The 19th chapter of Uttara Sthanam of Ashtanga Hridayam is named as Nasaroga Vijnaniya. This chapter deals with the explanation of ‘Knowledge of diseases of the nose’.

The topics covered in this chapter include –

• Pratishyaya
• Vataja Pratishyaya
• Pittaja Pratishyaya
• Kaphaja Pratishyaya
• Sarvaja Pratishyaya
• Raktaja Pratishyaya
• Dushta Pratishyaya
• Bhrishakshava
• Nasashosha
• Nasanaha
• Ghranapaka
• Ghranasrava
• Apinasa
• Dipti
• Putinasa
• Puyarakta
• Putaka
• Arshasa Arbuda

Pledge by the author(s)

अथातो नासारोगविज्ञानीयं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘Knowledge of diseases of the nose’. Thus, say (pledge) Atreya and other sages.

Pratishyaya

अवश्यायानिलरजोभाष्यातिस्वप्नजागरैः ।
नीचात्युच्चोपधानेन पीतेनान्येन वारिणा ॥ १ ॥
अत्यम्बुपानरमणच्छर्दिबाष्पग्रहादिभिः ।
क्रुद्धा वातोल्बणा दोषा नासायां स्त्यानतां गताः ॥२॥
जनयन्ति प्रतिश्यायं वर्धमानं क्षयप्रदम् ।
Exposure to dew (mist, fog), breeze and dust, too much of speaking, sleeping and keeping awake, keeping the pillow either very low or very high under the head, drinking other types of (unaccustomed) water, excessive drinking of water, sexual intercourse, planetary influence, suppression of vomiting and tears etc. By these and other similar causes, the doshas provoked by vitiation of Vata, become solidified in the nose and produce Pratishyaya which when advanced leads to Kshaya (consumption).

Vataja Pratishyaya

तत्र वातात्प्रतिश्याये मुखशोषो भृशं क्षवः ॥ ३ ॥
घ्राणोपरोधनिस्तोददन्तशङ्खशिरोव्यथाः ।
कीटिका इव सर्पन्तीर्मन्यते परितो भ्रुवौ ॥ ४ ॥
स्वरसादश्चिरात्पाकः शिशिराच्छकफस्रुतिः ।
In Partishyaya caused by Vata, there appears dryness of the mouth, profuse sneezing, blocking of the nose and pricking pain in the teeth, temples and headache, feeling of crawling like insects around the eyebrows, weak voice, delayed ripening, discharge of cold and thin fluid from the nose.

Pittaja Pratishyaya

पित्तात्तृष्णाज्वरघ्राणपिटिकासम्भवभ्रमाः ॥ ५ ॥
नासाग्रपाको रूक्षोष्णताम्रपीतकफस्रुतिः ।
In that caused by Pitta, there is thirst, fever, possibility of eruptions developing inside the nose, giddiness, ulceration of the nasal tip and discharge of fluid which is dry (non- sticky), warm, coppery or yellow in color.

Kaphaja Pratishyaya

कफात्कासोऽरुचिः श्वासो वमथुर्गात्रगौरवम् ॥ ६ ॥
माधुर्यं वदने कण्डूः स्निग्धशुक्लकफस्रुतिः ।
In that caused by Kapha, there is cough, loss of taste, dyspnea, vomiting, feeling of heaviness of the body, sweet taste in the mouth, itching (in the nose) and discharge of unctuous (sticky) white fluid.

Sarvaja Pratishyaya

सर्वजो लक्षणैः सर्वैरकस्माद्वृद्धिशान्तिमान् ॥ ७ ॥
In that caused by all the doshas, all the symptoms manifest and undergo increase or get subsided without any reason.

Raktaja Pratishyaya

दुष्टं नासासिराः प्राप्य प्रतिश्यायं करोत्यसृक् ।
उरसः सुप्तता ताम्रनेत्रत्वं श्वासपूतिता ॥ ८ ॥
कण्डूः श्रोत्राक्षिनासासु पित्तोक्तं चात्र लक्षणम् ।
Blood getting vitiated and localized in the veins of the nose produces (Raktaja) Pratishyaya, characterized by loss of movement of chest, copper-colored eyes, foul smelling breath, itching in the ears, eyes and nose and other symptoms of Pittaja kind.

Dushta Pratishyaya

सर्व एव प्रतिश्याया दुष्टतां यान्त्युपेक्षिताः ॥ ९ ॥
यथोक्तोपद्रवाधिक्यात्स सर्वेन्द्रियतापनः ।
साग्निसादज्वरश्वासकासोरःपार्श्ववेदनः ॥ १० ॥
कुप्यत्यकस्माद्बहुशो मुखदौर्गन्ध्यशोफकृत् ।
नासिकाक्लेदसंशोषशुद्धिरोधकरो मुहुः ॥ ११ ॥
पूयोपमासितारक्तग्रथितश्लेष्मसंस्रुतिः ।
मूर्छन्ति चात्र कृमयो दीर्घस्निग्धसिताणवः ॥ १२ ॥
All the varieties when neglected lead on to Dustapratishyaya, having many of the following complications and so tormenting all the organs of the body. weakness of digestion, fever, dyspnea, cough, pain in the chest and flanks; gets greatly aggravated without any reason, produces foul smelling mouth and swelling (of the face), drying of the moisture of the nose, opening and blocking of the passage of the nose often, discharge of fluid resembling pus, black and red in color and nodular, in this fluid, long, unctuous, white and minute worms etc. develop.

Symptoms of attaining pakwata (ripening)

पक्वलिङ्गानि तेष्वङ्गलाघवं क्षवथोः शमः ।
श्लेष्मा सचिक्कणः पीतोऽज्ञानं च रसगन्धयोः ॥ १३
In all of them (Pratishyaya) the symptoms of ripening are – feeling of lightness of the body, subsiding of sneezing, fluid discharge) is slimy (unctuous) and yellow and inability to understand taste and smell.

Bhrishakshava

तीक्ष्णाघ्राणोपयोगार्करश्मिसूत्रतृणादिभिः ।
वातकोपिभिरन्यैर्वा नासिकातरुणास्थनि ॥ १४ ॥
विघट्टितेऽनिलः क्रुद्धो रुद्धः शृङ्गाटकं व्रजेत् ।
निवृत्तः कुरुतेऽत्यर्थं क्षवथुं स भृशक्षवः ॥ १५ ॥
Inhaling strong smell (of pungent nature such as powder of chillies, ginger, tobacco etc.), exposure to sun rays, inserting threads, grass etc. (into the nose) and other causes which aggravate Vata, when the cartilage of the nose gets scratched, Vata getting aggravated and obstructed, moves upwards to the Shrungataka (a vital spot inside the head) and getting dislodged from that spot, gives rise to too much of sneezing. This disease is called Bhrishakshava.

Nasashosha

शोषयन्नासिकास्रोतः कफं च कुरुतेऽनिलः ।
शूकपूर्णाभनासात्वं कृच्छ्रादुच्छ्वसनं ततः ॥ १६ ॥
स्मृतोऽसौ नासिकाशोषो
Vata getting increased produces drying of Kapha (moistness of the nose) in the nasal passages; feeling of thorns filling in the nose, and difficulty in breathing. This is known as Nasika Shosha.

Nasanaha

नासानाहे तु जायते ।
नद्धत्वमिव नासायाः श्लेष्मरुद्धेन वायुना ॥ १७ ॥
निःश्वासोच्छ्वाससंरोधात्स्रोतसी संवृते इव ।
Vata produces distension of the nose as if the nose is completely blocked, by blocking it with Kapha, associated with obstruction to inspiration and expiration; the nasal passage feels as though constricted.

Ghranapaka

पचेन्नासापुटे पित्तं त्वङ्मांसं दाहशूलवत् ॥ १८ ॥
स घ्राणपाकः
Pitta (getting aggravated) produces ulcerations by cooking the skin and muscles inside the nose, accompanied with burning sensation and pain. This is Ghranapaka.

Ghranasrava

स्रावस्तु तत्संज्ञ: श्लेष्मसम्भवः ।
अच्छो जलोपमोऽजस्रं विशेषान्निशि जायते ॥ १९ ॥
Srava is produced by Kapha, there is discharge of clear, watery fluid continuously, especially during night. This is Ghranasrva.

Apinasa

कफः प्रवृद्धो नासायां रुद्ध्वा स्रोतांस्यपीनसम् ।
कुर्यात्सघुर्घुरश्वासं पीनसाधिकवेदनम् ॥ २० ॥
अवेरिव स्रवत्यस्य प्रक्लिन्ना तेन नासिका ।
अजस्रं पिच्छिलं पीतं पक्वं सिङ्घाणकं घनम् ॥२१॥
Kapha gets increased, blocks the passage of the nose and produces Apinasa, associated with breathing with rambling sounds which is more painful than Pinasa. There is continuous discharge of fluid from his nose and always keeps wet like that of a sheep (nose of sheep), the fluid being slimy, yellow and when ripe the nasal excretion becomes solidified.

Deepti

रक्तेन नासा दग्धेव बाह्यान्तःस्पर्शनासहा ।
भवेद्धूमोपमोच्छ्वासा सा दीप्तिर्दहतीव च ॥ २२ ॥
By aggravation of blood, the nose appears though burnt by fire, both externally and internally, unable to tolerate touch and expiration is like hot fumes coming out, as if burning the nose, this is called Deepti.

Putinasa

तालुमूले मलैर्दुष्टैर्मारुतो मुखनासिकात् ।
श्लेष्मा च पूतिर्निर्गच्छेत्पूतिनासं वदन्ति तम् ॥ २३ ॥
The root of the palate vitiated by the malas (doshas) chief of them, Vata and Kapha make for emission of bad smelling shleshma (nasal secretion) from the mouth and nose, this is called as Putinasa.

Puyarakta

निचयादभिघाताद्वा पूयासृङ्नासिका स्रवेत् ।
तत्पूयरक्तमाख्यातं शिरोदाहरुजाकरम् ॥ २४ ॥
Either by combination of all the doshas or by injury, there is discharge of pus and blood from the nose, producing burning sensation and pain in the head; this disease is known as Puryarakta.

Putaka

पित्तश्लेष्मावरुद्धोऽन्तर्नासायां शोषयेन्मरुत् ।
कफं स शुष्कः पुटतां प्राप्नोति पुटकं तु तत् ॥२५॥
Vata obstructed by Pitta and Kapha inside the nose, dries up the Kapha; the dried up Kapha assumes the shape of a leather bag, this is called Putaka.

Arshasa Arbuda

अर्शोऽर्बुदानि विभजेद्दोषलिङ्गैर्यथायथम् ।
सर्वेषु कृच्छ्रोच्छ्वसनं पीनसः प्रततं क्षुतिः ॥ २६ ॥
सानुनासिकवादित्वं पूतिनासः शिरोव्यथा ।
Arshas (nasal polyp) and Arbuda (malignant tumor) should be understood by characteristic symptoms of the doshas. Accordingly, in all of them there is difficulty breathing, running in the nose, continuous sneezing, nasal voice, foul smell from the nose and headache.

Dusta Pinasa treatment duration

अष्टादशानामित्येषां यापयेद्दुष्टपीनसम् ॥ २७ ॥
Among the eighteen diseases described so far only Dusta Pinasa is to be treated for a long period (all the others are curable).

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने नासारोगविज्ञानीयो नामैकोनविंशोऽध्याय: ॥ १९ ॥
Thus, ends the chapter-Nasaroga Vijnaniya- the nineteenth in Uttarasthana of Athanga Hridaya Samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.