An English Translation of the Sushruta Samhita (Bhishagratna ed.)

Benefits of proper purgation :— Clear

ness and expansion (Prasada) of the intellect, firmness of the organs and of the Dhatus (root-principles) of the body, increase of energy (Bala)*, improved digestive capacity and a lat^ or delayed old age are the blessings which follow a proper administration of purgative re- medies. The deranged Pitta of the system, having been fully removed (with the help of a purgative), precludes the possibility of the existence of any Pitta-orlgined com- plaint, just as the waters of a tank or any other reservoir of water, having been fully baled out, bar against the possibility of the existence of all aquatic animals and plants living therein. 18.

Persons who should not be purged :

. — Exhibition of purgatives are prohibit ?d in respect of persons of impaired digestion, or of those treated with an excessive application of any emulsive remedy (Sneha- Karma), or of those who are exceedingly corpulent, too old, fatigued, thirsty or intoxicated, or of those suffering from any ulcer. They are similarly prohibited in * Vrinda does not include "Bala" (energy) in the list.

Chap. XXXIII.] CHIKITSA STHANAM. 573

respect of frightened persons and Kshata-kshina pa-
tients or of those afflicted with haemorrhage from th;
downward orifices of the body or of persons with any
dart or foreign matter (salya) lying imbedded in the
organism as well as in respect of infants and enciente.
A purgative medicine should not be administered before
the digestion of a meal previously taken, neither in the
diseases due to an abuse of wine, nor in acute catarrh
and acute fever or to a newly parturient woman and
persons not previously treated with a Sneha (oil or
Ghrita). A mild purgative may, however, be adminis-
tered (in cases of emergency) to a person of extremely
Pitta-predominant temperament. Purgatives adminis-
tered by ignorant physicians to persons who ought
not to be purged (often) prove fatal. 19.

Persons who should be purged : —

The distempers of the body in which a purgative should be exhibited with good results are : --fever, effects of slow chemical poison (retained in the system), an aversion to food, haemorrhoids, tumours (Arvuda), ascites (Udara\ glandular swellings (Granthi), abscess (Vidra- dhi), jaundice, hysteric convulsions (Apasmara), heart- disease, Vata-rakta, vaginal or uterine diseases, fistula- in-ano, vomiting, erysipelas (Visarpa), Gulma, pain in the Pakvdsaya (intestines), retention of stool, Visu- chika, Alasaka, strangury (Mutraghata), cutaneous affec- tions (Kushtha), Visphotaka (carbuncle, etc.), Prameha, distension of the abdomen with the suppression of stool and urine (Anaha), enlargement of the spleen, oede- matous swellings (Sopha), Vriddhi (enlargement of the scrotum, etc.) and kindred complaints, ulcers inflicted by weapons, alkaline scalds and burns, malignant ulcers, (Dushta-vrana), inflammation of the eyes (Akshi-paka\ Kacha, Timira, conjunctivitis (Abhishyanda), burning

574 THE SUSHRUTA SAMHITA. [Chap. XXXIII.

sensations in the head, ears, eyes, nose, mouths, anus and the penis, haemorrhage from the upper channels (Urdhva- Rakta-pitta), worms, diseases of the Pittdsaya (bowels ?) ?>., the diseases which are peculiar to the seats of the Pitta in the organism as well as any other disease due to an aggravation of the Pitta. 20.

Metrical Texts :— Emetic and purgative remedies, in spite of their possessing in common the powers of motion (Saratva), subtlety, keenness, ex- pansiveness and heat-making properties, tend to remove the injurious and deranged morbific principles (Doshas) of the body in (two) different ways by virtue of their respective inherent qualities (Prakriti)*. A purgative, in the course of its digestion, carries down with it all the Doshas from the system (loosened and dislodged by virtue of its own specific properties). An emetic, on the other hand, is not digested, owing to (its lightness due to) its inherent extraordinary qualitiest, but it soon forces its way up with the Doshas (to be) removed. 21-22.

A strong purgative given to a man of loose or lax
bowels (Mridu-Koshtha) or of strong digestive capacity,
cannot remove all the Doshas fully owing to their being
suddenly and forcibly purged off. 23.

A purgative medicine, which is capable of being
digested and of expelling the Doshas from the body
in the time which a morning meal ordinarily takes to
be digested, should be regarded as pre-eminently the
best. 24.

• Dallana quotes a different reading which means that emetic and purgative remedies produce the wished-for result, if properly administered, otherwise not.

t The extraordinary qualities of an emetic are those of the V^yu and of the Agni.

Chap. XXXIII.] CHIKITSA STHANAM. 5/5

The (aggravated) Doshas accumulated in a large
quantity in the organism of a weak patient and found
to be dislodged from their seats should be gradually
expelled from the system, while soothing (S'amana)
remedies should be used in cases of the Doshas being
very slight, even if they be found to have been dislodged
from their seats. The aggravated Doshas matured and
spontaneously dislodged (from their seat or place of
accumulation in the system) should be purged off,
whether the patient be strong or weak, inasmuch as,
if neglected (and not expelled from the system\ they
(Doshas) tend to produce lasting troubles. 25-26,

A purgative should be administred to a patient of
impaired digestive capacity and extreme habitual con-
stipation of the bowels (Krura-koshtha) after having im-
proved his digestion with the admixture of rock-salt,
Yava-kshdra and clarified butter arid after applying
Sneha and Sveda (as usual). A purgative remedy used
after a due application of Sneha and Sveda to the body,
leads to the looseness and dislodgment per force of the
aggravated Doshas from their seats, since they do not
adhere to the internal channels and passages just as a
drop of water does not adhere to a pot or vessel saturated
with a Sneha. An oleaginous purgative should not be
given to persons who have already taken internally*
an abundant quantity of Sneha, as it would tend
to make the aggravated Doshas of the body dis-
lodge from their seats and again adhere to the internal
channels and passages. 27-28.

An excessive quantity of Sneha should be used in cases of poisoning, hurt, pustular eruptions (Pidakd),

* Vrinda reads *'^f%^^T?(^" in place of "^fWf ^?T^". This means that the Sneha might have been used both inletnally and externally.

576' THE SUSIIRUTA SAMHITA. [Chap. XXXIII.

oedema and cutaneous affections before the application
of purgatives or emetics. The body of a patient, habit-
uated to the use of oleaginous articles (Sneha), should
be first made dry (Ruksha). Sneha should then be used
again as usual and purgatives or emetics applied. The
aggravated Doshas would be thereby expelled from the
system and the patient would grow stronger*. 29-30.

Mild emetics and purgatives should be given at the
outset to a person to be treated with such medicines,
who had never taken any purgative or emetic before-
Emetics and purgatives should then again be adminis-
tered to him, after thus finding out the state and nature
of his Koshtha (bowels). An emetic or purgative
medicine of tested efficacy and which is pleasant,
aromatic, agreeable and small in dose but of mighty
potency should be given to a king; (in addition to these
qualities) the medicine should be such as would not
produce any serious injury. 31-32.

The body (health) of a patient to whom a purgative or emetic medicine is administered without first applying Sneha and Sveda thereto breaks up like a piece of sapless wood at the time of bending it. The aggravated Doshas dislodged from their seats in the organism through the effects of Sneha and Sveda and stirred by emollient foodf are easily expelled by emetics and purgatives. 33.

Thus ends the Thirty-third Chapter of the Chikitsita Sthanam in the Sus'ruta Samhita which deals with the treatment of diseases amenable to the use of emetics and purgatives.

* Vrinda reads "^'f^a^sTl" »" P^^c- of '^^^f^f ?rT"- This means that the Doshas, so long obstructed by Snchi, are thereby expelled, t Some explain '*i;^\ t%T&t" to mean "with emollient meat/soup".

CHAPTER XXXIY.

Now we shall discourse on the treatment of the dis- orders resulting from an injudicious use of emetics or

purgatives (Vamana-Virechana-Vygtpach- Chikitsitam). i.

Their Classes : ^Fifteen different kinds of disorders may result from an injudicious use of emetics and purgatives owing to the ignorance of the physician or of the patient. Of these (fifteen), the upward coursing in casesof purgatives and the downward coursing in cases of emetics are peculiar to each of them respectively. The fourteen other remaining disorders (Vy^pat) are common to both. They are Sstvaseshaushadhatva (continuance of the drug in the stomach), Jirnausha- dhatva (complete digestion of the medicine), Hina- dosha(pahritatva (insufficient elimination of the Doshas from the system) Adhika-doshaipahritatva (excessive elimination of the Doshas from the system), Vsita-sula (Vdtaja colicX Ayoga (insufficient dosage\ Ati-yoga (over dosage), Jivsidatna (haemorrhage), Adhm^na (tympanites), Pari-kartik^i (cutting pain in the anus, etc.), Parisraiva (oozing out of stools), Prav^hika( (diarrhoea), Hridayopasarana (rising of the Doshas towards the heart) and Vibandha (suppression of stool and urine). 2.

Causes and Treatment :— An emetic taken

by a hungry or a weak person or by one possessed
of a very keen digestive capacity (Tikshndgni) or
of lax bowels (Mridu koshtha), naturally drops down
into the intestines in virtue of the identical nature and
intensity of their attributes, in the event of its being
retained in the stomach, even for a short while. A
failure of the medicine to produce the wished-for result

578 THE SUSHRUTA SAMHITA. [Chap. XXXlV.

and a further stirred or agitated condition of the aggra-
vated Doshas are the effects thereof. In such a case
Sneha (and Sveda) should be again applied and a
stronger emetic administered. 3.

An obnoxious and large-dosed purgative taken by
a person with a residue of a previous meal remaining
undigested (in the stomach) or with an aggravated
Kapha or with a disordered stomach (Amds'aya), is
forced upward and is ejected through the mouth. In
a person of disordered stomach the accumulations
(Kapha) in the stomach should be first speedily ejected
with an emetic and a stronger purgative should then
be administered. A case where the food remains still
undigested (in the intestines) should be treated (with
fastings and digestants) as in a case of mucous diarrhoea.
A pleasant or tasteful purgative should be given in a
moderate dose in the event of a previous one having
been ejected on account of its obnoxious taste and ab-
normal dosage. A third dose should not be given in
the event of the second also b^ing not retained in the
stomach. At this stage; purging should be effected
with the help of a lambative (Leha) prepared with
honey, clarified butter and treacle. 4.

SaCvas'eshaudhatva (Evils of an unpurged
residue of a purgative or emetic) : — A small dose of
medicine, whether an emetic or a purgative, if it is
absorbed by the deranged Doshas of the body and
retained in the system, cannot produce the wished-for
result of cleansing the system. In such a case, it gives
rise to thirst, pain in the sides, vomiting, epileptic
fits, nausea, piercing or breaking pain in the joints,
aversion to food, impure eructations, and such like
symptoms. The patient in such a case should be made
to vomit the contents of his stomach with draughts of

Chap. XXXIV.] CIIIKITSA STHANAM. 579

hot water. When a least residue of a purgative medicine
previously administered would be found to have been
retained in the stomach of a strong patient and with
extremely aggravated Doshas of the body, the patient,
if there be an insufficient purging, should be similarly
made to vomit. 5.

Jirnaushadhatvam (Evils of a digested
purgative, etc.) :— A mild purgative or emetic or a
medicine administered in a small dose to a man of
extremely constipated bowels (Krura-koshtha) or of an
extremely keen digestive capacity (Tikshndgni), is like
food easily digested in the stomach (and therefore fails
to produce the wished-for results). The aggravated
Doshas, being thus unexpelled by the (purgative or
emetic) medicine from the body, brings on fresh distem-
pers and loss of strength (Bala)* of the body. Under
the circumstances a stronger medicine or a larger dose
of the same should be administered to the patient. A
mild medicine as well as a medicine administered
without a previous application of Sneha and Sveda
subdues only a slight aggravation of the Doshas. 6.

Evils of insufficient or excessive

expulsion of the Doshas :--A nausea, a sense of heaviness in the limbs, a sticky sensation in the chest and aggravation of the (existing) disease are the evils which attend an insufficient ejection of any bodily Dosha from the system after the administration of an emetic More satisfactory vomitings should be induced in such cases with the help of an appropriate (and stronger) medicine. Tympanites, heaviness of the head, sup- pression or incarceration of Vdyu (flatus), a cutting pain (Pari-kartana) in the anus and aggravation of the '.exist- ing) disease, are the evils which result from an imper-

* For the meaning of *'Bala" here see Chapter XV., Sutra-Slhana.

580 THE SUSHRUTA SAMHITA. [Chap. XXXIV.

feet or partial expulsion of the Doshas from the system
under the administration of a purgative remedy. The
remedy in such cases should consist in inducing stronger
purgings after a further application of Sneha and Sveda
to the patient. A mild medicine should hz administered
on the third day to a strong-limbed patient, if there be a
large quantity of dislodged agitated Dosha in his
system. 7.