अथातोऽतीसारचिकित्सितं व्याख्यास्यामः । इतिह स्माहुरात्रेयादयो महर्षयः ॥ १ ॥
We will now expound Atisara chikitsa- treatment of diarrhoea; thus said Atreya and other great sages. (1)
ATISARA CHIKITSA – Diarrhoea Treatment in Ayurveda
Langhana-fasting
प्रायेणातिसारो ह्यग्निमुपहः य प्रागामाधिष्ठानो भवति । तस्मादनिलजमप्यामपाचनार्थमादौ लङ्घनेनोपक्रमेत ।
तत्र शूलानाहप्रसेकार्तं लवणाम्बुनोष्णेन वामयेत् । न तु सामे पूर्वं सङ्ग्राहि प्रयुञ्जीत विबद्धे वा मले।
स्तिमिताध्मातगुरुसरुजकोष्ठः प्राणदामुष्णाम्बुनोपयुञ्जीत । सव्योषां वा धान्याम्लक्कथितांवा । अन्यद्वास्रंसनदीपनमौषधम् ॥ २ ॥
Generally Atisara (diarrhoea) develops from the destruction fo agni (digestive activity) first and (consequent) accumilation of ama (undigested materials). Hence, though it is born from anila (vata ) it should be treated first with langhara ( fasting) on order to help digestion of ama. The patient who is suffering from pain and distention of the abdomen and excess salivation, should be made to vomit by administering warm salt water. When ama is present, sangrahi ( drugs which bind the bowels) should not be adminstered in the beginning nor when the doshas (or faeces) are obstructed inside; if there is stiffness, distention, heaviness and pain in the abdomen pranada (haritaki) should be administered with hot water, or with vyosa and dhanyamla (fermented soup of grains); nor any other drug which is not laxative and increasing hunger (should be given). (2)
अपिच विशुद्धस्त्रोतसो ह्यस्य दोषशेषे प्रवाहिते | सुखं सङ्ग्रहणं कर्तुं पाचनैः स्तम्भनेन वा ॥ ३ ॥
Further, when all the remnants of the doshas have been eliminated and the alimentary tract has become clear, it is easy to bind the bowels either by the use of pacana (digestives) or stharmbana (constipating drugs or therapies). (3)
मध्यदोषस्तु विशोषयन् मागधीनागरवचाभूतीकधनिकाहरीतकीनां क्वाथं पिबेत् । जलजलदबिल्वपेशिकाशुण्ठीधान्यकानां वा । उभयमपि चैतत्प्रमथ्याख्यम्।वचादिवर्गंक्कथितंचूर्णितं वा । तद्वद्वचाभयाविडङ्गपाठाशुण्ठीबिडलवणानि वा । मुस्तपिप्पलीन्द्रयवपाठातेजोवतीर्वा । विडङ्गाभयाकणलवणपञ्चकानि वा । पिप्पलीन्द्रयवपाठाशुण्ठीर्वा । सरक्ते तु प्रवृत्त आमे गजपिप्पलीं मधुशर्करामधुराम् ।।४।।
If the doshas are of moderate increase, the patient should fast and drink the decoction of magadhi, nagara, vacha, bhutika, dhanika and haritaki, or of jala, jalada, bilva pesika, sunthi and dhanyaka; both these are known as pramathya; or drink the decoction or powder of drugs of vachadigana (chapter 16 of sutra sthana); similarly that of vacha, abhaya, vidanga, patha, sunthi and bida lavana, or that of musta, pippali, indrayava, patha and tejovati; or of vidanga, abhaya, kana and lavana panchaka; or of pippali, indrayava, patha and sunthi. If the faeces is found mixed with blood and ama, then gajapippali which is not sweet, should be used along with honey and sugar. (4)
अल्पदोषंपुनरुपवासयेत् । पानं त्वतिसारिणोम्बु वचातिविषाभ्यां क्वथितम् ।
शुण्ठ्यतिविषाभ्यां मुस्तपर्पटकाभ्यां नागरधान्यकाभ्यां वा । क्षुद्वतस्तु लघुपञ्चमूलपञ्चकोलहस्तिपिप्पलीबलाबिल्वपाठाहिङ्गुधान्यकजीरकशठीगन्धपलाशहपुषायवानीतिन्तिणीकदाडिमबिडसैन्धवैरन्नपानं यवाग्वादि कल्पयेत् ।।५ ॥
If the doshas are mild (slight increase) the patient should be made to fast. Drinking water for patients of diarrhoea should be prepared by boiling vacha and ativisa or sunthi and ativisa, or musta and parpataka or nagara and dhanyaka; when the patient is hungry, he should be given foods and drinks, such as yavagu (thin gruel) etc., processed with laghu panchamula, panchakola, hastipippali, bala, bilva, patha, hingu, dhanyaka, jiraka, sathi, gandhapalasa, hapusa, yavani, tintinika, dadima, bida and saindhava (5)
बिल्वशलाटुहरीतकीपिप्पलीमूलैर्मूढवातस्य । अंशुमतीद्वयबलाबिल्वशलाटुभिः पित्तोल्बणस्य । पिबेच्च तृषितः पटपूतंतक्रम् । मधुसुराधान्याम्लयवागूमण्डान्यतमंवा । एषक्रमोऽनिलकफघ्नोदीपनपाचनो रोचन: सग्राही बल्यश्च ।। ६ ।।
In case of non-movement of flatus (the decoction of) tender fruit of bilva, haritaki and pippalimula, and in case of increase of pitta, that of the two amsumati (saliparni and prsniparni) bala and bilva salatu; if the patient feels thirst, he can drink takra (buttermilk) filtered through cloth or madhu ( honey), sura dhanyamla, yavagu or manda. This regimen subdues, anila (vata) and kapha, produces hunger, improves digestion and taste, binds the bowels and bestows strength. (6)
Pravahika chikitsa – treatment of dysentery
पक्कदोषोऽपि तु योऽतिसार्यते बहुशोऽनिलेन विबद्धं सपिच्छं सफेनं सशूलपरिकर्तिकं तु सरोमहर्षं निष्पुरीषं च तां प्रवाहिकां बिम्बिसीमिति चाचक्षते । तत्रोदावर्तोपदिष्टांस्तेनैव विधिना संस्कृतांश्छाग- पिशितरसान्दद्यात् ।।७।।
When more (frequent) evacuation are produced by vata, even though the doshas are pakva (devoid of ama) the faeces is eliminated with difficulty (only after straining) and is slimy, frothy, accompanied with pain in the abdomen, pricking pain in the rectum and horripilations or with no faecal matter at all- then such a condition is spoken of as Pravahika or Bimbisi (dysentery). For this, the treatment is the same as described for udavarta (vide chapter 10 of chikitsasthana); juice of goats meat prepared in the same manner described there should be given. (7)
Aparajita Khala yoga
यूषांश्च वर्चः क्षये तृष्यतो यवमुद्गमाषतिलकृतान् । समेन वा तिलबालबिल्वयोः कल्केन दधिसरस्नेहयुक्तं खलकम् । चित्रकशृङ्गवेरपूतीकरञ्जबिल्वाजमोदैर्वा तक्रदाडिमतैलाढ्यं सैन्धवोपेतमजिताख्यम् । शठीतिन्तिणीकबिडदाडिमक्षारपञ्चकोलमरिचत्रिफलाधातकी धनिकापाठाजमोदाजाजीजीरककपित्थजम्ब्वाम्रास्थिभिर्वा तुल्यभागैः षड्गुणबिल्वमध्यैर्गुडमुद्गरसस्त्रेहदधिसिद्धोऽपराजिताख्यः खलको दीपनः पाचनो रुच्यो ग्राही बिम्बिसिनाशनः ॥ ८ ॥
When there is decrease of faeces and the patient develops thirst, he should drink yusa (soup) of yava ( barley), mudga ( greengram ), masa (blackgram) or tila (sesamum) or equal quantities of paste of tila and tender bilva fruit along with dadhisara (whey), and fatty material of curds are made into a Khalaka; or that prepared from chitraka, srngavera, putikaranja, bilva, ajamoda, with more of takra (buttermilk); juice of dadima, oil and added with saindhava (thin recipe) known as Ajita (khalaka); or that prepared from equal parts of marrow of bilva fruits, guda (jaggery) soup of mudga, oil, curds, all cooked together, this recipe known as Aparajita khalaka, increases hunger, digestion, improve taste, binds the bowels and cures bimbisi (pravahika). (8)
दधिसरं वा सगुडदाडिमं यमकभृष्टम् । यमकभृष्टान् वा सशुण्ठीचूर्णान् सक्तून् । माषान् वा सुसिद्धान् घृतमण्डोपसेचनान् मरिचोपदंशान्। छागमेषयोर्वान्तराधिरसं दाडिमाम्लं धान्यनागरोपेतं स्नेहविपक्कं व्यञ्जनं पानं च। तद्वत् सुरां यमकस्निग्धां पिबेद्वा। शुण्ठीबदरचूर्णं दधिघृततैलक्षौद्रफाणितोपेतम् ।। ९ ।।
Or he may drink dadhisara mixed with guda (jaggery) and dadima and fried in yamaka (mixture of ghee and oil), or eat the paste of flour, fried in yamaka and added the powder of sunthi. Or eat condiments of masa (blackgram) prepared by sprinkling scum of ghee and powder of maricha; Or partaka condiments or drink the juice prepared from the abdominal organs (stomach, intestines, liver etc.) of either a goat or ram, mixed with sour juice or dadima, dhanya, and nagara cooked in fat (oil or ghee); Or lick the powder of sunthi and badara mixed with curds, ghee, oil, honey and phanita (half-cooked jaggery). (9)
हिङ्गदाडिममहौषधोपकुल्याचूर्ण वा घृतक्षीरोष्णाम्बुमद्यान्यतमेन। लिह्याद्वा लोध्रबिल्वशलाटुगुडांस्त्रिकटुकोत्कटांस्तैलेन । अश्वत्थवातपोतक्वाथसिद्धं वा शाल्योदनं घृततैलक्षौद्रयुक्तं दक्षा खजाहतदधिसरानुपानमश्रीयात् ॥ १० ॥
Or lick the powder of hingu, dadima, mahausadha and upakulya mixed with ghee, milk, hot water or wine, or lick the powder of lodhra, bilvasalatu, guda, mixed with more of trikatu and oil.
He should eat the mess of sali (rice) boiled with the decoction of asvattha and vatapota (palasa) mixed with ghee, oil and honey or with curds, followed by well churned dadhisara (whey) as an after-drink. (10)
अपि च
दीपनं रोचनं रुच्यं दधिवातहरंपरम् । बद्धविड्वा हरत्यस्मात् त्चरोत्थामपिबिम्बिसीम् ।।११ ॥
Further still, dadhi (curds) increases hunger and appetite, improves taste, effectively subdues vata, removes the obstruction of faeces and so cures bimbisi, even of long duration. (11)
तृष्णोल्बणस्तु सरक्तपिच्छोपवेशी पानान्नविरतो धारोष्णं क्षीरमाकाङ्क्ष पिबेत् । शृतं वागन्धर्वहस्तमूलेनाथवा बिल्वशलाटुभिः । तदेव वाल्पतृष्णः सगुडतैलम् । शृतेन वा पयसा मरिचकल्कं द्विगुणतिलकल्कयुक्तम् । क्षीरेणैव वा पिप्पलीम्। व्योषसिद्धेन वापयसान्नानि भुञ्जीत ॥१२॥
If the patient has severe thirst, and voids faeces mixed with blood and slime, he should avoid solid and liquid foods and drink only warm milk, fresh (from the udder) as much as he desires; or the milk boiled with roots of gandharvahasta or bilva salatu.
If the thirst is mild, the same (milk) may be taken mixed with guda (jaggery) and oil, or milk boiled with (one part of) paste of maricha and two parts of paste of tila, or paste of pippali with milk or eat foods prepared with milk added with vyosa. (12)
शूलाधिक्ये तु दशमूलक्कथितेन पयसा सक्षौद्रेणास्थापनंदद्यात्। अथवापिच्छाबस्तिमनुवासनंच वातघ्नं वापित्तघ्नंवा ।। १३ ।।
If there is severe colic, he should be given asthapana (decoction enema) with decoction of dashamoola, mixed with milk and honey or picchabasti (enema with slimy materials) and anuvasana basti (enema with fatty materials) which subdues both vata and pitta. (13)
Guda bhramsa chikitsa – prolapse of rectum
गुदभ्रंशे शूले चाम्लबदरचाङ्गेरीरसदधिक्षारनागरकल्केन श्रुतमम्लं सर्पिर्निराममातुरंपाययेत् ।
मरिचपञ्चकोलाजाजीधनिकाबिडदाडिमगर्भं वापूर्ववदम्लम् । अनुवासयेद्वा दशमूलसिद्धेन स्त्रेहेन । पिप्पल्यादिनावा ||१४।।
In a patient (of pravahika) not having symptoms of ama, if gudabhramsa (prolapse of the rectum) and colic are present, he should be given a drink of ghee made sour by boiling with the juice of sour badara and cangeri, or dadhi (curds) along with paste of kshara (yavakshara) and nagara; or sour ghee as described earlier, cooked with maricha, panchakola, ajaji, dhanika, bida and dadima; or he can be given anuvasana (oil enema) with the oil processed in the decoction of dashamoola or with pippali etc. (as described in the treatment of arsas). (14)
गुदं चाभ्यङ्गपूर्वं स्वेदेन मृदुभूतं प्रवेशयेत् । सच्छिद्रेण चास्य चर्मणा गोष्फणाबन्धं कुर्यात् । मूषकमनान्त्रं कृत्वा महापञ्चमूलकषायं च क्षीरे विपचेत् । तेन पयसा वातहरकल्कप्रतीवापंतैलंपाचयेत् तदभ्यञ्जनेन पानेन च सुकृच्छ्रमपिगुदभ्रंशंसाधयति ।।१५।।
The rectum should be anointed with oil, fomented, made soft and pushed inside, held in position by a perforated leather strap and bound by a gophana bandage (described in chapter 38 of sutrasthana).
Musaka taila
A mouse, removed of its intestines, is cooked with the decoction of mahapanchamula and milk; medicated oil should then be prepared by using this (decoction and) milk, along with the paste of drugs which subdue vata. This medicated oil used both for (external) anointing and drinking, cures prolapse of the rectum, which is very difficult to manage. (15)
Pittaja atisara chikitsa
पित्तातिसारमपिसाममादौतीक्ष्णवज्यैरौषधैर्वातातिसारवत् पाचयेत्। तृष्णायांससारिवाभूनिम्बं ज्वरविहितमम्भः षडङ्गमवचारयेत् । उपोषितस्य चान्नकालेऽभीरुहस्वपञ्चमूलबलाद्वयशूर्पपर्ण्यादिमृदुमधुरतिक्तदीपनद्रव्यनिर्यूहयुक्तान् कालविन्मण्डपेयासक्तुयूषरसादीनीषदम्लाननम्लान् वा कवोष्णान् सुशीतान् वा सक्षौद्रान् ॥ १६ ॥
Even pittatisara (diarrhoea due to increase of pitta) having symptoms of ama, should be treated similar to vatatisara with drugs producing pacana (digesting ama), avoiding at the commencement those which possess tiksna (peenetrating) property; if there is thirst, sadanga paniya, prescribed in the treatment of jvara (pitta jvara) along with sariva and bhunimba should be used for drinking; if the patient has hunger, he should be given at the time of meals either manda (scum of gruel), peya (thin gruel), saktu (watery paste of flour), yusa (soup of grains), or rasa (meat soup) processed with the decoction of abhiru, hrsva panchamula, the two bala surpaparni, or others which are slightly sour or without sourness, warm or cooled, mixed with honey and used considering the time (season and time of the day). (16)
अनुबन्धे तु मूर्वातिविषेन्द्रयवहरिद्रारसाञ्जनानि क्वथितानि पिबेत् । केवलं वा वृक्षकबीजम् । पाठागुडूचीकटुकाकिराततिक्तानि वा । हरिद्रादिगणं वा । वत्सकबीजातिविषाबिल्वाम्बुमुस्तानि वा । तण्डुलोदकेन वातिविषावृक्षकत्वक्फलानि सक्षौद्राणि । चन्दनोशीरशुण्ठीलोधनीलोत्पलानि वा ।
नागरोत्पलधातकीपुष्पदाडिमत्वचो वा | कमलोत्पललोध्रमोचरससमङ्गातिलान् वा । मधुकशृङ्गवेरदीर्घवृन्तत्वचोवा । मधुयुक्तानिशर्करापद्मकेसरमुस्तापयस्याचन्दनानिया | शाल्मलीवृन्तकृतंवा शीतकषायंमधुमधुकोपेतम् ॥ १७ ॥
If the disease persists (inspite of the above treatment) he should drink the decoction of murva, ativisa, indrayava, haridra and rasanjana or of seeds of vrikshaka alone; or of patha, guduchi, katuka and kiratatikta; or of drugs of haridradigana, or of vatsakabija, ativisa, bil ambu and musta; or of ativisa, bark and fruits of vrikshaka with rice-wash and honey; or of chandana, usira, Sunthi, lodhara and nilotpala; or of nagara, utpala, dhatakipushpa and dadimitvak; or of kamala, utpala, lodhra, mocarasa, samanga and tila; or of madhuka, Srngavera and dirdhavrnta tvak; or of sarkara, padma kesara, musta, payasya and chandana along with honey; or cold infusion of salmali vrnta (tender sprouts) mixed with honey and madhuka. (17)
मधुकप्रियङ्गुकट्वङ्गत्वग्दाडिमाङ्कुरकल्केन वा दधियुतां यवागूं खलकं वा । बिल्वकपित्थजम्ब्बाम्रास्थिभिर्वा । मधुयुक्तान् वा लोध्राम्बष्ठाप्रियङ्ग्वादिगणान् क्वाथादिषु पृथक् कल्पितान् । श्यामादिमहाकषायंवा ।। १८ ।।
Or drink yavagu or khalaka containing the paste of madhuka, priyangu katvanga tvak, dadimankura mixed with curds; or the paste of bilva, kapittha, jambu asthi (seeds of jambu) and pulp of seeds of amra; or decoction of any one of five kinds of recipes of drugs of lodhraadi, ambasthadi or priyangavadi ganas (vide chapter 16 of sutrasthana) mixed with honey; or the decoction of syamadi maha kasaya (chapter 15 of sutrasthana). (18)
शूलार्तस्तु रूक्षकोष्ठो घृतं सक्षारं पिबेत् । क्षीरं वा बृहतीबलांशुमतीकच्छुरामूलसिद्धं मधुककट्वङ्गाजमोदशर्करावचूर्णितंसतैलक्षौद्रम् । क्षीरमेव वा धारोष्णम् ।।१९ ।।
The patient having pain and dryness of the alimentary tract should drink ghee mixed with yavakshara or milk boiled with brihati, bala, amsumati, and kacchuramula, mixed with the powder of madhuka, katvanga ajamoda and sarkara (sugar) added with oil and honey or drink warm fresh milk (from the udder). (19)
बलवान्विबद्धमलोविरेकार्थ त्रिफलाचूर्णयुक्तं वापलाशफलक्वाथसिद्धंवापय: पीत्वा पय एव कवोष्णमनुपिबेत् । एवमेव च त्रायमाणया शृतम् । ततो निस्सृते शकृति पुराणेऽतिसारः शान्तिमेति ||२०||
The patient who is strong and having obstruction of faeces, should drink milk mixed with powder of triphala; or milk mixed with the decoction of the fruits of palasa, followed by warm milk again, as an after-drink in order to induce purgations. In the same manner, milk boiled with trayamana, may be used. With eliminations of faeces chronic diarrhoea will get cured. (20)
Piccha basti
स्रुतदोषस्य च संसर्जनकाले शूलं चेदनुवर्तेत ततो बिल्वमधुकशताह्राद्वयगर्भं सक्षीरं तैलचतुर्गुणं सर्पिर्विपाच्यानुवासनं दद्यात् । ततः सम्यक्कृतायामपि संसर्ग्यामतीसारानुबन्धेपिच्छाबस्तयो योज्याः। शाल्मलीवृन्तान्यार्द्रदर्भेर्वेष्टयित्वा कृष्णमृदावलिप्य गोमयाग्निना स्वेदयेत् । शुष्कायां मृदि स्विन्नानि ज्ञात्वा वृन्तान्युलूखले समापोथ्य तेषां मुष्टिसम्मितं पिण्डं क्षीरप्रस्थे विमर्दयेत् । ततस्तेन पयसा पूतेन सघृततैलेन मधुमधुककल्कयुक्तेनास्थापयेत् । प्रत्यागते च स्त्रातः पयसा कच्छुराभूतेन जाङ्गलरसैर्वाश्नीयात्। एषपिच्छाबस्तिः पित्तरक्तातिसारग्रहणीगुल्मशोषज्वरान्विरेचनास्थापनातियोगं चशमयति ॥ २१ ॥
After the elimination of doshas (or faeces), if pain continues even during the period of dietic regimen,, then anuvasana with medicated ghee prepared from decoction of bilva, madhuka, Satahva dvaya, milk and four parts of oil (should be administered). Even after such enema therapy properly done, if diarrhoea continues to persist, then piccha basti (enema with slimy materials) should be administered.
Tender sprouts of salmali are wrapped with green darbha grass, made into a round ball and given a coating of mud and heated inside the fire of cowdung. After the mud becomes dry and the leaves soft, they are taken out, pounded in a pestle, made into a ball of paste; this paste, one musti (pala) in quantity is maccerated with one prastha of milk, and filtered; this filtered milk mixed with ghee, oil honey and the paste of madhuka should be used for asthapana basti (decoction enema ). After the evacuation of bowels, the patient should takebath, eat food either with milk mixed with decoction of kacchura or with soup of meat of animals of desert-like regions.
This picchabasti, cures diarrhoea of pitta origin, bleeding diarrhoea, duodenal diseases, abdominal tumors, consumptions, fever and also the disorders of excess purgation therapy and decoction enema therapy. (21)
चिरोत्थितं त्वतीसारमवेदनं पक्कमप्यशाम्यन्तं पुटपाकैरुपाचरेत् । अरलुकत्वक्कल्कं काश्मर्यपत्रप्रच्छन्नं पुटपाकविधिना पाचयेत् तद्रसं सुशीतं मधुयुतं पिबेत् । वटादित्वक्प्ररोहकल्कमप्येवं कल्पयेत् । अथवातित्तिरिमपनीतान्त्रपिच्छं न्यग्रोधादेर्वल्कलस्य प्ररोहाणांवा कल्केनपूरयित्वापूर्ववत् पुटपाकं कुर्यात् । ततः तस्माद्रसमादाय सिताक्षौद्रयुक्तं पाययेत् अनेन सर्वे जाङ्गलसत्वा व्याख्याताः ||२२ ॥
Diarrhoea which is long standing, not associated with pain in the abdomen, not relieved even though pakva (having no symptoms of ama) should be treated with putapaka. The paste of bark of araluka (mayurajangha) wrapped with the leaves of kasmarya should be cooked by putapaka method and juice extracted. After it cools, it should be administered along with honey. In the same manner the juices of the bark and sprouts of vata and such others can also be prepared and used. Or a tittiri bird whose feathers and intestines have been removed should be filled with the paste of bark or sprouts of nyagrodha etc and cooked by putapaka method as described previously. Afterwards the juice is extracted, mixed with sugar and honey and used. In this way, the use of any other animals of desert-like region can be made. (22)
Raktatisara chikitsa
यस्तु पित्तातिसारी पित्तलान्यासेवेत तस्य पित्तमतिवृद्धं रक्तातिसारं तृड्दाहमोहज्वरशूलपायुपाकांश्च करोति । तत्र क्षीरमाजं न्यग्रोधादिप्रसवशृतं सितामधुयुक्तमाहारे गुदप्रक्षालने च विदध्यात् । तद्विधं वा सर्पिः सपयस्कं पिबेत् । क्षीरोत्थं वा सर्पिः क्षीरानुपानं कपिञ्जलरसाशी क्षीराशी वालिह्यात् ||२३||
The patient suffering from diarrhoea of pitta origin, indulging in foods and activities which cause further increase of pitta, gets the disease raktatisara (bleeding diarrhoea) due to profound increase of pitta; he develops thirst, burning sensation, delusion, fever, colic and ulceration of the rectum. For this, goats milk boiled with tender sprouts of nyagrodha etc and mixed with sugar and honey should be used both as food and also for washing the rectum; ghee prepared by churning milk can be licked followed by milk as an afterdrink or partake the juice of meat of kapinjala bird or milk only as food. (23)
सल्लकीप्रियङ्गुतिनिशशाल्मलीप्लक्षत्वक्संसृष्टं सिद्धं वा सक्षौद्रं क्षीरं पिबेत् । यष्टीलोध्रसारिवाभिर्वा शृतं समधुसितम् । तद्वत् कृष्णतिलसमङ्गोत्पलयष्टीमधुभिः । शशकपिञ्जलपारावततण्डुलीयकमुद्द्रकाश्मर्यबीजादिरसांश्च सेवेत । घृतभृष्टं वा रक्तमाजं मार्ग वा । पूर्वोक्तान् वा पुटपाकान् मधुककृष्णमृत्तिकाशङ्खकल्कं वा सरुधिरं पिबेत् तण्डुलोदकेन । तेन वा समाक्षिकं फलिनीकल्कम् । अथवाससिताक्षौद्रं चन्दनम् ॥ २४ ॥
Or milk boiled with the barks of sallaki, priyangu, tinisa, salmali and plaksa added with honey should be used for drinking; or milk boiled with yasti, lodhra and sariva mixed with honey and sugar; likewise, with krsnatila, samanga, utpala and yastimadhu. He should make use of the juice of meat of rabbit, kapinjala or paravata, (birds) tanduliyaka, mudga, kasmaryabija; or make use of the blood or meat of either a goat or deer fried in ghee; or the juice of meat taken out by putapaka method described above, mixed with madhuka, krsnamrttika and paste of sankha mixed with blood should be consumed along with ricewash; or the paste of phalini, along with honey and ricewash; or paste of chandana mixed with sugar and honey. (24)
एते हि प्रयोगाः तृष्णादिप्रशमना रक्तातियोगघ्नाश्च । वातोत्तरस्तुशतावरीघृतं लिह्यात् । सशर्करं वा नवनीतम् । पिच्छिलस्वरससाधितं वा सर्पिः। लाक्षापिप्पली शृङ्गवेरकटुकेन्द्रयवदावत्वग्भिर्घृतं सिद्धं पेयामण्डेनपीतमतीसारंत्रिदोषमपिवारयति ॥ २५ ॥
These recipes, administered relieves thirst, etc and cure diarrhoea with even heavy bleeding. If vata is found to be predominant, the patient should lick satavari ghrta (described in chapter 39 of uttara sthana) or lick fresh butter mixed with sugar or ghee processed with fresh juice of trees having slimy sap or medicated ghee prepared from laksa, pippali, Srngavera, katuka, indrayava and darvitwak, consumed with either peya manda (thin fluid of gruel) cures even the diarrhoea arising from all the three doshas (25)
यदापुनर्वायुना विट् बद्धं सशोणितमल्पाल्पं सफेनं कृच्छ्रादुपवेश्यते तदा पूर्वोक्तं पिच्छाबस्तिं दद्यात् । मधुरौषधसिद्धेन च सर्पिषानुवासयेत् । प्रायेण हि दुर्बलगुदा गुदाश्रयामयिनो भवन्ति । विशेषतश्चिरकालातीसारिणः । अतिसारातिप्रवृत्तौ स्वस्थानबलवृद्धो वायुः पित्तमनुबलमवाप्य दुर्जयतरो भवति । तस्मात्तेषामभीक्ष्णमनुवासनं प्रयुञ्जीत । गुददाहे पुनः पटोलमधुकमधूकक्षीरिवृक्षादिकषायेण सघृतश कराक्षौद्रेण क्षीरेण वा गुदं तदासन्नांश्च प्रदेशान् सिञ्चेत् । शतधौतादिभिर्घृतैश्च पिचूनभ्यङ्गाश्च दद्यात् । पटोलादीनामेव च कल्केन सघृतेन प्रदिह्यात् । तच्चूर्णैर्धातकीलोध्रमाषचूर्णेन च पायुद्वारमवचूर्णयेत् । एवमेव च शूले वातहरतैलप्रदेहैरुपाचरेत् । यः पुनरेवमपि पित्तलान्यासेवेत सशीघ्रं गुदवलीषुपक्कासु व्यापद्यते ॥ २६ ॥
When due to (increase of) vata, the faeces is obstructed or comes out mixed with blood, little by little, frothy and with difficulty, then picchabasti ( enema with slimy substances) described earlier should be administered. Anuvasana (oily erema) prepared from drugs of sweet taste and ghee should be also administered.
Generally, the rectum becomes weak by the diseases involving the rectum, especially so by diarrhoea of long duration. Due to excess of purging, vata getting increased in its own seat and strengthened by the association of pitta, becomes very difficult to cure.
Hence, they should be treated quickly with anuvasana (fatty enema); if there is burning sensation in the rectum, then the rectum and surrounding area should be sprinkled with the decoction of patola, madhuka, trees having milky sap, mixed with ghee, sugar and honey or with milk (mixed with ghee, sugar and honey ). Pieces of cloth soaked in satadhquta ghrta etc should be placed on the area or the area may be anointed with the paste of drugs of patoladigana (chapter 16 of sutrasthana) mixed with ghee should be applied warm; the rectal orifice should be dusted with the powder of those drugs (patoladigana) and dhataki, lodhra and masa.
Even pain in the rectum should be treated similarly with warm application of medicated oils which subdue vata; he who continues to indulge in foods which increase pitta will soon die of ulceration of the rectum. ( 26 )
Kaphaja atisara chikitsa
श्रेष्मातीसारं तु प्रागेव नितरामामपाचनार्थं लङ्घनेन साधयेत् । अनुबन्धे च पिबेत् कषायं मुस्ताभयाशुण्ठीबिल्वशलाटूनाम् । वचाविडङ्गभूतीकधनिकादेवदारूणां वा । पाठातिविषाकुष्ठचव्यकटुरोहिणीनां वाचित्रकपिप्पलीद्वयपिप्पलीमूलानां वा । सुखाम्बुना वा हिङ्ग्ग्वाद्यमलसकोक्तम् । पथ्यासैन्धवशुण्ठीचूर्णं वा । लिह्याद्वा त्रिकटुचूर्णं क्षौद्रशर्करोपेतम् । कपित्थं क्षौद्रेण वा | कट्फलं वा पिप्पलीर्वा। पूर्ववच्च सर्वं वातपित्तामरक्तसंसर्गमपेक्ष्य यथायथमुपकल्पयेत् । सशूलप्रवाहिकस्य च निरामस्य वातेऽधिके वचाबिल्वपिप्पलीकुष्ठशताह्वाकल्कयुक्तं सलवणं पिच्छाबस्तिमनुवासनं च कोष्णेनबिल्वतैलेन बहुशो वचादिगर्भेण वा तैलेनेति । भवति चात्र ।।२७ ।।
Diarrhoea due to increase of kapha should be managed with fasting in the very beginning, in order to cook the ama (undigested materials). If it persists, then the decoction of musta, abhya, sunthi and tender fruit of bilva should be administered; or of vacha, vidanga, bhutika, dhanika and devadaru; or patha ativisa, kustha, chavya and katurohinı; or of chitraka, the two pippali, and pippalimula, or hingvadi (quatha) described in alasaka (chapter 11 of sutrasthana) with warm water; or lick the powder of pathya, saindhava and sunthi; or of trikatu with honey and sugar; or that of kapittha with honey or; of katphala or of pippali- all these to be used as described earlier, considering the association of vata, pitta, ama and rakta in suitable manner.
In case of pravahika associated with pain but without ama, if there is predominance of vata, picchabasti ( enema with slimy materials) prepared with vacha, bilva, pippali, kustha and satahva, made into a paste and mixed with salt should be given and anuvasana (oil enema) with warm bilva taila or with taila containing more quantity of vacha should be administered. (27)
Some verses more –
स्वस्थाने मारुतोऽवश्यंवर्धतेकफसङ्क्षयात् । सवृद्धः सहसाहन्यात्तस्मात्तंत्वरया जयेत् ॥ २८ ॥
Vata undergoes aggravation (increase) necessarily in its own place due to increase of kapha; once aggravated in its own place due to decrease of kapha, it kills the person quickly, hence it should be won over immediately. (28)
भीशोकाभ्यामपिमरुच्छीघ्रं कुप्यत्यतस्तयोः | कार्याक्रिया वातहरा हर्षणाश्वासनानि च ॥ २९ ॥
Maruta (vata) gets increased quickly, even by fear and sorrow; measures which subdue vata such as inducing happiness, creating confidence etc should be adopted. (29) यस्योच्चाराद्विना मूत्रंपवनो वा प्रवर्तते | दीप्ताग्नेर्लघुकोष्ठस्य शान्तस्तस्योदरामयः ॥ ३० ॥
This disease of the abdomen (diarrhoea) should be considered as cured, when the patient is able to eliminate urine or flatus without eliminating faeces; when his hunger has increased and the abdomen becomes light. (30)
आमस्य पाको मलसङ्ग्रहोऽनुन सङ्ग्रहे रुग्गुदनाभिजन्मा ।
विलनैग्रहिभिरीरणघ्नैः क्रमेण तैस्तैर्विधिभिर्विधेयः ॥ ३१ ॥
Digestion of ama, the control of accumilation of faeces (control of evacuations) and development of pain in the rectum and umbilicus due to non-control (of evacuations) should be treated with fasting, drugs which control purgations and which subdue vata should be done, respectively adopting their usual procedures. ( 31 )
नरिक्तकोष्ठस्य पुरीषबन्धो न रूक्षकुक्षेः सुहितस्य चाति । पित्तास्त्रतोऽन्यत्र न चातिशीतैरत्युष्णतीक्ष्णैर्न कदाचिदेव ।। ३२ ।।
Control of purgation can not happen when the alimentary tract is empty or when it is dry, or when it is over contented (filled with more amount of food), or by very cold things except in (the increase of pitta and asra (blood) and never by those (drugs or therapies) which are very hot (in potency) and penetrating property. (32)
खलरसदाधिका यमकदाडिमसारकृता | दधिसगुडंपयोऽसिततिलाश्च सुजर्जरिताः ।।
सलवणमारुतघ्नगण साधिततैलमलं । घृतमपि वाप्रवाहणकृतांविजयेत्जाम् । ॥ ३३ ॥
Khala (fruit juice), rasa (meat juice), dadhika (processed curds) yamaka (mixture of two fats) processed with juice of dadima, curds mixed with jaggery, milk (plain), asita tila well pounded, medicated oil or ghee prepared with drugs of groups which subdue vata, mixed with salt-these are enough to relieve the pain caused by severe straining. (33)
।। इतिएकादशोऽध्यायः ॥
Thus ends the Eleventh chapter.
