चत्वारिंशोऽध्यायः अथातोऽतीसाप्रतिषेधं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the (causes, symptoms and) medical treatment of diarrhoea, etc. (Atisara-pratisedha).1
Causes of Diarrhea – Atisara Nidana
भोजनैः ॥२॥ गुर्वतिस्निग्धरूक्षोष्ण-द्रवस्थूलातिशीतलैः विरुद्धाध्यशनाजीर्णैरसात्म्यैश्चापि स्नेहादैयरतियुक्तैश्च मिथ्यायुक्तैर्विषाद् भयात् । शोकाद् दुष्टाम्बुमद्यातिपानात् सात्म्यर्तु पर्ययात् ॥ ३ ॥ जलाभिरमणैर्वेग – विघातैः क्रिमिदोषतः । नृणां भवत्यतीसारो लक्षणं तस्य वक्ष्यते ॥ ४ ॥
Causes of Atisara — The excessive use of extremely heavy (hard to digest), oleaginous, dry, hot, cold, fluid, thick, and incompatible articles of food, eating irregularly and at improper time (or unaccustomed articles of fare), indigestion, eating before the digestion of the previous meal, excessive use or misuse of any lardacious substances, etc. (Sneha, Sveda, etc.), use of any poison, fright, grief, drinking impure water, the excessive drinking of liquor, change of season of physical contrarieties, indulgence in aquatic sports voluntary repression of any natural urging (of the body) or germination of any natural urging (of the body) or germination of parasites in the intestines are the causes which bring on an attack of diarrhoea (Atisara) the sym where of will be dealt with presently. 2-4.
Diarrhoea Pathology – Atisara Samprapti
संशम्यापां धातुरन्तः कृशानुं वर्चोमिश्रो मारुतेन प्रणुन्नः । वृद्धोऽतीवाधः सरत्येष यस्माद् व्याधिं घोरं तं त्वतीसारमाहुः ॥ ५ ॥ एकैकश: सर्वशश्चापि दोषैः शोकेनान्यः षष्ठ आमेन चोक्तः । केचित् प्राहुर्नैकरूपप्रकारं नैवेत्येवं काशिराजस्त्ववोचत् ॥ ६॥ दोषावस्थास्तस्य नैकप्रकाराः काले काले व्याधितस्योद्भवन्ति ॥७॥
Pathology — The liquid part ( Ap-dhatu) of the body, if aggravated and carried downward by the bodily Vayu, impairs the fire in the stomach (fire of digestion) and mixing with the fecal matter, is painfully and constantly emitted through the anus. This dangerous disease is named Atisara from the constant oozing out (Ati and Sarana) of the liquid fecal matter from the anus. It is usually clasified into six different types, viz., those due to the predominance of the deranged bodily Dosas separately involved there in, that due to the concerted action of the three Dosas, one due to grief and that due to the indigested mucous accumulations (Ama) in the intestines. Some authorities hold that Atisara is of many kinds but the holy Dhanvantari, on the contrary, hold that it is not so but that the physical conditions of a diarrohic patient undergo changes and become manifold. 5-7.
Diarrhoea Premonitory Symptoms
हृन्नाभिपायूदरकुक्षितोद-गात्रावसादानिलसन्निरोधाः । विट्सङ्गः आध्मानमथाविपाको भविष्यतस्तस्य पुरःसराणि ॥ ८ ॥
Premonitory Symptoms – Piercing pain in the regions of the heart, umbilicus, rectum, abdomen and in the Kuksi ( sides of the abdomen), a sense of numbness in the limbs, stoppage or supression of flatus and of stool, distension of the abdomen, and indigestion are the premonitory symptoms of the disease. 8.
Symptoms of Vataja, Pittaja, Kaphaja and Tri-dosaja Atisara
शूलाविष्टः सक्तमूत्रोऽन्त्रकूजी स्त्रस्तापानः सन्नकट्यरुजङ्घः । वर्चो मुञ्चत्यल्पमल्पं सफेनं रूक्षं श्यावं सानिलं मारुतेन ॥ ९ ॥ दुर्गन्ध्युष्णं वेगवन्मांसतोय-प्रख्यं भिन्नं स्विन्नदेहोऽतिरुग्नः । पित्तात् पीतं नीलमालोहितं वा तृष्णामूर्च्छादाहपाकज्वरार्तः ॥ १० ॥ तन्द्रानिद्रागौरवोत्क्लेशसादी वेगाशङ्की सृष्टविट्कोऽपि भूयः । शुक्लं सान्द्रं श्लेष्मणा श्लेष्मयुक्तं भक्तद्वेषी निःस्वनं हृष्टरोमा ॥ ११ ॥तन्द्रायुक्तो मोहसादास्यशोषी वर्चः कुर्यान्नैकवर्णं तृषार्तः । सर्वोद्भभूतेः सर्वलिङ्गोपपत्तिः कृच्छ्रश्चायं बालवृद्धेष्वसाध्यः ॥ १२ ॥
Symptoms of Vataja, Pittaja, Kaphaja and Tri-dosaja Types – The Vayu-origined type of the disease is marked by sula (colic), suppression of urine, rumbling sound in the intestines, looseness (constant movement in the intestines) of the abdominal (Apana) wind, agony feeling in the waist, in the thighs and in the legs, and frequent emissions with flatus of a scanty, frothy, dry (Ruksa) brown-coloured (yellowish black ) stool. The specific features of the Pitta-orgined type are that the stool is fetid, hot, yellow, blue or slightly red-coloured, or resembles the washing of meat, and is emitted with sharp or acute force and is accompained by thirst, epileptic fits ( fainting ), burning sensation, perspiration, suppuration and inflammation (Paka) of the affected organs, and fever. In the Kapha origined type of the disease the stool becomes loose and constant, gets mixed with the lump of mucus and looks white. The stool comes out without any sound. A sense of constant urging is complained of and each motion only creates the apprehension of a fresh one in the mind. The patient becomes drowsy or sleepy, and feels a sense of heaviness in the limbs, nausea, disrelish for food, horripalation and lassitude. The symptoms which mark a case of Tri-dosaja type (due to the concerted action of the three simultaneously deranged bodily Dosas) are drowsiness, swoon, lassitude, dryness of the mouth, thirst and a varied colour of the stools. A case of Tri-dosaja type, if attended with all the symptoms, is very hard to cure and if occurring in an infant, or an old person, is scarcely amenable to medical treatment. 9-12.
Symptoms of Sokaja and Amaja Atisara
तैस्तैर्भावैः शोचतोऽल्पाशनस्य वाष्पावेगः पक्तिमाविध्य जन्तोः । कोष्ठं गत्वा क्षोभयन् यस्य रक्तं तच्चाधस्तात् काकणन्तीप्रकाशम् ॥ १३ ॥ वर्चोमिश्रं निष्पुरीषं सगन्धं निर्गन्धं वा सार्यते तेन कोष्ठात् । शोकोत्पन्नो दुश्चिकित्स्योऽतिमात्रं रोगो वैद्यैः कष्ट एष प्रदिष्टः ॥ १४ ॥ आमाजीर्णोपद्रुताः क्षोभयन्तः कोष्ठं दोषाः सम्प्रदुष्टाः सभक्तम् । नानावर्णं नैकशः सारयन्ति कृच्छ्राज्जन्तोः षष्ठमेनं वदन्ति ॥ १५ ॥ Symptoms of Sokaja and Amaja Atisara – The suppressed tears of a bereaved person of sparing diet, on quenching the digestive fire, reach down into the Kostha (intestines) and there freely mix with and vitiate the local blood which becomes dark-red like Kakananti (Gunja). It then passes through the rectum, charged with a peculiar fetor imparted to it by the fecal matter in case of its combination with the latter or without any fetid smell, when passing out unmixed. Such an attack ushered in by the grief of bereavement of a person is accordingly considered very hard to cure. The local bodily Dosas in the Kostha (abdomen) are aggravated and deranged when they come in contact with the Ama (unassimilated chyle), and are brought down into the Kostha (bowels), where they are more agitated and emitted in combination with the undigested fecal matter in various ways, and are attended with pain and characterised by a variety of colour. This is the sixth type of Atisara. 13-15.
Symptoms of Ama and Pakva Atisara
संसृष्टमेभिर्दोषैस्तु न्यस्तमप्स्ववसीदति । पुरीषं भृशदुर्गन्धिं विच्छिन्नञ्चामसंज्ञितम् ॥ १६ ॥ एतान्येव तु लिङ्गानि विपरीतानि यस्य तु । लाघवञ्च मनुष्यस्य तस्य पक्कं विनिर्दिशेत् ॥ १७ ॥
Symptoms of Ama and Pakva Atisara — A case of Atisara (diarrhoea) would be said to be in the Ama (acute) state, if the stool of the patient suffering from any of the foregoing Dosas would be found to sink in water and to emit a very fetid smell and to pass in broken jets (D.R. — to be slimy ). A contrariety of the preceding symptoms and a sense of lightness of the body and in the affected cavity would indicate that the disease has passed an acute stage and it is then called Pakva (chronic) Atisara. 16-17.
Diarrhoea Prognosis
सर्पिर्मेदोवेसवाराम्बुतैलमज्जा क्षीरं क्षौद्ररूपं स्रवेद् यत् । मञ्जिष्ठाभं मस्तुलुङ्गोपमं वा विस्त्रं शीतं प्रेतगन्ध्यञ्जनाभम् ॥ १८ ॥ राजीमद् वा चन्द्रकैः सन्ततं वा पूयप्रख्यं कर्दमाभं तथोष्णम् । हन्यादेतद् यत् प्रतीपं भवेच्च क्षीणं हन्युश्चोपसर्गाः प्रभूताः ॥ १९ ॥ असंवृतगुदं क्षीणं दुरा – ( ध्मात ) – त्मानमुपद्रुतम् । गुदे पक्के गतोष्माणमतीसारकिणं त्यजेत् ॥ २० ॥
Prognosis— If the colour of the stool (in a case of Atisara) resembles that of clarified butter, fat the washings of Vesavara, oil, bone marrow, milk, honey, Manjistha, brain-matter, or Rasanjana or if the stool is cold or hot to the touch, or if it is charged with a fleshy or fetid smell, or marked with lines or specks of variegated colours, or if it looks like pus or clay, or if just the opposite or reverse symptoms or other distressing symptoms would be exhibited, the case is likely to end fatally in case the patient be weak. A patient suffering from an attack of Atisara would be given up (as incurable) if he be weak, if the orifice of his anus becomes suppurated and cannot be closed, if there be distension of the abdomen (D.R.-if the patient be not selfrestrained), if there be distressing symptoms and if the patient be found destitute of thermal heat. 18-20.
शरीरिणामतीसारः सम्भूतो येन केनचित् | दोषाणामेव लिङ्गानि कदाचिन्नातिवर्तते ॥ २१ ॥ स्नेहाजीर्णनिमित्तस्तु बहुशूलप्रवाहिकः । विसूचिकानिमित्तस्तु चान्योऽजीर्णनिमित्तजः । विषार्श: क्रिमिसम्भूतो यथास्वं दोषलक्षणः ॥ २२ ॥ आमपक्वक्रमं हित्वा नातिसारे क्रिया यतः । अतः सर्वेऽतिसारास्तु ज्ञेयाः पक्कामलक्षणैः ॥ २३ ॥
An attack of Atisara ushered in by whatsoever cause, is sure to be marked by the specific symptoms of the deranged bodily Dosa or Dosas complicated with it. All cases of Atisara whether due to the indigestion of any oleaginous food for drink (Ghrita, oil, etc.), whether with (or without) the symptoms of Pravahika and the accompanying colic, as well as those due to Visucika or any other kind of indigestion as also those due to the effect of any poison (affecting the digestive system), haemorrhoids ( Arsas ), or worms in the intestines — all of them are marked by the symptoms of the specific Dosa involved therein. The treatment of Atisara varies according to its acute or matured stage, the characteristic symptoms of those therefore are to be carefully observed and noted in each case under treatment. 21-23.
तत्रादौ लङ्घनं कार्यमतिसारेषु देहिनाम् । ततः पाचनसंयुक्तो यवाग्वादिक्रमो हितः ॥ २४ ॥ ॥ २५ ॥ अथवा वामयित्वाऽऽमे शूलाध्माननिपीडितम् । पिप्पलीसैन्धवाम्भोभिर्लङ्घनाद्यैरुपाचरेत् कार्यञ्च वमनस्यान्ते प्रद्रवं लघुभोजनम् । खडयूषयवागूषु पिप्पल्याद्यञ्च योजयेत् ॥ २६ ॥ अनेन विधिना चामं यस्य वै नोपशाम्यति । हरिद्रादिं वचादिं वा पिबेत् प्रातः स मानवः ॥ २७ ॥ आमातीसारिणां कार्यं नादौ संग्रहणं नृणाम् । तेषां दोषा विबद्धाः प्राग्जनयन्त्यामयानिमान् । प्लीहपाण्ड्वामयानाह-मेहकुष्ठोदरज्वरान् शोफगुल्मग्रहण्यर्श:-शूलालसकहृद्ग्रहान् । ॥ २८ ॥
The patient should be kept without food as soon as the premonitory symptoms of Atisara would appear, and then the dietic gruels (Yavagu) prepared with the admimxture of digestive drugs should be given in their proper order. In a case marked by colic and flatulent distension of the abdomen fasting should be first advised. And then vomiting should be induced with draughts of water mixed with powdered Pippali and Saindhava salt. A light diet in the shape of a Khada-yusa, Yavagu, etc., prepared with the admixture of the drugs of the Pippalyadi group, should then be prescribed after the cessation of vomiting. A decoction of the drugs of the Haridradi, or Vacadi group should be taken in the morning where the preceding remedies would fail to relieve mucous accumulations in the intestines (Amatisara). No astringent or curative medicine in the acute or immature (Ama) stage of the disease should be administered in as much as by obstructing the passage of the Dosas it might bring on an attack of enlarged spleen, chlorosis, distension of the abdomen with suppression of stool and urine, Meha (urinary complaints ), Kustha ( cutaneous affections), ascites, fever, oedematous swellings of the limbs, Gulma (abdominal gland, etc.) diarrhoea, piles colic, Alasaka and catching pain at the heart. 24-28.
सशूलं बहुश: कृच्छ्राद् विबद्धं योऽतिसार्यते । दोषान् सन्निचितान् वाथ पथ्याभिः सम्प्रवर्तयेत् ॥ २९ ॥ योऽतिद्रवं प्रभूतञ्च तस्यादौ वमनं कुर्यात् पुरीषमतिसार्यते । पश्चाल्लङ्घनपाचनम् ॥ ३० ॥ स्तोकं स्तोकं विबद्धं वा सशूलं योऽतिसार्यते । अभयापिप्पलीकल्कैः सुखोष्णैस्तं विरेचयेत् ॥ ३१ ॥ आमे च लङ्घनं शस्तमादौ पाचनमेव वा । योगाश्चात्र प्रवक्ष्यन्ते त्वामातीसारनाशनाः ॥ ३२ ॥
Purging should be induced with Haritaki in case marked by constant and scanty motions (of mucus and) attended with griping and pain (Sula) or by an incarceration of the deranged bodily Dosas (in the intestines). Emetics should be first exhibited and followed by fastings and digestive or assimilative (Pacana) remedies in a case marked by watery and copious motions. Powdered Haritaki and Pippali with tepid water should be administered for purgative purposes in a case marked by scanty emissions of stool at times attended with pain and colic (Sula). Fasting is the first remedy to be prescribed in case of Ama (acute) Atisara, or in the alternative, digestive remedies should be prescribed. The recipes of digestive medicinal compounds which are curative in the disease under discussion (Amatisara) are described below. 29-32.
Twenty different Recipes for Amati-sara
कलिङ्गातिविषाहिङ्ग-सौवर्चलवचाभयाः । देवदारुवचामुस्ता-नागरातिविषाभयाः ॥३३॥ अभया धान्यकं मुस्तं वालकं बिल्वमेव च । मुस्तं पर्पटकं शुण्ठी वचा प्रतिविषाऽभयाः ॥ ३४ ॥ अभयाऽतिविषा हिङ्गु वचा सौवर्चलं तथा । चित्रकं पिप्पलीमूलं वचा कटुकरोहिणी ॥ ३५ ॥ महौषधम् । पाठा वत्सकबीजानि हरीतक्यो मूर्वा निर्दहनी पाठा त्र्यूषणं गजपिप्पली ॥ ३६ ॥ सिद्धार्थका भद्रदारू शताह्वा कटुरोहिणी । एला सावरकं कुष्ठं हरिद्रे कौटजा यवाः ॥ ३७ ॥ मेषशृङ्गी त्वगेले च कृमिघ्नं वृक्षकाणि च । वृक्षादनी वीरतरुबृहत्यौ द्वे सहे तथा ॥३८ ॥ अरलुत्वक् तैन्दुकी च दाडिमी कौटजी शमी । पाठा तेजोवती मुस्तं पिप्पली कौटजं फलम् ॥ ३९ ॥ पटोलं दीप्यको बिल्वं हरिद्रे देवदारु च। विडङ्गमभया पाठा शृङ्गवेरं घनं वचा ॥ ४० ॥ सैन्धवं कटुरोहिणी । वचाबिल्वशलाटु च ॥४१॥ वचा वत्सकबीजानि हिङ्गु वत्सकबीजानि नागरातिविषे मुस्तं पिप्पल्यो वात्सकं फलम् । महौषधं प्रतिविषा प्रयोज्या विंशतिर्योगा: श्लोकार्धविहितास्त्विमे । मुस्तञ्चेत्यामपाचनाः ॥ ४२ ॥ धान्याम्लोष्णाम्बुमद्यानां निःक्वाथान् वा पिबेदेषां सुखोष्णान् साधुसाधितान् । निखिलेनोपदिष्टोऽयं पिबेदन्यतमेन वा ॥ ४३ ॥ विधिरामोपशान्तये ॥ ४४ ॥
Twenty different Recipes for Amati-sara— (1) Deva-daru, Vaca, Musta, Nagara, Ativisa, and Abhaya; or of (2) Kalinga (indrayava), Ativisa, Hingu, Sauvarcala-salt, Vaca and Abhaya or of ( 3 ) Abhaya (D.R.- Nagana), Dhanyaka, Musta, Balaka and Bilva; or of (4) Musta, Parpataka, Sunthi, Vaca, Ativisa and Abhaya; or of (5) Abhaya, Ativisa, Hingu, Vaca, and Sauvacala-Salt; or of (6) Citraka, Pippali, mula, Vaca, Katuka-rohini or of (7) Patha, Vatsaka seeds (Indra-yava), Haritaki and Mahausadha ( Sunthi), of (8) Murva, Nirdahani, (Citraka), Patha, Tryusana ( Tri-katu) and Gaja-pippali; or of (9) Siddharthaka, Bhadra-daru, Satahva and Katu-rohini; or of (10) Ela, Savaraka (Lodhra), Kustha, the two sorts of Haridra, Kutaja – seeds (Indra-yava); or of (11) Mesa-srngi, Tvaka, Ela, Krmighna (Vidanga) and Vrksaka (Indra-yava); or of (12) Vrksadani, Virataru, the two kinds of Brhati and the two kinds of Saha (Mudga-parni and Masa-parni); or of ( 13 ) barks of Eranda, Tinduka, Dadima, Kutaja and of Sami; or of (14) Patha, Tejovati, Musta, Pippali and Indrayava; or of (15) Patola, Dipyaka (Yamani), Bilva the two kinds of Haridra and Deva-daru; or of (16) Vidanga, Abhaya, Patha, Srngavera, Ghana (Musta) and Vaca; or of (17) Vaca, Vatsaka-seeds (Indra-yava), Saindhava and Katu-rohini; or of (18) Hingu, Vatsaka-seeds (Indrayava), Vaca and dried green Bilva; or of (19) Nagara, Ativisa, Musta, the two kinds of Pippali and Vatsaka-seeds (Indra-yava); or of (20) Mahausadha, Prati-visa and Musta- these are the Twenty different recipes of the remedies which are digestive (of the mucous accumulations) in cases of Ama-Atisara and should be administered (in the shape of powder) with Dhanyamla (Kanjika), tepid water or wine, or their decoctions in luke-warm state should be used. This is a detailed list of the best remedies in cases of Ama-Atisara.33-44.
पयस्युत्क्वाथ्य मुस्तानां विंशतिं त्रिगुणाम्भसि । क्षीरावशिष्टं तत्पीतं हन्त्यामं शूलमेव च ॥ ४५ ॥ हरीतकीमतिविषां हिङ्ग सौवर्चलं वचाम् । पिबेत् सुखाम्बुना जन्तुरामातीसारपीडितः ॥ ५६॥ पटोलं दीप्यकं बिल्वं वचापिप्पलिनागरम् । मुस्तं कुष्ठं विडङ्गञ्च पिबेद् वाऽपि सुखाम्बुना ॥ ४७ ॥ शृङ्गवेरं गुडूचीञ्च पिबेदुष्णेन वारिणा ॥ ४८ ॥
Twenty number of Musta should be boiled in one part of milk and three parts of water, when watery part is burnt and only milk part is remained then the same boiled liquid substance is used as a drink which removes ana Dosa pain (Sula). A compound of Haritaki, Ativisa, Hingu, Sauvarcala, and Vaca should be taken with tepid water in cases of Ama-Atisaras.Similarly a compound of Patola, Yamani, Bilva, Vaca, Pippali, Nagara, Musta, Vidanga, and Kustha, or that of Sunthi and Guduci should be taken with tepid water. 45-48.
लवणान्यथ पिप्पल्यो विडङ्गानि हरीतकी | चित्रकं शिंशपा पाठा शाङ्गेष्टा लवणानि च ॥ ४९ ॥ हिङ्गु वृक्षकबीजानि लवणानि च भागशः । हस्तिदन्त्यथ पिप्पल्यः कल्कावक्षसमौ स्मृतौ ॥ ५० ॥ वचा गुडूचीकाण्डानि योगोऽयं परमो मतः ॥५१॥ एते सुखाम्बुना योगा देयाः पञ्च सतां मताः ॥ ५२ ॥ The five following compounds separately composed (1) of kinds of officinal salt, Pippali, Vidanga and Haritaki; or of (2) CitrakaSimsapa, Patha, Sarngasta and all kinds of officinal salt; or of (Hingu, Vrksaka-seeds (Indra-yava) and all kinds of officinal salt taken in equal parts; or (4) of Naga-danti and Pippali, weighing two Tolas; or (5) of Vaca and Guduci-stems, would be found beneficial, if taken with tepid water. 48-52.
निवृत्तेष्वामशूलेषु यस्य न प्रगुणोऽनिलः । ॥ ५४॥ स्तोकं स्तोकं रुजामच्च सशूलं योऽतिसार्यते ॥ ५३ ॥ सक्षारलवणैर्युक्तं मन्दाग्निः प्रपिबेद् घृतम् । क्षीरनागरचाङ्गेरी – कोलदध्यम्लसाधितम् सर्पिरच्छं पिबेद् वापि शूलातिसारशान्तये । दक्षा तैलघुतं पक्कं सव्योषजातिचित्रकैः । सबिल्वपिप्पलीमूल-दाडिमैर्वा रुगन्वितैः ॥ ५५ ॥ निखिलो विधिरुक्तोऽयं वातश्लेष्मोपशान्तये । तीक्ष्णोष्णवर्ज्यमेनन्तु विदध्यात् पित्तजे भिषक् ॥ ५६ ॥
Clarified butter mixed with Saindhava-salt and Yava-ksara should be given to a patient of weak digestive power in a case in which the Vayu has not been restored to its normal condition in spite of the subsidence of the intestinal Sula (griping) and which is marked by scanty (but repeated) motions passed with pain. The Ghrita duly cooked with Nagara, Cangeri and Kola ( Badara) and with milk’, and (Dadhi) and Amla (Kanjika), or simply the transparent part of clarified butter should be taken as a relief for Atisara attended with Sula (pain). In the alternative, clarified butter mixed with (an equal quantity of) oil and duly coked with curd, together with a paste of Tri-katu, Jati (flower) and Citraka or with that of Pippali-mula, Bilva, Dadima-bark and Kustha should be given. All these are the remedies to be employed in a type of Atisara due to the action of Vata or of Slesma; and all the foregoing remedies with the exception of those of keen and heat-making potency, may be used in the Pittaja type of the disease. 53-56.
यथोक्तमुपवासान्ते बलयोरंशुमत्याञ्च प्रशस्यते । यवागूश्च श्वदंष्ट्राबृहतीषु च॥ ५७॥
1. We have the recipe of this Ghrita in Caraka Samhita also. But there we find Ksara in place of Ksira and that appears to be the better reading. See Chapter XIX, under Cangeri Ghrita, Caraka Samhita.
शतावर्याञ्च संसिद्धा: सुशीता: मधुसंयुताः । मुद्रादिषु च यूषाः स्युर्द्रव्यैरेतैः सुसंस्कृताः । मृदुभिर्दीपनैस्तिक्तैर्द्रव्यैः स्यादामपाचनम् ।। ५८ ।। हरिद्रातिविषा पाठा वत्सबीजं रसाञ्जनम् । रसाञ्जनं हरिद्रे द्वे बीजानि कुटजस्य च ॥ ५९॥ पाठा गुडूची भूनिम्बस्तथैव कटुरोहिणी । एतैः श्लोकार्धनिर्दिष्टैः क्वाथाः स्युः पित्तपाचनाः ॥ ६० ॥
Fasting as already advised should be first observed and it should be broken with gruels (Yavagu) duly cooked with the two kinds Bala, or with Ansu-mati, or Svadamstra and Brhati, or Satavari made cold and mixed with honey. The soup (Yusa) of Mudga duly cooked with the drugs of appetising property would cure (the Dosa in) the acute stage (ama-dosa) of the stool. Decoctions of Haridra, Ativisa, Patha, Vatsa-seeds (Indra-yava) and Rasanjana; or of Rasanjana, the two kinds of Haridra and Kutaja-seeds (Indra-yava; or of Patha, Guduci Bhu-nimba and Katu-rohini would prove extremely useful in correcting (Pacana) the deranged Pitta. 57-60.
Six Yogas for Pittaja-Atisara
मुस्तं कुटजबीजानि भूनिम्बं सरसाञ्जनम् । दार्वी दुरालभा बिल्वं वालकं रक्तचन्दनम् ॥ ६१ ॥ चन्दनं वालकं मुस्तं भूनिम्बं सदुरालभम् । मृणालं चन्दनं रोधं नागरं नीलमुत्पलम् ॥ ६२ ॥ पाठा मुस्तं हरिद्रे द्वे पिप्पली कौटजं फलम् । फलत्वचं वत्सकस्य शृङ्गवेरं घनं वचा | षडेतेऽभिहितो योगाः पित्तातीसारनाशनाः ॥ ६३ ॥
Six Yogas for Pittaja-Atisara — Any one of the six decoctions respectively prepared with Musta, Kutaja – seeds ( Indra-yava), Bhunimba and Rasanjana; or with Darvi, Duralabha, Bilva and red Candana; or with Candara, Balaka, Musta, Bhunimba, Duralabha; or with Mrnala, Candana, Rodhra, Nagara and Nilotpala; or with patha, Musta the two kinds of Haridra, Pippali and Kutaja seeds or with the seeds and barks of Vatsaka, Srngavera and Vaca mixed with clarified butter should be regarded as good remedies for the Pittaja type of Atisara. 61-63.
बिल्वशक्रयवाम्भोद वालकातिविषाकृतः । कषायो हन्त्यतीसारं सामं पित्तसमुद्भवम् ॥ ६४॥ मधुकोत्पलबिल्वाब्द-हीबेरोशीरनागरैः । कृतः क्वाथो मधुयुतः पित्तातीसारनाशनः ॥६५॥
A case of Pittaja-Atisara in its acute (Ama) stage would yield to the use of a decoction of (unripe). Bilva, Indra-yava, Ambhoda (Musta), Valaka and Ativisa. A decoction of Yasti- madhu, Utpala, Bilva, Amra, Hrivera, Usira and Nagara mixed with honey prove curative in the case of discussion. 64-65.
यदा पक्कोऽप्यतीसारः सरत्येव मुहुर्मुहुः । ग्रहण्या मार्दवाजन्तोस्तत्र संस्तम्भनं हितम् ॥ ६६ ॥ समङ्गा धातकीपुष्पं मञ्जिष्ठा लोध्रमुस्तकम् । शाल्मलीवेष्टकं रोधं वृक्षदाडिमयोस्त्वचौ ॥ ६७ ॥ आम्रास्थिमध्यं लोध्रञ्च बिल्वमध्यं प्रियङ्गवः | मधुकं शृङ्गवेरञ्च दीर्घवृन्तत्वगेव च ॥ ६८ ॥ चत्वार एते योगाः स्युः पक्कातीसारनाशनाः । उक्ता य उपयोज्यास्ते सक्षौद्रास्तण्डुलाम्बुना ॥ ६९ ॥
Astringent or constipating (Samstambhana) remedies should be employed in a case of the chronic (Pakva) Atisara marked by dullness of the Grahani, viz., the digestive fire and by constant motions. Any of the four following medicinal compounds, viz., Samanga, Dhatakiflower, Manjistha, Lodhra and Musta; or of Salmali-Vestaka, Rodhra and the bark of Vrksaka (Kutaja) and of Dadima; or of the stone of Amra, Lodhra, the inner pulp of (unripe ) Bilva and Priyangu; of or Yasti-madhu, Srngavera and the bark of Dirgha-vrnta (Syonaka) should be taken with honey and the washings of rice in cases of chronic (Pakva) Atisara. 66-69.
मौस्तं कषायमेकं वा पेयं मधुसमायुतम् । लोध्राम्बष्ठाप्रियङ्ग्वादीन् गणानेवं (नवान्) प्रयोजयेत् ॥ ७० ॥ पद्मां समङ्गां मधुकं बिल्वजम्बूशलाटु च। पिबेत् कच्छुरामूलकल्कं तण्डुलतोयेन पयस्या चन्दनं पद्मा सिता मुस्ताब्जकेशरम् । पक्कातीसारं योगोऽयं जयेत् पीतः सशोणितम् ॥ ७३ ।।
The decoction of Musta alone should be taken with honey in the case under discussion, or a decoction of any of the nine Ganas, viz., the Lodhradi, Ambasthadi, or Priyangvadi group, etc. (see Chapter XXXVIII Sutra-Sthana) should be employed. Similarly, the decoction of Padma, Samanga, Yasti-madhu and dried Bilva and Jambu fruits should be taken with the washings of rice mixed with honey. A paste of the root of Kacchura weighing an Udumbara (Two Tolas) should be similarly taken (with the same vehicles). A case of Pakvatisar marked by bloody stool or by emission of blood (from the intestines) would yield to the use of the decoction of Payasya, Candana, Padma (Bhargi), Sita (Sugar), Musta and the polens of lotus. 70-73.
सक्षौद्रमगदङ्करम् ॥ ७१ ॥ वाऽप्युदुम्बरफलोपमम् ॥ ७२ ॥ मधूक्षितं निरामरूपं शूलार्तं लङ्घनादैयश्च कर्षितम् । नरं रूक्षमवेक्ष्याग्निं सक्षारं पाययेद् घृतम् ॥ ७४ ॥ बलाबृहत्यंशुमती-कच्छुरामूलसाधितम् । समधुकं पिबेच्छूलैरभिद्रुतः ॥ ७५ ॥ दावबिल्वकणाद्राक्षा-कटुकेन्द्रयवैर्घृतम् । साधितं हन्त्यतीसारं वातपित्तकफात्मकम् ॥ ७६ ॥ ( दना चाम्लेन सम्पक्कं सव्योषाजाजि चित्रकम् । सचव्यपिप्पलीमूलं दाडिमैर्वा रुगर्दितः ॥ ) पयो घृतञ्च मधु च पिबेच्छूलैरभिद्रुतः । सिताजमोदकट्वङ्ग-मधुकैरवचूर्णितम् ॥७७॥
Application of Ghrita-Clarified butter with Yava-ksara should be given to a patient with due regard to the state of his digestive power, after being treated with fasting, etc. if he still be found to be affected with pain (Sula) and dryness and if the stool would be found to be free from mucus i.e., in a case of Pakvatisara. The colic (in a case of Atisara) is relieved by taking (a potion of clarified butter duly cooked with) Bala, Brhati, Amsu-mati and Kacchura-roots mixed with a little honey and Yasti-madhu (as an after-throw). Clarified butter duly cooked with Darvi, Bilva, Kana (Pippali), Draksa, Katuka and Indra-yava would prove curative in a case of Atisara due to the action of the Vaata, Pitta and Kapha (jointly or separetely). A draught of milk, honey and clarified butter (in equal parts) mixed with sugar, Ajamoda, Katvanga and Yastimadhu (as an after-throw) would relieve the griping pain (Sula) in the intestines (in a case of Atisara). 74-77.
Putapaka Preparations
अवेदनं सुसम्पक्कं दीप्ताग्ने: सुचिरोत्थितम् । नानावर्णमतीसारं त्वपिण्डं दीर्घवृन्तस्य काश्मरीपद्मपत्रैश्चावेष्ट्य मृदाऽवलिप्तं स्विन्नमुद्धृत्य निष्पीड्य रसमादाय तं ततः ॥ ८० ॥ शीतं मधुयुतं कृत्वा पाययेतोदरामये । जीवन्तीमेषशृङ्ग्यादिष्वेवं द्रव्येषु साधयेत् ॥ ८१ ॥ तित्तिरि लुञ्चितं सम्यक् निष्कृष्टान्त्रन्तु पूरयेत् । न्यग्रोधादित्वचां कल्कैः पूर्ववच्चावकूलयेत् ॥ ८२ ॥ रसमादाय तस्याथ सुस्विन्नस्य समाक्षिकम् | शर्करोपहितं शीतं पाययेच्चोदरामये ।। ८३ ॥ पुटपाकैरुपाचरेत् ॥ ७८ ॥ पद्मकेसरसंयुतम् । सूत्रेण तं दृढम् ॥ ७९ ॥ सुकृतमङ्गारेष्ववकूलयेत् । लोध्रचन्दनयष्ट्याह्व-दार्वीपाठासितोत्पलान् । तण्डुलोदकसम्पिष्टान् दीर्घवृन्तत्वगन्वितान् ॥ ८४ ॥ पूर्ववत् कूलितात् तस्माद्रसमादाय शीतलम् । मध्वाक्तं पाययेच्चैतत् कफपित्तोदरामये ॥ ८५ ॥ एवं प्ररोहै: कुर्वीत वटादीनां विधानवत् । पुटपाकान् यथायोगं जाङ्गलोपहितान् शुभान् ॥ ८६ ॥
Putapaka Preparations — A case of long-standing (chronic) Atisara marked by stools of various colours and a keen digestion but unattended with any sort of pain or complication should be remedied with medicicnes prepared in the maner of Putapaka preparation (described below). The barks of Dirgha-vrnta (Syonaka), and polens of lotus should be pasted together and wrapped up in leaves of Kasmari or of Padma (lotus) with their ends tied with string or thread (D.R.—— Kusa). The cover should be then coated with a plaster of clay and duly scorched in the fire of (Smokeless) charcoal (of Khadira). When well cooked, it should be taken out and the juice, squeezed out of its contents. This juice should be cooled and administered in combination with honey in a case of Atisara. Similar preparations of the drugs known as Jivanti and Mesa-srngi, etc., may also be used in the same way. The skin of the Tittira bird should be peeled off and a paste of the drugs of the Nyagrodhadi group should be stuffed into its belly after it has been previously drawn. After this is should be duly stitched up and cooked (scorched) in the fire in the above manner. The juice should then be squeezed out therefrom and administered, when cool, with the admixture of honey and sugar in a case of Atisara. The drugs known as Lodhra, Candana, Yasti-madhu, Darvi, Patha, Sita (sugar), Utpala and the barks of Dirgha-vrnta pasted together with the washing of rice should be duly scorched in the fire in the above manner (of a Putapaka). The juice pressed out of its contents and taken with honey, when cold, proves curative in cases of Atisara due to the action of the deranged Pitta and Kapha. Similar preparations may be made of the aerial roots of Vata etc. and may be advantageously prescribed with the soup of the flesh of any Jangala bird (such as Tittira, Kapinjala etc.). 78-86.
बहुश्लेष्म सरक्तञ्च मन्दवातं चिरोत्थितम् । कौटजं फाणितञ्चापि हन्त्यतीसारमोजसा । अम्बष्ठादिमधुयुतं पिप्पल्यादिसमन्वितम् ॥ ८७॥
The Kutaja-bark taken with treacle would cure perforce the longstanding cases of Astisara attended with blood and marked by the diminished action of the bodily Vayu but a predominant action of the deranged Kapha. The drugs of the Ambasthadi group as well as those of the Pippalyadi group taken with honey would be similarly beneficial. 87.
पृश्रिपर्णीबलाबिल्व-वालकोत्पलधान्यकैः । सनागरैः पिबेत् पेयां साधितामुदरामयी ॥ ८८ ॥ अरलुत्वक् प्रियङ्गुञ्च मधुकं दाडिमाङ्कुरान् । आवाप्य पिष्ट्वा दनि यवागूं साधयेद् द्रवाम् । एषा सर्वानतीसारान् हन्ति पक्कानसंशयम् ॥ ८९ ॥ रसाञ्जनं सातिविषं त्वग्बीजं कौटजं तथा । धातकीनागरञ्चैव पाययेत् तण्डुलाम्बुना । सशूलं रक्तजं घ्घ्रन्ति योगा मधुसमन्विताः ॥ ९० ॥
A Peya duly prepared with the admixture of Prsniparni. Bala, Bilva (D.R. Visva), Balaka, Utpala, Dhanyaka and Nagara, should be taken by a patient suffering from Atisara. A case of Pakvatisara would yield to the curative efficacy of a light medicinal gruel (Yavagu duly prepared with the admixture of the paste of Syonaka-bark, Priyangu, Yasti-madhu and tender sprouts of Dadima pasted together with curd. A case of Atisara attended with blood and colic (Sula) would be readily cured by the use of Rasanjana, Ativisa, Dhataki, Nagara and the bark and seeds of Kutaja taken with honey and the washings of rice. 88-90.
मधुकं बिल्वपेश्यश्च शर्करामधुसंयुताः । अतीसारं निहन्युश्च शालिषष्टिकयोः कणाः । तद्वल्लीढं मधुयुतं बदरीमूलमेव तु बदर्यर्जुन शर्कराः ॥ ९१ ॥ जम्ब्वाम्र-शल्लकीवेतसत्वचः । क्षौद्रसंयुक्ताः पीता घ्नन्त्युदरामयम् ॥ ९२ ॥ एतैरेव यवागूंश्च षडा- ( मण्डा ) – न्यूषांश्च कारयेत् । पानीयानि च तृष्णासु द्रव्येष्वेतेषु बुद्धिमान्कृ तं शाल्मलिवृन्तेषु निशापर्युषितं पेयं ॥ ९३ ॥ कषायं सक्षौद्रं हिमसंज्ञितम् । मधुकान्वितम् ॥ ९४ ॥
Yasti-madhu, ( dried) green Bilva-fruit mixed with honey and sugar, or particles of Sali and Sastika rice (administered with the same drugs) would prove curative in a case of Atisara. Badari-roots pasted with honey should be given to be licked with the same result. Barks of Badari, Arjuna, Jambu, Amra, Sallaki and Vetasa taken with honey and sugar would cure a case of Atisara. Gruels (Yavagu), Mandas (thick gruel squeezed through a piece of linen) and Yusa (soup) may also be duly prepared with the admixture of these drugs and in a case marked by excessive thirst, the water for drinking should be prepared by duly boiling these drugs. The cold infusion of¹ Salmali-stems kept in the open space for a whole night, may be given with good results as a drink in combination with Yasti-madhu and honey. 91-94.
Use of Milk in Atisara
विबद्धवातविद् शूलपरीतः सप्रवाहिकः । सरक्तपित्तश्च पयः पिबेत् तृष्णासमन्वितः ॥ ९५ ॥ यथाऽमृतं तथा क्षीरमतीसारेषु पूजितम् । चिरोत्थितेषु तत् पेयमपां भागैस्त्रिभिः शृतम् ॥ ९६ ॥ दोषशेषं हरेत् तद्धि तस्मात् पथ्यतमं स्मृतम् ॥ ९७ ॥ हितः स्नेहविरेको वा बस्तयः पिच्छिलाश्च ये । पिच्छिलस्वरसे सिद्धं हितञ्च घृतमुच्यते ।। ९८ ।।
Use of Milk in Atisara – Milk should be given in a case of Atisara marked by the suppression of stool and Vayu and attended with griping (Sula), constant scanty motions, symptoms of Rakta-pitta and thirst. Milk is ambrosia itself in such a case of Atisara (Diarrohea), and in long-standing cases the milk to be taken should be duly boiled with thrice as much water. This would remove the remnant, if any, of the Dosa involved and is, therefore, considered as the best remedy in such cases. Oily purgatives and application of Picchila-Basti (slimy intestinal injections) as well as the medicated Ghrita duly prepared with the expressed juice of the barks of slimy trees, e.g., Syonaka, Salmali, etc. are beneficial under the circumstances (in chronic or longstanding cases). 95-98.
शकृता यस्तु संसृष्टमतिसार्येत शोणितम् । प्राक् पश्चाद् वा पुरीषस्य सरुक् सपरिकर्तिकः । क्षीरिशुङ्गाशृतं सर्पिः पिबेत् सक्षौद्रशर्करम् ॥ ९९ ॥ दार्वीत्वपिप्पलीशुण्ठीलाक्षाशक्रयवैर्घृतम् । संयुक्तं भद्ररोहिण्या पक्कं पेयादिमिश्रितम् ।
1. powders of Salmali stem should be kept immersed for whole night in an equal quantity of water. In the morning the water should be passed through a piece of linen. Four- Pala-weight of this water mixed with a Karsa weight of Yasti madhu and honey should be taken.
त्रिदोषमप्यतीसारं पीतं हन्ति हन्ति सुदारुणम् ॥ १०० ॥
Draughts of clarified butter duly prepared with the tender sprouts of the Ksiri trees and mixed with honey and sugar (as an after-throw) should be taken in a case of Atisara marked with a discharge of blood before or after the passing of the stool and with a cutting pain (in the region of the anus). Draughts of medicated clarified butter duly prepared with the barks of Deva-daru and with Pippali, Sunthi, Laksa, Indrayava and Bhadra-rohini (Katuka) administered through the medium of any kind of Peya, would prove highly efficacious in a case of Tri-dosaja Atisara of severe type. 99-100.
गौरवे वमनं पथ्यं यस्य स्यात् प्रबलः कफः । ज्वरे दाहे सविड्बन्धे मारुताद् रक्तपित्तवत् ॥ १०१ ॥ सम्पके बहुदोषे च विबन्धे मूत्रशोधनैः । कार्यमास्थापनं क्षिप्रं तथा चैवानुवासनम् ॥ १०२ ॥
Exhibition of emetics or vomiting is an excellent remedy in a case of Atisara marked by heaviness (in the abdomen) and the predominance of the deranged bodily Kapha. A case attended with fever, burning sensation and suppression of stool and marked by an aggravation of Vayu should be treated as a case of Rakta-pitta. Intestinal injections with urine – purifying (Mutra-Sodhana) drugs should be speedily administered in the manner of an Asthapana or Anuvasana Basti, as the occasion might arise, in a case marked by an excessive accumulation of the deranged bodily Dosas in the affected locality as well as by the suppression (of stool) during the mature stage of the disease. 101 102.
प्रवाहणे गुदभ्रंशे मूत्राघाते कटिग्रहे । मधुराम्लशृतं तैलं सपिर्वाऽप्यनुवासनम् ॥ १०३ ।। गुदपाकस्तु पित्तेन यस्य स्यादहिताशिनः । तत्र पित्तहरा : सेकास्तत्सिद्धाश्चानुवासनाः ॥ १०४ ॥ दधिमण्डसुराबिल्व- सिद्धं तैलं समारुते । भोजने च हितं क्षीरं कच्छुरामूलसाधितम् ॥ १०५ ॥
Intestinal injections consisting of oil or clarified butter duly cooked and prepared with the drugs of sweet and acid tastes should be applied in the manner of an Anuvasana Vasti in a case marked by the protrusion of the bowel through violent and excessive straining and by painful obstruction of urine (Mutraghata) and pain in the waist. Pittasubduing washes and injections prepared with the Pitta-subduing drugs and applied in the manner of Anuvasana Basti, are the remedies in a case marked by the suppuration of the anus due to the aggravation of Pitta in an injudicicous or intemperate patient. Anuvasana Basti charged with oil duly cooked with wine, Bilva and Dadhi-manda should be applied in a case of Atisara marked by the aggravation of the deranged bodily Vayu, and milk duly boiled and cooked with the admixture of Kacchura-roots should be given to drink. 103-105.
अल्पाल्पं बहुशो रक्तं सरुग् य उपवेश्यते । यदा वायुर्विबद्धश्च पिच्छाबस्तिस्तदा हितः ॥ १०६ ॥ प्रायेण गुददौर्बल्यं दीर्घकालातिसारिणाम् । भवेत् तस्माद्धितं तेषां गुदे तैलावचारणम् ॥ १०७ ॥
Piccha-Basti should be applied (into the rectum in a case of Atisara marked by painful and frequent emission of blood, though in scanty quantities at a time, and by an entire suppression of Vayu (Flatus). An atonic condition of the anus results from a long-standing attack of Atisara which should, therefore, be remedied by rubbing the part with oil. 106-107.
कपित्थशाल्मलीफञ्जी वनकार्पासिदाडिमाः । यूथिका कच्छुरा शेलुः शणश्चच्चूः सदाधिकाः ॥ १०८ ॥ शालपर्णी पृश्चिपर्णी बृहती कण्टकारिका । बला श्वदंष्ट्रा बिल्वानि पाठानागरधान्यकम् ॥ १०९ ॥ एष आहारसंयो(गो)गे हितः सर्वातिसारिणाम् । तिलकल्को हितश्चात्र मौद्रो मुद्गरसस्तथा ॥ ११० ॥
Diet-The diet of the patient suffering from all kinds of Atisara should be prepared with the admixture of Kapittha, Salmali, Phanji (a kind of Patha), Vana – Karpasi ( D. R. Vata and Karpasi), Dadima, Yuthika, Kacchura, Selu, Sana, Cuccu, Dadhi (curd), Sala-parni, Prsniparni, Brhati, Kanta-karika, Bala, Svadarnstra, Bilva, Patha, Nagara and Dhanyaka and may also consists of the pastes of sesamum and Mudga pulse or of Mudga soup. 108-110.
Cause and Symptoms of Raktatisara
पित्तातिसारी यो मर्त्यः पित्तलानि निषेवते । पित्तं प्रदुष्टं तस्याशु रक्तातीसारमावहेत् । ज्वरं शूलं तृषां दाहं गुटपाकञ्च दारुणम् ॥ १११ ॥
Cause and Symptoms of Raktatisara – The bodily Pitta of person already suffering from an attack of Pittaja-Atisara is further deranged and aggravated, if Pitta-generating eatables are taken, and ushers in the discharge of blood with stool accompanied by fever, burning sensation, thirst, gripings (Sula) and excessive suppuration (inflammation) of the anus (Guda). The above are the characteristics of the Raktati-sara. 111.
यो रक्तं शकृतः पूर्वं पश्चाद् वा प्रतिसार्यते । स पल्लवैर्वटादीनां ससर्पिः साधितं पयः ॥ ११२ ॥ पिबेत् सशर्कराक्षौद्रमथवाऽप्यभिमथ्य तत् । नवनीतमथो लिह्यात् तक्रञ्चानुपिबेत् ततः ॥ ११३ ॥ प्रियालशाल्मलीप्लक्ष-शल्लकीतिनिशत्वचः । क्षीरे विमृदिताः पीताः सक्षौद्रा रक्तनाशनाः ।। ११४ ।। मधुकं शर्करां लोध्रं पयस्यामथ सारिवाम् । पिबेच्छागेन पयसा सक्षौ रक्तनाशनम् ॥ ११५ ॥ मञ्जिष्ठां सारिवां लोध्रं पद्मकं कुमुदोत्पलम् । पिबेत् पद्माञ्च दुग्धेन च्छागेनासृक्प्रशान्तये ॥ ११६ ॥
Treatment- Draughts of milk duly boiled and cooked with the leaves of Vata, etc. ( those included within the Nyagrodhadi group) should be given with clarified butter, or with sugar and honey in a case marked by a discharge of blood before or after motions; or the butter prepared by stirring the preceding preparation of milk should be taken; and draught of the Takra (thus prepared) should be taken as an afterpotion. The discharge of blood (in a case of Atisara) may be stopped by a potion consisting of the barks of Priyala, Salmali, Plaksa, Sallaki and Tinisa pasted together with milk and mixed with honey. The same result is obtained by administering the milk of a she-goat with a paste of Yasti-madhu, Sugar, Lodhra, Payasya (Arkapuspi) and Sariva and mixed with honey, or with a paste (or powder) of Manjistha, Sariva, Lodhra, Padmaka, Kumuda, Utpala and Padma (Bhargi). 112-116.
शर्करोत्पललोध्राणि समङ्गा मधुकं तिलाः । तिला: कृष्णाः सयष्ट्याह्वाः समङ्गाः चोत्पलानि च ॥ ११७ ॥ तिला मोचरसो लोघं तथैव मधुकोत्पलम् । कच्छुरा तिलकल्कश्च योगाश्चत्वार एव तु । आजेन पयसा पेयाः सरक्ते मधुसंयुताः ॥ ११८ ॥ द्रवे सरक्ते स्त्रवति बालबिल्वं सफाणितम् । सक्षौद्रतैलं प्रागेव लिह्यादाशु हितं हि तत् ॥ ११९ ॥ कोशकारं घृते भृष्टं लाजचूर्णं सिता मधु । सशूलं रक्तपित्तोत्थं लीढं हन्त्युदरामयम् ॥ १२० ॥ शर्कराक्षौद्रसंयुतम् । जयेत् ॥ १२१ ॥ बिल्वमध्यं समधुकं तण्डुलाम्बुयुतो योगः पित्तरक्तोत्थितं योगान् सांग्राहिकांश्चान्यान् पिबेत् सक्षौद्रशर्करान् । न्यग्रोधादिषु कुर्याच्च पुटपाकान् यथेरितान् ॥ १२२ ॥ गुदपाके च ये उक्तास्तेऽत्रापि विधयः स्मृताः । रुजायां चाप्रशाम्यन्त्यां पिच्छाबस्तिर्हितो भवेत् ॥ १२३ ॥ सक्तविड् दोषबहुलं दीप्ताग्निर्योऽतिसार्यते । विडङ्गत्रिफलाकृष्णा-कषायैस्तं AF विरेचयेत् अथवैरण्डसिद्धेन पयसा यवागूर्वितरेत् ॥ १२४॥ केवलेन वा । तस्य वातघ्नैर्दीपनैः कृताः ॥ १२५ ॥
Sugar, Utpala, Lodhra, Samanga, yasti-madhu and tila; or Tila, Krsna, Yasti Madhu, Samanga and Utpala or Tila, Moca-rasa and Lodhra; or Yasti-madhu and Utpala; Kacchura and Tila are the ingredients of four recipes which, if taken with the she-goat’s milk and honey, would remove the blood inthe stool. Pastes of unripe Bilva fruits, treacle, oil and honey taken before the meal would be a remedy in a case marked by watery motions mixed with blood. A case of blood dysentry due to the deranged blood, and Pitta and attended with Sula yields to the use of a compound consisting of Kosakara (a kind of sugar-cane) pulverised parched paddy fried in clarified butter and mixed with sugar and honey. A case of blood-dysentery due to the action of the deranged blood, and Pitta may be cured with a compound of the kernel of a (unripe) Bilva-fruit mixed with Yasti-madhu and taken with the washings of rice, honey and sugar. Astringent compounds should be taken mixed with honey and sugar. Puta paka measures as mentioned before are employed with the drugs of Nyagrodhadi group. The remedies mentioned in connection with a case of Guda-paka (suppuration of anus) should also be employed in these cases. Application of Piccha-Basti is recommended in the type where the pain does not subside. A purgative consisting of the decoction of Vidanga, Triphala and Pippali should be given to a patient of Atisara having hardened faeces and plenty Dosa with good digestive fire. In the alternative, a purgative consisting only of milk cooked with Erandaroots (castor plant) should be employed and the patient should be given Yavagu prepared with appetising and Vayu-subduing drugs. 117-125.
दीप्ताग्निर्निष्पुरीषो यः सार्यते फेनिलं शकृत् । स पिबेत् फाणितं शुण्ठी-दधितैलपयोघृतम् ॥ १२६ ॥ स्विन्नानि गुडतैलाभ्यां भक्षयेद् बदराणि च । fraaifa fugac arsfu qui facarımıef4: 11 8 30 11 दनोपयुज्य कुल्माषान् श्वेतामनुपिबेत् सुराम् । शशमांसं सरुधिरं समां सघृतं दधि ।खादेद् विपाच्य सेवेत मृद्वन्नं शकृतः क्षये ॥ १२८ ॥
Tracele (Phanita) mixed with powdered Sunthi, curd, oil, milk and clarified butter should be given in a case marked by good digestive fire but by frothy motions devoid of all foecal matter. Badara-fruits boiled with oil and treacie, or cakes prepared from them and dried unripe Bilva-fruits should be prescribed. Cakes prepared with boiled Masa-pulse should be prescribed to be taken with curd followed by a draught of Sveta (Cake-made) wine in the ase marked by the absence of fecal matter in the stool. The blood-stained flesh of fecal matter inthe stool. The blood-stained flesh of a hare cooked with Samanga, curd and clarified butter should be taken with well boiled rice in case of absence of stool. 126-128.
A decoction of Masa-pulse, Kola and barley duly cooked in equal parts of the oil and clarified butter mixed with curd and the expressed juice of Dadima should be prescribed as diet in the case. The absence of any fecal matter in the stool (Purisa-Ksaya) would yield to the use of Bit (black salt), dried unripe Bilva fruit and Sunthi pasted with any acid juice and mixed with curd-cream and cooked in equal parts of oil and clarified butter. Clarified butter duly cooked with astringent and appetising drugs should be given in a case of Atisara attended with Sula where the patient feels a good appetite after the loss of fecal matter. 129-131.
Symptoms of Pravahika
वायुः प्रवृद्धो निचितं बलासं नुदत्यधस्तादहिताशनस्य । प्रवाहमाणस्य मुहुर्मलाक्तं प्रवाहिकां तां प्रवदन्ति तज्ज्ञाः ॥ १३२ ॥ प्रवाहिका वातकृता सशूला पित्तात् सदाहा सकफा कफाच्च । सशोणिता शोणितसम्भवा तु ताः स्नेहरूक्षप्रभवा मतास्तु । तासामतीसारवदादिशेच्च लिङ्गं क्रमञ्चामविपक्कताञ्च ॥ १३३ ॥
Symptoms of Pravahika — The Vayu in the organism of person addicted to the use of unwholesome food, is deranged and aggravated. It carries down the accumulations of Balasa (mucus) into the lower part of the body, whence, mixed with stools, they are constantly passed off with tenesmus. The disease is called Pravahika (mucous diarrhoea). The diseases is called Pravahika (mucous diarrhoea). The motions are attended with Sula (pain) in the Vataja type of the disease, with burning sensation in the Pittaja one, with mucus in the Kaphaja one and with blood (blood-streaked mucus) in the Raktaja (blood-origined type).
Excessive use of dry (Ruksa) or of fatty articles of food may be regarded as the exciting factor of these cases. The specific indications of Pravahika as well as its Ama or acute and Pakva or mature stage are respectively identical with those of the several types of Atisara. 132-133.
न शान्तिमायाति विलङ्घनैर्या योगैरुदीर्णा यदि पाचनैर्वा । तां क्षीरमेवाशु शृतं निहन्ति तैलं तिलाः पिच्छिलबस्तयश्च ॥ १३४ ॥ आर्यैः कुशैः संपरिवेष्टितानि वृन्तान्यथार्द्राणि हि शाल्मलीनाम् । पक्कानि सम्यक् पुटपाकयोगेनापोथ्य तेभ्यो रसमाददीत ॥ १३५ ॥ क्षीरं शृतं तैलहविर्विमिश्रं कल्केन यष्टीमधुकस्य वाऽपि । बस्तिं विदध्याद् भिषगप्रमत्तः प्रवाहिकामूत्रपुरीषसङ्गे ॥ १३६ ॥ द्विपञ्चमूलीक्कथितेन शूले प्रवाहमाणस्य समाक्षिकेण । क्षीरेण चास्थापनमग्र्यमुक्तं तैलेन युञ्ज्यादनुवासनञ्च ।। १३७ ।।संस्कृतो यमके माष- यवकोलरसः शुभः । भोजनार्थं प्रदातव्यो दधिदाडिमसाधितः ॥ १२९ ॥ विडं बिल्वशलाटूनि नागरञ्चाम्लपेषितम् । दध्नः सरश्च यमके भृष्टो वर्चः क्षये हितम् ॥ १३० ॥ सशूलं क्षीणवर्चा यो दीप्ताग्निरतिसार्यते । स पिबेद् दीपनैर्युक्तं सर्पिः संग्राहकः सह ॥ १३१ ॥
Treatment— In the event of fasting and other digestive (Pacana) compounds (of Pravahika) producing no beneficial effect in serious cases they ae found to readily yield to the use of boiled milk, oil, Tila (sesamum) or Picchila Basti. The green stems of Salmali well covered with green Kusa-blades, should be scorched inthe fire in the manner of Puta-paka. The juice should be squeezed out there of and mixed with boiled milk, oil, clarified butter and powdered Yasti-madhu should be carefully injected into the rectum in the manner of Basti application in cases of Pravahika marked with the retention of stool and urine. Similar injections of a decoction of Dasa-mula duly cooked in milk and mixed with honey and applied in the manner of an AsthapanaBasti as well as the application of oil in the manner of an Anuvasana Basti would prove highly efficacious in cases marked with painful tenesmus. 134 137.
वातघ्नवर्गे लवणेषु चैव तैलञ्च सिद्धं हितमन्नपाने ॥ १३८ ॥ लोधं विडं बिल्वशलाटु चैव लिह्याच्च तैलेन कटुत्रिकाढ्यम् ॥ १३९ ॥ दक्षा ससारेण समाक्षिकेण भुञ्जीत निःसा ( निश्चा )रकपीडितस्तु । सुतप्तकुप्यक्कथितेन वाऽपि क्षीरेण शीतेन शूलार्दितो व्योषविदारिगन्धा-सिद्धेन वातघ्नसांग्राहिकदीपनीयैः मधुप्लुतेन ॥ १४० ॥ दुग्धेन हिताय भोज्यः । कृतान् षडांश्चाप्युपभोजयेच्च ॥ १४१ ॥ खादेच्च मत्स्यान् रसामाप्नुयाच्च वातघ्नसिद्धं सघृतं सतैलम् । एणाव्यजानान्तु वटप्रवालैः सिद्धानि सार्धं पिशितानि खादेत् ॥ १४२ ।।
मेध्य (द्य )स्य सिद्धन्त्वथवाऽपि रक्तं बस्तस्य दक्षा घृततैलयुक्तम् । खादेत् प्रदेहः शिखिलावजैर्वा भुञ्जीत यूषैर्दधिभिश्च मुख्यैः । माषान् सुसिद्धान् घृतमण्डयुक्तान् खादेच्च दक्षा मरिचोपदंशान् ॥ १४३ ॥
Diet- Oil duly cooked with the drugs of the Vayu-subduing (Vidari-gandhadi) group and with (the five officinal kinds of) salt should be used in the preparation of) food and drink. A compound consisting of Lodhra, Bit-salt and dried unripe Bilva-fruit pasted with oil and mixed with Tri-katu should be given to be licked’. The food (boiled rice) of a diarrhoeic patient should be taken with honey and curd from which the cream has not been removed; or with milk warmed by a piece of red-hot metal² (other than gold and silver) and mixed when cold with a profuse quantity of honey. The use of milk duly boiled and cooked with the admixture of Tri-katu and Vidari-gandha, with the food would prove curative in a case attended with Sula. He should also be given soups (Rasa) prepared with the drugs of appetising, astringent (Grahi) and Vayu-subduing virtues. Fishes should be taken and its soup should be prepared with oil and clarified butter with the admixture of Vayu-subduing drugs. The diet in this disease should consist of venison, mutton of goat’s flesh cooked with the tender sprouts of a Vata tree or of blood of a fatty goat duly cooked with curd (Dadhi), oil and clarified butter. He may take his food with an unsalted soup (Yusa) of a peacock or of a Lava bird, or with well prepared curd. He may take (with benefit) well cooked Masa-pulse mixed with the transparent upper part of clarified butter (Ghrita-manda) and with curd, while chewing at intervals (with his teeth) the unpowdered Marica (black pepper). 138-143.
महारुजे मूत्रकृच्छ्रे भिषग् बस्तिं प्रदापयेत् । पयोमधुघृतोन्मिश्रं सबस्तिः शमयेत् तस्य रक्तं दाहमथो ज्वरम् । मधुकोत्पलसाधितम् ॥ १४४ ॥ मधुरौषधसिद्धञ्च हितं तस्यानुवासनम् । रात्रावहनि वा नित्यं रुजार्तो यो भवेन्नरः ॥ १४५ ॥
1. According to some variants this compound should be taken thrice daily. 44 2. In place of ‘‘कुप्य ” – Kupya (any metal other than gold and silver some read “कुर्प” — Kurpa which is explained to mean a kind of stone.
यथा यथा सतैलः स्याद् वातशान्तिस्तथा तथा । प्रशान्ते मारुते चापि शान्तिं याति प्रवाहिका । तस्मात् प्रवाहिकारोगे मारुतं शमयेद् भिषक् ।। १४६ ॥
A compound of milk, honey and clarified butter mixed with the decoction of Yasti-madhu and Utpala should be applied in the manner of Basti-application in (a case of Pravahika, marked by) excessive pain ano painful micturition (Mutra-Krcchra). The application of this Basti would alleviate the burning sensation, allay the the accompanying fever and remove the blood (in the stool). Injections of the decoction ( of the drugs) of Madhura group (such as Kakoli, etc.) in the manner of an Anuvasana Basti, should also be applied every day at daytime or in the night, if the patient be feeling any pain. A Basti applied with the admixture of oil would pacify the aggravated bodily Vayu and Pravahika, would be removed with the pacification of the deranged bodily Vayu. The main treatment, therefore, in a cae of Pravahika is restore the deranged local Vayu to its normal condition, (which is identical with the cure). 144-146.
Treatment
पाठाजमोदा कुटजस्य बीजं शुण्ठी समा मागधिकाश्च पिष्टाः । सुखाम्बुपीताः शमयन्ति रोगं मेध्याण्डसिद्धं सघृतं पयो वा । शुण्ठीं घृतं सक्षवकं स तैलं विपाच्य लिट्वाऽऽमयमाशु हन्यात् ॥ १४७ ॥ गजाशनाकुम्भिकदाडिमानां रसैः कृता तैलघृते सदनि । बिल्वान्विता पथ्यतमा यवागूर्धारोष्णदुग्धस्य तथा च पानम् ॥ १४८ ।।
Medical Treatment – The drugs known as Patha, Ajamoda, Kutaja-seeds, Sunthi and Magadhika taken in equal parts, pasted together and dissolved in tepid water or milk duly boiled with the testicles of a goat and mixed with clarified butter would prove efficacious in a case of Pravahika. Clarified butter mixed with oil and duly cooked with Sunthi and Ksavaka would give instantaneous relief, if licked. Yavagu duly prepared with the admixture of Bilva and the expressed juice of Gajasana (Sallaki) Kumbhika and Dadima and with curd, oil and clarified butter would prove highly beneficial. The use of milk just drawn would similarly prove beneficial in the case. 147-148.
Yavagu
A wise and experienced physicain should employ the foregoing medicinal compounds and decoctions in the complaints of the bowels and of the stomach (Udaramaya) as well as light, appetising and emulsive (Snigdha) articles of fare and other articles of food prescribed before as diet in the cases. 149.
Yavagu – Yavagu (gruel) is always efficacious in cases of fever and Atisara in as much as it allays thirst, is light in digestion and appetising, and acts as a cleanser of the bladder ( diuretic). 150.
General Principle of Treatment
भयजे सान्त्वनापूर्वा शोकजे शोकनाशिनी ॥ १५१ ॥ विषार्श: क्रिमिसम्भूते हिता चोभयशर्मदा | छर्दिमूर्च्छातृडाद्यांश्च साधयेदविरोधतः ॥ १५२ ॥ समवाये तु दोषाणां पूर्वं पित्तमुपाचरेत् । ज्वरे चैवातिसारे च सर्वत्रान्यत्र मारुतम् ॥ १५३ ॥
General Principle of Treatment – Drying (Ruksa) measures should be employed in a case due to the excessive use of any oily or emulsive food, and emulsive (Snigdha) measures should be adopted in a case brought on through an excessive use of any dry (Ruksa) article. The cause of terror should be first removed in a case due to fright, while the mind should be calmed or consoled in the case due to any grief or bereavement. The treatment in cases (of Atisara) due to piles or worms (in the intestines) as well as in those due to the effect of poison (introduced into the system) consists in emplying therapeutic agents which are simultaneously remedial both to the diseae and to its exciting factors. Complications or distressing concomitants such as vomiting, thirst fainting fits, etc., should be removed with drugs which are not incompatible with the main treatment of the disease, and which do not aggravate the exciting factors. In a case of fever or Atisara marked by the simultaneous aggravation of the deranged bodily Dosas, the deranged Pitta should be first remedied, while in all other affections, it is the deranged bodily Vayu which should be first curbed down or corrected. 151-153.
लघूनि पथ्यान्यथ दीपनानि स्निग्धानि भोज्यान्युदरामयेषु । हिताय नित्यं वितरेद् विभज्य योगांश्च तांस्तान् भिषगप्रमत्तः ॥ १४९ ।।
तृष्णापनयनी लघ्वी दीपनी बस्तिशोधनी । ज्वरे चैवातिसारे च यवागूः सर्वदा हिता ॥ १५० ॥
रौक्ष्याज्जाते क्रिया स्निग्धा रूक्षा स्नेहनिमित्तजे । यस्योच्चारं विना मूत्रं सम्यग् वायुश्च गच्छति । दीप्ताग्नेर्लघुकोष्ठस्य स्थितस्तस्योदरामयः ॥ १५४ ॥
Indications of cure- Non-emission of stool at the time of urination and the free emission of flatus (Vayu), as well as the rousing of the appetite, and the lightness of the abdominal cavity (Kostha) are the indications of cure in a case of Udaramaya (Diarrhoea, etc.1 154.
Static or Dynamic causes of Diseases and Treatment
कर्मजा व्याधयः केचिद दोषजाः सन्ति चापरे । कर्मदोषोद्भवाश्चान्ये कर्मजास्तेष्वहेतुकाः ॥ १५५ ॥ नश्यन्ति त्वक्रियाभिस्ते क्रियाभिः कर्मसंक्षये। शाम्यन्ति दोषसम्भूता दोषसंक्षयहेतुभिः ॥ १५६ ॥ तेषामल्पनिदाना ये प्रतिकृष्टा भवन्ति च। मृदवो बहुदोषा वा कर्मदोषोद्भवास्तु ते। कर्मदोषक्षयकृता तेषां सिद्धिर्विधीयते ॥ १५७॥
Static or Dynamic causes of Diseases and Treatment- Some diseases are due to the dynamics of Karmas (deeds done by a man in the present or any prior existence), and some are due to the effects of deranged bodily Dosas, while there may be others which have their origin both in the dynamics of Karma and the necessary physiological (Dosaja) causes. Of these a Karma-origined disease may come on without any apparent exciting factor and it disappears with the extinction of its (Karma’s) result effected by means of any remedial measure (e.g. penance, etc.) other than medical treatment, whereas a Dosaorigined disease is conquered as soon as the involved deranged Dosas of the body are restored to their normal condition. Cases due to a slight derangement of the bodily Dosas of the body are restored to their normal condition. Cases due to a slight derangement of the bodily Dosas but attended with a good deal of troubles as well as those due to the excessive aggravation of the Dosas but attended with only slight troubles should be attributed both to the physiological causes and to the dynamics of Karma and these are cured only when both of these causes viz., Karma and aggravated Dosas are removed. 155-157.
1. The printed edition of Dalhanas commentary says that these are the symptoms of cases of aggravated Atisaru.
Grahani
ग्रहणी ग्रहणी जन्तोरग्निसादनहेतुभिः । दुष्यति अतिसारे निवृत्तेऽपि मन्दाग्नेरहिताशिनः । भूयः सन्दूषितो वह्निर्ग्रहणीमभिदूषयेत् ॥ १५८ ॥ तस्मात् कार्यः परीहारस्त्वतीसारे विरिक्तवत् । यावन्न प्रकृतिस्थ: स्याद् दोषतः प्राणतस्तथा ॥ १५९ ॥ षष्ठी पित्तधरा नाम या कला परिकीर्तिता । पक्कामाशयमध्यस्था ग्रहणी सा प्रकीर्तिता ॥ १६० ॥ ग्रहण्या बलमग्निर्हि स चापि ग्रहणीं श्रितः । तस्मात् सन्दूषिते वह्नौ ग्रहणी सम्प्रदुष्यति ॥ १६१ ॥
Grahani – The Grahani (lit, the uppermost extremity or the receiving duct of the intestines) is affected by the causes which produce dulness of appetite. The digestive fire of a patient is again deranged, even after the subsidence of an attack of Atisara, if, with the dulness of appetite, he still be intemperate and injudicious in matters of food and drink. Hence the regimen of diet and conduct in a case of Atisara should be as laid down in connection with the sequel of any purgative course (Virecana), until the deranged Dosas of the body would be completely restored to their normal condition, bringing in the natural health and strength in their train. The sixth Kala which has been described as the Pitta-dhara Kala (Pitta containing sheath) is situated between Pakvasaya and Amasaya (doudenum ?) is called Grahani. The strength of the organ of Grahani is dependent on the digestive fire (Agni) and the latter is situated in the former. Hence anythingthat impairs the digestive fire (Agni) necessarily affects the Grahani 158-161.
एकश: सर्वशश्चैव दोषैरत्यर्थमूच्छ्रितैः । सा दुष्टा बहुशो भुक्तमाममेव विमुञ्चति ॥ १६२॥
1. The use of “अपि” in the text shows, say the commentators, that Grahani is possibie even without a previous attack of Atisara.
पक्कं वा सरुजं पूति मुहुर्बद्धं मुहुर्द्रवम् । ग्रहणीरोगमाहुस्तमायुर्वेदविदो जनाः ॥ १६३ ॥
The aggravation of one or all the bodily Dosas leads to the derangement of the Grahani into which the food taken is passed off in the shape of undigested fecal matter, or if it is degested, it sometimes produces constipation of the bowels and sometimes liquid motions accompained (in both cases) by pain and fetid smell. The disease is called Grahani (chronic diarrhoea ? ) by experienced Physicians. 162-163.
Premonitory Symptoms
तस्योत्पत्तौ विदाहोऽन्ने सदनालस्यतृट्क्लमाः । बलक्षयोऽरुचिः कासः कर्णक्ष्वेडोऽन्त्रकूजनम् ॥ १६४ ॥
Premonitory Symptoms – Incomplete digestion, lassitude or a sense of physical langour, laziness, thirst, a sense of exhaustion, weakness, aversion to food, cough, ringing in the ears (Karna – Ksveda) and rumbling sound in the intestines are the symptoms which mark the Premonitory stage of the disease. 164.
Symptoms
अथ जाते भवेज्जन्तुः शूनपादकरः कृशः । पर्वरुग्लौल्यतृछर्दि-ज्वरारोचकदाहवान् ।
उद्गिरेच्छुक्ततिक्ताम्ल-लोहधूमामगन्धिकम् । प्रसेकमुखवैरस्य-तमकारुचिपीडितः ॥ १६५ ॥
Symptoms – Swelling or oedema of the hands and of the feet, emaciation, pain at the joints, greediness, thirst, vomiting, fever, aversion to food, burning sensation, eructations of bitter, acid or fermented taste, or of those smell of blood or smoke, water-brash, bad taste in the mouth and non-relish for food, as well an attack of TamakaSvasa (Variety of asthma) are the indications of the developed stage of the disease (Grahani). 165.
Specific Symptoms of Grahani
वाताच्छूलाधिकैः पायु-हृत्पार्श्वोदरमस्तकैः । पित्तात् सदाहैर्गुरुभिः कफात् त्रिभ्यस्त्रिलक्षणैः ॥ १६६ ॥ दोषवर्णैर्नखैस्तद्वद् विण्मूत्रनयनाननैः । हृत्पाण्डूदरगुल्मार्श: प्लीहाशङ्की च मानवः ॥ १६७ ॥
Specific Symptoms of Grahani- A case of the Vataja type is accompained by a severe aching pain at the anus, thorax ( Hrdaya), sides, abdomen and the head. A case of the Pittaja type is marked by a burning sensation in the body, while the one of Kaphaja origin is characterised by a sense of heaviness in the limbs. A cse of Tri-Dosaja Grahani exhibits symptoms belonging to all the symptoms of the three cases (Vataja, Pittaja and Kaphaja types). The deranged bodily Dosas involved in a case impart their characteristic colour to the finger-nails, eyes, face and excreta (stool and urine) of the patient. Thus it furnishes a satisfactory clue to the diagnosis of the disease, which, if neglected or unchecked at the outset, may usher in an attack of Hrd-roga (disease of the heart), Pandu (chlorrosis), Udara (Ascites, etc.), Gulma piles and enlargement of spleen. 166-167.
Treatment and Diet in Grahani
यथादोषोच्छ्रयं तस्य विशुद्धस्य यथाक्रमम् । पेयादिं वितरेत् सम्यग् दीपनीयोपसम्भृतम् ॥ १६८ ॥ पाचनसंग्राहि-दीपनीयगणत्रयम् । ततः पिबेत् प्रातः सुरारिष्ट – स्नेहमूत्रसुखाम्बुभिः । तक्रेण वाऽथ तक्रं वा केवलं हितमुच्यते ॥ १६९ ॥ क्रिमिगुल्मोदरार्शोघ्नीः क्रियाश्चात्रावचारयेत् । चूर्णं हिङ्ग्वादिकञ्चात्र घृतं वा प्लीहनाशनम् ॥ १७० ॥ कल्केन मगधादेश्च चाङ्गेरीस्वरसेन वा । चतुर्गुणेन दना च घृतं सिद्धं हितं भवेत् ॥ १७१ ॥ सर्वथा दीपनं सर्वं ग्रहणीरोगिणां हितम् । ज्वरादीनविरोधाच्च साधयेत् स्वैश्चिकित्सितैः ॥ १७२ ॥
Treatment and Diet – Appropriate emetics and purgatives should be exhibted (for cleansing the upper and lower parts of the body) in accordance with the aggravation of the Dosa or Dosas involved and Peyas (gruels) and other articles of diet duly prepared with appetising drugs should then be prescribed in their due order. Therapeutic agents possessed of digestive, astringent and appetising virtue should be taken in morning through the vehicles of Sura (wine), Arista, Sneha (oil or clarified butter), cow’s urine, tepid water, or Takra. The use of Takra in the morning is in itself an excellent cure for the disease (Grahani) Remedies mentioned in connection with the treatment of worms in the intestines, Gulma, ascites or piles may also be adopted with benefit in the disease under discussion. The compound known as the Hingvadi Churna, or the medicated calrified butter described a remedial in a case of enlarged spleen, or the one duly cooked with the expressed juice of Cangeri and with the drugs of the Magadhadi (Pippalyadi) group as Kalka may be likewise prescribed with beneficial results. Clarified butter duly cooked with four times as much curd (Dadhi) may also be used with benefit. Whatever is appetising (medicines, drug and diet, etc.) would be beneficial in cases of Grahani. Complications (Upadrava) such as fever, etc. should be subdued with drugs not incompatible with the main treatment nor in any way aggravative of the main disease. 168-172.
इति सश्रुत संहितायामुत्तरतन्त्रे अतिसारप्रतिषेधव्याख्यानाम चत्वारिंशोऽध्यायः ॥ ४० ॥ –
Thus ends the fortieth chapter of the Uttara-Tantra in the Susruta Samhita which deals with the (symptoms) and medical treatment of Atisara.
