Tuni Pratituni – which means, signs, administration, possible trendy correlation
Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Context and Reference
Tuni and Pratituni are two painful situations defined within the context of ‘Vata Vyadhi Nidanam’ chapter of Madhava Nidana treatise. This explains that they each are forms of vata vyadhi, particular problems brought on by extreme aggravation of solely vata. These two situations have been very briefly defined and the references of those situations are taken from chapter 1 of Nidana Sthana part of Sushruta Samhita treatise i.e. ‘Vata Vyadhi Nidanam’. Grasp Sushruta has defined the remedy for these situations in Sushruta Samhita Chikitsa Sthana, Chapter 5 i.e. ‘Mahavatavyadhi Chikitsa’. So, the context of the reasons of those situations offers a readability that they’re thought-about as vata vyadhis and are additionally handled on the strains of vata vyadhi remedy.
Tuni Pratituni: Signs
अधो या वेदनां याति वcÉÉåïमूत्राशयोत्थिता ।।
भिन्दतीव गुदोपस्थं सा तूनीत्यभिधीयते ।।८६ ।।
गुदोपस्थोत्थिता सैव प्रतिलोमविसर्पिणी ।।
वेगैः पक्वाशयं याति प्रतितूनीति सा स्मृता ।।८७ ।। Su.Ni.Ch 1 / Vata Vyadhi Nidanam
Tuni – The aggravated vata will get localized within the purisha ashaya – the seat of faeces or massive gut and mutra ashaya – seat of urine or urinary bladder. By doing so, the vata, whereas transferring downwards from these seats, offers rise to chopping ache within the rectum and penis. This situation known as Tuni.
Pratituni – The identical sort of ache (chopping ache) which begins within the rectum and penis, strikes upwards, reaches pakvashaya – massive intestines / colon in bouts. This situation known as Pratituni.
Going deeper with this rationalization,
Tuni and Pratituni clearly seem like severely painful situations, whereby the ache is travelling in reverse instructions.
Tuni has 2 programs. It follows one or each the programs as given beneath –
a. The aggravated vata strikes downwards from higher a part of massive gut alongside the colon, in the direction of rectum and causes ache within the rectum
b. The aggravated vata strikes downwards from urinary bladder / kidney alongside the urinary tract (passage), reaches the penis and causes ache therein
Pratituni additionally has 2 programs however within the reverse course. It follows one or each the programs as given beneath –
a. The aggravated vata strikes upwards from the rectum in the direction of the higher a part of the massive gut / colon and causes ache therein
b. The aggravated vata strikes upwards from the penis in the direction of the urinary bladder and causes ache therein
Within the verses, pakvashaya has been talked about however mutrashaya has not been talked about within the context of pratituni. However we will infer its involvement in accordance with the sample of ache occurring in tuni.
The ache brought about in tuni and pratituni needn’t be occurring on the finish factors i.e. rectum or penis in a single case and huge gut and urinary bladder within the different case. The truth is, it may be inferred that the ache in tuni or pratituni might happen all through the size of the pathway or channels during which the aggravated vata strikes, in bouts, like colic.
We have to see that the complete pathway during which vata strikes upwards or downwards and causes ache are hole organs.
Grasp Vagbhata’s View
पक्वाशयाद्गदोपस्थं वायुस्तीव्ररुजः प्रयान् ।
तूनी, प्रतूनी तु भवेत्स एवातो विपर्यये ॥ ६२|| As.Hr.Ni.Sth.11
The aggravated vata produces extreme ache because it travels from pakvashaya i.e. massive gut to the guda i.e. rectum and upastha i.e. penis. This situation known as Tuni.
When an identical sort of ache travels in a reverse course i.e. upwards from the rectum and penis to the massive gut it’s referred to as as Pratituni i.e. Tuni transferring in the wrong way.
One factor that we have to see is that the reason is nearly just like that of Grasp Sushruta however Grasp Vagbhata misses the point out of mutrashaya. The identical was finished by Grasp Sushruta within the rationalization of Pratituni.
Abstract and Collective inference
Summing up Sushruta and Vagbhata references, we will draw some inferences.
Aggravated vata causes each situations, tuni and pratituni. The character of ache will depend on the course during which the aggravated vata strikes. It strikes downwards in tuni and upwards in pratituni.
The organs concerned within the causation of tuni and pratituni are – massive gut, urinary bladder / kidney, rectum and penis. In ladies, the vulva / vagina is concerned.
Urinary bladder (Sushruta) could be concerned in tuni and might transmit ache to the penis or vulva. It’s a variant of Tuni. Urinary bladder might or might not be concerned in pratituni. As per Vagbhata it isn’t in any respect concerned. The involvement if any could also be as a result of they’re the constructions very carefully associated within the decrease stomach and pelvis and positioned within the Apana Vata zone. Apana vata controls these constructions and their capabilities.
Involvement of pakvashaya – colon is necessary in each these situations and so is the rectum and penis or vulva.
Because the ache strikes in upward or downward instructions (in pratituni and tuni respectively) together with motion of vata, the constructions coming within the pathway are additionally concerned. So, the urethra and nearly all of the colon above the extent of rectum shall be thought-about.
The purishavaha and mutravaha srotas are concerned in these situations.
The srotodushti (mode of contamination of channels / ducts) is within the type of
– sanga – impaction or obstruction brought on by fart or faeces (in colon) or stones or international our bodies (in urinary tract)
– sira granthi – cysts or tumours or area occupying lesions in or across the constructions concerned, imparting strain on them
– vimargagamana – reverse or retrograde motion of vata – restricted to pratituni
The potential completely different patterns of ache included in tuni and pratituni are –
Tuni –
– massive gut to rectum
– massive gut to penis / vulva
– urinary bladder to penis
– urinary bladder to the area of rectum
Pratituni –
– rectum to massive gut
– penis to area of enormous gut
– penis to urinary bladder
– rectum to urinary bladder
Common line of remedy
Nidana Parivarjana
Maintaining away the causative elements liable for aggravation of vata and likewise causation of illness needs to be averted.
Hetu Viparita and Vyadhi Viparita Chikitsa
The therapies and medicines that are deliberate needs to be antagonistic to the reason for the illness and illness itself. The underlying illness if causal needs to be handled. The sroto dushti needs to be analysed and remedy deliberate accordingly.
Coping with vata
Anti-vata technique must be applied by way of meals and way of life practices and likewise habits and behaviours. Medicines and therapies to fight vata shall be deliberate and applied.
Panchakarma therapies
Vasti and Virechana are the principle therapies for tuni and pratituni. Gudavarti – suppositories and Uttara Vasti – enema into urinary passage must also be thought-about as and when wanted.
Exterior therapies
Abhyanga – natural oil therapeutic massage, Swedana – sudation / fomentation, Avagaha – tub tub sudation, Lepa – anointment / utility of medicinal pastes ready with vata mitigating herbs and dhara – streaming or showering scorching / heat liquids like decoction or milk needs to be thought-about to fight vata and likewise to deal with the situations.
Particular line of remedy
तूनीप्रतून्योःस्नेहलवणमुष्णोदकेनपाययेत्,पिप्पल्यादिचूर्णवा,हिङ्गुयवक्षारप्रगाढंवासर्पिः,बस्तिभिश्चैनमुपक्रमेत्। Su Chi 5/26 Mahavatavyadhi Chikitsa
In each tuni and pratituni, Grasp Sushruta advocates the beneath talked about cures.
Sizzling / heat water added with sneha – oil and lavana – siandhava lavana or rock salt needs to be given to drink.
Powder of herbs of Pippalyadi Gana group combined in scorching or heat water shall be given to drink.
Giant portions of powder of Hingu – asafetida and Yava kshara – alkali of the entire plant needs to be given combined in ghee.
Vasti – medicated enemas are useful in combating ache and dosha (vata).
Kulattha Yusha – soup ready from horse gram can also be helpful within the remedy of tuni and pratituni.
Different issues
Vata Vyadhi Chikitsa – Tuni and Pratituni shall be handled on the strains and rules of vata vyadhi chikitsa – remedy of vata vyadhi.
Udavarta Chikitsa – Remedy as prescribed for irregular upward motion of vata and ailments brought on by the identical – particularly in pratituni.
Gudagata Vata Chikitsa – Remedy as prescribed for aggravated vata localized within the rectum – particularly in pratituni.
Mutrashmari and Mutrakrichra Chikitsa – Remedy as prescribed for urinary calculus and dysuria – particularly in tuni.
Vibandha, Anaha, Adhmana Chikitsa – Remedy as prescribed for constipation, platulence and distension of stomach – particularly in tuni.
Shula Chikitsa – Remedy as prescribed for belly colic.
Helpful formulations
– Gandharvahastadi Kashayam
– Brihatyadi Kashayam
– Gokshuradi Guggulu
– Gandharvahastadi Eranda Tailam
– Vayu Gulika
Trendy Correlation
Tuni – This situation could be correlated with
– belly colic
– acute or power constipation
– flatulent dyspepsia
– gaseous distension of stomach
– urinary bladder stone / cystic calculi
– urinary bladder ache
– renal calculi
Pratituni – This situation could be correlated with
– proctalgia / rectum ache
– urethral calculi
– balanitis / urethritis
– vaginitis / vulvitis
– urinary bladder ache / calculi
