द्विचत्वारिंशोऽध्यायः अथातो गुल्मप्रतिषेधं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the chapter which deals with the ( symptoms and) medical treatment of Gulma (Gulma-Pratiseda). 1
Definitaion and number of Gulmas
यथोक्तैः कोपनैर्दोषाः कुपिताः कोष्ठमागताः । जनयन्ति नृणां गुल्म स पञ्चविध उच्यते ॥ हृद्वस्त्योरन्तरे ग्रन्थिः सञ्चारी यदि वाऽचलः । चयापचयवान् वृत्तः स गुल्म हति कीर्त्तितः ॥ २ ॥
Definitaion and number of Gulmas – The fundamental principles of the body, deranged and aggravated by their respective or specific exciting causes and factors tend to accumulate in the cavity of the abdomen (Kostha) and help the formations of ball-like tumours or Gulmas (internal tumours inculsive of those known as the phantom tumours) somewhere inside the body lying between the regions of the heart and of the bladder (Basti). The Gulma is of five kinds and found to be round or spheroid in shape and may be either fixed or mobile (lit. shifting) in their character and subject to variations in their mass and size. 2
Localisation and nomenclature
पञ्च गुल्माश्रया नृणां पार्श्वे हृन्नाभिबस्तयः । कुपितानिलमूलत्वाद् गूढमूलोदयादपि । गुल्मवद् वा विशालत्वाद् गुल्म इत्यभिधीयते ॥ ३ ॥ स यस्मादात्मनि चयं गच्छत्यप्स्विव बुद्बुदः । अन्तः सरति यस्माच्च न पाकमुपयात्यतः ॥ ४ ॥ स व्यस्तैर्जायते दोषैः समस्तैरपि चोच्छ्रितैः । पुरुषाणां तथा स्त्रीणां ज्ञेयो रक्तेन चापरः ॥ ५ ॥
Localisation and nomenclature – They have five locations inside the abdominal cavity, viz. the two sides, the region of the heart, the bladder (Basti) and the region of the umbilicus. The Gulmas are so named because their root or base cannot be exactly localised as well as their cause cannot be exactly ascertained owing to the fact of their having their origin in the aggravated condition of the local bodily Vayu, or because of their being but a agglomeration of the deranged bodily Dosas in the affected locality and the shrub-like large converse outline of the surface (Gulma-shrub ). Since a Gulma, like a bubble of water, is a self-contained agglomeration of the deranged bodily Dosas and freely moves about in the cavity of its growth, it is not marked the advent of any suppurative process in its mass of body. The Gulmas are the products of either the single or concerted actions of the three Dosas, While in females a separate class of tumours (such as the ovarian or uterine tumours) intimately connected with the deranged or vitiated condition of the blood (catamenial fluid, etc.) is also recognised. 3-5.
Primonitory Symptoms of Gulma
सदनं मन्दता वह्नेराटोपोऽन्त्रविकूजनम् । विण्मूत्रानिलसङ्गश्च सौहित्यासहता तथा ।
द्वेषोऽन्ने वायुरूर्द्धञ्च पूर्वरूपेषु गुल्मिनाम् ॥ ६॥
Primonitory Symptoms – A sense of lassitude, dulness of digestive fire, pain and rumbling in the intestines, suppression of stool, urine and flatus, incapacity to take food to the full, aversion to food, and an upward coursing of the internal Vayu are the indications which may be set down as the premonitory symptoms of Gulma. 6
Specific Symptoms of Gulma
हृत्कुक्षिशूलं मुखकण्ठशोषो वायोर्निरोधो विषमाग्निता च । ते ते विकाराः पवनात्मकाश्च भवन्ति गुल्मेऽनिलसम्भवे तु ॥ ७ ॥ स्वेदज्वराहारविदाहदाहास्तृष्णाऽङ्गरागः कटुवक्त्रता च । पित्तस्य लिङ्गान्यखिलानि यानि पित्तात्मके तानि भवन्ति गुल्मे ॥ ८ ॥ स्तैमित्यमन्त्रेऽरुचिरङ्गसादश्छर्दिः प्रसेको मधुरास्यता च । कफस्य लिङ्गानि च यानि तानि भवन्ति गुल्मे कफसम्भवे तु ॥ ९ ॥ सर्वात्मकः सर्वविकारयुक्तः सोऽसाध्य उक्तः क्षतजं प्रवक्ष्ये ॥ १० ॥
Specific Symptoms – Pain (sula) in the region of the heart and the belly (Kuksi), dryness of the throat and of the mouth, suppression of Vayu (flatus), iregularity of digestion and all other symptoms which specifically indicate the deranged condition of the bodily Vayu are the characteristics of the Vataja-Gulma. Fever, perspiration, defective digestion, burning sensation, thirst, redness of the body (Anga-raga), bitter taste in the mouth and all other specific symptoms of the deranged Pitta mark the Pittaja type of the disease. A sensation of wetness all over the body, an aversion to food, lassitude, vomiting, water-brash, sweet taste in the mouth and all other specific indications of the deranged Kapha are exhibited in the Kaphaja type of the disease. The Tri-dosaja type exhibits the symptoms specifically belonging to each of the preceding ones and should be regarded as incurable. Now we shall deal the characteristics etc. of Raktaja Gulma.7-10.
Symptoms of Raktaja Gulma
नवप्रसूताsहितभोजना या या चामगर्भं विसृजेदृतौ वा ॥ ११ ॥ वायुर्हि तस्याः परिगृह्य रक्तं करोति गुल्मं सरुजं सदाहम् । पैत्तस्य लिङ्गेन समानलिङ्गं विशेषणञ्चाप्यपरं निबोध ॥ १२ ॥ न स्पन्दते नोदरमेति वृद्धिं भवन्ति लिङ्गानि च गर्भिणीनाम् । तं गर्भकालातिगमे चिकित्स्यमसृग्भवं गुल्ममुशन्ति तज्ज्ञाः ॥ १३ ॥
Symptoms of Raktaja-Gulma — The symptoms of RaktajaGulma are mentioned below. The bodily Vayu of woman newly delivered of a child as well as that of a woman who has recently miscarried, or of a woman in her courses is deranged by the use of unwholesome or injudicious food (and regimen of conduct), and by supressing the discharge of the blood (lochia) it gives rise to Gulma attended with pain and burning sensation. A Gulma of this type is easily mistaken for a case of conception, which exhibit all the symptoms of pregnancy as well as those which are peculiar to the state of the Pittaja type, with the exception that the abdomen does not enlarge and there is no movement (in the womb). The medical treatment of a Gulma of the present type should be taken in hand after the lapse of the natural term of gestation and this is known as the Raktaja-Gulma¹ by the experienced physician. 11-13.
General Treatment of Gulma
वातगुल्मार्दितं स्निग्धं युक्तं स्नेहविरेचनैः। उपाचरेद् यथाकालं निरूहै: सानुवासनैः ॥ १४ ॥ पित्तगुल्मार्दितं स्निग्धं काकोल्यादिघृतेन तु । विरिक्तं मधुरैर्योगैर्निरूहैः समुपाचरेत् ॥ १५ ॥ श्लेष्मगुल्मार्दितं स्निग्धं पिप्पल्यादिघृतेन तु । तीक्ष्णैर्विरिक्तं तद्रूपैर्निरूहै: समुपाचरेत्स न्निपातोत्थिते गुल्मे त्रिदोषघ्नो पित्तवद्रक्तगुल्मिन्या नार्याः कार्यः क्रियाविधिः ॥ १७ ॥ विशेषमपरञ्चास्याः रक्तविभेदनम् । पलाशक्षारतोयेन ॥ १६॥ विधिर्हितः । शृणु सिद्धं सर्पिःबस्तिञ्च प्रयोजयेत् ॥ १८ ॥ पिप्पल्यादिघृतेन तु। उष्णैर्वा भेदयेद् भिन्ने विधिरासृग्दरो हितः ॥ १९ ॥
General Treatment – A person suffering from the attack of Vataja Gulma should be duly treated with a Sneha, purged with any fatty purgative and then treated at the proper time with Niruha and Anuvasana Bastis. In a case of Pittaja type of the disease, the patient should be treated (rubbed) with clarified butter duly prepared and cooked with the drugs of the Kakolyadi group and then being properly purged with the compounds of sweet drugs (of the Aragvadhadi group) he should be treated with Niruha Vastis. In a case of the Kaphaja type, the patient should be first anointed with a medicated Ghrita duly cooked and prepared with the drugs of the Pippalyadi group, then purged with a strong (Tiksna) purgative and then treated with Niruha Basti of the same character. In a Tri-dosaja type, measures held to be remedial for each of the Dosas should be adopted or employed. Measures laid down in connection with the Pittaja type of the disease should be as well employed in cases of Raktaja (blood-origined) Gulma in female patients. Now hear me describing the recipes of the medicines which would particularly lead to the disintegration of the blood (in cases of Raktaja Gulma). Clarified butter duly cooked and prepared with the alkaline preparation of Palasa wood (water charged withthe burnt ashas of Palasa) should be internally administered, and the medicated clarified butter known as the Pippalyadi Ghrita should be employed after in the manner of an Uttara-Basti. In the alternative, the discharge (of blood) should be induced with the help of the drugs of heat-making (Usna) potency (e.g.,Pippalyadi group) and measures laid down in connection with menorrhagia (Asrgdara) should be adopted after the flow has fairly set in. 14-19.
1. This Raktaja Gulma is peculiar to the females only. But some authorities are of opinon that a kind of Raktaja (blood-origined) Gulmu due to the vitiated blood of the organism may be possible both in the males and females.
आनूपौदकमज्जानो वसा तैलं घृतं दधि | विपक्कमेकतः शस्तं वातगुल्मेऽनुवासनम् ॥ २० ॥
जाङ्गलैकशफानान्तु वसा सर्पिश्च पैत्तिके | तैलं जाङ्गलमज्जान एवं गुल्मे कफोत्थिते ॥ २१ ॥
Anuvasana – The use of curd, clarified butter, oil, lard (Vasa) and marrow of Anupa (such as boar, buffalo, etc.) and Audaka (Aquatic) animals, boiled together and applied after in the manner of an Anuvasana-basti, proves beneficial in a case of Vataja-Gulma. The application of similar Bastis charged with a solution of clarified butter and the lard of animals of the Jangala and Eka-sapha groups proves efficacious in the Pittaja type of the disease, while the application of these containing solutions of oil and the marrow of any Jangala animal will prove beneficial in a case of the Kaphajaa type¹. 20-21.
धात्रीफलानां स्वरसे षडङ्गं विपचेद् घृतम् ।
शर्करासैन्धवोपेतं तद्धितं वातकुल्मिने ॥ २२ ॥
In a case of Vataja type of Gulma the patient should be made to use the medicated Ghrita duly cooked with the expressed juice of Amalaka and with the Kalka of the six drugs² and with the admixture of sugar and Saindhava (as an after-throw). 22.
1. Dalhana recommends the use of Vayu-subduing, Pitta-subduing and Kaphasubdung drugs as Kalka in the preparation of these three Bastis respectively. 2. The six durgs to be used as Kalka are Pippali, Pippali-mula, Cavya, Citaraka, Nagara and Yava-ksara taken one Pala each
Chitraka Ghrita.
चित्रकव्योषसिन्धूत्थ – पृथ्वीकाचव्यदाडिमैः । दीप्यकग्रन्थिकाजाजी -हपुषाधान्यकैः समैः ॥ २३ ॥ दध्यारनालबदर – मूलकस्वरसैघृतम् । तत् पिबेद् वातगुल्माग्नि-दौर्बल्याटोपशूलनुत् ॥ २४ ॥
Chitraka Ghrita – Clarified butter duly cooked with curd, fermented rice-boilings (Kanjika) as well as with the decoction of Badara and the expressed juice of Mulaka and with the Kalka of Chitraka, Tri-katu, Saindhava, Prthvika, Cavya, Dadima, Dipyaka, Granthika, Ajaji, Hapusa and Dhanyaka taken in equal parts, proves curative in cases of Vataja Gulma, Sula (colic), distension of the abdomen and dulness of digestive fire. 23-24.
Hingvadi Ghrita
॥२५॥ हिङ्गुसौवर्चलाजाजी – विडदाडिमदीप्यकैः । पुष्करव्योषधान्याम्ल-वेतसक्षारचित्रकैः शटीवचाजगन्धैलासुरसैश्च विपाचितम् । शूलानाहहरं सर्पिर्दध्रा चानिलगुल्मिनाम् ॥ २६ ॥
Hingvadi Ghrita – Clarified butter duly cooked with Hingu, Sauvarcala-salt, Ajaji, Vit-salt, Dadima, Dipyaka, Puskara, Vyosa, Dhanyaka, Amla-vetasa, Yava-ksara, Citraka, Sathi, Vaca, Ajagandha, Ela and Surasa as Kalka and with the admixture of curd (Dadhi) as liquid, proves efficacious in a case of Vataja Gulma, colic-pain and suppression of stool and rine. 25-26.
Dadhika Ghrita
विडदाडिमसिन्धूत्थ-हुतभुग्व्योषजीरकैः । हिङ्गुसौवर्चलक्षार-रुग्वृक्षाम्लाम्लवेतसैः सर्पिर्दधि बीजपूररसोपेतं चतुर्गुणम् । साधितं दाधिकं नाम गुल्महृत् प्लीहशूलजित् ॥ २८ ॥ ॥२७॥
Dadhika Ghrita – Clarified butter duly cooked with Vit-salt, Dadima, Saindhava, Citraka, Vyosa, Jiraka, Hingu, Sauvarcala-salt, Yava-Ksara, Kustha, Sunthi, Vrksamla (turmerie) and Amla-vetasa as Kalka and with the expressed juice of Bija-pura and with curd weighing four times as much as of Ghrita, proves curative in cases of Gulma, enlargement of spleen and Sula. The clarified butter thus prepared is called Dadhika Ghrita. 27-28.
Rasona Ghrita
सह ॥ २९ ॥ । रसोनस्वरसे सर्पिः पञ्चमूलरसान्वितम् । सुरारनालदध्यम्ल-मूलकस्वरसैः व्योषदाडिमवृक्षाम्ल-यवानीचव्यसैन्धवैः हिङ्ग्वम्लवेतसाजाजी -दीप्यकैश्च समांशिकैः ॥ ३० ॥ सिद्धं गुल्मग्रहण्यर्शः – श्वासोन्मादक्षयज्वरान् । कासापस्मारमन्दाग्नि – प्लीहशूलानिलान् जयेत् ॥ ३१ ॥
Rasona Ghrita – Clarified butter duly cooked with the admixture of the expressed juice of Rasona and with the decoction of (major) Panca-mula as well as with wine ( Sura ) Aranala (fermented riceboilings), curd, and the expressed juice of Mulaka with the Kalka of Vyosa, Dadima, Vrksamla, Yamani, Cavya, Saindhava, Hingu, Amlavetasa, Ajaji and Dipyaka (Ajamoda ) taken in equal parts, includes within the range of its curative efficacy such diseases of the body as Gulma, Grahani (Chronic diarrhoea), piles, asthma, insantity, consumption, fever, cough, epilepsy (Apasmara) dulness of digestive fire, enlargement of spleen, colic, and the derangements of the bodily Vayu.29-31.
Dadhyadi Ghrita
दधि सौवीरकं सर्पिः क्वाथौ मुद्द्रकुलत्थजौ । पञ्चाढकानि विपचेदावाप्य द्विपलान्यथ ॥ ३२ ॥ सौवर्चलं सर्जिकाञ्च देवदार्वथ सैन्धवम् । वातगुल्मापहं सर्पिरेतद् दीपनमेव च ॥ ३३ ॥
Dadhyadi Ghrita – An Adhaka measure each of curd, Sauviraka (a kind of Kanjika), clarified butter and the decoctions of Mudga and Kulattha pulse should be cooked with the admixture of two Pala weight of each of the following drugs, viz., Sauvarcala, Sarjika, Devadaru and Saindhava. The medicated Ghrita thus prepared proves curative in cases of Vataja Gulma and acts as a good appetiser. 32-33.
Ghritas in Pittaja and Raktaja Gulmas
तृणमूलकषाये तु जीवनीयैः पचेद् घृतम् । न्यग्रोधादिगणे वाऽपि गणे वाऽप्युत्पलादिके | रक्तपित्तोत्थितं घ्नन्ति घृतान्येतान्यसंशयम् ॥ ३४ ॥
Ghritas in Pittaja and Raktaja Gulmas – Clarified butter duly cooked with the Kalka of the drugs of the Jivaniya (Kakolyadi) group and with the decoction of the component members of the Trna-pancamula, or of the Nyagrodhadi or of the Utpaladi group, would, undoubtedly prove curative in cases of Pittaja and Raktaja Gulma. 34.
Ghritas in Kaphaja Gulma
आरग्वधादौ विपचेद् दीपनीययुतं घृतम् । क्षारवर्गे पचेच्चान्यत् पचेन्मूत्रगणेऽपरम् ।
घ्नन्ति गुल्मं कफोद्भूतं घृतान्येतान्यसंशयम् ॥ ३५॥
Ghritas in Kaphaja Gulma – A Gulma of the Kaphaja type would surely yield to the use of medicated Ghritas duly cooked with the drugs of the Dipaniya (Pippalyadi) group as Kalka with the admixture (as liquid) of the decoction of the component members of either the Aragvadhdi group or the alkaline (Muskakadi) group or with the officinal group of (animal) urines. 35.
यथादोषोच्छ्रयञ्चापि चिकित्सेत् सान्निपातिकम् ॥ ३६॥
चूर्णं हिङ्ग्वादिकं वाऽपि घृतं वा प्लीहनाशनम् । पिबेद् गुल्मापहं काले सर्पिस्तैल्वकमेव वा ॥ ३७॥
A Gulma of the Sannipatika type (due to the concerted action of all the three fundamental Dosas of the body) should be treated according to the predominance of any specific deranged bodily Dosa involved therein. The patient should be made to take at the proper time (i.e., as soon as the disease sets in) the pulverised compound known as the Hingvadi-Churna or the medicated Ghrita known as Tilvaka-Sarpih or the one (Viz. Satpalaka Ghrita) which has been described as curative of the enlargement of the spleen, as these would prove curative in a case of Gulma. 36-37.
Internal use of Kshara — Alkaline preparation
तिलेक्षुरकपालाश – सार्षपं यावनालजम् । ॥३९॥ भस्म मूलकञ्चापि गोऽजाविखरहस्तिनाम् ॥ ३८ ॥ मूत्रेण महिषीणाञ्च पालिकैश्चावचूर्णितैः । कुष्ठसैन्धवयष्ट्याह्व- नागरक्रिमिघातिभिः साजमोदैश्च दशभिः सामुद्राच्च पलैर्युतम् । अयः पात्रेऽग्निनाऽल्पेन पक्त्वा लेह्यमथोद्धरेत् ॥ ४० ॥ तस्य मात्रां पिबेद् दध्रा सुरया सर्पिषाऽपि वा । धान्याम्लेनोष्णतोयेन कौलत्थेन रसेन वा ।गुल्मं वातविकारांश्च क्षारोऽयं हन्त्यसंशयम् ॥ ४१ ॥ स्वर्जिकाकुष्ठसहितः क्षारः केतकजोऽपि वा । तैलेन शमयेत् पीतो गुल्मं पदनसम्भवम् । पीतं सुखाम्बुना वाऽपि स्वर्जिकाकुष्ठसैन्धवम् ॥ ४२ ॥
Internal use of Kshara — Alkaline preparation should be duly made with the llowing drugs, viz., the ashes of (dried stems of) Tila, Iksuraka, Sarsapa and Yava and of (the barks of) Palasa and of Mulaka with the urines ( weighing four times as much) of a cow, she-goat, ewe, she-ass, she elephant and she-buffalo. This alkaline preparation should then be cooked in an iron vessel and on a slow fire with one Pala-weight of each of the following pulverised drugs, viz., Kustha, Saindhava, Yasti-madhu, Nagara, Vidanga and Ajamoda and with ten Pala weight of Samudra-salt thereto added and, should be taken in the form of a lambative with one or the other of clarified butter, curd, wine, fermented rice-boilings (Dhanyamla), warm water or the soup of Kulattha. The alkaline compound, thus prepared,undoubtedly proves curative in cases of Gulma and in the derangements of the bodily Vayu. Compounds consisting of Sarjika- Ksara, Kustha and the ashes of Ketaki taken with oill, or of Sarjika Ksara, Kustha and Saidhava taken with tepid water, would subdue an attack of the deranged bodily Vayu. 38-42.
Vruschirarista
वृश्चीव (र) मुरुबूकञ्च वर्षाभूबृहतीद्वयम् । चित्रकञ्च जलद्रोणे पक्त्वा पाकावशेषितम् ॥ ४३ ॥ मागधीचित्रकक्षौद्र – लिप्ते कुम्भे निधापयेत् । मधुनः प्रस्थमावाप्य पथ्याचूर्णार्द्धसंयुतम् ॥ ४४ ॥ वसोषितं दशाहन्तु जीर्णभक्तः पिबेन्नरः । अरिष्टोऽयं जयेद् गुल्ममविपाकमरोचकम् ॥ ४५ ॥
Vrscirarista— The drugs known as Vrscira, Urubuka, two kinds of Brhati and Chitraka should be duly boiled Varsabhu together with a Drona-measure of water and taken down from the oven after three-fourths of the water are evaporated by boiling. It should then be poured into an earthen pitcher of which the interior has been previously coated with pastes of Magadhi, Chitraka and honey. Half Prastha of powdered Pathya and one Prastha of honey should be subsequently added to its contents and the pitcher should be then kept buried in a heap of husks for ten days, after which it should be taken out and its contents should be given to the patient after the digestion of his daily food. The Arista (fermented wine) thus prepared proves curative in cases of Gulma, indigestion and aversion to food. 43-45.
1. According to Dalhana, Sarjika Ksara, Kustha and Yava Ksara with oil would form the 1st compond and the Ketaka-Ksara with oil would form a separate comp and.
Pathadi Churna
पाठानिकुम्भरजनीत्रिकटुत्रिफलाग्निकम्ल वणं वृक्षबीजञ्च तुल्यं स्यादनवं गुडम् ॥ ४६ ॥
पथ्याभिः सहितं चूर्णं गवां मूत्रयुतं पचेत् । गुटिकास्तद् घनीभूतं कृत्वा खादेदभुक्तवान् ॥ ४७ ॥
गुल्मप्लीहाग्निसादांस्तान् नाशयेयुरशेषतः । हृद्रोगं ग्रहणीदोषं पाण्डुरोगञ्च दारुणम् ॥ ४८ ॥
Pathadi Churna — Powders of Patha, Nikumbha, Rajani, Tri-katu, Triphala, Agnika (Citraka), Saindhava-salt and Vrksa-bija (Indra-yava) in equal parts should be taken with old treacle of their combined weight; or the powders of the above drugs with pulverised Pathya (weighing a fourth part only of the other powders taken together) should be cooked with cow’s urine (weighing four times) to a thick consistency and made into pills which should be taken in an empty stomach (by the patient). These medicines would radically cure the cases of Gulma, enlarged spleen, indigestion, heart-disease, chronic diarrhoea and violent forms of chlorosis. 46-48.
Blood-letting
सशूले सोन्नतेऽस्पन्दे दाहपाकरुगन्विते । गुल्मे रक्तं जलौकोभिः सिरामोक्षेण वा हरेत् ॥ ४९ ॥
Blood-letting — Blood-letting by the application of leeches or by venesection should be effected in a case of elevated and immobile (unshifting) Gulma characterised by Sula, burning sensation, inflammation and piercing pain. 49.
Diet and Sveda
सुखोष्णा जाङ्गलरसा: सुस्निग्धा व्यक्तसैन्धवाः | कटुत्रिकसमायुक्ता हिताः पाने च गुल्मिनाम् ॥ ५० ॥ पेया वातहरैः सिद्धाः कौलत्थाः संस्कृता रसाः । खला: सपञ्चमूलाश्च गुल्मिनां भोजने हिताः ॥ ५१ ॥ बद्धवर्चोऽनिलानान्तु सार्द्रकं क्षीरमिष्यते । कुम्भीपिण्डेष्टकास्वेदान् कारयेत् कुशलो भिषक् ॥ ५२ ॥
Diet and Sveda – Drinks composed of the meat-essence of an animal of the Jangala group, profusely salted with Saindhava and mixed with clarified butter and Tri-katu and taken lukewarm are good for Gulma-patients. Peyas prepared with the Vayu-subduing drugs and the soup of Kulattha-pulse cooked with a Sneha as well as the KhadaYusa prepared with Panca-mula also are likewise efficacious as diet. Draughts of milk with Ardraka should be prescribed in a case of Gulma attended with the suppression of stool and flatus. Fomentation (Sveda) in the manner of Kumbhika, Pinda and Istaka (see Chapter XXXII) Chikitsa Sthana) are also efficacious. 50-52.
गुल्मिनः सर्व एवोक्ता दुर्विरेच्यतमा भृशम् । अतश्चैतांस्तु सुस्विन्नान् स्स्रंसनेनोपपादयेत् ॥ ५३ ॥ ॥ विम्लापनाभ्यञ्जनानि तथा संदहनानि च । उपनाहाश्च कर्तव्याः सुखोष्णा: साल्वणादयः ॥ ५४॥ उदरोक्तानि सर्पीषि मूत्रवर्तिक्रियास्तथा । लवणानि च योज्यानि यान्युक्तान्यनिलामये ॥ ५५ ॥
Purgatives preceded by the application of fomentation should be exhibited to a Gulma-patient, since it is extremely difficult to purge him. Vimlapana (massage of the Gulma), applicatoin of unguents and poultices, Samdahana (cauterisation) as well as tepid fomentation in the manner of Salvana-Sveda and others are likewise applicable. Medicated Ghritas, powders and Vartis mentioned in connection with the treatment of Udara as well as medicated salts mentioned under the head Udaramaya¹ are likewise applicable in the present disease. 53-55.
1. Udaramaya may mean either indigestion or ascites. Anilamaya (Vata-vyadhi) is a variant adopted by Dulhana and is undoubetedly preferable since there are several medicated salts eg. Patra-Lavana, Kanda-Lavana, in the treatment of Vata-Vyadhi. See Chap. IV, Chikitsa Sthana.
वातवर्चोनिरोधे तु सामुद्रार्द्रकसर्षपैः । कृत्वा पायौ विधातव्या वर्तयो मरिचोत्तराः ॥ ५६ ॥ दन्तीचित्रकमूलेषु तथा वातहरेषु च। कुर्यादरिष्टान् सर्वांश्च श्लोकस्थाने यथेरितान् । खादेवाऽप्यङ्करान् भृष्टान् पूतीकनृपवृक्षयोः ॥ ५७॥ ऊर्ध्व वातंमनुष्यञ्च गुल्मिनं न निरूहयेत् ॥ ५८ ॥
Medicated Plugs or Vartis made of Samudra’, Ardraka, Sarsapa (mustard) and a profuse quantity of Marica pasted together should be inserted into the rectum in suppression of stool and flatus in a case of Gulma. Aristas made with Danti-roots, Citraka-roots, or with the Vayusubduing drugs according to the manner laid down in the Sutra-Sthana should be prescribed, or the patient should be made to use the duly fried tender sprouts of Putika and Nrpa-Vrksa. A Gulma patient with the upward coursing of his bodily Vayu should not be treated with Niruh Basti. 56-58.
पिबेत् त्रिवृन्नागरं वा सगुडां वा हरीतकीम् । गुग्गुलुं त्रिवृतां दन्तीं द्रवन्तीं सैन्धवं वचाम् ॥ ५९ ॥ मूत्रमद्यपयोद्राक्षा-रसैर्वीक्ष्य बलाबलम् । एवं पीलूनि पि ( भृ)ष्टानि पिबेत् सलवणानि तु ॥ ६० ॥ पिप्पलीपिप्पलीमूल-चव्यचित्रकसैन्धवैः 1 युक्ता हन्ति सुरा गुल्मं शीघ्रं काले प्रयोजिता ॥ ६१ ॥ बद्धविण्मारुतो गुल्मी भुञ्जीत पयसा यवान् । कुल्माषान् वा बहुस्नेहान् भक्षयेल्लवणोत्तरान् ॥ ६२ ॥
Compounds of Trivrit and Sunthi or the treacle and powdered, Haritaki as well as of Guggulu, Trivrt, Danti, Dravanti, Saindhava and Vaca should be administered through cow’s urine, milk, wine or the expressed juice of grapes, according to the strength (of the disease and of the patient). Pilu made into a paste and salted with the addition of Saindhava should also be similarly taken. Wine surcharged with Pippali, Pippali-roots, Cavya, Citraka and Saindhava and taken at an opportune moment (i.e. when attended with tympaanitis, etc.) would prove readily curative in a case of gulma. A Gulma-patient afflicted with suppression of stool and of flatus should take barley with milk or Kulmasa (Masa-cakes) profusely saturated with salt and clarified butter. 59-62.
1. According to some ‘Samudra’ means samudra-salt and others, it means Samudra Phena.
2. According to some commentators the first two compounds should be taken with water.
अथास्योपद्रवः शूलः कथञ्चिदुपजायते । शूलं निखानितमिवासुखं येन तु वेत्त्यसौ ॥ ६३ ॥ तत्र विण्मूत्रसंरोधः कृच्छ्रोच्छ्छ्रासः स्थिराङ्गता । तृष्णा दाहो भ्रमोऽन्नस्य विदग्धपरिवृद्धिता ॥ ६४ ॥ रोमहर्षोऽरुचिश्छर्दिर्भुक्तवृद्धिर्जडाङ्गता वाय्वादिभिर्यथासङ्ख्यं मिश्रैर्वा वीक्ष्य योजयेत् ॥ ६५॥
Supervening Symptoms – If Sula which is its supervening symptom anyhow appears whereupon the patient suffers a kind of digging and piercing pain resembling that arising from the piercing of a dart, there will also appear the following distressing concomitants according to the Dosa or Dosas involed, viz., supression of stool and urine difficult respiration, and numbness or stiffness of the limbs (in case of aggravated Vayu), thirst, burning sensation, vertigo, illdigestion of food, and excess of the colic pain ( in cases of aggravated Pitta), and horripilation, aversion to food, vomiting, increase of pain after taking food and a sense of lassitude in the limbs (in cases of aggravated Kapha). The course of medical treatment in such cases should be determined by the nature and number of the deranged bodily Dosas-specifically lying at the root and should be as followed as such. 63-65.
पथ्यात्रिलवणं क्षारं हिङ्गतुम्बुरुपौष्करम्। यवानीञ्च हरिद्राञ्च विडङ्गान्यम्लवेतसम् ॥६६॥ विदारीत्रिफलाऽभीरु – शृङ्गाटीगुडशर्कराः । काश्मरीफलयष्ट्याह्व-परूषकहिमानि च षड्ग्रन्थातिविषादारु-पथ्यामरिचवृक्षकान् । कृष्णामूलकचव्यञ्च नागरक्षारचित्रकान् ॥ ६८ ॥ ॥६७॥ उष्णाम्लकाञ्जिकक्षीर-तोयैः श्लोकसमापनान् । यथाक्रमं विमिश्रांश्च द्वन्द्वे सर्वाश्च सर्वजे ॥ ६९ ॥
The following three compounds, viz., ( 1 ) Pathya, the three kinds of salt (Saindhava, Sauvarcala and Vit) Yava Ksara, Hingu, Tumburu, Puskara, Yavani, Haridra, Vidanga and Amla vetasa; ( 2 ) Vidari, Triphala, Satavari, Srngata, Guda-sarkara (Gangeri-phala), Kasmariphala, Yasti madhu, Parusaka, Hima (Sandal wood) and (3) Sadgrantha (Vaca), Ativisa, Devadaru, Pathya, Marica, Vrksaka, Pippalimula, Cavya, Nagara, Ksara ( Yava-ksara ) and Citraka should be respectively given in the Vataja, Pittaja and Kaphaja types of the disease. The medium through which these compounds should be given would be tepid Amla-Kanjika, Luke-warm milk and tepid water respectively. The preceding three compounds should be jointly administered in cases where two or three Dosas are involved. 66-69.
तथैव सेकावगाह-प्रदेहाभ्यङ्गभोजनम् । शिशिरोदकपूर्णानां भाजनानाञ्च धारणम् ॥ ७० ॥ वमनोन्मर्दनस्वेद – लङ्गनक्षपणक्रियाः स्नेहादिश्च क्रमः सर्वो विशेषेणोपदिश्यते ॥ ७१ ॥
Sprinkling (of water), baths, plaster (Pradeha) unguents and dietetic treatment should be similarly applied in Vataja cases. Contacts with vessels filled with cold water should be applied in Pittaja cases, while the use of emetics, rubbing, fomentatoin (Sveda), fasting and other kapha-subduing remedies should be recommended in Kaphaja types. Applications of Sneha and such-like remedial measures are specifically recommednded in the disease, according to the Dosa or Dosas involved in each case. 70-71.
वल्लूरं मूलकं मत्स्यान् शुष्कशाकानि वैदलम् । न खादेदालुकं गुल्मी मधुराणि फलानि च ॥ ७२ ॥
Prohibited articles- A person suffering from Gulma, should refrain from taking Vallura (dried meat), Mulaka (radish), fish, dried pot-herbs, any preparation of pea, aluka, (Potato of any kind) and any kind of sweet fruit. 72.
Causes and symptoms of Sula
विना गुल्मेन यच्छूलं गुल्मस्थानेषु जायते । निदानं तस्य वक्ष्यामि रूपञ्च सचिकित्सितम् ॥ ७३ ॥ निग्रहादतिभोजनात् । वातमूत्रपुरीषाणां अजीर्णाध्यशनायास-विरुद्धान्नोपसेवनात् । पानीभयानात् क्षुत्काले विरुढानां च सेवनात् । पिष्टान्नशुष्कमांसानामुपयोगात् तथैव च एवंविधानां ॥ ७४ ॥ द्रव्याणामन्येषाञ्चोपसेवनात् । वायुः प्रकुपितः कोष्ठे शूलं सञ्जनयेद् भृशम् ॥ ७५॥ निरुच्छ्वासी भवेत् तेन वेदनापीडितो नरः । शङ्कुस्फोटनवत् तस्य यस्मात् तीव्राश्च वेदनाः । शूलासक्तस्य लक्ष्यन्ते तस्माच्छूलमिहोच्यते ॥ ७६ ॥
Causes and symptoms of Sula- Now I shall deal with the causes, the characteristic symptoms and the treatment of Sula occurring in any specific locality of a Gulma even without its actual presence or formation therein. A voluntary retention of flatus (Vata), stool or urine, over-eating, indigestion, eating before the digestion of previous food, over-exertion, use of articles of food which are incompatible in their combination, drinking water when hungry, use of germinated grains, dry food or cakes of dry meat, as well as the use of other such-like articles of fare, derange and aggravate the bodily Vayu, which produces a violent cutting and spasmodic pain (Sula) in the main cavity of the trunk (Kostha). The patient complains of as if being pierced with a Samku (spear) in the inside and of a feeling of suffocation under the influence of that excruciating pain, which fact has determined the nomenclature of sula (lit-a spear). 73-76.
Vataja Sula
निराहारस्य यस्यैव तीव्रं शूलमुदीर्यते । प्रस्तब्धगात्रो भवति कृच्छ्रेणोच्छ्रसितीव च ॥ ७७॥ वातमूत्रपुरीषाणि कृच्छ्रेण कुरुते नरः । एतैलिङ्गैर्विजानीयाच्छूलं वातसमुद्भवम् ॥ ७८ ।।
Vataja Sula – The patient experiences a violent colic whenever in an empty stomach and he feels a difficuclty of respiration. The limbs seem to be numbed or stuffed and the flatus, stool and urine are evacuated with the greatest difficulty-these are the symptoms which mark the Vataja type of the disease. 77-78.
Pittaja Sula
तृष्णा दाहो मदो मूर्च्छा तीव्रं शूलं तथैव च । शीताभिकामो भवति शीतेनैव प्रशाम्यति ।
एतैर्लिङ्गैर्विजानीयाच्छूलं पित्तसमुद्भवम् ॥ ७९ ॥
Pittaja Sula – Thirst and a burning sensation in the body attended with an excruciating pain, giddiness, loss of consciousness, desire for cold things and amelioration on application of cooling measures, are the specific features of the Pittaja type. 79.
Kaphaja and Sannipatika Sulas
शूलेनोत्पीड्यमानस्य हल्लास अतीवपूर्णकोष्ठत्वं तथैव उपजायते । गुरुगात्रता । एतत् श्लेष्मसमुत्थस्य शूलस्योक्तं निदर्शनम् ॥ ८० ॥ सर्वाणि दृष्ट्वा रूपाणि निर्दिशेत् सान्निपातिकम् । सन्निपातसमुत्थानमसाध्यं तं विनिर्दिशेत् ॥ ८१ ॥
Kaphaja and Sannipatika Sulas — An agonising pain attended with nausea, excessive fullness of the stomach and a sense of heaviness in the limbs are the indications which distinguish the Kaphaja type of the disease. The type due to the concerted action of the three simultaneously deranged Dosas of the body (Sannipatika Sula) exhibit all the series of symptoms which respectively mark the preceding types, and hence it is said to be incurable. 80-81.
General treatment of Gulma
शूलानां लक्षणं प्रोक्तं चिकित्साञ्च निबोध मे। आशुकारी हि पवनस्तस्मात् तं त्वरया जयेत् ॥ ८२ ॥ तस्य शूलाभिपन्नस्य स्वेद एव सुखावहः। पायसैः कृशरापिण्डैः स्त्रिग्धैर्वा पिशितैर्हितः ॥ ८३ ।। त्रिवृच्छाकेन वा स्निग्धमुष्णं भुञ्जीत भोजनम् । चिरबिल्वाङ्करान् वापि तैलभृष्टांस्तु भक्षयेत् ॥ ८४ ॥ वैहङ्गांश्च रसान् स्निग्धान् जाङ्गलान् शूलपीडितः । यथालाभं निषेवेत मांसानि बिलशायिनाम् ॥ ८५ ॥
General treatment — The Symptoms have been described. me describing the mode of medical treatment (to be generally pursued in curing a case of Sula). Since the deranged bodily Vayu (which is the principal and immediately exciting factor, is very active in its operation, hence it should be speedily subdued. Fomentations with Payasa, Krsara or cooked meat saturated with any Sneha (clarified butter, etc.) should be resorted to. Fomentation naturally gives relief to a patient suffering from Sula. The patient should take cooked Trivrtleaves (as pot-herbs) with his meals cooked with a Sneha (clarified butter) and served hot; or he should eat the tender sprouts of Cirabilva fried with oil, or drink the meat-essence of the flesh of any birds of the Jangala group charged with a Sneha or take the meat of any animal of the Bilesaya group. 82-85.
Treatment of Vataja sula
सुरा सौवीरकं चक्रं मस्तूदश्वित् तथा दधि | सकाललवणं पेयं शूले वातसमुद्भवे ॥ ८६ ॥ ॥ कुलत्थयूषो युक्ताम्लो लावकीयूषसंस्कृतः । ससैन्धवः समरिचो वातशूलविनाशनः ॥ ८७॥ विडङ्गशिग्रु कम्पिल्ल-पथ्याश्यामाम्लवेतसान्। सुरसामश्वमूत्रीञ्च सौवर्चलयुतान् पिबेत् । मद्येन वातजं शूलं क्षिप्रमेव प्रशाम्यति ॥८८ ॥
Treatment of Vataja sula – Sura, Sauviraka (fermented rice boilings), Sukta, the cream of curd and Udasvit (half-diluted Takra) saturated with Kala salt¹, should be taken in a case of Vataja Sula. The soup of Kulattha with an adequate quantity of the acid articles (e.g. pomegranate, etc.) and cooked with the soup of Lava bird salted with Saindhava and seasoned with Marica, exercise a curative efficacy in a case of the Vayu-origined type. The compound of Vidanga, Sigru, Kampilla, Pathya, Syama, Amla-vetasa, Surasa, Asva-karna and Sauvarcala should be taken with wine in an attack of the Vayu-origined type of sula. 86-88.
पृथ्वीकाजाजिचविका-यवानीव्योषचित्रकाः । पिप्पल्यः पिप्पलीमूलं सैन्धवञ्चेति चूर्णयेत् ॥ ८९ ॥
1. Kala Lavana generally means ‘Vit-salt’, but here, according to Dalhana, it means ‘Sauvarcala-salt.’
Pruthvikadi Churna and Vartik
तानि चूर्णानि पयसा पिबेत् काम्बलिकेन वा । मध्वासवेन चुक्रेण चुक्रेण सुरासौवीरकेण वा ॥ ९० ॥ अथवैतानि चूर्णानि मातुलुङ्गरसेन वा । तथा बदरयूषेण भावितानि पुनः पुनः । तानि हिङ्गुप्रगाढानि सह शर्करया पिबेत् ॥ ९१ ॥ सह दाडिमसारेण वर्तिः कार्या भिषग्जिता । सा वर्तिर्वातिकं शूलं क्षिप्रमेव व्यपोहति । गुडतैलेन वा लीढा पीता मद्येन वा पुनः ॥ ९२ ॥
Prthvikadi Churna and Vartik – A pulverised compound consisting of Prthvika, Ajaji, Cavika, Yavani, Vyosa, Citraka, Pippali, Pippala-mula and Saindhava pounded together should be taken with milk or Kambalika or Madhvasava (wine of honey) or Cukra or Sura (wine) or with Sauviraka (Fermented rice-boilings) as alternatives. The above pulverised compound should be soaked in the expressed juice of Matulunga and with the decoction of Badara several times in the manner of Bhavana saturation, and the compound should be taken with a profuse quantity of Hingu, and with sugar. A Varti made of the same powders and pulverised (pith of) Dadima mixed together should be licked with treacle or honey or taken with in cases of Vataja Sula as giving an instantaneous relief. 89-92.
बुभुक्षाप्रभवे शूले लघु सन्तर्पणं हितम् । उष्णैः क्षीरैर्यवागूभिः स्निग्धैमांसरसैस्तथा ॥ ९३ ॥ वातशूले समुत्पन्ने रूक्षं स्निग्धेन भोजयेत् । सुसंस्कृताः प्रदेयाः स्युर्घृतपूरा विशेषतः ॥ ९४ ॥ वारुणीञ्च पिबेज्जन्तुस्तथा सम्पद्यते सुखी | एतद् वातसमुत्थस्य शूलस्योक्तं चिकित्सितम् ॥ ९५ ॥
In a case of Sula due to hunger, light and sparing diet should be given with lukewarm milk, Yavagu or meat-soup charged with clarified butter. Emulsive diet should be given in a case of Vataja Sula to a patient of dry or parched organism, use of well seasoned Ghrrta-puras being specially recommended. The patient should also take Varuni wine whereform he will get relief. The treatment of Vataja Sula has been described. 93-95.
Treatment of Pittaja Sula
अथ पित्तसमुत्थस्य क्रियां वक्ष्याम्यतः परम् । स सुखं छर्दयित्वा तु पीत्वा शीतोदकं नरः । शीतलानि च सेवेत सर्वाणयुष्णानि वर्जयेत् ॥ ९६ ॥ मणिराजतताम्राणि भाजनानि च सर्वशः । वारिपूर्णानि तान्यस्य शूलस्योपरि निक्षिपेत् ॥ ९७ ॥ गुडशालियवाः क्षीरं सर्पिः पानं विरेचनम् । जाङ्गलानि च मांसानि भेषजं पित्तशूलिनाम् ॥ ९८ ॥ रसान् सेवेत पित्तघ्नान् पित्तलानि विवर्जयेत् । पालाशं धान्वनं वाऽपि पिबेद् यूषं सशर्करम् ॥ ९९ ॥ परूषकाणि मृद्वीका-खर्जूरोदकजान्यपि । तत् पिबेच्छर्करायुक्तं पित्तशूलनिवारणम् ॥ १०० ॥
Treatment of Pittaja Sula – Now I shall narrate the therapeutic agents and remedies in respect of Pittaja-Sula. A perosn aficted with an attack of the present type of the disease, should be made to vomit without any violent effort by drinking (a stomachful) cold water. He should have recourse to cooling measurs and avoid all heat-making ones. Vessels of copper, silver or precious stones and cooling gems and filled up to the brim with water, should be placed upon the seat of affection (Sula) in his body. Treacle, barley, Sali rice, milk, (Draughts of clarified butter, purgatives, the flesh of any Jangala animals—these should be prescribed in cases of Pittaja Sula. All Pitta-generating articles should be avoided and those which soothe the Pitta should be used. The soup of the meat of Jangala animals may be taken with sugar as an alternative, Parusaka, grapes, dates and aquatic fruits such as Srngataka etc. should also be taken with sugar as they tend to relieve Pittaja Sula. 96-100.
Treatment of Kaphaja Sula
अशने भुक्तमात्रे तु प्रकोपः श्लैष्मिकस्य च । वमनं कारयेत् तत्र पिप्पलीवारिणा भिषक् ॥ १०१ ॥ रूक्षः स्वेदः प्रयोज्यः स्यादन्याश्चोष्णाः क्रिया हिताः । पिप्पली शृङ्गवेरञ्च श्लेष्मशूले भिषग्जितम् ॥ १०२ ॥ पाठां वचां त्रिकटुकं तथा च कटुकरोहिणीम् । चित्रकस्य च निर्यूहे पिबेद् यूषं सहार्जकम् ॥ १०३ ॥
Treatment of Kaphaja Sula – A fit of Sula due to the action of the deranged Kapha is aggravated just after eating. Vomiting should be induced in such a case with draughts of the decoction of Pippali¹. Dry fomentations and other heating measures should be likewise resorted to and the patient should be made to take Pippali and Sunthi (in any shape) in cases of Kaphaja sula Patha, Vaca, Tri-katu, and Katuka-rohini should be used with the decoction of Citraka or the soup (of any sula-subduing article) should be taken with an equal part of Arjaka. 101-103.
एरण्डफलमूलानि मूलं गोक्षुरकस्य च । शालपर्णी पृश्रिपर्णी बृहतीं कण्टकारिकाम् ॥ १०४ ॥ दद्याच्छृगालविन्नाञ्च सहदेवां तथैव च ।महासहां क्षुद्रसहां मूलमिक्षुरकस्य च ॥ १०५ ॥ एतत् सम्भृत्य सम्भारं जलद्रोणे विपाचयेत् । चतुर्भागावशेषन्तु यवक्षारयुतं पिबेत् ॥ १०६ ॥ वातिकं पैत्तिकं वाऽपि श्लैष्मिकं सान्निपातिकम् । प्रसह्य नाशयेच्छूलं छिन्नाभ्रमिव मारुतः ॥ १०७॥ पिप्पल्यः स्वर्जिकाक्षारो यवाश्चित्रक एव च। सेव्यञ्चैतत् समानीय भस्म कुर्याद् विचक्षणः । तदुष्णवारिणा पीतं श्लेष्मशूले भिषग्जितम् ॥ १०८ ॥
Seeds and roots of Eranda, Goksura-roots, Salaparni, PrSniparni, Brhati, Kantakari, Srgala-vinna (a kind of Prsni-parni), Sahadeva, Mahasaha ( Masaparni), Ksudra-Saha (Mudga-parni) and Iksuraka-roots should be duly boiled with a Drona measure (sixty-four seers) of water and should be boiled till reduced to a quarter part. This decoction should be used with the admixture of Yava-ksara². By this compound attacks of Vataja, Pittaja, kaphaja and Tri-dosaja types of Sula would be thrown off just as the floating clouds are shattered and driven by the wind. Pippali, Yava, Citraka, Usira and Sarjika-ksara should be burnt together and reduced to ashes. Taken with tepid water, this compound proves curative in an attack of Kaphaja Sula. 104-108.
1. Some commentators, according to Dalhuna, take Pippali to mean seeds of Madanaphala.
1. The total weight of the drugs should be 8 seers, according to Dalhana. According to others, however, it should be 12 seers. The preparation should be used in any shape both internally and externally e.g. a bath, wshings, etc.
Symptoms of Parsva Sula
रुणद्धि मारुतं श्लेष्मा कुक्षिपार्श्वव्यवस्थितः । स संरुद्धः करात्याशु साध्मानं गुडगुडायनम् ॥ १०९ ॥ सूचीभिरिव निस्तोदः कृच्छ्रोच्छ्रासी तदा नरः । नानं वाञ्छति नो निद्रामुपैत्यर्तिनिपीडितः । पार्श्वशूलः स विज्ञेयः कफानिलसमुद्भवः ॥ ११० ॥
Symptoms of Parsva-Sula — The deranged Kapha in the regions of the Parsva (sides) arrests the course of local Vayu which thus irritated causes an immediate distension of the abdomen and a rumbling in the intestines. A pricking pain is felt in the affected part, which seems as if being pierced with needles and the patient complains of insomnia and has no relish for food and his respiration becomes painful and difficult. The disease is named Parsva-Sula (side-colic) and is brought on by the action of the deranged Vayu and Kapha. 109-110
तत्र पुष्करमूलानि हिङ्गु सौवर्चलं विडम् । सैन्धवं तुम्बुरुं पथ्यां चूर्णं कृत्वा तु पाययेत् ॥ १११ ॥ पार्श्वहद्वस्तिशूलेषु यवक्काथेन संयुतम् । सर्पिः प्लीहोदरोक्तं वा घृतं वा हिङ्गुसंयुतम् ॥११२॥ बीजपूरकसारं वा पयसा सह साधितम् । एरण्डतैलमथवा मद्यमस्तुपयोरसैः । भोजयेच्चापि पयसा जाङ्गलेन रसेन वा ॥ ११३ ॥
Treatment of Parsva-Sula— A pulverised compound of Puskara-roots, Hingu, Sauvarcala, Vit-salt, Saindhava, Tumburu and Pathya should be taken with a decoction of barley in a case of (colic) pain at the sides, at the region of the heart and at the region of the bladder. The medicated Ghrita Mentioned in connection with abdominal dropsy due to the enlarged spleen, or clarified butter mixed with Hingu should be as well administered in such cases. Bijapuraka-Saral duly cooked in milk as well as draughts of castor oil mixed with wine, Mastu, Milk or meat-soup (whichever of these may be conducive to the health of the patient) should be taken and the diet should be taken with milk or with the meat-soup of Jangala animals. 111-113.
Symptoms of Kuksi Sula
प्रकुप्यति यदा कुक्षौ वह्निमाक्रम्य मारुतः । तदाऽस्य भोजनं भुक्तं सोपस्तम्भं न पच्यते ॥ ११४ ॥ उच्छसित्यामशकृता शूलेनाहन्यते मुहुः । नैवासने न शयने तिष्ठन् स लभते सुखम् । कुक्षिशूल इति ख्यातो वातादामसमुद्भवः ॥ ११५ ॥
Symptoms of Kuksi-Sula – The deranged and aggravated bodily Vayu, affecting the fire of digestion and incarcerated in the region of the Kuksi (loins) interferes with the digestion of the food previously taken which remains stiff and undigested in consequence. The patient breathes heavily owing to the accumulation of undigested (fecal) matter and tosses about in agony of pain, finding no relief in any posture whatever, whether sitting or lying. The disease is called Kuksi-sula, and is due to indigestion incidental to the action of the deranged bodily Vayu. 114-115.
Treatment of Kuksi-Sula
वमनं कारयेत् तत्र लङ्घयेद् वा यथाबलम् । संसर्गपाचनं कुर्यादम्लैर्दीपनसंयुतैः ॥ ११६ ॥ नागरं दीप्यकं चव्यं हिङ्ग सौवर्चलं विडम् । मातुलुङ्गस्य बीजानि तथा श्यामोरुबूकयोः । बृहत्याः कण्टकार्याश्च क्वाथं शूलहरं पिबेत् ॥ ११७ ॥ वचा सौवर्चलं हिङ्ग कुष्ठं सातिविषाऽभया । कुटजस्य च बीजानि सद्यः शूलहराणि तु ॥ ११८ ॥ विरेचने प्रयुञ्जीत ज्ञात्वा दोषबलाबलम् । स्नेहबस्तीन् निरूहांश्च कुर्याद् दोषनिबर्हणान् ॥ ११९ ॥ उपनाहा: स्नेहसेका धान्याम्लपरिषेचनम् । अवगाहाश्च शस्यन्ते यच्चान्यदपि तद्धितम् ॥ १२० ॥
1. Bijapuraka-sara, according to Dalhana, means the fruit of Bijapuraka. Bijakasara (the pith of Bijaka) is, however, a variani.
Treatment of Kuksi-Sula— Vomitting should be induced and fasting should be prescribed in the case according to the strength of the patient. Acid and appetising drugs should be employed for the alleviation of the Dosas (Vayu and Ama ). A decoction of Nagara, Dipyaka, Cavya, Hingu, Sauvarcala, Virl, and the seeds of Matulunga, Syama, Uruvuka, Brhati and of Kantakari, should be taken for the relief of the pain ( Sula ). Vaca, Sauvarcala, Hingu, Kustha Ativisa, Abhaya, and Kutaja-seeds taken together would instantaneously relieve Sula. Purgatives should be administered, and Sneha Bastis and Niruha – Bastis should be applied for the ameliortion of the deranged Dosas according to their nature and intensity. Sneha-Sveda and poultices should be applied and Dhanyamla (fermented paddy-boilings) should be employed as washes. 116-120.
Symptoms and treatment of Hrudsula
कफपित्तावरुद्धस्तु मारुतो रसमूर्च्छितः । हृदिस्थः कुरुते शूलमुच्छ्छ्रासारोधकं परम् । स हृच्छूल इति ख्यातो रसमारुतसम्भवः ॥ १२१ ॥ तत्रापि कर्माभिहितं यदुक्तं हृद्विकारिणाम् ॥ १२२ ॥
Symptoms and treatment of Hrudsula -The deranged bodily Vayu aggravated by the vitiated Rasa (chyle) and incarcerated in the region of the heart through the action of the deranged Pitta and Kapha, produces Sula (pain) in the heart and gives rise to difficulty of respiraton. This disease which is called Hrc-chula (cardiac colic) is ushered in through the action of the deranged Vayu and Rasa of the body. Remedial measures mentioned in connection with the treatment of the diseases of the heart should be as well employed in the present malady. 121-122.
Symptoms of Basti-sula and Mutra-sula
संरोधात् कुपितो वायुर्बस्तिमावृत्य तिष्ठति । बस्तिवङ्क्षणनाभीषु ततः शूलोऽस्य जायते । विण्मूत्रवातसंरोधी बस्तिशूलः स मारुतात् ॥ १२३ ॥ नाभ्यां वड्ङ्क्षणपार्श्वेषु कुक्षौ मेढ्रान्त्रमर्दकः । मूत्रमावृत्य गृह्णाति मूत्रशूलः स मारुतात् ॥ १२४ ॥
1. Hingu, Souvarcala and Vit-salt should be used as an after throw.
Symptoms of Basti-sula and Mutra-sula – The local Vayu aggravated by the suppression of stool and urine is incarcerated in the region of the Basti (bladder) and gives rise to a pain in the bladder, in the groins and about the umbilicus causing a further suppression of the stool, urine and flatus. The disease is called Basti-sula (bladder colic) and is due to the action of the deranged bodily Vayu. A cutting pain experienced in the genital, the intestines and the loins as well as at the sides and in the inguinal regions and about the umbilicus and causing a complete suppression of urine, is called Mutra-Sula. The disease should be likewise attributed to the action of the deranged bodily Vayu. 123-124.
Symptoms of Vit Sula
वायुः प्रकुपितो यस्य रूक्षाहारस्य देहिनः । मलं रुणद्धि कोष्ठस्थं मन्दीकृत्य तु पावकम् ॥ १२५ ॥ शूलं सञ्जनयंस्तीव्रं स्त्रोतांस्यावृत्य तस्य हि । दक्षिणं यदि वा वामं कुक्षिमादाय जायते ॥ १२६ ॥ सर्वत्र वर्धते क्षिप्रं भ्रमन्नथ स घोषवान् । पिपासा वर्धते तीव्रा भ्रमो मूर्च्छा च जायते ॥ १२७॥ उच्चारितो मूत्रितश्च न शान्तिमधिगच्छति । विट्शूलमेतज्जानीयाद् भिषक् परमदारुणम् ॥ १२८ ॥
Symptoms of Vit-Sula — The bodily Vayu deranged and aggravated by the use of dry food, etc., affects or impairs the digestive fire and obstructs the evacuation of faeces accumulated in the bowels and gives rise to an excruciating pain in the locality by stuffing or choking the channels of the intestines. The pain is first experienced in the region of the right or left Kuksi (loin), but it soon extends over the whole abdomen with rumbling sounds there in. Thirst becomes unquenchable and vertigo and epileptic fits follow in its train, and the patient finds no relief even after the evacuation of the bladder and of the bowels. This disease is called Vit-sula and is a very violent one. 125-128.
Treatment
क्षिप्रं दोषहरं कार्यं भिषजा साधु जानता। स्वेदनं शमनञ्चैव निरूहाः स्नेहबस्तयः ॥ १२९ ॥ पूर्वोद्दिष्टान् पाययेत योगान् कोष्ठविशोधनान् । उदावर्तहराश्चास्य क्रियाः सर्वाः सुखावहाः ॥ १३० ॥
Treatment – An experienced physician should instantly employ (in such cases) the medicinal remedies which have the virtue of eliminating the deranged Dosas from the system. Fomentations, emetics as well as Sneha-Bastis and Niruha-bastis should be applied, and the bowel-cleansing compounds dealt with before should be administered. Medicinal measures mentioned in connection with the treatment of Udavarta should be likewise employed with advantage. 130.
Symptoms of Annaja Sula
अतिमात्रं यदा भुक्तं पावके मृदुतां गते । स्थिरीभूतन्तु तत् कोष्ठे वायुरावृत्य तिष्ठति ॥ १३१ ॥ अविपाकगतं ह्यन्नं शूलं तीव्रं करोत्यति । मूर्च्छाऽऽध्मानं विदाहञ्च हृदुत्क्लेशं विलम्बिका ॥ १३२ ॥ विरिच्यते छर्दयति कम्पतेऽथ विमुह्यति । अविपाकाद्व मनं भवेच्छूलस्त्वन्नदोषसमुद्भवः ॥ १३३ ॥ लङ्घनं स्वेदः पाचनं फलवर्तयः । क्षाराचूर्णानि गुटिका: शस्यन्ते शूलनाशनाः। गुल्मावस्थाः क्रियाः कार्या यथावत् सर्वशूलिनाम् ॥ १३४ ॥
Symptoms of Annaja Sula — A voracious eating in an impaired state of digestive fire, aggravate the local Vayu which makes the food taken remain stiffed in the Kostha. The food thus undigested in the Kostha causes an intolerable colic, which brings on distension of the abdomen, epileptic fits, acidic indigestion (Vidaha), nausea and an attack of Vilambika. The patient shivers, vomits, or passes stool, and even loses conciousness. Emesis, fasting, fomentation, digestive falvarti anti-colic (pain-killing ) pills, powders and medicinal Ksaras are recommended in the case. All the medical remedies applicable in cases of Gulma should likewise be applied in cases of sula. 131-134.
– इति सश्रुत संहितायामुत्तरतन्त्रे गुल्मरोगप्रतिषेधव्याख्यानाम द्विचत्वारिंशोऽध्यायः ॥ ४२ ॥
Thus ends the forty-second chapter of the Uttara-Tantra in the Susruta Samhita which deals with the medical treatment of Gulma.
