Ashtangasamgraha 27

English (machine translation) 27

Language: English

27.1

Now, therefore, we shall explain the chapter entitled "Procedure of Emesis and Purgation."
Thus spoke Ātreya and the other great seers.
Thus spoke Ātreya and the other great seers.

The elimination of doṣas in the upward direction is called emesis, in the downward direction it is called purgation; or both are termed purgation because of the purging of waste products.
By sweating, head-disease, facing the wind, suppressing tears, and weeping;

27.3

Therein, the medicines—being hot, sharp, subtle, permeating, and dispersing—reach the heart through their own potency, follow the vessels because of their subtlety and permeating nature, and when the internal body has been softened by oleation and liquefied like moist wood by the heat of sudation, they liquefy again by their heat the entire aggregate of doṣas from the gross and subtle bodily channels.
By their sharpness and dispersiveness, they sever it.
That liquefied and severed aggregate of doṣas, floating free like a handful of water placed in an oiled vessel, not adhering due to its non-adherent nature, reaches the stomach, and propelled by udāna, proceeds upward because of its composition of fire and wind and through the upward-specific potency of the medicine;
downward because of its composition of water and earth and through the downward-specific potency of the medicine;
and in both directions because of possessing both qualities and through the potency specific to both directions.
By pillows, cleansing, massage, aversion, and looking downward continuously.

27.4

Therein, when śleṣman is aggravated, or combined with pitta, or located in its site, or when pitta or vāta is dominated by śleṣman, one should perform emesis;
but in [aggravation of] pitta, or when combined with śleṣman, or when located in its site, or in śleṣman, purgation.
The doṣas produce diseases...

27.5

Therein, curable by emesis are: those who have drunk poison, been bitten, poisoned by an envenomed arrow, struck, [or affected by] incompatible food and indigestion; acute fever, consumption, diarrhea, downward bleeding disorder, cholera, sluggish digestion, dyspepsia, anorexia, scrofula, glandular swelling, tumors, elephantiasis, fat disorders, slow poisoning, insanity, epilepsy, dyspnea, cough, nausea, erysipelas, urinary disorders, leprosy, anemia, diseases of the eyelids, mouth, nose, and cranium, obstruction of the ear, swelling, disorders of breast milk, and so forth, and especially the śleṣman diseases mentioned in the classification of doṣas.
For these are completely destroyed by emesis, like unripened rice and the like by the withdrawal of water.
The two temples ache severely, and the occiput splits open as it were;
and the region between the eyebrows and the forehead feels as if falling, with extreme pain.

27.6

Those who should not be subjected to emesis, however, are: a pregnant woman, a delicate person, one preoccupied with other duties, an unctuous-depleted person, one whose diet consists mostly of dry food, one with excessively kindled digestive fire, one constantly exhausted from carrying loads, walking, or physical exertion, one who is chest-injured, an emaciated person, an excessively obese person, an emaciated person, an old person, a child, a weak person, one afflicted with fatigue, fear, grief, anger, intoxication, fainting, hunger, or thirst, one engaged in fasting, sexual intercourse, physical exercise, study, or anxiety, one with persistent vomiting, one with upward bleeding disorder, one suffering from upward vāta, one who has received an evacuating enema, one who has received an unctuous enema, one with an obstructed abdomen, one who vomits with difficulty, one afflicted with heart disease, upward movement of vāta, urinary retention, abdominal swelling, splenic enlargement, abdominal disease, prostate enlargement, hemorrhoids, impairment of voice, cataracts, dizziness, vāta disorders, facial paralysis, convulsive disorders, or pain in the eyes, head, temples, ears, or flanks, and one with parasites in the abdomen who has not received an evacuating enema.

[They may be subjected to emesis, however,] in cases of undigested toxins, artificial poisons, incompatible food, and food poisoning, because these act rapidly.

In that regard: in a pregnant woman, due to harm to the fetus and miscarriage of an unformed fetus, severe disease would arise.

In a delicate person, because of strain on the heart, blood would flow upward or downward.

In one preoccupied with other duties, the medicine does not take effect;

or, taking effect with difficulty, it would produce the faults of inadequate evacuation.

In an unctuous-depleted person, vāta produces stiffness of the limbs.

In one whose diet consists mostly of dry food, because the body is exhausted by vāta, loss of strength would ensue.

Likewise, in one with excessively kindled digestive fire, due to the power of the digestive fire, and in those constantly exhausted by carrying loads, walking, physical work, or vehicles, due to exertion, excessive bleeding occurs in the chest-injured person from further tearing of the wound.

In emaciated and similar persons, because of intolerance to the strength of the medicine, obstruction of the strength of the body and danger of internal trauma occur.

In persistent vomiting and upward bleeding disorder, the udāna [vāta], throwing upward, would snatch away the vital breaths and cause excessive discharge of blood.

In those with upward vāta and those who have received an evacuating or unctuous enema, excessive upward movement of vāta occurs.

In one with an obstructed abdomen or one who vomits with difficulty, due to excessive straining, the doṣas agitated within the abdomen cause erysipelas, stiffness, torpor, confusion, or death.

In a patient with heart disease, obstruction of the heart occurs.

In those afflicted with upward movement of vāta and the like, and those with facial paralysis and the like, their respective illnesses worsen or death occurs.

In one with a parasite-infested abdomen, because the parasites were not previously eliminated below by an evacuating enema and because of their excessive abundance, they do not emerge completely, and by severely pulling on the heart, excessive vomiting would occur.

/ The entire head feels as if it were whirling, and as if coming loose from its joints;

27.7

Those beginning with the pregnant woman and ending with one engaged in anxiety must generally be avoided here for all therapies down to fumigation, which will be described.

One with indigestion, however, must be avoided for all therapies except emesis, out of fear of the disorder of undigested matter;

and one with acute fever, out of fear of causing the doṣas to become obstructed.

/ Intolerance to light, discharge from the nose, and sudden cessation of pain [occur].

27.8

Now, those treatable by purgation are: chronic fever, upward bleeding disorder, abdominal swelling, abscess, splenic enlargement, hemorrhoids, fistula-in-ano, abdominal disease, a parasite-infested abdomen, urinary retention, disorders of semen and the female genital tract, vātarakta, advanced jaundice, dark facial patches, cataract, partial blindness, eye inflammation, suppuration of the eye, burns from alkali or fire, obstinate skin disease, wounds, pain in the head and the colon, upward movement of vāta, constipation, vomiting, eruptions, and the like, those illnesses mentioned as suitable for emesis such as cholera-like disease, and the pitta disorders mentioned in the chapter on the classification of doṣas.

Especially these reach complete destruction by purgation, just as the heat of a house on fire ceases upon the removal of the fire.

/ This burning sensation of the head #

27.9

Those who should not be purged, on the other hand, are: one with acute fever, diarrhea, downward bleeding disorder, an ulcerated rectum, one who has fasted, one who has stayed awake at night, one who has received an evacuating enema, one with weak digestive fire, one suffering from consumption or alcoholism, one with abdominal distension, one bearing a foreign body, one who is traumatized, one excessively oleated, one who is unctuous-depleted, and one with a hard bowel. Among them: in one with acute fever, one should not eliminate the unmatured doṣas;

and it would only provoke vāta.

In one with diarrhea and one with downward bleeding disorder, it would kill by excessive discharge.

In one with an ulcerated rectum, it causes obstruction of the vital breaths in the rectum; in one afflicted with consumption, because the bodily tissues are depleted, [life] depends on the strength of the feces;

in the absence of that, destruction of the body would result.

In one suffering from alcoholism, vāta in a body depleted by liquor causes obstruction of the vital breaths.

In one with abdominal distension, vāta accumulated in the colon, spreading out, would suddenly cause more severe distension or death.

In those bearing a foreign body and the traumatized, vāta resting in the wound would destroy life.

In one who is excessively oleated, excessive purgation would occur.

In one with a hard bowel, the doṣas, stirred up by the medicine but not flowing out, would produce heart pain, splitting pain in the joints, abdominal obstruction, vomiting, fainting, and exhaustion, and would destroy the vital breaths.

In the pregnant woman and the rest, the previously mentioned faults would occur.

/ It becomes aggravated after a fortnight or a month, or it subsides entirely on its own; / but if excessively aggravated, it would destroy the sight or the hearing.

27.10

Now, in a moderate season, having properly oleated and swetted a person whose mind is undisturbed, knowing that he is to be vomited tomorrow, after he has agitated his kapha with foods that are predominantly liquid—such as meat broth boiled with domestic, marshy, or aquatic animals, milk, curd, black gram, sesame seeds, pounded meat paste, and vegetables—has spent the night comfortably, has digested his food, in the forenoon, having bathed, anointed himself, adorned himself with a garland, put on unwashed garments, worshipped the deities, the sacred fire, the twice-born, elders, old persons, and physicians, and performed oblations, offerings, auspicious rites, expiations, and recitations of well-being, seated on a level seat of knee-height with cushions and a backrest, being without food or slightly oleated, having drunk a measured dose of ghee with thin barley gruel or scum, or—in the case of the fearful, emaciated, children, the aged, or the delicate, in accordance with the doṣas—having drunk up to the throat any one among milk, buttermilk, vegetable soup, sugarcane juice, meat soup, liquor, sour gruel, barley gruel, or scum; at an auspicious rising of the asterism, lunar day, half-lunar day, and hour, the dose of medicine prescribed according to the disease, doṣa, affected tissues, and other factors, mixed with honey and rock salt, comfortably warm, and consecrated with blessings uttered by Brāhmaṇas,

and further:

Sweating, burning sensation in the eyes, fainting, and softening at night with cooling measures [occur].

27.11

“May Brahmā, Dakṣa, the Aśvins, Rudra, Indra, the Earth, the Moon, the Sun, the Wind, and the Fire, / the ṛṣis together with the assembly of herbs, and the hosts of beings protect you!

Absence of pulsation in the veins, lethargy, pain that is mild by day and greater at night, / drowsiness, puffiness of the eye sockets, itching of the ears, and vomiting [occur].

27.12

“May this medicine be for you as rasāyana is to the great ṛṣis, as nectar is to the immortals, / and as ambrosia is to the foremost nāgas!”

When, due to indiscriminate foods, blood and flesh are moistened in the head, / and the combination of all three doṣas is provoked, worms are born in the head.

27.13

“Om, homage to the Blessed One, the Medicine Guru, the King of Vaidūrya Light, the Tathāgata, the Arhat, the Perfectly Awakened One! / Namely: / Om, / O medicine, O medicine, O great medicine, O thou who hast arisen from medicine, svāhā!”

Having thus consecrated [the medicine], facing north, he should cause the patient, facing east, to drink it.

/ Fever producing confusion of the mind, cough, and loss of strength [arise].

27.14

Then, having drunk [the medicine], resting his arms on his thighs, with his mind attentive to the emesis, being warmed by hands heated over a fire, he should wait for a muhūrta.

When he knows that, through the emergence of sweat, the doṣa is undergoing liquefaction;
and, through horripilation, it is displaced from its locations;
and, through distension of the belly, it has entered the belly; and gradually, through pressure on the heart, nausea, and salivation from the mouth, it has turned upward;

then, with several spittoons placed near at hand, with uninhibited attendants engaged in supporting his flanks and forehead, pressing his navel, and massaging his back in an upward direction, with lips, palate, and throat opened, not straining excessively to urge the urges, neither inducing urges that have not arisen nor failing to follow those that have arisen, touching the throat with two fingers whose nails have been closely clipped, or with stalks of blue lotus, white lotus, or castor, he should vomit.

He should be neither excessively erect, nor excessively bent forward, nor turned to one side.

In that regard, for one who is excessively erect, pain in the back and heart occurs;
for one who is excessively bent forward, pain in the head and abdomen occurs;
for one who is turned to one side, pain in the flanks, abdomen, heart, and supra-clavicular region occurs.

In that caused by parasites, there is itching, swelling, and bleary vision in the temples, palate, and head,
coppery and clear nasal discharge, and ringing in the ears.

27.15

Thus, in kapha, one should induce vomiting with pungent, sharp, and hot [substances];
with sweet ones when it is joined with pitta;
with sour ones accompanied by unctuous substances when it is combined with vāta;
until there is the cessation of kapha, the discharge of medicine alone, or the sight of pitta.

27.16

One whose urges are deficient, however, should induce them again and again with pippalī, āmalaka, mustard paste, salt, and hot water.

One unable to tolerate abundant emesis should rest for two or three days.

One should administer emetics that are disagreeable, repulsive, unsightly, and foul-smelling;
but purgatives that are the opposite.

And in all emetics, one should administer rock salt and honey for the sake of liquefying and breaking up kapha.

And one should inspect his urges that have entered the spittoon.

Severe burning sensation, pain, redness, delirium, fever, thirst, and giddiness [occur].

27.17

In that regard, non-occurrence [of vomiting], occurrence of the medicine alone, or obstruction of the urges is the symptom of inadequate administration.

And from that arise anorexia, heaviness, distension, itching, eruptions, urticaria, lassitude, colic, catarrh, horripilation, excessive salivation, swelling, chills, fever, and the like.

It destroys life within three nights, but if treated promptly it is cured.

27.18

The symptom of proper administration, on the other hand, is the discharge in due time and sequence of kapha, pitta, and vāta, distress that is not overly great, self-cessation, and thereupon health, mental clarity, purity of voice, and the reverse of anorexia and the other [complications].

It causes a throbbing pain that arises following the rising of the sun.

27.19

In excessive administration, however, there is the emergence of frothy, blood-flecked, shimmering liquid.

And from that arise emaciation, loss of voice, burning sensation, dryness of the throat, giddiness, delusion, delirium, fainting, a sense of emptiness in the head, a feeling of smoking in the heart, pain in the limbs, numbness, thirst, aggravation of upward-moving vāta, earache, facial paralysis, impediment of speech, lockjaw, retraction and protrusion of the tongue, rolling of the eyes, unconsciousness, and loss of sleep, strength, and digestive fire;
or death through the discharge of vital blood.

In the Kalpasthāna, the treatment for these will be explained.

Comfort is irregular with respect to cold and heat; it subsides after midday.
That is sūryāvarta.

27.20

When he has vomited by proper administration, however, his hands, feet, and face having been well cleansed, having comforted him for a muhūrta, having made him inhale whichever of the three types of medicinal smoke is appropriate according to his capacity, having made him rinse with water again, having honored him with fragrant betel, resting on a bed in a draft-free room, one should instruct him according to the regimen of conduct prescribed for oleation.

27.21

Then, having observed the strength of his digestive fire and hunger, in the evening or on the following day, sprinkled with comfortably warm water, eating well-cooked food made of aged red śāli rice, without unctuous substance, salt, or pungent seasonings, or with little unctuous substance, salt, and pungent seasonings, predominantly liquid, followed by warm water, consumed evening and morning, he should observe this regimen of peyā and the rest:

27.22

Thin gruel, thick gruel, unseasoned and seasoned soup, and meat broth—a person purified by superior, middling, or inferior purification should take each of these three times, twice, or once, respectively, at meal times.

Swelling of the same color as the skin and painless: one should know that as upaśīrṣaka.

27.23

Just as a tiny fire, being kindled gradually with grass, cow dung, and the like,
becomes great, stable, and capable of burning everything, so too does the internal digestive fire of a purified person through peyā and the rest.

27.24

In emesis, four, six, and eight urges are desired in the lowest, middling, and superior [purification];
in purgation, they are ten, doubled, and tripled, and the quantity [of discharge] is one prastha, doubled, and quadrupled.

Pustules resembling foxtail millet or white mustard seeds are arūṃṣikā.

27.25

They say that emesis ends with pitta, and purgation is half that of purgation ending with kapha.
Having removed two or three urges accompanied by stool, the measure is taken in purgation, but in emesis, what was drunk [is subtracted].
So it is said.

Very subtle, caused by kapha and vāta: one should know that as dāraṇaka.

27.26

Then, having prepared the person who has vomited in this manner again with oleation and sudation, intending to purge him the next day, one should feed him easily digestible, non-phlegm-forming, unctuous, fruit-sour, hot boiled rice with wild game meat broth, with warm water as an after-drink.

Then, when he has rested comfortably, according to the rule previously stated, after the time of śleṣman has passed, on an empty stomach, having evaluated his bowel, one should make him drink the appropriate dose of medicine;
but never without having performed emesis, except in the case of an excessively hard bowel.

Then śleṣman together with blood causes the hair to fall out.

27.27

For in one who has not undergone emesis, the medicine, impaired by śleṣman, moves upward;
or it remains obstructed in the chest;
consequently, it is insufficient for purgation.
And even in one who is properly purged, śleṣman fallen downward covers the grahaṇī and causes heaviness,
or dysentery.
However, this fault does not apply to one with an excessively hard bowel, because it is of the nature of vāyu.

Some call that indralupta, and others rujā.

27.28

During the time of śleṣman, however, having caused the faults mentioned for one who has not undergone emesis, or colic, distension, and heaviness, one should purge in the afternoon or at night when śleṣman has diminished through emesis.
It is similar also when it is obstructed by food;
and that produces vomiting again.
For one who has not been purged, however, emesis is to be employed during the time of śleṣman on an empty stomach,
for in that way it is eliminated upward with ease.

27.29

The alimentary tract (koṣṭha), however, is of three kinds:

mild, hard, and moderate.

Among them, one with predominant pitta is mild.

He is purged even by milk, sugarcane juice, sour buttermilk, whey, molasses, kṛsarā, ghee, fresh wine, hot water, pīlu, raisins, betel nut, and the like.

One with predominant vāta is hard.

He is difficult to purge even with triphalā, tilvaka, trivṛt, the fruits of nīlinī, and the like.

One with predominant śleṣman or balanced doṣas is moderate; that is common to both.

And those who are oleated by drinking unmixed fat usually [take] three, seven, or five nights.

From kapha, one should point out corresponding thickness of the skin and color on the skin.

27.30

In that case, purgation is performed with astringent and sweet substances in pitta;

with urine, pungent, and hot substances in kapha;

with unctuous, hot, and saline substances in vāta.

Immediately after the medicine is drunk, one should sprinkle his face suddenly with cold water to check vomiting.

Then, having cleansed his oral cavity with hot water, he should inhale heart-gladdening fragrances such as moist fragrant earth, citron, jambīra lime, jasmine, and white water lily.

Resting comfortably on a bed in a draft-free place, gargling little by little with hot water to prevent obstruction, focusing his mind on that, not suppressing urges, he should be purged while urges arise into a bedpan placed near the bed, not touching anything cold.

And just as in emesis, perspiration, salivation, medicine, kapha, pitta, and vāta emerge in succession, so in purgation, vāta, urine, feces, pitta, and kapha emerge,

and again vāta at the end;

for that is the arrangement of the doṣas in the body, and because of the opposite directions of the two purificatory procedures.

And that which arises without hair, with burning, as if burned by fire,

27.31

If it does not operate, however, one should make him drink hot water to stimulate the medicine,

and one should foment the abdomen with the heat of the hands.

And when it has operated, in one whose digestive fire is kindled, whose body is oleated, and who has abundant doṣas—or if it has operated only slightly or not at all—even in one with slight doṣas, once the medicine is digested, one may administer a further dose, considering the remainder of the day and [his] strength;

but not while the medicine is undigested, for fear of excess.

Associated with doṣa, it cooks the hair, whence graying arises.

27.32

Or on that very day after he has eaten, on the next day, or if oleation was not firm, after ten nights, when his body has been prepared, one who is attentive should make him drink again.

From pitta, with burning, yellowish; from kapha, unctuous and growing.

27.33

Out of shame, fear, and greed, women, those who attend upon a king, and merchants are usually prone to suppressing natural urges.

Therefore, because vāta has increased through the suppression of urges, these are constantly unwell and difficult to purge.

One should purify them after they are well oleated.

And another arising from headache, discolored, intolerant to touch.

27.34

And also others who practice excretion, recreation, and food at improper times.

And hence, because they are constantly unwell, even a slight disease becomes difficult to cure in them.

Their method of treatment, however, will be taught in the chapter on the management of oleation complications.

Those arising from the transformation of the body require rasāyana.

27.35

There, from inadequate purgation, there is unpurified state of the belly and cardiac region, distension, anorexia, salivation, excitement of kapha and pitta, vomiting, giddiness, itching, eruptive boils, burning sensation, heaviness, weakness of digestive fire, drowsiness, stiffness, catarrh, and retention of vāta, feces, and urine.

From proper purgation, there is alleviation of disease and the opposite of what has been stated [above].

From excessive purgation, however, there issues only water devoid of doṣas, or blood resembling water washed over fat and flesh, or black [discharge];

cutting pain in the rectum, twisting sensation in the cardiac region, prolapse of the rectum, sinking of the eyes, sensation as of ants crawling over the body, and conditions equal to the complications of excessive emesis.

Commentaries (1)

Śaśilekhā — Indu, Sanskrit

Linked texts (1)

Aṣṭāṅgasaṃgraha — Vāgbhaṭa, Sanskrit