A History of Indian Medical Literature v1.c15: Chapter 8

A History of Indian Medical Literature v1.c15

Language: English

Chapter 8 v1.c15.1

Chapter one, called kalpanāsiddhi (the successful application of therapeutic measures), begins with twelve questions of Agniveśa on the successful application of the fivefold treatment called pañcakarman (1.3–5)). Ātreya expounds, in answer to these questions, the general rules to be observed in pañcakarman.¹

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Sneha should be applied for a minimum of three and a maximum of seven days (1.6cd–7ab);² the effects of sneha are mentioned (1.7cd). The effects of sveda are described (1.8ab).³ The correct application of emetics and purgatives is discussed; the preliminary diet; after-treatment; the signs of adequate, deficient and excessive dosages;⁴ the degree of action of an emetic drug is inferior, moderate or superior according to the number of times a patient will vomit: four, six or eight times; the number of times a patient will open his bowels and the amount of the stools determine these degrees in a purgative drug: ten, twenty or thirty times, and an amount of faeces passed of two, three or four prastha (1.8cd–21).

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The correct application of anuvāsana (an evacuative, oleaginous enema) and nirūha (a medicated, non-oleaginous enema) is described; the preliminary diet and after-treatment; the seasons and parts of day and night which are most suitable; the succession of the two types of enema;⁵ the number of times a nirūha should be administered in kapha, pitta and vāta disorders: one or three, five or seven, nine or eleven times respectively (1.25); the effects of the two types of enema (1.27–31);⁶ their indications (1.32–34)⁷ and contra-indications (1.36–37); the signs of adequate, deficient and excessive application of enemas; three courses of treatment with enemas (basti): karma-, kāla-, and yogabasti; karmabasti consists of one nirūha to begin with, followed by twelve nirūhas and twelve anuvāsanas, and five nirūhas at the end;⁸ kālabasti is a course of one nirūha, six nirūhas and six anuvāsanas, alternately administered, and three nirūhas at the end; yogabasti consists of one nirūha, three nirūhas which alternate with three anuvāsanas, and one nirūha at the end (1.38–50ab).

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The correct application of śirovirecana (evacuation of the head) is described; the signs of adequate, deficient and excessive treatment; its indications; rules for the period preceding this type of treatment and during treatment (1.50cd–55ab). Some complications due to faulty application of the described therapeutic measures are dealt with (1.55cd–60ab).

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Chapter two, called pañcakarmīyasiddhi, is concerned with the types of persons suitable and unsuitable to treatment with pañcakarman (2.4–7), contra-indications and indications for treatment with emetics ((2.8–10)⁹, purgatives (2.11–13),¹⁰ anuvāsana¹¹ and nirūha (2.14–19),¹² and śirovirecana (2.20–22).¹³

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Chapter three, called bastisūtrīyasiddhi, begins with ten questions of Agniveśa concerning the application of enemas (basti) (3.3–5).¹⁴

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The subjects dealt with are: the material out of which the tube (nala) of the clyster should be made (3.7);¹⁵ its measurements for various age groups; the places for the three rings (karṇikā) on the tube (3.8–10ab);¹⁶ the requirements for a suitable pouch (basti) (3.10cd–11);¹⁷ substitutes for the pouch (3.12ab);¹⁸ the proper way of administering an enema (3.12cd–26ab);¹⁹ the first enema drags down vāta, the second one pitta, the third one kapha (3.26cd); after-treatment (3.27–30ab); dosages in various conditions (3.30cd–31ab) and age groups (3.31cd–33ab);²⁰ the requirements for the couch the patient is lying on (3.33cd–34ab); diet (3.34cd–35ab); formulations for medicated enemas (3.35cd–71).²¹

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Chapter four, called snehavyāpatsiddhi, gives a number of formulations for snehabasti (= anuvāsana) (4.4–24).²² The next part is devoted to six disorders (āpad, vyāpad) arising from faulty application²³ of a snehabasti;²⁴ the enema may be covered (āvṛta) by vāta, pitta, kapha, an excess of ingested food (atyanna), or faeces, or it may have been applied on an empty stomach (abhukta); the symptoms and treatment of these disorders are described (4.25–40). A number of rules relating to the administration of a snehabasti and nirūha are formulated (4.41–51).²⁵ A variety of snehabasti, called mātrābasti, is described (4.52–54).²⁶

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Chapter five, called netrabastivyāpatsiddhi, is concerned with types of tube (netra) and pouch (basti) to be avoided, and the treatment of disorders caused by an inappropriate tube or faulty handling of the tube (netravyāpad).²⁷

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Eight defects of the tube and their untoward effects are enumerated (5.4–5),²⁸ eight defects of the pouch and their effects (5.6–7),²⁹ eight ways of faulty handling of the tube, their effects, and the treatment of the disorders resulting (5.8–18).³⁰

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Chapter six, called vamanavirecanavyāpatsiddhi, discusses the proper administration (samyakkṛtayoga) of emetics and purgatives, defective procedures, and the treatment of the disorders resulting from these defects (6.3).

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Three chief seasons and three intermediate (sādhāraṇa) ones should be taken into consideration for the purpose of purificatory measures (i.e., emesis and purgation). The three chief seasons are grīṣma (summer), varṣāḥ (the rainy season) and himāgama (winter); the intermediate seasons are prāvṛṣ (the early rains), etc.³¹ Prāvṛṣ consists of the months called Śuci (= Āṣāḍha) and Nabha (= Śrāvaṇa), śarad of Ūrja (= Kārttika) and Saha (= Mārgaśīrṣa), vasanta of Tapasya (= Phālguna) and Madhu (= Caitra) (6.4–6).³²

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Numerous rules are formulated concerning the proper management of pañcakarma and the various complications which may arise.

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Subjects dealt with are: sneha facilitates the removal of the doṣas from the body, in the same way as water can easily be removed from a vessel after greasing it; sveda makes the fixed (sthira) doṣas flow out (viṣyandayati) of the body after application of sneha, as fire acts upon damp wood; śodhana (purification) eliminates the impurities (mala = doṣa), as dirt is removed from a cloth by water (6.11–13); a purificatory drug should not be taken during a disorder of digestion (ajīrṇa) (6.14); characteristics of a proper dose (6.15–17); the preparatory diet (6.18–19ab); the signs of proper elimination (6.19cd–20); removal of the remains of too large a dose (6.21–22ab);³³ the treatment to be applied when the signs of proper digestion of the drug are not observed (6.23); after-treatment (6.24); the treatment to be applied when kapha and pitta are only slightly eliminated (6.25);³⁴ signs indicating proper and improper digestion of the drug (6.26–27); types of improper administration (6.28); ten disorders (vyāpad) due to improper purification are enumerated:³⁵ ādhmāna (tympanitis), parikartikā,³⁶ srāva,³⁷ hṛdgraha,³⁸ gātragraha,³⁹ jīvādāna (bleeding), vibhramśa,⁴⁰ stambha (stiffness), upadrava (complications), and klama (exhaustion) (6.29–30); cases of wrong application of purificatory measures and their treatment (6.31–57);⁴¹ the symptoms and treatment of ādhmāna (6.58–60),⁴² parikartikā (6.61–67),⁴³ parisrāva (6.68–70),⁴⁴ hṛdgraha (6.71–75),⁴⁵ aṅgagraha (= gātragraha) (6.76–77), jīvādāna (6.78–84),⁴⁶ the three types of vibhramśa: gudabhramśa (prolapse of the rectum), saṃjñānāśa (loss of consciousness), and a syndrome characterized by kaṇḍū (itching) and other signs (6.85–87), stambha (6.88–89),⁴⁷ upadrava (6.90–91),⁴⁸ and klama (6.92–93).¹⁹

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Chapter seven, called bastivyāpatsiddhi, deals with the disorders caused by the improper administration of enemas.

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Twelve of these disorders (vyāpad) are enumerated: deficient application (ayoga), over-application (atiyoga), klama (exhaustion),⁵⁰ ādhmāna (tympanitis), hik-cā (hiccup), hṛtprāpti,⁵¹ ūrdhavatā (moving in an upward direction),⁵² pravāhikā,⁵³ śiro’rti (headache), aṅgārti (pains in the whole body), parikarta,⁵⁴ and parisrava⁵⁵ (7.5–6).

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The causes, symptoms and treatment of these disorders are described: ayoga (7.7–11), atiyoga (7.12–14), klama, due to a remnant of āmadoṣa (7.15–20),⁵⁶ ādhmāna (7.21–26),⁵⁷ hikkā (7.27–29), hṛdayaghaṭṭana (= hṛtprāpti; 7.30–31), ūrdhavatā (7.32–39), pravāhikā (7.40–42),⁵⁸ śiro’rti (7.43–46), aṅgārti (7.47–53), parikartikā (7.54–57), parisrava (7.58–62).⁵⁹ The composition of drastic (tīkṣṇa) and mild (mṛdu) enemas is dealt with (7.63).

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The chapter ends with some general statements on the action of enemas (7.54–65).

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Chapter eight, called prāśṛtayogīyasiddhi, begins with a number of formulations (yoga) for enemas, expressed in the unit of weight called prasṛta.⁶⁰ These enemas are especially suitable to delicate (sukumāra) patients and those suffering from the bad effects of improperly applied evacuative measures (8.3–18).⁶¹

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One of the formulations is called pañcatiktanirūha (8.8–9ab).⁶²

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The second part deals with diarrhoea (atisāra) as a disorder arising from the injudicious administration of enemas. Six main types are distinguished: accompanied by āma, or pakva (i.e., devoid of āma) and accompanied by faeces, vāta, blood, pitta or kapha; thirty subtypes are distinguished according to the combinations of doṣas involved. This diarrhoea may lead to various complications (upadrava), such as śūla (piercing pain), pravāhikā, ādhmāna (tympanitis), parikarti, aruci (loss of appetite), jvara (fever), tṛṣṇā (thirst), uṣṇa (heat), dāha (a burning sensation), mūrchā (fainting), etc. (8.19–22). The treatment of all the types of diarrhoea is discussed (8.23–45).

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Chapter nine, called trimarmīyasiddhi, deals with disorders of the three (main) vital organs (trimarman).63

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The total number of vital spots (marman) in trunk (skandha) and extremities (śākhā) is one hundred and seven.64 Excruciating (samadhika) pain is the result from any injury to them, because of their connection with the cetanā (the principle of consciousness). Those located in the trunk are more important than those located in the extremities, because the latter are dependent on the former. The most important ones are heart (hṛd), urinary bladder (basti) and head (śiras) (9.3).

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In the heart are established, like the spokes (ara) in the nave (nābhi) of a wheel, the ten dhamanīs,65 prāṇa and apāna,66 manas, buddhi, cetanā, and the mahābhūtas.67 In the head are located, as the rays of the sun, the senses and the channels carrying the (impressions of) the senses and the prāṇas. The bladder, situated in the midst of sthūlaguda (rectum), muṣkasevanī (the raphe of the perineum) and the tubes (nāḍī) transporting semen and urine, is the container (ādhāra) for the urine and the resort (pratiṣṭhā) of all the channels transporting the watery element, as the sea is the resort for all the rivers. The body is pervaded, like the sky by the rays of the sun, by numerous channels, known as marman, which are rooted in these (three vital organs). The latter should therefore be duly protected from external injury and the doṣas (9.4–5).

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The symptoms of injury to heart, head and bladder are enumerated (9.6). The three vital organs should be protected in particular from vāta, which causes agitation (samudīraṇa) of pitta and kapha and constitutes the root of the prāṇas; enemas are for that reason the best therapeutic measures for protection of the vital organs (9.7). Some recipes are given (9.8). The importance of protection of the vital organs as the seats of the prāṇas is stressed once more (9.9–10).

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The next part of the chapter is devoted to disorders of the three vital organs which have not already been dealt with in the trimarmīya chapter of the Cikitsāsthāna68 (9.11).

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The first diseases to be described, along with their treatment, are apatantraka69 and apatānaka (9.12–20),70 followed by tandrā71 (9.21–24).72

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Thirteen disorders affecting the urine (mūtradoṣa)73 are enumerated first (9.25–26)74 and then described, along with their treatment: mūtrakasāda75 (9.27–28),76 mūtrajaṭhara77 (9.29–31),78 mūtrakṛcchra79 (9.32), mūtrotsaṅga80 (9.33–34ab),81 mūtrasamkṣaya82 (9.34cd),83 mūtrātīta84 (9.35),85 aṣṭhilā86 (9.36),87 vātabasti (9.37),88 uṣṇavāta (9.38),89 vātakuṇḍalikā (9.39–40),90 mūtragranthi (9.41–42ab),91 viḍ(vi)-ghāta92 (9.42cd–43), and bastikuṇḍala93 (9.44–46). Doṣic varieties are described,94 as well as curable and incurable conditions95 (9.47–49ab).

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These disorders should be treated with measures removing mūtrakṛcchra; in all cases, basti and uttarabasti should be applied (9.49cd–50ab).96

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The instrument employed in uttarabasti (urethral douche) is described and the technique of its application (9.50cd–57),97 followed by the preparation and application of suppositories (varti), to be inserted into urethra (mūtranāḍī) or anus (pāyu) (9.58–61);⁹⁸ rules are given for the use of uttarabasti and suppositories in women⁹⁹, as well as for the application of uttarabasti as a vaginal douche (9.62–70ab).

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The third group of diseases to be discussed are those affecting the head. Five diseases are described, together with their treatment: śaṅkhaka¹⁰⁰ (9.71–73), ¹⁰¹ ardhāvabhedaka¹⁰² (9.74–78),¹⁰³ sūryāvarta¹⁰⁴ (9.79–83),¹⁰⁵ anantavāta¹⁰⁶ (9.84–86ab),¹⁰⁷ and śiraḥkampa (trembling of the head)¹⁰⁸ (9.86cd–87).

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Diseases of the head should be counteracted by means of nasal therapy (nastaḥkarman), because the nose is the gateway to the head (9.88).¹⁰⁹

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Five types of nastaḥkarman are distinguished: nāvana,¹¹⁰ avapīḍa,¹¹¹ dhmāpana,¹¹² dhūma,¹¹³ and pratimarsa.¹¹⁴ Nāvana is of two varieties: snehana (oleaginous) and śodhana (purificatory);¹¹⁵ avapīḍa is śodhana or stambhana;¹¹⁶ dhmāpana consists of the blowing (ādhmāpana) of a powdered drug (cūrṇa) into the nose; dhūma is of three varieties, as described earlier;¹¹⁷ pratimarsa performs both functions.¹¹⁸ Nasal therapy is thus of three kinds: recana (evacuative), tarpaṇa¹¹⁹ and śamana¹²⁰ (9.89–92).¹²¹

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Śirovirocana is recommended in kapha disorders of the head, tarpaṇa in vāta disorders, śamana in raktapitta and related disorders, dhmāpana and dhūma whenever required (9.93–95).¹²²

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The proper procedures for these types of nasal therapy are described, together with their indications and contra-indications (9.96–117).¹²³

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Chapter ten, called bastisiddhi, discusses indications and contra-indications for various types of enema (10.4–12); substances and drugs to be used (10.13–17); formulations for enemas to be employed in disorders caused by vāta, pitta, kapha (10.18–24); formulations for enemas which purify the pakvāśaya (10.25–27), promote the formation of semen and musculartissue (10.28–29), have a sāṅgrāhika action¹²⁴ (10.30–31), are active against parisrāva¹²⁵ (10.32), dāha (a burning sensation) (10.33), parikarta¹²⁶ (10.34–35), pravāhaṇa¹²⁷ (10.36), disorders resulting from over-application of enemas (10.37–38ab), jīvādāna (bleeding) (10.38cd–42), raktapitta and prameha (10.43), and various diseases (10.44–45). The total number of formulations described in this chapter is thirty-seven (10.46–48).

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Chapter eleven, called phalamātrāsiddhi,¹²⁸ contains a discussion among a group of sages about the most suitable fruit (phala) to be used in an āsthāpana.¹²⁹

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The sages mentioned as members of the assembly are Asita, Bhṛgu, Gautama, Kāpya, Kauśika, Pulastya, Śaunaka and others.¹³⁰

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Śaunaka argues that jīmūtaka¹³¹ is the best one; Vāmaka prefers kaṭutumba,¹³² Gautama has a preference for dhāmārgava,¹³³ Baḍiśa for kuṭaja,¹³⁴ Kāpya for kṛtavedhana.¹³⁵ Bhadraśaunaka restricts himself to rejecting Kāpya’s opinion (11.3–9).

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Ātreya replies to these claims that since there is no drug possessing merits or defects only, each one should be examined with regard to the relative preponderance of its merits; garāgarī¹³⁶ is useful in kuṣṭha, ikṣvāku in (pra)meha, the seeds of kuṭaja in hṛdroga, koṭhaphala¹³⁷ in pāṇḍu(roga), kṛtavedhana in udara, and madana fruits¹³⁸ in all diseases. The properties and actions of the fruits of madana are enumerated (11.10–

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Ātreya explains, on the request of the sages, how an enema, which displays its actions in the lower part of the trunk, is able to purify the whole body (11.15–18).

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The next section of the chapter is devoted to the treatment of elephants, camels, cattle, horses, sheep and goats by enemas. The material for the pouch, the length of the tube and the dosages for a nirūha are specified (11.19–22), followed by the names of the drugs to be employed (11.23–26).

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The last part of the chapter is concerned with persons who are always ill, the reasons for this, and the treatment of these groups of persons: priests (śrotriya, dvija), royal servants (rājasevaka, nṛpopasevin), courtezans (veśyā, paṇāṅanā) and merchants (paṇyajīvin) (11.27–36).

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Chapter twelve, called uttarabastisiddhi, 139 is about the after-treatment of patients to whom enemas have been administered (12.3–9).

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Eight patterns of behaviour should be avoided during the period of convalescence: loud speech (uccairbhāṣya), being jolted in vehicles (rathaṣobha), making too long walks, a sedentary life, eating before the previous meal has been digested, eating unwholesome foods, sleeping by day, and sexual intercourse; the painful conditions and disorders arising from these types of behaviour in general are mentioned (12.10–12). The symptoms brought about by each of these eight patterns of behaviour are listed (12.13–14) and their treatment is discussed (12.15).

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A series of twelve bastis (enemas) which are yāpana 140 in their action are described (12.16); 141 one more enema is added, in which the contents of raw chicken’s eggs (kukkuṭāṇdarasa), used in the last formula of the series of twelve, are replaced by those of the eggs of the pea-hen, gonarda, 142 goose (haṃsa), or sārasa 143 (12.17). 144

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A large number of other yāpana enemas containing animal products are described: 145 a series of twenty enemas with viṣkira birds, 146 thirty with pratuda birds, 147 twenty-nine with prasaha mammals and birds, 148 twenty-seven with aquatic (ambucara) birds, 149 nine with fish and other aquatic animals, ten with crabs (karkaṭaka) and other animals, 150 seventeen with animals of the mṛga group, 151 nineteen with viṣkira birds, ten with ānūpa animals, 152 and fourteen with bhūśaya animals 153 (12.18).

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A series of twenty-nine snehabastis, 154 also yāpana in action, is described; they are characterized as excellent aphrodisiacs (vṛṣya); the potency (vīrya) of these substances will be increased by boiling them a hundred or thousand times, dependent on the funds available (12.19). The total number of formulations comes up to two hundred and sixteen 155 (12.24–28).

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The actions of yāpana enemas are mentioned (12.20–22), together with what ought to be avoided by patients to whom they are administered (12.23). Some complications that may result from excessive application of yāpana enemas are dealt with, together with their treatment (12.29–32ab).

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Thus ends the Siddhisthāna (12.33cd–34ab).

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Agniveśa’s treatise in one hundred and twenty chapters, delivered by Ātreya, has been completed now. Its study will lead to longevity, fame, health, etc. (12.34cd–36ab).

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Agniveśa’s treatise, as redacted by Caraka, found to be incomplete by one-third, was fully restored by Dṛḍhabala (12.36cd--40ab).

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The work is adorned with the following thirty-six tantrayuktis: 156 adhikaraṇa, 157 yoga, 158 hetvartha, 159 padārtha, 160 pradeśa, 161 uddeśa, 162 nirdeśa, 163 vākyaśeṣa, 164 prayojana, 165 upadeśa, 166 apadeśa, 167 atideśa, 168 arthāpatti, 169 nirṇaya, 170 prasaṅga, 171 ekānta, 172 anekānta, 173 apavarga, 174 viparyaya, 175 pūrvapakṣa, 176 vidhāna, 177 anumata, 178 vyākhyāna, 179 saṃśaya, 180 atītāvekṣā, 181 anāgatāvekṣā, 182 svasaṃjñā, 183 ūhya, 184 samuccaya, 185 nidarśana, 186 nirvacana, 187 saṃniyoga, 188 vikalpana, 189 pratyutsāra, 190 uddhāra, 191 and saṃbhava 192 (12.40cd--45ab). 193

Linked texts (1)

Carakasaṃhitā — Agniveśa (Āyurveda) & Caraka, Sanskrit