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|title=Trimarmiya Siddhi

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|keywords=Marma (vital points), Diseases of head and nervous system, Heart and cardiovascular system, bladder, kidney and urinary system, Apatantraka, Ardhavabhedaka, Basti, Hridaya, Mutradosha, Nasya, Shiromarma, Suravarta, Tandra, Trimarma, Udavarta,Uttara basti, per vaginal drug delivery, per urethral drug delivery

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|keywords=Marma (vital points), Diseases of head and nervous system, Heart and cardiovascular system, bladder, kidney and urinary system, Apatantraka, Ardhavabhedaka, Basti, Hridaya, Mutradosha, Nasya, Shiromarma, Suravarta, Tandra, Trimarma, Udavarta,Uttara basti, per vaginal drug delivery, per urethral drug delivery,Ayurveda, Indian system of medicine, charak samhita.

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|description=Siddhi Sthana Chapter 9. Management of ~~disorders~~ of three vital organs

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|description=Siddhi Sthana Chapter 9. Management of diseases of three vital organs

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|image_alt=charak samhita

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|type=article

}}

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<big>'''[[Siddhi Sthana]] Chapter 9. Management of ~~disorders~~ of three vital organs'''</big>

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<big>'''[[Siddhi Sthana]] Chapter 9. Management of diseases of three vital organs'''</big>

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~~<big>''' Abstract </big>'''~~

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

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'''Keywords''': ''Marma'' (vital points), Diseases of head and nervous system, Heart and cardiovascular system, bladder, kidney and urinary system, ''Apatantraka, Ardhavabhedaka, Basti, Hridaya, Mutradosha, Nasya, Shiromarma, Suravarta, Tandra, Trimarma, Udavarta,Uttara basti,'' per vaginal drug delivery, per urethral drug delivery.

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{{Infobox

|title = Trimarmiya Siddhi

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|label5 = Other Sections

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]]

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|label6 = Translator and commentator

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|data6 = Shenoy R.

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|label7 = Reviewer

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|data7 = Panse A.

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|label8 = Editors

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|data8 = Thakar A. B., Mangalasseri P., Deole Y.S., Basisht G.

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s08.010 10.47468/CSNE.2020.e01.s08.010]

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}}

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<big>''' Abstract </big>'''

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

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'''Keywords''': ''Marma'' (vital points), Diseases of head and nervous system, Heart and cardiovascular system, bladder, kidney and urinary system, ''Apatantraka, Ardhavabhedaka, Basti, Hridaya, Mutradosha, [[Nasya]], Shiromarma, Suravarta, Tandra, Trimarma, Udavarta,Uttara basti,'' per vaginal drug delivery, per urethral drug delivery.

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</div>

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~~|header3 =~~

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== Introduction ==

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

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

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

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

== Sanskrit text, Transliteration and English Translation ==

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We shall ~~now elaborate~~ the chapter ~~on the~~ Management of ~~(disorders pertaining to~~) ~~three ''marmas''~~. Thus said Lord Atreya [1-2]

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

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</div>

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

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

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

</div></div>

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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]

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</div>

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

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=== Description of three vital organs ===

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

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

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

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

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

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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.

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

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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.

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==== Clinical signs of injury to three ''marmas'' ====

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

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</div>

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=== Clinical signs of injury to three ''marmas'' ===

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

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

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

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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.

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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.

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

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

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</div>

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

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=== Importance of ''[[vata dosha]]'' and ''[[basti]]'' therapy ===

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

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

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

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</div>

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

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

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

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

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

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

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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]

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

+

</div>

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utpannArtivighAtashca marmaNAM paripAlanam||10||<br />

</div></div>

−

+

Thereby concluding the ''Slokha''-

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

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

+

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

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</div></div>

−

''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 ''[[dosha]]s'' the person becomes healthy and becomes unconscious again when gets afflicted with ''[[dosha]]s'' and is due to severe aggravation of ''[[vata]]''. [12-15]

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

+

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

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</div></div>

−

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), a''mlavetasa'' (Garcinia pedunculata), ''sunthi'' (Zingiber officinale), with ''sauvarchala'' (sorchal salt) and ''dadima'' (juice of pomergranate/ Punica granatum) and employ treatment that alleviates ''vata kapha ~~doshas~~'' and which cures ''hridroga'' (cardiac disorders). ''Tikshna shodhana basti'' (strong purificatory enemas) is totally unsuitable. ''Ghrita'' prepared by ''sauvarchala'' salt, ''abhaya'' (Terminalia chebula), ''vyosha'' (''pippali, maricha, sunthi'' i.e., Piper longum, Piper indicum and Zingiber officinale) is suitable. [16-20]

+

The aggravated ''[[kapha]] [[vata]] [[dosha]]s'' 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), a''mlavetasa'' (Garcinia pedunculata), ''sunthi'' (Zingiber officinale), with ''sauvarchala'' (sorchal salt) and ''dadima'' (juice of pomergranate/ Punica granatum) and employ treatment that alleviates ''[[vata]] [[kapha]] [[dosha]]s'' and which cures ''hridroga'' (cardiac disorders). ''Tikshna shodhana [[basti]]'' (strong purificatory enemas) is totally unsuitable. ''Ghrita'' prepared by ''sauvarchala'' salt, ''abhaya'' (Terminalia chebula), ''vyosha'' (''pippali, maricha, sunthi'' i.e., Piper longum, Piper indicum and Zingiber officinale) is suitable. [16-20]

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

+

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

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</div></div>

−

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

+

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

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

+

=== Thirteen types of urinary disorders ===

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

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

+

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

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</div></div>

−

''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]] [[kapha]]hara'' measures.[27-28]

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

+

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

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</div></div>

−

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

+

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

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

+

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

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</div></div>

−

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

+

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

−

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

+

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

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</div></div>

−

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

+

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

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

+

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

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</div></div>

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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]

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

+

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

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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]

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

+

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

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</div></div>

−

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]

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

+

=== ''Vatabasti'' (''[[vata]]'' affliction of bladder) ===

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</div></div>

−

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) ===

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</div></div>

−

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

+

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

−

===~~= V~~''~~atakundalika~~'' (scanty and painful flow of urine) ====

+

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

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</div></div>

−

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

+

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

−

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

+

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

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</div></div>

−

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

+

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

−

==== ''Vid vighata'' (feces coming through urine) ====

+

=== ''Vid vighata'' (feces coming through urine) ===

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</div></div>

−

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

+

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

−

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

+

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

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</div></div>

−

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 ===

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</div></div>

−

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

+

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

−

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

+

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

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

−

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

+

The patient having bathed, taken food with ''mamsarasa'' or milk, after clearing the urges of urine and feces, seated erect comfortably on a soft seat of knee height, the erect penis probed with a ''shalaka'' (metallic probe) duly lubricated with ghee and if found to be unobstructed, then in accordance with the size of penis the enema nozzle should be introduced as per the procedure of ''guda[[basti]]'' 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)===

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

−

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

+

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

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</div></div>

−

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.Sa.[[Chikitsa Sthana]] 30th chapter], menorrhagia-metrorrhagia conditions, retention of urine and dribbling incontinence.[62-64½]

−

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

+

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

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</div></div>

−

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 ====

+

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

−

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

+

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

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</div></div>

−

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

+

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

−

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

+

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

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</div></div>

−

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

+

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

−

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

+

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

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</div></div>

−

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

+

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

−

==== ''Anantavata'' (pulsating headache involving all areas of head) ====

+

=== ''Anantavata'' (pulsating headache involving all areas of head) ===

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</div></div>

−

The three ''~~doshas~~'' aggravated due to fasting, severe grief, consumption of food which is ununctuous, cold and less in quantity, producing severe pain in ''manya'' (antero lateral part of neck) and then ''ghata'' (posterior part of neck). Later the pain localizes to the eye, eyebrow and temples, causes twitching in the cheek, diseases of the eye and stiffness of the jaw. The condition is called ''anantavata''.

+

The three ''[[dosha]]s'' aggravated due to fasting, severe grief, consumption of food which is ununctuous, cold and less in quantity, producing severe pain in ''manya'' (antero lateral part of neck) and then ''ghata'' (posterior part of neck). Later the pain localizes to the eye, eyebrow and temples, causes twitching in the cheek, diseases of the eye and stiffness of the jaw. The condition is called ''anantavata''.

−

It is treated by ''siravyadha'' (venesection) and medicines that cure ''suryavarta''. The ''vata'' aggravated by ''ruksha'' etc factors produces tremors of the head. In this condition ''amrita'' (Tinospora cordifolia), ''bala'' (Sida cordifolia), ''rasna'' (Pluchea lanceolata), ''mahashveta'' (Clitoria ternatea Linn.), ''ashvagandha'' (Withania sommifera) which are alleviators of ''vata'' should be used for oleation, fomentation and ''tarpana nasya'' (nourishing errhines) should be employed.[84-87]

+

It is treated by ''siravyadha'' (venesection) and medicines that cure ''suryavarta''. The ''[[vata]]'' aggravated by ''ruksha'' etc factors produces tremors of the head. In this condition ''amrita'' (Tinospora cordifolia), ''bala'' (Sida cordifolia), ''rasna'' (Pluchea lanceolata), ''mahashveta'' (Clitoria ternatea Linn.), ''ashvagandha'' (Withania sommifera) which are alleviators of ''[[vata]]'' should be used for oleation, fomentation and ''tarpana [[nasya]]'' (nourishing errhines) should be employed.[84-87]

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</div></div>

−

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

+

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

−

==== Types of ''nasya'' (nasal drug delivery therapy) ====

+

=== Types of ''[[nasya]]'' (nasal drug delivery therapy) ===

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</div></div>

−

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

+

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

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</div></div>

−

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

+

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

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

−

==== Procedure of nasya therapy ====

+

=== Procedure of [[nasya]] therapy ===

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</div></div>

−

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

+

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

−

==== ''Dhumapana'' (medicated smoking) and post ''nasya'' therapy ====

+

=== ''Dhumapana'' (medicated smoking) and post ''[[nasya]]'' therapy ===

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</div></div>

−

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

+

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

−

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

+

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

−

==== The treatment of vitiated ''~~doshas~~'' after ''nasya'' ====

+

=== The treatment of vitiated ''[[dosha]]s'' after ''[[nasya]]'' ===

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</div></div>

−

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

+

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

−

Ununctuous or dry errhines in persons who are emaciated, after purgation, pregnant, exhausted due to severe exercise, thirsty, leads to aggravation of ''vata'' and produce diseases due to it. In such conditions all ''vata'' alleviating measures such as oleation, nourishing therapy, sudation etc should be done. In case of pregnant especially, ghee and milk should be administered.

+

Ununctuous or dry errhines in persons who are emaciated, after purgation, pregnant, exhausted due to severe exercise, thirsty, leads to aggravation of ''[[vata]]'' and produce diseases due to it. In such conditions all ''[[vata]]'' alleviating measures such as oleation, nourishing therapy, sudation etc should be done. In case of pregnant especially, ghee and milk should be administered.

Unctuous errhine administered in those afflicted by severe fever, grief and alcoholics causes dimness of vision. It should be managed by collyrium and applications to the eye and instillation of medicine prepared by ''putapaka'' method which are un-unctuous and cold. [111-115]

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==== Types of ''navana'' (unctuous errhines) ====

+

=== Types of ''navana'' (unctuous errhines) ===

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

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==== Summary ====

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=== Summary ===

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To conclude the verses-

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

+

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

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*The vital organs in trunk and abdomen are more important that those in extremities or at superficial level.

*''Hridaya'' (heart including cardio-vascular system), ''basti'' (Urinary bladder including urinary system and kidneys) and ''shiras'' (head including sensory-motor nervous system) are important owing to the fact that they are the roots of body and the existence of life depends on them.

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*''Hridaya'' (heart) is the center for receiving the ten ''dhamani'' (ten great vessels arising from the heart), ''prana, apana, manas'' (mind), ''buddhi'' (intellect), ''chetana'' (life), ''~~mahabhutas~~'' (5 fundamental elements) just like spokes to the axle in the center of a wheel.

+

*''Hridaya'' (heart) is the center for receiving the ten ''dhamani'' (ten great vessels arising from the heart), ''prana, apana, [[manas]]'' (mind), ''[[buddhi]]'' (intellect), ''chetana'' (life), ''[[mahabhuta]]s'' (5 fundamental elements) just like spokes to the axle in the center of a wheel.

−

*''Shiras'' (head) is the centre for the ''~~indriyas~~'' (the seat of special senses), the ''srotas'' (channels) pertaining to the conduction of ''indriya'' and ''prana'' like the radiating spicules of the rays of sunlight.

+

*''Shiras'' (head) is the centre for the ''[[indriya]]s'' (the seat of special senses), the ''srotas'' (channels) pertaining to the conduction of ''[[indriya]]'' and ''prana'' like the radiating spicules of the rays of sunlight.

−

*The ''basti'' (bladder) is center that is related with the functions of ''sthula guda'' (rectum), ''mushka'' (scrotum), ''sevani'' (perineal raphe), urinary channels and ''shukra'' (semen). It is also the ''mutradhara'' (reservoir of urine) in to all the water carrying channels in the body drain, similar to all the rivers drain into the ''udadhi'' (sea/ ocean).

+

*The ''basti'' (bladder) is center that is related with the functions of ''sthula guda'' (rectum), ''mushka'' (scrotum), ''sevani'' (perineal raphe), urinary channels and ''[[shukra]]'' (semen). It is also the ''mutradhara'' (reservoir of urine) in to all the water carrying channels in the body drain, similar to all the rivers drain into the ''udadhi'' (sea/ ocean).

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*Injury to these three ''marmas'' (''hridaya, shiras'' and basti) leads to sudden loss to the life. Therefore these should be especially protected against external injury and ''vatadi ~~doshas~~''.

+

*Injury to these three ''marmas'' (''hridaya, shiras'' and basti) leads to sudden loss to the life. Therefore these should be especially protected against external injury and ''vatadi [[dosha]]s''.

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*''Vata'' is the prime factor or cause for the aggravation of ''pitta'' and ''kapha'' and also it is the cause of ''prana'' (life) and is best managed by ''basti''.

+

*''[[Vata]]'' is the prime factor or cause for the aggravation of ''[[pitta]]'' and ''[[kapha]]'' and also it is the cause of ''prana'' (life) and is best managed by ''[[basti]]''.

−

*''Prana'' (life) is situated at ''hridaya'' (heart), ''murdhna'' (head) and ''basti'' (bladder and urinary system). Hence attempts should be made to maintain ''paripalana'' (maintain normalcy) them. ''Abadhavarjana'' (avoidance of factors that cause affliction to ''marmas''), ''svasthavrittanuvartana'' (following the healthy regimen), ''utpannarti vighata'' (management of the existing conditions) ensures maintenance of ''marmas'' (''marma paripalana'').

+

*''Prana'' (life) is situated at ''hridaya'' (heart), ''murdhna'' (head) and ''[[basti]]'' (bladder and urinary system). Hence attempts should be made to maintain ''paripalana'' (maintain normalcy) them. ''Abadhavarjana'' (avoidance of factors that cause affliction to ''marmas''), ''svasthavrittanuvartana'' (following the healthy regimen), ''utpannarti vighata'' (management of the existing conditions) ensures maintenance of ''marmas'' (''marma paripalana'').

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*''Apatantraka'' (opisthotomus) disease is caused by ''kapha-vata'' dominance and it shall be managed by ''kapha-vata'' pacifying measures including ''tikshna pradhamana nasya'' (powder blowing into nostrils). Strong purification enemas are contraindicated in the treatment of ''apatantraka''.

+

*''Apatantraka'' (opisthotomus) disease is caused by ''[[kapha]]-[[vata]]'' dominance and it shall be managed by ''[[kapha]]-[[vata]]'' pacifying measures including ''tikshna pradhamana [[nasya]]'' (powder blowing into nostrils). Strong purification enemas are contraindicated in the treatment of ''apatantraka''.

−

*''Tandra'' (drowsiness) is caused due to vitiation of ''vata'' and ''kapha dosha''. This condition should be managed by ''shodhana'' and ''shamana'' measures that are ''kaphahara, vyayama'' (exercise), ''raktamokshana'' (bloodletting) and intake of foods that are predominantly ''katu'' (pungent) and ''tikta'' (bitter).

+

*''Tandra'' (drowsiness) is caused due to vitiation of ''[[vata]]'' and ''[[kapha dosha]]''. This condition should be managed by ''[[shodhana]]'' and ''shamana'' measures that are ''kaphahara, [[vyayama]]'' (exercise), ''[[raktamokshana]]'' (bloodletting) and intake of foods that are predominantly ''katu'' (pungent) and ''tikta'' (bitter).

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*The urinary disorder occur mainly due to suppression of urine urge, vitiation of ''~~doshas~~'' in urine. These conditions should be treated based on dominance of ''dosha'' and by measures that relieve ''mutrakrichchra'' (dysuria), ''basti'' ( per rectal enemas) and ''uttara basti'' (per urethral enemas).

+

*The urinary disorder occur mainly due to suppression of urine urge, vitiation of ''[[dosha]]s'' in urine. These conditions should be treated based on dominance of ''[[dosha]]'' and by measures that relieve ''mutrakrichchra'' (dysuria), ''[[basti]]'' ( per rectal enemas) and ''uttara basti'' (per urethral enemas).

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*Improper diet and lifestyle habits are causative factors for various types of headaches. The ''~~doshas~~'' with ''rakta'' are involved in the etio-pathology of head diseases.

+

*Improper diet and lifestyle habits are causative factors for various types of headaches. The ''[[dosha]]s'' with ''[[rakta]]'' are involved in the etio-pathology of head diseases.

−

*Administration of four ''snehas'' (''taila, ghrita, vasa'' and ''majja'') in the maximum dose, ''~~Kayavirechana~~'' (purgation), ''shirovirechana'' (purificatory errhines), ''nadisweda'' ( fomentation), 10 year old ghee, oil enemas, poultices, ''shirobasti'', cautery are advocated in the management of head diseases.

+

*Administration of four ''snehas'' (''taila, ghrita, vasa'' and ''majja'') in the maximum dose, ''Kaya[[virechana]]'' (purgation), ''shirovirechana'' (purificatory errhines), ''nadisweda'' ( fomentation), 10 year old ghee, oil enemas, poultices, ''shirobasti'', cautery are advocated in the management of head diseases.

−

*The disorders of head and organs in the supra-clavicular region can be managed by ''nasya karma'' (errhines). Nasal drug administration is the gateway of head, the medicines administered thereby pervade into the head and cures diseases pertaining to the head.

+

*The disorders of head and organs in the supra-clavicular region can be managed by ''[[nasya]] karma'' (errhines). Nasal drug administration is the gateway of head, the medicines administered thereby pervade into the head and cures diseases pertaining to the head.

−

*In ''kapha'' dominant diseases of head with obstructive pathology, ''nasya'' (nasal errhines) of purificatory type are advised.

+

*In ''[[kapha]]'' dominant diseases of head with obstructive pathology, ''[[nasya]]'' (nasal errhines) of purificatory type are advised.

−

*In ''vata'' dominant diseases of head with degenerative pathology, ''nasya'' (nasal errhines) of nourishing type are advised.

+

*In ''[[vata]]'' dominant diseases of head with degenerative pathology, ''[[nasya]]'' (nasal errhines) of nourishing type are advised.

−

*In ''pitta'' dominant diseases of head with hemorrhagic pathology, ''nasya'' (nasal errhines) of palliative type are advised.

+

*In ''[[pitta]]'' dominant diseases of head with hemorrhagic pathology, ''[[nasya]]'' (nasal errhines) of palliative type are advised.

== Vidhi Vimarsha (Applied Inferences ) ==

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

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

+

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

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

+

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

''Hridaya'' when gets affected, is managed by juices which are ''amla'' (sour) in taste ,as it is best among ''hridya dravyas''.

−

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

+

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

−

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

+

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

−

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

+

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

−

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

+

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

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

+

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

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

+

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

−

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

+

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

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

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

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

+

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

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

−

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

+

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

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

−

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

+

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

−

The drugs having ''mutrala'' (mutravirecaneeya and mutravirajaneeya) actions are all useful in the above mentioned ''mutradoshas''. The ''mutravirajaneeya, mutravirechaneeya gana dravyas''~~(Ca~~.Su.4/15) are very helpful.

+

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

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

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

−

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

+

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

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

−

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

+

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

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

−

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

+

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

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

−

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

+

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

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

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

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

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It is uncontroversial that nose is the gateway of head as all the authors of ''brihattrayis'' and ''laghutrayis'' have shared the importance of ''[[nasya]]karma'' in ''shirorogas''.

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

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

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

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

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

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

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~~=== Glossary ===~~

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~~#Marmas- Special sites where prana is situated and are said to be areas of confluence of mamsa, sira, snayu, asthi, sandhi etc.~~

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~~#Skandha- The point of attachment of upper limb to the body or which supports the upper limb. Refers to the shoulder~~

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~~#Shakha- The extremities ie upper and lower limbs~~

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~~#Dhamani-The channels or hollow tubular structures carrying the substances to body tissues(dhatus)characterized by pressure flow or pulsations~~

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~~#Basti- Which is a shelter for something. Here refers to urinary bladder that holds Urine~~

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~~#Sthula guda-The greater, dilated part of terminal large intestine. Here refers to the rectum~~

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~~#Mushka-Also called phalakosha refers to the Scrotum~~

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~~#Sevani- It is the sutures or embryological line of fusion. Here applies to perineal raphe~~

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~~#Kasa-Cough~~

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~~#Swasa- Breathlessness or difficulty in breathing~~

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#Klomakarshana- Kloma being an unclear organ from modern anatomical point of view, here considered chest, more specifically retrosternal area wherein patient feels a sense of stretchingpain or discomfort

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~~#Jihvanirgama- outward fall of tongue~~

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~~#Apasmara- a clinical condition characterised by convulsions and loss of memory to the time of events~~

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~~#Unmada- a clinical condition characterized by abnormal psychological events and behavioral patterns~~

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~~#Cittanasa- loss of mental alertness~~

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~~#Manyastambha- stiffness in anterior or antero lateral part of neck~~

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~~#Ardita- a clinical disease characterized by loss of movement on one half side of body with involvement of face(crossed hemiplegia)~~

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~~#Cakshuvibhrama- loss of movement of eyes~~

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~~#Udveshtana- twisting type of pain~~

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~~#Ceshtanasa- loss of movement~~

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~~#Hanugraha- stiffness of jaw~~

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~~#Muka- loss of speech or dumb~~

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~~#Gadgada- voice is hoarse~~

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~~#Akshinimilana- stooping of eyelids~~

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~~#Gandaspandana- twitching in cheek~~

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~~#Svarahani- partial loss of speech or feeble voice~~

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~~#Vadana Jihmatva- deviation of face~~

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~~#Vankshana- the lower part of trunk related to lower limbs; may be considered as groin~~

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~~#Kundala- twisted~~

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~~#Udavarta- upward movement or movement in opposite direction~~

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~~#Gulma- a clinical condition characterized by feeling of a compact mass in abdomen~~

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~~#Asthila- stone like swelling or mass~~

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~~#Upanaha- a form of fomentation with application of warm medications followed by covering~~

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~~#Avapidana- a form of nasya wherein expressed juice is instilled into nostrils~~

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~~#Kumbhisveda- a form of sweda wherein a pit is dug which is wider at its bottom than opening and the patient made to lie on it~~

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~~#Varti prayoga- instillation of suppository(in this context urethral suppository)~~

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~~#NiruhaBasti- decoction enemas~~

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~~#Abadhavarjana- avoidance of trauma~~

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~~#Svasthavrittanuvartana- following the rules of healthy regimen~~

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~~#Utpannarti Vighata- eliminating the disorders that have already occurred~~

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~~#Akshipet- frequent involuntary jerks towards the body~~

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~~#Apatantraka- a clinical condition characterized by falling to ground with involuntary jerks~~

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~~#Apatanaka- a clinical condition characterized by falling to the ground~~

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~~#Pradhamana- a form of nasya wherin fine medicinal powders are blown into nostril~~

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~~#Tandra- a clinical condition characterized by a state of sleepiness and excessive yawning~~

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~~#Raktamokshana- bloodletting for therapeutic purpose~~

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~~#Mutraukasada- a clinical condition characterised by burning and discoloration of urine~~

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~~#Mutrajathara- a clinical condition characterised by retention of urine~~

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~~#Mutrakrcchra- a clinical condition characterised by discomfort in passing urine especiallydue to withholding urge to urinate and indulging in sexual intercourse~~

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~~#Mutrotsanga- a clinical condition characterised by split flow of urine and retention in penis resulting in engorged penis~~

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~~#Mutrasamkshaya- a clinical condition characterised by reduced urine due to aggravated Vata~~

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~~#Mutratita- a clinical condition characterised by physiological bladder atony due to withholding the urge to micturate for long~~

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~~#Mutrashthila- a clinical condition characterised by firm distension of bladder resembling a stone~~

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~~#Vatabasti- a clinical condition characterised by retention of urine due to withholding the urge~~

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~~#Ushnavata- a clinical condition characterised by increased Ushnata in Mutra~~

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~~#Vatakundalika - a clinical condition characterised byaggravation of Vata which becomes Kundalibhoota~~

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~~#Mutragranthi- a clinical condition characterised by formation of Granthi in Mutramarga that obstructs the flow of urine~~

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~~#Vidvighata- a clinical condition characterised by Vimargagamana of Shakrut into Mutramarga~~

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~~#Bastikundala- a clinical condition characterized by upward distention of bladder with retention and obstructed flow~~

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~~#Vicchinna- split(in the flow of urine)~~

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~~#Ucchesha- a state of residual urine~~

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~~#Guru Shepha- engorged penis due to retention of urine in urethra~~

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~~#Adhmana- a clinical condition characterized by distension of abdomen with pain and gurgling sounds~~

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~~#Vyaviddha- abnormal movement or curved or zig zag movement~~

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~~#Veshtana- twisting pain~~

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~~#Hrnmoha- a state of mind being blanked out~~

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~~#Uttarabasti- enemas given trough the anterior route i.e., per urethral or into uterus~~

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~~#Mutravirajaneeya- set of drugs that color the urine or restore the normal color of urine~~

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~~#Mutravirecaneeya- set of drugs that increase the urine output~~

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~~#Pushpanetra- the enema nozzle used for uttarabasti~~

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~~#Pratyakhyeya- diseases that cannot be cured or even controlled~~

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~~#Ardhavabhedaka- a clinical disease characterized by pain on one half of head~~

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~~#Suryavarta- a clinical condition characterized by headache increasing with the rising sun~~

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~~#Anantavata- a clinical condition characterized by severe headache of a wide distribution imcluding the neck~~

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~~#Raktapitta- a clinical condition characterized by vitiation of rakta with pitta causing unprovoked bleeding~~

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~~#Pratimarsha- the milder form of snehanasya which can be done daily~~

=== Related Chapters ===

Line 1,672: Line 1,607:

* [[Trimarmiya Chikitsa]]

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