त्रयस्त्रिंशोऽध्यायः । अथातो वमनविरेचनसाध्योपद्रवचिकित्सितं यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥ ।।१।। व्याख्यास्यामः,
Now we shall discourse on the treatment of the distresses which prove amenable to the use of purgatives and emetics (Vamana Virechana Sadhyopadrava). 1
दोषाः क्षीणा बृंहयितव्याः, कुपिताः प्रशमयितव्याः, वृद्धा निहर्तव्याः समाः परिपाल्या इति सिद्धान्तः । प्राधान्येन वमनविरेचने वर्तते निर्हरणे दोषाणाम्। तस्मात् तयोर्विधानमुच्यमानमुपधारय ।।२।।
The principal maxims to be followed are to augment the loss or deficiency, to pacify the aggravation and reduce the increment of the Dosas and maintain them in a state of healthy equilibrium. Emetics and purgatives are the principal remedies in cleansing the system of all the Dosas (morbific principles ). Now hear me, therefore, discourse on the mode of their administration. 2
अथातुरं स्निग्धं स्विन्नमभिष्यन्दिभिराहारैरनवबद्धदोषमवलोक्य वो वमनं पाययिताऽस्मीति सम्भोजयेत् तीक्ष्णाग्निं बलवन्तं बहुदोषं महाव्याधिपरीतं वमनसात्म्यञ्च ||३||
The body of the patient should be first anointed with a Sneha (oil, etc.) and Sveda should then be applied thereto. He should then be made to partake of meals which would produce internal secretions from the system, so that all the Dosas (morbific diathesis, etc.) accumulated in the organism would be loosened and dislodged from their seats. Thus having observed the liquefaction and dislodgement of the Dosas (morbific diathesis) from their locations, the physician should feed the patient to his satisfaction, if he be found to be sufficiently strong with a strong digestive capacity and habituated to the use of emetics, but troubled with a plethora of Dosas and subject to serious diseases (Maha-vyadhi), telling him at the same time that an emetic medicine will be given to him on the day following. 3
भवति चात्रपेशलैर्विविधैरन्नैर्दोषानुत्क्लेश्य देहिनः । स्निग्धस्विन्नाय वमनं दत्तं सम्यक् प्रवर्तते । ॥ ४ ॥
Memorable Verse: An emetic medicine does its fullest action, when given to a man after having applied a Sneha and Sveda (to him) and after having stirred up the Dosas of his body with the help of a soft mucilaginous (Kapha-producing)¹ fluid and emollient food so as to accelerate their easy expulsion from the system. 4
अथापरेद्युः पूर्वाह्ने साधारणे काल वमनद्रव्यकषायकल्कचूर्णस्नेहानामन्यतमस्य मात्रां पाययित्वा वामयेद् यथायोगं कोष्ठविशेषमवेक्ष्य असात्म्यवीभत्सदुर्गन्धदुर्दर्शनानि च वमनानि विदध्यात् । अतो विपरीतानि विरेचनानि । ॥ ५ ॥
On the next morning, when it is neither too hot nor too cold² the patient should be made to vomit with an adequate dose of an emetic in any of the following forms, viz., powder, paste, decoction, (medicated) oil or Ghrita as the case may be. Such things as have a unpalatable, repulsive form, fetid or an obnoxious smell or sight should be used for emetic purposes having regard to the characteristic nature of the patient’s stomach ( Kostha). The contrary being the rule in respect of the use of purgatives. 5
तत्र सुकुमारं कृशं बालं वृद्धं भीरुं वा वमनसाध्येषु विकारेषु क्षीरदधितक्रथवागूनामन्यतममाकण्ठं पाययेत् । पीतौषधञ्च पाणि
1. Vrnda reads “श्लैष्मलैः”in place of “पेशलै:” but they would ultimately mean almost
the same thing.
2. Dalhana says that some explain “साधारणे काले” to mean in the proper seasons. viz., the rainy season, the Autumn and the Spring.”
भिरग्नितप्तैः प्रताप्यमानं मुहूर्त्तमुपेक्षेत | तस्य च स्वेदप्रादुर्भावेण शिथिलतामापन्नं स्वेभ्य: स्थानेभ्यः प्रचलितं कुक्षिमनुसृतं जानीयात्, ततः प्रवृत्तहल्लासं ज्ञात्वा जानुमात्रासनोपविष्टमाप्तैर्ललाटे पृष्ठे पार्श्वयोः कण्ठे च पाणिभिः सुपरिगृहीतमङ्गुलीगन्धर्वहस्तोत्पलनालानामन्यतमेन कण्ठमभिस्पृशन्तं वामयेत् तावत् यावद् सम्यग्वान्तलिङ्गानीति ।।६।।
Infants, old men, weak and timid persons as well as those who are of a delicate constitution should be first made to drink their full capacity ınilk, curd, milk-curd (Takra) or a gruel (Yavagu) in diseases amenable to emetics and in such quantities that the patient feels it rising up to the throat. After the emetic has been administred, the patient should wait for one Muhurta, while the body of the patient should be (gently) fomented for a short time with the heated palms of the hands and the effect ( of the emetic) observed). The dislodgment and passing of the Dosas from their respective seats into the Kuksi (stomach ?) should be inferred from the flow of perspiration (Sveda) that would ensue. The patient should then be made to sit on a seat as high as his knees and as soon as he would feel the least tendency to vomit, the attendants should be told to catch hold of his waist, sides, back, throat and forehead. Then a finger or the stem of (a leaf of) a castor plant or of a lotus should be inserted down his throat and the patient should be made to fully eject the contents of his stomach until the symptoms of satisfactory vomiting would fully appear. 6
कफप्रसेकं हृदयाविशुद्धिं कण्डूञ्च दुश्छर्द्दितलिङ्गमाहुः । पित्तातियोगञ्च विसंज्ञताञ्च हृत्कण्ठपीडामपि चातिवान्ते ॥ ७ ॥
पित्ते कफस्यानु सुखं प्रवृत्ते शुद्धेषु हृत्कण्ठशिरःसु चापि । लघौ च देहे कफसंस्त्रवे च स्थिते सुवान्तं पुरुषं व्यवस्येत् ||८ ॥
Memorable Verses: The symptoms of an imperfect emesis are water-brash (Kaphapraseka), sticking secretion or sensation of impurity in the regions of the Hrdaya (heart) and itching sensations. An excessive discharge of the Pitta, the loss of consciousness, pains in the throat and in the region of the heart are the features which mark excessive or over-vomiting. The indications which characterise the perfect and satisfactory action of an emetic remedy are the free emission of Pitta after that of Kapha, a light and pleasing sensation in the heart, the throat and the head, a lightness of the body and the complete cessation of the emission of Kapha (mucus). 7-8
1. The milk, the curd, the milk-curd and the gruel prescribed to be taken in this case should, according to Dalhana be either medicated with emetic drugs or should be taken alone as an-after-potion.
सम्यग् वान्तञ्चैनमभिसमीक्ष्य स्नेहनविरेचनशमनानां धूमानामन्यतमं सामर्थ्यतः पाययित्वाऽऽचारिकमादिशेत् ।।९।।
Thus having observed the symptoms of a satisfactory emesis, the patient should be advised to inhale the fumes ( Dhuma) of a (burning ) drug of either the Snehana, Virecana or Samana (soothing) virtues in such doses as he could conveniently take and to observe the proper regimen of diet and conduct. 9
ततोऽपराहे शुचिशुद्धदेहमुष्णाभिरद्भिः परिषिक्तगात्रम् । कुलत्थमुद्गाढकिजाङ्गलानां यूषै रसैर्वाऽप्युपभोजयेत् तु ।।१०।। कासोपलेपस्वरभेदनिद्रा-तन्द्रास्यदौर्गन्ध्यविषोपसर्गाः कफप्रसेकग्रहणीप्रदोषा न सन्ति जन्तोर्वमतः कदाचित् ॥ ११ ॥ छिन्ने तरौ पुष्पफलप्ररोहा यथा विनाशं सहसा व्रजन्ति । तथा हृते श्लेष्मणि शोधनेन तज्जा विकाराः प्रशमं प्रयान्ति ॥ १२ ॥
Memorable Verses: Then having washed his body with tepid water and having perceived him to be in a pure state of mind and body the patient should be advised to take his evening meal with the soup of Kulattha or of Mudga or of Adhaki or with the soup of the flesh of any Jangala animal. A person treated with emetics (at regular intervals) does not suffer by cough, accumulation of Kapha in the throat, hoarseness of voice, somnolence, drowsiness, fetid smell in the mouth, evil effects of poisoning (other supervening distresses of Kapha–D.R.). water-brash and sprue syndrome (Grahani). The (accumulated) Kapha of the system having been ejected by vomiting under a course of emetic treatment the possibility of all Kaphaorigined affections are removed, just as a fallen tree soon dries up together with all its twigs, fruits and flowers. 10-12
1. The diet of the patient who has taken an emetic should be very carefully prescribed inasmuch as his digestive capacity is liable to become very weak such cases.
न वामयेत् तैमिरिकोर्ध्ववात-गुल्मोदरप्लीहक्रिमिश्रमार्त्तान् । स्थूलक्षतक्षीणकृशातिवृद्ध-मूत्रातुरान् केवलवातरोगान् ॥ १३ ॥ स्वरोपघाताध्ययनप्रसक्त दुश्छर्दिदुःकोष्ठतृडार्त्तबालान् । ॥१४॥ ऊर्ध्वात्रपित्तिक्षुधितातिरूक्ष-गर्भिण्युदावर्त्तिनिरूहितांश्च
Cases where emesis is forbidden: Emesis or the exhibition of emetics is forbidden in cases of Timira (cataract, upward traversing of the Vayu in the body (Urdhva-vata), Gulma, Udavarta, abdominal dropsy, enlargement of the spleen, worms (in the intestines), those suffering from exertion, urinary complaints, or those suffering only from Vatik disorders, as well as corpulent; thirsty, hungry, emaciated, too old persons and of infants, Ksata-ksina patients and those suffering from a loss of voice and in respect of those also who are of studious habits or are capable of being treated with a strong emetic only with the greatest difficulty. It should be never resorted to in cases of Hoemoptysis and obstinate constipation of the bowels and in the case of an enciente and after the application of a Niruha-basti. It should not be applied in an extremely dry or parched condition of the organism’. 13-14
अवम्यवमनाद् रोगाः कुच्छ्रतां यान्ति देहिनाम् । असाध्यतां वा गच्छन्ति नैते वाम्यास्ततः स्मृताः ।। १५ ।।
एतेऽप्यजीर्णव्यथिता वाम्या ये च विषातुराः । अतीव चोल्बणकफास्ते च स्युर्मधुकाम्बुना ।। १६ ।।
To induce vomiting with an emetic medicine in the (aforesaid) diseases in which it ought not to have been resorted to is likely to give an irrecoverable turn to those diseases. Emetics should not, therefore, be applied in such cases. To induce vomiting, however, with the help of the decoction of Madhuka (Yasti-madhu) is not forbidden even in these cases, if the patient be suffering from indigestion or from an extremely aggravated condition of the deranged Kapha as well as from poisoning symptoms. 15-16
1. Persons afflicted with cataract or blindness, Gulma, facial paralysis, convulsion (aksepaka). jaundice, ascites, haemorrhoids and corpulency as well as extremely old men and Ksata-ksina patients should not be treated with emetics (lit. should not be caused to vomit). –D. R.
2. Jejjata explains Madhuka to mean honey. He means to say that vomiting should be induced with honey and water.
वाम्यास्तु-विषशोषस्तन्यदोषविषममन्दाग्न्युन्मादापस्मारश्लीपदार्बुदविदारिकामेदोमेह-गरज्वरारुच्यपच्यामातीसार-हृद्रोगचित्तविभ्रमविसर्पविद्रध्यजीर्णमुखप्रसेकहल्लासश्वासकासपीनसपूतिनासकण्ठौष्ठवक्तूपाक-कर्णस्त्रावाधिजिह्वोपजिह्विकागलशुण्डिकाऽधः शोणितपित्तिनः कफस्थानजेषु विकारेष्वन्ये च कफव्याधिपरीता इति ।। १७ ।।
Cases where emesis is recommended: On the other hand, vomiting or the exhibition of an emetic is recommended in cases of poisoning, in wasting diseases ( Sosa), in the derangements of the breast-milk, in precarious or sluggish (Visama) appetite, in insanity, in Apasmara (hysteric convulsions ) , in Elephantiasis (Slipada), in Vidarika in tumours (Arbuda), in obesity. in Meha (urinary complaints), in cases of slow chemical poisoning (Gara-dosa ) in the system in fever, in aversion to food, in scropfula (Apaci), in mucous dysentery. in heart-disease, in distraction of the mind, in erysipelas, in inflammatory abscesses (Vidradhi), in indigestion, in water-brash, in nausea, in asthama, in cough, in Pinasa (catarrh), in fetid smell of the nostrils ( Puti-nasa), in inflammations of the lips, throat and mouth’ in (fetid) discharges from the ears, in Adhi-jihvika, Upa-jihvika and Galasundika (affections of the glottis and the thorax), in haemorrhage from the lower channels, in the derangements due to the bodily Kapha and in all affections of the location of Kapha². 17
विरेचनमपि स्निग्धस्विन्नाय वान्ताय च देयम् । अवान्तस्य हि सम्यग्विरिक्तस्यापि सतोऽधः स्त्रस्तः श्लेष्मा ग्रहणीं छादयति, गौरवमापादयति प्रवाहिकां वा जनयति । अथातुरं श्वो विरेचनं पाययिताऽस्मीति पूर्वाहे लघु भोजयेत्, फलाम्लमुष्णोदकञ्चैनमनुपाययेत् । अथापरेऽहनि विगतश्लेष्मधातुमातुरोपक्रमणीयादवेक्ष्यातुरमथास्मै औषधमात्रां पातुं प्रयच्छेत् ।। १८ ।।
1. Some read here “Kustha, Galaganda, Prameha and Sopha (swelling)” but as Meha is mentioned above separately it seems to us that reading is not a good one. –Ed.
2. Dalhana says that some commentators do not read this part, but they say that the necessity of applying emetics is mentioned in each particular case where required.
Mode of administering purgatives
Mode of administering purgatives: Purgatives should also be administered to a patient after the due application of Sneha (oil, etc.) and Sveda (for a second time) after the administration of an emetic. However, even if the purgation treatment is properly done but without taking emesis treatment, the Kapha oozes down to cover the Grahani region and produces heaviness (of the body) or dysentry. On the day before the administration of the purgative, the paient should be told that a purgative would be given to him on the next morning. He should at this time be provided with a light repast followed by potions of hot water and (the expressed juice of) acid fruits. On the next morning an adequate dose of the (purgative) medicine should be administered after clearly ascertaining that the patient’s body has been cleansed of all mucous (Slesma) accumulations and in the manner laid down in the Aturopakramaniya chapter (Chapter XXXV. of the Sutra-sthana). 18
Classification of Kostha
तत्र मृदुः क्रूरो मध्यम इति त्रिविधः कोष्ठो भवति । तत्र बहुपित्तो मृदुः, स दुग्धेनापि विरिच्यते । बहुवातश्लेष्मा क्रूरः, स दुर्विरेच्यः । समदोषो मध्यमः, स साधारण इति । तत्र मृदौ मात्रा मृद्वी, तीक्ष्णा क्रूरे, मध्ये मध्या कर्त्तव्येति । पीतौषधश्च तन्मनाः शय्याभ्यासे विरिच्यते ।। १९ ।।
Classification of Kostha: Kostha (bowels) may be grouped under three heads as mild or easily movable (Mrdu), middling moderately constipated (Madhya) and hard or constipated (Krura). The first kind (Mrdu) of the Kostha should be ascribed to the abundance of Pitta therein and can be moved even with milk only; the last (Krura) is ascribable to the action of an abundance of Vayu and Kapha and can be moved only with the greatest difficulty; while the second, Madhyama, should be held as the product of a condition of equilibrium among the (three) Dosas and this is the most general type. Purgatives should be adminisered in small doses to persons of lax bowels (Mrdu Kostha), in moderate doses to those of moderately constipated bowels (Madhyama Kostha), and in large doses to persons of extremely constipated bowels (Krura Kostha). After having taken a purgative the patient should think of nothing else but purging and when passing his stool he should not go far from his bed-side. 19
विरेचनं पीतवांस्तु न वेगान् धारयेद् बुधः । निवातशायी शीताम्बु न स्पृशेन्न प्रवाहयेत् ।। २० ।।
यथा च वमने प्रसेकौषधकफपित्तानिलाः क्रमेण गच्छन्ति, एवं विरेचने मूत्रपुरीषपित्तौषधकफा इति ।। २१ ।।
Metrical Texts : After taking the purgation treatment the prudent patient should at this time lie in a windless chamber, foregoing the use of cold water and exposure to cold wind, and should not repress any urging (towards stool) nor should he strain. Emission of urine, stool, Pitta, the (purgative) medicine and lastly of Kapha consecutively follow under a course of purgative, in the same manner as an emission of saliva, the ( emetic) drug, Kapha, Pitta and lastly of Vayu are consecutively ejected under the course of an emetic. 20-21
(स्याद् दुर्विरिक्ते कफपित्त कोपो दाहोऽरुचिगौखिमग्निासादः) हृत्कुक्ष्यशुद्धिः परिदाहकण्डू-विण्मूत्रसङ्गाश्च न सद्धिरिक्ते । मूर्च्छागुदभ्रंशकफातियोगाः शूलोद्गमश्चातिविरिक्तलिङ्गम् ।। २२ ।। गतेषु दोषेषु कफान्वितेषु नाभ्या लघुत्वे मनसश्च तुष्टौ । गतेऽनिले चाप्यनुलोमभावं सम्यग्विरिक्तं मनुजं व्यवस्येत् || २३ ||
Memorable Verses: If the purgation treatment is improperly done, it produces vitiation of Kapha and Pitta and patient suffers from burning sensation, aversion to food heaviness (in the body) and poor digestion. Heaviness of the Kuksi and of the heart, itching and burning sensation, and the retention of stool and urine are the symptoms which follow in the wake of a purgative medicine which has failed to satisfactorily open and cleanse the bowels. Loss of consciousness, prolapse of the anus, aggravation of the bodily Kapha and Sula colic pian in the (intestines ) result from an act of over-purging. A sense of lightness about the region of the umbilicus¹ and hilarity of the wind due to the discharge of the distempers connected with the Kapha ( mucus, stool, etc. and restoration of the bodily Vayu to its normal condition due to the discharge of the ( deranged) Vayu ( from the system) are the symptoms which mark the satisfactory action of a purgative medicine. 22-23
1. In place of “नाभ्या लघुत्वे” some read “ग्लान्धां लघुत्वे” which means lightness and lassitude’. a sense of
मन्दाग्निमक्षीणमसद्विरिक्तं न पाययेताहनि तत्र पेयाम् । क्षीणं तृषार्त्तं सुविरेचितञ्च तन्वीमशीतां लघु पाययेच ॥ २४ ॥
Diet: No liquid food of Peya should be given to the patient on the day in the event of his not being properly purged and not being feebled (with purging) and in the event of his impaired digestion (after the use of a purgative ).
A light and lukewarm Peya should, however, be given to him in small doses, whenever he would feel weak and thirsty after the proper exhibition of a purgative medicine. 24
बुद्धेः प्रसादं बलमिन्द्रियाणां धातुस्थिरत्वं बलमग्निदीप्तिम् । चिराच्च पाकं वयसः करोति विरेचनं सम्यगुपास्यमानम् ॥ २५ ॥ यथौदकानामुदकेऽपनीते चरस्थिराणां भवति प्रणाशः । पित्ते हृते त्वेवमुपद्रवाणां पित्तात्मकानां भवति प्रणाशः ॥ २६ ॥
Benefits of proper purgation : Clearness and expansion (Prasada) of the intellect, firmness of the organs and of the Dhatus (root-principles) of the body, increase of energy (Bala)’, improved digestive capacity and a late or delayed old age are the blessings which follow a proper administration of purgative remedies. The deranged Pitta of the system, having been fully removed (with the help of a purgative), precludes the possibility of the existence of any Pittaorigined complaint, just as the waters of a tank or any other reservoir of water, having been fully baled out, bar against the possibility of the existence of all aquatic animals and plants living therein. 25-26
मन्दाग्न्यतिस्नेहितबालवृद्ध-स्थूला: क्षतक्षीणभयोपतप्ताः । श्रान्तस्तृषार्त्तोऽपरिजीर्णभक्तो गर्भिण्यधो गच्छति यस्य चासक् ॥ २७ ॥ नवप्रतिश्यायमदात्ययी च नवज्वरी या च नवप्रसूता । शल्यार्दिताश्चाप्यविरेचनीयाः स्नेहादिभिर्ये त्वनुपस्कृताश्च ॥ २८ ॥ अत्यर्थपित्ताभिपरीतदेहान् विरेचयेत् तानपि मन्दमन्दम् | विरेचनैर्यान्ति विनाशमज्ञप्रयुक्तैरविरेचनीयाः ॥ २९ ॥ नरा
Persons who should not be purged: Exhibition of purgatives are prohibited in respect of persons of impaired digestion, or of those treated with an excessive application of any emulsive remedy (Sneha Karma), or of those who are exceedingly corpulent, too old, fatigued, thirsty or intoxicated, or of those suffering from any ulcer. They are similarly prohibited in respect of frightened persons and Ksata-ksina patients or of those afflicted with haemorrhage from the downward orifices of the body or of persons with any dart or foreign matter (salya) lying imbedded in the organism as well as in respect of infants and enciente. A argative medicine ould not be administered before the digestion of a meal previously taken, neither in the diseases due to an abuse of wine, nor in acute catarrh and acute fever or to a newly parturient woman and persons not previously treated with a Sneha (oil or Ghrita). A mild purgative may, however, be administered (in cases of emergency) to a person of extremely Pitta-predominant temperament. Purgatives administered by ignorant physicians to persons who ought not to be purged (often) prove fatal. 27-29
Vrnda does not include “Bala” ( energy ) in the list.
विरेच्यास्तु-ज्वरगरारुच्यर्शोऽर्व्वदोदरग्रन्थिविद्रधिपाण्डुरोगापस्मारहृद्रोगवातरक्त-भगन्दरच्छर्द्दियोनिरोग विसर्पगुल्म-पक्वाशयरुग्विबन्धविसूचिकालसकमूत्राघातकुष्ठविस्फोटकप्रमेहानाहप्लीहशोफवृद्धिशस्त्रक्षतक्षाराग्निदग्ध-दुष्टव्रणाक्षिपाककाचतिमिराभिष्यन्द शिरःकर्णाक्षिनासास्यगुदमेढ्रदाहोर्ध्व-रक्तपित्त-क्रिमिकोष्ठिनः पित्तस्थानजेष्वन्येषु च विकारेष्वन्ये च पैत्तिकव्याधिपरीता इति ।। ३० ।।
Persons who should be purged: The distempers of the body in which a purgative should be exhibited with good results are – fever, effects of slow chemical poison (retained in the system), an aversion to food. haemorrhoids, tumours (Arbuda), ascites (Udara), glandular swellings (Granthi), abscess (Vidradhi), jaundice, hysteric convulsions (Apasmara), heart-disease, Vata-rakta, vaginal or uterine diseases, fistula-in-ano, vomiting, erysipelas (Visarpa), Gulma, pain in the Pakvasaya (intestines), retention of stool, Visucika, Alasaka, strangury (Mutraghata), Skin DIseases (Kustha), Visphotaka (carbuncle, etc.), Prameha, distension of the abdomen with the suppression of stool and urine (Anaha), enlargement of the spleen, oedematous swellings (Sopha), Vruddhi (enlargement of the scrotum, etc.) and kindred complaints, ulcers inflicted by weapons, alkaline scalds and burns, malignant ulcers, (Dusta-vrana), inflammation of the eyes (Aksi-paka), Kaca, Timira, conjunctivitis (Abhisyanda), burning sensations in the head, ears, eyes, nose, mouths, anus and the penis, haemorrhage from the upper channels (Urdhva-Rakta-pitta), worms, diseases of the Pittasaya (bowels) i.e., the diseases which are similar to the seats of the Pitta in the organism as well as any other disease due to an aggravation of the Pitta. 30
सरत्वसौक्ष्म्यतैक्ष्ण्यौष्ण्य-विकाशित्वैर्विरचनम् । वमनन्तु हरेद् दोषं प्रकृत्या गतमन्यथा ॥ ३१ ॥
यात्यधो दोषमादाय पच्यमानं विरेचनम् । गुणोत्कर्षाद् व्रजत्यूर्ध्वमपक्वं वमनं पुनः | ॥३२॥
Metrical Texts : Purgatives eliminate the Dosas ( from below) due to their properties, viz. laxation, fireness strong potency, hotness and dispersibility. The emetics eliminate the Dosas (from above) due to their specific effects themselves.¹. A purgative, in the course of its digestion, carries down with it all the Dosas from the system (loosened and dislodged by virtue of its own specific (properties). An emetic, on the other hand, is not digested, owing to ( its lightness due to ) its inherent extraordinary qualities² but it soon forces its way up with the Dosas (to be) removed. 31-32
मृदुकौष्ठस्य दीप्ताग्नेरतितीक्ष्णं विरेचनम् । न सम्यङ् निर्हरेद् दोषानतिवेगप्रधावितम् (तान ) ॥ ३३ ॥
A strong purgative given to a man of loose or lax bowels (MrduKostha) or of strong digestive capacity, cannot remove all the Dosas fully owing to their being suddenly and forcibly purged off. 33
पीतं यदौषधं प्रातर्भुक्तपाकसमे क्षणे ।
पक्तिं गच्छति दोषांश्च निर्हरेत् तत् प्रशस्यते ॥ ३४ ॥
A purgative medicine, which is capable of being digested and of expelling the Dosas from the body in the time which a morning meal ordinarily takes to be digested, should be regarded as pre-eminently the best. 34
1. Dalhana quotes a different reading which means that emetic and purgative remedies produce the wished-for result, if properly administered, otherwise not.
2. The extraordinary qualities of an emetic are those of the Vayu and of the Agni.
दुर्बलस्य चलान् दोषानल्पानल्यान् पुनः पुनः । हरेत् प्रभूतानल्पांस्तु शमयेत् प्रच्युतानपि ॥ ३५ ॥ हरेद् दोषांश्चलान् पक्वान् बलिनो दुर्बलस्य च । चला ह्युपेक्षिता दोषाः क्लेशयेयुश्चिरं नरम् ॥ ३६ ।।
The (aggravated) Dosas accumulated in a large quantity in the organism of a weak patient and found to be dislodged from their seats should be gradually expelled from the system, while soothing (Samana) remedies should be used I cases of the Dosas being very slight, even if they be found to have been dislodged from their seats. The aggravated Dosas matured and spontaneously dislodged (from their seat or place of accumulation in the system) should be purged off, whether the patient be strong or weak, inasmuch as, if neglected (and not expelled from the system), they ( Dosas) tend to produce lasting troubles. 35-36
मन्दाग्निं क्रूरकोष्ठञ्च सक्षारलवणैर्घृतैः । सन्धुक्षिताग्निं स्निग्धञ्च स्विन्नञ्चैव विरेचयेत् ॥३७॥
स्निग्धस्विन्नस्य भैषज्यैर्दोषस्तूत्क्लेशितो बलात् । विलीयते न मार्गेषु स्निग्धे भाण्ड इवोदकम् ॥ ३८ ॥
चातिस्नेहपीतस्तु पिबेत् पिबेत् स्नेहविरेचनम् । दोषा: प्रचलिताः स्थानाद् भूयः श्लिष्यन्ति वर्त्मसु ॥ ३९ ॥
A purgative should be administered to a patient of impaired digestive capacity and extreme habitual constipation of the bowels (Krura-kostha) after having improved his digestion with the admixture of rock-salt, Yava-kshara and clarified butter and after applying Sneha and Sveda (as usual). A purgative remedy used after a due application of Sneha and Sveda to the body, leads to the looseness and dislodgment per force of the aggravated Dosas from their seats, since they do not adhere to the internal channels and passages just as a drop of water does not adhere to a pot or vessel saturated with a Sneha. An oleaginous purgative should not be given to persons who have already taken internally¹ an abundant quantity of Sneha, as it would tend to make the aggravated Dosas of the body dislodge from their seats and again adhere to the internal channels and passages. 37-39
1. Vrnda reads “अतिस्निग्धकायस्य” in place of “अतिस्नेहपीतस्य”. This means that the Sneha might have been used both internally and externally.
विषाभिघातपिडका-शोफपाण्डुविसर्पिणः नातिस्निग्धा विशोध्याः स्युस्तथा कुष्ठिप्रमेहिणः ॥ ४० ॥ विरुक्ष्य स्नेहसात्म्यन्तु भूयः संस्नेह्य शोधयेत् । तेन दोषा हृतास्तस्य भवन्ति बलवर्धनाः ॥ ४१ ॥
The purgation treatment should be used in cases of poisoning, trauma, pustural eruptions (Pidaka), oedema and Skin DIseases anaemia, cellutis, diseases of urinary system and those who have not been excessively oleated. The body of a patient, habituated to the use of oleaginous articles (Sneha), should be first made dry (Ruksa). Sneha should then be used again as usual and purgatives or emetics applied. The aggravated Dosas would be thereby expelled from the system and the patient would grow stronger.¹ 40-41
प्रागपीतं नरं शोध्यं पाययेतौषधं मृदु । ततो विज्ञातकोष्ठस्य कार्यं संशोधनं पुनः ॥४२॥
सुखं दृष्टफलं हृद्यमल्पमात्रं महागुणम् । व्यापत्स्वल्पात्ययञ्चापि पिबेन्नृपतिरौषधम् ॥ ४३ ॥
Mild emetics and purgatives should be given at the outset to a person to be treated with such medicines, who had never taken any purgative or emetic before. Emetics and purgatives should then again be administered to him, after thus finding out the state and nature of his Kostha (bowels). An emetic or purgative medicine of tested efficacy and which is pleasant, aromatic, agreeable and small in dose but of mighty potency should be given to a king; (in addition to these qualities) the medicine should be such as would not produce any serious injury. 42-43
स्नेहस्वेदावनभ्यस्य यस्तु संशोधनं पिबेत् । दारु शुष्कमिवानामे देहस्तस्य विशीर्यते ॥४४॥ ॥
स्नेहस्वेदप्रचलिता रसैः स्निग्धैरुदीरिताः । दोषाः कोष्ठगता जन्तोः सुखा हर्त्तुं विशोधनैः ॥ ४५ ॥
1. Vrnda reads “स्नेहबन्धना” in place of “बलवर्धना”. This means that the Dosas, so long obstructed by Sneha, are thereby expelled.
The body (health) of a patient to whom a purgative or emetic medicine is administered without first applying Sneha and Sveda thereto breaks up like a piece of sapless wood at the time of bending it. The aggravated Dosas dislodged from their seats in the organism through the effects of Sneha and Sveda and stirred by emollient food¹ are easily expelled by emetics and purgatives. 44-45
इति सुश्रुत संहितायां चिकित्सास्थाने वमनविरेचनसाध्योपद्रवचिकित्सितं नाम त्रयस्त्रिंशोऽध्यायः ।। ३३ ।।
Thus ends the Thirty-third Chapter of the Chikitsa Sthana in the Susruta Samhita which deals with the treatment of diseases amenable to the use of emetics and purgatives.