पञ्चदशोऽध्यायः
अथात उपकल्पनीयमध्यायं व्याख्यास्यामः ॥ १ ॥ इति ह स्माह भगवानात्रेयः ॥ २ ॥
We shall now expound the chapter on the “Requirements of a Physician.”
Thus said Lord Atraya. [ 1-2 ] Elimination therapies always follow oleation and fomentation therapies. So immediately following the preceding chapter on formentation requirements of a physician in relation to the elimination therapy are being described in the present chapter.
Reasoning for a good store of medicine
इह खलु राजानं राजमात्रमन्यं वा विपुलद्रव्यं वमनं विरेचनं वा पाययितुकामेन भिषजा प्रागेवौषधपानात् संभारा उपकल्पनीया भवन्ति सम्यक् चैव हि गच्छत्यौषधे प्रतिभोगार्थाः, व्यापन्ने चौषधे व्यापदः परिसंख्याय प्रतीकारार्थाः, न हि सन्निकृष्टे काले प्रादुर्भूतायामापदि सत्यपि क्रयाकये सुकरमाशु संभरणमौषधानां यथावदिति ॥ ३ ॥ एवंवादिनं भगवन्तमात्रेयमग्निवेश उवाच-ननु भगवन् ! आदावेव ज्ञानवता तथा प्रतिविधातव्यं यथा प्रतिविहिते सिध्ये देवौषधमेकान्तेन, सम्यक्प्रयोगनिमित्ता हि सर्वकर्मणां सिद्धिरिटा, व्यापच्चासम्यक्प्रयोगमित्ता; अथ सम्यगसम्यक् च समारब्धं कर्म सिद्ध्यति व्यापद्यते वाऽनियमेन, तुल्यं भवति ज्ञानमज्ञानेनेति ॥ ४ ॥
The physician, desirous of administering emesis or purgation to a resourceful person like a King or somebody of that status should collect all requirements well in advance of the actual treatment. In case the therapy is successful (in eliminating the vitiated doshas) the collected material can be used for the management of the patient after the treatment. If the therapy goes wrong, these drugs can be utilised to correct the complications alter they have been asertained. (In any case the collection of materials well in advance is necessary because, ) in an emergency it may not be possible to obtain the required medicines within a short time even though they are locally available on sale. Thus said Lord Atreya.
Agnivesa solicited a clarification by saying, “O Lord! a wise physician at the outset should administer the therapy in such a way that it is always infallibly effective. Effectiveness of all actions depends on proper administration. Conversely failure is
the result of improper administration. On the other hand, success or failure of an action, properly or improperly done, if cannot be predicted, would it not indicate that knowledge and ignorance stand on the same footing ? [ 3-4 ]
Subtleness of the factors determining the result of the treatment
तमुवाच भगवानात्रेयः – शक्यं तथा प्रतिविधातुमस्माभिरस्मद्विधैर्वाप्यग्निवेश ! यथा प्रतिविहिते सिध्येदेवौषधमेकान्तेन, तथ्य प्रयोगसौष्ठवमुपदेष्टुं यथावत् न हि कश्चिदस्ति य एतदेवमुपदिष्टभु पधारयितुमुत्सहेत, उपधार्य वा तथा प्रतिपत्तुं प्रयोक्तुं वा; सूक्ष्माणि हि दोषभेषजदेशकालवलशरीराद्दारसात्म्य सत्त्व प्रकृतिवयसामवस्थान्तराणि, यान्यनुचिन्त्यमानानि विमलविपुलबुद्धेरपि पुद्धिमाकुलीकुर्युः किं पुनरल्पबुद्धेः; तस्मादुभयमेतद्यथावदुपदेक्ष्यामः- सम्यक्प्रयोगं चौषधानां, व्यापन्नानां च व्यापत्साधनानि सिद्धिपुत्तरकालम् ॥ ५ ॥ F
Lord Atreya replied, “O Agnivesa! we or other people like ourselves can certainly administer therapy in such a way that it will always be infallibly effective. It is again within our competence to impart instructions for the proper administration of therapy. But how many are there who would fully compre. hend our instructions or even after comprehension would act on them or use them properly? The difference in variations of dosha, medicinal drugs, location, time, strength, body, diet, wholesomeness, mind, constitution and age is very subtle. Such subtleties baffle the intelligence, even of the exceedingly brilliant persons who have clean understanding of the subject, what to say about the persons of small intelligence? So we shall subsequently explain in Siddhi section both these aspects, viz., proper administrationof the therapy and the antidotes of their complications. [5] It is no doubt that is it possible to eradicate the dieseases by means of proper treatment. It is also not impossible to impart therapeutical instructions so that one could be well conversant with the principles of treatment and act on such principles in an effective manner. But such persons as could retain the therapeutical instructions in their entirety or could act on them and apply them in individual cases properly, are very rare.
The dfference in variations of the factors to be kept in view at the time of treatment is very subtle in the sense that it is not easy to grasp them thoroughly. These variations are as follows:
(a) Variations relating to doshas-The quantity of doshas may either get diminished or aggravated or may remain in equilibrium. The dasas my vary according to their upward, downward or sideward movement or according to their location in the periferal, central or middle path. Doshas may also vary as they are a gravated in their place of origin (svadesa ) elsewhere (paradesa) or as their aggravation primary (svatantra) or secondary ( paratantra ). The aggravation of a dosha might vary in terms of its particular aspects. For example, aggravation of vata might sometimes be mainly related to the aggravation of coldness, lightness, etc. Doshas might also vary according as they vitiate different dhatus. Similarly these doshas might vary according to season, constitution of the patient and dhatus affected.
(b) Variations relating to the Drug-The drug may vary in its effect as it is young, old, green, dry, combined with some other drugs and different forms of preparation. They also vary as they are effective for the doshas of the body by virtue of their rasa ( taste ), virya (potency), vipaka and prabhava ( specific action).
(c) Variation relating to the place-Places vary as they are marshy, arid, ordinary or most suitable.
(d) Variation relating to Time-Time may vary according to the change of seasons or as it is forenoon, noon, afternoon, etc., or according to the periodicity of the diseases like the duration of fever for eight days, etc.
(e) Variations relating to Strength-The strength of the patient may vary as it is inherent, acquired or effected by time (season, age, etc.). It might also vary as it is superior, mediocre or inferior.
(f) Variation in relation to Body-The body may be fatty, lean, compact or porous. It may also be differentiated according to the vital organs, eye, etc. which are to be protected very carefully.
(g) Variations relating to Diet-It may vary according to its nature, method of preparation, combination, quantity, etc.
(h) Variation relating to wholesomeness-It my vary depending upon the locality, time (age and season), disease, constitution, nature and habits.
(i) Variations relating to Mind-It may vary as it is associated with fear, grief, sorrow, happiness, etc.
(j) Variations relating to Constitution-There are variations in bodily constitution as it is initiated by vata, etc.
(k) Variations relating to Agni-There may be variations in the individual according to his age, viz., child, youth, old and their dfferent stages. Examples regarding the relevance of all these variatinos of dosha, etc. in the treatment of diseases wil be furnished in appropriate places in the text; these details are not furnished here.
Hospital building
इदानीं तावत् संभारान् विविधानपि समासेनोपदेक्ष्यामः; तद्यथा- दृढं निवातं प्रवातैकदेशं सुखविचारमनुपत्यकं धूमातपजलरजसामनभिगमनीयमनिष्ठानां च शब्दस्पर्शरसरूपगन्धानां सोदपानोदूखलमुसलवर्चः स्थानवानभूमिमहानसं वास्तु विद्याकुशलः प्रशस्तं गृहमेव तावत् पूर्वमुपकल्पयेत् ॥ ६ ॥
Now we shall explain in brief the various requirements. First of all, an expert architect should design a good building. The building should be strong and it should not be exposed to winds. However, it should be so constructed as to allow wind only through one passage. It should provide for a comfortable moving space. The building should not be situated in a mountainous place nor should it be located near a bigger building. Besides the building should not be exposed to smokes, the sun, water, dust or undesirable noise nor should it have undesirable contacts, tastes, sight or smell. The building should be well equipped with a water reservoir or water pot, mortar, pestle, latrine, bath room and kitchcn. [ 6 ]
The requirements enumerated above are meant both for the treatment of complications in the course of the administration of the therapy as well as for the management of the patient thereafter.
Medical attendants and other general requirements of a hospital
ततः शीलशौचाचारानुरागदाक्ष्यप्रादक्षिण्योपपत्रानुपचारकुशलान् सर्वकर्मसु पर्यवदातान् सूपौदनपाचकस्ना पकसंवाहकोत्थापकसंवेश कौषधपेषकांश्च परिचारकान् सर्वकर्मस्वप्रतिकूलान्, तथा गीतवादित्रोल्लापकश्लोकगाथाख्यायिकेतिहासपुराणकुशलानभिप्रायशाननुमतांश्च देशकालविदः पारिषद्यांश्च । तथा लावकपिञ्जलशशहरिणैणकालपुच्छक मृगमातृकोरभ्रान्, गां दोग्ध्री शीलवतीमनातुरां जीवद्वत्सां सुप्रतिविहिततृणशरणपानीयां, पात्र्याचमनीयोदकोष्ठमणिकघटपिठरपर्योगकुम्भीकुम्भकुण्डशरावदवकटोदश्चन परिपचन मन्थानचर्मचे लसूत्रकार्पासोदीनि च शयनासनादीनि चोपन्यस्तभृङ्गारप्रतिनंहाणि सुप्रयुक्तास्तरणोत्तरप्रच्छदोपधानानि सोपाश्रयाणि संवेशनोपवेशनस्नेहस्वेदाभ्यङ्गप्रदेहपरिषेकानुलेप१ सुप्रनवमनविरेचनास्थापनानुवासनशिरोविरेचनसूत्रोच्चारकर्मणामुपचारसुखानि, क्षालितोपधानाश्च सुलक्ष्णखर मध्यमा दृषदः, शस्त्राणि चोपकरणार्थानि धूमनेत्रं च, वस्तिनेत्रं चोत्तरवस्तिकं च, कुशहस्तकं च, तुलां च, मानभाण्डं च, घृततैलवसामजक्षौद्र फाणितलवणेन्धनोदकमधुसीधुसुरासौवीरकतुषोदकमैरेय मेदकदधिद्धिमण्डोदस्विद्धान्याम्लसूत्राणि च, तथा शालिषष्टिकमुद्रभाषयवतिलकुलत्थबदरमुद्रीकाकाश्मर्यपरुषकाभयामलकविभीतकानि; नानाविधानि च स्नेहस्वेदोपकरणानि द्रव्याणि तथैवोर्ध्वहरानुलोमिकोभयभाञ्जि, संग्रहणीयदीपनीय पाचनीयोपशमनीयवातहरादिसमाख्यातानि चौषधानि; यश्चान्यदपि किञ्चिद्व्यापदः परिसंख्याय प्रतीकारार्थमुपकरणं विद्यात्, यच्च प्रतिभोगार्थं, तत्तदुपकल्पयेत् ॥ ७ ॥
Then arrangements are to be made for attendants who are endowed with good conduct, cleanliness, character, devotion, dexterity and sympathy and who are conversant with the art of nursing and good in administering therapies. Several such attendants are required for various purposes like cooking soup, porridge, etc., bathing, massaging, lifting, seating of patients and also for grinding of drugs. These attendants should all be willing workers. People well-versed with vocal and instrumental music, panegyrics, recitation of verses, ancient lores, short stories, itihasa ( the Mahabharata, etc.), purana ( mythology), those who can grasp the inner desires, who are obedient, and who have knowledge of the time and place should also be arranged.
Presence of lava (common quail ), kapinjala (grey partridge), sasa ( rabbit), harina (black buck), ena (antelope ), kalapucchaka (black-tailed deer ), mrgamatrka ( red deer ), urabhra (wild sheep) is necessary. There should be a milch-cow of good temper and free from diseases with her calf alive. Proper arrangement should be made for her fodder, dwelling and water. Provision should also be made for water vessel ( patri), spoon ( acamaniya), water tub ( udakostha ), big and small earthen jars ( manika and ghata ), frying pan (pithara), boiling pan (paryoga), small and big pitchers ( kumbhi kumbha ), bowl ( kunda ), saucer (sarava ), ladle (daroi), mat (kata), coverplate (udancana), cooking pan (paripacana), churning stick (manthana ), leather, cloth, thread, cotton, wool, etc.
Arrangements are to be made for beddings, seats, etc. Golden vase and spittoon are also to be provided. Bed sheet, towel, pillow and cushion should be kept there so as to facilitate lying flat, sitting, oleation, fomentation, massage, unction, a ffusion, anointment, emesis, purgation, asthapana type of enema, anuvasana type of enema, elimination of doshas from head and passing of stool and urine.
There should also be grinding stones (mortars)-smooth, hard and of medium size along with well cleaned pestles, sharp instruments, accessories, smoking pipe, tube for enema and douche, broom, scales and measuring vessels, ghee, oil, muscle fat, marrow, honey, phanita (a sugar cane preparation ), salt, fuel, various types of wine like the one prepared of honey, sidhu, sura, sauviraka, maireya, medaka, tusodaka, curd, whey,udasvit (a mixture of water and butter milk in equal parts, MW.), dhanyamla (sour gruel), sali (Oryza sativa Linn.), sastika (a variety of Oryza sativa Linn.), mudga (phaseolus mungo Linn.), masa ( Phaseolus radiatus Linn.), yava (Hordeum vulgara Linn.), tila ( Sesamum indicum Linn.), Kulattha ( Dolichos bifforus Linn.), badara ( Zizyphus jujuba Lam.), mrdvika ( Vitis vinifera Linn.), kasmarya (Gmelina arborea Linn. ), parusaka (Grewia asiatica Linn.), abhaya (Terminalia chebula Linn.), amalaki (Emblica officinalis Gaertn), bibhitaka (Termenalia bellerica Roxb.) and other drugs employed in oleation, fomentation, emesis, purgation, those having the combined action of emesis and purgation which are known as constipatives, and appetisers and ablatines of vata, etc., and are carminatives, such other medicines as are conducive to the treatment of complications, if any, and also those which are useful in and after-treatment should also be collected. [7]
Hospitalization and general plan for the treatment
ततस्तं पुरुषं यथोक्ताभ्यां स्नेहस्वेदाभ्यां यथार्हमुपपादयेत्, तं चेदस्मिन्नन्तरे मानसः शारीरो वा व्याधिः कश्चित्तीव्रतरः सहसाऽभ्यागच्छेत्तमेव तावदस्योपावर्त – यितुं यतेत, ततस्तमुपावर्त्य तावन्तमेवैनं कालं तथाविधेनैव कर्मणोपाचरेत् ॥ ८ ॥ ततस्तं पुरुषं स्नेहस्वेदोपपन्न मनुपहृतमनसमभिसमीक्ष्य सुखोषितं सुप्रजीर्णभक्तं शिरःखातमनुलिप्तगात्रं स्रग्विणमनुपहतवस्त्रसंवीतं देवताग्निद्विजगुरुवृद्धवैद्यानचितवन्तमिष्टे नक्षत्रतिथिकरणमुहूर्ते कारयित्वा ब्राह्मणान् स्वस्तिवाचनं प्रयुक्ताभिराशीर्भिरभिमन्त्रितां मधुमधुकसैन्धवफाणितोपहितां मदनफलकषायमात्रां पाययेत् ॥ ९ ॥
The patient should then be treated by means of oleation and fomentation therapies as required. In the event of a sudden attack of a more serious psychic or somatic disease during the course of this treatment, the physician should try to correct them first. Even after it has been corrected the same (corrective) therapy should be continued for an equivalent duration.
After the successful administration of oleation and fomentation therapies and on ensuring that the patient’s mind has come to normalcy, he has spent sometime at ease, the food taken by him is well-digested, he has taken full bath, anointed his body, worn a garland and an untorn clean cloth and has offered worship to the deity, fire, brahmana, preceptor, elderly persons and physician, brahmanas should be requested to recite auspicious mantras and bestow their blessings on the patient on an auspicious day with auspicious naksatra ( constellation ), date, karana and muhurta ( these terms are of astrological importance ). Thereafter, the physician should administer a dose of the decoction of the fruit of madana ( Randia dumetorum Lam.) along with honey, rocksalt, phanita ( a preparation of sugar cane juice ) and the powder of madhuka (Glycyrrhiza glabra Linn.) [8-9]
The physician should also take into account the various astrological factors while administering the above therapy to the patient. That is to say, this should be administered in a most auspicious moment which is conducive to the success of therapy for a given patient. As it has been said “Pusya, hasta, jyestha, rohini, Sravana, asvini, svati, mxgasiras are the auspicious constellations for the admimistration of medicine; the rest are inauspicious.”
Dose of emetics
मदनफलकषायमात्राप्रमाणं तु खलु सर्वसंशोधनमात्राप्रमाणानि च प्रतिपुरुषमपेक्षितव्यानि भवन्ति; यावद्धि यस्य संशोधनं पीतं वैकारिकदोषहरणायोपपद्यते न चातियोगायोगाय, तावदस्य मात्राप्रमाणं वेदितव्यं भवति ॥ १० ॥
The doshage of the decoction of the fruit of madanc (Randia dumetorum Lam.) as also of all the other drugs used in elimination therapy is to be determined according to the individual needs. In other words, the quantity, which, when taken brings about the desired effect in the form of elimination of the vitiated doshas which does not cause over-elimination or inadequate elimination, is to be regarded as the proper dose for the patient. [10]
Signs and symptoms indicating the proper action of the drug
पीतवन्तं तु खल्वेनं मुहूर्तमनुकांक्षेत, तस्य यदा जानीयात् स्वेदप्रादुर्भावेण दोषं प्रविलयनमापद्यमानं, लोमहर्षेण च स्थानेभ्यः प्रचलितं, कुक्षिसमाध्मापनेन च कुक्षिमनुगतं, हृल्लासास्यस्रवणाभ्यामपि चोर्ध्वमुखीभूतम्, अथास्मै जानुसममसंबाधं सुप्रयुक्तास्तरणोत्तर प्रच्छदोपधानं सोपाश्रयमासनमुपवेष्टुं प्रयच्छेत्, प्रतिप्रहांचोपचारयेत्; ललाटप्रतिग्रहे पाचपग्रहणे नाभिप्रपीडने पृष्ठोन्मर्दने चानपत्रपणीयाः सुहृदोऽनुमताः प्रयतेरन् ॥ ११ ॥
After the administration of the decoction, the patient should be watched for some time. The first effect of the administration of decoction would be perspiration which would indicate that the dosha has started melting. Thereafter, the patient would have horripilation which would show that the dosha has started moving from its own position. In the third stage will come the distension of the abdomen indicative of the doshas having shifted to the intestine. Nausea and salivation which occur in the fourth stage are indicative of the fact that the dosha has started moving upwards. It is at this stage that the patient should be asked to sit on a bed of knee height, comfortable, well-covered and equipped with bed-sheet, towel, pillow and cushion. A spittoon should also be kept (nearby). Such of the close friends whose presence is not embarrassing to the patient should then attend to him in supporting his head sides, pressing the navel and massaging the back.
Position of the patient during emesis
अथैनमनुशिष्यात् – विवृतोष्ठतालुकण्ठो नातिमहता व्यायामेन वेगानुवर्णानुदीरयन् किञ्चिदवनस्य ग्रीवा मूर्ध्वशरीरमुपवेगमप्रवृत्तान् प्रवर्तयन् सुपरिलिखितनखाभ्यामङ्गुलिभ्यामुत्पलकुमुदसौगन्धिकना लैर्वा कण्ठमभिस्पृशन् सुखं प्रवर्तयस्वेति, स तथाविधं कुर्यात्; ततोऽस्य वेगान् प्रतिग्रहगतानवेक्षेतावहितः, वेगविशेषदर्शनाद्धि कुशलो योगायोगातियोगविशेषानुपलभेत, वेगविशेषदर्शी पुनः कृत्यं यथार्हमवबुध्येत लक्षणेन; तस्माद्वेगानवेक्षेतावहितः ॥ १२ ॥
The patient should then be instructed as follows, “Keep your lips, palate and throat open; do not exert too much but allow the vomiting urge to be fully manifested. In case the urge is not well apparent, its manifestation will be facilitated if you slightly bend the neck and upper part of your body and touch your throat by means of two fingers whose nails heve been well clipped off. (You may touch your throat) with the stalks of kumuda (Nymphaea alba Linn.) or saugandhika (?)”. The patient should act on this advice. The physician should very carefully observe the vomit in the spittoon, ascertain the number of urges and should conclude thereby as to whether the therapy has been well administered, inadequately administered or administered in excess. It is from this observation that the physician can determine the further line of action. So he should very carefully observe the vomiting urges. [12]
If there is no urge for vomiting whatsoever, there should not be any forcible attempt for its manifestation. The physician should ascertain about the proper administration, excessive administration or inadequate administration of this therapy by observing the intensity or otherwise of the urges for vomiting cf. Siddhi 1:13-14.
Features of proper and improper administration of emetics
तत्रामून्ययोगयोगातियोग विशेषज्ञानानि भवन्तिः तद्यथा- अप्रवृत्तिः कुतश्चित् केवलस्य वाऽप्यौषधस्य विभ्रंशो विबन्धो वेगानामयोगलक्षणानि भवन्ति; काले प्रवृत्तिरनतिमहती व्यथा यथाक्रमं दोषहरणं स्वयं चावस्थानमिति योगलक्षणानि भवन्ति, योगेन तु दोषप्रमाणविशेषेण तीक्ष्णमृदुमध्यविभागो ज्ञेयः; योगाधिक्येन तु फेनिलरक्तचन्द्रिकोपगमनमित्यतियोगलक्षणानि भवन्ति । तत्रातियोगायोगनिमित्तानिमानुपद्रवान् विद्यात्-आध्मानं परिकर्तिका परित्रावो हृदयोपसरणमा ग्रहो जीवादानं विभ्रंशः स्तम्भः क्लमश्चेत्युपद्रवाः ॥ १३ ॥
The specific signs and symptoms of inadequate administration, proper administration and over-administration (of the emetic therapy) are as follows:1
Inadequate Administration
1. Absence of Administration, vomiting or occasional vomiting.
2. Vomiting of the drug material only, without the vitiated dosha through purgation.
4. Obstruction to the vomiting urges,
Over Manifestation of the vomiting urges in time. Administration of pain.
2. Absence of too much Excretion
1. Appearance of foam in the vomit.
2. Appearance of blood stained vomit.
3. Elimination of doshas the drug material in proper order.
4. Automatic stoppage of the vomiting urge (in time after the purpose has been served.)
5. Proper administration is of three types, viz. sharp, mild and moderate depending, among others, on the quantity of dosha eliminated.
The following complications arise out of over administration or inadequate administration of the therapy; distension of abdomen, sawing pain, salivation, palpitation, rigidity, stiffness and displacament of viscera of the body, hematemasis and exhaustion. [13]
When drugs are administered for emesis, the result expected is the elimination of doshas through vomiting. But in the event of inadequate administration of the therapy, the drugs administered for emesis sometimes come out through purgation. Similarly, the therapy meant for purgation may result in emesis-cf. Siddhi 6:31. If this therapy, is properly administered, the various doshas are eliminated in a definite order. The order is that kapha is eliminated first, then pitta and vata follow respectively-cf. Siddhi 1:15
The classification of the therapy as sharp, mild and moderate is intended to guide the duration of peya (gruel), etc., to be administered after the therapy-cf. Siddhi 1:11 Sings and symptoms of inadequate administration and over administration will be described in detail in Siddhi 6:58-93.
Post emesis management
योगेन तु खल्वेनं छर्दितवन्तमभिसमीक्ष्य सुप्रक्षालितपाणिपादास्यं मुहूर्तमा श्वास्य; स्नैहिकवैरेचनिकोपशमनीयानां धूमानामन्यतमं सामर्थ्यतः पाययित्वा पुनरेवोदकमुपस्पर्शयेत् ॥ १४ ॥ उपस्पृष्टोदकं चैनं निवातमागारमनुप्रवेश्य संवेश्य चानुशिष्यात्-उच्चैर्भाष्यमत्याशनमतिस्थानमतिचङ्क्रमणं क्रोधशोकहिमात पावश्यायातिप्रवातान् यानयानं ग्राम्यधर्ममस्वपनं निशि दिवा स्वप्नं विरुद्धाजीर्णासात्म्याकालप्रमितातिहीनगुरुविषमभोज नवेगसन्धारणोदीरणमिति भावानेतान्मनसाऽप्यसेवमानः सर्वमहो गमयस्वेति । स तथा कुर्यात् ॥ १५ ॥
After the therapy has been well-administered, the hands, feet and face of the patient should be well-washed and he should be consoled for sometime. He should then be asked to smoke unctuous type, eliminative type or alleviating type of cigar as it suits him and then he should wash ( his hands, feet and face) again. Thereafter, he should enter into a room which is not exposed to the wind and should lie down there. Then he should be instructed, “You should abstain from (not even think of) the following for the whole day-speaking aloud, too much of eating, standing or moving for a long time, resorting to anger and grief, exposing yourself to the sun, dew and stormy wind, travelling by vehicles, indulging in sexual intercourse, vigil during the night, sleeping in the day time, intake of diets of opposite qualities and those that are not digestible and unwholesome, those that go against the propriety of time, intake of diet exclusively having one taste, intake of diet deficient in nutritive value, or heavy (such as laddu, cipitaka, etc., even in moderate quantity) or irregularly mixed up and suppression or excitation of natural urges.” The patient should follow this advice. [14-15]
Regimen of dietetics after emesis
अथैनं सायाह्ने परे वाऽहि सुखोदकपरिषिक्तं पुराणानां लोहितशालितण्डु: लानां स्ववक्किन्नां मण्डपूर्वी सुखोष्णां यवागूं पाययेदग्निवलमभिसमीक्ष्य, एवं द्वितीये तृतीये चान्नकाले, चतुर्थे त्वन्नकाले तथाविधानामेव शालितण्डुलानामुत्स्विन्नां विलेपीमुष्णोदकद्वितीयामस्नेहलवणामल्पस्नेहलवणां वा भोजयेत्, एवं पञ्चमे षष्ठे चान्नकाले, सप्तमे त्वन्नकाले, तथाविधानामेव शालीनां द्विप्रसृतं सुस्विन्नमोदनमुष्णोदकानुपानं तनुना तनुस्नेहलवणोपपन्नेन मुद्यूषेण भोजयेत्, एवमष्टमे नवमे चान्नकाले, दशमे त्वन्नकाले लावकपिञ्जलादीनामन्यतमस्य मांसरसेनौदकलावणिकेन नातिसारवता भोजयेदुष्णोदकानुपानम् ; एवमेकादशे द्वादशे चान्नकाले; अत ऊर्ध्वमन्नगुणान् क्रमेणोपभुञ्जानः सप्तरात्रेण प्रकृतिभोजनमागच्छेत् ॥ १६ ॥
In the same evening or the next day after the patient has taken his bath in luke-warm water, he should be given luke-warm gruel prepared with oldred-variety of sali (Oryza sativa Linn.) rice well-cooked. The gruel should be very thin so much so that the manda, that is the liquid portion is very dominant. This is to be given with due regard to the power of digestion of the patient. This again is to be repeated for the second and third mealtimes. For the fourth meal-time, gruel prepared with the same sali rice, well-cooked, warm and devoid of unctuous substance and salt altogether or with unctuous substance or salt in small quantity is to be given. Warm water is to be taken after the intake of gruel. The same type of diet is to be continued for the fifth and sixth meal-times. For the seventh meal-time again, well-cooked porridge prepared with the same type of sali rice of two Prasyta alongwith a very thin soup of mudga (Phaseolus mungo Linn.) added with unctuous substance and salt in small quantity is to be given. Warm water is to be taken after the intake of the porridge. The same diet is to be repeated for the eighth and ninth meal-times. For the tenth meal-time, thin meat-soup of common quail, grey partridge, etc., prepared with water and salt should be given. Warm water is to be taken after this. This is again to be repeated for the eleventh and twelfth meal times. Thereafter, the patient should take food having different tastes by and by, and he should start taking his normal diet from the seventh night. [16]
After this therapy, the patient is to be watched very carefully. If it is clear from the signs and symptoms that the patient has revived his digestive power, some diet is required to be given the same evening. If his digestive power is not fully revived, diet is to be started the next day. As it has been said, “After the emesis, no diet should be given until the power of digestion has been revived. After the power of digestion is revived, the patient is no longer required to observe fast. He should be given some diet in the form of gruel, etc., by and by”-vide Siddhi 6:23.
The dietetic programme should be so planned that, in the case of the elimination therapy of the first type, the patient starts taking the normal diet after the twelfth meal-time, in case of moderate type of therapy after the eighth meal-time and in the case of mild type of therapy after the fourth meal-time-cf. Siddhi 1: 11-12. If the purgation therapy is not to be administered after the emesis then the patient should be brought to his normal diet with effect from the beginning of the post-therapeuticdietetic programme (samsarjanakrama). Otherwise, oleation is to be started immediately after the beginning of such a programme-cf. Siddhi 1:20. If this is not done it will not be possible to administer purgation therapy on the fifteenth day after emesis.
Purgation therapy
अथैनं पुनरेव स्नेहस्वेदाभ्यामुपपाद्यानुपहृतमनसमभिसमीक्ष्य सुखोषितं सुप्रजीर्णभक्तं कृतहोमबलिमङ्गलजपप्रायश्चित्तमिष्टे तिथिनक्षत्रकरण मुहूर्ते ब्राह्मणान् स्वस्ति वाचयित्वा त्रिवृत्कल्कमक्षमात्रं यथालोडनप्रतिविनीतं पाययेत् प्रसमीक्ष्य दोषभेवजदेशकालवलशरीराहारसात्म्य सत्व प्रकृतिवयसामवस्थान्तराणि विकारांच सम्यक् विरिक्तं चैनं वमनोक्तेन धूमवर्जेन विधिनोपपादयेदावलवर्णप्रकृतिलाभात्, बलवर्णोपपन्नं चैनमनुपहतमनसमभिसमीक्ष्य सुखोषितं सुप्रजीर्णभक्तं शिरःखातमनुलितगात्रं त्रग्विणमनुपहृतव स्त्र संवीतमनुरूपालङ्कारालङ्कृतं सुहृदां दर्शयित्वा ज्ञातीनां दर्शयेत्, अथैनं कामेष्ववसृजेत् ॥ १७ ॥
After the post-therapeutic dietetic programme, oleation and fomentation therapies should be administered again. After the patient has come to normalcy, has rested for a while and the food taken by him has been digested, he should be asked to offer oblations and worships ( to the fire and the gods), and to recite auspicious chants and expiatory verses. The brahmanas should then be invited to recite the auspicious svastivacanas on an auspicious day with auspicious constellations, karana and muhurta. The patient should thereafter be given the drink of the paste of trivrit (Operculina turpethum R. B.) in one aksa (12 g) dose after stirring and mixing up. The difference in the variation of of dosha, medicinal drugs, location, time, strength, body, diet, wholesomeness, mind, constitution and age should be kept in view while administering this therapy. After the patient has been administered purgation therapy properly the entire regimen (prescribed to be follwed after vamana therapy( except smoking is to be followed till he regains the normal strength, complexion and health. After he has regained all these, has come to psychic normalcy, has rested a while and the food taken by him is fully digested, he should take full bath, apply unction, wear garlands, untorn cloths and favourite ornaments and thus appear before friends and kins. Thereafter, he should be free to lead a normal life. [ 17 ]
भवन्ति चात्र –
अनेन विधिना राजा राजमात्रोऽथवा पुनः ।
यस्य वा विपुलं द्रव्यं स संशोधनमर्हति ॥ १८ ॥
Thus it is said :
The above mentioned process is to be followed while administering elimination therapy to resourceful persons like kings and others of an equivalent status. [18]
Plan for emergency management
दरिद्रस्त्वापदं प्राप्य प्राप्तकालं विशोधनम् । पिबेत् काममसंभृत्य संभारानपि दुर्लभान् ॥ १९ ॥ न हि सर्वमनुष्याणां सन्ति सर्वे परिच्छदाः । न च रोगा न बाधन्ते दरिद्वानपि दारुणाः ॥ २० ॥ यद्यच्छक्यं मनुष्येण कर्तुमौषधमापदि । तत्तत् सेव्यं यथाशक्ति वसनान्यशनानि च ॥ २१ ॥
A poor man (on the other hand ), in the event of emergency necessitating the administration of the elimination therapy should take the prescribed drugs available without caring for collecting all the rare medicaments in advance. All the prescribed medicaments are not available to all human beings. At the same time diseases cannot but attack even the poor. So in the case of emergency, whatever drugs, cloths, diets are easily available should be used by patients according to their capacity. [ 19-21]
Good effects of elimination therapy
मलापहं रोगहर बलवर्णप्रसादनम् । पीत्वा संशोधनं सम्यगायुषा युज्यते चिरम् ॥ २२ ॥
Elimination therapy eliminates the doshas, eradicates diseases and restores normal strength and complexion. If taken properly, it brings about longevity. [ 22 ]
तत्र श्लोकाःईश्वराणां वसुमतां वमनं सविरेचनम् । संभारा ये यदर्थं च समानीय प्रयोजयेत् ॥ २३ ॥ यथा प्रयोज्या मात्रा या यदयोगस्य लक्षणम् । योगातियोगयोर्यच्च दोषा ये चाप्युपद्रवाः ॥ २४ ॥ यदसेव्यं विशुद्धेन यश्च संसर्जनक्रमः । तत् सर्वे कल्पनाध्याये व्याजहार पुनर्वसुः ॥ २५ ॥
To sum up :
All the requirements for the administration of elimination therapy to resourceful presons like kings, etc., their utility, the dose, signs and symptoms of inadequate administration, proper administration, and over administration, the afflicted doshas, the complications, regimen prescribed during the therapy and those prescribed in the course of the post-therapeutic dietetic programme-these has all been explained by the Lord Punarvasu in this Chapter. [ 23-25]
इत्यग्निवेशकृते तन्त्रे चरक प्रतिसंस्कृते श्लोकस्थाने उपकल्पनीयो नाम पञ्चदशोऽध्यायः ॥ १५ ॥
Thus ends the fifteenth chapter on “Requirements of a Physician” of Sutra section of Agnivesa’s work as redacted by Charaka.