The commentary derives pratiśyāya as a condition in which kapha and the other doṣas move toward or against vāta. It explains pratiṣedha here as treatment.
Key terms
pratishyAya (pratiśyāya)
The nasal disorder that is the subject of this chapter.
pratiShedha (pratiṣedha)
Treatment or therapeutic management in this chapter title.
dhanvantari (Dhanvantari)
The authoritative teacher to whom the teaching is attributed.
Excessive association with women, heating or distress of the head, smoke, dust, cold, excessive heat, and suppression of urine and stool are stated to be immediate causes of pratiśyāya.
The commentary says that treatment cannot be undertaken for disorders whose features have not been identified, so the text first gives causes that produce pratiśyāya immediately, before describing its signs. Nārīprasaṅga is explained as excessive involvement with women. Śirobhitāpa means that by which the head is heated or distressed. A parenthetical explanation treats smoke and accumulated dust entering the nose as causes. Some do not read this verse, but the commentator rejects that omission because all the compilers accept the reading.
Key terms
nArIprasa~gga (nārīprasaṅga)
Excessive involvement with women, as explained by the commentary.
shirobhitApa (śirobhitāpa)
Heating or distress affecting the head.
sandhAraNa (sandhāraṇa)
Suppression or holding back of natural urges, here urine and stool.
sadyaH (sadyaḥ)
Immediately or at once, qualifying the stated causes.
Vāta and the other doṣas, and likewise blood, having accumulated either separately or together, produce pratiśyāya in people when provoked by various aggravating factors.
After stating immediately acting causes, the commentary explains causes that produce illness later through the sequence beginning with accumulation. One interpretation takes the doṣas to have accumulated in their own respective sites and then to cause pratiśyāya in the head when provoked. The provocations include such factors as violent conflict, anger, and daytime sleep. Another interpretation says that the doṣas accumulate in the head itself. Against the objection that accumulation is increase in a doṣa's own site and that vāta, pitta, kapha, and blood have no sites in the head, the commentary cites textual grounds for sites of each there: vāta moving in the mouth, pitta in skin and vision, the well-known site of śleṣman in the head, and blood through the all-pervading vessels. It therefore accepts accumulation in the head as reasonable.
Key terms
caya
Accumulation of a doṣa, interpreted either in its own site or in the head.
mArutAdayaH (mārutādayaḥ)
Vāta and the other doṣas.
shoNita (śoṇita)
Blood, included among the factors that may accumulate and be provoked.
Heaviness of the head, the onset of sneezing, bodily aching, horripilation, and various other complications are remembered as signs that precede pratiśyāya.
The commentary identifies these as the premonitory signs of pratiśyāya. The onset of kṣavathu means the occurrence of sneezing. Aṅgamarda is a particular kind of bodily pain. Parihṛṣṭaromatā means raised or bristling body hair. The various associated disturbances include fever and loss of appetite. Because they come first, these are called preceding signs or pūrvarūpas.
Key terms
shirogurutva (śirogurutva)
A feeling of heaviness in the head.
kShavathu (kṣavathu)
Sneezing.
a~ggamarda (aṅgamarda)
A particular form of bodily aching or pain.
pUrvarUpa (pūrvarūpa)
A sign appearing before the fully expressed disorder.
In pratiśyāya of the vāta type, the nose feels distended and obstructed yet produces a thin discharge; there is dryness of the throat, palate, and lips, pricking pain at the temples, and impairment of the voice.
The commentary introduces the features of vāta-type pratiśyāya. Ānaddhā means distended, as though filled, while pihitā means obstructed, as though packed with dust or sharp particles.
उष्णः सपीतकः स्रावो घ्राणात् स्रवति पैत्तिके ||७||
कृशोऽतिपाण्डुः सन्तप्तो भवत्तृष्णानि(भि)पीडितः |
सधूमं सहसा वह्निं वमतीव च मानवः ||८||
Meaning of the śloka
In pitta-type pratiśyāya, a warm, slightly yellow discharge flows from the nose. The person becomes thin, extremely pale, heated, and afflicted by thirst, and suddenly seems to expel fire together with smoke through the nose.
The commentary identifies these as the features of pitta-type pratiśyāya. Sapītaka means slightly yellow. The image of expelling fire with smoke means that the person appears to discharge smoky fire through the nose, and sahasā means suddenly.
Key terms
paittika
The pitta-associated type of pratiśyāya.
sapItaka srAva (sapītaka srāva)
A slightly yellow discharge.
tRuShNA (tṛṣṇā)
Thirst.
sadhUma vahni (sadhūma vahni)
The figurative sensation or appearance of smoky fire being expelled through the nose.
In kapha-type pratiśyāya, white and cold kapha repeatedly flows from the nose. The person has a pale or whitish appearance, swollen eyes, and heaviness of the head and face, together with intense itching of the head, throat, lips, and palate.
भूत्वा भूत्वा प्रतिश्यायो योऽकस्माद्विनिवर्तते ||१०||
सम्पक्वो वाऽप्यपक्वो वा स सर्वप्रभवः स्मृतः |
लिङ्गानि चैव सर्वेषां पीनसानां च सर्वजे ||११||
Meaning of the śloka
Pratiśyāya that repeatedly appears and then suddenly subsides, whether mature or immature, is regarded as arising from all the doṣas. In this combined type, the signs of every kind of pratiśyāya and pīnasa are present.
The commentary gives the features of the sannipātika type. Akasmāt means without an evident cause. In sarvaja pratiśyāya, the signs belonging to all the vāta-born and other types of pratiśyāya and pīnasa are to be understood as present. Citing Videha, the commentary states that sannipātika pratiśyāya is incurable.
Key terms
sarvaprabhava
Arising from all the doṣas.
sarvaja
The combined type in which features of all types occur.
pInasa (pīnasa)
A nasal disorder whose various signs are included in the combined presentation.
In blood-associated pratiśyāya there is nasal bleeding. The person has coppery-red eyes and is severely afflicted by uroghāta. The breath and mouth are foul-smelling, the sense of smell is lost, and minute, white, unctuous organisms fall from the affected area. Its features resemble those of the krimija disorder of the head.
The commentary identifies these as the features of blood-associated pratiśyāya. Uroghāta is understood according to its description in another text: the chest is injured, heavy, and rigid; the taste or fluid is foul and filled with kapha; and cough, fever, and pīnasa occur. Mūrcchanti is explained as 'they fall,' atra as 'in this blood-associated pratiśyāya,' and the krimis as minute. The condition's features are said to resemble those of krimija head disease. Some read the line about minute, white, unctuous krimis separately from the description of blood-associated pratiśyāya and explain 'here' as referring to all these types of pratiśyāya; this alternative is retained.
Key terms
raktaja pratishyAya (raktaja pratiśyāya)
The blood-associated type of pratiśyāya.
raktAsrAva (raktāsrāva)
Flow of blood or nasal bleeding.
uroghAta (uroghāta)
A chest disorder whose cited features include injury, heaviness, rigidity, foul kapha, cough, fever, and pīnasa.
kRumi (krimi)
Minute organisms described in the source; the commentary preserves disagreement about which types the line applies to.
प्रक्लिद्यति पुनर्नासा पुनश्च परिशुष्यति ||१४||
मुहुरानह्यते चापि मुहुर्विव्रियते तथा |
निःश्वासोच्छ्वासदौर्गन्ध्यं तथा गन्धान्न वेत्ति च ||१५||
एवं दुष्टप्रतिश्यायं जानीयात् कृच्छ्रसाधनम् |१६|
Meaning of the śloka
The nose repeatedly becomes moist and then dries up; at times it is obstructed and at times it opens. The inhaled and exhaled breath has an unpleasant odour, and the person cannot perceive smells. Such a condition should be understood as duṣṭa-pratiśyāya, which is difficult to treat.
The commentary says that even a pratiśyāya initially arising from a single doṣa may become vitiated through improper management when other doṣas are provoked. The verse beginning with ‘praklidyati’ describes the signs of that deteriorated state.
Key terms
duṣṭa-pratiśyāya
A deteriorated or complicated form of pratiśyāya.
niḥśvāsocchvāsa-daurgandhya
Unpleasant odour associated with inhalation and exhalation.
When all forms of pratiśyāya are left untreated, with time they give rise to other disorders and become duṣṭa-pīnasa. When aggravated, pīnasa is said to cause deafness, blindness, loss of smell, severe eye disorders, cough, weakening of agni, and swelling.
The commentary explains that neglect of any pratiśyāya, together with improper diet and conduct, may in time initiate other disorders and gradually develop into duṣṭa-pīnasa. It interprets the listed conditions as consequences of aggravated pratiśyāya. Ripeness is to be recognized from features such as thick, dependent discharge, while the opposite indicates an unripe state. It also preserves an alternative passage attributed to Vṛddha Suśruta: loss of appetite, an altered taste in the mouth, nasal discharge, pain, restlessness, heaviness of the head, sneezing, and fever are signs of the unripe state; attenuation of those signs, lightness of the head, nose, and mouth, and thick yellow kapha characterize ripe pīnasa.
Key terms
apratikārin
A person who does not undertake treatment or corrective measures.
duṣṭa-pīnasa
A deteriorated or complicated state of pīnasa.
āma
The unripe stage described by its accompanying signs.
pakva
The ripe or matured stage, here marked by reduction of earlier signs and thick yellow kapha.
Except in a newly arisen pratiśyāya, the other forms are to be managed with intake of ghee, various forms of sudation, appropriately applied emesis, and avapīḍana nasal procedures suited to the stage.
The commentary presents this as the general treatment of pratiśyāya. It glosses apāsya as ‘excluding,’ explains the use of ghee in all forms by regarding vāta as a component of each, defines kālopapanna as appropriate to the current stage, and identifies avapīḍana as a type of nasya. It then records an alternative, longer reading that prioritizes vāta even when kapha or pitta predominates and describes ghee preparations, sudation, strong emesis, and several pungent formulations for maturation. That reading also reports disagreement about whether head-cleansing and emesis should be used in the āma stage. The commentary states that Jejjaṭācārya did not accept this alternative passage.
Key terms
sarpiḥpāna (sarpiḥ-pāna)
Oral intake of ghee in the historical treatment described.
sveda
Sudation or fomentation procedure.
vamana
Therapeutic emesis in the classical regimen.
avapīḍana
A form of nasal administration identified by the commentary as a type of nasya.
अपच्यमानस्य हि पाचनार्थं स्वेदो हितोऽम्लैरहिमं च भोज्यम् |
निषेव्यमाणं पयसाऽऽर्द्रकं वा सम्पाचयेदिक्षुविकारयोगैः ||१९||
Meaning of the śloka
For a newly arisen pratiśyāya that has not matured, sudation is said to aid maturation, and warm food with sour substances is considered suitable. The verse also refers to ginger used with milk or with products of sugarcane as a means of bringing about maturation.
The commentary identifies this as management intended to mature a new pratiśyāya. It explains ahima as warm and bhojya as food. It interprets the next phrase as ginger taken with milk or with sugarcane products such as jaggery. It preserves another reading in which pungent substances are used, and notes two interpretations: ginger juice with milk, or dried ginger powder with milk. A further passage listing meats, curd, alcohol, pulses, salt, pungent and sour items, and raw radish is reported but rejected because all commentators omit it.
Key terms
apacyamāna
Not yet matured or ripened in the classical staging of the condition.
sveda
Sudation or fomentation.
ārdraka
Fresh ginger.
nāgara
Dried ginger, according to one interpretation recorded in the commentary.
ikṣuvikāra
A product derived from sugarcane, such as jaggery.
When the condition is mature and the discharge is thick and hanging down, it is said to be removed through śirovireka. After considering the doṣas, purgation, āsthāpana enema, medicated smoke, and holding medicinal preparations in the mouth are also prescribed.
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ਪਕ੍ਵਪ੍ਰਤਿਸ਼੍ਯਾਯਸ੍ਯ ਨਿਬਰ੍ਹਣਮਾਹ- ਪਕ੍ਵਮਿਤ੍ਯਾਦਿ||੨੦||
Meaning of the commentary
The commentary states briefly that this verse describes the removal or management of mature pratiśyāya.
Key terms
pakva
Mature or ripened stage of the condition.
śirovireka
A classical head-cleansing procedure.
āsthāpana
A decoction-based enema procedure in the classical regimen.
dhūmapāna
Use of medicated smoke in the historical treatment.
kavalagraha
Holding or moving a medicinal preparation in the mouth.
निवातशय्यासनचेष्टनानि मूर्ध्नो गुरूष्णं च तथैव वासः |
तीक्ष्णा विरेकाः शिरसः सधूमा रूक्षं यवान्नं विजया च सेव्या ||२१||
Meaning of the śloka
In mature pratiśyāya, the text advises sleeping, sitting, and activity in a place free from wind, along with heavy and warm covering of the head. It also prescribes strong head-cleansing measures with smoke, dry barley food, and vijayā (harītakī).
The commentary identifies these as measures to be used in mature pratiśyāya. It explains āsana as sitting, ceṣṭana as playful or physical activity, mūrdhan as the head, vāsa as clothing, and vijayā as harītakī.
शीताम्बुयोषिच्छिशिरावगाहचिन्तातिरूक्षाशनवेगरोधान् |
शोकं च मद्यानि नवानि चैव विवर्जयेत् पीनसरोगजुष्टः ||२२||
Meaning of the śloka
A person affected by pīnasa should avoid cold water, sexual intercourse, immersion in cold water, excessive worry, very dry food, suppression of natural urges, grief, and newly prepared alcoholic drinks.
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ਸੇਵ੍ਯਮੁਦ੍ਦਿਸ਼੍ਯ ਪਰਿਹਾਰ੍ਯਮਾਹ- ਸ਼ੀਤੇਤ੍ਯਾਦਿ||੨੨||
Meaning of the commentary
After stating what is to be used, the commentary says that this verse lists what should be avoided.
A person with pīnasa accompanied by vomiting, bodily weakness, fever, heaviness, loss of appetite, restlessness, and diarrhoea should be managed appropriately with lightening measures and substances intended to promote digestion and kindle agni.
The commentary presents this as stage-specific guidance for mature pratiśyāya with complications. It explains arati as a mental inability to remain settled in any place.
Key terms
sopadrava
Accompanied by complications.
vilaṅghana
Lightening measures in the classical therapeutic framework.
pācana
Measures intended to promote digestion or maturation.
dīpanīya
Substances intended to kindle agni.
arati
Restlessness or inability of the mind to remain settled, as glossed by the commentary.
For a young adult with pīnasa affected by vāta and kapha and associated with abundant fluid, the text prescribes induced vomiting. Complications are then to be addressed as previously taught, with their respective medicines and dietary arrangements. Once the earlier signs have become mild, the regimen described subsequently is to be applied.
The commentary says that this verse indicates when emesis is used in mature pratiśyāya: a young person with pīnasa involving vāta and kapha is to be made to vomit after taking abundant fluids. After vomiting, accompanying complications are treated with their respective medicines and diets as taught. The later treatment beginning ‘in vāta-type pratiśyāya one should drink…’ is introduced only after the signs of the unripe stage have diminished. The commentary also preserves a variant reading: ‘having recognized the mildness of those earlier signs, one should prescribe the regimen.’
Key terms
pracchardayet
One should induce vomiting, in the historical regimen.
vātakaphopasṛṣṭa
Affected by vāta and kapha.
vayaḥstha
A young adult, according to the commentary.
upadrava
An accompanying complication.
prāglakṣaṇa
Earlier signs, interpreted here as signs of the unripe stage.
In vātika pratiśyāya, ghee prepared with the five salts and with the first medicinal group should be taken according to the prescribed sequence. For nasya and the other measures, the complete procedure taught for ardita should be consulted.
The commentary identifies this as treatment for vātika pratiśyāya. ‘According to the sequence’ means according to the method for drinking an unctuous preparation. The first group is the Vidārigandhādi group. ‘Complete’ means the entire procedure, and the reference to ardita points to the treatment stated in the section on ardita.
Key terms
vAtika pratishyAya (vātika pratiśyāya)
The vāta-associated form of pratiśyāya addressed here.
pa~jca lavaNAni (pañca lavaṇāni)
The five salts used in preparing the ghee.
vidArigandhAdi gaNa (Vidārigandhādi gaṇa)
The first medicinal group identified by the commentary.
nasya
Historical nasal administration referenced among the measures.
ardita
The condition whose treatment section supplies the cross-referenced procedure.
For pratiśyāya arising from pitta or rakta, ghee cooked with sweet-group substances should be taken. Cool sprinklings and applications are also prescribed. Śrī, sarjarasa, pattaṅga, priyaṅgu, honey, sugar, drākṣā, madhūlikā, gojī, śrīparṇī, and madhuka are used here; medicinal mouthfuls and purgation with sweet substances are likewise indicated.
The commentary presents treatment for the pitta- and rakta-associated forms. ‘Sweet substances’ means members of the Kākolyādi group. It preserves another reading: some read that the ghee should be prepared with bitter, astringent, and sweet substances, interpreting the bitter substances as paṭola and others. Pradeha means an external paste. The commentary identifies śrī as śrīveṣṭaka, locally called guggulī; sarjarasa as rālā; pattaṅga as red sandalwood; madhūlikā as guḍūcī, while others identify it as markaṭatṛṇa; gojī as gojihvikā; and śrīparṇī as kāśmīrī. Kavala is explained as a kind of gaṇḍūṣa, and sweet purgative substances include drākṣā, āragvadha, honey, and sugar.
Oil should be cooked in ten parts milk with dhava bark, triphalā, śyāmā, tilvaka, madhuka, śrīparṇī, and rajanī. When used at the appropriate stage, this oil is said to be suitable as nasya for both pitta- and rakta-associated pratiśyāya.
The commentary says this oil is intended for nasal administration in the pitta- and rakta-associated forms. Pastes of dhava bark and the other substances, amounting to one quarter of the oil, are cooked with milk in tenfold quantity. Śyāmā is identified as trivṛt and tilvaka as paṭṭikārodhra. ‘At the appropriate stage’ means when the condition is nirāma. ‘For both’ refers to the pitta- and rakta-associated forms of pratiśyāya.
Key terms
nasya
Historical nasal administration for which the oil is intended.
shyAmA (śyāmā)
Identified in the commentary as trivṛt.
tilvaka
Identified in the commentary as paṭṭikārodhra.
nirAma (nirāma)
The stage the commentary regards as appropriate for use.
In kaphaja pratiśyāya, after oleation with ghee, emesis is prescribed using a gruel prepared with sesame and māṣa. After emesis, the kapha-reducing dietary sequence should be followed. Oil cooked with the two balās, the two bṛhatīs, viḍaṅga, trikaṇṭaka, śvetā root, sadābhadrā, and varṣābhū is prescribed as nasya. Wicks made from saralā, kiṇihī, dāru, nikumbha, and iṅgudī are prescribed for medicinal smoke according to the stated method.
The commentary explains treatment for kaphaja pratiśyāya. The gruel may be yavāgū or kṛsarā prepared with emetic substances, and after emesis the dietary restoration sequence called annasaṃsarjana is followed. Oil prepared with pastes of the two balās and the other listed substances is intended for nasya. Trikaṇṭaka is identified as gokṣuraka, śvetā as śvetasyanda, sadābhadrā as kāśmarī, saralā as trivṛt, kiṇihī as kaṭabhī, dāru as devadāru, and nikumbha as dantī.
Key terms
kaphaja pratishyAya (kaphaja pratiśyāya)
The kapha-associated form of pratiśyāya addressed here.
vamana
Therapeutic emesis prescribed in the historical treatment sequence.
annasaMsarjana (annasaṃsarjana)
The staged dietary restoration sequence followed after emesis.
dhUmapAna (dhūmapāna)
Historical inhalation of medicinal smoke from prepared wicks.
Ghee preparations made with pungent and bitter substances, strong medicinal smokes, and pungent medicines are said to counter pratiśyāya arising from the aggravation of all doṣas. For this condition, a knowledgeable physician should prepare oil with rasāñjana, ativiṣā, mustā, and bhadradāru for nasya.
The commentary identifies this as treatment for sannipātika pratiśyāya. The ghee is prepared with pungent and bitter substances. The word ‘and’ also gathers in the measures already associated with each of vāta and the other doṣas even though they are not repeated here. The oil containing rasāñjana and the other listed substances is intended for this sannipātika form.
Key terms
sAnnipAtika pratishyAya (sannipātika pratiśyāya)
Pratiśyāya attributed to the combined aggravation of all doṣas.
tIkShNa dhUma (tīkṣṇa dhūma)
Strong or sharp medicinal smoke prescribed historically.
rasA~jjana (rasāñjana)
A potent mineral-derived substance included in the nasal oil formula.
nasya
Historical nasal administration of the prepared oil.
A decoction prepared from mustā, tejovatī, pāṭhā, kaṭphala, kaṭukā, vacā, mustard, pippalī root, pippalī, saindhava, agnika, tuttha, karañja seed, salt, and bhadradāru is prescribed for use as kavala. Oil cooked with these substances is also said to be suitable for mūrdhavireka.
The commentary identifies tejovatī as kākamardanikā and agnika as ajamodā. It states that the decoction made from mustā and the other listed substances is suitable in sannipātika pratiśyāya; other authorities consider it suitable in every form of pratiśyāya.
Key terms
kavala
Holding or moving a medicinal liquid in the mouth.
mUrdhavireka (mūrdhavireka)
A historical head-cleansing procedure, here using medicated oil.
Milk mixed with half its quantity of water should be decocted with meat from jāṅgala animals and birds, aquatic flowers, and vāta-reducing medicinal substances. When cooled and reduced to milk, ghee is carefully obtained from it. This ghee is then cooked again with sarvagandha substances, sugar, anantā, madhuka, and candana, using ten times its quantity of milk. Used as nasya, it is said to remove aggravated forms of pratiśyāya. Oil may likewise be prepared carefully with substances that pacify the respective doṣa.
The commentary says the milk is eight times the quantity of the jāṅgala meat and related materials, while the water is half the quantity of the milk. Jāṅgala animals and birds include examples such as eṇa and lāva; aquatic flowers include nīlotpala, and vāta-reducing substances include the Vidārīgandhādi group. The implied step is to churn the prepared milk to obtain ghee. Sarvagandha refers to the aromatic group beginning with elā; sitā means sugar, anantā means utpalasārivā, and candana means red sandalwood. The ghee obtained by churning is then cooked with tenfold milk. The commentator says it is intended for all forms of pratiśyāya, while the oil is prepared with the drug group appropriate for pacifying each respective doṣa.
Key terms
jA~ggala (jāṅgala)
Animals and birds of dry-land habitat, exemplified here by eṇa and lāva.
sarvagandha
The aromatic group beginning with elā according to the commentary.
nasya
Historical nasal administration of the prepared ghee.
doShashamana (doṣaśamana)
Substances selected to pacify the respective doṣa.
For kṛmi, a knowledgeable physician should employ the previously prescribed measures together with urine and bile, and should also use kṛmi-reducing medicines for control of the condition.
The commentary links this treatment to the occurrence of kṛmi described in rakta-associated pratiśyāya. Measures previously designated as kṛmi-reducing are to be combined with cow urine and bile, together with kṛmi-reducing medicines such as members of the Surasādi group, for control rather than a stated cure. It also preserves another interpretation held by those who consider kṛmi possible in every form of pratiśyāya: the measures prescribed separately for the vāta and other forms should each be applied, as appropriate, with cow urine and bile when kṛmi are present.
Key terms
kRumi (kṛmi)
The class of organisms or infestation understood in this passage within the classical framework.
yApanArtha (yāpanārtha)
For control or maintenance of the condition, rather than an explicit claim of cure.
kRumighna (kṛmighna)
Measures or medicines characterized in the text as acting against kṛmi.
surasAdi (Surasādi)
The medicinal group cited by the commentary as an example of kṛmi-reducing medicines.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे प्रतिश्यायप्रतिषेधो नाम चतुर्विंशतितमोऽध्यायः ||२४||
Meaning of the śloka
Thus ends the twenty-fourth chapter, entitled ‘Prevention and Treatment of Pratiśyāya,’ in the Śālākya-tantra section of the Uttara-tantra of the Suśruta-saṃhitā.
Thus ends the twenty-fourth chapter in the Śālākya-tantra section of the Uttara-tantra in Dalhaṇa’s Nibandhasaṅgraha commentary on the Suśruta-saṃhitā.
Key terms
pratishyAyapratiShedha (pratiśyāya-pratiṣedha)
The chapter title concerning prevention and treatment of pratiśyāya.
shAlAkyatantra (Śālākya-tantra)
The textual section in which this chapter is placed.
uttaratantra (Uttara-tantra)
The division of the Suśruta-saṃhitā containing the chapter.
nibandhasa~ggraha (Nibandhasaṅgraha)
The title of Dalhaṇa’s commentary named in the colophon.