(instead of Udara in general) as unfit for Sveda and this is consistent with the treatment prescribed by Sus'ruta himself in Chapter XIV, Chikitsita Sthdna.
Thus ends the Thirty-second Chapter in the Chikitsita Sthanam of the Su&'iuta Samhita which treats of the applications of Sveda.
C?IAPTER XXXIIT.
Now we shall discourse on the treatment of the
distresses which prove amenable to the use of purga-
tives and emetics (Vamana-Virechana-
Sadhyopadrava). I .
The principal maxims to be followed are to augment
the loss or deficiency, to pacify the aggravation and
reduce the increment of the Doshas and maintain
them in a state of healthy equilibrium. Emetics and
purgatives are the principal remedies in cleansing the
system of all the Doshas (morbific principles\ Now
hear me, therefore, discourse on the mode of their
administration. 2.
The body of the patient should be first anointed with a Sneha (oil, etc.) and Sveda should then be applied thereto. He should then be made to partake of meals which would produce internal secretions from the system, so that all the Doshas (morbific diathesis, etc.) accumulated in the organism would bs loosened and dislodged from their seats. Thus having observed the liquefaction and dislodgment of the Doshas (morbific diathesis) from their locations, the physician should feed the patient to his satisfaction, if he be found to be sufficiently strong with a strong digestive capacity and habituated to the use of emetics, but troubled with a plethora of Doshas and subject to serious diseases (Mahd-vyddhi), telling him at the same time that an emetic medicine will be given to him on the day following. 3.
IVIemorable Verse :-An emetic medicine does its fullest action, when given to a man after having
566 THE SUSHRUTA SAMHITA. [Chap. XXXIII.
applied a Sneha and Sveda (to him) and after having
stirred up the Doshas of his body with the help of a
soft mucilaginous (Kapha-producing)* fluid and emol-
lient food so as to accelerate their easy expulsion
from the system 4.
On the next morning, when it is neither too hot
nor too coldf the patient should be made to vomit
with an adequate dose of an emetic in any of the follow-
ing forms, viz., powder, pa-te, decoction, (medicated)
oil or Ghrita as the case may be. Such things
as have a fetid or an obnoxious smell or sight
should be used for emetic purposes having regard to the
characteristic nature of the patient's stomach (Koshtha),
the contrary being the rule in respect of the use of
purgatives. 5.
Infants, old men, weak and timid persons as well
as those who are of a delicate constitution should ba
first made to drink their full of milk, curd, milk-curd
(Takra) or a gruel (Yavagu)]: in diseases amenable
to emetics and in such quantities that the patient
feels it rising up to the throat. After the emetic has
been administred, the body of the patient should be
(gently) fomented for a short time with the heated palms
of the hands and the effect (of the emetic) observed.)
The dislodgment and passing of the Doshas from their
respective seats into the Kukshi (stomach ?) should
* Vrinda reads "^I't^^;" in place of *"^?j^;'' but they would ulti- mately mean almost the same thing
t Dallana says that some explains "^j^j^ ^T%" 1° mean *4n the proper seasons, viz., the rainy season, the Autumn and the Spring."
t The milk, the curd, the milk-curd and the gruel prescribed to be taken in this case should, according to Dallana, be either medicated with emetic drugs or should be taken alone as an after-potion.
Chap. XXXIII] CHIKITSA STHANAM. 567
be inferred from the flow of perspiration (Sveda) that
would ensue. The patient should then be made to sit
on a seat as high as his knees and as soon as he would
feel the least tendency to vomit, the attendants should
be told to catch hold of his waist, sides, back, throat
and forehead. Then a finger or the stem of (a leaf of)
a castor plant or of a lotus should be inserted down
his throat and the patient should be made to fully eject
the contents of his stomach until the symptoms of
satisfactory vomiting would fully appear. 6.
Memorable Verses : -The symptoms of an
imperfect emesis are water-brash (Kaphapraseka), stick-
ing secretion or sensation of impurity in the regions of
the Hridaya (heart) and itching sensations. An excess-
ive discharge of the Pitta, the loss of consciousness,
pains in the throat and in the region of the heart are the
features which mark excessive or over- vomiting. The
indications which characterise the perfect and satis-
factory action of an emetic remedy are the free emission
of Pitta after that of Kapha, a light and pleasing
sensation in the heart, the throat and the head, a
lightness of the body and the complete cessation of the
emission of Kapha (mucus). 7.
Thus having observed the symptoms of a satisfactory
emesis, the patient should be advised to inhale the
fumes (Dhuma) of a (burning") drug of either the
Snehana, Vairechana or Sam ana (soothing) virtues in
such doses as he could conven iently take and to observe
the proper regimen of diet and conduct. 8.
Memorable Verses '.-Then having washed
his body with tepid water and having perceived him to
be in a pure state of mind and body the patient should
be advised to take his evening meal with the soup of
Kulattha or of Mudga or of Adhaki or with the soup
568 THE SUSHRUTA SAMHITA. [Chap. XXXIII.
of the flesh of any J^ngala animal.* A person treated with emetics (at regular intervals) by cough, accumula- tion of Kapha in the throat, loss of voice, somnolence, drowsiness, fetid smell in the mouth, evil effects of poisoning (other supervening distresses of Kapha — D. R.}, water-brash and lienteric diarrhoea (Grahani). The (accumulated) Kapha of the system having been ejected by vomiting under a course of emetic treatment the possibility of all Kapha-origined affections is removed, just as a felled tree soon dries up together with all its twigs, fruits and flowers. 9-10.
Cases where emesis is forbidden: —
Emesis or the exhibition of emetics is forbidden in cases of Timira (cataract, upward determination of the V^yu in the body (Urdhva-vata), Gulma, Uddvarta, abdominal dropsy, enlargement of the spleen, worms (in the intestines) and urinary complaints, as well as in respect of fatigued, corpulent, thirsty, hungry, emaciated and too old persons and of infants, Kshata« kshina patients and those suffering from a loss of voice and in respect of those also who are of studious habits or are capable of being treated with a strong emetic and that only with the greatest difficulty. It should be never resorted to in cases of Hoemoptysis and obstinate constipation of the bowels and in the case of an enciente and after the application of a Niruha-vasti, It should not be applied in an extremely dry or parched condition of the organism^* as well as in simple diseases due to the Vdyu. 11.
* The diet of the patient who has taken an emetic should be very carefully prescribed inasmuch as his digestive capacity is liable to become very weak in such cases.
t Persons afflicted with cataract or blindness, Gulmi, facial paralysis, convulsion (Akshepaka), jaunJice, ascites, hoemorrhoids and corpulency
Chap. XXXIII.] CHIKITSA STIIANAM. 569
To induce vomiting with an emetic medicine in the
(aforesaid) diseases in which it ought not to have been
resorted to is likely to give an irrecoverable turn to
those diseases. Emetics should not, therefore, be applied
in such cases. To induce vomiting, however, with the
help of the decoction of Madhuka (Yashti-madhu)*
is not forbidden even in these cases, if the patient be
suffering from indigestion or from an extremely aggra-
vated condition of the deranged Kapha as well as from
poisoning symptoms. 11-12.
Cases where emesis is recommend-i
ed : — On the other hand, vomiting or the exhibition of an emetic is recommended in cases of poisoning, in wasting diseases (S'osha), in the derangements of the breast-milk, in precarious or sluggish (Vishama) appetite, in Insanity, in Apasmara (hysteric convulsions), in Elephantiasis (S'lipada), in Vidarik^, in tumours (Arvu- da), in obesity, in Meha (urinary complaints), in cases of slow chemical poisoning (Gara-dosha^ in the system, in fever, in aversion to food, in scropfula (Apachi), in mucous dysentery, in heart-disease, in distraction of the mind, in erysipelas, in inflammatory abscesses (^Vidradhi), in indigestion, in water-brash, in nausea, in asthma, in cough, in Pinasa (catarrh), in fetid smell of the nostrils (Putl-ndsa), in inflammations of the lips, throat and mouth,f in (fetid) discharges from the ears, in Adhi-jlhvika, Upa-jihvik^ and Gala-s'undik^
as well as extremely old men and Kshata-kshina patients should not be treated with emetics (lit. should not be caused to vomit). —D. R.
* Jejjata explains Madhuka to mean honey. He means to say that vomiting should be induced with honey and water.
t Some read here **Kushtha, Galaganda, Prameha and S'opha (swelling)" but as Meha is mentioned above separately it seems to us that that reading is not a good one. — Ed.
570 THE SUSHRUTA SAMHITA. [Chap. XXXIII.
(affections of the glottis and the thorax), in haermorrhage
from the lower channels, in the derangements due to the
bodily Kapha and in all affections of the location
of Kapha*. 13.
lYIode of administering purga- tives : —Purgatives should also be administered to a patient after the due application of Sneha (oil, etc.) and Sveda (for a second time) after the administration of an emetic. O.i the day before the administration of the purgative, the patient should be told that a purgative should be given to him the next morning. He should at this time be provided with a light repast followed by potions of hot water and (the expressed juice of) acid fruits. On the next morning an adequate dose of the (purgative) medicine should be administered after clearly ascertaining that the patient's body has been cleansed of all mucous ^Sleshma) accumulations and in the manner laid down in the Aturopakramaniya chapter (Chapter XXXV. of tho Sutra-sthana). 14.
Classification of Koshtha : — Koshtha
(bowels) may be grouped under three heads as mild or
easily movable (Mridu), middling or moderately consti-
pated (Madhya^ and hard or constipated (Krura). The
first kind (Mridu) of the Koshtha should be ascribed to
the abundance of Pitta therein and can be moved even
with milk only ; the last (Krura) is ascribable to the
action of an abundance of Vatyu and Kapha and
can be moved only with the greatest difficulty ;
while the second, Madhayama, should be held as the
product of a condition of equilibrium among the (three)
Doshas and this is the most general type. Purgatives
* Dallana says that some commentators do not read this part, but they say that the necessity of applying emetics is mentioned in each particular case where required.
Chap. XXXIII.] CHIKITSA STHANAM. 571
should be administered in small doses to persons of lax
bowels (Mridu Koshtha), in moderate doses to those of
moderately constipated bowels (Madhayama Koshtha),
and in large doses to persons of extremely constipated
bowels (Krura Koshtha), After having taken a purga-
tive the patient should think of nothing else but purging
and when passing his stool he should not go far from
his bed-side. 15.
Metrical Texts :— He should at this time lie
in a windless chamber, foregoing the use of cold water
and exposure to cold wind, and should not repress any
urging (towards stool) nor should he strain. Emission
of urine, stool, Pitta, the (purgative) medicine and lastly
of Kapha consecutively follow under a course of pur-
gative, in the same manner as an emission of saliva,
the (emetic) drug, Kapha, Pitta and lastly of V^yu are
consecutively ejected uider the course of an emetic.
16-17.
IVIemorable Verses :— An aggravation of the
Kapha and Pitta, a burning sensation in the body, an
aversion to food, heaviness of the limbs and impaired
digestion (lassitude — D. R.) are the effects of an
improper application of a purgative. Heaviness of the
Kukshi and of the heart, itching and burning sensation,
and the retention of stool and urine are the symp-
toms which follow in the wake of a purgative medicine
which has failed to satisfactorily open and cleanse the
bowels. Loss of consciousness, prolapsus of the anus,
aggravation of the bodily Kapha and Sula colic pain in
the intestines) result from an act of over-purging. A
sense of lightness about the region of the umbilicus*
and hilarity of the wind due to the discharge of the dis-
* In place of «'^j*m ^Ttc^" some read "?^piff ^^" which means ''a sense of lightness and lassitude".
572 THE SUSHRUTA SAMHITA. [Chap. XXXIII.
tempers connected with the Kapha (mucus, stool, etc.>
and restoration of the bodily Vayu to its normal
condition due to the discharge of the (deranged; Vayu
(from the system) are the symptoms which mark the
satisfactory action of a purgative medicine. 18-A.
Diet :— No liquid food or Peya should be giveti
to the patient on the day in the event of his not
being properly purged and not being feebled (with pur-
ging"^ and in the event of his impaired digestion (after
the use of a purgative\ A light and lukewarm Peya
should, however, be given to him in small doses, when-
ever he would feel weak and thirsty after the proper
exhibition of a purgative medicine. I?-B.
