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Chapter 58 – Nasa Roga Nidanam

The 58th chapter of Madhava nidana is Nasa Roga Nidanam which deals with Disease of the Nose.

Apinasa ( ? Atrophic rhinitis)

आनह्यते यस्य विशुष्यते च प्रक्लिध्यते धूप्यति चापि नासा ।
न वेत्ति यो गन्धरसांश्च जन्तुर्जुष्टं व्यवत्वेत्तमपीनसेन ।
तं चालिन – श्लेष्मभवं विकारं ब्रूयात् प्रतिश्यायसमान लिङ्गम् ।। १ ।।

ānahyatē yasya viśuṣyatē ca praklidhyatē dhūpyati cāpi nāsā |
na vētti yō gandharasānśca janturjuṣṭaṁ vyavatvēttamapīnasēna |
taṁ cālina – ślēṣmabhavaṁ vikāraṁ brūyāt pratiśyāyasamāna liṅgam || 1 ||

The disease Apinasa relates to a condition when the nasal passage has been obstructed and dried up or turned very moist. If there is the feeling as though warm smoke is coming out of the nose, if one does not understand the smell or taste of materials, one is considered as suffering from the disease Apinasa. It arises from the morbid increase in Vata and kapha together and has features identical to those of the diseases Pratishyaya. 1

Putinasya (Foetid nasal discharge)

दोषैर्विदग्धेर्गल – तालुमूले संमूर्च्छितो यस्य समीरणस्तु |
निरेति पूतिर्मुखनासिकाभ्यां तं पूतिनस्यं प्रवदन्ति रोगम् || २ ||

dōṣairvidagdhērgala – tālumūlē sammūrcchitō yasya samīraṇastu |
nirēti pūtirmukhanāsikābhyāṁ taṁ pūtinasyaṁ pravadanti rōgam || 2 ||

The Vata along with other doshas undergoing vitiation and provocation, being localized at the junction of the throat and palate, generates bad smelling breath, from the mouth and nose. This disease has been identified as Putinasya. 2

Naasa paaka (Nasal Suppuration)

घ्राणाश्रितम् पित्तमरुंषि कुर्याध्यस्मिन् विकारे बल्वांश्च पाकः ।
तं नासिकापाकमिति व्यवस्येद्विक्लेद – कोथावथवा अपि यत्र ।। ३ ।।

ghrāṇāśritam pittamarunṣi kuryādhyasmin vikārē balvānśca pākaḥ |
taṁ nāsikāpākamiti vyavasyēdviklēda – kōthāvathavā api yatra || 3 ||

Pinnas located in the nose if vitiated and provoked, the vitiation and provocation generates ulcerations inside the nose, which exudes fluid and undergoes putrefaction. This condition has been identified as Nasika paaka. 3

Puyarakta (Blood and pus from the nose)

दोषैर्विदग्धैर्थवा अपि जन्तोर्ललाटदेशे अभिहतस्य तैस्तैः ।
नासा स्रवेत् पूयमस्रुग्विमिश्रं तं पूयरक्तं प्रवदन्ति रोगम् ।। ४ ।।

dōṣairvidagdhairthavā api jantōrlalāṭadēśē abhihatasya taistaiḥ |
nāsā sravēt pūyamasrugvimiśraṁ taṁ pūyaraktaṁ pravadanti rōgam || 4 ||

The disease Puyarakta has been identified with the condition when there is a continuous discharge of pus mixed with blood from the nose. It is either due to increase in the doshas or injury on the forehead. 4

Ksavathu (Sneezing; Vasomotor or allergic rhinitis)

घ्राणाश्रिते मर्मणि संप्रदुष्टो यस्यानिलो नासिकया निरेति |
कफानुयातो बहुशो अतिशब्दस्तं रोगमाहुः क्षवथुं विधिज्ञाः || ५ ||  

ghrāṇāśritē marmaṇi sampraduṣṭō yasyānilō nāsikayā nirēti |
kaphānuyātō bahuśō atiśabdastaṁ rōgamāhuḥ kṣavathuṁ vidhijñāḥ || 5 ||

Vata acting in the nose and vital organs like head if vitiated and associated with kapha comes out of the nose frequently with great force and noise. This disease has been identified as Ksavathu by the authorities. 5

तीक्ष्णोपयोगादभिजिघ्रतो वा भावान् कटूनर्कनिरीक्षणाद्वा |
सूत्रादिभिर्वा तरुणास्थि मर्मन्युद्घातिते अन्यः क्षवथुनिरेति || ६ ||

tīkṣṇōpayōgādabhijighratō vā bhāvān kaṭūnarkanirīkṣaṇādvā |
sūtrādibhirvā taruṇāsthi marmanyudghātitē anyaḥ kṣavathunirēti || 6 ||

The Ksvathu (sneezing) may also arise out of ingestion of pungent substances, smelling of spicy materials, looking up at the sun, introduction of thread and the like items into the nose or assualt to the cartilage and vital spots of the nose. 6

Bhramshathu (Mucoid Nasal Discharge) 

प्रभ्रश्यते नासिकया तु यस्य सान्द्रो विदग्धो लवणः कफस्तु |
प्राक्सञ्चितो मूर्ध्नि सूर्यतप्तस्तं भ्रंशथुं रोगमुदाहरन्ति || ७ || 

prabhraśyatē nāsikayā tu yasya sāndrō vidagdhō lavaṇaḥ kaphastu |
prāksañcitō mūrdhni sūryataptastaṁ bhranśathuṁ rōgamudāharanti || 7 ||

The previously accumulated Kapha inside the head undergoing liquefaction by the heat of the sun, coming out of nose as thick liquid with salty taste has been identified as the disease Bhramshathu. 7

Dipta (Acute Rhinitis)

घ्राणे भृशं दाहसमन्विते तु विनिः सरेद्धुम इवेह वायुः |
नासा प्रदिप्तमेव च यस्य जन्तोर्व्याधिं तु तं दीप्तमुदाहरन्ति || ८ ||

ghrāṇē bhr̥śaṁ dāhasamanvitē tu viniḥ sarēddhuma ivēha vāyuḥ |
nāsā pradiptamēva ca yasya jantōrvyādhiṁ tu taṁ dīptamudāharanti || 8 ||

The breath coming out of the nose like warm smoke, severe burning sensation in the nostrils as though the nostrils have caught fire are symptoms of the disease identified as Dipta. 8

Pratinaha (Nasal block)

उच्छवासमार्गं तु कफः सवातो रुन्ध्यात् प्रतिनाहमुदाहरेत्तम् |

ucchavāsamārgaṁ tu kaphaḥ savātō rundhyāt pratināhamudāharēttam |

Nasa Srava (Rhinorrhoea)

घ्राणादघनः पीत – सितस्तनुर्वा दोषः स्रवेत् स्रावमुदाहरेत्तम् || ९ ||

ghrāṇādaghanaḥ pīta – sitastanurvā dōṣaḥ sravēt srāvamudāharēttam || 9 ||

Vata and Kapha blocking the passage of respiration is called as Pratinaaha; continous discharge of thick, yellow, or white coloured thin fluid from the nose has been identified as the disease Nasa srava. 9

Nasa Shosha (Rhinitis sicca)

घ्राणाश्रिते स्रोतसि मारुतेन गाढं प्रतप्ते परिशोषिते च |
कृच्छ्राच्छवासेदूर्ध्वमधश्च जन्तुर्यस्मिन् स नासापरिशोष उक्तः || १० ||

ghrāṇāśritē srōtasi mārutēna gāḍhaṁ prataptē pariśōṣitē ca |
kr̥cchrācchavāsēdūrdhvamadhaśca janturyasmin sa nāsāpariśōṣa uktaḥ || 10 ||

The nostrils undergoing heat and drying by the action of Vata and other doshas make both expiration and inspiration difficult. This disease is known as Nasa Parishosha. 10

Stages of Pinasa (Rhinitis)

शिरोगुरुत्वमरुचिर्नासास्रावस्तनुः स्वरः |
क्षामः ष्तिवत्यथाभीक्षणमपीनसलक्षणम् || ११ ||
आमलिङ्गान्वितः श्लेष्मा घनः खेषु निमज्जति |
स्वर – वर्ण विशुद्धिश्च परिपक्वस्य लक्षणम् || १२ ||

śirōgurutvamarucirnāsāsrāvastanuḥ svaraḥ |
kṣāmaḥ ṣtivatyathābhīkṣaṇamapīnasalakṣaṇam || 11 ||
āmaliṅgānvitaḥ ślēṣmā ghanaḥ khēṣu nimajjati |
svara – varṇa viśuddhiśca paripakvasya lakṣaṇam || 12 ||

Feeling of heaviness of the head, loss of appetite, discharge of thin fluid from the nose, feeble voice, and frequent expectoration of the sputum are the features of the ama or unripe stage of the disease identified as Pinasa. While, the discharge becoming thick and remaining inside the passage, restoration of normal voice and complexion are the features of  pakva or advanced stage of Pinasa. 11 – 12

Pratishyaaya (Common cold)
Etiopathogenesis

संधरणाजीर्णरजोतिभाष्य – क्रोधर्तुवैषम्य – शिरोभितापैः |
प्रजागराति स्वप्नाम्बु – शीतैरवश्यया मैथुन – बाष्प – धूमैः |
संस्त्यानदोषे शिरसि प्रवृद्धो वायुः प्रतिश्यायमुदीरयेत्तु || १३ ||

sandharaṇājīrṇarajōtibhāṣya – krōdhartuvaiṣamya – śirōbhitāpaiḥ |
prajāgarāti svapnāmbu – śītairavaśyayā maithuna – bāṣpa – dhūmaiḥ |
sanstyānadōṣē śirasi pravr̥ddhō vāyuḥ pratiśyāyamudīrayēttu || 13 ||

The disease pratishyaaya has been identified with symptoms including the following:

  • Suppression of natural urges
  • Intake of uncooked eatables,
  • entry of dust, pollen and the like into the nose.

Moreover, the patient has a

  • tendency of excessive talking,
  • anger and
  • injury to head,
  • keeping awake at nights or sleeping too long during day
  • Longing for the use of very cold water and
  • Exposure to snow.

The patient also suffers from

  • the heat of sexual act
  • of tears, and
  • of smoke and
  • other identical factors that make accumulation of Vata and other doshas in thick form inside the head tpo generate Pratishyaya. 13

चयं गता मूर्धनि मारुतादयः पृथक् समस्ताश्च तथैव शोणितं |
प्रकुप्यमाणा विविधैः प्रकोपणैस्ततः प्रतिश्यायकरा भवन्ति हि || १४ ||

cayaṁ gatā mūrdhani mārutādayaḥ pr̥thak samastāśca tathaiva śōṇitaṁ |
prakupyamāṇā vividhaiḥ prakōpaṇaistataḥ pratiśyāyakarā bhavanti hi || 14 ||

Vata and other doshas gradually accumulating inside the head and activated suddenly by thier respective exit generate pratishyaaya in the head. 14

Prodromal Features

क्षवप्रवृत्तिः शिरसो अतिपूर्णता स्तम्भो अङ्गमर्दः परिहृष्टरोमता |
उपद्रवाश्चाप्यरे पृथग्विधा नृणां प्रतिश्यायपुरःसराः स्मृताः || १५ ||

kṣavapravr̥ttiḥ śirasō atipūrṇatā stambhō aṅgamardaḥ parihr̥ṣṭarōmatā |
upadravāścāpyarē pr̥thagvidhā nr̥ṇāṁ pratiśyāyapuraḥsarāḥ smr̥tāḥ || 15 ||

The premonitory stage of Pratishyaya includes bouts of sneezing, feeling of fullness of the head, Inactivity, and mild pain all over the body, horripilation, and several allied features. 15

Vataja Pratishyaya

आनद्धा पिहिता नासा तनुस्रावप्रसेकिनि |
गल – ताल्वोष्टशोषश्च निस्तोदः शङ्खयोस्तथा || १६ ||
क्षवप्रवृत्तिरत्यर्थं वक्त्रवैरस्यमेव च |
भवेत् स्वरोपघातश्च प्रतिश्यायो अनिलात्मके || १७ ||

ānaddhā pihitā nāsā tanusrāvaprasēkini |
gala – tālvōṣṭaśōṣaśca nistōdaḥ śaṅkhayōstathā || 16 ||
kṣavapravr̥ttiratyarthaṁ vaktravairasyamēva ca |
bhavēt svarōpaghātaśca pratiśyāyō anilātmakē || 17 ||

Nostrils obstructed partially or completely, discharge of thin fluid, dryness of the throat, palate and lips, constant pain in the temporal region,excessive sneezing, distaste in the mouth and broken voice are the features of pratishyaya generated by provoked Vata. 16-17

Pittaja Pratishyaya

उष्णः सपीतकः स्रावो घ्राणात् स्रवति पैत्तिके |
कृशो अतिपाण्डु संतप्तो भवेदुष्णाभीपीडितः || १८ ||
सधूममग्निं सहसा वमतीव स मानवः |

uṣṇaḥ sapītakaḥ srāvō ghrāṇāt sravati paittikē |
kr̥śō atipāṇḍu santaptō bhavēduṣṇābhīpīḍitaḥ || 18 ||
sadhūmamagniṁ sahasā vamatīva sa mānavaḥ |

The features of pratishyaya generated by provoked pitta include —

  • feeling of heat,
  • yellowish discharge,
  • emaciation,
  • and severe pallor of the body,
  • exhaustion by heat (high fever) and
  • feeling of vomitting of smoke and fire. 18
Kaphaja Pratishyaya

घ्राणात् कफः कफकृते शीतः पाण्डुः स्रवेद्बाहुः |
शुक्लावभासः शुक्लाक्षो भवेद्गुरुशिरा नरः || १९ ||
कण्ठ – ताल्वोष्ट – शिरसां कण्डुभिरभिपीडितः |

ghrāṇāt kaphaḥ kaphakr̥tē śītaḥ pāṇḍuḥ sravēdbāhuḥ |
śuklāvabhāsaḥ śuklākṣō bhavēdguruśirā naraḥ || 19 ||
kaṇṭha – tālvōṣṭa – śirasāṁ kaṇḍubhirabhipīḍitaḥ |

In pratishyaya generated by kapha, the patient would be discharging cold, whitish, thick fluid, large in quantity. His skin and eyes appear white; he would feel heaviness of the head, itching in the throat, palate, lips and , the head. 19

Sannipataja Pratishyaaya

भूत्वा भूत्वा प्रतिश्यायो यस्याकस्मान्निवर्तते || २० ||
संपक्वो वा अप्यपक्वो वा स सर्वप्रभवः स्मृतः |

bhūtvā bhūtvā pratiśyāyō yasyākasmānnivartatē || 20 ||
sampakvō vā apyapakvō vā sa sarvaprabhavaḥ smr̥taḥ |

Pratishyaaya appearing and disappearing frequently without any apparent reason either in its undeveloped or developed state is to be understood as being generated by provocation of all the three doshas together. 20

Dushta (Vitiated) Pratishyaya

प्रक्लिध्यते पुनर्नासा पुनश्च परिशुष्यति || २१ ||
पुनरानह्यते वा अपि पुनर्विव्रियते तथा |
निः श्वासो वा अतिदुर्गन्धो नरो गन्धान् न वेत्ति च || २२ ||
एवं दुष्टप्रतिश्यायं जानीयात् कृच्छ्रसाधनम् |

praklidhyatē punarnāsā punaśca pariśuṣyati || 21 ||
punarānahyatē vā api punarvivriyatē tathā |
niḥ śvāsō vā atidurgandhō narō gandhān na vētti ca || 22 ||
ēvaṁ duṣṭapratiśyāyaṁ jānīyāt kr̥cchrasādhanam |

The features of a bad type of common cold (dushta pratishyaaya) which is difficult to treat include the following —

  • Too much fluid in the nose or
  • too much of dryness manifesting alternately,
  • alternate blockage and clearance of the nasal passage without an apparent factor,
  • foul smell in the breath, and
  • loss of sense of smell. 21-22
Raktaja Pratishyaaya

रक्तजे तु प्रतिश्याये रक्तस्रावः प्रवर्तते || २३ ||
ताम्राक्षश्च भवेज्जन्तुरुरोघातप्रपीडितः |
दुर्गन्धोच्छवासवदनो गन्धानपि न वेत्ति सः || २४ ||

raktajē tu pratiśyāyē raktasrāvaḥ pravartatē || 23 ||
tāmrākṣaśca bhavējjantururōghātaprapīḍitaḥ |
durgandhōcchavāsavadanō gandhānapi na vētti saḥ || 24 ||

In pratishyaaya due to increase in blood (rakta), there could be

  • bleeding from nose,
  • redness of the eyes,
  • severe pain in the chest
  • foul smell in the breathing as well as in the mouth besides loss of sense of smell. 23-24
Pinasa (Untreated persistent common cold)

सर्व एव प्रतिश्याया नरस्याप्रतिकारिणः |
दुष्टतां यान्ति कालेन तदा असाध्या भवन्ति हि || २५ ||
मूर्च्छन्ति चात्र क्रिमयः श्वेताः स्निग्धास्तथा अणवः |
क्रिमितो यः शिरोरोगस्तुल्यं तेनास्य लक्षणं || २६ ||

sarva ēva pratiśyāyā narasyāpratikāriṇaḥ |
duṣṭatāṁ yānti kālēna tadā asādhyā bhavanti hi || 25 ||
mūrcchanti cātra krimayaḥ śvētāḥ snigdhāstathā aṇavaḥ |
krimitō yaḥ śirōrōgastulyaṁ tēnāsya lakṣaṇaṁ ||26||

The patients who do not take proper treatment for different types of common cold (pratishyaya) get complicated in due course of time and then disease turns incurable. At this stage, white, smooth and small worms appear and the features then resemble those of the headache due to organisms (like bacteria). 25-26

Complications of Pinasa

बाधिर्यमान्ध्यमघ्रत्वं घोरांश्च नयनामयान् |
शोथाग्निसाद – कासांश्च वृद्धाः कुर्वन्ति पीनसाः || २७ ||

bādhiryamāndhyamaghratvaṁ ghōrānśca nayanāmayān |
śōthāgnisāda – kāsānśca vr̥ddhāḥ kurvanti pīnasāḥ || 27 ||

All varieties of Pinasa ignored could in course of time, generate deafness, blindness, loss of sense of smell, severe kinds of eye diseases, swelling of the body, loss of digestion and cough. 27

Other diseases of the nose

अर्बुदं सप्तधा शोथाः चत्वारो अर्श चतुर्विधम् |
चतुर्विधं रक्तपित्तमुक्तं घ्राणो अपि तद्विदुः || २८ ||

arbudaṁ saptadhā śōthāḥ catvārō arśa caturvidham |
caturvidhaṁ raktapittamuktaṁ ghrāṇō api tadviduḥ || 28 ||

The seven kinds of arbuda, four kinds of shotha, four kinds of arshas and four kinds of raktapitta described previously might also manifest in the disease of the nose or these may also develop as implications of diseases of the nose. 28

इति श्रीमाधवकरविरचिते माधवनिदाने नासारोगनिदानं समाप्तम् || ५८ ||

iti śrīmādhavakaraviracitē mādhavanidānē nāsārōganidānaṁ samāptam || 58 ||

Thus conculdes the Chapter on Nasa roga.