Ashtanga Hridayam UttaraSthanam Chapter 20: Nasaroga Pratishedha (Treatment of Diseases of the Nose)

The 20th chapter of Uttara Sthanam of Ashtanga Hridayam is named as Nasaroga Pratishedham. This chapter deals with the explanation of ‘Treatment of diseases of the nose’.

The topics covered in this chapter include –

• Pinasa / Pratishyaya Cikitsa
• Ideal foods and drinks
• Chorakadi Churna
• Vyoshadi Vataka
• Shatahvadi Dhuma
• Pinasa / Pratishyaya Cikitsa – things to avoid
• Vataja Pratishyaya Cikitsa
• Pitta Raktaja Pratishyaya Cikitsa
• Kaphaja Pratishyaya Cikitsa
• Dusta Pinasa Cikitsa
• Ksavathu & Putaka Cikitsa
• Nasashosha Cikitsa
• Nasanaha Cikitsa
• Nasapaka and Dipti Cikitsa
• Putinasa Cikitsa
• Puyarakta Cikitsa
• Arshas – Arbuda Cikitsa

Pledge by the author(s)

अथातो नासारोगप्रतिषेधं 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 ‘Treatment of diseases of the nose’. Thus, say (pledge) Atreya and other sages.

Pinasa / Pratishyaya Chikitsa

सर्वेषु पीनसेष्वादौ निवातागारगो भजेत् ।
स्नेहनस्वेदवमनधूमगण्डूषधारणम् ॥ १ ॥
वासो गुरूष्णं शिरसः सुघनं परिवेष्टनम् ।
लघ्वम्ललवणं स्निग्धमुष्णं भोजनमद्रवम् ॥२॥
In all varieties of Pinasa (pratishyaya), in the beginning, the patient should reside in a room devoid of breeze, resort to oleation, sudation, emesis, inhalation of smoke and gargling the mouth therapies, tie a heavy, warm band of cloth round his head thickly; partake foods which are light, sour and salty, warm, mixed with fats and no liquids.

Ideal foods and drinks

धन्वमांसगुडक्षीरचणकत्रिकटूत्कटम् ।
यवगोधूमभूयिष्ठं दधिदाडिमसारिकम् ॥ ३ ॥
बालमूलकजो यूषः कुलत्थोत्थश्च पूजितः ।
कवोष्णं दशमूलाम्बु जीर्णां वा वारुणीं पिबेत् ॥ ४ ॥
Meat of animal of desert-like lands, jaggery, milk, caṇaka – Cicer arietinum, more of Trikatu-Black pepper – Piper nigrum, Long pepper fruit – Piper longum and Ginger – Zingiber officinale, yava – Hordeum vulgare, godhūma – Triticum aestivum processed with curds and juice of Punica granatum should be used as food, soup of bālamūlakajo – tender Raphanus sativus kulatthottha: – and of Dolichos biflorus are ideal, warm decoction of Dashamula -Bilva – Aegle marmelos, Agnimantha – Premna mucronata, Shyonaka – Oroxylum indicum, Patala – Stereospermum Suaveolens, Gambhari – Gmelina arborea, Shalaparni – Desmodium gangeticum, Prishniparni – Uraria picta, Brihati – Solanum indicum Kantakari – Solanum xanthocarpum, Gokshura – Tribulus terrestris or old Varuni (scum of beer) should be used for drinking.

Chorakadi Churna

जिघ्रेच्चोरकतर्कारीवचाजाज्युपकुञ्चिकाः ।
coraka – Angelica glauca, tarkārī – Premna­ integrifolia, vacā – Acorus calamus, ajāji – Cuminum cyminum and upakuñcikāḥ – Nigella sativa (made into powder) should be inhaled.

Vyoshadi Vataka

व्योषतालीशचविकातिन्तिडीकाम्लवेतसम् ॥ ५ ॥
साग्न्यजाजि द्विपलिकं त्वगेलापत्रपादिकम् ।
जीर्णाद्गुडात्तुलार्धेन पक्वेन वटकीकृतम् ॥ ६ ॥
पीनसश्वासकासघ्नं रुचिस्वरकरं परम् ।
Vyosha -Black pepper – Piper nigrum, Long pepper fruit – Piper longum and, Ginger – Zingiber officinale, tālīśa – Abies webbiana, cavikā – Piper chaba, tintiḍīka – Rhus parviflora, amlavetasam – Garcinia pedunculata, agni – Plumbago zeylanica, ajāji – Cuminum cyminum each two pala (98 grams), tvak – Cinnamomum zeylanica, elā – Elettaria cardamomum and patra – Cinnamomum tamala each one fourth pala (12 grams) are powdered and cooked in half tula (2.4 Kg) of old jaggery and rolled into pills. This cures nasal catarrah, dysponea and cough and bestows good taste and voice.

Shatahvadi Dhuma

शताह्वात्वग्बला मूलं श्योणाकैरण्डबिल्वजम् ॥ ७ ॥
सारग्वधं पिबेद्धूमं वसाज्यमदनान्वितम् ।
अथवा सघृतान् सक्तून् कृत्वा मल्लकसम्पुटे ॥ ८ ॥
śatāhvā – Anethum sowa­, tvak – Cinnamomum zeylanica, balā mūlaṃ – root of Sida cordifolia, śyoṇāka – root of Oroxylum indicum, eraṇḍa – Ricinus communis and bilvajam – Aegle marmelos āragvadhaṃ – along with Cassia fistula (made into coarse powder) added with muscle fat, ghee or beeswax should be used for smoke inhalation using a casket of saucers; or saktu (flour of barley) added with ghee may be used.

Pinasa / Pratishyaya Chikitsa: Things to avoid

त्यजेत्स्नानं शुचं क्रोधं भृशं शय्यां हिमं जलम् ।
The patient should avoid baths, ablutions (with cold water), anger, sleeping for long hours and cold water.

Vataja Pratishyaya Chikitsa

पिबेद्वातप्रतिश्याये सर्पिर्वातघ्नसाधितम् ॥ ९ ॥
पटुपञ्चकसिद्धं वा विदार्यादिगणेन वा ।
स्वेदनस्यादिकां कुर्यात्चिकित्सामर्दितोदिताम् ॥ १० ॥
In Pratishyaya of Vata origin,the patient should consume medicated ghee prepared with herbs mitigating Vata or with Patupanchaka (five salts) or herbs of Vidaryadi Gana (chapter 15 of sutrasthana), adopt sudation and nasal medication therapies described in the treatment of Ardita (chapter 21 of Cikistsathana).

Pitta Raktaja Pratishyaya Chikitsa

पित्तरक्तोत्थयोः पेयं सर्पिर्मधुरकैः शृतम् ।
परिषेकान् प्रदेहांश्च शीतैः कुर्वीत शीतलान् ॥ ११ ॥
धवत्वक्त्रिफलाश्यामाश्रीपर्णीयष्टितिल्वकैः ।
क्षीरे दशगुणे तैलं नावनं सनिशैः पचेत् ॥ १२ ॥
In those of Pitta and Rakta origin, the patient should consume ghee prepared with herbs of sweet taste, bathing and application of paste of herbs of cold potency, should be resorted to in cold state; medicated oil prepared with (the decoction and paste) of dhavatvak – bark Anogeissus latifolia, triphala- Haritaki – Terminalia chebula, Vibhitaki – Terminalia bellerica, Amalaki – Emblica officinalis, śyāmā – Ipomoea petaloides, śrīparṇī – Gmelina arborea, yaṣṭi – Glycyrrhiza glabra, tilvakaiḥ – Symplocos racemosa, niśaiḥ – and Curcuma longa, added ten parts of milk should be used as nasal drops.

Kaphaja Pratishyaya Chikitsa

कफजे लङ्घनं लेपः शिरसो गौरसर्षपैः ।
सक्षारं वा घृतं पीत्वा वमेत्पिष्टैस्तु नावनम् ॥ १३ ॥
बस्ताम्बुना पटुव्योषवेल्लवत्सकजीरकैः ।
In that of Kapha origin, the patient should fast (avoid food), the paste of gaurasarṣapaiḥ – Sinapis alba should be applied on the head, consume ghee mixed with alkali prepared of Hordeum vulgare and then vomit (by consuming emetic herbs); salt, Vyosa- Black pepper – Piper nigrum, Long pepper fruit – Piper longum and Ginger – Zingiber officinale, vella – Embelia ribes, vatsaka – Holarrhena antidysentirica and jīrakaiḥ – Cuminum cyminum should be macerated in goat’s urine and drops of this paste put into the nose.

Dusta Pinasa Chikitsa

कटुतीक्ष्णैर्घृतैर्नस्यैः कवलै: सर्वजं जयेत् ॥ १४ ॥
यक्ष्मकृमिक्रमं कुर्वन् यापयेद्दुष्टपीनसम् ।
व्योषोरुबूककृमिजिद्दारुमाद्रीगदेङ्गुदम् ॥ १५ ॥
वार्ताकबीजं त्रिवृता सिद्धार्थः पूतिमत्स्यकः ।
अग्निमन्थस्य पुष्पाणि पीलुशिग्रुफलानि च ॥ १६ ॥
अश्वविड्रसमूत्राभ्यां हस्तिमूत्रेण चैकतः ।
क्षौमगर्भां कृतां वर्तिं धूमं घ्राणास्यतः पिबेत् ॥ १७ ॥
Dusta Pinasa should be treated with the therapies advocated for Yakshma (pulmonary tuberculosis) and Krimi (intestinal worms, bacteria etc.), should be won with pungent and strong ghee, nasal medication, and gargles used for all three doshas. Medicinal wick (cigarette like) should be prepared with Vyosa-Black pepper – Piper nigrum, Long pepper fruit – Piper longum and, Ginger – Zingiber officinale, urubūka – Ricinus communis, kṛmijit – Embelia ribes, dāru – Berberis aristata, mādrī – Aconitum heterophyllum, gada – Saussurea lappa, iṅgudam – Balanites aegyptiaca,vārtākabījaṃ – seeds of Solanum melongena, trivṛtā – Operculina turpethum, siddhārthaḥ – Brassica juncea, bad smelling fish, flowers of agnimanthasya – Premna mucronata, fruit of pīlu – Salvadora persica and śigru – Moringa oleifera, macerated with any one of the following liquids, juice of horse dung, urine, elephant urine and enveloped with fibers of jute (flax), its smoke should be inhaled through the nose and mouth.

Kshavathu & Putaka Chikitsa

क्षवथौ पुटकाख्ये च तीक्ष्णैः प्रधमनं हितम् ।
शुण्ठीकुष्ठकणावेल्लद्राक्षाकल्ककषायवत् ॥ १८ ॥
साधितं तैलमाज्यं वा नस्यं क्षवपुटप्रणुत् ।
In Kshavathu and Putaka, it is beneficial to do pradhamana (blowing the powder of herbs into the nose) with herbs of strong action, medicated ghee or oil prepared with the paste and decoction of śuṇṭhī – Zingiber officinale, kuṣṭha – Saussurea lappa, kaṇā – Piper longum, vella – Embelia ribes and drākṣā – Vitis vinifera nasyaṃ praṇut – used for nasal medication cures Kshavathu and Putaka.

Nasashosha Chikitsa

नासाशोषे बलातैलं पानादौ भोजनं रसैः ॥ १९ ॥
स्निग्धो धूमस्तथा स्वेदो
In Nasashosha, Bala Taila (chapter 21 of Cikista Sthana) should be used for drinking etc. (anointing, nasal medication), Food should be consumed along withjuice of meat, snigdha dhuma (lubricatory inhalation) and sveda (fomentation) should be done.

नासानाहेऽप्ययं विधिः ।
Even for Nasanaha, the same treatment is suitable

Nasapaka and Deepti Chikitsa

पाके दीप्तौ च पित्तघ्नं तीक्ष्णं नस्यादि संस्रुतौ ॥ २० ॥
In Nasapaka and Deepti, treatment which mitigate Pitta should be done, in case of copious discharges from the nose, strong nasal medication etc. should be done.

Putinasa Chikitsa

कफपीनसवत्पूतिनासापीनसयोः क्रिया ।
लाक्षाकरञ्जमरिचवेल्लहिङ्गुकणागुडैः ॥ २१ ॥
अविमूत्रद्रुतैर्नस्यं कारयेद्वमने कृते ।
शिग्रुसिंहीनिकुम्भानां बीजैः सव्योषसैन्धवैः ॥ २२ ॥
सवेल्लसुरसैस्तैलं नावनं परमं हितम् ।
The treatment of Putinasa is the same as prescribed for Pinasa of Kapha origin.lākṣā – Laccifer lacca, karañja – Pongamia pinnata, marica – Piper nigrum, vella – Embelia ribes, hiṅgu – Ferula asafoetida, kaṇā – Piper longum and jaggery are macerated with sheep’s urine and drops of it put into the nose, after the patient has been given emesis therapy. Medicated oil prepared with seeds of śigru – Moringa oliefera, siṃhī – Solanum indicum and nikumbhānāṃ – Baliospermum montanum, Vyosa-Black pepper – Piper nigrum, Long pepper fruit – Piper longum and, Ginger – Zingiber officinale, rock salt, vella – Embelia ribes and surasai: – Ocimum sanctum is highly beneficial when used as nasal drops.

Puyarakta Chikitsa

पूयरक्ते नवे कुर्याद्रक्तपीनसवत्क्रमम् ॥ २३ ॥
अतिप्रवृद्धे नाडीवद्द
In Puyarakta of recent onset, the treatment should be done similar to that of Pinasa caused by blood; when it is highly advanced the treatment is similar to that of Nadivrana (Sinus ulcer).

Arshas: Arbuda Chikitsa

द्दग्धेष्वर्शोऽर्बुदेषु च ।
निकुम्भकुम्भसिन्धूत्थमनोह्वालकणाग्निकैः ॥ २४ ॥
कल्कितैर्घृतमध्वक्तां घ्राणे वर्तिं प्रवेशयेत् ।
शिग्र्वादिनावनं चात्र पूतिनासोदितं भजेत् ॥ २५ ॥
Arshas and Arbuda burnt (cauterised) first and after that a cotton wick smeared with the paste of nikumbha – Baliospermum montanum, kumbha – Fatropha glandulifera, rock salt, realgar, āla – arsenic trisulphidum, kaṇā – Piper longum and agnikaiḥ – Plumbago zeylanica, added with ghee should be introduced into the nose. Nasal drops with śigru – Moringa oliefera and other herbs mentioned in the treatment of Putinasa should be resorted to

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने नासारोगप्रतिषेधो नाम विंशोऽध्याय: ॥ २० ॥
Thus, ends the chapter Nasaroga Pratishedha the twentieth in Uttara sthana of Astanga Hridaya Samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.