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A History of Indian Medical Literature v1.c24: Part 3: Aṣṭāṅgahṛdayasaṃhitā

A History of Indian Medical Literature v1.c24

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English

Contents

Part 3: Aṣṭāṅgahṛdayasaṃhitā

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The Aṣṭāṅgahṛdayasaṃhitā opens with a maṅgala addressed to the Apūrvavaidya, who destroyed all the diseases, consisting of passion (rāga), etc., which give rise to desire (autsukya), delusion (moha) and distress (arati) (1.1).

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Chapter one (āyuṣkānīya)² begins with the transmission of āyurveda: Brahmā gave the science to Prajāpati, who gave it to the Aśvins; the Aśvins transmitted it to Sahasrākṣa (= Indra), who taught it to the son of Atri and other sages; these sages instructed Agniveśa and others, who composed treatises on the subject (1.3–4ab).³ The Aṣṭāṅgahṛdaya is said to be based on the essence of these treatises (1.4cd–5ab).

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The subjects of chapter one are: the eight divisions of āyurveda: kāya, bāla,⁴ graha,⁵ ūrdhvāṅga,⁶ śalya, daṃṣṭrā,⁷ jarā,⁸ and vṛṣa⁹ (1.5cd–6ab);¹⁰ the three doṣas (1.6cd–7ab); the main seats of the doṣas (1.7cd); the stages of life, periods of day and night, and stages of the digestive process in which one of the doṣas is predominantly active (1.8ab); the four types of digestive fire (1.8cd); the krūra, mṛdu and madhya types of koṣṭha (1.9ab); the constitutions (prakṛti) (1.9cd–10); the normal qualities of vāta (1.11ab),¹¹ pitta (1.11cd)¹² and kapha (1.12ab);¹³ combinations of two doṣas (saṃsarga) and three doṣas (saṃnipāta) (1.12cd); the seven bodily elements (dhātu), also called dūṣyas (1.13ab); urine, faeces and sweat are called mala (1.13cd); similar (samāna) substances, etc., cause increase (vṛddhi) (of doṣas, dhātus and malas), dissimilar ones decrease (1.14ab); the six tastes and their actions on the doṣas (1.14cd–16ab);¹⁴ the three types of substances: śamana (alleviating), kopana (aggravating) and svasthahita (maintaining health) (1.16cd); the two types of vīrya: uṣṇa and śīta (1.17ab);¹⁵ the three types of vipāka: svādu, amla and kaṭuka (1.17cd);¹⁶ the twenty qualities (guṇa), which consist of guru, manda, hima, snigdha, ślakṣṇa, sāndra, mṛdu, sthira, sūkṣma, and viśada, along with their opposites (1.18);¹⁷ diseases are essentially caused by defective, improper and excessive contact (yoga) with time, the objects of the senses, and activities; proper contact is the main cause of health (1.19);¹⁸ disease is equivalent to imbalance of the doṣas, health to their balance (1.20ab); diseases are either endogenous (nija) or exogenous (āgantu) (1.20cd); the basic seats of disease are body and mind (1.21ab); rajas and tamas are the doṣas affecting the mind (1.21cd); a patient should be examined by means of inspection (darśana), palpation (sparśana) and interrogation (praśna) (1.22ab); nidāna (aetiology), prāgrūpa (prodromes), lakṣaṇa (symptomatology), upāśaya (diagnosis ex iuvantibus) and āpti (= saṃprāpti; pathogenesis) are the means of examining a disease (1.22cd);

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deśa is of two kinds: bhūmideśa (the type of country) and dehadeśa (the body);¹⁹ bhū(mi)deśa is of three types: jāṅgala, ānūpa and sādhāraṇa (1.23–24ab);²⁰ the two kinds of time: divided into units, such as kṣaṇa, etc., and relating to the stages of a disease (1.24cd);²¹ remedial measures (auṣadha) are either purificatory (śodhana) or pacificatory (śamana) (1.25ab); enemas (basti), purgatives (vireka) and emetics (vamana), as well as oil, ghee and honey, are the best remedial measures against vāta, pitta and kapha respectively (1.25cd–26ab); discrimination (dhī), constancy (dhairya) and knowledge concerning the ātman, etc., are the best remedial measures against the mental doṣas (1.26cd); the four limbs of treatment (pādacatuṣṭaya) consist of the physician, the attendant, the drug and the patient; the four good qualities of each of the four (1.27–29);²² diseases are curable (sādhya) or incurable (asādhya); they are also divided into easily curable (susādhya), curable with difficulty (kṛcchrasādhya), palliable (yāpya), and not amenable to treatment (anupakrama);²³ the features of these four types (1.30–33);²⁴ types of patients to be rejected (1.34–35ab).

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The chapter ends with an enumeration of the titles of the one hundred and twenty chapters of the treatise (1.35cd–49).

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Chapter two is devoted to the daily regimen (dinacaryā).²⁵

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The subjects deal with are: the time to get up (2.1ab); urination and defecation (2.1cd); teeth-cleaning (dantapavana) (2.2–3);²⁶ disorders which make teeth-cleaning contra-indicated (2.4);²⁷ the application of a collyrium (sauvīrāñjana) (2.5–6ab), followed by an errhine (nāvana), a mouth wash (gaṇḍūṣa), the inhalation of a medicinal smoke (dhūma), and the chewing of betel (tāmbūla) (2.6cd);²⁸ contra-indications for betel-chewing (2.7);²⁹ massage with oil (abhyaṅga) (2.8–9ab);³⁰ contra-indications for massage (2.9cd); physical exercise (vyāyāma) (2.10);³¹ contra-indications for physical exercise (2.11ab); special rules (2.11cd–12ab); massage (mardana) after physical exercise (2.12cd); disorders arising from excessive physical exercise (2.13); udvartana (2.15);³² bathing (snāna) (2.16–17);³³ contra-indications for bathing (2.18); rules for good conduct (ācāra) (2.19–48).

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Chapter three (ṛtucaryā) describes the seasons, physiological changes during the seasons, and seasonal regimen.³⁴

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The seasons are arranged in the following order: śiśira, vasanta, grīṣma, varṣāḥ, śarad, hima (3.1). The period covering the seven last days of a season and the seven first days of the next one is called ṛtusandhi (3.58).³⁵

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Chapter four (rogānutpādanīya) begins with the statement that thirteen natural urges should not be suppressed; the urges distinguished are identical with those of the Caraka- and Suśrutasaṃhitā, apart from the replacement of udgāra (eructation) by kāsa (coughing) (4.1).³⁶ The symptoms caused by the suppression of each of these urges are listed and the treatment of these syndromes is described (4.2–21ab); the symptoms brought about by the suppression of the urge to eructate and the treatment to be adopted are, in spite of the absence of udgāra in the preceding list, also dealt with (4.7d–8).³⁷

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Particular symptoms in persons habitually suppressing their urges should make the physician decide to reject them for treatment (4.21cd). The specific treatments of the disorders resulting from suppression have been described, but, generally, one should try to normalize the course of the provoked vāta (4.22–23). Morally condemnable urges to be controlled are enumerated (4.24).38

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The remaining subjects of the chapter are: the importance of purificatory (śodhana) therapies (4.25–27); the treatment of patients emaciated by purificatory measures (bheṣajakṣapita) (4.28–30); the various types of āgantu diseases: those caused by malevolent beings (bhūta), poisonous substances (viṣa), wind,39 fire, wounds (kṣata), fractures (bhaṅga), passions (rāga), hatred (dveṣa), fear (bhaya), etc. (4.31);40 general rules for the prevention of nija and āgantu diseases, and the cure of diseases that have already arisen (4.32–34);41 the season in which doṣas accumulated in a particular season should be expelled by means of purificatory measures (4.35); the conduct leading to freedom from disease (4.36).

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Chapter five (dravadravyavijñānīya) 42 is concerned with fluids, their properties and their actions.

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The substances discussed are: kinds of water (5.1–20ab); milk (5.20cd–29ab); dadhi (5.29cd–32ab); takra and mastu (5.32cd–35ab); navanīta (5.35cd–36); ghee (5.37–40); kīlaṭa (caseous milk), pīyūṣa (early beestings), kūrcikā (condensed milk), moraṇa (late beestings) (5.41);43 superior and inferior types of ghee (5.42ab); the sugarcane and its products, along with yāsaśarkarā and honey (5.42cd–54); oils (5.55–61ab); other fatty substances (5.61cd–62ab); alcoholic and other fermented fluids: alcoholic fluids in general, surā, vāruṇī,44 vaibhītakī surā, yavasurā, ariṣṭa, mārdvīka, khārjūra, śārkara, gauḍa, sīdhu, madhvāsava, śukta, śāṇḍākī, dhānyāmla, sauvīraka, tuṣodaka (5.62cd–81); types of urine (5.82–83).

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Chapter six (annasvarūpavijñānīya) deals with articles of diet and medicinal substances.45

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The subjects are: the group called śūkadhānya,46 which consists of varieties of rice (6.1–11ab) and several kinds of tṛṇadhānya47 (6.11cd–16); the group called śimbīdhānya,48 mainly consisting of pulses (6.17–26ab); prepared foods (kṛtānna), amongst which are described: maṇḍa, peyā, vilepī, odana, (māṃsa)rasa, maudgarasa, kaulattharasa, tilavikṛti, piṇyākavikṛti, śuṣkaśāka, virūḍhaka, śāṇḍākīvaṭaka, rasālā, pānaka, lājāḷ, pṛthuka, dhānā, saktu, piṇyāka, vesavāra (6.26cd–42); the flesh of various animals, divided into the groups called mṛga, viṣkira, pratuda, bileśaya, prasaha, mahāmṛga, apcara, and matsya; goats and sheep do not belong to any of these groups; the first three of the eight groups are collectively known as jāṅgala, the last three as ānūpa, and the remaining two as sādhāraṇa (6.43–71);49 vegetables (śāka) (6.72–115ab); fruits (phala) (6.115cd–140ab); grains, vegetables and fruits to be rejected for use (6.140cd–143ab); medicinal substances (auṣadha): the group of salts, consisting of saindhava, sauvarcala, biḍa, sāmudra, audbhida, kṛṣṇalavaṇa, romaka, and pāṇiṣuttha (6.143cd–149), caustics (kṣāra) (6.150–152ab), medicinal plants (6.152cd–166ab);

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groups of medicinal substances: pañcakolaka, mahatpañcamūla, hrasvapañcamūla, madhyamapañcamūla, jīvanākhyapañcamūla, and tṛṇākhyapañcamūla (6.166cd–171).

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Chapter seven (annarakṣā) deals with a variety of subjects.

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The topics discussed in its first part (7.1–29ab) are: the royal physician (prāṇācārya), 50 who should reside near the royal palace; it is his duty to protect the king from poison (7.1–2); 51 signs indicating that particular foods and drinks contain poison (7.3–10ab); 52 the characteristics of a poisoner (7.12cd–13ab); 54 the detection of poison in foods by throwing them into a fire and examining the flames and the smell emitted (7.13cd–14ab); 55 the detection of poison in foods by making various animals eat them and examining the characteristic behaviour of these animals (7.14cd–18); 56 symptoms produced by poisoned foods when touched, when held in the mouth, after reaching the āmāśaya, after reaching the pakvāśaya; the treatment of these conditions (7.19–26); 57 a person who has consumed poison should be submitted to purificatory treatment along the upper and lower route; he should lick powdered copper (tāmrarajas), mixed with honey, in order to purify his heart (hṛdviśodhana), 58 and then take powdered gold (hemacūrṇa), which makes the poison lose its adherence (7.27–29ab). 59

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The second part (7.29cd–51) is concerned with incompatible articles of diet (viruddhāhāra); it is linked to the preceding part by the statement that these incompatible foods are similar to poison (viṣa) 60 (7.29cd). Many incompatible combinations are enumerated (7.30–45ab). 61 Viruddha is defined as anything that provokes the doṣas without eliminating them (7.45cd). 62 In general, purificatory or pacificatory treatment is recommended (7.46ab), 63 as well as the use of substances counteracting the provoked doṣas (7.46cd). 64 Circumstances making incompatible foods innocuous are mentioned (7.47). 65

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The best method of gradually discontinuing unwholesome habits and replacing them by healthy ones is described; 66 sudden changes would give rise to disorders (7.48–51).

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The third part begins with mentioning the three supports 67 of life, consisting of food (āhāra), sleep (śayana) and sexual activity (abrahmacarya) (7.52). 68 Rules concerning sleep are formulated; sleeping disorders and their treatment are discussed (7.53cd–68). 69 Finally, many rules regulating sexual behaviour are given (7.69–76).

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Chapter eight (mātrāsitīya) 70 deals with: the importance of consuming the proper quantity (mātrā) of food (8.1–2); 71 the bad effects of a deficient and excessive intake of food (8.3–4ab); 72 excessive intake may lead to the diseases called alasaka and visūcikā (8.4cd–6ab); the features of alasaka and visūcikā 73 (8.7cd–8ab) which explain their names; the symptoms of the vāta, pitta and kapha types of visūcikā (8.8cd–9); 74 the characteristics of alasaka (8.10–11); 75 the characteristics of the untreatable disease called daṇḍālasaka (8.12–13ab); 76 the characteristics of the equally untreatable disease called āmadoṣa or āmaviṣa (8.13cd–14); 77 the treatment of alasaka (8.15–16) and visūcikā (8.17); 78 the general management of ajīrṇa, which is due to āma (8.18–20ab); disorders caused by āma are relieved by the three kinds of apatarpaṇa (8.20cd–21ab); a small amount of āma requires laṅghana 79 (reducing measures), a moderate amount requires laṅghana and pācana measures, a large amount śodhana (purificatory measures) (8.21cd–22ab); 80 in general, diseases should be managed by measures which counteract their aetiological factors (nidāna- or hetuviparyaya), 81 but, when this is unsuccessful, with measures counteracting the disease itself (vyādhiviparyaya) (8.22cd–23); 82 as an alternative, therapies which are tadarthakārin 83 may be adopted; when the doṣas have become free from āma and the bodily fire is active again, one should employ massage with oil (abhyañjana), oleation, enemas, etc. (8.24); the three types of ajīrṇa (disorders of digestion): āmājīrṇa, viṣṭabdhājīrṇa and vidagdhājīrṇa, caused by kapha, vāta and pitta respectively (8.25–26); 84 the treatment of the three types of ajīrṇa (8.27); 85 the characteristics and treatment of vilambikā, a type of ajīrṇa caused by kapha and vāta, which possesses all the features of āma (8.28); 86 the symptoms and treatment of rasaśeṣājīrṇa (8.29); 87 the general management of ajīrṇa (8.30ab); the general symptoms of ajīrṇa (8.30cd–31ab); other causes, not yet mentioned, of āmadoṣa (8.31cd–33ab); the characteristics of samaśana, adhyaśana and viṣamāśana, 88 improper types of enjoying food which may cause death or give rise to serious diseases (8.33cd–35ab); rules for the proper consumption of food (8.35cd–38); 89 foods to be rejected (8.39); 90 articles of diet not suitable to habitual consumption (8.40–41); those suitable to habitual consumption (8.42–44); 91 foods to be consumed at the commencement, in the middle, and at the end of a meal (8.45–46ab); 92 two quarters of the stomach (kukṣi) should be filled with solid foods and one quarter with liquids, while the remaining quarter should be left empty (8.46cd–47ab); anupānas (8.47cd–52); 93 contra-indications for the use of an anupāna (8.53–54c); 94 rules to be observed after taking food and an anupāna (8.54d–55ab); 95 the proper time for taking a meal (8.55cd–ij).

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Chapter nine (dravyādivijñānīya) discusses a number of basic concepts.

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Substance (dravya) is the most important concept because taste, etc., reside in it; substances consist of the five mahābhūtas and are designated after the one that is predominantly present (9.1–2). 96 No substance possesses therefore one taste only; what is called its taste, is the taste manifestly present; the less manifest taste, or the taste perceived later on, is called the after-taste (anurasa) (9.3–4ab). 97 The qualities (guṇa), residing in a substance, are said to reside in its taste(s), figuratively, because of their intimate connection with taste (9.4cd–5ab). The qualities and actions of substances in which one of the mahābhūtas predominates are described (9.5cd–10a). 98 No substance found in the world is devoid of medicinal properties (9.10b–d). 99 Substances with a predominance of wind and fire possess an upwards-moving action, while substances with a predominance of earth and water possess a downwards-moving action (9.11). 100 Taste is a subject to be discussed later on (9.12ab). 101

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Some acknowledge eight kinds of vīrya: guru, laghu, snigdha, rūkṣa, uṣṇa, hima (= śīta), tīkṣṇa, and mṛdu (9.12cd–13ab); 102 Caraka has declared that action is brought about by vīrya only, no action being possible without vīrya (9.13cd–14ab); 103 guru, etc., are described as vīryas in agreement with the meaning of that term (anvartha), because they are the essential ones among the guṇas, possess great power, and prove to be the chief ones in practice; moreover, their range of application is important and wide (9.14cd–15);¹⁰⁴ for these reasons, the term vīrya is not applied to rasa, etc. (9.16); others maintain that uṣṇa and śīta are the only guṇas worthy to be called vīrya, because agni and soma are the most powerful among the constituents of substances and cannot be surpassed, just as vyakta and avyakta on a cosmical scale (9.17–18ab); the actions of uṣṇa and śīta vīrya are described (9.18cd–19); the change of taste at the conclusion of the digestive process, due to the contact with the abdominal fire, is called post-digestive taste (vipāka) (9.20);¹⁰⁵ the sweet and saltish tastes are sweet after digestion, the acid taste remains acid, the bitter, pungent and astringent tastes are generally pungent after digestion (9.21); the effects of the post-digestive tastes are the same as those of the tastes before digestion (9.22ab);¹⁰⁶ some substances exert their actions through their taste, other substances through their post-digestive taste, vīrya or prabhāva (9.22cd–23ab);¹⁰⁷ the strongest among rasa, vipāka, vīrya or prabhāva overcomes the other ones; when of equal strength, vipāka overcomes rasa, vīrya both rasa and vipāka, and prabhāva all the other ones (9.23cd–25);¹⁰⁸ when two substances with the same taste, etc., differ in their actions, these specific effects arise from prabhāva (9.26–27ab);¹⁰⁹ substances called vicitrapratyayārabdha differ in their actions, though their taste, etc., are similar (9.27cd–29).¹¹⁰

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Chapter ten (rasabhedīya) deals with the tastes.

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Its subjects are: the two mahābhūtas contributing to each of the six tastes (10.1);¹¹¹ the characteristic features of each taste (10.2–6); the actions of each taste on the human system (10.7–22ab);¹¹² groups of substances with a particular taste (10.22cd–32);¹¹³ general rules concerning the properties of substances with a particular taste and exceptions to these rules (10.33–36ab); the relationships between taste and potency (vīrya) (10.36cd–37ab);¹¹⁴ the tastes which are rūkṣa and promote retention of faeces, urine and flatus, followed by those which are snigdha and promote elimination of the waste products (10.37cd–38ab); tastes which are heavy (guru) and those which are light (laghu) (10.38cd–39ab);¹¹⁵ the six tastes separately and their fifty-seven combinations (10.39cd–43);¹¹⁶ the combinations of tastes and after-tastes become innumerable when taking into consideration their proportions in a combination (10.44).¹¹⁷

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Chapter eleven (doṣādivijñānīya) deals with states of increase and decrease of bodily constituents.

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The subjects are: the doṣas, elements of the body (dhātu), and waste products (mala) constitute the basic supports of the body (11.1);¹¹⁸ the normal functions of each doṣa (11.2–3),¹¹⁹ the chief function of each element of the body (11.4) ¹²⁰ and of each of the three waste products (11.5);¹²¹ the characteristic features of increase of each of the three doṣas (11.6–8ab),¹²² each of the seven elements (11.8cd–12),¹²³ each of the three main waste products (11.13–14ab),¹²⁴ and the other waste products, consisting of dūṣikā, ¹²⁵ etc. (11.14cd); the characteristic features of decrease of each doṣa (11.15–16),¹²⁶ element (11.17–20) ¹²⁷ and waste product (11.21–23);¹²⁸ general signs enabling a physician to infer that a doṣa, dhātu or mala has increased or decreased (11.24–25ab); decrease of waste products is more troublesome than increase (11.25cd); vāta resides in the bones, pitta in sweat and blood, kapha in the remaining dhātus and malas; treatments leading to increase or decrease of a doṣa also result in increase or decrease of the correspondig dhātu(s) and mala(s), and the other way round, but this does not apply to vāta and osseous tissue (11.26–27c); all types of increase are usually due to tarpaṇa, all types of decrease to the opposite of tarpaṇa; generally, increase leads to increase of kapha, decrease to decrease of vāta (11.27cd–28); disorders arising from increase should be treated by means of reducing measures (laṅghana), 129 those brought about by decrease by means of roborants (bṛṃhaṇa), 130 but increase of vāta requires bṛṃhaṇa, its decrease laṅghana measures (11.29); therapeutic procedures indicated in cases of increase or decrease of a bodily element or waste product (11.30–33); portions of the bodily fire (kāyāgni), which has its own seat, are present in the bodily elements; the increase or decrease of these portions results in increase or decrease of the elements; increase or decrease of a particular element gives rise to the same condition in the succeding one of the series (11.34–35ab); corrupted doṣas cause corruption of the bodily elements; corrupted doṣas and elements together make the waste products corrupted, which in their turn corrupt the channels transporting them (malāyana); two of these channels are present in the lower part (of the trunk), seven in the head, while sweat is transported in its own channels; corruption of these channels leads to diseases (11.35cd–36); ojas is described (11.37–39ab), 131 the causes and symptoms of decrease of ojas, 132 the treatment of this condition (11.39cd–41ab); 133 signs indicating increase of ojas (11. 41cd); general dietary rules relating to increase and decrease of the doṣas (11.42–43); general signs indicating increase or decrease of the doṣas (11.44); 134 the importance of avoiding increase or decrease of the doṣas (11.45).

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Chapter twelve (doṣabhedīya) discusses a number of issues related to the doṣas.

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The subjects are: the seats (sthāna) of vāta, pitta and kapha (12.1–3); 135 the seats and functions of the five kinds of vāta (12.4–9), 136 pitta (12.10–14) 137 and kapha (12. 15–18ab); 138 the qualities of substances leading to caya (accumulation), kopa (excitation) and śama (pacification) of vāta, pitta and kapha (12.19–22ab); 139 the characteristic features of caya, kopa and śama (12.22cd–24ab); 140 the three seasons in which caya, prakopa and praśama of vāta, pitta and kapha occur (12.24cd–25ab); 141 caya of vāta occurs in grīṣma (summer), of pitta in varṣāḥ (the rainy season), of kapha in śiśira (the cool season) (12.25cd–29ab); the doṣas spread over the whole body quickly, but, once excited, disappear again slowly (12.29cd–30ab); an endless number of disorders is brought about by the excited doṣas, which are their only causes (12.30cd–34c); the causes of excitement of the doṣas consist of wrong contact of the senses with their objects (asātmyārthasaṃyoga), seasonal abnormalities, and wrong conduct; each of these is of three types: deficient, excessive and improper (12.34d–35); these nine varieties are explained and illustrated by means of examples (12.36–44ab); 142 the three pathways of diseases: bahirmārga, antarmārga and madhyamamārga; examples of diseases taking one of these pathways (12.44cd–49ab); 143 signs indicating a disorder of vāta (12.49cd–51c), 144 pitta (12.51d–52) 145 and kapha (12.53–54ab); 146 the importance of these signs for a physician (12.54cd–56); diseases are of three kinds: arising from bad acts committed in the present life (dṛṣṭāpacāraja), committed in a former existence (pūrvāparādhaja), or arising from a combination of both (12.57); 147 a disease arising from the doṣas is brought about by specific aetiological factors (yathānidānam), a disease arising from one’s karman manifests itself without these causative factors (hetu), an illness arising from both doṣas and karman is powerful in its effects (mahārambha), even when the hetu is weak (12.58); the course of these types of diseases and their cure (12.59); diseases are either independent (svatantra) or subordinate (paratantra); the latter are divided into prodromes (pūrvarūpa) and complications (upadrava) (12. 60); 148 the characteristic features of these two groups (12.61a–c); the doṣas are also either svatantra or paratantra (12.61d); a subordinate disease or doṣa subsides together with the chief one, but, in case this does not happen, a powerful and afflicting complication arises which requires separate treatment (12.62–63); general rules for treating a disorder that cannot be labelled (12.64–66); any disorder can be treated adaequately by taking into consideration the corruptible constituents (dūṣya) of the body, the habitat (deśa) of the patient, his strength, the time of appearance of the disorder, the digestive fire of the patient, his constitution, age, character (sattva), sātmya, dietary habits, and the stage (avasthā) of the disease, thus determining which doṣas are involved and which treatment should be applied (12.67–68); 149 pitfalls to be avoided by a physician (12.69–73); the number of varieties of increase and decrease of one doṣa and combinations of two or three doṣas, to equal or inequal degrees; the total number is sixty-two; the sixty-third variety is the balanced state of the doṣas which is equivalent to health (12.74–78ab); 150 the number of varieties becomes exceedingly large when the bodily elements are also taken into consideration (12.7cd–ef).

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Chapter thirteen (doṣopakramaṇīya) is about the general treatment of disorders of the doṣas.

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The subjects are: the general treatment of disorders caused by vāta (13.1–3), 151 pitta (13.4–9) 152 and kapha (13.10–12); 153 combinations of doṣas require combinations of these treatments (13.13); in general, the treatment of disorders by vāta and pitta is like the regimen for the summer season, that of those by kapha and vāta like the regimen for the spring, that of those by kapha and pitta like the regimen for the autumn (13.14); a doṣa should be subdued in the stage of its accumulation (caya); when it has reached the stage of excitation (kopa), it should be treated without opposing one of the other doṣas; when all the doṣas are excited, the strongest one should be subdued without opposing the other ones (13.15); a treatment that pacifies a particular disease, but gives rise to another one, is inadequate; 154 adequate treatment leads to cure without bringing about another disease (13.16); factors which make the doṣas move from the viscera (koṣṭha) to the śākhās (extremities), bones and marmans; factors making the doṣas move from the śākhās to the viscera, where they stay, waiting for a cause (of excitation); having increased in strength, due to time, etc., they reach the stage of excitation, (not only locally,) but in other places too (13.17–19); a doṣa that has established itself in the seat of another doṣa should be treated, when weak, in accordance with the seat, but, when powerful, according to its own nature (13.20); such an āgantudoṣa should be pacified after opposing the normally present one, or the other way round (13.21ab); 155 doṣas which have moved sideways (tiryaggata)¹⁵⁶ trouble patients for a long time and should not be treated in haste; the physician should pacify them, bring them to the koṣṭha with gentle methods, and then try to expel them (13.21cd–23ab);¹⁵⁷ characteristics of doṣas associated with āma and devoid of it (13.23cd–24); the origin of āma (13.25); a divergent opinion on that subject (13.26); doṣas and corrupted dūṣyas, together with the diseases they bring about, are designated as sāma when they are mixed with this āma (13.27); the treatment of sāma conditions (13.28–33ab); the months most suitable for the elimination of doṣas (13.33cd–36); the ten periods of time for the administration of a medicine (13.37–41).¹⁵⁸

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Chapter fourteen (dvidivhopakramaṇīya) deals with two important ways of treatment.

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The subjects discussed are: the two types of treatment called saṃtarpaṇa or bṛṃhaṇa and apatarpaṇa or laṅghana (14.1–2);¹⁵⁹ the mahābhūtas predominantly present in roborant (bṛṃhaṇa) and reducing (laṅghana) substances (14.3ab); other therapeutic measures, such as snehana, rūkṣaṇa, svedana and stambhana can be subsumed under bṛṃhaṇa and laṅghana (14.3cd–4ab);¹⁶⁰ laṅghana is either śodhana (purificatory) or śamana (pacificatory) (14.4cd); śodhana, which eliminates the doṣas, is of five kinds: nirūha, vamana (emesis), kāyareka (purgation), śiroreka (evacuation of the head) and asravisruti (bloodletting) (14.5); śamana, which neither expels nor excites doṣas, but normalizes them, is of seven kinds: pācana measures, dīpana measures, hunger, thirst, physical exercise, exposure to the sun (ātapa) and exposure to wind (14.6–7ab);¹⁶¹ bṛṃhaṇais only śamana with regard to vāta and a combination of vāta and pitta (14.7cd); indications for bṛṃhaṇa (14.8–10ab)¹⁶² and laṅghana (14.10cd–15ab);¹⁶³ persons suitable for laṅghana should not be treated with bṛṃhaṇa measures when suffering from a disease, but those suitable for bṛṃhaṇa may be treated with mild laṅghana measures or a combination of laṅghana and bṛṃhaṇa, dependent on various circumstances (14.15cd–16ab); the results of bṛṃhaṇa and laṅghana measures (14.16cd–18ab); excessive bṛṃhaṇa and laṅghana in general (14.18cd–19); excessive bṛṃhaṇa, its effects (14.20)¹⁶⁴ and treatment (14.21–28);¹⁶⁵ excessive laṅghana, its effects (14.29–32ab)¹⁶⁶ and treatment (14.32cd–35);¹⁶⁷ foods to be recommended to obese (sthūla) and lean (kṛśa) persons (14.36); therapies are either bṛṃhaṇa or laṅghana, and all diseases are to be treated in one of these two ways (14.37).

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Chapter fifteen (śodhanādigaṇasaṃgraha)¹⁶⁸ deals with thirty-three groups of drugs and their actions.¹⁶⁹

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These groups consist of: emetics (chardaṇagaṇa) (15.1),¹⁷⁰ purgatives (virecana) (15.2),¹⁷¹ drugs suitable for nirūhaṇa (15.3)¹⁷² and evacuation of the head (uttamāṅgaśodhana) (15.4);¹⁷³ drugs which subdue vāta (15.5), pitta (15.6) and kapha (15.7);¹⁷⁴ the groups called jīvanīya (15.8),¹⁷⁵ vidāryādi (15.9–10),¹⁷⁶ sārivādi (15.11),¹⁷⁷ padmakādi (15.12),¹⁷⁸ parūṣakādi (15.13),¹⁷⁹ añjanādi (15.14),¹⁸⁰ paṭolādi (15.15),¹⁸¹ guḍūcyādi (15.16),¹⁸² āragvadhādi (15.17–18),¹⁸³ asanādi (15.19–20),¹⁸⁴ varuṇādi (15.21–22),¹⁸⁵ uṣakādi (15.23),¹⁸⁶ viratarādi (15.24–25),¹⁸⁷ rodhrādi (15.26–27),¹⁸⁸ arkādi (15.28–29),¹⁸⁹ surasādi (15.30–31),¹⁹⁰ muṣkakādi (15.32),¹⁹¹ vatsakādi (15.33–34),¹⁹² vacādi and haridrādi (15.35–36),¹⁹³ priyaṅgvādi and ambaṣṭhādi (15.

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37–39), 194 mustādi (15.40), 195 nyagrodhādi (15.41–42), 196 elādi (15.43–44), 197 and śyāmādi (15.45).198

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Drugs which are not available may be substituted and those inappropriate may be left out (15.46). The drugs mentioned may be employed in various types of preparation (15.47).

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Chapter sixteen (snehavidhi) is about oleation (sneha).199

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The subjects dealt with are: the properties of snehana substances; those with opposite properties are rūkṣaṇa (bringing about dryness) (16.1);200 the four most suitable substances for oleation: ghee, bone marrow, muscle fat (vasā) and oil; ghee is the very best among them (16.2–3ab);201 the effects on the doṣas of the four mentioned substances (16.3cd); their grades of heaviness (16.4ab); mixtures of two, three or four fatty substances are called yamaka, trivṛta and mahant respectively (16.4cd); indications and contra-indications for oleation (16.5–8ab);202 indications for oleation with ghee, oil, muscle fat and marrow (16.8cd–12ab);203 the proper time for oleation (16.12cd–14ab);204 the various ways of administration of a sneha, either mixed with food (vicāraṇā) or pure (acchapeya) (16.14cd–17ab);205 the doses of acchapeya: small, medium and large; indications for these doses (16.17cd–21);206 the general effects of a sneha (16.22);207 rules to be observed by a patient subjected to snehana (16.23–29ab);208 the duration of the treatment (16.29cd–30ab);209 signs indicating proper, improper and excessive oleation (16.30cd–31);210 the bad effects of improper oleation (snehavāpad) (16.32–33ab) and their treatment (16.33cd–35ab);211 the features indicating proper and improper virūkṣaṇa (16.35cd)212 and the therapy to be applied to manage the bad effects of improper application (16.36–37ab); rules for oleation in special groups of patients (16.37cd–39ab);213 types of patients who require a special type of sneha called sadyaḥsneha; recipes for sadyaḥsneha (16.39cd–43ab);214 more rules for particular groups of patients (16.43cd–45);215 the benefits of regularly applied oleation (16.46).216

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Chapter seventeen (svedavidhi) is concerned with sudation (sveda).217

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The subjects are: the four types of sudation: tāpa (application of dry heat), upanāha (application of poultices), ūṣman (application of warm vapour) and drava (application of warm liquids) (17.1ab);218 descriptions of these four methods (17.1cd–11);219 specifications regarding the procedure to be followed (17.12–14);220 benefits of sudation;221 after-treatment (17.15);222 the bad effects of excessive sudation223 and their treatment with stambhana (checking) measures; more indications for stambhana (17.16–17);224 the properties of svedana and stambhana substances (17.18–19);225 the effects of stambhana (17.20ab);226 the bad effects of excessive stambhana (17.20cd–21ab);227 contra-indications (17.21cd–24)228 and indications (17.25–27);229 types of sudation without the use of fire (anāgneyasveda) (17.28);230 the results of sudation (17.29).231

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Chapter eighteen (vamanavirecanavidhi) is about emesis (vamana) and purgation (virecana).

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The subjects dealt with are: emesis is indicated in disorders caused by kapha singly or by combinations with a predominance of kapha; disorders by pitta alone or by combinations with a predominance of pitta should preferably be treated by purgation (18.1);²³² indications for emesis (18.2–3ab);²³³ contra-indications (18.3cd–6);²³⁴ patients regarded to be unfit for a whole series of treatments (18.7); indications (18.8–10c)²³⁵ and contra-indications for purgation²³⁶ (18.10d–11); the procedure for emesis (18.12–23c);²³⁷ signs indicating deficient, proper and excessive emesis (18.23d–26);²³⁸ after-treatment (18.27–28);²³⁹ the regimen called peyādikrama²⁴⁰ and its results (18.29–30);²⁴¹ the minimum, intermediate and maximum number of bouts of vomiting during treatment is four, six and eight respectively; these numbers, when applied to voiding during a treatment with purgatives, are ten, twenty and thirty; the corresponding amounts of voided matter consist of one, two and four prastha (18.31;²⁴² the limits of emesis and purgation (18.32);²⁴³ the procedure for purgation, which is dependent on the type of digestive system (mṛdu- or krūrakoṣṭha)²⁴⁴ of the patient (18.33–38ab);²⁴⁵ signs indicating deficient, proper and excessive purgation (18.38cd–42ab);²⁴⁶ after-treatment (18.42cd–47ab);²⁴⁷ emesis eliminates immature (apakva) doṣas, purgation doṣas which are subject to maturation (pacyamāna) (18.47cd–48ab);²⁴⁸ rules for special groups of patients (8.48cd–57ab);²⁴⁹ oleation and sudation are indicated in the interval between emesis and purgation, between purgation and the application of an anuvāsana enema, etc., and at the end of such a series of treatments (18.57cd–58ab); oleation and sudation should always precede purificatory treatment (i.e., emesis and purgation) (18.58cd–59);²⁵⁰ the general benefits of purificatory treatment (18.60).²⁵¹

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Chapter nineteen (bastividhi) deals with enemas (basti).

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The subjects are: treatment with enemas is advisable when vāta has increased or when vāta is the predominant one among increased doṣas (19.1ab);²⁵² the three types of basti: nirūha, anuvāsana and uttarabasti (19.1cd–2ab); indications (19.2cd–3)²⁵³ and contra-indications (19.4–6ab)²⁵⁴ for an āsthāpana (= nirūha) enema; indications (19.6cd–7a)²⁵⁵ and contra-indications (19.7b–9ab)²⁵⁶ for an anuvāsana enema; the materials for the nozzle (netra); its shape (19.9cd–10ab); its length, dependent on the age of the patient (19.10cd–12ab); the dimensions of its orifice (19.12cd–14ab); the two rings (karṇikā) on the nozzle (19.14cd–15c);²⁵⁷ the pouch (19.15d–17);²⁵⁸ the dosages required for various age groups (19.18–19);²⁵⁹ the quantity of fluid for an anuvāsana should be one-fourth of that for a nirūha (19.20ab);²⁶⁰ the procedure for an anuvāsana (19.20cd–35)²⁶¹ and a nirūha (19.36–38ab);²⁶² the preparation of the decoction for a nirūha (19.38cd–46ab);²⁶³ rules for the application (19.46cd–50c);²⁶⁴ after-treatment (19.50d–51ab);²⁶⁵ the treatment of complications (19.51cd–52); the signs of deficient, proper and excessive application of anuvāsana (19.53–54ab);²⁶⁶ various rules for the application of anuvāsana and nirūha (19.54cd–62); the courses of treatment with enemas known as karma-, kāla- and yogabasti (19.63–65ab);²⁶⁷ the advantages of combining anuvāsana and nirūha (19.65cd–67ab); the variety of anuvāsana called mātrā-basti (19.67cd–68a); the indications for mātrābasti (19.68b–69);²⁶⁸ uttarabasti (urethral and vaginal douche), suitable in diseases of the bladder and gynaecological disorders, should be resorted to after the application of two or three anuvāsanas (19.70); the requirements for the nozzle (19.71–72) and the liquid (19.73ab) for an uttarabasti used as a urethral douche; the procedure (19.73cd–76ab); three or four douches should be given;²⁶⁹ the after-treatment and diet are like those after anuvāsana (19.76cd–77ab);²⁷⁰ indications for a vaginal douche (19.77cd–78); the nozzle (19.79–80ab); the quantity of fluid (19.80cd); the procedure (19.81–82);²⁷¹ the interval between emesis and purgation, and that between purgation and nirūha should be a fortnight; anuvāsana should follow immediately upon nirūha, but the interval should be seven days after purgation (19.83); the general effect of enemas (19.84); the eminence of the treatment with enemas (19.85–87ab); phlebotomy has the same eminent position in diseases due to blood (19.87cd).

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Chapter twenty (nasyavidhi) deals with nasal medications.

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The subjects are: nasal medication (nasya) is indicated in diseases located above the clavicles (ūrdhvajatru), because the nose is the gateway to the head (20.1);²⁷² the three types of nasya: virecana (evacuating), bṛṃhaṇa (roborant) and śamana (appeasing) (20.2ab);²⁷³ the indications for these three types (20.2cd–4);²⁷⁴ the materials used in the preparation of the three types (20.5–6);²⁷⁵ another classification of nasal medications: marśa and pratimarśa are prepared with fatty substances; avapīḍa is prepared with the paste (kalka), etc., of drugs with a sharp (tīkṣṇa) action; dhmāna is blown into the nose in the form of a powder (cūrṇa) by means of a tube (nāḍī) (20.7–9ab);²⁷⁶ the doses to be administered and the definition of their unit, the drop (bindu) (20.9cd–11a);²⁷⁷ contra-indications for nasal medication (20.11b–13c);²⁷⁸ the times of the day, dependent on the season, which are most suitable to the administration of a nasya (20.13d–16);²⁷⁹ the procedure to be followed in applying a nasya (20.17–21ab);²⁸⁰ the treatment to be applied when the patient faints (20.21cd); a fatty nasya should be given immediately after an evacuating one (20.22ab);²⁸¹ after-treatment (20.22cd–23ab);²⁸² the signs indicating proper, deficient and excessive treatment (20.23cd–25);²⁸³ indications and contra-indications for a pratimarśa, rules for its application, its effects (20.26–30ab);²⁸⁴ age limits for treatment with a nasya, dhūma (fumigation) and kavala (gargle), and for śuddhi (purificatory treatment) (20.30cd–31); the efficacy of the daily use of pratimarśa (20.32–34ab); the differences between marśa and pratimarśa; the use of marśa, though more difficult and risky, has the advantages of quicker action and better results; the same differences can be observed between acchapāna (of a sneha) and vicāraṇā, kuṭīsthiti and vātātapasthiti (as rasāyana methods), anuvāsana and mātrābasti (20.34cd–36); the preparation of the nasya called aṇutaila (20.37–38);²⁸⁵ the beneficial effects of habitual nasal therapy (20.39).²⁸⁶

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Chapter twenty-one (dhūmapānavidhi) is about the inhalation of medicinal smoke.

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The subjects dealt with are: the importance of daily inhaling the smoke (dhūmapāna) of drugs (21.1);²⁸⁷ snigdha, madhya and tīkṣṇa dhūmapāna are indicated against (disorders by) vāta, vāta and kapha together, and kapha respectively (21.2ab);²⁸⁸ contra-indications (21.2cd–4ab);²⁸⁹ disorders arising from inhaling smoke at an improper time or in excess;²⁹⁰ the treatment of these disorders (21.4cd–5ab); the times at which mṛdu (= snigdha), madhyama and virecana (= tīkṣṇa) dhūmapāna are useful (21.5cd–7ab); 291 requirements for the smoking pipe (dhūmanetraka) (21.7cd–9ab); 292 the procedure for medicinal smoking (21.9cd–12a); 293 the drugs to be used for the three types of dhūmapāna (21.13b–18); 294 the preparation of the wick (varti) (21.19–21ab); 295 a special type of dhūmapāna for the treatment of cough (21.21cd–22ab); 296 the beneficial effects of medicinal smoking (21.22c–f). 297

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Chapter twenty-two (gaṇḍūṣādividhi) is about gargles and a number of other medicinal preparations.

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The subjects dealt with are: the four kinds of gaṇḍūṣa (holding a medicinal fluid in the mouth): 298 snigdha, śamana, śodhana and ropaṇa; 299 the first three are active against the doṣas, the fourth kind heals wounds and sores (vraṇaghna); 300 the tastes of the drugs to be used in the preparation of these four kinds of gaṇḍūṣa (22.1–3c); the liquids to be employed 301 and their indications (22.3d–10ab); the procedure for the use of a gaṇḍūṣa (22.10cd–11); 302 the difference between a gaṇḍūṣa and a kavala (gargle) (22.12ab); 303 disorders curable by a kavala (22. 12c–f); the three forms of pratisāraṇa (the application of a medicinal preparation to the oral cavity): a kalka (paste), rasakriyā (inspissated decoction) and cūrṇa (powder); pratisāraṇa with the same drugs as those employed in gaṇḍūṣa is indicated in kapha disorders (22.13); 304 the three kinds of mukhālepa (the application of a paste to the face): doṣaha (counteracting the doṣas), viṣaha (counteracting poison) and varṇakara (producing a normal colour) (22.14); rukes for its application (22.15–16); rules for the patient (22.17ab); contra-indications (22.17cd–18a); the curative effects (22.18b–d); six recipes, one for each season (22.19–22ab); the beneficial effects of its habitual application (22.22cd–23ab); 305 the four kinds of mūrdhataila (application of oil to the head): abhyaṅga (inunction, accompanied by mild massage), (pari)ṣeka (pouring oil on the head), picu (application of a cloth soaked in oil), and (śiro)basti; each successive method is more efficacious than the preceding one (22.23cd–24ab); indications for these four types (22.24cd–26); the procedures for (śiro)basti; after-treatment; the maximum duration of the treatment (22.27–31); 306 karṇapūraṇa (filling the auditory duct with oil); this treatment should be applied until the complaints subside, or, in healthy patients, during one hundred mātrā (22.32); 307 the definition of a mātrā (22.33); the curative actions and beneficial effects in general of mūrdhataila (22.34). 308

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Chapter twenty-three (āścotanāñjanavidhi) is concerned with eyedrops and collyria.

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The subjects dealt with are: the usefulness of āścotana (the application of eyedrops) in the initial stage of all eye diseases (23.1); the suitable temperature of the drops, dependent on the doṣa involved (23.2ab); the procedure for the application of eyedrops (23.2cd–4); the bad effects of wrong application (23.5–6); the beneficial effects of correct administration (23.7); 309 indications for the application of an añjana (collyrium) to the eyes (23.8–9); 310 the three types of añjana: lekhana (scarifying), ropaṇa (healing) and dṛṣṭiprasādana (clarifying the vision); 311 the tastes and vīrya of the drugs to be employed in these three types (23.10–11ab); 312 a pratyañjana is a collyrium of prasādana action, to be used when the eyes are irritated by a sharp (tīkṣṇa) añjana (23.11cd– 12ab);³¹³ the requirements for the rod (śalākā) for the application of an añjana (23.12cd–13);³¹⁴ the three preparations employed in an añjana: piṇḍa (pill), rasakriyā (inspissated decoction) and cūrṇa (powder), indicated in serious, moderate and mild (disorders of the) doṣas respectively (23.14);³¹⁵ the correct doses of these three preparations (23.15–16ab);³¹⁶ the most suitable periods of time for an añjana (23.16cd–22);³¹⁷ contra-indications for an añjana (23.23–24);³¹⁸ properties making an añjana unsuitable for use (23.25); after-treatment (23.26–31).³¹⁹

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Chapter twenty-four (tarpaṇapuṭapakavidhi) is, as its title indicates, on the associated procedures called tarpaṇa and puṭapāka.

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Its subjects are: the indications for tarpaṇa (saturating the eyes by bathing them in a fatty substance); the suitable periods of time for this treatment; the procedure to be followed; the choice of the fatty substance; the duration of the treatment (24.1–9);³²⁰ daily tarpaṇa is required in disorders by vāta, tarpaṇa on alternate days in disorders by pitta, with an interval of two days in disorders by kapha and in healthy persons, or until the eyes are fully saturated (24.10);³²¹ signs indicating proper, deficient and excessive treatment (24.11);³²² tarpaṇa should be followed by puṭapāka treatment (24.12–13ab);³²³ indications for the snehana, lekhana and prasādana types of puṭapāka (24.13cd–14ab);³²⁴ the materials to be employed in these three types (24.14cd–17ab);³²⁵ the preparation of a puṭapāka (24.17cd–19ab);³²⁶ the procedure for its application (24.19cd–20c);³²⁷ the signs of proper, deficient and excessive treatment are like those of tarpaṇa (24.20d);³²⁸ contra-indications (24.21ab); after-treatment following tarpaṇa and puṭapāka (24.21cd–22ab);³²⁹ the importance of strengthening the eyes (24.22c–f).

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Chapter twenty-five (yantravidhi) is concerned with blunt surgical instruments.

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The subjects dealt with are: the definition of a yantra (blunt surgical instrument); its various uses (25.1–3ab);³³⁰ the various types of svastikayantra (25.4cd–7ab);³³¹ the two types of saṃdamśa (25.7cd–8);³³² the mucuṇḍī (25.9);³³³ the two types of tālayantra (25.10);³³⁴ nāḍīyantras in general (25.11–12);³³⁵ a number of particular nāḍīyantras, amongst which the arśoyantra³³⁶ (for examining haemorrhoids) and śamīyantra³³⁷ (for squeezing haemorrhoids); the aṅgulitrāṇaka (finger protector)³³⁸ (25.13–25); the śṛṅga (horn), alābu (hollowed gourd) and ghaṭī (pot) (25.26–28ab);³³⁹ the śalākās in general; various types of śalākā and śaṅku (hook) (25.28cd–35); more types of śalākā; the jāmbavauṣṭha³⁴⁰ (25.36–39ab);³⁴¹ the anuyantras (accessory blunt instruments) (25.39cd–41ab);³⁴² the functions of the yantras (25.41c–f);³⁴³ the excellent qualities of the kaṅkamukhayantra as the foremost among the yantras (25.42).³⁴⁴

v1.c24.62

Chapter twenty-six (śastravidhi) is concerned with sharp surgical instruments.

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The subjects dealt with are: the requirements for the twenty-six śastras (sharp instruments) (26.1–4);³⁴⁵ a list of the twenty-six śastras (four additional verses);³⁴⁶ descriptions of the form, dimensions, etc., and the uses of each instrument:³⁴⁷ maṇḍalāgra (26.5); vṛddhipattra (26.6–7ab); utpala(pattra) and adhyardhadhāra (26.7cd); sarpāsya (26.8ab);³⁴⁸ two kinds of eṣaṇī: gaṇḍūpadamukhā and sūcīmukhā (26.8cd–9ab);³⁴⁹ vetasa(pattra), śarāryāsya³⁵⁰ and trikūrcaka (26.9cd); kuśavadana ³⁵¹ and ātāvadana ³⁵² (26.10ab); antarmukha ³⁵³ (and ardhacandrānana)³⁵⁴ (26.10cd–11a); vrīhimukha (26.11b–d); kuṭhārī (26.12); śalākā (26.13a–c);³⁵⁵ aṅguliśastra (26.13c–15); ³⁵⁶ baḍiśa (26.16ab); karapattra (26.16cd–17ab); kartarī (26.17cd); ³⁵⁷ nakhaśastra (26.18); dantalekhanaka (26.19);³⁵⁸ three kinds of sūcī (26.20–21ab);³⁵⁹ vrīhivaktrā sūcī (26.21cd–22a); ³⁶⁰ kūrca (26.22b–23ab);³⁶¹ khaja (26.23cd–24ab);³⁶² karṇapā-līvyadhana (26.24cd);³⁶³ ārā, and a sūcī for piercing thick earlobes (26.25–26); non-metallic anuśastras (accessory sharp instruments), such as leeches, caustics, fire, glass, stones, nails, etc. (26.27–28ab);³⁶⁴ the functions of sharp instruments (26.28cd–29ab);³⁶⁵ the eight defects (doṣa) of sharp instruments (26.29cd–30ab);³⁶⁶ the ways of handling the sharp instruments (26.30cd–32);³⁶⁷ the case for keeping the instruments (śastrakośa) (26.33–34);³⁶⁸ indications for the use of leeches (jalaukas) (26.35ab);³⁶⁹ poisonous leeches, disorders caused by using them, the treatment of these disorders (26.35cd–37c); ³⁷⁰ non-poisonous leeches (26.37d–38); ³⁷¹ non-poisonous leeches are to be rejected when they are intoxicated by blood (raktamatta) (26.39);³⁷² the application of leeches and their removal (26.40–43ab); ³⁷³ the method for making the leeches vomit the blood sucked (26.43cd); the leeches should be protected from intoxication by blood (raktamada) and not be used again for seven days (26.44ab); signs indicating that their vomiting has been proper, deficient or excessive (26.44cd–45ab);³⁷⁴ the storage of leeches (26.45cd–46ab);³⁷⁵ the treatment to be applied when not all the corrupted blood has been removed (by the leeches) (26.46cd–47ab); removal of the corrupted blood makes redness and pain subside (26.47cd); corrupted blood that accumulates becomes sour (vyamla) (26.48); removal of corrupted blood by means of a gourd or pot is indicated when the corruption is caused by vāta or kapha, contra-indicated when caused by pitta (26.49); blood corrupted by vāta or pitta may be removed by a horn, but this is contra-indicated when kapha is the corrupting agent (26.50);³⁷⁶ bloodletting by means of scratching (pracchāna) (26.51–52);³⁷⁷ indications for bloodletting by scratching, by the use of leeches, a horn, gourd or pot, and by means of phlebotomy (26.53–55ab);³⁷⁸ the treatment of the site of bleeding (26.55–56).³⁷⁹

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Chapter twenty-seven (sirāvyadha)³⁸⁰ is concerned with phlebotomy.

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The subjects dealt with are: the characteristics of pure (śuddha) blood (27.1–2ab);³⁸¹ usually, blood gets corrupted by pitta and kapha; the disorders arising from corrupted blood (27.2cd–5ab);³⁸² phlebotomy is the appropriate treatment in these disorders (27.5cd); contra-indications for phlebotomy (27.6–9ab);³⁸³ the sites for phlebotomy in various diseases (27.9cd–18ab);³⁸⁴ the procedure to be followed for phlebotomy, dependent on the site where a vein should be cut (27.18cd–32);³⁸⁵ the depth of the incision and the instruments to be employed (27.33);³⁸⁶ the flow of blood when the cut is adequate, inadequate or too large (27.34–35ab);³⁸⁷ causes for the non-flowing of blood (27.35cd–36ab);³⁸⁸ the treatment of this condition (27.36cd–37);³⁸⁹ the corrupted blood flows out first (27.38ab);³⁹⁰ the signs of successful phlebotomy (27.38cd);³⁹¹ the treatment of patients who faint during bleeding (27.39);³⁹² the characteristics of blood corrupted by vāta, pitta, kapha, a combination of two doṣas and all three doṣas (27.40–41);³⁹³ the maximum amount of blood to be let;³⁹⁴ the bad effects of excessive bleeding³⁹⁵ and their treatment (27.42–43ab); the treatment of the site of bleeding (27.43cd–44ab); when to repeat the bleeding procedure (27.44cd–45ab);³⁹⁶ a small residue of corrupted blood may be allowed to remain; excessive letting should always be avoided (27.45cd–46ab);³⁹⁷ methods to remove small amounts of corrupted blood (27.46cd–47); haemostasis (27.48–50);³⁹⁸ after-treatment (27.51–52);³⁹⁹ the characteristics of persons with purified blood (27.53).⁴⁰⁰

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