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Chapter 17 – Murccha, Bhrama, Nidraa, Tandra, Samnyasa Nidanam

The 17th chapter of Madhava Nidana deals with Murccha, Bhrama, Nidraa, Tandra, Samnyasa which is Fainting, Giddiness, slumber, stupor and loss of consciousness.

क्षीणस्य बहुदोषस्य विरुद्धाहारसेविनः |
वेगाघातादभीघाताद्धीनसत्त्वस्य वा पुनः || १ ||
करणायतनेषूग्रा बाह्येष्वाभ्यन्तरेषु च |
निविशन्ते यदा दोषास्तदा मूर्छन्ति मानवाः || २ ||

kṣīṇasya bahudōṣasya viruddhāhārasēvinaḥ|
vēgāghātādabhīghātāddhīnasattvasya vā punaḥ || 1 ||
karaṇāyatanēṣūgrā bāhyēṣvābhyantarēṣu ca |
niviśantē yadā dōṣāstadā mūrchanti mānavāḥ || 2 ||

One who is afflicted with the disease Murcha (fainting) when he –

  •  is emaciated
  • Has all the three doshas increased
  • Regularly indulges in incompatible and irregular foods
  • Develops a habit of suppressing the natural urges.

The disease murcchaa also attacks those who are injured and those who are mentally weak. In such cases, all the doshas invade the external and internal organs of the mind of the individual and make him unconscious. 1 – 2

संज्ञावहासु नाडीषु पिहितास्वनिलादिभिः |
तमो अभ्युपैति सहसा सुखदुःखव्यपोहकृत् || ३ ||
सुखदुःखव्यपोहाच्च नरः पतति काष्टवत् |
मोहो मूर्च्छेति तामाहुः षड्विधा सा प्रकीर्तिता || ४ ||

sañjñāvahāsu nāḍīṣu pihitāsvanilādibhiḥ |
tamō abhyupaiti sahasā sukhaduḥkhavyapōhakr̥t || 3 ||
sukhaduḥkhavyapōhācca naraḥ patati kāṣṭavat |
mōhō mūrcchēti tāmāhuḥ ṣaḍvidhā sā prakīrtitā || 4 ||

When the sanjyavaha naadi (sensory nerves) are blocked by vata and other doshas, one is occupied by tamoguna (the darkness) which makes one devoid of discrimination of pleasure and agony and ultimately makes him fall down like a log of wood. This condition is known as moha or murccha. The disease is of six varieties. 3-4

वातादिभिः शोणितेन मध्येन च विषेण च |
षट्स्वप्येतासु पित्तं तु प्रभुत्वेनावतिष्टते || ५ ||

vātādibhiḥ śōṇitēna madhyēna ca viṣēṇa ca |
ṣaṭsvapyētāsu pittaṁ tu prabhutvēnāvatiṣṭatē || 5 ||

Out of these 6 varieties of the disease,

  • 3 are produced by each of the three doshas
  • One is produced from rakta
  • One from madya (alcoholic beverage) while
  • The sixth variety of moha is produced by visha.

However, in all these six types, the pitta dosha remains dominant. 5

Prodromal features of Murchaa –

हृत्पीडा जृम्भणं ग्लानिः संज्ञादौर्बल्यमेव च |
सर्वासां पूर्वरूपाणि, यथास्वं ता विभावयेत् || ६ ||

hr̥tpīḍā jr̥mbhaṇaṁ glāniḥ sañjñādaurbalyamēva ca |
sarvāsāṁ pūrvarūpāṇi, yathāsvaṁ tā vibhāvayēt || 6 ||

The premonitory features of the all varieties of murccha –

  • Pericardial pain
  • Yawning
  • Fatigue
  • Diminished sensory perception

However, the diagnosis of individual types has to be done judiciously based on their specific clinical features described below. 6

Vata Type of Murccha –

नीलं वा यदि वा कृष्णमाकाशमथवा अरुणम् |
पश्यंस्तमः प्रविशति शीघ्रं च प्रतिबुध्यते || ७ ||
वेपथुश्चाङ्गमर्दश्च प्रपीडा हृदयस्य च |
कार्श्यं श्यावा अरुणाच्छाया मूर्च्छाये यातसम्भवे || ८ ||

nīlaṁ vā yadi vā kr̥ṣṇamākāśamathavā aruṇam |
paśyanstamaḥ praviśati śīghraṁ ca pratibudhyatē || 7 ||
vēpathuścāṅgamardaśca prapīḍā hr̥dayasya ca |
kārśyaṁ śyāvā aruṇācchāyā mūrcchāyē yātasambhavē || 8 ||

The persons suffering from vataja type of murccha sees the sky as well as his surroundings in blue, black, or crimson colours. He goes into darkness, falls down unconscious, but regains consciousness quickly.

Moreover, there are

  • Tremors
  • Pain all over the body
  • Severe pain in the heart
  • Emaciation
  • Blackish red discoloration of the skin of patient. 7 – 8

Pitta type of murccha –

रक्तं हरितवर्णं वा वियत् पीतमथापि वा |
पश्यंस्तमः प्रविशति सस्वेदश्च प्रबुध्यते || ९ ||
सपिपासः ससन्तापो रक्त – पीताकुलेक्षणः |
(जातमात्रे पतति च शीघ्रं च प्रतिबुध्यते |)
सम्भिन्नवर्चाः पीताभो मूर्च्छाये पित्तसम्भवे || १० ||

raktaṁ haritavarṇaṁ vā viyat pītamathāpi vā |
paśyanstamaḥ praviśati sasvēdaśca prabudhyatē || 9 ||
sapipāsaḥ sasantāpō rakta – pītākulēkṣaṇaḥ |
(jātamātrē patati ca śīghraṁ ca pratibudhyatē |)
sambhinnavarcāḥ pītābhō mūrcchāyē pittasambhavē || 10 ||

While suffering from pitta type of murccha, the patient sees the sky in blood red, green, or yellow colour.

He becomes turbid and falls suddenly during the evenings, as it gets dark. Nevertheless, he comes to senses immediately. Moreover, he has diarrhea and his skin turns to yellowish in complexion. 9-10

Kapha Type of Murccha –

मेघसङ्काशमाकाशमावृतं वा तमोघनैः |
पश्यंतमः प्रविशति चिराच्च प्रतिबुध्यते || ११ ||
गुरुभिः प्रावृतैरङ्गैर्यथैवार्द्रेण चर्मणा |
सप्रसेकः सहृल्लासो मूर्च्छाये कफसम्भवे || १२ ||

mēghasaṅkāśamākāśamāvr̥taṁ vā tamōghanaiḥ |
paśyantamaḥ praviśati cirācca pratibudhyatē || 11 ||
gurubhiḥ prāvr̥tairaṅgairyathaivārdrēṇa carmaṇā |
saprasēkaḥ sahr̥llāsō mūrcchāyē kaphasambhavē || 12 ||

In kaphaja Murccha or fainting,

  • The person sees the sky like the clouds themselves or else as if it is covered with dense dark clouds and then he faints.
  • The patient regains consciousness very late, feels his body parts heavy,
  • And feels as if he has been covered with moist leather.
  • Moreover, he also faces salivation and nausea. 11 – 12

Sannipata (Tridosha) type of Murccha –

सर्वाकृतिः सन्निपातादपस्मार इवागतः |
स जन्तुं पातयत्याशु विना बीभत्सचेष्टितैः || १३ ||

sarvākr̥tiḥ sannipātādapasmāra ivāgataḥ |
sa jantuṁ pātayatyāśu vinā bībhatsacēṣṭitaiḥ || 13 ||

  • In sannipataja type (the murccha due to aggravation of all the doshas together), there could be manifestation of all the symptoms together.
  • The person behaves like a patient of apasmara
  • However, he would not indulge in the bibhasta chesta (that is cutting his own tongue, moving the eyeball without any direction or a purpose or like acts) 13

Raktaja Murccha (Syncope caused by smelling blood) –

पृथिव्यापस्तमोरूपं रक्तगन्धस्तदन्वयः |
तस्माद्रक्तस्य गन्धेन मूर्च्छन्ति भुवि मानवाः || १४ ||
द्रव्यस्वभाव इत्येके दृष्ट्वा यदभिमुह्यति |

pr̥thivyāpastamōrūpaṁ raktagandhastadanvayaḥ |
tasmādraktasya gandhēna mūrcchanti bhuvi mānavāḥ || 14 ||
dravyasvabhāva ityēkē dr̥ṣṭvā yadabhimuhyati |

Prithvi (the earth) and aapa (the water) are dominated by the tamas (the quality of darkness) while the raktagandha (smell of blood) also has both of these two components. Therefore, by the smell of blood, the human beings can be fainted. When the fainting occurs on mere seeing the blood, some authorities attribute this to the specific property of the blood. 14

Murccha caused by Visha (Poison) and Madya (alcohol) —

गुणास्तीव्रतरत्वेन स्थितास्तु विष – मध्ययोः || १५ ||
त एव तस्मात्ताभ्यां तु मोहौ स्यातां यथेरितौ |

guṇāstīvrataratvēna sthitāstu viṣa – madhyayōḥ || 15 ||
ta ēva tasmāttābhyāṁ tu mōhau syātāṁ yathēritau |

In murccha generated by poisons and alcoholic drinks, as many as ten features are very profound. These features are quite dangerous. They have been described elsewhere. 15

The features of murccha of rakta (blood), madya (alcohol) and visha (poison) –

स्तब्धाङ्गदृष्टिस्त्वसृजा गूढोच्छवासश्च मूर्च्छितः || १६ ||

stabdhāṅgadr̥ṣṭistvasr̥jā gūḍhōcchavāsaśca mūrcchitaḥ || 16 ||

In raktaja murcha, there is

  • Stiffness in the body
  • Gaze is fixed
  • The respiration of the patient turns deep. 16

मध्येन विलपन् शेते नष्ट – विभ्रान्तमानसः |
गात्राणि विक्षिपन् भूमौ जरां यावन्न याति तत् || १७ ||

madhyēna vilapan śētē naṣṭa – vibhrāntamānasaḥ |
gātrāṇi vikṣipan bhūmau jarāṁ yāvanna yāti tat || 17 ||

In the cases of the madyaja (alcoholic) murccha, there is

  • An inconsistent speech
  • He falls on the ground and loses his mental faculty. 17

वेपथु – स्वप्न – तृष्णाः स्युस्तमश्च विषमूर्च्छिते |
वेदितव्यं तीव्रतरं यथास्वं विषलक्षणैः || १८ ||

vēpathu – svapna – tr̥ṣṇāḥ syustamaśca viṣamūrcchitē |
vēditavyaṁ tīvrataraṁ yathāsvaṁ viṣalakṣaṇaiḥ || 18 ||

In a case of fainting due to poisons, there is

  • Trembling
  • Sleepiness
  • Excessive thirst and
  • Unconsciousness.

Nevertheless, more severe symptoms may appear specific to the respective poisons involved. 18

The factors involved in causing murccha, bhrama, tandra, and nidra –

मूर्च्छा पित्त – तमः प्राया रजः – पित्तानिलाद्भ्रमः |
तमो – वात – कफात्तन्द्रा निद्रा श्लेष्म – तमोभवा || १९ ||

mūrcchā pitta – tamaḥ prāyā rajaḥ – pittānilādbhramaḥ |
tamō – vāta – kaphāttandrā nidrā ślēṣma – tamōbhava || 19 ||

Murccha (syncope) is caused due to pitta and tamas; bhrama (giddiness) is caused due to Rajas, pitta, and anila (vata); the disease tandra is caused by tama, vata and kapha. The morbid sleeping tendency is produced due to involvement of Kapha and aama. 19

The features of Tandra –

इन्द्रियार्थेष्वसंवित्तिर्गौरवं जृम्भणं क्लमः |
निद्रार्तस्येव यस्येहा तस्य तन्द्रां विनिर्दिशेत् || २० ||

indriyārthēṣvasanvittirgauravaṁ jr̥mbhaṇaṁ klamaḥ |
nidrārtasyēva yasyēhā tasya tandrāṁ vinirdiśēt ||20 ||

In the cases of Tandra or stupor, there is

  • Non perception of the objects by the sense organs
  • Feeling of heaviness in the body
  • Excessive yawning

The patient feels weakness even without physical work and he ever appears as if sleeping. 20

Difference between murccha and samnyaasa –

दोषेषु मदमूर्च्छायाः कृतवेगेषु देहिनाम् |
स्वयमेवोपशाम्यन्ति संन्यासो नौषधैर्विना || २१ ||

dōṣēṣu madamūrcchāyāḥ kr̥tavēgēṣu dēhinām |
svayamēvōpaśāmyanti sannyāsō nauṣadhairvinā || 21 ||

In the cases of mada, murccha and the like, the person recover soon without medicines after the bout is over and, whereas in the case of samnyasa (coma) the disease does not subside without a proper treatment. 21

Features of Samnyasa –

वाग्देह – मनसां चेष्टामाक्षिप्यातिबला मलाः |
संन्यस्यन्त्यबलं जन्तुं प्राणायतनमाश्रिताः || २२ ||
स ना संन्यास संन्यस्तः काष्टीभूतो मृतोपमः |
प्राणैर्विमुच्यते शीघ्रं मुक्त्वा सध्यःफलां क्रियाम् || २३ ||

vāgdēha – manasāṁ cēṣṭāmākṣipyātibalā malāḥ |
sannyasyantyabalaṁ jantuṁ prāṇāyatanamāśritāḥ || 22 ||
sa nā sannyāsa sannyastaḥ kāṣṭībhūtō mr̥tōpamaḥ |
prāṇairvimucyatē śīghraṁ muktvā sadhyaḥphalāṁ kriyām || 23||

The doshas that have become very powerful and that are localized at the vital centres of the body, Paralyse the functions of speech, body and the mind, and render the person powerless.

The patient of coma or samnyasa lies unconscious and senseless like a log of wood as if he is dead. Unless quick and helpful measures are taken immediately the patient loses life. 22 – 23

इति श्रीमाधवकरविरचिते माधवनिदाने मूर्च्छा – भ्रम – निद्रा – तन्द्रा – संन्यासनिदानं समाप्तम् ||17 ||

iti śrīmādhavakaraviracitē mādhavanidānē mūrcchā – bhrama – nidrā – tandrā – sannyāsanidānaṁ samāptam ||17 ||

Thus concludes the chapter of Murcha and the like.