Now, therefore, we shall explain the chapter on the treatment (pratiṣedha) of kṛmiroga (worm disorders). Thus spoke Lord Dhanvantari. From indigestion, eating on top of food, unsuitable and incompatible food, unclean food; lack of exercise, daytime sleep, heavy, very unctuous and cold foods; māṣa-flour foods, pulses, lotus root, śālūka, serukas; leaf vegetables, surā, śukta, curd, milk, jaggery and sugarcane; palala, marsh-animal meat, piṇyāka, pṛthuka and the like; and sweet, sour and liquid drinks, kapha and pitta are aggravated. They produce worms of many shapes and many sites. In the āma and pakva sites, worms arising from kapha and stool; and in the vessels, those from blood, are mostly said to be born.
The commentary gives the general cause of worms. Ajīrṇa is indigestion (āma, vidagdha and so on); adhyaśana is eating on top of undigested food; asātmya is what is used without comfort; viruddha is incompatible; malina is unclean. Piṣṭānna is rice-flour foods; vidala is pulses like makuṣṭha; bisa is lotus root; śālūka is lotus tuber; parṇaśāka is leaf vegetable; śukta is a kind of fermented acid; palala is sesame paste; ānūpa meat is marsh-animal meat; piṇyāka is pressed sesame cake; pṛthuka is flattened rice. 'Many shapes and sites' means of various forms and various locations. 'Mostly' shows worms may also arise elsewhere. Some do not read the list of causes, since the causes are known from later prohibitions ('milk, meats...'); the commentator reads them for ease. Others read a different verse beginning 'one who eats when undigested, always with sweet and sour, fond of liquids, eating flour and jaggery, avoiding exercise, sleeping by day, obtains worms'.
Key terms
kṛmi
Worm, parasite or small creature, as understood classically.
The commentary says the word 'kinds' is used to convey that worms are endless, and this endless variety is included in twenty, so the count of twenty is meaningful. 'Origin' means cause. An objection: causes such as indigestion were already stated, so how are stool and the like now called causes? Answer: indigestion causes stool and the rest, and stool and the rest cause worms; though they do not literally build worms, by figure of speech they are causes. Doṣas seated in stool and the rest, like 'ghee-burned', are called by that name. So doṣas aggravated by indigestion settle in stool and the rest and produce the worms. Some read 'lakṣaṇam' (sign) for 'vistaram'; the commentary rejects it as confusing to students.
The commentary says these seven, from ajavā to dvimukha, are the worms from stool.
Key terms
purīṣaja kṛmi (purīṣajāḥ kṛmayaḥ)
Worms arising from stool.
gaṇḍūpada (gaṇḍūpadā)
Earthworm-like worm (named type).
Adhikarana 4 (9-10) · Śloka 10
śvētāḥ sūkṣmāstudantyētē gudaṁ pratisaranti ca |
tēṣāmēvāparē pucchaiḥ pr̥thavaśca bhavanti hi ||9||
śūlāgnimāndyapāṇḍutvaviṣṭambhabalasaṅkṣayāḥ |
prasēkārucihr̥drōgaviḍbhēdāstu purīṣajaiḥ ||10||
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श्वेताः सूक्ष्मास्तुदन्त्येते गुदं प्रतिसरन्ति च |
तेषामेवापरे पुच्छैः पृथवश्च भवन्ति हि ||९||
शूलाग्निमान्द्यपाण्डुत्वविष्टम्भबलसङ्क्षयाः |
प्रसेकारुचिहृद्रोगविड्भेदास्तु पुरीषजैः ||१०||
Meaning of the śloka
These are white and fine, prick the anus and creep about it; others among them are broad at the tail. From the stool-born worms come pain, weak agni, pallor, constipation, loss of strength, salivation, distaste for food, heart disease and loose stool.
The commentary gives the signs of stool-born worms. Those that are white and fine mostly prick the anus by biting and creep around it; among the seven, others are broad at the tail. Viṣṭambha is a gurgling sound; praseka is drooling; viḍbheda is liquid stool.
The commentary singles out the gaṇḍūpadas among the seven stool-born worms. 'Destroy digestion' means destroy agni, by figure of speech (effect for cause).
The commentary says 'disease' attaches to head and heart, so headache and heart disease; vamathu is vomiting. By 'ca' they produce other kapha disorders too. These are the kapha-born worms.
The commentary says that 'diseases arising from the seat of blood' means those listed in the chapter of disease enumeration, such as kuṣṭha, visarpa and boils.
From māṣa, flour foods, pulses and leaf vegetables arise the stool-born (worms); from meat, māṣa, jaggery, milk, curd and oils, the kapha-born; from incompatible and undigested foods, vegetables and the like, the blood-born. Fever, discolouration, pain, heart disease, sinking, giddiness, distaste for food and loose stool are the signs of worm infestation.
The commentary says that after the general cause of worms of stool and the other origins, the particular cause is now stated. Piṣṭānna is food made from rice flour and the like.
The commentary divides worms into visible and invisible, curable and incurable. 'First thirteen' are ajavā through dāruṇa. 'Kesāda and the rest' are the blood-born from kesāda to parīsarpa. 'The first two' are (among the blood-born) kesāda and romāda, quoting: 'the two called romāda and kesāda are to be known as incurable'.
Knowing any one of these (worms), wishing to destroy it, one should first oleate the patient with ghṛta cooked with the surasādi group, and make him vomit; then purge him with stronger yogas... (the verse is cut off).
The commentary states the treatment. Having identified the kind of worm, the physician oleates the patient with ghṛta cooked with surasādi, first induces emesis, and then purges with sharp, kapha-relieving purgation formulas. Although another passage forbids emesis in a patient with worms in a spoiled abdomen, emesis is recommended in the first stage of infestation, hence 'first vomited'.
Key terms
surasādi gaṇa (surasādigaṇa)
The surasa (tulasī) group of drugs.
vamana
Emesis.
virecana
Purgation.
Adhikarana 16 (21-22) · Śloka 22
... rāsthāpayēcca tam ||21||
yavakōlakulatthānāṁ surasādērgaṇasya ca |
viḍaṅgasnēhayuktēna kvāthēna lavaṇēna ca ||22||
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... रास्थापयेच्च तम् ||२१||
यवकोलकुलत्थानां सुरसादेर्गणस्य च |
विडङ्गस्नेहयुक्तेन क्वाथेन लवणेन च ||२२||
Meaning of the śloka
... and he should be given āsthāpana with the decoctions of barley, kola and kulattha, and of the surasādi group, with sneha cooked with viḍaṅga and with salt.
The commentary says that after purgation, the patient is given a decoction enema with the decoction of barley, kola, kulattha, and of the surasādi group, with viḍaṅga-cooked sneha and rock salt; by 'ca' the paste of the surasādi group is also to be added.
Key terms
āsthāpana
Decoction enema.
viḍaṅga
A vermifuge drug.
Adhikarana 17 (23) · Śloka 24
pratyāgatē nirūhē tu naraṁ snātaṁ sukhāmbunā |
yuñjyāt kr̥mighnairaśanaistataḥ śīghraṁ bhiṣagvaraḥ ||23||
snēhēnōktēna cainaṁ tu yōjayēt snēhabastinā |24|
When the enema has come out, the man, after bathing in comfortable warm water, should be given worm-destroying foods quickly by the best physician, and he should be given a snehabasti with the sneha described.
The commentary says 'come out' means turned back and fallen. Worm-destroying foods are those cooked with worm-destroying drugs, or naturally so. The sneha stated is the viḍaṅga-cooked sneha; the snehabasti is an anuvāsana.
Key terms
kṛmighna
Worm-destroying.
snehabasti
Oil enema.
Adhikarana 18 (24) · Śloka 24
tataḥ śirīṣakiṇihīrasaṁ kṣaudrayutaṁ pibēt ||24||
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ततः शिरीषकिणिहीरसं क्षौद्रयुतं पिबेत् ||२४||
Meaning of the śloka
Then he may drink the juice of śirīṣa and kiṇihī, with honey.
The commentary gives a worm-destroying lick. Ashvaśakṛt-cūrṇa is horse dung powder; vaiḍaṅga is viḍaṅga powder. Some read 'baiḍāla' (of the cat) for 'vaiḍaṅga', taking it as cat dung powder.
The commentary says mūṣikaparṇī is dantī, or a different drug 'mūṣikakarṇa' per others. Mixed with barley flour, since that is especially worm-destroying. Dhānyāmla is kāñjika, taken after the cakes. Although sour things are forbidden in the text stated later ('milks, meats, ghṛta...'), kāñjika is permitted here because it is used for this purpose and is seen to destroy worms in the description of its qualities.
The commentary says the oil is cooked with a decoction and paste of the surasādi group; 'ground' means barley and similar flours; foods means laddūs and the like. The alternatives are given relative to the earlier yoga.
Key terms
kṛmighna taila (surasādigaṇe pakvaṃ tailam)
Oil cooked with the surasādi group.
Adhikarana 25 (29) · Śloka 29
tatkaṣāyaprapītānāṁ tilānāṁ snēhamēva vā ||29||
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तत्कषायप्रपीतानां तिलानां स्नेहमेव वा ||२९||
Meaning of the śloka
Or the oil of sesame seeds well saturated in that decoction.
Powder of the dung of the śvāvit (porcupine), saturated seven times in viḍaṅga decoction and likewise in triphalā decoction, licked with honey; and afterwards he may drink the juice of āmalaka... or of akṣa and abhayā (bibhītaka and harītakī)... (the verse is cut off).
The commentary says śvāvit is the porcupine (seḍhā), and its dung powder is saturated seven times with viḍaṅga decoction and again with triphalā decoction, licked with honey. Afterwards, the juice from āmalaka or bibhītaka, or harītakī juice, is drunk with honey.
Key terms
śvāvit
Porcupine.
bhāvita
Saturated repeatedly.
Adhikarana 27 (31) · Śloka 31
... vidhirēṣō'yasāmapi ||31||
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... विधिरेषोऽयसामपि ||३१||
Meaning of the śloka
... this same procedure applies for iron powders (ayas) also.
The commentary extends the procedure of the porcupine-dung powder to metal powders: 'iron' here includes tin, lead, copper, silver and black iron. Thus, as with the porcupine-dung powder, the powders of each such metal are saturated and used by the same method.
Key terms
ayas
Iron, and by the commentary's extension other metals (tin, lead, copper, silver).
Or he may drink the juice of pūtīka with honey; or drink pippalīmūla with goat's urine for seven nights; or drink burnt (fried) trapu (tin) with curd whey.
The commentary says pūtīka is cirabilva; ajāmūtra is goat's urine. Trapu is tin ('kathīra'). The word 'curd whey' is stated to exclude other whey. Others explain 'dadhi' as excluding whey of a different kind (kūrcikā-maṇḍa), which the commentator rejects, as conflicting with all commentaries and similar tantras.
The commentary says the worms lodged in the head and other sites are treated with collyria and the like; by 'ca', gargles and mouth-retention too. Others say collyria are for the eye, nasal drops and avapīḍas for the nose and head, and that worms in the heart and ears are treated by the treatments of worm-caused heart disease and worm-caused ear disease, and those in the head by the treatment of worm-caused head disease. Some read 'vraṇajān' (wound-born) for 'saṃśritān'; others 'saṃsṛtān'; and 'vaktra' in place of 'karṇa'.
Key terms
añjana
Collyrium (eye application).
nasya
Nasal administration.
avapīḍa
A pressing nasal application.
Adhikarana 31 (35) · Śloka 35
śakr̥drasaṁ turaṅgasya suśuṣkaṁ bhāvayēdati |
niṣkvāthēna viḍaṅgānāṁ cūrṇaṁ pradhamanaṁ tu tat ||35||
The commentary gives a nasal insufflation for worms in the head and the like. 'Juice of horse dung' means the essence of horse dung, well dried; 'pradhamana' means throwing powder into the nose.
Key terms
pradhamana
Blowing powder into the nose.
turaṅgaśakṛt (turaṅgasya śakṛt)
Horse dung.
Adhikarana 32 (36) · Śloka 36
ayaścūrṇānyanēnaiva vidhinā yōjayēdbhiṣak |
sakāṁsyanīlaṁ tailaṁ ca nasyaṁ syātsurasādikē ||36||
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अयश्चूर्णान्यनेनैव विधिना योजयेद्भिषक् |
सकांस्यनीलं तैलं च नस्यं स्यात्सुरसादिके ||३६||
Meaning of the śloka
The physician should use iron powders by this same method; and oil with bronze-rust (kāṃsya-nīla) should be a nasal drop, cooked in the surasādi group.
The commentary extends the blowing method to iron powders: 'by this method' means the method of horse-dung juice insufflation. 'With bronze-rust' means bronze-scrapings with black pigment; 'cooked' is supplied, so oil cooked with a decoction of the surasādi group, with bronze scrapings, is a nasya. It quotes: 'oil cooked with surasādi, mixed with bronze residue, is a nasya'.
Key terms
ayaścūrṇa
Iron powders.
kāṃsyanīla
Bronze scrapings or residue.
Adhikarana 33 (37) · Śloka 37
indraluptavidhiścāpi vidhēyō rōmabhōjiṣu |37|
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इन्द्रलुप्तविधिश्चापि विधेयो रोमभोजिषु |३७|
Meaning of the śloka
The regimen for indralupta (patchy hair loss) should also be applied for those who eat hair (romabhojin).
The commentary extends the treatment to the hair-eating worms (romāda) by reference; by 'ca', it applies to those that eat scalp hair (keśabhojin) too.
The commentary extends the treatment to the tooth-eating worms by reference: the mukharoga treatment, especially that for worm-eaten teeth. Although romāda and dantāda are blood-born, so their special treatments would fit after the general blood-worm treatment, they are given first because even kapha-born worms eat hair and teeth, and so pungent-bitter food is beneficial; hence the special treatment of hair and tooth eaters is stated first.
Key terms
dantāda
Tooth-eating (worms).
mukharoga
Mouth disease.
Adhikarana 35 (38) · Śloka 38
raktajānāṁ pratīkāraṁ kuryāt kuṣṭhacikitsitē |38|
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रक्तजानां प्रतीकारं कुर्यात् कुष्ठचिकित्सिते |३८|
Meaning of the śloka
For the blood-born (worms), the remedy should be done as in the treatment of kuṣṭha.
The commentary extends the general treatment of the blood-born worms by reference to the treatment stated for kuṣṭha; 'stated' is supplied. Some read 'from the treatment of kuṣṭha'.
Key terms
raktaja kṛmi (raktajānāṃ pratīkāra)
Remedy for blood-born worms.
kuṣṭha
A classical skin-disease group.
Adhikarana 36 (38) · Śloka 38
surasādiṁ tu sarvēṣu sarvathaivōpayōjayēt ||38||
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सुरसादिं तु सर्वेषु सर्वथैवोपयोजयेत् ||३८||
Meaning of the śloka
The surasādi group should be used in every way in all of them.
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surasādiṁ tu sarvēṣvityādi| sarvēṣu purīṣajādiṣu| sarvathaiva annapānasnānādividhinā||38||
Meaning of the commentary
The commentary says 'in all' means in the stool-born and the rest; 'in every way' means by food, drink, bath and other methods.
Key terms
surasādi gaṇa (surasādi)
The surasa (tulasī) group of drugs.
Adhikarana 37 (39) · Śloka 39
pravyaktatiktakaṭukaṁ bhōjanaṁ ca hitaṁ bhavēt |39|
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प्रव्यक्ततिक्तकटुकं भोजनं च हितं भवेत् |३९|
Meaning of the śloka
Food with a clear predominance of bitter and pungent tastes is beneficial.
The commentary gives another drink: water with kulattha ash (alkali); kṣāra-drink means yava-kṣāra; Viśvāmitra is quoted: 'a drink of yavaśūka with kulattha-kṣāra water'. Some read 'viḍaṅga-kṣāra' in place of 'kulattha-kṣāra'.
The commentary gives what is to be avoided after treatment. Although the rule 'briefly, treatment is avoiding the cause' already implies the prohibition, the prohibition of milk and the rest is repeated to fix it, so that the very causes of worms (milk etc.) are not used as medicine, as wine is in the treatment of alcohol disorders.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे कृमिप्रतिषेधो नाम (षोडशोऽध्यायः, आदितः) चतुःपञ्चाशत्तमोऽध्यायः ||५४||
Meaning of the śloka
Thus ends the fifty-fourth chapter (the sixteenth from the beginning of this section), named Kṛmipratiṣedha, in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
Thus ends the fifty-fourth chapter, named Kṛmipratiṣedha, in the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.