We will now expound the chapter named Vamana Virechana Vidhi-procedure of emesis and purgation therapies; thus said atreya and other great sages.
अथातो वमनविरेचनविधिं नामाध्यायं व्याख्यास्यामः । इति हस्माहुरात्रेयादयो महर्षयः ॥१॥
Vamana and Virechana Nirukti – definition of vamana and virechana karma
दोषहरणमूर्ध्वभागं वमनाख्यमधोभागं विरेचनाख्यमुभयं वा मलविरेचनाद्विरेचनामित्युच्यते ॥२॥
That which removes the doshas from the upper parts of the body is called Vamana (emesis) and from the lower parts is called ‘Virechana’ (purgation); both are also called as Virechana because expel the malas (doshas) out of the body. (2)
Ausadha gunakarma – properties and actions of drugs
तत्रोष्णतीक्ष्णसूक्ष्मव्यवायिविकाषीण्यौषधानि स्ववीर्येण हृदयमुपेत्य सौक्ष्म्यात् व्यवयित्वाच्च धमनीरनुसृत्य स्नेहेन मृदूकृतेऽन्तश्शरीरे स्वेदोष्मणार्द्रदारुवद्विष्यण्णे स्थूलाणुस्त्रोतोभ्यः सकलमपि दोषसङ्घातमौष्ण्यात् पुनर्विष्यन्दयन्ति । तैक्ष्ण्याद्विकाषित्वच्च विच्छिन्दयन्ति । स विष्यण्णविच्छिन्नो दोषसङ्घातः पारिप्लवः स्नेहाक्तभाजनस्थ इवोदकाञ्जलिरसज्जन्ननुप्रसरण भावादामाशयमनुगम्य उदानप्रणुन्नः अग्निवाय्वात्मकत्वात् ऊर्ध्वभागप्रभावाच्चौषधस्योर्ध्वं प्रवर्तते । सलिलपृथिव्यात्मकत्वादधोभागप्रभावाच्च औषधस्याधः । उभयतश्चोभयगुणात्मक त्वादुभयभागप्रभावाच्च ॥३॥
Drugs which possess the properties such usna (hotpotency), tiksna (penetrating), suksma (passing through minute pores) vyavayi (spreading quickly all over the body) and vikasi (spreading quickly all over the body and causing loosening of the joints and debility), acting by their own power,
Reach the heart by their suksma and vyavayi properties spread all over the body through the dhamanis (blood vessels), break up the hard masses of the doshas, which have been made soft by the lubricating therapy, liquified by the heat of the sudation therapy but sticking on in all the small and big pores inside; cut off their adhesions by their penetrating and loosening action. The doshas which are thus, liquified and loosened from their places slowly move out, drop by drop, without adhering any where, just as water moves inside a pot smeared with oil and collect inside the Amasaya (stomach and small intestines). Helped by the action of Udana vata the drugs which are predominantly of Agni and Vayu bhutas when administered will bring out all the doshas collected in the stomach in the upward movement. Drugs which are predominantly of AP and Prthvi bhutas by their nature of moving downwards, bring out the doshas in the downward diection. Drugs which possess the property of moving in both directions will cause expulsion of doshas from both directions. (3)
तत्रोत्कृष्टे श्लेष्मणि पित्तसंसृष्टे वा तत्स्थानगते वा पित्ते अनिले वा श्लेष्मोत्तरे च वमनमाचरेत् । पित्ते तु विरेकं श्लेष्मसंसृष्टे वा तत्स्थानगते वा श्लेष्मणीति ॥४॥
Vamana (emesis) is to be administered in conditions where kapha has undergone increase either alone predominantly or in the association of pitta, or when pitta and vata have got localised in the seats of kapha or when all the doshas have undergone increase with predominance of kapha.
Virechana (purgation) is to be administered when pitta has undergone increase alone or in association with kapha or when kapha has got localised in the seat of pitta or when pitta has got localised abundantly in the seats of kapha. (4)
Vamanasadhya rogah – diseases curable by emesis
तत्र वमनसाध्या विषपीतदष्टदिग्धविद्धविरुद्धाजीर्णान्ननवज्वरराजयक्ष्मातीसाराधोरक्तपित्तवि षूचिकालसकाविपाकारोचकापचिग्रन्थ्यर्बुदश्लीपदमेदोगदगरोन्मादापस्मारश्वासकासहृल्लस वीसर्पप्रमेहकुष्ठपाण्डुवर्त्ममुखघ्राणकपालरोगकर्णरोधशोफस्तन्यदोषादयो दोषभेदीयोक्तश्च श्लेष्मव्याधयो विशेषेण । ऐत हि परं वमनेन नाशमुपयान्ति सलिलापगमनेनानिष्पन्नशाल्यादि वत् ॥५॥
The following diseases will be effectively cured by the administration of Vamana (emesis ) therapy;
Diseases caused by ingestion of poision, biting of poisonous animals, smearing or contact of poisons and injury by poisonous weapons; ingestion of incompatable and uncooked foods; nascent fevers, pulmonary tuberculosis, diarrhoeas, haemorrhagic disease with downward trend(Adhoga Raktapitta), visucika (vomiting and diarrhoea together) stasis of food inside the alimentary tract without digestion for a long time, indigestion, loss of appetite, scrofula, tumor, malignant tumor (cancer), filariasis, obesity, homicidal poisoning, insanity, epilepsy, dyspnoea, cough, nausea, visarga (herpes), diabetes, leprosy and other skin diseases, anaemia, diseases of the eyelids, face (mouth), nose and scalp; blocking of the ears and swelling, disorders of the breastmilk and also the other diseases of kapha origin enumerated in the chapter of Doshabhediya (Chapter 20 ). Just as the tender seedlings of rice etc., get destroyed by draining out all the water from the plot, so also these diseases will be rooted out completely by Vamana therapy. (5)
Avamyah – persons unsuited for emesis
अवाम्यास्तु गर्भिणीसुकुमारान्यकार्यव्यग्ररूक्षरूक्षाशनप्रायातिदीप्ताग्रिभाराध्वकर्मनित्यक्ला न्तक्षतक्षीणातिस्थूलकृशवृद्धबालदुर्बलश्रमभयशोकक्रोधमदमूर्छाक्षुत्पिपासार्त्तोपवासव्यवाय व्यायामाध्ययनचिन्ताप्रसक्तच्छर्दिरूर्ध्वरक्तपित्तवातास्थापितानुवासित संवृतकोष्ठदुश्छर्दितह द्रोगोदावर्तमूत्राघातगुल्मप्लीहोदराष्ठीलार्शः स्वरोपघाततिमिरभ्रमानिलार्तर्दिताक्षेपकाक्षिशि रःशङ्खकर्णपार्श्वशूलिनोऽनास्थापितकृमिणकोष्ठ इति । अन्यत्रामगरविषविरुद्धाभ्यवहारेभ्यः शीघ्रकारित्वादेषाम् । तत्र गर्भिण्या गर्भव्यापदामगर्भभ्रंशाच्च दारुणरोगप्राप्तिः स्यात् । सुकुमारस्य हृदयविकर्षणादूर्ध्वमधो वा रुधिरप्रवृत्तिः । अन्यकार्यव्यग्रस्यौषधं न प्रवर्तते । कृच्छ्रेण वा प्रवर्तमानमयोगदोषान् कुर्यात् । रूक्षस्य वायुरङ्गग्रहणम् । रूक्षाशनप्रायस्य वायुना क्षपितदेहत्वाद् बलक्षयः स्यात् । तथातिदीप्तग्नेरग्निबलेन भाराध्वकर्मनित्ययानक्लान्तानां चायासेन क्षतस्य भूयः क्षणनाद्रक्तातिप्रवृत्तिः । क्षीणादीनामौषधबलाक्षमत्वाद्देहबलोपरोधो ऽन्तःक्षतभयं च । प्रसक्तच्छछूंर्ध्वरक्तपित्तयोरुदान उत्क्षिप्य प्राणान् हरेद्रक्तं चातिप्रवर्तयेत् । ऊर्ध्ववातास्थापितानुवासितानामूर्ध्वं वातातिप्रवृत्तिः । संबृतकोष्ठस्य दुश्छर्दितस्य वातिमात्र प्रवाहणादन्तः कोष्ठसमुत्क्लिष्टैदोषौर्विसर्पस्तम्भजाड्यवैचित्यानि मरणं वा । हृद्रोगिणो हृदयोपरोधः । उदावर्तादिभिरार्तानामर्दितादिभिश्च यथायथमामयप्रवृद्धिर्मरणं वा । कृमिणकोष्ठस्थास्थापनेनाधः पूर्वमनिर्हतैः कृमिभिरतिबहुत्वा हृदयमतिकर्षद्भिश्छर्दिषोऽतिप्रवृत्तिः स्यात् ॥६॥
The following persons should not be administered vamana therapy; the pregnant lady, those of tender constitution, those engrossed in other kinds of work, who are dry, who eat dry foods, habitually, whose digestive capacity is very powerful, who are fatigued by lifting heavy weights, walking long distances daily; who are debilitated by wounds, who are very obese, very emaciated; the aged, children, the weak, who are afflicted with exhaustion, fear, grief, anger, toxicity, fainting, hunger, thirst; who are (greatly) indulging in fasting, coitus, exercises, study and thinking; in diseases such as vomitting, haemorrhagic disease with upward trend(Urdhwaga Raktapitta), diseases of vata origin, those who have been administered decoction and oil enemas, who have an obstructed alimentary tract, who have been vomiting badly by improper administration of emesis therapy, who have diseases of the heart, upward movement (reverse peristalisis), suppression of urine, abdominal tumor, enlargement of spleen, abdomen and prostate gland; haemorrhoids, loss of voice, blindness, giddiness, headache due to increased vata, facial paralysis, convulsions; pain in the eyes, head, temples, ears and flanks; who have not been administered decoction enema and who have parasites inside their intestines.
It can be given even in the above said conditions if the persons are having accumulation of Ama (undigested material), or homicidal poison or incompitable foods inside their alimentary tract as these are capable of causing immediate effect (death).
Administration of emesis to a pregnant woman will produce disorders of pregnancy, abortion and occurrence of severe diseases; in a person of tender constitution it may cause bleeding through upper and lower channels due to constriction of the heart; medicines administered to persons who are engrossed in other works do not act, or act with difficulty producing inadequate effect;
in a person who is dry, emesis produces catching pain in the parts of the body by increasing vata; in persons who are habituated to dry foods it causes loss of strength because their body will have been made weak by vata. Emesis causes heavy bleeding in persons who have very powerful digestive capacity by the heat of digestion, in persons who indulge daily in lifting weights, long walking or riding, by the fatigue of such exertion; in persons who are injured, by exacerbation of the wound.
In persons who are emaciated and others of that nature, there is risk of debility of the body and occurence of internal injury because of their inability to withstand the strength of the drugs administered. In cases of continuous vomiting and bleeding from upward channels, udana becoming very powerful produces death by severe haemorrhage.
In persons who have upward movement inside, in those who have been administered decoction and oil enemas, emesis therapy will cause excessive upward movement of vata; in those who have obstruction in their alimentary tract and in those who have been administered emesis therapy improperly causing poor vomiting, and consequent profound straining to vomit, the drugs administered will only excite the doshas accumulated in the alimentay tract leading to visarpa, (herpes), stiffness of the body, loss of movement, abnormal mental symptoms or even death. Emesis to a patient of heart disease will cause stopping of its functions.
To those suffering from upward movement of vata and those suffering from facial paralysis and other diseases, emesis will make for increase in the severity of their diseases or even death. In those who are having worms in their alimentary tract and who have not been administered decoction enema earlier, or the large number of worms blocking the passage, and consequent nonmovement of the bowels, emetic drugs cause constriction of the heart and produce excess vomittings. (6)
गर्भिण्यादिचिन्ताप्रसक्तान्ताश्चात्र धूमान्तैः प्रायः सर्वकर्मभिर्वक्ष्यमाणः परिहर्तव्याः । अजीर्णी तु सर्वैरेव च वमनवर्जेरामदोषभयात् । नवज्वरस्य दोषस्तम्भभयादिति ॥७॥
Among the persons enumerated above, those commencing from “the pregnant lady” and ending with “person engaged in thinking” are excluded from all therapies ending with Dhuma to be enumerated further on. Those suffering from indigestion are to be excluded from all other therapies except emesis, because of the fear of Amadosha, and so also in fevers of recent origin, due to the fear of stasis of the doshas inside. (7)
Notes: The therapies ending with Dhuma include emesis, purgation, decoction enema, oil-enema, purgations to the head and inhalation of smoke. In cases of indigestion and recent fevers only emesis can be given but not others.
Virechana sadhya rogah – diseases curable by purgation
अथ विरेचनसाध्या जीर्णज्वरोर्ध्वरक्तपित्तगुल्मविद्रधिप्लीहार्शोभगन्दरोदरकृमणकोष्ठ तरेतोयोनिदोषवातशोणितहलीमकव्यङ्गतिमिरकाचाभिंष्यन्दाक्षिपाकक्षाराग्निदग्धदुष्टव्रणशिर: पक्काशयशूलोदावर्तविबन्धच्छर्दिविस्फोटादयो वाम्योक्ताश्च विषूचिकादयो दोषभेदीयोक्ताश्च पित्तव्याधयः । विशेषेणैते हि परं विरेचनेन नाशमुपयान्त्यग्न्यपनयनेनाग्निगृहतापवत् ॥ ८ ॥
The following diseases will be cured better with administration of Virechana (purgation) therapy.
Protracted fevers, heamorrhagic disease of upward bouts (Urdhwaga Raktapitta), abdominal tumors, abscesses, disease of spleen, haemorrhoids, fistula-in-ano, enlargement of the abdomen(Udara), intestinal worms, suppression of urine, disorders of semen and vaginal tract, gout, halimaka (chlorosis), black discoloured patches on the face, blindness, disorder of the lens, conjunctivities, ulcerations of the eye, burn caused by alkalies and fire, foul ulcers, headache, pain in the colon, upward movement of vata, (reverse peristalsis), constipation, vomitting, small pox etc., the diseases enumerated under indications of emesis therapy commencing from Visucika, and also the diseases of pitta origin mentioned in Doshabhediya (chapter 20). All these diseases get cured especially by purgation therapy quickly just as the heat inside the kitchen becomes reduced after the removal of fire from it. (8)
Avirechyah – persons unsuited for purgation – Virechana Ayogya
अविरेच्याः पुनर्नवज्वरातिसार्यधोरक्तपित्तक्षत गुदलङ्घितरात्रिजागरितास्थापिताल्याग्निराज यक्ष्ममदात्ययार्ताध्मातसशल्याभिहतातिस्निग्धरूक्षक्रूरकोष्ठाः । तत्र नवज्वरस्याविपक्वान् दोषान्न निर्हरेत् । वातमेव च कोपयेत् । अतीसार्यधोरक्तपित्तयोरतिप्रवृत्त्या हन्यात् । क्षतगुदस्य गुदे प्राणोपरोधकरीं रुजां जनयेत् । लङ्घितादयो भेषजवेगं न सहेरन् । राजयक्ष्मार्तस्य क्षीणधातुतया मलबलत्त्वम् । तदभावाद्देहनाशः स्यात् । मदात्ययार्तस्य मद्यक्षीणे देहे वायुः प्राणोपरोधाय । आध्मातस्य पुरीषाशये निचितो वायुर्विसर्पन् सहसा तीव्रतरमाध्मानं मरणं वा
Vamana Vidhi – Procedure of Vamana Karma
any one of the liquids, such as milk, buttermilk, soup of corn or meat, wine, sour gruel prepared with bran, thin or thick gruel of rice etc., suitable to the dosha concerned, should be given to drink up to the brim of his throat (Akanthapana) (full capacity of drinking).
Then after the drug to produce vomiting, selected in accordance with the disease, dosha, dusyas etc., should be given to him, made warm and mixed with honey and saindhava (salt) at an auspicious stellar constellation, day, time movement etc., and which has been fortified earlier with the blessings of the brahmanas and by the physician again at the time of administration, with the following benedictions, recited by the physician, facing north and the patient hearing it facing east.
“Let the Lords Brahma, Daksa, Aswins, Rudra, Indra; earth, moon, sun, air, the sages, commity of herbs and living beings protect us.
Let this medicine be unto you, just as the elixirs are unto the sages, nectar unto the gods, and sudha unto the nagas. 2
Salutations to Bhagawan Bhaisajyaguru, (preceptor of medical science), the vaiduryaprabharaja, the Tathagata, the Arhata, the Samyaksambuddha (all these are Buddhist deities).
Bhaisajye, Bhaisejye, Maha Bhasaijye Bhaisajyasamudgate Swaha (salutations to
medicine the world of medicinal herbs and the science of medicine). (13)
ततः पीतवानूरुन्यस्तभुजो वमनानुगतमानसोग्निततैः पाणिभिरुपतप्यमानो मुहूर्तमनुपाल येत् । स यदा जानीयात् स्वेदप्रादुर्भावेन दोषं प्रविलयमानं, रोमहर्षेण च स्थानेभ्यः प्रविचलितं, कुक्ष्याध्मानेन चकुक्षिमनुसृतं चक्रमात् हृदयोपमर्दहृल्लासास्यसंस्त्रवणैश्चोर्ध्वमभि मुखीभूतम् । अथ समुपस्थितानेकप्रतिग्राहः पार्श्वललाटोपग्रहणेनाभिप्रपीडने पृष्ठप्रतिलोमोन्मर्दने च प्रवृत्ताव्यपत्रपणीयपुरुषो विवृतोष्ठतालुकण्ठो नातिमहता व्यायामेन वेगानुदीरयन् नाप्रवृत्तान्न प्रवर्तयन् प्रवृत्तांश्चानुप्रर्वर्तयन् सुपरिलिखितनखाभ्यामङ्गुलीभ्यामुत्पलकुमुदै – रण्डनालैर्वा कण्ठमभिमृशन् वमेत् । नात्युन्नतो नात्ववनतो न पार्श्वापवृत्तो वा । तत्रात्युन्नतस्य पृष्ठहृदयपीडा भवति । अत्यवनतस्य शिरः कोष्ठपीडा । पार्श्वापवृत्तस्य पार्श्वकोष्ठहृदयोर्ध्वजत्रु पीडेति ॥१४॥
The patient after taking the medicine should bend forward slightly, keeping his elbows on his thighs, anticipating in mind the starting of vomiting; his upper parts of the body should be kept warm by repeated touch of the hand, warmed on fire. The onset of sweating indicates the liquification of the doshas, horripilations indicate movement of the doshas from the places of lodging, enlargement of abdomen suggests the arrival of the doshas to the alimentary tract, oppression in the region of the heart, (nausea) and salivation in the mouth indicate the commencement of the upward movement; Then several vessels to receive the vomited materials should be kept ready nearby. Several attendents who are standing nearby should hold the flanks and forehead firmly, give mild massage in the upward direction over the umbilical region and back and instil courage.
The patient should keep open his lips, palate and throat, do mild exercises to intiate the bouts, not forcing the urges which have not yet started but helping the urges which have started, mildly by inducing them, by tickling the throat with either the fingers whose nails have been cut close, or stalks of lotus, lily or castor plant.
When the vomiting has commenced, the patient should not bring it out either from a great height, or from very low height or from the sides. Bringing out from great height (patient sitting erect without even slight bending) produces pain in the back and the region of the heart, bringing out from very low height (patient bending down too much) will cause pain in the head and abdomen; bringing out from the sides, causes pain in the flanks, adbomen, region of the heart and parts above the shoulders. (14)
एवं कटुतीक्ष्णोष्णैः कफे छर्दयेत् । स्वादुभिः पित्तयुक्ते । अम्लैः सस्नेहैरनिलसंसृष्टे ।
यावत् कफच्छेदः केवलमौषधप्रवृत्तिः पित्तदर्शनं वा ॥१५॥
हीनवेगस्तु पिप्पल्यामलकसर्षपकल्कलवणोष्णोदकैः पुनः पुनः प्रवर्तयेत् । प्रभूतवमनासहि ष्णुर्व्यहं त्र्यहं वा विश्रम्य । असात्म्यबीभत्सदुर्दर्शदुर्गन्धानि वमनानि विदध्यात् । विपरीतानि तु विरेचनानि । सर्वेषु च वमनेषु सैन्धवं मधु च विदध्यात्कफविलयनविच्छेदनार्थम् । वेगांश्चास्य प्रतिग्राहगतानवेक्षेत ॥ १६ ॥
In case of increase of only kapha, the drugs should be those possessing pungent taste, penetrating and hot in potency; if kapha is mixed with pitta, with those having sweet taste; if associated with vata, with those having sour taste and unctous property.
Bouts of vomitting should be allowed to continue either till the kapha is expelled out or the medicine administered comes out or till pitta (bile) comes out.
If the vomitting is inadequate the bouts should be induced, often by drinking warm water containing the paste of pippali, amalaka, sarsapa and salt.
may If the person is incapable of tolerating more vomitting in one day, he given the threapy with period of rest of two or three days.
During bouts of vomiting, the patient should be served with unaccustomed, horrifying, ugly and foul smelling things; but during bouts of purgations he should be served with those of qualities opposite of these.
Always, saindhava salt and honey should be mixed along with the emetic drug for the purpose of liquification and scraping out the kapha respectively.
The quantity of vomitted material collected in the receiving vessel each time as well as vegas (bouts/number of vomittings) should be noted. (15-16)
तत्राप्रवृत्तिः केवलस्य वा भेषजस्य प्रवृत्तिर्विबन्धो वा वेगानामयोगलक्षणम् । ततश्चारोचकगौर वाध्मानकण्डूस्फोटकोठालस्यशूलप्रतिश्यायलोमहर्षप्रसेकशोफशीतज्ववरादयः ॥१७॥
Absence of vomitting, expulsion of only the medicine and obstruction to each bout, are the features of ayoga (inadequate therapy). This is generally followed by either loss of appetite, feeling of heavyness of the body, distention of abdomen, itching, blebs, rashes, lassitude, pain in the abdomen, running in the nose, horripilations, copious salivation, dropsy, fever with chills etc. (17)
योगलक्षणं पुनः काले क्रमात् कफपित्तानिलप्रवृत्तिर्नातिमहती व्यथा स्वयं चावस्थानं ततश्च स्वस्थता मः प्रसाद स्वरविशुद्धिररोचकादिवैपरीत्यं च ॥१८॥
Features of samyagyoga (adequate therapy) are expulsion of kapha, pitta and vata in succeeding order at the propertime; quantity of vomitted material not being very large, coming out without much discomfort, bouts coming up and also subsiding of their own accord (without inducement), clearness of the mind, purity of the voice and absence of symptoms like loss of appetite etc. (18)
अतियोगे तु फेनिलरक्तचन्द्रिकोद्गमनम् । ततश्च क्षामतास्वरक्षयदाहकण्ठशोषभ्रममोहोन्मादमू र्च्छाशिरः शून्यताहृद्धूमायनगात्रशूलसुप्तितृष्णोर्ध्वानिलप्रकोपकर्णशूलार्द्दितवाक्सङ्ग्रहनुसंह ननजिह्वाप्रवेशनिर्गमाक्षिव्यावृत्तिविसंज्ञतानिद्राबलग्ग्रिहानयो भवन्ति । जीवशोणितप्रवृत्त्या मरणं वा । एषां सिद्धिषु साधनं वक्ष्यते ॥१९॥
In case of atiyoga (excess therapy) there will be expulsion of material containing forth, reddish and bright glistening particles. Next follow, one or more of symptoms such as emaciation, feeble voice, burning sensation, dryness of the throat, giddiness, delusion, insanity, fainting, feeling of emptiness inside the head, feeling of movement of hot smoke in the heart (region), aches all over the body, loss of tactile sensation, thirst, increase of upward movement of vata, earache, facial paralysis, loss of speech, lack-jaw, tongue drawn back and not able to come out, loss of movement of the eyes, unconsciousness, sleep, loss of strength and digestive activity, or even death may follow with heavy discharge of life sustaining blood. The methods of treatment of these symptoms will be described later in Siddhisthana. (19)
योगेन तु खल्वेनं छर्दितवन्तं सुविशोधितपाणिपादमुखं मुहूर्तमाश्वस्य धूमत्रयस्यान्यतमं सामर्थ्यतः पाययित्वा पुनरुपस्पृष्टोदकं सम्मानितसुरभिताम्बूलं निवातागारशय्यास्थितं स्नेहोक्तनाचारविधिनानुशिष्यात् ॥ २०॥
The person who has had Vamama (bouts of emesis) adequately should wash his hands, feet and mouth clean, take comfortable rest for about a muhurta (half an hour) next he should take one of the three kinds of inhalation of smoke according to his capacity, wash once again with water, chew sweet smelling betel leaves (with betel nut and other adjuvants), and sleep on a cot inside a room devoid of heavy breeze and follow all the regimen described under sneha (oleation) therapy. ( 20 )
Samsarjana Krama – regimen of liquid diet
ततोग्निबलमवेक्ष्य क्षुधं च सायाह्ने अपरे वाह्नि सुखोदकपरिषिक्तः पुराणानां रक्तशालितण्डु लानां सुसिद्धमन्नमस्त्रेहलवणकटुकमल्पस्नेहलवणकटकं वा द्रवप्रायमुष्णोदकानुप्रायं सायं प्रातरुपभुञ्जानो विधिमिममवेक्षेत पेयादीनाम् ॥२१॥
पेयां विलेपीमकृत कृतं च यूषं रसं त्रीनुभयं तथैकम् । क्रमेण सेवेत नरोऽन्नकालान् प्रधानमध्यावरशुद्धिशुद्धः ॥ २२ ॥
यथाणुरग्निस्तृणगोमयाद्यैः सन्धुक्ष्यमाणो भवति क्रमेण । महान् स्थिरः सर्वपचस्तथैव शुद्धस्य पेयादिभिरन्तराग्निः ॥२३॥
Then, taking note of his digestive capacity and appearance of hunger, either in the evening of the same day or the next day, he should take bath in comfortable warm water and take food prepared from old red rice boiled well, without mixing it with ghee, salt and pungents or mixed with very little quantities of these liquid in consistence, followed by drinking of warm water both in the afternoons and mornings. He should also adhere strictly to the following regimen of taking liquid foods;
Peya, vilepi, akrta yusa, krtayusa and rasa – should be used in that order for both the two meals, for three days and for one meal for one day, by the persons who have had maximum, medium (moderate) and minimum (poor) purificatory therapies (emesis, purgation and enema) respectively.
Notes: Peya is a thin gruel, vilepi is a thick gruel, akrta yusa is soup without addition of oil, salt and spices, krtayusa is soup processed with spices, salt and oil, rasa is meatsoup-each one, not so quickly digestible, in their successive order. So it is advised to take the most quickly digestible one in the beginning and then the next one in that order. Indu, the commentator explains the schedule of diet in the following manner :
Each day has two time of meals, viz., afternoon and night. On the day of emesis or purgation, the patient can have only one meal in the night. Peya (thin gruel) can be taken once in the night on the day of therapy and both the times on the next day making a total of three times in one and half days. Similarly for vilepi, akrta yusa, krtayusa and rasa – each one for one and half days, making up eight days in total for this schedule, for the person who had maximum therapy; for the person who had medium (moderate) therapy, each item should be for two times only making up five and half days and for the persons who had minimum therapy each item, shall be for one time only making up three days. The regimen of liquid food is known as samsarjana krama also.
Just as a small spark of fire, being fed gradually with hay, dry cowdung cakes etc., assumes a huge shape, becomes steady and capable of burning away any thing, so also the digestive fire of the person who has undergone purificatory therapies, being gradually built up by the schedule of peya and others (items of food). (23)
जघन्यमध्यप्रवरे तु वेगाश्चत्वार इष्टा वमने षडष्टौ । दशैव ते द्वित्रिगुणा विरेके प्रस्थस्तथास्याद् द्विचतुर्गुणश्च ॥ २४ ॥
Four, six and eight vegas (bouts) are desirable respectively for minimum, moderate and maximum Vamana (emesis) therapy; ten, twice of it, (twenty) and and thrice of it (thirty) are desirable respectively for the minimum, moderate and maximum Verecana (purgation) therapy; in terms of quantity, it is one, two and four prasthas respectively of the discharged material for purgation therapy. (24)
पित्तावसानं वमनं विरेकादर्द्धं कफान्तं च विरेकमाहुः । द्वित्रान् सविट्कानपनीय वेगान् मेयं विरेके वमने तु पीतम् ॥ २५ ॥
Some other authorities opine that Vamana (emesis) therapy is be counted till pitta is expelled out or it is to be half of Virechana (purgaion) therapy. Virechana (purgation) therapy should be counted till the expulsion of kapha. In terms of quantity of the materials expelled, the quantity of the first two or three bouts coming out with the faecal matter should be discrarded (and only the quantity of further bouts measured) in case of Virechana (purgation) therapy, whereas in case of vamana (emesis), the quantity of the fluid ingested should be discarded (form the total quantity of the vomitted material). (25)
Notes: From the above, it becomes clear that three methods, were in vogue to determine the three degrees of these therapies, Viz. (1) by observing the expulsion of pitta and kapha (2) by counting the number of bouts and (3) by measuring the expelled material. It was for the physician to decide, the continuance or otherwise of the therapy by relying on one or more of the above criterea.
Virechana vidhi – Procedure of purgation therapy
अथ वमितवन्तं पुनरेवं स्नेहस्वेदाभ्यामुपपाद्य श्वोविरेचयितव्य इति सुजरमश्लेष्मलं स्त्रिग्धं
फलाम्लमुष्णमुष्णौदकानुपानं जाङ्गलरसौदनं भोजयेत् । ततः सुखोषितं पूर्वोक्तेन विधिनातीते श्लेष्मकाले
निरन्नं विभज्य कोष्ठं यथार्हौषधमात्रां पाययेत् । न त्वकृतवमनमन्यत्रातिकुरकोष्ठात् ॥ २६ ॥
Further, planning for the administration of Virechana(purgation) therapy; the physician should ensure that the patient has undergone emesis therapy, and next, the lubrication and sudation therapies also. The day previous to purgation, he should be given sufficient quantity of soup of animals living in desert-like land, added with ghee and juice of fruits which are sour; it ( soup) should not be of the nature of increaseing the kapha, should undergo easy digestion, should be warm and followed by drinking of warm water.
Next day when he happily gets up from sleep and after attending to all the regimen described earlier (during the time of administration of vamana therapy), after the time of kapha predominance has passed off, the patient being in empty stomach, he should be given the dose of the purgative recipe, which has been decided as appropriate to the nature of his bowels (movement). Except for those having hard bowels (movement), purgative therapy should not be administered to any one without giving him emesis therapy earlier. (26)
अकृतवमनस्य हि श्लेष्मणोपहतमौषधमूर्ध्वं प्रवर्तते । उरसि वावरुद्धमवतिष्ठते । ततो नालं विरेकाय । सम्यग्विरिक्तस्यापि चाधः स्त्रस्तः श्लेष्मा ग्रहणीं छादयित्वा गौरवमापादयति । प्रवाहिकां वा । न त्वेष दोषोऽतिक्रूरकोष्ठस्य वाय्वात्मकत्वात् ॥२७॥
The purgative drug given to a person who has not undergone emesis therapy earlier, will get obstructed by the kapha and comes out in upward direction or stays in the chest itself, and so unable to produce purgation; in a person who had satisfactory purgations (therapy) the kapha which has been pulled downwards will invade the grahani (duodenum) producing heavyness or tenesmus. These troubles will not occur in the person who has hard bowels (movements) because of predominance of vata within. (27)
श्लेष्मकाले त्वकृतवमनोक्तदोषाः शूलाध्मानगौरवाणि वा कृत्वा छर्दिक्षीणे श्लेष्मण्यपराह्णे रात्रौ वा विरेचयेत् । तेनान्नावृतमपि तुल्यम् । छर्दिं च पुनस्तज्जनयति । अविरिक्तस्य तु श्लेष्मकाले च वमनं निरन्नं योज्यम् । तथोर्ध्वं सुखेन निर्हरणात् ॥ २८ ॥
If the purgative drug is administered during the time of predominance of kapha, the symptoms described above, along with colic, flatulence and heavyness of the abdomen will appear or the kapha which has decreased due to emesis will make the purgations to occur either in the afternoon or night. The condition will be the same even when it (purgative drug) is obstructed by the food, it will only produce vomiting. The emetic drug should be administered during the time of predominance of kapha to the person who has not undergone purgative therapy and who is in empty stomach, this will expel the contents easily in the upward direction. (28)
Trividha Kostha – three types of bowels
कोष्ठस्तु त्रिविधो भवति । मृदुः क्रूरो मध्यमश्च । तत्र बहुपित्तो मृदुः । स विरिच्यते क्षीरेक्षुरसाम्लतक्रमस्तुगुडकृसरसर्पिर्नवमद्योष्णोदकपीलुद्राक्षापूगफलादिभिरपि । बहुवातः क्रूरः । स दुर्विरेच्यस्त्रिफलातिल्वकत्रिवृन्नीलिनीफलादिभिरपि । बहुश्लेष्मासमदोषश्च मध्यः स साधारणः । ते च स्त्रिह्यन्त्यच्छपानेन प्रायशः त्रिसप्तपञ्चरात्रैरिति ॥२९॥
a Kostha (alimentary tract- vis a vis – movements of the bowels) is of three kinds – Mrdu (soft), Krura (hard) and madhya (medium). That which has the predominance of pitta is soft, it give, purgation even with milk, sugarcane juice, sour buttermilk, whey, pudding sweatened with mollasses; ghee, fresh wine, warm water, fruits of pilu, draksa, pugaphala etc. That which has the predominance of vata is hard, it gives purgation with difficulty even with triphala, tilwaka, trvrt, fruits of nilini and such others. That which has the predominance of kapha or that which has all the doshas in equal proportion is moderate (medium).
These three types, get lubricated satisfactorily by acchapana (fat drinking) in three, seven and five days respectively. (29)
तत्र कषायमधुरद्रव्यैः पित्ते विरेचनम् । मूत्रकटूष्णैः कफे। स्त्रिग्धोष्णलवणैर्वाते । पीतमात्र एव चौषधे छर्दिविघाताय शीताम्बुना मुखमस्य सहसा सिञ्चेत् । ततश्चोष्णोदकेन सोऽन्तर्मुखं विशोध्यार्द्रसुरभिमृन्मातुलुङ्गजम्बीरसुमनः सौगन्धिकादिहृद्य गन्धानुपजिघ्रेत् । निवातसुखश य्यास्थितश्चविबन्धार्थमल्पाल्पमुष्णोदकमनुकण्ठयंस्तन्मना वेगान्न धारयन् ईरयमाणश्च शय्या सन्ने प्रतिग्राहेऽशीतस्पृऽग्विरिच्येत । यथा च वमने स्वेदप्रसेकौषधकफपित्तानिलाः क्रमेण प्रवर्तन्ते तथा विरेचने वातमूत्रपुरीषपित्तकफाः । पुनश्चान्ते वायुः । दोषाणां हि देहे तथा सन्निवेशान्मार्गवैपरीत्याच्च शोधनयोरिति ॥ ३० ॥
In the treatment of pitta, purgative therapy should be done by drugs of astringent and sweet tastes,
in that of kapha with urines or drugs possessing pungent taste and hot potency and
in that of vata with fatty (unctuous) materials, which are hot in potency and salt in taste.
Soon after the purgative drug has been swallowed, cold water should be sprinkled on the face of the patient to prevent the occurence of vomitting; he should be asked to gargle his mouth with warm water and inhale the sweet smell of moist, good, smelling mud, fruits of matulunga, jambira sumana (jasmine) saugandhika (kalhara) – etc. He should then be made to lie on a cot, placed inside a room which is devoid of heavy breeze, with instructions to sip little quantities of warm water to moisten the throat and to initiate the urges and to be in eagerness of purging. He should be not suppress the urges, but evacuate his bowels into the reciving vessels (bed-pans) kept on the coat. He should avoid using cold water and thus fecilitate purgations.
Just as in emesis therapy, perspiration, salivation, the medicine swallowed, kapha, pitta and vata (gas) are seen coming out in that successive order so also during purgation therapy; flatus, urine, faecal matter, pitta and kapha come out in successive order and vayu (flatus) once again at the end.
The order of sequence of elimination of the doshas in these purificatory therapies is due to their location inside the body (normally) and to the reverse direction (of action) of the therapies. (30)
Notes: Indu, the commentator explains the above statement and says that Vamana (emesis) brings out kapha first because of the nearness of its location (chest and stomach)
to the mouth, next the pitta and lastly the vata; Virechana (purgation) brings out vata first because of the nearness of its location (the colon) next the pitta and lastly the kapha. Vata coming out once again in the end is due to absence of nourishment…
अप्रवृत्तौ तु भेषजोत्तेजनार्थमुष्णोदकं पाययेत् । पाणितापैश्च जठरं स्वेदयेत् । प्रवृत्ते च दीप्ताने: स्निग्धवपुषा बहुदोषस्याल्पदोषे नैव वा प्रवृत्तेऽल्पदोषस्यापि जीर्णभैषज्यस्याहः शेषं बलं चापेक्ष्य भूयो मात्रां विदध्यत् । न त्वजीर्णौषधस्यातियोगभयात् ॥३१॥
If purgations do not occur, the patient should drink hot water to activate the medicine and his abdomen should fomented with hands made warm.
For those who have powerful digestive activity, those who have more lubrication in their body, those in whom large quantities of doshas have accumulated but very little is seen coming out through purgings and in whom the purgative recipe given has been digested (and so made inactive), a second larger dose of purgative recipe should be administered, after carefully considering the remaining period of time of the day and the strength of the patient.
If the first dose of the recipe has not been digested, the second dose should not be given because of the risk of producing excess purgations. (31)
तदहर्वा भुक्तवतोऽन्येद्युरदृढस्त्रेहं वा दशरात्रादूर्ध्वमुपस्कृतदेहमवहितो भूयः पाययेत् ॥ ३२ ॥
Or it (second dose) may be given after meals, on the same day or the next day, after giving him little quantities of lubricating substance or after a lapse of ten nights preparing the patient once again (with lubrication, sudation and emesis therapies administered again). (32)
ह्रीभयलोभैश्च वेगाघातशीला: प्रायशः स्त्रियो राजसमीपस्था वणिजश्च भवन्ति । तस्मादेते वेगधारणप्रवृद्धवातत्वात्सदातुरा दुर्विरेच्याश्च । तान् सुस्निग्धान् शोधयेत् ॥३३॥
Women, persons who are near the king and merchants will be habituated to suppress the urges of their body due to shyness, fear and greed respectively. Hence, they by this habit of suppression and cosequent increase of vata will always be sick and unresponsive to purgation therapy. So they should be given the purificatory therapies only after satisfactory lubrication. (33)
अन्यानपि चाकालनिर्हारविहाराहारान् । ततश्चैषां सदातुरत्वादल्योऽप्यामयो दुःसाध्यो भवति । तेषां पुनः क्रियाविधिः स्नेहव्यापत्सिद्धावुपदेक्ष्यते ॥३४॥
So also others who are very irregular in attending to the calls of nature, daily activities, or food habits. Because of this, they also remain sick always and even minor diseases will become difficult for treatment in them. Methods of treatment of such persons will be described later in the chapter called Snehavyapat siddhi. (chapter 7 section 5). (34)
तत्रासम्यग्विरेकात् कुक्षिहृदयाविशुद्धिराध्मानमरुचिः प्रसेकः कफपित्तोत्क्लेशछर्दिभ्रमाः कण्डू पिटका विदाहो गौरवमग्निसादस्तन्द्रा स्तैमित्यं प्रतिश्यायो वातविण्मूत्रसङ्गश्च । सम्यग्विरेकात् व्याध्युपशमो यथोक्तविपर्ययश्च । अतिविरेकात्तु केवलं दोषरहितमुदकं रक्तं वा मेदोमांसधावनो पमं कृष्णं वा प्रवर्तते । परिकर्तिका हृदयोद्वेष्टनं गुदनिस्सरणं नयनप्रवेशः पिपीलिकासञ्चार इवाङ्गे वमनातियोगतुल्यता च ॥ ३५ ॥
Improper (inadequate) purgation therapy will produce incomplete cleaning of the abdomen and heart (region of the heart, chest), distention of abdomen with gas, loss of appetite, excessive salivation, excitation and vomitting of kapha and pitta, giddiness, itching, eruptions on the skin, feeling of heavyness, dyspepsia, stupor, inactivity, nasal catarrh, and non-elimination of flatus, feces and urine.
By proper (adequate) purgation therapy, there will be mitigation of the disease and absence (disappearance) of the symptoms mentioned above.
Excess of purgation therapy will produce elimination of water unmixed with the doshas, or even of blood resembling water in which fat or meat has been washed or black in colour, cutting pain in the rectum, constriction of the heart (severe constricting pain) prolapse of the rectum, sunken eyes, feeling as though ants are crawling on the skin and other symptoms enumerated under excessive emesis therapy. (35)
सम्यग्विरिक्तं चैनं वमनोक्तेन धूमवर्ज्येन विधिनोपपादयेत् । अथ वमितवानिव क्रमेणान्नान्युपयु ञ्जानः प्रकृतिभोजनमागच्छेदिति । भवति चात्र ॥३६॥
जीर्णेऽन्ने वमनं योज्यं कफे जीर्णे विरेचनम् ।
The person who has completed the purgations satisfatorily should follow all the regimen described under emesis therapy except, the inhalation of smoke. He should adhere to the schedule of liquid diet prescribed under emesis therapy and take the normal food at the end of it. Further, some more verses. (36)
Emetic recipe should be administered after the digestion of food taken the previous day and purgative recipe after the digestion of kapha. (36-1/2)
Notes: The ideal time for the administration of an emetic recipe is when kapha is predominant, that is, about half to one hour after sunrise and after making sure that food of the previous day has been well digested.
For the administration of the purgative recipe it will be after the period of predominance of kapha has passed off, that is, after about two to three hours after sunrise.
मन्दवह्निमसंशुद्धमक्षामं दोषदुर्बलम् ॥३७॥
अदृष्टजीर्णलिङ्गं च लङ्घयेत् पीतभेषजम् । स्नेहस्वेदौषधोत्क्लेशसङ्गैरिति न बाध्यते ॥३८॥
On the day of taking the purificatory recipe (either emetic or purgative), persons who have poor digestion, who have not eliminated the wastes (urine, feces etc.), who are not emaciated, who have weak (or little quantity) doshas and who have not developed symptoms of good digestion, should be made to fast. By this, they will not be troubled from the fatigue of lubrication and sudation therapies, from stimulation of the drugs taken and by the residue of drugs remaining inside (if at all, after purificatory bouts). (37-38)
संशोधनास्त्रविस्त्रावस्त्रेहयोजनलङ्घनैः। यात्यग्निर्मन्दतां तस्मात् क्रमं पेयदिमाचरेत् ॥३९॥
The digestive activity becomes weak by therapies such as purificatory, bloodletting, oleation and thinning of the body. So the schedule of peya and other liquid diets should be adhered to. (39)
स्रुताल्पपित्तश्लेष्माणं मद्यपं वातपैत्तिकम् । पेयां न पाययेत्तेषां तर्पणादिक्रमो हितः ॥४०॥
For those who have expelled very little quantities of pitta and kapha (during purificatory therapies), those who are alcoholics, those who belong to vata pitta dominant constitution, peya and other liquid foods should not be given. The schedule of Tarpana etc., (nutritious solid foods) will be ideal for them. (40)
अपक्कं वमनं दोषान् पच्यमानं विरेचनम् । निर्हरेद्वमनस्यातः पाकं न प्रतिपालयेत् ॥४१॥
Emesis brings out the doshas which are unripe (undigested, not processed by heat) whereas purgation brings out the doshas which are being processed. So, the physician need not wait for the doshas to undergo processing in case of emesis therapy.
Notes: All the constituents of the body including the doshas, have within them a certain moity of agni (tejas bhuta – fire like material) which transforms that material every moment. As per the doctrine of agni and dhatupaka (metabolism of tissues) described perviously, increase of any substance in mainly due to inability or weakness of the fire-like material and consequent accumulation of undigested materials. In course of time, and with other helpful factors, the fire-like activity will regain its strength and transform the materials suitably. If by any cause, it becomes very powerful it digests the very substance in which it resides and so leads to its decrease or even complete loss. Doshas which are in ama (unprocessed) state cause various diseases in the body and when they become pakwa (properly processed), the diseases disappear. Emesis therapy is mainly intended for increased kapha which requires long time to undergo the heat processing.
Within that long time it may produce many harmful side effects. So the physician should try to treat any comlications of emesis without waiting. Purgation therapy is mainly for increased pitta, which by nature, is predominant in tejas bhuta. So processing by heat is very quick and very less and even if present, the time required for their processing will be very short. So the physician can wait for some time during which complications will not develop and even if develop they can be relieved quickly because they will be mild.
ऊर्ध्वाधोरेचनं युक्तं वैपरीत्येन जायते । यदा तदा छर्दयतः सिञ्चेष्णेन वारिणा । पादौ शीतेन चोर्ध्वाङ्गं विपरीतं विरेचने ॥४२॥
When the upward and the downward purgaions act in their reverse (opposite) directions, the patient having vomittings should be sprinkled with warm water on his legs and with cold water on his face and upper parts of the body. It should be done in the opposite manner (reverse order) in case of the opposite effect. (42)
Notes: Emesis is also known as upward purgation, sometimes an emetic drug will produce purgations and a purgative drug will produce vomittings.
In case a purgative drug has been given and the patient develops vomitting his legs should be kept immersed in warm water and cold water sprinkled over the face, neck, shoulders, chest and back.
In case a emetic drug has been given and the patient develops purgation, his legs should be immersed in cold water and warm water sprinkled over the face etc.
दुर्बलो बहुदोषश्च दोषपाकेन यः स्वयम् । विरिच्यते भेदनीयैर्भोज्यैस्तमुपपादयेत् ॥४३॥
The person who is weak and having large quantities of doshas, develops purgations of its own accord due to the doshas undergoing paka (heat processing) he should be treated with good foods which are having mild purgative properties. (43)
Notes: Indu clarifies this point and says that the patient should be given neither a purgative drug nor a bowel binding drug.
दुर्बल: शोधितः पूर्वमल्पदोषः कृशो नरः । अपरिज्ञातकोष्ठश्च पिबेन्मृद्वल्पमौषधम् । वरं तदसकृत् पीतमन्यथा संशयावहम् ॥४४॥
A debilitated person who has undergone purificatory therapy earlier and a person who has very little quantity of doshas inside but is emaciated, and he whose nature of kostha (alimentary tract vis a vis bowel movements) is not known, should be given mild drugs in small doses, better still in repeated doses, otherwise it will create doubt (of excessive purgation) (44)
हरेद् बहूंश्चलान् दोषानल्पानल्पान् पुनः पुनः ।
दुर्बलस्य मृदुद्रव्यैरल्पान् संशयमेत्तुतान् । क्लेशयन्ति चिरं ते हि हन्युर्वैनमनिर्हताः ॥४५॥
If in a debilitated person the doshas are found to be in motion and large in quantity, they should be removed out of the body, little by little often, using mild drugs; if they are of little quantity they should be mitigated. If they remain inside for long, they cause many troubles to the body and might even kill the person if they are not expelled out. (45)
मन्दाग्निं क्रूरकोष्ठं च सक्षारलवणैर्वृतैः । सन्धुक्षिताग्निं विजितकफवातं च शोधयेत् ॥४६॥
Persons who have poor digestion and hard bowel movement should be treated first with ghee mixed with alkalies and salt. When his digetion improves and kapha and vata get mitigated by this, he should be given purificatory therapies. (46)
रूक्षबह्वनिलक्रूरकोष्ठव्यायामशीलिनाम् । दीप्ताग्नीनां च भैषज्यमविरेच्यैव जीर्यति ॥४७॥
तेभ्यो बस्तिं पुरो दद्यात्ततः स्निग्धं विरेचनम् । शकृन्निर्हत्य वाकिञ्चत्तीक्ष्णाभिः फलवर्त्तिभिः ।
प्रवृत्तं हि मलं स्निग्धो विरेको निर्हरेत्सुखम् ॥४८॥
In persons who are dry, who have predominance of Vata, hard bowel movements, who are habituated to physical exercises and those who have powerful digestive activity, the purgative recipe gets digested without producing purgations. Such persons should be given an enema first and then administered purgative recipe which is fatty or after removing the faeces by the use of strong suppositories made from fruits. A purgative recipe which is unctuous (fatty) will be able to remove the doshas after the faeces is expelled out first. (47-48)
विषाभिघातपिटकाकुष्ठशोफविसर्पिणः । कामलापाण्डुमेहार्तान् नातिस्निग्धान् विशोधयेत् ॥४९॥ सर्वान् स्नेहविरेकैश्च रूक्षैस्तु स्नेहभावितान् ॥५०॥
Persons suffering from poison, injury, skin eruptions, leprosy, swelling, visarpa, ( herpes), jaundice, anaemia and diabetes should be given purificatory therapies not after maximum of oleation therapy (in other words, it should be only after mild oleation therapy). The purificatory recipe should also be of fatty materials. If they (persons) have too much of lubrication, they should be given the recipes which are non-fatty. (49-50)
कर्मणां वमनादीनां पुनरप्यन्तरेऽन्तरे। स्नेहस्वेदौ प्रयुञ्जीत स्नेहमन्ते बलाय च ॥५१॥
During the course of emesis and other purifficatory therapies, oleation and sudation therapies should be done often, in the middle. At the end of the therapy one more oleation therapy should be given to restore the strength. ( 51 )
ऊषादिभिर्यथोत्क्लेश्य ह्रियते वाससो मलः । तथैव वपुषः स्नेहस्वेदमाषतिलादिभिः ॥५२॥
Just as the cloth gets rid of its dirt by being boiled with alkaline mud, so also the body by oleation and sudation therapies and use of black gram, seasum etc., as food. (52)
स्नेहस्वेदावनभ्यस्य कुर्यात्संशोधनं तु यः । दारुशुष्कमिवानामे शरीरं तस्य दीर्यते ॥५३॥
He, who administers purificatory therapies without making the body soft by oleation and sudation therapies done earlier, will be just like a person who tries to bend a dry faggot of wood. The body will be destroyed thereby. (53)
सुखं क्षिप्रं महावेगमसक्तं यत् प्रवर्तते । नातिग्लानिकरं नापि हृदि पायौ च रुक्करम् ॥५४॥ अन्तराशयगं क्लिन्नं कृत्स्नं दोषांनिरस्यति । विरेचनं निरूहं वा तत्तीक्ष्णमिति निर्दिशेत् ॥५५॥
A purgative drug or a decoction enema is said to be strong (powerful) when it produces the evacuations of the bowels easily, quickly, with great force without obstruction, without excessive, fatigue, without pain in the heart and rectum, and brings out the liquified doshas collected inside the kostha (alimentary tract) completely. (54-55)
जलाग्निकीटैरस्पृष्टं देशकालगुणान्वितम् । नवं मात्राधिकं किञ्चित् तुल्यवीर्यैः सुभावितम् ॥५६॥ स्नेहस्वेदोपपन्नस्य तीक्ष्णत्वं याति भेषजम् । अतो विपर्यये मन्दं मन्दतां च प्रपद्यते ॥५७ ॥
A purgative drug will be strong in action when it has not been affected by water, fire and insects; which possesses the qualites of the land and season, which is fresh, slightly more in dose, processed (fortified) with other drugs possessing similar properties and administered to a person who has been given oleation and sudation therapies earlier. It will be mild and acting mildly, when it possesses the qualities opposite of the above. (56-57)
तीक्ष्णो मध्यो मृदुर्व्याधिः सर्वमध्याल्पलक्षणः । बलापेक्षं हितं तेषु तीक्ष्णं मध्यं मृदु क्रमात् ॥५८ ॥
A disease is said to be severe, moderate or mild, when it presents all its symptoms fully, moderately or less number of symptoms respectively. For these, drugs which are strong, moderate or mild will be ideal, respectively, depending upon the strength of the patient. (58)
अप्रवर्त्य मलान् द्रव्यं सात्मीभूतं हि जीर्यति । वमनं वा विरेकं वा तस्मात्सात्म्यं न योजयेत् ॥५९ ॥
Drugs which are accustomed by long use should not be administered either for emesis or purgation therapies because such drugs get digested and do not eliminate the doshas. ( 59 )
विभ्रंशो विषवत्सम्यग्योगो यस्यामृतोपमः । कालेऽवश्यं प्रयोज्यं च यस्माद्यत्नेन तत् पिबेत् ॥६० ॥
Improperly administered purificatory therapices are like poison; so should be properly administered at the appropriate fime (to prevent or cure diseases) with all due precautions. (60)
बुद्धिप्रसादं बलमिन्द्रियाणां धातुस्थिरत्वं ज्वलनस्य दीप्तिम् । चिराच्च पाकं वयसः करोति संशोधनं सम्यगुपास्यमानम् ॥६१॥
Clarity of mental functions, keenness of the sense organs, stability of the tissues, improvement of digestive activities, slowing of aging-all these will accrue from purificatory therapies properly done. (61)
॥ इति सप्तविंशोऽध्यायः ॥
Thus ends the twenty-seventh chapter
