Processing of medicines

The texts describe various kinds of pharmaceutical preparations, such as, juices (svarasa), pastes (kalka), śṛta (decoction), hot infusion (phāṇṭa), cold infusion (śīta kaṣāya),^[1] decoctions (kaṣāya),^[2] powders (cūrṇa),^[3] linctus (avaleha, lehya, pāka, prāśa), fermented preparations (surā, mantha, āsava, ariṣṭa),^[4] medicated oils (taila) and ghṛta, milk preparation (kṣīra pāka),pills (guṭikā or vaṭi), triturated compounds (piṣṭī), collyrium (añjana), calcined powder of minerals, metals or gems (bhasma), iron compounds (ayaskṛtis) and dietetic preparations (yavāgu,^[5] yuṣa or rasa). A wise physician is advised to prepare thousands of medicated compounds on the basis of the formulae described in the texts.^[6] Such a huge number of formulations become necessary considering the various factors that govern drug action. These are deśa (habitat), kāla (time of their availability), sambhava (origin), āsvāda (palatability), rasa (taste), vīrya (potency), vipāka (taste after digestion) and prabhāva (specific action). Patients again are of different types depending upon the nature of their deha (physique), condition of the doṣas, prakṛti (constitution), age, strength (bala), agni (power of digestion and metabolism), bhakti (liking for a particular type of recipe), sātmya (wholesomeness), rogāvasathā (stage of the disease), etc. When all these factors are taken into consideration, the number of recipes needed to cater to various needs is innumerable.^[7]

Drug preparation is a complex and multifaceted issue in the medical texts. Some formulations involve protracted production processes that necessitate the involvement of several hands. This is from the method of processing of compounds like kṣāras or alkalis which are a type of medicinal salts extracted from plants and used in cauterisation. Its method of preparation has been discussed in detail by Suśruta. Kṣāras or alkalis are of two types: pratisāraṇīya (administered externally) and pānīya (administered internally). The pratisāraṇīya kṣāra, according to potency, can be mild, moderate and strong.

Alkalis can be prepared from large variety of trees such as kuṭaja, palāśa, asvakarṇa, pāribhadraka, bibhītaka, etc. Suśruta’s description pertains to kṣāra of the black muṣkaka identified as Schebera swietenioides Roxb., a moderate sized deciduous tree growing in the moist sub-Himalayan tracts eastwards of Kumaon as well as in central and peninsular India.^[8] A mature undamaged tree grown on good table land soil is identified first. The tree is uprooted on an auspicious day in autumn after consecration. All the parts including the roots, the fruits, the leaves and the branches are cut into pieces, heaped together, mixed with limestone, and burnt with sesame stalks. After the fire has burnt out, the wood ash and lime are collected separately.

One droṇa of the ash is dissolved in six times the quantity of water or urine, filtered twenty-one times, and stirred slowly on a fire till the liquid becomes clear, reddish, sharp and slimy. It is again filtered through a cloth, and one and a half kudava is kept aside and the rest of the filtrate is reheated. After boiling for a sufficient period of time, the alkaline water is cooled and stored in a covered iron vessel. By this the method the mild or mṛdu variety of ksāra is obtained.

The filtrate that is kept aside is the basic alkaline water or kśārodaka. For the moderate variety, certain other ingredients need to be added. Gravels of lime and ash, oyster shell and saṅkhanābhī (core of conch shell) are taken in equal quantities and burnt till they are red hot. They are dipped in the basic alkaline water in an iron vessel and made into a paste. Eight palas of this paste is mixed with two droṇas of the remaining alkaline water and further heated till the right consistency is obtained, that is neither too thick nor too thin. This results in the moderate (mṛdu) variety of the pratisāraṇīya alkali and stored in a covered iron vessel.^[9]

For preparing the strong or tikṣna variety of kṣāra, more drugs are added. Depending on availability fine powders of dantī, dravantī, citraka, lāṅgalī, pūtika, pravāla, tālapatri, viḍa, suvarcikā, kanakakṣīrī, hiṅgu, vacā, ativiṣā, in equal proportions, are mixed with the above alkaline liquid and further treated.^[10]

Many other formulations occurring in the texts are complex compounds of which we may mention the Mṛtasañjīvana-agada prepared with as many as forty-three ingredients^[11] and the Mahāgandhahastī that has even sixty ingredients.^[12] Certain formulations prepared by the śatapāka and sahaśrapāka methods require cooking the mixture a hundred or a thousand times over. Such methods of preparation could be afforded only by affluent patients.^[13] Suśruta’s description of the Sahaśrapāka oil for vātika disorders requires cooking oil a thousand times for as long a period as necessary with a thousand parts of several drugs.^[14] For the preparation of Gandha taila, an oil beneficial in fractures and dislocations, the ingredients are soaked in different liquids, pasted time and again and processed for over four weeks.^[15] A formulation of iron, lohāriṣṭa, takes 3-4 months to prepare.^[16]

There are many medicinal formulations of similar complexity that are labour-intensive. The Saṃhitās do not enlighten us about the assistants involved in their preparation. There is reference to attendants (paricārakas) for grinding herbs and pastes in hospitals.^[17] The Arthaśāstra mentions the presence of a cook and a pounder in the medicine store.^[18] As such a complex processing could not have been possible without considerable expertise, it would not be wrong to surmise the engagement of qualified assistants or trainee physicians under the supervision of an expert. In fact helping hands were necessary at different stages of pharmacy that is, for collection and procurement of the ingredients which included vegetable drugs, animal parts and minerals, for the processing and finally for storage. Besides, the handling of live animals like leeches required assistants as well. However, detailed information for such assistants is not forthcoming.

It appears that only a physician with adequate resources could possibly organise the elaborate processes involved in production of medicines, and perhaps, engage junior physicians in the task of supervision of production and storage. Management of individual drugs and formulations is another aspect of pharmacy that requires constant supervision. Old ones had to be replaced from time to time as those stored for long time undergo loss of potency.^[19] Besides, all drugs except honey, ghṛta, jaggery, long pepper (pippalī or Piper longum) and vidaṅga (Embelia ribes) are to be used in the fresh condition.^[20] This stipulation implies constant replenishment of the medical stores.

We get the description of the medical store (bheṣajāgāra), where medicines are wrapped in linen pieces and stored in earthenware pots and placed on wooden platforms and pegs^[21] or on swings.^[22] There are instructions for provision for ventilation of the storage room, and its protection from the natural elements, pollutants, pests and fire.^[23] There are special instructions with regard to some medications such as jīvanīya ghṛta,^[24] sahasrapāka oil,^[25] balā oil,^[26] khadira sāra,^[27] etc., to be stored safely in a concealed place (svanugupta) or well protected place (suguptaṃ) after performing protective rituals.^[28] The first two are used in vātika disorders and recommended particularly for the royalty, while the latter are meant for skin disorders. Extra precaution may have been necessitated by the exclusivity or rarity of these formulations or perhaps by the limited shelf life of drugs. The supervision of the store itself also called for managerial skills.

However, the question that arises here is whether it was at all possible for individual small-time physicians to build up the huge repertoire of drugs and pharmaceutical formulations mentioned in our two treatises. We get valuable reference to the availability of drugs in the market from the Caraka Saṃhitā. In the context of arrangement of all drugs as preparation for elimination therapies, the text insists that it should be done beforehand as in an emergency it may not be possible to obtain the required medicines within a short time even when they are locally available on sale.^[29] The sale of alkalis is known from the Arthaśāstra: the Superintendant of Mines established factories for certain items including caustics and arranged for its trade.^[30]

We may envisage a situation where smaller physicians may have manufactured simple ointments and pastes while patients procured most medicines from drug shops. Vaidya settlements are known from inscriptions (which we have noted in Chapter 2) and it is also possible that members established a central drug store by pooling resources. The presence of medicine shops indicates that some physicians were engaged in producing medicines for the market.

Footnotes and references:

[1]:

Caraka Saṃhitā Sūtrasthāna 4.7.

[2]:

Caraka Saṃhitā Sūtrasthāna 4.9-18.

[3]:

Caraka Saṃhitā Sūtrasthāna 3.10-11.

[4]:

Suśruta Saṃhitā Cikitsāsthāna 10.16.

[5]:

Caraka Saṃhitā Sūtrasthāna 2.17-33.

[6]:

Caraka Saṃhitā Kalpasthāna 12.49-50; Suśruta Saṃhitā Cikitsāsthāna 10.16.

[7]:

Caraka Saṃhitā Kalpasthāna 1.6.

[8]:

C.P. Khare, (Ed.), Indian Medicinal Plants: An Illustrated Dictionary, Springer-Verlag, Berlin/Heidelberg, 2007, p.589. www.iauamol.ac.ir/Files/medicinal%20plants.pdf

[9]:

Suśruta Saṃhitā Sūtrasthāna 11.11.

[10]:

Suśruta Saṃhitā Sūtrasthāna 11.13.

[11]:

Caraka Saṃhitā Cikitsāsthāna 23.54-57.

[12]:

Caraka Saṃhitā Cikitsāsthāna 23.77-81.

[13]:

Caraka Saṃhitā Siddhisthāna 12.19

[14]:

Suśruta Saṃhitā Cikitsāsthāna 4.29.

[15]:

Suśruta Saṃhitā Cikitsāsthāna 3.55-62.

[16]:

Suśruta Saṃhitā Cikitsāsthāna 12.12-19.

[17]:

Caraka Saṃhitā Sūtrasthāna 15.7.

[18]:

Arthaśāstra 1.21.9.

[19]:

Caraka Saṃhitā Siddhisthāna 6.28.

[20]:

Suśruta Saṃhitā Sūtrasthāna 36.7.

[21]:

Suśruta Saṃhitā Sūtrasthāna 36.17.

[22]:

Caraka Saṃhitā Kalpasthāna 1.11.

[23]:

Caraka Saṃhitā Kalpasthāna 1.11.

[24]:

Caraka Saṃhitā Cikitsāsthāna 29.61-67.

[25]:

Suśruta Saṃhitā Cikitsāsthāna 4.29.

[26]:

Suśruta Saṃhitā Cikitsāsthāna 15.28-39.

[27]:

Suśruta Saṃhitā Cikitsāsthāna 10.13.

[28]:

Caraka Saṃhitā Cikitsāsthāna 29.63.

[29]:

Caraka Saṃhitā Sūtrasthāna 15.3.

[30]:

Arthaśāstra 2.12.27.