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

Medicine duly injected (through the rectum) with the help of a Vasti remains in the intestines (Pakv^s'aya), in the region of the pelvis and below the umbilical region. The potency of the Vasti (medicine) spreads over the whole organism from the intestines (Pakvds'aya), just as the potency of the water poured at the root of a tree tends to permeate the whole tree (through its minutest cells and fibres). The liquid part of the Vasti is emitted out through the rectum either by J itself or with the fcBcal matter, etc.*, but its potency acts over the whole organism through the intervention of the Apdna and the other Vdyus. The potency of the Vasti in the Pakvds'aya acts on the whole organism from top to toe, like the sun in the heavens acting on the humidity (Rasa)

* Stikantha Dutta in his commentary quotes this sloka, but he reads there "^^t^j" (with Kapha) in. the place of '*^;ff^" (with the foecal matter, etc.). The reading in the text, however, is preferable inasmuch 9s Kapha is included in Mala.

596 THE SUSHRUTA SAMHITA. [Chap. XXXV.

of the earth below. The Vasti, if duly applied, tends to
eliminate completely from the system all the Doshas
(morbific diatheses) accumulated in the regions of the
back, waist and the abdomen (Koshtha). 15-A.

As the aggravation of all the Doshas (morbific
principles) of the body is principally dependent on the
derangement of the bodily Vayu ; an aggravated condi-
tion of the latter may hence lead to the dissolution of
the body, and consequently the application of a Vasti,
and nothing else, is the only means of coping with the
aggravation of the Vayu (by subduing and restoring
it to its normal condition), just as the sea-coast is the
only barrier to the swollen and wind-agitated surf of
the sea. A well-applied Vasti contributes to the
growth, health, strength and longevity of the body and
to the improvement in its complexion. 15.

The different defects of a Vasti :— Now

we shall deal with the defects and the evil effects which are consequent upon the wrong and injudicious appli- cation of a Vasti. The defects of wrongly handling a Vasti (Prauidhaina-doslia) are six in number, viz., the pipe may shake or revolve ; it may also be pressed side- wise or thrown upwards ; and it may sink down or may be pressed slantingly. Excessive thickness, coarseness, bending down, narrowness, cleavage, nearness or dis- tance of the tying bands (Karnikd), narrowness or excess- ive width of its internal aperture, excessive length or extreme shortness are the eleven defects which the pipe of a Vasti (Netra-dosha) maj^ have. The five objection- able features in the bladder (Vasti-dosha) are an excess- ive flabbiness, narrowness, width of its internal aperture, leakiness and an imperfect bending at its mouth (neck^ Variation in pressures put upon a Vasti (Enema syringe) during its application may be attended with any of the

Chap. XXXV.] CHIKITSA STHANAM. 597

four objectionable features (Pidana-dosha), viz., over-
pressure (pressing the injection into the rectum with an
injuriously excessive force), under-pressure, repeated
pressures and pressure at long intervals. The eleven de-
fects in the ingredients of the Vasti (Dravya-dosha) are
insufficient cooking, excessive or insufficient quantity,
extreme coldness, excessive heat, extreme keenness of
potency, excessive mildness, excess or want of oiliness
(Sneha), extreme thickness of consistency and over-
fluidity. Lying with the head raised up or hung down
or in a bent or sitting posture or resting on one's
back or in a contracted posture or on one's right
side are the seven defective postures (Say yai- dosha)
in which a patient should never be laid during the
application of a Vasti. These are the twenty-four
defects which attend the wrong application of a
Vasti owing to the ignorance or inexperience of a
physician, while those which are the effects of the
injudiciousness of a patient are fifteen in number and
would be described in the chapter on Aturopadrava-
Chikitsita (Chapter XXXIX, Chikitsita-sthdna). i6.

The Sneha injected into the bowels by a Vasti is
obstructed in its passage and cannot consequently
leave the system but is retained in it through any of the
following eight causes, viz ^ obstruction of the food
by the three Doshas, its admixture with the foecal
matter (accumulated in the bowels), its being injected
too high up into the intestines, an omission to foment
(the patient's body), using the Sneha in a cold state
or in a small quantity and lastly use of no meals or
of scanty meals by the patient previous to the
application of a Vasti. These (retentive conditions) are
due to the indiscretion of both the physician and the
patient. Nine distressing symptoms (Vydpad) namely

598 THE SUSHRUTA SAMHITA. [Chap. XXXV.

as a defective application of either the Anuvdsana or
the Asthapana Vastis, distension of the abdomen,
(Adhmdna), a cutting pain in the region of the anus,
(Parikartika) Dysenteric stools (Parisrdva), diarrhoea
(Pravdhikd), affecting the heart (Hridayaopasarana),
catching pain in the limbs, over-dosage, haemorrhage
manifest themselves in consequence of any act of in-
discretion of the physician in attendance. 17.

IVIemorable Verse :— The seventy six kinds
of the distressing symptoms (Vydpad) have been
briefly described above. Their symptoms and treat-
ment would be described in the following chapter. 18.

Thus ends the Thirty-fifth Chapter in the Chikitsita Sth^nani in the Sub'ruta Samhitd which deals with the dimensions, classifications aid therapeutical applications of a Netra and a Vasti.

CHAPTER XXXVI.

Now we shall discourse on the medical treat-
ment of the mishaps which are consequent on an
injudicious application of the pipe and of the vasti

(Nctravasti-Vaypach-Chikitsitam). i.

IVIetrical Text :— A displacement or retro- version of the pipe during the application of a Vasti produces a painful and bleeding ulcer in the rectum, which should be treated as a recent or incidental ulcer. An extremely up-turned or down-turned posture of the pipe at the time gives rise to a pain in the rectum which should be treated with Pitta-subduing remedies and sprinkled with Snehas (oil, clarified butter, etc.\ A slanting or one-sided posture of the pipe after its introduction into the rectum causes its mouth to be closed and thus prevents a complete and satisfactory injection of the fluid (into the bowels). Hence its mouth should be held straight (and steady) by an experienced physician. The use of an excess- ively thick or roujh pipe or of one with a down- turned or bent mouth, produces a bleeding and painful ulcer in the rectum which should be remedied in the manner mentioned above. The injection of a Vasti proves abortive in the event of the Karnikd (attached to the pipe) being too near the end of the pipe or itself being broken or too small. These defects should, therefore, be 'carefully avoided. In a case of the Kainikd (attached to the pipe) being at a greater distance from the mouth of the pipe, it would hurt the Guda marma (marma at the anus) and produce a considerable bleeding therefrom. Pitta-subduing remedies and

600 THE SUSHRUTA SAMHITA. fChap. XXXVI.

Pichchhila-Vastis should be employed in such a case.
The application of a Vasti with a pipe of small
length or narrow calibre produces pain, and the injected
fluid dribbles out (without entering into the rectum),
thus occasioning all the maladies* which attend an
insufficient or abortive use of a Vasti^l*. In the event
of the pipe being large and wide-calibred one, the
result would be that a large quantity of the fluid would
be at once injected into the bowels just as in a case of
Avapida-dosha (constant pressing). 2.

Disorders resulting from a defect-
ive bladder :— The eff'ects which result from the
use of a bladder (Vasti) too large or too thick are
identical with those which follow from an imperfect
fitting of its neck with the pipe. A (proportionately)
smaller efficacy is obtained from the use of a small
bladder (Capable (necessarily) of injecting a smaller
quantity of the medicinal fluid. An imperfectly fixed
bladder or the one with small pores therein produces
effects similar to those resulting from the use of a
cracked pipe. 3.

An injection made with considerable force by a
Vasti (Enema-syringe) enters the stomach (Am^saya)
which being forced higher up by the up-coursing
Vdyu in the organism is emitted through the mouth
and the nostrils. J Under the circumstances, the

• These are strangury (Mutra-krichchhra), suppression of urine (Mutra- ghata), etc.

t According to DalUna the remedy in this case would be that applicable in a case of Mutrdghdla, etc. ; but Jejjata holds that the remedy lies in applying a Pichchhila Vasti as in the preceding case.

X An additional reading says that it causes vomiting, nausea, epileptic fits and a burning sensation of the body. Vrinda supports this additional reading.

Chap. XXXVi.J CHIKITSA STHANAM. 66l

patient should be immediately pressed by thi neck and (his body) shaken, Strong purgatives and errhines should be administered, and sprinkling him with cold water should be prescribed. If a Vasti be applied with lesser force^ the medicinal fluid of the Vasti cannot reach the intestines (Pakvds'aya) and (consequently; fails to produce the desired effect Hence it should be duly pressed. If it be pressed at intervals, the wind (Vdyu) in the abdomen becomes enraged, and gives rise to tympanites (Adhmdnaj aad excruciating pain therein. The medicinal treatment in such a case should be the ap plications of proper Vastis in consideration of the nature of the aggravated Doshas involved therein. If the pipe be retained for an (unnecessarily) long time in the rectum during the application of a Vasti, it tends to increase the pain, and bring about an aggravation of the disease. This should be remedied by a second appli- cation of the Vasti charged with proper antidotal solutions sufficient to cope with the intensity of the disease. 4.

The use of an insufficiently cooked Sneha (in a
Vasti) leaves a slimy sticky deposit on the inner
lining of the rectum accompanied by a local swelling
which should be remedied by the application of a
Sams'odhana-vasti and the exhibition of purgatives.*
The application of a Vasti of either kind (Asthapana
and Anuvdsana) charged with a deficient or inadequate
quantity of a medicinal solution, proves abortive in all
instances; whereas diarrhoea (Atisdra), fatigue and Andha
(distension of the abdomen with the retention of stool,
urine, etc.) result from the application of one charged
with an excessive quantity of the fluid. The applica-
tion of a Vasti charged with an extremely warm or

* Gayadasa rea:ls and recommends that the purgatives to be used in such a case should be devoid of any oleaginous substances (Sneha).

602 THE SUSHRUTA SAMHITA [Chap. XXXVI.

Strong solution produces epileptic fits, a burning sensa-
tion, diarrhoea and (an aggravated condition of the)
Pitta. Tlie use of any extremely cold or mild medicine
for the purpose of a Vasti arrests the emission of the
flatus (Vayu), and produces Adhmana (distension of the
abdomen).* Antidotal measures should be adopted in
cases of the deficient or excessive quantity, etc The
fluid to be used in charging a Vasti should be thickened
in the event of its extremely attenuated consistency and
vice versa. The application of a Vasti charged with a
fluid consisting of an excessive quantity of Sneha
would produce a general inertness of the organism,
(dullness of organic functions), while one entirely
bereft of any Sneha would produce numbness of the
organism and a distension of the abdomen. The
remedy in either case consists in employing a Vasti
of the opposite kind i^vh.^ an oily or non-oily Vasti
respectively). 5.

The application of a Vasti to a patient with his
head downward is attended with symptoms peculiar to
an act of over-pressing (the bladder of the Vasti), and
the remedy also would be similar. The application
of a Vasti to a patient with his head held up high
and erect would block the urethra, Le.^ would suppress
the urine, in which case the patient should be treated
first with Sveda and then with an Uttara-vasti (urethral
syringe t which would give the patient much relief.
The injected fluid goes astray (within the abdomen)

• An additional reading says that a dry (thickend ?) Niruha-vasti produces a slimy deposit in the rectum and in the pelvic region, while one with its fluid of an extremely thin consistency would produce only a Utile effect and might produce diarrhoea.

t Jejjata's reading of this passage does not include the application of Sveda but means that the Uttara-vasti should be applied with a Sneha.

Chap. XXXVI.] CHIKITSA STHANAM. 603

and fails to enter into the intestines (Pakvds'aya) in
the event of the patient lying in a stooping posture
during the application of a Vasti. The V^yu in such
a case becomes aggravated and gives rise to pain in
the regions of the heart, abdomen and rectum. The
injected fluid fails to penetrate into the bowels in the
event of the patient lying on his back during the
application of a Vasti owing to the consequent obstruc-
tion of the passage. The bodily Vdyu becomes in this
case agitated and enraged by the (introduction of the)
pipe (of the Vasti> A contracted position of the body
or of both the thighs, during the application of a Vasti
prevents the full outflow of the injected medicine from
the intestines, owing to its being acted upon by
the bodily Vdyu. In a case of the application of a
Vasti to a patient in a sitting posture, the fluid rolls
down without entering into the bowels; it«, cannot
consequently soothe the As'aya and thus proves abor-
tive. The injected medicine cannot fully enter into
the Pakv^s'aya (intestines), when the Vasti is applied to
a patient lying on his right side, since the Pakvds'aya
is situated on the left side (of the abdomen). The
application of a Vasti is not recommended when the
patient lies on his face or in such other posture
since it is followed by an aggravation of the bodily
Vdyu, which should be remedied by medicines chosen
according to the exigencies of each case. 6.

We shall describe hereafter (in the next chapter)
the dangers (Vyaipat) which attend the misapplication of
a Sneha-vasti and the course of the medical treatment
to be adopted in each. The dangers (Vyaipat) attending
a deficient application (Ayoga) of a (Niruha) Vasti with
their respective treatment are described here in this
chapter. 7.