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AIAPGET Points

–        Murcha occurs in persons having Bahu Dosha and Hina Sattva, is Kshina and subjected to Abhighata and is habituated to Viruddha Ahara and Vegaghata.

–        HRT PIDA is one of the important Purvarupas of Sushruta.

–        Sanjnavaha Nadis are affected in Murcha.

–        In each type of Murcha, the symptoms of APASMARA will be generally manifested.

–        Predominance of Prithvi and Ap Mahabhutas in Rakta and Tamo Guna is responsible for Murcha caused due to Rakta Gandha.

–        JIVANIYA GANA SIDDHA Ghrta is indicated in Murcha.

–        Kashayas which cure JWARA can also be administered in treatment of all kinds of MURCHA.

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The 46th chapter of Uttaratantra of Sushruta Samhita is named as Mūrcha Pratiṣedha Adhyaya. This chapter deals with the Treatment of Syncope.   

अथातो मूर्च्छाप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Murcha pratiṣedha – treatment of syncope – fainting; as revealed by the venerable Dhanvantari.

Nidāna-samprāpti – causes and pathogenesis 

क्षीणस्य बहुदोषस्य विरुद्धाहारसेविनः |
वेगाघातादभीघाताद्धीनसत्त्वस्य वा पुनः ||३||
करणायतनेषूग्रा बाह्येष्वाभ्यन्तरेषु च |
निविशन्ते यदा दोषास्तदा मूर्च्छन्ति मानवाः ||४||

The doshas would get greatly aggravated in below mentioned kinds of persons –

–        those who are emaciated and have great aggravation of doshas,

–        those indulging in incompatible foods,

–        those who suppress urges of the body,

–        those injured and

–        those of weak mind (poor mind strength)

These aggravated doshas accumulate in both external and internal sense organs. Such persons would get murcha – fainting i.e. they would temporarily get unconscious.

Pūrvarūpa- premonitory symptoms

हृत्पीडा जृम्भणं ग्लानिः सञ्ज्ञानाशो बलस्य च |
सर्वासां पूर्वरूपाणि, यथास्वं ता विभावयेत् ||५||

Below mentioned are the premonitory symptoms of all kinds of Murcha –

–        pain or discomfort in the region of heart,

–        excessive yawning,

–        exhaustion,

–        loss of consciousness or lack of knowledge and awareness of the surroundings and

–        loss of strength

Nispatti – definition

सञ्ज्ञावहासु नाडीषु पिहितास्वनिलादिभिः |
तमोऽभ्युपैति सहसा सुखदुःखव्यपोहकृत् ||६||
सुखदुःखव्यपोहाच्च नरः पतति काष्ठवत् |
मोहो मूर्च्छेति तां प्राहुः… |७|

The aggravated doshas cause obstruction of Sanjnavaha Nadis i.e. channels carrying sensation (sensory nerves or sensory pathway).

When this happens, the person would experience a sudden increase of tamas – darkness in front of his eyes (becomes unconscious).

This would eventually destroy a person’s feelings towards happiness and misery (he will not be able to appreciate or differentiate between them).

When these feelings of comfort (happiness) and discomfort (misery) are destroyed, the person falls to the ground just like a dry log of wood. In this condition, there will be loss of consciousness and the person will not be able to move the body parts. This condition is called moha or Murcha.

… षड्विधा सा प्रकीर्तिता ||७||
वातादिभिः शोणितेन मद्येन च विषेण च |
षट्स्वप्येतासु पित्तं हि प्रभुत्वेनावतिष्ठते ||८||

Murcha is of six kinds –

–        one each from vata etc – vataja, pittaja and kaphaja,

–        one from rakta – vitiated blood,

–        one from madya – consumption of wine and

–        one from visa – intake of poisons

Pitta is the predominant dosha in all these six kinds of murcha.

अपस्मारोक्तलिङ्गानि तासामुक्तानि तत्त्वतः |९|

The physician should understand that in each of the types of Murcha, the symptoms of apasmara – epilepsy will be generally manifested.

पृथिव्यम्भस्तमोरूपं रक्तगन्धश्च तन्मयः ||९||
तस्माद्रक्तस्य गन्धेन मूर्च्छन्ति भुवि मानवाः |
द्रव्यस्वभाव इत्येके दृष्ट्वा यदभिमुह्यति ||१०||

Tamo Guna is predominant in the prthvi – earth and ap – water bhutas (elements). Rakta – blood tissue is made up of the same prthvi and ap bhutas. Therefore, human beings faint and fall on the ground because of the smell of blood. According to some scholars, the nature of the substance itself (natural properties of blood in this context) is the cause for fainting.

गुणास्तीव्रतरत्वेन स्थितास्तु विषमद्ययोः |
त एव तस्माज्जायेत मोहस्ताभ्यां यथेरितः ||११||

The same properties are present in both visa – poison and madya – wine / alcoholic drink but in greater strength. Therefore, when they are consumed in greater quantities, the person would get moha / murcha.

स्तब्धाङ्गदृष्टिस्त्वसृजा गूढोच्छ्वासश्च मूर्च्छितः |
मद्येन विलपंश्छेते नष्टविभ्रान्तमानसः |
गात्राणि विक्षिपन् भूमौ जरां यावन्न याति तत् ||१२||

Below mentioned are the symptoms (special) of murcha caused by the smell of blood –

–        loss of movements of the body parts,

–        loss of movements of the eyes and

–        imperceptible respiration

Below mentioned symptoms are found in murcha caused by madya – wine –

–        irrelevant speech,

–        falling down on the ground with loss of consciousness,

–        vigorous movements of the body

These symptoms are present until the madya completely gets digested.

वेपथुस्वप्नतृष्णाः स्युः स्तम्भश्च विषमूर्च्छिते |
वेदितव्यं तीव्रतरं यथास्वं विषलक्षणैः ||१३||

Shivering of the body parts, sleep, thirst and stiffness of the body are present in the murcha caused by visa. Depending on the properties of the poison, these symptoms would get greatly increased.

Murchā cikitsā – treatment of syncope

सेकावगाहौ मणयः सहाराः शीताः प्रदेहा व्यजनानिलाश्च |
शीतानि पानानि च गन्धवन्ति सर्वासु मूर्च्छास्वनिवारितानि ||१४||

Below mentioned treatments should be considered as unavoidable in all kinds of syncope (they necessarily need to be done) –

–        pouring medicated liquids on the body,

–        immersion in medicinal liquids,

–        wearing gems and garlands,

–        providing air using fans,

–        drinking liquids which are cold and having pleasant smell

सिताप्रियालेक्षुरसप्लुतानि द्राक्षामधूकस्वरसान्वितानि |
खर्जूरकाश्मर्यरसैः शृतानि पानानि सर्पींषि च जीवनानि ||१५||

Below mentioned recipes may be consumed –

–        cold drinks added with sita (sugar), priyala and iksurasa (sugarcane juice) or

–        juice of draksa and madhuka or

–        decoction of kharjura and kasmarya and

–        ghee cooked and prepared with herbs belonging to Jivaniya Gana (Kakolyadi Gana) group

सिद्धानि वर्गे मधुरे पयांसि सदाडिमा जाङ्गलजा रसाश्च |
तथा यवा लोहितशालयश्च मूर्च्छासु पथ्याश्च सदा सतीनाः ||१६||

Below mentioned foods can be given –

–        Milk cooked with herbs belonging to the Kakolyadi Gana (sweet group of herbs) group should be given.

–        Soup of meat of animals living in arid lands added with juice of Dadima should be administered.

–        Food prepared with Yava and Lohita Sali and soup of Satina are beneficial.

These foods are always beneficial in all kinds of fainting.

भुजङ्गपुष्पं मरिचान्युशीरं कोलस्य मध्यं च पिबेत् समानि |
शीतेन तोयेन बिसं मृणालं क्षौद्रेण कृष्णां सितया च पथ्याम् ||१७||

Equal quantities of below mentioned ingredients should be taken –

–        Bhujanga Puspa (Nagakesara),

–        Marica,

–        Usira,

–        Kola,

–        Madhya

They should be mixed in cold water and consumed.

Alternatively, Bisa and Mrnala may be consumed with cold water.

Powder of Krsna (Pippali) mixed with honey or powder of Pathya mixed with sugar may be consumed.

कुर्याच्च नासावदनावरोधं क्षीरं पिबेद्वाऽप्यथ मानुषीणाम् |
मूर्च्छां प्रसक्तां तु शिरोविरेकैर्जयेदभीक्ष्णं वमनैश्च तीक्ष्णैः ||१८||

The nose and mouth of the fainted person should be held closed for a few seconds. Or the person should be made to drink breast milk. Also, to relieve the person from fainting, purgation to the head and strong emetics should be administered.

हरीतकीक्वाथशृतं घृतं वा धात्रीफलानां स्वरसैः कृतं वा |
द्राक्षासितादाडिमलाजवन्ति शीतानि नीलोत्पलपद्मवन्ति ||१९||
पिबेत् कषायाणि च गन्धवन्ति पित्तज्वरं यानि शमं नयन्ति |२०|

Ghee boiled with decoction of haritaki or ghee boiled with fresh juice of dhatriphala, or ghee added with drākṣā, sita, dāḍima and lāja; or nilotpala and dadima; and lāja or nīlotpala or padma, or decoction which cures fever caused by pitta may be consumed.

Sannyasa – coma

प्रभूतदोषस्तमसोऽतिरेकात् सम्मूर्च्छितो नैव विबुध्यते यः ||२०||
सन्न्यस्तसञ्ज्ञो भृशदुश्चिकित्स्यो ज्ञेयस्तदा बुद्धिमता मनुष्यः |२१|

The person who has fainted cannot be easily awakened due to the effect of aggravation of doshas and or predominance of tamo guna. Such a condition is to be understood as Sannyasa (coma). This condition is difficult to treat.

यथाऽऽमलोष्टं सलिले निषिक्तं समुद्धरेदाश्वविलीनमेव ||२१||
तद्वच्चिकित्सेत्त्वरया भिषक्तमस्वेदनं मृत्युवशं प्रयातम् |२२|

An unbaked ball of mud put into water can be lifted out of water before it dissolves in it. Similarly, the patient who is not sweating and reaching death should be quickly treated by the physician.

तीक्ष्णाञ्जनाभ्यञ्जनधूमयोगैस्तथा नखाभ्यन्तरतोत्रपातैः ||२२||
वादित्रगीतानुनयैरपूर्वैर्विघट्टनैर्गुप्तफलावघर्षैः |
आभिः क्रियाभिश्च न लब्धसञ्ज्ञः सानाहलालाश्वसनश्च वर्ज्यः ||२३||

Below mentioned measures should be followed so as to awaken (bring to consciousness) the patient –

–        apply strong collyrium,

–        anointing,

–        inhalation of smoke,

–        pricking the nail bed of the person with needles,

–        creating extraordinary sounds using musical instruments and songs,

–        hitting the body with whip or similar other things or

–        rubbing pods of guptaphala (atmagupta) on the body

The person should be refused in the below mentioned conditions –

–        If the patient does not attain consciousness even after adopting these methods

–        If he is suffering from flatulence, excessive salivation and lack of breathing

प्रबुद्धसञ्ज्ञं वमनानुलोम्यैस्तीक्ष्णैर्विशुद्धं लघुपथ्यभुक्तम् |
फलत्रिकैश्चित्रकनागराढ्यैस्तथाऽश्मजाताज्जतुनः प्रयोगैः |
सशर्करैर्मासमुपक्रमेत विशेषतो जीर्णघृतं स पाय्यः ||२४||

Once the patient obtains consciousness, he should be treated by administering strong emesis and purgation. He should be given light and healthy foods.

For a period of one month, the person should be treated by administering –

–        triphala added with more quantity of citraka and nagara or

–        medicinal recipes prepared from silajatu added with sugar

Consumption of old ghee is especially beneficial.

यथास्वं च ज्वरघ्नानि कषायाण्युपयोजयेत् |
सर्वमूर्च्छापरीतानां विषजायां विषापहम् ||२५||

In all kinds of murcha, decoctions which cure fevers can also be administered.

In murcha caused by poisons, all medicines which are antitoxic can be used.

इति श्री सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे मूर्च्छाप्रतिषेधो नाम(अष्टमोऽध्यायः, आदितः) षट्चत्वारिंशत्तमोऽध्यायः।।४६।।

Thus ends the forty sixth chapter by name Mürcha pratiṣedha in Uttarasthana of Suśrutasamhita.