After the chapter on fever, the treatment of atīsāra is taken up because both are commonly preceded by impairment of agni. Atīsāra is defined as excessive movement or discharge: ati conveys excess and the verbal root sar denotes movement. Its pratiṣedha here means its treatment.
Key terms
atīsāra
A disorder characterized in the text by excessive downward discharge of stool.
agni
The digestive and transformative principle whose impairment is associated with the disorder.
Atīsāra may arise from foods that are heavy, excessively unctuous, dry, hot, liquid, coarse or bulky, or excessively cold; from incompatible food, eating again over undigested food, indigestion, or unaccustomed food; from excessive or improper use of oleation and the other therapeutic procedures; from poison, fear, grief, excessive drinking of contaminated water or unsuitable liquor, disturbance of accustomed regimen or season, excessive play in water, suppression of natural urges, and aggravation of kṛmi. Its features will now be described.
Because treatment depends on recognizing atīsāra, the commentary first explains its causes. Guru may be heavy by quantity, quality, or post-digestive effect, and ati applies separately to the qualities through sthūla. Sthūla includes foods made of coarse or large particles, such as flour preparations. Snigdha and sthūla are stated separately from guru to emphasize their strong causal role. Viruddha follows the account of incompatible diet; adhyashana is eating while the previous food remains undigested; and ajīrṇa includes āma and vidagdha forms. Snehādi comprises oleation, emesis, purgation, nirūha and anuvāsana, when used excessively or incorrectly. Viṣa is explained as dūṣīviṣa. Contaminated water is impaired in potency, post-digestive effect, or contact, while unsuitable liquor may be new, spoiled, or consumed out of season. Sātmyartuparyaya means reversal of accustomed regimen or of the season; unaccustomed foods remain a distinct cause. Jala-atiramaṇa means excessive activity in water, vegavighāta means restraining urges such as urination, and kṛmidoṣa means aggravation of kṛmi. The commentary also preserves another teachers’ account in which atīsāra first arose after excessive consumption of cows at a long sacrificial rite, weakening jatharāgni through incompatibility, heat, heaviness, and excessive unctuousness; this is presented as a textual tradition, not as a settled historical claim.
Key terms
adhyashana (adhyaśana)
Eating again before the earlier meal has been digested.
viruddha
Diet described by the tradition as incompatible.
sātmyartuparyaya
Disturbance or reversal of accustomed regimen and seasonal order.
vegavighāta
Obstruction or suppression of natural urges.
kṛmidoṣa
Aggravation of kṛmi as understood in the classical framework.
When the bodily fluid element suppresses the internal digestive fire, becomes mixed with fecal matter, is driven by vāta, increases greatly, and flows forcefully downward, teachers call this severe disorder atīsāra.
Having announced the features, the text gives the pathogenesis through an explanation of the name. The bodily fluid element, after weakening the internal agni and becoming mixed with stool, is propelled by vāta, increases, and moves excessively downward; hence the designation atīsāra. Saṃśamya means making weak, varcomiśra means mixed with feces, praṇunna means impelled, and vṛddha means increased. Apāndhātu is interpreted as bodily fluid such as śleṣman, pitta, and rasa; other authorities understand it specifically as rasa and sweat affected by kapha.
Key terms
apāndhātu
A bodily fluid element; interpreted alternatively as fluids such as śleṣman, pitta and rasa, or as kapha-affected rasa and sweat.
Atīsāra is said to arise from each doṣa separately, from all of them together, from grief, and, as the sixth type, from āma. Some describe it as having many distinct forms, but the king of Kāśī did not teach it in that way, because varying states of the doṣas arise at different times in the affected person.
The commentary explains the enumeration as sixfold and takes the explicit word ‘sixth’ as restrictive, indicating that dual-doṣa types are not counted as separate types. Other traditions also arrive at six by counting four types due to the doṣas singly and collectively and two due to fear and grief; in that scheme the āma type is included within sannipāta because the doṣas are disturbed by āma-indigestion. Hārīta and others describe many types, including dual-doṣa and blood-associated forms, but this is said not to be Dhanvantari’s preferred enumeration. Kāśirāja did not multiply the basic types because āma, pakva, blood-associated, and other mixed appearances are changing states of the doṣas. The first state is āma, followed by pakva; in a pitta type, continued pitta-aggravating intake may produce a blood-associated state. Even when one doṣa predominates, association with another may create the appearance of a dual-doṣa condition. Thus the text retains six basic types while recognizing many changing states.
Key terms
doṣāvasthā
A changing state of the doṣas, such as āma, pakva, or blood-associated stages.
āma
An incompletely processed state within the classical digestive framework.
Premonitory features include piercing pain in the heart region, navel, anus, abdomen and flanks; weakness of the limbs; obstruction of vāta; retention of stool; abdominal distension; and indigestion.
This passage states the pūrvarūpa of impending atīsāra. Hṛt means the heart region and pāyu means the anus. The word toda, piercing pain, applies individually from the heart region through the flanks. Although abdomen could include the navel and flanks, these locations are mentioned separately to show that pain is especially marked there. Puraḥsarāṇi means the features that precede the manifest disorder.
Key terms
pūrvarūpa
Premonitory features appearing before the disorder is fully manifest.
In vāta-associated atīsāra, the person is afflicted by colicky pain, has obstructed urination and intestinal gurgling, looseness or descent at the anal region, and weakness of the waist, thighs and legs. Small amounts of stool are passed repeatedly; they are frothy, dry, dark-colored, and accompanied by flatus.
This describes the features assigned to vāta-atīsāra. Śūlāviṣṭa means tormented by colicky pain; saktamūtra means obstructed urination; and antrakūjī indicates rumbling sounds in the intestines. Srastāpāna denotes downward displacement or descent at the anal region, while the waist, thighs, and legs are lax or weak. ‘Small amounts’ is relative to other forms of atīsāra. Sānila means accompanied by audible passage of vāta. Here śyāva includes reddish, ash-like, pigeon-colored, or bone-like shades described elsewhere for wound discharge.
Key terms
vāta-atīsāra (vātātīsāra)
The form of atīsāra attributed predominantly to vāta.
In pitta-associated atīsāra, the discharge is foul-smelling, hot, forceful, resembling water in which meat has been washed, broken or dispersed, and intensely sharp. The body perspires, and the stool may be yellow, blue-green, or reddish. The person suffers from thirst, fainting, burning, irritation or ulcerative change, and fever.
The person with pitta-atīsāra passes stool having these qualities. Vegavat means discharged with marked force, and māṃsatoyaprakhya means resembling water used to wash meat. Bhinna is explained as dispersed or broken, and atitīkṣṇa as intensely sharp or acrid; the commentary says this was recognized by flies moving away. Burning may occur at the anus or in the abdomen, while pāka is specifically understood at the anus.
Key terms
pitta-atīsāra (pittātīsāra)
The form of atīsāra attributed predominantly to pitta.
māṃsatoyaprakhya
Resembling water in which meat has been washed.
dāha
Burning sensation in the abdomen or anal region.
pāka
Irritation, suppurative change, or soreness understood here at the anus.
In śleṣman-associated atīsāra there are drowsiness, excessive sleep, heaviness, nausea or rising discomfort, and bodily fatigue. Even after passing stool, the person repeatedly feels that another urge is coming. The stool is white, thick, mixed with mucus, and passed without sound; there is aversion to food and horripilation.
This gives the features of śleṣma-atīsāra. Tandrā is a particular form of sleepiness described in Śārīrasthāna; utkleśa is explained as repeated spitting or nausea-like rising, and sādī as fatigue of the limbs. Even after evacuation, the person again anticipates an urge. Sāndra means dense or thick, niḥsvana means without sound, and hṛṣṭaromā means that the body hairs stand erect.
Key terms
śleṣma-atīsāra (śleṣmātīsāra)
The form of atīsāra attributed predominantly to śleṣman or kapha.
tandrā
A state of drowsiness or torpor.
utkleśa
Nausea-like rising discomfort, explained here with repeated spitting.
When all the doṣas are involved, the person has drowsiness, confusion, exhaustion, dryness of the mouth, and thirst, and passes stool of multiple colors. The features of all the doṣas are present. This condition is difficult, and the text regards it as incurable in children and older people.
This describes sannipāta-atīsāra. ‘Not of one color’ means that the stool displays colors associated with all the doṣas, and sarvaliṅgopapatti means the occurrence of all their characteristic signs.
Key terms
sannipāta-atīsāra (sannipātātīsāra)
Atīsāra characterized in the text by combined involvement of all three doṣas.
moha
Confusion or altered awareness.
sarvaliṅgopapatti
Presence of the characteristic signs of all the doṣas.
asādhya
Judged incurable in the classical prognosis stated here.
In a person grieving over various causes and eating little, the force born of tears and grief enters the abdomen, disturbs digestion, and agitates the blood. The blood is then passed downward with difficulty, appearing like kākaṇantī or guñjā, either mixed with stool or without fecal matter, and either with or without odor. Physicians describe this grief-originated disorder as extremely difficult to treat.
The commentary links this form to grief, such as separation from relatives, in a person taking little food. Bāṣpāvega is interpreted as an upsurge of heat born from grief; it enters the abdomen, disturbs agni, and agitates the blood. Some connect ‘downward’ with the agitation of blood, while others connect it with the subsequent discharge. Kākaṇantī is identified as guñjā, providing the color comparison. The presence or absence of odor is explained by whether fecal matter is mixed with the discharge. A variant reading says that the small amount of eaten food becomes dry, is seized by the heat arising from grief, reaches the abdomen, greatly heats the blood, and drives downward a guñjā-colored discharge, with or without stool and odor. Both readings are preserved.
Key terms
śokotpanna
Arising from grief in the classical account.
bāṣpāvega
An upsurge associated with tears and grief, interpreted by the commentary as grief-born heat.
kākaṇantī
Guñjā seed, used here as a comparison for the color of the discharge.
rakta
Blood, described here as being agitated and discharged downward.
The doṣas, strongly disturbed by indigestion characterized by āma, agitate the abdomen and repeatedly cause the person, with difficulty and pain, to pass material of various colors together with undigested food. This is called the sixth type.
This passage describes āma-atīsāra. The disturbed doṣas agitate the abdomen and cause painful, repeated passage of material of various colors rather than a single evacuation. Āmājīrṇopadruta means provoked by the type of indigestion called āma, and sabhakta means containing particles of food. Calling it the sixth type restricts the classification: types attributed to fear, oleation, indigestion, viṣūcikā, arśas, and related causes are not counted separately because they are included within the doṣa-based types. A variant reads ‘the collections of dhātus and the malas’ in place of ‘thoroughly disturbed, together with food,’ with ‘having vitiated’ understood. Although an āma state may occur initially in every atīsāra, this form is stated separately because abundant āma produces it; the commentary gives the same reasoning for distinguishing it despite its sannipāta character.
Key terms
āma-atīsāra (āmātīsāra)
The form of atīsāra attributed to abundant āma and āma-type indigestion.
āmājīrṇa
Indigestion characterized by āma in the classical framework.
sabhakta
Containing particles of ingested food.
dhātusaṅgha
Collections of bodily constituents in the preserved variant reading.
Stool associated with these doṣas sinks when placed in water, is extremely foul-smelling, and is passed in small interrupted portions; this is designated āma stool.
The stool is said to be pervaded by the previously described, strongly expressed signs of vāta and the other doṣas. Avasīdati means that it sinks in water. Vicchinna is explained as passage in repeated small amounts; some authorities instead read picchila, meaning slimy or mucilaginous.
Key terms
āmasaṃjñaka
Designated as being in the āma state.
avasīdati
Sinks in water, according to the traditional observation.
vicchinna
Passed intermittently in small quantities.
picchila
Slimy or mucilaginous, preserved as an alternative reading.
Adhikarana 13 (18) · Śloka 18
ētānyēva tu liṅgāni viparītāni yasya tu |
lāghavaṁ ca manuṣyasya tasya pakvaṁ vinirdiśēt ||18||
When those same signs occur in their opposite form and there is lightness in the person, the condition should be identified as pakva, the matured stage.
After describing the signs of the āma stage, the commentary gives the signs of the pakva stage: the immediately preceding āma signs appear in reverse. The word 'and' also includes stool free from disturbance by kapha. Some read 'lightness of the stool' instead of 'lightness of the person.' On that reading, although stool that does not sink in water is already implied by reversing the earlier sign, lightness is mentioned again to indicate freedom from kapha disturbance. The objection that even matured stool mixed with kapha may sink is answered by identifying matured kapha-type atīsāra from the other signs.
Key terms
pakva
The matured or processed stage of the disorder.
āma
The earlier, unprocessed stage whose signs are reversed here.
lāghava
Lightness, read either of the person or, in a variant, of the stool.
Discharge resembling ghee, fat, meat-preparation water, oil, marrow, milk, or honey; resembling madder, brain matter, or collyrium; having a raw or corpse-like odor; marked with colored streaks or peacock-feather-like circles; continuously mixed with pus, mud-like, or hot; or displaying signs contrary to the expected doṣa pattern is described as fatal. Numerous complications may kill an exhausted person. One should abandon as incurable a patient with an uncontracted anus, severe depletion, marked distension or other complications, destruction of the anal region, loss of bodily warmth, and chronic injury caused by atīsāra.
These verses present signs regarded as incurable so that such cases may be excluded from treatment. Each comparison applies separately to the appearance of the discharge. Vesavāra is explained as specially prepared meat, so vesavārāmbu means water mixed with it; mastuluṅga resembles partly melted mixtures of the four fats; visra means an āma-like odor; and the corpse-like smell is that of decomposed flesh. Añjanābha is compared with sauvīra collyrium, rājīmat means bearing blue, yellow, or other streaks, and candraka means markings like those on a peacock feather. Pratīpa is explained either as signs opposite to the expected doṣa signs or, by others, as fatal prognostic signs. Complications include fever, swelling, thirst, breathlessness, cough, loss of appetite, vomiting, hiccup, and fainting. Asaṃvṛtaguda means an anus that does not contract; kṣīṇa means lacking vitality, bodily substance, and strength. The received reading durātmā is glossed as lacking self-restraint, while some read sadādhmāta, meaning constantly distended. Loss of warmth when the anal region is damaged is also treated as an adverse sign.
Key terms
asādhyaliṅga
Signs regarded in the classical prognosis as indicating incurability.
pratīpa
Signs contrary to the expected doṣa pattern, or alternatively fatal prognostic signs.
Whatever its immediate cause, atīsāra in embodied beings does not at any time pass beyond the characteristic signs of the doṣas. Atīsāra may arise from indigestion caused by unctuous substances, with severe pain and pravāhikā; from visūcikā; from another form of indigestion; or from poison, arśas, or worms. Each displays the signs of its respective doṣa.
The passage is used to prevent the inference that there are more than six principal types. Although atīsāra may arise from many causes, it does not exceed the signs of the doṣas and is therefore identified through the signs of the relevant doṣa. Some place these verses immediately after the description of āma-type atīsāra and consider that order appropriate. The present placement follows Jejjaṭācārya; other commentators do not read the verses here, considering the passage unable to withstand close critical examination.
Key terms
atīsāra
The classical disorder characterized by excessive passage of stool.
pravāhikā
A named condition associated here with repeated painful evacuation.
visūcikā
A classical acute digestive condition named as a cause.
doṣalakṣaṇa
Characteristic signs assigned to the relevant doṣa.
Because treatment in atīsāra cannot disregard the sequence of āma and pakva stages, every case should be understood through the signs of the pakva and āma states.
At the beginning of atīsāra, laṅghana is to be undertaken; afterward, a sequence beginning with yavāgū and combined with digestive measures is considered suitable.
The verse begins the treatment section. Laṅghana is explained here as fasting and is placed first because all forms of atīsāra are regarded as having an āma state initially. After laṅghana, yavāgū, pulse soup, meat broth, and related preparations may be considered according to the individual's condition and what is suitable for that person. Some transmit a variant wording meaning 'laṅghana alone is beneficial initially,' but the commentator says he has not seen that reading and therefore does not present it as the accepted text.
Key terms
laṅghana
Lightening therapy, explained by the commentary here as fasting.
yavāgū
A thin gruel used in the stated dietary sequence.
pācana
Measures intended in the classical framework to process āma.
yūṣa
A pulse-based soup included among the possible foods.
अथवा वामयित्वाऽऽमे शूलाध्माननिपीडितम् |
पिप्पलीसैन्धवाम्भोभिर्लङ्घनाद्यैरुपाचरेत् ||२६||
Meaning of the śloka
Alternatively, in āma-type atīsāra accompanied by pain and distension, after inducing vomiting with water containing pippalī and rock salt, the person is treated with laṅghana and related measures.
This is presented as an alternative for a particular clinical state. In āma-type atīsāra with pain and distension, the commentary connects pippalī, rock salt, and water with induced vomiting, followed by laṅghana, sweating, drinking warm water, and related measures. In response to the objection that vomiting might further weaken agni when impaired agni is said to initiate atīsāra, the commentary says vomiting is used to remove the obstruction created by excessively active doṣas.
Key terms
āma-atīsāra
Atīsāra classified as being in the āma stage.
vamana
Therapeutically induced vomiting described in the historical regimen.
pippalī
The named substance combined here with rock salt and water.
ādhmāna
Abdominal distension.
Adhikarana 19 (27) · Śloka 27
kāryaṁ vamanasyāntē pradravaṁ laghubhōjanam |
khaḍayūṣayavāgūṣu pippalyādyaṁ ca yōjayēt ||27||
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कार्यं वमनस्यान्ते प्रद्रवं लघुभोजनम् |
खडयूषयवागूषु पिप्पल्याद्यं च योजयेत् ||२७||
Meaning of the śloka
After vomiting, light food with abundant liquid is to be given, and a preparation beginning with pippalī is to be added to khaḍa, yūṣa, or yavāgū.
The commentary explains pradrava as yavāgū, yūṣa, and similar foods having plentiful liquid. It answers the objection that liquids were prohibited in atīsāra by distinguishing plain liquid from liquid that has been processed or prepared; another interpretation takes pradrava to mean fluid that has passed onward, but the commentator rejects this because yavāgū is explicitly prescribed. Khaḍayūṣa is explained either as well-cooked buttermilk prepared with kapittha, pomegranate, pepper, and other substances, or, according to others, as six liquids prepared with pomegranate, sour buttermilk, greens, and related ingredients. Yūṣa is made from mudga, masūra, and similar pulses.
Key terms
pradrava
Food containing abundant prepared liquid; an alternative interpretation is explicitly rejected.
khaḍayūṣa
A prepared liquid food for which the commentary preserves alternative descriptions.
yavāgū
A thin gruel.
pippalyādi
A formulation or group beginning with pippalī.
Adhikarana 20 (28) · Śloka 28
anēna vidhinā cāmaṁ yasya vai nōpaśāmyati |
haridrādiṁ vacādiṁ vā pibēt prātaḥ sa mānavaḥ ||28||
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अनेन विधिना चामं यस्य वै नोपशाम्यति |
हरिद्रादिं वचादिं वा पिबेत् प्रातः स मानवः ||२८||
Meaning of the śloka
If the āma-type atīsāra does not subside through this method, the person is to drink either the haridrādi or vacādi preparation in the morning.
When atīsāra remains unprocessed despite the preceding khaḍayūṣa and related measures, the verse prescribes haridrādi or vacādi for pācana. The word 'morning' indicates administration without food.
Key terms
āma-atīsāra
Atīsāra remaining in the classical āma stage.
haridrādi
A preparation beginning with haridrā.
vacādi
A preparation beginning with vacā.
pācana
Processing or digestive treatment in the classical framework.
At the beginning of āma-type atīsāra, saṅgrahaṇa should not be performed, because obstructing the doṣas may first produce disorders such as splenic disease, pāṇḍu, ānāha, meha, kuṣṭha, abdominal disease, fever, swelling, gulma, grahaṇī disorder, arśas, pain, alasaka, and constriction of the heart region.
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āmātisārē ādau saṅgrahāddōṣamāha- āmātīsāriṇāmityādi| tēṣām āmātisāriṇām| vibaddhā viśēṣēṇa baddhā saṅgr̥hītā ityarthaḥ| anyē āmātīsāriṇāmityādipāṭhasya sthānē ‘dōṣastambhanamādau tu na kartavyaṁ vijānatā| tasyādau badhyamānastu balī kuryādupadravān’ iti paṭhanti| aparē tu anyathā pāṭhaṁ paṭhanti, sa cāprasiddha iti na darśitaḥ||29-30||
Meaning of the commentary
The commentary describes the fault in using a binding or retaining measure at the outset of āma-type atīsāra: the doṣas become strongly bound or retained and may cause the listed complications. Another transmitted reading says that a knowledgeable person should not initially arrest the doṣa, because when forcibly bound at the beginning it becomes powerful and causes complications. Yet another reading exists but is not given because the commentator considers it insufficiently established.
Key terms
saṅgrahaṇa
A binding or stool-retaining treatment.
vibaddha doṣa
Doṣas described as forcibly bound or retained.
grahaṇī
A classical digestive disorder named among the complications.
hṛdgraha
Constriction or distress in the heart or chest region.
When a person passes stool repeatedly, with pain and difficulty, and only small amounts as though obstructed, the accumulated doṣas are to be set in motion with pathyā preparations.
This is a regimen for a particular stage. Vibaddha means seemingly obstructed, with only small quantities passed at a time, and sannicita means accumulated or increased. The phrase 'repeatedly' is connected with causing the doṣas to move. Because accumulated doṣas producing pain are said to descend through virecana, purgation is employed here despite the presence of atīsāra.
Key terms
vibaddha
Seemingly obstructed, with small amounts passed at a time.
sannicita doṣa
Doṣas described as accumulated or increased.
pathyā
The named substance or preparations used to promote movement.
virecana
Therapeutic purgation in the classical regimen.
Adhikarana 23 (32) · Śloka 32
yō'tidravaṁ prabhūtaṁ ca pūrīṣamatisāryatē |
tasyādau vamanaṁ kuryāt paścāllaṅghanapācanam ||32||
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योऽतिद्रवं प्रभूतं च पूरीषमतिसार्यते |
तस्यादौ वमनं कुर्यात् पश्चाल्लङ्घनपाचनम् ||३२||
Meaning of the śloka
For a person passing very watery and abundant stool, vomiting is first to be induced, followed by laṅghana and pācana.
The commentary states that vomiting is used because, by removing material through the upward route, it is considered to interrupt the water-bearing bodily constituent.
Key terms
atidrava purīṣa
Very watery stool.
vamana
Therapeutically induced vomiting.
laṅghana
A lightening measure, often interpreted here as fasting.
udakadhātu
The water-bearing bodily constituent invoked in the commentary's reasoning.
When a person passes only a little stool at a time, or stool that is obstructed and accompanied by pain, the text directs purgation with warm pastes of abhayā and pippalī.
The commentary connects 'or' with the use of abhayā and pippalī pastes. Although the preceding verse about frequent, painful, obstructed passage already conveys the idea of small obstructed stools, the instruction is repeated here to specify the additional combination with pippalī.
Key terms
abhayā
A named substance used in the purgative paste.
pippalī
A named substance added to the purgative combination.
kalka
A paste preparation.
virecana
Therapeutic purgation described in the classical regimen.
Adhikarana 25 (34) · Śloka 34
āmē ca laṅghanaṁ śastamādau pācanamēva vā |34|
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आमे च लङ्घनं शस्तमादौ पाचनमेव वा |३४|
Meaning of the śloka
In āma (undigested) atisāra, langhana (lightening/fasting) is considered best at the outset, or else pācana alone.
The commentary says this verse offers an alternative to the langhana just mentioned. In āmātisāra langhana is to be done if the body can tolerate it and there is no desire for food. In the opposite situation, pācana is to be used first.
Key terms
āma
Undigested, unprocessed state in the context of atisāra.
laṅghana
Lightening measure, here mainly fasting/abstention.
Verses 35-44 list twenty combinations of drugs, each given in a half-verse, described as āma-digesting (āmapācana): for example kaliṅga, ativiṣā, hiṅgu, sauvarcala, vacā, abhayā; devadāru, vacā, mustā, nāgara; dhānyaka, pippalī; bilva, parpaṭaka, śuṇṭhī, prativiṣā; citraka, pippalīmūla, kaṭukarohiṇī, pāṭhā, vatsakabīja, harītakī; mūrvā, trikaṭu, gajapippalī; siddhārthaka, bhadradāru, śatāhvā; elā, sāvaraka, kuṣṭha, the two haridrās, kauṭaja yavas, meṣaśṛṅgī, tvak, kṛmighna, vṛkṣaka; vṛkṣādanī, vīrataru, the two bṛhatīs, the two sahās, araluka bark, taindukī, dāḍimī, śamī; tejovatī, paṭola, dīpyaka, viḍaṅga, śṛṅgavera, saindhava, and others. Verse 46 says these are to be drunk with one of dhānyāmla, warm water or madya, or their well-made decoctions taken lukewarm.
The commentary identifies the drugs: kaliṅga is indrayava; prativiṣā is a kind of ativiṣā (śyāmakanda); mahauṣadha is śuṇṭhī; mūrvā is corasnāyu; nirdahanī is citraka; tryūṣaṇa is trikaṭu; siddhārthaka is white mustard; kaṭurohiṇī is kaṭukā; sāvaraka is rodhra; haridre are the two haridrās; kauṭajā yavā are indrayava; meṣaśṛṅgī is karkaṭaśṛṅgī; kṛmighna is viḍaṅga; vṛkṣaka is kuṭaja; vṛkṣādanī is bandāka; vīrataru is śara; the two bṛhatīs are small-fruited and large-fruited; the two sahās are mudgaparṇī and māṣaparṇī; araluka is a type of śyonāka, though others call śyonāka itself araluka; tvak is to be linked by context with taindukī etc.; tejovatī is kākamardanikā; dīpyaka is yavānī, while others say ajamodā; śṛṅgavera is śuṇṭhī; bilvaśalāṭu is tender bilva; vātsaka phala is indrayava. 'Half-verse formulations' means each formula is made in half a verse. The powder is taken with one of dhānyāmla etc.; or their well-made decoctions are drunk. The commentary adds that older physicians do not favour this, because food/water prepared with many drugs may reduce appetite.
Key terms
āmapācana
Drugs or combinations that digest āma.
śloka-ardha-vihita (ślokārdhavihita)
Formulations each laid down in a half-verse.
dhānyāmla
A sour fermented grain preparation, one of the vehicles named.
A milk decoction of twenty parts of mustā boiled in three times the liquid and reduced to the milk quantity is said to remove āma and śūla. This whole procedure is taught for pacifying āma. Five further formulations are named for a person afflicted by āmātisāra, taken with warm water: harītakī, ativiṣā, hiṅgu, sauvarcala and vacā; paṭola, dīpyaka, bilva, vacā, pippalī and nāgara; mustā, kuṣṭha and viḍaṅga; śṛṅgavera with guḍūcī with hot water; and salts, pippalī, viḍaṅga, harītakī, citraka, śiṃśapā, pāṭhā, śārṅgeṣṭā, salts, hiṅgu and vṛkṣakabīja in equal parts, with hastidantī and pippalī as a paste of akṣa (a fixed unit) measure, vacā and guḍūcī stems, called the best yoga. These five, with warm water, are recommended by the wise. Where āma and pain have subsided but vāta is not settled, or where a person passes stool little by little with pain, a person with weak agni should drink ghṛta with kṣāra and lavaṇa. Ghṛta cooked with milk, nāgara, cāṅgerī, kola and sour curd, or clear ghṛta, may be drunk for śūla-atisāra. Oil-and-ghṛta cooked with curd, with vyoṣa, jātī and citraka, or with bilva, pippalīmūla and dāḍima, is for painful conditions. All this is said to pacify vāta and kapha. In pittaja conditions the physician should avoid tīkṣṇa and uṣṇa items. At the end of fasting, yavāgū as described is recommended, made with balā, aṃśumatī, śvadaṃṣṭrā, bṛhatī and śatāvarī, well cooked, well cooled and mixed with honey.
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saśūlē'tisārē yōgānāha- payasītyādi||47-59||
Meaning of the commentary
The commentary says only that, for atisāra with śūla, these formulations are being described.
Key terms
śūla
Colicky or piercing pain.
mandāgni
Weak digestive fire.
yavāgū
A thin gruel-like preparation given after fasting.
sarpis
Ghee/ghṛta used as a medium.
Adhikarana 29 (60) · Śloka 60
mudgādiṣu ca yūṣāḥ syurdravyairētaiḥ susaṁskr̥tāḥ |60|
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मुद्गादिषु च यूषाः स्युर्द्रव्यैरेतैः सुसंस्कृताः |६०|
Meaning of the śloka
Yūṣas (soups) may also be made with mudga and similar pulses, well prepared with these same drugs.
The commentary introduces yūṣa in the matter of yavāgū. By 'mudga etc.' the ādi word includes the group of forest mudga, kalāya, masūra and the like. 'These drugs' refers to balā and so on. The method of decoction is here as before.
Key terms
yūṣa
Soup prepared from pulses.
mudga
Green gram, first of the pulses named.
balā
One of the drugs named in the preceding verse, here referred to as 'these drugs'.
For āma-digestion in pittaja conditions, mild, appetite-stimulating and bitter drugs are used. The listed combinations are: haridrā, ativiṣā, pāṭhā, vatsakabīja and rasāñjana; rasāñjana, the two haridrās and kuṭaja seeds; pāṭhā, guḍūcī, bhūnimba and kaṭurohiṇī. Decoctions made from these, each given in a half-verse, are pācana for pitta.
The commentary explains that in paittika āmātisāra, āma-digestion should be understood to be done with bitter drugs such as durālabhā, guḍūcī and ativiṣā of that type. The objection is raised that bitters are cool in potency, so how are they pācana in āmātisāra? The reply: in jvara, atisāra and the like, even bitters are accepted as pācana. It is also said 'svedana, laṅghana, time, yavāgū and a bitter rasa are pācana for what is unripe'. Others, however, say that only hot-potency bitter drugs such as arka and agaru are to be used, not others because those are cool. In atisāra, since arka and similar are unsuitable, the verse states just these bitter drugs. Thus decoctions of haridrā and the like, stated in half-verses, are pitta-pācana.
Six formulations are described as destroying pittātisāra: mustā, kuṭaja seeds, bhūnimba and rasāñjana; dārvī, durālabhā, bilva, vālaka and red sandal; sandal, vālaka, mustā, bhūnimba and durālabhā; mṛṇāla, sandal, rodhra, nāgara and blue lotus; pāṭhā, mustā, the two haridrās, pippalī and kauṭaja fruit; and the fruit-rind of vatsaka, śṛṅgavera, ghana and vacā.
The commentary says these are the most effective formulations, given for digesting sāma pitta. Bhūnimba is kirāta; sarasāñjana is with rasāñjana; dārvī is dāruharidrā; bilva is bilva fruit; mṛṇāla is lotus stalk; candana is red sandal; rodha is śāvara; nāgara is śuṇṭhī; ghana is mustā. The words 'by half-verse' are understood. They are said to be the most effective and so are read separately from the earlier twenty. Some explain that in atisāra of vāta-kapha origin, pācana can lead to pitta involvement, hence these are stated to pacify it. Accordingly, before the section on pakvātisāra, treatment of pitta-originating pakvātisāra is given by them.
The commentary says a further most-effective yoga is stated here. Bilva is tender bilva fruit; shakrayavā are indrayava; ambhoda is mustā. The word 'kṛta' (made) in 'ativiṣākṛta' is to exclude cold infusions and similar. This yoga is seen to work even in a long-standing condition that is sāma and with blood.
The commentary identifies madhuka as yaṣṭīmadhu and utpala as blue lotus; abda is mustā and hrībera is vālaka. The decoction made from these, well cooled and with honey, destroys pittātisāra.
Key terms
madhuka
Yaṣṭīmadhu (liquorice), per the commentary.
abda
Mustā, per the commentary.
hrībera
Vālaka.
Adhikarana 34 (68) · Śloka 68
yadā pakvō'pyatīsāraḥ saratyēva muhurmuhuḥ |
grahaṇyā mārdavājjantōstatra saṁstambhanaṁ hitam ||68||
The commentary asks what is to be done when pakvātisāra keeps flowing, and explains that grahaṇī mārdava means agni-stambha (a stagnation/weakness of agni), and saṃstambhana means saṅgrahaṇa (holding).
Key terms
pakvātisāra
Atisāra in which āma has been digested.
grahaṇī
The digestive/retentive organ and function in this context.
saṃstambhana
Astringing or holding measure.
Adhikarana 35 (69-71) · Śloka 71
samaṅgā dhātakīpuṣpaṁ mañjiṣṭhā lōdhramustakam |
śālmalīvēṣṭakō rōdhraṁ vr̥kṣadāḍimayōstvacau ||69||
āmrāsthimadhyaṁ lōdhraṁ ca bilvamadhyaṁ priyaṅgavaḥ |
madhukaṁ śr̥ṅgavēraṁ ca dīrghavr̥ntatvagēva ca ||70||
catvāra ētē yōgāḥ syuḥ pakvātīsāranāśanāḥ |
uktā ya upayōjyāstē sakṣaudrāstaṇḍulāmbunā ||71||
Four formulations that destroy pakvātisāra are: samaṅgā, dhātakī flowers, mañjiṣṭhā, lodhra and mustaka with śālmalī-veṣṭaka; rodhra with the bark of vṛkṣa and dāḍima; mango-stone kernel, lodhra, bilva pulp and priyaṅgu; and madhuka, śṛṅgavera and dīrghavṛnta bark. Those formulas that have been described are to be taken with honey and rice water.
The commentary names these as stambhana formulas. Samaṅgā is lajjālu, though others say varāhakrāntā. Śālmalīveṣṭaka is śālmalī gum, though others say veṣṭaka means the stalk. Vṛkṣa is kuṭaja. Āmrāsthimadhya is the kernel of the mango. Śṛṅgavera is śuṇṭhī; dīrghavṛnta bark is araluka bark, though others say śyonāka bark. There are four formulas each in a half-verse. Others take a verse 'samaṅgā dhātakīpuṣpa...' as making a fifth yoga with śālmalīveṣṭaka alone and read 'these five yogas destroy pakvātisāra'. All are pakvātisāra-destroying, but others explain them as pittātisāra-destroying. How to use them: they are taken with honey and rice water.
The commentary asks why 'one decoction alone' is said when honey and water are also present, and answers that they are only a preparation and not primary. This yoga is to be understood specially for pakva pittaraktātisāra; some consider it for ordinary pakvātisāra, and cite 'to one with pakvātisāra a decoction of mustā with honey should be given'. The groups beginning with rodhra, ambaṣṭhā and priyaṅgu are to be made into decoctions and used with honey added.
Key terms
maustaṃ kaṣāyam
Decoction of mustā.
pittaraktātisāra
Atisāra with pitta and blood.
gaṇa
A named group of drugs.
Adhikarana 37 (73) · Śloka 73
padmāṁ samaṅgāṁ madhukaṁ bilvajambūśalāṭu ca |
pibēttaṇḍulatōyēna sakṣaudramagadaṅkaram ||73||
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पद्मां समङ्गां मधुकं बिल्वजम्बूशलाटु च |
पिबेत्तण्डुलतोयेन सक्षौद्रमगदङ्करम् ||७३||
Meaning of the śloka
Padmā, samaṅgā, madhuka, and the tender fruit of bilva and jambū, taken with rice water and honey, is an agadaṅkara (a remover of the disorder).
The commentary identifies padmā as bhārgī and samaṅgā as lajjālu. Bilva-jambū-śalāṭu means tender bilva fruit and tender jambū fruit. Agadaṅkara here means that which removes atisāra.
A paste of the root of kacchurā, of the size of an udumbara fruit, or payasyā, candana, padmā, sitā, mustā and lotus filament, when drunk, overcomes pakvātisāra with blood.
The commentary says kacchurā is kaṅkatikā, and its root paste of udumbara-fruit size (one karṣa) is taken with honey and rice water. Payasyā is arkapuṣpī, though others say dugdhikā and still others kṣīrakākolī. Candana is red sandal, padmā is bhārgī, sitā is sugar, and abjakesara is lotus filament. 'With blood' (saśoṇita) refers to pittātisāra only, not raktātisāra, since that treatment is to be described later. Others read 'pittātisāra' for 'pakvātisāra'. 'Drunk' means by the method of a boiled decoction.
Key terms
kacchurā
Kaṅkatikā, per the commentary.
payasyā
Arkapuṣpī, or dugdhikā or kṣīrakākolī according to others.
For a person who is free of āma, afflicted by pain, emaciated by fasting and similar measures, and dry, after observing the agni, ghṛta with kṣāra may be given to drink.
The commentary says this describes the atisāra patient suitable for ghṛta. Since 'free of āma' has already been implied in the context of pakvātisāra, repeating it is to emphasise that freedom from āma has been reached. 'After observing agni' means 'when kindled'. 'With kṣāra' means with yavakṣāra, or with svarjikākṣāra according to others. Others say that from 'nirāmarūpa' onward the description is of vāta treatment, because pain would not otherwise arise.
Key terms
nirāmarūpa
Free of āma.
kṣāra
Alkali preparation; identified as yava-kṣāra or svarjikā-kṣāra.
Ghṛta processed with balā, bṛhatī, aṃśumatī and the root of kacchurā, lightly moistened with honey and with madhuka, may be drunk by one troubled by pain.
The commentary carries 'ghṛta' forward from the previous verse. 'Madhūkṣita' means having only a little honey; 'samadhuka' means with yaṣṭīmadhu, and since yaṣṭīmadhu is shown as an addition in a formula to be stated later, its addition is understood here too. 'Afflicted by śūla' means suffering from pain.
Ghṛta processed with dārvī, bilva, kaṇā, drākṣā, kaṭuka and indrayava destroys atisāra of vāta, pitta and kapha nature. Ghṛta well cooked with sour curd, with vyoṣa, ajājī and citraka, or with cavya, pippalīmūla and dāḍima, is for one troubled by pain.
The commentary identifies dārvī as dāruharidrā and kaṇā as pippalī. It says atisāra 'of vāta, pitta and kapha nature' means arising from the doṣas individually or together.
Key terms
dārvī
Dāruharidrā.
kaṇā
Pippalī.
vyoṣa
The three pungent drugs: śuṇṭhī, pippalī, marica.
Adhikarana 42 (79) · Śloka 80
payō ghr̥taṁ ca madhu ca pibēcchūlairabhidrutaḥ ||79||
sitājamōdakaṭvaṅgamadhukairavacūrṇitam |80|
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पयो घृतं च मधु च पिबेच्छूलैरभिद्रुतः ||७९||
सिताजमोदकट्वङ्गमधुकैरवचूर्णितम् |८०|
Meaning of the śloka
One troubled by pain may drink milk, ghṛta and honey, mixed with powder of sitā, ajamodā, kaṭvaṅga and madhuka.
The commentary says milk, ghṛta and honey are taken in equal parts, blended with powders of sugar, ajamodā, araluka and yaṣṭīmadhu, and drunk by one afflicted with pain.
A lump of the bark of dīrghavṛnta with lotus filament, wrapped in kāśmarī and lotus leaves, tied with thread, coated with clay, is placed in embers; once cooked, it is removed, pressed, and the juice taken, cooled with honey added, is given for udarāmaya (here, diarrhoeal disorder). The same method may be applied to jīvantī, meṣaśṛṅgī and similar substances.
The commentary explains the puṭapāka method. Dīrghavṛnta is araluka; 'avakūlayet' means to cook. Udarāmaya here means atisāra. Equal parts of araluka bark and lotus filament are ground, wrapped in lotus and kāśmarī leaves, tied and clay-coated, then cooked in smokeless khadira embers until the outside becomes red, after which the juice is taken and cooled with honey of one karṣa, in the quantity of a decoction. All puṭapāka preparations follow this method. Some explain 'sukṛta' as 'wrapped in kuśa', and in their view the words 'tied with thread' are not in the text. Jīvantī in the north is a big-rooted plant with leaves like karkoṭikā, while in the Lāṭa country it is mūlinī. 'Etc.' includes pāṭhā and śaṭī. Others read 'jīvantīmeṣaśṛṅgeṣu caivaṃ vṛnteṣu kārayet'.
A tittiri (partridge), plucked and with its innards properly removed, is filled with pastes of the bark of nyagrodha and similar trees and cooked as before. The juice of that well-cooked bird, with honey and sugar and cooled, is given for udarāmaya.
The commentary explains that the bird is the black partridge; 'innards removed' is illustrative, so it is also taken to mean without feet and beak. 'As before' means the belly is filled with nyagrodha-group bark paste, put into a kāśmarī and lotus leaf wrapping, bound with kuśa, clay-coated and cooked in khadira embers, with the amounts of juice, honey and sugar as before. Śrī Brahmadeva explains that 'nyagrodha etc.' takes palāśa, nandīvṛkṣa and similar, which are sangrāhaka, not the entire nyagrodha group, which is stambhaka; he cites a passage distinguishing sangrāhi from stambhana. This procedure is for vāta-pitta atisāra.
Key terms
tittiri
Partridge; the commentary specifies the black partridge.
Lodhra, candana, yaṣṭyāhva, dārvī, pāṭhā and blue lotus, ground with rice water and with dīrghavṛnta bark, are cooked in the earlier manner. The cooled juice from that, with honey, is given in kapha-pitta udarāmaya.
The commentary explains that lodhra through blue lotus, with araluka bark, ground with rice water, are wrapped and cooked by the puṭapāka method as before. The juice from the ground and cooked paste is taken, cooled, and given with honey.
In the same way, puṭapākas may be made with the aerial roots (prarohas) of vaṭa and similar trees, according to the prescribed manner and as suits the case, together with jāṅgala meat, and are described as beneficial.
The commentary says 'in the same way' means as described before. Prarohas of vaṭa are the roots that come down from the branches; 'etc.' includes those of plakṣa, gardabhāṇḍa and others. 'According to the manner' means according to the condition (of the patient). By jāṅgala here are meant lāvaka, kapiñjala and similar, because of their lightness. The puṭapāka of jāṅgala meat with the descending roots of vaṭa etc. is made as before.
Key terms
praroha
Aerial root or descending shoot.
jāṅgala
Meat of animals/birds of dry land; here lāvaka, kapiñjala etc. per the commentary.
A kauṭaja (kuṭaja) phāṇita (thickened preparation), mixed with ambaṣṭhā etc., honey and pippalī etc., by its own potency destroys atisāra that has much kapha, with blood, little vāta and long standing.
The commentary explains that phāṇita means like phāṇita, thick and honey-like. Ojasā means by its power or its own effect. For the preparation: bark of male-named kuṭaja with large fruits, white flowers and smooth leaves is boiled in sixteen, eight or four times water, reduced to half, cloth-strained, and cooked again until it becomes like cooked phāṇita; then one-fourth of powder of ambaṣṭhā etc., honey and pippalī etc. is added and it is taken off the fire. Others say to take the juice of kuṭaja bark and boil it until phāṇita-like.
The commentary says bilva means tender bilva fruit, utpala is blue lotus, sanāgara means with śuṇṭhī, and udarāmayī means one with atisāra. The decoction method for the peyā is as before.
A liquid yavāgū prepared by adding araluka bark, priyaṅgu, madhuka and pomegranate sprouts, ground, into curd, undoubtedly destroys all kinds of pakva atisāra.
The commentary says dāḍimāṅkura means tender pomegranate leaves. The ground araluka bark and the others are placed in curd to prepare the yavāgū. The word 'ground' is used to forbid preparing the yavāgū with a decoction of araluka bark etc. 'Liquid' means not too thick. Because the context is already pakvātisāra, the repeated word 'pakva' indicates that this yavāgū is especially beneficial there.
Rasāñjana with ativiṣā; bark and seeds of kauṭaja; and dhātakī with nāgara, drunk with rice water and honey, destroy raktaja (blood-related) atisāra with pain.
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rasāñjanamityādi| ētē yōgāḥ| saśūlaṁ raktajaṁ ‘atīsāraṁ’ iti śēṣaḥ| anyē tu ‘hanti yōgō'yaṁ madhusaṁyutaḥ’ iti paṭhitvā ēka ēva yōgō'yamiti manyantē||93-94||
Meaning of the commentary
The commentary says these are the yogas, and that 'atisāra' is supplied. Others read 'hanti yogo'yam madhusaṃyutaḥ' and consider it a single yoga.
Key terms
rasāñjana
An extract prepared from certain plants, used as a drug.
raktaja
Blood-related in origin.
dhātakī
A flower drug.
Adhikarana 52 (95) · Śloka 96
madhukaṁ bilvapēśī ca śarkarāmadhusaṁyutā |
atīsāraṁ nihanyuśca śāliṣaṣṭikayōḥ kaṇāḥ ||95||
tadvallīḍhaṁ madhuyutaṁ badarīmūlamēva tu |96|
Madhuka, bilva pulp with sugar and honey, and the fine particles of śāli and ṣaṣṭika rice, may remove atisāra. In the same way, badarī root licked with honey.
The commentary says 'with sugar and honey' is to be taken here also for the particles of śāli and ṣaṣṭika. It adds that some read another yoga before 'madhukaṃ bilvapeśī ca', quoting: 'One should drink other saṅgrāhika yogas with honey and sugar, and make puṭapākas in nyagrodha and similar as described.'
The commentary identifies arjuna as kakubha, and says the barks of badarī and the others, drunk with sugar and honey, destroy udarāmaya, meaning atisāra.
The commentary says 'these' means badarī and the others. Ṣaḍa are preparations with pomegranate, cow's juices etc., made with dense sprouts or fruits. It notes that the section from 'rasāñjanaṃ sātiviṣam' to 'dravyeṣv eteṣu buddhimān' concerning raktātisāra treatment is not read by Kārttikācārya, because he does not accept raktātisāra as a separate category; the raktātisāra that arises in the pittātisāra stage has treatment stated later, beginning 'pittātisārī yo martya'. Śrī Jejjaṭācārya read this whole text with discussion, and Brahmadeva follows his view.
Key terms
ṣaḍa (ṣāḍava)
Sweet-sour type preparation with pomegranate etc., per the commentary.
The commentary says 'kaṣāya called hima' means śītakaṣāya (cold infusion), not boiled, because of the word hima. As the method, it says the powdered drug is kept in equal water for a day and night, then crushed, cloth-strained, and honey of four palas and yaṣṭīmadhu of one karṣa are added and it is drunk.
विबद्धवातविट् शूलपरीतः सप्रवाहिकः ||९९||
सरक्तपित्तश्च पयः पिबेत्तृष्णासमन्वितः |
यथाऽमृतं तथा क्षीरमतीसारेषु पूजितम् ||१००||
चिरोत्थितेषु तत् पेयमपां भागैस्त्रिभिः शृतम् |
दोषशेषं हरेत्तद्धि तस्मात्पथ्यतमं स्मृतम् ||१०१||
हितः स्नेहविरेको वा बस्तयः पिच्छिलाश्च ये |
पिच्छिलस्वरसे सिद्धं हितं च घृतमुच्यते ||१०२||
Meaning of the śloka
A person with obstructed vāta and stool, pain, straining (pravāhikā), and raktapitta with thirst may drink milk. As amṛta is, so milk is valued in atisāra. In long-standing cases it should be drunk boiled with three parts of water; it removes the residual doṣa and is regarded as most wholesome. Snehavirecana, or bastis, including picchila ones, are beneficial; ghṛta cooked in picchila juices is said to be beneficial.
After giving powders etc., the commentary says the field of milk is four conditions: obstructed vāta and stool, pain, pravāhikā, and raktapitta. Milk is to be prepared only with water in the proportion given (three parts). Its doṣa-residue-removing ability is due to its potency. Snehavirecana here means either a sneha processed with purgative substances, or a sneha which purges by its own nature. The bastis are those described in the basti disorders and to be described. Picchilas are araluka, śālmalī and similar; ghṛta cooked in their juices is beneficial in basti.
One who passes blood mixed with stool, either before or after stool, with pain and with cutting pain (parikartikā), may drink ghṛta cooked with kṣīriśuṅgā, with honey and sugar.
The commentary says this treatment depends on the condition. Saruk means with pain; saparikartika means with a cutting-like vāta pain in the bladder, anus and penis. Kṣīriśuṅga means new leaf shoots of vaṭa, aśvattha and similar. The proportion for cooking the ghṛta is as in the Snehādhyāya; honey and sugar are added each of one karṣa.
Key terms
parikartikā
Cutting-like pain, vāta type.
kṣīriśuṅga
New sprouts of milky trees like vaṭa and aśvattha.
Ghṛta cooked with dārvī bark, pippalī, śuṇṭhī, lākṣā and indrayava, together with bhadrarohiṇī and mixed with peyā, when drunk, destroys even tridoṣaja atisāra of terrible kind.
The commentary says this is another ghṛta for that same condition. Dārvītvak is the bark of dāruharidrā; others read dārvī as dāruharidrā and tvak as bark. Bhadrarohiṇī is kaṭukā. Ghṛta cooked with one-fourth of these drugs and four times water, and taken with peyā or yavāgū, destroys tridoṣaja atisāra.
The commentary says that after stating vamana in the earlier āma stage, vamana is now stated in the pakva stage as well. Gaurava means heaviness of the abdomen. Just as vamana is used in raktapitta going downward, so in atisāra with heaviness etc., in a person with strong kapha and stool obstruction from vāta, vamana is suitable. The objection: how can vamana destroy atisāra? The reply: by the depletion of liquid kapha, or by the power of treating in the opposite direction.
सम्पक्वे बहुदोषे च विबन्धे मूत्रशोधनैः |
कार्यमास्थापनं क्षिप्रं तथा चैवानुवासनम् ||१०७||
Meaning of the śloka
When the atisāra is well ripened, with much doṣa, and there is obstruction, after using diuretic cleansers (mūtraśodhana) one should quickly do āsthāpana, and likewise anuvāsana.
The commentary says this concerns āsthāpana and anuvāsana. 'In the well-ripened' is completed by 'atisāra'. Vibandha is non-passage of downward vāta and the like. Mūtraśodhanas are things like tṛṇapañcamūla, pāṣāṇabheda and gokṣura. Āsthāpana means nirūha.
In straining (pravāhaṇa), prolapse of the anus (gudabhraṃśa), retention of urine (mūtrāghāta) and stiffness of the waist (kaṭigraha), an anuvāsana with oil or ghṛta cooked with sweet and sour substances is described.
The commentary says this states another field for anuvāsana. Gudabhraṃśa means the anus coming out. Sweet substances are kākolī and similar; sour substances are bījapūraka, kapittha, cukrikā, vṛkṣāmla, kāñjika and similar.
If a person who eats unwholesome things develops gudapāka (inflammation/ulceration of the anus) from pitta, pitta-relieving sekas (pourings) and anuvāsanas prepared with those drugs are for him.
The commentary says 'ahitāśin' means one who eats unsuitable food. In gudapāka, sekas are made with milk, sugarcane juice, sugar water and decoctions of sweet drugs; anuvāsana oils are cooked with pitta-relieving drugs. Although gudapāka is by pitta alone, the verse's 'from pitta' is said to separate it from the gudapāka in the line 'one whose anus is ripe and heat has gone, abandon the atisāra patient', and to indicate treatment for gudapāka produced by aggravated pitta from unsuitable eating.
Key terms
gudapāka
Inflammation or suppuration of the anal region.
seka
Pouring/irrigation.
ahitāśin
One who eats unsuitable food.
Adhikarana 63 (110) · Śloka 110
dadhimaṇḍasurābilvasiddhaṁ tailaṁ samārutē |
bhōjanē ca hitaṁ kṣīraṁ kacchurāmūlasādhitam ||110||
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दधिमण्डसुराबिल्वसिद्धं तैलं समारुते |
भोजने च हितं क्षीरं कच्छुरामूलसाधितम् ||११०||
Meaning of the śloka
Oil cooked with dadhimaṇḍa, surā and bilva is for vāta-affected (atisāra), and milk cooked with kacchurā root is beneficial with meals.
The commentary says this states the field of oil anuvāsana. Dadhimaṇḍa is whey of curd. Oil cooked with dadhimaṇḍa etc. is to be given as anuvāsana. 'Samāruta' is completed by 'in atisāra'. Kacchurā is kaṅkatikā, some say śūkaśimbā, others durālabhā.
The commentary explains that the person who is repeatedly purged with pain is the subject, and picchābasti is made with picchila (mucilaginous) substances; it is described in the nirūha sequence beginning 'badaryairāvatīśelu śālmalī' (Cikitsā 38). Jejjaṭācārya holds that a paste of drugs such as 'kapittha, śālmalī, phañjī' taught later in this chapter is steamed by puṭapāka, pressed for juice, and picchābasti is given with that juice and milk; or the paste of kapittha etc. is mixed with milk and given as picchābasti.
In those who have had atisāra for a long time, weakness of the anus generally occurs; therefore application of oil into the anus is beneficial for them.
The commentary says this gives treatment for gudadaurbalya in long-standing atisāra. Tailāvacāraṇa is done by picu (cotton swab) application, seka and anuvāsana. If there is burning along with the weakness, ghṛta should be applied again.
The commentary says this gives treatment for pain in atisāra. Phañjī is a kind of pāṭhā, though others say bhārgī. Kacchurā is kaṅkatikā, others say durālabhā. Śelu is ślesmātaka. 'Dādhikā' means prepared with curd. The word 'beneficial' from the next verse is connected here, in plural sense: kapittha through cuccū, when prepared with curd, are beneficial.
Śālaparṇī, pṛśniparṇī, bṛhatī, kaṇṭakārikā, balā, śvadaṃṣṭrā, bilva, pāṭhā, nāgara and dhānyaka: this, in preparation of foods, is beneficial for all those with atisāra.
The commentary says these are drugs used in peyā and similar. 'In combination with food' means in preparation of peyā etc. The preparation, it explains, is that four palas of these drugs are cooked in an āḍhaka of water and, with the half-reduced liquid, peyā etc. is made. Older physicians, since food prepared with much drug-water is unappealing, cook only one pala of drug in an āḍhaka of water. The liquid ratio for cooked rice etc. is known from another tantra: rice with five parts water, yavāgū with six, peyā with fourteen, vilepī with four. This group is known as daśāṅga.
पित्तातिसारी यो मर्त्यः पित्तलान्यतिषेवते |
पित्तं प्रदुष्टं तस्याशु रक्तातीसारमावहेत् ||११६||
ज्वरं शूलं तृषां दाहं गुदपाकं च दारुणम् |११७|
Meaning of the śloka
A man with pittātisāra who indulges in pitta-aggravating things has his aggravated pitta quickly bring on raktātisāra, fever, pain, thirst, burning and severe gudapāka.
The commentary says a particular stage of pittātisāra itself, raktātisāra, is now stated. 'Pittala' things are foods and drinks that aggravate pitta. 'Dāruṇa' means difficult to cure (kaṣṭasādhya).
One who passes blood either before or after stool should drink milk cooked with the sprouts of vaṭa and similar trees together with ghṛta, with sugar and honey; or having churned it, should lick the butter and afterwards drink buttermilk.
The commentary says this gives treatment for another stage of pittātisāra. Vaṭādi means nyagrodha and similar; it gives half a pala of the sprouts, four palas of milk and four times the water, cooked and reduced to the milk quantity, with one karṣa of ghṛta added, to be drunk with moderate agni. 'Abhimathya' means having churned. The butter from that milk is licked with sugar and honey. Others hold that the milk cooked with vaṭa sprouts is drunk with honey, ghṛta and sugar, and that butter alone is licked and then buttermilk drunk.
The commentary says the barks of priyāla and the others are to be drunk each separately or all together. Priyāla is cāra, plakṣa is parkaṭī, tiniśa is syandana. 'Milk' here means goat's milk, based on another tantra. 'Vimṛditāḥ' means stirred, and 'sakṣaudra' means with honey.
The commentary says padmaka is well known, kumuda is the white one, utpala the blue one, and padmā is bhārgī. Mañjiṣṭhā and the others, made into a paste or powder, are drunk with goat's milk.
शर्करोत्पललोध्राणि समङ्गा मधुकं तिलाः ||१२२||
तिलाः कृष्णाः सयष्ट्याह्वाः समङ्गा चोत्पलानि च |
तिला मोचरसो लोध्रं तथैव मधुकोत्पलम् ||१२३||
कच्छुरा तिलकल्कश्च योगाश्चत्वार एव च |
आजेन पयसा पेयाः सरक्ते मधुसंयुताः ||१२४||
Meaning of the śloka
Four half-verse yogas are to be drunk with goat's milk and honey when stool is bloody: sugar, utpala, lodhra and samaṅgā; madhuka and sesame; black sesame with yaṣṭyāhva, samaṅgā and utpala; sesame, mocarasa, lodhra, madhuka and utpala; kacchurā and a paste of sesame.
The commentary says samaṅgā is varāhakrāntā; black sesame means kṛṣṇatila; sayaṣṭyāhva means with yaṣṭīmadhu; mocarasa is śālmalī gum; kacchurā is kaṅkatikā. 'When it flows' is supplied for 'in blood-mixed stool'. The four yogas are each in a half-verse, taken with honey in blood-mixed stool with goat's milk.
Key terms
mocarasa
Gum of śālmalī.
samaṅgā
Varāhakrāntā here, per the commentary.
sarakta
With blood.
Adhikarana 75 (125) · Śloka 125
dravē saraktē sravati bālabilvaṁ saphāṇitam |
sakṣaudratailaṁ prāgēva lihyādāśu hitaṁ hi tat ||125||
In a liquid stool with blood that keeps flowing, tender bilva with phāṇita, with honey and oil, may be licked even before food, since that is beneficial quickly.
The commentary says, having given treatment for atisāra with blood that is not liquid, the treatment for blood-with-liquid atisāra is now given. Drava means liquid stool, though others read 'udakadhātu'. Phāṇita is kākavī. Sakṣaudra-taila means with honey and oil. 'Prāg eva' means before food. Others read 'hitakaram' for 'hitam'.
Key terms
bālabilva
Tender bilva fruit.
phāṇita
Kākavī, a thickened sweet preparation, per the commentary.
The commentary says kośakāra is a kind of sugarcane. For the method, the peeled fine pieces of kośakāra are fried in ghṛta, ground, mixed with powder of parched rice and sugar, and licked with honey; it destroys atisāra with pain arising from raktapitta.
Key terms
kośakāra
A kind of sugarcane per the commentary.
lājā (lāja)
Parched rice.
raktapitta
A classical condition of bleeding involving pitta.
Bilva pulp with madhuka, sugar and honey, with rice water, overcomes atisāra arising from pitta and blood.
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bilvamadhyamityādi| avasthāvaśēna pittādraktādvā utthitaṁ, na tu raktapittābhyāmēvōtthitaṁ, ēvaṁ satyatīsārāṇāṁ saptatvaṁ syāt||127||
Meaning of the commentary
The commentary says the atisāra arises according to the condition either from pitta or from blood, not from raktapitta both together; otherwise the atisāras would number seven.
Key terms
bilvamadhya
Bilva pulp.
pittaraktotthita
Arising from pitta or from blood, as read by the commentary.
The commentary says that although 'sāṅgrāhika' is stated generally, those stated for pittātisāra are to be understood, as they are suitable. It raises the objection that puṭapākas in nyagrodha etc. have already been shown, so why restate; and replies that by connecting 'nyagrodhādiṣu kuryāt' with 'yatheritān', the meaning is 'make the puṭapākas as described'.
Key terms
sāṅgrāhika
Binding, holding stool.
puṭapāka
Sealed roasting preparation.
Adhikarana 79 (129) · Śloka 129
gudapākē ca yē uktāstē'trāpi vidhayaḥ smr̥tāḥ |129|
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गुदपाके च ये उक्तास्तेऽत्रापि विधयः स्मृताः |१२९|
Meaning of the śloka
The measures stated for gudapāka are considered applicable here as well.
A person with kindled agni who passes atisāra with obstructed stool and abundant doṣa should be purged with a decoction of viḍaṅga, triphalā and kṛṣṇā, or with milk cooked with eraṇḍa alone. Yavāgūs made with vāta-relieving, appetite-kindling drugs should be given to him afterwards.
The commentary says this is virecana in atisāra according to condition. Saktaviṭ is obstructed stool. 'Doṣa' here means stool, so 'abundant doṣa' means abundant stool. One should purge with decoction of viḍaṅga etc., or with milk cooked with eraṇḍa root. After the purge, yavāgūs with vāta-relieving, appetite-kindling drugs such as śāliparṇī are given. The objection: virecana was stated for scanty, incompletely passing stool; how can it be used where there is excessive flow? The reply: aggravated pitta causing the excess flow is removed by the purgation, so there is no fault.
The commentary says this gives the sign and treatment of a further stage of atisāra called niḥsāraka. Niṣpurīṣa means with depleted stool; phenila means frothy stool. Phāṇita is kākavī, taila is sesame oil, and the substances from phāṇita to ghṛta are combined and drunk together.
Key terms
niṣpurīṣa
With depleted stool.
phenila
Frothy.
niḥsāraka
The name given by the commentary to this stage.
Adhikarana 83 (133) · Śloka 133
svinnāni guḍatailābhyāṁ bhakṣayēdbadarāṇi ca |133|
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स्विन्नानि गुडतैलाभ्यां भक्षयेद्बदराणि च |१३३|
Meaning of the śloka
Steamed badara fruits, with jaggery and oil, may also be eaten.
The commentary says this is the third yoga, with 'badarāṇi' supplied. Piṣṭavat means by the method of steaming a ground mass. Bilvaśalāṭu means tender bilva fruits. Thus the badaras steamed by the ground-mass steaming method with tender bilva, when cooled, are to be eaten with jaggery and oil. Others read 'suṣvinnān piṣṭavad vāpi māṣān bilvaśalāṭubhiḥ', where māṣa is prescribed to produce stool in one whose stool is depleted.
The commentary says this is the fourth yoga. Kulmāṣa are barley-based preparations steamed on the surface (āstara-svinna). White surā means the flour-based (paiṣṭī) surā. The meaning is that kulmāṣa are eaten with curd and paiṣṭī surā is drunk.
Key terms
kulmāṣa
A steamed barley-based preparation per the commentary.
The commentary says this is the fifth yoga. Samaṅgā is lajjālu; a paste mixed with curd is eaten with rabbit blood when stool is depleted. Others read 'samāṃśaṃ' instead of 'samaṅgāṃ', explaining that rabbit meat and blood are made equal in part and cooked with ghṛta and curd and eaten. 'Mṛdvanna' here means processed foods like māṣa that produce stool. 'Śakṛtaḥ kṣaya' is depletion of stool.
The commentary says this gives soup in depletion of stool. Yamaka means ghṛta and oil; rasa here means decoction. A yūṣa of māṣa etc., prepared with ghṛta and oil and cooked with curd and pomegranate, is given as food to one with depleted stool.
The commentary says another yoga for one with depleted stool is being given. Viḍa is a type of salt; curd cream (sara) is the upper part of the curd; yamaka is ghṛta and oil.
Key terms
viḍa
A kind of salt (viḍalavaṇa).
dadhisara
Cream of curd.
Adhikarana 89 (137) · Śloka 137
saśūlaṁ kṣīṇavarcā yō dīptāgniratisāryatē |
sa pibēddīpanairyuktaṁ sarpiḥ saṅgrāhakaiḥ saha ||137||
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सशूलं क्षीणवर्चा यो दीप्ताग्निरतिसार्यते |
स पिबेद्दीपनैर्युक्तं सर्पिः सङ्ग्राहकैः सह ||१३७||
Meaning of the śloka
A person with kindled agni, depleted stool and pain who has atisāra should drink ghṛta together with appetite-kindling and binding drugs.
The commentary says this is the eighth yoga suitable to a particular condition. Dīpana drugs are citraka and similar; saṅgrāhaka drugs are dhātakī, bilvaśalāṭu and similar. One with depleted stool and kindled agni should drink the raw (unheated) ghṛta with the powders of citraka etc. and dhātakī etc.
Aggravated vāta pushes downward the accumulated balāsa (kapha) in a person who eats unwholesome food, and he strains again and again, passing a little stool-tinged material; those who know it call this pravāhikā.
The commentary says the type of atisāra called pravāhikā is now described. Nicita means accumulated; balāsa is kapha; 'downward' means through the anal passage. The person straining repeatedly passes kapha mixed slightly with stool. So the disease in which a person, driven by vāta, expels kapha is pravāhikā. Balāsa is illustrative, so accumulated pitta or blood should also be understood.
Key terms
pravāhikā
Atisāra type marked by repeated straining and small passages.
Pravāhikā caused by vāta comes with pain; from pitta with burning; from kapha with kapha; from blood with blood. These are considered to arise from oil-related or dry causes. Their signs, treatment sequence, and āma and vipakva states are to be told as in atisāra.
The commentary says 'sneha-rūkṣa-prabhava' means arising from oily or dry causes, and that this is generally so. Although signs of pravāhikā by doṣa have already been given, the statement 'signs as in atisāra' is to show additional signs. 'Krama' means order of treatment; 'āma-vipakvatā' means the stage of āma and of ripeness.
न शान्तिमायाति विलङ्घनैर्या योगैरुदीर्णा यदि पाचनैर्वा ||१४०||
तां क्षीरमेवाशु शृतं निहन्ति तैलं तिलाः पिच्छिलबस्तयश्च |१४१|
Meaning of the śloka
If a strongly risen pravāhikā does not settle with fasting or with pācana yogas, then boiled milk, oil, sesame and picchila bastis quickly destroy it.
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laṅghanādyupakramairyā pravāhikā na praśāmyati tāṁ kathaṁ cikitsēdityāha- na śāntimityādi| udīrṇā utkaṭā yā pravāhikā laṅghanaiḥ pācanayōgairvā śāntiṁ na yāti tāṁ kṣīrādikaṁ hantīti sambandhaḥ||140||-
Meaning of the commentary
The commentary explains how to treat pravāhikā that has not subsided with laṅghana and similar measures: udīrṇa means intense; milk and the others destroy such pravāhikā if it does not subside with fasting or with pācana yogas.
The ripe stalks of śālmalī, wrapped in fresh kuśa, are well cooked by puṭapāka, pounded, and their juice taken. Milk boiled and mixed with oil and ghṛta, or with a paste of madhuka, is used; the attentive physician should give a basti where pravāhikā is accompanied by retention of urine and stool.
The commentary says this describes picchābasti; its quantity should be known from the method given in the nirūha section (Cikitsā 38). 'Apramatta' means attentive.
In one straining with pain, an āsthāpana with milk cooked with the two pañcamūlas (daśamūla) and honey is said to be the best. The verse continues in the next entry.
The commentary says this gives the instruction of āsthāpana in a specific condition. Dvipañcamūlī is daśamūla; āsthāpana is nirūha; agrya means best. It is said that āsthāpana with milk cooked by the milk-cooking method with daśamūla and honey is best where there is pain with straining.
Key terms
dvipañcamūlī
Daśamūla, the ten-root group.
āsthāpana
Nirūha basti.
agrya
Best.
Adhikarana 95 (144) · Śloka 144
...tailēna yuñjyādanuvāsanaṁ ca |144|
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...तैलेन युञ्ज्यादनुवासनं च |१४४|
Meaning of the śloka
The remaining portion of the verse: an anuvāsana with oil is to be applied.
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anuvāsanamāha- tailēnētyādi| dvipañcamūlīsādhitakṣīrasiddhēna tailēnānuvāsanaṁ yuñjyādityarthaḥ; na punarapakvatailēna, tasya vyāpatkaratvāt|144|-
Meaning of the commentary
The commentary says anuvāsana should be given with oil cooked in milk that was cooked with daśamūla, and not with uncooked oil, because that would cause complication.
Key terms
anuvāsana
Oil enema.
apakvataila
Uncooked oil.
Adhikarana 96 (144) · Śloka 144
vātaghnavargē lavaṇēṣu caiva tailaṁ ca siddhaṁ hitamannapānē ||144||
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वातघ्नवर्गे लवणेषु चैव तैलं च सिद्धं हितमन्नपाने ||१४४||
Meaning of the śloka
Oil cooked with the vāta-relieving group and with salts is beneficial in food and drink.
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annasaṁskārārthaṁ pānārthaṁ ca tailamāha- vātaghnavargē ityādi| vātaghnavargē vidārigandhādau, lavaṇēṣu saindhavasauvarcalādiṣu; atra vidārigandhādikvāthēna saindhavādyāvāpēna siddhaṁ tailamannasaṁskārē pānē ca hitamityarthaḥ| anyē tu ‘lavaṇēṣu ca’ ityatra ‘madhurēṣu’ iti paṭhanti, ēvamanyatra dr̥ṣṭatvāt||144||
Meaning of the commentary
The commentary says oil is stated for preparing foods and drinks. The vātaghna group is vidārigandhā and similar; the salts are saindhava, sauvarcala and similar. Oil cooked with a decoction of vidārigandhā etc. and with added saindhava etc. is beneficial for processing food and drink. Others read 'madhureṣu' (sweet drugs) for 'lavaṇeṣu', because it is seen elsewhere.
Key terms
vātaghnavarga
The group of vāta-relieving drugs, vidārigandhādi.
The commentary says this gives a lehya (lick) formula. 'Kaṭutrikāḍhya' means with the trikaṭu predominating, that is, the well-marked trikaṭu (three pungents).
One troubled by niścāraka should eat with curd cream and honey. Or drink milk boiled with a well-heated kupya (metal) and cooled, mixed with honey. One with pain may be fed with milk cooked with vyoṣa and vidārigandhā-group drugs. Ṣaḍa preparations made with vāta-relieving, binding and appetite-kindling drugs may be given; he may eat fish and take meat juice cooked with vāta-relieving drugs, with ghṛta and oil. Meats of eṇa, avi and aja may be eaten cooked with vaṭa sprouts. Or the blood of a medhya goat, with curd and ghṛta and oil; or with pradehas of peacock or cock. Yūṣas and curd, or well-cooked māṣa with ghṛtamaṇḍa and pepper, with curd, may be eaten.
The commentary says this describes food after the lick. Sasāra curd is curd with its upper creamy part. Niścāraka is a type of pravāhikā, also called depletion of stool; others say niścāraka refers to both atisāra and pravāhikā so the formulas serve both. The commentary explains why this is restated even though 'signs as in atisāra' covers it: to show these formulas are especially beneficial in pravāhikā. Kupya milk: boiled with well-heated gold, silver or other metal; others say kupya is unworked silver etc.; some read 'kūrpa', a stone type in the south shaped like a conch top, used in rasāyana practice. Vyoṣa is trikaṭu; the vidārigandhādi group is understood. Vāta-relieving drugs are śālaparṇī etc., or bhadradāru etc. per others; binding are bilva, pāṭhā, cāṅgerī; appetite-kindling are citraka, śuṇṭhī. Ṣaḍa are pomegranate-containing thick milk preparations. Fish are binding types like rohita, śakula. 'Āpnuyāt' means 'may drink'. Eṇa is the black antelope, avi sheep, ajā she-goat. Medhya means fit for sacrifice; some read 'medhyaṃ ca' as qualifying blood. Pradeha means thickened juice; śikhī is peacock, or cock per others; some read 'pralepaiḥ'. Yūṣa is of māṣa etc.; ghṛtamaṇḍa is the upper part of solid ghṛta.
Key terms
niścāraka
A form of pravāhikā with depleted stool; per others, atisāra and pravāhikā both.
kupya
Metal used to heat milk; variously read as unworked silver etc. or as kūrpa (a stone).
ṣaḍa (ṣāḍava)
Dense pomegranate-based preparation per the commentary.
In severe pain and difficult urination, the physician should give a basti mixed with milk, honey and ghṛta and cooked with madhuka and utpala. That basti will pacify the blood, the burning and the fever.
The commentary says that after prescribing food, basti is now given. Basti here means nirūha. Madhuka is yaṣṭīmadhu; utpala is blue lotus. The physician gives a basti made with a decoction cooked with madhuka and blue lotus, mixed with milk, honey and ghṛta, and it pacifies the blood and other signs. Although basti in pravāhikā has been described earlier, these two bastis are stated here for the specific state called niścāraka accompanied by severe pain.
The commentary says that after nirūha, anuvāsana is stated. Sweet drugs are kākolī and similar. Although anuvāsana at night is prohibited, in a person with constant pain, burning and fever it may be given even at night.
As the person becomes more oiled, so vāta is pacified; when vāta is pacified pravāhikā also settles. Therefore in pravāhikā the physician should pacify vāta.
Pāṭhā, ajamodā, kuṭaja, utpala, śuṇṭhī, and pippalī in equal parts, ground and drunk with lukewarm water, pacify the disease... (the verse continues in the next entry).
The commentary says this states an appetite-kindling drug for pravāhikā. Sukhāmbu is slightly warm water. Pāṭhā through pippalī, in equal parts, ground and drunk with lukewarm water, pacify the disease called pravāhikā.
Key terms
sukhāmbu
Comfortably warm water.
māgadhikā
Pippalī.
pravāhikā
Dysenteric straining condition.
Adhikarana 103 (154) · Śloka 154
... mēdhyāṇḍasiddhaṁ saghr̥taṁ payō vā ||154||
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... मेध्याण्डसिद्धं सघृतं पयो वा ||१५४||
Meaning of the śloka
... or milk cooked with medhyāṇḍa and mixed with ghṛta (also pacifies it).
The commentary says medhyāṇḍa is the testis of a goat; milk cooked with it and with ghṛta is connected to 'pacifies pravāhikā'. The method of cooking milk was described earlier.
The commentary says kṣavaka is chikkākara, known in common speech as 'chiṅkinī'. The method is that a paste of śuṇṭhī and kṣavaka is cooked with ghṛta and oil by the method for an avaleha, and licked; it quickly destroys the disease called pravāhikā.
A yavāgū made with juices of gajāśanā, kumbhikā and pomegranate, prepared with oil and ghṛta in curd and with bilva, is most wholesome... (continues in next entry).
The commentary says gajāśanā is śallakī and kumbhikā is water-kumbhikā; 'juices' means decoctions; bilvānvitā means with bilva pulp. The yavāgū, prepared with decoctions of śallakī etc. and with bilva pulp, cooked in curd with oil and ghṛta, is most wholesome.
Key terms
gajāśanā
Śallakī.
kumbhikā
Water-kumbhikā (pānīyakumbhikā).
pathyatama
Most wholesome.
Adhikarana 106 (156) · Śloka 156
...rdhārōṣṇadugdhasya tathā ca pānam |156|
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...र्धारोष्णदुग्धस्य तथा च पानम् |१५६|
Meaning of the śloka
... and likewise the drinking of warm milk taken directly from the udder (dhāroṣṇa).
For udarāmaya, the attentive physician should always give light, wholesome, appetite-kindling and unctuous foods, and the various yogas, after distinguishing them.
The commentary says this concludes the topic. Bhojya means kinds of food. Udarāmaya here means atisāra and pravāhikā. 'After distinguishing' means by distinguishing the specific doṣa and condition. Others connect 'wholesome foods and yogas' after distinguishing them. Light, appetite-kindling and unctuous are the qualities of those yogas. 'Apramatta' means careful.
The commentary says this praises yavāgū to show it is beneficial without exception. Tṛṣṇāpanayanī means it removes thirst. 'Always' means in all conditions, because agni is dull in jvara and atisāra, and yavāgū kindles agni.
Key terms
yavāgū
Gruel.
bastiśodhanī
Cleansing of the basti (bladder or lower abdominal region).
In (atisāra) born of dryness, the treatment should be unctuous; in that born of oil-related cause, dry; in that born of fear, preceded by reassurance; in that born of grief, grief-relieving; and in that arising from poison, piles or worms, the treatment beneficial for both (the atisāra and its cause) is given.
The commentary says that after stating disease-opposing treatment, the treatment opposite to the cause is stated. 'Atisāra' and 'is beneficial' are supplied. In fear-born atisāra the treatment is preceded by consoling (sāma) measures. Grief-born atisāra is from separation from son, friends, spouse and the like. In atisāra arising from poison etc., the measure that is beneficial to both, meaning to poison, piles and worms and to the atisāra they produce, is meant. Thus treatment opposed to the cause and to the disease is stated.
The commentary raises the question of which doṣa is treated first in atisāra when three or two doṣas are combined. 'Samavāya' means combination, of three or two doṣas. In jvara and atisāra pitta is treated first; in all conditions other than these, vāta is treated first. Although in the jvara chapter it was said that in combinations pitta is treated first, the repetition here shows that in jvara particularly pitta is treated first. Those in other tantras who prefer treating vāta first in atisāra mean this: where atisāra is a combination of kapha and vāta, vāta is treated first, because pācana reduces āma and kapha, increasing vāta.
The commentary says the sign of cessation of atisāra is now given. Uccāra is stool; 'properly' means without doubt of urge; vāta here is downward wind. 'Kindled agni' is said with respect to the first stage, so the later statement that even when atisāra has ceased agni may be weak is not contradicted. 'Light abdomen' means without heaviness. 'Sthita' means ceased; udarāmaya is atisāra.
Some diseases are karmaja (born of past action), others are doṣaja (born of doṣas), and others are born of both karma and doṣa... (the verse continues in the next entry).
The commentary says this topic must necessarily be stated, and that this is the place for it, so diseases are here classed as threefold: karmaja and so on. Among those who follow wholesome conduct and the prescribed regimen, illnesses such as raktapitta in hemanta and śiśira, vāta disorders in spring, and kapha disorders in the rains, arising without a cause, are karmaja. Those produced when doṣas are aggravated by unsuitable sense-contact, offences of intellect, transformation (of time) and wrong foods and conduct contrary to the śāstra are doṣaja. Those from both causes are karmadoṣaja.
Key terms
karmaja
Born of past action.
doṣaja
Born of aggravated doṣas.
karmadoṣaja
Born of both.
prajñāparādha
Offence against wisdom, i.e., knowingly acting wrongly.
... Among them the karmaja are without (doṣa) cause; they disappear without treatment, or with treatments (of another kind) when the karma is exhausted.
The commentary says that among the three types, karmaja ones are ahetuka, meaning without cause in the form of doṣa or external agent. They are destroyed by non-treatment (akriyā) or by kriyās in the form of expiation, japa, homa and offerings, on exhaustion of the karma that gave rise to the disease. The sense is that diseases arising without a cause and vanishing without treatment on exhaustion of karma are karmaja.
The commentary says this gives the sign of karmadoṣaja diseases. Alpanidāna means slight cause or slightly producing doṣas. The prefix 'prati' in 'pratikaṣṭa' indicates 'being of such kind'; so those that are hard though thus, and those that are mild though caused by many doṣas, are karmadoṣaja.
Key terms
alpanidāna
With a slight cause.
pratikaṣṭa
Hard to treat.
bahudoṣa
With many doṣas.
Adhikarana 117 (166) · Śloka 166
karmadōṣakṣayakr̥tā tēṣāṁ siddhirvidhīyatē |166|
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कर्मदोषक्षयकृता तेषां सिद्धिर्विधीयते |१६६|
Meaning of the śloka
For these, cure is brought about by exhaustion of karma and doṣa.
The commentary says this gives treatment of karmadoṣaja diseases. Cure by exhaustion of karma means by sacrifice, gifts, mantra, offering, worship of deities and honouring teachers and the like; cure by exhaustion of doṣa means by oleation, sweating, emesis and the like.
Key terms
karmakṣaya
Exhaustion of karma through ritual and pious acts.
doṣakṣaya
Exhaustion of doṣa through therapies.
Adhikarana 118 (166) · Śloka 166
duṣyati grahaṇī jantōragnisādanahētubhiḥ ||166||
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दुष्यति ग्रहणी जन्तोरग्निसादनहेतुभिः ||१६६||
Meaning of the śloka
In a person, the grahaṇī becomes disturbed by causes that impair agni.
The commentary says the main topic is now taken up, and that grahaṇī disorder can arise even where atisāra has not occurred. Duṣyati means becomes abnormal. Grahaṇī is the kalā that holds pitta, having agni as its seat. Agnisādana-hetu are causes that extinguish agni. Thus grahaṇī disease can arise even without atisāra.
Key terms
grahaṇī
The kalā that holds pitta and is the seat of agni.
Even after atisāra has ended, in one with weak agni who eats unwholesome food, the agni, disturbed again, injures the grahaṇī. Therefore one should follow the regimen as after purgation, until he is restored to natural state in doṣa and vitality.
The commentary says this shows how grahaṇī disease arises after atisāra has occurred. 'Even when ended' includes 'even when not ended'. 'Again' means once more. Grahaṇī is the seat of agni. Because the disturbed agni injures the seat called grahaṇī, the regimen as after purgation is to be followed. The verse then gives the limit of that regimen: until he returns to normal in doṣas and in vitality.
The commentary asks what this grahaṇī is, which the disturbed agni disturbs. The kalā stated is the one described in the chapter on garbha-vyākaraṇa in the Śārīra section.
Agni is the strength of the grahaṇī, and that agni in turn rests in the grahaṇī. Therefore, when agni is disturbed, the grahaṇī becomes thoroughly disturbed.
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yathā'gnau dūṣitē sati grahaṇī praduṣyati tathā darśayati- grahaṇyā ityādi| hi yasmādarthē, yasmādgrahaṇyā agnyadhiṣṭhānabhūtāyā balamagniḥ sa, cāpyagnirgrahaṇīṁ śritō grahaṇīmāśritaḥ, tasmādagnau pradūṣitē grahaṇī sampraduṣyatīti||170||
Meaning of the commentary
The commentary shows how the grahaṇī is disturbed when agni is disturbed. Since agni is the strength of the grahaṇī, which is the seat of agni, and agni also resides in the grahaṇī, disturbance of agni disturbs the grahaṇī.
When the doṣas, singly or all together, are excessively increased, the disturbed grahaṇī repeatedly releases the eaten food only as āma, or it passes it as pakva but painful, foul-smelling, at times bound and at times loose. Those who know Āyurveda call this grahaṇīroga.
The commentary asks by which doṣas it is disturbed, and answers that the doṣas that are greatly increased, singly (vāta etc.) or all together, disturb it. Bahuśaḥ means many times. The disturbed grahaṇī releases the food as unripe (āma) only. The question of what else it releases is answered by 'or pakva...'. 'Those who know Āyurveda' means those who know the eight branches.
At its onset there are burning of the food, sinking (of the limbs), lassitude, thirst, exhaustion, loss of strength, loss of appetite, cough, ringing in the ears, and rumbling of the intestines.
The commentary says these are the premonitory signs of grahaṇīroga. Vidāha means the eaten food turns sour/burning. Sadana is limb-sinking; ālasya is lack of enthusiasm; tṛṭ is thirst; klama is fatigue without exertion. Karṇakṣveḍa is hearing various sounds like humming. Others read 'vidāho'ntaḥ' (burning inside), explaining that inside the abdomen the food undergoes burning.
When it has fully developed, the person becomes emaciated with swollen feet and hands, with joint pain, greediness, thirst, vomiting, fever, distaste for food and burning. He belches sour, bitter or sour-tasting matter smelling of iron or smoke or of āma, is troubled by salivation, bad taste in the mouth, tamaka and distaste.
The commentary says this gives the signs after the premonitory signs. Parvaruk is joint pain; laulya is greed for all tastes. Udgiret means vomits. Śukta is sour (cukra); 'smell' connects with each of iron, smoke and āma. Praseka is salivation. Tamaka is a kind of breathlessness, though others say tamaka means confusion. 'Afflicted' connects with each of salivation and the rest. Others read 'nirmāṃso vā kṛśaḥ' — nirmāṃsa meaning extremely wasted, kṛśa slightly wasted. Aruci is included already by 'arocaka', and is repeated to indicate that loss of appetite is inevitable in this disease.
Key terms
śūnapādakara
With swollen feet and hands.
praseka
Salivation.
tamaka
A kind of breathlessness, or confusion per others.
Grahaṇī disorder from vāta is recognised by (the anus, heart, both sides, abdomen and head) with more pain; from pitta by the same with burning; from kapha by the same with heaviness; and in the three (tridoṣa), by all three signs.
The commentary says that hereafter the signs of grahaṇī are given by doṣa. Pāyu is the anus, hṛd the heart, two pārśvas the sides. Grahaṇīroga from vāta is to be known by pain predominating in the anus, heart, sides, abdomen and head; the same applies to the others: with burning for pitta, with heaviness for kapha, and with all three qualities for tridoṣa.
Key terms
pāyu
Anus.
pārśva
Side.
trilakṣaṇa
Bearing the signs of all three doṣas.
Adhikarana 126 (177) · Śloka 177
dōṣavarṇairnakhaistadvadviṇmūtranayanānanaiḥ |
hr̥tpāṇḍūdaragulmārśaḥplīhāśaṅkhī ca mānavaḥ ||177||
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दोषवर्णैर्नखैस्तद्वद्विण्मूत्रनयनाननैः |
हृत्पाण्डूदरगुल्मार्शःप्लीहाशङ्खी च मानवः ||१७७||
Meaning of the śloka
Similarly, by the colours of the doṣas in the nails, and in the stool, urine, eyes and face; and the person comes to fear heart disease, pāṇḍu, udara, gulma, arśas, plīhā and śaṅkhaka.
The commentary asks whether grahaṇīroga is to be known only by these signs or also by others. 'Doṣa colours' means dark, red, blue, yellow, reddish, black and pale. The nails, and the stool and so on, in those colours, indicate grahaṇīroga. The person fears diseases such as hṛdroga, pāṇḍu and udara, when grahaṇīroga is increasing.
According to the doṣa's increase, after purification in due order, peyā and other foods prepared with appetite-kindling drugs should be given properly. Afterwards the three groups, pācana, saṅgrāhi and dīpanīya, may be drunk in the morning with surā, ariṣṭa, sneha, urine or warm water; or with buttermilk, or buttermilk alone is beneficial. Measures against worms, gulma, udara and arśas are to be used here. Powder beginning with hiṅgu, or ghṛta that destroys plīhā, is also used here.
The commentary says this now gives treatment of grahaṇīroga. Doṣocchraya is doṣa excess. After purification, for vāta excess with nirūha, for pitta with virecana, for kapha with vamana, each in the order stated in the purification section. 'Etc.' includes vilepī, yūṣa and soft rice. 'Dīpanīya' means with drugs like pañcakola. Others read 'yathādoṣabalam', meaning purification without exceeding the strength of the doṣa. The three groups are: haridrādi for pācana, ambaṣṭhādi for saṅgrāhi, pippalyādi for dīpanīya; taken with surā, ariṣṭa and the rest, up to buttermilk, according to doṣa, time and suitability. Buttermilk alone is stated because it is binding, appetite-kindling and light, by the maxim 'one thing is enough for many'. The measures against worms etc. are to be used according to doṣa excess, answering the objection that four kinds of grahaṇī exist and each treatment should be given. The hiṅgu-powder is from the mahāvātavyādhi section and the ghṛta is the six-pala ghṛta.
The commentary says this describes cāṅgerī ghṛta. 'Magadhādi' means pippalī and the like. Cāṅgerī is amlapatrikā. The ghṛta is cooked with cāṅgerī juice in four times the ghee, with a paste of pippalī etc. in one-fourth the ghee, and with curd in four times, and is beneficial.
Key terms
cāṅgerī
Amlapatrikā, per the commentary.
magadhādi
Pippalī and similar drugs.
Adhikarana 129 (182) · Śloka 182
sarvathā dīpanaṁ sarvaṁ grahaṇīrōgiṇāṁ hitam ||182||
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सर्वथा दीपनं सर्वं ग्रहणीरोगिणां हितम् ||१८२||
Meaning of the śloka
Everything that kindles agni, in every way, is beneficial for those with grahaṇīroga.
The commentary says this is stated to gather in everything not mentioned for grahaṇīroga: whatever kindles agni is in every way beneficial for those with grahaṇīroga.
The commentary says this is the remedy for the complications of grahaṇīroga, fever, anorexia and the like; 'etc.' includes anorexia, pain and swelling of hands and feet. 'Without contradiction' is completed with 'of the root disease'. The commentator notes that although the chapter is read in a scattered order by the compilers, he has read and explained it in the order taught by his own teacher.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रेऽतिसारप्रतिषेधो नाम (द्वितीयोऽध्यायः, आदितः) चत्वारिंशोऽध्यायः ||४०||
Meaning of the śloka
Thus ends the chapter named Atisāra-pratiṣedha (Prevention/Treatment of Atisāra), the fortieth chapter (the second chapter from the beginning of this section), in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
Thus ends the fortieth chapter, Atisāra-pratiṣedha, in the Kāyacikitsā of the Uttaratantra, in Suśruta-vyākhyā called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.
Key terms
atisāra-pratiṣedha (atisārapratiṣedha)
The chapter on measures against atisāra.
kāyacikitsā-tantra (kāyacikitsātantra)
The internal-medicine division within the Uttaratantra.