अथातः प्रतिश्यायप्रतिषेधं व्याख्यास्यामः धन्वन्तरिः ॥ १ ॥ यथोवाच भगवान्
Now we shall discourse on the chapter which deals with the (symptoms and) medical treatment of nasal catarrh (Pratisyaya-Pratisedha).1
नारीप्रसङ्गः शिरसोऽभितापो धूमो रजः शीतमतिप्रतापः । सन्धारणं मूत्रपूरीषयोश्च सद्यः प्रतिश्यायनिदानमुक्तम् ॥ २ ॥ चयं गता मूर्धनि मारुतादयः पृथक् समस्ताश्च तथैव शोणितम् । प्रकोप्यमाणा विविधैः प्रकोपणैर्नृणां प्रतिश्यायकरा भवन्ति हि ॥ ३ ॥
Causes- Excessive indulgence in sexual intercourse, hurting of the head, entrance of the minute particles of dust or smoke into the nostrils, excessive application of cold or heat, voluntary retention of stool and urine are the causes which may instantly usher in an attack of nasal catarrh (Pratisyaya). The fundamental principles of Vayu, Pitta and Kapha, jointly and separately, as well as of blood becoming aggravated by various aggravating causes, bring on an attack of nasal catarrh in course of time. 2.3.
शिरोगुरुत्वं क्षवथोः प्रवर्तनं तथाङ्गमर्दः परिहृष्टरोमता । उपद्रवाश्चाप्यपरे पृथग्विधा नृणां प्रतिश्यायपुरःसराः स्मृताः ॥ ४ ॥
Premonitary Symptoms- Heaviness of the head, sneezing and aching in the limbs, appearance of horripilation upon the body, as well as many other different kinds of supervening symptoms are seen to precede an attack of nasal catarrh (Pratisyaya).4
आनद्धा पिहिता नासा तनुस्रावप्रवर्तिनी । गलताल्वोष्ठशोषश्च निस्तोदः शङ्खयोस्तथा ॥ ५ ॥ क्षवप्रवृत्तिरत्यर्थं वक्त्रस्यारस्यमेव च। स्वरोपघातश्च भवेत् प्रतिश्यायेऽनिलात्मके ॥ ६ ॥ उष्णः सपीतकः स्त्रावो घ्राणात् स्त्रवति पैत्तिके । कृशोऽतिपाण्डुः सन्तप्तो भवेत् तृष्णाभिपीडितः । सधूमं सहसा वह्निं वमतीव च मानवः ॥ ७ ॥ कफः कफकृते घ्राणाच्छुक्ल: शीतः स्त्रवेन्मुहुः । शुक्लावभासः शूनाक्षो भवेद् गुरुशिरोमुखः । शिरोगलोष्ठतालूनां कण्डूयनमतीव च ॥ ८ ॥
Specific Symptoms- Hoarseness of voice, a sense of stuffedness and obstruction in the nostrils accompanied by a thin mucus secretion, dryness of the throat, of the palate and of the lips, a pricking and piercing pain in the region of the temples, as well as excessive snezing and a bad taste in the mouth are the characteristics of Vataja type of catarrh (Pratisyaya). A hot and yellowish secretion from the nose, heated skin, thirst, emaciation and yellowness of the complexion, as well as the secretion being sudden, hot and somky- these are the characteristics which mark the Pittaja type of catarrh. Constant running at the nose, the secretion being white and cold, paleness (of the skin) and swelling (D.R. whiteness) of the eyes, heaviness of the head, flabbines of the face¹ and tickling and itching sensation in the regions of the head, throat, lips and of the palate or the features which mark the Kaphaja type of the disease. 5-8.
भूत्वा भूत्वा प्रतिश्यायो योऽकस्माद् विनिवर्तते । सम्पक्को वाप्यपक्को वा स सर्वप्रभवः स्मृतः । लिङ्गानि चैव सर्वेषां पीनसानाञ्च सर्वजे ॥ ९ ॥ The spontaneous disappearance, as well as appearance of
Pratisyaya- be it acute or chronic- the charracteristic symptom of Tri-dosaja Pratisyaya where the specific symptoms of all (the three) kind of Apinasa are present. 9.
● 1. In place of “भवेद्गुरू शिरोमुखः – Some read ‘भवेद्गुरुशिरा नरः”— i.e. “the man (patient) gets heaviness of the head.” In this case the flabbiness of the face is not seperately mentioned.
Symptoms of Raktaja Pratisyaya
रक्तजे तु प्रतिश्याये रक्तास्त्रावः प्रवर्तते । ताम्राक्षश्च भवेज्जन्तुरुरोघातप्रपीडितः ॥ १० ॥
दुर्गन्धोच्छ्वासवदनस्तथा गन्धान् न वेत्ति च। मूर्च्छन्ति चात्र कृमयः श्वेताः कृष्णास्तथाऽणवः ।
कृमिमूर्धविकारेण समानञ्चास्य लक्षणम् ॥ ११ ॥
Symptoms of Raktaja Pratisyaya – Discharge of blood (from the nose), redness of the eyes, a bruised pain in the chest which seems as if struck with a blow, fetid smell in the breath and the mouth, and loss of the faculty of smelling are the characteristic symp toms of the Raktaja type of Pratisyaya which has its origin in the deranged condition of the blood. In these cases¹ hosts of extremely small worms of whitish or blackish2 hue are found to infest the affected localities (viz., the nostrils) which show symptoms identical with those of the head-disease due to the germination of parasites in that region. 10-11.
Prognosis of Pratisyaya
प्रक्लिद्यति पुनर्नासा पुनश्च परिशुष्यति । मुहुरानह्यते चापि मुहुर्विव्रियते तथा ॥ १२ ॥ निश्वासोच्छ्छ्रासदौर्गन्ध्यं तथा गन्धान् न वेत्ति च । एवं दुष्टप्रतिश्यायं जानीयात् कृच्छ्रसाधनम् ॥ १३ ॥ सर्व एव प्रतिश्याया नरस्याप्रतिकारिणः । कालेन रोगजनना जायन्ते दुष्टपीनसाः ॥ १४ ॥ बाधिर्यमान्ध्यमघ्राणं घोरांश्च नयनामयान् । कासाग्निसादशोफांश्च वृद्धाः कुर्वन्ति पीनसाः ॥ १५ ॥
Prognosis — The malignant nature of the disease (DustaPratisyaya) should be inferred from the constant alternate sliminess and dryness, as well as constant alternate contraction and expansion of the nostrils, fetor in the breath and loss of thefaculty of smell. Such a case of Pratisyaya should be regarded as extremely hard to cure which are neglected and not properly remedied at the outset of an attack. Any type of catarrh (Pratisyaya) may bring on cases of malignant Pinasa which in time gives rise to a number of diseases and produces in its train deafness, blindness, loss of sinell, violent ocular affections, cough, dulness of appetite, and Sopha (Swelling). 12-15.
1. According to some this is the characteristic symptom of another kind of Pratisyaya, and not one of the symptoms of the Raktaja type as appears at the first sight. 2. Madhava kar reads ‘श्वेता स्निग्धा’ ie, glossy in hue, in place of ‘श्वेता: कृष्णा’ i.e. whitish and balckish in hue.
General Treatment of Pratisyaya
नवं प्रतिश्यायमपास्य सर्वमुपाचरेत् सर्पिष एव पानैः । स्वेदैर्विचित्रैर्वमनैश्च युक्तैः कालोपपन्नैरवपीडनैश्च ॥ १६ ॥ अपच्यमानस्य हि पाचनार्थ स्वेदो हितोऽम्लैरहिमञ्च भोज्यम् । निषेव्यमाणं पयसाऽऽर्द्रकं वा सम्पाचयेदिक्षविकारयोगः ॥ १७ ॥ पक्कं घनञ्चाप्यवलम्बमानं शिरोविरेकैरपकर्षयेत् तम् । कवलग्रहैश्च विरेचनास्थापनधूमपानैरवेक्ष्य दोषान् ॥ १८ ॥
General Treatment of Pratisyaya – Potions of clarified butter, various sorts of emetics, and fomentations (Sveda)may be prescribed in nasal catarrh (Pratisyaya), except in fresh and acute cases. Errhines (Nasya) of Avapida type may also be employed in time, if required. Fomentation should be applied and diet should be taken in a tepid state with articles of acid taste, and draughts of milk should be administered with green ginger’ and with any modificaton of the expressed juice of sugar-cane² for the purpose of thickening and maturing the secreted mucus, in cases where that maturing process has not already spontaneously set in. The mucus found matured, thick and pendent should be made to secrete by applying head-purgatives (Sirovireka). Purgatives, Basti of the Asthapana kind, smoke-inhalations and medicinal gargles should also be prescribed according to the exigencies of each case under treatment and in consideration of the nature and intensity of the deranged Dosa involved there in. 16-18.
निवातशय्यासनचेष्टानानि मूर्ध्ना गुरूष्णञ्च तथैव वासः । तीक्ष्णा विरेकाः शिरसः सधूमा रूक्षं पलान्नं विजया च सेव्या ॥ १९ ॥
1. Some explain “ardraka” to mean the expressed juice of fresh giner, while others explain it to mean the powder of Dried singer.
11 2. In place of ‘‘इक्षुविकारयोगैः with any modification of the expressed juice of sugar-cane, such as treacle, sugar, etc. some read “कटुकीययोगै: “i.e., with articles of pungent taste.
Regimen of diet and conduct
शीताम्बुयोषिच्छिशिरावगाह-चिन्तातिरूक्षाशनवेगरोधान् ।
शोकञ्च मद्यानि नवानि चैव विवर्जयेत् पीनसरोगजुष्टः ॥ २० ॥
Regimen of diet and conduct – In a case of Pratisyaya the patient should sit, lie, or move about in closed and windless rooms and wear warm and thick turban on his head. He should take Vijaya (Haritaki) and partake of meals consisting of Palanna¹ cooked without clarified butter. He should also be subjected to a course of strong headpurging as well as of smoke-inhalations. use of new wine and cold drink, cold baths, sexual intercourse, anxious cares, lamentations, voluntary retention of stool and urine, as well as partaking of fares which are excessively dry (and beget dryness in the system), should be foregone by a person suffering from an attack of Pinasa. 19-20.
छर्द्दयङ्गसादज्वरगौरवार्तमरोचकारत्यतिसारयुक्तम् विलङ्घनैः पाचनदीपनीयैरुपाचरेत् पीनसिनं यथावत् ॥ २१ ॥ बहुद्रवैर्वातकफोपसृष्टं प्रच्छर्दयेत् पीनसिनं वयःस्थम् । उपद्रवांश्चापि यथोपदेशं स्वैर्भेषजैर्भोजनसंविधानैः । जयेद् विदित्वा मृदुतां गतेषु प्राग्लक्षणेषूक्तमथादिशेच्च ॥ २२ ॥
Fastings and employment of digestive (Pacana) and appetising (Dipaniya) remedies should be the medical treatment in cases of Pinasa ( nasal catarrh) accompanied by such distressing symptoms as vomiting, aching, heaviness in the limbs, feverishness, non-relish for food, apathy, and Atisara (diarrhoea). In case of an adult person suffering from an attack of Pinasa due to the concerted action of Vayu and Kapha the patient should be made to vomit by taking in large quantity of any liquid substance. The complicaitons (Upadrava) involved there in should be remedied by appropriate diet and remedial agents and after their subsidence, the patient should be treated according to the instructions given before. 21-22.
Treatment of Vataja Pratisyaya
वातिके तु प्रतिश्याये पिबेत् सर्पिर्यथाक्रमम् । पञ्चभिर्लवणैः सिद्धं प्रथमेन गणेन च । नस्यादिषु विधिं कृत्स्नमवेक्षेतार्दितेरितम् ॥ २३ ॥
1. Palanna is generally prepared by cooking together rice, meat and clarified butter as well as other spices, but in this case clarified butter should not be used.
Treatment of Vataja Type- In casese of Vataja-Pratisyaya clarified butter duly cooked with the drugs of the Vidari-gandhadi group or with the five officinal salts should be prescrbed for internal use, according to the rules of taking Sneha (see chapter XXXI. ChikitsaSthana). The process of snuffing, etc. should also be resorted to, if necessary, as in a case of Ardita (Facial paralysis). 23.
Treatment of Pittaja and Raktaja Pratisyaya
पित्तरक्तोत्थयोः पेयं सपिर्मधुरकैः शृतम् । परिषेकान् प्रदेहांश्च कुर्यादपि च शीतलान् ॥ २४ ॥ श्रीसर्जरसपत्तङ्गप्रियङ्गमधुशर्कराः द्राक्षामधूलिकागोजी – श्रीपर्णीमधुकैस्तथा । । युज्यन्ते कवलाश्चात्र विरेको मधुरैरपि ॥ २५ ॥ धवत्वत्रिफलाश्यामा-तिल्वकैर्मधुकेन च । श्रीपर्णीरजनीमिश्रैः क्षीरे दशगुणे पचेत् । तैलं कालोपपन्नं तन्नस्यं स्यादनयोर्हितम् ॥ २६ ॥
Treatment of Pittaja and Raktaja Types- In the Pittaja and Raktaja types (of Pratisyaya) the patient should be given draughts¹ of clarified butter duly cooked with the drugs of the Kakolyadi group. cold 2 washes and plaster should also be used. Sarjarasa (Resin), Pattanga (Red-sandal), Priyangu, Honey, Sugar, Draksa, Madhulika (Guduci) Goji, Sriparni and Yasti-madhu should be prescribed as gargles and purgings (errhines?) should be induced with the help of the drugs of sweet potency (Such as Draksa, Aragvadha, honey, sugar, etc.). Oil duly cooked with (a paste composed of) Dhava-bark, Triphala, Syama, Tilvaka, Yasti-madhu, Sri-parni, Rajani, and with milk weighing ten times as much as oil, should be preserved for a time and used as an errhine ( Nasya ) in either of these cases. 24-26.
1. Some read ‘‘तिक्त:” in place of “पेयम्” This word means that the clarified butter for use in this case should be duly cooked with the “तिक्त” (bitter) drugs, viz., the leaves of Patola etc.
2. Both the commentators of Vrnda and Cakradatta explain the term शौतलेन (cold) to mean ‘prepared with the drugs of cold potency such as the drugs of the Nyagrodhadi and Utpaladi groups.
Treatment of Kaphaja Pratisyaya
कफजे सर्पिषा स्निग्धं तिलमाषविपक्कया। यवाग्वा वामयेद् वान्तः कफघ्नं क्रममाचरेत् ॥ २७ ॥ उभे बले बृहत्यौ च विडङ्गं सत्रिकण्टकम् | श्वेतामूलं सदाभ्रद्रां वर्षाभूञ्चात्र संहरेत् । तैलमेभिर्विपक्रन्तु नस्यमस्योपकल्पयेत् ॥ २८ ॥ सरलाकिणिहीदारु-निकुम्भेङ्गुदिभिः कृताः । वर्तयश्चोपयोज्याः स्युर्धूमपाने यथाविधि ॥ २९॥
Treatment of Kaphaja Type — In a case of the KaphajaPratisyaya emulsive measures (Sneha-karma) should be performed with clarified butter, and the patient should be made to vomit by using Yavagu (gruel) prepared with Masa-pulse and Tila, ( sesamun seed), after which the general Kapha-subduing measure should be employed. Oil duly cooked with the two kinds of Bala, the two kinds of Brhati, Vidanga, Tri-kantaka, Sveta-roots, Saha (Mudgaparni), Bhadra (Gambhari) and Varsabhu should be employed as an errhine. Sarala, Kinihi, Daru, Nikumbha (Danti) and Ingudi should be pasted together and duly formed as Vartis. These Vartis should be duly used for the purpose of smoking (Dhuma-pana) 27-29.
Treatment of Tridosaja Pratisyaya
सर्पीषि कटुतिक्तानि तीक्ष्णधूमा: कटूनि च । भेषजान्युपयुक्तानि हन्युः सर्वप्रकोपजम् ॥ ३० ॥ रसाञ्जने सातिविषे मुस्तायां भद्रदारुणि । तैलं विपक्कं नस्यार्थे विदध्याच्यात्र बुद्धिमान् ॥ ३१ ॥ मुस्ता तेजोवती पाठा कट्फलं कटुका वचा । सर्षपाः पिप्पलीमूलं पिप्पल्यः सैन्धवाग्निकौ ॥ ३२ ॥ तुत्थं करञ्जबीजञ्च लवणं भद्रदारु च । एतैः कृतं कषायन्तु कवले सम्प्रयोजयेत् । हितं मूर्धविरेके च तैलमेभिर्विपाचितम् ॥ ३३ ॥
Treatment of Tridosaja Type- Clarified butter duly prepared with the drugs of bitter and pungent tastes, inhalation of the smoke of strong-potencied drugs as well as the use of articles of pungent taste and other appropriate medicianl preparations would prove curative in a case of Tri-dosaja Pratisyaya (nasal catarrh) brought abour by the aggravation of all the three Dosas. An intelligent physician should prescribe as an errhine the medicated oil duly cooked and prepared with the admixture of Rasanjana, Ati-visa, Musta and Bhadra-daru. Gargles prepared with the decoction of Musta, Tejovati, Patha, Katphala, Katuka, Vaca, Sarsapa (mustard), Pippali-mula, Pippali, Saindhava, Agnika (Ajamoda), Tuttha, Karanja-seeds, Salt and Bhadra-daru should be prescribed. Oil duly cooked with the preceding drugs is recommended for purging (Siro-vireka) the head of the patient. 30-33.
क्षीरमर्द्धजले क्वाथ्यं जाङ्गलैर्मृगपक्षिभिः । पुष्पैर्विमिश्रं जलजैर्वातघ्नैरोषधैरपि ॥ ३४ ॥ हिमे क्षीरावशिष्टे ऽस्मिन् घृतमुत्पाद्य यत्नतः । सर्वगन्धसितानन्ता मधुकं चन्दनं तथा ॥ ३५ ॥ आवाप्य विपचेद् भूयो दशक्षीरन्तु तद् घृतम् । नस्ये प्रयुक्तमुद्रिक्तान् प्रतिश्यायान् व्यपोहति ॥ ३६ ॥ यथास्वं दोषशमनैस्तैलं कुर्य्याच्च यत्नतः ॥ ३७॥
Flesh of birds and beasts of Jangala group, aquatic flowers and the Vayu-subduig drugs (Bhadra-darvadi) should be duly cooked in milk mixed with water weighing half as much as the milk.’ The liquid in this case should be reduced to the original quantity of milk, then it should be taken down and allowed to cool. Clarified butter should then be prepared from this milk and should be again duly cooked with the drugs of the Sarvagandha (Eladi) group, sugar, Ananta, Yasti-madhu and (red) Candana and with a quantity of milk ten times its own weight. All types of nasal catarrh, yield to the curative efficacy of this medicated Ghrita, if used as an errhine (Nasya ). Oils medicated with the drugs remedial to the specific deranged Dosa involved in each case under treatment should also be prescribed. 34-37.
समूत्रपित्ताश्चोद्दिष्टाः क्रियाः क्रिमिषु योजयेत् । यापनार्थं कृमिघ्नानि भेषजानि च बुद्धिमान् ॥ ३८
1. Some say that milk and water in equal parts shuld be taken.
All the foregoing preparations should be surcharged with the urine and bile of a cow and used in cases due to the existence of local parasites, as vermifuges (e.g., drugs of the Surasadi group) should be administered as a palliative measure¹. 38.
इति सश्रुत संहितायामुत्तरतन्त्रे प्रतिश्यामप्रतिषेधव्याख्यानाम agfariseura: 11 28 ||
Thus ends the twenty-forth chapter of the Uttara-Tantra in the Sisruta Samhita which deals with the (Symptoms and) medical treatment of Pratisyaya.
44 1. In place of “f” Cakradatta reads “f” i.e. as an errhine. He also reads “af: ” i.e. pasted with the urine (of a cow), and thus does not read the bile of a cow (f) in the text. Vrnda, however, reads “” in place of “f” which means that vermifuges should be used for washing purposes.
