Ashtanga Hridayam Nidanasthanam Chapter 6:  Madatyayadi Nidanam Adhyaya (Diagnosis of Alcoholic intoxication)

The 6th chapter of Nidanasthanam of Ashtanga Hridayam is named as Madatyayadi Nidanam Adhyayah. This chapter deals with the explanation of ‘diagnosis of alcoholic intoxication etc’.

The topics covered in this chapter include –

–       Madya Guna – Properties of wine
–       Prathama Mada – first stage of intoxication
–       Dvitiya Mada – second stage of intoxication
–       Tritiya Mada – third stage of intoxication
–       Madhyapana Dushpala – hazards of drinking wine
–       Persons who get intoxicated with difficulty and those who get intoxicated easily
–       Madatyaya Bheda – kinds of intoxication
–       Samanya Lakshana – common symptoms of intoxication
–       Intoxication caused by vata, pitta, kapha and all doshas
–       Dhwamsaka and Vikshaya type of intoxication and their symptoms
–       Causes of mada, murcha and sanyasa
–       Mada nidana – diagnosis of intoxication
–       Symptoms of different kinds of mada (intoxication)
–       Murcha nidanam – diagnosis of fainting
–       Sannyasa nidana – diagnosis of coma
–       Judicious consumption of wine
–       Wine acting like nectar

Pledge by the author(s)      

अथातो मदात्ययादिनिदानं व्याख्यास्याम ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘diagnosis of alcoholic intoxication etc’. Thus say (pledge) atreya and other sages.

Madya Guna (properties of wine)

तीक्ष्णोष्णरूक्षसूक्ष्माम्लं व्यवाय्याशुकरं लघु ।
विकाषि विशदं मद्यमोजसोऽस्माद्विपर्ययः ॥ १ ॥
तीक्ष्णादयो विषेऽप्युक्ताश्चित्तोपप्लाविनो गुणाः ।
जीवितान्ताय जायन्ते विषे तूत्कर्षवृत्तितः ॥ २ ॥
Madya (wine) is penetrating (deep into the tissues), hot (heat producing dry) non-unctous and causing dryness, entering even into minute pores, sour in taste, spreading all over the body first and then undergoing cooking (transformation), quick in action, easily digestible, causing looseness of the bindings of the joints and non-slimy; hence it is opposite of (antagonistic to) ojas (the essence of Dhatus). Tikshna and other properties which produce disorders of the mind, which are also found in poison, cause the end of life especially in poison because of their very potent activity.

Notes: Madya includes all types of alcoholic beverages which produce intoxication. Tiksna and such other properties present in alcoholic drinks are mild in action hence they do not kill the person but only cause disorders of the mild, whereas in poison, these properties are powerful and so kill the person.

Prathama Mada (first stage of intoxication)

तीक्ष्णादिभिर्गुणैर्मद्यं मन्दादीनोजसो गुणान् ।
दशभिर्दश सङ्क्षोभ्य चेतो नयति विक्रियाम् ॥ ३ ॥
आद्ये मदे
By Tiksna and other ten qualities, wine destroys Manda and other ten qualities of Ojas, and brings about increased activities of the mind in the first stage.

Dvitiya Mada (second stage)

द्वितीये तु प्रमादायतने स्थितः ।
दुर्विकल्पहतो मूढः सुखमित्यधिमुच्यते ॥ ४ ॥
मध्यमोत्तमयोः सन्धिं प्राप्य राजसतामसः ।
निरङ्कुश इव व्यालो न किञ्चिन्नाचरेज्जडः ॥ ५ ॥
इयं भूमिरवद्यानां दौःशील्यस्येदमास्पदम् ।
एकोऽयं बहुमार्गाय दुर्गतेर्देशिकः परम् ॥ ६ ॥
In the second, the person remains at the path of (border line of) wrongful (adventurous) activities, the ignorant one, infatuated by wrong thinking (and judgment) assuming them to be happy (good) ones. Remaining between the middle and higher stages attaining the predominance of Rajas and Tamas (primary qualities), he does not refrain from wrong activities just as a wild elephant which is deaf and unrestrained (begins to commit all sorts of bad actions). This is the stage for all bad activities; it is the commencement of all vices. Madya (wine) alone is the chief among the innumerable ways of ruin (self destruction) say the wise.

Tritiya Mada (third stage)

निश्चेष्टः शववच्छेते तृतीये तु मदे स्थितः ।
मरणादपि पापात्मा गतः पापतरां दशाम् ॥ ७ ॥
In the third stage of intoxication, the person lies on the ground, movement–less like a cadaver, a greater sinner than the one who dead, going through different stage of grave sins.

Madyapana Dushphala (hazards of drinking wine)

धर्माधर्मं सुखं दुःखमर्थानर्थं हिताहितम् ।
यदासक्तो न जानाति कथं तच्छीलयेद्बुधः ॥ ८ ॥
मद्ये मोहो भयं शोकः क्रोधो मृत्युश्च संश्रिताः ।
सोन्मादमदमूर्छायाः सापस्मारापतानकाः ॥ ९ ॥
यत्रैकः स्मृतिविभ्रंशस्तत्र सर्वमसाधु यत् ।
अयुक्तियुक्तमन्नं हि व्याधये मरणाय वा ॥ १० ॥
मद्यं त्रिवर्गधीधैर्यलज्जादेरपि नाशनम् ।
He who is addicted (to wine) does not understand, which is right and which is wrong, which is happiness and which is unhappiness, which is beneficial and which is non-beneficial (for the present and future lives) which is suitable and which is unsuitable (to his health, right living etc.); (with these bad effects) how do the wise indulge in it. In the wine, reside delusion, fear, grief, anger and even death, so also insanity, infatuation, fainting, epilepsy, and tetanus (convulsion). When loss of memory (awareness of surroundings, common sense etc.) alone is present then all the activities (of the persons) shall be improper (what to say when all the others are present). Food partaken in wrong way leads to either diseases or death. While wine (consumed in wrong way) leads even to loss of the three pursuits of life (Dharma, Artha and Kama) intelligence, courage, shame etc.

Persons who get intoxicated with difficulty and those who get intoxicated easily

नातिमाद्यन्ति बलिनः कृताहारा महाशनाः ॥ ११ ॥
स्निग्धाः सत्त्ववयोयुक्ता मद्यनित्यास्तदन्वयाः ।
मेदःकफाधिका मन्दवातपित्ता दृढाग्नयः ॥ १२ ॥
विपर्ययेऽतिमाद्यन्ति विश्रब्धाः कुपिताश्च ये ।
मद्येन चाम्लरूक्षेण साजीर्णे बहुनाति च ॥ १३ ॥
Persons who are strong, who have taken food, who consume more quantity of food (habitually), who are fatty, those endowed with (strong) mind and age (youth), who take wine daily (as a habit) and who belong to such a family; who have more of fat and Kapha and less of Vata and Pitta (in their constitution) and who have strong fire (digestive activity) do not get intoxicated greatly. Persons who are opposite of the above, who appreciate its properties, who are in anger get intoxicated greatly; especially so, by wines which are very sour and dry (non-unctous) if it is not digested, consumed in large quantity and too often (frequently).

Madatyaya Bheda (Kinds of intoxication)

वातात्पित्तात्कफात्सर्वैश्चत्वारः स्युर्मदात्ययाः ।
सर्वेऽपि सर्वैर्जायन्ते व्यपदेशस्तु भूयसा ॥ १४ ॥
Alcoholic intoxication is of four kinds viz., from Vata, Pitta, Kapha (individually) and from all of them together. All varieties of intoxication arise from all the Doshas (together undergoing increase) but the naming (of each kind as Vataja etc) is based on the predominance (of the Dosha)

Samanya Lakshana (general symptoms)

सामान्यं लक्षणं तेषां प्रमोहो हृदयव्यथा ।
विड्भेदः प्रततं तृष्णा सौम्याग्नेयो ज्वरोऽरुचिः ॥ १५ ॥
शिरःपार्श्वास्थिरुक्कम्पो मर्मभेदस्त्रिकग्रहः ।
उरोविबन्धस्तिमिरं कासः श्वासः प्रजागरः ॥ १६ ॥
स्वेदोऽतिमात्रं विष्टम्भः श्वयथुश्चित्तविभ्रमः ।
प्रलापश्छर्दिरुत्क्लेशो भ्रमो दुःस्वप्नदर्शनम् ॥ १७ ॥
The common symptoms of them are – profound delusion, discomfort in the region of the heart, diarrhea, constant thirst, mild or severe fever, loss of taste and appetite, pain in the head, flanks and bones; tremors, cutting pain in the vital spots, catching pain in the upper back constriction in the chest, blindness (or coma), cough, dyspnea / breathlessness, sleeplessness, excessive sweating, constipation, swelling, disorders of the mind, irrelevant talk, vomiting, nausea, dizziness and seeing bad dreams.

Vataja Madatyaya – intoxication caused by vata

विशेषाज्जागरश्वासकम्पमूर्धरुजोऽनिलात् ।
स्वप्ने भ्रमत्युत्पतति प्रेतैश्च सह भाषते ॥ १८ ॥
Loss of sleep, dyspnea, tremors, headache, seeing dreams such as roaming from place to place, falling from the sky and talking with devils – are specially of Vataja kind

Pittaja Madatyaya – intoxication caused by pitta

पित्ताद्दाहज्वरस्वेदमोहातीसारतृड्भ्रमाः ।
देहो हरितहारिद्रो रक्तनेत्रकपोलता ॥ १९ ॥
Burning sensation, fever, perspiration, delusion, diarrhea, thirst, dizziness, green or yellow discoloration of the body, red color of the eyes and cheeks – are especially of Pittaja kind.

Kaphaja & Sarvaja Madatyaya – intoxication caused by kapha and all doshas

श्लेष्मणा छर्दिहृल्लासनिद्रोदर्दाङ्गगौरवम् ।
सर्वजे सर्वलिङ्गत्वं
Vomiting, nausea sleep, appearance of rashes on the skin and feeling of heaviness of the body – are especially of Kaphaja kind. All the symptoms will be found in that caused by all the Doshas.

Dhwamsaka and Vikshaya type of intoxication

मुक्त्वा मद्यं पिबेत्तु यः ॥ २० ॥
सहसानुचितं वान्यत्तस्य ध्वंसकविक्षयौ ।
भवेतां मारुतात्कष्टौ दुर्बलस्य विशेषतः ॥ २१ ॥
He who discontinued drinking wine for some time begins to take it again suddenly or starts drinking another kind to which he is not accustomed becomes victim of Dhvamsaka and Viksaya which arise from Maruta (Vata); these are difficult to cure especially in the weak.

Symptoms of Dhwamsaka and Vikshaya type of intoxication

ध्वंसके श्लेष्मनिष्ठीवः कण्ठशोषोऽतिनिद्रता ।
शब्दासहत्वं तन्द्रा च विक्षयेऽङ्गशिरोऽतिरुक् ॥ २२ ॥
हृत्कण्ठरोगः सम्मोहः कासस्तृष्णा वमिर्ज्वरः ।
In Dhvamsaka, expectoration of sputum, dryness of the throat, more of sleep, inability to bear noise and stupor manifest. In Viksaya, severe pain in the body and head, disorders of the heart and throat, delusion, cough; thirst, vomiting, and fever are the symptoms

Conditions wherein intoxication doesn’t affect body and mind

निवृत्तो यस्तु मद्येभ्यो जितात्मा बुद्धिपूर्वकृत् ॥ २३ ॥
विकारैः स्पृश्यते जातु न स शारीरमानसैः ।
He who was discontinued drinking wine, who exercising control over his own self, if acts with intelligence (discrimination), (he) does not get affected by diseases of the body and mind.

Causes of Mada, Murcha and Sannyasa

रजोमोहाहिताहारपरस्य स्युस्त्रयो गदाः ॥ २४ ॥
रसासृक्चेतनावाहिस्रोतोरोधसमुद्भवाः । 
मदमूर्छायसन्न्यासा यथोत्तरबलोत्तराः ॥ २५ ॥
Three diseases – Mada (intoxication) Murcha (fainting) and Sannyasa (total loss of consciousness) each succeeding one stronger than its preceding, affect persons who are constantly engaged in Rajas (over – activity), Moha (indiscriminate actions) and unsuitable foods; these arise from the obstruction of channels of Rasa (plasma), Asrk (blood) and Cetana (consciousness).

Mada Nidana (diagnosis of intoxication)

मदोऽत्र दोषैः सर्वैश्च रक्तमद्यविषैरपि ।
Mada (intoxication) arises from the Doshas separately and from all of them together; by the blood, wine and poisons.

Symptoms of different kinds of Mada (intoxication)

सक्तानल्पद्रुताभाषश्चलः स्खलितचेष्टितः ॥ २६ ॥
रूक्षश्यावारुणतनुर्मदे वातोद्भवे भवेत् ।
पित्तेन क्रोधनो रक्तपीताभः कलहप्रियः ॥ २७ ॥
स्वल्पसम्बद्धवाक् पाण्डुः कफाद्ध्यानपरोऽलसः ।
सर्वात्मा सन्निपातेन रक्तात्स्तब्धाङ्गदृष्टिता ॥ २८ ॥
पित्तलिङ्गं च मद्येन विकृतेहस्वराङ्गता ।
विषे कम्पोऽतिनिद्रा च सर्वेभ्योऽभ्यधिकस्तु सः ॥ २९ ॥
लक्षयेल्लक्षणोत्कर्षाद्वातादीन् शोणितादिषु ।
Speech is obstructed, become less or fast, non-syllabic and unsteady; activities hindered in the middle, body becoming dry and blackish – red, these are symptoms of intoxication of Vata origin. In that of Pitta origin, the person is in anger, body reddish yellow and is fond of quarrel. In that of Kapha origin, the person speaks very less with mingling of words, body is yellowish – white (pale), is always found worrying and lazy (unenthusiastic). In that caused by all (the Doshas), all the symptoms will be found simultaneously. In that due to blood (sight of blood or effect of increased volume) the body is stiff, gaze fixed and other symptoms of Pitta are present. In that due to wine (drinking alcoholic beverages in excess) all the activities of speech and body are irregular. In that due to poison, there will be tremors and too much of sleep. This intoxication is more powerful than all others. In these kinds such as from blood etc. Vata and others (Doshas) should be determined by the predominance of symptoms

Thus ends the diagnosis of Mada (intoxication).

Murcha Nidanam (diagnosis of fainting, unconsciousness of short duration)

अरुणं कृष्णनीलं वा खं पश्यन्प्रविशेत्तमः ॥ ३० ॥
शीघ्रं च प्रतिबुध्येत हृत्पीडा वेपथुर्भ्रमः ।
कार्श्यं श्यावारुणा छाया मूर्छाये मारुतात्मके ॥ ३१ ॥
पित्तेन रक्तं पीतं वा नभः पश्यन् विशेत्तमः ।
विबुध्येत च सस्वेदो दाहतृट्तापपीडितः ॥ ३२ ॥
भिन्नविण्नीलपीताभो रक्तपीताकुलेक्षणः ।
कफेन मेघसङ्काशं पश्यन्नाकाशमाविशेत् ॥ ३३ ॥
तमश्चिराच्च बुध्येत सहृल्लासः प्रसेकवान् ।
गुरुभिः स्तिमितैरङ्गैरार्द्रचर्मावनद्धवत् ॥ ३४ ॥
सर्वाकृतिस्त्रिभिर्दोषैरपस्मार इवापरः ।
पातयत्याशु निश्चेष्टं विना बीभत्सचेष्टितैः ॥ ३५ ॥
The person sees the sky (surrounding space) to be light red, black or blue in color, enters into darkness (becomes unconscious) and wakes up (regains consciousness) soon; pain in the region of the heart, tremors, dizziness, emaciation, blackish – red complexion are the symptoms of Murcha (fainting) caused by Vata. In that caused by Pitta, the person sees the sky to be red or yellow, becomes unconscious and wakes up quick; sweating, burning sensation, thirst, increased heat, diarrhea, feces are blue or yellow, eyes red or yellow and gaze unsteady. In that due to Kapha, the person sees the sky to be full of clouds and becomes unconscious, wakes up after long time; associated with oppression in the heart, salivation, feeling of heaviness, restricted movements of the body as though covered with moist hide. In that caused by all the three Doshas, all the symptoms are present and the person appears like a patient of Apasmara (epilepsy), falling to the ground with loss of consciousness but without Bhibhatsacesta – horrifying movements (appearance of froth in the angles of the mouth, unusual sound from the throat, jerky movements of the arms and legs).

Thus ends the diagnosis of Murccha (fainting).

Sannyasa Nidana – diagnosis of coma (deep unconsciousness of long duration)

दोषेषु मदमूर्छायाः कृतवेगेषु देहिनाम् ।
स्वयमेवोपशाम्यन्ति सन्न्यासो नौषधैर्विना ॥ ३६ ॥
वाग्देहमनसां चेष्टामाक्षिप्यातिबला मलाः ।
सन्न्यासं सन्निपतिताः प्राणायतनसंश्रयाः ॥ ३७ ॥
कुर्वन्ति तेन पुरुषः काष्ठीभूतो मृतोपमः ।
म्रियेत शीघ्रं शीघ्रं चेच्चिकित्सा न प्रयुज्यते ॥ ३८ ॥
अगाधे ग्राहबहुले सलिलौघ इवाटते ।
सन्न्यासे विनिमज्जन्तं नरमाशु निवर्तयेत् ॥ ३९ ॥
In case of Mada (intoxication) and Murcha (fainting), the Doshas subside by themselves (without any treatment) soon after the bout (of unconsciousness) pass off; but in Sannyasa (coma) it does not happen so, without treatment. The Malas (Doshas) which are very strong, undergoing aggravation, together and getting localized in the seats of life, bring about impairment of the activities of speech, body and mind; because of this the person suffering from sanyasa appears like a log of wood and a dead man. He dies soon, if not treated quickly. The person who is sinking in the ocean of Sannyasa (coma) which is very deep, infested with many crocodiles, having huge waves and no shore should be abandoned soon

Judicious consumption of wine

मदमानरोषतोषप्रभृतिभिररिभिर्निजैः परिष्वङ्गः ।
युक्तायुक्तं च समं युक्तिवियुक्तेन मद्येन ॥ ४० ॥
By proper, improper and judicious use of wines, occur inseparable association of natural enemies such as infatuation, pride, anger, pleasure etc; hence only the judicious way should be adopted for obtaining moderation (in these qualities)

Wine acting like nectar

बलकालदेशसात्म्यप्रकृतिसहायामयवयांसि ।
प्रविभज्य तदनुरूपं यदि पिबति ततः पिबत्यमृतम् ॥ ४१ ॥
He who drinks wine, considering carefully, the Bala – (strength his own and of the wine), Kala (season, time of the day and night), Desa (place of residing and of drinking), Satmya (accustomed or unaccustomed kind of drink), Prakriti (his own constitution), Sahaya (help from others), Amaya (disease he is suffering from) and Vayas (age), suitable to all these – actually drinks nector.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया तृतीये निदानस्थाने मदात्ययादि निदानं नाम षष्टोऽध्याय: ।।१॥
Thus ends the chapter Madatyayadi Nidana – diagnosis of alcoholic intoxication etc, the sixth in Nidanasthana of Astangahrdaya Samhita composed by Srimad Vagbhata, son of Sri VaidyapatiSimhagupta.