Now the treatment of udara disorders will be explained, as taught by Bhagavān Dhanvantari. Eight forms of udara were described earlier. Among them, baddhaguda and parisrāvi are declared incurable, while the remaining forms are difficult to cure; treatment of every form should therefore be undertaken only after explaining the prognosis. The first group of four is treated with medicines and the later group with surgical measures. If too much time has elapsed, all may come to require surgery, or may have to be left untreated.
Although eight forms were already stated in the Nidānasthāna, their number is repeated here to show that plīhodara and yakṛddālyudara share one treatment. The remaining disorders become progressively harder to cure in the order given, as a cited Caraka verse also states. Some interpret “all” as the six forms called difficult to cure; others include baddhaguda and parisrāvi and understand all eight, because treatments are also described for those two and the wording is inclusive. The first four are the udara disorders caused respectively by vāta, pitta, kapha, and dūṣīviṣa. The later group comprises plīhodara, baddhaguda, chidrodara, and udakodara. “Because of prolongation” means that once the proper period for medicinal treatment has passed, even medicinally manageable forms may become surgical cases; once the proper period for surgery has also passed, surgical cases are to be abandoned.
Key terms
udara
The classical group of abdominal enlargement disorders discussed in this chapter.
baddhaguda
One of the eight udara forms, characterized in the source as incurable.
parisrāvi
One of the eight udara forms, likewise characterized here as incurable.
A person with udara should avoid heavy and abhiṣyandi foods, dry and burning substances, fatty meat, sprinkling therapies, and immersion baths. Śāli rice, ṣaṣṭika rice, barley, wheat, and nīvāra should be eaten regularly.
Abhiṣyandi denotes something that produces excessive moisture or obstruction in the doṣas, dhātus, malas, and srotases. Kāñjika and similar substances illustrate vidāhi, or burning-producing items. Snigdha piśita means fatty meat. Nīvāra is identified as the grain called ulikā.
Key terms
abhiṣyandi
A substance described here as promoting kleda in doṣas, tissues, wastes, and channels.
vidāhi
A substance regarded as producing a burning or irritating effect.
nīvāra
A grain identified by the commentary with ulikā.
srotas
A bodily channel in which the commentary says kleda may develop.
For vātodara, the text directs oleation with ghee prepared with the Vidārigandhādi group, followed by downward elimination with a preparation of tilvaka. It then describes both an āsthāpana basti and an anuvāsana basti using Vidārigandhādi decoction made strong with citrāphala oil, an abdominal poultice of the Sālvaṇa type, and food accompanied by milk prepared with Vidārigandhādi and by broth of jāṅgala animals. Repeated sudation is also prescribed.
Tilvaka is identified as paṭṭikārodhra, and anulomya is explained as inducing purgation. Citrāphala oil is identified with oil from the fruit of dantī. Āsthāpana means a nirūha basti, while the anuvāsana is to use the same citrāphala oil. The Sālvaṇa poultice is bound over the abdomen. The instruction for repeated sudation is said to apply also to the later kapha-origin disorder, but not to the pitta-origin disorder. Sudation is permitted only before the udaka stage; beyond that stage, all such patients are not to be subjected to it. The commentator raises an apparent conflict: later the text says an udara patient is not to receive oleation, sudation, anuvāsana, or āsthāpana. The answer given is that this prohibition applies specifically to chidrodara and udakodara; in other types, these measures may be used according to the condition.
Key terms
vātodara
The form of udara attributed predominantly to vāta.
anulomya
Here explained by the commentator as producing purgation or downward elimination.
āsthāpana
A nirūha-type basti described in the historical regimen.
anuvāsana
An unctuous basti, here said to use citrāphala oil.
sveda
Sudation, whose permitted use is limited by disorder type and stage in the commentary.
For pittodara, the text directs oleation with ghee prepared from the Madhura group, followed by downward elimination with a preparation of śyāmā, triphalā, and trivṛt. It describes āsthāpana and anuvāsana bastis using a decoction of the Nyagrodhādi group made strong with sugar, honey, and ghee, an abdominal poultice of pāyasa, and food accompanied by milk prepared with the Vidārigandhādi group.
For śleṣmodara, the text directs oleation with ghee prepared in a pippalyādi decoction, followed by downward elimination with a preparation of snuhī latex. It describes āsthāpana and anuvāsana bastis using a Muṣkakādi decoction made strong with trikaṭu, urine, alkali, and oil. An abdominal poultice is prepared from śaṇa, atasī, dhātakī, kiṇva, mustard, and radish seeds. Food is to include kulattha soup, or pāyasa, made strong with trikaṭu, and repeated sudation is prescribed.
The Muṣkakādi group begins with muṣkaka, palāśa, and dhāvanī. The anuvāsana is performed with oil prepared using the Āsthāpana group. Kiṇva means the fermenting starter or seed of surā.
Key terms
śleṣmodara
The form of udara attributed predominantly to śleṣman or kapha.
trikaṭu
The classical three-pungent combination used repeatedly in this regimen.
Muṣkakādi
A medicinal group said to begin with muṣkaka, palāśa, and dhāvanī.
kiṇva
The fermenting starter associated with surā.
kulattha-yūṣa
A soup of kulattha prescribed as food in this passage.
दूष्योदरिणं तु प्रत्याख्याय सप्तलाशङ्खिनीस्वरससिद्धेन सर्पिषा विरचयेन्मासमर्धमासं वा, महावृक्षक्षीरसुरागोमूत्रसिद्धेन वा; शुद्धकोष्ठं तु मद्येनाश्वमारकगुञ्जाकाकादनीमूलकल्कं पाययेत्; इक्षुकाण्डानि वा कृष्णसर्पेण दंशयित्वा भक्षयेद्वल्लीफलानि वा, मूलजं कन्दजं वा विषमासेवयेत्, तेनागदो भवत्यन्यं वा भावमापद्यते ||८||
Meaning of the śloka
For dūṣyodara, the text first requires that the grave prognosis be explained. It then describes purgation for a month or half a month with ghee prepared in the fresh juices of saptalā and śaṅkhinī, or with a preparation involving the latex of mahāvṛkṣa, surā, and cow urine. After cleansing of the bowel, it directs administration with alcohol of a root paste containing aśvamāraka, guñjā, and kākādanī. It further describes eating pieces of sugarcane made to be bitten by a black snake, eating certain vine fruits, or consuming poison derived from a root or tuber. The text states that by this the person may become free of disease, or may pass into another state—that is, may die.
The commentator introduces this as treatment of sannipātika udara and identifies śaṅkhinī as a variety of yavatiktā. Measures such as oleation in sannipātika udara are to be selected from all the medicinal groups previously stated for vāta and the other types. This is supported by citations from Caraka and Laghu Vāgbhaṭa, the latter limiting such treatment to a person whose strength and digestive fire are not greatly depleted and directing treatment according to the predominant doṣa, after explaining the prognosis. In the preparation beginning with mahāvṛkṣa, purgation is understood to be supplied from the prior sentence; mahāvṛkṣa is identified as sehuṇḍa, and its latex is used in the amount appropriate to the paste. Guñjā is identified as cirihiṇṭikā and kākādanī as vāyasatindukā. The commentator compares this hazardous method with other instances of countering a condition by a similar cause: alcohol in madātyaya, heat in burns, inducing stool in diarrhea, emesis in vomiting, and poison in snake poisoning. On that analogy, udara arising from poison is treated with snake-bitten sugarcane or poison. Vallī fruits include karkaṭī and similar fruits. “Another state” is explicitly interpreted as death. The commentator calls the act dreadful: because death is considered certain without treatment and success remains uncertain with it, it is to be attempted only with the ruler's authorization.
Key terms
dūṣyodara
The udara condition treated here and interpreted by the commentary as sannipātika udara.
pratyākhyāya
After clearly explaining the grave or uncertain prognosis.
śaṅkhinī
A medicinal plant identified here as a variety of yavatiktā.
mahāvṛkṣa
A plant identified by the commentator as sehuṇḍa, whose latex is used in the described preparation.
anyaṃ bhāvam āpadyate
“Reaches another state,” explicitly explained in the commentary as death.
Adhikarana ೭ (೯) · Śloka ೯
ಭವತಿ ಚಾತ್ರ- ಕುಪಿತಾನಿಲಮೂಲತ್ವಾತ್ ಸಞ್ಚಿತತ್ವಾನ್ಮಲಸ್ಯ ಚ |
ಸರ್ವೋದರೇಷು ಶಂಸನ್ತಿ ಬಹುಶಸ್ತ್ವನುಲೋಮನಮ್ ||೯||
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भवति चात्र- कुपितानिलमूलत्वात् सञ्चितत्वान्मलस्य च |
सर्वोदरेषु शंसन्ति बहुशस्त्वनुलोमनम् ||९||
Meaning of the śloka
Because aggravated anila (vata) is the root cause and mala has accumulated, repeated anulomana—promoting the proper downward movement of bodily wastes—is recommended in all types of udara.
The commentator explains that every form of udara proceeds with an increase of mala. Therefore, samshodhana, or cleansing, is considered beneficial and should be undertaken repeatedly and substantially, as indicated by the expression bahushah.
Key terms
kupitānila
Aggravated anila or vata, described here as the underlying cause.
mala
Bodily waste or morbid material said to have accumulated.
anulomana
Promoting the proper downward movement of vata and waste.
udara
The classical group of abdominal disorders discussed in this chapter.
अत ऊर्ध्वं सामान्ययोगान् वक्ष्यामः |
तद्यथा- एरण्डतैलमहरहर्मासं द्वौ वा केवलं मूत्रयुक्तं क्षीरयुक्तं वा सेवेतोदकवर्जी, माहिषं वा मूत्रं क्षीरेण निराहारःसप्तरात्रम्, उष्ट्रीक्षीराहारो वाऽन्नवारिवर्जी पक्षं, पिप्पलीं वा मासं पूर्वोक्तेन विधानेनासेवेत, सैन्धवाजमोदायुक्तं वा निकुम्भतैलम्, आर्द्रशृङ्गवेररसपात्रशतसिद्धं वा वातशूलेऽवचार्यं, शृङ्गवेररसविपक्वं क्षीरमासेवेत, चव्यशृङ्गवेरकल्कं वा पयसा सरलदेवदारुचित्रकमेव वा, मुरङ्गीशालपर्णीश्यामापुनर्नवाकल्कं वा, ज्योतिष्कफलतैलं वा क्षीरेण स्वर्जिकाहिङ्गुमिश्रं पिबेत्, गुडद्वितीयां वा हरीतकीं भक्षयेत्, स्नुहीक्षीरभावितानां वा पिप्पलीनां सहस्रं कालेन, पथ्याकृष्णाचूर्णं वा स्नुहीक्षीरभावितमुत्कारिकां पक्वां दापयेत्; हरीतकीचूर्णं प्रस्थमाढके घृतस्यावाप्याङ्गारेष्वभिविलाप्य खजेनाभिमथ्यानुगुप्तं कृत्वाऽर्धमासं यवपल्ले वासयेत्, ततश्चोद्धृत्य परिस्राव्य हरीतकीक्वाथाम्लदधीन्यावाप्य विपचेत्, तद्यथायोगं मासमर्धमासं वा पाययेत्; गव्ये पयसि महावृक्षक्षीरमावाप्य विपचेत्, विपक्वं चावतार्य शीतीभूतं मन्थानेनाभिमथ्य नवनीतमादाय भूयो महावृक्षक्षीरेणैव विपचेत्, तद्यथायोगं मासं मासार्धं वा पाययेत्; चव्यचित्रकदन्त्यतिविषाकुष्ठसारिवात्रिफलाजमोदहरिद्राशङ्खिनीत्रिवृत्त्रिकटुकानामर्धकार्षिका भागा, राजवृक्षफलमज्ज्ञामष्टौ कर्षाः, महावृक्षक्षीरपले द्वे, गवां क्षीरमूत्रयोरष्टावष्टौ पलानि, एतत् सर्वं घृतप्रस्थे समावाप्य विपचेत्, तद्यथायोगं मासमर्धमासं वा पाययेत्; एतानि तिल्वकघृतचतुर्थानि सर्पींष्युदरगुल्मविद्रध्यष्ठीलानाहकुष्ठोन्मादापस्मारेषूपयोज्यानि विरेचनार्थं; मूत्रासवारिष्टसुराश्चाभीक्ष्णं महावृक्षक्षीरसम्भृताः सेवेत; विरेचनद्रव्यकषायं वा शृङ्गवेरदेवदारुप्रगाढम् ||१०||
Meaning of the śloka
The passage next presents general formulations for udara. It describes a series of historical regimens involving castor oil with liquids such as urine or milk, buffalo urine with milk, camel milk as the sole diet, pippali used according to an earlier method, oils and preparations containing salts, ajamoda, ginger, chavya, chitraka, devadaru, trivrit, punarnava, haritaki, snuhi latex, alkalis, ghee, milk, and other listed substances. Several are prepared by repeated processing, decoction, fermentation, or cooking and are said to be taken for specified periods according to suitability. Four purgative ghees, including tilvaka ghee, are traditionally indicated for udara, gulma, vidradhi, ashthila, anaha, kushtha, unmada, and apasmara. The passage also mentions fermented preparations made with urine and mahavriksha latex, or a purgative decoction strongly combined with ginger and devadaru.
The commentator explains several compressed details and preserves disagreements. For the seven-day regimen, some read the milk as buffalo milk, while others prefer cow's milk because buffalo products are considered to impair digestion; the commentator rejects an interpretation that explicitly combines buffalo urine with cow's milk because it lacks the approval of authorities such as Jejjata. Some add trikatu to camel milk on the authority of another text. Pippali is to follow the earlier method given for vatarakta. Nikumbha oil is identified with danti oil, although other authorities prepare sesame oil instead; fresh ginger juice is explained as four times the oil. Sarala is identified as trivrit, murangi as shobhanjana, shyama as vriddhadaruka, and jyotishka as kakamardanika. The snuhi processing is said to be repeated twenty-one times, and the thousand pippali fruits are taken gradually for purgation as capacity permits. Utkārika means a soft cooked preparation, and khaja is a churning implement. The liquids added to haritaki ghee are each explained as four times the ghee. In the milk-and-mahavriksha preparation, the commentator supplies measures and says water is fourfold where no liquid is specified. Each member of triphala and trikatu receives its own stated share; some additionally use fourfold water because the stated liquid is scant. The group of four ghees consists of the three just described together with tilvaka ghee from the treatment of vata disorders. Fermented drinks may be prepared with urine as their liquid and mahavriksha latex as an addition. The final alternative is explained as a trivrit-based purgative decoction enriched with measured ginger and devadaru powders.
Key terms
sāmānyayoga
A general therapeutic formulation presented for the abdominal disorders under discussion.
nikumbhataila
Oil identified by the commentary as danti oil; an alternative tradition uses sesame oil.
mahāvṛkṣakṣīra
The latex of mahavriksha, identified in the commentary with snuhi or sehunda.
virecana
Purgative cleansing, the stated purpose of the group of medicated ghees.
tilvakaghṛta
Tilvaka medicated ghee, counted as the fourth among the purgative ghees.
utkārikā
A soft cooked preparation, glossed by the commentator as lapsikā.
वमनविरेचनशिरोविरेचनद्रव्याणां पालिका भागाः पिप्पल्यादिवचादिहरिद्रादिपरिपठितानां च द्रव्याणां श्लक्ष्णपिष्टानां यथोक्तानां च लवणानां तत्सर्वं मूत्रगणे प्रक्षिप्य महावृक्षक्षीरप्रस्थं च मृद्वग्निनाऽवघट्टयन् विपचेदप्रदग्धकल्कं, तत्साधुसिद्धमवतार्य शीतीभूतमक्षमात्रा गुटिका वर्तयेत्, तासामेकां द्वे तिस्रो वा गुटिका बलापेक्षया मासांस्त्रींश्चतुरो वा सेवेत, एषाऽऽनाहंवर्तिक्रिया विशेषेण महाव्याधिषूपयुज्यते (विशेषेण) कोष्ठजांश्च कृमीनपहन्ति कासश्वासकृमिकुष्ठप्रतिश्यायारोचकाविपाकोदावर्तांश्च नाशयति ||११||
Meaning of the śloka
The passage describes pills made from finely ground substances classed for emesis, purgation, and cleansing of the head, together with the pippali, vacha, and haridra groups and the stated salts. These are historically processed in a group of animal urines with mahavriksha latex, cooked gently without scorching, cooled, and formed into pills. The number used is said to depend on the person's strength and the regimen to continue for three or four months. Called the internal anaha-varti procedure, it is especially applied in serious disorders and is traditionally claimed to remove intestinal krimi and conditions named kasa, shvasa, krimi, kushtha, pratishyaya, arochaka, avipaka, and udavarta.
The commentator introduces this as an internal urine-based varti intended to kindle digestion and direct accumulated mala downward when it is obstructed by confined anila. The emetic, purgative, and head-cleansing substances are those taught in the earlier cleansing chapter, including groups beginning with madanaphala, trivrit, and vidanga; the other drug groups and salts are likewise drawn from their respective chapters. Available ingredients are ground with one or a combination of animal urines and cooked with four or eight times that liquid. The pills are described as thumb-sized. One, two, or three are taken according to whether the person's strength is low, medium, or high, with animal urine also serving as the accompanying drink. The stated course is three or four months, and its claimed effects include removing major disorders beginning with meha and intestinal krimi.
Key terms
ānāhavartikriyā
A pill-based procedure described for anaha or obstruction and abdominal distension.
mūtragaṇa
The group of animal urines used as processing liquids in the historical formulation.
analadīpanī
Described by the commentator as kindling digestive activity.
koṣṭhaja kṛmi
Krimi situated in the gastrointestinal tract, according to the source.
balāpekṣayā
With the stated amount selected in relation to the person's strength.
For anaha in a person with udara, the passage describes a thumb-sized rectal wick prepared from madanaphala kernel, kutaja, jimuta, ikshvaku, dhamargava, trivrit, trikatu, mustard, and salts, ground with either mahavriksha latex or urine. After the anal region is anointed with oil and salt, one, two, or three wicks are historically inserted. This anaha-varti procedure is also prescribed for obstruction or reverse movement of vata, urine, and feces, and for abdominal swelling and distension.
Following the internal varti, the commentator explains this as a phala-varti administered rectally. Jimuta is identified as devadali, ikshvaku as bitter gourd, and dhamargava as mahakoshataki. The verb 'cook' is understood to carry over from the preceding formulation, and urine is to be maintained during cooking. Payu means the anal passage. The indication extends beyond anaha associated with udara to obstruction or reverse movement of vata, urine, and feces, as well as adhmana and anaha. An alternative reading has 'either alkaline water or urine'; under that reading, kshara means alkaline water because the text speaks of grinding.
Key terms
phalavarti
A medicinal wick intended for rectal administration.
ānāha
Obstruction or abdominal distension for which the procedure is described.
udāvarta
Disordered upward or reverse movement associated here with obstructed vata, urine, or feces.
kṣārodaka
Alkaline water in an alternative reading of the processing liquid.
pāyu
The anal passage, as explicitly glossed by the commentary.
For a person with plihodara who has undergone oleation and sudation and eaten curd, the passage describes puncturing a vein on the inner side of the left arm near the elbow and manually pressing the spleen to promote blood flow. After bodily cleansing, it lists several historical oral preparations: marine-shell alkali with milk; hingu and sauvarcika with milk; yavakshara combined with filtered palasha or kimshuka alkaline liquid; alkalis from parijata, ikshuraka, or apamarga; shobhanjana soup with oil, pippali, saindhava, and chitraka; or putikaranja alkali repeatedly filtered through an acidic liquid and strongly combined with vida salt and pippali.
The commentator says curd is eaten that same day to provoke the blood, comparing this with using kapha-provoking substances before emesis in a kapha disorder. Kurpara denotes the middle or elbow region of the arm, and the purpose is bloodletting. Although venesection has already been taught in its own procedure, it is repeated here because it is relevant to the present context and is therefore not considered needless repetition. Samshuddhadeha means a person cleansed by emesis and purgation. Ikshuraka is identified as kokilaksha, while some read paribhadraka together with ikshuraka. The acidic liquid is kanjika. Putikaranja is identified as chirabilva, though others identify it as kantakikaranja. The commentary supplies a particular preparation using kantakikaranja alkali, acidic kanjika, pippali, and vida salt; some read saindhava in place of vida salt.
Key terms
plīhodara
A classical abdominal disorder associated in the passage with the spleen.
sirāvyadha
Venesection or puncturing a vein for bloodletting.
kūrpara
The elbow or middle region of the arm, according to the commentary.
saṃśuddhadeha
A person whose body has been cleansed by emesis and purgation.
kṣāra
An alkaline preparation used in several formulations in the passage.
pūtikarañja
A plant identified as chirabilva, with kantakikaranja preserved as an alternative identification.
पिप्पलीपिप्पलीमूलचव्यचित्रकशृङ्गवेरयवक्षारसैन्धवानां पालिका भागाः, घृतप्रस्थं तत्तुल्यं च क्षीरं तदैकध्यं विपाचयेत्, एतत् षट्पलकं नाम सर्पिः प्लीहाग्निसङ्गगुल्मोदरोदावर्तश्वयथुपाण्डुरोगकासश्वासप्रतिश्यायोर्ध्ववातविषमज्वरानपहन्ति |
मन्दाग्निर्वा हिङ्ग्वादिकं चूर्णमुपयुञ्जीत ||१४||
Meaning of the śloka
Equal pala portions of pippali, pippali root, chavya, chitraka, ginger, yavakshara, and saindhava are cooked together with a prastha of ghee and an equal quantity of milk. This medicated ghee is called Shatpalaka. The text traditionally attributes benefit to it in conditions named pliha, obstruction of agni, gulma, udara, udavarta, swelling, panduroga, kasa, shvasa, pratishyaya, upward-moving vata, and irregular fever. A person with weak digestion is alternatively directed to use hingvadi powder.
The commentator records that some physicians add four times the quantity of water, but rejects this because Jejjata prohibited it. Some manuscripts also read that a double quantity of decoction made from kola, kulattha, putika, and rohitaka should be added; this too is rejected on Jejjata's authority.
Key terms
ṣaṭpalaka sarpis
The named medicated ghee formulation described in the passage.
agnisaṅga
Obstruction or impairment of agni in the classical sense.
yavakṣāra
Barley-derived alkaline substance included in the formulation.
ūrdhvavāta
Upward movement of vata, listed among the classical indications.
hiṅgvādika cūrṇa
A powder beginning with hingu, offered as an alternative for weak digestion.
For yakṛddālī, the same division of treatment is prescribed, with the special addition of sirāvyadha in the right arm. For calming enlargement of the spleen, the physician is told to bend the wrist slightly and promptly cauterize the vein directed toward the left thumb with an arrow.
The commentator explains that maṇibandha means the base of the hand. After the wrist has been bent slightly, the vein running properly toward the left thumb is identified. The familiar arrow is to be heated until it has the appearance of fire and then used to cauterize that vein. These statements explain the compact procedural wording of verses 15–16.
Key terms
yakṛddālī
A classical abdominal disorder associated in this passage with the liver.
sirāvyadha
Puncturing or opening a vein, specified here for the right arm.
maṇibandha
The wrist or base of the hand, as clarified by the commentary.
plīhan
The spleen; the passage addresses calming its enlargement or disorder.
बद्धगुदे परिस्राविणि च स्निग्धस्विन्नस्याभ्यक्तस्याधो नाभेर्वामतश्चतुरङ्गुलमपहाय रोमराज्या उदरं पाटयित्वा चतुरङ्गुलप्रमाणमन्त्राणि निष्कृष्य निरीक्ष्य बद्धगुदस्यान्त्रप्रतिरोधकरमश्मानं बालं वाऽपोह्य मलजातं वा ततो मधुसर्पिर्भ्यामभ्यज्यान्त्राणि यथास्थानं स्थापयित्वा बाह्यं व्रणमुदरस्य सीव्येत् |
परिस्राविण्यप्येवमेव शल्यमुद्धृत्यान्त्रस्रावान् संशोध्य , तच्छिद्रमान्त्रं समाधाय कालपिपीलिकाभिर्दंशयेत्, दष्टे च तासां कायानपहरेन्न शिरांसि, ततः पूर्ववत् सीव्येत्, सन्धानं च यथोक्तं कारयेत्, यष्टीमधुकमिश्रया च कृष्णमृदाऽवलिप्य बन्धेनोपचरेत्, ततो निवातमागारं प्रवेश्याचारिकमुपदिशेत्, वासयेच्चैनं तैलद्रोण्यां सर्पिर्द्रोण्यां वा पयोवृत्तिमिति ||१७||
Meaning of the śloka
For baddhaguda and parisrāvin, the text describes a historical abdominal operation after oleation, sudation, and external anointing. It directs an incision below and to the left of the navel, examination of a drawn-out portion of intestine, and removal of a stone, hair, accumulated fecal material, or another obstruction in baddhaguda. The intestine is then described as being coated with honey and ghee, returned to its place, and the external wound sutured. In parisrāvin, it describes removing the foreign body, cleansing intestinal discharge, bringing the intestinal opening together, and using the bites of black ants to hold it, leaving their heads in place after removing their bodies. The external wound is then sutured, treated for union, coated with dark clay mixed with yaṣṭīmadhuka, and bandaged. The patient is placed in a draft-free room, given conduct rules, kept in a trough of oil or ghee, and maintained on milk.
The commentator presents this as the operative treatment for baddhaguda and parisrāvin. Sudation is interpreted as liquid sudation, and the incision is described as transverse, four finger-breadths long, below and four finger-breadths to the left of the navel, following the direction of the hair. In baddhaguda, an internal obstruction may be a stone, hair, grass, or similar material; an external cause may be the intestinal parts becoming entangled after improper activity or trauma, without necessarily requiring intestinal cutting. This distinction explains why intestinal repair is stated separately for parisrāvin. If a deeply troublesome internal object necessitates an intestinal incision, the object is removed, the opening is joined by the method described, and the intestine—coated with honey and ghee—is returned using a thumb, finger, probe, or similar means. A twisted or collapsed intestine is to be restored manually, and the external wound sutured after due attention to measures concerning blood and wound care. Residence in an oil or ghee trough is explained as intended to reduce distress from abdominal distension after wounding. A milk-only regimen is prescribed until cessation of mucus-like rectal discharge and blood is taken as evidence that the intestinal union has become firm. The commentator warns that ordinary food or its residue could disrupt the delicate ant-bite closure even when union appears proper; diet is therefore advanced gradually from milk to broth of animals of arid regions, then toward ordinary food with progressively less dilution. The operation is explicitly called uncertain in outcome and is said to be undertaken only after acknowledging its grave prognosis and invoking divine permission.
Key terms
baddhaguda
A classical abdominal condition characterized here by intestinal or fecal obstruction.
parisrāvin
A classical abdominal condition involving an intestinal wound or leakage in this operative account.
kālapipīlikā
Black ants whose bites are historically described as holding the intestinal edges together.
sandhāna
Joining, repair, or union of the divided tissue.
yaṣṭīmadhuka
A medicinal substance mixed with dark clay for the external application described.
दकोदरिणस्तु वातहरतैलाभ्यक्तस्योष्णोदकस्विन्नस्य स्थितस्याप्तैः सुपरिगृहीतस्याकक्षात् परिवेष्टितस्याधोनाभेर्वामतश्चतुरङ्गुलमपहाय रोमराज्या व्रीहिमुखेनाङ्गुष्ठोदरप्रमाणमवगाढं विध्येत्, तत्र त्रप्वादीनामन्यतमस्य नाडीं द्विद्वारां पक्षनाडीं वा संयोज्य दोषोदकमवसिञ्चेत्, ततो नाडीमपहृत्य तैललवणेनाभ्यज्य व्रणं बन्धेनोपचरेत्, न चैकस्मिन्नेव दिवसे सर्वं दोषोदकमपहरेत्, सहसा ह्यपहृते तृष्णाज्वराङ्गमर्दातीसारश्वासकासपाददाहा उत्पद्येरन्नापूर्यते वा भृशतरमुदरमसञ्जातप्राणस्य, तस्मात्ततीयचतुर्थपञ्चमषष्ठाष्टमदशमद्वादशषोडशरात्राणामन्यतममन्तरीकृत्य दोषोदकमल्पाल्पमवसिञ्चेत्; निःसृते च दोषे गाढतरमाविककौशेयचर्मणामन्यतमेन परिवेष्टयेदुदरं, तथा नाध्मापयति वायुः; षण्मासांश्च पयसा भोजयेज्जाङ्गलरसेन वा, ततस्त्रीन्मासानर्धोदकेन पयसा फलाम्लेन जाङ्गलरसेन वा, अवशिष्टं मासत्रयमन्नं लघु हितं वा सेवेत, एवं संवत्सरेणागदो भवति ||१८||
Meaning of the śloka
For a person with dakodara, the text describes a historical procedure after massage with vāta-reducing oil and warm-water sudation, with the standing patient firmly supported and bound around the trunk. It describes puncturing the abdomen below and to the left of the navel with a vrīhimukha instrument, fitting a two-opened metal tube or feather tube, and letting out the doṣa-associated fluid. The tube is then removed and the wound anointed with oil and salt and bandaged. The text expressly says that all the fluid must not be removed in one day: sudden withdrawal is said to cause thirst, fever, body pain, diarrhea, difficult breathing, cough, burning feet, renewed severe abdominal filling, or loss of vitality. It therefore prescribes removing small amounts at selected intervals. After drainage, the abdomen is to be wrapped firmly with wool, silk, or hide so that vāyu does not produce distension. The passage then gives a year-long staged dietary regimen: six months with milk or broth of animals of arid regions, three months with milk diluted by half with water or with sour-fruit or such meat broth, and a final three months of light, suitable food. It claims recovery after one year.
The commentator explains the dietary sequence. For six months, light and suitable food is taken with milk, with milk also replacing water. When predominance of kapha and vāta is observed, broth of animals of arid regions may be used, and that broth likewise replaces water. During the next three months, light and suitable food is taken with milk diluted by half with water or, according to the doṣa, with the stated meat broth; these liquids also serve in place of water. For the last three months, light and suitable food is taken and ordinary water again serves its usual purpose. A different regimen is then preserved: Vāgbhaṭa, following Caraka’s view, is said to prescribe subsistence on milk alone for six months rather than food and drink, followed by three months of gruel prepared with milk and another three months of food taken with milk, sour-fruit liquid, or broth, with small amounts of unctuous substance and salt and aged śyāmāka or kodrava. The two dietary accounts should remain distinct.
Key terms
dakodara
A classical abdominal disorder marked here by accumulated abdominal fluid.
vrīhimukha
A rice-grain-tipped puncturing instrument named in the historical procedure.
doṣodaka
The pathological abdominal fluid attributed to doṣa that the passage describes draining.
jāṅgala-rasa
Broth from animals of arid regions, used in the stated dietary regimen.
śyāmāka-kodrava
The aged grains named in the alternative dietary regimen quoted by the commentator.
भवति चात्र- आस्थापने चैव विरेचने च पाने तथाऽऽहारविधिक्रियासु |
सर्वोदरिभ्यः कुशलैः प्रयोज्यं क्षीरं शृतं जाङ्गलजो रसो वा ||१९||
Meaning of the śloka
In āsthāpana, virecana, drinking regimens, and dietary procedures for all persons with udara disorders, skilled practitioners are to employ boiled milk or broth from animals of arid regions.
The commentator says this verse specifies the permitted liquids when water is prohibited after a procedure. The two uses of the conjunction ca also extend the instruction to procedures that are not expressly listed in the verse, including abdominal incision and related measures.
Key terms
āsthāpana
A decoction-based enema procedure included in the passage.
virecana
A purgative procedure included in the passage.
udara
The group of classical abdominal disorders addressed by the chapter.
jāṅgalaja rasa
Broth obtained from animals of arid regions, offered here as an alternative liquid.
The commentary’s colophon states that the fourteenth chapter of the Cikitsāsthāna is complete in Dalhaṇa’s Sushruta commentary entitled Nibandhasaṅgraha. The supplied reading of the commentator’s name contains the textual form ‘Ḍalha(hla)ṇa,’ which should be checked against the source edition.
Key terms
Cikitsāsthāna (cikitsāsthāna)
The section of the Sushruta Samhita concerned with treatment.
udaracikitsita
Treatment of the classical group of udara disorders; the chapter title.
Nibandhasaṅgraha (nibandhasaṅgraha)
The title given to Dalhaṇa’s commentary on the Sushruta Samhita.