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Chapter 60 – Shiro Roga Nidana

The 60th chapter of Madhava Nidana is Shiro Roga Nidana which deals with Diseases of the head.

Types of Head Ailments

शिरोरोगास्तु जायन्ते वात – पित्त – कफैस्त्रिभिः |
सन्निपातेन रक्तेन क्षयेण क्रिमिभिस्तथा ||
सूर्यावर्तानन्तवातार्धावभेदक – शङ्खकैः || १ ||

śirōrōgāstu jāyantē vāta – pitta – kaphaistribhiḥ |
sannipātēna raktēna kṣayēṇa krimibhistathā ||
sūryāvartānantavātārdhāvabhēdaka – śaṅkhakaiḥ || 1 ||

Vata, pitta and kapha individually or by thier combination generate diseases of the head or headache to be specific. The ailments of head are also generated by rakta, by loss or decrease of tissues and by krmis (infection from micro organisms) and also as implications of indispositions like the ones called Suryaavarta, ananta vata, ardhavbhedaka and shankhaka. 1

Vataja Headache

यस्यानिमित्तं शिरसो रुजश्च भवन्ति तीव्रा निशि चातिमात्रम् |
बन्धोपतापैः प्रशमश्च यत्र शिरो अभितापः स समीरणेन || २ ||

yasyānimittaṁ śirasō rujaśca bhavanti tīvrā niśi cātimātram |
bandhōpatāpaiḥ praśamaśca yatra śirō abhitāpaḥ sa samīraṇēna || 2 ||

Vata generated headaches usually have the following features:

  • Sudden appearance of headache without any apparent cause.
  • They would appear more severe at nights; they are reduced by tight bandage, fomentation and the like methods. 2

Pittaja Headache

यस्योष्णमङ्गारचितं यथैव भवेच्छिरो धूप्यति चाक्षिनासम् |
शीतेन रात्रौ च भवेच्छ्रमश्च शिरो अभितापः स तु पित्तकोपात् || ३ ||

yasyōṣṇamaṅgāracitaṁ yathaiva bhavēcchirō dhūpyati cākṣināsam |
śītēna rātrau ca bhavēcchramaśca śirō abhitāpaḥ sa tu pittakōpāt || 3 ||

A person suffering from headache due to pitta would feel as if his head is very warm and is studded with burning charcoal. He would feel as if smoke is coming out of his eyes and nose. The patient gets relief by cold and during the nights. 3

Kaphaja Headache

शिरो भवेध्यस्य कफोपदिग्धं गुरु प्रतिष्टब्धमथो हिमं च |
शूनाक्षिकूटं वदनं च यस्य शिरो अभितापः स कफप्रकोपात् || ४ ||

śirō bhavēdhyasya kaphōpadigdhaṁ guru pratiṣṭabdhamathō himaṁ ca |
śūnākṣikūṭaṁ vadanaṁ ca yasya śirō abhitāpaḥ sa kaphaprakōpāt || 4 ||

Kapha induced headache would have features like feeling of heaviness and fullness, coldness of the head, swelling of the face especially round the eyes. 4

Sannipataja Headache

शिरो अभितापे त्रितयप्रवृत्ते सर्वाणि लिङ्गानि समुद्भवन्ति |

śirō abhitāpē tritayapravr̥ttē sarvāṇi liṅgāni samudbhavanti |

If all the three doshas are provoked together, there could be presence of all the features together.

रक्तात्मकः पित्तसमानलिङ्गः स्पर्शासहत्वं शिरसो भवेच्च || ५ ||

raktātmakaḥ pittasamānaliṅgaḥ sparśāsahatvaṁ śirasō bhavēcca || 5 ||

The headache caused due to vitiation of rakta has all the features of pittaja type besides the hyperesthesia of the head in addition. 5

Headache due to depletion of tissues

असृग्वसा – श्लेष्म – समीरणानां शिरोगतानामिह संक्षयेण |
क्षयप्रवृत्तः शिरसो अभितापः कष्टो भवेदुग्ररुजो अतिमात्रं |
संस्वेदन – च्छर्दन – धूम – नस्यैर्स्रुग्विमोक्षैश्च विवृद्धिमेति || ६ ||

asr̥gvasā – ślēṣma – samīraṇānāṁ śirōgatānāmiha saṅkṣayēṇa |
kṣayapravr̥ttaḥ śirasō abhitāpaḥ kaṣṭō bhavēdugrarujō atimātraṁ |
sansvēdana – cchardana – dhūma – nasyairsrugvimōkṣaiśca vivr̥ddhimēti || 6 ||

If the blood, muscle fat, kapha and vata residing normally in the head undergo decrease or loss, the headache generated thereby could be very severe. It only grows by therapies such as fomentation, emesis, blood – letting, and use of the nasal drops. 6

Headache due to Organisms/ Infections

निस्तुध्यते यस्य शिरो अतिमात्रं सम्भक्ष्यमाणं स्फुरतीव चान्तः |
घ्राणाच्च गच्छेत् सलिलं सपूयं शिरो अभितापः क्रिमिभिः स घोरः ||७ ||

nistudhyatē yasya śirō atimātraṁ sambhakṣyamāṇaṁ sphuratīva cāntaḥ |
ghrāṇācca gacchēt salilaṁ sapūyaṁ śirō abhitāpaḥ krimibhiḥ sa ghōraḥ ||7 ||

The following are the features of headache that is generated by krmis or infection by micro organisms:

  • constant and pricking pain,
  • very severe as though the head is being eaten away or going to explode from inside, discharge of water and pus from the nose. 7

Suryaavarta headache

सूर्योदयं या प्रति मन्दमन्दमक्षि – भ्रुवं रुक् समुपैति गूढ |
विवर्धते चांशुमता सहैव सूर्यापवृत्तौ विनिवर्तते च |
सर्वात्मकं कष्टतमं विकारं सूर्यापर्वतं तमुदाहरन्ति || ८ ||

sūryōdayaṁ yā prati mandamandamakṣi – bhruvaṁ ruk samupaiti gūḍha |
vivardhatē cānśumatā sahaiva sūryāpavr̥ttau vinivartatē ca |
sarvātmakaṁ kaṣṭatamaṁ vikāraṁ sūryāparvataṁ tamudāharanti || 8 ||

Suryaavarta is a kind of headache that is found to be starting at the time of sunrise, with pain in the eyes and eyebrows. Gradually, the pain increases in severity with the upward movement of the sun. On the other hand, it slowly reduces by the time of sunset. It is a dreaded disease generated by all the three doshas undergoing vitiation together. 8

Anantavaata Headache

दोषास्तु दुष्तास्त्रयः एव मन्याम् संपीड्य घाटासु रुजां सुतीव्राम् |
कुर्वन्ति यो अक्षिभ्रुवि शङ्क देशे स्थितिं करोत्याषु विशेषतस्तु || ९ ||
गण्डस्य पार्श्वे तु करोति कम्पं हनुग्रहं लोचनजांश्च रोगान् |
अनन्तवातं तमुदाहरन्ति दोषत्रयोत्थं शिरसो विकारम् || १० ||

dōṣāstu duṣtāstrayaḥ ēva manyām sampīḍya ghāṭāsu rujāṁ sutīvrām |
kurvanti yō akṣibhruvi śaṅka dēśē sthitiṁ karōtyāṣu viśēṣatastu || 9 ||
gaṇḍasya pārśvē tu karōti kampaṁ hanugrahaṁ lōcanajānśca rōgān |
anantavātaṁ tamudāharanti dōṣatrayōtthaṁ śirasō vikāram || 10 ||

All the three doshas undergoing vitiation in combination attack the areas of the nape of the neck, eyes, eyebrows, temples and generate very severe pain. Throbbing or pulsations at the top of the cheeks, stiffness of the lower jaw and pain in the eyes accompany the symptom. Such a condition is described as Anantavaata. This disease of the head arises from the combined vitiation of all the doshas. 9-10

Ardhaavabhedaka Headache

रूक्षाशनात्यध्यशन – प्राग्वातावश्यमैथुनैः |
वेगसन्धारणायास – व्यव्यामैः कुपितो अनिलः || ११ ||
केवलः सकफो वा अर्धं गृहीत्वा शिरसो बली |
मन्या – भ्रू – शङ्ख – कर्णाक्षि – ललाटार्धे अतिवेदनाम् || १२ ||
शस्त्राराणिनिभां कुर्यात्तीव्रां सो अर्धावभेदकः |
नयनं वा अथवा श्रोत्रमतिवृद्धो विनाशयेत् || १३ ||

rūkṣāśanātyadhyaśana – prāgvātāvaśyamaithunaiḥ |
vēgasandhāraṇāyāsa – vyavyāmaiḥ kupitō anilaḥ || 11 ||
kēvalaḥ sakaphō vā ardhaṁ gr̥hītvā śirasō balī |
manyā – bhrū – śaṅkha – karṇākṣi – lalāṭārdhē ativēdanām || 12||
śastrārāṇinibhāṁ kuryāttīvrāṁ sō ardhāvabhēdakaḥ |
nayanaṁ vā athavā śrōtramativr̥ddhō vināśayēt || 13 ||

Over indulgence in dry eatables, taking too much amount of eatables, exposure to direct breeze and snowfall, excessive sexual intercourse, suppression of natural urges, physical exertion by exercise, and such other  factors vitiate the vata, which either alone or in association with kapha, attacks the half portion of the head and generates severe pain in the sides of the neck, eye brows, temples, ears,eyes and forehead of anyone side (left or right).

Pain could be very severe as though one’s head is being cut by a sharp weapon or his head is being churned by a churner. As implication to this pathological condition, the functions of the eyes or ears are also severely damaged. This disease is called Ardhaavabhedaka. 11 – 13

Sankhaka Headache

रक्त – पित्तानिला दुष्टाः शङ्खदेशे विमूर्छिताः |
तीव्ररुग्दाह – रागं हि शोथं कुर्वन्ति दारुणम् || १४ ||
स शिरो विषवद्वेगी निरुद्धयाशु गलं तथा |
त्रिरात्रज्जीवितं हन्ति शङ्खको नामतः परम् |
त्र्यहाज्जीवति भैषज्यं प्रत्याख्याय समाचरेत् || १५ ||

rakta – pittānilā duṣṭāḥ śaṅkhadēśē vimūrchitāḥ |
tīvrarugdāha – rāgaṁ hi śōthaṁ kurvanti dāruṇam || 14 ||
sa śirō viṣavadvēgī niruddhayāśu galaṁ tathā |
trirātrajjīvitaṁ hanti śaṅkhakō nāmataḥ param |
tryahājjīvati bhaiṣajyaṁ pratyākhyāya samācarēt || 15 ||

When the vitiated pitta, rakta and vayu get mixed up in the temporal region, they produce severe inflammatory swelling with intense pain, burning sensation and reddish swelling which creates stiffness of the head and blockage to the throat and proves fatal within three days. This disease has been identified as Sankhaka. It is considered incurable. If the patient survives for the three days, treatment should be undertaken after giving due warning about its bad prognosis. 14-15

इति श्रीमाधवकरविरचिते माधवनिदाने शिरोरोगनिदानं समाप्तम् || ६० ||

iti śrīmādhavakaraviracitē mādhavanidānē śirōrōganidānaṁ samāptam || 60 ||

Thus concludes the chapter on Shiro Roga.