Chapter 18 – Panatyaya, Paramada, Panajirna and Panavibhrama Nidanam (Alcoholic intoxication)

The 18th chapter of Madhava Nidana deals with Panatyaya, Paramada, Panajirna and Panavibhrama Nidanam (Alcholic intoxication). Acute alcohol intoxication is a condition associated with drinking too much alcohol in a short amount of time. It’s also called alcohol poisoning. Alcohol intoxication is serious. It affects your body temperature, breathing, heart rate, and gag reflex. It can also sometimes lead to coma or death.

ये विषस्य गुणाः प्रोक्तास्ते अपि मध्ये प्रतिष्ठिताः |
तेन मिथ्योपयुक्तेन भवत्युग्रो मदात्ययः || १ ||

yē viṣasya guṇāḥ prōktāstē api madhyē pratiṣṭhitāḥ |
tēna mithyōpayuktēna bhavatyugrō madātyayaḥ || 1 ||

All the qualities and properties present in poisons are also found in a mild degree in madya (alcoholic beverages) hence, its indiscriminate use generates madatyaya or intoxication. 1

Good and bad effects of madya etc.,–

किन्तु मध्यं स्वभावेन यथैवान्नं तथा स्मृतं |
अयुक्त्तियुक्तं रोगाय युक्तियुक्तं यथा अमृतं || २ ||
प्राणाः प्राणभृतामन्नं तद्युक्त्या हिनस्त्यसून् |
विषं प्राणहरं तच्च युक्तियुक्तं रसायनम् || ३ ||

kintu madhyaṁ svabhāvēna yathaivānnaṁ tathā smr̥taṁ |
ayukttiyuktaṁ rōgāya yuktiyuktaṁ yathā amr̥taṁ || 2 ||
prāṇāḥ prāṇabhr̥tāmannaṁ tadyuktyā hinastyasūn |
viṣaṁ prāṇaharaṁ tacca yuktiyuktaṁ rasāyanam || 3 ||

Alcoholic drinks are identical to food in terms of natural properties. If they are not properly used they generate diseases. Nonetheless, if used properly the same act as nectar. The cereals sustain life if taken properly whereas they kill if improperly consumed. Similar is the case of poison; if improperly used it kills, but when used judiciously the same acts as a rejuvenator. 2-3

The benefit of using madya in a specific method –

विधिना मात्रया काले हितैरन्नैर्यथा बलम् |
प्रहृष्टो यः पिबेन्मध्यं तस्य स्यादमृतोपमम् || ४ ||
स्निग्धैस्तदन्नैर्मांसैश्च भक्ष्यैश्च सह सेवितम् |
भवेदायुःप्रकर्षाय बलायोपचयाय च || ५ ||
काम्यता मनसस्तुष्टिस्तेजो विक्रम एव च |
विधिवत्सेव्यमाने तु मध्ये सन्निहिता गुणाः ||६ ||

vidhinā mātrayā kālē hitairannairyathā balam |
prahr̥ṣṭō yaḥ pibēnmadhyaṁ tasya syādamr̥tōpamam || 4 ||
snigdhaistadannairmānsaiśca bhakṣyaiśca saha sēvitam|
bhavēdāyuḥprakarṣāya balāyōpacayāya ca || 5 ||
kāmyatā manasastuṣṭistējō vikrama ēva ca |
vidhivatsēvyamānē tu madhyē sannihitā guṇāḥ ||6 ||

Alcohol taken in accordance with proper procedure, dose, time, combination of eatables and the like and body strength gives happiness (joy) and acts like nectar.
Alcohol taken with fatty eatables, meat or other eatables rich in fat, makes way for increase of span of life and strength; those desiring happiness of the mind, physical strength and valour should take alcoholic drinks judiciously;
Madya, if taken along with unctuous substances and foods and meat which are prepared with a profuse amount of unctuous substances like ghee and oil and in a proper manner enhances longevity, strength, vigour of the body and bestows good looks, satisfaction of mind and valour. These are the qualities obtained by the proper use of madya. 4-6

Signs and symptoms of Prathama Mada (Primary intoxication) –

बुद्धि – स्मृति – प्रीतिकरः सुखश्च पानान्न – निद्रा – रतिवर्धनश्च |
सम्पाठ – गीत – स्वरवर्धनश्च प्रोक्तो अतिरम्यः प्रथमो मदो हि || ७ ||

buddhi – smr̥ti – prītikaraḥ sukhaśca pānānna – nidrā – rativardhanaśca |
sampāṭha – gīta – svaravardhanaśca prōktō atiramyaḥ prathamō madō hi || 7 ||

The first stage of drinking is considered to be very charming; it

• Increases intelligence, memory, affection and happiness
• Induces further interest in drinking, eating, sleeping and sex.

Moreover, it intensifies the power to recite, sing and the ability to speak loudly. 7

Madhyama Mada (Secondary or medium intoxication) –

अव्यक्तबुद्धि – स्मृति – वाग्विचेष्टः सोन्मत्तलीलाकृतिरप्रशान्तः |
आलस्य – निद्राभिहतो मुहुश्च मध्येन मत्तः पुरुषो मदेन || ८ ||

avyaktabuddhi – smr̥ti – vāgvicēṣṭaḥ sōnmattalīlākr̥tirapraśāntaḥ |
ālasya – nidrābhihatō muhuśca madhyēna mattaḥ puruṣō madēna || 8 ||

At the intermediary stage of intoxication, the user would only lose grip on his intellect and memory while his speech becomes confused, physical activities become irregular and he acts like insane. He becomes uncontrollable, develops laziness, and continues sleeping for long hours. 8

Tritiya Mada (Third stage of intoxication) —

गच्छेदगम्यान्न गुरुंश्च मन्येत् खादेदभक्ष्याणि च नष्टसंज्ञः |
ब्रूयाच्च गुह्यानि हृदि स्थितानि मदे तृतीये पुरुषो अस्वतन्त्रः || ९ ||

gacchēdagamyānna gurunśca manyēt khādēdabhakṣyāṇi ca naṣṭasañjñaḥ |
brūyācca guhyāni hr̥di sthitāni madē tr̥tīyē puruṣō asvatantraḥ || 9 ||

At the third stage of intoxication, the person indulges in forbidden acts and items, does not care for elders, he could consume items that are not to be eaten. Moreover, having lost control on his nerves, he speaks out secrets hidden in his heart. 9

Chaturtha Mada (Fourth stage of intoxication) –

चतुर्थे तु मदे भग्नदार्विव निष्क्रियः |
कार्याकार्यविभागज्ञो मृतादप्यपरो मृतः || १० ||
को मदं तादृशं गच्छेदुन्मादमिव चापरम् |
बहुदोषमिवामूढः कान्तारं स्ववशः कृती || ११ ||

caturthē tu madē bhagnadārviva niṣkriyaḥ |
kāryākāryavibhāgajñō mr̥tādapyaparō mr̥taḥ || 10 ||
kō madaṁ tādr̥śaṁ gacchēdunmādamiva cāparam |
bahudōṣamivāmūḍhaḥ kāntāraṁ svavaśaḥ kr̥tī || 11 ||

In the fourth and final stage of intoxication, the person falls to the ground unconscious like a tree cut down. He becomes incapable like a dead body. He no longer remains able to determine what to do and what not to do. Who would like to reach to the stage that is like another variety of dementia? No sensible, self controlled, and knowledgeable person would like to go to a jungle full of adversities. 10 -11

निर्भक्तमेकान्तत एव मध्यं निषेव्यमाणं मनुजेन नित्यम् |
आपादयेत् कष्टतमान्विकारानापादयेच्चापि शरीरभेदम् || १२ ||

nirbhaktamēkāntata ēva madhyaṁ niṣēvyamāṇaṁ manujēna nityam |
āpādayēt kaṣṭatamānvikārānāpādayēccāpi śarīrabhēdam || 12 ||

Only such a person who regularly drinks alcoholic beverages on an empty stomach and in solitude becomes victim of dreadful diseases entailing loss of life. 12

Some more irregularities in consuming alcohol and the effects –

क्रुद्धेन भीतेन पिपासितेन शोकाभितप्तेन बुभुक्षितेन |
व्यव्याम – भारध्वपरिक्षतेन वेगावरोधाभिहतेन चापि || १३ ||
अत्याम्बुभक्षावततोदरेण साजीर्णभुक्तेन तथा अबलेन |
उष्णाभितप्तेन च सेव्यमानं करोति मध्यं विविधान्विकारान् || १४ ||

kruddhēna bhītēna pipāsitēna śōkābhitaptēna bubhukṣitēna |
vyavyāma – bhāradhvaparikṣatēna vēgāvarōdhābhihatēna cāpi || 13 ||
atyāmbubhakṣāvatatōdarēṇa sājīrṇabhuktēna tathā abalēna |
uṣṇābhitaptēna ca sēvyamānaṁ karōti madhyaṁ vividhānvikārān || 14 ||

Alcoholic drinks generate several diseases in persons afflicted with anger, fear, thirst, grief and hunger and who have been emaciated due to strenuous exercise, carrying weight and walking long distances, weakened due to suppression of the natural urges of the body, drinking large quantities of water, eating too much amount of eatables or raw or undigestible eatables. The alcohol badly affects a person who is weak and who is exposed to too much of heat. 13-14

Diseases caused by irregular alcoholism –

पानात्ययं परमदं पानाजीर्णमथापि वा |
पानविभ्रममुग्रं च तेषां वक्ष्यामि लक्षणम् || १५ ||

pānātyayaṁ paramadaṁ pānājīrṇamathāpi vā |
pānavibhramamugraṁ ca tēṣāṁ vakṣyāmi lakṣaṇam || 15 ||

Panatyaya, Paramada, Panajirna and panavibhrama are the diseases caused by excessive use of alcohol. Features of these morbid conditions have been described below. 15

Madatyaya (Panatyaya) or excessive intoxication –

हिक्का – श्वास – शिरःकम्प – पार्श्वशूल – प्रजागरैः |
विध्याद्बहुप्रलापस्य वातप्रायं मदात्ययम् || १६ ||

hikkā – śvāsa – śiraḥkampa – pārśvaśūla – prajāgaraiḥ|
vidhyādbahupralāpasya vātaprāyaṁ madātyayam || 16 ||

These are the features of Panatyaya in which vata is the predominant dosha –

• Hikka — Hiccup,
• Shvasa — Dyspnea,
• Shirah kampa — Shaking of the head,
• Parshva Shula — pain in the flanks,
• loss of sleep and
• excessive talking 16

तृष्णा — दाह – ज्वर – स्वेद – मोहातिसार — विभ्रमैः |
विध्याद्धरितवर्णस्य पित्तप्रायं मदात्ययम् || १७ ||

tr̥ṣṇā — dāha – jvara – svēda – mōhātisāra — vibhramaiḥ|
vidhyāddharitavarṇasya pittaprāyaṁ madātyayam || 17||

The panaatyaya in which pitta is dominant, there appear symptoms like –

• Trshna — Morbid thirst
• Daha — Burning sensation
• Jwara — Fever
• Sveda — Perspiration
• Moha — Delusion
• Atisara — Diarrhea
• Vibhrama — Giddiness
• Greenish discolouration of the complexion of body. 17

च्छर्द्यरोचक – हृल्लास – तन्द्रा – स्तैमित्य – गौरवैः |
विध्याच्छीतपरीतस्य कफप्रायं मदात्ययम् || १८ ||
ज्ञेयस्त्रिदोषजश्चापि सर्व लिङ्गैर्मदात्ययः ||

cchardyarōcaka – hr̥llāsa – tandrā – staimitya – gauravaiḥ |
vidhyācchītaparītasya kaphaprāyaṁ madātyayam || 18 ||
jñēyastridōṣajaścāpi sarva liṅgairmadātyayaḥ ||

These symptoms signify madatyaya due to kapha predominance are –

• Chardi — Vomiting
• Arochaka — Anorexia
• Hrullasa — Nausea
• Tandra — Drowsiness
• Staimitya — Sensation of being covered with wet clothes
• Gaurav — Heaviness in the body
• And a feeling of cold

However, the symptoms of all the three doshas are found in the sannipataja type of Madatyaya. 18

Paramada (Ultimate intoxication) –

श्लेष्मोच्छ्रयो अङ्गगुरुता विरसास्यता च विण्मूत्रसक्तिरथ तन्द्रिररोचकश्च |
लिङ्गं परस्य च मदस्य वदन्ति तज्ज्ञास्तृष्णा रुजा शिरसि संधिषु चापि भेदः || १९ ||

ślēṣmōcchrayō aṅgagurutā virasāsyatā ca viṇmūtrasaktiratha tandrirarōcakaśca |
liṅgaṁ parasya ca madasya vadanti tajjñāstr̥ṣṇā rujā śirasi sandhiṣu cāpi bhēdaḥ || 19 ||

Experts enumerate the following as the features of Paramada –

• Morbid increase of Kapha (seen as excessive salivation, running of the nose and the like)
• Feeling of heaviness in the body
• Absence of any taste in the mouth
• Retention of faeces and urine
• Drowsiness
• Anorexia
• Thirst
• Headache
• And pain in the joints. 19

Panaajirna (undigested stage of alcohol) –

आध्मानमुग्रमथ चोद्गिरणं विदाहः पाने अजरां समुपगच्छति लक्षणानि |

ādhmānamugramatha cōdgiraṇaṁ vidāhaḥ pānē ajarāṁ samupagacchati lakṣaṇāni |

The symptoms when alcohol is not digested are –

• Profound bloating of the abdomen
• Vomiting
• Burning sensation

Panaavibhrama –

ह्रुद्गात्रतोद – कफसंस्रव – कण्ठधूम – मूर्च्छा – वमि – ज्वर – शिरोरुजन – प्रदाहाः || २० ||
द्वेषः सुरान्नविकृतेष्वपि तेषु तेषु तं पानविभ्रममुशन्त्यखिलेन धीराः |

hrudgātratōda – kaphasansrava – kaṇṭhadhūma – mūrcchā – vami – jvara – śirōrujana – pradāhāḥ || 20 ||
dvēṣaḥ surānnavikr̥tēṣvapi tēṣu tēṣu taṁ pānavibhramamuśantyakhilēna dhīrāḥ |

Panavibhrama, according to the expert, is cauterized by

• pricking sensation in the heart and the body,
• dribbling of saliva,
• fumes in the throat,
• syncope
• vomiting
• fever
• headache
• burning sensation, and
• hatred towards alcohol and food
• and in the preparations made with the concoction of these two as ingredients. 20

Incurability of intoxication –

हिनोत्तरौष्टमतिशीतमन्ददाहं तैलप्रभास्यमपि पानहतं त्यजेत्तु || २१ ||
जिह्वौष्ट – दन्तमसितं त्वथवा अपि नीलं पीते च यस्य नयने रुधिरप्रभे वा |

hinōttarauṣṭamatiśītamandadāhaṁ tailaprabhāsyamapi pānahataṁ tyajēttu || 21 ||
jihvauṣṭa – dantamasitaṁ tvathavā api nīlaṁ pītē ca yasya nayanē rudhiraprabhē vā |

The wise should not try to treat that patient of

• Excessive drinking whose upper lip has lowered down
• who has become very cold externally but feels a moderate burning sensation internally,
• who has a oily radiance on his face,
• whose tongue, lips and teeth have turned black or blue or
• whose eyes have turned yellow or bloody red. 21

Complications of Intoxication –

हिक्का – ज्वरौ वमथु वेपथु पार्श्व शूलाः
कास – भ्रमावापि च पानहतं भजन्ते || २२ ||

hikkā – jvarau vamathu vēpathu pārśva śūlāḥ
kāsa – bhramāvāpi ca pānahataṁ bhajantē || 22 ||

The complications of Intoxication are –

• Hiccup
• Fever
• Vomiting
• Rigors
• And pain in the flanks
• Cough
• Giddiness. 22

इति माधवकरविरचिते माधवनिदाने पानात्यय – परमद – पानाजीर्ण – पानविभ्रमनिदानं समाप्तम् ||18 ||

iti mādhavakaraviracitē mādhavanidānē pānātyaya – paramada – pānājīrṇa – pānavibhramanidānaṁ samāptam ||18 ||

Thus concludes the chapter of Madatyaya and the like.

Source —

1. Alcohol Intoxication