Trimarmiya Chikitsa

Trimarmiya Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 26
Preceding Chapter	Dwivraniya Chikitsa
Succeeding Chapter	Urusthambha Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 26, Chapter on the Management of Trimarma (i.e., Cardiovascular system, Cerebrovascular system, and Renal system)

Abstract

This chapter highlights the importance of trimarma (Three vital points/ areas, viz, cardiovascular system, cerebrovascular system and renal system) and treatment of their diseases. There are one hundred seven vital points (marma) on the body which when injured either cause disease or death. Ten of these vital points or pranayatana are the seat of prana (life force). Three of these marma are located in, cardiovascular system, cerebrovascular system and renal system. Since these three marma are the seats of prāna (life force), their disease and trauma can threaten life as they control the complete body system. A relationship exists between the marma, disease of one system affects the functioning of the other. Mortality and morbidity caused by these three controlling systems is the maximum. The chapter deals with etiology, signs and symptoms, classification, line of treatment for the diseases about these three marma.

Keywords: Trimarma (three vital organs), prāna (life force), uttarbasti,varti prayōga, udāvarta, mutra kruchra, hrudrōga, nasya karma, pratisyaya (rhinitis), dusta pratishaya (persistent rhinitis), apinasa (chronic rhinitis), puya rakta (purulent and sanguinous rhinitis), nāsa paka (suppurative rhinitis), nāsa shotha (edematous rhinitis), ksavathu (sneezing), nāsa shosha (dryness of nasal mucosal membrane), pratināha (nasal obstruction) pratisrāva (nasal discharge), puti nasya (ozena), nāsa arbuda (nasal tumor), arumsi (furunculosis), nāsa dipta (burnt nose), ānāha (constipation), arōcaka (anorexia)

Introduction

Morbidity and mortality from cardiovascular (including cerebrovascular) diseases and renal diseases are the leading cause of morbidity and mortality today. According to the Center for Disease Control and Prevention (CDC), Cerebrovascular diseases are the fifth leading cause of death . Cardiovascular diseases (CVDs), per the Media Centre Fact Sheet of the World Health Organization (WHO), are the “number 1 cause of death globally” with an estimated 17.7 million people dying of it in 2015 (31% of global deaths). . Last but not least, renal diseases (or chronic kidney diseases (CKDs) afflict 14% of the general population in the US and are one of the major causes of death worldwide .

Marma (vital points) are collection of muscle, tendons, ligaments, bone tissue, joints, blood vessels and nerves, nervous tissue, which forms the seat of life5 and it is also said that they are the seat for tridoṣha, triguna and the ātmā, hence any injury to these can be life threatening and can cause death.6

The word marma is derived from the mru marane dhātu of Sanskrit7 which states that, the marma are so vital that any trauma to them may lead to marana (death). In practical sense, marana here may not mean the death but can be considered as the pain and deformity which is so severe (marana tulya peeda) which may further lead to death.8 The adhisthāna (location) of these diseases of marma can be assessed by the physiological changes in the body which can be detected considering the type of rōgamārga (pathway of pathogenesis). Marma comes under madhyama (middle) rōgamārga9 so understanding of the rōgamārga is essential to analyze the characters of the diseases, related with dushti (pathogenesis).

Following are the sites of three most important marma:

1. Sira is the brain along with the spinal cord comprising the body's central nervous system which is control network for all the body activities, conscious communication and automatic operation of organs such as breathing, maintaining blood pressure, and releasing hormones etc.
2. Hr̥idaya is the heart which is the head of the circulatory system, which supplies oxygen and nutrients to the tissues. The body tissues need constant nutrition supply to be active, if there is lack of blood supply to the organs, the tissues may die.10
3. Basti is renal system which plays an important role in elimination of body waste and regulate blood volume, help to regulate blood pressure, pH, and maintains electrolyte balance in the body.

The loss of substance/ body (āsraya) leads to the loss of the substrate/ life (āshrayee) 11 hence, these trimarma should be especially protected against external injury and vātādi doṣha.

Sanskrit Text, Transliteration and English Translation

अथातस्त्रिमर्मीयचिकित्सितमध्यायंव्याख्यास्यामः||१||

इतिहस्माहभगवानात्रेयः||२||

athātastrimarmīyacikitsitamadhyāyaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAtastrimarmIyacikitsitamadhyAyaM vyAkhyAsyAmaH ||1||

iti ha smAha bhagavAnAtreyaH ||2||

Lord Atreya said, we shall now present the chapter on treatment pertaining to the disorders to the three marma (vital organs) [1-2]

सप्तोत्तरंमर्मशतंयदुक्तंशरीरसङ्ख्यामधिकृत्यतेभ्यः| मर्माणिबस्तिंहृदयंशिरश्चप्रधानभूतानिवदन्तितज्ज्ञाः||३||

प्राणाश्रयात्,तानिहिपीडयन्तोवातादयोऽसूनपिपीडयन्ति| तत्संश्रितानामनुपालनार्थंमहागदानांशृणुसौम्यरक्षाम्||४||

saptōttaraṁ marmaśataṁ yaduktaṁ śarīrasaṅkhyāmadhikr̥tya tēbhyaḥ| marmāṇi bastiṁ hr̥dayaṁ śiraśca pradhānabhūtāni vadanti tajjñāḥ||3||

prāṇāśrayāt, tāni hi pīḍayantō vātādayō'sūnapi pīḍayanti| tatsaṁśritānāmanupālanārthaṁ mahāgadānāṁ śr̥ṇu saumya rakṣām||4||

saptottaraM marmashataM yaduktaM sharIrasa~gkhyAmadhikRutya tebhyaH | marmANi bastiM hr̥dayaM shirashca pradhAnabhUtAni vadanti tajj~jAH ||3||

prANAshrayAt, tAni hi pIDayanto vAtAdayo~asUnapi pIDayanti | tatsaMshritAnAmanupAlanArthaM mahAgadAnAM shRuNu saumya rakShAm ||4||

The vital organs (marma) are mentioned as 107 in number while enumerating different body parts in śarīrasthāna (7th chapter). As per the specialists of the subjects, three vital organs, viz, basti (urinary bladder), hr̥dayaṁ (heart) and śira (head) are considered supreme among themselves, because they posess life (prāna) in them. Their suffering due to vāta etc also troubles/ endangers life (prāna). Hence to protect these vital organs, the method of protection from the attack of diseases, and their management will be discussed which you may listen (adressed to agnivesha) [3-4]

Etiology and pathogenesis, signs and symptoms of udavarta (abnormal upward movement of vata)

कषायतिक्तोषणरूक्षभोज्यैः पक्वाशयेकुप्यतिचेदपानःस्रोतांस्यधोगानिबलीसरुद्ध्वा||५|| करोतिविण्मारुतमूत्रसङ्गंक्रमादुदावर्तमतःसुघोरम्| रुग्बस्तिहृत्कुक्ष्युदरेष्वभीक्ष्णंसपृष्ठपार्श्वेष्वतिदारुणास्यात्||६|| आध्मानहृल्लासविकर्तिकाश्चतोदोऽविपाकश्चसबस्तिशोथः| वर्चोऽप्रवृत्तिर्जठरेचगण्डान्यूर्ध्वश्चवायुर्विहतोगुदेस्यात्||७|| कृच्छ्रेणशुष्कस्यचिरात्प्रवृत्तिःस्याद्वातनुःस्यात्खररूक्षशीता| ततश्चरोगाज्वरमूत्रकृच्छ्रप्रवाहिकाहृद्ग्रहणीप्रदोषाः||८|| वम्यान्ध्यबाधिर्यशिरोऽभितापवातोदराष्ठीलमनोविकाराः| तृष्णास्रपित्तारुचिगुल्मकासश्वासप्रतिश्यार्दितपार्श्वरोगाः||९|| अन्येचरोगाबहवोऽनिलोत्थाभवन्त्युदाsवर्तकृताःसुघोराः| चिकित्सितंचास्ययथावदूर्ध्वंप्रवक्ष्यतेतच्छृणुचाग्निवेश! ||१०|| kaṣāyatiktōṣaṇarūkṣabhōjyaiḥ sandhāraṇābhōjanamaithunaiśca pakvāśayē kupyati cēdapānaḥ srōtāṁsyadhōgāni balī sa ruddhvā||5|| karōti viṇmārutamūtrasaṅgaṁ kramādudāvartamataḥ sughōram| rugbastihr̥tkukṣyudarēṣvabhīkṣṇaṁ sapr̥ṣṭhapārśvēṣvatidāruṇā syāt||6|| ādhmānahr̥llāsavikartikāśca tōdō'vipākaśca sabastiśōthaḥ| varcō'pravr̥ttirjaṭharē ca gaṇḍānyūrdhvaśca vāyurvihatō gudē syāt||7|| kr̥cchrēṇa śuṣkasya cirāt pravr̥ttiḥ syādvā tanuḥ syāt khararūkṣaśītā| tataśca rōgā jwaramūtrakr̥cchrapravāhikāhr̥dgrahaṇīpradōṣāḥ||8|| vamyāndhyabādhiryaśirō'bhitāpavātōdarāṣṭhīlamanōvikārāḥ| tr̥ṣṇāsrapittārucigulmakāsaśvāsapratiśyārditapārśvarōgāḥ||9|| anyē ca rōgā bahavō'nilōtthā bhavantyudāvartakr̥tāḥ sughōrāḥ| cikitsitaṁ cāsya yathāvadūrdhvaṁ pravakṣyatē tacchr̥ṇu cāgnivēśa!||10||

kaShAyatiktoShaNarUkShabhojyaiH sandhAraNAbhojanamaithunaishca pakvAshaye kupyati cedapAnaH srotAMsyadhogAni balI sa ruddhvA ||5|| karoti viNmArutamUtrasa~ggaM kramAdudAvartamataH sughoram | rugbastihRutkukShyudareShvabhIkShNaM sapRuShThapArshveShvatidAruNA syAt ||6|| AdhmAnahRullAsavikartikAshca todo~avipAkashca sabastishothaH | varco~apravRuttirjaThare ca gaNDAnyUrdhvashca vAyurvihato gude syAt ||7|| kRucchreNa shuShkasya cirAt pravRuttiH syAdvA tanuH syAt khararUkShashItA | tatashca rogA jwaramUtrakRucchrapravAhikAhRudgrahaNIpradoShAH ||8|| vamyAndhyabAdhiryashiro~abhitApavAtodarAShThIlamanovikArAH | tRuShNAsrapittArucigulmakAsashvAsapratishyArditapArshvarogAH ||9|| anye ca rogA bahavo~anilotthA bhavantyudAvartakRutAH sughorAH | cikitsitaM cAsya yathAvadUrdhvaM pravakShyate tacchRuNu cAgnivesha! ||10||

Etiology and pathogenesis Due to the indulgence of astringent, bitter, pungent, dry/ un unctuous food consumption and indulgence of sex without proper food intake, strongly aggravates apana vāta in colon which obstructs downward moving channels and gradually obstructs the movement of stool, urine and the flatus causing udāvarta, the serious trouble. [5] Signs and symptoms of udavarta Intense and frequent pain in urinary bladder, cardiac region, pelvis, abdomen, and also severe pain in back and sides of chest; flatulence, nausea, cutting pain, piercing pain, indigestion, inflammation of urinary bladder; retention of stool, appearance of nodules in the abdomen, abnormal upward movement of vāta, Delayed and difficulty in evacuation of dry stool; body becomes rough, un unctuous, and cold and consequently disorders such as fever, dysuria, pravahika (spurious feeling of the need to evacuate stools with straining), cardiac disorders, grahani disorder (malabsorption syndrome), vomiting, blindness, deafness, burning sensation in head, vātodara (affliction of abdomen due to vata), asthilā (stony hard tumours), psychological disorders, thirst, hemorrhagic disorders, anorexia, gulma (lump like feeling), cough, dyspnea, rhinitis, facial paralysis and chest pain arise. Many other severe vāta disorders are caused by udāvarta. Treatment of these ailments will be described hereafter you may listen Agnivesha.

Treatment of udāvarta

तंतैलशीतज्वरनाशनाकंस्वेदैर्यथोक्तैःप्रविलीनदोषम्| उपाचरेद्वर्तिनिरूहबस्तिस्नेहैर्विरेकैरनुलोमनान्नैः||११|| श्यामात्रिवृन्मागधिकांसदन्तींगोमूत्रपिष्टांदशभागमाषाम्| सनीलिकांद्विर्लवणांगुडेनवर्तिंकराङ्गुष्ठनिभांविदध्यात्||१२|| पिण्याकसौवर्चलहिङ्गुभिर्वाससर्षपत्र्यूषणयावशूकैः| क्रिमिघ्नकम्पिल्लकशङ्खिनीभिःसुधार्कजक्षीरगुडैर्युताभिः||१३|| स्यात्पिप्पलीसर्षपराढवेश्मधूमैःसगोमूत्रगुडैश्चवर्तिः| श्यामाफलालाबुकपिप्पलीनांनाड्याऽथवातत्प्रधमेत्तुचूर्णम्||१४|| रक्षोघ्नतुम्बीकरहाटकृष्णाचूर्णंसजीमूतकसैन्धवंवा| स्निग्धेगुदेतान्यनुलोमयन्तिनरस्यवर्चोऽनिलमूत्रसङ्गम्||१५|| तेषांविघातेतुभिषग्विदध्यात्स्वभ्यक्तसुस्विन्नतनोर्निरूहम्| ऊर्ध्वानुलोमौषधमूत्रतैलक्षाराम्लवातघ्नयुतंसुतीक्ष्णम्||१६|| वातेऽधिकेऽम्लंलवणंसतैलं, क्षीरेणपित्तेतु, कफेसमूत्रम्| समूत्रवर्चोऽनिलसङ्गमाशुगुदंसिराश्चप्रगुणीकरोति||१७|| taṁ tailaśītajwaranāśanāktaṁ svēdairyathōktaiḥ pravilīnadōṣam| upācarēdvartinirūhabastisnēhairvirēkairanulōmanānnaiḥ||11|| śyāmātrivr̥nmāgadhikāṁ sadantīṁ gōmūtrapiṣṭāṁ daśabhāgamāṣām| sanīlikāṁ dvirlavaṇāṁ guḍēna vartiṁ karāṅguṣṭhanibhāṁ vidadhyāt||12|| piṇyākasauvarcalahiṅgubhirvā sasarṣapatryūṣaṇayāvaśūkaiḥ| krimighnakampillakaśaṅkhinībhiḥ sudhārkajakṣīraguḍairyutābhiḥ||13|| syāt pippalīsarṣaparāḍhavēśmadhūmaiḥ sagōmūtraguḍaiśca vartiḥ| śyāmāphalālābukapippalīnāṁ nāḍyā'thavā tat pradhamēttu cūrṇam||14|| rakṣōghnatumbīkarahāṭakr̥ṣṇācūrṇaṁ sajīmūtakasaindhavaṁ vā| snigdhē gudē tānyanulōmayanti narasya varcō'nilamūtrasaṅgam||15|| tēṣāṁ vighātē tu bhiṣagvidadhyāt svabhyaktasusvinnatanōrnirūham| ūrdhvānulōmauṣadhamūtratailakṣārāmlavātaghnayutaṁ sutīkṣṇam||16|| vātē'dhikē'mlaṁ lavaṇaṁ satailaṁ, kṣīrēṇa pittē tu, kaphē samūtram| sa mūtravarcō'nilasaṅgamāśu gudaṁ sirāśca praguṇīkarōti||17||

taM tailashItajwaranAshanAkaM svedairyathoktaiH pravilInadoSham | upAcaredvartinirUhabastisnehairvirekairanulomanAnnaiH ||11|| shyAmAtrivRunmAgadhikAM sadantIM gomUtrapiShTAM dashabhAgamAShAm | sanIlikAM dvirlavaNAM guDena vartiM karA~gguShThanibhAM vidadhyAt ||12|| piNyAkasauvarcalahi~ggubhirvA sasarShapatryUShaNayAvashUkaiH | krimighnakampillakasha~gkhinIbhiH sudhArkajakShIraguDairyutAbhiH ||13|| syAt pippalIsarShaparADhaveshmadhUmaiH sagomUtraguDaishca vartiH | shyAmAphalAlAbukapippalInAM nADyA~athavA tat pradhamettu cUrNam ||14|| rakShoghnatumbIkarahATakRuShNAcUrNaM sajImUtakasaindhavaM vA | snigdhe gude tAnyanulomayanti narasya varco~anilamUtrasa~ggam ||15|| teShAM vighAte tu bhiShagvidadhyAt svabhyaktasusvinnatanornirUham | UrdhvAnulomauShadhamUtratailakShArAmlavAtaghnayutaM sutIkShNam ||16|| vAte~adhike~amlaM lavaNaM satailaM, kShIreNa pitte tu, kaphe samUtram | sa mUtravarco~anilasa~ggamAshu gudaM sirAshca praguNIkaroti ||17|| The patient should be massaged with oil prepared with drugs alleviating shīta jwara (fever with external cold touch) and then fomented so that the adhered doṣha get detached. There after the patient should be managed with suppositories (varti), non-unctuous enema and unctuous purgatives and diet which regulates movement of vata in downward direction. [11] Anal suppository (varti) method of preparation and the usage: 1. Ingredients: equal parts of- śyāmātrivr̥it - Operculina turpethum(L.), māgadhikāṁ -Piper longum (L), dantī - Baliospermum.(Blume), nilika- Vitex Negundo (Linn) and 1/10 part of māsha-Vigna mungo(L.). Method of preparation: Triturate the above plants/ powders in cow’s urine then add 2 parts- salt and jaggery in sufficient quantity. Make a suppository of the size and shape of thumb finger. [12] 2. Ingredients: oil cake (pinyāka), sauvarcala (a type of salt), hingu- Ferula assa-foetida (L), mustard- Brassica nigra (L), trikatu (shunthi-Zingiber officinale (Roscoe), maricha- Piper nigrum (Linn) pippali- Piper Longum (Linn.), yavaksāra- Hordeum vulgare (L.), jaggery [13] 3. Ingredients: vidanga- Embelia ribes (Burm.f.), kampillaka- Mallotus philippensis(Lam.) Muell.Arg., śaṅkhinī- Xanthium strumarium (L), latex of- snuhi- Zingiber officinale (Roscoe), arka- Calotropis Gigantea (Linn), Jaggery [14] 4. Ingredients: pippali- Piper Longum (Linn), sarsapa- Brassica nigra (L), madanaphala- Randia dumetorum (lam.), house shoot, cow urine, jaggery. [14] Anal dusting treatment/ pradhamana (insufflation): The powder of following herbs is to be blowed up with the pipe/ tube in to the oleated anal canal. Drugs used are: 1. Powder of syāmā- Operculina turpethum (L.), madanaphala- Randia dumetorum (lam.), alābu- Cucurbita lagrenaria (Linn.) and pippali.- Piper Longum (Linn). [15] 2. Oleate the anus and through the tube, blow in the powder of rakshoghna (sarshapa)- Brassica nigra (L. Koch), tumbi- Cucurbita lagrenaria (Linn) karahata(madanaphala)-Randia dumetorum (lam.), krishna(pippali)-Piper Longum (Linn), jeemutaka(devadali)-Luffa echinata (Roxb).,and rock salt [15] If the above said therapies fail to produce the desired results the physician should advise oleation and foementation and administer niruha type of basti (un unctuous medicated enema) using a special combination of herbal decoctions which are sharp (tiksna) in nature and having emetic and purgative properties alongwith, cows urine, oil, alkali, drugs with drugs having sour taste and vāta alleviating quality, In vāta predominance: The enema should be sour, salty and oily. In pitta predominance: The enema should be with milk. In Kapha predominance: The enema should be with urine. Benefits of this enema: Relievs retention of urine, stool and flatus, it strengthens the anal region as well as the connected blood vessels. [16]

Diet in udāvarta

त्रिवृत्सुधापत्रतिलादिशाकग्राम्यौदकानूपरसैर्यवान्नम्| अन्यैश्चसृष्टानिलमूत्रविङ्भिरद्यात्प्रसन्नागुडसीधुपायी||१८|| trivr̥tsudhāpatratilādiśākagrāmyaudakānūparasairyavānnam| anyaiśca sr̥ṣṭānilamūtraviḍbhiradyāt prasannāguḍasīdhupāyī||18|| trivRutsudhApatratilAdishAkagrAmyaudakAnUparasairyavAnnam | anyaishca sRuShTAnilamUtravi~gbhiradyAt prasannAguDasIdhupAyI ||18|| The patient should be kept on diet of barley-made food, which is prepared with the following vegetables: 1. Leaves of trivrt- Operculina turpethum(L.), and snuhi leaves, sesamum-Brassica nigra (L. Koch), etc vegetables. 2. Meat soup of domestic, aquatic and marshy animals (animals inhabiting in marshy land) or other ingredients which help in elimination of flatus, urine and stool. 3. Followed by drink of prasanna (clear wine/top portion of alcohol) or gudasidhu-wine prepared out of jaggery. [18]

Treatment of chronic udāvarta and other complications

भूयोऽनुबन्धेतुभवेद्विरेच्योमूत्रप्रसन्नादधिमण्डशुक्तैः| स्वस्थंतुपश्चादनुवासयेत्तंरौक्ष्याद्धिसङ्गोऽनिलवर्चसोश्चेत्||१९|| bhūyō'nubandhē tu bhavēdvirēcyō mūtraprasannādadhimaṇḍaśuktaiḥ| svasthaṁ tu paścādanuvāsayēttaṁ raukṣyāddhi saṅgō'nilavarcasōścēt||19|| bhUyo~anubandhe tu bhavedvirecyo mUtraprasannAdadhimaNDashuktaiH | svasthaM tu pashcAdanuvAsayettaM raukShyAddhi sa~ggo~anilavarcasoshcet ||19|| If the udāvarta continues in spite of the above treatment, then the patient should be purgated with cow’s urine, prasanna (clear top portion of alcohol), dadhimanda (upper liquid portion of curd/ curd-scum) and shukta (vinegar). If the patient is normalized but there is retention of flatus and stool due to ununctuousness, then patient should be given anuvasana type of medicated enema (unctuous enema). [19]

Churna preparations

द्विरुत्तरंहिङ्गुवचाग्निकुष्ठंसुवर्चिकाचैवविडङ्गचूर्णम्| सुखाम्बुनाऽऽनाहविसूचिकार्तिहृद्रोगगुल्मोर्ध्वसमीरणघ्नम्||२०|| वचाभयाचित्रकयावशूकान्सपिप्पलीकातिविषान्सकुष्ठान्| उष्णाम्बुनाऽऽनाहविमूढवातान्पीत्वाजयेदाशुरसौदनाशी||२१|| हिङ्गूग्रगन्धाबिडशुण्ठ्यजाजीहरीतकीपुष्करमूलकुष्ठम्| यथोत्तरंभागविवृद्धमेतत्प्लीहोदराजीर्णविसूचिकासु||२२|| dviruttaraṁ hiṅgu vacāgnikuṣṭhaṁ [1] suvarcikā caiva viḍaṅgacūrṇam| sukhāmbunānāhavisūcikārtihr̥drōgagulmōrdhvasamīraṇaghnam ||20|| vacābhayācitrakayāvaśūkān sapippalīkātiviṣān sakuṣṭhān| uṣṇāmbunānāhavimūḍhavātān pītvā jayēdāśu rasaudanāśī||21|| hiṅgūgragandhābiḍaśuṇṭhyajājīharītakīpuṣkaramūlakuṣṭham| yathōttaraṁ bhāgavivr̥ddhamētat plīhōdarājīrṇavisūcikāsu||22|| dviruttaraM hi~ggu vacAgnikuShThaM [1] suvarcikA caiva viDa~ggacUrNam| sukhAmbunA~a~anAhavisUcikArtihRudrogagulmordhvasamIraNaghnam ||20|| vacAbhayAcitrakayAvashUkAn sapippalIkAtiviShAn sakuShThAn| uShNAmbunA~a~anAhavimUDhavAtAn pItvA jayedAshu rasaudanAshI||21|| hi~ggUgragandhAbiDashuNThyajAjIharItakIpuShkaramUlakuShTham| yathottaraM bhAgavivRuddhametat plIhodarAjIrNavisUcikAsu||22|| Dviruttara-hingvadi-churna: Ingredients: 1 part-hingu- Ferula asafetida (L) 2 parts- vaca- Acorus calamus Linn 4 parts- citraka-Plumbago zeylanicaLinn 8 parts-kustha- Saussurea lappa 16 parts-swarjiksara- 32 parts- vidanga- Embelia ribes Burm. Powder all the above together. This preparation of powder should be taken with warm water, it alleviates, visucika (diarrhea with pricking pain in abdomen), heart disease, gulma (lump like feeling in the abdomen) and urdhvasamirana (abnormal upward movement of vāta) [20] Vacadi- churna: Powders of- vaca, haritaki, citraka, yavaksara, pippali, ativisa, and kustha taken with hot water alleviates anaha (abdominal tympanites), vimoodha vāta (confounded vāta). Rice along with meat soup should be consumed while using this preparation. [21] Hingvadi churna Ingredients: 1 part- hingu- Ferula assa-foetida (L) 2 parts- ugragandhi/ ajamoda-Trachyspermum ammiLinn. Sprague 3 parts- bida lavana 4 parts- sunthi- Zingiber officinale (Roscoe) 5 parts- ajaji/ jiraka-Cuminum cyminum Linn. 6 parts- haritaki- Terminalia chebula Linn 7 parts - puskaramula- Inula Racemosa Hook. F. 8 parts- kustha- Saussurea lappa C.B Clarke Intake of this [powder] alleviates pleehodara (splenomegaly), indigestion and visucika (diarrhea with pricking pain in abdomen).[22]

Ghrita preparation

स्थिरादिवर्गस्यपुनर्नवायाःशम्पाकपूतीककरञ्जयोश्च| सिद्धःकषायेद्विपलांशिकानांप्रस्थोघृतात्स्यात्प्रतिरुद्धवाते||२३|| sthirAdivargasya punarnavAyAH shampAkapUtIkakara~jjayoshca | siddhaH kaShAye dvipalAMshikAnAM prastho ghRutAt syAt pratiruddhavAte ||23|| Sthiradi- ghrita: Ingredients: Decoction prepared out of two pala (80 grams) of each drugs of sthiradivarga (shalaparni-Desmodium gangeticum DC, Prisnaparni- Cyperus sp, brahati- Solanum indicum Linn./ anguivi Lam, kantakari- Garcinia morella Desr, gokshura- Tribulus terrestris Linn), Punarnava- Boerhaavia diffusa Linn, campak (aragvadha)-Cassia fistula Linn and putikarnja- Caesalpinia crista Linn cooked with one prasta (640 gms) of ghee. Intake of this medicated ghee cures pratiruddha vāta (obstructed flatus) [23]

Condiment

फलंचमूलंचविरेचनोक्तंहिङ्ग्वर्कमूलंदशमूलमग्र्यम्| स्नुक्चित्रकश्चैवपुनर्नवाचतुल्यानिसर्वैर्लवणानिपञ्च||२४|| स्नेहैःसमूत्रैःसहजर्जराणिशरावसन्धौविपचेत्सुलिप्ते| पक्वंसुपिष्टंलवणंतदन्नैःपानैस्तथाऽऽनाहरुजाघ्नमद्यात्||२५|| phalaṁ ca mūlaṁ ca virēcanōktaṁ hiṅgvarkamūlaṁ daśamūlamagryam| snuk citrakaścaiva punarnavā ca tulyāni sarvairlavaṇāni pañca||24|| snēhaiḥ samūtraiḥ saha jarjarāṇi śarāvasandhau vipacēt suliptē| pakvaṁ supiṣṭaṁ lavaṇaṁ tadannaiḥ pānaistathānāharujāghnamadyāt||25||

phalaM ca mUlaM ca virecanoktaM hi~ggvarkamUlaM dashamUlamagryam | snuk citrakashcaiva punarnavA ca tulyAni sarvairlavaNAni pa~jca ||24|| snehaiH samUtraiH saha jarjarANi sharAvasandhau vipacet sulipte | pakvaM supiShTaM lavaNaM tadannaiH pAnaistathA~a~anAharujAghnamadyAt ||25||

Fruits and roots mentioned under purgatives (Sutra.1:77-85) alongwith hingu- Ferula asafetida (L), arka- Calotropis Gigantea (Linn) roots, dasamula (bilva, syonaka, gambhari, patala, ghanikarnika, salaparni, prishnaparni, brahati, kantakari, gokshura), snuhi, citraka and punarnava to be taken in equal quantity. To this five types of salt in equal quantity is to be added and made in to coarse powder, this mixture is further triturated with cows urine and fat and cooked within closed earthen saucer with well-closed joints with clay smeared cloth, and then placed over fire, when cooked, the salt should be powdered and there after used with food and drinks. This eliminates anaha (bloating in the upper abdomen) and pain (abdominal pain).[24-25]

Diagnosis associated symptoms and treatment of anaha (bloating in upper abdomen) and use of castor oil

हृत्स्तम्भमूर्धामयगौरवाभ्यामुद्गारसङ्गेनसपीनसेन| आनाहमामप्रभवंजयेत्तुप्रच्छर्दनैर्लङ्घनपाचनैश्च||२६|| (गुल्मोदरब्रध्नार्शःप्लीहोदावर्तयोनिशुक्रगदेमेदःकफसंसृष्टेमारुतरक्तेऽवगाढेच||२७|| गृध्रसिपक्षवधादिषुविरेचनार्हेषुवातरोगेषु| वातेविबद्धमार्गेमेदःकफपित्तरक्तेन||२८|| पयसामांसरसैर्वात्रिफलारसयूषमूत्रमदिराभिः|दोषानुबन्धयोगात्प्रशस्तमेरण्डजंतैलम्||२९|| तद्वातनुत्स्वभावात्संयोगवशाद्विरेचनाच्चजयेत्| मेदोसृक्पित्तकफोन्मिश्रानिलरोगजित्तस्मात्||३०|| बलकोष्ठव्याधिवशादापञ्चपलाभवेन्मात्रा| मृदुकोष्ठाल्पबलानांसहभोज्यंतत्प्रयोज्यंस्यत्) ||३१|| इत्युदावर्तचिकित्सा| hr̥tstambhamūrdhāmayagauravābhyāmudgārasaṅgēna sapīnasēna| ānāhamāmaprabhavaṁ jayēttu pracchardanairlaṅghanapācanaiśca||26|| (gulmōdarabradhnārśaḥplīhōdāvartayōniśukragadē | mēdaḥkaphasaṁsr̥ṣṭē mārutaraktē'vagāḍhē ca||27|| gr̥dhrasipakṣavadhādiṣu virēcanārhēṣu vātarōgēṣu| vātē vibaddhamārgē mēdaḥkaphapittaraktēna||28|| payasā māṁsarasairvā triphalārasayūṣamūtramadirābhiḥ| dōṣānubandhayōgāt praśastamēraṇḍajaṁ tailam||29|| tadvātanutsvabhāvāt saṁyōgavaśādvirēcanācca jayēt| mēdōsr̥kpittakaphōnmiśrānilarōgajittasmāt||30|| balakōṣṭhavyādhivaśādāpañcapalā bhavēnmātrā| hRutstambhamUrdhAmayagauravAbhyAmudgArasa~ggena sapInasena | AnAhamAmaprabhavaM jayettu pracchardanairla~gghanapAcanaishca ||26|| (gulmodarabradhnArshaHplIhodAvartayonishukragade | medaHkaphasaMsRuShTe mArutarakte~avagADhe ca ||27|| gRudhrasipakShavadhAdiShu virecanArheShu vAtarogeShu | vAte vibaddhamArge medaHkaphapittaraktena ||28|| payasA mAMsarasairvA triphalArasayUShamUtramadirAbhiH | doShAnubandhayogAt prashastameraNDajaM tailam ||29|| tadvAtanutsvabhAvAt saMyogavashAdvirecanAcca jayet | medosRukpittakaphonmishrAnilarogajittasmAt ||30|| balakoShThavyAdhivashAdApa~jcapalA bhavenmAtrA | mRudukoShThAlpabalAnAM saha bhojyaM tatprayojyaM syat) ||31|| ityudAvartacikitsA | Anaha (bloating in upper abdomen) as caused by ama (improperly digested food/product of improper digestion), associated with stiffness in cardiac region, diseases of head and heaviness, retention of belching, common cold should be treated with emesis therapy, langhana (fasting therapy) and pachan (carminatives). [26] (If the vāta is obstructed by fat, kapha, pitta or rakta (vitiated blood) in the disease like gulma (lump like feeling in abdomen), udara (abdominal diseases includes ascites) bradhna (inguinal swelling), piles, splenic enlargement, udāvarta (abnormal upward movement of vāta), yoni-rōga (gynecological diseases), seminal disorders, disorders of fat by the vitiation of kapha, deep-seated vāta-rakta (gout), sciatica, hemiplegia etc and in such vatik disorders wherein purgation therapy is recommended for cure, Castor oil is an excellent remedy, which should be added with other such ingredients which pacifies aggravated vāta and administered along with milk, meat soup, juice or triphala decoction, vegetable soup, cows urine, alcoholic drink etc. Due to its vāta pacifying nature, due to addition of other drugs, and because of its purgative effects, it cures vatika disorders associated with vitiated fat, blood, pitta and kapha. [29-30] Castor oil should be administered up to the dose of five pala depending on the strength of the person, nature of disease, and the kosta. If the person is weak and is of mrudu kosta (laxed bowel) then, castor oil should be given along with food. [31] Thus ends the treatment of udāvarta[26-31]

Etiology, types, pathogenesis, signs and symptoms of mutrakrcchra (dysuria)

व्यायामतीक्ष्णौषधरूक्षमद्यप्रसङ्गनित्यद्रुतपृष्ठयानात्| आनूपमत्स्याध्यशनादजीर्णात्स्युर्मूत्रकृच्छ्राणिनृणामिहाष्टौ||३२|| पृथङ्मलाःस्वैःकुपितानिदानैःसर्वेऽथवाकोपमुपेत्यबस्तौ| मूत्रस्यमार्गंपरिपीडयन्तियदातदामूत्रयतीहकृच्छ्रात्||३३|| तीव्रारुजोवङ्क्षणबस्तिमेढ्रेस्वल्पंमुहुर्मूत्रयतीहवातात्| पीतंसरक्तंसरुजंसदाहंकृच्छ्रान्मुहुर्मूत्रयतीहपित्तात्||३४|| बस्तेःसलिङ्गस्यगुरुत्वशोथौमूत्रंसपिच्छंकफमूत्रकृच्छ्रे| सर्वाणिरूपाणितुसन्निपाताद्भवन्तितत्कृच्छ्रतमंहिकृच्छ्रम्||३५|| vyāyāmatīkṣṇauṣadharūkṣamadyaprasaṅganityadrutapr̥ṣṭhayānāt| ānūpamatsyādhyaśanādajīrṇāt syurmūtrakr̥cchrāṇi nr̥ṇāmihāṣṭau||32|| pr̥thaṅmalāḥ svaiḥ kupitā nidānaiḥ sarvē'thavā kōpamupētya bastau| mūtrasya mārgaṁ paripīḍayanti yadā tadā mūtrayatīha kr̥cchrāt||33|| tīvrā rujō vaṅkṣaṇabastimēḍhrē svalpaṁ muhurmūtrayatīha vātāt| pītaṁ saraktaṁ sarujaṁ sadāhaṁ kr̥cchrānmuhurmūtrayatīha pittāt||34|| bastēḥ saliṅgasya gurutvaśōthau mūtraṁ sapicchaṁ kaphamūtrakr̥cchrē| sarvāṇi rūpāṇi tu sannipātādbhavanti tat kr̥cchratamaṁ hi kr̥cchram||35|| vyAyAmatIkShNauShadharUkShamadyaprasa~gganityadrutapRuShThayAnAt | AnUpamatsyAdhyashanAdajIrNAt syurmUtrakRucchrANi nRuNAmihAShTau ||32|| pRutha~gmalAH svaiH kupitA nidAnaiH sarve~athavA kopamupetya bastau | mUtrasya mArgaM paripIDayanti yadA tadA mUtrayatIha kRucchrAt ||33|| tIvrA rujo va~gkShaNabastimeDhre svalpaM muhurmUtrayatIha vAtAt | pItaM saraktaM sarujaM sadAhaM kRucchrAnmuhurmUtrayatIha pittAt ||34|| basteH sali~ggasya gurutvashothau mUtraM sapicchaM kaphamUtrakRucchre | sarvANi rUpANi tu sannipAtAdbhavanti tat kRucchratamaM hi kRucchram ||35|| Etiology of dysuria: Excessive physical exertion, intake of drugs having tikshna (sharp) quality and ununctous food intake, habitual intake of alcohol, riding on a fast-moving vehicle, overeating meat of marshy animals and fish, Intake of food before the previous meal is digested and chronic indigestion leads to eight type of mutrakrcchra (dysuria). [32]

Pathogenesis: Doṣha aggravated separately or all together when being provoked by their vitiating factors which get located in kidney or urinary bladder and distress the urinary passage, leads to mutrakricchra(dysuria).[33] Signs of vataja dysuria: Severe pain in groins, urinary bladder and genitals and the patient frequently passes urine in small quantity. Signs of pittaja dysuria: The patient passes yellow or bloody urine with pain and burning sensation frequently and with difficulty. [34] Signs of kaphaja dysuria: Heaviness and oedema in urinary bladder and phallus and the urine is associated with slimy materials Signs of sannipata dysuria: All the signs and symptoms described above are manifested as all the doṣha are aggravated which is the cause for sannipatika type of dysuria which is most difficult type of dysuria for cure. [35]

Dysuria caused by asmari (urinary calculus): विशोषयेद्बस्तिगतंसशुक्रंमूत्रंसपित्तंपवनःकफंवा| यदातदाऽश्मर्युपजायतेतुक्रमेणपित्तेष्विवरोचनागोः||३६|| viśōṣayēdbastigataṁ saśukraṁ mūtraṁ sapittaṁ pavanaḥ kaphaṁ vā| yadā tadā'śmaryupajāyatē tu kramēṇa pittēṣviva rōcanā gōḥ||36|| vishoShayedbastigataM sashukraM mUtraM sapittaM pavanaH kaphaM vA | yadA tadA~ashmaryupajAyate tu krameNa pitteShviva rocanA goH ||36|| Pathogenesis: When the aggravated vāta dries up semen and urine alongwith pitta and kapha which is located in urinary bladder the calculus is formed gradually like gall stone in cow. [36] Signs and symptoms of urinary calculus: कदम्बपुष्पाकृतिरश्मतुल्याश्लक्ष्णात्रिपुट्यप्यथवाऽपिमृद्वी| मूत्रस्यचेन्मार्गमुपैतिरुद्ध्वामूत्रंरुजंतस्यकरोतिबस्तौ||३७|| ससेवनीमेहनबस्तिशूलंविशीर्णधारंचकरोतिमूत्रम्| मृद्नातिमेढ्रंसतुवेदनार्तोमुहुःशकृन्मुञ्चतिमेहतेच||३८|| क्षोभात्क्षतेमूत्रयतीहसासृक्तस्याःसुखंमेहतिचव्यपायात्|३९| kadambapuṣpākr̥tiraśmatulyā ślakṣṇā tripuṭyapyathavā'pi mr̥dvī| mūtrasya cēnmārgamupaiti ruddhvā mūtraṁ rujaṁ tasya karōti bastau||37|| sasēvanīmēhanabastiśūlaṁ viśīrṇadhāraṁ ca karōti mūtram| mr̥dnāti mēḍhraṁ sa tu vēdanārtō muhuḥ śakr̥nmuñcati mēhatē ca||38|| kṣōbhāt kṣatē mūtrayatīha sāsr̥k tasyāḥ sukhaṁ mēhati ca vyapāyāt|39| kadambapuShpAkRutirashmatulyA shlakShNA tripuTyapyathavA~api mRudvI | mUtrasya cenmArgamupaiti ruddhvA mUtraM rujaM tasya karoti bastau ||37|| sasevanImehanabastishUlaM vishIrNadhAraM ca karoti mUtram | mRudnAti meDhraM sa tu vedanArto muhuH shakRunmu~jcati mehate ca ||38|| kShobhAt kShate mUtrayatIha sAsRuk tasyAH sukhaM mehati ca vyapAyAt |39|

When the calculus resembles kadamba flower, stony, smooth, prismatic (having three layers) or soft and when it comes in the urinary passage, it obstructs the flow of urine and results in pain in urinary bladder and perineum-sevani (suture below the pudendum and between two testicles), phallus and hypogastric region (region over urinary bladder). Urine is passed in divided streams and because of pain; the patient squeezes the phallus and frequently voids stool and urine. [35-38] If the passage or bladder is injured by calculus, then the urine is passed with blood (hematuria). When calculus shifts from the passage, the patient passes urine with ease. [39] Dysuria caused by sarkara (graveluria)/semen एषाऽश्मरीमारुतभिन्नमूर्तिःस्याच्छर्करामूत्रपथात्क्षरन्ती||३९|| (रेतोऽभिघाताभिहतस्यपुंसःप्रवर्ततेयस्यतुमूत्रकृच्छ्रम्| स्याद्वेदनावङ्क्षणबस्तिमेढ्रेतस्यातिशूलंवृषणातिवृत्ते||४०|| शुक्रेणसंरुद्धगतिप्रवाहोमूत्रंसकृच्छ्रेणविमुञ्चतीह| तमण्डयोःस्तब्धमितिब्रुवन्तिरेतोऽभिघातात्प्रवदन्तिकृच्छ्रम्||४१|| ēṣā'śmarī mārutabhinnamūrtiḥ syāccharkarā mūtrapathāt kṣarantī||39|| (rētō'bhighātābhihatasya puṁsaḥ pravartatē yasya tu mūtrakr̥cchram| syādvēdanā vaṅkṣaṇabastimēḍhrē tasyātiśūlaṁ vr̥ṣaṇātivr̥ttē||40|| śukrēṇa saṁruddhagatipravāhō mūtraṁ sa kr̥cchrēṇa vimuñcatīha| tamaṇḍayōḥ stabdhamiti bruvanti rētō'bhighātāt pravadanti kr̥cchram ||41||

eShA~ashmarI mArutabhinnamUrtiH syAccharkarA mUtrapathAt kSharantI ||39|| (reto~abhighAtAbhihatasya puMsaH pravartate yasya tu mUtrakRucchram | syAdvedanA va~gkShaNabastimeDhre tasyAtishUlaM vRuShaNAtivRutte ||40|| shukreNa saMruddhagatipravAho mUtraM sa kRucchreNa vimu~jcatIha | tamaNDayoH stabdhamiti bruvanti reto~abhighAtAt pravadanti kRucchram||41|| Dysuria caused by sarkara (graveluria): When the calculus is broken into smaller particles due to vāta aggravation, then such particles which comes out of the urinary passage along with urine is called as sarkara.[39] Blocked discharge of semen/dysuria caused by semen: If the dysuria caused in a person is due to the obstruction of semen or injury of semen tract, then the patient suffers from pain in the groin, urinary bladder, and phallus. His testicles become swollen and intensely painful. [40] Since the urinary flow is obstructed by semen, urine is passed with difficulty and there is stiffness of the testicles known as aṇḍa stabdham. The dysuria, thus, manifested is considered to be caused by seminal obstruction. [41]

Dysuria caused by vitiated semen: शुक्रंमलाश्चैवपृथक्पृथग्वामूत्राशयस्थाःप्रतिवारयन्ति| तद्व्याहतंमेहनबस्तिशूलंमूत्रंसशुक्रंकुरुतेविबद्धम्||४२|| स्तब्धश्चशूनोभृशवेदनश्चतुद्येतबस्तिर्वृषणौचतस्य|४३| śukraṁ malāścaiva pr̥thak pr̥thagvā mūtrāśayasthāḥ prativārayanti| tadvyāhataṁ mēhanabastiśūlaṁ mūtraṁ saśukraṁ kurutē vibaddham||42|| stabdhaśca śūnō bhr̥śavēdanaśca tudyēta bastirvr̥ṣaṇau ca tasya|43| shukraM malAshcaiva pRuthak pRuthagvA mUtrAshayasthAH prativArayanti | tadvyAhataM mehanabastishUlaM mUtraM sashukraM kurute vibaddham ||42|| stabdhashca shUno bhRushavedanashca tudyeta bastirvRuShaNau ca tasya |43|

Mala’s (aggravated tridoṣha) located in the urinary bladder obstructs the flow of semen individually because of this seminal obstruction there is pain in the phallus and urinary bladder along with obstruction to the voiding of urine and ejaculation of semen which leads to stiffness, swelling, excessive pain and pricking pain in the urinary bladder and testicles. [42-43] Dysuria caused by kshata/trauma: क्षताभिघातात्क्षतजंक्षयाद्वाप्रकोपितंबस्तिगतंविबद्धम्||४३|| तीव्रार्तिमूत्रेणसहाश्मरीत्वमायातितस्मिन्नतिसञ्चितेच| आध्माततांविन्दतिगौरवंचबस्तेर्लघुत्वंचविनिःसृतेऽस्मिन्||४४|| इतिमूत्रकृच्छ्रनिदानम्| अभ्यञ्जनस्नेहनिरूहबस्तिस्नेहोपनाहोत्तरबस्तिसेकान्| kṣatābhighātāt kṣatajaṁ kṣayādvā prakōpitaṁ bastigataṁ vibaddham||43|| tīvrārti mūtrēṇa sahāśmarītvamāyāti tasminnatisañcitē ca| ādhmātatāṁ vindati gauravaṁ ca bastērlaghutvaṁ ca viniḥsr̥tē'smin||44||

kShatAbhighAtAt kShatajaM kShayAdvA prakopitaM bastigataM vibaddham ||43|| tIvrArti mUtreNa sahAshmarItvamAyAti tasminnatisa~jcite ca | AdhmAtatAM vindati gauravaM ca basterlaghutvaM ca viniHsRute~asmin ||44|| iti mUtrakRucchranidAnam | abhya~jjanasnehanirUhabastisnehopanAhottarabastisekAn | If the vitiated blood due to kshata (trauma) or kshaya (emaciation caused by excessive seminal discharge) when accumulated in urinary bladder, it causes obstruction and severe pain in the bladder. Vitiated blood when associates with urine forms the calculus, which causes the distention of abdomen and heaviness in the region of urinary bladder however the patient feels lightness when the calculus passes out. Thus, ends the diagnosis of dysuria(mootra krucra). [43-44] Treatment of vatika dsyuria: स्थिरादिभिर्वातहरैश्चसिद्धान्दद्याद्रसांश्चानिलमूत्रकृच्छ्रे||४५|| पुनर्नवैरण्डशतावरीभिःपत्तूरवृश्चीरबलाश्मभिद्भिः| द्विपञ्चमूलेनकुलत्थकोलयवैश्चतोयोत्क्वथितेकषाये||४६|| तैलंवराहर्क्षवसाघृतंचतैरेवकल्कैर्लवणैश्चसाध्यम्| तन्मात्रयाऽऽशुप्रतिहन्तिपीतंशूलान्वितंमारुतमूत्रकृच्छ्रम्||४७|| एतानिचान्यानिवरौषधानिपिष्टानिशस्तान्यपिचोपनाहे| स्युर्लाभतस्तैलफलानिचैवस्नेहाम्लयुक्तानिसुखोष्णवन्ति||४८|| sthirādibhirvātaharaiśca siddhān dadyādrasāṁścānilamūtrakr̥cchrē||45|| punarnavairaṇḍaśatāvarībhiḥ pattūravr̥ścīrabalāśmabhidbhiḥ| dvipañcamūlēna kulatthakōlayavaiśca tōyōtkvathitē kaṣāyē||46|| tailaṁ varāharkṣavasā ghr̥taṁ ca tairēva kalkairlavaṇaiśca sādhyam| tanmātrayāśu pratihanti pītaṁ śūlānvitaṁ mārutamūtrakr̥cchram||47|| ētāni cānyāni varauṣadhāni piṣṭāni śastānyapi cōpanāhē| syurlābhatastailaphalāni caiva snēhāmlayuktāni sukhōṣṇavanti||48||

sthirAdibhirvAtaharaishca siddhAn dadyAdrasAMshcAnilamUtrakRucchre ||45|| punarnavairaNDashatAvarIbhiH pattUravRushcIrabalAshmabhidbhiH | dvipa~jcamUlena kulatthakolayavaishca toyotkvathite kaShAye ||46|| tailaM varAharkShavasA ghRutaM ca taireva kalkairlavaNaishca sAdhyam | tanmAtrayA~a~ashu pratihanti pItaM shUlAnvitaM mArutamUtrakRucchram ||47|| etAni cAnyAni varauShadhAni piShTAni shastAnyapi copanAhe | syurlAbhatastailaphalAni caiva snehAmlayuktAni sukhoShNavanti ||48|| abhyañjanasnēhanirūhabastisnēhōpanāhōttarabastisēkān|

Treatment in vataja dysuria: Massage, unctuous and non-unctuous medicated enema, unctuous poultice, uttarabasti (urethral douche) and sekam (affusion) as well as the diet of soup prepared with sthiradi (laghupancmula drugs-salaparni, prishna parni,brahati,kantakari,and gokshura) and other vāta- alleviating drugs to be administered. [45] The following formula used in right dose quickly alleviates the painful vataja dysuria: Oil, fat of pig and bear and ghee cooked with the decoction and paste of- punarnava, eranda, satavari, pattura, vrscira, bala, pasanabheda, dasamula (bilva, shonaka, gambhari, patala, ganikarnika, salaparni, prishnaparni, brahati, kantakari and gokshura), kulattha, kola, yava, with five types of salt which is useful in pain associated in vataja type of dysuria. [46-47] Above said drugs and such other drugs having similar quality other good drugs may also be used in the form of upanaha. Oily seeds, as available pounded with unctuous substance and sour substance may be applied warm as a poultice. Intake of oil seeds along with sour things in lukewarm form is also useful. [48] Treatment of paittika dysuria: सेकावगाहाःशिशिराःप्रदेहाग्रैष्मोविधिर्बस्तिपयोविरेकाः| द्राक्षाविदारीक्षुरसैर्घृतैश्चकृच्छ्रेषुपित्तप्रभवेषुकार्याः||४९|| शतावरीकाशकुशश्वदंष्ट्राविदारिशालीक्षुकशेरुकाणाम्| क्वाथंसुशीतंमधुशर्कराभ्यांयुक्तंपिबेत्पैत्तिकमूत्रकृच्छ्री||५०|| पिबेत्कषायंकमलोत्पलानांशृङ्गाटकानामथवाविदार्याः| दण्डैरकाणामथवाऽपिमूलंपूर्वेणकल्पेनतथाऽम्बुशीतम्||५१|| sēkāvagāhāḥ śiśirāḥ pradēhā graiṣmō vidhirbastipayōvirēkāḥ| drākṣāvidārīkṣurasairghr̥taiśca kr̥cchrēṣu pittaprabhavēṣu kāryāḥ||49|| śatāvarīkāśakuśaśvadaṁṣṭrāvidāriśālīkṣukaśērukāṇām| kvāthaṁ suśītaṁ madhuśarkarābhyāṁ yuktaṁ pibēt paittikamūtrakr̥cchrī||50|| pibēt kaṣāyaṁ kamalōtpalānāṁ śr̥ṅgāṭakānāmathavā vidāryāḥ| daṇḍairakāṇāmathavā'pi mūlaṁ pūrvēṇa kalpēna tathā'mbu śītam||51||

sekAvagAhAH shishirAH pradehA graiShmo vidhirbastipayovirekAH | drAkShAvidArIkShurasairghRutaishca kRucchreShu pittaprabhaveShu kAryAH ||49|| shatAvarIkAshakushashvadaMShTrAvidArishAlIkShukasherukANAm | kvAthaM sushItaM madhusharkarAbhyAM yuktaM pibet paittikamUtrakRucchrI ||50|| pibet kaShAyaM kamalotpalAnAM shRu~ggATakAnAmathavA vidAryAH | daNDairakANAmathavA~api mUlaM pUrveNa kalpena tathA~ambu shItam ||51||

In paittika dysuria: Cold affusion, bath, anointings, following regimen prescribed during summer season, medicated enema, milk and purgatives prepared from the juice of draksha (grapes), vidari and sugarcane juice and ghee to be administered.[49] The following cold decoction reduces paittika dysuria: Satavari, kasa, kusha, svadamstra vidari, sali, ikshu, kaseruka mixed with water, honey, and sugar.[50] The decoction of kamala and utpala (water lily) or sringhataka or vidari or the root of danairaka with honey and sugar is useful in paittika type of dysuria. Simple cold water mixed with water, honey, and sugar is also helpful in paittika type of dysuria. [51] Formula /recipes for paittika dysuria: एर्वारुबीजंत्रपुषात्कुसुम्भात्सकुङ्कुमःस्याद्वृषकश्चपेयः| द्राक्षारसेनाश्मरिशर्करासुसर्वेषुकृच्छ्रेषुप्रशस्तएषः||५२|| एर्वारुबीजंमधुकंसदारुपैत्तेपिबेत्तण्डुलधावनेन| दार्वींतथैवामलकीरसेनसमाक्षिकांपित्तकृतेतुकृच्छ्रे||५३|| ērvārubījaṁ trapuṣāt kusumbhāt sakuṅkumaḥ syādvr̥ṣakaśca pēyaḥ| drākṣārasēnāśmariśarkarāsu sarvēṣu kr̥cchrēṣu praśasta ēṣaḥ||52|| ērvārubījaṁ madhukaṁ sadāru paittē pibēttaṇḍuladhāvanēna| dārvīṁ tathaivāmalakīrasēna samākṣikāṁ pittakr̥tē tu kr̥cchrē||53|| ervArubIjaM trapuShAt kusumbhAt saku~gkumaH syAdvRuShakashca peyaH | drAkShArasenAshmarisharkarAsu sarveShu kRucchreShu prashasta eShaH ||52|| ervArubIjaM madhukaM sadAru paitte pibettaNDuladhAvanena | dArvIM tathaivAmalakIrasena samAkShikAM pittakRute tu kRucchre ||53|| 1.The seeds of ervaruka- utilissimus (Roxb.), trapusa- Cucumis sativus Linn and kusumbha along with kumkuma- Carthamus tinctorius Linn and vasa- adhatoda vasaka Nees mixed with grape juice(drasha rasa)- Vitis vinifera Linn drink is prepared out of these ingredients which is extremely beneficial in ashmari (urinary calculus), sharkara (graveluria) and all types of dysuria. [52] 2.Drink prepared out of seeds of ervaruka- utilissimus (Roxb.), madhuka- Madhuca indica, devadaru- Cedrus deodara Loud should be taken along with tandulodaka (rice washed water) 3. Drink prepared out of daruharidra-Berberis vulgaris L, juice of amalaki-Emblica officinalis Gaertn mixed with honey is helpful in paittika mutra kruccra.[53] Treatment of kaphaja type of dysuria: क्षारोष्णतीक्ष्णौषधमन्नपानंस्वेदोयवान्नंवमनंनिरूहाः| तक्रंसतिक्तौषधसिद्धतैलमभ्यङ्गपानंकफमूत्रकृच्छ्रे||५४|| व्योषंश्वदंष्ट्रात्रुटिसारसास्थिकोलप्रमाणंमधुमूत्रयुक्तम्| पिबेत्त्रुटिंक्षौद्रयुतांकदल्यारसेनकैडर्यरसेनवाऽपि||५५|| तक्रेणयुक्तंशितिवारकस्यबीजंपिबेत्कृच्छ्रविनाशहेतोः| पिबेत्तथातण्डुलधावनेनप्रवालचूर्णंकफमूत्रकृच्छ्रे||५६|| सप्तच्छदारग्वधकेबुकैलाधवंकरञ्जंकुटजंगुडूचीम्| पक्त्वाजलेतेनपिबेद्यवागूंसिद्धंकषायंमधुसंयुतंवा||५७||

kṣārōṣṇatīkṣṇauṣadhamannapānaṁ svēdō yavānnaṁ vamanaṁ nirūhāḥ| takraṁ satiktauṣadhasiddhatailamabhyaṅgapānaṁ kaphamūtrakr̥cchrē||54|| vyōṣaṁ śvadaṁṣṭrātruṭisārasāsthi kōlapramāṇaṁ madhumūtrayuktam| pibēttruṭiṁ kṣaudrayutāṁ kadalyā rasēna kaiḍaryarasēna vā'pi||55|| takrēṇa yuktaṁ śitivārakasya bījaṁ pibēt kr̥cchravināśahētōḥ| pibēttathā taṇḍuladhāvanēna pravālacūrṇaṁ kaphamūtrakr̥cchrē||56|| saptacchadāragvadhakēbukailādhavaṁ karañjaṁ kuṭajaṁ guḍūcīm| paktvā jalē tēna pibēdyavāgūṁ siddhaṁ kaṣāyaṁ madhusaṁyutaṁ vā||57|| kShAroShNatIkShNauShadhamannapAnaM svedo yavAnnaM vamanaM nirUhAH | takraM satiktauShadhasiddhatailamabhya~ggapAnaM kaphamUtrakRucchre ||54|| vyoShaM shvadaMShTrAtruTisArasAsthi kolapramANaM madhumUtrayuktam | pibettruTiM kShaudrayutAM kadalyA rasena kaiDaryarasena vA~api ||55|| takreNa yuktaM shitivArakasya bIjaM pibet kRucchravinAshahetoH | pibettathA taNDuladhAvanena pravAlacUrNaM kaphamUtrakRucchre ||56|| saptacchadAragvadhakebukailAdhavaM kara~jjaM kuTajaM guDUcIm | paktvA jale tena pibedyavAgUM siddhaM kaShAyaM madhusaMyutaM vA ||57|| In kaphaja dysuria the following remedies are useful. 1. Alkaline, hot and sharp medicine and diet 2. Sudation (Hot fomentation therapies) 3. Barley 4. Medicated emesis 5. Niruha type of medicated enema (non-unctuous enema) 6. Buttermilk 7. Medicated oil prepared by bitter drugs is used for both massages as well as oral intake. [54] The following recipies are useful in kaphaja type of dysuria

1. Trikatu (sunthi, maricha- Piper nigrum Linn, pippali- Piper longum Linn), goksura- Tribulus terrestris Linn, truti (smaller cardamom)- Elettaria cardamomum Maton and bone of cranes(sarasa) to be taken in kola pramana along with honey and cows urine 2. Smaller cardamom- Elettaria cardamomum Maton and honey along with the juice of kadali- Acacia catechu Willd or kaidarya-(mahanimba)- Ailantus malabarica DC is helpful in dysuria. [55] 3. Drink prepared out of seeds of shitivara-Celosia argentea along with butter milk 4. Drink prepared out of powder of pravala (coral) along with tandulodaka (rice washed water) [56] 5. Decoction or the gruel prepared out of Sapatcchada-Alstonia scholars L. R. Br,Aragvada-Cassia fistula Linn,kebuka- Costus speciosus (Koeing) Sm.,ela-Elettaria cardamomum(L.) Maton, dhava- Anogeissus latifolia Wall.,karanja- Pongamia glabra Linn.,kutaja- Holarrhena antidysenterica (white) Wall,and guduchi- Tinospora cordifolia Miers, are consumed along with honey. [57]

Treatment of sannipataja dysuria: सर्वंत्रिदोषप्रभवेतुवायोःस्थानानुपूर्व्याप्रसमीक्ष्यकार्यम्| त्रिभ्योऽधिकेप्राग्वमनंकफेस्यात्पित्तेविरेकःपवनेतुबस्तिः||५८|| इतिमूत्रकृच्छ्रचिकित्सा| sarvaṁ tridōṣaprabhavē tu vāyōḥ sthānānupūrvyā prasamīkṣya kāryam| tribhyō'dhikē prāgvamanaṁ kaphē syāt pittē virēkaḥ pavanē tu bastiḥ||58|| iti mūtrakr̥cchracikitsā| sarvaM tridoṣhaprabhave tu vAyoH sthAnAnupUrvyA prasamIkShya kAryam | tribhyo~adhike prAgvamanaM kaphe syAt pitte virekaH pavane tu bastiH ||58|| iti mUtrakRucchracikitsA |

If the dysuria is caused due to the aggravation of all the tridoṣha simultaneously and equally, then the physician, should administer the therapies/ remedies to correct the aggravated vāta and there after the remaining doṣha after proper examination. Incase if the kapha is aggravated in excess then medicated emesis, if pitta the therapeutic purgation and if the vāta is aggravated in excess the medicated enema therapy should be administered. [58]

Treatment of dysuria caused by calculus and gravel:

क्रियाहितासाऽश्मरिशर्कराभ्यांकृच्छ्रेयथैवेहकफानिलाभ्याम्| कार्याऽश्मरीभेदनपातनायविशेषयुक्तंशृणुकर्मसिद्धम्||५९|| पाषाणभेदंवृषकंश्वदंष्ट्रापाठाभयाव्योषशटीनिकुम्भाः| हिंस्राखराश्वाशितिवारकाणामेर्वारुकाणांत्रपुषस्यबीजम्||६०|| उत्कुञ्चिकाहिङ्गुसवेतसाम्लंस्याद्द्वेबृहत्यौहपुषावचाच| चूर्णंपिबेदश्मरिभेदपक्वंसर्पिश्चगोमूत्रचतुर्गुणंतैः||६१|| मूलंश्वदंष्ट्रेक्षुरकोरुबूकात्क्षीरेणपिष्टंबृहतीद्वयाच्च| आलोड्यदध्नामधुरेणपेयंदिनानिसप्ताश्मरिभेदनाय||६२|| पुनर्नवायोरजनीश्वदंष्ट्राफल्गुप्रवालाश्चसदर्भपुष्पाः| क्षीराम्बुमद्येक्षुरसैःसुपिष्टंपेयंभवेदश्मरिशर्करासु||६३|| त्रुटिंसुराह्वंलवणानिपञ्चयवाग्रजंकुन्दुरुकाश्मभेदौ| कम्पिल्लकंगोक्षुरकस्यबीजमेर्वारुबीजंत्रपुषस्यबीजम्||६४|| चूर्णीकृतंचित्रकहिङ्गुमासीयवानितुल्यंत्रिफलाद्विभागम्| अम्लैरशुक्तैरसमद्ययुषैःपेयंहिगुल्माश्मरिभेदनार्थम्||६५|| बिल्वप्रमाणोघृततैलभृष्टोयूषःकृतःशिग्रुकमूलकल्कात्| शीतोऽश्मभित्स्याद्दधिमण्डयुक्तःपेयःप्रकामंलवणेनयुक्तः||६६|| जलेनशोभाञ्जनमूलकल्कःशीतोहितश्चाश्मरिशर्करासु| सितोपलावासमयावशूकाकृच्छ्रेषुसर्वेष्वपिभेषजंस्यात्||६७|| पीत्वाऽथमद्यंनिगदंरथेनहयेनवाशीघ्रजवेनयायात्| तैःशर्कराप्रच्यवतेऽश्मरीतुशम्येन्नचेच्छल्यविदुद्धरेत्ताम्||६८|| रेतोभिघातप्रभवेतुकृच्छ्रेसमीक्ष्यदोषंप्रतिकर्मकुर्यात्| कार्पासमूलंवृषकाश्मभेदौबलास्थिरादीनिगवेधुकाच||६९|| वृश्चीरऐन्द्रीचपुनर्नवाचशतावरीमध्वसनाख्यपर्ण्यौ| तत्क्वाथसिद्धःपवनेरसःस्यात्पित्तेऽधिकेक्षीरमथापिसर्पिः||७०|| कफेचयूषादिकमन्नपानंसंसर्गजेसर्वहितःक्रमःस्यात्| एवंनचेच्छाम्यतितस्ययुञ्ज्यात्सुरांपुराणांमधुकासवंवा||७१|| विहङ्गमांसानिचबृंहणायबस्तींश्चशुक्राशयशोधनार्थम्| शुद्धस्यतृप्तस्यचवृष्ययोगैःप्रियानुकूलाःप्रमदाविधेयाः||७२||

kriyā hitā sā'śmariśarkarābhyāṁ kr̥cchrē yathaivēha kaphānilābhyām| kāryā'śmarībhēdanapātanāya viśēṣayuktaṁ śr̥ṇu karma siddham||59|| pāṣāṇabhēdaṁ vr̥ṣakaṁ śvadaṁṣṭrāpāṭhābhayāvyōṣaśaṭīnikumbhāḥ| hiṁsrākharāśvāśitivārakāṇāmērvārukāṇāṁ [1] trapuṣasya bījam||60|| utkuñcikā hiṅgu savētasāmlaṁ syāddvē br̥hatyau hapuṣā vacā ca| cūrṇaṁ pibēdaśmaribhēdapakvaṁ sarpiśca gōmūtracaturguṇaṁ taiḥ||61|| mūlaṁ śvadaṁṣṭrēkṣurakōrubūkāt kṣīrēṇa piṣṭaṁ br̥hatīdvayācca| ālōḍya dadhnā madhurēṇa pēyaṁ dināni saptāśmaribhēdanāya||62|| punarnavāyōrajanīśvadaṁṣṭrāphalgupravālāśca sadarbhapuṣpāḥ| kṣīrāmbumadyēkṣurasaiḥ supiṣṭaṁ pēyaṁ bhavēdaśmariśarkarāsu||63|| truṭiṁ surāhvaṁ lavaṇāni pañca yavāgrajaṁ kundurukāśmabhēdau| kampillakaṁ gōkṣurakasya bījamērvārubījaṁ trapuṣasya bījam||64|| cūrṇīkr̥taṁ citrakahiṅgumāsīyavānitulyaṁ triphalādvibhāgam| amlairaśuktai rasamadyayuṣaiḥ pēyaṁ hi gulmāśmaribhēdanārtham||65|| bilvapramāṇō ghr̥tatailabhr̥ṣṭō yūṣaḥ kr̥taḥ śigrukamūlakalkāt| śītō'śmabhit syāddadhimaṇḍayuktaḥ pēyaḥ prakāmaṁ lavaṇēna yuktaḥ||66|| jalēna śōbhāñjanamūlakalkaḥ śītō hitaścāśmariśarkarāsu| sitōpalā vā samayāvaśūkā kr̥cchrēṣu sarvēṣvapi bhēṣajaṁ syāt||67|| pītvā'tha madyaṁ nigadaṁ rathēna hayēna vā śīghrajavēna yāyāt| taiḥ śarkarā pracyavatē'śmarī tu śamyēnna cēcchalyaviduddharēttām||68|| rētōbhighātaprabhavē tu kr̥cchrē samīkṣya dōṣaṁ pratikarma kuryāt| kārpāsamūlaṁ vr̥ṣakāśmabhēdau balā sthirādīni gavēdhukā ca||69|| vr̥ścīra aindrī ca punarnavā ca śatāvarī madhvasanākhyaparṇyau| tatkvāthasiddhaḥ pavanē rasaḥ syāt pittē'dhikē kṣīramathāpi sarpiḥ||70|| kaphē ca yūṣādikamannapānaṁ saṁsargajē sarvahitaḥ kramaḥ syāt| ēvaṁ na cēcchāmyati tasya yuñjyāt surāṁ purāṇāṁ madhukāsavaṁ vā||71|| vihaṅgamāṁsāni ca br̥ṁhaṇāya bastīṁśca śukrāśayaśōdhanārtham| śuddhasya tr̥ptasya ca vr̥ṣyayōgaiḥ priyānukūlāḥ pramadā vidhēyāḥ||72||

kriyA hitA sA~ashmarisharkarAbhyAM kRucchre yathaiveha kaphAnilAbhyAm | kAryA~ashmarIbhedanapAtanAya visheShayuktaM shRuNu karma siddham ||59|| pAShANabhedaM vRuShakaM shvadaMShTrApAThAbhayAvyoShashaTInikumbhAH | hiMsrAkharAshvAshitivArakANAmervArukANAM [1] trapuShasya bIjam ||60|| utku~jcikA hi~ggu savetasAmlaM syAddve bRuhatyau hapuShA vacA ca | cUrNaM pibedashmaribhedapakvaM sarpishca gomUtracaturguNaM taiH ||61|| mUlaM shvadaMShTrekShurakorubUkAt kShIreNa piShTaM bRuhatIdvayAcca | AloDya dadhnA madhureNa peyaM dinAni saptAshmaribhedanAya ||62|| punarnavAyorajanIshvadaMShTrAphalgupravAlAshca sadarbhapuShpAH | kShIrAmbumadyekShurasaiH supiShTaM peyaM bhavedashmarisharkarAsu ||63|| truTiM surAhvaM lavaNAni pa~jca yavAgrajaM kundurukAshmabhedau | kampillakaM gokShurakasya bIjamervArubIjaM trapuShasya bIjam ||64|| cUrNIkRutaM citrakahi~ggumAsIyavAnitulyaM triphalAdvibhAgam | amlairashuktai rasamadyayuShaiH peyaM hi gulmAshmaribhedanArtham ||65|| bilvapramANo ghRutatailabhRuShTo yUShaH kRutaH shigrukamUlakalkAt | shIto~ashmabhit syAddadhimaNDayuktaH peyaH prakAmaM lavaNena yuktaH ||66|| jalena shobhA~jjanamUlakalkaH shIto hitashcAshmarisharkarAsu | sitopalA vA samayAvashUkA kRucchreShu sarveShvapi bheShajaM syAt ||67|| pItvA~atha madyaM nigadaM rathena hayena vA shIghrajavena yAyAt | taiH sharkarA pracyavate~ashmarI tu shamyenna cecchalyaviduddharettAm ||68|| retobhighAtaprabhave tu kRucchre samIkShya doShaM pratikarma kuryAt | kArpAsamUlaM vRuShakAshmabhedau balA sthirAdIni gavedhukA ca ||69|| vRushcIra aindrI ca punarnavA ca shatAvarI madhvasanAkhyaparNyau | tatkvAthasiddhaH pavane rasaH syAt pitte~adhike kShIramathApi sarpiH ||70|| kaphe ca yUShAdikamannapAnaM saMsargaje sarvahitaH kramaH syAt | evaM na cecchAmyati tasya yu~jjyAt surAM purANAM madhukAsavaM vA ||71|| viha~ggamAMsAni ca bRuMhaNAya bastIMshca shukrAshayashodhanArtham | shuddhasya tRuptasya ca vRuShyayogaiH priyAnukUlAH pramadA vidheyAH ||72||

General treatment: If the dysuria is caused due to the ashmari (calculus) or the sharkara (gravel) then the therapies suggested for kaphaja and vataja type should be applied for physiological benefit. For breaking and flushing out of calculus the effective therapies are explained hereafter and listen to the tested remedy. [59]

1. Pashanbhedadi –kvathachurna :

Powder of pashanabheda- Cyclea peltata (Lam) Hook.f.& Thomas, vasa- Adhatoda vasaka Nees, goksura- Tribulus terrestris Linn., patha- Securinega leucopyrus (Willd.) Muell-Arg., haritaki- Terminalia chebula Retz, trikatu (shunthi, marica, pippali),sati- Asparagus racemosus Willd., nikumbha(danti) Baliospermum montanum Muell. Arg, seeds of himsra- Capparis Sepiaria Linn., kharasva (ajamoda)- Apium dulceMill, sitivaraka- Celosia argentea, ervaruka-- utilissimus (Roxb.), and trapusa- Cucumis sativus Linn, utkuncika(Krishna jiraka)- Carum carvi Linn., hingu- asafoetida Linn, amlavetasa-Garcinia pedunculata Roxb., brhati- Solanum indicum Linn, kantakari- Garcinia morella Desr., hapusa- Juniperus communis Linn.and vaca- Acorus calamus Linn consuming this powder dissolves the calculus in the urinary tract.[60]

2. Pashanabhedadi ghrita: Ghee prepared out of above mentioned drugs (four parts of ghee cooked with one part of paste of above mentioned drugs) and four parts of cows urine also helps in calculus in urinary tract. [61] 3. Roots of svadamstra- Tribulus terrestris Linn, iksuraka (kokilaksha)- Asteracantha longifiolia Nees, eranda- Ricinus communis Linn, brhati- Solanum indicum Linn and kantakari-Garcinia morella Desr. Mixed with sweet curd and taken for 7 days helps in breaking /dissolving the calculus.[62] 4. Punarnava- Boerhaavia diffusa Linn, rajani (haridra)- Curcuma longa Linn., goksura- Tribulus terrestris Linn, tender leaves of phalgu (kastodumbara)-Ficus hispida L.Fand darbha flowers-Briza bipinnata L. are to be triturated and made paste with milk, water, alcohol, or sugarcane juice and the recipe is to be taken in calculus and gravels. [63]

5. Turyadi churna: One parts of each drugs –truti (smaller cardamom)- Elettaria cardamomum Maton, devadaru-Cedrus deodara Loud., kunduru- Boswellia serrata Roxb, pasanabheda- Cyclea peltata (Lam), Kampillaka- Mallotus philippinensis Muell., five salts, yavaksara, seeds of goksura- Tribulus terrestris Linn, ervaru{cucumber}- utilissimus (Roxb.), trapusa- Cucumis sativus Linn, citraka- Plumbago zeylanica Linn., hingu-, Ferula assafoetidaL. mamsi- Nardostachys jatamansi DC, yavani- Trachispermum amami Linn. Two part of Triphala (haritaki, amalaki,vibhitaki) Powder of all the above taken with sours (except saktu- vinegar), meat soup, wine and vegetable soups helps in gulma (phantom tumour) and breaking /dissolving the calculus in the tract. [64-65] 6. The paste of shigru- Moringa oleifera Lam root which is fried in ghee or oil measuring one bilva, prepared into soup and cooled. Intake of this cold soup along with dadhi manda (whey) and salt helps in dissolving / breaking the calculus. [66]. 7 Paste prepared out of root of shobhanjana-Moringa oleiferaLam. Consumed along with water is good in calculus (ashmari) and gravels (sarkara). [67] 8. Seetopala taken along with equal quantity of yava-ksara is the remedy for all types of dysuria.[67] 9. Method of extraction of the calculus: 1) After drinking non contaminated wine, the patient should travel on a fast chariot or a horse. Thus, gravels fall out and calculus subsides. 2) Otherwise it should be extracted by surgeon. [68] Treatment for dysuria caused by obstruction of semen: If the cause of obstruction is due to the vitiated semen, then the remedies should be decided depending on the doṣha predominant for obstruction (vitiation of semen). [69] 1.Meat soup prepared with the decoction prepared out of karpasa- Gossypium herbaceum Linn root, vasa- Adhatoda vasaka Nees, pasanabheda- Cyclea peltata (Lam) Hook.f.& Thomas, bala-Sida cordifolia Linn., laghupancamula(salaparn-Desmodium gangeticum(L.)DCprishnaparni-Cyperus,brahati- Solanum indicum Linn, kantakari- Garcinia morella Desr.,Gokshura - Tribulus terrestris Linn.), gavedhuka- Coix lacryma-jobi Linn.,Vrscira(svetha –white punarnava)- Trianthema portulacastrum Linn, aindri (redpunarnava)- Boerhavia diffusa Linn, satavari-Asparagus rigidulusNakai, madhuparnii(guduci)-Tinospora cordifolia(Thunb.) Miers, asanaparni (aparajita)- Clitoria ternatea Linn decoction may be used in case of obstructed semen which is predominated by vāta.[70] 2. The above mentioned decoction if taken along with milk or ghee is useful in case of pitta predominance. [70] 3. Food and drinks such as soup etc. should be prepared with this decoction in case of kapha predominance. [71] 4. In case of combined doṣha (sannipatik), measures beneficial for all doṣha (combined form) should be used. [71] If the problem does not subside by the above mentioned therapies, then one needs be given: 1) Old wine or madhukasava and meat of birds to nourish /increase the body weight. 2) Urethral douches (uttara basti) for cleaning the seat of semen (seminal vesicle). 3) When the patient is cleansed and refreshed with aphrodisiacs he should be offered loving and favorite women for inducing intercourse. [72] Treatment of dysuria caused by rakta (vitiated blood):

रक्तोद्भवेतूत्पलनालतालकासेक्षुबालेक्षुकशेरुकाणि| पिबेत्सिताक्षौद्रयुतानिखादेदिक्षुंविदारींत्रपुषाणिचैव||७३|| घृतंश्वदंष्ट्रास्वरसेनसिद्धंक्षीरेणचैवाष्टगुणेनपेयम्| स्थिरादिकानांकनकादिकानामेकैकशोवाविधिनैवतेन||७४|| क्षीरेणबस्तिर्मधुरौषधैःस्यात्तैलेनवास्वादुफलोत्थितेन| यन्मूत्रकृच्छ्रेविहितंतुपैत्तेकार्यंतुतच्छोणितमूत्रकृच्छ्रे||७५||

raktōdbhavē tūtpalanālatālakāsēkṣubālēkṣukaśērukāṇi| pibēt sitākṣaudrayutāni khādēdikṣuṁ vidārīṁ trapuṣāṇi caiva||73|| ghr̥taṁ śvadaṁṣṭrāsvarasēna siddhaṁ kṣīrēṇa caivāṣṭaguṇēna pēyam| sthirādikānāṁ kanakādikānāmēkaikaśō vā vidhinaiva tēna||74|| kṣīrēṇa bastirmadhurauṣadhaiḥ syāttailēna vā svāduphalōtthitēna| yanmūtrakr̥cchrē vihitaṁ tu paittē kāryaṁ tu tacchōṇitamūtrakr̥cchrē||75|| raktodbhave tUtpalanAlatAlakAsekShubAlekShukasherukANi | pibet sitAkShaudrayutAni khAdedikShuM vidArIM trapuShANi caiva ||73|| ghRutaM shvadaMShTrAsvarasena siddhaM kShIreNa caivAShTaguNena peyam | sthirAdikAnAM kanakAdikAnAmekaikasho vA vidhinaiva tena ||74|| kShIreNa bastirmadhurauShadhaiH syAttailena vA svAduphalotthitena | yanmUtrakRucchre vihitaM tu paitte kAryaM tu tacchoNitamUtrakRucchre ||75|| 1. Drink prepared out of stalk of lily (utpala), tala, kasa, iksubala, iksu, kaseruka juice along with sugar, honey. 2. One should chew sugarcane, vidari and trapusha. [73] 3. Ghrita (medicated ghee) prepared out of juice of goksura by adding 8 times milk 4. Decoction prepared out of drugs of sthiradi (salaparni-Desmodium gangeticum (L.) DC prishnaparni- Cyperus, brahati- Solanum indicum Linn, kantakari- Garcinia morella Desr.Gokshura- Tribulus terrestris Linn.) and kanakadi group taken as single drug or together [74] 5. for urethral douche: 1) Medicated milk prepared with sweet drugs/ drugs having sweet taste. Or 2) Milk prepared with oil of sweet fruits (seeds) Therapeutic measures prescribed for paittika dysuria should be applied in raktaja dysuria as well. [75]

Prohibition in dysuria: व्यायामसन्धारणशुष्करूक्षपिष्टान्नवातार्ककरव्यवायान्| खर्जूरशालूककपित्थजम्बूबिसंकषायंनरसंभजेत||७६|| इत्यश्मरीचिकित्सा| vyāyāmasandhāraṇaśuṣkarūkṣapiṣṭānnavātārkakaravyavāyān| kharjūraśālūkakapitthajambūbisaṁ kaṣāyaṁ na rasaṁ bhajēta||76|| ityaśmarīcikitsā| vyAyAmasandhAraNashuShkarUkShapiShTAnnavAtArkakaravyavAyAn | kharjUrashAlUkakapitthajambUbisaM kaShAyaM na rasaM bhajeta ||76|| ityashmarIcikitsA |

Person suffering from mutra kricchra should avoid exercise, suppression of natural urges, dry and un unctuous food, pastries, exposure to strong wind, strong rays of sun, sexual intercourse, drugs like karjura, kapittha, jambu, bisa and food with astringent taste. Thus ends the description of treatment of mutra kricchra (dysuria). [76] Heart diseases: Etiology and specific features of different types of hridroga व्यायामतीक्ष्णातिविरेकबस्तिचिन्ताभयत्रासगदातिचाराः| छर्द्यामसन्धारणकर्शनानिहृद्रोगकर्तॄणितथाऽभिघातः||७७|| वैवर्ण्यमूर्च्छाज्वरकासहिक्काश्वासास्यवैरस्यतृषाप्रमोहाः| छर्दिःकफोत्क्लेशरुजोऽरुचिश्चहृद्रोगजाःस्युर्विविधास्तथाऽन्ये||७८|| हृच्छून्यभावद्रवशोषभेदस्तम्भाःसमोहाःपवनाद्विशेषः| पित्तात्तमोदूयनदाहमोहाःसन्त्रासतापज्वरपीतभावाः||७९|| स्तब्धंगुरुस्यात्स्तिमितंचमर्मकफात्प्रसेकज्वरकासतन्द्राः| विद्यात्त्रिदोषंत्वपिसर्वलिङ्गंतीव्रार्तितोदंकृमिजंसकण्डूम्||८०|| vyāyāmatīkṣṇātivirēkabasticintābhayatrāsagadāticārāḥ| chardyāmasandhāraṇakarśanāni hr̥drōgakartr̥̄ṇi tathā'bhighātaḥ||77|| vaivarṇyamūrcchājwarakāsahikkāśvāsāsyavairasyatr̥ṣāpramōhāḥ| chardiḥ kaphōtklēśarujō'ruciśca hr̥drōgajāḥ syurvividhāstathā'nyē||78|| hr̥cchūnyabhāvadravaśōṣabhēdastambhāḥ samōhāḥ pavanādviśēṣaḥ| pittāttamōdūyanadāhamōhāḥ santrāsatāpajwarapītabhāvāḥ||79|| stabdhaṁ guru syāt stimitaṁ ca marma kaphāt prasēkajwarakāsatandrāḥ| vidyāttridōṣaṁ tvapi sarvaliṅgaṁ tīvrārtitōdaṁ kr̥mijaṁ sakaṇḍūm||80|| vyAyAmatIkShNAtivirekabasticintAbhayatrAsagadAticArAH | chardyAmasandhAraNakarshanAni hRudrogakartRUNi tathA~abhighAtaH ||77|| vaivarNyamUrcchAjwarakAsahikkAshvAsAsyavairasyatRuShApramohAH | chardiH kaphotklesharujo~arucishca hRudrogajAH syurvividhAstathA~anye ||78|| hRucchUnyabhAvadravashoShabhedastambhAH samohAH pavanAdvisheShaH | pittAttamodUyanadAhamohAH santrAsatApajwarapItabhAvAH ||79|| stabdhaM guru syAt stimitaM ca marma kaphAt prasekajwarakAsatandrAH | vidyAttridoṣhaM tvapi sarvali~ggaM tIvrArtitodaM kRumijaM sakaNDUm ||80|| Etiology /causative factors: Excessive physical exertion, drastic and excessive administration of purgation and enema therapies, excessive anxiety/worry, fear, stress; and faulty management of diseases, suppression of vomiting and ama (products improperly digested), emaciation and trauma (physical and mental). [77] Symptoms: Discoloration in skin complexion, fainting, fever, cough, hiccup, dyspnea, unpleasant taste in mouth, excess thirst, confusion/unconsciousness, vomiting, nausea and distress/ pain, anorexia and such other various symptoms manifest in patient suffering from heart disease. [78] Specific features of different types of hrid-rogas:

In predominance of vāta [vataja heart disease]: Feeling of emptiness in the cardiac region, palpitation/ tachycardia, dryness of cardiac muscles (wasting/ atrophy), pricking pain, obstructed movement and mental confusion (unconsciousness) are the specific features of vatika type of heart disease. [79] In predominance of pitta [pittaja heart disease]: Darkness of vision/ blackout, giddiness, distress, burning sensation, confusion/unconsciousness, heat sensation, pyrexia and yellowishness are the specific features of paittika hridroga [80]

In predominance of kapha [kaphaja heart disease]: Bradycardia, heaviness, timidity of heart/ dullness associated with salivation, fever, cough and drowsiness are the specific features of kaphaja hridroga. In predominance of all three doṣha [sannipata]: All of the above symptoms are manifested together. [80] In heart disease caused by krimi (organisms): There is intense discomfort/acute pain and piercing pain with itching. [80]

Treatment of vatika hrid-roga: तैलंससौवीरकमस्तुतक्रंवातेप्रपेयंलवणंसुखोष्णम्| मूत्राम्बुसिद्धंलवणैश्चतैलमानाहगुल्मार्तिहृदामयघ्नम्||८१|| पुनर्नवांदारुसपञ्चमूलंरास्नांयवान्बिल्वकुलत्थकोलम्| पक्त्वाजलेतेनविपाच्यतैलमभ्यङ्गपानेऽनिलहृद्गदध्नम्||८२|| हरीतकीनागरपुष्कराह्वैर्वयःकयस्थालवणैश्चकल्कैः| सहिङ्गुभिःसाधितमग्र्यसर्पिर्गुल्मेसहृत्पार्श्वगदेऽनिलोत्थे||८३|| सपुष्कराह्वंफलपूरमूलंमहौषधंशट्यभयाचकल्काः| क्षाराम्बुसर्पिर्लवणैर्विमिश्राःस्युर्वातहृद्रोगविकर्तिकाघ्नाः||८४|| क्वाथःकृतःपौष्करमातुलुङ्गपलाशभूतीकशटीसुराह्वैः| सनागराजाजिवचायवानीक्षारःसुखोष्णोलवणश्चपेयः||८५|| पथ्याशटीपौष्करपञ्चकोलात्समातुलुङ्गाद्यमकेनकल्कः| गुडप्रसन्नालवणैश्चभृष्टोहृत्पार्श्वपृष्ठोदरयोनिशूले||८६|| स्यात्त्र्यूषणंद्वेत्रिफलेसपाठेनिदिग्धिकागोक्षुरकौबलेद्वे| ऋद्धिस्त्रुटिस्तामलकीस्वगुप्तामेदेमधूकंमधुकंस्थिराच||८७|| शतावरीजीवकपृश्निपर्ण्यौद्रव्यैरिमैरक्षसमैःसुपिष्टैः| प्रस्थंघृतस्येहपचेद्विधिज्ञःप्रस्थेनदध्नात्वथमाहिषेण||८८|| मात्रांपलंचार्धपलंपिचुंवाप्रयोजयेन्माक्षिकसम्प्रयुक्ताम्| श्वासेसकासेत्वथपाण्डुरोगेहलीमकेहृद्ग्रहणीप्रदोषे||८९|| tailaṁ sasauvīrakamastutakraṁ vātē prapēyaṁ lavaṇaṁ sukhōṣṇam| mūtrāmbusiddhaṁ lavaṇaiśca tailamānāhagulmārtihr̥dāmayaghnam||81|| punarnavāṁ dāru sapañcamūlaṁ rāsnāṁ yavān bilvakulatthakōlam| paktvā jalē tēna vipācya tailamabhyaṅgapānē'nilahr̥dgadadhnam||82|| harītakīnāgarapuṣkarāhvairvayaḥkayasthālavaṇaiśca kalkaiḥ| sahiṅgubhiḥ sādhitamagryasarpirgulmē sahr̥tpārśvagadē'nilōtthē||83|| sapuṣkarāhvaṁ phalapūramūlaṁ mahauṣadhaṁ śaṭyabhayā ca kalkāḥ| kṣārāmbusarpirlavaṇairvimiśrāḥ syurvātahr̥drōgavikartikāghnāḥ||84|| kvāthaḥ kr̥taḥ pauṣkaramātuluṅgapalāśabhūtīkaśaṭīsurāhvaiḥ| sanāgarājājivacāyavānīkṣāraḥ sukhōṣṇō lavaṇaśca pēyaḥ||85|| pathyāśaṭīpauṣkarapañcakōlāt samātuluṅgādyamakēna kalkaḥ| guḍaprasannālavaṇaiśca bhr̥ṣṭō hr̥tpārśvapr̥ṣṭhōdarayōniśūlē||86|| syāttryūṣaṇaṁ dvē triphalē sapāṭhē nidigdhikāgōkṣurakau balē dvē| r̥ddhistruṭistāmalakī svaguptā mēdē madhūkaṁ madhukaṁ sthirā ca||87|| śatāvarī jīvakapr̥śniparṇyau dravyairimairakṣasamaiḥ supiṣṭaiḥ| prasthaṁ ghr̥tasyēha pacēdvidhijñaḥ prasthēna dadhnā tvatha māhiṣēṇa||88|| mātrāṁ palaṁ cārdhapalaṁ picuṁ vā prayōjayēnmākṣikasamprayuktām| śvāsē sakāsē tvatha pāṇḍurōgē halīmakē hr̥dgrahaṇīpradōṣē||89||

tailaM sasauvIrakamastutakraM vAte prapeyaM lavaNaM sukhoShNam | mUtrAmbusiddhaM lavaNaishca tailamAnAhagulmArtihRudAmayaghnam ||81|| punarnavAM dAru sapa~jcamUlaM rAsnAM yavAn bilvakulatthakolam | paktvA jale tena vipAcya tailamabhya~ggapAne~anilahRudgadadhnam ||82|| harItakInAgarapuShkarAhvairvayaHkayasthAlavaNaishca kalkaiH | sahi~ggubhiH sAdhitamagryasarpirgulme sahRutpArshvagade~anilotthe ||83|| sapuShkarAhvaM phalapUramUlaM mahauShadhaM shaTyabhayA ca kalkAH | kShArAmbusarpirlavaNairvimishrAH syurvAtahRudrogavikartikAghnAH ||84|| kvAthaH kRutaH pauShkaramAtulu~ggapalAshabhUtIkashaTIsurAhvaiH | sanAgarAjAjivacAyavAnIkShAraH sukhoShNo lavaNashca peyaH ||85|| pathyAshaTIpauShkarapa~jcakolAt samAtulu~ggAdyamakena kalkaH | guDaprasannAlavaNaishca bhRuShTo hRutpArshvapRuShThodarayonishUle ||86|| syAttryUShaNaM dve triphale sapAThe nidigdhikAgokShurakau bale dve | RuddhistruTistAmalakI svaguptA mede madhUkaM madhukaM sthirA ca ||87|| shatAvarI jIvakapRushniparNyau dravyairimairakShasamaiH supiShTaiH | prasthaM ghRutasyeha pacedvidhij~jaH prasthena dadhnA tvatha mAhiSheNa ||88|| mAtrAM palaM cArdhapalaM picuM vA prayojayenmAkShikasamprayuktAm | shvAse sakAse tvatha pANDuroge halImake hRudgrahaNIpradoShe ||89||

Treatment of vataja hridroga: 1. Oil, sauviraka, mastu (curd water/whey), buttermilk, along with salt to be consumed in luke warm form. 2. Medicated oil prepared out of cow’s urine, water and salt cures flatulence, gulma (lump like feeling in abdomen), abdominal pain and heart disease. [81] 3. Decoction prepared out of punarnava, devadaru, pancamula (roots of bilva, syonaka, gambhari, patala, ganikarnika), rasna, barley grains, bilva (fruit), kulattha, kola. Medicated oil is prepared with above mentioned decoction and used for internally as well as externally (for massage) helps in vataja type of hridroga. [82] 4. Medicated ghee prepared with paste of haritaki, sunthi, puskaramula, vayastha (guducci), kayastha (amalaki), salt and hingu is useful in gulma (lump like feeling in abdomen), chest pain and pain in flanks caused due to aggravated vāta. [83] 5. Paste of puskaramula, sunthi, sati and haritaki mixed with alkali, water, ghrita and salt cures vatika type of heart disease and vikartika (angina pain) [84] 6. Decoction of puskaramula, matulunga, palasa, bhutika, sati, and devadaru sprinkled with the powders of sunthi, jiraka, vaca, yavani, yavaksara, and salt. It should be taken in warm water. [85]

7. Paste of haritaki, sati, puskaramula, pancakola (pippali, pippalimula, cavya, citraka, sunthi), matulunga fried with oil and ghee and to be consumed with jaggery and prasanna (scum of alcohol) and salt cures chest pain, and pain in flanks, back, abdomen, and vagina [85] 8. One aksa each of trikatu (shunti, maricha, pippali), triphala. (Haritaki, bibhitaki, amalaki), Draksa,kasmarya,kharjura,parusaka,patha,kantakari,goksura,bala,mahabala,truti(smaller cardamom), tamalaki, kapikacchu, meda, mahameda, madhuka, madhuka, salaparni, satavari, jivaka, prsniparni. All the above should be well-pounded and made into paste. One prasta of ghee and buffalow’s curd to be added and cook all the above together and taken in dose of one pala, mixed with half pala of honey. It useful in dyspnea, cough, anemia, halimaka (type of jaundice), heart disease and disorders of grahani (malabsorption syndrome) [86-89] Treatment of paittika hrid-roga: शीताःप्रदेहाःपरिषेचनानितथाविरेकोहृदिपित्तदुष्टे| द्राक्षासिताक्षौद्रपरूषकैःस्याच्छुद्धेतुपित्तापहमन्नपानम्||९०|| यष्ट्याह्विकातिक्तकरोहिणीभ्यांकल्कंपिबेच्चापिसिताजलेन| क्षतेचसर्पींषिहितानिसर्पिर्गुडाश्चयेतान्प्रसमीक्ष्यसम्यक्||९१|| दद्याद्भिषग्धन्वरसांश्चगव्यक्षीराशिनांपित्तहृदामयेषु| तैरेवसर्वेप्रशमंप्रयान्तिपित्तामयाःशोणितसंश्रयाये||९२|| द्राक्षाबलाश्रेयसिशर्कराभिःखर्जूरवीरर्षभकोत्पलैश्च| काकोलिमेदायुगजीवकैश्चक्षीरेणसिद्धंमहिषीघृतंस्यात्||९३|| कशेरुकाशैवलशृङ्गवेरप्रपौण्डरीकंमधुकंबिसस्य| ग्रन्थिश्चसर्पिःपयसापचेत्तैःक्षौद्रान्वितंपित्तहृदामयघ्नम्||९४|| स्थिरादिकल्कैःपयसाचसिद्धंद्राक्षारसेनेक्षुरसेनवाऽपि| सर्पिर्हितंस्वादुफलेक्षुजाश्चरसाःसुशीताहृदिपित्तदुष्टे||९५|| śītāḥ pradēhāḥ pariṣēcanāni tathā virēkō hr̥di pittaduṣṭē| drākṣāsitākṣaudraparūṣakaiḥ syācchuddhē tu pittāpahamannapānam||90|| yaṣṭyāhvikātiktakarōhiṇībhyāṁ kalkaṁ pibēccāpi sitājalēna| kṣatē ca sarpīṁṣi hitāni sarpirguḍāśca yē tān prasamīkṣya samyak||91|| dadyādbhiṣagdhanvarasāṁśca gavyakṣīrāśināṁ pittahr̥dāmayēṣu| tairēva sarvē praśamaṁ prayānti pittāmayāḥ śōṇitasaṁśrayā yē||92|| drākṣābalāśrēyasiśarkarābhiḥ kharjūravīrarṣabhakōtpalaiśca| kākōlimēdāyugajīvakaiśca kṣīrēṇa siddhaṁ mahiṣīghr̥taṁ syāt||93|| kaśērukāśaivalaśr̥ṅgavēraprapauṇḍarīkaṁ madhukaṁ bisasya| granthiśca sarpiḥ payasā pacēttaiḥ kṣaudrānvitaṁ pittahr̥dāmayaghnam||94|| sthirādikalkaiḥ payasā ca siddhaṁ drākṣārasēnēkṣurasēna vā'pi| sarpirhitaṁ svāduphalēkṣujāśca rasāḥ suśītā hr̥di pittaduṣṭē||95||

shItAH pradehAH pariShecanAni tathA vireko hRudi pittaduShTe | drAkShAsitAkShaudraparUShakaiH syAcchuddhe tu pittApahamannapAnam ||90|| yaShTyAhvikAtiktakarohiNIbhyAM kalkaM pibeccApi sitAjalena | kShate ca sarpIMShi hitAni sarpirguDAshca ye tAn prasamIkShya samyak ||91|| dadyAdbhiShagdhanvarasAMshca gavyakShIrAshinAM pittahRudAmayeShu | taireva sarve prashamaM prayAnti pittAmayAH shoNitasaMshrayA ye ||92|| drAkShAbalAshreyasisharkarAbhiH kharjUravIrarShabhakotpalaishca | kAkolimedAyugajIvakaishca kShIreNa siddhaM mahiShIghRutaM syAt ||93|| kasherukAshaivalashRu~ggaveraprapauNDarIkaM madhukaM bisasya | granthishca sarpiH payasA pacettaiH kShaudrAnvitaM pittahRudAmayaghnam ||94|| sthirAdikalkaiH payasA ca siddhaM drAkShArasenekShurasena vA~api | sarpirhitaM svAduphalekShujAshca rasAH sushItA hRudi pittaduShTe ||95|| Treatment of paittika Hrid-Roga: In case of aggravated pitta doṣha 1. Cold anointings, affusion and purgation therapy is indicated. After purgation the patient is advised, pitta -alleviating diet combined with draksa, sugar, honey and parusaka. [90] 2. Patient can also consume the paste of yastimadhu and katu rohini along with sugar water. 3. In case of chest wound after proper examination the medicated ghrita and the recipes of sarpirguda are used [91] 4. In pittaja hridroga, the patient should be kept on diet of soup of wild animals prepaired out of cow’s milk.By this all pittaja disorders located blood (diseases pertaining to the bloodstream) get pacified.[92] 5. Formulas useful in pittaja heart disease: medicated ghee prepared by Buffalow’s ghee and milk 6. Buffalow’s ghee alongwith milk and Paste of draksa, bala, sreyasi (rasna) and sarkara 7. Buffalow’s ghee alongwith milk, kharjura, vira, rsabhaka and utpala 8. Buffalow’s ghee, milk, kakoli, meda, mahameda and jivaka [93] 9. Paste of kaseruka, saivala, sringavera (sunthi), prapaundarika, madhuka, tuber of lotus stem, ghee and milk. Cooking all the above together added with honey (one fourth in quantity of ghee) alleviates paittika hridroga. [94] 10. Ghee and paste of laghu pancamula Cook the above togetherand taken with milk, grape juice or sugar cane juice is helpful in paittik hridroga. 8. Cold juice of sweet fruits or sugar cane is useful in paittika hridroga.[95]

Treatment of kaphaja hrid-roga: स्विन्नस्यवान्तस्यविलङ्घितस्यक्रियाकफघ्नीकफमर्मरोगे| कौलत्थधान्यैश्चरसैर्ववान्नंपानानितीक्ष्णानिचशङ्कराणि||९६|| मूत्रेशृताःकट्फलशृङ्गवेरपीतद्रुपथ्यातिविषाःप्रदेयाः| कृष्णाशटीपुष्करमूलरास्नावचाभयानागरचूर्णकं[च||९७|| उदुम्बराश्वत्थवटार्जुनाख्येपालाशरौहीतकखादिरेच| क्वाथेत्रिवृत्त्र्यूषणचूर्णसिद्धोलेहःकफघ्नोऽशिशिराम्बुयुक्तः||९८|| शिलाह्वयंवाभिषगप्रमत्तःप्रयोजयेत्कल्पविधानदिष्टम्|प्राशं तथाऽऽगस्त्यमथापि लेहं रसायनं ब्राह्ममथामलक्याः||९९|| svinnasya vāntasya vilaṅghitasya kriyā kaphaghnī kaphamarmarōgē| kaulatthadhānyaiśca rasairvavānnaṁ pānāni tīkṣṇāni ca [1] śaṅkarāṇi||96|| mūtrē śr̥tāḥ kaṭphalaśr̥ṅgavērapītadrupathyātiviṣāḥ pradēyāḥ| kr̥ṣṇāśaṭīpuṣkaramūlarāsnāvacābhayānāgaracūrṇakaṁ [2] ca||97|| udumbarāśvatthavaṭārjunākhyē pālāśarauhītakakhādirē ca| kvāthē trivr̥ttryūṣaṇacūrṇasiddhō lēhaḥ kaphaghnō'śiśirāmbuyuktaḥ||98|| śilāhvayaṁ vā bhiṣagapramattaḥ prayōjayēt kalpavidhānadiṣṭam| prāśaṁ tathāgastyamathāpi lēhaṁ rasāyanaṁ brāhmamathāmalakyāḥ||99||

svinnasya vAntasya vila~gghitasya kriyA kaphaghnI kaphamarmaroge | kaulatthadhAnyaishca rasairvavAnnaM pAnAni tIkShNAni ca [1] sha~gkarANi ||96|| mUtre shRutAH kaTphalashRu~ggaverapItadrupathyAtiviShAH pradeyAH | kRuShNAshaTIpuShkaramUlarAsnAvacAbhayAnAgaracUrNakaM [2] ca ||97|| udumbarAshvatthavaTArjunAkhye pAlAsharauhItakakhAdire ca | kvAthe trivRuttryUShaNacUrNasiddho lehaH kaphaghno~ashishirAmbuyuktaH ||98|| shilAhvayaM vA bhiShagapramattaH prayojayet kalpavidhAnadiShTam | prAshaM tathA~a~agastyamathApi lehaM rasAyanaM brAhmamathAmalakyAH ||99||

General treatment of kaphaja hridroga: Treatment should be done after the administration of fomentation/ sudation, therapeutic emesis and fasting therapies. Diet: Barley is to be taken as food along with the juice of kulattha and dhanyaka. Drinks with sharp (tikshna) attribute are wholesome. [96] Formulas useful in kaphaja heart disease: 1. Boil together katphala, sunthi, daruharidra, haritaki, ativisa and cow’s urine. 2. Powder of pippali, sati, puskaramula, rasna, vaca, haritaki, sunthi [97] 3. Decoction (three part) of udumbara, asvattha, vāta, arjuna, palasa, rohitaka, khadira and powder of trivrit, trikatu(shunti ,maricha, pippali) and made into a linctus (lehya).Taken with warm water cures kaphaja hridroga. [98] Rasayanas for kaphaja hridroga: An expert physician may also administer silajatu according to the method prescribed in “rasayana” section to get its rejuvenating effect. Chyavanaprasha, agastyaharitaki, brahma rasayana or amalaki rasayana may also be used for the patient suffering from kaphaja type of hridrōga. [99]

Treatment of tridoshja/sannipatika hridroga: त्रिदोषजेलङ्घनमादितःस्यादन्नंचसर्वेषुहितंविधेयम्| हीनातिमध्यत्वमवेक्ष्यचैवकार्यंत्रयाणामपिकर्मशस्तम्||१००|| tridōṣajē laṅghanamāditaḥ syādannaṁ ca sarvēṣu hitaṁ vidhēyam| hīnātimadhyatvamavēkṣya caiva kāryaṁ trayāṇāmapi karma śastam||100||

tridoṣhaje la~gghanamAditaH syAdannaM ca sarveShu hitaM vidheyam | hInAtimadhyatvamavekShya caiva kAryaM trayANAmapi karma shastam ||100||

General treatment in tridoṣhaja/sannipatika hridroga: 1) Firstly langhana (fasting therapy) 2) Diet which alleviates all the three doṣha to be advised. 3) Treatment of the three doṣha should be done after determining their relative degree (mild, moderate or severe aggravation) and appropriate therapeutic measures should be adopted depending on predominance to eliminate them. [100]

Treatment of non-cardiac chest pain: भुक्तेऽधिकंजीर्यतिशूलमल्पंजीर्णेस्थितंचेत्सुरदारुकुष्ठम्| सतिल्वकंद्वेलवणेविडङ्गमुष्णाम्बुनासातिविषंपिबेत्सः||१०१|| जीर्णेऽधिकेस्नेहविरेचनंस्यात्फलैर्विरेच्योयदिजीर्यतिस्यात्| त्रिष्वेवकालेष्वधिकेतुशूलेतीक्ष्णंहितंमूलविरेचनंस्यात्||१०२|| प्रायोऽनिलोरुद्धगतिःप्रकुप्यत्यामाशयेशोधनमेवतस्मात्| कार्यंतथालङ्घनपाचनंच..... |१०३|

bhuktē'dhikaṁ jīryati śūlamalpaṁ jīrṇē sthitaṁ cēt suradārukuṣṭham| satilvakaṁ dvē lavaṇē viḍaṅgamuṣṇāmbunā sātiviṣaṁ pibēt saḥ||101|| jīrṇē'dhikē snēhavirēcanaṁ syāt phalairvirēcyō yadi jīryati syāt| triṣvēva kālēṣvadhikē tu śūlē tīkṣṇaṁ hitaṁ mūlavirēcanaṁ syāt||102|| prāyō'nilō ruddhagatiḥ prakupyatyāmāśayē śōdhanamēva tasmāt| kāryaṁ tathā laṅghanapācanaṁ ca ...|103|

bhukte~adhikaM jIryati shUlamalpaM jIrNe sthitaM cet suradArukuShTham | satilvakaM dve lavaNe viDa~ggamuShNAmbunA sAtiviShaM pibet saH ||101|| jIrNe~adhike snehavirecanaM syAt phalairvirecyo yadi jIryati syAt | triShveva kAleShvadhike tu shUle tIkShNaM hitaM mUlavirecanaM syAt ||102|| prAyo~anilo ruddhagatiH prakupyatyAmAshaye shodhanameva tasmAt | kAryaM tathA la~gghanapAcanaM ca..... |103|

If pain (in the cardiac region) aggravates on consumption of food, demises during digestion and relieved on empty stomach, the patient should be given (powder of) devadaru, kustha, tilvaka, two salts (saindhava, sauvarcala), vidanga and ativisa along with hot water. [101] If pain aggravates on empty stomach (on digestion of food) unctuous purgative therapy should be administered. If pain aggravates during digestion then patient should be purgated with fruits. If the pain is intense and appears in all the periods (before, during and after digestion) then, the patient should be given strong (tiksna) purgation/drastic purgation therapy containing roots [102] Often vāta gets aggravated due to the obstruction in its movement in the amashaya (stomach including small intestine). Hence purgative measures should be adopted along with langhana (fasting therapy) and pachana (carminative therapy). [103] Treatment of krimija hridroga: ... सर्वंकृमिघ्नंकृमिहृद्गदेच||१०३|| इतिहृद्रोगचिकित्सा| ... sarvaM kRumighnaM kRumihRudgade ca ||103|| iti hRudrogacikitsA |

... sarvaṁ kr̥mighnaṁ kr̥mihr̥dgadē ca||103|| 

iti hr̥drōgacikitsā|

General Treatment for krmi hridroga (heart disease caused by micro organisms): all anthelmintic measures (all measures of destruction of these micro-organisms) should be applied. Thus ends the description of treatment of hridrōga (heart disease) [103]

Diseases of Head and neck (Nasal disorders): सन्धारणाजीर्णरजोतिभाष्यक्रोधर्तुवैषम्यशिरोभितापैः| प्रजागरातिस्वपनाम्बुशीतैरवश्ययामैथुनबाष्पधूमैः||१०४|| संस्त्यानदोषेशिरसिप्रवृद्धोवायुःप्रतिश्यायमुदीरयेत्तु| घ्राणार्तितोदौक्षवथुर्जलाभःस्रावोऽनिलात्सस्वरमूर्धरोगः||१०५|| नासाग्रपाकज्वरवक्त्रशोषतृष्णोष्णपीतस्रवणानिपित्तात्| कासारुचिस्रावघनप्रसेकाःकफाद्गुरुःस्रोतसिचापिकण्डूः||१०६|| सर्वाणिरूपाणितुसन्निपातात्स्युःपीनसेतीव्ररुजेऽतिदुःखे|१०७| सर्वोऽतिवृद्धोऽहितभोजनात्तुदुष्टप्रतिश्यायउपेक्षितःस्यात्||१०७||

sandhāraṇājīrṇarajōtibhāṣyakrōdhartuvaiṣamyaśirōbhitāpaiḥ| prajāgarātisvapanāmbuśītairavaśyayā maithunabāṣpadhūmaiḥ||104|| saṁstyānadōṣē śirasi pravr̥ddhō vāyuḥ pratiśyāyamudīrayēttu| ghrāṇārtitōdau kṣavathurjalābhaḥ srāvō'nilāt sasvaramūrdharōgaḥ||105|| nāsāgrapākajwaravaktraśōṣatr̥ṣṇōṣṇapītasravaṇāni pittāt| kāsārucisrāvaghanaprasēkāḥ kaphādguruḥ srōtasi cāpi kaṇḍūḥ||106|| sarvāṇi rūpāṇi tu sannipātāt syuḥ pīnasē tīvrarujē'tiduḥkhē |107|

sandhAraNAjIrNarajotibhAShyakrodhartuvaiShamyashirobhitApaiH | prajAgarAtisvapanAmbushItairavashyayA maithunabAShpadhUmaiH ||104|| saMstyAnadoShe shirasi pravRuddho vAyuH pratishyAyamudIrayettu | ghrANArtitodau kShavathurjalAbhaH srAvo~anilAt sasvaramUrdharogaH ||105|| nAsAgrapAkajwaravaktrashoShatRuShNoShNapItasravaNAni pittAt | kAsArucisrAvaghanaprasekAH kaphAdguruH srotasi cApi kaNDUH ||106|| sarvANi rUpANi tu sannipAtAt syuH pInase tIvraruje~atiduHkhe |107|

Etiology and pathogenesis of Pratisyaya (coryza/Rhinitis): Suppression of natural urges, indigestion, exposure to dust, excessive speech, anger, seasonal irregularity, excessive exposure of head to the heat, awakening at night, excessive day sleep, and exposure to cold water and frost, excessive coitus, excessive weeping, exposure to smoky atmosphere. These factors lead to the manifestation of doṣha in the head by aggravating vāta, gives rise to pratishyaya. [104] Classification and signs and symptoms of pratishyaya: Signs of vataja-type pratisyaya: Severe piercing pain in nostrils, sneezing, watery discharge, hoarseness of voice and mūrdharōga (manifestation of various disease related to head and brain).[105] Signs of pittaja-type pratisyaya: Inflammation of the tip of nose, fever, dryness of mouth, thirst, hot and yellow discharge.[106] Signs of kaphaja-type pratisyaya: Cough anorexia, thick discharge, excessive salivation, heaviness and itching in nasal passage. [106] Signs of sannipatika pratishyaya (caused by aggregation of three doṣha): All the above symptoms along with intense pain and distress. [107]

Duṣṭapratiśyāya (persistent rhinitis): ततस्तुरोगाःक्षवथुश्चनासाशोषःप्रतीनाहपरिस्रवौच| घ्राणस्यपूतित्वमपीनसश्चसपाकशोथार्बुदपूयरक्ताः||१०८|| अरूंषिशीर्षश्रवणाक्षिरोगखालित्यहर्यर्जुनलोमभावाः| तृट्श्वासकासज्वररक्तपित्तवैस्वर्यशोषाश्चततोभवन्ति||१०९||

sarvō'tivr̥ddhō'hitabhōjanāttu duṣṭapratiśyāya upēkṣitaḥ syāt||107|| tatastu rōgāḥ kṣavathuśca nāsāśōṣaḥ pratīnāhaparisravau ca| ghrāṇasya pūtitvamapīnasaśca sapākaśōthārbudapūyaraktāḥ||108|| arūṁṣi śīrṣaśravaṇākṣirōgakhālityaharyarjunalōmabhāvāḥ| tr̥ṭśvāsakāsajwararaktapittavaisvaryaśōṣāśca tatō bhavanti||109|| sarvo~ativRuddho~ahitabhojanAttu duShTapratishyAya upekShitaH syAt ||107|| tatastu rogAH kShavathushca nAsAshoShaH pratInAhaparisravau ca | ghrANasya pUtitvamapInasashca sapAkashothArbudapUyaraktAH ||108|| arUMShi shIrShashravaNAkShirogakhAlityaharyarjunalomabhAvAH | tRuTshvAsakAsajwararaktapittavaisvaryashoShAshca tato bhavanti ||109|| Cause of duṣṭapratiśyāya (persistent rhinitis): Each of the above types will turn into duṣṭapratiśyāya if the patient neglect appropriate treatment and continues unwholesome diet, all the doṣha get excessively aggravated and as a result this disease is caused. Signs of duṣṭapratiśyāya: Sneezing, dryness of nasal mucosa, pratinaha (nasal obstruction), parisrava (excessive discharge from nose), foul smell in nostrils (ozena), apinasa (chronic rhinitis), inflammation (suppurative rhinitis), swelling (oedematous rhinitis), nasarbuda (growth/nasal tumor), puya rakta (purulent and sanguineous rhinitis), arumsi (furunculosis), disorders of head, ear and eye, baldness, graying of hair or whitening of body hairs, thirst, dyspnea, cough, fever, internal hemorrhage, hoarseness of voice and cachexia. [107-109]

रोधाभिघातस्रवशोषपाकैर्घ्राणंयुतंयश्चनवेत्तिगन्धम्| दुर्गन्धिचास्यंबहुशःप्रकोपिदुष्टप्रतिश्यायमुदाहरेत्तम्||११०|| संस्पृश्यमर्माण्यनिलस्तुमूर्ध्निविष्वक्पथस्थःक्षवथुंकरोति| क्रुद्धःससंशोष्यकफंतुनासाशृङ्गाटकघ्राणविशोषणंच||१११|| उच्छ्वासमार्गंतुकफःसवातोरुन्ध्यात्प्रतीनाहमुदाहरेत्तम्| योमस्तुलुङ्गाद्घनपीतपक्वःकफःस्रवेदेषपरिस्रवस्तु||११२|| वैवर्ण्यदौर्गन्ध्यमुपेक्षयातुस्यात्पूतिनस्यंश्वयथुर्भ्रमश्च| आनह्यतेयस्यविशुष्यतेचप्रक्लिद्यतेधूप्यतिचापिनासा||११३|| नवेत्तियोगन्धरसांश्चजन्तुर्जुष्टंव्यवस्येत्तमपीनसेन| तंचानिलश्लेष्मभवंविकारंब्रूयात्प्रतिश्यायसमानलिङ्गम्||११४|| सदाहरागःश्वयथुःसपाकःस्याद्घ्राणपाकोऽपिचरक्तपित्तात्| घ्राणाश्रितासृक्प्रभृतीन्प्रदूष्यकुर्वन्तिनासाश्वयथुंमलाश्च||११५|| घ्राणेतथोच्छ्वासगतिंनिरुध्यमांसास्रदोषादपिचार्बुदानि| घ्राणात्स्रवेद्वाश्रवणान्मुखाद्वापित्ताक्तमस्रंत्वपिपूयरक्तम्||११६|| कुर्यात्सपित्तःपवनस्त्वगादीन्सन्दूष्यचारूंषिसपाकवन्ति| नासाप्रदीप्तेवनरस्ययस्यदीप्तंतुतंरोगमुदाहरन्ति||११७|| इतिनासारोगनिदानम्|

rōdhābhighātasravaśōṣapākairghrāṇaṁ yutaṁ yaśca na vētti gandham| durgandhi cāsyaṁ bahuśaḥprakōpi duṣṭapratiśyāyamudāharēttam||110|| saṁspr̥śya marmāṇyanilastu mūrdhni viṣvakpathasthaḥ kṣavathuṁ karōti| kruddhaḥ sa saṁśōṣya kaphaṁ tu nāsāśr̥ṅgāṭakaghrāṇaviśōṣaṇaṁ ca||111|| ucchvāsamārgaṁ tu kaphaḥ savātō rundhyāt pratīnāhamudāharēttam| yō mastuluṅgādghanapītapakvaḥ kaphaḥ sravēdēṣa parisravastu||112|| vaivarṇyadaurgandhyamupēkṣayā tu syāt pūtinasyaṁ śvayathurbhramaśca| ānahyatē yasya viśuṣyatē ca praklidyatē dhūpyati cāpi nāsā||113|| na vētti yō gandharasāṁśca janturjuṣṭaṁ vyavasyēttamapīnasēna| taṁ cānilaślēṣmabhavaṁ vikāraṁ brūyāt pratiśyāyasamānaliṅgam||114|| sadāharāgaḥ śvayathuḥ sapākaḥ syād ghrāṇapākō'pi ca raktapittāt| ghrāṇāśritāsr̥kprabhr̥tīn pradūṣya kurvanti nāsāśvayathuṁ malāśca||115|| ghrāṇē tathōcchvāsagatiṁ nirudhya māṁsāsradōṣādapi cārbudāni| ghrāṇāt sravēdvā śravaṇānmukhādvā pittāktamasraṁ tvapi pūyaraktam||116|| kuryāt sapittaḥ pavanastvagādīn sandūṣya cārūṁṣi sapākavanti| nāsā pradīptēva narasya yasya dīptaṁ tu taṁ rōgamudāharanti||117|| iti nāsārōganidānam|

rodhAbhighAtasravashoShapAkairghrANaM yutaM yashca na vetti gandham | durgandhi cAsyaM bahushaHprakopi duShTapratishyAyamudAharettam ||110|| saMspRushya marmANyanilastu mUrdhni viShvakpathasthaH kShavathuM karoti | kruddhaH sa saMshoShya kaphaM tu nAsAshRu~ggATakaghrANavishoShaNaM ca ||111|| ucchvAsamArgaM tu kaphaH savAto rundhyAt pratInAhamudAharettam | yo mastulu~ggAdghanapItapakvaH kaphaH sravedeSha parisravastu ||112|| vaivarNyadaurgandhyamupekShayA tu syAt pUtinasyaM shvayathurbhramashca | Anahyate yasya vishuShyate ca praklidyate dhUpyati cApi nAsA ||113|| na vetti yo gandharasAMshca janturjuShTaM vyavasyettamapInasena | taM cAnilashleShmabhavaM vikAraM brUyAt pratishyAyasamAnali~ggam ||114|| sadAharAgaH shvayathuH sapAkaH syAd ghrANapAko~api ca raktapittAt | ghrANAshritAsRukprabhRutIn pradUShya kurvanti nAsAshvayathuM malAshca ||115|| ghrANe tathocchvAsagatiM nirudhya mAMsAsradoShAdapi cArbudAni | ghrANAt sravedvA shravaNAnmukhAdvA pittAktamasraM tvapi pUyaraktam ||116|| kuryAt sapittaH pavanastvagAdIn sandUShya cArUMShi sapAkavanti | nAsA pradIpteva narasya yasya dIptaM tu taM rogamudAharanti ||117|| iti nAsAroganidAnam |

Definition of duṣṭapratiśyāya: When the nostril are effected with obstruction, injury, discharge, dryness and suppuration, the patient does not perceive smell. Mouth emits foul smell and aggravates frequently. This is known as duṣṭapratiśyāya (persisitent rhinitis).[110] Pathogenesis of sneezing (ksavathu): Vāta afflicting the vital organs and moving in random directions causes sneezing.[111] Pathogenesis of dryness of nasal mucosa (nasa shosha) Aggravated vāta dries up kapha in the junction of nose with forehead (shranghataka marma) causes dry nose and results in loss of sense of smell. [111] Pathogenesis of pratinaha (nasal obstruction): Condition where Kapha along with vāta blocks/obstructs the channel of expiration is called pratinaha. [112] Pathogenesis of parisrava (nasal discharge): The condition where thick, yellow and mature kapha (mucus) discharge comes out from the brain is called as parisrava.[112] Pathogenesis of putinasya (ozena): If rhinitis is neglected then, the condition where, abnormal colour and foul odour along with swelling and giddiness arises is called putinasya.[113] Sings and symptoms of apinasa (chronic rhinitis): The condition where the patient’s nose is obstructed, dryness exist, bougiey and fuming sensation in the nose and one does not perceive smell and taste is called apinasa. It is caused by vāta and kapha, and has symptoms similar to those of pratisyaya. [114] Granhapaka / nāsa pāka (suppurative rhinitis): It is caused by the vitiation of rakta-pitta where burning sensation, redness, swelling and inflammation/ suppuration occur. [115] Nāsa-shotha (oedematous rhinitis): The aggravated doṣha vitiate blood etc located in the nose gives rise to nasa shotha.[115] Nāsa arbuda (nasal tumor/ polyps): It is caused due to the vitiation of muscle tissue and blood located in the nose, thereby causing obstruction in the air passage.[116] Puya-rakta (purulent and sanguinous rhinitis): The condition where blood mixed with pus (pitta) is discharged from nose, ear, or mouth. [116] Arumsi (furunculosis): Caused by aggravated vāta along with pitta which vitiate skin etc. in the nose and which is associated with suppuration is called as furunculosis. [117] Nāsa dipta (burnt nose): The condition where the person feels as if his nose is burnt. Thus ends the description of diagnosis of nasal ailments.[117]

Diseases of head: Diagnosis of shiro-rōga(Diseases of Head) भृशार्तिशूलंस्फुरतीहवातात्पित्तात्सदाहार्तिकफाद्गुरुस्यात्| सर्वैस्त्रिदोषंक्रिमिभिस्तुकण्डूर्दौर्गन्ध्यतोदार्तियुतंशिरःस्यात्||११८|| इतिशिरोरोगनिदानम्|

bhr̥śārtiśūlaṁ sphuratīha vātāt pittāt sadāhārti kaphādguru syāt| sarvaistridōṣaṁ krimibhistu kaṇḍūrdaurgandhyatōdārtiyutaṁ śiraḥ syāt||118|| iti śirōrōganidānam|

bhRushArtishUlaM sphuratIha vAtAt pittAt sadAhArti kaphAdguru syAt | sarvaistridoṣhaM krimibhistu kaNDUrdaurgandhyatodArtiyutaM shiraH syAt ||118|| iti shiroroganidAnam | In vāta-predominant Head Disease:Excruciating pain, severe head ache, and has pulsating throbbing sensation. In pitta-predominant head disease: burning sensation and discomfort. In kapha-predominant head disease: It is associated with heaviness in the head Sannipatika/ head disease caused by three doṣha: All the symptoms mentioned above are present. Krimija shiro-roga/head disease due to parasitic infestation: There is itching, foul smell, pricking pain and head ache. Thus ends the description of diagnosis of diseases of head (shiro-roga).[118]

Oral diseases: मुखामयेमारुतजेतुशोषकार्कश्यरौक्ष्याणिचलारुजश्च| कृष्णारुणंनिष्पतनंसशीतंप्रस्रंसनस्पन्दनतोदभेदाः||११९|| तृष्णाज्वरस्फोटकतालुदाहाधूमायनंचाप्यवदीर्णताच| पित्तात्समूर्च्छाविविधारुजश्चवर्णाश्चशुक्लारुणवर्णवर्ज्याः||१२०|| कण्डूर्गुरुत्वंसितविज्जलत्वंस्नेहोऽरुचिर्जाड्यकफप्रसेकौ| उत्क्लेशमन्दानलताचतन्द्रारुजश्चमन्दाःकफवक्ररोगे||१२१|| सर्वाणिरूपाणितुवक्ररोगेभवन्तियस्मिन्सतुसर्वजःस्यात्| संस्थानदूष्याकृतिनामभेदाच्चैतेचतुःषष्टिविधाभवन्ति||१२२|| शालाक्यतन्त्रेऽभिहितानितेषांनिमित्तरूपाकृतिभेषजानि| यथाप्रदेशंतुचतुर्विधस्यक्रियांप्रवक्ष्यामिमुखामयस्य||१२३|| इतिमुखरोगनिदानम्| mukhāmayē mārutajē tu śōṣakārkaśyaraukṣyāṇi calā rujaśca| kr̥ṣṇāruṇaṁ niṣpatanaṁ saśītaṁ prasraṁsanaspandanatōdabhēdāḥ||119|| tr̥ṣṇājwarasphōṭakatāludāhā dhūmāyanaṁ cāpyavadīrṇatā ca| pittāt samūrcchā vividhā rujaśca varṇāśca śuklāruṇavarṇavarjyāḥ||120|| kaṇḍūrgurutvaṁ sitavijjalatvaṁ snēhō'rucirjāḍyakaphaprasēkau| utklēśamandānalatā ca tandrā rujaśca mandāḥ kaphavakrarōgē||121|| sarvāṇi rūpāṇi tu vakrarōgē bhavanti yasmin sa tu sarvajaḥ syāt| saṁsthānadūṣyākr̥tināmabhēdāccaitē catuḥṣaṣṭividhā bhavanti||122|| śālākyatantrē'bhihitāni tēṣāṁ nimittarūpākr̥tibhēṣajāni| yathāpradēśaṁ tu caturvidhasya kriyāṁ pravakṣyāmi mukhāmayasya||123|| iti mukharōganidānam|

mukhAmaye mArutaje tu shoShakArkashyaraukShyANi calA rujashca | kRuShNAruNaM niShpatanaM sashItaM prasraMsanaspandanatodabhedAH ||119|| tRuShNAjwarasphoTakatAludAhA dhUmAyanaM cApyavadIrNatA ca | pittAt samUrcchA vividhA rujashca varNAshca shuklAruNavarNavarjyAH ||120|| kaNDUrgurutvaM sitavijjalatvaM sneho~arucirjADyakaphaprasekau | utkleshamandAnalatA ca tandrA rujashca mandAH kaphavakraroge ||121|| sarvANi rUpANi tu vakraroge bhavanti yasmin sa tu sarvajaH syAt | saMsthAnadUShyAkRutinAmabhedAccaite catuHShaShTividhA bhavanti ||122|| shAlAkyatantre~abhihitAni teShAM nimittarUpAkRutibheShajAni | yathApradeshaM tu caturvidhasya kriyAM pravakShyAmi mukhAmayasya ||123|| iti mukharoganidAnam |

Diagnosis of oral diseases: Vāta-predominant oral disease: There is dryness, roughness, ununctuousness, shifting pain, black, reddish discoloration, salivation and coldness, loosening of teeth, pulsation/throbbing sensation, piercing and tearing pain.[119] Pitta-predominant oral disease: It is characterized by thirst, fever, eruptions, burning sensation in the palate, feeling of fumes in oral cavity, inflammations/ ulceration, different types of pain and various type of discoloration except white and redddish. [120] Kapha-predominant oral disease: Itching, heaviness, pallor, sliminess, unctuousness, anorexia, stiffness, excessive salivation, nausea, poor digestion, drowsiness and dull ache. [121] Tri-doshaja oral disease: All the above signs and symptoms may be seen which are caused by the simultaneous aggravation of all the three doṣha. These oral-diseases are classified to be of sixty-four types, depending upon the location, pathogenic substratum/ tissue element, signs and symptoms and their names. [122] Which are described in Salakyatantra with reference to their etiology, signs, symptoms and treatment however, here I will describe the treatment of the above-mentioned four types of the oral disorders. Thus, ends description of diagnosis of oral diseases. [123]

Arochaka (anorexia): Etiology, Diagnosis/ signs and symptoms of arochaka (anorexia): वातादिभिःशोकभयातिलोभक्रोधैर्मनोघ्नाशनगन्धरूपैः| अरोचकाःस्युःपरिहृष्टदन्तःकषायवक्रश्चमतोऽनिलेन||१२४|| कट्वम्लमुष्णंविरसंचपूतिपित्तेनविद्याल्लवणंचवक्रम्| माधुर्यपैच्छिल्यगुरुत्वशैत्यविबद्धसम्बद्धयुतंकफेन||१२५|| अरोचकेशोकभयानिलोभक्रोधाद्यहृद्याशनगन्धजेस्यात्| स्वाभाविकंवक्रमथारुचिश्चत्रिदोषजेनैकरसंभवेत्तु||१२६|| इत्यरोचकनिदानम्| vātādibhiḥ śōkabhayātilōbhakrōdhairmanōghnāśanagandharūpaiḥ| arōcakāḥ syuḥ parihr̥ṣṭadantaḥ kaṣāyavakraśca matō'nilēna||124|| kaṭvamlamuṣṇaṁ virasaṁ ca pūti pittēna vidyāllavaṇaṁ ca vakram| mādhuryapaicchilyagurutvaśaityavibaddhasambaddhayutaṁ [1] kaphēna||125|| arōcakē śōkabhayānilōbhakrōdhādyahr̥dyāśanagandhajē syāt| svābhāvikaṁ vakramathāruciśca tridōṣajē naikarasaṁ bhavēttu||126|| ityarōcakanidānam

vAtAdibhiH shokabhayAtilobhakrodhairmanoghnAshanagandharUpaiH | 

arocakAH syuH parihRuShTadantaH kaShAyavakrashca mato~anilena ||124|| kaTvamlamuShNaM virasaM ca pUti pittena vidyAllavaNaM ca vakram | mAdhuryapaicchilyagurutvashaityavibaddhasambaddhayutaM [1] kaphena ||125|| arocake shokabhayAnilobhakrodhAdyahRudyAshanagandhaje syAt | svAbhAvikaM vakramathArucishca tridoṣhaje naikarasaM bhavettu ||126|| ityarocakanidAnam |

General Cause of Anorexia: Vatadi doṣha and grief, fear, over greed, anger, unpleasant food, smell andsights are in general causes. Signs of vataja anorexia: Patient teeth become sensitive and get astringent taste in mouth. [124] Signs of pittaja anorexia: Mouth becomes pungent, sour, and hot, with abnormal taste, foul smell and saline taste. Signs of kaphaja anorexia: Mouth is affected with sweetness, sliminess, heaviness, coldness and thick bougieiness. [125] Signs of anorexia caused by mental factors: Grief, fear, over-greed, anger etc. and unpleasant food and smell leads to loss of desire for food even though the condition of mouth is normal. Signs of tridoṣhaja/ sannipatika anorexia: Several types of tastes appear in mouth. [126] Thus, ends description of diagnosis of arochaka (anorexia).

Ear diseases: नादोऽतिरुक्कर्णमलस्यशोषःस्रावस्तनुश्चाश्रवणंचवातात्| शोफःसरागोदरणंविदाहःसपीतपूतिश्रवणंचपित्तात्||१२७|| वैश्रुत्यकण्डूस्थिरशोफशुक्लस्निग्धश्रुतिःश्लेष्मभवेऽल्परुक्च| सर्वाणिरूपाणितुसन्निपातात्स्रावश्चतत्राधिकदोषवर्णः||१२८|| इतिकर्णरोगनिदानम्| nādō'tirukkarṇamalasya śōṣaḥ srāvastanuścāśravaṇaṁ ca vātāt| śōphaḥ sarāgō daraṇaṁ vidāhaḥ sapītapūtiśravaṇaṁ ca pittāt||127|| vaiśrutyakaṇḍūsthiraśōphaśuklasnigdhaśrutiḥ ślēṣmabhavē'lparuk ca| sarvāṇi rūpāṇi tu sannipātāt srāvaśca tatrādhikadōṣavarṇaḥ||128|| iti karṇarōganidānam|

nAdo~atirukkarNamalasya shoShaH srAvastanushcAshravaNaM ca vAtAt | shophaH sarAgo daraNaM vidAhaH sapItapUtishravaNaM ca pittAt ||127|| vaishrutyakaNDUsthirashophashuklasnigdhashrutiH shleShmabhave~alparuk ca | sarvANi rUpANi tu sannipAtAt srAvashca tatrAdhikadoShavarNaH ||128|| iti karNaroganidAnam |

Diagnosis/ signs and symptoms of ear diseases: Signs of vataja ear disease: Tinnitus, severe pain, dried ear wax, thin discharge, deafness/ inability to hear. Signs of pittaja ear disease: Oedema, redness, ulceration, burning sensation, yellow and purulent discharge. [127] Signs of kaphaja ear disease: Defective hearing, itching, stiffness, swelling, white and unctuous discharge and dullpain. Signs of tridoṣhaja/sannipatika ear diseases: With all the above symptoms there is extreme purulent discharge containing different colours according to the predominant doṣha. [128]

Thus, ends description of diagnosis of ear diseases.

Eye diseases: अल्पस्तुरागोऽनुपदेहवांश्चसतोदभेदोऽनिलजाक्षिरोगे| पित्तात्सदाहोऽतिरुजःसरागःपीतोपदेहःसुभृशोष्णवाही||१२९|| शुक्लोपदेहंबहुपिच्छिलाश्रुनेत्रंकफात्स्याद्गुरुतासकण्डुः| सर्वाणिरूपाणितुसन्निपातान्नेत्रामयाःषण्णवतिस्तुभेदात्||१३०|| तेषामभिव्यक्तिरभिप्रदिष्टाशालाक्यतन्त्रेषुचिकित्सितंच| पराधिकारेतुनविस्तरोक्तिःशस्तेतितेनात्रननःप्रयासः||१३१|| इतिनेत्ररोगनिदानम्| alpastu rāgō'nupadēhavāṁśca satōdabhēdō'nilajākṣirōgē| pittāt sadāhō'tirujaḥ sarāgaḥ pītōpadēhaḥ subhr̥śōṣṇavāhī||129|| śuklōpadēhaṁ bahupicchilāśru nētraṁ kaphāt syādgurutā sakaṇḍuḥ| sarvāṇi rūpāṇi tu sannipātānnētrāmayāḥ ṣaṇṇavatistu bhēdāt||130|| tēṣāmabhivyaktirabhipradiṣṭā śālākyatantrēṣu cikitsitaṁ ca| parādhikārē tu na vistarōktiḥ śastēti tēnātra na naḥ prayāsaḥ||131|| iti nētrarōganidānam|

alpastu rAgo~anupadehavAMshca satodabhedo~anilajAkShiroge | pittAt sadAho~atirujaH sarAgaH pItopadehaH subhRushoShNavAhI ||129|| shuklopadehaM bahupicchilAshru netraM kaphAt syAdgurutA sakaNDuH | sarvANi rUpANi tu sannipAtAnnetrAmayAH ShaNNavatistu bhedAt ||130|| teShAmabhivyaktirabhipradiShTA shAlAkyatantreShu cikitsitaM ca | parAdhikAre tu na vistaroktiH shasteti tenAtra na naH prayAsaH ||131|| iti netraroganidAnam |

Diagnosis of eye diseases: Signs of vataja eye disease: Redness, scanty or absence of lacrimation and bougiey discharge, cutting and piercing pain. Signs of pittaja eye disease: Burning sensation, intense pain, redness, yellow discharge and excessive hot lacrimation. [129] Signs of kaphaja eye disease: Whitish discharge, excessive slimy lacrimation, heaviness and itching in the eye. Signs of tridoṣhaja/sannipataj eye disease: All the above characters are observed. [130]

Total, eye diseases are 96 in number their features and treatment aredescribed in Salakyatantra. It is not desirable to divulge in details of another specialized branch. Hence such details are not attempted here. [131] Thus, ends description of diagnosis of eye diseases.

Hair diseases: तेजोऽनिलाद्यैःसहकेशभूमिंदग्ध्वाऽऽशुकुर्यात्खलतिंनरस्य| किञ्चित्तुदग्ध्वापलितानिकुर्याद्धरिप्रभत्वंचशिरोरुहाणाम्||१३२|| इत्यूर्ध्वजत्रूत्थगदैकदेशस्तन्त्रेनिबद्धोऽयमशून्यतार्थम्| अतःपरंभेषजसङ्ग्रहंतुनिबोधसङ्क्षेपतउच्यमानम्||१३३|| इतिखालित्यरोगनिदानम्| tejo~anilAdyaiH saha keshabhUmiM dagdhvA~a~ashu kuryAt khalatiM narasya | ki~jcittu dagdhvA palitAni kuryAddhariprabhatvaM ca shiroruhANAm ||132|| ityUrdhvajatrUtthagadaikadeshastantre nibaddho~ayamashUnyatArtham | ataH paraM bheShajasa~ggrahaM tu nibodha sa~gkShepata ucyamAnam ||133|| iti khAlityaroganidAnam | tējō'nilādyaiḥ saha kēśabhūmiṁ dagdhvāśu kuryāt khalatiṁ narasya| kiñcittu dagdhvā palitāni kuryāddhariprabhatvaṁ ca śirōruhāṇām||132|| ityūrdhvajatrūtthagadaikadēśastantrē nibaddhō'yamaśūnyatārtham| ataḥ paraṁ bhēṣajasaṅgrahaṁ tu nibōdha saṅkṣēpata ucyamānam||133|| iti khālityarōganidānam|

Pathogenesis of baldness: The body heat along with vatadi doṣha burns the hair root (scalp) instantaneously and thus causes baldness in men. If there is slight burning of hair root it produces whiteness or greying of head hairs. [132] Only some of the ailments affecting the organs of head and neck are described here, in order to prevent the allegation of absolute omission of these ailments in this text. Thus, ends description of diagnosis of disease of alopecia. [133]

Treatment of supra-clavicular diseases (urdva jatrugata roga): वातात्सकासवैस्वर्येसक्षारंपीनसेवृतम्| पिबेद्रसंपयश्चोष्णंस्नैहिकंधूममेववा||१३४|| शताह्वात्वग्बलामूलंस्योनाकैरण्डबिल्वजम्| सारग्वधंपिबेद्वर्तिंमधूच्छिष्टवसाघृतैः||१३५|| अथवासघृतान्सक्तून्कृत्वामल्लकसम्पुटे| नवप्रतिश्यायवतांधूमंवैद्यःप्रयोजयेत्||१३६|| शङ्खमूर्धललाटार्तौपाणिस्वेदोपनाहनम्| स्वभ्यक्तेक्षवथुस्रावरोधादौसङ्करादयः||१३७|| घ्रेयाश्चरोहिषाजाजीवचातर्कारिचोरकाः| त्वक्पत्रमरिचैलानांचूर्णावासोपकुञ्चिकाः||१३८|| स्रोतःशृङ्गाटनासाक्षिशोषेतैलंचनावनम्| प्रभाव्याजेतिलान्क्षीरेतेनपिष्टांस्तदुष्मणा||१३९|| मन्दस्विन्नान्सयष्ट्याह्वचूर्णांस्तेनैवपीडयेत्| दशमूलस्यनिष्क्वाथेरास्नामधुककल्कवत्||१४०|| सिद्धंससैन्धवंतैलंदशकृत्वोऽणुतत्स्मृतम्| स्निग्धस्यास्थापनैर्दोषंनिर्हरेद्वातपीनसे||१४१|| स्निग्धाम्लोष्णैश्चलघ्वन्नंग्राम्यादीनांरसैर्हितम्| उष्णाम्बुनास्नानपानेनिवातोष्णप्रतिश्रयः||१४२|| चिन्ताव्यायामवाक्चेष्टाव्यवायविरतोभवेत्| वातजेपीनसेधीमानिच्छन्नेवात्मनोहितम्||१४३|| vātāt sakāsavaisvaryē sakṣāraṁ pīnasē vr̥tam| pibēdrasaṁ payaścōṣṇaṁ snaihikaṁ dhūmamēva vā||134|| śatāhvā tvagbalā mūlaṁ syōnākairaṇḍabilvajam| sāragvadhaṁ pibēdvartiṁ madhūcchiṣṭavasāghr̥taiḥ||135|| athavā saghr̥tān saktūn kr̥tvā mallakasampuṭē| navapratiśyāyavatāṁ dhūmaṁ vaidyaḥ prayōjayēt||136|| śaṅkhamūrdhalalāṭārtau pāṇisvēdōpanāhanam| svabhyaktē kṣavathusrāvarōdhādau saṅkarādayaḥ||137|| ghrēyāśca rōhiṣājājīvacātarkāricōrakāḥ| tvakpatramaricailānāṁ cūrṇā vā sōpakuñcikāḥ||138|| srōtaḥśr̥ṅgāṭanāsākṣiśōṣē tailaṁ ca nāvanam| prabhāvyājē tilān kṣīrē tēna piṣṭāṁstaduṣmaṇā||139|| mandasvinnān sayaṣṭyāhvacūrṇāṁstēnaiva pīḍayēt| daśamūlasya niṣkvāthē rāsnāmadhukakalkavat||140|| siddhaṁ sasaindhavaṁ tailaṁ daśakr̥tvō'ṇu tat smr̥tam| snigdhasyāsthāpanairdōṣaṁ nirharēdvātapīnasē||141|| snigdhāmlōṣṇaiśca laghvannaṁ grāmyādīnāṁ rasairhitam| uṣṇāmbunā snānapānē nivātōṣṇapratiśrayaḥ||142|| cintāvyāyāmavākcēṣṭāvyavāyaviratō bhavēt| vātajē pīnasē dhīmānicchannēvātmanō hitam||143||

vAtAt sakAsavaisvarye sakShAraM pInase vRutam | pibedrasaM payashcoShNaM snaihikaM dhUmameva vA ||134|| shatAhvA tvagbalA mUlaM syonAkairaNDabilvajam | sAragvadhaM pibedvartiM madhUcchiShTavasAghRutaiH ||135|| athavA saghRutAn saktUn kRutvA mallakasampuTe | navapratishyAyavatAM dhUmaM vaidyaH prayojayet ||136|| sha~gkhamUrdhalalATArtau pANisvedopanAhanam | svabhyakte kShavathusrAvarodhAdau sa~gkarAdayaH ||137|| ghreyAshca rohiShAjAjIvacAtarkAricorakAH | tvakpatramaricailAnAM cUrNA vA sopaku~jcikAH ||138|| srotaHshRu~ggATanAsAkShishoShe tailaM ca nAvanam | prabhAvyAje tilAn kShIre tena piShTAMstaduShmaNA ||139|| mandasvinnAn sayaShTyAhvacUrNAMstenaiva pIDayet | dashamUlasya niShkvAthe rAsnAmadhukakalkavat ||140|| siddhaM sasaindhavaM tailaM dashakRutvo~aNu tat smRutam | snigdhasyAsthApanairdoShaM nirharedvAtapInase ||141|| snigdhAmloShNaishca laghvannaM grAmyAdInAM rasairhitam | uShNAmbunA snAnapAne nivAtoShNapratishrayaH ||142|| cintAvyAyAmavAkceShTAvyavAyavirato bhavet | vAtaje pInase dhImAnicchannevAtmano hitam ||143||

Treatment of vatika pinasa (..) if associated with cough and abnormal voice (hoarseness of voice): 1. Consume ghee and yavaksara 2. Drink hot meat soup or warm milk 3. Inhalation of unctuous medicated smoke. [134] 4. Varti (smoking bougie/cigarette) is to be prepared out of satahva, twak, balaroots, bark of syonaka, eranda root, bark of bilva, aragvadha and bee’s wax, muscle-fat and ghee. Use this as varti (cigarette) to smoke. [135] 5. Alternative formula can be adopted by the physician for smoke inhalation in cases of acute coryza /rhinitis: Roasted barley flour and ghee, mix together and keep in an earthen saucer, and cover it with another saucer having hole in the middle, seal the joint of these two earthen saucers then keep it over the fire. Reed should be fixed to the hole in the upper saucer. The smoke coming out of this is to be inhaled in acute rhinitis. [136] 6. If pain in temples, head and forehead, fomentation with warm palms and poultices should be used. 7. If sneezing, nasal obstruction or discharge, etc. then fomentation with bolus type (sankar sweda) and other such types foementation to be done after adequate massage [137]. 8. The patient should also inhale powders of rohisa, jiraka, vaca, tarkari, corakaorpowders of- twak, patra, marica, ela, upakuncika [138] 9. If there is dryness of nasal passage, srngataka (vital spot where the junction of vessels supplying nourishment to eye, nose and ear) nose and eye then oil inhalation is advisable. Also, the following oil known as anu-taila: Sesame seeds are impregnated in goat’s milk paste is prepared and triturated with goat’s milk again. Add madhuka and heat this paste on mild fire. Extract the oil and add decoction of dasamula and paste of rasna, madhuka and saindhava. Cook the above repeatedly for ten times. The processed in this manner is called anu-tailam. [139-140] Treatment of vataja- pinasa: After oleation therapy, one should be given asthapana type of enema therapy to eliminate the doṣha, [141] Dietary treatment in vataja- pinasa: One should consume unctuous, sour, hot, and light food along with the meat soup of domestic animals. Should use hot water for bath and drinking, [142] Patient should live in wind-free warm room and avoid anxiety, exertion, excessive speech and sexual intercourse considering once own well being. [143]

Treatment of pittaja pinasa: पैत्तेसर्पिःपिबेत्सिद्धंशृङ्गवेरशृतंपयः| पाचनार्थंपिबेत्पक्वेकार्यंमूर्धविरेचनम्||१४४|| पाठाद्विरजनीमूर्वापिप्पलीजातिपल्लवैः| दन्त्याचसाधितंतैलंनस्यंस्यात्पक्वपीनसे||१४५|| पूयास्रेरक्तपित्तघ्नाःकषायानावनानिच| पाकदाहाढ्यरूक्षेषुशीतालेपाःससेचनाः||१४६|| घ्रेयनस्योपचाराश्चकषायाःस्वादुशीतलाः| मन्दपित्तेप्रतिश्यायेस्निग्धैःकुर्याद्विरेचनम्||१४७|| घृतंक्षीरंयवाःशालिर्गोधूमाजाङ्गलारसाः| शीताम्लास्तिक्तशाकानियूषामुद्गादिभिर्हिताः||१४८||

paittē sarpiḥ pibēt siddhaṁ [1] śr̥ṅgavēraśr̥taṁ payaḥ| pācanārthaṁ pibēt pakvē kāryaṁ mūrdhavirēcanam||144|| pāṭhādvirajanīmūrvāpippalījātipallavaiḥ| dantyā ca sādhitaṁ tailaṁ nasyaṁ syāt pakvapīnasē||145|| pūyāsrē raktapittaghnāḥ kaṣāyā nāvanāni ca| pākadāhāḍhyarūkṣēṣu [2] śītā lēpāḥ [3] sasēcanāḥ||146|| ghrēyanasyōpacārāśca kaṣāyāḥ svāduśītalāḥ| mandapittē pratiśyāyē snigdhaiḥ kuryādvirēcanam||147|| ghr̥taṁ kṣīraṁ yavāḥ śālirgōdhūmā jāṅgalā rasāḥ| śītāmlāstiktaśākāni yūṣā mudgādibhirhitāḥ||148||

paitte sarpiH pibet siddhaM [1] shRu~ggaverashRutaM payaH | pAcanArthaM pibet pakve kAryaM mUrdhavirecanam ||144|| pAThAdvirajanImUrvApippalIjAtipallavaiH | dantyA ca sAdhitaM tailaM nasyaM syAt pakvapInase ||145|| pUyAsre raktapittaghnAH kaShAyA nAvanAni ca | pAkadAhADhyarUkSheShu [2] shItA lepAH [3] sasecanAH ||146|| ghreyanasyopacArAshcakaShAyAH svAdushItalAH | mandapitte pratishyAye snigdhaiH kuryAdvirecanam ||147|| ghRutaM kShIraM yavAH shAlirgodhUmA jA~ggalA rasAH | shItAmlAstiktashAkAni yUShA mudgAdibhirhitAH ||148||

General Treatment of pittaja pinasa: 1. One should be given ghee prepared with sringavera or milk boiled with sringavera for digestion of morbid matter. 2. There after, when the morbidity is ripened, head evacuation/errhines should be administered. [144] Errhines formulas: 1. Formula for ripened type of rhinitis/ Pakva-pinasa: Oil prepared out of patha, haridra, daruharidra, murva, pippali, tender leaves of jati and danti. [145] 2. Treatment of puya-rakta (purulent and sanguinous rhinitis) Decoctions and snuffs/ inhalation therapies prescribed in raktapitta should be administered. 3. Treatment of inflammation, burning sensation and boils etc: Cooling ointments and affusions should be applied. [146]

     4. In pittaja type of rhinitis inhalations and the decoctions used should be sweet in taste and cooling.

5. In case of rhinitis of less aggravated pitta, purgation with unctuous drugs should be administered. [147] 6. Diet in case of coryza having mild pitta involvement: Ghee, milk, barley, rice, wheat, meat soup of wild animals, cooling, sour and bitter vegetables and soup of mudga etc. are useful. [148]

Treatment of kaphaja pinasa and duṣṭapratiśyāya : गौरवारोचकेष्वादौ लङ्घनं कफपीनसे | स्वेदाःसेकाश्चपाकार्थंलिप्तेशिरसिसर्पिषा||१४९|| लशुनंमुद्गचूर्णेनव्योषक्षारघृतैर्युतम्| देयंकफघ्नवमनमुत्क्लिष्टश्लेष्मणेहितम्||१५०|| अपीनसेपूतिनस्येव्राणस्रावेसकण्डुके| धूमःशस्तोऽवपीडश्चकटुभिःकफपीनसे||१५१|| मनःशिलावचाव्योषंविडङ्गंहिङ्गुगुग्गुलुः| चूर्णोघ्रेयःप्रधमनंकटुभिश्चफलैस्तथा||१५२|| भार्गीमदनतर्कारीसुरसादिविपाचिते| मूत्रेलाक्षावचालम्बाविडङ्गंकुष्ठपिप्पली||१५३|| कृत्वाकल्कंकरञ्जंचतैलंतैःसार्षपंपचेत्| पाकान्मुक्तेघनेनस्यमेतन्मेदोनिभेकफे||१५४|| स्निग्धस्यव्याहतेवेगेच्छर्दनंकफपीनसे| वमनीयशृतक्षीरतिलमाषयवागुना||१५५|| वार्ताककुलकव्योषकुलत्थाढकिमुद्गजाः| यूषाःकफघ्नमन्नंचशस्तमुष्णाम्बुसेच(व)नम्||१५६|| सर्वजित्पीनसेदुष्टेकार्यंशोफेचशोफजित्| क्षारोऽर्बुदाधिमांसेषुक्रियाशेषेष्ववेक्ष्यच||१५७|| इतिपीनसनासारोगचिकित्सा| gauravārōcakēṣvādau laṅghanaṁ kaphapīnasē| svēdāḥ sēkāśca pākārthaṁ liptē śirasi sarpiṣā||149|| laśunaṁ mudgacūrṇēna vyōṣakṣāraghr̥tairyutam| dēyaṁ kaphaghnavamanamutkliṣṭaślēṣmaṇē hitam||150|| apīnasē pūtinasyē ghrāṇasrāvē sakaṇḍukē| dhūmaḥ śastō'vapīḍaśca kaṭubhiḥ kaphapīnasē||151|| manaḥśilā vacā vyōṣaṁ viḍaṅgaṁ hiṅgu gugguluḥ| cūrṇō ghrēyaḥ pradhamanaṁ kaṭubhiśca phalaistathā||152|| bhārgīmadanatarkārīsurasādivipācitē| mūtrē lākṣā vacā lambā viḍaṅgaṁ kuṣṭhapippalī||153|| kr̥tvā kalkaṁ karañjaṁ ca tailaṁ taiḥ sārṣapaṁ pacēt| pākānmuktē ghanē nasyamētanmēdōnibhē kaphē||154|| snigdhasya vyāhatē vēgē cchardanaṁ kaphapīnasē| vamanīyaśr̥takṣīratilamāṣayavāgunā||155|| vārtākakulakavyōṣakulatthāḍhakimudgajāḥ| yūṣāḥ kaphaghnamannaṁ ca śastamuṣṇāmbusēca(va)nam||156|| sarvajit pīnasē duṣṭē kāryaṁ śōphē ca śōphajit| kṣārō'rbudādhimāṁsēṣu kriyā śēṣēṣvavēkṣya ca||157|| iti pīnasanāsārōgacikitsā| gauravArocakeShvAdau la~gghanaM kaphapInase | svedAH sekAshca pAkArthaM lipte shirasi sarpiShA ||149|| lashunaM mudgacUrNena vyoShakShAraghRutairyutam | deyaM kaphaghnavamanamutkliShTashleShmaNe hitam ||150|| apInase pUtinasye vrANasrAve sakaNDuke | dhUmaH shasto~avapIDashca kaTubhiH kaphapInase ||151|| manaHshilA vacA vyoShaM viDa~ggaM hi~ggu gugguluH | cUrNo ghreyaH pradhamanaM kaTubhishca phalaistathA ||152|| bhArgImadanatarkArIsurasAdivipAcite | mUtre lAkShA vacA lambA viDa~ggaM kuShThapippalI ||153|| kRutvA kalkaM kara~jjaM ca tailaM taiH sArShapaM pacet | pAkAnmukte ghane nasyametanmedonibhe kaphe ||154|| snigdhasya vyAhate vege cchardanaM kaphapInase | vamanIyashRutakShIratilamAShayavAgunA ||155|| vArtAkakulakavyoShakulatthADhakimudgajAH | yUShAH kaphaghnamannaM ca shastamuShNAmbuseca(va)nam ||156|| sarvajit pInase duShTe kAryaM shophe ca shophajit | kShAro~arbudAdhimAMseShu kriyA sheSheShvavekShya ca ||157|| iti pInasanAsArogacikitsA | Treatment of kaphaja pinasa: 1. In kaphaja pinasa, associated with heaviness and anorexia, fasting therapy should be advised. For digestion (of impurity) head should be smeared with ghee and then, fomentation and affusion therapies should be administered. [149] 2. Garlic mixed with powder of green gram, trikatu, yavakshara and ghee should be given to reduce the alleviated kapha. When kapha is in excess alleviated condition then kapha alleviating emetic therapy should be given with [150] 3. In case of kaphaja pinasa, apinasa, puti nasya, running nose and itching medicated smoke inhalation therapy and avapeedana/ expressed juice of pungent drugs to be given. [151] 4. One should inhale the powder of manahshil, vaca, trikatu, vidanga, hingu and guggulu 5. The powder of pungent fruits should be sniffed / inhaled into the patient’s nose. [152] 6. In case of thick, fat-like mucous discharge which comes out when the rhinitis is ripened (pakve) should be advised snuff with mustard oil, cow’s urine, bharangi, madana, tarkari, drugs of the surasadi group. Boil the above together and cooked by adding paste of laksha, vaca, bittergourd, vidanga, kustha, pippali, karanja. [153-154] 7. Treatment for diminished/ milder kaphaja pinasa: The patient should be given oleation therapy followed by emetic therapy. Gruel prepared out of tila and black gram by adding milk boiled with emetic drugs should be used in this emetic therapy. [155]

Diet for kaphaja-pinasa: Soups of vartaka, patola, trikatu, kulattha, adhaki, mudga and kapha alleviating cereals and affusion of hot water is to be advised. [156] Treatment of dusta pinasa: The measures described above should be applied for overcoming all the three doṣha type rhinitis. Treatment of swelling of the nose/ edematous rhinitis: Edema reliving measures should be applied. Treatment of growth like tumors and polyps/ adhimāṁsa: Aplication of alkali is advised. Treatment of the remaining disorders of the nose: Steps should be taken according to the condition after proper investigation.

“Thus, ends the treatment of pinasa and other diseases of the nose.” [157]

Treatment of head-diseases: वातिकेशिरसोरोगेस्नेहान्स्वेदान्सनावनान्| पानान्नमुपनाहांश्चकुर्याद्वातामयापहान्||१५८|| तैलभृष्टैरगुर्वाद्यैःसुखोष्णैरुपनाहनम्| जीवनीयैःसुमनसामत्स्यैर्मांसैश्चशस्यते||१५९|| रास्नास्थिरादिभिःसिद्धंसक्षीरंनस्यमर्तिनुत्| तैलंरास्नाद्विकाकोलीशर्कराभिरथापिवा||१६०|| बलामधूकयष्ट्याह्वविदारीचन्दनोत्पलैः| जीवकर्षभकद्राक्षाशर्कराभिश्चसाधितः||१६१|| प्रस्थस्तैलस्यसक्षीरोजाङ्गलार्धतुलारसे| नस्यंसर्वोर्ध्वजत्रूत्थवातपित्तामयापहम्||१६२|| दशमूलबलारास्नात्रिफलामधुकैःसह| मयूरंपक्षपित्तान्त्रशकृत्तुण्डाङ्घ्रिवर्जितम्||१६३|| जलेपक्त्वाघृतप्रस्थंतस्मिन्क्षीरसमंपचेत्| मधुरैःकार्षिकैःकल्कैःशिरोरोगार्दितापहम्||१६४|| कर्णाक्षिनासिकाजिह्वाताल्वास्यगलरोगनुत्| मायूरमितिविख्यातमूर्ध्वजत्रुगदापहम्||१६५|| इतिमायूरघृतम्| vātikē śirasō rōgē snēhān svēdān sanāvanān| pānānnamupanāhāṁśca kuryādvātāmayāpahān||158|| tailabhr̥ṣṭairagurvādyaiḥ sukhōṣṇairupanāhanam| jīvanīyaiḥ sumanasā matsyairmāṁsaiśca śasyatē||159|| rāsnāsthirādibhiḥ siddhaṁ sakṣīraṁ nasyamartinut| tailaṁ rāsnādvikākōlīśarkarābhirathāpi vā||160|| balāmadhūkayaṣṭyāhvavidārīcandanōtpalaiḥ| jīvakarṣabhakadrākṣāśarkarābhiśca sādhitaḥ||161|| prasthastailasya sakṣīrō jāṅgalārdhatulārasē| nasyaṁ sarvōrdhvajatrūtthavātapittāmayāpaham||162|| daśamūlabalārāsnātriphalāmadhukaiḥ saha| mayūraṁ pakṣapittāntraśakr̥ttuṇḍāṅghrivarjitam||163|| jalē paktvā ghr̥taprasthaṁ tasmin kṣīrasamaṁ pacēt| madhuraiḥ kārṣikaiḥ kalkaiḥ śirōrōgārditāpaham||164|| karṇākṣināsikājihvātālvāsyagalarōganut| māyūramitivikhyātamūrdhvajatrugadāpaham||165|| iti māyūraghr̥tam|

vAtike shiraso roge snehAn svedAn sanAvanAn | pAnAnnamupanAhAMshca kuryAdvAtAmayApahAn ||158|| tailabhRuShTairagurvAdyaiH sukhoShNairupanAhanam | jIvanIyaiH sumanasA matsyairmAMsaishca shasyate ||159|| rAsnAsthirAdibhiH siddhaM sakShIraM nasyamartinut | tailaM rAsnAdvikAkolIsharkarAbhirathApi vA ||160|| balAmadhUkayaShTyAhvavidArIcandanotpalaiH | jIvakarShabhakadrAkShAsharkarAbhishca sAdhitaH ||161|| prasthastailasya sakShIro jA~ggalArdhatulArase | nasyaM sarvordhvajatrUtthavAtapittAmayApaham ||162|| dashamUlabalArAsnAtriphalAmadhukaiH saha | mayUraM pakShapittAntrashakRuttuNDA~gghrivarjitam ||163|| jale paktvA ghRutaprasthaM tasmin kShIrasamaM pacet | madhuraiH kArShikaiH kalkaiH shirorogArditApaham ||164|| karNAkShinAsikAjihvAtAlvAsyagalaroganut | mAyUramitivikhyAtamUrdhvajatrugadApaham ||165|| iti mAyUraghRutam |

Treatment of vataja head diseases: 1. General treatment of vataja head diseases: oleation, fomentation and snuffing/ inhalation therapy, vāta alleviating diet and poultices are used. [158] 2. Hot poultices/upanaha: One should use the paste of drugs of the agaru etc group, jivaniya group, sumanas (flowers of jati) or of fish or meat fried in oil and used for luke-warm poultices. [159] 3. Rasnadi-tailam: a. Oil Prepared out of rasna, laghu panchamula, milk and oil used for nasya cures headache. b. Oil prepared out of rasna, kakoli, ksirakakoli, sarkara and such oil when used for nasya cures headache [160]

    4. Baladya-tailam:

The following nasya alleviates all supraclavicular disorders caused by vāta and pitta: 640gm/ one prastha of oil, bala, madhuka, yasti, vidari, candana, utpala, jivaka, rsabhaka, draksa, sarkara, milk, 2 Kg/ 1/2 tula of meat soup of wild animals cooked together and oil prepared in this manner is used for nasya. [161-162] 5. Mayura-ghrita: This ghrita is beneficial in head diseases, facial paralysis, diseases of ear, eye, nose, tongue, palate, mouth, throat and other supraclavicular disorders. Peacock (which is devoid of feathers, bile, intestines, feces, beak and feet) alongwith dashamula, bala, rasna, triphala, madhuka and water are mixed together. Decoction is prepared of all the above. To this 640mg/1 prastha ghee, 640mg/ 1 prastha milk, 10 mg/1 karsha paste of madhuradi gana drugs is added and the prepared ghrita is well known as Mayura ghrita thus ends the description of mayura ghrita. [163-165]

Maha mayura ghrita: एतेनैवकषायेणघृतप्रस्थंविपाचयेत्| चतुर्गुणेनपयसाकल्कैरेभिश्चकार्षिकैः||१६६|| जीवन्तीत्रिफलामेदामृद्वीकर्धिपरूषकैः| समङ्गाचविकाभार्गीकाश्मरीसुरदारुभिः||१६७|| आत्मगुप्तामहामेदातालखर्जूरमस्तकैः| मृणालबिसशालूकशृङ्गीजीवकपद्मकैः||१६८|| शतावरीविदारीक्षुबृहतीसारिवायुगैः| मूर्वाश्वदंष्ट्रर्षभकशृङ्गाटककसेरुकैः||१६९|| रास्नास्थिरातामलकीसूक्ष्मैलाशटिपौष्करैः| पुनर्नवातुगाक्षीरीकाकोलीधन्वयासकैः||१७०|| खर्जूराक्षोटवाताममुञ्जाताभिषुकैरपि| द्रव्यैरेभिर्यथालाभंपूर्वकल्पेनसाधितम्||१७१|| नस्येपानेतथाऽभ्यङ्गेबस्तौचैवप्रयोजयेत्| शिरोरोगेषुसर्वेषुकासेश्वासेचदारुणे||१७२|| मन्यापृष्ठग्रहेशोषेस्वरभेदेतथाऽर्दिते| योन्यसृक्शुक्रदोषेषुशस्तंवन्ध्यासुतप्रदम्||१७३|| ऋतुस्नातातथानारीपीत्वापुत्रंप्रसूयते| महामायूरमित्येतद्घृतमात्रेयपूजितम्||१७४|| इतिमहामायूरघृतम्| आखुभिःकुक्कुटैर्हंसैःशशैश्चापिहिबुद्धिमान्| कल्पेनानेनविपचेत्सर्पिरूर्ध्वगदापहम्||१७५|| ētēnaiva kaṣāyēṇa ghr̥taprasthaṁ vipācayēt| caturguṇēna payasā kalkairēbhiśca kārṣikaiḥ||166|| jīvantītriphalāmēdāmr̥dvīkardhiparūṣakaiḥ| samaṅgācavikābhārgīkāśmarīsuradārubhiḥ||167|| ātmaguptāmahāmēdātālakharjūramastakaiḥ| mr̥ṇālabisaśālūkaśr̥ṅgījīvakapadmakaiḥ [1] ||168|| śatāvarīvidārīkṣubr̥hatīsārivāyugaiḥ| mūrvāśvadaṁṣṭrarṣabhakaśr̥ṅgāṭakakasērukaiḥ||169|| rāsnāsthirātāmalakīsūkṣmailāśaṭipauṣkaraiḥ| punarnavātugākṣīrīkākōlīdhanvayāsakaiḥ||170|| kharjūrākṣōṭavātāmamuñjātābhiṣukairapi | dravyairēbhiryathālābhaṁ pūrvakalpēna sādhitam||171|| nasyē pānē tathā'bhyaṅgē bastau caiva prayōjayēt| śirōrōgēṣu sarvēṣu kāsē śvāsē ca dāruṇē||172|| manyāpr̥ṣṭhagrahē śōṣē svarabhēdē tathā'rditē| yōnyasr̥kśukradōṣēṣu śastaṁ vandhyāsutapradam||173|| r̥tusnātā tathā nārī pītvā putraṁ prasūyatē| mahāmāyūramityētadghr̥tamātrēyapūjitam||174|| iti mahāmāyūraghr̥tam| ākhubhiḥ kukkuṭairhaṁsaiḥ śaśaiścāpi hi buddhimān| kalpēnānēna vipacēt sarpirūrdhvagadāpaham||175|| etenaiva kaShAyeNa ghRutaprasthaM vipAcayet | caturguNena payasA kalkairebhishca kArShikaiH ||166|| jIvantItriphalAmedAmRudvIkardhiparUShakaiH | sama~ggAcavikAbhArgIkAshmarIsuradArubhiH ||167|| AtmaguptAmahAmedAtAlakharjUramastakaiH | mRuNAlabisashAlUkashRu~ggIjIvakapadmakaiH [1] ||168|| shatAvarIvidArIkShubRuhatIsArivAyugaiH | mUrvAshvadaMShTrarShabhakashRu~ggATakakaserukaiH ||169|| rAsnAsthirAtAmalakIsUkShmailAshaTipauShkaraiH | punarnavAtugAkShIrIkAkolIdhanvayAsakaiH ||170|| kharjUrAkShoTavAtAmamu~jjAtAbhiShukairapi | dravyairebhiryathAlAbhaM pUrvakalpena sAdhitam ||171|| nasye pAne tathA~abhya~gge bastau caiva prayojayet | shirorogeShu sarveShu kAse shvAse ca dAruNe ||172|| manyApRuShThagrahe shoShe svarabhede tathA~ardite | yonyasRukshukradoSheShu shastaM vandhyAsutapradam ||173|| RutusnAtA tathA nArI pItvA putraM prasUyate | mahAmAyUramityetadghRutamAtreyapUjitam ||174|| iti mahAmAyUraghRutam | AkhubhiH kukkuTairhaMsaiH shashaishcApi hi buddhimAn | kalpenAnena vipacet sarpirUrdhvagadApaham ||175|| Mahamayura Ghrta: Decoction is prepared of Peacock devoid of feathers, bile, intestines, feces, beak and feet, dasamula, bala, rasna, triphala, madhuka and water. 640 mg ghee and four times of milk, 10gm paste of each jivanti, triphala, meda, mrdvika, rddhi, parusaka, samanga, cavika, bhargi, devadaru, kapikacchu, mahameda, talamastaka, kharjuramustaka, bisa,saluka, srngi, jivaka, padmaka, satavari, vidari, iksu, brhati, 2 types of sariva, murva,goksura, rsabhaka, srngataka, kaseruka, rasna, salaparni, tamalaki, suksmaila, sati, puskaramula, punarnava, tugaksiri, kakoli, dhanvayasa, kharjura, aksota, vatama,munjata, abhisuka (asper the availability) added and fortify the above into ghee. This ghrita is used as snuff, intake as drink, massage and enema therapies, in all head diseases, in severe cough and dyspnea, stiffness of neck and back, emaciation, hoarseness of voice, facial paralysis, diseases of vaginal track and menstruation and seminal vitiation and provides fertility to sterile women. Intake of it after bath at the end of the menstrual period delivers male offspring. This is called as maha mayura-ghrita and is praised by Lord Atreya, thus enda the description of maha mayura ghrita. [166-174] “A wise physician may prepare ghrita, with the above mentioned ingredients and the procedure, with rats, cocks, swans and rabbits [substituted for the peacock (mayura)] which also cure supraclavicular disorders” [175]

Treatment of paittika head diseases: पैत्तेघृतंपयःसेकाःशीतालेपाःसनावनाः| जीवनीयानिसर्पींषिपानान्नंचापिपित्तनुत्||१७६|| चन्दनोशीरयष्ट्याह्वबलाव्याघ्रनखोत्पलैः| क्षीरपिष्टैःप्रदेहःस्याच्छृतैर्वापरिषेचनम्||१७७|| त्वक्पत्रशर्कराकल्कःसुपिष्टस्तण्डुलाम्बुना| कार्योऽवपीडःसर्पिश्चनस्यंतस्यानुपैत्तिके||१७८|| यष्ट्याह्वचन्दनानन्ताक्षीरसिद्धंघृतंहितम्| नावनंशर्कराद्राक्षामधूकैर्वाऽपिपित्तजे||१७९|| paittē ghr̥taṁ payaḥ sēkāḥ śītā lēpāḥ sanāvanāḥ| jīvanīyāni sarpīṁṣi pānānnaṁ cāpi pittanut||176|| candanōśīrayaṣṭyāhvabalāvyāghranakhōtpalaiḥ| kṣīrapiṣṭaiḥ pradēhaḥ syācchr̥tairvā pariṣēcanam||177|| tvakpatraśarkarākalkaḥ supiṣṭastaṇḍulāmbunā| kāryō'vapīḍaḥ sarpiśca nasyaṁ tasyānu paittikē||178|| yaṣṭyāhvacandanānantākṣīrasiddhaṁ ghr̥taṁ hitam| nāvanaṁ śarkarādrākṣāmadhūkairvā'pi pittajē||179||

paitte ghRutaM payaH sekAH shItA lepAH sanAvanAH | 

jIvanIyAni sarpIMShi pAnAnnaM cApi pittanut ||176|| candanoshIrayaShTyAhvabalAvyAghranakhotpalaiH | kShIrapiShTaiH pradehaH syAcchRutairvA pariShecanam ||177|| tvakpatrasharkarAkalkaH supiShTastaNDulAmbunA | kAryo~avapIDaH sarpishca nasyaM tasyAnu paittike ||178|| yaShTyAhvacandanAnantAkShIrasiddhaM ghRutaM hitam | nAvanaM sharkarAdrAkShAmadhUkairvA~api pittaje ||179||

1. General Treatment of paittika head diseases: Ghee, Milk, Affusions, Cold pastes/poultice, Snuffs of drugs having cold potency, ghee prepared out of drugs belonging to jivaniya group and pitta-alleviating diet (food and drinks) should be taken. [176] 2. Ointment and affusion in pittaja head disease: Chandana, usira, madhuyasti, bala, vyaghranakha, utpala and milk (for trituration) made into paste and can be anointed on the patient of pattika head disease and also the decoction prepared out of above drugs can be used for affusion in paittika head diseases. [177] 3. The snuff in pittaja head disease: Paste prepared of twak, patra, sarkara alongwith rice water should be squeeze to extract out the juice and put the same in the nostrils followed by administration of ghee as nasya. [178] 4. The nasya in pittaja head disease: Ghee fortified with ingredients such as madhuyasti, chandana, ananta and milk is used for nasya. Similarly medicated ghee prepared from sarkara, draksa, madhuka is useful in pittaja head disease. [179] Treatment of kaphaja/ sannipatika and krimija head diseases: कफजेस्वेदितंधूमनस्यप्रधमनादिभिः| शुद्धंप्रलेपपानान्नैःकफघ्नैःसमुपाचरेत्||१८०|| पुराणसर्पिषःपानैस्तीक्ष्णैर्बस्तिभिरेवच| कफानिलोत्थितेदाहःशेषयोरक्तमोक्षणम्||१८१|| एरण्डनलदक्षौमगुग्गुल्वगुरुचन्दनैः| धूमवर्तिंपिबेद्गन्धैरकुष्ठतगरैस्तथा||१८२|| सन्निपातभवेकार्यासन्निपातहिताक्रिया| क्रिमिजेचैवकर्तव्यंतीक्ष्णंमूर्धविरेचनम्||१८३|| त्वग्दन्तीव्याघ्रकरजविडङ्गनवमालिकाः| अपामार्गफलंबीजंनक्तमालशिरीषयोः| क्षवकोऽश्मन्तकोबिल्वंहरिद्राहिङ्गुयूथिका||१८४|| फणिज्झकश्चतैस्तैलमविमूत्रेचतुर्गुणे| सिद्धंस्यान्नावनंचूर्णंचैषांप्रधमनंहितम्||१८५|| फलंशिग्रुकरञ्जाभ्यांसव्योषंचावपीडकः| कषायःस्वरसःक्षारश्चूर्णंकल्कोऽवपीडकः||१८६|| इतिशिरोरोगचिकित्सा| kaphajē svēditaṁ dhūmanasyapradhamanādibhiḥ| śuddhaṁ pralēpapānānnaiḥ kaphaghnaiḥ samupācarēt||180|| purāṇasarpiṣaḥ pānaistīkṣṇairbastibhirēva ca| kaphānilōtthitē dāhaḥ śēṣayō raktamōkṣaṇam||181|| ēraṇḍanaladakṣaumaguggulvagurucandanaiḥ| dhūmavartiṁ pibēdgandhairakuṣṭhatagaraistathā||182|| sannipātabhavē kāryā sannipātahitā kriyā| krimijē caiva kartavyaṁ tīkṣṇaṁ mūrdhavirēcanam||183|| tvagdantīvyāghrakarajaviḍaṅganavamālikāḥ| apāmārgaphalaṁ bījaṁ naktamālaśirīṣayōḥ| kṣavakō'śmantakō bilvaṁ haridrā hiṅgu yūthikā||184|| phaṇijjhakaśca taistailamavimūtrē caturguṇē| siddhaṁ syānnāvanaṁ cūrṇaṁ caiṣāṁ pradhamanaṁ hitam||185|| phalaṁ śigrukarañjābhyāṁ savyōṣaṁ cāvapīḍakaḥ| kaṣāyaḥ svarasaḥ kṣāraścūrṇaṁ kalkō'vapīḍakaḥ||186||

iti śirōrōgacikitsā|

kaphaje sveditaM dhUmanasyapradhamanAdibhiH | shuddhaM pralepapAnAnnaiH kaphaghnaiH samupAcaret ||180|| purANasarpiShaH pAnaistIkShNairbastibhireva ca | kaphAnilotthite dAhaH sheShayo raktamokShaNam ||181|| eraNDanaladakShaumaguggulvagurucandanaiH | dhUmavartiM pibedgandhairakuShThatagaraistathA ||182|| sannipAtabhave kAryA sannipAtahitA kriyA | krimije caiva kartavyaM tIkShNaM mUrdhavirecanam ||183|| tvagdantIvyAghrakarajaviDa~gganavamAlikAH | apAmArgaphalaM bIjaM naktamAlashirIShayoH | kShavako~ashmantako bilvaM haridrA hi~ggu yUthikA ||184|| phaNijjhakashca taistailamavimUtre caturguNe | siddhaM syAnnAvanaM cUrNaM caiShAM pradhamanaM hitam ||185|| phalaM shigrukara~jjAbhyAM savyoShaM cAvapIDakaH | kaShAyaH svarasaH kShArashcUrNaM kalko~avapIDakaH ||186|| iti shirorogacikitsA |

General treatment of kaphaja head diseases: Fomentation therapy, smoking, snuffing and insufflation of powders in to nostrils and then managed with kapha-alleviating paste and diet alongwith intake of old ghee and teekshna basti (medicated enema having strong cleansing property). [180-181] 1. In kaphaja and vataja head diseases, daha (agnikarma/ cauterization) on forehead and temples is done followed by blood-letting therapy considering the remaining morbid doṣha[181] 2. Dhooma varti (smoke bougie/cigar) prepared of eranda, nalada, ksauma, guggulu, aguru, chandana and other aromatic drugs except kustha and tagara should be used for medicated smoking. [182] Treatment of tri-doshic/sannipatika head diseases: Therapeutic measures prescribed for all the three types of head diseases should be administered in sannipatika head diseases. [183] Treatment of head disease due to micro organisms/ krimija: 1. Strong errhine having sharp (teekshna) ingredients should be administered. [183] 2. Medicated errhine prepared after fortifying oil with twak, danti, vyaghranakha, vidanga, navamallika, apamarga fruits and seeds of naktamala and sirisa, ksavaka, asmantaka, bilva, haridra, hingu, yuthika, phanijjaka alongwith 4 times sheep urine should be used or the same herbs may also be used for insufflation. [184-185] 4. The squeezed juice prepared from seeds of sigru karanja and trikatu may be put in the nostrils/ avapeedana. Similarly decoction, fresh juice, alkali preparation, powder preparation, paste of the same drugs may also be used for avapeedana in nostrils. Thus ends the treatment of head disease. [186] Treatment of diseases of the mouth: शुक्ततिक्तकटुक्षौद्रकषायैःकवलग्रहः| धूमःप्रधमनंशुद्धिरधश्छर्दनलङ्घनम्||१८७|| भोज्यंचमुखरोगेषुयथास्वंदोषनुद्धितम्| पिप्पल्यगुरुदार्वीत्वग्यवक्षाररसाञ्जनम्||१८८|| पाठांतेजोवतींपथ्यांसमभागंविचूर्णयेत्| मुखरोगेषुसर्वेषुसक्षौद्रंतद्विधारयेत्||१८९|| सीधुमाधवमाध्वीकैःश्रेष्ठोऽयंकवलग्रहः| तेजोह्वामभयामेलांसमङ्गांकटुकांघनम्||१९०|| पाठांज्योतिष्मतींलोध्रंदार्वींकुष्ठंचचूर्णयेत्| दन्तानांघर्षणंरक्तस्रावकण्डूरुजापहम्||१९१|| पञ्चकोलकतालीसपत्रैलामरिचत्वचः| पलाशमुष्ककक्षारयवक्षाराश्चचूर्णिताः||१९२|| गुडेपुराणेद्विगुणेक्वथितेगुटिकाःकृताः| कर्कन्धुमात्राःसप्ताहंस्थितामुष्ककभस्मनि||१९३|| कण्ठरोगेषुसर्वेषुधार्याःस्युरमृतोपमाः| गृहधूमोयवक्षारःपाठाव्योषंरसाञ्जनम्||१९४|| तेजोह्वात्रिफलालोध्रंचित्रकश्चेतिचूर्णितम्| सक्षौद्रंधारयेदेतद्गलरोगविनाशनम्||१९५|| कालकंनामतच्चूर्णंदन्तास्यगलरोगनुत्| इतिकालकचूर्णम्| मनःशिलायवक्षारोहरितालंससैन्धवम्||१९६|| दार्वीत्वक्चेतितच्चूर्णंमाक्षिकेणसमायुतम्| मूर्च्छितंघृतमण्डेनकण्ठरोगेषुधारयेत्||१९७|| मुखरोगेषुचश्रेष्ठंपीतकंनामकीर्तितम्| इतिपीतकचूर्णम्| मृद्वीकाकटुकाव्योषंदार्वीत्वक्त्रिफलाघनम्||१९८|| मूर्च्छितंघृतमण्डेनकण्ठरोगेषुधारयेत्| पाठारसाञ्जनंमूर्वातेजोह्वेतिचचूर्णितम्||१९९|| क्षौद्रयुक्तंविधातव्यंगलरोगेभिषग्जितम्| योगास्त्वेतेत्रयःप्रोक्तावातपित्तकफापहाः||२००|| कटुकातिविषापाठादार्वीमुस्तकलिङ्गकाः| गोमूत्रक्वथिताःपेयाःकण्ठरोगविनाशनाः||२०१|| स्वरसःक्वथितोदार्व्याघनीभूतोरसक्रिया| सक्षौद्रामुखरोगासृग्दोषनाडीव्रणापहा||२०२|| तालुशोषेत्वतृष्णस्यसर्पिरौत्तरभक्तिकम्| नावनंमधुराःस्निग्धाःशीताश्चैवरसाहिताः||२०३|| मुखपाकेसिराकर्मशिरःकायविरेचनम्| मूत्रतैलघृतक्षौद्रक्षीरैश्चकवलग्रहाः||२०४|| सक्षौद्रास्त्रिफलापाठामृद्वीकाजातिपल्लवाः| कषायतिक्तकाःशीताःक्वाथाश्चमुखधावनाः||२०५|| śuktatiktakaṭukṣaudrakaṣāyaiḥ kavalagrahaḥ| dhūmaḥ pradhamanaṁ śuddhiradhaśchardanalaṅghanam||187|| bhōjyaṁ ca mukharōgēṣu yathāsvaṁ dōṣanuddhitam| pippalyagurudārvītvagyavakṣārarasāñjanam||188|| pāṭhāṁ tējōvatīṁ pathyāṁ samabhāgaṁ vicūrṇayēt| mukharōgēṣu sarvēṣu sakṣaudraṁ tadvidhārayēt||189|| sīdhumādhavamādhvīkaiḥ śrēṣṭhō'yaṁ kavalagrahaḥ| tējōhvāmabhayāmēlāṁ samaṅgāṁ kaṭukāṁ ghanam||190|| pāṭhāṁ jyōtiṣmatīṁ lōdhraṁ dārvīṁ kuṣṭhaṁ ca cūrṇayēt| dantānāṁ gharṣaṇaṁ raktasrāvakaṇḍūrujāpaham||191|| pañcakōlakatālīsapatrailāmaricatvacaḥ| palāśamuṣkakakṣārayavakṣārāśca cūrṇitāḥ||192|| guḍē purāṇē dviguṇē kvathitē guṭikāḥ kr̥tāḥ| karkandhumātrāḥ saptāhaṁ sthitā muṣkakabhasmani||193|| kaṇṭharōgēṣu sarvēṣu dhāryāḥ syuramr̥tōpamāḥ| gr̥hadhūmō yavakṣāraḥ pāṭhā vyōṣaṁ rasāñjanam||194|| tējōhvā triphalā lōdhraṁ citrakaścēti cūrṇitam| sakṣaudraṁ dhārayēdētadgalarōgavināśanam||195|| kālakaṁ nāma taccūrṇaṁ dantāsyagalarōganut| iti kālakacūrṇam| manaḥśilā yavakṣārō haritālaṁ sasaindhavam||196|| dārvītvak cēti taccūrṇaṁ mākṣikēṇa samāyutam| mūrcchitaṁ ghr̥tamaṇḍēna kaṇṭharōgēṣu dhārayēt||197|| mukharōgēṣu ca śrēṣṭhaṁ pītakaṁ nāma kīrtitam| iti pītakacūrṇam| mr̥dvīkā kaṭukā vyōṣaṁ dārvītvak triphalā ghanam||198|| mūrcchitaṁ ghr̥tamaṇḍēna kaṇṭharōgēṣu dhārayēt| pāṭhā rasāñjanaṁ mūrvā tējōhvēti ca cūrṇitam||199|| kṣaudrayuktaṁ vidhātavyaṁ galarōgē bhiṣagjitam| yōgāstvētē trayaḥ prōktā vātapittakaphāpahāḥ||200|| kaṭukātiviṣāpāṭhādārvīmustakaliṅgakāḥ| gōmūtrakvathitāḥ pēyāḥ kaṇṭharōgavināśanāḥ||201|| svarasaḥ kvathitō dārvyā ghanībhūtō rasakriyā| sakṣaudrā mukharōgāsr̥gdōṣanāḍīvraṇāpahā||202|| tāluśōṣē tvatr̥ṣṇasya sarpirauttarabhaktikam| nāvanaṁ madhurāḥ snigdhāḥ śītāścaiva rasā hitāḥ||203|| mukhapākē sirākarma śiraḥkāyavirēcanam| mūtratailaghr̥takṣaudrakṣīraiśca kavalagrahāḥ||204|| sakṣaudrāstriphalāpāṭhāmr̥dvīkājātipallavāḥ| kaṣāyatiktakāḥ śītāḥ kvāthāśca mukhadhāvanāḥ||205||

shuktatiktakaTukShaudrakaShAyaiH kavalagrahaH dhUmaH pradhamanaM shuddhiradhashchardanala~gghanam ||187|| bhojyaM ca mukharogeShu yathAsvaM doShanuddhitam | pippalyagurudArvItvagyavakShArarasA~jjanam ||188|| pAThAM tejovatIM pathyAM samabhAgaM vicUrNayet | mukharogeShu sarveShu sakShaudraM tadvidhArayet ||189|| sIdhumAdhavamAdhvIkaiH shreShTho~ayaM kavalagrahaH | tejohvAmabhayAmelAM sama~ggAM kaTukAM ghanam ||190|| pAThAM jyotiShmatIM lodhraM dArvIM kuShThaM ca cUrNayet | dantAnAM gharShaNaM raktasrAvakaNDUrujApaham ||191|| pa~jcakolakatAlIsapatrailAmaricatvacaH | palAshamuShkakakShArayavakShArAshca cUrNitAH ||192|| guDe purANe dviguNe kvathite guTikAH kRutAH | karkandhumAtrAH saptAhaM sthitA muShkakabhasmani ||193|| kaNTharogeShu sarveShu dhAryAH syuramRutopamAH | gRuhadhUmo yavakShAraH pAThA vyoShaM rasA~jjanam ||194|| tejohvA triphalA lodhraM citrakashceti cUrNitam | sakShaudraM dhArayedetadgalarogavinAshanam ||195|| kAlakaM nAma taccUrNaM dantAsyagalaroganut | iti kAlakacUrNam | manaHshilA yavakShAro haritAlaM sasaindhavam ||196|| dArvItvak ceti taccUrNaM mAkShikeNa samAyutam | mUrcchitaM ghRutamaNDena kaNTharogeShu dhArayet ||197|| mukharogeShu ca shreShThaM pItakaM nAma kIrtitam | iti pItakacUrNam | mRudvIkA kaTukA vyoShaM dArvItvak triphalA ghanam ||198|| mUrcchitaM ghRutamaNDena kaNTharogeShu dhArayet | pAThA rasA~jjanaM mUrvA tejohveti ca cUrNitam ||199|| kShaudrayuktaM vidhAtavyaM galaroge bhiShagjitam | yogAstvete trayaH proktA vAtapittakaphApahAH ||200|| kaTukAtiviShApAThAdArvImustakali~ggakAH | gomUtrakvathitAH peyAH kaNTharogavinAshanAH ||201|| svarasaH kvathito dArvyA ghanIbhUto rasakriyA | sakShaudrA mukharogAsRugdoShanADIvraNApahA ||202|| tAlushoShe tvatRuShNasya sarpirauttarabhaktikam | nAvanaM madhurAH snigdhAH shItAshcaiva rasA hitAH ||203|| mukhapAke sirAkarma shiraHkAyavirecanam | mUtratailaghRutakShaudrakShIraishca kavalagrahAH ||204|| sakShaudrAstriphalApAThAmRudvIkAjAtipallavAH | kaShAyatiktakAH shItAH kvAthAshca mukhadhAvanAH ||205||

General treatment of diseases of the mouth:

Gargling/ holding paste of drugs in mouth (kavala graha) of contents such as vinegar, decoction of bitter and pungent drug and honey. Medicated Smoking, Insufflation, purgation, emesis, fasting and diet which alleviates the aggravated doṣha are beneficial in oral diseases. [187]

1. Pippalyadi-churna: Take equal quantity each of pippali, aguru, daruharidra bark, yavaksara, rasanjana, patha, tejovati, haritaki. Powder all the above drugs and Mix with honey. This linctus is to be kept in the mouth in all diseases of the mouth. [188] 2. Mix all the above mentioned drugs by adding sidhu (wine prepared out of sugarcane juice), madhava (wine prepared out of honey) and madhvika (wine prepared out of madhuka) together and used for gargling in all diseases of the mouth. [189] 3. Tejovatyadi tooth – powder: Brushing with powder of tejohva/tejabala, haritaki, ela, samanga, katuka, ghana/musta, patha, jyotismati, lodhra, daruharidra, kustha reduces bleeding, itching and pain in the teeth. [190-191] 4. Ksara-gutika: Panchakola (pippali,pippalimola,chavya, chitraka, nagara), talisapatra, ela, marica, twak, alkali of palasa, mustaka and yavaksara.Powder all of the above and cooked together with two times old jaggery. Make pills the size of small karkandu (jujube/ber fruit). Keep them within the heap of ash (alkali) of muskaka for a week. These pills are like ambrosia when kept in mouth for all throat disorders. [192-194] 5. Kalaka- churna: Powders of Grahadhooma (kitchen Shoot), yavaksara, patha, trikatu, rasanjana, tejohva, triphala, lodhra, citraka and Honey mix all the above together and keep in mouth (slowly sucked) it cures throat disease. This is called as kalaka churna and it alleviates diseases of teeth, mouth and throat. Thus ends the description of kalaka churna. [194-196]

6. Pitaka churna: Powder of manahsila (realgar), yavaksar, haratala (orpiment), saindhava (rock-salt), daruharidra bark mixed alongwith honey and ghee-scum and is kept in the mouth for cure of oral disease. It is known as pitaka-churna, this is an excellent remedy for oral diseases.Thus ends the description of pitaka-churna. [196-198] 7. Mrdvika, katuka, trikatu, daruharidra bark, triphala, musta and ghee-scum is to be kept in the mouth for diseases of the throat. [198-199] 8. Patha, rasanjana, murva, tejohva and honey kept in the mouth for the treatment of throat diseases. [199-200] 9. Katuka, ativisa, patha, daruharidra, musta, indrayava and cow’s urine. Boil together; this decoction is used to cure throat disorders. [201] 10. Rasakriya (the decoction of daruharidra boiled and solidified) and honey, is used to cure oral diseases and used in diseases caused by vitiation of blood and sinuses (nadi- vrana). [202] 11. In case of dryness of palate in non polydipsia (atrishna): ghee should be given to drink after meals (uttara-bhaktikam). Also, give snuff (inhalation therapy). Meat soups having sweet, unctuous and cold qualities should be given. [203] 12. Treatment of stomatitis: Venesection (rakta mokshana therapy), head -evacuation errhines and purgation therapy, gargling (kavala-graha therapy) with cow’s urine, oil, ghee, honey and milk, similarly another gargle with triphala, patha, mrdvika, tender leaves of jati and honey is helpful in stomatitis. Also mouth should be washed with astringent, bitter and cold decoctions. [204-205] Khadiradi Gutika and Khadiradi Taila: तुलांखदिरसारस्यद्विगुणामरिमेदसः| प्रक्षाल्यजर्जरीकृत्यचतुर्द्रोणेऽम्भसःपचेत्||२०६|| द्रोणशेषंकषायंतंपूत्वाभूयःपचेच्छनैः| ततस्तस्मिन्घनीभूतेचूर्णीकृत्याक्षभागिकम्||२०७|| चन्दनंपद्मकोशीरंमञ्जिष्ठाधातकीघनम्| प्रपौण्डरीकंयष्ट्याह्वत्वगेलापद्मकेशरम्||२०८|| लाक्षांरसाञ्जनंमांसीत्रिफलालोध्रवालकम्| रजन्यौफलिनीमेलांसमङ्गांकट्फलंवचाम्||२०९|| यवासागुरुपत्तङ्गगैरिकाञ्जनमावपेत्| लवङ्गनखकक्कोलजातिकोशान्पलोन्मितान्||२१०|| कर्पूरकुडवंचापिक्षिपेच्छीतेऽवतारिते| ततस्तुगुटिकाःकार्याःशुष्काश्चास्येनधारयेत्||२११|| तैलंचानेनकल्केनकषायेणचसाधयेत्| दन्तानांचलनभ्रंशशौशिर्यक्रिमिरोगनुत्||२१२|| मुखपाकास्यदौर्गन्ध्यजाड्यारोचकनाशनम्| स्रावोपलेपपैच्छिल्यवैस्वर्यगलशोषनुत्||२१३|| दन्तास्यगलरोगेषुसर्वेष्वेतत्परायणम्| खदिरादिगुटीकेयंतैलंचखदिरादिकम्||२१४|| इतिखदिरादिगुटिकातैलंच| tulāṁ khadirasārasya dviguṇāmarimēdasaḥ| prakṣālya jarjarīkr̥tya caturdrōṇē'mbhasaḥ pacēt||206|| drōṇaśēṣaṁ kaṣāyaṁ taṁ pūtvā bhūyaḥ pacēcchanaiḥ| tatastasmin ghanībhūtē cūrṇīkr̥tyākṣabhāgikam||207|| candanaṁ padmakōśīraṁ mañjiṣṭhā dhātakī ghanam| prapauṇḍarīkaṁ yaṣṭyāhvatvagēlāpadmakēśaram||208|| lākṣāṁ rasāñjanaṁ māṁsītriphalālōdhravālakam| rajanyau phalinīmēlāṁ samaṅgāṁ kaṭphalaṁ vacām||209|| yavāsāgurupattaṅgagairikāñjanamāvapēt| lavaṅganakhakakkōlajātikōśān palōnmitān||210|| karpūrakuḍavaṁ cāpi kṣipēcchītē'vatāritē| tatastu guṭikāḥkāryāḥśuṣkāścāsyēna dhārayēt||211|| tailaṁ cānēna kalkēna kaṣāyēṇa ca sādhayēt| dantānāṁ calanabhraṁśaśauśiryakrimirōganut||212|| mukhapākāsyadaurgandhyajāḍyārōcakanāśanam| srāvōpalēpapaicchilyavaisvaryagalaśōṣanut||213|| dantāsyagalarōgēṣu sarvēṣvētat parāyaṇam| khadirādiguṭīkēyaṁ tailaṁ ca khadirādikam||214|| iti khadirādiguṭikā tailaṁ ca|

tulAM khadirasArasya dviguNAmarimedasaH | 

prakShAlya jarjarIkRutya caturdroNe~ambhasaH pacet ||206|| droNasheShaM kaShAyaM taM pUtvA bhUyaH pacecchanaiH | tatastasmin ghanIbhUte cUrNIkRutyAkShabhAgikam ||207|| candanaM padmakoshIraM ma~jjiShThA dhAtakI ghanam | prapauNDarIkaM yaShTyAhvatvagelApadmakesharam ||208|| lAkShAM rasA~jjanaM mAMsItriphalAlodhravAlakam | rajanyau phalinImelAM sama~ggAM kaTphalaM vacAm ||209|| yavAsAgurupatta~ggagairikA~jjanamAvapet | lava~gganakhakakkolajAtikoshAn palonmitAn ||210|| karpUrakuDavaM cApi kShipecchIte~avatArite | tatastu guTikAHkAryAHshuShkAshcAsyena dhArayet ||211|| tailaM cAnena kalkena kaShAyeNa ca sAdhayet | dantAnAM calanabhraMshashaushiryakrimiroganut ||212|| mukhapAkAsyadaurgandhyajADyArocakanAshanam | srAvopalepapaicchilyavaisvaryagalashoShanut ||213|| dantAsyagalarogeShu sarveShvetat parAyaNam | khadirAdiguTIkeyaM tailaM ca khadirAdikam ||214|| iti khadirAdiguTikA tailaM ca |

Khadiradi gutika: One tula of heartwood of khadira, two tula- [heartwood of] arimeda. The above should be washed and made to a coarse powder and four drone of water should be added. Cook all the above and reduced to one drona. Then strain and heat again slowly till it is thickened to the consistency of paste. To this add one aksha of powder of each chandana, padmaka, usira, manjistha, dhataki, musta, prapaundarika, yasti, twak, ela, kamalakesara, laksa, rasanjana, mamsi, triphala, lodhra, balaka, two types of haridra (haridra and daruharidra), priyangu, ela, samanga, katphala, vaca, yavasa, aguru, pattanga, gairika, anjana. After it is brought down and cooled, and thereafter add one pala each of - lavanga, nakha, kakkola, jatikosa, one kudava of camphor. Then pills should be made and dried. These pills should be kept in the mouth and sucked. This alleviates looseness, displacement, caries and parasitic infestation of teeth, stomatitis, and foul smell from mouth, stiffness of mouth, anorexia, discharge, coating, sliminess, abnormal voice and dryness of throat. This is a good remedy in all diseases of teeth, mouth and throat. This pill is called as khadiradi gutika. [206-214]. 2. Khadiradi taila: Oil when fortified with above contents it is called as khadiradi tailam. Thus, ends the description of khadiradi gutika and khadiradi tailam and here ends the description of the treatment of oral-diseases. [206-214] Treatment of anorexia: अरुचौकवलग्राहाधूमाःसमुखधावनाः| मनोज्ञमन्नपानंचहर्षणाश्वासनानिच||२१५|| कुष्ठसौवर्चलाजाजीशर्करामरिचंबिडम्| धात्र्येलापद्मकोशीरपिप्पल्युत्पलचन्दनम्||२१६|| लोध्रंतेजोवतीपथ्यात्र्यूषणंसयवाग्रजम्| आर्द्रदाडिमनिर्यासश्चाजाजीशर्करायुतः||२१७|| सतैलमाक्षिकास्त्वेतेचत्वारःकवलग्रहाः| चतुरोऽरोचकान्हन्युर्वाताद्येकजसर्वजान्||२१८|| कारवीमरिचाजाजीद्राक्षावृक्षाम्लदाडिमम्| सौवर्चलंगुडःक्षौद्रंसर्वारोचकनाशनम्||२१९|| बस्तिंसमीरणे, पित्तेविरेकं, वमनंकफे| कुर्याद्धृद्यानुकूलानिहर्षणंचमनोघ्नजे||२२०|| इत्यरोचकचिकित्सा| arucau kavalagrāhā dhūmāḥ samukhadhāvanāḥ| manōjñamannapānaṁ ca harṣaṇāśvāsanāni ca||215|| kuṣṭhasauvarcalājājīśarkarāmaricaṁ biḍam| dhātryēlāpadmakōśīrapippalyutpalacandanam||216|| lōdhraṁ tējōvatī pathyā tryūṣaṇaṁ sayavāgrajam| ārdradāḍimaniryāsaścājājīśarkarāyutaḥ||217|| satailamākṣikāstvētē catvāraḥ kavalagrahāḥ| caturō'rōcakān hanyurvātādyēkajasarvajān||218|| kāravīmaricājājīdrākṣāvr̥kṣāmladāḍimam| sauvarcalaṁ guḍaḥ kṣaudraṁ sarvārōcakanāśanam||219|| bastiṁ samīraṇē, pittē virēkaṁ, vamanaṁ kaphē| kuryāddhr̥dyānukūlāni harṣaṇaṁ ca manōghnajē||220|| ityarōcakacikitsā|

arucau kavalagrAhA dhUmAH samukhadhAvanAH | manoj~jamannapAnaM ca harShaNAshvAsanAni ca ||215|| kuShThasauvarcalAjAjIsharkarAmaricaM biDam | dhAtryelApadmakoshIrapippalyutpalacandanam ||216|| lodhraM tejovatI pathyA tryUShaNaM sayavAgrajam | ArdradADimaniryAsashcAjAjIsharkarAyutaH ||217|| satailamAkShikAstvete catvAraH kavalagrahAH | caturo~arocakAn hanyurvAtAdyekajasarvajAn ||218|| kAravImaricAjAjIdrAkShAvRukShAmladADimam | sauvarcalaM guDaH kShaudraM sarvArocakanAshanam ||219|| bastiM samIraNe, pitte virekaM, vamanaM kaphe | kuryAddhRudyAnukUlAni harShaNaM ca manoghnaje ||220|| ityarocakacikitsA |

General Treatment of anorexia: Kaval graham (gargles/keeping thin paste of drugs in the mouth), dhuma (smoking therapy), mukha dhavana (mouth washes), delicious food and drink, gladdening and consolation is helpful in anorexia. [215] Gargle to be used for vatika type anorexia: Gargles prepared from kustha, sauvarcala, jiraka, sarkara, marica, bida, oil, and honey. [216] Gargle to be used for paittika anorexia: Gargle of amalaki/dhatri, ela, padmaka, usira, pippali, utpala, chandana, oil and honey. [216] Gargle to be used for kaphaja anorexia: Gargle of lodhra, tejovati, haritaki, trikatu, yavaksara, oil and honey. [217] Gargle to be used in tri-doshic/sannipatika anorexia: Fresh juice of pomengranate, jiraka, sarkara, oil and honey. [218] Karavyadi-yoga: karavi, marica, jiraka, draksa, vrksamla, dadima, sauvarcala, jaggery and honey. This [gargle] cures all types of anorexia. [219] General treatment of vatika anorexia: Medicated enema General treatment of paittika anorexia: Purgation therapy General Treatment of kaphaja anorexia: Medicated emesis therapy General treatment of psychic anorexia: Delicious favorite foods pleasing the heart, gladdening the patient should be given. Thus ends the description of the treatment of arochaka (anorexia). [220] Treatment of ear diseases: कर्णशूलेतुवातघ्नीहितापीनसवत्क्रिया| प्रदेहाःपूरणंनस्यंपाकस्रावेव्रणक्रियाः||२२१|| भोज्यानिचयथादोषंकुर्यात्स्नेहांश्चपूरणान्| हिङ्गुतुम्बरुशुण्ठीभिस्तैलंतुसार्षपंपचेत्||२२२|| एतद्धिपूरणंश्रेष्ठंकर्णशूलनिवारणम्| देवदारुवचाशुण्ठीशताह्वाकुष्ठसैन्धवैः||२२३|| तैलंसिद्धंबस्तमूत्रेकर्णशूलनिवारणम्| वराटकान्समाहृत्यदहेन्मृद्भाजनेनवे||२२४|| तद्भस्मश्च्योतयेत्तेनगन्धतैलंविपाचयेत्| रसाञ्जनस्यशुण्ठ्याश्चकल्काभ्यांकर्णशूलनुत्||२२५|| शुष्कमूलकशुण्ठानांक्षारोहिङ्गुमहौषधम्| शतपुष्पावचाकुष्ठंदारुशिग्रुरसाञ्जनम्||२२६|| सौवर्चलयवक्षारस्वर्जिकोद्भिदसैन्धवम्| भूर्जग्रन्थिर्बिडंमुस्तंमधुशुक्तंचतुर्गुणम्||२२७|| मातुलुङ्गरसश्चैवकदल्यारसएवच| सर्वैरेतैर्यथोद्दिष्टैःक्षारतैलंविपाचयेत्||२२८|| बाधिर्यंकर्णनादश्चपूयस्रावश्चदारुणः| क्रिमयःकर्णशूलंचपूरणादस्यनश्यति||२२९|| मुखकर्णाक्षिरोगेषुयथोक्तंपीनसेविधिम्| कुर्याद्भिषक्समीक्ष्यादौदोषकालबलाबलम्||२३०|| इतिकर्णरोगचिकित्सा| karṇaśūlē tu vātaghnī hitā pīnasavat kriyā| pradēhāḥ pūraṇaṁ nasyaṁ pākasrāvē vraṇakriyāḥ||221|| bhōjyāni ca yathādōṣaṁ kuryāt snēhāṁśca pūraṇān| hiṅgutumbaruśuṇṭhībhistailaṁ tu sārṣapaṁ pacēt||222|| ētaddhi pūraṇaṁ śrēṣṭhaṁ karṇaśūlanivāraṇam| dēvadāruvacāśuṇṭhīśatāhvākuṣṭhasaindhavaiḥ||223|| tailaṁ siddhaṁ bastamūtrē karṇaśūlanivāraṇam| varāṭakān samāhr̥tya dahēnmr̥dbhājanē navē||224|| tadbhasma ścyōtayēttēna [1] gandhatailaṁ vipācayēt| rasāñjanasya śuṇṭhyāśca kalkābhyāṁ karṇaśūlanut||225|| śuṣkamūlakaśuṇṭhānāṁ [2] kṣārō hiṅgu mahauṣadham| śatapuṣpā vacā kuṣṭhaṁ dāru śigru rasāñjanam||226|| sauvarcalayavakṣārasvarjikōdbhidasaindhavam| bhūrjagranthirbiḍaṁ mustaṁ madhuśuktaṁ caturguṇam||227|| mātuluṅgarasaścaiva kadalyā rasa ēva ca| sarvairētairyathōddiṣṭaiḥ [3] kṣāratailaṁ vipācayēt||228|| bādhiryaṁ karṇanādaśca pūyasrāvaśca dāruṇaḥ| krimayaḥ karṇaśūlaṁ ca pūraṇādasya naśyati||229|| mukhakarṇākṣirōgēṣu yathōktaṁ pīnasē vidhim| kuryādbhiṣak samīkṣyādau dōṣakālabalābalam||230|| iti karṇarōgacikitsā |

karNashUle tu vAtaghnI hitA pInasavat kriyA | pradehAH pUraNaM nasyaM pAkasrAve vraNakriyAH ||221|| bhojyAni ca yathAdoShaM kuryAt snehAMshca pUraNAn | hi~ggutumbarushuNThIbhistailaM tu sArShapaM pacet ||222|| etaddhi pUraNaM shreShThaM karNashUlanivAraNam | devadAruvacAshuNThIshatAhvAkuShThasaindhavaiH ||223|| tailaM siddhaM bastamUtre karNashUlanivAraNam | varATakAn samAhRutya dahenmRudbhAjane nave ||224|| tadbhasma shcyotayettena [1] gandhatailaM vipAcayet | rasA~jjanasya shuNThyAshca kalkAbhyAM karNashUlanut ||225|| shuShkamUlakashuNThAnAM [2] kShAro hi~ggu mahauShadham | shatapuShpA vacA kuShThaM dAru shigru rasA~jjanam ||226|| sauvarcalayavakShArasvarjikodbhidasaindhavam | bhUrjagranthirbiDaM mustaM madhushuktaM caturguNam ||227|| mAtulu~ggarasashcaiva kadalyA rasa eva ca | sarvairetairyathoddiShTaiH [3] kShAratailaM vipAcayet ||228|| bAdhiryaM karNanAdashca pUyasrAvashca dAruNaH | krimayaH karNashUlaM ca pUraNAdasya nashyati ||229|| mukhakarNAkShirogeShu yathoktaM pInase vidhim | kuryAdbhiShak samIkShyAdau doShakAlabalAbalam ||230|| iti karNarogacikitsA |

General treatment of ear diseases: Vāta alleviating treatment on the line listed under pinasa (vatika type of rhinitis) to be applied such as anointing, drops and snuffing as prescribed for pinasa. Treatment of suppuration and discharge: Surgical measures/treatment prescribed for vrana (ulcer) should be adopted. Diet and ear drop should be used depending upon the doṣha involvement. [221] Specific formulas for ear disease: 1. Hingvadi taila: Mustard oil, hingu, tumburu, sunthi cooked all together is useful for ear ache. [222] 2. Devadarvyadi-taila: Devadaru, vaca, sunthi, satahva, kustha, rock salt, oil and goat’s urine cooked together cures earache. [223] 3. Gandha-taila: Cowrie ash (one should collect cowries and burn them in new earthen pot.). This ash should be washed with water (alkaline water is obtained) and paste of- rasanjana, sunthi should be prepared. With all the above, perfumed oil should be fortified by cooking together. Ear drop with this medicated oil cures earache. [224-225] 4. Ksara-taila: Ash of dry raddish (dry radish cut into pieces and burnt to prepare ash), oil should be cooked by adding the paste of alkali preparation in total one fourth of quantity of oil of hingu, sunthi, satapuspa, vaca, kustha, devadaru, sigru, rasanjana, sauvarcalalavana, yavaksara, svarjika, audbhida, saindhavalavana, bhurja nodes, bidalavana, musta and 4 times the oil - madhusukta, juice of matulunga, kadali should be added. This ksara taila should be droped into the ear which cures deafness, tinnitus, severe purulent discharge and parasitic infestation of the ear and ear ache. [226-229] Treatment in general of mouth, ear and eyes diseases: In case of mouth, ear and eye disorders, the physician should, first evaluate strength and weakness of doṣha and the season, and thereafter decide the treatment/ therapies described for different types of pinasa (rhinitis). Thus ends the description of treatment of ear diseases. [230] Treatment of eye diseases: उत्पन्नमात्रेतरुणेनेत्ररोगेबिडालकः| कार्योदाहोपदेहाश्रुशोफरागानिवारणः||२३१|| नागरंसैन्धवंसर्पिर्मण्डेनचरसक्रिया| निघृष्टंवातिकेतद्वन्मधुसैन्धवगैरिकम्||२३२|| तथाशावरकंलोध्रंघृतभृष्टंबिडालकः| तद्वत्कार्योहरीतक्याघृतभृष्टोरुजापहः||२३३|| पैत्तिकेचन्दनानन्तामञ्जिष्ठाभिर्बिडालकः| कार्यःपद्मकयष्ट्याह्वमांसीकालीयकैस्तथा||२३४|| गैरिकंसैन्धवंमुस्तंरोचनाचरसक्रिया| कफेकार्यातथाक्षौद्रंप्रियङ्गुःसमनःशिला||२३५|| सन्निपातेतुसर्वैःस्याद्बहिरक्ष्णोःप्रलेपनम्| पक्ष्माण्यस्पृश्यताकार्यंसम्पक्वेत्वञ्जनंत्र्यहात्||२३६|| आश्च्योतनंमारुतजेक्वाथोबिल्वादिभिर्हितः| कोष्णःसैरण्डतर्कारीबृहतीमधुशिग्रुभिः||२३७|| पृथ्वीकादार्विमञ्जिष्ठालाक्षाद्विमधुकोत्पलैः| क्वाथःसशर्करःशीतःपूरणंरक्तपित्तनुत्||२३८|| नागरत्रिफलामुस्तनिम्बवासारसःकफे| कोष्णमाश्च्योतनंमिश्रैरोषधैःसान्निपातके||२३९|| बृहत्येरण्डमूलत्वक्शिग्रोःपुष्पंससैन्धवम्| अजाक्षीरेणपिष्टंस्याद्वर्तिर्वाताक्षिरोगनुत्||२४०|| सुमनःकोरकाःशङ्ख्स्त्रिफलामधुकंबला| पित्तरक्तापहावर्तिःपिष्टादिव्येनवारिणा||२४१|| सैन्धवंत्रिफलाव्योषंशङ्खनाभिःसमुद्रजः| फेनःशैलेयकंसर्जोवर्तिःश्लेष्माक्षिरोगनुत्||२४२|| अमृताह्वाबिसंबिल्वंपटोलंछागलंशकृत्| प्रपौण्डरीकंयष्ट्याह्वंदार्वीकालानुसारिवा||२४३|| एषामष्टपलान्भागान्सुधौताञ्जर्जरीकृतान्| तोयेपक्त्वारसेपूतेभूयःपक्वेरसेघने||२४४|| कर्षंचश्वेतमरिचाज्जातीपुष्पान्नवात्पलम्| चूर्णंक्षिप्त्वाकृतावर्तिःसर्वघ्नीदृक्प्रसादनी||२४५|| शङ्खप्रवालवैदूर्यलौहताम्रप्लवास्थिभिः| स्रोतोजश्वेतमरिचैर्वर्तिःसर्वाक्षिरोगनुत्||२४६|| शाणार्धंमरिचाद्द्वौचपिप्पल्यर्णवफेनयोः| शाणार्धंसैन्धवाच्छाणानवसौवीरकाञ्जनात्||२४७|| पिष्टंसुसूक्ष्मंचित्रायांचूर्णाञ्जनमिदंशुभम्| कण्डूकाचकफार्तानांमलानांचविशोधनम्||२४८|| बस्तमूत्रेत्र्यहंस्थाप्यमेलाचूर्णंसुभावितम्| चूर्णाञ्जनंहितैमिर्यक्रिमिपिल्लमलापहम्||२४९|| सौवीरमञ्जनंतुत्थंताप्योधातुर्मनःशिला| चक्षुष्यामधुकंलोहामणयःपौष्पमञ्जनम्||२५०|| सैन्धवंशौकरीदंष्ट्राकतकंचाञ्जनंशुभम्| तिमिरादिषुचुर्णंवावर्तिर्वेयमनुत्तमा||२५१|| कतकस्यफलंशङ्खःसैन्धवंत्र्यूषणंसिता| फेनोरसाञ्जनंक्षौद्रंविडङ्गानिमनःशिला||२५२|| कुक्कुटाण्डकपालानिवर्तिरेषाव्यपोहति| तिमिरंपटलंकाचंमलंचाशुसुखावती||२५३|| इतिसुखावतीवर्तिः| त्रिफलाकुक्कुटाण्डत्वक्कासीसमयसोरजः| नीलोत्पलंविडङ्गानिफेनंचसरितांपतेः||२५४|| आजेनपयसापिष्ट्वाभावयेत्ताम्रभाजने| सप्तरात्रंस्थितंभूयःपिष्ट्वाक्षीरेणवर्तयेत्||२५५|| एषादृष्टिप्रदावर्तिरन्धस्याभिन्नचक्षुषः||२५६|| इतिदृष्टिप्रदावर्तिः| वदनेकृष्णसर्पस्यनिहितंमासमञ्जनम्||२५६|| ततस्तस्मात्समृद्धृत्यसुशुष्कंचूर्णयेद्बुधः| सुमनःकोरकैःशुष्कैरर्धांशैःसैन्धवेनच||२५७|| एतन्नेत्राञ्जनंकार्यंतिमिरघ्नमनुत्तमम्| पिप्पल्यःकिंशुकरसोवसासर्पस्यसैन्धवम्||२५८|| जीर्णंघृतंचसर्वाक्षिरोगघ्नीस्याद्रसक्रिया| कृष्णसर्पवसाक्षौद्रंरसोधात्र्यारसक्रियाः||२५९|| शस्तासर्वाक्षिरोगेषुकाचार्बुदमलेषुच| धात्रीरसाञ्जनक्षौद्रसर्पिर्भिस्तुरसक्रिया||२६०|| पित्तरक्ताक्षिरोगघ्नीतैमिर्यपटलापहा| धात्रीसैन्धवपिप्पल्यःस्युरल्पमरिचाःसमाः||२६१|| क्षौद्रयुक्तानिहन्त्यान्ध्यंपटलंचरसक्रिया|२६२| इतिनेत्ररोगचिकित्सा| utpannamātrē taruṇē nētrarōgē biḍālakaḥ| kāryō dāhōpadēhāśruśōpharāganivāraṇaḥ||231|| nāgaraṁ saindhavaṁ sarpirmaṇḍēna ca rasakriyā| nighr̥ṣṭaṁ vātikē tadvanmadhusaindhavagairikam||232|| tathā śāvarakaṁ lōdhraṁ ghr̥tabhr̥ṣṭaṁ biḍālakaḥ| tadvat kāryō harītakyā ghr̥tabhr̥ṣṭō rujāpahaḥ||233|| paittikē candanānantāmañjiṣṭhābhirbiḍālakaḥ| kāryaḥ padmakayaṣṭyāhvamāṁsīkālīyakaistathā||234|| gairikaṁ saindhavaṁ mustaṁ rōcanā ca [1] rasakriyā| kaphē kāryā tathā kṣaudraṁ priyaṅguḥ samanaḥśilā||235|| sannipātē tu sarvaiḥ syādbahirakṣṇōḥ pralēpanam| pakṣmāṇyaspr̥śyatā [2] kāryaṁ sampakvē tvañjanaṁ tryahāt||236|| āścyōtanaṁ mārutajē kvāthō bilvādibhirhitaḥ| kōṣṇaḥ sairaṇḍatarkārībr̥hatīmadhuśigrubhiḥ||237|| pr̥thvīkādārvimañjiṣṭhālākṣādvimadhukōtpalaiḥ| kvāthaḥ saśarkaraḥ śītaḥ pūraṇaṁ raktapittanut||238|| nāgaratriphalāmustanimbavāsārasaḥ [3] kaphē| kōṣṇamāścyōtanaṁ miśrairōṣadhaiḥ sānnipātakē||239|| br̥hatyēraṇḍamūlatvak śigrōḥ puṣpaṁ sasaindhavam| ajākṣīrēṇa piṣṭaṁ syādvartirvātākṣirōganut||240|| sumanaḥkōrakāḥ śaṅkhastriphalā madhukaṁ balā| pittaraktāpahā vartiḥ piṣṭā divyēna vāriṇā||241|| saindhavaṁ triphalā vyōṣaṁ śaṅkhanābhiḥ samudrajaḥ| phēnaḥ śailēyakaṁ sarjō vartiḥ ślēṣmākṣirōganut||242|| amr̥tāhvā bisaṁ bilvaṁ paṭōlaṁ chāgalaṁ śakr̥t| prapauṇḍarīkaṁ yaṣṭyāhvaṁ dārvī kālānusārivā||243|| ēṣāmaṣṭapalān bhāgān sudhautāñjarjarīkr̥tān| tōyē paktvā rasē pūtē bhūyaḥ pakvē rasē ghanē||244|| karṣaṁ ca śvētamaricājjātīpuṣpānnavāt palam| cūrṇaṁ kṣiptvā kr̥tā vartiḥ sarvaghnī [4] dr̥kprasādanī||245|| śaṅkhapravālavaidūryalauhatāmraplavāsthibhiḥ| srōtōjaśvētamaricairvartiḥ sarvākṣirōganut||246|| śāṇārdhaṁ maricāddvau ca pippalyarṇavaphēnayōḥ| śāṇārdhaṁ saindhavācchāṇā nava sauvīrakāñjanāt||247|| piṣṭaṁ susūkṣmaṁ citrāyāṁ cūrṇāñjanamidaṁ śubham| kaṇḍūkācakaphārtānāṁ malānāṁ ca viśōdhanam||248|| bastamūtrē tryahaṁ sthāpyamēlācūrṇaṁ subhāvitam| cūrṇāñjanaṁ hi taimiryakrimipillamalāpaham||249|| sauvīramañjanaṁ tutthaṁ tāpyō dhāturmanaḥśilā| cakṣuṣyā madhukaṁ lōhā maṇayaḥ pauṣpamañjanam||250|| saindhavaṁ śaukarī daṁṣṭrā katakaṁ cāñjanaṁ śubham| timirādiṣu curṇaṁ vā vartirvēyamanuttamā||251|| katakasya phalaṁ śaṅkhaḥ saindhavaṁ tryūṣaṇaṁ sitā| phēnō rasāñjanaṁ kṣaudraṁ viḍaṅgāni manaḥśilā||252|| kukkuṭāṇḍakapālāni vartirēṣā vyapōhati| timiraṁ paṭalaṁ kācaṁ malaṁ cāśu sukhāvatī||253|| iti sukhāvatī vartiḥ | triphalākukkuṭāṇḍatvakkāsīsamayasō rajaḥ| nīlōtpalaṁ viḍaṅgāni phēnaṁ ca saritāṁ patēḥ||254|| ājēna payasā piṣṭvā bhāvayēttāmrabhājanē| saptarātraṁ sthitaṁ bhūyaḥ piṣṭvā kṣīrēṇa vartayēt||255|| ēṣā dr̥ṣṭipradā vartirandhasyābhinnacakṣuṣaḥ||256|| iti dr̥ṣṭipradā vartiḥ | vadanē kr̥ṣṇasarpasya nihitaṁ māsamañjanam||256|| tatastasmāt samr̥ddhr̥tya suśuṣkaṁ cūrṇayēdbudhaḥ| sumanaḥkōrakaiḥ śuṣkairardhāṁśaiḥ saindhavēna ca||257|| ētannētrāñjanaṁ kāryaṁ timiraghnamanuttamam| pippalyaḥ kiṁśukarasō vasā sarpasya saindhavam||258|| jīrṇaṁ ghr̥taṁ ca sarvākṣirōgaghnī syādrasakriyā| kr̥ṣṇasarpavasā kṣaudraṁ rasō dhātryā rasakriyāḥ||259|| śastā sarvākṣirōgēṣu kācārbudamalēṣu ca| dhātrīrasāñjanakṣaudrasarpirbhistu rasakriyā||260|| pittaraktākṣirōgaghnī taimiryapaṭalāpahā| dhātrīsaindhavapippalyaḥ syuralpamaricāḥ samāḥ||261|| kṣaudrayuktā nihantyāndhyaṁ paṭalaṁ ca rasakriyā|262| iti nētrarōgacikitsā |

utpannamAtre taruNe netraroge biDAlakaH | kAryo dAhopadehAshrushopharAgAnivAraNaH ||231|| nAgaraM saindhavaM sarpirmaNDena ca rasakriyA | nighRuShTaM vAtike tadvanmadhusaindhavagairikam ||232|| tathA shAvarakaM lodhraM ghRutabhRuShTaM biDAlakaH | tadvat kAryo harItakyA ghRutabhRuShTo rujApahaH ||233|| paittike candanAnantAma~jjiShThAbhirbiDAlakaH | kAryaH padmakayaShTyAhvamAMsIkAlIyakaistathA ||234|| gairikaM saindhavaM mustaM rocanA ca [1] rasakriyA | kaphe kAryA tathA kShaudraM priya~gguH samanaHshilA ||235|| sannipAte tu sarvaiH syAdbahirakShNoH pralepanam | pakShmANyaspRushyatA [2] kAryaM sampakve tva~jjanaM tryahAt ||236|| AshcyotanaM mArutaje kvAtho bilvAdibhirhitaH | koShNaH sairaNDatarkArIbRuhatImadhushigrubhiH ||237|| pRuthvIkAdArvima~jjiShThAlAkShAdvimadhukotpalaiH | kvAthaH sasharkaraH shItaH pUraNaM raktapittanut ||238|| nAgaratriphalAmustanimbavAsArasaH [3] kaphe | koShNamAshcyotanaM mishrairoShadhaiH sAnnipAtake ||239|| bRuhatyeraNDamUlatvak shigroH puShpaM sasaindhavam | ajAkShIreNa piShTaM syAdvartirvAtAkShiroganut ||240|| sumanaHkorakAH sha~gkhstriphalA madhukaM balA | pittaraktApahA vartiH piShTA divyena vAriNA ||241|| saindhavaM triphalA vyoShaM sha~gkhanAbhiH samudrajaH | phenaH shaileyakaM sarjo vartiH shleShmAkShiroganut ||242|| amRutAhvA bisaM bilvaM paTolaM chAgalaM shakRut | prapauNDarIkaM yaShTyAhvaM dArvI kAlAnusArivA ||243|| eShAmaShTapalAn bhAgAn sudhautA~jjarjarIkRutAn | toye paktvA rase pUte bhUyaH pakve rase ghane ||244|| karShaM ca shvetamaricAjjAtIpuShpAnnavAt palam | cUrNaM kShiptvA kRutA vartiH sarvaghnI [4] dRukprasAdanI ||245|| sha~gkhapravAlavaidUryalauhatAmraplavAsthibhiH | srotojashvetamaricairvartiH sarvAkShiroganut ||246|| shANArdhaM maricAddvau ca pippalyarNavaphenayoH | shANArdhaM saindhavAcchANA nava sauvIrakA~jjanAt ||247|| piShTaM susUkShmaM citrAyAM cUrNA~jjanamidaM shubham | kaNDUkAcakaphArtAnAM malAnAM ca vishodhanam ||248|| bastamUtre tryahaM sthApyamelAcUrNaMsubhAvitam | cUrNA~jjanaM hi taimiryakrimipillamalApaham ||249|| sauvIrama~jjanaM tutthaM tApyo dhAturmanaHshilA | cakShuShyA madhukaM lohA maNayaH pauShpama~jjanam ||250|| saindhavaM shaukarI daMShTrA katakaM cA~jjanaM shubham | timirAdiShu curNaM vA vartirveyamanuttamA ||251|| katakasya phalaM sha~gkhaH saindhavaM tryUShaNaM sitA | pheno rasA~jjanaM kShaudraM viDa~ggAni manaHshilA ||252|| kukkuTANDakapAlAni vartireShA vyapohati | timiraM paTalaM kAcaM malaM cAshu sukhAvatI ||253|| iti sukhAvatI vartiH | triphalAkukkuTANDatvakkAsIsamayaso rajaH | nIlotpalaM viDa~ggAni phenaM ca saritAM pateH ||254|| Ajena payasA piShTvA bhAvayettAmrabhAjane | saptarAtraM sthitaM bhUyaH piShTvA kShIreNa vartayet ||255|| eShA dRuShTipradA vartirandhasyAbhinnacakShuShaH ||256|| iti dRuShTipradA vartiH | vadane kRuShNasarpasya nihitaM mAsama~jjanam ||256|| tatastasmAt samRuddhRutya sushuShkaM cUrNayedbudhaH | sumanaHkorakaiH shuShkairardhAMshaiH saindhavena ca ||257|| etannetrA~jjanaM kAryaM timiraghnamanuttamam | pippalyaH kiMshukaraso vasA sarpasya saindhavam ||258|| jIrNaM ghRutaM ca sarvAkShirogaghnI syAdrasakriyA | kRuShNasarpavasA kShaudraM raso dhAtryA rasakriyAH ||259|| shastA sarvAkShirogeShu kAcArbudamaleShu ca | dhAtrIrasA~jjanakShaudrasarpirbhistu rasakriyA ||260|| pittaraktAkShirogaghnI taimiryapaTalApahA | dhAtrIsaindhavapippalyaH syuralpamaricAH samAH ||261|| kShaudrayuktA nihantyAndhyaM paTalaM ca rasakriyA |262| iti netrarogacikitsA |

Line of treatment: Treatment of critical stage of freshly occurred eye diseases: Bidalaka (it is the application of drugs in paste form on the closed eye lids excluding eye-lashes) relieves burning sensation, mucous discharge, lachrymation, swelling and congestion or redness. [231] Treatment of vatika eye disease: [Stage I, pastes for application on the eyelid] 1. Sunthi, saindhava, ghee-scum triturated and made a paste also known as “Rasakriya”) is applied as bidalaka 2. Honey, saindhava and gairika (red ochre) rubbed together and applied. [232] The following paste when applied relieves pain: 1. Savara lodhra fried in ghee 2. Haritaki fried in the ghee. [233] Treatment of paittika type eye diseases: 1. Paste of chandana, ananta, and manjistha is applied. 2. Paste of- padmaka, madhuyasti, mamsi, kaliyaka [234] Treatment of kaphaja eye diseases: 1. Paste of gairika, saindhava, musta, rocana: 2. Paste of priyangu, manah-sila (realgar) and honey. [235] Treatment of sannipataj eye diseases: Paste made with all the above mentioned drugs. While application of the paste over the eye lids, the eye-lashes should not be touched. When the disease is matured, collyrium [anjana] may be applied [into the eye] every third day without touching the eyelids. [236] Ascyotana - eye douche formulas for eye diseases: Eye drop for vatika eye disease: Decoction is prepared of bilvadi (brihat pancamula- bilva, syonaka, gambhari, patala and ganikarnika), eranda, tarkari, brhati, madhusigru and water. Use it as eye drops while warm. [237] Eye drop for paittika eye disease: Decoction is prepared with prthivka, daruharidra, manjistha, laksha, two types of madhuka, utpala and water and sugar. Use it as eye drop at cold temperature. Eye drop pacifies rakta and pitta disease

[238]

Eye drop for kaphaja disease: Decoction of sunthi, triphala, musta, nimba, vasa and water used when warm as eye drop is beneficial. Eye drops in sannipatika eye disease: All the above formulations mixed together should be used. [239] Varti (medicated bougies) in vatika eye diseases: Brahatyadi-varti: Pound the herbs such as Brhati, root- bark of eranda, sigru flowers, saindhava lavana and goat’s milk and triturate in milk. Make into a bougie/varti, use of this bougie as paste (after rubbing) alleviates vataja eye diseases. [240] Varti in paittika eye diseases: Sumanahkoradi-varti: Buds of jati pushpa (sumana), shankha/conch, triphala, madhuka, bala, rain water(distilled) are collected pound the above ingredients in the water. Make into a bougie. This varti/bougie alleviates eye diseases caused due to rakta and pitta. [241] Varti for kaphaja eye diseases: Saindhavadi-varti: Saindhava lavana, triphala, trikatu, sankhanabhi, samudraphena, saileyaka, sarja (rasa). Make the above into a bougie it cures kaphaja eye disease. [242] Varti for tridoshic/sannipatika eye diseases: Coarse powder each of guduchi, lotus stem, bilva, patola, goat’s feces, prapaundarika, madhuyasti, daruharidra, kalanusariva in the quantity of eight pala should be washed well and boil them in water and then strain. Reheat till it is thickened. To this add one karsha powder of sweta marica, one pala powder of fresh jati flowers. Make the above into a bougie. Application of this cures sannipatika eye disease and also promotes eye-sight. [243-245] Formulas for other eye diseases: 1. Shankhadi-varti: Varti (bougie) prepared of sankha bhasma, pravala bhasma, vaidurya pisti, lauha bhasma (iron), tamra bhasma (copper), bhasma of the bone of plava (pelican- bird called prasevaka-gala), srotonjana and sveta- maricha cures all types of eye diseases. [246] 2. churnanjana: Half sana of maricha (Black pepper fruit – piper nigrum), two sana of pippali – Piper longum, and samudra-phena, half sana of saindhava lavana, nine sana of sauviranjana should be triturated and made to a fine powder during chitra constellation. This powder collyrium is beneficial in itching, cataract and kaphaja eye diseases and eliminates impurities. [247-248] 3. Seeds of ela (Cardamom-Elattaria cardamom), goat’s urine (dip the cardamom in the urine for three days), let the cardamom be well-impregnated and dried and made to a powder. Application of this powder in the form of collyrium cures timira (a type of cataract), krimi (parasitic infestation), patala (another type of cataract) and discharge of mucoid matter from the eyes. [249] 4. Sauviranjana, tuttha, tapya-dhātu (maksika), manahshila, caksusya (variety of kulattha), madhuka (Licorice – Glycyrrhiza glabra), loha bhasma(iron), precious stones, puspanjana, saindhava, tusk of boar, kataka – strychnos potatorum may be used in the form of either powder or varti (bougie) as collyrium which is excellent remedies for timira (Cataract) and such other eye-diseases. [250-251] 5. Sukhavati varti: Kataka (Strychnos potatorum), shankha, saindhava (rock salt), sunthi, pippali – long pepper fruit, maricha – Black pepper fruit, sugar, samudraphena, rasanjana (aqueous extract of berberis aristata), honey, vidanga – Embelia ribes, manahshila and shell of hen’s egg. Varti prepared out of these ingredients alleviates blurred vision, patala (covering), kacha (type of cataract) and putrid discharge from the eyes quickly. Thus, ends the description of sukhavati- varti. [252-253] 6. Drushtiprada varti: Triturate together triphala, crust of hen’s eggs, kasisa, iron powder, nilotpala, vidanga, samudraphena in goat’s milk and impregnate with the same in a copper vessel for 1 week and rolled in the form of varti. This is called as dristi-prada varti. This varti revives vision even in the blind provided the pupils of his eyes have not undergone any physical change or been damaged. Thus ends the prescription of dristi-prada varti. [254-255] 7. Collyrium for timira: A wise physician should keep anjana inside the buccal cavity of a dead black snake cobra for one month.Then, after taking it out, one should dry it well and powder it. To this equal quantity of dried buds of jati puspa, half quantity- rock salt/ saindhva is to be added. Mix all the above together made to a fine powder. This is wonderful recipe for the cure of timira (cataract/ blurred vision). [256-257] 8. Pippalyadi rasakriya: Rasa-kriya (thin paste) prepared out of pippali – Piper longum, Juice of kimsuka – Butea monosperma, snake’s fat, saindhva/ rock salt and old ghee cures all types of eye-diseases. [258-259] 9. Krishna sarpa vasadi –rasakriya: Rasakriya (thin paste) prepared of the fat of black snake cobra, honey, the juice of amalaki – phyllanthus emblicais useful in curing all eye-diseases like kaca (Cataract), arbuda (tumor in the eyes) and discharge from the eyes. [259-260] 10. Other recipes for eye diseases: a. The Rasakriya (thin paste) prepared of dhatri, rasanjana (aqueous extract of berberis aristata), honey and ghee cures eye-diseases caused by the vitiation of pitta and rakta (blood), timira (Cataract /blurred vision) and patala (another type of Cataract).

b. One parts each of amalaka, pippali, white maricha, one part of rock salt and honey. This rasakriya alleviates blindness and patala. Thus, ends the description of the treatment of eye diseases. [260 ½ –262½] Treatment of baldness and greying of hair: खालित्येपलितेवल्यांहरिलोम्निचशोधितम्||२६२|| नस्यैस्तैलैःशिरोवक्रप्रलेपैश्चाप्युपाचरेत्| सिद्धंविदारीगन्धाद्यैर्जीवनीयैरथापिच||२६३|| नस्यंस्यादणुतैलंवाखालित्यपलितापहम्| क्षीरात्सहचराद्भृङ्गराजाच्चसौरसाद्रसात्||२६४|| प्रस्थैस्तुकुडवस्तैलाद्यष्ट्याह्वपलकल्कितः| सिद्धःशिलासमेभाण्डेमेषशृङ्गादिषुस्थितः||२६५|| नस्यंस्याद्भिषजासम्यग्योजितंपलितापहम्| भिषजाक्षीरपिष्टौवादुग्धिकाकरवीरकौ||२६६|| उत्पाट्यपलितेदेयौतावुभौपलितापहौ| मार्कवस्वरसात्क्षीराद्द्विप्रस्थंमधुकात्पलम्||२६७|| तैःपचेत्कुडवंतैलात्तन्नस्यंपलितापहम्| आदित्यवल्ल्यामूलानिकृष्णशैरेयकस्यच||२६८|| सुरसस्यचपत्राणिपत्रंकृष्णशणस्यच| मार्कवःकाकमाचीचमधुकंदेवदारुच||२६९|| पृथग्दशपलांशानिपिप्पल्यस्त्रिफलाऽञ्जनम्| प्रपौण्डरीकंमञ्जिष्ठालोध्रंकृष्णागुरूत्पलम्||२७०|| आम्रास्थिकर्दमःकृष्णोमृणालंरक्तचन्दनम्| नीलीभल्लातकास्थीनिकासीसंमदयन्तिका||२७१|| सोमराज्यसनःशस्त्रंकृष्णौपिण्डीतचित्रकौ| पुष्करार्जुनकाश्मर्याण्याम्रजम्बूफलानिच||२७२|| पृथक्पञ्चपलांशानितैःपिष्टैराढकंपचेत्| बैभीतकस्यतैलस्यधात्रीरसचतुर्गुणम्||२७३|| कुर्यादादित्यपाकंवायावच्छुष्कोभवेद्रसः| लोहपात्रेततःपूतंसंशुद्धमुपयोजयेत्||२७४|| पानेनस्यक्रियायांचशिरोभ्यङ्गेतथैवच| एतच्चक्षुष्यमायुष्यंशिरसःसर्वरोगनुत्||२७५|| महानीलमितिख्यातंपलितघ्नमनुत्तमम्| इतिमहानीलतैलम्| प्रपौण्डरीकमधुकपिप्पलीचन्दनोत्पलैः||२७६|| कार्षिकैस्तैलकुडवोद्विगुणामलकीरसः| सिद्धःसप्रतिमर्शःस्यात्सर्वमूर्धगदापहः||२७७|| (पलितघ्नोविशेषेणकृष्णात्रेयेणभाषितः|) क्षीरंप्रियालयष्ट्याह्वेजीवकाद्योगणस्तिलाः||२७८|| कृष्णावक्त्रेप्रलेपःस्याद्धरिलोमनिवारणः| तिलाःसामलकाश्चैवकिञ्जल्कोमधुकंमधु||२७९|| बृंहयेद्रञ्जयेचैतत्केशान्मूर्धप्रलेपनात्| पचेत्सैन्धवशुक्ताम्लैरयश्चूर्णंसतण्डुलम्||२८०|| तेनालिप्तंशिरःशुद्धमस्निग्धमुषितंनिशि| तत्प्रातस्त्रिफलाधौतंस्यात्कृष्णमृदुमूर्धजम्||२८१|| अयश्चूर्णोऽम्लपिष्टश्चरागःसत्रिफलोवरः| कुर्याच्छेषेषुरोगेषुक्रियांस्वांस्वाच्चिकित्सितात्| शेषेष्वादौचनिर्दिष्टासिद्धौचान्याप्रवक्ष्यते||२८२|| इतिखालित्यादिचिकित्सा| khālityē palitē valyāṁ harilōmni ca śōdhitam||262|| nasyaistailaiḥ śirōvakrapralēpaiścāpyupācarēt| siddhaṁ vidārīgandhādyairjīvanīyairathāpi ca||263|| nasyaṁ syādaṇutailaṁ vā khālityapalitāpaham| kṣīrāt sahacarādbhr̥ṅgarājācca saurasādrasāt||264|| prasthaistu kuḍavastailādyaṣṭyāhvapalakalkitaḥ| siddhaḥ śilāsamē bhāṇḍē mēṣaśr̥ṅgādiṣu sthitaḥ||265|| nasyaṁ syādbhiṣajā samyagyōjitaṁ palitāpaham| bhiṣajā kṣīrapiṣṭau vā dugdhikākaravīrakau||266|| utpāṭya palitē dēyau tāvubhau palitāpahau| mārkavasvarasāt kṣīrāddviprasthaṁ madhukāt palam||267|| taiḥ pacēt kuḍavaṁ tailāttannasyaṁ palitāpaham| ādityavallyā mūlāni kr̥ṣṇaśairēyakasya ca||268|| surasasya ca patrāṇi patraṁ [1] kr̥ṣṇaśaṇasya ca| mārkavaḥ kākamācī ca madhukaṁ dēvadāru ca||269|| pr̥thagdaśapalāṁśāni pippalyastriphalā'ñjanam| prapauṇḍarīkaṁ mañjiṣṭhā lōdhraṁ kr̥ṣṇāgurūtpalam||270|| āmrāsthi kardamaḥ kr̥ṣṇō mr̥ṇālaṁ raktacandanam| nīlī bhallātakāsthīni kāsīsaṁ madayantikā||271|| sōmarājyasanaḥ śastraṁ kr̥ṣṇau piṇḍītacitrakau| puṣkarārjunakāśmaryāṇyāmrajambūphalāni ca||272|| pr̥thak pañcapalāṁśāni taiḥ piṣṭairāḍhakaṁ pacēt| baibhītakasya tailasya dhātrīrasacaturguṇam||273|| kuryādādityapākaṁ vā yāvacchuṣkō bhavēdrasaḥ| lōhapātrē tataḥ pūtaṁ saṁśuddhamupayōjayēt||274|| pānē nasyakriyāyāṁ ca śirōbhyaṅgē tathaiva ca| ētaccakṣuṣyamāyuṣyaṁ śirasaḥ sarvarōganut||275|| mahānīlamiti khyātaṁ palitaghnamanuttamam| iti mahānīlatailam| prapauṇḍarīkamadhukapippalīcandanōtpalaiḥ||276|| kārṣikaistailakuḍavō dviguṇāmalakīrasaḥ| siddhaḥ sa pratimarśaḥ syāt sarvamūrdhagadāpahaḥ||277|| (palitaghnō [2] viśēṣēṇa kr̥ṣṇātrēyēṇa bhāṣitaḥ|) kṣīraṁ priyālayaṣṭyāhvē jīvakādyō gaṇastilāḥ||278|| kr̥ṣṇā vaktrē pralēpaḥ syāddharilōmanivāraṇaḥ| tilāḥsāmalakāścaiva kiñjalkō madhukaṁ madhu||279|| br̥ṁhayēdrañjayēcaitat kēśānmūrdhapralēpanāt| pacētsaindhavaśuktāmlairayaścūrṇaṁ sataṇḍulam||280|| tēnāliptaṁ śiraḥ śuddhamasnigdhamuṣitaṁ niśi| tat prātastriphalādhautaṁ syāt kr̥ṣṇamr̥dumūrdhajam||281|| ayaścūrṇō'mlapiṣṭaśca rāgaḥ satriphalō varaḥ| kuryācchēṣēṣu rōgēṣu kriyāṁ svāṁ svāccikitsitāt| śēṣēṣvādau ca nirdiṣṭā siddhau cānyā pravakṣyatē||282|| iti khālityādicikitsā|

khAlitye palite valyAM harilomni ca shodhitam ||262|| nasyaistailaiH shirovakrapralepaishcApyupAcaret | siddhaM vidArIgandhAdyairjIvanIyairathApi ca ||263|| nasyaM syAdaNutailaM vA khAlityapalitApaham | kShIrAt sahacarAdbhRu~ggarAjAcca saurasAdrasAt ||264|| prasthaistu kuDavastailAdyaShTyAhvapalakalkitaH | siddhaH shilAsame bhANDe meShashRu~ggAdiShu sthitaH ||265|| nasyaM syAdbhiShajA samyagyojitaM palitApaham | bhiShajA kShIrapiShTau vA dugdhikAkaravIrakau ||266|| utpATya palite deyau tAvubhau palitApahau | mArkavasvarasAt kShIrAddviprasthaM madhukAt palam ||267|| taiH pacet kuDavaM tailAttannasyaM palitApaham | AdityavallyA mUlAni kRuShNashaireyakasya ca ||268|| surasasya ca patrANi patraM [1] kRuShNashaNasya ca | mArkavaH kAkamAcI ca madhukaM devadAru ca ||269|| pRuthagdashapalAMshAni pippalyastriphalA~a~jjanam | prapauNDarIkaM ma~jjiShThA lodhraM kRuShNAgurUtpalam ||270|| AmrAsthi kardamaH kRuShNo mRuNAlaM raktacandanam | nIlI bhallAtakAsthIni kAsIsaM madayantikA ||271|| somarAjyasanaH shastraM kRuShNau piNDItacitrakau | puShkarArjunakAshmaryANyAmrajambUphalAni ca ||272|| pRuthak pa~jcapalAMshAni taiH piShTairADhakaM pacet | baibhItakasya tailasya dhAtrIrasacaturguNam ||273|| kuryAdAdityapAkaM vA yAvacchuShko bhavedrasaH | lohapAtre tataH pUtaM saMshuddhamupayojayet ||274|| pAne nasyakriyAyAM ca shirobhya~gge tathaiva ca | etaccakShuShyamAyuShyaM shirasaH sarvaroganut ||275|| mahAnIlamiti khyAtaM palitaghnamanuttamam | iti mahAnIlatailam | prapauNDarIkamadhukapippalIcandanotpalaiH ||276|| kArShikaistailakuDavo dviguNAmalakIrasaH | siddhaH sa pratimarshaH syAt sarvamUrdhagadApahaH ||277|| (palitaghno [2] visheSheNa kRuShNAtreyeNa bhAShitaH|) kShIraM priyAlayaShTyAhve jIvakAdyo gaNastilAH ||278|| kRuShNA vaktre pralepaH syAddharilomanivAraNaH | tilAH sAmalakAshcaiva ki~jjalko madhukaM madhu ||279|| bRuMhayedra~jjayecaitat keshAnmUrdhapralepanAt | pacetsaindhavashuktAmlairayashcUrNaM sataNDulam ||280|| tenAliptaM shiraH shuddhamasnigdhamuShitaM nishi | tat prAtastriphalAdhautaM syAt kRuShNamRudumUrdhajam ||281|| ayashcUrNo~amlapiShTashca rAgaH satriphalo varaH | kuryAccheSheShu rogeShu kriyAM svAM svAccikitsitAt | sheSheShvAdau ca nirdiShTA siddhau cAnyA pravakShyate ||282|| iti khAlityAdicikitsA |

General treatment of balding and greying of hair: In case of khalitya (alopecia), palitya (graying of the hair), vali (appearance of wrinkles over the face) and hari loman (tawny hair), the patient should be managed after elimination/ detoxification therapies in the beginning and thereafter be given nasya (inhalation therapy) with medicated oil, and application of paste of drugs over the head and face. [262 1/2- 263½] 1. Oils which should be used in treatment of balding and greying of hair: The following snuffs should be used to alleviate baldness and greying of hair: Drugs of vidarigandhadi group (vidarigandha—Pueraria tuberosa, shalaparni, prishnaparni, brhati – Solanum indicum, kantakari – Garcinia Morella and goksura – Tribulus terrestris) or jeevaneeya group (vitalizer drugs) (jivaka – Malaxiz acuminata, rsabhaka – Manilkara hexandra, meda – Polygonatum cirrhifolium, maha-meda – Polygonatum verticillatum, kakoli – Fritillaria roylei, mudga – Green gram- parni and masa-parni – Teramnus labialis.) and Oil. Medicated oil is prepared by cooking all above ingredients. Inhalation therapy with these medicated oils or with anu taila cures alopecia and graying of the hair. [263-264] 2. One prastha of milk and juice of sahacara – Barleria prionitis, bhrngaraja – Eclipta alba, surasa –Cinnamonum zeylanica, one kudava of oil, one pala paste of yastimadhu – glychrizza glabra is cooked and kept inside a pot of stone or the horn of sheep. Appropriately administered by the physician for inhalation therapy, this medicated oil cures graying of hair. [264-265] 3. Dugdhika – Euphorbia hirta, karavira – Nerium indicumare made to a paste by triturating them with milk. After pulling out gray hairs, the physician should apply this paste over the head of the patient for curing graying of hair. [265-266] 4. One kudava of oil is cooked by adding one prastha of the juice of markava (Bhrngaraja – Eclipta alba) and milk. To this one pala of yastimadhu – Glychriza glabra is added. Administration of this medicated oil for inhalation therapy cures graying of hair. [266 ½- 268½] 5. Mahaneela taila: Paste of ten pala of each of the root of adityavalli and black variety of saireyaka – Barleria prionitis, leaves of surasa – Cinnamonum zeylanica, Black variety of sana – Brassica alba, markava (Bhrnga-Raja – Eclipta alba), kakamaci – Solanum nigrum, yastimadhu –Glycrrhiza glabra and devadaru – Cedrus deodara. Five pala each of pippali – Piper longum, triphala (haritaki–Terminalia chebula, vibhitaka –Terminalia bellerica, amalaki–Phyllanthus emblica), anjana, prapaundarika, manjistha – Rubia cordifolia, lodhra – Symplocos racemose, black variety of aguru – Aquallaria agallocha, Utpala – Nymphaea alba, amrasthi (seeds of Mango –Mangifera indica), krishna – kardama (black mud), mrinala – Lotus stalk, rakta chandana- Pterocapus santalinus Linn. F, Nili – Indigofera tinctoria, seeds of bhallataka – Semecarpus anacardium Linn., Kasisa, Madayantika – Lawsonia alba, somaraji – Psorelea corylifolia, asana – Terminalia crenulata, Sastra Bhasma of Tiksna (type of iron), black variety of pinditaka (Madana –Randia dumetorum), chitraka – Leadword – Plumbago zeylanica, puskara – Inula racemose, arjuna – Terminalia arjuna, kasmarya – Gmelina arborea, fruits of amra – mango – Mangifera indica as well as jambu – Syzmium cumini. Pound all the above ingredients and cooked with one adhaka of oil extracted from the seeds of vibhitaka – Terminalia bellerica, four adhaka of juice of amalaki – Phyllanthus emblica in an iron pot by solar heat till the water is evaporated. This medicated oil is given to a patient whose body is cleansed/ detoxified [by purgation therapy etc], in the form of inhalation therapy or massage over the head. It promotes eye-sight and longevity and cures all the diseases of the head. This is called mahanila taila which is a wonder cure of gray hair. Thus, ends the description of mahanila taila. [268 ½ –276½] 6. Prapaundarikadya taila: Paste of one karsa each of prapaundarika, yastimadhu – Glycrrhiza glabra, Pippali – Long pepper fruit – Piper longum, chandana – sandalwood – Santalum album and utpala – Nymphaea alba. One kudava of oil and two kudava of the juice of amalaki – Phyllanthus emblica Cook all the above ingredients and obtain medicated oil.

Administration of pratimarsa nasya (errhine therapy wherein dose of drops to be put in nostrils is minimum (two drops per nostrils)) quantity and it cures all the diseases of the head. According to Krsnatreya, this therapy is especially useful for curing graying of hair. [276 ½- 278½]

7. Ointment for tawny hair: Application of the paste prepared of milk, priyala (Buchanania lanzan), yastimadhu – Glycrrchiza glabra, jivaka – Malaxis acuminata, rishabhaka – Manilkara hexandra, meda – Polygonatum cirrhifolium, maha-meda – Polygonatum cirrhifolium, kakoli – Fritillaria roylei, ksira-kakoli, mudgaparni – Phaseolus trilobus, masaparni – Teramnus labialis, jivanti –Leptadenia reticulata, madhuka, honey, tila – Sesame Sesamum indicum) and pippali – Piper longum cures tawny hair. [278 ½- 279½] 8. Recipe for restoration of hair: Application of the paste of tila – Sesame (Sesamum indicum), amalaki – Phyllanthus emblica, kinjalka, madhuka– Licorice – Glycyrrhiza glabra and honey over the head restores the color of hair, and promotes hair growth. [279 ½- 280½] 9. Recipes for dyeing and softening hair: Lauha powder (bhasma), saindhava lavana, suktamla (sour vinegar) and rice [all taken in equal quantities] to be cooked together. In the morning, the head is washed with the decoction of haritaki – Terminalia chebula, bibhitaka – Terminalia bellerica and amalaki – Phyllanthus emblica to make it free from oily matter and thereafter this paste is applied over the scalp, and kept overnight with this therapy, the hair becomes black and soft. Lauha powder (bhasma) triturated with sour articles and trifala is an excellent hair-dye. [280 ½- 2821/3]

Treatment of remaining Shiroroga – head diseases: Treatment of the remaining disorders which appear as complications of the diseases described above, the treatment suitable for these has been said partially in the beginning and will be explained further in siddhi-sthana. Thus, ends the treatment of alopecia etc. [282 2/3]

Treatment of hoarseness of voice: सर्पींष्युपरिभक्तानिस्वरभेदेऽनिलात्मके| तैलैश्चतुष्प्रयोगैश्चबलारास्नामृताह्वयैः||२८३|| बर्हितित्तिरिदक्षाणांपञ्चमूलशृतान्रसान्| मायूरंक्षीरसर्पिर्वापिबेत्त्र्यूषणमेववा||२८४|| पैत्तिकेतुविरेकःस्यात्पयश्चमधुरैःशृतम्| सर्पिर्गुडाघृतंतिक्तंजीवनीयंवृषस्यवा||२८५|| कफजेस्वरभेदेतुतीक्ष्णंमूर्धविरेचनम्| विरेकोवमनंधूमोयवान्नकटुसेवनम्||२८६|| चव्यभार्ग्यभयाव्योषक्षारमाक्षिकचित्रकान्| लिह्याद्वापिप्पलीपथ्येतीक्ष्णंमद्यंपिबेच्चसः||२८७|| रक्तजेस्वरभेदेतुसघृताजाङ्गलारसाः| द्राक्षाविदारीक्षुरसाःसघृतक्षौद्रशर्कराः||२८८|| यच्चोक्तंक्षयकासघ्नंतच्चसर्वंचिकित्सितम्| पित्तजस्वरभेदघ्नंसिरावेधश्चरक्तजे||२८९|| सन्निपातेहिताःसर्वाःक्रियानतुसिराव्यधः| इत्युक्तंस्वरभेदस्यसमासेनचिकित्सितम्||२९०|| इतिस्वरभेदचिकित्सा| sarpīṁṣyuparibhaktāni svarabhēdē'nilātmakē| tailaiścatuṣprayōgaiśca balārāsnāmr̥tāhvayaiḥ||283|| barhitittiridakṣāṇāṁ pañcamūlaśr̥tān rasān| māyūraṁ kṣīrasarpirvā pibēttryūṣaṇamēva vā||284|| paittikē tu virēkaḥ syāt payaśca madhuraiḥ śr̥tam| sarpirguḍā ghr̥taṁ tiktaṁ jīvanīyaṁ vr̥ṣasya vā||285|| kaphajē svarabhēdē tu tīkṣṇaṁ mūrdhavirēcanam| virēkō vamanaṁ dhūmō yavānnakaṭusēvanam||286|| cavyabhārgyabhayāvyōṣakṣāramākṣikacitrakān| lihyādvā pippalīpathyē tīkṣṇaṁ madyaṁ pibēcca saḥ||287|| raktajē svarabhēdē tu saghr̥tā [jāṅgalā rasāḥ| drākṣāvidārīkṣurasāḥ saghr̥takṣaudraśarkarāḥ||288|| yaccōktaṁ kṣayakāsaghnaṁ tacca sarvaṁ cikitsitam| pittajasvarabhēdaghnaṁ sirāvēdhaśca raktajē||289|| sannipātē hitāḥ sarvāḥ kriyā na tu sirāvyadhaḥ| ityuktaṁ svarabhēdasya samāsēna cikitsitam||290|| iti svarabhēdacikitsā|

sarpIMShyuparibhaktAni svarabhede~anilAtmake | tailaishcatuShprayogaishca balArAsnAmRutAhvayaiH ||283|| barhitittiridakShANAM pa~jcamUlashRutAn rasAn | mAyUraM kShIrasarpirvA pibettryUShaNameva vA ||284|| paittike tu virekaH syAt payashca madhuraiH shRutam | sarpirguDA ghRutaM tiktaM jIvanIyaM vRuShasya vA ||285|| kaphaje svarabhede tu tIkShNaM mUrdhavirecanam | vireko vamanaM dhUmo yavAnnakaTusevanam ||286|| cavyabhArgyabhayAvyoShakShAramAkShikacitrakAn | lihyAdvA pippalIpathye tIkShNaM madyaM pibecca saH ||287|| raktaje svarabhede tu saghRutA jA~ggalA rasAH | drAkShAvidArIkShurasAH saghRutakShaudrasharkarAH ||288|| yaccoktaM kShayakAsaghnaM tacca sarvaM cikitsitam | pittajasvarabhedaghnaM sirAvedhashca raktaje ||289|| sannipAte hitAH sarvAH kriyA na tu sirAvyadhaH | ityuktaM svarabhedasya samAsena cikitsitam ||290|| iti svarabhedacikitsA |

Treatment of vatika svara-bheda: In vatika svarabheda (hoarseness of voice) medicated ghee is given after the intake of food. Medicated oil prepared by cooking with bala – Country mallow root – Sida cordifolia, etc), rasna (Vanda roxburghi / Pluchea lanceolata) etc), and guduchi – Tinospora cordifolia etc., is administered in four ways viz, pana or drinking, abhyanga – massage, gargle and basti – enema Meat-soup of pea-cock, partridge and cock prepared by cooking with pancamula (Bilva- Aegle marmelos, syonaka – Orchis mascula, gambhari – Gmelina arborea, patala – Ficus microcarpa and ganikarika or medicated milk and medicated ghee prepared by boiling with the meat of peacock or tryusana (sunthi – ginger, pippali – Long pepper fruit and maricha – Black pepper) are beneficial in this condition. [283- 284]

Treatment of paittika svara-bheda: For paittika type of svara-bheda (hoarseness of voice), purgation therapy is useful. In addition, following recipes are useful in this condition: 1. Milk boiled with drugs having sweet taste 2. Sarpirguda 3. Tiktaka ghrita 4. Jivaniya ghrita 5. Vrusha ghrita [285] Treatment of kaphaja svarabheda: In kaphaja svarabheda (hoarseness of voice), the patient is given strong errhine, purgation, emetic and smoking therapies. He should eat barley diet added with pungent ingredients. He should take the linctus prepared of chavya – Piper retrofractum, bharngi – Clerodendrum serratum, abhaya, sunthi – ginger, pippali – Long pepper, maricha – Black pepper fruit – piper nigrum, yavaksara, and chitraka – Plumbago zeylanica, or the linctus prepared of pippali – Long pepper fruit – Piper longum and pathya (haritaki – Terminalia chebula). He should drink strong wine. [286- 287] Treatment of raktaja svara bheda: If svara bheda (hoarseness of voice) is caused due to vitiated blood (raktaja), then the patient is given the meat soup of wild animals added with ghee. The juice of draksha – raisin – Vitis vinifera, vidari (Ipomoea paniculata / Pueraria tuberosa) and sugar- cane added with ghee and sugar. The entire therapeutic measures prescribed for the treatment of ksayaja kasa and of paittika svara bheda alongwith venesection therapy are beneficial in raktaja type svarabheda (hoarseness of voice). [288-289] Treatment of sannipatika svara-bheda: Svara bheda (hoarseness of voice) caused by sannipata (simultaneous vitiation of all the three doṣha) is treated with all the therapeutic measures prescribed above for the vatika, paittika and kaphaja, except vensection therapy (siravyadha). Thus, in brief, the treatment of svara-bheda is described. This ends the description of the treatment of svara-bheda (hoarseness of voice). [290]

भवन्तिचात्र- वातपित्तकफानॄणांबस्तिहृन्मूर्धसंश्रयाः| तस्मात्तत्स्थानसामीप्याद्धर्तव्यावमनादिभिः||२९१|| bhavanti cātra- vātapittakaphā nr̥̄ṇāṁ bastihr̥nmūrdhasaṁśrayāḥ| tasmāttatsthānasāmīpyāddhartavyā vamanādibhiḥ||291|| bhavanticAtra- vAtapittakaphA nRUNAM bastihRunmUrdhasaMshrayAH | tasmAttatsthAnasAmIpyAddhartavyA vamanAdibhiH ||291|| To Sum Up, In human beings, vāta, pitta and kapha are located in the basti (region of the urinary bladder, i.e Pelvic region), heart (cardiac region) and murdha (head) respectively therefore, the morbid matter located in these places is eliminated from the nearby region appropriately by emetic therapy etc [291] Micro- cosm and macro- cosm: अध्यात्मलोकोवाताद्यैर्लोकोवातरवीन्दुभिः| पीड्यतेधार्यतेचैवविकृताविकृतैस्तथा||२९२|| adhyātmalōkō vātādyairlōkō vātaravīndubhiḥ| pīḍyatē dhāryatē caiva vikr̥tāvikr̥taistathā||292|| adhyAtmalokovAtAdyairlokovAtaravIndubhiH | pIDyate dhAryate caiva vikRutAvikRutaistathA ||292|| As the Loka (macro-cosm) is afflicted or maintained respectively by the morbidity and normal state of the wind, sun and moon, so also the adhyatma-loka (sentient world or micro-cosm) is either afflicted or maintained respectively by the morbidity and normal state of vayu, pitta and kapha. [292] Harmony among the doṣha: विरुद्धैरपिनत्वेतेगुणैर्घ्नन्तिपरस्परम्| दोषाःसहजसात्म्यत्वाद्विषंघोरमहीनिव||२९३|| viruddhairapi na tvētē guṇairghnanti parasparam| dōṣāḥ sahajasātmyatvādviṣaṁ ghōramahīniva||293||

viruddhairapi na tvete guNairghnanti parasparam | doShAH sahajasAtmyatvAdviShaM ghoramahIniva ||293||

The doṣha viz, vayu, pitta and kapha never destroy each other inspite of having contradictory properties, they coexist in a harmonious state. This happens because of their sahaja- satmya (natural wholesome disposition of coexistence), as even fatal poison does not effect snakes [293].

To, Sum Up तत्रश्लोकः- त्रिमर्मजानांरोगाणांनिदानाकृतिभेषजम्| विस्तरेणपृथग्दिष्टंत्रिमर्मीयेचिकित्सिते||२९४|| tatra ślōkaḥ- trimarmajānāṁ rōgāṇāṁ nidānākr̥tibhēṣajam| vistarēṇa pr̥thagdiṣṭaṁ trimarmīyē cikitsitē||294||

tatrashlokaH- trimarmajAnAM rogANAM nidAnAkRutibheShajam | vistareNa pRuthagdiShTaM trimarmIye cikitsite ||294|| In this chapter on “the Treatment of diseases of the Three Vital Organs”, the etiology, signs and symptoms, and treatment of the individual diseases afflicting the three vital organs of the body are described in detail. इत्यग्निवेशकृतेतन्त्रेचरकप्रतिसंस्कृतेऽप्राप्तेदृढबलसम्पूरितेचिकित्सास्थानेत्रिमर्मीयचिकित्सितंनामषड्विंशोऽध्यायः||२६||

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē trimarmīyacikitsitaṁnāma ṣaḍviṁśō'dhyāyaḥ||26||

ityagniveshakRute tantre carakapratisaMskRute~aprApte dRuDhabalasampUrite cikitsAsthAne trimarmIyacikitsitaM nAma ShaDviMsho~adhyAyaH ||26|| Thus, ends the 26th chapter of cikitsā sthana section dealing with the treatment of diseases of the three vital organs in Agnivesha’s work as redacted by Charaka, and supplemented by Drudhabala.

Tattva Vimarsha

• The marma are the vital points as prāna (life force) resides in them. Among the ten prānāyatana, three marma i.e., śira, hr̥daya and basti have been given importance.12 • If doṣha affect these three marma, they will have impact on the prāna. Hence their pro-tection, for management of disorders is crucial. • Udāvarta means abnormal upward movement of vāta doṣha. Commonly this condition is caused due to the suppression of natural urges and vāta aggravating factors.13 Udavarta hampers digestion and retains the toxic elements to cause various diseases. • Symptoms of udavarta are also seen in pakvashaya gata vata, kostagata vata, gudagata vata, purisavrita vata and gulma. Vitiation of vata is common in all the above men-tioned diseases. • Ashmari (lithiasis) is caused by either increase in prithvi mahabhuta or decrease of jala mahabhuta or both. Excessive exercise, food having ruksha (dry), ushna (hot) potency like alcoholic preparations cause absorption and thus depletion of jala mahabhuta whereas aetiological factors like eating flesh of animals residing in marshy land; fish etc are the one which increases prithvi mahabhuta. • Site of doṣha aggravation is important. As like in jwara, if patient is suffering from sama sannipataj mutrakrichra then first treat vata dosha as sthansamshraya (site of collection of morbid doṣha) of the disease is in vatasthana (seat of vata doṣha), followed by treat-ment of pitta and lastly kapha. Whereas, in visham sannipataj mutrakricchra, depending on the predominant doṣha do the treatment i.e. if kapha is dominant vaman, if pitta is dominant virechana and if vata is dominant then basti. • Relationship exists between krimi, annavahasrotas (gastrointestinal tract) and heart dis-ease. In Ca. Vi. 7/12 Diet such as milk, sesame, fish etc leads to kaphaja krimi which have origin in amashaya (gastrointestinal tract) and ‘hridaychara’ a type of kaphaja krimi can cause chest discomfort.14 • If chest pain increases just after food intake and relieved during digestion and on empty stomach than it is kapha dominant whereas, if pain aggravates during digestion it is pitta dominant and if pain increases after digestion or on empty stomach it is vata dominated. • Treatment for samasannipataja hridroga (heart disease), in which all three doṣha are equally vitiated, in such a case heart being in kapha dominant seat, first do the langhana (fasting therapy) and other kapha pacifying treatment followed by treatment of pitta and lastly treatment of vata. In vishamsannipataj hridroga depending on predominant doṣha chikitsa should be done. • Pratishyaya (rhinitis) has also been mentioned in rajyakshma chikitsa chapter but there it is classified as one of the symptom of rajyakshma disease whereas over here it is men-tioned as independent disease.15 • Exaggerated doṣha should be removed from the nearest site i.e. if doṣha are in amashaya (above navel area) vaman (emetic therapy) should be administered, if in pitta sthana (around navel area) virechana (purgation therapy) should be administered and basti (en-ema therapy) for doṣha in vata sthana (below navel area). Vidhi Vimarsha: This chapter explains the treatment of diseases effecting three vital systems (cerebrovascular, cardiovascular and renovascular system) and not the organs themselves. Brain, heart and kidney axis support each other in maintaining the homeostasis. Declining car-diac function is associated with a spectrum of compensatory mechanisms to preserve cardiovas-cular homoeostasis. Two of the major participants in the neurohormonal system that are intri-cately intertwined in order to achieve stability are (i) the Autonomic nervous system and (ii) the Renin–angiotensin–aldosterone system (RAAS). A reduction in cardiac output activates afferent stimuli from the baroreceptors to the central nervous system cardio-regulatory centres, which in turn leads to an activation of the sympathetic nervous pathway. Reduced renal perfusion, sec-ondary to reduced forward flow activates the RAAS system via renin release. Importantly, renin facilitates the conversion of angiotensinogen to angiotensin I. Angiotensin-converting enzyme subsequently converts angiotensin I to angiotensin II. Although angiotensin II has a central ef-fect on increasing sympathetic activity, it is also involved in sodium and water retention and has a systemic vasoconstrictive effect. It is noteworthy that these compensatory mechanisms are initially important to maintain cardiac outputbut over the long term are detrimental through their adverse impact on the structural adaptive response of the heart. Heightened sympathetic tone modulates heart rate, enhances AV conduction, as well as myocardial contractility, but when sustained over time it is associated with reduced cardiac sympathetic neuronal density and responsiveness. Sympathetic activation in turn increases the vasoconstrictor tone, accompanied by activation of the RAAS and the endothelin 1 and vasopressin system, which may be respon-sible for peripheral organ dysfunction and damage in the setting of congestive heart failure.16 Thus, a functional interrelationship is essential for homeostasis as well as disease condition. Diseases such as diabetes mellitus have an impact on all the three system and they in turn have impact on each other. Similarly, Acharya Charak observed udavarta, a disease of gastrointesti-nal tract origin and dominated by vata doṣha to have impact on this trimarma. In other words, these marma have to be protected especially from Anila (vāta), as vāta is the main cause for the aggravation of pitta and kapha and also is the cause of prāna (Life force).17 Vāta gets vitiated due to the vātaja aggravating factors and especially retaining or unnecessarily provoking the natural urges. Caraka in Vimānasthāna mentioned that diet if consumed without following the rules of proper dietary intake can lead to manifestation of disease by vitiating doṣha and deteriorating the healthy status of dhātu.18 (5-10) The toxins retained due to retention of mala due to impaired apana can lead to various diseases. The impaired apana has first impact on agni to hamper the metabolism. The impaired metabo-lism leads to impaired gut microbiome and the latest research has shown that impaired gut mi-crobiota can lead to various disorders, from heart disorders to psychological disorders which the Acharya have mentioned in verse 9-10. It is generally observed that patient exaggerate pressure to evacuate the faecal matter which is not easily passed in case of udavarta. This increases the intra rectal pressure which can lead to arsha (piles), parikartika (fissure). The continuous increased pressure can further lead to bleed-ing leading to anaemia (pandu). As discussed in shwas adhyaya, pandu is cause of shwas (dysp-noea). Shwas has its impact on hridaya (heart) as it is seat of pranvahasrotas. Hridaya may also get involved due to pandu. Involvement of hridaya opens the gate for various disorders from brain to kidneys. Increased rectal pressure further leads to increased abdominal pressure which has been recorded as cause for TIA/ CVA in elderly individuals. Increased abdominal pressure has impact on movement of diaphragm which further increased the thoracic pressure. Restless-ness attained due to improper evacuation of faeces increases the irritability and non attentive-ness leading to psychological distress. Some Acharyas have accepted guda as a sthana of mana. (6-10) It is also observed that due to impaired digestion and absorption, nutritional deficiency occurs especially folic acid etc which lead to increased homocystine levels, another cause for various serious diseases of three marma. Therefore, one finds explanation of udavarta which as a disease alone only has impact of ab-dominal discomfort but later on may be the basic pathogenic factor for various diseases related to three marma. Hence Caraka explained udavarta as a disease of gastrointestinal tract prior to the explanation of diseases like mutrakrichra, hridroga and shiroroga. The method of preparation of suppository is to be followed as described in verse 12. Then gen-tly insert the pointed tip of suppository first into lubricated rectum of the patient for downward movement of vāta and treat the retention of stool, flatus and urine which is caused by udāvar-ta.[11-14] https://infoayushdarpan.wordpress.com/2017/01/15/%e2%80%8bmy-approach-why-udaavarta-is-mentioned-in-trimarmiya-chikitsa-adhyaaya-of-charak-samhita/ All drugs mentioned in the verse possess vāta pacifying quality and therefore useful in the erad-ication of the symptoms. Here Yavakshāra can play a significant role in the treatment as men-tioned in siddhisthān. Yavakshāra is useful in hrudroga – heart diseases, pāndu – anemia, grahani – malabsorption syndrome, pleeha – enlargement of spleen, ānāha – bloating, constipation, galagraha – obstruc-tion in throat, kāsa – coughing and kaphaja arsha – piles of shlaismika variety. Alkali preparations (kshāra) in general are sharp, hot, light, unctuous, softening, carminative, corrosive, caustic, digestive stimulant and depletive. (11-14). Importance of sneha in udavarta: As discussed in pathogenesis, ruksha guna is the one that gets increased during metabolism (katuvipaka) and opposite of ruksha is snigdha guna. It helps in lubrication and pacifying the vitiated vata. The lubrication softens the stool thereby helping downward movement. Further due to its quality to enter the lipid membrane of cell wall it helps in removing the toxins i.e. remove the vilina doṣha. Snigdha guna also helps to maintain the strength (bala). Thus, oleated suppository, medications prepared of oily substances having laxative/ purgative properties have been mentioned. Even in decoction enema (niruha basti) oil is always added which gives the essential oleation that is needed. The main etiology for udāvarta is vitiated vāta; the aggravated vāta inturn can aggravate the other two doṣha, pitta and kapha, therefore medicated enemas as a line of treatment for each aggravated doṣha causing udāvarta is described in the verse. [15-17]. Purgation therapy should be followed with the gap of seven days of administration of niruha basti.20 [19] Hingvastaka or Lavanbhaskarchurna are the substitutes for Dviruttara-hingvadi-churna. Anaha (bloated abdomen especially upper half) is a type of udāvarta which has specific etiolo-gy, signs and symptoms. [26] Among sneha, eranda taila is more effective in udavarta or in any such condition where the gati of vata is impeded by kapha, pitta, meda, rakta or by ruksha guna of vata itself. Snigdha and anuloma action of eranda taila helps in normalizing the movement of vata dosha. 26-31 In human beings mutrakrcchra (dysuria) is of eight types which are as follows; Dysuria caused due to aggravated vāta, pitta, and kapha individually, and all the doṣha aggravated simultaneously (sannipatika) [33-35]. Dysuria caused due to calculus in the urinary tract. [36-39] 6. Dysuria caused due to sarkara (granules) [39] 7. Dysuria caused due to diseases of semen [40-43] 8. Dysuria caused due to kshata (trauma) to urinary tract.ver. [43-44]

Vataj mutrakriccha may be compared with various crystaluria which result in painfull and diffi-culty in micturation. Pittaj mutrakriccha can be compared with infective cystitis or various UTI whereas kaphaj can be compared with non infective cystitis. Sannipatik is a mixture of above three. Spermaturia can be understood as shukraja mutrakricchra. Spermatorrhoea is a condition of excessive, involuntary ejaculation it may be cause for spermaturia. Raktaj mutrakrichhra: Kshata (skin breaching/ trauma) and abhighat (not bridging skin) along-with kshaya (depletion of body tissues) to be the cause for raktaj mutrakrichhra. Kshata and abhighata although both have common meaning i.e. trauma yet Acharya has used both the words to explain that both external trauma and internal trauma may be the cause of bleeding. Further, in kshatakshina adhyaya while explaining prodormal features raktamutratvam has been explained. Haematuria may occur due to kshat (trauma) as well as kshaya (shukra oja kshaya).34 Renal tuberculosis is one of the causes for haematuria. Various cancers of the kidney, prostate or bladder and benign prostatic hyperplasia, in older men, especially those over 50 is cause for haematuria. Some causes of dysuria are explained below.35 Drugs and irritants (tikshna aaushada) Chemical Irritants, e.g., soaps, tampons, toilet paper Drugs, e.g., anticholinergics, NSAIDs Crystalluria is considered as one of the side effects of sulfonamides and penicillins Genital Benign prostatic hyperplasia (male) Endometriosis (female) Prostatic cancer (male) Prostatitis (male) Vaginitis (female) Urinary Tract Chlamydia Cystitis Hemorrhagic cystitis Kidney stones Malignancy, i.e., bladder cancer, prostatic cancer, or urethral cancer Prostatic enlargement, i.e., benign prostatic hyperplasia (male), prostatic cancer Prostatitis (male) Pyelonephritis Sexually transmitted disease Trichomoniasis Urethral stricture Urethritis Urinary schistosomiasis Urinary tract infection (UTI) caused by bacterial infection Other Diverticulitis Hypotension Mass in the abdomen Reactive arthritis (https://en.wikipedia.org/wiki/Dysuria) The most common causes of hematuria are: Urinary tract infection with bacteria. The vast majority of UTIs are caused by Escherichia coli, with a smaller percentage due to Klebsiella pneumonia and Staphylococcus saprophyt-icus Nephrolithiasis: stones in the kidney, bladder or ureter Polycystic kidney disease Trauma Cancer of the kidney, prostate or bladder Benign prostatic hyperplasia, in older men, especially those over 50. Vigorous exercise- Exertion and excessive exercise (vyayama) increases peripheral circula-tion and reduces central circulation as per demand thus glomerular filtration is reduced re-sulting in less production of urine reducing the pH of urine causing burning and painful uri-nation. Further in athletes it is seen that high-intensity exercise can occasionally cause he-maturia. http://www.sjzkidney.com/faq/1674.html No cause found Other, less common causes of hematuria include: Glomerular bleeding: e.g.: IgA nephropathy ("Berger's disease"), Alport syndrome, thin basement membrane disease Sickle cell disease Schistosomiasis (caused by Schistosoma haematobium) - a major cause for hematuria in many African and Middle-Eastern countries Recent instrumentation of the urinary tract Prostatitis Urethritis Kidney diseases Arteriovenous malformation of the kidney (rare, but may impress like renal cell carcinoma on scans as both are highly vascular). Rare causes include: Paroxysmal nocturnal hemoglobinuria - a rare dis-ease where hemoglobin of hemolyzed cells is passed into the urine Arteriovenous malformation of the kidney (rare, but may impress like renal cell carcinoma on scans as both are highly vascular) Fibrinoid necrosis of the Glomeruli (as a result of malignant hypertension) Vesical varices may rarely develop secondary to obstruction of the inferior vena cava Allergy may rarely cause episodic gross hematuria in children Left renal vein hypertension, also called "nutcracker phenomenon" or "nutcracker syn-drome," is a rare vascular abnormality responsible for gross hematuria Ureteral Pelvic Junction Obstruction (UPJ) is a rare condition beginning from birth in which the ureter is blocked between the kidney and bladder. This condition may cause blood in the urine March hematuria secondary to repetitive impacts on the body, usually the feet Athletic nephritis secondary to strenuous exercise Alport syndrome Others signs that resemble hematuria include: Medications can cause red discoloration of the urine, but not hematuria. Some examples in-clude: sulfonamides, quinine, rifampin, phenytoin consumption of beets ("beeturia") menstruation http://www.sjzkidney.com/faq/1674.html In general terms though we find that mutraghata is described as condition with suppression or less production of urine and mutrakricchra as dysuria, not all conditions described under mut-raghata are characterized by oliguria or reduced output. Most of the conditions seem to be pre-dominated by retention or bladder distension. Mutrasaada, mutraukasaada and ushnavata may be considered as scanty urination or oliguria; Mutrakshaya may be equated to oliguria or anuria. Mutrakricchra is a condition of dysuria and others like vatabasti, mutratita, mutrajathara seem to occur due to voluntary withholding of the urge of micturition resulting in physiological blad-der atony as in mutratita or retention with pain as in vatabasti and atonied distended bladder in mutrajathara all progressive conditions of the same pathological process. Bastikundala also seems to be a condition of bladder atony but with superadded cystitis due to severe physical stress and states of dehydration. In vatashthila and mutragranthi there seems to be an obvious anatomical growth which causes obstruction to the urine pathway which may be considered as prostatomegaly and vesical tumors respectively. The condition of vatakundalika, though from the aetiological factors seems to be similar to the conditions of withholding the urge of urina-tion, due to the symptoms seems more or less like urethral stricture. Mutrotsanga seems to be a condition of acute urethritis or cystitis where there is stranguary, dysuria, and hesitancy along-with haematuria. Vidvighata clearly seems a case of recto vesical or rectourethral fistula.36 [43-44] Summer season regimens are described in sutra /6:27-32 in detail. Oily, cold, sweet and liquid dominated diet should be taken. Alcohol should be avoided or should be taken in very less quantity and with more of water. Food dominated with salt, sour and spicy taste and exercise should be avoided so also sexual intercourse.37 [49] In verse 77 common causes of all hridroga has been explained whereas in Sutrasthan 17 chapter aetiological factors specific to the type of hridroga have been explained. If one analyzes the aetiological factors as mentioned in Chikitsasthan they are more like exaberating factors (sadyo nidana) rather than etiological factors mentioned in Sutrasthan which do cause hridroga in long duration (kalantara nidan).38 Excessive exercise/ exertion, explains the increased demand on already compromised heart. Strong and excessive virechan and/ orbasti which will induce loose motions in excess will re-duce water content leading to reduced fluid volume (hypovolaemia) and inturn hypotension. Thus, to maintain the blood pressure, heart will need to pump blood but due to reduced fluid volume the heart may be unable to pump or if the heart is already compromised and may not be able to bear the excessive workload. Further loss of fluid volume due to strong virechan and basti can also cause electrolyte imbalance leading to arrhythmia and hence heart disease. Chinta (excessive thinking) bhaya (fear) explain the adrenaline influx which causes tachycardia which may again lead to heart disease in a compromised heart. Chakrapani has mentioned that vaivarnya (discoloration) etc are seen after hridroga which manifest in some cases as presenting symptoms. Vaivarnya explains the discoloration with which the patient may present. Cyanosis is general presentation in cardiac diseases but other cutaneous presentation may also help in diagnosing cardiac involvement for eg; lupuspernio, a pink discoloration on the tip of nose and face etc which is generally a feature of sarcoidosis wth cardio-pulmonary involvement.39 Livedo reticularis, is characterized by mottled, erythematous discoloration of the skin, which blanches on pressure. Livedo reticularis is the most common dermatologic manifestation ofArteriosclerosis (cholesterol emboli).40 Erythema marginatum occurs in 10% of children with their first attack of acute rheumatic fever (ARF). Erythema marginatum is a flat to mildly elevated, pinkish, nonpruritic, transient erup-tion found primarily on the trunk and proximal extremities. Overall, it occurs in less than 5% of patients with rheumatic fever. Subcutaneous nodules are also rare in rheumatic fever but are associated with more severe car-ditis, as they usually present many weeks after the onset of disease; they are generally found over bony prominences and are usually painless because it can involve the pericardium, epicar-dium, myocardium, and endocardium. Xanthelasma is Yellow flat plaques over the upper or lower eyelids, most often near the inner part of the eye.Xanthelasma palpebrarum is observed in patient with hyperlipidemia. Eruptive xanthomas are characterized by crops of 1- to 5-mm yellow-orange papules with sur-rounding erythema, most commonly on the extensor surfaces of extremities and the buttocks. This condition is most strongly associated with hypertriglyceridemia Conjunctival pallor; Pallor in a patient with a prosthetic valve may be indicative of hemolytic anemia. Janeway lesions are associated with acute endocarditis, of which S aureus is the most common cause. Osler's nodes are associated with subacute bacterial endocarditis and S viridans. Osler's nodes are painful, erythematous nodules most commonly found on the pulp of fingers and toes. Other cutaneous manifestations of infective endocarditis include splinter/subungual hemorrhag-es.Thus a variety of colour changes (vaivarnya) may be observed in cardiac patient.41 http://csccm.org.cn/?p=9963 Murcha (Syncope): Cardiac syncope may be due to arrhythmias or structural cardiac diseases that cause a decrease in cardiac output leading to acute global impairment of cerebral blood flow. Cough (Kasa), hiccups (hikka) and dyspnea (shwas) have been discussed in Hikka shwas chikitsa adhyaya. It is caused due to cardio-pulmonary relationship. Anorexia (Aruchi and aasya vairasya): Cardiac disease of any cause can cause hepatic dysfunc-tion through elevated hepatic vein pressure (congestive hepatopathy), decreased hepatic blood flow (ischemic hepatitis), or hypoxemia. Further cardiac dysfunction can lead to secondary re-nal injury through reduced renal blood flow (low cardiac output), renal venous congestion, and impaired renal autoregulation. In both the organ (liver and kidney) injury alongwith anemia caused due to cardiac disorders anorexia and unpleasant taste is the common feature. In conges-tive cardiac failure, Accumulation of fluid in the liver and intestines may cause nausea, ab-dominal pain, and decreased appetite. Anorexia nervosa can complicate heart disease as patients with anorexia loose weight, they loose muscle mass, both of the skeletal and cardiacmuscle mass, They can develop mitral valve prolapse which can present as sharp pain beneath the sternum. Cardiac vomiting [chardi]: Left ventricular receptors which appear to signal intramyocardial tension cause bradycardia and vasodilatation, and increase urine flow. They are probably im-portant in blood volume control and in adjusting the circulation during exercise. When strongly stimulated they cause nausea and reflex vomiting. They may be involved in the autonomic dis-turbances at the onset of myocardial infarction, syncope in aortic stenosis, vasovagal syncope, and fluid retention in heart failure.42 The extra fluid in the body may cause increased urination, particularly at night which can lead to increase thirst [trishna]. [78] Vataj Hridroga: As mentioned in sutrasthana the, grief, fasting, excessive exercise, intake of unctuous, dry and inadequate quantities of food, causes, vāta vitiation and affects the heart. 43 Excruciating pain, trembling, cramps, stiffness, darkness, feeling of sense of emptiness, worsen-ing of pain after the digestion of food are the symptoms mentioned in Sutrasthana while ex-plaining the heart disease.44 [79] Vataj Hridroga: Vata is necessary for the coordinated functioning of heart. If vata gets vitiated the conduction defects may occur. Tachycardia and bradycardia are the two main classification of impaired cardiac conduction. Dara or dardarika as explained by Chakrapani or hrudrava as explained by Yogindranath Sen explains the tachycardia. Various rhythmic and arrhythmic tachycardia have been described by Modern science eg. Sinus tachycardia, which originates from the sino-atrial (SA) node, near the base of the superior vena cava, Atrial fibrillation, Atrial flutter, AV nodal reentrant tachycardia, Accessory pathway me-diated tachycardia, Atrial tachycardia, Multifocal atrial tachycardia, Junctional tachycardia, Ventricular tachycardia, any tachycardia that originates in the ventricles, any narrow complex tachycardia combined with a problem with the conduction system of the heart, often termed "supraventricular tachycardia with aberrancy", A narrow complex tachycardia with an accesso-ry conduction pathway, often termed "supraventricular tachycardia with pre-excitation" (e.g. Wolff–Parkinson–White syndrome). https://en.wikipedia.org/wiki/Tachycardia Hridstambha explains the bradycardia. Stoppage, obstruction, suppression are various meaning of stambha. Sinus bradycardia, Sick sinus syndrome, AV block etc explain the condition of slow heart rate. Asystole, also known as flatline, is a state of no electrical activity from the heart and therefore no blood flow. It results in cardiac arrest. It may also be noted that tachycardia may later convert into asystole. Thus various conditions resulting into tachy and bradycardia may be considered in vataj hridroga.Near-fainting or fainting (murcha), dizziness, confusion or memory problems (pramoha/ sam moha) are the symptoms other then chest pain, Fatigue and Shortness of breath Hritshunyata explains the emptiness due to non filling of the heart chambers, desolate is also meaning of sunyata or it may also be understood as akinesia wherein no movement (asystole) is observed. Pittaj Hridroga: Acharya gives specific features and causes in Sutrasthana like intake of hot, sour, salty, alkaline (caustic) and pungent foods, taking food during indigestion, excess of alco-hol, anger, exposure to Sun, vitiates pitta located in the heart and gives rise to the symptoms like heartburn, bitter taste in the mouth, eruptions with bitter and sour taste, exhaustion, thirst, unconsciousness, dizziness, perspiration.45 [80] Pittaj hridroga includes infective conditions of cardiac diseases like infective endocarditis/ my-ocarditis/ pericarditis, infective cardiomyopathy. Further alcohol, chemotherapeutic drugs, heavy metals like arsenic etc induced heart disease has similarity with pittaj hridroga. A small number of patients present with fulminant myocarditis, with rapid progression from a severe febrile (jwar) respiratory syndrome to cardiogenic shock that may involve multiple organ systems, leading to renal failure, hepatic failure (cause for yellowish discoloration (pittata)), and coagulopathy. The cardiogenic shock leads to cardiac syncope (tamo darshan/ moha). The myalgia due to infection leads to distress (santras). Breakdown of haemoglobin may also be the cause for yellow discoloration alongwith hepatic involvement. In tuberculous pericarditis, fever, night sweats (sweda), and weight loss, were commonly noted. Acute pericarditis presents as burning pain sensation (daha). Aetiological factors like excess use of saltexplains the vitiated increase of blood (rakta) which leads to hypervolaemia contributing to hypertension and thereby hypertensive cardiac disease. Kaphaja Hridroga: Excessive intake of food, intake of heavy and unctuous food, inadequate mental exercise, sedentary habits, excessive sleep which gives rise to symptoms like, bradycar-dia, lesser activities of heart, stiffness and heaviness of the heart, drowsiness and anorexia. The patient feels as if he is loaded with stones.46 [80] Kaphaja hridroga: stabdha, supta and stimita are the three symptoms mentioned by Caraka. The Sanskrit meaning of the word stabdha is firmly fixed, stiff, rigid, immovable, paralyzed, senseless, dull, solidified, tardy, slack, slow whereas supta means insensible, dull, resting, la-tent, inactive and stimita means fixed, rigid, unmoved, motionless, steady; paralysed, flowing gently along. It means heart is motionless, inactive, slow, solidified, and rigid, these three words extend the scope of kaphaja hridroga from non infective cardiomyopathy to cardiac tamponade. Pulseless electrical activity (PEA), also known by as electromechanical dissociation, refers to cardiac arrest in which a heart rhythm is observed only on the electrocardiogram. Pulseless electrical activity leads to a loss of cardiac output, and the blood supply to the brain is inter-rupted. As a result, PEA is usually noticed when a person loses consciousness (suptata) and stops breathing spontaneously. The cool touch resembles stimitata and the heaviness felt is ashmavrita. Alternately as there is no pulse, it may be explained as the suptata as Chakrapani defines suptata as motionless (niskriyata). The contractility of myocardium is reduced, resem-bling the stabdhata and due to collection of fluid the steady motionless condition wherein the apex beat is not palpable explains stimitata. Sannipatika hridroga: This type of heart disease is caused by the combined vitiation of all the three doṣhas. This can be diagnosed by the existence of the various signs and symptoms of all the three types of heart diseases. This type of heart disease is very painful and difficult to cure. http://easyayurveda.com/2014/05/04/diseases-head-heart-abscess-charaka-samhita-sutrasthana-17/ Rheumatic Fever should be correlated with pran avrita udan which may be the reason of tridosha involvement therefore multiple features appear like carditis, chorea etc are manifested. In this patient, dyspnea is common feature but chest pain is also severe complaint. Rheumatic Fever if not corrected with appropriate antimicrobial drug in time is complicated as Rheumatic Heart Disease (RHD) where Aschoff nodules (granthivat jayate) are present in endo-cardium leading to endocarditis and inturn valvitis. Mitral valve is commonly affected followed by aortic valve involvement. It resembles the same explanation wherein Sannipataj hridroga patient when consumes diet favourable for krimi converts into krimija hridroga. After explanation of five types of hridroga Charaka has explained differential diagnosis of chest pain. Cardiac and non cardiac chest pain do exist which present the symptoms at different phas-es of digestion such as stable angina pectoris usually develops gradually with exertion, emo-tional excitement, or after heavy meals. Similarly, chest discomfort due to esophageal reflux is worsened by post prandial recumbency and relieved by antacids so is the case with gall bladder disease wherein chest discomfort may follow meal whereas chest discomfort due to peptic ulcer is relieved with food and antacid. Dust, smoke, excessive sexual intercourse, indigestion, contact with cold water are some com-mon aetiological factors between pratishyaya and hikka shwas which explains that these factors have impact on local immunity of pranvaha srotas (respiratory system). As previously discussed in hikka shwas chapter these factors stimulate the immune response leading to secretion from the nasal cavity (pratiśyāyamudīrayēttu). Śītairavaśyayā47 (cold dew drops) has been mentioned as one of the cause wherein avashyaya means water drops which may be compared with dew drops, fountains or in present era coolers and air conditioners which have been found to be common aetiological factors even in present era. (104-105) All the pratishyaya if not treated and if aetiological factors are not avoided the pratishyaya dis-ease converts into dusta pratishyaya (persistent rhinitis). It may complicate into various disor-ders from hairloss to asthama, epistaxis etc disease. (107-109) Caraka has mentioned that 64 various diseases of mukhroga. Depending on the seat of disease (lips, gums etc), symptoms, nomenclature etc but as the root cause of all these diseases is three dosha therefore these 64 diseases can be classified in to four groups such as vataj, pittaj, kaphaj and sannipataj and accordingly treatment has been mentioned. [122-123] One of the causes of anorexia is atilobha; here it means repeated use of only one type of food which can cause aruchi (anorexia). [124-126]

CHARTS 1. Pathophysiology of udavarta and its complication

                                Food predominant in Kashaya, Katu, Tikta Rasa
                                               Ruksha bhavad (Ca. Su. 26/60)   
                                                  Katu Vipaka (Ca. Su. 26/58)
                             Increase of vitiated vata and Increase ruksha guna
  Impaired peristalsis and increased absorption of fluid content as a feature of vikarvighat bha-va
  Difficulty in passing/ retention of mutra (urine), purisha (faeces), vata (flatus) and retasa
                                            Further vitiation of movement of vata
                                                                                      If takes tiryak gati              Gulma
                                          Vitiated vata if takes upward direction

                                                 Further hampers digestion process       Reduced nutrition

Retention of toxic factors Leads to ama visha

                                            Dushit aahar rasa Nutritional Disorders (aandhya, badhirya)

Ama janya vikar depending on sthana like hridroga, rajyakshma, mutragata etc (Ca. Ci 15/)

2. Comparative pathology between Ischemic heart disease and Vatik Hridroga Coronary Atherosclerosis Hridayasta Dhamani Pratichaya

            Thrombosis			                Grathita Rakta

Narrowing of coronary vessel Srotosanga/Avarodha Myocardial Ischaemia Apatarpana (Hridayastha)

             Chest Pain	                                          Vataprakopa

I.H.D. Hrithshool (Chest Pain) Vatik Hridroga

3. Pathology of vatika hridroga

Role of excessive salt intake, stress leading to diseases related to trimarma

4. Relationship between Sannipatik and Krimija Hridroga:

                                         Congenital cause (sahaja nidan) of Valvular disease

Vitiate tridosha.

                                                              Sannipatik hridroga 

with intake of krimija aahar Krimija hridroga.

              In CHD Secondary Infective Endocarditis may arise (Krimija hridroga)

5. Pathogenesis explaining how aortic stenosis causes chest pain and dyspnoea

                             Rheumatic fever is one of the causes of Aortic Stenosis

Aortic Stenosis Systolic murmur S2 – Loud Ejection Sound Lt. Ventricular Out flow Obstruction

       Sanga 

        C.O.			                         Bhrama, Aayasena Shwas 

Vimargagaman

Pranavaha Srotodushti Lt. Ventricular hypertrophy

   Shwasadi					                        Demand

Hridayagata vata Chest pain

6. Physiological Relationship between trimarma

Courtesy: http://eurheartj.oxfordjournals.org/content/35/2/77

1. udāvarta (उदावर्त- udAvarta): Abnormal condition characterized by retention of feces, urine and flatus, associated with pain and leading to or caused by anti-peristaltic move-ments in the body by vata. 2. pravāhikā (प्रवाहिका- pravAhikA): spurious feeling of the need to evacuate stools with straining. 3. asthilā (अष्ठील AShThIla): stony hard tumour 4. śīta jwara (शीतज्वर- shItajwara) fever with external cold touch. 5. vartiṁ (वर्ति-vartiM): Anal suppository 6. pradhamēt (प्रधमेत्तु - pradhamett): Insufflations- powder is blowed up with the pipe/ tube in to the oleated anal canal 7. prasannā (प्रसन्ना- prasannA): clear top portion of alcohol 8. guḍasīdhu (गुडसीधु –guDasIdhu): wine prepared out of jaggery. 9. dadhimaṇḍa (दधिमण्ड- dadhimaNDa): upper liquid portion of curd/ curd-scum 10. ānāha (आनाह-AnAha): bloated abdomen above navel area 11. bradhna (ब्रध्ना- bradhna): inguinal swelling 12. mūtrakr̥cchra (मूत्रकृच्छ्र- mUtrakRucchra): Dysuria 13. tripuṭ (त्रिपुट्य- tripuT): prismatic i.e. having three layers 14. sēvanī (सेवनी- sevanI): perineum- suture below the pudendum and between two testicles. 15. ccharkarā (च्छर्करा-ccharkarA): Graveluria 16. aṇḍa stabdham (अण्डयोःस्तब्ध aNDa stabdham): stiffness of the testicles 17. drava (द्रव-drava): palpitation/ tachycardia 18. dūyana (दूयन- dUyana): giddiness 19. santrāsa (सन्त्रास- santrAsa): distress 20. stimita (त्स्तिमितं- stimita): timidity of heart 21. vikartikā (विकर्तिका- vikartikA): cutting pain in this chapter it is related to Angina pain 22. pratiśyāya (प्रतिश्याय-pratishyAya): Chronic rhinitis 23. śirōbhitāpa (शिरोभिताshirobhitApa): excessive exposure of head to the heat 24. duṣṭapratiśyāya (duShTapratishyAya): vicious coryza 25. pratīnāha (प्रतीनाह- pratInAha): nasal obstruction 26. parisrava (परिस्रवौ- parisrava): excessive discharge from the nose 27. pūti ghrāṇa (पूतिघ्राण- pUtighrANa) foul smell in nostrils (ozena), 28. apīnasa (अपीनस- apInasa- ) chronic rhinitis 29. nāsāpāka (पाक- nasApAka) inflammation (suppurative rhinitis), 30. nāsāśōtha (शोथा- shotha) swelling (oedematous rhinitis), 31. nāsārbuda (अर्बुद- nasArbuda) growth/nasal tumor, 32. pūyarakta (पूयरक्ताः- pUyaraktA) purulent and sanguineous rhinitis, 33. arūṁṣi (अरूंषि- arUMShi) furunculosis 34. vaisvarya (वैस्वर्ये- vaisvarye): hoarseness of voice 35. śr̥ṅgāṭak (शृङ्गाट- shRu~ggATak): vital spot where the junction of vessels supplying nourishment to eye, nose and ear takes place. 36. avapīḍaka (वपीडकः-avapIDaka): juice extracted after squeezing 37. kavalagrahaḥ - (कवलग्रहः-kavalagrahaH): gargling or holding paste of drugs in mouth. 38. gr̥hadhūmō (गृहधूमो- gRuhadhUmo): Kitchen shoot deposited after burning wood of various plants. 39. Rasakriyā (रसक्रिया-rasakriyA): the decoction of daruharidra when solidified is called rasakriya. 40. biḍālakaḥ (बिडालकः-biDAlakaH): application of drugs in paste form on the closed eye lids excluding eye-lashes. 41. Āścyōtana (आश्च्योतनं- Ashcyotana): eye douche 42. khālityē (खालित्ये- khAlityA): alopecia 43. palitē (पलिते- palite): Graying of the hair 44. Vali (वलि- vali): appearance of wrinkles over the face 45. visūcikā (विसूचिका-visUcikA) diarrhea with pricking pain in abdomen

1. https://www.cdc.gov/heartdisease/facts.htm, https://www.cdc.gov/nchs/fastats/stroke.htm, https://www.cdc.gov/nchs/fastats/deaths.htm 2. Ca.Ci. 25/121 3. Ca. Ci. 25/6 4. Cakrapani Ca. Ci.26/1 5. Su. Sa. 6/15 6. Dr. Harsh Arvind July 2015 7. Dalhana Tika Su. Sa. 6/2 8. Su. Sa. 6/42 9. Ca. Su.11/48 10. Tanya Lewis Jan 2015 11. Ca.Si.9/5 12. Ca.Su.29/3 13. Su. Ut. 55/3 14. Ca. Vi. 7/12 15. Cakrapani Ca.Ci.26/104-106 16. http://eurheartj.oxfordjournals.org/content/35/2/77 17. Ca.Si.9/7 18. Ca Vi, 1/7 19. Ca.Su. 27/306 20. Ca. Si. 1/26 21. Su.Ut. 56/24-26 22. Su. Ni 3/1-28 23. Ca.Si 9/29 24. Ca.Si 9/32 25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525130/ 26. Fad diets and their effect on urinary stone formation:Antonio Nouvenne, Andrea Ticinesi, Ilaria Morelli, Loredana Guida, Loris Borghi,and Tiziana Meschi: PMID:9883212) 27. Ibid 28. Ibid 29. Ibid 30. Ibid 31. Ibid 32. Ibid 33. Ibid 34. Ca. Ci.11/11 35. https://en.wikipedia.org/wiki/Haematuria 36. Dr.Ravishankar Shenoy 2015 37. Ca. Su. 6/27-32 38. C. Su. 17/34 39. https://en.m.wikipedia.org/wiki/Lupus_pernio 40. http://en.m.wikipedia.org/wiki/Livedo_reticularis 41. http://reference.medscape.com/features/slideshow/ci-card 42. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC482594/pdf/brheartj00185-0013.pdf 43. Ca.Su.17/30 44. Ca.Su.17/31 45. Ca.Su.17/32-33 46. Ca.Su.17/34-35 47. Ca.Ci.17/13

REFERENCE BOOKS 1. CHARAK SAMHITA by AGNIVESHA edited by Yadavji Trikamji Acharya-Munshiram Mano-harlal Publishers Pvt. Ltd. 4th Edition.

2. SUSRUTA SAMHITA of SUSRUTA edited by Yadavji Trikamji Acharya- Chaukhamba Orien-talia, Varanasi- 6th Edition.

3. ASTANGA HRUDAYA by vagbhat-chaukhamba publication

4. Caraka Samhita (Text with English translation & critical exposition based on Cakrapani Datta Ayurved Dipika) by R K Sharma and Bhagwan Dash, Chowkhamba Sanskrit Series Office, Va-ranasi.

5. HARRISON’S PRINCIPLES OF INTERNAL MEDICINE –Mc Graw Hill Medical Publication- 17th Edition (Volume I & II)