Treatment has three stages: purvakarma, the preparatory measures; pradhanakarma, the principal procedure; and pashchatkarma, the subsequent care. These will be explained in relation to each disorder.
Several interpretations of the three stages are preserved. One describes measures from langhana through purgation as preliminary care for a wound, opening and healing the wound as the principal treatment, and measures concerning strength, complexion and agni as subsequent care. Another applies the division to a person undergoing shodhana: pachana, oleation and sweating are preliminary; emesis, purgation, basti, nasya and venesection are principal procedures; and a gradual dietary sequence beginning with peya is subsequent care. A third makes the division according to the course of illness: measures before its manifestation, from accumulation through premonitory signs, are preliminary; those during manifest illness are principal; and care for what persists after the illness subsides is subsequent. These measures are not all detailed here because that would make the text unnecessarily lengthy; they will be explained under individual disorders.
Key terms
pUrvakarma (pūrvakarma)
Preparatory measures, defined differently in the commentary's three interpretations.
pradhAnakarma (pradhānakarma)
The principal treatment or procedure.
pashcAtkarma (paścātkarma)
Care following the principal procedure or the subsiding of illness.
peyA (peyā)
A thin gruel placed first in the gradual dietary sequence mentioned here.
Because procedures performed with surgical instruments have a central place in this text, we shall first explain those procedures and the supplies they require.
This answers why procedures such as excision and their supplies are introduced first, rather than oleation and the materials and procedures associated with it: surgical work is the principal concern of this text.
Procedures performed with instruments differ in their particular form and purpose. Chedya refers to something to be completely excised, such as arshas; bhedya to something to be opened, such as vidradhi; lekhya to something to be scraped, such as rohini; and vedhya to something to be punctured with a small-pointed instrument, such as a sira. Some read vyadhya in place of vedhya. Eshya refers to something to be explored, such as a nadi tract; aharya to something to be removed, such as sharkara; and visravya to something to be drained, with vidradhi and kushtha given as examples. Sivya refers to what is to be sutured; the commentary cites a later passage about disorders arising from medas that have been opened and thoroughly scraped. Although these words literally designate conditions requiring the actions, they also designate the procedures by treating the condition and its treatment as closely associated. Some do not consider probing and extraction surgical procedures. The commentator nevertheless includes them because they may be performed after cutting or opening.
Key terms
chedyaM (chedyam)
What is to be excised; also the corresponding operation.
For a physician intending to undertake any of these procedures, the text calls for supplies to be assembled beforehand: yantras, sharp instruments, kshara, fire, probes or rods, horns, leeches, gourds, the jambavaushtha implement, cotton, cloth, thread, leaves, bandaging material, honey, ghee, fat, milk, oil, tarpana preparations, decoctions, applications and pastes, a fan, cold and warm water, vessels and other necessities. It also calls for attendants who are devoted, steady and strong.
The required articles are to be brought nearby before undertaking a procedure such as excision. Jambavaushtha is described as a black-stone implement whose tip resembles a jambu fruit. Picu is cotton, prota is cloth, and patta is material for binding a wound. Tarpana includes preparations such as saktu mixed with water and milk preparations; kashaya is water in which medicinal substances have been boiled. A fan may be made of bamboo, and the vessel called kataha of iron or another material. The inclusive ending also covers pads, earthenware pieces, pots, cooking vessels, beds, seats and similar supplies. Some articles are needed for the procedure itself, while others address complications. Attendants, as well as equipment, must be prepared. They should be devoted to the person they serve, unwavering, and capable of carrying out the required tasks.
Key terms
jAmbavauShThaM (jāmbavauṣṭham)
A black-stone implement with a tip likened to a jambu fruit.
The passage describes the historical preparation and performance of an incision. After choosing favourable calendrical occasions, it prescribes honouring fire, learned Brahmanas and physicians with curds, grains, food, drink and gems, followed by offerings, auspicious observances and blessings. The patient, having eaten lightly, is seated facing east and held steady; the physician faces west. The text describes introducing the instrument in the direction of the hairs until pus appears, avoiding marmas, siras, snayus, joints, bones and dhamanis, and withdrawing it promptly in a single movement. Even for a large suppurating lesion, it specifies an operative extent of two or three angulas.
These steps follow the assembling of equipment. Favourable tithis, karanas, muhurtas and nakshatras are to be determined by those versed in astral science. Akshata is glossed here as barley grains; gems include rubies and pearls. Bali means an offering, mangala includes singing, and svastivachana means pronouncing blessings. The anatomical structures to be avoided are counted as 107 marmas, 700 siras, 900 snayus, 210 joints, 300 bones and 24 dhamanis originating at the navel. Anuloma means following the direction in which the hairs lie; the commentator attributes bluntness of the edge and pain to working against that direction. The limit of entry is the appearance of pus. Both withdrawal in one movement and prompt withdrawal are stressed. Repetition of the word 'instrument' is explained as appropriate because entry and withdrawal are different actions. To limit harm from an excessively extensive incision, the passage specifies a space of two angulas for a less deep lesion and three for a deeper one. Some readings omit the word antara, 'space'.
Key terms
anulomam
Following the direction in which the hairs lie.
a~ggula (aṅgula)
A finger-breadth unit used for the stated operative extent.
In this operative context, favourable qualities of a vrana are that it is elongated, broad, even, clearly defined and free from an unfavourable site of attachment.
The commentary preserves different accounts of these qualities. Ayata means long and vishala broad. Sama is first understood as uniformly suppurated: a lesion partly suppurated and partly not is unsuitable for easy incision. Others take vishala as square and sama as round, relating the passage to a classification of wound shapes as elongated, square, round and triangular. Another interpretation takes sama to mean straight rather than following an irregular, winding course; it then qualifies the elongated wound. Suvibhakta means distinctly delineated, with its parts clearly separated. Nirashraya means not situated in an inaccessible place such as the tongue or the junction of teeth. A further interpretation applies the entire description to an incision made by the physician: sama then means without uneven depressions or elevations, and suvibhakta means free from the defects of insufficiency and excess. Such an incision permits easier application of pastes, decoctions and similar measures. Opposite features are regarded as defects.
Key terms
samaH (samaḥ)
Even; interpreted here as uniform suppuration, roundness, a straight course, or an even surface.
suvibhaktaH (suvibhaktaḥ)
Clearly delineated; alternatively free from insufficient or excessive division.
nirAshrayaH (nirāśrayaḥ)
Not based in an unfavourable or inaccessible site in this explanation.
For operative work, the text commends a vrana that is elongated and broad, clearly defined, free from an unfavourable site, and made at the appropriate time.
The verse restates the preceding description. The repeated conjunction allows an elongated wound, a broad wound, or one possessing both features. Nirashraya is explained as not involving marmas and similar structures. Some read nirashaya, interpreted as not remaining adherent there. Appropriate timing is illustrated by restrictions on procedures using instruments, kshara or fire in children and older people; another example contrasts the cold season with summer for a lesion considered suitable for fire treatment. Some read yuktakalakrita and explain it as uniform suppuration; others as treatment performed when suppuration has properly occurred. Some textual traditions omit this verse.
Key terms
prAptakAlakRutaH (prāptakālakṛtaḥ)
Performed at an appropriate time, with different explanations preserved in the commentary.
Courage means freedom from fear: fear may prevent a physician from undertaking even a treatable, deeply rooted lesion, or lead to leaving a procedure unfinished. Prompt action means dexterity and swift performance, which the commentary links with avoiding prolonged distress for the patient. Instrument sharpness means a well-sharpened, effective edge, to which the commentary attributes avoidance of pain. An unconfused mind is explained as clear recognition of unripe and suppurated lesions and correct performance of the required action. Others understand it as remaining composed at the sight of blood and similar appearances during cutting. Some textual traditions omit this verse.
Key terms
shauryaM (śauryam)
Courage or freedom from fear during the procedure.
asammohaH (asammohaḥ)
Clear understanding or composure, according to the alternative explanations.
एकेन वा व्रणेनाशुध्यमाने नाऽन्तरा बुद्ध्याऽवेक्ष्यापरान् व्रणान् कुर्यात् ||११||
भवति चात्र- यतो यतो गतिं विद्यादुत्सङ्गो यत्र यत्र च |
तत्र तत्र व्रणं कुर्याद्यथा दोषो न तिष्ठति ||१२||
Meaning of the śloka
If a lesion is not cleared through a single opening, the passage calls for careful assessment and further openings where needed. Wherever a tract or a recess is found, it describes making an opening so that the offending material does not remain.
Further openings are discussed when the first does not permit clearance. The commentator explicitly glosses na as 'the person' and antara as 'within'. Gati means a nadi tract. Utsanga is first explained as a depressed internal recess formed when pus remains for a long time and breaks down surrounding unripe tissue, resembling a hollow or lap. Another interpretation derives it from pus collecting above. Dosha here specifically means pus: retained pus leads to the involvement of vata and the other doshas, so the effect's name is applied to its cause.
Key terms
gatiM (gatim)
A tract, glossed as nadi.
utsa~ggaH (utsaṅgaḥ)
An internal recess retaining pus; alternatively a collection above.
The text specifies transverse incisions for the eyebrows, cheeks, temples, forehead, eyelids, lips, gums, armpits, abdomen and groins. A parenthesized verse describes circular incisions on the hands and feet and semicircular ones at the anus and penis. Departing from the stated pattern is associated in the passage with injury to siras and snayus, excessive pain, delayed healing and the appearance of fleshy projections.
Although transverse incision is elsewhere listed among complications, the commentator treats these named sites as exceptions. The anatomical terms are explained as cheek, eyelid, flesh surrounding the teeth, root of the arm, abdomen and junction of the thigh. Mamsakandi means a small tuber-shaped projection of flesh. Some read 'elsewhere' instead of 'otherwise', taking the warning to concern incision at other sites. Some also read kshanana, injury, instead of chedana, cutting.
Key terms
tiryak
Transversely, describing the incision's direction.
This limits the earlier instruction concerning a patient who has eaten. The commentator states that a full digestive tract, together with application of instruments and related actions in these conditions, may produce severe distress or death and aggravate anila. In diseases of the mouth, food expelled through pressure from a finger or another instrument, or through disgust, may obstruct the procedure.
Key terms
abhuktavataH (abhuktavataḥ)
Of a patient who has not eaten before the procedure described.
anilaH (anilaḥ)
Vata in this explanation of procedural difficulty.
After using the instrument, the text describes comforting the patient with cold water, applying pressure around the lesion with a finger, attending to the wound, washing it with a decoction and taking up the water with cloth. It then describes placing a medicated varti coated with sesame paste, honey and ghee, neither excessively oily nor excessively dry; covering the site with paste and a thick pad; and securing it with a cloth bandage. Fumigation and protective mantras are prescribed for relief of pain and protection from harmful beings within the text's ritual framework.
Cold water is explained as relieving distress caused by the procedure and preventing fainting and similar events. Pressure around the lesion is intended to release discharge. With the reading abhimridya, attending to the wound means manipulation to even out the operative site. Others read abhimrijya and connect it with detecting hairs, bone, tracts and recesses. The commentary specifies a decoction intended for fresh wounds during the first seven nights and, thereafter, one prepared for the relevant dosha. Water inside the wound is taken up with cloth. The varti is thickly coated with sesame paste, honey and ghee and contains cleansing medicines referred to in a later chapter. The covering paste is likewise associated with fresh-wound medicines. Kavalika is a covering pad intended to keep the medicinal liquid from escaping. One account describes bark or leaves such as palasha and udumbara; another describes soft cloth folded twice or four times; a third describes a thick pad using roasted barley meal with ghee. Fumigants for pain are exemplified by hingu and salt, and those for protection against rakshasas by vacha and related substances.
Key terms
vartiM (vartim)
The medicated wick or insert described for the wound.
kavalikA (kavalikā)
A covering pad, with several materials proposed in the commentary.
The text next describes fumigation using powders of guggulu, aguru, sarjarasa, vacha and white mustard, combined with salt, neem leaves and ghee. It then prescribes anointing the patient's vital sites with the remaining ghee.
The commentator extends fumigation to the bed and related articles, as well as the wound, explaining its purposes as removing wound odour and keeping away blue flies and similar insects. The arrival of these flies is connected with the appearance of krimis in the wound. The remaining ghee means what is left from the ghee mixed with the fumigation materials. Pranas here denotes sites such as the heart because they are regarded as seats of the vital principles. Anointing them is described as nourishing those principles.
Key terms
AjyasheSheNa (ājyaśeṣeṇa)
With the ghee remaining from the preparation described.
prANAn (prāṇān)
Vital sites such as the heart, according to this commentary.
उदकुम्भाच्चापो गृहीत्वा प्रोक्षयन् रक्षाकर्म कुर्यात्; तद्वक्ष्यामः- ||१९||
कृत्यानां प्रतिघातार्थं तथा रक्षोभयस्य च |
रक्षाकर्म करिष्यामि ब्रह्मा तदनुमन्यताम् ||२०||
नागाः पिशाचा गन्धर्वाः पितरो यक्षराक्षसाः |
अभिद्रवन्ति ये ये त्वां ब्रह्माद्या घ्नन्तु तान् सदा ||२१||
पृथिव्यामन्तरीक्षे च ये चरन्ति निशाचराः |
दिक्षु वास्तुनिवासाश्च पान्तु त्वां ते नमस्कृताः ||२२||
पान्तु त्वां मुनयो ब्राह्मया दिव्या राजर्षयस्तथा |
पर्वताश्चैव नद्यश्च सर्वाः सर्वे च सागराः ||२३||
अग्नी रक्षतु ते जिह्वां प्राणान् वायुस्तथैव च |
सोमो व्यानमपानं ते पर्जन्यः परिरक्षतु ||२४||
उदानं विद्युतः पान्तु समानं स्तनयित्नवः |
बलमिन्द्रो बलपतिर्मनुर्मन्ये मतिं तथा ||२५||
कामांस्ते पान्तु गन्धर्वाः सत्त्वमिन्द्रोऽभिरक्षतु |
प्रज्ञां ते वरुणो राजा समुद्रो नाभिमण्डलम् ||२६||
चक्षुः सूर्यो दिशः श्रोत्रे चन्द्रमाः पातु ते मनः |
नक्षत्राणि सदा रूपं छायां पान्तु निशास्तव ||२७||
रेतस्त्वाप्याययन्त्वापो रोमाण्योषधयस्तथा |
आकाशं खानि ते पान्तु देहं तव वसुन्धरा ||२८||
वैश्वानरः शिरः पातु विष्णुस्तव पराक्रमम् |
पौरुषं पुरुषश्रेष्ठो ब्रह्माऽऽत्मानं ध्रुवो भ्रुवौ ||२९||
एता देहे विशेषेण तव नित्या हि देवताः |
एतास्त्वां सततं पान्तु दीर्घमायुरवाप्नुहि ||३०||
स्वस्ति ते भगवान् ब्रह्मा स्वस्ति देवाश्च कुर्वताम् |
(स्वस्ति ते चन्द्रसूर्यौ च स्वस्ति नारदपर्वतौ) |
स्वस्त्यग्निश्चौव वायुश्च स्वस्ति देवाः सहेन्द्रगाः ||३१||
पितामहकृता रक्षा स्वस्त्यायुर्वर्धतां तव |
ईतयस्ते प्रशाम्यन्तु सदा भव गतव्यथः ||३२||
इति स्वाहा |
एतैर्वेदात्मकैर्मन्त्रैः कृत्याव्याधिविनाशनैः |
मयैवं कृतरक्षस्त्वं दीर्घमायुरवाप्नुहि ||३३||
Meaning of the śloka
The passage describes a protective rite performed while sprinkling water from a vessel. The practitioner announces the rite against harmful rites and fear of rakshasas, seeking Brahma's assent. Brahma and the other deities are invoked against beings that afflict the patient, while beings of the earth, atmosphere, directions and dwelling are respectfully asked to protect. Sages, divine and royal seers, mountains, rivers and oceans are also invoked. The prayer assigns protection of the tongue to Agni, pranas to Vayu, vyana to Soma, apana to Parjanya, udana to lightning and samana to thunder. Indra is asked to protect strength; Manu is invoked in connection with manye and understanding. Gandharvas protect desires, Indra sattva, Varuna discernment, and the ocean the navel region. The sun protects sight, the directions hearing, the moon the mind, the stars beauty and the nights the body's lustre. Waters are asked to nourish semen and plants the hairs; space protects the openings and earth the body. Vaishvanara protects the head, Vishnu capability, the foremost Purusha paurusha, Brahma the self, and Dhruva the eyebrows. These deities, described as continually present in the body, are asked to grant protection and long life. The concluding blessings invoke Brahma and the gods, with a parenthesized blessing from the sun, moon, Narada and Parvata, and pray for well-being, longevity, an end to calamities and freedom from suffering. The practitioner closes with svaha and a wish for long life through this protection by mantras described as Vedic and as dispelling harmful rites and disease.
The rite is introduced in response to fear of rakshasas associated with blood, pus and similar wound conditions. Some authorities hold that the words should not be explained because they are mantras; others provide the explanation that follows. Kritya is interpreted as a harmful female being produced through a hostile practitioner's ritual. An alternative wording speaks of protection rather than repelling. Brahma's assent means acceptance of the rite. The commentary identifies nagas with beings such as Vasuki, pishachas as flesh-eaters, gandharvas as divine singers, pitrs with groups such as the Agnishvattas, yakshas with figures such as Dhanada, and rakshasas with figures such as Ravana. Beings of the dwelling inhabit the house site. Prana is discussed through a list of twelve vital principles, but Vayu's role here is taken specifically as the prana division of vata because the other four divisions are named next. Soma is the moon; Parjanya is a rain-bearing cloud, or Indra according to others; and stanayitnu denotes clouds. Manu is Prajapati. One reading understands manye as the two siras at the back of the neck and also assigns protection of understanding to Manu; another takes manye as 'I think', rather than as anatomical wording. Rupa means beauty, and chaya a kind of lustre, distinguished from prabha as visible nearby rather than from afar. Retas is semen. Kha is interpreted as bodily channels, or alternatively the senses. Parakrama means capability; paurusha is glossed as the penis; the foremost Purusha as Narayana; atman as the living self; and Dhruva as a particular star. The deities are described as continually present. Svasti means auspicious well-being. The calamities mentioned at the end are illustrated as excessive rain, drought, rodents, locusts, birds, and one's own or an opposing army, all associated with destruction of food and other resources.
Key terms
rakShAkarma (rakṣākarma)
The protective rite described in this passage.
kRutyA (kṛtyā)
A harmful being attributed by the commentary to hostile ritual activity.
manye
Read either as two neck siras or as 'I think' in the alternative explanation.
ItayaH (ītayaḥ)
Calamities destructive of food and other resources.
ततस्तृतीयेऽहनि विमुच्यैवमेव बध्नीयाद्वस्त्रपट्टेन; न चैनं त्वरमाणोऽपरेद्युर्मोक्षयेत् ||३५||
Meaning of the śloka
The text next specifies removing the dressing on the third day and bandaging again with cloth in the same manner. It cautions against hurriedly opening it on the following day.
The 'following day' is explicitly identified as the second day. An alternative reading adds washing with a decoction after opening the dressing on the third day. That decoction is explained as one made from the substances described for fresh wounds, and the bandaging is performed as before.
Key terms
aparedyuH (aparedyuḥ)
On the following day, here explained as the second day.
Vigrathita is glossed as granthita, knotted. An alternative replaces the prefix vi with hi and reads the wording as a reason: because the wound becomes knotted and has not properly developed healing tissue, it does not heal readily and becomes intensely painful.
Key terms
vigrathitaH (vigrathitaḥ)
Knotted or indurated, as explained through granthita.
After this, decoctions, external applications, bandaging, diet and conduct are to be selected with consideration of dosha, season, strength and other relevant factors.
The first explanation understands 'after this' as after the third day. Doshas are vata and the others; seasons begin with hemanta; strength is low, moderate or high. Age, suitability through habituation and similar factors are also included. These are assessed while treatment continues until healing. Another reading shortens the list to 'decoctions and so on' and understands the time as the fourth bandaging, after the third. In that reading, the inclusive phrase also covers pastes and unctuous substances.
Key terms
sAtmya (sātmya)
Suitability or accustomed tolerance considered when choosing the regimen.
न चैनं त्वरमाणः सान्तर्दोषं रोपयेत्; स ह्यल्पेनाप्यपचारेणाभ्यन्तरमुत्सङ्गं कृत्वा भूयोऽपि विकरोति ||३८||
Meaning of the śloka
The text warns against hastening closure of a wound while offending material remains inside. Even a small departure from proper care may then lead to an internal recess and renewed disorder.
The internal dosha is specifically explained as pus remaining within. A small apachara means even a slight contrary or unsuitable action. The final phrase means that the wound again becomes disordered.
Key terms
sAntardoSham (sāntardoṣam)
Containing internal offending material, identified here as pus.
Therefore the text calls for healing a wound only when it is thoroughly clear both internally and externally. Even after closure, it prescribes avoiding indigestion, exertion, sexual activity and related disturbances, as well as excitement, anger and fear, until the healed site has become firm.
Internal clearance is indicated by the disappearance of pain associated with vata and the other doshas. External clearance is described through four features: appropriate colour, rasa, condition or site, and smell. Some textual traditions omit the words beginning with excitement, anger and fear, but include these through the earlier phrase 'sexual activity and so on'.
Key terms
sushuddham (suśuddham)
Thoroughly clear, both internally and externally, in the stated wound assessment.
The verse describes opening the dressing after three days in hemanta, shishira and vasanta, and after two days in sharad, grishma and varsha, with knowledgeable judgment.
The commentary links the longer interval in the first group of seasons to cold and the absence of concern about rapid suppuration, and the shorter interval in the latter group to warmth and quicker suppuration. It then limits any rigid application of this rule. For a paittika wound, the interval in hemanta and shishira is adjusted as appropriate. In vasanta, the heat of Vaishakha may justify the two-day interval for any wound, and the commentary also allows twice-daily bandaging for a paittika wound. In summer, a paittika wound may likewise require bandaging twice in a day. Another reading replaces shishira with pravrit, the onset of rains; the commentator rejects it because it was criticized in the Panjika. Finally, the seasons are not identical in their intensity: the intervals of three and two days are not absolute, and the degree of seasonal conditions must be assessed.
Key terms
paittika
Associated with pitta, qualifying the wound in the exceptions discussed.
mokShayet (mokṣayet)
Should release or open the dressing in this passage.
In rapidly progressing disorders, the physician should not insist on this prescribed sequence. The text calls for prompt action, as one would respond to a house on fire.
One explanation takes the verse as answering whether procedures such as excision must always wait for all supplies to be assembled. Atipatin means acting rapidly. An alternative applies the exception specifically to rules such as the timing of bandaging in rapidly progressing disease.
Key terms
atipAtiShu (atipātiṣu)
In rapidly acting or rapidly progressing conditions.
The verse describes severe pain caused by use of the surgical instrument as afflicting the person's body, and associates its relief with a lukewarm preparation containing yashtimadhuka. The carrier is unclear in the stored wording.
This verse addresses distress following the use of the instrument. Pradunoti means afflicts or causes distress. Some read pratanoti, explained as spreading or pervading.
Key terms
koShNena (koṣṇena)
Lukewarm, describing the preparation in the verse.
yaShTImadhuka (yaṣṭīmadhuka)
The named medicinal substance included in the preparation described.