Vidhishonitiya Adhyaya

Sutra Sthana Chapter 24. Characteristics of Shonita (Blood), its vitiation and disorders

Vidhishonitiya Adhyaya

Section/Chapter	Sutra Sthana Chapter 24
Tetrad/Sub-section	Yojana Chatushka
Preceding Chapter	Santarpaniya Adhyaya
Succeeding Chapter	Yajjah Purushiyaadhyaya
Other Sections	Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana
Translator and commentator	Bharadwaj P.K., Sharma A.K.
Reviewer	Byadgi P.S.
Editors	Dwivedi R.B., Deole Y.S., Basisht G.
Year of publication	2020
Publisher	Charak Samhita Research, Training and Skill Development Centre
DOI	10.47468/CSNE.2020.e01.s01.026

Abstract

Blood is important for maintaining vitality of individuals. It is also the most important factor in patho-physiology of any disease as it carries vitiated [[dosha] leading to disease. This chapter focuses on rakta dhatu (blood tissue), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. Pure blood (Shuddha rakta) is formed by following proper dietary habits. 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.
Keywords: Rakta, rakta visravana, sanyasa sangyavahi srotas, vegetative state, shonita, sadyaphala kriya, 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 dosha 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 chapter. 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 raktapitta (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 murchcha, purificatory measures (Panchakarma) have been suggested, while for sanyasa, an emergency treatment (attyaika chikitsa) should be followed.

Sanskrit text, Transliteration and English Translation

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 we shall expound the chapter "Vidhishonitiya" (Characteristics of Shonita (Blood), its vitiation and disorders). Thus 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||

The blood is vitiated due to the following causes:

By habitual intake of spoiled or unsuitable food and/or liquids, overeating, acidic or pungent liquor and other similar drinks, too much salty, 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 due to natural pattern in autumn season.[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 and 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 raktapitta 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||

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 (intoxication), murchcha (syncope) and sanyasa(coma)

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 dosha, 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 dosha distress the mind and alter the sensorium leading to further impairment of consciousness. [25-29]

Dosha specific features of mada (intoxication)

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 dosha viz. vata, pitta and kapha. [34]

Specific features of dosha dominant murchcha (syncope)

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 murchcha, the patient becomes unconscious after seeing the sky as blue, black or reddish and regains consciousness quickly. Other symptoms include trembling, body-ache, excessive pain in the cardiac region, emaciation, and blackish and reddish luster. In paittika murchcha, 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 murchcha 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 murchcha has characters of all the above types and the patient suffers from (epilepsy-like) bouts of paroxysm, with the difference that in this murchcha 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 murchcha 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 murchcha (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 and murchcha

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 murchcha, 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 murchcha 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, murchcha 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 (Fundamental Principles)

• 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 raktapitta 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. They 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]
• Murchcha is a transient loss of consciousness with prodromal visual hallucinations specific to vata, pitta,and kapha. [35-41]
• Mada and murchcha are mostly self-limiting conditions in which spontaneous recovery occurs most of the time. Sanyasa requires intensive management. [42-53]
• Purification of channels through Panchakarma is indicated before administration of drugs.[54-58]

Vidhi Vimarsha (Applied Inferences)

Chapter on formation of blood and its disorders (Vidhishonitiya Adhyaya)

Blood tissue (rakta dhatu) is essential component of life. It is continuously circulated throughout the body and supplies oxygen and nutrients to cells. Formation of blood mainly depends upon the food that is in accordance with the habitat (desha), season and time (kala) and suitability (satmya) of the individual. The normal formation and circulation of blood maintains equilibrium in the cardio-vascular system and end organs. Any kind of abnormality like impaired growth and development of blood cells, inflammation, trauma, changes in oncotic pressure, internal bleeding leads to disequilibrium and disease. Advanced modern technologies are helpful to identify and diagnose exact nature of abnormalities. However, the causative factors for these abnormalities need more research and analysis. This chapter opens new windows to learn about causes of abnormalities, non-invasive observational methods of assessment, its role in cerebrovascular disorders like syncope and coma.

Examination of normal blood

The normalcy of blood is assessed on the basis of its observational features.

The normal blood resembles the color of heated red gold, firefly (indragopa), red lotus, lac (laksha) or Abrus precatorius fruit (gunja).[Cha.Sa.Sutra Sthana 24/22] As blood cells mature, their red color may change to different shades from heated gold to gunja color. Different dosha and body constitution (deha prakriti) may also be responsible for different shades of red color of blood. The color of human blood resembles to that of sheep and rabbit.

Characteristic features of a person with normal blood tissue

The person having normal blood, possesses good complexion, clarity of sense organs, cheerful nature, normal digestion, unobstructed natural urges and has good strength. [Cha.Sa.Sutra Sthana 24/24] It can be inferred that blood plays key role in maintaining these physiological functions.

Contemporary physiology states that the color of blood depends on hemoglobin percentage (Hb%). The clotting time represents coagulation, and packed cell volume etc.can be viewed in terms of thickness of blood.

Dosha specific features of blood

When the blood tissue is vitiated by dosha, it shows following features.

Table 1: Dosha specific features of blood

Dosha	Features
Vata	Reddish, non-slimy, frothy and thin
Pitta	Yellow/blackish, delayed coagulation
Kapha	Slight pale, slimy, fibrous, viscous

[Cha.Sa.Sutra Sthana 24/20]

If the blood is vitiated by more than one dosha, it shows mixed features. The features can be inferred on the basis of pathological parameters like packed cell volume, coagulations factors and viscosity. Robust research is required to establish the relation between dosha specific changes in blood tissue.

When the blood is vitiated, it can cause various diseases ranging from mouth ulcer to coma.

Causes of vitiation of blood

Dietary causes:

• Habitual intake of spoiled or unsuitable food and/or liquids
• Overeating
• Acidic or pungent liquor and other similar drinks
• Too much salty, alkaline substances, sour and pungent food
• Dolichos biflorus Linn. (Kulatha)
• Phaseolus mungo Linn. (Masha)
• Dolichos lablab Linn. (Nishpava)
• Sesamum indicum Linn. oils (Tila taila)
• Randia uliginosa DC. (Pindalu)
• Radish and all green (leafy) vegetables
• Meat of aquatic and marshy animals, burrowing animals and those animals that snatch birds
• Excessive intake of curd, sour whey (curd-water), vinegars and other sour fermented liquids
• Consuming decomposed, putrid food with contradictory properties
• Untreated indigestion
• Taking meal during indigestion

Lifestyle causes:

• Excessive sleeping during daytime especially after taking liquids, unctuous and heavy food
• Excessive exposure to the sun and wind
• Suppression of the natural urges like vomiting
• Avoidance of blood-letting at appropriate indicated time or in the autumn season when the blood is affected due to natural aggravation of pitta dosha
• Excess exertion
• Injury
• Exposure to heat

Mental factors:

• Excessive anger

Environmental conditions:

• Autumn season due to natural aggravation of pitta dosha [Cha.Sa.Sutra Sthana 24/5-10]

Clinical features of abnormal blood

Abnormalities in the blood can be diagnosed by observing following clinical features in an individual. These features suggest involvement of organs and body systems affected by abnormal blood.

• Stomatitis
• Redness in eyes
• Foul smell in nose and mouth (halitosis)
• Abdominal lump (gulma)
• Gingivitis, periodontitis and tooth loss (upakusha)
• Erysipelas (visarpa)
• Bleeding disorders
• Sleepiness
• Abscess
• Hematuria
• Menorrhagia
• Vatarakta
• Discoloration of skin
• Poor digestive capacity
• Excess thirst
• Heaviness in body
• Increased body temperature and mental irritation
• Extreme debility
• Anorexia
• Headache
• Burning sensation after meals
• Bitter and sour eructation
• Physical and mental exhaustion
• Excessive anger
• State of confusion
• Saline taste in mouth
• Excess sweating
• Fetid body odor
• Narcosis or intoxication
• Tremors
• Feeble voice
• Drowsiness
• Hypersomnia
• Fainting and black outs
• Pruritus
• Pustules
• Boils
• Skin disorders
• Thick skin as in scleroderma and ichthyosis vulgaris
• All diseases that are not relieved by conventional treatment

Principles of treatment

The principles of treatment of these conditions include one or all of the following depending upon the clinical condition.

• The principles applied for pacification of pitta dosha and rakta dhatu. These are described in management of bleeding disorders (raktapitta) in fourth chapter of section on therapeutics (Chikitsa Sthana).
• Therapeutic purgation (virechana)
• Fasting (upavasa)
• Blood letting (rakta mokshana)

Intoxication (mada), Syncope (murchha) and Coma (sanyasa)

If these treatments are not followed at appropriate time, then the abnormal blood can lead to severe disorders like intoxication, syncope and coma. These three are progressive stages of diseases due to vitiation of blood. Intoxication (mada) state may arise due to consumption of alcohol, poisoning or due to vitiation of blood. The person may be semiconscious or in an altered state of consciousness. [Su.Sa.Sutra Sthana.11/19] In murchcha, the person may be unconscious but involuntary physical movements might be present.[Su.Sa.Nidhana Sthana.1/23] Sanyasa is a condition in which the person will remain unconscious and also there won’t be any physical movements.[Cha.Sa.Sharira Sthana 1/154]

Intoxication (mada)

Pathogenesis

If an individual continuously indulges in stale foods and unhealthy/unhygienic habits, the dosha are vitiated at physical and mental level. His mind gets afflicted with raja and tama. The vitiated dosha obstructs channels carrying nutrient fluid (rasa), blood (rakta) and consciousness (sanjna). This causes altered state of consciousness resulting in intoxication (mada), syncope (murchcha) and coma (sanyasa). [Cha.Sa.Sutra Sthana 24/24-29] Weak minded persons are more susceptible if exposed to vitiation of tridosha (vata/pitta/kapha) separately or in combination. [Cha.Sa.Sutra Sthana 24/28]

Stages of intoxication (mada)

Three stages of intoxication (mada) are mentioned. In initial stage the person will be over enthusiastic. [Su.Sa.Uttara Sthana. 47/11] In the second stage person may talk irrelevantly and will be in delusion stage. In the final stage the person lies unconscious. He may loose his ability to perform any physical action. [Su.Sa.Uttara Sthana. 47/12]

Types and dosha specific features of intoxication (mada)

Table 2: Types and dosha specific features of intoxication (mada)

Dosha	Features of intoxication
Vata	Excessive and fast speech; unstable movements; rough, reddish or blackish skin discoloration
Pitta	Angry; uses harsh words; quarrelsome; reddish, yellowish or blackish skin discoloration
Kapha	Incoherent speech; drowsy and lethargic; pale appearance
Sannipata	Mixed symptoms
Blood (rakta)	Stiffness of body parts, fixed gaze [A.Hr. Nidhana Sthana. 6/28]
Alcohol (madya)	Features similar to pitta dominant type, abnormal movements of body parts, abnormal speech, abnormal voice [A.Hr. Nidhana Sthana. 6/29]
Poison (visha)	Tremors and excessive sleep [A.Hr. Nidhana Sthana 6/29]

[Cha.Sa.Sutra Sthana 24/30-33]

Prognosis

Intoxication (mada) caused by poison is most difficult to treat among all types. [A.Hr. Nidhana Sthana 6/29] The transient episodes of other types of intoxication (mada) and syncope (murchha) subside without any medical treatment. However, treatment is required to prevent recurrent episodes and progression in all these disorders.

Syncope (murchha)

The obstruction of channel of consciousness by aggravated dosha lead to sudden aggravation of tamas. This results in cessation of feeling of happiness. The person falls down just like a log of wood. [Su.Sa.Uttara Sthana. 46/6] This is a transient state of unconsciousness. The person awakes after the episode of aggravation of dosha is over.

Pathogenesis

Weak or emaciated person with excessive vitiation of dosha are susceptible. If these persons indulge in incompatible food, suppression of natural urges, or if afflicted by injuries; then the excessively aggravated dosha affect sensory organs and mind. This results in sudden loss of consciousness. [Su.Sa.Uttara Sthana.46/4] The predominant dosha in the pathogenesis of murchha is pitta. [Su.Sa.Uttara Sthana.46/8]

Premonitory symptoms

Pain in chest, excessive yawning, exhaustion, loss of strength and consciousness. [Su.Sa.Uttara Sthana.46/5]

Types and Features of Syncope (murchha)

Table 3: Types and Features of Syncope (murchha)

Types	Features
Vata dosha	Irregular and unpredictable pattern of unconsciousness. While losing consciousness, he may feel bluish, blackish or reddish discoloration of surroundings. [Cha.Sa.Sutra Sthana 24/35-36] Tremors, pain in chest and body ache may also present.
Pitta dosha	Regains consciousness associated with sweating, feeling of warmth, thirst, reddish yellow discoloration of eyes and may pass loose stools. [Cha.Sa.Sutra Sthana 24/37-38][A.Hr. Nidhana Sthana 6/32]
Kapha dosha	Regains consciousness slowly, feels as if body is covered with thick blanket, salivation and nausea. [Cha.Sa.Sutra Sthana 24/39-40] [A.Hr. Nidhana Sthana 6/35]
Sannipata	Symptoms resembles epilepsy (apasmara) but devoid of irregular body movements. [Cha.Sa.Sutra Sthana 24/41][A.Hr. Nidhana Sthana 6/35]
Blood (rakta)	Stiffness of body parts, fixed gaze and feeble respiration. [Su.Sa.Uttara Sthana 46/11]
Alcohol (Madya)	Irrelevant speech, altered state of mind, irregular movements of body parts. [Su.Sa.Uttara Sthana 46/12]
Visha	Tremors, sleep, thirst and body stiffness. [Su.Sa.Uttara Sthana 46/13]

Coma (sanyasa)

The excessively aggravated dosha affect speech, body and mind. They are lodged in heart (hridaya) and result in cessation of all body activities with absolute loss of consciousness. This condition is coma (sanyasa). [Cha.Sa.Sutra Sthana 24/42] This is a prolonged episode of unconsciousness.

Diagnostic tests

A variety of blood tests like complete blood count, blood smear, blood type, Coomb's test, blood culture, mixing study, bone marrow biopsy are available to diagnose the quality of blood tissue. Angiography, computed tomography scan, magnetic resonance imaging techniques are useful to diagnose abnormalities in blood vessels and blood circulation. Utilization of these diagnostic tools is helpful in knowing precise nature of pathological events in syncope and coma.

Prognosis

Immediate medical intervention is needed for coma (sanyasa). [A.Hr. Nidhana Sthana 6/36] Medical treatment is required to prevent recurrent episodes of disease and correct vitiation of blood tissues.

Metabolic acidosis and alkalosis should be considered to gain an understanding of blood disorders (raktaja vikara). Electrolyte imbalances should be evaluated for the keen diagnosis of mada, murchcha, and sanyasa. [59-60]

Management

The first aim of treatments mentioned are under emergency medical care is regaining consciousness. It includes stimulating and irritant therapies. Sensory stimuli by pricking with needle, applying potent collyrium etc. are used to check the level of consciousness. The drugs used are strong and penetrating in nature.

After regaining the consciousness, the treatment should be continued to prevent the remission. This includes purification procedures like emesis (vamana), purgation (virechana), bloodletting (raktamoksha) etc. After that rejuvenating therapy (rasayana) is also advised. Medicated ghee processed with herbs is used for this purpose. The lipoidal nature of ghee (cow’s ghee) makes it an effective vehicle for carrying the active principles of processed drugs and it can easily cross the blood brain barrier.

Case reports

Case 1:

A sixty one year old female patient in state of coma was treated successively through Ayurveda treatment. Initially the GCS score of patient was 3. Nasal medication (nasya) with trikatu powder was administered for seven days followed by seven days of inhalation of medicated smoke (dhumapana). The GCS score was improved to 11 after the treatment. Smell sensation projects to higher cortical area and to the limbic system. Drugs administered in powder form may stimulate the limbic system, hypothalamus and thalamus. This in turn may activate the reticular activating system which provokes higher degree of consciousness.

Case 2:

An elderly male patient diagnosed with grade-3 hepatic encephalopathy in comatose state was treated with Ayurvedic medicines. The medicines like siddha makaradhwaja, brihad vata chintamani rasa, a proprietary syrup of extract of Phyllanthus niruri, and a proprietary syrup of hepatoprotective and cholegouge herbs were administered through Ryle's tube. Reorientation was started in the patient after 5 hours of initiation of the Ayurvedic therapy. The clinical parameters and pathological biomarkers gradually improved in a period of fifteen days. This case provides scope of ayurvedic interventions in critical care.

Case 3, 4 and 5:

A case series on efficacy of functional medicine approach to treat traumatic brain injuries (TBI) was published. It included two cases of teenagers suffered TBI due to motor vehicle accidents in separate events. These patients showed significant improvement and recovered from comatose state after treatment through functional medicine approach. Another case of military veteran was diagnosed with post traumatic stress disorder (PTSD) and post concussion syndrome (PCS) due to blast injury. He completely recovered from PTSD with the help of hyperbaric oxygen therapy (HBOT). The functional medicine approach includes use of acupuncture, Ayurveda, chiropractic manipulation, detoxification programs, herbal and homeopathic supplements, specialized diets, massage, meditation and mindfulness practices, neurobiofeedback, nutritional supplements, t'ai chi, and yoga. Nutritional therapy and HBOT showed improvement in these cases.

Case 6:

A 68 year old male patient with a history of hypertension for 10 years, alcoholic liver disease, cirrhosis and adenocarcinoma stomach was treated with ayurvedic treatments. He was in comatose state after suffering from seizures, cerebrovascular stroke due to intracranial hemorrhage and hemiplegia. The patient was treated with medicines like Sutendra rasayana with honey, Arpisa rasayana, a combination of Phyllanthus emblica (dhatri), raktapachaka and Alhagi maurorum Medik.(dhamasa). Tapyadi loha, swarna raja vangeshwara rasa, haridra ghana, kukkuta nakhi, rasa sindura with honey. The patient regained consciousness in three to four days and was relived of major symptoms. He survived for more than one and half years.

Case 7:

A thirty year old male patient suffered from road traffic accident. He was in coma due to traumatic brain injury. The injury included 10x,2x deep lacerated wound on right side forehead, brain contusion at frontal lobe and intraventricular bleeding on right side. In addition to the conventional treatment, the patient was treated with Ayurvedic medicines like Swarna sindoora (30 mg) mixed with haridra ghana and honey applying on gums of patient. The patient became semiconscious in two days and improved in orientation, too. The patient was further treated with Yogendra rasa (60 mg). He regained consciousness and recovered completely.

Case 8:

A 43 year old male patient suffered from skull and facial bones fractures due to road traffic accident 10 years ago. He suffered from epilepsy and was taking treatment. The patient reported history of excess mental stress, excess fasting, anorexia and anger. He suffered from convulsions and became unconscious due to intracerebral hemorrhage of 7.9 x 5.6 cm size in right temporo-parietal region. The patient was treated with Ayurvedic medicines like Sindura bhushana mixed with Haridra ghana every four hourly applied on gums. Medicated water processed with gold (Suvarna siddha jala) and green gram soup was given to patient through Ryle’s tube. Jaymangal rasa and Guduchi ghana was added to treat fever. The fever subsided in one day and subsequently the patient started maintaining oxygen levels. The life support system was taken off. The orientation and consciousness improved significantly in a week of treatment. Arpisa rasayana, Jaymangal rasa, vara, and raktapachaka medicines were continued for next two weeks, till complete recovery of the patient. Significant clinical improvement in neurological functions were observed in this patient.

Effect of seasonal variations in blood physiology

A research work was conducted to study effect of seasonal variations on clinical features of blood vitiation described in this chapter. The research also included observations on hematological parameters. The study concluded that significant increase in clinical features of blood vitiation was observed in autumn season (sharad ritu) as compared to rainy season (varsha ritu) and early winters (hemant ritu). Mild seasonal variations were observed in hematological parameters like total red blood cells, white blood cell count, erythrocyte sedimentation rate, absolute eosinophil count, serum cholesterol. A large sample study is required to derive a concrete conclusion.

Contemporary views

Advanced medical technology has enhanced the understanding of microscopic nature of blood tissue, its components and all physical characteristics. The features described in Ayurveda text describe macroscopic changes related to affecting dosha. However, there is much scope of research in bridging the gaps between concepts of these two biomedical sciences.

Some researchers state that the clinical features are similar to the state of disorders due to change in blood pressure leading to hypertension. Some researchers opine that the pathogenesis and features of mada, murchcha and sanyasa show many similarities with shock due to severe hypotension.

Future research areas

• Role of causative factors described in this chapter in hematological disorders and disorders of cardio vascular system
• Understanding exact pathological and microscopic nature of vitiation of blood and relation with dosha specific changes
• Influence of seasonal changes on blood physiology
• Epigenetic changes in blood tissue and its patho-physiological understanding

Related chapters

• Raktapitta Nidana
• Raktapitta Chikitsa
• Rakta dhatu
• Raktamokshana

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References