Leeches are described as an especially gentle means of removing blood, intended for the benefit of kings, wealthy people, children, older people, the fearful, the weak, women and those of delicate constitution.
Anugraha means benefit or assistance. 'Especially gentle' means foremost in gentleness: horn and gourd are gentle methods, while leeches are especially gentle. Scarification and puncturing a vessel are classified as methods that are not gentle.
The text assigns the horn, leeches and gourd respectively to removing blood affected by vata, pitta and kapha. Alternatively, any of the three may be used for blood affected by any of these doshas. A parenthetical qualification concerns removing blood that especially requires drainage by these means.
Some add 'because of unctuousness, coldness and dryness' as the rationale for the respective assignments; the commentary's compilers omit that reading. The alternative permits any instrument according to availability. An objection notes that allowing all instruments seems to undermine the fixed correspondence. The additional qualification is explained as permitting removal by the horn and other means when blood particularly needs drainage because of the great severity of its disorder. Only some commentators include and explain this qualification; many, including Jejjhata, omit it.
Key terms
yathAsa~gkhyaM
In corresponding order: horn for vata, leeches for pitta, gourd for kapha.
The verses describe a cow's horn as hot, somewhat sweet and unctuous, and therefore suitable for bloodletting when vata is involved. The leech is described as living in a cold habitat, sweet and born in water, and therefore suitable when pitta is involved. The gourd is described as pungent, dry and sharp, and therefore suitable when kapha is involved.
The verses give the stated reasons for each method according to the dosha. The supplied commentary glosses samadhura as slightly unctuous. Some instead read 'unctuous, smooth and somewhat sweet.' Shitadhivasa means having a cold dwelling.
After scarification, the text describes drawing out blood by suction through a horn covered with a thin membrane, or by a gourd containing a lighted lamp. The account of leeches follows.
Basti means the urinary bladder. Patala is described as a dense, white, spider-web-like layer, and 'thin' qualifies both terms. Others read 'covered with a thin cloth layer' and explain a fine-fabric covering. The instruction to remove blood also applies to the gourd with an inner lamp. Some give a different gourd procedure beginning with birch bark, hemp and cotton; the commentary says the full reading is unavailable and has not been reproduced. For dimensions it cites Bhaluki: a crescent-curved horn from a white cow, seven angulas long, containing a piece of cotton, with a base opening like the base of the thumb and a tip opening like a mung bean. The gourd is described as eight angulas in circumference, with a four-angula neck, a well-formed mouth and a body coated with black clay. Others include instrument dimensions and signs of blood affected by vata and other doshas here, but those readings are also omitted as unavailable.
Key terms
basti
Urinary bladder, referring here to a covering membrane.
The commentary supplies the understood verb 'are called' in the first derivation: water is the life of these leeches. The second gives another derivation of their name from water being their dwelling.
The enumeration is relevant to treatment. The twelve are divided into poisonous and nonpoisonous groups. The emphatic word eva excludes the possibility of eight poisonous kinds stated in another treatise.
The six leeches classified as poisonous are Krishna, Karbura, Alagarda, Indrayudha, Samudrika and Gochandana. Krishna is the colour of powdered anjana and has a broad head. Karbura is elongated like a varmi fish, with an abdomen depressed in places and raised in others. Alagarda looks hairy, has large sides and a dark mouth. Indrayudha is patterned with upright stripes like a rainbow. Samudrika is somewhat dark-yellow, with varied flower-like markings. Gochandana has a divided appearance underneath, resembling a bull's scrotum, and a small mouth. The text associates their bites with marked swelling at the site, severe itching, fainting, fever, burning, vomiting, an intoxicated state and bodily exhaustion. It describes Mahagada for drinking, application, nasal administration and other measures. A person bitten by Indrayudha is declared incurable in this account. Thus the poisonous kinds and their treatment have been described.
These names are given to exclude such leeches from keeping and application, and to explain management of complications when one is applied accidentally or attaches by itself. Anjana here means soot or collyrium, and a broad head means a large head. Varmi is explained as a snake-shaped fish; others identify it as rohita. Karbura has an abdomen depressed in some places and raised in others. Alagarda appears hairy because of its folds. Indrayudha means Indra's bow, the rainbow. Samudrika's flower-like pattern is explained as white spots of different shapes. Gochandana's underside appears divided in two like a bull's scrotum. 'Excessive' qualifies itching and the other symptoms individually. Mada resembles the intoxicated condition associated with areca fruit; sadana means weariness of the limbs. Mahagada refers to the preparation taught in Kalpasthana in the passage beginning 'trivridvishalye madhukam haridre'. The additional measures include pouring and immersion. For Indrayudha, incurable means not fit for curative treatment. One explanation says its signs should be understood by comparison with the stages of poisoning in an incurable snakebite. Others identify it by the full set of swelling and the other symptoms, the presence of ominous signs, and failure to subside even after Mahagada.
Key terms
saviShAH (saviṣāḥ)
Leeches classified in the text as poisonous.
mahAgadaH (mahāgadaḥ)
The named preparation referred to Kalpasthana for the complications described here.
The six leeches classified as non-poisonous are Kapila, Pingala, Shankumukhi, Mushika, Pundarikamukhi and Savarika. Kapila has sides that look coloured with manahshila, and a smooth, mudga-coloured back. Pingala is somewhat reddish, rounded in body, tawny and quick-moving. Shankumukhi has the colour of liver, sucks quickly, and has a long, pointed mouth. Mushika resembles a mouse in shape and colour and has an unpleasant smell. Pundarikamukhi is mudga-coloured and has a lotus-like mouth. Savarika is smooth, has the colour of a lotus leaf, and measures eighteen angulas; the text assigns this kind to use on animals.
These names are supplied to identify the kinds to be selected. Mudga colour means the green colour of mung beans. Pingala's colour is glossed as tawny, and ashuga means moving quickly. Liver colour is explained as blue-red. Mushika resembles a mouse in both shape and colour. A lotus-like mouth means a broadly spread mouth. Savarika is assigned to elephants, horses and other animals, not to humans.
Key terms
nirviShAH (nirviṣāḥ)
Leeches classified in the text as non-poisonous.
shIghrapAyinI (śīghrapāyinī)
Sucking quickly, a feature given for Shankumukhi.
aShTAdashA~ggulapramANA (aṣṭādaśāṅgulapramāṇā)
Measuring eighteen angulas, the length assigned to Savarika.
Their regions include Yavana, Pandya, Sahya and Pautana. The text especially describes leeches from these places as large-bodied, strong, quick to suck, able to take a large amount, and non-poisonous.
The commentary identifies Yavana as Turushka country, Pandya as a southern region, Sahya as a particular mountain beyond the Narmada, and Pautana as the Mathura region. Some readers omit this list of geographical regions. They object that the habitats or sources of poisonous leeches are decomposing poisonous creatures and similar matter, whereas those of non-poisonous leeches are decomposing lotuses and related plants; on that understanding, they consider the geographical list inappropriate here.
Key terms
kShetrANi (kṣetrāṇi)
Regions or sources of occurrence; the commentary records disagreement over its scope here.
Adhikarana ೧೧ (೧೪-೧೫) · Śloka ೧೫
ತತ್ರ, ಸವಿಷಮತ್ಸ್ಯಕೀಟದರ್ದುರಮೂತ್ರಪುರೀಷಕೋಥಜಾತಾಃ ಕಲುಷೇಷ್ವಮ್ಭಸು ಚ ಸವಿಷಾಃ; ಪದ್ಮೋತ್ಪಲನಲಿನಕುಮುದಸೌಗನ್ಧಿಕಕುವಲಯಪುಣ್ಡರೀಕಶೈವಲಕೋಥಜಾತಾ ವಿಮಲೇಷ್ವಮ್ಭಃಸು ಚ ನಿರ್ವಿಷಾಃ ||೧೪||
ಭವತಿ ಚಾತ್ರ- ಕ್ಷೇತ್ರೇಷು ವಿಚರನ್ತ್ಯೇತಾಃ ಸಲಿಲಾಢ್ಯಸುಗನ್ಧಿಷು |
ನ ಚ ಸಙ್ಕೀರ್ಣಚಾರಿಣ್ಯೋ ನ ಚ ಪಙ್ಕೇಶಯಾಃ ಸುಖಾಃ ||೧೫||
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तत्र, सविषमत्स्यकीटदर्दुरमूत्रपुरीषकोथजाताः कलुषेष्वम्भसु च सविषाः; पद्मोत्पलनलिनकुमुदसौगन्धिककुवलयपुण्डरीकशैवलकोथजाता विमलेष्वम्भःसु च निर्विषाः ||१४||
भवति चात्र- क्षेत्रेषु विचरन्त्येताः सलिलाढ्यसुगन्धिषु |
न च सङ्कीर्णचारिण्यो न च पङ्केशयाः सुखाः ||१५||
Meaning of the śloka
The text classifies as poisonous those leeches arising in the decomposing matter of poisonous fish, insects, frogs, urine and faeces, and in turbid water. Those arising in the decomposing matter of padma, utpala, nalina, kumuda, saugandhika, kuvalaya, pundarika and shaivala, and in clear water, are classified as non-poisonous. A verse states that these beneficial leeches move through pleasantly scented places rich in water; they do not range among mixed, unsuitable matter or lie in mud.
Kotha means decomposition or putrefaction, and turbid water means dirty water. The plant names are distinguished as follows: padma is somewhat white, utpala somewhat blue, and nalina somewhat red. Kumuda has the vernacular name 'kuia'. Saugandhika is called gardabhapushpa, is very fragrant and opens at moonrise. Kuvalaya is the red utpala, pundarika a very white lotus, and shaivala is the aquatic growth of that name. The text describes the leeches as arising from these plants in their decomposed state. The concluding verse refers to the non-poisonous kinds already mentioned. Pleasantly scented means having a good smell. The statement about not ranging in mixed places is interpreted as not consuming poison and other unsuitable food, because they feed on shaivala and similar material. They do not sleep in mud but rest on grass and aquatic leaves. Calling them pleasant or beneficial refers to their being a cause of comfort.
Key terms
kothaH (kothaḥ)
Decomposition or putrefaction, in the source's account of where leeches arise.
vimaleShvambhaHsu (vimaleṣvambhaḥsu)
In clear water.
sukhAH (sukhāḥ)
Bringing comfort or benefit, as explained of the selected leeches.
Their collection is assigned to autumn on the authority of another treatise. The other methods include freshly killed animal flesh and body parts such as the shanks smeared with fresh butter, ghee, milk and similar materials.
Key terms
ArdracarmaNA (ārdracarmaṇā)
With moist hide, a means of collecting leeches described here.
अथैनां नवे महति घटे सरस्तडागोदकपङ्कमावाप्य निदध्यात्; भक्ष्यार्थे चासामुपहरेच्छैवलं वल्लूरमौदकांश्च कन्दांश्चूर्णीकृत्य; शय्यार्थं तृणमौदकानि च पत्राणि; त्र्यहात्त्र्यहाच्चाभ्योऽन्यज्जलं भक्ष्यं च दद्यात्; सप्तरात्रात् सप्तरात्राच्च घटमन्यं सङ्क्रामयेत् ||१७||
Meaning of the śloka
The text describes keeping the leeches in a large new pot containing water and mud from a lake or pond. Their food consists of shaivala, vallura and aquatic tubers reduced to small particles. Grass and aquatic leaves are provided for resting. Water and food are replaced every three days, and the leeches are transferred to another pot every seven days.
A verse states that leeches with thick middles, a distressed appearance, excessive breadth or sluggish movement, those that do not attach or take little blood, and the poisonous kinds are not favoured.
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ತಾಸ್ವಯೋಗ್ಯಾ ನಿದರ್ಶಯನ್ನಾಹ- ಭವತಿ ಚಾತ್ರೇತ್ಯಾದಿ| ಪರಿಕ್ಲಿಷ್ಟಾ ಅಮನೋಜ್ಞದರ್ಶನಾಃ, ಪೃಥ್ವ್ಯೋ ವಿಸ್ತೀರ್ಣಾಃ, ಮನ್ದವಿಚೇಷ್ಟಿತಾ ಮನ್ದಗಾಮಿನ್ಯಃ, ನ ಪೂಜಿತಾ ನ ಶ್ಲಾಘಿತಾಃ||೧೮||
Meaning of the commentary
This identifies unsuitable leeches. Pariklishta is explained as unpleasant in appearance; prithvi means broad; slow movement means moving sluggishly. 'Not honoured' means not commended for selection.
The historical procedure seats or lays down a patient with a condition considered suitable for leech application. If the site is free from a wound or pain, it describes drying or roughening it with powdered earth and cow dung. The leeches are coated with a watery paste of mustard and turmeric, kept briefly in a water vessel and applied to the affected area once free from fatigue. Smooth, white, damp cotton or cloth covers the leech, with its mouth exposed. If it does not attach, the text describes offering a drop of milk or blood, or making small instrument marks at the site. Another leech is used if it still does not attach.
Samveshya means laying the patient down. Aruja is explained as unwounded: on an existing wound, smell and moisture themselves cause attachment. Alternatively it means without pain, since roughening a painful site would increase pain. Salilasaraka means a water vessel; some instead read a phrase describing leeches moving in a water-filled vessel. Roga means the location of the disease or dosha. Picu is seedless cotton and prota is cloth. The commentary glosses apavrunuyat as 'cover,' contrary to the sense of uncovering supported by the instruction concerning the mouth.
Key terms
picuH (picuḥ)
Cotton without its seeds, used as a covering.
Adhikarana ೧೬ (೨೦) · Śloka ೨೦
ಯದಾ ಚ ನಿವಿಶತೇಽಶ್ವಖುರವದಾನನಂ ಕೃತ್ವೋನ್ನಮ್ಯ ಚ ಸ್ಕನ್ಧಂ ತದಾ ಜಾನೀಯಾದ್ಗೃಹ್ಣಾತೀತಿ; ಗೃಹ್ಣನ್ತೀಂ ಚಾರ್ದ್ರವಸ್ತ್ರಾವಚ್ಛನ್ನಾಂ ಕೃತ್ವಾ ಧಾರಯೇತ್ ||೨೦||
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यदा च निविशतेऽश्वखुरवदाननं कृत्वोन्नम्य च स्कन्धं तदा जानीयाद्गृह्णातीति; गृह्णन्तीं चार्द्रवस्त्रावच्छन्नां कृत्वा धारयेत् ||२०||
Meaning of the śloka
The leech is considered attached when it settles with its mouth shaped like a horse's hoof and raises its neck region. While it takes blood, the text describes keeping it covered with damp cloth.
Nivishate means attaching, and gruhnati first means piercing, while its following related form means taking blood. The damp cloth is said to keep the leech comfortable so that it drinks quickly. The commentator claims that the leech's distinctive property enables it to drink vitiated blood first, comparing this with the traditional image of a hamsa drinking milk alone from a mixture of milk and water.
Adhikarana ೧೭ (೨೧) · Śloka ೨೧
ದಂಶೇ ತೋದಕಣ್ಡುಪ್ರಾದುರ್ಭಾವೈರ್ಜಾನೀಯಾಚ್ಛುದ್ಧಮಿಯಮಾದತ್ತ ಇತಿ; ಶುದ್ಧಮಾದದಾನಾಮಪನಯೇತಃ ಅಥ ಶೋಣಿತಗನ್ಧೇನ ನ ಮುಞ್ಚೇನ್ಮುಖಮಸ್ಯಾಃ ಸೈನ್ಧವಚೂರ್ಣೇನಾವಕಿರೇತ್ ||೨೧||
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दंशे तोदकण्डुप्रादुर्भावैर्जानीयाच्छुद्धमियमादत्त इति; शुद्धमाददानामपनयेतः अथ शोणितगन्धेन न मुञ्चेन्मुखमस्याः सैन्धवचूर्णेनावकिरेत् ||२१||
Meaning of the śloka
Pricking pain and itching at the bite are presented as signs that the leech is taking pure blood. The text calls for its removal at that point. If it does not release because of the smell of blood, its mouth is sprinkled with powdered saindhava.
Toda means pain, attributed here to vata arising from tissue depletion. Some omit itching, arguing that a kapha effect should not arise from depletion of pure blood. Others defend the reading: depletion of fiery rakta allows cool, moist kapha, further increased by moisture from the leech's mouth, to increase and cause itching. Another reading compares the itching with that accompanying the painful bite of a forest fly; this kind of itching signals pure blood being drawn. Avakiret means sprinkling with powder. Some read 'desire for blood' instead of 'smell of blood,' rejecting the smell reading on the stated ground that leeches lack an organ of smell.
Key terms
gardhena
Through desire, an alternative reading to gandhena, through smell.
After the leech drops off, the text describes coating its body with rice-pounding particles and its mouth with oil and salt. Its tail is held with the left thumb and finger while the right thumb and finger stroke gently towards the mouth until signs of complete disgorging appear. A properly emptied leech moves in water as though seeking food. One that sinks and does not move is considered incompletely emptied, and the process is repeated. The text names indramada as an incurable disease of an incompletely emptied leech. A properly emptied leech is stored as previously described.
The rice-pounding material means small particles. Anuloma means in the appropriate direction, anumarjayet wiping or stroking, and amukha as far as the mouth. Movement in a water-filled bowl indicates proper disgorging. Sidati means sinking. Some omit the statement about indramada because the treatise does not specify its signs. Storage 'as before' refers to the directions beginning with a new, large pot.
Key terms
indramado
A named disease of an incompletely emptied leech; some authorities omit the statement because its signs are unspecified.
After considering whether blood removal has been appropriate, the text describes applying shatadhauta ghee or holding cotton soaked in it against the site. It also names stimulating leech wounds with honey, pouring cold water, bandaging, and applying astringent, sweet, unctuous and cooling pastes.
Yoga means proper blood flow; ayoga includes insufficient, excessive and improper blood removal. For proper removal, the commentary assigns shatadhauta ghee or cotton soaked in it. For insufficient removal, honey is used to stimulate bleeding. For excessive removal, cold water and bandaging at the bite are intended to stop the flow. For improper removal, astringent pastes are explained as improving remaining vitiated blood, and sweet pastes as replenishing pure blood that has escaped. Others explain cold water as countering complications such as fainting, and honey with astringent and other pastes as promoting closure. The quantity removed should reflect the person's strength, the strength of the dosha or disease, purification of the blood, and the affected site's extent: less from a small site, more from a large one. A traditional measurement scheme follows in pala and related units, referring to a mashaka based on seven ripe gunja fruits. One prastha equals twelve and a half pala and is described as the largest amount from an individual sira over two days. The middle amount is half a prastha, expressed as six pala plus one karsha, also over two days. The smallest is one kudava, expressed as three pala plus eight masha, again over two days. These are reported as the commentary's customary procedure, without conversion to modern units.
Key terms
shatadhautaghRuta (śatadhautaghṛta)
Ghee washed one hundred times, named for care of the site.
Adhikarana ೨೦ (೨೪) · Śloka ೨೪
ಭವತಿ ಚಾತ್ರ- ಕ್ಷೇತ್ರಾಣಿ ಗ್ರಹಣಂ ಜಾತೀಃ ಪೋಷಣಂ ಸಾವಚಾರಣಮ್ |
ಜಲೌಕಸಾಂ ಚ ಯೋ ವೇತ್ತಿ ತತ್ಸಾಧ್ಯಾನ್ ಸ ಜಯೇದ್ಗದಾನ್ ||೨೪||
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भवति चात्र- क्षेत्राणि ग्रहणं जातीः पोषणं सावचारणम् |
जलौकसां च यो वेत्ति तत्साध्यान् स जयेद्गदान् ||२४||
Meaning of the śloka
A concluding verse states that someone who understands the habitats, collection, varieties, maintenance and application of leeches can overcome the diseases considered amenable to them.
The commentary identifies the earlier passages being summarised. Habitats refers to descriptions of poisonous leeches beginning with poisonous insects, and non-poisonous leeches beginning with lotus and utpala leaves. Collection refers to moist leather. Varieties includes Krishna and Karbura among poisonous kinds, and Kapila and Pingala among non-poisonous kinds. Maintenance refers to the directions beginning with a new, large pot. Application refers to the passage beginning with the patient whose disease is suitable for leeches. The conjunction also includes subsequent care and related procedures.
Thus ends the thirteenth chapter, called Jalaukavacharaniya, in the Sutrasthana of the commentary on Sushruta named Nibandhasangraha, composed by Shri Dalhana.