The commentator first reports an interpretation according to which the title means a major account of treatment because this chapter discusses both major and minor forms of kuṣṭha. This is rejected as conflicting with the earlier teaching sequence that separately mentions the major forms. The preferred explanation is therefore ‘treatment of the major kuṣṭhas’: the seven forms said to have penetrated the dhātus. Gayī gives a different view, identifying these as seven major forms excluding kākaṇaka.
Key terms
mahAkuShTha (mahākuṣṭha)
The major forms of the classical disease category kuṣṭha discussed in this chapter.
dhAtvanupraviShTa (dhātv-anupraviṣṭa)
Described as having penetrated or entered the bodily dhātus.
kAkaNaka (kākaṇaka)
A named form of kuṣṭha excluded from Gayī’s count in the interpretation reported here.
Adhikarana २ (३) · Śloka ३
कुष्ठेषु मेहेषु कफामयेषु सर्वाङ्गशोफेषु च दारुणेषु |
कृशत्वमिच्छत्सु च मेदुरेषु योगानिमानग्र्यमतिर्विदध्यात् ||३||
Meaning of the śloka
A physician of excellent judgment should prescribe the following formulations in severe cases of kuṣṭha, meha, disorders of kapha, and swelling of the whole body, and also for corpulent persons who seek leanness.
The qualifier ‘severe’ applies to all four groups: kuṣṭha, meha, kapha disorders, and generalized swelling. Kapha disorders include conditions described as impaired digestive fire and excessive flow of kapha. Medura means a person possessing abundant medas. ‘Of excellent judgment’ characterizes the physician as discerning and capable of recognizing changes in constitution, age, strength, bodily condition, and related factors.
Key terms
kuShTha (kuṣṭha)
A classical disease category for which the ensuing formulations are presented.
meha
A classical group of disorders named among the indications.
kaphAmaya (kaphāmaya)
A disorder attributed to kapha, exemplified in the commentary by agnisāda and kapha-praseka.
agryamati (agrya-mati)
A physician with excellent, discriminating judgment.
Adhikarana ३ (४-५) · Śloka ५
क्षुण्णान् यवान्निष्पूतान् रात्रौ गोमूत्रपर्युषितान् महति किलिञ्जे शोषयेत्, एवं सप्तरात्रं भावयेच्छोषयेच्च, ततस्तान् कपालभृष्टान् शक्तून् कारयित्वा, प्रातः प्रातरेव कुष्ठिनं प्रमेहिणं वा सालसारादिकषायेण कण्टकिवृक्षकषायेण वा पाययेद्भल्लातकप्रपुन्नाडावल्गुजार्कचित्रकविडङ्गमुस्तचूर्णचतुर्भागयुक्तान्; एवमेव सालसारादिकषायपरिपीतानामारग्वधादिकषायपरिपीतानां वा गवाश्वाशकृद्भूतानां वा यवानां शक्तून् कारयित्वा भल्लातकादीनां चूर्णान्यावाप्य खदिराशननिम्बराजवृक्षरोहीतकगुडूचीनामन्यतमस्य कषायेण शर्करामधुमधुरेण द्राक्षायुक्तेन दाडिमामलकवेतसाम्लेन सैन्धवलवणान्वितेन पाययेत्; एष सर्वमन्थकल्पः ||४||
यावकांश्च भक्ष्यान् धानोलुम्बककुल्माषापूपपूर्णकोशोत्कारिकाशष्कुलिकाकुणावीप्रभृतीन् सेवेत; यवविधानेन गोधूमवेणुयवानुपयुञ्जीत ||५||
Meaning of the śloka
The passage describes barley that is crushed and cleaned, soaked overnight in cow urine, dried on a large woven mat, and repeatedly processed in this way for seven nights. It is then roasted in an earthen fragment, made into flour, combined in the stated proportion with powders including bhallātaka, prapunnāḍa, avalguja, arka, citraka, viḍaṅga, and musta, and historically prescribed in the morning with one of the specified decoctions for a person with kuṣṭha or prameha. Alternative barley preparations use impregnation with other decoctions or processing through cow or horse dung, followed by the listed powders and a decoction made sweet, sour, and saline with the specified additions; this is called the general preparation of mantha. The passage also lists several barley foods and says wheat and bamboo grain may be used according to the barley method.
The commentary defines kiliñja as a basket-like woven object made from bamboo bark or similar material, kapāla as a potsherd, and thorny trees as including khadira, badara, arimeda, srug-dāru, and others. The powders beginning with bhallātaka are to form one quarter of the flour in all such preparations. ‘Paripīta’ means impregnated or steeped. Sour ingredients and rock salt are added only in the amount needed to produce the intended sourness and saltiness. The various barley foods are then explained: dhānā are dry-roasted barley grains, ulumbaka are freshly roasted grains, kulmāṣa are sour-cooked foods made from barley flour, apūpa are thick cakes, pūrṇakośa are filled barley preparations containing pulses regarded as suitable for kuṣṭha, utkārikā is a type of saṃyāva, śaṣkulī is prepared from processed sesame and barley flour, and kuṇāvī is a barley wafer. Other readings give konāḍi or konālika with the same meaning, while Gayī reads citrā, a particular cake, before utkārikā. Veṇuyava means bamboo seed or grain.
Key terms
mantha
A stirred drink or preparation; this passage presents a general method for it.
bhAvita (bhāvita)
Impregnated or repeatedly processed with a liquid.
The text next describes an ariṣṭa. Powders of pūtīka, cavya, citraka, suradāru, sārivā, dantī, trivṛt, and trikaṭu are taken in the stated quantities, together with badara and triphalā. In a previously prepared vessel coated inside with pippalī, honey, and ghee, the powders are combined with the specified amounts of water, ayorajas, and jaggery, sealed, and kept in a heap of barley for seven nights. It is then historically directed for use according to strength and is said to alleviate kuṣṭha, meha, excess medas, pāṇḍu, and swelling. Ariṣṭas may similarly be made with substances from the Śālasārādi, Nyagrodhādi, and Āragvadhādi groups.
The commentary introduces these fermented preparations for people with vāta-kapha kuṣṭha who are accustomed to alcoholic preparations, and notes that āsava and surā are discussed afterward. Some authorities take one kuḍava as the combined amount of triphalā, while others assign one kuḍava to each constituent because the collective term refers primarily to its individual members. Jejjaṭa interprets seven kuḍavas of water as twenty-eight palas, but Gayī rejects this because the treatises generally define a liquid kuḍava as eight palas. The preparation is called piṇḍāriṣṭa and is described as being mixed with a kuṣṭha-directed decoction such as khadira before drinking. Alternative quantities and an interpretation of use according to digestive capacity are reported. Some say it should be filtered because of the large quantity of powders; others say it should be taken unfiltered like piṇḍāsava. The commentator acknowledges further textual and interpretive variants but does not record them because of their length.
Key terms
ariShTa (ariṣṭa)
A fermented medicinal preparation described here.
triphalA (triphalā)
A collective name whose quantity is interpreted differently by the cited authorities.
ayorajas (ayo-rajas)
Iron particles or powder included in the historical formulation.
yathAbala (yathā-bala)
According to the person’s strength; alternatively related by some to digestive capacity.
The text next describes āsavas. Three parts of hot water filtered through palāśa ash and then cooled are combined with two parts of phāṇita and prepared according to the ariṣṭa method. The same method is stated for alkaline preparations derived from sesame and related materials. Āsavas are also to be made using substances from the Śālasārādi, Nyagrodhādi, and Āragvadhādi groups and using urines.
The commentary explains the three parts as three āḍhakas and the two parts of phāṇita as two āḍhakas. ‘According to the ariṣṭa method’ means following the method previously described with pūtīka and the other ingredients; the triphalā powder and all other components mentioned there are therefore to be supplied by implication. ‘Vidadhyāt’ simply means ‘one should make.’ The sesame and related alkaline substances are those listed in the earlier urinary-stone chapter, beginning with sesame, apāmārga, plantain, and straw.
Key terms
Asava (āsava)
A fermented preparation described by reference to the preceding ariṣṭa method.
palAshabhasma (palāśa-bhasma)
Ash of palāśa through which the hot water is filtered.
phANita (phāṇita)
A concentrated sugarcane product used here as the sweet base.
kShAra (kṣāra)
An alkaline preparation derived here from plant ashes.
Adhikarana ६ (८) · Śloka ८
अथ सुरा वक्ष्यामः- शिंशपाखदीरयोः सारमादायोत्पाट्य चोत्तमारणीब्राह्मीकोशवतीस्तत्सर्वमेकतः कषायकल्पेन विपाच्योदकमाददीत मण्डोदकार्थं, किण्वपिष्टमभिषुणुयाच्च यथोक्तम् |
एवं सुराः शालसारादौ न्यग्रोधादावारग्वधादौ च विदध्यात् ||८||
Meaning of the śloka
The text next describes preparations of surā. The heartwood of śiṃśapā and khadira is combined with uttamāraṇī, brāhmī, and kośavatī, cooked as a decoction, and its liquid is used for the māṇḍodaka; the prescribed fermenting material is then added. Surā is to be prepared in the same manner from the śālasāra, nyagrodha, and āragvadha groups.
The commentator identifies uttamāraṇī with uttamakaraṇī and kośavatī with devadālī. Here udaka means a decoction, and abhiṣuṇuyāt means that the preparation is to be set for fermentation according to the method stated in the purgation section of Sūtrasthāna. The proposed proportion is two parts of the heartwood of śiṃśapā and khadira to one part of uttamāraṇī and the other drugs, because heartwoods are regarded as removing kuṣṭha. Further quantities and preparation details are derived from the rule for the strength of fermented preparations. Vidadhyāt means ‘one should make the surā.’
Key terms
surA (surā)
A fermented preparation described here using medicinal decoctions.
sAra (sāra)
The heartwood portion of the named trees.
mANDodaka (māṇḍodaka)
The liquid component for which the prepared decoction is used.
kiNvapiShTa (kiṇvapiṣṭa)
Fermenting material added according to the cited preparation rule.
The text next describes avaleha preparations. Finely ground portions of the heartwoods of khadira, asana, nimba, rājavṛkṣa, and śāla are added to their decoction and cooked until the result is neither too fluid nor too thick. Before the morning meal, a palmful mixed with honey is to be licked. Similar linctuses may be made from the śālasāra, nyagrodha, and āragvadha groups.
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अतोऽवलेहानित्यादि| खदिरादीनां द्रोणमेकं पानीयस्य द्रोणचतुष्टयम्, एतद्द्रोणशेषं ग्राह्यं, पुनः पाकाद्घनीभवत्यस्मिन् चरककुटजावलेहचूर्णप्रक्षेपणप्रमाणोहबीजेन प्रत्येकं सार्धपलानां पञ्चानामेव श्लक्ष्णपिष्टानां पिण्डान् प्रक्षिप्य फाणितीभूतमवतारयेत्; यद्यपि पाणितलं कर्षमित्युक्तं, तथाऽपि पूर्णशब्दात् पाणितलं हस्ततलमङ्गुलिरहितं व्याख्यातम्| अप्रातराशः सायमेव भुञ्जानः| गयी तु शालसारं न पठति, खदिरादीनि चत्वार्येव पठति||९||
Meaning of the commentary
The commentator explains the reduction and thickening process and infers the amount of each finely ground heartwood from the rule for adding powder to the kuṭaja avaleha described by Caraka. Although pāṇitala can denote a karṣa, the word ‘full’ leads the commentator to understand it here as the palm excluding the fingers. Aprātarāśa is interpreted as a person who eats only in the evening. Gayi preserves a different reading that omits śālasāra and lists only the four drugs beginning with khadira.
Key terms
avaleha
A thick preparation intended to be licked.
sArapiNDa (sārapiṇḍa)
A finely ground portion prepared from the named heartwoods.
pANitala (pāṇitala)
The dose expression interpreted here as a full palm excluding the fingers.
aprAtarAsha (aprātarāśa)
Interpreted by the commentator as one who takes food only in the evening.
The text next describes powders. A prastha of heartwood powder from the śālasāra group is repeatedly impregnated with a decoction of the āragvadha group and is then administered with a decoction of the śālasāra group. The same method is prescribed for the fruits of the nyagrodha group and the flowers of the āragvadha group.
The commentator explains paripīta as bhāvita, meaning repeatedly impregnated or processed with liquid. For a prastha of śālasāra-group powder, a prastha of the āragvadha-group decoction drugs is described; the reduced decoction is used to moisten and dry the powder. After this process is repeated for seven days, the commentator supplies quantities for the powder and its accompanying śālasāra decoction. The comparatively large quantity is justified on the ground that kuṣṭha is considered eligible for the highest dose.
Key terms
cUrNakriyA (cūrṇa-kriyā)
The method of preparing and administering medicinal powder described here.
paripIta (paripīta)
Explained as bhāvita, powder repeatedly moistened or impregnated with a decoction and dried.
shAlasArAdi (śālasārādi)
The group beginning with śālasāra used for the powder and accompanying decoction.
uttamamAtrA (uttama-mātrā)
The highest dose category invoked by the commentator in relation to kuṣṭha.
The text next describes ayaskṛti. Thin sheets of tīkṣṇa iron, coated with salts, are repeatedly heated in a cow-dung fire and quenched in decoctions of triphalā and the śālasāra group. They are again heated over khadira charcoal, cooled, finely powdered, and passed through dense cloth. A quantity suited to the person’s strength is mixed with ghee and honey and taken, followed after digestion by food appropriate to the disorder and free from sour and salty tastes. After a tulā has been consumed in this manner, the text attributes removal of kuṣṭha, meha, excess medas, swelling, pāṇḍuroga, unmāda, and apasmāra and claims extension of life by one hundred years for each tulā. The same general ayaskṛti method is extended to other metals.
The commentator defines the sheets as very thin and lists the salts used for coating them. Heating over khadira charcoal is also understood as repeated sixteen times. The powder is strained through closely woven cloth, begun in a small quantity, and increased progressively to the stated upper measure. Proper mixing means thoroughly combining iron, honey, and ghee in an iron vessel with an iron rod. A large quantity of disorder-specific decocted water is prescribed as anupāna by received tradition, and both the accompanying drink and food are selected according to the disorder; avoidance of sour and salty tastes is treated as generally beneficial. The concluding rule is understood to extend this processed-metal rasāyana method to tin, lead, copper, silver, and gold.
Key terms
ayaskRuti (ayaskṛti)
A processed-metal preparation, centered here on iron.
tIkShNaloha (tīkṣṇa-loha)
The iron specified for the thin sheets in this preparation.
anupAna (anupāna)
The accompanying liquid taken after the preparation, selected according to the disorder.
rasAyana (rasāyana)
The restorative or longevity-oriented regimen to which the commentator assigns this metal-processing method.
An auṣadha-ayaskṛti is described using liquid from trivṛt, śyāmā, agnimantha, saptalā, kevuka, śaṅkhinī, tilvaka, triphalā, palāśa, and śiṃśapā. In a palāśa trough, a heated iron mass is repeatedly quenched in this liquid; the liquid is then cooked, reduced, strained, and combined again with heated iron sheets. Pippalyādi powder, honey, and ghee are added, and the finished preparation is stored in an iron vessel and taken in a strength-appropriate quantity, with food suited to the disorder after digestion. The text attributes effects upon difficult kuṣṭha or prameha, corpulence, swelling, and weakened agni, especially recommends it for rājayakṣman, and makes a longevity claim. A second mahauṣadha-ayaskṛti is prepared from a śālasāra-group decoction with heated iron pieces, powder, honey, and jaggery, matured for a stated period, and taken according to strength. The procedure is extended to the nyagrodha and āragvadha groups.
The commentator supplies identifications for several plants and preserves differing views about svarasa: when fresh juice is unavailable, an overnight infusion of powders may substitute; older physicians also use the word for a decoction, while Gayi gives another decoction proportion. The palāśa trough is explained as a moist palāśa-wood vessel, and the iron mass and repeated quenching are quantified. The processed sheets are ground with the same decoction and cooked again. Pippalyādi is interpreted as equal to the iron mass, with specified honey, jaggery, and ghee, but Gayi gives different proportions that are not reproduced. Śukti and prakuñca are defined as dose measures. For the second, ariṣṭa-style vessel preparation and maturation are explained; old honey and aged jaggery are specified. An alternative view gives different ingredient ratios. The wording ayoghana is said to specify tīkṣṇa iron and exclude lead and similar metals. Finally, ārevatādi is understood as āragvadhādi.
Key terms
auShadhAyaskRuti (auṣadha-ayaskṛti)
A medicinal preparation made through repeated processing with iron.
svarasa
Plant liquid whose interpretation here varies among fresh juice, an overnight infusion substitute, and decoction.
trisaptakRutvaH (trisaptakṛtvaḥ)
Three times seven, interpreted by the commentator as twenty-one repetitions.
rAjayakShman (rājayakṣman)
A classical disease category for which this preparation is especially recommended in the source.
ariShTasaMskAra (ariṣṭa-saṃskāra)
The fermented-preparation method invoked for preparing the second formulation in a vessel.
The text describes a preparation from khadira. A sound, middle-aged tree growing in a suitable place is excavated around its base, its central root is cut, and an iron vessel is positioned to collect the liquid released when the covered wood is heated with fuel mixed with cow dung. The collected liquid is filtered, securely stored, and taken in a suitable quantity with āmalaka juice, honey, and ghee, with diet and restrictions following the bhallātaka regimen. The text attributes an increase of one hundred years of life to consuming one prastha. As alternatives, khadira heartwood is decocted in a droṇa of water to one-sixteenth, stored, and used with āmalaka juice, honey, and ghee; the same procedure is extended to the heartwood of other trees. It also prescribes daily morning use of khadira-heartwood powder or decoction, or sheep ghee prepared with that decoction.
The commentator states that the amount of āmalaka juice equals that of the khadira liquid, while honey and ghee together amount to one quarter of the principal substance. Milk is allowed in the diet following the bhallātaka regimen even though it is ordinarily regarded here as promoting kuṣṭha, because the power of the rasāyana is considered inconceivable. When fresh juice cannot be obtained from moist khadira heartwood, the decoction beginning with the instruction on khadira heartwood serves as its substitute. Under the convention for preparing a sneha from a decoction, ghee is one quarter of the decoction. Sheep ghee, though ordinarily considered unsuitable, is called suitable here because the effect of the combination is considered inconceivable. Another reading gives simply ghee and omits the qualification that it is sheep ghee.
Key terms
khadira
The tree whose expressed liquid, heartwood, powder, and decoction are used in the described regimen.
rasAyana (rasāyana)
The restorative regimen whose special power is invoked by the commentary.
bhallAtakavidhAna (bhallātaka-vidhāna)
The bhallātaka regimen used as the model for diet and restrictions.
Avika sarpis (āvika sarpis)
Sheep ghee; an alternative reading in the commentary gives ghee without specifying sheep ghee.
Adhikarana १२ (१४) · Śloka १४
अमृतवल्लीस्वरसं क्वाथं वा प्रातः प्रातरुपसेवेत, तत्सिद्धं वा सर्पिः, अपराह्णे ससर्पिष्कमोदनमामलकयूषेण भुञ्जीत; एवं मासमुपयुज्य सर्वकुष्ठैर्विमुच्यत इति ||१४||
Meaning of the śloka
The text prescribes taking fresh juice or a decoction of amṛtavallī each morning, or ghee prepared with it. In the afternoon, rice with ghee is to be eaten with an āmalaka pulse-soup. It states that following this regimen for one month frees a person from all forms of kuṣṭha.
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अमृतेत्यादि| अमृतवल्ली गुडूची||१४||
Meaning of the commentary
The commentator identifies amṛtavallī as guḍūcī.
Key terms
amRutavallI (amṛtavallī)
The plant identified by the commentary as guḍūcī.
guDUcI (guḍūcī)
The commentator's identification of amṛtavallī.
AmalakayUSha (āmalaka-yūṣa)
The āmalaka-based pulse-soup prescribed with the afternoon meal.
kuShTha (kuṣṭha)
The classical disease category for which the month-long regimen is stated.
A compound sneha is described using one droṇa each of black-sesame oil, bhallātaka oil, āmalaka juice, ghee, and a śālasāra-group decoction, together with one pala portions of a long list beginning with triphalā and trikaṭu. These are cooked by the method for preparing medicated fat, filtered when properly prepared, and securely stored. After prior bodily preparation, a pāṇiśukti measure is taken each morning mixed with honey. Once digested, soft rice cooked in khadira water, with ghee and without salt, is eaten with mudga and āmalaka soup, while khadira water is used for drinking. The text says that consuming one droṇa frees a person from all kuṣṭha and results in a purified body, good memory, freedom from illness, and a hundred-year lifespan. It adds that an informed person may use this basic formulation to prepare many kinds of surā, mantha, āsava, ariṣṭa, electuaries, powders, and iron preparations.
The commentator introduces this as a particular mixed sneha on the basis of its shared character as fat. The oils are those of black sesame and bhallātaka; together with ghee these make three droṇas of fatty substances, which are cooked with one droṇa each of āmalaka juice and the śālasāra-group decoction, and with triphalā and the other drugs made into paste. A person whose body is prepared means one who has undergone procedures beginning with vamana. Pāṇiśukti is explained as one pala. From the word meaning ‘even by the thousands,’ the commentator also gathers that preparations of heartwood and fatty substances not stated explicitly may be fashioned by the procedure already described for khadira heartwood.
Key terms
mishraka sneha (miśraka sneha)
The mixed medicated-fat preparation formed from the oils and ghee in this formula.
upasaMskRutasharIra (upasaṃskṛta-śarīra)
A person whose body has first been prepared, explained as having undergone procedures beginning with vamana.
pANishukti (pāṇiśukti)
The prescribed quantity, interpreted by the commentator as one pala.
bIja (bīja)
The basic formula proposed as a basis for numerous further types of preparation.
kuShTha (kuṣṭha)
The classical disease category addressed by the regimen.
Adhikarana पुष्पिका · Śloka १०
इति सुश्रुतसंहितायां चिकित्सास्थाने महाकुष्ठचिकित्सितं नाम दशमोऽध्यायः ||१०||
Meaning of the śloka
Thus ends the tenth chapter of the Cikitsāsthāna in the Suśruta Saṃhitā, entitled Mahākuṣṭhacikitsita, the treatment of major kuṣṭha.
Thus ends the tenth chapter of the Cikitsāsthāna in Dalhaṇa's commentary on Suśruta entitled Nibandhasaṅgraha. The source preserves the commentator's name with the variant spelling ‘Dalhaṇa/Dahlana.’
Key terms
cikitsAsthAna (cikitsāsthāna)
The section of the Suśruta Saṃhitā concerned here with treatment.
mahAkuShThacikitsita (mahākuṣṭhacikitsita)
The title of the chapter that concludes here.
nibandhasa~ggraha (Nibandhasaṅgraha)
The title of Dalhaṇa's commentary on the Suśruta Saṃhitā.