Ashtangasamgraha 23

English (machine translation) 23

Language: English

23.1

Now we shall explain the chapter on the administration of medicaments;
thus spoke the great sages, Ātreya and the others;
thus spoke the great sages, Ātreya and the others;
thus spoke the great sages, Ātreya and the others.

23.2

Administering a medicament, one should first of all examine the patient thus:
In what region was this person born, reared, or taken ill; and in what region is this the food of the people, this the regimen of conduct, of such degree is their strength, of such nature their mental state, of such nature their habituation, this their fondness, these their diseases, this is wholesome, and this is unwholesome?
Or by prior intake of which specific etiological factor has his doṣa become aggravated?
For there are many causes for the aggravation of even a single doṣa;
therefore, having understood the doṣa by its respective characteristics and actions, the physician should comprehend it thus:
namely,
was vāta aggravated by food, or by regimen, likewise by dry, light, or cold [things], or by rash exertion, suppression of natural urges, or fear, or grief?
And then, a medicine that is its counteractive being applied, it leads quickly to success;
there, sweet, sour, and saline tastes, and pungent, bitter, and astringent ones, are mutually counteractive.
Immediately thereafter, one should ascertain:
How was the etiology indulged in, according to mild, moderate, or excessive variations?
For even of a single cause, according to the distinction of mild and so forth, and of the separate or combined doṣas, due to the specific variation of strength in fraction by fraction, there is a variation of strength and weakness of the disease;
there, in diseases consisting of multiple doṣas and in medicaments with multiple tastes, having examined the specific potency of tastes and doṣas one by one, he should determine the reality of the potency of the disease and the medicament;
but it is not so in every case.
And with those very meats, mixed with the great unctuous substances, bolus-sudation and the like [are administered] frequently to those anointed with them;
by a low or very high pillow, or by other water drunk.

23.3

For in the case of [conditions] joined together in an uneven transformation, consisting of diverse components, supporting or countering one another, and altered through various combinations, it is impossible to determine the true overall effect of the aggregate by inferring from the individual action of each component.

Indeed, in such an aggregate, only by observing the overall effect of the whole should one understand the true effect of both the disease and the medicine.

Likewise, one must determine in which site this disease is located.

For a doṣa that has spread, fixing itself upon its own seat or upon the head and other regions to produce disease, becomes difficult to overcome.

Therefore, in accordance with the specific site, a specific medicament must be sought.

Jujube, horse gram, Himalayan cedar, barley, dill, black gram, linseed, sweet flag, and kuṣṭha,
with rāsnā and castor seeds, made into a warm and sour poultice, conquer vāta.

Enraged doṣas with a predominance of vāta, having become thickened in the nose,
generate catarrh which, if increasing, causes wasting.

23.4

Then one should reflect in this manner:

For what medicament is this disease or patient suitable,

or for how much?

For the proportioning of the potency and quantity of medicine according to the doṣa depends on the strength of the disease and of the diseased person.

Unctuous enemas and nasal drops should be employed,

and one should examine [the principles in the chapter on] the treatment of the doṣas.

Obstruction of the nose, piercing pain, and aches in the teeth, temples, and head [occur].

23.5

Purifying medicines that are suddenly violent, fiery, airy, excessively cooling, or in excessive doses,

and likewise cautery, alkali, and surgical procedures, might kill a patient who is weak in mind or weak in bodily strength.

Pacifying medicines, on the other hand, if exceeding the strength of the disease, after subduing that disease, quickly bring on another in a body exhausted by disease.

If exceeding bodily strength, they cause exhaustion, fainting, intoxication, stupor, and loss of strength;

if exceeding the strength of the digestive fire, they cause exhaustion and failure of the digestive fire.

And unction nourishes the bodily tissues and produces strength in the body;

therefore, one should practice oleation and sudation again and again,

and when the alimentary tract has been softened by that, wind disorders do not remain.

Hoarseness of voice, delayed ripening, and cold discharge of kapha [occur].

23.6

Moreover,

one who is excessively corpulent, excessively emaciated, weak, with poorly knit muscles, blood, and bones in his limbs, with low digestive fire, eating little, nourished on unwholesome food, or devoid of constitutional essence is incapable even of enduring the strength of a disease;

how much less could such a one endure medicine of such violence?

Therefore, one should treat such a person with medicines that do not produce distress, that are mild, pleasant, gradually heavier, and without erratic action, especially women;

for they have unsteady, soft, and timid minds, are mostly delicate, and are dependent on others;

even more especially, children.

Likewise, when the disease and patient are strong, a medicine that has weak strength or is small in quantity, being ineffective, only further aggravates the doṣa and inflames the disease.

For in this manner, moving unhindered through cleared bodily channels, wind quickly attains peace.

Inflammation of the tip of the nose, and a dry, hot, coppery, or yellow discharge of kapha [occur].

23.7

And one should examine an appropriate medicine in this way:

Having such-and-such taste, potency, post-digestive effect, having such qualities, such substance, such action, such specific effect, grown in this region, gathered in this season in this manner, stored thus, prepared thus, contraindicated thus, processed thus, combined thus, applied thus in this dose, for a person of such type at such a time, does it extract or pacify this much doṣa?

And was there another medicine of such kind, or applied in this measure or specific manner, which accomplished this?

For subtle are the varying states of the doṣas, medicines, affected tissues, regions, times, strength, digestive fire, diet, tastes, suitability, mental fortitude, constitution, and ages;

which, if not reflected upon, would kill the patient;

and when being reflected upon, they might confound even a physician of vast intellect,

how much more one of little intellect!

Therefore, one should constantly cultivate understanding through regular study of the texts and their application.

Moreover,

there are diseases whose treatments are laid down in the treatises by general rules and exceptions;

there, only a wise physician can rightly decide on one of the determinations based on the relative heaviness or lightness of the doṣas and other factors.

For waste matter accumulated by unctuous, sour, salty, and hot foods

obstructs the bodily channel and blocks wind; therefore, one should direct it downward.

Sweetness in the mouth, itching, and an unctuous, white discharge of kapha [occur].

23.8

Time also confers fitness upon a medicament.

It has been stated previously to be twofold, distinguished by divisions such as moments, instants, and hours, and by the stage of the patient; and also:

time is threefold, characterized by cold, heat, and rain.

Among them, between cold and heat, and between rain and cold, are the two intermediate seasons, spring and autumn;

and between summer and the rainy season, the beginning of the rains is differentiated as the early rainy season.

During those intermediate days occurs the administration of emesis and other procedures, while during the others there is cessation due to fear of deficient or excessive application.

For the intermediate [times], being mild in cold, heat, and rain, are pleasant and do not perturb bodies or medicines;

the others are contrary.

Or one should administer a mild laxative mixed with food;

and for one who is cleansed, when the digestive fire is ignited, oleation and sudation repeatedly, and food and drink that are sweet, sour, and salty [are indicated].

Even so, if it does not subside, one should apply nasal press-juices, unctuous substances, and enema therapy.

23.9

For in the cold season, because the body is excessively struck by cold, it is utterly obstructed by cold wind, with extremely stiffened, abundant, and heavy doṣas;

and a purifying medicament administered after that, even though hot by nature, having lost its potency because it is overcome by cold, results in deficient action,

and the body is exposed to complications largely consisting of vāta.

Likewise in the rainy season too, when the sky is covered on all sides by dense, heavy masses of clouds, when the rays of the sun, the source of light, are blocked, and when the earth is muddy with torrents of overflowing sheets of water, the body becomes excessively moist, its digestive fire depressed, and it is weakened by the depletive season.

When located in the region of the navel, fish prepared with tender bael fruits [are indicated];

when located throughout the entire alimentary tract, one should employ the digestion of unprocessed food and waste prescribed for piles and dysentery, the use of alkalis, and the treatment for internal abdominal swelling;

when located in the heart, milk boiled with aṃśumatī [is indicated].

Numbness of the chest, copper-colored eyes, foul breath,
itching in the ears, eyes, and nose, and the symptoms described for pitta [occur] here.

23.10

The collection of medicinal plants, however, has its root-system and core branches submerged in water collected from unbroken downpours loosed from the belly of clouds, and its trunk and boughs covered in dense, tender shoots; having returned, as it were, to a state of infancy, it possesses little potency.

Moreover, on account of their unsettled nature, the waters—abounding in the impurities of the earth, sour in post-digestive effect, and contaminated by the carcasses, bodily tissues, urine, and feces of birds, beasts, reptiles, and the like—together with the heat of the cloud-burst mixed with cold wind pierced by chilled water-spray, produce intense burning digestion in these [plants] that are tender and immature.

Hence, having become unsuitable, the medicine inevitably leads to inadequate action, even if gathered earlier, once the earth has been afflicted by wind following the waters of the clouds.

From the excess of complications as described, it torments all the sense organs.

23.11

In the hot season, however, because the body is impaired by the period of depletion, scorched by hot, dry wind and sun, excessively perspired, excessively flaccid, and has doṣas that are deeply lodged;

the medicine, even if not hot [by nature], acquires heat and sharpness due to the fall of the sun's rays and leads to excessive action;

and the body [is exposed] to the complications of thirst, dizziness, and fatigue.

Therefore, one should administer emesis and the like only in the temperate periods between them, unless the disease is an emergency.

In an emergency, however, an attentive physician should administer medicine having adapted it with artificial qualities, contrary to the qualities of the season, and by means of combinations, processing, and variations of dosage.

When [the doṣa is] in the blood, cold poultices, purgation, and bloodletting [are indicated].

When in the flesh and fat, purgation, non-unctuous enemas, and pacification.

When in the bones and marrow, internal and external oleations.

When it has reached the semen, sexual arousal and virilizing food and drink.

When semen is obstructed, however, purgation.

Then, if it persists, one should perform the treatment just stated and consult [the chapter on] one desiring a son.

It flares up suddenly and frequently, causing foul odor in the mouth and dryness.

23.12

In the states of the patient, however, divisions of time are termed 'times' [of administration]:

namely, in this state, it is the time or not the time for this medicine.

For a medicine administered before its time or past its time is not efficacious.

Its administration is elevenfold,

namely:

on an empty stomach, before a meal, during a meal, after a meal, with a meal, between meals, enclosed [by meals], repeatedly, with each morsel, between morsels, and at night.

And meat broths of carnivorous animals combined with nourishing fats.

A discharge of knotted śleṣman resembling pus, blackish and mixed with blood;

and herein breed worms that are long, unctuous, white, and minute.

23.13

Among these, 'on an empty stomach' means the medicine taken entirely alone; because of its use without food, it has great potency.

A strong person whose stomach channels are freed from the surge of kapha should take it in the morning.

The other [types], such as 'before a meal,' are suitable and do not cause excessive exhaustion due to the admixture of food.

In contraction, an inunction of oil prepared with black gram and rock salt [is indicated].

In numbness, frequent bloodletting.

Not, however, when the limbs are emaciated, for fear of consumption.

For one whose blood has flown, a poultice of oil, salt, and chimney-soot [is applied].

Śleṣman is very sticky and yellow, and there is perception of tastes and smells.

23.14

'Before a meal' means immediately before food.

That is to be employed in disorders of apāna wind, to impart strength to the lower body, to pacify diseases located there, and for the purpose of slimming.

Due to things that aggravate vāta or other causes, in the cartilage of the nose.

23.15

'During a meal' means in the middle of a meal; that is in disorders of samāna wind,

and in diseases located in the gastrointestinal tract, and in those caused by pitta.

Thus the wind does not spread excessively.

Ceasing, it causes extreme sneezing; that is excessive sneezing.

23.16

'After a meal' means immediately after a meal.

That is at the end of the morning meal in disorders of vyāna, but at the end of the evening meal in disorders of udāna,

and to impart strength to the upper body, to pacify diseases located there, in those caused by śleṣman, and for the purpose of making stout.

One should treat that patient suffering from apatānaka with inunctions, affusions, tub baths, drinks, food, unctuous enemas, and nasal medications.

A feeling in the nose as if filled with bristles, and thence breathing with difficulty;

this is recorded as nasal dryness, while in nasal obstruction there occurs

23.17

'With a meal' is that which is cooked together with the food or stirred into it afterward.

That is in children, delicate persons, those averse to medicine, in anorexia, and in diseases affecting all limbs.

Or one should lay him, covered with straw, upon a heated cartwright's hearth or upon a stone slab sprinkled with liquor;

or one should foment him with a bolus.

Or oil prepared with the fresh juice of radish, castor, sphūrjātaka, arka, saptalā, and śaṅkhinī should be used in inunctions and the like; and this, drunk on an empty stomach combined with sour curds, black pepper, and sweet flag, dispels convulsion.

Because of the obstruction of inhalation and exhalation, the two channels are as if closed.

23.18

'Between meals' is when medicine is taken at midday after the morning meal has digested,

and food is taken again in the afternoon after that has digested.

By this, the night is also explained.

That is for one with kindled digestive fire in diseases born of vyāna.

Then, taking that fat from above the water with either a hand or an earthen saucer, having added a paste of vāta-destroying medicines, one should cook it according to the method of cooking medicated fats.

This is Aṇu oil, which removes all vāta disorders.

It is called Aṇu oil because it is produced from the ingredients of Aṇu oil.

That is nasal suppuration; while the discharge of that name arises from śleṣman.

23.19

'Enclosed' is that which is at the beginning and end of a meal.

That, combined with light and little food, consists of digestive electuaries, powders, and the like in hiccup, tremor, and convulsion, and when the doṣa resides in the upper and lower [parts].

Thus, through the departure of śleṣman and the release of respiration, his consciousness is not repeatedly obstructed.

One should give him the fats of rooster, crab, crocodile, and boar to drink,

and gruel prepared with barley, jujube, horse gram, radish, curd, ghee, and oil;

and once the paroxysm has passed, he should resort to oil-purgatives, non-unctuous enemas, and unctuous enemas in all forms.

23.20

'Repeatedly' is again and again, whether after food or on an empty stomach.

That is in dyspnea, cough, hiccup, thirst, vomiting, and in disorders caused by poison.

The procedure for tilvaka alone is to be seen for aśoka and ramyaka.

This is the procedure for apatānaka caused by pure vāta;

when combined, according to the combination.

It produces wheezing respiration with pain exceeding that of chronic rhinitis.

23.21

"With a morsel" means mixed with a morsel of food.

"Between morsels" means in the middle of successive morsels of food; both of these [methods] are used in disorders of the prāṇa vāta.

Likewise, along with a morsel, one should administer powders, linctuses, pills, and the like that stimulate the digestive fire, as well as aphrodisiacs.

Between morsels, emetics and medicated smoking are used in heart disease.

At night, [medicine is given] in diseases of the supra-clavicular region.

Or the powder of asafoetida, dry ginger, pomegranate, Amlavetasa, and black salt [may be given].

Or the powder of Mustā, Pippalī, dry ginger, Ativiṣā, Bibhītaka, and Bhārṅgī with wine or hot water relieves apatantraka, cough, and heart disease.

Ghee prepared with black salt, Abhayā, and tryūṣaṇa [may be given].

And a paste of Rāsnā, Amlavetasa, rock salt, Vacā, and Harītakī, fried in ghee, eaten [cures this].

[When there is] constant, unctuous, cold, ripe, thick nasal discharge,

23.22

At that first time [of medicine administration], one who is thirsty, who has drunk cold water, who has indigestion, who is hungry, and who is emaciated should avoid medicine.

In the remaining [times, one should avoid that which is] unpalatable, unwholesome, excessively sharp, hot, strong-smelling, and given in excessive dose.

And on this there is a verse:

That, when drunk, is supreme in destroying apatantraka, dyspnea, hiccup, and heart disease.

Or one should cook one prastha of ghee with a paste of fifty Pathyā fruits, two palas of black salt, and four times as much milk; that cures apatantraka.

And sharp enemas should not be administered to him for the purpose of purification.

And he should attend to the treatment of heart disease.

The breath becomes smoke-like, and it burns intensely, as it were.

23.23

First one should examine the disease, and immediately after that the medicine;

Thereafter, acting with knowledge, the physician should perform the treatment.

And here, lying down in an oil-trough [is indicated].

And between these two, antaryāma (emprosthotonos) is more terrible; moreover:

And putrid śleṣman comes out; they call it pūtināsa.

23.24

Even when a disease has resolved, it returns through a slight cause,

When the channels of the body have been opened by the doṣas, like a remaining subtle fire.

And sweating, shaking like a bow, he does not survive ten nights.

That is declared to be pūyarakta, producing burning and pain in the head.

23.25

Therefore, one should pursue it with unfailing administration,

Securing the firmness of the successful formulations previously given.

Lame, with a crippled arm, paralyzed in one side, paraplegic, or impaired in limb.

That kapha, being dried up, attains the form of a pouch, and that is puṭaka.

23.26

When a wholesome food has become disliked through constancy or lack of taste,

One should make it pleasing again by various methods of preparation.

And having fomented the jaws when stiff or displaced, one should press them with both hands and restore them to their proper position.

When the mouth is open, one should elevate the chin;

And when the mouth is closed, one should depress it.

23.27

Through agreeable objects of the mind arise satisfaction, energy, appetite, strength,

And enjoyment of comfort; and from this comes the destruction of disease.

Likewise, having boiled the large five-roots of grasses, the Vidāryādi group, the Jīvanīya herbs, fatty meats, and aquatic tubers in twice as much water down to the residue of milk, strained it, and mixed it with a prastha of oil, one should boil it again.

When the milk has evaporated, one should take it down, let it cool, and churn it.

Then, taking up the unctuous substance, one should cook it as before.

This milk-oil is to be prescribed for drinks, massages, and the like.

This very [preparation] without oil is milk-ghee, used for nourishing the eyes.

Nasal speech, putrid nose, and headache—

Among the eighteen, this [condition] alleviates intractable rhinitis.

23.28

Whatever appetite arises from craving, diminution of the doṣas, or the irregularity of the disease,

One who knows the wholesome regimens should arrange food suitably according to the circumstances.

And the prescribed gruels, unctuous nasal drops, medicated smoking, and gargles should be employed.

One should burn a patch of black-soil field with not-too-dry Rohiṇī wood.

And having smeared it with cow dung, burnt it again with Khadira wood, and cleared away those ashes, one should pour oil there when it has cooled.

And after it has rested for a night, one should dig it up.

Taking that soil soaked with oil, one should boil it with the pañcamūla.

And having strained that decoction, one should boil it with eight times as much milk down to the remainder of oil.

This Aṇutaila, administered as nasal drops, also destroys all vāta diseases.

23.29

Accumulated during the cold, hot, and rainy seasons, in Caitra, Śrāvaṇa, and Kārtika

Respectively, in temperate [periods], one should quickly eliminate śleṣman, vāta, and pitta.

And while this is being prepared, one should sound the conch,

Beat the drums,

Teach and feed Brahmins,

Hold an umbrella,

And fan with chowries.

When it is ready, one should employ it in nasal medication, drinks, massages, and enemas.

This oil, boiled a thousand times, has irresistible potency; likewise, when cooked a hundred times in portions, it is a hundred-times-boiled.

And one should sweat him repeatedly.

Then, for the patient who has been oleated and sweated, one should bandage and bind the crooked parts from all sides, securing them with four-finger-wide strips of smooth, soft leather or cloth.

Having bound it at night, one should release it by day; or having bound it by day, at night.

And at the end of releasing it, one should sweat him with very unctuous warm poultices prepared with vāta-dispelling [drugs].

And without causing pain, rubbing against the grain of the hair and straightening [the limb], one should bind it again.

In this manner for seven nights.

When there is swelling, however, one should perform emesis.

When there is burning sensation and redness in a strong person, venesection [is indicated],

As well as enemas and affusions of ghee and milk, and treatments that destroy vāta and pitta.

23.30

Or in these months of the early rainy season, autumn, and spring,

During temperate periods, one should systematically remove the waste products that have accumulated at three-month intervals.

Especially Balātaila for the purpose of unctuous enema.

In combination of doṣas, [treatment should be] according to the combination.

Or one should use a hen according to the method of rejuvenation therapy.

In apabāhuka (frozen shoulder), nasal drops and [ghee taken] after food; and when free of āma, the drinking of unctuous substances.

In viśvācī and so forth, down to burning sensation of the feet, having punctured the indicated vein, one should treat them like vāta diseases.

23.31

Having countered cold, heat, and rain as appropriate,

One should apply the treatment that has arrived; one should not let the time of treatment slip by.

Because of their opposition to āma and śleṣman;

And because those [doṣas] lodged in the thighs and stiffened by vāta cannot be brought upward by emesis and the like, just as water cannot be carried from a depression to high ground.

Therefore, considering the proper method, one should repeatedly apply pacifying and drying therapies there.

One should make use of dry treatments: barley, Śyāmāka, Kodrava, Uddālaka, vegetables cooked without salt and with little oil, alkalis, fermented liquors, and honey-water.

23.32

If no benefit is obtained within seven days, another treatment should be applied / after the force of the previous one has subsided; a confusion of therapies is not beneficial. / Even if the benefit is small, [one should continue] that very one to attain a superior result.
Or [one should use] the ṣaḍdharaṇa [formulation], or harītakī, or pippalī;
or śārṅgeṣṭā, madana, dantī, and vatsaka;
or one should drink the powder of svādukaṇṭaka, āragvadha, dārvī, marubaka, pāṭhā, karañja, and kūlaka together with honey in whey;
or lick citraka, devadāru, kuṣṭha, pāṭhā, and tiktakarohiṇī with honey;
or triphalā, pippalī, mustā, cavikā, and kaṭurohiṇī;
and one should administer dry sudations.

23.33

A pure [physician should administer] to a king a medicine that is agreeable, small [in dose], causing slight complications, / possessing pure traditional authority, very beneficial, and repeatedly tried.
Or one should drink mustard oil cooked with sarala, kuṣṭha, śrīveṣṭaka, suradāru, nāgakesara, and ajagandhā, mixed with honey.
Having made a paste of one pala of rock salt, two palas each of dry ginger, citraka, and pippalī root, and ten bhallātaka nuts, one should cook a prastha of oil together with an āḍhaka of fermented gruel.
This is wholesome in all vāta disorders, especially destroying ūrustambha, hemorrhoids, and sciatica, and granting offspring.
Externally too, for reducing śleṣman, one should apply warm poultices of honey, mustard, karañja fruit, ant-hill earth, and cow's urine.
One should apply pastes, rubs, and affusions with saubhāñjana, the two tarkārīs, sarala, arjuna, karañja, āḍhakī, and gokṣura;
and one should reduce fat by various physical exercises,
leap over high ground,
[and] swim against the current of a river free of wild beasts.
For in this manner ūrustambha subsides when the śleṣman is dried out.

23.34

Devoted to this task alone, attentive, and approved by his ministers, / [the physician] should administer it himself after it has been tasted by attendants.
Drinking sahacara, suradāru, and dry ginger boiled in water and mixed with oil, / a person whose body's movements are afflicted by wind walks swiftly or slowly according to his wish.

23.35

Whatever region is customary for a person, medicine originating there is wholesome for him; / even when living in another region, that which originates with similar qualities is wholesome.
Having ground [the drugs], one should cook ghee; it is supreme in dispelling vāta diseases.

23.36

Potent, thoroughly macerated repeatedly with fresh juices, light, / endowed with taste, smell, and the rest, taken in appropriate measure at the proper time after food is digested / and administered with a concentrated mind, medicine acts like nectar.
And with that liquid reduced to one-eighth, one should cook again a prastha of ghee with pastes measured in picu units.

23.36_1

Thus ends the twenty-third chapter.

Commentaries (1)

Śaśilekhā — Indu, Sanskrit

Linked texts (1)

Aṣṭāṅgasaṃgraha — Vāgbhaṭa, Sanskrit