अथातो भेषजावचरणीयमध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥ १ ॥
We will now expound the chapter called BHESHAJAVACHRANIYA-prerequisites for treatment; thus said atreya and other great sages. (1)
Rogi pariksa – examination of the patient
भेषजमवचारयन् प्रागेव तावदेवमातुरं परीक्षेत । कस्मिन्नयं देशे जातः संवृद्धो व्याधितो वा कस्मिंश्च देशे मनुष्याणामिदमाहारजातमिदं विहारजातमेतावत् मलमेवंविधं सत्वमेवंविधं सात्यमियं भक्तिरिमे व्याधयो हितमिदमहितमिदमिति । प्राग्ग्रहणेन केन वा निदानविशेषेणाऽस्यकुपितो दोषः । दोषस्य ह्येकस्याऽपि बहवः प्रकोपे हेतवः । तस्माद्यथास्वलक्षणैः कर्मभिश्च बुध्वा भिषक्दोषमेवमवगमयेत् । तद्यथा । किमाहारेण कुपितो वायुः किं विहारेण तथा रूक्षेण लघुना शिशिरेण वा साहसेन वेगरोधेन वा भयेन शोकेन वेति । ततश्च तत्प्रतिपक्षमौषधं प्रयुज्यमानमाशु सिद्धये सम्पद्यते । तत्र मधुराम्ललवणा रसाः कटुतिक्तकषायाश्चेतरेतरप्रतिपक्षाः । तदनन्तरञ्चोपलभेत । मृदुमध्यातिमात्रविकल्पनया कथं निदानमासेवितम् । एकरूपस्यापि हि हेतोः मृद्वादिविभागेन पृथक् समवेतानाञ्च दोषाणामंशांशबलविकल्पविशेषात् व्याधेर्बलाबलविशेषः । तत्रानेक दोषात्मकेषु व्याधिष्वनेकरसेषु च भेषजेषु रसदोषप्रभावमेकैकशोऽभिसमीक्ष्य व्याधिभेषजप्रभा वतत्वं व्यवस्येत । नत्वेवं सर्वत्र ॥ २ ॥
Before starting the treatment of the disease, the physcian should examine patient, as follows
In which region is he born? Where has he been brought up? Where has he developed the disease ? Which are the type of food, activities, strength, mental attitude, accustomed things, the likes, the prevailent diseases, the suitable and unsuitable things of the people living in that region? Knowing these beforehand will facilitate the determination of the specific causes for the increase of the doshas. Though the dosha may be one, there are many causes for its increase.
Carefully noting the qualities and functions of each, the physican has to determine the dosha involved. For example, has vata undergone increase by indulgence in (bad) food or by bad activities? Whether it is due to indulgence in foods which are dry, quickly digestible, or cold, or by overexertion, suppression of the urges of the body, fear or grief? Prescribing the opposite kind of treatment after determining all these facts, will certinly lead to quick success. Sweet, sour and salt tastes have their opposites in pungent, bitter and astringent tastes respectively.
Dosha pariksa – determination of the doshas
Next it is to be ascertained in what manner he has indulged in the causes of disease, whether by mild, moderate or profound measure (quantity, degree). Even though the cause may be one only, by its different variations (qualities, quantity) it produces changes in the defferent facets (parts) of the doshas, which in turn, make the disease to become either mild or severe.
In diseases which have many doshas and in drugs which have many tastes, the physician should carefully consider the special effects of each of the doshas and of each of the tastes and plan out the appropriate mode of treatment of the disease. (2)
न हि विषमविकृतिसमवेताना नानात्मकानां परस्परेणोपगृहीतानामुपहतानाञ्चान्यैश्च विकल्पनैर्विकल्पितानामवयवप्रभावानुमानेन समुदायप्रभावतत्वमध्यवसितुं शक्यम् । तथाविधे हि समुदाये समुदायप्रभावमेवोपलभ्य व्याध्यौषधप्रभावतत्वमवगच्छेत् । तथा कस्य धामाऽधिष्ठाय व्याधिरयमवस्थित इति निरूपयेत् । प्रविसृतो हि दोषः स्वमेव स्थानमातङ्कायाधितिष्ठन् मूर्द्धादीन् वा दुस्तरो भवति । ततश्च स्थानविशेषेण भेषजविशेष: पर्येषितव्यः॥३॥
But this need not apply (by the same) in all cases. In conditions caused by the combination of things of dissimilar qualities, in that caused by the combination of different things each one supporting or antagonising the other and in conditions which are being influenced by other factors, it is possible to relay on the special effect of the whole (dosha, disease or drug) than of each part of it. Thus, in such conditions, the treatment should be planned, taking into consideration the effect of the whole.
Deha desha pariksa – determination of seats of diseases
Further, it is to be decided, in which place (part) of the body the disease is localised. The doshas which have increased may not produce the diseases in their own seats but may do so in other places such as the head etc., and so may become difficult to treat. Hence the treatment has to be planned as is found appropriate to the seat of the disease (3)
Aushadha pariksa – determination of the drug
ततश्चैवमालोचयेत् । कस्याऽयमौषधस्य व्याधि रातुरो वा योग्यः । कियतो वा । दोषानुरूपो
हि भैषज्यवीर्यप्रमाणविकल्पो व्याधिव्याधितबलापेक्षो भवति ॥४॥ सहसातिबलानि संशोधनौषधान्याग्नेयवायव्यान्यतिसौम्यान्यतिमात्राणि वा । तथाऽग्निक्षारश स्त्रकर्माण्यल्पसत्वमातुरमल्पबलं वातिपाययेयुः । संशमनानि तु व्याधिबलादधिकानि तमुपशमय्य व्याधिं व्याधिक्षपितदेहे शीघ्रमन्यमावहन्ति । शरीरबलाधिकानि ग्लानिमूर्च्छामदमोहबलक्षयान् । अग्निबलादधिकानि ग्लानिमग्निसादश्च ॥ ५ ॥
Think next; to which drug and to what dose of it, are the disease and the patient suitable? Determination of the drug, its potency, dose etc., should be appropriate to the dosha, the strength of the disease and the diseased (person ). Whether the urgent use of powerful purificatory drugs (or treatments) having the properties of agni (tejas bhuta) and vayu bhuta is needed or the use of the drugs possessing mild properties in greater doses will be necessary; treatments such as branding with fire, use of alkalies and surgical instruments, are more harmful, to patients who have poor mental stamina and physical strength. Palliative drugs (or treatment) also if stronger than the strength of the disease will produce opposite diseases quickly, after mitigating the earlier ones, in the body which has become weak by the effect of the disease. Those (drugs and treatment) which are stronger than the body will cause exhaustion, fainting, toxicity, delusion and decrease of strength; those which are more powerful than the digestive capacity will produce exhaustion and poor digestion (4-5)
अपि च । अतिस्थूलोऽतिकृशो दुर्बलो दुर्बद्धमांसशोणितास्थ्यंगावयवोऽल्पाग्निरल्पाहारोऽसा
भेषजमेवंवेगम् । त्म्याहारोपचित: साररहितो वा व्याधिबलमेव तावदसमर्थसोढुम् । किं पुनस्तथाविधो तस्मात्तादृशमविषादकरैर्मृदुसुखैरुत्तरोत्तरगुरुभिरविभ्रमै श्चोपाचरेदौषधैर्वि शेषादबलाः । ताह्यनवस्थितमृदुविक्लवहृदयाः प्रायः सुकुमाराः परायत्ताश्च । ततोऽपिविशेषेण शिशवः । तथा बलवति व्याध्यातुरेऽल्पबलमल्पं वा भेषजमकिञ्चित्करं भूय एव दोषमुत्क्लेश्य व्याधिमुदीरयेत् ॥६॥
Further, persons who are very stout, very emaciated, weak, who have their body parts not having well knit muscles, blood and bones; of poor digestive ability, take very little food, who are habituated to unhealthy unaccustomed foods; whose body is impoverished of essences of the tissues, will be incapable of with standing the desease it self. Then how can they with stand the effect of such strong drugs (or treatment)? Hence, such weak patient are to be treated specially with drugs which do not cause discomfort, which are mild, pleasant, successively hard (increasingly strong) and which do not cause debility.
This should be so, especially for women because they are unsteady, tender and of weak heart (mind), tender in body and dependent on others (men) : it should be still more so especially for children.
Likewise, drugs (or treatment) which are very mild and of very little quantity (dosha) will not do any good for severe diseases and for strong persons; on the other hand, they will only aggravate the disease by exciting the doshas. (6).
योग्यमपि चौषधमेवं परीक्षेत । इदमेवंरसवीर्यविपाकमेवंगुणमेवंद्रव्यमेवंकर्मैवंप्रभावमस्मिन् देशे जातमस्मिन्नृतावेवंगृहीतमेवंनिहितमेवंविहितमेवंनिषिद्धमेवमुपसंस्कृतमेवंसंयुक्त मेवंयुक्त मनया मात्रयैवंविधस्य पुरुषस्यैवंविधे काले एतावन्तं दोषमपकर्षत्युपशमयति वा । अन्यदपि चैवंविधं भेषजमभूत् तन्मानेन वा विशेषेण प्रयुक्तमिदमकरोत् । सूक्ष्माणि हि दोषौषधदूष्यदेश कालबलानलाहाररससात्म्यसत्वप्रकृतिवयसामवस्थान्तराणि । यान्यनालोचितानि निहन्युरातुरम् । आलोच्यमानानि तु विपुलबुद्धिमपि चिकित्सकमाकुलीकुर्युः । किं पुनरल्पबुद्धिम् । तस्मादभीक्ष्णशः शास्त्रार्थकर्मानुशीलनेन संस्कुर्वीत यज्ञाम् | अपि च । सन्ति व्याधयो ये शास्त्र उत्सर्गापवादैरुपक्रमं प्रति निर्दिष्टाः । तत्र प्राज्ञ एव दोषादिगुरुलाघवेन सम्यगध्यवस्येदन्यतरनिष्ठायाम् ॥७॥
Though a drug is found suitable, still it should be examined to determine its taste, potency, taste after its digestion, qualities, nature of the substance (mass), actions, special effects, place of growth, season of collection, method of preservation, correct mode of using, prohibited mode of use, methods of processing, combinations (or admixtures), procedure of use, dosage, the type of patient for whom it is meant, the time (season) of use, the dosha which it expels out or mitigates inside etc. If there happens to be another drug of similar properties, then both are to be compared and the best of them should be used.
Very subtle are the variations in different states (stages) of the doshas, drugs, dusya (tissues and wastes) regions, time, strength, digestive activity, food, tastes, accustmos, mental make up, constitution, age etc., which, if not considered deeply, will lead to death of the patient. If taken up for careful consideration, these will create confusion even in the mind of a very intelligent physician. What to say then one of poor intellect?
Hence the physician should study the scriptures, engage himself in practical work constantly and transform his intellect (endeavour) for gaining mastery.
There are some diseases which stand out as exceptions to the general line of treatment prescribed in the texts. In such cases, the intelligent physician should himself be the judge to determine the strength or weakness of the doshas without seeking help from elsewhere. (7)
Kala ausadha Sambandha – relationship of time and treatments
कालश्च भेषजस्य योग्यतामादधाति । स क्षणलवमुहूर्तादिभेदेनातुरावस्थया च द्विधोक्तः प्रागपि च । शीतोष्णवर्षलक्षणस्त्रिविधः कालः । तत्र शीतोष्णयोर्वृष्टिशीतयोश्चाऽन्तरे साधारणौ वसन्तजलदात्ययौ । ग्रीष्मवर्षकालयोस्तु, प्रारम्भो वृष्टेः प्रावृडिति विकल्प्यते । तेषु साधारणेष्वहस्सु वमनादीनां प्रवित्तिर्निवृत्तिरितरेयोगाऽतियोगभयात् । साधारणा हि मन्दशीतोष्णवर्षतया सुखत्वात् भवन्त्यविकल्पकाः शरीरौषधानाम्। विपरीतास्त्वितरे ॥ ८ ॥
Kala (time) also confers suitability to the drugs. It was described earlier itself (chapter 4) that it (time) as of two kinds viz., first, such as ksana, lava, muhurta etc., the second as the stages of the patient (or disease). Time (seasons) are of three characteristics, cold, hot and rainy. Between cold (sisira) and hot (grisma) seasons and in between rainy (varsa) and cold (hemanta) seasons, there are two ordinary seasons (temporate) viz. vasanta and sarat respectively. The ordinary (temporate) season found inbetween grisma and varsa which, is the first commencement of rain is known as pravrt.
The ideal time for administration of therapies like emesis and purgations is the day time of the ordinary (temporate) seasons; where as the daytime of other seasons are unsuitable because of the risk of inadequate or excessive bouts. Similarly, the ordinary seasons are ideal even for the administration of other drugs (or treatments) to the body, because of mild degrees of cold, heat and rain during these seasons and so are easy and harmless. Opposite will be the condition in other seasons. (8)
तथा हि शीतकालेऽतिमात्रशीतोपहितत्वाच्छरीरमत्यर्थशीतवातविष्टब्धमतिस्तब्धबहुगुरुदोषं भवित । तदनु प्राप्तश्च भेषजं संशोधनार्थमुष्णस्वभावमपि शीतोपहतत्वान्मन्दवीर्यतां गतमयोगाय जायते । शरीरञ्च वातप्रायोपद्रवाय । तद्वद्वर्षास्वपि समन्तादतिघनेन बहलेन घनसम्पातेनावतते नभसि उपरुद्धतेजः प्रसरेषु दिनकरकरेषु जलपटलोत्प्लावनोद्दामकर्दमायां भूमावत्यर्थोपक्लिन्नमवसन्नानबलमादानदुर्बलं शरीरं भवति ॥ ९ ॥
Further, during cold season, the body being a victin of severe cold and cold breeze, the doshas become stable (immobile, stagnated, stick on inside the channels) and heavy (greatly increased). Purificatory drugs (or therapies) administered during this period, though generally of hot potency, get vanquished (defeated) by the profound cold, become inefficient in action, give only inadequate bouts and make the body susceptible to many diseases of vata origin.
Similarly, during rainy season also, similar is the result (the drugs become weak and produce only inadequate bouts) because in this season the sky is full of thick clouds which obstruct the hot (warm) rays of the sun reaching the earth, the earth becomes full of slush by lashing rain and flowing water, the bodies of men get water logged, lose the efficiency of digestive activity and become weak by the effect of season. (9)
औषधग्रामस्तु जलदोदरप्रततप्रमुक्तधारावपातसम्भृताम्बुनिवहोपप्लावितमूलजालसारविटपो बहल कोमलपल्लवोपचितस्कन्धाशाख: पुनरिव बालतामुपगतोऽल्पवीर्यो भवति । अपरिसं स्थिततया च क्षितिमलप्रायाभिरम्लविपाकाभिः खगमृगसरीसृपादिशवधातुमूत्रपुरीषसंस्पृष्टा भिराद्भिः सलिलशिशिरशीकरानुविद्धशिशिरपवनस्पृक्तेन च धाराधरोष्मणा कोमलत्वादपरिणतस्याऽस्य सुतरां विदाहो जन्यते । ततश्चासावपथ्यतामुपगतो ध्रुवमयोगाय प्रथमसंगृहीतमपि चौषधं तोयदतोयानुगतमारुतोपहते जगतीति ॥१०॥
The condition of the entire vegetation will be poor in potency because of the net work of roots of trees will have been submerged in water due to continuous rain falling in torrents from the womb of the clouds, the stem and banches will have become full with tender leaves and buds, making the trees appear to have become young. Because of this tenderness and the effect of slush of the soil they will undergo sourness during digestion; the water will have become contaminated with the cadavers, tissues, urine and excreta of birds, animals, reptiles etc., the wind will be very cold due to presence of water vapour, snow and mist; the heat of the earth having become greatly reduced, the vegetaion not having attained maturity in their potency, they will only cause burning sensation during digestion in the human body. Because of these reasons, the drugs which are collected even at the commencement (of the rainy season) will be unsuitable for health (and produce inadequate bouts only) due to the preponderance of water and wind full of water vapour (10)
ग्रीष्मे पुनरादानोपहतत्वाच्छरीरमुष्णरूक्षवातातपाघ्मातमतिस्विन्नमतिशिथिलमति प्रविलीन दोषं भवति । भेषजं पुनरनुष्णमपि तपनकरनिपातादुष्णतीक्ष्णतामुपगतमतियोगायोपकल्पते । शरीरञ्च पिपासा भ्रमक्लमोपद्रवाय । तस्मात्साधारणेष्वेव तदन्तरालेषु वमनादीनि योजयेन्नचेदात्ययिको व्याधिः । अत्ययिके तु कृत्रिमगुणोपदानेन यथर्तुगुणविपरीतेन संयोगसंस्कारप्रमाण विकल्पैश्चोपपाद्यौषधमेवा वहितोऽवचारयेत् ॥ ११ ॥
During grisma (summer) due to the effect of withdrawal (of moisture by the sun), the body (of man) under the influence of hot and dry wind will have severe perspiration, and the doshas will be very loose (fluid, moving freely) and in very little quantity. Purificatory drugs though not hot in potency will aquire the properties of heat and penetrating deep inside, cause excessive bouts (of emesis and purgation); the body will suffer from complications like thirst, giddiness and exhaustion.
So, it is ideal to administer emesis and other purificatory therapies, during temperate seasons only, if there is no emergency disease. In case of an emergency disease, purificatory treatment should be done by creating conditions opposite of the seasons artificially and administering drugs which have been made suitable with appropriate processing, combination, dosage, mode of use and other procedures. (11)
Ausadha Kala – time of administration of drugs
आतुरावस्थासु तु कलाः कालसंज्ञाः । तद्यथाऽस्यामवस्थायामस्यौषधस्य कालो कालो वा। नह्यप्राप्तातीतकालमौषधंयौगिकं भवति । तस्यत्वेकादशधाऽवचारणम् । तद्यथा अभक्तं प्राग्भक्तं मध्यभक्तमधोभक्तं सभक्तमन्तरभक्तं सामुद्गं मुहुर्मुहुः सग्रासं ग्रासान्तरा निशि च ॥१२॥
In the context of the conditions or stages of the patient (or the disease), time means the different parts, viz. a certian time whether appropriate for administration of medicine, or not, whether a particular time either suitable or unsuitable for a paricular drug etc. Drugs administered either at premature time or elapsed time will not yield the desired results.
The times of administration of medicines are eleven in number such as; without food, before meals, during meals, after meals, mixed with food during its preparation itself, in between meals (of afternoon and night), at the commencement and end of the meals, often (frequently) irrespective of meals, mixed or along with one morsel, in between such morsels and at night (bed time). (12)
तत्राऽभक्तं नाम केवलमेवौषधं निरन्नोपयोगादतिवीर्यम् । कफोद्रेकविमुक्तामाशयस्त्रोताः प्रातर्बलवानुपयुञ्जीत । इतरस्तु प्राग्भक्तादिकमन्नसंसर्गेण हितं नातिग्लानिकरं भवति ॥१३॥
Abhakta (without food) is administration of the drug separately without giving any food to the patient. The action of the drug in that case, will be very powerful. So, for persons who are astrong, drugs should be given in the morning after the increased kapha has moved out of the stomach; in case of others it should be before food (of the morning; or breakfast) as the person will not suffer from fatigue by the support of the food. ( 13 )
प्राग्भक्तं नाम यदनन्तरभक्तम् ।
तदपानानिलविकृतावधः कायस्य च बलाधानार्थं तद्गतेषु च व्याधिषु प्रशमनाय कृशीकरणार्थञ्च योज्यम् ॥१४॥
Pragbhakta is the administration of the drug just prior to the meal. It is useful in the treatment of diseases caused by apanavata, in diseases of the lower extremities, for strengthening the body and for making the body thin. (14)
मध्यभक्तं मध्ये भक्तस्य तत् समानानिलविकृतौ । कोष्ठगतेषु च व्याधिषु पैत्तिकेषु च ॥१५॥
Madhyabhakta is administration of the drug in the middle of the meal and is useful in diseases caused by samanavata, in diseases of the alimentary tract and diseases of pitta origin. (15)
अधोभक्तं भक्तादनन्तरम् । तत्तुव्यानविकृतौ प्रातराशान्तमुदानविकृतौ पुनः सायमाशान्तम्पूर्व कायस्य च बलाधानार्थं तद्गतेषु व्याधिषु च श्लेष्मिकेषु च प्रशमाय स्थूलीकरणार्थञ्च ॥१६॥
Adhobhakta is the use of the drug after the meal, in diseases due to vyanavata; it should be after the morning (midday) meal and in diseases due to udanavata it should be after the evening (night) meal. This method is useful for strengthening the upper part of the body and cure of their diseases, for diseases, caused by kapha and to cause stoutness (plumpiness) of the body. (16)
सभक्तं यदन्नेन समं साधितं पश्चाद्वा समालोडितम् । तत् बालेषु सुकुमारेष्वौषधद्वेषिष्वरुचौ सर्वाङ्गगेषु च रोगेषु ॥१७॥
Sabhakta, is partaking food prepared by mixing the drug or mixing the drug to the prepared food and eating immediately. It is indicated for children, persons who are of tender constitution, those who hate medicines, in loss of appetite and in diseases affecting the whole body. ( 17 )
अन्तराभक्तं यत् पूर्वाह्ने भक्ते जीर्णे मध्याह्ने भेषजमुपयुज्यते । तस्मिंश्च जीर्णे पुनरपराह्णे भोजनम् । एतेन रात्रिर्व्याख्याता । तद्दीप्ताग्रेर्व्यानजेष्वामयेषु ॥ १८ ॥
Antarabhkta is the administration of medicines first at midday after the digestion of the forenoon meal (breakfast) and once again in the afternoon after the digestion of the midday meal. Likewise in case of the night also. This method is indicated for those who have strong digestion and in disorders caused by vyanavata. (18)
सामुद्द्रं यदाऽदावन्ते च भुक्तस्य । तत्तु लघ्वल्पान्नयुक्तं पाचनावलेहचूर्णादि हिघ्मायां कम्पाक्षेपयोरूध्वधस्संश्रये च दोषे ॥१९॥
Samudga is the use of medicine twice – once just before meals and once again immediately after meals. Food should be easily digestible and little in quantity, drugs should be having digestive properties and be in the form of confection, powder etc. This method is indicated in hiccups, tremors, convulsions and when the doshas are localised at both upper and lower parts of the body. (19)
मुहुर्मुहुस्तु पुनः पुनर्भुक्ते यदभुक्ते वा । तच्छवासकासहिध्मातृछर्दिषु विषनिमित्तेषु च विकारेषु ॥ २०॥
Muhurmuhu is the use of medicine, frequently (often) with or without food. This method is useful in diseases like dyspnoea, cough, hiccup thirst, vomiting and diseases caused by poisons. (20)
सग्रासं यत् ग्राससम्पृक्तम् । ग्रासान्तरं यत् ग्रासयोग्रसयोर्मध्ये द्वयमप्येतत् प्राणानिलविकृतौ । तथा सग्रासं चूर्णलेहवटकादिकमग्निदीपनं वाजीकरणानि चोपयुञ्जीत। ग्रासान्तरं हृद्वोगे वमनं घूमञ्च । जत्रूर्ध्वामयेषु निशायाम् ॥ २१ ॥
Sagrasa is taking medicine only once with (first) morsel of food, and Grasantara is taking it after every morsel. Both these are indicated in disorders of pranavata. Medicines which are in the form of powder, confection pill etc., and having the property of kindling digestion and those which are aphrodisiacs are to be used along with one morsel. Drugs which cure diseases of the heart, drugs to produce vomiting and those useful for inhalation of smoke, they can be administered after every morsel.
Nisa (night) administration of drugs at night (bed – time, before sleep ) is ideal for the treatment of diseases of parts of the body above the shoulders. ( 21 )
तत्राद्ये काले तृषितः पीतशीताम्बुरजीर्णी क्षुधितः क्षामश्च भेषजं वर्जयेत् । शेषेषु वाऽहृद्यमसात्म्यमतितीक्ष्णोष्णोग्रगन्धं भूरिमात्रञ्चेति । भवति चात्र श्लोकः ॥२२॥
The use of medicine during the first of these time (that is, on empty stomach) should be avoided for those who are thirsty, who have just drunk cold water, who have indigestion, who are hungry and who are very emaciated. Even at other times, drugs which are unpleasant, unaccustomed, very strong very hot in potency, having strong smell and large quantity should be avoided. ( 22 )
Herein are some verses;
रोगमादौ परीक्षेत तदनन्तरमौषधम् । ततः कर्म भिषक् पश्चात् ज्ञानपूर्वं समाचरेत् ॥ २३ ॥
The disease is to be examined first and next, the drug; and then after, the physician should treat the disease with full knowledge. (23)
निवृत्तोऽपि पुनर्व्याधिरल्पेनायाति हेतुना । देहे मार्गीकृते दोषैः शेषः सूक्ष्म इवानलः ॥२४॥ तस्मात्तमनुबध्ध्रीयात् प्रयोगेणानपायिना । सिद्धानामपि योगानां पूर्वेषां दार्ढ्यमावहन् ॥ २५ ॥
Though the diseases get cured, they may reappear again due to (residue) of the doshas remaining inside the body and getting excited even by trivial causes, just like the fire (which flares up from a small spark ). Hence it (dosha residue) should be cleared out with harmless methods and effective recipes described earlier, made potent with suitable processes. (24-25)
सातत्यात्स्वाद्वभावाद्वा पथ्यं द्वेष्यत्वमागतम् । कल्पनाविधिभिस्तैस्तैः प्रियत्वं गमयेत् पुनः ॥२६॥
A drug which is good for health becomes disagreeable (disliked) due to constant use or lack of sweetness (or pleasantness); hence such things should be made agreeable (acceptable, liked, pleasant) with different kinds of processing.
मनसोर्थानुकूल्येन तुष्टिरूर्जा रुचिर्बलम् । सुखोपभोगता च स्यात् व्याधेश्चातः परिक्षयः॥२७॥
Nourishment, valour, desire, strength and enjoyment of happiness all are dependent upon the feeling of comfort (happiness) in the mind; then follows the relief (cure) of the diseases. (27)
लौल्याद्दोषक्षयाद्व्याधिवैषम्येण चया रुचिः । तासु पथ्योपचारज्ञो योगेनाद्यं विकल्पयेत् ॥ २८ ॥
Desire (or liking) towards a thing (which is bad to health) develops during the course of the disease due to fondness, decrease of the doshas or peculiar effect of the disease; the physician who is versed in the knowledge of the good, should make appropriate alterations and make it (bad thing) suitable to health and permit its use.
Dosha nirharana Kala – time for elimination of doshas
शीतोष्णवर्षानिचितं चैत्र श्रावणकार्तिके | क्रमात् साधारणे श्लेष्मवातपित्तं हरेद्रुतम् ॥ २९ ॥
प्रावृटशरद्वसन्तानां मासेष्वेतेषु वा हरेत् । साधारणेषु विधिना त्रिमासान्तरितान्मलान् ॥३०॥
कृत्वा शीतोष्णवृष्टीनां प्रतीकारं यथायथम् । प्रयोजयेत् क्रियां प्राप्तां क्रियाकालं नहापयेत् ॥३१॥
सप्ताहेन गुणालाभे क्रियामन्यां प्रयोजयेत् । पूर्वस्यां शान्तवेगायां न क्रियासङ्करोहितः । गुणेऽल्पेपि तु तामेव विशेषोत्कर्षलब्धये ॥ ३२ ॥
The doshas kapha, vata and pitta which have undergone increase in cold, hot and rainy seasons respectively should expelled out of the body either during the three ordinary (temperate) months the caitra, sravana and kartika or during the ordinary (temperate) months of pravrut, sarat and vasanta rutus (seasons) respectively with the prescribed procedure. Having created conditions opposite of the cold, hot and rainy seasons artificially treatments should be done in appropriate time, without skipping (avoiding) the sequences of time (and / or of the treatment).
If no relief is found within seven days (with one method of treatment) another alternate treatment should be started and that only after the effect of the earlier treatment has disappeared. Mixing of two kinds of treatment is not good. Even if slight improvement has been obtained by any one treatment, the same should be continued with suitable modifications to obtain better improvement. (29-32)
भेषजं नृपतेर्हृद्यमल्पमल्पात्ययं शुचिः । शुद्धागमं बहुगुणं बहुकृत्वः प्रयोजितम् ॥३३॥ अनन्यकार्योऽवहितः तथा तन्मन्त्रिसम्मतः । आस्वादितं परिचरैः स्वयञ्चानुप्रयोजयेत् ॥३४॥
The drug (or treatment) to be administered to the king, should be pleasant (acceptable), small in quantity, with no deleterious effects, pure (genuine), scientifically prepared, possessing many good qualities and found efficacious many times. The physician (while treating the king), should not engage himself in any other work, and should obtain the consent of his friends (ministers, relatives etc.) for his treatment; the drug having been tasted by the royal retinue earlier and also by himself and then administered to the king. (33-34)
उचितो यस्य यो देशस्तज्जं तस्यौषधं हितम् । देशेऽन्यत्रापि वसतस्तत्तुल्यगुणजन्म च ॥३५॥ वीर्यवद्भावितं सम्यक् स्वरसैरसकृल्लघु | रसगन्धादिसम्पन्नं काले जीर्णे च मात्रया । एकाग्रमनसा युक्तं भैषज्यममृतायते ॥३६॥
That drug which is grown in the same land (region) in which a person lives will be ideal for that person; those drugs which possess properties similar to the properties of the land in which a person is born should be used for those living in a different land (temporarily or permanently).
The drug, which by nature, is potent, fortified further by soaking it in the fresh juices of others, made easily digestible, endowed with pleasant taste, smell etc., administered at proper time, in the mild dose and with steady mind (full confidence) is sure to become nectar. (35-36)
॥ इति त्रयोविंशोऽध्यायः ॥
Thus ends the twenty-third chapter.