Ashtanga Sangraha Chapter 39 – Kshara paka vidhi – preparation of caustic alkalies; thus said Atreya and other great sages. (1)
अथातः क्षारपाकविधिमध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
Kshara guna – properties of caustic alkalies
क्षारो हि नानौषधसमवायनिर्वृत्तेः सर्वरसाधिष्ठानं कटुकलवणरसभूयिष्ठस्तीक्ष्णोष्णो दहनः पाचनोविदारणो विलायनः शोधनो रोपणः क्रिम्याममेदोविषापहः सर्वशस्त्रानुशस्त्राणां च वरिष्ठः छेदनभेदनपाटनलेखनकरणाद्यतश्च सम्बाधावकाशजेषु दुःखावचारणीयशस्त्रेषु नासा र्शोऽर्बुदादिषुशस्त्रेण चासिध्यत्सु दुष्टव्रणेषु बहुशः प्रकोपिषु प्रयुज्यते ॥२॥
Ksharas (caustic alkalies) derived from the combination of different kinds of drugs only, is the repository of all the tastes, with a predominance of pungent (Katu) and salt (Lavana), possesses properties such as penetrating and hot potency, and does functions such as burning, digesting, tearing, dissolving (liquifying), cleansing, healing; destroys worms (bacteria), undigested materials, fat and poisons; best among all major and minor (accessory) sharp instruments, serves the purposes of cutting, dividing, puncturing, scratching and other activities, fit to be used in places where sharp instruments can be used with difficulty such as a nasal polyp, malignant tumours etc., where treatment with sharp instruments does not succeed such as bad ulcers and in diseases produced by profound increase of the doshas. (2)
Dvividha ksharopayoga – two kinds of usage of caustics
स द्विविधो वाह्याभ्यन्तरपरिमार्जनभेदेन तत्रार्शोऽर्बुदभगन्दरग्रन्थिदुष्टव्रणनाडीचर्मकीलवर्त्ममुखरोगकुष्ठकिलासतिलकालकादिषु बहिः परिमार्जनेन । अन्तः परिमार्जनेन तु गुल्मगरोदराग्निसादमलसङ्गशूलानाहाश्मरीशर्करादिषु स यथास्वमेवोपदेक्ष्यते ॥३॥
It is of two kinds – Bahyaparimarjana (external application) and Abhyantara Parimarjana (internal potion).
External application is indicated in diseases such as haemorrhoids, malignant tumors, rectal fistula, tumors, bad ulcers, sinus ulcers, warts, diseases of the eyelids and face, leprosy, and other skin diseases, leucoderma, black moles on the skin and such others.
The internal option is indicated in abdominal tumours, poisoning (artificial, homicidal) enlargement of the abdomen, dyspepsia, accumulation of faeces (and other waste products), colic, distension of the abdomen, urinary caliculi and gravel. The procedure of this (internal potion) will be described in the context of these diseases. (3)
Kshara varjyah – contraindication for caustic therapy
न तूभयोऽपि योज्यो भीरुदुर्बलक्षामवातपित्तार्दितज्वरातिसारपाण्डुशिरोहृदयरोगमेहाक्षिपाका तिमिरारोचकातुरकृतवमनविरेकतुर्मतीगर्भिण्युद्वृत्तफलयोनिसर्वाङ्गशूलविषमद्यपीतेषु । मर्म सिरास्त्रायुसन्धितरुणास्थिसेवनीधमनीगलनाभिनखान्तरमुष्कशेफस्त्रोतस्स्वल्पमांसेषु च देशेष्व क्ष्णोश्चान्यत्र वर्त्मरोगात् । तथा शीतोष्णवर्षदुर्दिनप्रवातेषु च ॥४॥
Neither of the two methods should be used for persons who are frightful, weak, emaciated, those suffering from increase of vata and pitta, fever, diarrhoea, anaemia, diseases of the head and heart, diabetes, ulcerations of the eye, blindness, loss of appetite / taste; who have undergone emesis and purgaiton therapies, the lady in menstrual periods and pregnancy, inflamed ovaries and vagina, pain all over the body, poisoning and those who have drunk alcoholic beverages.
External application of alkalies should not be done in places such as vital spots, veins, tendons, joints, cartilages, sutures, arteries, throat, umblicus, interior of the nails, scrotum, penis, tissues pores or channels, places which have very little musculature and the eyes except in diseases of the eyelids. So also on days which are cold, hot, rainy, cloudy (without sunlight) and breezy. (4)
Kshara nirmana vidhi – How to prepare Kshara
अथ बहिः परिमार्जनस्त्रिविधो मध्यो मृदुस्तीक्ष्णश्च । तस्य पाकविधिः शरदि शुचिरुपोषितः
शुक्लवासाः प्रशस्तेः ऽहनि प्रशस्तदेशजातंमध्यमवयसमनुपहतंमहान्तंकालमुष्ककं सुरापलल सुमनोऽक्षतादिभिश्चतुर्दिशं बलिं कृत्वा प्रदक्षिणं चाभ्यर्त्यैनमधिवासयेत् ।।५ ॥
दैवतेभ्यो नमस्तेभ्योनिवसन्तीहयेश्रिताः । गन्तुमर्हन्त्यसङ्क्रद्धास्त्यक्त्वेमं वासमव्ययम् ।।६।।
भेषजार्थं ग्रहीप्यामि सर्वप्राणभृतामिमम् । वृक्षं न लोभान्न क्रोधाद् ब्राह्मणोर्थे विशेषतः ॥७॥ इति ।
External application is of three kinds – Madhya or moderate (by the use of alkalies of moderate strength), mridu or mild (by the use of alkalies of mild strength and Tikshna or strong (by the use of strong alkalies). ( 5 )
The method of preparing the Kshara ( alkali) is as follows :
During the sarat ritu (autumn), on an auspicious day, the physician having purified himself, abstaining from food and wearing white clothes, should go to a big kalamuskaka tree of middle age, and not damaged, worship it by offering wine, meat, flowers, coloured grains etc. at all its four quarters, going round it in reverence and pray to the gods (spirits) of the tree and others in these words “Oh gods, who are residing in this tree, accept my salutations and the offerings, please depart from this tree without anger, this abode of yours. I am taking this tree, the supporter of all living beings for the purpose of preparing medicine but not with either greed or anger; especially for the use of Brahmana” (and then return home). (6-7)
अथापरेस्तत्र यद्यद्भुतं वैकृतं वा किञ्चिन्नश्येत्ततो युगमात्रमारूढे सवितरि ब्राह्मणान् वार्चयित्वातं पादपं पूर्वाग्रमुत्तराग्रं वा पातयेत् । एवं च पारिभद्रपलाशाश्वकर्णराजवृक्षमहावृक्षवृक्षकेन्द्रवृक्षास्फोतसप्तच्छदनक्तमालतिल्वककदलीविभीतकाश्वमारकपूतीकचित्रकार्ककाकजङ्घापामार्गाग्निमन्थान् वसन्तेसगृहीतांश्च यवान् सशूकनालांश्चतस्त्रश्च कोशातकी: सर्वान् समूलफलपत्रशाखान् खण्डशः कल्पयित्वा नातिशुष्कान् शिलातलस्थान् निवाते पृथक् निचयीकृत्य मुष्ककनिचये च सुधाशर्कराः प्रक्षिप्य तिलकुन्तलैरादीपयेत् । दग्ध्वा च शान्तेऽग्नौ पृथक् सुधाशर्कराभस्म कृत्वेतरत् सर्वक्षारद्रोणमधिकमुष्ककं सलिलपलसहस्रेण गवादिमूत्रपलसहस्त्रेण चालोड्य महता वस्त्रेण परित्रावयेत्। यावदच्छोरक्तस्तीक्ष्णः पिच्छिलश्च जातस्तदा तं क्षारनिष्यन्दं गृहीत्वा भस्म विवर्जयेत् । ततः स्नेहपाकविधिनापाचयेत्। पच्यमाने चतस्मिंस्ताः सुधाभस्मशर्कराः क्षीरबकं शङ्खनाभिं चायसे पात्रेऽग्निवर्णान् कृत्वातत्क्षाराच्छकुड वमात्रे निर्वाप्य तेनैव च सुश्लक्ष्णं पिष्ट्वा प्रतीवापं दद्यात्। ततश्च सुतरां दर्व्यावघट्टयन् विपचेत् यावच्च सबाष्पैर्बुदबुदैः समुत्तिष्ठेत् सान्द्रतया च दर्वीप्रलेपी स्यात्तदैनमवतार्यायोघटे यवराशौसु गुप्तं स्थापयेत् । एष मध्यमः क्षारः ॥ ८ ॥
The next day, when he does not witness any unnatural or inauspicious omen (either in the sky or on his way) should go to the tree, when the sun has risen above two-arms length, worship the brahmanas present and cut the branches of the tree which have spread either to the east or north. Likewise the branches of paribhadra, palasa, aswakarna, raja vrksa, mahavraksa (snuhi) vrksaka, indravrksa asphota, saptachada naktamala tilwaka kadali vibhitaka, aswamaraka putika chitraka arka kakajangha apamarga and agnimantha; the plant of yava (barley) along with its thorny plumage, the roots, fruit, leaves and branches, the four kinds of kosataki all collected during vasanta (spring) should be cut into small bits, slightly dried and made into heaps separately on slabs of stone, at a place devoid of heavy breeze.
Likewise another heap of crystals of limestone should also be made near the heap of logs of muskaka. All the heaps are set on fire by using the dired plants of sesamum. After every heap has been consumed by fire, the ashes are collected separately after they are cooled. Then a mixture of all the ashes is made with the ashes of muskaka being more in quantity and dissolved in one thousand palas (48000 ml) – of water; another one thousand palas of cow’s urine is also added, the mixture is stirred well and filtered through a thick cloth, several times till a clear, red, strong-smelling, slimy, thick liquid is obtained. The ashes remaining over the cloth is thrown away. keeping only the precipitate in the vessel.
It is then kept on an oven and cooked in the process of preparing medicated oil. When cooking is in progress the nicely macerated powder of limestones (well burnt), Ksirabaka (clay) and sankhanabhi (conch shell) all made red hot in an iron pan are mixed with the ash in the proportion of one kudava (192 gms). All these should be cooked, stirred continuously with ladle till it becomes a thick liquid. It is then removed from fire, filled into an iron pot and kept hidden in a heap of barley. This is the method of preparing a Madhyama Kshara (alkalie of medium strength). (8)
मृदौ शर्करादीन्निर्वाप्यापनयेन्न तु पिष्वाक्षिपेत् । तीक्ष्णे तु दन्तीचित्रकलाङ्गलिकापूतीकप्रवालतालपत्रीबिडस्वर्जिकाकनकक्षीरीहिङ्गवचातिविषाः श्लक्ष्णचूर्णीकृता दग्धाश्च शङ्ख शुक्ती: पूर्व वत् प्रतिवापं दद्यात्। तांश्च व्याधिबलतः सप्तरात्रादूर्ध्वं प्रयुञ्जीत । क्षीणबले तु बलाधानार्थं पुनः क्षारजलमावपेत् । तत्रनातितीक्ष्णो नातिमृदुः श्वेतः श्लक्ष्णः शीघ्र पिच्छिलः शिखरी सुखनिर्वाप्यो ऽल्परुगनभिष्यन्दीचेति दश क्षारस्य गुणाः । दशैत च दोषां: तद्यथा । अत्युष्णोऽतिशीतोऽतितीक्ष्णोऽतिमृदुरतितनुरतिघनोऽतिपिच्छिलोविसर्पी हीनौषधो हीन पाकश्चेति ॥९॥ :
For preparing the alkalie of mild strength (mridu) the ash of lime etc., should be put in rough powder form only but not nicely macerated.
For preparing the alkali of strong potency (tiksna), the ashes of danti, chitraka langali, putika pravala (tender sprouts of putika) talapatra bida lavana, swarajika Kshara, kanaka ksiri, hingu, vaca, ativisa, all are powdered nicely, ashes of the conch shell and cowrie shell added to the solution while boiling. This should be used for a period of more than seven days depending upon the strength of the disease for which it is meant. If it is found to have become weak, it should again be dissolved in an alkaline solution.
Kshara gunah good qualities of alkalies
The ten ideal qualities of caustic alkalies are – neither too strong nor too weak, white in colour, soft, quick in action, slimy, form a small peak (heap) if made to fall from a little height, easily dissolving, causing little pain and no exudations.
Kshara dosha – bad qualities of alkalies
The ten bad qualities are very hot or very cold (in potency), very strong or very mild, very thin or very thick, very slimy, not spreading around, prepared with few drugs and cooked inadequately. (9) –
Kshara karma vidhi – procedure of external alkali therapy
तत्रक्षारकर्मण्युपहरेत् पिचुवर्तिशलाकादर्व्यञ्जलिकाघृतमधुशुक्ततुषोदकमस्तुक्षीरोदक – शीतप्रदेहशयनासनादीनि । अथ क्षारार्हस्योपविष्टस्य संविष्टस्य वाप्तपरिचारकगृहीतस्य व्याधिं छित्वावलिख्य प्रच्छाय वा पिचुप्लोतान्यतरावगुण्ठितया शलाकया क्षारं पातयेत् । ततो मात्राशतमुपेक्षेत । वर्त्मरोगे तुनिर्भुज्य वर्त्मनी पिचुना मधूच्छिष्टेन वा कृष्णभागं प्रच्छाद्य पद्मपत्रतनुः क्षारलेपः। घ्राणजेषुत्वर्शोऽर्बुदेष्वादित्याभिमुखस्योन्नमय्य नासिकामुपेक्ष्याश्च पञ्चाशन्मात्राः। तद्वच्छ्रोत्रजेषु | गुदार्शस्सुपाणिनायन्त्रद्वारं पिधाय धारयेन्मात्राशतमेव । ततः प्रमार्जनेन प्रमृज्य क्षारं सम्यग्दग्धमवेक्ष्य निर्वापयेत्सर्पिर्मघुभ्यां शुक्ततुषोदकमस्तुक्षीरादि भिश्च । ततः परं शीतमधुरैः सघृतैः प्रदिह्यात् । अभिष्यन्दीनिभोज्यानि भोज्यानि क्लेदनाय च । स्थिरमूलत्वात्तु यदि क्षारदग्धं न विशीर्यते ततो धान्याम्लबीजमधुयष्टिकायुक्तैस्तिलैरालेपये त्सुवर्णक्षीरीयुतैर्वा त्रिवृद्विडङ्गसारवद्भिर्वा । मालतीवृषाङ्कोलनिम्बास्फोतपटोलीकरवीरपत्रक्वाथेन व्रणप्रक्षालनम् । एषामेव च कल्कक्वाथे सिद्धं सर्पिस्तैलं वा रोपणम्। नागपुष्पमञ्जिष्ठाचन्द नतिलपर्णिकासु वा । यथात्त्याधिदोषं च व्रणमुपक्रमेत् । तिलाः सयष्टि – मधुका रोपणे पूजिताः ॥१०॥
Before commencing the caustic therapy the following materials should be kept ready at hand – cloth, wick, metal rods, laddles, anjalika (a young mouse), ghee, honey, sukta (sour gruel), tusodaka (sour liquid prepared from husks), mastu (whey), water, milk, cold pastes, cots and other furniture etc.
Then the patient eligible to receive caustic therapy should be made to sit or lie (on a cot) and held tight by loyal attendants. The diseased part (on which he alkali is to be applied) should be punctured, scratched or cut by a knife, and the alkali applied to the spot with a metal rod whose tip is wrapped with piece of cloth, pad of wool or any other covering. After the application, a period of one hundred matras (time required to pronounce a vowel is one matra and a hundred matras will be about 20 seconds).
In diseases of the eyelids, they should be held everted, the cornea should be covered with either a piece of cloth or with beeswax and the alkali applied in thin layer as thin as a lotus petal.
In nasal polyps, malignant tumors, the patient is made to sit facing the sun, the nostrils everted and alkali applied and allowed for a duration of fifty matras. Similar is the procedure in polyps of the ears.
In haemorrhoids, the rectal orifice and surrounding parts should be covered with the rectal speculam held in the hand, alkali applied on the pile mass and allowed for a duration of one hundred matras.
After the stipulated time, the alkali is removed by a brush, the site inspected for signs of proper burning and then smeared with ghee and honey or sour liquid prepared from grains, husks; whey, milk etc. After some time the area should be covered with a paste of drugs which are cold in potency and sweet (in taste) mixed with ghee. He should be given foods and other therapies which promote secretions and moistening of the body.
If the pile mass does not shrink or fall off due to being deep seated then it should be given a covering with the paste made from the precipitate of rice-gruel, powder of madhuyasthi mixed with sesame oil, or with the milky sap of suvarnaksiri or powder of trivrit mixed with decoction of vidanga. The wound is then to be washed with a decoction of malati, vrsa, ankola, nimba, asphota, patola and leaves of karavira. The medicated oil prepared with the paste or decoction above drugs, should be applied for healing of the wound or oil prepared with nagapuspa, manjista, candana and tila parnika. The wound is to be treated depending upon the disease and the doshas involved. Tila and yastimadhuka together are ideal for the healing of wound. (10)
Trividha dagdha – three kinds of burns
तोदकण्डूजाड्यादिभिश्चदुर्दग्धम् तत्र पक्वजाम्बवसङ्काशमवसन्नमीषद्यथास्वविकारोपशान्तौ च सम्यग्दग्धं भवति । तद्विपर्ययेण । तत्र पुनः पातयेत् । ऊषादाहरागशोफज्वरपाकविसर्पशिरो रोगवातपित्तकोपैरतिग्धम् । अपि च । नेत्रेऽतियोगाद्वर्त्मनिर्भेदेनेन्द्रियभ्रंशः । घ्राणे नासावंशतरुणास्थिदरणंसङ्कोचो गन्धाज्ञानं च । तद्वच्छोत्रादिष्वपि च यथास्वं व्यापत् । गुदे विण्मूत्ररोधोऽतीसारः पुंस्त्वोपघातोगुदविदरणाच्च मृत्युर्वा सर्वदा वा शोफतोदवेदना स्त्रावा: । शकृन्मूत्रवातविधारणाशक्तिर्वा । तमतिप्रवृत्रमाशु पूर्वोक्तैरेव निर्वापणैः पुनःपुनर्नि र्वापयेत् । अतश्च दाह्यमतिप्रमाणं न सकृदेवं दहेदिति । भवति चात्र ॥ ११ ॥
The site of application of the caustic alkalies assuming the colour of ripe fruit of Jambu, slightly depressed in the centre, the symptoms of itself (burn by caustic alkali) and of the original disease subsiding – are the features of Samyak dagdha (burns caused by properly applied caustic alkali); symptoms opposite to the above, developing pricking pain, itching, and lassitude are the features of Durdagdha (inadequate therapy). In such a case the alkali should be applied again.
Appearance of local burning sensation, redness and swelling, fever, ulceration, erysepelas, diseases of the head due to increase of vata and pitta are the features of Atidagdha (excess therapy).
Further, in case of eyelids, disruption of sensory function of the eye due to puncture in the lids; in case of the nose, destruction of the nasal cartilage, constriction of the passage and loss of sense of smell; likewise in the ears; in case of the rectum, obstruction of urine and faeces, diarrhoea, loss of sexual vigour (impotence), fissures in the rectum, or death; or presence of swelling, pricking pain and exudation continuously always, loss of capacity to withhold the urges of faeces, urine and flatus are all produced by excessive alkali therapy. These, conditions are to be treated quickly by repeated washing and application of soothing oils etc. as described earlier. Another application of alkali should not be done soon even if necessary. (11)
Some verses more:
अम्लो हि शीतः स्पर्शेन क्षारस्तेनोपसंहितः । यात्याशु स्वादुतां तस्मादम्लैर्निर्वापयेत्तराम् ॥ १२ ॥
The effects of the caustic alkalies become mitigated (nullified) by contact with cold and sour substances because it (alkali) becomes sweet. So the place on which alkali has been applied should be smeared with sour substances. (12)
ज्वरातिसारतृण्मोहमूर्छाहद्वेदनार्तिभिः । कक्षं दहत्यग्निरिव शरीरं क्षारविभ्रमः ॥१३॥ पाययेतातियोगेऽतस्तं शीघ्रं सघृतं दधि | सगुडं वा दधिसरं तैलं वा ससितोपलम् ॥१४॥ धात्री फलकपित्थाम्लदाडिमस्वरसे घृतम् । द्विगुणे साधितं पानसेकैः क्षारातिरुग्धरम् ॥ १५ ॥ दाडिमामलकाम्रातकपित्थकरमर्दकान् । आम्राच्च मातुलुङ्गाच्च रसं मृद्वग्निना पचेत् ॥ १६ ॥
ततोऽतिवृत्तक्षाराय दद्यान्मात्रां यथाबलम् । क्षारो निवर्तते तेन प्रसादं त्वक् च गच्छति ॥१७॥
Excess of alkali therapy will produce fever, diarrhoea, thirst, delusion, fainting, pain in the heart and elsewhere and burns the body just like fire in the hearth. Hence such a patient should be given ghee, curds, whey mixed with mollasses or oil mixed with sugar or juice of fruits of dhatri, kapittha with ghee; the juice with twice its quantity of ghee is ideal as a drink and as on external application to relieve the pain of excess alkali therapy.
The juice of fruits of dadima, amalaka, amrata, kapittha, karamardaka, amra and matulunga should be cooked on mild fire and given as a drink to those who had excess alkali therapy, according to their strength. By this, all the effects of the alkali will be removed and the skin regains its complexion. In case of excess of bleeding, the patient should be given cold treatment both external and internal.
॥ इति एकोनचत्वारिंशोऽध्यायः ॥
Thus ends the Ashtanga Sangraha Sutrasthana 39th chapter.
