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Sushruta SamhitaChikitsasthanaPrameha Chikitsa - Treatment of diseases of the urinary tract - Sushrutasamhita...

Prameha Chikitsa – Treatment of diseases of the urinary tract – Sushrutasamhita Chikitsasthana Chapter 11

एकादशोऽध्यायः । अथातः प्रमेहचिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥

Now we shall discourse on the medical treatment of the diseases of the urinary tract (Prameha). As it was described by Lord Dhanvantari. 1

– द्वौ प्रमेहौ भवतः – सहजोऽपथ्यनिमित्तश्च । तत्र सहजो मातृपितृबीजदोषकृतः, अहिताहारजोऽपथ्यनिमित्तः । तयोः पूर्वेणोपद्रुतः कृशो रुक्षोऽल्पाशी पिपासुभृशं परिसरणशीलश्च भवति । उत्तरेण स्थूलो बहाशी स्निग्धः शय्यासनस्वप्नशीलः प्रायेणेति । तत्र कृशमन्नपानप्रतिसंस्कृताभिः क्रियाभिश्चिकित्सेित, स्थूलमपतर्पणयुक्ताभिः ॥ २॥

This disease may be ascribed to two causes, such as the congenital (Sahaja) and that attributable to the use of injudicious diet. The first type (Sahaja ) is due to a defect in the seeds of one’s parents and the second is originated from the use of unwholesome food. The symptoms, which mark the first of these two types, are emaciation and a dryness (of the body), diminished capacity of eating, too much thirst and of wandering habits; while the symptoms, which usually attend the latter type of the disease, are obesity, voracity, gloss of the body, increased soporific tendency and inclination for lounging in bed or on cushions. A case of emaciation, etc., (viz., the first kind of Prameha) should be remedied with nutritious food and drink, etc., whereas Apatarpana etc., (fasting, physical exercise, depletary measures etc.), should be adopted in cases of obesity viz., the second kind of (Prameha). 2

सर्व एव च परिहरेयुः सौवीरकतुषोदकशुक्तमैरेयसुरासवतोयपयस्तैलघृतेक्षुविकारदधिपिष्टान्नाम्लपानकानि ग्राम्यानूपौदकमांसानि चेति ॥ ३ ॥

Forbidden Articles of Food and Drink: All patients suffering from Prameha should forego the use of (the different species of wine and fermented liquor known as) Sauviraka, Tusodaka, Sukta, Maireya, Sura, and asava, water, oil, clarified butter, milk, any odification of the expressed juice of sugarcane, cakes, milk-curd, acid, Panaka¹, the flesh of domestic and aquatic animals and of those which are inhabitant of swampy or marshy places. 3

ततः शालिषष्टिकयवगोधूमकोद्रवोद्दालकाननवान् भुञ्जीत चणकाढकीकुलत्थमुद्गविकल्पेन, तिक्तकषायाभ्यां च शाकगणाभ्यां निकुम्भेङ्गुदीसर्षपातसीतैलसिद्धाभ्यां बद्धमूत्रैर्वा जाङ्गलैर्मांसैरपहृतमेदोभिरनम्लै रघृतैश्चेति ॥ ४ ॥

Articles of diet: The use of sufficiently old and matured, Sali and Sastika rice, barley, wheat, Kodrava, Uddalaka, with the different preparations of Canaka, Adhaki, Kulattha or Mudga pulse is recommended; or the meal should be taken with the Sakas ( potherbs) or bitter or astringent taste cooked with the oils of Nikumbha, Ingudi, mustard or linseed oil; or with the soup of the lean flesh of Jangala animals which are possessed of anti-diuretic properties cooked without any clarified butter and unseasoned with any acid juice. 4

तत्रादित एव प्रमेहिणं स्निग्धमन्यतमेन तैलेन प्रियङ्वादिसिद्धेन वा घृतेन वामयेत् प्रगाढं विरेचयेच्च, विरेचनादनन्तरं सुरसादिकषायेणास्थापयेन्महौषधभद्रदारुमुस्तावापेन मधुसैन्धवयुक्तेन, दह्यमानञ्च न्यग्रोधादिकषायेण निःस्नेहेन ॥ ५ ॥

Preliminary Treatment: The patient should be first anointed with any of the oils (of Nikumbha, Ingudi, Sarsapa, Atasi, etc.); or with the medicated clarified butter² cooked with the drugs of the priyangvadi

1. Made of sugar, lemon-juice, or fermented rice-gruel boiled together. 2. The patient should be anointed with the medicated clarified butter in a case of Pittaja-meha.

group and should also be treated with strong emetics and purgatives¹. After the application of purgatives, an Asthapana measure with a decoction of the drugs of the Surasadi group, mixed with honey and Saindhava salt and with the powders of Sunthi, Bhadradaru and musta by way of an after-throw, should be resorted to. In a case attended with a burning sensation, a decoction of the nyagrodhadi group without (i.e., mixed with a little quantity of) Sneha (oil or clarified butter) should be used (in the manner of an Asthapana). 5

ततः शुद्धदेहमामलकरसेन हरिद्रां मधुसंयुक्तां पाययेत्, त्रिफलाविशालादेवदारुमुस्तकषायं वा, शाल-कम्पिल्लकमुष्कककल्कमक्षमात्रं वा मधुमधुरमामलकरसेन हरिद्रायुतम्, कुटज-कपित्थरोहितकविभीतकसप्तपर्णपुष्पकल्कं वा, निम्बारग्वध-सप्तपर्ण-मूर्वा-कुटज-सोमवृक्ष – पलाशानां वा त्वकूपत्रमूलफलपुष्पकषायाणि । एते पञ्च योगाः सर्वमेहानामपहन्तारो व्याख्याताः ॥ ६ ॥

The five Medicinal remedies : After ansing the system, the expressed juice² of Amalaka mixed with Haridra (powder) and honey should be administered. As an alternative, a decoction³ of Triphala, Visala, Deva-daru and musta or an Aksa (two Tola) measure of Kalka (powders)* of Sala, Kamphillaka and Muskaka (both of them) sweetened with honey and the expressed juice of Amalaka should be taken; or powders of the flowers of kutaja, Kapittha, Rohita, Vibhitaka and Saptaparna (should be taken with honey, Haridra and the expressed

1. Emetics in cases of Kaphaja-meha and purgatives in those of Pittaja-meha should be applied.

2. This is also found in Charaka and has been quoted by Cakradatta in his compilation.

3. This is quoted by Cakradatta but he reads “*” in place of “ders › and does not mention the use of the expressed juice of Amalaka. The practice, however, is to follow the recipe of Cakradatta.

4. The third Yoga of the text is also quoted by Cakradatta but no addition of Haridra powder is prescribed there. Cakradatta is more generally followed in the case.

5. The fourth Yoga of the text is found also in Charaka although with some variation. Charaka adds the flowers of Kampilla and Sala in the list, but does not recommend the use of Haridra powder nor of the expressed juice of Amalaki as the medium of taking the medicine. Charaka, however, is quoted verbatim by Cakradatta and is followed in practical use.

juice of Amalaka) or a decoction of the roots, leaves, barks, flowers and fruits of Nimba, Aragvadha, Saptaparna, Murva, Kutaja, Somavrksa, Palasa should be given to the patient. All cases of Meha are often found to yield to the use of any of these five medicinal preparations. 6

विशेषश्चात ऊर्ध्वं । तत्रोदकमेहिनं पारिजातकषायं पाययेत्, इक्षुमेहिनं वैजयन्तीकषायम्, सुरामेहिनं निम्बकषायम्, सिकतामेहिनं चित्रककषायम्, शनैर्मेहिनं खदिरकषायम्, लवणमेहिनं पाठाऽगुरुहरिद्राकषायम्, पिष्टमेहिनं हरिद्रादारुहरिद्राकषायम्, सान्द्रमेहिनं सप्तपर्णकषायम्, शुक्रमेहिनं दूर्वा – शैवलप्लव-हठ-करञ्ज-कशेरुककषायं ककुभचन्दनकषायं वा, फेनमेहिनं त्रिफलारग्वधमृद्वीकाकषायं मधु-मधुरमिति । पैत्तिकेषु नीलमेहिनं शालसारादिकषायमश्वत्थकषायं वा पाययेत्, हरिद्रामेहिनं राजवृक्षकषायम्, अम्लमेहिनं न्यग्रोधादिकषायं, क्षारमेहिनं त्रिफलाकषायम्, मञ्जिष्ठामेहिनं मञ्जिष्ठाचन्दनकषायम्, शोणितमेहिनं गुडूचीतिन्दुकास्थिकाश्मर्य-खर्जूरकषायं मधुमिश्रम् ॥ ७ ॥

Specific Treatment: Now we shall specifically describe the course of treatment to be adopted in each particular type of the disease (Prameha). A decoction of Parijata should be given in a case of Udaka meha; a decoction of Vaijayanti in a case of Iksu meha; a decoction of Nimba in a case of Sura-meha; a decoction of Citraka in a case of Sikata-meha; a decoction of khadira in a case of Sanairmeha; a decoction of Patha, Aguru and Haridra in a case of Lavana meha; a decoction of Haridra and Daru-haridra in a case of Pistameha, a decoction of Saptaparna in a case of Sandra-meha; a decoction of Durva, Saivala, Plava, Hatha-karanja and Kaseruka, or that of Kakubha and red-sandal wood in a case of Sukra-meha; and a decoction of Triphala, Aragvadha and Draksa mixed with honey in a case of Phena-meha.

Treatment of Pittaja Prameha : In the Pittaja types of the disease, a decoction of the drugs of the Sala-saradi group or that of Asvattha should be administered in a case of Nila-meha; similarly a decoction of Raja-vrksa should be given in a case of Haridra meha; a decoction of the Nyagrodhadi group, in a case of Amla-meha; a decoction of Triphala in a case of Kshara-meha; a decoction of

Manjistha and (red) Chandana in a case of Manjistha-meha; and a decoction of Guduci, seeds of Tinduka, Kasmarya and Kharjura, mixed with honey, in a case of Sonita-meha.17

अत ऊर्ध्वमसाध्येष्वपि योगान् यापनार्थं वक्ष्यामः । तद्यथासर्पिर्मेहिनं कुष्ठकुटजपाठाहिङ्गकटुरोहिणीकल्कं गुडूचीचित्रककषायेण पाययेत्, वसामेहिनमग्निमन्थकषायं शिंशपाकषायं वा क्षौद्रमेहिनं खदिरक्रमुककषायम्, हस्तिमेहिनं तिन्दुककपित्थशिरीषपलाशपाठामूर्वादुःस्पर्शाकषायं मधुमिश्रं, हस्त्यश्वशूकरखरोष्ट्रास्थिक्षारञ्चेति । दह्यमानमौदककन्दक्वाथसिद्धां यवागूं क्षीरेक्षुरसमधुरां पाययेत् ॥ ८ ॥

Palliative Measures : Now we shall describe the palliative measures to be adopted even in cases of incurable types of the disease. A Kalka compound of Kustha, Kutaja, Patha, Hingu and Katu-rohini should be taken with a decoction of Guduci and Citraka in a case of Sarpir-meha. A patient afflicted with an attack of Vasa-meha should be made to drink a decoction of Agni-mantha or of Simsapa. Similarly a decoction of Khadira and Kramuka should be given in a case of Ksaudra-meha; a decoction of Tinduka, Kapittha, Sirisa, Palasa, Patha, Murva, and Dusparsa (Duralabha) mixed with honey, or the Kshara, (alkaline water) prepared from the ashes of the bones of an elephant, horse, hog, ass or camel, in a case of Hasti-meha. A gruel (Yavagu prepared in the manner of Sadanga-kalpa) with a decoction of aquatic bulbs and sweetened with milk and the juice of sugarcane should be prescribed in a case attended with a burning sensation. 8

ततः प्रियङ्ग्वनन्तायूथिकापद्मात्रायन्तिकालोहितिकाम्बष्ठादाडिमत्वक्शालपर्णी- पद्म-तुङ्ग – केशर – धातकीबकुल- शाल्मली श्रीवेष्टकमोचरसेष्वरिष्टानयस्कृतीर्लेहानासवांश्च कुर्वीत | शृङ्गाटकगिलोड्यविसमृणालकाशकशेरुक-मधुकाम्रजम्ब्वसनतिनिश- ककुभकट्वङ्गरोघ्रभल्लातक – पलाश- चर्मिवृक्षगिरिकर्णिकाशीतशिवनिचुलदाडिमाजकर्णहरिवृक्ष – राजादनगोपघोण्टाविकङ्कतेषु वा, यवान्नविकारांश्च सेवेत ।

1. Honey should be added to all of these decoctions prescribed in cases of Pittajameha.–Dalhana.

2. Honey should also be added to these decoction prescibed in cases of Vataja Meha.–Dalhana.

3. Jejjata interprets it as grape-wine, but Gayadasa does not support this view.

यथोक्तकषायसिद्धाञ्चास्मै यवागूं प्रयच्छेत्, कषायाणि वा पातुम् । महाधनमहिताहारमौषधद्वेषिणमीश्वरं वा पाठाभयाचित्रकप्रगाढमनल्पमाक्षिकमन्यतममासवं पाययेत्, अङ्गारशूल्यावदंशं वा माध्वीकमभीक्ष्णम्। मधु-कपित्थमरिचानुविद्धानि चास्मै पानभोजनान्युपहरेत् ॥ ९ ॥

Medicinal Aristas, Asvas, Yavagus, etc. : Likewise Aristas, Ayaskrtis, lambatives and Asavas should be prepared (in the manner herein before described) with Priyangu, Ananta, Yuthika, Padma (Bhargi), Trayantika, Lohitaka, Ambastha, bark of pomegranate, Sala-parni, (D.R.–Tala-parni), Padma (lotus), Tunga, Kesara, Dhataki, Vakula, Salmali, Sri-vestaka and Mocarasa, should be administered to the patient. As an alternative, similar preparations made of Srngataka, Gilodya, Mrnal, Kaseruka, Madhuka, Amra, Jambu, Asana, Tinisa, Arjuna, Katvanga, Lodhra, Bhallataka, Carmivrksa, Giri-karnika, Sita-siva, Nicula, Dadima, Aja-karna, Harivrksa, Rajadana, Gopaghorta and Vikamkata should be prescibed. Different preparations of Yavagu, etc. should be given to the patient as diet. A gruel (Yavagu) cooked with the decoction of the preceding medicinal drugs or (only these) decoctions should be given to the patient as drinks.

Potions of any of the aforesaid Asavas thickened with an admixture of powdered Patha, Citraka and Haritaki and sweetened with a liberal quantity of honey should be prescribed for a rich or royal patient of injudicious conduct and refusing to take medicines; or he should be made to drink frequent potions of Madhvika liquors (prepared from honey)¹ with meat roasted on gridiron over a charcoal fire. Food and drinks mixed with honey, kapittha and black pepper should be prescribed for him. 9

उष्ट्राश्वतरखरपुरीषचूर्णानि चास्मै दद्यादशनेषु । हिङ्गुसैन्धवयुक्तैर्यूषैः सार्षपैश्च रागैर्भोजयेत् ।

अविरुद्धानि चास्मै पानभोजनान्युपहरेद्रसगन्धवन्ति च ॥ १० ॥

The powdered dung of a camel, a mule, or an ass should be administered to him in food; he should take his meal with soups saturated with a compound of asafoetida and Saindhava salt or with

1. Some read”:”i.e. potherb (of mustard) in place of mustard preparations (Raga).¹ His food and drink should be fragrant and well flavoured with ingredient not incompatible with the nature of the disease. 10

व्यायामनियुद्धक्रीडागजतुरगरथपदातिचर्यापरिप्रवृद्धमेहास्तु क्रमणान्यस्त्रोपास्त्रे वा सेवेरन् ॥ ११ ॥

The practice of regular physical exercise, wrestling, active sports, riding on a horse or an elephant or on a chariot long walks, pedestrial journeys, practising archery, casting of javelines, etc., should be resorted to in a case where the disease has made a decided advance. 11

अधनस्त्वबान्धवो वा पादत्राणातपत्रविरहितो भैक्ष्याशी ग्रामैकरात्रानुवासी मुनिरिव संयतात्मा योजनशतमधिकं वा गच्छेत्, महाधनो वा श्यामाकनीवारवृत्तिरामलककपित्थतिन्दुकाश्मन्तकफलाहारो मृगैः सह वसेत्, तन्मूत्रशकृद्भक्षी सततमनुव्रजेद् गाः । ब्राह्मणो वा शीलोञ्छवृत्तिर्भूत्वा ब्रह्मरथमुपधारयेत्, पठेत् सततम् । इतर: खनेद् वा कूपम । कृशन्तु सततं रक्षेत् ॥ १२ ॥

A poor and friendless patient should live on alms, lead a life of perfect continence like an ascetic, forego the use of shoes and umbrella and walk a hundred Yojanas² or more on foot without staying for more than one night at a single village. A rich man (suffering from Prameha) should live on grains of Syamaka and Nivara and fruits of Kapittha, Tinduka and Asmantaka and live among the deer. He should constantly follow the tracks of cows and take their dung and urine (for food and drink). A Brahman patient should live on the grain, spontaneously fallen from plants, constantly study the Vedas and draw charriots occupied by Brahmanas.³ A patient belonging to the lower orders of society (Sudras, etc.) should be made to dig wells (under such circumstances) and the strength of a weak or emaciated patient should be preserved (with nutritive diets, etc.). 12

2. A Yojana is equal to eight miles.

3. Some explain the phrase ” ब्रह्मरथमुपधारयेत्” to mean that he should retain in his memory (the teaching of ) the Vedas. –Dalhana.

भवति चात्र । अधनो वैद्यसन्देशादेवं कुर्वन्नतन्द्रितः । संवत्सरादन्तराद् वा प्रमेहात् प्रतिमुच्यते ॥ १३ ॥

Memorable Verse: A poor patient, carefully following these directions of his medical advisers without the least demur or delay, should be able to get rid of the disease (Prameha) in the course of a year or even in less than that time. 13

इति सुश्रुत र -संहितायां चिकित्सितस्थाने प्रमेहचिकित्सितं नामैकादशोऽध्यायः ॥ ११ ॥

Thus ends the eleventh Chapter of the Chikitsa Sthana in the Susruta Samhita which deals with the medical treatment of Prameha.


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