The commentary says that, to describe the nature of tṛṣṇā, the kind of person who is afflicted by it is stated. 'Does not attain' means does not reach satisfaction.
From agitation, grief, exertion, drinking of madya, use of dry, sour, dried, hot and pungent things, depletion of dhātus, fasting and heat of the sun, pitta and vāta are greatly aggravated. Together they spoil the channels that carry water in living beings; when the water-carrying channels are spoiled, very strong thirst arises.
The commentary gives cause and pathogenesis of tṛṣṇā. Saṅkṣobha is excessive movement; śrama is sweat born of exertion. 'Together' means joined. The water-carrying channels are those in the tongue, throat, palate and kloma, and the rasa-carrying vessels. 'Very strong' means exceedingly powerful. The list from agitation to the sun's heat is the cause; 'pitta and vāta greatly...' up to 'thirst arises' is the pathogenesis.
Three are stated (from the doṣas), the fourth is from injury (kṣataja), another is from depletion (kṣayaja), another arises from āma, and the seventh arises from food; hear the signs in order.
The commentary states the number. 'Three' are from vāta, pitta and kapha. Although kapha by its dampness would not normally produce thirst, aggravated kapha, when covering vāta with pitta, causes thirst when they dry up. Kṣataja is from a wound. The wording 'fourth' indicates that the first four are easily curable, while the depletion-type and the āma-type are hard to cure. Kṣayaja is from depletion of rasa; āma is from indigestion; the seventh arises from unctuous and similar foods. Although another tantra says five, this text says seven because treatment differs by cause. The natural (svabhāvaja) thirst is outside this chapter, as it belongs to care of the healthy; the hunger-born thirst is covered under fever where fasting is described; that which is a sign of pitta fever is included in the pitta type; that from drinking is in the depletion type; so the count is not exceeded. Some read 'hear their signs with their remedies'.
Dryness and burning of the palate, lips, throat and mouth, feverish heat, confusion, giddiness and raving are the premonitory signs of them, especially at the times of their onset.
The commentary gives the premonitory signs of tṛṣṇā. 'Dryness and burning' attach to each of palate and the rest. Santāpa is heat as if from the sun; moha is disturbed thinking; vipralāpa is talking in various ways. These signs occur especially at the time of onset.
In (thirst) arising from vāta there are dryness of the mouth, pricking pain in the temples, obstruction of the channels, tastelessness of the mouth, and it increases with cool water.
The commentary gives the signs of vātaja tṛṣṇā. Śaṅkha-śiras means the temples. 'Obstruction of the channels' means of the ear channels. 'Virasa' means unpleasant taste. It increases (is aggravated) with cold water. Some read 'kṣāmāsyatā' (a faded mouth) for 'śuṣkāsyatā', explained as inability to speak or chew; and 'śaṅkhaśirogaleṣu' for the temples.
मूर्च्छाप्रलापारुचिवक्त्रशोषाः पीतेक्षणत्वं प्रततश्च दाहः |
शीताभिकाङ्क्षा मुखतिक्तता च पित्तात्मिकायां परिधूपनं च ||९||
Meaning of the śloka
Fainting, raving, distaste for food, dryness of the mouth, yellow eyes, continuous burning, desire for cold things and a bitter taste in the mouth, and a smoke-like sensation, occur in the pitta type.
The commentary gives the signs of paittika tṛṣṇā. Mūrcchā is loss of consciousness; pītekṣaṇatva is yellow eyes; pratata is continuous; paridhūpana is as if smoke is being emitted.
Kapha, dried and covered by (obstructing) vāta and pitta, itself produces thirst: sleep, heaviness, sweetness in the mouth, and the person afflicted dries up greatly; coating of the throat, sliminess of the mouth, chill-fever, vomiting, distaste for food, heaviness of the body, swelling of the limbs and indigestion occur in the kapha type; afflicted by it, he desires water but not much.
The commentary gives the signs of kaphaja tṛṣṇā. 'Vāta and pitta' are the two by which the kapha is covered; 'heaviness' is in the abdomen. Kaṇṭhopalepa is accumulation of mucus in the throat; śītajvara is fever preceded by chill; śākhā means arms and legs; avipāka is indigestion. 'He does not much desire' means he does not greatly want water. Some read a different verse: 'from obstruction of vapour, when agni is covered by kapha, thirst arises by kapha'.
The fourth, kṣataja tṛṣṇā, is regarded as arising from injury, from pain and the flow of blood; one overcome by it passes days and nights in distress even though drinking water.
The commentary gives the signs of thirst from injury. The thirst of a person with a wound is the fourth, kṣataja. The person afflicted by it passes nights and days in misery even while drinking water.
The one arising from depletion of rasa and so on is regarded as kṣayaja; afflicted by it he dries up and burns, and greatly desires water. Some say it arises from sannipāta. The physician should determine in it all the signs stated for depletion of rasa.
The commentary says kṣayaja means from depletion of rasa. 'Some say from sannipāta' is because the thirst is not pacified even by drinking water at all six times of day and night. This is another's view, not refuted, so accepted. The signs of rasa depletion are those such as 'in depletion of rasa, pain in the heart, trembling'. Some read 'signs arising from depletion of rasa'.
The commentary gives the signs of āmaja tṛṣṇā. It has the signs of all three doṣas, since indigestion aggravates all three. Niṣṭhīvana is repeated spitting; sāda is limb weariness.
The commentary gives the signs (cause) of thirst from food. 'Great thirst' means thirst; this is from kapha, while vāta and pitta (thirst) are covered in all in the cause.
The commentary says that in this stage abandonment applies to all the thirsts. Vicitta means one whose mind has been lost; tṛṣārta is afflicted by thirst.
When thirst is greatly increased and the abdomen is full, one should make him vomit with pippalī water; a tempting measure (vilobhana) is beneficial here, with pomegranate, āmrātaka and citron. The three (doṣic) thirsts should be checked here by the (following) applications and by cool things of complete rasa and potency.
The commentary says that emesis is done except in the depletion-type, where emesis is unsuitable because the dhātus are depleted, quoting another tantra: 'vomiting is suited in thirst except from depletion'. 'With pippalī water' means water mixed with pippalī. Vilobhana is a special enticement; others should eat sour fruit like pomegranate in front of him so that he salivates; some wish enticement by talk of many kinds. Some read 'vilaṅghana' (light eating, not fasting, as fasting causes pitta). The three are the thirsts from vāta, pitta and kapha; 'applications' means those to be described; 'complete rasa and potency' means with full rasa and virya.
Key terms
vamana
Emesis.
vilobhana
Enticement, here to induce salivation and vomiting.
The commentary says sour substances are madya, āranāla, citron and the like. The word 'ca' after 'tasteless' shows that the gargle is made not only with sour things but also with powders of āmalaka.
सुवर्णरूप्यादिभिरग्नितप्तैर्लोष्टैः कृतं वा सिकतादिभिर्वा |
जलं सुखोष्णं शमयेत्तु तृष्णां सशर्करं क्षौद्रयुतं हिमं वा ||१८||
Meaning of the śloka
Water prepared with clods of gold, silver and the like, or sand and the like, heated in fire, pacifies thirst when taken lukewarm; or cooled water with sugar and honey.
The commentary says that water processed by dropping heated clods of gold or silver, or heated sand or similar, into it, drunk slightly warm, quiets thirst; or the same made cold with sugar and honey.
पञ्चाङ्गिकाः पञ्चगणा य उक्तास्तेष्वम्बु सिद्धं प्रथमे गणे वा |
पिबेत् सुखोष्णं मनुजोऽचिरेण तृषो विमुच्येत हि वातजायाः ||१९||
Meaning of the śloka
The five-part groups (pañcāṅgika) of five kinds that have been stated, or water cooked in the first group, drunk lukewarm, quickly frees a person from vātaja thirst.
The commentary says that after the general treatment, the specific treatment is given. The five-part groups are the pañcamūlas; the first group is the vidārigandhādi.
A decoction made from the pitta-relieving groups, with sugar and honey, well cooled and drunk, destroys pittaja thirst; or milk cooked with jīvanīya drugs.
Water cooked with bilva, āḍhakī, the small pañcamūla and darbha destroys kaphaja thirst; vomiting is also beneficial here, with hot water made with neem sprouts.
The commentary says kanyaka-pañcamūla is the laghupañcamūla. 'With neem sprout water' means water made with neem shoots. Some read 'kaṇṭaka-pañcamūlī' (the thorny five roots) and others read 'pañcakola'; Kārttikakuṇḍa rejects the pañcakola reading because pitta is present in all thirsts, making pañcakola unsuitable.
The commentary says that the pitta-relieving regimen, to be described, with sweet and cooling drinks, applications and pouring, is to be done in all thirsts; by that regimen, the thirsts do not arise.
पर्यागतोदुम्बरजो रसस्तु सशर्करस्तत्क्वथितोदकं वा ||२२||
वर्गस्य सिद्धस्य च सारिवादेः पातव्यमम्भः शिशिरं तृषार्तैः |२३|
Meaning of the śloka
Juice of fully ripe udumbara with sugar, or water boiled with it, and cool water cooked with the sārivādi group, should be drunk by those afflicted by thirst.
The commentary says paryāgatodumbara-juice is the juice of ripe fig; the boiled water is water cooked with ripe fig. 'Cooked' has the sense of decoction; 'cool' means made cold.
One should put lājā, utpala, uśīra and kucandana in water and leave it at night in the breeze; that water, fragrant, is called the best (for injury-type thirst), and is said to be given with sugar and honey; and the physician should give it, rich in grapes, to those afflicted by thirst for their benefit.
The commentary gives another yoga for kṣataja thirst. The water is left in the breeze at night with the drugs, and, perfumed with fragrant flowers, sugar and honey added, is called the best in kṣataja thirst. Some join the earlier verse (kaseru...) with this one, and read 'having put lājā and others in the water cooked with kaseru and left it at night', taking the kaseru verse to 'make decoctions as told' as general thirst treatment; that reading is not shown because it is not in the text.
ससारिवादौ तृणपञ्चमूले तथोत्पलादौ प्रथमे गणे च ||२५||
कुर्यात् कषायं च यथेरितेन ... |२६|
Meaning of the śloka
With the sārivādi (group), the tṛṇapañcamūla, likewise the utpalādi, and the first group, one should make a decoction as stated... (the verse is cut off).
The commentary gives other yogas for kṣataja thirst. The tṛṇapañcamūla is kuśa, kāśa, nala, darbha and the like; the utpalādi group begins with utpala and raktotpala; the first group is vidārigandhādi. 'As stated' means by the method described before; the placing of lājā and others at night in the breeze and adding sugar is also implied. Some read 'yathaitaduktam' with the same sense.
The commentary lists six pānakas for kṣataja thirst. 'Madhūka flowers and others' means the four in the raktapitta-relieving group: madhūka, śobhāñjana, kovidāra and priyaṅgu flowers; others say madhūka flowers, grapes, kāśmarī and dates, the four in the raktapitta context. Rājādana is cāra (priyāla), or kṣīrikā per others. Kṣīrikapītana is fresh śirīṣa; others read a separate drug 'kṣīrī', but then seven drugs would exceed the count. Pānakas are decoctions. Here too 'as stated' applies: lājā and others placed at night in the breeze, with sugar added. Some count the six pānakas from 'sasārivādau...' through 'kṣīrikapītaneṣu', which the commentary rejects because sārivādi is a qualifier of the tṛṇapañcamūla and so on, making five. Others count six from kaseru onward, also rejected because that was shown separately.
The commentary says tuṇḍikerī is wild cotton; 'born of cotton' means cotton fruits. So the ground fruits of wild and garden cotton are to be drunk. Kārttikakuṇḍa reads all from 'or in all thirsts' up to 'born of cotton' as treatment for all thirsts.
The commentary says a further special treatment for kṣataja thirst is given. 'By relieving the pain' means removing the pain of the injury. 'Of meat juices' means juices of meat; 'of blood' means blood of eṇa and similar animals.
The commentary says kṣīraghṛta is ghṛta from churned milk, or milk mixed with ghṛta. Māṃsodaka is the clear part of meat juice, called saurā. Madhukodaka is water with yaṣṭīmadhu. Some read 'māṣodaka' (māṣa water) and explain it as māṣa soup.
Thirst arising from āma should be overcome by decoctions with bilva and vacā, or by appetite-kindling ones; one may drink decoctions with āmrāta, bhallātaka and balā, or appetite-kindling drugs.
The commentary says appetite-kindling (dīpanīya) means those made of pippalī and similar drugs. Decoctions with āmrātaka and the rest, made appetite-kindling, are drunk in āmaja thirst.
The commentary gives treatment of food-caused thirst. Thirst from heavy food is overcome by emetics. Also, apart from the depletion type, thirst arising from all doṣas is overcome by emetics. The words 'except depletion' show that emesis is not to be done in the depletion type since the dhātus are depleted, even if that arises from all doṣas. 'Made by all' means the āma type, as that too is from three doṣas. Others read 'and thirsts made by all', meaning every thirst except depletion.
The commentary gives, by way of the topic of thirst, the treatment of thirsts from exertion and the like. Mantha is described as barley flour anointed with ghṛta and mixed with cool water. When exertion-thirst is vāta-predominant, meat juice removes it; when pitta-predominant, mantha.
The commentary says bhaktoparodha means stopping of food. The concluded sense: warm yavāgū when vāta is predominant; cool mantha when pitta is predominant.
The commentary says that though the treatment of thirst from drinking sneha was already stated in another context ('if thirst arises in one who has drunk sneha, he should drink...'), it is repeated here for confirmation, as the topic is different.
The commentary says the treatment of madya-caused thirst was already stated in the context of madātyaya, but is repeated here because the topic is different, so there is no fault.
The commentary says 'thirst from thirst' means thirst arising later in a person weakened by heart disease. The well-cooled drinking water with sugar, and water with sugarcane juice, destroy it. Kārttikakuṇḍa does not read from 'exertion-born meat juice' to 'well-cooled water with sugar and sugarcane water'; the commentator reads it as it was read by Śrī Jejjaṭa.
The commentary says that the emetics stated earlier for thirst are made with their own decoctions, meaning those decoctions stated for pacifying vomiting-type conditions; and the pācana measures stated in fever should be done too.
Applications (lepa), immersion baths, pourings, and cool houses should be arranged; also purgation, milk, meat juices, ghṛtas, and sweet licks and cool (drinks) in all thirsts.
The commentary says that this states the pitta-relieving regimen that was earlier said to apply to all thirsts. Saṃśodhana here means purgation, because it relieves pitta.
Thus ends the forty-eighth chapter (the tenth from the beginning of this section) in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
Thus ends the forty-eighth chapter, named Tṛṣṇāpratiṣedha, in the Kāyacikitsā of the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.