Ashtangasamgraha 36

English (machine translation) 36

Language: English

36.1

Now we shall explain the chapter named The Procedure of Venesection. / Thus said the great sages led by Ātreya. / Thus said the great sages led by Ātreya.

Many methods of bloodletting have indeed been stated earlier; among them and other procedures such as purgation, venesection is foremost in diseases curable thereby; / for through it those [diseases] are dried up along with their roots, just as rice paddy and other crops are when a dike around a field is breached. / And likewise: / The eruptions [known as] ajagallikā in children arise from kapha and vāta.

36.3

Venesection is half of the treatment, or the complete treatment, / just as enema is regarded in internal medicine, so is it considered in surgery. / An alajī is mouthless, round, has little pus, and is thick and elevated; / five or six nodules elevated like a tortoise constitute kacchapī.

36.4

Since blood is the seat of mutable disorders, / no other dūṣya is like it; therefore, this procedure is primary. / A panasikā resembles a lotus root; but pāṣāṇagardabha is a firm swelling with mild pain / arising at the jaw joint from the two [doṣas].

36.5

Here, the bodily liquid which is the essence of food, termed rasa, untransformed, coloured by untransformed tejas, shaped like an indragopa insect, possessing the colour of hare's blood, guñjā berry, lac, lotus, or gold, losing its stain upon washing, sweet, slightly salty, unctuous, uncoagulated, neither hot nor cold, heavy, whose accumulation, provocation, and pacification coincide with pitta, of a cooling and fiery nature, is called blood by its inherent constitution. / Likewise [they say it is] a doṣa; / some say it is a dūṣya; / others that it consists of both. / Mukhadūṣikā [consists of eruptions] filled with fat, swollen on the face, caused by the two [doṣas].

36.6

And blood of this very kind, purified through the customary habituation to proper food and conduct, is the source of strength, complexion, happiness, and lifespan. / Otherwise, or naturally vitiated by the autumn season, it causes ophthalmia, adhimantha, pterygium, cataracts, red streaks in the eyes, pricking pain, splitting pain, burning, and itching in the head, ear diseases, stomatitis, foul-smelling nose and mouth, coated tongue, phantom tumor of the skin, spleen enlargement, abscess, erysipelas, fever, bleeding disorder, obstinate skin diseases, eruptions, elephantiasis, chancroid, temporal swelling, gout, bloody urine, minor diseases, loss of digestive fire and voice, heaviness and debility of limbs, anorexia, sour eructations, salty taste in the mouth, anger, delusion, perspiration, intoxication, fainting, collapse, tremors, stupor, and so forth; / and those disorders which, though curable, are not cured even when properly treated with cold, hot, unctuous, dry, and all other antagonists of the doṣas, / and which are born from the provocation of blood; therefore, in those conditions one should puncture a vein appropriate [to each] to drain off the overly aggravated blood. / The body is covered with painless, white [growths] born of kapha and vāta.

36.7

However, [it should] not [be performed] on those who have drunk unctuous substances, who have undergone any of the five purificatory therapies, pregnant women, puerperal women, those suffering from indigestion, jaundice, or impotence, those under sixteen or past seventy years of age, those injured by trauma, those who have bled excessively, those whose blood is unvitiated, those who are unctuated, excessively unctuated, or un-sudated, or those afflicted by convulsions, hemiplegia, diarrhea, vomiting, dyspnea, cough, abdominal disease, bleeding disorder, hemorrhoids, anemia, and generalized edema. / Nor should veins that are not fit to be punctured, unbound, or unraised be punctured, nor obliquely, nor during excessive cold, heat, rain, wind, or cloudy weather. / There, in those who have drunk unctuous substances and the like, veins even if properly punctured do not bleed, or bleed excessively; whereas in one who is properly oleated and sudated, the doṣas, having liquefied and entered the blood, flow out properly. / But this prohibition does not apply in cases of poison contact, infections, or emergency diseases. / The division regarding puncture is given according to each disease. / Vivṛtā causes severe burning and fever, is wide open, and has an open mouth.

36.8

In diseases of the head and eyes, [the vein to be punctured is] on the forehead, near the nose, or at the outer corner of the eye; in diseases of the ears, all around both ears; / in diseases of the nose, at the tip of the nose; / but in catarrh, those situated on the nose and forehead; / in diseases of the mouth, those going to the tongue, lips, jaw, and palate; / in tumors above the collarbone, those going to the neck, ears, temples, and vertex; / in epilepsy, those situated in the middle of the jaw joint; / in insanity, however, those going to the chest, outer corners of the eyes, and forehead; / in an abscess and flank pain, those situated between the flanks, armpits, and breasts; / in a quartan [fever], [puncture] the one descending below the shoulder, situated on either flank; / in a tertian [fever], the one between the shoulders situated in the middle of the sacral joint; / in painful dysentery, two finger-breadths all around the pelvis; / in fully developed venereal ulcer and disorders of the semen, on the penis; / in goitre, the one situated at the root of the thigh; / in sciatica, four finger-breadths above or below the knee-joint; / in scrofulous adenitis, two finger-breadths below the indrabasti [vital spot]; / in kroṣṭukaśīrṣa and pains of vāta in the legs, four finger-breadths above the ankle; / in elephantiasis, [the vein] will be mentioned according to its specific condition; / in foot diseases such as burning sensation, hypersensitivity, chilblain, vāta-blood, vātakaṇṭaka, vidārikā, and cracked feet, two finger-breadths above the kṣipra vital spot; / by this, the other leg and arms are explained; / but specifically, on the inner aspect of the left side, in the middle of the arm, in enlargement of the spleen; / likewise on the right arm, in what is called [enlargement of] the liver; / they prescribe similarly for cough and dyspnea as well; / in viśvācī, just as in sciatica; / some [prescribe it] also in wasting of the arm and brachial neuralgia; / but when these are not visible, in a disease that is extremely advanced, puncture may be performed even at [veins] indicated for other diseases, according to proximity. / Firm eruptions the size and color of lentils, having the same name [masūrikā] [arise from kapha and pitta].

36.9

And beforehand one should prepare a bed, seat, water-pot, cloth, bandaging strip, and so forth; / and according to availability, powder of tagara, elā, śīta, śivā, kuṣṭha, pāṭhā, viḍaṅga, bhadradāru, trikaṭu, soot from the house, turmeric, buds of arka, and naktamāla, for making the blood flow; / and to arrest the blood, powder of lodhra, madhuka, priyaṅgu, pattaṅga, red ochre, rasāñjana, śālmali, conch shell, barley, wheat, and māṣa; / or powder of the bark, sprouts, and exudates of vaṭa, aśvattha, aśvakarṇa, palāśa, bibhītaka, sarja, arjuna, dhanvana, dhātakī, the heartwood of sāla, arimeda, and tinduka, together with turpentine resin, potsherd clay, lotus stalk, and collyrium; / or charcoal of linen, lac, and cuttlefish bone; / and also other equipment for remedying complications of excessive bloodletting; / for a physician equipped with preparations does not fall into confusion.

36.10

Then, having performed auspicious rites for the patient, considering the disease, strength, habituation, and so forth, having made him drink unctuous wild meat broth or gruel, and having comforted him for just a muhūrta, in the forenoon or afternoon, having fomented him with one of the heating methods—charcoal heat or hot steam—one should seat him on a soft seat as high as the knees, with his elbows placed on his knees, his feet planted evenly, facing the sun. / And at the hairline, one should bind [his head] with one of a cloth, leather, or bark strip. / Then the patient himself, with two fists having the thumbs tucked inside the cloth, should firmly press his own neck veins, and bite his teeth with his teeth, / and inflate both cheeks. / And a man standing behind him should restrain him with a cloth placed between the fabric and the nape of the neck, without obstructing his vital breaths; this is the method of restraint for puncturing veins, except for those facing inside the mouth. / Then the physician should tap the vein with the middle finger braced against the thumb. / And having observed it raised, pulsating, or giving a tactile sensation, holding the kuṭhārikā in the left hand with its shaft upright, having placed it in the middle of the vein and sighted it, he should strike it in the same manner with the middle finger or press with the pad of the thumb. / In the case of [a vein] hidden by thick skin, he should observe its raising from the pressure of the thumb. / Veins fill up from coughing and by the agitation of anger. / But having raised the tip of the nose with the thumb, one should puncture the near-nasal vein with a vrīhimukha instrument. / That [eruption] which is punctured, caused by vāta and pitta, is [called] gardabhī by those two [doṣas].

36.11

[Puncture the vein] beneath the tongue of one whose tongue has its tip raised and bitten; / on the palate and root of the teeth of one whose mouth is wide open; / in the case of neck veins, one should apply restraint above the breasts; / on the abdomen and chest, of one whose chest is expanded and head raised; / on the flanks, of one hanging suspended by his arms; / on the penis, of one whose penis is erect; / on the pelvis, back, and shoulders, of one seated with raised back and head bent down; / in viśvācī and sciatica, of one comfortably seated with unbent elbow and knee, with fists clenched with hidden thumbs, and having bound the vein of the hand four finger-breadths above the site to be punctured with a strip of cloth or the like; / likewise, having positioned one foot properly placed and set the other foot slightly flexed on top of it, pressing with both hands from below the knee joint down to the ankle, and having bound it as before, one should puncture the vein of the foot; / and here and there one should apply restraint having devised it by various means.

36.12

There, in fleshy regions, [the puncture is] the measure of a barley grain with a vrīhimukha instrument; / otherwise, the measure of half a barley grain or the measure of a grain of rice; / above bones, the measure of half a barley grain with a kuṭhārikā; / and everywhere, neither superficial nor deep, straight, unconfused, without injuring the vital spots and so on, one should swiftly drop the instrument in the middle of the vein. / From pitta arise minute, firm eruptions resembling puffed rice; / but one of such kind that is large is called gandhanāmā.

36.13

That [vein] which, struck with a single blow, discharges blood in a stream, / and when held for a moment stops, they know as properly punctured. / Those having the color, shape, and size of mustard seeds are named rājikā.

36.14

An improperly punctured [vein] flows for a short time and little, [and is checked] by oils and powders; / but an over-punctured [vein] discharges with a sound and is checked with difficulty. / An unsuppurating, thin, copper-colored swelling causing fever is jālagardabha.

36.15

And the causes for non-flow of veins even when properly punctured are: fainting, fear, looseness of the ligature, excessive tightness [of the ligature], excessive repletion, emaciation, puncture with a blunt instrument, urge for urination or defecation, inadequate sudation, and obstruction of the wound's orifice by kapha.
Then, having identified each cause of non-flow according to its nature, one should counteract it.
One should also dust the orifice of the vein with a powder of tagara and other herbs heavily mixed with oil and salt.
And one should press the patient along the middle of the back.
In this way it flows properly.
When it has flown properly, in order to pacify kapha and vāta and to prevent cessation of the blood flow, one should sprinkle the mouth of the vein with warm drops of salted oil.
Those which arise in the region of the armpits, resembling fire, constitute agnirohiṇī;
It destroys life within five days, seven nights, or a fortnight.

36.16

At first, vitiated blood flows out, as the yellow [juice comes out] from safflower and the like;
Having flowed properly, when it stops on its own, it is pure; therefore one should not take [more].

36.17

If, however, while the blood is flowing, fainting occurs in a patient, one should release his ligature, revive him by touch of hands wet with cold water, by the breeze of a fan, and by speech pleasant to the ears, and having pacified the fainting, let the blood flow again.
If he faints again, [one should do it] on the next day, or even after three days.
However, the maximum measure of bloodletting is one prastha.
Other than that, one should take into consideration the disease, the body, the season, and the strength.

36.18

There, blood that is frothy, reddish, dusky, clear, dry, non-clotting, with an astringent aftertaste, smelling of iron, flowing in gushes, and cold, is from vāta.
Black like soot or collyrium water, yellow, greenish, foul-smelling, smelling of fish, repulsive to flies because of pungency, non-clotting on account of heat, with glistening oily spots, and resembling cow's urine, is from pitta.
Pale like a kovidāra flower or red-ochre water, cold, unctuous, clotting, thick, slimy, thread-like, sinking down at the opening of the wound, salty in taste, and smelling of fat, is from kapha.
Mixed with two kinds [of characteristics] is from a combination of two [doṣas].
Dark-blue like bronze, turbid, and foul-smelling is from a combination of all three.
Pure [blood] has been described previously.
Then, after the blood has flowed, one should close the puncture with the thumb in the normal direction [of hair], remove the ligature very slowly, and comfort the patient.
And placing a piece of cloth soaked in oil over the mouth of the vein, one should bandage it.
And one should have him lie down.
When broken, it discharges [fluid] resembling muscle fat, ghee, and honey; there vāta is aggravated.

36.19

If, however, the blood does not stop, in order to unite the mouth of the vein, one should dust it with the previously mentioned powders and press it with the fingertip.
Or, applying the mucilage of śālmali or upodakā to the mouth of the wound, one should bandage it tightly.
Or a bandage smeared with beeswax [should be applied].
One should sprinkle it with cold water.
Or one should treat it for clotting with cold, sweet, and astringent food, drink, sprinkling, poultices, and a well-ventilated chamber.
One should puncture a vein of one among blackbuck, spotted deer, goat, ram, buffalo, or wild boar, and give its blood raw or fried in ghee as a drink, or [give] a decoction of padmaka and other herbs sweetened with sugar and honey, milk, or sugarcane juice.
Or with that very [blood] rubbed with the root of darbha grass, one should administer an unctuous enema.
And one should feed him unctuous vegetable soups and meat broths.
Or immediately after the puncture, one should puncture that very vein again.
And if it does not stop by any means, one should apply alkali to cause suppuration.
Or, to constrict it, one should cauterize the mouth of the vein with a heated probe.
And one should not neglect it even for a moment.
For in one whose blood is depleted, vāta, seizing the vital points, causes fainting, loss of consciousness, tremor of the head, giddiness, torticollis, convulsions, dislocation of the jaw, hiccup, paleness, deafness, depletion of bodily tissues, convulsions, and the like,
or death.
Foul-smelling, moist, variegated in colour—then the bodily wastes,
Accumulated, cause it to discharge; one should know that as śarkarārbuda.

36.20

Blood is the vital breath of living beings; by its depletion, the digestive fire is depleted,
And vāta increases; therefore, one should employ nourishing therapy with discretion.
Gradually, like an anthill, a nodule [forms], likewise with many minute openings
Abounding in pain, burning sensation, itching, and moisture; this is valmīka, caused by all [doṣas].

36.21

Impure blood, however, one should cause to flow again in the afternoon or on the next day.
Even after that, if any remains, or in one whose blood should not be let out by any means, one should clarify it by means of cold sprinkling, poultices, purgation, fasting, and unctuous, sweet food and drinks.
Or, treating him for about a month with oleation and other measures, one should puncture again.
Whatever complications might arise from a defect in puncturing, such as a bad puncture, excessive puncture, bent puncture, or oblique puncture, one should treat them appropriately.
And on this it is said:
A nodule raised like a peg is formed; that indeed is kadara.

36.22

Until the vitiated doṣas which, having entered the blood, strayed from their proper channels due to the pressure of the ligature, return to their own sites, so long should he adhere to wholesome food and conduct.
It narrows the external and internal passage of this; then the feces
Passes out with difficulty; this disease is regarded as ruddhaguda.

36.23

Once blood has been removed, wholesome food and drink is that which is neither too hot nor too cold, light, and digestive-fire-stimulating;
For at that time the blood of the body is unsettled; therefore, the digestive fire must be especially protected.
One should know cippa and akṣataroga and that upanakha [to be the same].

36.24

One who has a clear complexion and clear sense organs, desires sense objects, has an unobstructed urge of digestion,
Is endowed with happiness, and possessed of nourishment and strength, is said to be a person of completely purified blood.
Due to contact with foul mud, the spaces between the fingers
Become accompanied by itching and moisture; they call this alasa; black moles are tilakālaka.

36.24_1

Thus ends the thirty-sixth chapter.

Commentaries (1)

Śaśilekhā — Indu, Sanskrit

Linked texts (1)

Aṣṭāṅgasaṃgraha — Vāgbhaṭa, Sanskrit