౧౨. ప్రమేహపిడకాచికిత్సితం

Meaning of the śloka

Now the treatment of prameha-piḍakā will be explained, as taught by Bhagavān Dhanvantari. The nine piḍakās beginning with Śarāvikā have already been described. They are curable when the affected person retains vitality, the lesions are few, confined to the skin and flesh, soft, only mildly painful, and quickly mature and open.

Key terms

prameha-piḍakā

The group of lesions discussed in this chapter, whether associated with prameha or arising independently under comparable doṣa-dūṣya conditions.

Śarāvikā (śarāvikā)

The first named type in the previously described group of nine piḍakās.

doṣa-dūṣya

The causative bodily factors and the tissues or substances affected by them, said here to be alike in both presentations.

sādhya

Considered amenable to treatment when the listed favorable features are present.

Meaning of the śloka

A person with prameha afflicted by these piḍakās should be treated. At the stage of preliminary signs, the text prescribes apatarpaṇa, a decoction of trees, and goat urine. If this is not done while the person continues taking sweet food, the urine, sweat, and mucus become sweet and prameha becomes manifest; then cleansing in both directions is advised. If that is not done, the increased doṣas vitiate flesh and blood and produce swelling or other complications; the previously taught measures and venesection are then advised. If still untreated, the swelling greatly increases, becomes very painful, and undergoes inflammatory suppuration; the text then directs surgical intervention and wound treatment. If this too is not done, pus dissects inward, creates a large cavity or sinus-like space, and the condition advances to become incurable. Therefore, the text urges treatment of the person with prameha from the outset.

Key terms

apatarpaṇa

Reducing treatment, explained here as fasting and related measures.

ubhayataḥ saṃśodhana

Cleansing in both directions, explicitly interpreted as emesis and purgation.

sirāmokṣa

Venesection prescribed at the stage of swelling in the historical treatment sequence.

vidāha

The inflammatory or suppurative transformation of an enlarged, very painful swelling.

utsaṅga

Interpreted either as a pus-dissected internal cavity resembling an overhang or, in another view, as upward retention of pus.

Meaning of the śloka

The passage describes a preparation called Dhānvantara. Ten palas each of bhallātaka, bilva, ambu, pippalīmūla, udakīryā, varṣābhū or punarnavā, citraka, śaṭī, snuhī, varuṇaka, puṣkara, dantī, and pathyā, together with one prastha each of barley, kola, and kulattha, are decocted in one droṇa of water until one quarter remains. After straining, one prastha of ghee is cooked with half a pala each of vacā, trivṛt, kampillaka, bhārṅgī, nicula, dry ginger, gajapippalī, viḍaṅga, rodhra, and śirīṣa. The text attributes to this formulation the removal of meha, swelling, kuṣṭha, gulma, disorders of the abdomen, arśas, disorders of the spleen, vidradhi, and piḍakā.

Key terms

Dhānvantara (dhānvantara)

The name assigned to the compound formulation in this passage.

anārṣa

Not accepted by the commentator as belonging to the authoritative sage-derived textual tradition.

niṣkvāthya

To be decocted, here until the liquid is reduced to one quarter.

vidradhi

One of the classical conditions for which the passage claims the formulation is useful; no modern equivalence is asserted.

Meaning of the śloka

The text says that persons with madhumeha are difficult to purge because medas pervades their bodies; it therefore advises strong cleansing for them. It further states that every type of prameha accompanied by piḍakās and complications conventionally receives the designation madhumeha when urine and the other named substances have sweetness and a honey-like odor in common.

Key terms

madhumeha

A conventional designation applied here to complicated prameha sharing sweetness and honey-like odor in urine and related substances.

medas

A classical bodily tissue said in this passage to pervade the body and make purgation difficult.

tīkṣṇa śodhana

Strong cleansing advised by the historical text.

pāribhāṣikī ākhyā

A conventional or technical designation used under the stated conditions.

Meaning of the śloka

These patients should never be subjected to svedana (sudation). Because of their abundance of medas, their bodies become disintegrated or severely weakened by sweating.

Key terms

svedana

A sudation or sweating intervention prohibited for the patients described here.

medas

The bodily tissue whose abundance is given as the reason sweating is harmful in this passage.

pramehin

A person affected by prameha; the term is retained without assigning a modern diagnosis.

Meaning of the śloka

Because the rasāyanīs are weak, the doṣas in persons with prameha do not rise upward. Consequently, piḍakās appear in the lower part of the body in persons with madhumeha.

Key terms

rasāyanī

Interpreted here as vessels or channels carrying rasa and, by an understood extension, pitta, kapha, and śoṇita.

piḍakā

A lesion or eruption said here to manifest in the lower part of the body.

apāna-vyāna

Two movements or divisions of vāta invoked by the commentator to explain a downward direction of bodily fluids.

rasahāriṇī

A variant reading meaning structures that carry rasa.

Meaning of the śloka

An unripe piḍakā is to be managed like a śopha, while a ripe one is to be managed like a wound. At the beginning of the wound-healing stage, the text directs the use of oil. It assigns a decoction of the āragvadhādi group for raising a depressed wound, a decoction of the śālasārādi group for irrigation, and a decoction of the pippalyādi group in drinks and foods. It also prescribes taking powders of pāṭhā, citraka, śārṅgeṣṭā, kṣudrā, bṛhatī, sārivā, somavalka, saptaparṇa, āragvadha, and kuṭaja root mixed with honey.

Key terms

apakva piḍakā

An unripe or not-yet-mature lesion, managed here according to the approach for śopha.

ropaṇa

The wound-healing stage or action for which the commentator gives priority to medicated oil.

utsādana

A procedure intended to raise the surface of a depressed wound.

pariṣecana

Irrigation or pouring over the affected area, assigned here to the śālasārādi decoction.

elādi

A plant group beginning with elā, preserved as an alternative reading for the initial measure.

Meaning of the śloka

The decoction of the śālasārādi group is reduced until one quarter remains, removed from the fire, filtered, returned to the vessel, and cooked again. As it reaches completion, powders of āmalaka, rodhra, priyaṅgu, dantī, kṛṣṇāyas, and copper are added. It is taken down before scorching, stored securely after it acquires the consistency of a leha, and used as appropriate. The text describes this leha as destroying all forms of meha.

Key terms

śālasārādi-varga

The classical group beginning with śālasāra used to prepare the decoction.

leha

A preparation cooked to a lickable, semisolid consistency.

kṛṣṇāyas

A black iron material included as a powder in the formulation.

tāmra

Copper, included as a powdered ingredient in the historical formulation.

pala

A classical unit of weight used in the commentator's two differing quantity interpretations.

Meaning of the śloka

The text describes a preparation called navāyasa. Triphalā, citraka, trikaṭu, viḍaṅga, and mustā are combined in the stated proportions with powdered black iron, and an appropriate dose is taken mixed with ghee and honey. The passage traditionally attributes to it the prevention of jāṭharya, restoration of weakened agni, and relief from conditions named durnāma, śopha, pāṇḍu, kuṣṭha, avipāka, kāsa, śvāsa, and prameha.

Key terms

navāyasa

The iron-containing preparation named in this passage.

kṛṣṇāyas-cūrṇa

Powder of black iron, according to the commentary.

jāṭharya

Stoutness or obesity in the commentator's explanation.

sannāgni (sanna-agni)

A weakened state of agni that the text says is restored by the preparation.

Meaning of the śloka

The passage describes a fermented preparation called lohāriṣṭa. A reduced and strained decoction of the śālasārādi group is cooled and combined with mādhvīka, purified jaggery, and finely powdered herbs of the pippalyādi group in a clean, strong vessel conditioned with ghee and coated inside with pippalī powder and honey. Thin sheets of sharp iron, repeatedly heated over khadira charcoal, are placed in it. The closed vessel is kept among barley for three or four months, or until the iron has been consumed. Once the preparation has developed its characteristic rasa, it is taken each morning according to strength, with a suitable diet. The text traditionally says that it reduces excess weight in strong persons, supports diminished agni, and relieves śopha, gulma, kuṣṭha, meha, pāṇḍu, disorders of the spleen and abdomen, irregular fever, and abhiṣyanda.

Key terms

lohāriṣṭa

The iron-associated fermented preparation described and named in the passage.

niryūha

A decoction; the commentary specifies that it is reduced to one quarter.

mādhvīka

Understood in the main commentary as a honey-based fermented drink, while Gayī takes it to mean honey itself.

abhiṣyanda

Interpreted here by the commentator as urinary discharge or outflow.

yathābalam

According to the person's strength.

Meaning of the śloka

When the urine of a person affected by prameha is no longer slimy or turbid, and is clear, drying, bitter, and pungent, the text regards this as a sign of restored health.

Key terms

prameha

The classical disease category whose recovery signs are discussed here.

apicchila

Not slimy or mucilaginous.

anāvila

Not turbid; explained by the commentator as clear.

viśada

Explained in this commentary as drying or non-unctuous.

anāviddha

A variant reading that the commentator also glosses as clear.

Meaning of the śloka

Thus ends the twelfth chapter of the Cikitsāsthāna in the Suśruta Saṃhitā, entitled Pramehapiḍakācikitsita, concerning the treatment of prameha-related piḍakā.

Key terms

Cikitsāsthāna (cikitsāsthāna)

The treatment section of the Suśruta Saṃhitā.

Pramehapiḍakācikitsita (prameha-piḍakā-cikitsita)

The chapter title, concerning treatment of piḍakā associated with prameha.

Nibandhasaṅgraha

The title of Dalhaṇa's commentary on the Suśruta Saṃhitā.