अथातो वातशोणितचिकित्सितं व्याख्यास्यामः । इतिह स्माहुरात्रेयादयो महर्षयः ।। १ ।।
We will now expound – Vatasonita chikitsa – treatment of Gout, thus said Atreya and other great sages. (1)
VATASONITA CHIKITSA – Treatment of Gout – Vatarakta Chikitsa
वातशोणितिनः स्निग्धस्य दाहरागरुक्तोदेषु जलौकोभिः कण्डूपतापस्वः पचिमिचिमायनेषु शृङ्गतुम्बैर्दशादेशान्तरंसञ्चर सिरया प्रच्छानेन वा दुष्टमसृगसकृदल्पमवसेचयेत् ॥ २ ॥
The patient of Vatasonita (gout), who has been administered oleation therapy, should be made to bleed by using leeches if there is burning sensation, redness, pain and pricking; by using a horn or a bottle gourd if there is itching, mild warmth, loss of sensation and tingling sensation; by cutting the vein or by scrapping if the pain is travelling from place to place – the bad (vitiated) blood should be let out not at once (but many times) and in little quantity. (2)
असृक्क्षये हि गम्भीरशोफस्तम्भकम्पग्लानिसङ्कोचादयः स्युः सिराव्यधोक्ताश्च मूर्छादयः । नैव च स्रावयेदङ्गग्लानौ रूक्षे वातोत्तरं च रक्तम् । ततश्च पुनः स्नेहयुक्तानि रूक्षाणि वा विरेचनानि बस्तिकर्म चासकृत प्रयोजयेत् ।। ३ ।।
By loss of blood (due to heavy bleeding) severe swelling, stiffness tremors, debility, cohtractures etc, develop, so also fainting and other diseases mentioned in the chapter of siravyadha (chapter 36 of the sutrasthana). If weakness of the body, dryness and predominance of vata are present, blood should not be let out; then the patient should be administered either lubricant or non-lubricant purgative and enema therapies repeatedly. (3)
अथ वातप्रबले पुराणघृतं पिबेच्छतावरीघृतं वा ॥ ४ ॥
If vata is predominant, the patient should be made to drink old ghee or satavarighrita (4)
Jivaniya ghrita
दशमूलपुनर्नवद्वयैरण्डमुद्गपर्णीमाषपर्णीमहामेदाशतावरीरास्त्रावाक्पुष्पीशङ्खपुष्पीबलातिबला द्विपलांशाः पृथक् जलद्रोणे विपाचयेत् । पादशेषे च तत्तुल्यानि पृथक् छागमांसामलकेक्षुरसघृतक्षीराणि संयोज्य कल्कं च पिप्पलीमरिचकाश्मर्यफलोत्पलद्विमेदाद्विश्रावणीवीरापुर्ननव नागरसमङ्गातुगाक्षीरीक्षीरकाकोलीद्राक्षाक्षोडपद्ममबीजशृङ्गाटकनिकोचकभव्योरुमाणखर्जूरवाताममुञ्जाताभिषुकाणां पुनः पचेत् । एतज्जीवनीयाख्यं सर्पिर्वातविकारान् विशेषतश्च पाण्डुरोगज्वरापस्मारभगन्दरश्वासकासहिध्मास्वरभेदपार्श्वशूलयकृत्प्लीहमूत्रसङ्गाश्मरीवातशोणितसर्वाङ्गै काङ्गरोगानपहरति । बल्यं वर्ण्य वृष्यं चक्षुष्यं पुत्रदं च । तैलसात्म्यो वा क्षीरसितोपेतंतैलंपिबेत् ॥५॥
Dashamoola, the two punarnava, eranda, mudgaparni, masaparni, mahameda, satavari, rasna, avakpuspi, sankhapuspi, bala, atibala-each two pala, are boiled in one drona of water, decoction reduced to a quarter; to that are added equal quantities of each of goats milk, juice of amalaka and sugarcane, ghee and milk, paste of pippali, maricha, kasmaryaphala, utpala, the two meda, the two srvani, vira, punarnava, nagara, samanga, tugaksiri,kshirakakoli, draksa, aksoda, padmabija, Sringataka, nikocaka, bhavya, urumana, kharjura, vatama, munjata and abhisuka – all are cooked together and medicated ghee prepard. This recipe known as Jivaniya ghrita especially cures all disease of vata, and also anaemia, fever, epilepsy, rectal fistula, dyspnoea, cough hiccup, hoarseness, pain in the flanks, disease of the liver and spleen obstruction to micturition, urinary calculi, gout, hemiplegia; is aphrodisiac, good for the eye and provides children. (5)
अथवाशतावरीमयूरक क्षीरविदारीबलाद्वयतृणपञ्चमूलक्वाथे पद्मकादिगर्भंसाधितम् | बला- तैलं वा वातव्याध्युक्तम् । शतपाकं वा । वातहरसिद्धेन पयसाम्लैर्वा स्पर्शसुखंपरिषेकं कुर्वीत ||६||
Patients (of gout) are accustomed to oil, can drink oil (medicated) mixed with milk and sugar; or the oil prepared from decoction of Satavar mayuraka (apamarga) kshiravidari, the two bala and trna panchamula, and the paste of drugs of padmakadi gana (chapter 16 of sutrasthana) or bala taila described in the treatment of vatavyadhi or the same cooked one hundred times.
Milk medicated with drugs which a subdue vata or sour liquids processed likewise made comfortably warm should be poured repeatedly over the body. (6)
प्रत्येकशो यवगोधूमतिलमुद्गमाषेषु काकोलीजीवकर्षभकबलातिबला शृगालविन्नामेषशृङ्गीप्रियालसितोपलासुरभिवचाकशेरुकल्कमिश्रेषूपनाहार्थं सर्पिस्तैलवसामज्जदुग्धसिद्धान पञ्च पायसानुपकल्पयेत् । स्नैहिकफलमज्जोत्कारिकांवा | बिल्वपेशिकातगरदेवदारुसरलरास्नाहरेणुकुष्ठतपुष्पाभिर्वादधिमस्तुयुक्ताभिरुपनाहः ॥७॥
Five kinds of payasa ( milk pudding ) are prepared from yava (barley) godhuma (wheat), tila (sesame ), mudga ( green-gram) and masa (black-gram ) ( one from each seperately) and mixed with the paste of kakoli, jivaka, rsabhaka, bala, atibala, srigalavinna, imesasrringi, priyala, sitopala, surabhi, vacha and kaseruka, ghee, oil, fat, marrow and milk – all are cooked together. This should be used for warm application over the body; poultice made of the marrow of fatty fruits or poultice of marrow of bilva, tagara, devadaru, sarala, rasna, harenuka, kustha and satapushpa, mixed with whey may be tied warm over the body. (7)
यवमधुकैरण्डबीजपुनर्नवैर्धान्याम्बुपिष्टैः प्रलेपः । मातुलुङ्गाम्लवेतससैन्धवघृतमिश्रं वाशिग्रुमूलम् । सहचरजीवन्तीमूलं वा । रास्त्रामधुकगुडूचीबलाद्वयजीवकर्षभकल्कक्षीरसिद्धं ससिक्थकं सर्पिरभ्यङ्गः ॥८॥
Application over the body of a paste of yava, madhuka, eranda bija and punarnava made with dhanyambu, or paste of sigrumula mixed with matulumga, amlavetasa, saindhava and ghee; or that of roots of sahachara, and jivanti should be made. Ghee processed with the paste of rasna, madhuka, guduchi, the two bala, jivaka and rsabhaka along with milk and bees wax should be used for massage and bath. (8)
पित्तप्रबले द्राक्षारेवतफलपयस्यामधुकचन्दनकाश्मर्यकषायं शर्करामधुमधुरं पाययेत् । शतावरीपटोलत्रिफलागुडूचीकटुकाकषायं वा । स्वादुतिक्तवर्गसिद्धं च सर्पिः क्षीरं च । रास्त्राभीरुदशमूलबलासिद्धं वा । धारोष्णं वा । विरेकार्थे त्रिवृच्चूर्णयुक्तं वा । क्षीराहारो वा क्षीरेणैरण्डतैलं बहुशः पिबेत् । अमृतारग्वधाटरूषककषायेण वा । क्षीरबस्तीन् वा सघृतान् दद्यात् ॥९॥
If pitta is predominant, decoction of draksa, arevataphala, payasya, madhuka, chandana and kasmarya, made sweet with sugar and honey should be consumed; or the decoction of satavari, patola triphala, guduchi and katuka, ghee and milk boiled with group of drugs of sweet and bitter taste; or that prepared from rasna, abhiru, dashamoola and bala or fresh warm milk (direct from the udder) may be consumed; for producing purgations the use of milk mixed with powder of trivrit, or taking eranda, alone with decoction of amrita, aragvadha and atarusaka; or kshirabasti (enema containing more of milk) mixed with ghee may be administered. (9)
शीतैश्च चन्दनपद्मकबिसमृणालादिभिः शृतेन क्षीरेण परिषेक: । क्षीरेक्षुरसमधुशर्करातण्डुलोदकेन वा | द्राक्षामधुककाश्मर्ययुतेन वा । धान्याम्लेन वा जीवनीयसिद्धेन वा सर्पिषा शतधौतेन वा ।। १० ।
Milk boiled with chandana, padmaka, bisa, mrinala, etc and allowed to cool should be poured over the body often, or it may be done with cold milk mixed with sugarcane juice, honey, sugar and rice-wash, or mixed with draksa, madhuka, kasmarya or with dhanyamla (fermented rice wash) or with ghee boiled with drugs of jivaniya gana (chapter 15 of sutrasthana) or with satadhauta ghrita ( ghee washed a hundered times). (10)
मसूरोशीरप्रपौण्डरीकदार्वीमधुकमञ्जिष्ठाचन्दनोत्पलपद्मकैरकासक्तुभिः सघृतक्षीरशर्करैः प्रदहे दाहरागरुग्विसर्पशोफहरः । गोधूमचूर्णोवाछागक्षीरसंयुक्तोलेपः । तिलाश्च पयसा पिष्टाः भृष्टाः कपाले पुनः पयसिप्रक्षिप्यनिर्वापिताः ॥११ ।।
Application of paste of masura, usira, prapaundariika, darvi, madhuka, manjistha, chandana, utpala, padmaka, eraka, flour mixed with ghee, milk and sugar, relieves burning sensation, redness, pain, spreading and swelling; application of paste of wheat flour mixed with goats milk or that of tila made into a paste with milk, fried on a frying pan, soaked again in milk and made cool (can also be applied over the body). (11)
रक्तप्रबलेऽप्येवं बहुशश्च शोणितमवसेचयेत् ।।१२।।
For (vatasonita) which has the predominance of rakta (blood) the treatment is the same, along with blood letting being done many times. (12)
लेष्मप्रबले धात्रीनिशामुस्ताकषायं मधुमधुरपिबेत् । त्रिफलाकषायंवा | मधुकशृङ्गिवेराभयाकटुरोहिणीनिर्यूहं वा ।
यथार्हस्त्रेहपीतं च मृदु वामयेद्विरुक्षयेच्च । न चातिसेकलेपान् दद्यात् ||१३||
If kapha is predominant, the patient should drink the decoction of dhatri, nisa, musta made sweet with honey or the decoction of triphala or of madhuka, srngavera, abhaya and katurohini; he should be administered mild emesis therapy if he is fit after making him drink medicated fats; he should also be given therapies to cause dryness inside, bathing the body and application of pastes should not be done in excess. (13)
निम्बसर्षपाश्वगन्धाक्षारतिलैः कोष्णैर्लेपः । वचागारधूमद्विनिशाकुष्ठशतपुष्पाभिर्वा | पुनर्नवेनवा सघृतेन | तिलसर्षपातसीयवचूर्णोवा | लेष्मातककपित्थमधुशिग्रुमिश्रः क्षारमूत्रपिष्टः कटुकस्कन्धसिद्धैः क्षारोदकतैलमूत्रैः सेकः ॥१४॥
Warm application of paste of nimba, sarsapa, ashwagandha, kshara and tila or of vacha, agaradhuma, two nisa, kustha, and satapushpa; or with that of punarnava mixed with ghee; or tila, sarsapa, atasi and flour of yava, alkaline solution prepared from the group of drugs possessing pungent taste (vide chapter 18 of sutrasthana) along with slesmataka, kapittha, madhusigru, made into a paste with cows urine added with kshara (yavakshara) oil and cows urine only be used for pouring on the body. (14)
संसर्गे मिश्रं यथोद्रेकं वा प्रतिकुर्यात् । सर्वेषु च यथायथं गुड़चीं गुडहरीतकीं पिप्पलीवर्धमानं वाशीलयेद्वस्तिकर्मचाभीक्ष्णमिति । भवति चात्र ।। १५ ।।
If the disease, has arisen out of combination of either two or all the three doshas, the predominant among them should be treated first.
In all varieties, guduchi, guda (jaggery) and haritaki; or pippali vardhamana recipes should be resorted to habitually and also enema therapies often. (15)
Further, some verses here
बाह्यमालेपनाभ्यङ्गपरिषेकावगाहनैः । विरेकास्थापनस्त्रेहपानैरान्तरमाचरेत् ।।१६।।
External application of pastes, oil massage, pouring warm liquid over the body, tubbath, purgatives, decoction enema and drinking of medicated fats, should be administered repeatedly. (16)
सर्पिस्तैलवसामज्जपानाभ्यञ्जनबस्तिभिः | लेपोपनाहसेकैश्चकोष्णैर्वातोत्तरंजयेत् ॥१७॥
That (vatasonita) having the predominance of vata should be subdued by the use of (medicated) ghee, oil, fat and marrow in the form of drinking, massage and enemas, warm application of pastes, poultices and formentations. (17)
विरेचनैर्घृतक्षीरपानसेचनबस्तिभिः । पित्तरक्तोत्तरंवातरक्तं लेपैश्चशीतलैः ॥ १८ ॥
That having the predominance of pitta or rakta (blood) by purgations, drinking of (medicated) ghee and milk, by pouring liquids over the body, enema therpay and by applications of pastes in a coled conditions. (18)
वमनं मृदु नात्यर्थं स्नेहसेकादिलङ्घनम् । कोष्णा लेपाश्चशस्यन्ते वातरक्ते कफोत्तरे । ॥ १९ ॥
Mild emesis therapy, not too much of oleation and fomentation fasting and other slimming measures and warm application of pastes are ideal for that having the predominance of kapha. (19)
वातश्लेष्मोत्तरेशीतैः प्रलिप्ते वातशोणिते । विदाहशोफरुक्कण्डूविवृद्धिः स्तम्भनाद्भवेत् ॥ २० ॥
In those having the predominance of vata and kapha, cold application of paste will result in the increase of burning sensation, swelling, pain and itching because of stagnation of doshas. ( 20 )
पित्तरक्तोत्तरेवातरक्ते लेपादयोहिमाः । उष्णैः प्लोषोषरुग्रागस्वेदावदरणोद्भवः ॥ २१ ॥
In those having the predominance of pitta and rakta (blood) cold application of pastes will result in the increase of local burning, sensation, burning sensation all over the body, pain, redness, sweating and exudation by the heat (obstructed by cold application). (21)
Madhuyasti taila
मधुयष्ट्याः पलशतत् कषाये पादशेषिते । तैलाढकं समक्षीरंपचेत् कल्कैः पलोन्मितैः ॥ २२ ॥
शतपुष्पावरीमूर्वापयस्याभीरुचन्दनैः । स्थिराहंसपदीमांसीद्विमेदामधुपर्णिभिः ॥ २३ ॥
काकोलीक्षीरकाकोलीतामलक्यर्धिपद्मकैः । जीवन्तीजीवकर्षभत्वक्पत्रनखवालकैः ||२४ ॥
प्रपौण्डरीकमञ्जिष्ठासारिवैन्द्रीवितुन्नकैः । चतुष्प्रयोगंवातासृपित्तदाहज्वरार्तिनुत् ॥ २५ ॥
Hundred pala of madhuyasthi are boiled in water and decoction reduced to a quarter; to this are added one adhaka of oil, equal quantity of milk and a paste of one pala each of satapushpa, vari, murva, payasya, abhiru, chandana, sthira, hamsapadi, mamasi, the two meda, madhuparni, kakoli, kshirakakoli, tamalaki, rddhi, padmaka, jivanti, jivaka, rsabhaka, tvak, patra, nakha, valaka, prapaundarika, manjistha, sariva, aindri, and vitunnakaare cooked and medicated oil prepared. This oil used in all the four forms (drinking, nasal drops and continuous pouring on the body) cures fever and burning sensation caused by pitta. (22-25)
मधुयष्ट्याः पलं दत्वा तैलप्रस्थं चतुर्गुणे । क्षीरेपचेच्छतं वारांस्तदेवं मधुच्छते || २६ ॥
सिद्धंंयोज्यंतृडुन्मादश्वासकासविसर्पिषु | हृत्पाण्डुरोगवातासृपित्तादिषु चपूर्ववत् ॥२७॥
Medicated oil is prepared from one pala of madhuyasthi, one prastha of oil and four parts of (prastha) of milk, the process is repeated one hundred times (every time adding fresh madhyasthi and milk), thus prepared (the satapaka madhuyasthi taila) it should be used, for the cure of thirst, incanity, dyspnoea, cough, erysepelas, heart disease, anaemia, gour and diseases of pitta origin like the earlier (recipes ) (26-27)
कुपिते मार्गसंरोधान्मेदसो वा कफस्य वा । अतिवृद्ध्यानिले शस्तं नादौ स्नेहनबृंहणम् ॥ २८ ॥
कृत्वा तत्राढ्यवातोक्तं वातशोणितिकं ततः । भेषजं स्नेहनं कुर्याद्यच्च रक्तप्रसादनम् ॥ २९ ॥
When vata gets greatly aggravated due to obstructed on its channels either by increase of either medas (fat) or kapha, then snehana (oleation) and brimhana (stoutening therapy) should not be administered first; the method of treatment prescribed for adhya vata (stiffness of the legs) should be done first and then that of gout, oleation therapy and measures to purify the blood. (28-29)
गम्भीरे रक्तमाक्रान्तं स्याच्चेद्वातेन वर्जयेत् । रक्तपित्तातिवृध्या तु पाकमाशु निगच्छति ॥ ३० ॥
भिन्नं स्रवति तद्रक्तं विदग्धं पूयमेव वा । तयोश्चिकित्सां व्रणवत् भेदशोधनरोपणीम् ॥ ३१ ॥
In the gambhira kind (vatarakta residing in deeper tissues ) if rakta (blood) gets invaded by vata, the it should be rejected (for treatment ). When the blood and pitta get aggravated greatly, paka (maturation, sippuration) sets in, the blood gets brokent and over burnt (becoming thin by these changes) and begins to flow out, or pus may flow out, For these, the line of treatment is like vrana (ulcer) comprising of puncturing, cleansing and healing; the complications should also be treated with appropriate treatments. (30-31)
कुर्यादुपद्रवाणां च तस्मात्तस्माच्चिकित्सितात् । प्राणादिकोपे युगपद्यथोद्दिष्टंयथामयम् ।
यथासन्नं च भैषज्यं विकल्प्यं स्वाद्यथाबलम् ॥ ३२ ॥
The conditions created by the aggravation of prana and other division of vata should be treated appropriately, as also the disease produced by such aggravation; treating the more urgent ones first and others next, planning themethods of treatment suitable to the strength (of the doshas and the patient) . ( 32 )
नीते निरामतां सामेस्वेदलङ्घनपाचनैः ।रूक्षैश्चालेपसेकाद्यैः कुर्यात्केवलवातनुत् ||३३॥
By adopting sudation, fasting and other thinning methods and digestive therapies, when the ama (unripe, immature) condition changes into nirama (ripe, mature) then treatments such as applying of dry pastes and dry fomentation should be done to subdue vata. (33)
Avarana vata chikitsa
वायौपित्तावृते शीतामुष्णांच बहुशः क्रियाम् । व्यत्यासाद्योजयेत्सर्पिर्जीवनीयं च पाययेत् ॥३४॥
धन्वमांसंयवः शालिर्विरेकः क्षीरवान्मृदुः । सक्षीरा बस्तयः क्षीरंपञ्चमूलबलाशृतम् ॥ ३५ ॥
कालेऽनुवासनं तैलैर्मधुरौषधसाधितैः । यष्टीमधुबलातैलघृतक्षीरैश्च सेचनाम् ।
पञ्चमूलकषायेण वारिणाशीतलेनवा ||३६ ॥
When vata gets covered (obstructed, hindred in its activity) by pitta, many kinds of cold and hot therapies should be adopted alternately; he should be made to drink jivaniya ghrita, partake meat of animals of desert-like regions, yava (barley) and sali (rice); mild purgatives along with milk, enema with milk (processed with drugs) drink milk boiled with drugs of pancham ula and bala; oil enemas at a proper time with oil processed with drugs of sweet taste, fomentation by pouring warm yasthimadhu taila, bala taila (medicated) ghrita and milk or pouring the decoction of panchamula, cold over the body (should be done ) . ( 34-36 )
कफावृते यवान्नानिजाङ्गला मृगपक्षिणः |स्वेदास्तीक्ष्णा निरूहाश्च वमनं सविरेचनम् ॥३७॥
पुराणसर्पिस्तैलं च तिलसर्षपजंहितम् । संसृष्टेकफपित्ताभ्यां पित्तमादौ विनिर्जयेत् ॥ ३८ ॥
When (vata) gets covered (obstructed in its functions) by kapha, use of foods prepared with yava ( barley), meat of animals and birds of desert-like regions, strong sudation, decoction enema, emesis and purgation therapies, use of old ghee and oils of tila and sarsapa are suitable.
If both kapha and pitta are associated together (to cause hinderance) then pitta should be subdued first. (37-38)
कारयेद्रक्तसंसृष्टे वातशोणितिक क्रियाम् । स्वेदाभ्यङ्गरसाः क्षीरं स्नेहो मांसावृते हितम् ॥ ३९ ॥
प्रमेहमेदोवातघ्नमाढ्यवाते भिषग्जतम् । महास्नेहोऽस्थिमज्जस्थेपूर्वोक्तं रेतसावृते ॥ ४० ॥
If (vata) is hindred by rakta (blood), then methods of treatment prescribed for vatasonita (gout) should be adhered to; sudation, oil massage, meat juice, milk and oleation therapies are suitable if hindred by mamsa (muscle tissue); if hindred by medas (fat tissue) treatment which cure diabetes, obsity and prescribed for stiffness of the legs should be adopted; if hindered by bone and marrow tissues, the use of mahasneha (combination of all the four fats ) is ideal and if hindered by retas (semen) treatments described earlier (in sukragata vata in vatavyadhi chapter 23 of chikitsathana and in putrakamiya chapter 1 of Sarisasthana) should be adopted. (39-40)
अन्नावृते पाचनीयं वमनं दीपनं लघु | मूत्रावृते मूत्रलानि स्वेदाश्चोत्तरबस्तयः । एरण्डतैलंवर्चस्थेबस्तिस्त्रेहाश्च भेदिनः ॥४१॥
If (vata) is hindred by anna (food), therapies like digestives, emesis, kindling hunger and making the body light should be followed; if hindred by mutra (urine) diuretics, sudations, and urinary douches; ifhindred by varca (faeces) drinking eranda taila, enemas containing fatty materials and purgatives (should be used). (41)
कफपित्ताविरुद्धं यद्यच्च वातानुलोमनम् । सर्वस्थानावृतेप्याशु तत्कार्यं मातरिश्वनि |॥ ४२ ॥
अनभिष्यन्दि च स्निग्धं स्त्रोतसांशुद्धिकारणम् | यापनाबस्तयः प्रायो मधुराः सानुवासनाः ॥४३॥
प्रसमीक्ष्य बलाधिक्यं मृदु कार्यं विरेचनम् । रसायनानां सर्वेषामुपयोगः प्रशस्ते ॥४४॥
शिलाह्वस्य विशेषेण पयसा शुद्धगुग्गुलोः । लेहो वा भार्गवस्तद्वदेकादशसिताशतः ॥ ४५ ॥
अपाने त्वावृते सर्वं दीपनं ग्राहि भेषजम् । वातानुलोमनं कार्यं मूत्राशयविशोधनम् ॥४६॥
इति सङ्क्षेपतः प्रोक्तमावृतानां चिकित्सितम् । प्राणाद्यानां भिषक् कुर्याद्वितर्क्य स्वयमेव तत् ॥४७॥
उदानं योजयेदूर्ध्वमपानं चानुलोमयेत् । समानं शमयेद्विद्वांस्त्रिधा व्यानं च योजयेत् ॥४८॥
प्राणो रक्ष्यश्चतुर्भ्योऽपि तत्स्थितौ देहसंस्थितिः । स्वं स्वं स्थानं नयेदेवं वृतान् वातान् विमार्गगान् ।।४९ ।।
In sarva avarana (hinderance of all the divisions of vata) the other two doshas, quick treatments should be done for matarisva (vata) which are not antagonistic to kapha and pitta, such as use of foods and drugs which are not abhisyandi (produce exudation in the channels, pores etc) which are unctous and which purify (clear) the channels, yapanakind of (decoction) enemas made from sweet drugs, along with oil enemas, mild purgative therapies in consideration of the good strength (of the patient) should be done.
For all (the patients) use the rasayanas (rejuvinatory therapies ) is best suited, especially the use of silahva (silajatu) and purified guggulu along with milk; or of Bhargavaleha (cyavanaprasa described in chapter 49 of uttarasthana); similarly of Ekadasa sitasata (a kind of brahmarasayana method in the same chapter).
If apana (division of vata) is hindred, the treatments are kindlihunger, absorption of water from the faeces, making vata move downwards, and purifications (clearing) of the urinary bladder.
Thus are described, in brief, the treatment of avarana of prana other divisions of vata; the physician should adopt the appropriate ones judging by his own intellect.
Udana should be controlled by adopting therapies which promote upward movement, apana by therapies which promote downward movement, samana should be pacified (mitigated in its own place), vyana should be controlled in all three directions (upward, downward and outward), prana should be protected more than the other four (divisions) because the very existence of body (living) depends upon it.
By these methods, the divisons of vata should be relieved of their hinderance and brought back to their respective (normal) places from their abnormal places. (42-49)
सर्वं चावरणं पित्तरक्तसंसर्गवर्जितम् । रसायनविधानेन लशुनो हन्ति शीलितः ॥५०॥
पित्तावृते पित्तहरंमरुतश्चानुलोमनम् । रक्तावृतेऽपि तद्वच्च खुडोक्तं यच्च भेषजाम् ।
पित्तरक्ता-निलहितं विविधं च रसायनम् ॥५१ ।।
Lasuna used in the rasayana method cures all kinds of avarana except those associated with pitta and rakta (blood).
In obstruction or hinderance by pitta, the treatment should be those which subdue pitta and produce downward movement of vata; in hiderance caused by rakta (blood) the treatment is the same, and also that prescribed for khuda (gout) and the use of various rasayana(rejuvinatory recipes) which are suitable for pitta, rakta and anila (vata). (50-51)
यथानिदानंनिर्दिष्टमितिसम्यक्चिकित्सितम् । आयुर्वेदफलं स्थानमेतत्सद्योऽर्तिनाशनात् ।।५२ ।।
Thus was described the treatment of diseases as enumerated in the Nidana sthana; this section embodies the fruits of Ayurveda, that is quick dispelling of pain and suffering. (52)
चिकित्सितं हितं पथ्यं प्रायश्चित्तंभिषग्जितम् । भेषजं शमनं शस्तं पर्यायैः स्मृतमौषधम् ॥५३॥
Ausadha (medication) is known by its other synonyms such as cikisita, hita, pathya, prayascitta, bhisagjita bhesaja, samana and sasta (53)
॥ इति चतुर्विंशोऽध्यायः ॥
Thus ends the Twentyfourth chapter.
Thus ends Chikitsa sthana (section on therapeutics) the Fourth Section.
