctuousness, dryness, hot potency, sour, pungent in post digestive effect, and heavy to digest property are contraindicated in children. (282-286) − • The new diseases which are not described in this text due to their various names and clinical presentations shall also be treated according to the dominance of dosha etc.factors(as mentioned earlier). (291) − • The treatment that is opposite to dosha, dushya and nidana (causative factors) is always beneficial. − • The medicines shall be prescribed after due consideration of desha (habitat), kala (season), pramana (dosage), satmya (adaptability) and asatmya (non-adaptability). If this is properly considered, then it is pathya (beneficial to body systems).Otherwise it is non-beneficial. (293) − • The medicines shall always be administered through nearest route to the site of affliction. If the doshas are located in stomach, then medicines shall be administered orally; if at head region, then through nose; and if at colon then medicines quickly act if given per rectum. The doshas at other body parts and diseases originated from them like visarpa, pidaka etc, shall be treated with pradeha etc. specific local pacification procedures. (294-295) − • Medicines must be administered taking into consideration day (time), the diseased person, type of medicine, disease, digestive status, and season. The time of administration of medicine depends on the day like emetics should be given early in the morning.(296) − • The time of administration of drug depends upon circadian rhythm of dosha, status of digestion, interaction with food and type of vata vitiated in body. − • In vitiation of apana vayu medicines must be consumed before food , in vitiation of samana vayu food must be consumed in between meals, in vyana vayu vitiation, early morning medication is advised and in udana vayu vitiation medicine is advised after meals. When prana vayu is vitiated medicines is to be advocated along with each morsel and in between two morsel. In diseases like shwas, kasa, pipasa (thirst) frequent doses of medicines must be given. − • Good appetite, natural passage of urges like stools and urine, lightness in the body and unobstructed vata dosha are the symptoms of jeerna (complete digestion). − • Generally kaphaja disorders are manifested in vasanta ritu; pittaja disorders appear during sharada ritu and vataja disorders manifest during varsha ritu. (308-309) − • End of night, end of day, end of rainy season time is prone for vataja disorders. Beginning of day, morning and evening times is susceptible for kaphaja disorders and middle time of day is prone for pittaja disorders.(310) − • In prathama vaya (childhood), there is predominance of kapha; in madhya vaya (youth and adulthood), there is predominance of pitta and in anta vaya (old age), there is predominance of vata dosha. These doshas have a natural predominance as per the age of the person.(311) − • Taking into consideration the time of digestion of food, when it gets completely digested, that is at the end of food digestion vata dosha disorders occur; in middle of digestion pitta dosha disorders manifest and immediately when food is under process of digestion kapha dosha dominant disorder may appear.(312) − • The treatment shall always consider adaptability of an individual to food, lifestyle and medicines as per desha(habitat). − • The disease can relapse even after exposure to small amount of causative factors in an individual with weak strength. Hence for the better results of the medicines given before to treat the disease, pathya (wholesome diet) must be followed after the disease is completely treated. − • The feeling of satisfaction, enthusiasm, energy, taste, strength and happiness through food and other subjects reduces the influence of disease. − − − − Vidhi vimarsha: − Female genital tract and its disorders: − Female is considered most important to have progeny. Amongst the four factors responsible for fetus, i.e. ritu, kshetra, ambu and beeja; all four are present in female. Hence reproductive health maintainece will lead to procuring a healthy progeny. [5] − General causes of Yonivyapada: − The four common factors responsible for yonivyapada are mentioned as − 1. Mithyaachara – Faulty diet habits and unhygieneic conditions with faulty sexual practices are responsible for vitiation of dosha leading to female reproductive system disorders. − 2. Pradushta artava – Menstruation is mirror of reproductive health. Any abnormality in menstrual cycle indicates pathology in the female reproductive system. Hence pradushta artava indicates any hormonal / organic pathology leading to menstrual abnormality. − 3. Beeja dosha – Congenital anomalies occurs because of sperm or ovum defect. Here the word beeja refers to both male and female gametes. − 4. Daiva – The deeds of the past are also held responsible for certain conditions related with the reproductive system. The unexplained factors of certain diseases can be considered as result of poorva janma karma (deeds of past life). [8] − Doshaja yonivyapad: − Dosha Clinical correlation − Vataja Dysmenorrhoea − Endometriosis − Pittaja Trichomonas vaginalis − Genital infection − Pelvic inflammatory disease − Kaphaja Moniliais, candidiasis − Sannipataja Mixed vagnitis, endometritis, Chronic infection − [9-15] − Other yonivyapada and their possible clinical correlation − Asruja – Rakta yoni Menorrhagia because of coagulation factors leading to failure of implantation hence failure of conception − anticardiolipin antibody and antiphospholipid antibody present. − Arajaska Secondary pathological amenorrhoea because of poor nutritional status. In anorexia and even female athlete’s amenorrhoea − Acharna Genital infections because of poor hygienic conditions − Aticharana Local vulval and vaginal inflammation due to excessive intercourse. Common example is honeymmon cystits − Prakacharana Vaginal tearing, ligament stretching because of sexual intercourse before adolescence − Upapluta Candidia infection during pregnancy − Paripluta Pelvic inflammatory disease − Udavartini Primary spasmodic dysmenorrhoea − Karnini Old cervical tears leading to formation of tag, polyps − Putraghni Recurrent late first trimester and second trimester abortion − Vamini Recurrent first trimester abortion − Antarmukhi Fixed retroverted uterus − Suchimukhi Congenital pinhole os of cervix − Sushka Menopause or estrogen deficiency, premature menopause − Sandhi Turner’s syndrome, Genetic abnormality with absent breast and uterus − Mahayoni Complete genital prolapse, procidentia − [16-37] − The complication of these diseases is infertility due to coital, vaignal, uterine and other factors. Along with the doshas which are aggravated and responsible for causing certain ailment of reproductive system also causes ailments of nearby systems like urinary, intestinal and rectum. [38-39] − Princples of Treatment of yonivyapada − The general line of treatment should be targeted towards the dosha, hence vataja, pittaja, kaphaja yonivypada should be treated accordingly with snehana swedana, raktapittahara sheeta, ruksha ushna therapies respectively. In all types of gynaecological disorders, panchakarma should be administered in mild form in order to eliminate the vitiated doshas and restoring normal reproductive health. Principals of surgical corrections of congenital anomalies and and displaced organs are also given stating that the uterus which has been displaced from its original place should be regarded as shalya and the treatment of shalya is its removal. Hence this is the indication of hysterectomy in complete genital prolapse. The method of such procedure is not given in any classics. [41-46] − Local treatments like douching, fomentation, keeping oil tampon, vaginal suppositories, fumigation. Indications and method of preparation of such medicines in form of oil, ghee, suppository and others are described later. Other preparations are in the form of churna, vati, kwath, oil, ghee are to be used orally or in the form of basti (medicated enema) or uttarbasti ( administration of medicine in uterus through vaginal route) are given in detail. [47-114] − The importance of vata dosha in causing female reproductive tract disorders is highlighted as the location of genital organs is also the seat of apana vayu and all the functions like menstruation, pregnancy, labour are governed by apana vayu. Hence considering the crucial role of vata, the treatment should be aimed at vata alleviation along with other therapies. [114-116] − The soul resides when the genital organs are cleansed with all therapies and the male and female gamet are favourable for conception and best. [126] − − Male genital tract and its disorders: − By retovaha srotas the pathway through which the semen flows out shall be considered; which can be correlated to the seminal vesicles and ejaculatory duct. Retovaha srotas has been discussed separately to make it understand that is is different than shukrawaha srotas. As mentioned earlier shukravaha srotas comparises of medhra (the penis) and vrushana (the scrotum), which is referred for stationary semen; while retas is the word for virile semen, that is flowing semen. Therefore the words shukra and retas have been used separately in different context as per the suitability and the intention of description. [133-139] − Abnormal semen − For achievement of conception, more emphasis is given on quantity and quality of sperm. Little work has been done on the change in the characteristics of semen. Although change in volume, viscosity, pH effect the sperm motility and concentration and hence can lead to reduced fertility. The causative factors of change in characteristics of semen can be genital infections, trauma, malignancy, ejaculation problems, sex abuse and some medications. − The characteristics of abnormal semen: The shukra dushti has been mentioned of eight types by sushruta also though the nomenclature is different. − Table : 1 Classification of shukra dushti according to Sushruta (Su. Sa. 2/2-3) and Ashtanga sangraha − Classification Characteristics Clinical conditions − Vata dushta − Aruna, krishna varna, phenila, tanu, rooksha, alpa, vilambita vedana yukta Oligospermia and azospermia − Injury, chronic inflammation − Low fructose, obstruction in seminal vesicle − Pitta dushta − Neela varna, ushna, putigandha, daha chosha type of pain during ejaculation Acute prostitis − Sleshma dushta − Shukla varna, atipicchila, prabuta, kandu yukta, visra gandha Chronic inflammatory condition, hypofunction of male sex accessory glands − Kunapa – Shonita dushta − Cadaver smelling, analpa, associated with osha and chosha Haemospermia (benign prostate hypertrophy) or acute injury to external genitals. − Granthi –Kapha vata dushta Clot formation Prostatic dysfunction and inflammation − Putipuya - pitta kapha dushta Foul smelling, semen containing puya Pyospermia, Chalmydia infection, STD − Kshina – pitta vata dushta − Hypospermia and oligospermia Decreased semen volume because of obstruction in seminal vesicle. − Mutrapurishagandhi - Tridosha − Semen with smell of urine and faeces Carcinoma, recto – genital urinary tract fistula − − [139-144] − Characteristics of normal semen: − The Shuddha Shukra should be white like sphatika, liquid, viscous, sweet in taste, smell of honey also should look like mixture of oil and honey. − Following are the criteria for normal semen according to modern science. − Normal semen − Composition − Most of the fluid in semen is made up of secretions from male reproductive organs. Semen contains citric acid, free amino acids, fructose, enzymes, phosphorylcholine, prostaglandin, potassium, and zinc. Recent studies have also evaluated calcium, magnesium and gold in semen. − • 46 to 80 per cent of the fluid is produced by the seminal vesicles − • 13 to 33 per cent by the prostate gland − • 5 per cent from the testicles and epididymis − • 2-5 percent from Bulbourethral and urethral glands − Normal semen sample − Normal semen has certain characteristics. These can be broken down into appearance, volume, smell and so forth. − Appearance of human semen − A normal sample has a grey-opalescent appearance. If left open for a while the semen initially clots or coagulates over the first hour and then it becomes liquefied. − Volume − A usual semen volume per ejaculate is around 2 to 3 ml or more. Sperm constitute approximately 10% of semen volume. − Smell − A chlorine smell or fishy odour in semen is normal. − Taste − Semen tastes slightly sweet due to a high content of fructose. The taste of semen tends to change slightly from person to person and may be affected by diet. − pH of semen − The pH range should be 7.2 to 7.8. This is the normal pH of the body. If the pH is lower than 7.2, it may mean that there is a low sperm counts or malformations in the reproductive tract. If the pH is above 7.8, it may indicate a urinary tract infection. − Sperm concentration − The normal range of sperm in semen samples is 20 million/ml or more and a total count of 40 million or more. [145-146] − Present criteria of klaibya (Impotency) due to beejopaghata (Less / absence of Sperm): − Oligozoospermia: When sperm concentration is < 20 million/ml. − Asthenozoospermia: Fewer than 50% spermatozoa with forward progression (categories (a) and (b) or fewer than 25% spermatozoa with category (a) movement. − Teratozoospermia: Fewer than 50% spermatozoa with normal morphology. − Oligoasthenoteratozoospermia: Signifies disturbance of all the three variables (combination of only two prefixes may also be used). − Azoospermia: No spermatozoa in the ejaculate − Aspermia: No ejaculate [158-163] − Erection is a neuro vasculo tissue phenomenon under hormonal control. Erectile dysfunction (ED) is defined as persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. There is increasing evidence that ED can be an early manifestation of coronary artery and peripheral vascular disease; thus ED should not be regarded only as quality of life issue but also as potential warning sign of cardiovascular diseases.- − ED shares risk factors with cardiovascular disease. − Lifestyle modification (intensive exercise and decrease in BMI) can improve erectile function. − ED is a symptom, not a disease. Some patients may not be properly evaluated or receive treatment for an underlying disease or condition that may be causing ED. − ED is common after radical prostatectomy, irrespective of the surgical technique used. − ED is common after external radiotherapy and brachytherapy − Common causes of ED: − Vasculogenic − - Cardiovascular disease − - Hypertension − - Diabetes mellitus − - Hyperlipidaemia − - Smoking − - Major surgery (RP) or radiotherapy (pelvis or retroperitoneum) − Neurogenic − Central causes − - Degenerative disorders (multiple sclerosis, Parkinson’s disease, multiple atrophy etc.) − - Spinal cord trauma or diseases − - Stroke − - Central nervous system tumours − Peripheral causes − - Type 1 and 2 diabetes mellitus − - Chronic renal failure − - Polyneuropathy − - Surgery (pelvis or retroperitoneum, radical prostatectomy, colorectal surgery, etc.) − Anatomical or structural − - Hypospadias, epispedias − - Micropenis − - Congenital curvature of the penis − - La Peyronie’s disease − Hormonal − - Hypogonadism − - Hyperprolactinemia − - Hyper- and hypothyroidism − - Hyper- and hypocortisolism (Cushing’s disease etc) − Drug-induced − - Antihypertensives (diuretics are the most common medication causing ED) − - Antidepressants (selective serotonin reuptake inhibitors, tricyclics) − - Antipsychotics (incl. neuroleptics) − - Antiandrogens; GnRH analogues and antagonists − - Recreational drugs (alcohol, heroin, cocaine, marijuana, methadone) − Psychogenic − - Generalised type (e.g., lack of arousability and disorders of sexual intimacy) − - Situational type (e.g., partner-related, performance-related issues or due to distress) [162-167] − Text word Translation Disease correlation − Lingapaka Penile Inflammation Balanitis − Shwayathu Swelling − Mamsaabhivruddhi Warts Condyloma, Mollusum contagiosum, warts − Chirat Pakam Chronic inflammation Chronic Urethritis, Prastatitis − Medhra vedana Pain at Penis Urethral Calculi, − Valayi kushtha? Circular skin lesions Trichomoniasis − Teevra Sphota Erupting Boils Chancroid, Herpes − Pulakodaka srava Exudative secretions Gonorrhea, Chlamydia − Vrana Wounds Penile Cancer − [168-173] − Penile & Testicular diseases of Chronic Inflammatory etiology: − Veneral diseases − Benign and Malignant tumors of male genitalia − Penile Fractures [174-175] − After age 40 years, testosterone levels in men begin to decrease. This decline, alternatively referred to as the male climacteric, andropause, viropause, or partial androgen deficiency of the aging male (PADAM), may account for a number of pathophysiologic changes associated with aging. Decreased bone density, loss of lean body mass, depressed erythropoiesis, oligospermia, sexual dysfunction; cognitive deficits, memory problems, and depression have all been hypothesized to result from a reduction in serum androgen levels. The symptoms of andropause are indolent, because the nature of androgen loss with age is slow and progressive3. [179-180] − Causes for Kashyaj Klaibya as per recent researches: − 1. Vasal agenesis – absence of Vasa deferentia − 2. Bilateral testicular atrophy − 3. Ductal obstruction – Ejaculatory Duct obstruction − 4. Genetic factors − − Concept of shukrashmari & ejaculatory duct obstruction − − − − Surgical measures described in the treatment of klaibya (impotency): − − Medhrachheda: Partial and /or complete penectomy − Vrishana patana: Orchiectomy [181-191] − Times of administration of medicines: − Last part of this chapter discuss the importance of pathya (wholesome diet) in treatment and dosage timings of administrations can be termed as slots and Sharangdhar samhita elaborates this time of administration in five different slots. − Drugs can be administered at five designated time slots during the day as under. − 1. Kinchit suryodaya jate (just after sunrise) − 2. Divasa bhojana (around lunch) − 3. Sayam bhojana (around evening meal i.e. dinner) − 4. Muhurmuhu (repeated) − 5. Nishi (at night) [297] − The second time of administration elaborated by Sharangdhar samhita is divided into five parts that is before meals, in between meals, after meals, medicines mixed with food and before and after meals. − 1. Bhojanagre (prior to start of lunch) e.g. mixture of lavana (rock salt) and ardraka (fresh ginger) − 2. Bhojanamishra (drug mixed in food) e.g. Mixture of hingu (asafetida) and ghrita (ghee). − 3. Bhojanamadhya (in the midst of lunch) e.g. water or any liquids − 4. Bhojanante (at the end of lunch) e.g. lavanga (clove) and fruits of haritaki (Chebulic myrobalans) − 5. Bhojanapurvante (before and after lunch) e.g. dhatriloha: a formulation made of dhatri (Emblica officinalis) and loha (iron) bhasma prescribed in amlapitta (acid peptic disease). [299] − The time of drug administration which is related to the type of disease and status of the doshas in the body can be called as chrono therapeutics. Chronotherapeutics refers to a treatment method in which in vivo drug availability is timed to match rhythms of disease in order to optimize therapeutic outcomes and minimize side effects. It is based on the observation that there is an interdependent relationship between the peak-to-trough rhythmic activity in disease symptoms and risk factors, pharmacologic sensitivity, and pharmacokinetics of many drugs − − The circadian timing system is composed of molecular clocks, which drive 24-h changes in xenobiotic metabolism and detoxification, cell cycle events, DNA repair, apoptosis, and angiogenesis. The cellular circadian clocks are coordinated by endogenous physiological rhythms, so that they tick in synchrony in the host tissues that can be damaged by anticancer agents. As a result, circadian timing can modify 2- to 10-fold the tolerability of anticancer medications in experimental models and in cancer patients. Improved efficacy is also seen when drugs are given near their respective times of best tolerability, due to − (a) Inherently poor circadian entrainment of tumors and − (b) Persistent circadian entrainment of healthy tissues. − Conversely, host clocks are disrupted whenever anticancer drugs are administered at their most toxic time. On the other hand, circadian disruption accelerates experimental and clinical cancer processes. Gender, circadian physiology, clock genes, and cell cycle critically affect outcome on cancer chronotherapeutics. Mathematical and systems biology approaches currently develop and integrate theoretical, experimental, and technological tools in order to further optimize and personalize the circadian administration of cancer treatments. − − Many biological functions wax and wane in cycles that repeat each day, month, or year. Such patterns do not reflect simply an organism’s passive response to environmental changes, such as daily cycles of light and darkness. Rather, they reflect the organism’s biological rhythms, that is, its ability to keep track of time and to direct changes in function accordingly. Biological rhythms that repeat approximately every 24 hours are called circadian rhythms (from the Latin circa, for around, and dies,for day) − − The frequency of heart attacks peaks between 6 a.m. and noon asthma attacks are most prevalent at night, human babies are born predominantly in the early morning hours , . While these patterns do not necessarily indicate that the events are driven by the circadian pacemaker, they do suggest temporal order in the functioning of the human body. − − This temporal organization appears to be beneficial; the human body is prepared for routine changes in state, such as awakening each morning, rather than simply reacting after shifts in demand In addition, these regular cycles in the body present considerations for diagnosis of health problems and for the timing of medical treatment − − The circadian rhythms of various functions in humans, such as hormone production, body temperature, and sleepiness, are normally coordinated— i.e., they bear a specific relationship to each other. This temporal organization suggests that some biological timekeeping device must drive, regulate, or at least integrate various circadian rhythms. In mammals, considerable experimental evidence indicates that a region of the brain called the suprachiasmatic nucleus (SCN) is the circadian pacemaker? . The SCN, composed of a cluster of thousands of small nerve cells, is located within a region of the brain, the hypothalamus, that controls such basic functions as food intake and body temperature. [297] − − The secretion of cortisol, a steroid hormone important for metabolism and responses to stress, fluctuates daily, peaking in the very early morning hours and falling to a negligible amount by the end of the day (181). Besides its use as a marker for the internal pacemaker, the circadian rhythm of cortisol secretion may drive other rhythms in the body and has important clinical implications. − − Also, cortisol-like steroid hormones used therapeutically to treat asthma and allergies and to − suppress the immune system, are best administered in the morning, when they interfere least with the body's own cortisol production. Circadian rhythms in cardiovascular function have long been recognized. Indicators of heart and blood vessel function that demonstrate daily rhythms include blood pressure, heart rate, blood volume and flow, heart muscle function, and responsiveness to hormones (84). The daily fluctuations in cardiovascular function are further illustrated by symptoms of disease. Data have shown that abnormal electrical activity in the heart and chest pains peak at approximately 4 a.m. in patients suffering from coronary heart disease (189,190). As stated earlier, the number of heart attacks has been shown to peak between 6 a.m. and noon (117,140). − These temporal characteristics of cardiovascular disease indicate the importance of careful timing in their assessment, monitoring, and treatment (120). [299] − − References:
→Treatment of pradara
योनीनां वातलाद्यानां यदुक्तमिह भेषजम् |
योनीनां वातलाद्यानां यदुक्तमिह भेषजम् |
चतुर्णां प्रदराणां च तत् सर्वं कारयेद्भिषक् ||२२७||
चतुर्णां प्रदराणां च तत् सर्वं कारयेद्भिषक् ||२२७||
yōnīnāṁ vātalādyānāṁ yaduktamiha bhēṣajam|
yōnīnāṁ vātalādyānāṁ yaduktamiha bhēṣajam|
caturṇāṁ pradarāṇāṁ ca tat sarvaṁ kārayēdbhiṣak||227||
caturṇāṁ pradarāṇāṁ ca tat sarvaṁ kārayēdbhiṣak||227||
yonInAM vAtalAdyAnAM yaduktamiha bheShajam |
yonInAM vAtalAdyAnAM yaduktamiha bheShajam |
caturNAM pradarANAM ca tat sarvaM kArayedbhiShak ||227||
caturNAM pradarANAM ca tat sarvaM kArayedbhiShak ||227||
The treatment of vatala and other yonivyapad which has been mentioned earlier in this chapter, should also be administered all four types of pradara roga respectively.(227)
The treatment of ''vatala'' and other ''yonivyapat'' which has been mentioned earlier in this chapter, should also be administered all four types of ''pradara roga'' respectively.[227]
रक्तातिसारिणां यच्च तथा शोणितपित्तिनाम् |
रक्तातिसारिणां यच्च तथा शोणितपित्तिनाम् |
रक्तार्शसां च यत् प्रोक्तं भेषजं तच्च कारयेत् ||२२८||
रक्तार्शसां च यत् प्रोक्तं भेषजं तच्च कारयेत् ||२२८||
raktātisāriṇāṁ yacca tathā śōṇitapittinām|
raktātisāriṇāṁ yacca tathā śōṇitapittinām|
raktārśasāṁ ca yat prōktaṁ bhēṣajaṁ tacca kārayēt||228||
raktārśasāṁ ca yat prōktaṁ bhēṣajaṁ tacca kārayēt||228||
raktAtisAriNAM yacca tathA shoNitapittinAm |
raktAtisAriNAM yacca tathA shoNitapittinAm |
raktArshasAM ca yat proktaM bheShajaM tacca kArayet ||228||
raktArshasAM ca yat proktaM bheShajaM tacca kArayet ||228||
The treatment which is advised for raktatisara (diarrhoea with expulsion of blood), raktapitta (internal haemorrhage) and raktarsha (bleeding piles) should be administered in pradara roga.(228)
Stanya dushti (abnormalities of breast milk and lactation):
The treatment which is advised for ''raktatisara'' (diarrhea with expulsion of blood), ''raktapitta'' (internal hemorrhage) and ''raktarsha'' (bleeding piles) should be administered in ''pradara roga''.[228]
==== ''Stanya dushti'' (abnormalities of breast milk and lactation) ====
धात्रीस्तनस्तन्यसम्पदुक्ता विस्तरतः पुरा |
धात्रीस्तनस्तन्यसम्पदुक्ता विस्तरतः पुरा |
स्तन्यसञ्जननं चैव स्तन्यस्य च विशोधनम् ||२२९||
स्तन्यसञ्जननं चैव स्तन्यस्य च विशोधनम् ||२२९||
Or she should drink the decoction of pippali mula, chavya, chitraka, shunthi or apply the paste of bala, shunthi, kakamachi and murva or similarly application of paste of pithivan and ksheer vidari should be done on her breasts.(280)
Or she should drink the decoction of pippali mula, chavya, chitraka, shunthi or apply the paste of bala, shunthi, kakamachi and murva or similarly application of paste of pithivan and ksheer vidari should be done on her breasts.(280)
अष्टावेते क्षीरदोषा हेतुलक्षणभेषजैः ||२८१||
अष्टावेते क्षीरदोषा हेतुलक्षणभेषजैः ||२८१||
निर्दिष्टाः क्षीरदोषोत्थास्तथोक्ताः केचिदामयाः |२८२|
निर्दिष्टाः क्षीरदोषोत्