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 cham- ber, 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 out- stretched posture and the right one flexed, and should refrain from speaking to any body. The diges- tion 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 con- tracted 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.
face of the pipe, nor to admit of even a bubble of air into the bladder (of the enema), nor to produce its over-con- traction nor dilatation during the process (of pouring the medicine). The bladder filled with the proper quan- tity 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 previous- ly 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 medi-
cinal 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*
* 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
Chap. XXXVIII.] CHIKITSA STHANAM. 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.
IVIetrical Texts:— This method of applying
the Vasti should be continued three or four times
as required in each case by the physician, experienced
in the application of the same. It should be disconti-
nued after certain characteristic symptoms had been
fully developed and manifested (in the system of the
patient). Less is better than excess (in respect of
Vasti-applications and more so particularly in the case
of a patient of a delicate constitution. 5.
Symptoms of an inadequate and excessive application of a Vasti :— The
emission of only a small quantity of flatus (Vdyu), fcecal
matter and (of the medicinal solution applied in; the
Vasti, as abo the appearance of the supervening dis-
tresses of urinary disorders, an aversion to food and
physical lassitude indicate the inadequacy of the appli-
cation of the Vasti. Symptoms which have been
described before* as marking an excessive use of
purgatives are also said to result from an excessive
application of a Niruha-vasti. 6 -A.
Symptoms of a satisfactory appli-
cation of a Vasti :— A lightness of the body,
experienced in consequence of the successive and satis-
factory evacuations of stoolj-f Pitta (bilious matters),
bowds.— Dallanau The period of a Matra has elsewhere been defined as that required to utter a short vowel. — Ed.
* See Chapter XXXIII, Para. l8, Chikitsita Sthanam.
t Satisfactory urination should also be understood as one of the sysnptoms of the satisfactory application of a Niruha-vasti. — Ed.
630 THE SUSHRUTA SAMHITA. [Chap. XXXVIII.
Kapha (mucus) and Vayu (flatus) from the bowels, are
the salient features of a satisfactory application of a
Niruha-vasti (Su-nirudha). After the manifestation of
the foregoing symptoms the patient should be advised
to bathe (in hot water) and to take meat-soup (Rasa),
milk and pulse-soup (Yusha) in diseases due to the
action of the deranged Vdyu, Pitta and Kapha respect-
ively. The essence (Rasa) of the meat of any Jdngala
animal may, however, be prescribed in all cases under
the circumstances, since it would produce no harm. Only
a quarter, a half or three-quarter part of the usual diet
should be prescribed according to the digestive capacity
of the patient, and the nature and intensity of the
Doshas involved in each case. 6-B.
The subsequent treatment should consist in apply-
ing a Sneha-vasti (oleaginous enema) according to
the nature and intensity of the underlying Doshas
in each case. A lightness of the body, sprightli-
ness of the mind, amelioration or abatement of the
disease, an emulsive condition of the organism, are
the features which mark the satisfactory application of
an Asthdpana as well as of an Anuvasana-vasti. 6-C.
The patient should be made to partake of his meal
with meat-soup on the day of his being treated with a
(Niruha) Vasti ; since there is an apprehension of the
Vayu being greatly deranged and aggravated (by the
application of the Vasti). He should then be treated
with an Anuvdsana (Vasti) on the same day. There-
after tha application of the Sneha-vasti should be
regulated* with a regard to the state of the appetite
and the intensity of the deranged Vdyu, and in the
Chap. XXXVIII.] CHIKITSA STHANAM. 63 1
event of the Koshtha (stomach) being found to have been stuffed with food. 6
A fresh and stronger Nirudha injection (Vasti),
composed of Yava-kshdra, cow's urine, Kdnjika and the
S'odhana (purifying) drugs, should be applied (.into the
bowels) in the event of the previous one not passing out
within a Muhurta, since a Nirudha injection (Vasti)
long retained in the bowels by the enraged and aggra-
vated Vayu causes Sula (colic), an aversion to food,
fever and Anaha* (distension of the abdomen with
suppression of stool and urine), or may ultimately
have a fatal termination. 7.
The application of an Asthapana enema is for- bidden after a meal as it may bring on an attack of Visuchika* (D. R.— Ama), or of vomiting, or may tend to aggravate the Doshas of the body. Hence an Asthapana-vasti (enema) should be applied only on an empty stomach. The Doshas (in the system) of a person He in a free and potent state at the close of the process of digestion, and are easily and spontaneously eliminated from the system (by the application of the Asthapana-vasti), when the stomach (As'aya) is not further oppressed or stuffed with food. The digestive fire ifdthards^ni) can not digest the food, if scattered or diffused by the application of an Asthapana-vasti (into the bowels). Hence it is that an Asthdpana injection should be made on an empty stomach. The application of a Niruha-vasti (which is not applicable in all cases) should, however, be determined with a regard to the exigencies of the case, since the strength of the aggravated Doshas of the body abate with the evacua-
* Both Vrinda and Chakradatta read ^^A'^topa'' (rumbling sounds in the intestines) in place of ^*A'^ndha/^
632 THE SUSHRUTA SAMHITA. [Chap. XXXVIII.
tions of the bowels (as well as with the elimination of all filthy matters from the system). 8.
Drugs to be used in a Niruha-
vaSti :— The following drugs and articles, or as many
of them as would be available, such as, all kinds of
milk, acid group (Kanjika, etc.), urine, Sneha (olea-
ginous substances), the drug decoctions (Kashaya), meat-
soup (Rasa), salts, Phala (Triphala), honey, S^atdhvd,
Sarshapa, Vacha, Eld, Trikatu, Rdsnd, Sarala, Deva-
ddru, Rajani, Yashti-madhu, Hingu, Kushtha, the drugs
of the Sams' odhana (corrective) group (Trivrit, etc.),
Katuka, Sugar, Musta, Usira, Chandana, S athi,
Manjishthd, Madana, Chandd Trdyamdnd, Rasdnjana,
(dried) Vilva fruit, Yamdni, Phalini, Indrayava, Yava,
Kdkoli, Kshira-kdkoli , Jivaka, Rishahhaka, Medd, Mahd-
medd, Riddhi, Vriddhi and MadhuHkd, should be used
in charging a Nirudha-vasti. 9.
Formula of the Niruha-vasti :— In the
case of a healthy person (marked by an equilibrium
of Vayu, Pitta and Kapha), the solution to be injected
should be composed of four parts of the decoction of
drugs* and one part (a fifth part of the entire com-
pound) of the Sneha (any oleaginous substance). In
any case marked by a preponderance of the deranged
Vayu, the Sneha should measure a quarter part of the
whole, one-sixth in a case of a preponderance of the
deranged Pitta and an eighth part in a case of the
deranged Kapha. In a case of aggravation of all the
(three) Doshas, the Kalka should measure an eighth
part (of the entire quantity of the medicinal solution
to be injected), and the following drugs or articles,
* Dallana means to say that of the whole compound weighing twelve Prasrita measures (twenty-four Palas), there should be four Prasrila weights (8 Palas) of the docoction, and so on.
Chap. XXXVIII.] CHIKITSA STHANAM. 633
viz.y salt, honey, cow's urine, Phala (Madana), milk,
add group (Kdnjika, etc.) and extract of meat, in
charging a Nirudha-Vasti should, as regards dosage^
be determined by a due consideration of the require-
ments in each case. When the Kalka, the Sneha,
and the decoction would be well mixed together,
the solution for injection should be considered to
have been well prepared The application of such a
solution would be supposed to produce the wished-for
results. lO-A.
The process of preparation :— An
Aksha measure (two ToUs) of Saindhava salt should be first mixed with the palms of the hand on a plate with two Prasrita (thirty-two Tolds) measures of honey, to which Sneha (oil, etc.) should be gradually added. When well dissolved, the pastes of (Madana) Phala should be added thereto. The drugs to be used as the Kalka in proportion to the prescribed parts should then be finely powdered and mixed with the preceding compound. The whole should then be well stirred in a deep vessel with a ladle (Khaja) * so as not to make it too thick, nor too thin. The compound thus prepared should be mixed with five Prasrita measures of the well-filtered drug decoction (prescribed in each case) and with cow's urine, meat-essence, milk and acid articles (Kdnjika, etc.) according to the nature of the Doshas involved in the case. 10.
Dva-das^a Prasriti :— Now we shall describe
the (recipe ani preparation of) Vastis (technically)
called the "Dvai-das'a-Prasrita" (weighing twelve
Prasritas). An Aksha measure (two Tolas) of Saindhava
salt should be rubbed with two Prasritas (thirty-two
ToUs) of honey to which should be added three Prasritas
* The hand would serve the purpose of a ladle bast in this case.
634 THE SUSHRUTA SAMHITA. [Chap. XXXVII .
