The Sushruta Samhita — trans. Bhishagratna

p. 625

again applied with (the decoctions of) the S'odhana* (purifying) drugs, or a Varti (plug) prepared with the Sodhana drugs should be injected into the rectum. As an alternative, an indicator (Eshani) should be inserted into the mouth of the bladder, or the region of the abdomen below the umbilicus, and be firmly pressed with a close fist, or medicinal plugs or sticks (Varti) of the size of a Mudj^a-pulsQ, cardamom- seed (Ela), or mustard-seed should be made up of Saindhava and the leaves of the Aragvadha pasted with the expressed juice of Nirgundi and cow's urine, and these plugs (Varti) should, according to the age of the patient, be inserted (into the mouth of the bladder) with (the top-end of) a rod or an indicator (Saldkd) for the out-flow of the injected fluid. Another alternative is to use a stick (^ Varti) made up of the pendant soot of a room ( Agdra-dhuma\ Vrihati, Pippali, Madana'fru'it, Saindhava salt and S'unthi pasted with S'ukta (a sort of Kanjika) and cow's urine (in the preceding manner). Other (similar) measures should be adopted for the successful action of an Anuvjisana enema (Vasti). 44-A.

A cold decoction of Yashti-madhu saturated with honey and sugart or a decoction of the (bark of the) milk-exuding trees (Kshiri-Vriksha\ or cold milk, should again be injected into the bladder, in the event of there being a burning sensation in that organ. 44.

Diseases such as derangements of the semen, or of ovum, or difficult menstruation, excess or suppression t According to Dallana a quantity of sugar and honey should be added in each of the three cases, viz., (ij the decoction of Yashtimadhu, (2) that of the Kshiri-trees, and (3) milk.

* The S'odhana drugs here are the Trina-pancha-muja and such other drugs. — Dallana.

p. 79

p. 626

of the monthly flow, diseases of the uterus and of the vaginal canal, non-falling of the placenta, strangury and other diseases of the urine, gravel, stones (As'mari), spermatorrhea (S'ukrotseka), cramps in the bladder, in the groins and in the urethra and all other severe diseases of the bladder other than Meha, will all yield to the application of an TJttara-vasti (urethral enema). Symptoms which mark, or dangers which attend, a judicious or an injudicious application of an Uttara-vasti are respectively identical with those which characterise or attend those of a Sneha-vasti, 45-46.

Symptoms which mark, or dangers which attend, a judicious or an injudicious application of an Uttara-vasti are respectively identical with those which characterise or attend those of a Sneha-vasti, 45-46.

Thus ends the Thirty-seventh Chapter of the Chikitsita Sthdnam in the Sus'ruta Samhitd which deals with the Anuvdsana-vasti and the UUarav^stL

CH.\PTER XXXVIIT.

Now we shall discourse on the mode of applying as well as on the treatment with a Nirudha-vasti

(Nirudhopakrama-Chlkltsitam). i.
The mode of preparing a Vasti :— The

application of an Anuvasana-vasti (enema) should be followed by that of one of the Asthdpana class. The body of the patient should be first anointed (with a Sneha) and fomented. Previous to the application of a vasti, the bowels and bladder should be relieved of all (foecal) accumulations (flatus and urine). The clyster (Vasti) should be applied at noon in a well-cleansed chamber, devoid of any gust of wind, and the patient should be laid on his left side on a spacious bed not furnished with any pillows, but a little raised up there where his buttocks would rest, and there should be attendants at his feet. The patient should continue in a. cheerful mood with his left thigh held in an outstretched posture and the right one flexed, and should refrain from speaking to any body. The digestion of the ingested food taken by the patient is necessary (before the application of the Vasti). The physician having placed the pipe of the enema (Vasti) upon his left foot should firmly press its Karnikd with the first and the second toes of his right foot. One half of the mouth of the Vasti should be kept contracted by pressing it with the small and ring finger of his left hand and the (other) half should be stretched with the aid of his thumb, index and middle fingers, and thus the medicinal solution should be poured into the bladder (Vasti). The pipe should be held with the middle and the index finger of the right hand . Care should be taken not to let the medicinal solution overflow from the sur-

628 THE SUSHRUTA SA.MIIITA [Chap. XXXVIII.

The pipe should be held with the middle and the index finger of the right hand . Care should be taken not to let the medicinal solution overflow from the sur-

628 THE SUSHRUTA SA.MIIITA [Chap. XXXVIII.

face of the pipe, nor to admit of even a bubble of air into the bladder (of the enema), nor to produce its over-contraction nor dilatation during the process (of pouring the medicine). The bladder filled with the proper quantity of medicinal solution should then be held in the left hand, and washed with the right hand. It should then be firmly tied (at the neck) just over the (surface of the) medicinal solution with ligatures of two or three rounds of thread. 2- A.

The mode of applying a Vast! :— The

Vasti should then be held up on the palm of the right hand, its pipe gripped with the middle and index fingers of the left hand, and the orifice closed with the thumb of the same hand. The neck of the pipe should be previously lubricated with clarified butter, and gently introduced into the rectum of the patient up to its Karnikd (protuberance) along the line of spinal column and with its mouth up-turned. The patient should be asked to take the same with care. 2.

Metrical Text :— The physician should then hold the enema (Vasti) with his left hand and press its bladder with his right. The injection (of the medicinal solution contained in the enema) should be made at once, neither too slowly nor too hurriedly. 3.

The pipe should then be withdrawn and removed, and the patient should be asked to remain in the same position for a period sufficient to utter thirty Mdtras*p. 629 from the time of injection. The patient should then be asked to get up and sit on his legs for the full outflow of the injected solution. The period of a Muhurta (about forty-eight minutes) is usually required for a complete outflow of the Niruha-vasti (from the bowels;. 4.

* According to Agnives'a the lime necessary for the tips of the fingers to fall down upon the right thighs, i.e.^ the time required for a twinkling of the eye (Nimesha) is called a MsCtrsi. Paras'ara says that the time necessary to close and open the eye-lids (Nimesha and Unmesha) once, while throwing the arm around the right thigh is called a Matra. He has prescribed one hundred such Mdlras in respect of a patient of constipated bo.vels, and thirty-seven in respect of a patient of lax