Sushruta Samhita, volume 4: Cikitsasthana

by Kaviraj Kunja Lal Bhishagratna | 1911 | 123,229 words

This current book, the Chikitsa-sthana (english translation), deals with therapeutics, surgical emergencies, geriatrics, aphrodisiacs and various other subjects. The Sushruta Samhita is the most representative work of the Hindu system of medicine. It embraces all that can possibly appertain to the science of medicine. Susruta-samhita is recognized...

Chapter XXXVI - The injudicious application of the Netra and Vasti

Now we shall discourse on the medical treatment of the mishaps which are consequent on an injudicious application of the pipe and of the vasti (Netravasti-Vaypach-Chikitsita). 1.

Metrical Text:—

A displacement or retroversion of the pipe during the application of a Vasti produces a painful and bleeding ulcer in the rectum, which should be treated as a recent or incidental ulcer. An extremely up-turned or down-turned posture of the pipe at the time gives rise to a pain in the rectum which should be treated with Pitta-subduing remedies and sprinkled with Snehas (oil, clarified butter, etc.). A slanting or one-sided posture of the pipe after its introduction into the rectum causes its mouth to be closed and thus prevents a complete and satisfactory injection of the fluid (into the bowels). Hence its mouth should be held straight (and steady) by an experienced physician. The use of an excessively thick or rough pipe or of one with a down- turned or bent mouth, produces a bleeding and painful ulcer in the rectum which should be remedied in the manner mentioned above. The injection of a Vasti proves abortive in the event of the Karnika (attached to the pipe) being too near the end of the pipe or itself being broken or too small. These defects should, therefore, be carefully avoided. In a case of the Karnika (attached to the pipe) being at a greater distance from the mouth of the pipe, it would hurt the Guda-marma (marma at the anus) and produce a considerable bleeding therefrom. Pitta-subduing remedies and Picchila-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 dribbles out (without entering into the rectum), thus occasioning all the maladies[1] which attend an insufficient or abortive use of a Vasti[2]. 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. 3.

An injection made with considerable force by a Vasti (Enema-syringe) enters the stomach (Amashaya) which being forced higher up by the up-coursing Vayu in the organism is emitted through the mouth and the nostrils.[3] Under the circumstances, the patient should be immediately pressed by the neck and (his body) shaken. Strong purgatives and errhines should be administered, and sprinkling him with cold water should be prescribed. If a Vasti be applied with lesser force, the medicinal fluid of the Vasti cannot reach the intestines (Pakvashaya) and (consequently; fails to produce the desired effect Hence it should be duly pressed. If it be pressed at intervals, the wind (Vayu) in the abdomen becomes enraged, and gives rise to tympanites (adhmanaj and excruciating pain therein. The medicinal treatment in such a case should be the applications of proper Vastis in consideration of the nature of the aggravated Doshas involved therein. If the pipe be retained for an (unnecessarily) long time in the rectum during the application of a Vasti, it tends to increase the pain, and bring about an aggravation of the disease. This should be remedied by a second application of the Vasti charged with proper antidotal solutions sufficient to cope with the intensity of the disease. 4.

The use of an insufficiently cooked Sneha (in a Vasti) leaves a slimy sticky deposit on the inner lining of the rectum accompanied by a local swelling which should be remedied by the application of a Samshodhana-vasti and the exhibition of purgatives.[4] The application of a Vasti of either kind (asthapana and Anuvasana) charged with a deficient or inadequate quantity of a medicinal solution, proves abortive in all instances; whereas diarrhea (Atisara), fatigue and anaha (distension of the abdomen with the retention of stool, urine, etc.) result from the application of one charged with an excessive quantity of the fluid. The application of a Vasti charged with an extremely warm or strong solution produces epileptic fits, a burning sensation, diarrhea and (an aggravated condition of the) Pitta. The use of any extremely cold or mild medicine for the purpose of a Vasti arrests the emission of the flatus (Vayu), and produces adhmana (distension of the abdomen).[5] Antidotal measures should be adopted in cases of the deficient or excessive quantity, etc The fluid to be used in charging a Vasti should be thickened in the event of its extremely attenuated consistency and vice versa. The application of a Vasti charged with a fluid consisting of an excessive quantity of Sneha would produce a general inertness of the organism, (dullness of organic functions), while one entirely bereft of any Sneha would produce numbness of the organism and a distension of the abdomen. The remedy in either case consists in employing a Vasti of the opposite kind (viz., an oily or non-oily Vasti respectively). 5.

The application of a Vasti to a patient with his head downward is attended with symptoms peculiar to an act of over-pressing (the bladder of the Vasti), and the remedy also would be similar. The application of a Vasti to a patient with his head held up high and erect would block the urethra, i.e., would suppress the urine, in which case the patient should be treated first with Sveda and then with an Uttara-vasti (urethral syringe)[6] which would give the patient much relief. The injected fluid goes astray (within the abdomen) and fails to enter into the intestines (Pakvashaya) in the event of the patient lying in a stooping posture during the application of a Vasti. The Vayu in such a case becomes aggravated and gives rise to pain in the regions of the heart, abdomen and rectum. The injected fluid fails to penetrate into the bowels in the event of the patient lying on his back during the application of a Vasti owing to the consequent obstruction of the passage. The bodily Vayu becomes in this case agitated and enraged by the (introduction of the) pipe (of the Vasti). A contracted position of the body or of both the thighs, during the application of a Vasti prevents the full outflow of the injected medicine from the intestines, owing to its being acted upon by the bodily Vayu. In a case of the application of a Vasti to a patient in a sitting posture, the fluid rolls down without entering into the bowels; it cannot consequently soothe the ashaya and thus proves abortive. The injected medicine cannot fully enter into the Pakvashaya (intestines), when the Vasti is applied to a patient lying on his right side, since the Pakvashaya is situated on the left side (of the abdomen). The application of a Vasti is not recommended when the patient lies on his face or in such other posture since it is followed by an aggravation of the bodily Vayu, which should be remedied by medicines chosen according to the exigencies of each case. 6.

We shall describe hereafter (in the next chapter) the dangers (Vyapat) which attend the misapplication of a Sneha-vasti and the course of the medical treatment to be adopted in each. The dangers (Vyapat) attending a deficient application (Ayoga) of a (Niruha) Vasti with their respective treatment are described here in this chapter. 7.

Ayoga:—

Cramps or colic pains (Shula) 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. 8.

Distension of the abdomen and consequently an excruciating pain (Shula) 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 fecal 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. 9.

The Pitta and the Vayu 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 Parikartika, attended with a sort of cutting pain in the pelvis and about the anus and the region of the umbilicus. Applications of the Picchila-vasti of a medicated Sneha cooked with the drugs of the Madhura group should be the remedies in these cases 10.

The distress known as Parisrava attended with loss of strength, and bodily lassitude results from the application of a Vasti charged with solutions of extremely strong, acid and saline substances. Pitta begins to secrete at this stage, and produces a consequent burning sensation in the anus. Applications of a Picchila-vasti as well as a Vasti of clarified butter churned from milk should be the remedy in these cases. 11.

The distress known as Pravahika or the passing of bloody stools or painful motions, attended with colic (Shula) and a burning sensation, is the effect of an excessively strong Ashthapana or Anuvasana Vasti. This disorder should be remedied by the application of a Picchila-vasti, a diet of boiled rice saturated with milk and with injections into the bowels, in the manner of an Anuvasana Vasti, of a medicated Sneha (oil or clarified. butter) cooked with the drugs of the Madhura group. 12.

The distress known as Hridayopasarana, accompanied with such symptoms as, aching pains in the limbs, epilepsy, delirium, heaviness of the body and all other discomforts peculiar to the action of the deranged Vayu, originates from the application of a Niruha- vasti charged with extremely parching solutions as well as from those of an Anuvasana-vasti in the complicated diseases of the deranged bodily Vayu. The remedy in these cases consists in applying the Shodhana Vasti charged with solutions efficacious in subduing the actions of all the Doshas of the body. 13.

A breaking pain in the joints and the limbs, numbness (Anga-graha), yawning, shivering and lassitude are the symptoms which follow the applications of a Vasti inadequately charged, or charged with medicinal solutions which are either too mild or too Ruksha (dry) in their potency, or applied in the case of a patient having lain in any of the objectionable postures at the time of the application, or possessed of a dry or Vayu- predominating temperament. The remedy in these cases should consist in applying Sveda, anointments and appropriate Vastis. 14.

Symptoms which are known as Atiyoga, following applications of Vastis charged with an inordinate quantity of medicinal fluid or with extremely hot or strong solutions as well as the application of Vastis after an excessive application of Sveda (fomentation) and in slight derangements of the bodily Doshas should be treated identically as in cases laid down in connection with an Atiyoga (excessive use) of purgatives. The use of a Picchila vasti in a cold state is also recommended, as it would give the patient much relief. 15.

Measures and remedies mentioned in respect of Jivadana (hemorrhage of the bowels) in connection with an excessive use of purgatives should be employed in the case of similar symptoms (Jivadana) following the excessive use of a Vasti. Applications of Picchila-vasti charged with blood are likewise recommended in these cases. 16.

The foregoing nine kinds of distressing symptoms (Vyapat) resulting from an injudicious application of a Niruha-vasti are also found to result from the injudicious application of a Sneha-vasti. All the distresses (of the injudicious applications of a Vasti) with their symptoms and the course of medical treatment to be adopted (in each case) have thus been described. A discrete and experienced physician should so act as not to induce these distresses (Vyapat) in connection with the applications of a Vasti. 17-18.

A purgative should be given after the lapse of a fortnight from the date of the exhibition of an emetic drug. An Asthapana-vasti should be applied a week after the date of purging. An Anuvasana-vasti should also be applied on the very same day. 19.

 

Thus ends the Thirty-sixth Chapter of the Chikitsita Sthana in the Sushruta Samhita which treats of the medical treatment of the diseases consequent on the injudicious applications of a Vasti.

Footnotes and references:

[1]:

These are strangury (Mutra-kricchra), suppression of urine (Mutra- ghata), etc.

[2]:

According to Dallana the remedy in this case would be that applicable in a case of Mutraghata, etc.; but Jejjata holds that the remedy lies in applying a Picchila Vasti as in the preceding case.

[3]:

An additional reading says that it causes vomiting, nausea, epileptic fits and a burning sensation of the body. Vrinda supports this additional reading.

[4]:

Gayadasa reads and recommends that the purgatives to be used in such a case should be devoid of any oleaginous substances (Sneha).

[5]:

An additional reading says that a dry (thickend?) Niruha-vasti produces a slimy deposit in the rectum and in the pelvic region, while one with its fluid of an extremely thin consistency would produce only a little effect and might produce diarrhea.

[6]:

Jejjata’s reading of this passage does not include the application of Sveda but means that the Uttara-vasti should be applied with a Sneha.

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