1. The-Sushruta-Samhita--Vol2_English

SANTINIKETAN VISWA BHARATI LIBRARY

817.613 K96 V.2

AN ENGLISH TRANSLATION OF THE SUSHRUTA SAMHITA Vol. II. NIDANA-STHÁNA TO KALPA-STHÁNA

AN ENGLISH TRANSLATION OF THE SUSHRUTA SAMHITA WITH A FULL AND COMPREHENSIVE INTRODUCTION, ADDITIONAL TEXTS, DIFFERENT READINGS, NOTES, COMPARATIVE VIEWS, INDEX, GLOSSARY AND PLATES IN THREE VOLUMES EDITED BY KAVIRAJ KUNJA LAL BHISHAGRATNA, M.R.A.S. Vol. II. NIDÁNA-STHÁNA, S'ÁRIRA-STHÁNA, CHIKITSITA-STHÁNA AND KALPÁ-STHÁNA. CALCUTTA : PUBLISHED BY THE AUTHOR, NO. 10, KASHI GHOSE'S LANE 1911 All Rights Reserved.

PRINTED BY M. BHATTACHARYYA, AT THE BHARAT MIHIR PRESS, 25, ROY BAGAN STREET, CALCUTTA

PREFACE.

It is with mingled feelings of pain and pleasure that we now place before the public the Second Volume of our English Translation of the Susruta Samhita. The arduous task of compiling a connected and succinct history of any part whatever, of the ancient Hindu System of Medicine--requires greater leisure and more extensive reading than we can lay any pretension to. Years of patient study and constant discourse with our sainted preceptor the late lamented Mahamahopadhyaya Kaviraj Dwaraka Nath Sen, Kaviratna, that refulgent link of the golden chain of the Dhanyantaric succession, have enabled us, however, to grasp the leading facts, and during the last few years we have worked continuously, in moments snatched from the practice of an anxious profession that knows no respite, to arrange these facts in their present form. It breaks our heart to record the sad departure of our venerable Acharyya from this sublunary sphere to a land "from whose bourne no traveller e'er returns."

It is hardly necessary for us to reply to those critics who, through their ignorance of the original

Sanskrit works, persist in describing Ayurveda as an empirical system destitute of Anatomy, Physiology or Pathology in any scientific sense.

It behoves us, however, in this preface to meet some of the charges which have been brought against us.

Exception has been taken to our not including in the opening stanza the usual invocation to the Supreme Self (for a successful completion of the work) although it has found its way into almost all the printed editions of the work extant.

Now the stanza referred to finds no place in the various manuscript copies of the original work which are in our possession, or on which we have been able to lay our hands.

The work was first put into print by the late Dr. Madhusudan Gupta and we believe that it was only in this printed edition that the benedictory address in question appeared for the first time, and that it has since crept, by the process of circulation, into subsequent printed editions.

In this opinion we are supported by the fact, that in none of the various commentaries and annotations on the Susruta Samhita is any mention made of the line in question, whereas, had it been the opening stanza of the original work, it would certainly have received at least a passing notice at the hands of the commentators, however easy or simple it might have been.

Further, were it composed by Susruta himself, it would not have

( 3 ) been in the form in which we find it in the printed editions. The ancient sages used invariably the auspicious expression "व्यथातः" or "व्योम्" and the like, when commencing a work and never invoked any particular deity for a happy termination of their undertaking.* These are the reasons which have led us to omit the passage in our present translation.

Another objection raised by a certain section of the community is that we should not have at all undertaken to translate the work into the English language. Their contention is that the Ayurveda, being an integral portion of the Eternal Vedas, should, on no account, be rendered into a Mlechchha Bháshá and thus made accessible to the public at large, irrespective of caste or creed.

Such an objection, at this time of the day, is, to say the least, most puerile ! Truth is truth, and latitudes and longitudes are not its boundary lines. The Vedas themselves have been translated into many European languages. To keep the truths promulgated by our ancient sages confined within the coterie of the privileged classes and thus to deprive the educated public of the

• Thus :-- (a) "व्यथातां द्रिरिज्जोविततीयमध्यायं व्याख्यास्यामः"—Charaka Samhitá (b) "व्यथातो धर्म्म व्याख्यास्यामः"—Kanáda Vaiseshika Sutra (c) "व्यथातां ब्रह्मविद्यास"—Vedánta Sutra.

( 4 ) benefit of such truths would certainly be a sacrilege. In giving preference to English as the medium of translation we have been actuated by more reasons than one.

It cannot be gainsaid that English has now become almost the lingua franca of the world, and to disseminate the ancient wisdom of India throughout the world, we could not have selected a medium better than the English language.

Besides this, we have been actuated by the hope of drawing the direct attention of our benign Government to the scientific value of our system of Medicine by the adoption of such a procedure.

Here we must not stop without expressing our sincere and hearty thanks to our learned and valued friends Kaviraj Jogindranath Sen, M.A., Vidyabhusana, Kaviraj Jnanendranath Sen, B.A., Kaviratna and Professor Satyendranath Sen, M.A., Vidyávágisa, who have rendered us material help in the publication of this volume.

We must freely admit that but for the active and continued co-operation of the above-named gentlemen we could not have brought out this volume so promptly and successfully.

Our thanks are also due to Dr. S. Sanyal, B.Sc., L.M.S. for his kind help, to Dr. S. N. Goswami, B.A., L.M.S. for his kindly supplying us with materials for writing the Introduction, and to our readers for their kind encouragement.

( 5 ) In conclusion, we implore our readers to excuse the errors of omission and commission which are inevitable in the execution of such a huge work, more especially when the author is encumbered with the responsible duties of his profession involving, as they do, the life and death of persons entrusted to his care. 10, Kashi Ghoshie's Lane, Calcutta. November, 1911. Kunja Lal Biishagratna.

INTRODUCTION.

In the introduction of the first volume of our translation

of the Susruta-Samhitá we have attempted

to place before the public a correct

`Ayurveda is not an Encyclopædia

of ancient medical works, but a Trea-

tise on Biology.

interpretation of Váyu, Pitta and Kapha,

the falsely so-called humours of the

body* and it is a great pleasure to us,

that our pronouncement has been very kindly accepted. In

the introduction of the present volume we would draw the

attention of the readers to the fact that Ayurveda is not at

all an encyclopædic work,—an Encyclopædia of the Indian

• Berdoe says :—“What is known as the Humoral Pathology formed

the most essential part of the system of the Dogmatics. Humoral

Pathology explains all diseases as caused by the mixture of the four

cardinal humours, viz., the blood, bile, mucus or phlegm and water. Hip-

pocrates first leaned towards it, but it was Plato who devoloped it. The

stomach is the common source of all these humours. When diseases

develop, they attract humours. The source of the bile is the liver, of the

mucus the head, of the water the spleen. Bile causes catarrhs and rheu-

matism, dropsy depends on the spleen.”

Be it observed that among the humours of Hippocrates there is no

place for Váta although in point of fact both his Physiology and Patho-

logy are to be traced to the “Tri-dhátu” of Ayurveda. The secret of

this anomaly is that the theory of Váta was found to be a complicated one

and Hippocrates, not being able to comprehend its original import, left

it out and cautiously introduced, in its stead, his own theory of “water”.

Sowe find “Humoral Pathology is not of Indian origin; neither it is the

same which the Indian Rishis of Rigveda developed under the name of

Tri-dhátu.” It is simply an imitation of Susruta who introduced blood

( रक्तपित्तचतुष्टयेः ) as the fourth factor in the genesis of diseases. But the bor-

rower, in his interpretation of Susruta, had made a mess of it. He retain-

ed blood, but substituted “water” in place of Vata, the most important

of the three, for reasons best known to him.

ii INTRODUCTION.

system of Medicine in all its departments, but it is the

Science of Life entire.

Though it is customary and convenient to group apart

such phenomena as are termed mental and such of them as

are exhibited by men in society, under the heads of Psycho-

logy and Sociology, yet it must be allowed that there are no

absolute demarcations in Nature, corresponding to them,

and so in the entire Science of Life, psychology and sociology

are inseparably linked with Anatomy and Physiology, ay,

more, with Pathology and Hygiene and above all with

Treatment. In short the Biological Sciences must deal with

whatever phenomena are manifested by living matter in

whatever condition it is placed. Life in health ( सुखायु: ) as

well as Life in disease ( दुःखायु: ), therefore, fall within the

scope of Biology—even life exhibited by man in Society

( हिताहितं ) is not exempted from it.

हिताहितं सुखं दुःखमायुस्तस्य हिताहितम् ।

मानष तच्च यथोक्तमायुर्वेद: स उच्यते ॥ चरक, श्लोकार्थम्, १म अध्याय ।

In calling Ayurveda, therefore, the entire Science of Life,

Ayurveda,—the entire Science of Life.

we are not guided by any prejudice of our own, but we rely solely on

facts and figures, and these, when closely studied, will lead any one to arrive at the same

conclusion, not unlike our own and to interpret Ayurveda

as a collection of Biological Sciences in all departments.

In the first place, for the guidance of our readers, we will

mention that the name Ayurveda itself is a strong evidence

in favour of its being called the Science

Negative Eviden- ces thereof :-

1. The Name it- self.

in the Sárira-sthána which is popu-

larly belived to be the anatomical portion of the book, as

tending to the same conclusion. In

II. The arrange- ment of the sub- ject-matters.

this section, chapters on Midwifery

and Management of Infants follow

close to the heels of those on Anatomy and Physiology, and

these latter again are immediately preceded by chapters on Psychology. This intermixture is certainly an anomaly and can in no wise be satisfactorily explained unless we have to look upon these as general truths of Biology, elucidated by the Introduction of special truths exclusively collected from the science of medicine--भिषगादिषु संसार्ये सन्दर्भितानि । To call it Descriptive Anatomy or Physiology, in the modern sense of the term is simply ridiculous. The absence of any reference to brain and

Want of Descriptive Anatomy and Physiology in the sections of Sarira-sthana itself :-

spinal cord, to pancreas and heart, in a book of Anatomy and Physiology is unpardonable and in the Sárira-sthána we feel this absence almost to despondency. Moreover, in western medical science, Grey's Anatomy and Kirke's Physiology, for instance, in their bulk, exceeds, each, more than a thousand of pages and to present to the public, under the same name less than half a dozen of pages, as the result of Indian wisdom, is certainly a very miserable contrast—a contrast that is calculated to inspire no admiration, but, on the contrary, to generate in scientific minds an universal apathy, at least an apathy towards all that is connected with the system of Indian Medicine In order to save our venerable Rishis from this disastrous plight, we announce here foremost of all, that our beloved Science of Ayurveda is by no means an Encyclopædic work, but distinctly possesses every characteristic

Positive Evidences.

that marks the Science of Biology. I The definition The very name Ayurvada indicates of Ayus. that it is actually a science of Ayus Same as Life as defined by Mr. Her- and the word Ayus is used here in the same sense as Mr. Herbert Spencer bert Spencer. understands by his remarkable definition of Life.

In his masterly classification Mr. Herbert Spencer has, in his Biology, given, indeed, the first place to Anatomy and Physiology, but still it is divested of any elaborate chapters dealing with the subjects.

B

In the science of Life a short reference to the structures of the body or its functions is quite sufficient to illustrate its principles, and if we fail to find therein any discourse on the descriptive Anatomy and Physiology, we still consider that there is nothing amiss.

But unfortunately the fate of Ayurveda is otherwise. Though the very name indicates that it is Biology pure and simple, still it is denounced for its dificiencies in Anatomy and Physiology, and doomed for ever.

Sanskrit words are notorious for their confusion of meanings, but, as regards Ayurveda there exists no difference of opinion, at least, so far as the first word is concerned. Ayus is Ayus everywhere in Ayurveda and it is the only fault our venerable Rishis may be reasonably charged with, that they did not put themselves into any great trouble to explain Ayus, but, on the contrary, unlike scientific men, misspent their energy to ascertain the significance of the insignificant portion of Ayurveda, that is the meanings of the root "Vida" in the light of Grammar.

The scientific ear, ever unsatisfied with these grammatical eruditions, has ultimately thrust an Encyclopædic value upon what is properly speaking, a book of Biology. Of course, there is a marked difference between the two. An ordinary treatise on Biology deals with the general truths of life, and does not represent, by way of illustrations, all its special truths, nor their practical sides, but so far as Ayurveda is concerned, the general truths of Biology are thrown into the background and the special truths, gleaned exclusively from the science of medicine, are given great prominence (भिषग्गादिषु संसार्य सन्दर्शितानि), so much so, that it is now regarded as a systgm of Medicine and Surgery which has neither Biology, nor Anatomy, nor Physiology, nor Pathology—but is a systematised Empiricism or Quackery. This is certainly a great misfortune. Apart from the name, the arrangement of the subject, to which we have just referred, at least, in the section of Sárira-sthána (the falsely so-called Anatomy of

the Hindus),—is a direct contradiction to its being considered as an Encyclopædic work. The existence of the chapters on midwifery and management of infants in the same, following

• immediately the chapters on Anatomy, serv·is as a strong additional evidence thereof. It is an anomaly no doubt, that Midwifery has been offered a place in the section of

Reasons for incor-porating Midwifery into this Anatomic-al section.

Anatomy, but the confusion does not get at all confounded, if we are led to believe that the science of generation of a superior race (if we are at all permitted to use the term) forms, indeed, an important department of Practical Biology.

From whatever standpoint we look to the question, we find there are grounds to lead any one to pronounce in our favour and to come to the conclusion at which we now venture to arrive. Besides these two important facts,

Internal evidence. we now cite the following passage as a strong internal evidence in favour of our view. Maharshi Punarvasu, after giving us a short table of the principal structures of the human body, remarks that even this reference is considered by many as superfluous,

Reasons for omit-ting Descriptive Anatomy.

on the ground, that an acquaintance with the molecular construction of an organism is quite sufficient to help us as a reliable guide to treatment.

The passage referred to is quoted below :—

"एकेऽ सदुभयमपि न विकल्पयन्ते प्रकृतिभावाच्चरौषधम् i"

Now we ask the reader if this is not a sufficient evidence, proving to the hilt, that Ayurveda is nothing but Biology and that we run no risk of committing a grave omission if the chapter on Anatomy is wholesale dispensed with from Ayurveda. For the improvement of this awkwsard position—that in the section of Anatomy there should be no Anatomy

—the entire credit is due to Susruta, as he has very wisely made the suggestion, that a knowledge of the anatomical structures of the body is of great value, at least so far as it

न प्रकृत्यनपा दृश्यं देहं सत्त्वतमो विभुः । दश्यते ज्ञानचक्षुषा भिषगुपायैः सच्यभिर्देव च ॥ प्राप्तौ चैव नाशे च दृश्यार्थः स्यादिगीरतः । दृष्टस्तु लाम्यां सन् देहमवापोच्याचरन् क्रिया: ॥

तस्माद्विःसंगरं ज्ञाने हृच्छा श्लाघ्य वाज्छता । ग्रोर्ध्येया मृता सम्यग दृश्यैरडार्ङवनियतैः ॥ प्रत्यक्षतों हि यद् दृष्टं शास्त्रदृष्टं यदचैवत् । समासतस्तदुभयं भूयों ज्ञानविवर्धनम् ॥

of dead body (not of living body as proclaimed by Herophilus), nay, the Avagharshana which brings into view

The knowledge of the Molecular Construction of the body is all that is wanted.

the layers of the epidermis and the dermis, the number and branches of blood-vessels and nerves that lie embedded in muscles, etc., is only necessary.

Professor Michael Foster's remarks in his article on Physiology in the Encyclopedia Britannica, to all appearances, are just in the same line, if not identical with our extract, when he says "that the problem of Physiology, in the future, is largely concerned in arriving by experiment and inference, by the mind's eye, and not by the body's eye alone, assisted, as that may be, by lenses yet to be introduced at a knowledge of the molecular construction of the protean protoplasm; of the laws according to which it is built up and the laws according to which it breaks down; for these laws when ascertained will clear up the mysteries of the protean work which the protoplasm does."

In short the knowledge of the molecular construction of the body is just the thing with which Biology is concerned, and such is the unanimous verdict both in the East as well as in the West, in the most ancient and in the most modern Sciences of the world.

Now, if the 'knowledge of the molecular construction of the protoplasm, of the laws according to which it is built up, and the laws according to which it breaks down,' is all that is necessary for an accurate knowledge of Anatomy and Physiology, our Ayurveda is pre-eminently the Science we want.

The following extracts, from Charaka Samhitā, are cited here to prove that we are quite justified in our contention.

1. ग्रबौीरावयववास्तु परमाणुभेदेनापरिसंख्येया भवन्ति—तेषां संयौगविभागे वायु: कारषाम् । कच्मी स्वभावश्रेति ।

2. शरौरसंख्यां यो वेद सर्वावयवयश्रो भिषक् । तद्रुलान्निसितेन स मोह्हेन न युज्यते ॥

That is, the body is composed of molecules and these are said to be numberless, because no body can count them up.

viii INTRODUCTION.

By their union, they build up the body, and this union is governed by three Laws, viz., the Laws of Váyu, Karma and Swabháva (which are almost equivalent to the three Biological Laws, i e., the law of heredity, the law of external relations and the law of molecular motion caused by Ethereal vibrations compared with which nerve-impulses-akin to electric force,-are grosser and coarser shocks). So far we think we have proved that Ayurveda, as a Biology is not defective, if it contains no descriptive Anatomy and Physiology-descriptive in the same sense as Grey's Anatomy or Kirke's Physiology is. Its Histiolegy is molecular; its Pathology is molecular ; its Physiology is molecular. Molecular in every sense is the Biology of the Hindus. Virtually speaking, Ayurveda is our Science of Life, and we will presently shew that Life and Ayus are identical.

The continuous adjustment of molecules, their successive breaking down and buildîng up within an organised living body, without destroying its identity, is the definition of Ayus as suggested by Maharshi Punarvasu.

He says :- प्राणो'पिन्द्रियसत्त्वात्मसंयोगो धारि जीlवितम् । नित्यगस्थानुवन्धश्च पर्यायैरायुचर्यते ॥

The Definition of Ayu.

So we find, the definition of Ayus, as sugessted by Punarvasu, includes more than what is proposed in The same as Life. Mr. Herbert Spencer's definition of Life.

first bearing upon the existence in the system of a preven-

tive factor of putrefaction, the second pointing to the agent or agents that

More compre- hensive than Life as defined by Mr. Herbert Spencer.

Foster speaks of as "contin:uously passing from protoplasm to

protoplasm and compared with which the nervous impulses are grosser and coarser shocks." Now

Prof. Michael Foster on the The- ory of Sensation.

The Findings of the Upanishads.

are one and the same principle. In the second place, "चः प्राणः स वायुः", i.e., Prána and Váyu are identical. In the third place, "स एव पञ्चायं वायुराकाशमनामन्यः", i.e., Váyu is not unlike Ether.

In the fourth place, "ख्वं पुबागम वायुरं वः", i.e., the primitive fluid (according to Lord Kelvin) is divided into two parts, viz., one without motion, another endued with motion.

In the fifth place, "सर्वमित्याकाशः", i.e., everything in this world are waves of this Ether endued with motion.

In the sixth place, "वायुरेव संर्वेगे। "वायुरेव देवेषु, प्राणः प्राणेषु", i.e., Váyu is the universal store of energy; in the Physical world it is known by the name of Váyu; in the Living world it is called under a different name and that name is Prána (प्राणः)

From the above short table we cone to know that the agent that adjusts the internal relations to external relations, is Ayus and that Ayus is Life, and that Life is a motion of the great etherial fluid which is known in Sanskrit as 'वात' and that

The same as pri- mitive fluid as de- fined by Lord Kelvin.

"वायुरं बलं" is the sum of all the various energies-biological and abiological- which under the name of heat, light, electricity or consciousness, etc., manifest

themselves both in the Physical as well as in the Metaphysical

world, and that Práṇa (प्राण:) is another name of the same force that, in acting on an aggregated living body, divides itself into five distinct forces, viz., Prána, Apána, Samána, Uddna, and Vyána, and subserves the functions of correlation ( वायु: ) and sustentation ( पित्तं ) and controls oxidation ( तैष्मा ). So Prána continuously helps to adjust, like the main-spring of a watch, the internal relations to the external relations. We are indebted to the master mind of Sankara for his able exposition of the functions of this main-spring,

The Identity of Váyu and Ether.

that is, of the etherial vibrations (वायुप्राण:) as transformed into the vital force in an organised body. We quote below what he says about it in his celeberated commentary on the Vedánta Darsana.

वायुरेवाऽयमध्येाऽऽत्मापन्न: पञ्चव्युष्ट्रो विशेषात्मनाऽऽवलि-ष्ठमान: प्राणाङ्ग नाम भगवते न तत्त्वान्तरं नाऽऽपि वायुमात्रं । छतथोभे ऽपि भेदाभेद्म्यतौ न विकल्प्येते । रौषत् ।

The five divisions of Váyu in its action on a living aggregate.

Biology forms the basis —— Medical Science developed as so much collateral branches.

have all their origin and start. In fact, Biology forms the basis upon which the great edifice of the Indian Medical Science, as a collateral branch, has been developed.

Conclusion.

The general truths of Biology are all there in the Ayurveda; but the special truths from medicine

INTRODUCTION.

have boen given so great a prominence that the real character

of the book has been over-shadowed and it has been trans-

formed into a Science of Medicine.

With a view to convey to the minds of our readers

an idea of the different branches of the Medical Science

which developed as a collateral branch of this great Science of

Life, we would here touch upon a few of them in passing.

Magnetism had formed its way into the therapeutics of

Magnetism.

the ancient Hindus and animal magnetism was very extensively practised in

India long before they were recognised by Mesmer in Germany

and subsequently by John Elliotson in England.

The Indian writers on Medical Science of the good

Hydropathy.

old days have described in length the

medicinal properties of the waters of

the principal rivers, lakes, water-falls and mineral springs of

the country that were known at the time and their respec-

tive curative powers as applied to various ailments that

human flesh is heir to. This goes a long way to establish

the fact that Hydropathy was known in India long before

it was even dreamt of in the Western world.

The ancient Hindu sages from time immemorial had

Massage.

been cognizant of the benefits of

massage and shampooing and taken

to practising them. Whereas, it is but of late that the

advantages of these methods have begun to be appreciated

by the Western Medical School and it no longer hesitates

to acknowledge them as efficacious therapeutic agents.

The Science of begetting healthy and beautiful children,

Genesiology.

which is just beginning to receiye atten-

tion in other countries was not un-

known to the ancient Hindus, and Manu in his Mānava-

dharma-Sāstra has laid down special injunctions which still

form an integral part of the domestic life of the orthodox

section of the community. As a matter of fact, they knew

xii INTRODUCTION. that mental impressions of the parents at the time of conception exercise a great influence over the future destiny of the child in embryo.

Thus we read in the Sastras :-“A woman, though at a distance, conceives a child of the shape of the person she loves ardently and thinks of at the time. Just as a tree that grows is not different from the parent tree whether we plant a branch or sow a seed, so the main features of the child partake of the features of its father, though there might be slight changes due to the soil.” The subtle soul co-operates with the Manas (the mind) ; the mind co-operates with the senses ; the senses perceive objects ; all this takes place in little or no time. The above is the connection between the soul and objects around us. What is there which the mind cannot comprehend ? Therefore, wherever the mind enters, the soul follows it. “The soul being subtle, whenever it enters another soul, requires some time and an effort of the mind to know the latter. The soul, which intensely meditates on an object, assumes the shape of that object.” etc, etc.

In a book entitled Bhoja-Prabandha being a collection of the anecdotes relating to the reign of Bhoja Raja, by Pandita Ballala there is narrated the detail of an interesting surgical operation which had been performed on the Raji, who was suffering from an excruciating pain in the head. All the medical aid obtaining at the same time was availed of, but in vain and his condition became quite critical when two brother physicians accidentally arrived in Dhar, who were duly called in. These physicians, after carefully examining the patient, held that unless surgically treated no relief could possibly be afforded to the Royal patient. Accordingly they administered an anæsthetic called Sammohini with

• Vide—Baraha Mihir's Brihat Sambita Book, II. Chapter lxxv. Verses 1-3.

Anæsthetics.

a view to render him insensible and, when completely under the influence of the drug, they trephined his skull, removed the malignant portion of the brain, the actual seat

of the complaint, closed and stitched up the opening and applied a healing balm to the wound. Then they administered a restoration known as Sanjivani to the patient, who, thereupon, regained consciousness and felt quite at

ease. This incident (as narrated by Thakur Saheb of Gondal in his Short History of Aryan Medical Science) goes to prove that the attendant physician of Buddha, is

likewise recorded to have practised cranial surgery with the greatest success. Instances of successful cases of abdominal

section are also not rare. Thus it will appear that the ancient Indians knew and successfully practised surgical operations

which are regarded now-a-days as the greatest triumphs of modern surgery. The purpose of chloroform in the palmy

days of yore was used to be served by Sammohini, but there is hardly a drug known to modern Pharmacopaeias,

corresponding with Sanjivani which certainly lessens the chances of deaths that at present sometimes occur under

anæsthetics.

Let them, who allege that the Hiudu system of the healing Art is unscientific, now pause and reflect ere they make

such an unwarranted and irresponsible assertion. How can a system which contains so accurate an account of the unions of

bones and ligaments, anastomoses of nerves, veins and arteries, etc., and which assures the world of the existence of

three crores and a half of veins and arteries in the human body giving facts and figures thereof with such mathe-

matical precision, be regarded as being unscientific ?

It is certainly an undeniable fact that one of the colossal achievements of modern Western Medical Science is its

Anatomy; but the point at issue is whether the process of

Dissection. with the lancets, is at all a satisfactory

method. For, is it not a fact that the finest and the

minutest arteries of the skin are never disclosed, if the scalpel is used so recklessly to remove the skin all at once and not allowed to go deeper into the muscles to expose the minute branches of blood vessels and nerves that may happen to lie embedded therein ? But, on the contrary, look at the process promulgated by Susruta for demonstrating practical Anatomy ! Its originality and perfection beats· hollow all the known methods, although it was discovered in almost the pre-historic age. The process prescribed by the Hindu system is as follows :-Cover a dead body with Kuṡa grass and place it at the edge of the water of a rivulet. After three days take it out carefully, and gradually take off the succesive layers of the epidermis and dermis and of the muscles beneath by gently and lightly rubbing it over with a soft brush. Thus the smallest and the thinnest arteries, which have by this time swelled and obtained a distinct existence are made palpable everywhere even to the minutest.

The process is termed, as we have pointed before, Ava-gharshana by Susruta. The Western method might be an easier and a more off-hand one, but by no means precise. Avagharshana. Though the merit of discovering this mode of dissection is due to Susruta, we are all blind to it and call Hippocrates the father of Medicine ! It is generally believed that with a view to further his researches and perfect his knowledge, it is Hippocrates who inaugurated the system of dissection of dead human bodies and he did the work secretly. Credulous people may lend a willing ear to such assertions but the fact is, that it was not till a century later that Hirophilus openly resorted to dissection of human bodies and thereby earned an undying fame in Europe,· obliterating Susruta's name for ever, though, virtually speaking, he (Susruta) was the pioneer of dissection and figured in the world more than a millenium before the advent of Hippocrates and over eleven centuries prior to the age of Herophilus.

It would not, perhaps, be out of place here to mention that Dr. A. F. R. Hoernle, M. A , F. R. S, C. I. E., Ph. D., in his recent publication on Hindu Osteology, has proved it to the hilt, how systematic, scientific, unerring and exact were the researches of the ancient Hindus and what a mine of resplendent truths lay imbedded in them ! We, in our Introduction of the first volume of this work, have tried to prove how very superb, salutary and supremely happy was the theory of Váyu, Pitta, and Kapha promulgated by Susruta. There we have incidentally mentioned that the Science of Embryology was not unknown to the Hindu sages. In the present volume we mean to prove to a point that the main principles promulgated in the Anatomy, the Physiology and the Pathology of Susruta yield in no way to the principles on those subjects included by the modern Western Scientists and investigators. On the other hand, we boldly affirm that in the theories propounded by Susruta some two thousand years back there lies a fund of truths which might well throw a flood of light on the field of labour of the modern scientific men of the West. For is it not a fact that the theories of Vamana (causing to eject the contents of the stomach by mouth), Virechana (causing the evacuation of the intestines), Nasya (causing to inhale through the nose), Anuvásana and Asthá-pana which, in ancient India, had earned the appellation of Pancha-Karma, and had gained universal prevalence, and were extensively practised by oriental physicians from time immemorial, have, of late, been hailed by the medical authorities of the day as the most approved and commended mode of treatment.

Sceptics who care nor to examine and weigh solid facts, bluntly allege that the Ayurvedic system is not based upon experiment and observation-the key-stone of all true Science, and such being the case its Anatomy, Physiology, Pathology and Therapeutics are all erroneous. The suggestion, cruel and baseless as it is, originally emanated from an eminent Indian physician who has earned an un-

xvi INTRODUCTION.

enviable reputation by writing a Treatise on Hindu Materia Medica.

He says:-“It (the Ayurvedic system) is built not so much upon experiment and observation as upon an erroneous system of Pathology and Therapeutics.”

But such an expression would not stand the light of day.

Indeed none but the ancient Hindu sages did set a high value on experiment and observation, and where they did not claim some occult knowledge or intuition, it is upon these two that they mainly based all their knowledge.

The Materia Medica of the Hindus is really a marvel.

Its description of the properties of drugs belonging to the animal, vegetable and mineral kingdoms, and of the articles of food essential to the maintenance of health and strength, its selection of the specific dietaries and elimination of what are prohibited in particular ailments are every day being found correct.

The European preparations of Indian drugs and diets are corroborative evidence thereof.

The theory adopted by the ancient Hindus as the basis of their investigation is that every substance, whether vegitable or animal, possesses five properties namely,—Rasa, Guna, Viryya, Vipáka and Prabháva which lenses alone cannot reveal, nor the body's eye after observation and experiment made upon rats and rabbits.

And those who have opportunities of studying and practising both the Eastern and Western Medical Science assert that the ancient Medical Science of the Hindus once reached the highest standard of excellence and perfection in Materia Medica, Therapeutics and Hygiene and was simply unrivalled and unapproachable, as it blended Philosophy with Science–the mind's eye with the body's eye.

A dispassionate examination of these facts (and such as can be multiplied to any extent), will convince an impartial reader that Ayurveda, as we find it described in Charaka Samhitá and Susruta Samhitá, if approached in a spirit of fairness and enquiry, might reveal the germs of not a few of the marvellous achievement of the present age in the domain of Medical Science and afford to the assiduous

student a vast scope and varied materials for comparision between the Eastern and the Western systems, and render material help in improving upon the one with the aid of the other, and this to the benefit of the suffering humanity at large.

Lastly it is our prayer, that if Western Medical Science was ever anywise, directly or indirectly, benefited by the ancient Medical Science of the Hindus, it is but meet and fair that the former should come forward to render all possible aid to her parent Science, and that as it is almost dying now for want of aid and succour we look hopefully to our present benign Government in whose power lies the means of its complete regeneration.

PLATE No I.

Vital points (Marmas) in the arm (inner side). Vital points (Marmas) in the arm (outer side). "J" indicates the points recognised in Juijutsu. See Chapter VI, S'arira-S'thana.

PLATE No II.

Vital points (Marmas) in the leg (continued).

"* indicates the points recognised in Juijutsu.

Vital points (Marmas) in the back of the thigh and the leg.

See Chapter VI, Sthrira-Sthána.

NIDÁNA STHÁNA

CHAPTER I

Diseases of the Nervous System, etc :-The action of the Váyu in its normal state.-The Prána Váyu-The Udána Váyu-The Samána Váyu-The Vyána Váyu-The Apána Váyu.-Descriptions of the nature of the diseases-When they are localised in the different parts of the system.-Pathology of Váta-rakta-Its premonitory symptoms-Its prognosis.-S?asms-Convulsions-Epilepsy without Convulsions-Epilepsy with Convulsions. -Hemiplegia-Its Prognosis.-Wry-neck or Torticollis.-Facial Paralysis-Its Premonitory Symptoms-Its Prognosis. -Sciatica.-Erb's Paralysis. -Synovitis of the Knee-joints. -Lameness. -Váta-Kantaka.-Páda-Dáha -Páda-Harsha. -Ams'a-s'oshaka. -Ear-ache. -Deafness.-Nasal voice.-Indistinct Speech.-Tuni.-Prati-tuni.-Tympanites.-Vátá-shthilá.-Pratyashthilá.

Pages 1—17

Hæmorrhoids :-Classifications-Pathology-Premonitory Symptoms.-Vátaja Type-Pittaja Type-Kaphaja Type-Raktaja Type-Sannipátaja Type-Congenital Type. -Figwarts or condylomatous growths about the genitals. -Prognosis.

18—24

Urinary Calculi :-General Ætiology.-Premonitory Symptoms.-Lceading Indications. -S'leshmaja As'mari-Pittaja As'mari-Vátaja As'mari.-Seminal Concretions. -Supervening Symptoms. -Situation of the Bladder. -How stones are formed in the Bladder.

25—30

CHAPTER IV.

Fistula-in-ano and Fistular Ulcers :-Classifications—Premonitory Symptoms.—Derivation of the term Bhagandara.—Vátaja Type—Pittaja Type—Kapphaja Type—Sánnipátika Type—Traumatic Type—S'ata-ponaka Type—Ushtra-griva Type—Parisrávi Type—S'ambukávarta áppc—Un- y/ márgi Type.—Fistulous Pustules.—Prognosis.

CHAPTER V.

Cutaneous Affections in general :-Premonitory Symptoms—Ætiology—Classifications.—Aruna-Kushtha—Audumbara.—Kishya-jihva —Kapála Kushtha (Macula).—Kákanaka—Pundarika— Dadru (ring-worm) —Sthulárushka—Eka-Kushtha (Ichthyósis)—Charma-dala (Hypertrophy of the skin)—Visarpa-Kushtha—Parisarpa-Kushtha—Sidhma—Vicharchiká (Psoriasis)—Vipádiká—Kitima (Keloid)—Pámá (Eczema)—Kachchhu—Rakása (Dry Erythcma)—Kílása.—Congenital cause of Kushtha.—Prognosis.—How Kushtha becomes contageous.—Some other contagious discases cnumerated.

CHAPTER VI.

Diseases of the Urinary tracts :-Pathology—Premonitory Symptoms.—Gencral characteristics.—Kapphaja Type—Pittaja Type.—Names and Symptoms of Kapphaja Meha—Surá-meha—Lavanna-meha—Pishta-meha—Sándra-meha—S'ukra-meha.—Names and Symptoms of Pittaja Meha—Nila-Meha—Haridrā-meha—Amla-meha—Kshára-Meha —Manjishthá-meha—Rakta-meha.—Names and Symptoms of Vátaja Meha —Sarpir-meha—Vasá-meha—Kshaudra-meha—Hasti-meha.—Supervening Symptoms.—Kapphaja Types—Pittaja Types—Vátaja Types.—Abscesss.—Carbuncles.—Pimples.—Pustules, etc., due to Prameha.—Prognosis.—Symptoms of Madhu-Meha.

CHAPTER VII.

Dropsy with an abnormal condition of the abdomen:-Classifications.—Predisposing causes.—Premonitory Symptoms.—Vátaja, Pittaja and Kapphaja Types.—Tridoshaja Type.—Enlargement of the Spleen and the Liver with dropsy of the Abdomen.—Vaddha-gudodara—Parisrávi-Udara.—Jalodara (Ascites).—Gencral Charactstics of Dropsy.—Prognosis.

CHAPTER VIII

False Presentations and Difficult Labour :-Causes.—Definition.—Classifications and Symptoms.—Abortion.—Miscarriage.—Prognosis. Cæsarian Section. … … … 55–60.

CHAPTER IX

Vidradhi (Abscess, etc.) :—Definition and Classification—Vátaja, Pittaja and Kaphaja Types—Sánnipátika Type—Traumatic Type—Raktaja Type—Incurable type of External Abscess.—Internal Abscesses—Their localities.—Differentiating diagnosis of Gulma and Vidradhi.—Incurable Type . … … … 61—66.

CHAPTER X

Erysipelas, Sinus and Diseases affecting the mammary glands of women :—Definition of Erysipelas —Vátaja, Pittaja and Kaphaja Types —Sánnipátika Type—Kshataja Type.—Prognosis.—Nádi-Vrana (Sinus).—Classification—Vátaja, Kaphaja and Pittaja Types—Dvandvaja and Tri-doshaja Types—S'alyaja Type.—Stana-roga.—Breast-milk—Its character—Its normal and abnormal traits.—Stana-Vidradhi (Inflammation of mammary glands). … … … 67—71.

CHAPTER XI

Glands, Scrofula, Tumours and Goitre :—Dosha-origened Glands —Sirája gland (aneurysm or Varicose Veins).—Apachi (Scrofula, etc.)—Its symptoms.— Tumour—Its symptoms—Blood-orignced Tumour.—Mámsa-Arvuda. —Prognosis.—Adhyarvuda.—Dvirarvuda. —Cause of its not being suppurated.—D- finition of Goitre—Its specific Symptoms—Vátaja Goitre—Kapha ja Goitre—Medoja Goitre.—Prognosis.—General shape of Goitre. — … … … 73—78.

CHAPTER XII

Hydrocele, Hernia, Scrotal Tumours, Upadamśa (disease of the genital organ) and Elephantiasis:—Classification of Vriddhi—Definition and Premonitory Symptoms of Vriddhi.—Symptoms of Dosha-origncd Vriddhi.—Medoja Vriddhi—Raktaja Vriddhi—Hydrocele. —Inguinal

Hernia.—Upadams'a.—Symptoms of different Dosha-orginéd types of Upadams'a.—Raktaja Upadams'a.—Definition of Elephantiasis.—Causes and Symptoms of different kinds of Elephantiasis.—Prog­nosis of Elephantiasis.—Localisation of Elephantiasis.

79-84

CHAPTER XIII.

Diseases known by the general name of Kshudra-Roga (minor ailments):—The Names and Symptoms of the discases included therein.—Ajagalliká—Yava-prakhyá—Andhálaji—Vivritá—Kachchhápiká—Valmika—Indra-vriddhá—Panasiká—Páshána.Gardabha—Jála-Gaiddabha Kakshá—Vishphota—Agni-Rohini—Chippa—Kunakha—Anus'ayi—Vidáriká—S'arkarábuda—Pámá—Vicharchiká—Rakasa—Páda-dáriká—Kadara—Alasa—Indra-lupta (Alope­cia)—Dárunaka—Arumshiká—Palita—Masuriká etc.—Tila-kálaka—Nyachchha—Charma-kila—Vyangá—Parivartiká—Ava-pátiká—Niruddha-Prakas'a—Niruddha-guda—Ahi-putana—Vrishana-kachchhu—Guda-Bhrams'a.

85-93

CHAPTER XIV.

Suka-dosha:—Its classification.—Symptoms of different Types.—Progonsis.

94-95

CHAPTER XV.

Fracture and Dislocation, etc :—Th ir Causzs.—General features of Sandhi-mukta (Dislocation).—Diagnostic Symptons of Dislocation.—Different kinds of Kánda-bhagna (Fracture)—General symptoms of Kánda-bhagna.—Curable and incurable Types.

97-100

CHAPTER XVI.

Mukha-Roga (Diseases which affect the cavity of the mouth in general):—General Classification and Localisation.—Diseases of the lips.—Dosha-orgined Types.—Raktaja Type—Mángsaja Type—Medoja Type—Diseases of the roots of the teeth.—Their Names and specific Symp­toms.—Danta-Nádi (Sinus at the root of a tooth).—Diseases of the tooth proper.—Their Names and specific Symptoms.—Diseases of the tongue—Their Names and specific Symptoms.—Diseases of the Palate—Their Names and specific Symptoms.—Diseases of the Throat and Larynx

ŚÁRIRA STHÁNA

CHAPTER I

The Science of Being in General :-The Twenty-four Tattwas or first Principles. - The Purusha or the Primordial Being or the Self-conscious Realty. - The Prakriti or the External Nature personified or the non-conscious Eternity - Traits of Commonalty and Diversity. - Comparison of the Philosophy of A'yurveda with that of Sámkhya as well as with the other branches of Philosophy. - Prakriti and Purusha how understood in the A'yurvedia - Different kinds of Manas (mind). - The five Primary Elements of Creation - Their specific function - Their mutual co-operation in creation.

113—121

CHAPTER II

122—133

Purification of Semen and Cataminal fluid etc. :-Derangement of Semen. - Specific treatment. - Derangement of Cataminal fluid. - Specific treatment. - Traits of pure and healthy Semen and Cataminal fluid. - Menorrhagia. - Amenorrhœa. - Their treatment. - Regimen to be observed during Menses. - Conduct of husband during the period. - Prohibited period. - Conception - Subsequent Conduct. - Causes of different Colours in the child. - About twins - Causes of the child being of Defective Organ - Fecundation without sexual intercourse - Causes of Deformity in the child - State of the Fœtus - Its activity while in the womb.

CHAPTER III

Pregnancy, etc. :-Combination of Self with the Impregnated Matter. - Factors which determine Sex. - Period and Signs of Menstruation. - Signs of Pregnancy. - Prohibited conducts during Gestation. - Develop-

CHAPTER IV

The development of Factors in the womb as well as the Factors which contribute to the growths of its different bodily organs and principles :-Different folds of skin over the fœtus.—The definition of Kalás and their varieties.—Seat of the semen. -Why and how semen is discharged.—Placenta.—Formation of different limbs and organs of the Fœtal body.—Sleep and its effect.—Heart and its action.—Effects of day-sleep.—Somnolence.—Effect of Sleep on an Enciente woman.—Gnawing.—The temperaments.—Symptoms of Vátaja, Pittaja and Kafaja temperaments - Symptoms of Dvandvaja and Sánnipátika temperaments.—Sáttvika, Rájasika and Támasika features.

CHAPTER V

The Anatomy of the Human body :-Definition of fœtus.—Enumeration of the different Limbs and Members of body.—Their Numbers-The Cavities or Viscera.—Channels.—Kandarā.—Jála or Plexuses.—Kurcha or Cluster.—Sevani or Sutures.—Asthi-Sangháta.—Simanta.—Bones of the four Extremeties.—Bones of the Trunk.—Bones above the Cavicles-Different kinds of Bones and their situation—Sandhi or Joints.—Joints of the four Extremities.—Sandhis of the Koshtha and Clavicles.—Their forms, distinctions and locations.—The Snáyu or Ligaments.—Their Number and Situations.—Muscles.—Muscles in the extremities in the Koshtha—Of the Head and Neck.—Extra Muscles in Women.—The Vaginal Canal—The Uterus—The Womb.—Superiority of Surgery -Preparations of dead body—Mode of dissection.

CHAPTER VI

The Marmas or Vital parts of the body:-Classifications of Marmas-Their different Numbers.—Their Locations.—Their Names and Distributions.—The different Heads of Marmas.—Qualitative Classes.—Different opinions on Marmas.—Marmas of the Extremities.—Marmas of the Thorax, etc.—Marmas in the Back.—Marmas in the Clavicular region.—Their specific Symptoms when injured.

CHAPTER VII.

The Description and Classification of Sirá or the Vascular System:-Their Numbers and action.-Names and Classification of the principal SiráS. -Their specific Locations. -The Pitta, Kapha, Váyu and Rakta-carrying SiráS. -Specific Colours of SiráS. -The specific SiráS not to be punctured. -SiráS of the four Extremeties, Trunk and the region above the Clavicles and their roots.

CHAPTER VIII.

The method of Venesection :-Persons unfit for Venesection :-Preliminary Rules. -The Jantrá-Vi?dhi or how the patient should be placed in cases of Venesection. -Venesection in the Extremeties. -Venesection on the different parts of the body. -Proper and Defective Venesection -Classification and definition of Defective Venesection.

CHAPTER IX.

The Description of the Arteries, Nerves and Ducts :-Region and Number of Dhamánís. -Functions of the up-coursing Dhamánís. -Functions of the down-coursing Dhamánís. -Functions of the lateral coursing Dhamánís. -The Situation of the Srotás and the specific Symptoms when pierced at the roots.

CHAPTER X.

Nursing and Management, etc. of Pregnant Women from the day of conception till parturition :-(ieneral rules. -Especial Regimen during the period of Gestation. -Sign of imminent Parturition-Effects of premature Urging-Preliminary Measures. -Post-parturient Measures. -Natal Rites. -Diet for Children. -Treatment of the Mother-Makkálla pain and its treatment. -Management of the Child. -Lactation. -S?lection of Wet-nurses. -Examination, etc. of Breast-milk. -Treatment of Wet-nurses. -Infantile Diseases and their Diagonosis. -Treatment of Infants. -Infantile Elixirs. -Nursing of child. -Symptoms when malignant stars, etc. strike the child. -Education and Marriage. -Defective Pregnancy-Its Symptoms an I Medical treatment. -Miscarriage-Its treatment. -Management of Pregnancy and special Recipe for Pregnant Women according to e months of Gestation.

End of the contents of SáSthána.

CHIKITSITA STHÁNA

CHAPTER I.

The two kinds of inflamed Ulcers:-The Causes, Symptoms and Classification of Ulcers. -Idiopathic and Traumatic ulcers. -General and specific Symptoms. -Symptoms of different Dosha-origined ulcers. -Symptoms of Blood-origined ulcers. -Symptoms of Suddha Vrana. -Therapeutics. -The sixty different Factors of medical treatment of ulcers. -Upadrava or the Supervening Symptoms of ulcers.

269-264

CHAPTER II.

The medical treatment of Traumatic Wounds or Sores :-Different Shapes and Classifications of Sores. -Their definitions-Their specific Symptoms-Their treatment. -Treatment of Cuts or Incised Wounds. -Treatment of Excised Wounds. -Treatment of Viscera when perforated. -Subsequent treatment. -Treatment of Diabetic Ulcers. -Treatment of Ulcers due to Kushtha or malignant Ulcers.

CHAPTER III.

265-278

The medical treatment of Fractures and Dislocations :-Symptoms of incurable fractures. -Bandage. -Diet. -Defective Bandaging -Washing. -Prrgnosis. -Treatment of fractures in particular limbs. -Gandha-Taila. -Suppuration of fractured Bones-Symptoms of Complete union of fractured Joints.

279-288

CHAPTER IV.

The medical treatment of Vata-Vyádhi or Nervous disorders :-Nervous affection of the A'más'aya-Nervous affections of the Pakvás'áya -S'álvana-upanáha. -General Measures beneficial to Vâta-Vyádhi. -The Tilvaka-Ghrita. -The Anu-Taila. -The S'ata-páka and Sahasra-páka Taila. -The Patra-lavana. -The Káncla or Sneha-lavana. -The Kalyánaka-lavana.

289-296

CHAPTER V

The medical treatment of Mahā-Vāta-Vyādhi :-Causes of Vāta-Rakta.—Its definition—Premonitory symptoms—Specific features of Vāta-Rakta—Prognosis.—Preliminary remedial measures.—Plasters etc.—Treatment of Vāta-Rakta with a preponderance of different Doshas.—The five Pradehas—Guda-Haritakī and Pippalī-Vardhamāna Yogas.—Diet.—Regimen of conduct.—The Medical Treatment of Apatānāka. —Traivrita Ghrita.—Treatment of Pakshāghāta. —Treatment of Manyā-stambha.—Treatment of Apatantraka.—Treatment of Arḍita.—Kshira-Taila.—Tympanites etc.—Hingvādi-vati.—Symptoms and Treatment of Uru-stambha. —Therapeutic properties of Guggulu.

CHAPTER VI

The medical treatment of Ars'as (Hæmorhoids) :-General remedial measures.—Application of Kshāra (Alkali).—Symptoms of satisfactory, excessive and defective Cauterisation.—Diet —Rectal Speculum.—Plasters.—Treatment of Internal piles.—Dantyarishta.—Abhayārishta.—Bhallātaka-yoga.—Other forms of Bhallātakayoga.—Regimen of diet and conduct.

CHAPTER VII

The medical treatment of As'mari (Urinary Calculus, etc) :-Different modes of treatment in As'mari.—Treatment of Vātaja, Pittaja and Kaphaja As'mari.—Alkaline treatments.—Modes of Surgical operations.—Prognosis.—Lithotomic operations.—Post-surgical measures.—Surgical treatment in Seminal Concretions.—Diet.—Parts to be guarded in Lithotomic operations.

CHAPTER VIII

The medical treatment of Bhagandara (Fistula-in-ano, etc) :-Classification.—General treatment.—Specific measures.—Different Forms and Names of incision.—Treatment of Ushṭra-grīva.—Treatment of Parisrāvi.—Bhagandara in infants—Treatment.—Treatment of traumatic type.—Treatment of Tri-doshaja type.—Syandana Taila.—Description of instrument.—Regimen of diet.

CHAPTER IX

The medical treatment of Kushtha (Cutaneous Affections in general) :-Pathology.—Conduct of diet and regimen.—Regulation of diet and conduct.—Preliminary treatment.—Treatment of Dosha types. — Mahá-tikta (hrita.—Tikta-Sarpih.—Medicinal plasters.—Alkaline treatment.—Treatment of Svitra.—Nila-Ghrita. —Mahá-nila Ghrita.—Treatment by Bleeding, Emetics and Purgatives.—Vajraka Taila.—Mahá-Vajraka Taila.—Treatment by Khadira.—Dict. ...

CHAPTER X

The medical treatment of Mahá-Kushtha (Major Cutaneous Affections).—Mantha-Kalpas.—Dict.—Medicated Arishtas, Ásavas, Surás (Wine) and Powders.—Medicinal Ayas-kriti.—Aushadha Ayas-kriti. —Mahaushadha Ayas-kriti.—Khadira preparations...Khadira-Sára preparations.

CHAPTER XI

The medical treatment of Prameha (Diseases of the Urinary tracts):-Two-fold Classifications, Causes and Symptoms. — Forbidden articles of food and drink.—Articles of diet.—Preliminary treatment.—The five medicinal remedies.—Specific treatment of Kaphaja Meha —Specific treatment of Pittaja Meha.—Specific treatment of Vátaja Meha.—Palliative measures—Medicinal Arishtas, Ásavas, Yavágus, etc.—Mode of treating a poor Prameha-patient....

CHAPTER XII

The medical treatment of Prameha-Pidaká (the Abscesses or Eruptions which mark the sequel of a case of Prameha):-Curable cases of Prameha-Pidaká. — Treatment.—Dhánvantara-Ghrita.—Fomentations forbidden in cases of Madhu-meha.—S'ála-sárádi Avalcha.—Naváyasa Churna. —Lohárishta.—Traits of cure.

CHAPTER XIII

The medical treatment of Madhu-meha :-S'ilá-jatu—Its origin, properties and use.—The Mákshika-Kalpa.—The Tuvaraka-Kalpa.

CHAPTER XIV.

The medical treatment of Udara. (Dropsy with an abnormal condition of the Abdomen) :- Symptoms of curable and incurable types. - Diet of articles forbidden. - Treatment of Vátaja, Pittaja and Kaphaja types. - Treatment of Dushyodara. - General treatment of Udara. - Haritaki Ghrita. - Mahá-vriksha Ghritá. - Chavya Ghrita. - Anáha-Vartis. - Treatment of Plihodara. - Shat-palaka Ghrita. - Treatment by Venesection. - Treatment of Baddha-Gudodara. - Treatment of Parisrávi Udara. - Treatment of Udakodara. - Treatment by tapping. - Diet.

CHAPTER XV.

The medical treatment of Mudha-Garbha (Difficult and malpresentation of the Fœtus and Difficult Labour) :- Varieties of Mudha-Garbha. - Incantations. - Postures of the Fœtus. - Operations involving destruction of the Fœtus. - Craniotomy. - After-measures. - Diet and regimen of conduct. - The Balá Taila. - The Balá-Kalpa.

CHAPTER XVI.

The medical treatment of Vidradhi (Abscesses) and Tumours :- Classifications. - Treatment of Vátaja, Pittaja and Kaphaja Vidradhi. - Karanjálya Ghrita. - Treatment of traumatic and blood-originated types. - Treatment of internal Vidradhi. - Treatment of Vidradhi. - Treatment of Majja-játa Vidradhi.

CHAPTER XVII.

The medical treatment of Erysipelas etc., Sinus and Diseases of the Mammary Glands :- Classifications of curable and incurable types of Visarpa (Erysipelas) - Treatment of Vátaja and Pittaja Visarpa. - Gauryádi Ghrita. - Treatment of Kaphaja Visarpa. - Treatment of Nádi-Vrana (Sinus). - Treatment of Vátaja, Pittaja, Kaphaja and S'alyaja Nádi (Sinus). - Alkaline treatment - Treatment by Plug-stick - Bhallátakády a Taila - Treatment of Stana-Roga - Purification of breast-milk - Surgical treatment of Stana-Roga.

CHAPTER XVIII.

The medical treatment of Granthi (Glandular Swellings), Apachi (Scarvi), Arvuda (Tumour) and Gala-ganda (Goitre) :- General

treatment of Granthi--Treatment of Vátaja, Pittaja, Kaphaja and Medoja Granthi.--Medical treatment of Apachi.--Surgical treatment of Apachi.--Arvuda--Treatment of Vátaja, Pittaja, Kaphaja and Medoja types of Arvuda (Tumour).--Gala-ganda--Treatment of Vátaja, Kaphaja and Medoja types of Gala-ganda (Goitre). ...

427-438

CHAPTER XIX.

The medical treatment of Vriddhi (Hernia, Hydrocele, Scrotal Tumour, etc.), Upadamsa (Diseases of the Genital Organ) and Slinada (Elephantiasis) :-Treatment of Vátaja, Pittaja, Raktaja, Kaphaja, Medoja and Mutraja Vriddhi.--Treatment of Antra-Vriddhi.--Treatment of Upadamsa--General treatment--Treatment of Vátaja, Pittaja, Kaphaja, Tridoshaja and Raktaja types of Upadamsa.--Treatment of Slipada--(General treatment--Treatment of Vátaja, Pittaja and Kaphaja types of Slipada--Alkaline remedies.

439-449

CHAPTER XX

The medical treatment of Kshudra-Roga (Minor Ailments) :-Treatment of Aja-galliká and Yava-prakhyá.--Treatment of Vivritá, etc.--Treatment of S'arkarávula, etc.--Treatment of Páda-dári, etc.--Treatment of Alasa and Kadara.--Treatment of Baldness and Alopecia, etc.--Treatment of Dárunaka, etc.--Treatment of Jatu-mani, etc--Treatment of Yuvána-pidaká--Treatment of the Retroflexion of the Prepuce.--Treatment of the Constriction or Stricture of the Urethra--Its surgical treatment.--Treatment of the Stricture of the Anus, etc.--Treatment of Valmika, Ahi-putana and the Prolapsus of the Anus.

450-458

CHAPTER XXI.

The medical treatment of the Sores on the Penis produced by the Suka :-The specific treatment of the different types of S'uka-dosha--General treatment.--Prognosis.

459-461

CHAPTER XXII.

The medical treatment of the Affections of the Mouth :-Treatment of Vátaja, Pittaja, Kayhaja and Medoja types of Oshtha-

CHAPTER XXIII.

The medical treatment of S'opha (swellings).--Classifications of general S'opha--Its causes.--The specific symptoms of Dosha-orginied types of S'opha.--Symptom of Vishaja S'opha--Complications--Prognosis.--The Special treatment of the different types of S'opha.--General remedies.--Diet.

CHAPTER XXIV.

The Rules of Hygiene and the Prophylactic Measures :--Tooth-brushing--Cases where tooth-brushing is forbidden.--Eye and Mouth-washing.--Collyrium.--Siro'bhyanga.--Combing.--Anointing.--Parisheka.--Affusion.--Effusion.--Anointments.--Prohibitions of Anointments, etc.--Physical Exercise.--Rubbing and Friction.--Massage.--Bathing.--Prohibition of Bathing.--Anulepana.--Alepa.--Food.--Pravata and Nivata.--Sleep--General Rules of Conduct.--Rules for Drinking Water, etc.--Curd (Dadhi)--When and How to be taken.--Women unfit to visit.--Evil Effects of the foregoing Abuses.

CHAPTER XXV.

The medical treatment of a Variety of Diseases :--Diseases of the Ear-lobes--Classification--Causes and Symptoms--General treatment--Specific treatment.--Treatment of Palita.--Treatment of Vyanga, etc.

CHAPTER XXVI.

The medical treatment for inc ing the Strength and the Viril9 Power of weak persons :-Definition of Vájí-Karana--Means of Vájí-karana.--Causes and Symptoms of the six Forms of Sexu*l incapacity. -Incurable types. -Remedies-Utkáriká—l'upaliká. -Cakes etc. 510-514.

CHAPTER XXVII.

The Recipes and Modes of using Elixirs and Rejuvenators :- The Human Organism--Which will make it invulnerable to the inroads of any Disease and Decay. -Time of using Rasâyana. -Rasâyana for Mental and Physical maladies. -Vidanga-Rasâyana--Vidanga-kalpa --Kâs'marya- kalpa. -Balâ-kalpa. -Ati-balâ, Nâga-balâ, Vidâri and S'atâvari-kalpa. - Várâhi-kalpa -Use of S'ana (-seeds). ... 515-521.

CHAPTER XXVIII.

The Elixirs and Remedial Agents which tend to improve the Memory and invigorate the Mental Faculties as well as to increase the Duration of Human Life :-S'vetâvalguja Rasâyana--Krishnâvalguja- Rasâyana--Manduka-parni-Rasâyana--Brâhmi-Rasâyana - Brâhmi-Ghrita --Vachâ-Rásayana-S'rata-pâka-Vachâ-Ghrita. -Measures for prolonging life. -Uses of Gold. ... 522-523.

CHAPTER XXIX.

The Restorative and the Constructive Agents which arrest innate morbific tendencies and decays :-Classifications of Soma. -Mode of using the Soma. -Regimen of Diet and Conduct after taking Soma. -Its Therapeutic effects. -Distinctive features of the Soma-plants-Their descriptions-Their Habitats. ... 530-538.

CHAPTER XXX.

The Tonic Remedies which remove Mental and Physical Distress :-Persons unfit for the use of Rasâyana -Names of the healing drugs. -The Mode of their use. -Regimen of Diet and Conduct-Dosage- Therapeutic effects-Differentiating traits. -Mode of Culling the above drugs. -Their Habitats. -The common Habitat of all the Oshadhis. 539-545.

CHAPTER XXXI.

The medicinal uses of Sneha, etc,:-Classifications of Sneha-Description of Sneha—The specific uses.—Measures of drugs.—The Kasháya-páka-Kalpa —The Sneha-páka-Kalpa.—Alternative methods.—Application of Sneha according to specific Dosha and Season.—Degrees of Cooking a Sneha ·-Distinctive traits of the complete cooling of a Sneha.—Process of Internal Use of Sneha —The Specific Uses of Clarified butter-The Dosage.—Evil Effects of over-dosage—Sadyah-Sneha.—Forbidden cases of Sneha-pána.—Good Effects of Sneha-pána.

CHAPTER XXXII.

The medical treatment by measures of Sveda (Fomentations, Diaphoretic measures etc.):-Classifications of Sveda.—Its Specific Applications.—Effects of Sveda — Prohibited cases of Sveda.—Symptoms of perfect and imperfect Sveda.—Measures to be followed after Sveda.

CHAPTER XXXIII.

The Distresses which prove amenable to the use of Purgatives and Emetics:-Importance of Purgatives and Emetics.—Mode of application of Emetics.—Symptoms of excessive, satisfactory and deficient Emetics.—Effects of satisfactory emetics.—Cases where Emesis is forbidden.—Cases where Emesis is recommended.—Mode of administering Purgatives.—Classifications of Koshtha.—Diet.—Benefits of proper Purgation.—Persons who should not be purged.—Persons who should be purged.—Necessity of applying sneha before the administration of Purgative or Emetic.

CHAPTER XXXIV.

The treatment of the Disorders resulting from an Injudicious Use of Emetics or Purgatives:-Their Classes.—Causes and treatment.—Evils of an Unpurged Residue of a Purgative or Emetic.—Evils of a Digested Purgative, etc.—Evils of insufficient or excessive expulsion of the Doshas.—Flatulent Colic.—Partial and Deficient Medication (Ayoga).—Over-drugging with purgatives, etc. (Ati-yoga).—Hæmorrhage due to excessive Vomiting or excessive Purging (Jivádána).—Jiva-s'onita, how to be known.—Flatulent distention of the Abdomen (Ádhmána).—Cutting

CHAPTER XXXV.

The Dimensions and Classifications of a Netra and a Vasti with their therapeutic applications :-The importance of Vasti-Karma. -The application of Vasti in different diseases. -Dimensions of the Pipe. -Materials of the Pipe. -Construction of the Vasti. -Classifications of the Vasti. -Nomenclature of the Vasti. -Application of Niruha-Vasti and Ásthápana-Vasti. -Their therapeutic Effects-The difierent Defects of a Vasti. ... ... ... ... 590–598

CHAPTER XXXVI.

The medical treatment of the mishaps which are consequent on the Injudicious Application of the Pipe and the Vasti :-Remedies for the injudicious application of the Pipe. -Disorders resulting from a defective Vasti (bladder) and its contents. -Disorders resulting from the defective Position of the Patient. -Remedies for the Complications of the defective position of Niruha-Vasti and Sneha-Vasti. -Intervals for the application of Purgative, Emetic, Ásthápana-Vasti and Anuvásana-Vasti. ... ... ... ... 599–607.

CHAPTER XXXVII.

The treatment with Anuvásana-Vasti and Uttara-Vasti:-The Process of Anuvásana-Vasti—The process of preparing several medicated Oils and Snehas. -Proper time for the application of Sneha-Vasti. -The mode of applying a Sneha-Vasti. -Symptoms of insufficient, excessive, and satisfactory application of Anuvásana-Vasti. -Diet after the application of a Vasti. -The Succcessive Actions of a Vasti. -Distresses from Injudicious Applicatfon of Sneha-Vasti. -Specific Symptoms. -Their remedies. -Uttara-Vastis—Dimensions of the Pipe of the Vasti for a Male and for a Female patient. -Mode of application. -Vaginal Uttara-Vasti. -Diseases amenable to Uttara-Vasti. ... ... ... ... 608–626.

CHAPTER XXXVIII.

The mode of applying, as well as the treatment with a Nirudha-Vasti:-The mode of Preparing a Vasti. -The mode of Applying a Vasti. -Symptoms of a satisfactory application of a Vasti. -Subsequent treatment and Diet -Drugs to be used in a Niruha-Vasti. -The Formula of a Niruha-Vasti. -The process of preparation. -The Dvádaśa-Prasriti. - Classifications of Vasti according to the range of their therapeutic applications. -Corrective Vasti. -Lekhana-Vasti. -Váji-Karana-Vasti. - Vrimhana-Vasti. - P'ichchhila-Vasti. - (iráhi-Vasti. - Sneha-Vasti. - Utkles'ana-Vasti. -Dosha-hara-Vasti. - Soothing Vasti. -Yukta-ratha-Vasti. -Siddha-Vasti. -Mustádika-Vasti. -Variations in the composition of Vasti in cases of persons of different Temperaments. -Nomenclature of different Vasti and their Specific Uses.

CHAPTER XXXIX.

The treatment of distressing Symptoms which are manifested in a patient :-The quantity of diet to be taken after the exhibition of a Niruha-Vasti. -Internal application of Sneha after Blood-letting. -Preparations of different diets. -Diet to be taken according to the Dosha and to the Strength of the patient. -Regimen of conduct. -Articles of diet.

CHAPTER XL.

The treatment which consists in employing the Dhuma (Fumes), Nasya (Snuffs) and Kavala (Gargles);-Classifications of Dhuma-Materials of different Dhuma-Varti. -Formation of the Pipe used in Dhuma-Pána-Mode of inhalation of different Dhumás-Prohibitive cases -Time of Dhuma-pána (Smoking)-The therapeutic effects of Dhuma-pána-Mode of Smoking. -Snuffs and Errhines (Nasya)-The Nomenclature of the term "Nasya"-Classifications of Nasya-S'iro-Virechana-Its application-Dosage of Sneha Nasya-Effects of proper, excessive and deficient application of a Sneha-Nasya-Avapida-Nasya--Forbidden cases.-Prati-marsha Nasya when to be used-Its effects. -Specific use of Sneha-Nasya. -Kavala-graha (Gargles)-Classification-Mode of application-Their uses-Kavala and Gandusha distinguished-How long Kavala should be retained-Symptoms of satisfactory, deficient and excessive Gargling. -Prati-sárana-Its classification and effects.

End of the Contents of the Chikitsita Sthána.

KALPASTHÁNA

(SECTION ON TOXICOLOGY)

CHAPTER I.

The mode of Preserving Food and Drink from the effects of Poison :-The necessary qualifications of a Superintendent of the Royal Kitchen-The necessary features of a Royal Kitchen. - Characteristic features of a Poisoner. - Indications of poisoned food and drink, etc. - General treatment. - The mode of preparing Soup, etc.

CHAPTER II.

The Indications (Effects, Nature and Operations) of Sthávára Poisons :-Sth.ivara Poison-Its source. - Names of the different Vegetable and Mineral poisons. - Effects of poison on the Human organism. - Effects of Bulb-poisons-Specific properties and actions of Bulb-poisons-Definition of Dushi-visha-Symptoms of weak and slow poisoning-Derivative meaning of Dushi-visha. - Symptoms of the different stages of Sthávára poisoning-The medical treatment. - Koshátakyádi-Yavágu-Ajeya-Ghrita - Vishári Agada. - Treatment of the supervening Symptoms of Poisoning. - Prognosis.

CHAPTER III.

The Subject of (the nature, virtue, etc. of) Animal Poisons :-Different locations-Characteristic features and purifications of poisoned Water. - Poisons in the Atmosphere and its purification. - Mythological origin of Poison. - Properties of poison-Nature and Location of Snake-poison-General treatment of poisoning-Symptoms of taking poison internally. - Fatal bites. - Prognosis.

CHAPTER IV.

The Specific Features of the Poison of a Snake-bite :-Clasifications of Snakes. - Clasifications of Snake-bites-Their specific Symptoms-Characteristic features of the different species of Snakes. - Features of the different Castes amongst Snakes. - Particular Habits of the different kinds of Snakes. - Names of the different species of Darvi-kara Snakes-Names of

CHAPTER V.

The medical treatment of Snake-bites :-General treatment of Snake-bites.—Mantras (Incantations)—Blood-letting in Snake-bites—Specific treatement of the bite by a Hooded (Darvi-kara) snake, a Mandail Snake and a Rájimán Snake.—Contra-indication to blood-letting in cases of Snake-bites.—Dosage of Collyrium, etc., to be resorted to in cases of different Beasts and Birds.—General dosage of medicines in cases of Snake-bites—Specific treatment of poisoning according to the Physical Symptoms --Specific treatment of the different Supervening Symptoms.—Remedy for the aggravated Doshas due to Poison—Medical treatment of persons made unconscious from the effects of a Fall or Suspended Animation.—Symptoms of wounds from Poisoned Darts, etc.—Treatment of a Poisoned Wound—Recipe of different Agadas—Mahágada—Ajitágada—Tárkshyágada—Risha-bhágada -- Sanjivana Agada—Darvi-kara-Rájila-visha-hara-Agada —Man-dali-visha-hara Agada—Vams'a-tvagáli Agada—Pancha-s'irisha Agada—Sarva-Kámika Agada—Ekasara Agada. ... 715—727.

CHAPTER VI.

Cases of Rat-poisoning :-Different Varieties of Rats—(General Symptoms of Rat-poisoning—Specific symptoms and treatment of Rat-poisoning—General treatment.—Causes of Rabies—Symptoms of Hydro-phobia—Prognosis. —Symptoms of Jala-trása—Its treatment—Treatment of bites by rabid-dogs—Treatment of teeth and nail-scratching. 728—736.

CHAPTER VII.

Treatment with the Sounds of a (medicated) Drum, etc., possessed of Anti-venomous Virtues :--Kshárágada--Its Uses and Therapeutic Effects--Kalyánaka-Ghri:ta--Amrita-Ghrita -- Mahá-sugandhi Agad1--Rules of Diet and Conduct.--Symptoms of Elimination of Poison.

737--741.

CHAPTER VIII.

On insects, i.e., the measures, etc. to be adopted in cases of Insect-bites, etc. :--The Germination and Classification of Insects -- Insects of Vátaja, Pittaja, Kaphaja and Sánnipátika temperaments. -- Symptoms of their Bites--The Kanabha class of Insects--The Gaudheyaka class of Insects--S'ata-padi--Manduka (Frogs)--Pipiliká (Ants)--Makshiká (Stinging Flies)--Mas'akas (Mosquitoes).--Incurable classes--Treatment of a bite by strong and acute-poisoned Insects--Recipes of Remedies in different cases.--Origin and Classification of Scorpions--Specific traits and characteristics of Mild-poisoned Scorpions, Madhya-visha Scorpions and Tikshna-visha Scorpions--Treatment of Scorpion-bites. -- Spider-bites.-- Development of Lutá-poison--Its Potency--Location. -- Characteristics of Poison according to its seat in the body of a Spider--Mythological Account of the Origin of Lutá.--The different names of Spiders and the general Symptoms of their Bodies-- Specific Symptoms of Spider-bites and their Treatment--(;eneral Remedies--Specific symptoms of the Incurable cases of Spider-bites--Their treatment.--Surgical Treatment--Treatment of Ulcers incidental to the Bites by Insects or Snakes.

742--762.

End of the Contents of the Kalpa Sthána.

THE SUS'HRUTA SAMHITÁ

NIDÁNA STHÁNAM.

CHAPTER I.

Now we shall discourse on the Vátavyádhi-(diseases of the nervous system) Nidánam*.

Metrical text:-Having clasped the feet of

the holy Dhanvantari, who had arisen out of the primordial ocean with the pitcher of ambrosia on his head, and who was the foremost of all knowers of truth, Sus'hruta interrogated him as follows :-“Tell me, O thou, the foremost of discoursers, all about the different locations and functions of the bodily Váyu (nerve force), both in its normal and agitated conditions, (as well as when it changes its natural seat through a concourse of disturbing or aggravating causes). Instruct me on the nature of distempers, which result from its deranged condition.”

The holy Dhanvantari, the greatest of all healers, having listened to the foregoing words of Sus'hruta, replied as follows:-This vital Váyu (nerve force), which courses through the body, is self-begotten in its origin, and

• The term Nidánam, usually translated as Pathology, is meant to include factors, which fall within the respective provinces of Pathology, Etiology, Symptomology and Pathognomy as well. For the meaning and functions of Váyu see Introduction vol. I. pp. xli.—xlii.

THE SUSHRUTA SAMHITA

3. The action of Váyu in its normal State

Chap. I.] NIDANA STHANAM.

3

tends to maintain uniform state in the metabolism of

the body, (protoplasmic, Agni*) and helps the organs

of sense-perception in discharging their specific functions.

The bodily Váyu, like the Pittam in the organism, is

grouped under five different subheads according to the

difference in its functions and locations, and is classified

as the Prána, Udána, Samána, Vyána and Apána.†

These five classes of Váyu, located in their specific

regions, contribute towards the integration and main-

tenance of the body. 4—6

The Prána Váyu :-The Váyu, that courses in

(governs)the cavity of the mouth,‡ is called the Prána, its

function being to force down the food into the cavity of

the stomach, and to assist the different vitalising principles

of the body (such as the internal heat or fire etc ) in dis-

charging their functions in life, and to contribute to the

genral sustenance of the body. A deranged condition of

this particular kind of Váyu (Prána) is usually followed

by hic-cough, dyspnoea and other kindred distempers. 7.

The Udána Váyu :-The most important of the

vital Váyus, which courses (sends its vibrations) upward,

is called the Udána. It produces speech, song, etc. In

its deranged state it brings on discases which are speci-

fically confined to regions lying above the clavicles. 8.

The Samána Váyu :-The Samána Váyu

courses in (governs) the stomach (Ámáshaya) and in the

• See Introduction Vol. I. p.p XLVIII—XLIX Mahâmahopâdhyâya

Dvárkâ Nâtha Kaviratna interprets this Agni as digestive heat (Jatharágni).

† The Prána Váyu is identical with the energy of the nerve centre

in the medulla ; the Udána with that of the one which is situated in the

speech centre. The Samâna is same as the energy of the epigastric

plexus, the Udána is same as the energy of the Motor-Sensory Nerves, and

the Apána is identical with the force of the Hypogastric plexus.

‡ The field of its action includes the regions of the heart, throat, head

and the nose,

THE SUSHRUTA SAMHITA

4

region of intestines (Pakváshaya). Its functions consist in digesting the chymc brought down into the intestines in unison with the digestive ferment (Agni), and especially in disintegrating its essence from its refuse or excreted matter. A deranged or aggravated condition of the Samána Váyu causes dysentery, Gulma, and impaired digestion, etc.

The Vyána Váyu :-The Váyu known as the Vyána courses (acts) through the whole organism, and its functions consist in sending the lymph chyle etc. all through the body and in helping the out-flow of blood (Asrik) and perspiration. Five kinds of muscular movements* are ascribed to the action of the Vyána Váyu, a deranged condition of which is generally attended with diseases which are not confined to any particular region, member, or organ of the body, but are found to affect the whole organism (such as, fever, etc.).

The Apána Váyu :-The Váyu known as the Apána acts in the lower region of the intestines (Pakvádhána). Its functions consist in bearing down the fœtus and the faeces and in evacuating the urine, semen and catamenial blood. An enraged condition of this Váyu tends to bring on serious diseases, which are peculiar to the urinary bladder and the distal portion of the large intestine (Guda). An aggravated condition of both the Vyána and Apána Váyus may produce Pramcha and disorders of the seminal fluid, while a simultaneous excitement of the five vital Váyus leads to a sure and speedy termination of life.

11-12.

Now we shall describe the nature of diseases, brought about by the localization of the variously aggravated Váyus in the different parts of the body.-In the cavity

• Such as expansion, flexion, lowering down and lifting up or lateral thrusting of any part of the body.

Chap. I.] NIDANÁ STHANAM. 5

of the stomach (Ámáshaya) the deranged or aggravated Váyu gives rise to vomiting, vertigo, epileptic fits, thirst and pain at the sides (Párs'va Sula) and about the region of the heart (Hridgraha). In the intestincs (Pakváshaya) the enraged or disturbed Váyu gives rise to a rumbling in the intestines. a piercing pain about the region of the umbilicus, scanty and painful urination and stool, or their entire suppression (Ánáha), and pain about the region of the coccyx (Trika). 13—15. Similarly, incarcerated in the sense-organs, such as the cars, etc. it tends to deprive them of their respective faculties. In the skin (lymph chyle) it produces a discolouring of the complexion, parchedness and twitching in the skin, and causes a complete local anæsthesia, giving rise to a tingling, piercing pain in the skin, which spontaneously bursts, or becomes marked with cracks and fissures. Similarly, the aggravated Váyu interfering with the principle of blood gives rise to ulcers. In the flesh, it produces painful nodes and tumours (Granthi). whilc in the principle of fat it brings on almost painless tumours (Granthi) unattended with any kind of ulcer. Incarcerated in the veins &c. (Sirâ) it produces a stiffening or painful contraction, or a varicose or neuralgic condition ; in a ligament (Snáyu), it produces numbness (anæsthesia), palsy, aching pain and convulsive jerks ; in a long joint, it tends to deprive it of its contractibility and produces a painful inflammatory swelling (about the affected part). In the bones it produces a wasting (atrophy) of the bones which crack and begin to spontaneously burst, attended with the characteristic bone-ache. Again in that important principle of life, the marrow, it tends to dry it up and produces a sort of pain, extending all over the body which knows no respite or abatement. Similarly, in the principle of semen it tends to produce a scanty,

6 THE SUSHRUTA SAMHITA.

defective, or excessive emission of that vital fluid, or a complete stoppage thereof. 16—23.

The Váyu, thus disturbed and agitated, affects in succession the lower and the upper extremities of the body, and the head, or extends all over the body and deranges all its root-principles (Dhátu). The symptoms, which mark such conditions of the body, are numbness (paralysis), convulsive contortions of the limbs (Akshepa), anæsthesia, and various kinds of pain (Śula), and swelling (Śopha) of the body. The deranged Váyu, having entered the natural seats of the Pittam or Kapham, develops symptoms, which are peculiar to either of them, and gives rise to numerous diseases. 24—25.

The symptoms, which characterise the union of the deranged Váyu with the Pittam (in its particular seat) are a burning sensation, heat, thirst, and loss of consciousness, in addition to the symptoms of the Vátaja disease so generated in that particular part of the body, while a similar unison with the Kapham develops coldness, swelling and heaviness (of the affected part). The disturbed or agitated Váyu in unison with the principle of blood gives rise to a sort of pricking pain (pins and needles in the affected locality), which can not bear the least touch, or is marked by complete anæsthesia, and symptoms, peculiar to the deranged Pittam, follow in its train. 26—28.

Vomiting, and a burning sensation, etc. in the body, mark the instance when the Prána Váyu is surcharged (Ávrita) with the Pittam; while weakness, lassitude, somnolence and a general discolouring of the complexion (D. R.,—loss of taste) characterise a case when it is surcharged with the deranged Kapham A burning sensation in the body, loss of consciousness or epileptic fits, and a sense of giddiness (vertigo) and

Chap. I.] NIDANĀ STHANAM. 7

physical languor are the indications, which distinguish a case of the Udàna Váyu being surcharged with the Pittam ; while a stoppage or absence of perspiration, 'appearance of goose-flesh on the skin, impaired digestion, coldness and numbness of the affected part characterise a case of the same being surcharged with the Kapham. 29–32.

Copious flow of perspiration, heat with a burning sensation in the body, and epileptic fits indicate a case 'when the Samána Váyu has become united with the Pittam ; while a copious flow of stool and urine, and an excess of mucous secretion (Kapham) from the nose (fluent coryza) etc. and horripilation mark a case, where it has become saturated with the Kapham. 33–34.

Heat and a burning sensation in the affected part and a profuse menorrhagia mark a case when the Apána Váyu becomes surcharged with the Pittam, whereas a sense of heaviness in the lower limbs characterises a case when it becomes overcharged with the Kapham. 35–36.

[Symptoms such as,] burning and jerking in the limbs, and a sense of physical languor become manifest in the event of the Vyána Váyu being surcharged with the Pittam, while a general heaviness of the limbs, stiffness or numbness of the bone-joints, and an incapability of locomotion indicate the fact of its being surcharged with the Kapham. 37–38.

The Nidānam of Vāta Raktam :-

An over-indulgence in grief, excessive sexual intercourse, inordinate physical exercise, drinking large quantities of wine, observance of a regimen of diet and conduct in a particular season of the year which is improper to it, use of articles of food which are not congenial to one's own temperament and an improper or

THE SUSHRUTÂ SAMHITA

8

baneftul use of such oleaginous substances (as oil, clarified butter etc.) are the factors, which vitiate in common the blood and Pittam of a person. The foregoing causes especially tend to vitiate or agitate the Váyu

and blood in persons of delicate constitutions, or in corpulent persons, or in those who observe a form of perfect continence. 39.

The vital Váyu becomes enraged or agitated by excessive riding on horses, camels or elephants, or through the lifting or carrying of great weights, etc., or by an inordinate indulgence in things which are possessed of the specific virtue of enraging or aggravating that vital principle. On the other hand, an over-indulgence in such articles of food as are heat-making in their potency, or a surfeit of edibles largely composed of sharp, acid or alkaline substances, as well as a large consumption of potherbs etc., or an exposure to heat tends to vitiate the blood of the organism, and which, on account of such contamination, tends to speedily obstruct the passage of the fleet-coursing Váyu. The Váyu, thus impeded in its course, becomes more and more agitated each moment,

and is prone to speedily agitate the blood in a similar way. The antecedence of the term "Váta" or "Váyu" in the nomenclature of the disease (Váta-Rakta) is owing to the precedence accorded to the action of the deranged Váyu in bringing about the malady, although it effects this in concert with the vitiated blood of the organism. 40.

Similarly, the disease brought about by the agitated Pittam, in conjunction with the vitiated or agitated blood, is called the Pitta-Raktam, while the one incidental to the combination of the deranged Kapham with the vitiated blood is called Kapha-Raktam. In a case of Vata-Raktam, the legs, or the lower extremities can

Chap. I] NIDANA*STHANAM.

9

not bear the least touch (Hyperæsthesia) and a sort of

pricking, piercing pain (pins and needles) is experienced

in those regions. The legs become withered or

atrophied and lose all sensibility to touch. In a case

of Pitta-Raktam, the legs become extremely red, hot,

soft and swollen, characterised by a sort of indescribable

burning sensation. In a case of Kapha-Raktam, the

legs become swollen and numbed. The swelling assumes

a whitish hue and feels cold to the touch, and is

accompanied by excessive itching. In the Sánnipátika

or Tridoshaja form of Dushta-Raktam, the legs exhibit

symptoms, which are respectively peculiar to all the

three preceding types. 41—43.

Premonitory Symptoms:—In the incuba-

tive stage of the disease the legs perspire and become

cold and flabby, or (on the contrary), the local perspira-

tion is stopped and the legs become hot and hard. More-

over, a pricking pain is experienced in the affected parts

which are marked by complete anæsthesia, heaviness, or

heat, and discolouring of the skin. The disease creeps

in either from the lower extremities, or in some cases,

first affects the upper ones and gradually extends all

over the body like an enraged rat-poison.

Prognosis :—The form of the disease in which the

skin of the part lying between the instep and the knee-

joint becomes abraded or spontaneously bursts open,

exuding pus and blood, attended with loss of strength

(Prána) and flesh, curvature of the fingers, and eruptions

of nodules, should be regarded as incurable; while a

case of one year's standing admits only of palliative

measures. 44.

The enraged or agitated Váyu, while coursing swiftly

through the Dhamanis (nerves) of the body, shakes it in

quick succession, and a disease, (exhibiting such

2

THE SUSHRUTA SAMHITA

symptoms as shaking or convulsive jerks), is originated which is called Ákshepaka* (spasms, convulsions). The form of the disease, in which the patient falls to the ground, at intervals, is called Apatánaka (Epilepsy without convulsions). The aggravated or agitated Váyu, charged with an abnormal quantity of Kapham, sometimes affects and stuffs the entire nervous system, and gives rise to a form of disease, which is called Dandá-patánakam† (Epilepsy with convulsions), inasmuch as it deprives the body of its power of movement and flexibility, making it stiff and rigid like a rod (Danda).

The disease but rarely yields to medicine and, is cured in rare instances only with the greatest difficulty; its characteristic symptom being a paralysis of the jaw-bone, which makes deglutition extremely difficult. The disease in which the enraged Váyu bends the body like a bow is called Dhanushtambha (Tetanus). The disease admits of being divided into two distinct types accordingly as the body of the patient is curved internally (Antaráyáma, lit :-inwardly or forwardly extended, emprosthotonos), or externally (Vahiráyáma, lit :-extended or bent on the back, resting on his heels and occiput—Opisthotonos). When the extremely enraged and powerful bodily Váyu (nerve-force), accumulated in

• The patient suffers from vanishings (támya té) and loss of consciousness through the instrumentality of the enraged and aggravated Váyu, hence the disease is so named—Gayaddsa.

† Jejjada holds that the enraged Váyu, in unison with the deranged Kapham, gives rise to another kind of convulsions (Ákshepaka) which he has denominated as Dandâ-patânakh which, exhibits such symptoms as coldness, swelling and heaviness of the body on account of its being brought about by a concerted action of the deranged Pittam and Kapham. Several authorities aver that there are four distinct types of Ákshepakah, such as Dandâ-patânakh, Antarâyâmah, Vahirâyâmah, and Ákshepakh of traumatic (Abhighâtaja) origin.

Chap. I.] NIDANA STHANAM. 11

the regions of the fingers, insteps, abdomen, chest, heart and throat, forcibly draws in the local ligaments (Snáyu), the body becomes contracted and bent forward, bringing about a curvature of the inner trunk. The disease in this form is called Antarāyāma Dhanushtambha. The movements of the eyes become impossible, which become fixed in their sockets; the jaw-bones become paralysed, the sides are broken, and the patient ejects (at intervals quantities of) slimy mucous (Kapham). These are the features which mark the first type (Antarāyāma Dhanushtambha). On the contrary, when the same enraged Váyu, centred or lodged in ligaments which traverse the posterior side of the body, attracts them violently, the body is naturally bent backward. The patient experiences a sort of breaking pain at the chest, waist and thighs, (which are ultimately broken). The disease is called Vahirāyāma, and should be looked upon as beyond the pale of all medicinal treatment. 47--50.

Four types of Ákshepak are usually recognised in practice such as, the (1) one incidental to the concerted action of the enraged body Váyu and Kapham (2), the one brought about through the union of the enraged Váyu with the deranged Pittam, (3), the one due to the single action of the agitated Váyu (4) and the one due to any external injury or blow (Abhighátaja).* An attack of Apatankah due to excessive hæmorrhage, or following closely upon an abortion or miscarriage at pregnancy (difficult labour), or which is incidental to an external blow or injury (traumatic), should be regarded as incurable. 51--52.

Four types of Ákshepak are usually recognised in practice such as, the (1) one incidental to the concerted action of the enraged body Váyu and Kapham (2), the one brought about through the union of the enraged Váyu with the deranged Pittam, (3), the one due to the single action of the agitated Váyu (4) and the one due to any external injury or blow (Abhighátaja).* An attack of Apatankah due to excessive hæmorrhage, or following closely upon an abortion or miscarriage at pregnancy (difficult labour), or which is incidental to an external blow or injury (traumatic), should be regarded as incurable. 51--52.

• Brahma Deva designated the four types of the disease, as Apatánakah, Samarishta Ákshepakab, simple Ákshepakah and the Abhighátaja (traumatic).

• Brahma Deva designated the four types of the disease, as Apatánakah, Samarishta Ákshepakab, simple Ákshepakah and the Abhighátaja (traumatic).

THE SUSHRUTA SAMHITA

12

The disease, in which the extremely agitated Váyu affects the nerve chains (Dhamanis) which spread either in the left or in the right side of the body, whether in the upward, downward, or lateral direction, making them lax and vigourless, and in which the joints of the other side of the body become useless and inoperative, is called Pakshágháta (Hemiplegia) by eminent physicians.

The patient, the whole or half of whose body has become (almost) inoperative and lost all sensibility, but who retains his consciousness so long as there remains the least vestige of vitality in the affected part, suddenly falls down and expires.

53–54.

Prognosis:-A case of Pakshágháta (Hemiplegia), brought about through the single action of the enraged or agitated Váyu of the body, can be cured only with the greatest care and difficulty.

A case of the same disease, engendered by the aggravated Váyu in conjunction with the deranged Pittam or Kapham, proves amenable to medicine (Sádhya).

It becomes incurable when caused through the waste of the root principles (Dhátu) of the body.

Apatantrakaḥ (Convulsions):-The Váyu, aggravated (by its specifically exciting factors and principles) and dislodged from its natural seat or receptacle in the body in consequence thereof, courses upwards and finds lodgment in the regions of the head, heart and temples.

It presses upon those parts and gives rise to convulsive movements of hands and legs, or at times bends them down.

Symptoms:-The patient lies with his eyes closely shut, or stares with a sort of fixed or vacant gaze, the eyes remaining fixed or immovable.

The patient loses all perception, and groans. Respiration becomes difficult, or symptoms of temporary asphyxia

Chap. I.] NIDANA STHANAM. 13

and unconsciousness set in. Consciousness and a normal condition of the organism return with the passage of the enraged Váyu from the heart, while on the other hand the patient relapses into unconsciousness simultaneously with the envelopment of the heart with that enraged and Kapha-saturated Váyu. This disease is called Apatantrakah and is ascribed to the action of the enraged Váyu surcharged with the deranged Kapham. 56.

Manyástambha :-The local Váyu, agitated

through such causes as sleep in the day time, reclining with the neck on an uneven place or pillow, gazing upward for a considerable length of time, or looking aside in a contorted way, and enveloped in the deranged Kapham, gives rise to the disease known as Manyá-stambha (wry neck or torticollis). 57.

Arditam (Facial Paralysis):-*Pregnant women,

mothers immediately after parturition (Sutiká), infants, old and enfeebled persons are most prone to fall victims to this disease*. It has been also known to result from excessive hæmorrhage or loss of blood. The local Váyu, extremely enraged or aggravated by continuous talking in an extremely loud voice, chewing of hard substances, loud laughter, yawning, carrying extremely heavy loads, and lying down in an uneven position on the ground, finds lodgment in the regions of the head, nose, upper lip, chin, forehead and the joints (inner cornea) of the eye, and produces the disease called Arditam by distorting the face.

Symptoms :-The neck and half of the face

longitudinally suffer distortion and are bent. The head shakes; the power of articulating speech is lost, and the

• The portion of the text included within asterisks bas been rejected

by Jeijadácháryya as spufious.

THE SUSHRUTA SAMHITA

Premonitory Symptoms :-The disease generally commences with shivering, horripilation, cloudiness of vision, upcoursing of the bodily Váyu and anæsthesia, a pricking pain in the affected locality, numbness or paralysis of the jaw-bone, or of the cervical muscles of the neck. Physicians, conversant with the Ætiology of diseases, call it Arditam (Facial paralysis). Prognosis :-A case of Arditam, appearing in an extremely enfeebled or emaciated patient, or exhibiting such symptoms as a winkless vision, inarticulate speech which hardly seems to come out of the throat, excessive palsy of the face, as well as the one of more than three years' standing, should be deemed as incurable.

Gridhras'i (Sciatica):-The disease in which the two great nerve-trunks (Kandarà), which emanating from below the lower extremity of the thigh reach down to the bottom of the insteps and toes, and become stuffed or pressed with the enraged Váyu, thus depriving the lower extremities of their power of locomotion, is called Gridhras'i.

59

Vis'vachi (Erbe's paralysis or Brachial neuralgia):-The disease in which the enraged Váyu affecting the nerve-trunks (Kandarà) which run to the tips of fingers from behind the roots of the upper arms, making them incapable of movement and depriving them of their power of flexion or expansion is called Vis'vachi.*

60

Kroshtukas'irsha (Synovitis of the knee-joints):-An extremely painful swelling in the knee-joints.

• When the aforesaid nerve of a single arm is affected the disease is restricted to it alone, whilst it attacks the both when both their nerves are affected.

Kroshtukas'irsha

joints, which is originated through the concerted action of the deranged Váyu and the vitiated blood is called Kroshtukas'irsha from the fact of its resembling the head of a jackal (Kroshtuka) in shape.

Khanja (Lameness)

The disease proceeds from the drawing up of the nerve trunks (Kandarâ) of a leg by the deranged Váyu lying about the region of the waist. When both the legs are similarly affected, the patient is called a Pangu. He, whose legs tremble before starting for a walk and who afterwards manages to go on limping is called a Kaláya Khanja one in whom the bone-joints become loose.

Váta Kantaka

The local Váyu, enraged by making a false step on an uneven ground, finds lodgment in the region of the ankle (Khudaka, instep according to others), thus giving rise to a disease which is called Váta Kantaka. The burning sensation in the soles of the feet caused by the enraged local Váyu, in conjunction with the deranged Pittam and blood, is called Páda-dáha, which is generally seen to afflict persons of pedestrian habits. When the legs are deprived of all sensibility of touch, and a sort of tingling pain is experienced in them it is termed Pádaharsha, which is due to the deranged action of the Váyu and Kapham. The disease in which the enraged local Váyu dries up the normal Kapham lying about the shoulder-joints is called Ansa-shoshaka. The form in which the aggravated local Váyu contracts the nerves of the arms is called Avaváhuka.

Vádhiryayam (deafness)

The disease occurs only when the deranged Váyu, either singly or sur

• The Ansa-shosha is due to the single action of the enraged Váyu, while Ava-váhuka is due to the concerted action of the deranged Váyu and Kapham.

THE SUSHRUTA SAMHITA

Karna s'ulam :-The disease in which the deranged Váyu causing a piercing pain in the regions of the cheekbones, head, temples and neck, gives rise to a sort of aching pain in the tympanum, is called Karna-s'ulam (otitis). The local Váyu, deranged and saturated with the Kapham stuffing the nerves (Dhamani) which conduct of the sound of speech, produces complete (in some cases partial) loss of the power of speech—e.g. Muka (dumbness', Minmina (nasal voice) and Gad-gada (indistinct speech).

THE SUSHRUTA SAMHITA

A sort of pain, which (rising from the bowels or the urinary bladder and ranging downward) gives rise to a bursting sensation in the regions of the anus and the genitals, is called Tuni, whereas the one, rising upward from the preceding parts and extending up to the region of the intestines, is called Prati-tuni. A distension of the abdomen (Udara), attended with the incarceration of flatus (Váyu) and an intense pain and rumbling in its inside, is called Ádhmánam (Tympanites). When it first affects the stomach (Ámásaya) and is unattended with an oppressive feeling about the heart and pain at the sides it is called Pratyádhmánam. The Váyu saturated with the deranged Kapham causes the preceding type of distemper.

THE SUSHRUTA SAMHITA

A knotty stone-like tumour (Granthi) of considerable density, whether fixed or mobile, and appearing below the umbilicus, and having an elevated shape which is always found to be extended in an upward direction, is called a Vatásthila, (which) as its name implies, is due to the action of the local deranged Váyu. The tumour, thus formed, obstructs the emission of flatus and impedes the evacuation of fæces. A tumour of similar shape,

NIDANÂ STHANAM

Chap. I.

appearing laterally or across the region of the abdomen (Jathara) and obstructing the passage of stool, urine and flatus (Váta) is called a Pratyashthilá. 75—76.

Thus ends the first Chapter of the Nidâna Sthânam in the Sushruta Samhitâ, which treats of the Nidânam of the diseases of the nervous system.

CHAPTER II.

Now we shall discourse on the Nidānam of Ars'as (Hæmorrhoids).

Hæmorrhoids may be divided into six classes viz:— (i) Vātaja (due to the action of the deranged Vāyu), (ii) Pittaja (due to the action of deranged.Pittam), (iii) Kaphaja (due to the action of deranged Kaphafn), (iv) Raktaja (due to the action of the vitiated blood), (v) Sannipātaja (due to the concerted action of the deranged Váyu, Pittam and Kaphain) and (vi) Sahaja (congenital).

Pathology :—

The deranged Váyu, Pittam, etc. enraged by their specific aggravating causes, or by such acts or conduct as partaking of food composed of incompatible substaifces, eating before the previous meal has been digested, inórdinate sexual intercourse, sitting on the haunches, cxcessive riding, and the voluntary suppres- sion of any natural urging of the body, either severally or in combination of two or three Doshas, or vitiating the blood of a person, who observes no moderation in food and drink &c., become dislodged from their natural seats in the body [according to the law of Prasaranam (expansion and change of place by a deranged organic principle)] and are carried down through the large intestine (Pradhána Dhamani) into the descending colon and getting lodged therein, give rise to growths of polypi or fleshy condylomata, which are known as piles.

These growths chiefly appear in persons suffering from impaired digestion (Agni), and gain in size through friction with the wearing apparel, weeds, wood, lumps of clay or stone, or by contact with cold water.

The lower end of the large intestine, which passes into the flexure of the rectum and measures four and

a half fingers in length, is called the Gudam (lit—the channel of fecal matter), the interior of which is provided with three spiral grooves. Each of these grooves or ring-like muscles lie a finger and a half apart, and are respectively known as Pra'vāhini, Vi'sarjani and Samvarani, or the grooves of out-flow, defecation and closure of the anus (sphincter ani), covering a space of four fingers and having laterally an elevation of one finger's width.

Metrical Texts :-These grooves are like the involuted indentures of a conch shell, situated one above the other, coloured like the palate of an elephant. A part of the channel, half a finger's width in length as it is usually measured from the outer hairy orifice of the rectum, is called the anus (Gudoushtha).

5.—6.

The first of the aforesaid grooves or rings lies about a finger's width apart from the orifice of the anus.

Premonitory Symptoms :-A non-relish for food, a tardy and difficult digestion of food (brought into the stomach), acid eructations, a sense of weakness in the thighs, a rumbling sound in the intestines, emaciation of the body, frequent eructations, swellings around the eyes, a croaking sound in the intestines, cutting pain in the rectum (Guda), apparent indications of an attack of phthisis, jaundice, dysentery, cough, dyspnœa, vertigo, somnolence, excessive sleep, weakness of the organs (Indriya), are indications which predict the advent of this disease, and which become more marked with its progress.

The Vāta'ja Type :-Piles, due to the action of the aggravated Vāyu, are non-exuding, rose-coloured, and uneven in their surface. They resemble the Kadamba flowers in structure, and are either tubular or sharp-pointed like a needle, sometimes assuming the shape of

the wild Tundikeri flower. The stool of a hæmorrhoid patient of this type becomes excessively hard, and can be evacuated only in a sitting posture, with the greatest pain and difficulty. An excruciating pain is experienced in the regions of the waist, back, sides, anus, umbilicus and the genitals. Symptoms peculiar to Gulma, Ashthilá, enlarged spleen and abdominal dropsy add to the distress of the patient, whose skin, nails, eyes, teeth, face, urine and stool also assume a dark black colour.

The Pittaja Type :- Piles, brought on through the action of the deranged Pittam, are slender, blue-topped, shifting in their nature, yellowish in their hue, or are coloured like shreds of liver, resembling in shape the tongue of the Śuka bird. They are thick at middle, like barley grains, or resemble the mouth of leeches and secrete a sort of slimy exudation. The stool is marked with blood, and the patient complains of a painful, burning sensation (in the rectum) at the time of defecation. Fever, with a burning sensation and thirst, and epileptic fits, supervene. The skin, nails, eyes, face, teeth, stool, and urine of the patient assume a yellow hue.

The Kaphaja Type :- Piles, due to the action of the deranged Kapham, become white, are sunk about their roots, and are hard, round and glossy. They assume a greyish hue and resemble the teats of a cow or the stones of the Karira, or of a Panasa fruit. These piles do not burst, nor do they exude any sort of secretion. The patient feels an irresistible tendency to scratch the excrescences. The stools become copious in quantity and are charged with mucous (Śleshmá), resembling the washings of meat. Indigestion, fever with shivering (Śita-jvara), and heaviness of the head and œdema

with a non-relish for food are the symptoms which become manifest with the progress of the discase. The patient also assume a white colour.

The Raktaja Type :- Piles (hæmorrhoids), having their origin in the vitiated condition of the blood resemble the sprouts of the Vata tree in shape and are of the colqur of red coral, or the seeds (dark red) of Gunja berry.

The Sannipáta Type :- In a case of hæmorrhoids due to the concerted action of the deranged Váyu, Pittam and Kapham, symptoms characteristic of each of these types manifest themselves in unison.

The Congenital Type :- Congenital hæmorroids (Sahaja Arśas) are usually ascribed to defects in the semen and ovum of one's parents and should be medicinally treated with an eye to the special deranged Doshas involved in the casc.

THE SUSHRUTA SAMHITA

Auhoritative verse on the subject

THE SUSHRUTA SAMHITA

Lingárs'as (Fig warts or condylomatous growths about the genitals)

THE SUSHRUTA SAMHITA

Bhagárs'as

NIDAN STHANAM

upward course, and finding a lodgment in the ears, nose,

mouth and eyes may produce similar warts in those

localities. Warts, which crop up inside the cavities of

the ears may bring on earache, dumbness, and a foul dis-

charge from those organs, while those (cysts) cropping up

in the eyes will obstruct the movement of the eye-lids,

giving rise to pain and a local secretion and ultimately

destroy the eye-sight. Similarly, such growths in the

nostrils produce catarrh, excessive sneezing, shortness

of breath, headache, nasal speech and the complaint

known as Putinasya. Such vegetations cropping up in

and about the lips, palate or the larynx, tend to make the

speech confused and indistinct. When appearing in the

mouth, they impair the faculty of taste, and diseases

which affect the cavity of the mouth follow. The ex-

cited Vyána Váyu, united with the aggravated Kapham,

produces a kind of hard papillomatous growths on the

skin (about the anus) which are called the Charmakilas

(papillomata).* 15.

Authoritative verses on the subject :

• These Charmakilas may be attended with a kind of

pricking pain through an excess of the deranged Váyu,

whereas those which have their origin in the deranged

Kapham (lymphatics) assume a knotty shape and be-

come of the same colour as the surrounding skin. On

the other hand, they become dry, black or white, and

extremely hard through an exuberance of the deranged

local blood and Pittam. 16.

The symptoms of polypi, appearing in the neighbour-

hood of the anus, have been described in full, while the

general characteristics of those, which are found to

crop up around the genitals, have been briefly discoursed

• According to others, Charmakilas may crop up on the skin of any

part of the b dy.

24 THE SUSHRUTĀ SAMHITA. [Chap. II.

upon. An intelligent physician should ponder over the two groups of symptoms while engaged in treating a case of piles. A case of piles exhibiting symptoms peculiar to the two deranged Doshas is called the Samsargajam. Six distinct types of bio-Doshaja piles are known in practice.* 17. Prognosis :-A case of piles due to the concerted action of the three deranged Doshas of the body, (with its characteristic symptoms) but partially developed, may be temporarily checked (Yápya). Cases, which are of more than a year's standing, as well as those in which the hæmorrhoids are due to the concerted action of the two Doshas (Samsargaja), or are situated in the middle groove of the rectum, may be cured but with the greatest difficulty. Cases of the Sánnipátika or congenital (Sahaja) types should be given up as incurable. The Apána Váyu, in a person whose rectum is overrun with such polypus growths, tries to pass out through the anus, but is driven back upward, being obstructed in its passage by the vegetations, and then mixes with his Vyána Váyu, thus imparing (the five-functioned) fire (Pittam) in his body. 18-19.

• Such as (1) the one due to the concerted action of the deranged Pittam and Kapham, (2) the one incidental to the simultaneous derangement of the Váyu and the Kapham, (3) the one brought about through the disordered condition of the Váyu and blood, (4) the one due to the combination of the deranged Pittam and Kapham, (5) the one produced by the concerted action of the deranged Pittam and blood, (6) the one which results from the combined action of the deranged Kapham and blood.

• Such as (1) the one due to the concerted action of the deranged Pittam and Kapham, (2) the one incidental to the simultaneous derangement of the Váyu and the Kapham, (3) the one brought about through the disordered condition of the Váyu and blood, (4) the one due to the combination of the deranged Pittam and Kapham, (5) the one produced by the concerted action of the deranged Pittam and blood, (6) the one which results from the combined action of the deranged Kapham and blood.

Thus ends the second Chapter of the Nidānasthānam in the Sus'ruta Samhitâ which deals with the Nidânam of piles.

Thus ends the second Chapter of the Nidānasthānam in the Sus'ruta Samhitâ which deals with the Nidânam of piles.

CHAPTER III.

Now we shall discourse on the Nidánam of As'marl (urinary calculi).

The disease admits of being divided into four several types, such as the Vátaja, the Pittaja, the Kaphaja and the Śukraja (Seminal) concretions. An exuberance or preponderance of the deranged Kapham should be understood as the underlying cause of all invasions of this disease.

General ætiology :--The Kaphah of a man, who neglects to cleanse (Sams'odhana) the internal channels of his organism, or is in the habit of taking unwholesome food, enraged and aggravated by its own exciting causes, is carried into the urinary bladder. Here it becomes saturated with the urine, and gives rise to the formation of concretions or gravels in its cavity.

Premonitory Symptoms:--An aching pain in the bladder, with a non-relish for food, difficulty in urination, an excruciating pain in the scrotum, penis, and the neck of the bladder, febrile symptoms, physical lassitude, and a goat-like smell in the urine are the symptoms, which indicate the formation of gravel in the bladder.

Metrical Text :--The deranged Doshas involved in a particular case respectively impart their specific colour to the urine, and determine the character of the accompanying pain. The urine becomes thick, turbid, and vitiated with the action of the aggravated Doshas, and micturition becomes extremely painful.

Leading Indications :--A sort of excruciating pain is experienced either about the umbilicus, or in the bladder, or at the median rape of the

THE SUSHRUTA SAMHITA

The Śleshmás'mari :-Stone or gravel, originated through the action of the deranged Kapham, saturated with an excessive quantity of that Dosha by the constant ingestion of phlegm-generating (Ślesh-mala) substances, increases in size at the lower orifice of the bladder and ultimately obstructs the passage of the urine. The pressure and recoil of that incarcerated fluid on the walls of the urinary badder gives rise to a kind of crushing, bursting, pricking pain in that organ, which becomes cold and heavy. A Kapha-originated stone or gravel is white and glossy, attains to a large size, to that of a hen's egg, and has the colour of the Madhuka flower. This type is called Śleshmás'mari.

The Pittaja As'mari :-The Kapham charged (dried) with the deranged Pittam becomes hard (condensed) and large in the aforesaid way, and lying at the mouth of the bladder obstructs the passage of the urine. The bladder, on account of the flowing back of the obstructed urine into its cavity, seems as if it has been exposed to the heat of an adjacent fire, boiling with the energy of an alkaline solution. A kind of sucking, drawing and burning pain is experienced in the organ. This type of As'mari is further marked by symptoms which characterise Ushna-váta (stricture). The concretion is found to be of a reddish, yellowish

Chap. III.] NIDANA STHANAM. 27

black colour like the stone of the Bhallátaka fruit, or it is coloured like honey. This type is called Pittaja Asmari. 8.

The Vátásmari :-The deranged Kapham (mucus) inordinately saturated with the bodily Váyu, acquires hardness and gains in dimensions, and these lying at the mouth of the bladder obstructs the passage of the urine.

The incarcerated fluid causes extreme pain in the organ. The patient constantly under severe pain gnashes his teeth or presses his umbilical region, or rubs his penis, or fingers his rectum (Páyu) and loudly screams.

A burning sensation is experienced in the penis, and urination, belching and defecation become difficult and painful.*

The concretions in this type of Asmari are found to be of a dusky colour, rough, uneven in shape, hard, facetted and nodular like a Kadamva flower.

This type is called Vátásmari. 9.

Infants are more susceptible to an attack of any of the three preceding types of Asmari, inasmuch as they are fond of day sleep or of food composed of both wholesome and unwholesome ingredients, and are in the habit of eating before the digestion of a previous meal, or of taking heavy, sweet, emollient and demulcent food.

In children the bladder is of diminished size and poor in muscular structure.

These facts contribute to the easy possibility of the organ being grappled (with a surgical instrument) and of the stone being extracted with the greatest ease in cases of infantile Asmari. 10.

The Sukrásmari :-Sukrásmaris or seminal concretions are usually formed in adults owing to the germination of semen in their organisms.

A sudden or abrupt stoppage of a sexual act, or excessive coition tends to dislodge the semen from its natural receptacle

• Stool and urine can be voided only with the greatest straining.

in the body. The fluid thus dislodged, but not emitted, finds a wrong passage. The Váyu gathers up the fluid (semen), thus led astray, and deposits it (in a round or oval shape) at a place lying about the junction of the penis and the scrotum and dries up the humidity with which it is charged. The matter, thus formed, condensed, and hardened, is called the seminal stone (Śukrásmari), which then obstructs the passage of the urine, giving rise to pain in the bladder, painful micturition, and swelling of the scrotum. The stone vanishes under pressure in its seat*. 11—12.

Authoritative verses on the subject :-Concretions, sands and sediments found to be deposited in the urine in a case of Bhashma-meha are but the modifications, or attendant symptoms of a case of stone in the bladder (Asmari). The same group of symptoms and the same kind of pain are exhibited and experienced in a case of gravel (S'arkara) as in a case of stone (Asmari) in the bladder. The local Váyu coursing in its natural direction helps the discharge of calculi (Asmari) with the urine in the event of they being extremely attenuated in structure. Particles of a stone broken by the Váyu are called urinary calculi (S'arkara). A pain about the cardiac region, a sense of weakness and lassitude in the thighs, a griping pain in the regions of the spleen and liver (Kukshi-sula), a shivering sensation, thirst, hiccough or eructations, darkness or sallowness of complexion, weakness, emaciation with a non-relish for food and

Chap. III.] NIDANA STHANAM.

29

impaired digestion are the symptoms which are manifest in a gravel-patient. A gravel (S'arkará) obstructed at the mouth of the urinary channel is detected by the following indications :-vís., weakness, lassitude, emaciation, cachectic condition of the body, pain over the hepatic region (Kukshi-s'ula), a non-relish for food, sallowness of complexion, hot and high coloured urine, thirst, pressing pain at the cardiac region and vomiting.

The bladder is situated in the pelvic cavity, surrounded on its different sides by the back, loin (Kati), umbilicus, scrotum, rectum (Guda), groins and penis. This organ is provided with a single aperture or opening and lies with its mouth downward, covered with nets of nerves (Sirá) and ligaments (Snáyu), in the shape of a gourd. The organ is extremely thin in structure ; and thus situated within the pelvic cavity, it is connected, through its mouth or external orifice, with the rectum, the penis, and the testes. It is also known by the name of Maládhára (the receptacle of impure matter) and forms (one of) the primary seats of vital energy (Prána)*. The urinary ducts (ureters) pass close by the large intestines (Pakvás'aya) and constantly replenish the bladder and keep it moist with that waste product of the system in the same manner as rivers carry their contributions of water into the ocean. These passages or ducts (which are two) are found to take their origin from hundreds of branches (or mouths tubuli uriniferi), which are not visible to the naked eyes, on account of their extremely attenuated structures and carry, whether in a state of sleep or wakening, the urine from below the region of the

• The text has Pránayatanam, which means that an injury to the urinary bladder may be attended with fatal result.

THE SUSHRUTA SAMHITA

30

stomach† (Amáśaya) into the bladder keeping it filled with this important fluid of the body, just as a new pitcher, immersed up to its neck in a vessel full of water, is filled by transudation through its lateral pores.

14

In the same way the Váyu, Kapham and Pittam are carried into the bladder (through their respective ducts or channels), and in unison with the retained urine, give rise to the formation of stone, on account of the slimy character of the deposit produced. Stone is formed in the same way in the bladder as sediments are ultimately deposited from clear and transparent water at the bottom of a new pitcher which contains it.

As the wind and lightning jointly condense the rainwater into hailstones, so the bodily Váyu and Pittam (heat) jointly contribute to the condensation of the Kapham in the bladder and transform it into stone.

The Váyu in the bladder, coursing in its natural downward direction, helps the full and complete emission of urine ; while coursing in a contrary direction, it gives rise to various forms of maladies such as, Prameha, strangury, as well as seminal disorders ; in short, it produces any urinary trouble to which the bladder may be subjected.

15

† From the kidneys.

Thus ends the third Chapter of the Nidána Sthánam in the Sushruta Samhitá which treats of the Nidánam of urinary calculi.

CHAPTER IV.

Now we shall discourse on the Nidánam of Bhag-andaram (fistula in ano and fistular ulcers). 1. The deranged Váyu, Pittam, Kaphaḥ and Sannipátah (a simultaneous derangement of the three bodily Doshas) and extraneous causes (such as a blow etc.) give rise to the types of Bhagandaram known as Śataponaka, Ushtagriva, Parisrávi, Samvukávarta and Unmargi. The disease is so named from the fact that it bursts the rectum, the perineum, the bladder and the place adjoning to them (thus setting up a mutual communication between them). The pustules, which appear in this regions are called as Pidakás in their unsuppurated stage, while they are called Bhagandaram when they are in a stage of suppuration. A pain about the sacral bone and an itching about the anus, accompanied by a swelling and burning sensation, are the premonitory symptoms of this disease. 2.

The Śataponakah Type :-The Váyu,

excited, condensed, and rendered motionless by a course of unwholesome food, gives rise to a pustule within one or two fingers' length from the rectum (anal region, —Guda), by vitiating the flesh (areolar tissue) and blood (of the locality). It assumes a vermilion colour and is characterised by a variety of pricking, piercing pain. If neglected at the outset, the pustule runs into suppuration. Owing to its vicinity to the bladder, the abscess or the suppurated pustule exudes a kind of slimy secretion and becomes covered with hundreds of small sieve-like holes, through which a constant frothy discharge is secreted in large quantities. The ulcer, thus formed, seems as if it is being thrashed with a rod, pierced

The Sushrutá Samhitá

Sataponakah

The Sushrutá Samhitá

The Ushtra-grivah Type

The Sushrutá Samhitá

The Parisrávi Type

The Sushrutá Samhitá

The Samvukávartah Type

Chap. IV.] NIDANA*STHANAM. 33

pain, and burning, itching sensations etc. Such a pustule, neglected at the outset, speedily suppurates, and the incidental ulcer exudes secretions of diverse colours, characterised by a kind of whirling pain, which revolves about, in the direction of the involuted indentures (within the grooves of the rectum) such as are found within the body of a river or fresh water mollusc. This is called Samvukávartah. 6.

The Unmárgi Type :-Particles of bones, eaten with (cooked) meat by an imprudent, greedy, gluttonous person, may be carried down with the hard and constipated stool by the Apána Váyu (into the rectum), thus scratching or abrading the margin of the anus, or burrowing into the rectum in the event of their being evacuated in improper directions through (transverse or horizontal postures). The scratch or abrasion is soon transformed into a fetid and putrid ulcer, infested with worms and parasites, as a plot of miry ground will soon swarm with a spontaneous germination of similar parasites. These worms and parasites eat away the sides of, or largely burrow into, the region of the anus, and jets of urine, fecal matter, and flatus (Váyu) are found to gush out of these holes. This type of Bhagandaram is called Unmárgi. 7.

The Unmárgi Type :-Particles of bones, eaten with (cooked) meat by an imprudent, greedy, gluttonous person, may be carried down with the hard and constipated stool by the Apána Váyu (into the rectum), thus scratching or abrading the margin of the anus, or burrowing into the rectum in the event of their being evacuated in improper directions through (transverse or horizontal postures). The scratch or abrasion is soon transformed into a fetid and putrid ulcer, infested with worms and parasites, as a plot of miry ground will soon swarm with a spontaneous germination of similar parasites. These worms and parasites eat away the sides of, or largely burrow into, the region of the anus, and jets of urine, fecal matter, and flatus (Váyu) are found to gush out of these holes. This type of Bhagandaram is called Unmárgi. 7.

Authoritative verses on the subject :-A pustule, appearing about the region of the anus and characterised by a slight pain and swelling, and spontaneously subsiding, should be regarded as a simple pustule, which is of a quite different nature from a fistula in ano, which has contrary features (i.e., invariably found to be attended with a violent pain and swelling etc., and takes a long time to heal). A Fistula-pustule crops up within a space of two fingers' width of the Páyu proper (distal end of the

Authoritative verses on the subject :-A pustule, appearing about the region of the anus and characterised by a slight pain and swelling, and spontaneously subsiding, should be regarded as a simple pustule, which is of a quite different nature from a fistula in ano, which has contrary features (i.e., invariably found to be attended with a violent pain and swelling etc., and takes a long time to heal). A Fistula-pustule crops up within a space of two fingers' width of the Páyu proper (distal end of the

THE SUSHRUTA SAMHITA

rectum), is sunk at its root, and attended with pain and febrile symptoms. Pain, itching and burning sensations are experienced about the anus after a ride in a carriage, or after defecation. The anus becomes swollen, and the waist painful in the premonitory stages of Bhagandaram.

8-9

Prognosis :-Almost all the types of this disease (Fistula in ano) yield to medicine after a prolonged course of treatment, and are hard to cure, except the Sannipàtah and traumatic ones, which are incurable.

10

Thus ends the fourth Chapter of the Nidâna Sthânam in the Sushruta Samhitâ, which treats of the Nidânam of Fistula in ano (Bhagandaram).

CHAPTER V

Now we shall discourse on the Nidánam of Kush-tham (cutaneous affections in general). I. Improper diet or conduct; especially ingestion of improper, unwholesome, indigestible, or incongenial food; physical exercise or sexual intercourse immediately after partaking of any oleaginous substance, or after vomiting; constant use of milk in combination with the meat of any domestic, aquatic or amphibious animal; a cold water bath after an exposure to heat; and repression of any natural urging for vomiting etc. are the factors which tend to derange and aggravate the fundamental principle of Váyu in a person. The enraged or aggravated Váyu, in combination with the agitated Pittam and Kapham, enters into the vessels or ducts (Sirá), which transversely spread over the surface of the body. Thus the enraged Váyu deposits the Pittam and Kapham on the skin through the medium of their channels and spreads them over the entire surface of the body. The regions of the skin in which the aforesaid morbific diatheses are deposited become marked with circular rings or patches. The morbific diatheses (Doshas), thus lodged in the skin, continue to aggravate, and having been neglected at the outset, tend to enter into the deeper tissues and thus contaminate the fundamental principles (Dhátus) of the body.

Premonitory Symptoms :-A roughness of the skin, sudden horripilation, an itching sensation in the surface of the body, excess or absence of perspiration, anæthesia of the parts, a black colour of the blood, and a rapid growth and expansion of any ulcer (appearing on the body) are the symptoms which mark the premonitory stages of Kushtham.

2. Premonitory Symptoms :-A roughness of the skin, sudden horripilation, an itching sensation in the surface of the body, excess or absence of perspiration, anæthesia of the parts, a black colour of the blood, and a rapid growth and expansion of any ulcer (appearing on the body) are the symptoms which mark the premonitory stages of Kushtham. 3.

Classification :-

[Diseases, falling under the group of Kushtham, may be divided into two broad subdivisions], viz.,—Mahákushthas (major) and Kshudra (minor) Kushthas, the first consisting of seven, and the second of eleven different types, aggregating eighteen in all. The Mahákushthas are classified as, Aruna, Audumvara,Rishya-Jihva, Kapála, Kákanaka,Pundarika, and Dadru. The minor or Kshudra-kushthas (Lichen and Dermatitis) are Sthulárushkam, Mahákushthạm, Eka-kushtham, Charmadalam, Visarpah, Parisarpah, Sidhma,Vicharchiká, Kitima, Pámá, and Rakasá. All the types of Kushtham, whether major or minor, involve the action of the deranged Váyu, Pittam or Kapham, and are connected with the presence of parasites in those localities.* The preponderance of any particular morbific diathesis (Dosha) in any case of Kushtham should be looked upon as its originating cause. The type, known as Aruna Kushtha, is due to the action of the preponderant Váyu; Audumvara, together with Rishya-Jihva, Kapála and Kákanaka, to a preponderance of the deranged Pittam ; while Pundarika and Dadru owe their origin to an excess of the deranged Kapham. These types of major or minor Kushthas are successively more extensive in their action and more incurable on account of their respectively invading a greater number of the bodily elements (Dhátus). 4—6.

Mahákushthas :-

Aruna-kushtha owes its origin to an exuberance of the deranged Váyu. It is slightly vermilion-coloured, thin and spreading in its

• Certain authorities hold that, all types of Kushtham (cutaneous affections) to be of parasitic origin. The Garuda Puranam avers that, the parasites, which infest the external principles of the body, are the primary causes of cutaneous affections—Kushthaika·hetavontarjdsh shlemshajd vadhya·sambhavdh. Ch. CLXIXV. 4.

Chap. V.] NIDANA STHANAM. 37

nature. A sort of pricking, piercing pain (is experienced in the affected locality) which loses all sensibility to the touch. The type known as Audumbara is coloured and shaped like a ripe or mature Audumbara fruit and has its origin in the deranged Pittam. The type called Rishyajihva is rough and resembles the tongue of a Rishya (Deer) in shape and colour. The type known as Kapala (Macula cærule) resembles a black (deep blue) Kharpara (baked clay). The Kakanaka type is characterised by a dark red and black colour like the seed of the Gunja berry. A sort of sucking and burning pain is experienced in the affected locality in all the four preceding types of the disease which are the outcome of the deranged Pittam. The whole diseased surface seems as if burning with fire, and emitting hot fumes. They are speedy in their origin and rapidly suppurate and break. All these types soon become infested with parasites. These are the general features of these forms of Kushthas.

7. Pundarika :- The patches resemble the petals of a (full blown) lotus flower in colour, and Dadru (Ringworm) assumes the colour (faint blue) of an Atasi flower, or of copper. They are spreading in their nature and are found to be overspread with pustules. Both the Dadru and Pundarika types are raised, circular, and characterised by itching and take a considerable time to be fully patent. These are the general characteristics of Dadru and Pundarika.

Kshudra Kushthas :- We shall now describe (the features of the diseases known as) Kshudrakushthas (M. Text) :- The type known as Sthulárushka appears about the joints. It is extremely thick at its base, is cured with the greatest difficulty, and is strewn over with hard pustules (Arungshi). In the type known

THE SUSHRÚTA SAMHITA

as of Mahákushtham the skin contracts, and with the bursting of the skin (a piercing pain is felt in the affected part), which loses all sensibility to the touch, accompanied by a general sense of lassitude in the limbs. In the Ekakushtham (Ichthyosis) type the skin assumes a reddish black colour. It is incurable. In the form known as Charmadalam (Hypertrophy of the skin) a burning, sucking, drawing pain is experienced in the palms of the hands and in the soles of the feet which become characterised with an itching sensation. The disease, which affects in succession the (organic principles of) skin, blood and flesh, and speedily extends all over the body, like Erysipelas, and is attended with a burning sensation (Vidáha), restlessness, suppuration and a piercing pain and loss of consciousness (epileptic fits), is called Visarpa Kushtham. The form in which a number of exuding pustules gradually extend over the surface of the body is called Parisarpa Kushtham. The type of the disease which is white and thin, and is characterised by itching and does not create any disturbance (in the patient), is called Sidhma (Maculæ atrophicæ). This form is generally found to restrict itself to the upper part of the body. Vicharchiká (Psoriasis) is characterised by excessive pain and itching and gives rise to extremely dry crack-like marks on the body [hands and feet]. The same form of malady attended with pain, burning and itching, and restricting itself solely to the lower extremities, is called Vipádiká. The type in which the eruptions exude (a kind of slimy secretion) and which are circular, thick, excessively itching, glossy and black-coloured is called Kitima (Keloid tumours). Small pustules or pimples characterised by an itching, burning secretion and appearing on the surface of the body are called Pámá (Eczéma). The preceding kinds of pimples attended

Chap. V.] NIDANA STHÁNAM.

39

with burning vesicles, are called Kachchus and are

found to be chiefly confined to the legs, hands and

buttocks. A sort of dry and non-exuding pimples

characterised by excessive itching and appearing all

over the body, is called Rakasá (dry Erythema). 9–10.

The forms known as Sthulárushka, Sidhma, Rakasá,

Mahákushṭham and Ekakushtham should be considered

as offspring of the deranged Kapham. Parisarpa-kush-

tham alone is due to the action of the deranged Váyu,

while the remaining types (of minor Kushtham) owe

their origin to the action of the deranged Pittam. 11.

Kilásam :—The disease known as Kilásam is

but another form of Kushtham. It may be divided into

three types according as it is brought about through

the action of the deranged Váyu, Pittam or Kapham.

The difference between Kilásam and Kushtham is that

the former confines itself only to the Tvaka (the skin)and

is marked by the absence of any secretion.* A case of

Kilásam caused by the action of the deranged Váyu is

circular, vermilion-coloured and rough to the touch.

The affected part when rubbed peals off scales of morbid skin.

A case of Kilásam, due to the action of the deranged

Pittam, is marked by eruptions, resembling the petals

of a lotus flower (in shape and colour), and are attended

with an extremely burning sensation. In the type

originated through the action of the deranged Kapham,

the affected part (skin) assumes a glossy, white colour,

becomes thick and is marked by an itching sensation.

The form in which the eruptions or patches extend and

become confluent, invading even the soles of the feet,

• A case of Kushtham has its primary seat in the blood and skin (of the patient), in which it lies confined during the period of incubation, after which it attacks the skin and secretes the characteristic secretion of the deranged Dosha involved in it.

the palms of the hands and the region of the anus, and in which the local hairs assume a red colour should be regarded as incurable. A case of Kilásham, which is the outcome of a burn (cicatrix) should be likewise considered as incurable.

A preponderance of the deranged Váyu in a case of Kushtham (leprosy) is indicated by a contraction of the skin, local anæsthesia, a copious flow of perspiration, swelling, and piercing or cutting pain in the affected part, together with a deformity of the limbs and hoarseness. Similarly, an excess of the deranged Pittam in a case of Kushtham, should be presumed from the suppuration of the affected part, from the breaking of the local skin, from the falling off of the fingers, from the sinking of the nose and ears, from the redness of the eyes and from the germination of parasites in the incidental ulcer. An excessive action of the deranged Kapham, in a case of Kushtham, gives rise to itching, discolouring and swelling of the affected part which becomes heavy and exudes the characteristic secretion. The types, Pundarika and Kákanam, which are due to the germinal defect of the patient, are incurable, inasmuch as they involve (according to Dallana) the concerted action of the three simultaneously deranged Doshas from the very outset.

Memorial verses :- As a tree, full grown in the course of time, has driven its roots, which derive their nourishment from the rain water, deeper and deeper into the successive strata of the soil, so this disease (Kushtham), first affecting and confining itself to the upper layers of the skin, will invade the deeper tissues and organs etc. of the patient, if unchecked until almost all the fundamental principles or elements Dhátus are attacked by its virus in the course of time.

Chap. V. j NIDĀNA STHĀNAM.

41

The symptoms of a case of Kushtam confined only to the serous (Tvaka) fluid of the skin are the loss of the perception of touch, a scanty perspiration, itching and discoloration and roughness of the affected part. The symptoms which manifest themselves when the disease is confined to the blood are complete anæsthesia, horripilation, absence of perspiration, itching and excessive accumulation of pus in the affected parts,

The symptoms of Kushtam affecting only the flesh are thickness of the patches, dryness of the mouth, roughness and hardness of the patches which become covered with pustular eruptions and vesicles, and an excruciating pricking pain in, and numbness of, the affected part.

The symptoms of (Kushtam) invading the principle of fat only are a fetid smell and an excessive accumulation of pus in the affected part and a breaking of the skin, exposing deep gashing wounds which soon become infested with parasites. The body seems as if covered with a plaster.

Symptoms of (Kushtam) affecting only the bones and the marrow are a sinking (lit: breaking) of the nose, a redness of the eyes, loss of voice and the germination of parasites in the incidental ulcers.

Symptoms of the disease restricting itself only to the principle of semen are a crippled state of the hands and distortion of the limbs, loss of the power of locomotion, spreading of ulcers and all the other symptoms peculiar to the preceding types of the disease. 15–20.

A child, which is the offspring of the contaminated semen and ovum of its parents afflicted with Kushtam, should be likewise regarded as a Kushthi. 21.

Prognosis:–A case of Kushtam appearing in a person of prudence and discretion and confined only to the serum (Tvaka), flesh and blood of his organism should be regarded as curable. A palliative treat-

6

ment is the only remedy in cases where the disease is found to invade the principle of fat ; whereas a case where the poison is found to have penetrated into any of the remaining organic principles should be given up as incurable.

Wise men hold that, for killing a Bráhmana, or a woman, or one of his own relations, for theft, as well as for doing acts of impiety, a man is sometimes cursed with this foul disease by way of divine retribution. The disease reattacks a man even in his next rebirth in the event of his dying with it.

23–24.

Uncured Kushtham (leprosy) is the most painful, and most troublesome of all diseases.

A Kushthi (leper), getting rid of this foul malady by observing the proper regimen of diet and conduct and by practising expiatory penances and by resorting to proper medicinal measures, gets an elevated status after death.

Kushtham (Leprosy) is a highly contagious disease ; the contagion being usually communicated through sexual intercourse with a leper (Kushthi), or by his touch or breath, or through partaking of the same bed, and eating and drinking out of the same vessel with him, or through using the wearing apparel, unguents and garlands of flowers previously used by a person afflicted with this dreadful disease.

Kushtham (Leprosy), fever, pulmonary consumption, ophthalmia and other Aupasargika disease (incidental to the influences of malignant planets or due to the effects of impious deeds) are communicated from one person to another.

Thus ends the fifth Chapter of the Nidánasthánam in the Sushruta Samhitá which treats of the Nidánam of cutaneous affections (Kushtham).

CHAPTER VI.

Now we shall discourse on the Nidánam of Pra-meha (diseases of the urinary tracts). 1. It may be prognosticated that an idle man, who indulges in day sleep, or follows sedentary pursuits or is in the habit of taking sweet liquids, or cold and fat-making or emollient food, will ere long fall an easy victim to this disease. 2.

Pathology :-The bodily principles of Váyu, Pittam and Kaphah of such a person get mixed with improperly formed chyle of the organism. Thus deranged, they carry down through the urinary ducts the deranged fat, etc.* of the body and find lodgment at the mouth (neck) of the bladder, whence they are emitted through the urethra†, causing diseases, known by the (generic) name of Prameha. 3

Premonitory symptoms :-A burning sensation in the palms of the hands and of the soles of the feet, a heaviness of the body, coldness or sliminess of the skin and limbs, sweetness and whiteness of the urine, somnolence, lassitude, thirst, a bad-smelling breath, a shortness of breath, slimy mucous deposit on the tongue, palate, pharynx and teeth, clotted hair and an inordinate growth of the finger and toe nails are the indications which mark the advent of the disease. 4.

General Characteristics:-A copious flow of cloudy or turbid urine characterises all the types of the disease, which, together with the abscesses and eruptions (Pidaká) which mark its sequel, should be

• The particle "chá" in the text denotes other virus or morbific matter. Dallana.

† Remain incarcirated therein according to others.

THE SUSHRUTA SAMHITA

The Kaphaja Types :- Cases of Prameha, which are caused by an exuberance of the deranged Kapham, may be grouped under ten subheads such as, Udaka-meha, Ikshu-meha, Sura-meha, Sikatà-meha, S'a-nai-meha, Lavana-meha, Pishta-meha, Sàndra-meha, S'uk-ra-meha and Phena-meha. The ten aforesaid types are curable, inasmuch as the medicines which tend to remedy the deranged Kapham (Dosha), the cause of the disease, prove also remedial to the other principles of the body (flesh, marrow, blood, semen etc) deranged (Dushya) from the same causes.

The Pittaja Types :-The types, which are brought about through an exuberance of the deranged Pittam, are named as Nila-meha, Haridrâ-meha, Amla-meha, Kshàrà-meha, Manjishthà-meha, and S'onita-meha. Palliation is all that can be effected in these types, inasmuch as the medicines which tend to correct the deranged Pittam, which has brought on the disease, fail to exert similar virtues on the organic principles (Dushyas) deranged by it.

The Vátaja Types :-The types of Prameha which are produced by an aggravated condition of the bodily Váyu are divided into four subgroups, such as Sarpi-meha, Vasa-meha, Kshoudra-meha and Hasti-meha. These should be regarded as most incurable inasmuch as no kind of medicine can restore the fleet-coursing, deep diving (i.e. invading the bones and the marrow) Váyu, which at the same time also augments the Pittam, to its normal state and thus advances (unchecked) in its work of disintegration.

The deranged Kaphah, in conjunction with the (morbid) Pittam, Váyu and fat, gives rise to all Kaphajà

Chap. VI. NIDANA STHANAM.

types of Prameha. The deranged Pittam, in conjunction with the deranged Váyu, blood, fat and Kapham, produces the Pittaja ones; while the deranged Váyu, in unison with the deranged Kapham, Pittam, fat, marrow and Vasá (myosin), engenders the types of Vátaja Prameha.

Symptoms of Kaphaja-Mehas :-The

urine* of a person suffering from an attack of Udakameha Becomes white and water-like and is passed without the least pain. In a case of Ikshumeha the urine resembles the expressed juice of sugarcane. It has the colour of wine in a case of Surámeha. The urine in a case of Sikatámeha is passed with pain and is found to leave a sediment of extremely fine and sand-like concretions (Sikata's).

In a case of Sanaimeha

the urine gushes out at intervals in jets and is charged with a slimy mucous (kaphah). The urine in a case of Lavaunameha becomes limpid (non-viscid) and acquires a saline taste. There is horripilation at the time of micturition in a case of Pishtameha (Chyluria), the urine resembling a stream of water, charged with a solution of pasted rice (Pishtam).

In a case of Sandrameha,

the urine becomes thick and turbid, while in a case of Sukrameha the urine resembles semen (or the urine is found to be charged with semen :-Mádhaba).

• The Sanskrit term Meha literally means to micturate.

The verbal noun Mehanam signifies urination as well as the act of passing any morbid urethal secretion. Hence the urine in most of these cases denotes the fact of its being charged with pus or any other morbid secretion of the urinary organs such as Ojsh (albumen), marrow, etc., which imparts their characteristic colours to the fluid, - a fact which determines the nomenclature of the disease and forms the keynote of its diagnosis in the Ayurveda.

Phenameha the patient passes frothy urine in broken jets.

10. Symptoms of Pittaja Mehas :-Now we shall describe the characteristic features of the types of Prameha, which are due to the action of the deranged Pittam. The urine in a case of Nilameha becomes frothy, transparent and bluish. The urine in a case of Haridrameha becomes deep yellow like turmeric (Haridrá) and is passed with a burning pain. The urine in a case of Amlameha acquires an acid taste and smell. The urine in a case of Ksharameha* resembles an alkaline solution filtered (through a piece of linen). The urine in a case of Manjisthameha resembles the washing of the Manjisthá, while in a case of Raktameha, the urine is found to be of blood-colour or charged with blood - Madhava). 11.

Symptoms of Vatájà-Mehas :-Now we shall describe the characteristics of the different types of Prameha, which are due to an exuberance of the deranged Váyu.

In a case of Sarpimeha, the urine looks like a stream of clarified butter, while in one of Vasameha it resembles the washings of Vasá. In a case of Kshaudrameha, the urine looks like honey and acquires a sweet taste. In one of Hastimeha, the patient passes a copious quantity of urine, like an excited elephant, at a time, and in one unbroken stream, (the organ becoming steady immediately after the act of micturition). 12.

Supervening symptoms :-The fact of the urine being assailed by a swarm of flies, lassitude, growth of flesh(obesity), catarrh, looseness of the limbs,

non-relish for food, indigestion, expectoration of mucous, vomiting, excessive sleep, cough and laboured breathing (Śváśa) are the supervening traits (Upadrava) of the Kaphaja Prameha.

A piercing pain in the testes, a pricking (veda) pain in the bladder, a shooting pain (Tuda) in the penis, a griping pain at the heart, acid eructations, fever, dysentery, a non-relish for food, vomiting, a sensation as if the entire body is emitting fumes, a burning sensation in the skin, thirst, epileptic fits, insomnia, jaundice (Pándu) and a yellow colour of the stool and urine are the supervening symptoms which mark the Pittaja types of Prameha.

An oppressive feeling at the heart (Hridgraha), eager longings for foods of all tastes, insomnia, numbness of the body, fits of shivering, colic pain and constipation of the bowels are the supervening symptoms, which specifically mark the Vátaja types.

Thus we have described the nature of the twenty different types of Meha with their supervening evils as well. 13–16.

The ten different types of Pidaká (abscess, carbuncles, pimples, pustules etc.) are found to crop up on the bodies of patients suffering from Prameha, and abounding in fat and Vasá, and whose fundamental principles have been affected by the simultaneous derangement of the Váyu, Pittam and Kapham.

They are named as Śaráviká, Sarshapiká, Kachchapiká, Jálini, Vinalá, Putrini, Masuriká, Alaji, Vidáriká and Vidradhiká. 17.

Metrical Texts :–An abscess which is raised at the margin and dipped in its centre, so as to resemble an Indian saucer in its shape is called Saráviká.

Pimples or pustules of the shape and size of white mustard seeds are called Sarshápiká.

An abscess, resembling (the back of) a tortoise in shape and attended with a burning sensation, is called Kachchapiká by the wise.

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Jalini

THE SUSHRUTA SAMHITA

Prognosis

THE SUSHRUTA SAMHITA

Pur-varupam

Chap. VI. NIDANA STHANAM.

should be considered as one suffering from an attack of Prameha. 31—32.

A Prameha patient afflicted with deep-seated abscesses and other distressing symptoms, which are usually found to supervene in the disease, should be pronounced as suffering from Madhumeha and adjudged incurable.

A Madhumeha patient seeks a halting place while walking, wants a place to sit on while halting, lies down if he finds a sitting place, and sleeps if he lies down. 33—34.

As five mixed colours such as grey, brown, Kapila (bluish yellow), Kapota (blackish grey), Mechaka (light-green) may be produced by combination of the five primary colours in definite proportions (such as white, green, black, yellow and red), so a diversity of causes, through the relative preponderance of the particular kinds of food, and of the deranged Doshas, root principles (Dhátu) and excretions of the body (Mala), may be attributed to the origin of Prameha.

35. Memorial verses :-All types of Prameha, not properly treated and attended to at the outset, may ultimately develop into those of Madhumeha types, which are incurable.

36 For English equivalents of the different types of Prameha compare :-

Cystitis (Acute Infective)—Frequent, painful micturition, small quantity of urine voided with pain and urgency. Urine—slightly acid or alkaline in reaction, cloudy, containing blood corpuscles. Cystitis (Chronic Infective) —Great and frequent pain, in the lumbar region, rigor. Urine—thick, offenaive and alkaline, containing ropy mucous and blood. Cystitis (Non-Infective)—Symptoms like those of acute inflamatory type. Urine—acid and cloudy with mucous. Blood is generally present in considerable quantity. Neuralgia of the bladder, compare Albuminuria, Albemosuria, Hæmoglobinuria, Hæmaturia, Peptonuria, Pyuria, Spermatorthoea and Diabetes, Proteuria and Polyuria.

Thus ends the sixth Chapter of the Nidâna Sthânam in the Sushruta Samhitâ, which treats of the Nidânam of Prameha.

7

CHAPTER VII.

Now we shall discourse on the Nidánam of Udara (dropsy with an abnormal condition of the abdomen).

Metrical Text :-The royal sage Dhanvan-

tari, the foremost of all pious men who equalled in splendour and glory the lord of the celestials, thus blissfully discoursed on the Nidánam of Udara to Suśruta, the son of the holy Viśvámitra, who devoutly approached him for that purpose.

Classification :-This disease may be divided

into eight different types, of which four are produced by the several actions of the three deranged Doshas of the body and their concerted action as well. Of the remaining types, two being known as Plíhodara (including Yakritodara), and Vaddha-Gudodara (tympanites due to the constriction of the anus), the seventh Ágantuka (traumatic or of extraneous origin), and the eighth Dakodara (Ascites proper).

Predisposing Causes :-The deranged

Doshas of a person of extremely impaired digestion, addicted to the habit of taking unwholesome food, or of eating dry, putrid food, or of violating the rules of conduct to be observed in connection with oleaginous measures etc.,* are aggravated and find lodgment in the abdomen. Thus appearing in the shape of an abdominal tumour (Gulma), they give rise to this dreadful disease, attended with all its characteristic symptoms. The lymph chyle formed out of the assimilated food gets vitiated, and, impelled by the aggravated Váyu, it percolates

• These include purgative, emetic, A'stha'panam and Anuva'sanam measures,

NIDANA STHANAM

through the peritoneum in the same manner as a quantity of oil or clarified butter kept in a new earthen pot will transude through the pores of its sides. It thus gradually distends the skin (Tvak) of the abdomen. The process becomes general all through the abdominal region and the disease (Udara) is produced in consequence. 4--5.

Premonitory sypmtoms

The precursory symptoms of the disease are loss of strength, complexion and appetite, emaciation of the muscles of the abdomen, appearance of veins on its surface, acid reaction of food closely following upon its digestion (Vidáha), pain in the bladder, and swelling of the lower extremities. The patient cannot ascertain whether his meal has been digested or not. 6.

The Vátaja, Pittaja, and Kaphaja Types

A case of Udara in which the abdomen enlarges on its sides and posterior part, and is overspread with nets of black veins should be ascribed to the action of the deranged Váyu. A pain (Śula), suppression of the stool and urine (Anáha) and a cutting and piercing pain and flatulent rumbling in the intestines are the symptoms which likewise characterise this Vátaja form of Udara. A sucking pain in the abdomen, thirst, fever with a burning sensation, yellow colour of the swollen skin of the abdomen, on the surface of which yellow veins appear, yellow colour of the eyes, nails, face, stool and urine and the rapid increase of the dropsical swelling, are the characteristics of the Pittaja Udara. In a case of Kaphaja type the dropsical swelling is cold to the touch and becomes overspread with white-coloured veins. The abdomen seems heavy, hard, glossy and is extremely distended. The swelling slowly increases, and the finger-nails and face of the patient become white, and he complains of a general lassitude. 7--9.

The Tridoshaja Type :-Evil-natured women (with a view to win the affections of their husbands or lovers sometimes) mix with their food and drink such refuse matters of their bodies as nails, hair, fæces, urine, catamenial blood etc. (which are supposed to be possessed of talismanic virtues). The three Doshas of the body, vitiated by such food or drink, or through imbibing any sort of chemical poison (Gara) administered by one's enemy, or by taking poisonous waters, or Dushi-Visha (slow poison whose active properties have been destroyed by fire or any antipoisonous medicine), will vitiate the blood and abdomen, marked by the specific symptoms of each of them The disease is aggravated in cold and cloudy days and a burning sensation is felt (in the inside of the abdomen). The patient becomes pale, yellow and emaciated, and is afflicted with thirst and dryness in the mouth, and loses consciousness at short intervals. This disease is also known as the dreadful Dushyodaram.

10

Plihodaram.-(Spleen with dropsy of the abdomen) :-Now hear me describe the symptoms of Plihodaram. The blood and the Kapham of a person, deranged and aggravated through the ingestion of phlegmagogic food, or of those which is followed by an acid digestionary reaction (Vidáha), often enlarge the spleen, (which gives rise to a swelling of the abdomen). This disease is called Plihodara by the experts. Plihodaram protrudes on the left side of the abdomen, its characteristic symptoms being lassitude, low fever, impaired digestion, loss of strength, jaundice, weakness, and other distressing symptoms peculiar to the deranged Pittam and Kapham. A similar enlargement of the liver through similar causes on the right side of the abdomen is called Jakriddyudaram.

11-12

Vaddha-gudodaram

Parisrávi-Udaram

Dakodaram

the water-carrying channels of the body: The same result may be produced by the drinking of oil, etc. in inordinate quantities The water, by percolating or transuding through the walls of these channels, as before described, inordinately enlarges the abdomen, which becomes glossy on the surface and is full of water, being rounded about the umbilicus and raised like a full-bloated water-drum. The simile is complete as it fluctuates under pressure, oscillates, and makes a 'peculiar sound like a water-drum under percussion.

Distension of the stomach, incapacity of locomotion, weakness, impaired digestion, oedematous swelling of the limbs, a general sense of lassitude and looseness in the limbs, suppression of flatus and stool, and a burning sensation and thirst are among the general characteristics of the disease in its various forms.

Prognosis :-All cases of Udaram after the lapse of considerable time develop into those of ascites, and a case arriving at such a stage should be given up as incurable.

Thus ends the seventh Chapter of the Nidàna Sthànam in the Sus'ruta Samhitá which treats of the Nidánam of Udaram.

CHAPTER VIII.

Now we shall discourse on the Nidánam of Mudhagarbham (false presentations and difficult labour). I.

Causes of Mudha-garbham :-

Sexual intercourse during pregnancy, riding on horseback, etc., or in any sort of conveyance, a long walk, a false step, a fall, pressure on the womb, running, a blow, sitting or lying down on an uneven ground, or in an uneven posture, fasting, voluntary repression of any natural urging of the body, partaking of extremely bitter, pungent, parching articles, eating in inordinate quantities of Śákas and alkaline substances, dysentery (Atisára), use of emetics or purgatives, swinging in a swing or hammock, indigestion, and use of medicines which induce the labour pain or bring about abortions, and such like causes tend to expel the fœtus from its fixture. These causes tend to sever the child from the uterine wall with its placental attachment owing to a kind of Abhighátam (uterine contraction) just as a blow tends to sever a fruit from its pedicel.

Definition :-

The fœtus, thus severed and dislodged from its seat, excites peristalsis not only in the uterus, but induces a sort of constant, spasmodic contraction of the intestinal cavities (Koshthas), producing pain in the liver, spleen, etc. The Apána Váyu, thus obstructed through the spasmodic contraction of her abdomen, produces any of the following symptoms, viz. a sort of spasmodic pain in the sides, or in the neck of the bladder, or in the pelvic cavity, or in the abdomen, or in the vagina, or Ánáha (tympanites with obstruction, etc.) or retention of urine,

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56

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3. Classification and Symptoms:- Cases of Mudha-garbha may be roughly divided into four different classes such as, the Kilah, the Pratikhurah, the Vijakah and the Parighah.

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The sort of false presentation in which the child comes with its hands, legs and head turned upward and with its back firmly obstructed at the entrance to the vagina, like a stake or a kila, is called Kilah.

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The sort of presentation, in which the hands, feet and head of the child come out, with its body impacted at the entrance to vagina, is called Prathikhurah.

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The type in which only a single hand and the head of the child come out (with the rest of its body obstructed at the same place), is called the Vijakah.

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The type in which the child remains obstructing the head of the passage in a horizontal position, like a bolt, is called the Parighah.

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Certain authorities aver that, these are the only four kinds of Mudhgarbha. But we can not subscribe to the opinion (which recognises only four kinds of false presentations), inasmuch as the deranged Váyu (Apána) can present the fœtus in various different postures at the head of the vaginal canal.

THE SUSHRUTA SAMHITA

Sometimes, the two thighs of the child are first presented, and sometimes it comes with a single leg flexed up.

THE SUSHRUTA SAMHITA

Sometimes the child comes with its body, bent double, and thighs drawn up, so that only breech is obliquely presented.

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Sometimes the child is presented, impacted at the head

NIDANA STHANAM

Chap. VIII.]

of the passage with its chest, or sides, or back. Sometimes the child is presented with its arm around its head, resting on the side, and the hand coming out first. Sometimes only the two hands are first presented, the head leaning on one side; sometimes the two hands, legs and the head of the child, the rest of the body being impacted at the exit in a doubled up posture. Sometimes one leg is presented, the other thigh being impacted at the passage (Páyu). I have briefly described these eight sorts of presentation of which the last two are irremediable. The rest should be given up as hopeless if these are attended with the following complications viz., deranged sense-perception of the mother, convulsions, displacement or contraction of the reproductive organ (yoni) a peculiar pain like the after-pain of child birth, cough, difficult respiration, or vertigo.

57

Memorial verses :-As a fruit, fully matured, is naturally severed from its pedicel and falls to the ground and not otherwise, so the cord, which binds the fœtus to its maternal part, is severed in course of time, and the child comes out of the uterus (into this world of action). On the other hand, as a fruit, worm-eaten or shaken by the wind or a blow, untimely falls to the ground, so will a fœtus be expelled out of its mother's womb, before its time. For four months after the date of fecundation, the fœtus remains in a liquid state, and hence its destruction or coming out of the womb goes by the name of abortion. In the course of the fifth and sixth months the limbs of the fœtus gain in firmness and density, and hence, its coming out at such a time is called miscarriage.

Prognosis :-The enceinte who violently tosses her head in agony (at the time of parturition) and the surface of whose body becomes cold, compelling

8

THE SUSHRUTA SAMHITA

her to forego all natural modesty, and whose sides and abdomen are covered with nets of large blue-coloured veins, invariably dies with the dead child locked in her womb. The death of the fœtus in the womb may be ascertained by the absence of movements of the fœtus (in the womb) or of any pain of child-birth, by a brown or yellow complexion of the enceinta, cadaverous smell in her breath, and colic pain in the abdomen and its distension owing to the continuance of the swollen and decomposed child in the womb.

8-9.

The death of a child in the womb may result from some emotional disturbance of its mother, (such as caused by bereavement or by loss of fortune during pregnancy) ; while an external blow or injury (to the womb) or any serious disease of the mother may also produce the like result.

A child, moving in the womb of a dead mother, who had just expired (from convulsions etc.) during parturition at term, like a goat (Vastámára) should be removed immediately by the Surgeon from the womb (by Cæsarean Section);* as a delay in extracting the child may leads to its death.

10-11.

• Cæcsarean Section means incision of the uterus through the abdominal walls and extrication of the fœtus therefrom. Operation like this upon a dead subject requires no skill of a surgeon. Any one can do it without the help of any anatomical knowledge. In modern times, when the mother's life is in peril, and the expulsion of the fœtus becomes nearly impossible, by the natural passage, owing to an existenee of deformity either in the parturient canal or in the forms and structures of the fœtus, to save both mother and child this operation is principally undertaken.

The evidence of similar attempts, in ancient India, is found recorded in passages like what we have just translated and that the operation was practised on living subjects, there is not the least doubt about it. This custom is still preserved in Central Africa, and it is possible that the Egyptians like Hindu philosophy and religion learnt this also from the Hindus. "Felkin," says "Baas in his History of Medicine p. 70 'saw a case of the Cæsarean operation in Central Africa performed by a man. At one stroke

NIDANA STHANAM

Additional Text :-The bladder is ruptured, the dead child lies like a weight upon the placenta and is pressed upward on the spleen, liver and gall bladder. The mother shivers and is oppressed with tremor, dryness of the tongue, dyspnoea and perspiration. She complains of a 'cadaverous smell in her breath and stands in danger of imminent death. By these symptoms a physician shall know the death of the child in the womb. This portion is partly recognised by Brahmadeva and is totally rejected by Jejjadáchárya as spurious.

an incision was made through both the abdominal walls and the uterus. The opening in the latter organ was then enlarged, the hæmorrhage checked by the actual cautery, and the child removed. While an assistant compressed the abdomen, the operator then removed the placenta. The bleeding from the abdominal walls was then checked. No sutures were placed on the walls of the uterus but the abdominal parietes were fastened together by seven figure-of-eight sutures, formed with polished iron needles and threads of bark. The wound was then dressed with a paste prepared from various roots, the woman placed quietly upon her abdomen, in order to favour perfect drainage, and the task of the African Spencer Wells was finished. It appears that the patient was first rendered half unconscious with banana wine. One hour after the operation the patient was doing well. And her temperature never rose above IOI F. On the eleventh day the wound was completely healed, and the woman apparently as well as usual.

When we read this evidence of Felkin, we are reminded of the operative steps as described in our own ancient book of Surgery from which modern surgeons have been able to borrow the operation of rhinoplasty. It is a great pity that while in Africa the same practice is still retained intact, we in India by spurious attempts and disgraceful contortions, substitutions of false readings and dismal knowledge of grammar and rhetoric try to prove in the face of strong evidence that in ancient India Cæsarean Section was attempted only on cases where one 'might not perspire.'

If we take मृतप्रायाः in the sense of 'a woman whose life is in great danger' and not exactly in the sense of 'a woman who is dead' as recommended by Dallan and Arundutta (and which might have been the meaning if instead of मृतप्रायाः a word like व्यापन्ना had been used in the text), we find at once that Weber's remark in his History of Indian Literature p. 270 'that in Surgery they (the Hindus) attained to high proficiency' is not based on the solitary evidence of rhinoplasty alone.

In performing obstetric operations with success examples like this are not rare. If the two different readings मृतप्रायाः and व्यास्रावे be taken conjointly into consideration we are impressed with the idea that in ancient

60 THE SUSHRUTA SAMHITA. [Chap. VIII.

India Cæsarean operations were very frequently undertaken in cases of puerperal eclampsia, where the mother had been in the deplorable condition of a goat suffering from cramps and convulsions as well as in cases of an accidental death not unlike that which fell to the lot of the poor mother of him in whose name the operation is called. वत्स = goat मार = destroyer (See Monier William's Dictionary) hence a goat-destroyer = a tiger or wolf) or in cases where the presence of deformity in the parturient canal or of malformation of the foetus prevented the natural delivery of a living child. The incision is not to be made anywhere else but exactly in the place where Felkin saw the illiterate Negro successfully apply his knife, the selection of वत्स हारक as suggested by some commentators being a tempest on a tea pot especially when the subject is beyond the grave. In a living subject the selection of a proper site for the operation is of course very commendable. Hence we venture to suggest that extraction of the living foetus from the womb by making incision through this part of the pelvis was also attempted later on. We extract here the two different readings and leave our readers to judge whether we are correct to draw the above inferences.—Ed.

वत्सहारे विपन्नायाः कुक्षौः प्रस्यन्दते यदि जन्तुकाष्ठे ततः प्रोन्न पाटयित्वोदरे-

फकृत्पम्। Bágabhata S'árira Sthánam. ch. II. slo. 53.

वसामार विपन्नायाः कुक्षिः प्रस्यन्दते यदि मृतषपाज्जननकाष्ठे तं पाटयित्वोदरे-

श्रिवक।

Thus ends the eighth Chapter of the Nidâna Sthânam in the Sus'ruta Samhitâ, which treats of Nidânam of difficult labour and false presentations.

CHAPTER IX.

Now we shall discourse on the Nidánam of Vidradhí (abscess etc.).

The blessed Dhanvantari, the honoured of the gods, who for the promulgation of the knowledge of the Áyurveda and for administering proper medicines (to the sick), took his birth at Kási, (Benares) as a king, thus fully discoursed on the symptoms of Vidradhí (abscess etc.) to his disciple, Sus'ruta.

Definition and classification :-The extremely deranged and aggravated Váyu, Pittam and Kapham, resorting to the bone and vitiating the Tvaka (skin), blood, flesh, and fat of a person (with their own specific properties), gradually give rise to a deep-seated, painful, round or extended swelling which is called Vidradhi by the wise.

The disease admits of being divided into six types such as the Vátaja type, the Pittaja type, the Kaphaja type, the Sánnipátika type, the Kshataja type (traumatic), and the Asrijja (which has its seat in the vitiated blood).

3-4.

Now we shall describe their specific symptoms.

The Vátaja Type :-This abscess assumes a black or vermilion colour, is felt rough to the touch and is characterised by a sort of excruciating pain.

The growth and suppuration of the abscess are brought about in a variety of forms (owing to the variable and irregular action of the deranged Váyu involved in these cases).

The Pittaja Type :-This abscess assumes a blackish yellow colour or one like that of a ripe Audumvara fruit.

It is attended with fever and a burning sensation, and is of rapid growth and suppuration.

The Kaphaja Type :-This abscess is shaped like an Indian saucer (s'arava) and seems cold to the touch. It assumes a light yellow colour and is characterised by numbness, itching and little pain. The growth and suppuration of this abscess is very slow. The secretions from a Vataja abscess are thin, those from a Pittaja type are yellow, while the exudations from a Kaphaja abscess are white.

The Sannipatika Type :-An abscess of the Sannipatika type is of varied colour, and is attended with a varied sort of pain (sucking, drawing, turning etc.) and exudes secretions of various colours (white, yellow, etc.). It is little raised or elevated at its top, large and irregular in its shape and does not uniformly suppurate in all its parts.

Agantuja or Kshataja Type :-The local or inherent heat of an ulcer, (caused by a blow or a dirt) in a person, addicted to unwholesome regimen, is augmented and conducted by the deranged Vayu and vitiates the blood and Pittam, thus giving rise to a kind of abscess which is known as the Agantuja Vidradhi (traumatic abscess). Symptoms of the Pittaja type likewise mark this type of abscess and fever, thirst and a burning sensation attend it from the very beginning.

The Raktaja Type :-This abscess assumes a black or tawny colour, covered with a large number of black vesicles, and fever and an intolerable burning and pain attended with all the symptoms peculiar to the Pittaja type, mark the present form of the disease. It is called Raktaja Vidradhi. Of external Vidradhis or abscesses, those of the Sannipatika type should be regarded as incurable.

10—11.

Antara-Vidradhi :-Now we shall describe the characteristic features of internal abscesses (Antara-

Vidradhi

Localities : - They are generally found to be seated at the mouth (neck) of the bladder, or about the umbilicus, or in the sides, or in the Kukshi (inguinal regions), or on the Vrikkas, or on the liver, or in the heart, or on the Kloma, or on the splcen, or in the rectum. Their general characteristics are identical with those of the several types of external abscess. The symptoms of their suppurated or unsuppurated stages should be determined in the light of the chapter on Ámapakvaishanyam (Ch. XVII Sutra.). 14-15.

Their specific symptoms : - Now hear me describe the symptoms which specifically mark these internal abscesses according to their seats in the different regions of the organism. An abscess appearing in the rectum (Guda) is marked by the suppression of the flatus (Váta). Seated in the bladder, it gives rise to difficulty of urination and scantiness of urine. Appearing about the umbilicus it produces a distressing hic-cough and a rumbling sound (Átopa) in the intestines. Seated in either of the sides (Kukshi) it tends to aggravate inordinately the váyu of the body. Appearing in the inguinal region it gives rise to an extreme catching pain at the back and waist. Seated in either

NIDANA STHANAM

64

NIDANA STHANAM

Prognosis :-

NIDANA STHANAM

A woman,

Chap. IX.] NIDANA STHANAM. 65

hyper-pyrexia (Dáhajvará) should be considered as having had its origin to the vitiated blood (Raktaja Vidradhi) accumulated in the organism. The abscess, which appears in the Kukshi (in the iliac region) of a safely delivered woman owing to the presence of the unexpelled blood-clots in those regions after child-birth, should be also diagnosed as a case of Raktaja abscess. The unexpelled blood is called Makkalla. Such an abscess, if not absorbed in the course of a week. is sure to suppurate. 20–21.

Differentiating diagnosis of Gulma and Vidradhi* :–Now I shall discuss the features which distinguish a Gulma (internal tumour) from a Vidradhi (internal abscess). It may be asked, how is it that Gulma, (internal tumour) though caused by, and involving the co-operation of the same deranged Doshas as an internal abscess, does nut suppurate, while the latter (Vidradhi) does run to suppuration ? 22–23.

Differentiating diagnosis of Gulma and Vidradhi* :–Now I shall discuss the features which distinguish a Gulma (internal tumour) from a Vidradhi (internal abscess). It may be asked, how is it that Gulma, (internal tumour) though caused by, and involving the co-operation of the same deranged Doshas as an internal abscess, does nut suppurate, while the latter (Vidradhi) does run to suppuration ? 22–23.

The answer is that a Gulma (internal tumour), though caused by the same deranged Doshas as a Vidradhi (internal abscess), does not resort to any deranged organic matter, such as flesh, blood, etc., while, on the contrary, in a case of Vidradhi, the diseased flesh and blood of a locality are in themselves transformed into an abscess. An internal tumour (Gulma) is like a water bubble floating and moving about within a cavity.

The answer is that a Gulma (internal tumour), though caused by the same deranged Doshas as a Vidradhi (internal abscess), does not resort to any deranged organic matter, such as flesh, blood, etc., while, on the contrary, in a case of Vidradhi, the diseased flesh and blood of a locality are in themselves transformed into an abscess. An internal tumour (Gulma) is like a water bubble floating and moving about within a cavity.

• A Gulma according to Sus'ruta does not suppurate, but the term "Api" (also) contemplates instances in which a Gulma may suppurate as in the case where it has got its basis in the deranged flesh etc. of the locality. Charaka asserts that retarded digestion of the ingested food followed by digestional acid reaction, colic pain, insompnia with fever and a non-relish for food and a sense of oppression, etc. are the symptoms which indicate that suppuration has set in a Gulma, and he advises that it (Gulma) should be treated with poultices, etc. 9

• A Gulma according to Sus'ruta does not suppurate, but the term "Api" (also) contemplates instances in which a Gulma may suppurate as in the case where it has got its basis in the deranged flesh etc. of the locality. Charaka asserts that retarded digestion of the ingested food followed by digestional acid reaction, colic pain, insompnia with fever and a non-relish for food and a sense of oppression, etc. are the symptoms which indicate that suppuration has set in a Gulma, and he advises that it (Gulma) should be treated with poultices, etc. 9

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66

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24

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25-26

CHAPTER X.

Now we shall discourse on the Nidánam of Visarpa (erysipelas), Nádi (sinus) and Stana-roga (diseases affecting the mammæ of a woman). 1.

Definition of Visarpa :-The deranged and aggravated Doshas, (Váyu, Pittam and Kapham) having recourse to, and affecting the Tvaka (Skin), flesh and blood, speedily give rise to a sort of shifting, elevated swelling (Sotha) marked by the characteristic symptoms of any of them involved in the case. This swelling tends to extend all over the body. The disease is called Visarpa from the fact of its extending or swiftly shifting character (Skr. srip -to go, to extend). 2.

The Vátaja Type :-The swelling (Sotha) is soft and rough and assumes a black colour attended with an aching pain in the limbs and a cutting or piercing pain (in the affected locality). It is further marked by (all the usual) symptoms of the Vátika fever. A case of this type in which uneven flame coloured vesicles or bulbs appear on the affected part through the extreme vitiation (of the Váyu and Pittam) should be given up as incurable. 3.

The Pittaja and Kaphaja Types :-The Pittaja Visarpa (crysipelas) rapidly extends (over the body), attended with severe fever, a burning sensation, suppuration and cracking (of the skin). A large number of vesicles appears on the spot which assume a blood-red colour. A case of this type, characterised by the destruction of the local flesh and veins owing to the excessively aggravated condition of the deranged Doshas (Kaphha and Pittam) and a

collyrium-like black colour (of the swelling), should be regarded as incurable. The Kaphaja Visarpa extends slowly and the process of suppuration is tardy. The affected part becomes white, glossy and swollen, and is marked by a slight pain and excessive itching.

4-5.

The Sánnipátika Type :-The Visarpa of the Tridoshaja type is deep-seated and the affected part assumes all colours and is attended with all sorts of pain which are peculiar to the three aforesaid types. The local flesh and veins are destroyed in the suppurating stage of this discase and hence, it should be looked upon as incurable.

The Kshataja Type (Erysipelas due to a wound or an ulcer) :-The Pittam of a person with a temperament marked by the extreme aggravation of all the three Doshas, in conjunction with the blood, resorts to a wound* in his body and immediately gives rise to Erysipelas (Sopha—lit rash) which assumes a reddish-brown colour, with high fever with a burning sensation, and suppuration in its train, and it is found to be covered with black vesicles to the size of Kulattha pulse.

Prognosis :-The Vátaja, Pittaja and Kaphaja Visarpas are curable; the Sánnipátika and Khataja ones being incurable. The symptoms, which indicate an unfavourable prognosis in a case of Vátaja or Pittaja Erysipelas, have been described before. Those, which attack the vital parts (Marmas) of the body, can be cured only with the greatest difficulty.†

• Or through the extreme augmentation of all the three doshas in the ulcer (Sadyah-kshata-Vrana) according to otbers.

† Golden coloured (yellow) Erysipelas due to the action of the (deranged) Pitlam is incurable (Pittálmá Künchana-vapuscha ta!há na sydtsyat.).—D. R.

The Nádi-Vrana :-The pus of an abscess or swelling burrows into the affected part if a person neglects it in its fully suppurated stage, dubious of its being so*conditioned, or not, or even neglects to open a fully suppurated abscess. An abscess or swelling is called a Gati Vrana owing to an excessive infiltration of pus, and it is also called a Nádi-vrana owing to the presence of a large number of recesses or cavities in its inside. There are five different types of Nádi-vrana (sinuses) such as the Vátaja, Pittaja, Kaphaja, Tridoshaja and Śalyaja.

9-10

The Vátaja, Kaphaja and Pittaja Types :-The Vátaja Sinus is rough and short-mouthed, characterised by an aching pain (in its inside). It exudes a sort of frothy secretion which becomes greater at night and is attended with an aching pain. Thirst, lassitude, heat and a piercing pain(in the affected locality) are the usual accompaniments of the Pittaja types. Fever is present from the beginning and the Sinus exudes a large quantity of hot and yellow coloured secretion which is more by day than by night. The Kaphaja Sinus becomes hard and is characterised by itching and a slight pain (numbed ?). It is found to secrete a copious quantity of thick, shiny, white-coloured pus which becomes greater at night.

11-13

Dvandaja and Tridoshaja Types :-A case of Nádi-Vrana involving the concerted action of any two of the deranged Doshas (Váyu, Pittam and Kapham) and exhibiting symptoms peculiar to both, is called a Dvandaja* one. There are * three

• Gáyadása does not read the symptoms of Dvidoshaja (i.e., due to two morbific principles) types of sinus a g ven in the text which he has rejected as spurious

types of this class of disease, (such as the Vata-pittaja, Vata-kaphaja and Pitta-kaphaja). A case of Nadi-vrana, cxhibiting symptcms of the threc aforesaid types, and attended with fever and a burning sensatïon, difficult breathing, dryness of the mouth and syncope, is called Tridoshaja. An attack of this type should be regarded as drcadful and fatal, casting around the gloom of dcath.

14–15.

The Śalyaja Nádi-Vrana :—A forcign matter (such as dirt, bonc, splinter etc.), lodgcd within the body and invisiolc to the cyc, tends to burst open the skin, etc. of the locality along its channcl of insertion and gives risc to a type of Sinus. It is charactcr-iscl by a constant pain, and suddenly and rapidly exudes a sort of hot, blood-tinged, agitated, frothy sccre-tion. This typc is callcd Śalyaja.

The Stana-Roga:—Thcsc may le divided into as many types as the aforesaid Nádi-Vrana and are caused by the samc exciting factors as the last named malady. The milk-carrying ducts remain closed in the breast of a nullipcra thus barring the possibility of the descent of the Doshas through them and of an attack of any discase at that part of the body. On the contrary, such ducts in the breast of a pïmipara open and expand of their own accord, thus making the advent of diseases possible that are peculiar to the mamma.

17–19.

The breast-milk : —The sweet essence of the Rasa (lymph chyle) drawn from the digested food courscs through the whole body and is ultimately con-centrated in the breast of a mother or a woman (big with child) which is called milk.

Its character :—The breast-milk, like semen, lies hidden and invisible in the organism, though

Chap. X.J NIDANA STHANAM.

permeating it in a subtle or essential form. The characteristic features of the breast-milk bear analogy to those of semen The breast milk is secreted, and flows out at the touch, sight or thought of the child in the same manner as the semen is dislodged and emitted at the sight, touch or recollection etc. of a beloved woman. As the strong and unclouded affections of a man are the cause of the emission of semen, so the fondest love of a mother for her children brings about the secretion of her breast-milk Both semen and breast-milk are the product of the essence of digested food, this essence being converted into milk in women. 21–22.

Its abnormal and normal Traits :-

The milk of a mother vitiated by the deranged Vàyu of her system has an astringent taste and floats on water. The milk of a mother vitiated by the deranged Pittam has an acid and pungent taste and becomes marked with a yellow hue,* if left to float on water. The milk of a mother vitiated by the deranged Kapham is thick and slimy and sinks in water. The milk of a mother vitiated by the concerted and simultaneous derangement of the three Doshas of the body is marked by the combination of all the preceding symptoms. An external blow or hurt too (Abhigháta) sometimes produces vitiation of the mother's milk. 23.

The milk (of a mother), which instantly mixes with water, tastes sweet and retains its natural greyish tint, should be regarded as pure. 24.

The milk (of a mother), which instantly mixes with water, tastes sweet and retains its natural greyish tint, should be regarded as pure. 24.

The bodily Doshas having recourse to the breasts of a woman whether filled with milk or not and vitiating the local flesh and blood give rise to mammary diseases,

The bodily Doshas having recourse to the breasts of a woman whether filled with milk or not and vitiating the local flesh and blood give rise to mammary diseases,

• The particle “Chà” in the text indicates that the colour may turn blue or pink in some cases.

• The particle “Chà” in the text indicates that the colour may turn blue or pink in some cases.

72 THE SUSHRUTA SAMHITA.

(Stana-roga). All the types of abscess (Vidradhi) excepting the one called the Raktaja out of the six types described before are found to attack the mammæ, and their symptoms should be understood as identical with those of external abscesses. 25.

Thus ends the tenth Chapter of the Nidánam Sthánam̉ in the Sus'ruta Samhitá w ich treats of the etiology and symptoms of Erysipelas, Sinus and mammary abscesses.

CHAPTER XI.

Now we shall discourse on the Nidànam of Granthi (Glands etc.), Apachi (Scrofula etc.), Arvuda (Tumours) and Galaganda (Goitre).

The deranged and unusually aggravated Váyu etc. (Pittam and Kapham), by vitiating the flesh, blood and fat mixed with the Kapham (of any part of the organism), give rise to the formation of round, knotty, elevated swellings which are called Granthi (Glandular inflammation).

The Dosha-Origined Types :-The swelling (Śopha) of the Vàtàja type seems as if it were drawn into and elevated or as if severed or pricked with a needle, cleft in two or drawn asunder or as if cut in two or pierced. The knotty growth assumes a black colour, and is rough and elongated like a bladder. On bursting a granthi of this type exudes clear bright red blood.

The Pittaja Granthi is characterised by heat and an excessive burning sensation (in its inside). A pain, like that of being boiled by an alkali or by fire, is felt in the inside. The knotty formation assumes a red or yellowish colour and exudes a flow of extremely hot blood on bursting.

The Kaphaja Granthi is slightly discoloured and cold to the touch. It is characterised by a slight pain and excessive itching, and feels hard and compact as a stone. It is slow or tardy in its growth and exudes a secretion of thick white-coloured pus when it bursts.

3-5.

The Medaja Type :-

The fat origined Granthi is large and glossy and gains or loses in size with the gain or loss of flesh by the patient.

10

It is marked

THE SUSHRUTA SAMHITA

74

THE SUSHRUTA SAMHITA

Širá-Granthi-(aneurism or varicose veins) :-

THE SUSHRUTA SAMHITA

THE SUSHRUTA SAMHITA

THE SUSHRUTA SAMHITA

Apachi-(Scrofula etc.) :-

THE SUSHRUTA SAMHITA

THE SUSHRUTA SAMHITA

THE SUSHRUTA SAMHITA

NIDANA STHANAM

These knotty formations are characterised by itching and a slight pain. Some of them spontaneously burst exuding secretions while others are observed to vanish and re-appear (in succession). Such vanishings, re-appearances, or fresh formations continue for a considerable time. The disease undoubtedly owes its origin to the deranged fat and Kapham, and may only be made amenable (to medicine) with the greatest difficulty lasting for years at a time. 10.

Arvuda-(tumour etc.) :-The large vegetation of flesh which appears at any part of the body, becomes slightly painful, rounded, immovable and deep-seated, and has its root sunk considerably deep in the affected part, and which is due to the vitiation of the flesh and blood by the deranged and aggravated Doshas (Váyu, Pittam and Kapham) is called an Arvuda (tumour) by the learned physicians*. The growth of an Arvuda is often found to be slow, and it seldom suppurates. The characteristic symptoms of an Arvuda which owes its origin to the deranged condition of the Váyu, Pittam, Kapham, flesh or fat, are respectively identical with those, which mark the cases of Granthis, brought about by the same deranged principles of the body. 11.

Arvuda-(tumour etc.)

Raktaja-Arvuda :-The deranged Doshas (Váyu, Pittam and Kapham) contracting, compressing

Raktaja-Arvuda

They resemble spawns of fish in shape and size and are due to the action of the deranged Váyu, Pittam and Kapham. The appearance of such glands in the upper part of the body should be attributed to the action of the deranged and aggravated Váyu. They are extremely hard to cure in as much as their growth (formation) involves the concerted action of the morbific principles (Doshas) of the body.-Bhoja.

They resemble spawns of fish in shape and size and are due to the action of the deranged Váyu, Pittam and Kapham. The appearance of such glands in the upper part of the body should be attributed to the action of the deranged and aggravated Váyu. They are extremely hard to cure in as much as their growth (formation) involves the concerted action of the morbific principles (Doshas) of the body.-Bhoja.

Charaka, who designates this disease as Gandamálá, describes its location in regions about the jawbones alone.

Charaka, who designates this disease as Gandamálá, describes its location in regions about the jawbones alone.

• That they having recourse to the flesh, produce deep-seated vegetations (of flesh) is the reading adopted by Gayádása and others.

• That they having recourse to the flesh, produce deep-seated vegetations (of flesh) is the reading adopted by Gayádása and others.

and drawing the vessels (Sira) and blood (of the affected part), raise a slightly suppurated and exuding tumour which is covered with small warts and fleshy tubercles and is called a Raktarvuda. This tumour is rapid in its growth and exudes a constant flow of (vitiated) blood. The complexion of the patient owing to depletive actions and other concomitant evils of hæmorrhage becomes pale and yellow. The type should be considered incurable on account of its having its origin in the blood.* 12—13.

Mansarvuda :-The flesh of any part of the body hurt by an external blow etc. (hurting it with a log of wood—D.R.) and vitiated in consequence, gives rise to a sort of swelling (tumour) which is called Mansarvuda, which originates through the action of the deranged Váyu. It is glossy, painless, non-suppurating, hard as a stone, immobile, and of the same colour as the surrounding skin. Such a tumour appearing in a person addicted to meat diet becomes deep seated owing to the consequent vitiation of the bodily flesh and soon lapses into one of an incurable type. 14.

Prognosis :-Even of the aforesaid curable types (such as the Vátaja, etc.), the following types of Arvudam (tumours) should be likewise regarded as incurable, those which appear in the cavity of a Srota channel or an artery, or any vulnerable joint of the body and are characterised by any sort of secretion and also immovable, should be deemed incurable. An Arvudam (tumour) cropping up on one existing from before is

• Although all types of Arvuda have their origin in the deranged flesh and blood, preponderant action of the deranged blood is found in Raktarvuda, while a dominant action of the deranged flesh marks the Mansarvuda type.

called Adhyarvudam, which should be likewise deemed as incurable. A couple of contiguous Arvudam (tumours) cropping up simultaneously or one after another is called Dviarvudam, which should be held as equally incurable (with one of the foregoing types). An Arvuda (tumour) of whatsoever type, never suppurates owing to the exuberance of the deranged Kapham and fat as well as in consequence of the immobility, condensation and compactness of the deranged Doshas (Váyu, Pittam and Kapham involved in the case, or out of a specific trait of its own nature.

15-16.

Definition of Galaganda (Goitre):-The deranged and aggravated Vàyu in combination with the deranged and augmented Kapham and fat of the locality affects the two tendons of the neck (Manyás) and gradually gives rise to a swelling about that part of the neck characterised by the specific symptoms of the deranged Doshas (Vàyu or Kapham) and principles involved in the case.

The swelling is called Galganda (Goitre).

Symptoms of the Dosha-orgined Types:-The swelling or tumour in the Vátaja goitre is characterised by a pricking pain (in its inside) marked by the appearance of blue or dark coloured veins Sírá) on its surface.

It assumes a vermilion or tawny brown hue.

The goitre becomes united with the local fat in course of time, and gains in size, giving rise to a sense of burning in the throat, or is characterised by the absence of any pain at all.

A Vátaja goitre is rough to the touch, slow in its growth, and never or but rarely suppurates.

A sense of dryness in the throat and the palate as well as a bad taste in the mouth likewise marks this type.

The swelling in the Kaphaja Type assumes a large shape and becomes hard, firm, cold

and of the same colour (white). There is but slight pain and the patient feels an irresistible inclination to scratch the part. It is slow in its progress and suppuration is rare and tardy. A sweet taste is felt in the mouth and the throat and the palate seem as if smeared with a sort of sticky mucous.

18-20.

Symptoms of the Medaja Type:- The swelling is glossy, soft (heavy-D.R). and pale- coloured. It emits a fetid smell and is characterised by excessive itching and an absence of pain. It is short at its root and hangs down from the neck in the shape of a pumpkin (Alávu), gradually gaining its full rotundity at the top. The size of the goitre is proportionate to the growth or loss of flesh of the body. The face of the patient looks as if it has been anointed with oil and a peculiar rumbling sound is constantly heard in the throat.

Prognosis : - A case of goitre attended with difficult respiration, a softening of the whole body, weakness, a nonrelish for food, loss of voice as well as the one which is more than of a year's standing should be abandoned by the physician as incurable.

Metrical Text :- A pendent swelling whether large or small and occurring about the region of the throat and resembling the scrotum in shape is called a Gala-Ganda.

Thus ends the eleventh Chapter of the Nidána Sthánam in the Susrutá Samhitá which treats of the Nidánam of Granthi, Scrofula, etc.

CHAPTER XII

Now we shall discourse on the Nidánam of Vriddhi (hydrocele, hernia, scrotal tumours etc), Upadanśa (discase of the genital organ, and Ślipada (elephantiasis).

Clȧsses :

• There are seven different types of Vriddhi such as the Vátaja, Pittaja, Kaphaja, Raktaja, Medaja, Mutraja and the Antra-vriddhi. Of these both the Mutraja-vriddhi (hydrocele or extravagation of the urine), and Antra-vriddhi types, though owing their origin to the deranged condition of the bodily Vàyu, have been so named after the organic matters or anatomical parts (urine, iliac colon etc.) involved in them.

Definition and Premonitory symptoms :

• Any of the deranged Doshas (Vàyu, Pittam, etc ) lying in the nether regions of the body may resort to the spermatic cords (Dhamani) and give risc to a swelling and inflammation of Phalacośha (scrotal sac) which is called Vriddhi (scrotal tumour etc.). A pain in the bladder, scrotum, penis and the waist (Kati) incarceration of the Vàyu and the swelling of the scrotum, are the premonitory symptoms of the disease.

The Dosha-orlgined Types :

• The type in which the scrotum becomes distended with Vàyu like an inflated air-drum, marked by roughness of (its surface) and the presence of a varied sort of Vátaja pain (in its interior) without any apparent cause is called Vataja Vriddhi.

Pittaja Vriddhi,

assumes the colour of a ripe

Audumvara fruit and is attended with fever, a burning sensation and heat in the affected part. It is of a marked rapid growth and speedy suppuration (of the scrotum). The swollen organ in the Kaphaja Vriddhi becomes hard and cold to the touch accompanied by little pain, and itching (in the affected part). In the Raktaja type the swollen scrotum is covered over with black vesicles, all other symptoms of the type being identical with those of the Pittaja one. In the Medaja type the swollen scrotum looks like a ripe Tala fruit and becomes soft, glossy and slightly painful. The patient feels a constant inclination to scratch the part. The Mutraja-vriddhi (hydrocele) owes its origin to a habit of voluntary retention of urine, its characteristic symptoms being softness and fluctuation on the surface of the swollen scrotum like a skin-bladder filled with water, painful urination, pain in the testes and swelling of the scrotum.

Antra-vriddhi (Inguinal hernia):—The local Vàyu enraged and unusually aggravated by lifting a great load, wrestling with a stronger person, violent physical strain or a fall from a tree and such like physical labour doubles up a part of the small intestine and presses it down into the inguinal regions lying there strangulated in the form of a knot (Granthi) which is known as Antra-vriddhi (inguinal hernia). The part not properly attended to at the outset descends into the scrotum which becomes ultimately elongated and intensely swollen and looks like an inflated air-bladder. It (hernia) ascends upwards under pressure, making a peculiar sound, (gurgling); while let free it comes down and again gives rise to the swelling of the scrotum. This disease is called Antra-vriddhi and is incurable.

Chap. XII.] NIDANA STHANAM. 81

The Upadanśam:-An inflammatory swelling of the genital, whether ulcerated or not is called Upadans'a*. The disease owes its origin to the action of the local Doshas, aggravated by promiscuous and excessive sexual intercourse, or by entire abstinence in sexual matter; or by visiting a woman, who had observed a vow of lifelong continence or one who has not long known a man, or one in her menses or one with an extremely narrow or spacious vulva, or with rough or harsh or large pubic hairs; or by going unto a woman whose partturient canal is studded with hairs along its entire length; or by visiting a woman not amorously disposed towards the visitor and vice versa; or by knowing a woman who washes her private parts with foul water or neglects the cleanliness of those parts, or suffers from any of the vaginal diseases, or one whose vagina is naturally foul; or by going unto a woman in any of the natural fissures of her body other than the organ of copulation (Vi.yoni); or by pricking the genital with finger nails, or biting it with the teeth, or through poisonous contact, or through practice of getting the (penis abnormally elongated by pricking the) bristles of a water parasite (S'uka) into its body; or by practising

• Upadans'a is not syphilis whole to whole. Certain types of Upadans'a such as the Raktaja and Sànnipátika types which entail the destruction of the organs concerned exibit certain symptoms which are common to syphilis as well. The secondary eruptions and tertiary symptoms of syphilis are not mentioned by the A'yurvedic Rishis who used to treat it only with vegetable medicines and this fact intimates the probability that the secondary and tertiary symptoms of syphilis might not arise by their efficient and able treatment from the very beginning, preventing the absorption of the poison into the system. The practice of ablution, so common among the Hindus, might be taken into consideration as one of the important preventive factors. Maharshi Charaka has comprised it within the chapter on 'Senile Impotency'. -Ed.

masturbation, or any unnatural offence with female quadrupeds; or by washing the genitals with filthy or poisonous water; or through neglect to wash the parts after coition, or voluntary suppression of a natural flow of semen or urine or through any hurt or pressure on the organ etc. The inflammation of the genital thus engendered is called Upadans'a. The disease admits of being divided into five distinct types, such as, the Vátaja, Pittaja, Kaphaja, Tridoshaja and the Raktaja.

7—8

The symptoms of different Types:- The roughness of the genitals, the bursting or cracking of the integuments of the penis and prepuce etc., numbness and swelling of the affected part which is perceived rough to the touch and the presence of a varied sort of pain peculiar to the deranged Váyu are the characteristic indications of the Vátaja type. In the Pittaja type fever sets in (from the very beginning), the penis becomes swollen and assumes the colour of a ripe Indian fig (reddish-yellow), attended with a sort of intolerable burning sensation The process of suppuration is rapid and a variety of pain peculiar to the deranged Pittam, (distinguishes it from the other forms of the disease). The penis becomes swollen, hard and glossy in the Kaphaja type marked by itching and a variety of pain characteristic of the deranged Kapham.

In the blood-origined type (Raktaja) the organ bleeds heavily and is covered with the eruptions of large black vesicles. Fever, thirst, (Soska), burning sensations and other characteristic symptoms of the deranged Pittam are also present. Palliation is all that can be occasionally effected in these cases. Symptoms specifically betraying to each of the Vátaja, Pittaja and Kaphaja types concurrently manifest themselves in the Sánnipátika type of Upa-

Chap. XII.] NIDANA STHANAM.

83

dansa. The organ cracks, the ulcers or cancers become infested with parasites and death comes in to put a stop to the suffering of its wretched victim. 9-13.

Slipadam (Elephantiasis) :- The disease in which the deranged Vayu, Pittam and Kapham, taking a downward course, are lodged in the thighs, knee-joints, legs and the inguinal regions and spread to the feet in course of time and gradually give rise to a swelling therein, is called Slipadam. There are three types of Slipada severally due to the actions of the deranged Vayu, Pittam and Kapham. 14-15.

The symptoms of the different Types:-The swollen parts assume a black colour in the Vataja type and are felt rough and uneven to the touch. A sort of spasmodic pain without any apparent reason is felt (at intervals in the seat of the disease), which largely begins to crack or burst. The Pittaja type is characterised by a little softness and yellowish hue (of the diseased localities) and often attended with fever, and a burning sensation. In the Kaphaja type the affected localities become white, glossy, slightly painful, heavy, contain large nodules (Granthis) and are studded over with crops of papillae. 16.

Prognosis :-A case of elephantiasis of a year's growth as well as the one which is characterised by excessive swelling (of the affected parts), exudation and vegetation of knotty excrescences resembling the sum-mits of an ant-hill should be given up as incurable. 17.

Memorable Verses :- A preponderance of the deranged Kapham marks the three types of the disease, in as much as, the heaviness and largeness (of the swelling) can not be brought about by any other factor than Kapham. The disease is peculiar to countries

in which large quantities of old rain-water remain stagnant during the greater part (lit.- all seasons) of the year making them damp and humid in all seasons. 18-91

The disease is usually found to be confined to the legs and hands of men but cases are on record in which it has extended to the ear, nose, lips and the regions of the eyes. (Penis—Mádhaba-Nidánam). 20.

CHAPTER XIII.

Now we shall discourse on the Nidánam of Kshudrarogam (diseases which are known by the general name of minor ailments). I.

These diseases are generally divided into forty-four distinct varieties or types such as -- Ajagalliká, Yavaprakshyá, Andhálaji, Vivritá, Kachchapiká, Valmika, Indravriddhá, Panasiká, Páshána-garddabha, Jála-garddabha, Kakshá, Vishphota, Agni-rohini, Chippam, Kunakha, Anusaye, Vidáriká, Sarkará-Arbudam, Pámá, Vicharchiká. Rakasá, Pádadáriká, Kadara, Alasa, Indralupta, Dárunaka, Arunshiká, Palitam, Masuriká, Yauvana-pidaká, Padmini-kantaka, Yatumani, Masaka, Charmakila, Tilakálaka, Nyachchhya, Vyanga, Parivartiká, Avapátiká, Niruddha-prakása, Niruddha-guda, Ahiputanam, Vrishana-kachchu, and Guda-bhransá. * 2.

Metrical Texts : --The species of pimples or eruptions which are shaped like the Mudga pulse and are glossy, knotty and painless is called Ajagalliká. They are of the same colour (as the surrounding skin) and their origin is usually ascribed to the action of the deranged Kapham and Váyu. The disease is peculiar to infants.† Yaváprakshyá:-The eruptions

• Brahmadeva comprising Garddavika, Irveliika, Gandhapidiká and Tilakdlaka in the list reads it as consisting of thirty-four different species. Jejjata does not hold the four forms of disease commencing with Gardda-vika, etc. as included within the list. Gayádása, finding them included in all the recensions reads Garddabhiká, etc. as included within the list of Kshudra Roga, and Pámá etc. as included within the list of Kshudra Kushtham.

† They afflict certain infants--Dallana.

Yavaprakshyá

which are shaped like the barley-corns, extremely hard, thick at the middle, knotty and affect (lit. - confined to) the flesh are called Yavaprakshyá. They are due to the action of the deranged Váyu and Kapham.

Andhálaji

-The dense, raised, slender-topped eruptions which appear in circular patches and exude a slight pus are called Andhálaji. They are due to the action of the deranged Váyu and Kapham.

Vivritá

-Pustules or eruptions, which are coloured like a ripe fig. fruit and are flat-topped and appear in circular patches with an intolerable burning sensation, are called Vivritá They are due to the action of the deranged Pittam.

Kachchapiká

:-A group of five or six hard, elevated, nodular eruptions (Granthis), arranged in the shape of a tortoise (which may appear on the surface of any part of the body), are called Kachchapiká. They are due to the action of the deranged Kapham and Váyu.

Valmiká

:-The knotty undurated eruptions (Granthis) which gradually appear on the soles, palms, joints, neck and on the regions above clavicles and resemble an ant-hill in shape, slowly gaining in size are called Valmiká. Ulcers attended with pricking pain, burning, itching sensations and exuding muco-purulent discharges appear around the aforesaid eruptions (Granthis). The disease is due to the action of the deranged Kapham, Pittam and Váyu.

Indravriddhá

:-Pimples or eruptions (Pidaká) arising (on the surface of the body), arranged in the same circular array as marks the distribution of the seed (sacks) in a lotus flower are called Indravriddhá by the physicians. The disease is caused by the action of the deranged Váyu and Pittam.

Panasiká

:-Eruptions (Pidaká) of a sort of extremely painful pustules all over the back or the ears which resemble the

Chap. XIII.] NIDANA STHANAM.

87

Kumuda bulb in shape, are called Panasika. They are due to the action of the deranged Kapham and Vàyu. Páshána-Garddabha :-A slightly painful and non-shifting hard swelling, which appears on the joint of the jawbones, (Hanú-sandhi, is called Páshána-Garddabha. The disease is the effect of the deranged Kapham and Váyu.

Jala-Garddabha :-A thin and superficial swelling, which like erysipelas is of a shifting or progressive character and is further attended with fever and a burning sensation and which is but rarely found to suppurate, is called Jála-Garddabha.* The disease results from the deranged Pittam.

Kakshà :-The disease characterised by the eruptions of black and painful vesicles (Shphota) on the back, sides, and on the region about the arm-pits, is called Kakshá. The disease is likewise attributed to the action of the aggravated Pittam.

Vishphotaka :-The disease in which eruptions of burnlike vesicles (Shphota) crop up on the whole surface of the body, or on that of any particular locality, attended with fever, is called Vish-photaka. The disease is the effect of vitiated blood and Pittam.

9-14.

Agni-Rohini† :-Vesicles (Shphota) having the appearance of burns and cropping up about the waist

• The circular raised spots studded with vesicles are called Gardda-bhá. They are reddish and painful and produced by the action of Váyu and Pittam. Gayàdása reads it so.

† Dallana quotes from another Tantram that the morbific principles in men, aggravated through the action of the enraged and augmented Pittam and blood, give rise to vesicles (blisters) like red-hot charcoal by breaking open the flesh at the waist, attended with extreme pain, high fever and an insufferable burning sensation which,if not properly remedied, bring on death within a fortnight, or ten days of their first appearance. These (vesicles) are called Vahni-Rohini. And again from another work he cites that a case of Vahni-Rohini due to the action of the deranged

(Kakshá) by bursting the local flesh, and which is attended with fever and a sensation as if a blazing fire is burning in the inside (of the affected part), are called Agni-Rohini. The disease is caused by the concerted action of the three deranged Doshas (Vayu, Pittam and Kapham). It is incurable and ends in the death of the patient either on the seventh*, tenth or fifteenth day (of its first appearance). 15.

Chippam :-The deranged Váyu and Pittam vitiating the flesh of the finger-nails, give rise to a disease which is characterised by pain, burning and suppuration. The disease called Chippam, is also denominated Upanakha and Kshataroga. Kunakham :-The nails of fingers becoming rough, dry, black, and injured through the action of the Doshas enraged through the effect of a blow, are called Kunakha (bad nails). It is also called Kulinam. Anusayi :-A small swelling (on the surface of the body) which is of the same colour (as the surrounding skin), but is deep-seated, and suppurates in its deeper strata, is called Anusayi by the physicians. The disease is the effect of the deranged Kapham. Vidáriká :-A round reddish swelling rising either on the auxiliary or inguinal regions in the shape of a gourd (Viddarikanda) is known as Vidáriká. The disease is due to the concerted action of the deranged Váyu, Pittam and Kapham and is characterised by symptoms peculiar to each of them. 16 - 19,

Kapham proves fatal within a fortnight, that due to the deranged Pittam, within ten days, and that due to the deranged Váyu, within a week.

• The patient dies on the seventh day in a case of disease marked by the dominant Váyu, on the tenth day in a case marked by the dominant Pittam and on the fifteenth day in a case of dominant deranged Kapham.

Śarkarárbudam

Pádadáriká

Alasa

Indralupta

Indralupta

Dárunaka

Arunshiká

Arunshi

Palitam

Masuriká

Yauvana-pidaká

Mukhadushiká

Padmini-Kantaka

Women

studded over with thorny papilla of the skin resembling the thorns on the stem of the lotus marked by itching are called Padmini-kantaka. The disease is due to the deranged condition of the Váyu and Kapham. Yatu-mani (mole) :-The reddish, glossy, circular, and painless, congenital marks (Sahajam) or moles on the body not more elevated (than the surrounding skin) are called Yatumani. The disease is due to the deranged condition of the blood and Pittam.

26—33.

Maśaka (Lichen) :-The hard, painless, black and elevated eruptions on the body (skin) resembling the Másha pulse in shape, caused by the aggravated condition of the bodily Váyu are called Maśaka Tilakálaka:-The black painless spots on the skin about the size of a sesamum seed and level with the skin are called Tilakálaka. This disease is caused through the aggravated condition of the Váyu, Pittam and Kapham.† Nyachchham :-The congenital, painless, circular, white or brown (Śyáva) patches on the skin, which are found to be restricted to a small or comparatively diffused area of the skin, are called Nyachchham. Charmakila (hypertrophy of the skin) :-The causes and symptoms of the disease known as Charmakila have been already described (under the head of the Arśa-Nidànam). Vyanga :-The Váyu being aggravated through wrath and over-fatiguing physical exercise, and surcharged with Pittam, and suddenly appearing on the face of a person, causes thin, circular, painless and brown-coloured patches or stains. They are known by the name of Vyanga.*

34—38.

• According to certain authorities it is due to the absorption of blood by Váyu and Pittam. † According to others the spot goes by the name of Nilikami, if it is black-coloured and appears anywhere other than on the face.

The Parivartiká

Avapátiká

Niruddha-prakása

39-41.

Niruddhaguda

NIDANA STHANAM

Ahiputana :-A sort of itch-like eruptions appecaring about thc anus of a child owing to a deposit of urine, perspiration, feces etc consequent on thc neglect in cleansing that part. The eruptions which are the effects of the deranged blood and Kapham soon assume an Eczematous character and exade a purulent discharge on account of constant scratching. The Eczema (Vrana) soon spreads, and coalesces and proves very obstinate in the end. The disease is called Ahiputana. Vrishana-kachchu :-When thc filthy matter, deposited in the scrotal integuments of a person who is negligent in washing the parts or in thc habit of taking daily ablutions, is moistend by thc local perspiration, it gives rise to an itching sensation in the skin of the scrotum, which is speedily turned into running Eczema by constant scratching of the parts. The disease is called Vrishana-kachchu and is due to the aggravated condition of the Kapham and blood. Guda-Bhrans'a :-A prolapse or falling out of the anus(duc to the Váyu) in a weak and lean patient through straining, urging or flow of stool as in dysentery is called Guda-Bhrans'a or prolapsus ani. 42—45.

Thus ends the thirteenth Chapter of the Nidána Sthánam in the Sus'ruta Samhitá which treats of the Nidánam of minor ailments.

CHAPTER XIV.

Now we shall discourse on the Nidánâm of the disease known as Śukadosha. 1. Any of the eighteen different types of the disease may affect the genital (penis) of a man who foolishly resorts to the practice of getting it abnormally elongated and swollen by plastering it with Śuka (a kind of irritating water insect) and not in the usual officinal way. Classification :-Diseases, which result from such malpractices, are known as,-Sarshapiká, Ashthiliká, Grathitam, Kumbhiká, Alaji, Mriditam, Sammudhapidaká, Avamantha, Pushkariká, Sparśabáni, Uttamá, Śataponaka, Tvakapáka, Śonitárvudam, Mánsárvudam, Mánsapáka, Vidradhi and Tilakálak.

Metrical Texts :-The tiny herpetic eruptions (Pidaká) which resemble the seeds of white mustard in shape and size, (and are found to crop up on the male organ of generation) on account of a deranged condition of the blood and Kapham, as the result of an injudicious application of Śuka plasters are called Sarshapiká (Pidaká) by the wise. Eruptions of hard stone-like pimples, (Pidaká) irregular at their sides or edges and which are caused by the aggravation of the local Váyu by the use of a plaster of the poisonous Śuka, are called Ashthiliká. The knotty Granthis (nodules) on the penis owing to its being frequently stuffed with the bristles of a Śuka insect are called Grathitam. This type is caused by the deranged action of the Kapham. A black wart resembling the stone or seed of a jambolin fruit in shape is called Kumbhiká. This type is due to the deranged condition of the blood and Pittam.

2. The tiny herpetic eruptions (Pidaká) which resemble the seeds of white mustard in shape and size, (and are found to crop up on the male organ of generation) on account of a deranged condition of the blood and Kapham, as the result of an injudicious application of Śuka plasters are called Sarshapiká (Pidaká) by the wise. Eruptions of hard stone-like pimples, (Pidaká) irregular at their sides or edges and which are caused by the aggravation of the local Váyu by the use of a plaster of the poisonous Śuka, are called Ashthiliká. The knotty Granthis (nodules) on the penis owing to its being frequently stuffed with the bristles of a Śuka insect are called Grathitam. This type is caused by the deranged action of the Kapham. A black wart resembling the stone or seed of a jambolin fruit in shape is called Kumbhiká. This type is due to the deranged condition of the blood and Pittam. 3-5.

NIDANA STHANAM

An Alaji (incidental to an injudicious application of Śuka on the penis) exhibits symptoms, which are identical with those manifested by a case of Alaji in Prameha (Ch. vi). A wart (papilloma) attended with swelling of the part and caused by the aggravated Váyu on the hard and inflamed penis causing pressure (on the urethra) is called Mriditam. The pustule or eruption appearing on the penis on account of its being extremely pressed by the hand (for the insertion of the hairs of the Śuka) in its dorsum is called Sammudha-pidaka. (It is the outcome of the aggravated Váyu*). A large number of elongated pustules on the penis (incidental to an application of Śuka to the part) which burst at the middle, causing pain and shivering, is called Avamantha (epithelioma). 6—10.

The Pushkariká type of the disease is marked by the cruptions of small pimples around the principal one The type has its origin in the deranged condition of the blood and Pittam, and is so called from the part of the excrescences being arranged in rings or circles like the petals of a lotus flower in shape. A complete anesthesia (of the affected organ) owing to the vitiated blood by the injudicious application of a Śuka is called Sparśa-háni. Pustules appearing on the penis through the vitiation of the local blood and Pittam by such constant applications are called Uttamá. A suppuration of the prepuce under the circumstance is called Tvakapákh. There is fever with a burning sensation in the affected organ. The disease is due to the vitiated condition of the blood and Pittam. 11—15.

The type of the disease in which the penis is marked by the eruption of black vesicles and is covered over with a large number of red pimples or pustules with

• According to Dallana it is due to the action of Váyu and blood.

an excruciating pain in the ulcerated region of the organ is called śonitârvudam. The vegetation of a fleshy tumour on the penis (incidental to a blow on the organ to alleviate the pain of inserting the hairs of the Śuka insect into its body), is called Mânsârvudam. A suppuration as well as sloughing of the penis attended with different kinds of pain which severally mark the deranged Váyu, Pittam and Kapham is called Mânsapâka. This type is caused by the concerted action of the deranged Váyu, Pittam and Kapham.

15-18.

The specific symptoms of a Tridoshaja Vidradhi as described before (Chap.ix.) mark the one which affects the penis (owing to an injudicious application of the highly poisonous irritant Śuka to the organs). The disease is called Vidradhi. A process of general suppuration and sloughing of the organ marks the type which is produced by the application of a black Śuka or one of a variegated coloured insect of the same species. The type is called Tilakâlaka, and should be regarded as Tridoshaja one.

19-21.

Prognosis :-Of the above enumerated malignant diseases of the penis, those known as Mânsârvuda, Mânsapâka, Vidradhi and Tilakâlak shoulda be deemed as incurable.

Thus ends the fourteenth Chapter of the Nidána Sthánam in the Sus'ruta Samhitá which treats of Nidánam of different types of Śukadohsa.

CHAPTER XV.

Now we shall discourse on the Nidánam of Bhag-nam (fractures and dislocations etc. of bones).

1

Various kinds of fracture may be caused from a variety of causes, such as by a fall, pressure, blow, violent jerking or by the bites of ferocious beasts etc.

These cases may be grouped under the two main subdivisions such as Sandhi-Muktam (dislocation) and Kánda-Bhagnam (fracture of a kánda).

Cases of Sandhi-muktam (dislocation) may be divided into six different types, such as the Utplishtam, Vis-lishtam, Vivartitam, Adhah-Kshiptam, Ati-kshiptam and Tiryak-kshiptam.

General features of a dislocation :- Inca-pability of extension, flexion, movement, circum-duction and rotation (immobility, considered in respect of the natural movements of the joint), of the dislocated limb, which becomes extremely painful and cannot bear the least touch.

These are said to be the general symptoms of a dislocation.

Diagnostic symptoms of a disloca-tion :- In case of a friction of a joint by two articular extremeties (Utplishtam) a swelling is found to appear on either side of the articulation attended with a variety of pain at night.

A little swelling accompanied by a constant pain and disordered function of the dislocated joint, marks the case of simple-looseness (Vislishtam) of the articulation ;

while pain and unevenness of the joint owing to the displacement of the connected bones distinguish a case of Vivartitam (lateral displacement).

An excruciating pain, and looseness of the dislocated

13

THE SUSHRUTA SAMHITA

Different kinds of Kánda Bhagnam :-Now we shall describe the Kánda-Bhagnam (fracture etc.). Fractures may be divided into twelve different kinds which are known as, Karkatakam, Aśva-karnam,Churnitam,Pichchhitam,Asthi-chchalitam, Kánda-bhagnam, Majjágatam, Atipátitam, Vakram, Chchinnam, Pátitam and Sphutitam.

THE SUSHRUTA SAMHITA

General symptoms of Kánda-bhagnam :-A violent swelling (about the seat of fracture) with throbbings or pulsations, abnormality in the position (of the fractured limb), which cannot bear the least touch, crepitus under pressure, a looseness or dropping of the limb, the presence of a variety of pain and a sense of discomfort in all positions are the indications which generally mark all kinds of fracture (Kánda-bhagnam).

THE SUSHRUTA SAMHITA

Diagnostic symptoms :-The case where a fractured bone, pressed or bent down at its two articular extremities, bulges out at the middle so as to resemble the shape of a knot (Granthi), is called Karkatam. The case where the fractured bone projects upward like the ear of a horse is called Aśvakarnam. The fractured bone is found to be shattered into fragments in a case of the Churnitam or comminuted kind which can be detected both by palpation and crepitation. A smashed condition of the fractured bone marks a

case of the Pichohitam kind which is often found to be marked by a great swelling. The case where the covering or skin of the bone (periosteum) is cast or splintered off is called the Asthi-chohallitam. The case where the completely broken or severed bones are found to project through the local skin, is called Kanda-bhagnam (compound). The case where a fragment of the fractured or broken bone is found to pierce into the bone and dig out the marrow, is called Majjanugatam, (Impacted fracture). The case where the fractured bone droops or hangs down is called Ati-patitam. The case where the unloosened bone (from its position) is bent down in the form of an arch is called Vakram The case where only one articular extremity of the bone is severed is called Chhinnam. The case where the bone is slightly fractured and pierced with a large number of holes, is called Patitam, an excruciating pain being the leading indication. The case where the bone largely cracked and swollen becomes painful as if stuffed with the bristles of a Suka insect is called Sphutitam (Green-stick fracture). Of the several kinds of fracture, cures are effected with extreme difficulty in a case of the Churnitam, Chhinnam, Ati-patitam or Majjanugatam kind. A case of displacement or laxation occurring in a child or in an old or weak patient or in one suffering from asthma (Svasa) or from any cutaneous affection (Kushtha) or Kshata-Kshina disease is difficult to cure. 8.

Memorable verses : -The following cases are to be given up as hopeless -viz. fracture of the pelvic bone (or of bones that are of this description, wherever they may be situated) ; dislocation of the pelvic joints ; compound fracture of the thigh bone or of the flat bones) ; fracture into small pieces of the

frontal bone or its dislocation ; simple fracture of the breast-bones, back-bone and temporal and cranial bones. If the dislocations and fractures be improperly set from the outset (Ádito)* or if the union be anyhow disturbed there is no hope for recovery.

9—11.

If fractures happen at any time of the first three stages of adalt life which has been described before (vide Sutrasthána Chap. XXXV.) and if they are set up by an able surgeon they have a great chance of being united.

A bending of a gristle or cartilage (Taruna) is called its fracture. A Nalaka (long bone) bone is usually found to be severed. A Kapála bone is found to be cracked, while a Ruchakat (tooth) is found to be splintered off.

• The word Ádito may be taken into the sense of congenital malformation which is beyond remedy.

† The presence of the particle 'cha' denotes Valya-asthi.

Thus ends the fifteenth Chapter of the Nidána Sthánam in the Sus'ruta amhitâ which treats of the Nidánam of dislocations and fractures.

CHAPTER XVI.

Now we shall discourse on the Nidánam of Mukharogam (diseases which affect the cavity of the mouth in general). 1.

General Classifications:-Sixty five* different forms of mouth disease are known in practice.

They are found to attack seven different localities viz. the lips, the gums of the teeth, tongue, palate, throat and the entire cavity; of these eight are peculiar to the lips ; fifteen, to the roots of the teeth; eight to the teeth; five to the tongue; nine to the palate; seventeen to the throat; and three to the entire cavity. 2–3.

Diseases of the lips:-The eight forms which affect the lips, are either Vátaja, Pittaja, Kaphaja, Sánni-pátika, Raktaja, Máns´aja, Medaja or Abhighátaja (Traumatic). 4.

The Vátaja Type:-The lips become dry, rough, numbed, black, extremely painful and the affected part seems as if it were smashed and pulled out or cracked by the action of the aggravated Váyu.

In the Pittaja type-the lips become blue or yellow-coloured and studded with (a large number of small) mustard-seed-like eruptions, which suppurate and exude a purulent discharge attended with a burning sensation (in the locality).

In the Kaphaja type-the affected lips are covered with small eruptions, which are of the same colour as the surrounding part, and become slimy, heavy or thick, cold and swollen.

Pain is absent in this type and the patient feels an irresistible inclination to scratch the parts.

In the Sánnipátaja type, the lips change

• According to others sixty-seven—but Dallan does not support this.

The Raktaja type:-(Produced by the vitiated condition of the blood) the affected lips look as red as blood and profusely bleed and crops of date coloured (chocolate-coloured) eruptions appear on their surface. In the Mamsaja type (due to the vitiated condition of the local flesh), the lips become heavy, thick and gathered up in the form of a lump of flesh. The angles of the mouth become infested with parasites which germinate and spread themselves in the affected parts. In the Medaja (fat-origined) type the lips become numbed, soft, heavy and marked by an itching sensation. The skin of the inflamed surface becomes glossy and looks like the surface layer of clarified butter exuding a thin crystal-like (transparent) watery discharge.

In the Abhighataja (Traumatic) type, the lips become red, knotty and marked by an itching sensation and seem as if pierced into or cut open with an axe and (become cracked and fissured).

Disease of the roots of the teeth:- Diseases which are peculiar to the roots of the teeth, are known as Sitada, Danta-pupputaka, Danta-veshtaka, Sausira, Maha-Sausira, Paridara, Upakusa, Danta-vaidarbha, Vardhana, Adhimansa and the five sorts of Nadi (sinus).

Sitada(Scurvy);-The gums of the teeth suddenly bleed and become putrified, black,slimy and emit a fetid smell. They become soft and gradually slough off. The disease has its origin in the deranged condition of the local blood and Kapham.

Danta-puppataka (gum boil):-The disease in which the roots of two or three teeth at a time is marked by a violent swelling and

Danta-pupputaka

The disease is due to the vitiated condition of the blood and Kapham. Danta-veshtaka:-The teeth become loose in the gums, which exude a discharge of blood and pus. This disease is due to the vitiated blood of the locality. Saushira:-The disease in which an itching painful swelling appears about the gums attended with copious flow of saliva is called Saushira (Alveolar abscess). It is caused by the deranged blood and Kapham of the locality. Mahá-Saushira:-The disease in which the teeth become loose, the palate marked by sinuses or fissures, the gums putrified, and the whole cavity of the mouth inflamed, is called Mahá'saushira, the outcome of the concerted action of the deranged Doshas of the body. 14–18.

Paridara

The disease in which the gums become putrified, wear off and bleed is called Paridara (bleeding gums). The disease has its origin in the deranged condition of the blood, Kapham and Pittam. Upakuśa : - The disease in which the gums become marked by a burning sensation and suppuration and the teeth become loose and shaky (in their gums) in consequence and bleed at the least shaking, is called Upakuśa. There is a slight pain, and the entire cavity of the mouth becomes swollen and emits a fetid smell ; this disease is due to the vitiated condition of the blood and Pittam. 19.

Danta-Vaidarbha

The disease which is consequent upon the friction of the gums marked by the appearance of a violent swelling about the portion (so rubbed and in which) the teeth beeome loose and can be moved about, is called Danta-vaidarbha which is due to an extraneous cause such as a blow etc. Vardhana :- the disease which is marked by the advent of an additional tooth (the last molar) through the action

of the deranged Vàyu with a specific excruciating pain of its own, is called Vardhana or eruption of the Wisdom tooth. The pain subsides with the cutting of the tooth. Adhimánsa :- The disease in which a violent and extremely painful tumour appears about the root of the tooth, and is situated in the farthest end of the cavity of the cheek-bone accompanied by a copious flow of saliva is called Adhimánsa or Epulis. It is due to the deranged Kapham. The five sorts of Nàdi (sinus) which affect the roots of the teeth (are either Vátaja, Pittaja, Kaphaja, Sánnipátaja or Abhighátaja), their symptoms being respectively identical with those of the types of Nàdi-vrana.

20 - 24

Diseases to the teeth proper :- Diseases which are restricted to the teeth proper are named as, Dálana, Krimi-dantaka, Danta-harsha, Bhanjaka, Śarkará, Kapálika, Śyáva-dantaka and Hanu-moksha.

25

Dálana :- The disease in which the teeth seem as if being cleft asunder with a violent pain is called Dálana or toothache, the origin of which is ascribed to the action of the aggravated state of the bodily Vàyu. Krimi-dantaka :- The disease in which the teeth are eaten into by worms, is called Krimi-dantaka (caries). The teeth become loose and perforated by black holes accompanied by a copious flow of saliva. The appearance of an extremely diffused swelling (about the roots of decayed teeth) with a sudden aggravation of the accompanying pain without any apparent cause is also one of its specific features. Danta-harsha :- The disease in which the teeth cannot bear the heat, cold or touch is called Danta-harsha. It is due to the deranged condition of Váyu. Bhanjaka :- The disease in which the face is distorted, the teeth break, and the accompanying pain is severe, is called Bhanjaka (degeneration of the

Chap. XVI ] NIDANA STHANAM.

105

teeth). The disease is due to the deranged condition of the Váyu and Kapham. Śarkará :- The disease, in which sordes, formed on the teeth and hardened (by the action of the deranged Váyu), lie in a crystallised form at the roots of the teeth, is called Śarkará (Tartar). Such deposits tend to destroy the healthy growth and functions of the teeth. Kapaliká :- The disease in which the preceding crystallised deposits get cemented together and afterwards separate from the teeth taking away a part of their coating (enamel) is called Kapáliká (calcareous deposit) which naturally makes an erosion into and destroys the teeth Śyáva-dantaka :- The disease, in which the teeth variously scorched by the action of the deranged Pittam assumes a blackish or blue colour, is named as Śyáva-dantaka (black teeth). Hanu-moksha :- The disease in which the Váyu aggravated (by such causes, as by loud talking, chewing of hard substances, or immoderate yawning) produces the dislocation of the jawbones is called Hanu-moksha It is identical with Ardditam as regards its symptoms. 26 - 33.

Diseases of the tongue :- The five kinds of diseases which affect the organ of taste are the three sorts of Kantakas due to the three deranged Doshas (Vátaja Pittaja and Kaphaja), Alása and Upa-jihviká. 34.

The three Kantaks :--In the Vátaja Kantaka type the tongue becomes cracked, loses the sense of taste and becomes rough like a teak leaf (giving the organ a warty appearance). In the Pittaja Kantaka form the tongue is coloured yellow and studded over with furred blood-coloured papillæ with the burning sensation (of the Pittam in them). In the Kaphaja Kantaka type the tongue becomes heavy, thick and grown over with vegetation of slender fleshy warts in the

14

THE SUSHRUTA SAMHITA

shape of S'álmali thorns. Alása :- The severe inflammatory swelling about the under surface of the tongue is called Alása, which if allowed to grow on unchecked gives rise to numbness and immobility of the organ and tends to a process of rapid suppuration at its base. The disease is caused by the deranged blood and Kapham. The Upa-jihvá :- The disease in which a (cystic) swelling shaped like the tip of the tongue appears about the under-surface of that organ by raising it a little is called Upa-jihviká (Ranula). The accompanying symptoms are salivation, burning and itching sensations in the affected organ ; these are due to the deranged Kapham and blood (of the locality).

Disease of the palate :- Diseases which are peculiar to the part of the palate are named Gala-śundiká, Tundikeri, Adhrusha, Mánsa-kachchhapa, Arvuda, Mánsa-sangháta, Tálu-śosha and Tálu-páka.

Gala-śundiká :-The diffused and elongated swelling, caused by the deranged blood and Kapham, which first appears about the root of the palate and goes on extending till it looks like an inflated skin-bladder is called Gala-śundiká (tonsilitis) by physicians. Thirst, cough, difficult breathing are the indications of the disease. Tundikeri :- A thick swelling resembling the fruit of the Tundikeri plant in shape and appearing about the root of the palate attended with a burning, piercing or .pricking pain and suppuration is called Tundikeri (abscess of the tonsil). Adhrusha :- A red, numbed swelling appearing about the same region, as the effect of the vitiated blood of the locality, attended with severe fever and pain, is known by the name of Adhrusha. Mánsa-kachchhapa :- A brownish and slightly painful swelling somewhat shaped like the back of a tortoise (and appearing about the region of the soft

Chap. XVI.] NIDANA STHANAM.

107

palate) is called Mánsa-kachchhapa. The disease is slow in its growth or development and is due to the deranged Kapham.

Arvuda:-A swelling shaped like the petal of the lotus lily and appearing in the region of the soft palate as an outcome of the aggravated condition of the local blood is called Arvudam. The swelling is identical with the Raktárvuda described before.

Mánsa-Sangháta:-A vegetation of morbid flesh at the edge or extremity of the soft palate through the action of the deranged Kapham is called Mánsa-Sangháta. It is painless.

Tálu-pupputa:-A painless permanent swelling to the shape of the Kola fruit (plum) caused by the deranged fat and Kapham at the region of the soft palate is called Tálu-pupputa.

Tálu-śosha:-The disease of the soft palate in which the patient feels a sort of parched sensation with dyspnoea and a severe piercing pain in the affected part is called Tálu-śosha, which has its origin in the aggravated condition of the bodily Váyu acting in concert with the deranged Pittam.

Tálu-páka-The disease in which the deranged Pittam sets up a very severe suppurative process in the soft palate is called Tálu-páka. 39-47.

The diseases of the throat and larynx:-The diseases peculiar to the throat and the larynx are seventeen in number and are known as the five types of Rohini, Kantha-Śáluka, Adhijihva, Valaya, Valása, Eka-vrinda, Vrinda, Śataghni, Giláyu, Gala-vidradhi, Galagha, Svaraghna, Mánsatána, and Vidári. 48.

General features of Rohinis:-The aggravated Váyu, Pittam, Kapham, either severally or in combination, or blood may affect the mucous of the throat and give rise to vegetations of fleshy papillæ,

The Váta ja Rohini

A vegetation of extremely painful fleshy Ankuras (nodules), crops up all over the tongue which tend to obstruct the passage of the throat and are usually accompanied by other distressing symptoms characteristic of the deranged Váyu.

Pittaja Rohini

The Ankuras (nodules) in the present type are marked by speedy growth and suppuration, and are accompanied by a burning sensation and high fever.

Kaphaja Rohini

The Ankuras (nodules) become heavy, hard and characterised by slow suppuration gradually obstructing the passage of the throat.

The Sámnipátika Type

Suppuration takes place in the deeper strata of the membrane accompanied by all the dangerous symptoms peculiar to the three aforesaid types of the disease. It is rarely amenable to treatment.

Raktaja Type

Symptoms characteristic of the Pittaja type of the disease are present and the fleshy outgrowth formed in the throat, is found to be covered with small vesicles. This type is incurable.

Kántha-Sálukam

The disease in which a hard rough nodular growth (Granthi) in the shape of a plum-stone crops up in the throat, which seems as if it has been stuffed with the bristle of a S'uka insect or been pricked by thorns is called Kántha-Sálukam. The disease is due to the action of the deranged Kaphám. It is amenable to surgical treatment only.

Adhijihva

A small swelling like the tip of the tongue caused by the

deranged blood and Kapham over the root of the tongue is called Adhijihva, which should be given up as soon as suppuration sets in. Valaya :- A circular or ring-shaped raised swelling obstructing or closing up the upper end of the œsophagus (structure of œsophagus) is called Valaya. It cannot be cured and hence should be given up. It is due to the deranged action of the Kapham in the locality. Valása :- The disease in which the unusually aggravated Váyu and Kapham give risc to a swelling in the throat, which is extremcly painful and causes a difficulty of respiration, ultimately prodncing symptoms of complete asphyxia is called Valása by learned physicians and is very difficult to cure.

55–58.

Eka-vrinda and Vrinda*:-The disease in which a circular, raised, heavy and slightly soft swelling appears in the throat attended with itching, a slightly burning sensation and a slight suppuration is called Eka-vrinda. The disease is due to the effect of vitiated blood and Kapham. The disease in which a round elevated swelling attended with high fever and a slightly burning sensation is formed in the throat through the aggravated condition of the blood and Pittam is called Vrinda. A piercing pain in the swelling points to its Vátaja origin.

59–60.

Śataghni :-The disease in which, through the conccrted action of the deranged Váyu, Pittam and Kapham, a hard throat obstructing Varti (jagged membered) edged like a Śataghni† and densely beset with fleshy excrescences is formed along the inner lining of

• The diseases of the throat are 17 in number. Taking Vrinda as a separate disease they amount to 18 ; but Vrinda, affecting similar place and being similar in appearance with but a slight distinction of symptoms, is only a particular state of Eka-vrinda, and not a separate disease.

† Sataghni is a kind of weapon used in ancient warfare.

that pipe is denominated as Śataghni. Various kinds of pains, (characteristics of each of the deranged Váyu, Pittam and Kapham) are present in this type which should be necessarily considered as irremediable. 61.

Giláyu :-The disease in which the aggravated Kapham and blood give rise to a hard and slightly painful (D. R extremely painful) glandular swelling in the throat to the size of the stone of the Amalaka fruit is called Giláyu. A sensation as if a morsel or bolus of food is stuck in the throat is experienced which by its very nature is a surgical case. 62.

Gala-vidradhi:-The disease in which an extensive swelling occurs along the whole inner lining of the throat, owing to the concerted action of the deranged Váyu, Pittam and Kapham is called Gala-vidradhi which exhibits all the features present in a Vidradhi of the Sánipátika type.

Galaugha :-The disease in which a large swelling occurs in the throat so as to completely obstruct the passage of any solid or liquid food and also that of Udána-váyu (choking the pharynx, larynx and the mouth of the esophagus), attended with a high fever is called Galaugha, the origin of which should be ascribed to the action of the deranged blood and Kapham.

Svaraghna: -The disease in which the patient faints owing to the choking of the larynx by the deranged Kapham which is marked by stertorous breathing, hoarseness, dryness and paralysed condition of the throat is called Svaraghna which has its origin in the deranged Váyu.

63–65. Mánsátána :-The disease in which a pendent, spreading and extremely painful swelling appears in the throat which gradually obstructs the pipe is called Mánsátána.

It invariably proves fatal and is caused by the deranged Váyu, Pittam and Kapham : 66

Vidári

67

The disease in the entire cavity

68

In the Vátaja type the entire cavity of the mouth is studded with vesicles attended with a pricking sensation in their inside. In the Pittaja type a large number of small ycllow or red-coloured vesicles attended with a burning sensation crops up on the entire (mucous membrane lining the cavity of the mouth. In the Kaphaja variety a similar crop of slightly painful, itching vesicles of the same colour as the skin (is found on the entire inner surface of the mouth.) The blood-orgained Raktaja type is nothing but a modification of the Pittaja one (giving rise to similar symptoms) ; it is also by others called Mukha-páka.

69-72

Thus ends the sixteenth Chapter of the Nidána Sthánam in the Sus'ruta Samhitá which treats of the Nidánam of the diseases of the mouth.

Here ends the Nidána Sthánam.

THE SUŚRUTA SAMHITA

ŚÁRIRA STHÁNAM.(SECTION ON ANATOMY). CHAPTER I.

The latent (lit : unmanifest) supreme nature (Prakriti) is the progenitor of all created things. She is self-begotten and connotes the three fundamental or primary virtues of Sattva, Rajas and Tamas. She is imaged or embodied in the eightfold categories of Avyakta (unmanifest), Mahán (intellection), Ahamkára (Egoism) and the five Tanmátras or elementals (proper sensibles) and is the sole and primary factor in working out the evolution of the universe. The one absolute and original nature is the fundamental stone house of materials out of which the bodies of all self-conscious (Karma-Purusha) working agents (agents who come into being through the dynamical energy of their acts or Karmas) have been evolved in the same manner as all water, whether confined in a tank or a reservoir, or coursing free through the channels of streams and of mighty rivers, have been welled up from the one and shoreless primordial ocean.

Out of that latent unmanifest (Avyakta) or original nature (impregnated by the atoms or elemental units of

114 THE SUSHRUTA SAMHITA.

consciousness or Purushas) Intellection or Mahán has been evolved, and out of Mahán egoism.

This Mahán or intellection should be likewise considered as partaking of the three fundamental attributes (Sattva, Rajas, and Tamas) of the latent (Avyakta) or original nature.*

Ahamkára or egoism in its turn may be grouped under three subheads as the Vaikárika Taijasa (operative) or Rájasika, and Bhutádi (illusve or Tàmasika).

The eleven organs of cognition, communication or sense perception have emanated from the co-opcration of the aforesaid Vaikárika Ahamkára with the Taijasa or Rajasa.

They are the ears, skin, cyes, tongue, nose, speech, hands, genitals, anus, feet and the mind (Manah).

Of these foregoing organs the first five are intellectual or sense organs (Vuddhi-Indriya) ; the next five being operative (Karma-Indriya).

The mind (Manah) partakes of the character of both the intellectual and operative organs alike.

The five Tanmátras or elementals (or the five proper sensibies of hearing, touch, sight, taste, and smell) characterised by the Nescicence, etc.

have been evolved out of the Bhutádi etc. (or Támása Ahamkára) concocted with the Taijasa Ahamkára through the instrumentality of the Vaikárikam.

The gross or perceptible modifications of these five Tanmátras are sound, touch, taste, sight and smell.

From the combination of the aforesaid five Tanmátras (Bhutádi) taken one at a timc, have successively emanated the five gross matters of space such as

• Sattva, Rajas and Tamas :-Adhesion, cohesion and disintegration in the Physical plane ; affection, love and hate in the moral ; emancipation, spiritual affinity and sin in the Psychic.

Simply phenomenal or the simple outcome of the phenomenal evolution without being by other specific attributes of matter and hence Sàttvika or illuminating or quasi-spiritual.

Chap. I.] SARIRA STHANAM.

ether, air, heat, (fire,) fluid (water), and earth (solid). These twenty four categories combinedly form what is technically known as the twenty four elements (Tattvas). Thus we have discoursed on the twenty four fundamental principles (Chaturvins'ati-tattvam). 6.

Hearing, touch, sight, taste and smell respectively form the subjects of the five intellectual (Vuddhi) organs of man, whereas the faculty of speech, handling, pleasure, ejections or evacuation, locomotion successively belong to the (remaining) five operative (Karma-Indriya) ones.

The original nature (Avyakta), Mahán* (intellection), Egoism (Ahamkára), the five sensibles (Tanmátras), and the five gross material principles in their nascent stage in evolution form what is included within the eight categories of Nature (Prakriti), the remaining sixteen categories being her modifications (Vikára).

The objects of intellection (Mahán) and Egoism (Ahamkárá) as well as of the sense organs of knowledge and actions are the material principles (Ádibhautika) though they are spiritual in themselves and in their nature.

The tutelary god of intellection (Buddhi) is Brahmá. The god Is'vara is the presiding deity of the sense of egoism (Ahamkára) ; the moon god is that of the mind (Manah) ; the quarters of the heaven, of the ears ; the wind god is that of the skin ; the sun is that of the eyes ; the water is that of the taste : the earth is that of the smell ; the fire is that of the speech ; Indra is that of the hands ; Vishnu is that of the legs ; Mitra is that of the anus and Prajápati is that of the organs of generations. 7.

• Mahán, Ahamkára and the five Tanmátras, though but modifications of the original Nature in themselves, have been included within the category of Nature (Prakriti) inasmuch as they form the immediately prior or antecedent conditions of the evolution of the phenomenal universe.

THE SUSHRUTA SAMHITA

All the aforesaid (twenty-four) categories or elementals (Chaturvinsati-Tanmátras) are devoid of consciousness. Similarly the modifications of the primal cause of Prakriti such as the Mahat etc. are all bereft of consciousness in as much as the cause itself, the Avyakta or the original nature is devoid of it. The Purusha or the self-conscious subjectivity, enters into the primal cause (Mula-Prakriti or original Nature) and its necessary effect (the evolved out phenomena) and makes them endued with his own essence or self-consciousness. The preceptors and holy sages explain the proposition by an analogy that as the milk in the breast of a mother, though unconscious in itself, originates and flows out for the growth and sustenance of her child ; (as the semen in the organism of an adult male though devoid of consciousness, flows out during an act of sexual intercourse) ; so these twenty-four primary material principles (elementals), though unconscious in themselves, tend to contribute towards the making of the self-conscious self or the universal individual (the aggregate of limited or conditional selves) for the purpose of working out his final liberation or emancipation i.e., attainment of the stage of pure consciousness or perfect knowledge.

THE SUSHRUTA SAMHITA

Now we shall describe the tracts which the Purusha (subjective or self-conscious reality) and Prakriti or nature (passive non-conscious eternity) pass in common as well as those wherein they differ from each other.

THE SUSHRUTA SAMHITA

Traits of commonalty :–Both the Purusha and Prakriti are eternal realities, both of them are unmanifest, disembodied, without a beginning or origin, eternal, without a second, all–pervading and omnipresent.

Chap. 1.] SAKIRA STHANAM. 117

Traits of diversity :-Of the Purusha and the Prakriti, only the latter is non-conscious and possesses the three fundamental qualities of Sattva, Rajas and Tamas. Prakriti performs the function of the seed or in otherwords she lies inherent as the seed or the primary cause in the latter phenomenal evolution of the Mahat etc. and contributes the maternat element in the conception, development and birth of the primordial cosmic matter (phenomenal universe), fecundated by the Purusha (self-conscious subjectivity) in its different stages of evolution. These stages are called Mahat, Ahamkára etc.; and Prakriti is not indifferent, as the Purusha is to the pleasures and misery of life. But the Purusha (units or atoms of consciousness), devoid of the threefold virtucs of Sattva etc. are non-concerning hence non-producing and berctft of the sccd-attributes of lying inherent in all as the primary cause of cvoution. They are mere witnesses to the joys and miscriefs of life, and do not participate in their enjoyment though imprisoned in the human organism.

Since an effect is uniform in virtue to its producing cause, the evolutionised effects or products of the Prakriti such as the Mahat, Ahamkára etc. must needs partake of the three fundamental qualities (Sattva, Rajas and Tamas) which are predicated of the Prakriti. In other words, these Mahat, Ahamkára, etc, are but the modifications of the three fundamental qualities of Sattva, Rajas and Tamas. Moreover, certain authorities hold that the Purushas are units of self-consciousness, possessed of the three aforesaid qualities owing to their antecedent conditions or causes (the gross material universe) being permeated with and characterised by them.

Metrical Text (Vaidyake.) :-It is asserted in the Áyurveda that it is only the gross-sighted ones and men capable of observing only the superficial appearances, who confound cternal order, or sequence of things and events (Svabhába), God (Íśvara).* Time (Kála), sudden and unlooked for appearances of the phenomena (Yadrichchhá), Necessity (Niyati) and transformation (Parináma) with the original Nature (Prakriti). The five different forms of matter (such as Ether etc ) are nothing but the modifications or transformed states of the original nature and are characterised by the three universal qualities of Sattva, Rajas and Tamas, and all created things, whether mobile or immobile, should be considered as alike exponented by the samc. In the Science of medicine the cause of a disease is the one sole aim to be achicved by means of administering proper medicinal remcdics (matter), and hence the properties of matter are the only fit subject to be dealt with in a book on pharmacy. And further, because the immediately prior cause of the human organism is a proper and congenial admixturc of the sperm and ovum (matter), the sense organs are the resultants of phenomenal—evolution of matter, and the objects of sense perception are equally material or phenomenal in their nature. 12 - 14.

Memorable verse :- A man by a particular organ of his body perceives the same matter which forms the proper object of that sense organ in as much as the perceiving sense organ and the perceived sensible are produced by the same material cause. The matter,

• The second factor according to Sánkhya, in the order of cosmic evolution, which as the seed of the universe, was hid in the burning disc of the central, primordial Sun, out of which the different solar systems have come into being.

Chap. I.] SARIRA STHANAM.

which specifically forms the object of a particular sense organ, cannot be perceived by the other. We see a flower with the cyes and not with the nose. 15.

• Here lies the difference between Sânkhya and Âyurveda. While the former discourses on material character of the soul, the latter commences to discuss on the questions how the material environment in which the soul is said to inhabit is evolved, and how the inclusion of the spiritual within the material organism is effected.

Hence Sus'ruta's Physiology, like that of Charaka, is in the strictest sense of the word molecular and his science of life is an attempt at explanation of consciousness from the materialistic standpoint, which agrees with the views of modern western science. Intellect according to Sus'ruta is material and belongs to the same category which the Sânkhya system of philosophy in its explanation of evolution enumerates originally as seven. The soul, according to Sus'ruta, is an independent existence and is often associated with what is called life. Where there is life, there is a soul, and it is not everywhere the same. The soul in Sus'ruta is individual

The attributes of an organic Individual :- Longing for pleasure, shunning of pain, enemity, energetic undertaking of work, respiration (Prána), emission of flatus (Apána), closing and opening of the eyelids, intellect (Vuddhi), sentiment (Manah), deliberation, discretion, memory, knowlege of art, perseverence, sensation and perception, are the attributes of an organic individual.

18

Distinctive features of the different classes of mental temperaments :- An absence of all killing or hostile propensities, a judicious regimen of diet, forbearance, truthfulness, piety, a belief in God, spiritual knowledge, intellect, a good retentive memory, comprehension, and the doing of good deeds irrespective of consequences, are the qualities which grace the mind of a person of a Sáttvika temperament.

Feeling of much pain and misery, a roving spirit, non-comprehension, vanity, untruthfulness, nonclemency, pride, an over winning confidence in one's own excellence, lust, anger and hilarity are the attributes, which mark a mind of the Rajashika cast.

Dcspondency, stupidity, disbelief in the existence of God, impiety, stupification and perversity of intellect, lethargy in action and sleepiness are the qualities which mark a mind of a Támashika stamp.

19

The distinctive traits of the five material of Elements of the world :- The properties of Ákáśa (ether) are sound, the sense of hearing, porosity and differentia evolution of the veins, ligaments etc. into their characterised species (Viyikitatá)

रामिम यतः and takes cognisance of sorrow, disease and death by its union with the body ( परं मझाभूते प्रचोरि समन्वाय: पुरुष इहुच्यते ). Hence the living frame together with the soul that ia said to inhabit it forms the subject-matter of Âyurvedic medical treatment.

Ed.

Chap. I j. SARIRA STHÀNAM.

The properties Váyu (etherin) are touch, the skin, all functional activities of the organism, throbbing of the whole body (Spandana) and lightness. The properties of Teja (fire or heat) are form, the eyes, colours, heat, illumination, digestion, anger, generation of instantaneous energy and valour. The properties of Ápa (water or liquid) are taste, the tongue, fluidity, heaviness, coldness, olioginousness and semen. The properties or modifications of Prithivi (the carth matter or solid) are smell, the nose, embodiment and heaviness. 20.

Of these the ether or Akása abounds in attributes of the Sáttvika stamp, the Váyu or etherin in Rájashika, the Teja in Sáttvika and Rájashika, the water in Sáttvika and Támashika and the carth in Támasha attributes. 21.

Of these the ether or Akása abounds in attributes of the Sáttvika stamp, the Váyu or etherin in Rájashika, the Teja in Sáttvika and Rájashika, the water in Sáttvika and Támashika and the carth in Támasha attributes. 21.

There are Memorable Verses : - These qualities are found to characterise and enter into the successive elements in the order of their enumeration. The specific attributes of these elements are manifest in the substances which are respectively originated from them. The term Prakriti or original nature connotes the eight categories (of Avyakta, Mahán, Ahamkára, and the five Tanmátras) and the rest of the twenty four fundamental principles are its modifications. The Purusha forms the twenty fifth principle. These twenty five fundamental principles of cosmogony have been dealt with in the present treatise (Salya-Tantram) as well as in the other treatise (Sálaky-Tantram and Sánkhya Philosophy). 22—23.

There are Memorable Verses : - These qualities are found to characterise and enter into the successive elements in the order of their enumeration. The specific attributes of these elements are manifest in the substances which are respectively originated from them. The term Prakriti or original nature connotes the eight categories (of Avyakta, Mahán, Ahamkára, and the five Tanmátras) and the rest of the twenty four fundamental principles are its modifications. The Purusha forms the twenty fifth principle. These twenty five fundamental principles of cosmogony have been dealt with in the present treatise (Salya-Tantram) as well as in the other treatise (Sálaky-Tantram and Sánkhya Philosophy). 22—23.

Thus ends the first Chapter of the Sárira Sthânan in the Sus'ruta Sambitá which deals with the science of Being in general.

Thus ends the first Chapter of the Sárira Sthânan in the Sus'ruta Sambitá which deals with the science of Being in general.

CHAPTER II.

Now we shall discourse on the Śári:am which treats of the purification of semen and cataminal fluid etc. (Śukra-Śonita-Śuddhirnáma Śáriram). 1.

A man is incapable of begetting children, whose seminal fluid, affected by the aggravated Váyu, Pittam or Kapham, emits a cadaverous smell, or has acquired a clotted or shreddy character· or which looks like putrid pus, or has become thin, or smells like urine or stool, 2.

Deranged Semen :- Semen vitiated by the deranged Váyu acquires a (reddish-black) colour and gives rise to a pain (piercing and cutting etc.) which characterises the Váyu (at the time of being emitted).

Similarly semen deranged by the Pittam gets a (yellowish or bluish etc.) colour and produces the specific pain (burning and sucking etc.) of the deranged Pittam (at the time of emission).

Semen vitiated by the action of the deranged Kapham has a (white) colour and produces the pain (itching sensation etc.) peculiar to the deranged Kapham (at the time of its outflow).

The semen vitiated by blood is tinged with a bloody hue, produces all kinds of pain peculiar to the deranged Sonita (Pittam).

The semen smells like a putrid corpse and is emitted in large quantities. The shreddy or clotted character of the fluid (Granthila) should be ascribed to the action of the deranged Váyu and Kapham.

If vitiated by the action of the deranged Pittam and Kapham it looks like putrid pus (Puti-puya). Thin semen is caused by the deranged Váyu and

Pittam as described before. A concerted action of the deranged Váyu, Pittam, and Kapham causes the semen to smell like urine or fecal matter. Of these, the cadaverously smelling, shreddy and clotted, putrid pus-like and thinned semen can be remedied and corrected only with the greatest difficulty; whilc the one, having the smell of stool or urine, should be regarded as beyond cure. The remaining kinds are curable.

3. Deranged Ártavam :-The catamenial fluid (Ártavam) of a woman vitiated by the deranged Váyu, Pittam, Kapham, or blood, cither severally or in combination of two or more Doshas should be likewisc considcred as unfit for the purpose of fccundation. Vitiated catamenial fluid cxhibits the charactcristic colour and pain of the deranged Doshas or blood (underlying at its roots). Of the scveral kinds (of vitiated catamenial fluids) those which smell like a putrid corpsc or fctid pus, or which is clotted. or is thin, or cmits the smell of urine or fecal matter. should be deemcd as being beyond remedy, the rest being amenable.

clotted and shredded semen (Granthi), the patient should be made to drink a medicated Ghrita prepared with a (decoction and Kalka of) S'athi, or with an alkaline solution prepared from the ashes of the burnt Palás'ha wood. In the case of a pus like appearance of the fluid the patient should be treated with the medicated Ghrita prepared with (a decoction and Kalka of) the drugs included within the groups of Parushakadi and Vatádi (Nyágrodhádi) Ganas. In a case of thin semen, measures laid down under the same head before, as well as those to be hereafter described should be resorted to. Similarly a medicated Ghrita, prepared with (a decoction and Kalka of) Chitrak roots, Ushira roots and Hingu, should be drunk in a case of the semen smelling like urine or fecal matter. In all cases of seminal disorders as well as in menstrual anomalies, Uttara-Vssti (uretheral or vaginal injection) should be made after having recourse to the application of medicated oil etc. (Sncha-karma', purgatives, emetics, Ásthá pana and Anuvásana measures.

Treatment of deranged Ártava :-In all the four cases when the catamenial blood would be found to be vitiated (by the deranged Váyu, Pittam, Kaphah or Sonita), the preliminary remedial measures of the application of oil etc. purgatives etc. (Pancha-karma) should be first employed and then the following measures should be undertaken viz. application of Kalka, (levigated paste of drugs), Pichu (medicated plugs - pecharies etc), Pathya (diet) and Áchamana (washes with decoctions) as described under the treatment of Gynecocological cases etc. Appearance of clots of blood (Granthi) in place of the healthy menstrual fluid would indicate, decoction or a pulverised compound of Pathá, Trushuna and Vrikshaka (Kutaja).

Chap. II.] NIDANA STHANAM.

A decoction of Bhadras'riyan* and Chandanam is indicated in the case when the menstrual fluid would smell like fetid pus, or contain marrow. The remedies described under the head of seminal disorders, should be likewise prescribed in cases of menstrual anomalies caused by the action of the deranged Váyu, Pittam and Kaphah according to the requirements of each individual case under treatment. Sáli-rice, barley, wine and meat with cholagogue properties should be deemed as a wholesome diet in these cases. 13—16.

Traits of pure and healthy semen and menstrual blood :- Semen which is transparent like crystal, fluid, glossy, sweet and emits the smell of honey ; or like oil or honey in appearance according to others, should be considered as healthy. The catamenial blood (Ártava) which is red like the blood of a hare, or the washings of shellac and leaves no stains on clothes (which may be washed off by simply soaking them in water) should be considered as healthy. 17—18.

Traits of pure and healthy semen and menstrual blood :- Semen which is transparent like crystal, fluid, glossy, sweet and emits the smell of honey ; or like oil or honey in appearance according to others, should be considered as healthy. The catamenial blood (Ártava) which is red like the blood of a hare, or the washings of shellac and leaves no stains on clothes (which may be washed off by simply soaking them in water) should be considered as healthy. 17—18.

Asrigdara (Menorrhagia) :- An abnormal or excessive discharge of the menstrual blood (Ártava), or its long persistence even after the wonted time, or its appearance at a premature or unnatural period (as well as contrariety in its colour or properties) is called Asrigdara. All types of the disease (Asrigdara) are attended with an aching in the limbs and a painful flow (of the catamenial fluid). In case of excessive hæmorrhage (from the uterus), symptoms such as weakness, vertigo, loss of consciousness, darkness of vision, or difficult breathing, thirst, burning (sensation of the body), delirium, palour, somnolence and other Vátaja

Asrigdara (Menorrhagia) :- An abnormal or excessive discharge of the menstrual blood (Ártava), or its long persistence even after the wonted time, or its appearance at a premature or unnatural period (as well as contrariety in its colour or properties) is called Asrigdara. All types of the disease (Asrigdara) are attended with an aching in the limbs and a painful flow (of the catamenial fluid). In case of excessive hæmorrhage (from the uterus), symptoms such as weakness, vertigo, loss of consciousness, darkness of vision, or difficult breathing, thirst, burning (sensation of the body), delirium, palour, somnolence and other Vátaja

• Bhadras'riyan is S'richandanam according to Dallana or white Sandal wood according Gayádása.

• Bhadras'riyan is S'richandanam according to Dallana or white Sandal wood according Gayádása.

THE SUSHRUTA SAMHITA

troubles (convulsion, hysteria etc.) may set in. A physician should treat a case of Asrigdara with measures and remedies as laid down under the head of Rakta-pittam (hæmorrhage) in a case when the patient is young (of sixteen years), careful in her diet, and the disease unattended with severe complications. 19–21.

Amenorrhœ :–In a case of suppression of menstruation (Amenorrhœ) caused by the obstruction of the deranged Doshas (Váyu and Kapham) in the passage, the patient should be advised to take fish, Kulattha pulse, Másha pulse, Kánjikam fermented sour gru·l etc.), Tila, wine (Surá), cow's urine, whey, half diluted Takra, curd and S´uktum for her diet. The symptoms and treatment of thin and scanty menstruation have been described before. Still in such a case measures laid down for the treatment of Nashta-Rakta (amenorrhœ) may be adopted. Under a course of treatment described as before, the semen or the catamenial blood of a person would be resorted to their healthy and normal condition. 22–23.

A woman with (healthy) catamenial flow should forego the bed of her husband during the first three days of her uncleanness, as well as day sleep and collyrium. She shall not shed tears nor bathe, nor smear her person (with sandal paste etc.), nor anoint her body, nor pare her nail, nor run, nor indulge in loud and excessive laughter and talk, nor should she hear loud noise, nor comb her hair, nor expose herself to droughts, nor do any fatiguing work at all ; because if a woman sleeps in the day time (during the first three days of her period) her child of subsequent conception becomes sleepy or somnolent. The woman who applies collyrium along her eyelids (during those days), gives

Chap. II.] SARIRA STHANAM.

127

birth to a blind child ; by shedding tears (during her period) a woman gives birth to a child of defective eye-sight ; by bathing or smearing her body (with sandal paste etc.) a miserable one ; by anointing her body a leper (Kushthi) ; by paring her nails a child with bad nails ; by running a restless one ; by indulging in excessive laughter, a child with brown (Syàva) teeth or palate or tongue ; by excessive talking a garrulous child or one of incoherent speech ; by hearing loud sounds, a deaf child ; by combing her hair, a bald one ; whereas by exposure to the wind or by doing fatiguing work (during the first three days of her period) she gives birth to an insane child (conceived immediately after it). Hence these acts (day sleep etc) are to be avoided.

Regimen to be observed in her menses : - A woman in her menses should lie down on a matress made of Kus'a blades (during the first three days of her uncleanness), should take her food from her own blended palms or from earthen sauccs, or from trays made of leaves. She shonld live on a course of Habishya diet and forswear during the time, even the sight of her husband. After this period, on the fourth day she should take a ceremonial ablution, put on a new (untorn) garment and ornaments and then visit her husband after having uttered the words of necessary benediction

Metrical Text :-A child conceived after the period resembles the man whom she first sees after ablution on the fourth day of her menses ; hence she should see none but her husband* at that time (so°that the child may resemble his father). After that the priest shall perform the rites (Garbhàdhàna ceremony),

• In the case of the husband being absent at the time, she should look at the sun.

THE S'US'HRUTA SAMHITA

to help the conception of a male child and after the

ceremony a wise husband should observe the following

rules of conduct. 26–27.

Conduct of Husband :–A husband wish-

ing to beget a son by his wife, should not visit her bed

for a month (before the day of the next flow). Then on

the fourth day of her uncleanness, he should anoint or

lubricate his body with Ghrita, should partake of a food

in the afternoon or evening composed of boiled S'áli rice,

milk and clarified butter, and then visit the bed of his

wife The wife also, in her tern, should observe a similar

vow of sexual abstinence (Brahmachárini) for a month

before that day on which she should anoint or lubricate

her body with oil, partake of food largely composed

of oil and Màs'ha pulse, and then meet her husband

at night. The husband then having uttered the appro-

priate Veda Mantras and having awakened confidence

in the wife, should go unto her on the fourth, sixth,

eighth, tenth or on the twelfth night of her menses for

the progenation of a male child. 28.

Metrical Text :–A visit to the wife on any

of these nights leads to the continual increase of the

wealth, progeny, and the duration of the husband's life.

On the other hand, a visit to one's wife on the fifth,

seventh, ninth, or eleventh day of her flow leads to the

conception of a female child The thirteenth and the

remaining days (till the next course) are condemned

as regards intercourse. 29–30

Prohibited Period etc. :–A going unto one's wife on the first day of her monthly course tends to

shorten one's life and a child born of the act dies imme-

diately after its delivery. The same result is produced

by a visit on the second day, or the child dies lying-in

room i.e. ten days of its birth ; A visit on the third day

leads to the child's being deformed and short-lived. A child which is the fruit of a visit on the fourth day lives long, will be well develuped and*remain in the full vigour of health. The semen cast in the womb of a woman during the continuance of her monthly flow does not become fruitful because it is carried back and flows out in the same manneras a thing thrown into a stream does not go against but is carried with the current. Hence a husband should foreswear the company of his wife during the first three days of her uncleanness, when she also should observe a vow of sexual abstinence ; the husband should not visit his wife within the month 'after the twelfth day of her menses).

Metrical Text :-A co-ordination of the four factors of menstrual period (Ritu), healthy womb (Kshetra), nutrient liquid i.e. chyle of digested food (Ambu), healthy semen (Vija) and the proper observance of the rules is necessary for the conception and development of a healthy child just as the proper season (Ritu), good soil (Kshetra), water (containing nutrient matter) and vigorous seeds (Vija) together with proper care, help the germination of strong and undiseased sprouts.

Causes of different colours of the Child :- The fiery principle (Teja-dhátu) of the organism, which is the originator of all colours of the skin (complexion), happening to mix largely with the watery principle of the body at the time of conception, serves to make the child a fair complexioned one (Gaura-varna) ; mixed with a large quantity of the earth principle (Kshiti) of the body, it makes the child a dark complexioned one (Krishna-varna). In combination with a large quantity of earth and ethereal principles of the organism, it imparts a dusky (Krishna-śyáma) complexion (to the full developed foetus). A similar combination of watery and ethereal principles serves to make the child dusky yellow (Gaura-śyáma). Others on the contrary aver that the complexion of the child is determined by the colours of the food taken by its mother during the period of gestation.

34

A child is born blind in the failure of the fiery principle (Teja-dhátu) of the organism in reaching the region of its still undeveloped eyes (part--where the eyes would be) ; so also a penetration by the same (Teja-dhátu) into its blood accounts for the blood-shot eyes of the child. Entered into the Pittam it makes the child a yellow-pupiled one (Pingaláksha). Entered into its bodily Kapham it makes it a white-eyed body and mixed with its bodily Váyu, a child of defective eyesight.

35

Memorable verses :-As a lump of condensed clarified butter melts and expands if placed by the side of a fire, so the ovum (Ártava) of a woman is dislodged and glides away in contact with an adult male*.

• Sus'rutá's theory is that ovulation occurs about the same time as menstruation and rather initiates the latter, and the shed ova are washed out with the menstrual flow, hence there is a possibility of conception on

Chap. II., SARIRA STHANAM.

131

A seed divided into two by the deranged Váyu within the (cavity of the) uterus (Kukshi) gives rise to the birth of twins, conditioned by the good or evil deeds of their prior existence * A child born of scanty paternal sperm becomes an Ásekya and feels no sexual desire (erection) without previously (sucking the genitals and) drinking the semen of another man. A child begotten in a sordid vagina is called a Sougandhika, whose organ does not respond to the sexual desire without smelling the genitals of others. The man who first becomes a passive member of an act of sodomy and then again commits sodomy with the woman (he visits) is called a Kumbhika (or Guda-yoni and is included within the category of a Kliva).

36—40.

The man who cannot copulate with a woman without previously seeing the sexual intercourse of another couple is called Irshaka. A child born of an act of fecundation foolishly or ignorantly effected during the menses of its mother by its progenitor by holding her on his bosom during the act is called a Shanda and invariably exhibits effeminate traits in his character. A daughter born of a woman riding on her husband during the act of sexual intercourse will develop masculine traits in her character.

41—43.

connexion during the period of flow. But when the menstruation stops of itself by the end of the third day, it also indicates that ovulation has ceased and no ovum is left to be fertilized, hence the question arises how can there be conception then on connexion on the fourth day and thereafter ? The explanation (as in the following verse) is that the ovulating organ though quiescent at the time is again stimulated to activity by intercourse with a male and new ova are shed which are ready to be fertilized by the semen.—Ed.

• Gayi interprets the term "Dharmatara" to mean evil deeds (other than good) and quotes verses from S'rutis, S'mritis and Tantras on expiations of sin in support of his view.

132 THE SUSHRUTA SAMHITA [Chap. II.

Semen is developed in the four types of Kliva known as Ásekya, Sougandhika, Kumbhika and Irshaka, whereas a Shanda is devoid of that fluid (Śukra). The semen carrying ducts of an Ásekya etc. are expanded by the drinking of the semen as above described which helps the erection of his reproductive organ. 44-45

The conduct and character of a child and its inclination to particular dictafy are determined by those of its parents during the act of fecundation. A boncless (i.e. with cartilaginous bones) monstrosity is the outcome of the sexual act in which both the partics are female and their Śukra (sexual secretion) unite some how or other in the womb of one of them. Fecundation may take place in the womb of a woman, dreaming of sexual intercourse in the night of her menstrual ablution. The local Váyu carries the dislodged ovum into the uterus and exhibits symptoms of pregnancy, which develop month after month till the full period of gestation. The offspring of such a conception is a Kalala (a thin boneless jelly-like mass) on account of the absence of the paternal elements* in its development. Such monstrosities as serpents, scorpions, or gourd shaped foetus delivered from the womb of a woman should be ascribed as the effects of deadly sins. 46-49.

The child of a mother whose wishes are not honoured and gratified during pregnancy stands in danger of being born palmless, hunchbacked, lame, dumb or nasal voiced through the deranged condition of the Váyu of its mother's body. The malformation of a child in the womb should be ascribed to the atheism of its parents, or to the effects of their misdeeds in a prior existence, or

• Hair, beard, nails, teeth, arteries, veins, ligaments and semen are called paternal elements inasmuch as these are said to be inherited by the child from its father

Chap. II.] SARIRA STHANAM. 133

to the aggravated condition of the Váyu, Pittam and Kapham. 50–51.

A fœtus in uterus does not excrete fæces or urine, owing to the scantiness of the fecal matter, etc , in its intestines and also to the obstruction and consequently lessened admission of the Váyu into its lower bowels.

A child in the womb does not cry inasmuch as its mouth remains covered with the sheath of the placenta i.e. fœtal membranes (Yaráu) and its throat is stuffed with Kapham.

The processes of respiration, sleeping and movement of the fœtus in the womb are effected through those of its mother. 52–53.

The adjustment of the different limbs and organs of the body of a child in the womb at their proper places, the non-development of hair on its palms and soles and the subsequent cutting and falling off of its teeth are spontaneously effected according to the laws of nature after the model of its own species.

An honest, pious, crudite man, who has acquired a vast knowledge of the Sástras in his prior existence, becomes largely possessed of mental traits of the Sáttvika stamp in this life too and also remembers his prior births (Játismara).

Acts similar to those, which a man performs in a prior existence, overtake him also in the next.

Similarly the traits and the temperament which he had developed in a previous existence are likewise sure to be patent in the next. 54–55.

Thus ends the second Chapter of the S'árira Sthánam in the Sus'ruta Samhitá which treats of the purification of sperm and ovum.

CHAPTER III.

Now we shall discourse on the Sáríram which treats of pregnancy, etc. (Garbhá Vakráńti Sáríram).1.

The male reproductive element (Śukra) is endowed with Soma-guna (i.e., thermolytic properties) the female element Ártava) presents the opposite property and is therefore Agni-guna (i.e., thermogenetic properties).

The principles of earth, water, fire, air and ether are also present in men in their subtile forms and contribute to the formation of the material parts by their molccular adjustment in the way of supplying nutritions and in way of the adding to their bulk. 2.

Combination of Self with the impregnated matter :-The local Váyu (nerve-force) heightens or aggravates the heat generated by the friction of the sexual organs in an act of copulation.

The Váyu and heat thus aggravated tend to dislodge the semen from its sac or receptacle in a man which enters into the uterus of a woman through the vaginal canal and there it mixes with the ovum (Ártavam) dislodged and secrcted by similar causes.

The combined ovum and semen are subsequently con-fined in the uterus (Garbhás'aya).

After that, He who is known by the epithet; of Self-conscious, impressioner (creator of sensations and perceptions), toucher, smeller, seer, hearer, taster, Self or Ego, creator, wanderer, wit-ness; ordainer, speaker, though eternal, unmanifested and incomprehensible in his real nature, takes hold of the five subtile or essential material principles contributed by the united impregnating matter, assumes a subtile shape throughout, marked by the three fundamental

SARIRA STHANAM

Chap. III ]

qualitics of Sattva, Rajas and Tamas, and led away by

the Váyu, lies confined in the uterus to be subsequently

evolved out in the shape of a god, animal, or monster,

as determined by his acts in the former existence. 3.

Factors which determine sex :-The

birth of a male-child marks the preponderance of semen

over the ovum (in its conception); the birth of a

daughter shows the preponderance of the maternal ele-

ment. A child of no-sex (hermaphrodite) is the product

when ovum and sperm are equal (in their quality and

quantity). The first twelve nights after the cessation

of the flow should be deemed as the proper period for

conception, as being the time during which the ova are

secreted. Certain authoritics hold that there are women

who never menstruate to all appearances 4–5.

Memorable verses :-The face of a woman

(lit: a woman of undetected menstruation) becomes

full and lively. A moist and clumsy deposit is found

on the body, face, teeth and gums. She feels a

desire for sexual intercourse and speaks sweet words.

Her eyes, hair, and belly drop down. A sort of

distinct throbbing is felt in her aims, thighs, mammæ,

umbilicus, perinæum and buttocks. Her sexual desire

grows intense and prominent, and its gratification gives

her utmost joy and pleasure. These symptoms will at

once indicate that a woman has menstruated (inter-

nally). 6.

Just as the petals of a full blown lotus flower are

gathered up during the night, so the uterus (Yoni) of a

woman is folded up (i. e., os of the uterus is closed)* after

the lapse of the menstrual period (i e. fifteen days from the

date of the flow). The menstrual flow, accumulated in

the course of a month, is led in time by the local Váyu

through its specific duct (Dhamani) into the mouth of

136 THE SUSHRUTA SAMIIITA.

the uterus (Yoni) whence it flows out odourless and blackish. 7.

Period of Menstruation :-The process (menstruation) commences at the twelfth year, flowing once in every month, and continues till the fiftieth* year when it disappears with the sensible decay of the body. 8

A visit† to one's wife on even days during the catamenial period (twelve days in all from the cessation of the flow) leads to the conception of a male child* while an intercourse on odd days results in the birth of a daughter. Hence a man, seeking a male-issue, should approach his wife for the purpose in a clean body and with a quiet and calm spirit on an even date. 9.

A sense of fatigue and physical languor, thirst, lassitude and weariness in the thighs, suppression of the flow of semen and menstrual secretion (Sukra and Sonita) out of the uterus (Yoni), and throbbing in the organ (after coition) are symptoms of a recent fecundation. 10.

Signs of Pregnancy—(M. T. :-A black rash (areola) around the nipples of the mammæ, the rising appearance of a row of hair (as far as the umbilicus), contractions of the eye-wings, sudden vomitings, nausea which does not abate even on smelling perfumes, water-

• Some are of opinion that the menstruation continues up to the sixtieth year.

† According to Videha, menstrual secretion flows less on even days, hence a son is born if the sexual intercourse be made on those days ; whereas menstrual secretion becomes more on odd days, so a daughter is born if the intercourse be made on odd days.

According to Bhoja, a son is born from intercourse on even days and a daughter is born from that on odd days. The birth of a male issue is due to the preponderance of semen virile and that of a female sex is due to the preponderance of menstrual secretion. If both the secretions be equal (in quality and quantity) a hermaphrodite is issued.

Chap. III.] SARIRA STHANAM.

Prohibited conducts during gestation :-Immediately on the ascertainment of her pregnancy, a woman should avoid all kinds of physical labour, sexual intercourse, fasting, causes of emaciation of the body, day-sleep, keeping of late hours, indulgence in grief, fright, journey by carriage or in any kind of conveyance, sitting on her haunches, excessive application of Sneha-karmas etc., and venesection at an improper time (i.e., after the eighth month of gestation), and voluntary retention of any natural urging of the body.

Metrical Text :-The child in the womb feels pain in the same part of its body as the one in which its mother feels any ; whether this (pain) may be from an injury or through the effect of any deranged morbific principle (Dosha) of her organism.

Development of the Foetus:-In the first month of gestation a gelatinous substance is only formed (in the womb) ; the molecules of the primary elements (Mahabhuta---air, fire, earth, water, and ether) being acted upon by cold (Kapham), heat (Pittam) and air (Váyu or nerve-force) are condensed in the second month. A lump-like appearance (of that confused matter) indicates the male-sex (of the embryo). An elongated-like shape of the matter denotes that the foetus belong to the opposite sex ; whereas its tumour-like shape (like a Sálmali-bud) predicts the absence of any sex (i.e. a hermaphrodite).

In the third month, five lump-like protuberances appear at the places where the five organs -namely the two hands, two legs and the head-would be and the minor limbs and members of the body are formed in the shape of extremely small

138 THE SUSHRUTA SAMHITA. [Chap. III.

papillæ. In the fourth month all the limbs and organs (of the body of the embryo) become more potent and the foetus is endowed with consciousness owing to the formation of viscus of the heart. As heart is the seat of consciousness, so as the heart becomes potent, it is endowed with consciousness and hence it expresses its desire for things of taste, smell etc. (through the longings of its mother). The enciente is called double-hearted (Dauhrida) at the time, whose wishes and desires--not being honoured and gratified--lead to the birth of a paralysed, hump-backed, crooked-armed, lame, dwarfed, defect-eyed, and a blind child. Hence the desires of the enciente should be gratified, which would ensure the birth of a strong, vigorous and long-lived son. 14.

Memorable Verses :-A physician should

cause the longings of a pregnant woman (Dauhrida) to be gratified inasmuch as such gratifications would alleviate the discomforts of gestation ; her desires being fulfilled ensure the birth of a strong, long-lived, and virtuous son. A non-fulfilment of her desires during pregnancy, proves injurious both to her child and her ownself. A non-gratification of any sensual enjoyment by its mother (Dauhrida) during gestation tends to painfully affect the particular sense-organ of the child.

Longings and its effects during pregnancy :-An enciente longing for a royal

interview during her gestation (fourth month) gives birth of a child, who is sure to be rich and to hold a high position in life Her longing for fine silks, clothes, ornaments etc. indicates the birth of a beautiful child of aesthetic taste. The birth of a pious and self-controlled child is indicated by its mother's longing

Chap. III.] SARIRA STHANAM.

for a visit to a hermitage. The desire of a pregnant woman to see a divine image or an idol, predicts the birth of a child in her womb who would grace the council of an august assembly in life. Similarly, a desire to see a savage animal on the part of a pregnant woman signifies the presence of a child of savage and cruel temperament in her womb. A desire for the flesh of a Godhà indicates the presence of a sleepy, drowsy person in her womb who would be tenaciously fond of good things in life. Similarly a longing for beef on the part of the mother (during gestation) indicates the birth of a strong and vigorous child capable of sustaining any amount of fatigue and physical pain. A longing for buffalo-meat of the mother indicates the birth of a hairy, valiant and red-eyed child (in her womb); a longing for boar-flesh indicates the birth of a drowsy child though valiant ; a longing for venison indicates that of an energetic, determined and sylvan-habited child ; a longing for Srimàra-meat indicates that of a distracted person ; a longing for the flesh of Tittira bird indicates that of a child of timid disposition ; whereas a desire on the part of an enciente for the flesh of any particular animal indicates that the child in the womb would be of such stature and would develop such traits of character in life as are peculiar to that animal. The desires of a woman during her pregnancy are determined by ordained fate and effects of the acts of the child in its prior existence (that are to be happened during the present life).

Development of the Fœtus :-In the fifth month the fœtus is endowed with mind (Manah) and wakes up from the sleep of its sub-conscious existence. In the sixth month cognition (Buddhi) comes in. In the seventh month all the limbs and members

Development of the Fœtus :-In the fifth month the fœtus is endowed with mind (Manah) and wakes up from the sleep of its sub-conscious existence. In the sixth month cognition (Buddhi) comes in. In the seventh month all the limbs and members

of its body are more markedly developed. The Ojo-dhátu (in the heart of the fœtus) does not remain silent in the eighth month* A child born at that time (eighth month) dies for want of Ojo-dhátu soon after its birth, a fact which may be equally ascribed to the agency of the malignant monsters. Hence (in the eighth month of gestation) offerings of meat should be made to the demons and monsters (for the safe continuance of the child). The parturition takes place either in the ninth, tenth, eleventh or twelfth month of conception, otherwise something wrong with the fœtus should be apprehended.

Different opinions on the formation of the fœtal body :-Saunaka says that probably the head of the fœtus is first developed since head is the only organ that makes the functions of all other organs possible. Kritavirya says, it is the heart that is first developed since heart is the seat of Manah and Buddhi (mind and intellect).

• Sometimes it passes from the body of the child to that of the mother and vice versa.

Sarira Sthanam

Chap. III.]

Paraśara says that the development of the umbilical region of foetus must necessarily precede (that of any other part of its body) inasmuch as it is through umbilical chord that an embryo draws its substance from mother's body.

Mārkandeya says that the hands and feet of a foetus are first to be developed since they are the only means of movements in the womb.

Śubhuti Gautama says that the development of the trunk is the earliest in point of time since all other limbs and organs lie soldered to and imbedded in that part of the body.

But all these are not really the fact.

Dhanvantari holds that the development of all the parts of the body of an embryo goes on simultaneously;

and they can not be perceived or detected in their earlier stages of development in the womb owing to their extremely attenuated size like a mango fruit or sprouts of bamboo.

As the stone, marrow, pith etc. of a ripe and matured mango-fruit or the sprouts of bamboo, cannot be separately perceived in the earlier stage of their growth but are quite distinguishable in the course of their development,

likewise in the early stage of pregnancy the limbs and organs of the body (foetus) are not perceptible for their extremely attenuated stage but become potent (and therefore they are distinctly perceived) in the course of time for their development.

Factors respectively supplied by the paternal and maternal elements :-

Now we shall describe the parts and principles of the body of a foetus which are respectively contributed by the paternal element, maternal factor, the ścrum (Rasaja), the soul (Atmaja), the natural (Sattvaja) and the innate physiological conditions (Sátmyaja).

The hairs of the head and body, beard and moustaches, bones, nails, teeth, veins (Sira), nerves, arteries (Dhamani),

semen and all the steady and hard substances (in the organism of a child) are contributed by the paternal element in the conception Pitraja ; whereas flesh, blood, fat, marrow, heart, umbilicus, liver, spleen, intestines, anus (Guda) and all other soft matters in the body owe their origin to the maternal element (Mátrija) ; strength, complexion, growth, rotundity and decay of the body are due to the serum (Rasaja). The sensual organs, conciousness, knowledge, wisdom, duration of life (longivity), pleasure and pain etc. are the outcome of the spiritual element in man (Átmaja). We shall describe the Sattvaja features of the body in the next chapter. Valour, healthfulness, strength, glow and memory are the products of a child naturally born with physiological conditions of the parents (Sátmyaja).

Signs of male and female conception :-An enciente, in whose right mammæ the milk is first detected, who first lifts up her right leg at the time of locomotion, whose right eye looks larger, or who evinces a longing largely for things of masculine names, dreams of having received lotus flowers (red and white), Utpala, Kumuda, Ámrataka, or flowers of such masculine denomination in her sleep, or the glow of whose face becomes brighter during pregnancy, may be expected to give birth to a male child ; whereas the birth of a daughter or a female child should be pre-assumed from the contriety of the foregoing indications. An enciente whose sides become raised and the forepart of whose abdomen is found to bulge out will give birth to a sex-less (hermaphrodite) child. An enciente, the middle part of whose abdomen becomes sunk or divided in the middle like a leather-bag, will give birth to a twin.

Chap. III.-] SARIRA STHANAM. 143

Memorable verses :-Those women who are devout in their worship of the gods and the Bráhmins and cherish a clean soul in a clean body during pregnancy are sure to be blest with good, virtuous and generous children; whereas a contrary conduct during the period is sure to be attended with contrary fruits. The development of the limbs and the members etc. of a foetus in the womb is natural and spóntaneous, and the qualities and conditions which mark these organs are determined by the acts of the child which are anterior to its genesis and were done in its prior existence. 21-22.

Thus ends the third Chapter of the S'árira Sthánam in the Su'ruta Samhita which treats of the generation and pregnancy.

Thus ends the third Chapter of the S'árira Sthánam in the Su'ruta Samhita which treats of the generation and pregnancy.

CHAPTER IV.

Now we shall discourse on the Śáriram which treats of the development of a foetus in the womb, as well as of the factors which contribute to the growth of its different bodily organs and principles (Garbha-Vyakáranam-Śáriram).

The Pittam (fiery or thermogenic) and Śleshma (lunar principles of the body, the bodily Váyu, the three primary qualities of Sattva, Rajas, and Tamas (adhesion, cohesion and disintegration), the five sense organs, and the Self (Karma-Purusha) are the preserver of the life (Pránáh) of the Foetus.

Folds of Skin : -Seven folds or layers of covering (Tvaka - skin) are formed and deposited on the rapidly transforming product of the combination of (semen) Śukra and Śonita (fertilized ovum) which have been thus charged with the individual Soul or Self in the same manner as layers (of cream) are formed and deposited on the surface of (boiling) milk.

Of these the first fold or layer is called Avabhá́sini (reflecting) as it serves to reflect all colours and is capable of being tinged with the hues of all the five material principles of the body. The thickness of this fold measures eighteen-twentieth of a Vrihi* (rice grain) and it is the seat of skin diseases, such as Sidhma, Padma-

The complexion of a person is due to this first layer ; and as the colour of an opaque body is due to the rays that are reflected from its surface, this layer is rightly named Avabhás'ini or reflecting layer.

**

The text runs "Vriherashtadashabhága," which means eighteen (or so many) parts of a Vrihi ; and Dallan comments that "Vrihi" stands for a measure equal to the twentieth division of a Vrihi or rice grain.

kantaka etc. The second fold (from the surface) is called Lohitá; it measures a sixteen-twentieth of a Vrihi and is the seat of such (cutaneous affections) as Tilakálaka, Nyachchha and Vyanga etc. The third fold or layer is called Śrita, which measures in thickness, a twelve-twentieth of a Vrihi, and forms the seat of such diseases as Ajigalli, Charinadala, and Maśuka etc. The fourth fold or layer is called Támra measuring an eight-twentieth of a Vrihi and forms the seat of such diseases as the various kinds of Kilása and Kushtha etc. The fifth fold or layer is called Vedini, measuring in thickness a five-twentieth of a Vrihi and forms the seat of Kushtha, Visarpa, etc. The sixth fold or layer is called Rohini, which is of equal thickness as a Vrihi (grain), and is the seat of Granthi, Apachi, Arvuda, Ślipada and Gala-ganda etc. The seventh fold or layer is called Mánsa-dhará twice a Vrihi in thickness and is the seat of Bhagandara, Vidradhi, and Arśa etc. These dimensions should be understood to hold good of the skin of the fleshy parts of the body, and not of the skin on the forehead, or about the tips of the fingers, inasmuch as there is a surgical dictum to the effect that an incision as deep as the thickness of the thumb may be made into the region of the abdomen with the help of a Vrihi-mukha (instrument).

The Kalás too number seven in all and are situated at the extreme borders (forming encasement and support) of the different fundamental principles (Dhátus) of the organism.

Memorable Verses :- As the duramen or core of a piece of wood or stem becomes exposed to view by cutting into it, so the root principles (Dhátus) of the y may be seen by removing the successive layers or

Mánsadhará-Kalá: - Of these Kalás, the first is named Mánsadhará (fascia), in the contained flesh (bodily substance of the Kalá) of the Sirá (veins), Snáyu (fibrous tissues), Dhamani (arteries) and other Śrotas (channels) are found to spread and branch out.

Memorable Verse :-As the roots and stems of a lotus plant respectively situated in the ooze and water (of a tank), do simultaneously grow and expand, so the veins etc. situated in the flesh, grow and ramify.

Raktadhará-Kalá : - The second Kalá is called Raktá-dhará (Vascular tissue of the blood vessels etc.). The blood is contained in these inside the flesh and specially in the veins (Sirá) and in such viscera of the body as the liver and spleen.

Memorable Verse :-As a plant containing latex in its tissues, when injured or pricked, exudes milky juice, so blood oozes out instantaneously on the flesh of the body (supplied with the Raktádhará-kalá) being injured.

Medadhará-Kalá :-The third Kalá is called Medadhará (adipose tissue). Meda (fat) is present (chiefly) in the abdomen of all animals, as well as in the cartilages (small bones). The fatty substance present in large bones is called Majjá (marrow).

Memorable Verse :-Marrow is found inside large bones, whereas a substance similar in appearance and found inside other bony structures (cartilages) should be considered as Meda, mixed with blood. The fats, present in purely muscular structures, go by the name of Vasa (muscle-fat).

Śleshmádhará-Kalá :-The fourth Kalá is called Śleshmádhará (Synovial tissues) and is present about all the bone-joints of animals.

Memorable Verse :-As a wheel easily turns upon a well greased axle, so the joints moistened by the mucous (Śleshmá) contained in these sacs admit of easy movements.

Purishádhará-Kalá :-The fifth kalá is called Purishádhará and being situated in the Kostha (abdomen) serves to separate the fæcal refuse in the (Pakváśaya) lower gut (from other ingested matters).

Memorable Verse :-This Kalá extends about the liver, upper and lower intestines and other abdominal viscera and keeps the fæces in the lower intestines (Undukam) separate and hence is called Maladhará-kalá

Pittádhará-Kalá :-The sixth Kalá is called Pittaphard-kalá; it holds (the chyme derived from) the four kinds of solid and liquid foods (in the Pitta-sthánam or biliary region) propelled from the stomach (Ámáśaya or Grahani-Nádi) and on its way to the (Pakáśaya) intestines (for the proper action of the digestive juices upon it).

Memorable Verse :-The four kinds of food, viz. those that are chewed, swallowed, drunk, or licked, and brought into the intestines (Kostha) of a man, are digested in proper time through the heating agency (action) of the Pittam

Śukradhará-Kalá :-The seventh Kalá is called Śukradhará (semen-bearing), which extends throughout the entire body of all living creatures.

Memorable Verse :-The physician should know that like fat (Sarpi) in the milk, or sugar in the expressed juice of sugar-cane, the (seat of) semen is coextensive with the whole organism of a man (or animal).

The semen passes through the ducts situated about two fingers' breadth on either side (vas deferens) and just below the neck of the bladder and finally flows out through the canal. The semen of a man during an act of sexual intercourse with a female under exhilaration comes down from all parts of his body owing to the extreme excitement (engendered by the act).

21-33.

The orifices of the Artava-carrying channels (vessels of the uterine mucosa) of a pregnant woman are obstructed by the foetus during pregnancy and hence there is no show of menses (during gestation). The menstrual blood thus obstructed in its downward course ascends upwards; a part of it accumulates and goes to the formation of placenta (Apará), while the rest ascends higher up and reaches the breasts; this is the reason why the breasts of a pregnant woman become full and plump.

The spleen and liver of the foetus are formed out of blood; the lungs are made of the froth of the blood; and the Unduka or faecal receptacle, of the refuse matter (Mala) of the blood.

Metrical Texts:-The intestines (Antrac), the bladder (Vasti), and the anus (Guda) of the foetus are formed out of the essence of the blood and Kapham, baked by the Pittam into which Váyu enters as well. As fire fed by draughts of air refines the dregs of golden ore and transforms it into pure metal, so blood and Kapham acted upon by the heat of the Pittam are transformed into the shape of the intestines etc. in the abdomen. The tongue is made of the essence of the flesh, blood and Kapham. The Váyu, combined with heat (Pittam) in adequate proportion, rends through the internal channels into the flesh and transforms them into muscles (Peśi).

the oily principles of fat (Meda), transforms them into (Sira' and (fibrous tissues) Snayu, the underbaked (Mridu) ones being converted into the Sira and the overbaked (Kshara) ones into the Snayu. The internal cavities (Asayas) of the body mark the spots or regions where the Vayu had constantly stayed in its embryo stage. 26-29.

The kidneys (Vrikkas) are made out of the essence of the blood and fat. The testes are formed out of the essence of the blood, flesh, Kapham and fat. The heart is formed out of the essence of blood and Kapham ; and the vessels (Dhamanis) carrying the vital principles of the body are attached to it (heart). The spleen and the lungs are situated below and beneath the heart on the left side, and the liver and Kloma (Pancreas ?) below and beneath it (heart) on the right. The heart is the special seat of consciousness (Chetana) in all creatures. Sects in when this viscus (heart) of a person becomes enveloped by the effects of the Tamas (principles of illusion or nescience). 30-31.

Memorable Verse :-The heart which is of the shape of a lotus bud hangs with its apex downward, folding itself up during sleep and expanding with the return of wakening or consciousness. 32.

Sleep and its virtues :-Sleep is the illusive energy of God (lit.-the all-pervading deity) and naturally has its sway over all created beings. The kind of sleep which sets in when the sensation-carrying channels (Snayu) of the body are choked by Sleshma, which abounds in the quality of Tamas, is known as Tamasi-nidra. It is this sleep which produces unconsciousness at the time of dissolution or death. A man of Tamasika-temperament sleeps both in the day and night ; one of the Rajasika-temperament sleeps either in the day or in the night ; while sleep never visits the

THE SUŚHRUTA SAMHITA

O Suśruta ! the heart is said to be the primary seat of consciousness (Chetaná) in the animated beings. Sleep overcomes a man whenever the heart is enveloped in the illusive effects of Tamas. Sleep is the offspring of Tamas and it is the quality of Sattvam that brings on awakening. This is the fundamental law of Nature. The self-conscious individuality (Self), ensconced in the material frame of man which is composed of the five material elements, recollects through the agency of the mind (Manah), which abounds in the quality of Rajas, the renaissance of his by-gone existences, and wakens up in his psychic plane the pictures of good or evil deeds done by him therein. Dreams are but the embodiment of these recollections. The self or Jivatmá, though he sleeps not himself, is said to be sleeping, whenever the sense organs are overpowered by the illusive energy of Tamas.

Day sleep is forbidden in all seasons of the year, except in summer and in the case of infants, old men, and persons enfeebled by sexual excesses, or in Kshata-kshina diseases and in case of habitual tipplers. A sleep in the day may be enjoyed after the fatigue of a long journey, riding, or physical labour, or on an empty stomach. It may be allowed as well to men suffering from the loss of fat, Kapham or blood, to those of

• Such persons may get sleep only, when being tired and exhausted they cease to think of their affairs.

O f. Charaka :-When the active self of a person, tired in body and mind, loses touch with his worldly affairs, sleep comes to him,

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THE SUSHRUTA SAMHITA

wheat prepared with sugar or other derivatives of sugar-cane, sweet or soothing articles with milk or meat juice or flesh of animals of the Biskira or Vileśaya class, and eating of grapes, sugar and sugar-cane at night, are beneficial (in such cases) ; so also a soft and pleasant bed, and easy and convenient seats and means of loco-motion. Hence, a wise physician should advise those and similar other measures to allay insomnia.

Excessive sleep should be remedied by emetics, Sans'odhana measures, fastings, bleeding, and works which tend to disturb the mental equanimity of man. Keeping up at night is beneficial to persons afflicted with obesity, poison or the deranged Kapham ; so also a nap in the day is beneficial to people troubled with hiccough, colic pain, dysentery, indigestion, or thirst.

Somnolence or Drowsiness etc. :-In this kind of light sleep, or in the preliminary stage of sleep, the sense organs are overpowered and remain only partially cognisant of their respective objects and all (subjective and objective) symptoms of a sleepy person such as, yawning, sense off atigue and heaviness of the limbs, present themselves in succession ; these are the special features of Tandra. One (prolonged) inhaling of the air through a widely open mouth and subsequent exhaling with the contraction of the limbs and tearful eyes are (all together) called Jrimbha or yawning.

A sense of fatigue without any physical labour which comes upon a person unaccompanied by hurried respiration is called Klama. It obstructs the proper functions of the senses as also the workings of the active organs.* An inordinate love of pleasure and a great aversion to pain, attended with an apathy to all sorts of

• Hand, leg, anus, and generative organ etc.

Chap. IV.] SARIRA STHANAM. 153

work even with the capacity of carrying them through is called Alasyam (laziness) Nausea, without vomiting of ingested food, attended with salivation and formation of sputum, and cardiac distress are the symptoms of Utklesham. A sweet taste in the mouth, drowsiness, a beating pain in the heart, dizziness, and non-relish for food are the signs of Glaai (languor). A feeling as if the whole body were wrapped in a wet sheet, accompanied by an extreme heaviness of the heart, is called Gauravam. 44-50.

Loss of consciousness (Murchchha) is due to an excess of the deranged Pittam and to the quality of the Tamas ; vertigo (Bhrama) is due to an aggravated state of the Váyu, Pittam,and to the quality of the Rajas ; drowsiness (Tandra) is due to a similar condition of the Váyu, Kapham and to the quality of the Tamas ; while sleep (Nidrá) is produced by the predominance of Kapham and to the quality of the Tamas in the organism. 51.

Loss of consciousness (Murchchha) is due to an excess of the deranged Pittam and to the quality of the Tamas ; vertigo (Bhrama) is due to an aggravated state of the Váyu, Pittam,and to the quality of the Rajas ; drowsiness (Tandra) is due to a similar condition of the Váyu, Kapham and to the quality of the Tamas ; while sleep (Nidrá) is produced by the predominance of Kapham and to the quality of the Tamas in the organism. 51.

The growth of a fœtus in the womb is effected by the serum (Rasay) prepared out of the food (assimilated by its mother) incarcerated by the Váyu in the internal passage of its body. 52.

The growth of a fœtus in the womb is effected by the serum (Rasay) prepared out of the food (assimilated by its mother) incarcerated by the Váyu in the internal passage of its body. 52.

Memorable Verses :-Be it clearly understood that there exists fire or heat (Jyoti) in the umbilical region of the fœtus which is fanned by its bodily Váyu and thus contributes to the growth of its body. The same Váyu in combination with the heat (thus generated), expands the upward, downward, and lateral channels (in the body of the embryo) and thus leads to the growth of the fœtus. The cyes (Dristi-aperture of sight) and the hair-follicles of a man do not

Memorable Verses :-Be it clearly understood that there exists fire or heat (Jyoti) in the umbilical region of the fœtus which is fanned by its bodily Váyu and thus contributes to the growth of its body. The same Váyu in combination with the heat (thus generated), expands the upward, downward, and lateral channels (in the body of the embryo) and thus leads to the growth of the fœtus. The cyes (Dristi-aperture of sight) and the hair-follicles of a man do not

• In the text we find the word "Indriya" which refers to both Jnánendriya (sensory functions) and Karmendriya (motor functions) of the body.

• In the text we find the word "Indriya" which refers to both Jnánendriya (sensory functions) and Karmendriya (motor functions) of the body.

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Pittvaja-Temperament :-A man of Pittvaja temperament perspires copiously emitting a fetid smell. His limbs are loosely shaped and yellowish in colour. The finger nails, eyes, palate, tongue, lips, soles and palms of such a person are copper-coloured. He looks ugly with wrinkles, baldness and grey hair; he eats much, is averse to warmth and irritable in temper, though he cools down very soon. He is a man of middling strength and lives up to middle age. He is intelligent and possesses a good retentive memory and loves to monopolise the conversation (by pulling down any speaker that may be present). He is vigorous and is simply irresistible in battle. He dreams in his sleep of such things as meteors, lightning-flashes, fire, Nágeshvara, Palásá or Karnikára plants. He is never overpowered with fear nor bends before a powerful antagonist ; he protects the suppliant and is very often afflicted with suppuration in the cavity of the mouth. The traits of his character resemble those of a serpent, an owl, a Gandharba (heavenly musician), Yaksha, cat, monkey, tiger, bear, and of a mongoose. 61-64.

Kaphaja-Temperament :-The complexion of a man of S'leshmd temperament resembles either the colour of a blade of grass, blue lotus, polished sword, wet Arishta, or that of the stem of the Sara grass. He is comely in appearance, fond of sweet tastes, grateful, self-controlled, forbearing, unselfish and strong ; he does not hastily form any opinion, and is fast in his enmity. His eyes are white ; his hair curly and raven black. He is prosperous in life. His voice resembles the rumblings of a rain-cloud, the roar of a lion, or the sound of a Mridanga. He dreams in his sleep of large lakes or pools decked with myriads of full blown lotus flowers, swans and Chakravákas. His eyes are slightly

The Sushruta Samhita

156

red towards the corners, the limbs are proportionate and symmetrically developed with a cool effulgence radiating from them He is possessed of the qualities of the Sáttvika stamp, capable of sustaining pain and fatigue and respectful towards his superiors He possesses faith in the Sástras and is unflinching and unchanging in his friendship ; he suffers no vicissitudes of fortune, makes large gifts after long deliberation, is true to his word and always obedient to his preceptors. The traits of his character resemble those of Brahma, Rudra, Indra, Varuna, a lion, horse, an elephant, cow, bull, an eagle, swan and of the lower animals. 65-68.

A combination of two different temperaments should be called a double temperament or a Dvandaja one ; and one of all the three temperaments in a person should be stated as a Sánnipátika one. 69.

The temperament of a man is never altered, nor does it suffer any deterioration or abatement. A change, abatement or deterioration in any particular case should be regarded as the harbinger of death.

As a worm, bred in poison, is not troubled with it, so the temperament of a person however painful to others does no inconvenience to himself. Several authorities hold that the temperaments of persons have their origin in the material elements of the body and accordingly they classify them as the Vátika Prakriti, the Taijasa Prakriti, and the Ápya (watery) Prakriti, the characteristic traits of which respectively correspond to the first three temperaments described above. 70–71.

A man of the Párthiva temperament is large in his stature,and is firm, strong and muscular in his limbs.

A man of the Nabhasa temperament is pious and long-lived, has large aural cavities. The mental temperaments are classified according to their qualities. 72.

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THE SUSHRUTA SAMHITA

Enumeration of the different limbs and members of the body :-The different layers of the skin, the Kalás, the Dhátus (root principles, such as blood, chyle, etc.), the Mala (excrements), the Doshas (morbific principles, such as the Váyu, Pittam, or Kapham), the spleen, the liver, the lungs, the colon and cæcum (Unduka), the heart, the cavities or viscera (Ásayas), the intestines (Antras), the Vrikkou (Kidneys) the Srōtas (internal passages or ducts), the Kandará (nerve trunks), the Jálas (membranes), the Kur chas,* the Rajjus (tendons) the Scvanis (sutures), the Sangháta (facets), the Simanta, the bones, the joints, the Snáyu (ligament), the Peśi (muscles), the Marmas (vital parts, such as anastomosis of veins and arteries, etc.), the Sirá (veins), the Dhamani (arteries), and the Yogaváhini Srōtas†, constitute what is collectively called the organism.

THE SUSHRUTA SAMHITA

Their number :-The layers of skin (Tvak) number seven in all. There are seven connective tissues or fascia (Kalás). The cavities or viscera (Ásayas) are seven in all. The root principles (Dhátu) of the body are seven in number. There are seven hundred Sirá (veins), five hundred Peśi (muscles), nine hundred Snáyu (ligaments), three hundred bones, two hundred and ten Sandhi (joints), one hundred and seven Marmas (vital parts), twenty-four Dhamanis (arteries etc.), three Doshas (morbific principle—such as the Váyu, Pittam,

THE SUSHRUTA SAMHITA

• Meetings of muscles, ligaments, veins, nerves and bones as at the annular ligament.

THE SUSHRUTA SAMHITA

† Those, that are in connection with the Dhamani.

SARIRA STHANAM

Chap. V.]

and Kapham), three kinds of Mala (excrements) and nine Srota (canals) in all in the human organism, which will be described in detail later on. 5.

161

The skin, Kalá, the root- principles of the body, (Dhátus) the morbific principles (Doshas) such as the Váyu etc, of the body, liver, spleen, lungs, Unduka (colons), heart and the Vrikkas (kidneys) have been already described (in the preceding chapter). 6.

The Áśayas (cavities or viscera) :-They are named as the Vátáśaya (the receptacle of the bodily Váyu), Pittáśaya (the receptacle of the Pittam), Śleshmáśaya (the receptacle of Śleshmá or Kapham), Raktáśaya (the receptacle of the blood), Amáśaya (stomach), Pákváśaya (intestines), and the Mutráśaya (bladder). Females have another Áśaya (receptacle) in addition to these which is called the Garbháśaya (uterus). The intestines (of an adult) male, measure fourteen cubits (three and a half Vyámás) in length, while those of an adult female measure only twelve cubits. 7—8.

The Srotas or Channels :-The nine canals (Śrotas) of the body, such as the ears, the eyes, the mouth, the nostrils, the anus and the urethra, open on the outside. Females have three more such ducts or canals as the two breasts (milk channels) and the one which carries off the menstrual blood. 9.

The Kandaráś :–The Kandarás number sixteen in all, of which four are in the legs, four in the hands, four in the neck, and four in the back. The Kandarás of the four extremeties extend to the roots of the nails of the fingers and toes. The four Kandarás of the neck, connecting it with the heart, extend down to the penis. The four Kandarás at the back and in the region of the Śróni extend down to the buttocks 21

(Vimba). These Kandarás terminate above in the head, the thighs, the breast and in the balls of the shoulders respectively (i.c. the Kandarás of the neck terminate above in the head, those of the legs in the thighs, those of the dorsum in the chest, and those of the arms in the shoulders).

The Jála or Plexuses :-The Jála or plexuses are of four kinds, such as the muscular plexuses, the Vascular plexuses, ligamentous plexuses, and bony plexuses. One of each of the four kinds of plexuscs, is found about each of the Manibandda (wrists) and Gulfa (ankles). These four kinds of plexuses intermingle and cross one another in the form of a net-work. The whole body is a chain-work of plexuses.

The kurchas :-There are six Kurchas* in all ; of which two are in the hands, two in the feet, one in the neck, and one in the penis. There are four great muscular cords or kajjus which originate from either side of the spinal column, one pair going inwards and another outwards for the purpose of binding the muscles together.†

12-13.

The Sevanis or Sutures :--‡They are seven in number, e. g. five in the head, one in the tongue and one in the genital. An incision should not be made into any of these sevanis.

The Asthi-Sanghátas :-The Asthi-sanghátas (collection of a number of bones) are fourteen in number.

• The Kurchas (clusters or groups) may be made up of muscles, bones, vessels and ligamentous structure--Dallana.

† According to Gayádása four such cords are found on each side of the spinal column and thus totalling eight in all.

‡ Sevani evidently means the central tendinous band which looks like a suture from which the muscles on either side arise.

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Chap. V.] SARIRA STHANAM. 165

(hips), and the fifth one is the Trika or triangular bone (the sacrum). There are thirty-six bones in one Párśva (side), and the same number in the other ; thirty in the Prishtha (back), eight in the Urah (chest) ; and two more known as Akshaka (collar-bone). (Thus making one hundred and seventeen in all). 19.

Bones above the Clavicles :–There are nine bones in the Grivá (neck) ; four in the Kantha-nádi* (wind-pipe) ; two in the Hanu (Jaws). The tecth number thirty-two. There are three bones in the nose ; one in the Tálu (palate) ; also one in each Karna (ear), Śankha (temple), and Ganda (cheek), (thus making six in all) ; six bones form the Śirá (cranium). [Thus making sixty-three in all]. 20.

Bones above the Clavicles :–There are nine bones in the Grivá (neck) ; four in the Kantha-nádi* (wind-pipe) ; two in the Hanu (Jaws). The tecth number thirty-two. There are three bones in the nose ; one in the Tálu (palate) ; also one in each Karna (ear), Śankha (temple), and Ganda (cheek), (thus making six in all) ; six bones form the Śirá (cranium). [Thus making sixty-three in all]. 20.

Different kinds of Bones and their situations :–These bones may be divided into five classes (according to their character), such as the Kapála, Ruchaka, Taruna, Valaya and the Nalaka. The bones, situated in the knee-joints, shoulders (Ansa†), hips (Nitambas), cheeks (Ganda), palate, temples, and the cranium belong to the Kapála kind (flat bones). The teeth belong to the Ruchaka class. The bones in the nose, ears, throat (trachea) and the socket of the eyes (Akshi-kosha†) are called Taruna (cartilages) ; while those which are found in the palm (wrist), foot (ankle), sides back, chest and regions of the abdomen, belong to the Valaya (irregular or curved) class. The remaining

Different kinds of Bones and their situations :–These bones may be divided into five classes (according to their character), such as the Kapála, Ruchaka, Taruna, Valaya and the Nalaka. The bones, situated in the knee-joints, shoulders (Ansa†), hips (Nitambas), cheeks (Ganda), palate, temples, and the cranium belong to the Kapála kind (flat bones). The teeth belong to the Ruchaka class. The bones in the nose, ears, throat (trachea) and the socket of the eyes (Akshi-kosha†) are called Taruna (cartilages) ; while those which are found in the palm (wrist), foot (ankle), sides back, chest and regions of the abdomen, belong to the Valaya (irregular or curved) class. The remaining

• Tala, Kurcha, and Kantha-nádi are identical with Chatak's Sálaká, Sthána and Jatru respectively.

• Tala, Kurcha, and Kantha-nádi are identical with Chatak's Sálaká, Sthána and Jatru respectively.

† Though it is asserted here that there exist Taruna bones in the sockets of the eyes (Akshi-kosha) but there is no mention at all in the text, of the presence of any such therein. There is no mention of the shoulder-blade (Ansa) here though it is a part of the skeleton.

† Though it is asserted here that there exist Taruna bones in the sockets of the eyes (Akshi-kosha) but there is no mention at all in the text, of the presence of any such therein. There is no mention of the shoulder-blade (Ansa) here though it is a part of the skeleton.

166 THE SUSHRUTA SAMHITA. [Chap. V.

bones belong to Nalaka class (long-bones, lit.—recd-like or cylindrical). 21. Memorable Verses :– As trees are supported by the hard core inside their trunks, so the body is supported (and kept erect) by the firm bones (which are found in its inside). And since these bones form the pith (Sára) of the human organism, they are not destroyed even after the destruction and falling off of the attached flesh, skin, etc. of the body. Muscles are attached strongly to the bones by means of the veins (Sírás) and ligaments (Snáyus), and are thus kept in position and do not fall off. 22.

The Sandhis or Joints – (M. T.) :– The

joints may be divided into two kinds according as they are immovable (synarthrosis) and movable (diarthrosis). Those which are situated at the four extremities as well as in the Kati (waist) and Hanus (jaws) are movable ; the others are known to be unmovable by the learned. There are two hundred and ten articulations (Sandhis) in the human body. Of these sixty-eight are in the four extremities ; fifty-nine in the trunk (Koshtha); and eighty-three in the neck and in the region above it. 23.

Sandhis of the four Extremities :–

Three joints are found in each toe, two only in the great toe, thus making fourteen in each leg ; one is placed in each ankle, knee-joint and groin, thus making seventeen Sandhis in each leg or thirty-four in the two lower extremities. A similar number is to be found in each of the two upper extremities. 24-25.

Sandhis of the koshtha and Clavicles :–

There are three Sandhis about the Kapála or flat bone in the Kati (waist, hence pelvis); twenty-four in the vertibral column; twenty-four in the sides; cight in the

chest ; eight in the Grivá (neck) ; three in the Kanthas (windpipe) ; eighteen in the cords or bands (Nádi) binding the Kloma and the heart ; thirty-two about the roots of the teeth, one in the region of the thyroid (Kákalaka) ; one in the nose ; two in the cyes ; one in each of the two ears, temples and cheeks (thus making six in all) ; two about the joints of the jaw-bones ; two over the eyebrows ; two above the temples ; five in the Kapála bone of the fore-head and one in the head.

Their forms, distinctions, and locations :-These joints may be divided into eight different classes (named after the objects which they respectively resemble in shape), namely Kora (hinged or lap-shaped), Udukhala (ball and socket), Sámudga (back of the palm), Pratara (raft), Tunna-sevani (scam-like or dove-tailed), Váyasa-tunda (crow-beak), Mandala (circular), and Sankhá-vartah (involutions of conch-shell). The joints in the fingers, wrists, ankles knee-joints and elbows (Karpura) belong to the Kora group.

Those in the axilla or shoulder-joint (Kakshá), teeth, and hip (Vankshana) are of the Udukhala type. The joints in the region of the anus, vagina, shoulders (Ansa-pitha -i.e glenoid cavity) and hips, belong to the Sámudga form.

The joints in the neck and the spinal columns, belong to the Pratara (irregular) type ; while those found in the Kapála bones of the pelvis (Kati) and the forehead, are of Tunna-sevani (suture) form.

The joints on either side of the cheek-bones (temporomandibular) belong to the Vá yasa-tunda type.

The Mandala joints occur in the encircling Nádi of the heart, throat, eyes and Kloma.

Sankhá-varta joints occur in the bones of the ears and the nostrils.

The peculiar features of these different kinds of joints (Sandhis) are evident from their names.

Metrical Text :-Only the bone-joints have been enumerated and described ; the joints of muscles ligaments and veins are innumerable.

The Ligaments (Snáyu) :-There are nine hundred ligaments (Snáyus) in the human body, of which six hundred occur in the four extermities ; two hundred and thirty in the trunk (Kos'htha) and seventy in the neck and upwards. (Of the six hundred ligaments in the four extremities), six ligaments are situated in each toe making thirty (in the toes of each foot) ; thirty in the Tala (soles), Gulpha (ankles), and the Kurchha (ankle-joint) ; thirty in the leg (Janghá) ; ten in the knee-joints (Jánu) ; forty in the Udara (abdomen) ; ten in the groin (Vankshana) ; thus making one hundred and fifty in each leg. The same number is found in the other lower limb and in each of the two upper extremities. (Of the two hundred and thirty ligaments in the trunk), there are sixty in the lumbar region (Kati) ; eighty in the back ; sixty in the sides ; and thirty in the chest. (Of the seventy ligaments to be found in the region above the clavicles) there are thirty six in the neck (Grivá) and thirty-four in the head. Thus the total number of ligaments in a human body is nine hundred.

Memorable Verses :-Now hear me describe the ligaments (Snáyus). They may be grouped under four distinct heads, viz., Pratánavati (ramifying or branching), Vritta (ring-shaped or circular), Prithu (thick or broad), and Sushira (perforated). The ligaments (Snáyus) which present in the four extremities and the joints belong to the Pratanavati type. The Kandaras or large ligaments are of the Vritta type ; while those which are found in the stomach (Ámás'aya) or in the intestines (Pakvás'aya), and in the bladder belong

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anus (Pà'yu); one in the penis; one in the perincum (Sevani); two in the scrotum; five in each of the haunches (Sphik); two in the top or head of the bladder; five in the abdomen (Udara); one about the umbilicus; five along each side (of the spinal column), on the upper part of the back (making ten in all); six in the sides; ten in the chest; seven around the armpits and shoulders (Akshaka-Ansa); two in the region of heart and stomach (Ámás'aya); and six in the region of the liver, spleen and colon (Unduka).

39

Muscles of the Head and Neck :-(Of the thirty-four muscles found in this region), four arc in the throat (Grivá); eight in the two jaw-bones (Hanu); one each in the regions of the throat (Kákalaka and Gala); two in the palate; one in the tongue; two in the lips: two in the nose; two in the cyes; four in the cheeks; two in the ears; four in the forehead; and one in the head. Thus the positions and distributions of the five hundred muscles (Pes'is) have been described.

40

Metrical Text :-The ligaments, veins, bones and joints etc., of a human body, derive their strength from the fact of their being supported by or covered over by the muscles.

41

Extra Muscles in Women :-Females have twenty extra muscles; ten muscles are to be found about the two breasts, five in each, which (muscles) attain their full growth during puberty; four muscles are present about the parturient passage; and of these (four) two are about the external and two in the internal orifices (of the vagina); three about the region of the os, and three along the passages of the ovum and sperm. The Garbhás'aya or uterus is situated in the space bounded by the Pittás'aya (small intestine) and Pakvás'aya

Chap. V.] SARIRA STHANAM. 171

(large intestine) and the foetus lies in this during the period of gestation.* 42-43. According to their position in the system, these muscles are found to be thick, slender, small, expanded, circular, short, long, hard, soft, smooth or rough. The muscles cover the veins, ligaments, bones and joints; hence their shape and size are determined by the exigencies (organic structures) of their positions. 44.

Memorable Verses :-The muscles which are found in the penis and scrotum of a man as described before correspond to the covering of the uterus in the case of a woman owing to the absence of those organs in her body. The positions and classifications of the veins, channels, Marmas and arteries will be dealt with in a separate chapter. 45-46.

The vagina of a woman resembles the navel of a conch-shell in shape and is possessed of three involuted turns (Ávartas) like the interior of mollusc. The uterus (Garbhás´aya—fœtal bed) is situated at the third posterior involuted turn. The shape of the uterus resembles the mouth of a Rohit-fish (narrow at the mouth and expanded in the upper end). The fœtus lies in a crouched or doubled up posture in the uterus and thus naturally at the time of parturition its head is presented at the entrance to the vagina. 47-48.

Superiority of Śalya-Tantram :-The different parts or members of the body as mentioned before including even the skin cannot be correctly described by any one who is not versed in Anatomy. Hence, any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully observe (by dissecting it) and examine

• If we read Mutrás'aya (bladder) in place of Pittás'aya it explains the anatomy better. -Ed.

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CHAPTER VI.

Now we shall discourse on the Sáriram which specifically treats of the Marmas* or vital parts of the body (Pratyeka-marma-nirdeśa Sáiriram.) I. Classification of Marmas :--There are one hundred and seven Marmas (in the human organism), which may be divided into five classes, such as the Mánsa-Marmas, Śirá-Marmas, Snáyu-Marmas, Asthi-Marmas and the Sandhi-Marmas. Indced there are no other Marmas (vulnerable or vital parts) to be found in the body than the preceding ones.

2. Their different numbers :--There are eleven Mánsa-Marmas (vulnerable muscle-joints) ; forty-one Śirá-Marmas (similar veins, anastomosis) ; twenty-seven Snáyu-Marmas (vital ligament-unions) ; eight Asthi-Marmas (bone-unions) and twenty Sandhi-Marmas (vulnerable joints).

3. Their Locations :--Of these, eleven are in one leg, thus making twenty-two in the two lower extremities. The same number counts in the two hands. There are twelve Marmas in the regions of the chest and the abdomen (Udarà); fourteen in the back ; and thirty-seven in the region of the neck (Grivá) and above it.

4. Names and distributions of Marmas :--The Marmas which are situated in each leg are known as Kshipra, Tala-Hridaya, Kurchcha, Kurchcha-Śirah, Gulpha, Indravasti, Jánu, Ani, Urvi, Lohitáksha and Vitapà.

The twelve Marmas which are situated in the * Places where veins, arteries, ligaments, joints and muscles unite and an injury to which proves generally fatal.

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Qualitative classes :- Again these Marmas (vital unions of the body) are under five distinct heads, namcly, Sadya-Pránahara, (fatal within twenty-four hours), Kálántara-Pránahara, (fatal within a fortnight or a month), Viśalyaghna (fatal as soon as a dart or any other imbedded forcign matter is extracted therefrom), Vaikalyakara, (maiming or deforming) and Rujákar (painful) [according as an injury respectively produces the aforesaid effects]. Of these, nineteen Marmas belong to the Sadya-Pránahara group ; thirty-three to the Kálántara-Pránahara group ; threc to the Viśalyaghna group; forty-four to the Vaikalyakara group ; and cight to the Rujákara group.

Memorable Verses :- To the Sadya-Prána-hara group (fatal in the course of a day if anyway hurt) belong the four Śringátakas, one Adhipati, the two Śankhas, the cight Kantha-Śirás, the Guda, the Hridaya, the Vasti and the Nábhi. To the Kálántara-Pránahara group (fatal later on, if any way hurt) belong the eight Vaksha-Marmas, the five Simantas, the four Tala-Marmas, the four Kshipra-Marmas, the four Indra-vastis, the two Katika-tarunas, the two Párśva-Sandhis, the two Vrihatis, and the two Nitamvas. To the Viśalyaghna class belong the two Utkshcpas and the one Sthapani. To the Vaikalyakara (deforming) group belong the Marmas, known as the four Lohitákshas, the four Anis, the two Jánus, the four Urvis, the four Kurcchas, the two Vitapas, the two Kurparas, the two Kukundaras, the two Kaksha-dharas, the two Vidhurás, the two Krikátikás, the two Ansas (shoulder), the two Ansa-phalakas, (shoulder-blades), the two Apángas (tips of cycs), the two Niáls, the two Manyás, the two Phanas and the two Ávartas. A learned physician should know that the two Gulphas

the two Mani-vandhas and the four Kurchcha-Śirah (of the hands and legs) belong to the Rujákara group (painful if hurt). A piercing of the Kshipra-Marma ends in an instantaneous death ; or death may follow at a later time. 16-21.

Firm unions of Mánsa (muscles), Śirá (veins), Snáyu (ligaments), bones or bone-joints are called Marmas (or vital parts of the body) which naturally and specifically form the seats of life (Prána), and hence à hurt to any one of the Marmas invariably produces such symptoms as arise from the hurt of a certain Marma.* 22.

The Marmas belonging to the Sadya-Pránahara group are possessed of fiery virtues (thermogenetic) ; as fiery virtues are easily enfeebled, so they prove fatal to life (in the event of being any way hurt) ; while those belonging to the Kálántara-Pránahara group are fiery and lunar (cool) in their properties. And as the fiery virtues are enfeebled easily and the cooling virtues take a considerable time in being so, the Marmas of this group prove fatal in the long run (in the event of being any way hurt, if not instantaneously like the preceding ones). The Viśalya-ghna Marmas are possessed of Vátaja propertics (that is, they arrest the escape of the vital Váyu) ; so long as the dart does not allow the Váyu to escape from their injured interior, the life prolongs ; but as soon as the dart is extricated, the Váyu escapes from the inside of the hurt and necessarily proves fatal. The Vaikalyakáras are possessed of Saumya (lunar properties) and they retain the vital fluid owing to their steady and cooling virtucs, and hence tend only to deform the organism

• Some are of opinion that hallucination, delirium, death, stupor and coma as described in the Sutrastánam are the results of injuries to thes Mar as.

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178 THE SUSHRUTA SAMHITA.

group ; and those in which only one of them exists

belongs to the last or pain-generating type (Rujákara)*.

But the fore going theory is not a sound one, inas-

much as blood is found to exude from an injured joint

which would be an impossibility in the absence of any

vein, ligament (Snáyu) and muscle being intimately

connected with it. Hence every Marma should be

understood as a junction or meeting place of the five

organic principles of ligaments, veins, muscles, bones

and joints. 24-25.

Metrical text :-This is further corroborated

by the fact that the four classes of Sirá or vessels (which

respectively carry the Váyu, Pitta, Kapha and the blood)

are found to enter into the Marmas for the purpose

of keeping or maintaining the moisture of the local

ligaments (Snáyu), bones, muscles and joints and thus

sustain the organism.† The Váyu, aggravated by an

injury to a Marma, blocks up (those four classes of

vessels) in their entire course throughout the organism

and gives rise to great pain which extends all over the

body. All the internal mechanism of a man (of which a

Marma has been pierced into with a shaft or with any

other piercing matter) becomes extremely painful, and

seems as if it were being constantly shaken or jerked,

and symptoms of syncope are found to set in. Hence a

careful examination of the affected Marma should

(of the said group) is devoid of Mânsa, Snáyu and Sandhi ; the Nilá,

Manyá and Phana Marmas (of the same group) are devoid of Mânsa,

Sandhi and Asthi ; the Ávarta-marına is devoid of S'irá, Snâyu and

Mânsa ; the Apánga-marına (of the said class) is devoid of Mânsa, Snáyu

and Sandhi.

• The Gulpha, Manibandha, and Kurchcha-s'ira Marmas, belonging

to the Rujákara group, are devoid of Mânsa, S'irá, Snáyu and Asthi, i.e.

Sandhi alone is present in these.

† Hence the piercing of a bone is attended with bleeding.

Chap. VI.] SARIRA STHANAM.

179

precede all the foregoing acts of extricating a Śalya from its inside. From that similar aggravated conditions and actions of the Pitta and the Kapha should be presumed in the event of a Marma being any way injured or pierced into. 26—29.

A Marma of the Sadyah-Pránahara type being perforated at its edge brings on death at a later time (within seven days), whereas a deformity of the organ follows from the piercing of a Kálántara-Máraka* Marma at the side (instead of in the centre). Similarly, an excruciating pain and distressful after-effects mark a similar perforation of a Marma of the Viśalyaghna† group. And a Marma of the Rujákara‡ class produces an excruciating pain (instead of a sharp one) in the event of its being pierced at the fringe. 30.

An injured Marma of the Sadyah-Pránahara type terminates in death within seven days of the injury, while one of the Kálántara type, within a fortnight or a month from the date of hurt(according to circumstances). A case of injured Kshipra-Marma seldom proves fatal before that time (seven days). An injured Marma of the Viśalyaghna or Vaikalyakara group may prove fatal in the event of its being severely injured. 31.

Marmas of the Extremities :–Now we shall describe the situation of every Marma.

• If any of the Marmas of the Kálántara-Pránahara group be deeply perforated, then this perforation is sure to bring on death within a day (i.e. it will act like a slightly injured Marma of the Sadyah-Pránahara group).

† Any Marma of the Viśalyaghna-group, being deeply perforated, brings on death within seven days (i. e. it will behave like a slightly injured Marma of the Kálántara-Prànahara class).

‡ Any Marma of the Rujákara class, being deeply perforated (injured), is sure to bring excruciating pain etc, (i.e., it will act like a slightly injured Marma of the Viśalyaghna group).

Marma, known as the Kshipra*, is situated in the region between the first and the second toes (Tarsal articulation), which, being injured or pierced, brings on death from convulsions. The Marma, known as the Tala-Hridayat, is situated in the middle of the sole of the foot in a straight line drawn from the root of the middle toe. An injury to this Marma gives rise to extreme pain which ends in death. The Marma, known as the Kurchchhat, is situated two fingers' width above from the Kshipra one on cach side of the foot. An injury to this Marma results in shivering and bending in of the foot. The Marma called Kurchcha-Sirah § is situated under the ankle-joints, one on each side of the foot (Gulpha-Sandhi) ; an injury to it gives rise to pain and swelling of the affected part. A perforation of the Gulpha-Marma !!, which is situated at the junction of the foot and the calf, results in pain, paralysis and maimedness of the affected leg. 32-37.

An injury to the Marma which is situated in the middle muscle of the calf to the distance of between twelve and thirteen fingers' width from the ankle, and known as the Indravasti-Marma,¶ results in excessive haemorrhage which ends in death. 38.

• It is a Snáyu-Marma (ligament) to the width of half a finger, and belongs to the Kálántara group.

† It is a Mánsa-Marma to the width of half a finger and belongs to the Kálántara group.

‡ It is a Snáyu-Marma to the length of four fingers' width, and b?longs to the Vaikalyakara group.

§ It is a Snáyu-Marma, one finger in length and belongs to the Vaikalyakara group.

!! It is a Sandhi-Marma, to the length of two fingers', and belongs to the Vaikalyakara group.

¶ Indravasti measures two fingers in length according to Bhoja and

Chap. VI.] SARIRA STHANAM.

An injury to or piercing of the Jānu-Marma,* situated at the union of the thigh and the knee, results in lameness of the patient. 39.

A piercing of the Áni-Marma,† situated on both the sides above three fingers' width from the Jánu (knee-joint), brings on swelling and paralysis (numbness) of the leg. 40.

A perforation of the Urvi-Marma‡ situated in the middle of the Uru (thigh), results in the atrophy of the leg, owing to the incidental hæmorrhage. An injury to the Lohitaksha-Marma,|| situated respectively a little above and below the Urvi-Marma and the Vankshana (groin-joint), and placed near the thigh, is attended with excessive hæmorrhage and causes paralysis (of the leg). 41-42.

An injury to the Vitapa-Marma,¶ situated between the Scrotum and the Vankshana (inguinal region), brings on loss of manhood or scantiness of semen. Thus the eleven Sakthi-Marmas of one leg have been described ; those in the other being of an identical nature with the preceding ones. The Marmas in the hands are almost identical with those of the legs, with the exception that Manivandha, Kurpara and Kakshad-hara Marmas

Gayádása, though half a finger in width according to others. It is a Mànsa-Marma and belongs to the Kálántara group.

• It is a joint-Marma, three fingers in length and belongs to the Vaikalyakara group.

† It is a ligament-Marma, half a finger in length, (three fingers according to Gayàdása) and is of the Vaikalyakara class.

‡ It is a S'irâ-Marma, half a finger in length and of the Vaikalya-kara group.

|| It is a S'irâ-Marma, half a finger in length and of the Vaikalya-kara group.

¶ It is a Snàyu-Marma to the length of one finger and of the Vaikalyakara group.

182 THE SUSHRUTA SAMHITA.

[Chap. VI.

occur in the place of the Gulpha, Jánu and

Vitapa Marmas respectively. As the Vitapa-Marma

is situated between the scrotum and the Vankshana

(inguinal region), so the Kakshadhara-Marma is situated

between the Vaksha (chest) and the Kaksha (armpit).

An injury to these causes supervening symptoms.

An injury to the Mànivandha-Marma (wrist-marma)

results specially in inoperativeness (Kunṭha) of the

affected hand ; an injury to the Kurpara-Marma ends

in dangling (Kuni) of the hand ; and an injury to

the Kakshadhara results in hemiplegia. Thus the

forty-four Marmas of the upper and the lower extremi-

ties have been described. 43-46.

Marmas on the Thorax etc. :-Now we

shall describe the Marmas, situated in the region of

the thorax and the abdomen (trunk). A hurt to

the Guda-Marma*, which is attached to the large

intestine and serves as the passage of stool and flatus,

ends fatally (within twenty-four hours of the hurt).

An injury to the Vasti-Marma,† situated inside

the cavity of the pelvic region and the bladder and

composed of small muscles and blood (and which

serves as the receptacle of urine), proves fatal with-

in the day, except in the cases of extracting the

gravel, only when the injury to the organ is short

of complete perforation of both of its walls. The

urine oozes out through the aperture in the case

where only one of its walls has been perforated, and

which may be closed and healed up with proper

and judicious medical treatment. An injury to the

• It is a Mânsa-Marma to the length of four fingers' width and be-

longs to the Sadyo-máraka class.

† It is a ligament combination (Snáyu-marma) to the length of four

fingers, belonging to the Sadyah-Pránhara class.

Nábhi-Marma,* the root of all the S'irâs and situated between the Ámâśaya (stomach) and the Pakvâśaya (intestines) ends in death within the day. 47-50.

A hurt to the Hridaya-Marma,† which is situated in the thorax between the two breasts and above the pit of the Ámâśaya and forms the seat of the qualities of Sattva, Rajas and Tamas, proves fatal within the day.

An injury to the Stana-mula-Marmas,‡ situated immediately below each of the breasts and about two fingers in width fills the Koshtha (thorax) with deranged Kapha, brings on cough, difficult breathing (asthma) and proves fatal.

An injury to any of the Stana-Rohita-Marmas,§ situated above the nipples of the breasts about two fingers in width, fills the cavity of the Koshtha (thorax) with blood, producing symptoms of cough and asthma, and ends fatally.

An injury to the Apalápa-Marmas,|| situated below the Ansa-kuta (balls of the shoulders) and above the sides (meeting of the different branches of the sub-clavicle veins i.e. axilla), transforms the blood of the organism into pus and proves fatal thereby. 51-54.

An injury to any of the Váyu-carrying vessels, known as the Apastambha-Marma¶ (meeting of the bifurcated branches of the bronchi lying on both the sides

• It is a S'irá-Marma to the length of four fingers, belonging to the Sadyah-Pránahara class.

† It is a S'irá-Marma to the length of four fingers and of the Sadyah-Pránahara class.

‡ It is a S'irá-Marma, two fingers in length and of the Kálántara class.

§ It is a Mánsa-Marma about half a finger in length and of the Kálántara class. (according to Vgabhata, of the Sadyo-Máraka class).

|| It is a S'irá-Marma, half a finger in length, and of the Kálántara class.

¶ It is a S'irá-Marma, half a finger in length and belongs to the Kálántara class.

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which commencing from the roots of the breast course round both the sides of the spinal column (Pristha-vamśa), cause excessive bleeding, and the patient dies, as supervening symptoms arise from an excessive loss of blood. An injury to any of the two Amsa-phalaka-Marmas* situated on either side of the vertebral column and connected with the scapula brings on anesthesia or atrophy (Śosha) of the arms. There are two Marmas known as Amsa-Marmas† which are situated on either side midway between the neck and the head of the arms and connect the Amsa-Pitha (glenoid cavity) and the Skandha (shoulder). An injury to any of these Marmas is attended with an incapacity of moving the hands. Thus the fourteen Marmas in the back have been described. 57-65.

The Jatru gata-Marmas :- Now we shall describe the Marmas which are situated in the regions above the clavicles (Urddhva-Jatru). There are four Dhamani (arteries) about the two sides of the Kantha-Nádi (wind-pipe). Two of them are known as Nilá, and the other two as Manyá. One Nilá and one Manyá are situated on either side of the larynx, (i.e., anterior and posterior side of the larynx). An injury to any of them produces dumbness, and change of voice (hoarseness), and also the loss of the faculty of taste.‡ An injury to any of the eight Sirá-s (arteries), four being on each side of the neck (Grivá), and known as Sirá-Mátrika-Marmas §) ends fatally within the day. 65-69.

• It is an Asthi-Marma, half a finger in length and is Vaikalyakara. † They are Snáyu-Marmas, half a finger in length and of the Vaikalyakara class. ‡ They are S'irá-Marmas, to the length of four fingers and of the Vaikalyakara class. § They are S'irá-Marmas, four fingers in length and of the Sadyo-Máran class.

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Chap. VI.] SARIRA STHANAM. 187 extraneous pointed thing lodged into these Marmas, results in the death of the patient, who, on the contrary, lives as long as the shaft is allowed to remain inside or if the shaft comes out itself (after putrefaction). 70-75.

An injury to the Sthapani-Mar-ma* (nasal arch of the frontal veins), situated in the middle of the eyebrows, ends in the manner of the preceding one. An injury to any of the five joints of the head which are known as the Simanta-Marmas†, results in fear, insensibility and madness of the patient and terminates in death.

An injury to any of the four Sringataka-Marmas‡ which forms the junction of the four Sirás (nerves), (branches of the facial artery) and soothes the nose, the eyes, the ears and the tongue, proves fatal within the day.

An injury to the Adhipati-Marmas § (the vertical groove on the frontal bone) which is marked in the inner side of the roof of the cranium by the Sirá-Sannipáta (superior longitudinal sinus), and on the exterior side by the ringlet of the hair (Romávarta) proves fatal within the day.

Thus we have described the thirty-seven Marmas, situated in the region above the clavicles (Urdhva-Jatru). 76-80.

Memorable Verses :-An incision should be made at the spot a finger's width remote from the Urvi, Kurchcha-Sirá, Vitapa, Kaksha and a Pársva-Marma ; whereas, a clear space of two fingers should

• They are S'irá-Marmas to the length of half a finger and of the Visályaghna class.

† They are Sandhi-Marmas to the length of four fingers and of the Kálántara-Pránahara class.

‡ They are S'irá-Marmas to the length of four fingers and of the Sadyah-Pránahara class.

§ It is a Sandhi-Marma, half a finger in length and of the Sadyah-Pránahara class.

be avoided from its situation in making any incision about the Stanamula, Manivandha or Gulpha-Marma. Similarly a space of three fingers should be avoided from the Hridaya, Vasti, Kurchcha, Guda or Nábhi Marma ; and a space of four fingers should be avoided in respect of the four Śringátakas, five Simantas and ten Marmas in the neck (Nilá etc.) ; a space of half a finger being the rule in respect of the remaining (fifty-six).* Men, versed in the science of surgery, have laid down the rule that, in a case of surgical operation, the situation and dimension of each local Marma should be first taken into account and the incision should be made in a way so as not to affect that particular Marma, inasmuch as an incision, even extending or affecting, in the least, the edge or the side of the Marma, may prove fatal. Hence all the Marma-Sthánas should be carefully avoided in a surgical operation.

The amputation of a hand or a leg may not prove fatal whereas a wound in any of the Marmas situated therein is sure to bring on death. The vessels become contracted in the case of a cut in the leg or in the hand of a man, and hence the incidental bleeding is comparatively scantier. Therefore it is that a cut in any of these parts of the body, however painful, does not necessarily prove fatal, like the lopping off of the branches of a tree. On the contrary, a man pierced into in any such Marmas, as the Kshipra or the Tala, suffers from excessive

• Some are of opinion that a surgical operation (in the case of the remaining fifty-six) should be made, leaving a space equal in measurement to the dimensions of a palm (from the affected part). Gayádása, having learnt from Bhoja, explains that a space of two fingers should be left (from the affected part) in making surgical operations of the ten marmas, namely, the two Gulphas, the roots of the two breasts, the four Indravastis, and the two Manivandhas.

Chap. VI.] SARIRA STHANAM.

hæmorrhage (from the affected part) and attended with an excruciating pain, owing to the derangement of the Váyu, and meets his doom like a tree whose roots have been severed. Hence, in a case of piercing or of injury to any of these Marmas, the hand or the leg should be immediatcly amputated at the wrist or at the ankle (respectivecly). 82.

The medical authorities have describcd the Marmas to have covered half in the scope of Śalya Tantra (Surgery), inasmuch as a person hurt in any of the Marmas dies presently (i. e., within seven days of the hurt). A deformity of the organ is sure to result from an injury to one of these Marmas, even if death be averted by a course of judicious and skillful medical treatment. 83.

The life of the patient is not to be despaired of even in the casc of fracture or crushing of a bone of the Koshtha, Śirah and Kapála or perforation of the intestines etc, if the local Marmas are found not to be in any way hurt or affected. Recovery is common in cases of cuts (pierce) in the Sakthí, Bhuja, Páda and Kara or in any other part of the body and even where a whole leg or hand is found to be severed and carried away if the Marmas are not in any way hurt or affected. 84.

These Marma; form the primary seats of the Váyu, the Soma (lunar) and Tejas (fiery principles of the organism), as well as of the three fundamental qualities of Satva, Rajas and Tamas, and that is the reason why a man, hurt in any of the Marmas, does not live. 85.

An injury to a Marma of the Sadyah-Pránahara class (in which death occurs within a day) is attended with the imperfection of the sense organs, loss of consciousness, bewilderment of Manah (mind) and Buddhi

(intellect) and various kinds of pain. An injury to a Marma of the Kálántara group (of a person) is sure to be attended with the loss of Dhátus (blood etc.) and various kinds of supervening symptoms (Upadrava) which end in death. The body of a person, hurt (in any of the Vaikalyakara Marmas, may remain operative only under a skillful medical treatment ; but a deformity of the affected organ is inevitable. An injury to any of the Vis'alyaghna Marmas ends in death for the reasons mentioned above. An injury to any of the Rujákara Marmas gives rise to various kinds of pain in the affected organ, which may ultimately bring about a deformity of the same, if placed under the treatment of an ignorant and unskillful Vaidya (Surgeon).

An injury to the adjacent part of a Marma, whether incidental to a cut, incision, blow (Abhigháta), burn, puncture, or to any other cause exhibits the same series of symptoms as an actually affected one. An injury to a Marma, whether it be severe or slight, is sure to bring deformity or death.* The diseases which are seated in the Marmas, are generally serious, but they may be made to prove amenable with the greatest care and difficulty.

CHAPTER VII.

Now we shall discourse on the Sáriram which treats of the description and classification of Sirá or vascular system * (Sirá-Varnana-Vibháktináma Śáriram).

There are seven hundred Sírás (vessels) in the human organism (except those which cannot be counted for their extremely attenuated size). The vessels (Sírás) by their contractibility and expansibility &c, sustain and nourish the organism in the same manner as streamlets and canals serve to keep a field or a garden moist and fruitful. From the principal or central trunk hundreds of small and minute vessels branch off and spread all over the body, just as small or minute fibres are found to emanate from the large central vein of the leaf of a plant. They originate from the umbilical region and thence they spread all over the body upwards and downwards and obliquely. 2.

Memorable Verses :-All the Sírás (vessels) that are found in the organisms of created beings, originate from the umbilical region (Nábhi)† and thence they spread all over their bodies. The life of an organic animal is seated in the vessels surrounding its navel which forms their starting point. The navel in its turn rests on or is attached to the Pránas (the life-carrying vessels-nerves attached to it) in the same

• The Sanskrita term S'irá denotes veins, nerves, arteries and lymphatic vessels as well. Some read S'ird·Varna (different colours of the Sirás) in lieu of S'irá·varnana (description of S'irás). † Most probably the idea is derive l from the appearance of the S'irás in their foetal state.

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Chap. VII.] SARIRA STHANAM. 193

Pitta-carrying and Kapha-carrying channels in the respective regions of the body), with the exception that in these three cases, ( Pitta, Kapha and blood ) ten occur in the eyes and two in the ears in lieu of eight and four respectively, as in the case of Váyu-carrying Sírás (vessels). Thus we have described the seven hundred Sírás with their branches. 7.

Memorable Verses-The Váyu-carrying Sírás :-The Váyu in its normal state and coursing through its specific Sírás (vessels) helps the unobstructed performance of its specific functions viz., expansion, contraction, speech, &c., and produces the clearness and non-illusiveness of Buddhi ( intellect ) and the sense-organs, whereas a coursing of the said Váyu in a deranged condition through the aforesaid Sírás (vessels), gives rise to a host of such diseases as are due to the derangement of Váyu. 8.

The Pitta-carrying Sírás :-The Pitta in its normal state and coursing through its specific Sírás (vessels) produces the healthy glow of complexion, relish for food, kindling of the appetite, healthfulness and other good effects, characteristic of the Pitta, which however being aggravated and coursing through them gives rise to a host of Pittaja diseases. 9.

The Kapha-conveying SiráS :-The Kapha in its normal state and coursing through itsspecific Sírás (vessels) smoothes and contributes to the firmness of the limbs and joints, improves the strength and produces all other good effects specially belonging to it, whereas the same Kapha, flowing through them in an aggravated condition, ushers in a large number of the Kaphaja distempers of the body. 10.

The Rakta-carrying SiráS :-The blood in its normal state and flowing through its specific Sírás

25

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of the Kurchicha-Sirah) as well as the three internal ones, of which two are known as the Urvi-veins and the other as the Lohitaksha, together with the corresponding ones in the other leg and in the two hands, thus making sixteen in all, which are situated in the upper and lower extremities, should be held unfit for opening. Of the thirty-two veins in the pelvic region (Sroni), eight such, known as 'the four) Vitapas (two on each side of the testicles) and the four known as the Katika-tarun as (two on cach side) should be considered unfit for bleeding or opening. Of the sixteen veins (eight on each side) at the sides, the one which courses upward from each of the two sides and is attached to the Marma known as the Parsva-Sandhi, should be considered unfit for similar purposes. Of the twenty-four Siras which are found in either side of the spinal column, an incision should not be made into any of the two Siras (on each side) known as the Vrihati and which run upward along either side of it (spinal column). Similarly of the twenty-four Siras in the abdomen, the two along each of the two sides of symphis pubis should be held unfit for opening or bleeding. Of the forty veins in the chest, the two in the heart, two in the root of each breast and two in each of the Stana-rohita (muscle of the breast) and one in cach of the Apastambhas and Apalapas, making fourteen in all, should not be opened. Thus thirty-two Siras In the regions of the back (i. e., the sides and the pelvic regions), the abdomen and the chest should be regarded as unfit for opening or other surgical purposes.

There are one hundred and sixty-four Siras in the region above the clavicles. Of these the eight and four (making twelve and respectively known as the eight Matrikas, the two Nilás and the two Manyás) out of the fifty-six in the neck and the throat, should be

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in each of the two Utkshepa-Marmas, one in each of the (five) Simanta-Marmas and one in the Adhipati-Marma, should be held unfit for the purpose. No incision or opening should be made into any of these fifty vessels situated in the region above the clavicles. 23-31.

Memorable verses :-As the stem and leaves etc., of a lotus plant, originated from its bulb, spread over the whole surface of a pool or tank (lit: water), so the vessels emanating from the umbilicus of a man spread over his whole organism. 32.

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Chap. VIII.] SARI˙RA STH˙ANAM. 199

blood-poisoning (such as snake-bite etc.) and in fatal diseases (Vidradhi etc.). 3-4.

Preliminary rules :-The patient should be duly fomented (Sweda) and anointed (Sneha) with oily preparations.

A liquid* food or diet consisting of articles which are antidotal to the bodily principles (Doshas) which engendered the disease or Yavágu (gruel) should be given to him at first.

Then at the proper season (i.e., not in the rainy or winter season etc.) the patient should be brought near the surgeon and made to sit or lie down and the part to be incised upon should be bound, neither too loosely (e.g., in the extremities etc.) nor too tightly (e.g., in the head etc.), with any of the accessories, such as cloth, linen, skin, the inner fibres of a bark, creepers etc., so as not to create any pain or agitation in his mind.

Then the vein should be duly opened with proper instrument (and with a careful regard to the situation of any local Marma). 5

Metrical text :-Venesection should not be performed in an extremely cold or hot, cloudy or windy day.

It is forbidden to open a vein without necessity or in a healthy person, or in a disease in which such as a proceeding is absolutely prohibited.

The Yantra-Vidhi :-The patient whose vein is to be operated upon should be seated on a stool to the height of an Aratni (distance of the elbow from the tip of the small finger) with his face turned towards the sun.

He should keep his legs in a drawn up or contracted posture resting his elbows (Kurpara) on his knee-joints and the hands with his two thumbs closed in his fists placed on (the upper ends of) his Manyás (sterno mastoid muscles),

Then having cast the binding

• A liquid food is recommended for the purpose of liquefying the blood so as to bleed easily.
  

THE SUSHRUTA SAMHITA

linen on the two closed fists thus placed on the neck, the surgeon should ask another man from the back side of the patient to take hold of the two ends of the cloth with his left hand having the palm turned upward, and then ask him to tie up with his right hand the bandage round the part, neither too diffusely nor too tightly nor too loosely, so as to raise the vein and to press the bandage round the back for a good out-flow of blood. Then he (surgeon) should perform the operation in the desired spot, the patient having been previously asked to sit with his mouth full of air (i.e., he should confine his breathing till the surgical operation is completed). This proceeding should be adopted in opening any vein of the head, save those which are situated in the cavity of the mouth.

In the case of opening a vein (Sirá) in the leg, the affected leg should be placed on a level ground, while the other leg should be held in a somewhat contracted posture, at a little higher place. The affected leg should be bound with a piece of linen below its knee-joint and pressed with the hands down to the ankle. A ligature of the above kind should then be tied four fingers above the region to be incised upon, after which the vein should be opened.

In the case of opening a vein (Sirá) in the arms, the patient should be caused to sit easily and fixedly with his two thumbs closed in his fists (as above). A ligature of the above-mentioned kind (rope etc.,) should be tied (four fingers above the part to be incised upon and the vein opened in the aforesaid manner. The knee-joint and the elbow should be held in a contracted or drawn up posture at the time of opening a vein in a case of Gridhrasi (Sciatica) and Visvachi, respectively. The patient should hold his back raised

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and successfully pierced vein bleeds in streams (almost simultaneously with the thrusting of the knife) and spontaneously stops after a Muhurta (a little while). The vitiated blood is seen first to flow out of an opened vein, like the drop of yellow pigment first coming out of a Kusumbha flower. Blood does not flow out from an incision made into a vein of an unconscious (Murchchhita), much frightened, or a thirsty patient. An incision of a vein without proper bandaging and raising up is attended with a similar result.

20-23.

A weak person, or one affected with the unusual derangement of the bodily Doshas etc., or one fainted (under operation), should not be subjected to a measure of continuous blood-letting at a time; instead of that, the vein should be opened afresh in the same afternoon or on the following day, or on the third day (as the exigency requires). An intelligent surgeon should not allow the flow of blood to an excess but should stop the flow even with a remnant of the diseased blood in the system and administer soothing internal remedies (Sams'amana) for the purification of the diseased remnant.

24-26.

Bleeding to the quantity of a Prastha* measure should be deemed sufficient for a strong and adult patient, stuffed with a large quantity of the deranged Doshas (in the body).

The vein should be incised with a Vrihimukha instrument at a distance of two fingers above the seat of the Kshipra-marman in such diseases as Pádadáha, Páda-harsha, Ava-váhuka, Chippa, Visarpa, Váta-rakta, Váta-kantaka, Vicharchiká, Pádadári etc.

The mode of opening a vein in the case of Slipada (Elephantiasis)

• In medicinal preparations, a Prastha measure is understood to be four seers in the case of liquids, but in cases of excreta due to emetic and purgative measures and of blood-letting, a Prastha is meant to be thirteen Palas and a half only.

[Chap. VIII. ŚARĪRA STHANAM.]

would be described under the treatment of that disease. In Vāta-rogas, such as Kroshtuka-śirah (Synovites), maimedness (Pangu) and lameness (Khanja), the Śirá (vein) of the Janghá (lower leg-calf), four fingers above the Gúlpha, should be opened. In cases of Apachi (scrofula), the vein should be opened simultaneously with the appearance of the disease two fingers below the Indravasti-marına. In a case of Gridhrasi (sciatica), the vein should be opened four fingers above or below the Jánu (knee-joint). In a case of goitre, the veins attached to the roots of the Uru (thighs) should be opened. The instructions regarding the opening of a vein in one leg shall hold good in the case of that in the other, as well as in cases of those situated in the two upper extremities (hands), but the speciality is that in a case of enlarged spleen, the vein near the Kurpara-sandhi (elbow-joint) of the left hand or that inside the fourth and the fifth fingers should be opened. Similarly in a case of Yakriddályodara or Kaphodara, the corresponding vein in the right hand should be opened. Several authorities advise the opening of the same vein in cases of cough and asthma* due to the action of the deranged Kapha. 27-35.

In a case of Viśvachi, the same argument holds good (four fingers above or below the Kurpara-sandhi) as in a case of Gridhrasi. In a case of Praváhiká (diarrhœa) attended with Śula (colic), the vein within two fingers width around of the Pelvis (Śroni) should be opened. The vein of the penis should be opened in a case of Parikartiká (D.R.-Parivartiká), Upadanśa, Śuka-dosha and seminal disorders. The vein on either side of

• Gayi holds that in cases of asthma and cough venesection should be had recourse to only when they are in a mild form.

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A vein with a large incision in its body made with a sharp and flat-edged instrument, is called Atyudirná (improperly wide-incised). An opened vein in which blood oozes out in small quantity is called Ante-abhihatá (struck in the interior). An opened vein in an anæmic patient (marked by a total absence of bleeding and) stuffed with Váyu (lit., as if the flow has been dried up by the Váyu), is called Parisúshká (dried up). A vein opened but to a quarter part of the proper length and attended with a scanty outflow of blood, is called Kunitá (partially incised). A vein which trembles owing to its being bandaged at a wrong place and from which blood does not flow out in consequence, is called Vepitá (quivering). A vein incised without being previously properly raised up and attended with a similar result (i e., absence of blood), is called Anutthita-viddhá. A vein cut into two and attended with excessive bleeding and inoperativeness of the organ is called Sastrahatá (knife-cut). A vein incised with an instrument applied slantingly and (consequently) not fully opened, is called Tiryag-viddhá (obliquely incised). A vein incised several times and (every time) with an improper instrument, is called Apaviddhá (wrongly incised). A vein unfit for opening (i.e., whose opening has been forbidden in the Sástras), is called Avyádhyá (unfit for opening). A vein opened carelessly and hastily is called Vidrutá (erratic). A vein bleeding continuously owing to its being repeatedly pressed and successively opened, is called Dhenuká. A vein variously cut owing to its being pierced into the same part with an extremely slender-pointed instrument, is called Punah-punarvidahá (repeatedly incised). If a vein in the Snáyu-mármas, the Asthi-marmas, the Sirá-marmas or the Sandhi-marmas be opened, it is

206

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CHAPTER IX.

Now we shall discourse on the Śáriram which treats of the description of the arteries, nerves and ducts, etc.* (Dhamani-Vyákarana-Śáriram). 1. There are twenty-four Dhamanies (ducts) in all, and all of them have their origins in the naval region (which includes the whole abdominal region†). Several authorities assert that no arbitrary distinctions should be made among the Siras (veins), Dhamanis (arteries), and the Srotas, (channels), since Dhamanis and Srotas are but different modifications of one original kind of Sirá (vessels). But this opinion is not a sound one inasmuch as they have got different natures, origins and functions and as being described so in the Áyurveda. But owing to their adjacent positions, the existence of several authoritative dicta (Ápta-vák) regarding the oneness of their character, similarity of their functions, and the minute nature of their shape, they appear to be homologus in their action, even amidst the real diversities in their work and office. 2. Of the twenty-four Dhamanis, which (originally) have their roots in the naval region (Nábhi), ten have upward course, ten have downward course, and four flow laterally or transversely. 3. Functions of the up-coursing Dhamanis :– The ten up-coursing Dhamanis (nerves)

• Sans. Dhama—to be filled with air, so called from the fact of their being distended with air after death. + So far, as in foetal life, allantoic arteries and the umbilical veins subserve the purposes of nutrition, excretion, etc., and reflects the rudimentary vascular system.

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integrity of the parts of the body below the naval region, such as the Pakvás´aya (Intestine), the waist, the organic principles of stool and urine; the organs of generation; the anus, the bladder, and the lower limbs of the body (Sakthi) (according to their utiñity in the physical economy of the organism).

6. Memorable Verse :-These down-coursing Dhamanis perform the afore-said functions. Now I shall describe the specific functions (i.e., nàture, office, and situations, etc.,) of the lateral-coursing Dhamanis.

7. Functions of the lateral-coursing Dhamanis:-The four lateral-coursing Dhamanis, gradually ramifying themselves into hundreds and thousands of branches, simply baffle counting. The net-work of these Dhamanis spreads over the whole orgnism and maintain its integrity. Their exterior orifices are attached to the roots of hairs (pores of the skin) through which they convey the perspiration and the Rasa (serum), thus supplying the body, both internally and externally, with the soothing nutritions (moisture of healthy lymph-chyle).

The effects and potencies of the articles of anointment, sprinkling, immersion, and plasters, enter through these orifices into the internal organism through the agency of the heat in the skin, and sensations of a pleasant or painful contact are experienced through their instrumentality.

Thus we have finished describing the four lateral-coursing Dhamanis with their ramifications throughout the whole organism.

8. Memorable Verses :-The Dhamanis have got pores in their sides through which they carry the Rasa (lymph-chyle) throughout the organism, like the filaments and fibres of water-lily and lotus.

These Dhamanis furnish the self-conscious Ego, confined in

Chap. IX.] SARIRA STHANAM.

the material body, which is the resultant of the combination of the five material elements, with a distinct sensation* peculiar to each of the five sense-organs† and break up the combination (of the five material elements) at* the time of death. 9—10.

Now we shall describe the symptoms produced by a Srota (duct or channel) pierced at its root or starting point. The ducts or channels respectively conveying the life, the food, the water, (the organic principle of) the Rasa (serum), the blood, the muscles, the fat, the urine, the stool, the semen, and the catamenial blood, naturally fall within the scope of Surgery (Śalya-tantra). Several authorities assert that the Srotas (vessels) are innumerable‡, and perform different functions in their different aspects.

The two Srotas (channels) of Prána (bronchi) have their roots in the heart and the Rasa-carrying Dhamanis (pulmonary arteries). An injury to any of these Srotas (vessels) produces groaning, bending down of the body, loss of consciousness (Moha), illusion, and shivering, or may ultimately prove fatal. The food-carrying Srotas (Œsophagus) have their roots in the Ámásaya (stomach) and in the food-carrying Dhamanis (intestines). An injury to or piercing of such a duct (Srota), gives rise to tympanites, colic pain, aversion to food, vomiting, thirst, blindness or darkness of vision, or may even end in death. There are two water-carrying (Udaka-vaha) ducts or channels which have their roots in the palate and the Kloma, and a pie!cing of any

• Hearing, touch, smell, taste, and sight.

† Eyes, ears, nose, tongue and skin.

‡ But this science does not take any cognisa nce of them, since the pain incidental to a piercing of, or an injury to, any of these extremely attenuated channels, must be slight in its charaçter.

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CHAPTER X.

Now we shall discourse on the Śáriram which treats of the nursing and management, etc., of pregnant women from the day of conception till parturition (Garbhini-Vyákarana-Śáriram). I. General Rules :- An enciente, from the first day of conception, should always cherish a clear joyful spirit in a clean body. She should wear clean and white garments, ornaments, &c., engage herself in the doing of peace-giving and benedictory rites and live in devotion to the gods, the Brahmins and her elders and superiors. She should not touch nor come into contact with unclean, deformed or maimed persons, and should forego the use of. fetid smelling things, avoid dreadful sights and painful or agitating sounds and the use of dry, stale and dirty food as well as that prepared overnight. Long and distant walks from home, resorts to cremation-grounds or to a solitary retreat, or to a Chaitya*, and sitting under the shadow of a tree should be absolutely forbidden (to her during the period of gestation). Indulgence in anger, fright or other agitating emotions of the mind should be deemed injurious. To carry a heavy load, to talk in a loud voice and all other things which might occasion injury to the foetus, (sexual intercourse, &c.) should be refrained from. The practice of constant anointment and the cleansing of the body, &c., (with Ámalaki, Haridrā, etc. -lit. cosmetics) should be given up. All fatiguing exercises should be discontinued and the rules laid down for the

• Chaitya—is a haunted or died tree, or according to others a Budhhistic monastery.

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the child her breast. (This rule should be observed at the time of tending the child every day). 13-14.

Treatment of the mother :-The body of the mother should be anointed (after parturition) with the Valá-Taila and treated both internally and externally with a decoction of Vàyu-subduing drugs (such as the Bhadra-Dárvddi group, etc.). If still there be any abnormality in the condition of the Doshas (the discharge of vitiated blood i e., lochia), the mother should be given to drink a luke-warm solution of treacle mixed with powders of Pippali, Pippali roots, Hasti-pippali, Chitraka and S'ringavera, and the medicine should be continued for two or three days or longer, (if necessary), till the disappearance of the vitiated blood (lochia). When the discharge gets normal (i e., on the appearance of healthy lochia), the mother should be made to take for three days a gruel (Yavágu) prepared with the decoction of the drugs constituting the Vidári-Gandhadi Gana and mixed with (a good quantity of) clarified butter or a Yavágu prepared in milk. After that a meal of boiled Sáli-rice and a broth made from the meats of Jangala animals boiled with barley, Kola and Kulattha pulse, should be prescribed for her, taking into consideration the strength and the condition of her appetite (Agni or digesting power). The mother should observe this regimen of diet and conduct for one month and a half (after delivery). After this period she may be at liberty to choose any food to her liking and revert to her natural mode of living. According to several authorities, however, a woman does not regain her natural temperament of body till the reappearance of the healthy menstruation (after parturition). 15.

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roots should be applied to the palms and soles of her hands and feet ; or the milky juice of Snuhi tree should be applied over her scalp ; or a compound made of pasted Langali roots and Kushtha mixed with either wine or the cow's urine should be given her for drink. A Kalka either of S'áli roots or of the drugs constituting the Pippalyadi Gana mixed with wine (Surá) should be given her for the purpose In the alternative, an Ásthápaṇa (enema) of white mustard seeds Kushthá (Kuda), Langali, and the milky juice of Mahá-vriksha, mixed with Surá-manda should be prescribed. (If the above measures fail) an Uttara-Vasti (uterine douche) prepared with the aforesaid drugs and boiled in mustard oil should be applied ; or else the placenta should be removed by the hand lubricated with an oleaginous substance and with the nails clipped off.

18. Makkalla and its Treatment :-The lochia of a newly delivered woman whose organism has become excessively dry on account of profuse use of absorbants or deranged by any other causes,–the lochia being obstructed in its exit by the local Váyu,–gives rise to Granthis (nodules) which may appear below the navel, on the sides of the pelvis about the region of the bladder or of the pubis. Severe piercing pain (Śula) is felt about the region of the navel, the stomach and the bladder and a sensation of pricking with needle and cutting pain in the intestines. At the same time the abdomen becomes distended with the retention of urine. The:se are the symptoms of Makkalla. In such a case, a decoction of the drugs of the Viratarvadi Gana mixed with a powdered compound of the Ushakddi Gana should be given her. In the alternative; a potion of carbonate of potash (Yavakshdra) dissolved in tepid water or in clarified butter ; of rock-

salt dissolved in the decoction of the Pippalyáddi Gana; of a compound made of the powdered drugs of the latter Gana with Surá-manda ; of the powders of cardamom and Pancha-kolas dissolved in the decoction of the drugs of the Varunádi Gana ; of the powders of pepper and Bhadra-dru dissolved in the decoction of the Prithakparnydi Gana ; or of pulverized Trikatu, Chaturjátaka and Kustum-buru mixed with old treacle ; or of simple Arishta, should be prescribed.

Management of the Child :-The baby being wrapped up in silk should be laid on a bed covered with a silken sheet ; it should be fanned with the branches of a Pilu, Nimba, Vadari, or Parushaka tree. A (thin´) pad (Pichu) soaked in oil should be constantly kept on the head of the child, and its body should be fumigated with the fumes of drugs (e.g., Vacha, mustard, etc.) potent enough to keep off the (evil) influences of demons and evil spirits. The same drugs should be tied round the neck, hands, legs and head of the infant and the floor of the lying-in room should be kept strewn over with powdered sesamum, mustard, linseed (Atasi). A fire should also be kept kindled in the chamber. Measures laid down in the chapter on the nursing of an Ulcer-patient (chapter IX. Sutra.) should be observed in the present case as well.

Then on the tenth day of its birth the parents having performed the necessary rites of benediction and celebrated the occasion with suitable festivities, shall give the child a name of their own choice or one determined by its natal astrism, etc.

Lactation and selection of a wet-nurse :-For the healthy gro´nth of the child a wet-nurse should be selected from among the matrons of its own caste (Varna), and possessed of the following

THE SUSHRUTA SAMHITA

necessary qualifications. She should be of middle stature, neither too old nor too young (middle-aged), of sound health, of good character (not irascible or easily excitable), not fickle, ungreedy, neither too thin nor too corpulent, with lips unprotruded, and with healthy and pure milk in her breasts which should neither be too much pendulent nor drawn up. It should be carefully observed that her skin is healthy and unmarked by any moles or stains, she being free from any sort of crime (such as gambling, day-sleep, debauchery, etc.). She should be of an affectionate heart, and with all her children living. She should be of respectable parentage and consequently possessed of many good qualities, with an exuberance of milk in her breasts, and not in the habit of doing anything that degrades woman in life. A "Śyāmā" girl possessed of the aforesaid qualities makes a good wet-nurse. A child nursed at the breast of a woman with upturned or unprominent nipples is apt to be deformed (Karāla) in features, while extremely pendulous (large and flabby) breasts may suffocate the child by covering its mouth and nostrils. Having chosen a wet-nurse of the commendable type, the child with its head well-washed should, on an auspicious day, be laid on her lap wrapped in a clean and untorn linen. The face of the child should be turned towards the north, while the nurse should look to the east at the time. Then, after first having a small quantity of the milk pressed out and the breast washed and consecrated with the following Mantras (incantations) the child should be made to suck her right breast.

Metrical Texts

"O, thou beautiful damsel, may the four oceans of the earth contribute to the secretion of milk in thy breasts for the purpose of im-

Chap. X.] SARIRA STHANAM. 227

proving the bodily strength of the child. O, thou with a beautiful face, may the child, reared on your milk, attain a long life, like the gods made immortal with drinks of ambrosia". 22.

A child nursed at the breast of any and every woman for want of a nurse of the commendable type, may fall an casy prey to disease, owing to the fact of the promiscuous nature of the milk proving incongenial to its physical temperament. The milk of a nurse not being pressed out and speld off at the outset may produce cough, difficulty of breathing, or vomiting of the child, owing to the sudden rush of the accumulated milk into its throat choking up the channels. Hence a child should not be allowed to suck in such milk. 23.

The loss or suppression of the milk in the breasts of a woman is usually due to anger, grief, and the absence of natural affection for her child, etc. For the purpose of establishing a flow in her breast, her equanimity should be first restored, and diets consisting of Śáli-rice, barley, wheat, Shashtika, meat-soup, wine (Surá), Souviraka, sesamum-paste, garlic, fish, Kas'eruka, S'ringátaka, lotus-stalk, Vidári-kandá, Madhuka flower, S'attzari, Naliká, Alávu, and Kála-S'áka, etc., should be prescribed. 24.

Examination, etc., of milk : —The breast-milk of a nurse or a mother should be tested by casting it in water. The milk which is thin, cold, clear, and tinged like the hue of a conch-shell, is found to be easily miscible with water, does not give rise to froths and shreds, and neither floats nor sinks in water, should be regarded as pure and healthy. A child fed on such milk is sure to thrive and gain in strentgh and health. A child should not be allowed to take the breast of a hungry, aggrieved, fatigued, too thin, too corpulent, fevered, or a pregnant wōman, nor of one in

THE SUSHRUTA SAMHITA

whom the assimilated food is followed by an acid reaction, or of one who is fond of incongenial and unhealthy dietary, or whose fundamental principles are vitiated. A child should not be given the breast until an adminis-tered medicine is assimilated in its organisin, lest this should give rise to a violent aggravation of the pharmacological action of the medicine, as well as of the deranged Doshas (Váyu, Pitta, etc.), and the refuse matters (Malas) of its body.

Memorable Verses

The Doshas (Váyu, Pitta and Kapha) of a wet-nurse are aggravated by ingestion of indigestible or incompatible food, or of those articles which tend to derange the Doshas of the body, and hence her milk may be vitiated. A child, fed on the vitiated milk of a woman, vitiated by the deranged Doshas owing to injudicious and intemperate eating and living, falls an easy prey to physical disease. An intelligent physician in such a case should devise means for the purification of the milk as well as of the deranged Doshas which account for such vitiation (inasmuch as the medication of the child alone will not produce any satisfactory effect).

Infantile diseases and their Diagnosis

A child constantly touches its diseased part or organ and cries for the least touch (by another of that part of its body). If the seat of disease be its head, the child cannot raise nor move that organ and remains with its eyes closely shut. A disease seated in its bladder gives rise to retention of urine, thirst, pain and occasional fainting fits. A retention of urine and stool, discolouring of complexion, vomiting, distention of the abdomen, and gurgling in the intestines indicate the seat of the disease to be its Koshtha (colon). A constant crying (and the child's refusal to be consoled)

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Metrical Texts :-In the case of any disease of a child nursed at the breast, the breasts of the nurse should be plastered with the pastes of drugs recommended by physicians for the particular malady (instead of giving the drugs to the child), and the child made to suck the same. The use of clarified butter is not beneficial to a child on the first day of an attack of Vata-jvara (fever due to the derangement of the bodily Vayu), within the first two days of an attack of Pittaja fever, and within the first three days of that of Kaphaja fever. But the use of clarified butter may be prescribed for an infant fed on milk and boiled rice, or on boiled rice alone, according to requirements. 30-31.

In case of fever a child should be given no suck at all, lest the symptoms of thirst might develop. Purgatives, Vastis, or emetics are forbidden in the disease of children, unless the disease threatens to take a fatal course. 32.

If the local Vayu aggravated by the waste of brain-materials (Mastulunga), bends down the palate bone of a child attended with an excessive thirst and agony, clarified butter boiled with (the decoction and Kalka of) the drugs of the Madhura Gana, should be used both internally and externally, and the patient should as well be treated with spray of cold water (to stimulate him). The disease in which the navel of a child becomes swollen and painful, is called Tundi. It should be remedied by applying fomentations, medicated oils, Upanahas, etc., possessed of the virtue of subduing the Vayu. A suppuration of the anal region (Guda-paka) of a child should be treated with Pittaghna (Pitta-destroying) measures and medicines. Rasanjana used internally and externally (as an unguent) proves very efficacious in these cases, 33-35.

Infantile Elixirs :-Clarified butter cooked with (the decoction and Kalka of) white mustard seeds, Vachá, Mánsi, Payasyá, Apámárga, S'atdhavari, Sárivá, Bráhmi, Pippali, Haridrá, Kushtha and Saindhava salt should be given to an infant fed exclusively on milk. Clarified butter prepared with (the docoction and Kalka of) Madhuka (Yashtimadhu), Vacha, Chitraka, Pippali and Triphalá should be given to an infant fed both on milk and (boiled) rice (solid and liquid food). Clarified butter boiled with (the decoction and Kalkaof) Das'amula, milk, Tagara, Bhadradarú, Maricha, honey, Vidanga, Drákshá and the two sorts of Bráhmis should be given to an infant fed on (boiled) rice (solid food). By these the health, strength, intellect and longivity of the child is improved.

36-37.

A child should be so handled or lifted as not to cause any discomfort. A baby should not be scolded, nor suddenly roused up (from sleep), lest it might get awfully frightened. It should not be suddenly drawn up nor suddenly laid down, lest this should result in the derangement of its bodily Váyu. An attempt to seat it (before it has learnt to sit steadily), may lead to haunch-back (Kyphosis). Lovingly should a child be fondled and amused with toys and play-things. A child unruffled by any of the above ways becomes healthy, cheerful and intelligent as it grows older. An infant should be guarded against any exposure to the rains, the sun,or the glare of lightning. He should not be placed uder a trec or a creeper, in low lands, and in lonely houses or in their shades (caves); and it should be protected from the malignant influences of evil stars and occult powers.

Metrical Texts :-A child should not be left (alone) in an unclean and unholy place, nor under the sky

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234 THE SUSHRUTA SAMHITA. [Chap. X.

Medical Treatment :-In a case of pain under the circumstances, the enciente should be made to drink a potion consisting of milk boiled with Mahd-saka, Kshudrasahá, Madhuka flower, S'vadanstrá and Kantakári, mixed with sugar and honey. In the case of retention of ùrine, the patient should be made to drink a potion of milk boiled with drugs known as the Dárvádi Gana (mixed with sugar and honey). In the case of A'náha (retention of stool attended with distention of the abdomen), a potion consisting of milk boiled with asafetida, Sauvarchala salt, garlic and Vacha (mixed with honey and sugar) should be given. In cases of excessive bleeding, linctus made of the powdered chamber of a Koshthágáriká insect *, Samangá, Dhátaki flowers, Navamliká, Gairika, resin and Rasán-jana, or of as many of them as would be available, mixed with honey, should be licked. In the alternative, the bark and sprouts of the drugs known as the Nya-grodhádi Gana mixed with boiled milk should be administered, or a Kalka of the drugs of the Utpaládi group mixed with boiled milk should be used, or a Kalka of S'áluka, S'ringátaka and Kas'eru mixed with boiled milk should be given. As a further alternative, the enciente may be made to eat cakes made of powdered Sáli rice with the decoction of Udumbara fruit and Audaka-kanda, mixed with honey and sugar. A piece of linen or a plug soaked in the expressed juice of the drugs of the Nyagrodhádi group should be inserted into the passage of the vagina. 47.

In a case of pain unattended with bleeding, the enciente should be made to drink a potion compused of milk-boiled with Madhuka (Yashtimadhu), Devadáru and

• There is a kind of insect which makes its chamber with earth generally under the ceiling or on the walls. This earth should be used.

Payasyd ; or with As'mantaka, Satdvari and Payasyd ; or with the drugs of the group of Vidarigandhadi Gana ; or with Vrihati, Kantakdri, Utpala, S'atdvari, Sarivd, Payasyd and Madhuka (Yashtimadhu). These remedies speedily applied tend to alleviate the pain and make the foetus steady in the womb. 48.

After the foetus has been steadied by the aforesaid mesaures, a diet consisting of (boiled rice and) cow's milk, boiled with the dried tender fruits of Udumvara, should be prescribled for the patient. In the event of miscarriage, the patient should be made to drink a Yavagu (gruel) of the Uddalaka rice, &c., cooked with the decoction of the Pachaniya group (Pippalyadi) and devoid of all saline and fatty matter, for a number of days corresponding to that of the month of gestation.

Old treacle mixed with the powdered drugs of the Dipaniya group (Panchakola), or simply some Arishta (Abhayarishta, etc.), should be given, in the event of there being pain in the pelvis, bladder and abdomen. 49.

The internal ducts and channels (Srotas) stuffed with aggravated Vayu lead to the weakening (Laya) of the foetus and, if the state continues, it leads even to its death. Hence the case should be treated with mild anointing measures, etc., (Sneha-karma, etc.,) and gruels made of the flesh of the birds of the Utkrosa species and mixed with a sufficient quantity of clarified butter, should be given to her.

As an alternative, Kulmasha boiled with Masha, sesamum and pieces of dried (tender) Vilva fruit should be given her, after which she should be made to drink, for a week, honey and Maddhvika (a kind of weak wine).

At the non-delivery of the child * "Kulmasa" may mean either Kulattha pulse or half boiled wheat, barley, etc.

even after the lapse of the full term of gestation, the enciente should be made to thrash corn with a pestle in an Udukhala or mortar (husking apparatus) or should be made to|sit or move (on legs or by conveyance), on an uneven ground. 50.

Atrophy of a fœtus in the womb should be ascribed to the action of the deranged Váyu. This is detected by the comparatively lesser fulness of the abdomen of the enciente and slow movement of the fœtus in the womb. In such a case, the enciente should be treated with milk, with the Vrimhaniya (of restorative and constructive properties) drugs, and with meat-soup.* 51.

A combination of ovum and semen affected by the deranged Váyu in the womb, may not give rise to a successful fecundation (living impregnated matter), but leads to a distention of the abdomen (as in pregnancy), which again, at any time, may disappear of itself. And this is ascribed by the ignorant to the malignant influence of Naigamesha (spirits). Such an impregnated matter, sometimes lying concealed in the uterus, is called Nágodara, which should be treated with the remedies laid down under the head of Lina-Garbha (weak fœtus). 52.

Now we shall discourse on the management of pregnancy according to the months (period) of gestation.

Metrical Texts :-The following recipes, such as, (1) Madhuka (Yashtimadhu), S'ákavija, Payasyá, and Devadáru ; (2) As'mantaka, black sesamum, pippali, Manjíshthá, Támra-valli and Satávarí ; (3) Vrikshádani, Payasyá, Latá (Durvá), Utpala and Sárivá ; (4) Anantá, Sárivá, Rásná; Padma, and Madhuka (Yashtimadhu) ;

• The particle "cha" in the text signifies the use of any other constructive tonic.

(5) Vrihati, Kantakári, Kás'mari, sprouts (Súnga) and barks of milk-exuding trees (as, Vata, etc.), and clarified butter† ; (6) Pris'ni-parni, Valá, Sigru, S'vadanshtrá and Madhuparniká ; and (7) S'ring'taka, Visa (stalks of lotus), Drákshá, Kas'áru, Madhuka (Yashtimadhu), and sugar ; should successively be given with milk* to an enciente, from the first to the seventh month of her gestation, in the case of a threatened miscarraige or abortion. 53.

An enciente should be made to drink milk boiled with the roots of Kapittha, Vrihati, Vilva, Patola, Ikshu and Kantakári, (in case of impending or thrcatened miscarraige) in the eighth month of her pregnancy. In the ninth month (and under similar conditions), the potion should be made up of Madhuka (Yashtimadhu), Ananta-mula, Payashá and Sárivá. In the tenth month (and under similar conditions), a potion consisting of milk boiled with Sunthi and Payasyá is benéficial,or, in the alternative, may be given a potion made up of milk with Sunthi, Madhuka (Liquorice; and Devadáru. The severe pain would vanish and the foetus would continue to develop safely in the womb, under the aforesaid mode of treatment. 54–57.

A child born of a woman, who had remained sterile (not-conceived) for a period of six years (Nivitta-prasavá)* after a previous chiłd-birth, becomes a short-lived one. 58.

• Chakradatta reads "Visam" (stalks of lotus) instead of "Gbritam" (clarified butter).

† If a conception does not occur in a woman for a period of more than five years after a child-birth, she is called Nivritta-prasavá.

• Sivádása also says that powders of these drugs should be given with boiled milk, but he adds that some authorities recommend theae drugs to be boiled in milk according to Kshira-páka-vidhi.

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THE SUŚRUTA SAMHITĀ CHIKITSĀ-STHĀNAM

CHAPTER I.

Now we shall discourse on the medical treatment of the two kinds of inflamed ulcers (Dvivraniya Chikitsitam).

Ulcers may be grouped under two heads according as they are Idiopathic or Traumatic in their origin.

The first group includes within its boundary all ulcers that are caused through the vitiated condition of the blood or the several deranged conditions of the Váyu, Pitta and Kapha, or are due to their concerted action (Sannipáta),

while the second group embraces those which are caused by the bites of men, beasts, birds, ferocious animals, reptiles or lizards, or by a fall, pressure and blow, or by fire, alkali, poison, or irritant drugs, or through injuries inflicted by pointed wood, skeletal bones*, horns, discus, arrows, axes, tridents, or Kuntas (a kind of shovel), or such other weapons.

Although both these classes of ulcers possess many features in common, they have been grouped under two distinct heads on account of the diversity of their origin,

• Fragments of broken pottery.—Dallana.

THE SUSHRUTA SAMHITA

Dvivraniya. 2.

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The Váta-Pittaja Type :-An ulcer due to the concerted action of the deranged Váyu and Pitta is marked by a pricking and burning pain and a red or vermilion colour. A sensation of fumes arising out of it (is also felt) and the ulcer exudes a secretion which partakes of the characteristic colours of both the deranged Váyu and Pitta. An itching and piercing pain is felt in the ulcer due to the combined action of the deranged Váyu and Kapha (Kapha-Vátaja type), which becomes heavy and indurated, constantly discharging a cold, slimy secretion. An ulcer resulting from the deranged condition of the Pitta and Kapha (Kapha-Pittaja type) becomes heavy, hot and yellow. It is marked by a burning sensatian and exudes a pale, yellow-coloured secretion. An ulcer marked by the aggravated condition of the deranged Váyu and blood (Váta-Raktaja type) is dry and thin and is largely attended with a piercing pain and anæsthesia. It exudes blood or a vermil-coloured secretion and is marked by the combined hues respectively peculiar to the deranged Váyu and blood. An ulcer due to the combined action of the deranged Pitta and blood (Rakta-Pittaja type) is marked by a colour which resembles the surface cream of clarified butter. It smells like the washing of fish, is soft, spreading (erysipelatous), and secretes a hot blackish matter. An ulcer due to the combined action of the deranged Kapha and blood (Kapha-Raktaja type) is red-coloured, heavy, slimy, glossy and indurated. It is usually marked by itching and exudes a yellowish bloody secretion. An ulcer due to the concerted action of the deranged Váyu, Pitta and blood (Váta-Pitta-Raktaja type) is marked by a sort of throbbing, pricking and burning pain. It discharges a flow of thin yellowish

242

CHIKITSA STHANAM

Chap. I.]

blood and produces a sensation, as if fumes were escaping (out of its cavity). An ulcer due to the concerted action of the deranged Váyu, Kapha and blood (Váta-Śleshma-Raktaja type) is usually attended with itching, throbbing and tingling sensations and thick, grey, blood-streaked discharge.

An ulcer associated with the deranged Kapha, Pitta, and blood (Kapha-Pitta-Raktaja type) is largely attended with redness, itching, suppuration and burning sensation. It emits a thick, greyish, bloody secretion.

An ulcer marked by the concerted action of the deranged Váyu, Pitta and Kapha (Sánnipátika) is attended with diverse kinds of pain, secretion, colour, &c., peculiar to each of these types.

An ulcer associated with the combined action of the deranged Váyu, Pitta, Kapha and blood (Váta-Pitta-Kapha-Raktaja type) is attended with a sensation, as if it were being burnt and lacerated.

It is largely accompanied by throbbing, itching sensation, a sort of pricking and burning pain, with complete anæsthesia in the locality; redness, suppuration, various other kinds of colour, pain and secretion are its further characteristics.

10—20.

An ulcer (Vrana) which is of the same colour with the back of the tongue, soft, glossy, smooth, painless, well-shaped and marked by the absence of any kind of secretion whatsoever, is called a clean ulcer (Suddha-Vrana).

Therapeutics :-The medical (and surgical) treatment of a Vrana (ulcer) admits of being divided into sixty different factors, such as,—Apatarpana (fasting or low diet), Alepa (plastering), Parisheka (irrigating or spraying), Abhyanga (anointing), Sveda

N.B. Authorities, however, differ in enumerating these factors, although every one of them sticks to the total number of sixty.

(fomentations, etc.), Vimlápana (resolution by massage or rubbing), Upanáha (poultice), Páchana (inducing suppuration), Visrávana (evacuating or draining), Sneha (internal use of medicated oils, ghrita, etc.), Vamana (emetics), Virechana (purgatives), Chhedana (excision), Bhedana (opening—e.g., of an abscess), Dárana (bursting by medicinal applications), Lekhana (scraping), Áharana (extraction), Eshana (probing), Vyadhana (puncturing—opening a vein), Vidrávana (inducing discharge), Sivana (suturing), Sandhána (helping re-union or adhesion), Pidana (pressing), Sonitásthápana (arrest of bleeding), Nirvápana (cooling application), Utkáriká (massive poultices), Kasháya (washing with decoctions), Varti (lint or plug), Kalka (paste), Ghrita (application of medicated clarified butter), Taila (application of medicated oil), Rasa-kriyá (application of drug-extracts),

Avachurnana (dusting with medicinal powders), Vrana-Dhupana (fumigation of an ulcer), Utsádana (raising of the margins or bed of an ulcer), Avasádana (destruction of exuberant granulation), Mridu-Karma (softening), Dáruna-Karma (hardening of soft parts), Kshára-Karma (application of caustics), Agni-Karma (cauterization), Krishna-Karma (blackening), Pándu-Karma (making yellow-coloured cicatrix), Pratisárana (rubbing with medicinal powders), Roma-sanjanana (growing of hairs), Lomápaharana (epilation), Vasti-karma (application of enemas), Uttara-Vasti-karma (urethral and vaginal injections), Vandha (bandaging), Patradána (application of certain leaves—vide Infra), Krimighna (Vermifugal measures), Vrimhana (application of restorative tonics), Vishaghna (disinfectant or anti-poisonous applications), Siro-virechana (errhines), Nasya (snuff), Kavala-dhárana (holding in the mouth of certain drug-masses for diseases of the oral cavity or gargling), Dhuma (smoking

CHIKITSA STHANAM

Of these, Kasháya, Varti, Kalka, Ghrita, Taila, Rasa-kriyá and Avachurnana are the measures for the cleansing (Sodhana) of an ulcer and for helping its granulation (Ropana). The eight acts (from Chhedana to Sivana) are surgical operations. We have already spoken of such acts as Sonitásthápana, Kshára-karma, Agni-karma, Yantra, Áhára, Rakshá-vidhána and Vandha-Vidhána (in the Sutra-sthána). Later on, we shall discourse on Sneha, Sveda, Vamana, Virechana, Vasti, Uttara-vasti, Siro-virechana, Nasya, Dhuma, and Kavala-dhárana. Of the remaining measures we shall speak in the present chapter.

There are six kinds of swellings (Sophaś), as described before, and the following eleven measures: commencing with Apatarpana and ending in Virechana, should be regarded as their cure. These are the proper remedies for a swelling and do not (cease to be efficacious in, nor) prove hostile to cases of swelling which are transformed into ulcers. The other measures should be deemed as remedial to ulcers but Apatarpana is the first, general and principal remedy in all types of swellings (Sophaś).

Memorable Verses :-Apatarpana (fasting) should be prescribed in the case of a patient, full of enraged Doshaś, as well as, in one having his organic principles (Dhátus) and refuse matters (Malas) of the system, deranged by them, for the purpose of bringing them to their normal condition, with a regard both to their nature and to the strength, age, &c., of the patient.

from the up-coursing of the deranged Váyu (Urdhva-váta) such as cough, asthma, &c., or with thirst, hunger, dryness of the mouth and fatigue, as well as old men, infants, weak persons, men of timid dispositions and pregnant women should never fast. A swelling and an extremely painful ulcer should be respectively treated with a proper medicated plaster at the very outset. The pain in such a case will yield to the medicinal plaster as a blazing room or house is readily extinguished by means of steady watering. Such plasters not only give comfort to the patient (by removing the pain and leading to the absorption of the swelling), but heaves up the bed of the sore or the ulcer and contributes to its speedy purification and healing up (granulation).

25—28.

In the case of a swelling brought on by the deranged Váyu, the affected part should be washed or sprinkled (Parisheka) with a warm lotion of clarified butter, oil, Dhányámla and essence of meat or with a decoction of the drugs that tend to pacify the enraged Váyu and to relieve the pain. A swelling due to the action of the deranged Pitta or blood or to the effect of a blow or poison should be washed or sprinkled with a lotion of milk, clarified butter, honey and sugar dissolved in water, the expressed juice of sugar-cane and a cold decoction of the drugs of the Madhura group (Kákolyádi-gana) and the Kshira-Vrikshas. A Kaphaja swelling on the body should be washed or sprinkled with a luke-warm lotion of oil, cow's urine, alkaline solution, wine (Surá), Śukta and with a decoction of drugs that destroy the deranged Kapha.

29—31.

Metrical Text :—As a fire is put out by jets of water, so the fire of the deranged morbific principles (Doshágni) of the body are speedily subdued and put down by the application of (medicinal lotions) washes.

Chap. 1.] CHIKITSA STHANAM.

An anointing (Abhyanga), duly prescribed and used with a full regard to the nature of the aggravated Doshas, leads to their pacification (restoration to the normal condition) and to softness (subsidence) of the swelling. 33.

Metrical Texts:-An application of an anointment (Abhyanga) should precede the measures of fomentation, resolution, &c, while it should follow all evacuating measures, &c.

A painful, extended and indurated swelling, as well as an ulcer of a similar nature, should be fomented, while an act of Vimlápana (resolution by gentle massage) should be done in respect of a fixed or unfluctuating swelling attended with little or no pain whatsoever.

A wise physician should first annoint and foment the part and then gently and slowly press it with a bamboo-reed or with the back of his thumb or palm.

A non-suppurated swelling or one that is partially suppurated should be treated with poultice (Upanáha), which would lead to its resolution or suppuration, as the case might be.

A swelling, not resolved or not subsiding even after the adoption of the measures beginning with Apatarpana and ending in Virechana (in the given list), should be caused to suppurate with the drugs enumerated in the chapter of Misraka, such as curd, whey, wine (Surá), Śukta and Dhányámla (a kind of fermented paddy gruel).

They should be formed into a paste and the paste should be cooked into an efficacious poultice-like composition (Utkáriká), and mixed with salt and oil or clarified butter, it should be applied over the affected part (swelling) and bandaged with the leaves of an Eranda plant.

The patient should be allowed to take a wholesome (i.e., which does not produce Kapha) diet as soon as suppuration would set in (in the swelling). 34-39.

Blood-letting :-Blood-letting should be resorted to in a case of newly formed swelling for its resolution and for alleviating the pain. Bleeding (Visrávana) is recommended in the case of an ulcer which is indurated, marked by a considerable swelling and inflammation and is reddish black or red-coloured, extremely painful, gagged in its shape and considerably extended at its base (congested), specially in the case of a poisonous ulcer, for the subsidence of the pain and for warding off a process of suppuration therein, either by applying leeches or by opening (a vein in the locality) by means of an instrument. An ulcer-patient of a dry or parched temperament affected with distressing supervenients or ulcer-cachixia or who is weak should be made to drink an emulsive potion cooked with (a decoction of) appropriate drugs. A patient afflicted with an ulcer with an elevated margin and attended with swelling and specially marked by the presence of the deranged Kapha and by a flow of blackish red blood should be treated with emetics. Ulcer-experts recommend purgatives to a patient afflicted with an old or long-standing ulcer, attended with a deranged condition of the Váyu and Pitta. An excision should be made into an ulcer which refuses to suppurate and which is of a hard and indurated character attended with sloughing of the local nerves and ligaments (Snáyu). An opening or excision (Bhedana) should be made into an ulcer (Vrana) in the inside of which pus has accumulated and makes it heave up and which not finding any outlet consequently eats into the underlying tissues and makes fissures and cavities.

248 THE SUSHRUTA SAMHITA. [Chap. I.

Chap. I.] CHIKITSA STHANAM.

patient, or of one incapable of bearing the pain (of a surgical operation), or of a person of a timid disposition, as well as in the case of a woman, and in the case of swellings which appear on the vulnerable parts (Marmas) of the body. Remedies which lead to the spontaneous bursting of a swelling should be applied by a wise physician to a well-suppurated swelling drawn up and with all its pus gathered to a head; or an alkaline substance should be applied on its surface and a bursting should be effected when the Doshas are found to be just aggravated by the incarcerated pus.

An ulcer which is indurated, whose edges are thick and rounded, which has been repeatedly burst open, and the flesh of whose cavity is hard and elevated, should be scarified by a surgeon; or, in other words, an indurated ulcer should be deeply scarified, one with thick and rounded edges should be excessively scarified, while the one which has been repeatedly burst open should be entirely scraped off. An ulcer with a hard and elevated bed should be scraped evenly and longitudinally along the length of its cavity. In the absence of a scarifying instrument, the act should be performed with a piece of Kshauma (cloth made of the fibres of an Atasi plant), a linen (Plota) or a cotton pad (Pichu), or with such alkaline substances as nitrate of potash, Samudra-phena, rock-salt, or rough leaves of trees (e.g., those of Udumbara, &c.).

The cavities or courses of a sinus, or of an ulcer which had any foreign matter lying imbedded in its inside, of which takes a crooked or round about direction, as well as of the one formed into cavities within its interior, should

• This scraping off of the ulcer should be done by an instrument of Surgery and not by any rough leaf or the like, mentioned hereafter.

THE SUSHṚUTA SAMHITĀ

250

be probed by gently introducing the tender fibres of

bamboo sprouts (Karira), a (lock of) hair, a finger, or an

indicator into its inside. The course of a sinus occurring

about the anus or in the region of the eyes (Netra-

Vartma) should be probed with the slênder fibres

of Chuchchu, Upodikā, or Karira, in the event of

their mouths being narrow and attended with bleeding.

The Śalya (incarcerated pus, etc.) should be extricated,

whether the mouth of the sinus is constricted or other-

wise, in conformityw ith the directions laid down before

on that behalf.In diseases amenable to acts of punctur-

ing (Vyadhana), the knife should be inserted into the

seat of the disease to a proper depth and extent, to be

determined by its situation in the body, and the

Doshas (pus, etc.) should be let out, as stated before.

Ulcers with a wide mouth, unattended with any symptoms

of suppuration, and occurring in a fleshy part of the

body, should be sutured up, and the adhesion (San-

dhána) of the edges should likewise be effected, as direct-

ed before. A plaster composed of drugs (capable of

drawing out and secreting the pus), as described before,

should be applied around the mouth of an ulcer seated

in any of the Marmas (vulnerable parts), or full of pus

in its inside, with a narrow-mouthed aperture. The

plaster should be removed when dry, and should not

be applied on the orifice of the ulcer, as it would, in that

case, interfere with the spontaneous secretion of pus

(Dosha). 49-54.

An excessive hæmorrhage incidental to such acts, as

excessive hurting of the vein, etc., should be arrested with

suitable styptic* measures and remedies (Sonitāsthāpana).

• Styptic measures are of four kinds–Sandhāna, Skandana, Pāchana,

and Dahana. See Sutra-Sthánam, Chap. XIV.

CHIKITSA STHANAM

An ulcer attended with fever, suppuration and burning sensation due to the excited state of the deranged Pitta and congestion of blood should be allayed (Nir-vápana—literally putting out) with suitable and proper medicinal remedies. It should be allayed with compounds made up of the proper cooling drugs (of the Misraka chapter), pasted with milk and lubricated with clarified butter. Cooling plasters (Lepa) should then be applied as well.

CHIKITSA STHANAM

An ulcer whose flesh is eaten away, which discharges a thin secretion, or is non-suppurating in its character, and is marked by roughness, hardness, shivering and the presence of an aching and piercing pain, should be fomented with a poultice-like efficacious preparation (Utkáriká )cooked with the drugs of Váyu-subduing properties, those included within the Amla-varga, and those which belong to the Kákolyádi group, and with the oily seeds (such as linseed, sesamum, mustard, castor, etc.). An indurated, painful, fætid, moist and slimy ulcer should be washed with a disinfectant or purifying lotion consisting of a decoction of the drugs mentioned before for the purpose.

CHIKITSA STHANAM

Plugs or lints plastered with a paste of the purifying drugs (enumerated before) should be inserted into an ulcer with any foreign matter (e.g., pus) lying embedded in it, or into one with a deep but narrow opening, or into one situated in a fleshy part of the body. An ulcer full of putrid flesh and marked by the action of the highly deranged Doshas (Váyu and Kapha) should be purified with a paste of the aforesaid available drugs making up the plug. An ulcer of a Pittaja origin, which is deep-seated and attended with a burning sensation and with suppuration, should be purified with the application of a medicated clarified butter, prepared with the purifying

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CHIKITSA STHANAM

A Kalka or a levigated paste of sesamum and honey (mentioned in the Misraka Chapter) should be applied for the purpose of healing up an ulcer situated in a muscular part from which all putrid flesh has been removed or sloughed off and which exhibited a clear cavity. This paste (of sesamum) tends to allay the deranged Váyu through its sweet taste, oleaginousness and heat-making potency ; subdues the deranged Pitta through its astringent, sweet and bitter taste and proves beneficial even in the case of the deranged Kapha through its heat-producing potency and bitter and astringent taste. An application of the levigated paste of sesamum mixed with the drugs of purifying and healing properties tends to purify and heal up an ulcer. An application of the levigated paste of sesamum mixed with honey and Nimba-leaves leads to the purification of sores ; whereas an application of the same paste (ie, sesamum, honey and leaves of Nimba), mixed with clarified butter tends to heal up the ulcer. Several authorities attribute the same virtue to a barley-paste. Levigated pastes of barley and of sesamum (or a paste of barley mixed with sesamum) contribute to the resolution or subsidence of a non-suppurated swelling, fully suppurate one which is partially suppurated, lead to the spontaneous bursting of a fully suppurated one, and purify as well as heal up one that has already burst out. 63.65.

An ulcer,which is due to the effects of poison, vitiated blood, or aggravated Pitta, and which is deep-seated or is of traumatic origin, should be healed up with a medicated clarified butter prepared with the drugs of healing virtues (Ropaniya-enumerated before) and milk. An ulcer marked by an aggravated condition of the deranged

• Jejjada and Gayadása interpret the term to mean "barley-paste mixed with sesamum."

Váyu and Kapha should be healed up with the application of an oil, boiled and prepared with the proper purifying drugs mentioned before. 66 67.

Rasa-kriyā* with the two kinds of Haridrā should be resorted to for the purpose of healing up ān ulcer, in which bandaging is forbidden (such as those due to the deranged Pitta or blood, or to blow, &c., or to the effects of poison), and an ulcer appearing on theₘ moveable joints, which, though exhibiting all the features of a well-cleansed sore, has not been marked by any process of healthy granulation†.

Healing medicinal powders should be used in the case of an ulcer which is confined to the skin, and is firm-fleshed and marked by the absence of any irregularity in its shape (i.e., not uneven in its margin). The mode of applying medicinal powders, as stated in the Sutra-sthána, should be adopted in the present instance. 68-69.

The healing and purifying measures described above should be deemed equally applicable to, and efficacious in cases of ulcers in general with regard to their Doshas (both idiopathic and traumatic). The success of these measures has been witnessed in thousands of cases and has been recorded in the Śāstras (authorised works on medicine).

Hence they should be used as incantations without any doubt as to their tested and infallible efficacy. An intelligent physician should employ the drugs, mentioned before, in any of the seven forms (either in the shape of a decoction, or a

• The decoction of Triphald and the drugs of the Nyagrodhádi group should be duly prepared, filtered and then condensed to the consistency of treacle. Powders of Haridrd and Dáru-hāridrá should be then thrown into it. In the end, the whole preparation should be well-stirred, mixed with honey and applied. This is what is called Rasa-kriyā.

† Several editions read "though cleansed yet ungranulating ulcers."

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256 THE SUSHRUTA SAMHITA.

vorous animals should be taken in the proper manner by the patient, inasmuch as meat properly partaken of in a calm and joyful frame of mind adds to the bodily flesh of its partaker.

Avasádana (destruction of super-growths) :-

Proper drugs or articles (such as sulphate of copper, etc.) powdered and pasted with honey should be applied for destroying the soft marginal growths of an ulcer found to be more elevated than the surrounding surface of the affected locality.

Mridu-Karma (softening) :-

In respect of indurated and fleshless (not seated in a part of the body where flesh abounds) ulcers marked by a deranged condition of Váyu, softening measures (with the help of repeated applications of lotions and plasters composed of sweet and demulcent substances mixed with salt in a tepid or luke-warm state) and blood-letting* should be resorted to. Sprinkling (Seka) and application of clarified butter or oil prepared with the Váyu-subduing drugs should also be resorted to.

Dáruna-karma :-

The employment of hardening measures (Dáruna-karma) is efficacious in connection with soft ulcers and in the following manner. Barks of Dhava, Priyangu, As'oka, Rohini, Triphalá, Dhátakí flowers, Lodhra and Sarjarasa, taken in equal parts and pounded into fine powders, should be strewn over the ulcer, i.e., the ulcer should be dusted with the same.

Kshára-Karma (Potential cauterization) :-

The measure of applying alkali should be adopted for the * Blood-letting should be resorted to in the event of any vitiated blood being found to have been involved in the case ; but in the event of a similar participation of any deranged Kapha, oils and lotions composed of the Váyu-destroying drugs should be made use of.

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THE SUSHRUTA SAMHITA

258

mixed with this powder, and applied to the white cicatrix. Similarly, the oily essence of the piths of some kinds of wood, as well as of some kinds of fruit (Phala-sneha) prepared in the manner of the Bhallátaka oil (and mixed with the powdered ashes of hoofs) should be used for the blackening of a cicatrix.

82-83

Pándu-karana :-The natural and healthy colour (Pándu) of the surrounding skin should be imparted to a cicatrix which has assumed a black colour owing to the defective or faulty healing up of the sore in the following manner. The fruit of the Rohini* should be immersed in goat's milk for seven nights and, afterwards finely pasted with the same milk, should be applied to the skin. This measure is called Pándu-karana (imparting a yellow or natural skin-colour to the cicatrix).

To attain the same result, the powder of a new earthen pot, Vetasà roots, S'dla roots, Sulphate of iron, and Madhuka (Yashti-madhu) pasted together with honey may be used.

As an alternative, the hollow rind of the Kapittha fruit, from which the pulp has been removed, should be filled with the urine of a goat together with Kásísa (Sulphate of iron), Rochana, Tuttham (Sulphate of copper). Haritála, Manahs'ila, scrapings of raw bamboo skin, Prapunnáda (seeds of Chákunde), and Rasánjana and buried a month beneath the roots of an Arjuna tree after which it should be taken out and applied to the black cicatrix.

The shell of a hen's egg, Kataka, Madhuka, (Yashti-madhu), sea-oysters and crystals† (pearls according to Jejjata and Brahmadeva) taken in equal parts should be pounded and pasted with honey and used.

• Rohini, according to some commentators, means a kind of Haritaki ; according to others, it means Katu-tumbi.

† Burat ashes of sea-oysters and pearls etc., should be used.

Chap. I.] CHIKITSA STHANAM.

the urine of a cow and made into boluses which should be rubbed over the cicatrix.* 84-87. Roma-sanjanana--hair-producers :- The burnt ashes of ivory and pure Rasdjana (black antimony) pounded (and pasted with goat's milk) should be applied to the spot where the appearance of hair (Lomotpatti) is desired. An application of this plaster would lead to the appearance of hair even on the palms of the hands. Another alternative is a pulverised compound consisting of the burnt ashes of the bones, nails, hair, skin, hoofs and horns of any quadruped, over a part of the body, previously anointed (rubbed) with oil, which would lead to the appearance of hair in that region. And lastly, a plaster composed of Sulphate of iron, and tender Karanja leaves pasted with the expressed juice of Kapittha, would be attended with the same result. 88-90.

Hair-depilators :-The hair of an ulcerated part of the body found to interfere with the satisfactory healing up of the ulcer, should be shaved with a razor or clipped with scissors, or rooted out with the help of forceps. As an alternative, an application of a plaster consisting of two parts of pulverised (burnt ashes of) conch-shell and one part of Haritála (yellow orpiment or yellow oxide of arsenic) pasted with Súkta (an acid gruel) over the desired spot, would be attended with the same result. A compound made of the oil of Bhallátaka mixed with the milky exudation of Snuhi,

should be used by an intelligent physician as a depilatory measure. As an alternative, the burnt ashes of the stems of plantain leaves and Dirghavrinta (Syonáka) mixed with rock-salt, Haritála and the seeds of Sámi,

• This also is a remedy for giving a natural colour to the skin.

THE SUSHRUTA SAMHITA

Vasti-Karma :-A medicated Vasti (enema) should be applicd to the rectum in the case* of an ulcer marked by an aggravated condition of the deranged Váyu which is extremely dry and is attended with an excruciating pain occurring specially in the lower region of the body. A mcasure of Uttara-vasti. (Vaginal or Urethral syringe) should be adopted in the cases of strictures and other disorders connected with urine, semen and menstruation, as well as in cases of gravel † in case these are due to an ulcer. An ulcer is purified, softened and healed up by bandaging leaving no room for the apprehension of a relapse. Hence bandaging is recommended. 96-98.

THE SUSHRUTA SAMHITA

Patradána (application of leaves on an ulcer) :- Leaves possessed of proper medicinal virtues taking into consideration the particular Dosha and season of the year should be tied (over the medicinal plaster applied) over an ulcer of non-shifting or non-changing character and not affecting a large depth of flesh and which refuses to be healed up owing to its extreme dryness. An ulcer of the deranged Váyu should be tied over with the leaves of the Eranda, Bhurja, Putika, or Haridrá plants as well as with those of the Upodiká and Gámbhári. An ulcer marked by an aggravated condition

of the deranged Pitta, or incidental to a vitiated condition of the blood, should be tied in the aforesaid manner with the leaves of the Kás'mari, the Kshirá trees (milk-exuding trees), and aquatic plants. An ulcer due to the deranged and aggravated Kapha, should be tied over with the leaves of the Páthá, Murvá, Guduchi, Káka-máchi, Haridrá or of the S'ukandásá. Only those leaves which are not rough, nor putrid, nor old and decomposed, nor worm-ëaten and which are soft and tender should be used for purposes of Patradána.* The rationale of such a procedure (Patra-vandha) is that the leaves tied by an intelligent physician in the manner above indicated serve to generate heat or cold and retain the liniment or medicated oil in their seat of application.

99-102.

Vermifugal :-The germination of worms due to flies in an ulcer is attended with various kinds of extreme pain, swelling and bleeding in case the worms eat up the flesh. A decoction of the drugs of the Surasáddi gana proves efficacious as a wash and healing medicine in such a case. The ulcer should be plastered with such drugs as the bark of Saptaparna, Karanja, Arka, Nimba, and Rájádana pasted with the urine of a cow, or washed with an alkaline wash (for expelling the vermin from it). As an alternative, the worms should be brought out of the ulcer by placing a small piece of raw flesh on the ulcer. These vermin may be divided into twenty groups or classes, which will be fully dealt with later on. (Uttara-Tantram–ch. 54).

Vrinhanam (use of restorative and constructive tonics) :-All kinds of tone-giving and constructive measures should be adopted in the case of a patient

• The leaf which does not poison the Sneha and the essence of the medicinal drugs placed in a folded piece of linen (and applied over an ulcer is the proper leaf and) should be used for tying over the paste.

weak and emaciated with the troubles of a long-standing sore, taking full precaution not to tax his digestive powers. Anti-toxic (Vishaghna) medicines and measures and symptoms of poisonings will be described under their respective heads in the Kalpa-Sthánam.

104-105. Śiro-virechana and Nasya :-Śiro-virechana measures (errhines) should be resorted to by skilful physicians in respect of ulcers situated in the clavicle regions and marked by itching and swelling. The usc of medicated (fatty) snuff (Nasya) is recommended in cases where the ulcers would be found to be seated in the regions above the clavicles and marked by an aggravated condition of the deranged Váyu, pain, and absence of the oily matter.

Kavala-dhárana :-Medicated gargles (consisting of decoctions of drugs) of purifying or healing virtues either hot or cold * (according to requirements) should be used in the case of an ulcer in the mouth, for the purpose of alleviating the Doshas therein, for allaying the local pain and burning, and for removing the impurities of the teeth and the tongue.

108. Dhuma-pána :-Inhaling of smoke or vapours (of medicated drugs) should be prescribed in cases of ulcers of the deranged Váyu and Kapha attended with swelling, secretion and pain and situated in the region above the clavicles. Application of honey and clarified butter, separately or mixed together should be prescribed in cases of extended or elongated ulcers which are traumatic or incidental in their character (Sadyo-Vrana) for allaying the heat of the ulcer and for bringing about its adhesion.

Surgical instruments should be used in connexion.

• Hot gargles are recommended in cases of ulcers of the deranged Váyu and Kapha while cold ones in cases of ulcers of the aggravated Pitta and blood.

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of doing any mischief thereby. Recipes consisting of rare or a large number of drugs or ingredients, should be made up with as many of them as would be available in the absence of all of them, as mentioned in the present work. A drug belonging to any particular Gana or group if separately described as non-efficacious to any specific disease, should be omitted whereas a drug not belonging to a group may be added to it if it is elsewhere laid down as positively beneficial thereto.

115-117. Upadrava :-The distressing supervening symptoms which are found to attend a case of ulcer, are quite different from those of an ulcer-patient. Those which confine themselves solely to the ulcer are five in all—smell, colour, etc., and those which are exclusively manifest in the patient are fever, diarrhœa, hiccup, vomiting, fainting fits, aversion to food, cough, difficult breathing, indigestion and thirst. The medical treatment of ulcers though described in detail in the present chapter, will be further dealt with in the next chapter on Sadyo-Vrana.

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THE SUSHRUTA SAMHITA

Their definitions:--A traumatic ulcer which is oblique or straight and elongated is called a Chhinná (cut) ulcer, while a complete severance of a part or member of the body is also designated by that name. A perforation of any of the cavities or receptacles of the body by the tip of a Kunta, spear, Rishti, or a sword or by a horn, attended with a little discharge, constitutes what is called a Bhinna (punctured) wound or ulcer. The Ámás'aya (stomach), the Pakváśaya (intestines), the Agnyáśaya (gall-bladder?), the Mutráśaya (urinary bladder), the Raktáśaya (receptacle of blood), the heart, the Unduka and the lungs constitute what is called the Koshtha (viscus). A perforation (of the wall of any) of the Áśayas causes it to become filled with blood which is discharged through the urethra, the anus, the mouth or the nostrils and is attended with fever, thirst, fainting fits, dyspnœa, burning sensations, tympanites, suppression of stool, urine and flatus (Váta) with an aversion for food, perspiration, redness of the eyes, a bloody smell in the mouth, and feted one in the body and an aching pain in the heart and in the sides. 7—10.

THE SUSHRUTA SAMHITA

Now hear me discourse on (their) detailed symptoms. A perforation of the wall of the Ámáśaya (stomach) is marked by constant vomiting of blood, excessive tympanites and an excruciating pain. A perforation of the Pakváśaya fills it with blood and is attended with extreme pain, a heaviness in the limbs, coldness of the sub-umbilical region, and bleeding through the (lower) ducts and orifices of the body. Even in the absence of any perforation, the Antraś (intestines) are filled with blood through the small pores or apertures in their walls in the same manner as a pitcher with its mouth firmly covered may be filled through the pores (in its sides), and a sense of heaviness is also perceived in their inside. 11—13.

Chap. II.] CHIKITSA STHANAM.

267

A wound or an ulcer caused by any sharp pointed Salya (shaft) in any part of the body other than the aforesaid As'ayas with or without that Salya being extricated is called a Viddha (pierced one). An ulcer which is neither a cut nor a perforation or puncture but partakes of the nature of both and is uneven is called a Kshata (wound). A part of the body with the local bone crushed between the folds of a door or by a blow becomes extended and covered with blood and marrow and is called a Pichohita (thrashed) wound or ulcer. The skin of any part of the body suffering abrasion through friction or from any other such like causes and attended with heat and a secretion is called a Ghrishta (mangled or lacerated) wound or ulcer.

14-17.

Their Treatment : -A part or member of the body any wise cut, perforated, pierced or wounded which is attended with excessive bleeding and with the local Váyu enraged or aggravated by the incidental bleeding, or hæmorrhage will occasion excruciating pain. Potions of Sneha (oily or fatty liquids) and using the same as a washing (in a lukewarm state) should be advised in such cases. Preparation of Vesaváras and other Krisaras largely mixed with oil or clarified butter should be used as poultices and fomentations with the Másha pulse, etc., and the use of oily ungents and emulsíve Vástis (enematas)* prepared with decoctions of Váyu-subduing drugs should be applied.

A crushed or thrashed wound or abrasion is not attended with any excessive bleeding an absolute absence whereof, (on the contrary) gives rise to an excessive burning sensation and suppuration in the affected part. Cold washes and cooling plasters should be used in these cases for the alleviation of the

• Snehapána is recommended when the ulcer is in a region above the umbilicus and Vasti-karma when the ulcer is in a subumbilical region.

THE SUSHRUTA SAMHITA

Treatment of cuts or incised wounds &c :-Now we shall discourse on the medical treatment of Chhinná cuts. An open mouthed ulcer on the side of the head* should be duly sutured as described before and firmly bandaged. An ear severed or lopped off should be sutured in the proper way and position and oil should be poured into its cavity. A Chhinná cut on the Krikátiká (lying on the posterior side of the junction of the neck and the head) and even if it allow the Váyu † (air) to escape through its cavity should be brought together and duly sutured and bandaged in a manner (so as not to leave any intervening space between). The part thus adhesioned should be sprinkled with clarified butter prepared from goat's milk. The patient should be made to take his food lying on his back, properly secured or fastened with straps (so that he might not move his head and advised to perform all other physical acts such as, urination, defecation etc., in that position). 21-24 In the case of a lateral and wide-mouthed wound (sword-cut, etc.) on the extremeties, the bone-joints should be duly set and joined together as instructed before and the wound should be sutured and speedily *bandaged in the manner of a Vellitaka bandage, or

• Several commentators explain those that are situated either on the head or on the sides. † The dictum that a hurt on any of the wind-carrying sounding channels is pronounced to be incurable, should not be supposed to hold good in the present case.

Chap. II.] CHIKITSA STHANAM.

with a piece of skin or hide in the Gophaná or such other form as would seem proper and beneficial and oil should be poured over it. In the case of the back the patient should be laid on his back, while in the case of its occurring on the chest the patient should be laid on his face.* 25-27.

In the case of a hand or a leg being carried away or completely severed the wound should be cauterised with the application of hot oil and bandaged in the manner of a Kosha bandage and proper healing medicines should be applied.

An oil cooked with the eight drugs Chandana, Padmaka, Rodhra, Utpala, Priyangu, Haridrā, Madhuka, (Yasthimadhu) and milk, forms one of the most efficacious healing (Ropana) agents A Kalka of the thirteen drugs - Chandana, Karkatākhyja, the two kinds of Sahá (Mugáni and Másháni), Mánsi, (D.R.- Máshahva, Somáhva), Amritá, Harenu, Mrindá Triphalá, Padmaka and Utpalá should be cooked in oil mixed with milk (four times that of oil) and the three other kinds of oily matter (lard, marrow and clarified butter) and this medicated oil should be used for sprinkling over a wound of this type for the purpose of healing (Ropana).

Medical Treatment of Bhinna :- Henceforth we shall deal with the medical treatment of Bhinna (excised) wounds. A case of an excised eyc (Bhinna) should be given up as incurable. But in the case where an eye (ball) instead of being completely separated would be found to be dangling out (of its

• For the complete elimination of the deranged Dosha i.e., pus, etc., of the wound invloved in the case-Jejjata.

He who has got a wound on his back should be laid on his face and he who has got an ulcer on his breast should be laid on his back-Differcut Reading Gayi.

THE SUSHRUTA SAMHITA

socket) the affected organ should be re-instated in its natural cavity in a manner so as not to disturb the connected Śirás (nerve arrangements) and gently pressed with the palms of the hand by first putting a lotus leaf on its (eye) surface. After that the eye should be filled (Tarpana) with the following (D.R, - Ájena in place of 'Ancna'--i.e., prepared from goat's milk) medicated clarified butter, which should be as well used in the form of an errhine. The recipe is as follows :-Clarified butter prepared from goat's milk, Madhuka, Utpala, Jivaka and Rishavaka taken in equal parts should be pasted together, and cooked with sixteen seers of cow's milk and four seers of clarified butter.* The use of the medicated Ghrita thus prepared should be regarded as commendable in all types of occular hurt or injury. 29.

In the case of a perforation of the abdomen marked by the discharge of lumps or rope-like Varti (fat) through the wound, the emitted or ejected fat-lump should be dusted with the burnt ashes (D. R. - powders) of astringent woods (such as Manu, Arjuna, etc.) and black clay (pounded together). A ligature of thread should then be bound round the fat-lump and the fat-lump cut off with a heated instrument. Honey should then be applied and the wound (Vrana) should then be duly bandaged. The patient should be caused to drink clarified butter after the full digestion of his injested food. Instead of this Ghrita, milk prepared

• Several authorities, however, say that equal parts of clarified butter prepared from goat's milk and from cow's milk should be taken and cooked with 16 seers of cow's milk and with the four drugs as a Kalka.

But Gayi recommends only four seers of clarified butter prepared from goat's milk cooked with 16 seers of cow's milk and the four drugs as a Kalka.

medicinally with Yashti-maddu, Lakshd and Gokshura, mixed with (a proper quantity of) sugar and castor cil (as Prakshepa)*, is equally commendable for the alleviation of the pain and the burning sensation, (in the wound or ulcer). The fat-lump (pariental fat) aforesaid causes a rumbling sound with pain in the abdomen and may prove even fatal in the event of its being left uncut. The medicated oil to be mentioned hereafter in connection with Medaja-Granthi should be applied in such cases.

30-32

Foreign bodies (Salya) piercing into any of the Koshthas after having run through the (seven layers of) skin, whether passing through the veins, etc., (muscles, nerves, bones or joints or not, produces the distressing symptoms described before (Ch. III.—Sutra). The blood (of the affected chamber or receptacle) in such case lies incarcerated therein in the event of its failing to find an outlet and causes a pallor of the face and a coldness of the extremities and of the face in the patient. Respiration becomes cold, the eyes red-coloured, the bowels constipated and the abdomen distended. The manifestation of these symptoms indicates the incurable character of the disease.

33-34

• This explanation is given on the authority of old Vagabhata. Dallana, however, explains the verse in a different way. He explains it to mean two different preparations of milk—one with Yashti-madhu and mixed with sugar and castor oil as a Prakshepa and the other with Gokshura and mixed with Lakshá and castor oil as a Prakshepa.

A third in'erpretation woul! make three preparations of milk prepared separately with Yashtia-madhu, Lakshá and Gokshura—sugar and castor oil being mixed in the first (as Prakshepa) and castor oil alone in the second and third.

A fourth preparation would be to prepare the milk separately with Yashtimadhu, Lakshá and Gokshura as in the preceding case—without the addition of castor oil (as Prakshepa).

Emesis is beneficial in the case where the blood would be found to be confined in the Amáśaya (stomach). Purgatives should unhesitatingly be prescribed where the blood would be found to have been lodged in the Pakváśaya (intestines) and Asthápana measures without oil should be employed with hot, purifying (Śodhana) substances (such as the cow-urine, etc.). The patient should be made to drink a Yavágu (gruel) with Saindhava salt and his diet should consist of boiled rice mixed with the soup of barley, Kola and Kulattha pulse divested of oil.

35-36.

In a case of a perforation or piercing of any of the bodily Koshthas attended with excessive hæmorrhage or bleeding, the patient should be caused to drink (a potion of animal) blood and such a case marked by the passage of stool, urine, etc., through their proper channels of outlet and by the absence of fever and tympanites and other dangerous symptoms, (Upadrava), may end in the ultimate recovery of the patient.

37-38.

In a case of a perforation of the Koshtha (abdomen) where the intestines have protruded or bulged out in an untorn condition, they should be gently re-introduced into the cavity and placed in their original position, and not otherwise. According to others, however, large black ants should be applied even to the perforated intestines in such a case and their bodies should be separated from their heads after they had firmly bitten the perforated parts with their claws. After that the intestines with the heads of the ants attached to them should be gently pushed back into the cavity and re-instated in their original situation therein. The bulged out intestines should be rinsed with grass, blood and dust, washed with milk and lubricated with clarified butter and gently re-introduced into the cavity of

Chap. II.j CHIKITSĀ STHĀNAM

273

the abdomen with the hand with its finger nails cleanly paired. The dried intestines should be washed with milk and lubricated with clarified butter before introducing it into their former and natural place in the abdomen. 39-41.

In a case where the intestines could be but partially introduced, the three following measures should be adopted. The interior of the throat of the patient should be gently rubbed with a finger [and the urging for vomiting thus engendered, would help the full introduction of the intestines into the abdominal cavity].

As an alternative, he should be enlivened with sprays of cold water; or he should be caught hold of by his hands and lifted up into the air with the help of strong attendants and shaken in a manner that would bring about a complete introduction of the intestines into the natural position in the abdominal cavity. They should be so introduced as to press upon their specific (Maladharā) Kalā (facia). 42-43.

In a case where the re-introduction of the intestines into the abdominal cavity would be found to be difficult owing to the narrowness or largeness of the orifice of the wound, it should be extended or widened with a small or slight incisiona ccording to requirements, and the intestines re-introduced into their proper place.

The orifice or mouth of the wound should be forthwith carefully sutured as soon as the intestines would be found to have been introduced into their right place. Intestines dislodged from their proper seat, or not introduced into their correct position, or coiled up into a lump bring on death. 44-46.

Subsequent Treatment :- [After the full and correct introduction of the intestines] the wound should be bandaged with a piece of silk-cloth saturated

35

274 THE SUSHRUTA SAMHITA.

with clarified butter, and the patient should be given a draught of tepid clarified butter (D. R. tepid milk) with castor oil for an easy passage of the stool and downward coursing of the Váyu (spontaneous emission of the flatus). Then, for its healing up (Ropana), a medicated oil, prepared with the bark of the Asvakarna, Dhava, S'dlmalí, Mesha-s'ringi, S'allaki, Arjuna, Viddri, and Kshíri trees and Valá roots should be applied to the wound. For a year the patient should live a life of strictest conticence and forego all kinds of physical exercise.

The legs and the eyes of the patient should be washed and sprinkled with water in the event of the bursting out of the testicles which should be introduced into their proper place within the scrotum, and sewn up in the manner of a Tunna-sevani (raised seam). The scrotum should be bandaged in the shape of a Gophaná-Vandha and a restraining apparatus (Ghatta-Yantra) placed round the waist of the patient (to guard it against its oscillations or hanging down). The wound should not be lubricated with any kind of oil or Ghrita inasmuch as it would make the wound moist and slimy.

The wound should be healed with a medicated oil prepared with Kálánusdrí, Aguru, Elá, Játí flower, Chandana, Padmaka, Manahs'ílá, Devadáru, Amrita and sulphate of copper (pounded together). 49-50. A plug of hair should be inserted into a wound on the head, after having extracted the foreign matter therefrom, with a view to arrest the exuding of the brain matter (Mastulunga) which invariably proves fatal to the patient through the aggravation of the deranged Váyu in consequence thereof.

The hairs of the plug should be taken out one by one as the healing process progresses (granulation). An oleaginous medicated plug or lint should be inserted into a wound on any other

Chap. II. ] CHIKITSA STHANAM. 275

part of the body, which should be treated with the measures and remedial agents laid down in connection with a traumatic ulcer after having first allowed the vitiated blood to escape. 51-52.

The medicated oil known as the Chakra-taila* should be poured (frequently applied) by means of a slender pipe into an ulcer (wound) which is deep-seated but narrow-mouthed, after first letting out the vitiated blood†. An oil duly prepared and boiled with Samangá, Haridrā, Padmá, Trivargat Tuttha, Vidanga, Katuka, Pathya, Guduchi and Karanja acts as a good healing (Ropana) agent (in these cases). The use of an oil prepared with Tális'a, Padmaka, Mánsi, Harenu, Aguru, Chandana, and the two kinds of Haridrā, Padma-vija, Us'ira and Yashti-madhu acts as a good healing remedy in cases of traumatic ulcers. 53-55.

A cut wound (Kshata) should be treated with its own specific measures and remedies, while a bruised one (Pichchhita) should be treated (to all intents and purposes) as a case of Bhagna (bone-fracture). The first treatment of a mangled or contused wound (Ghrishta) is to extinguish pain, after which it should be dusted with the powder of proper medicinal drugs (such as S'dla, Sarja, Arjuna, etc.). 56-57.

In the case of a dislocation of any part of the body, caused by a fall (from a tree), or in the event of having been run over or trampled down (Mathita—by a carriage or by a beast), or of being wounded (by a blow, etc.),

• The oil just pressed out of an old oil-mill or squeezed out of the chips of wood belonging to an old one, in the manner of the Anu-talla to be described hereafter, is called the Chakra-talla

† The vitiated blood should first be let out for fear of putrefaction of the ulcer.

‡ Triphalá, Trikatu and Trimada are called Trivarga.

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Chap. II.] CHIKITSA STHANAM.

277

Treatment of Dushta-Vrana :-In the case of a malignant ulcer (Dushta-Vrana) emetics, errhines, purgatives, Ásthá pana, fasting, specific sorts of diet (composed of bitter, pungent and astringent things) and blood-letting, should be prescribed (according to the requirements of each case). The ulcer or sore should be washed with the decoctions of the drugs of both the Áragvadhádi and the Surasádi ganas, and an oil cooked with a decoction of the said drugs should be applied to the wound for the purification (Sodhana) thereof.

As an alternative, an oil boiled and prepared in an alkaline water or solution (four times that of oil) with a Kalka of alkaline substances (such as Ghantápáruli, Palásá, etc.) should be used for that end. Oil cooked with Dravanti (Śatamuli, according to certain authorities, Mushikaparni according to others), Chiravilva, Danti, Chit-raka, Prithvikd Nimba-leaves, Kásisa, Tuttha, Trivrit, Tejovati, Nili (indigo), the two kinds of Haridrd, Saindhava salt, Tila, Bhumi-Kadamba, Suvahd, Śukd-khyd, Langaldhv6, Naipdli, Jalini, Madayanti, Mrigádani, Sudhd, Murud, Arka, Kitdri, Haritdla, and Karanja, or with as many of them as would be available, should be used for the purification (of a malignant sore or ulcer).

If found applicable, a medicated Ghríta prepared and cooked with the foregoing drugs and substances as Kalka should be used for the same purpose. In the case of a malignant ulcer, due to the aggravated Váyu, the purifying remedy should cohsiśt of a Kalka of Saindhava salt, Trivrit and castor leaves.

In the case of a (malignant) Pittaja sore, the remedy should consist of a Kalka of Trivrit, Haridrd, Yashti-madhu and Tila. In the case of a malignant ulcer, caused by the aggravated Kapha, the purifying remedial

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CHAPTER III.

Now we shall discourse on the medical treatments of fractures and dislocations (Bhagnas). I. Metrical Texts :--A fracture or dislocation (Bhagna) occuring in a person of a Vátika temperament, or of intemperate habits, or in one who is sparing in his diet, or is affected with such supervening disorders (as fever, tympanites, suppression of the stool and urine, &c.) is hard to cure.* A fracture-patient must forego the use of salt, acid, pungent and alkaline substances and must live a life of strictest continence, avoid exposure to the sun and forego physical exercises and parching (devoid of oleaginous) articles of food. A diet consisting of boiled rice, meat-soup, milk, + clarified butter, soup of Satina pulse and all other nutritive and constructive food and drink, should be discriminately given to a fracture-patient. The barks of Udumbara, Madhuka, Asvattha, Palása, Kakubha, Bamboo, Vata or Sála trees should be used as splints (Kusa). Manjishthá, Madhuka, red sandal wood and Sáli-rice mixed with S'ata-Dhauta clarified butter (i.e., clarified butter with S'ata-Dhauta clarified butter (i.e., clarified butter

• Jejjala does not read the first verse, but Gayi does.

• As a general rule, milk should not be prescribed to a patient suffering from an ulcer (Vrana) in general ; but a case of fracture forms an exception thereto. Some authorities hold that tepid milk may be given to a fracture-patient, if there be no ulcer (Vrana). Others, on the contrary, are of opinion that milk should not, in any case, be given to a fracture-patient for fear of suppuration and the setting in of pus.

Others, however, take "Kshira-sarpih" to be a compound word and explain the term to mean the clarified butter prepared from milk (as distinguished from that prepared from curd).

But experience tells us that in cases of excessive weakness or emaciation, milk may be given without any hesitation--Ed.

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Chap. III.] CHIKITSA STHANAM.

281

fracture attended with ulcer on the part, an astringent plaster plentifully mixed with honey and clarified butter should be applied ; and the rest (diet and regimen of conduct) should be as laid down in the case of a (simple) fracture. 11-12.

Prognosis : -A case of fracture occurring in a youth or a person with slightly deranged Doshas or in winter, is held to be easily curable (with the help of the aforesaid medicines and diet). A fractured bone in a youth is joined by the aforesaid treatment in the course of a month, in two months in the case of a middle-aged man and in three months in one of old age. 13-14.

An elevated and fractured joint should be reduced by pressing it down, while one hanging down should be set by raising it up, by pulling it in the case of its being pushed aside, and by reinstating it in its upward (proper) position in the event of its being lowered down. An intelligent physician should set all dislocated (Bhagna) joints, whether fixed or movable, by the mode of reduction, known as Ánchhana, Pidana, (pressure), Sankshepa and Vandhana (bandaging). 15-16.

Treatment :-A crushed or dislocated joint should not be shaken (i.e., should be kept at rest) and cold lotions or washes and medicated plasters (Pradeha) should be applied to the part. A joint is spontaneously reset to its natural or normal state or position after the correction of its deformity incidental to a blow or hurt having been effected. The fractured or dislocated part should be first covered with a piece of linen soaked in clarified butter. Splint should then be placed over it and the part properly bandaged. 17-19.

Treatment of fractures in particular limbs :-Now we shall discourse on the measures to be adopted in fractures occurring in each particular

36

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284 THE SUSHRUTA SAMHITA.

In the case of a bending (twisting) or intussusception of the neck downward, the head should be lifted up

by putting the fingers into the hollow (Avatu) above the nape of the neck and at the roots of the jaw-bones (Hanu)*.

Then the part should be bandaged with a piece of linen

after having evenly put the splint (Kus'a round the neck).

The patient should be caused to lie constantly on his

back for a week. In a case of a dislocation of the joints

of the jaw-bones (Hanu), the jaw-bones should be fomented

ed and duly set in their right position, bandaged in the

manner of a Panchángi-vandha, and a Ghrita boiled

and prepared with (the Kalka and a decoction of) the

Madhura (Kákolyádi) and Váyu-subduing (Chavyádi)

groups should be used as errhines by the patient. 33-34.

A tooth of a young person, not broken but loose,

should be plastered with a cooling paste on its outside

after having pressed out the accumulated blood at the

root. The tooth should be sprinkled or washed with

cold water and treated with drugs having Sandháníya

(adhesive) properties.† The patient should be caused

to drink milk with the help of a lotus stem. The

loose tooth of an old man should be drawn. A nose

sunk down or depressed (by a blow) should be raised

up with the help of a rod or director, while it should

be straightened in a case of simple bending. Then

two tubes, open at both ends, should be inserted into

the nostrils (to facilitate the process of breathing)

and the organ should be bandaged and sprinkled with

clarified butter. In the case of (the cartilage of) the

ear being broken, the organ should be rubbed with

• According to Gayi, the lifting up of the head by putting fingers in

the Avatu and in the Hanus should be made in cases of bending and

intussusception of the neck respectively.

† Honey, clarified butter, and drugs of the Nyagrodhádi group.

CHIKITSA STHANAM

37. In a case of a fracture of the bone of the forehead unattended by any oozing out of brain matter, the affected part should be simply rubbed with honey and clarified butter and then duly bandaged. The patient should take clarified butter for a week* 38.

CHIKITSA STHANAM

Cooling plasters and washes should be applied to a part of the body, swollen but not in any way ulcerated on account of a fall or a blow. In the case of a fracture of the bone in the leg and in the thigh, the patient should be laid down on a plank or board and bound to five stakes or pegs in five different places for the purpose of preventing any movements of his limbs. The distribution of the (bindings) pegs in each case should be as follows. In the first case (fractured leg-bone), two on each side of the two thighs making four and one on the exterior side of the enguinal region of the affected side. In the second case (fracture of knee-joint) two on each side of the ankle-joints making four and one on the side of the sole of the affected leg. The same sort of bed and fastenings should be used in cases of fractures and dislocations of the pelvic-joint, the spinal column, the chest and the shoulders†. In cases of long-standing dislocations, the joint should be lubricated with oily or lardaceous applications, fomented and softened (with

CHIKITSA STHANAM

• In the case of such an emission or oozing out a plug of bristles or hair as described in the preceding chapter and remedial agents laid down in connection therewith, should be used.

CHIKITSA STHANAM

† The principle of splintering and bandaging may be profitably compared with those followed in Agnur's splint.

286 THE SUSHRUTA SAMHITA.

proper medicinal drugs) in the manner mentioned above in order to reduce it to its natural state. 39-40.

In the case of a faulty union of a (fractured) bone lying between two joints (Kànda-bhagna), the union should be again disjointed, and the fractured bone should again be set right and treated as a case of ordinary fracture. In the case where a fractured bone would be found to have protruded out of the ulcerated part and dried, it should be carefully cut off near the margin of the (incidental) ulcer,(so as not to create a fresh ulcer on any other spot of the affected part) and subsequently treated as a case of fractural ulcer. A fracture occurring in the upper part of the body should be treated with applications of Mastikya-Sirovasti [oil-soaked pads on the head] and pourings of oil into the cavity of the ears. Potions of clarified butter,* errhines and Anuvásana (enematas) should be prescribed in cases of fractures in the extremeties. 41-43.

Gandha-Taila :-Now we shall discourse on the recipe of a medicated oil, capable of bringing about the union of fractured bones. A quantity of black sesamum-seeds (tied up into a knot with a piece of linen) should be kept immersed at night in a stream of running water and taken out and dried in the sun (for seven consecutive days). It should then be saturated with cow's milk (at night and dried in the sun, during the second week). During the third week the sesamum-seeds should be saturated with a decoction of Yashti-madhu (at night) and dried in the sun the next day. Then (during the fourth week) it should be again saturated with cow's milk and dried and powdered. The said sesamum-

According to Jejjata, not only Anuvásana-enemata but potions of clarified butter and errhines also should be prescribed in cases of fractures in the extremeties.

powder and powder of the drugs, constituting the Kákolyádi Gana as well as Yasthi-madhu, Manjishthá, Sárivá, Kushtha, Sarja-rasa, Mánsi, Deva-dáru, (red) Chandana, and S'atapushpá should be mixed together. Then a quantity of cow's milk boiled with the aromatic drugs (of the Eládi group) should be used with the preceding pulverised compound for the purpose of pressing out the oil therefrom. The oil thus pressed out should be boiled in four times the quantity of cow's milk with the drugs such as Elá, S'álparni, Tejapatra, Jivaka, Tagara, Rodhra, Prapaundarika, Káldnusdri, (Tagara), Saireyaka, Kshira-Vidári, Anantá, Madhuliká, S'ringátaka, and those of the aforesaid list (Kákolyádi group and Yasthi-madhu, etc., up to S'atapushpá) pasted together. The oil should be duly cooked over a gentle fire and is called the Gandha-Taila. This oil should be administered with good results in possible ways (e.g., as potions, liniments, unguents and errhines) to a fracture-patient. Its efficacy is witnessed in cases of convulsions, hemiplegia, parchedness or atrophy of the palate, in Ardita. (facial paralysis) as well as in Manyá-stambha (Paralysis or stiffness of the neck), in diseases of the head (cephalalgia), in ear-ache in Hanu-graha, in deafness and in blindness and in emaciation due to sexual excesses. Administered in food or drink, or employed as a liniment, in Vasti-karma (enemata measures) or as an errhine, it acts as a sovereign restorative. Rubbed over the neck, chest and shoulders, it adds to the strength and expansion of those parts of the body, makes the face fair and lovely like a full-blown lotus and imparts a sweet

• There should be three parts of sesamum powder and one part of the powders of Kákolyádi, Yashti-madhu, Manjishthá, etc. (combined). But siva Dása says that four parts of sesamum-powders should be taken.

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CHAPTER IV

Now we shall diseourse on the medical treatment of nervous disorders (Váta-vyádhi). 1. Metrical Texts :-The patient having been made to vomit in the event of the deranged Váyu being incarcerated (lodged) in the Amásaya (stomach), a pulverised compound known as the Shad-Dharana-yoga (a compound of six Dharanas or twenty-four Máshá weight) with tepid water should be administered to him for seven days. A compound made up of Chitraka, Indra-yava, Píthá, Katuka, Ativishá, Abhayá (taken in equal parts) together is known as the Shad-Dharana-yogá* and contains the properties of subduing an attack of Váta-vyádhi. 2-3.

In the event of the aggravated Váyu being incarcerated in the Pakvásaya (intestines), purgatives of fatty matters (Sneha-Virechana, i.e., Tilvaka-Sarpih,etc.), and Sodhana- Vasti of purifying drugs (with decoctions and Kalka of fatty matters) and diet (Prásá) abounding in salt† or saline articles should be prescribed. In the case of the aggravated Váyu being incarcerated in the Vasti (urinary bladder), diuretic (lit. bladder-cleansing) measures and remedial agents should be resorted to. Anointing with medicated oils, Ghritas, etc., application of poultices (Upanáha) compounded of Váyu-subduing drugs, massage, and plasters (Álepa) of similar properties are the remedies in cases where the aggravated Váyu is lodged in the internal ducts or channels such

• One Dharana is equal to four Máshás. † Sneha-Lavana and Kánda-Lavana, etc.

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CHIKITSA STHANAM

would be found to have been confined in any parti ular part of the body.* 10-12.

In the event of the aggravated Váyu being connected either with the Pitta or the Kapha, such a course of treatment should be adopted as would not be hostile to the two other Doshas. Blood-letting (in small quantitics) should be resorted to several times in a case of complete ænesthesia (Supta-Váta) and the body should be anointed with oil mixed with salt and chamber-dust (Agára-dhuma) Milk boiled with a decuction of the drugs of the Pancha-mula group, acid-fruits (PhalámIa), meat-soup or soup of (well-cooked) corn (Dhánya) with clarified butter are beneficial in cases of Váta-roga. 13-15.

Sálvana-Upanáha :- A poultice composed of the drugs of the Kákolyádi group, the Váyu-subduing drugs (those of Bhadra-dárvádi and Vidári-gandhádi groups), and all kinds of acid articlet (such as, Kánjika, Sauira, fermented rice-gruel, etc.), the flesh of animals which live in swamps (Ánupa) or in water (Audaka)‡, oil, clarified butter and all kinds of lardaceous sub,tances, mixed together and saturated with a profuse quantity of salt and then slightly heated is known by the name of Sálvana. A person suffering from any form of Váta roga should be always treated with such Sálvana poultices Upanáha). The poultice should be applied to such part of the body as is

• It is to be understood that measures and remedies laid down under the head of Sarvánga-gata should be used when the Váyu would be found to be diffused throughout the whole organism instead of being confined to any specific part.

† According to others it means all kinds of acid-fruits, etc.

‡ Chakradatta reads "शामुनाद्य: सुरसिद्ध:" (well-cooked with the flesh of "Ánupa" animals) in place of शनूपोद्भवमांसवस्।

numbed, painful or contracted and the affected part should be firmly ban daged thereafter with a piece of Kshauma* linen (, r woollen cloth. As an alternative, the affected part should be plastered (and well rubbed) with the ingredients of the Sálvana-Upanáha and inserted into a bag made of cat or mungoosé skin or that of a camel or deer hide. 16.

The aggravated Váyu, if located in the shoulders, the chest, the sacrum (Trika) or the Manyá, should'be subdued by emetics and errhines judiciously employed. Síro-Vasti should be applied to the head of the patient as long as it would take one to utter a thousand Mátrás (a short vowel sound), more or less, as the case may require, where the aggravated Váyu would be found to have located itself in the head, (if necessary) blood-letting should be resorted to. As a mountain is capable of obstructing the passage of the wind, so the Sneha-Vasti (oily enema) is alone capable of resisting the action of the aggravated Váyu whether it extends throughout the whole system or is confined to a single part. 17-19

• Some read it as Válká, i.e., made up bark.

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294 THE SUSHRUTA SAMHITA.

plot of land, so as to make the soil black. The fire should be kept burning one whole night ; on the following morning on the cxtinction of the fire the ashes should be removed and the ground, when cool, should be soaked with one hundred Ghatas (six thousand and four hundred seers) of oil cooked with the drugs of the Viddri-gandhadi group and with the same quantity of milk and kept in that condition for one night more. On the next morning the earth should be dug up, down to the stratum found to have been soaked with the oil and the soil should then be dissolved in warm water in large cauldrons for the purpose. The oil that will be found floating on the surface of the water should be skimmed off with both hands and kept in a safe basin. Then the decoction of the Vayu-subduing drugs (the Bhadra-darvadi group), meat-juice, milk, fermented rice-gruel (each taken in a quantity measuring a quarter part of that oil) should be taken one thousand times and each time should be boiled with the oil. Vayu-subduing and aromatic drugs and spices, in the northern (trans-Himalaya) and southern (Deccan) countries, should be thrown into it and boiled with the oil. The boiling should be completed within the period during which it could be properly done. Then after the completion of the cooking, conch-shells should be blown, Dundubhis should be sounded, umbrellas should be held open, chowries should be blown into it and a thousand Brahmins should be treated with repasts. The oil so sacredly prepared should be stored carefully in golden, silver or earthen pitchers. This oil is called the Sahasrapaka-Taila and is of irresistible potency and fit even for the use of kings. Satapaka-Taila is also prepared in the above manner (with the aforesaid ingredients) by cooking it one hundred times only.

The Patra-Lavana :-The green leaves of the Eranda plants and those of the trees known as Mushkaka, Naktamla, Atarushaka, Putika, Áragvadha and Chitraka should be thrashed with (salt of equal quantity) in an Udulhala (a hand thrashing mill) and placed in an earthen pitcher, saturated with oil or clarified butter. Having covered the mouth of the pitcher with a lid, it should be plastered and burnt in fire of cow-dung. The medicine thus prepared (with the help of internal heat) is called the Patra-Lavana. Medical experts advise the application of this medicine in cases of Váta-roga.

The Káanda-Lavana :-Similarly, Snuhi-twigs, Brinjal (Vártáku), and S'igru-bark (taken in equal parts) and rock-salt (of equal weight as the entire drugs) should be thrashed and kept in a pitcher. Oil, clarified butter, lard and marrow should be added to it equal in weight with salt and then having covered the mouth of the pitcher with a lid, it should be plastered and burnt in a fire of cow-dung (as before). The use of this medicated salt which is called the Káanda-Lavana or Sneha-Lavana is recommended by experts in Váta-roga.

The Kalyánaka-Lavana :-The following drugs with their roots, leaves and twigs, viz., Gandira, Palása, Kutaja, Yilva, Arka, Snuhi, Apámárga, Pátalá, Páribhadra, Nádeyi, Krishnagandhá Nipa, Nimba, Nirdahani, Atarushaka, Nakta-málaka, Putika, Vrihati, Kantikari, Bhallátaka, Ingudi, Baijayanti, Kadali, Varshábhu, Hrivera, Kshuraka, Indra-vdruni, Svetamokshaka and Asoka should be gathered in a green condition and mixed with (as large a quantity of) rock-salt and having thrashed them in an Udukhala should be burnt in a hermetically sealed pitcher as

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Men of a mild and delicate constitution, as well as those who are (inordinately) stout or sedentary in their habits or are addicted to unwholesome and incompatible food, ctc., are generally found to be susceptible to an attack of Vata-Rakta.

A physician is advised to take in hand the medical treatment of a Vata-Rakta-patient who has as yet not lost much strength and muscle, nor is afflicted with thirst, fever, epileptic fits, dyspnoea, cough, numbness (of the affected part), aversion to food, indigestion, extension and contraction of the limb, as well as of a person who is strong and temperate in his living and can afford to pay for the diet and other necessary accessories of the treatement.

In the first stage of the disease the blood, having become vitiated owing to its being obstructed in its course (by the unusually agitated Vayu in the system), should be gradually and not profusely bled, except when the body would be found to have become extremely dry or to have lost its natural healthful glow or complexion through the action of the aggravated morbific principle (Vayu), for fear of further aggravating the Vayu. Emetics, purgatives, and Vasti (enemas), etc., should be administered and the patient should be made to take a diet consisting

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parts and pounded separately ; and the paste of the following drugs, viz., Kakoli, Kshira-kakoli, Jivaka, Rishabaka, Vala, Ati-vala, Visa-mrindala (lotus stem), Pris'ni-parni, Mesha-s'ringi, Piyala, S'arkara (sugar), Kas'eruka, Surabhi, and Vacha should be mixed with each of the preceding powders and each of these compounds (so formed) should be boiled with milk, oil, lard, marrow and clarified butter. The five compounds, thus prepared, are called Payasas, which should be applied as a hot poultice (Upanaha) to the affected part ; or an Utkarika, made of the pulp of oily fruit (seeds) (prepared by cooking them with milk) should be applied ; or powders of wheat, barley, sesamum, Mudga pulse, or Masha pulse, and Vesavara, made of various kinds of fish and flesh, should be used as a plaster. Vilvapes'ika, Tagara, Deva-daru, Sarala, Rasna, Harenu, Kushtha, S'ata-pushpa, Ela, Sura and cream of milk-curd pasted together, should be applied to the affected part as a plaster (Upanaha). As an alternative, the expressed juice of Matulunga, mixed with Kanjika, Saindhava salt and clarified butter, pasted together with the root of the Madhu-s'igru and with sesamum,† should be used in a similar way. The preceding remedies should be administered in a case of Vata-Rakta marked by a preponderance of the aggravated Vayu.

8. Vata-Rakta with a preponderance of Pitta :-In cases of Vata-Rakta where the Pitta preponderates, the patient should be made to drink a potion consisting of a decoction of Draksha, Aragvadha, Katphala, Kshira-vidari, Yashti-madhu, Chandana and Kas'marya sweetened with a quantity of sugar and honey.

• Such as sesamum, castor-seed, linseed, Vibhitaka-seeds, etc.

† Some say that a paste of sesamum only should be used as a separate plaster.

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302 THE SUSHRUTA SAMHITA.

be advantageously applied in cases marked by a preponderance of the vitiated blood, with this exception that cold plasters and repeated blood-lettings should be resorted to in the latter (Raktaja-Váta-Rakta).

Váta-Rakta With a preponderance of Kapha:-In cases where the Kapha preponderates,

the patient should be made to drink a potion consisting of a decoction of Haridrâ and Ámalaka, sweetened with honey ; or a decoction of Triphalâ, or a Kalka of Madhuka, S'ringavera, Haritaki and Tikta-rohini mixed with honey. As an alternative, Haritaki and treacle with either cow's urine or water, should be given to him.

The affected part or limb should be sprinkled or washed with cow's urine, oil, alkaline water, Surá, S'ukta, or with a decoction of Kapha-destroying drugs. A hot decoction of the drugs constituting the Áragvadhádi group may be used with benefit in sprinkling the affected part.

The body of the patient should be lubricated or anointed with clarified butter, boiled with the cream of milk-curd, cow's urine, wine, S'ukta and with the Kalka of Yashti-madhu, Sárivá and Padma-káshtha. A plaster (Pradeha) composed of pounded sesamum, mustard seed, linseed and barley (taken in equal parts) and mixed and pasted with S'leshmátaka, Kapittha, Madhu-s'igru and cow's urine, and Yava-kshára should be applied (hot to the seat of the disease).

The Five Pradehas :--(1) A paste of white

mustard seed, (2) that of sesamum and As'vagandhá, (3) a similar paste of Piyála, S'elu and Kapittha bark, (4) that of Madhu-s'igru, Punarnavá and (5) a paste of Vyosha, Tiktá, Prithakparni and Vrihati, these five kinds of Pradehas should be separately pasted with alkaline water and (any of them) applied lukewarm to the affected locality.

As an alternative, a plaster composed S'álaparni, Pris'niparni, Vrihati and Kantakári, pasted together with milk and mixed with Tarpana,* should be applied (to the seat of the disease). In cases of Váta-Rakta involving the concerted action of two or three of the Doshas, the remedy consists in applying such drugs in combination as are possessed of the efficacy of subduing the action of each of them.

Guda-Haritaki and Pippali-Vardhamána Yogas :-Haritaki with treacle may be used in all types of Váta-Rakta. As an alternative, the patient should be enjoined to use Pippali, pasted with milk or water, every day (in the following way).† The number of Pippali should be increased by five or ten respectively on each successive day till the tenth day of its use ; after which period the number of Pippali should be decreased (by a similar number) on each successive day till it is reduced to the original five or ten. The patient should live on a diet of milk and rice only (during the entire course of this treatment). This medicine which is known as the Pippali-Vardhamána,‡ proves efficacious in cases of Vata-Rakta, chronic fever (Vishama-Jvara), aversion to food, jaundice, enlarged spleen, piles, cough, asthma, œdema, phthisis, loss of appetite, heart-disease and ascitis.

• Flour of barley or fried grain, dissolved in water, is known as Tarpana.

† The dosage should begin originally with five or ten Pippalis according to the strength of the patient.

‡ Maharshi Charaka mentions this Yoga in the chapter on Rasáyana and prescribes it also in the treatment of Udara. Chakradatta mentions the use of this medicine in the treatment of liver and spleen and of fever.

304 THE SUSHRUTA SAMHITA. Chap. V.

anointing (the body of the patient). A plaster, composed of Sahá, Sahadevâ, Chandana, Murvá, Mustá, Piyála, S'atd́vari, Kas'eru, Padma-kâstha Yashti-madhu, S'ata-pushpá (A. D. Vidári) and Kushtha, pasted together with milk and mixed with the cream of clarified butter, should be applied (hot) to the affected locality. A plaster composed of Saireyaka, Atarushaka, Vald́, Ati-vald́ Jivanti and Sushavi, pasted together with the milk of a she-goat, should be likewise applied (to the seat of the disease). As an alternative, the diseased locality should be plastered with the pastes of Kás'marya, Yashti-madhu and Tarpana mixed together ; or it should be treated with Pinda-Taila, prepared by cooking Madhu-chchhishta (bee's wax), Manjishthá, resin, and Ananta-mula in milk* (and oil taken together). 17-20.

In all cases of Váta-Rakta, old and matured clarified butter boiled with the expressed juice of Ámalaka should be prescibed as drinks. The affected part should be washed or sprinkled with old and matured clarified butter, boiled with. a decoction and paste (Kalka) of the drugs belonging to the Kakolyádi group, or with those of the Jivaníya group, or with the decoction of Sushavi, or of Káravellaka. The Valá-Tailat should be used for sprinkling and immersing purposes, and as drink and Vasti-karma (enemas).

In all cases of Váta-Rakta, old and matured clarified butter boiled with the expressed juice of Ámalaka should be prescibed as drinks. The affected part should be washed or sprinkled with old and matured clarified butter, boiled with. a decoction and paste (Kalka) of the drugs belonging to the Kakolyádi group, or with those of the Jivaníya group, or with the decoction of Sushavi, or of Káravellaka. The Valá-Tailat should be used for sprinkling and immersing purposes, and as drink and Vasti-karma (enemas).

Diet :-The diet should consist of articles made of old and matured S'áli or Shashtika rice, wheat or barley, taken with milk ‡ or with the soup of Mudga

Diet :-The diet should consist of articles made of old and matured S'áli or Shashtika rice, wheat or barley, taken with milk ‡ or with the soup of Mudga

• Milk four times of oil should be taken. † The "Valá-Taila" described in the medical treatment of Mudha-garbha, ch. XV. ‡ In the case of Váta-roga with preponderant Pitta, the patient should take the food with milk ; in the preponderance of Váyu, with the soup of Jangala meat; and in the preponderance of Kapha, with Mudga-soup, devoid of any acid combination.

• Milk four times of oil should be taken. † The "Valá-Taila" described in the medical treatment of Mudha-garbha, ch. XV. ‡ In the case of Váta-roga with preponderant Pitta, the patient should take the food with milk ; in the preponderance of Váyu, with the soup of Jangala meat; and in the preponderance of Kapha, with Mudga-soup, devoid of any acid combination.

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of perspiration, quivering, delirium and the numbness of genitals, found not to fall on the ground but capable of being supported on his arms (Akhatta-pati) and whose trunk is not bent or arched on its posterior (dorsal) side (Vahiráyáma); may be attempted (with success). The body of the patient should be first anointed with emulsions (Sneha) and then fomented ; strong medicated snuff should then be administred for purifying (the accumulated mucus in) the head. After that the patient should be made to drink a clear potion prepared of clarified butter, cooked in combination with a decoction of the drugs constituting the Vidari-gandhadi group, extract of meat, milk and milk-curd, so as to arrest the further expansion of the deranged Váyu into the system.

Traivrita Ghrita :-A decoction of the Váyusubduing drugs, such as, Bhadra-dáruadi, etc., barley, Kulattha pulse, Kola, and the flesh of the Anupa and Audaka animals with the Pancha-Vargas* should be

• According to Jejjata, "Pancha-Vargam" means the flesh of the five kinds of Anupa animals, viz., Kulachara, Plava, Kosastha, Padin and Matsya (fishes).

The reading here is doubful. The term "Audaka" in the compound word "Sánupaudaka-mámsam" seems to be redundant, inasmuch as "Audaka" animals are included in the "Anupa" class. (Sutra. chap. XLVI. Page 487, Vol I). In this case the word "Pancha-vargam" also seems to be only an explanation of the term "Anupa" meaning the five kinds of Anupa flesh, and it seems to have surreptitiously crept into the body of the text from the marginal notes of some authoritative manuscript copy of the book. If, however, we are to abide by the current reading of the book, "Pancha-varga" cannot mean the five kinds of flesh in the presence of the wurd "Audaka" mentioned separately, as Jejjata would have it. In that case it can only mean either the five groups of Pancha-mulas, viz., the major Pancha-mulas, the minor Pancha-mulas, the Valli-Pancha-mulas, the Kantaka-Pancha-mulas and the Trina-Pancha-mulas. (Sutra, chap. XXXVIII, Pages 355-6, Vol. I), as some would explain it to mean. Others, however, prefer the reading as it is and explain the term "Fanchavarga" to be the five kinds of medicinal drugs mentioned before in the sentence,

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juice of Mulaka, Eranda, Sphurja, Arjaka, Arka, Saptalá and S'amkhini should be used in washing (Parisheka), etc., the body of an Apatánaka-patient. Potions consisting of sour Dadhi (milk-curd) mixed with powdered pepper and Vachá, or of oil, clarified butter, lard, or honey, mixed with the same things and taken in an empty stomach, prove curative in cases of Apatánaka.

26. These remedial measures are applicable in cases of Apatánaka when the action of the aggravated Váyu alone preponderates. In a case involving the concerted action of two or more of the Doshas, drugs, remedial to each of them, should be combinedly employed. Medicinal liquid errhines (Avapida) should be employed after the subsidence of a severe attack The fat or lard of a cock, crab, Krishna-fish, porpoise or of a boar should be taken* by the patient. As an alternative, he should be made to drink (a potion consisting of) milk boiled with Váyu-subduing drugs (Dasá-mula, etc.), or a gruel (Yavágu) composed of barley, Kola, Kulattha-pulse and Mulaka, cooked with curd, oil and clarified butter. Oily purgatives, Ásthá́pana and Anuvásana measures, should be employed if the paroxysm does not subside even in ten days. Medicines and remedial measures laid down under the head of Váta-vyádhi and the process of Rakshá-karma, should be likewise adopted (in cases of Apatánaka).

27. Treatment of Pakshágháta :—A physician is enjoined to take in hand the medical treatment of a patient laid up with Pakshágháta, unattended by a discolouring of the skin, but having pain in the affected part, and who habitually observes the rules of lards,

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THE SUSHRUTA SAMHITA

butter, cooked in combination with sixteen seers of milk, two Pala weight of Sauvarchala salt and fifty of Haritakis should be prescribed for the use of the patient. All other remedial agents, possessing the virtue of subduing the deranged Váyu and Kapha should be likewise employed. 30.

THE SUSHRUTA SAMHITA

Treatment of Ardita :-A patient suffering from Ardita (facial Paralysis) should be treated with the measures and remedies laid down under the head of Vata-vyádhi in the event of his being found to be sufficiently strong and capable of affording the necessary expenses for his treatment. Errhines, Mastikya-Siro-vasti, inhalation of the smoke (Dhumapána) from medicated drugs, poulticing (Upanáha), unguents and Nádi-sveda, etc., are the special features of the medical treatment of this disease.

THE SUSHRUTA SAMHITA

After that, a decoction should be made of the drugs constituting the groups of Trina-Pancha-mula, Madhu-Pancha-mula, Kakolyádi and Vidári-gandhádi groups, aquatic bulbs, and the flesh of animals which are aquatic in their habits (Audaka) and those which frequent swampy places (Ánupa), by boiling them together with a Drona measure of milk and double the quantity of water.

THE SUSHRUTA SAMHITA

The decoction should be considered boiled when three quarter parts of its original weight of the liquid has been evaporated and should then be strained.

THE SUSHRUTA SAMHITA

The decoction thus prepared should be boiled with a Prastha measure of oil (four seers) and be removed from the fire when the oil is well mixed with the milk. The compound (oil and milk) thus prepared should be allowed to cool down and then churned.

THE SUSHRUTA SAMHITA

The churned off cream (Sneha) should be again boiled with the drugs of the Madhura (Kákolyádi) group, Másha-parni and milk (four times that of the original oil). This medicated oil is known as the Kshira-Taila and should

be administered as potions and unguents, etc, to an Ardita-patient. The above preparation with clarified butter in the place of oil is known as the Kshira-sarpih and it should be used as an Akshi-tarpana (eye-lotion).

31—32.

Venesection should be duly resorted to in the affected parts, according to the directions given before, in cases of Sciatica, Gridhrasi, Viśvachi (Synovitis of the knee-joints), Kroshtuka-śirah, Khanja (lameness), Pangula, Vata-kantaka, Pada-dáha, Pada-harsha, Ava-váhuka and Vádhiryya and in cases where the deranged Váyu would be found to be seated in a Dhamani. Measures and remedies laid down under the head of Vata-vyádhi should be adopted, except in a case of Ava-váhuka.

The expressed juice of green ginger, made lukewarm after mixing it with (equal quantities of) oil, honey and Saindhava salt, should be poured into the cavity of the ear in a case of (acute) ear-ache. As an alternative, the urine of a she-goat, or oil and honey, or oil with the urine (of a cow) mixed with the expressed juice of Mátulunga, pomegranate and tamarind, or the oil boiled and prepared with Surá, Takra, Śukta, salt and the urine (of a cow), should be poured into the cavity of the ear; fomentation should be given (to the interior of the affected organ) after the manner of Nádi-sveda. The remedial measures for Vata-vyádhi should be resorted to. We shall, however, revert to the subject in the Uttara-Tantra.

The patient should be made to drink a potion of Sneha-Lavana* dissolved in an adequate quantity of water, or the powders of the Pippalyádi group (with an

• Sneha-Lavana has been described in Chap. 4. (treatment of Vata-vyádhi) para. 24.

THE SUSHRUTA SAMHITA

adequate quantity of water, or clarified butter, thickened or saturated with pulverised asafœtida and Yava-kshára (Carbonate of Potass), in cases of Tuni and Prati-tuni. Applications of Vástis should also be resorted to.

In a case of Adhmána (Tympanites), the remedy should consist in the applications of powders of the Dipaniya (appetising) group, of suppositories (Phala-varti), Vástis and digestive drugs (Páchaníya group). The patient should also be advised to observe a rigid fast and his abdomen should be fomented with hot palms. After that he should break his fast with boiled rice prepared with appetising (Dípana) drugs such as, Dhányaka, Jíraka, etc. Similarly, a case of Pratyadhmána should be treated with fasting, emetics and appetising drugs. Cases of Ashthilá or Pratyashthilá should be treated as a case of Gulma and internal abscess, to all intents and purposes.

Hingvádi-Váti :— A compound consisting of asafœtida, Trikatu, Vachá, Ajamodá, Dhanyá, Ajagandhá, Dádimba, Tintidí, Páthá, Chitraka, Yava-kshára, Saindhava salt, Vid salt, Sauvárchala salt, Svarjiká-kshára, Pippalímula, Amlavetasa, S'athi, Pushkara-mula, Hapushá, Chavyá, Ajáji and Pathyá, powdered together and treated many times with the expressed juice of Mátu-lunga in the manner of Bhávaná* saturation, should be made into boluses, each weighing an Aksha (two Tolás) in weight. One (such) pill should be taken (in an empty stomach) every morning in all diseases of the deranged Váyu. This compound proves curative in cough, asthma, internal tumour (Gulma), ascites, heart-disease,

• "Bhávaná" consists in soaking a powder or a pulverised compound with the expressed juice or decoction of any drugs or with any liquid and in getting it dry (generally). This process should be cotinued many times (generally seven times) in succesion.

tympanites, aching pain at the sides, in the abdomen and in the bladder, in cases of an aversion to food, retention of stool, strangunary, enlarged spleen, piles, Tuni and Prati-tuni.

In a case of cold, compact and painful swelling (appearing in any part of the body) owing to the combination of the deranged Váyu with fat, the treatment should be identical with that of a swelling in general.

40-41.

Its Treatment :-The patient should be made to drink a potion consisting of the pulverised compound known as the Shad-dharana-yoga; or of the drugs constituting the Pippallyádi group, dissolved in (an adequate quantity of) hot water without using any oleaginous substance ; or a lambative, composed of pulverised Triphalá and Katuka mixed with honey, should be

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CHAPTER VI.

Now we shall discourse on the medical treatment of Hæmorrhoids (Arśas).

The remedial measures in hæmorrhoids may be grouped under four subheads ; namely, the employment of (active) medicinal remedies, the application of an alkali (into the seat of the disease), actual cauterization (of the polypii) and surgical operation.

A case of recent origin involving the action of the Doshas to a slight degree and uncomplicated with any grave or dangerous symptom and complication may prove amenable to medicine alone.

Deep-seated polypii, which are soft to the touch and markedly elevated and extended (external—D R.), should be treated with alkaline applications, while those which are rough, firm, thick and hard should be cauterized with fire.

Polypii which are raised, exuding and slender at the roots should be surgically treated.

Hæmorrhoids which are held amenable to medicine and are not visible (to the naked eye) should be treated with the help of medicines alone.

Now, listen to the procedure to be adopted in the treatment of Arśas which would require alkaline applications, a cauterization, or a surgical operation.

Application of Kshára :-The body of the patient suffering from hæmorrhoids, in the event of possessing sufficient strength, should be anointed and duly fomented.

He should be made to eat warm but demulcent food (Anna) in a fluid state (of a gruel-like consistency) to alleviate the excessive pain incidental to the action of the deranged Váyu.

In a season neither too hot nor too cold, and when the

Chap. VI.] CHIKITSA STHANAM.

sky is cloudless, he should be placed in a raised up position in a clean and well-equipped place on a plain slab or on a clean bed with his head resting on the lap of an attendant and the anal region exposed to the sun. In this position the waist should be made to elevate a little and to rest on a cushion of cloths or blankets. The neck and the thighs of the patient should be drawn out, and then secured with trappings and held fast by the attendants so as not to allow him to move. Then a straight and slender-mouthed instrument (somewhat like the modern rectal speculum), lubricated with clarified butter, should be gently inserted into the rectum and the patient should be asked to strain down gently at the time. After seeing the polypus (through the speculum), it should be scraped with an indicator and cleansed with a piece of cotton or linen after which an alkali should be applied to it. The exterior orifice of the instrument should be closed with the palm of the hand after this application and kept in that manner for a period that would be required to utter a hundred words.

Then after having cleansed the polypus, a fresh application should be made according to the strength of the alkali and the intensity of the aggravated Doshas involved in the case. Further application of the alkali should be stopped and the polypus washed with fermented rice-gruel (Dhányámla), curd-cream, Sukta, or the juice of acid fruits, in the event of its having been found to have become a little flabby, bent down, and to have assumed the colour of a ripe Jambu fruit. After that it should be cooled with clarified butter mixed with Yashti-Madhu, the trappings should be removed and the patient should be raised up and placed in a sitting posture in warm water and refreshed with

318 THE SUSHRUTA SAMHITA.

sprays of cold water, or, according to some authorities, with warm water. Then the patient should be made to

lie in a spacious chamber, not exposed to the blasts of cold winds (specially), and advised as regards his diet and

regimen. Each of the remaining polypii, if any, should be cauterized with the alkaline application at an interval

of seven days. In case of a number of polypii, those on the right side should be first cauterized and then

those on the left, and after that those on the posterior side ; and lastly those that would be found to be in

front. 3.

Polypii, having their origin in the deranged Váyu and Kapha, should be cauterized with fire or alkali ; while

those, which are the outcome of the deranged Pitta and vitiated blood should be treated with a mild alkali alone.

A perfect and satisfactory cauterization (Samyagdagdha) of a polypus should be understood from such

symptoms as, restoration of the bodily Váyu to its normal condition, relish for food, keenness of the appe-

tite, lightness of the body and improvement in strength, complexion and pleasure. An over-cauterized (Ati-

dagdha) polypus gives rise to such symptoms as, cracking of the region of the anus, a burning sensation

(in the affected locality), fainting, fever, thirst, and profuse hæmorrhage (from the rectum), and consequent

complications ; while an insufficiently cauterized (Hina-dagdha) polypus is known by its tawny brown colour,

smallness of the incidental ulcer, itching, derangement of the bodily Váyu, discomforts of the cognitive organs

and a non-cure of the disease. 4.

A large polypus, appearing in a strong person, should be clipped off (with a knife) and cauterized with fire.

As regards an external polypus full of extremely aggravated Došhas (Váyu, Pitta, Kapha and blood) no

Yantras should be used, but the treatment should consist of fomentation, anointing, poulticing, immersion, plastering, evacuating measures (Visráva), cauterization with fire and alkali and a surgical operation. Measures laid down under the head of Rakta-pitta should be resorted to in cases of hæmorrhage (from the seat of affection). Remedies mentioned in connection with dysentery (Atisára) should be employed in cases of a looseness of the bowels; whereas in cases of constipation of the bowels oily purgatives should be administered, or the remedies for Udávartta should be adopted. These rules shall hold good in the cases of treating (cauterization, etc.) a polypus occurring in any part of the body whatsoever. 5.

A polypus should be caught hold of and an alkali should be applied thereto with a Darvi, or a brush (Kurcha), or an indicator (Śaláká). In a case of a prolapsus of the anus, cauterization should be made without the help of any Yantra (speculum).

Diet :-In all types of hæmorrhoids, the diet should consist of wheat barley, Shashtika rice or Sáli rice, (boiled) and mixed with clarified butter, to be taken with milk, Nimba-soup, or Patola-soup. The patient should be advised to take (his meal) with Vástuka, Tanduliyaka, Jivanti, Upodiká, As'va-vala, tender Mulaka, Pálanka, Asana, Chilli, Chuchchu, Kaláya, Valli, or any other S'ákas (pot-herbs), according to the nature of rhe Doshas involved in the case Any other oleaginous, diuretic, laxative and appetising (Dipana) diet possessing the virtue of curing piles should also be prescribed. 6.

After the cauterization of the polypus, as well as in a case where no cauterization would be necessary, the body of the patient should be anointed with clarified

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CHIKITSA STHANAM

operation in the present disease should be effected by introducing the Yantra (speculum) into the rectum (with the utmost care, inasmuch as an error happening in any of these cases may bring on impotency, swelling (Sopha), a burning sensation, epilepsy, rumbling in the intestines, retention of stool and urine, dysentery, diarrhœa, or may ultimately end in death. 8.

Rectal Speculum

Now we shall describe the dimensions of the Yantras (and the materials of which they are made of). The instrument may be made of iron, ivory, horn or wood. It should be made to resemble the teat of a cow. In the case of a male patient, it should be four fingers in length and five fingers in circumference ; whereas in the case of a female patient, the length should be commensurate with that of the palm of the hand (of the same length as before-D. R.) and six fingers in circumference. The instrument should be provided with two separate apertures in its inside, one for seeing the interior of the rectum and the other for applying an alkali, or actual cautery (Agni) to the polypus, since it is impossible to apply fire and alkali through the same aperture. The circumference of the aperture in the upper three fingers of the instrument should be like that of a thumb. There should be a bulb-like protrusion of the same width, at the bottom, and above it a space of half a finger's width. Thus we have briefly described the shape of the instrument. 9-10.

Alepa (plasters)

Now we shall describe the plasters to be applied to the hæmorrhoids (to cause their spontaneous dropping off). The first consists of pulverised turmeric mixed with the milky exudation of the Snuhi tree. The second contains of the cock-evacuations and pulverised Gunjá, turmeric and Pippali

322 THE SUSHRUTA SAMHITA.

pasted with the urine and bile of a cow. The third is compounded of Danti, Chitraka, Suvarchika and Langali pounded together and made into a paste with cow's bile. The fourth consists of Pippali, rock-salt, S'irisha-seeds and Kushtha pasted with the milky juice of an Arka, or Snuhi plant. An oil cooked in combination with Kasisa (sulphate of iron), Haritala (yellow orpiment), rock-salt, As'vamdraka, Vidanga, Putika, Kritavedhana, Jambu, Arka, Uttamarani, Danti, Chitraka, Alarka and Snuhi-milk, and used as an unguent, leads to the falling off of the polypus.

Internal piles :-Now we shall describe the remedial measures which bring about the falling off of the invisible (internal) hæmorrhoids.

The patient should take Haritaki with treacle every morning ; or a hundred Haritakis should be boiled in a Drona measure of cow's urine and the patient, observing a strict continence, should take with honey every morning as many of them as suit his constitution ; or he should be made to take every day a paste made of the roots of Apamarga with the washings of rice and with honey.

S'atdvari pasted with an adequate quantity of milk or (a Karsha measure of) the powders of Chitraka mixed with a copious quantity of good Sidhu wine, or a gruel (Mantha) (neither extremely thick nor thin), or powdered barley or wheat mixed with Takra and Bhallataka powder, should be administered without any salt.

A quantity of Takra should be kept in an earthen pitcher, plastered inside with a paste of Chitraka roots, and given to the patient in food and drinks whether fermented or not.

A Takra should also be separately prepared as in the preceding manner with Bhdrgi, Asphotd, barley, Amalaka and Guduchi and administered similarly.; this is called the Takra-kalpa (butter-milk compound).

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Dantyárishta

A Tulá weight* (twelve seers and a half) of the following drugs, viz., Das'a-mula, Danti, Chitraka and Haritaki should be boiled with four Drona measures of water till reduced to one quarter part (one Drona). The decoction, thus prepared, should be cooled down, filtered, mixed with a Tulá measure of treacle and preserved into a receptacle which formerly contained clarified butter, which should then be kept buried for a month in a heap of unthrashed barley At the close of this period an adequate dose of this preparation should be given to the patient every morning. This medicine proves beneficial in cases of hæmorrhoids, chronic diarrhœa (Grahaṇi), jaundice, obstinate constipation of the bowels (Udávartta) and in an aversion to food. It is also a good stomachic agent.

Abhayárishtat

Two Pala weight of each of the following drugs, viz., Pippali, Maricha, Vidanga, Elaváluká and Lodhra, five‡ Pala weight of Indra-varuni, ten Pala weight of the inner pulps of the Kapittha fruit, half a Prastha measure (one Prastha is equal to two seers) of Haritaki and one Prastha weight of Ámalaki, boiled together with four Drona measures of

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A ripe and fresh Bhallátaka should be cut into two, three or four pieces and a decoction should be made of them in the usual way. The patient should be made to drink four Tolá weight of this cold every morning after lubricating or anointing his tongue, palate and lips with clarified butter, and should take his chief meal with milk and clarified butter in the afternoon. The number of Bhallátakas in preparing the decoction should be increased by one every day till the fifth day, (and the quantity of the decoction to be drunk by the patient should be similarly increased). After that, the number of Bhallátakas (and consequently the quantity of the decoction to be taken) should be increased by five every day. This method should be followed till the number of the Bhallátakas reaches seventy, after which it should be decreased every day by five until it is reduced to five Bhallátakas only (and five Śukti measures of the decoction). Subsequently the number of Bhallátaka (and the dose) should be diminished by one (and one Śukti measure respectively) every day,until it is reduced to the original one (and one Śukti measure). By taking a thousand Bhallátakas in this manner, one may get rid of an attack of any kind of Kushtha and Arśas, and, having become strong and healthy, may live for one hundred years.

Other forms of Bhallátaka-yoga :- The oil extracted from or pressed out of Bhallátakas, in the manner laid down in the chapter on Dvi-vrana, should be taken in a dose of one Śukti (four Tolás) every morning. The patient, as in the preceding case, should take his meal ( of boiled rice, milk and clarified butter) after the digestion of the oil with a similar good effect. As an alternative, oil should be extracted from

the marrow of Bhallátakas

and the patient, after cleansing his system with emetics and purgatives, etc., and regulating his diet in the order of Peyá, etc. should enter into a spacious chamber, protected from the blasts of the winds and take two Palas, or one Pala weight of the oil according to his strength.

A meal of boiled rice, milk and clarified butter, etc., should be taken after the oil had been fully digested. The oil should be continued, in this way, for a month, the regimen of diet should be strictly observed for a period of three months and the patient should abstain from anger, etc., during this period.

The use of this oil, in the above mentioned way, not only ensures a radical cure of the disease with all its complications, but would increase the duration of life to a hundred years with the glow of youth and health and with an increment in the powers of memory, retention and wisdom.

The application of this oil for every one month will extend one's life for a period of one hundred years. In the same way a continuous use for ten months would enable him to live for a thousand years.

17. Memorable Verses :– Vrikshaka (Kutaja) and Bhallátaka* prove as much curative in cases of all kinds of hæmorrhoids, as Kshadira and Vijaka are effective in cases of cutaneous affections (Kushtha).

Cauterization with fire, or with an alkali, proves as much palliative in cases of external hæmorrhoids as turmeric proves soothing in those of Prameha. 18-19.

Medicated Ghritas, appetising drugs, electuaries, medicinal wines, Ayaskriti and Ásava should be prescribed in cases of hæmorrhoids, according to the nature and intensity of the Doshas involved

• Boiled with sixteen times of water in the event of the Bhallátaka being dry, otherwise with eight times of water only.

therein. Voluntary suppression of any natural urgings of the body, sexual intercourse, riding on horse-back, etc., sitting on the legs and such diets as would aggravate the Doshas, should be avoided in cases of hæmorrhoids. 20-21.

Thus ends the sixth Chapter in the Chikitsita Sthánam of the Sus'ruta Samhitá which deals with the medical treatment of Ars'as,

Thus ends the sixth Chapter in the Chikitsita Sthánam of the Sus'ruta Samhitá which deals with the medical treatment of Ars'as,

CHAPTER VII.

Now we shall discourse on the medical treatment of urinary calculus, etc. (Aśmari). 1. Metrical Texts :–Aśmari (urinary calculus, etc) is a dangerous disease and is as fatal as death itself. A case of recent origin (acute) proves amenable to medicines, while an enlarged or chronic one requires surgical operations. The remedial measures, in the order of anointing, etc., should be employed in the first or incipient stage of the disease, whereby the entire defects with their causes (i.e., roots of the disease) would be radically cured. 2. Treatment of Vátaja Aśmarī :–Clarified butter cooked with a decoction of Páshánabheda, Vasuka, Vas'ira, As'mantaka, S'atávari, S'vadamstrá, Vrihati, Kantakáriká, Kapotavamka, A'rtagala, Kakubha*, Us'ira, Kubjaka, Vrikshádani, Bhalluka, Varuna, S'aka-phala, barley, Kulattha, Kola and Kataka fruits and with the Kalka of the drugs constituting the group of Ushakádi, speedily brings about the disintergration of As'mari (urinary calculi, etc.) due to the action of the deranged Váyu. Milk, Yavágu (gruel), a decoction, soup, or an alkali, properly prepared with the above Váyu-subduing drugs should also be administered as food and drink in the above cases. 3. Treatment of Pittaja Aśmari :–Similary a medicated clarified butter cooked with the

• Chakradatta reads "Kopotavaktrá" in place of "Kapotavamka" "Kánchana" in place of "Kakubha"; and "Gulmake" in place of "Kubjaka." From an examination of Dallana it appears that "Kachchhaka" is also a reading of "Kakubha." 42

decoction of Kus'a, Kás'a, S'ara, Gundrá, Ikata; Morata, As'mabhid, S'atidvari, Viddri, Várdhi, S'dili-mula, Tri-kantaka, Bhalluka, Pátalá, Páthá, Pattura, Kuruntiká, Punarnavá*, S'irísha, with the paste (Kalka) consisting of S'ilájatu, Madhuka (flower) and the seeds of Indivara†, Trapusha and Erváruka, would speedily bring about the disintegration of Pittaja As'mari (calculi, etc.). An alkali, Yavágu (gruel), soup, a decoction, or milk, properly prepared with the above Pitta-subduing drugs, should also be prescribed as food and drink in these cases. 4.

Treatment of Kaphaja As'mari :- The use of medicated clarified butter prepared from the milk of a she-goat† and cooked with the paste (Kalka) of the drugs constituting the Varunádi group‡, Guggulu, Elá, Harenu, Kushtha, the Bhadrádi group, Maricha, Chitraka, Surdhvá and the Ushakádi group, leads to the speedy disintegration and expulsion of the As'mari (stone, etc.) due to the action of the deranged Kaphá. So also the use of an alkali, Yavágu (gruel), soup, milk, or a decoction, properly prepared with the above Kapha-subduing drugs, is recommended as food and drink in such cases. 5.

A potion consisting of the powdered fruit of the Pichuka, Amkola, Kataka, S'áka and Indivara mixed with treacle§

• Chakradatta reads "Punarnavě" i.e., both the kinds of Punarnavá. † Jejjata explains "Indivara" as 'Nilotpala.' But Gayádása does not support this. ‡ Some say that "Aja-sarpih" is superfluous. Chakradatta reads "गवो वह्नाकादौ च गुग्गुल्वे:हरेषभि:" in place of "गवो वह्नाकादिस्तु गुग्गुल्वादिहरेपिभि:" meaning ther by that the decoction of the Varunádi-gana is to be used. Chakradatta's reading seems to be the correct one and is observed in practice with good results. -Ed. § The quantity of treacle, to be taken, should be equal to the entire quantity of the powders : and hot water should be used -Dallana.

and water proves beneficial in cases of Gràvel (Śarkará). The bones of the Krauncha, camel and ass, as well as the drugs known as S'vadamshthrá,† Tálamuli, Ajamóddá, Kadamba-roots and Nágara pounded together and administered through the vehicle of wine (Surá) or hot water, leads to the disintegration of Śarkará (gravel). The milk of an ewe mixed with powdered Trikantaka-seeds and honey should be used for seven days for the disintegration and separation of an Aśmari.

Alkaline Treatments :- An alkali should be prepared from the ashes of the drugs used in the preparation of the aforesaid medicated clarified butters, by dissolving and filtering them in ewe's urine The alkali should then be slowly boiled with an alkali similarly prepared from the dung of domestic animals, with the powders of Trikatu and the drugs of the Ushakddi group thrown into them as an after-throw. It proves curative in cases of stone, Gulma, and gravel.

6-7

Alkalies† from burnt bark of sesamum, Apámárga, plantain, Paláśa and barley taken with the urine of an ewe destroy the gravel (S'arkará). As an alternative, the alkalies of Pátalá and Karavira should be used in the preceding manner.

8-9

Two Tolá (Aksha) weights of the pastes of S'vadamstrá, Yashti-madhu and Bráhmi (mixed with ewe's urine) should be given to the patient ; or the expressed juice of the Edaká, S'obhánjana and Márkava (with the said urine) should be given, or a potion consisting of the pasted roots of the Kapotavamka with Kánjika, or Surá, etc., should be administered. Milk boiled with the aforesaid drug (Kapotavamka) should be taken by a patient

• Some explain it as "Gokshura-seeds" and others as "Markataka-seeds." † Four or six Tolá weight of an alkali should be dissolved and filtered for a number of times before use.

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THE SUSHRUTA SAMHITA

of the raphe of the perineum at the distance of a barley-corn and of a sufficient width to allow the free egress of the stone. Several authorities recommend the opening to be on the right side of the raphe of the perineum for the convenience of the operation. Spcial care should be taken in extracting the stone from its cavity so that it may not break into pieces nor leave any broken particles behind (i.e., inside the bladder), however small, as they would, in such a case, be sure to grow larger again. Hence the entire stone should be extracted with the help of an Agravaktra Yantra (a kind of forceps the points of which are not too sharp).

Lithotomic Operation in a female

In a woman, the uterus (Garbhás'aya) is adjacent to the urinary bladder, hence the stone should be removed by making an oblique and upward incision, otherwise a urine-exuding ulcer might result from the deep incision in that locality. Any hurt to the urethra during the operation would be attended with the same result even in a male patient. An incision made only on one side of the organ in a disease other than that of stone, baffles all attempts at healing; while an ulcer incidental to an incision made on both its sides, should be deemed incurable An ulcer incidental to an incision made on either side of the bladder in extracting a stone might be healed up, inasmuch as medicinal potions and fomentations, etc., employed for the healing of a surgical wound, lead to the healing of the wound in the bladder ; secondly because the surgical opening is only made large enough for the extraction of the stone as recommended in the authoritative books ; and thirdly because an increase in the quantity of urine contributes to an increase in the size of the stone and hence a slight secretion of that

Chap. VII.] CHIKITSA STHANAM. 335

fluid or employment of diuretic Peyás, etc., are not attended with any injurious effects. Post-Surgical Measures : -After the extraction of a stone, the patient should be made to sit in a Droni (cauldron) full of warm water and be fomented thereby. In doing so the possibility of an accumulation of blood in the bladder will be prevented ; however if blood be accumulated therein, a decoction of the Kshira-trees should be injected into the bladder with the help of a Pushpa-netra (urethral Syringe). 14-15.

Memorable Verse :-Stones and the accumulated blood in the bladder would be speedily expelled by means of injecting a decoction of the Kshira-trees into it with the help of a Pushpa-netra (urethral Syringe). 16.

For the clearance of the urinary passage, a treacle solution should be given to the patient ; and after taking him out of the Droni, the incidental ulcer should be lubricated with honey and clarified butter. A Yavágu, boiled with the drugs* possessed of the virtue of cleansing or purifying the urine, and mixed with clarified butter, should be given to the patient in a warm state every morning and evening for three consecutive days.

After that period a diet (meal) of rice well boiled and mixed with milk and a large quantity of treacle, should be given (to the patient) in small quantities for ten days for the purification of the blood and the secretion of urine as well as for the purpose of establishing secretion in the ulcer. The patient should be made to partake of a diet (of rice) with the soup of the flesh of Jángala animals and the expressed juice of acid fruits after the lapse of these ten days. 17.

• The urine-purifying drugs are the Trina-Panchamulas, Gokshura, Kásamarda, Páshánabheda, etc.

336 THE SUSHRUTA SAMHITA. [Chap. VII.

After that period, the body of the patient should be carefully fomented for ten successive days by applying any warm oleaginous substance or with any warm medicinal fluid (Drava-Sveda). As an alternative, the ulcer should be washed with the decoction of (the bark of) the Kshira-Vrikshas. A paste of Rodhra, Madhuka, Manjishthá and Prapaundarika (pounded together), should be applied then to the ulcer. A medicated oil or Ghrita cooked with turmeric and the preceding drugs should be applied to the ulcer. The accumulated blood in the affected part should be removed with the help of a Uttara-vasti (urethral Syringe). The ulcer should be cauterized with fire in the manner described before in the event of the urine not flowing through its natural passage after the lapse of seven days. After the urine takes its natural course, Uttara-vasti, Asthá pana and Anuvásana measures should be employed with the decoction of the drugs belonging to the Madhura-Varga.

A seminial stone or gravel (S'arkará) spontaneously brought down into the urinary passage should be removed through the same passage. The urethra should be cut open and the stone should be extracted with a hook (Vadiśa) or any other instrument in the case of its not being expelled out by the passage. The patient should refrain from sexual intercourse, riding on horse back or on the back of an elephant, swimming, climbing on trees and up mountains and partaking of indigestible substances for a year even after the healing of the ulcer. 18.

Parts to be guarded in Lithotomic Operations: -The Mutra-vaha (urine-carrying) and the S'ukra-vaha (semen-carrying) ducts or channels, the Mushka-srotas (cords of the testes), the Mutra-praseka

Chap. VII.] CHIKITSA STHANAM. 337

(urinary) channels, the Sevani (the raphe of the perineum), the Yoni (uterus, vagina, etc.), the Guda(rectum)and the Vasti (bladder) should be carefully guarded at the time of performing a lithotomic operation. Death results in the event of the*urine-carrying channels being in any way hurt during the operation owing to an accumulation of urine in the bladder. Similarly,any hurt or injury to the semen-carrying ducts at the time, results in death or in impotency of the patient; a hurt to the cords of the testes begets an incapacity of fecundation ; a hurt to the urinary ducts leads to a frequent dribbling of urine ; while a hurt to the Yoni (uterus, vagina, etc.), or to the raphe of the perineum gives rise to extreme pain. The symptoms which characterise a hurt to the rectum or to the bladder have been described before. 19.

Memorable Verses:-The surgeon who is not well cognisant of the nature and positions of the Marmas or vulunerable parts seated in the eight Srotas (ducts) of the body such as, the raphe of the perineum, the spermatic cords, the cords of the testes and the corresponding ones in females (Yoni), the anal region, the urinary ducts, the urine-carrying ducts, and the urinary bladder and is not practiced in the art of surgery brings about the death of many an innocent victim. 20.

Memorable Verses:-The surgeon who is not well cognisant of the nature and positions of the Marmas or vulunerable parts seated in the eight Srotas (ducts) of the body such as, the raphe of the perineum, the spermatic cords, the cords of the testes and the corresponding ones in females (Yoni), the anal region, the urinary ducts, the urine-carrying ducts, and the urinary bladder and is not practiced in the art of surgery brings about the death of many an innocent victim. 20.

Thus ends the seventh Chapter of the Chikitsita Sthánam in the Sus'ruta Sambitá which deals with the treatment of Urinary calculus.

Thus ends the seventh Chapter of the Chikitsita Sthánam in the Sus'ruta Sambitá which deals with the treatment of Urinary calculus.

CHAPTER VIII

Now we shall discourse on the medical treatment of Fistula-in-ano, etc., (Bhagandara). 1. The disease admits of being divided into five different groups, of which the two, known as S'ambukávarta and S'alyaja (traumatic), should be regarded as incurable, and the rest as extremely difficult to cure. 2. The General Treatment:--The eleven* kinds of remedial measures commencing with Apatarpana up to purgatives (as described under the treatment of Dvi-vrana) should be employed as long as any fistular ulcer would remain in an insuppurated stage. The patient should be soothed by the application of medicated oil, etc., and his body should be fomented by immersing him in a receptacle of warm water, etc. as soon as suppuration would set in (and even after the ulcer had burst). Then having laid him on a bed and bound his hands and thighs with straps as described under the treatment of Hæmorrhoïd, the surgeon should examine closely as to where the mouth of the fistula is directed, outward or inward, and whether the ulcer itself is situated, upward or downward. Then the whole cavity or receptacle of pus (sinus) should be raised up and scraped out with an Eshani (indicator or probe). In a case of inter-mouthed fistula, the patient should be secured with straps (as before described) and asked to strain down. An incision should then be made by first directing the indicator when its mouth would become visible from the outside. Cauterization

• Apatarpana, Alepa, Parisheka, Abhyanga, Sveda, Vimlápana, Upanáha, Páchana, Visrávana, Sneha, and Vamana.

Chap. VIII.] CHIKITSA STHANAM.

339

with fire or an alkali is a general remedial measure which may be resorted to in all the types of this disease.

3-4. Specific Measures--M. Texts :- In cases of the Śataponaka type all the small Vranas about the anus should be first incisioned and the principal sinus in the locality should not be looked after until these small ones had been healed up.

The connected abscesses should be respectively incisioned on the external side, while the unconnected ones should not be opened at the same time in order that they may not run into one another and be thus converted into a wide-mouthed ulcer.

The urine and the fæcal matter are found in each case to flow out of the cavity of such a wide-mouthed ulcer ; and aching pains in the rectum and a rumbling sound in the abdomen, due to the action of the aggravated Váyu, are experienced.

Such a case is enough to confound even a well-read and experienced physician. Hence the mouth of a fistula of the Śataponaka type should not be opened with a broad incision.

Forms of incision :- An experienced surgeon should know that the Lángalaka, Ardha-Lángalaka, Sarvatobhadraka and the Gotirthaka forms of incision should be the different shapes of incision, in a case of a many-mouthed Śataponaka.

An incision equal in its two sides is called the Lángalaka (curvilineal), while the one with one arm longer than the other is named the Ardha-Lángalaka.

An incision made in the region of the anus in the shape of a cross (crucial) and a little removed from the raphe of the perineum, is called the Sarvatobhadraka by men conversant with the shapes of surgical incisions.

An incision made by inserting the knife in one side is called the Gotirthaka (longitudinal). All exuding (bleeding) channels in the affected region should be cauterized with fire by the surgeon.

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Chap. VIII.] CHIKITSA STHANAM.

the progress of the disease. We have described the treatment of a case of fistula-in-ano of the Śataponaka (sieve) type ; now listen to me about the treatment of the Ushtragriva (camel's neck) type of the disease. 5,

Treatment of Ushstra-griva:

The ulcer should first be searched with a probe or director and, after an operation, an alkali should be applied to it. To remove all sloughed off or sloughing flesh and membranes cauterization with fire is forbidden. [The fissures of pus (sinuses) and sloughed off flesh should be first drawn out]. A plaster of clarified butter and pasted sesamum should then be applied to it, and the ulcer duly bandaged. Clarified butter should be constantly applied over the bandage which should be removed on the third day. Cleansing or disinfecting (S'odhana) measures should then be used by the surgeon, according to the Doshas involved in the ulcer, and the successive healing (Ropana) measures resorted after its being properly purified (S'odhana). 6

Treatment of Parisrávi:

In a case of the Parisrávi (exuding) type, where there is bleeding and secretion from the ulcer, the sinus and the cavities of pus should be first removed and then cauterized with an alkali or with fire by an intelligent surgeon. The region of the anus should then be kept wet by the sprinkling of lukewarm Anu-toila (described in the chapter on Váta-vyádhi). Warm plasters, or poultices, mixed with Yavakshára and the urine (of a cow) should then be applied. Decoction of the emetic drugs as the seeds of Madana, etc.), should also be sprinkled slightly on the affected part. The ulcer when found to be softened and nearly free from pain and secretion (owing to the preceding measures) should be searched with a probe and the principal sinus should be cut open and again

completely cauterized with fire or with an alkali. The incisions should be made in the shape or form of a Kharjura-patra (leaf of the date-palm), Ardha-chandra (half-moon), Chandra-chakra (moon's disc), Suchi-mukha (needle's mouth), or Avámmukha (with downward mouth). After that the ulcer should be purified with mild cleansing or disinfecting remedies (as described above)

In the case of an infant cauterization with fire or with an alkali, the use of strong purgatives and surgical operations are forbidden in the case of the disease (Bhagandara), whether outer-mouthed or inter-mouthed. Medicinal remedies calculated to be mild, though keen in their efficacy, should be used in such cases. A plug or a Varti in the shape of a wick and made of powdered Aragvadha, Haridrá and Kálá, mixed with honey and clarified butter, should be inserted into the ulcer for purifying purposes. This medicinal compound speedily brings about the healing of a sinus, just as the wind will drive away a cloud.

8—9.

Treatment of Ágantuka Bhágandara :-The sinus in a fistula of traumatic origin should be carefully cut open by a surgeon (with a knife) and cauterized, according to the rules laid down, with a red-hot Jambvoshtha (instrument) or with a red-hot director (Śaláká). Vermifugal remedies should be applied to it, and measures laid down in connection with the extraction of a Śalya from the body should be carefully resorted to.

Treatment of Tridoshaja Bhágandara :-A case of Bhagandara, due to the concerted action of the three Doshas, should be treated without holding out any hope of recovery tot he patient's people, or should be given up as hopeless. The measures and remedies mentioned above should be adopted in

Chap. VIII.] CHIKITSA STHANAM.

succession in all types of Bhagandara. In the event of there being any pain in it, owing to the insertion of a knife or to any other surgical operation, luke-warm Anu-taila should be applied. As an alternative, the drugs possessed of the virtue of subduing the deranged Váyu (Bhadra-dárvádi and Erandádi groups) should be boiled in a pot covered by a lid having a hole or aperture on its top ; then the patient with his rectum anointed with oil, etc., should be made to sit in such a way over the said covered pot that the seat of the disease may be fomented with the warm fumes escaping through that aperture ; or Nádi-sveda should be applied to the affected region through a pipe in a recumbent posture to alleviate the pain. As an alternative, a hot bath should be prescribed for the alleviation of the pain. Sálvana Upanáha (described in connection with the treatment of Váta-vyádhi and that with the skins of the Kadali Mriga, Lopáka and Priyaka, should be applied to the affected locality to subdue the pain. A potion of the drugs or substances such as, Trikatu, Vachá, Hingu, salt (five kinds of salt) and Dipyaka, should be administered with wine, Kánjiká, Sauviraka and Kulattha-Soup, etc. 11-12.

Jyotishmati, Lángalaki, S'yamá, Danti, Trivrit, Tila, Kushtha, S'atdhvá, Golomi, Tilvaka, Giri-karniká, Kásisa and the two kinds of Kánchana-kshiri, compose the group which is possessed of the virtue of purifying (afistular sore). (The decoction of these substances should be applied for the purification of the ulcer). The sore of a fistula may be filled (healed) up by the application of (a compound of) Trivrit, Tila, Nágadanti, Manjishthá and rock-salt pasted together with milk and honey.

A plaster (Kalka) consisting of Rasdnjana, turmeric, Dáru-háridrá; Manjishthá, Nimba leaves, Trivrit, Tejovati and Danti

Kushtha, Trivrit, Tila, Danti, Pippali, Saindhava, honey, turmeric, Triphalá and sulphate of copper (Tuttha)

Oil* cooked (slowly) with Pippali, Yashti-madhu, Lodhra, Kushtha, Ela, Harenu, Samangá (Baráha-krántá), Dháttaki flower, Sárivá, the two kinds of Haridrâ, Priyangu, Sarja-rasa, Padmaka, Padmá-kes'ara, Sudhá, Vachá,Lángaliká, wax, and Saindhava

The remedy proves beneficial in cases of scrofula (Ganda-málá), Meha, ulcers and in the Mandala type of cutaneous affections as well.

The drugs which constitute the Nyagrodhâdi group are efficacious in disinfecting (Sodhana) and healing up an ulcer.

A medicated oil or Ghrita prepared with the preceding drugs proves curative in a case of fistula in-ano

Similarly a medicated oil duly cooked and prepared with the roots of Trivrit, Danti, Haridrâ, and Arka, as well as with Vidanga, Triphalâ, milk of both Snuhi and Arka, honey and wax should be applied, as it is specifically efficacious in a case of Bhagandara

Syandana Taila :-Oil slowly cooked and prepared (in the manner aforesaid) with Chitraka, Arka Trivrit, Páthâ, Malapu (Kákodumbara), Karavira, Sudhá (Snuhi), Vachâ, Lángalaki, Saptaparṇa, Suvar-chikâ and Jyotishmati, is called the Syandana-Taila

and should be constantly applied in a case of Bhagandara. It is efficacious in purifying, healing and imparting a natural skin-colour to the cicatrix.

A learned and experienced physician should adopt the remedial measures for this disease according to the procedure laid down.

• Four seers of oil, one seer of the drugs and sixteen seers of water should be taken at the time of preparation.

Chap. VIII.] CHIKITSA STHÁNAM.

down under the treatment of Dvi-Vrana, when there is any ulcer (vrana) in existence. 20. The bulb-like protrusion-above the hole of the instrument (speculum), mentioned in connection with the treatment of Arśas, should be removed and the instrument, now in the shape of a half-moon, should be used by an experienced surgeon in the treatment of a case of fistula-in-ano. The patient should refrain from sexual intercourse, physical exercise, riding, anger, and the use of heavy and indigestible articles of food for a full period of one year even after the healing up of the ulcer in a Bhagandara. 21—22.

Thus ends the eighth Chapter of the Chikitsita Sthánam of the Sus'ruta-Sambitá which deals with the treatment of Bhagandara.

CHAPTER IX.

Now we shall discourse on the medical treatment of cutaneous affections in general (Kushtha).

A cutaneous disease (Twag-dosha) originates through injudicious conduct of life such as, partaking of large quantities of unwholesome food, or taking it before the previously eaten one is digested (i.e., eating too often), indulgenc in incompatible articles of fare, voluntary suppression of the natural urgings of the body, and improper application of medicated oil, clarified butter, or other lardacious articles.

It is attributed even to the dynamics of sinful acts done by a man in this or in some prior existence.

Conduct of diet and regimen :-A person afflicted with any kind of skin disease should refrain from taking meat, lard, milk, curd, oil, Kulattha pulse, Mdsha pulse, Nishpava, preparations and modifications of sugarcane juice, acid substances, incompatible food, meals taken before the complete digestion of the preceding one, unwholesome and indigestible food, or food causing a burning sensation and some kind of internal secretion, day-sleep and sexual intercourse.

Regulation of diet and conduct :-The old and matured grain of Sali, Shashtika, barley, wheat, Koradusha, S'yamaka, Uddalaka, etc., boiled and taken along with the soup (Supa) or a decoction* (Yusha)

• An unsalted decoction of any substance not seasoned with any spices whatever is called Yusha, while the one salted and seasoned with spices is called Supa. In preparing the soup of any pulse, all husks should be carefully thrashed out and the grain should be slightly fried before boiling.

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THE SUSHRUTA SAMHITA

Treatments of Doshaja Types :-In the first stage of Kushtha, the patient should be treated in accordance with the prescribed maxims (rules) of Sneha-pána. In a case of Vátaja-Kushtha, cil or clarified butter, cooked with (a decoction and Kalka of) Mesha-s'ringi, S'wadamshtrá, S'arngashtá, Guduchi and the drugs included in the group of Das'amula should be used as drink and ointment. In cases of the Pittaja type, the patient should be made to drink (a potion consisting of) clarified butter prepared with (a decoction and Kalka of) Dháva, As'vakarna, Kakubha, Palás'a, Pichu-mardha, Parpataka, Madhuka, Rodhra and Samangá. In the Kaphaja type, clarified butter cooked with (a decoction and Kalka of) Piyála, S'ála, Aragvadha, Nimba, Saptaparṇa, Chitraka, Maricha, Vacha and Kushtha should be prescribed.

• Bhallátaka-preparations have been described in the treatment of Ars'as, preparations of S'ilájatu, Guggulu, Aguru and Tuvaraka in the treatment of Prameha-pidaká, and Khadira, Asana and Ayaskriti preparations in the treatment of Mahá-kushtha.

† Oil should be used in a case of Kapha-predominance, whereas clarified butter in that of Pitta-predominance. Others assert that clarified butter should be used for drinking purposes and oil for anointments.

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Chandana, Kirdta and Pippali should be pasted together. This pasted Kalka and the decoction should be cooked with a Prastha measure of clarified butter. The medicated Ghrita thus prepared is called the Tikta-Sarpih. Diseases such as Kushtha, chronic fever, Gulma, Hæmorrhoids, Grahani, œdema, jaundice, crysipelas and impotency readily yield to the curative efficacy of this Ghrita.

Medicinal Plasters for Kushtha :- Having first soothed the patient with any of the preceding medicated clarified butters and having his body fomented, the surgeon should have recourse to the venisection. One, two, three, four, or five s'irás (veins) of the patient may be opened (according to the circumtances). The raised or elevated patches on the skin should be scraped off, or should be kept constantly covered with a medicinal plaster. As an alternative, the characteristic patches of the disease should be first rubbed with the substance known as the Samudra-phena or with the leaves of S'áka, Goji, or Kákodumbara and a plaster (Lepa) composed of Lakshá, Sarja-rasa, Rasánjana, Propunaddá, Avalguja, Tejovati and the roots of As'va-máraka, Arka, Kutaja, and Árevata, pasted with the urine or bile of a cow, should be applied to them; or Svarjiká, sulphate of copper, sulphate of iron, Vidanga, Agára-dhuma, Chitraka, Katuka, Sudhá, turmeric and Saindhava pounded together with the urine or bile of a cow should be applied to the diseased localities.

As an alternative, the alkali, prepared from the ashes of Palás'a wood in the prescribed manner, should be boiled with the powders of the preceding drugs ; it should be removed from the oven after reducing it to the thickness or consistency of a Phánita and used in plastering (the diseased patches) ; or a plaster composed

of Jyotishka fruits, Lakshd, Maricha, Pippali and the leaves of the Jati flower pasted together ; or a plaster composed of yellow orpiment, Manah-s'ild, the milky juice of Arka, sesamum, S'igru and Maricha, pasted together ; or a plaster composed of Svarjika, Kushtha, sulphate of copper, Kutaja, chitraka, Vidanga, Maricha and Manah-s'ilá pasted together ; or a plaster of Haritaki, Karanjika, Vidanga, white mustard seeds, rock-salt, Goro-chand, Somaráji and Haridrá pasted together should be applicd to the diseased localities.

Metrical Text :-The preceding seven medicinal plasters are possessed of the virtue of destroying or curing Kushtha in general. Now hear me deal with the remedies to be specifically employed in cases of ringworm (Dadru) and leucoderma (Svitra). II.

Treatment of Dadru :- A plaster composed of Kushtha, mustard seeds, S'ri-niketa, Haridrá, Trikatu and the seeds of Chakra-marda and of Mulaka pasted together with Takra (butter milk ?) should be applied to the ringworm. The disease is found to readily yield to the curative efficacy of a medicinal plaster, composed of Saindhava, Chakra-marda seeds, treacle, Kes'ara (Vakula), and Tarksha-s'aila (Rasánjana)pasted together with expressed Kapittha juice. Preparations of Hemakshiri, Vyádhi-gháta (Áragvadha), S'irisha, Nimba, Sarja, Vatsaka and Aja-karna (a species of Sarja) should be used in cases of ringworm of a virulent type for baths (D. R. Drinks),* plasters and rubbing. 12.

Treatment of Svitra :-In cases of Svitra and Pundarika, the patient should be made to drink a lukewarm decoction prepared with equal parts of the

• In drinks or baths, a decoction should be used and in plasters and rubbings the ingredients should be pasted with Takra and the expressed juice of Kapittha.

roots of Bhadrá (Udumbara) and Malapu. The use of this potion would produce blisters on the patches. These blisters should be treated,after their bursting,with a plaster (Pralepa) composed of the ashes of the burnt skin of leopards and elephants and madeinto a thin paste with (mustard) oil. A plaster composcd of the insect kncwn as the Puti and the Kshára (alkali) of Áragvadha should be found to be the best remedy for Śvitra.

13

All kinds of Śvitra are found to readily yield to the application of a medicinal plaster made of the black ashes of a well-burnt cobra (Krishna-Sarpa) pasted with the oil of Vibhitaka. The white ashes of the said cobra mixed with one and a half time of its own weight of water should be filtered seven times in the manner of preparing an álkali. Mustard oil* should be cooked with this alkaline water weighing four times as much. An application of this oil proves curative in cases of Śvitra.

14

The Prapunnáda seeds, Kushtha and Yashti-madhu should be pasted together with clarified butter. The plaster thus prepared should be given to a domestic white cock, purposely kept without food for a day and a half when it would evince any sign of hunger after the period. The dung of the said cock should then be collected after a full digestion of the said medicated drugs and applied as plasters on the affected patches for a month. It would bring about the cure (even) of internal† Śvitras.

15

• This is the best medicine for curing S'vitra. † The internal S'vitras are those under the blisters produced by the application of the remedy mentioned first in the list. ‡ S'ivádása, the commentator of Chakradatta, says that some read मलयन्धजे in place of गजस्खकजे in which case it would mean "S'amatba."

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Chap. IX. 1 CHIKITSA STHANAM.

aggravated Doshas of the system. The diseased patches should be rubbed with it, in the event of the affection being found to be confined to the Tvak (skin) alone. Even the type of Kushtha, commonly held to be incurable, has been found to prove amenable to the use of this medicated clarified butter, which is known as the Nila-Ghrita. 20. Mah&-Nila-Ghrita :-A Tulá* weight of the drugs known as Triphalá, Tvak, Trikatú, Surasá, Madayantikä, Váydsi and Aragvadha and ten Pala weights of each of the drugs known as Kákamáchi, Arkd, Varuna, Danti, Kutaja, Chitrakd, Ddru-hdridrd and Kantakdri should be boiled together with three Drona measures of water. This decoction, boiled down or reduced to six Prastha measures, should be again boiled with the watery secretion of cowdung, cow's urine, milk, curd and clarified butter, each weighing an Adhakd, and with the Kalka (weighing one-fourth as much of clarified butter) of Bhu-nimbd, Trikatú, Chitrakd, Kdranjá-fruit, Nilikd, S'ydmd, Avalgujd, Pilu, Nilini and Nimbd-flowers. It is a curative for Kushtha. The rubbing of the diseased patches with this Ghrita imparts a healthy and natural colour to the skin in cases of Svitra or white leprosy. It also cures diseases like fislula-in-ano, worms in the intestines and Ar'sas. It is known as the Mahd-Nila-Ghrita.† 21. A compound consisting of cow's urine, Chitrakd, Trikatú and honey should be kept for a fortnight in a

• A Tulá is equal to a hundred Palas or twelve seers and a half of our modern measure.

† Dallana, in his commentary, says that the two Ghritas (Nila and Mahá-Nila) seem to be spurious (Anársha). But he has included them in his commentary as Jejjata and Gayadása have read and explained them before him,

THE SUSHRUTA SAMHITA

closed earthen pitcher which formerly contained clarified butter. A Śvitra-patient would do well to take this medicine after this period. He should also observe the rules of diet and regimen of a Kushtha-patient. The application of a Lepa (medicinal plaster), prepared by pasting the tender twigs of the Putika, Arka, Snuhi, Áragvadha and of the Játi flower with cow's urine, would prove curative in cases of Śvitra, ringworm, ulcer, bad types of hæmorrhoids and sinus. 22-23.

THE SUSHRUTA SAMHITA

In case the foregoing medicinal remedies prove ineffective, the patient should be duly bled for the purpose of letting out the vitiated blood from the system, and after sufficiently recouping his strength (after blood-bètting) his body should be anointed with clarified butter. Copious vomitings should be induced with the help of strong emetics and the patient should be treated subsequently with a judicious administration of purgatives (so as to remove the aggravated Doshas from the system). The aggravated Doshas of the body, not being fully expelled from the organism of a Kushtha-patient by means of the preceding emetic and purgative measures, tend to extend all over the organism and the disease in consequence thereof is sure to lapse into one of an incurable type. Hence the aggravated Doshas should be fully eliminated from the organism. 24-25.

THE SUSHRUTA SAMHITA

Emetics should be administered to a Kushtha-patient once a fortnight and Sramsana (purgatives) once a month. He should be bled twice a year though not profusely and medicated snuffs should be administered to him every fourth day. 26.

THE SUSHRUTA SAMHITA

Internal application of Haritaki, Trikatu and treacle (prepared from the juice of the sugarcane) mixed with oil would lead to the early recovery of a case of Kushtha.

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THE SUSHRUTA SAMHITA

name of Mahā-Vajraka oil and is possessed of supreme and unquestionable efficacy. 35. The drugs which constitute the Lakshaddi group should be pasted with an adequate quantity of cow's urine and cooked* with sesamum-oil and mixed with Pitta (cow's bile). The oil, thus prepared, should be preserved for a week inside the body of a Krtukaldaru. The oil should be taken out (after this period) and the patient should use it both internally and externally (in an adequate quantity). After doing this, he should expose himself to the heat of the sun whereby all the Doshas would be eliminated from his organism. After the complete elimination of the Doshas from the system, the patient should be removed from the sun and bathed with a decoction† of Khadira, and a gruel, prepared with the decoction of Khadira, should be given him as diet. Similarly, oil or clarified butter boiled and prepared with the drugs constituting the Sams'odhana group (mentioned in chap. xxxix, Sutra.) or with the drugs possessing anti-Kushtha properties should be used as hot plasters and rubbings (in the diseased localities). Purgatives should be administered every morning with good results. The preceding remedies should be taken and continued for five, six, seven, or eight days, or till the Doshas of the system producing the disease are not perfectly eliminated. As an alternative, camel's urine and after its full digestion, camel's milk should be taken. Even parasitic types of Kushtha are sure to disappear within six months (under the course of this treatment). 36.

• In cooking the oil, cow's urine weighing four times of oil should be taken. - Dallana. † The decoction of Khadira in the bath as well as in the preparation of the gruel should be prepared after the manner of Shadanga-Kalpa. - Dallana.

Cháp. IX.] CHIKITSA STHANAM.

361

A Kushtha-patient desirous of being perfectly cured should constantly use preparations of Khadira in his drinks, food, bath, etc. Khadira, if properly used, is potent enough to curb the virulence of the disease in the same proportion as the latter is in invading the successive strata of the human organism and ultimately in bringing on the death of the patient. 37.

The paring of the nails and shaving the hair off, light physical exercise, the use of wholesome food, regularity in using medicines, abstinence from wine, women and meat-diet are the rules of conduct which should be strictly observed by a patient affected with Kushtha. With the strict observance of the above rules a Kushtha-patient may be expected to recover. 38.

Thus ends the ninth Chapter of the Chikitsita Sthánam in the Sus'ruta Samhitá which deals with the medical treatment of Kushtha.

46

CHAPTER X.

Now we shall discourse on the medical treatment of major cutaneous affections (Mahā-Kushṭha).* 1. Metrical Text :-An intelligent physician should have recourse to the following medicinal compounds in virulent types of Kushtha, urinary complaints (Meha), diseases due to the action of the deranged and aggravated Kapha and general œdima of the body and also in respect of inordinately corpulent persons wishing to reduce their obesity. 2. Mantha-Kalpas :-Pounded barley-corn should be saturated with the urine of a cow and kept in a large bamboo basket (Kilinja) for the whole night ; and should then be dried in the sun on the following day. This process should be continued for seven consecutive days. At the close of this period it should be fried in an earthen vessel (Kapála) and then ground to fine powder (Śaktu). The powder, thus prepared should be given every morning to a person afflicted with Kushtha (leprosy), or any urinary complaint (Prameha) through the medium of a decoction of the drugs included within the S'dlasárddi group, or of the Kantaki (thorny) † trees, and mixed with a pulverised compound of Bhallā-taka, Prapunnáda, Avalguja, Arka, Chitraka, Vidanga and Musta weighing a fourth part of the Śaktu. Barley-corn should, in the same manner, be soaked in a

• Kushṭha which affec's the deeper tissues and fundamental principles of the body is called Mahā-Kushṭha. Gayi interprets the term "Mahā-Kushṭha" as signifying those seven types of Kushṭha which cannot be attributed to any detectable cause,

† Vadara, Khadira, Arimeda, S'nuhi, etc.

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THE SUSHRUTA SAMHITA

many times (i. e., seven days) saturated with the decoction of the drugs of the Aragvadhádi group (and dried). Then the prepared compound should be taken with the vehicle of the decoction of the drugs of the said S'álasárádi group. A pulverised compound (Churna) may be as well prepared in the above manner from the fruits of the Nyagrodhádi group or from the flowers of the Aragvadhádi group.

Medicinal Ayaskriti

:-Now we shall describe the process of preparing an Ayaskriti (iron compound). Thin leaves of steel should be plastered with the (five officinal kinds of) salts and heated in fire a of dried cow-dung. When red-hot, they should be immersed in a decoction of Triphalá and the drugs of the S'dla-sarádi group. The above process should be repeated sixteen times in succession after which they should be heated and burnt in a fire of Khadira wood. When cooled down, the iron foils should be pounded into fine powder and passed through a piece of thick linen. The patient should be made to take this powder with honey and clarified butter in an adequate dose suiting his capacity. After the digestion of the medicine, he should take such a meal as is not hostile to his particular disease and is devoid of salt and acid articles. The use of a Tulá measure of this medicinal iron preparation in the above manner leads to the recovery of Kushtha, Meha (urinary complaints), obesity, oedima, jaundice, insanity and epilepsy and makes the patient live for one hundred years. The use of each additional Tulá weight of the preparation adds a century to the duration of the user's life.

This is the mode of medically preparing all kinds of Loha (zinc, copper, lead and gold).

11-12. Aushadha Ayaskriti :-A ball of iron (weighing fifty Palas) heated and made red-hot in a

Chap. X.] CHIKITSA STHANAM.

367

fire of Khadira wood should be cooled by immersing it

in a cauldran (Droni), made of (green) Palása wood

and containing (five-hundred Palas of) Svarasa (expressed

juice*, of Trivit, S'yámá, Agnimantha, Samkhini, Kevuka,

Lodhra, Triphalá, Palás'a and Simśapá. The iron mass

should be thus heated and cooled twenty one times

in succession ; finally the iron ball should be immersed

and boiled in the expressed juice of the foregoing drugs

over a fire of cow-dungs. It should be removed from

the fire when only a quarter part of the liquid would

remain. It should now be filtered. and the mass of

iron should be again heated in the fire mixed with the

same liquid and boiled again; when the cooking is

nearly complete, (it should be removed from the fire

and) a pulverised compound of the drugs included in the

Pippalyddi group together with honey and clarified butter

each weighing double the quantity of the iron mass or

ball should be mixed with the same. When cooled down,

this preparation should be preserved in a well-sealed

iron-pitcher. The medicine; thus prepared, should be

given to the patient according to his capacity but not

less than a Sukti (half a Pala) or a Prakuncha measure

(one Pala). After the digestion of this medicine, a diet

should be given to the patient determined by the nature

of his disease. This is called the Aushadha Ayaskriti

and it cures even the incurable types of Kushtha and

urinary complaints (Meha), reduces obesety, impairs

oedima and improves the impaired digestive functions.

• Old and experienced physicians explain "Svarasam" to be the

decoction as well. Gayacasa says that a decoction of one Drona weight

of the drugs, boiled in four Drona weight of water and reduced to its

quarter part should be taken. Dallana says that if the expressed juice of

the drugs be not available, then a cold infusion of one Adhaka weight of

the powdered drugs should be taken.

Mahaushadha-Ayaskriti

368

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THE SUSHRUTA SAMHITA.

Oils pressed out of black sesamum and Bhallataka, clarified butter, the expressed juice of Amalaka and the decoction of the drugs of the S'ala-s'aradi group, each weighing a Drona measure, and a Pala weight of each of the following drugs, viz., Triphalá, Trikatu, Chitraka, Arka, Avalguja, Haridrâ, Dâru-haridrâ, Trivrit, Danti, Indra-yava, Yashti-madhu, Ativishâ, Rasánjana and Priyangu, should be boiled together in the manner of cooking medicated oil, etc. (Sneha-páka Vidhána). When well cooked, this medicated compound should be strained (through a piece of clean linen) and carefully preserved (in an earthen pitcher with its mouth well closed with a lid). The system of the patient should be well cleansed (with appropriate emetics and purgatives) and a Pala weight of this preparation, mixed with honey, should be given to him every morning. After the digestion of this medicine, he should be made to take a light meal of rice well cooked with a decoction of the Khadira-wood and mixed with clarified butter, and the soup (Yusha) of Amalaka or Mudga unseasoned with salt. A Drona measure (of this compound), gradually taken in the aforesaid manner by a patient taking a (light) decoction* of Khadira (instead of water), would ensure a speedy recovery from all types of Kushtha and enable the patient to witness a hundred summers (on earth) in the full enjoyment of sound health and intellect.

• The decoction of Khadira-wood for drink should be prepared after the manner of Shadanga-pániya preparation. -Ed.

The decoction of Khadira-wood for drink should be prepared after the manner of Shadanga-pániya preparation. -Ed.

Chap. X.] CHIKITSA STHANAM.

Memorable Verse :-An intelligent physician may prepare a thousand varieties of medicated remedies, such as Surás, Ásavas, Arishtas, Lehas (lambatives), powders and Ayaskritis (metal-preparations) with the aforesaid drugs and in the manner described above. 19.

Thus ends the tenth Chapter of Chikitsita Sthánam in the Sus'ruta Samhitá which deals with the medical treatment of Mahá-Kushtha.

CHAPTER XI.

Now we shall discourse on the medical treatment of the diseases of the urinary tracts (Prameha). 1. This disease may be ascribed to two causes, such as the congenital (Sahaja) and that attributable to the use of injudicious diet. The first type (Sahaja) is due to a defect in the seeds of one's parents and the second is originated from the use of unwholesome food. The symptoms, which mark the first of these two types, are emaciation and a dryness (of the body), diminished capacity of eating, too much thirst and restlessness; while the symptoms, which usually attend the latter type of the disease, are obesity, voracity, gloss of the body, increased soporific tendency and inclination for lounging in bed or on cushions. A case of emaciation, etc., (viz., the first kind of Prameha) should be remedied with nutritious food and drink, etc., whereas Apatarpana, etc., (fasting, physical exercise, depletory measures etc.), should be adopted in cases of obesity viz., the second kind of (Prameha).

2. Forbidden Articles of Food & Drink : All patients suffering from Prameha should forego the use of (the different species of wine and fermented liquor known as) Sauviraka, Tushodaka, Sukta, Maireya, Sura, and Asava, water, oil, clarified butter, milk, any modification of the expressed juice of sugarcane, cakes, milk-curd, acid, Panaka*, the flesh of domestic and aquatic animals and of those which frequent swamps or marshy places.

• Made of sugar, lemon-juice, or fermented rice-gruel boiled together.

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be administered. As an alternative, a decoction* of Triphalá, Vis'dálá, Deva-dáru and Musta or an Aksha (two Tolá) measure of the Kalka (powders)† of S'álá, Kampillaka and Mushkaka (both of them) sweetened with honey and the expressed juice of Ámalaka should be taken ; or powders‡ of the flowers of Kutaja,Kapittha, Rohita, Vibhitaka and Saptaparṇa (should be taken with honey, Haridrā and the expressed juice of Ámalakā); or a decoction of the roots, leaves, barks, flowers and fruits of Nimba, Áragvadha, Saptaparṇa, Murvá, Kutaja, Soma-vriksha, Palás'a should be given to the patient. All cases of Meha are often found to yield to the use of any of these five medicinal preparations.

5. Specific Treatments :- Now we shall specifically describe the course of treatment to be adopted in each particular type of the disease (Prameha). A decoction of Párijāta should be given in a case of Udaka-meha ; a decoction of Vaijayantī in that of Ikshu-meha ; a decoction of Nimba in a case of Surā-meha ; a decoction of Chitraka in a case of S'ikatā-meha; a decoction of Khadira in a case of S'anair-meha ; a decoction of Páṭhā and Aguru in a case of Lavana-meha ; a decoction of Haridrā

and Dáru-haridrá in a case of Pishta-meha ; a decoction of S'aptaparṇa in a case of Sándra-meha ; a decoction of Durvá, S'aivála, Plava, Hathakaranja and Kaseruka, or that of Kakubha and red-sandal wood in a case of Sukra-meha ; and a decoction of Triphalá, Áragvadha and Drákshá mixed with honey in a case of a Phena-meha. All decoctions, to be employed in the foregoing ten types of Kaphaja-meha, should be sweetened with honey (slightly sweetened with honcy—D. R).

Treatment of Pittaja Prameha :- In the Pittaja types of the disease, a decoction of the drugs of the S'ála-sárádi group or that of As'vattha should be administered in a case of Nila-meha ; similarly a decoction of Rája-vriksha should be given in a case of Haridrā-meha ; a decoction of the Nvagrodhádi group, mixed with honey, in a case of Amla-meha ; a decoction of Triphlá in a case of Kshāra-meha ; a decoction of Manjishthá and (red) Chandana in a case of Manjishthā-meha ; and a decoction of Guduchi, sceds of Tinduka, Kás'marya and Kharjura, mixed with honey, in a case of Śonita-meha*. 6.

Palliative Measures :-Now we shall describe the palliative measures to be adopted even in cases of incurable types of the disease. A Kalka compound *of Káshtha, Kutaja,Páthá, Hingu and Katu-rohini should be taken with a decoction of Guduchi and Chitraka in a case of Sarpir-meha. A patient afflicted with an attack of Vasā-meha should be made to drink a decoction of Agni-mantha or of S'ims'apa. Similarly a decoction of

• Honey should be added to all oi these decoctions prescribed in cases Pittaja-meha.—Dallana.

• Honey should also be added to these decoctions prescribed in cases of Vátja Meha.—Dallana.

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chariots occupied by Bráhmanas.* A patient belonging to the lower orders of society (Śudras, etc.) should be made to sink wells (under such circumstances) and the strength of a weak or emaciated patient should be preserved (with nutritive diets, etc.). 12.

Memorable Verse :--A poor patient, carcfully following these directions of his medical advisers without the least demur or delay, should be able to get rid of the disease (Prameha) in the course of a year or even in less than that time. I3.

Thus ends the eleventh Chapter of the Chikitsita Sthánam in the Sus'ruta Samhitá which deals with the medical treatment of Prameha.

• Some explain the phrase "ब्रह्मरयसुपधाययेत" to mean that he should retain in his memory (the teachings of) the Vedas. -Dallana.

CHAPTER XII

Now we shall discourse on the medical treatment of the abscesses or eruptions which mark the sequel of a case of Prameha (Prameha-Pidakā). 1.

The nine kinds of abscesses (Pidakás), such as Śaráviká, etc., have been described before. Of such abscesses those, appearing in a strong person but small in size, affecting (only) the Tvak (skin) and the flesh, soft to the touch, slightly painful, easily suppurative and after a time bursting, are curable. 2.

Patients suffering from Prameha and afflicted with the above kinds of abscesses (Pidakás) should be treated (in the following manner). Measures, such as fastings (Apatarpana), etc., decoctions * (of Vata, etc.) and the urine of a she-goat, should be employed in the incubative stage of the disease.

The urinc, perspiration and the Śleshmá (sputum, etc.), soon acquire a sweetish taste, if the aforesaid preliminary measures are not resorted to and if the patient goes on using sweet articles of food in utter disregard of the instructions, thus developing fully the specific indications of Prameha.

In this stage the system of the patient should be cleansed (Sams'odhana) with both emetics and purgatives. If the disease is not checked (even at this stage) with the aforesaid measures (emetics and purgatives), the aggravated Doshas of the body go on increasing in intensity and tend to affect or vitiate the flesh and the blood and produce an inflammatory swelling of the body, or bring on other supervening distresses

• Astringent drugs of fig-tree (Vata-tree), etc. -D. R.

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Chap. XII.] CHIKITSA STHANAM.

381

It is called the Dhanvantara-Ghrita* and covers within the range of its therapeutic application Meha (urinary diseases), swelling, (S'otha), Kushtha, Gulma, Ascites, hæmorrhoids, enlargement of the spleen, carbuncles (Pidaká) and abscesses. 7.

Ordinary purgatives fail to produce any satisfactory effect in cases of Madhu-Meha owing to the excessive accumulation and pervasion of Medas (fat) in the organism of the patient. Hence strong S'odhana (purgatives) should be employed in such cases. In all types of Meha, attended with Pidaká (eruptions or abscesses) and other complications, the perspiration and expectorations, etc. of a Prameha-patient acquire a sweet taste and smell like that of honey. Hence they are technically known as Madhu-Meha (to all intents and purposes . Fomentation (of any kind) is forbidden in the case of a patient suffering from Madhu-Meha, since it might lead to the gradual emaciation of his frame by drying up the organic fat (Medas), which is usually found to abound in his organism.

The aggravated Doshas of the body fail to make an upward passage in the organism of a Prameha-patient, owing to the weakness of the channels of chyle, blood, Kapha and Pitta (as well as for an exhausted condition of the nerves in his body) and the Doshas are thus forced to course in and confine themselves into the lower part of the body where their incarceration helps the easy formation of Pidaká's (abscesses), etc.

Such a Pidaká should be remedied with the measures described in connection with Vranas, as soon as the process of suppuration would set in; whereas

• According to Dallana, the introduction of this medicated Ghrita into the text is an interpolation. Since Jejjata has not explained it in his commentary, Dallana does not explain it. Chakradatta, however, mentions this Ghrita in his compilation, though with some additions and alterations under the treatment of Prameha.—Ed.

it should be treated as a swelling in its unsuppurated stage. Medicated oils should be likewise employed for the purposes of healing (Ropana), etc.

A decoction of the drugs of the Áragvadhádi group should be used for the purpose of raising up (Utsádana) the cavity of the incidental ulcer; that of the S'ála-sára'di group should be used for sprinkling purposes ; that of the drugs of the Pippalyádi group should be given as food and drinks. A pulverised compound of Páthá, Chitraka, S'armgashtá, Kshudra, Vrihati, S'árivá Soma-valka, Saptaparṇa, Áragvadha and Kuṭaja roots mixed with honey should be internally given to the patient.

S'ála-sárádi Ávaleha :-A decoction of (one hundred Pala weight of). the drugs of the S'ála-sárádi group should be made by boiling it (in sixteen times the weight of water) down to a quarter part (of the water) and then duly filtered (through a piece of linen). It should be cooked again very carefully, so that it may not be burnt; powders of Ámalaka,* Rodhra, Priyamgu, Danti, black-iron and copper should then be added to it just before the completion of the cooking, so that it may be reduced to the consistency of an Ávalcha (lambative). It should then be removed from the fire and kept in a closed earthen pitcher. The patient should take an adequate dose of this medicine as it is a sovereign remedy for all types of Prameha.

Naváyasa-Churna :-Equal parts of the powders of the following nine drugs, viz., Triphald, Chitraka, Trikatu, Vidaṅga and Musta, and nine parts

• Chakradatta reads "S'ivá" in place of "Ámalaka" and does not include "Priyamgu" in the list. According to some commentators the total weight of the after-throw (Prakshepa) would be a quarter part of the total weight of the drugs boiled ; whereas, according to others, the different drugs for Prakshepa would weigh one Pala each.

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The Sushruta Samhita

384

rated with clarified butter should be purified (in the usual way) and its interior plastered with coating of honey and powdered Pippali made into a thin paste. The medicinal compound prepared as above should be kept in the pitcher. After that, thin foils of steel made red-hot in a fire of Khadira wood should be immersed into the compound prepared before. Then the pitcher with the steel-foils immersed into its contents should be kept buried in a heap of barley for three or four months or until the steel-foils are entirely eaten away by the medicine and the characteristic flavour is produced. It should be used in proper doses every morning and a suitable diet should be given to the patient after its use. It reduces fat, improves the impaired digestion and proves efficacious in cases of swellings, internal tumours, Kushtha, Meha, jaundice, dropsy of the spleen (Plihodara), chronic fever, and excessive urination (dribbling of urine). This preparation is called Loharishta* and it is a highly efficacious remedy.

• The recipe of Lohárishta, according to Vágbhata, is as follows :-The drugs of the Asanádi group (which corresponds with Sus'ruta's S'ála-sárádi group), each weighing twenty Palas, should be boiled in eight Dronas of water down to a quarter part of its weight. Two hundred Pala weight of treacle and half an Ádhaka (four seers) of honey and the powders of the drugs of the Vatsakádi group (which corresponds with the Pippalya'di group of Sus'ruta), each weighing one Pala, should be mixed with the abovedccoction when cooled. A (new earthen) pitcher should be plastered inside with (an adequate quantity of) Pippali-powder and honey, the outer side being plastered with shellac. The above preparation should now be poured into this pitcher which should be kept in a heap of barley. A fire should be kindled with Khadira charcoal. Thin iron-foils should be alternately heated in this fire and immersed in the above preparation until the iron-foils are powdered. Vágbhata gives the name of Ayaskriti to this preparation.

We, however, follow Vágbhata in the preparation of this Arishta with good results.—Ed.

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388 THE SUSHRUTA SAMHITA.

which does not yield to its highly curative virtues. It acts as a potent solvent in cases of long-standing Śarkará (gravel) in the bladder as well as of stone. Śilájatu should be treated (soaked and dried) with appropriate medicinal drugs by stirring it up with the same.

The Mákshika Kalpa :-The metal known

as Mákshika (iron-pyrites), which grows in the river Tápi and which copes with the divine ambrosia in its highly therapeutic properties, may be also used in the same way and under the same sort of preparation. The metal is divided into two classes according to its colour, as Svarna-Mákshika (gold-coloured) and Rajata-Mákshika (silver-coloured). Of these the first has a sweet taste while the second is acid. Both of them prove efficacious in cases of decrepitude, Kushtha, Meha, jaundice and consumption. A person using Śilájátu and Mákshika (in the manner prescribed above) should refrain from taking pigeon-flesh and Kulattha pulse (during his life-time).

The following measures should be adopted by an experienced physician in the case of a patient suffering from (Meha and) Kushtha and who has a firm faith in medicines and is desirous of existence (life) and in whose case the curative efficacy of Pancha-karma* has been baffled.

The Tuvaraka Kalpa :-The Tuvaraka plants which grow on the shores of the Western Sea (Arabian Sea) are constantly tossed about by the winds raised by the waves of the sea. The pith or marrow of the seeds (lit.-fruits) of these plants should be care-

• Some take the term in its ordinary sense to mean the five measures of emetics, purgatives, etc. ; but Dallana would explain it as the measures adopted in the treatment of the Kushtha affecting the bone which is the fifth Dhátu in the system.

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Chap. XIII.] CHIKITSA STHANAM.

The pith (inner pulp of the seeds` of the Tuvaraka burnt in a closed vessel (Antar-dhuma) should be mixed with Saindhava-salt, Anjana* and Tuvaraka oil. This prepared compound, used as a collyrium, is efficacious in cases of eye-diseases, such as night-blindness, Arman, Nili, Kácha-roga (dimness of sight) and Timira. II.

Thus ends the thirteenth Chapter of the Chikitsita Sthánam in the Sus'ruta Samhitá which-deals with the treatment of Madhu-Meha.

• Dallana recommends the three things, viz., the pith of the Tuvaraka, the Saindhava-salt and the Rasánjana to be mixed and burnt together in a closed vessel.

CHAPTER XIV

Now we shall discourse on the medical treatment of dropsy with an abnormal condition of the abdomen (Udara). 1. Of the eight different types of Udara, described before, those severally known as the Vaddha-guda and the Parisrávi should be understood as incurable, the rest being equally hard to cure. Hence the medical treatment of all cases of Udara (abdominal dropsy) should be resorted to without holding out any positive hope of recovery. The first four types of the disease (as metioned in the list of cnumeration), may prove amenable to medicine ; but the rest would require Surgical treatment. All the types of the disease, however, would, with the progress of time, require a surgical operation, or (attaining an incurable stage) they may have to be abondned.

2. Diet of articles forbidden

A patient, afflicted with an attack of Udara, should forego the use of heavy (indigestible), or emollient fare, of all kinds of meats and of those that produce a state of extreme dryness in the system, or produce a slimy secretion from the channels (of the Doshas and the vital principles) of the body, or give rise to a sort of digestional acid reaction (acid transformation in the stomach) and refrain from bathing and using effusions. Meals consisting of well cooked S'áli rice, barley, wheat, or Nidra seeds should be the daily diet of such a patient.

3. Treatment of the Vátaja type

In a case of Vátaja Udara, the body of the patient should be anointed with clarified butter cooked with the drugs of the Viddri-gandhadi group, while the one cooked with

Tilvaka should be used as purgatives (Anuloma). A compound made of a copious quantity of oil of Chitra seeds, mixed with a decoction of the drugs of the Vidari-gandhadi group, should be used as Asthapana and Anuvasana measures. The Salvana Upanaha (poultice) should be applied to the abdomen. Milk cooked with the drugs of the Vidari-gandhadi group, or the soup of the flesh of Jangala animals should be given to the patient with his meal and the affected region should be frequently fomented.

4. Treatment of the Pittaja Type :- In a case of Pittaja Udara, the patient should be anointed with clarified butter cooked with the drugs of the Madhura (Kakolyadi) group. Similarly, clarified butter cooked with S'yama, Triphala and Trivrit should be used as purgatives and the decoction of the drugs of the Nyagrodhadi group, mixed with a copious quantity of sugar, honey and clarified butter, should be used as Anuvasana and Asthapana measures. The abdomen should be poulticed with Payasa (porridge prepared with rice and milk) and the diet should consist of boiled rice and milk, cooked with the drugs of the Vidari-gandhadi group.

5. Treatment of the Kaphaja Type :- In a case of Kaphaja Udara, the patient should be anointed with clarified butter, cooked with the decoction of the drugs of the Pippalyadi group. Likewise, clarified butter, cooked with the milky juice of Snuhi plants, should be used as purgatives ; and the decoction of the drugs of the Mushkakadi group, with a copious quantity of Trikatu, cow's urine, Kshara (Yava-kshara) and oil, should be applied as Anuvasana and Asthapana measures. A poultice (Upanaha) prepared of S'ana seeds, Atasi seeds, Dhataki (flower), mustard, Mulaka

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Haritaki should be soaked with the milky juice of the Snuhi plant (and dried in the sun). Utkáriká should now be preapared with this compound and given to the patient. 10.

The Haritaki Ghrita :-A Prastha measure of powdered Haritaki should be mixed with an Ádhaka measure of clarified butter and heated over a charcoal fire by stirring it up quickly with a ladle ; when well mixed, the compound should be poured into an earthen pitcher, which should be kept well corked and buried in a heap of barley for a fortnight. The pitcher should then be taken out and the compound should be strained and cooked again with an adequate quantity of the decoction of Haritaki, Kánjika (fermented rice-gruel) and curd. The patient should use this medicine for a month or a fortnight in proper doses and with adequate vehicles. 11.

The Mahá-vriksha Ghrita :-A quantity of the milky juice (one fourth of the cow's milk in quantity) of the Mahá-vriksha (Snuhi plant), should be boiled with cow's milk. Then it should be removed from the oven, cooled down and churned (with a churning rod). The butter thus prepared and cooked again with the milky exudations of the Mahá-vriksha (and an adequate quantity of water) should be given to the patient for a month or a fortnight in adequate doses and with proper vehicles. 12.

The Chavyádi Ghrita :-Half a Karsha (one Tola) measure of each of the following drugs,viz., Chavya, Chitraka, Danti, Ativishá, Haridrâ, S'amkhini, Trivrit and Trikatu, together with an eight Karsha measure of the inner pulps of the fruit (seeds) of the Rája-vriksha,

• Each of the three things (liquids) should be four times as much as the clarified butter.

two Pala weight of the milky juice of the Mahd-vriksha, eight Pala weight of cow's milk and eight Pala weight of cow's urine, should be cooked* with a Prastha measure (four seers) of clarified butter. The medicated Ghrita, thus prepared, should be given in convenient doses to the patient for the period of a month or a fortnight.

The aforesaid three Ghritas (Haritaki-Ghrita, Mahá-vriksha-Ghrita and Chavyádi-Ghrita) and the Tilvaka-Ghrita (mentioned in the chapter dealing with Váta-vyádi) should be employed, whenever purgatives would be necessary in cases of Udara, internal tumour (Gulma), abscess, Ashthilá, Ánáha, Kushtha, insanity and epilepsy.

Constant use of (cow's) urine or (any kind of) Ásava, Arishta or wine, cooked with the milky exudation of Mahá-vrikshd,† is recommended. A decoction of purgative drugs, thickened with an admixture, in copious quantity, of powdered S'unthi and Deva-dáru, may be used with advantage in this desease.

Ánáha Varti :– A Pala weight of the emetic and purgative drugs and the same weight of the fine powders of the drugs of each of the Vachádi, Pippalyádi and the Haridradi group, and all the officinal kinds of salt should be mixed (with four or eight times that of) the urine (of a cow, buffalo, etc.). Then this (mixture) compound should be boiled and cooked over a gentle fire with a Prastha measure of the milky juice of Mahá-vriksha

• In the absence of any mention about the quantity of water to be added, four times as much of water should be added for the completion of the preparation according to the general maxim. — Ed.

† Dallana explains the sentence as follows :– Ásavas, Arishtas and Surás should be prepared with urine (instead of the liquid i.e., water) and the milky exudation of Mahá-vriksha (as an after-throw), and should be constantly used.

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Chap. XIV ] CHIKITSA STHANAM.

399

( fomentations ) should be made and the patient

should be fed on boiled rice mixed with milk-curd.

Then the vein (Sirá) inside the elbow of his left hand,

should be duly opened. The spleen should be rubbed

with the hand for the proper out-flow of its deranged

blood (for the relief of that enlarged organ). Then

having properly cleansed his system, the physician

should advise the patient to take the alkali of marine

oyster-shells through the medium of milk. As an alter-

native, Yava-kshára should be given to him with Sauvarch-

iká and Hingu, or with filtered alkali (made with the

ashes) of Palása wood. As an alternative, the alkali

of Párijátaka, Ikshváku and Apámárga, mixed with oil,

should be prescribed ; or the decoction of S'obhánjana,

mixed with Chitraká, Saindhava and Pippali,or the alkali

of Puti-karanja, filtered with Kánjika and mixed with

a copious quantity of Vid salt (black salt) and

powdered Pippali should be administered. 17.

Shat-palaka Ghrita :-One pala weight of

cach of the following drugs, viz,. Pippali, Pippali-roots,

Chitraka, S'unthi, Yava-kshára and Saindhava should

be cooked with one Prastha measure of clarified butter

and the same quantity of milk*. The medicated Ghrita

thus prepared is called the Shat-palaka-Ghrita. It is high-

ly efficacious in cases of an enlargement of the spleen,

impaired digestion, Gulma, dropsy, Udávarta, swelling

(Śvayathu), jaundice, cough, asthma, catarrh, Urdhva-

Váta and Vishama-Jvara. In cases of Udara attended

with impaired digestion, the Hingva'di Churna should be-

prescribed. These measures should be as well employ-

ed in a case of an enlargement of the liver (Yakrit),

but the speciality is that the vein (inside the elbow) of

• The practice, in this case, is to add twelve Seers (three prastha

measures) of water to the Prastha measure of milk at the time of cooking.

the right hand (instead of the left hand) should be opened in this case. 18.

Metrical Text :--After slightly bending down the wrist (of the left hand), the vein in connection with the thumb of the left hand should be cauterized with a (burning) Śara for the purpose of giving relief in a case of enlarged spleen. 19.

Treatment of Vaddha-gudodara, etc. :--In cases of the Vaddhā-guda (Enertis) and the Parisrāvi types of Udara, the patient should be first treated with emulsive measures and fomentations and then anointed with a sneha. Then an incision should be made on the left side of the abdomen below the um-bilicus and four fingers to the left of the line of hair which stretches downward from the navel.

The intestine to the length of four fingers should be gently drawn out ; any stone, any dry hardened substance (Scybalum ?), or any hair found stifling to the intestine should be carefully examined and removed.

Then the intestine should be moistened with honey and clarified butter. It should then be gently replaced in its original position and the mouth of the incision in the abdomen should be sewn up. 20.

Treatment of Parisrāvi-Udara :--In cases of the Parisrāvi type of Udara, the obstructing matter should be similarly removed (from the intestines), as in the preceding case, and the secreting intestine should be purified.

The (two ends of the severed intestines should be firmly pressed and adhered together and large black ants should be applied to these spots to grip them fastly with their claws.

Then the bodies of the ants having their heads firmly adhering to the spots, as directed, should be severed and the intestines should be gently reintroduced into their original

Chap. XIV.] CHIKITSA STHANAM.

position (with the severed heads of the ants adhering to the ends of the incision) and sutured up, as in the preceding case. A union or adhesion of the incidental wound should then be duly effected. The seam should now be plastered with black earth mixed with Yashti-madhu and duly bandaged. The surgeon should cause the patient to be removed to a chamber protected from the wind and give him the necessary instructions. The patient should be made to sit in a vessel full of oil or clarified butter and his diet should consist only of milk.

Treatment of Udakodara :-A

patient afflicted with Jalodara (ascites) should be first anointed with medicated oils, possessed of Váyu-subduing virtues, and fomented with hot water. Then his friends and relatives should be asked to hold him firmly by his arm-pits, when the surgeon would make a puncture with a surgical instrument, known as the Vrihi-mukha, on the left side of the abdomen below the umbilicus, to the breadth of the thumb in depth and at a distance of four fingers to the left of the dividing line of hairs in the abdomen. Simultaneously with that, a metal tube or a bird's quill, open at both ends, should be introduced through the passage of the puncture to allow the morbific fluids (Doshodoka), accumulated in the abdomen, to ooze out. And then having removed the tube or the quill, the puncture should be lubricated with oil and Saindhava salt and bandaged in the manner described in connection with the bandaging of ulcers.

The entire quantity of the morbific fluid should not

be allowed to ooze out in a single day, inasmuch as thirst, fever, aching of the limbs, dysentery, dyspnoea and a burning of the feet (Páda-dáha) might supervene in consequence, or as it might lead to a fresh accumulation

of matter in the abdomen, in the event of the patient being of a weak coustitution. Hence it should be gradually tapped at intervals of three, four, five, six, eight, ten, twelve, or of even sixteen days. After the complete outflow of the fluid, the abdomen should be firmly tied with a piece of flannel, silk-cloth or leather, inasmuch as this would prevent its flatulent distention.

Diet :-For six months the patient should take his food only with milk or with the soup (Rasa) of Jangala animals.

Memorable Verse :-Skilled physicians should prescribe boiled milk and the soup of the flesh

• The use of water is forbidden during these nine months.

Vagbhata following Charaka says:-

The patient should live only on milk for six months. After this period, he should live on porridge (Peya) boiled with milk ; and for the next three months he should live on boiled S'yamārice with milk, or with the soup of meat seasoned with the juice or acid fruits and mixed with clarified butter and a small quantity of salt.

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Chap. XV.] CHIKITSA STHANAM.

failure in the first attempts at effecting parturition. The mantras are as follows. 2.

Metrical Texts :-“O thou beautiful damsel, may the divine ambrosia' and the Moon god with Chitra-bhánu and the celestial horse Uchchaih-Sravas take their residence in thy room ; may this water-begotten nectar, help thee, O lady, in swiftly casting off thy womb.

May the Sun, the Vásavas and the Wind-god (Pavana) in the company of the saline Ocean give thee peace. The incarcerated beasts have been freed from their fastenings and binding chords. The Sun god has freed his rays of light. Freed from all danger, come, O, come, O child, and rest in peace in these precincts.” 3.

Proper and useful medicinal remedies should also be employed for the delivery of the child.

Postures of the Foetus :-In the case of the foetus being dead in the womb, the enciente should be made to lie on her back with her thighs flexed down and with a pillow of rags under her waist so as to keep it a little elevated. Then the physician should lubricate his (own) hand with a compound consisting of earth, clarified butter and (the compressed juice of) S'allaki, Dhanvana and S'álmali and inserting it into the passage of parturition (Yoni) should draw out the dead foetus (downward with the hand). 4.

In the case of a leg-presentation (Sakthi), the foetus should be drawn downward by pulling its legs. In case where a single leg (Sakthi) is presented, the other leg of the foetus should be expanded and then it should be drawn downward.

In the case of the presentation of the buttocks (Sphik) (breech-presentation), the buttocks should be first pressed and lifted up and then the foetus should be drawn downward by the legs. In the case of a longitudinal

406 THE SUSHRUTA SAMHITA.

presentation (the child coming stretched cross-wise) like a belt and arrested in the passage, its lower extremities should be pushed upward with the hand and the child should be drawn out with its upper part (viz., the head, etc.), thus pointed downward, and brought straight into the passage of parturition.

In a case of the head being hung back a little on one side, the shoulder should be lifted up by pressing it (with the hand) after chafening it, so as to bring the head at the door of the passage and the child should be drawn straight downward.

Similarly in the case of the presentation of the two arms, the shoulder should be lifted up by pressing it (with the hand) and, the head being brought back to the passage, the child should be drawn downward.

The remaining two kinds of false presentation (Mudha-garbha) previously described (in the eighth Chapter of the Nidána Sthána) should be considered as irremediable.

The applications of instruments (Sastra) should be the last resort when such manipulatory measures would fail.

5. Metrical Text : -But even in such irremediable (Asádhya) cases, surgical operations should not be made if the foetus could be detected alive in the womb, as such a course (as the cutting of the foetus, etc.) would fatally end both as regards the child and its mother.

6. Operations involving destruction of the Foetus-Craniotomy :-In cases where there would be any necessity of using an instrument for the purpose of delivery, the enciente should be encouraged (with hopes of life) before making the surgical operation.

The head or skull of the child in such cases should be severed with the knife known as the Mandalágra or the Anguli-sastra; then having carefully taken out the particles of the skull-bone (Kapála),

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408 THE SUSHRUTA SAMHITA. [Chap. XV.

A non-falling placenta (Apará) should be extracted in the way indicated before or the enciente should be firmly pressed and the placenta extracted with the hand. Her body should be constantly shaken or her shoulders constantly rubbed at the time (of extracting the placenta) after lubricating the passage of parturition with oil. 11.

After-measures :--Thus having extracted the Śalya (fœtus), the body of the mother should be washed with warm water and anointed with oil, etc. Oil should also be copiously applied to the passage of parturition,* as it would soften the Yoni and alleviate the pain therein. After that, powdered Pippali, Pippali-roots, Sunthi, Elá, Hingu, Bhárgi, Dipyaka, Vachá, Ativishá, Kásná and Chavya should be given in a Sneha (clarified butter, etc.), for the (proper) discharge (i.e., purification) of the Doshas (lochia) and for the alleviation of the pain. A plaster, or a decoction, or a pulverised compound of the said drugs without the addition of any Sneha (clarified butter, etc.) may also be given to her. As an alternative, the physician should ask the parturient woman to take S'áka-bark, Hingu, Ativishá, Páthá, Katu-rohini and Tejovati prepared and administered in the preceding manner. Then for three, five or seven days, Sneha (clarified butter, etc.) should again be given ; or the patient should be asked to take well prepared Ásavas and Arishtas at night time. A decoction of the bark of S'irisha and Kakubha should be used for washing (Áchamana†) purposes and the other supervening distresses (i.e., complications) should be remedied with proper medicines. 12-A.

• The oil should be introduced into the vaginal canal by means o. Pichu, i.e., cotton plugs soaked in oil, etc.

† This decoction should be specially used for washing the uterus (Yoni). -Ed.

Chap. XV* CHIKITSA STHANAM.

409

Diet and regimen of conduct :-The

mother should always be neat and clean and subjected to a course of a small quantity of wholesome and emollient diet and to daily anointments and fomentations ; and she should be advised to renounce all anger. Milk cooked with the Váyu-subduing drugs should be used for the first ten days. Meat-soup should then be prescribed for another such period, after which a diet should be prescribed according to the patient's health and nature. This regimen should be observed for a period of four months, after which, the patient would be found to have regained her health, strength and glow of complexion, without any complications, when the medical treatment, etc , should be discontinued. 12-14.

The following Valá-Taila should be used for applying into the Yoni (Vagina, etc.), for anointing the body and for drinking and eating purposes (i.e., along with other food) as well as for Vasti-Karma, as the oil is highly efficacious in curbing the action of the deranged and aggravated bodily Váyu. 15-A.

The Valá Taila :-* An adequate quantity of

sesamum oil should be cooked with eight times as much of the decoction of each of the following ; viz., Valá roots, Das'a-mula and the three combined drugs of Yava, Kola and Kulattha and with eight times as much of milk and (one-fourtth as much of) a paste (Kalka) compound of the drugs included in the Madhura group as well as with Saindhava-salt, Aguru, Sarja-rasa, Sarala-Káshtha, Deva-daru, Manjishthá, Chandana, Kushtha,

• Four seers of sesamun oil, thirty-two seers of the decoction of the Valá-roots, thirty-two seers of the decoction of Das'a-mula, thirty-two seers of the decoction of the drugs Yava, Kola and Kulattha taken together, thirty-two seers of milk and one seer of the paste compound (Kalka) should be taken in the preparation of the oil.

52

Elá, Kálánusádrivá, Mánsi, S'aileya, Teja-patra, Tagara, S'árivá, Vachá, S'atávari, As'va-gandhá, S'áta-pushpá and Punar-navá.

After the completion of its cooking the oil should be kept carefully in a golden, silver, or earthen pitcher with its mouth well-stoppered. This oil is known as the Valá-Taila and proves curative in all diseases due to the action of the deranged Váyu.

A newly delivered woman should use this oil in adequate doses, according to her physical condition.

Women wishing to be mothers and men seeking the blessings of fatherhood should use this Taila, which proves equally beneficial in cases of an emaciation of the body due to the action of the deranged Váyu, weariness of the body through hard labour, and also in cases of hurt or injury to any vital and vulnerable part of the body (Marma), in cases of fractured bones, convulsions, Váta-Vyádhi, hiccough, cough, Adhimantha, Gulma and dyspnoea.

A case of hernia would likewise yield to the continuous use of this oil for six months.

The essential and vital principles (Dhátus) of the organism of a man are strengthened through its use and his youth will suffer no decay.

It should be used alike by kings, king-like and wealthy persons, as well as by those of a delicate and case-loving temperament.

The Valá-Kalpa :- Seeds of sesamum should be successively soaked a number of times in a decoction of Valá roots* and then dried (in the manner of a Bhávaná saturation).

The oil pressed out of such sesamum should be successively conked a hundred times with the decoction of Valá-roots.

This being done, the oil should be poured into an earthen pitcher and the

• Valá wou'd be the Kalka in this oil, says Dallana. But he also says that some authorities hold that the Kalkas used in the Valá-Taila should be used as the Kalka in this oil as well.

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CHAPTER XVI.

Now we shall discourse on the medical treatment of Abscesses and Tumours (Vidradhi). 1. Of the six types of Vidradhis, the one of the Sánni-pátika type should be regarded as incurable In all other types curative measures* should be speedily resorted to in their unsuppurated stage, as in the treatment of a case of Śopha (inflammatory swelling or boil). 2.

Treatment of Vátaja-Vidradhi :-In

a case of Vátaja Vidradhi, a compact or thick plaster (Álepa) composed of pasted Murangi-roots,† mixed with clarified butter, oil and lard (Vasá), should be applied lukewarm. The flesh of the animals which frequent swamps and marshes as well as of aquatic animals boiled with the drugs of the Kákolyádi group, Kánjika, salt, barley powder and Sneha (clarified butter, &c.), should be applied as a poultice (Upanáha), and the affected part should be constantly fomented with (warm) Veśavára, Kriśará, milk and Páyasa. Blood-letting should also be resorted to. 3.

If, in spite of the use of the preceding remedies, suppuration should begin to set in, suppurating measures should be resorted to and the abscess (finally) lanced

• Commencing with Apatarpana up to purgative measures (Chikitsá, chapter. -1). † Both Dallana and Chakrápani Datta read "Vátaghna" in place of "Murangi" of the text. Dallana explains the term "Vátaghna" as the "Bhadra-dárvádi group" and S'iva-dása, the commentator of Chakrapáni, explains it as the "Das'a-mula". Both of them, however, say that he different reading is "Surangi" meaning "S'obhánjana." "Murangi" also means "S'obhánjana." -Ep.

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416 THE SUSHRUTA SAMHITA.

the aggravated Doshas involved in the case, should be administered. Applications of poultices, Sneha-Karma (emollient measures), as well as Anulomana (Váyu-subduing) measures should be frequently resorted to in such cases. 15-20. The veins (S'irá) should be opened in a case of the Kaphaja type of abscess as directed before ; while some authorities advise to open the veins at the arms in cases of Raktaja, Vátaja and Pittaja types. 21.

Treatment of Suppurated internal Vidradhi :-

A suppurated internal Vidradhi having bulged up (above the surface of the body) should be opened with a knife and treated in the manner of an (incidental) ulcer. Whether the pus drains through the lower or the upper channel of the body (rectum or mouth) the patient should be made to take the drugs of the Varunádi group or Madhu-s'igru mixed with (a copious quantity of) Maireya, Surá, Ásava, or Kánjika. The diet should consist of rice boiled and cooked with white mustard seed in the decoction of Madhu-s'igru and taken with the soup of barley, Kola and Kulattha pulse. The Tilvaka Ghrita (Chikitsá Sthána, ch. IV.), or clarified butter cooked with the decoction of the Trivritaddi group, should be taken every morning in adequate doses for the purpose. Particular care should be taken by the physician to guard against the suppuration of an internal abscess, since suppuration in such cases leads but to a slender hope of success. 22-23.

Treatment of Majja-játa Vidradhi :

The medical treatment of a patient, afflicated with a Majja-játa abscess (abscess affecting the marrow), should be taken in hand without holding out any definite hope of recovery (as a proper course of treatment in such cases does not invariably prove successful). Sneha-karma

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CHAPTER XVII.

Now we shall discourse on the medical treatment of erysipclas, etc., (Visarpa), sinus, etc., (Nádi-Vrana) and diseases of the mammary glands (Stana-roga). 1.

Of the types of erysipelas (Visarpa) the first three (viz., the Vátaja, Pittaja and Kaphaja ones) are curable ; the two remaining types, viz., those caused by the concerted action of the three Doshas (of the body) and those originating from wounds (Kshataja) should be considered as incurable. In cases of the curable types, medicated Ghritas, plasters (Upadchas) and affusions (Seka) prepared with the drugs (antidotal to the specific aggravated Dosha or Doshas (involved in the case) should be prescribed. 2.

Treatment of Vátaja Visarpa :-In cases of the Vátaja type of the disease, Mustá, S'atáhvá, Sura-dáru, Kushtha, Várdhí, Kustumuru (Dhanyáka) Krishna-gandhá, and the drugs of a heat-making potency (Ushna-gana)* should be used in preparing the medicinal washings (Seka), plasters and Ghritas. The drugs respectively included within the groups of the Vrihat-Pancha-mula and the Svalpa-Pancha-mula, the Kantaka-Pancha-mula and the Valli-Pancha-mula should be (separately) used to prepare the medicinal plasters, affusions, medicated Ghritas and as well as the necessary oils. 3.

• Chakradatta reads “Arka”, Vams'á and Artagala instead of the drugs of a heat-making potency. Dallana explains the drugs of a heat-making potency to be the drugs of the Bhadra-dárvádi and the Pippalyádi groups.

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and with the decoctions, weighing four times that of the Ghríta, of the drugs of the Nyagrodhádi, Shiráddi (minor Pancha-mula) and Vilvádii (major Pancha-mula) groups together with the same weight (sixteen seers) of milk. The washing (of the affected part) with this medicated Ghríta proves curative in Pittaja erysipelas and sinus. Visphota (boils), head diseases, malignant sores and inflammatory affections of the mouth, yield to the internal use of this Ghríta. It is called the Gauryyádi Ghríta and is highly efficacious in the derangements to which children are liable, (commonly) attributed to the malignant influences of evil stars, as well as in cases of emaciated ones. 6.

Treatment of Kaphaja Visarpa :- Cases of the Kaphaja type of Visarpa readily yield to a proper application of a medicinal plaster (Pradeha) composed of Aja-gandhá, As'va-gandhá, Saralá*, Kálá, Ekáishikát and Aja-s'ringi‡ pasted with the urine of a cow. Drugs, such as Kálánusdryá, Aguru, Chocha (cardamom), Gunjá, Rásná, Vachá, S'ita-s'iva, Indra-parni, Páthindi, Munijáta and Mahi-Kadamba (applied similarly) are also efficacious in the present type. Drugs of the Varunádi group may be used in any form (such as plasters, washes, etc.), for erysipelas. Blood-letting (by means of leeches) and Sams'odhana (purifying) measures are the principal remedies in all cases of this disease (Visarpa). Suppurated erysipelas should be first purified and then treated with the remedies described in the treatment of Vrana (ulcer). 7-8.

• "Saralá" here means "Trivrit". Chakradatta reads "शाल" which also means "Trivrit". † 'Ekáishiká,' according to Dallana, would mean S'atávari but S'ivadása explains it as Pálhá. ‡ Gayadása explains it as Karkata-S'ringi.

Chap. XVII. CHIKITSA STHANAM.

Treatment of Nádi-vrana :-A Case of Nádi-Vrana (sinus) due to the concerted action of the three Doshas (Sannipátaja) baffles all cure, while the four remaining types are amenable to careful medical treatment. Poultices (Upanáha)* should be applied at the outset in the Vátaja Nádi-Vrana and then the course of the pus-channels should be (ascertained and) fully opened (with a knife) and bandaged with a paste of sesamum, Apámárga-seeds and Saindhava salt. A decoction of (the drugs of) the Vrihat-Pancha-mula group should be constantly used in washing the ulcer. Oil † duly cooked with the following drugs, viz, Himsrá, Haridrá, Katuka, Valá, Gojihviká and Vilva-roots should be used for the purification, filling up and healing of the sores of the sinus. 9-11.

Treatment of Pittaja Nádi :-In a case of Pittaja sinus, an intelligent surgeon should employ a porridge (Utkáriká) mixed with milk and clarified butter as a poultice. Then having opened the sinus with a knife, a plaster composed of Tila, Nága-danti and Yashti-madhu should be applied to heal it. A decoction of Soma, Nimba and Haridrá should be used by a skillful surgeon in washing the ulcer daily. A medicated Ghrita cooked with S'yámá, Trivrit, Triphalá, Haridrá, Dáru-Haridrá, Rodhra and Kutaja and with milk should be used to lubricate (Tarpana) the sinus. This Ghrita will even heal a sinus affecting the Koshtha. 12-13.

• Poulticing with the drugs which induce suppuration is not approved of by Gayadása.

† Four seers of oil, the (Kalka) drugs combindely weighing one seer and sixteen seers of water are to be taken in its preparation.-Dallana.

Treatment of Kaphaja Nádi:-In a case of the Kaphaja type of the Nádi, the sinus should be duly poulticed Upanáha) with Kulattha, white mustard seeds, S'aktu and Kinva. When softened by its application, the direction of the sinus (with the help of a director) should be first ascertained ; and an expert surgeon should then open it fully with a knife and plaster it with a compound composed of Nimba, sesamum, Saindhava salt and Sauráshtra-mrittiká. A decoction (Sva-rasa-lit.—expressed juice) of the Karanja, Nimba, Játi, Aksha and Pílu should be used in washing the incidental ulcer. Oil duly cooked with Suvarchiká, Saindhava, Chitraka, Nikumbha, Táli,* Nala, Rupiká and Apámárga-seeds and with cow's urine should be used for healing purposes. 14.

Treatment of Salyaja Nádi :-In a case of Salyaja Nádi (incidental to any foreign matter into the body), the Salya should be first extracted by an incision into the sinus. Then having fully cleansed the channel, the ulcer should be purified with a plaster of sesamum profusely saturated with honey and clarified butter. It should be then healed up. Oil cooked with the decoction of the tender fruits of the Kumbhíká, Kharjura, Kapittha, Vilva and the Vanáspatis (Vata, etc.), and with the Kalkas of Mustá, Sarald, Priyangu, Sugandhiká, Mocharasa,† Ahi-pushpa (Nágesvara), Rodhra and Dhá taki flowers leads to a speedy healing up (granulation) of ulcers (Vrana) and traumatic sinuses. 15.

• Dallana's reading evidently is "Táli-tala" and he explains it as the roots of "Bhumyámalaki". Chakradatta also prescribes this oil but he takes "Niliká" instead of "Táli". S'ivadása, again, in his commentary quotes from Sus'ruta but reads "Nili-Nala' in place of "Tála-Nala." + "Mocha-rasa" is explained by Dallana to be "S'obhánjana," but it generally means "S'álmali-veshta," and S'ivadása explains it as such.—Ed.

Chap. XVII.] CHIKITSA STHANAM.

Treatment with Kshára-Sutra :-An erudite surgcon should open a sinus, occuring in any of the Marmas, or in a weak, timid, or emaciated person with an alkalined string (Kshára-Sutra), and not with a surgical knife. The course of the sinus should be first ascertained with a director ; and a needle, threaded with a string of alkalined thread should be passed from one end of the sinus and quickly drawn out through the other. Then the two ends of the thread should be firmly fastened together. An intelligent surgeon should likewise pass another alkalined thread in the event of the alkali of the first thread being comparatively weak. This should be repeated till the sinus completely bursts out. The surgeon should know that the same procedure may be as well adopted in cases of fistula-in-ano. Similarly in cases of tumours (Arvuda), etc. they should be lifted up (with the hand) and tied round at their base with an alkalined thread, or it should be punctured around with a kind of needle with their mouth resembling a barley corn and then tied again at their base with an alkalined thread. After their bursting (and falling off), they should be treated as common ulcers (Vrana).

The different kinds of Plug-Stick (Varti) described in the Dvi-Vraniya Chapter (Chikitsita-chap.-I.) may be similarly used with advantage in all cases of sinus. The use of a plug made of the following drugs, viz., the bark and fruit of the Ghonta, (the five officinal kinds of) salt,* Lákshá, Puga and the leaves of the Alavaná †

• According to Chakradatta's reading and S'ivadás's commentary thereon, only the Saindhava (instead of the five officinal kinds of salt) should be taken. We, however, follow Dallana's interpretation with good results.-Ed.

† "Alavaná" has been explained by Dallana as "Káka-mardaniká" and by S'ivadása as "Jyotishmati". S'ivadása is, however, followed in practice in this case.

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Chap. XVII.] CHIKITSA STHANAM.

425

(mother or wet-nurse) by the physician ; and in the

evening â draught composed of the decoction of Nimba,

mixed with honey and Mágadhiká, should be given

to her for emetic purposes. Next day she should

take a meal (of boiled rice) with the soup (Yusha)

of Mudga pulse. The use of emetics should be

continued for three, four, or six days ; or she

should be made to drink a potion of clarified butter

(cooked) with Triphalá. A decoction of Bhárgi,

Ativishá, Vachá, Sura-dáru, Páthá, the drugs of the

Mustádi Gana, Murvá and Katu-rohini, or that of the

drugs of the Áragvadhádi group mixed with honey,

should be given to the Dhátri (wet-nurse) for the purifi-

cation of her breast-milk. 26.

The above are the general remedial measures which

are to be adopted in the affections of breast-milk. Any

other defect in the breast-milk should be corrected

specially with an eye to the nature of the Dosha

involved in the case. In cases of inflammatory

swellings of the breasts, the physician should remedy

them by means of any one of the various measures laid

down under the head of Vidradhi with a due considera-

tion to the requirements of each particular case. Medici-

nal remedies should only be internally employed and no

poultices should be applied for the speedy suppuration

of the swelling of the breast, even if found to have al-

ready commenced to suppurate ; since the breasts are of

an extremely soft and fleshy growth, any tight banda-

ging about those parts may be followed by local slough-

ing or even bursting. In a case where suppuration had

already taken place, an operation should be made

in the affected part, avoiding the milk-carrying veins

as well as the nipple with its black surroundings.

In all the cases of Stana-Vidradhi< whether

54

non-suppurated, suppuraing, or suppurated—the milk should be pressed out from the breast of the Dhátri.* 27-29.

Thus ends the Seventeenth Chapter of the Chikitsita Sthánam in the Sus'ruta Samhitá which deals with the treatment of erysipelas, sinus and the diseases of the mammary glands.

CHAPTER XVIII.

Now we shall discourse on the medical treatment of Glandular Swellings, etc. (Granthi), Scurvy (Apachi), Tumour, etc. (Arvuda) and Goître (Gala-ganda). I. General treatment of Granthi :-In the non-suppurated or acute (inflammatory) stage of Granthi, an experienced physician should prescribe the measures * laid down in connection with (inflammatory) swellings (Sopha) in general. As bodily strength arrests the progress of the disease, the strength of the patient should hence be always carefully guarded against suffering any diminution in that respect. The patient should be made to drink oil, or clarified butter, or both ; or he should be made to drink lard, oil and clarified butter, mixed together.† Apehivátá (Prasárani) and Das'a-mula cooked with the four kinds of lardacious or emollient substances (oil, clarified

• Beginning with Apatarpana up to the purgative measures.

† Oil, clarified butter and lard mixed together is technically called the "Trivrita."-Dallana. In the case of a Vátaja Granth§, a potion of oil cooked with the decoction and paste (Kalka) of the Váyu-subduing drugs should be prescribed for the patient ; in the case of a Pittaja Granthi, clarified butter cooked with the decoction and Kalka of the Pitta-subduing drugs should be administered in the same manner ; while in the case of a Kaphaja Granthi, oil cooked with the decuction and Kalkı of the Kapha-subduing drugs should be taken by the patient. But in a case of Granthi due to the concerted action of the two, or three of the Doshas, any compound medicated oil, prepared by cooking any two, three, or four of the oily substances, vis., oil, clarified butter, lard and marrow, with the decoction and Kalka of those drugs which are antidotes to the said Doshas, should be prescribed for the patient as drinks.

Treatment of Vátaja Granthi :-A medicinal plaster composed of Himsrá, Rohini, Amritá, Bhárgí, S'yónáka, Vilvá, Agúru, Krishna-gandhá, Goji and Tála-patri (Táta-parni—D. R) pasted together, should be applied (to the inflamed gland) in the Vátaja type of Granthi. Different kinds of fomentation (Sveda), poulticing (Upanáha) and medicinal plasters (Lepa), possessed of the efficacy of subduing the deranged Váyu, should be likewise resorted to. A suppurated swelling should be opened and the pus drained. Then the incised wound should be washed with a decoction of Vilvá,* Arka and Narendra (Áragvadha) and purified (disinfected) with a plaster consisting of sesamum and the leaves of the Panchagula (castor oil plants), together with Saindhava salt. After the purification, it should be healed up by applying a medicated oil, mixed with the powders of Rásná and Saralá; or by a medicated oil prepared by cooking it with Vidanga, Yashti-madhu and Amritá and cow's milk. 4.

Treatment of Pittaja Granthi :-In a case of the Pittaja type of the disease, leeches should be applied to the affected part, which should be further affused with milk and water. The patient should be made to drink a cold decoction of the drugs of the Kakolyádi group with the addition of sugar; or he should take the powders of Haritaki through the medium of grape-juice, or of the expressed juice of sugar-cane. Hot plasters, prepared by pasting together the bark of the Madhuka (flower) tree, and of the Jambu

• Some read "फल्वाकं गण्यादितोऽपि:" and explain that the decoctions of the Vilvadi and the Arkadi groups are to be taken for the purpose.

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not (otherwise) resolved and absorbed should be cut open even in its non-suppurated stage and the glands removed. The expert surgeon should then cauterize the incidental wound after the cessation of the bleeding and treat it in the manner * of the Sadyo-Vrana treatment. These remedies should be employed by the experienced physician, where the swelling would be found to have assumed a large, stiff, elevated and fleshy aspect (bulging from the deeper tissues of the flesh). A Kaphaja Granthi should be opened with an incision as soon as it becomes fully suppurated and should then be washed with a decoction of appropriate medicinal drugs. The incidental ulcer should be purified (disinfected) with a purifying remedy prepared with a profuse quantity of Yava-kshara, honey and clarified butter; and finally it should be healed up by the application of an oil, cooked with Vidanga, Páthá and Rohini. 7-9.

Treatment of Medoja Granthi :-In a case of Medoja Granthi (originated from the vitiated condition of the bodily fat) a plaster of pasted sesamum, placed inside the folds of a piece of linen, should be applied to the seat of the affected part and fomentations with hot iron-rods should be frequently applied, inasmuch as application of heat (lit.-fire) is efficacious in such cases. As an alternative, the affected part should be fomented with a ladle, pasted with heated shellac (Lákshá). The Granthi (in its non-suppurated stage) should be opened by an incision and the fat removed; the incidental ulcer should then be (actually) cauterized. On the other hand, the Granthi, when fully suppurated, should be incised and washed with the urine (of a cow). Then a paste, composed of

sesamum, Suvanchikā, Haritāla and rock-salt, pounded together and mixed with honey, clarified butter and an abundant quantity of Yava-kshāra, should be applied to the incidental wound for purifying purposes. Oil, cooked with the two kinds of Karanja, Gunjā, the green scrapings of bamboo, Ingudi and the urine* of a cow, should be used to heal the ulcer. 10-11.

Treatment of Apachi :-Clarified butter cooked with the fruit of Jimutaka and Kosha-vati, and with (the roots of) Danti, Dravanti and Trivrit, is a very powerful and efficacious remedy.† Administered internally as well as externally, it leads to the cure of the advanced cases of Apachi. 12.

A strong emetic composed of Nirgundi, Jāti (flower) and Varihistha (Válá) together with Jimútaka, profusely mixed with honey and Saindhava, should be given warm to the patient. It is a very powerful emetic, and leads to the recovery of even a malignant form of Apachi. An oil, cooked with the pastes (Kalka) of Kaitaryya,‡ Vimbī and Karavīra, may be profitably used as an errhine (Siro-virechana). Oil cooked with the expressed juice of S'ákhotaka may also be used profitably as an errhine.§ Avapīda errhines (used in drops

• Cow's urine measuring four times the oil should be taken in the preparation of this medicated oil.‡ In preparing this medicated Ghrita, the quantity of clarified butter should be taken four times as much as the combined weight of the Kalka (paste). These should be boiled with water, taken four times as much as the quantity of clarified butter. Some authorities, however, are of opinion that both the paste (Kalka) and the decoction of the drugs are to be taken in its preparation.

‡ Some read 'Nirgundi' after it.§ This medicated oil should be cooked without any Kalka. But some are of opinion that both the decoction and the Kalka of S'ákhotaka should be used.

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The Sushruta Samhita

434

The Sushruta Samhita

Treatment of Vátaja Arvuda :-

The Sushruta Samhita

Treatment of Pittaja Arvuda :-

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and flies attracted to it (and so consume the ulcer). A small portion of the ulcer, left unconsumed (un-eaten) by worms and parasites, etc., should be scarified and the ulcer should then be cauterised with fire.

27-28.

A comparatively superficial tumour (Arvuda) should be covered with thin leaves of zinc, copper, lead, or of iron, and cauterization with fire or with an alkali as well as surgical operations should be carefully and repeatedly resorted to, so as not to hurt, nor in any way injure the body. The incidental ulcer should be washed with the decoction of the leaves of the Ásphota, Jati, and Karavira for the purpose of purification. A medicated oil, cooked with Bhárgi, Vidanga, Páthá, and Triphalá should then be used as a healing remedy. An experienced physician should treat a tumour, spontaneously suppurating, in the manner of a suppurated ulcer.

29-31.

Treatment of Medoja Arvuda :-A Medoja Arvuda (fat origined tumour) should be first fomented and then incised. The blood in its inside having been cleansed it should be quickly sutured and then plastered over with a compound composed of Haridrá, Griha-dluma (soot of a room), Rodhra, Pattanga, Manah´sildá and Haritdla pounded together and mixed with a proper quantity of honey After its purification, thus produced, it should be treated with the application of Karanja-Taila (prescribed before in cases of Vidradhi). Even the least particle of Doshas (pus, etc.) in a tumour, left unremoved, would lead to a fresh growth of the excrescence and bring on death just like the least particle of an unextinguished fire. Hence it should be destroyed in its entirety.

32-33.

Treatment of Vátaja Gala-ganda :-A case of the Vátaja type of Gala-ganda (goitre) should

be treated with fomentations of the vapours of the decoctions of tender leaves of the Váyu-subduing drugs prepared by boiling them with Kánjika, various kinds of urine and milk as well as with minced meat and oil, and should be applied in the manner of a Nádisveda. After this fomentation, the contents should be carefully drained (from inside the goitre). Then after having duly purified (the incidental ulcer), it should be plastered with a medicinal compound composed of (the seeds of) the S'ana, Atasi, Mulaka, S'igru and sesamum and Kinva and the piths of the Piyála, or with that composed of Kálá, Amritá, S'igru, Punarnavá, Arka, Gaja-pippali, Karaháta Madana) and Kushtha, or with that composed of Ekáshiká, Vrikshaka and Tilvaka. All of them should be pasted with Surá and Kánjika and applied hot to the affected part. The internal use of a medicated oil, cooked* with Amritá, Nimba, Hamsadhvá, Vrikshaka, Pippali, Valá, áti-valá, and Deva-dáru, always proves efficacious in a case of goitrc.

Treatment of Kaphaja Gala-ganda : — A case of the Kaphaja type of goitre should be treated with applications of fomentation and poultice and should be duly drained (Visráva). Then a medicinal plaster composed of Aja-gandhá, Ati-vishá, Vis'alyá, Vishániká, Kushtha, S'ukáhváya, Gunjá (taken in equal parts) and pasted with the alkaline water prepared from the ashes of the Palás'a wood should be applied hot to the affected part. A medicated oil cooked with the drugs of the Pippalyádi group and mixed with the five officinal kinds of salt should

34-36.

• Some say that the oil should be prepared with the decoction as well as with Kalka of the said drugs. Others, however, hold that water should be used in the preparation of the oil and the said drugs should be used only as a Kalka.

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CHAPTER XIX.

Now we shall discourse on the medical treatment of hernia, hydrocele, scrotal tumour, etc. (Vriddhi), diseases of the genital organ (Upadams'a) and elephantiiasis (Ślipada). 1. In the six types of Vriddhi other than the one known as the Antra-Vriddhi (Hernia), riding on horse back, etc., excessive physical labour, fastings, sitting in an unnatural position, constant walking, voluntary restraint of any natural urging (for stool and urine, etc.), sexual intercourse and eating of food difficult of digestion should be avoided. 2.

Treatment of Vátaja Vriddhi :-

In the Vátaja type of Vriddhi, the patient should be first soothed (Snigdha) with the application of Traivrrita Ghrita (vide, Chap. V. Chikitsita Sthána). He should then be duly fomented and subjected to a proper course of purgatives. As an alternative, he should be made to drink the expressed oil of the Kos'ámra, Tilvaka, or Eranda (castor) oil (as a purgative) with milk for a month. A decoction of the Váyu subduing drugs mixed with the powders of the same drugs should then be employed by an experienced physician at a proper time * in the manner of a Niruha Vasti. The patient should then be made to take a meal (of boiled rice) along with meat soup ; and oil cooked with Yashti madhu should be applied (in the manner of an Anuvásana measure).

• After a period of one week from the time of the application of purgatives and in case the patient is strong enough to undergo the Niruha Vasti measure.

Applications of Sneha (oil, etc.), poultices (Upanáha), and plasters (Pradeha) of the Váyu-subduing drugs should be applied to the affected part. If the tumour (Vriddhi) begins to suppurate, it should be made to do so fully. It should be then opened with an incision avoiding the median line (Sevani) of the perineum and the proper purifying (i.e., antiseptic and healing) measures should be resorted to in the usual way laid down (in the treatment of Dvi-vrana*).

Treatment of Pittaja Vriddhi :- A case of the non-suppurated stage of Pittaja Vriddhi may be beneficially treated with the remedies laid down in connection with a case of the same type of glandular swelling (Pittaja Granthi). In the case of it being suppurated, the surgeon should open it with a knife and purify it with the application of honey and clarified butter. The incidental ulcer should then be healed up with oils and pastes of healing virtues.

Treatment of Raktaja Vriddhi :-In a case of Raktaja Vriddhi (originated through the vitiated condition of the blood), the (vitiated) blood should be drawn out by the application of leeches. As an alternative, purgatives should be administered through the medium of honey and sugar. Remedial measures described in connection with the Pittaja type of the disease should be employed both in the suppurated and the non-suppurated stages (of this type).

Treatment of Kaphaja Vriddhi :-In a case of the Kaphaja type of the disease, poultices with the heat-making † drugs (i.e., Vachádi, Pippályadi

• According to Gayadása, the measures to be adopted should be those laid down in the Mis'raka chapter (Chap. XXV).

† Some say that the heat-producing drugs are those comprised in the Aja-gandhádi group mentioned in the Mis'raka chapter, Sutra Sthánam.

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THE SUSHRUTA SAMHITA

cooked with Manahs'ilá, Haritdla (yellow oxide of arsenic), rock-salt, and Bhallátaka.

THE SUSHRUTA SAMHITA

7. Treatment of Mutraja Vriddhi : - In a case of an enlargement of the scrotun (hydrocele) due to the derangement of urine, it should be first fomented and then a piece of cloth should be tightened rount it. A puncture should then be made in the bottom of the sac with a Vrihimukha instrument, on either side of the raphe of the perincum (Sevani). A tube open at both ends should be introduced (into the puncture) and the accumulated (morbid) fluid should be let out. The tube should then be taken off and the scrotum should be tied up with a bandage of the Sthagiká pattern and the incidental ulcer should be purified and healed up with appropriate medicinal applications.

THE SUSHRUTA SAMHITA

8. Treatment of Antra-Vriddhi : - A case of Antra-Vriddhi (hernia when strangulated) extending down to the scrotal sac (Koslia) should be given up as irremediable ; but, in the case of its not being so extended, it should be treated as a case of Vátaja-Vriddhi. If the colon be found to have descended down to inguinal region (Vamkshana), it should be cauterized with a heated crescent-mouthed rod (Arddha-Chandra S'aláká) to prevent its descending down into the scrotal sac. A case of hernia that, in spite of all these precautions, descends down into the scrotal sac (Koslia), should be given up as irremediable. The first finger of the hand opposite * the affccted part (i.e., the affected testes) should be incised at its middle and cauterized.

THE SUSHRUTA SAMHITA

• Incision and cauterization should be performed in the thumb of the right hand, if the left testis is affected, and in case the affection is in the right testis, incision and cauterization should be made in the thumb of the left hand,

Chap. XIX.] CHIKITSA STHANAM.

443

In cases of hernia (Antra-Vriddhi) of the Vátaja and of the Kaphaja type the affected part should be carcfullly cauterized in the above manner ; but in these two cases, the Snáyu (ligaments) should be cut off in addition (before cauterization). In a case of Antra-Vriddhi the veins (S'irâ) of the temples at the (upper) end of the ears on the opposite sides of the affection should be carcfullly opened avoiding the Sevani therein. 9-12.

Treatment of Upadams'a * :--In cases of the curable type of Upadams'a, Sncha (oleaginous substances) should be first applied, and the affected part should be fomented. Then the veins of the penis should be opened, or leeches should be applied (to the organ) for the elimination of the contaminated blood † (according as the affections are more or less severe). 13.

General Treatments :--The system of the patient should be cleansed with both emetics and purgatives in the event of an excessive aggravation of the Doshas inasmuch as the local pain and swelling would subside simultaneously with the elimination of the aggravated Doshas from the system. Medicinal Vástis (enemas) should be injected (into the rectum) in the way of a Niruha-Vasti for the climination of the aggravated Doshas, where the weakness of the patient would prohibit the application of purgatives. 14.

Treatment of Vátaja Upadams'a :--In a case of the Vátaja type of the disease, drugs such as, Propaundarika, Yashti-madhu, Varshábhu, Kushtha, Deva-dáru, Saralá, Aguru and Rásná, should be used as a plaster (over the affected organ). Similarly

• See note, Chapter XII., Nidána Sthánam. † Jejjata holds that leeches should be applied in a case of superficial Upadams'a.

plasters composed of Nichula, castor-seeds, and pulverised wheat and barley grains pasted with Sneha (clarified butter, oil, etc.) should be applied lukewarm to the seat of the disease, which should also be affused with a decoction of the above-mentioned drugs, viz., Prapaundarika, etc. 15.

Treatment of Pittaja Upadams'a :-In a case of the Pittaja type of the disease, a plaster composed of Gairika, Anjana, Yashti-madhu, S'ariva, Us'ira, Padmaka, (red) Chandana and Utpala mixed with a Sneha (clarified butter),* or that composed of Padma, Mrindla, Sarjja, Arjuna, Vetasa, and Yashti-madhu mixed with clarified butter should be applied to the affected organ which should be sprinkled with a solution of milk, clarified butter, sugar, sugar-cane juice and honey, or with a cold decoction of the drugs of Vata, etc. 16.

Treatment of Kaphaja Upadams'a :-In a case of the Kaphaja type of the disease, a plaster composed of the barks of S'ala, As'va-karna, Aja-karna and Dhava pasted with Sura and mixed with oil, should be applied hot to the affected part. As an alternative, the drugs such as, Haridra, Ativisha, Musta, Sarala, Deva-daru, Patra, Patha, and Pattura should be used for similar purposes and the affected organ should be affused with a decoction of the drugs of the Sura-sadi and A'ragvadhadi groups. 17.

The above remedial measures, viz., plasters, sprinkling (Parisheka), blood-letting and Sams'odhana (i.e., application of purgatives, emetics, etc.) as well as those

• According to S'ivadasa the Sneha to be used in the plaster should be clarified butter washed a hundred times.

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an Upadams'a-ulcer of whatsoever type. The use of a pulverised compound composed of Svarjiká, Tuttha, Kásisa, S'aileya, Rasánjana, and Manahs'ild taken in equal parts arrests the extension of an ulcer and Visarpa. Cises of Upadams'a and Visarpa readily yield to the application of a pulverised compound of the ashes of Gundrá, Haritála and Manahs'ild. An (external) application of Bhringarája, Triphalá and Danti mixed with the powders of copper and iron, destroys Upadams'a just as the thunder bolt of Indra (completely) destroys a tree.

21-22.

Treatment of Ślipada :-In a case of Elephantiasis (Ślipada) due to the action of the deranged and aggravated Váyu, the vein (Sirá) at a distance

of four fingers above the instep (Gulpha) should be opened after an application of Sneha and Sveda * to the patient. Vastis should be employed when the patient has been (soothed and) restored to his former condition (with appropriate and nutritious diet, etc.). He should be made to take continuously for a month, a potion consisting of castor-oil mixed with (an adequate quantity of cow's) urine The patient should take rice as his diet with milk duly cooked with S'unthi The use of the Traivrita Ghrita as well as cauterization of the affected part with fire is also recommended in such a case.

23

Treatment of Pittaja Ślipada :- In a case of Pittaja type of Elephantiasis, the vein (Śirá) below the instep (Gulpha) should be opened. Medicinal remedies mentioned in connection with the treatment of the Pittaja type of tumours (Arvuda) and of Erysipelas (Visarpa) as well as other Pitta-subduing remedies and measures should be employed†.

24

Treatment of Kaphaja Ślipada :- In a case of the Kaphaja type of elephantiasis the principal vein (Śirá) of the first toe should be opened by an experienced surgeon and the patient should be made to take at intervals the decoction (of the Kapha-subduing drugs) with honey. As an alternative, the patient should be advised to take the powders (Kalka) of Abhayá mixed with any officinal kind of urine. The affected locality should be constantly plastered with the paste

• Chakradatta reads "चो हख्षे दोपनाह्याः" in place of "चो हख्षे दोपपक्ने तु" meaning thereby that such Sveda and Upanáha should be applied before the incision of the vein. Gayadása also supports this reading as is evident from Dallana's commentary. - Ed.

† The partlcle "च" in the text shows that Kapha-subduing remedies and measures should also be used in all these cases.

of Katuka, Amritá, S'unthi, Vidanga, Deva-dáru and Chitraka, or with Chitraka and Deva-dáru. An oil cooked with Vidanga, Maricha, Arka, S'unthi, Chitraka, Deva-dáru, Elaká and all the five officinal kinds of salt should be given him as a potion. Cooked parley is specially recommended as diet in the present case.

As an alternative, the patient should be made to drink a potion of mustard oil* or of the expressed juice of the leaves of Puti-Karanja according to his capacity for the cure of Ślipada. In the same way† the juice of Putranjivaka should be prescribed by a physician after a due consideration as to the strength of the patient and of the time.

The Alkaline Remedies :—An alkali should be prepared from the ashes of Kákadani, Káka-janghá, Vrihati, Kantakáriká, Kadamba-pushpa, Mandá-ri, Lambá Sukanasá in the usual way by filtering them (twenty-one times) after dissolving them in cow's urine. The expressed juice of Kákodumbariká, Sukanasá and the decoction of Madana fruit should be mixed with the above alkaline preparation (and duly cooked in the manner of Kshára-páka).

Diseases, such as Ślipada

• Chakradatta reads "पिबेत सर्षप तैलेन" in place of "पिबेत सर्षप तेलं" which shows that the expressed juice of Puti-Karanja leaves should be taken with mustard oil and not separately. Dallana evidently supports this in his commentary. That Chakradatta's reading is the correct one is also evident from the next couplet which says that the expressed juice of Putranjivaka should be taken in the preceding manner. This "preceding manner" evidently means "with mustard oil", and unless we accept Chakradatta's reading, the expression would be unmeaning.—Ed.

† It evidently means that the expressed juice of Putranjivaka should be taken with mustard oil—see last note.—Ed.

CHIKITSA STHANAM

(Elephantiasis), Apachi (Scrofula), Gala-ganda (Goitre), Grahani (chronic diarrhœa), aversion to food and the affections of all kinds of poison, yield to the iuternal use of this alkaline preparation. An oil cooked with the aforesaid drugs, if used as errhines and anointments, will cure all the foregoing maladies as well as malignant ulcers (Dushta-vrana). 27.

CHIKITSA STHANAM

The ashes of the Dravanti, Trivrit, Danti, Nili, S'yamá, Saptalá and S'amkhiní should be filtered in the way of preparing alkalies after dissolving them in cow's urine. The solution, thus prepared, should be boiled with a decoction of Triphala. Taken internally it tends to act in the lower part of the body (i.e, it moves the bowels). This medicine produces the same effect as the preceding ones. 28.

CHIKITSA STHANAM

Thus ends the nineteenth Chapter of the Chikitsita Sthánam in the Sus'ruta Samhitá which deals with the medical treatment of Vriddhi, Upadams'a and S'lipada.

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the drugs of the Madhura (Kákolyádi) group should be applied in healing up the ulcers in the suppu:ated stages.

5. Treatment of Chipya, etc :—In a case of Chipya, the affected part should be first washed* with hot water and (the incarcerated pus, etc.) drained (Visráva) by cutting it away (with a knife). Then after anointing it with (the oil known as) the Chakra-taila it should be dusted over with the powders of Sarja (resin) and duly bandaged. If this process of treatment fail, the affected part should be cauterised with fire and an oil cooked with (a decoction of) the drugs of the Madhura (Kákolyádi) group should be applied to heal (the incidental ulcer). The same course of treatment should also be adopted in a case of Ku-nakha (bad nail). 6-7.

Treatment of Vidáriká :—In a case of Vidáriká, the affected part should be first anointed (with oleaginous substances) and then fomented. It should then be rubbed (with the fingers) ; and a plaster composed of Naga-Vrittika, Varshábhu and Vilva-roots, well pasted together, should be applied to it. Purifying and disinfecting (Sams'odhana) remedies should be employed as soon as the affected part would be found to have been changed into the state of an ulcer (Vrana), and it should then be healed up with the application of an oil cooked with the decoction of (the drugs of the Kasháya (Nyagrodhádi) and Madhura (Kákolyádi) groups. In the non-suppurated stage of Vidáriká, the vitiated blood therein should be let out by means of Prachchhána (scarification), or by applying leeches. The affected part should then be plastered with

• Vrinda and Chakradatta prescribe fomentation (Sveda), and not washing, with hot water and they do not prescribe secretion (Visráva).

the roots of the Aja-karṇa and of the Palāsa pasted together. A case of fully suppurated Vidārikā should be lanced and plastered with a paste compound of Patola, Pichumarda and sesamum, mixed with clarified butter and should then be duly bandaged. The incidental ulcer should then be washed with a decoction (of the barks of the Kshiri trees and Khadira. Healing remedies should be applied after it has been properly purified (disinfected). 8-9.

Treatment of Sarkarārvuda, etc.:—A case of Sarkarārvuda should be treated like that of an Arvuda (tumour) of the fat-origined type. Cases of Kachchhu, Vicharchikā and Pāmā should be treated in the manner of a Kushtha. A medicinal plaster composed of Siktha (wax), S'atāhvā and white mustard seeds, or of Vachā, Dāru-hāridrā and mustard seeds, pasted together, should be applied (to the seat of the disease). As an alternative, Naktamālā (Karanja) oil, or Sāra-taila * boiled with (the drugs of) the Katuka (Pippalyādi) group should be applied for anointing purposes. 10-11.

Treatment of Pāda-dāri :—In a case of Pāda-dāri, the prescribed vein should be opened, and the affected part should be treated with fomentations and unguents.† The affected part should be plastered with (an ointment composed of) wax, lard, marrow, powder of Sarja (resin),‡ clarified butter, Yava-Kshāra and Gairika. 12.

• By "Sāra-taila" is meant the oil pressed from the Sāra (essential parts) of S'ims'apa, Aguru, Sarala, Deva-dāru and such other trees. Some, however, read "Sarala-taila" in place of "Sāra-taila."—Dallana.

† According to Dallana and S'ivadāsa, fomentations and unguents should be first applied, and the vein should be next opened.

‡ Chakradatta also prescribes a similar remedy, but there he does not read "Sarja" and "Gairika."—Ed.

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454 THE SUSHRUTA SAMHITA.

ting* from the affected part should be first resorted to in a case of Arumshikā; and it should then be affused with the decoction of Nimba. Medicinal plasters prepared with the Risa (liquid) pressed from horse-dung, mixed with Saindhava, should be applied to it. As an alternative, it should be plastered with the paste compound (Kalka) of Haritāla. Haridrā. Nimba and Patola, or with that of Yasthi-madhu, Nilotpala, Eranda, and Markava.

Treatment of Dárunaka, etc.:

Anoint- ment and fomentation of the diseased patches are the (pre- liminary) remedies in a case of Dárunaka, after which bleeding should be effected by opening the vein in the forehead. Remedial measures such as, Avapida-Sirovasti and Abhyanga (anointment) should be employed as well ; and the affected parts should be washed with the alkaline solution of burnt Kodrava weeds. Measures for arresting the premature greyness of hair (Palitā) will be described later on (in the Mis'raka Chapter XXV). Curative plasters and remedies, etc., mentioned in connection with the treatment of Kushta should be employed in cases of Masurikā; or those, laid down under the treatment of Erysipelas (Visarpa) originated through the concerted action of the deranged Pitta and Kapha should as well be used.

Treatment of Jatu-mani, etc.:

The seats of affection should be scraped (with a knife) and gradually and judiciously cauterised† by applying an alkali or fire in cases of Jatu- mani (congenital moles), Mas'aka and Tila-kālaka

• According to Chakradatta blood-letting should be resorted to in such cases only by means of venesection, or with leeches.

† The cauterisation should be effected with an alkuli, when the disease is superficial and with fire when it is deep-seated.

Chap. XX. CHIKITSA STHANAM.

(freckles). An opening of the local veins in the temporal region, etc., should be effected in cases of Nyachchha, Vyanga and Nilika, in accordance with the prescribed rules. The affected parts should be rubbed (with Sanludra-phena, etc.) and plastered with the barks of Kshiri trees,pasted with milk ; or with Valá, Ati-valá, Yashti-madhu and Rajani, pasted together. As an alternative, plasters composed of Payasyá, Aguru and Kálíya pasted together with Gairika, or of a tooth of a boar pasted with clarified butter and honey, or of Kapittha and Rijádana pasted together, may also be used with benefit 20 21.

Treatment of Yuvána-Pidáká, etc.:

Emetics are specially efficacious in cases of Yuvána-pidaká (pimples) which disfigure the face in youth. The application of medicinal plasters composed of Vachá, Lodhra, Saindhava and (white mustard seeds or of Kustumbaru, Vachá, Lodhra and Kushtha pasted together is also recommended. In a case of Padmini-Kantaka, a decoction of Nimba bark should be given as an emetic, and the patient should be made to drink a potion of clarified butter cooked with a decoction of Nimba and mixed with honey. A decoction * of Nimba and Áragvadha should be used for chafing (Utsádana) the diseased locality. 22-23.

Treatment of Parivartiká, etc.:

In a case of Parivartiká (retroflexion of the prepuce) the glans penis should be rubbed with clarified butter and duly fomented, and Sálvana and such other Váyu-subduing plasters.(Upanáha) should be applied for three * Chakrapáni prescribes the powders (चूर्ण) in place of the decoction (काथ) of Nimba and Áragvadha. He also reads "उत्सादन" in place of "उखादन", but here they mean the same thing.—Ed.

THE SUSHRUTA SAMHITA

Treatment of Niruddha-Prakas'a

In a case of Niruddha-Prakaśa

(constriction or stricture of the urethra), a tube (open at both ends) made of iron, wood, or shellac should be lubricated with clarified butter and gently introduced into the urethra.

The marrow or lard of a boar, or of a porpoise, or the Chakra-taila, mixed with Váyu-subduing drugs should be sprinkled over the affected part.

Thicker and thicker tubes should be duly introduced into the urethra every third day.

The passage should be made to dilate in the aforesaid manner, and emollient food should be given to the patient.

As an alternative, an incision should be made (into the lower part of the penis), avoiding the sevani (raphe of the perineum), and it should be treated as an incidental ulcer (Sadyo-vrana).

26

Treatment of Sanniruddha-Guda, etc.

Cases of Sanniruddha-Guda (stricture of the anus)

Valmika and Agni-Rohini should be duly treated with regard to the nature and intensity (of the Doshas engendering the disease), but without holding out any definite hope of recovery.

The treatment of a case of Agni-Rohini should be like that of Visarpa (Erysipelas), while the remedial measures, mentioned in connection

Chap. XX.] CHIKITSA STHANAM.

457

tion with Niruddha-prakas'a, should be employed in a case of Sanniruddha-Guda.

Treatment of Valmika :--The diseased patches should be scraped off in a case of Valmika and cauterised with fire or with an alkali ; while the purification and healing up (of the incidental ulcer) should be effected as in the treatment of an Arvuda (tumour).

A case of Valmika appearing in any part of the body other than a Marma, and not of a considerable growth should be duly treated with venesection after the application of Samśodhana measures (purgative, emetic, etc.).

The affected part should be plastered (Pralepa) with a medicinal compound composed of the roots of (Vana-) Kulattha, Arevata, Danti and Syámá, pasted together with Guduchi, rock-salt, Palala (pastes of sesamum) and powdered barley.

It should be poulticed (Upanáha) with the same compound, well mixed with clarified butter and made lukewarm (in case suppuration be desired).

When found to be fully suppurated, the course of the pus-channels should be ascertained by an experienced surgeon.

The ulcer should then be opened (with a knife) and cauterised, and after being fully purified of the putrid flesh (in its cavity), it should be again cauterised with an alkali.

Healing (Ropana) remedies should be applied to it after it has been found to be thoroughly cleansed.

Nimba-oil cooked with Sumanas (Játi leaves, Granthi, Bhallátaka, Manahśilá, Káśmusdri, small Ela, Aguru and red Chandana should be applied with advantage to heal up the incidental ulcer in a case of) Valmika.

A patient suffering from an attack of Valmika appearing either on his hands or feet and attended with swelling and a large number of cavities should be abandoned by a wise physician.

58

THE SUSHRUTÁ SAMHITÁ

Treatment of Ahi-putaná, etc.:-In the treatment of an infant laid up with an attack of Ahi putaná the breast-milk of its mother or nurse should be first purified. Cases of Ahi-putaná yield to the use of a potion of clarified butter, cooked with Triphalá, Rasán-jana and Patola leaves, and a decoction of Triphalá, Kola and Khadira should be used (as a wash) to heal the ulcer. Plasters composed of sulphate of iron, Goro-chandá, sulphate of copper (Tuttha), Haritála and Rasán-jana, pasted together with Kánjika, or of Vadari bark and rock-salt, should be applied (to the diseased locality). It should be dusted as well with the pulverised compound of a burnt earthen pot and sulphate of copper. The preceding measures should be adopted in cases of Vrishana-Kachchhu as well.

Treatment of Guda-Bhramśa : - In a case of Guda-Bhramśa, the protruded part should be fomented and lubricated with Sneha.* It should then be gently re-introduced. The region of the anus should then be bandaged with a piece of hide in the manner of a Gophaná Bandha, with an opening in it (lying immediately below the anus), so that it may not in any way interfere with the emission of Váyu. The affected part should then be constantly fomented. A quantity of milk, Mahd-pancha-mula and the body (flesh) of a mouse, bereft of its entrails should be first boiled together (with water). An oil cooked with the milk thus prepared (with water) and the Váyu-subduing drugs should be administered as drink and unguents. By these measures the most difficult cases of prolapsus ani would be cured.

• According to S'iva-dása, cow's fat only should be used. Thus ends the twentieth Chapter of the Chikitsita Sthánam in the Sus'ruta Sambitá which deals with the treatment of minor ailments.

CHAPTER XXI.

Now we shall discourse on the medical treatment of the Sores on the penis produced by the Śuka, a kind of poisonous insect (Śuka-Roga). i. Treatment of Sarshapi, etc. :-In a case of the Sarshapi type of the disease, the affected (ulcerated) part should be scarified and dusted with the (powdered) drugs of an astringent taste (as described in the Miśraka chapter), and an oil, cooked with (the Kalka and decoction of) the same drugs, should be applied for healing purposes. In a case of the Ashthilika type of the disease, the skilful physician should apply leeches to the seat of affection. In case the swelling does not still subside, it should be removed and treated as a Kaphaja Granthi (glandular swelling). A Granthi type of the disease should be constantly fomented in the manner of Nādi-Sveda, and should be poulticed with a lukewarm medicinal compound mixed with a profuse quantity of Sneha (oil). 2-4.

Treatment of Kumbhika, etc. :-An incision should be made into the suppurated seat of affection in a case of the Kumbhika type of the disease, and the incidental ulcer should be purified (disinfected) and healed up with the application of the oil, cooked with Triphald, Lodhra, Tinduka and Amrdatka.* In the Alaji type of the disease, the affected part should be bled by applying leeches to it and should then be affused with a decoction of the astringent drugs. An

• Siva-dása in his commentary on Chakra-datta quotes this couplet from Sus'ruta, but there he reads मार्ज्जार्तेन in place of मार्षातकैः; that is to say, he says that Amra should be used in place of Amrátaka. He further adds that the stones of Amra and Tinduka fruits should be taken,

THE SUSHRUTA SAMHITA

Treatment of Mridita, etc. :-In the Mridita type of the disease, the affected part should be affused with tepid Vala oil and poulticed, with a lukewarm plaster (Upanáha) of the drugs of the Madhura (Kákolyádi) group, pasted and mixed with clarified butter. Leeches should be speedily applied to the condylomatous growths (Pidaká) in a case of Sammudha-Pidaká. In cases of suppuration, they should be opened and plastered with honey and clarified butter. In a case of Avamantha, the growths (Pidaká) should be opened, when suppurated, and healed up with the application of an oil, cooked with Dhava, As'va-Karna, Pattanga, S'allaki and Tinduka.

THE SUSHRUTA SAMHITA

Treatment of Pushkariká, etc. :-In a case of Pushk iriká, all kinds of cooling measures should be applied and the vitiated blood should be extracted by applying leeches. The affected part should be subsequently affused with clarified butter. In a case of the Sparsa-háni type of the disease, blood should be let out and plasters (Pradeha) of Madhura (Kákolyádi) drugs should be applied. The affected part should be affused with a very cold compound of milk, clarified butter and the expressed juice of sugar cane. In the type of the disease known as Uttamá, the Pidakás 'condylomatous growths) should be removed with the help of a Vadisa instrument, and powders of astringent drugs with honey should be applied to the seat of affection.

THE SUSHRUTA SAMHITA

Treatment of Sáta-ponaka, etc.:-In a case of the Sáta-ponaka type of the disease, the affected part should be scarified and the measures laid down in connection with Raṣa-Kriyá should be resorted to,

After this, an oil, cooked with the Prithak-parnyddi drugs* should be likewise applied to the seat of the disease.' The medicinal treatment, in a case of Tvak-páka, should be the same as described in connection with Erysipelas (Visarpa). The remedial measures, laid down under the head of Rakta-vidradhi, should be employed in a case of the Sonitárvuda type of the disease.

General Treatment :-Remedies such as medicinal decoctions, pastes (Kalka), medicated clarified butter, powders, Rasa-Kriyá, etc., and the measures for purifying and healing (incidental sores or ulcers'), should be employed with due consideration to the nature and intensity of the aggravated Doshas involved in the case. The application of specifically prepared medicated clarified butter, purgatives, blood-letting and light diet should be similarly prescribed.†

Prognosis :-The medical treatment of the patient affected with any of the following types of the disease, viz., Arvuda, Mámsa-páka, Vidradhi and Tila-Kálaka should be undertaken without holding out any definite prospect of recovery.

Thus ends the twenty-first Chapter of the Chikitsita Sthánam in the Sus'ruta Samhitá which deals with the treatment of S'uka-Roga.

• For Rasa-kriyá and the Prithak-parnyádi drugs, see Chapter XXXVI—Sutra-sthána.

† This seems to be the general treatment of all the types of S'uka-Roga.

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sisting of Trikatu, Sarjikā-kshāra, Yavā-Kshāra and Vid-lavana (black-salt)* pounded together and made into a thin paste with the admixture of honey.

Treatment of Medoja Oshtha-kopa : -In a case of the fatty type of Oshtha-kopa, the affected part should be fomented and opened (when suppurated) ; and should then be purified and cauterised with fire.

A paste compound of Priyangu, Triphalā, Lodhra and honey should be rubbed over the affected part (Prati-sārana).

These are the remedies for the curable types of Oshtha-kopa.

7-8.

Treatment of the Diseases of Danta Mula : -Now we shall describe the treatment of the affection of the roots of the teeth (Gingivitis).

In a case of the Sitāda type of the disease, the gums should be first bled and a decoction of Sarshapa, Nāgara, Triphalā and Musta† mixed with Rasānjana should then be used as gargles.

The gums should be plastered (Pralepa) with Priyangu, Musta and Triphalā and (clarified butter, cooked with) the decoction of Triphalā, Madhuka, Utpala and Padmaka should be used as an errhine.

In an acute case of Danta-Pupputaka, the gums should be first bled and then rubbed (Prati-sārana) with the five officinal kinds of salt and Yava-Kshāra mixed with honey.

The use of errhines (Siro-virechana), medicated snuffs (Nasya) and demulcent food is recommended.

9-10.

Treatment of Danta-Veshta, etc. :-In a case of Danta-Veshta, the swelling should be first bled and then rubbed with a pulverised compound of Rodhra, Pattanga, Yashti-madhu and Lākshā mixed with a profuse quantity of honey.

• Vrinda and Chakrapáni do not read Vid-lavana.

† Vrinda and Chakra-datta do not read Musta, nor Rasānjana.

THE SUSHRUTA SAMHITA

464

THE SUSHRUTA SAMHITA

THE SUSHRUTA SAMHITA

THE SUSHRUTA SAMHITA

CHIKITSA STHANAM

Treatment of Danta-Vaidarbha, etc.

-In a case of Danta-Vaidarbha, the regions about the roots of the teeth should be cleansed by opening them with a (Mandalágra) instrument and subsequently treated with alkaline applications. Cooling measures should also be resorted to (during the treatment of this disease). In a case of Adhika-danta, the additional tooth should be uprooted and removed; then (in order to arrest the bleeding, if any), the part should be cauterised with fire, and then an experienced physician should apply the remedies mentioned under the head of worm-eaten teeth (Krimi-dantaka).

15-16.

Treatment of Adhi-mámsa :-In a case of Adhi-mámsa, the additional fleshy growth about the roots of a tooth should be removed (with a knife) and treated with a compound of Vachá, Tejovati, Páthá, Sarjiká and Yava-kshára, pasted together with honey. Powdered Pippali, mixed with honey, should be used as a gurgle (Kavala); and a decoction of Patola, Triphalá and Nimba for washing the affected part. Errhines (Siro-virechana) and inhalation of Vairechana smoke, (that lead to the secretion of mucus from the head), would likewise prove efficacious in such cases.

Treatment of Danta-Nádi : -In a case of Danta-Nadi, the treatment of Nádi (Sinus) about the teeth is identical with that of sinus in general. The specific remedial measure, however. is that the gum of the affected tooth should be incised, and the tooth should be extracted, if it be not in the upper jaw. The affected part should then be purified and cauterised with an alkali or fire. Hence in a case of Sinus (Nádi), a com-

466 THE SUSHRUTA SAMHITA.

plete extraction of any fragment of the broken bone, or tooth, is essentially necessary (for its cure), inasmuch as, if left unextracted, it may cause the sinus to affect (run below) the jaw-bone. If the affected tooth be in the upper jaw, and if it be found to be nirm and steady at its roots, though attended with tooth-ache,* it should not be extracted, inasmuch as it might produce an excessive hæmorrhage from its roots, and usher in blindness, facial paralysis, or other dangerous affections (such as convulsion, etc.) due to the excessive loss of blood. Hence in the case of a looseness of such a tooth in the upper jaw, it should not be extracted. A decoction † of Jâti, Madana, Svâdu-Kantaka and Khadira should be used to wash the mouth. An oil cooked with Jâti, Madana. Katuka, Svadu-Kantaka, Yashti-madhu, Rodhra, Manjishthá and Khadira should be used to cleanse and heal a sinus invading the roots of a tooth. The remedial measures to be employed in the diseases affecting the roots of the teeth have thus been described above.

• Both Vrinda and Chakradatta quote this passage from the text, but both of them read "मूलात्‌ समूलसिच्चते" (excessive bleeding takes place) in place of "समूले स्थिरवत्तने" (if it be found to be firm and steady at its roots, though attended with tooth-ache). S'ri-kantha Datta, again, in his commentary quotes another reading "समूलेऽस्थिरवत्तने" (if it be loose in its sockets and be extracted with its roots). In our humble opinion, however, the current reading of the text seems to be the correct one, inasmuch as both the readings quoted above seem to be redundant in the presence of the two following sentences "दृढातियोगात्......" and "चलमप्युत्पतन् हन्‍...".—Ed.

• Both Vrinda and Chakradatta quote this passage from the text, but both of them read "मूलात्‌ समूलसिच्चते" (excessive bleeding takes place) in place of "समूले स्थिरवत्तने" (if it be found to be firm and steady at its roots, though attended with tooth-ache). S'ri-kantha Datta, again, in his commentary quotes another reading "समूलेऽस्थिरवत्तने" (if it be loose in its sockets and be extracted with its roots). In our humble opinion, however, the current reading of the text seems to be the correct one, inasmuch as both the readings quoted above seem to be redundant in the presence of the two following sentences "दृढातियोगात्......" and "चलमप्युत्पतन् हन्‍...".—Ed.

† According to S'rikantha and S'ivadása, it appears that the application of this decoction as a wash is not to be found in all editions of the Sus'ruta Sambitá, but they say that it is found only in Jejjata's reading. Jeijjatá's reading and explanation seem to be correct and have been followed by us in the translation.—Ed.

† According to S'rikantha and S'ivadása, it appears that the application of this decoction as a wash is not to be found in all editions of the Sus'ruta Sambitá, but they say that it is found only in Jejjata's reading. Jeijjatá's reading and explanation seem to be correct and have been followed by us in the translation.—Ed.

Chap. XXII.] CHIKITSA STHANAM. 467

We shall now proceed to describe the medicinal remedies to be employed in the diseases which confine them- selves exclusively to the teeth. 18-21.

Treatment of the diseases of Tooth proper :- A case of Danta-harsha yields to the use of any lukewarm Sneha,* or the Traivrita-ghrita (mentioned in Chapter V), or of the decoction of the Váyu-subduing drugs as gurgles (Kavala). An applica- tion of Snaihika Dhuma (emulsive fumes) and the use of snuff (Nasya), emulsive articles of food, meat soups, gruel prepared with meat (Rasa-Yavágu), milk, milk- cream, clarified butter, Siro-vasti and the other Váyu- subduing measures generally prove efficacious. 22.

In a case of Danta Sarkará (Tartar-calcareous deposits on the teeth), the deposit should be removed in such a way as not to hurt the roots of the tooth, after which the part should be dusted (Prati-sárana) with powdered Lákshá with honey. All the remedies men- tioned in connection with the treatment of Danta- harsha may as well be employed in this disease. 23.

Treatment of Kapáliká, etc. :- These remedies are also efficacious in a case of Kapáliká (caries of the tooth) which is extremely hard to cure. In a case of Krimi-Danta (worm-eaten tooth) found to be firm and unloosened (in its socket), the affected tooth should be fomented, and the accumulation (i. e., the pus, blood, etc.) should be removed. It should then be treated with some Váyu-subduing errhines of the Ava-pida form and with emollient gurgles (Gandusha), as well as with plasters, prepared with Varshábhu and the drugs of the Bhadra-Dárvadi group and with a diet of emulsive articles of food. In the case, however, where

• All the four kinds of Sneha should be used separately or cembinedly.

the tooth is found to be loose (in the socket', the loose tooth should be extracted, and the cavity cauterised with fire or an alkali (for the purpose of arresting the bleeding). An oil cooked with the pastes (Kalka) of Vidâri, Yashti-madhu, S'ringâtaka, and Kas'eruka and with ten times its own weight of milk should be administered as an errhine (in such cases). The course of treatment in a case of Hanu-moksha is the same as in one of facial paralysis.

24-27.

A person suffering from any affection of the teeth should refrain from taking acid fruits, cold water, dry (Ruksha) food, excessively hard articles of food and from brushing his teeth (with a twig). The treatment of the curable types of tooth-diseases has been thus described above, we shall now (proceed to) describe the treatment of the curable types of tongue-diseases.

28 29.

Treatment of Tongue-diseases :-In the Vâtaja type of Jihvâ-kantaka (Papilla), the treatment should be the same as in the case of Vátaja Oshtha-kopa. In the Pittaja type (of Jihvá kantaka), the vitiated blood should be made to secrete from the affected organ by rubbing it with any article of rough surface (such as the leaves of S'dkhotaka, etc.), and the drugs of the Madhura (Kákolyádi) group should be used for gurgles and errhines, as well as for being.rubbed over (Prati-sárana) the affected organ.

In the Kaphaja type (of Jihvá-kantaka), the organ should be bled by scarifying it (with a Mandala patra and such other instrument) ; it should then be rubbed with the powders of the drugs of the Pippalyddi group mixed with honey. A compound of powdered white mustard-seed and Saindhava should be administered as gurgles (Kavala), and the patient should be made to take his food with the soup of Patola, Nimba,

and Vartaku mixed with (a liberal quantity of) Yava-Kshara 30.

Treatment of Upa-Jihva :-In a case of Upa-jihva (Ranula), the affected part shoul be scarified and rubbed with an alkali, and the patient should be treated with errhines (Siro-vireka), gurgles (Gandusha) and inhalations of smokes (Dhuma). The treatment of the tongue diseases has been thus described above. We shall now describe the medical treatment of the affections of the palate (Talu-gata Roga).

31-32. Treatment of the Talu-gata diseases:-In a case of Gala-sundika, the Sundika (protuberance) should be drawn out along the tongue with the help of the thumb and the second finger of the hand, or with a Samdamsa (forceps) and then cut off with a Mandalagra instrument. But it should be severed neither more nor less than three-quarters of the appendage, inasmuch as profuse haemorrhage might follow an excessive incision,and death might result therefrom ; whereas, a case of lesser severance is usually found to be attended with swelling, excessive salivation, somnolence,* vertigo, darkness of vision, etc.

Hence a surgeon, well-versed in the science of surgery and well-skilled in practical operations, should carefully operate a Gala-sundika (with a knife) and subsequently adopt the following measures. The incidental ulcer should be treated with the pulverised compound of Maricha, Ati-visha, Patha, Vacha, Kushtha and Kutannata, mixed with honey and rock-salt. A decoction of Vacha, Ati-visha, Patha, Rasna, Katuka-rohini and Pichu-marda should be used as gurgle (Kavala).

The five drugs, viz.,

• S'rikantha Datta, in his commentary on Vrinda's compilation, quotes this passage from the text, but does not include "somnolence" therein. He reads "काष्ठास्वापो भवस्ततः" in place of "काष्ठा निद्रा भवस्ततः".

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rubbed with salts. Gurgles (Gandusha) of tepid Sneha (oil, clarified butter, etc.) should be constantly resorted to. In cases of the Pittaja Rohini, the powdered Pattanga, honey and sugar should be rubbed (Prati-sárana) over (the affected part), and the decoctions* of Drákshá and of Parushaka, should be used as gurgles (Kavala). In the Kaphaja type of Rohini, the affected part should be rubbed with Katuka and Agára-dhuma (soot of a house-chimney-soot). An oil properly cooked with S'vetá Vidanga, Danti and Saindhava should be employed as (Nasya) and employed as gurgles (Kavala). In a case of Raktaja Rohini, a physician shall employ the same measures of treatment as in the Pittaja type of the disease.

Treatment of Kantha-Śáluka, etc.: —In a case of Kantha-Śaluka, it should be bled and treated as a case of Tundikeri, and the patient should be enjoined to take a single meal in the day consisting only of a small quantity of Yavánna (barley-rice) with clarified butter. The treatment of a case of Adhi-jihviká should be the same as that of Upa-jihviká. In a case of Eka-vrinda, blood-letting of the affected part should be resorted to (by the application of leeches), and Śodhana† (purifying) remedies should be employed. The medical treatment of a case of Giláyu (Śiláyu.-D.R.) consists of a surgical operation (on the seat of the disease). Incision should be made into a

37

• According to Chakra-páni, Drákshá and Parushaka should be combinedly used in preparing the decoction. † The "purifying remedies" here means S'iro-virechana, fumigation, plasters and applications of alkali, etc., for purifying the Doshas in the throat.

Gala-Vidradhi (throat-abscess) in its suppurated stage and appearing at a part other than a Marma (vulnerable part). 38-42. Treatment of Sarva-sara Mukha-Roga :-The affected part should be rubbed with powdered salts* in a case of Sarva-sara Mukha-roga (invading the entire cavity of the mouth) due to the aggravated Vayu. Oil cooked with the (decoction and the pastes of) Vayu-subduing drugs (such as, the Bhadra-darvaadi group, etc.) and used as errhines (Nasya) and gurgles (Kavala) is efficacious in this disease. After the application of this oil, the patient should be treated with the Snaihika form of fumigation (Dhuma) in the following manner. Tuntuka leaves smeared with honey should be plastered with a compound of the Sara of S'ala, Piyala and castor wood, the marrow of Ingudi and Madhuka, Guggulu, Dhyamaka (Gandha-trina), Mamsi, Kadanu-srivad, S'ri (Lavanga), Sarja-rasa, S'alileya and wax pounded together and mixed with an adequate quantity of clarified butter or oil. It should then be burnt, and the patient made to inhale the fumes. This medicinal fumigation (Dhuma) proves remedial in the disease. It destroys the deranged Vayu and Kapha, and proves curative in all affections of the mouth. In the Pittaja type of the Sarva-sara Mukha-roga, all the morbific principles (Doshas) should be eliminated from the patient's body (with emetics and purgatives),

472

• Dallana and Nis'chala explain the term "पञ्चलवणकः" as the powders of the five officinal kinds of salt. S'iva-dasa, however, holds that powdered Saindhava salt only should be used. Vrinda reads " चूर्णौषधम् " and the commentator S'ri-kantha Datta explains it to mean either the powders of "लवणा", i.e., Jyotishmati or those of "लवण", i.e., the five officinal kinds of salt.—Ed.

and all kinds of sweet, soothing and Pitta-subduing drugs should be administered. Medicated gurgles (Gandusha), fumigation (Dhuma), Pratisárana (rubbings) and purifying (S'odhana) measures as well as the Kapha-subduing remedies should be employed in the Kaphaja type of the Sarva-sara-Mukha-roga, and the patient should be made to take one Dharana measure (Twenty-four Ratis) of powdered Ati-vishá Páthá, Musta, Deva-ddru, Katuka and Kutaja seeds, with an adequate quantity of cow's urine. This medicine acts as a potent remedy for all the Kaphaja disorders of the body. Gurgles (Kavala) with milk, sugarcane juice, cow's urine, curd-cream, Kánjika, oil or clarified butter (Sneha) should be prescribed according to the nature of the aggravated Doshas involved in each case (of the Sarva-sara-Mukha-roga). We have described above the medical treatment of the affections of mouth which yield to medical remedies.

43-45.

Incurable Types :– Now we shall enumerate the different incurable types of mouth-diseases. Of the types of Osht.ha-páka, those due to the vitiated condition of the flesh, or of blood, and those due to the concerted action of the aggravated Doshas (Sannipáta) should be deemed as incurable. Of the diseases peculiar to the roots of the teeth, the affections known as the Sannipátika Dantba-nádi (Sinus in the gums) and the Sannipátika Saushira (Mahá-Saushira) should be also deemed as incurable. Of the affections of the teeth, those known as the Syáva-dantaka, Dálana and Bhanjana, and of the diseases which restrict themselves to the tongue, the one known as the Alása should be looked upon as incurable. Similarly of the affections of the palate, the Arvuda should be deemed as incurable. Of those of the throat, the Svar

60

ghna, Valaya, Brinda, Bala'ssa, Bid'srika, Galangha, Mamsa-tana, Sataghni and Rohini should be regarded as beyond the pale of medicine. The nineteen kinds of the disease mentioned above are incurable, and the medical treatment of these diseases should be taken in hand without holding out any definite hope of recovery.

46 - 49

Thus ends the Twenty-second Chapter of the Chikitsita-Sthánam in the Sus'ruta Samhitá which deals with the medical treatment of the diseases of the mouth.

CHAPTER XXIII.

Now we shall discourse on the (symptoms and) medical treatment of swellings (Śopha).

The six kinds of swelling (Śopha) appearing in the particular parts of the body have already been described* with the variations in their symptoms and the medical treatment to be pursued in each case. But the swelling known as the Sarva-sara Śopha (general Anasarca) may be divided into five subheads. They are as follows, namely, the Vātaja, Pittaja, Kapahja San-nipātaja and Vişaja (i.e., the one due to the introduction of any extraneous poison into the system).

Their causes :-The Doshas (morbific principles) become aggravated and give rise to swellings (Śopha) of the body, by such causes, as by undertaking a journey immediately after a meal, or by the use of Harita-sākas (potherbs, cakes and salts in inordinate quantities, or by the excessive use of acids by weak and emaciated persons, or by the use of clay, baked or unbaked, of lime-stones, or of the flesh of aquatic animals, or of those frequenting swampy places, excessive sexual intercourse, use of fares consisting of incompatible articles and lastly by the joltings when riding on elephants, horses, camels, in vehicles, etc., or on persons on the part of dyspeptic patients.

Specific Symptoms :-A swelling (Śopha) of the Vātajá type is vermilion or black-coloured and is attended with softness and a pricking pain in the swelling which disappears at intervals. A swelling of the Pittaja type assumes a blood-red or yellow colour, swiftly expands and is attended with a burning and

• See Sutra-sthāna, Chapter XVII.

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CHAPTER XXIV.

Now we shall discourse on the rules of hygiene and the prophylactic measures in general (Anágatávádha-Prati-shedhaníya).

Metrical Texts :-Now we shall describe the rules of conduct to be daily observed by an intelligent man (after leaving his bed) seeking perfect health and a sound body.

Tooth-brushing :-A man should leave his bed early in the morning and brush his teeth.

The tooth-brush (Danta-Káshta) should be made of a fresh twig of a tree or a plant grown on a commendable tract and it should be straight, not worm-eaten, devoid of any knot or at most with one knot only (on one side), and should be twelve fingers in length and like the small finger in girth.

The potency and taste of the twig (tooth-brush) should be determined by or vary according to the season of the year and the preponderance of any particular Dosha in the physical temperament of its user.*

The twig of a plant possessed of any of the four tastes as sweet, bitter, astringent and pungent should be alone collected and used.

Nimba is the best of all the bitter trees ; Khadira of the astringent ones ; Madhuka of the sweet ; and Karanja of the pungent ones.

• A man of a Kaphaja temperament should use a twig of a plant possessed of a pungent taste (Tikta) in brushing his teeth.

A man of a Pittaja temperament should brush his teeth with a twig possessed of a sweet taste (Madhura), while a man of a Vátika temperament (nervous) should use that with an astringent (Kasáya) taste.

This rule should be observed even in respect of the preponderant Doshas of the body, in a disease.

The teeth should be daily cleansed with (a compound consisting of) honey, powdered Tri-katu, Tri-varga*, Tejovati, Saindhava and oil Each tooth should be separately cleansed with the preceding cleansing paste applied on (the top of the twig bitten into the form of) a soft brush, and care should be taken not to hurt the gum anywise during the rubbing. This tends to cleanse and remove the bad smell (from the mouth) and the uncleanliness (of the teeth) as well as to subdue the Kapha (of the body). It cleanses the mouth and also produces a good relish for food and a cheerfulness of mind†. 4.

Cases where tooth-brushing is forbidden:- Tooth-brushing is forbidden to the persons suffering from affections of the teeth, lips, throat, palate, or tongue, or from stomatitis, cough, asthma, hiccough and vomiting, weakness, indigestion, epilepsy, head-disease, thirst, fatigue, alcoholism, facial paralysis, car-ache, and to persons tired with over-drinking. 5.

• The term "Tri-varga" generally means Tri-katu, Tri-phala and Tri-mada. Dallana explains it as meaning Tri-sugandhi, i.e., Tvak, Ela and Patra.—Ed.

† Additional Texts :-It brings on a relish for food, imparts a cleanliness, lightness and sense of freedom to the teeth, tongue, lips and palate. It protects the mouth, throat, palate, lips and tongue from being affected by any disease. It arrests salivation, imparts an agreeable aroma to the mouth and relieves nausea and water-brush. It strengthens the religious inclination and gives a lightness to the organs. Hence one should every day use the tooth-twig, but its use is prohibited in respect of persons suffering from diseases of the palate, lips or tongue as well as from Mukha-paka (stomatitis), dyspnoea, hiccough, parchedness of the mouth and nausea. The last two lines of the additional text, however, occur in the text in a slightly different form. See the next two lines of the text.

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the blasts of the wind and the glare of the sun and guards against the inroads of occular affections. Hence the application of collyrium (along the eye-lids) is highly recommened ; but its use is forbidden just after taking one's meal or bath (washing the head) and after the fatigue of vomiting, or riding, etc., nor after keeping late hours and also not during an attack of fever. 9-11.

A betel-leaf prepared with cloves. camphor, nutmeg (Játi), lime, araca-nut, Kakkola and Katukdhva (Lata-kasturi), etc., should be taken (chewed after meals), as it tends to cleanse the mouth, impart a sweet aroma to it, enhance its beauty and cleanse and strengthen the voice, the tongue, the teeth, the jaws and the sense-organs. It checks excessive salivation, soothes the body (Hridya), and acts as a general safeguard against throat discase. A betel-leaf (prepared as before) proves wholesome after a bath, after meals, after anointing as well as after rising from sleep.

A person suffering from Rakta-Pitta, Kshata-Kshina, thirst, or parchedness of the mouth should refrain from taking betel-leaf, the use of which is equally forbidden in such discases as anæmia, internal dryness of the organism and epilepsy. 12.

Sirobhyanga :--Anointing (Abhyanga) the head with oil is a good cure for the affections of the head. It makes the hair grow luxuriantly, and imparts thickness, softness and a dark gloss to them. It soothes and invigorates the head and the sense-organs and removes the wrinkles of the face. The medicinal oil known as the Chakra-Taila should be cooked with the paste (Kalka) and the decoction of Madhuka, Kshira-s'uklá, Sarala, Deva-dáru and the minor Pancha-mula taken in equal parts (in each case). The head should be constantly anointed with this cooling oil. 13-14.

484 THE SUSHRUTA SAMHITA. [Chap. XXIV.

Combing the hair improves its growth, removes dandriff and dirt, and destroys the parasites of the scalp. Pouring oil (Karna-purana) into the cavities of the ears is highly efficacious in pains of the jaws (Hanu and of the Manyá, and acts as a good cure for head-ache and ear-ache. Anointing (Abhyanga) the body (with oil, etc ) imparts a glossy softness to the skin, guards against the aggravation of the Váyu and the Kapha, improves the colour and strength and gives a tone to the root-principles (Dhátus) of the body.* 15-17. Parisheka :-Affusing the body (Parisheka) removes the sense of fatigue, and brings about the adhesion of broken joints. It alleviates the pain which usually attends burns, scalds, bruises and lacerations, and subdues the actions of the deranged Váyu. Sneha (oil) affused on the human organism imparts a tone and vigour to its root-principles (Dhátus), in the same manner as water furnishes the roots of a tree or a plant with the necessary nutritive elements, and fosters its growth, when poured into the soil where it grows. The use of Sneha (oil, etc.) at a bath causes the Sneha to penetrate into the system through the mouths of the veins (Sirás) and the ducts (Dhamanis) of the body, as also through

• Rubbed on the body and allowed to stand or kept un-wiped, the Sneha (oil) reaches down the skin, through the hair-follicles in the course of time necessary to utter four hundred Mátrás. It reaches the principle of blood in the course of that necessary to utter five hundred Mátrás, and to the principle of flesh in the course of that necessary to utter six hundred Mátrás. It penetrates further to the principle of fat in the course of that necessary to utter seven hundred Mátrás, and to the principle of bone in the course of that necessary to utter eight hundred Mátrás, and lastly to the principle of marrow in the course of that necessary to utter nine hundred Mátrás. It successively cures the diseases respectively located in those principles.-Dallana.

Chap. XXIV. CHIKITSA STHANAM.

the roots of the hair, and thus soothes and invigorates the body with its own essence. 18—20.

Under the circumstances, affusions and anointments of the body with oil or clarified butter should be prescribed by an intelligent person with due regard to one's habit, congeniality and temperament and to the climate and the season of the year as well as to the preponderance of the deranged Dosha or Doshas in one's physical constitution. 21.

Prohibitions of anointments, etc.:-

Anointments of the body simply with (unmedicated) Sneha are strictly forbidden in cases of undigested (Áma) Doshas (as long as the aggravated Doshas of the body continue in an unassimilated or undigested state and in their full virulence and intensity). Anointment should not be resorted to in cases of acute fever and indigestion, nor after the exhibition of emetics and purgatives, nor after an application of a Nirudha-Vasti. Anointment in the first two cases (acute fever and indigestion) serves to make the diseases curable with difficulty and even incurable, while that made on the same day after the application of purgatives, emetics, or a Nirudha-Vasti, tends to impair the digestive capacity, etc. Anointment is similarly prohibited in diseases due to Samtar-pana (repletion, etc). 22—24.

Physical Exercise :- What is (popularly) known as physical exercise is (nothing but) a sense of weariness from bodily labour, and it should be taken every day. After taking physical exercise, the whole body should be shampooed, until it gives rise to a comfortable sensation in the limbs. It makes the body stout and strong, helps the symmetrical growth of the limbs and muscles, improves the complexion and the digestive powers, prevents laziness and

486 THE SUSHRUTA SAMHIT . [Chap. XXIV.

makes the body light and glossy, firm and compact. The power of enduring fatigue and weariness and the variations of temperature, thirst, etc., are the virtues which are invariably found to follow in its train. It leads to an undiseased existence and is the best means of reducing corpulency. The enemics of a man habituated to regular physical exercises, dare not molest him through fear (for his strength—D. R.). Imbecility and senile decay never approach him, and the muscles of his body become firm and steady. Diseases fly from the presence of a person, habituated* to regular physical exercise and (subsequent) shampooing, just as small beasts do on seeing a lion. It makes an aged and deformed man (young and) good-looking. Food consisting of articles incompatible in their potency, and indigested and decomposed food are easily digested in a man who takes regular physical exercise (and cannot produce any bad effect). Regular physical exercise is (particularly) beneficial to a strong man accustomed to the use of emollient food (abounding in proteid matter), in all seasons of the year ; but in the winter and the spring, it is highly (indispensably) necessary for him. A man sceking his own good should take physical exercise every day only to the half extent of his capacity (Valárdha), as otherwise it may prove fatal. That amount of exercise which makes the Prána-Váyu come out through the moutht (i.e., as soon as

• Dallana's reading here evidently is "व्यायामस्विन्नगात्रस्य" in place of "व्यायामस्नुषगात्रस्य" . "This would mean "of one taking so much exercise as produces sweat."

† According to several authorities, the appearance of perspiration on the nose, the axilla, the forehead and in the joints of the hands and the legs and dryness of the mouth are the symptoms which indicate that one has taken Valárdha physical exercise (i.e., to the half extent of his capacity).—Dallana.

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on, the dilation of the orifices of the bodily ducts, and cures itches and Kotha. 29-32.

Bathing :- Bathing removes somnolence, (in-ordinate) bodily heat and a sense of fatigue. It allays thirst and checks itching and perspiration, brings on a fresh relish for food, removes all bodily impurities, clears the sense-organs, gladdens the mind, purifies the blood, increases the appetising power, destroys drowsiness and sin, and increases semen. The sight of a man is invigorated by applying cold water to the head at the time of bathing, while the pouring of warm water on the head tends to injure the cye-sight. In cases of an aggravation of the deranged Váyu and Kapha, the head may be washed with warm water, as a medicine, after a careful consideration of the intensity of the disease. 33-35

Prohibition of Bathing :- Bathing in extremely cold water in winter tends to enrage the bodily Váyu and the Kapha, while bathing in hot water in summer agitates the blood and the Pitta. Bathing is not beneficial in fever, diarrhœa, ear-ache, tympanites, Adhimána, aversion to food and indigestion, and in the disorders or diseases due to the actions of the deranged Váyu. It should not also be taken just after a meal. 36-38.

Anulepana :- Anointing (Anulepana) the body (with scented pastes) removes a sense of fatigue and fœtor and perspiration. It produces a sense of pleasure and improves the Ojas, the strength and the complexion of the body, enhances the beauty and glow of the frame and gives it a lovely appearance. Anulepana is forbidden in those cases in which bathing is prohibited. 39.

The wearing of gems, flowers and clean clothes is beneficial in a variety of ways, as it acts as a good

Chap. XXIV.] CHIKITSA STHANAM.

489

prophylactic against the influences of monsters and malignant spirits, enhances the Ojas and the beauty of the body and keeps the mind in a cheerful mood and proves highly auspicious.

Alepa :-Besmearing (Alepa, the face (with scented pastes, etc.) imparts steadiness to the eyes, brings on a broad and graceful contour of the cheeks and mouth, produces their healthful glow like that of a lotus flower and prevents its disfigurement by pimples, moles and such like growths and eruptions (Vyanga). The use of collyrium (Anjana) furthers the growth of large and beautiful eye lashes, cleanses the eyes by removing the unhealthy secretions, makes the eyes more wide and graceful and also imparts a brilliant lustre to the pupils.

41-42.

Devotion to the gods and Bráhmanas and hospitality towards guests (Atithi) add to one's good name, piety, wealth, progeny and duration of life. Food (Áhára) nourishes and gladdens the heart and directly contributes to one's bodily strength. It improves the memory, appetising power, energy and the natural strength of the mind (Tejas), and increases the Ojas and the duration of one's life.

43-44.

Washing the feet increases the semen (Vrishya), removes the sense of fatigue, gladdens the heart, makes the soles free from all adhering dirt and local diseases, acts as a prophylactic against evil spirits (Rakshoghna) and clears up* the vision. Anointing (Abhyanga) the feet (with oil, etc) brings on sleep. It is refreshing and invigorating to the body and the sight, removes all

• Dallana explains that washing the feet keeps the nerve (Nádi) joining the soles with the eyes cool and thus helps to clear up the vision. There is a custom of frequently washing the feet amongst the Hindus most probably on this account.—Ed.

62

490 THE SUSHRUTA SAMHITA.

The use of shoes is efficacious in curing the diseases of the feet and is conducive to pleasure and verile potency. It acts as a prophylactic against the influences of evil spirits, makes walking easy and pleasant, and improves the Ojas in the body. Walking without shoes is perilous to life and health, and is attended with the danger of impaired vision.

The shaving of hair and the paring of nails lead to the expiation of one's sins, make a man cheerful, tend to appease his fate, increase his energy and impart a lightness to the frame. The putting on of armour (Vánavára) improves one's strength, energy and complexion and gives a lustre to the body. The wearing of a turban (Ushnisha) acts as a protection against wind, dust, sun and light, helps the luxurious growth of hair and tends to improve the purity of the mind.

The use of an umbrella is a protection against rain, wind, dust, dew and sun. It improves one's energy, Ojas, eye-sight and complexion, and is an auspicious thing in itself. The use of a stick (Danda) dispels the fear of dogs, snakes, beasts of prey, (tigers, etc.) and horned animals. It considerably alleviates the toil of a journey, lessens the probability of making a false step and is specially commended to the weak and imbecile. It increases one's energy, strength and patience, makes the mind firm and bold, acts as a proper support and makes one fearless.

Sitting idle (Asyá) gives pleasure. It improves the glow of one's complexion, increases the Kapha and corpulency and makes the body delicate, while an active pedestrian habit (Adhva) is detrimental to the complexion. It reduces the fat and Kapha of the body, and removes

Chap. XXIV.] CHIKITSA STHAÑAM.

the delicateness of the frame. Contrary results (to those produced by sitting idle) are produced by excessive walking which further brings on weakness and emaciation of the body. A gentle walk or stroll, which is not very fatiguing to the body, tends, on the contrary, to improve his memory, strength, digestive capacity (Agni) and the functions of the sense-organs. It increases also the duration of life. 54 57.

Lying down in an easy posture on a soft bed removes the sense of fatigue, pacifies or soothes the bodily Váyu, brings on sleep and lost recollections to the mind, is spermatopoetic and is conducive to the growth of the body ; while lying down in a contrary manner is attended with contrary results. Fanning with Chow:ies (Vála-vyajana) is refreshing and keeps off flies and mosquitoes ; while fanning (with ordinary fans) arrests perspiration, removes the sense of fatigue and fainting fits, and alleviates the burning, scorching and parched sensations. Shampooing (Samvahana) is pleasant, refreshing, soporific, and spermatopoetic (Vrishya). It destroys the bodily Váyu and Kapha, removes the sense of fatigue and is soothing to the blood, skin and the muscles. 58-60.

A strong wind (Praváta) is parchifying in its effect and injurious to the complexion. It destroys the burning sensation (if any) in the body, allays thirst, removes fainting fits and stops perspiration, but (at the same time) produces numbness of the body and destroys the digestive powers ; whereas the contrary results are produced by a gentle wind. The gentle breeze of summer and of autumn should be breathed (as it is attended with beneficial results to the health). A seeker after health and a long life should reside in a chamber, not exposed to strong blasts of wind (Niváta). An

undue exposure to the sun (Átapa) aggravates the Pitta, but increascs the power of digestion. It agitates the blood and begets thirst, perspiration, faintness (sun-stroke), vertigo and a burning sensation in the body attended with a discolouring of the complexion, etc. ; whereas the contrary results are produced by a (cool) shade (Chháyá). A basking in the glare of fire (Agni) remcdics the (wrong) coursing of the Váyu and Kapha, removes cold and shivering, digests the slimy secretions in the channels ; but aggravates the blood and Pitta. A good sleep (Nidrā) enjoyed at the proper time (and for the proper period) tends to improve the growth, strength, vigour and complexion of the body. It increases the power of digestion, removes drowsiness, and restores the natural equilibrium among the different fundamental principles (Dhátus) of the organism.

61 65. General rules of conduct :-The first rule is that one should keep his nails and hair short, always put on clean and white clothes,wear a light turban and a pair of shoes and carry an umbrella and a stick in his hand. One should discourse, when necessary, with another in a sweet and gentle voice and his speech should be laconic and pleasing. He should first accost his elders and acquaintances in cases of meeting before they speak. He should be kind and compassionate to all creatures, and be approved of by his elders and superiors. He should be in full possession of re-sources and in an undisturbed state of the mind. One should not stir out at night nor walk about in the grounds of public exccutions, undulated places, dens and rocks.* He should not go (at night) to where roads cross nor to places covered with heaps of husks, ashes, bones,

• The text has Indra-kila which means a hilly country inhabited by barbarous people.

Chap. XXIV.] CHIKITSĀ STHANAM.

493 hair, stones, baked earth and charcoal, nor to places commonly considered as unholy. 66.

Men should never deride a king, nor use harsh and impolite words to, nor act meanly and treacherously towards him. One should not speak ill of the king, the gods, the Bráhmanas and the Pitris (departed Manes), and he should never use harsh and slanderous words. He should not tell a lie nor associate with king-haters nor with the insane, degraded, mean and narrow-hearted persons. 67.

Climbing up trees, mountains, ant-hills and undulating grounds, etc., and going up to a waterfall as well as riding on a wild and unbroken horse or elephant are strictly prohibited. One should not descend into an unknown tank, den as well as into the sea or into a river at flood times. Old haunted and deserted houses, cremation grounds and solitary forests should be strictly shunned. One should not come into actual contact with fire, wild beasts, snakes and venomous insects. The site infested with wild beasts, snakes, venomous insects, lizards and horned animals as well as where virulent epidemics would be raging should be avoided, nor should the sites of actual affrays and battles be resorted to, nor the scene of a violent conflagration of fire. 68.

Passing between two rows of fire, between cows, elders, Bráhmanas, moving cradles and a married couple is forbidden. One should not (unnecessarily) follow a corpse. Even the shadow of a fallen, degraded and sick person as well as of a cow, Bráhmana, divine image, banner or of a Chaitya (tree growing on a cremation ground) should not be trodden upon. One should not gaze at the rising or the setting sun. One should not report to another the fact of a milch

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Chap XXIV.] CHIKITSA STHANAM.

particularly towards the sun or any luminous body* or towards any extremely attenuated, revolving or moving object. Never carry a load on the head. Sleeping, waking, sitting, lying down, walking, jumping, running fast, plunging in water, swimming, riding on a horse or in a vehicle, talking, laughing, sexual intercourse and taking (any other) physical exercise though accustomed and recommended should not be inordinately indulged in. 73.

A bad habit should be gradually discontinued and a good one even when (beneficial to health) should similarly be gradually inculcated by a quarter only and not all at once. 74.

It is improper to lie down with one's head downward. One should not drink water from a broken vessel nor with the help of blended palms. Food, which is wholesome and approved of by one's physician and which abounds in articles of sweet and emollient properties† should be taken at the proper (and regular) time (every day) in a moderate quantity. It is forbidden to take any food in the house of a trader (i.e., of a hotel-keeper) or a courtesan, nor in the house of a wily, degenerate or inimical person, nor at a village-assembly. The refuse of another's dishes, as well as articles of food infested with flies, insects, etc., or spoiled by an objectionable colour, taste, smell, touch or

• Some explain "Jyotish" as a blaze of fire and others explain it as stars.

† The framers of the Ayurveda were aware of the fact that the human system is incapable of directly assimilating starchy substances without converting them into sugar. This has been emphasised in the Sutra-Sthana, where Sus'ruta insists that a food stuff, in order to be worthy of the epithet, must be Madhura (i.e., of sweet flavour) and contain a large quantity of proteid matter such as is found in milk, butter, meat, etc.—Ed.

sound or those which producean unpleasant impression in the mind, or food of like nature as well as those served (handled) by many persons should not be partaken of (in spite of repeated requests inthat behalf). It is not advisable to sit down to a meal without washing one's hands and feet. One should never take anything by repressing a natural urging for stool and urine, nor sit down to a meal just at the break or the close of day, nor in an unprotected situation (i.e. without any shade, or without somcthing to sit upon). One should not take his meal after the expiry of the (daily) appointed time nor in an insufficient or inordinate quantity, nor partake of food whose Sneha (oleaginous substance) has been removed.

Metrical Text :-It is forbidden to see one's image reflected in water, nor is it advisable to plunge naked into water. Curd should never be taken at night, nor should it be taken (at all) without sugar * or clarified butter, nor without saturating it with Mudga-soup or the admixture of honey, nor without (the expressed juice of) the A'malaka, nor with any hot substance † or article, as otherwise it may bring on Kushtha (cutaneous affections), erysipelas, etc.

76-77.

Exercise, addiction to wine, gambling and music are bad. One should not bear witness to any fact (before a

• Dallana adds that curd should not be taken without an addition of water and salt as well. This is also the practice in general.

† All the existing editions of the Sus'ruta Samhitá read "उष्णेन" (i e., curd should not be taken with any "hot" substance). Here it should be noted that the term "hot" may also include the substances which are heat-making in their potency. Here, however, the reading seems to be incorrect. The lines are found verbatim in the work of Charaka, where he reads "उष्णे," i.e., hot curd should not be taken, since it produces, as he himself tells us later on, an aggravation of the blood and the Pitta.

-Ed.

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502 THE SUSHRUTA SAMHITA. [Chap. XXIV.

sound sleep. Food or milk, saturated with sugar, and meat-juice, prove very refreshing after the act. 89.

CHAPTER XXV.

Now we shall discourse on the medical treatment of a variety of diseases (Misraka-Chikitsita). I.

It has been stated before that blood-letting is the remedy in diseases of the Pāli (ear-lobes). Now hear me describe in detail the treatment of those affections which are confined to the lobes of the ears. They are five in number and are called the Paripota, Utpāta, Unmautha Duhkha-Vardhana and the Parilehi. 2-3.

Causes and Symptoms : -If the lobe of an ear be suddenly pulled and kept in that position for a long time, a numbed and painful swelling of a blackish red colour is produced on the lobe, owing to its soft and delicate nature. This is found to spontaneously burst or crack and is called the Paripota, which should be ascribed to the action of the deranged Vāyu (of the system). 4.

A painful swelling attended with a burning sensation and suppuration, appearing in the lobe of the ear, owing to the friction and movements of a heavy ornament worn in the lobe, is originated from the vitiated condition of the blood and the Pitta. Its colour is either brown or red and is called the Utpāta. 5.

Pulling the ear-lobes down by force tends to enrage the Vāyu (of the localities) which in union with (the deranged) Kapha gives rise to a painful swelling in those regions, attended with itching and tinged with the specific colours* and symptoms of the Doshas involved. The disease is called the Unmantha, and is

• Mādhava in his compilation reads "सममनिदानम्" (that the swelling is attended with a numbness and no pain) in place of "सकृद्वेदनम्." Vāgbhata also supports this. -Ed.

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Chap. XXV.] CHIKITSA STHANAM.

505

Specific Treatment :-Now we shall describe the medical remedies which should be specially used in anointing (the affected parts in these diseases). Drugs, such as Khara-Manjari, Yashti-madhu, Saindhava, Deva-daru, Asva-gandha and the seeds of Mulaka and of Avalguja should be pasted together and cooked with a compound of milk, oil, clarified butter, lard, marrow and wax. This preparation should be applied lukewarm to the affected lobe in a case of the Pari-potaka type.

10-11.

Manjishtha, Sesamum, Yashti-madhu, Sariva, Utpala, Padma-kashtha, Rodhra, Kadamba and the tender leaves of the Vala, Jambu and Amra (mango) should be cooked together with (an adequate quantity of) oil and Dhanyamla (Kanjika). This oil proves curative in a case of Utpata.

Similarly (a medicated) oil cooked with Tala patri, Asva-gandha, Arka, Vakuchi-seeds, Saindhava, Sarala,* Langali, lard of a Karkata (crab) and of a Godha (a kind of lizard), proves beneficial in cases of Unmantha. The affected lobes should be washed (Sechana) with a decoction of the leaves of the Asmantaka, Jambu and Amra (in such cases).

In a case of Parilehi, the affected lobe (Pali) should be dusted with powdered Prapaundarika, Yashti-madhu, Manjishtha and the two kinds of Haridra after lubricating it with the oil cooked with the Kalkas of Laksha and Vidanga. It should be as well fomented with heated cow-dung and plastered with the lukewarm pastes of Vidanga alone, or in combination with Trivrit, etc., should be resorted to in cases of the affection being due to the concerted action of the vitiated blood and the Pitta.

• Sarala here means Dhupa-kashtha, according to Dallana.

64

S'yámá and Arka pasted together (with cow's urine', or with the pastes of Karanja-seed, Ingudi seed, Kutaja and Áragvadha (pasted with cow's urine). Mustard oil cooked* with the admixture of all the foregoing drugs and with Maricha, Nimba-leaves and wax, proves efficacious as unguents (in such cases): 14-15.

In cases where the ear-lobes are affected and have become either thin, or hard, an ointment should be applied to them in order respectively to increase their growth, or to soften them. 16.

The marrow of a jackal and of an animal frequenting and living in swampy grounds (Ánupa, such as a buffalo, etc.), together with lard, oil and fresh clarified butter, should be cooked with a quantity of milk weighing ten times their combined weight and with the drugs of the Madhura (Kákolyádi) group, As'va-gandhá and Apá-márga and Lákshá-Rasa (decoction or infusion of Lákshá). The oil thus prepared should be filtered and preserved carefully in an earthen pitcher. The affected ear-lobes should be constantly fomented and well-lubricated with it. The use of this medicated oil helps the growth of the ear-lobes and makes them healthy, soft, smooth, painless, evenly developed and capable of bearing the weight of ear-pendants. 17.

Treatment of Palita :-The expressed juice of the Bhringa-rája and (the decoction of) Triphalá, powders of indigo leaves, Arjuna bark, Bhringa-rája, Pinditaka, black-iron, flowers of the Vija and of Saha-chara, Haritaki, Vibhitaka and Ámalaka mixed together and pasted with a quantity of mud found adherent to lotus-bulbs weighing as much as the combined

Chap. XXV.] CHIKITSA STHANAM.

weight of the aforesaid drugs should be kept in an iron-pitcher well covered and preserved inside a room for a fortnight. After this period it should be cooked with (an adequate quantity of) oil and with the expressed juice* of the Bhringa-rája and (a decoction of) Triphalá. For the purposc of ascertaining the proper cooking of the oil, a (white) feather of a Valáká (crane) should be dipped into it, and satisfactory preparation should be judged from the deep blue colour imparted to the feather. The oil should be then preserved in a black-iron pitcher for a month. Used as anointments, this oil arrests a premature greyncss of the hair.

The flowers of the S'árira, Jambu, Arjuna and of the Kás'mari, sesamum, Bhringra-rája-seeds, mango-stones, Punarnavá,† mud, Kantakári, Kásísa, marrow of the sceds of Madana, Triphalá, powdered iron, Rasánjana, Yashti-madhu, Nilotpala, S'árivá, and Madayanti‡ should be pasted together with the decoction of the Sára (pith) of the Vijaka. It should then be mixed with seven Prastha measures of the decoction of the Sára of Vijaka and preserved for ten days in a covered iron vessel.

The flowers of S'árira, Jambu, Arjuna, and Kás'mari, sesamum, Bhringra-rája seeds, mango stones, Punarnavá, mud, Kantakári, Kásísa, marrow of Madana seeds, Triphalá, powdered iron, Rasánjana, Yashti-madhu, Nilotpala, S'árivá, and Madayanti should be ground together with the decoction of the Sára (pith) of Vijaka. It should then be mixed with seven Prastha measures of the decoction of Vijaka's Sára and preserved for ten days in a covered iron vessel.

This compound should then be carcfullly cooked with an A'dhaka measure of Vibhitaka-oil and again preserved in a new iron-pitcher for a month. Then after cleansing the system of the paticnt, the oil thus prepared

This compound should then be carefully cooked with an A'dhaka measure of Vibhitaka oil and again preserved in a new iron pitcher for a month. Then, after cleansing the patient's system, the oil thus prepared

• In the cases of cooking an oil, the liquid substance to be used, should be, as a general rule, four times as much as the oil ; but in this case, the expressed juice of Bhringra-rdja and (the decoction of) Triphalá should be continued to be added, so long as the feather does not become deep blue.

† According to Dallana, the reading would have b:en "पुनर्नवे," i e., the two kinds of Punarnavá.

‡ One Karsha measure of each of the aforesaid drugs should be taken.

508 THE SUSHRUTA SAMHITA.

should be used as errhines (Nasya) and in anointing the head, and the patient should be advised to live on diet consisting of Masha-pulsc, or of Kris'ara. In the course of a month, it imparts a (deep black) gloss like that of a black bee, or that of Rasanjana to the hair and makes it grow thick and curly. It cures baldness, arrests the susceptibility of the system to an attack of pre-mature decay, removes the wrinkles of the face, and invigorates the sense-organs in the performance of their proper and respective functions. This oil should not be given to a man who does not wish to use it, nor to an indigent person, to an ungrateful wretch, nor to an enemy.

Treatment of Vyanga, etc. :-Laksha,

Rodhra, the two kinds of Haridra, Manah silá, Haritála, Kushta, Nágu (lead), Gairika, Varnaka, Manjishthá, Vacha, Saurishtra-mrittiká, Pattanga, Gorochana, Rasánjana, bark of Hemánga (Champaka), the tender leaves of Vata, Kálíya-Káshtha, Padma-káshtha, the filaments of a lotus, both red and white chandana, Mercury* and the drugs of the Kákolyádi group should be pasted together with milk. The paste, thus prepared, as well as lard, marrow, wax, clarified butter, milk and a decoction of the drugs of the Kshira trees should be cooked together. This medicated clarified butter, is the best of all the unguents that may be applied to the face. It cures the most difficult cases of Vyanga and Niliká, and removes all tans, specks, marks, moles, eruptions, etc., from the face. It imparts smoothness to the wrinkled skin, gives a healthy plumpness and bloom to the cheeks, and makes the face as beautiful as a lotus.

• This is the first time that we come across the mention and use of 'Párada' (Mercury) in the Sus'ruta Samhitá.-Ed.

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CHAPTER XXVI.

Now we shall discourse on the medical treatment for increasing the strength and virile power of weak persons (Kshina-Valiyam Vájí-Karana).

A youth in sound health taking regularly some sort of Vájí-Karana (aphrodisiac) remedy may enjoy the pleasures of youth every night during all the seasons of the year.

Old men, those wishing to enjoy sexual pleasures or to secure the affections of women, as well as those suffering from senile decay or sexual incapacity, and persons weakened with sexual excesses, should do well to submit themselves to a course of Vájí-karana remedies.

They are highly beneficial to gay, handsome and opulent youths and to persons who have got many wives.

2 A.

Definition of Vájí-Karana :-If duly taken, the Vájí-karana* remedies make a man sexually as strong as a horse (Váji), and enable him to cheerfully satisfy the heat and amorous ardours of young maidens, a fact which has determined the nomenclature of this class of (medicinal) remedies.

2-B.

Means of Vájí-Karana :--Various kinds of (nutritious and palatable) food and (sweet, luscious and refreshing) liquid cordials, speech that gladdens the ears, and touch which seems delicious to the skin, clear nights mellowed by the beams of the full moon and damsels young, beautiful and gay, dulcet songs that charm the soul and captivate the mind, use of betel-leaves, wine and wreaths of (sweet-scented) flowers,

• The Vájí-Karana remedies are of three kinds, viz., (1) those producing the semen, (2) those secreting the semen, and (3) those producing as well as secreting the semen.

Chap. XXVI.] CHIKITSA STHANAM.

511 and a mer:y careless heart, these are the best aphro-disiacs in lifc. 2.

Causes of Sexual Incapacity :-

A cessa-tion of the sexual desire owing to the rising of bitter thoughts of recollection in the mind of a man, or a forced inter-course with a disagreeable woman (who fails to sufficiently rouse up the sexual desire in the heart of her mate) illustrates an instance of mental impotency.

Excessive use of articles of pungent, acid, or saline taste, or of heat-making articles of fare leads to the loss of the Saumya Dhátu (watery principle) of the organism. This is another kind of impotency.

Virile impotency resulting from the loss of semen in persons addicted to excessive sexual pleasure without using any aphrodisiac remedy is the merit form of virile impotency.

A long-standing disease of the male generative organ (syphilis, etc.), or the destruction of a local Marma such as the spermatic cord, destroys the powers of coition altogether. This is the fourth form of impotency.

Sexual incapacity from the very birth is called the congenital (Sahaja) impotency.

Voluntary suppression of the sexual desire by a strong man observing perfect continence, or through utter apathy produces a hardness of the spermatic fluid, and is the cause of the sixth form of virile impotency.

Of the six foregoing types of impotency, the congenital form as well as the one due to the destruction of any local Marma (spermatic cord) should be regarded as incurable, the rest being curable and amenable to the measures and remedies antidotal to their respective originating causes. 3.

Their Remedies :-

Now we shall describe the different Vŕji-Karana (aphrodisiac) remedies. Powders of sesamun, Mâsha-pulse, Vidâri, or S'âli-rice should

be mixed with Saindhava salt and pasted with a copious quantity of the expressed juice of the sugarcane of the Paundarika species. It should then be mixed with hog's lard, and Utkáriká should be prepared by cooking it with clarified butter. By using this (medicinal) Utkáriká, a man would be able to visit a hundred women.

4

The testes of a he-goat should be boiled in milk. Sesamum seeds should then be successively treated with this milk in the manner of a Bhávaná saturation. Cakes should be made of these sesamum seeds with the lard of a porpoise. This medicine exerts the same action as the preceding one without producing any exertion whatever. By eating the testes of a he-goat with (an adequate quantity of) salt and powdered long-pepper (Pippali), fried in clarified butter prepared from churning milk (and not from curd), a man is enabled to visit a hundred women.

5

Powders of Pippali, Máska-pulse, S'áli-rice wheat and barley, should be taken in equal parts. Cakes (Pupáliká) should be prepared with this compound and fried in clarified butter. By taking these cakes and a potion of milk sweetened with (a copious quantity of) sugar, a man becomes potent enough to enjoy the pleasures of love like a sparrow (Chataka).

6

Powdered Viddári successively soaked in the expressed juice of the same and dried, should be licked with honey and clarified butter, whereby a man would be able to visit ten women successively (at a time). Similarly powders of (dried) Ámalaka successively soaked in its own expressed juice should be licked with honey, sugar* and clarified butter, after which a quantity of

• According to S'ivadása it may also be taken with honey and clarified butter only.

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514 THE SUSHRUTA SAMHITA.

The use of pulverised Átma guptá and Ikshuraka (Kokiláksha) seeds mixed with sugar and taken with milk just milched enables a man to indulge in the pleasures of youth for the whole night without any sense of fatigue. The powders of the Uchchata should also be taken similarly (with milk and sugar). S'atavari and Uchchata roots should also be similarly taken by a man wishing to have (sexual) vigour. A soup of Átma-guptá seeds and Másha-pulse (boiled together) should be taken. Átma guptá-seeds, Gokshura seeds and Uchchata should be boiled with milk and constantly stirred with a ladle. The use of this preparation (with an adequate quantity of sugar) enables a man to enjoy the pleasures of love all the night long. Likewise the milk boiled with Másha-pulse, Vidári, or Uchchata should be taken with honey, clarified butter and sugar. By using this a man may indulge in the pleasures of the bed for the whole night like a sparrow.

The use of the milk of a Grishti (a cow delivered only once) with a grown up calf (one year old) and exclusively fed on the (fresh) leaves of the Másha-parna, is recommended as a sexual tonic. All kinds of meat and milk, as well as the drugs of the Kákoljádi group should be regarded as being highly possessed of the virtue of imparting tone and vigour (to the male productive organs). They should, therefore, be used (for that purpose). The medicinal remedies and compounds described in the present chapter should be taken in sound health and proper seasons, as they are exhilarating and invigorating, and help the procreation of children.

Thus ends the Twenty-sixth Chapter of the Chikitsita Sthánam in the Sus'ruta Sambitá which deals with the treatment of the vriile impotency.

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Vidanga-Rasáyana :-The powdered seeds of the Vidanga (Tandula) and pulverised Yashti-madhu should be mixed together and taken in cold water in an adequate dose (according to the strength of the patient), and a potion of cold water should then be taken. This medicine should be regularly continued for a month. The same pulverised Vidanga seeds should be similarly taken for a month through the vehicle of the decoction of Bhallátaka mixed with honey; or of the decoction of grapes mixed with honey ; or with the expressed juice of Amalaka sweetened with honey ; or through the vehicle of the decoction of Guduchi. Thus there are these five ways (of taking pulverised Vidanga seeds (Tandula) as an elixir. A meal of boiled rice with a copious quantity of clarified butter should be taken with the soup of Amalaka and Mudga pulse unseasoned with salt and cooked with only a small quantity of Sneha (clarified butter) after the medicine has been well digested. These (Rasáyana) remedies prove curative in cases of hæmorrhoids and in complaints of worms. They improve memory and the power of comprehension and their use for every month increases the life-time of the user by one hundred years.

Vidanga-Kalpa :-One Drona measure of Vidanga (seeds) should be boiled in the way of preparing cakes in an Indian cake-pan. When the watery portion (of the cakes) have been removed (evaporated) and the Vidanga-grains well boiled, they should be taken down and well pasted on a stone-slab. They should then be kept in a strong iron pitcher after having been mixed with a copious quantity of the

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518 THE SUSHRUTA SAMHITA.

(which is not usually given to mortal eyes to descry). The mind, shorn of the qualities of Rajas (action) and Tamas (nescience), becomes possessed of Sattva (illuminating principles or true knowledge). Things are permanently and indelibly impressed upon his (user's) memory at a single hearing and the faculty of invention wonderfully expands. Old age and decay permanently vanish and youth returns to stay in him for good, bringing with it an elephantine strength and a horse-like speed, and he is enabled to live for eight hundred springs The medicated oil known as Anu-taila should be used in anointing (the body at this stage of treatment); a decoction of Aja-karna for Utsádana washing) purposes, well-water saturated with Us'ira for bathing purposes, sandal paste in anointing (Anulepana) the body, and the regimen of diet and conduct as described in connection with the Bhallátaka treatment (Vidhána)should be observed. 6. Kásmarya Kalpa :-The use of huskless Kás'maryaja seeds for rejuvinating purposes, is similar to the preceding one, except that it requires a separate kind of diet and does not require the use to lie on the ground. Under this treatment, the diet should consist of (boiled) rice and well-boiled milk and the beneficial effects that would result from its use, are identical with those of the foregoing one. These remedies should be employed in diseases originating through the vitiated blood and Pitta of the system. 7. Vala-Kalpa :-A Pala or half a Pala weight of the (powdered) roots of the Vala should be well-stirred in cow's milk and taken (every day), and the patient or the user should not be allowed to stir out of his room as prescribed before (during the entire course of taking the medicine). He should be advised to take a meal con-

sisting of boiled ricc, milk and clarified butter after the medicine had been fully digested. Premature old age and senile dccay would be arrested for a period of twelve years by taking this elixir continuously for twelve days in the foregoing manner, whereas an extension of its course to a hundred days would add a hundred summers to the duration of his youthful age. Ati-vala, Naga-vala, Vidari, Satavari may be similarly taken for the same purposes, with this distinction that the (powders of) the Ati-vala should be taken with water, those of the Naga-vala, with honey, whereas Vidari and the S'atavari powders should be taken with milk. The regimen of diet and conduct as well as the beneficial results produced therefrom should be the same (as from the use of Valai). The present remcdies are recommended to persons seeking strength or suffering from an attack of Hæmatemesis or Hæmatochczia.* 8. Varahi Kalpa :-A Tula measure of the powders of Varahi-bulbs should be taken in an adequate dose (everyday) by mixing it with honey and stirring it with milk A meal of boiled rice with clarified butter and milk should be taken after it had been digested and the patient should be advised to observe a regimen of diet and conduct (Pratishcdha) as laid down before (in connection with the foregoing elixirs). By using it a man is enabled to witness a hundred summers and docs not feel any fatigue after sexual excesses. A quantity of this powder should be mixed with milk and boiled (according to the rules of Kshira-paka). When sufficiently cooled, the milk should be churned and the clarified butter produced therefrom should be taken after the medicine had been digested. A

Chap. XXVII.] CHIKITSA STHANAM. 519

continuous use of the medicine for a month enables a man to live up to a good hundred years.

A decoction should be made by boiling together the pith of the Vijaka* (Pita Sála) and the roots of the Agni-mantha with which a Prastha measure of Másha-pulse should be duly cooked. When the Másha-pulse is sufficiently boiled, an Aksha measure of powdered Chitraka roots and the expressed juice of the Ámalaka weighing a fourth part of the Mádha-pulse should be added to it, and the whole compound should be removed (from the oven) at the close of the cooking. When cooled down this compound should be taken in adequate doses with honey and clarified butter after consecrating it a thousand times with appropriate Mantras. Persons secking longevity and a stronger or improved range of vision should take this and they should be advised to take their meals without any salt. The meal, after the digestion of the medicine, should consist of boiled rice and a copious quantity of clarified butter and should be taken with unsalted Mudga, and Ámalaka soup or with milk alone. A continuous use of either of these two medicines for three consecutive months would make a man's eye-sight as keen and foresighted as that of a Suparna† and enable him to witness a hundred summers in the full vigour of health, strength and manhood.‡

• Dallana recommends one Pala weight of Vijaka Sára and Agni-mantha to be boiled in an Ádhaka measure of water which should be reduced to one half for the preparation of the decoction.

† Suparna is the king of birds and is said to be the most keen-sighted.

‡ Dallana says that some commentators do not read this, since they do not consider it to be a part of the original text. Jejjata also has not read this.

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Vachá Rasáyana:-A paste of white Vachá to the size of an Ámalaka should be taken with (an adequate quantity of) milk, after consecrating it (in the proper manner). The medicine should be taken after cleansing the system (with emctics and purgatives, etc.) and after entering the Agára (room). After the medicine had been digested, a meal of boiled rice with milk and clarified butter should be partaken of. A continuous use of this elixir for twelve days improves the power of hearing. It increases the power of memory if taken for the next twelve days. It enables the user to remember a hundred words at a time by a thrice repetition of the same (i.e., by taking it for a period of thirty-six days). A repetition of a twelve days' (i.e., forty-eight days) use of the medicine leads to the expiation of all sins ; it imparts a keenness of sight like that of Garuda and enables the user to witness a hundred summers on earth. A decoction prepared with two Pala weight of any other species of Vachá should be taken with milk.* The benefits which would result from its use and the rules of diet and conduct to be

• According to Dallana, this preparation of Vachá should be prepared by boiling it in the manner of Kshira-páka Vidhi.

Śata-páka Vachá-Ghrita :-Clarified butter should be cooked a hundred times in succession with an adequate quantity of Vachá. The use of a Drona measure of this medicated Ghrita (taken every day in an adequate dose) extends the earthly career of its user to five centuries, and proves beneficial in cases of scrofula, goitre, elephantiasis and hoarseness.

Measures for prolonging life—M. T. :—Now we shall discourse on life-prolonging measures and remedies. The powders of Vilva (roots) should be consecrated a thousand times with Vilva flowers by reciting the Sree-Sukta (as mentioned in the Rig-Veda). They should then be mixed with (powdered) gold, honey and clarified butter (in the form of an electuary), and licked every morning. It is thus a combination of medicine and Mantra, and, if used continuously for a year, would remove all inauspicious features (both of the body and of the mind).

9-10.

Every morning after a bath, a man should offer ten thousand oblations in fire and take the powders and decoction of the roots and bark of the Vilva with milk in a spirit of self-control, whereby he would be able to acquire longevity. This remedy should be considered as a good Rasáyana. Similarly a decoction of Mrinála mixed with honey and fried paddy and duly consecrated a hundred thousand times with oblations in fire would be considered an infallible Rasáyana.

11-12.

The use (of a compound consisting of gold, Padma-eeod, Priyangu and fried paddy mixed with honey and taken in (an adequate quantity of) cow's milk gives a favourable turn to one's fortune. A potion

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Chap. XXVIII.] CHIKITSA STHANAM.

fortune. It increases longevity and makes the user (fortunate like) a king. 22-A. The Tri-padi (lit. three-footed) Gáyatri should be recited in connection with the use of any of these elixirs where no Mantra would be found to be specifically mentioned. The use of the foregoing medicinal compounds improves one's beauty, surrounds a man with the majesty and effulgence of the gods and makes him as strong as an elephant. Constant study, disquisitions (on philosophical and scientific topics), discussions in other subjects, and residence with professors or men learned in the respective branches of knowledge, are the best means for improving memory and expanding one's intellect. Eating after the digestion of a previous meal, non-repression of any natural urgings of the body, annihilation of all killing propensities, perfect continence, self-control and refraining from rash and hazardous undertakings, should be deemed the keys to a long life. 22.

Thus ends the Twenty-eighth Chapter of the Chikitsita-Sthánam in the Sus'ruta Samhitá which deals with elixirs and remedial agents for improving the memory and intellect and increasing longevity.

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532 THE SUSHRUTA SAMHITA.

etc., done unto him) should drink off an Anjali (Kudava) measure of the secreted juice at a draught without tasting it, and the remainder, if any, should be cast into water. He should then wash and rinse his mouth with water in the manner of Achamana. Then having controlled his mind and speech with the vows cf Yama (paramount duties,* and Niyama (minor duties)† should stay in the protected inner chamber surrounded by his friends.

Metrical Text :-After having drunk the Rasâyana (Elixir) one should reside in a windless (prescribed) chamber, spend his time in perfect control over his senses, sitting, standing or walking about in his chamber in a holy spirit and by no means indulging in sleep (which is injurious under the circumstances).

Or the patient may, after taking his meal in the evening and hearing the benedictory words, lie down on a mattress of Kus'a-grass covered with black-deer skin and thus pass the night among his friends and may take cold water when thirsty. Then having got out of his bed in the morning he should hear the benedictory words recited and have the benedictory rites performed unto him. He should then touch the body of a cow and sit down in the same manner (in his chamber). Vomitings mark the digestion of the Soma-juice and after vomiting the blood-streaked worm-infested matter,

*Patanjali, the propounder of the Yoga system of Philosophy, enumerates the Yamas as follows :-“माहिंसा” (harmlessness), “सत्य” (truthfuln:ss), “अस्तेय” (abstinence from stealing), “ब्रह्मचर्य्ये” (continence) and “वपरिग्रह” (non-acceptance of offerings except in prescribed cases).

†The Niyamas, according to the same authority, are :- “शौच” (purity–external or internal), “सन्तोष” (contentment) “तपः” (penance), “स्वाध्याय” (religious study) an 1 “ईश्वर-प्रणिधान” (meditation of the Divine Being).

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juice of the A'malaka should be invariably mixed with any kind of Yusha or supa (he may take). Soup and black sesamum seeds boiled with milk and Yashti-madhu should be used (in the preparation of the food). These rules of diet and conduct should be observed for ten consecutive days.

7 C.

The patient should stay in the second (outer) chamber for a second ten days. Then he should be made to come out and enter the third (outmost) chamber (veranda) and to remain there for ten days with a quiet control over the mind and should be allowed to take a short exposure to the sun and wind during this period (of ten days). He should then be made to re-enter again the inner compartment.

7.D.

The patient should not contemplate himself in a mirror during this time owing to his enhanced personal beauty and renounce all passions and anger for a further period of ten days. This rule holds good in respect of all kinds of Soma; but there is this distinction that the Soma plants which are found to trail upon the ground or grow as small shrubs or in bushes should (themselves) be taken (instead of their expressed juice being drunk) and a dose of these would be four Mushtis* and a half.

The expressed juice of the Ams'uman Soma) should be pressed and taken in a golden pot and that of the Chandramah (Soma) in a silver one. By its use a man is sure to develop the eight godly powers+ and is thus able to imitate the god Is'ana. The expressed juice of a Soma plant belonging to any other species should be

• A Mushti measure is equal to eight Tolás.

• The eight godly powers, according to some authorities, are :--

अणिमा लचिमा व्याप्ति: प्राकाम्यं महिमा तथा । ईशिलत्वं वशितवश तथा कामवसरायिता ॥

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CHAPTER XXX.

Now we shall discourse on the tonic remedies which remove mental and physical distress (Nivritta-samtápiya-Rasáyana). 1. Metrical Text : - Even in this world mortals may live happily, free from disease and care like the gods in heaven if they (mortals) can secure the after-mentioned drugs (of all-healing potency). 2. Persons unfit for the use of Rasá-yana : - The (following) seven classes of persons, viz., the intemperate, the lazy, the indigent, the unwise, the immoral (Vyasaní), the sinful and the triflers of medicine, are unfit to take these ambrosial (Rasáyána) drugs on account of their respective ignorance, inactivity, poverty, vacillation, intemperance, impiety and inability to secure the genuine medicines. 3. Names of all-healing drugs : - Now we shall discourse on these drugs. They are Svetá-kpotí, Krishna-kpotí, Gonasi, Vdrathí, Kanyd, Chhatrá, Ati-chhatrá, Karenu, Ajá, Chakraká, Aditya-parniní, Suvarchald, Brahma-suvarchald, S'rdvání, Mahá-s'rdvání, Golomí, Aja-lomí and Mahd-Vegavatí. These are the names of the eighteen different kinds of drugs of mighty potency. The mode of their use, their * व्यसन is a technical term and is divided into two classes, viz., कामज (i.e., produced by passion or desire) and क्रोधज (i.e., originated from anger). The first group comprises hunting, dice-playing, day-sleep, censuring, addiction to woman, intoxication, singing, dancing, playing on musical instruments and idle wanderings. The second class comprises wickedness, violence, malice, jealousy, envy, extravagance, roughness in language and assault. See Manu, Ch. 7. 47, 43.

540 THE SUSHRUTA SAMHITA.

therapeutical effects and the religious rites to be observed in their connection, have been described in the S'astras and are identical with those of the Soma plants. In order to use them a man should enter the (prescribed) chamber (Agára) and perform the (prescribed) Homa coremonies. A Kudava measure of the milky juice of the secreting species of the plants should be taken once for all after entering the chamber. 4.

Three twigs or branches, however, to the length of a span of those of the non-secreting species having roots should be taken for a single dose. The (whole of) S'veta-kdpoti with its leaves and roots should be used. A quantity of the severed pieces of either of the Gonasi, Ajagari (Suvarchalá) or Krishna-kdpoti species including their thorns, and weighing a Musti (Sanakha-mushtika),* should be boiled with (an adequate quantity of) milk (and water). The milk thus cooked and prepared should be passed through a piece of cloth and taken only once duly consecrated. The milk cooked and prepared with one of the Chakrakᆠspecies also should be taken with milk only once, whereas (that of one of) the Brahma-suvarchalá species should be taken for seven days in succession. 5.

Five Palas of any of the remaining species should be boiled with an A'dhaka measure of milk and taken down with one quarter left. This should then be strained and the milk thus cooked should be taken in a single

• Some explain "Sanakha mustika" as what would be contained in the hollow of a palm, with the finger nails (i.e., the fingers) extended. But "Nakha" seems to refer to the thorns of the plants and "Mushti" a Pala weight (i.e., eight Tolás). † Gayi reads "कन्यकाया: पायसं" in place of "चक्रकाया: पय:" and explains it as a preparation of one part of the powders of the fruit of Kanyaká and two parts of rice cooked with milk.

CHIKITSA STHANAM

The use of any of the aforesaid drugs rejuvenates the system, fills it with the strength of a lion, invests it with a beautiful shape, blesses the user with such powerful memory that he can commit to memory anything once heard, and ultimately extends his career to two thousand earthly years. Crowned with diadems of celestial beauty, decorated, as if, with Angadas (bracelets), Kundalas (ear-rings), crowns and heavenly wreathes (of flowers), Sandal paste and dress, the users are enabled to traverse, like the gods, the cloud-spangled high ways of heaven, unflinchingly in their pursuits. Persons whose systems have been fortified with these medicinal herbs (Oshadhi-s), like the users of Soma go not by the roads on earth but scale those inaccessible heights of heaven from whence the pendent rain-clouds look down upon the soil below and where the feathered wings of the ethereal blue frequently soar up to.

Differentiating Traits

Now we shall describe the different traits of these (all-healing) Oshadhi-s. The Ajagari Oshadhi is found to put forth five leaves which have a brown colour and are marked with variegated ring-like patches. It looks like a snake and measures five Aratnis (a cubit of the middle length from the elbow to the tip of the little finger) in length.

• There is no mention of "Ajagari" in the list (para. 2) and there is no mention of "Suvarchala" in this descriptive list. It seems, therefore, probable that "Ajagari" and "Suvarchala" are identical.

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544 THE SUSHRUTA SAMHITA. [Chap. XXX.

drunk the celestial ambrosia to their fill cast the residue to the Somas and kindred plants as well as to the moon, the lord of the Oshadhis. 10-A.

Their habitats :-The Brahman-suvarchala species (of the Oshadhis) is found to grow in and about the waters of the great river Indus and the lake Deva-sunda. The Aditya-parnini species may be had in those two regions at the end of winter, and Gonasi and Ajagari at the beginning of the rains The Karenu, the Kanya, the Chhatra, the Ati-chchhatra, the Golomi, the Aja-lomi, and the Maha-s'ravani varieties of the Oshad-his are found (in spring) in the lake of Kshudraka-Mánasa in Kashmir. The Krishna-sarpikhyá and the Gonasi species also are found in that locality during the spring. The S'veta-kdpoti species is white coloured and is found to grow on the ant-hills which cover a space of three Yojanas on the other (viz., the western) side of the river Kaus'iki and to the east of the Sanjaya-nti. The Oshadhi of the Vegavati species grows on the Malaya hills and on the Nala-setu. 10-B.

Any one of these Oshadhis should be taken after a fast under the auspices of the full-moon in the month of Kártika. The regimen of diet and conduct is the same as laid down in connection with Soma-Rasáyana and the results have been already described to be the same. 10 C.

The common habitats of all the Oshadhis :-The Soma as well all the other Oshadhi plants may be had on (the summits of) the Arvuda mountains whose cloud-rending summits are the favourite haunts of the gods and which abound in holy pools and fountains frequented by the gods, the Siddhas and the holy Rishis, and whose large hollow caves are reverberated with the thundering roars of

Chap. XXX.] CHIKITSA STHANAM.

lion and which are moated on all sides by swift coursing rivers, whose waters are perpetually tossed by sportive elephants of the forests and whose brows are effulgent with the lustres of various brilliant metals imbedded in their hearts. 10.

These ambrosial plants (as well as other drugs) are to be sought in the rivers, the holy forests and hermitages, as well as in lakes and on hills, since this world is a bed of gems and is known to hold priceless treasures in all places. 11.

Thus ends the Thirtieth Chapter of the Chikitsita Sthánam in the Sus'ruta Sambitá which deals with the tonic remedies which have the power of removing the mental and physical distresses.

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s'igru, Surya-valli, Pilu, Siddharthaka and of Jyotishmati act as errhines (S'iro-virechana).

The expressed oils prepared from (the seeds of) Karanja, Putika, Kritamala, Mdtulunga, Ingudi and of Kirata-tikta are used in cases of Dushta-vrana (malignant ulcers).

The expressed oils of Tuvaraka, Kapittha, Kampillaka, Bhallataka and of Patola are used in cases of Mahd-vyddhi (Kushtha, etc.).

The expressed oils of Trapusha, Ervdruka, Karkdru, Tumbi and of Kushmanda are used in cases of Mutra-sanga (for diuretic purposes).

The expressed oils of Kapotd-vamka, Avalguja and of Haritaki are used in cases of Sarkards'mari (gravels, stones, etc.).

The expressed oils of Kusum bha, S'arshapa, Atasi, Pichu-marda, Atimuktaka Bhandi, Katu-tumbi and of Katabhi are used in cases of Prameha (urinary complaints).

The expressed oils of the fruits of Tdla, Narikeld, Panasa, Mocha, Piyala, Vilva, Madhuka, S'leshmataka and of Amrataka are used in discases due to the deranged Vayu acting in concert with the deranged Pitta.

The expressed oils of Vibhitaka, Bhallataka and of Pinditaka are used in Krishna-karma (blackening the cicatrix of a healed ulcer, etc.).

The expressed oils of S'ravana, Kanguka and of Tuntuka are used in imparting a yellow colour (to a cicatrix).

The expressed oils of the pith of S'ims'apa and of the Aguru are used in cases of Kushtha known as Dadru (ring-worm) and Kitima.

6-7.

The primary action of all kinds of Sneha (oil, clarified butter, etc.) is to subduc the aggravation of the deranged Vayu of the body, and the general virtues of all kinds of (vegetable) oil have been described above.

Now we shall describe the process of preparing drug-decoctions and of medicating oils (therewith).

According to several authorities, the bark, roots and leaves,

548 THE SUSHRUTA SAMHITA. [Chap. XXXI.

etc., of the drugs to be used should be boiled with water weighing four times their combined weight, and should be taken down with three-fourths of the original water evaporated by boiling. This is the rule of preparing drug-decoctions (Kasháya). Six Prasrita (one Prasrita being equal to sixteen Tolás) weight of oil, twenty-four Prasrita weights of the liquid (decoction prepared before) and four Aksha measures (one Aksha being equal two to Tolás) of pasted drugs (as Kalka) are the proportions to be observed in cooking a medicated oil. But this is not correct. Why ? Because it is not in conformity with the injunctions of the Scriptures (officinal standard). We shall now proceed to explain the different measures of Pala, Kudava, etc. 9-10.

Measures of Drugs :-The weight of twelve middle-sized Dhánya-máshas (corns of paddy) make one Suvarna-máshaka. Sixteen Suvarna-máshakas make one Suvarna. The weight of nineteen middle-sized Nishpávas (pulse) make one Dharana. Three Dharanas and a half make one Karsha. Four Karshas make one Kudava. Four Kudavas make one Prastha.* Four Prasthas make one Adhaka. Four Adhakas make one Drona. Hundred Palas make one Tulá. Twenty Tulás make one Bhára. This is the measure in respect of dried substances. The quantity should be doubled in cases of fresh vegetables and fluids.† 11.

• Thirty-two Palas make one Prastha in respect of water ; but in respect of non-oily substances a Prastha is equal to twenty Palas, where-as in respect of fresh drugs it is equal to only sixteen Palas.

† Some drugs, viz. :-Vási, Kutaja, Kushmanda, Prasa'rani Valá, Amrita and Nimba, etc., are invariably employed in their fresh state and the practice is not to take them in double measures in spite of their freshness. Two different kinds of measure have been adopted in the Ayurvedic Pharmacopœia. One is called the Kállinga and the

The Kasháya-Páka Kalpa :-The bark, roots and leaves, etc., of medicinal drugs should be dried in the sun and taken in any of the aforesaid measures, should be cut in small pieces, or pounded, as the cuse may be, and soaked in a quantity of water* weighing eight or sixteen times their combined weight. They should then be boiled over a fire and the decoction should be taken down from the oven with only a quarter part of the water left. This is the general rule for preparing a decoction (Kasháya).

The Sneha-Páka Kalpa :-One part of the Sneha (oil, clarified butter, etc.), four parts of (any one or more) liquid† substances, a fourth part of the medicinal pastes (Kalka) should be boiled together. This is the general rule for the preparation of a medicated Sneha (oil, clarified butter, etc.).

Alternative Methods :-As an alternative, a Tulá measure of the bark, roots and leaves, etc. (as the case may be) of the drugs to be decocted, should be boiled with a Drona measure of water. The water in the preparation should be boiled down to a quarter part of its original quantity and then considered as cooked and

other the Mágadha measure. Mahars'hi Charaka has adopted the first, but that adopted by Sus'ruta is the second one.

• Water weighing four times as much as the drugs when the drugs are of a solt consistency and eight times as much when they are hard and sixteen times as much when they are very hard.

† When there are more liquids to be used than one, the general rule is that the total weight of all the liquids would be four times that of the Sneha, if not otherwise directed. All this liquid part should, however, be boiled away and the Sneha part should be left before the Sneha is removed from the fire and before it can be fit for use. It should be noted that the cooking of a Sneha should not be completed in one day.

-Ed.

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a strongly cooked one should be used for the purposes of Vasti-Karma and as ear-drops.* 16.

Memorable Verses :-The cooking of a Ghrita should be considered medically complete as soon as the froth and the sound would vanish and the peculiar smell, colour and taste of preparation would be manifest. The medically cooking of an oil resembles in all respects that of a Ghrita with this exception that an abundance of froth appears on the surface of the oil at the cumpletion of the cooking. 17.

The process of taking a Sneha internally :- Now we shall describe the process of taking a Sneha internally. A man with an empty stomach should be made to take a draught of a medicinal or medicated oil or Ghrita, just as the god of day (sun) would appear on the summit of the hill at dawn and lighten up the horizon with the first shoots of his vermilion-tinted golden rays. Rites of benediction should be first done unto the patient before administering to him the oil or the Ghrita in an adequate dose. After that he should wash his mouth with warm water and quietly stroll about with his shoes on. 18.

Metrical Texts :-The use of a potion of a (medicated) Ghrita is recommended to patients suffering from an extremely parched or dry condition of the organism, or from ulcers, or from the effects of a poison, or from those due to the actions of the deranged Váyu and Pitta, as well as to persons of weak memory and intellect. Potions of (medicated) oils should be prescribed in aggravations of the Kapha and

• Charaka, on the contrary, holds that a Khara (strongly cooked) Sneha should be used in anointing the body, a middling-cooked one for the purposes of drinks and Vasti-karma and a mildly cooked (Mridu) one for the purposes of errhines.

THE SÚSHRÚTA SAMHITA.

552

• Vide Uttara-Tantra, Chapter LXIII.

Chap. XXXI. ] CHIKITSA STHANAM.

553

the year which are neither too hot nor too cold* in-

asmuch as the use of clear or transparent oil or Ghrita'

is above being commendable. A Sneha should be taken

in the morning (lit. day-time) during the cold months of

the year and in case of the joint aggravation of the bodily

Váyu and Kapha ; whereas it should be taken in the

evening (lit. night) during summer and in cases of the

joint aggravation of the bodily Váyu and Pitta. Potions

of oil or clarified butter taken in summer by a person

suffering from an aggravation of the bodily Váyu

and Pitta may bring on thirst, epileptic fits and

insanity. In the same manner draughts of oil or

clarified butter taken in winter by a person suffering

from an aggravation of the bodily Váyu or Kapha

may be followed by a heaviness of the limbs, aver-

sion to food and colic (Śula). If a patient feels thirsty

after taking a Sneha, he should take warm water, and

be made to vomit the Sneha with (further) draughts of

hot water in the event of the thirst still not subsiding.

Cooling plasters should be applied to his head and

a cold water bath should be prescribed. 19-B.

The Dosage :-The Dosage of a Sneha which

requires the quarter part of a day (i.e., three hours)

to be digested, should be deemed appetising and bene-

ficial in slight aggravations of the bodily Doshas ; that

which requires half a day to be digested should be

regarded as invigorating, spermatopoietic, construct-

ive and beneficial in moderate aggravations of the

• Both Vrinda and Chakrapáni read this but with little difference.

Both of them read "शीते च शीतलैः" i.e., in the cold season. But their

commentators accept the reading "काले नात्यश्शीतले," as in the text, to be

a variant. We have the authority of Charaka, however, to accept the

• reading of the text.

70

554 THE SUSHRUTA SAMHITA. [Chap. XXXI.

bodily Doshas. The dosage of a Sneha which takes three-quarter parts of a day to be digested, acts as a bodily emollient and should be prescribed in cases of extreme aggravation of the bodily Doshas, while the quantity which can only be digested in the course of an entire day (twelve hours) should be considered efficacious in all affections of the body and does not produce physical lassitude, fainting fits and delirious conditions. The measure or quantity of a Sneha which takes a whole day and night to be digested without undergoing any kind of vitiation (reactionary acidity) in the stomach, proves curative even in cases of Kushtha (cutaneous affections), insanity, poisoning (effects of poison) and Apasmára (hysteric convulsions), ascribed to the baneful influences of the malignant stars. I9·C.

The evil effects of Over-dosage :-A patient should be made to take as much of the Sneha as he would be able to easily digest inasmuch as an excessive over-dose may prove fatal. The patient should be made to vomit with draughts of hot water in a case of over-dose or abuse of a Sneha and in the event of its continuing in an undigested or partially digested state in the stomach. In cases of doubtful digestion, similar potions of hot water should be administered which would produce good eructations and bring on a fresh relish for food. I9-D.

When the Sneha begins to be digested, it is attended with thirst, vertigo, lassitude, weariness, a disturbed state of the mind and a burning sensation. When the Sneha appears to have been fully digested the patient should be affused with hot water. A gruel prepared with only a small quantity of rice should be given lukewarm to the patient (at this stage). As an alternative, a well-

Chap. XXXI.] CHIKITSA STHANAM.

aromatized soup (of Mudga, etc.) or meat-juice cooked without the addition of any Sneha (oil or Ghrita) or with only a small admixture of clarified butter should be given, or he may take Yavágu (pure and simple). 19-E. A Sñeha should be taken three, four, five or six days consecutively ; used (continually) for more than a week it becomes habituated to the user. A Sneha should be taken with food (at the time of mid-day meal) by a weak, or an old man or an infant, or a thirsty person, or one of a delicate constitution, or one averse to its use in summer. 19-F. Sadyah-Snehana :- The administration of a potion composed of powdered Pippalí and (Saindhava) salt mixed with curd-cream and the four kinds of oleaginous substances (Sneha) constitute what is known as the Sadyah-Snehana (i.e., it produces the effects of the Sneha within a very short time). The use of a Yavágu well-cooked* with the soup of half-fried meat (instead of water) and a Sneha (clarified butter), and mixed with honey acts as a Sadyah-snehana. A Yavágu prepared with milk† and a small quantity of rice and taken lukewarm with clarified butter produces the same result. The use of cow's milk milked into a pot containing clarified butter and sugar produces an instantaneous emulsive effect (Sadyah-snehana), if taken by a man with a parched state of the organism. Clarified butter cooked with three parts of the decoction of Yava, Kola and

• In place of "श्रद्धाक्वथिता" (well-cooked), Chakradatta reads 'ल्प-क्वथिता' (prepared with a small quantity of rice). † In place of "पयःसिद्धा" (prepared with milk), Chakradatta reads 'तिलसिद्धा' (prepared with an abundance of sesamum which, according to S'ivadása, would constitute three parts with only one part of rice).

Kulattha pulse (taken together) and one part each of milk, curd, wine and clarified butter churned from milk acts as an instantaneous demulcent (Sadyah-snehana) and is hence recommended to kings and king-like personages.

This potent emulsive measure (Sadyah-snehana) should be prescribed for the old, the imbecile, to females and to persons of sluggish appetite, as well as to sensitive persons and in diseases due to a slight aggravation of the bodily Doshas. 19-G.

Forbidden cases of Sneha-pána :-

The internal use of a Sneha is forbidden to persons suffering from ascites, fever, delirium, alcoholism, aversion to food and vomiting, as well as to weak, corpulent, thirsty, fatigued, or intoxicated persons.

It is forbidden on a cloudy day, in an improper season of the year, after the application of Vasti-measures, purgatives and emetics and after premature parturition.

The internal use of a Sneha (oil or Ghrita) gives rise to a host of maladies in the foregoing cases, or the diseases become more serious or may even become incurable.

In cases of premature parturition, there remains a quantity of mucus and vitiated lochia in the womb; therefore, stomachic (Páchana) and parching (Ruksha) drugs should be administered to females after child-birth.

After a period of ten days, however, draughts of oil or clarified butter should be given according to requirements. 19.

A dry or parched condition of the organism should be inferred from a general dryness of the body, the hard and knotty character of the fæcal matter (stools), a sluggish digestion with a burning sensation on the epigastrium (Uras) and an upward coursing of the Váyu from the abdomen (Koshtha) as well as from the weakness and discoloration of the body.

Lassitude, a sense of heaviness

in the limbs, the oozing out of the Sneha through the lower orifices of the body and an aversion to any kind of oleaginous substance are the indications which mark the satisfactory action of an emulsive remedy in a human organisin, while its abrupt excess or abuse is followed by aversion to food, salivation, a burning sensation about the anus, dysentery and diarrhœa and such like symptoms. A condition of dryness in the organism should be remedied with a Sneha, whilc an excess of the latter should be corrected with meals of S'yamdka or Kora-dusha grains, as well as with milk-curd (Takra), levigated sesamum paste (Pinyáka) and powdered barley (Saktu). 20-23.

The good effects of Sneha-pána :- The blessings which attend a person who has duly taken a Sneha are improved digestive capacity, regular and satisfactory motions of the bowels, a growth of all the vital principles of the body, strength and firmness of the organs, improvement of complexion, a delayed old age and the enjoyment of a hundred summers on earth. The application of a Sneha is potent enough to increase the strength and the digestive capacity of a weak person suffering from impaired digestion, and a person having his health and digestive capacity recouped (by the use of a Sneha) does not yield to the evil effects of errors of diet. 54-55.

Thus ends the Thirty-first Chapter in the Chikitsita Sthánam of the Sus'ruta Samhitá which deals with the treatment of the diseases where oleaginous medicines are useful.

CHAPTER XXXII.

Now we shall discourse on the medical treatment by measures of fomentations, diaphoretic measures, etc. (Svedá-vacharanya). 1.

Sveda* (calorification, fomentation, diaphoretic measures, etc.) may be divided into four groups such as, the application of direct heat (Tápa-sveda), fomentation (Ushma-sveda), poulticing (Upanáha-sveda) and the application of heated fluids (Dravar-sveda). All kinds of diaphoretic measures (Sveda) belong to one or the other of these groups. 2.

Sveda* (calorification, fomentation, diaphoretic measures, etc.) may be divided into four groups such as, the application of direct heat (Tápa-sveda), fomentation (Ushma-sveda), poulticing (Upanáha-sveda) and the application of heated fluids (Dravar-sveda). All kinds of diaphoretic measures (Sveda) belong to one or the other of these groups. 2.

Tápa-sveda :-Of these the Tápa-sveda consists in repeatedly applying heat to (any affected part of the body of) a patient made to lie down (on a bed) with the help of the palm of the hand, a piece of brass, an Indian saucer, a piece of baked clay or sand, or a piece of cloth after heating them over a fire of Khadira wood, etc. 3.

Tápa-sveda :-Of these the Tápa-sveda consists in repeatedly applying heat to (any affected part of the body of) a patient made to lie down (on a bed) with the help of the palm of the hand, a piece of brass, an Indian saucer, a piece of baked clay or sand, or a piece of cloth after heating them over a fire of Khadira wood, etc. 3.

Ushma-sveda :-A piece of stone, brick, iron, or baked clay should be made red-hot and sprinkled over with water or with sour gruel (Kánjika). The affected part of the body should be covered with (cotton plugs soaked in) Alaktaka† and then fomented with

Ushma-sveda :-A piece of stone, brick, iron, or baked clay should be made red-hot and sprinkled over with water or with sour gruel (Kánjika). The affected part of the body should be covered with (cotton plugs soaked in) Alaktaka† and then fomented with

• The Sanskrit term "Sveda" is not properly rendered by the terms fomentations, diaphoretic measures or any other such word or phrase. Sveda is used to mean the application of heat in any possible way-it may be to cause or not to cause perspiration. Vapour baths, hot water baths, applications of warm poultices, etc., are also included in the meaning of the term Sveda. We have, however, for convenience sake, used the term fomentation as a synonym of Sveda in general.

• The Sanskrit term "Sveda" is not properly rendered by the terms fomentations, diaphoretic measures or any other such word or phrase. Sveda is used to mean the application of heat in any possible way-it may be to cause or not to cause perspiration. Vapour baths, hot water baths, applications of warm poultices, etc., are also included in the meaning of the term Sveda. We have, however, for convenience sake, used the term fomentation as a synonym of Sveda in general.

† Jejjata reads "तेनाद्रेःस्नातकपरिषेक्तिन" instead of "तेनाद्रौस्नातकपरिषेक्तिन" and explains that the cotton plug soaked in Alaktaka should be made wet and placed over the affected part before applying the fomentation.

† Jejjata reads "तेनाद्रेःस्नातकपरिषेक्तिन" instead of "तेनाद्रौस्नातकपरिषेक्तिन" and explains that the cotton plug soaked in Alaktaka should be made wet and placed over the affected part before applying the fomentation.

Chap. XXXII.] CHIKITSA STHANAM.

the above-named (heated) articles. As an alternative, a metal saucer containing milk, curd, Dhányámla, meat-soup and a decoction of the tender leaves of the Váyu-subduing plants (jointly or separately) should be heated over a fire. The mouth of the saucer should be covered (with a piece of blanket or such other cloth)* and the affected part of the body should be fomented with the vapours rising therefrom. As an alternative, another pitcher should be placed with its mouth downward over the mouth of the above pitcher (containing the above-named heated articles). Then an aperture should be made in the side of the upper pitcher and a pipe to the shape of an elephant's trunk should be inserted into it. The affected part of the body should then be fomented with the vapour escaping through that pipe. 4.

Metrical Texts :-The mode of applying heat to a patient suffering from any disease or affection of the bodily Váyu (disease of the nervous system, etc.,) is as follows :-He should be first anointed with oil, etc.,) and wrapped up in a thick cloth. He should then be made to sit in an easy posture. Heat should then be applied through a pipe shaped as an elephant's trunk. The advantage of this mode of fomentation is that the entire body of the patient may be easily fomented without causing him any serious trouble. The pipe should be made half a Vyáma† in length with three bends or turns‡ in its body to resemble

Metrical Texts :-The mode of applying heat to a patient suffering from any disease or affection of the bodily Váyu (disease of the nervous system, etc.,) is as follows :-He should be first anointed with oil, etc.,) and wrapped up in a thick cloth. He should then be made to sit in an easy posture. Heat should then be applied through a pipe shaped as an elephant's trunk. The advantage of this mode of fomentation is that the entire body of the patient may be easily fomented without causing him any serious trouble. The pipe should be made half a Vyáma† in length with three bends or turns‡ in its body to resemble

• The mouth of the pitcher should be covered only to mitigate and regulate the heat. † A Vyáma is the length measured by the outstretched hands of a man. ‡ The reasons for bending the tube are to make the fomentation delightful, in consequence of the vapour not passing in a straight course.

• The mouth of the pitcher should be covered only to mitigate and regulate the heat. † A Vyáma is the length measured by the outstretched hands of a man. ‡ The reasons for bending the tube are to make the fomentation delightful, in consequence of the vapour not passing in a straight course.

560 THE SUSHRUTA SAMHITA. [Chap. XXXII.

the trunk of an elephant.* The use of a pipe made of the materials (such as Kus'a, Kás'a, etc.) used in the making of a Kilinji (basket) and resembling the trunk of an elephant in shape is only recommended for the purposes of Sveda 'heat-application). 5.

A plot of ground commensurate with the length of the patient's body should be dug and heated with fire of Khadira wood and then sprinkled over with milk, water and Dhányámla. The heated ground should be then covered with a layer of leaves (of the Váyu-subduing plants) and the patient should be made to lie down full stretched upon the (bed of) leaves and thereby fomented.† As an alternative, a stone slab should be heated and the fomentation (Sveda) should be applied similarly to the patient by making him lie down upon it after the ashes and cinders have been removed‡. As an alternative, the patient should be seated inside a chamber with four doors (one on each side) and fomented by lighting up a good blazing fire (of Khadira wood) at all the doors (simultaneously §. Another alternative is that the patient should be laid on a mattress (made of Kus'a, Kás'a, etc.) or on a similar bed as before and fomented with the fumes of duly boiled paddy (and Másha-pulse, etc.) kept under the same mattress. In the same manner, Sveda (fomentation) might be applied with the help of heated cow-dung, ashes, husks of paddy, weeds, etc. 7.

Upanáha-Sveda (Poulticing) :--The roots of the Váyu-subduing drugs should be pasted together.

• This is called the "Nádi-sveda".

† This is called the "Karshu-sveda".

‡ This is called the "As'ma-ghana-sveda".

§ This is called the "Kuti-Sveda".

with Amla (Kánjika) and mixed with an abundant quantity of rock-salt and of Sneha (clarified butter, etc.). The paste should be heated and applied lukewarm to the affected part. The pastes of the drugs included within the Kákolyádi, the Eládi or the Surasádi groups as well as a paste of mustard seed, sesamum or linseed, or Krisará, Páyasa (porridge) Otkáriká, or Vesávadra, or the drugs of S'álvana* (as described under the treatment of Váta-Vyádhi) should be similarly applied (lukewarm to the affected locality) folded in a piecec of thin linen. This is what is called the Upansha-Sveda.

Drava-Sveda (Diaphoresis with fluids) :- A jar or a cauldron should be filled with a lukewarm decoction of any of the Váyu-subduing drugs and the patient should be immersed therein. In the same way, the patient might be immersed in a tubful of warm milk, meat-soup, soup (of Mudga or Más'ha pulse), oil, Dhányám'la (fermented or sour gruel), clarified butter, lard, cow's urine, etc.† The patient may also be sprinkled over or washed with a tepid decoction (of the above-mentioned drugs).‡ This is what is called the Drava-Sveda.

Of the four forms of Sveda described above those known as the Tápa-Sveda and Ushma-Sveda pre-eminently destroy the deranged Kapha, while the Upansha-Sveda subdues the deranged Váyu of the body ;

• Drugs of the Kákolyádi group should be used in cases of the dominant deranged Pitta acting in concert with the deranged Váyu ; those of Eládi group in cases of the dominant deranged Kapha acting in concert with the deranged Váyu and the S'álvana, or sesamum, linseed, etc., in cases of a simple or complicated deranged Váyu.

† This is called the Avagáha-Sveda.

‡ This is called the "Parisheka-Sveda."

the Drava-Sveda, however, is beneficial in cases due to the concerted action of the deranged Pitta with either of the other two Doshas (viz., Váyu and Kapha).

10-A. The patient should be diaphorised by making him put on warm clothing or exposing himself to the sun or by becoming fatigued after a long walk, or by wrestling, or some other physical exercise, load-carrying, etc., or by arousing his anger in a case where the deranged Váyu would be found to be subcharged with the deranged fat or Kapha.

Memorable Verses :--The four forms of Sveda mentioned above may be employed in two ways, viz.:--either to the whole body or to any particular part of it.

Sveda should be first employed in cases of patients fit to be treated with errhines (Nasya), purgatives, emetics or with Vasti-measures. It should be applied to the enciente in cases of obstructed foetus (Mudha-garbha) unattended with any other supervening distresses (i.e., excessive discharge of blood, etc.) after the extraction of the S'álya (the obstructed foetus) from the womb, and after parturition, and in cases where pregnancy runs to its full and natural term.

Sveda should be first employed in cases of patients fit to be treated with errhines (Nasya), purgatives, emetics or with Vasti-measures.

It should be applied to the enciente in cases of obstructed foetus (Mudha-garbha) unattended with any other supervening distresses (i.e., excessive discharge of blood, etc.) after the extraction of the S'álya (the obstructed foetus) from the womb, and after parturition, and in cases where pregnancy runs to its full and natural term.

It should be applied to the enciente in cases of obstructed foetus (Mudha-garbha) unattended with any other supervening distresses (i.e., excessive discharge of blood, etc.) after the extraction of the S'álya (the obstructed foetus) from the womb, and after parturition, and in cases where pregnancy runs to its full and natural term.

Sveda should similarly be applied both before and after the surgical operation in cases of fistula-in-ano and stones, gravel, etc., (in the bladder) and of hæmorrhoids.

Sveda should similarly be applied both before and after the surgical operation in cases of fistula-in-ano and stones, gravel, etc., (in the bladder) and of hæmorrhoids.

Specific modes of applying Sveda in other diseases should be duly described under their respective heads. 11.

Specific modes of applying Sveda in other diseases should be duly described under their respective heads.

11. Men conversant with the rules of Sveda (fomentations, etc.) should, under no circumstances, employ it before rubbing or softening the body or the limb with a Sneha (oil, etc.) inasmuch as a piece of wood is found to break or burst immediately under the application of heat if not previously rubbed with a Sneha.

Chap. XXXII.] CHIKITSA STHANAM.

Effects of Sveda :- Improved digestive capacity (Agni-dipti), softness of the limbs, smoothness and clearness of the skin, relish for food, clearness of the bodily ducts or channels, absence of somnolence and drowsiness and restored functions (free movements) of the numbed bone-joints are the benefits which result from an application of Sveda. The Doshas (morbific principles) having been moistened with a Sneha and lying inherent in the root principles (Dhátus) of the body or imbedded in its ducts or channels or located in their specific seats within the system, become liquefied and carried down into the bowels (Koshtha) by and after an application of Sveda and are eventually totally 'eliminated from the system (by means of correcting measures-D. R.). 12-B. A perfect or satisfactory application of Sveda is marked by a copious flow of perspiration, an abatement or amelioration of the disease, a lightness of the body and a desire for cool things and the softening of the patient's limbs, while the contrary effects result from an imperfect or unsatisfactory application of the same. An excessive application of Sveda would produce pain in the joints, and a burning sensation (in the body). It produces blisters, an aggravation of the Pitta, an excited condition of the blood, epileptic fits, vertigo, thirst, and fatigue. In such a case the evils should be speedily remedied with cooling measures. 12.

Prohibited cases of Sveda :-Applications of Sveda should not be resorted to in cases of persons suffering from jaundice, urinary complaints, hæmorrhage, pulmonary consumption (Kshaya), emaciation, indigestion, ascites (Udara),* thirst, vomiting.

• Vrinda evidently quotes this verse from Sus'ruta Samhitá but by a little change in the versification he excludes cases of vomiting and poisoning from the list and mentions only the cases of Dakodara

THE SUSHRUTA SAMHITA. Chap. XXXII.

ing, dysentery, and from diseases due to the effects of poison. It is also prohibited in respect of pregnant women and intoxicated persons, inasmuch as an application of Sveda proves fatal in these cases or tends to impart an incurable character to the disease (inflicting an irreparable injury to the whole organism). 13. Mild Sveda may be applied (and that only in cases of emergency) to the aforesaid persons suffering from diseases amenable only to an application of Sveda, as well as to the regions of the eyes, the heart (Hridaya) and the scrotum.

Sveda should be applied unto a patient in a covered and windless place and after the complete digestion of his ingested food, and after having anointed his body with a Sneha. During the application of Sveda (to the eyes and to the heart) the eyes of the patient should be (first) covered with something cold (e.g., lotus leaves, etc.) and the heart should be constantly touched with something cold (e.g., cold palms of the hand, etc.). 15.

Sveda should be applied unto a patient in a covered and windless place and after the complete digestion of his ingested food, and after having anointed his body with a Sneha. During the application of Sveda (to the eyes and to the heart) the eyes of the patient should be (first) covered with something cold (e.g., lotus leaves, etc.) and the heart should be constantly touched with something cold (e.g., cold palms of the hand, etc.). 15.

After a full and complete application of Sveda, the (body of the) patient should be well rubbed with a Sneha (oil, etc.) and a hot bath should be prescribed. The patient should then be made to keep his body well covered (with warm clothes) and be removed to a windless chamber (immediately afterwards). The diet should consist of such articles as would not produce any internal secretion (in the channels of the system) and he should observe, if necessary, the other rules of conduct (enjoined in such cases). 16.

After a full and complete application of Sveda, the (body of the) patient should be well rubbed with a Sneha (oil, etc.) and a hot bath should be prescribed. The patient should then be made to keep his body well covered (with warm clothes) and be removed to a windless chamber (immediately afterwards). The diet should consist of such articles as would not produce any internal secretion (in the channels of the system) and he should observe, if necessary, the other rules of conduct (enjoined in such cases). 16.

(instead of Udara in general) as unfit for Sveda and this is consistent with the treatment prescribed by Sus'ruta himself in Chapter XIV, Chikitsita Sthána. Thus ends the Thirty-second Chapter in the Chikitsita Sthánam of the Sus'ruta Sambitá which treats of the applications of Sveda.

(instead of Udara in general) as unfit for Sveda and this is consistent with the treatment prescribed by Sus'ruta himself in Chapter XIV, Chikitsita Sthána. Thus ends the Thirty-second Chapter in the Chikitsita Sthánam of the Sus'ruta Sambitá which treats of the applications of Sveda.

CHAPTER XXXIII

Now we shall discourse on the treatment of the distresses which prove amenable to the use of purgatives and emetics (Vamana-Virechana-Sádhyopadrava). 1.

The principal maxims to be followed are to augment the loss or deficiency, to pacify the aggravation and reduce the increment of the Doshas and maintain them in a state of healthy equilibrium. Emetics and purgatives are the principal remedies in cleansing the system of all the Doshas (morbific principles). Now hear me, therefore, discourse on the mode of their administration.

The body of the patient should be first anointed with a Sneha (oil, etc.) and Sveda should then be applied thereto. He should then be made to partake of meals which would produce internal secretions from the system, so that all the Doshas (morbific diathesis, etc.) accumulated in the organism would be loosened and dislodged from their seats. Thus having observed the liquefaction and dislodgment of the Doshas (morbific diathesis) from their locations, the physician should feed the patient to his satisfaction, if he be found to be sufficiently strong with a strong digestive capacity and habituated to the use of emetics, but troubled with a plethora of Doshas and subject to serious diseases (Mahá-vyádhi), telling him at the same time that an emetic medicine will be given to him on the day following.

Memorable Verse :- An emetic medicine does its fullest action, when given to a man after having

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Chap. XXXIII ] CHIKITSA STHANAM.

be inferred from the flow of perspiration (Sveda) that would ensue. The patient should then be made to sit on a seat as high as his knees and as soon as he would feel the least tendency to vomit, the attendants should be told to catch hold of his waist, sides, back, throat and forehead. Then a finger or the stem of (a leaf of) a castor plant or of a lotus should be inserted down his throat and the patient should be made to fully eject the contents of his stomach until the symptoms of satisfactory vomiting would fully appear. 6.

Memorable Verses :-

The symptoms of an imperfect emesis are water-brash (Kaphapraseka), sticking secretion or sensation of impurity in the regions of the Hridaya (heart) and itching sensations. An excessive discharge of the Pitta, the loss of consciousness, pains in the throat and in the region of the heart are the features which mark excessive or over-vomiting. The indications which characterise the perfect and satisfactory action of an emetic remedy are the free emission of Pitta after that of Kapha, a light and pleasing sensation in the heart, the throat and the head, a lightness of the body and the complete cessation of the emission of Kapha (mucus). 7.

Thus having observed the symptoms of a satisfactory emesis, the patient should be advised to inhale the fumes (Dhuma) of a (burning) drug of either the Snehana, Vairechana or Sámana (soothing) virtues in such doses as he could conveniently take and to observe the proper regimen of diet and conduct. 8.

Memorable Verses :-

Then having washed his body with tepid water and having perceived him to be in a pure state of mind and body the patient should be advised to take his evening meal with the soup of Kulattha or of Mudga or of Adhaki or with the soup

568 THE SUSHRUTA SAMHITA.

of the flesh of any Jangala animal.* A person treated with emetics (at regular intervals) by cough, accumulation cf Kapha in the throat, loss of voice, somnolence, drowsiness, fetid smell in the mouth, evil effects of poisoning (other supervening distresses of Kapha—D. R.), water-brash and lienteric diarrhœa (Grahaṇi). The (accumulated) Kapha of the system having been ejected by vomiting under a course of emetic treatment, the possibility of all Kapha-origined affections is removed, just as a felled tree soon dries up together with all its twigs, fruits and flowers. 9-10.

Cases where emesis is forbidden :-

Emesis or the exhibition of emetics is forbidden in cases of Timira (cataract, upward determination of the Váyu in the body (Urdhva-váta), Gulma, Udávarta, abdominal dropsy, enlargement of the spleen, worms (in the intestines) and urinary complaints, as well as in respect of fatigued, corpulent, thirsty, hungry, emaciated and too old persons and of infants, Kshata-kshina patients and those suffering from a loss of voice and in respect of those also who are of studious habits or are capable of being treated with a strong emetic and that only with the greatest difficulty.

It should be never resorted to in cases of Hœmoptysis and obstinate constipation of the bowels and in the case of an enciente and after the application of a Niruha-vasti. It should not be applied in an extremely dry or parched condition of the organism† as well as in simple diseases due to the Váyu.

• The diet of the patient who has taken an emetic should be very carefully prescribed inasmuch as his digestive capacity is liable to become very weak in such cases.

† Persons afflicted with cataract or blindness, Gulma, facial paralysis, convulsion (Ákshepaka), jaundice, ascites, hæmorrhoids and corpulency

To induce vomiting with an emctic medicine in the (aforesaid) diseases in which it ought not to have been resorted to is likely to give an irrecoverable turn to those diseases. Emetics should not, therefore, be applied in such cases. To induce vomiting, however, with the help of the decoction of Madhuka (Yashti-madhu)* is not forbidden even in these cases, if the patient be suffering from indigestion or from an extremely aggravated condition of the deranged Kapha as well as from poisoning symptoms. II-12.

Cases where emesis is recommended :-On the other hand, vomiting or the exhibition of an emetic is recommended in cases of poisoning, in wasting diseases (S'osha), in the derangements of the breast-milk, in precarious or sluggish (Vishama) appetite, in insanity, in Apasmára (hysteric convulsions), in Elephantiasis (S'lipada), in Vidáriká, in tumours (Arvuda), in obesity, in Meha (urinary complaints), in cases of slow chemical poisoning (Gara-dosha` in the system, in fever, in aversion to food, in scrofula (Apachi), in mucous dysentery, in heart-disease, in distraction of the mind, in erysipelas, in inflammatory abscesses (Vidradhi), in indigestion, in water-brash, in nausea, in asthma, in cough, in Pinasa (catarrh), in fetid smell of the nostrils (Puti-nása), in inflammations of the lips, throat and mouth,† in (fetid) discharges from the ears, in Adhi-jihviká, Upa-jihviká and Gala-s'undiká as well as extremely old men and Kshata-kshina patients should not be treated with emetics (lit. should not be caused to vomit).--D. R. * Jejjata explains Madhuka to mean honey. He means to say that vomiting should be induced with honey and water. † Some read here "Kushtha, Galaganda, Prameha and S'opha (swelling)" but as Meha is mentioned above separately it seems to us that that reading is not a good one.--Ed.

570 THE SUSHRUTA SAMHITA.

Mode of administering purgatives :-Purgatives should also be administered to a patient after the due application of Sneha (oil, etc.) and Sveda (for a second time) after the administration of an emetic. O.1 the day before the administration of the purgative, the patient should be told that a purgative should be given to him the next morning. He should at this time be provided with a light repast followed by potions of hot water and (the expressed juice of) acid fruits. On the next morning an adequate dose of the (purgative) medicine should be administered after clearly ascertaining that the patient's body has been cleansed of all mucous (Śleshmá) accumulations and in the manner laid down in the Áturopakramaniya chapter (Chapter XXXV. of tho Sutra-sthána).

Classification of Koshtha :-Koshtha (bowels) may be grouped under three heads as mild or easily movable (Mridu); middling or moderately constipated (Madhya) and hard or constipated (Krura).

The first kind (Mridu) of the Koshtha should be ascribed to the abundance of Pitta therein and can be moved even with milk only; the last (Krura) is ascribable to the action of an abundance of Váyu and Kapha and can be moved only with the greatest difficulty; while the second, Madhayama, should be held as the product of a condition of equilibrium among the (three) Doshas and this is the most general type.

• Dallana says that some commentators do not read this part, but they say that the necessity of applying emetics is mentioned in each particular case where required.

should be administered in small doses to persons of lax bowels (Mridu Koshtha), in moderate doses to those of moderately constipated bowels (Madhayama Koshtha), and in large doses to persons of extremely constipated bowels (Krura Koshtha). After having taken a purgative the patient should think of nothing else but purging and when passing his stool he should not go far from his bed-side.

Metrical Texts :-He should at this time lie in a windless chamber, foregoing the use of cold water and exposure to cold wind, and should not repress any urging (towards stool) nor should he strain. Emission of urine, stool, Pitta, the (purgative) medicine and lastly of Kapha consecutively follow under a course of purgative, in the same manner as an emission of saliva, the (emetic) drug, Kapha, Pitta and lastly of Váyu are consecutively ejected under the course of an emetic.

16-17.

Memorable Verses :-An aggravation of the Kapha and Pitta, a burning sensation in the body, an aversion to food, heaviness of the limbs and impaired digestion (Jassitude—D. R.) are the effects of an improper application of a purgative. Heaviness of the Kukshi and of the heart, itching and burning sensation, and the retention of stool and urine are the symptoms which follow in the wake of a purgative medicine which has failed to satisfactorily open and cleanse the bowels. Loss of consciousness, prolapsus of the anus, aggravation of the bodily Kapha and Sula colic pain in the intestines) result from an act of over-purging. A sense of lightness about the region of the umbilicus* and hilarity of the wind due to the discharge of the dis-

• In place of "माघ्या लघुत्व" some read "लाघवां जडुत्वे" which means "a sense of lightness and lassitude".

tempers connected with the Kapha (mucus, stool, etc.) and restoration of the bodily Váyu to its normal condition due to the discharge of the (deranged) Váyu (from the system) are the symptoms which mark the satisfactory action of a purgative medicine.

18.--A.

Diet :--No liquid food or Peyá should be given to the patient on the day in the event of his not being properly purged and not being feebled (with purging) and in the event of his impaired digestion (after the use of a purgative). A light and lukewarm Peyá should, however, be given to him in small doses, whenever he would feel weak and thirsty after the proper exhibition of a purgative medicine.

19-B.

Benefits of proper purgation :-Cleanness and expansion (Prasáda) of the intellect, firmness of the organs and of the Dhátus (root-principles) of the body, increase of energy (Bala)*, improved digestive capacity and a late or delayed old age are the blessings which follow a proper administration of purgative remedies. The deranged Pitta of the system, having been fully removed (with the help of a purgative), precludes the possibility of the existence of any Pitta-orignied complaint, just as the waters of a tank or any other reservoir of water, having been fully baled out, bar against the possibility of the existence of all aquatic animals and plants living therein.

Persons who should not be purged :-Exhibition of purgatives are prohibit d in respect of persons of impaired digestion, or of those treated with an excessive application of any emulsive remedy (Sneha-Karma), or of those who are exceedingly corpulent, too old, fatigued, thirsty or intoxicated, or of those suffering from any ulcer. They are similarly prohibited in

• Vrinda does not include "Bala" (energy) in the list.

CHIKITSA STHANAM

Chap. XXXIII.]

respect of frightened persons and Kshata-kshina patients or of those afflicted with hæmorrhage from the downward orifices of the body or of persons with any dart or foreign matter (śalya) lying imbedded in the organism as well as in respect of infants and enciente.

A purgative medicine should not be administered before the digestion of a meal previously taken, neither in the diseases due to an abuse of wine, nor in acute catarrh and acute fever or to a newly parturient woman and persons not previously treated with a Sncha (oil or Ghrita).

A mild purgative may, however, be administered (in cases of emergency) to a person of extremely Pitta-predominant temperament.

Purgatives administered by ignorant physicians to persons who ought not to be purged (often) prove fatal.

Persons who should be purged :- The distempers of the body in which a purgative should be exhibited with good results are :-fever, effects of slow chemical poison (retained in the system), an aversion to food, hæmorrhoids, tumours (Arvuda), ascites (Uda.ra), glandular swellings (Granthi), abscess (Vidra.dhi), jaundice, hysteric convulsions (Apasmára), heart-disease, Váta-rakta, vaginal or uterine diseases, fistula-in-ano, vomiting, crysipelas (Visarpa), Gulma, pain in the Pakvás´aya (intestines), retention of stool, Visu.chiká, Alasaka, strangury (Mutrágháta), cutaneous affections (Kushtha), Vishphotaka (carbuncle, etc.), Prameha, distension of the abdomen with the suppression of stool and urine (Ánáha), enlargement of the spleen, œdematous swellings (Śopha), Vriddhi (enlargement of the scrotum, etc.) and kindred complaints, ulcers inflicted by weapons, alkaline scalds and burns, malignant ulcers, (Dushta-vrana), inflammation of the eyes (Akshi-páka), Kácha, Tímira, conjunctivitis (Abhishyanda), burning

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The (aggravated) Doshas accumulated in a large quantity in the organism of a weak patient and found to be dislodged from their seats should be gradually expelled from the system, while soothing (S'amana) remedies should be used in cases of the Doshas being very slight, even if they be found to have been dislodged from their seats. The aggravated Doshas matured and spontaneously dislodged (from their seat or place of accumulation in the system) should be purged off, whether the patient be strong or weak, inasmuch as, if neglected (and not expelled from the system), they (Doshas) tend to produce lasting troubles.

A purgative should be administred to a patient of impaired digestive capacity and extreme habitual constipation of the bowels (Krura-koshtha) after having improved his digestion with the admixture of rock-salt, Yava-kshdra and clarified butter and after applying Sneha and Sveda (as usual). A purgative remedy used after a due application of Sneha and Sveda to the body, leads to the looseness and dislodgment per force of the aggravated Doshas from their seats, since they do not adhere to the internal channels and passages just as a drop of water does not adhere to a pot or vessel saturated with a Sneha. An oleaginous purgative should not be given to persons who have already taken internally* an abundant quantity of Sneha, as it would tend to make the aggravated Doshas of the body dislodge from their seats and again adhere to the internal channels and passages.

25-26, 27-28.

An excessive quantity of Sneha should be used in cases of poisoning, hurt, pustular eruptions (Pidaká),

• Vrinda reads "मतिक्रि न्धकायस्य" in place of "मतिक्र हपौतस्य". This means that the Sneha might have been used both internally and externally.

œdema and cutaneous affections before the application of purgatives or emetics. The body of a patient, habituated to the use of oleaginous articles (Sneha), should be first made dry (Ruksha). Sneha should then be used again as usual and purgatives or emetics applied. The aggravated Doshas would be thereby expelled from the system and the patient would grow stronger*. 29-30.

Mild emetics and purgatives should be given at the outset to a person to be treated with such medicines, who had never taken any purgative or emetic before. Emetics and purgatives should then again be administered to him, after thus finding out the state and nature of his Koshtha (bowels). An emetic or purgative medicine of tested efficacy and which is pleasant, aromatic, agreeable and small in dose but of mighty potency should be given to a king ; (in addition to these qualities) the medicine should be such as would not produce any serious injury. 31-32.

The body (health) of a patient to whom a purgative or emetic medicine is administered without first applying Sneha and Sveda thereto breaks up like a piece of sapless wood at the time of bending it. The aggravated Doshas dislodged from their seats in the organism through the effects of Sneha and Sveda and stirred by emollient food† are easily expelled by emetics and purgatives. 33.

Thus ends the Thirty-third Chapter of the Chikitsita Sthánam in the Sus'ruta Samhitá which deals with the treatment of diseases amenable to the use of emetics and purgatives.

• Vrinda reads "चो हि वसन्ना" in place of "बलवद्न ना". This means that the Doshas, so long obstructed by Sneh?, are thereby expelled.

† Some explain "अन्ने: क्विपे:" to mean "with emollient meat-soup".

CHAPTER XXXIV.

Now we shall discourse on the treatment of the disorders resulting from an injudicious use of emetics or purgatives (Vamana-Virechana-Vyápach-Chikitsitam). I.

Their Classes :—Fifteen different kinds of disorders may result from an injudicious use of emetics and purgatives owing to the ignorance of the physician or of the patient. Of these (fifteen), the upward coursing in casesof purgatives and the downward coursing in cases of emetics are peculiar to each of them respectively.

The fourteen other remaining disorders (Vyápat) are common to both. They are Sávaśeshaushadhatva (continuance of the drug in the stomach), Jirnausha-dhatva (complete digestion of the medicine), Hina-doshápahritatva (insufficient elimination of the Doshas from the system) Adhika-doshápahritatva (excessive elimination of the Doshas from the system), Váta-súla (Vátaja colic), Ayoga (insufficient dosage), Ati-yoga (over dosage), Jivyádána (hæmorrhage), Ádhmána (tympanites), Pari-kartiká (cutting pain in the anus, etc.), Parisráva (oozing out of stools), Praváhiká (diarrhœa), Hridayopasarana (rising of the Doshas towards the heart) and Vibandha(suppression of stool and urine). 2.

Causes and Treatment :—An emetic taken by a hungry or a weak person or by one possessed of a very keen digestive capacity (Tikshnágni) or of lax bowels (Mridu koshtha), naturally drops down into the intestines in virtue of the identical nature and intensity of their attributes, in the event of its being retained in the stomach, even for a short while. A failure of the medicine to produce the wished-for result

578 THE SUSHRUTA SAMHITA.

and a further stirred or agitated condition of the aggravated Doshas are the effects thereof. In such a case Sneha (and Sveda) should be again applied and a stronger emetic administered. 3. An obnoxious and large-dosed purgative taken by a person with a residue of a previous meal remaining undigested (in the stomach) or with an aggravated Kapha or with a disordered stomach (Ámás'aya), is forced upward and is ejected through the mouth. In a person of disordered stomach the accumulations (Kapha) in the stomach should be first speedily ejected with an emetic and a stronger purgative should then be administered. A case where the food remains still undigested (in the intestines) should be treated (with fastings and digestants) as in a case of mucous diarrhœa.

A pleasant or tasteful purgative should be given in a moderate dose in the event of a previous one having been ejected on account of its obnoxious taste and abnormal dosage. A third dose should not be given in the event of the second also being not retained in the stomach. At this stage, purging should be effected with the help of a lambative (Leha) prepared with honey, clarified butter and treacle. 4. Sávas'eshaudhatva (Evils of an unpurged residue of a purgative or emetic) :-A small dose of medicine, whether an emetic or a purgative, if it is absorbed by the deranged Doshas of the body and retained in the system, cannot produce the wished-for result of cleansing the system.

In such a case, it gives rise to thirst, pain in the sides, vomiting, epileptic fits, nausea, piercing or breaking pain in the joints, aversion to food, impure eructations, and such like symptoms. The patient in such a case should be made to vomit the contents of his stomach with draughts of

Jirnaushadhatvam

Evils of a digested purgative, etc.

Evils of insufficient or excessive expulsion of the Doshas

580 THE SÜSHRUTA SAMHITA. [Chap. XXXIV.

fect or partial expulsion of the Doshas from the system under the administration of a purgative remedy. The remedy in such cases should consist in inducing stronger purgings after a further application of Sneha and Sveda to the patient. A mild medicine should be administered on the third day to a strong-limbed patient, if there be a large quantity of dislodged agitated Dosha in his system. 7.

Váta-s'ula (Flatulent colic) :-

The bodily Váyu become enraged or agitated by the use of parching (Ruksha) medicines by a person who has not been treated with a previous application of Sneha and Sveda or by one who does not observe a total abstinence in sexual matters. The Váyu thus enraged tends to produce a kind of pain (S'ula) in the sides, waist (S'roni), back, tendons and the (principal) Marma (heart) and brings on vertigo, epileptic fits and loss of consciousness. The remedy under such circumstances consists in anointing the patient's body with oil or clarified butter, fomenting it with (hot and half-boiled) paddy (Dhánya-Sveda). An oil cooked with Yashti-madhu should then be employed as an Anuvásana-Vasti. 8-A.

Ayoga (Partial and deficient medication) :-

A mild or an insufficient dose of an emetic or purgative, administered without a previous application of Sneha and Sveda to the patient, fails to find an outlet either through the upper or the lower fissures of the body and hence brings about an aggravation of the Doshas incarcerated in the organism and produces a loss of strength (Bala), as well as tympanites with a catching pain in the chest (Hridaya-graha), thirst, epileptic fits and a burning sensation in the body. This is called Ayoga. The remedy in such cases should consist in inducing, without any delay, vomiting with powdered Madana

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CHIKITSA STHANAM

Chap. XXXIV.]

and Durvá grass subsequently cooled and mixed with the cream of clarified butter and Anjana, should be syringed into the rectum in the manner of an Asthá-pana-Vasti in the case of an excessive flow of red blood (lit. life-blood) from the bowels. Vasti should be employed in such cases, with a decoction of the Nyagrodhád di group mixed with milk, clarified butter, expressed juice of sugar-cane and (goat's) blood. Remedies mentioned under hæmoptysis (Rakta-pitta) and bloody dysentery should be employed in cases marked by spitting of life-blood (Jiva-sonita). Decoctions of the drugs of the Nyagrodhád di group should be given with food and drink.

Jiva-Sonita, how to be known :-A piece of a linen or cotton should be soaked in (and dyed with) the emitted blood where any doubt would arise whether it is a case of arterial blood (Jiva-s'onita) or one of Rakta pitta. The continuance of the dye or red stain on the linen even after being washed with hot water would conclusively establish its identity with the arterial blood or Jiva-s'onita. As an alternative, the discharged blood mixed with barley-powder or any other kind of food should be given to a dog to eat. If it is eaten by the dog, it would at once establish the identity of the emitted blood with the healthy arterial blood of the organism.

Adhmána (flatulent distention of the abdomen):-If a person who is suffering from a plethora of the Doshas in his system and who has not previously been treated with a Sncha and whose bowels still contain the undigested residue of a previous meal and (consequently) an abundance of Váyu therein, takes a (purgative or an emetic) which is neither emollient nor hot the medicine is likely to produce a flatulent distention of his abdo-

74

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Chap. XXXIV.] CHIIKITSA STHANAM.

587

(emetic or purgative) medicine. The Doshas (conse-

quently) try to pass out of the body constantly but in

small quantities and bring on weakness, numbness and

rigidity of the abdomen, aversion to food and lassitude

of the limbs. The deranged Pitta (bile) and Kapha

(mucus) are constantly emitted with pain (through the

anus) in such a case, and the disease is called Parisrava.

Asthapana-vasti with a decoction of Aja-karna, Dhavd,

Tinis'a and Palasa saturated with honey is recommended

in such cases. After the subsidence of the bodily

Doshas involved in the case, the patient should be

treated with Sneha and Samsodhana * (emetic or

purgative) remedies should again be employed.

Pravahika (Diarrhœa) :-A medicine (purgative

or emetic) administered to a person who has been

excessively treated with Sveda or with Sneha produ-

ces Pravdhikd in him by making him pass his stool

and flatus without any straining or by restraining

altogether those natural urgings respectively. Constant

passing of slimy, black, white or red-coloured mucus

(Kapha) with cramps, loud flatus and burning sensation

form the chief characteristics of this disease. Its medical

treatment should be similar to that of a case of

Parisrava.

Hridayopasarana (Overwhelming the heart) :

-Urgings towards vomiting or purging being injudi-

ciouslyly checked by a person from ignorance, causes

a downward or upward coursing of the Doshas of the

body to and in the heart, thus pressing the greatest of the

Marmas and giving rise to an excruciating pain in that

locality. The patient, in such a case, drops down

unconscious in a swoon with upturned eyes, violently

• Dallana recommends that a strong purgative or emetic should be

employed.

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Saindhava, Kanjika and cow's urine in cases of the retention of the stool, etc., due to an abuse of a purgative. Proper Asthapana and Anuvasana Vastiis should be prescribed in consideration of the nature and intensity of the Doshas involved in the case. The nature of the diet should be judiciously determined according to the nature of the Doshas The supervening distresses in both the cases should be remedied with due consideration of the nature of the Doshas originating them.

20

The cutting pain in the anus in connection with purging corresponds to the digging in the throat in a case of vomiting. The oozing out of the faecal matter downward (Parirava) in connection with a purgative corresponds to the water-brash in the case of an emetic. What diarrhoea (Pravahika) is to purging, a dry eructation is to vomiting.

21

Memorable Verse :-The fifteen kinds of distempers (Vyapat) described in the present chapter originate through an excessive, injudicious or insufficient use of purgatives or emetics.

22

Thus ends the Thirty-fourth Chapter of the Chikitsita Sthanam in the Sus'ruta Sambita which deals with the treatment of the disorders resulting from an injudicious use of purgatives and emetics.

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4. Memorable Verse :-The length of the pipe and the quantity of the fluid to charge with should be gradually increased with the progress of the patient's age and in consideration of his strength and bodily capacity.

592

5. The pipe of a Vasti in respect of an adult above twenty-five years of age, should be made twelve fingers in length having a girth equal to that of his thumb at its base and a girth equal to that of the small finger at its mouth. At a distance of three fingers from above the mouth the Karnikás should be fixed. The bore should be such as to allow a feather of a vulture to pass through it, while the fissure at the mouth would have a girth to allow the stone of a Kola fruit or of a boiled Kaláya pulse. The pipe should in all cases be supplied with two Karnikás at its root, for the purpose of firmly securing it to the mouth of the Vasti (bladder). The quantity of the fluid to charge with in the case of an Ásthá'pana Vasti is twelve Prasritas.

The length of the pipe in respect of persons above seventy years of age should be like that in the preceding case but the quantity of the fluid to charge with should be made as in the case of a youth of sixteen.

7. Materials of the pipes :-The pipe should be made either of gold, silver, copper, iron, brass, ivory, horn, gems or wood. It should be straight, smooth and firm, tapering at the top like the tuft of hair in the tail of a cow, and bulbar (i.e., not pointed) at its mouth. The Vasti * should be (prepared with) the * The Vasti is so called from its being prepared with the bladder (Vasti) of an animal. Dallana notes in this connection that the bladder

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diatheses) from the system and from its curing the diseases of the body ; while Asthápana is so named from its virtue of rejuvenating the organism or producing longevity. The process of Madhu-tailika would be described in connexion with the mode of applying a Niruha-vasti. 10.

The Anuvásana is only an alternative of a Sneha-Vasti, but (with this difference that) the quantity of the fluid to charge with should be three-fourths, and the amount of the good effect therefrom would also be three-fourths. An Anuvásana-vasti is so called from the fact of its not injuring the system even in the event of its being retained in the bowels a whole day, or from the fact of its being adapted to daily application. The Mátra-vasti again which is applicable in all cases, is an alternative to an Anuvásana-vasti, but should be charged with only a half part of the fluid of that used in an Anuvásana-vasti. 11.

Metrical Texts :-A Niruha-vasti acts as a cleanser of the system (Sodhana). It is anti-fat (Lekhàna), emulsive (Snehana) and constructive (Vrimhana). Oleaginous matter (Sneha) may freely enter into the organism when all its ducts and channels have been previously cleansed by the application of a Niruha-vasti. As water will freely run through channels previously cleansed of all refuse matter, so does an Anu-vásana tend to cleanse the organism of all Doshas (morbific diatheses) and to increase the vitality of the organism. A Sneha-vasti should, therefore, be applied to a person previously purged of all Doshas by the application of a Niruha-vasti. 12.

Both the Anuvásana and the Ásthapána Vastis should be regarded as forbidden in cases of insanity, in the mental conditions of terror and grief, of a thirsty state of the body, of aversion to food and of indigestion, jaundice

Chap. XXXV.] CHIKITSA STHANAM.

595

(Pándu), giddiness, delirium, epilepsy, vomiting, Kushtha, Meha, ascites, obesity, asthma, cough, dryness of the throat and œdema as well as in respect of a Kshata-Kshina patient and a pregnant woman in (and before) the third or the fourth month of her gestation, in the case of a person suffering from dulness of appetite, impatient and incapable of bearing the least pain as well as in respect of infants, old men and persons emaciated by a bodily distemper other than one due to Váyu 13.

Metrical Text :-The Asthápana-vasti should be exclusively applied in cases of ascites, urinary complaints (Meha), Kushtha and obesity. The application of an Anuvásna-vasti is entirely forbidden in those cases inasmuch as it might make the disease run into an incurable type, and a great amount of lassitude of the organism would be the consequence. 14.

Medicine duly injected (through the rectum) with the help of a Vasti remains in the intestines(Pakvás"aya), in the region of the pelvis and below the umbilical region. The potency of the Vasti (medicine) spreads over the whole organism from the intestines (Pakvás'aya), just as the potency of the water poured at the root of a tree tends to permeate the whole tree (through its minutest cells and fibres). The liquid part of the Vasti is emitted out through the rectum either by itself or with the fæcal matter, etc.*, but its potency acts over the whole organism through the intervention of the Apána and the other Váyus. The potency of the Vasti in the Pakvás'aya acts on the whole organism from top to toe, like the sun in the heavens acting on the humidity (Rasa)

• Srïkantha Dutta in his commentary quotes this sloka, but he reads there "मलापः" (with Kapha) in. the place of "मलस्थ" with the fæcal matter, etc.). The reading in the text, however, is preferable inasmuch as Kapha is included in Mala.

of the earth below. The Vasti, if duly applied, tends to eliminate completely from the system all the Doshas (morbific diatheses) accumulated in the regions of the back, waist and the abdomen (Koshtha). 15-A. As the aggravation of all the Doshas (morbific principles) of the body is principally dependcnt on the derangement of the bodily Váyu ; an aggravated condition of the latter may hence lead to the dissolution of the body, and consequently the application of a Vasti, and nothing else, is the only means of coping with the aggravation of the Váyu (by subduing and restoring it to its normal condition), just as the sea-coast is the only barrier to the swollen and wind-agitated surf of the sea. A well-applied Vasti contributes to the growth, health, strength and longevity of the body and to the improvement in its complexion. 15.

The different defects of a Vasti :-Now we shall deal with the defects and the civil effects which are consequent upon the wrong and injudicious application of a Vasti. The defects of wrongly handling a Vasti (Pranidhána-dosha) are six in number, viz., the pipe may shake or revolve ; it may also be pressed side-wise or thrown upwards ; and it may sink down or may be pressed slantingly. Excessive thickness, coarseness, bending down, narrowness, cleavage, nearness or distance of the tying bands (Karnikā), narrowness or excessive width of its internal aperture, excessive length or extreme shortness are the eleven defects which the pipe of a Vasti (Netra-dosha) may have.

The different defects of a Vasti :-Now we shall deal with the defects and the civil effects which are consequent upon the wrong and injudicious application of a Vasti. The defects of wrongly handling a Vasti (Pranidhána-dosha) are six in number, viz., the pipe may shake or revolve ; it may also be pressed side-wise or thrown upwards ; and it may sink down or may be pressed slantingly. Excessive thickness, coarseness, bending down, narrowness, cleavage, nearness or distance of the tying bands (Karnikā), narrowness or excessive width of its internal aperture, excessive length or extreme shortness are the eleven defects which the pipe of a Vasti (Netra-dosha) may have. The five objectionable features in the bladder (Vasti-dosha) are an excessive flabbiness, narrowness, width of its internal aperture, leakiness and an imperfect bending at its mouth (neck). Variation in pressures put upon a Vasti (Enema syringe) during its application may be attended with any of the

Chap. XXXV.] CHIKITSA STHANAM.

four objectionable features (Pidana-dosha) viz., over-pressure (pressing the injection into the rectum with an injuriously excessive force), under-pressure, repeated pressures and pressure at long intervals. The eleven defects in the ingredients of the Vasti (Dravya-dosha) are insufficient cooking, excessive or insufficient quantity, extreme coldness, excessive heat, extreme keenness of potency, excessive mildness, excess or want of oiliness (Sncha), extreme thickness of consistency and over-fluidity. Lying with the head raised up or hung down or in a bent or sitting posture or resting on one's back or in a contracted posture or on one's right side are the seven defective postures (Sayyá-dosha) in which a patient should never be laid during the application of a Vasti. These are the twenty-four defects which attend the wrong application of a Vasti owing to the ignorance or inexperience of a physician, while those which are the effects of the injudiciousness of a patient are fifteen in number and would be described in the chapter on Átropadrava-Chikitsita (Chapter XXXIX, Chikitsita-sthána). 16.

The Sneha injected into the bowels by a Vasti is obstructed in its passage and cannot consequently leave the system but is retained in it through any of the following eight causes, viz., obstruction of the food by the three Doshas, its admixture with the fæcal matter (accumulated in the bowels), its being injected too high up into the intestines, an omission to foment (the patient's body), using the Sneha in a cold state or in a small quantity and lastly use of no meals or of scanty meals by the patient previous to the application of a Vasti. These (retentive conditions) are due to the indiscretion of both the physician and the patient. Nine distressing symptoms (Vyápad) namely

598 THE SUSHRUTA SAMHITA. [Chap. XXXV.

as a defective application of either the Anuvásana or the Ásthá́pana Vástis, distension of the abdomen, (Ádhmána), a cutting pain in the region of the anus, (Parikartiká) Dysenteric stools (Parisrá́va), diarrhœa (Praváhiká), affecting the heart (Hridayaopasarana), catching pain in the limbs, over-dosage, hæmorrhage manifest themselves in consequence of any act of indiscretion of the physician in attendance. 17.

Memorable Verse :-The seventy-six kinds

of the distressing symptoms (Vyápad) have been briefly described above. Their symptoms and treatment would be described in the following chapter. 18.

Thus ends the Thirty-fifth Chapter in the Chikitsita Sthánam in the

Sus'ruta Sambitá which deals with the dimensions, classifications and therapeutical applications of a Netra and a Vasti.

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Pichchhila-Vastis should be employed in such a case. The application of a Vasti with a pipe of small length or narrow calibre produces pain, and the injected fluid dribblcs out (without entering into the rectum), thus occasioning all the maladies* which attend an insufficient or abortive use of a Vasti†. In the event of the pipe being large and wide-calibred one, the result would be that a large quantity of the fluid would be at once injected into the bowels just as in a case of Avapida-dosha (constant pressing).

2. Disorders resulting from a defective bladder :-The effects which result from the use of a bladder (Vasti) too large or too thick are identical with those which follow from an imperfect fitting of its neck with the pipe. A (proportionately) smaller efficacy is obtained from the use of a small bladder : capable (necessarily) of injecting a smaller quantity of the medicinal fluid. An imperfectly fixed bladder or the one with small pores therein produces effects similar to those resulting from the use of a cracked pipe.

• These are strangury (Mutra-krichchhra), suppression of urine (Mutrá-ghata), etc.

† According to Dallana the remedy in this case would be that applicable in a case of Mutrágháta, etc ; but Jeijata holds that the remedy lies in applying a Pichchhila Vasti as in the preceding case.

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Ayoga :-Cramps or colic pains (Sula) in the intestines, and heaviness and distension of the abdomen result from the application of a Vasti charged with a medicinal solution either cold, inadequate in quantity, or deficient in its therapeutic virtues. All these symptoms are included within the term Ayoga or deficient application of a Vasti which should be remedied by a strong Vasti and a strong purgative.

Distension of the abdomen and consequently an excruciating pain (Sula) in the regions of the sides, back, waist and the heart result from the applications of a Vasti to a person who has taken a second meal before the digestion of a previous one, or in the event of the presence of a large accumulation of Doshas (in his body). If the Vasti be applied in a tepid state and in a large quantity just after a heavy meal, the results would be the same. Similar results would follow injections of cold medicinal solutions in large doses saturated with only a small quantity of salt and Sneha (oil or clarified butter as well as from those in a person with a large accumulation of foecal matter (in his bowels). The remedy in all these cases should consist in the application of a Vasti charged with stronger medicinal solutions as well as of an Anuvasana-vasti.

The Pitta and the Váyu of the body are conjointly aggravated by the application of a Vasti charged with extremely parching, hot and saline solutions which give rise to the distress, known as Parikartiká, attended with a sort of cutting pain in the pelvis and about the anus and the region of the umbilicus. Applications of the Piohohhilá-vasti of a medicated Sneha cooked with the drugs of the Madhura group should be the remedies in these cases.

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ap. XXXVI.] CHIKITSA STHANAM.

A purgative should be given after the lapse of a fortnight from the date of the exhibition of an emetic drug. An Ásthá­pana­vasti should be applied a week after the date of purging. An Anuvásana­vasti should also be applied on the very same day.

607

Thus ends the Thirty-sixth Chapter of the Chikitsita Sthánam in the Sus'ruta Samhitá which treats of the medical treatment of the diseases consequent on the injudicious applications of a Vasti.

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four times their combined (weight) and milk weighing twice and water, four times as much as the oil. The use of this medicated oil as a Vasti-measure proves curative in pacifying the incarcerated Váyu and in cases of hæmorrhoids, lienteric diarrhœa (Grahani), tympanites with retention of stool aud urine, Vishama-jvara and the affections of Váyu (nervous disorders) in the waist (lumbago), the thighs (sciatica), the back and the abdomen.

Second Taila:- Vachâ, Pushkara, Kushtha, Elâ, Madana, Deva-dáru, Saindhava, Kákoli, Kshira-Kákoli, Yashti-madhu, Medá, Mahá-medá, Narádhipa (Áragvadha), Páthá, Jivaka, Jivanti, Bhárgi, Chandana, Katphala, Saralá (white Trivrit), Aguru, Vibhí, Vílaka, Asvá-gandhá, Chitraka, Vriddhi, Vidanga, Áragvadha, S'yámá Trivrit, Pippali and Riddhi should be pasted together and cooked with the proper quantity of oil, milk and the decoction of the drugs of the (major) Pancha-mula group. Anuvásana-vastis of this kind are highly efficacious in cases of Gulma, tympanites with suppressed stool and urine, impaired digestion, hæmorrhoids, lienteric diarrhœa (Grahani), retentions of urine and diseases due to the action of the deranged Váyu.

Third Taila :-Chitraka, Ativishá, Páthá, Danti, Vilva, Vacha, Ámisha (Guggulu), Sarald (white Trivrit), Ams'umati (Sálaparni), Rásná, Nilini, Chatur-angula (Áragvadha), Chavya, Ajamodá, Kákoli, the two kinds of Medá, Deva-dáru, Jivaka, Rishavaka, Varshá-bhu, Aja-gandhá, S'atáhva, Harenu, As'va-gandhá, Man-jishthá S'athi, Pushkara and Taskara (Choraka) should be pasted together and cooked with the proper quantity of milk and oil. The oil thus prepared is highly efficacious in the disorders of the deranged Váyu. In-jected into the bowels in the manner of (an Anuvásana-

Fourth Taila :-A decoction of the drugs Bhutika, Eranda, Varshabhu, Rasna, Vasaka, Rohisha, Bhargi, Shad-granthi (Vacha), Deva-daru, Valá, Naga-vala, Murvá, As'va-gandhá, the two Amritá (Guduchi and Haritaki), Saháchara, Vari (S'ata-vari), S'unthi, Káka-násá, Vidári Yava, Másha, Atasi, Kola and Kulattha should be cooked in an adequate quantity of oil with (a Kalka of) the drugs of the Jivaniya group and a quantity of milk weighing four times as much as the oil. The oil, if employed in the manner of a Vasti, would prove beneficial in cases of discases due to the action of the deranged Váyu localised in the regions of the thighs, legs, coccy (Trika), sides (Pársva), balls of the shoulders (Amsa) and in the hands, the head and Manyá (nerves of the neck).

Fifth Taila (with clarified butter):-The drugs Jivanti, Ativalá, Medá, the two kinds of Kákoli, Jivaka, Rishavaka, Ativishá, Krishná, Káka-násá, Vacha, Deva-dáru, Rásná, Madana, Yashti-madhu, Saralá (white Trivrit), S'atdvárl, Chandana, Svayam-guptá with an adequate quantity of oil and clarified butter (in equal parts) with a quantity of milk weighing eight times as much as the combined weight of the oil and clarified butter. This oil should be employed in the manner of an Anuvásana-vasti in cases of Gulma and retentions of stool and urine with a distension of the abdomen. It conquers the deranged Váyu and Pittá of the body, acts as an invigorating and constructive tonic, improves digestion, increases strength and creates fresh

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Nimba, Aragvadha, Shad-grantha (Vacha), Sapta-parna, the two kinds of Haridra, (Haridra and Daru-haridra), Guduchi, Indra-sura, (Indra-varuni), Pippali, Kushtha, Sarshapa and Nagara in equal parts (weighing one seer in all), should be cooked with an adequate quantity (four seers) of oil and (sixteen seers of) the decoction of the drugs of the Surasadi group. Obesity, a feeling of physical languor, itches, etc., as well as diseases due to the deranged condition of Kapha, readily yield to the use of this (medicated oil) employed as a medicinal snuff (Nasya), a gargle (Gandusha), a drink, or anointment, or as a Vasti.

Ninth Sneha :-A paste weighing one seer in all) composed of Patha, Ajamoda, Sarmgashta, Pippali, Gaja-pippali, Sunthi, Sarala (D. R.-Saptala) Aguru, Kaliya, Bhargi, Chavya, Deva-daru, Maricha, Ela, Haritaki, Katuka, Pippali-mula, Katphala pounded together and mixed with a decoction of the Valli * and the Kantaka each weighing twice as much as the weight of the oil, should be cooked with an adequate quantity of sesamum or castor oil (weighing four seers). All kinds of diseases due to a deranged condition of the bodily Kapha readily yield to the use of this (medicated) oil when employed in the manner of an Anuvasana enema (Vasti).

Tenth Sneha :-A pasted compound of Vidanga, Udichya, Saindhava salt, Sathi, Pushkara, Chitraka, Katphala, Ativisha, Bhargi, Vacha, Kushtha, Deva-daru, Meda, Madana, Yashthi-madhu, Sydma +

• The "Valli" and the "Kantaka" here evidently mean the "Valli-pancha-mula" and the "Kantaka-Pancha-mula" respectively for which see chapter XXXVIII. Sutra-Sthanam.

• Dallana explains "Syama" as "Vriddha-daraka" and "Renu" as "Parpataka".

Nichula (Jala-Vetasa), Nágara, S' atdáhvâ, Nilini, Rásná, Kadali, Vásaka, Renu, Vilva, Ajamoda, Pippali, Danti, Chavya, Naradhipa (Áragvadha) with the decoction of the drugs of the Mushkakádi group, should be cooked with an adequate quantity of sesamum or castor oil. The use of this oil in the manner of an Anuvásana-vasti (enema) speedily proves curative in cases of Plihodara (enlargement of the spleen), obstinate constipation of the bowels, Váta-Rakta, Gulma, retentions of stool and urine with a flatulent distention of the abdomen, in diseases due to the action of the deranged Kapha, in urinary complaints, gravels in the bladder (S'arkará) and in hæmorrhoids.

An Anuvásna-vasti may be applied in all parts of the day and night and even (if necessary) without any previous exhibition of emetics and purgatives, in the case of a patient in whose system the Váyu has been incarcerated and extremely aggravated. The application of a Nirudha-vasti (enema) should, however, be made in respect of a person of an extremely dry temperament, or in whose system the deranged and aggravated Váyu extremely predominates, only after his system had been made sufficiently emulcent (Snigdha) by two or three injections with an Anu-vásana-vasti. But if his system be agitated only with an extremely aggravated condition of his bodily Váyu, a Nirudha-vasti (enema), charged with a medicinal solution and with a profuse quantity of Sneha added therewith, may be applied even before applying a Sneha (Vasti). On finding that the Nirudha-vasti has fully acted, the physician should treat the patient with medicinal solutions of oils prepared with Yashti-madhu and Madana fruit respectively in the manner of an Anuvásana-vasti in cases of the aggravations of Váyu, etc.

A.Vasti should not be applied in the night since the Doshas of the system are (generally) aggravated at this time and since the Sneha (of the Vasti) owing to its potency is likely to give rise to a distention of the abdomen attended with fever and heaviness of the limbs. The mouths of the internal ducts of the body remain dilated and the Doshas remain in their proper places (i.e., are not generally agitated), and the digestive fire remains surcharged with the essence of the digestive food during the day time, hence the potency (Ojas) of a Sneha-vasti employed during the day time easily spreads through the ducts of the body. An Anuvasana-vasti may be applied during (the early part of) the night in summer in a case marked by a preponderance of the deranged Pitta and a (consequent) weakness of the Kapha, and an extremely parched condition of the organism, as well as in cases of the affections of Vayu (Vata-roga). Unfavourable symptoms such as a burning sensation in the body, etc., arise from the application of a Vasti in the day time during a preponderance of the Pitta, or in summer. The physician should, therefore, make such applications in the evening (Pradosha) in such instances.

Proper time for the application of the Sneha-vasti:-A Sneha-vasti should be employed during the day in spring and winter and in the evening during summer and the rainy season, with a view to ward off the dangers due to the misapplication in the internal use of a Sneha.* It may, however, be applied at any time during the day, or in the night in a case marked by a preponderance of the deranged bodily Vayu.

In the serious stage of a disease an Anuvasana-enema should be applied after the patient has partaken

• See Chapter XXXI.,C kitsita-Sthánam.

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The mode of applying a Sneha-vasti :-The body of the patient to be treated with an Anuvàsana-vasti should be first anointed (with a Sneha) and gently fomented with hot water. Then he should be advised to take his meal in the prescribed way and made to take a short walk. Then^ having passed stools and urine, he should be treated with the Sneha-vasti. The mode of applying (the apparatus) is described under that of Niruha-vasti. He should be kept silently lying on his back as long as it would take to count a hundred words (Vàk). The potency (Virja) of the injected Sneha spreads through the entire organism in the event of one's lying with outstretched limbs in the above manner after the application of a Sneha-vasti. The patient should be gently struck* three times on each of the soles and the palms of his hands and on the buttocks†. The (patient with his) bedding should be thrice raised (and shaken with gentle jerks). After that he should be laid on a bed stretched out at full length and be advised to speak and exert himself as little as possible and conform to a strict regimen of diet and conduct.

17-19. A quantity of S'atchvà and Saindhava should be mixed with the Sneha (to be used in the Vasti) and (the whole compoundy) applied lukewarm, inasmuch as the injected Sneha would thereby easily flow back (without producing any pain and burning sensation, etc.) and dribble

• Dallana explains that the patient should be caught hold of by his wrists and ankles and given the gentle jerks so as to allow the potency of the Sneha spread through the organism.

† Some explain that the buttocks of the patient should be raised up with his bedding and his couch. At any rate his buttocks should be raised up in order to enable the injected Sneha to remain inside the intestines and not to come out instantly.

CHIKITSA STHANAM

down in due time after the application. If at any time a quantity of the Sneha injected into the bowels in the manner of an Anuvásana enema (Vasti) is instantly driven back by the pressure of the incarcerated abdominal VÁyu or the VÁyu (air) of the bladder (Vasti), or by an excessive heat, keenness (in potency), or an over-dose of the injected fluid itself, or by the over dose of the medicines (subsequently) added thereto, a Sneha-vasti charged with a smaller dose of the Sneha should be again applied, since a Sneha un-retained in the abdomen fails to produce any emulsive effect. 20-21.

Retention of stool, urine and VÁyu (flatus) is produced by using an insufficient quantity of Sneha in an Anuvásana-vasti. A burning sensation in the body, diarrhœa (PravÁha) and fatigue accompanied with pain set in as the natural resultants of an excessive Anuvásana enema. The satisfactory nature of the application of an Anuvásana-vasti should be inferred from the timely discharge of the injected Sneha with flatus and fæcal matter out of the bowels of a patient without giving rise to any distressing symptoms such as burning and sucking + sensations, etc. 22.

The patient may be given a light ‡ meal or diet in the evening, in case he is possessed of a keen digestive capacity§, subsequent to the digestion of a previous meal and (should he feel hungry) after the discharging of the injected Sneha. Tepid water boiled with Dhanydka

• It should be noted that the particle "घ" in the text means that on the satisfactory action of an Anuvásana-Vasti, the injected Sneha may come out with urine as well. + Dallana explains "चोष" to mean thirst. ‡ "Light" means both light in quantity as well as in quality. § Some commentators explain this couplet to mean that a patient of ordinary digestive capacity should be given a light food, whereas a patient of keen digestive capacity may take a full one.

and S'unthi should be given hot to the patient on the (following morning as it would sharpen his appetite and produce a fresh relish for food.

24-A. The Successive actions of the Vastis :-The first application of the Vasti permeates the pelvic and the inguinal regions with the emulcent essence of the injected Sneha.

The second tends to restore the Vâyu in the cephalic part of the body to its normal condition.

The fourth permeates the Rasa (lymph chyle) with its own oily essence.

In this way the fifth application of a Vasti permeates the blood, the sixth the flesh, the seventh the fat, the eighth the bones, and the ninth the marrow with the oily essence.

A person treated with eighteen series (three hundred and twenty-four in number) of such Sneha-vastis and Niruha-vastis in the above mentioned way and observing the prescribed rules of diet and conduct is enabled to develop a muscular strength in no way inferior to that of an elephant, and to live a sinless life a thousand years, in the full enjoyment of his intellectual faculties, god-like beauty and horse-like swiftness.

An excessive application of only one kind of Vasti, either of a Sneha-vasti, or of a Niruha vasti, should be avoided, since an excess of the first (Sneha-vasti) tends to

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A scent of the Sneha in the mouth, cough, difficult breathing, an aversion to food and dullness of all sense-organs which become internally charged with a coating of oil and a glossy appearance of the skin (mouth—D. R.) mark an undesirably higher introduction of the Sneha injected into the system previously cleansed (with proper emetics and purgatives). Such a case should be treated as a case of Ati-pidita (over-pressure on the bladder of the) encma and with the applications of Asthapana-vastis as well.

An inadequate quantity of Sneha of a mild or weak potency, injected cold with the help of an enema, is not retained in the system, if not duly fomented and cleansed before, but gives rise to scanty stools, cramps (Sula), heaviness and distention in the region of the intestines (Pakvasaya) and (ultimate) suppression of stool, etc. Such cases should be speedily remedied by the application of an Asthapana as well as by that of an Anuvasana-vasti.

A small quantity of Sneha of mild potency, injected into the bowels of a patient taking only a small quantity of food, fails to flow therefrom and gives rise to a dullness of spirit, a tendency to vomit and a sense of lassitude which should be remedied by the application of Asthapana-vastis charged with (the decoction of) S'odhaniya (cleansing) drugs and by the application of Anuvasana enemas charged with Sneha boiled and cooked with those (S'odhaniya) drugs.

The Sneha of a Vasti, if found to dribble down (from the system) after the lapse of even a whole day and night from the time of its application, without giving rise to any physical discomfort, does no mischief but exerts all the good effects of the application of the Vasti.

622 THE SUSHRUTA SAMHITA. [Chap. XXXVII.

Whereas, if digested, it produces but very little benefit to the patient. The retention of the whole or of any portion of the Sneha injected into the bowels of a patient without producing any special physical discomfort should be ascribed to an extremely parched or dry condition of his organism, and would not require any special medical treatment. 35-36. In case of a Sneha not flowing out from the bowels within a period of twenty-four hours of its introduction (and in case of its producing any supervening symptoms), corrective (S'odhana) remedies should be employed and all subsequent applications of Sneha should be stopped. Thus we have finished describing the diseases (Vyâpat) and symptoms which result from the injudicious use of Sneha (-Vastis) together with the nature of the medical treatment to be employed in each of them. 37.

Uttara-vastis :-Now we shall describe the mode of applying an Uttara-vasti (injection into the urethra of a male or of a female patient). The pipe to be used for the purpose (in the case of a male patient) should be made to measure fourteen fingers in length, measured by the patient's own fingers. It should be shaped like the stem of a Málati flower (in girth) at its top-end and provided with an aperture admitting the passage of a mustard seed. Several authorities hold that the length of the pipe should be equal to that of the penis (of the patient). The largest dose of a Sneha to be used in connection with an urethral injection (Uttara-vasti) is only one Kuncha (Pala); and this should be determined with discretion in respect of patients below twenty-five years of age. There should be (two) Karnikâs (protrusions) in the middle part of the pipe (Netra) in the case of a male.

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624 THE SUSHRUTA SAMHITA. [Chap. XXXVII.

knee-joints. Lukewarm oil should be rubbed over the region of the neck of the bladder, and the penis should be (artificially) excited and made steady and straight. The orifice or the channel of the urethra should be first (dilated and) searched with the help of an indicator (S' alâkâ), and then the pipe of the Uttara-vasti lubricated with clarified butter, should be gently and gradually inserted therein to the extent of six fingers. The Sneha should be injected into the urethra by gently pressing the bladder of the Uttara-vasti, and the pipe should then be gradually withdrawn from the urethra. The patient should be made to partake of a moderate quantity of boiled rice with milk, Yusha (Mudga-soup, etc.), or meat-soup in the evening after the dribbling out of the injected Sneha. Three or four injections should be thus made with the help of an urethral enema (Uttara-vasti). 41.

Vaginal Uttara-vasti :-A grown up female patient, (under the circumstances), should be laid on her back with arched and up-drawn knees, and an injection should be made into her vaginal canal (Yoni) by an experienced physician (D. R.—carefully). The pipe should be most gently pressed in the case of a girl before menstruation. For the purpose of purifying the uterus (Garbhâśaya), double the ordinary (one Prasrita) quantity of Sneha should be injected into the vaginal canal (by means of a Vasti) with a pipe having three Karnikâs (protuberance) attached to it. 42-43.

Vaginal Uttara-vasti :-A grown up female patient, (under the circumstances), should be laid on her back with arched and up-drawn knees, and an injection should be made into her vaginal canal (Yoni) by an experienced physician (D. R.—carefully). The pipe should be most gently pressed in the case of a girl before menstruation. For the purpose of purifying the uterus (Garbhâśaya), double the ordinary (one Prasrita) quantity of Sneha should be injected into the vaginal canal (by means of a Vasti) with a pipe having three Karnikâs (protuberance) attached to it. 42-43.

In case the injected fluid does not come back (within the prescribed time), a fresh Vasti (enema) should be

In case the injected fluid does not come back (within the prescribed time), a fresh Vasti (enema) should be

• Milk, Yusha and meat-soup should be prescribed in cases of the predominance of Kapha, Pitta and Váyu respectively.—Dallana.

• Milk, Yusha and meat-soup should be prescribed in cases of the predominance of Kapha, Pitta and Váyu respectively.—Dallana.

(Trp. XXXVII.] CHIKITSA STHANAM.

625

again applied with (the decoctions of) the S'odhana* (purifying) drugs, or a Varti (plug) prepared with the Sodhana drugs should be injected into the rectum.

As an alternative, an indicator (Eshani) should be inserted into the mouth of the bladder, or the region of the abdomen below the umbilicus, and be firmly pressed with a close fist, or medicinal plugs or sticks (Varti) of the size of a Mudga-pulse, cardamom-seed (Elá), or mustard-seed should be made up of Saindhava and the leaves of the Aragvadha pasted with the expressed juice of Nirgundi and cow's urine, and these plugs (Varti) should, according to the age of the patient; be inserted (into the mouth of the bladder) with (the top-end of) a rod or an indicator (S'aláká) for the out-flow of the injected fluid.

Another alternative is to use a stick (Varti) made up of the pendant soot of a room (Agára-dhuma), Vrihati, Pippali, Madana-fruit, Saindhava salt and S'unthi pasted with S'ukta (a sort of Kánjika) and cow's urine (in the preceding manner).

Other (similar) measures should be adopted for the successful action of an Anuvásana enema (Vasti). 44-A.

A cold decoction of Yashti-madhu saturated with honey and sugart or a decoction of the (bark of the) milk-exuding trees(Kshiri-Vriksha), or cold milk, should again be injected into the bladder, in the event of there being a burning sensation in that organ.

Diseases such as derangements of the semen, or of ovum, or difficult menstruation, excess or suppression

• The S'odhana drugs here are the Trina-pancha-mula and such other drugs. -Dallana.

† According to Dallana a quantity of sugar and honey should be added in each of the three cases, viz., (1) the decoction of Yashti-madhu, (2) that of the Kshiri-trees, and (3) milk.

79

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CHAPTER XXXVIII.

Now we shall discourse on the mode of applying as well as on the treatment with a Nirudha-vasti (Nirudhopakrama-Chlkitsitam). I. The mode of preparing a Vasti :-The application of an Anuvásana-vasti (enema) should be followed by that of one of the Ásthápana class. The body of the patient should be first anointed (with a Sneha) and fomented. Previous to the application of a vasti, the bowels and bladder should be relieved of all (fœcal) accumulations (flatus and urine). The clyster (Vasti) should be applied at noon in a well-cleansed chamber, devoid of any gust of wind, and the patient should be laid on his left side on a spacious bed not furnished with any pillows, but a little raised up there where his buttocks would rest, and there should be attendants at his feet. The patient should continue in a cheerful mood with his left thigh held in an outstretched posture and the right one flexed, and should refrain from speaking to any body. The digestion of the ingested food taken by the patient is necessary (before the application of the Vasti). The physician having placed the pipe of the enema (Vasti) upon his left foot should firmly press its Karniká with the first and the second toes of his right foot. One half of the mouth of the Vasti should be kept contracted by pressing it with the small and ring finger of his left hand and the (other) half should be stretched with the aid of his thumb, index and middle fingers, and thus the medicinal solution should be poured into the bladder (Vasti). The pipe should be held with the middle and the index finger of the right hand. Care should be taken not to let the medicinal solution overflow from the sur-

628 THE SUSHRUTA SAMHITA. [Chap. XXXVIII.

face of the pipe, nor to admit of even a bubble of air into the bladder (of the enema), nor to produce its over-contraction nor dilatation during the process (of pouring the medicine). The bladder filled with the proper quantity of medicinal solution should then be held in the left hand, and washed with the right hand. It should then be firmly tied (at the neck) just over the (surface of the) medicinal solution with ligatures of two or three rounds of thread. 2-A. The mode of applying a Vasti :-The Vasti should then be held up on the palm of the right hand, its pipe gripped with the middle and index fingers of the left hand, and the orifice closed with the thumb of the same hand. The neck of the pipe should be previously lubricated with clarified butter, and gently introduced into the rectum of the patient up to its Karniká (protuberance) along the line of spinal column and with its mouth up-turned. The patient should be asked to take the same with care. 2.

Metrical Text :-The physician should then hold the enema (Vasti) with his left hand and press its bladder with his right. The injection (of the medicinal solution contained in the enema) should be made at once, neither too slowly nor too hurriedly. 3. The pipe should then be withdrawn and removed, and the patient should be asked to remain in the same position for a period sufficient to utter thirty Mátrás*

Metrical Text :-The physician should then hold the enema (Vasti) with his left hand and press its bladder with his right. The injection (of the medicinal solution contained in the enema) should be made at once, neither too slowly nor too hurriedly. 3. The pipe should then be withdrawn and removed, and the patient should be asked to remain in the same position for a period sufficient to utter thirty Mátrás*

• According to Agnives'a the time necessary for the tips of the fingers to fall down upon the right thighs, i.e., the time required for a twinkling of the eye (Nimesha) is called a Mátrá. Parás'ara says that the time necessary to close and open the eye-lids (Nimesha and Unmesha) once, while throwing the arm around the right thigh is called a Mátrá. He has prescribed one hundred such Mátrás in respect of a patient of constipated bowels, and thirty-seven in respect of a patient of lax

• According to Agnives'a the time necessary for the tips of the fingers to fall down upon the right thighs, i.e., the time required for a twinkling of the eye (Nimesha) is called a Mátrá. Parás'ara says that the time necessary to close and open the eye-lids (Nimesha and Unmesha) once, while throwing the arm around the right thigh is called a Mátrá. He has prescribed one hundred such Mátrás in respect of a patient of constipated bowels, and thirty-seven in respect of a patient of lax

CHIKITSA STHANAM

from the time of injection. The patient should then be asked to get up and sit on his legs for the full outflow of the injected solution. The period of a Muhurta (about forty-eight minutes) is usually required for a complete outflow of the Niruha-vasti (from the bowels). 4.

Metrical Texts :--This method of applying the Vasti should be continued three or four times as required in each case by the physician, experienced in the application of the same. It should be discontinued after certain characteristic symptoms had been fully developed and manifested (in the system of the patient). Less is better than excess (in respect of Vasti-applications and more so particularly in the case of a patient of a delicate constitution). 5.

Symptoms of an inadequate and excessive application of a Vasti :--The emission of only a small quantity of flatus (Váyu), fæcal matter and (of the medicinal solution applied in) the Vasti, as also the appearance of the supervening distresses of urinary disorders, an aversion to food and physical lassitude indicate the inadequacy of the application of the Vasti. Symptoms which have been described before* as marking an excessive use of purgatives are also said to result from an excessive application of a Niruha-vasti‡. 6.A.

Symptoms of a satisfactory application of a Vasti :--A lightness of the body, experienced in consequence of the successive and satisfactory evacuations of stool,† Pitta (bilious matters), bowels.--Dallana‡ The period‡ of a Mátrá has elsewhere been defined as that required to utter a short vowel.--Ed.

• See Chapter XXXIII, Para. 18, Chikitsita Sthánam. † Satisfactory urination should also be understood as one of the symptoms of the satisfactory application of a Niruha-vasti.--Ed.

Kapha (mucus) and Váyu (flatus) from the bowels, are the salient features of a satisfactory application of a Niruha-vasti (Su-nirudha). After the manifestation of the foregoing symptoms the patient should be advised to bathe (in hot water) and to take meat-soup (Rasa), milk and pulse-soup (Yusha) in diseases due to the action of the deranged Váyu, Pitta and Kapha respectively. The essence (Rasa) of the meat of any Jángala animal may, however, be prescribed in all cases under the circumstances, since it would produce no harm. Only a quarter, a half or three-quarter part of the usual diet should be prescribed according to the digestive capacity of the patient, and the nature and intensity of the Doshas involved in each case. 6-B. The subsequent treatment should consist in applying a Sneha-vasti (oleaginous enema) according to the nature and intensity of the underlying Doshas in each case. A lightness of the body, sprightliness of the mind, amelioration or abatement of the disease, an emulsive condition of the organism, are the features which mark the satisfactory application of an Ásthápana as well as of an Anuvásana vasti. 6-C. The patient should be made to partake of his meal with meat-soup on the day of his being treated with a (Niruha) Vasti ; since there is an apprehension of the Váyu being greatly deranged and aggravated (by the application of the Vasti). He should then be treated with an Anuvásana (Vasti) on the same day. Thereafter the application of the Sneha-vasti should be regulated* with a regard to the state of the appetite and the intensity of the deranged Váyu, and in the

• A second application of the Sneha-vasti should be made, if necessary, on the 2nd, 3rd, or 5th day with a due regard to the symptoms mentioned in the text.

Chap. XXXVIII.] CHIKITSA STHANAM.

631

event of the Kos'tha (stomach) being found to have been

stuffed with food. 6

A fresh and stronger Nirudha injection (Vasti),

composed of Yava-kshdra, cow's urine, Kanjika and the

S'odhan* (purifying) drugs, should be applied (into the

bowels) in the event of the previous one not passing out

within a Muhurta, since a Nirudha injection (Vasti)

long retained in the bowels by the enraged and

aggravated Váyu causes S'ula (colic), an aversion to food,

fever and Ánáha* (distension of the abdomen with

suppression of stool and urine), or may ultimately

have a fatal termination. 7.

The application of an Ásthápa'na enema is for-

bidden after a meal as it may bring on an attack of

Visuchiká* (D. R.—Áma), or of vomiting, or may tend

to aggravate the Doshas of the body. Hence an

Ásthápa'na-vasti (cnema) should be applied only on

an empty stomach. The Doshas (in the system) of a

person lie in a free and potent state at the close of the

process of digestion, and are easily and spontaneously

eliminated from the system (by the application of the

Ásthápa'na-vasti), when the stomach (Ás'aya) is not

further oppressed or stuffed with food. The digestive

fire (Játharágní) can not digest the food, if scattered or

diffused by the application of an Ásthápa'na-vasti

(into the bowels). Hence it is that an Ásthápa'na

injection should be made on an empty stomach. The

application of a Niruha-vasti (which is not applicable

in all cases) should, however, be determined with a

regard to the exigencies of the case, since the strength of

the aggravated Doshas of the body abate with the evacua-

• Both Vrinda and Chakradatta read "A'topa" (rumbling sounds in

the intestines) in place of "A'ndha."

632 THE SUSHRUTA SAMHITA. [Chap. XXXVIII.

Drugs to be used in a Niruhavasti :-The following drugs and articles, or as many of them as would be available, such as, all kinds of milk, acid group (Kánjika, etc.), urine, Sneha (oleaginous substances), the drug decoctions (Kasháya), meat-soup (Rasa), salts, Phala (Triphalá), honey, S'atáhv a, Sarshapa, Vacha, Elá, Trikatu, Rásná, Sarala, Deva-dáru, Rajani, Yashti-madhu, Hingu, Kushtha, the drugs of the Sams'odhana (corrective) group (Trivrit, etc.), Katuka, Sugar, Musta, Us'ira, Chandana, S'áli, Manjishthá, Madana, Chandá Tráyamáná, Rasanjana, (dried) Vilva fruit, Yamáni, Phalini, Indra yava, Yava, Kákoli, Kshira-kákoli', Jivaka, Rishabháka, Medá, Mahá-medá, Riddhi, Vriddhi and Madhu'liká, should be used in charging a Nirudha-vasti.

Formula of the Niruhavasti :-In the case of a healthy person (marked by an equilibrium of Váyu, Pitta and Kapha), the solution to be injected should be composed of four parts of the decoction of drugs* and one part (a fifth part of the entire compound) of the Sneha (any oleaginous substance). In any case marked by a preponderance of the deranged Váyu, the Sneha should measure a quarter part of the whole, one-sixth in a case of a preponderance of the deranged Pitta and an eighth part in a case of the deranged Kapha. In a case of aggravation of all the (three) Doshas, the Kalka should measure an eighth part (of the entire quantity of the medicinal solution to be injected), and the following drugs or articles,

• Dallana means to say that of the whole compound weighing twelve Prasrita measures (twenty-four Palas), there should be four Prasrita weights (8 Palas) of the docoction, and so on.

Chap.*XXXVIII.] CHIKITSA STHANAM.

633

vis., salt, honey, cow's urine, Phala (Madana), milk, acid group (Kanjika, etc.) and extract of meat, in charging a Nirudha-Vasti should, as regards dosage, be determined by a due consideration of the requirements in each case. When the Kalka, the Sneha, and the decoction would be well mixed together, the solution for injection should be considered to have been well prepared The application of such a solution would be supposed to produce the wished-for results. 10-A.

The process of preparation :-An Aksha measure (two Tolás) of Saindhava salt should be first mixed with the palms of the hand on a plate with two Prasrita (thirty-two Tolás) measures of honey, to which Sneha (oil, etc.) should be gradually added. When well dissolved, the pastes of (Madana) Phala should be added thereto. The drugs to be used as the Kalka in proportion to the prescribed parts should then be finely powdered and mixed with the preceding compound. The whole should then be well stirred in a deep vessel with a ladle (Khaja) * so as not to make it too thick, nor too thin. The compound thus prepared should be mixed with five Prasrita measures of the well-filtered drug decoction (prescribed in each case) and with cow's urine, meat-essence, milk and acid articles (Kanjika, etc.) according to the nature of the Doshas involved in the case. 10.

Dvá-dasa Prasriti :-Now we shall describe the (recipe and preparation of) Vasti (technically) called the 'Dvá-dasa-Prasrita' (weighing twelve Prasritas). An Aksha measure (two Tolás) of Saindhava salt should be rubbed with two Prasritas (thirty-two Tolás) of honey to which should be added three Prasritas

80

634 THE SUSHRUTA SAMHITA. [Chap. XXXVII .

of a Sneha (oleaginous substance). The whole should then be stirred and when the Sneha would be well mixed, a Prasrita measure of a medicinal Kalka, four Prasritas of a decoction, and two Prasritas of medicinal after-throws (powdered drugs thrown to or cast in a medicinal compound at the close of its decoction) should be added to it. In this way an enema solution should be made to measure twelve Prasritas in all and is hence called "Dvá-dásá-Prasrita". This should be regarded as the rule in respect of a full dose and the physician may reduce the numbers of Prasritas (if required). This kind of variation according to the age of the patient, in the quantity of each drug of a Niruha-Vasti which commences with the Saindhava salt and ends with the liquid (viz., Kasháya) has always been observed by the physician aspiring after success (in prescribing a Vasti). II.

Classification of Vastis according to the range of their therapeutic applications : --Now we shall deal with the classification of (Nirudha) enemas (according to the difference in their therapeutic ranges) which, when applied with due consideration of the aggravated Doshas (acting as the exciting factors), will conquer many a disease. 12.

Classification of Vastis according to the range of their therapeutic applications : --Now we shall deal with the classification of (Nirudha) enemas (according to the difference in their therapeutic ranges) which, when applied with due consideration of the aggravated Doshas (acting as the exciting factors), will conquer many a disease. 12.

A decoction should be prepared with one Pala of each of Sampdka, Ruvu, Varshábhu, As'va-gandhá, Nis'd-chchháda (Sathí), Pancha-mula, Vala, Rdsna, Guduchi and Deva-dáru and Madana fruit eight (two Palas) in number (boiled together and reduced to a quarter part of the original quantity of water). After that a paste (Kalka) composed of Mágadhiká, Ambhoda, (Mustá), Havushá, Misi (anisi), Saindhava, Vatsádhva, Priyangu, Ugrá (Vacha), Yash tydhva, and Rasdnjana

A decoction should be prepared with one Pala of each of Sampdka, Ruvu, Varshábhu, As'va-gandhá, Nis'd-chchháda (Sathí), Pancha-mula, Vala, Rdsna, Guduchi and Deva-dáru and Madana fruit eight (two Palas) in number (boiled together and reduced to a quarter part of the original quantity of water). After that a paste (Kalka) composed of Mágadhiká, Ambhoda, (Mustá), Havushá, Misi (anisi), Saindhava, Vatsádhva, Priyangu, Ugrá (Vacha), Yash tydhva, and Rasdnjana

Chap. XXXVIII.] CHIKITSA STHANAM.

being mixed with honey, etc.,* should be dissolved in the preceding medicinal decoction and injected lukewarm (into the bowels) in the manner of an Ásthá­pana-Vasti. Pain in the back, the thighs and in the regions of the sacrum (Trika), stone, retention of stool, urine and flatus, diarrhœa (Grahani), Hæmorrhoids and diseases due to the action of the deranged Váyu, readily yield to the curative efficacy of such injections, by which also, the blood, muscles and the strength are improved.

A decoction duly prepared with Guduchi, Triphalá, Rdsnd, Das'a-mula and Valá weighing one Pala † each, and a pulverised compound consisting of Priyangu, Rasd­njana, Saindhava, S'ata-pushpá, Vachá, Krishná, Yamáni, Kushtha, Vilva fruit and treacle each weighing an Aksha (two Tolás) and half a Pala of pulverised Madana fruit, should be injected into the bowels (in the manner of an Ásthá­pana enema injection), stirred and mixed with an adequate quantity of honey, oil, clarified butter, milk, S'ukta, Kánjika, Mastu (curd-cream) and cow's urine‡. Strength, energy, vigour, complexion, digestive capacity, verility and vital duration of the user would be increased by its application, and all derangements of the bodily Váyu would yield to its curative efficacy. It is one of the best rejuvenating agents.

A decoction should be made by boiling together the drugs of the Kshudra-Pancha-mula group, Musta,

• Honey, S'neha, milk, Kánjika, cow's urine, meat-juice, etc., should be taken.

† Dallana takes Pala in the sense of meat मांसम् (Mámsam).

‡ The quantity of honey, oil, and clarified butter, should be as before, that of S'ukta, Kánjika, Mastu and urine half a Pala each, and that of milk two Palas.—Dallana.

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Chap. XXXVIII.] CHIKITSA STHANAM.

637

strong acid ones (Kánjika, etc.). It should then be injected well cooled in the manner of an Ásthá­pana­Vasti. It would undoubtedly prove curative in cases of Gulma, menorrhœgia (Asrig-dara), heart discases, Jaundice, Vishama-jvara, Hæmorrhage (Rakta-pitta), dysentery, and other Pittaja ailments.

A compound of Valá, Madana fruit, Sarshapa, Saindhava, Deva-dáru, Kushtha, Elá, Pippalí, Vilva and S'unthi (weighing three Palas in all) pounded together and mixed with the decoction of Bhadrá, Nimba, Kulattha pulse, Arka, Kos'átaki, Amrita, (Guduchi), Diva-dáru, Sáriká, Vrihati, Páthá, Murvá, Áragvadha and Kutaja-seeds (weighing sixteen Palas in all) cooked with water (one hundred and twenty-eight Palas) should be injected in the manner of an Ásthá­pana-Vasti, with the addition of an adequate quantity of mustard oil, honey, alkali, cow's urine, sesamum oil and water (three Palas).

This would speedily conquer an attack of Chlorosis (Kámalá), Jaundice, Meha, obesity, impaired digestion, aversion to food, goitre, slow poisoning, (Gara visha), elephantiasis, Udara, or of any disorders due to the deranged Kapha.

Musta, Saindhava, Deva-dáru, Páthá, Pippalí and Indra-yava, pounded together, and made into a paste with the admixture of the decoction prepared with such drugs as Das'a­mula, Haridrâ, Vilva, Patola, Triphalá, and Deva-dáru, should be stirred and saturated with oil, Yava-kshára and honey and reduced to a soluble fluidity by adding (an adequate quantity of) cow's urine, Madana-phala and Kánjika.

The solution thus prepared should be injected (into the rectum of the patient) in the manner of an Ásthâ­pana enema-injection and this would prove curative in cases of Jaundice, deranged Kapha, alcoholism, lassitude,

638 THE SUSHRUTA SAMHITA. [Chap. XXXVIII.

suppression of flatus (Váyu) and of urine, in cases of there being any rumbling sounds in the intestines (Átopa), and Gulma and in diseases due to worms. 18. Madana-phala, Yashti-madhu, Vacha, Deva-dáru, Sarshapa, Pippali-múla, Saindhava salt (Síndhuttha), Yamáni, Misi and Indra-yava should be pounded together and made into a paste with the admixture of the decoction prepared with a Pala measure each of Vásaka, As'ma bheda, Varshábhu, Dhánya, Eranda-mula, Das'a-mula, Valá, Murvá, Yava, Kola, Nis'a-chchháda (Sathí), Kulattha, Vilva, and Bhu-nimba and dissolved in an adequate quantity of honey and the expressed juice of sugar-cane, milk, oil, clarified butter, meat-essence, and the urine (of a cow) by stirring them together. The solution thus prepared should be speedily injected in the manner of an Ásthá́pana injection into the rectum of a patient suffering from a disease marked by the concerted action of two or more of the deranged Doshas. Diseases such as Gridhrasi, S'arkará, Ashthilá Tuni and Gulma may be rapidly cured with this injection (Vasti) 19.

Madana fruit, Yashti-madhu, Misi(anisi), Saindhava, Priyangu and Indra-yava pounded together and made into a paste with the decoction of the drug:, one Pala each of Rásná, Aragvadha, Varshábhu, Kaluka, Us'ira, Mustaka, Trdyamánd, Amrita (Guduchí), Raktá (Man-jishthá), Pancha-mula, Vibhitaka and Valá should be duly mixed with (an adequate quantity) of Rasánjana, extract of meat (Rasa), honey, Sauvira and the expressed juice of the Drákshá. The solution thus prepared should be injected lukewarm into the bowels of the patient in the manner of an Ásthá́pana-Vasti. It adds to the growth of flesh, creates fresh semen and Ojas, improves the digestive capacity and the strength

Madana fruit, Yashti-madhu, Misi(anisi), Saindhava, Priyangu and Indra-yava pounded together and made into a paste with the decoction of the drug:, one Pala each of Rásná, Aragvadha, Varshábhu, Kaluka, Us'ira, Mustaka, Trdyamánd, Amrita (Guduchí), Raktá (Man-jishthá), Pancha-mula, Vibhitaka and Valá should be duly mixed with (an adequate quantity) of Rasánjana, extract of meat (Rasa), honey, Sauvira and the expressed juice of the Drákshá. The solution thus prepared should be injected lukewarm into the bowels of the patient in the manner of an Ásthá́pana-Vasti. It adds to the growth of flesh, creates fresh semen and Ojas, improves the digestive capacity and the strength

Chap. XXXVIII.] CHIKITSA STHANAM.

639

of the body, imparts longevity and cures and conquers

the following diseases, viz., Gulma, Menorrhagia,

Erysipelas (Visarpa), Strangury, Kshata-kshaya,

Vishama-jvara, Hæmorrhoids, Diarrhœa (Grahani),

Váta-kundali, catching pain due to the incarceration of

the Váya in the regions of the thighs, knee-joints, head

and bladder (Vasti), obstinate constipation of the bowels,

(Udávarta) and the other distempers of the bodily

Váyu, Vata-rakta, Ṡarkará (gravels in the bladder),

Ashthilá, cramp in the groins, Udara, aversion to food,

Rakta-pitta (Hæmorrhage), affections of the deranged

Kapha, Insanity, Prameha, distension of the abdomen

(Adhmána), catching pain at the heart (Hrid-graha). 20.

A Vasti composed of the decoction of the Váyu-

subduing drugs mixed with Trivrit*, Saindhava and

Kanjika (or the expressed juice of acid fruits) should be

applied lukewarm in cases due to the aggravation of

the bodily Váyu. Similarly, a Vasti composed of the

decoctions of the drugs included within the Nyagrodhádi

group mixed with sugar, clarified butter, powders of

those included within the Kakolyádi group shculd be

applied in diseases due to the aggravation of the Pitta.

A Vasti composed of the decoction of the drugs of the

Aragvadhádi group saturated with the pulverised com-

pound of those included within the Pippalyádi group,

should be employed with (an adequate quantity of) cow's

urine, added thereto in a case of the aggravation of

Kapha. A Vasti composed of a copious quantity of the

decoction of Kshira-Vrikshas mixed with (an adequate

quantity of) the expressed juice of the sugar-cane, milk,

• According to Dallana, "Trivrit" should be understood to mean the

same as "Travrita" mentioned in the treatment of Mahá-váta-vyádhi

(see Chapter V., Para. 25, Chikitsita Sthánam).

S'odhana (corrective) Vasti

The drugs of the S'odhana group 'possessed of corrective therapeutic properties) should be pounded together and mixed with an admixture of their own decoction. The solution thus formed should be mixed with Saindhava and S'neha and stirred with ladle. It should then be injected into the bowels of the patient. This is called the S'odhana-Vasti*.

Lekhana-Vasti

The powders of the drugs of the Ushakadi group should be mixed with the decoction of Triphala and with cow's urine, honey and Yava-kshara. The whole solution should be applied as a Vasti and is called the Lekhana-Vasti.

Vrimhana-Vasti

A paste composed of the drugs of the Madhura (Kakolyadi) group mixed with the decoction of the drugs possessed of tonic and constructive properties (Vrimhana drugs) should be injected into the bowels with clarified butter and the extract of meat added thereto. It is called the Vrimhana-Vasti.

Vaji-karana-Vasti

The seeds of the Atmagupta should be pounded and mixed with the decoction of (the roots of) the Uchchata together with (the contents of) the egg of a sparrow (Chataka) and an adequate quantity of milk, clarified butter and sugar. The solution should be injected into the bowels in the manner of a Vasti and is called the Vaji-karana-Vasti (aphrodisiac).

According to Dallana, four Pala weights of honey, one Pala of milk, one Pala and a half of cow's urine, and four Pala and a half of Kanjika, should be added to this solution.

Pichchhila-Vasti :-Milk cooked with Viddári,* Airávati, S'elu, S'álmali and the tender sprouts of Dhanvana should be used as a Vasti with the blood and honey (added to it);† it is called the Pichchhila-Vasti.

The fresh blood of a buffalo, hog, sheep, or of a cat, or the contents of a newly laid (hen's) egg‡ may be used for the purpose.

29-30.

Gráhi-Vasti :-A paste of the drugs of the Ambashthádi group, dissolved in a decoction of those of the Priyangvádi group and mixed with honey and clarified butter, may be used as a Vasti and is called the Gráhi-Vasti.

Sneha-Vasti :-A Sneha-Vasti should be prepared by duly cooking the drugs of one or two of the above groups with a Sneha.

Sterile women should be treated with a Vasti consisting of the S'ata-páka-Valá-Taila or the Traivrita-Ghrita (as described before)§ after being cleansed (S'odhana) in due succession.

Strong enemas (possessed of keen medicinal potency) should be employed in respect of extremely strong

• Both Vrinda and Chakrapáni read "Vadári" in place of "Viddári", and their annotators mean to say that the tender sprouts of all trees, viz., Vadari, etc., should be used.

† Vrinda does not recommend the addition of honey; he reads "सुखोतः स्यु." (i.e., the Vasti should be in a cold state), in place of "वैद्रयुता:" . But it is evident from the reading of Dallana's commentary, as quoted by S'rikantha Datta, that honey should be added.

‡ Both Vrinda and Chakrapáni read "आञ्ज" in place of "आद्रि" which means that the newly spilt blood of a goat should be added to the list and hen's egg should be eliminated therefrom.

§ Valá-Taila has been mentioned in the treatment of Mudha-garbha (Chapter XV, Chikitsita Sthánam) and the Traivrita-Ghrita has been described in the treatment of Mahá-Vátavyádhi (Chapter V, Chikitsita Sthánam).

642 THE SUSHRUTA SAMHITA. [Chap. XXXVIII.

patients, and those of moderate potency should be employed in respect of persons possessed of a middling sort of bodily strength, while weak persons should be treated with Vastis (enemas) of mild potency. An experienced physician should thus apply Vastis (enemas) with due regard to the nature of the season, the strength of the patient, the nature and intensity of the disease under treatment and of the Doshas involved therein and to the nature of the potency of the ingredients to be used in charging the Vasti (enema).* 34.

Loosening or disintegrating (Utkles'ana—lit. irritating) enemas (i.e., those possessed of the virtue of dislodging and disintegrating the accumulated Doshas in the system) should be employed at the outset and corrective ones (Doshahara) should then be employed, while those exerting a soothing influence on the organism (Sam-s'amana) should be employed last of all towards the close of the treatment. 35.

Different Vasti

s:-An Utkles'ana (disintegrating) Vasti consists of castor seeds, Yashti-madhu, Pippali, Saindhava, Vacha, Habushá and Phala (Triphalá —Madana-phala, according to others) pasted together. A Dosha-hara-vasti (corrective enema) consists (of a solution) of Yashti-madhu, Kutaja seeds and Madanaphala with Kánjika and cow's urine. A Sams'odhanaVasti|(soothing enema) consists of Priyangu, Yashtimadhu, Musta and Rasánjana with cow's milk. 36—38.

Mádhu-Tallika Vasti

:-Now we shall describe in short the process of applying a Mádhu-Tailika

• S'ivadása, the commentator of Chakradatta, quotes two additional lines as being incorporated in Sus'ruta's text which, when translated, would be as follows :-Better use a Vasti of milder potency but never use on of strong potency than what is necessary and this is recommended e-pecially in cases of delicate persons. — Ed.

Chap. XXXVIII.] CHIKITSA STHĀNAM.

Vasti (enema) which should be resorted to only in respect of kings or king-like personages as well as in respect of women, old men, infants and persons of delicate constitutions for the purposes of eliminating the Doshas (accumulated in the organism) and of improving the strength and complexion. The use of this remedy does not entail any strict observance of continence or of any particular rules, diet, conduct, or conveyance on the part of the patient, nor is it attended with any possible complication though it is quite on a par with any other kind of Vasti as regards its excellent and highly beneficial therapeutic virtues. It may thus be applied at any time by an experienced physician in the manner of a Nirudha-Vasti (enema) whenever the patient wishes to be treated therewith. Equal parts of honey, oil and the decoction of castor roots, half a Pala of S'ata-pushpá, a quarter Pala of Saindhava, and one entire Madana fruit should be mixed together by stirring the whole with a ladle. The whole compound thus prepared should be injected lukewarm into the rectum of the patient. This measure is called the Mādhu-Tailika-Vasti.* 39.

Yukta-ratha & Dosha-hara Vastis :- The Yukta-ratha Vasti consists in injecting a medicinal solution surcharged with Vacha, Madhuka (honey),† oil, meat-essence, Saindhava, Pippali, Madana fruit, and the decoction (of Eranda) into the bowels of a patient.

• The quantity of the fluid should be nine Prasritas in all cases of the Mādhu-Tailika Vasti and such-like Vāstis (enemas).—Dallana. † Vacha, salt, Madana-phala, Pippali, each should be one Karsha ; honey and oil four Prasritas and two Karshas each, and the decoction of Eranda roots four Prasritas and two Karshas.—Dallana.

In the text we find "Madhnka" which generally means Yashti-madhu. Here, however, it should mean "honey". This is evident from Dallana's commentary.

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of urine, Hæmorrhage (Rakta-Pitta), Erysipelas, fever, and a looseness of the bowels. It acts as an aphrodisiac and vitalising tonic ; it also invigorates the eye-sight and is anti colic in its action It is known as the Mustádi-Vasti and is the best of all the Ásthápaṇa enemas.

45-46.

The compound Mádhu-Tailika Vasti is so called from the facts of its being principally composed of Madhu (hóney) and Taila (oil) The term Yukta-Ratha Vasti owes its nomenclature to the fact of its imposing no restriction as regards riding in carriages (Rathas), or on horses and elephants after their application.

A Siddha- asti does not produce any distress or discomfort, since it is mild in potency and is applied

646 THE SUSHRUTA SAMHITA. [Chap. XXXVIII.

in only three quarters of the usual dose (nine Prasritas only) and does not entail any strict observance of the regimen of diet and conduct (such as the previous administration of emetics and purgatives, etc.), and since it produces a satisfactory result by a single application. 47.

Thus ends the Thirty-eighth Chapter of the Chikitsita Sthánam in the Sus'ruta Samhitá which deals with Niruha-Vastis.

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