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अथातस्त्रिमर्मीयां सिद्धिं व्याख्यास्यामः||१||  

अथातस्त्रिमर्मीयां सिद्धिं व्याख्यास्यामः||१||  

इति ह स्माह भगवानात्रेयः||२||

इति ह स्माह भगवानात्रेयः||२||

athātastrimarmīyāṁ siddhiṁ vyākhyāsyāmaḥ||1||  

 

athātastrimarmīyāṁ siddhiṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

iti ha smāha bhagavānātrēyaḥ||2||

athAtastrimarmIyAM siddhiM vyAkhyAsyAmaH||1||  

athAtastrimarmIyAM siddhiM vyAkhyAsyAmaH||1||  

iti ha smAha bhagavAnAtreyaH||2||  

iti ha smAha bhagavAnAtreyaH||2||  

Description of marma (vital points and organs):

 

==== Description of marma (vital points and organs) ====

सप्तोत्तरं मर्मशतमस्मिञ्छरीरे स्कन्धशाखासमाश्रितमग्निवेश!|  

सप्तोत्तरं मर्मशतमस्मिञ्छरीरे स्कन्धशाखासमाश्रितमग्निवेश!|  

तेषामन्यतमपीडायां समधिका पीडा भवति, चेतनानिबन्धवैशेष्यात्|  

तेषामन्यतमपीडायां समधिका पीडा भवति, चेतनानिबन्धवैशेष्यात्|  

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

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

saptōttaraṁ marmaśatamasmiñcharīrē skandhaśākhāsamāśritamagnivēśa!|  

saptōttaraṁ marmaśatamasmiñcharīrē skandhaśākhāsamāśritamagnivēśa!|  

tēṣāmanyatamapīḍāyāṁ samadhikā pīḍā bhavati, cētanānibandhavaiśēṣyāt|  

tēṣāmanyatamapīḍāyāṁ samadhikā pīḍā bhavati, cētanānibandhavaiśēṣyāt|  

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

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

saptottaraM marmashatamasmi~jcharIre skandhashAkhAsamAshritamagnivesha!|  

saptottaraM marmashatamasmi~jcharIre skandhashAkhAsamAshritamagnivesha!|  

teShAmanyatamapIDAyAM samadhikA pIDA bhavati, cetanAnibandhavaisheShyAt|  

teShAmanyatamapIDAyAM samadhikA pIDA bhavati, cetanAnibandhavaisheShyAt|  

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

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

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

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

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

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

Description of three vital organs:

   

==== Description of three vital organs ====

 

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

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

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

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

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

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

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

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

Clnical signs of injury to three marmas:

 

==== Clnical signs of injury to three marmas ====

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

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

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

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

Affliction of basti causes vata- mutra- varcha nigraha (retention of flatus, urine and stools), vankshana- mehana- basti shula (pain in groin, genitals and bladder region), kundala (retrogressive movement of vata or mutra), udavarta (reflux of vata or mutra), gulma (abdominal lumps ), anila asthila (a solid mass due to aggravated vata), upastambha (obstruction or retention of urine), nabhi- kukshi- guda- shroni graha (stiffness in umbilicus, epigastrium, rectum and pelvis) etc. These mentioned symptoms due to affliction by vatadi doshas have been explained in Chikitsa Sthana with their management. (6)  

Affliction of basti causes vata- mutra- varcha nigraha (retention of flatus, urine and stools), vankshana- mehana- basti shula (pain in groin, genitals and bladder region), kundala (retrogressive movement of vata or mutra), udavarta (reflux of vata or mutra), gulma (abdominal lumps ), anila asthila (a solid mass due to aggravated vata), upastambha (obstruction or retention of urine), nabhi- kukshi- guda- shroni graha (stiffness in umbilicus, epigastrium, rectum and pelvis) etc. These mentioned symptoms due to affliction by vatadi doshas have been explained in Chikitsa Sthana with their management. (6)  

Importance of vata dosha and basti therapy:

==== Importance of vata dosha and basti therapy ====

 

किन्त्वेतानि विशेषतोऽनिलाद्रक्ष्याणि, अनिलो हि पित्तकफसमुदीरणे हेतुः प्राणमूलं च, स बस्तिकर्मसाध्यतमः, तस्मान्न बस्तिसमं किञ्चित् कर्म मर्मपरिपालनमस्ति|  

किन्त्वेतानि विशेषतोऽनिलाद्रक्ष्याणि, अनिलो हि पित्तकफसमुदीरणे हेतुः प्राणमूलं च, स बस्तिकर्मसाध्यतमः, तस्मान्न बस्तिसमं किञ्चित् कर्म मर्मपरिपालनमस्ति|  

तत्र षडास्थापनस्कन्धान् विमाने द्वौ चानुवासनस्कन्धाविह च विहितान् बस्तीन् बुद्ध्या विचार्य महामर्मपरिपालनार्थं प्रयोजयेद्वातव्याधिचिकित्सां च||७||

तत्र षडास्थापनस्कन्धान् विमाने द्वौ चानुवासनस्कन्धाविह च विहितान् बस्तीन् बुद्ध्या विचार्य महामर्मपरिपालनार्थं प्रयोजयेद्वातव्याधिचिकित्सां च||७||

tatra ShaDAsthApanaskandhAn vimAne dvau cAnuvAsanaskandhAviha ca vihitAn bastIn buddhyA vicArya mahAmarmaparipAlanArthaM prayojayedvAtavyAdhicikitsAM ca||7||

tatra ShaDAsthApanaskandhAn vimAne dvau cAnuvAsanaskandhAviha ca vihitAn bastIn buddhyA vicArya mahAmarmaparipAlanArthaM prayojayedvAtavyAdhicikitsAM ca||7||

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

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

Management of marma disorders:

 

==== Management of marma disorders ====

 

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

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

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

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

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

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

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

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

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

 

In disorders of basti, kumbhisweda ( a type of mahasweda described in Ca.Su.14/56-58), varti prayoga (urethral suppository), niruha basti (decoction enema) prepared of shyamadi (Operculina turpethum etc) drugs with gomutra (Cows Urine) or bilvadi (Aegle marmelos etc) drugs with sura (fermented liquid), or  with sara (Saccharum munja), kasa (Saccharum spontaneum), ikshu (Saccharum officinarum), darbha (Eragrostis cynosuroides/ Desmostachya bipinnata), gokshura (Tribulus terrestris), mulaka (Raphanus sativus) kvatha mixed with milk and paste of trapusa ( Cucumis sativus), ervaruka (Cucumis sativus- bitter), kharasvabija (Ajamoda- Apium graveolens), yava (Hordeum vulgare), rishabhaka (Microstylis muscifera Ridley ), vriddhi ((Habenaria intermedia D.Don syn. Habenaria arietina H.f.) ); anuvasana (Oil enema) with taila prepared from pitadaru (Berberis aristata), ghee prepared out of tilvaka (Symplocos racemosa or Viburnum sp.) for virechana (purgation); oil prepared out of kashaya (decoction) of shatavari (Asparagus racemosus), gokshura (Tribulus terrestris), brahati (Solanum indicum), kantakari (Solanum xanthocarpum), guduchi (Tinospora cordifolia), punarnava (Boerhavia diffusa), usira (Vetiveria zizanoides), madhuka (Glycyrrhiza glabra), 2 sariva(sveta sariva- Hemidesmus indicus and krishna sariva- Cryptolepis buchanana), lodhra (Symplocos racemosa), shreyasi (Cavya-

 

Piper chaba), kusha (Desmostachys bipinnata), kasha (Saccharum spontaneum) roots, with 4 times kshira (milk), kalka(paste) made of bala (Sida cordifolia), vrisha (Adhatoda vasica), rishabhaka (Microstylis muscifera Ridley ), kharashva (Ajamoda- Apium graveolens), upakunchika (Elatteria cardomum), vatsaka (Holarrhena antidysenterica), trapusha (Cucumis sativus), ervarubija (Cucumis sativus seeds), shitivaraka (Sunishannaka- Marsilea quadrifida), madhuka (Glycyrrhiza glabra), vacha (Acorus calamus), shatapushpa (Peucedanum graveolens/ Anethum graveolens), asmabhedaka (Bergenia ligulata), varshabhu (Trianthema monogyna/ crystallina), madanaphala (Randia spinosa) should be used for uttara basti (enema into urethral route), and niruha (decoction enema) after shodhana (purification) , in an individual who is snigdha svinna (who is properly oleated and fomented) alleviates basti shula (pain in basti) and mutra vikara (urinary disorders). (8)   

 

भवन्ति चात्र श्लोकाः-  

भवन्ति चात्र श्लोकाः-  

हृदये मूर्ध्नि बस्तौ च नृणां प्राणाः प्रतिष्ठिताः|  

हृदये मूर्ध्नि बस्तौ च नृणां प्राणाः प्रतिष्ठिताः|  

Thereby concluding the Slokha-

Thereby concluding the Slokha-

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

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

अत उर्ध्वं विकारा ये त्रिमर्मीये चिकित्सिते|  

अत उर्ध्वं विकारा ये त्रिमर्मीये चिकित्सिते|  

न प्रोक्ता मर्मजास्तेषां कांश्चिद्वक्ष्यामि सौषधान्||११||

न प्रोक्ता मर्मजास्तेषां कांश्चिद्वक्ष्यामि सौषधान्||११||

ata urdhvaM vikArA ye trimarmIye cikitsite|  

ata urdhvaM vikArA ye trimarmIye cikitsite|  

na proktA marmajAsteShAM kAMshcidvakShyAmi sauShadhAn||11||

na proktA marmajAsteShAM kAMshcidvakShyAmi sauShadhAn||11||

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

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

Etiopathology of apatantraka (Opisthtomus):

 

==== Etiopathology of apatantraka (Opisthtomus) ====

 

क्रुद्धः स्वैः कोपनैर्वायुः स्थानादूर्ध्वं प्रपद्यते|  

क्रुद्धः स्वैः कोपनैर्वायुः स्थानादूर्ध्वं प्रपद्यते|  

पीडयन् हृदयं गत्वा शिरः शङ्खौ च पीडयन्||१२||  

पीडयन् हृदयं गत्वा शिरः शङ्खौ च पीडयन्||१२||  

vAyunA dAruNaM prAhureke tamapatAnakam||15||

vAyunA dAruNaM prAhureke tamapatAnakam||15||

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

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

Management of apatantraka (opisthotomus):

 

==== Management of apatantraka (opisthotomus) ====

 

वसनं कफवाताभ्यां रुद्धं तस्य  विमोक्षयेत्|  

वसनं कफवाताभ्यां रुद्धं तस्य  विमोक्षयेत्|  

तीक्ष्णैः प्रधमनैः सञ्ज्ञां तासु मुक्तासु विन्दति||१६||  

तीक्ष्णैः प्रधमनैः सञ्ज्ञां तासु मुक्तासु विन्दति||१६||  

sauvarcalAbhayAvyoShaiH siddhaM tasmai ghRutaM hitam||20||

sauvarcalAbhayAvyoShaiH siddhaM tasmai ghRutaM hitam||20||

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

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

Etiopathology and treatment of tandra (drowsiness):

 

==== Etiopathology and treatment of tandra (drowsiness) ====

 

मधुरस्निग्धगुर्वन्नसेवनाच्चिन्तनाच्छ्रमात् |  

मधुरस्निग्धगुर्वन्नसेवनाच्चिन्तनाच्छ्रमात् |  

शोकाद्व्याध्यनुषङ्गाच्च वायुनोदीरितः कफः||२१||  

शोकाद्व्याध्यनुषङ्गाच्च वायुनोदीरितः कफः||२१||  

kaphaghnaM tatra kartavyaM shodhanaM shamanAni ca|  

kaphaghnaM tatra kartavyaM shodhanaM shamanAni ca|  

vyAyAmo raktamokShashca bhojyaM ca kaTutiktakam||24||

vyAyAmo raktamokShashca bhojyaM ca kaTutiktakam||24||

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

 

Thirteen types of urinary disorders:

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

 

==== Thirteen types of urinary disorders ====

 

मूत्रौकसादो  जठरं कृच्छ्रमुत्सङ्गसङ्क्षयौ|  

मूत्रौकसादो  जठरं कृच्छ्रमुत्सङ्गसङ्क्षयौ|  

मूत्रातीतोऽनिलाष्ठीला वातबस्त्युष्णमारुतौ||२५||  

मूत्रातीतोऽनिलाष्ठीला वातबस्त्युष्णमारुतौ||२५||  

trayodashaite mUtrasya doShAstA@mlli~ggataH shRuNu||26||

trayodashaite mUtrasya doShAstA@mlli~ggataH shRuNu||26||

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

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

Mutraukasada (dense urine):

 

==== Mutraukasada (dense urine) ====

 

पित्तं कफो द्वावपि वा बस्तौ संहन्यते यदा|  

पित्तं कफो द्वावपि वा बस्तौ संहन्यते यदा|  

मारुतेन तदा मूत्रं रक्तं पीतं घनं सृजेत्||२७||  

मारुतेन तदा मूत्रं रक्तं पीतं घनं सृजेत्||२७||  

mUtraukasAdaM  taM vidyAt pittashleShmaharairjayet||28||

mUtraukasAdaM  taM vidyAt pittashleShmaharairjayet||28||

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

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

Mutra jathara (accumulation of urine in abdominal cavity) :

 

==== Mutra jathara (accumulation of urine in abdominal cavity) ====

 

विधारणात् प्रतिहतं वातोदावर्तितं यदा|  

विधारणात् प्रतिहतं वातोदावर्तितं यदा|  

पूरयत्युदरं मूत्रं तदा तदनिमित्तरुक्||२९||  

पूरयत्युदरं मूत्रं तदा तदनिमित्तरुक्||२९||  

hanyAnmUtrodarAnAhamAdhmAnaM  gudameDhrayoH||31||

hanyAnmUtrodarAnAhamAdhmAnaM  gudameDhrayoH||31||

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

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

Mutra krichchra (dysuria):

 

==== Mutra krichchra (dysuria) ====

 

मूत्रितस्य व्यवायात्तु रेतो वातोद्धतं च्युतम्|  

मूत्रितस्य व्यवायात्तु रेतो वातोद्धतं च्युतम्|  

पूर्वं मूत्रस्य पश्चाद्वा स्रवेत् कृच्छ्रं तदुच्यते||३२||  

पूर्वं मूत्रस्य पश्चाद्वा स्रवेत् कृच्छ्रं तदुच्यते||३२||  

pUrvaM mUtrasya pashcAdvA sravet kRucchraM taducyate||32||

pUrvaM mUtrasya pashcAdvA sravet kRucchraM taducyate||32||

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

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

Mutrotsanga (residual urination):

 

==== Mutrotsanga (residual urination) ====

खवैगुण्यानिलाक्षेपैः किञ्चिन्मूत्रं च तिष्ठति|  

खवैगुण्यानिलाक्षेपैः किञ्चिन्मूत्रं च तिष्ठति|  

mUtrotsa~ggaH sa vicchinnamuccheShagurushephasaH  |  

mUtrotsa~ggaH sa vicchinnamuccheShagurushephasaH  |  

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

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

Mutra samkshaya (suppression of urine formation):

 

==== Mutra samkshaya (suppression of urine formation) ====

 

वाताकृतिर्भवेद्वातान्मूत्रे शुष्यति सङ्क्षयः||३४||  

वाताकृतिर्भवेद्वातान्मूत्रे शुष्यति सङ्क्षयः||३४||  

vātākr̥tirbhavēdvātānmūtrē śuṣyati saṅkṣayaḥ||34||  

vātākr̥tirbhavēdvātānmūtrē śuṣyati saṅkṣayaḥ||34||  

vAtAkRutirbhavedvAtAnmUtre shuShyati sa~gkShayaH||34||  

vAtAkRutirbhavedvAtAnmUtre shuShyati sa~gkShayaH||34||  

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

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

Mutratita (delayed micturition):

 

==== Mutratita (delayed micturition) ====

 

चिरं धारयतो मूत्रं त्वरया न प्रवर्तते|  

चिरं धारयतो मूत्रं त्वरया न प्रवर्तते|  

मेहमानस्य मन्दं वा मूत्रातीतः स उच्यते||३५||  

मेहमानस्य मन्दं वा मूत्रातीतः स उच्यते||३५||  

mehamAnasya mandaM vA mUtrAtItaH sa ucyate||35||  

mehamAnasya mandaM vA mUtrAtItaH sa ucyate||35||  

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

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

Ashthila (hard globular swelling like tumor):

 

==== Ashthila (hard globular swelling like tumor) ====

 

आध्मापयन् बस्तिगुदं रुद्ध्वा वायुश्चलोन्नताम्|  

आध्मापयन् बस्तिगुदं रुद्ध्वा वायुश्चलोन्नताम्|  

कुर्यात्तीव्रार्तिमष्ठीलां मूत्रविण्मार्गरोधिनीम्||३६||  

कुर्यात्तीव्रार्तिमष्ठीलां मूत्रविण्मार्गरोधिनीम्||३६||  

kuryAttIvrArtimaShThIlAM mUtraviNmArgarodhinIm||36||  

kuryAttIvrArtimaShThIlAM mUtraviNmArgarodhinIm||36||  

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

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

Vatabasti (vata affliction of bladder):

 

==== Vatabasti (vata affliction of bladder) ====

 

मूत्रं  धारयतो बस्तौ वायुः क्रुद्धो विधारणात्|  

मूत्रं  धारयतो बस्तौ वायुः क्रुद्धो विधारणात्|  

मूत्ररोधार्तिकण्डूभिर्वातबस्तिः स उच्यते||३७||  

मूत्ररोधार्तिकण्डूभिर्वातबस्तिः स उच्यते||३७||  

mUtrarodhArtikaNDUbhirvAtabastiH sa ucyate||37||  

mUtrarodhArtikaNDUbhirvAtabastiH sa ucyate||37||  

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

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

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

 

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

 

उष्मणा सोष्मकं मूत्रं शोषयन् रक्तपीतकम्|  

उष्मणा सोष्मकं मूत्रं शोषयन् रक्तपीतकम्|  

उष्णवातः सृजेत् कृच्छ्राद्बस्त्युपस्थार्तिदाहवान्||३८||  

उष्णवातः सृजेत् कृच्छ्राद्बस्त्युपस्थार्तिदाहवान्||३८||  

uShNavAtaH sRujet kRucchrAdbastyupasthArtidAhavAn||38||  

uShNavAtaH sRujet kRucchrAdbastyupasthArtidAhavAn||38||  

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

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

Vatakundalika (scanty and painful flow of urine) :

 

==== Vatakundalika (scanty and painful flow of urine) ====

 

गतिसङ्गादुदावृत्तः स मूत्रस्थानमार्गयोः|  

गतिसङ्गादुदावृत्तः स मूत्रस्थानमार्गयोः|  

मूत्रस्य विगुणो वायुर्भग्नव्याविद्धकुण्डली||३९||  

मूत्रस्य विगुणो वायुर्भग्नव्याविद्धकुण्डली||३९||  

tIvraru~gmUtraviTsa~ggairvAtakuNDaliketi sA||40||  

tIvraru~gmUtraviTsa~ggairvAtakuNDaliketi sA||40||  

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

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

Raktagranthi (nodular swelling in bladder):

 

==== Raktagranthi (nodular swelling in bladder) ====

 

रक्तं वातकफाद्दुष्टं बस्तिद्वारे सुदारुणम्|  

रक्तं वातकफाद्दुष्टं बस्तिद्वारे सुदारुणम्|  

ग्रन्थिं कुर्यात् स कृच्छ्रेण सृजेन्मूत्रं तदावृतम्||४१||  

ग्रन्थिं कुर्यात् स कृच्छ्रेण सृजेन्मूत्रं तदावृतम्||४१||  

ashmarIsamashUlaM taM raktagranthiM pracakShate|  

ashmarIsamashUlaM taM raktagranthiM pracakShate|  

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

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

Vid vighata (faeces coming through urine):

 

==== Vid vighata (faeces coming through urine) ====

 

रूक्षदुर्बलयोर्वातेनोदावृत्तं शकृद्यदा||४२||  

रूक्षदुर्बलयोर्वातेनोदावृत्तं शकृद्यदा||४२||  

मूत्रस्रोतः प्रपद्येत विट्संसृष्टं तदा नरः|  

मूत्रस्रोतः प्रपद्येत विट्संसृष्टं तदा नरः|  

viDgandhaM mUtrayet kRucchrAdviDvighAtaM vinirdishet||43||

viDgandhaM mUtrayet kRucchrAdviDvighAtaM vinirdishet||43||

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

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

Basti kundala (circular distension of bladder):

 

==== Basti kundala (circular distension of bladder) ====

 

द्रुताध्वलङ्घनायासादभिघातात् प्रपीडनात्|  

द्रुताध्वलङ्घनायासादभिघातात् प्रपीडनात्|  

स्वस्थानाद्वस्तिरुद्वृत्तः स्थूलस्तिष्ठति गर्भवत्||४४||  

स्वस्थानाद्वस्तिरुद्वृत्तः स्थूलस्तिष्ठति गर्भवत्||४४||  

syAdvastau kuNDalIbhUte hRunmohaH shvAsa eva ca|49|

syAdvastau kuNDalIbhUte hRunmohaH shvAsa eva ca|49|

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

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

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

 

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

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

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

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

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

Management of urinary disorders:

==== Management of urinary disorders ====

 

दोषाधिक्यमवेक्ष्यैतान् मूत्रकृच्छ्रहरैर्जयेत्॥४९॥

दोषाधिक्यमवेक्ष्यैतान् मूत्रकृच्छ्रहरैर्जयेत्॥४९॥

बस्तिमुत्तरबस्तिं च सर्वेषामेव दापयेत् |

बस्तिमुत्तरबस्तिं च सर्वेषामेव दापयेत् |

bastimuttarabastiM ca sarveShAmeva dApayet|50|

bastimuttarabastiM ca sarveShAmeva dApayet|50|

These conditions should be examined in terms of dominance of Dosha and treated by measures that relieve Mutrakrcchra (Dysuria). Basti (rectal enemas) and Uttara basti (Bladder enemas) should be administered in all these conditions. (49-49½)

These conditions should be examined in terms of dominance of Dosha and treated by measures that relieve Mutrakrcchra (Dysuria). Basti (rectal enemas) and Uttara basti (Bladder enemas) should be administered in all these conditions. (49-49½)

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

 

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

 

पुष्पनेत्रं तु हैमं स्याच्छ्लक्ष्णमौत्तरबस्तिकम्||५०||  

पुष्पनेत्रं तु हैमं स्याच्छ्लक्ष्णमौत्तरबस्तिकम्||५०||  

जात्यश्वहनवृन्तेन समं गोपुच्छसंस्थितम्|  

जात्यश्वहनवृन्तेन समं गोपुच्छसंस्थितम्|  

sukhaM prapIDya niShkampaM niShkarShennetrameva ca||56||  

sukhaM prapIDya niShkampaM niShkarShennetrameva ca||56||  

pratyAgate dvitIyaM ca tRutIyaM ca pradApayet|  

pratyAgate dvitIyaM ca tRutIyaM ca pradApayet|  

  rajanIvyuShitasya ca||57||

rajanIvyuShitasya ca||57||

 

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

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

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

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

Pippalyadi varti (medicated wick/suppository):

 

==== Pippalyadi varti (medicated wick/suppository)====

 

पिप्पलीलवणागारधूमापामार्गसर्षपैः|  

पिप्पलीलवणागारधूमापामार्गसर्षपैः|  

वार्ताकुरसनिर्गुण्डीशम्पाकैः ससहाचरैः||५८||  

वार्ताकुरसनिर्गुण्डीशम्पाकैः ससहाचरैः||५८||  

snehe pratyAgate tAbhyAmAnuvAsaniko vidhiH|  

snehe pratyAgate tAbhyAmAnuvAsaniko vidhiH|  

parihArashca savyApat sasamyagdattalakShaNaH||61||  

parihArashca savyApat sasamyagdattalakShaNaH||61||  

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

 

Time of administration of uttara basti:

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

 

==== Time of administration of uttara basti ====

 

स्त्रीणामार्तवकाले तु प्रतिकर्म तदाचरेत्|  

स्त्रीणामार्तवकाले तु प्रतिकर्म तदाचरेत्|  

गर्भासना सुखं स्नेहं तदाऽऽदत्ते ह्यपावृता||६२||  

गर्भासना सुखं स्नेहं तदाऽऽदत्ते ह्यपावृता||६२||  

vidadhyAduttaraM bastiM yathAsvauShadhasaMskRutam [2] |65|

vidadhyAduttaraM bastiM yathAsvauShadhasaMskRutam [2] |65|

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

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

Dimensions of nozzle for uttara basti and its procedure:

 

==== Dimensions of nozzle for uttara basti and its procedure ====

 

पुष्पनेत्रप्रमाणं तु प्रमदानां दशाङ्गुलम्||६५||  

पुष्पनेत्रप्रमाणं तु प्रमदानां दशाङ्गुलम्||६५||  

मूत्रस्रोतःपरीणाहं मुद्गस्रोतोऽनुवाहि च|  

मूत्रस्रोतःपरीणाहं मुद्गस्रोतोऽनुवाहि च|  

anenaiva vidhAnena karma kuryAt punastryahAt|70|

anenaiva vidhAnena karma kuryAt punastryahAt|70|

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

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

Etiopathology and management of diseases of Head:

 

Shankhaka (temporal headache):

==== Etiopathology and management of diseases of Head ====

 

===== Shankhaka (temporal headache) =====

 

अतः शिरोविकाराणां कश्चिद्भेदः प्रवक्ष्यते||७०||  

अतः शिरोविकाराणां कश्चिद्भेदः प्रवक्ष्यते||७०||  

रक्तपित्तानिला दुष्टाः शङ्खदेशे विमूर्च्छिताः|  

रक्तपित्तानिला दुष्टाः शङ्खदेशे विमूर्च्छिताः|  

shirovirekasekAdi sarvaM vIsarpanucca yat||73||

shirovirekasekAdi sarvaM vIsarpanucca yat||73||

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

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

Ardhavabhedaka (migraine affecting one side of head):

 

===== Ardhavabhedaka (migraine affecting one side of head) =====

 

रूक्षात्यध्यशनात्  पूर्ववातावश्यायमैथुनैः|  

रूक्षात्यध्यशनात्  पूर्ववातावश्यायमैथुनैः|  

वेगसन्धारणायासव्यायामैः कुपितोऽनिलः||७४||  

वेगसन्धारणायासव्यायामैः कुपितोऽनिलः||७४||