Chapter XXXIX - The treatment of distressing symptoms

Now we shall discourse on the treatment of distressing symptoms^[1] which are manifested in a patient (aturopadrava-Chikitsita). 1.

The digestive fire (Kayagni) of a person naturally grows dull^[2] after the exhibition of emetics and purgatives, after the administration of a Niruha-Vasti, after the internal application of a Sneha and after blood-letting. It is further lessened by the eating of extremely heavy (difficult of digestion) articles of fare, just as a low or dull fire is extinguished by a heavy load of fuel. Light meals taken in small quantities, on the other hand, increase the digestive fire under these circumstances, just as light fuel in small quantities serves to re-kindle a low fire. 2.

The quantity of diet should be proportionate to the Dosha (morbific diathesis) eliminated from the organism. The quantity of the Dosha or Doshas eliminated consists of three measures, viz., one Prastha,^[3] half an adhaka or an adhaka (at most). The first is the lowest, the second is the intermediate and the last named measure (one Adhaka) should be deemed as the highest quantity (of the Dosha that can be eliminated under the circumstances). 3.

Yavagu (gruel) prepared with a small quantity of rice (Tandula) should be given once, twice or thrice respect ively in cases of the eliminated Dosha being a Prastha, half an adhaka or an adhaka in quantity. 4.

After this a quarter part of the quantity of rice or grain otherwise deemed proper and adequate for the patient, should be cooked in the form of Vilepi. The rice or the grain (used in the preparation) should be well boiled, without the addition of any Sneha (oil or clarified butter) or salt. 5.

It should then be (passed through a piece of cloth and) made non-slimy, and should be taken in the above-prescribed manner with a clear (pure) soup of Mudga- pulse. The patient should then be given a diet measuring half the quantity of his usual one. The food, in this case, should be well saturated with any oleaginous substance (Sneha). The meal of the patient in the next stage should consist of well-boiled rice measuring three parts only of his usual diet and should be made palatable to the taste and sufficient to stimulate the sense-organs. The meal in this case, should be taken with the transparent surface of clarified butter (Ghrita-manda). After this period the patient should be allowed to take his full meal with well-prepared soups of venison, etc. 6-7.

The above order of taking one-fourth, half and three-fourths of the usual meal applies in cases of deficient, intermediate (moderate), or satisfactory action of a purgative. 8.

Peyas, taken in an aggravated condition of the deranged Pitta, and Kapha, or by a person addicted to drinking habits or subsequent to a deficient exhibition of emetics and purgatives, may give rise to an increased (mucous) secretion (Abhishyanda) in the organism. Tarpana measures (demulcent food) should, therefore, be deemed beneficial in these instances. 9.

A person is likely to fast from any of the following causes, e. g., pain, unattainment of wished-for objects, penance, bereavement, and mental distraction. Rules enjoined to be observed after a course of purgatives should as well be adhered to in such cases. 10.

An Adhaka, half an Adhaka and a Prastha measure should similarly be the quantity of excretion in connection with a course of purgatives under the three different degrees of its action. But some are of opinion that there may be no fixed quantity of excretion in this case, since purgation should not be considered satisfactory until the S'leshma (mucus) of the system has come out.^[4] A purgation should be considered satisfactory when the S'leshma comes out and in that case no more purgative should be given. The strength (Bala) of a patient has been laid down to be of three degrees, consequently the rules of diet and conduct should be similarly determined. A strong patient should observe the regimen of diet only once, one of middling strength (Madhya-bala) twice, while a weak patient thrice. Certain authorities, however, assert that this order of diet should be observed by the patients with an impaired, intermediate and keen digestion. 11.

Lest the Doshas might become aggravated by the appetite already kindled by the observation of the rules of diet prescribed for the purpose, the patient should be made to take his meal in the following order at this stage. Sweet and bitter articles of fare should be partaken of at the outset of a meal, followed by oleaginous, acid, saline and pungent food. After this, sweet, acid and saline food should again be taken followed by articles of sweet and bitter tastes. Dry (Ruksha) and demulcent food should be enjoined in succession in the course of a meal. The meals of a healthy person should then be prescribed. 12.

Light diet should be given for a week after the internal use of a Sneha and after the exhibition of emetics. A patient should observe a proper regimen of recoupment of his health, after having been subjected to a course of blood letting or treated with a course of Shodhana remedy (purgative). Intervals of three days should be allowed between two successive applications of a Vasti and the period of the third interval thus allowed, should be determined according to the requirements of each case.^[5] 13.

A patient suffering from an ulcer (Vrana) or recently treated with emulsive measures (Sneha-karma) or cleansing (emetics or purgatives) measures, or afflicted with any affection of the eyes or with fever attended with dysentery (Jvaratisara) resembles a vessel of unbaked clay fitted with oil, i.e., such a patient is greatly liable to the derangement of the Doshas. 14.

An irascible mood or fit of anger (in such a person) agitates his Pitta and produces Pitta-origined distempers;^[7] physical labour and grief cause a distracted state of the mind; and gratification of sexual desires (in such a state) brings on such dangerous diseases as convulsions, epileptic fits, paralysis, aching pain in the limbs, swelling about the anus, cough, hiccup and emission of blood-streaked semen and hemorrhage from the vagina. 15–A.

Day-sleep under the circumstances, gives rise to the affections of the deranged Kapha, viz., enlargement of the spleen (Plihodara), catarrh, jaundice, edema, fever, loss of consciousness, a sense of physical langour, indigestion, an aversion to food, and causes the patient to become overwhelmed with the quality of Tamas which produces in him a desire for sleep. 15–B.

Talking in a loud voice aggravates the Vayu and is attended with such grave consequences as pain in the head, blindness, inertness, loss of the faculty of smell, dumbness, deafness, dislocation of the jaw-bones (Hanu- moksha), Adhi-mantha, facial paralysis, paralysis of the eye-balls (Netra-stambha), thirst, cough, insomnia, shaking of the teeth and similar other distempers (due to an aggravation of the Vayu). 15–C.

Riding (on horse-back, etc.) under the circumstances may cause vomitings, swoons, vertigo, a sense of fatigue, stiffness of limbs, and the serious functional derangements of the sense organs. A long continuance in a sitting posture or bathing may give rise to pain in the region of the pelvis; while, on the contrary, excessive walking under the circumstances aggravates the Vayu and is attended with pain in the knee-joints, atrophy of the thighs, edematous swellings of the localities, or the form of disease known as Pada-harsha (sensitiveness in the feet). 15–D.

The use of cold water and other cold things^[8] (such as paste of Sandal, etc.) under the circumstances tends to aggravate the bodily Vayu and brings on an aching pain in the limbs, Shula (gastralgia), stuffedness of the injested food in the stomach (Vishtambha) and inflation of the abdomen (Adhmana) and shivering. An undue exposure to the sun and wind produces fever and discoloration of the complexion. The use of any unwholesome and incompatible diet as well as food taken before the complete digestion of the previous meal tends to produce serious distempers and may ultimately result in death. The use of incongenial fare undoubtedly leads to the deterioration of the strength and complexion of the body. A man of irregular and intemperate habits, who eats voraciously like an animal, suffers from indigestion which is the cause (source) of a number of physical distempers. 15.

In all these instances the real cause of the distress should be first ascertained, which should be then remedied with proper antidotal measures and remedies. 16.

Articles o f Diet:—

A diet consisting of cooked Shashti grain (Tandula) or matured Shali rice, Mudga pulse as well as (the soup of the flesh of) an Ena, Lava, hare, peacock, Tittiri, or deer, and such other light food should be given to a patient after the exhibition of emetics and purgatives. 17.

 

Thus ends the Thirty-ninth Chapter of the Chikitsita Sthana in the Sushruta Samhita which deals with the treatment of distressing symptoms which are manifested in a patient.

Footnotes and references:

[1]:

By “distressing symptoms” are generally meant those complications that follow the exhibition of emetics, purgatives, Vastis, etc.

[2]:

We have been told that the digestive fire is kindled by the exhibition of emetics, purgatives, etc., but here we are told just the reverse. The solution is that the digestive fire is ultimately kindled by these measures, whereas, immediately after the exhibition, it becomes dull and sluggish.

[3]:

The Prastha measure here means thirteen Palas and a half.

[4]:

Here a line is not found in the printed edition of the Sushruta Samhita, which is evident from Dallana’s commentary and supported by Shrikantha Datta in his commentary on Vrinda.

The line is as follows:—

“shleṣmantatvahirekasya na tamicchanti tahidaḥ |”

[5]:

Some commentators explain this verse to mean that the patient should observe the rules of diet and conduct (prescribed hereafter) for a period of three days after each application of a Vasti, but after the third application the rules of diet and conduct should be determined according to requirements.

[6]:

Here a line is not found in the printed edition of the Sushruta Samhita, which is evident from Dallana’s commentary and supported by Shrikantha Datta in his commentary on Vrinda.

The line is as follows:—

“śleṣmantatvahirekasya na tamicchanti tahidaḥ |”

[7]:

The Pitta-origined distempers are thirst, burning sensation, etc.

[8]:

In place of “shītasambhogatoyanaṃ (?)” Gayadasa reads “shītabhojanatoyanaṃ” which means the use of cold food and drink. This reading seems to be better.—Ed.

[9]:

In place of “śītasambhogatoyanaṃ (?)” Gayadasa reads “śītabhojanatoyanaṃ” which means the use of cold food and drink. This reading seems to be better.—Ed.