Charaka Madatyaya Chikitsa 24th Chapter – Alcoholism

24th chapter of Charaka Samhita Chikitsa Sthana deals with symptoms and treatment for alcoholism. Its called Madatyaya Chikitsa Adhyaya. 
Treatment of Alcoholism
We shall now explain to the Treatment on Alcoholism. Thus, said Lord Atreya. [1-2]

Whisky, Alcohol

Appreciation of alcohol

Appreciation of Sura – alcohol:
The Drink, which, in the time of Yore, was adored by the gods along with their master Indra, which is offered as oblation to fire during Satramani sacrifice (for details of this type of Vedic ritual, Vide Suka- Yajurveda: Kanvasakha Chapters 21- 23 – reference from CS by Bhagwan Dash and Sharma PK); which is respected by the priests which sustains the Vedic rituals: which when taken appropriately eliminated the miseries of Indra who had fallen down, lost his energies (ojas), and was afflicted with diseases because of excessive alcoholic intake; which is a visible, touchable and applicable instrument of sacrifice conducive to its successful completion as enjoyed by the great sages performing sacrifices according to the methods prescribed by the Vedas; which has different types depending upon its specific source material, Samskara (method of reparation), nomenclature, etc, which is at the same time unitary in character on account of the common feature of intoxication which bestows auspiciousness par excellence by providing nourishment to the gods in the form of ambrosia, to the pitrus(Manes) in the form of Svadha(the term used for offering oratory offerings to the manes), to Dvijas (the twice born, viz, Brahmanas, Kshatriyas and Vaisyas) in the form of Soma; which represents the great Lustre of the Ashvini Kumaras, the prowess of the mantras, and the supremacy of Indra; which is perfected Soma in the Sautramani sacrifice; which eradicates grief, depression, fear and be wilderness; which in itself represents the invincible strength, love, voice, nourishment and peace; and which is called Sura by the Gods, Gandharvas (celestial musicians), Yakshas, Raksas and human beings, is taken appropriately (according to the prescription of the Shastra).[ 3-10]

Method of alcohol consumption

The right method of Alcohol consumption:
The following rules are observed for taking alcohol:
1. Before taking alcohol, the person should follow proper rituals (Samskara), hygiene (Shuchi).
2. He should wear the most pleasing perfumed and have pleasant disposition
3. He should wear clean clothes and follow rituals as per the requirement of the season,
4. He should wear different types of garland of different colors, jewels and ornaments.
5. He should offer prayer to the Gods and Dvijas or the Twice born (Brahmanas, Kshatriyas and Vaisyas)
6. He should touch auspicious objects
7. Alcohol is taken in an air-conditioned (Yathartuka) place which is surrounded with tress having falling flowers, which is exceedingly liked by the beloved ones, which is perfumed with the aroma of incense and which is provided with well spread beds and seats along with pillows;
8. The person comfortably sitting or lying in an incumbent posture over the above mentioned seats or bed should take alcohol.
9. The alcohol should beserved to him in a beaker of gold, silver or costly stone or in other clean and well prepared vessels.
10. While drinking alcohol, he should eat delicious refreshments like fruits, Haritaka (green salads) which are sauted and aromatic, and which go well with type of alcohol and seasonal needs
11. Along with alcohol, he should take different type of roasted meat- preparations of animals and birds inhabiting  water and sky, and other various types of eatables prepared by expert cooks
12. Before drinking, he should offer prayer to the gods and solicit their blessings and.
13. He should pour of the alcohol along with water on the ground for the needy (celestial beings like Baladeva, chandi and Yaksa) before starting the drink [ 11-12]

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Regimen to be followed

Regimes to be followed by Persons of Different Body Types
A person having Vatika type of constitution should drink alcohol after
Abhyanga – massage
Utsadana – Unction
Snana – Bath
Dhupana – Fumigation and
Snigdha Anu lepana – Application of unguent and
After having taken food which is unctuous and hot
A person having Pitta body type does not get adversely afflicted if he drinks alcohol after resorting to different types of cooling regimens, and take food- preparations which are sweet, unctuous and cooling regimens, and take food- preparations which are sweet, unctuous and cooling.

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The person having kapha type of constitution should drink alcohol after resorting to heating regimens, and along with food prepared of Barley, wheat and meat of animals inhabiting arid one mixed black pepper.
The rules of drinking alcohol described above are meant for wealthy persons or for those who are going to attain wealth (in near future). However, drinking alcohol is useful for them only when appropriate procedure is followed and the drink is taken in proper quantity.
For persons of Vatika constitution, alcohol prepared of Jaggery and Pishta (paste of the flour of wheat, etc) is generally useful. For persons dominated by Kapha (having Kaphaja constitution) alcohol prepared of honey is useful. Similarly, for persons having Paittika type of constitution, alcohol prepared of grapes is useful. [21-25]

Alcohol good and bad effects

Alcoholic drinks are prepared of different types of ingredients; they have different qualities and actions, and they are intoxicating in nature. Therefore, they have both useful and harmful effects.
If taken in an appropriate manner, in a right dose, at an appropriate time, along with a cheerful mind, alcohol works like ambrosia.
If, however, a person drinks whichever type of alcohol is available (without considering its appropriateness), and that too in excess quantity, and if his body is regularly ununctuous and exhausted because of physical exercise (Vyayama), then it works as a poison. [26- 28]

Attributes of alcohol vis Ojas:
Alcohol, while reaching the Hrdaya (heart) afflicts the 10 qualities of Ojas (located in the heart), by virtue of its 10 qualities, giving rise to mental distortions.

Madya Dasha guna

Madya Dasha Guna – The 10 qualities of alcohol are
Laghu – light to digest – lightness
Ushna – hot
Tikshna – Sharpness
Sukshma – subtleness
Amla – sourness
Vyavayi – prevasiveness or the quality of a substance which first of all pervades the entire body and thereafter gets digested
Ashuga – Swiftness
Rooksha – Dryness
Vikasi – expansiveness and
Vishada – (non- sliminess)

10 gunas of Ojas

The 10 qualities of Ojas are
Guru heaviness
Sita – cold
Mrudu – softness
Slaksna – smoothness
Bahala – density
Madhura sweetness
Sthira – Stability
Passanna clearness or leisureliness
Picchila Sliminess and
Snigdha – unctuousness
Read more: what is ojas How to increase it

The counteraction of Ojas
Heaviness of Ojas is counteracted by the lightness of alcohol;
The cold attribute of Ojas is counteracted by the heating attribute of alcohol;
The softness of Ojas is counteracted by the sharpness of alcohol;
The leisureliness or clarity of Ojas is counteracted by the swiftness of alcohol;
The unctuousness of ojas is counteracted by the dryness of alcohol
The stability of Ojas is counteracted by the pervasiveness of alcohol
The smoothness of Ojas is counteracted b the expansiveness of alcohol
The sliminess of Ojas is counteracted by the non sliminess of alcohol and
The density of Ojas is counteracted by the subtleness of alcohol.

Thus, alcohol destroyers all the attributes of Ojas which is the abode of Sattva (mind) by Virtue of its 10 attributes, and as a result of this affliction, the mind gets Agitated, and so cause’s intoxication.
Heart is the abode (controlling organ) of the channels of  circulation of Rasa (plasma), Vata, etc, the Satva (mind), the Buddhi (wisdom), indriyas (senses), Atman (soul) and Ojas (vital essence) gets destroyed by the excess intake of alcohol, and morbidities appear in the heart and in the Dhatus(Sattva, Etc) Located in it. [29-36]

Affliction of Ojas in Different Stages of Introduction:
There are 3 stages of intoxication caused by the intake of alcohol during the
First stage, the Ojas (Vital essence) is not afflicted but the heart gets stimulated
Middle stage, Ojas is mildly afflicted, and
Third stage, Ojas is entirely afflicted and produces Mada – intoxication. [37]

Specific Nature of Alcohol Prepared of Cereals (Paishtika)
The Paiitika type of alcohol(prepared of the paste of cereals) does not cause extreme affliction of the Ojas (Vital Essence), because it is not dominated by attributes like Vikasi (expansiveness), dryness and Vishada(non- sliminess). [38]

Effects of excessive alcohol intake

The heart gets afflicted by the excessive intake of alcohol on account of the attributes of alcohols resulting in
Exhilaration
Passionate desire
Erotic stimulation
Sense of pleasure and
Varieties of psychic morbidities of Rajasika (dynamic) and Tamasika (sluggish) nature depending upon the mental attitude of the person culminating in Moha- Nidra (Coma)
This mental perversion caused by alcohol (Madya-Vidhrama) is called Mada or Intoxication.

Prathama Mada

Prathama Mada – First Stage of Alcoholic Intoxication:
Intake of alcohol results in 3 stage of intoxication, viz, the beginning (first), the middle (second), and the last (third) stages their characteristic features will be described hereafter.
The first stage is characterized by
Praharshana – Exhilaration
Priti karah – Passion
Pana anna guna darshakah – Proper manifestation of the attributes of food and drinks, and
Vadya gita praharshanam kathanam cha pravartaka – Creativity of music, song, humor and stories
Na cha buddhi smrti haro viayeu na ckama – It does not impair the wisdom and memory and does not cause inability for the sense to perceive their objects.
This first stage of intoxication results in Sukha nidra (sound sleep) and post waking feeling of freshness. Thus, this stage of intoxication brings happiness [41- 43]

Dvitiya Mada

Dwiteeya Mada – Second Stage of Alcoholic intoxication:
During the second stage of intoxication, the person often remembers things and often forgets them, his voice becomes inarticulate and confused, and speaks sense and non- sense simultaneously.
His movement, posture, drinking, eating and talking are all appropriately funny these are the signs and symptoms of the second stage of intoxication. [44- 45]

alcohol abuse on liver

Triteeya Mada

Truteeya mada Lakshana – Third Stage of Alcoholic Intoxication:
After crossing the second stage and in the beginning of the third stage, there comes a stage when the person is afflicted with Rajas and Tamas. This stage predisposes the person to serious complications like insanity. This can be compared to a person walking to an an unhappy destination with lot of dangers. So, a wise person would not subject himself as a victim of that stage.
At the third stage of Madatyaya, a person becomes inactive like a broken tree with his mind afflicted with intoxicating morbid deities and unconsciousness though alive, he resembles a dead person.
He becomes incapable of recognizing pleasing things and friends. He is soon deprived of all happiness for which he had taken alcohol in this stage of intoxication, his losses the very sense of distinction of rightful, happy and useful items from the wrong, miserable and harmful ones respectively.
No wise person will ever like to place himself in such a stage of intoxication. He is condemned and censured by all persons, and disliked by them. As the natural outcome of this indulgence he suffers from miseries and diseases of alcoholism all the time [46- 51]

Adverse effects of Alcohol

Whatsoever is useful after death, whatsoever is good for the present life, and whatsoever is supreme for attaining salvation are based on the tranquility of the mind of an individual alcohol considerable agitates this mind as a strong wind shakes the tree located on the bank of a river.
Unwise people, ignorant of the serious adverse effects of alcohol and serious nature of intoxication (mahagada), being impelled by Rajas and Moha (illusion), consider indulgence in drinking alcohol as a source of happiness

alcoholism

Their minds get afflicted by the adverse effects of alcohol and become derived of the Sattvika qualities. These people, with a craving for intoxication, become blinded by alcohol, and lose all happiness of life.
Illusion, fear, grief, anger and death and diseases like insanity, intoxication, fainting, epilepsy and apatanaka (convulsion) are caused by alcohol.
Wherever there is impairment of memory, all the evil deeds are manifested there because of this; people acquainted with the adverse effects of alcohol vehemently condemn its drinking. [52-57]

Food Value of Alcohol

The serious adverse effects of alcohol described above are undoubtedly true. Such adverse effects are produced when unwholesome type of alcohol is taken in excess quantity without observing the appropriate procedure.
But alcohol is like food which when taken in excess quantity without observing the appropriate rules can result in diseases. Alcohol, like food,  when taken appropriately, it is like ambrosia (Amruta).
For all the living beings, food is the sustainer of life, but when taken inappropriately, it causes death. Similarly, poison which causes death works like Rasayana (rejuvenating agent) when used appropriately [58- 60]

Alcohol in appropriate manner

Good effects of Alcohol Taken in appropriate manner:
Alcohol taken in appropriate manner produces
Harsha – Exhilaration
Urja energy
Mudam – happiness (mental satisfaction),
Pushti – nourishment,
Aarogyam – good health,
Paurushyam – excellent virility and
Sukha madya – pleasant intoxication instantaneously. [61]

In Praise of Alcohol Taken Appropriately
Alcohol taken appropriately produces invigorating effects as follows:
It promotes Rochana (appetite), Dipanam (stimulates the power of digestion), Hrdyam (tones up the heart), promotes Swara (voice) and Varna (complexion), Prasadanam (produces the feeling of refreshment) and Prinanam (corpulence), balyam (increases strength), and removes Bhaya (fear), Shoka (grief) and Shrama (fatigue).
Patients suffering from insomnia enjoy sound sleep by taking alcohol and it stimulates in timid persons(Mooka = lit dumb);
It helps persons having excessive sleep to remain awake and causes bowel movement in constipated patients
It renders the mind insensitive to the miseries of injury, imprisonment and fatigue.
Alcohol itself cures the diseases caused by its excessive and inappropriate intake.
It represents erotic passion, and when associated with an object, it promotes the association of pleasure in it.
It stimulates passion and hilarity even in persons of old age
The enjoyment derived from the 5 enjoyable objects of senses by the young or old during the first stage of alcoholic intoxication has no parallel in this world and
It provides respite to persons afflicted with multitudinous suffering and grief. [62-67]

Appropriateness of Alcohol Intake
One should always drink alcohol with due regard to the 3 varieties of each of the 6 factors, viz food drinks, age, diseases, strength and season and of the Doshas and mental faculties.
Proper application of the triads of these 8 factors is called Yukti or appropriateness in view, and then a person does not suffer from the evil effects of drinking. On the other hand, he with his exalted state of mind enjoys all the good effects of alcohol as stated before without endangering Dharma (religious virtues) and Artha (satisfaction of senses).
During the first stage of intoxication, the mental facilities generally get stimulated.
During the second stage and in between the second and third stages of intoxication, these faculties get suppressed or become unmanifested.
Simile – As the rain stimulates the growth of crops, and fire demonstrates the real nature (Purity) of gold, similarly, alcohol both stimulates and demonstrates the minds of all creatures.
As fire demonstrates the nature of superior, medium and inferior qualities of gold, similarly alcohol demonstrates the characteristic features of the (different types of) mind. [68- 73]

Alcohol effect on Satvika, Rajasika, Tamasika faculties

Effects of Alcohol on Sattvika, Rajasika and Tamasika Faculties:
A person having Sattvika type of mental faculty drinks alcohol while wearing aromatic garlands and while hearing songs. The alcohol he takes is well prepared and not polluted. While taking alcohol, he takes wholesome and delicious food as well as drinks, while drinking alcohol, he always engages himself in delightful conversations. He takes alcohol in a happy mood leading to a pleasing type of intoxication which promotes cheerfulness and poison. It terminates as a pleasing event, and it does not lead to the third stage of intoxication. Sattvika type of persons do not exhibit perverted activities immediately after taking alcohol because alcohol is incapable of adversely afflicting the powerful minds of Sattvika persons instantaneously.
A person having Rajasika type of mental faculty generally talks some time gently and at times rudely, some time distinctly and at times indistinctly, and so demonstrates his irregular varieties of behaviors after taking alcohol. It terminates as a tragic event.
A person having Tamasika type of mental faculty, after taking alcohol, becomes excited and passionate in his talks, he never gets satisfaction in eating and drinking, and his alcoholic intoxication terminates in unconsciousness, anger and sleep. [74- 78]

Company for alcohol consumption

Friends to be associated while Drinking Alcohol:
While drinking alcohol , one should ascertain the Satvika, Rajasika and Tamasika nature of the friends (keeping company in drinking) and should avoid the company of the Rajasika and Tamasika types of friends, because drinking along with them may lead to the transgression of alcohol quantity which may result in the adverse effects of alcohol. [79]

Characteristics of Good Friends for Company during Drinking Alcohol:
Persons who are pleasure-loving, who talk pleasantly, who are amiable in disposition, who are admired by the wise, who have artistic talent, who are friendly, who are experts in different fields of knowledge, who are sympathetic to each other, who are united because of sincere friendship, who promote the good effects of alcohol by their joyful attitude, affection and sweetness, and whose company protest more and more of delightfulness among each other are the best friends to (Keep company with). One derives maximum delight in drinking alcohol in their company. [80-82]

Good environment for Drinking Alcohol

Persons who drink alcohol in the company of good friends while enjoying the easing objects of senses like sight, smell, taste, touch and sound are[really fortune] like the most virtuous ones.
One should drink alcohol with happiness of the mind (soul), in an appropriate time with the pleasing environment represented by the most enjoyable objects of the 5 sense organs. [83- 84]

Persons who do not get Intoxicated Easily:
Persons having strong mind and stable body, who have taken food before drinking alcohol in to a rare quantity, do not get intoxicated by alcohol immediately [85]

People who get intoxicated very quickly:
Persons who are afflicted with hunger and thirst, who are weak, who are of Vatika and Paittika types of constitution, who are given to dry food, less of food and limited quantity of food, who are constipated, who are weak mind, who are wrathful in nature, who are not accustomed to taking alcohol, who are weak and fatigued, and who are afflicted by alcoholism, get intoxicated quickly after drinking alcohol even in small quantity. [86-87].

Vataja Madatyaya

Etiology, signs and symptoms of Vatika Madatyaya:
O! Agnivesha, I shall explain seriatim the etiology, signs and symptoms and treatment of (the various types of) Madataya (alcoholic intoxication).
If a person excessively emaciated because of indulgence in women, grief, fear, carrying heavy load, walking long distance and other strenuous activities, while eating dry food, less quantity of food or limited quantity of food, drinks alcohol which is dry in nature and which is excessively fomented, at night, then this leads to the impairment of his sleep, and Vatika type of Madatyaya instantaneously.
If a person excessively emaciated because of indolence in women, grief, fear, carrying heavy load, walking long distance and other strenuous activates, while eating dry food, less quantity of food or limited quantity of food, drinks alcohol which is dry in nature and which is excessively fermented, at night, then this leads to the impairment of his sleep, and Vatika type of Madatyaya instantaneously.
This Vatika type of Madataya is characterized by signs and symptoms like
Hikka – hiccup, Shwasa – Asthma
Shira kampa – Tremors in the head
Parshva shoola – pain in the sides of the chest
Nidra nasha – insomnia and
Pralapa – Delirium in excess [88- 91]

Pittaja Madatyaya

Pittaja Madatyaya Nidana Lakshana: 
Etiology, signs and symptoms of Paittika Madatyaya:
If a person, indulging in food which is sour, hot and Tikshna (sharp), having wrathful disposition, and having liking for excessive expose to the fire and sun, drinks excess quantity of alcohol which is Tikshna (sharp), heat- producing and sour, then he suffers from Paittika type of Madatyaya.
If this Paittika type of Madatyaya is also dominated by aggravated Vata, then the ailment may either get cured immediately or may cause instantaneous death.
This Paittika type of Madataya is characterized by signs and symptoms like
Trshna – Morbid thirst
Daha – burning sensation
Jwara – fever
Sweda – sweating
Murchha – fainting
Atisara – diarrhoea
Vibhrama – giddiness and
Harita varna – green coloration of the body [92-94]

Kaphaja Madatyaya

Kaphaja Madatyaya Nidana, Lakshana:
Etiology, Signs and Symptoms of Kaphaja Madatyaya:
If a person who is habituated to sweet, unctuous and heavy food, who does not undertake exercise, who sleeps during the day- time, and indulges in the comforts of beds and seats, excessively drinks alcohol which is not fermented well or which in generally set in taste like Gauda (alcohol prepared of Guda or Jaggery) and Paistika (alcohol prepared of the assets of cereals), then he immediately develops Madatyay dominated by Kapha.
Kaphaja type of Madatyaya is characterized by the signs and symptoms like
Chardi – vomiting
Arochaka – anorexia
Hrillasa – Nausea
Tandra – drowsiness
Staimitya – timidity
Gaurava – heaviness and chilliness [95- 97]

Sannipataja Madatyaya

Sannipatika Nature of all the Madatyaya (Alcoholism):
Qualities of Visha (poison) which cause aggravation of all the 3 Doshas (Sannipata) are also found in the alcohol, the only difference being in poison, these attributes are more powerful.
Poison at times, causes death, and at times, causes diseases in the afflicted person, the intoxicating effect of alcohol, at times, leads to death and, at times, causes diseases as the ultimate effect. Therefore, in all types of Madatyaya, the signs and symptoms of all the 3 Doshas are manifested. But on the basis of the specific nature or predominance of the signs and symptoms of a Dosha, this ailments is classified into different types [namely Vatika, Paittika and Kaphaja Madatyaya] [98- 100]

Madatyaya signs and symptoms

Signs and Symptoms of Madatyaya (Alcoholism) in General:
All the signs and symptoms manifested in Madatyaya are as followed:
Sharira dukha – Excruciating pain in the body
Sam moha – Unconsciousness
Hrdi vyatha – pain in the cardiac region
Aruchi – anorexia and
Pratata trshna – incessant thirst
Shita ushna jwara – Fever having the characteristics of cold and heat
Shirah, prvsthi sandhn vidyuttuly ca vedan – Lightening pain in the head, sides of the chest, bones and joints
Ati jrmbha – severe yawning, Sphuranam – throbbing, Vepanam – twitching, Shrama – Fatigue
Uro vibandha – obstruction in the chest
Kasa – coughing, Hikka – hiccup, Shwasa – Asthma
Prajagaran – insomnia and Sharira kampa – trembling of the body
Karna akshi mukha roga – Diseases of the ears, eyes and mouth
Trika graha – Stiffness of the Trika (sacro- iliac joint)
Chardi – Vomiting,
Atisara – diarrhoea and
Vata, pitta , kapha hrillasa – Nausea caused by Vata, Pitta and Kapha
Bhrama – Giddiness, Pralapa – delirium and
Rupanam cha mastanam cha darshana – Visualisation of non- existing objects
ta bhasma lat para pubhicvapraam – Feeling as if the body is covered with grass, ash, creepers, leaves and dust and dashing of birds over the body because of bewilderment and
pradharaa vihagaica bhrntacet sa manyate – Dreaming of terrifying and inauspicious objects [101- 106]

Chikitsa Sutra

Madatyaya Chikitsa Sutra: Line of treatment
All the types of Madatyaya are caused by the vitiation of all the 3 Doshas in the beginning, treatment is made of the most predominant Dosha. If all the Doshas are equally aggravated, the treatment is started from the location of Kapha, followed by that of Pitta, and lastly that of Vata.
The ailments caused by the drinking alcohol in wrongful manner or in excess quantity or in less quantity can be cured by taking the same alcohol in an appropriate manner and specific quantity.
After the morbidity caused by the immaturity of the digestion and metabolism of alcohol is overcome by its proper digestion and metabolism, when the patient desire to have food and drinks, and when there is a feeling of lightness of the body, he is given alcohol which is cooling in effect, which is added with Bida and Saindhava types of salt, and which is diluted with the juice of Matulunga – Lemon variety – Citrus decumana / Citrus lemon and water by a physician well versed with posology i.e appropriate quantity. [107- 111]

Alcohol administration in alcoholism

Justification of Giving Alcohol in Alcoholism
Intake of excessive alcohol which is Teekshna(sharp), hot , sour and Vidahi (causing burning sensation) makes the Anna Rasa (juice of the food after digestion) sticky and improperly digested (Vidagdha) which ultimately turns alkaline(Kshara), and causes Antardaha (Burning sensation in the interior of the body), Jwara (fever), Trishna (thirst), Pramoha (unconsciousness), Vibhrama (giddiness) and Madam (intoxication) instantaneously.
To correct these ailments, alcohol is administered because when an alkaline substance (Kshara) gets mixed with a sour substance, the outcome become sweet in taste, and alcohol is the best among the articles having sour taste.
Now, hear about the attributes of alcohol which make it best among the sour articles. Alcohol by nature is sour and it has 4 subsidiary tastes like sweet, astringent, bitter and pungent. Thus, along with the ten attributes described before (in verse no 31), alcohol has 14 qualities in total. It is because of these 14 attributes, alcohol stands supreme among all the sour articles. [112- 116]

Vataja Madatyaya treatment

Pathogenesis and Treatment of Vatika Madatyaya:
The Dosha incited by alcohol causes obstruction of the movement of Vata in the channels of circulation as a result of which the patient suffers from tivra shira asthi, sandhi shoola – excruciating pain in the head, bones and joints.
In spite of the availability of other sour ingredients, alcohol should specifically be administered to such a patient for the Dosha because of its Vyavayi (diffusive), Tikshna (sharp) and hot attributes.
Alcohol removes:
Sroto vibandha (obstruction in the channels of circulation)
Marutasya anuloman – helps in the downward movement of Vata,
Rochana – acts as an appetizer,
Dipanam – stimulates the power of digestion, and
Satmya – becomes wholesome when consumed habitually.
When the obstruction in the channels is removed, and Vata moves downwards, the pain subsides and the ailments caused by alcoholism get cured. [117- 120]

Recipe for Vatika Madatyay: 
For the alleviation of Vayu, alcohol prepared of the
Paistika- Madya – paste of cereals mixed with
Bija- Puraka Citrus medica
Vrksamla Garcinia gummigatta
Kola Zizyphus jujuba and
Dadima pomegranate and
Sprinkled with the powder of
Yavani – Trachispermum amami
Hapusa – Juniperus communis
Ajaji Cuminum cyminum and
Sringavera – ginger is taken along with salt.
While taking this alcohol, the patient should take delicious snacks prepared of Saktu (roasted flour of cereals) by adding ghee. [121- 122]

Meat soup for Vatika Madatyaya 
After observing the signs and symptoms of aggravated Vata Dosha in the patient suffering from alcoholism, he is given the soup of the meat of Lava, Tittiri Patridge, chicken and pea-cock, or birds, animals and fish inhabiting marshy land and burrows (Bhusaya) and of the meat of Prasaha (those who eat their food by scanting) type of animals with Shali types of rice. [123- 124]
Veshavara and Pan- Cakes for Vatika Alcoholism:
The person suffering from Vatika type of alcoholism is given delicious Veshavara (a type of appetizer) added with ghee, hot (pungent) ingredients, salt and sour articles.
He is given different food articles prepared of wheat by adding Varuni (a type of alcohol), Pupa- Vartis (Scrolls) stuffed with meat and ginger, and made unctuous by adding ghee are useful for him. Pupalikas (pan- cakes) prepared of Masha are also useful for Vatika type of alcoholism. [125- 126]

Meat and pastries for Vatika Alcoholism:
Meat of the fatty animals described before (in verse nos 123- 124) which is neither too unctuous nor too sour is added with black pepper and ginger, and given to the patient along with the juice of Dadima – Pomegranate.
Pastries smeared with sugar syrup (Rasa- pralepi) which are luke- warm, and which are added with Trijataka (Cinnamon, cardamom and cinnamon leaves), Dhanya, and Maricha – Black pepper fruit and is given to such a patient. [127- 128]

Post- Prandial Drinks for Vatika Madatyaya
After taking food if the patient feels thirsty, he is given supernatant part of the Varuni type of wine or the juice of Dadima – Pomegranate or the decoction of panchamoola  (the roots of Bilva – bael, Syonaka Orchis mascula, Gambhari Gmelina arborea, patala Ficus microcarpa and Ganikarika Premna integrifolia) or the decoction of Dhanya and Nagara or the supernatant part of curd or the supernatant part of sour Kanji (a sour drink) or vinegar to drink [129- 130]
Effects of Therapies:

The above mentioned effective therapeutic measures administered in appropriate dose and time, cures the ailment . These measures also help in the promotion of strength and complexion of the patient. [131]

Other Regimes for Vatika Madatyaya:
Madatayaya caused  predominantly by the aggravated vata gets immediately cured by the following regimens:
1. Intake of meat, vegetable preparations, Pastries, Barley, wheat and Shali- rice mixed different types of appetizing Ragas and Shadava (pungent, sour and Saline reparations)
2. Massage, unction and bath with hot ingredients
3. Wearing of thick blankets
4. Application of thick paste of Aguru- Aquallaria agallocha, and thick fumigation with smoke of Aguru
5. Strong embracement of ladies having the warmth of youth, and enjoying of the warmth
6. Use of warm beds and bed-sheets and
7. Enjoyment of the happiness of the interior apartments which are warm [132- 135]

Pittaja Madatyaya treatment

Treatment for Paittkia Madatyaya:
Drinks for Paittika Madatyaya:

In the alcoholism caused by Pitta, the patient is given in appropriate time, Sarkara (made of sugar) or Mrdvika (made of grapes) types of alcohol added with sugar along with the juice of Bhavya Kharjura, Mrdvika and parusaka, or along with the Juice of Dadima – Pomegranate, after making them cool, after sprinkling Saktu (roasted flour of cereals) over them and after diluting with large quantity of after. [136- 137]

Food for Patitika Alcoholism:
The patient suffering from paittika alcoholism should take the meat of Shasha, Kapinjala, Ena, Lava and Asita Puccha, Sweet and sour ingredients and Shali and Shashtika types of rice as food. [138]

Soups for Paittika Alcoholism:
The soup of the meat of goat is prepared by adding the soup of Patola or the soup of Satina and Mudga, and mixed with Dadima – Pomegranate and Amalaka -Phyllanthus emblica. Similarly, different types of Tarpana (refreshing drinks), Yusha (soup) and Rasa (meat soup) is reared by adding the juice of Draksha – Raisin – Vitis vinifera, Amalaka Phyllanthus emblica, Kharjura Phoenix sylvestris and Parusaka Grewia asiatica which are useful for the patient suffering from Paittika type of Alcoholism. [139 140]

Vamana for Paittika Alcoholism:
If in the patient of alcoholism, Kapha and Pitta located in the Amashaya (stomach including small intestine) are incited, if there is excess of morbidity, and if he is suffering from Daha (burning sensation) and Trishna (morbid thirst), then he is given alcohol, grapes juice, water or Tarpana (refreshing drink), and thereafter, administered emetic therapy to eliminate the morbid matter completely. This makes the patient free from Paittika alcoholism instantaneously. [141-142]

Samsarjana Krama:
In appropriate time, when the patient is hungry, Tarpana (refreshing drinks), etc., is given as samsarjana Krama (post therapeutic dietary regimen), by which the power of digestion gets stimulated, and the residual Doshas (morbid matter adhered to the wall of the Intestines) and food get digested. [143]

Treatment of Complications:
If the patient of Paittika alcoholism suffers from
Kasa (cough),
Rakta sthivana – spitting of blood,
Parshva stana ruja – pain in the sides of the chest and breasts,
Trishna – morbid thirst,
Daha – burning sensation,
Hrudaya ura utklesha – agitation in the heart and chest then he is given the decoction of
Guduchi Tinospora cordifolia and
Bhadra-Musta (Cyperus rotundus) or
Patola Luffa acutangula along with
Nagara Zingiber officinale
After its digestion, the soup of the meat of Tittiri- bird is given to him along with food [144-145]

Treatment of excess Thirst:
If along with morbid thirst, there is excessive aggravation of Vayu and Pitta, then the patient is given cold grape-juice to drink which causes downward movement of the Doshas (morbid matter).
After its digestion, he is given food along with the sweet and sour soup of the meat of goat.
If there is thirst, then the patient is given alcohol as anurasa or Anupana (post- prandial drink) in such quantity as would not adversely affect the mind. [146 – 148]

Method of Giving Alcohol:
To the patient having morbid thirst, alcohol diluted with more water is given in small quantities by which the thirst alleviates with any intoxicating effect [148 – 149]

Recipes of excess Thirst:
The following recipes alleviate thirst
1. Cold infusion of Parusaka Grewia asiatica and Pilu Salvadora oleoides.
2. Cold infusion of 4 types of Parni (Shala- Parni , Prsni- Parni, Masa- parni Phaseolus mungo and Mudga- Parni Phaseolus trilobus) and
3. The decoction (cold) of musta (Cyperus rotundus), Dadima – Pomegranate and laja (roasted Paddy). [149 – 150]

Panchamalaka Yoga:
Application of the juice of Panchamlaka (5 sour- drugs), viz,
Kola Zizyphus jujuba,
Dadima – Pomegranate – ,
Vrikshamla – Garcinia morella,
Cukrika (Cangeri) Oxalis corniculata and
Cukrika Tamarindus indica as mouth paint,instantaneously cures morbid thirst. [151]

External therapies for Paittik Madatyaya:
For Paitika types of Alcoholism, the following cooling regimes are useful
1. Intake of cooling food and drinks
2. Use of cooling beds and seats
3. Contact of cold air and water
4. Walking in parks
5. Wearing silken garments, lotus, water-lily, gems and pearl and application of sandal paste added with water which is cooling like the cooling rays of the moon.
6. Touch of the vessels of gold, silver and bronze filled with cold water, and of leather bags filled with ice which is exposed to wind.
7. Contact of woman smeared with sandal paste, and of breeze perfumed with the best type of sandal scent
8. Application of all such regimens which are cold in potency.
9. If there is burning sensation in alcoholism, then the contact of beautiful leaves of Kumuda Nymphaea alba and Utpala sprinkled with sandal water is useful.
10. Hearing of different pleasing stories, sound of peacock and the roaring of the cloud cures alcoholism.
11. To cure burning sensation the physician should ask the patient to use Jala- Yantra (instrument for the shower of water) for sprinkling water, Vata- Yantra (instrument for movement of air) for blowing air in the room, and Dhara- Grha(a room where water sprinkles from the roof) for the stay;
12. For curing Daha (burning sensation), application of the paste of phalini, Sevya, Lodhra Symplocos racemosa, Hema (Mesua ferrea), Patra and Kutannata reared b triturating with the juice of kaliyaka is useful
13. Application of the lather prepared of the pieces of Baari, Aristaka(Nimba – Neem (Azadirachta indica)) and Phenila is useful in curing the burning sensation
14. Sura(alcohol), Sura- Manda(Supernatant art of alcohol), sour yogurt (curd), juice of Matulunga – Lemon variety – Citrus decumana / Citrus limon, honey and sour Kanji(a fermented liquid) are useful as seka(sprinkling) and Pradeha(application in the form of a paste by adding to other drugs) for curing burning sensation and
15. Use of cold water for affusion and bath, and for making the fan wet is useful in curing burning sensation and morbid thirst
Use of the above mentioned therapies in appropriate dose and time person to get cured of the Paittika type of alcoholism. [152- 164]

Kaphaja Madatyaya treatment

Treatment of Kaphaja Madatyaya:
The physician should overcome the Kaphaja type of Madatyaya by emetic therapy and fasting therapy (Upavasa).
If the patient suffers from morbid thirst, then he is given the decoction of
Hribera – Coleus vettiveroides
Bala Sida cordifolia
Prsni-Parni or
Kantakari – Solanum xanthocarpum
He may also be given the boiled and cooled decoction of all the above mentioned drugs along with Nagara Zingiber officinale
The patient is given water boiled with either Dusparsa and Musta (Cyperus rotundus) or
Musta (Cyperus rotundus) and parpataka or
Musta (Cyperus rotundus) alone for the pachana (metabolic transformation) of Doshas.
The above mentioned drinks (decoctions) can be safely administered in all types of Madatyaya for curing morbid thirst and fever.
When the patient is free from Ama – A product of indigestion and altered metabolism (Product of improper digestion and metabolism), and if he so desires, he may be given Sarkara (alcohol prepared of sugar), Madhu (Alcohol prepared of honey), old Arishta (a type of wine) and Sidhu (another type of wine) along with honey, by adding dry type of Tarpana (refreshing drink), Yavani and Nagara. [164 – 169]

Food and drinks for Kaphaja Alcoholism:
The patient suffering from Kaphaja alcoholism is given food prepared of barley and wheat along with the dry soup of Kulattha or dried radish. This vegetables- soup is thin, small in quantity and light for digestion. It is added with pungent and sour ingredients, and ghee in small quantity.
He may be given food prepared of barley along with the soup of Patola Trichosanthes dioica prepared by adding sour ingredients or the soup of Amalaki added with pungent ingredients profusely or the sour soup of Vyosha (sunthi Zingiber officinale, Pippali Piper longum and Maricha Piper nigrum) or the soup of Amla-Vetasa Garcinia pedunculata or the soup of the meat of goat and animals inhabiting arid zone (Jangala) prepared by adding ingredients, and without adding ghee.
Meat is roasted in metal pan or earthen pan till it becomes completely dry. This is added with pungent, sour and saline ingredients. After taking this meat preparation, the patient of Kaphaja alcoholism should drink Madhu (alcohol prepared of honey).
Meat mixed with profuse quantity of Maricha Piper nigrum, and added with the juice of matulunga Citrus medica, pungent ingredients in large quantity, Yavani Carum copticum and Nagara Zingiber officinale is roasted. This is then made sour by adding the juice of Dadima pomegranate and stuffed into a roll of pancake. Depending upon the power of digestion, the patient suffering from Kaphaja type of alcoholism should eat it along with pieces of ginger mixed copiously. Thereafter, he should drink wholesome alcohol. [170- 176]

Ashtanga Lavana:
One part of each of Sauvarcala,
Ajaji Cuminum cyminum,
Vriksamla Garcinia gummigutta and
Amlavetasa Garcinia pedunculata,
half part of each of Tvak Cinnamonum zeylanica, Ela Ellataria cardamum and marica Piper nigrum, and one part of sugar is mixed together. This is called Ashtanga- Lavana.
It is an excellent promoter of the power of digestion, and is given to the patient suffering from alcoholism caused by the predominance of Kapha for the cleansing the channels of circulation.
Being diluted appropriately with sweet and sour ingredients, the above mentioned recipe may be added to the preparation of wheat and barley or to different types of meat- preparations to make them exceeding delicious. [177- 179] Read more about Ashtanga Lavana Churna

Recipes of digestive Stimulants:
White variety of Mrudveeka raisins free from seeds is made into a paste by adding pungent ingredients, and the juice of Matulunga Citrus medica or Dadima pomegranate. To this paste, sauvarcala, Ela- Elattaria cardamum, Maricha -Piper nigrum, Ajaji- Cuminum cyminum, Bhrnga (Tvak) and Dipyaka is added. This Raga (sweet, sour, Saline and pungent appetizer), taken along with honey is an excellent appetizer and digestive stimulant.
Following the above procedure, the Raga of Karavi (small variety of grape) is prepared. Intake of this along with Sukta (Vinegar) and Matsyandika (a preparation of jaggery) stimulates the power of digestion, and it is carminative (Panaca).
Similarly, separate Ragas are prepared of the pulp of Amra Mangifera indica and Amalaka Phyllanthus emblica by adding Dhanya, Sauvarcala, Ajaji Cuminum cyminum, Karavi Carum carvi and Marica Piper nigrum. These recipes along with jaggery,honey and profuse quantity of sour and saline ingredients is taken.Food along with these recipes becomes very delicious, and gets digested properly. [180- 184]

Other Regimens for Kaphaja Alcoholism
Alcoholism caused by the predominance of Kapha gets cured quickly by the following regimes:
1. Intake of food and drinks which are dry and hot in potency
2. Hot water bath
3. Physical exercise and fasting therapy
4. Remaining awake at night appropriately
5. Bath and unction with dry articles in appropriate time.
6. Rubbing the body with ingredients which are promoters of life and complexion
7. Wearing of heavy clothing
8. Application of the past of Aguru (Aquallaria agallocha) all over the body
9. Embracing women whose pleasant limbs are smeared with Sankoca (Kunkuma or saffron) and
10. Pleasant massages by women hands are warm and well trained. [158- 188]

Sannipataja Madatyaya treatment

Treatment of Sannipatika Alcoholism:
The therapeutic measures described above for the treatment of 3 different types of alcoholism separately for each Dosha is carefully combined by the wise physician for the treatment of the (remaining) ten types of alcoholism caused by Sannipata (or simultaneous aggravation of all the 3 Doshas).
The physician who is well versed with the knowledge of proportionate increase or decrease of different aggravated Doshas (Dosha- Vikalpana), who is well verse with the knowledge of preparing medicines to carter to the requirement of these differently aggravated Doshas (Ausadhi- Vikalpavit), and who is well versed with the knowledge of curability and incurability of diseases (Sadhyasadhya- Vidhagavit) is capable of curing all the curable diseases. [189- 190]

Regimens for Alcoholism:
The following factors help a person to overcome alcoholism
1. Beautiful forests
2. Ponds and lakes with lotus- flowers
3. Clean food and drinks
4. Exciting companions
5. Use of garlands and perfumes
6. Clean garments
7. Musical performances
8. Pleasing and delightful companions
9. Exposition of refreshing stories, jokes and songs and
10. Companionship of lovely and devoted women. [ 191- 193]

Psychotherapy for Alcoholism

Alcohol does not cause alcoholism without causing agitation of the mind without causing morbidity in the body. Therefore,
a patient suffering from alcoholism, therapeutic measures (pscyho- therapy) for the cheerfulness of the mind are administered. [194]

Milk for Alcoholism:
The above mentioned effective therapeutic measures cure alcoholism. If not, then the physician should give up therapies comprising alcohol, and administer milk for its treatment.
After the diseases are cured by the administration of milk, and after the patient has gained strength, the milk is gradually withdrawn, and alcohol is substituted in its place little by little. [195- 196]

Dhvamsaka and Vikshaya

If, a person who has stopped drinking alcohol suddenly takes recourse to drinking alcohol in excess, he suffers from 2 diseases, viz, Dhvamsaka and Viksaya. Since such a person is already emaciated because of his earlier drinking habit, these 2 diseases appearing in him are very difficult of cure. Their signs symptoms and treatment will not be described appropriately.

The signs and symptoms of Dhvamsaka:
Sleshma praseka – Excessive salivation
Kantha aasya shosha – dryness of the throat and mouth
Shabda asahisnuta – intolerance to noise and
Tandra – excessive drowsiness and
Nidra ati yoga – sleep

The signs and symptoms of Viksaya:
Hrt roga – Cardiac disorder
Kantha roga – throat- disorder
Sammoha – unconsciousness
Chardi -vomiting
Anga ruja – pain in the limbs,
Jwara – fever,
Trshna – morbid thirst,
Kasa – cough
Shiro ruja – headache
Since both these ailments appear in an emaciated and weak person, their treatment is done on the line suggested for the treatment of Vatika type of Madatyaya.

Treatment: Basti (medicated enema), Sarpis (medicated ghee), milk, ghee, massage, unction, bath, food and drinks which cause alleviation of Vata Dosha. By the above mentioned therapeutic measures, Dhvamsaka and Viksaya get alleviated.
Intake of alcohol in appropriate manner will not give rise to disease caused by [excessive intake of] alcohol. [190-205]

Virtues of Abstinence from Alcohol

A wise person who has self- control over the sense and who abstains from drinking all types of alcohol preparations never gets afflicted with physical and mental disorders. [206]

Summary:
In this chapter on the Treatment of Alcoholism, the following topics are described entirely:
The powers of the goddess Sura (alcohol)
The method of drinking alcohol
The ingredients with which alcohol is to be taken
Wholesomeness of different varieties of alcohol for different types of persons
The methods of its appropriate use
The process by which intoxication is caused
The properties of alcohol which is endowed with great attributes
Signs and symptoms of alcoholic intoxication
Different stages of alcoholic intoxication
Signs and symptoms of each of the three stages of alcoholic intoxication
Adverse effects of alcohol
Good effects of alcohol
Use of alcohol keeping in view the three varieties [of eight factors]
Signs and symptoms manifested in persons having 3 types of mental faculties.
Characteristics of good companions in drinking parties
Characteristics of persons who get drunk slowly and who get drunk quickly
causes, signs and symptoms of Madatyaya
The type of alcohol and the manner in which alcohol cures Madatyaya and
Line of treatment of Madatyaya; [207- 211]

Thus, ends the 24th chapter of Cikitsa sthana (section on the treatment of diseases) dealing with the treatment of Madatyaya in the Agnivesha’s work as redacted by Charaka

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