Now the treatment of arshas will be explained, as taught by the revered Dhanvantari. The text gives four therapeutic approaches: medicines, kshara, fire cautery, and surgical instruments. Recently developed cases with few doshas, signs, and complications are assigned to medicines; soft, spreading, deep-seated, and raised lesions to kshara; rough, fixed, broad, and hard lesions to fire cautery; and raised, moist lesions with a slender base to surgery. Medicines are also prescribed when the lesions are not visible. The procedures for cases assigned to kshara, cautery, and surgery are to be explained next.
The commentary explains that 'recently developed' means less than one year old, 'fixed' means not spreading, 'broad' means extensive, and 'hard' means not soft.
Key terms
arshas
The classical condition treated in this chapter.
bheShaja (bheshaja)
Medicinal treatment.
kShAra (kshara)
A caustic alkaline preparation used in a classical procedure.
The passage describes a historical kshara procedure for a sufficiently strong patient affected by arshas. It calls for preliminary oiling, sweating, and a small warm, unctuous, mainly liquid meal, followed by positioning and restraint, lubrication, introduction of an instrument, exposure and cleansing of the lesion, and application of kshara. The effect is observed and the application may be repeated according to the strength of the kshara and the disorder. A properly treated lesion is described as depressed, slightly bent, and resembling a ripe jambu fruit. The kshara is then washed away with sour liquids, the area is soothed with ghee mixed with yashtimadhu, and aftercare is given. Residual lesions may be treated again, one at a time at seven-day intervals, in the stated right, left, posterior, and anterior sequence.
The commentary preserves several interpretations of 'strong': some take it as mental fortitude, others as bodily robustness, and others as a patient who is not elderly, not extremely depleted, or predominantly courageous. It also records disagreement about food: some read the meal as preparation during the preceding two to five days, whereas others permit a small unctuous meal on the procedure day, interpreting the earlier fasting rule as limited to lesions of the mouth. It explains the moderate season, wooden board, attendants, closure of the instrument opening to intensify the burning action, and assessment of both kshara strength and lesion depth. Another source gives different colors for adequate burning according to the dosha. Dhanyamla, shukta, and fruit acid are identified as sour washing agents. Warm immersion is linked to kapha-vata association, while cool immersion is assigned to uncombined rakta or pitta conditions.
Key terms
kShArakarma (kshara-karma)
A classical procedure using a caustic alkaline preparation.
kShArabala (kshara-bala)
The strength or caustic potency of the preparation.
vyAdhibala (vyadhi-bala)
The strength or extent of the disorder, including depth or prominence here.
dhAnyAmla (dhanyamla)
A sour fermented grain liquid identified by the commentator as kanjika.
yaShTImadhuka (yashtimadhuka)
A named substance mixed with ghee for soothing the treated site.
Adhikarana 3 (5-6) · Śloka 6
tatra vātaślēṣmanimittānyagnikṣārābhyāṁ sādhayēt, kṣārēṇaiva mr̥dunā pittaraktanimittāni ||5||
tatra vātānulōmyamannaruciragnidīptirlāghavaṁ balavarṇōtpattirmanastuṣṭiriti samyagdagdhaliṅgāni, atidagdhē tu gudāvadaraṇaṁ dāhō mūrcchā jvaraḥ pipāsā śōṇitātipravr̥ttistannimittāścōpadravā bhavanti, dhyāmālpavraṇatā kaṇḍūranilavaiguṇyamindriyāṇāmaprasādō vikārasya cāśāntirhīnadagdhē ||6||
The text assigns arshas attributed to vata and shleshma to fire cautery or kshara, and those attributed to pitta and rakta to mild kshara alone. Signs of an adequate burn are restoration of vata's normal direction, desire for food, stronger digestive fire, lightness, recovery of strength and complexion, and mental satisfaction. Excessive burning may cause tearing of the anal region, burning pain, fainting, fever, thirst, profuse bleeding, and further complications arising from that bleeding. Inadequate burning is marked by a dark, small wound, itching, disturbance of vata, lack of clarity in the senses, and persistence of the disorder.
The commentary specifies that the resulting complications are caused by blood loss, and that dhyama denotes a dark or blackish-brown appearance.
Key terms
samyagdagdha (samyag-dagdha)
A lesion judged adequately cauterized according to the classical signs.
atidagdha (ati-dagdha)
Excessive burning or cauterization.
hInadagdha (hina-dagdha)
Insufficient burning or cauterization.
shoNitAtipravRutti (shonita-atipravritti)
Excessive discharge of blood.
Adhikarana 4 (7) · Śloka 7
mahānti ca prāṇavataśchittvā dahēt, nirgatāni cātyarthaṁ dōṣapūrṇāni yantrādvinā svēdābhyaṅgasnēhāvagāhōpanāhavisrāvaṇālēpakṣārāgniśastrairupācarēt; pravr̥ttaraktāni ca raktapittavidhānēna, bhinnapurīṣāṇicātīsāravidhānēna, baddhavarcāṁsi snēhapānavidhānēnōdāvartavidhānēna vā; ēṣa sarvasthānagatānāmarśasāṁ dahanakalpaḥ ||7||
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महान्ति च प्राणवतश्छित्त्वा दहेत्, निर्गतानि चात्यर्थं दोषपूर्णानि यन्त्राद्विना स्वेदाभ्यङ्गस्नेहावगाहोपनाहविस्रावणालेपक्षाराग्निशस्त्रैरुपाचरेत्; प्रवृत्तरक्तानि च रक्तपित्तविधानेन, भिन्नपुरीषाणिचातीसारविधानेन, बद्धवर्चांसि स्नेहपानविधानेनोदावर्तविधानेन वा; एष सर्वस्थानगतानामर्शसां दहनकल्पः ||७||
Meaning of the śloka
The passage says that large arshas in a patient with sufficient vitality should be cut and then cauterized. Severely protruding lesions described as filled with doshas may be managed without the instrument by measures including sweating, massage, unctuous applications, immersion, poultices, drainage, topical applications, kshara, fire cautery, or surgery. Active bleeding is to be managed according to the treatment of raktapitta, loose stool according to the treatment of atisara, and retained stool by internal oleation or the treatment of udavarta. This is presented as the cautery framework for arshas occurring at all bodily sites.
The commentary explains that the cautery following excision is by fire because kshara cautery has already been discussed. 'Filled with doshas' means filled with vata, pitta, kapha, or rakta. 'All sites' includes locations such as the genital region. The word 'cautery' is said to stand more broadly for the other listed measures, including oleation and surgery, even where each is not repeated explicitly.
Key terms
chedana
Cutting or excision.
dAha (daha)
Cauterization, specified by the commentator here as fire cautery.
visrAvaNa (visravana)
A drainage or evacuative procedure.
raktapitta (rakta-pitta)
A classical bleeding disorder whose treatment framework is referenced.
udAvarta (udavarta)
A classical condition involving obstructed or upward movement, referenced for retained stool.
Adhikarana 5 (8) · Śloka 8
āsādya ca darvīkūrcakaśalākānāmanyatamēna kṣāraṁ pātayēt |
bhraṣṭagudasya tu vinā yantrēṇa kṣārādikarma prayuñjīta |
sarvēṣu ca śāliṣaṣṭikayavagōdhūmānnaṁ sarpiḥsnigdhamupasēvēta payasā nimbayūṣēṇa paṭōlayūṣēṇa vā, yathādōṣaṁ śākairvāstūkataṇḍulīyakajīvantyupōdikāśvabalābālamūlakapālaṅkyasanacillīcuccūkalāyavallībhiranyairvā |
yaccānyadapi snigdhamagnidīpanamarśōghnaṁ sr̥ṣṭamūtrapurīṣaṁ ca tadupasēvēta ||8||
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आसाद्य च दर्वीकूर्चकशलाकानामन्यतमेन क्षारं पातयेत् |
भ्रष्टगुदस्य तु विना यन्त्रेण क्षारादिकर्म प्रयुञ्जीत |
सर्वेषु च शालिषष्टिकयवगोधूमान्नं सर्पिःस्निग्धमुपसेवेत पयसा निम्बयूषेण पटोलयूषेण वा, यथादोषं शाकैर्वास्तूकतण्डुलीयकजीवन्त्युपोदिकाश्वबलाबालमूलकपालङ्क्यसनचिल्लीचुच्चूकलायवल्लीभिरन्यैर्वा |
यच्चान्यदपि स्निग्धमग्निदीपनमर्शोघ्नं सृष्टमूत्रपुरीषं च तदुपसेवेत ||८||
Meaning of the śloka
When a lesion can be reached, the text directs application of kshara with one of several named applicators. For prolapse of the anal region, it says that kshara and related procedures may be performed without the instrument. It then prescribes foods made from shali rice, shashtika rice, barley, or wheat, made unctuous with ghee and taken with milk, nimba soup, patola soup, or vegetables selected according to the dosha. Other suitable food, drink, or medicinal substances should be unctuous, support digestive fire, oppose arshas, and permit the free passage of urine and stool.
The commentary says wheat is used despite being heavy because it is intended to promote moisture or suppuration and keep the kshara wound moist. It supplies regional identifications for several vegetables, though these identifications may be uncertain. The final phrase includes foods or medicines not individually named in the verse. 'Free urine and stool' means restoring their passage when obstruction caused by arshas has disturbed vata and retained them; the word 'and' also includes other substances mentioned elsewhere, such as palandu.
Key terms
bhraShTaguda (bhrashta-guda)
Prolapse or displacement of the anal region in this context.
kShAravraNa (kshara-vrana)
A wound produced by the caustic kshara procedure.
agnidIpana (agni-dipana)
Supporting or kindling digestive function in classical terms.
After arshas have been cauterized, the patient is directed to follow the general course of unctuous measures to kindle digestive fire and guard against aggravation of vata. More specifically, the text assigns ghee prepared with vata-reducing and digestive substances, combined with hingvadi powders, to vata-type arshas. For pitta-type arshas it describes ghee prepared in a decoction beginning with prithakparni and supplemented with digestive substances; for bleeding arshas, ghee prepared in a decoction beginning with manjishtha and murungi; and for shleshma-type arshas, ghee prepared in a decoction of the surasadi group. Complications are to be treated according to their individual character.
The commentary says this regimen also applies to uncauterized lesions. It distinguishes a general arshas regimen from the specific regimen following cautery for each dosha type. Bhadradaru and related substances exemplify the vata-reducing group, while pippali and related substances exemplify the digestive group. Decoction and paste are to follow the standard preparation method, and older authorities add hingvadi powder to the prepared ghee for vata conditions but pippalyadi paste to the other three preparations. It identifies the prithakparni group by reference to a wound-healing ghee, identifies murungi as madhushigru within the varunadi group, and connects the omitted phrase 'prepared ghee' to the later recipes. Complications such as gulma and fever are to receive their own respective treatment.
Key terms
sneha
Unctuous therapy or an unctuous medicinal substance.
dIpanIya (dipaniya)
A substance classically described as supporting digestive fire.
परं च यत्नमास्थाय गुदे क्षाराग्निशस्त्राण्यवचारयेत्, तद्विभ्रमाद्धि षाण्ढ्यशोफदाहमदमूर्च्छाटोपानाहातीसारप्रवाहणानि भवन्ति मरणं वा ||१०||
Meaning of the śloka
The passage insists on the greatest care when using kshara, fire cautery, or surgical instruments in the anal region. Incorrect use may cause impotence, swelling, burning, intoxication or confusion, fainting, abdominal distension, obstruction, diarrhea, straining, or death.
Because kshara and the other measures are extremely sharp or powerful and can cause many harms when misapplied, the commentary says the verse identifies excellent care as the single basis of proper use. It glosses param as 'the utmost' or 'excellent.'
Key terms
paraM yatnam (param yatnam)
The utmost care or effort.
vibhrama
Incorrect or disordered application.
mUrcchA (murchha)
Fainting or loss of consciousness.
AnAha (anaha)
Obstruction with abdominal distension in this context.
pravAhaNa (pravahana)
Straining or forceful bearing down.
Adhikarana 8 (11) · Śloka 11
ata ūrdhvaṁ yantrapramāṇamupadēkṣyāmaḥ- tatra yantraṁ lauhaṁ dāntaṁ śārṅgaṁ vārkṣaṁ vā gōstanākāraṁ caturaṅgulāyataṁ pañcāṅgulapariṇāhaṁ puṁsāṁ, ṣaḍaṅgulapariṇāhaṁ nārīṇāṁ talāyataṁ; tad dvicchidraṁ darśanārtham, ēkachidraṁ tu karmaṇi; ēkadvārē hi śastrakṣārāgnīnāmatikramō na bhavati; chidrapramāṇaṁ tu tryaṅgulāyatamaṅguṣṭhōdarapariṇāhaṁ, yadaṅgulamavaśiṣṭaṁ tasyārdhāṅgulādadhastādardhāṅgulōcchritōparivr̥ttakarṇikam; ēṣa yantrākr̥tisamāsaḥ ||11||
The text next describes the dimensions of an instrument. It may be made of metal, ivory or tooth, horn, or hard wood, and is shaped like a cow's teat. For men it is four aṅgulas long and five aṅgulas in circumference; for women its circumference is six aṅgulas and its length is related to the palm. A two-aperture instrument is for examination, while a single-aperture one is for treatment, because the single opening prevents a knife, alkali, or cautery from extending beyond the intended site. The opening is three aṅgulas long and about the circumference of the middle of the thumb. In the remaining one aṅgula, a raised circular rim is formed near the end. This is a concise description of its form.
The commentary explains that metal includes gold, silver, and other metals; dānta includes elephant and other tooth or ivory; śārṅga means buffalo and other horn; and wood should come from a sound heartwood tree such as śiṃśapā. Āyata means length and pariṇāha means circumference. It first understands talāyata as the length of one's own palm. Some authorities omit the separate description for women and use the same instrument for both sexes. Others read tadāyata instead of talāyata: on their interpretation the instruments differ in circumference but have the same length as the male instrument. The rim is half an aṅgula high and circular above. Some read apavṛttakarṇika; the commentary says that reading gives substantially the same sense. This account is only a summary, since the material, form, dimensions, and aperture are to vary with the size and shape of the affected channel and the location of the arśas.
Key terms
yantra
An instrument used here for examining or treating arśas.
aṅgula (angula)
A traditional finger-based unit of measure.
darśana (darshana)
Visual examination through the instrument.
śastra-kṣāra-agni (shastra-kshara-agni)
Knife, caustic alkali, and thermal cautery as historical treatment means.
karṇikā (karnika)
The raised circular rim described near the instrument's end.
The text then lists topical applications for arśas. The first combines turmeric powder with the latex of snuhī. A second combines powders of fowl feces, guñjā, turmeric, and pippalī, ground with cow urine and bile. A third uses a paste of dantī, citraka, suvarcikā, and lāṅgalī ground with cow bile. A fourth uses pippalī, rock salt, kuṣṭha, and śirīṣa fruit ground with snuhī latex or arka latex. It finally describes an oil processed with kāsīsa, haritāla, rock salt, aśvamāraka, viḍaṅga, pūtīka, kṛtavedhana, jambū, arka, uttamāraṇī, dantī, citraka, alarka, and snuhī liquids, claiming that application causes the arśas to fall away.
The labels first, second, and so forth are said to emphasize that every formula is very powerful; other authorities take them to mark the order of use, with each succeeding formula being stronger. The second paste is ground with both cow urine and cow bile. Kṛtavedhana is identified as kośātakī, jambū here as bhūmijambū, uttamāraṇī as yodhāmallī, arka as arka latex, and alarka as mandāra.
Key terms
arśas (arshas)
The classical anorectal lesions being treated in this chapter.
ālepa (alepa)
A topical paste or coating.
snuhī-kṣīra (snuhi-kshira)
The caustic latex of snuhī used as a processing liquid.
haritāla (haritala)
A mineral ingredient traditionally used in the oil formula.
śātayati (shatayati)
Causes the lesion to shed or fall away, as claimed by the text.
अत ऊर्ध्वं भेषजसाध्येष्वदृश्येष्वर्शःसु योगान् यापनार्थं वक्ष्यामः- प्रातः प्रातर्गुडहरीतकीमासेवेत, ब्रह्मचारी गोमूत्रद्रोणसिद्धं वा हरीतकीशतं प्रातः प्रातर्यथाबलं क्षौद्रेण, अपामार्गमूलं वा तण्डुलोदकेन सक्षौद्रमहरहः, शतावरीमूलकल्कं वा क्षीरेण, चित्रकचूर्णयुक्तं वा सीधुं परार्ध्यं, भल्लातचूर्णयुक्तं वा सक्तुमन्थमलवणं तक्रेण, कलशे वाऽन्तश्चित्रकमूलकल्कावलिप्ते निषिक्तं तक्रमम्लमनम्लं वा पानभोजनेषूपयुञ्जीत, एष एव भार्ग्यास्फोतायवान्यामलकगुडूचीषु तक्रकल्पः, पिप्पलीपिप्पलीमूलचव्यचित्रकविडङ्गशुण्ठीहरीतकीषु च पूर्ववदेव, निरन्नो वा तक्रमहरहर्मासमुपसेवेत, शृङ्गवेरपुनर्नवाचित्रककषायसिद्धं वा पयः, कुटजमूलत्वक्फाणितं वा पिप्पल्यादिप्रतीवापं क्षौद्रेण, महावातव्याध्युक्तं हिङ्ग्वादिचूर्णमुपसेवेत तक्राहारः क्षीराहारो वा, क्षारलवणांश्चित्रकमूलक्षारोदकसिद्धान् वा कुल्माषान् भक्षयेत्, चित्रकमूलक्षारोदकसिद्धं वा पयः पलाशतरूक्षारसिद्धं वा, पलाशतरूक्षारसिद्धान् वा कुल्माषान्, पाटलापामार्गबृहतीपलाशक्षारं वा परिस्नुतमहरहर्घृतसंसृष्टं, कुटजबन्दाकमूलकल्कं वा तक्रेण, चित्रकपूतीकनागरकल्कं वा पूतीकक्षारेण, क्षारोदकसिद्धं वा सर्पिः पिप्पल्यादिप्रतीवापं, कृष्णतिलप्रसृतं प्रकुञ्चं वा प्रातः प्रातरुपसेवेत शीतोदकानुपानम्; एभिरभिवर्धतेऽग्निरर्शांसि चोपशाम्यन्ति ||१३||
Meaning of the śloka
For arśas that are not visible and are considered manageable by medicines, the text presents numerous sustaining regimens. These include combinations based on jaggery and harītakī; harītakī processed in cow urine and taken with honey; apāmārga root with rice-wash water and honey; śatāvarī root with milk; citraka powder with high-quality sīdhu; bhallātaka powder in an unsalted flour drink with buttermilk; and buttermilk kept in a jar coated internally with citraka-root paste. It extends this buttermilk method to several other herbs and also describes a month on buttermilk without solid food. Further preparations use medicated milk, kuṭaja phāṇita with pippalī-group powder and honey, hiṅgu-group powder, alkaline and salted barley preparations, several plant-derived alkalis, pastes with buttermilk or alkaline liquid, ghee processed in alkaline water, and black sesame with cold water. The stated purpose is to strengthen agni and quiet the arśas.
The commentary explains the intended classical selection of these regimens. It assigns cow-urine harītakī to hard stool and weak agni, apāmārga differently to pitta-rakta arśas or, according to Gayadāsa, kapha-associated bleeding disease, and śatāvarī to rakta disease associated with vāta and pitta. Citraka with sīdhu is assigned to kapha-related weak agni or retained stool. For the bhallātaka preparation, Jejjaṭa and Gayī disagree over the proportion of powder. Buttermilk regimens are directed to dry vāta-kapha arśas, whereas milk-based food and drink are introduced for moist rakta-pitta forms. A variant reading changes the scope of the ginger-based medicated milk. Kuṭaja phāṇita is assigned to rakta disease associated with kapha and pitta; hiṅgu powder and buttermilk to vāta-kapha patterns; and milk diet to vāta-pitta association. The commentary supplies traditional quantities and processing rules for the alkalis, ghee, and pastes, and repeatedly adds ghee, milk, and sweet food afterward because of concern that sharp alkali could impair ojas.
Key terms
yāpana (yapana)
Sustaining or managing a condition rather than asserting complete cure.
agni
Digestive and transformative capacity in the classical framework.
takra
Buttermilk used as food, drink, or a processing medium.
kṣāra (kshara)
A sharp alkaline preparation derived here from plant materials.
bhallātaka (bhallataka)
A potent plant ingredient for which the commentators dispute the proportion.
The text describes a fermented preparation made from equal parts of the two pañcamūla groups, dantī, citraka, and pathyā. These are decocted in water until one quarter remains, cooled, mixed with an equal traditional weight of jaggery, placed in a ghee-coated vessel, and left for a month within a heap of barley. A suitable amount is then taken each morning. The text claims that arśas, grahaṇī disorder, pāṇḍu, udāvarta, and loss of appetite do not occur and that agni becomes strong.
The commentary takes the stated tulā as a total of one hundred palas made from equal portions of the ingredients. Although not named in the passage, older authorities prescribe two or three palas of dhātakī flowers to initiate or support fermentation. Other readers repeat tulā and interpret it as one tulā of each ingredient, but Gayī rejects that reading. Yavapalla means a heap of barley. Another treatise calls the preparation dantyariṣṭa.
Key terms
dvi-pañcamūlī (dvi-panchamuli)
The two classical groups of five roots.
ariṣṭa (arishta)
A fermented medicinal preparation.
yavapalla
A heap of barley in which the vessel is kept.
grahaṇī-doṣa (grahani-dosha)
A classical disorder involving grahaṇī and digestion.
dantyariṣṭa (dantyarishta)
The name given to this preparation in another treatise.
Another fermented preparation combines specified traditional amounts of pippalī, marica, viḍaṅga, elavāluka, lodhra, indravāruṇī, the pulp of kapittha, pathyā fruits, and dhātrī fruits. They are decocted in water until one quarter remains, strained and thoroughly cooled, mixed with two tulās of jaggery, placed in a ghee-coated vessel, and left for a fortnight within a heap of barley. A quantity suited to the person's strength is then taken each morning. The text claims benefit for disorders of the spleen, impaired agni, arśas, grahaṇī, the heart, pāṇḍu, swelling, kuṣṭha, gulma, abdominal disease, and worms, and also claims increased strength and complexion.
Although the passage specifies five palas of indravāruṇī, older physicians use half that amount to reduce its excessive sharpness or bitterness. The same preparation appears in the Caraka tradition under the name abhayāriṣṭa.
Key terms
ariṣṭa (arishta)
A fermented medicinal preparation.
indravāruṇī (indravaruni)
A potent plant ingredient whose stated amount older physicians reduce.
pāṇḍu-roga (pandu-roga)
A classical disease category characterized in part by altered coloration.
gulma
A classical category involving an abdominal mass or complex.
abhayāriṣṭa (abhayarishta)
The name under which the commentary says this formula occurs in Caraka.
तत्र, वातप्रायेषु स्नेहस्वेदवमनविरेचनास्थापनानुवासनमप्रतिषिद्धं, पित्तजेषु विरेचनम्, एवं रक्तजेषु संशमनं, कफजेषु शृङ्गवेरकुलत्थोपयोगः, सर्वदोषहरं यथोक्तं सर्वजेषु, यथास्वौषधिसिद्धं च पयः सर्वेष्विति ||१६||
Meaning of the śloka
The text assigns treatment according to the predominant doṣa. In vāta-predominant arśas, oleation, sudation, emesis, purgation, decoction enema, and oil enema are allowed where not otherwise prohibited. Pitta-predominant and, similarly, rakta-predominant forms receive purgation or pacifying treatment as stated. Kapha-predominant forms use ginger and kulattha. Forms involving all doṣas receive the previously described doṣa-reducing measures, and in every type milk processed with the appropriate medicines may be used.
The commentary says these measures serve curative intent in recently arisen cases with few doṣa signs and sustaining intent in invisible cases regarded as manageable. Although emesis is generally prohibited in arśas, it may be considered in states such as excessive kapha discharge. Some authorities call the entire passage beginning with vāta-predominant forms non-authoritative; the commentator explains it because Gayadāsa commented on it. In the pitta and rakta clauses, 'similarly' carries forward purgation. Saṃśamana is defined as quieting the disease in place without either emesis or purgation.
Key terms
vāta-prāya (vata-praya)
A presentation in which vāta predominates.
āsthāpana (asthapana)
A decoction-based medicated enema.
anuvāsana (anuvasana)
An oil-based medicated enema.
saṃśamana (samshamana)
Pacifying a disorder without evacuative emesis or purgation.
anārṣa (anarsha)
Regarded by some authorities as not belonging to the authoritative original text.
The text introduces a regimen using mature, undamaged bhallataka fruits. It describes preparing a decoction, taking it in the morning while protecting the mouth with ghee, and following it later with milk and rice with ghee. The number of fruits is gradually increased and then decreased in a prescribed sequence. Completion of the regimen is praised as removing all kushtha and arshas, restoring strength and health, and supporting a life of one hundred years.
The commentary says this special regimen is intended to cure recent, mild cases and to manage older or non-visible arshas. It treats the repeated requirement that the fruits be mature and undamaged as emphasizing the regimen's importance. As the number of fruits rises, the amount of decoction water is also to rise proportionately. It reports differing schedules from other traditions: one reaches seventy fruits and totals one thousand over thirty-five days; another reaches one hundred and is understood to total two thousand after excluding introductory and concluding adjustment days; these are classified as medium and superior regimens, while a schedule reaching thirty is inferior. A further inherited schedule involving stored fruits is discussed because its arithmetic does not otherwise yield a total of one thousand. Crucially, the commentator rejects the claim that every kushtha and every arshas is cured: some forms are regarded as incurable, and blood-and-pitta forms of arshas are outside bhallataka's scope. The commentary also states that hot water is prohibited with bhallataka and tuvaraka, preferring lightly boiled cooled water.
Key terms
bhallAtaka (bhallataka)
A potent medicinal fruit used in the historical graduated regimen.
kaShAya (kashaya)
The decoction prepared from the fruit in this passage.
arshas
The classical disorder category treated in this chapter.
kuShTha (kushtha)
A broad classical category of skin disorders invoked in the claimed benefits.
yApana (yapana)
Management or sustaining treatment rather than assured cure.
The text gives another bhallataka regimen using either expressed oil prepared by the method taught in the Dvivraniya chapter or oil obtained from the kernels. It is taken in measured amounts after preparatory purification and restoration of food, followed after digestion by milk and rice with ghee. A month of use is followed by three months of the prescribed diet and self-restraint. The passage praises the regimen with claims of freedom from affliction, good complexion and strength, improved hearing, comprehension and retention, and extraordinary increases in lifespan.
The commentary identifies this as an alternative bhallataka regimen. It explains restoration of food as progressing through the gruel and related dietary stages after purgation, and lays out a sequence in which the bhallataka-kernel oil is taken on the ninth day. 'According to strength' means without exceeding the strength of the person or the illness. The selected measure is described as mixed with one-eighth honey and twice as much ghee, cooled, and taken after coating the palate and lips with ghee, with cooling care afterward. It defines prasriti as two pala and prakuncha as one pala. The instruction to protect oneself is completed by the understood phrase 'from anger and the like.'
Key terms
bhallAtakasneha (bhallataka-sneha)
Oil or fatty extract obtained from bhallataka fruit or kernels.
pratisaMsRuShTabhakta (pratisamsrishta-bhakta)
A state in which food has been gradually restored after purification.
prasRuti (prasriti)
A classical liquid measure explained here as two pala.
praku~jca (prakuncha)
A classical measure explained here as one pala.
yathAbala (yatha-bala)
Adjusted so as not to exceed the strength of the person or disease.
These verses compare established remedies: as khadira and bijaka are said to overcome kushtha, vriksha and karushkara are said to overcome arshas; and as turmeric is used for sixteen kinds of prameha, visible growths arising at the anus are said not to escape treatment by alkali and cautery.
The commentary presents these as older authoritative verses describing the specific efficacy attributed to the substances. It identifies vriksha and karushkara here as kutaja and bhallataka and limits each to its appropriate field: bhallataka for vata-kapha arshas and kutaja for blood-pitta arshas. Therefore 'all' does not include every mixed, three-dosha, or otherwise incurable form. The kushtha comparison must likewise be restricted to curable forms. The sixteen pramehas exclude the four vata-origin types.
Key terms
khadira
A medicinal tree cited in the comparison concerning kushtha.
bIjaka (bijaka)
A medicinal tree paired with khadira in the comparison.
vRukSha (vriksha)
Interpreted by the commentary as kutaja in this verse.
kAruShkara (karushkara)
Interpreted by the commentary as bhallataka in this verse.
kShArAgni (kshara-agni)
Alkali and thermal cautery applied to visible anal growths in the historical surgical system.
After assessing which dosha is predominant, the text allows the use of digestive-stimulating ghee preparations, medicinal linctuses, ayaskriti preparations, sura, and asava.
The commentary says treatment is selected according to the predominance of dosha. Linctuses include kutaja avaleha and similar preparations; ayaskritis include navayasa and others taught in the treatment of major kushtha, madhumeha, and related disorders. Sura includes different grain-based and other forms prepared by the method described in the purgation chapter. Asavas are made from various medicinal decoctions, jaggery, and related materials and are conditioned with dhataki powder and similar substances. An alternative reading says, 'having examined the dosha, according to the result'; the commentary takes this to mean without exceeding the stated therapeutic purpose or outcome.
Key terms
doShasamucchriti (dosha-samucchriti)
Predominance or elevation of a particular dosha.
leha
A lickable medicinal preparation or linctus.
ayaskRuti (ayaskriti)
A class of processed medicinal preparations, exemplified here by navayasa.
surA (sura)
A class of fermented alcoholic preparations.
Asava (asava)
A fermented medicinal preparation made from decoctions and sweetening material.
In arshas, the text advises avoiding suppression of natural urges, riding on the back of animals or similar conveyance, prolonged squatting, and foods that aggravate the individual's relevant dosha.
The commentary explains vega as the natural impulse of flatus, urine, feces, and similar functions to move outward through their proper pathways. Utukutukasana is explained as remaining for a long time in a squatting posture.
Key terms
vegAvarodha (vega-avarodha)
Suppression or obstruction of a natural bodily urge.
vega
The natural impulse of flatus, urine, feces, or similar functions to proceed through their normal pathway.
utkuTukAsana (utkutukasana)
Prolonged sitting in a squatting posture.
doShala anna (doshala anna)
Food considered aggravating to the relevant dosha.
arshas
The classical disorder category addressed by the avoidance advice.
The commentary states that the sixth chapter of the Cikitsasthana is complete in Dalhana's Nibandhasangraha commentary on Sushruta. The transmitted text records a spelling variation in Dalhana's name.
Key terms
arshashcikitsita (arshas-chikitsita)
The treatment of the classical disorder category arshas.