षष्ठोऽध्यायः । अथातोऽर्शसां चिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the medical treatment of Haemorrhoids (Arsas). 1
चतुर्विधोऽर्शसां साधनोपायः । तद्यथा – भेषजंक्षारोऽग्निः शस्त्रमिति । तत्राचिरकालजातान्यल्पदोषलिङ्गोपद्रवाणि भेषजसाध्यानि, मृदुप्रसृतावगाढान्युच्छ्रितानि क्षारेण, कर्कशस्थिरपृथुकठिनान्याग्निना, तनुमूलान्युच्छ्रि तानि क्लेदवन्ति च शस्त्रेण । तत्र भेषजसाध्या नामर्शसामदृश्यानान्तु भेषजं भवति; क्षाराग्निशस्त्रसाध्यानान्तु विधानमुच्यमानमुपधारय ।। २ ।।
The remedial measures in haemorrhoids may be grouped under four subheads; namely, the employment of (active) medicinal remedies, the application of an alkali (into the seat of the disease), actual cauterization (of the polypii) and surgical operation. A case of recent origin involving the action of the Dosas to a slight degree and uncomplicated without any grave or dangerous symptom and complication may prove amenable to medicine alone. Deep-seated polypu, which are soft to the touch and markedly elevated and extended should be treated with alkaline applications, while those which are rough firm, thick and hard should be cauterized with fire. Polypii which are raised, exuding and slender at the roots should be surgically treated. Hoemorrhoids which are held amenable to medicine and are not visible (to the naked eye) should be treated with the help of medicines alone. Now, listen to the procedure to be adopted in the treatment of Arsas which would require alkaline applications, a cauterization, or a surgical operation. 2
तत्र बलवन्तमातुरमर्शोभिरुपद्रुतमुपस्निग्धं परिस्विन्नमनिलवेदनाभिवृद्धि – प्रशमार्थं स्निग्धमुष्णमल्पमन्नं द्रवप्रायं भुक्तवन्तमुपवेश्य सम्भृते शुचौ देशे साधारणे व्यभ्रे काले समे फलके शय्यायां वा प्रत्यादित्यगुदमन्यस्योत्सङ्गे निषण्णपूर्वकायमुत्तानं किञ्चिदुन्नतकटिकं वस्त्रकम्बलकोपविष्टं यन्त्रण शाटकेन परिक्षिप्तग्रीवासक्थि पारिकर्मिभिः सुपरिगृहीतमस्पन्दनशरीरं कृत्वा ततोऽस्मै घृताभ्यक्तगुदाय घृताभ्यक्तं यन्त्रमृज्वणुमुखं पायौ शनैः शनै: प्रवाहमाणस्य प्रणिधाय, प्रविष्टे चार्शो वीक्ष्य, शलाकयोत्पीड्य, पिचुवस्त्रयोरन्यतरेण प्रमृज्य, क्षारं पातयेत्, पातयित्वा च पाणिना यन्त्रद्वारं पिधाय वाक्च्छतमात्रमुपेक्षेत । ततः प्रमृज्य क्षारबलं व्याधिबलञ्चावेक्ष्य पुनरालेपयेत् । अथार्शः पक्वजाम्बवप्रतीकाशमवसन्नमीषन्नतमभिसमीक्ष्योपावर्तयेत् । क्षारं प्रक्षालयेद्धान्याम्लेन दधिमस्तुशुक्तफलाम्लैर्वा । ततो यष्टीमधुकमिश्रेण सर्पिषा निर्वाप्य यन्त्रमपनीयोत्थाप्यातुरमुष्णोदकोपविष्टं शीताभिरद्भिः परिषिञ्चेदशीताभिरित्येके । ततो निर्वातमागारं प्रवेश्याचारिकमादिशेत्, सावशेषं पुनर्दहेत् । एवं सप्तरात्रात् सप्तरात्रादेकैकमुपक्रमेत । तत्र बहुषु पूर्वं दक्षिणं साधयेत्; दक्षिणाद् वामं, वामात् पृष्ठजं, ततोऽग्रजमिति ॥ ३ ॥
Application of Kshara : Strong patient suffering from haemorrhoids, should be anointed and duly fomented. He should be made to eat warm and demulcent food (Anna) in a fluid state (of a gruel-like consistency) to alleviate the excessive pain incidental to the action of the deranged Vayu. In a season neither too hot nor too cold, and when the sky is cloudless, he should be placed in a raised up position in a clean and well-equipped place on a plain slab or on a clean bed with his head resting on the lap of an attendant and the anal region exposed to the sun. In this position the waist should be made to elevate a little and to rest on a cushion of cloths or blankets. The neck and the thighs of the patient should be drawn out, and then secured with trappings and held fast by the attendants so as not to allow him to move. Then a straight and slender-mouthed instrument (somewhat like the modern rectal speculum), lubricated with clarified butter, should be gently inserted into the rectum and the patient should be asked to strain down gently at the time. After seeing the polypus (through the speculum), it should be scraped with an indicator and cleansed with a piece of cotton or linen after which an alkali should be applied to it. The exterior orifice of the instrument should be closed with the palm of the hand after this application and kept in that manner for a period that would be required to utter a hundred words.
Then after having cleansed the polypus, a fresh application should b made according to the strength of the alkali and the intensity of the aggravated Dosas involved in the case. Further application of the alkali should be stopped when the piles begin to acquire the colour of a ripe Jambu fruit and get depressed and shrivelled. The caustie should then be washed with fermented rice-gruel (Dhanyamla), curdcream, Sukta or the juice of acid fruits. After that it should be cooled with clarified butter mixed with Yasti-Madhu, the trappings should be removed and the patient should be raised up and placed in a sitting posture in warm water and refreshed with sprays of cold water, or, according to some authorities, with warm water. Then the patient should be made to lie in a spacious chamber, not exposed to the blasts of cold winds (specially), and advised to observe proper diet and regimen. Each of the remaining polypii, if any, should be cauterized with the alkaline application at an interval of seven days. In case of multiple number of polypii, those on the right side should be first cauterized and then those on the left, and after that those on the posterior side; and lastly those that would be found to be in front. 3
तत्र वातश्लेष्मनिमित्तान्यग्निक्षाराभ्यां साधयेत्, क्षारेणैव मृदुना पित्तरक्त-निमित्तानि । तत्र वातानुलोम्यमन्नरुचिरग्निदीप्तिर्लाघवं बलवर्णोत्पत्तिर्मनस्तुष्टिरिति सम्यग्दग्धलिङ्गानि । अतिदग्धे तु गुदावदरणं दाहो …, ध्यामाल्पव्रणता कण्डूरनिलवैगुण्यमिन्द्रियाणामप्रसादो विकारस्य चाशान्तिर्हीनदग्धे ।। ४ ।॥
Polypii, having their origin in the deranged Vayu and Kapha, should be cauterized with fire or alkali; while those, which are the outcome of the deranged Pitta and vitiated blood should be treated with a mild alkali alone. A perfect and satisfactory cauterization (Samyagdagdha) of a polypus should be understood from such symptoms as, restoration of the bodily Vayu to its normal condition, relish for food, keenness of the appetite, lightness of the body and improvement in strength, complexion and pleasure. An over-cauterized (Atidagdha) polypus gives rise to such symptoms as, cracking of the region of the anus, a burning sensation ( in the affected locality), fainting, fever, thirst, and profuse haemorrhage (from the rectum), and consequent complications; while an insufficiently cauterized (Hinadagdha) polypus is known by its tawny brown colour, smallness of the incidental ulcer, itching, derangement of the bodily Vayu, discomforts of the cognitive organs and a non-cure of the disease. 4
महान्ति च प्राणवतरिछत्त्वा दहेत् । निर्गतानि चात्यर्थं दोषपूर्णानि यन्त्राद् विना स्वेदाभ्यङ्गस्नेहावगाहोपनाहवित्रावणालेपक्षाराग्निशस्त्रैरूपाचरेत्; प्रवृत्तरक्तानि च रक्तपित्तविधानेन, भिन्नपुरीषाणि चातीसारविधानेन, बद्ध वर्चांसि स्नेहपानविधानेनोदावर्तविधानेन वा । एष सर्वस्थानगतानामर्शसां दहनकल्पः ।। ५॥
A large polypus, appearing in a strong person, should be clipped off (with a knife) and cauterized with fire. As regards an external polypus full of extremely aggravated Dosas (Vayu, Pitta, Kapha and blood) no Yantra should be used, but the treatment should consist of fomentation, anointing, poulticing, immersion, plastering, evacuating measures (Visrava), cauterization with fire and alkali and a surgical operation. Measures laid down under the head of Rakta-pitta should be resorted to in cases of haemorrhage (from the seat of affection). Remedies mentioned in connection with diarrohea (Atisara) should be employed in cases of a looseness of the bowels; whereas in cases of constipation of the bowels oily purgatives should be administered, or the remedies for Udavartta should be adopted. These rules shall hold good in the cases of treating (cauterization, etc.) a polypus occurring in any part of the body whatsoever. 5
आसाद्य च दर्वीकूर्चकशलाकानामन्यतमेन क्षारं पातयेत् । भ्रष्टगुदस्य तु विना यन्त्रेण क्षारादिकर्म प्रयुञ्जीत । सर्वेषु च शालिषष्टिकयवगोधूमान्नं सर्पिः स्निग्धमुपसेवेत पयसा निम्बयूषेण पटोलयूषेण वा । यथादोषं शाकैर्वास्तूक-तण्डुलीयक-जीवन्त्युपोदिकाश्वबला-बाल मूलक-पालङ्कयसनचिल्लीचुच्चू कलाय-वल्लीभिरन्यैर्वा । यच्चान्यदपि स्निग्धमग्निदीपनमर्शोघ्नं सृष्टमूत्रपुरीषञ्च तदुप-सेवेत ।। ६ ।।
A polypus should be caught hold of and an alkali should be applied thereto with a Darvi, or a brush (Kurca), or an indicator (Salaka). In a case of a prolapse of the anus, cauterization should be made without the help of any Yantra instrument).
Diet: In all types of haemorrhoids, the diet should consist of wheat barley, Sastika rice or Sali rice, (boiled) and mixed with clarified butter, to be taken with milk, Nimba-soup. or Patola-soup. The patient should be advised to take (his meal) with Vastuka, Tanduliyaka, Jivanti, Upodika, Asva-bala, tender Mulaka, Palanka, Asana. Cilli, Cuccu, Kalaya, Valli, or any other Sakas (pot-herbs), according to the nature of the Dosas involved in the case. Any other oleaginous, diuretic, laxative and appetising (Dipana) diet possessing the virtue of curing piles should also be prescribed. 6
दग्धेषु चार्शः स्वभ्यक्तोऽनलसन्धुक्षणार्थमनिलप्रकोपसंरक्षणार्थञ्च स्नेहादीनां सामान्यतः क्रियापथमुपसेवेत । विशेषतस्तु वातार्श: :सु सर्पषि च दीपनीयवातहर-सिद्धानि हिङ्ग्वादिभिश्चूर्णै: प्रतिसंसृज्य पिबेत्, पित्तार्श:सु पृथकूपर्ण्यादीनां कषायेण दीपनीयप्रतिवापं सर्पिः, शोणितार्श:सु मञ्जिष्ठामुरुङ्गयादीनां कषाये पाचयेत्, श्लेष्मार्श: सु सुरसादीनां कषाये। उपद्रवांश्च यथास्वमुपाचरेत् ।। ७ ।।
After the cauterization of the polypus, as well as in a case where no cauterization would be necessary, the body of the patient should be anointed with clarified butter and oil, etc., and measures both general and specific (mentioned below and in accordance with the Dosa c Dosas involved) should be employed for the purpose of improving the digestive powers and to alleviate any aggravation of the Vayu. He should be made to drink a potion consisting of clarified butter cooked with the Vayu-subduing and appetisting (Dipana) drugs) (Kalka and Kvatha) mixed with the powders of Hingu, etc. ( described in the treatment of Maha-Vata-vyadhi, chapter. V). In a case of Pittaja
1. Such as the decoction of the drugs of the Bhadra-darvadi (Vayu-subduing) and Pippalyadi (Dipaniya) groups. This Ghrita should be prescribed in a Vataja Arsas.
Arsas, clarified butter prepared by cooking it with the drugs of the Pippallyadi and Bhadra-darvadi groups, should again be cooked with the decoction of Prthakparnyadi group and the Kalka of the Dipaniya (Pippallyadi) group and given as a potion to the patient. In a case of haemorrhoid due to the action of the deranged blood² (Raktarsas), the clarified butter should be cooked with a decoction of Manjistha, Murungi (D. R. Surangi ), etc., while in a case of one due to the action of the deranged Kapha, the clarified butter should be cooked with a decoction of the drugs constituting the Surasadi group. The supervening distresses should be alleviated by the remedial measures similar to each of them. 7
परञ्च यत्नमास्थाय गुदे क्षाराग्निशस्त्राण्यवचारयेत् ।
तद्विभ्रमाद्धि षाण्ढ्य-शोफदाहमदमूर्च्छाटोपानाहातीसारप्रवाहणानि भवन्ति मरणं वा ।। ८ ।।
Cauterization with fire or with an alkali or any surgical operation in the present disease should be effected into the rectum (with the utmost care, inasmuch as an error happening in any of these cases may bring on impotency, swelling, ( Sopha), a burning sensation, intoxication, fainting, rumbling in the intestines, retention of stool and urine, dysentery, diarrhoea, or may ultimately end in death. 8
अत ऊर्ध्वं यन्त्रप्रमाणमुपदेक्ष्यामः । तत्र यन्त्रं लौहं दान्तं शार्ङ्ग वा वा गोस्तनाकारं चतुरङ्गलायतं पञ्चाङ्गुलपरिणाहं पुंसां, षडङ्गुलपरिणाहं नारीणां तलायतम् । तद् द्विच्छिद्रं – दर्शनार्थम् एकं छिद्रन्तु कर्मणि । एकद्वारे हि शस्त्रक्षाराग्नीनामतिक्रमो न भवति । छिद्रप्रमाणन्तु त्र्यङ्गुलायतमङ्गुष्ठोदरपरिणाहम् । यदङ्गुलमवशिष्टं तस्यार्धाङ्गुलमधस्तादर्धाङ्गुलोच्छ्रितो-परिवृत्तकर्णिकम् । एष यन्त्राकृतिसमासः ।। ९ ।। “
अत उर्ध्वमर्शसामालेपान् वक्ष्यामः । स्नुहीक्षीरयुक्तं हरिद्राचूर्ण
1. The epithet Bhadra-darvadi-pippallyadi” in the phrase Bhadra darvadipippallyadi-sarpih” seems to be included into the body of the text through an accident. In our opinion, it is only an annotation of the phrase Dipuniya-Vatahara-siddha” occurring in the last sentence. –Ed.
2. The Kalkas of the Pippallyadi group should also be taken in the preparation of the two kinds of medicated clarified butter to be used in Raktarsas, and Pittarsas. –Dalhana.
मालेपः प्रथमः । कुक्कुटपुरीषगुञ्जाहरिद्रापिप्पलीचूर्णमिति गोमूत्रपित्तपिष्टो द्वितीयः । दन्तीचित्रकसुवर्चिकालाङ्गलीकल्को वा गोपित्तपिष्टस्तृतीयः । पिप्पली-सैन्धवकुष्ठशिरीषफलकल्कः स्नुहीक्षीरपिष्टोऽर्कक्षीरपिष्टो वा चतुर्थः । कासीस-हरिताल- सैन्धवाश्वमारक – विडङ्गपूतीककृतवेधनजम्ब्वर्कोत्तमारणीदन्तीचित्रकालर्कस्नुहीपयःसु तैलं विपक्वमभ्यञ्जनेनार्शः शातयति ।। १०-११ ।।
Rectal Speculum: Now we shall describe the dimensions of the Yantras (and the materials of which they are made of). The instrument may be made of iron, ivory, horn or wood. It should be made to resemble the teat of a cow. In the case of a male patient, it should be four fingers in length and five fingers in circumference; whereas in the case of a female patient, the length should be commensurate with that of the palm of the hand (of the same length as before–D. R.) and six fingers in circumference. The instrument should be provided with two separate apertures in its inside, one for seeing the interior of the rectum and the other for applying an alkali, or actual cautery (Agni) to the polypus, since it is impossible to apply fire and alkali through the same aperture. The circumference of the aperture in the upper three fingers of the instrument should be like that of a thumb. There should be a bulb-like protrusion of the same width, at the bottom, and above it a space of half a finger’s width. Thus we have briefly described the shape of the instrument.
Alepa (plasters): Now we shall describe the plasters to be applied to the haemorrhoids (to cause their spontaneous dropping off). The first consists of pulverised turmeric mixed with the milky exudation of the Snuhi tree. The second contains of the cock-faeces and pulverised Gunja, turmeric and Pippali pasted with the urine and bile of a cow. The third is compounded of Danti, Citraka, Suvarcika and Langali pounded together and made into a paste with cow’s bile. The fourth consists of Pippali, rock-salt, Sirisa-seeds and Kustha-pasted with the milky juice of an Arka, or Suuhi plant. An oil cooked in combination with Kasisa (sulphate of iron), Haritala (yellow orpiment), rock-salt, Asvamaraka, Vidanga, Putika, Krtavedhana, Jambu, Arka, Uttamarani, Danti, Citraka, Alarka and Snuhi-milk, and used as an unguent, leads to the falling off of the piles. 9-11
अत ऊर्ध्वं भेषजसाध्येष्वदृश्येष्वर्शःसु योगान् यापनार्थं (पातनार्थं) वक्ष्यामः । प्रातःप्रातर्गुडहरीतकीमासेवेत, ब्रह्मचारी गोमूत्रद्रोणसिद्धं वा हरीतकीशतं प्रातः प्रातर्यथाबलमुपयुञ्जीत क्षौद्रेण, अपामार्गमूलं वा तण्डुलोदकेन सक्षौद्रमहरहः, शतावरीमूलकल्कं वा क्षीरेण, चित्रकचूर्णयुक्तं वा सीधुपरार्ध्यम्, भल्लातक-चूर्णयुक्तं वा शक्तुमन्थमलवणं तक्रेण, कलशे वाऽन्तश्चित्रकमूलकल्कावलिप्ते निषिक्तं तक्रमम्लमनम्लं वा पानभोजनेषूपयुञ्जीत; एष एव भार्ग्यास्फोता-यवान्यामलकगुडूचीषु तक्रकल्पः ।। १२ ।।
Internal piles: Now we shall describe the remedial measures which bring about the falling off of the invisible (intermal) haemorrhoids. The patient should take Haritaki with treacle every morning; or a hundred Haritakis should be boiled in a Drona measure of cow’s urine and the patient, observing a strict continence, should take with honey every morning as many of them as suit his constitution; or he should be made to take every day a paste made of the roots of Apamarga with the washings of rice and with honey. Satavari pasted with an adequate quantity of milk or a Karsa measure of) the powders of Citraka mixed with a copious quantity of good Sidhu wine, or a grue (Mantha) neither extremely thick nor thin), or powdered barley or wheat mixed with Takra and Bhallataka powder, should be administered without any salt. A quntity of Takra should be kept in an earthen pitcher, plastered inside with a paste of Citraka roots, and given to the patient in food and drinks whether fermented or not. A Takra should also be separately prepared as in the preceding manner with Bhargi, Asphota, barley, Amlaka and Guduci and administered similarly, this is called the Takra-kalpa (butter-milk compound). 12
पिप्पलीपिप्पलीमूलचव्यचित्रकविडङ्गशुण्ठीहरीतकीषु च पूर्ववदेव, निरन्नो वा तक्रमहरहर्मासमुपसेवेत । शृङ्गवेरपुनर्नवाचित्रककषायसिद्धं वा पयः । कुटज मूलत्वक्फाणितं वा पिप्पल्यादिप्रतीवापं क्षौद्रेण, महावातव्याध्युक्तं हिङ्ग्वादिचूर्णमुपसेवेत तक्राहारः, क्षीराहारो वा, क्षारलवणान् चित्रकमूलक्षारोदकसिद्धान् वा कुल्माषान् भक्षयेत्, चित्रकमूलक्षारोदकसिद्धं वा पयः, पलाशतरुक्षारसिद्धं वा, पलाशतरु क्षार सिद्धान् वा कुल्माषान्, पाटलापामार्गबृहतीपलाशक्षारं वा, परिस्स्रुतमहरहर्घृतसंसृष्टम्, कुटजबन्दाकमूलकल्कं वा तक्रेण, चित्रकपूतीकनागरकल्कं वा पूतीकक्षारेण क्षारोदकसिद्धं वा सर्पिः पिप्पल्यादिप्रतीवापम्, कृष्णतिलप्रसृतं प्रकुञ्चं वा प्रातः प्रातरनुसेवेत शीतोदकानुपानम् । एभिरभिवर्धतेऽग्निरशसि चोपशाम्यन्ति ।। १३ ।।
A medicated Takra should also be prepared with Pippali, Pippali-mula, Cavya, Citraka, Vidanga, Sunthi and Haritaki, in the manner described above, (and given to the patient), who should abstain from taking any solid food, but live only on (this) Takra for a peirod of one full month: or he should be given milk boiled with a decoction of Srigavera, Punarnava and Citraka, or a condensed decoction (Phanita) of the bark of Kutaja roots mixed with an afterthrow of the powdered drugs of the Pippalyadi group and honey. The patient should be made to partake of the medicinal compound known as the Hingvadi-curna¹ described in the chapter on Maha-Vatavyadhi, and be made to live either on milk, or on Takra. As an alternative, he should take Kulmasa boiled in Ksarodaka (alkaline water) prepared from Citraka-roots and made saline with a liberal after-throw of Yava-kshara; or he should take milk boiled with the Ksarodaka (alkaline water) prepared from Citraka-roots, or Kulmasa boiled with the alkaline water prepared from the ashes of burnt Palasa, or he should drink frequent potions of clarified butter mixed with the alkali made of the ashes of either Patola, Apamarga, Brihati, or Palasa wood; or drink Takra mixed with the Kalka of the roots of Kutaja and of Bandaka; or take the alkaline water of Putika mixed with a Kalka of Citraka, Putika and Nagara; or use the clarified butter boiled in an alkaline solution with the powdered drugs of the Pippalyadi group added to it by way of an after-throw; or he should take every morning one or two Palas of black sesamum (according as required), with cold water. These measures prove remedial in cases of haemorrhoids and tend to improve the digestion. 13
द्विपञ्चमूलीदन्तीचित्रकपथ्यानां तुलामाहृत्य जलचतुर्द्रोणे विपाचयेत् ।
1. In a preponderance of Vayu and Kapha, Takra should be taken as diet; whereas milk should be taken in a case of the preponderance of vitiated blood.
2. During the period when the above mentioned alkaline preparations are used. the diet of the patient should consist of clarified butter, milk and meat-soup for fear of the loss of the Ojo-Dhaatu.
ततः पादावशिष्टं कषायमादाय सुशीतं गुडतुलया सहोन्मिश्य घृतभाजने निःक्षिप्य मासमुपेक्षेत यवपल्ले, ततः प्रातः प्रातर्मात्रां पाययेत; तेनार्शोग्रहणीदोषपाण्डुरोगोदावर्तारोचका न भवन्ति, दीप्तोऽग्निश्च र्भवति ।।
पिप्पलीमरिचविडङ्गैलवालुकलोध्राणां द्वे द्वे पले, इन्द्रवारुण्याः पञ्च पलानि, कपित्थमध्यस्य दश, पथ्याफलानामर्धप्रस्थः प्रस्थो धात्रीफलानाम्, एतदैकध्यं जलचतुणे विपाच्य पादावशेषं परित्राव्य, सुशीतं गुडतुलाद्वयेनोन्मिश्य, घृतभाजने नि:क्षिप्य पक्षमुपेक्षेत यवपल्ले । ततः प्रातः प्रातर्यथाबलमुपयुञ्जीत । एष खल्वरिष्ट : प्लीहाग्निषङ्गार्शोग्रहणीहृत्पाण्डुरोग-शोफ-कुष्ठगुल्मोदर- कृमिहरो बलवर्णकरश्चेति ।। १४ ।।
Dantyarista : A Tula weight ( twelve seers and a half) of the following drugs. viz.. Dasamula Danti Citraka and Haritaki should be boiled with four Drona measures of water till reduced to one quarter part (one Drona). The decoction. thus prepared should be cooled down, filtered, mixed with a Tula measure of treacle and preserved into a receptacle which formerly contained clarified butter, which should then be kept buried for a month in a heap of unthrashed barley. At the close of this period an adeqate dose of this preparation should be given to the patient every morning. This medicine proves beneficial in cases of haemorrhoids, chronic diarrhoea (Grahani), anaemea, obstinate constipation of the bowels (Udavartta) and in an aversion to food. It is also a good stomachic agent.
Abhyarista: Two Pala weight of each of the following drugs, viz.. Pippali, Marica, Vidaiga, Elavaluka and Lodhra, five Pala weight of Indravaruni, ten Pala weight of the inner pulps of the Kapittha fruit, half a Prastha measure (one Prastha is equal to two seers) of Haritaki and one Prastha weight of Amalaki, boiled together with four Drona measures of water until reudced to one quarter of its
1. Some are of opinion that one Tula weight of each of the drugs should be taken; but Gayadasa does not say so.
2. Charaka also reads this under the name of Abhayarista.
3. Experienced physicians recommend two and a half Pala weight of IndraVaruni in lieu of five Palas for its astringent taste. Charaka, however, recommends only “half a Pala quantity. This decoction should be filtered (through a piece of linen) and cooled down, after which two Tula weight of treacle should be added to it. The whole preparation should be then kept in a receptacle which formerly contained clarified butter, and be kept buried half a month in a heap of unthrashed barley. After the lapse of the said period, the patient should be made to drink (an adequate quantity of) this preparation every morning according to his strength. This Arista proves curative in cases of an enlarged spleen, impaired digestion. chronic diarrhoea (Grahani), Arsas, heart-disease, anaemea, cutaneous affection, ascites, Gulma, oedema (Sopha), and worms in the intestines, and improves the strength and complexion of the body. 14
तत्र वातप्रायेषु स्नेहस्वेदवमनविरेचनास्थापनानुवासनमप्रतिषिद्धम् । पित्तजेषु विरेचनम्, एवं रक्तजेषु संशमनम् ।
कफजेषु शृङ्गवेरकुलत्थो – पयोगः । सर्वदोषहरं यथोक्तं सर्वजेषु यथास्वौषधिसिद्धं च पयः सर्वेष्विति ।। १५ ।।
Anointing (Sneha-karma), fomentation, use of emetics and purgatives and the application of Anuvasana and Asthapana-measures should be employed in cases of haemorrhoids due to the action of the deranged Vayu¹. The use of purgatives is recommended in the Pittaja type: soothing or pacifying (Samsamana) measures in the Raktaja type: and use of Srngavera and Kulattha in the type caused by the action of the deranged Kapha. All the preceding remedies should be combinedly employed when the concerted action of all the Dosas would be detected. As an alternative, milk boiloed with the proper drugs may be administered in every case. 15
अत ऊर्ध्वं भल्लातकविधानमुपदेक्ष्यामः । भल्लातकानि परिपक्वान्यनुपहतान्याहृत्य तत एकमादाय द्विधा त्रिधा चतुर्धा वाच्छेदयित्वा कषायकल्पेन विपाच्य तस्य कषायस्य शुक्तिमनुष्णां घृताभ्यक्ततालुजिह्रौष्ठ: प्रातः प्रातरुपसेवेत; ततोऽपराह्ने क्षीरं सर्पिरोदन इत्याहारः । एवमेकैकं वर्धयेत् यावत् पञ्चेति । ततः पञ्च पञ्चाभिवर्धयेत् यावत् सप्ततिरिति । प्राप्य च सप्ततिमपकर्षयेद् भूयः पञ्च पञ्च यावत् पञ्चेति;
1. Some are of opinion that the Risis do not read this line. But as Gayadasa explains it, so Dalhana, he tells us, also does the same.
पञ्चभ्यस्त्वेकैकं यावदेकमिति । एवं भल्लातकसहस्त्रमुपयुज्य सर्वकुष्ठाशोभिर्विमुक्तो बलवानरोगः शतायुर्भवति । । १६ ।।
Bhallataka-yoga¹: Now we shall describe the mode of using Bhallataka in cases of haemorrhoids. A ripe and fresh Bhallataka should be cut into two, three or four pieces and a decoction should be made of them in the usual way. The patient should be made to drink four Tola weight of this cold decoction every morning after lubricating or anointing his tongue, palate and lips with clarified butter, and should take his chief meal with milk and clarified butter in the afternoon. The number of Bhallatakas in preparing the decoction should be increased by one every day till the fifth day, (and the quantity of the decoction to be drunk by the patient should be similarly increased). After that, the number of Bhallatakas ( and consequently the quantity of the decoction to be taken) should be increased by five every day. This method should be followed till the number of the Bhallatakas reaches seventy, after which it should be descreased every day by five until it is reduced to five Ballatakas only (and five Sukti measures of the decoction). Subsequently the number of Bhallataka (and the dose) should be diminished by one (and one Sukti measure respectively) every day, until it is reduced to the original one (and one Sukti measure). By taking a thousand Bhallatakas in this manner, one may get rid of an attack of any kind of Kustha and Arsas, and having become strong and healthy, may live for one hundred years. 16
द्विव्रणीयोक्तेन विधानेन भल्लातकनिश्च्युतितं स्नेहमादाय प्रातःप्रातः शुक्तिमात्रमुपयुञ्जीत, जीर्णे पूर्ववदाहारः फलप्रकर्षश्च । भल्लातकमज्जभ्यो वा स्नेहमादायापकृष्टदोषः प्रतिसंसृष्टभक्तो निवातमागारं प्रविश्य यथाबलं प्रसूतिं प्रकुञ्चं वोपयुञ्जीत । तस्मिन् जीर्णे क्षीरं सर्पिरोदन इत्याहारः । एवं मासमुपयुज्य मासत्रयमादिष्टाहारो रक्षेदात्मानम् । ततः सर्वोपतापानपहृत्य वर्णवान् बलवान् श्रवणग्रहणधारणशक्तिसम्पन्नो वर्षशतायुर्भवति । मासे मासे च प्रयोगे वर्षशतं वर्षशतमायुषोऽभिवृ द्धिर्भवति । एवं दश मासानुपयुज्य वर्षसहस्त्रायुर्भवति ।। १७ ।।
Other forms of Bhallataka-yoga: The oil extracted from 1. A physician should apply this medicine after a due consideration and according to the physical condition of the patient.
pressed out of Bhallatakas in the manner laid down in the chapter on Dvi-vrana, should be taken in a dose of one Sukti (four Tolas) every morning. The patient, as in the preceding case, shoul take his meal (of boiled rice, milk and clarified butter) after the digestion of the oil with a similar good effect. As an alternative, oil should be extracted from the marrow of Bhallatakas and the patient, after cleansing his system with emetics and purgatives, etc., and regulating his diet in the order of Peyu, etc. should enter into a spacious chamber, protected from the blasts of the winds and take two Palas, or one Pala weight of the oil according to his strength. A meal of boiled rice, milk and clarified butter, etc., should be taken after the oil had been fully digested. The oil should be continued, in this way, for a month, the regimen of diet should be strictly observed for a period of three months and the patient should abstain from anger, etc.. during this period. The use of this oil, in the above mentioned way, not only ensures a radical cure of the disease with all its complications, but would increase the duration of life to a hundred years with the glow of youth and health and with an increment in the powers of hearing, memory, retention and wisdom. The application of this oil for every one month will extend one’s life for a period of one hundred years. In the same way a continuous use for ten months would enable him to live for a thousand years. 17
यथा सर्वाणि कुष्ठानि हतः खदिरबीजकौ । तथैवाशसि सर्वाणि वृक्षकारुष्करौ हतः ।। १८ ।।
साध्या नाप्यतिवर्तन्ते प्रमेहा रजनीं यथा । क्षाराग्नि नातिवर्तन्ते तथा दृश्या गुदोद्भवाः ।। १९ । ।
Memorable Verses: Vrksaka (Kutaja) and Bhallataka¹ prove as much curative in cases of all kinds of haemorrhoids, as Khadira and Bijaka are effective in cases of cutaneous affections (Kustha). Cauterization with fire, or with an alkali, proves as much palliative in cases of external haemorrhoids as turmeric proves soothing in those of Prameha. 18-19
1. Boiled with sixteen times of water in the event of the Bhallataka being dry. otherwise with eight times of water only.
घृतानि दीपनीयानि लेहायस्कृतयः सुराः । आसवाश्च प्रयोक्तव्या वीक्ष्य दोषसमुच्छ्रितिम् ।। २० । । वेगावरोधस्त्रीपृष्ठयानान्युत्कुटुकासनम् यथास्वं दोषलञ्चान्नमर्श:सु परिवर्जयेत् ।। २१ ।।
Medicated Ghritas, appetising drugs, electuaries, medicinal wines, Ayaskrti and Asava should be prescribed in cases of haemorrhoids, according to the nature and intensity of the Dosas involved therein. Voluntary suppression of any natural urgings of the body, sexual intercourse, riding on horse-back, etc., sitting on the legs and such diets as would aggravate the Dosas, should be avoided in cases of haemorrhoids. 20-21
इति सुश्रुतसंहितायां चिकित्सितस्थानेऽर्शचिकित्सितं नाम षष्ठोऽध्यायः ।। ६ ।।
Thus ends the sixth Chapter in the Chikitsa Sthana of the Susruta Samhita which deals with the medical treatment of Arsas.