Changes

evaM tadrecanaM karma tarpaNaM shamanaM tridhA||92||

evaM tadrecanaM karma tarpaNaM shamanaM tridhA||92||

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

स्तम्भसुप्तिगुरुत्वाद्याः श्लैष्मिका ये शिरोगदाः|  

स्तम्भसुप्तिगुरुत्वाद्याः श्लैष्मिका ये शिरोगदाः|  

शिरोविरेचनं तेषु नस्तःकर्म प्रशस्यते||९३||  

शिरोविरेचनं तेषु नस्तःकर्म प्रशस्यते||९३||  

sAdhayitvA bhiShak snehaM nastaH kuryAdvidhAnavit|98|

sAdhayitvA bhiShak snehaM nastaH kuryAdvidhAnavit|98|

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

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

Procedure of nasya therapy:

 

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

 

प्राक्सूर्ये मध्यसूर्ये वा प्राक्कृतावश्यकस्य च||९८||  

प्राक्सूर्ये मध्यसूर्ये वा प्राक्कृतावश्यकस्य च||९८||  

उत्तानस्य शयानस्य शयने स्वास्तृते सुखम्|  

उत्तानस्य शयानस्य शयने स्वास्तृते सुखम्|  

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

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

Tarpana sneha nasya should be administered into the nostrils of a patient in the early morning or 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 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)

Dhumapana (medicated smoking) and post nasya therapy:

 

स्वेदेनोत्क्लेशितः श्लेष्मा नस्तःकर्मण्युपस्थितः  ||१०४||  

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

 

स्वेदेनोत्क्लेशितः श्लेष्मा नस्तःकर्मण्युपस्थितः  ||१०४||  

भूयः स्नेहस्य शैत्येन शिरसि स्त्यायते  ततः|  

भूयः स्नेहस्य शैत्येन शिरसि स्त्यायते  ततः|  

श्रोत्रमन्यागलाद्येषु विकाराय स कल्पते||१०५||  

श्रोत्रमन्यागलाद्येषु विकाराय स कल्पते||१०५||  

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 doshas, and then made to reside in a breezeless place by vigilant physician. One who is purified off the doshas if indulges in factors which cause dosha aggravation, the doshas getting provoked move about in the body producing many diseases due to them. In these the wise physician should carry out treatments as mentioned and as appropriate for diseases arising due to untimely administration of errhine therapy. (104-110)

      

      

The treatment of vitiated doshas after nasya:

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

 

अजीर्णे भोजने भुक्ते तोये पीतेऽथ दुर्दिने|  

अजीर्णे भोजने भुक्ते तोये पीतेऽथ दुर्दिने|  

प्रतिश्याये नवे स्नाते  स्नेहपानेऽनुवासने||१११||  

प्रतिश्याये नवे स्नाते  स्नेहपानेऽनुवासने||१११||  

jvarashokAtitaptAnAM timiraM madyapasya tu|  

jvarashokAtitaptAnAM timiraM madyapasya tu|  

rUkShaiH shItA~jjanairlepaiH puTapAkaishca sAdhayet ||115||

rUkShaiH shItA~jjanairlepaiH puTapAkaishca sAdhayet ||115||

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

 

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, preganant, 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, preganant, 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)

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

Types of navana (unctuous errhines):

 

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

 

स्नेहनं शोधनं चैव द्विविधं नावनं मतम्|  

स्नेहनं शोधनं चैव द्विविधं नावनं मतम्|  

प्रतिमर्शस्तु नस्यार्थं करोति न च दोषावान्||११६||  

प्रतिमर्शस्तु नस्यार्थं करोति न च दोषावान्||११६||  

na cocchi~gghedarogANAM pratimarshaH sa dArDhyakRut||117||

na cocchi~gghedarogANAM pratimarshaH sa dArDhyakRut||117||

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

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

Summary:

 

==== Summary ====

 

तत्र श्लोकौ-  

तत्र श्लोकौ-  

त्रीणि यस्मात् प्रधानानि मर्माण्यभिहतेषु च|  

त्रीणि यस्मात् प्रधानानि मर्माण्यभिहतेषु च|  

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

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

Tattva Vimarsha

=== Tattva Vimarsha ===

 

• Marmas are the vital junctions and organs in the body.  

• Marmas are the vital junctions and organs in the body.  

• Marmas are the site of chetana (vital power of life). Therefore, their diseases/injuries are more severe and need immediate attention in treatment.  

• Marmas are the site of chetana (vital power of life). Therefore, their diseases/injuries are more severe and need immediate attention in treatment.  

• 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

=== ''Vidhi Vimarsha'' ===

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

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

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

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

The 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 varities of prameha and the latter includes two categories of disorders – 8 types of mutrakrcchra (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.  

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 varities of prameha and the latter includes two categories of disorders – 8 types of mutrakrcchra (dysuria) and 12 types mutraghata (urinary disorders), though both the set of disorders are described under the title mutraghata. Under mutraghata, bastikundala (circular distension of bladder) is not described.  

In general terms though we find that mutraghata is described as condition with suppression or less production of urine and mutrakricchra as dysuria, not all conditions described under mutraghata are characterized by oliguria or reduced output. Most of the conditions seem to occur predominantly by retention of urine or bladder distension. Mutrasaada, mutraukasaada and ushnavata may be considered as scanty urination or oliguria; Mutrakshaya may be equated to oliguria or anuria. Mutrakricchra is a condition of dysuria due to spermorrhoea. Others like Vatabasti, Mutratita, Mutrajathara seem to occur due to voluntary withholding of the urge of micturition resulting in physiological bladder atony as in mutratita or retention with pain as in vatabasti and atonied distended bladder in mutrajathara all progressive conditions of the same pathological process. Bastikundala also seems to be a condition of bladder atony but with superadded cystitis due to severe physical stress and states of dehydration. In vatashthila and mutragranthi there seems to be an obvious anatomical growth which causes obstruction to the urine pathway which may be considered as prostatomegaly and vesical tumors respectively. The condition of vatakundalika, though from the Nidana seems to be similar to the conditions of withholding the urge of urination, due to the symptoms seems more or less like urethral stricture. Mutrotsanga seems to be a condition of acute urethritis or cystitis where there is stranguary, dysuria, hesitancy and sometimes blood in urine. Mutrakshaya more or less seems like anuria or oliguria due to dehydration. Vidvighata clearly seems a case of recto vesical or rectourethral fistula.   

 

In general terms though we find that mutraghata is described as condition with suppression or less production of urine and mutrakricchra as dysuria, not all conditions described under mutraghata are characterized by oliguria or reduced output. Most of the conditions seem to occur predominantly by retention of urine or bladder distension. Mutrasaada, mutraukasaada and ushnavata may be considered as scanty urination or oliguria; Mutrakshaya may be equated to oliguria or anuria. Mutrakricchra is a condition of dysuria due to spermorrhoea. Others like Vatabasti, Mutratita, Mutrajathara seem to occur due to voluntary withholding of the urge of micturition resulting in physiological bladder atony as in mutratita or retention with pain as in vatabasti and atonied distended bladder in mutrajathara all progressive conditions of the same pathological process. Bastikundala also seems to be a condition of bladder atony but with superadded cystitis due to severe physical stress and states of dehydration. In vatashthila and mutragranthi there seems to be an obvious anatomical growth which causes obstruction to the urine pathway which may be considered as prostatomegaly and vesical tumors respectively. The condition of vatakundalika, though from the Nidana seems to be similar to the conditions of withholding the urge of urination, due to the symptoms seems more or less like urethral stricture. Mutrotsanga seems to be a condition of acute urethritis or cystitis where there is stranguary, dysuria, hesitancy and sometimes blood in urine. Mutrakshaya more or less seems like anuria or oliguria due to dehydration. Vidvighata clearly seems a case of recto vesical or rectourethral fistula.   

Susruta describes pittaja and kaphaja types of mutraukasada (dense urine) as two different conditions. In pittaja mutraukasada he describes that on drying, the urine resembles gorocana 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).  

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 gorocana churna (powder of a stone or 'bezoar' found in cattle) and in case of kaphaja variety, on drying the urine becomes like shankha churna (powder of conch shell).  

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

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.

The role of basti chikitsa and specifically uttarabasti in the management of apana vata vikrti 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 vikrti 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, mutravirecaneeya 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, mutravirecaneeya gana dravyas(Ca.Su.4/15 ) are very helpful.   

The descriptions of the procedure with materials or equipments 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.

The descriptions of the procedure with materials or equipments 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.

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 the os is naturally open to shed the endometrium which almost closes by the period of ovulation. Further, not only do the medicaments enter the uterus with ease but also it acts at a time ideal for it to receive the sperms as well as provides a condusive environment for implantation of fertilized ovum maximizing the chances to conceive.

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 the os is naturally open to shed the endometrium which almost closes by the period of ovulation. Further, not only do the medicaments enter the uterus with ease but also it acts at a time ideal for it to receive the sperms as well as provides a condusive 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 Carakacarya 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 raktadhatu in diseases of shirah is appreciated by Carakacarya 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.

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.

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.

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.

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 are described.

In Ashtanga Hridaya, ten specific timings  suitable for administration of pratimarsha are 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.  

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.  

Glossary of terms used in the chapter

 

=== Glossary ===

 

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

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

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

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