Vidhishonitiya Adhyaya

Sutra sthana Chapter 24: Vidhishonitiya Adhyaya (Chapter on Characteristics of Blood and its Disorders) Abstract: This chapter focuses on rakta dhatu (blood tissues), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. Shuddha rakta (pure blood) is formed by following proper dietary habits as described in Ayurveda. Therefore, characteristics of pure blood, the causative factors for vitiation of blood, dosha specific features of vitiated blood, their treatment and procedure of bloodletting are described in this chapter. Since blood plays an important role in the treatment of cerebrovascular diseases, a description of ailments such as mada (intoxication/confusion), murchha (syncope), and sanyasa (coma), their pathology and courses of treatment, and mind’s role in the pathogenesis of some of these diseases have also been provided. Key Words: Rakta, rakta visravana, sanyasa sangyavahi srotas, vegetative state, sadyahphalaakriyaah, sangyaprabodhanam, pure blood, blood vitiating factors, coma, syncope, intoxication, drug addiction. Introduction: In the previous chapters of Yojana chatushka (tetrad on management protocol), procedures for the management of disorders caused due to vitiation of three doshas were described. In continuation, the present chapter describes the management principles of disorders due to shonita (blood) vitiation. Formation of pure blood is very important for survival because blood is vital for sustaining life [1,2]. Origin, development, and survival of the body depend on blood [3]. Various etiological factors for vitiation of rakta have been explained in this treatise. Vitiated rakta causes various diseases e.g. stomatitis, redness in the eye, etc. If cold (or hot) and rough (or unctuous) dravyas are used for treatment without response, raktaja vikara (blood disorder) should be the reason. The line of treatment for raktaja vikara constitutes courses of treatment for rakta pitta (i.e., prescribed for cases of vitiated pitta such as purgation and fasting, along with bloodletting). The physical appearance of pure blood has been described to be of golden colors, like red lotus, firefly, lakh (laksha), the fruit of gunja (Abrus precatorius Linn.). Any deviation from these could be explained to be due to vikaras or disorders. Some of the prominent blood-related disorders such as mada (intoxication), murchcha (syncope) and sanyasa (coma) have therefore been described in this chapter. Their etiopathogenesis, types, symptoms and grades of severity - in this sequence - have been explained, along with some suggested courses of treatment. In the case of mada and murchha, purificatory measures (panchakarma) have been suggested, while for sanyasa, an emergency treatment (aattyaika chikitsa) should be followed.

The chapter: विधिशोणितीयाध्यायोपक्रमः अथातो विधिशोणितीयमध्यायं व्याख्यास्यामः ||१|| इति ह स्माह भगवानात्रेयः||२|| athātō vidhiśōṇitīyamadhyāyaṁ vyākhyāsyāmaḥ ||1|| iti ha smāha bhagavānātrēyaḥ||2|| athAto vidhishoNitIyamadhyAyaM vyAkhyAsyAmaH ||1|| iti ha smAha bhagavAnAtreyaH||2||

“Now I shall expound the chapter on properly formed blood”, said Lord Atreya. [1-2]

Formation of pure blood: विधिना शोणितं जातं शुद्धं भवति देहिनाम्| देशकालौकसात्म्यानां विधिर्यः सम्प्रकाशितः||३|| vidhinā śōṇitaṁ jātaṁ śuddhaṁ bhavati dēhinām| dēśakālaukasātmyānāṁ vidhiryaḥ samprakāśitaḥ||3|| vidhinA shoNitaM jAtaM shuddhaM bhavati dehinAm| deshakAlaukasAtmyAnAM vidhiryaH samprakAshitaH||3|| Pure blood is formed in harmony with place, time, and adaptation, as said earlier. (C.Su.6) [3] Effects of pure blood on body: तद्विशुद्धं हि रुधिरं बलवर्णसुखायुषा| युनक्ति प्राणिनं प्राणः शोणितं ह्यनुवर्तते||४|| tadviśuddhaṁ hi rudhiraṁ balavarṇasukhāyuṣā| yunakti prāṇinaṁ prāṇaḥ śōṇitaṁ hyanuvartatē||4|| tadvishuddhaM hi rudhiraM balavarNasukhAyuShA| yunakti prANinaM prANaH shoNitaM hyanuvartate||4||

That pure blood provides the individual with strength, complexion, happiness, and life. Because vitality of life depends on blood. [4]

Causes of blood vitiation: प्रदुष्टबहुतीक्ष्णोष्णैर्मद्यैरन्यैश्च तद्विधैः| तथाऽतिलवणक्षारैरम्लैः कटुभिरेव च||५|| कुलत्थमाषनिष्पावतिलतैलनिषेवणैः| पिण्डालुमूलकादीनां हरितानां च सर्वशः||६|| जलजानूपबैलानां प्रसहानां च सेवनात्| दध्यम्लमस्तुसुक्तानां सुरासौवीरकस्य च||७|| विरुद्धानामुपक्लिन्नपूतीनां भक्षणेन च| भुक्त्वा दिवा प्रस्वपतां द्रवस्निग्धगुरूणि च||८|| अत्यादानं तथा क्रोधं भजतां चातपानलौ| छर्दिवेगप्रतीघातात् काले चानवसेचनात्||९|| श्रमाभिघातसन्तापैरजीर्णाध्यशनैस्तथा| शरत्कालस्वभावाच्च शोणितं सम्प्रदुष्यति||१०||

praduṣṭabahutīkṣṇōṣṇairmadyairanyaiśca tadvidhaiḥ| tathā'tilavaṇakṣārairamlaiḥ kaṭubhirēva ca||5|| kulatthamāṣaniṣpāvatilatailaniṣēvaṇaiḥ| piṇḍālumūlakādīnāṁ haritānāṁ ca sarvaśaḥ||6|| jalajānūpabailānāṁ prasahānāṁ ca sēvanāt| dadhyamlamastusuktānāṁ surāsauvīrakasya ca||7|| viruddhānāmupaklinnapūtīnāṁ bhakṣaṇēna ca| bhuktvā divā prasvapatāṁ dravasnigdhagurūṇi ca||8|| atyādānaṁ tathā krōdhaṁ bhajatāṁ cātapānalau| chardivēgapratīghātāt kālē cānavasēcanāt||9|| śramābhighātasantāpairajīrṇādhyaśanaistathā| śaratkālasvabhāvācca śōṇitaṁ sampraduṣyati||10|| praduShTabahutIkShNoShNairmadyairanyaishca tadvidhaiH| tathA~atilavaNakShArairamlaiH kaTubhireva ca||5|| kulatthamAShaniShpAvatilatailaniShevaNaiH| piNDAlumUlakAdInAM haritAnAM ca sarvashaH||6|| jalajAnUpabailAnAM prasahAnAM ca sevanAt| dadhyamlamastusuktAnAM surAsauvIrakasya ca||7|| viruddhAnAmupaklinnapUtInAM bhakShaNena ca| bhuktvA divA prasvapatAM dravasnigdhagurUNi ca||8|| atyAdAnaM tathA krodhaM bhajatAM cAtapAnalau| chardivegapratIghAtAt kAle cAnavasecanAt||9|| shramAbhighAtasantApairajIrNAdhyashanaistathA| sharatkAlasvabhAvAcca shoNitaM sampraduShyati||10|| By habitual intake of spoiled food and/or liquids, overeating, imbibing hard liquor and other similar drinks, too much salt, alkaline substances, sour and pungent food, kulatha (Dolichos biflorus Linn.), masha (Phaseolus mungo Linn.), nishpava (Dolichos lablab Linn.), tila taila (Sesamum indicum Linn. oils), pindalu (Randia uliginosa DC.), radish and all green (leafy) vegetables, meat of aquatic and marshy animals, burrowing animals and those that snatch birds, excessive intake of curd, sour whey (curd-water), vinegars and other sour fermented liquids, consuming decomposed, putrid food with opposite properties excessive sleeping during the day especially after taking liquids, unctuous and heavy food, excessive anger, excessive exposure to the sun and the wind, suppression of the natural urges like vomiting, avoidance of blood-letting in prescribed time (autumn), too much exertion, injury, heat, indigestion, taking meal during indigestion and in the autumn season naturally vitiates rakta (blood).[5-10] Diseases due to vitiation of blood: ततः शोणितजा रोगाः प्रजायन्ते पृथग्विधाः| मुखपाकोऽक्षिरागश्च पूतिघ्राणास्यगन्धिता||११|| गुल्मोपकुशवीसर्परक्तपित्तप्रमीलकाः| विद्रधी रक्तमेहश्च प्रदरो वातशोणितम्||१२|| वैवर्ण्यमग्निसादश्च पिपासा गुरुगात्रता| सन्तापश्चातिदौर्बल्यमरुचिः शिरसश्च रुक्||१३|| विदाहश्चान्नपानस्य तिक्ताम्लोद्गिरणं क्लमः| क्रोधप्रचुरता बुद्धेः सम्मोहो लवणास्यता||१४|| स्वेदः शरीरदौर्गन्ध्यं मदः कम्पः स्वरक्षयः| तन्द्रानिद्रातियोगश्च तमसश्चातिदर्शनम्||१५|| कण्ड्वरुःकोठपिडकाकुष्ठचर्मदलादयः| विकाराः सर्व एवैते विज्ञेयाः शोणिताश्रयाः||१६|| शीतोष्णस्निग्धरूक्षाद्यैरुपक्रान्ताश्च ये गदाः| सम्यक् साध्या न सिध्यन्ति रक्तजांस्तान् विभावयेत्||१७|| tataḥ śōṇitajā rōgāḥ prajāyantē pr̥thagvidhāḥ| mukhapākō'kṣirāgaśca pūtighrāṇāsyagandhitā||11|| gulmōpakuśavīsarparaktapittapramīlakāḥ| vidradhī raktamēhaśca pradarō vātaśōṇitam||12|| vaivarṇyamagnisādaśca pipāsā gurugātratā| santāpaścātidaurbalyamaruciḥ śirasaśca ruk||13|| vidāhaścānnapānasya tiktāmlōdgiraṇaṁ klamaḥ| krōdhapracuratā buddhēḥ sammōhō lavaṇāsyatā||14|| svēdaḥ śarīradaurgandhyaṁ madaḥ kampaḥ svarakṣayaḥ| tandrānidrātiyōgaśca tamasaścātidarśanam||15|| kaṇḍvaruḥkōṭhapiḍakākuṣṭhacarmadalādayaḥ| vikārāḥ sarva ēvaitē vijñēyāḥ śōṇitāśrayāḥ||16|| śītōṣṇasnigdharūkṣādyairupakrāntāśca yē gadāḥ| samyak sādhyā na sidhyanti raktajāṁstān vibhāvayēt||17 || tataH shoNitajA rogAH prajAyante pRuthagvidhAH| mukhapAko~akShirAgashca pUtighrANAsyagandhitA||11|| gulmopakushavIsarparaktapittapramIlakAH| vidradhI raktamehashca pradaro vAtashoNitam||12|| vaivarNyamagnisAdashca pipAsA gurugAtratA| santApashcAtidaurbalyamaruciH shirasashca ruk||13|| vidAhashcAnnapAnasya tiktAmlodgiraNaM klamaH| krodhapracuratA buddheH sammoho lavaNAsyatA||14|| svedaH sharIradaurgandhyaM madaH kampaH svarakShayaH| tandrAnidrAtiyogashca tamasashcAtidarshanam||15|| kaNDvaruHkoThapiDakAkuShThacarmadalAdayaH| vikArAH sarva evaite vij~jeyAH shoNitAshrayAH||16|| shItoShNasnigdharUkShAdyairupakrAntAshca ye gadAH| samyak sAdhyA na sidhyanti raktajAMstAn vibhAvayet||17|| The above mentioned dietary habits or lifestyle choices cause various diseases that should be considered blood disorders, such as stomatitis, redness in eyes, foul smell in nose and mouth, gulma (lump abdomen), upakusha (inflammation of gum leads to falling of teeth), erysipelas, bleeding disorder, sleepiness, abscess, hematuria, menorrhagia, vatarakta, discoloration of skin, loss of digestive power, thirst, heaviness in body, pyrexia, extreme debility, anorexia, headache, burning sensation after meals, bitter and sour eructation, physical & mental exhaustion, excessive anger, state of confusion, saline taste in mouth, sweating, fetid odor in body, narcosis, tremors, decreased voice, drowsiness, excessive sleep and feeling of darkness, itching, pustules, patches, boils, leprosy, thick skin, etc. The diseases, which, in spite of being curable, are not alleviated after treatment with any of six therapies like cold-hot, unctuous-rough etc. should be considered as caused by (impure) blood. [11-17] Management of blood vitiation disorders: कुर्याच्छोणितरोगेषु रक्तपित्तहरीं क्रियाम्| विरेकमुपवासं च स्रावणं शोणितस्य च||१८|| kuryācchōṇitarōgēṣu raktapittaharīṁ kriyām| virēkamupavāsaṁ ca srāvaṇaṁ śōṇitasya ca||18|| kuryAcchoNitarogeShu raktapittaharIM kriyAm| virekamupavAsaM ca srAvaNaM shoNitasya ca||18|| Treatment for blood disorder is as per rakta- pitta with therapeutic purgation, fasting and bloodletting. [18] Extent of bloodletting: बलदोषप्रमाणाद्वा विशुद्ध्या रुधिरस्य वा| रुधिरं स्रावयेज्जन्तोराशयं प्रसमीक्ष्य वा||१९|| baladōṣapramāṇādvā viśuddhyā rudhirasya vā| rudhiraṁ srāvayējjantōrāśayaṁ prasamīkṣya vā||19|| baladoShapramANAdvA vishuddhyA rudhirasya vA| rudhiraM srAvayejjantorAshayaM prasamIkShya vA||19||

Bloodletting should be done considering the strength of the person, dosha, location of the disease, and until pure blood starts to flow out.[19]

Dosha specific features of vitiated blood: अरुणाभं भवेद्वाताद्विशदं फेनिलं तनु| पित्तात् पीतासितं रक्तं स्त्यायत्यौष्ण्याच्चिरेण च||२०|| ईषत्पाण्डु कफाद्दुष्टं पिच्छिलं तन्तुमद्घनम्| संसृष्टलिङ्गं संसर्गात्त्रिलिङ्गं ||२१|| aruṇābhaṁ bhavēdvātādviśadaṁ phēnilaṁ tanu| pittāt pītāsitaṁ raktaṁ styāyatyauṣṇyāccirēṇa ca||20|| īṣatpāṇḍu kaphādduṣṭaṁ picchilaṁ tantumadghanam| saṁsr̥ṣṭaliṅgaṁ saṁsargāttriliṅgaṁ sānnipātikam||21|| aruNAbhaM bhavedvAtAdvishadaM phenilaM tanu| pittAt pItAsitaM raktaM styAyatyauShNyAccireNa ca||20|| IShatpANDu kaphAdduShTaM picchilaM tantumadghanam| saMsRuShTali~ggaM saMsargAttrili~ggaM sAnnipAtikam||21||

Due to vitiated vata, blood becomes arunabham (reddish), non-slimy, frothy and thin. Due to vitiated pitta, it becomes yellow or blackish, with delayed coagulation because of heat. Due to vitiated kapha it is slightly pale, slimy, fibrous and more viscous. In the case of combination of vitiated doshas, it acquires mixed characters and in sannipata, has symptoms of all the three doshas.[20-21]

Characteristics of pure blood: तपनीयेन्द्रगोपाभं पद्मालक्तकसन्निभम्| गुञ्जाफलसवर्णं च विशुद्धं विद्धि शोणितम्||२२|| tapanīyēndragōpābhaṁ padmālaktakasannibham| guñjāphalasavarṇaṁ ca viśuddhaṁ viddhi śōṇitam||22|| tapanIyendragopAbhaM padmAlaktakasannibham| gu~jjAphalasavarNaM ca vishuddhaM viddhi shoNitam||22|| 22. Blood should be regarded as pure when its color resembles red-gold, firefly, red lotus, laksha (lac-resinous material) and gunja fruit (Abrus precatorius Linn.).[22] Diet after bloodletting: नात्युष्णशीतं लघु दीपनीयं रक्तेऽपनीते हितमन्नपानम्| तदा शरीरं ह्यनवस्थितासृगग्निर्विशेषेण च रक्षितव्यः||२३|| nātyuṣṇaśītaṁ laghu dīpanīyaṁ raktē'panītē hitamannapānam| tadā śarīraṁ hyanavasthitāsr̥gagnirviśēṣēṇa ca rakṣitavyaḥ||23|| nAtyuShNashItaM laghu dIpanIyaM rakte~apanIte hitamannapAnam| tadA sharIraM hyanavasthitAsRugagnirvisheSheNa ca rakShitavyaH||23||

After bloodletting, it is beneficial to take diet that is neither too hot nor cold, is light (to digest), and is appetizing . During this period, the body is vulnerable to relapse of various other forms of blood-related diseases, so the agni (digestive power) should be protected with care. [23]

Characteristics of a person with pure blood: प्रसन्नवर्णेन्द्रियमिन्द्रियार्थानिच्छन्तमव्याहतपक्तृवेगम्| सुखान्वितं तु(पु)ष्टिबलोपपन्नं विशुद्धरक्तं पुरुषं वदन्ति||२४|| prasannavarṇēndriyamindriyārthānicchantamavyāhatapaktr̥vēgam| sukhānvitaṁ tu(pu)ṣṭibalōpapannaṁ viśuddharaktaṁ puruṣaṁ vadanti||24|| prasannavarNendriyamindriyArthAnicchantamavyAhatapaktRuvegam| sukhAnvitaM tu(pu)ShTibalopapannaM vishuddharaktaM puruShaM vadanti||24||

A person should be considered as having pure blood if he has glowing complexion, well-functioning sense organs, and is cheerful. A person with unvitiated blood has normal digestion and unobstructed natural urges, is happy and is endowed with saturation and strength. [24]

Causative factors and pathogenesis of mada, moorchha and sanyasa: यदा तु रक्तवाहीनि रससञ्ज्ञावहानि च| पृथक् पृथक् समस्ता वा स्रोतांसि कुपिता मलाः||२५|| मलिनाहारशीलस्य रजोमोहावृतात्मनः| प्रतिहत्यावतिष्ठन्ते जायन्ते व्याधयस्तदा||२६|| मदमूर्च्छायसन्न्यासास्तेषां विद्याद्विचक्षणः| यथोत्तरं बलाधिक्यं हेतुलिङ्गोपशान्तिषु||२७|| दुर्बलं चेतसः स्थानं यदा वायुः प्रपद्यते| मनो विक्षोभयञ्जन्तोः सञ्ज्ञां सम्मोहयेत्तदा||२८|| पित्तमेवं कफश्चैवं मनो विक्षोभयन्नृणाम्| सञ्ज्ञां नयत्याकुलतां विशेषश्चात्र वक्ष्यते||२९|| yadā tu raktavāhīni rasasañjñāvahāni ca| pr̥thak pr̥thak samastā vā srōtāṁsi kupitā malāḥ||25|| malināhāraśīlasya rajōmōhāvr̥tātmanaḥ| pratihatyāvatiṣṭhantē jāyantē vyādhayastadā||26|| madamūrcchāyasannyāsāstēṣāṁ vidyādvicakṣaṇaḥ| yathōttaraṁ balādhikyaṁ hētuliṅgōpaśāntiṣu||27|| durbalaṁ cētasaḥ sthānaṁ yadā vāyuḥ prapadyatē| manō vikṣōbhayañjantōḥ sañjñāṁ sammōhayēttadā||28|| pittamēvaṁ kaphaścaivaṁ manō vikṣōbhayannr̥ṇām| sañjñāṁ nayatyākulatāṁ viśēṣaścātra vakṣyatē||29|| yadA tu raktavAhIni rasasa~jj~jAvahAni ca| pRuthak pRuthak samastA vA srotAMsi kupitA malAH||25|| malinAhArashIlasya rajomohAvRutAtmanaH| pratihatyAvatiShThante jAyante vyAdhayastadA||26|| madamUrcchAyasannyAsAsteShAM vidyAdvicakShaNaH| yathottaraM balAdhikyaM hetuli~ggopashAntiShu||27|| durbalaM cetasaH sthAnaM yadA vAyuH prapadyate| mano vikShobhaya~jjantoH sa~jj~jAM sammohayettadA||28|| pittamevaM kaphashcaivaM mano vikShobhayannRuNAm| sa~jj~jAM nayatyAkulatAM visheShashcAtra vakShyate||29|| When a person indulges in spoiled food and unhealthy habits, he develops a clouded sensorium with rajas and tamas qualities. The vitiated doshas, singly or in combination, reside and obstruct the channels that carry rakta, rasa (plasma), and consciousness. This leads to various diseases such as mada (intoxication), murchcha (syncope), and sanyasa (coma) which are etiologically, symptomatically and therapeutically progressive. Vitiated doshas distress the mind and alter the sensorium leading to further impairment of consciousness. [25-29] Dosha specific features of mada: सक्तानल्पद्रुताभाषं चलस्खलितचेष्टितम्| विद्याद्वातमदाविष्टं रूक्षश्यावारुणाकृतिम्||३०|| सक्रोधपरुषाभाषं सम्प्रहारकलिप्रियम्| विद्यात् पित्तमदाविष्टं रक्तपीतासिताकृतिम्||३१|| स्वल्पासम्बद्धवचनं तन्द्रालस्यसमन्वितम्| विद्यात् कफमदाविष्टं पाण्डुं प्रध्यानतत्परम्||३२|| सर्वाण्येतानि रूपाणि सन्निपातकृते मदे|३३| saktānalpadrutābhāṣaṁ calaskhalitacēṣṭitam | vidyādvātamadāviṣṭaṁ rūkṣaśyāvāruṇākr̥tim||30|| sakrōdhaparuṣābhāṣaṁ samprahārakalipriyam| vidyāt pittamadāviṣṭaṁ raktapītāsitākr̥tim||31|| svalpāsambaddhavacanaṁ tandrālasyasamanvitam| vidyāt kaphamadāviṣṭaṁ pāṇḍuṁ pradhyānatatparam||32|| sarvāṇyētāni rūpāṇi sannipātakr̥tē madē|33| saktAnalpadrutAbhAShaM calaskhalitaceShTitam | vidyAdvAtamadAviShTaM rUkShashyAvAruNAkRutim||30|| sakrodhaparuShAbhAShaM samprahArakalipriyam| vidyAt pittamadAviShTaM raktapItAsitAkRutim||31|| svalpAsambaddhavacanaM tandrAlasyasamanvitam| vidyAt kaphamadAviShTaM pANDuM pradhyAnatatparam||32|| sarvANyetAni rUpANi sannipAtakRute made|33| The person should be diagnosed as suffering from vatika mada, if his speech is excessive and fast, movement is unstable, and face is rough, reddish or blackish. A person with angry and harsh tongue, quarrelsome, tends to be physical with a red, yellow and black face should be known to be suffering from paittika mada. The one affected with kaphaja mada speaks less with incoherence, seems drowsy and lethargic, is pale and is continuously in a state of anxiety. In sannipataja mada, all these features are found in combination. [30-33] जायते शाम्यति क्षिप्रं मदो मद्यमदाकृतिः||३३|| jāyatē śāmyati kṣipraṁ madō madyamadākr̥tiḥ||33|| jAyate shAmyati kShipraM mado madyamadAkRutiH||33||

Sannipataja mada (a type of narcosis) arises and subsides quickly like alcoholic narcosis. [33]

यश्च मद्यकृतः प्रोक्तो विषजो रौधिरश्च यः| सर्व एते मदा नर्ते वातपित्तकफत्रयात्||३४|| yaśca madyakr̥taḥ prōktō viṣajō raudhiraśca yaḥ| sarva ētē madā nartē vātapittakaphatrayāt||34|| yashca madyakRutaH prokto viShajo raudhirashca yaH| sarva ete madA narte vAtapittakaphatrayAt||34||

All types of narcosis are caused by alcoholic drinks, poisons or by vitiation of blood. It can be concluded that all types of narcosis are caused by nothing but the vitiation of the three doshas viz. vata, pitta and kapha. [34]

Specific features of dosha dominant murchha: नीलं वा यदि वा कृष्णमाकाशमथवाऽरुणम्| पश्यंस्तमः प्रविशति शीघ्रं च प्रतिबुध्यते ||३५|| वेपथुश्चाङ्गमर्दश्च प्रपीडा हृदयस्य च| कार्श्यं श्यावारुणा च्छायामूर्च्छाये वातसम्भवे||३६|| रक्तं हरितवर्णं वा वियत् पीतमथापि वा| पश्यंस्तमः प्रविशति सस्वेदः प्रतिबुध्यते||३७|| सपिपासः ससन्तापो रक्तपीताकुलेक्षणः| सम्भिन्नवर्चाः पीताभो मूर्च्छाये पित्तसम्भवे||३८|| मेघसङ्काशमाकाशमावृतं वा तमोघनैः| पश्यंस्तमः प्रविशति चिराच्च प्रतिबुध्यते||३९|| गुरुभिः प्रावृतैरङ्गैर्यथैवार्द्रेण चर्मणा| सप्रसेकः सहृल्लासो मूर्च्छाये कफसम्भवे||४०|| सर्वाकृतिः सन्निपातादपस्मार इवागतः| स जन्तुं पातयत्याशु विना बीभत्सचेष्टितैः||४१|| nīlaṁ vā yadi vā kr̥ṣṇamākāśamathavā'ruṇam| paśyaṁstamaḥ praviśati śīghraṁ ca pratibudhyatē ||35|| vēpathuścāṅgamardaśca prapīḍā hr̥dayasya ca| kārśyaṁ śyāvāruṇā cchāyāmūrcchāyē vātasambhavē||36|| raktaṁ haritavarṇaṁ vā viyat pītamathāpi vā| paśyaṁstamaḥ praviśati sasvēdaḥ pratibudhyatē||37|| sapipāsaḥ sasantāpō raktapītākulēkṣaṇaḥ| sambhinnavarcāḥ pītābhō mūrcchāyē pittasambhavē||38|| mēghasaṅkāśamākāśamāvr̥taṁ vā tamōghanaiḥ| paśyaṁstamaḥ praviśati cirācca pratibudhyatē||39|| gurubhiḥ prāvr̥tairaṅgairyathaivārdrēṇa carmaṇā| saprasēkaḥ sahr̥llāsō mūrcchāyē kaphasambhavē||40|| sarvākr̥tiḥ sannipātādapasmāra ivāgataḥ| sa jantuṁ pātayatyāśu vinā bībhatsacēṣṭitaiḥ||41|| nIlaM vA yadi vA kRuShNamAkAshamathavA~aruNam| pashyaMstamaH pravishati shIghraM ca pratibudhyate ||35|| vepathushcA~ggamardashca prapIDA hRudayasya ca| kArshyaM shyAvAruNA cchAyAmUrcchAye vAtasambhave||36|| raktaM haritavarNaM vA viyat pItamathApi vA| pashyaMstamaH pravishati sasvedaH pratibudhyate||37|| sapipAsaH sasantApo raktapItAkulekShaNaH| sambhinnavarcAH pItAbho mUrcchAye pittasambhave||38|| meghasa~gkAshamAkAshamAvRutaM vA tamoghanaiH| pashyaMstamaH pravishati cirAcca pratibudhyate||39|| gurubhiH prAvRutaira~ggairyathaivArdreNa carmaNA| saprasekaH sahRullAso mUrcchAye kaphasambhave||40|| sarvAkRutiH sannipAtAdapasmAra ivAgataH| sa jantuM pAtayatyAshu vinA bIbhatsaceShTitaiH||41|| In vatika murchha, the patient becomes unconscious after seeing the sky as blue, black or reddish and regains consciousness quickly. Other symptoms include trembling, bodyache, excessive pain in the cardiac region, emaciation, and blackish and reddish luster. In paittika murcha, unconciousness comes after seeing the sky as red, green or yellow, and recovery is accompanied by sweating. There are also symptoms like thirst, pyrexia, red or yellow distressed eyes, loose motion, and yellowish pallor. The patient of kaphaja murchha gets unconscious after seeing the sky covered in clouds or covered with deep darkness and recovers after a long time. He generally finds his body parts feel heavy and wrapped in wet hide. He also suffers from excessive salivation and nausea. Sannipataja murchha has characters of all the above types and the patient suffers from (epilepsy-like) bouts of paroxysm, with the difference that in this murccha the patient falls unconscious without violent or revolting movements.[35-41] Sanyasa [coma]: दोषेषु मदमूर्च्छायाः कृतवेगेषु देहिनाम्| स्वयमेवोपशाम्यन्ति सन्न्यासो नौषधैर्विना||४२|| वाग्देहमनसां चेष्टामाक्षिप्यातिबला मलाः| सन्न्यस्यन्त्यबलं जन्तुं प्राणायतनसंश्रिताः||४३|| स ना सन्न्याससन्न्यस्तः काष्ठीभूतो मृतोपमः| प्राणैर्वियुज्यते शीघ्रं मुक्त्वा सद्यःफलाः क्रियाः||४४|| दुर्गेऽम्भसि यथा मज्जद्भाजनं त्वरया बुधः| गृह्णीयात्तलमप्राप्तं तथा सन्न्यासपीडितम्||४५|| अञ्जनान्यवपीडाश्च धूमाः प्रधमनानि च| सूचीभिस्तोदनं शस्तं दाहः पीडा नखान्तरे||४६|| लुञ्चनं केशलोम्नां च दन्तैर्दशनमेव च| आत्मगुप्तावघर्षश्च हितं तस्यावबोधने||४७|| सम्मूर्च्छितानि तीक्ष्णानि मद्यानि विविधानि च| प्रभूतकटुयुक्तानि तस्यास्ये गालयेन्मुहुः||४८|| मातुलुङ्गरसं तद्वन्महौषधसमायुतम्| तद्वत्सौवर्चलं दद्याद्युक्तं मद्याम्लकाञ्जिकैः||४९|| हिङ्गूषणसमायुक्तं यावत् सञ्ज्ञाप्रबोधनम्| प्रबुद्धसञ्ज्ञमन्नैश्च लघुभिस्तमुपाचरेत्||५०|| विस्मापनैः स्मारणैश्च प्रियश्रुतिभिरेव च| पटुभिर्गीतवादित्रशब्दैश्चित्रैश्च दर्शनैः||५१|| स्रंसनोल्लेखनैर्धूमैरञ्जनैः कवलग्रहैः| शोणितस्यावसेकैश्च व्यायामोद्घर्षणैस्तथा||५२|| प्रबुद्धसञ्ज्ञं मतिमाननुबन्धमुपक्रमेत्| तस्य संरक्षितव्यं हि मनः प्रलयहेतुतः||५३|| dōṣēṣu madamūrcchāyāḥ kr̥tavēgēṣu dēhinām| svayamēvōpaśāmyanti sannyāsō nauṣadhairvinā||42|| vāgdēhamanasāṁ cēṣṭāmākṣipyātibalā malāḥ| sannyasyantyabalaṁ jantuṁ prāṇāyatanasaṁśritāḥ||43|| sa nā sannyāsasannyastaḥ kāṣṭhībhūtō mr̥tōpamaḥ| prāṇairviyujyatē śīghraṁ muktvā sadyaḥphalāḥ kriyāḥ||44|| durgē'mbhasi yathā majjadbhājanaṁ tvarayā budhaḥ| gr̥hṇīyāttalamaprāptaṁ tathā sannyāsapīḍitam||45|| añjanānyavapīḍāśca dhūmāḥ pradhamanāni ca| sūcībhistōdanaṁ śastaṁ dāhaḥ pīḍā nakhāntarē||46|| luñcanaṁ kēśalōmnāṁ ca dantairdaśanamēva ca| ātmaguptāvagharṣaśca hitaṁ tasyāvabōdhanē||47|| sammūrcchitāni tīkṣṇāni madyāni vividhāni ca| prabhūtakaṭuyuktāni tasyāsyē gālayēnmuhuḥ||48|| mātuluṅgarasaṁ tadvanmahauṣadhasamāyutam| tadvatsauvarcalaṁ dadyādyuktaṁ madyāmlakāñjikaiḥ||49|| hiṅgūṣaṇasamāyuktaṁ yāvat sañjñāprabōdhanam| prabuddhasañjñamannaiśca laghubhistamupācarēt||50|| vismāpanaiḥ smāraṇaiśca priyaśrutibhirēva ca| paṭubhirgītavāditraśabdaiścitraiśca darśanaiḥ||51|| sraṁsanōllēkhanairdhūmairañjanaiḥ kavalagrahaiḥ| śōṇitasyāvasēkaiśca vyāyāmōdgharṣaṇaistathā||52|| prabuddhasañjñaṁ matimānanubandhamupakramēt| tasya aṁrakṣitavyaṁ hi manaḥ pralayahētutaḥ||53|| doSheShu madamUrcchAyAH kRutavegeShu dehinAm| svayamevopashAmyanti sannyAso nauShadhairvinA||42|| vAgdehamanasAM ceShTAmAkShipyAtibalA malAH| sannyasyantyabalaM jantuM prANAyatanasaMshritAH||43|| sa nA sannyAsasannyastaH kAShThIbhUto mRutopamaH| prANairviyujyate shIghraM muktvA sadyaHphalAH kriyAH||44|| durge~ambhasi yathA majjadbhAjanaM tvarayA budhaH| gRuhNIyAttalamaprAptaM tathA sannyAsapIDitam||45|| a~jjanAnyavapIDAshca dhUmAH pradhamanAni ca| sUcIbhistodanaM shastaM dAhaH pIDA nakhAntare||46|| lu~jcanaM keshalomnAM ca dantairdashanameva ca| AtmaguptAvagharShashca hitaM tasyAvabodhane||47|| sammUrcchitAni tIkShNAni madyAni vividhAni ca| prabhUtakaTuyuktAni tasyAsye gAlayenmuhuH||48|| mAtulu~ggarasaM tadvanmahauShadhasamAyutam| tadvatsauvarcalaM dadyAdyuktaM madyAmlakA~jjikaiH||49|| hi~ggUShaNasamAyuktaM yAvat sa~jj~jAprabodhanam| prabuddhasa~jj~jamannaishca laghubhistamupAcaret||50|| vismApanaiH smAraNaishca priyashrutibhireva ca| paTubhirgItavAditrashabdaishcitraishca darshanaiH||51|| sraMsanollekhanairdhUmaira~jjanaiH kavalagrahaiH| shoNitasyAvasekaishca vyAyAmodgharShaNaistathA||52|| prabuddhasa~jj~jaM matimAnanubandhamupakramet| tasya saMrakShitavyaM hi manaH pralayahetutaH||53|| Mada and murchha subside on their own when the vitiated doshas subside. However, sanyasa (coma) does not subside without medical treatment. In weak patients, when vitiated doshas move into a vital organ (i.e. brain and heart) and start affecting speech, physical movement, and the mind, coma ensues. A person affected with coma appears to be in a vegetative state or seems dead. Death can occur if prompt and effective treatment is not given. The physician should manage a comatose patient just as a wise person recovers a utensil sinking in deep water quickly before it settles down in the bottom.

  To make someone recover from coma, the use of collyriums, drops, smokes, blowing, needling, burning, causing pain by making the patient lie on a  nail-bed, plucking the hair on the head and body of the patient, biting the patient, rubbing with hairy fruits of atmagupta (Mucuna prurita Hook.) is recommended and considered effective. Besides, various types of strong alcoholic drinks mixed with plenty of pungent substances should be poured into the mouth of the patient suffering from murchha (syncope). Similarly, the juice of matulunga rasa (citrus medica) mixed with dry ginger, sauvarchala (black salt), hingu (ie. resinous of material Ferula foetida Regel), wine, and sour juice or vinegar should be administered for helping someone regain consciousness. 
 When the patient regains consciousness, he should be given a light diet and should be entertained with interesting stories or anecdotes, memoirs, pleasing talks, enchanting songs, and live music, and colorful scenery. Moreover, he should be treated with purgation, emesis, smoking, collyriums, gargles, bloodletting, exercise and rubbing over the body. His mind should be protected well from the causes of distress or confusion. [42-53]

Various treatments of mada amd murchha: स्नेहस्वेदोपपन्नानां यथादोषं यथाबलम्| पञ्च कर्माणि कुर्वीत मूर्च्छायेषु मदेषु च||५४|| अष्टाविंशत्यौषधस्य तथा तिक्तस्य सर्पिषः| प्रयोगः शस्यते तद्वन्महतः षट्पलस्य वा||५५|| त्रिफलायाः प्रयोगो वा सघृतक्षौद्रशर्करः| शिलाजतुप्रयोगो वा प्रयोगः पयसोऽपि वा||५६|| पिप्पलीनां प्रयोगो वा पयसा चित्रकस्य वा| रसायनानां कौम्भस्य सर्पिषो वा प्रशस्यते||५७|| रक्तावसेकाच्छास्त्राणां सतां सत्त्ववतामपि| सेवनान्मदमूर्च्छायाः प्रशाम्यन्ति शरीरिणाम्||५८|| snēhasvēdōpapannānāṁ yathādōṣaṁ yathābalam| pañca karmāṇi kurvīta mūrcchāyēṣu madēṣu ca||54|| aṣṭāviṁśatyauṣadhasya tathā tiktasya sarpiṣaḥ| prayōgaḥ śasyatē tadvanmahataḥ ṣaṭpalasya vā||55|| triphalāyāḥ prayōgō vā saghr̥takṣaudraśarkaraḥ| śilājatuprayōgō vā prayōgaḥ payasō'pi vā||56|| pippalīnāṁ prayōgō vā payasā citrakasya vā| rasāyanānāṁ kaumbhasya sarpiṣō vā praśasyatē||57|| raktāvasēkācchāstrāṇāṁ satāṁ sattvavatāmapi| sēvanānmadamūrcchāyāḥ praśāmyanti śarīriṇām||58|| snehasvedopapannAnAM yathAdoShaM yathAbalam| pa~jca karmANi kurvIta mUrcchAyeShu madeShu ca||54|| aShTAviMshatyauShadhasya tathA tiktasya sarpiShaH| prayogaH shasyate tadvanmahataH ShaTpalasya vA||55|| triphalAyAH prayogo vA saghRutakShaudrasharkaraH| shilAjatuprayogo vA prayogaH payaso~api vA||56|| pippalInAM prayogo vA payasA citrakasya vA| rasAyanAnAM kaumbhasya sarpiSho vA prashasyate||57|| raktAvasekAcchAstrANAM satAM sattvavatAmapi| sevanAnmadamUrcchAyAH prashAmyanti sharIriNAm||58||

In the cases of mada and murchha, patients should be subjected to five (evacuative) measures, after proper oleation and fomentation, according to the dosha and strength of the person and the disease. Likewise, the administration of paniya-kalyana ghrita, tiktashatpala ghrita or mahatikta ghrita is recommended. The use of triphala with ghrita, honey and sugar, shilajatu, milk, pippali (Piper longum) or chitraka (Plumbago zeylanica Linn.) with milk, rasayana, and kaumbha (ten year old) ghrita are also beneficial.
Mada and murchha are alleviated by bloodletting and constantly keeping the patient regaled with anecdotes from the scriptures, and in the company of noble and intelligent persons. [54-58]

Summary: तत्र श्लोकौ- विशुद्धं चाविशुद्धं च शोणितं तस्य हेतवः| रक्तप्रदोषजा रोगास्तेषु रोगेषु चौषधम्||५९|| मदमूर्च्छायसन्न्यासहेतुलक्षणभेषजम्| विधिशोणितकेऽध्याये सर्वमेतत् प्रकाशितम्||६०|| tatra ślōkau- viśuddhaṁ cāviśuddhaṁ ca śōṇitaṁ tasya hētavaḥ| raktapradōṣajā rōgāstēṣu rōgēṣu cauṣadham||59|| madamūrcchāyasannyāsahētulakṣaṇabhēṣajam| vidhiśōṇitakē'dhyāyē sarvamētat prakāśitam||60|| tatra shlokau- vishuddhaM cAvishuddhaM ca shoNitaM tasya hetavaH| raktapradoShajA rogAsteShu rogeShu cauShadham||59|| madamUrcchAyasannyAsahetulakShaNabheShajam| vidhishoNitake~adhyAye sarvametat prakAshitam||60|| Now the (summing up) verses- Characteristics of pure and impure blood, its causes, disorders of blood and their treatment, causes, symptoms and treatment of mada, murchha and sanyasa – all this has been described in the chapter on properly formed blood etc. Diseases with variable state of consciousness, from confusion to coma have been described in this chapter. [59-60]

Tattva vimarsha: • Formation of pure blood depends upon the place, time, diet, and lifestyle. [3] • Pureblood is one of ten vital components of the body. [4] • Katu,(pungent) amla (sour), lavana (salty), ushna (hot) foods, excessive anger, excessive food, exposure to sun & fire, trauma and autumn season are main causes of raktaja vikara. All diet and lifestyle factors responsible for pitta vitiation can cause vitiation of blood. [5-10] • Treatment of blood vitiation disorders is like rakta- pitta with purgation, fasting, and bloodletting. [18] • The extent of bloodletting is decided according to the severity of the disease, location of the disease, and strength of the patient.[19] • vata and pitta increase bleeding and delay blood-clotting while kapha does the opposite.[20-21] • A person should take digestion-enhancing diet consisting of shali (red rice), moong (green gram), etc. to strengthen digestive power after bloodletting. [23] • Mada, murchcha, and sanyasa are caused due to vitiated doshas as well as rajas and tamas, which impair and obstruct rasavaha, raktavaha, and sangyavahi srotas and are responsible for various states of consciousness. Altered sensorium and consciousness are caused by consumption of contaminated diet and conduct. Mind and body are equally involved in the pathology of intoxication, syncope, and coma. [25-29] • Mada and madatyaya are clinically interchangeable. All types of narcosis and intoxication are caused by the vitiation of the three doshas.[34] • Murchha is a transient loss of consciousness with prodromal visual hallucinations specific to vata, pitta, and kapha. [35-41] • Mada and murchha are mostly self-limiting conditions in which spontaneous recovery occurs most of the time. Sanyasa requires intensive care management. [42-53] • Purification of channels through panchakarma is indicated before administration of drugs.[54-58]

 Vidhi  vimarsha:

A person who is following a regimen or conduct suitable to a location (desha-satmya), time (kala-satmya), and habit or lifestyle (oka-satmya), when he takes food according to aahara vidhi visheshayatana (as described in the first chapter of Charaka Vimana section[3]) - food having six rasaja, taken at proper time, proper place, in proper quantity, and that which is wholesome in nature, will have pure (or healthy) blood. Pure blood formed after proper digestion of food is full of nutritional values necessary for life. Formation of pure blood takes place due to extrinsic and intrinsic factors. Extrinsic factors are obtained from dietary sources. On the other hand, intrinsic factors are generated inside the body, such as Ranjaka pitta and majjagata substances (bone marrow). The importance of pure blood is described in Sushruta Sutra [4]15/7 and Charaka Chikitsa [5] 15/28.[3] Pure-blood is the basis of life as it nourishes dasha pranayatna (ten important “life areas” of the body: two temples, heart, head, bladder, throat, blood, semen, ojas and rectum [6], (Ch. Sha. 7/9) [7]. Rakta increases the physical strength, complexion, immunity, and vitality of life (Su.Su. 15/7) [8]. [4] Severe indigestion, eating leftover foods, and suppression of urge of vomiting can form vasoactive intestinal peptides and in turn lead to allergic diathesis. [5-10] The recommended therapies for the treatment of vitiated blood disorders – such as bloodletting - are not to be administered or applied in all diseases. Like in the case of any disease, treatment measures are to be selected according to the nature of the disease and condition of the patient. Bloodletting should be administered till the vitiated dosha are eliminated from blood. [18] Any line of treatment should be planned keeping in mind the basic principles of blood coagulation as described in Ayurvedic texts. [20-21] After bloodletting is administered, the patient should be prescribed a nourishing diet and regimen that rejuvenates his blood, and thus, vitalizes his life. The diet shall not interfere with the coagulation process or vitiate his blood but should aid in the bodily processes to replenish blood.[23] Without going for blood investigations, a person with pure blood can be recognized by his physical appearance: glowing complexion, well-functioning sense organs, and a cheerful persona. Such a person has normal digestion, and natural urges are unobstructed. [24] Blood supply, neuronal metabolism of the cerebral cortex, especially reticular formation, and limbic system are affected by vitiated dosha to impair consciousness, from acute confusion to deep coma. [25-29] In any drug addiction or narcosis, the dominant dosha should be diagnosed and managed accordingly. [34] The absence of abnormal movements and postures differentiates murchha (syncope) from apasmara (epilepsy). If there are abnormal movements or postures while falling unconscious, syncope and pseudo-syncope should be ruled out. [35-41] The goal of any course of treatment of sanyasa is selecting the right formulation to help the patient regain consciousness. [42-53] Various medicated ghrita are indicated for sanyasa since lipid matrix helps to cross the blood-brain barrier and act on the brain. [54-58] Metabolic acidosis and alkalosis should be considered to gain an understanding of raktaja vikara. Electrolyte imbalances should be evaluated for the keen diagnosis of mada, murchha, and sanyasa. [59-60] References: 1. Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sutrasthana, Chap 24, shloka no.4, Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 443. 2. Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Sutra sthana Chap 15, shloka no.44, Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 73. 3. Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, 2nd part, Chikitsa sthana, Chap 15, shlok no.28 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 457. 4. Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Vimana sthana, Chap 1, shlok no.21 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 680. 5. Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Sutra sthana Chap 15, shlok no.7 ,Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 75. 6. Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, 2nd part, Chikitsa sthana, Chap 15, shlok no.28 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 457. 7. Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sutrasthana, Chap 29, shlok no.3 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 576. 8. Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sharira sthana, Chap 7, shlok no. 9 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 913. 9. Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Indriya sthana, Chap 7, shlok no. 13 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 995.

 Glossary of Technical Terms:

1.aukasātmyā (aukasAtmyA; अ©कसात्म्य)– Acquired homologation/adaptation 2. ādhyaśana (Adhyashana; अध्यशनै ) - Eating before the complete digestion of the previous food. 3. ajīrṇā (ajIrNA ; अजीर्णा) – Indigestion. 4. virēka (virekam; विरेक ) - Purgative action. 5. tantu (tantu; तन्तु ) – Thread-like.

6. dīpanīya (dIpanIya; दीपनीयं) – To increase appetite or digestive power. 7. viśadaṁ (vishadaM ; द्विशदं ) – Nonslimy. 8. agnisāda (agnisAda; ग्निसाद) – loss of appetite or decreased digestive power. 9. gurugātratā (gurugAtratA; गुरुगात्रता) – Heaviness of body. 10. santāpa (santApa; सन्ताप) – Pyrexia. 11. klamaḥ (klamaḥ; क्लमः) – Feeling of exhaustion. 12. buddhēḥ sammōhō (buddheH sammoho ; बुद्धेः सम्मोहो ) – Confusion of mind. 13. svarakṣayaḥ (svarakShayaH; स्वरक्षयः) – Weakness of voice. 14. tandrā (tandrA; तन्द्रा) – Excessive drowsiness. 15. kōṭha (koTha; कोठ) –Patches on skin. 16. Prasahanam (प्रसहानां)- Animals and birds that take in their food by snatching. 17. Prameelakah (प्रमीलकाः)- It is a state of almost falling asleep. 18. Pradhyantatparam (प्रध्यानतत्परम्)- A person who is continuous in a state of anxiety.