अथातो वमनविरेचनसाध्योपद्रवचिकित्सितं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
Meaning of the śloka
The chapter now begins with an explanation of the treatment of complications or disorders regarded as manageable by vamana and virecana, as taught by Bhagavan Dhanvantari.
The commentary glosses upadrava as disease or complication. It says that cikitsita here specifically takes the form of vamana and virecana because the conditions discussed are regarded in the text as responsive to those two measures.
Key terms
vamana
Therapeutic emesis in the chapter's historical framework.
virecana
Therapeutic purgation in the chapter's historical framework.
upadrava
A disorder or complication, as glossed by the commentary.
cikitsita
The therapeutic discussion introduced by the chapter title.
The established principle is that diminished dosas should be nourished, aggravated dosas should be pacified, greatly increased dosas should be expelled, and dosas in equilibrium should be maintained.
The commentary explains that vamana and virecana are not intended for every state of dosa. A dosa recognized as depleted is to be supported; one mildly disturbed is to be pacified; and one greatly increased and displaced from its own site is to be removed by samsodhana. Jejjata reads pravrddha and distinguishes accumulation, described as compact gathering, from prakopa, described as liquefaction or active disturbance. The commentary also distinguishes disturbance preceded by accumulation from disturbance without it, assigning elimination to the former. Dosas remaining in their proper sites are to be protected, while balanced dosas are maintained through the regimen for health. It notes that these broader principles appear here through contextual extension.
Key terms
ksina (kṣīṇa)
Diminished or depleted, identified through signs of loss.
kupita
Disturbed or aggravated; the commentary distinguishes more than one mode of aggravation.
vrddha (vṛddha)
Greatly increased and, in the commentary's account, displaced from its proper site.
sama
Balanced and conducive to health.
samsodhana (saṃśodhana)
Eliminative treatment assigned to particular increased or accumulated states.
Vamana and virecana are presented as the principal means for removing dosas, and their procedure is therefore introduced. For a person assessed as oleated, sweated, and having dosas no longer obstructed, the text describes giving particular foods on the day before intended emesis when the person has strong digestive capacity, strength, abundant dosa, serious disease, or familiarity with vamana.
The commentary contrasts vamana and virecana with basti and measures such as dhuma, nasya, and kavala, saying the latter remove dosas in more limited ways while the former are described as acting in greater quantity. It answers an objection that vamana and virecana chiefly concern kapha and pitta by saying they may also redirect liquefied vayu through upward or downward routes; other readers avoid this extension and read 'the two dosas.' The singular command 'understand' is addressed specifically to Susruta despite the presence of other pupils. The procedural preparation in the verse is explained as intended to mobilize or excite kapha before the following day's vamana.
Key terms
nirharana (nirharaṇa)
Removal or expulsion of dosas in the text's therapeutic model.
snigdha
Made unctuous through prior oleation.
svinna
Having undergone sweating or heating preparation.
anavabaddhadosa (anavabaddhadoṣa)
A state in which dosas are described as no longer obstructed or fixed.
dosayoh (doṣayoḥ)
The variant reading 'of the two dosas,' preserved by some readers.
The text says that emesis proceeds properly after dosas have been excited by various soft or heavy foods and the person has undergone oleation and sweating. It then gives a detailed historical sequence involving selection of an emetic preparation according to the person's kostha, sensory qualities intended to provoke emesis, special preparation for delicate, thin, young, old, or fearful people, warming after administration, observation for sweating and nausea, supported seating, stimulation of the throat, and continuation until signs regarded as proper emesis appear.
The commentary expands the preceding and present verses into a staged procedure. It interprets the prior meal as intended to excite kapha and discusses strength, digestive capacity, dosa burden, serious disease, and familiarity with emesis as selection considerations. It records differing explanations of the interval and of a 'moderate' season, and quotes other authorities on timing and quantities. For vulnerable persons, milk, curd, buttermilk, or gruel may either be medicated or given before the emetic; another cited formulation also lists alcohol, sugarcane juice, or meat broth. After administration, warmth and observed signs are used to infer movement of dosa, while hrllasa is variously understood as retching or vomiting. These details describe historical reasoning and do not establish a safe protocol.
Key terms
utklesa (utkleśa)
Excitation or mobilization of dosa, especially kapha, sought by the preparatory food.
kostha (koṣṭha)
The person's internal or bowel disposition considered when selecting the preparation.
vamana
Induced therapeutic emesis described by the passage.
hrllasa (hṛllāsa)
Nausea or retching; the commentary records differing interpretations.
samyagvanta (samyagvānta)
A person judged to have vomited properly by traditional signs.
Adhikarana 5 (8) · Śloka 8
bhavataścātra- kaphaprasēkaṁ hr̥dayāviśuddhiṁ kaṇḍūṁ ca duścharditaliṅgamāhuḥ |
pittātiyōgaṁ ca visañjñatāṁ ca hr̥tkaṇṭhapīḍāmapi cātivāntē ||8||
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भवतश्चात्र- कफप्रसेकं हृदयाविशुद्धिं कण्डूं च दुश्छर्दितलिङ्गमाहुः |
पित्तातियोगं च विसञ्ज्ञतां च हृत्कण्ठपीडामपि चातिवान्ते ||८||
Meaning of the śloka
Salivation with kapha, lack of clarity or discomfort in the heart region, and itching are said to indicate difficult or inadequate vomiting. Excess flow of pitta, obstruction, and distress in the heart and throat are said to occur when vomiting is excessive.
The commentary presents these as preliminary signs through which complications of insufficient and excessive vamana may be anticipated. It specifically explains pittatiyoga as an excessive discharge of pitta.
Key terms
duschardi (duśchardi)
Difficult or inadequate vomiting indicated by the listed signs.
kaphapraseka
Excess salivary or kapha discharge listed as a sign.
pittatiyoga (pittātiyoga)
Excessive discharge of pitta, as glossed by the commentary.
hrtkantapida (hṛtkaṇṭhapīḍā)
Distress affecting the heart or chest region and throat.
Adhikarana 6 (9) · Śloka 9
pittē kaphasyānu sukhaṁ pravr̥ttē śuddhēṣu hr̥tkaṇṭhaśiraḥsu cāpi |
laghau ca dēhē kaphasaṁsravē ca sthitē suvāntaṁ puruṣaṁ vyavasyēt ||9||
View original
पित्ते कफस्यानु सुखं प्रवृत्ते शुद्धेषु हृत्कण्ठशिरःसु चापि |
लघौ च देहे कफसंस्रवे च स्थिते सुवान्तं पुरुषं व्यवस्येत् ||९||
Meaning of the śloka
A person is judged by the text to have vomited properly when pitta follows kapha, the heart region, throat, and head feel clear, the body feels light, and the discharge of kapha has stopped.
The commentary explains anu as 'after' and interprets clarity as the absence of heaviness and related signs. It says that signs of proper, inadequate, and excessive emesis are given to guide recognition and response to complications. Some authorities assess purification in three ways: by signs, by counting bouts, and by measuring expelled material. The commentary rejects fixed measurement because bodies and their constituents vary, and rejects a fixed bout count because purification may or may not occur with the same number in different people. It therefore favors assessment by the qualitative signs stated in the verse.
Key terms
suvanta (suvānta)
A person judged to have undergone proper emesis by traditional signs.
laingiki suddhi (laiṅgikī śuddhi)
Assessment of purification through observed signs.
vaigiki suddhi (vaigikī śuddhi)
Assessment through a count of emetic or purgative bouts.
maniki suddhi (mānikī śuddhi)
Assessment through measurement of expelled material.
After confirming what the text regards as proper vomiting, it directs selection, according to capacity, of one among unctuous, eliminative, or pacifying forms of dhuma, followed by instructions concerning conduct and regimen.
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Show commentary
samyagvāntasya paścātkarma nirdiśannāha- samyagvāntamityādi| vamanānantaraṁ srōtōvilagnakaphaharaṇārthaṁ dhūmapānamatrōktam| vātaprakr̥tau snaihikaṁ, kaphapittaprakr̥tāvutkliṣṭadōṣē ca vairēcanikaṁ, samadōṣaprakr̥tāvupaśamanīyaṁ prāyōgikaṁ svasthavr̥ttikamityarthaḥ | ācārikamādiśēditi caratērgatibhakṣaṇārthakatvādāhārō vihāraścācāraḥ| tatra vihārō bahuvidhō'pi trividha ēva, kāyavāṅmanōbhēdāt; sa trividhō'pyayuktō'pavarjyaścāturōpadravīyē vakṣyatē||10||
Meaning of the commentary
The commentary treats this as post-procedure care. It says dhumapana is intended to remove kapha said to remain attached in the channels after vomiting. It assigns an unctuous kind to a vata constitution, an eliminative kind to kapha-pitta constitution or excited dosa, and a pacifying or habitual kind to balanced constitution. Acara is explained as both diet and conduct; conduct is further divided into bodily, verbal, and mental activity, with unsuitable forms said to be discussed later.
Key terms
dhuma (dhūma)
Medicated smoke use described as a historical post-emesis measure.
snehana
The unctuous category of dhuma named in the passage.
virecana
Here, the eliminative category of dhuma rather than bowel purgation.
samana (śamana)
The pacifying category of dhuma.
acarika (ācārika)
Instructions concerning diet and conduct after the procedure.
Later that afternoon, after bodily cleansing and bathing with warm water, the text directs feeding with soup prepared from kulattha, mudga, or adhaki, or with the broth of animals classed as jangala.
The commentary asks why soups or meat broth are mentioned for a person whose digestion is weak after vomiting and who would ordinarily follow a sequence beginning with peya. It answers that the word 'also' includes that gradual sequence. Peya is assigned to those with greatly depleted kapha; meat broth may be used, with attention to habituation, for those among them who are vata-predominant and have strong agni. Soup is assigned where some kapha remains, according to dosa, season, and constitution, while vilepi and yavagu are excluded in that situation. A cited analogy says that gruel increases already disturbed slesma as rain makes dusty ground excessively muddy.
Key terms
peya (peyā)
A thin liquid preparation beginning a gradual post-procedure dietary sequence.
yusa (yūṣa)
Pulse soup discussed as a post-emesis food in selected traditional contexts.
jangala rasa (jāṅgala rasa)
Broth from animals classed as living in dry or open country.
satmya (sātmya)
Habituation or suitability considered in the commentary's dietary choice.
Adhikarana 9 (12) · Śloka 12
kāsōpalēpasvarabhēdanidrātandrāsyadaurgandhyaviṣōpasargāḥ |
kaphaprasēkagrahaṇīpradōṣā na santi jantōrvamataḥ kadācit ||12||
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कासोपलेपस्वरभेदनिद्रातन्द्रास्यदौर्गन्ध्यविषोपसर्गाः |
कफप्रसेकग्रहणीप्रदोषा न सन्ति जन्तोर्वमतः कदाचित् ||१२||
Meaning of the śloka
The verse claims that a person who undergoes vamana will not experience cough, coating or obstruction, altered voice, sleepiness, torpor, foul odor of the mouth, complications attributed to visa, excessive kapha discharge, or disorders of grahani.
The commentary introduces these as claimed benefits of vamana. It defines upalepa as an increase of impurity in the channels and gives sitalika and similar conditions as examples of upasarga. It also preserves an alternative reading that lists kapha discharge, altered voice, torpor, sleep, foul mouth odor, kapha-related complications, heaviness, itching, and grahani disorder.
Key terms
upalepa
An increase of impurity in the srotases, according to the commentary.
svarabheda
Alteration or impairment of the voice.
kaphapraseka
Excess discharge or flow of kapha.
grahaniprodosa (grahaṇīpradoṣa)
Disorder of grahani within the classical framework.
छिन्ने तरौ पुष्पफलप्ररोहा यथा विनाशं सहसा व्रजन्ति |
तथा हृते श्लेष्मणि शोधनेन तज्जा विकाराः प्रशमं प्रयान्ति ||१३||
Meaning of the śloka
Just as flowers, fruits, and new shoots quickly perish when a tree is cut down, the text says that disorders arising from slesma subside when slesma is removed through sodhana.
The commentary says that the tree simile is offered to reinforce the preceding claim about the effects of removing slesma.
Key terms
slesman (śleṣman)
Kapha, presented as the source of the disorders in this analogy.
sodhana (śodhana)
Eliminative therapy said to remove slesma.
tajja vikara (tajja vikāra)
Disorders described as arising from that slesma.
Adhikarana 11 (14-15) · Śloka 15
na vāmayēttaimirikōrdhvavātagulmōdaraplīhakr̥miśramārtān |
sthūlakṣatakṣīṇakr̥śātivr̥ddhamūtrāturān kēvalavātarōgān ||14||
svarōpaghātādhyayanaprasaktaduśchardiduḥkōṣṭhatr̥ḍārtabālān |
ūrdhvāsrapittikṣudhitātirūkṣagarbhiṇyudāvartinirūhitāṁśca ||15||
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न वामयेत्तैमिरिकोर्ध्ववातगुल्मोदरप्लीहकृमिश्रमार्तान् |
स्थूलक्षतक्षीणकृशातिवृद्धमूत्रातुरान् केवलवातरोगान् ||१४||
स्वरोपघाताध्ययनप्रसक्तदुश्छर्दिदुःकोष्ठतृडार्तबालान् |
ऊर्ध्वास्रपित्तिक्षुधितातिरूक्षगर्भिण्युदावर्तिनिरूहितांश्च ||१५||
Meaning of the śloka
The text lists people who should not be subjected to vamana, including those affected by timira, urdhvavata, gulma, abdominal or splenic disorders, worms, exertional fatigue, marked obesity, injury, depletion, emaciation, extreme old age, urinary distress, or disorders attributed solely to vata. It also excludes those with damaged voice or intensive recitation, difficult vomiting, difficult kostha, severe thirst, childhood, upward bleeding associated with pitta, hunger, extreme dryness, pregnancy, udavarta, or recent niruha basti.
The commentary introduces the groups considered unsuitable for emesis and glosses taimirika as a person affected by timira. It preserves an alternative reading that includes gulma, pandu and udara disorders, obesity, injury, depletion, emaciation, extreme age, arsas, facial palsy, and convulsive illness. Some interpret urdhvavata as svasa, but the commentator rejects this because persons with svasa are elsewhere considered eligible for vamana. Instead, he cites another definition: vayu obstructed below by kapha causes repeated belching and is called urdhvavata.
Key terms
avamya (avāmya)
A person considered unsuitable for therapeutic emesis.
urdhvavata (ūrdhvavāta)
Repeated upward movement or belching attributed to obstructed vayu; explicitly distinguished here from svasa.
urdhvasrapitta (ūrdhvāsrapitta)
An upward bleeding condition associated with pitta in the classical terminology.
garbhini (garbhiṇī)
A pregnant person, listed as unsuitable for vamana.
The text warns that performing vamana on people considered unsuitable can make their diseases difficult to treat or even incurable; for that reason, they are remembered as persons who should not undergo emesis.
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Show commentary
avamanārhasya vamanē vyādhēḥ parivr̥ddhimasādhyatāṁ ca darśayannāha- avamyētyādi||16||
Meaning of the commentary
The commentary says the verse shows both worsening of disease and progression toward incurability when emesis is performed on someone who is not eligible for it.
Key terms
avamya (avāmya)
A person considered unsuitable for vamana.
krcchrata (kṛcchratā)
A state of increased difficulty in treating the disease.
asadhyata (asādhyatā)
A condition regarded as incurable.
Adhikarana 13 (17) · Śloka 17
ētē'pyajīrṇavyathitā vāmyā yē ca viṣāturāḥ |
atīva cōlbaṇakaphāstē ca syurmadhukāmbunā ||17||
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एतेऽप्यजीर्णव्यथिता वाम्या ये च विषातुराः |
अतीव चोल्बणकफास्ते च स्युर्मधुकाम्बुना ||१७||
Meaning of the śloka
The text makes an exception, stating that even some of the previously excluded people may be considered for vamana when distressed by indigestion, affected by poison, or burdened by extremely aggravated kapha; it names madhuka water for this purpose.
The commentary treats indigestion, poisoning from plant, animal, or artificial sources, and extreme increase of kapha as urgent exceptions because delay is said to cause continuing harm or rapid death. It preserves another reading concerning incompatible food, poison, gara, and increased kapha after digestion. Madhukambu is explained by one view as a decoction of yastimadhu used prominently with vamana, while Jejjata interprets madhuka as honey and therefore understands water with honey. The commentary explicitly calls this a counter-exception to the prohibition and records a further alternative contraindication list. These differing readings and the emergency claims must remain distinct.
Key terms
pratiprasava
A stated exception to the preceding rule of contraindication.
visatura (viṣātura)
A person affected by poison in the traditional account.
ulbanakapha (ulbaṇakapha)
A state described as an extreme increase of kapha.
madhukambu (madhukāmbu)
Interpreted either as yastimadhu decoction or, by Jejjata, water with honey.
gara
A type of toxic condition appearing in an alternative reading.
Adhikarana 14 (18) · Śloka 18
vāmyāstu- viṣaśōṣastanyadōṣamandāgnyunmādāpasmāraślīpadārbudavidārikāmēdōmēhagarajvarārucyapacyāmātīsārahr̥drōga- cittavibhramavisarpavidradhyajīrṇamukhaprasēkahr̥llāsaśvāsakāsapīnasapūtīnāsakaṇṭhauṣṭhavaktrapāka- karṇasrāvādhijihvōpajihvikāgalaśuṇḍikādhaḥśōṇitapittinaḥ kaphasthānajēṣu vikārēṣvanyē ca kaphavyādhiparītā iti ||18||
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वाम्यास्तु- विषशोषस्तन्यदोषमन्दाग्न्युन्मादापस्मारश्लीपदार्बुदविदारिकामेदोमेहगरज्वरारुच्यपच्यामातीसारहृद्रोग- चित्तविभ्रमविसर्पविद्रध्यजीर्णमुखप्रसेकहृल्लासश्वासकासपीनसपूतीनासकण्ठौष्ठवक्त्रपाक- कर्णस्रावाधिजिह्वोपजिह्विकागलशुण्डिकाधःशोणितपित्तिनः कफस्थानजेषु विकारेष्वन्ये च कफव्याधिपरीता इति ||१८||
Meaning of the śloka
The passage gives a long classical list of conditions regarded as eligible for vamana. These include conditions named visa, sosa, stanyadosa, mandagni, unmada, apasmara, slipada, arbuda, vidarika, medas or meha disorders, gara, jvara, loss of appetite, apaci, ama-associated diarrhea, heart disease, disturbance of mind, visarpa, vidradhi, indigestion, excessive oral discharge, nausea, svasa, cough, pinasa, putinasa, inflammations of the throat, lips, or mouth, ear discharge, adhijihva, upajihvika, galasundika, downward bleeding associated with pitta, other disorders arising in kapha sites, and other kapha disorders.
The commentary explains that jvara here means recent fever and intermittent fever. It notes that some versions add kustha, galaganda, prameha, and swelling before putinasa. Some students of Susruta omit the entire list, apparently because each relevant disease section already directs vamana where considered appropriate, making this general list unnecessary in their view.
Key terms
vamya (vāmya)
A condition or person considered eligible for vamana in the text's historical framework.
navajvara
Recent fever, one of the commentary's contextual meanings of jvara.
visamajvara (viṣamajvara)
Intermittent or irregular fever included by the commentary.
kaphasthanaja vikara (kaphasthānaja vikāra)
A disorder described as arising in a site of kapha.
adhahsonitapitta (adhaḥśoṇitapitta)
Downward bleeding associated with pitta in the classical terminology.
Adhikarana 15 (19) · Śloka 19
virēcanamapi snigdhasvinnāya vāntāya ca dēyam; avāntasya hi samyagvirīktasyāpi satō'dhaḥ srastaḥ ślēṣmā grahaṇīṁ chādayati, gauravamāpādayati, pravāhikāṁ vā janayati ||19||
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विरेचनमपि स्निग्धस्विन्नाय वान्ताय च देयम्; अवान्तस्य हि सम्यग्विरीक्तस्यापि सतोऽधः स्रस्तः श्लेष्मा ग्रहणीं छादयति, गौरवमापादयति, प्रवाहिकां वा जनयति ||१९||
Meaning of the śloka
The text says that virecana should be given to a person who has undergone sneha and sveda and has first received vamana. It explains that if virecana is given without prior vamana, even when evacuation appears adequate, kapha may descend, cover the grahaṇī, produce heaviness, or cause pravāhikā.
The commentary explains the preparatory sequence for virecana. Even a person who has undergone vamana is again prepared with sneha and sveda; it cites other authorities for the intervening dietary sequence and timing. It distinguishes the shorter interval after sneha before vamana from the longer interval before virecana. The alleged consequences of omitting vamana are used to support the rule stated in the passage.
Key terms
virecana
The downward eliminative procedure discussed in the passage.
snigdhasvinna
Prepared by sneha and sveda in the prescribed sequence.
grahaṇī
An internal site said here to become covered by descended kapha.
pravāhikā
A disorder of repeated straining or evacuation named as a possible consequence.
When virecana is planned for the following day, the text directs a light meal in the earlier part of the day, followed by a sour fruit preparation and warm water. On the next day, after assessing the patient according to the stated clinical considerations and when kapha is regarded as diminished, an individually determined quantity of the medicine is given.
The commentary says that specifying the earlier part of the day excludes an evening meal. It gives bījapūra as an example of a sour fruit and records two explanations for the sour fruit and warm-water accompaniment: increasing pitta, or, according to others, overcoming kapha. It interprets the wording about diminished kapha as also indicating the associated rasa dhātu and warns against proceeding while salivation remains. It then cites three traditional dose categories based on strength.
Key terms
pūrvāhṇa
The earlier part of the day, interpreted as excluding an evening meal.
phalāmla
A sour fruit preparation used in the described preparation.
vigataśleṣmadhātu
A state interpreted as diminished kapha together with its associated rasa context.
auṣadhamātrā
The quantity of medicine selected with reference to the person's strength.
Adhikarana 17 (21-22) · Śloka 22
tatra mr̥duḥ, krūrō, madhyama iti trividhaḥ kōṣṭhō bhavati |
tatra bahupittō mr̥duḥ, sa dugdhēnāpi viricyatē; bahuvātaślēṣmā krūraḥ, sa durvirēcyaḥ; samadōṣō madhyamaḥ, sa sādhāraṇa iti |
tatra mr̥dau mātrā mr̥dvī, tīkṣṇā krūrē, madhyē madhyā kartavyēti |
pītauṣadhaśca tanmanāḥ śayyābhyāśē virēcyatē ||21||
virēcanaṁ pītavāṁstu na vēgān dhārayēdbudhaḥ |
nivātaśāyī śītāmbu na spr̥śēnna pravāhayēt ||22||
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तत्र मृदुः, क्रूरो, मध्यम इति त्रिविधः कोष्ठो भवति |
तत्र बहुपित्तो मृदुः, स दुग्धेनापि विरिच्यते; बहुवातश्लेष्मा क्रूरः, स दुर्विरेच्यः; समदोषो मध्यमः, स साधारण इति |
तत्र मृदौ मात्रा मृद्वी, तीक्ष्णा क्रूरे, मध्ये मध्या कर्तव्येति |
पीतौषधश्च तन्मनाः शय्याभ्याशे विरेच्यते ||२१||
विरेचनं पीतवांस्तु न वेगान् धारयेद्बुधः |
निवातशायी शीताम्बु न स्पृशेन्न प्रवाहयेत् ||२२||
Meaning of the śloka
Koṣṭha is described as threefold: mṛdu, krūra, and madhyama. A person with abundant pitta has mṛdu koṣṭha and is said to evacuate even with milk; one with abundant vāta and kapha has krūra koṣṭha and is difficult to purge; one with balanced doṣas has madhyama koṣṭha. The text associates mild, strong, and intermediate medicines with these respective types. After taking the medicine, the person remains attentive to its action near the bed, does not suppress urges, rests away from wind, avoids cold water, and does not strain.
Milk is presented only as one example; the commentary lists other substances said to produce evacuation in mṛdu koṣṭha and stronger substances said to work only with difficulty in krūra koṣṭha. It defines mild and strong in terms of lesser or greater intensity of the qualities attributed to purgative drugs. Tanmanā means keeping the mind on the evacuation, and abhyāśa means nearby.
Key terms
mṛdu koṣṭha
A bowel constitution described as readily responsive to evacuation.
krūra koṣṭha
A bowel constitution described as difficult to evacuate.
madhyama koṣṭha
The intermediate bowel constitution associated with balanced doṣas.
यथा च वमने प्रसेकौषधकफपित्तानिलाः क्रमेण गच्छन्ति, एवं विरेचने मूत्रपुरीषपित्तौषधकफा इति ||२३||
Meaning of the śloka
The text gives traditional sequences for the materials observed during vamana and virecana. In vamana it lists salivary flow, medicine, kapha, pitta, and vāta in order; in virecana it lists urine, feces, pitta, medicine, and kapha.
The commentary defines praseka as salivary discharge from the mouth. For vamana, it explains the listed medicine, stomach-based kapha, pitta as marking the endpoint, and vāta manifested as belching and interpreted as purification of vāta. For virecana, it says the movement of vāta is addressed in a later statement about anulomabhāva and describes crystal-like kapha in the pakvāśaya as an endpoint sign.
Key terms
praseka
Salivary discharge from the mouth.
vamanāvadhi
The traditional endpoint of emesis, here associated with the appearance of pitta.
virekāvadhi
The traditional endpoint of purgation, here associated with kapha.
anulomabhāva
The downward or normal-direction movement of vāta referenced by the commentary.
Adhikarana 19 (24) · Śloka 24
bhavanti cātra- hr̥tkukṣyaśuddhiḥ paridāhakaṇḍūviṇmūtrasaṅgāśca na sadviriktē |
mūrcchāgudabhraṁśakaphātiyōgāḥ śūlōdgamaścātiviriktaliṅgam ||24||
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भवन्ति चात्र- हृत्कुक्ष्यशुद्धिः परिदाहकण्डूविण्मूत्रसङ्गाश्च न सद्विरिक्ते |
मूर्च्छागुदभ्रंशकफातियोगाः शूलोद्गमश्चातिविरिक्तलिङ्गम् ||२४||
Meaning of the śloka
According to the verse, proper virecana is associated with clarity or purification of the heart region and abdomen and with absence of burning, itching, and obstruction of stool or urine. Fainting, rectal prolapse, excessive kapha discharge, and the onset of colicky pain are listed as signs of excessive evacuation.
After noting the endpoint signs used for proper vamana and virecana, the commentary says this verse identifies inadequate and excessive virecana through their signs. It also preserves an alternative reading attributed to some authorities: difficult or inadequate evacuation is accompanied by aggravation of kapha and pitta, burning, loss of appetite, heaviness, and weakened agni.
Key terms
sadvirikta
A person regarded as properly evacuated according to the text's signs.
mūrcchā
Fainting or loss of consciousness, listed as a sign of excessive evacuation.
gudabhraṃśa
Rectal prolapse, listed among signs of excessive evacuation.
ativirikta
A state of excessive purgation identified through dangerous signs.
A person is regarded as properly purged when the doṣas accompanied by kapha have passed, the region around the navel feels light, the mind is content, and vāta has returned to anuloma, its proper direction.
The commentary explains that doṣa here includes fecal matter characterized by the doṣas in the pitta region, together with kapha and pitta. Thus the verse's sign is interpreted within the text's model of the materials expelled during virecana.
Key terms
kaphānvita doṣa
The expelled doṣas accompanied by kapha in the verse's endpoint description.
nābhyā laghutva
A feeling of lightness around the navel.
manasaḥ tuṣṭi
Contentment or ease of mind listed as a sign.
anulomabhāva
Restoration of vāta to its proper directional movement.
Adhikarana 21 (26) · Śloka 26
mandāgnimakṣīṇamasadvirīktaṁ na pāyayētāhani tatra pēyām |
kṣīṇaṁ tr̥ṣārtaṁ suvirēcitaṁ ca tanvīṁ sukhōṣṇāṁ laghu pāyayēcca ||26||
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मन्दाग्निमक्षीणमसद्विरीक्तं न पाययेताहनि तत्र पेयाम् |
क्षीणं तृषार्तं सुविरेचितं च तन्वीं सुखोष्णां लघु पाययेच्च ||२६||
Meaning of the śloka
On that day, the text says not to give peyā to a person with weak agni who has not become depleted and has not been properly purged. A person who is depleted, thirsty, and properly purged is instead to receive a thin, comfortably warm, light preparation.
The commentary presents this as a special qualification within the post-procedure regimen, based on the person's condition. It explains laghu here as light in quantity rather than adding a broader property to the preparation.
Key terms
mandāgni
Weak digestive capacity in the text's assessment.
asadvirikta
Not properly purged according to the text's criteria.
peyā
A thin drink or gruel considered in the post-procedure regimen.
mātrālaghu
Light specifically in quantity, as clarified by the commentary.
When properly undertaken, virecana is said to bring clarity of intellect, strength of the senses, stability of the dhātus, bodily strength, kindling of agni, and a delayed manifestation of aging.
The commentary reasons that body and mind influence one another: because virecana is regarded as purifying the body, it is said to support purity of mind and thereby clarity of intellect. Stability of the dhātus is explained through strength characterized by nourishment, while another occurrence of strength refers to vigor or initiative. It preserves an alternative reading and differing temporal interpretations: some take all the benefits as immediate, while others say agni-kindling and later benefits arise only after the subsequent dietary sequence. A final analogy attributes strength to clearing the srotases despite loss of mala.
Key terms
buddhiprasāda
Clarity of intellect attributed to properly conducted virecana.
dhātusthiratva
Stability of the dhātus, explained through nourishment-related strength.
agnidīpti
Kindling of agni, whose timing is disputed in the commentary.
srotasśuddhi
Clearing of channels within the traditional explanatory model.
Just as aquatic plants and animals perish when their water is removed, the text says that disorders whose nature or cause is pitta disappear when pitta is removed.
The commentary identifies the moving and stationary aquatic beings in the analogy as animals such as fish and plants such as lotuses. It explains upadrava here as diseases and pittātmaka as those caused by pitta.
Key terms
audaka
Aquatic beings used in the verse's analogy.
carasthira
Moving and stationary beings, exemplified by fish and lotuses.
upadrava
Disorders or diseases in this commentary's explanation.
pittātmaka
Characterized or caused by pitta within the traditional framework.
मन्दाग्न्यतिस्नेहितबालवृद्धस्थूलाः क्षतक्षीणभयोपतप्ताः |
श्रान्तस्तृषार्तोऽपरिजीर्णभक्तो गर्भिण्यधो गच्छति यस्य चासृक् ||२९||
नवप्रविश्यायमदात्ययी च नवज्वरी या च नवप्रसृता |
शल्यार्दिताश्चाप्यविरेचनीयाः स्नेहादिभिर्ये त्वनुपस्कृताश्च ||३०||
अत्यर्थपित्ताभिपरीतदेहान् विरेचयेत्तानपि मन्दमन्दम् |३१|
Meaning of the śloka
The passage lists people for whom virecana is generally prohibited: those with weak agni; those excessively oleated; children, older adults, and persons described as obese; those depleted by injury, wasting, or fear; the exhausted or intensely thirsty; those whose meal is not digested; pregnant people; those with downward bleeding; recent arrivals; those affected by madātyaya or a recent fever; those who have recently given birth; persons afflicted by a foreign body; and those not prepared with sneha and related measures. It then states an exception for persons overwhelmed by pitta, for whom only very mild virecana is described.
The commentary introduces the circumstances in which virecana does not proceed appropriately. It preserves an alternative reading of mandamandam, 'very mildly,' as mandavīryaiḥ, meaning with substances of mild potency. The supplied commentary does not expand the individual contraindications.
Key terms
avirecanīya
A person for whom virecana is prohibited in the stated circumstances.
garbhiṇī
A pregnant person, explicitly included among the contraindications.
navaprasūtā
A person who has recently given birth.
mandamandam
Very mildly; alternatively read as use of mildly potent substances.
The verse warns that people for whom virecana is contraindicated may die when purgative procedures are administered by someone who does not understand those contraindications.
The commentary says that this statement shows the harm caused when persons who should not receive virecana are treated by practitioners who lack knowledge of its proper use.
Key terms
avirecanīya
A person contraindicated for virecana.
ajñaprayukta
Administered by someone lacking the required knowledge.
vināśa
Destruction or death, the grave outcome warned of in the verse.
virecana
The purgative procedure whose misuse is condemned.
Adhikarana 26 (32) · Śloka 32
virēcyāstu- jvaragarārucyarśō'rbudōdaragranthividgādhipāṇḍurōgāpasmārahr̥drōgavātaraktabhagandaracchardiyōnirōgavisarpa- gulmapakvāśayarugvibandhavisūcikālasakamūtrāghātakuṣṭhavisphōṭakapramēhānāhaplīhaśōphavr̥ddhiśastrakṣatakṣārāgnidagdha- duṣṭavraṇākṣipākakācatimirābhiṣyandaśiraḥkarṇākṣināsāsyagudamēḍhradāhōrdhvaraktapittakr̥mikōṣṭhinaḥ pittasthānajēṣvanyēṣu ca vikārēṣvanyē ca paittikavyādhiparītā iti ||32||
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विरेच्यास्तु- ज्वरगरारुच्यर्शोऽर्बुदोदरग्रन्थिविद्गाधिपाण्डुरोगापस्मारहृद्रोगवातरक्तभगन्दरच्छर्दियोनिरोगविसर्प- गुल्मपक्वाशयरुग्विबन्धविसूचिकालसकमूत्राघातकुष्ठविस्फोटकप्रमेहानाहप्लीहशोफवृद्धिशस्त्रक्षतक्षाराग्निदग्ध- दुष्टव्रणाक्षिपाककाचतिमिराभिष्यन्दशिरःकर्णाक्षिनासास्यगुदमेढ्रदाहोर्ध्वरक्तपित्तकृमिकोष्ठिनः पित्तस्थानजेष्वन्येषु च विकारेष्वन्ये च पैत्तिकव्याधिपरीता इति ||३२||
Meaning of the śloka
The text lists a wide range of named conditions and persons affected by disorders situated in the pitta region or dominated by pitta as candidates for virecana within its traditional therapeutic system.
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virēcyānāha- virēcyāstvityādi||32||
Meaning of the commentary
The commentary only introduces the list as identifying those considered suitable for virecana; it supplies no further explanation of the individual conditions or criteria.
Key terms
virecya
A person considered suitable for virecana within the source's framework.
pittasthānaja vikāra
A disorder said to arise in the site of pitta.
paittikavyādhi
A disease characterized as dominated by pitta.
virecana
The purgative procedure proposed for the listed categories.
Adhikarana 27 (33) · Śloka 33
saratvasaukṣmyataikṣṇyauṣṇyavikāśitvairvirēcanam |
vamanaṁ tu harēddōṣaṁ prakr̥tyā gatamanyathā ||33||
Virecana is said to carry doṣas downward through the qualities of flowing action, subtlety, sharpness, heat, and loosening or dispersing action. Vamana, although described with comparable qualities, carries them in the opposite, upward direction because of its inherent specific action.
The commentary defines each quality: saratva as downward movement or, according to Gayī, a tendency to spread; saukṣmya as following subtle channels; taikṣṇya as producing rapid discharge; auṣṇya as the capacity to overcome cooling substances; and vikāśitva as loosening the dhātus. It treats prakṛti, svabhāva, a specific śakti, prabhāva, and vīrya as equivalent explanations of the distinctive direction of action. It cites examples to argue that prabhāva accounts for effects not explained by shared qualities. It also preserves two variant readings. One commentator interprets correct combination as carrying doṣas in the expected direction and incorrect combination as acting oppositely. Another reading says that properly combined qualities rapidly remove doṣas, whereas improper use may draw out vital blood, dhātus, rasa, senses, mind, ojas, and other essentials and cause death.
Key terms
saratva
Flowing or downward-moving action; alternatively, a tendency to spread.
saukṣmya
The quality of following subtle channels.
vikāśitva
A loosening or dispersing quality said to relax the dhātus.
prabhāva
A specific inherent action used to explain the different directional effects.
यात्यधो दोषमादाय पच्यमानं विरेचनम् |
गुणोत्कर्षाद्व्रजत्यूर्ध्वमपक्वं वमनं पुनः ||३४||
Meaning of the śloka
The verse says that virecana medicine, while undergoing digestion, carries doṣa downward. Vamana medicine, because of the predominance of its qualities, rises upward while still undigested.
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kīdr̥śaṁ sat punarvirēcanaṁ vamanadravyaṁ ca dōṣānādāya adha ūrdhvaṁ ca yātītyāha- yātyadhō dōṣamityādi| virēcanadravyāṇi sthiragurvyōḥ pr̥thivyambhasōrguṇabhūyiṣṭhāni, ata ēva sthiratvāt pacyamānāni gurutvādadhō yānti; vamanadravyāṇi tu vāyvagnyōḥ śīghragalaghuguṇayōrguṇabhūyiṣṭhāni, ataḥ śīghragatvādapakvānyēva laghutvādūrdhvamuttiṣṭhanti| dravyāṇi hi dravyaprabhāvāt guṇaprabhāvācca kārmukāṇi bhavanti||34||
Meaning of the commentary
The commentary explains the contrast through elemental and qualitative predominance. Virecana substances are said to be dominated by earth and water, whose stability and heaviness allow them to be digested and move downward. Vamana substances are said to be dominated by air and fire, whose speed and lightness make them rise before digestion. It concludes that substances act through both the specific nature of the substance and the influence of its qualities.
Key terms
pacyamāna
Undergoing digestion, as said of virecana medicine.
guṇotkarṣa
Predominance of qualities used to explain upward movement.
pṛthivyambhas
Earth and water, said to predominate in virecana substances.
vāyvagni
Air and fire, said to predominate in vamana substances.
Adhikarana 29 (35) · Śloka 35
mr̥dukōṣṭhasya dīptāgnēratitīkṣṇaṁ virēcanam |
na samyaṅgirharēddōṣānativēgapradhāvitam ||35||
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मृदुकोष्ठस्य दीप्ताग्नेरतितीक्ष्णं विरेचनम् |
न सम्यङ्गिर्हरेद्दोषानतिवेगप्रधावितम् ||३५||
Meaning of the śloka
In a person with mṛdu koṣṭha and strong agni, an excessively sharp virecana rushes forth with too much force and does not properly remove the doṣas.
The commentary explains the improper action described here. Softness of the koṣṭha causes an early response; strong agni makes the medicine pass quickly through its digestive stage; and the sharpness of the virecana further accelerates its action. Because these three causes produce a rapid discharge, the doṣas are not removed completely. It therefore concludes, within this historical regimen, that only a mild virecana in a small quantity should be used for such a person.
Key terms
mṛdu koṣṭha
A readily responsive or soft bowel constitution in the text's therapeutic classification.
dīptāgni
Strong digestive activity as understood in the classical framework.
virecana
Purgative elimination therapy discussed in this chapter.
ativega
An excessively rapid or forceful therapeutic response.
The commentary presents this as the proper application. For a person of moderate agni, it places the processing of food and medicine within three yāmas. It also preserves another reading: the medicine is praised when it matures within the time food is digested and removes the doṣas comfortably. The two formulations should remain distinct.
Key terms
bhuktapāka
The digestion or processing of eaten food used here as a temporal comparison.
madhyamāgni
Moderate digestive activity in the commentary's classification.
yāma
A traditional division of time; the commentary mentions three yāmas.
doṣanirharaṇa
Removal of doṣas within the classical therapeutic account.
दुर्बलस्य चलान् दोषानल्पानल्पान् पुनः पुनः |
हरेत् प्रभूतानल्पांस्तु शमयेत् प्रच्युतानपि ||३७||
Meaning of the śloka
In a weak person, abundant and mobile doṣas should be removed little by little, repeatedly; doṣas that are small in quantity should instead be pacified, even when they have begun to move from their place.
The commentary treats this as an exception to a general direction to pacify aggravated doṣas. In a weak person, abundant, mobile, aggravated doṣas are to be removed gradually in small portions, using measures that are not sharp. It supplies the sense that flowing foods, rather than sharp eliminative therapies, are intended, and says removal applies to ripened doṣas. A small amount should be pacified even if displaced. A cited verse similarly distinguishes pacifying a small amount from guiding abundant mobile doṣas with flowing foods.
Key terms
durbala
A person described as weak or of limited strength.
cala doṣa
A doṣa that has become mobile or displaced in the classical account.
pakva
Ripened or brought to a state considered ready for removal.
Mobile, ripened doṣas should be removed in either a strong or a weak person, because mobile doṣas left unattended may trouble a person for a long time.
The commentary states that doṣas which are abundant and inclined toward the ripened state are to be removed even in a strong or weak person. It gives no further method in this passage.
Key terms
cala doṣa
Doṣas regarded as mobile in the text's model.
pakva
A ripened state considered suitable for removal.
balin
A person possessing strength.
durbala
A person lacking strength.
Adhikarana 33 (39) · Śloka 39
mandāgniṁ krūrakōṣṭhaṁ ca sakṣāralavaṇairghr̥taiḥ |
sandhukṣitāgniṁ snigdhaṁ ca svinnaṁ caiva virēcayēt ||39||
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मन्दाग्निं क्रूरकोष्ठं च सक्षारलवणैर्घृतैः |
सन्धुक्षिताग्निं स्निग्धं च स्विन्नं चैव विरेचयेत् ||३९||
Meaning of the śloka
For a person described as having weak agni and krūra koṣṭha, the text says first to kindle agni with ghee combined with alkali and salt, then to make the person oleated and fomented before virecana.
In one who has been oleated and fomented, the doṣa mobilized by medicines according to the person's strength does not adhere within the pathways, just as water does not cling to an oiled vessel.
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kutaḥ punaḥ snēhasvēdapūrvakamēva śōdhanamityāha- snigdhētyādi| snigdhasvinnasya puruṣasya bhaiṣajyairbhōjanauṣadharūpaiḥ, yatō bhaiṣajyagrahaṇēna bhōjanamapi gr̥hyatē| balāt puruṣabalādikamabhisamīkṣya dōṣa utklēśitaḥ| na mārgēṣu nilīyatē na śliṣyati, na saṁyujyatē na lagnō bhavatītyarthaḥ||40||
Meaning of the commentary
The commentary explains why śodhana is preceded by sneha and sveda. Here bhaiṣajya includes both food and medicine. The person's strength and related factors are assessed when mobilizing the doṣa. The statement that it does not remain in the pathways is glossed as not adhering, joining, or becoming fixed there.
The commentary introduces a distinction between the use of unctuous and dry forms of virecana according to the person's condition. It explains bhūyaḥ as the doṣas again lodging in the pathways. It also preserves a variant reading, 'one whose body is excessively oleated,' in place of 'one who has consumed excessive sneha.'
Key terms
atisneha
Excessive intake or state of oleation in the supplied readings.
snehavirecana
An unctuous form of purgative therapy.
pracalita doṣa
Doṣas described as displaced or set in motion.
vartman
The bodily pathways in which doṣas are said to lodge.
The text says that persons affected by poison or injury, piḍakā, swelling, pāṇḍu, visarpa, kuṣṭha, or prameha should undergo śodhana without being excessively oleated.
The commentary presents a restriction against excessive oleation before śodhana in these conditions. It glosses na atisnigdhāḥ as meaning that they should be only slightly oleated.
Key terms
viṣa
Poisoning or toxic exposure named among the conditions.
abhighāta
Injury or trauma.
nā́tisnigdha (nātisnigdha)
Not excessively oleated; glossed by the commentary as slightly oleated.
A person accustomed to sneha should first be made dry, then oleated again and subjected to śodhana; the text says that removing the doṣas in this way promotes strength.
The commentary explains that a naturally unctuous condition is not by itself a reason to proceed directly to śodhana. It records a variant reading, snehabandhanāḥ, instead of balavardhanāḥ. Under that reading, the phrase refers to obstruction of the srotases through coating by sneha, rather than to an increase of strength. These alternatives should not be merged.
Key terms
snehasātmya
Being accustomed or suited to sneha.
virūkṣya
After first applying a drying measure, as stated in the historical sequence.
balavardhana
Strength-promoting, according to the main supplied reading.
snehabandhana
A variant reading interpreted as obstruction associated with coating by sneha.
For a person who is to undergo śodhana but has not previously taken a purgative, the text says first to administer a mild medicine; after the nature of the koṣṭha is known, śodhana may be undertaken again.
The commentary says that when the person's koṣṭha response is unknown, a mild virecana is to be given. It explains prāg apītam as a person who has not previously taken a purgative.
Key terms
avijñātakoṣṭha
A person whose bowel response or koṣṭha type has not yet been ascertained.
mṛdu auṣadha
A medicine characterized as mild in the historical regimen.
The text says that a king should take a medicine that is comfortable, has an evident result, is agreeable, small in quantity, rich in beneficial qualities, and able to bring even minor complications to an end.
The commentary applies this description to a particularly delicate person and to the selection of virecana for such a person. It explains vyāpatsvalpātyaya as a medicine in which even small complications come to an end.
Key terms
sukumāra
A particularly delicate or sensitive person in the commentary's classification.
dṛṣṭaphala
Having a result regarded as evident or observed.
hṛdya
Agreeable or pleasing in this context.
vyāpat
A complication or adverse outcome associated with treatment.
Doṣas set in motion by sneha and sveda and further impelled by unctuous liquids are said to reach the koṣṭha, where they are easier to remove by śodhana.
The commentary says that sneha brings even doṣas located in the śākhā toward the koṣṭha, while sveda helps those that have reached the koṣṭha to move readily. It supplies the omitted verb 'are able' with the phrase 'to be removed by śodhana.'
Key terms
śākhā
Peripheral bodily regions contrasted with koṣṭha in the classical model.
koṣṭha
The central internal tract to which doṣas are said to move.
snigdha rasa
Unctuous liquid or food described as further impelling the doṣas.
viśodhana
Eliminative measures by which the doṣas are said to be removed.
इति सुश्रुतसंहितायां चिकित्सास्थाने वमनविरेचनसाध्योपद्रवचिकित्सितं नाम त्रयस्त्रिंशोऽध्यायः ||३३||
Meaning of the śloka
Thus ends the thirty-third chapter of the Cikitsāsthāna in the Suśruta Saṃhitā, entitled 'Treatment of complications manageable in relation to vamana and virecana.'
The colophon states that the thirty-third chapter of the Cikitsāsthāna ends here in Dalhaṇa's commentary on Suśruta called the Nibandhasaṅgraha. The supplied spelling of the commentator's name contains a parenthetical textual irregularity.
Key terms
Cikitsāsthāna
The section of the Suśruta Saṃhitā concerned with treatment.
vamana
Therapeutic emesis named in the chapter title.
virecana
Therapeutic purgation named in the chapter title.
Nibandhasaṅgraha
The title given for Dalhaṇa's commentary on Suśruta.