Changes

Cardiovascular diseases (CVDs), per the Media Center Fact Sheet of the World Health Organization (WHO), are the “number one cause of death globally” with an estimated 17.7 million people dying of it in 2015 (31% of global deaths). Last but not least, renal diseases (or chronic kidney diseases (CKDs) afflict 14% of the general population in the US and are one of the major causes of death worldwide .  

Cardiovascular diseases (CVDs), per the Media Center Fact Sheet of the World Health Organization (WHO), are the “number one cause of death globally” with an estimated 17.7 million people dying of it in 2015 (31% of global deaths). Last but not least, renal diseases (or chronic kidney diseases (CKDs) afflict 14% of the general population in the US and are one of the major causes of death worldwide .  

''Marma'' (vital points) are junctures of muscle, tendons, ligaments, bone tissue, joints, blood vessels and nerves, nervous tissue, which forms the seat of life and it is also said that they are the seat for ''tridosha, triguna'' and the ''atma'', hence any injury can be life threatening leading to death.

''Marma'' (vital points) are junctures of muscle, tendons, ligaments, bone tissue, joints, blood vessels and nerves, nervous tissue, which forms the seat of life and it is also said that they are the seat for tri[[dosha]], tri[[guna]] and the [[atma]], hence any injury can be life threatening leading to death.

   

   

The word ''marma'' is derived from the ''mru marane dhatu'' (Sanskrit) which states that any trauma to ''marma'' may lead to ''marana'' (death) or dysfunction of that particular site. The ''adhisthana'' (location) of diseases of ''marma'' can be assessed by changes in physiological functions in the body and through type of ''rogamarga'' (pathway of pathogenesis). ''Marma'' comes under ''madhyama'' (middle) ''rogamarga''. Therefore understanding of the ''rogamarga'' is essential to analyze the characters of the diseases, related with ''dushti'' (pathogenesis).

The word ''marma'' is derived from the ''mru marane dhatu'' (Sanskrit) which states that any trauma to ''marma'' may lead to ''marana'' (death) or dysfunction of that particular site. The ''adhisthana'' (location) of diseases of ''marma'' can be assessed by changes in physiological functions in the body and through type of ''rogamarga'' (pathway of pathogenesis). ''Marma'' comes under ''madhyama'' (middle) ''rogamarga''. Therefore understanding of the ''rogamarga'' is essential to analyze the characters of the diseases, related with ''dushti'' (pathogenesis).

#''Basti marma'' relates with the urinary bladder and renal system plays an important role in elimination of body wastes and regulate blood volume, help to regulate blood pressure, pH and maintains electrolyte balance in the body.

#''Basti marma'' relates with the urinary bladder and renal system plays an important role in elimination of body wastes and regulate blood volume, help to regulate blood pressure, pH and maintains electrolyte balance in the body.

The loss of substance/ body (''ashraya'') leads to the loss of the substrate/ life (''ashrayee'') hence, these ''trimarma'' should be especially protected against external injury and ''vatadi dosha''. The clinical features of diseases of head as per ''dosha'' dominance have already been described in [[Kiyanta Shiraseeya Adhyaya]]. In the present context, ''dosha'' dominant features observed in diseases of three ''marma'', of eyes, nose, ears and oral cavity are described. The diseases of scalp and hair are also described.  

The loss of substance/ body (''ashraya'') leads to the loss of the substrate/ life (''ashrayee'') hence, these ''trimarma'' should be especially protected against external injury and [[vata]]di [[dosha]]. The clinical features of diseases of head as per [[dosha]] dominance have already been described in [[Kiyanta Shiraseeya Adhyaya]]. In the present context, [[dosha]] dominant features observed in diseases of three ''marma'', of eyes, nose, ears and oral cavity are described. The diseases of scalp and hair are also described.  

Later, in [[Trimarmiya Siddhi]], the importance of three ''marma'', consequences of their injury and management with [[Panchakarma]] procedures is described in detail. In the present chapter, however, management of disorders with medicines only has been described.   

Later, in [[Trimarmiya Siddhi]], the importance of three ''marma'', consequences of their injury and management with [[Panchakarma]] procedures is described in detail. In the present chapter, however, management of disorders with medicines only has been described.   

''Udavarta'' literally means upward and opposite frequent movement of ''vata dosha''. The term itself suggests pathology of aggravation of ''vata'' either due to its own causes or due to obstruction to its movement due to other ''dosha''. If the aggravated ''vata'' affects vital ''marma'' like heart, brain and urinary bladder, then it can cause serious disorders. The chapter details about the diseases of these three regions with etiological factors, clinical features and management.

''Udavarta'' literally means upward and opposite frequent movement of [[vata]] [[dosha]]. The term itself suggests pathology of aggravation of [[vata]] either due to its own causes or due to obstruction to its movement due to other [[dosha]]. If the aggravated [[vata]] affects vital ''marma'' like heart, brain and urinary bladder, then it can cause serious disorders. The chapter details about the diseases of these three regions with etiological factors, clinical features and management.

   

   

There are thirteen types of ''udavarta'' based upon suppression of natural urges described in [[Naveganadharaniya Adhyaya]]. The diseases vary depending upon vitiation of ''vata'' due to respective urges and so is the management of ''udavarta''. In the present chapter, the diseases due to ''apana vaigunaya'' (impairment of ''apana'') in the pelvis region due to suppression of urge of flatus, defecation and urination are described. Though, ''udavarta'' is dealt in the initial part of the chapter and three ''marma'' in latter part, the name of the chapter is given as [[Trimarmiya Chikitsa]], because it emphasizes the management of diseases of three ''marma''. ''Udavarta'' can be considered as cause for the diseases of three marma.

There are thirteen types of ''udavarta'' based upon suppression of natural urges described in [[Naveganadharaniya Adhyaya]]. The diseases vary depending upon vitiation of [[vata]] due to respective urges and so is the management of ''udavarta''. In the present chapter, the diseases due to ''apana vaigunaya'' (impairment of ''apana'') in the pelvis region due to suppression of urge of flatus, defecation and urination are described. Though, ''udavarta'' is dealt in the initial part of the chapter and three ''marma'' in latter part, the name of the chapter is given as [[Trimarmiya Chikitsa]], because it emphasizes the management of diseases of three ''marma''. ''Udavarta'' can be considered as cause for the diseases of three marma.

=== Sanskrit Text, Transliteration and English Translation ===

=== Sanskrit Text, Transliteration and English Translation ===

The vital organs (''marma'') are mentioned as 107 in number while enumerating different body parts in [[Sankhya Sharira]]. As per the specialists of the subjects, three vital organs, viz, ''basti'' (urinary bladder), ''hridayam'' (heart) and ''shira'' (head) are considered supreme among themselves, because they possess life (prana) in them. Their suffering due to ''vata'', etc. also troubles/ endangers life (''prana''). Hence to protect these vital organs, the method of protection from the attack of diseases, and their management will be discussed which you may listen (addressed to Agnivesha) [3-4]

The vital organs (''marma'') are mentioned as 107 in number while enumerating different body parts in [[Sankhya Sharira]]. As per the specialists of the subjects, three vital organs, viz, ''basti'' (urinary bladder), ''hridayam'' (heart) and ''shira'' (head) are considered supreme among themselves, because they possess life (prana) in them. Their suffering due to ''vata'', etc. also troubles/ endangers life (''prana''). Hence to protect these vital organs, the method of protection from the attack of diseases, and their management will be discussed which you may listen (addressed to Agnivesha) [3-4]

==== Etiology and pathogenesis, signs and symptoms of ''udavarta'' (abnormal upward movement of ''vata'') ====

==== Etiology and pathogenesis, signs and symptoms of ''udavarta'' (abnormal upward movement of [[vata]]) ====

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Excessive consumption of astringent, bitter, pungent, dry/ ununctuous food, suppression of natural urges, starvation, and excess indulgence of sex excessively aggravates ''apana vata'' in the colon. This obstructs downward moving channels and gradually obstructs the movement of stool, urine and the flatus causing ''udavarta'', the serious trouble. [5]

Excessive consumption of astringent, bitter, pungent, dry/ ununctuous food, suppression of natural urges, starvation, and excess indulgence of sex excessively aggravates apana [[vata]] in the colon. This obstructs downward moving channels and gradually obstructs the movement of stool, urine and the flatus causing ''udavarta'', the serious trouble. [5]

==== Signs and symptoms of ''udavarta'' ====

==== Signs and symptoms of ''udavarta'' ====

Intense and frequent pain in urinary bladder, cardiac region, pelvis, abdomen, and also severe pain in back and sides of chest; flatulence, nausea, cutting pain, piercing pain, indigestion, inflammation of urinary bladder; retention of stool, appearance of nodules in the abdomen, abnormal upward movement of ''vata'', delayed and difficulty in evacuation of dry stool; body becomes  rough, ununctuous, and cold and consequently disorders such as fever, dysuria, ''pravahika'' (spurious feeling of the need to evacuate stools with straining), cardiac disorders, ''grahani'' disorder (malabsorption syndrome), vomiting, blindness, deafness, burning sensation in head, ''vatodara'' (affliction of abdomen due to vata), ''asthila'' (stony hard tumours), psychological disorders, thirst, hemorrhagic disorders, anorexia, ''gulma'' (lump like feeling), cough, dyspnea, rhinitis, facial paralysis and chest pain arise. Many other severe ''vata'' disorders are caused by ''udavarta''. Treatment of these ailments will be described hereafter you may listen Agnivesha.[5-10]

Intense and frequent pain in urinary bladder, cardiac region, pelvis, abdomen, and also severe pain in back and sides of chest; flatulence, nausea, cutting pain, piercing pain, indigestion, inflammation of urinary bladder; retention of stool, appearance of nodules in the abdomen, abnormal upward movement of [[vata]], delayed and difficulty in evacuation of dry stool; body becomes  rough, ununctuous, and cold and consequently disorders such as fever, dysuria, ''pravahika'' (spurious feeling of the need to evacuate stools with straining), cardiac disorders, ''grahani'' disorder (malabsorption syndrome), vomiting, blindness, deafness, burning sensation in head, ''vatodara'' (affliction of abdomen due to vata), ''asthila'' (stony hard tumours), psychological disorders, thirst, hemorrhagic disorders, anorexia, ''gulma'' (lump like feeling), cough, dyspnea, rhinitis, facial paralysis and chest pain arise. Many other severe [[vata]] disorders are caused by ''udavarta''. Treatment of these ailments will be described hereafter you may listen Agnivesha.[5-10]

==== Treatment of ''udavarta'' ====

==== Treatment of ''udavarta'' ====

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The patient should be massaged with oil prepared with drugs alleviating ''sheeta jwara'' (fever with external cold touch) and then fomented so that the adhered ''dosha'' get detached. There after the patient should be managed with suppositories (''varti''), non-unctuous enema and unctuous purgatives and diet which regulates movement of ''vata'' in downward direction. [11]

The patient should be massaged with oil prepared with drugs alleviating ''sheeta jwara'' (fever with external cold touch) and then fomented so that the adhered [[dosha]] get detached. There after the patient should be managed with suppositories (''varti''), non-unctuous enema and unctuous purgatives and diet which regulates movement of [[vata]] in downward direction. [11]

===== Anal suppository (''varti'') method of preparation and the usage =====

===== Anal suppository (''varti'') method of preparation and the usage =====

#Oleate the anus and through the tube, blow in the powder of ''rakshoghna'' (''sarshapa'')- Brassica nigra (L. Koch), ''tumbi''- Cucurbita lagrenaria (Linn), ''karahata''(''madanaphala'')-Randia dumetorum (lam.), ''krishna''(''pippali'')-Piper Longum (Linn), ''jeemutaka''(''devadali'')-Luffa echinata (Roxb).,and rock salt [15]

#Oleate the anus and through the tube, blow in the powder of ''rakshoghna'' (''sarshapa'')- Brassica nigra (L. Koch), ''tumbi''- Cucurbita lagrenaria (Linn), ''karahata''(''madanaphala'')-Randia dumetorum (lam.), ''krishna''(''pippali'')-Piper Longum (Linn), ''jeemutaka''(''devadali'')-Luffa echinata (Roxb).,and rock salt [15]

If the above said therapies fail to produce the desired results the physician should advise oleation and fomentation and administer ''niruha'' type of ''basti'' (ununctuous medicated enema) using a special combination of herbal decoctions which are sharp (''tikshna'') in nature and having emetic and purgative properties alongwith, cows urine, oil, alkali, drugs with drugs having sour taste and ''vāta'' alleviating quality:  

If the above said therapies fail to produce the desired results the physician should advise oleation and fomentation and administer ''niruha'' type of [[basti]] (ununctuous medicated enema) using a special combination of herbal decoctions which are sharp (''tikshna'') in nature and having emetic and purgative properties alongwith, cows urine, oil, alkali, drugs with drugs having sour taste and [[vata]] alleviating quality:  

#In ''vata'' predominance: The enema should be sour, salty and oily.

#In [[vata]] predominance: The enema should be sour, salty and oily.

#In ''pitta'' predominance: The enema should be with milk.

#In [[pitta]] predominance: The enema should be with milk.

#In ''kapha'' predominance: The enema should be with urine.

#In [[kapha]] predominance: The enema should be with urine.

Benefits of this enema: Relieves retention of urine, stool and flatus, it strengthens the anal region as well as the connected blood vessels. [16]

Benefits of this enema: Relieves retention of urine, stool and flatus, it strengthens the anal region as well as the connected blood vessels. [16]

Powder all the above together.

Powder all the above together.

This preparation of powder should be taken with warm water, it alleviates, ''visuchika'' (diarrhea with pricking pain in abdomen), heart disease, ''gulma'' (lump like feeling in the abdomen) and ''urdhvasamirana'' (abnormal upward movement of ''vata'') [20]

This preparation of powder should be taken with warm water, it alleviates, ''visuchika'' (diarrhea with pricking pain in abdomen), heart disease, ''gulma'' (lump like feeling in the abdomen) and ''urdhvasamirana'' (abnormal upward movement of [[vata]]) [20]

===== ''Vachadi- churna'' =====

===== ''Vachadi- churna'' =====

Powders of ''vacha, haritaki, chitraka, yavakshara, pippali, ativisha,'' and ''kushtha'' taken with hot water alleviates ''anaha'' (abdominal tympanites), ''vimoodha vata'' (confounded ''vata'').

Powders of ''vacha, haritaki, chitraka, yavakshara, pippali, ativisha,'' and ''kushtha'' taken with hot water alleviates ''anaha'' (abdominal tympanites), vimoodha [[vata]] (confounded [[vata]]).

Rice along with meat soup should be consumed while using this preparation. [21]

Rice along with meat soup should be consumed while using this preparation. [21]

Decoction prepared out of two ''pala'' (80 grams) of each drugs of ''sthiradivarga'' (''shalaparni''-Desmodium gangeticum DC, ''Prishnaparni''- Cyperus sp, ''brahati''- Solanum indicum Linn./ ''anguivi'' Lam, ''kantakari''- Garcinia morella Desr, ''gokshura''- Tribulus terrestris Linn), ''punarnava''- Boerhaavia diffusa Linn, ''champaka'' (''aragvadha'')-Cassia fistula Linn and ''putikarnja''- Caesalpinia crista Linn cooked with one ''prasta'' (640 gms) of ghee.

Decoction prepared out of two ''pala'' (80 grams) of each drugs of ''sthiradivarga'' (''shalaparni''-Desmodium gangeticum DC, ''Prishnaparni''- Cyperus sp, ''brahati''- Solanum indicum Linn./ ''anguivi'' Lam, ''kantakari''- Garcinia morella Desr, ''gokshura''- Tribulus terrestris Linn), ''punarnava''- Boerhaavia diffusa Linn, ''champaka'' (''aragvadha'')-Cassia fistula Linn and ''putikarnja''- Caesalpinia crista Linn cooked with one ''prasta'' (640 gms) of ghee.

Intake of this medicated ghee cures ''pratiruddha vata'' (obstructed flatus) [23]

Intake of this medicated ghee cures pratiruddha vata (obstructed flatus) [23]

===== Condiments =====

===== Condiments =====

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''Anaha'' (bloating in upper abdomen) as caused by ''ama'' (improperly digested food/product of improper digestion), associated with stiffness in cardiac region, diseases of head and heaviness, retention of belching, common cold should be treated with emesis therapy, ''langhana'' (fasting therapy) and ''pachana'' (carminatives). [26]

''Anaha'' (bloating in upper abdomen) as caused by ''ama'' (improperly digested food/product of improper digestion), associated with stiffness in cardiac region, diseases of head and heaviness, retention of belching, common cold should be treated with emesis therapy, [[langhana]] (fasting therapy) and [[pachana]] (carminatives). [26]

(If the ''vata'' is obstructed by fat, ''kapha, pitta'' or ''rakta'' (vitiated blood) in the disease like ''gulma'' (lump like feeling in abdomen), ''udara'' (abdominal diseases includes ascites), ''bradhna'' (inguinal swelling), piles, splenic enlargement, ''udavarta'' (abnormal upward movement of ''vata''), ''yoni-roga'' (gynecological diseases), seminal disorders, disorders of fat by the vitiation of ''kapha'', deep-seated ''vatarakta'' (gout), sciatica, hemiplegia etc and in such ''vatika'' disorders wherein purgation therapy is recommended for cure, Castor oil is an excellent remedy, which should be added with other such ingredients which pacifies aggravated ''vata'' and administered along with milk, meat soup, juice or ''triphala'' decoction, vegetable soup, cows urine, alcoholic drink etc.

(If the [[vata]] is obstructed by fat, [[kapha]], [[pitta]] or [[rakta]] (vitiated blood) in the disease like ''gulma'' (lump like feeling in abdomen), ''udara'' (abdominal diseases includes ascites), ''bradhna'' (inguinal swelling), piles, splenic enlargement, ''udavarta'' (abnormal upward movement of [[vata]]), ''yoni-roga'' (gynecological diseases), seminal disorders, disorders of fat by the vitiation of [[kapha]], deep-seated ''vatarakta'' (gout), sciatica, hemiplegia etc and in such ''vatika'' disorders wherein purgation therapy is recommended for cure, Castor oil is an excellent remedy, which should be added with other such ingredients which pacifies aggravated [[vata]] and administered along with milk, meat soup, juice or ''triphala'' decoction, vegetable soup, cows urine, alcoholic drink etc.

Due to its ''vata'' pacifying nature, due to addition of other drugs, and because of its purgative effects, it cures ''vatika'' disorders associated with vitiated fat, blood, ''pitta'' and ''kapha''. [29-30]

Due to its [[vata]] pacifying nature, due to addition of other drugs, and because of its purgative effects, it cures ''vatika'' disorders associated with vitiated fat, blood, [[pitta]] and [[kapha]]. [29-30]

Castor oil should be administered up to the dose of five ''pala'' depending on the strength of the person, nature of disease, and the ''koshta''. If the person is weak and is of ''mridu kosta'' (laxed bowel) then, castor oil should be given along with food. [31]

Castor oil should be administered up to the dose of five ''pala'' depending on the strength of the person, nature of disease, and the ''koshta''. If the person is weak and is of ''mridu kosta'' (laxed bowel) then, castor oil should be given along with food. [31]

''Dosha'' aggravated separately or all together when being provoked by their vitiating factors which get located in kidney or urinary bladder and distress the urinary passage, leads to ''mutrakricchra''(dysuria).[33]

''Dosha'' aggravated separately or all together when being provoked by their vitiating factors which get located in kidney or urinary bladder and distress the urinary passage, leads to ''mutrakricchra''(dysuria).[33]

====== Signs of ''vataja'' dysuria ======

====== Signs of [[vata]]ja dysuria ======

Severe pain in groins, urinary bladder and genitals and the patient frequently passes urine in small quantity.

Severe pain in groins, urinary bladder and genitals and the patient frequently passes urine in small quantity.

====== Signs of ''pittaja'' dysuria ======  

====== Signs of [[pitta]]ja dysuria ======  

The patient passes yellow or bloody urine with pain and burning sensation frequently and with difficulty. [34]

The patient passes yellow or bloody urine with pain and burning sensation frequently and with difficulty. [34]

====== Signs of ''kaphaja'' dysuria ======  

====== Signs of [[kapha]]ja dysuria ======  

Heaviness and oedema in urinary bladder and phallus and the urine is associated with slimy materials.

Heaviness and oedema in urinary bladder and phallus and the urine is associated with slimy materials.

====== Signs of ''sannipata'' dysuria ======  

====== Signs of ''sannipata'' dysuria ======  

All the signs and symptoms described above are manifested as all the ''dosha'' are aggravated which is the cause for ''sannipatika'' type of dysuria which is most difficult type of dysuria for cure. [35]

All the signs and symptoms described above are manifested as all the [[dosha]] are aggravated which is the cause for ''sannipatika'' type of dysuria which is most difficult type of dysuria for cure. [35]

==== Dysuria caused by ''ashmari'' (urinary calculus) ====

==== Dysuria caused by ''ashmari'' (urinary calculus) ====

===== Pathogenesis =====

===== Pathogenesis =====

When the aggravated ''vata'' dries up semen and urine along with ''pitta'' and ''kapha'' which is located in urinary bladder the calculus is formed gradually like gallstone in cow. [36]

When the aggravated [[vata]] dries up semen and urine along with [[pitta]] and [[kapha]] which is located in urinary bladder the calculus is formed gradually like gallstone in cow. [36]

==== Signs and symptoms of urinary calculus ====

==== Signs and symptoms of urinary calculus ====

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When the calculus is broken into smaller particles due to ''vata'' aggravation, then such particles which comes out of the urinary passage along with urine is called as ''sharkara''.[39]

When the calculus is broken into smaller particles due to [[vata]] aggravation, then such particles which comes out of the urinary passage along with urine is called as ''sharkara''.[39]

===== Blocked discharge of semen/dysuria caused by semen =====

===== Blocked discharge of semen/dysuria caused by semen =====

If the vitiated blood due to ''kshata'' (trauma) or ''kshaya'' (emaciation caused by excessive discharge of semen) when accumulated in urinary bladder, it causes obstruction and severe pain in the bladder. Vitiated blood when associate with urine forms the calculus, which causes the distention of abdomen and heaviness in the region of urinary bladder however the patient feels lightness when the calculus passes out. Thus, ends the diagnosis of dysuria (''mootra krucchrara''). [43-44]

If the vitiated blood due to ''kshata'' (trauma) or ''kshaya'' (emaciation caused by excessive discharge of semen) when accumulated in urinary bladder, it causes obstruction and severe pain in the bladder. Vitiated blood when associate with urine forms the calculus, which causes the distention of abdomen and heaviness in the region of urinary bladder however the patient feels lightness when the calculus passes out. Thus, ends the diagnosis of dysuria (''mootra krucchrara''). [43-44]

==== Treatment of ''vataja'' dsyuria ====

==== Treatment of [[vata]]ja dsyuria ====

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Massage, unctuous and non-unctuous medicated enema, unctuous poultice, ''uttarabasti'' (urethral douche) and ''sekam'' (affusion) as well as the diet of soup prepared with ''sthiradi'' (''laghupanchamula'' drugs-''salaparni, prishna parni,brahati,kantakari'',and ''gokshura'') and other ''vata''- alleviating drugs to be administered. [45]

Massage, unctuous and non-unctuous medicated enema, unctuous poultice, ''uttarabasti'' (urethral douche) and ''sekam'' (affusion) as well as the diet of soup prepared with ''sthiradi'' (''laghupanchamula'' drugs-''salaparni, prishna parni,brahati,kantakari'',and ''gokshura'') and other [[vata]]- alleviating drugs to be administered. [45]

The following formula used in right dose quickly alleviates the painful ''vataja'' dysuria:

The following formula used in right dose quickly alleviates the painful [[vata]]ja dysuria:

Oil, fat of pig and bear and ghee cooked with the decoction and paste of- ''punarnava, eranda, shatavari, pattura, vrishchira, bala, pasanabheda, dashamula'' (''bilva, shonaka, gambhari, patala, ganikarnika, salaparni, prishnaparni, brahati, kantakari'' and ''gokshura''), ''kulattha, kola, yava,'' with five types of salt which is useful in pain associated in ''vataja'' type of dysuria. [46-47]

Oil, fat of pig and bear and ghee cooked with the decoction and paste of- ''punarnava, eranda, shatavari, pattura, vrishchira, bala, pasanabheda, dashamula'' (''bilva, shonaka, gambhari, patala, ganikarnika, salaparni, prishnaparni, brahati, kantakari'' and ''gokshura''), ''kulattha, kola, yava,'' with five types of salt which is useful in pain associated in [[vata]]ja type of dysuria. [46-47]

Above said drugs and such other drugs having similar quality other good drugs may also be used in the form of ''upanaha''. Oily seeds, as available pounded with unctuous substance and sour substance may be applied warm as a poultice.

Above said drugs and such other drugs having similar quality other good drugs may also be used in the form of ''upanaha''. Oily seeds, as available pounded with unctuous substance and sour substance may be applied warm as a poultice.

Intake of oil seeds along with sour things in lukewarm form is also useful. [48]

Intake of oil seeds along with sour things in lukewarm form is also useful. [48]

==== Treatment of ''pittaja'' dysuria ====

==== Treatment of [[pitta]]ja dysuria ====

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In ''pittaja'' dysuria:

In [[pitta]]ja dysuria:

Cold affusion, bath, anointings, following regimen prescribed during summer season, medicated enema, milk and purgatives prepared from the juice of ''draksha'' (grapes), ''vidari'' and sugarcane juice and ghee to be administered.[49]

Cold affusion, bath, anointings, following regimen prescribed during summer season, medicated enema, milk and purgatives prepared from the juice of ''draksha'' (grapes), ''vidari'' and sugarcane juice and ghee to be administered.[49]

The following cold decoction reduces ''pittaja'' dysuria: ''Shatavari, kasa, kusha, svadamstra vidari, sali, ikshu, kaseruka'' mixed with water, honey, and sugar.[50]

The following cold decoction reduces [[pitta]]ja dysuria: ''Shatavari, kasa, kusha, svadamstra vidari, sali, ikshu, kaseruka'' mixed with water, honey, and sugar.[50]

The decoction of ''kamala'' and ''utpala'' (water lily) or ''shringhataka'' or ''vidari'' or the root of ''danairaka'' with honey and sugar is useful in ''pittaja'' type of dysuria. Simple cold water mixed with water, honey, and sugar is also helpful in ''paittika'' type of dysuria. [51]

The decoction of ''kamala'' and ''utpala'' (water lily) or ''shringhataka'' or ''vidari'' or the root of ''danairaka'' with honey and sugar is useful in [[pitta]]ja type of dysuria. Simple cold water mixed with water, honey, and sugar is also helpful in ''paittika'' type of dysuria. [51]

==== Remedies for ''pittaja'' dysuria ====

==== Remedies for [[pitta]]ja dysuria ====

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#The seeds of ''ervaruka''- utilissimus (Roxb.), ''trapusha''- Cucumis sativus Linn and ''kusumbha'' along with ''kumkuma''- Carthamus tinctorius Linn and ''vasa- adhatoda vasaka'' Nees mixed with grape juice(''drasha rasa'')- Vitis vinifera Linn drink is prepared out of these ingredients which is extremely beneficial in ''ashmari'' (urinary calculus), ''sharkara'' (graveluria) and all types of dysuria. [52]

#The seeds of ''ervaruka''- utilissimus (Roxb.), ''trapusha''- Cucumis sativus Linn and ''kusumbha'' along with ''kumkuma''- Carthamus tinctorius Linn and ''vasa- adhatoda vasaka'' Nees mixed with grape juice(''drasha rasa'')- Vitis vinifera Linn drink is prepared out of these ingredients which is extremely beneficial in ''ashmari'' (urinary calculus), ''sharkara'' (graveluria) and all types of dysuria. [52]

#Drink prepared out of seeds of ''ervaruka''- utilissimus (Roxb.), ''madhuka''- Madhuca indica, ''devadaru''- Cedrus deodara Loud should be taken along with ''tandulodaka'' (rice washed water)

#Drink prepared out of seeds of ''ervaruka''- utilissimus (Roxb.), ''madhuka''- Madhuca indica, ''devadaru''- Cedrus deodara Loud should be taken along with ''tandulodaka'' (rice washed water)

#Drink prepared out of ''daruharidra''-Berberis vulgaris L, juice of ''amalaki''-Emblica officinalis Gaertn mixed with honey is helpful in ''pittaja mutra krucchra''.[53]

#Drink prepared out of ''daruharidra''-Berberis vulgaris L, juice of ''amalaki''-Emblica officinalis Gaertn mixed with honey is helpful in [[pitta]]ja mutra krucchra''.[53]

==== Treatment of ''kaphaja'' type of dysuria ====

==== Treatment of [[kapha]]ja type of dysuria ====

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In ''kaphaja'' dysuria the following remedies are useful:

In [[kapha]]ja dysuria the following remedies are useful:

#Alkaline, hot and sharp medicine and diet

#Alkaline, hot and sharp medicine and diet

#Sudation (Hot fomentation therapies)

#Sudation (Hot fomentation therapies)

#Medicated oil prepared by bitter drugs is used for both massages as well as oral intake. [54]

#Medicated oil prepared by bitter drugs is used for both massages as well as oral intake. [54]

The following recipes are useful in ''kaphaja'' type of dysuria:

The following recipes are useful in [[kapha]]ja type of dysuria:

#''Trikatu'' (''sunthi, maricha''- Piper nigrum Linn, ''pippali''- Piper longum Linn), ''gokshura''- Tribulus terrestris Linn, ''truti'' (smaller cardamom)- Elettaria cardamomum Maton and bone of cranes(''sarasa'') to be taken in ''kola pramana'' along with honey and cows urine.

#''Trikatu'' (''sunthi, maricha''- Piper nigrum Linn, ''pippali''- Piper longum Linn), ''gokshura''- Tribulus terrestris Linn, ''truti'' (smaller cardamom)- Elettaria cardamomum Maton and bone of cranes(''sarasa'') to be taken in ''kola pramana'' along with honey and cows urine.

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If the dysuria is caused due to the aggravation of all the ''tridosha'' simultaneously and equally, then the physician, should administer the therapies/ remedies to correct the aggravated vāta and there after the remaining ''dosha'' after proper examination.

If the dysuria is caused due to the aggravation of all the tri[[dosha]] simultaneously and equally, then the physician, should administer the therapies/ remedies to correct the aggravated vāta and there after the remaining [[dosha]] after proper examination.

In case if the ''kapha'' is aggravated in excess then medicated emesis, if ''pitta'' the therapeutic purgation and if the ''vata'' is aggravated in excess the medicated enema therapy should be administered. [58]

In case if the [[kapha]] is aggravated in excess then medicated emesis, if [[pitta]] the therapeutic purgation and if the [[vata]] is aggravated in excess the medicated enema therapy should be administered. [58]

==== Treatment of dysuria caused by calculus and gravel ====

==== Treatment of dysuria caused by calculus and gravel ====

===== General treatment =====

===== General treatment =====

If the dysuria is caused due to the ''ashmari'' (calculus) or the ''sharkara'' (gravel) then the therapies suggested for ''kaphaja'' and ''vataja'' type should be applied for physiological benefit.

If the dysuria is caused due to the ''ashmari'' (calculus) or the ''sharkara'' (gravel) then the therapies suggested for [[kapha]]ja and [[vata]]ja type should be applied for physiological benefit.

For breaking and flushing out of calculus the effective therapies are explained hereafter and listen to the tested remedy. [59]

For breaking and flushing out of calculus the effective therapies are explained hereafter and listen to the tested remedy. [59]

====== Treatment for dysuria caused by obstruction of semen ======

====== Treatment for dysuria caused by obstruction of semen ======

If the cause of obstruction is due to the vitiated semen, then the remedies should be decided depending on the ''dosha'' predominant for obstruction (vitiation of semen). [69]

If the cause of obstruction is due to the vitiated semen, then the remedies should be decided depending on the [[dosha]] predominant for obstruction (vitiation of semen). [69]

#Meat soup prepared with the decoction prepared out of ''karpasa''- Gossypium herbaceum Linn root, ''vasa''- Adhatoda vasaka Nees, ''pashanabheda''- Cyclea peltata (Lam) Hook.f.& Thomas, ''bala''-Sida cordifolia Linn., ''laghupanchamula''(''salaparna''-Desmodium gangeticum(L.)DC ''prishnaparni''-Cyperus,''brahati''- Solanum indicum Linn, ''kantakari''- Garcinia morella Desr.,''Gokshura'' - Tribulus terrestris Linn.), ''gavedhuka''- Coix lacryma-jobi Linn.,''Vrshchira''(svetha –white punarnava)- Trianthema portulacastrum Linn, ''aindri'' (red ''punarnava'')- Boerhavia diffusa Linn, ''satavari''-Asparagus rigidulusNakai, ''madhuparni''(''guduchi'')-Tinospora cordifolia(Thunb.) Miers, ''asanaparni'' (''aparajita'')- Clitoria ternatea Linn decoction may be used in case of obstructed semen which is predominated by ''vata''.[70]

#Meat soup prepared with the decoction prepared out of ''karpasa''- Gossypium herbaceum Linn root, ''vasa''- Adhatoda vasaka Nees, ''pashanabheda''- Cyclea peltata (Lam) Hook.f.& Thomas, ''bala''-Sida cordifolia Linn., ''laghupanchamula''(''salaparna''-Desmodium gangeticum(L.)DC ''prishnaparni''-Cyperus,''brahati''- Solanum indicum Linn, ''kantakari''- Garcinia morella Desr.,''Gokshura'' - Tribulus terrestris Linn.), ''gavedhuka''- Coix lacryma-jobi Linn.,''Vrshchira''(svetha –white punarnava)- Trianthema portulacastrum Linn, ''aindri'' (red ''punarnava'')- Boerhavia diffusa Linn, ''satavari''-Asparagus rigidulusNakai, ''madhuparni''(''guduchi'')-Tinospora cordifolia(Thunb.) Miers, ''asanaparni'' (''aparajita'')- Clitoria ternatea Linn decoction may be used in case of obstructed semen which is predominated by [[vata]].[70]

#The above mentioned decoction if taken along with milk or ghee is useful in case of ''pitta'' predominance. [70]

#The above mentioned decoction if taken along with milk or ghee is useful in case of [[pitta]] predominance. [70]

#Food and drinks such as soup etc. should be prepared with this decoction in case of ''kapha'' predominance. [71]

#Food and drinks such as soup etc. should be prepared with this decoction in case of [[kapha]] predominance. [71]

#In case of combined ''dosha'' (''sannipatika''), measures beneficial for all ''dosha'' (combined form) should be used. [71]

#In case of combined [[dosha]] (''sannipatika''), measures beneficial for all [[dosha]] (combined form) should be used. [71]

If the problem does not subside by the above mentioned therapies, then one needs be given:

If the problem does not subside by the above mentioned therapies, then one needs be given:

#Old wine or ''madhukasava'' and meat of birds to nourish /increase the body weight.

#Old wine or ''madhukasava'' and meat of birds to nourish /increase the body weight.

#Urethral douches (''uttara basti'') for cleaning the seat of semen (seminal vesicle).

#Urethral douches (uttara [[basti]]) for cleaning the seat of semen (seminal vesicle).

#When the patient is cleansed and refreshed with aphrodisiacs he should be offered loving and favorite women for inducing intercourse. [72]

#When the patient is cleansed and refreshed with aphrodisiacs he should be offered loving and favorite women for inducing intercourse. [72]