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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]

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

 

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

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

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

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

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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.

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

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

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

 

=== Description of three vital organs ===

=== Description of three vital organs ===

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

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), ''mahabhutas'' (5 fundamental elements) just like spokes to the axle in the center of a wheel.  

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.  

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]

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]

 

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

=== 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||

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 ''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.

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

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

 

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

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

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

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

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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]

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]

 

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

=== 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||

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''.

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''.

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

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

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

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

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Thereby concluding the ''Slokha''-

Thereby concluding the ''Slokha''-