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Sushruta SamhitaChikitsasthanaAturopadrava chikitsa - treatment of distressing symptoms - Sushrutasamhita Chikitsasthana Chapter 39

Aturopadrava chikitsa – treatment of distressing symptoms – Sushrutasamhita Chikitsasthana Chapter 39

एकोनचत्वारिंशोऽध्यायः । अथात आतुरोपद्रवचिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ।। १ ।।

Now we shall discourse on the treatment of distressing symptoms ¹ which are manifested in a patient ( Aturopadrava-chikitsa). 1

स्नेहपीतस्य वान्तस्य विरिक्तस्य स्रुतासृजः । निरूढस्य च कायाग्निर्मन्दो भवति देहिनः || २ ||

सोऽन्नैरत्यर्थगुरुभिरुपयुक्तैः प्रशाम्यति । अल्पो महद्भिर्बहुभिश्छादितोऽग्निरिवेन्धनैः ।। ३ ।।

चाल्पैर्लघुभिश्चान्नैरुपयुक्तैर्विवर्धते स । काष्ठैरणुभिरल्यैश्च सन्धुक्षित इवानलः ॥ ४ ॥

The digestive fire (Kayagni) of a person naturally grows dull after the exhibition of emetics and purgatives, after the administration of a Niruha-Basti, after the internal application of a Sneha and after blood-letting. It is further lessened by the eating of extremely heavy (difficult of digestion) articles of fare, just as a low or dull fire is extinguished by a heavy load of fuel. Light meals taken in small quantities, on the other hand, increase the digestive fire under these circumstances, just as light fuel in small quantities serves to re-kindle a low fire. 2-4

1. By ‘‘distressing symptoms” are generally meant those complications that follow the exhibition of emetics, purgatives, Bastis, etc.

2. We have been told that the digestive fire is kindled by the exhibition of emetics, purgatives, etc., but here we are told just the reverse. The solution is that the digestive fire is ultimately kindled by these measures, whereas, immediately after the exhibition, if becomes dull and sluggish.

हृतदोषप्रमाणेन सदाहारविधिः स्मृतः । त्रीणि चात्र प्रमाणानि प्रस्थोऽर्थाढकमाढकम् ।। तत्रावरं प्रस्थमात्रं द्वे शेषे मध्यमोत्तमे ॥ ५ ॥ ।।

The quantity of diet should be proportionate to the Dosa (morbific diathesis) eliminated from the organism. The quantity of the Dosa or Dosas eliminated consists of three measures, viz., one Prastha¹ half an adhaka or an adhaka (utmost). The first is the lowest, the second is the intermediate and the last named measure (one Adhaka) should be deemed as the highest quantity (of the Dosa that can be eliminated under the circumstances). 5

प्रस्थे परिस्रुते देया यवागूः स्वल्पतण्डुला द्वे चैवार्धाढके देये तिस्त्रश्चाप्याढके गते ।। ६ ।।

Yavagu (gruel) prepared with a small quantity of rice (Tandula) should be given once. twice or thrice respectively in cases of the eliminated Dosa being a Prastha, half an Adhaka or an Adhaka in quantity. 6

विलेपीमुचिताद् भक्ताच्चतुर्थांशकृतां ततः । दद्यादुक्तेन विधिना क्लिन्नसिक्थामपिच्छिलाम् ।। अस्निग्धलवणां स्वच्छ मुद्द्रयूषयुतां ततः ।। ७ ।। अंशद्वयप्रमाणेन दद्यात् सुस्निग्धमोदनम् । हृद्येनेन्द्रियबोधिना ॥ ८ ॥ ततस्तु कृतसंज्ञेन त्रीनंशान् वितरेद् भोक्तुमातुरायौदनं मृदुम् । ततो यथोचितं भक्तं भोक्तुमस्मै विचक्षणः । लावैणहरिणादीनां रसैर्दद्यात् सुसंस्कृतैः ॥ ९ ॥ ।।

After this a quarter part of the quantity of rice or grain otherwise deemed proper and adequate for the patient, should be cooked in the form of Vilepi. The rice or the grain (used in the preparation) should be well boiled, without the addition of any Sneha (oil or clarified butter) or salt. It should then be (passed through a piece of cloth and ) made non-slimy, and should be taken in the above-prescribed manner with a clear (pure) soup of Mudga pulse. The patient should then be given a diet measuring half the quantity of his usual one. The food, in this case, should be well saturated with any oleaginous substance (Sneha). The meal of the patient in the next stage should consist of well-boiled rice measuring three parts only of his usual diet and should be made palatable to the taste and sufficient to stimulate the senseorgans. The meal in this case, should be taken with the transparent surface of clarified butter (Ghrita-manda). After this period the patient should be allowed to take his full meal with well-prepared soups of venision, etc. 7-9

1. The Prastha measure here means thirteen Palas and a half.

हीनमध्योत्तमेष्वेव विरेकेष विधिः स्मृतः । एकद्वित्रिगुणः सम्यगाहारस्य क्रमो हितः ॥ १० ॥

The above order of taking one-fourth, half and three-fourths of the usual meal applies in cases of deficient, intermediate (moderate), or satisfactory action of a purgative. 10

कफपित्ताधिकान् मद्य-नित्यान् हीनविशोधितान् । पेयाऽभिष्यन्दयेत् तेषां तर्पणादिक्रमो हितः ॥ ११ ॥

Peyas, taken in an aggravated condition of the deranged Pitta, and Kapha, or by a person addicted to drinking habits or subsequent to a deficient exhibition of emetics and purgatives, may give rise to an increased (mucous) secretion (Abhisyanda) in the organism. Tarpana measures (demulcent food) should, therefore, be deemed beneficial in these instances. 11

वेदनालाभनियम शोकवैचित्त्यहेतुभिः । नरानुपोषितांश्चापि विरिक्तवदुपाचरेत् ॥ १२ ॥

Persons who have pain, who are in a deficiency state or are emaciated due to (irregular) regimen, and who have grief and mental distress should be treated (by measures ) as after purgation therapy. 12

आढकार्धाढकप्रस्थ-सङ्ख्या ह्येषा विरेचने । श्लेष्मान्तत्वाद् विरेकस्य न तामिच्छन्ति तद्विदः ।

एको विरेकः श्लेष्मान्तो न द्वितीयोऽस्ति कश्चन ॥ १३ ॥

बलं यत् त्रिविधं प्रोक्तमतस्तत्र क्रमस्त्रिधा तत्रानुक्रममेकन्तु बलस्थ: सकृदाचरेत् ॥

द्विराचरेन्मध्यबलस्त्रीन् वारान् दुर्बलस्तथा । केचिदेवं क्रमं प्राहुर्मन्दमध्योत्तमाग्निषु ।। १४ ।।

An Adhaka, half an Adhaka and a Prastha measure should similarly be the quantity of excretion in connection with a course of purgatives under the three different degrees of its action. But some are of opinion that there may be no fixed quantity of excretion in this case, since purgation should not be considered satisfactory until the Slesma (mucus) of the system has come out.¹ A purgation should be considered satisfactory when the Slesma comes out and in that case no more purgative should be given. The strength (Bala) of a patient has been laid down to be of three degrees, consequently the rules of diet and conduct should be similarly determined. A strong patient should observe the regimen of diet only once, one of middling strength (Madhya-bala) twice, while a weak patient thrice. Certain authorities, however, assert that this order of diet should be observed by the patients with an impaired, intermediate and keen digestion. 13-14

संसर्गेण विवृद्धेऽग्नौ दोषकोपभयाद्भजेत् प्राक्स्वादुतिक्तौ स्निग्धाम्ल-लवणान् कटुकं ततः ।। १५ ।।

स्वाद्वम्ललवणान् भूयः स्वादुतिक्तावतः परम् । स्निग्धरूक्षान् रसांश्चैव व्यत्यासात् स्वस्थवत् ततः ।। १६ ।।

Lest the Dosas might become aggravated by the appetite already kindled by the observation of the rules of diet prescribed for the purpose, the patient should be made to take his meal in the following order at this stage. Sweet and bitter articles of fare should be partaken of at the outset of a meal, followed by oleaginous, acid, saline and pungent food. After this, sweet, acid and saline food should again be taken followed by articles of sweet and bitter tastes. Dry (Ruksa) and demulcent food should be enjoined in succession in the course of a meal. The meals of a healthy person should then be prescribed. 15-16

1.Here a line is not found in the printed edition of the Susruta Samhita, which is evident from Dalhana’s commentary and supported by Srikantha Datta in his commentary on Vrnda. The line is as follows:

“श्लेष्मान्तत्वाद्दिरेकस्य न तामिच्छन्ति तद्दिदः” ।केवलं स्नेहपीतो वा वान्तो यश्चापि केवलम् ।

स सप्तरात्रं मनुजो भुञ्जीत लघु भोजनम् ।। १७ ।।

कृतः सिराव्यधो यस्य कृतं यस्य च शोधनम् । स ना परिहरेन्मासं यावद् वा बलवान् भवेत् ।। १८ ।।

त्रयहं त्र्यहं परिहरेदेकैकं बस्तिमातुरः । तृतीये तु परीहारे यथायोगं समाचरेत् ।। १९ ।।

Light diet should be given for a week after the internal use of a Sneha and after the exhibition of emetics. A patient should observe a proper regimen of recoupment of his health, after having been subjected to a course of blood-letting or treated with a course of Sodhana remedy (purgative) for one month or until he gets back his proper strength. Intervals of three days should be allowed between two successive applications of a Basti and the period of the third interval thus allowed, should be determined according to the requirements of each case.¹ 17-19

तैलपूर्णाममृद्भाण्ड-सधर्माणो व्रणातुराः । स्निग्धशुद्धाक्षिरोगार्त्ता ज्वरातीसारिणश्च ये ।। २० ।।

A patient suffering from an ulcer (Vrana) or recently treated with emulsive measures (Sneha-karma) or cleansing (emetics or purgatives) measures, or afflicted with any affection of the eyes or with fever attended with dysentery (Jvaratisara) resembles a vessel of unbaked clay fitted with oil, i.e., such a patient is greatly liable to the derangement of the Dosas. 20

क्रुध्यतः कुपितं पित्तं कुर्यात् तांस्तानुपद्रवान् । आयास्यतः शोचतो वा चित्तं विभ्रममृच्छति ।। २१ ।।

मैथुनोपगमाद् घोरान् व्याधीनाप्नोति दुर्मतिः। आक्षेपकं पक्षघातमङ्गप्रग्रहमेव गुह्यप्रदेशे श्वयथुं कासश्वासौ च दारुणौ ।

शुक्रवच्वापि रुधिरं सरजस्कं च ।। २२ ।। प्रवर्त्तते ।। २३ ।।

1. Some commentators explain this verse to mean that the patient should observe the rules of diet and conduct (prescribed hereafter) for a period of three days after each application of a Basti, but after the third application the rules of diet and conduct should be determined according to requirements.

An irascible mood or fit of anger (in such a person) agitates his Pitta and produces Pitta originated distempers;¹ physical labour and grief cause a distracted state of the mind; and gratification of sexual desires (in such a state) brings on such dangerious diseases as convulsions hemiplegia stiffness of the limbs, swelling over the external genitalia, cough, dyspnoea and emission of blood-streaked semen and haemorrhage from the vagina. 21-23

लभते च दिवास्वप्नात् तांस्तान् व्याधीन् कफात्मकान् । प्लीहोदरं पाण्डुतां श्वयथुं मोहं तमसा प्रतिश्यायं प्रतिश्यायं ज्वरम् ।। २४ ।।

तथाऽरुचिम् । स्वप्नमेवाभिनन्दति ।। २५ । । सदनमङ्गानामविपाकं चाभिभूतस्तु

Day-sleep under the circumstances gives rise to the affections of the deranged Kapha, viz., enlargement of the spleen (Plihodara), catarrh, anaemia, edema, fever, mental confusion, a sense of physical langour, indigestion, an aversion to food, and cause the patient to become overwhelmed with the quality of Tamas which produces in him a desire for sleep. 24-25

उच्चैः सम्भाषणाद् वायुः शिरस्यापादयेद्रुजम् । आन्ध्यं जाडयमजिघ्रत्वं बाधिर्य मूकतां तथा ।। २६ ।।

हनुमोक्षमधीमन्थमर्दितञ्च सुदारुणम् । नेत्रस्तम्भं निमेषं वा तृष्णां कासं प्रजागरम् ।

लभते दन्तचालञ्च यानयानेन लभते तथैवाङ्गग्रहं घोरमिन्द्रियाणाञ्च विभ्रमम् ।। २८ ।।

चिरासनात् तथा स्थानाच्छ्रोण्यां भवति वेदना । अतिचंक्रमणाद् वायुर्जङ्घयोः कुरुते रुजः ।

सक्थिप्रशोषं शोकं वा पादहर्षमथापि वा ।। २९ ।। तांस्तांश्चान्यानुपद्रवान् ।। २७ ।। छर्दिमूर्च्छाभ्रमक्लमान् ।

Talking in a loud voice aggravates the Vayu and is attended with such grave consequences as pain in the head, blindness, inertness, loss of the faculty of smell, dumbness, deafness, dislocation of the jawbones (Hanumoksa), Adhi-mantha, facial paralysis, paralysis of the eye-balls (Netra-stambha), thirst, cough, insomnia, shaking of the teeth and similar other distempers (due to an aggravation of the Vayu).

Riding (on horse-back, etc.) under the circumstances may cause vomitings, swoons, vertigo, a sense of fatigue, stiffness of limbs, and the serious functional derangements of the sense organs. A long continuance in a sitting posture or bathing may give rise to pain in the region of the pelvis; while on the contrary, excessive walking under the circumstances aggravates the Vayu and is attended with pain in the knee-joints, atrophy of the thighs, edematous swellings of the localities, or the form of disease known as Pada-harsa (sensitiveness in the feet). 26-29

1. The Pitta-origined distempers are thirst, burning sensation, etc.

।।३०।। शीतसम्भोगतोयानां सेवा मारुतवृद्धये । ततोऽङ्गमर्दविष्टम्भ-शूलाध्मानप्रवेपकाः वातातपाभ्यां वैवर्ण्य ज्वरञ्चापि समाप्नुयात् । विरुद्धाध्यशनान्मृत्युं व्याधिं वा घोरमृच्छति । असात्म्यभोजनं हन्याद् बलवर्णमसंशयम् ।। ३१ ।। अनात्मवन्तः पशुवद् भुञ्जते येऽप्रमाणतः। रोगानीकस्य ते मूलमजीर्णं प्राप्नुवन्ति हि ॥ ३२ ॥

The use of cold water and other cold things¹ (such as paste of Sandal, etc.) under the circumstances tends to aggravate the bodily Vayu and brings on an aching pain in the limbs, Sula (gastralgia), stuffedness of the ingested food in the stomach (Vistambha) and distension of the abdomen (Adhmana) and shivering. An undue exposure to the sun and wind produces fever and discolouration of the complexion. The use of any unwholesome and incompatible diet as well as food taken before the complete digestion of the previous meal tends to produce serious distempers and may ultimately result in death. The use of incongenial fare undoubtedly leads to the deterioration of the strength and complexion of the body. A man of irregular and intemperate habits, who eats voraciously like an animal, suffers from indigestion which is the cause (source) of a number of physical distempers. 30-32

1. In place of “शीतसन्भोगतोयाना” Gayadasa reads “शीतभोजनतोयाना” which means the use of cold food and drink. This reading seems to be better.

व्यापदां कारणं वीक्ष्य व्यापत्स्वेतासु बुद्धिमान् । प्रयतेतातुरारोग्ये प्रत्यनीकेन हेतुना ।। ३३ ।।

In all these instances the real cause of the distress should be first ascertained, which should be then remedied with proper antidotal measures and remedies. 33

विरिक्तवान्तैर्हरिणैणलावका: शशश्च सेव्यः समयूरतित्तिरिः । सपष्टिकाश्चैव पुराणशालयस्तथैव मुद्गा लघु यच्च कीर्त्तितम् ॥ ३४ ॥

Articles of Diet: A diet consisting of cooked Sasti grain (Tandula) or matured sali rice, Mudga pulse as well as (the soup of the flesh of) an Ena, Lava, hare, peacock, Tittiri, or deer, and such other light food should be given to a patient after the exhibition of emetics and purgatives. 34

इति सुश्रुत संहितायां चिकित्सितस्थाने आतुरोपद्रवचिकित्सितं नामैकोनचत्वारिंशोऽध्यायः ।। ३९ ।।

Thus ends the Thirty-ninth Chapter of the Chikitsa Sthana in the Susruta Samhita which deals with the treatment of distressing symptoms which are manifested in a patient.


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