We shall now expound the chapter-Vamana Virecana Vyapat Siddhi-management of complications of emesis and purgation therapies; thus said Atreya and other great sages.
अथातो वमनविरेचनव्यापत्सिद्धि व्याख्यास्यामः । स्माहुरात्रेयादयो इति ह महर्षयः ।
Vamana ayoga – inadequacy of emesis therapy
वमनं मृदुकोष्ठेन क्षुद्वताऽल्पकफेन वा । अतितीक्ष्णहिमस्तोकमजीर्णे दुर्बलेन वा ॥ १ ॥
प्रयात्यधस्तस्मिन्निष्टहानिर्मलोदयः ।
पीतं वामयेत्तं पुनः स्निग्धं स्मरन् पूर्वमतिक्रमम् ॥ २ ॥
Ementic drug administered to those who have soft bowels, who are hungry, who have slight increase of kapha, the recipe if very strong, very cold, or very little in quantity, consumed by persons who have indigestion and who are debilitated, comes out by the downward route (through the rectum). By that, there is loss of purpose, and increase of the mala (dosa). Such a patient should be made to vomit again (by administering the emetic recipe) after making him lubricated (by oleation therapy) remembering the mistake committed earlier. 1-2.
Virecana ayoga – inadequacy of purgation therapy
अजीर्णिनः श्लेष्मवतो व्रजत्यूर्ध्वं विरेचनम् । अतितीक्ष्णोष्णलवणमहृद्यमतिभूरि वा ॥ ३ ॥
तत्र पूर्वोदिता व्यापत्सिद्धिश्च, न तथाऽपि चेत् । आशये तिष्ठति ततस्तृतीयं नावचारयेत् ॥ ४ ॥
अन्यत्र सात्म्याद्धृद्याद्वा भेषजान्निरपायतः ।
Purgative recipe administered to those who have indigestion and accumulation of slesman (kapha) the recipe if very strong, very hot (in potency) salty, unpleasant or large in quantity-comes out through the upper route, (through the mouth). By that the same hazards described earlier (loss of purpose and increase of dosa) occur. The treatment for that is also the same described earlier (administration of a second dose of medice after giving oleation therapy). If even by this the purgative medicines does not remain inside the abdomen (alimentary tract), then a third dose should not be administered except when the drug is that which is habituated, pleasant and harmless. 3-5a.
अस्निग्धस्विन्नदेहस्य पुराणं रूक्षमौषधम् ॥ ५ ॥
दोषानुत्क्लेश्य निर्हर्तुमशक्तं जनयेद्गदान् । विभ्रंशं श्वयथुं हिध्मां तमसो दर्शनं तृषम् ॥ ६॥
पिण्डीकोद्वेष्टनं कण्डूमूर्वोः सादं विवर्णताम् । स्निग्धस्विन्नस्य वाऽत्यल्पं दीप्ताग्नेर्जीर्णमौषधम् ॥ ७॥
शीतैर्वा स्तब्धमामे वा समुत्क्लेश्याहरन्मलान् । तानेव जनयेद्रोगानयोगः सर्व एव सः ॥ ८ ॥
Purgative recipe administered to the person who has bot been given oleation and sudation therapies, the drug if old and dry (non-unctous), leads to excitation increase of the dosas, and being unable to expel them out of the body gives rise to diseases such as vibhramsa (absence of desire in anything), swelling, hiccup, seeing darkness ( fainting ), thirst, twisting pain in the calves, itching, weakness of the thighs and discolouration.
Very little quantity of purgative recipe administered to the person who has been given oleation and sudation therapies, when the medicine gets digested by strong digestive fire, when it becomes inactive by cold (use of cold water for drinking and ablutions, eating cold foods etc.) or when there is ama (undigested mebolities) in the body, then also the medicine leads to increase of malas (dosas) and being unable to expel them out gives rise to the same diseases (lack of desire, swelling, hiccup etc.). All these are Ayoga (inadequacy of purgative therapy). 5b-8.
तं तैललवणाभ्यक्तं स्विन्नं प्रस्तरसङ्करैः । निरूढं जाङ्गलरसैर्भोजयित्वाऽनुवासयेत् ॥ ९ ॥
फलमागधिकादारुसिद्धतैलेन मात्रया | स्निग्धं वातहरैः स्नेहैः पुनस्तीक्ष्णेन शोधयेत् ॥ १० ॥
Such a patient should be anointed with oil mixed with salt, made to perspire by prastara and samkara methods (two kinds of exposure to steam), then administered a niruha (decoction enema), he should then be given food along with juice of meat of animals of desert-like regions, followed by an anuvasana (oil enema ), using the oil prepared with phala (madana), magadhika and daru. After this, he should be given oleation therapy, using fats which mitigate vata and then purified (administered purgative therapy) with strong drugs. 9-10.
Mithya yoga – improper therapy
बहुदोषस्य रूक्षस्य मन्दाग्नेरल्पमौषधम् । सोदावर्तस्य चोत्क्लेश्य दोषान् मार्गान् निरुध्य तैः ॥ ११ ॥
भृशमाध्मापयेन्नाभिं पृष्ठपार्श्वशिरोरुजम् । श्वासं विण्मूत्रवातानां सङ्गं कुर्याच्च दारुणम्॥१२॥
अभ्यङ्गस्वेदवर्त्यादि सनिरूहानुवासनम् । उदावर्तहरं सर्वं कर्माध्मातस्य शस्यते ॥ १३ ॥
पञ्चमूलयवक्षारवचाभूतिकसैन्धवैः सुकृता यवागूः शूलविबन्धानाहनाशनी ॥ १४ ॥
Small quantity of the (purgative) recipe administered to persons having profound increase of dosas, to those who are dry, who have weak digestive activity, and who have udavarta (upward movement of vata) increases the dosas and getting hindered in their movement of them (increased dosas) produce profound distention of the ( area around) umbilicus, pain in the back, flanks and head, dyspnoea and severe ob struction of the faeces, urine and flatus. For such conditions, oil massage, sudation, rectal wick ( suppository), niruha (decoction enema ), anuvasana (oil enema) and all other therapies which relieve udavarta are beneficial; for the person having distention of the abdomen, yavagu (thin gruel) prepared with pancamula, yavaksara, vaca, bhutika, and saindhava and well processed (with addition of trikatu, lavana and fats ) cures colic, obstruction of faeces etc, and distention of the abdomen. 11-14.
पिप्पलीदाडिमक्षारहिङ्गुशुण्ठ्यम्लवेतसान् स सैन्धवान् पिबेन्मद्यैः सर्पिषोष्णोदकेन वा ॥ १५ ॥ प्रवाहिकापरस्त्राववेदनापरिकर्तने ।
(Powder of) pippali, dadima, ksara, hingu, sunthi, amlavetasa and saindhava should be consumed along with either madya ( wine ) , sarpis ( ghee ) or warm water for the cure of pravahika ( dysestery ) , parissrava (slimy discharge from the rectum) and parikartini vedana (cutting pain in the rectum). 15-16a.
॥१७॥ पीतौषधस्य वेगानां निग्रहान्मारुतादयः ॥ १६ ॥
कुपिता हृदयं गत्वा घोरं कुर्वन्ति हृद्ग्रहम् । हिध्मापार्श्वरुजाकासदैन्यलालाक्षिविभ्रमैः जिह्वां खादति निःसंज्ञो दन्तान् कटकटाययन् ।
न गच्छेद्विभ्रमं तत्र वामयेदाशु तं भिषक् ॥ १८ ॥
मधुरै: पित्तमूर्च्छार्तं कटुभिः कफमूर्च्छितम् । पाचनीयैस्ततश्चास्य दोषशेषं विपाचयेत् ॥ १९ ॥
कायाग्निं च बलं चास्य क्रमेणाभिप्रवर्धयेत् ।
By suppressing the urges (of purgations) arising after the consumption of the medicines, maruta (vata) and others (dosas) get aggravated/increased and produce severe catching pain in the heart, accompanied with hiccup, pain in the flanks, cough, helplessness, excess salivation and rolling of the eye balls; the patient chews his tongue, loses consciousness and grinds his teeth. At such a state the physician should not become agitated but should make the patient vomit immediately by administering emetic drugs of sweet taste if the patient is unconscious by pitta, with those of pungent taste; if he is unconscious by kapha, next the residual dosas should be got cooked (mitigated) by drugs which promote digestion. His digestive activity and strength of the body should be improved gradually. 16b-20a.
Vamana Atiyoga – excessive emesis therapy
पवनेनातिवमतो हृदयं यस्य पीड्यते ॥ २० ॥ तस्मै स्निग्धाम्ललवणान् दद्यात्पित्तकफेऽन्यथा ।
By excess of vomitting, there arises pain in the heart due to (increase of ) vata; for such a patient medicines which possess unctousness, sour and salt taste should be administered. In case of (increase of) pitta and kapha, the drugs of opposite qualities (dry, sweet and cold) should be given. 20b-21a.
पीतौषधस्य वेगानां निग्रहेण कफेन वा ॥ २१ ॥
रुद्धोऽति वा विशुद्धस्य गृह्णात्यङ्गानि मारुतः । स्तम्भवेपथुनिस्तोदसादोद्वेष्टार्तिभेदनैः ॥२२॥ तत्र वातहरं सर्वं स्नेहस्वेदादि शस्यते ।
After consuming the medicine, if the urges (of vomitting) are suppressed or their channels are obstructed by kapha or by excess of purification (by more of vomittings) maruta (vata) (getting increased) seizes the body producing rigidity, tremors, continuous pricking pain, debility, twisting pain and cutting pain. In such a condition oleation, sudation and all other remedial measures which mitigate vata are recommended.
बहुतीक्ष्णं क्षुधार्तस्य मृदुकोष्ठस्य भेषजम् ॥ २३ ॥
हृत्वाऽऽशु विपित्तकफान् धातूनास्त्रावयेद्रवान्। तत्रातियोगे मधुरैः शेषमौषधमुल्लिखेत् ॥ २४ ॥
योज्योऽति वमने रेको विरेके वमनं मृदु । परिषेकावगाहाद्यैः सुशीतैः स्तम्भयेच्च तम् ॥ २५ ॥
अञ्जनं चन्दनोशीरमजासृक्शर्करोदकम् । पिबेन्मन्थमतियोगहरं लाजचूर्णै: परम् ॥ २६ ॥
Very powerful drug administered to the patient who is suffering from hunger or who is having soft bowels, expels the faeces, pitta and kapha quick and causes discharge of liquid tissues. In such excess bouts, the medicines remaining inside should be brought out by drugs should be administered and in case of more of purgations, mild emetics; excess bouts should be controlled by pariseka (pouring cold water on the body) or by avagaha (immersing the patient in cold water) etc. (applying cold packs, fanning and other methods of cooling the body) mantha (groats/sweet paste) prepared from anjana (sauviranjana), candana, usira, goats blood and sugar water which is best to control excess bouts should be consumed. 23b-26.
वमनस्यातियोगे तु शीताम्बुपरिषेचितः । पिबेत्फलरसैर्मन्थं सघृतक्षौद्रशर्करम् ॥ २७ ॥
सोद्गारायां भृशं छर्द्या मूर्वाया धान्यमुस्तयोः | समधूकाञ्जनं चूर्णं लेहयेन्मधुसंयुतम् ॥ २८ ॥
In case of excess bouts of vomitings, cold water should be poured over the body and mantha (groats) prepared with juice of fruits mixed with ghee, honey and sugar should be consumed, when there is severe erectations ( belching) associated with excess of vomitting, powder of murva, dhanya, musta, madhuka and anjana, mixed with honey should be licked. 27-28.
वमतोऽन्तः प्रविष्टायां जिह्वायां कवलग्रहाः । स्निग्धाम्ललवणा हृद्या यूषमांसरसा हिताः ॥ २९ ॥
फलान्यम्लानि खादेयुस्तस्य चान्येऽग्रतो नराः । निःसृता तु तिलद्राक्षाकल्कलिप्तां प्रवेशयेत् ॥ ३० ॥
If the tongue has gone deep inside due to excess of vomiting, kavala (mouth gargling) with soups and meat juices added with fats, sours and salts and pleasant to the mind are beneficial. Another person should sit in front of the patient and eat sour fruits. When the tongue comes out, it should be smeared with the paste of tila and draksa and then pushed in.
वाग्ग्रहानिलरोगेषु घृतमांसोपसाधिताम् ।
यवागूं तनुकां दद्यात्स्नेहस्वेदौ च कालवित् ॥ ३१ ॥
In case of obstruction to speech and such other disorders of anila (vata) thin yavagu (gruel) processed with ghee and meat should be given, oleation and sudation therapies suitable to the time ( season) administered. 31.
अतियोगाच्च भैषज्यं जीवं हरति शोणितम् । तज्जीवादानमित्युक्तमादत्ते जीवितं यतः ॥ ३२ ॥
शुने काकाय वा दद्यात्तेनान्नमसृजा सह । भुक्तेऽभुक्ते वदेज्जीवं पित्तं वा भेषजेरितम् ॥ ३३ ॥
शुक्लं वा भावितं वस्त्रमावानं कोष्णवारिणा । प्रक्षालितं विवर्णं स्यात्पित्ते शुद्धं तु शोणिते ॥ ३४ ॥
That medicine which by excess bouts (of vomitting) takes away the jiva sonita (life supporting blood) is known as jivadana, since it takes away the life. The food mixed with the blood (coming out by excess bouts) should be given to either a dog or a crow, if the animal eats it or rejects it, then the blood is to be decided as jiva sonita (life supporting blood or pure blood) and pitta increased by the medicines, respectively; if a white cloth soaked in the blood when washed with warm water becomes discoloured then it is pitta and if it re32-34. mains clean white, then it is pure blood.
Virecana atiyoga – excess of purgation therapy
तृष्णामूर्च्छामदार्तस्य कुर्यादामरणात्क्रियाम् । रक्तपित्तातिसारघ्नीं तस्याशु प्राणरक्षणीम् ॥ ३५ ॥
मृगगोमहिषाजानां सद्यस्कं जीवतामसृक् । पिबेज्जीवाभिसन्धानं जीवं तद्व्याशु गच्छति ॥ ३६ ॥
तदेव दर्भमृदितं रक्तं बस्तौ निषेचयेत् । श्यामाकाश्मर्यमधुकदूर्वोशीरैः शृतं पयः ॥ ३७ ॥
घृतमण्डाञ्जनयुतं बस्तिं वा योजयेद्धिमम् । पिच्छाबस्तिं सुशीतं वा घृतमण्डानुवासनम् ॥ ३८ ॥
The patient having thirst, fainting (unconsciousness) and toxicity should be administered therapies, which cure rakta pitta (bleeding disease) till the last moment of death, he should be made to drink fresh blood of the deer, cow, buffalow or goat, which protects the life and replenishes the blood lost. The same (blood) churned along with darbha grass should be administered as an enema, milk boiled with syama, kasmarya, madhuka, durva and usira, added with scum of ghee and anjana should be administered as enema in cold state or a piccha basti (enema containing slimy material) or anuvasana basti (lubricating retention enema) 35-38. should be administered.
गुदं भ्रष्टं कषायैश्च स्तम्भयित्वा प्रवेशयेत् । farisi श्रावयेत्सामवेणुगीतादिनिस्वनम् ॥ ३९॥
The protruded rectum (prolapse of the rectum) should be made static/hard by application of paste of astringent drugs and then pushed in the unconscious patient should be made to hear the melodeous notes of samaveda hymns, the flute and other songs. 39.
Notes In Astanga sangraha, twelve vyapats (complications) arising from Vamana and Virechana therapies are enumerated, they are
1) Pratikula gati-movement in reverse direction,
2) paka-drug undergoing digestion,
3) gratithatva-drug getting enveloped by dosas and made inactive,
4) gaurava-feeling of heavyness of the body,
5) dosotklesa-dosas getting excited but not going out,
6) bhrsadhmana-profound flatulence,
7) parikarta cutting pain in the rectum,
8) parisrava slimy discharge from the rectum,
9) pravahika-staining at stools/tenesmus,
10) hrdgraha-catching pain in the region of the heart,
11) sarvagatra parigraha/stiffness/rigidity/loss of movements in all the body parts,
12) saha dhatu sravana-evacuations associated with discharge/depletion of tissues (body water, blood, muscle etc.).
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां
पञ्चमे कल्पसिद्धिस्थाने वमनविरेचनव्यापत्सिद्धिर्नाम
Thus ends the chapter Vamana-Virecana Vyapat Siddhi the third in of Astangahrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
