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Ashtanga samgrahaARSAS CHIKITSAM - Treatment of Haemorrhoids / Piles - Ashtanga Samgraha Chikitsasthana...

ARSAS CHIKITSAM – Treatment of Haemorrhoids / Piles – Ashtanga Samgraha Chikitsasthana Chapter 10

अथातोऽर्शस चिकित्सितं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयोः महर्षयः ॥१॥ We will now expound Arsas chikitsa – treatment of haemorrhoids (piles); thus said Atreya and other great sages. (1)

Kshara – Agni karma in Arsa – cauterisation in haemorrhoids

अथ खलु बलवन्तमर्शोभिरुपद्रुतं यथार्हस्त्रेहोपस्निग्धस्विन्नमनिलवेदना वृद्धिशमनार्थं स्निग्धमुष्णमल्पमन्नं द्रवप्रायं भुक्तवन्तं शुचिं कृतस्वस्त्यनं मुक्तविण्मूत्रमव्यथं समे शुचौ विविक्ते देशे साधारणे व्यभ्रे काले शय्यायां समे फलके वा प्रत्यादित्यगुदमन्यस्योत्सङ्गे निषण्णपूर्वकायं उत्तानमुन्नतकटीदेशं यन्त्रणशाटकेन परिक्षिप्तग्रीवासक्थिसन्धिमलज्जार्हैराप्तपरिचारकै: सुपरिगृहीतं कृत्वा ततोऽस्मै घृताभ्यक्तगुदाय घृताभ्यक्तं यन्त्रमृज्वनुसुखं शनैः पायौ प्रणिदध्यात् । प्रवाहणप्रविष्टं चार्शोऽभिवीक्ष्यपिचुप्लोतकयोरन्यतरेणावगुण्ठितया शलाकयोत्पीड्य यथोक्तविधिनाग्निक्षाराभ्यामुपाचरेत् सम्यड्निर्वा पयेच्च ॥ २ ॥

The person who is suffering from piles, if strong, and fit for oleation, should be administered oleation and sudation therapies to prevent aggravation of anila (vata) and relief of pain; then given little quantity of liquid food which is unctous, and warm, kept clean, told to offer obesiances, eliminate faeces and urine and keep free from worry. Next he should be made to lie, on a bed or a broad and even wooden plank, placed in a secluded place, on a non-cloudy sunlight day; his rectum facing towards the sun, his upper body lowered, waist and hip raised, neck, thighs and joints of thighs ( knee) fastened by a band of cloth (rope like); buttock raised and kept firm by tight binding; he then held in that position by trusted attendants who are free from shyness and dislike; then the rectum is smeared with ghee so also the anal speculum, which should be introduced straight, slowly with its mouth facing outward; then asking the patient to bear down, taking a good look of the pile mass, raise it up by rubbing with a metal probe which is covered at its tip either with threads, pieces of cloth or such others (soft materials), it should then be burnt (cauterised) either by fire (by a red hot metal rod) or touched by caustic alkali following the procedure ( described in chapter 39 and 40 of sutrasthana), and then treated with palliatives; fats applied cold when burnt by fire and sours applied cold when touched by alkali. (2)

महान्ति प्राणवतश्छित्वा दहेत् । छत्राकाराण्यूर्ध्वविसृतानि क्षारसूत्रेण बध्वा ॥३॥

Those (pile masses) which are big in size, present in strong persons should be cut and then burnt; those which resembles an umbrella and found situated upward should be tied with a alkali thread (thread prepared by dipping it in solution of alkalies) and then burnt. (3)

ततो यन्त्रमपनीयोत्थाप्यातुरं स्वभ्यक्तगुदजघनवङ्क्षणं यथाकालमुष्णोदककोष्ठेऽवगाहयेत् ।

ततो निवातमगारं प्रवेश्याचारिकमुपदिशेत् ॥४॥

Then after, the speculum is removed, patient is raised, his rectum, pelvis and groins anoninted with oil and made to sit in a tub of warm water for some time. After that he should retire to an apartment devoid of breeze and provided with (warm) comforts as usual. (4)

सावशेषं पुनर्दाहयेत् । एवं सप्तरात्रात्सप्तरात्रादेकैकमुपक्रमेत् । बहुषु तु प्रादक्षिणं ततो वामं वामात् पृष्ठाग्रजम् ।

एकाहात्तु सर्वाणि दहतोऽतियोगोक्तो दोषः । तत्र शुष्काण्यग्निना क्षारेण वा साधयेत् । क्षारेणैव मृदुनार्द्राणि ।

एष सर्वप्रदेशेष्वर्शसां दहनविकल्पः । तृतीये तु गुदवलौ प्रत्याख्यायोपत्तरेन्न वेत्येके ॥५॥

If remnants (of pile masses) remain over, they should be burnt again.

In this way, they should be treated one after the other, week after week; in case of many (pile masses) being present, those situated on the right side should be treated first, next those on the left and lastly which are at the end of the back (top); cauterising all of them in one day itself will give rise to symptoms of over-burning. Those which are dry (non-exudative, non-bleeding) can be treated either with burning or by caustic alkali and those which are soft and wet (exudative, bleeding) only by alkali, this is the classification of treatment of burning of piles situated in all the places. those which are found in the third fold (innermost) should be treated as incurable or rejectable; some say it should not be treated at all. (5)

अथ सम्यग्दग्धे वातानुलोम्यमन्नाभिरुचिरने र्दीप्सिर्लाघवमिन्द्रियप्रसादो यथोक्तोपद्रवनिवृत्तिर्बलवर्णोपपत्तिश्च ।

असम्यग्दाहे तु क्षाराग्निकर्मणोर्विधिमीक्षेत् ॥ ६ ॥

If the burning has been done properly the patient will have easy downward movement (of flatus, faeces, urine etc ), desire for food, keen digestion, feeling of lightness of the body, clarity of the senses, relief of all the secondary diseases, and improvement of strength and colour; symptoms of improper burning should be noticed as described in chapter on fire and alkali therapies (chapter 39 and 40 of sutrasthana). ( 6 )

बस्तिवेदनायां कुष्ठशतपुष्पादेवदारुसुरभिपुनर्नवागरुकल्केन नाभेरधः सर्वमालिम्पेत् ।

मूत्रपुरीषप्रतीघाते वरणालम्बुसैरण्डपुनर्नवाश्वदंष्ट्रासुरभीसुषवीकषायं सुखोष्णं

स्वभ्यक्तपृष्ठकटीवङ्क्षणगुदस्य परिषेकेऽवगाहे वा योजयेत् । क्षीरं सस्त्रेहं तैलमेव वा ।

दग्धेषु चार्श:सु शकृच्छैथिल्यार्थंत्रिवृद्वास्तुकोपोदकाचुञ्ञ्जुपर्णीशाकयुक्तमन्नमश्रीयात् ॥७॥

If there is pain in the (region of) urinary bladder, paste of kusta, satapushpa, devadaru, surabhi, punarnava and aguru should be applied (on the abdomen) below the umbilicus; if there is obstruction for elimination of urine and faeces, then the back, waist, groins and rectum of the patient should be anointed with oil, slightly massaged and bathed with warm decoction of varana, alambusa, eranda, punarnava, svadamstra, surabhi and susaivi or he may be made to sit in the tub containing this decoction, or bathed with milk mixed with fats or with only oil.

After cauterisation is completed, the patient should eat boiled rice processed with leaves of trivrit, vastuka, upodaka and cancuparni so as to loosen (liquify) the faeces. (7)

अनिलानलरक्षणोत्तेजनार्थं देहपुष्टये च स्नेहादीन् सम्यगासेवेत् ।

संशोधना: प्रलेपाद्याः कषायास्तैलयुक्तयः । व्रणाधिकारमालोच्य योक्तव्या हतनामसु ॥८॥

For protecting the anila (vata), anala (digestive activity) and nourishment of the body, snehana (oleation) and others (therapies) should be administered. Purificatory therapies, external applications, decoctions and other recipes, medicated oils, etc, should be resorted to in the treatment of piles also, after perusing these in the chapter on treatment of vrana (vide chapter 30 of uttarasthana). (8)

Lepa Yoga

अथानवचारणीयशस्त्रक्षाराग्नेर्वातकफोल्बणानि दोषसम्पूर्णत्वान्निर्गतानि सस्तम्भकण्डूशोफशूलानि क्षारचित्रककुष्ठबिल्वमूलकसिद्धेन तैलेन वा कृष्णाहिबिडालौष्ट्रजलौकः सूकरवसाभिर्वाभ्यज्य । पिण्डेन स्वेदयेद्रवस्वेदेन वा । धूपयेच्च सघृतशमीपत्रार्कमूलमानुषकेशाहिनिर्मोकबिडालचर्मभिः । कुञ्जरवराहवृषशकृत्सक्तुसर्जरसैर्वा । सुरसाबृहतीपिप्पल्यश्वगन्धाभिर्वा सघृताभिः । अरिष्टशिग्रुपत्रकुलत्थवचाभिर्वा । प्रदिह्याच्च स्रुहीक्षीरयुक्तेन हरिद्राचूर्णेन । गोमूत्रपिष्टैर्वा कुक्कुटशकृन्निशापिप्पलीगुञ्जामूलैः । गोपित्तपिष्टाभिर्वा दन्तीचित्रकसुवर्चिकाभिः । सुधाक्षीरपिष्टैर्वा गुडकृष्णासैन्धवकुष्ठशिरीषबीजैः । तद्वच्च गजास्थितुत्थभल्लातकलाङ्गलीकुलीरशृङ्गीवचाभयाहिंगुकुष्टबिल्वशिग्रुमूलकबीजनिम्बाश्वमारपत्रपीलुमूलैः बस्तमूत्रपिष्टैर्वा सुधाकाण्डार्कक्षीरतुम्बप्रसवकरजैः । पिप्पल्यादिभिर्वानुवासनद्रव्यैः । एभिर्हिप्रदिग्धान्यशसि दुष्टमसृक्सञ्चितं पिच्छां च विमुच्य प्रशाम्यन्ति । एभिश्चतैलान्यभ्यङ्गार्थमुपकल्पयेत् ॥९॥

Next, those (pile masses) which are unfit for surgery, alkali application or burning, which have predominance of vata and kapha, which are protruding out being filled with doshas, having stiffness, itching, swelling and pain, should be anointed with oil processed with kshara (yavakshara), chitraka, kustha, bilva and mulaka, with the fat of black serpent, cat, camel, leech or pig and then given fomentation either by pinda sveda (heated balls of herbs) or drava sveda (warm liquid) methods; next, they should be fumigated with smoke of drugs such as leaves of sami, root of arka, human hair, snake peel or skin of cat, each smeared with ghee; or with excreta of elephant, boar or bull, cornflour and sarjarasa; or with surasa, brihati, pippali and ashwagandha mixed with ghee or with arista, sigrupatra, kulattha and vacha. They should be applied with paste made with powder of haridra and mixed with milky sap of snuhi; or excreta of cock, nisa, pippali and root of gunja macerated with cow urine; or of danti, chitraka and suvarcika (yavakshara) macerated with guda (jaggery); krsna, saindhava, kustha and seeds of sirisa macerated with milky sap of sudha; or of bone of elephant, tuttha, bhallataka, langali, kulirasringi, vacha, abhaya, hingu, kustha, bilva, sigru, seeds of mulaka, leaves of nimba and asvamara and root of pilu – all made into a paste with goats urine; or of the stem of sudha, milky sap of arka, juice of tumbi and karanja; or of pippali along with drugs prescribed for oil enema. The pile masses applied with these pastes, become free of the accumilated blood and slimy exudations and subside. Afterwards, the following oils should be made use of for anointing them. (9)

Kshara taila

तथा कासीससैन्धवालपिप्पलीकुष्ठशुण्ठीविडङ्गविदारीलाङ्गलीकरवीराईकस्वर्णक्षीरदन्ती – चित्रकालर्क सुधापयोभिस्तैलं चतुर्गुणमूत्रविपक्कमप्रदूषयत् गुदमभ्यङ्गात् क्षारवदर्शासि शातयति। तैलाभ्यक्तं वा पायुप्रदेशं पक्केष्टकाशकलैस्तीक्ष्णकोटिभिरग्निवर्णैर्महिषीमूत्रनिर्वापितैर्निष्पीडयन् द्विकालं सप्तदिनानि स्वेदयेत् । अनन्तरं च यथोक्तेनावगाहनेन । ततो गते सप्तरात्रे पूतीकरञ्जप लवकल्केन ससैन्धवेन स्नुहीर्पयसा वर्तिं कृत्वा नातिशुष्कां गुदे विदध्यात्। कृतविण्मूत्रं चावगाहे स्थापयेत् । प्रातः सायं चैष विधिः प्रत्यहमेकान्तरं वा यावत्त्रिरात्रम् । ततो देवदालीक्षारहरीतकीः शीलयेत् । एवमर्शांसि शीर्यन्ते ॥१०॥

Medicated oil prepared from kasisa, saindhava, ala, pippali kusta, sunthi, vidanga, vidari, langali, karavira, ardraka, svarnaksiri, danti, chitraka, alarka and milky sap of sudha, along with taila (oil) and four parts of cows urine. Anointed to the piles in the rectum, it makes them fall off as happens when caustic alkali is applied.

After anointing the rectum with oil it should be fomented with a bolus of innumerable small pieces of brick, made red hot and cooled by sprinkling buffalos urine over them; such fomentation being given twice a day for seven days; after fomentation, he should take a tub-bath as explained earlier. After seven days, a gudavarti (rectal suppository) prepared from a paste of tender sprouts of putikaranja mixed with saindhava and milky sap of snuhi, and not very dry should be inserted into the rectum; after the elimination of faeces and urine he should be made to sit in a bath-tub. This procedure is done both in the morning and evening daily or on alternate days for three days, later he should resort to devadalikshara (alkali prepared from devadali) and haritaki. By these methods pile masses shrink/fall off. (10)

अथ हरीतकीपाकविधिः । सजालमूलं जीमूतकमन्तधूंमं दहेत् तस्यभस्मनोर्द्धाढकं गोमूत्रपात्रद्वयेनैकविंशतिकृत्वो गालयेत् । ततस्तेन क्षारमूत्रेण कुटजचित्रकव्याधिघातचूर्णप्रसृतत्रयान्वितेन पथ्याशतद्वयमाघनीभावात् पचेत् । अवतीर्णं च तमवलेहं व्योषरजःप्रसृतयुक्तं घृतभाविते भाजने निदध्यात् । स लेहः सावलेहविजयाद्वयोपयोगमभ्यस्यमानो गुदजजठरजघनवङ्क्षणशूलगरानाहगुल्म- पाण्डुरोगाश्मरीशर्कराश्वासकासान् नियच्छति । सदा च पत्रभङ्गोदकेन कोष्णेनाम्बुना वा शौचमाचरेत् । अप्रवर्तमानं च रुधिरमुच्छूनकठिनेष्वर्शः सु जलौकाभिः सूचीकूर्चेन वा प्रवर्तयेत् ॥ ११ ॥

Now, the method of cooking haritaki;- Jimutaka along with its creeper and root (the entire plant) should be converted into ash, in the closed method; this ash is mixed with half adhaka of cow’s urine, and poured from one pot into another for twentyone times. To this solution are added three prasrta of powder of kutaja, chitraka and vyadhighata, each one prasrta and powder of pathya – two hundred (by number) and cooked on fire till the mass becomes solid. After taking it out from the pot it is mixed with one prasrta of powder of vyosa and transferred into another pot, smeared inside with ghee. This confection, consumed habitually in doses of (size of) two vijaya (haritaki) per day, cures piles, pain of the rectum, abdomen, pelvis, and groins, artificial poisons, flatulance, abdominal tumors, anaemia, urinary calculi and gravel, dyspnoea and cough.

The patient should use water boiled with bits of leaves or warm water for washing and ablutions.

If blood does not come out from pile masses which are swollen and hard, it should be drained out either with the help of leeches or by using sucikuraca (brush with sharp pins ) ( 11 )

Takra pana – Recipes of buttermilk

अग्निसादे गुदशोफशूलार्तौ च हिङ्ग्ग्वर्धकर्षं सौवर्चलयवक्षारेन्द्रयवपिप्पलीनां पृथक् क मूर्वार्धपलं पाठापलं शुण्ठीद्विपलं चैकत्र चूर्णितमुष्णाम्बुसर्पिर्मद्याद्यैरुपयोज्यम् । त्रिलवणादिचूर्णं वा । हिङ्ग्वतिविषाकुष्ठस्वर्जिकाक्षारबिडलवणानि वा द्विगुणोत्तराणि प्रयोजयेत् । प्राणदां वा तक्रानुपानां सगुडाम् । प्रातः प्राग्भक्तं वा निरन्नो वा तक्रमहरहस्तस्मिन् जीर्णे तक्रे सायं तक्रपेयां ससैन्धवां पिबेत् । तक्रेणैव वा लाजसक्तूनवलिह्यात् । पीलूनि वा तक्रानुपानानि प्रातः पक्षं पक्षार्धं वा प्रयोजयेत् । कटुकिकामूलकल्कं वा प्रातस्तक्रेण ॥१२॥

If there is weakness of digestion, swelling and pain in the rectum, then a powder prepared with half karsa of hingu, one karsa each of sauvarchala, yavakshara, indrayava and pippali, half pala of murva, one pala of patha and two pala of sunthi, should be used along with warm water, ghee or wine.

Or Trilavanadi curna (described in the treatment of gulma) may be used; powder of hingu, ativisa, kustha, sarjika kshara and bida lavana in double the usual dose; or powder of pranada (haritaki) and guda (jaggery) followed by drink of takra (buttermilk).

He should drink buttermilk every day in the morning, before food, or only buttermilk without any solid food. After its digestion, in the evening he should drink peya (thin gruel) mixed with buttermilk and saindhava or lick a thick paste of laja flour along with buttermilk or (powder of) pilu followed with a drink of buttermilk every morning for one fortnight or half of it; or paste of root of katukika (katukarohini) with buttermilk in the morning a( for a fortnight or half of it). (12)

शुण्ठीचित्रकपुनर्नवाक्काथसिद्धं वा क्षीरम् | गोमूत्रपरिस्रुते वा बहुकृत्वो जीमूतकक्षार उषिता हरीतकी: । गोमूत्रार्धद्रोणसिद्धं वा क्षौद्रवदभयाशतम्। वासिष्ठहरीतकीर्वा । भल्लातकानि वा रसायनोपदेशेन पुनर्नवामलंबुसां वा शोफोक्तविधिना गुडार्द्रकं वा ॥१३॥

He may drink milk processed with decoction of sunthi, chitraka and punarnava; or eat haritaki made soft by soaking it in the solution of jimutaka kshara (ash obtained from jimutaka plant) and cows urine, mixed well many times; or eat the confection prepared by boiling one hundred abhaya in half drona of cows urine and mixed with honey; or eat Vasistha haritaki (lehya described in treatment of kasa) or bhallataka in the manner of rasayana therapy; or punarnava and alambusa in the same way; or gudardraka as described in the treatment of sopha. (13)

सक्तुमन्थं वा भल्लातकचूर्णयुक्तं नातिलवणं तक्रेण तक्रेण वाऽऽषाढकार्तिकमार्गशीर्षाणां मासानामन्यतमस्मिन् पुष्ययोगे समुद्धृतं चित्रकमथवा मस्तुयूषक्षीरघृततैलाद्यन्यतमेन ॥१४॥

Eat mantha (thin paste) of saktu (corn flour) mixed with powder of bhallataka, without much of salt and with buttermilk.

Or consume paste of chitraka which has been collected either in asadha, kartika or margasirsa months or during the constellation of pusya in any other months, mixed with either takra (buttermilk), mastu (whey), yusa (soup) milk, ghee, oil or any other liquid. (14)

चित्रकमूलक्काथं वा लेहतां गतं समधुगुडं तक्राशी शीलयेत् । कलशे वान्तश्चित्रकमूलत्वक्कल्कलिप्तशुष्के जातं दधि कालशेयं वा पानभोजनेषु । एवं भाङ्ग्र्यास्फोतगुडूचीपञ्चकोलेषु तक्रकल्पः ॥१५॥

Or the confection prepared with the decoction of chitraka, made thick, mixed with honey and jaggery can be eaten followed by a drink of buttermilk; paste of bark of citramula is smeared to the inside of a mud pot and allowed to dry, milk is poured into the pot and converted into curds, this should be used either as a drink or along with food.

In this manner, recipes of buttermilk can be prepared with bharigi, asphota, guduchi or panchakola and made use of. (15)

घृतघटे वा हपुषोपकुञ्चिकाधानकाजमोदाजाजीशठीकारवीयवानीचित्रकपिप्पलीद्वयपिप्पलीमूलचूर्णासुतं जातं तक्रम् । तक्रमेव वातिमन्दवह्निः सप्ताहमर्धमासं वा मासमपि वा कालाद्यपेक्षया रूक्षं सस्नेहमम्लमनम्लं वा सान्नमनन्नं वा शीलयेत् ॥१६॥

Buttermilk is poured into a pot smeared inside with ghee and added with the powder of hapusa, upakunchika, dhinyaka, ajamoda, ajaji, sathi karavi, yavani, chitraka, the two pippali and pippalimula and allowed to ferment; this buttermilk may also be used.

Or persons who have very weak digestive capacity may drink plain buttermilk only, both times of the day for seven days, half a month or one mouth; or it may be mixed with little quantity of oil and sours, or without sours, either along with food (rice) or even without food. (16)

ततस्तक्रसिद्धानि क्रमशोऽर्शोघ्नलघुदीपनीयद्रव्यधान्यपिशितशाकोपकल्पितानि पेयायूषरसव्यञ्जनानि। तक्रं हि परमौषधमनिलकफार्तीनां विशेषाज्जठराश्रितानाम्। तत्रापि विशेषेण दुर्नाम्नाम् । न हि तद्विहतान्यशसि पुनः प्ररोहन्ति । भूमावपि तन्निषिच्यमानमहरहः समूलमुच्छिनत्ति तृणजालमप्स्वपि च शैवालम्। तद्विशोधितेषु पुनर्देहस्रोतः सूपचीयमानोऽन्नरसः पुष्टिबलवर्णीजसामाशु वृद्धये सम्पद्यते ॥१७॥

Peya(thin gruel) yusa (soup), meat juice or condiments prepared from drugs, grains, meat and vegetables, which possess properties of curing piles, easily digestable and augment digestion, processed in buttermilk should be made use of. Takra (buttermilk) is the best medicine for those suffering from diseases of anila (vata) and kapha origin, especially confined to the abdomen, especially so for piles among them. Piles which are once cured by it (buttermilk) do not develop again; even the grass on the ground and algae in water will get destroyed by their roots if their seats are bathed with buttermilk everday. The channels of the body which are purified by it (buttermilk) make for increase of (production) the essence of food, provides nourishment to the body and improves nutrition, strength, colour and ojas (essence) quickly. ( 17 )

मद्यपश्च सेवेत चव्यचित्रकाजाजीचूर्णानुविद्धं शीधुं गौडं वा । सौवर्चलहपुषान्वितां वा सुराम् ॥१८॥

Those who are addicted to wine, should drink sidhu or gouda (fermented beverages) mixed with powder of chavya, chitraka, ajaji or drink sura (beer) mixed with sauvarchala and hapusa ( 18 )


अभयापलाष्टकं द्विगुणामलकमिन्द्रवारुणीपलपञ्चकं च द्विगुणकपित्थमध्यं लोध्रविडङ्गैलवालुकपिप्पलीमरिचानि द्विपलांशानि जर्जरितान्युदकभारे विपाच्य पादशेषं रसं पूतशीतं गुडतुलाद्वयेन धातकीपलाष्टकेन संयोज्य घृतभाजनेऽर्धमासस्थं प्रातरन्नकाले वोपयुञ्जीत | अयमभयारिष्टोऽर्शोग्रहणीपाण्डुहृद्रोगकामलायक्ष्मविषमज्वरप्लीहगुल्मोदरश्वयथुकुष्ठकृमिग्रन्थ्यर्बुदघ्नोऽग्रिरुचिवर्णकरश्च ॥ १९॥

Eight pala of abhaya, twice that quantity of amalaka, five pala of indravaruni, twice that quantity of marrow of kapittha (fruit) and two pala each of lodhra, vidanga, elavaluka, pippali and maricha are powdered, boiled in one bhara of water and decoction reduced to one-fourth the quantity; after it cools, it is mixed with two tula of guda (jaggery) and eight pala of dhataki (flowers), filled into a pot smeared inside with ghee, its mouth sealed and kept undisturbed for half-a-month; afterwards, it is used in the mornings daily. This recipe known as Abhayarista cures piles, duodenal disease, anaemia, heart disease, jaundice, tuberculosis, intermittant fevers, diseases of spleen, abdominal tumor, enlargement of abdomen, dropsy, leprosy, worms, tumors and cancer, improves digestion, taste and colour (complexion). (19)


दन्तीचित्रकत्रिफलादशमूलानि पालिकान्युदकद्रोणे साधयित्वा पादशेषे पूतशीते तस्मिन् गुडतुलार्धं धातकीकुडवं च प्रक्षिप्य घृतभाजने मासमुषितो दन्त्यरिष्टः समानः पूर्वेण दुरालभायाः प्रस्थमभयामलकवृषपाठाचित्रकदन्तीमहौषधीनां प्रत्येकं द्विपलमम्भसां द्रोणे पूर्ववत् सिद्धं पूतशीतं शर्करातुलयोन्मिश्रं मधुघृतप्रियङ्गपिप्पलीचविकाकल्कलिप्ते-घृतकुम्भे पक्षं निधापयेत् । अयं दुरालभारिष्टः समानः पूर्वेण ॥ २० ॥

One pala each of danti, chitraka, triphala and dashamoola are boiled in one drona of water, decoction reduced to one-fourth and cooled; to this are added half a tula of jaggery and one kudava of dhataki (flowers), filled into a pot smeared inside with ghee and kept for one month; this recipe known as Dantryarista is similar in properties as the previous one.


One prastha of duralabha, two pala each of abhaya, amalaka, vrsa, patha, chitraka, danti and mahausadhi are boiled in one drona of water, decoction reduced to one-fourth, cooled and added with one tula of sugar, poured into a pot coated inside with a paste of honey, ghee, priyangu, pippali and cavika and kept undistrubed for a fortnight. This recipe Duralabharista is similar to the earlier, in properties. ( 20 )


नवामलकपलशतं पिप्पलीनागपुष्पकुडवद्वयं पालिकानि चव्यचित्रकक्रमुकलोध्रपाठामरिचविडङ्गमञ्जिष्ठैलवालुकपिप्पलीमूलान्यर्धपलांशिकानि दार्वीशताहेन्द्राह्रासारिवाद्वयमुस्तकुष्ठान्यैकध्यं च जल द्रोणद्वयेऽर्धावशेषं साधयेत् । स रसः पूतशीतः समद्राक्षास्वरस: सितापलशतद्वयेन क्षौद्रार्धप्रस्थेन पृथक् कार्षिकेण च त्वगेलालोध्रकुटन्नटाम्बुसेव्यक्रमुककेसरचूर्णन युक्तो गुडशर्कराधूपिते घृतभाण्डे प्रक्षिप्य पक्षमुपेक्षितोऽयमामलकारिष्टः समानः पूर्वेण | अकालवलीपलितखलतिशमनश्च ॥ २१ ॥

One hundered pala of fresh amalaka, two kudava each of pippali and nagapushpa, one pala each of chavya, chitraka, kramuka, lodhra, patha and maricha, vidanga, manjistha, elavaluka and pippalimula, half pala each of darvi, satahva, indrahva the two sariva, musta and kustha – are all cooked in two drona of water and decoction reduced to half. After it cools, it is mixed with equal quantity of juice of draksa, two hundred pala of sugar, half prastha of honey and powder of one karsa each of twak, ela, lodhra, kutannata, ambu, sevya, kramuka and kesara, filled into a pot smeared inside with ghee and fumigated with the smoke of jaggery and sugar and kept undisturbed for a fortnight. This recipe Amalakarista, is similar in properties as the earlier and also cures premature wrinkles of the skin, grey hairs and baldness. (21)


गुग्गुलुपलचतुष्टयमामलकप्रस्थं धातकीप्रस्थमभयाशतमक्षशतञ्च गुडपलशतद्वयं पालिकानि पञ्चकोलाजमोदचतुर्जातककट्फलमुस्तमरिचानि दशपलिकानि च खण्डद्राक्षादाडिमानि सर्वमैकध्यमम्भसाप्लाव्यालोड्य च पुराणे जतुसृते द्रोणक्षमे भाजने निक्षिप्य स्थापयेत् । गन्धवर्णरसोपपत्रं चासवमभिसमीक्ष्य तं कुम्भमिक्षुरसस्य पूरयेत् । एष षण्मासस्थितो गुग्गुल्वासवः समान: पूर्वेण ॥२२॥

Four pala of guggulu, one prastha of amalaka, one; prastha of dhataki, one hundered number of each of abhaya and aksa, two hundred pala of guda (jaggery), one pala each of panchakola, ajamoda, caturjataka, katphala, musta and maricha, ten pala each of khanda, draksa and dadima all are made into a paste, mixed well with water and poured into a old non-leaking, jatusruta (glazed) earthen pot of one drona capacity and kept undisturbed for some days; when fermented and attains good smell, colour and taste, the same pot is filled with juice of sugarcane to its full capacity (one drona) sealed and kept again for six months more. This recipe Guggulvasava is similar in action as the earlier. ( 22 )

अमद्यपो वा पिबेच्च श्रुतशीतमल्पमुदकं शृतं धान्यनागराभ्याम् । लघुना पञ्चमूलेन वा । पञ्चकोलकाजाजीकारवीगजशौण्डीबिल्वशलाटुपाठा तुम्बुरुधान्यकैर्वा ॥२३॥

He who is not habituated to liquors, should drink little quantitites of water boiled with dhanya and nagara and then cooled; boiled with drugs of laghu panchamula or with panchakola, ajaji, karavi, gajasaundi (gajapippali), bilva salatu ( tender fruit of bilva), patha, tumburu and dhanyaka. ( 23 )

एभिश्च फलाम्लान् यमकस्निग्धान् पेयायूषरसादीन् कुर्यात् । एभिरेव घृतं साधयेत् । पिबेद्वा मस्तु धान्याम्लं मधुशुक्तोदकं वा ॥ २४ ॥

In the same way peya (thin gruel), yusa (soup) rasa (meat soup) and others processed with sour fruits and yamaka (two fats-ghee and oil) should be used as drink. Similarly ghee also can be processed and used. He can drink even mastu (whey) dhanyamla (fermented gruel) or water of madhusukta (fermented liquor prepared from honey). (24)

Karanja sukta

पूतीकरञ्जत्वक्पलशतद्वयं शुष्कमुदकद्रोणे क्वाथयेत् । पादशेषे च तस्मिन् पूतशीते गुडपलान्यशीतिं व्योषार्धप्रस्थचूर्णं च दत्वा यवपल्ले घृतकुम्भस्थं मासं निधापयेत् । एतत् करञ्जशुक्तमभ्यस्यमानमलमनलजननमर्शोगुल्मानाहप्लीहगरोदरघ्नं च । पीलुतुलां तुल्यगुडां मस्तुनस्तक्रस्य वा द्रोणेऽभिषुणुयात् । तत्र पालिकानामभयातिविषापाठामुस्तकटुकादेवदारुहिंस्राजीरकारुष्करचव्याजमोदैलाचित्रकगजपिप्पलीव्योषविडङ्गशताह्वाहरेणुचिरबिल्वत्वक्कुष्ठकुटजबीजत्रिवृत्पिप्पलीमूलोपकुञ्चिकानां चूर्णं क्षिप्त्वा पूर्ववन्निधापयेत् तदधिकगुणं पूर्वस्मात् ॥२५॥

Two hundred pala of dry bark of putikaranja is boiled in one drona of water, decoction reduced to a quarter, cooled and mixed with eighty pala of guda (jaggery); powder of half prastha of vyosa is poured into the pot smeared inside with ghee, the pot is sealed with and kept undisturbed, inside a heap of barley husk for one month. This Karanja sukta (karanjasava) taken habitually, is enough to generate digestive capacity, and cure piles, abdominal tumor, flatulence, disease of spleen artificial poisoning and enlargement of abdomen.

Pilu sukta

One tula of (juice of) pilu and equal quantity of guda (jaggery) are soaked in one drona of either mastu or takra (whey and buttermilk); to this is added powder of one pala each of abhaya, ativisa, patha, musta, katuka, devadaru, himsra, jiraka, aruskara, chavya, ajamoda, ela, chitraka, gajapippali, vyosa, vidanga, satahva, harenu, bark of chirabilva, kusta, seeds of kutaja, trivrit, pippalimula and upakunchika; poured into a pot, its mouth sealed and kept undisturbed as described earlier. This recipe is better in properties and actions than the earlier ones. (25)

(Iksu) Gandira kanjika

सुतक्षितानामिक्षुगण्डिकानां द्रोणमुदकद्रोणेन घृतभाविते भाजनेऽभिषुणुयात् । आवपेच्चात्र जर्जरीकृता यवानीयवानककुस्तुम्बरीपृथ्वीकाः पृथक् कुडवांशास्तथा द्विपलोन्मितास्तेजोवतीपञ्चकोलकाजाजीजीरकद्वयकारवी: क्षौद्रकुडवं च प्रक्षिप्य ततो दशरात्रेण सञ्जातात् तस्मान्मात्रां सौवर्चलार्द्रकभूस्तृणैः सुरभीकृतां भुञ्जानः पिबेत् । पुनः पुनश्चात्र पानीयं प्रक्षिपेदिक्षुगण्डिकादिकञ्च सम्भारम् । तत् गण्डीराख्यं काञ्जिकं परं रुचिकरमग्निदीपनमर्शोग्रहणीविकारोदरगरकृमिगुल्ममदात्ययपाण्डुरोगघ्नम्॥२६॥

One drona of pieces of iksu (sugarcane) are soaked in one drona of water kept in a pot smeared insde with ghee. To this is added the powder of one kudava each of yavani, yavanaka, kustumburi and prithvika, two pala each of tejovati, panchakola, ajaji, the two jiraka and karavi, one kudava of honey and the pot kept undisturbed for ten days. This recipe made fragrant by addition of sauvarchala, ardraka and bhutrna, should be taken after meals in the usual dose.

To the same pot, fresh water, pieces of sugarcane and other drugs should be put in often; this recipe Gandira kanjika by name is best to improve taste and hunger, cures piles, duodenal disorders, abdominal enlargement, artificial poisoning, intestinal parasite, abdominal tumors, alcoholic intoxication and anaemia. (26)

Ghrita yoga in Arsha – medicated ghees in Piles

रूक्षकोष्ठश्चार्शसो नागरक्षारकृष्णाजाजीधान्यकारवीगर्भं फलाम्लं सफाणितं सर्पिः पिबेत् । गुल्मोक्तानि वा घृतानि । किंशुकक्षारोदकेन वा विपकं व्योषगर्भम् । पाठामरिचपञ्चकोलकक्षारयवानीकुस्तुम्बरु हरीतकीबिल्वविडङ्गसैन्धवगर्भं चतुर्गुणेन दध्ना विपक्कं सर्पिः प्रवाहिकागुदभ्रंशपिच्छास्त्रावानाहगुल्मपायुपार्श्ववङ्क्षणवेदनाग्रहणीदोषहृद्रोगमूत्रकृच्छ्रघ्नम्॥२७॥

Patients of piles who have dryness of bowels should drink ghee boiled with nagara, kshara (yavakshara) krsna, ajaji, dhanya, karavi, phalamla (sour fruits or tintini phala) and phanita (half-cooked jaggery/molasses) or those medicated ghee/described in the treatment of gulma or the one processed with solution of alkali of kimsuka mixed with vyosa, ghee prepared from the decoction of patha, maricha, paneakolaka, kshara, yavani, kustumburu, haritaki, bilva, vidanga and saindhava added with four times its quantity of dadhi (curds) is beneficial in tenesmus, dysentery, prolapse of rectum, slimy exudation from the rectum, flatulance, abdominal tumor, pain in the anus, flanks and groins, disorders of the duodenum, heart disease and strangury. ( 27 )

पिप्पलीपाठानागरगोक्षुरकाणां त्रिपलिकानां निर्यूहे गण्डीरमरिचपञ्चकोलकान्यर्धपलिकानि कल्कीकृत्य षड्गुणेन दना चत्वारिंशत् घृतपलानि तुल्यचाङ्गेरीरसानि पाचयेत् । तत् सर्पिः समानं पूर्वेण । शोफोदरश्वासकासहिमाघ्नं च ॥ २८ ॥

Three pala each of pippali, patha, nagara and goksura is made into a decoction, to this are added the paste of half pala each of gandira, maricha and panchakola, dadhi (curds ) six times the quantity,forty pala of ghee and equal quantity of juice of cangeri and medicated ghee prepared. This recipe is similar in actions to previous ones and also cures dropsy, enlargement of abdomen, dyspnoea, cough and hiccup. (28)

बद्धवर्चांसि चार्शांस्युदावर्तवदुपाचरेत् । भिन्नवर्चांसि चाशा॑स्यतीसारवत् । अतिप्रवृत्तरक्तानि रक्तपित्तातिसारवत् ॥२९॥

Constipation in patients of piles, should be treated like udavarta (upward movement of vata), loose motions in patients of piles should be treated like diarhoea, too much of bleeding should be treated like raktapitta (bleeding diseases) and raktatisara (bleeding diarrhoea). (29)

अशुद्धं च कालबलापेक्षी स्रवद्रुधिरमपेक्षेत । उभौ च तत्रानुबध्येते लेष्मानिलो वा । तत्र पित्तश्रेष्मोल्बणं पाचनदीपनद्रव्यैरुपेक्षया च संशोध्य शमयेत् । पित्तानिलोल्बणमन्तर्बहिरूर्ध्वमधश्च यथाग्निस्त्रेहैः । केवलपित्तोल्बणमुष्णकाले विशेषतश्च दुर्बलस्य स्तम्भनैः ॥३०॥

If impure blood is flowing out, it should be neglected keeping in mind, the season and strength of the person, since in such a condition both slesma (kapha) and anila (vata) will be secondary doshas. In case pitta and slesma (kapha) are aggravated, they should be mitigated by drugs which are pacana (digestives) and dipana (increasing hunger or by gaining time) or by sodhana (purifactory) therapies. If pitta and anila (vata) are found aggravated (they should be mitigated) by sneha (oleation) therapy-internal and external, above (oil drinking) and below (oil enema) considering his digestive ability. If pitta alone is found aggravated, specially during hot season and in weak persons, it should be mitigated by stambhana (stoping bleeding). (30)


अथ श्रेष्मोल्बणे कुटजत्वग्विश्वभेषजक्वाथं पिबेत् । तण्डुलोदकेन वा कुटजत्वक्फलातिविषारसाञ्जनानि सक्षौद्राणि । कुटजत्वक्पलशतमार्द्रं दिव्याम्बुनाक्काथयेत् । मुक्तरसे च पूते तस्मिन् पालिकान् सुलक्ष्णपिष्टान् प्रियगुसमङ्गामोचरसान् कुटजबीजत्रिपलं च प्रक्षिप्य मृद्वग्निना पुनः साधयेदादर्वीलेपात् । अयमवलेहश्छागलीक्षीरेण पेयामण्डेन वा सहाजक्षीरभुजः प्रयुक्तो रक्तजान्यर्शास्यतीसारं कफपित्तञ्चोर्ध्वमधो वा प्रवृत्तमपहरति । कुटजत्वक्पलशतमुदकद्रोणेऽष्टभागशेषं साधयेत् । परिस्राव्य तदुकं कल्कीकृतैर्व्योषरसाञ्जनमोचरसमुस्ताधातकीफलबिल्वशलाटुदाडिमशलादुत्वक्समङ्गालोध्रद्वयैः पलांशैः पलैश्च कुटजत्वचो दशभिस्तथा विंशत्या घृतस्य गुडस्य च त्रिंशता संसृष्टमधिश्रयेत् । अथावलेहतां गतमवतारितं सप्ताहमर्धमासं मासं वा धान्यमध्ये सुगुप्तं निहितमुपयुक्तमाशु सर्वार्शोग्रहणीदोषश्वासकासानपोहति ॥ ३१ ॥

In case kapha is found-aggravated (and vitiating the blood) the patient should drink the decoction of bark of kutaja and visvabhesaja, or (powder of) bark of kutaja, phala (madana), ativisa and rasanjana with rice-wash and honey.

One hundered pala of fresh bark of kutaja is boiled in rain water (or pure water); after obtaining the decoction and filtering it, nice paste of one pala each of priyangu, samanga and mocarasa and three pala of kutaja beeja is added and cooked over mild fire till the material begins to adhere to the ladle. This confection (kutajavaleha) consumed either with goats milk, peya or manda (thin gruel) by persons who take only goats milk as food, cures bleeding piles and bleeding diarrhoea, discharge of kapha and pitta from upper and lower tracts.


One hundred pala of bark of kutaja is boiled in one drona of water, decoction reduced to one-eighth, filtered and added with a nice paste of one pala each of vyosa, rasanjana, mocarasa, musta, dhataki, phala (madana), tender fruit of bilva, bark of tender fruit of dadima, samnga, the tv/o lodhras and ten pala of bark of kutaja, twenty (pala) of ghee and thirty (pala) of guda (jaggery) and confection prepared. It is hidden in a heap of corn either for seven days, a fortnight or a month and then used; this recipe (kutajavaleha) relieves quickly all types of piles, duodenal disorders, dyspnoea, and cough. (31)

मोचरससमङ्गातिललोध्रचन्दननीलोत्पलानि वा छागपयसा पिबेत् । शूले तु बिल्वयवानीनागररसाञ्जनदुरालभावत्सकबीजानामन्यतमेनापि युक्तं पाठाचूर्णं शृतेन कोष्णेनांभसा तक्रेण वा । शूले रक्तातिप्रवृत्तौ च लोध्रधातकीकुटजत्वगिन्द्रयव केसरनीलोत्पलकल्कसिद्धं सर्पिर्दुग्धिकानिदिग्धिकाकल्कसिद्धं वा ॥ ३२ ॥

He may drink a paste of mocaras, smanga, tila, lodhra, chandana and nilotpala along with goats milk. If there is pain, he may drink the decoction of powder of patha added with any one of bilva, yavani, nagara, rasanjana, duralabha or vatsakabija, either with warm water or takra (butter milk); in case of pain and also excessive bleeding, medicated ghee prepared with the paste of lodhra, dhataki, kutaja tvak, indrayava, kesara (naga kesara) and nilotpala, or that prepared from paste of dugdhika and nidigdhika (may be consumed). (32)

वातोल्बणे तु रक्ते बलातिबलाबिल्वत्रिफलाहस्तिपिप्पलीन्यग्रोधकरञ्जपत्रमधुकतिन्दुकोत्पलैः कार्षिकैर्घृतप्रस्थमजाक्षीरे दशगुणे पचेत् । तत् परं रक्तार्शोघ्नम्पा ठालोध्रहीबेरोत्पलचव्यचन्दनसमङ्गातिविषाबिल्बधातकीमधुकदेवदारुदार्वीत्वङ्मुस्तामांसीनागरयवक्षारचित्रककल्केन चाङ्गेरी – स्वरसेन चसाधितं सर्पिर्दोषत्रयघ्नमर्शोऽतिसारप्रवाहिकाबस्त्यानाहगुदभ्रंशपिच्छास्त्रुतिग्रहणीपाण्ड्वामयज्वरमूत्रकृच्छ्रारोचकदुर्नामशूलेषु योज्यम्। बलादार्व्यवाक्पुष्पीगोक्षुरकपृश्चिपर्णीनामश्वत्थोदुम्बरन्यग्रोधप्लक्षबदरीवेतसप्रवालानां च द्विपलोन्मितानां कषायेण जीवन्तीकटुकापञ्चकोलेन्द्रयवदेवदारुशाल्मलीपुष्पवीराचन्दनाञ्जनकट्फलमुस्तश्यामास्थिरातिविषासमङ्गाव्याघ्रीमोचरसबिल्वकमलोत्पल

किञ्जल्कानां चार्धकर्षोन्मितानां कल्केन चाङ्गेरीसुनिषण्णकस्वरसप्रस्थाभ्यां चघृतप्रस्थं पाचयेत् । तत् समानं पूर्वेण ॥३३॥

If vata is predominant in rakta arsas, medicated ghee is prepared from paste of one karsa each of bala, atibala, bilva, triphala, hastipippali, nyagrodha, karanja patra, madhuka, tinduka and utpala, one prastha of ghee and ten parts of goats milk; this recipe is best to cure bleeding piles.

Medicated ghee is prepared from paste of patha, lodhra, hribera, utpala, chavya, chandana, samanga, ativisa, bilva, dhataki, madhuka, devadaru, darvi, tvak, musta, mamsi, nagara, yavakshara and chitraka and fresh juice of cangeri. This should be administered to mitigate the tridoshas and cure piles, diarrhoea, dysentery, distention of the urinary bladder, rectal prolapse, discharge of slimy material from the rectum, disease of the duodenum, anaemia, fever, dysurea, anorexia piles and colic.

Medicated ghee prepared from the decoction of two pala each of bala, darvi, yava, avakpuspi, goksurakam, prsniparni, tender sprouts of asvattha, udumbara, nyagrodha, plaksa, badari and vetasa, paste of half karsa each of jivanti, katuka, panchakola, indrayava, devadaru, salmalipushpa, vira, chandana, anjana, katphala, musta, syama, sthira, ativisa, samanga, vyaghri, mocarasa, bilva, kamala, utpala and kinjalka, one prastha of fresh juice of each of cangeri and sunisannaka and one prastha of ghee, this recipe is similar ( in action) the earlier one. (33)

रक्तस्तम्भनाय च शीताभ्यङ्गप्रदेहसेकावगाहादीन् प्रयुञ्जीत । तदशान्तौ यथोदितानि घृतानि कवोष्णान्यवपीडकयोजनया पाययेत्। कवोष्णानेव च घृततैलक्षीररसकानथवा स्निग्धोष्णैर्मांसरसैर्भोजयित्वा घृतमण्डेन कोष्णेनानुवासयेत् । शीतवीर्यद्रव्यसिद्धेन वा यथास्वं स्त्रेहेन । शाल्मलीपुष्पयवासकुशकाशमूलन्यग्रोधोदुम्बराश्वत्थशृङ्गान् द्विपलाशान् क्षीरप्रस्थेन त्रिगुणोदकेन साधयित्वा क्षीरावशेषमवतारयेत् । स निर्यूहः शाल्मलीनिर्याससमङ्गाचन्दनोत्पलेन्द्रयवप्रियङ्गपद्मकेसरकल्कगर्भो घृतक्षौद्रशर्करोपेतः पिच्छाबस्तिर्गुदभ्रंशप्रवाहिकारक्तस्रुतिज्वरघ्नः ॥३४॥

To stop bleeding, anointing of oil, application of paste, pouring liquids and dipping (the rectum) in liquids, all cold, should be resorted to. If it does not stop, then medicated ghee described earlier should be given to drink in the regimen of avapidaka (described in chapter 5 of sutrasthana). He should take food along with ghee, oil, milk and meat juice slightly warmed or with juice of meat mixed with fats and warmed. After food, he should be given anuvasana (retention enema) using fat with scum of ghee. Or with decoction of drugs possessing cold potency mixed vyosa, roots of kusa, kasa, sprouts of nyagrodha, udumbara and asvattha. One prastha of milk, three parts of water are well boiled together and reduced to the quantity of milk, to this are added a paste of salmali niryasa, samanga, chandana, utpala, indrayava, priyangu and padmakesara, ghee, honey and sugar and the mass made slimy suitable to be administered as enema. This will cure prolaps of the rectum, dysentery, bleeding per rectum and fever. (34)


लाजै: पेया पीता चुक्रीकाकेसरोत्पलैः सिद्धा | हन्त्याशु रक्तरोगं तथा बलापृश्निपर्णीभ्याम् ॥ ३५ ॥

Further, lajapeya (thin gruel of fried paddy) prepared by mixing the decoction of cukrika, nagakesara and utpala, used as a drink quickly cures bleeding diseases (piles); similarly, that prepared from the decoction of bala and prsniparni. (35)

हीबेरबिल्वनागरनिर्यूहे साधितां सनवनीताम् । वृक्षाम्लदाडिमाम्लामम्लीकाम्लां सकोलाम्लाम् ॥३६॥

गृञ्जनकसुरससिद्धां दद्याद्यमकेन भर्जितां पेयाम् । रक्तातिसारग्रहणीप्रवाहिकाशोफनिग्रहणीम् ॥३७॥

Decoction of hribera, ilva, and nagara mixed with butter, vrikshamla, dadimamla, amlikamla and kolamla; or peya (thin gruel) prepared with grnjanaka and surasa, fried in yamaka (mixture of two fats usually of ghee and oil), cure bleeding diarrhoea, duodenal disease, dysentery and oedema. (36-37)

काश्मर्यामलकानां सकच्छुराणां खलान् फलाम्लांश्च । गृञ्जनकशाल्मलीनां दुग्धीकाचुक्रिकाणां च ॥३८॥

न्यग्रोधशृङ्गिकानां खलांस्तथा कोविदारपुष्पाणाम् । दध्नः सरेण सिद्धान् दद्याद्रक्ते प्रवृत्तेऽति ॥ ३९ ॥

सिद्धं पलाण्डुशाकं तक्रेणोपोदकां सबदरां च । रुधिरस्रुतौ प्रदद्यान्मसूरसूपं सतक्राम्लम् ॥४०॥

पयसा शृतेन यूषै: सतीनमुद्गाढकीमसूराणाम्। भोजनमद्यादम्लैः शालिश्यामाककोद्रवजम् ॥४१॥

शशहरिणलावमांसैः सकपिञ्जलैणेयकैः सुसिद्धैश्च। शालीनद्यान्मधुरैरम्लैरीषत्समरिचैर्वा ॥४२॥

Khal. (sweet juice of fruits) of kasmarya, amalaka, and kacchura or juice of sour fruits, juice of grnjanaka, salmali or of dugdhika and cukrika; khala of sprouts of nyagrodha or of flowers of kovidara, prepared with dadhisara (solid of curds) should be administered in case of heavy bleeding; or takra (buttermilk) processed with leaves of palandu, upodika and badara; or soup of masura mixed with sour buttermilk, or soup of satina, mudga, adhaki or masura mixed with milk should be given, in severe bleeding. He should eat foods prepared from sali, syamaka and kodrava along with sours or meat of rabbit, deer, lava bird, kapinjala bird and ena (antelope) well prepared or sali (boiled rice, mess) with sweet and sour materials mixed with little of maricha. (38-42)

दक्षशिखितित्तिरिरसैर्द्विककुल्लोपाकजैश्च मधुराम्लैः । अद्याद्रसैरतिवहेष्वर्शः स्वनिलोल्बणशरीरः ॥४३॥

छगलीपयः प्रयुक्तं निहन्तिरक्तं सवास्तुकरसश्च । धन्वविहगमृगाणां रसो निरम्लः कदम्लो वा ॥४४॥

रसखलशाकयवागूघृतयुक्तः केवलोऽथवा जयति । रक्तमतिवर्तमानं वातं च पलाण्डुरुपयुक्तः ॥

छागान्तराधितरुणं सरुधिरमुपसाधितं बहुपलाण्डु ॥४५॥

He who has severe bleeding, with aggravation of vata in the body, should take food along with juice of meat of cock, peacock, tittiri, camel or jackal made sweet and sour; drinking of gaots milk mixed with juice of vastuka stops bleeding; juice of meat of birds or animals of desert-like regions, either without sours or with very little of sours, stops bleeding; palandu, used along with meat juice, fruit juice, vegetables, yavagu ( thick gruel) mixed with ghee or even alone cures severe bleeding and also increased vata; or juice (soup) of intestines along with its blood of a young goat and more of palandu (also stops bleeding). (43-45 )

व्यत्यासान्मधुराम्लं विट्शोणितसङ्क्षये योज्यम्। नवनीततिलाभ्यासात् केसरनवनीतशर्कराभ्यासात् ॥

दधिसरमथिताभ्यासात् गुदजाः शाम्यन्ति रक्तवहाः ॥ ४६॥

If there is diminition of faeces and blood, then foods and drugs which are sweet and sour should be used alternately; or habitual use of butter and tila (cooked) or of kesara (nagakesara), butter and sugar or of dadhisara (solid of curds), well churned, will cure bleeding piles. (46)

नवनीतघृतं छागं सपयोमांसं सषष्टिकः शालिः | तरुणश्च सुरामण्डस्तरुणीव सुरा जयत्यत्रम् ॥४७॥

Bleeding (piles) will be cured by the use of butter, ghee, milk and meat all derived from the goat, sastikariceand fresh suramanda (scum of beer) oreven fresh sura (beer) (47)

रक्ते । दृष्टेऽपि हि कफपित्ते तस्मादनिलोऽधिकं जेयः ॥४८॥

प्रायेण वातबहुलान्यशसि भवन्त्यतिस्रुते दृष्ट्वा शोणितपित्तं प्रबलं कफवातरूपमल्पं च ।

शीताः क्रिया: प्रयोज्या यथेरिताः पित्तरोगेषु ॥४९॥

Usually, piles arising from vata predominance, has profuse bleeding, hence even though (aggravation of) kapha and pitta are noticed, vata is to be subdued quickly; if (aggravation of) blood and pitta is found to be predominant and symptoms of kapha and vata less (predominant) then cold treatments described in diseases of pitta origin should be done. (48-49)

उदावर्ते तु दोषविलयनाय शीतज्वरघ्नतैलाभ्यक्तस्विन्नस्य श्यामात्रिवृत्पिप्पलीनिकुम्भनीलिनीचूर्णं गोमूत्रपरिपीतं द्विगुणलवणगुडेन कराङ्गुष्ठाकारां वर्तिं कृत्वा घृताभ्यक्तगुदस्य गुदे वातविण्मूत्रानुलोमनार्थं निदध्यात्। पिप्पलीमदनफलसर्षपागारधूमैर्वा समूत्रगुडै: | तुम्बीकरघाटकणासिद्धार्थकसैन्धवजीमूतकैर्वा । एतेषामेव वा चूर्णं नाड्या प्रथमेत् । तद्विघाते त्वानुलोमिकौषधतैलमूत्राम्ललवणक्षारयुक्तं सुतीक्ष्णमास्थापनं दद्यात् ॥५०॥

If udavarta is present (in patients of piles) he should be given message with oils mentioned as curing fever proceeded by cold, sudation followed by inserting of a rectal wick (suppository) of the size of the thumb, prepared from powder of syamatrivrit, pippali, nikumbha and nilini soaked in cows urine, twice the quantity of salt and guda (jaggery) lubricated with ghee to fecilitate movement of flatus, faeces and urine; or it (suppository) may be prepared from pippali, madanaphala, sarsapa, (agaradhuma (chimney soot) mixed with cows urine and jaggery; or from tumbi, karaghata, kana, siddharthaka, saindhava and jimutaka. The powder of the above drugs may be blown into the rectum through a pipe; if these methods fail, then a powerful asthapana (decoction enema) prepared with decoction of drugs having property of initiating downward movement (of vata etc ) mixed with oil, cows urine, sours, salts, and alkali should be administered. (50)

Kalyanaka kshara

त्रिफलात्रिकटुत्रिलवणदन्तीचित्रकभल्लातकानि जर्जरितानि सस्नेहमूत्राणि शरावद्वयकोष्ठे मृत्प्रलिप्ते गोमयाग्निना विपचेत् । स कल्याणकाख्यः क्षारः क्षीरमांसरसाशिना घृतेन पीतोऽन्नपाने वा प्रणीतोऽर्शोगुल्मपाण्डुहृद्रोगोदावर्तग्रहणीमूत्रविबन्धाश्मरीकृमिश्वयथुहिध्माश्वासकासशूलानाहप्लीहमेहापहः । वैरेचनिकमूलफलानि सहिंस्रार्कमूलदशमूलगुडाद्वीपिद्विपुनर्नवानि सर्वैश्च तुल्यानि पञ्चलवणानि क्षारः पूर्ववत् कृतः काङ्कायनोक्तोऽधिकगुणः पूर्वस्मात् । हिङ्गुपाठात्र्यूषणत्रिफला – कटभीबिल्वमध्यायारेजः कटुकापञ्चकोलकमुस्तकुष्ठक्षारद्वयमुष्कक-मधुकोग्रगन्धाविडङ्गमूर्वाजमोदेन्द्रयवगुडूचीदेवदारूणि कार्षिकाणि पृथक् पलांशानि पञ्चलवणा-न्यैकध्यमापोथ्य घृततैलकुडवेन दधिकुडवेन च संयोज्य कल्याणकविधिना दग्धो महाक्षारस्तत्तुल्यः । सर्वगरविषनिबर्हणश्च ॥५१॥

Fruits and roots of purgative drugs, along with himsra, root of arka, dashamoola, guda (jaggery) dvipi (chitraka), the two punarnava- each equal in quantity making up one part in total, panchalavanas and ksharas each equal to the total of drugs – are cooked in the same way as the above; this kshara (alkali) described by Kankayana, has better qualitites than the previous.

Maha kshara

Powder of one karsa each of hingu, patha, triphala, tryusana, triphala, katabhi, bilva madhya (pulp of bilva fruit), katuka, panchakola, musta, kustha, the two kshara, muskaka, madhuka, ugragandha, vidanga, murva, ajamoda, indrayava, guduchi and devadaru; one pala each of the pancha lavana – are nicely powdered, mixed with one kudava each of ghee, oil and dadhi (curds) and cooked in the same manner as was described for kalyanaka kshara; this recipe (known as) Mahakshara, is equal toit in properties and also cures all types of artificial poisoning. (51)

प्राग्भक्तं वा वितरेत् घृतगुंडयवक्षारान् । दाडिमरसं वा सयवानीपाठामहौषधलवणगुडतक्रम् | यमकस्नेहभृष्टान् वा सक्तुयुक्तान् करञ्जप्रसवान्। दधिदाडिमाम्लबदरतिन्तिणीकमातुलुङ्गलवणसुरां यमकसंस्कृताम् | त्रिवृद्दन्तीगुडचित्रकचाङ्गेरीबालमूलकलोणीकासुवर्चलोपोदकाचुञ्चपर्णीवीरा वास्तुकपल्लवांस्तथा दक्षशिखिश्वाविद्गोधामार्जारोष्ट्रलोपाककूर्मशल्यकमांसान् मांसरसान् यवप्रायं चान्नं भोजनार्थे। पानार्थे तु सपिप्पलीचूर्णं गौडमच्छसुरां सलवणानासवांश्च दीपनीयवातहरानारनालमस्तु वा संस्कृतम् ॥५२॥

A mixture of ghee, guda (jaggery) and yavakshara should be administered before food. Or juice of dadima (fruit) mixed with yavani, patha mahausadha, lavana, guda (jaggery) and takra (buttermilk) or sprouts of karanja mixed with corn flour and fried in yamakasneha (mixture two fats-ghee and oil); Or drink sura (beer) prepared from dadhi, dadhyamla, badara, tintinika, matulunga, lavana and mixed with yamaka (two fats-ghee and oil); Or that prepared from trivrit, danti, guda, chitraka, cangeri, balamulaka, lonika, suvarchala, upodaka, cuncuparni, vira and vastuuka pallava.

Meat or meat juice (soup) of cock, peacock, porcupine godha (iguana) cat, carnel, jackal, tortoise or hedgehog and more of yava (barley) should be used as food; for drinking, clear fluid of sura prepared with guda (jaggery) mixed with powder of pippali, or asava (fermented infusion) along with salt; or aranala (sourrice-wash) or mastu (water of buttermilk) processed ( with oil, salt etc,) which enhance hunger and subdue vata should be used. (52)

अनुबन्धेतु भूयोमदिरामस्तुमूत्रयुक्तं विरेकम्। सपिप्पलीं वाघृतभृष्टां सगुडांहरीतकीं सकुम्भनिकुम्भां वा। द्विविधोपक्रमणीयोदितान् वा तर्पणप्रयोगान् | त्रिवृच्चूर्णं वा त्रिफलारसानुविद्धम् । अभयामलकविडङ्गान् वा समत्रिवृतान् सगुडान् माणिभद्रकाख्यान्। मिश्रकस्त्रेहं सुकुमारकं नीलिनीघृतं वा कल्पोदितानि वा विरेचनान्यवचारयेत् । गुदाश्रये हि दोषेऽपहृते व्याधयोऽपि तज्जा: प्रशाम्यन्ति ॥५३॥

If the disease still continues (inspite of the above therapies) the patient should be administered virecana (purgative) drugs mixed with madira (liquor), mastu and mutra (cows urine).

Or pippali fried in ghee mixed with guda (jaggery), haritaki, kumbha, and nikumbha; or tarpana (corn flour mixed with ghee, sugar and honey) regimen described in dvividhopakramaniya (chapter 24 of sutrasthana) should be adopted. Or powder of trivit soaked in juice (decoction) of triphala. Or mixture of abhaya, amalaka, vidanga, each equal in quantity, added with trivrit equal to their total quantity; Or the recipe known as Manibhadra guda (described in the treatment of kustha chapter 21 of chikitsasthana) mixed with guda (jaggery). Or recipes such as Misrakasneha (described in the treatment of gulma), sukumaraka (ghrta) or nilinighrta (described in chapter 2 Kalpasthana) should be used for purgation therapy. When the doshas localised in the rectum are removed even the diseases arising from them will also subside. (53)

रूक्षतया च विड्वातविबन्धेन शूलोदावर्तसम्भवः तस्मात्तत्राशुतरं स्नेहनमनुवासनं विदध्यात्।

पिप्पलीमदनबिल्ववचामधुकशतपुष्पाशठीकुष्ठपुष्करमूलद्वीपिदेवदारुभिः शुक्ष्णपिष्टैर्द्विगुणपयस्तैलं सिद्धमर्शोगुदभ्रंशयोनिशूलवङ्क्षणानाहगुदशोफोत्थानप्रवाहिकापिच्छास्त्रावोरुकटीपृष्ठदौर्बल्यवैवर्ण्यमूत्रकृच्छ्रनिषूदनं वातमूत्रशकृत्पित्तश्लेष्मानुलोमकरं च । वातानुलोम्ये हि सति ध्रुवमनलो याति दीप्तिमशसि चातः सङ्कोचमिति । भवन्ति चात्र ॥५४॥

Pain in the abdomen and upward movement of vata, might develop due to dryness (of the alimentary tract) and consequent obstruction to elimination of faeces and flatus, hence snehana (oleation) and anuvasana (retention enema with fatty materials) should be administered soon.

Medicated oil is prepared from a nice paste of pippali, madana bilva, vacha, madhuka, satapushpa, sathi, kustha, pu skaramula, dvipi (chitraka) and devadaru-together making one part, mixed with two parts, each of milk and oil ( sesame ). This oil cures piles, prolapse of the rectum, pain of the vagina, distention of the groins, swelling of the rectum, dysentery with severe symptoms, slimy discharge per rectum, weakness of the thighs, waist and back, discolc uration and difficulty of urination, produces downward movement of flatus, urine, feaces, pitta and slesma ( kapha ). Once the vata gets its (normal) downward movement, the digestive capacity, becomes enhanced and then the pile masses get shrunk. (54)

Some more verses here :

अर्शांसि शस्त्रक्षाराग्निलेपाभ्यङ्गैरुपाचरेत् । दृश्यान्यदृश्यानि पुनः सदान्तः परिमार्जनैः ॥५५॥ अल्पकालोत्थितेष्वल्पलिङ्गदोषेषु चौषधम् । नात्युच्छ्रितेषु मृदुषु क्षारोऽस्त्रस्स्रुतिमत्सु च ॥५६॥ उच्छ्रिते वल्पमूलेषु शस्तं शस्त्रं कुनामसु । युक्तेषु स्थैर्यकाठिन्यकार्कश्यैः शस्त्रपावकौ ॥५७॥ योज्यौ महत्सु वा क्षार: पाटयित्वा विकुट्य वा । सूचीकूर्चेन तद्वच्च बडिशं तेषु शस्त्रकम् ॥५८ ॥

Pile masses which are visible should be treated with surgery, application of caustic alkalies, burning by fire, topical application (of paste); anoint (with oil etc) those which are not visible, by constant ingernal administration of medicines. For those piles which are of recent onset, with mild symptoms of doshas, treatment with drugs is enough, for those piles which are not very big which are soft and having bleeding, application of kshara (caustic alkali) is ideal; for piles which are big and of shallow roots, use of knife is ideal; for those piles which are immovable, hard and rough, both knife and fire should be used; for those which are very big, alkalies should be applied either after incising or crushing the pile mass with a brush of needles and badisa (hook like instrument) being the instruments for those two operations respectively. (55-58)

अतिस्थूलातिदीर्घे तु यन्त्रके मर्मघट्टनम् । अणुच्छिद्रे महद्रूपमेकदेशेऽवशिष्यते ॥ ५९॥

अतिच्छिद्रेऽधिकं रूपादवतीर्णं प्रवाहणात् । स्थूलान्त्रमपि हिंस्याच्च यथोक्तं योजयेदतः ॥६०॥

If the yantra (rectal speculum) is big and long, it causes injury to the vital part (rectum) and if it has very small/narrow slit, then big pile masses will remain outside only; if the slit is wide, then the area around the pile mass also gets into the slit during the act of straining and even hurts the large intestines; hence a suitable speculum should be used during treatment. (59-60)

शुष्केषु भल्लातकमग्र्यमुक्तं भैषज्यमार्द्रेषु तु वत्सकत्वक् । सर्वेषु सर्वर्तुषु कालशेय मर्शःसु बल्यं च मलापहं च ॥६१ ॥

भित्त्वा विबन्धाननुलोमनाय यन्मारुतस्याग्निबलाय यच्च । तनपानौषधमर्शसेन सेव्यं विवर्ज्यं विपरीतमस्मात् ॥६२ ॥

For piles which are dry (non-bleeding), bhallataka is said to be the drug of choice and for moist piles (bleeding) the bark of vatsaka; for all the types of piles and in all seasons, kalaseya (buttermilk processed and stored in mud pot), is best to give strength and eliminate the faeces.

It (buttermilk) should be used as food, drink and medicine (or along with these in large quantity), by patients of piles because it removes constipation, helps the downward movement of vata and improvement of digestive capacity. All others (foods etc) which are opposite (of these qualities) should be avoided. (61-62)

अर्शोऽतिसारग्रहणीविकाराः प्रायेण चान्योन्यनिदानभूताः । सन्नेऽनले सन्ति न सन्ति दीप्ते रक्षेदतस्तेषु विशेषतोऽग्निम् ॥६३ ॥

Piles, diarrhoea and disease of the duodenum act as causitive factors for one another among themselves, they develop only when the digestive fire is weak and not when it is werful; hence in these diseases the digestive fire should be specially protected. (63)

॥ इति दशमोऽध्यायः ॥

Thus ends the Tenth chapter.


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