Sushruta Samhita, Volume 6: Uttara-tantra

by Kaviraj Kunja Lal Bhishagratna | 1916 | 113,078 words

This current book, the Uttara-tantra (english translation) is the supplementary part of the Sushrutasamhita and deals various subjects such as diseases of the eye, treatment of fever, diarrhea, diseases resulting from superhuman influences, insanity, rules of health etc. The Sushruta Samhita is the most representative work of the Hindu system of m...

Chapter XL - Symptoms and treatment of Diarrhea (Atisara)

Now we shall discourse on the (causes, symptoms and) medical treatment of diarrhea, etc. (Atisara-pratisheda). 1.

Causes of Atisara:—

The excessive use of extremely heavy (hard to digest), oleaginous, dry, hot, cold, fluid, thick, and incompatible articles of food, eating irregularly and at improper time (or unaccustomed articles of fare), indigestion, eating before the digestion of the previous meal, excessive use or misuse of any lardacious substances, etc., (Sneha, Sveda, etc.), use of any poison, fright, grief, drinking impure water, the excessive drinking of liquor, change of season or physical contrarieties, indulgence in aquatic sports, voluntary repression of any natural urging (of the body) or germination of parasites in the intestines are the causes which bring on an attack of diarrhea (Atisara) the symptoms whereof will be dealt with presently. 2.

Pathology:—

The liquid part (Ap-dhatu) of the body, if aggravated and carried downward by the bodily Vayu, impairs the fire in the stomach (fire of digestion) and mixing with the fecal matter, is painfully and constantly emitted through the anus. This dangerous disease is named Atisara from the constant oozing out (Ati and Sarana) of the liquid fecal matter from the anus. It is usually classified into six different types, viz., those due to the predominance of the deranged bodily Doshas severally involved therein, that due to the concerted action of the three Doshas, one due to grief and that due to the indigested mucous accumulations (Ama) in the intestines. Some authorities hold that Atisara is of many kinds but the holy Dhanvantari, on the contrary, holds that it is not so but that the physical conditions of a diarrheic patient undergo changes and become manifold. 3.

Premonitory Symptoms:—

Piercing pain in the regions of the heart, umbilicus, rectum, abdomen and in the Kukshi (sides of the abdomen), a sense of numbness in the limbs, stoppage or suppression of flatus and of stool, distension of the abdomen, and indigestion are the premonitory symptoms of the disease. 4.

Symptoms of Vataja, Pittaja, Kaphaja and Tri-doshaja Types:—

The Vayu -origined type of the disease is marked by Shula (colic), suppression of urine, rumbling sound in the intestines, looseness (constant movement in the intestines) of the abdominal (Apana) wind, a gone feeling in the waist, in the thighs and in the legs, and frequent emissions with flatus of a scanty, frothy, dry (Ruksha) brown-coloured (yellowish black) stool. The specific features of the Pitta-origined type are that the stool is fetid, hot, yellow, blue or slightly red-coloured, or resembles the washings of meat, and is emitted with sharp or acute force and is accompanied by thirst, epileptic fits (fainting), burning sensation, perspiration, suppuration and inflamation (Paka) of the affected organs, and fever. In the Kapha-origined type of the disease the stool becomes loose and constant, gets mixed with the lump of mucus and looks white. The stool comes out without any sound. A sense of constant urging is complained of and each motion only creates the apprehension of a fresh one in the mind. The patient becomes drowsy or sleepy, and feels a sense of heaviness in the limbs, nausea, disrelish for food, horripalation and lassitude. The symptoms which mark a case of Tri-doshaja type (due to the concerted action of the three simultaneously deranged bodily Doshas) are drowsiness, swoon, lassitude, dryness of the mouth, thirst and a varied colour of the stools. A case of Tri-doshaja type, if attended with all the symptoms, is very hard to cure and if occurring in an infant, or an old person, is scarcely amenable to medical treatment. 5–3.

Symptoms of Shokaja and Amaja Atisara:—

The suppressed tears of a bereaved person of sparing diet, on quenching the digestive fire, reach down into the Koshtha (intestines) and there freely mix with, and vitiate the local blood which becomes dark-red like Kakananti (Gunja). It then passes through the rectum, charged with a peculiar fetour imparted to it by the fecal matter in case of its combination with the latter or without any fetid smell, when passing out unmixed. Such an attack ushered in by the grief of bereavement of a person is accordingly considered very hard to cure. The local bodily Doshas in the Koshtha (abdomen) are aggravated and deranged when they come in contact with the Ama (unassimilated chyle), and are brought down into the Koshtha (bowels), where they are more agitated and emitted in combination with the undigested fecal matter in various ways, and are attended with pain and characterised by a variety of colour. This is the sixth type of Atisara. 9–10

Symptoms of Ama and Pakva Atisara:—

A case of Atisara (diarrhea) would be said to be in the Ama (acute) state, if the stool of the patient suffering from any of the foregoing Doshas would be found to sink in water and to emit a very fetid smell and to pass in broken jets (D. R.—to be slimy). A contrariety of the preceding symptoms and a sense of lightness of the body and in the affected cavity would indicate that the disease has passed the acute stage and it is then called Pakva (chronic) Atisara. II.

Prognosis:—

If the colour of the stool (in a case of Atisara) resembles that of clarified butter, fat, the washings of Veshavara, oil, goat’s milk, honey, Manjishtha, brain-matter, or Rasanjana, or if the stool is cold or hot to the touch, or if it is charged with a fleshy or fetid smell, or marked with lines or specks of variegated colours, or if it looks like pus or clay, or if just the opposite or reverse symptoms or other distressing symptoms would be exhibited, the case is likely to end fatally in case the patient be weak. A patient suffering from an attack of Atisara would be given up (as incurable) if he be weak, if the orifice of his anus become suppurated and cannot be closed, if there be distension of the abdomen (D. R.—if the patient be not self-restrained), if there be distressing symptoms and if the patient be found destitute of thermal heat. 12–13.

An attack of Atisara ushered in by whatsoever cause, is sure to be marked by the specific symptoms of the deranged bodily Dosha or Doshas complicated with it. All cases of Atisara whether due to the indigestion of any oleaginous food or drink (Ghrita, oil, etc.), whether with (or without) the symptoms of Pravahika and the accompanying colic, as well as those due to Visuchika or any other kind of indigestion as also those due to the effect of any poison (affecting the digestive system), hemorrhoids (Arshas), or worms in the intestines,—all of them are marked by the symptoms of the specific Dosha involved therein. The treatment of Atisara varies according to its acute or matured stage, the characteristic symptoms of those therefore are to be carefully observed and noted in each case under treatment 14–15.

The patient should be kept without food as soon as the premonitory symptoms of Atisara would appear, and then the dietic gruels (Yavagu) prepared with the admixture of digestive drugs should be given in their proper order. In a case marked by colic and flatulent distension of the abdomen, fasting should be first advised. And then vomiting should be induced with draughts of water mixed with powdered Pippali and Saindhava salt. A light diet in the shape of a Khada-yusha, Yavagu, etc., prepared with the admixture of the drugs of the Pippalyadi group, should then be prescribed after the cessation of vomiting. A decoction of the drugs of the Haridradi, or Vacadi group, should be be taken in the morning where the preceding remedies would fail to relieve mucous accumulations in the intestines (Amatisara). No astringent or costive medicine in the acute or immature (Ama) stage of the disease should be administered in as much as by obstructing the passage of the Doshas it might bring on an attack of enlarged spleen, chlorosis, distension of the abdomen with suppression of stool and urine, Meha (urinary complaints), Kushtha (cutaneous affections), ascites, fever, edematous swellings of the limbs, Gulma (abdominal gland, etc.,) diarrhea, piles, colic, Alasaka and catching pain at the heart. 16–17.

Purging should be induced with Haritaki in a case marked by constant and scanty motions (of mucus and) attended with griping and pain (Shula) or by an incarceration of the deranged bodily Doshas (in the intestines). Emetics should be first exhibited and followed by fastings and digestive or assimilative (Pacana) remedies in a case marked by watery and copious motions. Powdered Haritaki and Pippali with tepid water should be administered for purgative purposes in a case marked by scanty emissions of stool at times attended with pain and colic (Shula). Fasting is the first remedy to be prescribed in cases of Ama (acute) Atisara, or in the alternative, digestive remedies should be prescribed. The recipes of digestive medicinal compounds which are curative in the disease under discussion (Amatisara) are described below. 18–19.

Twenty different Recipes for Amatisara:—

  1. Deva-daru, Vaca, Musta, Nagara, Ativisha and Abhaya;
  2. Kalinga (Indra-yava), Ativisha, Hingu, Sauvarchala- salt, Vaca and Abhaya,
  3. Abhaya (D. R.-Nagara), Dhanyaka, Musta, Valaka and Vilva;
  4. Musta, Parpataka, Shunthi, Vaca, Ativisha and Abhaya;
  5. Abhaya, Ativisha, Hingu, Vaca, and Sauvarchala- salt;
  6. Citraka, Pippali-mula, Vaca, Katuka-rohini,
  7. Patha, Vatsaka- seeds (Indra-yava), Haritaki and Mahaushadha (Shunthi),
  8. Murva, Nirdahani, (Citraka), Patha, Tryushana (Tri-katu) and Gaja-pippali;
  9. Siddharthaka, Bhadra-daru, Shatahva and Katu-rohini;
  10. Ela, Savaraka (Lodhra), Kushtha, the two sorts of Haridra, Kutaja -seeds (Indra-yava);
  11. Mesha-shringi, Tvak, Ela, Krimighna (Vidanga) and Vrikshaka (Indra-yava);
  12. Brikshadani, Virataru, the two kinds of Vrihati and the two kinds of Saha (Mudga-parni and Masha-parni);
  13. barks of Eranda, Tinduka, Dadima, Kutaja and of Shami;
  14. Patha, Tejovati, Musta, Pippali and Indra-yava;
  15. Patola, Dipyaka (Yamani), Vilva, the two kinds of Haridra and Deva-daru;
  16. Vidanga, Abhaya, Patha, Shringavera, Ghana (Musta) and Vaca;
  17. Vaca, Vatsaka- seeds (Indra-yava), Saindhava and Katu-rohini;
  18. Hingu, Vatsaka-secas (Indra-yava), Vaca and dried green Vilva;
  19. Nagara, Ativisha, Musta, the two kinds of Pippali and Vatsaka- seeds (Indra-yava);
  20. Mahaushadha, Prati-visha and Musta,

—these are the Twenty different recipes of the remedies which are digestive (of the mucous accumulations) in cases of Ama-Atisara and should be administered (in the shape of powder) with Dhanyamla (Kanjika), tepid water or wine, or their decoctions in luke-warm state should be used. This is a detailed list of the best remedies in cases of Ama-Atisara. 20.

A compound of Haritaki, Ativisha, Hingu, Sauvarchala and Vaca should be taken with tepid water in cases of Ama-Atisaras. Similarly a compound of Patola, Yamani, Vishva, Vaca, Pippali, Nagara, Musta, Vidanga, and Kushtha, or that of Shunthi and Guduci should be taken with tepid water. 21-23.

The five following compounds separately composed

  1. of all kinds of officinal salt, Pippali, Vidanga and Haritaki;
  2. or of Citraka, Shimshapa, Patha, Sharngashta, and all kinds of officinal salt;
  3. or of Hingu, Vrikshaka- seeds (Indra-yava) and all kinds of officinal salt taken in equal parts;
  4. or of Naga-danti and Pippali, weighing two Tolas;
  5. or of Vaca and Guduci- stems, would be found beneficial, if taken with tepid water.

Twenty Musta, should be boiled in a quantity of milk and thrice as much water. The milk which is left back after all the water is evaporated by boiling, should be used for the relief of the griping (Shula) due to the accumulation of mucus (Ama) in the intestines. 24–25.

Clarified butter mixed with Saindhava -salt and Yava-kshara should be given to a patient of weak digestive power in a case in which the Vayu has not been restored to its normal condition in spite of the subsidence of the intestinal Shula (griping) and which is marked by scanty (but repeated) motions passed with pain. The Ghrita duly cooked with Nagara, Changeri and Kola (Vadara) and with milk[1], curd (Dadhi) and Amla (Kanjika), or simply the transparent part of clarified butter should be taken as a relief for Atisara attended with Sula (pain). In the alternative, clarified butter mixed with (an equal quantity of) oil and duly cooked with curd, together with a paste of Tri-katu, Jati (flower) and Citraka, or with that of Pippali-mula, Vilva, Dadima-bark and Kushtha should be given. All these are the remedies to be employed in a type of Atisara due to the action of Vata or of Shleshma; and all the foregoing remedies with the exception of those of keen and heat-making potency, may be used in the Pittaja type of the disease. 26–27.

Fasting as already advised should be first observed and it should be broken with gruels (Yavagu) duly cooked with the two kinds Vala, or with Amsh?-mati, or Shvadamshtra and Vrihati, or Shatavari made cold and mixed with honey. The soup (Yusha) of Mudga duly cooked with the drugs of appetising virtue, or with mild and bitter drugs of appetising property would cure (the Dosha in) the acute stage (Ama-dosha) of the stool. Decoctions of Haridra, Ativisha, Patha, Vatsa -seeds (Indra-yava) and Rasanjana; or of Rasanjana, the two kinds of Haridra and Kutaja -seeds (Indra-yava; or of Patha, Guduci, Bhu-nimba and Katu-rohini would prove extremly useful in correcting (Pacana) the deranged Pitta. 28–29.

Six Yogas for Pittaja-Atisara:—

Any one of the six decoctions respectively prepared with Musta, Kutaja- seeds (Indra-yava), Bhu-nimba and Rasanjana; or with Darvi, Duralabha, Vilva and red Chandana; or with Chandana, Valaka, Musta, Bhu-nimba, Duralava; or with Mrinala, Chandana, Rodhra, Nagara and Nilotpala; or with Patha, Musta, the two kinds of Haridra, Pippali and Kutaja- seeds; or with the seeds and barks of Vatsaka, Shringavera and Vaca mixed with clarified butter should be regarded as good remedies for the Pittaja type of Atisara. 30.

A case of Pittaja -Atisara in its acute (Ama) stage would yield to the use of a decoction of (unripe) Vilva, Indra-yava, Ambhoda (Musta), Valaka and Ativisha. A decoction of Yashti-madhu, Utpala, Vilva, Amra, Hrivera, Ushira and Nagara mixed with honey proves curative in the case under discussion. 31–32.

Astringent or constipating (Samstambhana) remedies should be employed in a case of the chronic (Pakva) Atisara marked by dullness of the Grahani, viz., the digestive fire and by constant motions. Any of the four following medicinal compounds, viz., Samanga, Dhataki-flower, Manjistha, Lodhra and Musta; or of Shalmali-veshtaka, Rodhra and the bark of Vrikshaka (Kutaja) and of Dadima; or of the stone of Amra, Lodhra, the inner pulp of (unripe) Vilva and Priyangu; or of Yashti-madhu, Shringavera and the bark of Dirgha-vrinta (Shyonaka) should be taken with honey and the washings of rice in cases of chronic (Pakva) Atisara. 33–34.

The decoction of Musta alone should be taken with honey in the case under discussion, or a decoction of any of the nine Ganas, viz., the Lodhradi, Amboshthadi, or Priyangvadi groups, etc. (see Chapter XXXVIII, Sutra-Sthana) should be employed. Similarly, the decoction of Padma, Samanga, Yashti-madhu and dried Vilva and Jambu fruits should be taken with the washings of rice mixed with honey. A paste of the root of Kacchura weighing an Udumvara (two Tolas) should be similarly taken (with the same vehicles). A case of Pakvatisara marked by bloody stool or by emission of blood (from the intestines) would yield to the use of the decoction of Payasya, Chandana, Padma (Bhargi), Sita (sugar), Musta and the polens of lotus. 35—38.

Application o f Ghrita:—

Clarified butter with Yava-kshara should be given to a patient with due regard to the state of his digestive power if, after being treated with fasting, etc., he be still found to be affected with Sula and dryness and if the stool would be found to be free from mucus i.e., in a case of Pakvatisara. The colic (in a case of Atisara) is relieved by taking (a potion of clarified butter duly cooked with) Vala, Vrihati, Amshu-mati and Kacchura- roots mixed with a little honey and Yashti-madhu (as an after-throw). Clarified butter duly cooked with Darvi, Vilva, Kana (Pippali), Draksha, Katuka and Indra-yava would prove curative in a case of Atisara due to the action of the Vata, Pitta and Kapha (jointly or separately). A draught of milk, honey and clarified butter (in equal parts) mixed with sugar, Ajamoda, Katvanga and Yashti-madhu (as an after-throw) would relieve the griping (Shula) in the intestines (in a case of Atisara). 39 —42.

Putapaka Preparations:—

A case of long-standing (chronic) Atisara marked by stools of various colours and a keen digestion but unattended with any sort of pain or complication should be remedied with medicines prepared in the maner of Puta-paka preparation (described below). The barks of Dirgha-vrinta (Shyonaka), and polens of lotus should be pasted together and wrapped up in leaves of Kashmari or of Padma (lotus) with their ends tied with string or thread (D. R.—Kusha). The cover should be then coated with a plaster of clay and duly scorched in the fire of (smokeless) charcoal (of Khadira). When well cooked, it should be taken out and the juice, squeezed out of its contents. This juice should be cooled and administered in combination with honey in a case of Atisara. Similar preparations of the drugs known as Jivanti and Mesha-shringi, etc., may also be used in the same way. The skin of a Tittira bird should be peeled off and a paste of the drugs of the Nyagrodhadi group should be stuffed into its belly after it has been previously drawn. After this it should be duly stitched up and cooked (scorched) in the fire in the above manner. The juice should then be squeezed out therefrom and administered, when cool, with the admixture of honey and sugar in a case of Atisara. The drugs known as Lodhra, Chandana, Yashti-madhu, Darvi, Patha, Sita (sugar), Utpala and the barks of Dirgha-vrinta pasted together with the washings of rice should be duly scorched in the fire in the above manner (of a Puta-paka)..The juice pressed out of its contents and taken with honey, when cold, proves curative in cases of Atisara due to the action of the deranged Pitta and Kapha. Similar preparations may be made of the aerial roots of Vata, etc., and may be advantageously prescribed with the soup of the flesh of any Jangala bird (such as Tittira, Kapinjala, etc,). 43–47.

The Kutaja -bark taken with treacle would cure perforce the long-standing cases of Atisara attended with blood and marked by the diminished action of the bodily Vayu but a predominant action of the deranged Kapha. The drugs of the Ambashtadi group as well as those of the Pippalyadi group taken with honey would be similarly beneficial. 48-49

A Peya duly prepared with the admixture of Prishni-parni, Bala, Vilva (D. R. Vishva), Balaka, Utpala, Dhanyaka and Nagara, should be taken by a patient suffering from Atisara. A case of Pakvatisara would yield to the curative efficacy of a light medicinal gruel (Yavagu) duly prepared with the admixture of the paste of Shyonaka- bark, Priyangu, Yashti-madhu, and tender sprouts of Dadima pasted together with curd. A case of Atisara attended with blood and colic (Sula) would be readily cured by the use of Rasanjana, Ativisha, Dhataki, Nagara and the bark and seeds of Kutaja taken with honey and the washings of rice. 50—52.

Yashti-madhu, (dried) green Vilva -fruit mixed with honey and sugar, or particles of Shali and Shashtika rice (administered with the same drugs) would prove curative in a case of Atisara. Badari -roots pasted with honey should be given to be licked with the same result. Barks of Badari, Arjuna, Jambu, Amra, Shallaki and Vetasa taken with honey and sugar would cure a case of Atisara. Gruels (Yavagu), Mandas (thick gruel squeezed through a piece of linen) and Yusha (soup) may also be duly prepared with the admixture of these drugs, and in a case marked by excessive thirst, the water for drinking should be prepared by duly boiling these drugs. The cold infusion of[2] Shalmali-stems kept in the open space for a whole night, may be given good with good results as a drink in combination with Yasthi-madhu and honey. 53—54.

Use of Milk in Atisara:—

Milk should be given in a case of Atisara marked by the suppression of stool and Vayu and attended with griping (Shula), constant scanty motions, symptoms of Rakta-pitta and thirst. Milk is ambrosia itself in such a case of Atisara (Dysentery), and in long-standing cases the milk to be taken should be duly boiled with thrice as much water. This would remove the remnant, if any, of the Dosha involved and is, therefore, considered as the best remedy in such cases. Oily purgatives and application of Picchila-Vasti (slimy intestinal injections) as well as the medicated Ghrita duly prepared with the expressed juice of the barks of slimy trees, e.g., Shyona, Shalmali, etc., are beneficial under the circumstances (in chronic or longstanding cases). 56.

Draughts of clarified butter duly prepared with the tender sprouts of the Kshiri trees and mixed with honey and sugar (as an after-throw) should be taken in a case of Atisara marked with a discharge of blood before or after the passing of the stool and with a cutting pain (in the region of the anus). Draughts of medicated clarified butter duly prepared with the barks of Deva-daru, and with Pippali, Shunthi, Laksha, Indrayava, and Bhadra-rohini (Katuka) administered through the medium of any kind of Peya, would prove highly efficacious in a case of Tri-doshaja Atisara of severe type. 57–58.

Exhibition of emetics or vomiting is an excellent remedy in a case of Atisara marked by heaviness (in the abdomen) and the predominance of the deranged bodily Kapha. A case attended with fever, burning sensation and suppression of stool and marked by an aggravation of Vayu should be treated as a case of Rakta-pitta. Intestinal injections with urine-purifying (Mutra-Shodhana) drugs should be speedily administered in the manner of an Asthapana or Anuvasana Vasti, as the occasion might arise, in a case marked by an excessive accumulation of the deranged bodily Doshas in the affected locality as well as by the suppression (of stool) during the mature stage of the disease. 59-60.

Intestinal injections consisting of oil or clarified butter duly cooked and prepared with the drugs of sweet and acid tastes should be applied in the manner of an Anuvasana Vasti in a case marked by the protrusion of the bowel through violent and excessive straining and by painful obstruction of urine (Mutraghata) and pain in the waist. Pitta-subduing washes, and injections prepared with the Pitta-subduing drugs and applied in the manner of Anuvasana Vasti, are the remedies in a case marked by the suppuration of the anus due to the aggravation of Pitta in an injudicious or intemperate patient. Anuvasana Vasti charged with oil duly cooked with wine, Viha and Dadhi-manda should be applied in a case of Atisara marked by the aggravation of the deranged bodily Vayu, and milk duly boiled and cooked with the admixture of Kacchura- roots should be given to drink. 61–63.

Piccha-Vasti should be applied (into the rectum) in a case of Atisara marked by painful and frequent emission of blood, though in scanty quantities at a time, and by an entire suppression of Vayu (flatus). An atonic condition of the anus results from a longstanding attack of Atisara which should, therefore, be remedied by rubbing the part with oil. 64–65.

Diet:—

The diet of the patient suffering from Atisara should be prepared with the admixture of Kapittha, Shalmali, Phanji (a kind of Patha), Vana-Karpasi (D. R. Vata and Karpasi), Dadima, Yuthika, Kacchura, Shelu, Shana, Chucchu, Dadhi (curd), Shala-parni, Prishniparni, Vrihati, Kanta-karika, Vala, Shvadamstra, Vilva, Patha, Nagara and Dhanyaka and may also consists of the pastes of sesamum and Mudga pulse or of Mudga soup. 66.

Causes and Symptoms of Raktatisara:—

The bodily Pitta of a person already suffering from an attack of Pittaja-Atisara is further deranged and aggravated, if Pitta-generating eatables are taken, and ushers in the discharge of blood with stool accompanied by fever, burning sensation, thirst, gripings (Shula) and excessive suppuration (inflamation) of the anus (Guda). The above are the characteristics of the Raktati-sara. 67.

Treatment:—

Draughts of milk duly boiled and cooked with the leaves of Vata, etc. (those included within the Nyagrodhadi group) should be given with clarified butter, or with sugar and honey in a case marked by a discharge of blood before or after motions; or the butter prepared by stirring the preceding preparation of milk should be taken; and draught of the Takra (thus prepared) should be taken as an after-potion. The discharge of blood (in a case of Atisara) may be stopped by a potion consisting of the barks of Piyala, Shalmali, Plaksha, Shallaki, and of Tinisha pasted together with milk and mixed with honey. The same result is obtained by administering the milk of a she-goat with a paste of Yashti-nuidhu, sugar, Lodhra, Payasya (Arkapushpi) and Darvi and mixed with honey, or with a paste (or powder) of Manjishtha, Shariva, Lodhra, Padmaka, Kumuda, Utpala and Padma (Bhargi.) 68–71.

Sugar, Utpala, Lodhra, Samanga, Yashti-madhu and Tila; or Tila, Moca-rasa and Lodhra; or Yashti-madhu and Utpala; or Kacchura and Tila are the ingredients of four recipes which, if taken with the she-goat’s milk and honey, would remove the blood in the stool. Pastes of unripe Vilva fruits, treacle and honey taken before the meal would be a remedy in a case marked by watery motions mixed with blood. A case of blood-dysentry due to the deranged blood, and Pitta and attended with Shula yields to the use of a compound consisting of Koshakara (a kind of sugar-cane) pulverised parched paddy fried in clarified butter and mixed with sugar and honey. A case of blood-dysentery due to the action of the deranged blood, and Pitta may be cured with a compound of the kernel of a (unripe) Vilva-fruit mixed with Yashti-madhu and taken with the washings of rice, honey and sugar. The remedies mentioned in connection with a case of Guda-paka (suppuration of anus) should also be employed in these cases. Application of Piccha-Vasti is recommended in the type where the pain begins to subside. A purgative consisting of the decoction of Vidanga, Triphala and Pippali should be given to a patient with good appetite as soon as the stool would assume[3] the colour of blood. In the alternative, a purgative consisting only of milk cooked with Eranda- roots (castor plant) should be employed and the patient should be given Yavagu prepared with appetising and Vayu-subduing drugs. 72–78.

Treacle (Phanita) mixed with powdered Shunthi, curd, oil, milk and clarified butter should be given in a case marked by good appetite but by frothy motions devoid of all fecal matter. Badara -fruits boiled with oil and treacle, or cakes prepared from them and dried unripe Vilva -fruits should be prescribed. Cakes prepared with boiled Masha -pulse should be prescribed to be taken with curd followed by a draught of Shveta (cake-made) wine in the case marked by the absence of fecal matter in the stool. The blood-stained flesh of a hare cooked with Samanga, curd and clarified butter should be taken with well boiled rice. 79.

A decoction of Masha- pulse, Kola and barley duly cooked in equal parts of the oil and clarified butter and mixed with curd and the expressed juice of Dadima should be prescribed as diet in the case. The absence of any fecal matter in the stool (Purisha-Kshaya) would yield to the use of Bit (black salt), dried unripe Vilva fruit and Shunthi pasted with any acid juice and mixed with curd-cream and cooked in equal parts of oil and clarified butter. Clarified butter duly cooked with as tringent and appetising drugs should be given in a case of Atisara attended with Shula where the patient feels a good appetite after the loss of fecal matter. 80—81.

Symptoms of Pravahika:—

The Vayu in the organism of a person addicted to the use of unwholesome food, is deranged and aggravated. It carries down the accumulations of Valasa (mucus) into the lower part of the body, whence, mixed with stools, they are constantly passed off with tenesmus. The disease is called Pravahika (mucous diarrhea). The motions are attended with Sula (pain) in the Vataja type of the disease, with burning sensation in the Pittaja one, with mucus in the Kaphaja one and with blood (blood-streaked mucus) in the R aktaja (blood-origined type). Excessive use of dry (Ruksha) or of fatty articles of food may be regarded as the exciting factor of these cases. The specific indications of Pravahika as well as its Ama or acute and Pakva or mature stage are respectively identical with those of the several types of Atisara. 82–83.

Treatment:—

In the event of fasting and other digestive (Pacana) compounds (of Pravahika) producing no beneficial effect in serious cases they are found to readily yield to the use of boiled milk, oil, Tila (sesamum) or Picchila Vasti. The green stems of Shalmali well covered with green Kusha- blades, should be scorched in the fire in the manner of Puta-paka. The juice should be squeezed out thereof and mixed with boiled milk, oil, clarified butter and powdered Yashti-madhu, and should be carefully injected into the rectum in the manner of Vasti application in cases of Pravahika marked with the retention of stool and urine. Similar injections of a decoction of Dasha-mula duly cooked in milk and mixed with honey and applied in the manner of an Asthapana -Vasti as well as the application of oil in the manner of an Anuvasana Vasti would prove highly efficacious in cases marked with painful tenesmus. 84—86.

Diet:—

Oil duly cooked with the drugs of the Vayu-subduing (Vidari-gandhadi) group and with (the five officinal kinds of) salt should be used in (the preparation of) food and drink. A compound consisting of Lodhra, Bit -salt and dried unripe Vilva -fruit pasted with oil and mixed with Tri-katu should be given to be licked[4]. The food (boiled rice) of a diar-rhetic patient should be taken with honey and curd from which the cream has not been removed; or with milk warmed by a piece of red-hot metal[5] (other than gold and silver) and mixed when cold with a profuse quantity of honey. The use of milk duly boiled and cooked with the admixture of Tri-katu and Vidari-gandha, with the food would prove curative in a case attended with Shula. He should also be given soups (Rasa) prepared with the drugs of appetising, astringent (Grahi) and Vayu-subduing virtues. Fish he may take and his soup should be prepared with oil and clarified butter with the admixture of Vayu-subduing drugs. The diet in this disease should consist of venison, mutton or goat’s flesh cooked with the tender sprouts of a Vata tree or of blood of a fatty goat duly cooked with curd (Dadhi), oil and clarified butter. He may take his food with an unsalted soup (Yusha) of a peacock or of a Lava bird, or with well prepared curd. He may take (with benefit) well cooked Masha-pulse mixed with the transparent upper part of clarified butter (Ghrita-manda) and with curd, while chewing at intervals (with his teeth) the unpowdered Marica (black pepper). 87—89.

A compound of milk, honey and clarified butter mixed with the decoction of Yashti-madhu and Utpala should be applied in the manner of Vasti-application in (a case of Pravahika, marked by) excessive pain and painful micturation (Mutra-Kricchra). The application of this Vasti would alleviate the burning sensation, allay the the accompanying fever and remove the blood (in the stool). Injections of the decoction (of the drugs) of Madhura group (such as Kakoli, etc.) in the manner of an Anuvasana Vasti, should also be applied every day—at daytime or in the night, if the patient be feeling any pain. 90.

A Vasti applied with the admixture of oil would pacify the aggravated bodily Vayu and Pravahika, would be removed with the pacification of the deranged bodily Vayu. The main treatment, therefore, in a case of Pravahika is to restore the deranged local Vayu to its normal condition, (which is identical with a cure). 91.

Medical Treatment:—

The drugs known as Patha, Ajamoda, Kutaja-seeds, Shunthi and Magadhika taken in equal parts, pasted together and dissolved in tepid water or milk duly boiled with the testicles of a goat and mixed with clarified butter would prove efficacious in a case of Pravahika. Clarified butter mixed with oil and duly cooked with Shunthi and Kshavaka would give instantaneous relief, if licked. Yavagu duly prepared with the admixture of Vilva and the expressed juice of Gajashana (Shallaki), Kumbhika and Dadima and with curd, oil and clarified butter would prove highly beneficial. The use of milk just drawn would similarly prove beneficial in the case. 92.

A wise and experienced physician should employ the foregoing medicinal compounds and decotions in the complaints of the bowels and of the stomach (Udaramaya) as well as light, appetising and emulsive (Snigdha) articles of fare and other articles of food prescribed before as diet in the cases. 93.

Yavagu:—

Yavagu (gruel) is always efficacious in cases of fever and Atisara in as much as it allays thirst, is light in digestion and appetising, and acts as a cleanser of the bladder (diuretic). 94.

General Principle of Treatment:—

Drying (Ruksha) measures should be employed in a case due to the excessive use of any oily or emulsive food and emulsive (Snigdha) measures should be adopted in a case brought on through an excessive use of any dry (Ruksha) article. The cause of terror should be first removed in a case due to fright, while the mind should be calmed or consoled in the case due to any grief or bereavement. The treatment in cases (of Atisara) due to piles or worms (in the intestines) as well as in those due to the effect of poison (introduced into the system) consits in employing therapeutic agents which are simultaneously remedial both to the disease and to its exciting factors. Complications or distressing concomitants such as vomiting, thirst, fainting fits, etc., should be removed with drugs which are not incompatible with the main treatment of the disease, and which do not aggravate the exciting factors. In a case of fever or Atisara marked by the simultaneous aggravation of the deranged bodily Doshas, the deranged Pitta should be first remedied, while in all other affections, it is the deranged bodily Vayu which should be first curbed down or corrected. 95—96.

Indications of Cure:—

Non-emission of stool at the time of urination and the free emission of flatus (Vayu), as well as the rousing of the appetite, and the lightness of the abdominal cavity (Koshtha) are the indications of cure in a case of Udaramaya (Diarrhea, etc.).[6] 97.

Static or Dynamic causes of Diseases and Treatment:—

Some diseases are due to the dynamics of Karmas (deeds done by a man in the present or any prior existence), and some are due to the effects of deranged bodily Doshas, while there may be others which have their origin both in the dynamics of Karma and the necessary physiological (Doshaja) causes. Of these a Karma-origined disease may come on without any apparent exciting factor and it disappears with the extinction of its (Karma’s) result effected by means of any remedial measure (e. g. penance, etc.) other than medical treatment, whereas as a Dosha -origined disease is conquered as soon as the involved deranged Doshas of the body are restored to their normal condition. Cases due to a slight derangement of the bodily Doshas but attended with a good deal of troubles as well as those due to the excessive aggravation of the Doshas but attended with only slight troubles should be attributed both to the physiological causes and to the dynamics of Karma, and these are cured only when both of these causes viz., Karma and aggravated Doshas are removed. 98.

Grahani:—

The Grahani (lit. the uppermost extremity or the receiving ducts of the intestines) is affected by the causes which produce dulness of appetite. The digestive fire of a patient is again deranged, even after[7] the subsidence of an attack of Atisara, if, with the dulness of appetite, he be still intemperate and injudicious in matters of food and drink. Hence the regimen of diet and conduct in a case of Atisara should be as laid down in connection with the sequel of any purgative course (Virecana), until the deranged Doshas of the body would be completely restored to their normal condition, bringing in the natural health and strength in their train. The sixth Kala which has been described as the Pitta-dhara Kala (Pitta-containing sheath) is situated between Pakvashaya and Amashaya (duodenum?) is called Grahani. The strength of the organ of Grahani is dependent on the digestive fire (Agni) and the latter is situate in the former. Hence anything that impairs the digestive fire (Agni) necessarily affects the Grahani. 99-102.

The aggravation of one or all the bodily Doshas leads to the derangement of the Grahani into which the food taken is passed off in the shape of undigested fecal matter, or if it is digested, it sometimes produces constipation of the bowels and sometimes liquid motions accompained (in both cases) by pain and fetid smell. The disease is called Grahani (chronic diarrhea?) by experienced Physicians. 103.

Premonitory Symptoms:—

Incomplete digestion, lassitude or a sense of physical langour, laziness, thirst, a sense of exhaustion, weakness, aversion to food, cough, ringing in the ears (Karna-Kheda) and rumbling sound in the intestines are the symptoms which mark the premonitory stage of the disease. 104.

Symptoms:—

Swelling or oedema of the hands and of the feet, emaciation, pain at the joints, greediness, thirst, vomiting, fever, aversion to food, burning sensation, eructations of bitter, acid or fermented taste, or of those smelling of blood or smoke, water-brash, bad taste in the mouth and non-relish for food, as well an attack of Tamaka-Shvasa (variety of asthma) are the indications of the developed stage of the disease (Grahani). 105.

Specific Symptoms of Grahani:—

A case of the Vataja type is accompanied by a severe aching pain at the anus, thorax (Hridaya), sides, abdomen and the head. A case of the Pittaja type is marked by a burning sensation in the body, while the one of Kaphaja origin is characterised by a sense of heaviness in the limbs. A case of Tri-Doshaja Grahani exhibits symptoms belonging to all the symptoms of the three cases (Vataja, Pittaja and Kaphaja types). The deranged bodily Dosha involved in a case imparts its characteristic colour to the finger-nails, eyes, face and excreta (stool and urine) of the patient. Thus it furnishes a satisfactory clue to the diagnosis of the disease, which, if neglected or unchecked at the outset, may usher in an attack of Hrid-roga (disease of the heart), Pandu (chlorosis), Udara (ascites, etc), Gulma, piles and enlargement of spleen. 106.

Treatment and Diet:—

Appropriate emetics and purgatives should be exhibted (for cleansing the upper and lower parts of the body) in accordance with the aggravation of the Dosha or Doshas involved, and Peyas (gruels) and other articles of diet duly prepared with appetising drugs should then he prescribed in their due order. Therapeutic agents possessed of digestive, astringent and appetising virtue should then be employed through the vehicles of Sura, Arishta (wine), Sneha (oil or clarified butter), cow’s urine, tepid water, or Takra. The use of Takra in the morning is in itself an excellent cure for the disease (Grahani). Remedies mentioned in connection with the treatment of worms in the intestines, Gulma, ascites or piles may also be adopted with benefit in the disease under discussion. The compound known as the Hingvadi-churna, or the medicated clarified butter described as remedial in a case of enlarged spleen, or the one duly cooked with the expressed juice of Changeri and with the drugs of the Magadhadi (Pippalyadi) group as Kalka may be likewise prescribed with beneficial results. Clarified butter duly cooked with four times as much curd (Dadhi) may also be used with benefit. Whatever is appetising (medicines, drugs and diet, etc.) would be beneficial in cases of Grahani. Complications (Upadrava) such as fever, etc. should be subdued with drugs not incompatible with the main treatment of nor in any way aggravative of the main disease. 107

 

Thus ends the fortieth chapter of the Uttara-Tantra in the Sushruta Samhita which deals with the (symptoms) and medical treatment of Atisara.

Footnotes and references:

1.

We have the recipe of this Ghrita in Charaka Samhitā also. But there we find Kshārā in place of Kshira and that appears to be the better reading. See Chapter XIX,—under Cāngeri Ghrita, Charaka Samhitā.

2.

Powders of Śālmali stem should be kept immersed for whole night in an equal quantity of water. In the morning the water should be passed through a piece of linen. Four-Pala-weight of this water mixed with a Karsha weight of Yashti-madhu and honey should be taken.

3.

D. R.—When the stool would harden “saktaviṭ

4.

According to some variants this compound should be taken thrice daily.

5.

In place of “kupya”—Kupya (any metal other than gold and silver) some read “kurpa”—Kurpa which is explained to mean a kind of stone.

6.

The printed edition of Dallana’s commentary says that these are the symptoms of cases of aggravated Atisāra.

7.

The use of “api” in the text shows, say the commentators, that Grahani is possible even without a previous attack of Atisāra.

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