The Sushruta Samhita — trans. Bhishagratna

An alkali, Yavagu (gruel), soup, a decoction, or milk, properly prepared with the above Pitta-subduing drugs, should also be prescribed as food and drink in these cases. 4.

Treatment of Kaphaja Asmari :—

The use of medicated clarified butter prepared from the milk of a she-goatf and cooked with the paste (Kalka) of the drugs constituting the Varunddi groupj, Guggulu, Eld, Harenu^ Kushtha, the Bhadrddi group, Maricha. Chitraka, Surdhvd and the Ushakddi group, leads to the speedy disintegration and expulsion of the As'mari (stone, etc.) due to the action of the deranged Kapha. So also the use of an alkali, Yavdgu (gruel), soup, milk, or a decoction, properly prepared with the above Kapha-subduing drugs, is recommended as food and drink in such cases. 5.

A potion consisting of the powdered fruit of the Pichuka,
Amkola, Kataka, S'dka and /;^<^2Wr^ mixed with treacle§

* Chakradatta reads "Punarnave" i.e.^ both the kinds of Punarnava.

t Jejjata explains *'Indivara" as 'Nilotpala.' But Gayadasa does not support this.

X S^me say that "Aja-sarpih" is superfluous. Chakradatta reads ''■m ^^II^l^ "^ ^^1#^l^^f*(:'' in place of "^^t ^^^if^^ ^I^^IfT^?r^ ''"' meaning thereby that the decoction of the Varunadi-gana is to be used. Chakradatta's reading seems to be the correct one and is observed in practice with good results. — Ed.

§ The quantity of treacle, to be taken, should be equal to the entire quantity of the powders ; anci hot water should be use4 — PaUan^^.

Chap. VII.] CHIKITSA STHANAM. '33'r

and water proves beneficial in cases of Gravel (Sarkard). The bones of the Krauncha, camel and ass, as well as the drugs known as S'vadamshtrd* Tdlamuli^ Ajamodd^ Kadambaxoots and Ndgara pounded together and administered through the vehicle of wine (Surd) or hot water, leads to the disintegration of Sarkara gravel). The milk of an ewe mixed with powdered Trikantakaseeds and honey should be used for seven days for the disintegration and separation of an Asmari. 6-y,

Alkaline Treatments:— An alkali should be

The milk of an ewe mixed with powdered Trikantakaseeds and honey should be used for seven days for the disintegration and separation of an Asmari. 6-y,

Alkaline Treatments:— An alkali should be

prepared from the ashes of the drugs used in the preparation of the aforesaid medicated clarified butters, by dissolving and filtering them in ewe's urine The alkali should then be slowly boiled with an alkali similarly prepared from the dung of domestic animals, with the powders of Trikatu and the drugs of the Ushakddi group thrown into them as an after-throw. It proves curative in cases of stone, Gulma, and gravel. Alkaliesf from burnt bark of sesamum, Apdmdrga^ plantain, P aids' a and barley taken with the urine of an ewe destroy the gravel (S'arkard). As an alternative, the alkalies of Pdtald and Karavira should be used in the preceding manner. 8-9. Two Tola (Aksha) weights of the pastes of S'vadamstrd, Yashti-madhu and Brdhmi (mixed with ewe's urine) should be given to the patient ; or the expressed juice of the Edakd, S'obJidnjana and Mdrkava (with the said urine) should be given, or a potion consisting of the pasted roots of the Kapotavamka with Kanjika, or Sura, etc., should be administered. Milk boiled with the aforesaid drug (Kapotavamka) should be taken by a patient

* Some explain it as **Gokshura-seeds" and others as "Markatakaseeds."

t Four or six Tola weight of an alkali should be dissolved and filterrd for a number of times before use.

p. 332

in case there is pain (in urinating). Milk boiled with Triphald or Varshdbhu should be administered as a drink and a decoction of the drugs of the Vira-tarddi group should be employed in all these cases.* lo.

A physician should have recourse to the following measures (surgical operations) in cases where the above-mentioned decoctions, medicated milk, alkalies, clarified butter and Uttara-vasti (urethral syringe) of the aforesaid drugs, etc., would prove ineffective. Surgical operations in these cases do not prove successful even in the hands of a skilful and experienced surgeon ; so a surgical (Lithotomic) operation should be considered a remedy that has little to recommend itself. The death of the patient is almost certain without a surgical operation and the result to be derived from it is also uncertain. Hence a skilled surgeon should perform such operations only with the permission of the king. 11-12.

IVIodes of Surgical Operations :— The

Hence a skilled surgeon should perform such operations only with the permission of the king. 11-12.

IVIodes of Surgical Operations :— The

patient should be soothed (Snigdha) by the application of oleaginous substances, his system should be cleansed with emetics and purgatives and be slightly reduced thereby ; he should then be fomented after being anointed with oily unguents ; and be made to pertake of a meal. Prayers, offerings and prophylactic charms should be offered and the instruments and surgical accessories required in the case should be arranged in the order laid down in the Agropaharaniya chapter] of the present work (Sutra-sthanam, ch. V.). Thej

* Dallana recommends the use of Triphala boiled with milk in] cases of pain accompanying Plttaja As'mari, while that boiled with] Varshabhu is advised to be given for the alleviation of pain in a case of! Vdtaja or Kaphaja As'mari. The drugs of Vira-taradi group should be] used with milk, clarified butter, a decoction, Yavagu (gruel), food, etc.,j and also for bath, immersion, etc.

Chap. VII.] CHIKITSA STHANAM. 333

surgeon should use his best endeavours to encourage the patient and infuse hope and confidence in the patient's mind. A person of strong physique and unagitated mind should be first made to sit on a level board or table as high as the knee-joint. The patient should then be made to lie on his back on the table placing the upper part of his body in the attendant's lap, with his waist resting on an elevated cloth cushion. Then the elbows and knee-joints (of the patient) should be contracted and bound up with fastenings (S'ataka) or with linen. After that the umbclical region (abdomen) of the patient should be well rubbed with oil or with clarified butter and the left side of the umbelical region should be pressed down with a closed fist so that the stone comes within the reach of the operator. The surgeon should then introduce into the rectum, the second and third fingers of his left hand, duly anointed and with the nails well pared. Then the fingers should be carried upward towards the rope of the perineum i.e , in the middle line so as to bring the stone between the rectum and the penis, when it should be so firmly and strongly pressed as to look like an elevated Granthi (tumour), taking care that the bladder remains contracted but at the same time even.