Application of the concept of mala suddhi with special reference to various medicines mentioned in Siddha literature

Dr. Senthamizh chelvan,BSMS Dr.C. Mary Sharmila,BSMS

Based on the classes taken by Dr. L. Mahadevan,BAMS,MD

Mala suddhis is an integral part of Indian classical medicine. In siddha system, it has been given primary importance. It is done before starting any therapeutic procedures. It is called virechana in ayurveda. It is a process by which the toxins or the malas from the body are eliminated through anal route by internal administration of medicines. Malam denotes excreta or toxins. There are mano malas or the toxins of the mind. Tamil literature call this as Anavam, kanmam and mayai. Once the detoxification takes place in the body, there will be automatic detoxification in the mind also. So while we plan a detoxification or suddhi, cleansing the body is the primefaca of the treatment. Considering the anatomical structure of the body the upper stomach is

predominant of kapha, the duodenum is predominant of pitta and the large colon is the seat of vata. This is an order. The doshas do their physiological activity by being predominant in these receptors or sites. There are three malas that are produced as a part of day-to-day physiology. They are sweat urine and fecal matter. It is sweat through which the mala rupa of pitta is eliminated. When we do sweating therapy like kizhi we usually do it in vata kapha conditions namely low back ache or osteo arthritis. Here, the sita guna of vata is reduced by the heat, excess pitta is produced,

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vata and kapha are brought to normalcy. If we take the next mala ,urine, kapha and pitta are eliminated through that. proteins, ketones acetones, urobilinogen and leucocytes are eliminated. This is called mutra virechanam. When we give kashayam prepared out of nerunchil (B.N Tribulus terrestris), satavari (B.N Asparagus racemoses), anai nerunchil (Pedalium murex), saranai ver (Trianthema

portulacastrum), detoxification of urinary tract take place. Modern medicines talk in terms of acidity and alkalinity of the human body. Vata pitta predominant is acidic in nature, pitta kapha predominant is alkaline in nature. When assessing the fecal matter, it is the channel through which vata pitta kapha, i.e., the tridoshas are eliminated. Evacuation of bowels in a regular interval and in a regular schedule is considered as a characteristic feature of health in Indian medicine. It is not only the amount, consistency and the smell of the fecal matter but also the time taken for the evacuation is also considered to understand the tridosha suddhi. These questions are asked to the patient by the vaidya in his OPD. When we perform therapeutic purgation we can see kapha at the end of evacuation. What does it mean? The virechanam cleanses, large colon, small colon and cleanses the upper stomach in order. Kapha present in the upper stomach comes in the end. So seeing kapha in the purgation is considered as a good characteristic feature for the virechana. But when we do vamana therapy ,kapha will come first, then pitta will come because in the oesophagus and upper stomach kapha is predominant and bile is predominant in the lower part of the duodenum that comes in the end. This has to be observed by the clinician. This is very important. If this does not happen, it means that a proper suddhi is not done and , the residual toxins may stay in the body and produce unwanted complications like indigestion,

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itching, etc in the due course. Even though the virechanam is the base therapy for pitta diseases, it can be given for vata, kapha, etc., In siddha medicine, virechanam is considered as a full detoxification because it handle and remove the endotoxins of all the tridoshic physiology. When we treat a patient with low back pain, we understand that it is produced by the blockage of apana vayu, so as vayu is ruksha, we select castor oil based medicines here. What is the reason? Vata is dry, dryness increases pain, dryness is compensated by

oiliness, oiliness is the opposite quality of dryness, so we select castor oil based medicines like siddhathi oil here. We get another patient with herpes. The herpes is produced pitta and kapha. The common gunas between pitta and kapha is snehana or oiliness. We do not select castor oil in this case. Here we will select a dry

purgative. What is meant by dry purgative? Creating a purgation with raw drug, churna, svarasa, kashaya is called dry purgative. Peipudal (B.N -Trichosanthes cucurmerina), katukarohini(B.N-Picrorhiza kurroa), Sivathai ver(B.N-Operculina turpethum), Kadukkai(B.N -Terminalia chebula), Peithumatti(B.N-Citrullus

colocynthis), Nilavarai(B.N -Cassia obtusa) are the examples. So we can understand that we have to use intelligently snigda virechana and ruksha virechana in practice. If there is vata vruddhi, vata is associated with pitta, or when vata is associated with kapha we have to consider, For example, Lavanagunadi tailam which is an oily purgative which is selected in the following conditions.

Lumbar disc prolapse, Lumbar canal stenosis, Acute radiculopathy,

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Sciatic neuropathy, Ankylosing spondylitis, Rheumatoid spectrum, Osteo arthrosis, Endometriosis, PCOD, Sub fertility, Dysmenorrhoea, etc.,

Dry purgative like churnas are selected in following condition.

Renal failure, Lymphatic oedema, Hypothyroidism, Metabolic syndrome X, Herpes recovery, Hepatobilliary disorders, Vesiculo bullous disorders, Toxic pathology, Insect bite allergy, Skin diseases, Folliculitis, Eczema.

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In some conditions, we may use both purgatives intelligently. For example, we will assess bronchial asthma, which is a vata kapha predominant disease. If expectoration is more and wheezing is more, we select a dry purgative. If dyspnea is more we understand that vata is the factor behind the dyspnea and we will select an oily purgative after application of karpura taila in the chest region after warming. In some conditions like SLE, castor oil is given with sugarcane juice, coconut oil or milk because there is little bit of pitta predominant along with vata. So we give castor oil with pitta reducing anupana like milk and coconut water. In conditions like cirrhosis, ascities, portal hypertension we have to use dry purgative on everyday basis. In renal failure also, sweating is reduced, urine is not eliminated daily, so the two pathways of elimination of mala is blocked. The only pathway that is available for the elimination of mala is the anal route. So we have to do purgation everyday. Here various medicines are available in Siddha literature like Kausikar kuzhambu, Agasthiyar kuzhambu, Siddhathi Ennai, etc. Usually strong purgations are avoided before the age 10 and after the age of 70. Mild laxative can be done. Usually we give purgative medicines at the bed time, but after bed time when we sleep there is mantha guna vruddhi, that is kapha vruddhi. So it will be ideal to do purgation in morning around 9O clock in empty stomach. There are literary evidences to support this. We have to give medicines by 9.30 in the morning. The patient should get up,he should not take any food. Castor oil is given with small amount of salt and warm water, we can wait for 2 to 3 hours. Mala will start evacuating. After evacuation or when the vegas have started, we can give warm water little by little to felicitate the intestinal movement. Anupanam plays a major role. Anupanam prevents electrolyte imbalance in virechana. If man is having Kalkudal(spastic colon) virechanam is avoided or virechanam is given with salt but

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vasti is preferred. After virechana small quantity of kanji with salt and buttermilk is given. The patient should not take oil bath after that nor sleep in the morning. In the Night he can take a light kanji diet and sleep. After virechana there will be constipation for one or two days and the physiology will take at least 48 hours to come to normalcy. If the patient has not attained a complete suddhi, the next day another dose can be intellectually applied. If we give virechana in night time with nervala(B.N Croton tiglium) like medicines and if complication occurs in the mid night, it will be difficult to manage,so, Virechanam is given in empty stomach, so that it penetrates and the cleansing of the tract is possible. The medicines for vata virechana will act on colon. For example, kadukkai podi(B.N Terminalia chebula) reduces vata. It will take 8 to 10 hours. 20 gms is needed for the suddhi. The pitta medicines work on the small intestine. Katukurohini (B.N Picrorhiza kurroa)is the example. It will take 6 hours to produce of the effect. In kapha conditions, drastic purgatives have to be given. It has to cover large colon starting from the stomach. Nervala(B.N Croton tiglium) is the better example. This has to be kept in mind. Croton tiglium takes about 1 hr to act. Kadukkai 12 hrs

katukurohini 6 hrs. it varies to the type of the colon. Croton tiglium should not be given for a mrdu

koshta, but can be given for mathyama and krura koshta.

Once we give medicines for purgation, some times excess vegas are produced. Maximum 20 vegas per day is considered as is normal for an ordinary koshta. In mrdu koshta it may be high, in kalkudal (Spastic colon) it may be less. So

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we may give cold water to stop the purgation. When vegas are less, we give hot water. In the case of nervalam(B.N Croton tiglium) ,We have to do the opposite one. When there is more purgation we have to give hot water. Because hot water helps in reducing intestinal colic. When there is less purgation, we have to give cold water. Because of an improper purgation, there will be burning sensation. Many texts of 16 th century texts quote about this. The word Naga danti, Naga is Sanskrit means

elephant, danti means tusk. Naga danti means it is a plant whose root resembles the Elephant tusk. It is basically a root. The botanical name is Baliospermum montanum, But select crotton seed or nervalam. Nervalam is a seed not a root. What exactly is Nagadanti has to be standardized.

In siddha medicines, virechana medicines can be classified as those containing Croton tiglium, those with Castor oil, those with kadukkai (Terminalia chebula) and those with sivathai (Operculina turpethum). peipudal and katukarohini are not used much.

1. ASTA BAIRAVAM MATHIRAI This medicine contains Croton tiglium as a major constituent -50%. It is given for conditions like fever, uncontrollably vitiated doshas and for toxicities. The need for purgation in fever is very less. Practically, purgations can be performed only in conditions like pyrexia of unknown origin, hodgkins lymphoma, non hodgkins lymphoma, which are chronic states producing fever. It cannot be done in typhoid fever, viral infections, considering the weak general health of the individual. It is contra indicated in conditions like cough, cold, fever, pneumonia, typhoid.

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It can be given along with lavanga kashayam for toxicity.

The term toxicity includes a broad spectrum of conditions like long term usage of drugs, plant toxicity, lead poison, mercury poison, arsenic poison, sulphur toxicity. This medicine is best handled in conditions like incompatibility of adverse drug reactions and toxic conditions. Dosage 100 mg tablet,one tablet can be given

2. JALODARI MANI This medicine contains the drugs which can be given for gulma like dried ginger, pepper, long pepper, alum, rock salt and asafoetida. It has a similar composition as that of Ashta churnam. This medicine contains croton tiglium along with those of Ashta churnam. This medicine has the property to exert it effects on the abdominal areas. It can be practically used in pathologies where the normal pathway of the apana vayu is blocked like ascites, portal hypertension, hernia, BPH, liver cirrhosis, etc., Dosage Anupanam - 200 mg tablet .one or two tablet can be used - water

3. LAVANGADI MATHIRAI It contains Croton tiglium, rasa karpooram, lingam in the ratio of 12:2:1. It is generally given for kapha vata diseases like stroke, infarction, Ischemic heart disease, carotid atherosclerosis, lumbar disc disease, lumbar canal stenosis, spondylolisthesis, and bronchial asthma. It is not the choice of medicines in pathologies like kushta, SLE, vasculitis as it contains drugs of hot potency.

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Dosage

100 mg tablet ,one or two can be used

Anupanam hot water

4. MEHA NATHA GULIKAI This contains lingam, vasambu (Acorus calamus), dried ginger, vaividangam (Emblica ribes), Root of Kattamankku (white variety) along with Croton tiglium. It is generally a choice of medicine for worm infestations, gulma, sopha. Since the medicines has the coined term mega nadhan and also sivathai (Operculina turpetum) as an ingredient it can be given for reactive arthritis, second stage of bacterial arthritis . When given along with chukku kashayam it arrests the excessive evacuation of bowel. Chukku (dried ginger) has the property of Grahi. Dosage 100 mg tablet ,2 or 4 can be given Anupanam chukku kashayam (gingiber officinale)

5. MURUKAN VITHAI MATHIRAI It contains katukarohini (Piccoriza kurrora), murukan vithai (Butea

monosperma), Croton tiglium. It is an anti helmintic with laxative property. Dosage 500 mg tablet ,1 or 2 can be given Anupanam water or palm jaggery

6. PACCHAI KARPOORAM MATHIRAI It also contains Croton tiglium. Though it is mentioned in the context that it can be given for fever as a virechana drug, it also contains ushna virya drugs like lavangam, jathikai, rasa padangam, gandakam (sulphur) which have the property to

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pacify the sita guna of kapha and vata. Hence it can be implemented in vata kapha conditions like demyelination, motor neuropathy etc. It has to be understood that ginger juice mentioned is ushna virya in nature and acts as a deepana helps reducing kapha vatam. Dosage 100 mg tablet ,1 or 2 can be given Anupanam extract of inji (gingiber officinale)

7. SOOLAI BOOPATHI It contains mercury, sulphur, naabi (Aconitum ferox) along with bile of snake and boar. It can be understood from the name that it cures Soolai. Soolai can be interpreted as abdominal colic. Virechanam is contraindicated in acute abdominal conditions like appendicitis, but can be done in the second stage of the pathology when the severity of the disease has subsided. It can be used in hepatic flexure syndrome, spleenic flexure syndrome, Renal colic, abdominal colic, endometriosis, BPH, Proctalgia fugax. As it is a ushna virya, drug it is contraindicated in peptic ulcer and duodenal ulcer. Dosage 100 mg tablet ,1 tablet can be given

8. SANJEEVI MATHIRAI Contains 50% of Croton tiglium in composition. This is processed with extracts of veliparuthi (Pongamia daemia). When given along with Jathikkai churnam it rectifies the block of apana vayu in bleeding piles. Practically it can be given with lemon juice for urticaria. Dosage - 100 mg tablet ,one or two can be given

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DRUGS WHICH CONTAIN KUMATTI How to differentiate the action potential of medicines which contain Croton tiglium and those which contain kumatti Croton tiglium eliminates the toxins alone from the body, but kumatti acts as a purifying agent in vata rogas diseases of female reproductive system mind related rogas.

Kumatti is a constituent of Kalyanaka ghrta in Ayurveda.In the ayurvedic text astanga hrudayam, vata vyadhi, cikitsa thivatha ghrtam contains kumatti. Kumatti is chosen when vata is vitiated in dhatus Castor oil for vitiated vata in colon Croton tiglium for vitiated vata & kapha in colon.

9. LINGA CHENDURAM Prepared with 2 litres of extracts of kumatti. Although it is given for vata kapha diseases, it eliminates the toxins in the dhatus, affected by Kulir vatam & Megam. Dosage - 50 mg - 100 mg tablet , one can be given

Anupanam - Honey

10 . KUMATTI MEZHUGU It is a choice of drug for portal hypertension, liver cirrhosis,

endometriosis, dysmenorrheoa, infertility etc. dosage is carefully determined.

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Dosage

- 200 mg - 500 mg tablet , one can be given

Anupanam - Palm jaggery

KUZHAMBU Anything that has an oily texture is termed as kuzhambu. That which is unctuous in nature is kuzhambu. It is a stage of process. Lehyam is that which is licked . Kuzhambu is used when the dry guna of vata is vitiated. Also used when vata is associated with pitta or when vata is associated with kapha. Spastic colon Chronic gastritis Dyspnoea Vertigo Infraction when vata alone is vitiated vata associated with pitta vata associated with kapha pitta associated with vata kapha associated with vata

Medicines with unctuous guna can be given to pacify the dry guna of vata.

Although Agasthiyar kuzhambu is used in a wide spectrum with anupanam specificity,it is given along with kumatti extract for gulma. For cough, it is coupled with kadukkai kashayam which reduces vata kapha. In endometriosis, which is a vata disease, agasthiyar kuzhambu is given with chukku kashayam. In bleeding piles which is vata pitta roga, it is given along with buffalo milk which is sweet in rasa and has unctuous guna. In kapha related pandu, if is given along with extract of onion.

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In fever for ama pachana, it is given with chukku kashayam.

11. KAUSHIKAR KUZHAMBU It has purgative property, contains katukurohini, Croton tiglium as key ingredients. It is given for vata disease (suthaka vayu) with extracts of Pongamia daemia. For kapha diseases with hot water and kadukkai kashayam . It is given with ksheera kashayam for pitta diseases. It is an important drug for toxins like rat bite, snake bite, etc. The anupanam designed by the Rishis for a particular disease fulfills three categories . It decreases the intensity of the roga (disease) of the patient Pacifies the vitiated dosha Increases the bio availability of the plasma half life of the particular medicine As it contains katukarohini, manosilai, it can be given for tonsilitis. It has 30% of the ash of coconut shell. The peculiarity of the composition is that it acts as an alkalizer, which is not included in any other yogas. zymethicone is given in conditions where there is increased secretion of pepsin & HCL. Modern medicines pacify the dosha. Kaushikar kuzhambu pacifies & eliminates the dosha involved.It reminds of the pre kinetic action of the medicine.

12. MALAKUDARA MEZHUGU It is a mild laxative drug, can be given even for children. It takes, about 8 hours for the medicine to produce its effect, causes one or two vegas. Does not produce abdominal cramps, can be taken as a routine laxative drug.

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Dosage

- 100 mg - 200 mg tablet , one can be given

Anupanam - palm jaggery

13. NAVA UPPU MEZHUGU It is also a medicine prepared with Croton tiglium. Can be given for motor neuron disease, motor neuropathy should follow pathyam without salt when the medicine is given, as the medicine is composed of varieties of salt as its composition. Dosage Anupanam - 100 mg - 200 mg tablet , one can be given - palm jaggery

14. NEELAVARAI CHURNAM It is a digestive and dry purgative. Dry purgative is used in portal hypertension, ascities, liver diseases, hepatitis, hepatomas, herpes recovery, oedema, hypothyroidism, all the conditions where agni mandhya is associated with pitta and kapha problems. Dosage - 1 2 gms

Anupanam - hot water

15. SIVATHAI CHURNAM It is also a mild laxative. A low dose of Sivathai Churnam pacifies pitta. In a higher dose it eliminates pitta. It can be given upto 15 gms with hot water. Dosage - 15 gms

Anupanam - hot water

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1`6. KARUDANKIZHANGU ENNAI It is katu rasam, ushna veeryam, agni deepanam, gulmaharam. It is highly useful in vata kapha diseases. It contains castor oil as an ingredient. Dosage is 15 to 20 ml. It is useful in endometriosis, dysmenorrhoea, disc problem, benign prostrate hyperplasia, constipation, non ulcer dyspepsia , etc., Dosage - 15 20 ml

17 .KAZHARCHI TAILAM It is a very powerful purgative. It contains a greater of proportion of castor oil along with Croton tiglium. So a single dose of 5 to 10 ml with specific pathya in given, Murungai pinchu(B.N Moringa oleifera) and Avarai pinchu(B.N Lablab purpureus) should be given. Practically it is given for renal failure, udambu veekkam. Kazharchi tailam is the choice of drug for purgation for suitable conditions in mechanical intestinal obstruction. Dosage - 5 to 10 ml

18 . MALAI VEMBADI TAILAM It contains varikumatti and castor oil. It is a specific purgative for pumsavana (Sub-fertility spectrum). This is given for 3 days only. This is given during the menstrual cycle. This is a pre sodhana therapy before starting the treatment for pumsavana, sub-fertility management. But this can be also used in endometriosis, PCOD, fallopian tube block, dysmenorrhoea, Premenstrual tension,

Amenorrhoea, secondary amenorrhoea, etc., Dosage Anupanam - 15 30 ml - rice water

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19 . MANTHA ENNAI This is a katu rasa oil. Castor oil is the base. Dosage of 2 to 3 ml can be given. This can be given in kapha diseases of children. Mal-absorption, worms, rickets are the common conditions where Mantha ennai is used. In another type of Mantha ennai, uttama kanya swarasam (veli paruthi) is used. Dosage Anupanam - 2 to 3 ml - Milk

20 . MOOLAKUDARA TAILAM It is a very mild laxative which contains tender haritaki along with castor oil. 2 to 3 spoon at night. Produces one or two vegas. Dosage - 10 - 15 ml

21 . MERUKULLI TAILAM It contains Merukan kizhangu, Botanical name a castor oil. It is highly useful in Rheumatoid spectrum of diseases, gout, psoriatic arthropathy , etc., Dosage - 10 - 15 ml

22. MENI TAILAM It contains Kuppameni with castor oil. It is highly useful in fistula worm infestations, syphilitic ulcer. Dosage - 10 - 15 ml

23. SIDDHATHI ENNAI

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It is katu rasam, ushna veeryam, vatakapha haram. It contains croton, tiglium, Kalli Paal, etc., It has a wide range of utility. This is a choice of drug in our practice in Schizophrenia. In Schizophrenia it produces specific suddhi. It is useful in uterine diseases, but in our experiences we use it specifically in psychiatry problem that needs drastic sodhana. Dosage - 5 - 10 ml

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