The commentary says that after the chapter on śoṣa, beginning the treatment of gulma is fitting, following the order of the list of disorders stated in the Ariṣṭa (prognostic) context.
Key terms
gulma
A classical abdominal swelling or lump-like disorder.
The commentary says that since treatment follows the cause, the cause, pathogenesis and number of gulmas are stated first. 'As described' means the aggravating factors taught in the Vraṇaprāśna chapter, such as fighting beyond one's strength, anger and daytime sleep. Koṣṭha refers to āma, pakva and agni sites, the bladder, the heart, uṇḍuka and lungs, as quoted: 'the seats of āma, agni and pakva, of urine and blood, the heart, uṇḍuka and lungs are called koṣṭha'. Gulma is fivefold: three from the doṣas separately, one from all together, and one from blood. This is stated as 'generally', since combined-pair gulmas also exist, quoted as: 'the others with mixed signs are to be taught by a physician for making treatment'; and from the extension in the Vraṇaprāśna, fifteen kinds are possible. The verse's first line states the cause, the second the pathogenesis, and the phrase 'fivefold' states the number.
Key terms
koṣṭha
The visceral region or abdominal-thoracic cavity with its organs.
pañcavidha
Of five kinds.
dvandvaja
Arising from two doṣas together.
Adhikarana ३ (४) · Śloka ४
हृद्बस्त्योरन्तरे ग्रन्थिः सञ्चारी यदि वाऽचलः |
चयापचयवान् वृत्तः स गुल्म इति कीर्तितः ||४||
Meaning of the śloka
A lump between the heart and the bladder, either moving or immovable, increasing and decreasing, and round, is called gulma.
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गुल्मस्य रूपमाह- हृद्बस्त्योरन्तरे ग्रन्थिरित्यादि| हृद्बस्त्योः हृदये च बस्तौ च, वा तयोरेवान्तरे; तेन सर्वमुदरमाक्षिप्तम्| सञ्चारी चलनशीलः, वाताधिक्यात्| अचल एकस्थानशायी, वायोरल्पत्वात्| चयापचयवान् कदाचिदुपचितः कदाचिदपचित इति, विचित्रक्रियत्वाद्वायोः| वृत्तो वर्तुलः| केचित् ‘हृन्नाभ्योरन्तरे’ इति पठन्ति; ते च नाभिग्रहणेनैव सामीप्याद्बस्तिं गृह्णन्ति| ‘चयापचयवान्’ इत्यत्र ‘स्थिरोपचयवान्’ इति केचित् पठन्ति, स्थिर उपचयो वृद्धिर्यस्य स इति च व्याख्यानयन्ति||४||
Meaning of the commentary
The commentary describes the form of gulma. 'Between the heart and bladder' includes the heart, the bladder and the space between them, so the whole abdomen is covered. Moving means it is mobile because of excess vāta; immovable means staying in one place because vāta is scanty. 'Increasing and decreasing' means sometimes enlarged and sometimes reduced because of the varied action of vāta. Vṛtta means round. Some read 'between heart and navel', and include the bladder by proximity to the navel. Some read 'sthiropacayavān', explaining it as having steady growth.
The commentary says the five sites of gulma within the abdomen are stated; the meaning is clear. It notes that Kārttikakuṇḍa reads this verse after the line beginning 'it arises from the doṣas separately'.
The commentary gives the derivation. 'Root in aggravated vāta' means vāta that has been agitated is its root, so vāta is the cause of all gulmas. 'Hidden root' is explained as: it arises like bulbs and the like whose roots are hidden; others say its cause is concealed, and the root, vāta, is hidden, meaning covered, according to two ways vāta is disturbed, quoted as: 'vāta is aggravated by depletion of dhātus and by obstruction of the path'. 'Like a gulma' means like a cluster of people and such. Just as groups of men or trees are called 'gulma' (a thicket), broadness gives the name. The three illustrations show that gulma arises from three doṣas. Some read 'kupitānilamūlatvāt' with the same meaning, and 'gūḍhagulmodayāt', explaining it as arising like a round bush hidden by creepers.
Key terms
gulma-nirukti (gulmanirukti)
Etymological explanation of the name gulma.
gūḍhamūla
With a hidden root or cause.
viśāla
Broad or extensive.
Adhikarana ६ (६) · Śloka ७
स यस्मादात्मनि चयं गच्छत्यप्स्विव बुद्बुदः ||६||
अन्तः सरति यस्माच्च न पाकमुपयात्यतः |७|
Meaning of the śloka
Because it gathers within itself like a bubble in water, and because it moves inside, it does not suppurate.
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इदानीं यथा न पच्यते गुल्मस्तथाऽऽह- स यस्मादित्यादि| स गुल्मो यस्मात् कारणादात्मनि स्वावयवे चयं निचयं गच्छति याति; अप्स्विव बुद्बुद उद्गच्छति उद्गतिं याति, तथा गुल्मरूपोऽपि दोषः स्वावयवे उद्गच्छति उद्गतिं याति; अन्तः अभ्यन्तरे, सरति भ्राम्यति| एवम्भूतः प्रायेण वातिको भवति, स च न पच्यते; इतरे च गुल्मा यदा रक्तादिदूष्यमधिष्ठाय अवतिष्ठन्ते तदा कदाचित् पच्यन्ते| तथा चोक्तम्- “रक्तपित्तातिवृद्धत्वात् क्रियामनुपलभ्य वा| यदि गुल्मो विदह्येत शस्त्रं तत्र भिषग्जितम्”- इति| अथैवमन्तर्विद्रधेर्गुल्मस्य च शीघ्रमन्दपाकित्वेन भेदः||६||-
Meaning of the commentary
The commentary explains why gulma does not suppurate. Gulma collects within its own substance, as a bubble rises in water; the doṣa in the form of gulma rises within its own part and circulates inside. Such a gulma, generally of vāta type, does not suppurate. Other gulmas, when they settle on blood or another duṣya, may sometimes suppurate, quoted as: 'if gulma suppurates from great increase of blood and pitta, or when treatment cannot be found, the physician should use a knife'. Thus gulma differs from internal abscess (antarvidradhi) in that gulma suppurates quickly or slowly.
Key terms
budbuda
Bubble.
pāka
Suppuration.
antarvidradhi
Internal abscess.
Adhikarana ७ (७) · Śloka ८
स व्यस्तैर्जायते दोषैः समस्तैरपि चोच्छ्रितैः ||७||
पुरुषाणां तथा स्त्रीणां ज्ञेयो रक्तेन चापरः |८|
Meaning of the śloka
It arises from the doṣas separately, or from all together when they are greatly increased. In men and women it should be known also that another is caused by blood.
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इदानीं ‘स पञ्चविध उच्यते’ इत्यस्यैव विवरणमाह- स व्यस्तैर्जायते दोषैरित्यादि| स गुल्मः, व्यस्तैः एकैकैः; उच्छ्रितैः प्रकुपितैः, रक्तेन आर्तवरक्तेन; चकारात् धातुरक्तेनापि गुल्मो जायते, स च पुंसां स्त्रीणां च भवति; तस्य च पृथगुपादानं न कृतं, पैत्तिकगुल्मसमानलक्षणतया तत्रैवावरोधात्||७||-
Meaning of the commentary
The commentary says this explains the statement 'it is fivefold'. Vyasta means one by one; ucchrita means aggravated. Rakta here is menstrual blood; by the word 'ca' gulma from blood dhātu is also included. It occurs in men and women. It is not listed separately because its signs are like those of pittaja gulma, and it is included there.
Key terms
raktagulma
Gulma arising from blood.
ārtavarakta
Menstrual blood.
ucchrita
Aggravated.
Adhikarana ८ (८-९) · Śloka ९
सदनं मदन्ता वह्नेराटोपोऽन्त्रविकूजनम् ||८||
विण्मूत्रानिलसङ्गश्च सौहित्यासहता तथा |
द्वेषोऽन्ने वायुरूर्ध्वं च पूर्वरूपेषु गुल्मिनाम् ||९||
Meaning of the śloka
Among the premonitory signs in those who will have gulma: limb-sinking, weakened agni, distension, rumbling of the intestines, retention of stool, urine and wind, inability to bear satiety, dislike of food, and upward-moving wind.
The commentary lists the forerunners of gulma. Āṭopa means fullness of the abdomen. Saṅga means obstruction. Sauhityāsahatā means inability to bear satiety. Upward wind means continuous belching.
Key terms
pūrvarūpa
Premonitory signs.
āṭopa
Abdominal fullness or distension.
sauhityāsahatā
Inability to tolerate satiety.
Adhikarana ९ (१०) · Śloka १०
हृत्कुक्षिशूलं मुखकण्ठशोषो वायोर्निरोधो विषमाग्निता च |
ते ते विकाराः पवनात्मकाश्च भवन्ति गुल्मेऽनिलसम्भवे तु ||१०||
Meaning of the śloka
Pain in the heart and flanks, dryness of the mouth and throat, obstruction of wind, and irregular agni; and the various disorders of vāta nature occur in gulma arising from vāta.
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वातगुल्मलक्षणमाह- हृत्कुक्षिशूलमित्यादि| विषमाग्निता चेति चकारान्मुखवैरस्यं ग्राह्यम्| ते ते विकाराः स्तम्भकम्पादयः| केचिद्वातगुल्मलक्षणं ‘आध्मानशूले भवतोऽतिमात्रं’ इत्यादिना पाठेन पठन्ति; स चाभावान्न लिखितः||१०||
Meaning of the commentary
The commentary gives the signs of vātagulma. The word 'ca' adds a bad taste in the mouth. 'Those various disorders' means things such as stiffness and tremor. Some read the signs of vātagulma with a different text beginning 'distension and pain occur greatly', which is not written here because it is not in the commentators' reading.
Sweating, fever, burning after food, heat, thirst, colouring of the body, and a pungent taste in the mouth; whatever signs there are of pitta, all of these occur in gulma of pitta nature.
The commentary gives the signs of pittagulma. Āhāravidāha is sourness and the like of food just after eating. The signs of pitta are giddiness, intoxication, fainting and the like. Some read a different verse for the signs of pittagulma: 'food turns sour, then fever, burning, thirst and pungent taste in the mouth; these are the signs of pitta in gulma of pitta origin'.
Key terms
pittagulma
Gulma of pitta nature.
āhāravidāha
Burning or sourness of food after eating.
aṅgarāga
Colouring or flushing of the body.
Adhikarana ११ (१२) · Śloka १२
स्तैमित्यमन्नेऽरुचिरङ्गसादश्छर्दिः प्रसेको मधुरास्यता च |
कफस्य लिङ्गानि च यानि तानि भवन्ति गुल्मे कफसम्भवे तु ||१२||
Meaning of the śloka
Stiffness (a feeling of dampness), distaste for food, limb-sinking, vomiting, salivation, a sweet taste in the mouth; whatever signs there are of kapha, these occur in gulma of kapha origin.
The commentary explains staimitya as stimitatā (a feeling of being wrapped in wet cloth). Aruci is lack of desire for food. Praseka is salivation. The signs of kapha are heaviness, coldness and the like. Some read a different verse for kaphagulma ('no desire for food, heaviness of the body, vomiting, salivation, sweet taste in mouth'), which is not given here because it is not in the commentators' text.
The commentary gives the signs of sannipātagulma. Sarvavikārayukta means with the signs of each of vātika and other gulmas. Some read 'in the sarvātmaka, all pains occur', explaining that 'all pains' instead of 'all signs' shows great pain. Some read nicaya-gulma here, produced from stool, lasikā and blood, situated on the right side, with a description: 'covered with a network of vessels, with burning, redness and fever, its edge like a tortoise, of three doṣas, it is not cured'. Others read a different verse giving a special stage of gulma called upastambha: 'as milk mixed with sour turns to curd, so gulma too becomes upastambha in one who neglects it; having obstructed the water-carrying channels in the abdominal seat, it sits in the belly; that is known as upastambha'.
Key terms
sannipātagulma (sarvātmaka gulma)
Gulma involving all three doṣas.
nicayagulma
A gulma variety read by some, from stool, lasikā and blood.
upastambha
A stage read by some in which gulma obstructs water channels.
Adhikarana १३ (१३-१५) · Śloka १५
... क्षतजं प्रवक्ष्ये |
नवप्रसूताऽहितभोजना या या चामगर्भं विसृजेदृतौ वा ||१३||
वायुर्हि तस्याः परिगृह्य रक्तं करोति गुल्मं सरुजं सदाहम् |
पैत्तस्य लिङ्गेन समानलिङ्गं विशेषणं चाप्यपरं निबोध ||१४||
न स्पन्दते नोदरमेति वृद्धिं भवन्ति लिङ्गानि च गर्भिणीनाम् |
तं गर्भकालातिगमे चिकित्स्यमसृग्भवं गुल्ममुशन्ति तज्ज्ञाः ||१५||
Meaning of the śloka
... I shall speak of the (gulma) born from kṣata (bleeding). A woman recently delivered who eats unsuitable food, or one who passes an unripe (immature) foetus, or in the season (menstruation): vāta seizes her blood and makes a gulma with pain and burning. Its signs are like those of pitta, but hear a further distinction: it does not move, nor does the abdomen enlarge, though signs of pregnancy are present. When the time of gestation has passed, the knowers call this gulma from blood (asṛgbhava) suitable for treatment.
The commentary says raktaja gulma is described by cause and other aspects. 'Kṣataja' means born of menstrual blood, by figurative use of cause for effect. 'Unripe foetus' means up to six months. 'Unsuitable food' connects also with 'in the season'. 'Of pitta' means pittaja gulma. 'Nibodha' means know. 'Does not move' is supplied with 'by the limbs'; others, taking the negation to apply to both clauses, explain that it does move, as a lump it does throb, quoting: 'that which throbs as a lump but not by the limbs' (Caraka Cikitsā 5). The signs of pregnancy, such as fatigue and limb-sinking, occur here from the nature of the disease. 'Passing of the time of gestation' means when the time of delivery has passed; after the lump has formed, one whose body has been prepared with oleation and the like is easily curable, quoting: 'as in fever, likeness of season and doṣa; in prameha, likeness of the affected tissue; in blood gulma, long standing is a sign of easy curability'. Some explain that instead of saying 'treat in the tenth month' it says 'when the time of gestation has passed' to show that, once the blood gulma is well prepared, treatment may be done even before the time of delivery.
Key terms
raktagulma (asṛgbhava gulma)
Gulma arising from blood.
kṣataja
Born of menstrual blood in the commentary's reading.
āmagarbha
Unripe or immature foetus, per the commentary up to six months.
The commentary says the treatment is now stated. 'Oleated' means with the four snehas, as the condition requires. 'At the proper time' means without transgressing the time stated in 'purgation of one who has vomited is after a fortnight' and similar. Some read 'yathāyogam' for 'yathākālam' and explain it as 'according to condition'.
The commentary says sweet preparations means those with āragvadha and similar, or with milk and sugar; others explain them as sweet preparations stated in 'having split sugarcane into two' and the like. He should be treated with nirūhas made only of sweet substances.
One afflicted with kaphagulma should be oleated with ghṛta such as pippalyādi, purged with sharp (tīkṣṇa) agents, and treated with nirūhas of similar nature.
The commentary says sharp agents are dantī, dravantī and the like; nirūhas of that nature are sharp ones such as decoctions of āragvadha and similar. It adds that oleation and sweating are to be used in all gulmas, since they arise from vāta.
The commentary raises an objection: earlier sannipāta gulma was called incurable, so how is treatment prescribed? It answers: as gulma from irregular sannipāta is incurable, so recent gulma from balanced (equal) sannipāta in a strong person is curable with difficulty, so treatment is stated. It quotes: 'gulma arising from sannipāta, long-standing, of unequal doṣas, is to be avoided; otherwise it is curable with difficulty in a strong person'.
For a woman with raktagulma, the treatment should be as for pitta. Hear now a further special method for breaking up the blood: ghṛta cooked with palāśa-kṣāra water may be given; uttarabasti with ghṛta of pippalyādi may be given; or the mass may be broken with hot (drugs); after it is broken, the regimen of asṛgdara is beneficial.
The commentary says 'as for pitta' means as for pittagulma. After treating by pittagulma methods, the special treatment for the raktagulma that has not responded is given. 'Palāśa-kṣāra water' means water strained through palāśa ash; some explain toya as decoction, and the kṣāra decoction is to be prepared by the method given for oleation use. Ghṛta is cooked with paste and decoction of the pippalyādi group. 'Hot' means pippalī and similar drugs. 'The regimen of asṛgdara' means that given for raktapitta, since the extension from asṛgdara to raktapitta is thus made, showing that the treatment of downward-going raktapitta is to be applied here.
The commentary says the anuvāsana is now specified. Ānūpa animals are elephants, gavaya and the like; audaka are fish and the like; the fat is also of those animals. 'Cooked together' means cooked with the oils combined, understood to be with vāta-relieving drugs.
Key terms
ānūpa
Animals of marshy habitat.
audaka
Aquatic animals.
vasā
Animal fat.
Adhikarana २० (२३) · Śloka २३
जाङ्गलैकशफानां तु वसा सर्पिश्च पैत्तिके |२३|
Meaning of the śloka
For the pitta type, the fat of jāṅgala animals and of solid-hoofed animals, and ghṛta.
The commentary says that by jāṅgala here the birds jaṅghāla and viṣkira are mainly meant; solid-hoofed animals are horses, mules and the like. 'Fat and ghṛta' are each cooked, with pitta-relieving drugs, as anuvāsana in pittaja gulma.
Key terms
jāṅgala
Animals of dry regions.
ekaśapha
Solid-hoofed animals such as horses.
anuvāsana
Oil enema.
Adhikarana २१ (२३) · Śloka २३
तैलं जाङ्गलमज्जान एवं गुल्मे कफोत्थिते ||२३||
Meaning of the śloka
Oil and the marrow of jāṅgala animals likewise in gulma of kapha origin.
Ghṛta with six ingredients (ṣaḍaṅga) is cooked in the juice of āmalaka fruits, with sugar and rock salt added; this is beneficial to one with vātagulma.
The commentary says this gives vāta-relieving ghṛtas after describing the anuvāsana in gulmas of vāta and other types. The juice is four times the ghṛta. 'Ṣaḍaṅga' means six palas, giving here the paste of pañcakola and yavakṣāra. Ghṛta with added sugar and rock salt is beneficial in vātagulma.
Ghṛta cooked with equal parts of citraka, vyoṣa, rock salt, pṛthvīkā, cavya, pomegranate, dīpyaka, granthika, ajājī, hapuṣā and dhānyaka, in the juices of curd, āranāla, badara and radish, is to be drunk; it removes vātagulma, weak agni, distension and pain.
The commentary says pṛthvīkā is hiṅgupatrikā, or black cumin per others; dīpyaka is ajamodā; granthika is pippalīmūla. 'Equal' means made into a paste. Each of the juices from curd to radish is four times the ghṛta.
Ghṛta cooked with hiṅgu, sauvarcala, ajājī, viḍa, pomegranate, dīpyaka, puṣkara, vyoṣa, dhānya, sour vetasa, kṣāra, citraka, śaṭī, vacā, ajagandhā, elā and surasa, together with curd, removes pain and distension in those with vātagulma.
The commentary says dhānya is dhānyaka; ajagandhā is bovayikā; surasa is tulasī. The ghṛta is cooked in a paste of hiṅgu through surasa, with curd four times its measure, and removes pain and the rest.
Ghṛta cooked with viḍa, pomegranate, rock salt, citraka, vyoṣa, jīraka, hiṅgu, sauvarcala, kṣāra, ruk (kuṣṭha), vṛkṣāmla, sour vetasa, and the juice of bījapūra, with four times curd, is called dādhika; it removes gulma and relieves spleen disorder and pain.
The commentary says this is the ghṛta called dādhika. Hutabhuk is citraka; kṣāra is yavakṣāra; ruk is kuṣṭha; vṛkṣāmla is tintiḍīka. The juice of bījapūraka is four times, since it is a liquid ingredient.
The commentary says this is the garlic ghṛta. 'With pañcamūla juice' means with a decoction of the bilva-type pañcamūla. Āranāla is kāñjika; sour curd is dadhimastu; dīpyaka is ajamodā. The six liquids from garlic juice to radish juice are each equal to the ghṛta, and the drugs from vyoṣa onward are pasted to a quarter of the ghṛta; the ghṛta thus cooked overcomes gulma and the rest.
Key terms
rasona
Garlic.
āranāla
Kāñjika, sour fermented gruel.
surā
Fermented liquor.
Adhikarana २७ (३४-३५) · Śloka ३५
दधि सौवीरकं सर्पिः क्वाथौ मुद्गकुलत्थजौ |
पञ्चाढकानि विपचेदावाप्य द्विपलान्यथ ||३४||
सौवर्चलं सर्जिकां च देवदार्वथ सैन्धवम् |
वातगुल्मापहं सर्पिरेतद्दीपनमेव च ||३५||
Meaning of the śloka
Curd, sauvīraka, ghṛta, and decoctions of mudga and kulattha, five āḍhakas (in total), are to be cooked with two palas each of sauvarcala, sarjikā, devadāru and rock salt; this ghṛta removes vātagulma and kindles agni.
The commentary says curd and the other three are each an āḍhaka; the two-pala items are added and an āḍhaka of ghṛta is cooked. This reading is accepted because it is remembered in an unbroken tradition. In current manuscripts a different reading is read, beginning 'kulattha, mūlaka decoction'.
Ghṛta cooked in a decoction of tṛṇa roots with the jīvanīya drugs, or in the nyagrodhādi group, or in the utpalādi group, undoubtedly destroys gulma arising from raktapitta.
The commentary says these ghṛtas are for pittaja and raktaja gulma. 'Tṛṇa root decoction' means decoction of the tṛṇapañcamūla. 'With jīvanīya' means with kākolī and similar as a paste; the nyagrodhādi group is made into a decoction. The word 'api' adds cooking with jīvanīya as well, and it should be taken with the utpalādi also. 'Gulma' is supplied to 'arising from raktapitta'.
Ghṛta cooked in the āragvadhādi group with appetite-kindling drugs; another cooked in the kṣāra group; another in the mūtra group: these ghṛtas undoubtedly destroy gulma of kapha origin.
The commentary says these are ghṛtas for kaphagulma. 'In the āragvadhādi' means a decoction; 'with appetite-kindling drugs' means with a paste of pippalī and similar. The second ghṛta is cooked in the kṣāra group, from muṣkaka up to the four koshātakīs, though others say the muṣkakādi group; here too with dīpanīya paste. The third is cooked in the mūtra group of eight urines such as cow's urine, again with dīpanīya. Others read 'dīpanīyagaṇe 'param' for 'mūtragaṇe 'param', which the commentators call non-authoritative (anārṣa). Some place this kaphagulma treatment after the vātagulma treatment and explain that ghṛtas that remove kapha are even recommended in vātagulma when vāta is covered by kapha, to pacify kapha.
Key terms
āragvadhādi (āragvadhādigaṇa)
The āragvadha group of drugs.
kṣāravarga
The group of alkali-yielding plants.
mūtragaṇa
The group of eight urines.
Adhikarana ३० (३९) · Śloka ३९
यथादोषोच्छ्रयं चापि चिकित्सेत्सान्निपातिकम् |३९|
Meaning of the śloka
One should treat sannipātika (gulma) according to the excess of the doṣa.
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एवं घृतान्यभिधायाधुना सान्निपातिके दोषोद्रेकेण घृतचूर्णादिभिश्चिकित्सितमाह- यथेत्यादि| यथादोषोच्छ्रयं यो यो दोष उच्छ्रित उत्कटस्तच्चिकित्सया चिकित्सेदित्यर्थः| ‘यथादोषोच्छ्रयं’ इत्यत्रान्ये ‘यथादोषबलं’ इति पठन्ति; तत्राप्येकोऽर्थः|३९|-
Meaning of the commentary
The commentary says that after stating ghṛtas, the treatment of sannipātika gulma by ghṛta, powders and other means, according to the excess of doṣa, is stated: treat with the remedy for whichever doṣa is predominant. Some read 'yathādoṣabalam', with the same meaning.
Key terms
yathādoṣocchraya
According to the doṣa that is in excess.
sānnipātika
Of all three doṣas.
Adhikarana ३१ (३९) · Śloka ४०
चूर्णं हिङ्ग्वादिकं वाऽपि घृतं वा प्लीहनाशनम् ||३९||
पिबेद्गुल्मापहं काले सर्पिस्तैल्वकमेव वा |४०|
Meaning of the śloka
Or he may drink hiṅgvādi powder, or the plīha-removing ghṛta, or in due time the ghṛta that removes gulma, or tailvaka ghṛta.
The commentary says the treatment by doṣa excess is done after vāta is overcome, so a vāta-relieving method is given. Hiṅgvādi powder is that stated in the vātavyādhi context ('hiṅgu, trikaṭu...'); the plīha-removing ghṛta means the six-pala ghṛta. Although the six-pala ghṛta is shown in another tantra as kapha-gulma relieving, here, being a special single-drug type, it is vāta-gulma relieving. 'In due time' means just at the time when it arises, or in the appropriate stage, per others. Tailvaka ghṛta is ghṛta prepared with tilvaka (paṭṭikā lodhra), or that stated in the vātavyādhi chapter.
A kṣāra (alkali) is described: the ash of sesame, sugarcane, kapāla, palāśa, mustard, yavanāla and radish, and of the (dung/waste) of cow, sheep, donkey and elephant, with the urine of buffalo females, mixed with the powders of kuṣṭha, rock salt, yaṣṭyāhva, nāgara and viḍaṅga, with ten palas of ajamodā and sea salt, is cooked in an iron vessel over a mild fire until it is a lehya and taken out. A dose of it is drunk with curd, surā, ghṛta, dhānyāmla, warm water or kulattha soup; this kṣāra undoubtedly destroys gulma and vāta disorders.
The commentary says this is a drinkable kṣāra. Ikṣuraka is kokilākṣa. In place of nāgara some read trikaṭu. Kṛmighāti is viḍaṅga. The ash from sesame up to radish is strained with four times the group of urines of cow and others by the kṣāra method, and to that is added powder of kuṣṭha and up to ajamodā, and the powders of ten palas of sea salt; it is cooked in an iron vessel over mild fire as lehya. Others explain: take a hundred palas of the ashes, boil with four times cow and other urine, reduce to a quarter, add a quarter measure of powder of kuṣṭha and the rest, and cook until lehya. The many admixtures such as curd are prescribed according to doṣa, time and agni. 'Vāta disorders' means tūnī and similar.
The commentary says two yogas are stated in one verse. Kṣāra is yavakṣāra. Yavakṣāra with svarjikā and kuṣṭha, with oil, is one yoga; the ketakī kṣāra with oil is the second. The Bengal (gauḍa) commentators take it as one yoga: ketakī kṣāra with svarjikā and kuṣṭha and oil.
Key terms
yavakṣāra
Alkali from barley plant.
ketakīkṣāra
Alkali from ketakī.
svarjikā
Sarjikṣāra, an alkali.
Adhikarana ३४ (४६) · Śloka ४६
पीतं सुखाम्बुना वाऽपि स्वर्जिकाकुष्ठसैन्धवम् |४६|
Meaning of the śloka
Or svarjikā, kuṣṭha and rock salt may be drunk with lukewarm water.
Vṛścīva, urubūka, varṣābhū, the two bṛhatīs and citraka are boiled in a drona of water reduced to a quarter; it is put in a jar smeared with pippalī, citraka and honey, a prastha of honey is added along with half the powder of pathyā, and it is kept in husks for ten days; taken by one whose food is digested, this ariṣṭa overcomes gulma, indigestion and distaste for food.
The commentary says this is the vṛścīva ariṣṭa. Vṛścīva is white punarnavā; urubūka is white eraṇḍa; varṣābhū is red punarnavā; the two bṛhatīs are the small-fruited and the large-fruited kaṇṭakārī. The quantity is an āḍhaka of each, though others say a hundred palas, since the passage specifies 'a hundred palas in a drona of water'. 'Reduced to a quarter' means the decoction is reduced to a fourth. The jar is smeared with pippalī and other pastes as much as suffices. Pathyā powder half is eight palas of harītakī powder. 'In husks' means kept inside husks. 'One whose food is digested' means one with a light koṣṭha. It is drunk only in the morning.
Pāṭhā, nikumbha, rajanī, trikaṭu, triphalā, agnika, salt, and vṛkṣabīja, in equal parts, with old jaggery; or the powder with pathyā cooked in cow's urine, made thick into pills and eaten (on an empty stomach). These destroy gulma, spleen disorder and weak agni completely, and also heart disease, grahaṇī disorder and severe pāṇḍu.
The commentary says nikumbha is dantī; agnika is citraka, or agnimantha or moraṭa per others; vṛkṣabīja is indrayava; anava guḍa is old jaggery. The powder with an equal quantity of old jaggery is eaten; alternatively the powder with harītakī is cooked in cow's urine, and when thick made into pills eaten in the morning. The harītakī quantity is a quarter of the powder; the cow's urine is four times.
In a gulma that is painful, raised, motionless, and accompanied by burning, suppuration-like pain, the blood may be drawn off with leeches, or by venesection (sirāmokṣa).
The commentary says bloodletting in gulma in a particular condition is stated. Aspande means motionless. With pākarugānvita, meaning with the pain of suppuration, blood is taken by leeches at the site of the gulma itself, and by venesection at the arms, as taught in another tantra. Some read a line 'and cutting with a gourd is also recommended in gulma of kapha nature'.
Slightly warm meat juices of jāṅgala animals, well unctuous, with rock salt evident and mixed with kaṭutrika, are beneficial as drinks for those with gulma.
The commentary says slightly warm means mildly hot. Jāṅgala juices are meat juices of jaṅghāla and viṣkira birds, well prepared; 'well unctuous' means properly prepared with fat. 'Beneficial' is understood 'according to the doṣa'.
The commentary says vāta-relieving drugs are bhadradāru and the like; 'well prepared' means with sneha and the like. Khalas are preparations with kapittha, pomegranate, buttermilk and vegetables, known as 'kacilā'. With pañcamūla means made with kapittha and the like together with pañcamūla. 'Beneficial' is qualified as 'according to the doṣa'.
Key terms
peyā
Thin gruel.
khala
A sour buttermilk-based preparation, known as kacilā.
kaulattha rasa
Soup of kulattha (horse gram).
Adhikarana ४० (५५) · Śloka ५५
बद्धवर्चोनिलानां तु सार्द्रकं क्षीरमिष्यते ||५५||
Meaning of the śloka
For those with obstructed stool and wind, milk with ginger is recommended.
The commentary says this states special food according to condition: for those in whom stool and wind are obstructed, milk with fresh ginger is recommended as food.
The commentary says that after internal treatments, external treatment by sweating is stated for the condition. Kumbhī and the other sweatings are described in the chapter on sweating. The physician should perform them skilfully.
Key terms
kumbhīsveda
Sweating using a pot.
piṇḍasveda
Sweating using a bolus.
iṣṭakāsveda
Sweating using heated bricks.
Adhikarana ४२ (५६) · Śloka ५७
गुल्मिनः सर्व एवोक्ता दुर्विरेच्यतमा भृशम् ||५६||
अतश्चैतांस्तु सुस्विन्नान् स्रंसनेनोपपादयेत् |५७|
Meaning of the śloka
All those with gulma are said to be extremely difficult to purge; therefore, after they are well sweated, purgation should be applied.
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वातश्लेष्मात्मके सशूले कठिने च गुल्मे गुल्मिनो विरेकमाह- गुल्मिन इत्यादि| सुखिन्नानिति स्नेहो हि स्वेदेनैवाक्षिप्तः, तेन सम्यक् स्निग्धस्विन्नान्| स्रंसनेन विरेकेण| उपपादयेत् योजयेत्||५६||-
Meaning of the commentary
The commentary says purgation in a gulma of vāta-kapha nature that is painful and hard is stated. 'Well sweated' means well oleated and sweated, since sneha is drawn out only by sweating. 'Purgation' is virecana; 'apply' means use.
Key terms
durvirecyatama
Extremely hard to purge.
sraṃsana
Purgation.
susvinna
Well sweated.
Adhikarana ४३ (५७-५८) · Śloka ५९
विम्लापनाभ्यञ्जनानि तथैव दहनानि च ||५७||
उपनाहाश्च कर्तव्याः सुखोष्णाः साल्वणादयः |
उदरोक्तानि सर्पींषि मूत्रवर्तिक्रियास्तथा ||५८||
लवणानि च योज्यानि यान्युक्तान्यनिलामये |५९|
Meaning of the śloka
Vimlāpana (kneading), anointing, and likewise burning (dahana) and poultices (upanāha), lukewarm, of the sālvaṇa type and others, are to be done. The ghṛtas stated in udara, mūtravarti procedures, and the salts prescribed in vāta disorders are to be used.
The commentary asks whether purgation alone is done in gulma or other measures too. Vimlāpana is pressing the gulma with the fingers; dahana is burning with an instrument such as a jāmbava. In 'sālvaṇa etc.' the word ādi indicates kinds; so other poultice sweatings of the sālvaṇa type are done on a gulma that is turning towards suppuration. The ghṛtas of udara are those beginning 'a prastha of harītakī powder'. The mūtravarti procedures are those in the udara chapter beginning 'of substances for vamana and śirovirecana'. The salts are patra-lavaṇa, sneha-lavaṇa and kalyāṇa-lavaṇa, from the vāta disorder context. Some read 'powders' after 'ghṛtas' and explain them as nārācaka and the like.
When vāta and stool are obstructed, suppositories (vartis) rich in pepper, made with sea salt, ginger and mustard, should be made and placed at the anus.
The commentary says this gives another suppository application for this condition. Sāmudra is sea salt, or sea foam per others. 'Pepper-predominant' means with pepper as the chief ingredient.
Key terms
varti
Suppository or wick.
marica
Black pepper.
sāmudra
Sea salt, or sea foam per others.
Adhikarana ४५ (६०) · Śloka ६१
दन्तीचित्रकमूलेषु तथा वातहरेषु च ||६०||
कुर्यादरिष्टान् सर्वांश्च श्लोकस्थाने यथेरितान् |६१|
Meaning of the śloka
One should make ariṣṭas with the roots of dantī and citraka, and with vāta-relieving drugs, and all as described in the śloka-sthāna.
The commentary explains that vāta-relieving drugs are vidārigandhā and similar. 'As described in the śloka-sthāna' means the āsava-making stated in the Sūtrasthāna in the purgation preparations should be followed here with decoctions of dantī and others. Others say the word 'sthāna' is omitted, so 'as described' refers to this gulma chapter, meaning ariṣṭa is made with a decoction of dantī and the like, with honey and pathyā powder added like the vṛścīva ariṣṭa mentioned above, or by the Sūtrasthāna method.
The commentary says aṅkura means tender shoots. 'Fried' is supplied with 'in sneha'; others say fried on fire, in which view even sprouts that aggravate vāta are beneficial in gulma because they oppose the disease. Pūtīka is cirabilva (Holoptelea); nṛpavṛkṣa is girimālaka.
Key terms
pūtīka
Cirabilva.
nṛpavṛkṣa
Girimālaka.
aṅkura
Tender sprout.
Adhikarana ४७ (६२) · Śloka ६२
ऊर्ध्ववातं मनुष्यं च गुल्मिनं न निरूहयेत् |६२|
Meaning of the śloka
A person with gulma who has upward-moving vāta should not be given nirūha (decoction enema).
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इदानीं गुल्मे हितस्यापि निरूहस्यावस्थायां निषेधमाह- ऊर्ध्ववातमित्यादि| ऊर्ध्ववातम् ऊर्ध्ववातयुक्तं गुल्मिनं मनुष्यं न निरूहयेदिति सम्बन्धः| केचिदिमं पाठं न पठन्ति|६२|-
Meaning of the commentary
The commentary says this states a prohibition of nirūha, even though it is beneficial in gulma, in this condition. It adds that some do not read this verse.
Key terms
ūrdhvavāta
Upward-moving vāta.
nirūha
Decoction enema.
Adhikarana ४८ (६२-६३) · Śloka ६३
पिबेत्त्रिवृन्नागरं वा सगुडां वा हरीतकीम् ||६२||
गुग्गुलुं त्रिवृतां दन्तीं द्रवन्तीं सैन्धवं वचाम् |
मूत्रमद्यपयोद्राक्षारसैर्वीक्ष्य बलाबलम् ||६३||
Meaning of the śloka
He may drink trivṛt with nāgara, or harītakī with jaggery; or guggulu, trivṛt, dantī, dravantī, rock salt and vacā, with urine, wine, milk or grape juice, considering strength and weakness.
The commentary says 'drink' is with the liquid stated next (urine, wine and so on); others say with water. 'Trivṛt with nāgara' is one yoga and 'harītakī with jaggery' is another. Dravantī is a kind of dantī with leaves like cīrita. 'Considering strength and weakness' is completed with 'of the doṣas and other factors'; 'drink' applies here also.
Key terms
trivṛt
Operculina (a purgative root).
dravantī
A variety of dantī.
balābala
Strength and weakness.
Adhikarana ४९ (६४) · Śloka ६४
एवं पीलूनि भृष्टानि पिबेत् सलवणानि तु |६४|
Meaning of the śloka
In the same way, he may drink pīlu fruits, fried, with salt.
The commentary says surā here means flour-based (paiṣṭī) surā. 'Quickly' is connected with 'destroys'. 'At the proper time' means in the stage of distension and the like.
The commentary says 'with milk' means with cow's milk; barley means barley made into porridge or the like; kulmāṣas are foods made of barley flour; 'salt-predominant' means with rock salt chiefly.
The commentary says a complication of gulma is now stated. 'Of this' means of the gulma. Upadrava is a condition arising later. 'Somehow' means from its own causes. The pain is as if a stake or peg had been driven in.
In it (the pain complication) there is retention of stool and urine, difficult breathing, stiffness of the body, thirst, burning, giddiness, increase of pain with burning of food, horripilation, distaste for food, vomiting, increase of pain after eating, and heaviness of the limbs; (these arise) singly from vāta and the other doṣas, or, in mixed forms... (the verse is cut off).
The commentary gives the signs and number by doṣa. Sthirāṅgatā is hardness of the body. 'Increase with burning of food' means the pain increases when food is burning. 'Increase after eating' means pain increases just after eating. Jaḍāṅgatā is heaviness or numbness of the limbs. 'Mixed' means by pairs and by combined forms. The first group beginning 'retention of stool and urine' are the signs of vātaja pain; 'thirst, burning' etc. are of pittaja pain; 'horripilation, distaste for food' etc. are of kaphaja pain; signs of two doṣas by pairs; signs of all together in the combined one.
Key terms
śūla-upadrava (śūlopadrava)
Pain as a complication of gulma.
sthirāṅgatā
Hardness of the body.
jaḍāṅgatā
Heaviness or numbness of the limbs.
Adhikarana ५४ (६९-७२) · Śloka ७३
...वीक्ष्य योजयेत् |
पथ्यात्रिलवणं क्षारं हिङ्गुतुम्बुरुपौष्करम् ||६९||
यवानीं च हरिद्रां च विडङ्गान्यम्लवेतसम् |
विदारीत्रिफलाऽभीरुशृङ्गाटीगुडशर्कराः ||७०||
काश्मरीफलयष्ट्याह्वपरूषकहिमानि च |
षड्ग्रन्थातिविषादारुपथ्यामरिचवृक्षजान् ||७१||
कृष्णामूलकचव्यं च नागरक्षारचित्रकान् |
उष्णाम्लकाञ्जिकक्षीरतोयैः श्लोकसमापनान् ||७२||
यथाक्रमं विमिश्रांश्च द्वन्द्वे सर्वांश्च सर्वजे |७३|
Meaning of the śloka
... after examining (the type), one should apply the following listed yogas: pathyā, the three salts, kṣāra, hiṅgu, tumburu, puṣkara, yavānī, haridrā, viḍaṅga, sour vetasa; vidārī, triphalā, abhīru (śatāvarī), śṛṅgāṭī, jaggery and sugar; kāśmarī fruit, yaṣṭyāhva, parūṣaka and himā (sandal); vacā, ativiṣā, dāru, pathyā, pepper and vṛkṣaja (indrayava); kṛṣṇā, mūlaka, cavya, nāgara, kṣāra and citraka; with hot sour kāñjika, milk or water, the (yogas) completing a verse; mixed in pairs, or all together in the combined type.
The commentary gives the treatment of the complication of pain. 'After examining' means examining the pain by doṣa. The three salts are saindhava, sauvarcala and biḍa. Kṣāra is yavakṣāra; abhīru is śatāvarī; śṛṅgāṭī is the aquatic three-thorned fruit; guḍa-śarkarā is gāṅgeṭī fruit; himā is sandal; ṣaḍgranthā is vacā; vṛkṣaja is indrayava; mūlaka is pippalīmūla. Hot applies to sour kāñjika and the rest. 'Completing a verse' is supplied as 'yogas'. In order: from pathyā to sour vetasa with hot sour kāñjika for the vātika; vidārī to himā with hot milk for the paittika; ṣaḍgranthā to citraka with hot water for the śleṣmika. Mixed in pairs: pathyā group with the vidārī group for vāta-pitta; pathyā with ṣaḍgranthā group for vāta-kapha; vidārī with ṣaḍgranthā group for pitta-kapha; and all three of the groups in sannipāta.
Likewise, pouring (seka), immersion baths (avagāha), pastes (pradeha), anointing (abhyaṅga) and food; holding vessels filled with cool water; emesis, kneading, sweating, fasting and depleting measures, and the whole order beginning with oleation, are taught in particular.
The commentary asks whether only this is done in the pain complication or other measures too. 'Likewise' means in order (yathāsaṅkhyam): pouring and the like for the vātika, cool water and the like for the paittika, emesis and the like for the śleṣmika. The order of oleation and the rest applies according to doṣa and stage: two for the two-doṣa type, all for the combined type. Depletion measures are also other kapha-reducing measures.
Key terms
seka
Pouring or irrigation.
avagāha
Immersion bath.
kṣapaṇa
Depleting therapy.
Adhikarana ५६ (७५) · Śloka ७६
वल्लूरं मूलकं मत्स्यान् शुष्कशाकानि वैदलम् ||७५||
न खादेदालुकं गुल्मी मधुराणि फलानि च |७६|
Meaning of the śloka
A person with gulma should not eat vallūra, radish, fish, dry vegetables, split pulses, ālu tubers, and sweet fruits.
The commentary says that after the complication of gulma, what is to be avoided is stated. Vallūra is dried meat; vaidala is mudga and forest mudga pulses and the like; āluka is of many kinds such as piṇḍāluka; sweet fruits are milky-tree fruits such as coca and moca. By 'ca' other similar things are also to be avoided. Some read further after this: 'light food that kindles agni, is unctuous, warm, vāta-moving and nourishing is beneficial for all with gulma; bleeding at the site, venesection in the middle of the arm, sweating and moving of vāta are recommended in all gulmas'. Ḍalhaṇa says it is not written because it is absent in the text, and that it is stated on seeing other books.
The commentary says that after gulma's complication of pain, pain alone is now taken up. 'At the sites of gulma' means at the sites stated in this chapter. Others give up this verse and read a separate chapter beginning 'now, therefore, we shall explain the treatment of śūla', with the pratijñā, and then the passage beginning 'from suppression of vāta, urine and stool' as a separate śūla chapter; they give up the earlier order. Still others hear this verse and abandon it. The commentator says he has read it by Jejjaṭa's intention, following all views.
From suppression of wind, urine and stool, excessive eating, indigestion, over-eating on top of undigested food, exertion, eating incompatible food, drinking water at a time of hunger, eating sprouted grains, eating flour foods and dried meat, and using such and other things, vāta aggravated in the koṣṭha produces severe pain, and the person, tormented by it, cannot breathe.
The commentary gives cause and pathogenesis of śūla. Nigraha is holding back when the urge comes. Ajīrṇa is of kinds such as āma and vidagdha. Adhyaśana is eating on top of undigested food. Āyāsa is action causing bodily strain. Viruddhānna is incompatible food, as taught in the 'hitāhitīya' chapter. Virūḍha is grain that has sprouted. 'Such things' means other doṣa-aggravating things. Koṣṭha is the whole abdomen. Nirucchvāsa means breath obstructed by that pain. The first part up to 'and other things' is the cause; 'vāta aggravated' onwards is the pathogenesis.
The commentary explains why it is called śūla: like the hammering of a stake, the pains of the afflicted person are intense; just as someone struck by a peg feels sharp pain, so from this comes the name śūla.
In the person in whom severe pain arises even when fasting, who becomes stiff in the body, breathes as if with difficulty, and passes wind, urine and stool with difficulty: by these signs one should recognise śūla arising from vāta.
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वातशूललक्षणमाह- निराहारस्येत्यादि||८२-८३||
Meaning of the commentary
The commentary states the signs of vātaja śūla; no further explanation is given.
Thirst, burning, intoxication-like state, fainting and severe pain; he desires cold things and is relieved by cold. By these signs one should recognise śūla arising from pitta.
In one pressed by the pain, nausea arises, with great fullness of the abdomen and heaviness of the body. This is said to be the indication of śūla arising from kapha.
Having seen all the signs, one should declare it sannipātika; śūla born of sannipāta should be declared incurable. The signs of the pains have been told... (the verse is cut off).
The commentary gives the signs of sannipātika śūla. An objection is raised: some earlier teachers have fixed a site for śūla by doṣa, quoting: 'they say vāta-type is in the bladder, pitta-type at the navel, kapha settled in the heart, sides and flanks, and in all places from sannipāta'; why is that not stated here? The reply: since aggravated doṣas can cause disease both in their own site and in others, there is no fixed site, therefore it is not so stated.
Key terms
sānnipātika śūla
Pain involving all three doṣas.
asādhya
Incurable.
niyata sthāna
A fixed site.
Adhikarana ६४ (८८) · Śloka ८९
...चिकित्सां तु निबोध मे |
आशुकारी हि पवनस्तस्मात्तं त्वरया जयेत् ||८८||
तस्य शूलाभिपन्नस्य स्वेद एव सुखावहः |८९|
Meaning of the śloka
... hear from me the treatment. Vāta acts quickly; therefore one should overcome it swiftly. For one afflicted by that pain, sweating alone brings comfort.
The commentary says 'hear' means know it from me. Āśukārī means quick-acting, because it causes fatal harm swiftly. 'Him' means the vāta. 'Afflicted by pain' means overcome by vātika pain; others explain it as one overcome by the pain of that vāta.
With pāyasa, kṛsarā-piṇḍa, or unctuous meats, (sweating) is beneficial.
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स च स्वेदः कैर्द्रव्यैः कार्य इत्याह- पायसैरित्यादि| पायसो दुग्धसिद्धास्तण्डुलाः| कृशरापिण्डैः तिलतण्डुलमाषकृतयवागूपिण्डैः| हित इति ‘स्वेद’ इति शेषः||८९||
Meaning of the commentary
The commentary says this states with what materials the sweating is done. Pāyasa is rice cooked in milk. Kṛsarāpiṇḍa is a lump of gruel made of sesame, rice and māṣa. 'Sweating' is supplied with 'beneficial'.
He may eat unctuous, warm food with trivṛt greens; or eat the sprouts of cirabilva fried in oil. One afflicted by pain should use, as available, unctuous soups of vaihaṅga (game birds), jāṅgala meats, and the meat of burrowing animals.
The commentary says the food should be unctuous and so on, eaten with trivṛt greens. Aṅkura here means shoots. Vaihaṅga jāṅgala means made from birds such as lāvaka. Bileśaya are dog-like animals, śallaka and similar.
The commentary says surā is flour-made; sauvīraka is a kind of kāñjika; cukra is a sour preparation; mastu is dadhimastu; udaśvit is buttermilk with half water. 'As available' is meant by 'likewise'. Although kālalavaṇa is said to be odourless sauvarcala, here the scented sauvarcala is meant because it is stated so in another tantra.
The commentary says 'appropriate sour' means sour substances such as pomegranate added in proper measure. 'Prepared with lāvaka soup' means it is treated with a soup made from lāvaka.
The commentary says śigru is the tree vegetable, though others say śobhāñjana; śyāmā is trivṛt with a red root; surasā is tulasī; aśvamūtrī is śallakī.
Key terms
śyāmā
Trivṛt with red root.
aśvamūtrī
Śallakī.
madya
Wine or liquor.
Adhikarana ७० (९५-९९) · Śloka १००
पृथ्वीकाजाजिचविकायवानीव्योषचित्रकाः ||९५||
पिप्पल्यः पिप्पलीमूलं सैन्धवं चेति चूर्णयेत् |
तानि चूर्णानि पयसा पिबेत् काम्बलिकेन वा ||९६||
मध्वासवेन चुक्रेण सुरासौवीरकेण वा |
अथवै(चै)तानि चूर्णानि मातुलुङ्गरसेन वा ||९७||
तथा बदरयूषेण भावितानि पुनः पुनः |
तानि हिङ्गुप्रगाढानि सह शर्करया पिबेत् ||९८||
सह दाडिमसारेण वर्तिः कार्या भिषग्जिता |
सा वर्तिर्वातिकं शूलं क्षिप्रमेव व्यपोहति ||९९||
गुडतैलेन वा लीढा पीता मद्येन वा पुनः |१००|
Meaning of the śloka
Pṛthvīkā, ajājī, cavikā, yavānī, vyoṣa, citraka, pippalī, pippalīmūla and rock salt are powdered. These powders are drunk with milk, or with kāmbalika, honey āsava, cukra, surā or sauvīraka; or the powders, repeatedly saturated with mātuluṅga juice or badara soup, made rich in hiṅgu, may be drunk with sugar. A vartī (pill/suppository) made with pomegranate essence by the physician, licked with jaggery and oil or drunk with wine, quickly removes vātaśūla.
The commentary says pṛthvīkā is hiṅgupatrikā; ajājī is a variety of jīraka in the northern region; kāmbalika is a soup of curd-whey cooked with sour. The powders are alternatively saturated repeatedly with bījapūraka juice or badara soup, with much hiṅgu, and drunk with sugar and mātuluṅga juice. Or a vartī is made from the same powders with pomegranate essence; licked with jaggery and oil or drunk with wine, it removes vātika śūla.
When vātaśūla has arisen, one should feed a dry (rūkṣa) patient with unctuous food. Well-prepared ghṛtapūras should be given especially, and he should drink vāruṇī; thus he becomes comfortable. This is the treatment told for śūla arising from vāta.
The commentary says 'well prepared' means with ginger, pepper and the like. Ghṛtapūra means ghṛta-cakes. Vāruṇī is surā. 'Thus' means in that way. The last line is the conclusion: this is the treatment of vātaja śūla.
Key terms
ghṛtapūra
A ghee-based cake.
vāruṇī
A kind of surā.
Adhikarana ७३ (१०३-१०४) · Śloka १०४
अथ पित्तसमुत्थस्य क्रियां वक्ष्याम्यतः परम् ||१०३||
स सुखं छर्दयित्वा तु पीत्वा शीतोदकं नरः |
शीतलानि च सेवेत सर्वाण्युष्णानि वर्जयेत् ||१०४||
Meaning of the śloka
Now I shall describe the treatment of pain arising from pitta. Such a man, after drinking cold water and vomiting comfortably, should use cooling things and avoid everything hot.
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वातशूलोपक्रममभिधायेदानीं पित्तशूलचिकित्सामाह- अथेत्यादि| अथेति वाक्यालङ्कारे, वाक्योपक्रमे इत्यन्ये| तदेष चिकित्सितमाह- स इत्यादि| स पित्तशूली नरः, शीतोदकं पीत्वा, सुखं यथा भवति तथा छर्दयित्वा, शीतलानि भजेत, उष्णानि सर्वाणि वर्जयेदिति पिण्डार्थः||१०३-१०४||
Meaning of the commentary
The commentary says that after the vāta-śūla treatment, the pitta-śūla treatment is given. 'Atha' is a verse-ornament word, or marks the beginning of a topic per others. The pittaśūla patient, having drunk cold water and vomited comfortably, should use cooling things and avoid all hot ones.
Key terms
pittaśūla
Pain arising from pitta.
śītodaka
Cold water.
chardana
Vomiting.
Adhikarana ७४ (१०५) · Śloka १०५
मणिराजतताम्राणि भाजनानि च सर्वशः |
वारिपूर्णानि तान्यस्य शूलस्योपरि निक्षिपेत् ||१०५||
Meaning of the śloka
Vessels of gems, silver and copper, in all cases filled with water, should be placed over the site of that pain.
Jaggery, śāli rice, barley, milk, drinking ghṛta, purgation, jāṅgala meats are the remedies for those with pittaśūla. He should use pitta-relieving juices and avoid pitta-aggravating things. He may drink palāśa or dhānvana soup with sugar.
The commentary says pitta-relieving juices are the meat juices of the pitta-reducing meats listed in the jāṅgala group. Pittala things are foods and drinks that aggravate pitta. Pālāśa soup means the juice of flesh-eating animals' meat; dhānvana is the juice of jāṅgala meat.
The commentary gives the treatment of kaphaśūla. 'Eating' means the meal. 'With pippalī water' means water with pippalī; others take 'water' to mean decoction, and still others say pippalī here means madana fruit seeds.
Key terms
śleṣmaśūla
Pain arising from kapha.
vamana
Therapeutic emesis.
pippalīvāri
Water with pippalī, decoction, or madana seeds per others.
Adhikarana ७८ (११०) · Śloka ११०
रूक्षः स्वेदः प्रयोज्यः स्यादन्याश्चोष्णाः क्रिया हिताः |
पिप्पली शृङ्गवेरं च श्लेष्मशूले भिषग्जितम् ||११०||
Meaning of the śloka
Dry sweating should be used, and other warming measures are beneficial. Pippalī and ginger are the physician's remedy for kaphaśūla.
The commentary says dry sweating is without oleation, done with things such as dried dung. The use of pippalī and ginger is in the form of powder, paste, decoction and the like.
Key terms
rūkṣa sveda
Dry sweating without oleation.
śṛṅgavera
Fresh ginger.
Adhikarana ७९ (१११) · Śloka १११
पाठां वचां त्रिकटुकं तथा कटुकरोहिणीम् |
चित्रकस्य च निर्यूहे पिबेद्यूषं सहार्जकम् ||१११||
Meaning of the śloka
Pāṭhā, vacā, trikaṭu and kaṭurohiṇī may be drunk in a decoction of citraka; or a soup with arjaka may be drunk.
The commentary says pāṭhā and the other drugs, powdered or made into a paste, are drunk in a decoction of citraka, which is one yoga. The soup with arjaka is a second yoga: a śūla-relieving soup of śimbi grain. Arjaka is kuṭheraka.
Fruits and roots of eraṇḍa, root of gokṣura, śālaparṇī, pṛśniparṇī, bṛhatī, kaṇṭakārikā, śṛgālavinnā, sahadevā, mahāsahā, kṣudrasahā and root of ikṣuraka are to be collected and cooked in a drona of water, reduced to a quarter, and drunk with yavakṣāra. It forcibly destroys śūla of vāta, pitta, kapha or sannipāta, as the wind (destroys) torn clouds.
The commentary says this is the 'eraṇḍa twelve'. Śṛgālavinnā is a kind of pṛśniparṇī; mahāsahā is māṣaparṇī; kṣudrasahā is mudgaparṇī; ikṣuraka is kokilākṣaka. The drug ingredients total sixty-four palas, or a tulā per others. 'Forcibly' means by force. The word 'drink' here indicates use by swallowing, so it may also be sipped in thirst; otherwise, drinking two palas of a decoction that has been cooked to a quarter of a drona would be pointless. Although this yoga removes all śūla, it is stated here because it is especially for kaphaśūla. Some read 'dadyāccaivekṣuvālikām' in place of 'mūlaṃ cekṣurakasya' and explain it as khaggalī.
Pippalī, svarjikākṣāra, barley and citraka, together with sevya, should be brought together and made into ash by the skilful; that, drunk with hot water, is the physician's remedy for kaphaśūla.
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पिप्पलीत्यादि| सेव्यम् उशीरं, तत् भस्म||११६||-
Meaning of the commentary
The commentary says sevya is uśīra, and 'that' refers to the ash.
Kapha lodged in the sides of the abdomen obstructs the vāta. Thus obstructed, it quickly produces distension, a rumbling sound, and pricking as if with needles; the person breathes with difficulty, does not desire food, gets no sleep, and is tormented by pain. This is to be known as pārśvaśūla arising from kapha and vāta.
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यद्यपि चत्वारः शूलाः, तथापि दोषधातुमलसंसर्गादायतनविशेषान्निमित्ततश्चैषां विकल्प इति कृत्वा पार्श्वादिशूलमाह- रुणद्धीत्यादि| स वायुः| आध्मानम् उदरापूरः| गुड्गुडायनमत्र अव्यक्तशब्दः| नो निद्रामुपैति न निद्रां प्राप्नोतीत्यर्थः||११७-११९||
Meaning of the commentary
The commentary says that although there are four kinds of śūla, the classification by the site and cause through mixture of doṣa, dhātu and mala leads to the side-pain and others being stated. Ādhmāna is fullness of the abdomen. Guḍguḍāyana is an indistinct sound.
Key terms
pārśvaśūla
Pain in the sides.
ādhmāna
Distension.
guḍguḍāyana
Gurgling sound.
Adhikarana ८३ (१२०-१२२) · Śloka १२३
तत्र पुष्करमूलानि हिङ्गु सौवर्चलं विडम् |
सैन्धवं तुम्बुरुं पथ्यां चूर्णं कृत्वा तु पाययेत् ||१२०||
पार्श्वहृद्बस्तिशूलेषु यवक्वाथेन संयुतम् |
सर्पिः प्लीहोदरोक्तं वा घृतं वा हिङ्गुसंयुतम् ||१२१||
बीजपूरकसारं वा पयसा सह साधितम् |
एरण्डतैलमथवा मद्यमस्तुपयोरसैः ||१२२||
भोजयेच्चापि पयसा जाङ्गलेन रसेन वा |१२३|
Meaning of the śloka
For that, a powder of puṣkaramūla, hiṅgu, sauvarcala, viḍa, saindhava, tumburu and pathyā should be made and given with a barley decoction in pains of the sides, heart and bladder. Or the plīhodara ghṛta, or ghṛta with hiṅgu, or the seed-essence of bījapūraka cooked with milk; or castor oil, or wine, curd-water and milk with juice; and he should be fed with milk or jāṅgala meat juice.
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पार्श्वशूले चिकित्सितमाह- तत्रेत्यादि| पुष्करमूलादीनि द्रव्याणि चूर्णं कृत्वा पार्श्वादिशूलेषु यवक्वाथेन संयुतं पाययेदिति पिण्डार्थः| यद्यप्ययं योगोऽपतन्त्रकेऽपि पठितः, तथाऽप्यत्राम्लवेतसाभावात् पुनः पठितः| सर्पिः प्लीहोदरोक्तमित्यादि प्लीहोदरोक्तं सर्पिः षट्पलं, हिङ्गुसंयुतं घृतं वा असिद्धमेव| पयसा क्षीरेण, साधितं क्वाथितं, बीजपूरकसारं बीजपूरकफलबीजम्, अत्रापि पाययेदिति सम्बध्यते| केचित् ‘बीजपूरकसारं च’ इत्यत्र ‘पिबेद्बीजकसारं च’ इति पठन्ति| एरण्डतैलमित्यादि|- एरण्डतैलं वा मद्यादिभिर्यथासात्म्यं यथादोषं च प्रातरेव पिबेत्, जीर्णे च क्षीरेण जाङ्गलरसेन वा भोजयेत्||१२०-१२२||-
Meaning of the commentary
The commentary says the powder from puṣkaramūla onward is given with barley decoction in pains of the sides, heart and bladder. Although this yoga is also read in the Apatantraka, it is repeated here because sour vetasa is absent there. 'Ghṛta from plīhodara' means the six-pala ghṛta, or ghṛta with hiṅgu (not cooked); bījapūraka essence is the fruit seeds, cooked in milk; some read 'pibed bījakasāraṃ ca'. Castor oil is taken in the morning with wine or the like according to suitability and doṣa, and after digestion he is fed with milk or jāṅgala meat juice.
Key terms
puṣkaramūla
Root of puṣkara.
eraṇḍataila
Castor oil.
ṣaṭpalaka ghṛta
The six-pala ghṛta of plīhodara.
Adhikarana ८४ (१२३-१२५) · Śloka १२५
प्रकुप्यति यदा कुक्षौ वह्निमाक्रम्य मारुतः ||१२३||
तदाऽस्य भोजनं भुक्तं सोपस्तम्भं न पच्यते |
उच्छ्वसित्यामशकृता शूलेनाहन्यते मुहुः ||१२४||
नैवासने न शयने तिष्ठन् वा लभते सुखम् |
कुक्षिशूल इति ख्यातो वातादामसमुद्भवः ||१२५||
Meaning of the śloka
When vāta, having overpowered agni in the abdomen, becomes aggravated, the food eaten by him is not digested and becomes stiff. He breathes, and is repeatedly struck by pain with unripe stool; he finds no comfort in sitting, lying or standing. This is known as kukṣiśūla, arising from vāta and āma.
The commentary describes kukṣiśūla. Ākramya means having weakened. Sopastambha means with stiffness. 'Breathes' has the subject 'the man'. 'With unripe stool' means with undigested stool. 'Standing' means getting up.
In that (kukṣiśūla), emesis should be done, or fasting according to strength; then saṃsarga-pācana (the graded dietary sequence with digestion-promoting measures) should be done with sour things combined with appetite-kindling ones.
The commentary gives the treatment of kukṣiśūla. 'According to strength' means without exceeding the strength. Saṃsarga-pācana is digestion through the graded sequence beginning with peyā. Sour things are pomegranate, buttermilk and the like; 'with appetite-kindling' means with pañcakola.
A decoction of nāgara, dīpyaka, cavya, hiṅgu, sauvarcala, viḍa, seeds of mātuluṅga, śyāmā, urubūka, bṛhatī and kaṇṭakārī, which removes pain, may be drunk.
The commentary says the decoction is of nāgara and the rest, with hiṅgu, sauvarcala and viḍa added. 'Seeds' applies to all items from mātuluṅga to kaṇṭakārī. Śyāmā is vṛddhadāraka; urubūka is red eraṇḍa, or white per others. Bṛhatī is the small-fruited or large-fruited kind.
Vacā, sauvarcala, hiṅgu, kuṣṭha, ativiṣā, abhayā and kuṭaja seeds remove pain immediately; they should be used for purgation after knowing the strength and weakness of the doṣas.
The commentary says purgation in kukṣiśūla is stated. Vacā through kuṭaja seeds remove pain at once and are used for purgation after knowing the strength of the doṣas. The word 'ādi' is understood to be omitted, so constitution and other factors are also to be known.
The commentary raises the question of whether only purgation suits kukṣiśūla or other measures also, and answers with this statement of snehabasti and nirūha.
The commentary says sweating measures are praised in kukṣiśūla. Upanāha are the sālvaṇa type poultices. Dhānyāmla is kāñjika. Avagāha is immersion in a tub filled with vāta-relieving liquid. 'Whatever else is beneficial' means anything else beneficial in kukṣiśūla is also recommended.
Vāta, obstructed by kapha and pitta and combined with rasa, sits in the heart and produces pain that greatly obstructs breathing. This is called hṛcchūla, arising from rasa and vāta.
The commentary describes hṛcchūla. 'Obstructed' means blocked; 'combined with rasa' means joined with rasa. Ucchvāsārodhaka means completely obstructing breathing. Because this hṛcchūla differs from hṛdroga, it is distinct from it, and also from the difference in pathogenesis.
Key terms
hṛcchūla
Pain in the heart region.
hṛdroga
Heart disease in the classical sense.
rasamūrcchita
Combined with rasa.
Adhikarana ९१ (१३३) · Śloka १३३
तत्रापि कर्माभिहितं यदुक्तं हृद्विकारिणाम् |१३३|
Meaning of the śloka
The treatment stated for heart disorders is also to be applied there.
Vāta, aggravated by suppression, stays covering the bladder; then pain arises in the bladder, groin and navel, with obstruction of stool, urine and wind. This is bastiśūla, from vāta.
When vāta, pressing between the navel, groin, sides, abdomen and penis, covers and seizes the urine, that is mūtraśūla, from vāta.
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मूत्रशूलमाह- नाभ्यामित्यादि| यदा मेढ्रान्त्रमर्दको वायुरावृत्य अवरुध्य मूत्रं गृह्णाति , तदा नाभ्यादिषु शूलो जायते| स च मारुतात् मूत्रशूलो ज्ञेयः||१३५||
Meaning of the commentary
The commentary says when vāta that presses within the penis covers and obstructs the urine, pain arises in the navel and other places; it is to be known as mūtraśūla from vāta.
Key terms
mūtraśūla
Pain associated with obstructed urine.
meḍhrāntara
Within the penis.
Adhikarana ९४ (१३६-१३९) · Śloka १३९
वायुः प्रकुपितो यस्य रूक्षाहारस्य देहिनः |
मलं रुणद्धि कोष्ठस्थं मन्दीकृत्य तु पावकम् ||१३६||
शूलं सञ्जनयंस्तीव्रं स्रोतांस्यावृत्य तस्य हि |
दक्षिणं यदि वा वामं कुक्षिमादाय जायते ||१३७||
सर्वत्र वर्धते क्षिप्रं भ्रमन्नथ सघोषवान् |
पिपासा वर्धते तीव्रा भ्रमो मूर्च्छा च जायते ||१३८||
उच्चारितो मूत्रितश्च न शान्तिमधिगच्छति |
विट्शूलमेतज्जानीयाद्भिषक् परमदारुणम् ||१३९||
Meaning of the śloka
When vāta is aggravated in a person who eats dry food, it obstructs the stool in the abdomen and weakens agni, and, covering the channels, produces severe pain, arising by seizing the right or left side of the abdomen. It quickly spreads everywhere, roaming and with a sound; intense thirst increases, and giddiness and fainting arise. He finds no relief after passing stool or urine. This should be known by the physician as viṭśūla, extremely severe.
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पुरीषशूलमाह- वायुरित्यादि| एवम्भूतस्य देहिनो वह्निं मन्दीकृत्य स्रोतांसि चावृत्य प्रकुपितो वायुस्तीव्रं शूलं सञ्जनयन् कोष्ठस्थं मलं रुणद्धि, तस्य च दक्षिणं वामं वा कुक्षिं गृहीत्वा शूलाय जायते, स च सर्वत्र भ्रमन् घोषवान् शब्दयुक्तो वर्धते इति पिण्डार्थः| उच्चारितः सञ्जातपुरीषवेगः| नाधिगच्छति न प्राप्नोति| परमदारुणम् अतिशयकष्टकारि||१३६-१३९||
Meaning of the commentary
The commentary describes purīṣaśūla (viṭśūla). For such a person, vāta weakens agni, covers the channels, obstructs stool in the abdomen and produces severe pain, seizing the right or left side; it roams everywhere and grows with sound. 'Passes stool' means when the urge for stool has arisen. 'Does not attain' means does not get relief. 'Extremely severe' means causing great suffering.
The physician who knows well should quickly do doṣa-removing treatment: sweating, pacification, nirūhas and snehabastis; he should give the previously described yogas that cleanse the abdomen, and all measures that relieve udāvarta are comfortable for him.
When the food eaten in excess, while agni has become weak, becomes stiff in the abdomen and vāta stays covering it, the undigested food produces intense pain, fainting, distension, burning, nausea and slowness (vilambikā); he purges, vomits, trembles and becomes bewildered. This pain arising from indigestion is due to a fault of the food (annadoṣa).
The commentary says this gives the conclusion. 'Properly' means according to the stage.
Key terms
gulmāvasthā
Stage of gulma.
yathāvat
Properly, as suits.
Adhikarana पुष्पिका · Śloka ४२
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते काय चिकित्सातन्त्रे गुल्मप्रतिषेधो नाम (चतुर्थोऽध्यायः, आदितः) द्विचत्वारिंशोऽध्यायः ||४२||
Meaning of the śloka
Thus ends the chapter named Gulmapratiṣedha, the forty-second chapter (the fourth from the beginning of this section), in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
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इति श्रीडल्ह(ह्ल)णविरचितायां सुश्रुतव्याख्यायां निबन्धसङ्ग्रहाख्यायामुत्तरतन्त्रे कायचिकित्सायां गुल्मप्रतिषेधो नाम द्विचत्वारिंशत्तमोऽध्यायः||४२||
Meaning of the commentary
Thus ends the forty-second chapter, named Gulmapratiṣedha, in the Kāyacikitsā of the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.
Key terms
gulmapratiṣedha
The chapter on measures against gulma.
kāyacikitsātantra
The internal-medicine division of the Uttaratantra.