चतुस्त्रिंशोऽध्यायः । अथातो वमनविरेचनव्यापच्चिकित्सितं यथोवाच भगवान् धन्वन्तरि: ।। १ ।।
Now we shall discourse on the treatment of the disorders resulting from an injudicious use of emetics or purgatives (Vamana Virechana Vyapad chikitsa). 1
वैद्यातुरनिमित्तं वमनं विरेचनञ्च पञ्चदशधा व्यापद्यते । तत्र वमनस्याधोगतिरूर्ध्वं विरेचनस्येति पृथक् । सामान्यमुभयो:- सावशेषौषधत्वं, जीर्णौषधत्वं, हीनदोषापहृतत्वं वातशूलम् अयोगः, अतियोगः, जीवादानम्, आध्मानं, परिकर्त्तिका, परित्रावः, प्रवाहिका, हृदयोपसरणं, विबन्ध अङ्गप्रग्रह इति । ॥ २ ॥
Their Classes: Fifteen different kinds of disorders may result from an injudicious use of emetics and purgatives owing to the ignorance of the physician or of the patient. Of these (fifteen), the upward coursing in cases of purgatives and the downward coursing in cases of emetics are peculiar to each of them respectively. The fourteen other remaining disorders (Vyapat) are common to both. They are Savasesausadhatva (continuance of the drug in the stomach), Jirnausadhatva (complete digestion of the medicine ), Hina-dosapahytatva (insufficient elimination of the Dosas from the system) Adhikadosapahrtatva (excessive elimination of the Dosas from the system), Vata-sula (Vataja colic), Ayoga ( insufficient dosage), Ati-yoga (over dosage), Jivadana (haemorrhage), Adhmana (tympanitis), Pari-kartika (cutting pain in the anus, etc.), Parisrava (oozing out of stools), Pravahika) (dysentry ), Hrdayopasarana (rising of the Dosas towards the heart), Vibandha (suppression of stool and urine) and stiffness of the limbs. 2
तत्र बुभुक्षापीडितस्यातितीक्ष्णाग्नेर्मृदुकोष्ठस्य चावतिष्ठमानं दुर्बलस्य वा गुणसामान्यभावाद् वमनमधो गच्छति । तत्रेप्सितानवाप्तिर्दोषोत्क्लेशश्च । तमाशु स्नेहयित्वा भूयस्तीक्ष्णतरैर्वामयेत् ।। ३ ।।
Causes and Treatment: An emetic taken by a hungry or a weak person or by one possessed of a very keen digestive capacity (Tiksnagni) or of lax bowels (Mrdu kostha), naturally dropped down into the intestines in virtue of the identical nature and intensity of their attributes, in the event of its being retained in the stomach, even for a short while. A failure of the medicine to produce the wished-for result and a further stirred or agitated condition of the aggravated Dosas are the effects thereof. In such a case Sneha (and Sveda) should be again applied and a stronger emeic administered. 3
अपरिशुद्धामाशयस्योत्कृष्टश्लेष्मणः सशेषान्नस्य वाऽहृद्यमतिप्रभूतं वा विरेचनं पीतमूर्ध्वं गच्छति । तत्रेप्सितानवाप्तिर्दोषोत्क्लेशश्च । तत्राशुद्धामाशयमुल्बणश्लेष्माणमाशु वामयित्वा भूयस्तीक्ष्णतरैर्विरेचयेत् । आमान्वये दोषे त्वामवत् संविधानम् । अहृद्येऽतिप्रभूते च हृद्यं प्रमाणयुक्तञ्च, अत ऊर्ध्वमुत्तिष्ठत्यौषधे न तृतीयं पाययेत् । ततस्त्वेनं मधुघृतफाणितयुक्तैर्लेहैर्विरेचयेत् ।। ४ ।।
An obnoxious and large-dosed purgative taken by a person with a residue of a previous meal remaining undigested (in the stomach) or wih an aggravated Kapha or with a disordered stomach (Amasaya), is forced upward and is ejected through the mouth. In a person of disordered stomach the accumulation (Kapha) in the stomach should be first speedily ejected with an emetic and a stronger purgative should then be administered. A case where the food remains still undigested (in the intestines) should be treated (with fastings and digestants) as in a case of mucous diarrhoea. A pleasant or tasteful purgative should be given in a moderate dose in the event of a previous one having been ejected on account of its obnoxious taste and abnormal dosage. A third dose should not be given in the event of the second also being not retained in the stomach. At this stage, purging should be effected with the help of a lambaive (Leha) prepared with honey, clarified butter and treacle. 4
Evil of unpurged residue of a purgative or emetic
वा न दोषविग्रथितमल्पमौषधमवस्थितमूर्ध्वभागिकमधोभागिकं स्त्रंसयति दोषान् । तत्र तृष्णा पार्श्वशूलं छर्दिर्मूर्च्छा पर्वभेदो हल्लासोऽरतिरुद्गाराविशुद्धिश्च भवति । तमुष्णाभिरद्भिराशु वामयेदूर्ध्वभागिके, अधोभागिकेऽपि च सावशेषौषधमतिप्रधावितदोषमतिबलमसम्यग्विरिक्तमप्येवं वामयेत् ।। ५ ।।
Savasesaudhatva (Evil of an unpurged residue of a purgative or emetic): A small dose of medicine, whether an emetic or a purgative, if it is absorbed by the deranged Dosas of the body and retained in the system, cannot produce the wished-for result of cleansing the system. In such a case, it gives rise to thirst, pain in the sides, vomiting, fainting, nausea, piercing or breaking pain in the joints, uneasiness, impure eructations, and such like symptoms. The patient in such a case should be made to vomit the contents of his stomach immediately with draughts of hot water. When a least residue of a purgative medicine previously administered would be found to have been retained in the stomach of a strong patient and with extremely aggravated Dosas of the body, the paient, if there be an insufficient purging, should be similarly made to vomit. 5
Evils of a digested purgative
क्रूरकोष्ठस्यातितीक्ष्णाग्नेरल्पमौषधमल्पगुणं वा भक्तवत् पाकमुपैति; तत्र समुदीर्णा दोषा यथाकालमनियिमाणा व्याधिविभ्रमं बलविभ्रंशञ्चापादयन्ति । तमनल्पममन्दमौषधञ्च पाययेत् ।। ६ ।।
Jirnausadhatva (Evils of a digested purgative, etc.) : A mild purgative or emetic or a medicine administered in a small dose to a man of extremely constipated bowels (Krura-kostha) or of an extremely keen digestive capacity (Tiksnagni), is like food easily digested in the stomach (and therefore fails to produce the wished-for results). The aggravated Dosas, being thus unexpelled by the (purgative or emetic) medicine from the body, brings on fresh distempers and loss of strength (Bala)¹ of the body. Under the circumstances a stronger medicine in a larger dose should be administered to the patient. 6
1. For the meaning of “Bala” here see Chapter XV Sutra-Sthana.
Evils of insufficient expulsion of the Dosas
अस्निग्धस्विन्नेनाल्पगुणं वा भेषजमुपयुक्तमल्पान् दोषान् हन्ति । तत्र वमने दोषशेषो गौरवमुत्क्लेशं हृदयाविशुद्धिं व्याधिवृद्धिञ्च करोति । तत्र तं यथायोगं पाययित्वा वामयेद् दृढतरम् । विरेचने तु गुदपरिकर्त्तनमाध्मानं शिरोगौरवमनिःसरणं वा वायोर्व्याधिवृद्धिञ्च करोति । तमुपपाद्य भूयः स्नेहस्वेदाभ्यां विरेचयेद् दृढतरम् । दृढं बहुप्रचलितदोषं वा तृतीये दिवसेऽल्पगुणञ्चेति ।। ७ ।।
Evils of insufficient expulsion of the Dosas : A mild medicine as well as a medicine administered wihout a previous application of Sneha and Sveda subdues only a slight aggravation of the Dosas. A nausea, a sense of heaviness in the limbs, a sticky sensation in the chest and aggravation of the (existing) disease are the evils which attend an insufficient ejection of any bodily Dosa from the system after the administraion of an emetic. More satisfactory vomitings should be induced in such cases with the help of an appropriate (and stronger) medicine. Tympanitis, heaviness of the head, suppression or incarceration of Vayu (flatus), a cutting pain (Pari-kartana) in the anus and aggravation of the (existing) disease, are the evils which result from an imperfect or partial expulsion of the Dosas from the system’ under the administration of a purgative remedy. The remedy in such cases should consist in inducing stronger purgings after a further application of Sneha and Sveda to the patient. A mild medicine should be administered on the third day to a strong-limbed patient, if there be a large quantity of dislodged agitated Dosa in his system. 7
Vata-sula – Flatulent colic
अस्निग्धस्विन्नेन रुक्षमौषधमुपयुक्तमब्रह्मचारिणा वा वायुं कोपयति । तत्र वायुः प्रकुपितः पार्श्वपृष्ठश्रोणिमन्यामर्मशूलं मूर्च्छा भ्रमं संज्ञानाशञ्च करोति, तं वातशूलमित्याचक्षते, तमभ्यज्य धान्यस्वेदेन स्वेदयित्वा यष्टीमधुकविपक्वेन तैलेनानुवासयेत् ।। ८-अ ।।
Vata-sula (Flatulent colic ): The bodily Vayu become enraged or agitated by the use of parching (Ruksa) medicines by a person who has not been treated with a previous application of Sneha and Sveda or by one who does not observe a total abstinence in sexual matters. The Vayu thus enraged tends to produce a kind of pain (Sula) in the sides, waist (Sroni), back, vugular-region and the Marma (heart) and brings on vertigo, fainting and loss of consciousness. This condition is known as Vata Sula. The remedy under such circumstances consists in anointing the patient’s body with oil or clarified butter, fomenting it with (hot and half-boiled) paddy (Dhanya-Sveda). An oil cooked with Yasti-madhu should then be employed as an Anuvasanabasti. 8-A
Ayoga – Partial and deficient medicaion
स्नेहस्वेदाभ्यामविभावितशरीरेणाल्पमौषधमल्पगुणं वा पीतमूर्ध्वमधो वा नाभ्येति दोषांश्चोत्क्लेश्य तैः सह बलक्षयमापादयति । तत्राध्मानं हृदयग्रहस्तृष्णा मूर्च्छा दाहश्च भवति । तमयोगमित्याचक्षते । तमाशु वामयेन्मदनफललवणाम्बुभिर्विरेचयेत् तीक्ष्णतरैः कषायैश्च ।। ८ – ब ।।
Ayoga (Partial and deficient medicaion): A mild or an insufficient dose of an emetic or purgative, administered without a previous application of Sneha and Sveda to the patient, fails to find an outlet either through the upper or the lower orfices of the body and hence brings about an aggravation of the Dosas incarcerated in the organism and produces a loss of strength (Bala), as well as flatulence with a catching pain in the chest ( Hrdaya-graha), thirst, fainting and a burning sensation in the body. This is called Ayoga. The remedy in such cases should consist in inducing, without any delay, vomitng with powered Madana fruit dissolved in a saline solution, or in moving the bowels with a stronger purgative in the shape of decoctions. 8-B
दुर्वान्तस्य तु समुक्लिष्टा दोषा व्याप्य शरीरं कण्डूश्वयथुकुष्ठपिडकाज्वराङ्गमर्दनिस्तोदनानि कुर्वन्ति । ततस्तानवशेषान् महौषधेनापहरेत् । अस्निग्धस्विन्नस्य मृदुविरिक्तस्याधो नाभे: स्तब्धपूर्णोदरता शूलं वातपुरीषसङ्गः कण्डूमण्डलप्रादुर्भावो वा भवति; तमास्थाप्य पुनः संस्नेह्य विरेचयेत् तीक्ष्णेन । नातिप्रवर्त्तमाने तिष्ठति वा दुष्टसंशोध ने तत्सन्तेजनार्थमुष्णोदकं पाययेत्, पाणितापैश्च पार्श्वोदरमुपस्वेदयेत् । ततः प्रवर्त्तन्ते दोषाः। अनुप्रवृत्ते चाल्पदोषे जीर्णौषधं बहुदोषमहः शेषं बलञ्चावेक्ष्य भूयो मात्रां विदध्यात् । अप्रवृत्तदोषं दशरात्रादूर्ध्वमुपसंस्कृतदेहं स्नेहस्वेदाभ्यां भूयः शोधयेत् | दुर्विरेच्यमास्थाप्य पुनः संस्नेह्य विरेचयेत् ।।८।। –
The bodily Dosas are aggravated through deficient or scanty vomitings under the action of an emetic drug and expands through the entire organism, giving rise to itching, swelling, Skin Diseases, pustular eruptions, fever aching of the limbs, piercing pain and suchlike symptoms. The remaining or uneliminated Dosas should then be expelled wih (adequate) medicines of strong potency (Mahausadhi). Similarly, insufficient purgings under the action of a mild purgative, administered without a previous application of Sneha and Sveda to the patient, produce a numbed and drum-like distension of the abdomen below the umbilicus, causing a retention of the stool and flatus, and produce (colic) pain (Sula), itching and urticarious eruptions (Mandala). The remedy under these circumstances should consist in employing emulsive measures (Sneha) and a stronger purgative after having employed an Asthapana-basti. Draughts of hot water should be given to the patient and the abdomen and the sides should be fomented with the heated palms of the hands for exciting or inducing purging in the event of an unsatisfactory purging and of obnoxious matter not being expelled from the system. The purging (of Dosa) would thus be induced. A second dose of a purgative should be again administered in the evening with a due consideration to the strength of the patient when the first would be found to have been digested before producing a sufficient purging if the system of the patient be still full of Dosas and morbid matter. In case of failure of this also to remove the Dosas (excreta), the system of the patient should be first treated with Sneha and Sveda after the lapse of ten days and should then be again cleansed with a further dose of a purgative.¹ Patients in whom purging can be induced only with the greatest difficulty should be first treated with Asthapana. Sneha should again be applied and a strong purgative should then be administered. 8
Ati-yoga – Over-drugging with purgatives
ह्रीभयलोभैर्वेगाघातशीला: प्रायशः स्त्रियो राजसमीपस्था वणिज: श्रोत्रियाश्च भवन्ति, तस्मादेते दुर्विरेच्या बहुवातत्वात् । अतएव तानतिस्निग्धान् स्वेदोपपन्नान् शोधयेत् । स्निग्धस्विन्नस्यातिमात्रमतिमृदुकोष्ठस्य वाऽतितीक्ष्णमधिकं वा दत्तमौषधमतियोगं कुर्यात् ।। ९॥
Ati-yoga (Over-drugging with purgatives, etc.): Women, merchants, persons attending a king and pious Brahmanas learned in the Vedas (Srotriya) are often subjected to the necessity of repressing their natural urgings of the body towards micturition, etc., out of a sense of delicacy, fear or greed. The Vayu in their systems remains consequently aggravated and accordingly purgatives fail to easily produce any effect in their organism. Hence their system should be cleansed with purgatives preceded by Sveda (fomentations) and a copious application of Sneha. An over-dose of a purgative or a strong one administered to a person copiously treated with Sneha and Sveda or to one whose bowels are easily moved would exhibit the symptoms of an over-dosage (Ati-yoga) or purgatives. 9
1. Dalhana says that the system of the patient, in this case, should be cleansed with an emetic or a purgative as the case may be.
तत्र वमनातियोगे पित्तातिप्रवृत्तिर्बलविस्त्रंसो वातकोपश्च बलवान् भवति। तं घृतेनाभ्यज्यावगाह्य शीतास्वप्सु शर्करामधुमिश्रैर्लेहैरुपचरेत् यथास्वम् । विरेचनातियोगे कफस्यातिप्रवृत्तिरुत्तरकालञ्च सरक्तस्य; तत्रापि बलविस्त्रंसो वातकोपश्च बलवान् भवति । तमतिशीताम्बुभिः परिषिच्यावगाह्य वा शीतैस्तण्डुलाम्बुभिर्मधुमिश्रैश्छर्दयेत्, पिच्छाबस्तिञ्चास्मै दद्यात्, क्षीरसर्पिषा चैनमनुवासयेत्, प्रियङ्वादिञ्चास्मै तण्डुलाम्बुना पातुं प्रयच्छेत्, क्षीररसयोश्चान्यतरेण भोजयेत् ।। १० ।।
Excessive emission of Pitta (bile), loss of strength (Bala) and an aggravation and augmentation of the deranged Vayu follow from the over dosage (Ati-yoga) of an emetic medicine. In such cases, the body of the patient should be anointed with clarified butter and he should be bathed in cold water and made to take a lambative¹ with sugar and honey with a due consideration of the nature and intensity of the Dosas involved. An over-dose of a purgative may bring on excessive emission of Kapha (mucus) mixed even with blood in the end. In this case, too, loss of strength (Bala) and enragement of the bodily Vayu would be the consequence. The patient in such a case should be sprinkled over with or bathed in very cold water and vomiting should be induced with potions of cold washings of rice mixed with honey. Applications of Piccha-basti and of Anuvasana enemetas with milk and clarified butter are recommended. The patient should also be made to drink potions of the washings of rice mixed with the drugs of the Priyangvadi group. The diet should consist of boiled rice with milk or meat-soup. 10
1. A different reading says that the patient should be fomented with washings of rice mixed with honey.
Jivadana (Haemorrhage) due to excessive vomiting
तस्मिन्नेव वमनातियोगे प्रवृद्धे शोणितं ष्ठीवति छर्दयति वा; तत्र जिह्वानिःसरणमपसरणमक्ष्णोर्व्यावृत्तिर्हनुसंहननं तृष्णा हिक्का ज्वरो वैसंज्ञच – मित्युपद्रवा भवन्ति । तमजासक्चन्दनोशीराञ्जनलाजचूर्णै: सशर्करोद- कैर्मन्थं पाययेत् । फलरसैर्वा सघृतक्षौद्रशकरैः शुङ्गाभिर्वा वटादीनां पेयां सिद्धां सक्षौद्रां वर्चोग्राहिभिर्वा, पयसा जाङ्गलरसेन वा भोजयेत्, अतिस्त्रुतशोणितविधानेनोपचरेत् । जिह्वामतिसर्पितां त्रिकटुलवणचूर्ण-प्रघृष्टां तिलद्राक्षाप्रलिप्तां वाऽन्तः पीडयेत् । अन्तः प्रविष्टायामम्लमन्ये तस्य पुरस्तात् स्वादयेयुः । व्यावृत्ते चाक्षिणी घृताभ्यक्ते पीडयेत् । हनुसंहनने वातश्लेष्महरं नस्यं स्वेदांश्च विदध्यात् । तृष्णादिषु च यथास्वं प्रतिकुर्वीत । विसंज्ञे वेणुवीणागीतस्वनं श्रावयेत् ।। ११-१२ । ॥ :
Jivadana (Haemorrhage) due to excessive vomiting : In the event of an excessive use of an emetic the patient may spit or vomit blood. In such a case the tongue hangs out (of the mouth) and the eyes seem to expand, and numbness of the jaws, thirst, hiccough, fever and faintness are found to supervene. A potion of goat’s blood, red Candana, Usira, Anjana and the powders of fried paddy mixed with water and sugar, should be administered in these cases. As an alternative, the patient should be made to take his food in the Peya form with the expressed juice of fruits (such as the Dadimba, etc.,) and with clarified butter, honey and sugar, or a Peya prepared with the sprouts of Vata, etc. with honey, or one cooked with any drug having the power of producing costiveness; or he should be made to take his food with milk or with the soup of the meat of a Jangala animal. Measures laid down in respect of excessive bleeding or haemorrhage should also be resorted to.
In a case of excessive protrusion or hanging down of the tongue, the organ should be rubbed with powdered Trikatu and rock-salt or pasted with a plaster of sesamum and grapes (Draksa and re-introduced into its proper place and position after which some other men should be made to taste any acid article in the sight of the patient. In a case of the expansion of the eyes they should be rubbed with clarified butter and (gently) pressed. Errhines and fomentations of the part with drugs) antidotal to the deranged Vayu and Kapha, are recommended in a case of lock-jaw. The other supervening distresses such as thirst etc., should be treated with appropriate medicinal remedies. A faintness ( under the circumstances) should be broken with the (sweet) sounds of a flute or a lyre. 11-12
Jivadana (Haemorrhage) due to excessive purging
विरेचनातियोगे च सचन्द्रकं सलिलमधः स्रवति, ततो मांसधावनप्रकाशमुत्तरकालं जीवशोणितञ्च, ततो गुदनि:सरणं वेपथुर्वमनातियोगोपद्रवाश्चास्य भवन्ति; तमपि निःस्स्रुतशोणितविधानेनोपचरेत् । निःसर्पितगुदस्य गुदमभ्यज्य परिस्वेद्यान्तः पीडयेत्, क्षुद्ररोगचिकित्सितं वा वीक्षेत । वेपथौ वातव्याधिविधानं कुर्वीत । जिह्वानि:सरणादिषूक्तः प्रतीकारः । अतिप्रवृत्ते वा जीवशोणिते काश्मरीफलबदरीदूर्वोशीरैः शृतेन पयसा घृतमण्डाञ्जजनयुक्तेन सुशीतेनास्थापयेत् । न्यग्रोधादिकषायक्षुरसघृतशोणितसंसृष्टैश्चैनं बस्तिभिरुपाचरेत् । शोणितष्ठीवने रक्तपित्तरक्तातीसारक्रियाश्चास्य विदध्यात्। न्यग्रोधादिञ्चास्य विदध्यात् पानभोजनेषु ।।१३।।
Jivadana (Haemorrhage) due to excessive purging: An excess (Ati-yoga) of purging is marked, at the outset, by a flow of watery mucus through the rectum, resembling the crest of a peacock’s plume in colour. This is followed by an emission of shreddy and bloodstreaked mucus resembling the washings of meat, succeeded by an oozing out of actual red blood attended with a shivering, protrusion of the anus and all the supervening distresses of emetics. The treatment in such cases should be as in those of haemorrhage. The protruded anus should be first lubricated (with a Sneha) and subsequently fomented and re-introduced into its proper place or it should be treated according to the directions laid down in the chapter of Ksudra-Roga.¹ The shivering should be treated with remedies laid down in connection with Vata-vyadhi Remedies in cases of a protrusion of the tongue etc.. have been already described Milk boiled (according to the Ksirapaka-vidhi) with KAshmari fruit, Badari fruit, Usira and Durva grass subsequently cooled and mixed with the cream of clarified butter and Anjana, should be syringed into the rectum in the manner of an Asthapana Basti in the case of an excessive flow of red blood (lit. life-blood) with a from the bowels. Basti should be employed in such cases, decoction of the drugs of the Nyagrodhadi group mixed with clarified butter, expressed juice of sugar-cane and (goat’s) blood. Remedies mentioned under haemoptysis (Rakta-pitta) and bloody dysentery should be employed in cases marked by spitting of life-blood (Jivasonita). Decoctions of the drugs of the Nyagrodhadi group should be given with food and drink. 13
1. The remedial measures for the treatment of Guda-bhramsa, etc., under the Ksudra-Roga, should be employed in such cases.
जीवशोणितरक्तपित्तयोश्च जिज्ञासार्थं तस्मिन् पिचुं प्लोतं वा क्षिपेत्, यद्युष्णोदकप्रक्षालितमपि वस्त्रं रञ्जयति तज्जीवशोणितमवगन्तव्यम् । सभक्तञ्च शुने दद्यात् सक्तुसंमिश्रं वा स यद्यपभुञ्जीत तज्जीवशोणितमवगन्तव्यम्, अन्यथा रक्तपित्तमिति ।।१४।।
Jiva-Sonita, how to be known : A piece of a linen or cotton should be soaked in (and dyed with) the emitted blood where any doubt would arise whether it is a case of arterial blood (Jiva-sonita) or one of Rakta pitta. The continuance of the dye or red stain on the linen even after being washed with hot water would conclusively establish its identity with the arterial blood or Jiva-sonita. As an alternative, the discharged blood mixed with barley-powder or any other kind of food should be given to a dog to eat. If it is eaten by the dog, it would at once establish the identity of the emitted blood with the healthy arterial blood of the organism.
Adhmana – flatulent distention of the abdomen
सशेषान्नेन बहुदोषेण रुक्षेणानिलप्रायकोष्ठेनानुष्णमस्निग्धं वा पीतमौषधमाध्मापयति, तत्रानिलमूत्रपुरीषसङ्गः समुन्नद्धोदरता पार्श्वभङ्गो गुदबस्तिनिस्तोदनं भक्तारुचिश्च भवति, तञ्चाध्मानमित्याचक्षते; तमुपस्वेद्यानाहवर्तिदीपनबस्तिक्रियाभिरुपचरेत् ।। १५ ।।
Adhmana (flatulent distention of the abdomen) : If a person who is suffering from a plethora of the Dosas in his system and who has not previously been treated with a Sneha and whose bowels still contain the undigested residue of a previous meal and (consequently) an abundance of Vayu therein, takes a (purgative or an emetic) which is neither emollient nor hot, the medicine is likely to produce a flatulent distension of his abdomen (Adhmana). It arrests the emission of flatus (Vayu), stool and urine, makes the abdomen distended, produces a breaking pain in the sides, a pricking pain in the anus (Guda) and in the urinary bladder (Basti) as well as a disrelish for food. This is called Adhmana. The patient, in such a case, should be treated with anahavarti, appetising medicines and with Basti measures. 15
Parikartika – cutting pain in the anus
क्षामेणातिमृदुकोष्ठेन मन्दाग्निना रुक्षेण वाऽतितीक्ष्णोष्णातिलवणमतिरुक्षं वा पीतमौषधं पित्तानिलौ प्रदूष्य परिकर्त्तिकामापादयति । तत्र गुदनाभिमेद्रबस्तिशिरःसु सदाहं परिकर्तनमनिलसङ्गो वायुविष्टम्भो भक्तारुचिश्च भवति। तत्र पिच्छाबस्तिर्यष्टिमधुककृष्णतिलकल्कमधुघृतयुक्तः । शीताम्बुपरिषिक्तञ्चैनं पयसा भुक्तवन्तं घृतमण्डेन यष्टिमधुकसिद्धेन तैलैन वाऽनुवासयेत् ।।१६।।
Parikartika (cutting pain in the anus, etc.) : The Vayu and Pitta in the organism of an enfeebled person or of a person whose bowels can be easily moved or of one of a dry and arid temperament or afflicted with impaired digestive capacity, are deranged and aggravated by the use of any extremely sharp, hot, saline or dry (emetic or purgative) which give rise to a sort of cutting, sawing pain (Parikartika) in the anus, penis, umbilical region and the neck of the bladder (Basti). The emession of flatus is arrested, the Vayu (wind) lies incarcerated in the abdomen and relish for food vanishes. The remedy consists in employing a Piccha-Basti with Yasti-madhu and black sesamum pasted together and dissolved in clarified butter and honey. The patient should be bathed in cold water and be given his food with milk. AnuvasanaBasti¹ with the cream of clarified butter or with oil cooked with Yastimadhu should be also employed. 16
Parisrava – Dysenteric stools
क्रूरकोष्ठस्यातिप्रभूतदोषस्य मृद्वौषधमवचारितं समुत्क्लिश्य दोषान् न निःशेषानपहरति ततस्ते दोषाः परित्रावमापादयन्ति । तत्र दौर्बल्योदरविष्टम्भारुचिगात्रसदनानि भवन्ति, सवेदनौ चाय पित्तश्लेष्माणौ परित्रवतः तं परित्रावमित्याचक्षते, तमजकर्णधवतिनिशपलाशबलाकषायैर्मधुसंयुक्तैरास्थापयेत् । उपशान्तदोषं स्निग्धञ्च भूयः संशोधयेत् ।।१७।। ,
Parisrava (Dysenteric stools): The Dosas and the morbid matter accumulated in the system of a man of extremely constipated bowels and almost saturated with a plethora of Dosas (morbific diathesis) are stirred up but are not fully emitted under the action of a mild (emetic or purgative) medicine. The Dosas (consequently) try to pass out of the body constantly but in small quantities and bring on weakness, numbness and rigidity of the abdomen, aversion to food and lassitude of the limbs. The deranged Pitta (bile) and Kapha (mucus) are constantly emitted with pain (through the anus) in such a case, and the disease is called Parisrava. Asthapana basti with a decoction of Aja-karna, Dhava, Tinisa, Palasa and Bala saturated with honey is recommended in such cases. After the subsidence of the bodily Dosas involved in the case, the patient should be treated with Sneha and Samsodhana¹ (emetic or purgative) remedies should again be employed. 17
1. In cases of a Pitta-predominance, the Basti should be employed with the cream of clarified butter and in cases of a Vayu predominance, with oil.
Pravahika – Diarrhoea
अतिरुक्षेऽतिस्निग्धे वा भेषजमवचारितमप्राप्तं वातवर्च उदीरयति वेगाघातेन वा, तदा प्रवाहिका भवति । तत्र सवातं सदाहं सशूलं गुरुं पिच्छिलं श्वेतं कृष्णं सरक्तं वा भृशं प्रवाहमाणः कफमुपविशति, तां परित्रावविधानेनोपचरेत् । । १८ ।।
Pravahika (Diarrhoea) : A medicine (purgative or emetic) administered to a person who has been excessively treated with Sveda or with Sneha produces Pravahika in him by making him pass his stool and flatus without any straining or by restraining altogether those natural urgins respectively. Constant passing of slimy, black, white or red-coloured mucus (Kapha) with cramps loud flatus and burning sensation form the chief characteristics of his disease. Its medical treatment should be similar to that of a case of Parisrava, 18
Hridayopasarana – Overwhelming the heart
यस्तूर्ध्वमधो वा भेषजवेगं प्रवृत्तमज्ञत्वाद् विनिहन्ति, तस्योपसरणं हृदि कुर्वन्ति दोषाः । तत्र प्रधानमर्मसन्तापाद् वेदनाभिरत्यर्थं पीडयमानो दन्तान् किट्किटायते, उद्गताक्षो जिह्वां खादति, प्रताम्यत्यचेताश्च भवति, तं परिवर्जयन्ति मूर्खा:; तमभ्यज्य धान्यस्वेदेन स्वेदयेत्, यष्टिमधुकसिद्धेन च तैलेनानुवासयेत् । शिरोविरेचनञ्चास्मै तीक्ष्णं विदध्यात् । ततो यष्टिमधुकमिश्रेण तण्डुलाम्बुनाच्छर्दयेत्, यथादोषोच्छ्रायेण चैनं बस्तिभिरुपाचरेत् ।। १९ ।।
1. Dalhana recommends that a strong purgative or emetic should be employed.
Hrdayopasarana (Overwhelming the heart) : Urgings towards vomiting or purging being injudiciously checked up a person from ignorance, causes a downward or upward coursing of the Dosas of the body to and in the heart, thus pressing the greatest of the Marmas and giving rise to an excruciating pain in that locality. The patient, in such a case, drops down unconscious in a swoon with upturned eyes, violently gushing his teeth and biting his tongue. An inexperienced physician usually abandons such a patient as lost, whereas the remedy in such cases consists in anointing his body with a Sneha (oil or clarified butter) and fomenting it wih half-boiled and unhusked paddy (Dhanya-Sveda). Oil cooked with Yasti-madhu should be employed in the manner of an Anuvasana Basti and strong errhines (Nasya) should also be administered. After that the patient should be made to vomit with draughts of the washings of rice mixed with Yasti-madhu and Bastis¹ should be employed in consideration of the preponderance of the Dosa or Dosas involved in the case. 19
Vibandha – Retention of flatus, stool and urine
यस्तूर्ध्वमधो वा प्रवृत्तदोष: शीतागारमुदकमनिलमन्यद् वा सेवेत, तस्य दोषाः स्त्रोतः स्ववलीयमाना घनीभावमापन्ना वातमूत्रशकृद्ग्रहमापाद्य विबध्यन्ते । तस्याटोपो दाहो ज्वरो वेदनाश्च तीव्रा भवन्ति; तमाशु वामयित्वा प्राप्तकालां क्रियां कुर्वीत । अधोभागे त्वधोभागहरद्रव्यसैन्धवाम्लमूत्रसंसृष्टं विरेचनं पाययेत्, आस्थापनमनुवासनञ्च यथादोषं विदध्यात्, यथादोषमाहारक्रमञ्च । उभयतोभागे तूपद्रवविशेषान् यथास्वं प्रतिकुर्वीत ॥ २० ॥
Vibandha (retention of flatus, stool and urine): Use of cold water, exposure to cold winds and resorting to cool places and such other conduct during the action of an emetic or a purgative remedy in a person tend to thicken the Dosas loosened and dis-lodged from their seats by virtue of its potency, arrest their out-flow, make them adhere to the internal passages through which they pass and, by affecting the excretions, give rise to a suppression of stool, urine and Vayu (flatus), attended with rumbling in the intestines, fever, burning sensation and excruciating pain. The patient should in such a case² be made speedily vomit the contents of his stomach, and the concomitant symptoms (such as fever, etc.) should be treated with appropriate medicinal remedies (as in the case of their actual and respective attacks). Drugs efficacious in subduing the Dosas confined in the lower cavity (abdomen) of he body (Adhobhaga-hara)¹ should be employed for purgative purposes with the admixture of Saindhava, Kanjika and cow’s urine in cases of the retention of the stool, etc., due to an abuse of a purgative. Proper Asthapana and Anuvasana Bastis should be prescribed in consideration of the nature and intensity of the Dosas involved in the case. The nature of the diet should be judiciously determined according to the nature of the Dosas. The supervening distresses in both the cases should be remedied with due consideration of the nature of the Dosas originating them. 20
1. Dalhana recommends both Niruha and Snaihika Bastis in such cases. 2. This evidently refers to the case of an abuse of an emetic.
या तु विरेचने गुदपरिकर्त्तिका तद् वमने कण्ठक्षणनम्, यदधः परिस्रवणं स ऊर्ध्वभागे श्लेष्मप्रसेकः । या त्वधः प्रवाहिका सा तूर्ध्वं शुष्कोद्गारा इति ।। २१ ।।
The cutting pain in the anus in connection with purging corresponds to the digging in the throat in a case of vomiting. The oozing out of the faecal matter downward (Parisrava) in connection with a purgative corresponds to the water-brash in the case of an emetic. What diarrhoea (Pravahika) is to purging, a dry eructation is to vomiting. 21
यास्त्वेता व्यापदः प्रोक्ता दश पञ्च च तत्त्वतः । एता विरेकातियोग दुर्योगायोगजाः स्मृताः ॥ २२ ॥
Memorable Verse: The fifteen kinds of distempers (Vyapat) described in the present chapter originate through an excessive, injudicious or insufficient use of purgatives or emetics. 22
इति सुश्रुत संहितायां चिकित्सितस्थाने वमनविरेचनव्यापच्चिकित्सितं नाम चतुस्त्रिंशोऽध्यायः ।। ३४ ।।
Thus ends the Thirty-fourth Chapter of the Chikitsa Sthana in the Susruta Samhita which deals with the treatment of the disorders resulting from an injudicious use of purgatives and emetics.