पञ्चपञ्चाशत्तमोऽध्यायः अथात उदावर्तप्रतिषेधमध्यायं व्याख्यास्यामः, यथोवाच धन्वन्तरिः॥१॥ भगवान्
Now we shall discourse on the chapter which deals with the (symptoms and) medical treatment of the disease due to the retention of any natural physical urging (Udavarta – Pratisedha). 1.
Udavarta Causes
अधश्चोर्ध्वञ्च भावानां प्रवृत्तानां स्वभावतः । न वेगान् धारयेत् प्राज्ञो वातादीनां जिजीविषुः ॥ २ ॥ वातविण्मूत्रजृम्भाश्रु-क्षवोद्गारवमीन्द्रियैः व्याहन्यमानैरुदितैरुदावर्तो । निरुच्यते ॥ ३ ॥ क्षुत्तृष्णाश्वासनिद्राणामुदावर्तो विधारणात् । तस्याभिधास्ये व्यासेन लक्षणञ्च चिकित्सितम् ॥ ४ ॥ त्रयोदशविधश्चासौ भिन्न एतैस्तु कारणैः । अपथ्यभोजनाच्चापि वक्ष्यते च तथाऽपरः ॥ ५ ॥
Causes – A wise man valuing his life shall never repress any natural urging of his body, whether upward or downward, e.g. that of Vayu, etc. Udavarta is so called from its origin from the repression of any natural urging such as Vata (flatus ), evacuation of bowels, micturition, yawning, lacrimation, sneezing, eructation, vomiting and discharge of semen when it makes its appearance (Udita) and urges a person to answer its call. Udavarta is also brought on by the repression of hunger, thirst, respiration and sleep. I shall now fully describe its symptoms and the mode of medical treatment to be pursued therein. It is of thirteen different types and are brought about through the aforesaid causes, over and above the one incidental to the habitual use of unwholesome food and drink (Apathya). 2-5.
Symptoms of Vataja Udavarta
आध्मानशूलौ हृदयोपरोधं शिरोरुजं श्वासमतीव हिक्काम् । कासप्रतिश्यायगलग्रहांश्च बलासपित्तप्रसरञ्च घोरम् ॥ ६ ॥ कुर्यादपानोऽभिहतः स्वमार्गे हन्यात् पुरीषं मुखतः क्षिपेद् वा ॥ ७ ॥
Symptoms of Vataja Udavarta – The vital Apana-Vayu (at the anus) anyhow obstructed in its passage gives rise to distension and cramps in the abdomen, oppression and a constricted feeling at the heart, headache, laboured breathing, hiccough, cough, catarrh, catching pain at the throat which makes speaking and deglutition difficult (Galagraha), violent movement of deranged Pitta and Kapha all through the body and suppression of stools or emission of fecal matter through the mouth. 6-7.
Purisaja Udavarta
आटोपशूलौ परिकर्तनञ्च सङ्गः पुरीषस्य तथोर्ध्ववातः । पुरीषमास्यादपि वा निरेति पुरीषवेगेऽभिहते नरस्य ॥ ८ ॥
Purisaja Udavarta – A repressed urging for stool is followed by the exhibition of such symptoms, as rumbling in the intestines, severe pain (in the abdomen), cutting pain in the anus, upward coursing of the flatus suppression of stool or even emission of feces through the mouth. 8.
Mutraja Udavarta
मूत्रस्य वेगेऽभिहते नरस्तु कृच्छ्रेण मूत्रं कुरुतेऽल्पमल्पम् । मेढ्रे गुदे वड्ङ्क्षणमुष्कयोश्च नाभिप्रदेशेष्वथवाऽपि मूर्ध्नि । आनद्धबस्तिश्च भवन्ति तीव्राः शूलाश्च शूलैरिव भिन्नमूर्तेः ॥ ९ ॥
Mutraja Udavarta – A repression of the desire of making water is followed by scanty emission of urine which is often given out by painful drops producing distension of the bladder and an excruciating pain in the urethra, anus, scrotum and the inguinal regions and about the umbilicus, and sometimes even in the head, accompanied with distortion of features in consequence. 9.
मन्यागलस्तम्भशिरोविकारा जृम्भोपघातात् पवनात्मकाः स्युः । श्रोत्राननघ्राणविलोचनोत्था भवन्ति तीव्राश्च तथा विकाराः ॥ १० ॥
आनन्दजं शोकसमुद्भवं वा नेत्रोदकं प्राप्तममुञ्चतो हि । शिरोगुरुत्वं नयनामयाश्च भवन्ति तीव्राः सह पीनसेन ॥ ११ ॥
A repression of yawning leads to wry-neck (numbness of the Manya and of the neck) as well as troubles of the head due to the incarcerated local Vayu and violent diseases affecting the eyes, nose, ears and the mouth. Tears born of any mental condition of grief or joy and voluntarily repressed without being given free tend to, give rise to severe distease of the eyes, heaviness of the head and catarrh ( Pinasa). 10-11.
भवन्ति गाढं क्षवथोर्विघाताच्छिरोऽक्षिनासाश्रवणेषु रोगाः ।
कण्ठास्यपूर्णत्वमतीव तोदः कूजश्च वायोरुत वाऽप्रवृत्तिः ॥ १२ ॥ उद्गारवेगेऽभिहते भवन्ति घोरा विकाराः पवनप्रसूताः ॥ १३ ॥
A repression of sneezing is followed by acute diseases of the head, eyes, nose and ears. A sense of fulness in the throat as well as the suppression and croaking of the incarcerated Vayu (wind) are also exhibited in this case. The voluntary repression of any natural urging towards eructation gives rise to diseases peculiar to the derangement of the bodily Vayu. 12-13.
छर्देर्विघातेन भवेच्च कुष्ठं येनैव दोषेण विदग्धमन्नम् ॥ १४ ॥ मूत्राशये पायुनि मुष्कयोश्च शोफो रुजो मूत्रविनिग्रहश्च । शुक्राश्मरी तत्स्त्रवणं भवेद् वा ते ते विकारा विहते तु शुक्रे ॥ १५ ॥
A repression of Vomiting is followed by cutaneous affections (Kustha) due to the bodily Dosas which, being vitiated, interferes the gastric digestion with reactionary acidity. Painful swelling of the bladder and of the scrotum, and about the anus as well as suppression of urine, formation of gravels in the bladder and involuntary emission of semen are the symptoms which manifest themselves in a case of repressed seminal discharge. 14-15.
तन्द्राङ्गमर्दारुचिविभ्रमाः स्युः क्षुधोऽभिघातात् कृशता च दृष्टेः ॥ १६ ॥
1. The symptoms mentioned in this sentence (which comprises a line in the verse ) is taken by Madhava with the following line which enumerates the symptoms of Udavarta due to the voluntary repression of eructation.
कण्ठास्यशोषः श्रवणावरोधस्तृष्णाभिघाताद्धृदये व्यथा च। श्रान्तस्य निःश्वासविनिग्रहेण हृद्रोगमोहावथवाऽपि गुल्मः ॥ १७॥ जृम्भाङ्गमर्दोऽङ्गशिरोऽक्षिजाड्यं निद्राभिघातादथवाऽपि तन्द्रा ॥ १८ ॥
Ungratified hunger brings on drowsiness, aching pain in the limbs, disrelish for food, sense of exhaustion, and weakness of eyesight. An ungratified thirst brings on dryness of the throat and mouth, dulness of hearing and pain at the heart. A suppression of breath in an exhausted person brings on cardiac troubles, fainting fits and an attack of Gulma. An unindulged sleep produces yawning, aching pain in the limbs, and a sense of heaviness in the limbs as well as in the head and may also bring on drowsiness. 16-18. the eyes.
Prognosis of Udavarta
तृष्णार्दितं परिक्लिष्टं क्षीणं शूलैरभिद्रुतम् । शकृद् वमन्तं मतिमानुदावर्तिनमुत्सृजेत् ॥ १९ ॥
Prognosis of Udavarta – patient afflicted with thirst and cramps (Sula), vomiting fecal matter and suffering from weakness and a distressing exhaustion should be given up by a wise physician. 19.
General Treatment of Udavarta
सर्वेष्वेतेषु विधिवदुदावर्तेषु कृत्स्नशः । वायोः क्रिया विधातव्याः स्वमार्गप्रतिपत्तये ॥ २० ॥ सामान्यतः पृथक्त्वेन क्रियां भूयो निबोध मे ॥ २१ ॥
General Treatment – In all forms of Udavarta the preliminary treatment generally consists in restoring the deranged and incarcerated bodily Vayu to its normal course and direction. Now hear me again describing the specific medicinal remedies to be separately employed in each case. 20-21.
Specific Treatment of Udavarta
आस्थापनं मारुतजे स्निग्धस्विन्ने विशिष्यते ॥ २२ ॥ पुरीषजे तु कर्तव्यो विधिरानाहिको भवेत् ॥ २३ ॥
Specific Treatment – In a case of Vataja Udavarta the patient should be first treated with a Sneha and Sveda (fomentation) after which medicinal injections should be made into the rectum in the manner of an Asthapana-basti. In a case due to the incarceration of feces in the intestines (Purisaja), the remedial measures and medicines laid down in connection with the treatment of anaha should be employed. 22-23
सौवर्चलाढ्यां मदिरां मूत्रे त्वभिहते पिबेत् । एलामप्यथ मद्येन क्षीरं वाऽपि पिबेन्नरः । धात्रीफलानां स्वरसं सजलं वा पिबेत् त्र्यहम् । रसमश्वपुरीषस्य गर्दभस्याथवा पिबेत् ॥ २४ ॥ मांसोपदंशं मधु वा पिबेद् वा सीधु गौडिकम् ॥ २५ ॥ भद्रदारू घनं मूर्वां हरिद्रां मधुकं तथा । कोलप्रमाणानि पिबेदान्तरीक्षेण वारिणा ॥ २६ ॥ दुःस्पर्शास्वरसं वाऽपि कषायं कुङ्कुमस्य च । एर्वारुबीजं तोयेन पिबेद् वाऽलवणीकृतम् ॥ २७ ॥ पञ्चमूलीशृतं क्षीरं द्राक्षारसमथापि योगांश्च वा । वितरेदत्र पूर्वोक्तानश्मरीभिदः ॥ २८ ॥ कुर्यान्निरवशेषतः ॥ २९ ॥ मूत्रकृच्छ्रक्रमञ्चापि भूयो वक्ष्यामि योगान् यान् मूत्राघातोपशान्तये ॥ ३० ॥
Wine charged with a large quantity of Sauvarcala-salt should be administered in a case due to the retention of urine. Milk or Ela should also be taken in combination with wine. The expressed juice of Dhatri diluted with water should be taken for three successive days; or the expressed liquid of the dung of a horse or of an ass should be taken; or wine made from treacle (Goudika) should be taken with honey and cooked meat should be taken by biting at intervals. One Tola weight of the compound consisting of Bhadra daru, Musta, Murva, Haridra and Yasti-madhu should be dissolved in an adequate quantity of rainwater and then be taken. The expressed juice of Duhsparsa (Duralabha) or an infusion of Kum- Kuma (D.R. — decoction of Kakubha i.e. Arjuna) should be taken, or Ervaruka-seeds mixed with a little salt should also be taken with water. Milk duly cooked with Panca-mula¹ or the expressed juice of Draksa should be prescribed. The medicinal remedies previously described as possessed of the efficacy of disintegrating gravels, ( ASmari ) 2 should be administered. Similarly, all the measures to be mentioned hereafter in connection with the medical treatment of Mutra-Krcchra’ (strangury) and of Mutraghata (obstruction of urine) which I shall have occasion to deal with later on should also be adopted in this case. 24-30.
1. Both Dalhana and Sivadasa recommend the use of minor Panca mula, but Srikantha recommeds the Trna Panca-mula. 2. For Asmari- See Ciktisita-sthana, Chapter VII.
स्नेहै: स्वेदैरुदावर्तं जृम्भाजं समुपाचरेत् । अश्रुमोक्षोऽश्रुजे कार्यः स्निग्धस्विन्नस्य देहिनः ॥ ३१ ॥ तीक्ष्णाञ्जनावपीडाभ्यां तीक्ष्णगन्धोपशिङ्गनैः । वर्तिप्रयोगैरथवा क्षवसक्तिं प्रवर्तयेत् ॥ ३२॥ ( तीक्ष्णौषधप्रधमनैरथवाऽऽदित्यरश्मिभिः ।) ॥ ३३ ॥
A case of Udavarta due to the suppression of yawning should be conquered with the applications of Sneha and of Sveda (fomentation). The patient should be treated with Sneha and then fomented and lachrymation should then be induced (with appropriate remedies)³ in a case where the flow of tears has been suddenly checked. Sneezing should be induced with the help of strong Anjanas and Avapidas, or by the application of Vartis, or by holding any strong smell at his nose or by blowing any strong medicinal powder into the nose (Pradhamana) or by making the patient look towards the sun (or such like luminous body) in a case of Udavarta due to the suppression of sneezing. 31-33.
उदारजे क्रमोपेतं स्नैहिकं धूममाचरेत् ॥ ३४ ॥ सुरां सौवर्चलवतीं बीजपुररसान्विताम् ॥ ३५ ॥ छर्द्याघातं यथादोषं सम्यक् स्नेहादिभिर्जयेत् । सक्षारलवणोपेतमभ्यङ्गं चात्र दापयेत् ॥ ३६ ॥
In a case of Udavatra due to suppressed eructation, the patient should be made to inhale the fumes of oily or lardaceous articles in due order or to take draught of wine surcharged with Souvarcala-salt and the expressed juice of Bija-pura. A case of Udavarta due to suppressed vomiting should be duly conquered with emulsive measures (treating with a Sneha ), etc., according to the nature of the deranged bodily Dosa involved in each case. In the alternative unguents with (Saindhava) salt and (Yava) Kshara should be applied. 34-36.
1. For Mutra- Krcchra- See ch. LIX., Uttara-Tantra. 2. For Mutraghata- See Ch. LVIII, Uttara-Tantra. 3. These are the applications of strong Anjanas and Avapida Nasyas. 4. The order is (1) Dhuma-inhalation, (2) Nasya ( errhine) and (3) Kavala ( gargle ).
बस्तिशुद्धिकरावापं चतुर्गुणजलं पयः । अवारिनाशात् कथितं पीतवन्तं प्रकामतः । रमयेयुः प्रिया नार्यः शुक्रोदावर्तिनं नरम् ॥ ३७॥
Milk should be duly cooked with the admixture of four times as much water and with the drugs of bladder-cleansing virtues¹ and boiled until all the water is evaporated. Draughts of this medicated milk should be prescribed in copious quantities in a case of Udavarta due to the retention of seminal fluid and the patient should be advised to have sexual intercourse with lovely women. 37.
क्षुद्विघाते हितं स्निग्धमुष्णमल्पञ्च भोजनम् । तृष्णाघाते पिबेन्मन्थं यवागूं वाऽपि शीतलाम् ॥ ३८ ॥ भोज्यो रसेन विश्रान्तः श्रमश्वासातुरो नरः । निद्राघाते पिबेत् क्षीरं स्वप्याच्चेष्टकथा नरः ॥ ३९ ॥
Fatty (Snigdha) things should be taken lukewarm and in small quantities in a case of Udavarta due to ungratified hunger. Cold manthas or Yavagus should be given to the patient in a case of Udavarta due to the suppression of thirst. Food with meat-soup should be given to the patient after sufficient rest in a case of Udavarta originated from the suppression of breath in a tired state of the body. Milk² should be given in a case of Udavarta due to the suppression of sleep and the patient should be made to sleep with the help of sweet discourses. 38-39.
Cases of distension of the abdomen / adhmana
आध्मानाद्येषु रोगेषु यथास्वं प्रयतेत हि । यच्च यस्मिन् भवेत् प्राप्तं तच्च तस्मिन् प्रयोजयेत् ॥ ४० ॥
Cases of adhmana (distension of the abdomen), etc., which are the supervening symptoms of Udavarta should be remedied with appropriate medicines and other measues with an eye to the nature and intensity of the deranged Dosa or Dosas involved in each case underlying at the root. 40.
1. These are the drugs of the Trna-panca-mula as well as of the Virataradi groups (Chapter XXXVIII, Sutra Sthana).
2. Sivadasa advises the use of buffalo’s milk in this case as being more efficacious in bringing on sleep. But Dalhana refutes this and recommends the use of cow’s milk.
Udavarta due to errors in diet
वायुः कोष्ठानुगो रूक्षैः कषायकटुतिक्तकैः । भोजनैः कुपितः सद्य उदावर्तं करोति हि ॥ ४१ ॥ वातमूत्रपुरीषासृक्-कफमेदोवहानि स्त्रोतांस्युदावर्तयति वै। पुरीषञ्चातिवर्तयेत् ॥ ४२ ॥ ततो हृद्वस्तिशूलार्तो गौरवारुचिपीडितः । वातमूत्रपुरीषाणि कृच्छ्रेण कुरुते नरः ॥ ४३ ॥ श्वासकासप्रतिश्याय-दाहमोहवमिज्वरान् । तृष्णाहिक्काशिरोरोग-मनः श्रवणविभ्रमान् । लभते च बहूनन्यान् विकारान् वातकोपजान् ॥ ४४ ॥
Udavarta due to errors in diet — The abdominal (Kosthaja) Vayu deranged and aggravated by such factors as eating dry, astringent, pungent or bitter articles of fare (in inordinate quantities) causes an immediate attack of Udavarta in which the Vayu follows an upward course and obstructs its own channels as well as those of faeces, urine, kapha, fat and blood. it dries up the fecal matter (in the body) causing pain in the heart and bladder, a sense of heaviness in the limbs (D.R. nausea), aversion to food (D.r. unwillingness to do anything) and difficult and scanty emission of stool, urine and flatus. Laboured breathing, cough, catarrh, burning sensation in the body, fits of unconsciousness, vomiting, fever, thirst hiccough troubles in the head, defective functional activity of the Manas (mind) and of the ear and such like symptoms, in consequence, pre-eminently mark the deranged action of the bodily Vayu. 41-44.
Treatment
तं तैललवणाभ्यक्तं स्त्रिग्धं स्विन्नं निरूहयेत् । दोषतो भिन्नवर्चस्कं भुक्तञ्चाप्यनुवासयेत् ॥ ४५ ॥ न चेच्छान्तिं प्रयात्येवमुदावर्तः सुदारुणः । अथैनं बहुशः स्विन्नं युञ्ज्यात् स्नेहविरेचनैः । पाययेत त्रिवृत्पीलु-यवानीरम्लपाचनैः ॥ ४६ ॥ हिङ्गुकुष्ठवचास्वर्जि-विडङ्गं वा द्विरुत्तरम् । योगावेतावुदावर्तं शूलञ्चानिलजं हतः ॥ ४७॥
Treatment – The patient’s body should be made emulsive (Snigdha) by the application of unguents composed of salt and oil. Fomentation should then be applied under the circumstances, and intestinal injections should be applied in the manner of a Niruha Basti. Intestinal enemas (Basti) of the Anuvasana kind should also be applied after meal, if the case be attended with loose motions in virtue of the specific nature of the deranged bodily Dosas involved therein. Fatty purgtives should be exhibited after having fully fomented the body of the patient, when the foregoing remedies would fail to give any relief from attacks of Udavarta and be should be made to drink a potion of any acid cordial together with the compound of Pilu, Trivrit and Yavani or with the compound consisting of Hingu, Kustha, Vaca, SvarjikaKshara and Vidanga¹, each succeeding drug weighing double the one immediately preceding it in the order of enumeration. These two medicinal compounds may be employed with advantage in relieving attacks of Sula and Udavarta. 45-47.
देवदाग्निक कुष्ठं शुण्ठीं पथ्यां पलङ्कषाम् । पौष्कराणि च मूलानि तोयस्यार्धाढके पचेत् । पादावशिष्टं तत् पीतमुदावर्तं व्यपोहति ॥ ४८ ॥
The drugs known as Deva-daru, Chitraka, Kustha, Vaca (D.R.—Sunthi), Haritaki, Palamkasa (Guggulu) and Puskara-roots should be duly boiled with half an Adhaka measure (thirty-two Palas) of water and taken down from the oven with a quarter part of the original solution remaining. Draughts of this decoction would relieve an attack of Udavarta. 48.
मूलकं शुष्कमार्द्रञ्च वर्षाभूः पञ्चमूलकम् । आरेवतफलञ्चाप्सु पक्त्वा तेन घृतं पचेत् । तत् पीयमानं शास्त्युग्रमुदावर्तमशेषतः ॥ ४९ ॥
A potion of clarified butter duly cooked with the decoction of dried¹ Mulaka, Ardraka, Varsabhu, Panca-mula² and Arevata (aragvadha) fruit would cure any form of Udavarta whatsoever. 49.
वचामतिविषां कुष्ठं यवक्षारं हरीतकीम् । कृष्णां निर्दहनीञ्चापि पिबेदुष्णेन वारिणा ॥ ५० ॥ इक्ष्वाकुमूलं मदनं विशल्यातिविषे वचाम् । कुष्ठं किण्वाग्निकौ चापि पिबेत् तुल्यानि मूत्रेण देवदार्वग्नि- त्रिफलाबृहतीः पूर्ववत् ॥५१॥ पिबेत् ॥ ५२ ॥ यवप्रस्थं फलैः सार्धं कण्टकार्या जलाढके । पक्त्वार्धप्रस्थशेषन्तु पिबेद्धिङ्गुसमन्वितम् ॥ ५३॥
A compound consisting of Vaca, Ativisa, Kustha, Yava-Kshara, Haritaki, Pippali and Chitraka should also be taken with tepid water, or a compound consisting of Iksvaku-roots, Madana, Visalya, Ativisa, Vaca, Kustha, Kinva ( sediment of wine) and Agnika taken in equal parts should also be taken in the aforesaid manner. A compound of Deva – Daru, Agni, Tri-phala and Brhati, should be taken with the urine of a cow. The docoction of Kantakari-fruits and barley weighing a Prastha cooked in an Adhaka measure of water and boiled down to half a Prastha only, should be taken in combination with Hingu. 50-53.
मदनालावुबीजानि पिप्पलीं सनिदिग्धिकाम् । सञ्चूर्ण्य प्रधमेन्नाड्या विशत्येतद् यथा गुदम् ॥ ५४॥ चूर्णं निकुम्भकम्पिल्ल-श्यामेक्ष्वाकग्निकोद्भवम् । साधयेत् ॥ ५५ ॥ कृतवेधनमागध्योर्लवणानाञ्च गवां मूत्रेण ता वर्ती: कारयेत् तु गुदानुगाः । सद्यः शर्मकरावेतौ योगावमृतसम्मितौ ॥ ५६ ॥
A compound consisting of the pulverised seeds of Madana and of Alavu, Pippali and Nidigdhika should be blown into the rectum with a pipe. A Varti made of Nikumbha (Danti), Kampilla, Syama (Trivrit), Iksvaku, Agnika, (Ajamoda), Krta-Vedhana (Kosataka), Magadhi and salt pounded together, made into a paste with the addition of cow’s urine, dried and cut into a proportionate size, should be inserted into the rectum. The last two ambrosial remedies give instantaneous relief in a case of Udavarta.54-56.
1. Dalhana Takes dried (Suska) with the Mulaka and ardraka. 2. Dalhana recommends of major Panca-mula; but according to Cakrapani’s commentary, “Bhanumati”, it should be the minor Panca-mula.
इति सुश्रुत संहितायामुत्तरतन्त्रे उदावर्तप्रतिषेधव्याख्यानाम पञ्चपञ्चाशत्तमोऽध्यायः ॥ ५५ ॥
Thus ends fifty-fifth chapter of the Uttara-Tantra in the Susruta Samhita which deals with the (symptoms) and treatment of Udavarta
