The commentary says that after the chapter on udāvarta, beginning visūcikā is fitting because dull digestive fire, caused by reverse movement of vāta in udāvarta, is a cause of visūcikā. The word 'ādi' is understood to be omitted after visūcikā, so alasaka and vilambikā are included.
Key terms
visūcikā
A classical acute gastrointestinal disorder with vomiting, purging and pricking pain.
alasaka
A related condition of obstructed, distended abdomen.
vilambikā
A related, hard-to-treat condition where food neither moves up nor down.
The commentary gives the cause. 'Described' is completed with 'in the chapter on food and drink'. The fourth kind of indigestion (rasaśeṣa, residual rasa) is not included, since it is merely a failure of transformation and does not start visūcikā and the rest; it is mentioned as the view of some. Vilambikā is named separately from visūcikā and alasaka to show that it is incurable, while the other two are mostly curable with difficulty.
The commentary gives the derivation. 'Physicians' means the early ones; the wording is justified grammatically. Some read 'bhindan' (splitting) for 'tudan' (pricking). No premonitory signs of visūcikā and the rest are given, showing that their few mild signs are themselves the premonitory signs and there are no others.
Key terms
sūcī
Needle.
visūcikā
Named for needle-like pricking pain.
Adhikarana ౪ (౫) · Śloka ౫
న తాం పరిమితాహారా లభంతే విదితాగమాః |
మూఢాస్తామజితాత్మానో లభంతే కలుషాశయాః ||5||
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न तां परिमिताहारा लभन्ते विदितागमाः |
मूढास्तामजितात्मानो लभन्ते कलुषाशयाः ||५||
Meaning of the śloka
Those who take measured food, who know the teachings, do not get it; the foolish, uncontrolled and impure-minded (of foul stomach) get it.
The commentary says this stresses avoiding indigestion diligently. 'Measured food' means eating what is not forbidden; 'know the teachings' means know the instructions on food; 'foolish' means like animals, ignorant of what to eat; 'uncontrolled' means not master of the senses; 'foul-stomached' means one whose āmāśaya is spoiled, from contact with spoiled food and from aggravation of vāta and others. Some read 'greedy for food' in place of 'foul stomach'.
In it there are fainting, purging, vomiting, thirst, colicky pain, giddiness, twisting (cramps), yawning, burning, discolouration, trembling, pain in the heart, and splitting pain in the head.
The commentary gives the signs of visūcikā. Vamathu is vomiting; udveṣṭana is twisting of the calves and other parts, called cramp in common speech; 'splitting of the head' is pain as if the head were torn.
The abdomen is greatly distended; he sinks (into darkness), murmurs; the obstructed vāyu also runs around in the abdomen; there is great obstruction of wind and stool in the abdomen: this they call alasaka, with thirst, belching and obstruction.
The commentary gives the signs of alasaka. Kukṣi is the abdomen; 'distended' means with fullness; 'sinks' means as if entering darkness; 'murmurs' means makes indistinct sounds; the vāyu 'runs around' means goes about everywhere.
The spoiled food eaten, by kapha and vāta, does not move upward or downward in one: that the ancient learned ones call vilambikā, extremely hard to treat.
The commentary gives the signs of vilambikā. 'Spoiled by kapha and vāta' is the joining. Although vilambikā mostly arises from vidagdha indigestion and there pitta is spoiled, not vāta or kapha, yet by the spoiling of pitta the other two are also spoiled, hence 'spoiled by kapha and vāta'. Likewise visūcikā and alasaka, arising from āma-tinged indigestion, have the other doṣas present even where kapha or vāta predominates. Some read 'lodged' for 'spoiled'. In another tantra vilambikā is called 'daṇḍālasaka'.
Key terms
vilambikā
A stagnant condition where food is stuck and moves neither way.
Where the āma is lodged, that very site aches especially, by disorders arising from the doṣa that pervades it; one should recognise it by its own signs and by those arising from āma.
The commentary extends the specifics of signs by reference. Wherever the āma sits and by whichever doṣa it is pervaded, that very site is especially painful; so the site is recognised by the signs of that doṣa (pricking and so on) and by the āma-born signs (stiffness, distension and so on). An objection: why state the site of āma, since the pain will be where the disordered doṣa is? Answer: not always; as in gaṇḍamālā, where a doṣa in the abdomen can produce disease in the neck. Knowing the painful site helps ease of treatment. Brahmadeva explains differently: whichever doṣa the āma-born doṣa follows, it is recognised by that doṣa's signs. Others read otherwise, which is omitted.
One with dusky teeth, lips and nails, of little consciousness, afflicted by vomiting, with eyes sunk inward, faint voice, and all joints slackened, goes not to return.
The commentary gives the signs of incurability. 'Dusky' attaches to teeth, lips and nails each; 'little consciousness' means dulled awareness; 'eyes sunk inward' means failing vision; 'not to return' means never to return.
साध्यासु पार्ष्ण्योर्दहनं प्रशस्तमग्निप्रतापो वमनं च तीक्ष्णम् |
पक्वे ततोऽन्ने तु विलङ्घनं स्यात् सम्पाचनं चापि विरेचनं च ||१२||
Meaning of the śloka
In the curable (types), cauterising the heels is recommended, warming at a fire, and sharp emesis; after the food has ripened, fasting, digestion measures and purgation.
The commentary gives the treatment. In curable visūcikā, cautery of the heels is done to rouse the patient and to stop excessive downward purging; heating at a fire is for digesting āma; sharp emesis is to remove the food-thorn. The word 'curable' excludes the incurable and also stresses effort once curability is known. When the food is turning to digestion, fasting (of various kinds according to the stage; others say complete fasting), digestion by sweating, and purgation by fruit-suppositories are done; purgation is meant where there is obstruction. Some read 'after vomiting, fasting and digestion, with purgation and kindling'. Pāchana is that stated in atisāra ('devadāru, abhayā...'); dīpana is pippalī and the like. Some read 'after a fortnight'.
The commentary says that although āsthāpana is forbidden in indigestion in another passage, here, when food is turning to digestion, a nirūha after digestion measures is praised to remove the obstruction. 'In all' means in all visūcikās; some take it as visūcikā, alasaka and vilambikā. Some read 'and all' as an adjective of the yogas to come. 'To digest the unripe and to loosen the ripe' is understood.
A powder of pathyā, vacā, hiṅgu, kaliṅga, gṛñjana and sauvarcala with ativiṣā, drunk with lukewarm water, quickly destroys indigestion, colic, visūcī and distaste for food.
The commentary says kaliṅga is indrayava; gṛñjana is a kind of garlic. 'Indigestion' here means residual āma, not fresh indigestion, since medicines are forbidden there; 'visūcī' here means a lingering one, not a sudden one, for the same reason.
क्षारागदं वा लवणं विडं वा गुडप्रगाढानथ सर्षपान् वा |
अम्लेन वा सैन्धवहिङ्गुयुक्तौ सबीजपूर्णौ सघृतौ त्रिवर्गौ ||१५||
कटुत्रिकं वा लवणैरुपेतं पिबेत् स्नुहीक्षीरविमिश्रितं तु |
कल्याणकं वा लवणं पिबेतु यदुक्तमादावनिलामयेषु ||१६||
Meaning of the śloka
Kṣārāgada (an alkali-antidote preparation), or salt, or viḍa salt; or mustard seeds rich in jaggery; or, with sour liquid, rock salt and hiṅgu; or the two triads with citron seeds and ghṛta; or kaṭutrika with salts, mixed with snuhī latex; or kalyāṇaka salt as described first for vāta disorders, may be drunk.
The commentary says kṣārāgada is the preparation described in the chapter on the Dundubhi (poison) section beginning 'dhava, aśvakarṇa, śirīṣa...'. 'Salt' is viḍa salt, taken with warm water. 'With sour' means with kāñjika; 'the two triads' are triphalā and trikaṭu; 'with citron seeds' (some read 'with vegetable seeds'); 'with ghṛta' in equal amount. 'As described first' refers to the preparation 'gaṇḍīra, palāśa...' in the vāta-disease chapter; some read 'in āma-vāta disorders'.
Key terms
kṣārāgada
An alkali-based preparation from the toxicology section.
He may drink kṛṣṇā, ajamodā and kṣavaka; or equal parts of māgadhī and nikumbha; or with dantī, or a paste of pippalīs with koṣavatī juice; or with warm water a paste of pippalī with nāgara powder.
The commentary says kṣava is a plant with a shape like phaṇijjaka, mostly found on the Pāriyātra mountain; some read 'kṣavakāgnikān'. Each is taken with sour liquid. Nikumbha is dantī; the pippalī-and-dantī drink is for purging when there is viṣṭambha; some prefer warm water. Koṣavatī is ghoṣaka (a gourd). Some read the last yoga as in the verse.
Vyoṣa, karañja fruit, both haridrās, and mātuluṅgī root in equal parts, made into pills dried in shade, destroy visūcī when used as collyrium for the eyes.
The commentary says some take mātuluṅgī as madhukarkaṭī. 'Visūcī' here includes conditions produced by visūcī such as pramīlaka (eye-closing) and head disorders, by figure of speech; or the pills destroy visūcī itself by the power of the collyrium.
Having judged the man well-vomited, or well-purged, and well-fasted, and when he is properly hungry, he should be treated with gruels and the like with digestion- and appetite-promoting drugs.
The commentary says this is for giving wholesome food to one who has been cleansed and well fasted. The commentary notes that some read here two yogas beginning 'kuṣṭha, aguru leaf, rāsnā, śigru bark, vacā ground in sour, the best for body ache in visūcikā' and 'citraka, pūtikapiṇyāka, kuṣṭha, bhallātaka, the two kṣāras, rock salt, white oil, cooked; this to be used as rubbing or paste', and rejects them as not found in similar tantras.
Undigested matter or stool that has accumulated in order and is bound up again by deranged vāta, not moving on in its own way: this they call the disorder ānāha.
The commentary describes ānāha (distension with obstruction), which is stated though not announced because its treatment is like visūcikā's and it is a complication of visūcikā. Āma is unripe food-rasa; śakṛt is stool; nicita means increased; vibaddha means obstructed by vāta going the wrong way; 'not moving' means not going downward. Some take āma as an adjective of stool; the commentary rejects this because similar tantras show ānāha from āma too, quoting 'in ānāha arising from āma, or from stool...'.
Key terms
ānāha
Abdominal distension with obstruction of stool and wind.
In it, when arising from āma, there are thirst, running nose, burning in the head, pain in the āmāśaya, heaviness, nausea, and obstruction of belching.
The commentary gives the signs of āma-born ānāha. Heaviness generally occurs in the āmāśaya in āmaja ānāha. Some read 'hṛtstambha' (stiffness of the heart) for 'hṛllāsa'. Udgāravighātana means improper belching. Some explain 'arising from āma' as 'arising in the āmāśaya'.
Stiffness of the waist, back, stool and urine; colic and fainting; he vomits stool; and breathlessness: these occur in the type arising from pakvāśaya, along with the signs of alasaka.
The commentary gives the signs of stool-born ānāha. 'Stiffness' attaches to waist through urine each; colic too is in the waist and the like; the man vomits stool. Here pakvāśaya means stool by figure of speech; others say it means 'in the pakvāśaya'.
The commentary gives treatment of āma-born ānāha. After emesis, the peyā-first graded diet with appetite-kindling drugs such as pippalī is given. Some say 'in the type arising in the āmāśaya'.
Key terms
saṃsarga (saṃsargabhaktakrama)
Graded reintroduction of food.
dīpanīya
Appetite-kindling drugs.
Adhikarana ౨౨ (౨౪) · Śloka ౨౪
అథేతరం యో న శకృద్వమేత్తమామం జయేత్ స్వేదనపాచనైశ్చ |24|
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अथेतरं यो न शकृद्वमेत्तमामं जयेत् स्वेदनपाचनैश्च |२४|
Meaning of the śloka
But in the other (type), where he does not vomit stool, he should overcome it (with) sweating and digestion measures.
The commentary gives treatment of the stool-born ānāha. The person who does not vomit stool has the stool-type distension with some āma, which is overcome by sweating and the like; one who vomits stool is not to be treated, as that is incurable. Kārttikakuṇḍa reads the first as 'the man with pakvāśaya ānāha'. He reads 'svedya yathāvidhānam' (having sweated, by the method of easing stool and urine) in place of 'sweating and digestion'.
The purgative drugs described in visūcikā should be powdered and made into wicks (suppositories) with the urine of buffalo, goat, sheep, elephant and cow; after sweating the patient, insert the wicks into the anus, and blow their powders in with a tube.
The commentary extends treatment by reference. The purgative drugs (dantī and the like) named in the visūcikā treatment are powdered, cooked in the urine of buffalo and others, and made into suppositories; after sweating, they are placed in the anus, and the powders of these purgatives are blown in through a tube. Ibha means elephant.
The drugs that move upward and downward, cooked in urines by the rule, with that decoction, half with urine, and with honey, one should give a nirūha at once, with a praku~jca (a palm's measure) of salt with trivṛt; and follow the regimen after purgation.
The commentary gives the nirūha in ānāha. The drugs that act both upward and downward, such as koṣātakī and others of the cleansing group, are cooked in those urines by the decoction method; the decoction, with half urine and honey, plus a praku~jca (one pala) of rock salt with trivṛt, is given as a nirūha. Kārttikakuṇḍa reads 'mātrārdha' (half measure). 'Follow the regimen after purgation' means the regimen of one who has been properly purged; some take 'do' as causative (have it done by the physician). This nirūha is given after digestion, not in the āma stage.
The commentary gives anuvāsana in ānāha. 'In these' means the koṣātakī and other drugs named in the nirūha; 'if the time has come' means at the proper time and stage: when the āma is fully digested and after a good nirūha, if vāta is aggravated, an anuvāsana is given.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे विसूचिकाप्रतिषेधो नाम (अष्टादशोऽध्यायः, आदितः ) षट्पञ्चाशत्तमोऽध्यायः ||५६||
Meaning of the śloka
Thus ends the fifty-sixth chapter (the eighteenth from the beginning of this section), named Visūcikāpratiṣedha, in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
Thus ends the fifty-sixth chapter, named Visūcikāpratiṣedha, in the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.