एकादशोऽध्यायः । अथातः भारपाकविधिमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥
Now we shall discuss the Chapter which treats of the pharmacy of alkalis or potential cauteries (Ksharapaka-vidhi-adhyaya). 1
शस्त्रानुशस्त्रेभ्यः क्षारः प्रधानतमश्छेद्य-भेद्य – लेख्य- करणात् त्रिदोषघ्नत्वात् विशेषक्रियावचारणाच्च ॥२॥
In cases that require incising, excising and scraping, alkalis or alkaline preparations are of greater importance than surgical instruments and appliances (both principal and secondary or substitutive, as they are possessed of the virtues of subduing the three deranged bodily humours (such as wind, bile and phlegm). 2
तत्र क्षरणात् क्षणनाद् वा क्षारः । नानौषधिसमवायात् त्रिदोषघ्नः, शुक्लत्वात् सौम्यस्तस्य सौम्यस्यापि सतो दहनपचनदारणादिशक्तिरविरुद्धा, स खलवाग्नेयौषधिगणभूयिष्ठत्वात् कटुक उष्णस्तीक्ष्णः पाचनो विलयनः शोधनो रोपणः शोषणः स्तम्भनो लेखनः क्रिम्यामकफकुष्ठविषमेदसामुपहन्ता पुंस्त्वस्य जातिसेवितः ॥३॥
The etymological signification of the term Ksara (alkalis) is based on their property of corroding (the skin or the flesh of an affected part of the body), or on their peculiar quality in destroying the skin and flesh where such an effect is desired). Since a variety of substances
SUSRUTA SAMHITA
enter into the composition of Ksara (alkalis), they are endued with the virtue of subduing the three deranged bodily humours. Owing to their white colour, Ksaras should be included within the category of cooling substances (Saumya).
But since many drugs or substances of a hot or fiery nature (Agneya) enter into their composition, Karas (alkalis) are endued with the properties of blistering, burning, suppurating (Pacana), opening etc., without involving any contradiction to their generic (Saumya) nature, and hence they are included within the list of those substances which are both hot and cooling (Saumya and Agneya) in their virtues. They are pungent in taste, of a heat-making potency, irritant, digestive, corrosive, absorbent, liquefacient, improve unhealthy sores and granulation, and act as styptic and paralysing agents. They exercise destructive action on animal tissues. They are antitoxic, anthelmintic and possess the property of curing mucous accumulations in the intestines. They tend to reduce fat and phlegm and they have the virtue of destroying skin disease. In large doses, (alkalis) have the effect of destroying the virile potency of a man. 3
स द्विविधः प्रतिसारणीयः पानीयश्च । तत्र प्रतिसारणीयः कुष्ठकिटिभदद्रुमण्डलकिलासभगन्दरार्बुदार्शोदुष्टुव्रणनाडीचर्म्मकीलतिलकालक-न्यच्छव्यङ्ग- मशकबाह्यविद्रधि- क्रिमिविषादिषूपदिश्यते सप्तसु च मुखरोगेषूपजिह्वाधिजिह्वोपकुग़दन्तवैदर्भेषु तिसृषु च रोहिणीष्वेतेषु चैवानुशस्त्रप्रणिधानमुक्तम् । धानीयस्तु गरगुल्मोदराग्निषङ्गाजीर्णारोचकाना हःशर्कराश्मर्य्याभ्यन्तरविद्रधि क्रिमिविषार्शः सूपयुज्यते ॥४॥
Ksara (caustics) may be grouped under two distinct heads (according to their mode of administration), such as the Pratisaraniya (for external application) and the Paniya (alkaline potions). Alkaline preparations should be externally used in such skin diseases as Kitibha, Dadru, Kilasa, Mandala, Fistula-in-ano, tumour, bad ulcer (Dusta Vrana), sinus., Carma-kila, Tilkalaka, Nyaccha, Vyanga, Masaka and external abscesses and haemorrhoids. In case of worms and poisoning as well as in the seven forms of diseases which affect the cavity of the mouth, such, as Upajihva, Adhigihva, Upaku sa, Danta-Vaidarbha, and in the three types of Rohinis, external applications of alkalis act like substitutive surgical instruments. Alkaline potions or any other
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internal use of alkalis, should be prescribed in cases of Gulma (abdominal glands), Ascites, loss of appetite, indigestion, flatulent distension of the abdomen with suppression of stool and urine, urinary calculi, stone in the bladder, internal abscesses, worms in the intestines and haemorrhoids, as well as for subduing or eliminating any sort of poison from the system. 4
अहितस्तु रक्तपित्तज्वरितपित्तप्रकृति- बालवृद्धदुर्बल- भ्रममदमूर्च्छातिमिरपरीतेभ्योऽन्येभ्यश्चैवं विधेभ्यः । तञ्चेतरक्षारवद् दग्ध्वा परिस्रावयेत् । तस्य विस्तरोऽन्यत्र ॥५॥
Akalis or alkaline potions will prove positively injurious to a patient laid up with fever or haemoptysis, to a man of bilious temperament, to an infant, or to an old man, and they will work similar mischief in a weak person, or in a patient suffering from vertigo, insensibility, syncope and Timira ( darkness of vision). These preparations of Alkalis should be made in one and the same way by filtering; and we reserve the full description of this process for another occasion. 5
अथेतरो मृदुर्मध्यस्तीक्ष्णश्च । तं चिकीर्षुः शरदि गिरिसानुजं शुचिरुपोष्य प्रशस्तेऽहनि प्रशस्तदेशजातमनुपहतं मध्यमवयसं महान्तमसितमुष्ककमधिवास्य अपरेद्युः पाटयित्वा खण्डशः प्रकल्प्यावपाटय निवाते देशे निचितिं कृत्वा (सुधाशर्कराश्च प्रक्षिप्य) तिलनालैरादीपयेत् । अथोपशान्तेऽग्नौ तद्भस्म पृथग्गृह्णीयाद् भस्मशर्कराश्च ॥६॥
Alkalis for external applications are prepared in three different potencies; the mild, middling and strong ( extremely irritant ). A physician wishing to prepare such an alkali, should first purify his body and mind, and observe a fast on a day in autumn marked by auspicious astral combinations. Then having ascended the brow of a hill, he should select a full grown Asita-muska (Ghanta parul) tree of middle age, and growing on soil recommended in the works on pharmacy and not anywise affected. Then having formally invoked the spirit of the aforesaid tree, which bears no white flowers) the physician should feel it on the day following- reciting the Mantra which reads as:- “O thou possessed of mighty virtues, O thou endued with fiery potency, may the potency never decrease or vanish. Stay
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here, O thou blissful one, execute my work, and after the performance thereof thou shalt be at liberty to ascend to the heavenly regions.” Then having performed the Homa ceremony with thousands of white and red flowers, the physician should cut the wood of the abovesaid tree into small pieces and put them in a place protected from the wind. Then having placed pieces of unslaked limestone over them, the physician should burn them to ashes with the lighted faggots of dried sesamum plants. They after the fire has fairly burnt itself out, the ashes of the limestone and the Ghanta-parula wood should be separately collected and stored. 6
अथानेनैव विधानेन कुटजपलाशाश्वकर्णपारिभद्रकबिभीतकारबघतिल्वकार्कस्नुह्यपामार्गपाटलानक्तमालवृषकदलीचित्रकपूतीकेन्द्रवृक्षास्फोताश्वमारकसप्तच्छदाग्निमन्थगुञ्जाश्चतस्रश्च कोशातकीः समूलफलपत्रशाखा दहेत् ॥ ७॥
Similarly the wood as well as the leaves, roots and fruits of Kutaja, Palasa, Asvakarna, Paribhadraka, Bibhitaka, Aragvadha, Tilvaka, Arka, Snuhi, Apamarga, Patala, Naktamala, Vrsa, Kadali, Citraka, Putika, Indra-Vrksa, Sphota, Asvamaraka, Saptacchada, Agnimantha, Gunja, and the four species of Kosataki, should be burnt down to ashes. 7
ततः क्षारद्रोणमुदकद्रोणैः षड्भिरालोडच मूत्रैर्वा यथोक्तैरेकविंशतिकृत्वो परिस्राव्य महति कटाहे शनैद्रर्व्यावघट्टयन् विपचेत् । स यदा भवत्यच्छो रक्तस्तीक्ष्णः पिच्छिलश्च तमादाय महति वस्त्रे परिस्राव्येतरं विभज्य च पुनरग्नावधिश्रयेत् । तत एव च क्षारोदकात् कुडवमध्यर्द्ध वापनयेत् ॥८॥
Then a Drona measure of the ashes thus prepared’ should be dissolved and stirred up in six Drona measures of pure water or cow’s urine, and be filtered twenty-one times in succession. The (allkaline water filtered as above) should be kept in a large caldron over a fire and boiled by gently agitating it with a ladle. It should be taken down from the fire when by gradual stirring, the saturated water would appear transparent, slimy, red and irritating. It should then be filtered
1. Two parts of the burnt ashes of Ghanta-parula and one part of the ashes of Kutaja, etc.
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through a piece of clean linen, and the drugs thrown away. After this a Kudava measure and a half (12 Palas) of the (abovesaid) saturated or alkaline water should be taken out of the caldron, and the rest should be again kept boiling over the fire. 8
ततः कटशर्कराभस्मशर्कराक्षीरपाकशङ्खनाभिरग्निवर्णाः कृत्वायसे पात्रे तस्मिन्नेव क्षारोदके निषिच्य पिष्ट्वा तेनैव द्विद्रोणेऽष्टपलसम्मितं शंखनाभ्यादीनां प्रमाणं प्रतिवाप्य सततमप्रमत्तश्चैनमवघट्टयन् विपचेत् । स यथा नातिसान्द्रो नातिद्रव भवति तथा प्रयतेत। अथैनमागतपाकमवतार्य्यानुगुप्तमायसे कुम्भे संवृतमुखे निदध्यादेष मध्यमः । एष एवाप्रतीवापः पक्वः संव्यूहिमो मृदुः ॥९॥
Following this, substances known as Kata-Sarkara, the ashes of the burnt limestone previously obtained, Ksirapakas (fresh water oysters) and sankhanabhi, should be burnt red hot in equal proportions, and then immersed and pressed in the Kudava measure of alkaline water previously set apart in an iron basin as above described. Then having immersed eight Pala measures of the substances known as the Sankhanabhi etc., in the abovesaid alkaline water, the physician should boil it by continuous and steady stirring, care being taken not to make it of too thin nor of too thick a consistency. Then the basin or the caldron should be taken down from the oven, and its contents poured into an iron pitcher, carefully covering its mouth after filling it. The alkali thus prepared is called the Ksara (alkali) of middling potency, which, if prepared without the subsequent addition (lit : throw-over) of the ashes of Katasarkara, etc., goes by the name of mild alkali (Mrdu Ksara). 9
प्रतीवापे यथालाभं दन्तीद्रवन्तीचित्रकलाङ्गलकीपूतिकप्रवालतालपत्रीविडसुवर्च्चिकाकनकक्षीरीहिङ्गवचातिविषाः समाः श्लक्ष्णचूर्णाः शुक्तिप्रमाणाः प्रतीवापः । स एव सप्रतीवापः पक्व: पाक्यस्तीक्ष्णस्तेषां यथाव्याधिबलमुपयोगः । क्षीणबले तु क्षारोदकमावपेबलकरणार्थम् ॥१०॥
Similarly, alkali prepared with the addition of the powders of the drugs known as Danti, Dravanti, Citraka, Langalaki, Putika-Pravala Talpatri, Vida, Suvarcika, Kanaka Ksiri, Hingu, Vaca, and Visa, or with as many of them as are available, each weighing four tolas, is called the strong Ksara (extremely irritating alkali). These alkaline
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preparations of different potencies, should be severally used in cases where their administrations would be clearly indicated. An alkaline preparation, any way weakened, should be strengthened by adding to it alkaline water(water saturated with an alkali) as before described. 10
भवतश्चात्र ।
नैवातितीक्ष्णो न मृदुः शुक्लः श्लक्ष्णोऽथ पिच्छिलः । अविष्यन्दी शिवः शीघ्रः क्षारो ह्यष्टगुणः स्मृतः || अतिमार्द्दवश्वैत्यौष्ण्यतैक्ष्ण्यपैच्छिल्यसर्पिता: सान्द्रताऽपक्वता हीनद्रव्यता दोष उच्यते ।। ११ ।।
Authoritative verses on the subject: The commendable fetures in an alkali are based on its whiteness, on its being neither too mild nor too strong, on its gloss and sliminess, on its sticking to the place of application, and on its power of secreting (Abhisyandi) the morbid fluid, and on its rapid effect. On the other hand, its defective traits consist in its being too mild, of excessive whiteness, excessive strength or irritability, of over-sliminess, excessive stickiness or thickness, insufficient boiling, and insufficiency of component ingredients. 11
तत्र क्षारसाध्यव्याधिव्याधितमुपवेश्य निर्व्वातातपे देशेऽसम्बाधेऽग्रोपहरणीयोक्तेन विधानेनोपसम्भृतसम्भारं ततोऽस्य तमवकाशं निरीक्ष्यावघृष्यावलिख्य प्रच्छयित्वा शलाकया क्षारं प्रतिसारयेत् । दत्त्वा वाक्च्छतमात्रमुपेक्षेत ॥१२॥
A patient laid up with a disease amenable to an application of alkali (potential cautery or caustic) should be kept in a spacious chamber, and should not be exposed to draughts and to the hot rays of the sun, [Then the physician having secured] the necessary appliances etc., as already laid down in the Chapter V, should view the part of the patient’s body to which the alkali is to be applied. The affected part should be then’ rubbed or scarified with an alkali, and covered over 3
1. In a case brought about by (Pitta) ascendency of the deranged bile. 2. It should be scraped with the alkali where the skin would appear hard and
benumbed owing to the action of the deranged vital winds (Vayu).
3. In a case of deranged phlegm (Kafa) the affected part being marked by itching and swelling.
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with a piece of linen. The alkaline preparation should be applied with a rod or director* and kept undisturbed for a period needed to articulate a hundred long letter (sounds). 12
तस्मिन् निपतिते व्याधौ कृष्णता दग्धलक्षणम् । तत्राम्लवर्ग: सर्पिर्मधुकसंयुतः ।। शमनः
अथ चेत् स्थिरमूलत्वात् क्षारदग्धं न शीर्य्यते । इदमालेपनं समग्रमवचारयेत् ।। तत्र
अम्लकाञ्जिकबीजानि तिलान् मधुकमेव च । प्रपेष्य समभागानि तेनैनमनुलेपयेत् ।।
तिलकल्कः समधुको घृताक्तो व्रणरोपणः ।।१३।।
Metrical texts : The perfect burning (blistering should be inferred from the black colour of the skin of the affected part. Madhuka and the substances included within the Amla-varga (group of acid drugs) pasted with clarified butter, should be applied to allay the incidental burning (sensation). A plaster composed of the shreds of Amla-Kanjika, sesamum and Madhuka taken in equal parts, and pasted together, should be applied to the part burnt with an alkali; in the event of the latter having failed to produce the desired effect owing to the disease being deeply seated. Madhuka and the Kalka (paste) of sesamum mixed with clarified butter would cause such an (incidental) ulcer to heal. 13
रसेनाम्लेन तीक्ष्णेन वीर्य्योष्णेन च योजितः । आग्नेयेनाग्निना तुल्यः कथं क्षारः प्रशाम्यति ।।१४।। एवं चेन्मन्यसे वत्स प्रोच्यमानं निबोध मे। अम्लवर्ज्यान् रसान् क्षारे सर्व्वानेव विभावयेत् ।। कटुकस्तत्र भूयिष्ठो लवणोऽनुरसस्तथा । अम्लेन सह संयुक्तः स तीक्ष्णलवणो रसः ।। माधुर्य्यं भजतेऽत्यर्थं तीक्ष्णभावं विमुञ्चति । माधुर्य्याच्छममाप्नोति वहिरद्भिरिवाप्लुतः ।।१५।।
Now you may ask the question how can an acid substance, which is fiery in its virtue and heat-making in its potency, tend to subdue the effects of an alkali which is possessed of simillar virtues and properties, Vol 1.6
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instead of augmenting them, as can naturally be apprehended? Well my child, the question can be fairly answered by stating, that substances of all tastes enter into the composition of an alkali except the acid one. The pungent (Katu) taste is the principal taste of an alkali, while the saline (Lavana) forms its minor or accessory flavour (Anurasa). Now this saline taste in conjuction with the acid one renounces its extremely sharp or irritating property and is thus transformed into one of sweetness or of soothing virtue. Hence it is that an acid taste tends to allay the burning incidental to an application of alkali (potential caustic) in the same way as water tends to put out fire. 14-15
तत्र सम्यगूदग्धे विकारोपशमो लाघवमनास्रावश्च । हीनदग्धे तोदकण्डूजाड्यानि व्याधिवृद्धिश्च । अतिदग्धे दाहपाकरागस्रावाङ्गमर्द्दक्लमपिपासामूर्च्छाः स्युर्मरणं वा । क्षारदग्धव्रणन्तु यथादोषं यथाव्याधि चोपक्रमेत् ॥१६॥
An operation of perfect cauterisation with an alkaline application brings about an amelioration of the disease, or the disease is entirely subdued, accompanied by lightness of the limbs and absence of secretion from the affected part; while an insufficient burning [of the part] is generally attended by symptoms of aggravation of the malady and also gives rise to local pain, itching and numbness. [On the other hand], excessive burning [of the part] with an alkaline preparation may have a fatal termination, and is attended by such symptoms as burning, suppuration, redness, secretion in and from the seat of affection. A feeling of languor and fatigue comes upon the patient accompanied with thirst, swooning and an aching sensation. An ulcer incidental to a burn by an alkali should be treated with a special eye to the nature of the disease and the deranged bodily humour specifically involved in the case. 16
अथ नैते क्षारकृत्याः । तद्यथा- दुर्बलबालस्थविरभीरुसर्व्वाङ्गशूनोदरिरक्तपित्तिगर्भिण्यृतुमतीप्रवृद्धज्वरिप्रमेहिरूक्षक्षतक्षीणतृष्णामूर्च्छापद्वतक्लीबवृत्तापवृत्तफलयोनयः ॥१७॥
तथा मर्म्मशिरास्नायुसन्धितरुणास्थिसेवनीधमनीगलनाभिनखान्तरशेफःस्रोतःस्वल्पमांसेषु च प्रदेशेष्वक्ष्णोश्च न दद्यादन्यत्र वर्त्मरोगात् ॥१८॥
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A weak person, an infant, an aged person, a man of timid disposition, a patient suffering from abdominal dropsy with general anasarca or from haemoptysis, a pregnant woman, a woman in her menses, a person suffering from an attack of high fever or urethral discharges, or emaciated with chronic inflammation of the lungs, or a person subjected to fits of fainting or abnormal thirst, or a person suffering from virile impotency, or whose testes have become deranged either upwards or downwards, or a woman suffering from retroversion or introversion of the uterus or prolapses of the vagina, should be deemed unfit for being cauterised with alkalis. Moreover their application is not to be sanctioned over the veins, nerves, joints, gristles or tender bones or cartilages, sutures, arteries, throat, umbilicus, genitals, regions of Srotas (external channels), parts covered over with a thin layer of flesh, insider the nails and other vulnerable parts of the body, nor in diseases of the eyes, excepting those which affect the eyelids. 17-18
तत्र क्षारसाध्येष्वपि व्याधिषु शूनगात्रमस्थिशूलिनमन्नद्वेषिणं हृदयसन्धिपीडोपद्रुतञ्च क्षारो न साधयति ॥१९॥
Alkalis fail to produce any beneficial effect in a patient suffering from oedema of the limbs, or suffering from bone-ache, or laid up with a disease affecting the joints or the heart, or in a person of impaired appetite who has lost all relish for food, even when their use is otherwise indicated. 19
भवति चात्र ।
विषाग्निशस्त्राशनिमृत्युकल्पः क्षारो भवत्यल्पमतिप्रयुक्तः । स धीमता सम्यगनुप्रयुक्तो रोगान् निहन्यादचिरेण घोरान् ॥ २० ॥
Authoritative verse on the subject: An Alkali administered by an ignorant physician is to be dreaded more than poison, fire blows with a weapon, thunder-bolts, or death itself; while in the hand of an intelligent physician it is potent enough to speedily subdue all serious diseases in which its use is indicated. 20
इति सुश्रुतसंहितायां सूत्रस्थाने क्षारपाकविधिर्नामैकादशोऽध्यायः ॥११॥
Thus ends the eleventh Chapter of the Sutrasthana in the Susruta Samhita which treats of the Pharmacy of Alkalis.
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