Chapter XXXIV - The injudicious use of emetics and purgatives

Now we shall discourse on the treatment of the disorders resulting from an injudicious use of emetics or purgatives (Vamana-Virecana-Vyapach-Chikitsita). 1.

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 cases of purgatives and the downward coursing in cases of emetics are peculiar to each of them respectively. The fourteen other remaining disorders (Vyapat) are common to both. They are Savasheshaushadhatva (continuance of the drug in the stomach), Jirnausha- dhatva (complete digestion of the medicine), Hina- doshapahritatva (insufficient elimination of the Doshas from the system) Adhika-doshapahritatva (excessive elimination of the Doshas from the system), Vata-shula (Vataja colic), Ayoga (insufficient dosage), Ati-yoga (over dosage), Jivadana (hemorrhage), adhmana (tympanites), Pari-kartika (cutting pain in the anus, etc.), Parisrava (oozing out of stools), Pravahika (diarrhea), 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 (Tikshnagni) 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 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 (Amashaya), 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 diarrhea. 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 bsing 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.

Savasheshaudhatva (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 hot water. When a least residue of a purgative medicine previously administered would be found to have been retained in the stomach of a strong patient and with extremely aggravated Doshas of the body, the patient, if there be an insufficient purging, should be similarly made to vomit. 5.

Jirnaushadhatvam (Evils of a digested purgative, etc.):—

A mild purgative or emetic or a medicine administered in a small dose to a man of extremely constipated bowels (Krura-koshtha) or of an extremely keen digestive capacity (Tikshnagni), is like food easily digested in the stomach (and therefore fails to produce the wished-for results). The aggravated Doshas, being thus unexpelled by the (purgative or emetic) medicine from the body, brings on fresh distempers and loss of strength (Bala)^[1] of the body. Under the circumstances a stronger medicine or a larger dose of the same should be administered to the patient. A mild medicine as well as a medicine administered without a previous application of Sneha and Sveda subdues only a slight aggravation of the Doshas. 6.

Evils of insufficient or excessive expulsion Of the Doshas:—

A nausea, a sense of heaviness in the limbs, a sticky sensation in the chest and aggravation of the (existing) disease are the evils which attend an insufficient ejection of any bodily Dosha from the system after the administration of an emetic. More satisfactory vomitings should be induced in such cases with the help of an appropriate (and stronger) medicine. Tympanites, heaviness of the head, suppression or incarceration of Vayu (flatus), a cutting pain (Pari-kartana) in the anus and aggravation of the (existing) disease, are the evils which result from an imperfect 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.

Vata-Shula (Flatulent colic):—

The bodily Vayu 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 Vayu thus enraged tends to produce a kind of pain (Shula) in the sides, waist (Shroni), 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 (Dhanya-Sveda). An oil cooked with Yashti-madhu should then be employed as an Anuvasana-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 powered Madana fruit dissolved in a saline solution, or in moving the bowels with a stronger purgative in the shape of decoctions. 8-B.

The bodily Doshas are aggravated through deficient or scanty vomitings under the action of an emetic drug and expands through the entire organism, giving rise to itching, swelling, cutaneous affections, pustular eruptions, fever, aching of the limbs, piercing pain and suchlike symptoms. The remaining or uneliminated Doshas should then be expelled with (adequate) medicines of strong potency (Mahaushadhi). Similarly, insufficient purgings under the action of a mild purgative, administered without a previous application of Sneha and Sveda to the patient, produce a numbed and drumlike distension of the abdomen below the umbilicus, causing a retention of the stool and flatus, and produce (colic) pain (Shula), itching and urticarious eruptions (Mandala). The remedy under these circumstances should consist in employing emulsive measures (Sneha) and a stronger purgative after having employed an asthapana-Vasti. Draughts of hot water should be given to the patient and the abdomen and the sides should be fomented with the heated palms of the hands for exciting or inducing purging in the event of an unsatisfactory purging and of obnoxious matter not being expelled from the system. The purging (of Dosha) would thus be induced. A second dose of a purgative should be again administered in the evening with a due consideration to the strength of the patient when the first would be found to have been digested before producing a sufficient purging if the system of the patient be still full of Doshas and morbid matter. In case of failure of this also to remove the Doshas (excreta), the system of the patient should be first treated with Sneha and Sveda after the lapse of ten days and should then be again cleansed with a further dose of a purgative^[2]. Patients in whom purging can be induced only with the greatest difficulty should be first treated with asthapana. Sneha should again be applied and a strong purgative should then be administered. 8.

Ati-yoga (Over-drugging with purgatives, etc.):—

Women, merchants, persons attending a king and pious Brahmanas learned in the Vedas (Shrotriya) are often subjected to the necessity of repressing their natural urgings of the body towards micturition, etc., out of a sense of delicacy, fear or greed. The Vayu in their systems remains consequently aggravated and accordingly purgatives fail to easily produce any effect in their organism. Hence their system should be cleansed with purgatives preceded by Sveda (fomentations) and a copious application of Sneha. An over-dose of a purgative or a strong one administered to a person copiously treated with Sneha and Sveda or to one whose bowels are easily moved would exhibit the symptoms of an over-dosage (Ati-yoga) of purgatives.

Excessive emission of Pitta (bile), loss of strength (Bala) and an aggravation and augmentation of the deranged Vayu follow from the over dosage (Ati-yoga) of an emetic medicine. In such cases, the body of the patient should be anointed with clarified butter and he should be bathed in cold water and made to take a lambative^[3] with sugar and honey with a due consideration of the nature and intensity of the Doshas involved. An over-dose of a purgative may bring on excessive emission of Kapha (mucus) mixed even with blood in the end. In this case, too, loss of strength (Bala) and enragement of the bodily Vayu would be the consequence. The patient in such a case should be sprinkled over with or bathed in very cold water and vomiting should be induced with potions of cold washings of rice mixed with honey. Applications of Piccha-vasti and of Anuvasana enemetas with milk and clarified butter are recommended. The patient should also be made to drink potions of the washings of rice mixed with the drugs of the Priyangvadi group The diet should consist of boiled rice with milk or meat-soup. 9-10.

Jivadana (Hemorrhage) due to excessive vomiting:—

In the event of an excessive use of an emetic the patient may spit or vomit blood. In such a case the tongue hangs out (of the mouth) and the eyes seem to expand, and numbness of the jaws, thirst, hiccough, fever and faintness are found to supervene. A potion of goat’s blood, red Chandana, Ushira, Anjana and the powders of fried paddy mixed with water and sugar, should be administered in these cases. As an alternative, the patient should be made to take his food in the Peya form with the expressed juice of fruits (such as the Dadimba, etc.,) and with clarified butter, honey and sugar, or a Peya prepared with the sprouts of Vata, etc. with honey, or one cooked with any drug having the power of producing costiveness; or he should be made to take his food with milk or with the soup of the meat of a Jangala animal. Measures laid down in respect of excessive bleeding or hemorrhage should also be resorted to 11.

In a case of excessive protrusion or hanging down of the tongue, the organ should be rubbed with powdered Trikatu and rock-salt or pasted with a plaster of sesamum and grapes (Draksha; and re-introduced into its proper place and position after which some other men should be made to taste any acid article in the sight of the patient. In a case of the expansion of the eyes they should be rubbed with clarified butter and (gently) pressed. Errhines and fomentations (of the part with drugs) antidotal to the deranged Vayu and Kapha, are recommended in a case of a numbness or catching pain of the jaw-bones in such cases. The other supervening distresses such as thirst, etc, should be treated with appropriate medicinal remedies. A faintness (under the circumstances) should be broken with the (sweet) sounds of a lute or a lyre. 12.

Jivadana (Hemorrhage) due to excessive purging:—

An excess (Ati-yoga) of purging is marked, at the outset, by a flow of watery mucus through the rectum, resembling the crest of a peacock’s plume in colour. This is followed by an emission of shreddy and blood- streaked mucus resembling the washings of meat, succeeded by an oozing out of actual red blood attended with a shivering, protrusion of the anus and all the supervening distresses of emetics. The treatment in such cases should be as in those of hemorrhage. The protruded anus should be first lubricated (with a Sneha) and subsequently fomented and re-introduced into its proper place or it should be treated according to the directions laid down in the chapter of Kshudra- Roga^[4]. The shivering should be treated with remedies laid down in connection with Vata-vyadhi. Remedies in cases of a protrusion of the tongue, etc., have been already described. Milk boiled (according to the Kshirapaka-vidhi) with Kashmari fruit, Vadari fruit, Ushira and Durva grass subsequently cooled and mixed with the cream of clarified butter and Anjana, should be syringed into the rectum in the manner of an asthapana-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 drugs of the Nyagrodhadi group mixed with milk, clarified butter, expressed juice of sugar-cane and (goat’s) blood. Remedies mentioned under hemoptysis (Rakta- pitta) and bloody dysentery should be employed in cases marked by spitting of life-blood (Jiva-shonita). Decoctions of the drugs of the Nyagrodhadi group should be given with food and drink. 13.

Jiva-Shonita, 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-shonita) 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-shonita, 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. 14.

Adhmana (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 Sneha and whose bowels still contain the undigested residue of a previous meal and (consequently) an abundance of Vayu therein, takes a (purgative or an emetic) which is neither emollient nor hot, the medicine is likely to produce a flatulent distention of his abdomen (adhmana). It arrests the emission of flatus (Vayu), stool and urine, makes the abdomen distended, produces a breaking pain in the sides, a pricking pain in the anus (Guda) and in the urinary bladder (Vasti) as well as a disrelish for food. This is called adhmana. The patient, in such a case, should be treated with anaha-varti, appetising medicines and with Vasti measures. 15.

Parikartika (cutting pain in the anus, etc.):—

The Vayu and Pitta in the organism of an enfeebled person or of a person whose bowels can be easily moved or of one of a dry and arid temperament or afflicted with impaired digestive capacity, are deranged and aggravated by the use of any extremely sharp, hot, saline or dry (emetic or purgative) which give rise to a sort of cutting, sawing pain (Parikartika) in the anus, penis, umbilical region and the neck of the bladder (Vasti). The emission of flatus is arrested, the Vayu (wind) lies incarcerated in the abdomen and relish for food vanishes. The remedy consists in employing a Piccha-Vasti with Yashti-madhu and black sesamum pasted together and dissolved in clarified butter and honey. The patient should be laved in cold water and be given his food with milk. Anuvasana-Vasti^[5] with the cream of clarified butter or with oil cooked with Yashti-madhu should be employed. 16.

Parisrava (Dysenteric stools):—

The Doshas and the morbid matter accumulated in the system of a man of extremely constipated bowels and almost saturated with a plethora of Doshas (morbific diathesis) are stirred up but are not fully emitted under the action of a mild (emetic or purgative) medicine. The Doshas (consequently) 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, Dhava, Tinisha and Palasha saturated with honey is recommended ;n such cases. After the subsidence of the bodily Doshas involved in the case, the patient should be :reated with Sneha and Samshodhana^[6] (emetic or purgative) remedies should again be employed. 17.

Pravahika (Diarrhea):—

A medicine (purgative or emetic) administered to a person who has been excessively treated with Sveda or with Sneha produces Pravahika 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. 18.

Hridayopasarana (Overwhelming the heart):—

Urgings towards vomiting or purging being injudiciously 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 gushing his teeth and biting his tongue. An inexperienced physician usually abandons such a patient as lost, whereas the remedy in such cases consists in anointing his body with a Sneha (oil or clarified butter) and fomenting it with half-boiled and unhusked paddy (Dhanya-Sveda). Oil cooked with Yashti-madhu should be employed in the manner of an Anuvasana Vasti, and strong errhines (Nasya) should also be administered. After that the patient should be made to vomit with draughts of the washings of rice mixed with Yashti-madhu and Vastis^[7] should be employed in consideration of the preponderance of the Dosha or Doshas involved in the case. 19.

Vibandha (retention of flatus, stool and urine):—

Use of cold water, exposure to cold winds and resorting to cool places and such other conduct during the action of an emetic or a purgative remedy in a person tend to thicken the Doshas loosened and dislodged from their seats by virtue of its potency, arrest their out-flow, make them adhere to the internal passages through which they pass and, by affecting the excretions, give rise to a suppression of stool, urine and Vayu (flatus), attended with rumbling in the intestines, fever, burning sensation and excruciating pain. The patient should in such a case^[8] be made to speedily vomit the contents of his stomach, and the concomitant symptoms (such as fever, etc.) should be treated with appropriate medicinal remedies (as in the case of their actual and respective attacks). Drugs efficacious in subduing the Doshas confined in the lower cavity (abdomen) of the body (Adhobhaga-hara)^[9] should be employed for purgative purposes with the admixture of 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 Vastis 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 fecal matter downward (Parisrava) in connection with a purgative corresponds to the water-brash in the case of an emetic. What diarrhea (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 Sthana in the Sushruta Samhita which deals with the treatment of the disorders resulting from an injudicious use of purgatives and emetics.

Footnotes and references:

[1]:

For the meaning of “Bala” here see Chapter XV., Sutra-Sthana.

[2]:

Dallana says that the system of the patient, in this case, should be cleansed with an emetic or a purgative as the case may be.

[3]:

A different reading says that the patient should be fomented with washings of rice mixed with honey.

[4]:

The remedial measures for the treatment of Guda-bhramsha, etc., under the Kshudra-Roga, should be employed in such cases.

[5]:

In cases of a Pitta predominance, the Vasti should be employed with the cream of clarified butter and in cases of a Vayu predominancy with oil.

[6]:

Dallana recommends that a strong purgative or emetic should be employed(?).

[7]:

Dallana recommends both Niruha and Snaihika Vastis in such cases.

[8]:

This evidently refers to the case of an abuse of an emetic.

[9]:

See Chapter XXXIX., Sutra-Sthana.