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.

Prologue

अथातस्त्रिमर्मीयां सिद्धिं व्याख्यास्यामः||१|| इति ह स्माह भगवानात्रेयः||२||
athātastrimarmīyāṃ siddhiṃ vyākhyāsyāmaḥ||1|| iti ha smāha bhagavānātreyaḥ||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

सप्तोत्तरं मर्मशतमस्मिञ्छरीरे स्कन्धशाखासमाश्रितमग्निवेश!| तेषामन्यतमपीडायां समधिका पीडा भवति, चेतनानिबन्धवैशेष्यात्|
तत्र शाखाश्रितेभ्यो मर्मभ्यः स्कन्धाश्रितानि गरीयांसि, शाखानां तदाश्रितत्वात्; स्कन्धाश्रितेभ्योऽपि हृद्वस्तिशिरांसि, तन्मूलत्वाच्छरीरस्य||३||
saptottaraṃ marmaśatamasmiñcharīre skandhaśākhāsamāśritamagniveśa!| teṣāmanyatamapīḍāyāṃ samadhikā pīḍā bhavati, cetanānibandhavaiśeṣyāt|
tatra śākhāśritebhyo marmabhyaḥ skandhāśritāni garīyāṃsi, śākhānāṃ tadāśritatvāt; skandhāśritebhyo’pi hṛdvastiśirāṃsi, tanmūlatvāccharīrasya||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

तत्र हृदयेदश धमन्यः प्राणापानौमनो बुद्धिश्चेतना महाभूतानि च नाभ्यामरा इव प्रतिष्ठितानि, शिरसि इन्द्रियाणि इन्द्रियप्राणवहानि च स्रोतांसि सूर्यमिव गभस्तयः संश्रितानि, बस्तिस्तु स्थूलगुदमुष्कसेवनीशुक्रमूत्रवाहिनीनां नाडी(ली)नां मध्ये मूत्रधारोऽम्बुवहानां सर्वस्रोतसामुदधिरिवापगानां प्रतिष्ठा , बहुभिश्च तन्मूलैर्मर्मसञ्ज्ञकैः स्रोतोभिर्गगनमिव दिनकरकरैर्व्याप्तमिदं शरीरम्||४||
tatra hṛdayedaśa dhamanyaḥ prāṇāpānaumano buddhiścetanā mahābhūtāni ca nābhyāmarā iva pratiṣṭhitāni, śirasi indriyāṇi indriyaprāṇavahāni ca srotāṃsi sūryamiva gabhastayaḥ saṃśritāni, bastistu sthūlagudamuṣkasevanīśukramūtravāhinīnāṃ nāḍī(lī)nāṃ madhye mūtradhāro’mbuvahānāṃ sarvasrotasāmudadhirivāpagānāṃ pratiṣṭhā , bahubhiśca tanmūlairmarmasañjñakaiḥ srotobhirgaganamiva dinakarakarairvyāptamidaṃ śarīram||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

तेषां त्रयाणामन्यतमस्यापि भेदादाश्वेव शरीरभेदः स्यात्, आश्रयनाशादाश्रितस्यापि विनाशः; तदुपघातात्तु घोरतरव्याधिप्रादुर्भावः; तस्मादेतानि विशेषेण रक्ष्याणि बाह्याभिघाद्वातादिभ्यश्च||५||
teṣāṃ trayāṇāmanyatamasyāpi bhedādāśveva śarīrabhedaḥ syāt, āśrayanāśādāśritasyāpi vināśaḥ; tadupaghātāttu ghorataravyādhiprādurbhāvaḥ; tasmādetāni viśeṣeṇa rakṣyāṇi bāhyābhighādvātādibhyaśca||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

तत्र हृद्यभिहते कासश्वासबलक्षयकण्ठशोषक्लोमाकर्षणजिह्वानिर्गममुखतालुशोषापस्मारोन्मादप्रलापचित्तनाशादयः स्युः; शिरस्यभिहते मन्यास्तम्भार्दितचक्षुर्विभ्रममोहोद्वेष्टनचेष्टानाशकासश्वासहनुग्रहमूकगद्गदत्वाक्षिनिमीलन- गण्डस्पन्दनजृम्भणलालास्रावस्वरहानिवदनजिह्मत्वादीनि, बस्तौ तु वातमूत्रवर्चोनिग्रहवङ्क्षणमेहनबस्तिशूलकुण्डलोदावर्तगुल्मानिलाष्ठीलोपस्तम्भनाभिकुक्षिगुदश्रोणिग्रहादयः ; वाताद्युपसृष्टानां त्वेषां लिङ्गानि चिकित्सिते सक्रियाविधीन्युक्तानि||६||
tatra hṛdyabhihate kāsaśvāsabalakṣayakaṇṭhaśoṣaklomākarṣaṇajihvānirgamamukhatāluśoṣāpasmāronmādapralāpacittanāśādayaḥ syuḥ; śirasyabhihate manyāstambhārditacakṣurvibhramamohodveṣṭanaceṣṭānāśakāsaśvāsahanugrahamūkagadgadatvākṣinimīlana- gaṇḍaspandanajṛmbhaṇalālāsrāvasvarahānivadanajihmatvādīni, bastau tu vātamūtravarconigrahavaṅkṣaṇamehanabastiśūlakuṇḍalodāvartagulmānilāṣṭhīlopastambhanābhikukṣigudaśroṇigrahādayaḥ ; vātādyupasṛṣṭānāṃ tveṣāṃ liṅgāni cikitsite sakriyāvidhīnyuktāni||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

किन्त्वेतानि विशेषतोऽनिलाद्रक्ष्याणि, अनिलो हि पित्तकफसमुदीरणे हेतुः प्राणमूलं च, स बस्तिकर्मसाध्यतमः, तस्मान्न बस्तिसमं किञ्चित् कर्म मर्मपरिपालनमस्ति| तत्र षडास्थापनस्कन्धान् विमाने द्वौ चानुवासनस्कन्धाविह च विहितान् बस्तीन् बुद्ध्या विचार्य महामर्मपरिपालनार्थं प्रयोजयेद्वातव्याधिचिकित्सां च||७||
kintvetāni viśeṣato’nilādrakṣyāṇi, anilo hi pittakaphasamudīraṇe hetuḥ prāṇamūlaṃ ca, sa bastikarmasādhyatamaḥ, tasmānna bastisamaṃ kiñcit karma marmaparipālanamasti| tatra ṣaḍāsthāpanaskandhān vimāne dvau cānuvāsanaskandhāviha ca vihitān bastīn buddhyā vicārya mahāmarmaparipālanārthaṃ prayojayedvātavyādhicikitsāṃ 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

भूयश्च हृद्युपसृष्टे हिङ्गुचूर्णं लवणानामन्यतमचूर्णसंयुक्तं मातुलुङ्गस्य रसेनान्येन वाऽम्लेन हृद्येन वा पाययेत्, स्थिरादिपञ्चमूलीरसः सशर्करः पानार्थं, बिल्वादिपञ्चमूलरससिद्धा च यवागूः, हृद्रोगविहितं च कर्म; मूर्ध्नि तु वातोपसृष्टेऽभ्यङ्गस्वेदनोपनाहस्नेहपाननस्तःकर्मावपीडनधूमादीनि; बस्तौ तु कुम्भीस्वेदः, वर्तयः, श्यामादिभिर्गोमूत्रसिद्धो निरूहः, बिल्वादिभिश्च सुरासिद्धः, शरकाशेक्षुदर्भगोक्षुरकमूलशृतक्षीरैश्च त्रपुसैर्वारुखराश्वाबीजयवर्षभकवृद्धिकल्कितो निरूहः, पीतदारुसिद्धतैलेनानुवासनं, तैल्वकं च सर्पिर्विरेकार्थं, शतावरीगोक्षुरकबृहतीकण्टकारिकागुडूचीपुनर्नवोशीरमधुकद्विसारिवालोध्रश्रेयसीकुशकाशमूलकषायक्षीरचतुर्गुणं बलावृषर्षभकखराश्वोपकुञ्चिकावत्सकत्रपुसैर्वारुबीजशितिवारकमधुकवचाशतपुष्पाश्मभेदकवर्षाभूमदनफलकल्कसिद्धं तैलमुत्तरबस्तिर्निरूहो वा शुद्धस्निग्धस्विन्नस्य बस्तिशूलमूत्रविकारहर इति||८||
bhūyaśca hṛdyupasṛṣṭe hiṅgucūrṇaṃ lavaṇānāmanyatamacūrṇasaṃyuktaṃ mātuluṅgasya rasenānyena vā’mlena hṛdyena vā pāyayet, sthirādipañcamūlīrasaḥ saśarkaraḥ pānārthaṃ, bilvādipañcamūlarasasiddhā ca yavāgūḥ, hṛdrogavihitaṃ ca karma; mūrdhni tu vātopasṛṣṭe’bhyaṅgasvedanopanāhasnehapānanastaḥkarmāvapīḍanadhūmādīni; bastau tu kumbhīsvedaḥ, vartayaḥ, śyāmādibhirgomūtrasiddho nirūhaḥ, bilvādibhiśca surāsiddhaḥ, śarakāśekṣudarbhagokṣurakamūlaśṛtakṣīraiśca trapusairvārukharāśvābījayavarṣabhakavṛddhikalkito nirūhaḥ, pītadārusiddhatailenānuvāsanaṃ, tailvakaṃ ca sarpirvirekārthaṃ, śatāvarīgokṣurakabṛhatīkaṇṭakārikāguḍūcīpunarnavośīramadhukadvisārivālodhraśreyasīkuśakāśamūlakaṣāyakṣīracaturguṇaṃ balāvṛṣarṣabhakakharāśvopakuñcikāvatsakatrapusairvārubījaśitivārakamadhukavacāśatapuṣpāśmabhedakavarṣābhūmadanaphalakalkasiddhaṃ tailamuttarabastirnirūho vā śuddhasnigdhasvinnasya bastiśūlamūtravikārahara 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

भवन्ति चात्र श्लोकाः-
हृदये मूर्ध्नि बस्तौ च नृणां प्राणाः प्रतिष्ठिताः| तस्मात्तेषां सदा यत्नं कुर्वीत परिपालने||९||
आबाधवर्जनं नित्यं स्वस्थवृत्तानुवर्तनम्| उत्पन्नार्तिविघातश्च मर्मणां परिपालनम्||१०||
bhavanti cātra ślokāḥ-
hṛdaye mūrdhni bastau ca nṛṇāṃ prāṇāḥ pratiṣṭhitāḥ| tasmātteṣāṃ sadā yatnaṃ kurvīta paripālane||9||
ābādhavarjanaṃ nityaṃ svasthavṛttānuvartanam| utpannārtivighātaśca marmaṇāṃ paripālanam||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

अत उर्ध्वं विकारा ये त्रिमर्मीये चिकित्सिते| न प्रोक्ता मर्मजास्तेषां कांश्चिद्वक्ष्यामि सौषधान्||११||
ata urdhvaṃ vikārā ye trimarmīye cikitsite| na proktā marmajāsteṣāṃ kāṃścidvakṣyāmi sauṣadhān||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)

क्रुद्धः स्वैः कोपनैर्वायुः स्थानादूर्ध्वं प्रपद्यते| पीडयन् हृदयं गत्वा शिरः शङ्खौ च पीडयन्||१२||
धनुर्वन्नमयेद्गात्राण्याक्षिपेन्मोहयेत्तथा| (नमयेच्चाक्षिपेच्चाङ्गान्युच्छ्वासं निरुणद्धि च)|
कृच्छ्रेण चाप्युच्छ्वसिति स्तब्धाक्षोऽथ निमीलकः ||१३||
कपोत इव कूजेच्च निःसञ्ज्ञः सोऽपतन्त्रकः| दृष्टिं संस्तम्भ्य सञ्ज्ञां च हत्वा कण्ठेन कूजति||१४||
हृदि मुक्ते नरः स्वास्थ्यं याति मोहं वृते पुनः| वायुना दारुणं प्राहुरेके तमपतानकम्||१५||
kruddhaḥ svaiḥ kopanairvāyuḥ sthānādūrdhvaṃ prapadyate| pīḍayan hṛdayaṃ gatvā śiraḥ śaṅkhau ca pīḍayan||12||
dhanurvannamayedgātrāṇyākṣipenmohayettathā| (namayeccākṣipeccāṅgānyucchvāsaṃ niruṇaddhi ca)|
kṛcchreṇa cāpyucchvasiti stabdhākṣo’tha nimīlakaḥ ||13||
kapota iva kūjecca niḥsañjñaḥ so’patantrakaḥ| dṛṣṭiṃ saṃstambhya sañjñāṃ ca hatvā kaṇṭhena kūjati||14||
hṛdi mukte naraḥ svāsthyaṃ yāti mohaṃ vṛte punaḥ| vāyunā dāruṇaṃ prāhureke tamapatānakam||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

श्वसनं कफवाताभ्यां रुद्धं तस्य विमोक्षयेत्| तीक्ष्णैः प्रधमनैः सञ्ज्ञां तासु मुक्तासु विन्दति||१६||
मरिचं शिग्रुबीजानि विडङ्गं च फणिज्झकम्| एतानि सूक्ष्मचूर्णानि दद्याच्छीर्षविरेचनम्||१७||
तुम्बुरूण्यभया हिङ्गु पौष्करं लवणत्रयम्| यवक्वाथाम्बुना पेयं हृद्ग्रहे चापतन्त्रके ||१८||
हिङ्ग्वम्लवेतसं शुण्ठीं ससौवर्चलदाडिमम्| पिबेद्वातकफघ्नं च कर्म हृद्रोगनुद्धितम्||१९||
शोधना बस्तयस्तीक्ष्णा न हितास्तस्य कृत्स्नशः| सौवर्चलाभयाव्योषैः सिद्धं तस्मै घृतं हितम्||२०||
śvasanaṃ kaphavātābhyāṃ ruddhaṃ tasya vimokṣayet| tīkṣṇaiḥ pradhamanaiḥ sañjñāṃ tāsu muktāsu vindati||16||
maricaṃ śigrubījāni viḍaṅgaṃ ca phaṇijjhakam| etāni sūkṣmacūrṇāni dadyācchīrṣavirecanam||17||
tumburūṇyabhayā hiṅgu pauṣkaraṃ lavaṇatrayam| yavakvāthāmbunā peyaṃ hṛdgrahe cāpatantrake ||18||
hiṅgvamlavetasaṃ śuṇṭhīṃ sasauvarcaladāḍimam| pibedvātakaphaghnaṃ ca karma hṛdroganuddhitam||19||
śodhanā bastayastīkṣṇā na hitāstasya kṛtsnaśaḥ| sauvarcalābhayāvyoṣaiḥ siddhaṃ tasmai ghṛtaṃ 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

मधुरस्निग्धगुर्वन्नसेवनाच्चिन्तनाच्छ्रमात् शोकाद्व्याध्यनुषङ्गाच्च वायुनोदीरितः कफः||२१||
यदाऽसौ समवस्कन्द्य हृदयं हृदयाश्रयान्| समावृणोति ज्ञानादींस्तदा तन्द्रोपजायते||२२||
हृदये व्याकुलीभावो वाक्चेष्टेन्द्रियगौरवम्| मनोबुद्ध्यप्रसादश्च तन्द्राया लक्षणं मतम्||२३||
कफघ्नं तत्र कर्तव्यं शोधनं शमनानि च| व्यायामो रक्तमोक्षश्च भोज्यं च कटुतिक्तकम्||२४||
madhurasnigdhagurvannasevanāccintanācchramāt śokādvyādhyanuṣaṅgācca vāyunodīritaḥ kaphaḥ||21||
yadā’sau samavaskandya hṛdayaṃ hṛdayāśrayān| samāvṛṇoti jñānādīṃstadā tandropajāyate||22||
hṛdaye vyākulībhāvo vākceṣṭendriyagauravam| manobuddhyaprasādaśca tandrāyā lakṣaṇaṃ matam||23||
kaphaghnaṃ tatra kartavyaṃ śodhanaṃ śamanāni ca| vyāyāmo raktamokṣaśca bhojyaṃ ca kaṭutiktakam||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

मूत्रौकसादो जठरं कृच्छ्रमुत्सङ्गसङ्क्षयौ| मूत्रातीतोऽनिलाष्ठीला वातबस्त्युष्णमारुतौ||२५||
वातकुण्डलिका ग्रन्थिर्विड्घातो बस्तिकुण्डलम्| त्रयोदशैते मूत्रस्य दोषास्ताँल्लिङ्गतः शृणु||२६||
mūtraukasādo jaṭharaṃ kṛcchramutsaṅgasaṅkṣayau| mūtrātīto’nilāṣṭhīlā vātabastyuṣṇamārutau||25||
vātakuṇḍalikā granthirviḍghāto bastikuṇḍalam| trayodaśaite mūtrasya doṣāstāँlliṅgataḥ śṛṇu||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) and
• Basti-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

पित्तं कफो द्वावपि वा बस्तौ संहन्यते यदा| मारुतेन तदा मूत्रं रक्तं पीतं घनं सृजेत्||२७||
सदाहं श्वेतसान्द्रं वा सर्वैर्वा लक्षणैर्युतम्| मूत्रौकसादं तं विद्यात् पित्तश्लेष्महरैर्जयेत्||२८||
pittaṃ kapho dvāvapi vā bastau saṃhanyate yadā| mārutena tadā mūtraṃ raktaṃ pītaṃ ghanaṃ sṛjet||27||
sadāhaṃ śvetasāndraṃ vā sarvairvā lakṣaṇairyutam| mūtraukasādaṃ taṃ vidyāt pittaśleṣmaharairjayet||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

विधारणात् प्रतिहतं वातोदावर्तितं यदा| पूरयत्युदरं मूत्रं तदा तदनिमित्तरुक्||२९||
अपक्तिमूत्रविट्सङ्गैस्तन्मूत्रजठरं वदेत्| मूत्रवैरेचनीं तत्र चिकित्सां सम्प्रयोजयेत्||३०||
हिङ्गुद्विरुत्तरं चूर्णं त्रिमर्मीये प्रकीर्तितम्| हन्यान्मूत्रोदरानाहमाध्मानं गुदमेढ्रयोः||३१||
vidhāraṇāt pratihataṃ vātodāvartitaṃ yadā| pūrayatyudaraṃ mūtraṃ tadā tadanimittaruk||29||
apaktimūtraviṭsaṅgaistanmūtrajaṭharaṃ vadet| mūtravairecanīṃ tatra cikitsāṃ samprayojayet||30||
hiṅgudviruttaraṃ cūrṇaṃ trimarmīye prakīrtitam| hanyānmūtrodarānāhamādhmānaṃ gudameḍhrayoḥ||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

मूत्रितस्य व्यवायात्तु रेतो वातोद्धतं च्युतम्| पूर्वं मूत्रस्य पश्चाद्वा स्रवेत् कृच्छ्रं तदुच्यते||३२||
mūtritasya vyavāyāttu reto vātoddhataṃ cyutam| pūrvaṃ mūtrasya paścādvā sravet kṛcchraṃ 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

खवैगुण्यानिलाक्षेपैः किञ्चिन्मूत्रं च तिष्ठति| मणिसन्धौ स्रवेत् पश्चात्तदरुग्वाऽथ चातिरुक्||३३||
मूत्रोत्सङ्गः स विच्छिन्नमुच्छेषगुरुशेफसः |
khavaiguṇyānilākṣepaiḥ kiñcinmūtraṃ ca tiṣṭhati| maṇisandhau sravet paścāttadarugvā’tha cātiruk||33||
mūtrotsaṅgaḥ sa vicchinnamuccheṣaguruśephasaḥ |

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 – ½ 34]

Etiology and signs of mutra sanksaya

वाताकृतिर्भवेद्वातान्मूत्रे शुष्यति सङ्क्षयः||३४||
vātākṛtirbhavedvātānmūtre śuṣyati saṅkṣayaḥ||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 ½]

Etiology and signs of mutratita

चिरं धारयतो मूत्रं त्वरया न प्रवर्तते| मेहमानस्य मन्दं वा मूत्रातीतः स उच्यते||३५||
ciraṃ dhārayato mūtraṃ tvarayā na pravartate| mehamānasya mandaṃ vā mūtrātītaḥ 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

आध्मापयन् बस्तिगुदं रुद्ध्वा वायुश्चलोन्नताम्| कुर्यात्तीव्रार्तिमष्ठीलां मूत्रविण्मार्गरोधिनीम्||३६||
ādhmāpayan bastigudaṃ ruddhvā vāyuścalonnatām| kuryāttīvrārtimaṣṭhīlāṃ mūtraviṇmārgarodhinīm||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

मूत्रं धारयतो बस्तौ वायुः क्रुद्धो विधारणात्| मूत्ररोधार्तिकण्डूभिर्वातबस्तिः स उच्यते||३७||
mūtraṃ dhārayato bastau vāyuḥ kruddho vidhāraṇāt| mūtrarodhārtikaṇḍūbhirvātabastiḥ 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

उष्मणा सोष्मकं मूत्रं शोषयन् रक्तपीतकम्| उष्णवातः सृजेत् कृच्छ्राद्बस्त्युपस्थार्तिदाहवान्||३८||
uṣmaṇā soṣmakaṃ mūtraṃ śoṣayan raktapītakam| uṣṇavātaḥ sṛjet kṛcchrādbastyupasthārtidāhavān||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

गतिसङ्गादुदावृत्तः स मूत्रस्थानमार्गयोः| मूत्रस्य विगुणो वायुर्भग्नव्याविद्धकुण्डली||३९||
मूत्रं विहन्ति संस्तम्भभङ्गगौरववेष्टनैः| तीव्ररुङ्मूत्रविट्सङ्गैर्वातकुण्डलिकेति सा||४०||
gatisaṅgādudāvṛttaḥ sa mūtrasthānamārgayoḥ| mūtrasya viguṇo vāyurbhagnavyāviddhakuṇḍalī||39||
mūtraṃ vihanti saṃstambhabhaṅgagauravaveṣṭanaiḥ| tīvraruṅmūtraviṭsaṅgairvātakuṇḍaliketi sā||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

रक्तं वातकफाद्दुष्टं बस्तिद्वारे सुदारुणम्|
ग्रन्थिं कुर्यात् स कृच्छ्रेण सृजेन्मूत्रं तदावृतम्||४१|| अश्मरीसमशूलं तं रक्तग्रन्थिं प्रचक्षते|
raktaṃ vātakaphādduṣṭaṃ bastidvāre sudāruṇam|
granthiṃ kuryāt sa kṛcchreṇa sṛjenmūtraṃ tadāvṛtam||41|| aśmarīsamaśūlaṃ taṃ raktagranthiṃ pracakṣate|

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- ½ 42]

Etiology and signs of vid-vighata

रूक्षदुर्बलयोर्वातेनोदावृत्तं शकृद्यदा||४२||
मूत्रस्रोतः प्रपद्येत विट्संसृष्टं तदा नरः| विड्गन्धं मूत्रयेत् कृच्छ्राद्विड्विघातं विनिर्दिशेत्||४३||
rūkṣadurbalayorvātenodāvṛttaṃ śakṛdyadā||42||
mūtrasrotaḥ prapadyeta viṭsaṃsṛṣṭaṃ tadā naraḥ| viḍgandhaṃ mūtrayet kṛcchrādviḍvighātaṃ vinirdiśet||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 ½-43]

Etiology and signs of basti-kundala

द्रुताध्वलङ्घनायासादभिघातात् प्रपीडनात्| स्वस्थानाद्वस्तिरुद्वृत्तः स्थूलस्तिष्ठति गर्भवत्||४४||
शूलस्पन्दनदाहार्तो बिन्दुं बिन्दुं स्रवत्यपि| पीडितस्तु सृजेद्धारां संस्तम्भोद्वेष्टनार्तिमान्||४५||
बस्तिकुण्डलमाहुस्तं घोरं शस्त्रविषोपमम्| पवनप्रबलं प्रायो दुर्निवारमबुद्धिभिः||४६||
तस्मिन् पित्तान्विते दाहः शूलं मूत्रविवर्णता| श्लेष्मणा गौरवं शोफः स्निग्धं मूत्रं घनं सितम्||४७||
श्लेष्मरुद्धबिलो बस्तिः पित्तोदीर्णो न सिध्यति| अविभ्रान्तबिलः साध्यो न तु यः कुण्डलीकृतः||४८||
स्याद्वस्तौ कुण्डलीभूते हृन्मोहः श्वास एव च|४९|
drutādhvalaṅghanāyāsādabhighātāt prapīḍanāt| svasthānādvastirudvṛttaḥ sthūlastiṣṭhati garbhavat||44||
śūlaspandanadāhārto binduṃ binduṃ sravatyapi| pīḍitastu sṛjeddhārāṃ saṃstambhodveṣṭanārtimān||45||
bastikuṇḍalamāhustaṃ ghoraṃ śastraviṣopamam| pavanaprabalaṃ prāyo durnivāramabuddhibhiḥ||46||
tasmin pittānvite dāhaḥ śūlaṃ mūtravivarṇatā| śleṣmaṇā gauravaṃ śophaḥ snigdhaṃ mūtraṃ ghanaṃ sitam||47||
śleṣmaruddhabilo bastiḥ pittodīrṇo na sidhyati| avibhrāntabilaḥ sādhyo na tu yaḥ kuṇḍalīkṛtaḥ||48||
syādvastau kuṇḍalībhūte hṛnmohaḥ śvāsa 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- ½ 49]

Line of treatment of urinary morbidities

दोषाधिक्यमवेक्ष्यैतान् मूत्रकृच्छ्रहरैर्जयेत्||४९||
बस्तिमुत्तरबस्तिं च सर्वेषामेव दापयेत्|५०|
doṣādhikyamavekṣyaitān mūtrakṛcchraharairjayet||49||
bastimuttarabastiṃ ca sarveṣāmeva dāpayet|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 ½- ½ 50]

Netra (nozzle or catheter)

पुष्पनेत्रं तु हैमं स्याच्छ्लक्ष्णमौत्तरबस्तिकम्||५०||
जात्यश्वहनवृन्तेन समं गोपुच्छसंस्थितम्| रौप्यं वा सर्षपच्छिद्रं द्विकर्णं द्वादशाङ्गुलम्||५१||
puṣpanetraṃ tu haimaṃ syācchlakṣṇamauttarabastikam||50||
jātyaśvahanavṛntena samaṃ gopucchasaṃsthitam| raupyaṃ vā sarṣapacchidraṃ dvikarṇaṃ dvādaśāṅgulam||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= ¾ th of an inch approximately) [50 ½ -51]

Dose of recipe for douche

तेनाजबस्तियुक्तेन स्नेहस्यार्धपलं नयेत्| यथावयोविशेषेण स्नेहमात्रां विकल्प्य वा||५२||
tenājabastiyuktena snehasyārdhapalaṃ nayet| yathāvayoviśeṣeṇa snehamātrāṃ vikalpya vā||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

स्नातस्य भुक्तभक्तस्य रसेन पयसाऽपि वा| सृष्टविण्मूत्रवेगस्य पीठे जानुसमे मृदौ||५३||
ऋजोः सुखोपविष्टस्य हृष्टे मेढ्रे घृताक्तया| शलाकयाऽन्विष्य गतिं यद्यप्रतिहता व्रजेत्||५४||
ततः शेफःप्रमाणेन पुष्पनेत्रं प्रवेशयेत्| गुदवन्मूत्रमार्गेण प्रणयेदनु सेवनीम्||५५||
हिंस्यादतिगतं बस्तिमूने स्नेहो न गच्छति| सुखं प्रपीड्य निष्कम्पं निष्कर्षेन्नेत्रमेव च||५६||
प्रत्यागते द्वितीयं च तृतीयं च प्रदापयेत्|
snātasya bhuktabhaktasya rasena payasā’pi vā| sṛṣṭaviṇmūtravegasya pīṭhe jānusame mṛdau||53||
ṛjoḥ sukhopaviṣṭasya hṛṣṭe meḍhre ghṛtāktayā| śalākayā’nviṣya gatiṃ yadyapratihatā vrajet||54||
tataḥ śephaḥpramāṇena puṣpanetraṃ praveśayet| gudavanmūtramārgeṇa praṇayedanu sevanīm||55||
hiṃsyādatigataṃ bastimūne sneho na gacchati| sukhaṃ prapīḍya niṣkampaṃ niṣkarṣennetrameva ca||56||
pratyāgate dvitīyaṃ ca tṛtīyaṃ ca pradāpayet|

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- ½ 57]

Retention of douche-fluid

अनागच्छन्नुपेक्ष्यस्तु रजनीव्युषितस्य च||५७||
पिप्पलीलवणागारधूमापामार्गसर्षपैः| वार्ताकुरसनिर्गुण्डीशम्पाकैः ससहाचरैः||५८||
मूत्राम्लपिष्टैः सगुडैर्वर्तिं कृत्वा प्रवेशयेत्| अग्रे तु सर्षपाकारां पश्चार्धे माषसम्मिताम्||५९||
नेत्रदीर्घां घृताभ्यक्तां सुकुमारामभङ्गुराम्| नेत्रवन्मूत्रनाड्यां तु पायौ चाङ्गुष्ठसम्मिताम्||६०||
स्नेहे प्रत्यागते ताभ्यामानुवासनिको विधिः| परिहारश्च सव्यापत् ससम्यग्दत्तलक्षणः||६१||
anāgacchannupekṣyastu rajanīvyuṣitasya ca||57||
pippalīlavaṇāgāradhūmāpāmārgasarṣapaiḥ| vārtākurasanirguṇḍīśampākaiḥ sasahācaraiḥ||58||
mūtrāmlapiṣṭaiḥ saguḍairvartiṃ kṛtvā praveśayet| agre tu sarṣapākārāṃ paścārdhe māṣasammitām||59||
netradīrghāṃ ghṛtābhyaktāṃ sukumārāmabhaṅgurām| netravanmūtranāḍyāṃ tu pāyau cāṅguṣṭhasammitām||60||
snehe pratyāgate tābhyāmānuvāsaniko vidhiḥ| parihāraśca savyāpat sasamyagdattalakṣaṇaḥ||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

स्त्रीणामार्तवकाले तु प्रतिकर्म तदाचरेत्| गर्भासना सुखं स्नेहं तदाऽऽदत्ते ह्यपावृता||६२||
गर्भं योनिस्तदा शीघ्रं जिते गृह्णाति मारुते| बस्तिजेषु विकारेषु योनिविभ्रंशजेषु च||६३||
योनिशूलेषु तीव्रेषु योनिव्यापत्स्वसृग्दरे| अप्रस्रवति मूत्रे च बिन्दुं बिन्दुं स्रवत्यपि||६४||
विदध्यादुत्तरं बस्तिं यथास्वौषधसंस्कृतम् |६५|
strīṇāmārtavakāle tu pratikarma tadācaret| garbhāsanā sukhaṃ snehaṃ tadā”datte hyapāvṛtā||62||
garbhaṃ yonistadā śīghraṃ jite gṛhṇāti mārute| bastijeṣu vikāreṣu yonivibhraṃśajeṣu ca||63||
yoniśūleṣu tīvreṣu yonivyāpatsvasṛgdare| aprasravati mūtre ca binduṃ binduṃ sravatyapi||64||
vidadhyāduttaraṃ bastiṃ yathāsvauṣadhasaṃskṛtam |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

पुष्पनेत्रप्रमाणं तु प्रमदानां दशाङ्गुलम्||६५|| मूत्रस्रोतःपरीणाहं मुद्गस्रोतोऽनुवाहि च|
अपत्यमार्गे नारीणां विधेयं चतुरङ्गुलम्||६६|| द्व्यङ्गुलं मूत्रमार्गे तु बालायास्त्वेकमङ्गुलम्|
puṣpanetrapramāṇaṃ tu pramadānāṃ daśāṅgulam||65|| mūtrasrotaḥparīṇāhaṃ mudgasroto’nuvāhi ca|
apatyamārge nārīṇāṃ vidheyaṃ caturaṅgulam||66|| dvyaṅgulaṃ mūtramārge tu bālāyāstvekamaṅgulam|

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. [65½ -1/2 67]

Method of administering Uttara-Basti to Females

उत्तानायाः शयानायाः सम्यक् सङ्कोच्य सक्थिनी||६७|| अथास्याः प्रणयेन्नेत्रमनुवंशगतं सुखम्|
द्विस्त्रिश्चतुरिति स्नेहानहोरात्रेण योजयेत्||६८|| बस्तौ , बस्तौ प्रणीते च वर्तिः पीनतरा भवेत्|त्रिरात्रं कर्म कुर्वीत स्नेहमात्रां विवर्धयेत्||६९|| अनेनैव विधानेन कर्म कुर्यात् पुनस्त्र्यहात्|७०|
uttānāyāḥ śayānāyāḥ samyak saṅkocya sakthinī||67||
athāsyāḥ praṇayennetramanuvaṃśagataṃ sukham|
dvistriścaturiti snehānahorātreṇa yojayet||68|| bastau , bastau praṇīte ca vartiḥ pīnatarā bhavet|trirātraṃ karma kurvīta snehamātrāṃ vivardhayet||69|| anenaiva vidhānena karma kuryāt punastryahāt|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 ½- ½ 70]

Diseases of Head

अतः शिरोविकाराणां कश्चिद्भेदः प्रवक्ष्यते||७०||
ataḥ śirovikārāṇāṃ kaścidbhedaḥ pravakṣyate||70||

Hereafter we shall describe some diseases of the head (Shiro-Roga). [70 ½]

Hereafter we shall describe some diseases of the head (Shiro-Roga). [70 ½]

Sankhaka

रक्तपित्तानिला दुष्टाः शङ्खदेशे विमूर्च्छिताः| तीव्ररुग्दाहरागं हि शोफं कुर्वन्ति दारुणम्||७१||
स शिरो विषवद्वेगी निरुध्याशु गलं तथा| त्रिरात्राज्जीवितं हन्ति शङ्खको नाम नामतः||७२||
परं त्र्यहाज्जीवति चेत् प्रत्याख्यायाचरेत् क्रियाम्| शिरोविरेकसेकादि सर्वं वीसर्पनुच्च यत्||७३||
raktapittānilā duṣṭāḥ śaṅkhadeśe vimūrcchitāḥ| tīvrarugdāharāgaṃ hi śophaṃ kurvanti dāruṇam||71||
sa śiro viṣavadvegī nirudhyāśu galaṃ tathā| trirātrājjīvitaṃ hanti śaṅkhako nāma nāmataḥ||72||
paraṃ tryahājjīvati cet pratyākhyāyācaret kriyām| śirovirekasekādi sarvaṃ vīsarpanucca 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 ½- 73]
Read: Shankaka Shiroroga – Causes, Symptoms, Treatment

Etiology, Signs and Treatment of Ardhavadhedaka (Hemicrania)

रूक्षात्यध्यशनात् पूर्ववातावश्यायमैथुनैः| वेगसन्धारणायासव्यायामैः कुपितोऽनिलः||७४||
केवलः सकफो वाऽर्धं गृहीत्वा शिरसस्ततः| मन्याभ्रूशङ्खकर्णाक्षिललाटार्धेऽतिवेदनाम्||७५||
शस्त्रारणिनिभां कुर्यात्तीव्रां सोऽर्धावभेदकः| नयनं वाऽथवा श्रोत्रमतिवृद्धो विनाशयेत्||७६||
चतुःस्नेहोत्तमा मात्रा शिरःकायविरेचनम्| नाडीस्वेदो घृतं जीर्णं बस्तिकर्मानुवासनम्||७७||
उपनाहः शिरोबस्तिर्दहनं चात्र शस्यते| प्रतिश्याये शिरोरोगे यच्चोद्दिष्टं चिकित्सितम्||७८||
rūkṣātyadhyaśanāt pūrvavātāvaśyāyamaithunaiḥ| vegasandhāraṇāyāsavyāyāmaiḥ kupito’nilaḥ||74||
kevalaḥ sakapho vā’rdhaṃ gṛhītvā śirasastataḥ| manyābhrūśaṅkhakarṇākṣilalāṭārdhe’tivedanām||75||
śastrāraṇinibhāṃ kuryāttīvrāṃ so’rdhāvabhedakaḥ| nayanaṃ vā’thavā śrotramativṛddho vināśayet||76||
catuḥsnehottamā mātrā śiraḥkāyavirecanam| nāḍīsvedo ghṛtaṃ jīrṇaṃ bastikarmānuvāsanam||77||
upanāhaḥ śirobastirdahanaṃ cātra śasyate| pratiśyāye śiroroge yaccoddiṣṭaṃ 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 enema
• Upanaha (Application of hot poultice)
• Shiro- basti (Keeping medicated oil over head with the help of a cap with open ends)
• Dahana (cauterization) and
• Therapies prescribed for Pratisyaya and Shiro-Roga (head- diseases) [74-78]
  Read: Ardhavabhedaka Shiroroga – Causes, Symptoms, Treatment

Etiology, signs and Treatment of Suryavarta

सन्धारणादजीर्णाद्यैर्मस्तिष्कं रक्तमारुतौ| दुष्टौ दूषयतस्तच्च दुष्टं ताभ्यां विमूर्च्छितम्||७९||
सूर्योदयेंऽशुसन्तापाद्द्रवं विष्यन्दते शनैः| ततो दिने शिरःशूलं दिनवृद्ध्या विवर्धते||८०||
दिनक्षये ततः स्त्याने मस्तिष्के सम्प्रशाम्यति| सूर्यावर्तः स तत्र स्यात् सर्पिरौत्तरभक्तिकम्||८१||
शिरःकायविरेकौ च मूर्ध्ना त्रिस्नेहधारणम् | जाङ्गलैरुपनाहश्च घृतक्षीरैश्च सेचनम् [३] ||८२||
बर्हितित्तिरिलावादिशृतक्षीरोत्थितं घृतम्| स्यान्नावनं जीवनीयक्षीराष्टगुणसाधितम्||८३||
sandhāraṇādajīrṇādyairmastiṣkaṃ raktamārutau| duṣṭau dūṣayatastacca duṣṭaṃ tābhyāṃ vimūrcchitam||79||
sūryodayeṃ’śusantāpāddravaṃ viṣyandate śanaiḥ| tato dine śiraḥśūlaṃ dinavṛddhyā vivardhate||80||
dinakṣaye tataḥ styāne mastiṣke sampraśāmyati| sūryāvartaḥ sa tatra syāt sarpirauttarabhaktikam||81||
śiraḥkāyavirekau ca mūrdhnā trisnehadhāraṇam | jāṅgalairupanāhaśca ghṛtakṣīraiśca secanam [3] ||82||
barhitittirilāvādiśṛtakṣīrotthitaṃ ghṛtam| syānnāvanaṃ jīvanīyakṣīrāṣṭaguṇasādhitam||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 and
• Milk 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

(उपवासातिशोकातिरूक्षशीताल्पभोजनैः)|
दुष्टा दोषास्त्रयो मन्यापश्चाद्घाटासु [२] वेदनाम्||८४|| तीव्रां कुर्वन्ति सा चाक्षिभ्रूशङ्खेष्ववतिष्ठते|
स्पन्दनं गण्डपार्श्वस्य नेत्ररोगं हनुग्रहम्||८५|| सोऽनन्तवातस्तं हन्यात् सिरार्कावर्तनाशनैः|
(upavāsātiśokātirūkṣaśītālpabhojanaiḥ)|
duṣṭā doṣāstrayo manyāpaścādghāṭāsu [2] vedanām||84|| tīvrāṃ kurvanti sā cākṣibhrūśaṅkheṣvavatiṣṭhate|
spandanaṃ gaṇḍapārśvasya netrarogaṃ hanugraham||85|| so’nantavātastaṃ hanyāt sirārkāvartanāśanaiḥ|

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

वातो रूक्षादिभिः क्रुद्धः शिरःकम्पमुदीरयेत्||८६|| तत्रामृताबलारास्नामहाश्वेताश्वगन्धकैः|
स्नेहस्वेदादि वातघ्नं शस्तं नस्यं च तर्पणम्||८७||
vāto rūkṣādibhiḥ kruddhaḥ śiraḥkampamudīrayet||86|| tatrāmṛtābalārāsnāmahāśvetāśvagandhakaiḥ|
snehasvedādi vātaghnaṃ śastaṃ nasyaṃ ca tarpaṇam||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 ½ – 87]

Importance of inhalation therapy

नस्तःकर्म च कुर्वीत शिरोरोगेषु शास्त्रविद्| द्वारं हि शिरसो नासा तेन तद् व्याप्य हन्ति तान्||८८||
nastaḥkarma ca kurvīta śirorogeṣu śāstravid| dvāraṃ hi śiraso nāsā tena tad vyāpya hanti tān||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

नावनं चावपीडश्च ध्मापनं धूम एव च| प्रतिमर्शश्च विज्ञेयं नस्तःकर्म तु पञ्चधा||८९||
स्नेहनं शोधनं चैव द्विविधं नावनं स्मृतम्| शोधनः स्तम्भनश्च स्यादवपीडो द्विधा मतः ||९०||
चूर्णस्याध्मापनं तद्धि देहस्रोतोविशोधनम्| विज्ञेयस्त्रिविधो धूमः प्रागुक्तः शमनादिकः||९१||
प्रतिमर्शो भवेत् स्नेहो निर्दोष उभयार्थकृत्| एवं तद्रेचनं कर्म तर्पणं शमनं त्रिधा||९२||
nāvanaṃ cāvapīḍaśca dhmāpanaṃ dhūma eva ca| pratimarśaśca vijñeyaṃ nastaḥkarma tu pañcadhā||89||
snehanaṃ śodhanaṃ caiva dvividhaṃ nāvanaṃ smṛtam| śodhanaḥ stambhanaśca syādavapīḍo dvidhā mataḥ ||90||
cūrṇasyādhmāpanaṃ taddhi dehasrotoviśodhanam| vijñeyastrividho dhūmaḥ prāguktaḥ śamanādikaḥ||91||
pratimarśo bhavet sneho nirdoṣa ubhayārthakṛt| evaṃ tadrecanaṃ karma tarpaṇaṃ śamanaṃ tridhā||92||

Inhalation therapy is of five types as follows:

1. 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);
2. 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);

3. Dhmapana (insufflations of drugs in powder form through the Nasal passage) – It cleanses the channels of the body;
4. 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

5. 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

स्तम्भसुप्तिगुरुत्वाद्याः श्लैष्मिका ये शिरोगदाः| शिरोविरेचनं तेषु नस्तःकर्म प्रशस्यते||९३||
ये च वातात्मका रोगाः शिरःकम्पार्दितादयः| शिरसस्तर्पणं तेषु नस्तःकर्म प्रशस्यते ||९४||
क्तपित्तादिरोगेषु शमनं नस्यमिष्यते| ध्मापनं धूमपानं च तथा योग्येषु शस्यते ||९५||
(दोषादिकं समीक्ष्यैव भिषक् सम्यक् च कारयेत्)|९६|
stambhasuptigurutvādyāḥ ślaiṣmikā ye śirogadāḥ| śirovirecanaṃ teṣu nastaḥkarma praśasyate||93||
ye ca vātātmakā rogāḥ śiraḥkampārditādayaḥ| śirasastarpaṇaṃ teṣu nastaḥkarma praśasyate ||94||
raktapittādirogeṣu śamanaṃ nasyamiṣyate| dhmāpanaṃ dhūmapānaṃ ca tathā yogyeṣu śasyate ||95||
(doṣādikaṃ samīkṣyaiva bhiṣak samyak ca kārayet)|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- ½ 96]

Drugs for Virechana and Tarpana Nasya

फलादिभेषजं प्रोक्तं शिरसो यद्विरेचनम्||९६|| तच्चूर्णं कल्पयेत्तेन पचेत् स्नेहं विरेचनम्|
यदुक्तं मधुरस्कन्धे भेषजं तेन तर्पणम्||९७||
phalādibheṣajaṃ proktaṃ śiraso yadvirecanam||96|| taccūrṇaṃ kalpayettena pacet snehaṃ virecanam|
yaduktaṃ madhuraskandhe bheṣajaṃ tena tarpaṇam||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

साधयित्वा भिषक् स्नेहं नस्तः कुर्याद्विधानवित्|९८|
प्राक्सूर्ये मध्यसूर्ये वा प्राक्कृतावश्यकस्य च||९८|| उत्तानस्य शयानस्य शयने स्वास्तृते सुखम्|
प्रलम्बशिरसः किञ्चित् किञ्चित् पादोन्नतस्य च||९९|| दद्यान्नासापुटे स्नेहं तर्पणं बुद्धिमान् भिषक्|
अनवाक्शिरसो नस्यं न शिरः प्रतिपद्यते||१००|| अत्यवाक्शिरसो नस्यं मस्तुलुङ्गेऽवतिष्ठति|
अत एवंशयानस्य शुद्ध्यर्थं स्वेदयेच्छिरः||१०१|| संस्वेद्य नासामुन्नम्य वामेनाङ्गुष्ठपर्वणा|
हस्तेन दक्षिणेनाथ कुर्यादुभयतः समम्||१०२|| प्रणाड्या पिचुना वाऽपि नस्तःस्नेहं यथाविधि|
कृते च स्वेदयेद्भूय आकर्षेच्च पुनः पुनः||१०३|| तं स्नेहं श्लेष्मणा साकं तथा स्नेहो न तिष्ठति|
स्वेदेनोत्क्लेशितः श्लेष्मा नस्तःकर्मण्युपस्थितः ||१०४|| भूयः स्नेहस्य शैत्येन शिरसि स्त्यायते ततः|
श्रोत्रमन्यागलाद्येषु विकाराय स कल्पते||१०५|| ततो नस्तःकृते धूमं पिबेत् कफविनाशनम् |
हितान्नभुङ्निवातोष्णसेवी स्यान्नियतेन्द्रियः||१०६|| विधिरेषोऽवपीडस्य कार्यः प्रध्मापनस्य तु|
sādhayitvā bhiṣak snehaṃ nastaḥ kuryādvidhānavit|98|
prāksūrye madhyasūrye vā prākkṛtāvaśyakasya ca||98|| uttānasya śayānasya śayane svāstṛtesukham|
pralambaśirasaḥ kiñcit kiñcit pādonnatasya ca||99|| dadyānnāsāpuṭe snehaṃ tarpaṇaṃ buddhimān bhiṣak|
anavākśiraso nasyaṃ na śiraḥ pratipadyate||100|| atyavākśiraso nasyaṃ mastuluṅge’vatiṣṭhati|
ata evaṃśayānasya śuddhyarthaṃ svedayecchiraḥ||101|| saṃsvedya nāsāmunnamya vāmenāṅguṣṭhaparvaṇā|
hastena dakṣiṇenātha kuryādubhayataḥ samam||102|| praṇāḍyā picunā vā’pi nastaḥsnehaṃ yathāvidhi|
kṛte ca svedayedbhūya ākarṣecca punaḥ punaḥ||103|| taṃ snehaṃ śleṣmaṇā sākaṃ tathā sneho na tiṣṭhati|
svedenotkleśitaḥ śleṣmā nastaḥkarmaṇyupasthitaḥ ||104|| bhūyaḥ snehasya śaityena śirasi styāyate tataḥ|
śrotramanyāgalādyeṣu vikārāya sa kalpate||105|| tato nastaḥkṛte dhūmaṃ pibet kaphavināśanam |
hitānnabhuṅnivātoṣṇasevī syānniyatendriyaḥ||106|| vidhireṣo’vapīḍasya kāryaḥ pradhmāpanasya 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 ½- ½ 107]

Pradhaman Type of Inhalation therapy

तत् षडङ्गुलया नाड्या धमेच्चूर्णं मुखेन तु||१०७|| विरिक्तशिरसं तूष्णं पाययित्वाऽम्बु भोजयेत्|
लघु त्रिष्वविरुद्धं च निवातस्थमतन्द्रितः||१०८|| विरेकशुद्धो दोषस्य कोपनं यस्य सेवते|
स दोषो विचरंस्तत्र करोति स्वान् गदान् बहून् ||१०९|| यथास्वं विहितां तेषु क्रियां कुर्याद्विचक्षणः|
अकालकृतजातानां रोगाणामनुरूपतः||११०||
tat ṣaḍaṅgulayā nāḍyā dhameccūrṇaṃ mukhena tu||107|| viriktaśirasaṃ tūṣṇaṃ pāyayitvā’mbu bhojayet|
laghu triṣvaviruddhaṃ ca nivātasthamatandritaḥ||108|| virekaśuddho doṣasya kopanaṃ yasya sevate|
sa doṣo vicaraṃstatra karoti svān gadān bahūn ||109|| yathāsvaṃ vihitāṃ teṣu kriyāṃ kuryādvicakṣaṇaḥ|
akālakṛtajātānāṃ rogāṇāmanurūpataḥ||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 ½- 110]

Complications arising out of Kapha and Their Treatment

अजीर्णे भोजने भुक्ते तोये पीतेऽथ दुर्दिने| प्रतिश्याये नवे स्नाते स्नेहपानेऽनुवासने||१११||
नावनं स्नेहनं रोगान् करोति श्लैष्मिकान् बहून्| तत्र श्लेष्महरः सर्वस्तीक्ष्णोष्णादिर्विधिर्हितः||११२||
ajīrṇe bhojane bhukte toye pīte’tha durdine| pratiśyāye nave snāte snehapāne’nuvāsane||111||
nāvanaṃ snehanaṃ rogān karoti ślaiṣmikān bahūn| tatra śleṣmaharaḥ sarvastīkṣṇoṣṇādirvidhirhitaḥ||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

क्षामे विरेचिते गर्भे व्यायामाभिहते तृषि| वातो रूक्षेण नस्येन क्रुद्धः स्वाञ्जनयेद्गदान्||११३||
तत्र वातहरः सर्वो विधिः स्नेहनबृंहणः| स्वेदादिः, स्याद्घृतं क्षीरं गर्भिण्यास्तु विशेषतः||११४||
kṣāme virecite garbhe vyāyāmābhihate tṛṣi| vāto rūkṣeṇa nasyena kruddhaḥ svāñjanayedgadān||113||
tatra vātaharaḥ sarvo vidhiḥ snehanabṛṃhaṇaḥ| svedādiḥ, syādghṛtaṃ kṣīraṃ garbhiṇyāstu viśeṣataḥ||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 emaciated
• If the patient has taken purgation therapy
• If the patient (woman) is pregnant
• If the patient is afflicted with hard work and
• If 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

ज्वरशोकातितप्तानां तिमिरं मद्यपस्य तु| रूक्षैः शीताञ्जनैर्लेपैः पुटपाकैश्च साधयेत् ||११५||
jvaraśokātitaptānāṃ timiraṃ madyapasya tu| rūkṣaiḥ śītāñjanairlepaiḥ puṭapākaiśca sādhayet ||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

स्नेहनं शोधनं चैव द्विविधं नावनं मतम्| प्रतिमर्शस्तु नस्यार्थं करोति न च दोषावान्||११६||
नस्तः स्नेहाङ्गुलिं दद्यात् प्रातर्निशि च सर्वदा| न चोच्छिङ्घेदरोगाणां प्रतिमर्शः स दार्ढ्यकृत्||११७||
snehanaṃ śodhanaṃ caiva dvividhaṃ nāvanaṃ matam| pratimarśastu nasyārthaṃ karoti na ca doṣāvān||116||
nastaḥ snehāṅguliṃ dadyāt prātarniśi ca sarvadā| na cocchiṅghedarogāṇāṃ pratimarśaḥ sa dārḍhyakṛt||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.

तत्र श्लोकौ-
त्रीणि यस्मात् प्रधानानि मर्माण्यभिहतेषु च| तेषु लिङ्गं चिकित्सां च रोगभेदाश्च सौषधाः||११८||
विधिरुत्तरबस्तेश्च नस्तःकर्मविधिस्तथा| सव्यापद्भेषजं सिद्धौ मर्माख्यायां प्रकीर्तितम्||११९||
trīṇi yasmāt pradhānāni marmāṇyabhihateṣu ca| teṣu liṅgaṃ cikitsāṃ ca rogabhedāśca sauṣadhāḥ||118||
vidhiruttarabasteśca nastaḥkarmavidhistathā| savyāpadbheṣajaṃ siddhau marmākhyāyāṃ prakīrtitam||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 ½- 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 ½- 117) [118-119]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते सिद्धिस्थाने त्रिमर्मीयसिद्धिर्नाम नवमोऽध्यायः||९||
ityagniveśakṛte tantre carakapratisaṃskṛte’prāpte dṛḍhabalasampūrite siddhisthāne trimarmīyasiddhirnāma navamo’dhyāyaḥ||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.