Chapter XXXIII - Description of purgative and emetic medicines

Now we shall discourse on the treatment of the distresses which prove amenable to the use of purgatives and emetics (Vamana-Virecana- Sadhyopadrava). 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. 2.

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 (Maha-vyadhi), telling him at the same time that an emetic medicine will be given to him on the day following. 3.

Memorable Verse:—

An emetic medicine does its fullest action, when given to a man after having applied a Sneha and Sveda (to him) and after having stirred up the Doshas of his body with the help of a soft mucilaginous (Kapha-producing)^[1] fluid and emollient food so as to accelerate their easy expulsion from the system 4.

On the next morning, when it is neither too hot nor too cold^[2] the patient should be made to vomit with an adequate dose of an emetic in any of the following forms, viz., powder, paste, decoction, (medicated) oil or Ghrita as the case may be. Such things as have a fetid or an obnoxious smell or sight should be used for emetic purposes having regard to the characteristic nature of the patient’s stomach (Koshtha), the contrary being the rule in respect of the use of purgatives. 5.

Infants, old men, weak and timid persons as well as those who are of a delicate constitution should be first made to drink their full of milk, curd, milk-curd (Takra) or a gruel (Yavagu)^[3] in diseases amenable to emetics and in such quantities that the patient feels it rising up to the throat. After the emetic has been administred, the body of the patient should be (gently) fomented for a short time with the heated palms of the hands and the effect (of the emetic) observed.) The dislodgment and passing of the Doshas from their respective seats into the Kukshi (stomach?) should 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, Vairecana or Samana (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 of the flesh of any Jangala animal.^[4] A person treated with emetics (at regular intervals) by cough, accumulation of 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 diarrhea (Grahani). 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 Vayu in the body (Urdhva-vata), Gulma, Udavarta, 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 Hemoptysis 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^[5] as well as in simple diseases due to the Vayu. 11.

To induce vomiting with an emetic 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)^[6] 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, 11-12.

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 (Shosha), in the derangements of the breast-milk, in precarious or sluggish (Vishama) appetite, in insanity, in Apasmara (hysteric convulsions), in Elephantiasis (Shlipada), in Vidarika, 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 scropfula (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-nasa), in inflammations of the lips, throat and mouth,^[7] in (fetid) discharges from the ears, in Adhi-jihvika, Upa-jihvika and Gala-shundika (affections of the glottis and the thorax), in hermorrhage from the lower channels, in the derangements due to the bodily Kapha and in all affections of the location of Kapha^[8]. 13.

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. On 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 (Shleshma) accumulations and in the manner laid down in the Aturopakramaniya chapter (Chapter XXXV. of tho (the?) Sutra-sthana). 14.

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 Vayu 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. Purgatives 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. 15.

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 Vayu 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 (lassitude—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 Shula colic pain in the intestines) result from an act of over-purging. A sense of lightness about the region of the umbilicus^[9] and hilarity of the wind due to the discharge of the distempers connected with the Kapha (mucus, stool. etc.) and restoration of the bodily Vayu to its normal condition due to the discharge of the (deranged) Vayu (from the system) are the symptoms which mark the satisfactory action of a purgative medicine. 18-A.

Diet:—

No liquid food or Peya 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 Peya should, however, be given to him in small doses, whenever he would feel weak and thirsty after the proper exhibition of a purgative medicine. 18-B,

Benefits of proper purgation:—

Clear ness and expansion (Prasada) of the intellect, firmness of the organs and of the Dhatus (root-principles) of the body, increase of energy (Bala)^[10], 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-origined 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. 18.

Persons who should not be purged:—

Exhibition of purgatives are prohibited 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 respect of frightened persons and Kshata-kshina patients or of those afflicted with hemorrhage from the downward orifices of the body or of persons with any dart or foreign matter (salya) 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 Sneha (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. 19.

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, hemorrhoids, tumours (Arvuda), ascites (Udara), glandular swellings (Granthi), abscess (Vidra- dhi), jaundice, hysteric convulsions (Apasmara), heart- disease, Vata-rakta, vaginal or uterine diseases, fistula- in-ano, vomiting, erysipelas (Visarpa), Gulma, pain in the Pakvashaya (intestines), retention of stool, Visu- chika, Alasaka, strangury (Mutraghata), cutaneous affections (Kushtha), Visphotaka (carbuncle, etc.), Prameha, distension of the abdomen with the suppression of stool and urine (Anaha), enlargement of the spleen, edematous swellings (Shopha), 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-paka), Kacha, Timira, conjunctivitis (Abhishyanda), burning sensations in the head, ears, eyes, nose, mouths, anus and the penis, hemorrhage from the upper channels (Urdhva- Rakta-pitta), worms, diseases of the Pittashaya (bowels?) i.e., the diseases which are peculiar to the seats of the Pitta in the organism as well as any other disease due to an aggravation of the Pitta. 20.

Metrical Texts:—

Emetic and purgative remedies, in spite of their possessing in common the powers of motion (Saratva), subtlety, keenness, expansiveness and heat-making properties, tend to remove the injurious and deranged morbific principles (Doshas) of the body in (two) different ways by virtue of their respective inherent qualities (Prakriti)^[11]. A purgative, in the course of its digestion, carries down with it all the Doshas from the system (loosened and dislodged by virtue of its own specific properties). An emetic, on the other hand, is not digested, owing to (its lightness due to) its inherent extraordinary qualities^[12], but it soon forces its way up with the Doshas (to be) removed. 21-22.

A strong purgative given to a man of loose or lax bowels (Mridu-Koshtha) or of strong digestive capacity, cannot remove all the Doshas fully owing to their being suddenly and forcibly purged off. 23.

A purgative medicine, which is capable of being digested and of expelling the Doshas from the body in the time which a morning meal ordinarily takes to be digested, should be regarded as pre-eminently the best. 24.

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 (Shamana) 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. 25-26,

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-kshara 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^[13] 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. 27-28.

An excessive quantity of Sneha should be used in cases of poisoning, hurt, pustular eruptions (Pidaka), edema 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^[14]. 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^[15] are easily expelled by emetics and purgatives. 33.

 

Thus ends the Thirty-third Chapter of the Chikitsita Sthana in the Sushruta Samhita which deals with the treatment of diseases amenable to the use of emetics and purgatives.

Footnotes and references:

[1]:

Vrinda reads “shloṣmalaiḥ”(?) in place of “peshalaiḥ”(?) but they would ultimately mean almost the same thing.

[2]:

Dallana says that some explains “sadharaṇe kale” to mean “in the proper seasons, viz., the rainy season, the Autumn and the Spring.”

[3]:

The milk, the curd, the milk-curd and the gruel prescribed to be taken in this case should, according to Dallana, be either medicated with emetic drugs or should be taken alone as an after-potion.

[4]:

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.

[5]:

Persons afflicted with cataract or blindness, Gulma, facial paralysis, convulsion (Akshepaka), jaundice, ascites, hemorrhoids and corpulency 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.

[6]:

Jejjata explains Madhuka to mean honey. He means to say that vomiting should be induced with honey and water.

[7]:

Some read here “Kushtha, Galaganda, Prameha and Shopha (swelling)” but as Meha is mentioned above separately it seems to us that that reading is not a good one.—Ed.

[8]:

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.

[9]:

In place of “nabhya ladhutve” some read “glanyaṃ ladhutve” which means “a sense of lightness and lassitude”.

[10]:

Vrinda does not include “Bala” (energy) in the list.

[11]:

Dallana quotes a different reading which means that emetic and purgative remedies produce the wished-for result, if properly administered, otherwise not.

[12]:

The extraordinary qualities of an emetic are those of the Vayu and of the Agni.

[13]:

Vrinda reads “atisnigdhakayasya” in place of “atisnehapītasya”. This means that the Sneha might have been used both internally and externally.

[14]:

Vrinda reads “snehabandhana”(?) in place of “balavarddhana” This means that the Doshas, so long obstructed by Sneha, are thereby expelled.

[15]:

Some explain “rasaiḥ snegdhaiḥ”(?) to mean “with emollient meat-soup”.