Sushruta Samhita Uttaratantra Chapter 24 Pratiśāyaya Pratiṣedha (Treatment of Nasal Catarrh / Rhinitis/ Common Cold)

The 24th chapter of Uttaratantra of Sushruta Samhita is named as Pratiśāyaya Pratiṣedha Adhyaya. This chapter deals with the Treatment of Nasal Catarrh / Rhinitis/ Common Cold.

अथातः प्रतिश्यायप्रतिषेधं व्याख्यास्यामः ।। १ ।।
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound pratiśyāya pratişedha – treatment of nasal catarrh / common cold; as revealed by the venerable Dhanvantari.

Pratiśyāya nidāna – causes

नारीप्रसङ्गः शिरसोऽभितापो धूमो रजः शीतमतिप्रतायः ।।
संधारणं मूत्रपुरीषयोश्च सद्यः प्रतिश्यायनिदानमुक्तम् ।। ३ ।।

Below mentioned are the immediate causes for Pratisyaya –

–        Indulgence in copulation,

–        Head injury,

–        Being afflicted by exposure to smoke, sunlight, dust etc.

–        Affected by too much cold due to exposure to mist, fog, rain, breeze etc.

–        Suppression of urges of urine and faeces

Samprāpti – pathogenesis

चयं गता मूर्धनि मारुतादयः पृथक् समस्ताश्च तथैव शोणितम् ||
प्रकोप्यमाणा विविधैः प्रकोपणैर्नृणां प्रतिश्यायकरा भवन्ति हि ।।४।।

Due to exposure to exciting / causative factors mentioned above, vata and other doshas get aggravated, either individually or in combination and also would get associated with rakta – blood. These doshas accumulate in the head and produce Pratisyaya – nasal catarrh.

Pūrvarūpa – premonitory symptoms

शिरोगुरुत्वं क्षवथोः प्रवर्तनं तथाऽङ्गमर्दः परिहृष्टरोमता ।।
उपद्रवाश्चाप्यपरे पृथग्विधा नृणां प्रतिश्यायपुरःसराः स्मृताः ||५||

Below mentioned are the premonitory symptoms of pratisyaya –

–        Feeling of heaviness of the hed,

–        More sneezes,

–        Body aches,

–        Horripilations and

–        Many complications such as fever, loss of taste etc.

Pratilyaya laksana

Vataja Pratisyaya

आनद्धा पिहिता नासा तनुस्रावप्रवर्तिनी |
गलताल्वोष्ठशोषश्च निस्तोदः शङ्खयोस्तथा ||६||
स्वरोपघातश्च भवेत् प्रतिश्यायेऽनिलात्मके |

Symptoms of Pratisyaya produced by aggravated vata –

–        Bloating and obstruction of nose,

–        Flow of thin (watery) fluid out of nose,

–        Dryness of throat and lips,

–        Constant pain in the temples,

–        Voice disorders

Pittaja Pratisyaya

उष्णः सपीतकः स्रावो घ्राणात् स्रवति पैत्तिके ||७||
कृशोऽतिपाण्डुः सन्तप्तो भवत्तृष्णानि(भि)पीडितः |
सधूमं सहसा वह्निं वमतीव च मानवः ||८||

Symptoms of Pratisyaya produced by aggravated Pitta –

–        Flow of warm, yellow fluid from the nose,

–        Emaciation,

–        Severe anaemia,

–        Excessive thirst,

–        Feeling of hot smoke coming out from the nose

Kaphaja Pratisyaya

कफ: कफकृते प्राणाः शीत: वेमुहुः ॥
शुक्लावभासः शूनाक्षो भवेरुशरोमुखः ॥९॥
शिरोगलौष्ठतालूनां कण्डूयनमतीव च

Symptoms of Pratisyaya produced by aggravated kapha –

–        Flow of white or yellow and cold fluid from the nose,

–        Whitish colouration of skin etc.

–        Swelling of eyes,

–        Feeling of heaviness of head and face,

–        Severe itching in the head, throat, lips and palate

Sarvabhava (Sannipataja) Pratisyaya

भूत्वा भूत्वा प्रतिश्यायो योऽकस्माद्भिनिवर्तते ।।१०।।
संपको वाऽप्यपको वा स सर्वप्रभवः स्मृतः ॥
लिङ्गानि चैव सर्वेशं पीनसानां च सर्वजे ।।११।।

Symptoms of Pratisyaya produced by all doshas –

–        Appearance and disappearance of symptoms without any cause,

–        Signs of ripe or unripe doshas may be produced

Raktaja Pratisyaya

रक्तजे तु प्रतिश्याये रक्तास्त्रायः प्रवर्तते ।।
ताम्राक्षश्च भवेम्जन्तुरुरोपातप्रपीडितः ॥१२॥
दुर्गन्योच्यासवदनस्तथा गन्यत्र येति ॥
मूर्च्छन्ति चात्र कृमयः घेता: स्निग्धास्तावः ||१३||
कृमिमूर्धविकारेण समानं चास्य लक्षणम् ।।

Symptoms of Pratisyaya produced by aggravated Rakta – blood,

–        Bleeding from nose,

–        Reddish eyes,

–        Chest pain,

–        Foul smelling breath,

–        Unable to understand or differentiate between different odours,

–        Krimis (worms, bacteria) – which are white, unctuous and minute are formed in the nose and also come out of the nose and

–        Features similar to krimija sirasula – headaches caused by worms and bacteria

Duşta pratisyāya

प्रक्लिद्यति पुनर्नासा पुनश्च परिशुष्यति ।।१४।।
मुहुरानहाते चापि मुहुर्विवियते तथा ।।
निःश्वासोच्छ्रासदौर्गन्ध्यं तथा गन्यान्न वेत्ति च ।। १५ ।।
एवं दुष्टप्रतिश्यायं जानीयात् कृच्छ्रसाधनम् ।।

Symptoms of Dusta Pratisyaya – chronic rhinitis –

–        Moistness or dryness of the nose again and again,

–        Bloating / swelling sometimes and widening sometimes (of the nose),

–        Bad smell during inspiration and expiration

–        Unable to recognize and appreciate smell

This condition is difficult to cure.

Pratiśyāya pariņāma

सर्व एव प्रतिश्याया नरस्याप्रतिकारिणः ।। १६ ।।
कालेन रोगजनना जायन्ते दुष्टपीनसाः ।।
बाधिर्यमान्ध्यमघ्राणं घोरांच नयनामयान् ॥
कासाग्निसादशोफांश्च वृद्धाः कुर्वन्ति पीनसाः ।।१७।।

All kinds of Pratisyaya give rise to many diseases in due course of time when not treated at appropriate time. Below mentioned are some of those conditions –

–        Chronic rhinitis,

–        Deafness,

–        Blindness,

–        Loss of sensation of smell,

–        Dreaded diseases of the eyes,

–        Cough,

–        Weak digestive capacity (weak digestive fire) and

–        Dropsy

Pratiśyāya cikitsä – treatment of nasal catarrh

नवं प्रतिश्यायमपास्य सर्व मुपाचरेत् सर्पिष एव पानैः ।।
स्वेदैर्विचित्रैर्वमनैश्च युक्तैः कालोपपन्नैरवपीडनैश्च ।।१८।।

Treatment principles of all kinds of Pratisyaya other than nascent (of recent origin) type of the disease –

–        Drinking of ghee only followed by

–        Sudation of different kinds,

–        Emesis and

–        Nasal medication

These therapies are beneficial when done at appropriate times.

अपच्यमानस्य हि पाचनार्थं स्वेदो हितोऽप्लैरहिमं च भोज्यम् ।।
निषेव्यमाणं पयसाऽऽर्द्रकं वा संपाचयेदिक्षुविकारयोगैः ।।१९।।

Sudation is beneficial to ripen the unripe state of doshas. Foods which are sour in taste and hot in potency should be used. Milk boiled with ardraka should be eaten. Likewise, products of sugarcane juice like jaggery, sugarcandy, sugar etc too should be consumed.

पक्वं घनं चाप्यवलम्बमानं शिरोविरेकैरपकर्षयेत्तम् |
विरेचनास्थापनधूमपानैरवेक्ष्य दोषान् कवलग्रहैश्च ||२०||

The exudate has become solid (jelly like) and hangs out of the nose in the ripe state of the disease. This should be removed by the below mentioned measures after considering the condition of doshas –

–        Purgation to the head,

–        Purgation,

–        Decoction enema,

–        Inhalation of medicated smoke and

–        Mouth gargles

निवातशय्यासनचेष्टनानि मूर्ध्नो गुरूष्णं च तथैव वासः |
तीक्ष्णा विरेकाः शिरसः सधूमा रूक्षं यवान्नं विजया च सेव्या ||२१||

The patient should do the below mentioned things –

–        Should sleep, sit and involve in other activities in a house devoid of breeze,

–        Wear heavy garments on the head,

–        Should undergo strong purgation to the head and inhalation of medicated smoke,

–        Consume foods prepared with boiled barley and haritaki without addition of fats

शीताम्बुयोषिच्छिशिरावगाहचिन्तातिरूक्षाशनवेगरोधान् |
शोकं च मद्यानि नवानि चैव विवर्जयेत् पीनसरोगजुष्टः ||२२||

The patient of pinasa / pratisyaya should avoid the below mentioned –

–        Drinking cold water,

–        Copulation,

–        Immersion in cold water,

–        Worry,

–        Very dry foods,

–        Suppression of body urges,

–        Grief and

–        Drinking fresh wines

छर्द्यङ्गसादज्वरगौरवार्तमरोचकारत्यतिसारयुक्तम् |
विलङ्घनैः पाचनदीपनीयैरुपाचरेत् पीनसिनं यथावत् ||२३||

The patient with below mentioned conditions should be treated with fasting and use of appetizer and carminative herbs –

–        Vomiting,

–        Debility,

–        Fever,

–        Feeling of heaviness of the body,

–        Loss of taste,

–        Restlessness and

–        Diarrhea

बहुद्रवैर्वातकफोपसृष्टं प्रच्छर्दयेत् पीनसिनं वयःस्थम् |
उपद्रवांश्चापि यथोपदेशं स्वैर्भेषजैर्भोजनसंविधानैः |
जयेद्विदित्वा मृदुतां गतेषु प्राग्लक्षणेषूक्तमथादिशेच्च ||२४||

Vomiting should be administered with liquid emetics to patients of Pinasa of suitable (middle) age and having predominance of vata and kapha.

Suitable medicines and diet (foods) according to the dosha aggravated should be used to treat the complications. Suitable foods and activities should be advised after determining the mitigation of disease from the symptoms described earlier.

वातिके तु प्रतिश्याये पिबेत् सर्पिर्यथाक्रमम् |
पञ्चभिर्लवणैः सिद्धं प्रथमेन गणेन च ||२५||
नस्यादिषु विधिं कृत्स्नमवेक्षेतार्दितेरितम् |

Treatment of Vataja Pratisyaya – Below mentioned recipes may be administered –

–        Ghee boiled with five salts for drinking and

–        Herbs belonging to Vidarigandhadi Gana group,

–        Nasal medication – as indicated in the treatment of ardita (Chikitsa Sthana, chapter 5)

पित्तरक्तोत्थयोः पेयं सर्पिर्मधुरकैः शृतम् ||२६||
परिषेकान् प्रदेहांश्च कुर्यादपि च शीतलान् |
श्रीसर्जरसपत्तङ्गप्रियङ्गुमधुशर्कराः ||२७||
द्राक्षामधूलिकागोजीश्रीपर्णीमधुकैस्तथा |
युज्यन्ते कवलाश्चात्र विरेको मधुरैरपि ||२८||

Treatment of Pittaja and Raktaja Pratisyaya – Below mentioned recipes may be administered –

–        Ghee boiled and prepared with herbs which predominantly have sweet taste

–        Liquids for pouring should be used cold and

–        Poultices too should be used cold,

–        Mouth gargle may be done with – Srivestaka, Sarjarasa, Pattanga, Priyangu, Madhu and Sarkara

–        Mouth gargle may be done with – Draksa, Madhulika, Gojihva, Sriparni and Madhuka

–        Purgation – should be induced by using herbs predominantly having sweet taste

धवत्वक्त्रिफलाश्यामातिल्वकैर्मधुकेन च |
श्रीपर्णीरजनीमिश्रैः क्षीरे दशगुणे पचेत् ||२९||
तैलं कालोपपन्नं तन्नस्यं स्यादनयोर्हितम् |

Decoction is prepared by boiling the below mentioned herbs in water –

–        Bark of Dhava,

–        Triphala, Syama,

–        Tilvaka,

–        Madhuka,

–        Sriparni and

–        Rajani

Ten parts of milk and one part of oil are added to this, cooked and medicated oil is prepared. This oil should be used as nasal drops with benefit, in both these diseases.

कफजे सर्पिषा स्निग्धं तिलमाषविपक्वया ||३०||
यवाग्वा वामयेद्वान्तः कफघ्नं क्रममाचरेत् |
उभे बले बृहत्यौ च विडङ्गं सत्रिकण्टकम् ||३१||
श्वेतामूलं सदाभद्रां वर्षाभूं चात्र संहरेत् |
तैलमेभिर्विपक्वं तु नस्यमस्योपकल्पयेत् ||३२||
सरलाकिणिहीदारुनिकुम्भेङ्गुदिभिः कृताः |
वर्तयश्चोपयोज्याः स्युर्धूमपाने यथाविधि ||३३||

Treatment of Kaphaja Pratisyaya – This condition may be treated as explained below –

–        Emesis – Ghee or thick gruel boiled with tila and masa should be used to produce vomiting.

–        Kapha mitigating therapies – should be administered after administering vomiting.

Also,

Nasal drops should be instilled with medicated oil prepared using the below mentioned herbs –

–        Two kinds of Bala,

–        Two varieties of Brhati,

–        Vidanga,

–        Trikantaka,

–        Roots of Sveta,

–        Sadabhadra (Kasmari) and

–        Varsabhu

A smoke wick (cigar) should be prepared with the below mentioned herbs –

–        Sarala,

–        Kinihi,

–        Devadaru,

–        Nikumbha and

–        Ingudi

The smoke from this should be inhaled according to the procedure.

सर्पींषि कटुतिक्तानि तीक्ष्णधूमाः कटूनि च |
भेषजान्युपयुक्तानि हन्युः सर्वप्रकोपजम् ||३४||
रसाञ्जने सातिविषे मुस्तायां भद्रदारुणि |
तैलं विपक्वं नस्यार्थे विदध्याच्चात्र बुद्धिमान् ||३५||

Treatment of Pratisyaya produced by all the three doshas – This condition shall be treated as below mentioned –

–        Ghee boiled with pungent and bitter herbs shall be given for drinking,

–        Smoke inhalation – with strong and pungent herbs (alt – smoke inhalation with strong drugs and consumption of powders or medicines prepared using pungent drugs)

–        For nasal drops – Oil prepared by boiling with rasanjana, ativisa, musta and bhadradaru should be used

मुस्ता तेजोवती पाठा कट्फलं कटुका वचा |
सर्षपाः पिप्पलीमूलं पिप्पल्यः सैन्धवाग्निकौ ||३६||
तुत्थं करञ्जबीजं च लवणं भद्रदारु च |
एतैः कृतं कषायं तु कवले सम्प्रयोजयेत् ||३७||
हितं मूर्धविरेके च तैलमेभिर्विपाचितम् |३८|

Decoction is prepared with the below mentioned herbs –

–        Musta,

–        Tejovati,

–        Patha,

–        Katphala,

–        Katuka,

–        Vaca,

–        Sarsapa,

–        Pippalimula,

–        Pippali,

–        Saindhava,

–        Agnika,

–        Tuttha,

–        Karanja Bija,

–        Lavana and

–        Bhadradaru

This decoction should be used as mouth gargles.

For purgation to the head – oil prepared with the same herbs (above mentioned) should be used.

Dasaksira ghrta

क्षीरमर्धजले क्वाथ्यं जाङ्गलैर्मृगपक्षिभिः ||३८||
पुष्पैर्विमिश्रं जलजैर्वातघ्नैरौषधैरपि |
हिमे क्षीरावशिष्टेऽस्मिन् घृतमुत्पाद्य यत्नतः ||३९||
सर्वगन्धसितानन्तामधुकं चन्दनं तथा |
आवाप्य विपयेद्भूयो दशक्षीरं तु तद्घृतम् ||४०||
नस्ये प्रयुक्तमुद्रिक्तान् प्रतिश्यायान् व्यपोहति |
यथास्वं दोषशमनैस्तैलं कुर्याच्च यत्नतः ||४१||

Milk is added with the below mentioned and boiled together –

–        Half its quantity of water,

–        Meat of animals and birds living in arid regions,

–        Flowers of plants growing in water and

–        Vata mitigating herbs

All these are cooked until only milk remains.

This should now be churned, its butter obtained and made into ghee later.

This is added with the below mentioned ingredients and cooked to form medicated ghee –

–        Paste of Sarvagandha – fragrant herbs like ela, karpura etc.

–        Sita – sugar,

–        Ananta – sariva,

–        Madhuka and

–        Chandana and

–        Ten parts of milk

This ghee should be used as nasal drops. It mitigates the increased nasal catarrh.

In the same way, medicated oil may be prepared with dosha mitigating herbs and used as nasal drops.

समूत्रपित्ताश्चोद्दिष्टाः क्रियाः कृमिषु योजयेत् |
यापनार्थं कृमिघ्नानि भेषजानि च बुद्धिमान् ||४२||

Herbs which are krimighna – ‘worm destroying’ in action should be mixed with urine and bile of animals and administered in pratisyaya produced by krimi – worms (bacteria, virus etc.).

The therapies which destroy worms should be continued until the disease persists.

इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे प्रतिश्यायप्रतिषेधो नाम चतुर्विंशतितमोऽध्यायः ||२४||

Thus ends the twenty fourth chapter by name Pratiśyāya Pratişedha in Uttara Sthana of Susruta Samhita.