Chapter XXIV - Symptoms and treatment of Catarrh

Now we shall discourse on the chapter which deals with the (symptoms and) medical treatment of catarrh (Pratishyaya-Pratishedha). 1.

Causes:—

Excessive indulgence in sexual intercourse, heating of the head, entrance of the minute particles of dust or smoke into the nostrils, excessive application of cold or heat, voluntary retention of stool and urine are the causes which may instantly usher in an attack of nasal catarrh (Pratishyaya). The fundamental principles of Vayu, Pitta and Kapha, jointly and separately, as well as of blood becoming aggravated by various aggravating causes, bring on an attack of nasal catarrh in course of time. 2–3.

Premonitary Symptoms:—

Heaviness of the head, sneezing and aching in the limbs, appearance of goose-flesh upon the body, as well as many other different kinds of supervening symptoms are seen to precede an attack of nasal catarrh (Pratishyaya). 4.

Specific Symptoms:—

Hoarseness of voice, a sense of stuffedness and obstruction in the nostrils accompanied by a thin mucous secretion, dryness of the throat, of the palate and of the lips, a pricking, and piercing pain in the region of the temples, as well as excessive sneezing and a bad taste in the mouth are the characteristics of Vataja type of catarrh (Pratishyaya). A hot and yellowish secretion from the nose, heated skin, thirst, emaciation and yellowness of the complexion, as well as the secretion being sudden, hot and smoky—these are the characteristics which mark the Pittaja type of catarrh. Constant running at the nose, the secretion being white and cold, paleness (of the skin) and swelling (D. R. whiteness) of the eyes, heaviness of the head, flabbiness of the face^[1] and tickling and itching sensation in the regions of the head, throat, lips and of the palate are the features which mark the Kaphaja type of the disease. 5-7.

The spontaneous disappearance, as well as reappearance of Pratishyaya—be it acute or chronic—is the characteristic symptom of Tri-doshaja Pratishyaya, wherein the specific symptoms of all (the three) kinds of Apinasa are present. 8.

Symptoms of Raktaja Pratishyaya:—

Discharge of blood (from the nose), redness of the eyes, a bruised pain in the chest which seems as if struck with a blow, fetid smell in the breath and the mouth, and loss of the faculty of smelling are the characteristic symptoms of the Raktaja type of Pratishyaya which has its origin in the deranged condition of the blood. In these cases^[2] hosts of extremely small worms of whitish or blackish^[3] hue are found to infest the affected localities (viz., the nostrils) which show symptoms identical with those of the head-disease due to the germination of parasites in that region. 9.

Prognosis:—

The malignant nature of the disease (Dushta-Pratishyaya) should be inferred from the constant alternate sliminess and dryness, as well as constant alternate contraction and expansion of the nostrils, fetour in the breath and loss of the faculty of smell. Such a case of Pratishyaya should be regarded as extremely hard to cure. Neglected and not properly remedied at the outset of an attack, any type of catarrh (Pratishyaya) may bring on cases of malignant Pinasa, which in time gives rise to a number of diseases and produces.in its train deafness, blindness, loss of smell, violent ocular affections, cough, dulness of appetite, and Sopha (swelling), 10-11.

General Treatment of Pratishyaya:—

Potions of clarified butter, various sorts of emetics, and fomentations (Sveda) may be prescribed in nasal catarrh (Pratishyaya), except in fresh and acute cases. Errhines (Nasya) of Avapida type may also be employed in time, if required. Fomentation should be applied and diet should be taken in a tepid state with articles of acid taste, and draughts of milk should be administered with green ginger^[4] and with any modification of the expressed juice of sugar-cane^[5] for the purpose of thickening and maturing the secreted mucus, in cases where that maturing process has not already spontaneously set in. The mucus found matured, thick and pendent should be made to secrete by applying head-purgatives (Shiro-vireka). Purgatives, Vasti of the Asthapana kind, smoke-inhalations and medicinal gurgles should also be prescribed according to the exigencies of each case under treatment and in consideration of the nature and intensity of the deranged Dosha involved therein. 12–14.

Regimen of diet and conduct:—

In a case of Pratishyaya the patient should sit, lie, or move about in closed and windless rooms and wear warm and thick turban on his head. He should take Vijaya (Haritaki) and partake of meals consisting of Palanna^[6] cooked without clarified butter. He should also be subjected to a course of strong head-purging as well as of smoke-inhalations. Use of new wine and cold drink, cold baths, sexual intercourse, anxious cares, lamentations, voluntary retention of stools and urine, as well as partaking of fares which are excessively dry (and beget dryness in the system), should be foregone by a person suffering from an attack of Pinasa. 15-16.

Fastings and employment of digestive (Pacana) and appetising (Dipaniya) remedies should be the medical treatment in cases of Pinasa (nasal catarrh) accompanied by such distressing symptoms as vomiting, aching, heaviness in the limbs, feverishness, non-relish for food, apathy, and Atisara (diarrhea). In case of an adult person suffering from an attack of Pinasa due to the concerted action of Vayu and Kapha, the patient should be made to vomit by taking in a large quantity of any liquid substance. The complications (Upadrava) involved therein should be remedied by appropriate diet and remedial agents and after their subsidence, the patient should be treated according to the instructions given before. 17–18.

Treatment of Vataja Type:—

In cases of Vataja-Pratishyaya clarified butter duly cooked with the drugs of the Vidari-gandhadi group or with the five officinal salts should be prescribed for internal use, according to the rules of taking Sneha (see chapter XXXI., Chikitshita-Sthana). The process of snuffing, etc., should also be resorted to, if necessary, as in a case of Ardita (Facial paralysis). 19.

Treatment of Pittaja and Raktaja types:—

In the Pittaja and Raktaja types (of Pratishyaya) the patient should be given draughts^[7] of clarified butter duly cooked with the drugs of the Kakolyadi group. Cold^[8] washes and plasters should also be used. Sarjarasa (Resin), Pattanga (red-sandal), Priyangu, honey, sugar, Draksha, Madhulika (Guduci), Goji, Shri-parni and Yashti-madhu should be prescribed as gurgles, and purgings (errhines?) should be induced with the help of the drugs of sweet potency (such as Draksha, Aragbadha, honey, sugar, etc.). Oil duly cooked with (a paste composed of) Dhava- bark, Tri-phala, Shyama, Tilvaka, Yashti-madhu, Shri-parni, Rajani, and with milk weighing ten times as much as oil, should be preserved for a time and used as an errhine (Nasya) in either of these cases. 20.

Treatment of Kaphaja Type:—

In a case of the Kaphaja-Pratishyaya, emulsive measures (Sneha-karma) should be performed with clarified butter, and the patient should be made to vomit by using Yavagu (gruel) prepared with Masha-pulse and Tila, (sesamum-seed), after which the general Kapha-subduing measure should be employed. Oil duly cooked with the two kinds of Bala, the two kinds of Brihati, Vidanga, Tri-kantaka, Shveta- roots, Saha (Mudga-parni), Bhadra (Gambhari) and Varshabhu should be employed as an errhine. Sarala, Kini hi, Daru, Nikumbha (Danti) and Ingudi should be pasted together and duly formed as Vartis. These Vartis should be duly used for the purposes of smoking (Dhuma-pana) 21–22.

Treatment of Tri-doshaja Type:—

Clarified butter duly prepared with the drugs of bitter and pungent tastes, inhalation of the smoke of strong-potencied drugs as well as the use of articles of pungent taste and other appropriate medicinal preparations would prove curative in a case of Tri-doshaja Pratishyaya (nasal catarrh) brought about by the aggravation of all the three Doshas. An intelligent physician should prescribe as an errhine the medicated oil duly cooked and prepared with the admixture of Rasanjana, Ati-visha, Musta and Bhadra-daru. Gargles prepared with the decoction of Musta, Tejovati, Patha, Katphala, Katuka, Vaca, Sarshapa (mustard), Pippali-mula, Pippali, Saindhava, Agnika (Ajamoda), Tuttha, Karanja-seeds, Salt and Bhadra-daru should be prescribed. Oil duly cooked with the preceding drugs is recommended for purging (Siro-vireka) the head of the patient. 23–24.

Flesh of birds and beasts of the Jangala group, aquatic flowers and the Vayu-subduing drugs (Bhadra-darvadi) should be duly cooked in milk mixed with water weighing half as much as the milk.^[9] The liquid in this case should be reduced to the original quantity of milk, when it should be taken down and allowed to cool. Clarified butter should then be prepared from this milk and should be again duly cooked with the drugs of the Sarvagandha (Eladi) group, sugar, Ananta, Yashti-madhu and (red) Chandana and with a quantity of milk ten times its own weight. All types of nasal catarrh, yield to the curative efficacy of this medicated Ghrita, if used as an errhine (Nasya). Oils medicated with the drugs remedial to the specific deranged Dosha involved in each case under treatment should also be prescribed. 25–26.

All the foregoing preparations should be surcharged with the urine and bile of a cow and used in cases due to the existence of local parasites, and vermifuges (e.g., drugs of the Surasadi group) should be administered as a palliative measure.^[10] 27.

 

Thus ends the twenty-fourth chapter of the Uttara-Tantra in the Sushruta Samhita which deals with the (symptoms and) medical treatment of Pratishyaya.

Footnotes and references:

[1]:

In place of “bhavedguru śiromukhaḥ”’—some read “bhavedguruśiro naraḥ”—i.e., “the man (patient) gets heaviness of the head.” In this case the flabbiness of the face is not seperately mentioned.

[2]:

According to some this is the characteristic symptom of another kind of Pratiśyāya, and not one of the symptoms of the Raktaja type as appears at the first sight.

[3]:

Mādhava Kar reads ‘śvetāḥ snegdhāḥ’ i.e., glossy white in hue, in place of ‘śvetāḥ kṛṣṇāḥ’ i.e., whitish and blackish in hue.

[4]:

Some explain “Ārdraka” to mean the expressed juice of fresh ginger, while others explain it to mean the powder of dried ginger.

[5]:

In place of “ikṣuvikārayogaiḥ”—with any modification of the expressed juice of sugar-cane, such as treacle, sugar, etc, some read “kadukopayogaiḥ” i.e., with articles of pungent taste.

[6]:

Palānna is generally prepared by cooking together rice, meat and clarified butter as well as other spices, but in this case clarified butter should not be used.

[7]:

Some read ‘tiktaiḥ’ in place of ‘peyam’. This word means that the clarified butter for use in this case should be duly cooked with the tikta (bitter) drugs, viz., the leaves of Patola, etc.

[8]:

Both the commentators of Vrinda and Chakradatta explain the term śītalena (cold) to mean ‘prepared with the drugs of cold potency such as the drugs of the Nyagrodhādi and Utpalādi groups.’

[9]:

Some say that milk and water in equal parts should be taken.

[10]:

In places of “yāpanārtha’ Chakradatta reads “nāvanārthaṃ” as an errhine. He also reads “samūtrapiṣṭāḥṃ” i.e., pasted with the urine (of a cow), and thus does not read the bile of a cow (pitta) in the text. Vrinda, however, reads “dhāvanāni” in place of “yāpanārthaṃ” which means that vermifuges should be used for washing purposes.