एकोनपञ्चाशत्तमोऽध्यायः अथातश्छर्दिप्रतिषेधमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the chapter which deals with the ( symptoms and) medical treatment of vomiting (Chardi – Pratisedha). 1.
Causes and Nomenclature of Vomiting
अतिद्रवैरतिस्निग्धैरहृद्यैर्लवणैरति अकाले चातिमात्रैश्च तथाऽसात्म्यैश्च भोजनैः ॥ २ ॥ श्रमात् क्षयात्तथोद्वेगादजीर्णात् क्रिमिदोषतः । नार्याश्चापन्नसत्वायास्तथादिद्रुतमश्नतः ॥३॥ ( अत्यन्तामपरीतस्य छर्देर्वै सम्भवो ध्रुवम् वीभत्सैर्हेतुभिश्चान्यैर्द्रुतमुत्क्लेशितो बलात् । वेगैरर्दयन्नङ्गभञ्जनैः । छादयन्नाननं निरुच्यते च्छर्दिरिति दोषो वक्त्राद् विनिश्चरन् ॥ ४ ॥
Causes and Nomenclature – The bodily Dosas are deranged and aggravated per force by the use of extremely liquid, emollient, unpalatable or oversalted food or of one taken at an improper time or in an inordinate quantity or which is incongenial to the physical temperament of its user, as well as by over-fatiguing physical exercise, fear, mental agitation, indigestion, presence of worms (in the intestines), or quick eating or owing to pregnancy or any disgusting or loathsome causes. Thus deranged, Dosas rush up to the mouth and after covering the whole of it come out with great force and with an aching pain in the limbs. This is, therefore, called Vomiting (Chardi). 2-4.
दोषानुदीरयन् वृद्धानुदानो व्यानसङ्गतः । ऊर्ध्वमागच्छति भृशं विरुद्धाहारसेवनात् ॥ ५ ॥
The vital Vayu known as the Udana-Vayu coming in combination with the one known as the Vyana-Vayu in a man addicted to incompatible food and drink leads to the derangement of the bodily Dosas which rush up to the upper part of his body (which causes vomiting). 5.
Premonitory Symptoms of Vomiting
प्रसेको हृदयोत्क्लेशो भक्तस्यानभिनन्दनम् । पूर्वरूपं मतं छर्घा यथास्वञ्च विभावयेत् ॥ ६॥
Premonitory Symptoms — nausea, supression of eructations, thin and saline water-brash and an aversion to food and drink are the premonitory symptoms of vomitting. 6.
Specific Symptoms of Vomiting
प्रच्छर्दयेत् फेनिलमल्पमल्पं शूलार्दितोऽभ्यर्दितपार्श्वपृष्ठः । श्रान्तः सघोषं बहुशः कषायं जीर्णेऽधिकं साऽनिलजा वमिस्तु ॥ ७ ॥ योऽम्लं भृशं वा कटुतिक्तवक्त्रः पीतं सरक्तं हरितं वमेद् वा । सदाहचोषज्वरवक्त्रशोष-मूर्च्छान्वितः पित्तनिमित्तजा सा॥८॥ यो हृष्टरोमा मधुरं प्रभूतं शुक्लं हिमं सान्द्रकफानुविद्धम् । अभक्तरुग्गौरवसादयुक्तो वमेद् वमी सा कफकोपजा स्यात् ॥ ९ ॥ सर्वाणि रूपाणि भवन्ति यस्यां सा सर्वदोषप्रभवा मता तु ॥ १० ॥
Specific Symptoms – Scanty ejections of frothy matter of strong astringent taste accompanied with a loud sound and cramps at the back and the sides produce a sense of exhaustion of fatigue and increase after the digestion of a meal, this should be ascribed to the action of the deranged bodily Vayu. Vomiting of yellow, greenish or blood-streaked matter with an excessively acid, pungent or bitter taste in the mouth and attended with such complications as fever, dryness of mouth, fainting fits and burning and sucking (Cosa) sensations in the body, should be ascribed to the action of the deranged Pitta. Excessively cold, white, sweet, thick and mucous vomiting attended with horripilation, an aversion to food, heaviness of the limbs and lassitude should be ascribed to the Kaphaja type of vomiting. The specific features of all the three preceding types are present in the type due to the concerted action of all the three Dosas. 7-10.
Traumatic Cases
की भक्तजा दौहदजाऽऽएजा च सात्य्यप्रकोणात् किमिजा च या हि । सा पञ्चमी ता(श्च) – ञ्च विभावयेत् तु दोषोच्छ्रयेणैव थथोक्तमादौ ॥ ११ ॥ शूलहल्लासबहुला विशेषतः । क्रिमिजा लक्षिता ॥ १२ ॥ क्रिमिहृद्रोगतुल्येन लक्षणेन च
Traumatic Cases – The five cases of vomiting due to any disgusting or loathsome cause or to pregnancy, indigestion, presence of worms (in the bowels) or the taking of uncongenial food and drink, should be duly classified according to the Dosa aggravated in each case. The stomach is irritated in all types of vomiting. Fasting should, therefore, be the first remedy in these cases. Violent cramps and nausea as well as the symptoms of Krmija-Hrdroga are the special characteristics of a case of vomiting due to the presence of worms in the bowels. 11-12.
Prognosis of Vomiting
क्षीणस्योपद्रवैर्युक्तां सासृक्पूयां सचन्द्रिकाम् । छर्दि प्रसक्तां कुशलो नारभेत चिकित्सितुम् ॥ १३ ॥
Prognosis – A skiful physican shall not take in hand the medical treatment of a patient afflicted with vomiting, where the patient is emaciated and is distressed with the supervening symptoms’, and in which the ejected matter is mixed with pus and blood, and resembles the variegated colour of a peacock’s plume and where vomiting is almost constant. 13.
General Treatment of Vomiting
आमाशयोत्क्लेशभवाश्च सर्वास्तस्माद्धितं लङ्घनमेव तासु ॥ १४ ॥ वमीषु बहुदोषासु छर्दनं हितमुच्यते । विरेचनं वा कुर्वीत यथादोषोच्छ्रयं भिषक् ॥ १५ ॥ संसर्गश्चानुपूर्वेण यथास्वं भेषजायुतः । लघूनि परिशुष्काणि सात्म्यान्यन्नानि चाचरेत् । यथास्वञ्च कषायाणि ज्वरघ्नानि प्रयोजयेत् ॥ १६ ॥
1. The supervening symptoms are- – cough, asthma, fever, hic-cough, thirst, mental dejection, heart-disease and Tamaka Svasa.
General Treatment – In a case of vomiting marked by an excessive preponderance of any Dosa (or by the presence of all the three Dosas), emetics or purgatives should be administered with a due regard to the nature and intensity of the Dosa or Dosas involved.In cases due to the concerted action of any two of the deranged bodily Dosas the medical treatment should be determined according to their relative order of preponderance. Diet in these cases should consist of dry and light a rticles and what the patient is accustomed to. Febrifuge decoctions should be administered according to the nature and intensity of the deranged bodily Dosas involved in each case. 14-16.
Treatment of Vataja Type
हन्यात् क्षीरघृतं पीतं छर्दि पवनसम्भवाम् । ससैन्धवं पिबेत् सर्पिर्वातच्छर्दिनिवारणम् । मुद्गामलकयूषो वा ससर्पिष्कः ससैन्धवः ॥ १७ ॥ यवागूं मधुमिश्रां वा पञ्चमूलीकृतां पिबेत् । पिबेद् वा व्यक्तसिन्धूत्थं फलाम्लं वैष्किरं रसम् ॥ १८ ॥ सुखोष्णलवणं चात्र हितं स्नेहविरेचनम् ॥ १९ ॥
Treatment of Vataja Type — Draught of clarified butter churned milk¹, or the soup of Mudga and Amalaka taken with clarified butter and Saindhava-salt, or gruels (Yavagu) prepared with the drugs Panca-mula and taken with honey, would prove curative in the Vataja type of vomiting. The use of the meat soup of any bird of the Viskira group (e.g. chicken, etc.) taken with a little quantity of salt and of acid-fruits would likewise prove efficacious. Lukewarm oily purgtives from of juice mixed with salt are also recommended in such cases. 17-19.
Treatment of Pittaja Type
पित्तोपशमनीयानि पाक्यानि शिशिराणि च । कषायाण्युपयुक्तानि घ्नन्ति पित्तकृतां वमीम् ॥ २० ॥ शोधनं मधुरैश्चात्र द्राक्षारससमायुतः । बलवत्यां प्रशंसन्ति सर्पिस्तैल्वकमेव च ॥ २१ ॥
Treatment of Pittaja Type – Cold drinks and decoctions of Pitta-subduing virtue would relieve vomiting due to the derangement of Pitta. Emetics or Purgatives composed of the drugs of the Madhura-drugs and mixed with the expressed juice of Draksa may likewise be employed in the present type. In violent attacks of vomiting the medicated clarified butter known as Tailvaka-ghrita should also be prescribed. 20-21.
1. “ क्षीरघृतं” has been explained by some commentators as milk mixed with clarified butter. Cakradatta reads ” क्षौरोदकं” milk and water in place of “क्षीरघृतं”.
Treatment of Kaphaja Type
आरग्वधादिनिर्यूहं दशाङ्गयोगमेव वा । पाययेताथ सक्षौद्रं कफजायां चिकित्सकः ॥ २२ ॥ कृतं गुडूच्या विधिवत् कषायं हिमसंज्ञितम् । तिसृष्वपि भवेत् पथ्यं माक्षिकेण समन्वितम् ॥ २३ ॥
Treatment of Kaphaja Type – A decoction of the drugs of the Aragvadhadi-group or of Das-mula should be given with honey in a case of vomiting due to the aggravation of Kapha. A cold infusion (Hima-Kasaya) of Guduci mixed with honey would prove an excellent remedy in all the three preceding types of vomiting. 15-16.
Traumatic Types
बीभत्सजां हृद्यतमैदौंहृदीं काङ्क्षितैः फलैः । लङ्घनैर्वमनैश्चामां सात्म्यैः सात्म्यप्रकोपजाम् । क्रिमिहृद्रोगवच्चापि क्रिमिजां साधयेद् वमीम् ॥ २४ ॥ वितरेच्च यथादोषं शस्तं विधिमनन्तरम् ॥ २५ ॥
Vomiting due to (the use or sight of) any disgusting or loathsome thing should be treated with agreeable things, while that peculiar to pregnancy should be relieved by giving to the enceinte the things she longs for.
Traumatic Types – Vomiting due to use of any unaccustomed or incongenial food should be relieved with fasting, vomiting or with the administration of habituated or congenial food. Vomiting due to the presence of worms in the bowels (Krmija) should be treated with remedies applicable in a case of Krmija Hrd-roga (heart-disease of parasitic origin). The measures and remedies prescribed before should be employed with a due regard to the nature and intensity of the deranged bodily Dosa or Dosas involved in each case. 24-25.
दधित्थरससंयुक्तां पिप्पलीं माक्षिकान्विताम् । मुहुर्मुहुर्नरो लीवाछर्दिभ्यः प्रतिमुच्यते ॥ २६ ॥
समाक्षिका मधुरसा पीता वा तण्डुलाम्बुना। तर्पणं वा मधुयुतं तिसृणामपि भेषजम् । स्वयंगुप्तां यष्ट्याह्वां तण्डुलाम्बुमधुद्रवाम् ।
पिबेद् यवागूमथवा सिद्धां पत्रैः करञ्जजैः ॥ २७ ॥ युक्ताम्ललवणाः पिष्टाः कुस्तुम्बुर्योऽथवा हिताः ।
तण्डुलाम्बुयुतं खादेत् कपित्थं त्र्यषणेन वा ॥ २८ ॥
General Treatment- Vomiting is relieved by frequently licking a lambative made of Pippali, honey and the expressed juice of Kapittha-fruit. Madhurasa’ with the washings of rice and with honey may be likewise taken for the purpose. Tarpana (soothing) measure with the admixture of honey would be beneficial in all the three cases (due to the aggravation of the Dosas). A potion composed of powdered Atma-gupta-seeds and yasti-madhu mixed with a copious quantity of rice-washing and with honey as well as gruels prepared with the admixture of Karanja-leaves should be administered. Kustumburu pasted and mixed with salt and acid would also be benificial. Kapittha should also be taken with Tri-katu and rice-washing. 26-28.
सिताचन्दनमध्वाक्तं लिह्याद् वा मक्षिकाशकृत् । पिबेत् पयोऽग्नितप्तञ्च निर्वाप्य गृहगोधि (पि ) काम् ॥ २९ ॥ सर्पिः क्षौद्रयुतान् वाऽपि लाजशक्तून् पिबेत्तथा । सर्पिः क्षौद्रसितोपेतां मागधीं वा लिहेत्तथा ॥ ३० ॥ मुद्द्रदलाम्बुना । चन्दनं वा घृष्टं धात्रीरसे कोलामलकमज्जानं लिह्याद् वा त्रिसुगन्धिकम् ॥ ३१ ॥ पिबेन्नरः । वा सक्षौद्रां शालिलाजानां यवागूं घ्रेयाण्युपहरेच्चापि मनोज्ञानि सुखानि च ॥ ३२ ॥
The excreta of flies should be licked with sugar, honey and sandal paste. A lizard should be immersed in hot milk and this milkwhen cooled, should be given to the patient to drink. Powdered fried paddy mixed with honey and clarified butter should be given to drink pulverised Pippali mixed with honey, sugar and clarified butter should be licked. Sandal-paste¹ with the expressed juice of Amalaka or the decoction of the leaves of Mudga² as well as a lambative composed of the marrow of Kola and Amalaka spiced with the Trisugandhi drugs (viz., Ela, Patra and Tvak) powdered together should be prescribed. Gruels of fried Sali paddy mixed with honey should also be prescribed. The use of perfumes which are agreeable both to the mind and to the organ of smell, also recomended. 29-32.
1. “Madhurasa” may mean (1) Draksa (2) Gambhari fruit (3) Murva or (4) Yastimadhu. The practice is to prescribe Draksa.
जाङ्गलानि च मांसानि शुभानि पानकानि च । भोजनानि विचित्राणि कुर्यात् सर्वास्वतन्द्रितः ॥ ३३ ॥
Diet The meat of any Jangala animal and palatable cordials and victuals of various plates should be likewise taken with care in all cases. 33.
इति सुश्रुत संहितायामुत्तरतन्त्रे छर्दिप्रतिषेधोनामैकोनपञ्चाशत्तमोऽध्यायः ॥ ४९ ॥ –
Thus ends of the forty-ninth chapter of the Uttara-Tantra in the Susruta Samhita which deals with the (symptoms and) treatment of Vomiting.
1. The practice is to take white Sandal in this case. 2. Vagbhata prescribes the decoction alone as a separate remedy.
