Now the treatment of prameha is explained, as taught by Dhanvantari. Two forms of prameha are described: sahaja, arising from a defect in the parental reproductive seed, and apathyanimitta, caused by unsuitable diet. A person affected by the former is generally lean, dry, eats little, is intensely thirsty, and tends to move about; one affected by the latter is generally stout, eats much, is unctuous, and is inclined to lying down, sitting, and sleeping.
The commentator notes that some authorities say women do not develop prameha, citing another text which reasons that monthly menstrual discharge purifies the whole body and its doṣas. The commentator rejects this position because it is not accepted across the textual tradition and conflicts with direct observation.
Key terms
prameha
The classical disease category whose two causal forms are distinguished here.
sahaja
The form described as arising from a defect in the parental reproductive seed.
apathyanimitta (apathya-nimitta)
The form attributed here to unsuitable diet.
mātṛpitṛbījadoṣa (mātṛ-pitṛ-bīja-doṣa)
A defect in the maternal and paternal reproductive seed, given as the cause of sahaja prameha.
Of these, the lean person should be treated with measures supported by suitably prepared foods and drinks, while the stout person should be treated with measures associated with apatarpaṇa.
The commentator explains the lean person as one with signs such as emaciation and identifies this with the sahaja form. The stout person, characterized by stoutness and related features, is understood as having the form produced by unsuitable diet and conduct. Apatarpaṇa is explained as laṅghana, or reducing treatment; its measures include exercise, cleansing procedures, and substances with tastes such as bitter and pungent.
Key terms
kṛśa
The lean or emaciated person, linked by the commentary with sahaja prameha.
apatarpaṇa
A reducing approach prescribed for the stout person and explained as laṅghana.
laṅghana
The reducing treatment by which the commentary defines apatarpaṇa.
śodhana
Cleansing procedures included among the apatarpaṇa measures.
सर्व एव च परिहरेयुः सौवीरकतुषोदकशुक्तमैरेयसुरासवतोयपयस्तैलघृतेक्षुविकारदधिपिष्टान्नाम्लयवागूपानकानि ग्राम्यानूपौदकमांसानि चेति ||५||
Meaning of the śloka
All such persons should avoid sauvīraka, tuṣodaka, śukta, maireya, surā, āsava, water, milk, oil, ghee, sugarcane products, curd, foods made from flour, sour gruel and other drinks, as well as the meat of domesticated, marsh-dwelling, and aquatic animals.
The commentator says sauvīraka is the preparation described in the chapter on purgation, and identifies tuṣodaka with the kāñjika described there. Śukta is identified as cukra. Maireya is explained as the product made by combining separately prepared surā and āsava and fermenting them again. Surā is made from flour or paste, whereas āsava is predominantly liquid. Marsh-dwelling animals include buffalo and others, while aquatic animals include fish and others.
Key terms
sauvīraka
A preparation referenced from the purgation chapter and included among the items to avoid.
tuṣodaka
A drink identified by the commentator with kāñjika.
maireya
A fermented drink explained as surā and āsava combined and fermented again.
ānūpa
Marsh-dwelling animals, exemplified in the commentary by buffalo and others.
The person should then eat aged śāli rice, ṣaṣṭika rice, barley, wheat, kodrava, or uddālaka, together with a choice of chickpea, āḍhakī, kulattha, or mudga. Vegetables from the bitter and astringent groups may be prepared with oils of nikumbha, iṅgudī, mustard, or linseed. Alternatively, the passage permits lean, non-sour meat from urine-retaining animals of arid regions, without ghee.
The commentator identifies uddālaka as wild kodrava and explains anava here as old or aged grain. The bitter group includes plants beginning with prapunnāṭa and paṭola, while the astringent group includes those beginning with banyan shoots. Oils beginning with nikumbha oil are used in preparing these vegetables, and nikumbha is identified as dantī. The urine-retaining animals are exemplified by eṇa and similar animals. The phrase apahṛtamedas is explained as animals having no fat.
Key terms
anava
Interpreted by the commentator in this context as old or aged grain.
uddālaka
A grain identified by the commentary as wild kodrava.
nikumbha
A source of oil in the passage, identified by the commentary as dantī.
apahṛtamedas (apahṛta-medas)
Explained by the commentator as having no fat or being lean.
jāṅgala
Animals associated with arid regions in the dietary option described here.
तत्रादित एव प्रमेहिणं स्निग्धमन्यतमेन तैलेन प्रियङ्ग्वादिसिद्धेन वा घृतेन वामयेत् प्रगाढं विरेचयेच्च, विरेचनादनन्तरं सुरसादिकषायेणास्थापयेन्महौषधभद्रदारुमुस्तावापेन मधुसैन्धवयुक्तेन, दह्यमानं च न्यग्रोधादिकषायेण निस्तैलेन ||७||
Meaning of the śloka
At the outset, a person with prameha is to be oleated with one of the indicated oils, or with ghee prepared using the priyaṅgvādi group. The text then prescribes forceful vamana and virecana. After virecana, it directs an āsthāpana enema made from a surasādi decoction with mahauṣadha, bhadradāru, and musta, combined with honey and rock salt. For a person experiencing burning, it prescribes an āsthāpana prepared from a nyagrodhādi decoction without oil.
Because vamana was prohibited for a dry or unoleated person with prameha, the commentator understands this instruction to apply to another, sufficiently strong person after oleation. ‘One of the oils’ may mean one of the nikumbha and related oils named immediately afterward, or one of the fats described elsewhere as useful in prameha, including those from nikumbha, mustard, flax, picumarda, and atimuktaka. In paittika forms, ghee prepared with the priyaṅgvādi group is inferred from the general convention for medicated-fat preparation. The commentator distinguishes the procedures by doṣa and site: vamana for kaphaja prameha, virecana for pittaja prameha, vamana when kapha or pitta is situated in the āmāśaya, and virecana when pitta is in the pakvāśaya. The surasādi āsthāpana is understood to be given after seven nights following virecana, with the paste beginning with mahauṣadha and a predominance of honey, as described in the treatment of vāta-vidradhi and related conditions. One interpretation says that explicitly mentioning honey and rock salt, though already supplied by the general rule, excludes oil. For burning, the nyagrodhādi āsthāpana is prescribed. Although it is called oil-free, one view permits a small amount of ghee; another explains the wording as allowing only a small quantity of fat.
Key terms
prameha
The classical group of urinary disorders addressed in this chapter, without implying a modern diagnostic equivalent.
vamana
The therapeutic emesis procedure prescribed selectively in the commentary.
virecana
The purgation procedure prescribed here, especially in the commentator's discussion of pittaja conditions.
āsthāpana
A decoction-based enema prescribed after cleansing and for burning.
āmāśaya / pakvāśaya
The two classical sites used by the commentator to determine whether vamana or virecana is indicated.
Adhikarana ৬ (৮) · Śloka ৮
ততঃ শুদ্ধদেহমামলকরসেন হরিদ্রাং মধুসংযুক্তাং পাযযেত্, ত্রিফলাবিশালাদেবদারুমুস্তকষাযং বা, শালকম্পিল্লকমুষ্কককল্কমক্ষমাত্রং বা মধুমধুরমামলকরসেন হরিদ্রাযুতং, কুটজকপিত্থরোহীতকবিভীতকসপ্তপর্ণপুষ্পকল্কং বা নিম্বারগ্বধসপ্তপর্ণমূর্বাকুটজসোমবৃক্ষপলাশানাং বা ত্বক্পত্রমূলফলপুষ্পকষাযাণি, এতে পঞ্চ যোগাঃ সর্বমেহানামপহন্তারো ব্যাখ্যাতাঃ ||৮||
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ततः शुद्धदेहमामलकरसेन हरिद्रां मधुसंयुक्तां पाययेत्, त्रिफलाविशालादेवदारुमुस्तकषायं वा, शालकम्पिल्लकमुष्कककल्कमक्षमात्रं वा मधुमधुरमामलकरसेन हरिद्रायुतं, कुटजकपित्थरोहीतकबिभीतकसप्तपर्णपुष्पकल्कं वा निम्बारग्वधसप्तपर्णमूर्वाकुटजसोमवृक्षपलाशानां वा त्वक्पत्रमूलफलपुष्पकषायाणि, एते पञ्च योगाः सर्वमेहानामपहन्तारो व्याख्याताः ||८||
Meaning of the śloka
After the body has been cleansed, the text gives five formulations said to counter all forms of prameha: haridrā with honey in āmalaka juice; a decoction of triphalā, viśālā, devadāru, and musta; an akṣa measure of paste made from śāla, kampillaka, and muṣkaka, sweetened with honey and taken with āmalaka juice and haridrā; a flower paste of kuṭaja, kapittha, rohītaka, bibhītaka, and saptaparṇa; or decoctions made from the bark, leaves, roots, fruits, and flowers of nimba, āragvadha, saptaparṇa, mūrvā, kuṭaja, somavṛkṣa, and palāśa.
The commentator specifies four pala of āmalaka juice, with one karṣa each of haridrā and honey, to be divided and consumed. For the decoction from triphalā through musta, sixteen parts of water are added for each pala of drugs and reduced to one quarter; a quoted rule is supplied to establish this decoction method. In the fourth formulation, the word ‘flower’ is connected individually with kuṭaja and each following plant, and honey and āmalaka juice are understood to carry over into this formulation as well. The fifth formulation consists of decoctions prepared from the bark, leaves, roots, fruits, and flowers of the listed plants. Regarding the statement that all five apply to every prameha, one opinion includes both conditions considered curable and incurable, whereas another says their role in incurable conditions is only yāpana, maintenance or palliation rather than cure.
Key terms
śuddhadeha (śuddha-deha)
A person whose body has undergone the cleansing assumed before these formulations.
āmalakarasa (āmalaka-rasa)
Āmalaka juice used as the liquid vehicle in several formulations.
kaṣāya
A decoction prepared from the specified plant materials.
akṣamātra (akṣa-mātra)
The traditional quantity specified for one paste formulation.
yāpana
Maintenance or palliation, offered by one interpretation for conditions regarded as incurable.
The text next assigns particular decoctions to named varieties of prameha. For the ten forms associated with kapha, it lists preparations based respectively on pārijāta, vaijayantī, nimba, citraka, khadira, pāṭhā with aguru and haridrā, haridrā with dāruharidrā, saptaparṇa, a group including dūrvā and aquatic plants or alternatively kakubha with candana, and triphalā with āragvadha and mṛdvīkā, with honey as the sweetening agent. For the pittaja forms, it gives śālasārādi or aśvattha, rājavṛkṣa, nyagrodhādi, triphalā, mañjiṣṭhā with candana, and a honey-mixed decoction of guḍūcī, tinduka seed, kāśmarya, and kharjūra. It then describes maintaining formulations even for forms regarded as incurable: pastes and decoctions are assigned to sarpir-, vasā-, kṣaudra-, and hasti-meha, including in the last case an alkali made from the bones of elephant, horse, pig, donkey, and camel. For a person experiencing burning, it prescribes a cooled yavāgū prepared with a decoction of aquatic tubers, milk, sugarcane juice, and honey.
The commentator supplies identifications for several plants: pārijāta as pāribhadra, vaijayantī as araṇikā, plava as gopāladamanaka, haṭha as jalakumbhikā, and kakubha as a fragrant-rooted tree, among others. The phrase ‘sweetened with honey,’ placed after the ten kaphaja prescriptions, is taken to apply to all ten and likewise to the pittaja prescriptions because honey is understood as a yogavāhin and as countering meha. Further identifications include rājavṛkṣa as kiramālaka, kadara as a yellow-hearted khadira-like tree, kramuka as areca fruit, mūrvā as caurasnāyu, and duḥsparśā as durālabhā. Honey is also carried over into the formulations beginning with sarpir-meha. The cold alkaline water from the listed animal bones is explained by its rough and sharp qualities. The commentator explains burning as arising when the watery tissue is depleted and its opposing pitta increases. The cooling gruel is prepared from the ṣaḍaṅga-type decoction of śālūka and other aquatic plants, with milk and sugarcane juice, cooled and sweetened with honey; a quoted preparation rule is provided. This gruel is an exception to an earlier prohibition, but only in pittaja meha; the prohibition remains for vāta- and śleṣma-associated forms.
Key terms
meha
The classical urinary-disorder category subdivided here by observed characteristics and doṣa.
yāpana
Maintenance or palliation proposed for forms the text regards as incurable.
yogavāhin
The property by which the commentary explains honey's inclusion across the formulations.
asthikṣāra (asthi-kṣāra)
An alkaline preparation made from animal bones in the prescription for hasti-meha.
yavāgū
A thin gruel prescribed here in a cooling preparation for burning in pittaja meha.
The text directs that ariṣṭa, ayaskṛti, leha, and āsava preparations be made from either of two extensive groups of plants, beginning respectively with priyaṅgu and with śṛṅgāṭaka. It also recommends foods prepared from barley. The person may be given yavāgū cooked with one of the previously stated decoctions, or may drink those decoctions themselves.
After first giving general and then specific formulations for the various forms of meha, the commentator understands this passage as returning to general preparations such as ariṣṭa. Numerous ingredient identifications are supplied: anantā is utpalasārivā, padmā is bhārgī, trāyantikā is madayantikā, and lohitikā is mañjiṣṭhā, though another opinion calls it rāmataruṇī. Ambaṣṭhā is identified as mācikā with a vernacular name. Some read tālaparṇī instead of śālaparṇī, identifying tālaparṇī as muṣalī. Tuṅga is punnāga, keśara is nāgakeśara, śrīveṣṭaka is sarala resin, and mocarasa is śālmalī resin. The ariṣṭa and related preparations are to follow the method stated earlier. The commentary similarly identifies many members of the second group, while preserving several alternatives for harivṛkṣa: indravṛkṣa, a dhava-like tree, kuṭaja in another reading, or haridrāvṛkṣa according to a further reading. Ariṣṭa and the other preparations may be made from this group by the same earlier method. Barley foods include forms such as gṛñja, barley rice, and roasted grain. The yavāgū or drinking decoctions are made from the immediately preceding priyaṅgu and śṛṅgāṭaka groups.
Key terms
ariṣṭa / āsava
Classical fermented preparations to be made from the listed plant groups by an earlier method.
ayaskṛti
A classical preparation involving processed iron, listed among the possible dosage forms.
leha
A lickable or electuary-type preparation made from the stated ingredients.
yavānnavikāra (yavānna-vikāra)
Foods prepared from barley, including examples explained by the commentary.
harivṛkṣa
A plant name for which the commentary preserves several competing identifications or readings.
Adhikarana ৯ (১১) · Śloka ১১
মহাধনমহিতাহারমৌষধদ্বেষিণমীশ্বরং বা পাঠাভযাচিত্রকপ্রগাঢমনল্পমাক্ষিকমন্যতমমাসবং পাযযেত্, অঙ্গারশূল্যোপদংশং বা মাধ্বীকমভীক্ষ্ণং, ক্ষৌদ্রকপিত্থমরিচানুবিদ্ধানি চাস্মৈ পানভোজনান্যুপহরেত্, উষ্ট্রাশ্বতরখরপুরীষচূর্ণানি চাস্মৈ দদ্যাদশনেষু; হিঙ্গুসৈন্ধবযুক্তৈর্যূষৈঃ সার্ষপৈশ্চ রাগৈর্ভোজযেত্; অবিরুদ্ধানি চাস্মৈ পানভোজনান্যুপহরেদ্রসগন্ধবন্তি চ; প্রবৃদ্ধমেহাস্তু ব্যাযামনিযুদ্ধক্রীডাগজতুরগরথপদাতিচর্যাপরিক্রমণান্যস্ত্রোপাস্ত্রে বা সেবেরন্ ||১১||
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महाधनमहिताहारमौषधद्वेषिणमीश्वरं वा पाठाभयाचित्रकप्रगाढमनल्पमाक्षिकमन्यतममासवं पाययेत्, अङ्गारशूल्योपदंशं वा माध्वीकमभीक्ष्णं, क्षौद्रकपित्थमरिचानुविद्धानि चास्मै पानभोजनान्युपहरेत्, उष्ट्राश्वतरखरपुरीषचूर्णानि चास्मै दद्यादशनेषु; हिङ्गुसैन्धवयुक्तैर्यूषैः सार्षपैश्च रागैर्भोजयेत्; अविरुद्धानि चास्मै पानभोजनान्युपहरेद्रसगन्धवन्ति च; प्रवृद्धमेहास्तु व्यायामनियुद्धक्रीडागजतुरगरथपदातिचर्यापरिक्रमणान्यस्त्रोपास्त्रे वा सेवेरन् ||११||
Meaning of the śloka
For a wealthy person, one accustomed to unsuitable food, one who dislikes medicine, or a ruler, the text advises administering a substantial quantity of an āsava strongly prepared with pāṭhā, abhayā, and citraka, with honey used in place of jaggery; alternatively, another āsava may be given. It also describes frequent use of aged mādhvīka with food roasted over coals, drinks and foods combined with honey, kapittha, and marica, and food treated with powdered dung of camel, mule, or donkey. Soups seasoned with hiṅgu and rock salt and mustard preparations are prescribed, together with other compatible, flavorful, fragrant foods and drinks. A person with advanced meha is directed to engage in exercise, wrestling, play, riding elephants and horses, travelling by chariot or on foot, walking about, and practice with regulated or unregulated bows.
The commentator explains the opening category by examples such as wealthy merchants and interprets īśvara as a ruler. Here honey replaces jaggery. ‘A substantial quantity’ means plentiful, while ‘strong’ is explained as adding three karṣas of a decoction of pāṭhā, abhayā, and citraka to the ingredients; another view takes the alternative āsava to be the previously described priyaṅgvādi āsava. Food accompanying the drink is understood as roasted in a furnace or over coals. Mādhvīka is an aged alcoholic drink derived from honey; Jejjaṭa instead identifies it as grape āsava, an interpretation that Gayī rejects. Food is said to be dusted with powdered dung of camel and the other named animals. One reading describes mustard-paste preparations, while another reads ‘vegetables prepared with mustard.’ Other foods and drinks should be compatible with a person affected by prameha and should have agreeable taste and fragrance. The preceding diet-based measures are said to concern chiefly the lean person; the passage then turns to reducing measures for a stout person with advanced meha. Exercise is defined as varied exertion of the limbs, illustrated by activities such as moving weights, drawing a rope, and drawing a bow. Niyuddha means arm-to-arm wrestling here, though Dhanurveda gives another explanation that is omitted for brevity. Play is explained as familiar, lighthearted movements of the hands and feet. The commentator refers the details of elephant, horse, chariot, and infantry activity to their respective disciplines, preserves two interpretations of parikramaṇa—as walking back and forth or moving all around—and distinguishes astra as a bow used according to formal rules from upāstra as a bow used without those rules.
Key terms
āsava
A fermented preparation prescribed in several alternative forms in this passage.
mādhvīka
An aged honey-derived alcoholic drink; Jejjaṭa alternatively identifies it as grape āsava, which Gayī rejects.
pravṛddhameha (pravṛddha-meha)
An advanced state of meha for which the passage prescribes sustained physical activity.
niyuddha
Arm-to-arm wrestling in the commentator's explanation, while another discipline uses the term differently.
parikramaṇa
Walking or roaming, interpreted either as going back and forth or moving all around.
Adhikarana ১০ (১২-১৩) · Śloka ১৩
অধনস্ত্ববান্ধবো বা পাদত্রাণাতপত্রবিরহিতো ভৈক্ষ্যাশী গ্রামৈকরাত্রবাসী মুনিরিব সংযতাত্মা যোজনশতমধিকং বা গচ্ছেত্, মহাধনো বা শ্যামাকনীবারবৃত্তিরামলককপিত্থতিন্দুকাশ্মন্তকফলাহারো মৃগৈঃ সহ বসেত্, তন্মূত্রশকৃদ্ভক্ষঃ সততমনুব্রজেদ্গাঃ, ব্রাহ্মণো বা শিলোঞ্ছবৃত্তির্ভূত্বা ব্রহ্মরথমুদ্ধরেত্, কৃষেত্ সততমিতরঃ খনেদ্বা কূপং, কৃশং তু সততং রক্ষেত্ ||১২||
ভবতি চাত্র- অধনো বৈদ্যসন্দেশাদেবং কুর্বন্নতন্দ্রিতঃ |
সংবত্সরাদন্তরাদ্বা প্রমেহাত্ প্রতিমুচ্যতে ||১৩||
The text prescribes an austere and physically demanding way of life. A poor person without family support is to go barefoot and without a parasol, live on alms, stay only one night in each village, remain self-controlled like a sage, and travel more than one hundred yojanas. Alternatively, a very wealthy person is to subsist on śyāmāka and nīvāra grains and the fruits of āmalaka, kapittha, tinduka, and aśmantaka, live with deer, and continually follow cattle while consuming their urine and dung. A Brāhmaṇa is to live by gleaning and undertake brahmaratha; another person is to plough continually or dig a well. A lean person, however, is always to be protected. The concluding verse states that a poor person who diligently follows the physician’s instruction in this way is released from prameha within a year or earlier.
The commentator says that ‘more than one hundred’ may mean two or three hundred yojanas. Nīvāra is described as a wild grain of two kinds: one resembles cultivated grain and grows in fields, while the other has a large leafy stalk and grows in water; the water-grown kind develops with rising water, has red awns, and is called prasādhi or prasārika in another text. The urine and dung specified are those of cows. Śila means collecting scattered grains left on the ground, while uñcha means taking grain that remains standing or lies at the field surface. Brahmaratha is explained in two ways: lifting a cart occupied by a Brāhmaṇa together with his lawful wife, or sustaining ‘Brahman as the chariot,’ meaning maintaining Vedic study. The commentary associates the latter explanation with its view that prameha, considered largely connected with wrongdoing, subsides through Vedic study. ‘The other’ is glossed as a Śūdra. It assigns the instruction from poverty through living with deer to a Kṣatriya, and the instruction to follow cattle and consume their urine and dung to a Vaiśya. These caste-based assignments and the two interpretations of brahmaratha are preserved as the commentator’s historical reasoning rather than combined into one conclusion.
Key terms
nīvāra
A wild grain described by the commentary as having field-grown and water-grown varieties.
śiloñchavṛtti (śiloñcha-vṛtti)
A livelihood based on gleaning scattered or remaining grains.
brahmaratha
Interpreted either as lifting a cart occupied by a Brāhmaṇa and his wife or as sustaining Vedic study.
prameha
The classical disease category from which the text claims release through the prescribed austerities.
yojana
A traditional unit of distance used to describe the extensive travel prescribed here.
Thus ends the eleventh chapter of the Cikitsāsthāna in Dalhaṇa’s commentary on Suśruta, entitled Nibandhasaṅgraha. The supplied source preserves a variant spelling of the commentator’s name as Dalhaṇa/Dahlana.
Key terms
cikitsāsthāna
The treatment section of the Suśruta Saṃhitā.
pramehacikitsita (prameha-cikitsita)
The title of the chapter on the treatment of prameha.
Nibandhasaṅgraha
The title of Dalhaṇa’s commentary on the Suśruta Saṃhitā.