The commentary says that after the chapter on tṛṣṇā, beginning chardi is fitting, because the treatment of tṛṣṇā is similar and because chardi is mentioned in the tṛṣṇā treatment.
From foods that are too liquid, too unctuous, unpleasing, too salty, at the wrong time, in excess, or unsuitable; from exertion, depletion, agitation, indigestion, worm faults; in a pregnant woman; from eating too fast; and in one wrapped in āma: chardi surely arises. (A bracketed line adds: or by other disgusting causes, one who is forcibly nauseated quickly.)
The commentary states the causes. Ahṛdya means disagreeable; udvega means agitation; āpannasattvā means a pregnant woman; atidruta means very fast eating; 'wrapped in āma' means thoroughly enveloped by undigested matter. Some read the bracketed line 'disgusting causes' and explain them as horrifying things such as pus and filth, in sight, smell or taste.
The commentary gives the derivation. Chādayan means filling; vega is the state of standing ready to come out; ardayan means troubling; aṅgabhañjana is bodily pain; 'coming out of the mouth' means emerging. Some read 'vaktraṃ pradhāvitaḥ' (has run to the mouth) for 'vaktrād viniścaran'.
The commentary gives the pathogenesis. Udāna united with vyāna, from eating incompatible foods, stirs up the aggravated doṣas and goes strongly upward. Some read a different verse ('stirring kapha and pitta, udāna joined with vyāna, in those eating incompatible food, the rasa rises'), which Kārttikakuṇḍa does not accept because 'the doṣa runs to the mouth' already covers it and because chardi is described as arising from the rasa and doṣa together.
Key terms
udāna
Upward-moving vāta.
vyāna
Pervading vāta.
Adhikarana ൫ (൮) · Śloka ൮
പ്രസേകോ ഹൃദയോത്ക്ലേശോ ഭക്തസ്യാനഭിനന്ദനമ് |
പൂര്വരൂപം മതം ഛര്ദ്യാ... |൮|
The commentary says that, after the premonitory signs, the disease becomes fully manifest; the signs are described for each. The premonitory signs, when fully developed, are recognised especially by the taste of the salivation: astringent, sour or sweet.
He vomits frothy matter in small amounts, tormented by pain, with pressed sides and back, tired, with sound, repeatedly, astringent matter, and more after digestion: that is vomiting from vāta.
The commentary gives the signs of vātaja chardi. 'With pressed sides and back' means with pained sides and back. 'With sound' means noisily. Some read the verse differently, which is not shown because it is absent in the text.
One who vomits sour matter, or a great amount of pungent or bitter matter, yellow, blood-stained or greenish; with burning, sucking pain, fever, dryness of the mouth, fainting: that is from pitta.
One with horripilation who vomits sweet, abundant, white, cold, thick matter mixed with kapha, with distaste for food, heaviness and sinking of limbs: that vomiting is from kapha.
The commentary gives the signs of kaphaja chardi. Hṛṣṭaroma means with erect body hair; prabhūta is much; sāndra is thick; abhaktaruk is lack of desire for food; sāda is limb weariness.
The commentary says all the signs means the signs of vāta and the others together. Although another tantra states special signs for a sannipāta chardi, here the second variety is indicated later in 'of the depleted' and so on, and so it is not stated here.
बीभत्सजा दौहृदजाऽऽमजा च सात्म्यप्रकोपात् कृमिजा च या हि |
सा पञ्चमी तां च विभावयेत्तु दोषोच्छ्रयेणैव यथोक्तमादौ ||१२||
Meaning of the śloka
That arising from disgusting causes, from pregnancy cravings (dauhṛda), from āma, from disagreement of the accustomed (sātmya), and from worms is the fifth; one should recognise it by the excess of doṣa, as told at the beginning.
The commentary says that although these causes are many, they are gathered into a single fifth. Bībhatsaja is from disgusting, unclean, putrid or filthy things; dauhṛdaja is from a denied pregnancy craving, or per others from pregnancy in itself; āmaja is from indigestion such as visūcikā; sātmya-prakopa is sudden abandonment of what one is used to; kṛmija is from worms. It should be recognised by doṣa excess. Others explain that the fifth is the worm-born kind, and that this should be recognised only by doṣa excess.
A skilled physician should not undertake to treat chardi in one who is depleted, accompanied by complications, with blood and pus (in the vomit), with moonlike iridescent (candrikā) appearance, or persistent.
The commentary says this states incurability in the stage of all vomiting. The phrase 'should not undertake' applies to each: one who is wasted, one with complications, one with blood and pus, and so on. 'Persistent' means continuously flowing.
Key terms
prasaktā chardi
Continuous, persistent vomiting.
candrikā
A moon-like or peacock-eye iridescent appearance in the vomit.
The commentary gives the general treatment of all vomitings. 'Arising from irritation of the āmāśaya' means produced by doṣas irritating the āmāśaya. 'Beneficial' has the supplied condition 'for a strong person'.
Key terms
āmāśayotkleśa
Irritation of the site of undigested matter (upper digestive tract).
The commentary says 'much doṣa' means with strongly predominant kapha; otherwise emesis would apply only to the combined type, which would not fit the plural. 'According to excess of doṣa' means considering which doṣa is more.
Key terms
chardana
Induced vomiting.
virecana
Purgation.
Adhikarana ൧൬ (൧൭) · Śloka ൧൭
സംസര്ഗശ്ചാനുപൂര്വേണ യഥാസ്വം ഭേഷജായുതഃ |൧൭|
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संसर्गश्चानुपूर्वेण यथास्वं भेषजायुतः |१७|
Meaning of the śloka
Graded reintroduction of diet (saṃsarga), in order, together with the appropriate medicine for each...
The commentary says that after cleansing, what follows is saṃsarga: the graded diet beginning with peyā, or tarpaṇa and the like per others, in the order stated in 'peyā, vilepī, unprepared and prepared yūṣa'. 'With appropriate medicine' means combined lightly with the medicine opposing that doṣa, vāta and so on.
The commentary says light means light in quantity and in nature; well-dried are things such as fried cakes (śaṣkulī); suitable means opposed to the season and the disease. Some take 'light...' as pacifying treatment for one fit for emesis, because the remaining doṣa left after emesis is curable by pacification.
Key terms
parishuṣka (pariśuṣka)
Well-dried (foods).
sātmya
Suitable, habitually agreeing.
Adhikarana ൧൮ (൧൮) · Śloka ൧൮
യഥാസ്വം ച കഷായാണി ജ്വരഘ്നാനി പ്രയോജയേത് |൧൮|
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यथास्वं च कषायाणि ज्वरघ्नानि प्रयोजयेत् |१८|
Meaning of the śloka
According to each, the fever-relieving decoctions should be used.
Milk-ghṛta, when drunk, destroys vomiting arising from vāta; ghṛta with rock salt, drunk, prevents vātaja vomiting; or a soup of mudga and āmalaka with ghṛta and rock salt; or a thin gruel mixed with honey and made with the pañcamūla; or a sour-fruit juice of vaiṣkira (game bird) meat with evident rock salt; and a snehavirecana with lukewarm salt is beneficial here.
The commentary says milk-ghṛta is ghṛta from churned milk or ghṛta with milk (some read 'milk-water'). Ghṛta with rock salt is taken uncooked, as Vāgbhaṭa states. The pañcamūla is that of śālaparṇī and others, or of bilva and others. Ghṛta in the soup is for enriching it. Pañcamūla is 'large' per Candrikākāra, 'small' per Cakrapāṇi. Vaiṣkira juice is meat juice of birds such as lāva, made sour with pomegranate or citron and with evident rock salt. Snehavirecana is purgation with a sneha such as castor oil, made 'pleasantly warm and salty' (as Vāgbhaṭa states); some read 'sukhoṣṇaṃ lavaṇaṃ cātra'.
पित्तोपशमनीयानि पाक्यानि शिशिराणि च |
कषायाण्युपयुक्तानि घ्नन्ति पित्तकृतां वमीम् ||२१||
शोधनं मधुरैश्चात्र द्राक्षारससमायुतैः |
बलवत्यां प्रशंसन्ति सर्पिस्तैल्वकमेव च ||२२||
Meaning of the śloka
Pitta-relieving, boiled and cool decoctions, when used, destroy vomiting arising from pitta. In it, cleansing with sweet drugs mixed with grape juice; and, in a strong patient, tailvaka ghṛta, are recommended.
The commentary says the pitta-relieving decoctions are those relieving pitta fever, as stated in 'according to each, fever-relieving decoctions'. 'Boiled' means cooked; 'cool' means cold infusions. 'Cleansing' (śodhana) may mean emesis or purgation; some say purgation only, because that is praised in pitta type. Tailvaka ghṛta is that stated in the vāta-disease chapter, or one prepared with rodhra.
The commentary says niryūha is decoction. The commentators disagree about what daśāṅga yoga means: some say the ten-drug list beginning 'nāgara, dhānyaka, bhārgī, abhayā, suradāru, vacā, parpaṭa, mustā, bhūtīka, kaṭphala' (boiled and drunk); Kārttikakuṇḍa rejects this, because it is not accepted as vomiting-relieving; Kārttika instead takes it as the kaphajvara list beginning 'kaṭukā, citraka', repeated here for use without pepper; others take it as śālaparṇī and the atisāra group; Kārttikakuṇḍa also rejects the daśamūla since it is non-āma-relieving.
The commentary says 'by the rule' means by the method for the cold infusion, called hima. 'In all three' means vāta, pitta and kapha, and also in the combined one. Sannipātaja vomiting is mostly incurable, so its treatment is not stated. The method of cold infusion: bruised medicine (a pala) is soaked in four palas of warm water and kept overnight, then taken; another tantra gives a slightly different formulation. An objection: guḍūcī in the vegetable group is said to relieve only kapha and pitta, so why for all three? Answer: by the greatness of its combination with honey; or, its leaf relieves kapha and pitta while the vine relieves vāta, quoting Caraka on guḍūcī as binding, appetite-kindling, and relieving vāta, kapha and blood obstruction.
The vomiting from disgust should be treated with the most heart-pleasing things; that from pregnancy cravings with the fruits desired; that from āma by fasting and emetics; that from lapse of accustomed things with the accustomed; and the worm-caused vomiting should be treated like worm hṛdroga.
The commentary gives the treatment for the disgust and other kinds. Dauhṛdī vomiting is from a denied craving, or per others from pregnancy. Emesis is already mentioned for all types, but is repeated for āmaja to show that emesis is to be done even without strength there; otherwise āma would bring complications. 'Lapse of accustomed' means abandoning what one is used to.
Key terms
dauhṛdī vamī (dauhṛdī)
Vomiting from an unfulfilled craving, or from pregnancy per others.
sātmya
What one is accustomed to.
Adhikarana ൨൪ (൨൬) · Śloka ൨൬
വിതരേച്ച യഥാദോഷം ശസ്തം വിധിമനന്തരമ് ||൨൬||
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वितरेच्च यथादोषं शस्तं विधिमनन्तरम् ||२६||
Meaning of the śloka
One should also give the appropriate, praised regimen next, according to the doṣa.
The commentary says that by extension the treatment according to doṣa applies: 'according to doṣa' means without transgressing the doṣa; each is first treated by its own remedy so as to restore the doṣa to its natural state, and afterwards the doṣa treatment. Therefore no medicine is named here. Others say this should be done in all vomitings to prevent recurrence. Some read 'vyastam' for 'śastam'.
दधित्थरससंसक्तां पिप्पलीं माक्षिकान्विताम् |
मुहुर्मुहुर्नरो लीढ्वा छर्दिभ्यः प्रवि(ति)मुच्यते ||२७||
समाक्षिका मधुरसा पीता वा तण्डुलाम्बुना |
तर्पणं वा मधुयुतं तिसृणामपि भेषजम् ||२८||
स्वयङ्गुप्तां सयष्ट्याह्वां तण्डुलाम्बुमधुद्रवाम् |
पिबेद्यवागूमथवा सिद्धां पत्रैः करञ्जजैः ||२९||
युक्ताम्ललवणाः पिष्टाः कुस्तुम्बुर्योऽथवा हिताः |
तण्डुलाम्बुयुतं खादेत् कपित्थं त्र्यूषणेन वा ||३०||
सिताचन्दनमध्वाक्तं लिह्याद्वा मक्षिकाशकृत् |
पिबेत् पयोऽग्नितप्तं च निर्वाप्य गृहगोधिकाम् ||३१||
सर्पिःक्षौद्रयुतान् वाऽपि लाजशक्तून् पिबेत्तथा |
सर्पिःक्षौद्रसितोपेतां मागधीं वा लिहेत्तथा ||३२||
धात्रीरसे चन्दनं वा घृष्टं मुद्गदलाम्बुना |
कोलामलकमज्जानं लिह्याद्वा त्रिसुगन्धिकम् ||३३||
सक्षौद्रां शालिलाजानां यवागूं वा पिबेन्नरः |
घ्रेयाण्युपहरेच्चापि मनोघ्राणसुखानि च ||३४||
जाङ्गलानि च मांसानि शुभानि पानकानि च |
भोजनानि विचित्राणि कुर्यात्सर्वास्वतन्द्रितः ||३५||
Meaning of the śloka
A long list of remedies for vomiting in general: pippalī licked repeatedly with kapittha juice and honey; madhurasā (mūrvā) with honey, or drunk in rice water; a tarpaṇa with honey, beneficial in all three types; kapikacchū gruel with yaṣṭīmadhu, rice water and honey, or gruel cooked with karañja leaves; kustumburu with suitable sour and salt, ground; kapittha with rice water, or with trikaṭu; a lick of fly dung with sugar, sandal and honey; milk in which a heated house-lizard has been quenched; parched-rice flour drink with ghṛta and honey; pippalī with ghṛta, honey and sugar; sandal ground in āmalaka juice with mudga-leaf water; jujube-seed kernel, or trisugandhi, licked with honey; a gruel of śāli parched rice with honey; pleasant smells offered; jāṅgala meats, pānakas and varied foods in all types without laziness.
The commentary explains: dadhittha is kapittha; madhurasā is mūrvā; taṇḍulāmbu is rice-washing water; tarpaṇa is made of parched rice and flour, since parched rice relieves vomiting; 'in all three' means the vāta, pitta and kapha types, and by that it is also good in the combined type, as a quoted rule states that what treats the three separately suits them combined by nature; and a further quotation adds that the physician should apply this to sannipāta diseases with sharp judgement according to doṣa, fire and strength. Svayaṃguptā is kapikacchū; the gruel is made with honey (one karṣa) and rice water (four times). The karañja-leaf gruel is for kapha predominance. Kustumburu is coriander. Trikaṭu is the three pungents. Makṣikā-śakṛt is fly dung. 'House-lizard' here is explained as figurative for an earthen house made of clay (a heated brick), not the animal; 'water' means the water quenched. Ghreya are pleasant fragrant substances that gladden mind and nose; jāṅgala meats are skewered and cooked; 'without laziness' means diligently.
Key terms
tarpaṇa
Nourishing drink of parched-grain flour.
svayaṃguptā
Kapikacchū (velvet bean).
gṛhagodhikā
House-lizard, or per the commentary a figure for a heated clay item.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे छर्दिप्रतिषेधो नाम (एकादशोऽध्यायः, आदितः) एकोनपञ्चाशत्तमोऽध्यायः ||४९||
Meaning of the śloka
Thus ends the forty-ninth chapter (the eleventh from the beginning of this section) in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
Thus ends the forty-ninth chapter, named Chardipratiṣedha, in the Kāyacikitsā of the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.