Charaka Siddhisthana Chapter 9 Tri Marmiya Siddhi

This article explains the 9th chapter of siddhisthana of Charaka samhita called 'Trimarmeeya Siddhi Adhyaya'. In this chapter, treatment of diseases affecting three vital organs have been explained.

Table of Contents

PrologueDialogueHeart, head and urinary bladderInjury to vital organsAilments caused by injury to vital organsInvolvement of vata in ailments of vital organsRecipes for treatment of ailments of vital organsSummary of the topicsDescription of additional diseases of vital organsApatantraka and apatanaka (convulsions)Treatment of apatantraka and apatanakaEtiology, pathogenesis, signs and treatment of TandraEnumeration of urinary diseasesPathology, signs and treatment of mutraukasadaEtiology, signs and treatment of mutra -jatharaEtiology of mutra krichraEtiology and signs of mutra-utsangaEtiology and signs of mutra sanksayaEtiology and signs of mutratitaEtiology and signs of vatasthilaEtiology and signs of vata- bastiEtiology and signs of usna-vataEtiology and signs of vata- kundalikaEtiology and signs of rakta-granthi - tumor, fibroidEtiology and signs of vid-vighataLine of treatment of urinary morbiditiesNetra (nozzle or catheter)Dose of recipe for doucheMethods of administering urethral doucheRetention of douche-fluidUrethral douche for womenNozzles of Utrara-Basti for FemalesMethod of administering Uttara-Basti to FemalesDiseases of HeadSankhakaEtiology, Signs and Treatment of Ardhavadhedaka (Hemicrania)Etiology, signs and Treatment of SuryavartaEtiology, signs and symptoms of AnantavataEtiology, signs and treatment of Sirah-kampaImportance of inhalation therapyVarieties of Inhalation TherapyInhalation therapy for different ailmentsDrugs for Virechana and Tarpana NasyaMethods of administering Avapida NasyaPradhaman Type of Inhalation therapyComplications caused by Vayu, treatmentTimira and its treatmentPratimarsa type of inhalation therapy

Prologue

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athatastrimarmiyam siddhim vyakhyasyamah||1|| iti ha smaha bhagavanatreyah||2||

Now, we shall expound the chapter dealing with "perfection in the treatment of diseases affecting three vital organs.
Thus said lord Atreya. [1-2]

Dialogue

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???? ?????????????? ???????? ??????????????? ????????, ??????? ??????????????; ???????????????????? ????????????????, ???????????????????||?||
saptottaram marmasatamasmincharire skandhasakhasamasritamagnivesa!| tesamanyatamapidayam samadhika pida bhavati, cetananibandhavaisesyat|
tatra sakhasritebhyo marmabhyah skandhasritani gariyamsi, sakhanam tadasritatvat; skandhasritebhyo'pi hrdvastisiramsi, tanmulatvaccharirasya||3||

Oh! Agnivesha, (addressed by Guru Atreya), there are one hundred and seven vital spots (marmas) located in the trunk and limbs of the body. Affliction of any one of these produces excruciating pain because of the specific association of consciousness in these parts.

Amongst these vital spots, the ones located in the Sakhas (limbs) are important because these limbs are dependent upon the trunk.

Amongst vital organs in the trunk, the ones located in the heart, urinary bladder and head are the most important because these organs constitute every basic substratum of the body. [3]

Heart, head and urinary bladder

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tatra hrdayedasa dhamanyah pranapanaumano buddhiscetana mahabhutani ca nabhyamara iva pratisthitani, sirasi indriyani indriyapranavahani ca srotamsi suryamiva gabhastayah samsritani, bastistu sthulagudamuskasevanisukramutravahininam nadi(li)nam madhye mutradharo'mbuvahanam sarvasrotasamudadhirivapaganam pratistha , bahubhisca tanmulairmarmasanjnakaih srotobhirgaganamiva dinakarakarairvyaptamidam sariram||4||

As the spokes of a wheel are attached to the centre (Nabhi), similarly the ten vessels, Prana-vayu, Apana-vayu, Manas (mind), Buddhi (wisdom), consciousness and Mahabhutas are attached to (associated with) the heart.

Head is the abode of senses, sensory channels and Pranavaha srotas as the sun is the abode of its rays.

Just as all the rivers on the earth flow into the ocean, the urinary bladder, located in the midst of sthula-guda (rectum), muska (testicles), sevani (perennial sutures) and seminal vessels as well as urinary channels, is the receptacle of urine into which all the channels of the body carrying liquid elements converge.

From the base of these three, viz., heart, head and urinary bladder, which are called Marmas (vital organs), the entire body is pervaded with channels (Srotas) just like the entire sky is pervaded with the rays of the sun. [4]

Injury to vital organs

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tesam trayanamanyatamasyapi bhedadasveva sarirabhedah syat, asrayanasadasritasyapi vinasah; tadupaghatattu ghorataravyadhipradurbhavah; tasmadetani visesena raksyani bahyabhighadvatadibhyasca||5||

Serious injury to any one of these vital organs (heart, head and urinary bladder) causes destruction of the body since the destruction of the substratum leads to the destruction of the superstructure. Partial injury to vital organs leads to affliction by serious diseases. Therefore, these three vital organs are specially protected from external injury and afflictions by vata etc. [5]

Ailments caused by injury to vital organs

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tatra hrdyabhihate kasasvasabalaksayakanthasosaklomakarsanajihvanirgamamukhatalusosapasmaronmadapralapacittanasadayah syuh; sirasyabhihate manyastambharditacaksurvibhramamohodvestanacestanasakasasvasahanugrahamukagadgadatvaksinimilana- gandaspandanajrmbhanalalasravasvarahanivadanajihmatvadini, bastau tu vatamutravarconigrahavanksanamehanabastisulakundalodavartagulmanilasthilopastambhanabhikuksigudasronigrahadayah ; vatadyupasrstanam tvesam lingani cikitsite sakriyavidhinyuktani||6||

Injury to the heart gives rise to cough, asthma, loss of strength, dryness of throat, klomakarsana (pain as if there is stretching of the Kloman or lungs), protraction of the tongue, dryness of mouth as well as palate, epilepsy, insanity, delirium, unconsciousness etc.,

Injury to the head gives rise to
Manyastambha (torticollis),
Ardita (facial paralysis),
Caksu vibhrama (agitation of eyes),
Moha (unconsciousness),
Udvestana (cramps),
cesta -nasa (loss of motor activities), Cough, Asthma,
Hanugraha (lock-jaw),
Mukatva (dumbness),
gadgadatva (lulling speech),
aksi-nimilana (closure of the eye-lids),
Ganda-spandana (twitching of cheeks),
Jrmbhana (yawning),
Lala srava (excessive salivation),
Svara hani (aphasia),
asana-jihmatva (twisting of the face), etc.

Injury to the urinary bladder gives rise to retention of flatus, urine as well as faeces, pain in the groin, phallus as well as urinary bladder, Kundala (spiraling spasm in the bladder), Udavarta (upward movement of wind in the abdomen), gulma (phantom tumour), Vatasthila (hard tumour caused by vayu), Upastambha (spasticity of the bladder), stiffness of umbilicus, pelvis, anus as well as hips etc.

The signs, symptoms and treatment of different varieties of the above-mentioned ailments caused by the affliction of vital organs by vayu, etc., are already described in (the twenty sixth chapter of) chikitsa-section.

Involvement of vata in ailments of vital organs

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kintvetani visesato'niladraksyani, anilo hi pittakaphasamudirane hetuh pranamulam ca, sa bastikarmasadhyatamah, tasmanna bastisamam kincit karma marmaparipalanamasti| tatra sadasthapanaskandhan vimane dvau canuvasanaskandhaviha ca vihitan bastin buddhya vicarya mahamarmaparipalanartham prayojayedvatavyadhicikitsam ca||7||

These marmas (vital organs, viz, heart, head and urinary bladder) are to be protected from aggravated vata because, it is this aggravated vata which is responsible for the excitation (aggravation) of pitta and kapha, and the Prana is dependent upon its vata. This vata is best treated by basti treatment. Therefore, there is none other than basti therapy which can safeguard the vital organs.

Therefore, after intelligent consideration, basti recipes prepared of six groups of drugs for niruha (vide Charaka Vimana 8: 139-144), two groups of drugs for anuvasana (vide vimana 8:150) and therapeutic measures prescribed for the treatment of vata-vyadhi (diseases caused by aggravated vayu- as described in 28th chapter of Charaka chikitsa sthana) is employed to protect these vital organs. [7]

Recipes for treatment of ailments of vital organs

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bhuyasca hrdyupasrste hingucurnam lavananamanyatamacurnasamyuktam matulungasya rasenanyena va'mlena hrdyena va payayet, sthiradipancamulirasah sasarkarah panartham, bilvadipancamularasasiddha ca yavaguh, hrdrogavihitam ca karma; murdhni tu vatopasrste'bhyangasvedanopanahasnehapananastahkarmavapidanadhumadini; bastau tu kumbhisvedah, vartayah, syamadibhirgomutrasiddho niruhah, bilvadibhisca surasiddhah, sarakaseksudarbhagoksurakamulasrtaksiraisca trapusairvarukharasvabijayavarsabhakavrddhikalkito niruhah, pitadarusiddhatailenanuvasanam, tailvakam ca sarpirvirekartham, satavarigoksurakabrhatikantakarikaguducipunarnavosiramadhukadvisarivalodhrasreyasikusakasamulakasayaksiracaturgunam balavrsarsabhakakharasvopakuncikavatsakatrapusairvarubijasitivarakamadhukavacasatapuspasmabhedakavarsabhumadanaphalakalkasiddham tailamuttarabastirniruho va suddhasnigdhasvinnasya bastisulamutravikarahara iti||8||

If the heart gets afflicted by vata Dosha, then [in addition to basti] the following measures are employed:
The patient should drink the juice of matulunga or any other sour drink which is pleasing to the heart by adding the powder of hingu and any of the salts;

Decoction of ksudra pancamula (salaparni, prsniparni, brhati, kantakari and goksura) added with sugar may also be used as a drink.

He may take yavagu (thick gruel) prepared with the decoction of bilva, syonaka, gambhari, patala and ganikarika.

He may give other therapeutic measures prescribed for the treatment of heart diseases (vide chikitsa 2-81-103).

Vata Upasrushta Murdhni - If the head is afflicted by vata, then [in addition to basti], the following therapeutic measures are employed:

Abhyanga - Massage
Svedana - Fomentation
Upanaha - Application of hot poultices
Snehapana - Unctuous potions
Nasya - Inhalation therapy
Avapida (administration of medical powders through the nostrils by applying pressure) and
Dhumapana - Smoking and such other therapies

If the urinary bladder is afflicted by vayu, then the following therapeutic measures are employed:
Kumbhi-sveda (types of fomentation therapy vide Charaka sutrasthana 14:5-58)
Vartis (medicated suppositaries)
Niruha type of enema prepared of cow's urine boiled with shyama, etc., (shyama, trivrt, chaturangula, tilvaka, maha-vrksa, saptala, sankhini, danti and dravanti- vide vimana 8:136)

Niruha basti prepared of alcohol boiled with bilva etc., (bilva, syonaka, gambhari, patala, ganikarika) or root of bilva, trivrt, devadaru, yava, kola and kulattha (vide siddhi 7:11)

NNiruha basti containing milk boiled with the root of sara, kasa, iksu, darbha and goksura, and added with the paste of trapusa, ervaruka, seeds of kharasva (ajamoda), yava, rsabhaka and vrddhi.

Anuvasana basti with the oil cooked with pittadaru (daruharidra; some physician interpret this term "pitta-daru-siddha-tailena" as extracted from the heartwood of sarala);

Purgation with tilvaka sarpis (vide Charaka kalpasthana 9:14-15)

Uttarabasti or niruha with the medicated oil cooked by adding the following:

Decoction of shatavari, goksuraka, brhati, kantakarika, guduchi, punarnava, usira, madhuka, two varieties of sariva (anantamula and shyama) lodhra, sreyasti (rasna) and roots of kusa as well as kasa.

The above mentioned decoction and four times of milk and paste of bala, vrsa (vasaka), rasabhaka, kharasva (ajamoda), upakuncika (krsana-jiraka), vatsaka, seeds of trapusa as well as ervaruka, sitivaraka (salinaca), madhuka, vaca, satapuspa, asmabhedaka, (pasanabheda), varsabhu and madana phala and after the patient has been subjected to purgation, oleation and fomentation therapies, niruha basti is given for the cure of pain in the bladder and urinary disorders. [8]

Summary of the topics

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bhavanti catra slokah-
hrdaye murdhni bastau ca nrnam pranah pratisthitah| tasmattesam sada yatnam kurvita paripalane||9||
abadhavarjanam nityam svasthavrttanuvartanam| utpannartivighatasca marmanam paripalanam||10||

Thus, it is said:
Prana of human beings are located in the heart, head and urinary bladder. Therefore, efforts should always be made to protect these vital organs.
The measures to be taken for or the protection of these vital organs (heart, head and urinary bladder) are as follows:
Avoidance of the cause of injury to those organs

Constantly following the rules and regimens for svastha-vrtta (maintenance of positive health and prevention of diseases) and

Prompt treatment of the diseases of these vital organs immediately after their onset. [9]

Description of additional diseases of vital organs

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ata urdhvam vikara ye trimarmiye cikitsite| na prokta marmajastesam kamscidvaksyami sausadhan||11||

Hereafter, I (Guru Atreya) shall describe some diseases along with their treatment, originating from these vital organs which were left out in the twenty sixth chapter of Charaka Chikitsa Sthana [11]

Apatantraka and apatanaka (convulsions)

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kruddhah svaih kopanairvayuh sthanadurdhvam prapadyate| pidayan hrdayam gatva sirah sankhau ca pidayan||12||
dhanurvannamayedgatranyaksipenmohayettatha| (namayeccaksipeccanganyucchvasam nirunaddhi ca)|
krcchrena capyucchvasiti stabdhakso'tha nimilakah ||13||
kapota iva kujecca nihsanjnah so'patantrakah| drstim samstambhya sanjnam ca hatva kanthena kujati||14||
hrdi mukte narah svasthyam yati moham vrte punah| vayuna darunam prahureke tamapatanakam||15||

There are specific factors for the aggravation of vata. Being provoked by these factors, it spreads upwards from its natural habitat to affect the heart. From there, it moves further upwards to the head, and afflicts the two temples (sankha). As a result of this, it bends the limbs [of the body] like a bow, causes convulsions and fainting [after causing bending and convulsions, it obstructs the expiration] eyes remain either fixed or closed. He breathes like the cooing of a pigeon, and becomes unconscious. This aliment is called apatantraka.

This aggravated vayu, after keeping the eyes fixed and causing unconsciousness, makes the patient moan with a cooing sound coming out of the throat. After the affliction of the heart by this vata is relieved, the patient's normal health is restored. If the affliction of the heart by this aggravated vata takes place again, then the patient becomes unconscious again. Some physicians call this serious ailment caused by the [exceedingly] aggravated vata (with aggravated kapha) as apatanaka. [12-15]
Read: Vata Disorders (Vatavyadhi): Definition, Causes, Symptoms

Treatment of apatantraka and apatanaka

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svasanam kaphavatabhyam ruddham tasya vimoksayet| tiksnaih pradhamanaih sanjnam tasu muktasu vindati||16||
maricam sigrubijani vidangam ca phanijjhakam| etani suksmacurnani dadyacchirsavirecanam||17||
tumburunyabhaya hingu pauskaram lavanatrayam| yavakvathambuna peyam hrdgrahe capatantrake ||18||
hingvamlavetasam sunthim sasauvarcaladadimam| pibedvatakaphaghnam ca karma hrdroganuddhitam||19||
sodhana bastayastiksna na hitastasya krtsnasah| sauvarcalabhayavyosaih siddham tasmai ghrtam hitam||20||

If the breath of the patient gets obstructed by kapha and vata, this obstruction is corrected, and he should be made capable of breathing freely by the administration of strong pradhamana nasya (powdered herbsare blown into the nostrils). After the obstruction to breath (in the channel carrying consciousness) is removed, then the patient gets back consciousness.

For Shiro virechana, fine powder of marica, seeds of sigru, vidanga and phanijihaka is used.

If there is hrd-graha (cardiac spasm) in apatantraka, then the patient is given the powder of tumburu, abhaya, hingu, puskaramula and three type of salt along with the decoction of yava (prepared according to the method prescribed for sadanga paniya - vide commentary on Charaka Samhita chikitsa sthana 3/145-147)

The patient suffering from cardiac spasm and apatantraka should take the decoction of hingu, amlavetasa, sunthi, sauvarcala and dadima.

Therapies which alleviate vata and kapha, and which are curative of heart diseases are useful in the treatment of apatantraka (including apatanaka).

Niruha basti of strong nature should not be given in full quantity (but can be given in small dose because in large doses they may provoke aggravated vayu).

For such patients (of apatantraka and apatanaka), medicated ghee prepared by cooking with sauvarcala, abhaya, sunthi, pippali and marica is useful. [16-20]

Etiology, pathogenesis, signs and treatment of Tandra

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madhurasnigdhagurvannasevanaccintanacchramat sokadvyadhyanusangacca vayunodiritah kaphah||21||
yada'sau samavaskandya hrdayam hrdayasrayan| samavrnoti jnanadimstada tandropajayate||22||
hrdaye vyakulibhavo vakcestendriyagauravam| manobuddhyaprasadasca tandraya laksanam matam||23||
kaphaghnam tatra kartavyam sodhanam samanani ca| vyayamo raktamoksasca bhojyam ca katutiktakam||24||

When the vata is provoked by the intake of sweet, unctuous and heavy food, fatigue and grief and by constant suffering from chronic diseases, incites kapha, then this kapha getting lodged in the heart occludes the jnana (knowledge) etc, located therein, giving rise to tandra (drowsiness).

The symptoms of tandra - When with kapha, the vitiated vata enters the hrdaya, the hrdaya gets disturbed, there would appear heaviness in the speech, body activities and sense organs, the pleasantness of the mind and intellect (consciousness) would disappear.

This ailment is treated with the following:
Therapies for the alleviation and elimination of kapha
Physical exercise
Bloodletting and
Food ingredients which are pungent and bitter in taste [21-24]

Enumeration of urinary diseases

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mutraukasado jatharam krcchramutsangasanksayau| mutratito'nilasthila vatabastyusnamarutau||25||
vatakundalika granthirvidghato bastikundalam| trayodasaite mutrasya dosasta?llingatah srnu||26||

The following are the thirteen urinary diseases:

Mutraukasada (passage of dense urine)Mutra-jathara (abdominal swelling because of urinary retention);Mutra-krcchra (dysuria)Mutra-utsanga (retention of residual urine in the bladder)Mutra-sanksaya (anuria)Mutratita (delayed urination)Vatasthila (stone like growth in the bladder because of aggravated vayu)Vata-basti (affliction of bladder by vayu)Usna-maruta (burning micturition)Vata-kudalika (spiral movement of vata in the bladder)Granthi (tumour)Vid-vighata (fecal fistula) andBasti-kundala (spiral distension of bladder)

The signs of the mentioned urinary disorders will be described hereafter which you (addressed by Guru Atreya to Agnivesha) may listen to. [25-26]
Read: Dysuria: Causes, Remedies, Tips, Diet, Ayurvedic Treatment

Pathology, signs and treatment of mutraukasada

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pittam kapho dvavapi va bastau samhanyate yada| marutena tada mutram raktam pitam ghanam srjet||27||
sadaham svetasandram va sarvairva laksanairyutam| mutraukasadam tam vidyat pittaslesmaharairjayet||28||

When, either vayu, pitta or kapha, or both pitta and kapha in the bladder get considered, then the patient voids urine which is either red or yellow, thick and associated with burning sensation. The urine may also be white and dense and may be associated with all the signs (relating to all the three Doshas).

This ailment is called mutraukasada, and it is treated with therapies for the alleviation of pitta and kapha. [27-28]

Etiology, signs and treatment of mutra -jathara

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vidharanat pratihatam vatodavartitam yada| purayatyudaram mutram tada tadanimittaruk||29||
apaktimutravitsangaistanmutrajatharam vadet| mutravairecanim tatra cikitsam samprayojayet||30||
hingudviruttaram curnam trimarmiye prakirtitam| hanyanmutrodaranahamadhmanam gudamedhrayoh||31||

When because of the suppression of urge for urination, the retarded flow of urine moves upwards, and fills up the abdominal cavity, then the patient suffers from the following:
Pain without any appreciable reason
Indigestion and
Retention of urine and stool
This condition is called mutra-jathara (abdominal swelling by urine).

The patient is treated with diuretics, Hingu dviruttara- churna (or dviruttara hingvadi churna) described in chikitsa 26-20 cures mutrodara (or mutra-jathara) constipation and distension of rectum as well as phallus. [29-31]
Read: Urinary Obstruction: Causes, Types, Symptoms, Ayurvedic Treatment

Etiology of mutra krichra

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mutritasya vyavayattu reto vatoddhatam cyutam| purvam mutrasya pascadva sravet krcchram taducyate||32||

If a person having the manifested urge for urination enters into sexual act, the semen excited by vata gets discharged from its location. It is ejaculated before or after the passage of urine which is painful, and it is called mutrakrichra . [32]

Etiology and signs of mutra-utsanga

???????????????????? ?????????????? ? ???????| ???????? ??????? ????????????????? ????????||??||
????????????? ? ????????????????????????? |
khavaigunyanilaksepaih kincinmutram ca tisthati| manisandhau sravet pascattadarugva'tha catiruk||33||
mutrotsangah sa vicchinnamucchesagurusephasah |

If the urinary tract (urethra) is vitiated, then because of the spasm caused by Vata, a part of the urine remains accumulated in the sphincter of glans penis. Subsequently the residual urine [flows out with interruptions] with either severe pain or without pain flows from the heavy phallus. This condition is called mutrotsanga (dribbling of the residual urine). [33 - 1/2 34]

Etiology and signs of mutra sanksaya

??????????????????????????? ??????? ????????||??||
vatakrtirbhavedvatanmutre susyati sanksayah||34||

If the urinary secretion gets dried up (becomes less in quantity) because of aggravated Vata, then signs and symptoms of vata are manifested, and this condition is called mutra-sanksaya (diminution of urine-flow) [34 1/2 ]

Etiology and signs of mutratita

???? ?????? ?????? ?????? ? ?????????| ????????? ????? ?? ?????????? ? ??????||??||
ciram dharayato mutram tvaraya na pravartate| mehamanasya mandam va mutratitah sa ucyate||35||

The person with the habit of holding up urination for a long time becomes incapable of passing urine immediately after the urge, and the flow of urine becomes slow, this condition is called mutratita (delayed urination). [35]

Etiology and signs of vatasthila

????????? ????????? ???????? ????????????????| ?????????????????????????? ??????????????????????||??||
adhmapayan bastigudam ruddhva vayuscalonnatam| kuryattivrartimasthilam mutravinmargarodhinim||36||

vatacausing obstruction in the bladder and rectum, and distension of these organs, produces hard tumour (asthila) which is mobile and elevated, which is exceedingly painful and which obstructs the urinary and fecal passages. This ailment is called vatasthila]
Read: Benign Prostatic Hyperplasia (BPH) In Ayurveda - Symptoms, Treatment

Etiology and signs of vata- basti

?????? ?????? ????? ????? ???????? ?????????| ??????????????????????????????? ? ??????||??||
mutram dharayato bastau vayuh kruddho vidharanat| mutrarodhartikandubhirvatabastih sa ucyate||37||

In the person who habitually suppresses the manifested urge for urination, vata gets aggravated because of obstruction thereby giving rise to retention of urine, pain and itching. This ailment is called vata- basti (affliction of bladder by vayu). [37]

Etiology and signs of usna-vata

?????? ??????? ?????? ?????? ??????????| ???????? ?????? ?????????????????????????????????||??||
usmana sosmakam mutram sosayan raktapitakam| usnavatah srjet krcchradbastyupasthartidahavan||38||

Vayu, in association with pitta, dries up the urine. It is associated with pitta, and thereafter, becomes red and yellow in colour, burning sensation in the bladder and phallus. This is called usna-vata (affliction of the bladder and phallus). This is called usna-vata (affliction of urine by vatain association with pitta) [38]

Etiology and signs of vata- kundalika

?????????????????? ? ??????????????????| ???????? ?????? ??????????????????????????||??||
?????? ??????? ????????????????????????| ??????????????????????????????????????? ??||??||
gatisangadudavrttah sa mutrasthanamargayoh| mutrasya viguno vayurbhagnavyaviddhakundali||39||
mutram vihanti samstambhabhangagauravavestanaih| tivrarunmutravitsangairvatakundaliketi sa||40||

Because of the obstruction in the urinary passage, the vitiated vatamoves upwards, and afflicts the bladder as well as urinary channel as a result of which urination takes place in broken, curved and spiral manner. This ailment is called vata-kundalika (spiralmovement of vata in bladder). It is characterized by morbidities of urinary tract like stiffness, breaking pain, heaviness, twisting, excruciating pain and retention of urine as well as faeces. [39-40]

Etiology and signs of rakta-granthi - tumor, fibroid

????? ?????????????? ??????????? ?????????|
???????? ???????? ? ????????? ???????????? ????????||??|| ???????????? ?? ???????????? ?????????|
raktam vatakaphaddustam bastidvare sudarunam|
granthim kuryat sa krcchrena srjenmutram tadavrtam||41|| asmarisamasulam tam raktagranthim pracaksate|

Blood vitiated by vataand kapha produces serious type of tumour in the neck of the bladder. Because of this occlusion, the patient voids urine with difficulty and experiences pain like that which is felt because of calculi in the urinary passage. This is called rakta-granthi - tumour, fibroid (blood tumour in bladder) [41- 1/2 42]

Etiology and signs of vid-vighata

????????????????????????????? ????????||??||
??????????? ????????? ???????????? ??? ???| ????????? ????????? ???????????????????? ????????????||??||
ruksadurbalayorvatenodavrttam sakrdyada||42||
mutrasrotah prapadyeta vitsamsrstam tada narah| vidgandham mutrayet krcchradvidvighatam vinirdiset||43||

When the faeces gets occluded by vatato enter the urinary passage in an un-unctuous and weak person, then he voids foul smelling urine mixed with faecal matter with difficulty. This condition is called vid-vigraha (recto-vesical fistula). [42 1/2 -43]

Etiology and signs of basti-kundala

???????????????????????????? ??????????| ?????????????????????????? ?????????????? ???????||??||
?????????????????? ??????? ??????? ?????????| ????????? ??????????? ??????????????????????????||??||
??????????????????? ???? ??????????????| ????????? ?????? ???????????????????||??||
??????? ???????????? ???? ???? ?????????????| ????????? ????? ???? ???????? ?????? ??? ?????||??||
???????????????? ?????? ???????????? ? ???????| ?????????????? ?????? ? ?? ?? ???????????||??||
??????????? ??????????? ???????? ????? ?? ?|??|
drutadhvalanghanayasadabhighatat prapidanat| svasthanadvastirudvrttah sthulastisthati garbhavat||44||
sulaspandanadaharto bindum bindum sravatyapi| piditastu srjeddharam samstambhodvestanartiman||45||
bastikundalamahustam ghoram sastravisopamam| pavanaprabalam prayo durnivaramabuddhibhih||46||
tasmin pittanvite dahah sulam mutravivarnata| slesmana gauravam sophah snigdham mutram ghanam sitam||47||
slesmaruddhabilo bastih pittodirno na sidhyati| avibhrantabilah sadhyo na tu yah kundalikrtah||48||
syadvastau kundalibhute hrnmohah svasa eva ca|49|

Because of fast-wayfaring, fasting, exhaustion, trauma, and compression, the urinary bladder gets displaced upwards, and becomes enlarged to appear like a gravid uterus.

Being afflicted with colic pain, throbbing pain and burning sensation, the patient passes urine in drops. When pressed in the bladder region, the urine comes out in a jet. The patient suffers from stiffness, cramps and pain. This ailment is called basti-kundala (spiral distension of bladder). This is a serious condition like injury by weapons or poison. This is generally dominated by aggravated vayu, and cannot be handled by less intelligent physicians.

Associated with vitiated pitta, this ailment gives rise to burning sensation, colic pain and discoloration of urine.

Associated with kapha, this ailment gives rise to heaviness, oedema and unctuousness, density as well as white coloration of the urine.

If the urinary passage is clogged by kapha, and if pitta is aggravated, then the ailment is incurable. If the passage is not blocked or twisted, then the ailment is curable. Twisting of the bladder is characterised by cardiac distress and asthma. [44- 1/2 49]

Line of treatment of urinary morbidities

?????????????????????? ??????????????????????||??||
????????????????? ? ?????????? ???????|??|
dosadhikyamaveksyaitan mutrakrcchraharairjayet||49||
bastimuttarabastim ca sarvesameva dapayet|50|

After ascertaining the predominance of various Doshas in the above-mentioned urinary disorders, the patient is treated with therapies prescribed for curing mutra-krcchra (vide Charaka chikitsa sthana 26/45-58). Basti (medicated enema) and uttata basti (urethral douche) are administered in all the above mentioned ailments. [49 1/2 - 1/2 50]

Netra (nozzle or catheter)

??????????? ?? ???? ????????????????????????????||??||
????????????????? ??? ????????????????| ?????? ?? ????????????? ????????? ??????????????||??||
puspanetram tu haimam syacchlaksnamauttarabastikam||50||
jatyasvahanavrntena samam gopucchasamsthitam| raupyam va sarsapacchidram dvikarnam dvadasangulam||51||

The netra (nozzle of catheter) for uttara-basti (urethral douche) is prepared of gold or silver, and it is smooth. Its tip is of the size of the flower-stalk of jati or asvahana (karavira), and in shape it is tapering like the cow's tail. It must have a hole in the middle which should allow a mustard seed to pass through. It should have two rings, and its length must be twelve angulas (one angula or finger-breadth= 3/4 th of an inch approximately) [50 1/2 -51]

Dose of recipe for douche

????????????????? ??????????????? ?????| ????????????? ???????????? ???????? ??||??||
tenajabastiyuktena snehasyardhapalam nayet| yathavayovisesena snehamatram vikalpya va||52||

The nozzle or catheter is tied to a goat's bladder containing half pala of the unctuous recipe which is to be administered. The exact dose in which this unctuous recipe is to be administered is determined on the basis of the age of the patient. [52]
Read: Uttara Basti: Method, Indications, Mode of Action

Methods of administering urethral douche

???????? ???????????? ???? ??????? ??| ???????????????????? ???? ??????? ????||??||
???? ????????????? ?????? ?????? ?????????| ?????????????? ???? ???????????? ???????||??||
??? ???????????? ??????????? ??????????| ?????????????????? ????????? ???????||??||
????????????? ????????? ?????? ? ??????| ???? ???????? ????????? ??????????????????? ?||??||
?????????? ???????? ? ?????? ? ??????????|
snatasya bhuktabhaktasya rasena payasa'pi va| srstavinmutravegasya pithe janusame mrdau||53||
rjoh sukhopavistasya hrste medhre ghrtaktaya| salakaya'nvisya gatim yadyapratihata vrajet||54||
tatah sephahpramanena puspanetram pravesayet| gudavanmutramargena pranayedanu sevanim||55||
himsyadatigatam bastimune sneho na gacchati| sukham prapidya niskampam niskarsennetrameva ca||56||
pratyagate dvitiyam ca trtiyam ca pradapayet|

The patient who has taken bath, who has taken food along with meat soup or milk and who has voided stool as well as urine is made to sit over a knee-high soft seat in a straight and comfortable position with his erected phallus. The passage of the urethra is determined with the help of a ghee smeared probe. If the probe passes through the urethra without any difficulty, then the nozzle of the cateter is inserted up to the length of the phallus following the direction of perineal suture in the manner prescribed for the insertion of the enema -nozzle in the anus (for basti or medicated enema).

If the catheter is inserted beyond the prescribed limit, it will cause injury to the bladder. If it is inserted less than that limit, the unctuous recipe will not enter the bladder.

Gentle pressure is applied over the douche, receptable without shaking it. Therafter, the catheter is withdrawn. After the injected fluid has come out, the process is repeated for the second and third time. [53- 1/2 57]

Retention of douche-fluid

?????????????????????? ?????????????? ?||??||
????????????????????????????????| ???????????????????????????? ????????||??||
???????????????? ????????????? ?????? ??????????| ????? ?? ??????????? ????????? ????????????||??||
???????????? ???????????? ??????????????????| ???????????????????? ?? ???? ??????????????????||??||
?????? ?????????? ????????????????? ?????| ????????? ???????? ?????????????????||??||
anagacchannupeksyastu rajanivyusitasya ca||57||
pippalilavanagaradhumapamargasarsapaih| vartakurasanirgundisampakaih sasahacaraih||58||
mutramlapistaih sagudairvartim krtva pravesayet| agre tu sarsapakaram pascardhe masasammitam||59||
netradirgham ghrtabhyaktam sukumaramabhanguram| netravanmutranadyam tu payau cangusthasammitam||60||
snehe pratyagate tabhyamanuvasaniko vidhih| pariharasca savyapat sasamyagdattalaksanah||61||

If the fluid does not come out then the physician should wait for one night. Thereafter, a varti (medicated suppository) is inserted into the urethra. For this varti, pippali - long pepper fruit - Piper longum, salt, house-soot, apamarga - Achyranthes aspera, sarsapa, juice of vartaku, nirgundi, sampaka - amaltas - Cassia fistula and sahacara is triturated with cow's urine and sour juice. By cooking with jaggery syrup, varti is prepared (cooking with jaggery syrup is done in such a way that the suppository becomes hard and smooth). The tip of the varti is the size of sarshapa (mustard) in the front and that of a Masha (black gram) at the back. The length of this varti is similar to the length of the netra (nozzle or catheter). Smeared with ghee, this tender and unbreakable suppository is inserted into the urethra. Simultaneously, the suppository of the size of the thumb is inserted into the anus of the patient.

After the return of sneha (unctuous recipe used for douche) by these two vartis or suppositories (one inserted in the urethra and the other in the anus), the patient is given regimens which are prescribed to be given after the administration of the anuvasana or unctuous type of medicated enema.

Prohibitions (parihara), complications (vyapat) and signs of appropriate administration (samyak_ yoga_laksana) of uttara-basti are the same as those described in respect of anuvasana-basti. [58-61]

Urethral douche for women

?????????????????? ?? ????????? ????????| ???????? ???? ?????? ?????????? ?????????||??||
????? ????????? ?????? ???? ???????? ??????| ????????? ???????? ??????????????? ?||??||
?????????? ???????? ?????????????????????| ?????????? ?????? ? ??????? ??????? ?????????||??||
?????????????? ?????? ?????????????????? |??|
strinamartavakale tu pratikarma tadacaret| garbhasana sukham sneham tada"datte hyapavrta||62||
garbham yonistada sighram jite grhnati marute| bastijesu vikaresu yonivibhramsajesu ca||63||
yonisulesu tivresu yonivyapatsvasrgdare| aprasravati mutre ca bindum bindum sravatyapi||64||
vidadhyaduttaram bastim yathasvausadhasamskrtam |65|

In the case of a woman, this uttara-basti (urethral douche) is administered during her menstrual period because [the cervix of] the uterus remains open during this time, and readily receives the unctuous fluid given in the form of douche. This therapy subdues the (local) vataas a result of which the uterus becomes capable of conception.

The douche prepared with appropriate drugs is administered to the women for the following ailments:

Diseases of the urinary bladder
Prolapsed of uterus
Excruciating pain in the uterus
Gynecic disorders
Menorrhagia
Anuria and
Dribbling of urine [62-1/2 65]

Nozzles of Utrara-Basti for Females

????????????????? ?? ????????? ??????????||??|| ?????????????????? ?????????????????? ?|
??????????? ??????? ?????? ???????????||??|| ??????????? ??????????? ?? ?????????????????????|
puspanetrapramanam tu pramadanam dasangulam||65|| mutrasrotahparinaham mudgasroto'nuvahi ca|
apatyamarge narinam vidheyam caturangulam||66|| dvyangulam mutramarge tu balayastvekamangulam|

The Puspa-Netra (nozzle or catheter) for women should be ten Angulas in length. In circumference, it is of the size of their urethral canal. The hole in the middle of the nozzle or catheter is spacious enough to allow the passage of the seed of Mudga (green gram).

For giving douche in the gential organ of an adult woman, the nozzle is inserted up to four Angulas (finger breadth), and for douche in their urethral passage, it is inserted up to two Angulas. In the case of young girls, the catheter is inserted up to one Angula in their urethral passage. [65 1/2 -1/2 67]

Method of administering Uttara-Basti to Females

?????????? ???????? ?????? ???????? ???????||??|| ???????? ?????????????????????? ?????|
??????????????????? ???????????????? ???????||??|| ????? , ????? ??????? ? ?????? ?????? ?????|?????????? ???? ??????? ???????????? ??????????||??|| ?????? ??????? ???? ???????? ??????????????|??|
uttanayah sayanayah samyak sankocya sakthini||67||
athasyah pranayennetramanuvamsagatam sukham|
dvistriscaturiti snehanahoratrena yojayet||68|| bastau , bastau pranite ca vartih pinatara bhavet|triratram karma kurvita snehamatram vivardhayet||69|| anenaiva vidhanena karma kuryat punastryahat|70|

Uttara-Basti is given to a female when she is lying in the bed on her back with thighs lifted up and flexed.the catheter (nozzle) is inserted comfortably in the direction of her spinal (vertrbral) column. Two, three or four unctuous recipes should thus be administered into the bladder during the course of a day and night.

For women, the (varti) suppository to be inserted into the urethra [in the case of retention of unctuous fluid] is thicker.

In the aforesaid manner, douching is done for three nights by gradually increasing the dose of unctuous recipe. After a gap of three days, this douching therapy is repeated following the above mentioned procedure. [67 1/2 - 1/2 70]

Diseases of Head

??? ????????????? ??????????? ???????????||??||
atah sirovikaranam kascidbhedah pravaksyate||70||

Hereafter we shall describe some diseases of the head (Shiro-Roga). [70 1/2 ]

Hereafter we shall describe some diseases of the head (Shiro-Roga). [70 1/2 ]

Sankhaka

?????????????? ??????? ???????? ?????????????| ???????????????? ?? ???? ????????? ???????||??||
? ???? ?????????? ?????????? ??? ???| ?????????????????? ????? ?????? ??? ?????||??||
??? ?????????????? ???? ?????????????????? ????????| ??????????????? ????? ??????????? ???||??||
raktapittanila dustah sankhadese vimurcchitah| tivrarugdaharagam hi sopham kurvanti darunam||71||
sa siro visavadvegi nirudhyasu galam tatha| triratrajjivitam hanti sankhako nama namatah||72||
param tryahajjivati cet pratyakhyayacaret kriyam| sirovirekasekadi sarvam visarpanucca yat||73||

The vitiated blood, Pitta and Kapha, interact in the region of temples to cause a serious type of oedema associated with excruciating pain, burning sensation and inflammation. This disease called Sankhaka with the velocity of poison, causes immediate obstruction in the head as well as throat leading to the death of the patient within three nights.

If the patient survives after three critical days, the physician, while appropriately informing about the difficulty in curing the patient, should administer all therapies like Shirovirechana and effusion including those prescribed for the treatment of Visarpa (erysipelas).[ 70 1/2 - 73]
Read: Shankaka Shiroroga - Causes, Symptoms, Treatment

Etiology, Signs and Treatment of Ardhavadhedaka (Hemicrania)

????????????????? ??????????????????????| ??????????????????????? ???????????||??||
????? ???? ??????? ???????? ?????????| ?????????????????????????????????????????||??||
??????????????? ??????????????? ?????????????| ???? ?????? ???????????????? ?????????||??||
??????????????? ?????? ???????????????| ?????????? ???? ?????? ??????????????????||??||
?????? ??????????????? ????? ??????| ??????????? ???????? ????????????? ???????????||??||
ruksatyadhyasanat purvavatavasyayamaithunaih| vegasandharanayasavyayamaih kupito'nilah||74||
kevalah sakapho va'rdham grhitva sirasastatah| manyabhrusankhakarnaksilalatardhe'tivedanam||75||
sastraraninibham kuryattivram so'rdhavabhedakah| nayanam va'thava srotramativrddho vinasayet||76||
catuhsnehottama matra sirahkayavirecanam| nadisvedo ghrtam jirnam bastikarmanuvasanam||77||
upanahah sirobastirdahanam catra sasyate| pratisyaye siroroge yaccoddistam cikitsitam||78||

The vata gets aggravated by the intake of un-unctuous ingredients, food in excess quantity, intake of food before the previous meal is digested, exposure to the east wind as well as fog, excessive sexual indulgence, suppression of natural urges, fatigue and physical work. This Vata, alone or in association with Kapha causes seizure of half of the head thereby causing excruciating pain in the sterno-mastoid region, eye-brows, temples, ears, and forehead of that half side. The patient experiences excruciating pain as if caused by the injury of a weapon or Arani (churning rod used for producing sacrificial fire), i.e by the fire itself. This ailment is called Ardhavadhedaka (hemicrania). If exceedingly aggravated, this ailment may even destroy the eyes and ears of the patient.

For the treatment of this ailment the therapies to be used are as follows:

Catuh sneha (four types of of fat, viz, oil, ghee, muscle-fat and bone-marrow) to be taken in heavy dose;Shiro-virechana (inhalation therapy for the elimination of morbid matter from the head)Kaya-Virechana (enemies and purgation therapy for the elimination of morbid from the body)Nadi-sveda (a type of fomentation therapy- vide Charaka Samhita Sutrasthan 14/43)Jirna-Ghrta (ten years old ghee)Niruha and Anuvasana types of medicated enemaUpanaha (Application of hot poultice)Shiro- basti (Keeping medicated oil over head with the help of a cap with open ends)Dahana (cauterization) andTherapies prescribed for Pratisyaya and Shiro-Roga (head- diseases) [74-78]
Read: Ardhavabhedaka Shiroroga - Causes, Symptoms, Treatment

Etiology, signs and Treatment of Suryavarta

?????????????????????????????? ??????????| ?????? ??????????? ?????? ??????? ?????????????||??||
??????????????????????????? ?????????? ????| ??? ???? ???????? ??????????? ????????||??||
???????? ??? ???????? ????????? ?????????????| ??????????? ? ???? ?????? ???????????????????||??||
????????????? ? ???????? ??????????????? | ???????????????? ???????????? ?????? [?] ||??||
?????????????????????????????????? ?????| ??????????? ?????????????????????????||??||
sandharanadajirnadyairmastiskam raktamarutau| dustau dusayatastacca dustam tabhyam vimurcchitam||79||
suryodayem'susantapaddravam visyandate sanaih| tato dine sirahsulam dinavrddhya vivardhate||80||
dinaksaye tatah styane mastiske samprasamyati| suryavartah sa tatra syat sarpirauttarabhaktikam||81||
sirahkayavirekau ca murdhna trisnehadharanam | jangalairupanahasca ghrtaksiraisca secanam [3] ||82||
barhitittirilavadisrtaksirotthitam ghrtam| syannavanam jivaniyaksirastagunasadhitam||83||

Because of vega-sandharana (suppression of the manifestation of natural urges), Ajirna (indigestion) etc., Rakta (blood) and Maruta (Vayu) being vitiated, afflict the mastiska (brain). The brain / cerebrum thus get afflicted by these two vitiated factors. Because of the effect of sun-rays after the sun-rise, the morbid matter in the cerebrum which is in liquid form gets exudates slowly. Therefore, during day time, as the day advances, the headache becomes more and more intense. When the sun goes down, the liquefied morbid material becomes thicker and thicker on density in the brain as a result of which the headache gets alleviated. This ailment is called Suryavarta.

For the cure of this ailment, therapeutic measures to be given are as follows:

The patient is given a potion of ghee after meals.Shiro-virechana (inhalation therapy for the elimination of morbid matter from the head)Kaya-virechana (emesis and purgation for the elimination of morbid matter from the body)Shiro-basti is given with three types of fat (oil, ghee and muscle-fat)Upanaha (hot poultice) prepared of the meat of animals inhabiting arid zone forests;Sprinkling of the head with ghee and milk andMilk should be made with the meat of peacock, partridge, quails, etc., and ghee is taken out of this milk. This ghee is added with eight times of milk, and the paste of drugs belonging to Jivaniya-Group (vide Charaka Samhita Sutrasthana 4/ 9: 1) with this medicated ghee, (inhalation therapy) is given to the patient. [79-83]
Read: Suryavarta Shiroroga - Causes, Symptoms, Treatment

Etiology, signs and symptoms of Anantavata

(????????????????????????????????)|
?????? ??????????? ?????????????????? [?] ???????||??|| ??????? ????????? ?? ??????????????????????????|
???????? ?????????????? ????????? ?????????||??|| ?????????????? ??????? ??????????????????|
(upavasatisokatiruksasitalpabhojanaih)|
dusta dosastrayo manyapascadghatasu [2] vedanam||84|| tivram kurvanti sa caksibhrusankhesvavatisthate|
spandanam gandaparsvasya netrarogam hanugraham||85|| so'nantavatastam hanyat sirarkavartanasanaih|

Because of fasting, excessive grief, intake of food which is exceedingly un-unctuous and cold, and intake of extremely small quantity of food, all the three Doshas (vayu, pitta and Kapha) get vitiated to cause acute pain in the sterno-mastoid (region of jugular veins), in the back and at the back of the neck (ghata). This pain (thereafter) gets localised in the eyes, eye-brows and temples. The patient gets throbbing pain in the sides of cheeks, eye-diseases and lockjaw. This ailment is called Ananta-vata. It can be cured by venesection and by therapies prescribed for the treatment of Suryavarta (vide verse nos. 79-83). [84-1/2 86]
Read: Anantavata Shiroroga - Causes, Symptoms, Treatment

Etiology, signs and treatment of Sirah-kampa

???? ??????????? ???????? ?????????????????||??|| ?????????????????????????????????????|
????????????? ??????? ????? ????? ? ???????||??||
vato ruksadibhih kruddhah sirahkampamudirayet||86|| tatramrtabalarasnamahasvetasvagandhakaih|
snehasvedadi vataghnam sastam nasyam ca tarpanam||87||

Being aggravated by the use of ununctuous and such other ingredients, vatacauses trembling of the head (Sirah Kampa). For the treatment of this ailment, oleation, fomentation, Nasya (inhalation) and Tarpana (demulcent nasal medication) therapies prepared with Vayu- alleviating drugs like Amrta, Bala, Rasna, Maha-Sveta and Asvagandha are useful.[86 1/2 - 87]

Importance of inhalation therapy

????????? ? ??????? ?????????? ???????????| ?????? ?? ????? ???? ??? ??? ??????? ????? ????||??||
nastahkarma ca kurvita sirorogesu sastravid| dvaram hi siraso nasa tena tad vyapya hanti tan||88||

For the treatment of the diseases of the head, the expert physician should administer Nasta-Karma (inhalation therapy) because the nose is the gateway of the head. The inhalation therapy given through the nasal passage spreads into the different parts of the head, and cures diseases located there. [88]
Read: Nasya therapy benefits types indication - Ashtang Hruday Sutrasthan 20

Varieties of Inhalation Therapy

????? ????????? ??????? ??? ?? ?| ???????????? ???????? ????????? ?? ??????||??||
??????? ????? ??? ???????? ????? ???????| ????? ?????????? ?????????? ?????? ??? ||??||
???????????????? ????? ?????????????????| ????????????????? ???? ?????????? ????????||??||
?????????? ????? ?????? ??????? ???????????| ??? ???????? ???? ?????? ???? ??????||??||
navanam cavapidasca dhmapanam dhuma eva ca| pratimarsasca vijneyam nastahkarma tu pancadha||89||
snehanam sodhanam caiva dvividham navanam smrtam| sodhanah stambhanasca syadavapido dvidha matah ||90||
curnasyadhmapanam taddhi dehasrotovisodhanam| vijneyastrividho dhumah praguktah samanadikah||91||
pratimarso bhavet sneho nirdosa ubhayarthakrt| evam tadrecanam karma tarpanam samanam tridha||92||

Inhalation therapy is of five types as follows:

Navana (inhalation of drug in the form of nasal drops) - This is of two types, viz., snehana (drops for oleation) and Sodhana (drops for elimination of morbid material from the head);

Avapida (insufflations of drugs in thin paste from through the nasal passage) - This is of two types, viz.

Navana (inhalation of drug in the form of nasal drops) - This is of two types, viz., snehana (drops for oleation) and Sodhana (drops for elimination of morbid material from the head);Avapida (insufflations of drugs in thin paste from through the nasal passage) - This is of two types, viz.

Sodhana (insufflations of drugs for the elimination of morbid matter) and Stambhana (insufflations of drugs for the stoppage of excessive secretion);

Dhmapana (insufflations of drugs in powder form through the Nasal passage) - It cleanses the channels of the body;

Dhuma (inhalation of drugs in the form of smoke) - it is of three types, viz., Samana or Prayogika (smoke used for the alleviation of Doshas), Snaihika (smoke used for oleation of different parts of the head), and Virechana (smoke used for the alimentation of morbid material from the head) and

Dhmapana (insufflations of drugs in powder form through the Nasal passage) - It cleanses the channels of the body;Dhuma (inhalation of drugs in the form of smoke) - it is of three types, viz., Samana or Prayogika (smoke used for the alleviation of Doshas), Snaihika (smoke used for oleation of different parts of the head), and Virechana (smoke used for the alimentation of morbid material from the head) and

Prati-Marsa (application of medicated oil in the nostrils). It is harmless and it serves both the purposes (i.e oleation and elimination of morbid matter from the head).

Prati-Marsa (application of medicated oil in the nostrils). It is harmless and it serves both the purposes (i.e oleation and elimination of morbid matter from the head).

The inhalation therapy (as a whole) can be reclassified into three categories as follows:

Rechana (which causes elimination of morbid matter from the head)
Tarpana (which provides nourishment to the organs located in the head) - It includes Snehana action also and
Samana (which alleviates the aggravated Doshas in the head) - It includes Stambhana action also. [89-92]

Inhalation therapy for different ailments

????????????????????????? ?????????? ?? ????????| ??????????? ???? ????????? ?????????||??||
?? ? ????????? ????? ??????????????????| ???????????? ???? ????????? ????????? ||??||
????????????????? ???? ???????????| ??????? ??????? ? ??? ???????? ?????? ||??||
(???????? ?????????? ????? ?????? ? ???????)|??|
stambhasuptigurutvadyah slaismika ye sirogadah| sirovirecanam tesu nastahkarma prasasyate||93||
ye ca vatatmaka rogah sirahkamparditadayah| sirasastarpanam tesu nastahkarma prasasyate ||94||
raktapittadirogesu samanam nasyamisyate| dhmapanam dhumapanam ca tatha yogyesu sasyate ||95||
(dosadikam samiksyaiva bhisak samyak ca karayet)|96|

In the case of head-diseases associated with stiffness, numbness, heaviness etc., caused by the aggravated kapha inhalation therapy of sira-Virechana type of (which causes elimination of morbid matter from the head) is useful.

In sirah-Kampa (trembling of head), Ardita (facial paralysis) etc., caused by aggravated vayu, inhalation therapy which causes tarpana (nourishment by oleation) of the head is useful.

In diseases like Rakta-Pitta (an ailment characterized by bleeding from different parts of the body) and such other diseases, Samana (which causes alleviation of Doshas) type of inhalation therapy is useful.

Inhalation therapy through Adhmapana (Insufflation) and Dhumapana (inhalation of smoke) is used in appropriate conditions.

After appropriate examination of Doshas, etc., involved in the causation of the diseases, the physician should administer suitable inhalation therapy. [93- 1/2 96]

Drugs for Virechana and Tarpana Nasya

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??????? ??????????? ????? ??? ???????||??||
phaladibhesajam proktam siraso yadvirecanam||96|| taccurnam kalpayettena pacet sneham virecanam|
yaduktam madhuraskandhe bhesajam tena tarpanam||97||

In Vimana 8:15 (seven categories of) drugs whose fruits, (Leaves, roots, rhizomes, flowers, excludes and barks) are useful for Shiro-virechana are described. These drugs can be used for pradhmana and Avapida types of inhalation therapy in powder form. Oil may be cooked by adding the powder of these drugs. This medicated oil may be used for inhalation therapy of Virechana type (which eliminates the morbid matter from the head).

Oil may be cooked by adding drugs belonging to Madhura skandha (sweet Group) described in Vimana 8:139). This medicated oil may also be used for Tarpana type of inhalation therapy. [96-97]

Methods of administering Avapida Nasya

????????? ????? ?????? ????? ?????????????????|??|
???????????? ?????????? ?? ?????????????????? ?||??|| ????????? ??????? ???? ?????????? ?????|
???????????? ???????? ???????? ??????????? ?||??|| ??????????????? ?????? ?????? ?????????? ?????|
??????????? ????? ? ???? ???????????||???|| ????????????? ????? ????????????????????|
?? ?????????? ??????????? ?????????????||???|| ????????? ???????????? ???????????????????|
?????? ?????????? ???????????? ????||???|| ????????? ?????? ????? ??????????? ???????|
???? ? ???????????? ????????? ???? ????||???|| ?? ?????? ????????? ???? ??? ?????? ? ???????|
?????????????????? ???????? ???????????????????? ||???|| ???? ???????? ??????? ????? ????????? ???|
????????????????????? ??????? ? ??????||???|| ??? ????????? ???? ?????? ?????????? |
???????????????????????? ???????????????????||???|| ???????????????? ?????? ???????????? ??|
sadhayitva bhisak sneham nastah kuryadvidhanavit|98|
praksurye madhyasurye va prakkrtavasyakasya ca||98|| uttanasya sayanasya sayane svastrtesukham|
pralambasirasah kincit kincit padonnatasya ca||99|| dadyannasapute sneham tarpanam buddhiman bhisak|
anavaksiraso nasyam na sirah pratipadyate||100|| atyavaksiraso nasyam mastulunge'vatisthati|
ata evamsayanasya suddhyartham svedayecchirah||101|| samsvedya nasamunnamya vamenangusthaparvana|
hastena daksinenatha kuryadubhayatah samam||102|| pranadya picuna va'pi nastahsneham yathavidhi|
krte ca svedayedbhuya akarsecca punah punah||103|| tam sneham slesmana sakam tatha sneho na tisthati|
svedenotklesitah slesma nastahkarmanyupasthitah ||104|| bhuyah snehasya saityena sirasi styayate tatah|
srotramanyagaladyesu vikaraya sa kalpate||105|| tato nastahkrte dhumam pibet kaphavinasanam |
hitannabhunnivatosnasevi syanniyatendriyah||106|| vidhireso'vapidasya karyah pradhmapanasya tu|

In the morning or noon time, after the patient has completed his daily acts of ablutions, he is made to lie comfortably in supine position on a well spread bed with his head slightly hanging down, and legs slightly raised. A wise physician should give him Tarpana (nourishing) type of medicated oil through his nostrils.

If the head is not kept in a lower position then the recipe for inhalation therapy will not reach the desired destination in the head. If the head is lowered in excess then the recipe gets lodged in the brain (mastulunga). Therefore, the patient should maintain the aforesaid position while lying down.

As a preparatory measure for cleaning, fomentation therapy is applied over the head of the patient. Thereafter, the physician with the thumb of his left hand should raise the tip of the nose, and with his right hand, should appropriately pour the recipe of medicated oil through a Pranadi (pipette) or Picu (cotton swab) in equal quantities in each of the nostrils.

After this, fomentation therapy is applied over the head once again, and the recipe of medicated oil along with Slesma (Phlegm or mucous matter) is drained out frequently till no trace of medicated oil is left.

Because of fomentation, the Slesma (Mucous matter) gets excited and by the administration of inhalation therapy, it gets dislodged, if a part of the medicated oil is left behind then because of its cooling effort, the localized mucous matter gets concealed in the head. This may give rise to diseases of the ears, manya (sides of the neck), throat etc.

After the administration of the inhalation therapy, the patient is given Dhuma-Pana (smoking therapy) which is curative of Kapha.

The patient should take wholesome food, and stay in a warm apartment free from drought. He should observe sensual restraint.

This is the procedure to be followed for the administration of Avapida and Adhumapana types of Nasya. [98 1/2 - 1/2 107]

Pradhaman Type of Inhalation therapy

??? ????????? ?????? ??????????? ????? ??||???|| ???????????? ?????? ?????????????? ???????|
??? ??????????????? ? ??????????????????||???|| ??????????? ?????? ????? ???? ?????|
? ???? ??????????? ????? ?????? ????? ????? ||???|| ??????? ??????? ???? ??????? ????????????????|
?????????????? ??????????????||???||
tat sadangulaya nadya dhameccurnam mukhena tu||107|| viriktasirasam tusnam payayitva'mbu bhojayet|
laghu trisvaviruddham ca nivatasthamatandritah||108|| virekasuddho dosasya kopanam yasya sevate|
sa doso vicaramstatra karoti svan gadan bahun ||109|| yathasvam vihitam tesu kriyam kuryadvicaksanah|
akalakrtajatanam roganamanurupatah||110||

As per Pradhamana types of inhalation therapy, the recipe in powder form is blown by the physician through his mouth into the nostrils of the patient with the help of tubes which are six Angulas in breadth. After the morbid matter is eliminated from the head of the patient, the physician should make him drink warm water and give him food ingredients which are light and in harmony with all the three Doshas. Thereafter, the patient is made to stay in a breeze free house.

After the body is cleansed of morbid matter, intake of unwholesome (dosa-aggravating) regimen causes the aggravated Doshas to circulate all over the body giving rise to several diseases peculiar to that Doshas. In that case, the wise physician should administer therapies specifically required for the same aggravated Dosha. Complications arising out of untimely administration of inhalation therapy are treated on the same line specifically suggested for each of these complications. [107 1/2 - 110]

Complications arising out of Kapha and Their Treatment

??????? ????? ?????? ???? ?????? ????????| ??????????? ??? ?????? ?????????????????||???||
????? ??????? ?????? ????? ???????????? ?????| ???? ?????????? ????????????????????????????????||???||
ajirne bhojane bhukte toye pite'tha durdine| pratisyaye nave snate snehapane'nuvasane||111||
navanam snehanam rogan karoti slaismikan bahun| tatra slesmaharah sarvastiksnosnadirvidhirhitah||112||

Several Kaphaja types of ailments are manifested when virechana or snehana (Oleating) type of inhalation therapy is administered in the following conditions:

During indigestion
After-the intake of food
After drink water
In a cloudy day
During corzya of recent origin
After bath
After the intake of Sneha (potion of ghee) and
After and Anuvasana (Unctuous) type of enema

For the treatment of such ailments all the Kapha-alleviating, therapeutic measures containing ingredients which are Tiksna (sharp) hot, etc are useful. [111-112]

Complications caused by Vayu, treatment

?????? ???????? ????? ????????????? ????| ???? ??????? ?????? ???????? ?????????????????||???||
???? ?????? ????? ????? ????????????| ?????????, ?????????? ?????? ????????????? ???????||???||
ksame virecite garbhe vyayamabhihate trsi| vato ruksena nasyena kruddhah svanjanayedgadan||113||
tatra vataharah sarvo vidhih snehanabrmhanah| svedadih, syadghrtam ksiram garbhinyastu visesatah||114||

Several Vatika types of ailments are manifested by the aggravated vataif Ruksa (non unctuous) type of inhalation therapy is administered in the following conditions:

If the patient is emaciatedIf the patient has taken purgation therapyIf the patient (woman) is pregnantIf the patient is afflicted with hard work andIf the patient is thirsty

For the treatment of these ailments, all the Snehana (oleation), Brimhana, (Nourishing), Svedana (fomentation) and such other therapies which alleviate vata are useful. In the case of pregnant women, ghee and milk is specially given. [113-114]

Timira and its treatment

?????????????????? ?????? ???????? ??| ??????? ???????????????? ?????????? ??????? ||???||
jvarasokatitaptanam timiram madyapasya tu| ruksaih sitanjanairlepaih putapakaisca sadhayet ||115||

Inhalation therapy given to a patient who is exceedingly afflicted with fever as well as grief, and who is alcoholic gives rise to Timira (Cataract). For the treatment of this Timira, the patient is given Sitanjana, Lepa (application of ointment over the eyes) and Puta-paka (juice of the paste of herbs covered with mud and cooked over fire) with ununctuous ingredients. [115]
Read: Eye Diseases Causes, Pathogenesis, Symptoms, Treatment, Herbs

Pratimarsa type of inhalation therapy

??????? ????? ??? ???????? ????? ????| ????????????? ????????? ????? ? ? ????????||???||
????? ????????????? ??????? ??????????? ? ??????| ? ?????????????????? ?????????? ? ???????????||???||
snehanam sodhanam caiva dvividham navanam matam| pratimarsastu nasyartham karoti na ca dosavan||116||
nastah snehangulim dadyat pratarnisi ca sarvada| na cocchinghedaroganam pratimarsah sa dardhyakrt||117||

Navana type of inhalation therapy is of two types viz Snehana (which causes oleation) and Sodhana (which causes elimination of Doshas). Pratimarsa (application of oil in the nostrils) type of inhaliation therapy performs both these actions, and it is harmless.

???? ??????-
?????? ??????? ????????? ??????????????? ?| ???? ?????? ????????? ? ?????????? ??????||???||
?????????????????? ??????????????????| ????????????? ?????? ???????????? ????????????||???||
trini yasmat pradhanani marmanyabhihatesu ca| tesu lingam cikitsam ca rogabhedasca sausadhah||118||
vidhiruttarabastesca nastahkarmavidhistatha| savyapadbhesajam siddhau marmakhyayam prakirtitam||119||

In this chapter dealing with the success in the treatment of three vital organs, the topics discussed are as follows:

Reasons for which three organs (viz., heart, head and urinary bladder) are the most important ones; (vide verse nos. 3-5)

Signs and symptoms of the afflictions of these three vital organs, and their treatment; (vide verse nos. 6-8)

Varieties of the diseases of these vital organs, and medicaments to be used for the treatment of these ailments and (vide verse nos. 9 1/2 - 49)

Method of administration of Uttara Basti (urethral and vaginal douche) and Nasta-Karma (inhalation therapy), their complications, and treatment of these complications. (Vide verse nos. 49 1/2 - 117) [118-119]

??????????????? ??????? ????????????????????????? ?????????????? ???????????? ????????????????????? ???????????||?||
ityagnivesakrte tantre carakapratisamskrte'prapte drdhabalasampurite siddhisthane trimarmiyasiddhirnama navamo'dhyayah||9||

Thus, ends the ninth chapter of Siddhi- sthana dealing with the "Successful Treatment of Ailments Caused by the Afflictions of three Vital Organs" in Agnivesha's work as redacted by Caraka, and because of its non-availability supplemented by Dridhabala.

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