अथात उदरचिकित्सितं व्याख्यास्यामः । इतिहस्माहुरात्रेयादयोमहर्षयः ||१ ।।
We will now expound Udara chikitsa- treatment of Enlargement of the abdomen; thus said Atreya and other great sages. (1)
Udararoga Chikitsa – Ayurvedic Treatment of Ascites
सर्वमेवोदरमतिमात्रदोषसञ्चयानुबन्धेन स्त्रोतोमुखनिरोधादव्याकुलानिलतया यत् प्रजायते तस्मादभीक्ष्णमुदरी विरेचनान्युपयुञ्जीत। मूत्रक्षीरान्यतरयुक्तमेरण्डतैलमहरहर्मासमेकं द्वौ वा क्षीरो वा गव्यं वा माहिषं वा मूत्रम् | उष्ट्रीक्षीरवृत्तिर्वा स्यात् ॥ २ ॥
All types of enlargement of the abdomen are produced by accumulation of doshas, in large amounts, for long period of time causing obstruction of the openings of the channels (cell pores, ducts, passages etc ) and by disorders of vata; hence patients of abdominal enlargement should be administered purgatives repeatedly; should drink eranda taila daily mixed with (cows) urine, milk or any such fluids, for a month or two; take only milk as diet, and drink the urine of cow or buffalo, or subsist on camels milk only. (2)
शोफशूलानाहतृणमूर्च्छापरीतो विशेषेण पयोऽनुपानं गोमूत्रेण प्राणदां पिबेत् । पिप्पलीसहस्त्रं वा स्नुहीक्षीरभावितं सेवेत । तद्भावितेन वा कृष्णाभयाचूर्णेन कासरम् । सैन्धवाजमोदयुक्तं वा नैम्बं तैलम् । अथवार्द्रकरसानुविद्धम् | सिद्धंवा || ३ ||
If swelling, pain and distention of the abdomen, thirst and fainting are associated, then (powder of ) pranada ( haritaki) mixed with cows urine should be especially consumed followed by milk as afterdrink; or one thousand pippali, soaked and macerated in the milky sap of snuhi should be made use of; or kasara (guggulu) mixed with the powder of krsna and abhaya soaked and macerated with the same (milky sap of snuhi) or nimba taila (oil of neem) mixed with saindhava and ajamoda or mixed with juice of ardraka or boiled with it (juice of ardraka). (3)
हरीतकी चूर्णप्रस्थयुक्तमाढकंघृतस्याङ्गझरेष्वभिविलाप्यखजेनाभिमथ्यसुगुप्तंयवपल्लेमासंस्थापयेत् । ततश्चोवृत्यपरित्राव्य हरीतकीक्काथाम्लदधिप्रतीवापंविपाचयेत् ॥४॥
One prastha of powder of haritaki is mixed with one adhaka of ghrta (ghee), melted over fire, churned well with a churner, the pot removed from the oven and kept concealed in a heap of barley for one month. Afterwards, it is taken out, filtered, inixed with (equal quantities of) decoction of haritaki and sour curds and cooked again (and made use of). (4)
अथवा गर्व्ये पयसि महावृक्षक्षीरमावाप्य विपाच्य शीतीभूतमभिमथ्य तं नवनीतं महावृक्षक्षरिणैव सह साधयेत् ॥ ५ ॥
Or milky sap of mahavriksha (sudha) is mixed with cows milk, boiled cooled, churned and butter taken out; this butter is again cooked with the milky sap of mahavriksha (and made use of). (5)
अथवा चविकाचित्रकदन्त्यतिविषाकुष्ठसारिवाविडङ्गत्रिफलाकटुरोहिणीद्विहरिद्राशङ्खिनीत्रिवृद्दीप्यकानर्धकार्षिकान्राजवृक्षफलमज्जाद्विपलंमहावृक्षक्षीरद्विपलं गोमूत्रक्षीरघृतत्रिकुडवं चैकध्यं पाचयेत् । एतानि तिल्वकचतुर्थानि सर्पीषि पीतान्युदरगुल्मविद्रध्यष्ठीलानाहकुष्ठोन्मादापस्मन्निनन्ति || ६ ||
Or half karsa each of cavika, chitraka, danti, ativisa, kustha, sariva, vidanga, triphala, katurohini, the two haridra, sankhini, trivrit, and dipyaka, two pala of marrow (gum) of fruits of rajavriksha, two pala of milky sap of mahavriksha, three kudava of cows urine, milk and ghee (one kudava each) are all cooked together.
These three medicated ghee recipes and fourth, the tilvaka ghrta (mentioned in the treatment of vatavyadhi, chapter 23 of chikitsasthana) consumed cure enlargement of the abdomen, abdominal tumor, abscess, enlargement of prostate, flatulence, leprosy (and other skin diseases), insanity and epilepsy. (6)
यावशूकपञ्चकोलकषट्पलेन वा मस्तुदशमूलक्वाथाढकद्वयेन च सिद्ध सर्पिः प्रस्थं प्रयोजयेत् ।।७।।
Yavasuka (yavakshara) and panchakola totalling six pala (one pala of yavakshara) and five pala of panchakola) are mixed with two adhaka of mastu (whey) and decoction of dashamoola (each one adhaka) and one prastha of ghee are all cooked into medicated ghee and administered. (7)
यवकोलकुलत्थपञ्चमूलकषायेण वा सुरासौवीरकयुक्तं सर्पिः ॥८॥
Medicated ghee prepared with decoction of yava, kola, kulattha, and panchamula mixed with sura and sauviraka (can also be made use of ). (8)
सर्पिष्यानस्त्रस्ते च दोषे बलवान् विरेचनार्थं मूत्रासवारिष्टसुराः स्नुहीक्षीरयुक्ताः शीलयेत् । विरेचनद्रव्यकषायं नागरदेवदारुप्रगाढम्। त्रिलवणादिचूर्णंवाद्वित्रिगुणानुलोमनद्रव्यम् ।।९ ।।
When by drinking of medicated ghee, the doshas become weak, the patient who is strong, should made use of the cowsurine, asava (fermented infusion) arista ( fermented decoction) or sura (beer), mixed with milky sap of snuhi, for the purpose of purgation; or the decoction of purgative drugs added with more of nagara and devadaru; or trilavanadi curna (described in the treatment of gulma, chapter 16 of chikitsathana) with double or trebble the quantity of anulomana dravyas (laxative drugs) may be use of. (9)
पटोलमूलरजनीविडङ्गत्रिफलाः कर्षांशाः। कम्पिल्लकनीलिनीफलत्रिवृतानांक्रमाद्वित्रिचतुर्भिः कर्षैर्युक्ताश्चर्णयित्वा मूत्रेण पिबेत् । जीर्णे च पेयामण्डपो रसाशी वा स्यात् । ततः षड्रात्रं सव्योषेण पयसानीयात् । ततः सप्तमेऽहनि पुनश्चूर्णं पिबेत् । अनेन विधिना चूर्णमिदमुदराणि जातोदकान्यपि निबर्हयति । गुल्मभेदनानिचप्रयुञ्जीत ॥ १० ॥
One karsa each of patola mula, rajani, vidanga, and triphala, karmpillaka, niliniphala, trivrit; two, three and four karsa respectively are all to be powdered and consumed mixed with cowsurine. After it gets digested, he should take peyamanda (the scum of thin gruel) or meat juice as food. For the next six days, the food (rice of barley) along with milk boiled with vyosa, then again on the seventh day he should drink the powder (with cows urine). Consumed in this manner this powder will cure abdominal enlargements though fluid has formed inside. Drugs and therapies which break up the abdominal tumors should also be administered. (10)
Mutravarti
वमनविरेचनशिरोविरेचनवत्सकादिवचाहरिद्रादिवर्गद्रव्याणि पृथक्पालिकानि सूक्ष्मकल्कीकृतानि लवणानि च वज्रवृक्षक्षीरप्रस्थं च प्रक्षिप्य मूत्रगणे मृद्वग्निना घट्टयन् पाचयेत् । अविदग्धकल्कं च तत्सिद्धमवतार्य शीतीभूतमङ्गुष्ठमात्रां गुटिकां वर्तयित्वा यथाबलं त्रिचतुरो मासानुपयोजयेत् । एषामूत्रवर्तिर्महारोगश्वासकासपीनसप्रसेकश्वयथुगुल्मपाण्डुकृमिकोष्ठारोचकाविपाकोदावर्तेषु परभमगदम् ॥ ११ ॥
One pala of each of the drugs of vamanagana, virecanagana, sirovirecana gana, vatsakadigana and vacha haridradigana (vide chapter 15 and 16 of sutrasthana) and the lavanas (five salts) are made into nice paste, mixed with one prastha of milky sap of vajravriksha (sudha) and group of urine (of cow, goat, sheep, buffalo, elephant, horse, camel and donkey). This mixture is cooked over fire stirring all the time and removed from the oven before the paste gets charred. After it cools, it should be rolled into long pills (dragees) of the size of the thumb and used for three or four months depending upon the strength of the persons. This Mutravarti is the best medicine for the maharogas (difficult diseases), dyspnoea, cough, nasal catarrah, excess salivation, dropsy, abdominal tumors, anaemia, intestinal worms, anorexia, indigestion and upward movement of vata. (11)
Notes – Maharogas are eight viz- vatavyadhi (nervous diseases), asmari (urinary calculli), kustha ( leprosy) meha ( diabetes), udara (enlargement of the abdomen), bhagandara (fistula-in-ano) arsas (haemorrhoids) and grahani (duodenal disease).
कृतविरेचनश्च क्षामदेहोऽन्तरान्तरा क्षीरमौष्ट्रकं गव्यमाजं वा व्योषयुक्तं शीलयेत् । दोषशेषविजयाय च शीलयेच्चविकानागरं क्षीरेण पिष्टम् । सुरदारूचित्रकं वा सुरङ्गां वा पुनर्नवं वा त्रिफलादन्तीरौहीतकनिर्यूहं वाव्योषक्षारोपेतं तत्स्नुहीक्षीरघृतयुक्तम् ॥१२॥
After purgation, the body of the person having become thin, he should drink, often and on, milk of either the camel, cow or goat mixed with vyosa. To get over the residue of the doshas, he should take cavika, and nagara made into a paste with milk; or suradaru and chitraka or suranga (murva) or punarnava; or drink the decoction of triphala, danti and rohitaka mixed with vyosa and (yava) kshara; or the same (decoction) along with milky sap of snuhi and ghee. (12)
पुराणमन्नं तक्रमरिष्टांश्च तांस्तान् क्षीरंच दन्तीचित्रकविडङ्गचविकात्रिकटुकोपेतम् । तुल्यार्द्रकरसं वा क्षीरं शीलयेत् । पिप्पलींवर्धमानां वा सेवेत | शिलाजतु वा क्षीराशी गुग्गुलं वा । पुनः पुनश्च स्नेहयेद्विरेचयेच्च।आत्ययिकां तु स्नेहविरेकैरेवोपक्रमेत । सलिलं तु वर्जयेत् । आनाहोदावर्तयोर्यथास्वं प्रतिकुर्वीत ॥१३॥
Foods prepared from old grains and takrarista and kshira (preparation of milk described in the treatraent of arsas- (chapter 10 of cikistasthana) or milk boiled with danti, chitraka, vidanga, cavika, trikatu and equal quantity of juice of ardraka should be made use of (as diet).
Or resort to pippali vardhamana therapy (described in rasayana kılpa chapter 49 of uttarasthana).
Or resort to the use of silajatu or guggulu and subsist on milk only as food. Again and again oleation and purgation therapies should be adopted treatments of those with troublesome symptoms should start with fatty purgatives only. Water (drinking) should be avoided. Flatulence and upward movement of the vata should be treated appropriately. (13)
वातकृतेषु पार्श्वशूलोपस्तम्भहृद्ग्रहेषु बिल्वक्षाराम्भसा तैलं पाचयेत् । स्योनाकाग्निमन्थतिलकुन्तलकदल्यपामार्गान्यतमक्षारेण वा विपक्वं तैलम् ।।१४।।
If pain in the flanks, stiffness and catching pain in the (region of) the heart caused by vata are present, oil cooked with solution of bilvakshara (ash of bilva tree) should be used or oil cooked with solution of ash of any one of syonaka, agnimantha, tilakuntala, (stem of tila plant), kadali or apamarga (be used). (14)
कफे पित्ते वा वातेनावृते ताभ्यां वा वाते बलवान् वातगुल्मोक्तक्रमेणैरण्डतैलं पिबेत् ॥ १५ ॥
If kapha or pitta is obstructed by the vata or vate is obstructed by either of these and if the patient is strong, he should drink eranda taila in the manner described for gulma (abdominal tumor) of vata origin (vide previous chapter). (15)
लिम्पेच्च जठरमुदरिणां शिग्रुपलाशार्काश्वकर्णगजपिप्पलीदेवद ,भिर्मूत्रपिष्टैःसुखोष्णैः । वृश्चिकालीकुष्ठषड्ग्रन्थाद्विपुनर्नवधान्यनागरपञ्चमूलक्काथैर्मूत्रैश्चपरिषेचयेत्।प्रततमेवचस्वेदयेत् ।।१६।।
The abdomen of patients of udara should be coated with comfortably warm paste of sigru, palasa, arka, asvakarna, gajapippali, and devadaru, macerated with cows urine. Decoction of vscikali, kustha, sadgrantha, the two punarnava, dhanya, nagara and panchamula and different kinds of urine should be poured (over the abdomen slowly), fomentation should also be done constantly. (16)
विरिक्तस्य चास्य सदा म्लानमुदरं साल्वलादिभिरुपनद्धं घनेन वाससा वेष्टयेत् । एवमेनमनवकाशो वायुर्न पुनराधमापयति । तथापिपुनः सुविरिक्तस्याध्मानेऽम्ललवणान् सुस्निग्धान् निरूहान् दद्यात् । सोपस्तम्भे तुवायौतीक्ष्णोष्णान् ।।१७ ॥
The abdomen which has become flabby (loose) by frequent purgations should be covered with a warm paste of salvala etc (a recipe of fomentation chapter 26 of sutrasthana) and wrapped with a band of thick cloth; by this, vayu (air) not getting any space, does not make the abdomen distended again.
Even then, if distention occurs, he should be administered decoction enemas prepared with drugs which have sour, salty and unctous properties; if there is obstruction of vata, then with drugs possessing penetrating and heat producing properties. (17) Vataja udara chikitsa –
अथ वातोदरिणं विदार्यादिसिद्धेन सर्पिषोपस्त्रेह्य स्वेदिताङ्गं तिल्वकघृतेन बहुशोऽनुलोमयेत् । कृतायां च संसर्ग्या बलार्थं क्षीरमवचारयेत् । निवर्तयेच्च प्रागुत्क्लेशात् क्रमेण । ततो यूषरसादिभिर्भन्दाम्ललवणैः समिद्धानलमुदावर्तिनं पुनः स्निग्धस्विन्नमास्थापयेद्विदार्यादिक्वाथेन चित्राफलतैलप्रगाढेन तीक्ष्णोष्णाधोभागिकद्रव्ययुक्तेन वादाशमूलिकेन ॥१८॥
Further, the patient of vatodara (enlargement of abdomen caused by vata, should be given oleation therapy with medicated ghee prepared from drugs of vidaryadi gana (chapter 16 of sutrasthana) followed by sudation therapy Tilvakaghrta should be administered many times, to cause downward movement of vata; it should be followed by a regimen of diet of milk to improve strength but it (milk) should be discontinued gradually, before it causes nausea. Next, when his digestive activity has improved by the use of soups and juice of meat etc which are slightly sour and salty but the upward movement of vata persists, the patient should again be given oleation and sudation therapies, followed by enema therapy with the decoction of drugs of vidaryadigana, made thick with mixture of oil of citraphala, or with drugs possessing penetrating, heat producing and purgative properties; or by using decoction of dashamoola. (18)
दीप्ताग्निं च बद्धमलमस्थिसन्धित्रिकपार्श्वादिशूल स्फुरणाक्षेपयुक्तं रूक्षमनुवासयेद्वातहराम्लसिद्धाभ्यां तिलोरुबूकतैलाभ्याम् । भोजयेच्चैनं जाङ्गलरसेन विदार्यादिभृतेन वा पयसा ।। १९ ।।
When the patient has keen digestive activity and has constipation pain and throbbing pain in the bony joints of upper back, flanks, etc convulsive movements (of the extremities) and dryness, then he should be administered, oil enemas with oils of tila and urubuka processed with drugs which mitigate vata and are sour. He should be made to take food along with juice of meat of animals of desert-like regions or along with milk boiled with drugs of vidaryadigana (chapter 16 of sutrasthana). (19)
सरलमधुशिग्रुमूलकबीजस्त्रेहाश्चपानाभ्यञ्जनेनशूलघ्नाः | स्वेदयेच्चाभीक्ष्णंजठरम् ॥ २० ॥
The oil of sarala, madhusigru, seeds of mulaka cure pain of the abdomen by using them for drinking and anointing; the abdomen should be frequently fomented. (20) अविरेच्यस्य तुपयः सर्पिर्यूषर राबस्त्यभ्यङ्गसमभक्तौषधैः संशमयेत् ॥ २१ ॥
He, who cannot be given purgatives, should be administered palliative therapy with the use of milk, ghee, meat juice, enemas, oil massage, and medicines mixed with food. (21)
Pittaja udara chikitsa
पित्तोदरिणं मधुरविपक्रेन सर्पिषोपस्त्रेह्य श्यामात्रिवृत्रिफलाविपक्वेनानुलोम्यैनं मधुघृतसिताढ्येनन्यग्रोधादिनिर्यूहेणास्थापयेदनुवासयेच्च ॥ २२ ॥
The patient of pittodara (enlargement caused by pitta) should be given oleation therapy with ghee cooked with drugs of sweet taste, use mild laxatives such as ghee cooked with syama, trivrit and triphala; then enema therapy with the decoction of drugs of nyagrodhadigana (chapter 16 of sutrasthana) mixed with more of honey, ghee and sugar, followed by oil enema (with oil prepared from the same drugs ) . ( 22 ) दुर्बलं तुप्रागेवानुवास्य क्षीरबस्तिभिः शोधयेत् ।।२३ ॥
The weak patient should be given oil enema therapy in the beginning itself, and then purificatory therapy using kshira basti ( enema containing medicated milk). (23)
सञ्जातबलाग्निं च स्निग्धं पुनः क्षीरेण सत्रिवृत्कल्केनोरुबूक शृतेन वा ।
सातलात्रायमाणाभ्यां वारग्वन्धेन वा सलेष्मणि पित्ते समूत्रेण सवाते तिक्तघृतान्वितेन पयसा पुनःपुनर्विरेचयेत् बस्तिकर्म चाचरेत् ।। २४ ।।
After he gains strength and keen digestive activity, he should be given oleation therapy again and then purgatives, using milk mixed with paste of trivrit and decoction of urubuka; or with decoction of satala and trayamana or of aragvadha. If pitta is associated with kapha, then with milk mixed with cows urine and if vata is associated, with milk mixed with tikta ghrta (ghee prepared with drugs of bitter taste); purgation therapy and enema therapy should be administered again and again. (24)
एभिरेव क्षीरैर्विदार्यादिश्रुतेन वा भोजयेत् । पायसेन चोपनाहयेदरम् ॥२५ ।।
The patient should take food along with these milks or with that boiled along with drugs of vidaryadigana, the abdomen should be fomented with a payasa (rice pudding prepared with milk). (25)
Kaphaja udara chikitsa
लेष्मोदरिणं वत्सकादिसिद्धेन सर्पिषोपस्त्रेह्यस्नुहीक्षीरविपक्केनानुलोम्य कटुक्षारयुक्तैः कफहरैराहारैः संसर्प्य त्रिकटुमूत्रतैलप्रगाढेन मुष्ककादिक्काथेनास्थापयेदनुवासयेच्च । कुलत्थयूषेण व्योषवता क्षीरेण वा भोजयेत् । स्त्यानकफोदरं क्षारमरिष्टांश्च तीक्ष्णान् पाययेत् । सततं च स्वेदयेत् । किण्वसर्षपमूलकबीजकल्कैर्जठरमुपनाहयेत् ।।२६ ।।
The patient of slesmaodara (enlargement caused by kapha) should be administered oleation therapy with ghee prepared from the decoction of drugs of vatsakadigana; mild purgation therapy with ghee cooked with milky sap of snuhi; his food prepared with ghee which subdue kapha, decoction enema therapy using the decoction of drugs of muskakadigana ( chapter 16 of sutrasthana) made with mixing of (powder of) trikatu, cows urine and oil; oil enema therapy also from oil prepared with the same drugs. He should take food along with soups of kulattha added with vyosa or with milk. The abdomen, if hard, the patient should be made to drink solution of strong ksharas (alkalies) and aristas (fermented decoction it should be fomented constantly, covered with warm paste of kinva (yeast) sarsapa and seeds of mulaka. (26)
Sannipataja udara chikitsa
सान्निपातिकमुदरं प्रत्याख्याय चिकित्सेत् । सर्वमेवेत्येके सर्वस्य सर्वात्मकत्वात् कृच्छ्रतमत्वाच्च । दोषोद्रेकतस्तुप्रतिकुर्वीत ॥ २७ ॥
Sannipata udara (enlargement of caused by all the three doshas together) should be treated only after explaining (to the patient or his guardians) its incurability. Some authorities say that all (varieties of udara) should be considered as incurable because all are produced by all the doshas increasing simultaneously, and also because of great difficulty in treatment. The treatment should be mainly in consideration of the aggravated doshas- (the dosha more predominantly increased should be controlled first and others next). ( 27 )
सप्तलाशङ्क्षिीनिर्याससिद्धेनचसर्पिषाविरेचयेन्मासमर्धमासंवा। महावृक्षक्षीरमूत्रसिद्धेनवा | ॥ २८ ॥
The patient should be given decoction of saptala and sankhini or with that (ghee) prepared with milky sap of mahavriksha mixed with cowsurine. (28)
अथवाजगन्धाजशृङ्गीदन्तीद्रवन्तीस्वादुकण्टकपुनर्नवाझरसीवृश्चिकालीमूषिकपर्णीमहासहाक्षुद्रसहावृक्षादिनीभागृध्रनखीतण्डुलीयकदाडिममातुलुङ्गमूलक्वाथेन मदनफलैलाकुष्ठ – कुटिलरास्त्राकल्कगोमूत्रसंसृष्टेन सैन्धवलवणितेनस्निग्धेनास्थापयेत् ||२९||
Or decoction enema should be administered, with the decoction of ajagandha, ajasringi, danti, dravanti, svadukantaka, punarnava, harasi vrscikali, musakaparni, mahasaha, ksudrasaha, vrikshadidni, bharangi, grdhrankhi tanduliyaka, dadima and root of matulunga, mixed with paste of madanaphala, ela, kustha, kutila rasna mixed with cowsurine, and saindhava lavana and fat (oil or ghee). (29)
तथा चानुपशाम्यति निचयात्मके सर्वत्र च जठरे ज्ञातीनाश्राव्य मद्येनाश्वमारकगुञ्जाकाकादनी – मूलकल्कं पाययेत् । पानभोजनेषु वा विषं निक्षिपेत् । इक्षुगण्डकांवा भक्षयेत् कृष्णसर्पेण दंशयित्वा वल्लीफलानि वामूलकं वा ॥ ३० ॥
If the enlargement of the abdomen caused by all the three doshas or even others do not subside by the above methods of treatment, then the relatives (guardians) of the patient should be intimated (of the next teatment of administering poison) and the patient made to drink a mixture of wine and paste of roots of asvamaraka, gunja, and kakadani or poison mixed with his food and drink; or piece of iksu (sugar cane) or of valliphala (ash gourd, pumpkin) or of mulaka should be got bitten by a black serpent and that (containing the poison) given to the patient to eat. (30)
एवं ह्यस्य दोषसङ्घातः स्थिरो लीन उन्मार्गगो विषेणाशु प्रमाधिना विभिन्नो बहिः प्रवर्तते । तेनागदतांव्रजति । भवान्तरवा ॥ ३१ ॥
By this treatment, the accumulation of doshas which are static, hiding inside (the tissue) and travelling in all directions, get broken up by the pramathi action (quick spreading) of the poisor and comes out; by that the patient may either get cured of the disease or get one more cycle of birth and death (may die). (31)
हृतदोषं च शीताम्बुपरिषिक्तं क्षीरयवागूं पाययेत् । ततस्त्रिवृद्वास्तुकमण्डूकपर्णीकालशाकयवशाकानामन्यतमं स्वरससाधितमनम्ललवणस्त्रेहं स्विन्नास्विन्नमनन्त्रभुभासमेकमनीयात् । तत्स्वरसमेव च तृषितः पिबेत् । ततः शाकैर्निहृते दोषे परतो दुर्बलाय कारभं क्षीरंप्रयुञ्जीत ||३२||
After the patient has got rid of the doshas (by the use of poison) he should be given bath in cold water and kshirayavagu (gruel prepared with milk) to drink. Next eat any one of the following leafy vegetables such as trivrit, vastuka, mandukaparni, kalasaka and yavasaka cooked in their own fresh juice, without adding sour, salt and fats; steamed or unsteamed, for one month without eating any other food; if thirsty he should drink their fresh juice only. After he gets rid of the doshas by this diet of leafy vegetables and having become weak, he should be given camels milk (as diet). (32)
Plihodara yakurtodara chikitsa
प्लीहोदरे यथादोषमुपस्निग्धस्विन्नस्य दक्षा भुक्तवतो वामबाहौ सिरां विध्येत् | रुधिरस्यन्दनार्थंच पाणिना प्लीहानं विमर्दयेत् । पुनश्च स्नेहपीतं विशुद्धदेहं समुद्रशुक्तिक्षारं पयसा पाययेत् हिगु सुवर्चिकांवा | पलाशक्षारोदकेन वायवक्षारम् ||३३ ॥
In plihodara (enlargement of spleen) oleation and sudation therapies should be administered appropriate to the doshas, the patient made to eat food along with dadhi (curds); vein of his left arm cut (to let out blood) the spleen should be massaged by the hand to make the blood thin (and flow out freely). After that, he should again made to drink fats (medicated oil or ghee) and take purifactory therapies; then he should be given milk mixed with either the kshara (ash) of sea-shells, or hingu or suvarcika or drink the solution of palasakshara (ash of leaves of palasa), mixed with yavakshara. ( 33 )
पारिजातकेक्ष्वाक्वपामार्गक्षारंवातैलसंसृष्टम् । सौभञ्जनकनिर्यूहं वा पिप्पलीचित्रकसैन्धवचूर्णयुक्तम् । अम्लस्स्रुतं वा बिडमागधिकाढ्यं पूतिकरञ्जक्षारम् । अग्निसादे तु त्रिलवणादिं क्षारनरिष्टांश्च पिबेत् । घृतंषट्पलं महाषट्पलं रोहीतकषट्पलं वा ॥ ३४ ॥
Or drink oil processed with kshara (ash) of parijataka, iksvaku or apamarga; Or drink the decoction of sobhanjana mixed with powder of pippali, chitraka and saindhava; Or drink the kshara (ash) of putikarnja mixed with bida and magadhika along with sour liquids ( gruel, wines etc).
In case of weakness of digestive activity, he should drink trilavanadi (curna), ksharas or aristas; or drink either satpala ghrta, mahasatpala ghrta or rohitaka satpala ghrta. ( 34 )
रोहीतकत्वकूपलानि पञ्चविंशतिं कोलप्रस्थद्वयं च तोये क्वाथयेत् तेन क्वाथेन तथा पालिकैः पञ्चकोलकैस्तैः सर्वैश्च तुल्यया रोहीतकत्वचा कल्कीकृतैर्घृतप्रस्थं साधयेत् । तत् परं प्लीहहितम् ॥ ३५ ॥
Twenty five pala of bark of rohitaka, two prastha of kola are made into decoction; one pala each of panchakola, paste of rohitaka bark equal to all of them and one prastha of ghrta- are all cooked together into a medicated ghee. This recipe is specially beneficial to the spleen (enlargement). (35)
रोहीतकलताः खण्डशः कल्पिताः हरीतकीश्च तोये गोमूत्रे वा सप्तरात्रमासुनुयात् । स रसः प्लीह-गुल्मोदरकृमिमेहकामलाशसि साधयति । एवमनुपशाम्यत्यप्राप्तपिच्छोदके वातकफोल्बणे गुल्मविधिनाग्निकर्मकुर्यात् ।। ३६ ।।
Tender shoots of rohitaka and haritaki are cut into small pieces immersed either in water or cowsurine for seven days and allowed to ferment. This fluid is filtered later and used, cures enlargement of spleen, abdominal tumor, enlargement of abdomen, worms, diabetes, jaundice and piles.
If by these methods, it (splenic enlargement) does not subside and if slimy fluid collection inside the abdomen has not taken place and if vata and kapha are found to be greatly aggravated, then branding (touching by fire) should be done as described in the treatment of gulma (abdominal tumor vide chapter 16 of chikitsasthana). ( 36 )
पित्तोल्बणे तु जीवनीयघृतक्षीरबस्तिविरेचनानि प्रयुञ्जीत । पुनःपुनश्च रुधिरमवसेचयेत् । यकृदाख्येऽप्ययमेवक्रियाविभागः ॥३७॥
If pitta is aggravated, use of jivaniya ghrta, kshira basti (enema with medicated milk) and virecana (purgative therapy) should be administered, blood should be let out again and again. Even for yakritodara (abdominal enlargement due to enlargement of liver) the mode of treatment is the same. (37)
Baddhodara chikitsa
बद्धोदरे स्विन्नाय सतैललवणमूत्रं तीक्ष्णं निरूहमनुवासनं च दद्यात् । स्रंसनानि चान्नान्युदावर्तहराणिच तीक्ष्णं च विरेचनं यच्च किञ्चिद्वातघ्नम् ॥ ३८ ॥
For baddhodara (enlargement of abdomen due to intestinal obstruction) the patient should be administered sudation therapy, strong decoction enemas, with decoction mixed with oil, salt and cowsurine, and also oil enemas; foods processed with drugs which are sramsana (laxative) and subdue upward movement of vata; and also strong purgatives which subdue vata. (38)
Chidrodara chikitsa
छिद्रोदरे स्वेदवर्ज्यं कफोदरवदाचरेत् । दकोदरेतु पूर्वमुदकदोषहरणार्थं रूक्षतीक्ष्णौषधान् समूत्रान्निर्यूहचूर्णक्षारान् कफघ्नानिदीपनीयानि चान्नपानानि योजयेत् ।।३९ ।।
For chidrodara (enlargement of the abdomen due to intestinal perforation) the treatment similar to kaphodara, excepting sudation therapy should be adopted. Dakodara chikitsa –
Dakodara (enlargement of the abdomen due to accumulation of water/ascitis) should be treated first for the prevention of accumulation of water, by using drugs which are dry and penetrating, mixed with cowsurine, decoction, powders and alkalies (ash); food and drinks which subdue kapha and improve digestion. (39)
Sastra chikitsa- surgical treatment.
एवमसिद्धौ बद्धच्छिद्रदकोदरेष्वश्मर्यामिव सुहृदां प्रकाश्य शस्त्रमवचारयेत् । तत्र बद्धच्छिद्रो`दरयोः स्निग्धस्विन्नस्याधो नाभेश्चतुरङ्गुलानि वामतोऽपहायोदरं पाटयित्वा चतुरङ्गुलप्रमाणमान्त्राणि निष्कास्य निरीक्ष्य बद्धगुदोदरस्यान्त्रप्रतिरोधकरं बालं मलोपलेपमश्मानं चापहरेत् । परित्राविणि शल्यमुद्धृत्यान्त्रपरित्रावं विशोध्य तच्छिद्रं मर्कोटकैर्दंशयेत् । लग्नेषु च शिरस्सु कायमपनयेत् । ततो मधुघृताभ्यामभ्यज्यान्त्राणि यथास्थानं स्थापयित्वा बाह्यं व्रणमुदरस्य सीव्येत् । यष्टीमधुकमिश्रयाच कृष्णमृदा व्रणमभिलिप्य बनीयात् । अथ निवातमागारंप्रवेश्य क्षीरवृत्तिं स्नेहद्रोण्यां वासयेत् ।।४० ।।
If the above methods of treatment do not succeed, in baddhodara, chidrodara and udakodara, then surgical treatment should be done as in the case of asmari (urinary stone), by intimating the patient or his guardians (about the gravity of the diseases and necessity of surgery).
In baddhodara and chidrodara, the patient should be anointed with oil and given sudation; then avoiding four angula (fingers breath) of space from the umbilicus, below and to the left side of it, the abdomen should be cut open; the intestine four angula in length (having the obstruction) taken out, examined carefully, the hairs, faeces or stones which are causing obstruction removed. In parisravi udara (chidrodara) the foreign body (which is the cause of perforation) is pulled out, the perforated intestine cleaned and the perforation (slit or opening) is got bitten by large ants; when they are found to have adhered, their body ( of ants) should be cut off from their head. Then the intestine is placed into its normal place, the abdomen closed and the external wound sutured. Black soil mixed with (powder of) yastimadhuka (made into a plaster) applied over the wound and (the abdomen) tied with a bandage. Afterwards, the patient is removed to a room devoid of breeze and placed in a taildroni (wooden tub filled with medicated oil) and allowed only milk, as diet. (40)
दकोदरे सर्वेषु च जातोदकेषु जठरेषु वातहरतैलाभ्यक्तस्योष्णोदकस्विन्नस्याप्तैः परिगृहीतस्याकक्ष्यातः पटवेष्टितोदरस्याधो नाभेर्वामतश्चतुरङ्गुलमपहाय व्रीहिमुखेनाङ्गुष्ठोदरमात्रमवगाढं विध्वा नाडीं निधाय दोषोदकमर्धमात्रमवसिञ्चेत् । ततोनाडीमुद्धृत्य तैललवणेनाभ्यज्य व्रणं बन्धनेनोपचरेत् ।।४१ ।।
In Dakodara and other kinds of udara in which fluid has accumulate inside, the patient should be anointed with medicated oil which subdue vata and given fomentation with hot water; he should be held tight by his trusted friends, his abdomen tied with cloth from the level of the axillae downwards; then avoiding a space of four angula below the umbilicus, on the left side, the vrihimukha yantra (trocar), is thurst into the abdomen to a depth of the size of the mid portion of the thumb (about two angula), then a tube (canula) is inserted and half the quantity of fluid removed; afterwards the tube is removed, the wound anointed with oil and salt and bandaged (tight). (41)
सहसा सर्वस्मिन्विस्त्राविते तृष्णा ज्वरोऽङ्गमर्दोऽतीसारः श्वासः कासः पाददाहो वा जायते । पूर्यते चसुतराम् । अतस्तृतीयचतुर्थपञ्चमषष्ठाष्टमद्वादशषोडशरात्राणामन्यतममन्तरंकृत्वादोषोदकम-ल्पशो विस्रावयेत् । निस्स्रुते च दोषोदके विमृद्योदरमाविककौशेयचर्मणामन्यतरेण गाढतरं वेष्टयेत् । तथा नाध्मापयति वायुः । लङ्घयित्वा च यवागूमल्पस्त्रेहलवणां मात्रया पाययेत् । ततः परं षण्मासान् क्षीरवृत्तिर्भवेत् । ततोमासत्रयं क्षीरपेयां पिबेत् । अन्यच्च मासत्रयमल्पलवणमल्पक्षीरंश्यामाकं कोरदूषं वा भुञ्जीतेति । भवति चात्र । ॥ ४२ ॥
If the abdomen is evaculated all at once, thirst, fever, dull pain all over the body, diarrhoea, dyspnoea, cough and burning sensation of the soles develop, it fills up again quickly. Hence the bade fluid should be removed, little by little with intervals of three, four, five, six, eight, twelve, sixteen or other days. After the fluid is drained the abdomen should be massaged gently and wrapped tight with a band of woollen or silk cloth or skin; then the abdomen will not get enlarged again. He should be given langhana therapy (fasting) and allowed to drink small quantity of yavagu (gruel) with little of fat and salt. For further six months, he should take only milk as diet; next three months, milk mixed with peya (thin gruel); some others opine that for three months he should partake little (or no) salt, little (or no) milk and eat either syamaka or koradusa (only). (42)
Some verses more
प्रयतो वत्सरेणैवं विजयेत जलोदरम् । वर्ज्येषु यन्त्रितो दिष्टे नात्यदिष्टे जितेन्द्रियः ॥४३ ॥
With all-out efforts, the patient of jalodara should be cured within in one year by these methods (of drugs and diet); he should be under strict control regarding things (foods, drinks and activities) forbidden, regarding things prescribed he need not be very strict and with regards to things not prescribed, he must exercise control over his sensex (take very little of them) (43)
सर्वमेवोदरंप्रायो दोषसङ्घातजंयतः । अतो वातादिशमनी क्रिया सर्वत्र शस्यते ॥४४॥
Generally, all types of abdominal enlargement are born from the combination of all the doshas together; hence measures to control vata and other doshas are beneficial in all of them. (44)
वह्निर्मन्दत्वमायाति दोषैः कुक्षौ प्रपूरिते । तस्मात् भोज्यानि योज्यानि दीपनानि लघूनि च ॥ ४५ ॥
When the doshas accumulate in the abdomen greatly, weakness of fire (digestive activity) develops; hence foods which improve digestion and which are easily digestable should be prescribed. (45)
सपञ्चमूलान्यल्पाम्लपटुस्नेहकटूनि च । भावितानां गवां मूत्रेषष्टिकानां च तण्डुलैः ॥४६ ॥ यवागूं पयसा सिद्धां प्रकामं भोजयेन्नरम् | पिबेदिक्षुरसं चानु जठराणां निवृत्तये ॥४७॥ स्वं स्वं स्थानं व्रजन्त्येषां वातपित्तकफास्तथा ।
Foods which should be processed with drugs of panchamula and should have very litle of sour, salt, fats and pungent things; yavagu (gruel) prepared from sastika rice or tandula (ordinary rice) soaked in cows urine (and dried) along with milk can be alowed as much as he desires, followed by juice of sugar-cane as after-drink for the cure of all kinds of abdominal enlargements. By these measures, vata, pitta and kapha will get back into their own seats. (46-48a)
अत्यर्थोष्णाम्ललवणं रूग्राहि हिमं गुरु | ॥४८॥
गुडं तिलकृतं शाकंवारिपानावगाहयोः ।आयासाध्वदिवास्वप्नयानयानानि च त्यजेत् ॥४९ ।।
Indulgence in too much of hot (heat producing), sour, salt, dry, (dryness causing) constipating, cold and heavy foods and drinks, guda (jaggery), eatables prepared from tila, leafy vegetables, drinking water and bathing in water, physical exertion, walking long distance, sleeping at day time, riding on animals and vehicles should be avoided. (48b-49)
नात्यच्छसान्द्रमधुरंपान तक्रं प्रशस्यते । सकणालवणं वाते पित्ते सोषणशर्करम् ॥ ५० ॥
यवानीसैन्धवाजाजीमधुव्योषैः कफोदरे । त्र्यूषणक्षारलवणैः संयुक्तं निचयोदरे ।।५१ ।।
मधुतैलवचाशुण्ठीशताह्वाकुष्ठसैन्धवैः । प्लीह्निबद्धे तुहपुषायवानीपट्वजाजिभिः ॥५२॥
सकृष्णामाक्षिकं छिद्रे व्योषवत्सलिलोदरे || गौरवारोचकानाहमन्दवह्नयतिसारिणाम् ।
तक्रं वातकफार्तानाममृतत्वाय कल्पते ॥५३॥
Drinking of takra (buttermilk) which is neither too thin nor too thick and which is sweet is very beneficial; it should be taken mixed with kana and lavana in vatodara, with usana (maricha) and sarkara (sugar) in pittodara; with yavani, saindhava, ajaji, madhu (honey) and vyosa in kaphodara; with tryusana, kshara and lavana in sannipatodara; with madhu (honey), taila (oil), vacha, Sunthi, satahva, kustha and saindhava in plihodara; in baddhodara with hapusa, yavani, patu (salt) and ajaji, with krsna and maksika (honey ) in chiddrodara and with vyosa in dakodara.
For those suffering from feeling of heaviness of the body, anorexia flatulence, poor digestion, diarrhoea, disorders of vata and kapha, take a (buttermilk) acts like nector. (50-53)
प्रयोगाणां च सर्वेषामनु क्षीरं प्रयोजयेत् । स्थैर्यकृत् सर्वधातूनां बल्यं दोषानुबन्धहृत् ।। भेषजापचिताङ्गानां क्षीरमेवामृतायते ॥५४॥
After every therapy, milk should be administered, it makes all the dhatus (tissues), stable, bestows strength and prevents the doshas persisting for long periods; for the body emaciated by drugs and therapies milk alone acts as nector. (54)
।। इतिसप्तदशोऽध्यायः ॥
Thus ends the Seventeenth chapter.
