Charaka Siddhisthana Chapter 6 – Vamana Virechana Vyapat Siddhi

This article explains the 6th chapter of siddhisthana of Charaka samhita called ‘Vamana Virechana vyapat Siddhi Adhyaya’. In this chapter, seasons for Vamana, Virechana, necessity of snehana and swedana, appropriate dosage, signs of shodhana, dietetic regimen, adverse effects, causes, Ayoga, Atiyoga, their management, etc. have been explained.

अथातो वमनविरेचनव्यापत्सिद्धिं व्याख्यास्यामः|
इति ह स्माह भगवानात्रेयः||२||
athāto vamanavirecanavyāpatsiddhiṃ vyākhyāsyāmaḥ|
iti ha smāha bhagavānātreyaḥ||2||
Now we shall explore the chapter on “Vamana Virechana Vyapat Siddhi”. Thus said Lord Atreya [1-2]

Topics to be discussed:

अथ शोधनयोः सम्यग्विधिमूर्ध्वानुलोमयोः| असम्यक्कृतयोश्चैव दोषान् वक्ष्यामि सौषधान्||३||
atha śodhanayoḥ samyagvidhimūrdhvānulomayoḥ| asamyakkṛtayoścaiva doṣān vakṣyāmi sauṣadhān||3||
Now the topics to be described in this chapter are as follows:
Appropriate methods for the administration of the upward and downward purificatory therapies (Vamana, Virechana);
Complications arising out of the improper administration of these therapies and
Treatment of these complications [3]
Read: Vamana Therapy – Right Method, Side Effects, Management

Suitable seasons

अत्युष्णवर्षशीता हि ग्रीष्मवर्षाहिमागमाः| तदन्तरे प्रावृडाद्यास्तेषां साधारणास्त्रयः||४||
प्रावृट् शुचिनभौ ज्ञेयौ शरदूर्जसहौ पुनः| तपस्यश्च मधुश्चैव वसन्तः शोधनं प्रति||५||
एतानृतून् विकल्प्यैवं दद्यात् संशोधनं भिषक्| स्वस्थवृत्तमभिप्रेत्य व्याधौ व्याधिवशेन तु||६||
atyuṣṇavarṣaśītā hi grīṣmavarṣāhimāgamāḥ| tadantare prāvṛḍādyāsteṣāṃ sādhāraṇāstrayaḥ||4||
prāvṛṭ śucinabhau jñeyau śaradūrjasahau punaḥ| tapasyaśca madhuścaiva vasantaḥ śodhanaṃ prati||5||
etānṛtūn vikalpyaivaṃ dadyāt saṃśodhanaṃ bhiṣak| svasthavṛttamabhipretya vyādhau vyādhivaśena tu||6||

Greeshma (summer), Varsha (rainy season) and Himagama or Hemanta (winter) are characterised by excessive heat, rain and cold respectively.
The three intervening seasons, viz.,
Pravrt (end of rainy season)
Sharat Rutu – Autumn or fall
and
Vasanta or spring (the period between winter and summer)] are of general nature.

The months composing the three seasons of general nature are as follows:
Pravrt (approx, June- August) is composed of Suci or Aasada (June- July) and Nabha or Sravana (july- August);
Sarat or autumn (approx October- December) is composed of urja or Kartika (October – November) and Saha or Margasira (November- December) and
Vasanta or spring (February- April) is composed of Tapasya or Phalguna (February- March) and Madhu or Caitra (March- April).

The above mentioned three seasons i.e.,
Pravrit (end of raining season)
Sharat (Autumn / fall)
and
Vasanta Rutu (Spring) are suitable for the administration of elimination therapies.

After determining the exact months consisting of the above-mentioned seasons, the physician should give appropriate elimination therapies to a healthy person. However, for a patient, the appropriateness of the time (season) is determined on the basis of the nature of the diseases. [4-6]

Administration of Snehana and Swedana in Intervals

कर्मणां वमनादीनामन्तरेष्वन्तरेषु च| स्नेहस्वेदौ प्रयुञ्जीत स्नेहं चान्ते प्रयोजयेत्||७||
karmaṇāṃ vamanādīnāmantareṣvantareṣu ca| snehasvedau prayuñjīta snehaṃ cānte prayojayet||7||
During the interval between two therapies, viz., emesis, etc., the patient is given oleation and fomentation therapies, and at the end of such therapy, oleation therapy should again be given. [7]

Prohibition of Excessive Oleation

विसर्पपिडकाशोफकामलापाण्डुरोगिणः|अभिघातविषार्तांश्च नातिस्निग्धान् विरेचयेत्||८||
visarpapiḍakāśophakāmalāpāṇḍurogiṇaḥ|abhighātaviṣārtāṃśca nātisnigdhān virecayet||8||
Purgation therapy is to be given to the patient suffering from Visarpa (Erysipelas), Pidaka (acne, cysts), Sopha (oedema), Kamala (Jaundice), Pandu (anaemia), injury and poisoning only when the patient is not excessively oleated. [8]

Nature of Purgation Recipe

नातिस्निग्धशरीराय दद्यात् स्नेहविरेचनम्| स्नेहोत्क्लिष्टशरीराय रूक्षं दद्याद्विरेचनम्||९||
nātisnigdhaśarīrāya dadyāt snehavirecanam| snehotkliṣṭaśarīrāya rūkṣaṃ dadyādvirecanam||9||
Sneha Virechana (unctuous recipe for purgation) should not be given to a patient whose body is Ati Snigdha (excessively oleated). If the unctuous element in the body of the patient is excited (Sneha Utklishta), then he is given a purgation therapy recipe which is dry in nature. [9]
Read: Virechana Therapy – Right Method, Side Effects, Management

Conditions responsible for Appropriate Effect

स्नेहस्वेदोपपन्नेन जीर्णे मात्रावदौषधम्| एकाग्रमनसा पीतं सम्यग्योगाय कल्पते||१०||
snehasvedopapannena jīrṇe mātrāvadauṣadham| ekāgramanasā pītaṃ samyagyogāya kalpate||10||
Factors responsible for appropriate effect (Samyag Yoga) are the following;
The patient should have taken snehana and swedana therapies; [further explained in verse 11-13]
The purgation therapy is given only after the previous meal is digested [to be further explained in verse 14]
The purgation therapy is given in appropriate dose; [further explained in verse 15-16] and
The patient should take the therapy with concentration of mind. [further explained in verse 17] [10]

Need for Snehana, Swedana

स्निग्धात् पात्राद्यथा तोयमयत्नेन प्रणुद्यते| कफादयः प्रणुद्यन्ते स्निग्धाद्देहात्तथौषधैः||११||
आर्द्रं काष्ठं यथा वह्निर्विष्यन्दयति सर्वतः| तथा स्निग्धस्य वै दोषान् स्वेदो विष्यन्दयेत् स्थिरान्||१२||
क्लिष्टं वासो यथोत्क्लेश्य मलः संशोध्यतेऽम्भसा| स्नेहस्वेदैस्तथोत्क्लेश्य शोध्यते शोधनैर्मलः ||१३||
snigdhāt pātrādyathā toyamayatnena praṇudyate| kaphādayaḥ praṇudyante snigdhāddehāttathauṣadhaiḥ||11||
ārdraṃ kāṣṭhaṃ yathā vahnirviṣyandayati sarvataḥ| tathā snigdhasya vai doṣān svedo viṣyandayet sthirān||12||
kliṣṭaṃ vāso yathotkleśya malaḥ saṃśodhyate’mbhasā| snehasvedaistathotkleśya śodhyate śodhanairmalaḥ ||13||

Kapha, etc. morbid doshas can be taken out easily by therapies from the body of the patient who is oleated just like the water can be taken out easily from a pot smeared with oil.
The fomentation therapy helps the stable (adhered) Doshas in an oleated person to get eliminated completely just like the fire makes the liquid content of a piece of wet wood to ooze out in all the directions.
The Malas (morbid and Adhered Doshas) become detached by the application of oleation and fomentation therapies, and elimination therapy just like the dirt adhered to a piece of dirty cloth gets detached [by the application of heat or hot steam and alkaline] which can be washed out easily by rinsing with water. [11-13]

Digestion of food

अजीर्णे वर्धते ग्लानिर्विबन्धश्चापि जायते| पीतं संशोधनं चैव विपरीतं प्रवर्तते||१४||
ajīrṇe vardhate glānirvibandhaścāpi jāyate| pītaṃ saṃśodhanaṃ caiva viparītaṃ pravartate||14||
If elimination therapies are administered before the previous meal (Ajeerne) is digested, then it gives rise to the following complications:
glani (depression)
vibandha (constipation) and
the therapy works in the opposite way (i.e., the emetic therapy causes purgation and the purgative therapy causes emesis) [14]

Appropriate Dose

अल्पमात्रं महावेगं बहुदोषहरं सुखम्| लघुपाकं सुखास्वादं प्रीणनं व्याधिनाशनम्||१५||
अविकारि च व्यापत्तौ नातिग्लानिकरं च यत्| गन्धवर्णरसोपेतं विद्यान्मात्रावदौषधम्||१६||
alpamātraṃ mahāvegaṃ bahudoṣaharaṃ sukham| laghupākaṃ sukhāsvādaṃ prīṇanaṃ vyādhināśanam||15||
avikāri ca vyāpattau nātiglānikaraṃ ca yat| gandhavarṇarasopetaṃ vidyānmātrāvadauṣadham||16||

Appropriate dose of the recipe for Shodhana is characterised as follows:
It should be small in quantity, but quick in action
It should be able to eliminate morbid Doshas in large quantity but easily
It should be light for digestion, palatable, pleasing and curative of the concerned diseases
It should not cause serious complications
It should not cause depression/fatigue in excess and
It should possess agreeable smell, colour and taste [15-16]

Concentration of mind

विधूय मानसान् दोषान् कामादीनशुभोदयान् | एकाग्रमनसा पीतं सम्यग्योगाय कल्पते||१७||
vidhūya mānasān doṣān kāmādīnaśubhodayān | ekāgramanasā pītaṃ samyagyogāya kalpate||17||

Lust, distraction, desire etc. are inauspicious impurities of the mind. If a person whose mind is cleansed of these impurities, and whose mind is concentrated on the therapy, takes recipes for the elimination of morbid matter, then appropriate effects (Samyag Yoga) of the therapy are produced. [17]
Read: Vamana in Fever

नरः श्वो वमनं पाता भुञ्जीत कफवर्धनम्| सुजरं द्रवभूयिष्ठं, लघ्वशीतं विरेचनम्||१८||
उत्क्लिष्टाल्पकफत्वेन क्षिप्रं दोषाः स्रवन्ति हि|१९|
naraḥ śvo vamanaṃ pātā bhuñjīta kaphavardhanam| sujaraṃ dravabhūyiṣṭhaṃ, laghvaśītaṃ virecanam||18||
utkliṣṭālpakaphatvena kṣipraṃ doṣāḥ sravanti hi|19|

The person scheduled to take Vamana the next day should eat a Kapha aggravating diet which is easy for digestion and which is mostly of liquid nature (in the night of the previous day). The person scheduled to take purgation therapy the next day should take a diet which is light and hot.
Because of the aforesaid diet, the Kapha gets excited or aggravated (in the patient who is to be given emesis the next morning). In the case of the patient who is to be given purgation therapy in the next morning, intake of the above mentioned light and hot diet during the previous night causes reduction of kapha. As a result of this [the emesis and purgation therapies] helps in the elimination of Doshas quickly. [18- ½ 19]
Read: Rules For Vamana and Virechana Treatment- Charak Samhita Sutrasthan 15

Preparatory Measures

Signs of Appropriate purification

पीतौषधस्य तु भिषक् शुद्धिलिङ्गानि लक्षयेत्||१९|| ऊर्ध्वं कफानुगे पित्ते विट्पित्तेऽनुकफे त्वधः|
हृतदोषं वदेत् कार्श्यदौर्बल्ये चेत् सलाघवे||२०||
pītauṣadhasya tu bhiṣak śuddhiliṅgāni lakṣayet||19|| ūrdhvaṃ kaphānuge pitte viṭpitte’nukaphe tvadhaḥ|
hṛtadoṣaṃ vadet kārśyadaurbalye cet salāghave||20||
After the therapy is administered, the physician should keep observing the appearance of signs of appropriate purification which are as follows:
• In the case of emesis, the bile appears after the elimination of kapha;
• In the case of purgation, Kapha appears after the voiding of stool and bile
• After the therapies (both emesis and purgation) the body becomes emaciated, weak and light
Appearance of the above signs indicates appropriate elimination of the (morbid) Doshas). [19 ½ – 20]

Measures to remove Residual Drugs (Shesha Aushadha)

वामयेत्तु ततः शेषमौषधं न त्वलाघवे| स्तैमित्येऽनिलसङ्गे च निरुद्गारेऽपि वामयेत्||२१||
आलाघवात्तनुत्वाच्च कफस्यापत् परं भवेत्|२२|
vāmayettu tataḥ śeṣamauṣadhaṃ na tvalāghave| staimitye’nilasaṅge ca nirudgāre’pi vāmayet||21||
ālāghavāttanutvācca kaphasyāpat paraṃ bhavet|22|

The patient is given emetic therapy to remove the residual drugs (provided all the signs of appropriate administration of elimination therapy are observed). But if only lightness of the body is not observed (in spite of the presence of the remaining signs), then emesis should not be given.
If there is Staimitya (a feeling as if the body is covered with a wet skin) and occlusion of Vata, the emetic therapy is administered, even if there is no eructation, till there is lightness of the body and thinness of Kapha. Giving emesis thereafter leads to serious consequences. [21- ½ 22]
Read: Benefits of Vamana and Virechana Treatment – Charaka Sutrasthana 16

After-care

वमिते वर्धते वह्निः शमं दोषा व्रजन्ति हि||२२|| वमितं लङ्घयेत् सम्यग्जीर्णलिङ्गान्यलक्षयन्|
तानि दृष्ट्वा तु पेयादिक्रमं कुर्यान्न लङ्घनम्||२३||
vamite vardhate vahniḥ śamaṃ doṣā vrajanti hi||22|| vamitaṃ laṅghayet samyagjīrṇaliṅgānyalakṣayan|
tāni dṛṣṭvā tu peyādikramaṃ kuryānna laṅghanam||23||

Vamana promotes the Agni [after some time], and alleviates Doshas. After Vamana, the patient should keep fasting till the appearance of the signs of proper digestion of the medicines. After having observed these signs, the patient is given a regulated diet in the form of Peya (thin gruel), etc. and he should not be made to keep fast any more. [22 ½ -23]

Need for regulated Diet

संशोधनाभ्यां शुद्धस्य हृतदोषस्यदेहिनः| यात्यग्निर्मन्दतां तस्मात् क्रमं पेयादिमाचरेत्||२४||
saṃśodhanābhyāṃ śuddhasya hṛtadoṣasyadehinaḥ| yātyagnirmandatāṃ tasmāt kramaṃ peyādimācaret||24||

[Immediately] after purification of the body, and elimination of Doshas from the body by emetic and purgative therapies, the Agni (power of digestion and metabolism) in a person gets subdued. Therefore, for him, a controlled diet in the form of Peya (thin gruel), etc., is recommended. [24]

Dietetic Regimen

कफपित्ते विशुद्धेऽल्पं मद्यपे वातपैत्तिके| तर्पणादिक्रमं कुर्यात् पेयाऽभिष्यन्दयेद्धि तान्||२५||
kaphapitte viśuddhe’lpaṃ madyape vātapaittike| tarpaṇādikramaṃ kuryāt peyā’bhiṣyandayeddhi tān||25||

If Kapha and Pitta are cleansed partially because of Alpa Yoga or less effect (of emetic and purgative therapies), if the patient is addicted to alcohol, and if he suffers from Vatika or Paittika diseases, then he is given the regulated diet in the form of Tarpana – Nourishing, calming or demulcent drinks, etc., because Peya (thin gruel), etc. produces Abhisyandi effect (i.e., obstruction to the channels of circulation) in such cases. [25]

Signs of Drug- Digestion (Jirna Aushadhi)

अनुलोमोऽनिलः स्वास्थ्यं क्षुत्तृष्णोर्जो मनस्विता| लघुत्वमिन्द्रियोद्गारशुद्धिर्जीर्णौषधाकृतिः||२६||
anulomo’nilaḥ svāsthyaṃ kṣuttṛṣṇorjo manasvitā| laghutvamindriyodgāraśuddhirjīrṇauṣadhākṛtiḥ||26||

Signs of complete digestion of drugs used in the recipe are as follows:
Anuloma Anila – Downward movement of the wind in the intestine
Svasthya – A sense of well being
Kshrut, Trut – Proper hunger and thirst
Urja, Manasvita – Feeling of energy (promotion of strength) and self confidence
Laghutva – Lightness of the body
Indriya Shuddhi – Clarity (excellence in the functioning) of sense; and
Udgara Shuddhi – Purity of eructation (without the smell of drugs) are the signs of digestion and utilization of Shodhana Aushadha. [26]

Signs of residual Drugs (Shesha Aushadha)

क्लमो दाहोऽङ्गसदनं भ्रमो मूर्च्छा शिरोरुजा| अरतिर्बलहानिश्च सावशेषौषधाकृतिः||२७||
klamo dāho’ṅgasadanaṃ bhramo mūrcchā śirorujā| aratirbalahāniśca sāvaśeṣauṣadhākṛtiḥ||27||

If the drugs of the recipe are not fully digested, and a part remains undigested, then this gives rise to the following signs:
Klama (mental fatigue), Daha – Burning sensation,
Anga Sadana – Prostration of limbs, Bhrama, Murcha – Giddiness, Fainting,
Shiroruja – Headache,
Arati, Balahani Disliking for everything around and, Diminution of strength. [27]

Characteristics of Drugs Producing Undesirable effects

अकालेऽल्पातिमात्रं च पुराणं न च भावितम्| असम्यक्संस्कृतं चैव व्यापद्येतौषधं द्रुतम्||२८||
akāle’lpātimātraṃ ca purāṇaṃ na ca bhāvitam| asamyaksaṃskṛtaṃ caiva vyāpadyetauṣadhaṃ drutam||28||

Drugs of the following nature, if used in the recipes for elimination therapies, produce adverse effects quickly:
Akala – Unseasonal and untimely collected
Alpa, Atimatra – Administration in less or excess dose
Purana – old medicine, stored for a longer period after collection
Na bhavita – Used without proper impregnation and
Asamyak Samskrita – Improperly processed [28]

Adverse effects and their causative factors

आध्मानं परिकर्तिश्च स्रावो हृद्गात्रयोर्ग्रहः| जीवादानं सविभ्रंशः स्तम्भः सोपद्रवः क्लमः||२९||
अयोगादतियोगाच्च दशैता व्यापदो मताः| प्रेष्यभैषज्यवैद्यानां वैगुण्यादातुरस्य च||३०||
ādhmānaṃ parikartiśca srāvo hṛdgātrayorgrahaḥ| jīvādānaṃ savibhraṃśaḥ stambhaḥ sopadravaḥ klamaḥ||29||
ayogādatiyogācca daśaitā vyāpado matāḥ| preṣyabhaiṣajyavaidyānāṃ vaiguṇyādāturasya ca||30||
Emetic and purgative therapies may produce ten adverse effects (vyapat) as follows:
Adhmana or Flatulence (caused by Ayoga or under action of the recipe)
Parikartika or gripping pain (caused by Atiyoga or over action of the recipe)
Srava or excessive discharge (caused by Ayoga)
Hrdgraha or stiffness in the cardiac region (caused by Ayoga)
Gatragraha or stiffness of the body (caused by Ayoga)
Jivadana or bleeding (caused by Atiyoga)
Vibhramsa, i.e. Guda-Bhramsa or Prolapsed rectum
Sanjna-Bhramsa or mental perversion (caused by atiyoga) and others like itching (caused by Ayoga):
Stambha or rigidity
Upadrava or complications (caused by Ayoga) and
Klama or mental fatigue (caused by Ayoga)
The above mentioned adverse effects arise out of the Ayoga (under action) and Ati Yoga (over action) of the recipe because of the following.
Presya Vaigunya (defect in the attendant)
Bhaisajya Vaigunya (defect in the recipe)
Vaidya Vaigunya (defect in the physician) and
Atura Vaigunya (defect in the patient) [29-30]

Different types of Actions of Elimination therapies

योगः सम्यक्प्रवृत्तिः स्यादतियोगोऽतिवर्तनम्| अयोगः प्रातिलोम्येन न चाल्पं वा प्रवर्तनम्||३१||
yogaḥ samyakpravṛttiḥ syādatiyogo’tivartanam| ayogaḥ prātilomyena na cālpaṃ vā pravartanam||31||

Emesis and purgation therapies act in three different ways as follows:
Yoga or appropriate action resulting in proper elimination of Doshas
Atiyoga or over action which causes excessive elimination of Doshas and
Ayoga or under action which causes movement of drugs in reverse direction (Pratiloma Gati), non-elimination of Doshas, or their elimination in less quantity. [31]

Movement in reverse direction

श्लेष्मोत्क्लिष्टेन दुर्गन्धमहृद्यमति वा बहु| विरेचनमजीर्णे च पीतमूर्ध्वं प्रवर्तते||३२||
क्षुधार्तमृदुकोष्ठाभ्यां स्वल्पोत्क्लिष्टकफेन वा| तीक्ष्णं पीतं स्थितं क्षुब्धं वमनं स्याद्विरेचनम्||३३||
प्रातिलोम्येन दोषाणां हरणात्ते ह्यकृत्स्नशः| अयोगसञ्ज्ञे, कृच्छ्रेण याति दोषो नवाऽल्पशः||३४||
śleṣmotkliṣṭena durgandhamahṛdyamati vā bahu| virecanamajīrṇe ca pītamūrdhvaṃ pravartate||32||
kṣudhārtamṛdukoṣṭhābhyāṃ svalpotkliṣṭakaphena vā| tīkṣṇaṃ pītaṃ sthitaṃ kṣubdhaṃ vamanaṃ syādvirecanam||33||
prātilomyena doṣāṇāṃ haraṇātte hyakṛtsnaśaḥ| ayogasañjñe, kṛcchreṇa yāti doṣo navā’lpaśaḥ||34||

Intake of purgation therapy by a person with excited (aggravated) Kapha may produce action in reverse direction (it may cause Vamana) because of the following factors:
Durgandha – Foul odour of the recipe
Ahridya – Non-palatability of the recipe
Ati / Bahu – Larger quantity of the recipe and
Ajirne peetam – Intake of the recipe before the previous meal has been digested

Similarly, Vamana dravya may produce Virechana because of the following factors
Kshudha Arta – Affliction of the patient with hunger
Mrudu Koshta – Lax bowel / smooth intestinal lumen,
Svalpa Utklishta Kapha – Less excitement of kapha
Tikshna (sharp) nature of the drug
Sthita or stagnation of the recipe and
Kshubdham or agitating nature of the recipe.

If the emetic and purgative therapies produce action in the reverse order, then they become incapable of eliminating the morbid matter entirely. Thus, these conditions are called Ayoga (inappropriate or under action). In these conditions, the morbid Doshas get eliminated with difficulty or they do not get eliminated at all or they get eliminated only in small quantities. [32-34]
Read: Vamana And Virechana In The Treatment Of Kushta

Indigestion of recipe

पीतौषधो न शुद्धश्चेज्जीर्णे तस्मिन् पुनः पिबेत्| औषधं न त्वजीर्णेऽन्यद्भयं स्यादतियोगतः||३५||
pītauṣadho na śuddhaścejjīrṇe tasmin punaḥ pibet| auṣadhaṃ na tvajīrṇe’nyadbhayaṃ syādatiyogataḥ||35||

If the medicine taken for emesis and purgation does not produce the appropriate cleansing effects, then after its digestion, the therapy is administered again (on the same day). Before the digestion of the earlier recipe, the therapy should not be administered. Repetition of the therapy may lead to AtiYoga (excessive action). [35]

Repetition of Therapy

कोष्ठस्य गुरुतां ज्ञात्वा लघुत्वं बलमेव च| अयोगे मृदु वा दद्यादौषधं तीक्ष्णमेव वा||३६||
koṣṭhasya gurutāṃ jñātvā laghutvaṃ balameva ca| ayoge mṛdu vā dadyādauṣadhaṃ tīkṣṇameva vā||36||

If there is Ayoga (no action), then after ascertaining the nature of the Koshta (hard or soft bowel) and the strength, the patient is given [repeated dose] of the medicine which is either Mrdu (mild) or Tikshna (Sharp or strong) in nature. [36]

Avoiding Repeat- dose

वमनं न तु दुश्छर्दं दुष्कोष्ठं न विरेचनम्| पाययेतौषधं भूयो हन्यात् पीतं पुनर्हि तौ||३७||
vamanaṃ na tu duśchardaṃ duṣkoṣṭhaṃ na virecanam| pāyayetauṣadhaṃ bhūyo hanyāt pītaṃ punarhi tau||37||

If the patient is a bad subject (not an ideal candidate) for emesis, then a second emetic dose should not be given. Similarly, a second purgative dose should not be given if the patient has a hard bowel. Repeat doses of emesis and purgation to these two categories of patients may lead to their death. [37]

Causes and Complications of Ayoga

अस्निग्धास्विन्नदेहस्य रूक्षस्यानवमौषधम्| दोषानुत्क्लिश्य निर्हर्तुमशक्तं जनयेद्गदान्||३८||
विभ्रंशं श्वयथुं हिक्कां तमसो दर्शनं भृशम् | पिण्डिकोद्वेष्टनं कण्डूमूर्वोः सादं विवर्णताम्||३९||
asnigdhāsvinnadehasya rūkṣasyānavamauṣadham| doṣānutkliśya nirhartumaśaktaṃ janayedgadān||38||
vibhraṃśaṃ śvayathuṃ hikkāṃ tamaso darśanaṃ bhṛśam | piṇḍikodveṣṭanaṃ kaṇḍūmūrvoḥ sādaṃ vivarṇatām||39||

Asnigdha, Asvinna – If the patient is not oleated and fomented,
Rooksha – if there is dryness in his body and
Anava Aushadha – the ingredients of the recipe have become old (stored for a long time beyond shelf life), then in such a situation the therapy becomes incapable of (completely) eliminating the morbid Doshas in spite of having caused their excitation.

This gives rise to ailments like
Vibhramsa (action in reverse direction),
Shvayathu (oedema),
Hikka (hiccup),
Tamaso Darshana (excessive fainting), and
Pindikodveshtana cramps in the calf region,
(Kandu) itching,
Uru Sada – asthenia of the thighs and
Vivarnata (discoloration of the skin). [38-39]

Another type of Ayoga and its management

स्निग्धस्विन्नस्य चात्यल्पं दीप्ताग्नेर्जीर्णमौषधम्| शीतैर्वा स्तब्धमामे वा दोषानुत्क्लिश्य नाहरेत्||४०||
तानेव जनयेद्रोगानयोगः सर्व एव सः| विज्ञाय मतिमांस्तत्र यथोक्तां कारयेत् क्रियाम्||४१||
snigdhasvinnasya cātyalpaṃ dīptāgnerjīrṇamauṣadham| śītairvā stabdhamāme vā doṣānutkliśya nāharet||40||
tāneva janayedrogānayogaḥ sarva eva saḥ| vijñāya matimāṃstatra yathoktāṃ kārayet kriyām||41||

Even in a person who is properly oleated and fomented, the Doshas which are already excited do not get eliminated because of the following factors:
Atyalpa – If the recipe is administered in a very small dose
Deepta Agni – If the patient has strong power of digestion as a result of which the recipe administered in small dose itself gets digested (without producing its effects)
Sheeta – If the recipe has become ineffective because of cold ingredients and
Stabdha, Ama – If the recipe is taken when the body of the patient is afflicted with Ama (product of improper digestion and metabolism)
In the above-mentioned conditions, all the complications (like Vibhramsa-Vide verse nos. 38-39 above) are manifested.

All the conditions are the result of Ayoga (under action of the purificatory recipe). Having determined this condition, a wise physician should treat them on the suggested lines (vide verse nos. 35-42) [40-41]

Treatment of Ayoga

तं तैललवणाभ्यक्तं स्विन्नं प्रस्तरसङ्करैः|पाययेत पुनर्जीर्णे समूत्रैर्वा निरूहयेत्||४२||
निरूढं च रसैर्धान्वैर्भोजयित्वाऽनुवासयेत्| फलमागधिकादारुसिद्धतैलेन मात्रया||४३||
स्निग्धं वातहरैः स्नेहैः पुनस्तीक्ष्णेन शोधयेत्| न चातितीक्ष्णेन ततो ह्यतियोगस्तु जायते||४४||
taṃ tailalavaṇābhyaktaṃ svinnaṃ prastarasaṅkaraiḥ|pāyayeta punarjīrṇe samūtrairvā nirūhayet||42||
nirūḍhaṃ ca rasairdhānvairbhojayitvā’nuvāsayet| phalamāgadhikādārusiddhatailena mātrayā||43||
snigdhaṃ vātaharaiḥ snehaiḥ punastīkṣṇena śodhayet| na cātitīkṣṇena tato hyatiyogastu jāyate||44||

After digestion of the previously administered recipe, the patient is given Abhyanga with oil mixed with salt, and fomented with Prastara and Sankara type of fomentation therapies (vide sutra 14:41 & 42). Thereafter, he is given another dose of the Virechana recipe or may be given Niruha type of enema mixed with cow’s urine.
After Niruha Basti, the patient is given food along with the soup of the meat of animals living in arid zones. Thereafter, Anuvasana Basti is given to him with the medicated oil prepared by boiling with Phala (madana phala), Magadhika (pippali) and Daru (Devadaru) in appropriate doses.
Thereafter, he is oleated with medicated fat prepared by cooking with Vata alleviating drugs, and then purificatory therapy with recipe containing Teekshna (sharp) ingredients is given again. The ingredients should not be exceedingly sharp because that may result in Ati Yoga (over action). [42-44]

Signs and treatment of Ati-Yoga

अतितीक्ष्णं क्षुधार्तस्य मृदुकोष्ठस्य भेषजम्| हृत्वाऽऽशु विट्पित्तकफान् धातून्विस्रावयेद्द्रवान्||४५||
बलस्वरक्षयं दाहं कण्ठशोषं भ्रमं तृषाम्| कुर्याच्च मधुरैस्तत्र शेषमौषधमुल्लिखेत्||४६||
वमने तु विरेकः स्याद्विरेके वमनं पुनः | परिषेकावगाहाद्यैः सुशीतैः स्तम्भयेच्च तत्||४७||
कषायमधुरैः शीतैरन्नपानौषधैस्तथा| रक्तपित्तातिसारघ्नैर्दाहज्वरहरैरपि||४८||
atitīkṣṇaṃ kṣudhārtasya mṛdukoṣṭhasya bheṣajam| hṛtvā”śu viṭpittakaphān dhātūnvisrāvayeddravān||45||
balasvarakṣayaṃ dāhaṃ kaṇṭhaśoṣaṃ bhramaṃ tṛṣām| kuryācca madhuraistatra śeṣamauṣadhamullikhet||46||
vamane tu virekaḥ syādvireke vamanaṃ punaḥ | pariṣekāvagāhādyaiḥ suśītaiḥ stambhayecca tat||47||
kaṣāyamadhuraiḥ śītairannapānauṣadhaistathā| raktapittātisāraghnairdāhajvaraharairapi||48||

Exceedingly Teekshna medicine given to a patient who is hungry, and who has soft bowel (Mrudu koshta), quickly eliminates not only stool, Pitta (bile) and kapha (phlegm), but also the Dhatus – liquid elements of tissues of the body.
As a result of this, loss of strength and voice, burning sensation, dryness of the throat, giddiness and morbid thirst are manifested.
In such a condition, the residual drugs are eliminated with ingredients belonging to the group of sweet drugs (madhura-gana).
In case of Ati Yoga (over-action) of emetic therapy, the patient is given purgation therapy, and in case of atiyoga (over action) of purgation therapy he is given emesis.
The urge for vomiting and purgation in excess because of over-action may be arrested by the following:
Exceedingly cold Pariseka (sprinkling of water), Avagaha (bath) etc. measures,
Intake of food, drinks and medications which are cooling, astringent as well as sweet in taste and
Therapies which are curative of Rakta-Pitta (an ailment characterised by bleeding from different parts of the body), Atisara (diarrhoea), Daha (burning sensation) and Jvara (fever). [45-48]

Recipes for treatment of over-action of Purgation Therapies

अञ्जनं चन्दनोशीरमज्जासृक्शर्करोदकम्| लाजचूर्णैः पिबेन्मन्थमतियोगहरं परम्||४९||
शुङ्गाभिर्वा वटादीनां सिद्धां पेयां समाक्षिकाम्| वर्चःसाङ्ग्राहिकैः सिद्धं क्षीरं भोज्यं च दापयेत्||५०||
जाङ्गलैर्वा रसैर्भोज्यं पिच्छाबस्तिश्च शस्यते| मधुरैरनुवास्यश्च सिद्धेन क्षीरसर्पिषा||५१||
añjanaṃ candanośīramajjāsṛkśarkarodakam| lājacūrṇaiḥ pibenmanthamatiyogaharaṃ param||49||
śuṅgābhirvā vaṭādīnāṃ siddhāṃ peyāṃ samākṣikām| varcaḥsāṅgrāhikaiḥ siddhaṃ kṣīraṃ bhojyaṃ ca dāpayet||50||
jāṅgalairvā rasairbhojyaṃ picchābastiśca śasyate| madhurairanuvāsyaśca siddhena kṣīrasarpiṣā||51||

The patient suffering from the complications of over action of purgative therapies should take the following recipes:
Mantha (demulcent drink) prepared with Anjana (daruharidra), Candana, Usira, bone marrow, blood, sugar and water along with the powder of the roasted paddy. This is an excellent recipe for curing over action of elimination therapies.
Peya (thin gruel) prepared of the Sunga (still root) of Vata, etc. (nyagroda, Udumbara, Asvattha and Kapitana), mixed with honey.
Milk and food articles prepared by boiling with drugs which are Varcas Sangrahika or intestinal astringents (vide Sutra 4:5: 15).
Food along with the soup of the meat of animals inhabiting arid zone,
Piccha Basti (sticky medicated enema);
Anuvasana Basti or unctuous enema of Ksira Sarpis belonging to Madhura varga (group of drugs having sweet taste) [49-51]

Treatment of over-action of emetic Therapy

वमनस्यातियोगे तु शीताम्बुपरिषेचितः| पिबेत् कफहरैर्मन्थं सघृतक्षौद्रशर्करम्||५२||
सोद्गारायां भृशं वम्यां मूर्च्छायां धान्यमुस्तयोः| समधूकाञ्जनं चूर्णं लेहयेन्मधुसंयुतम्||५३||
वमतोऽन्तःप्रविष्टायां जिह्वायां कवलग्रहाः| स्निग्धाम्ललवणैर्हृद्यैर्यूषक्षीररसैर्हिताः||५४||
फलान्यम्लानि खादेयुस्तस्य चान्येऽग्रतो नराः| निःसृतां तु तिलद्राक्षाकल्कलिप्तां प्रवेशयेत्||५५||
वाग्ग्रहानिलरोगेषु घृतमांसोपसाधिताम्| यवागूं तनुकां दद्यात् स्नेहस्वेदौ च बुद्धिमान्||५६||
vamanasyātiyoge tu śītāmbupariṣecitaḥ| pibet kaphaharairmanthaṃ saghṛtakṣaudraśarkaram||52||
sodgārāyāṃ bhṛśaṃ vamyāṃ mūrcchāyāṃ dhānyamustayoḥ| samadhūkāñjanaṃ cūrṇaṃ lehayenmadhusaṃyutam||53||
vamato’ntaḥpraviṣṭāyāṃ jihvāyāṃ kavalagrahāḥ| snigdhāmlalavaṇairhṛdyairyūṣakṣīrarasairhitāḥ||54||
phalānyamlāni khādeyustasya cānye’grato narāḥ| niḥsṛtāṃ tu tiladrākṣākalkaliptāṃ praveśayet||55||
vāggrahānilarogeṣu ghṛtamāṃsopasādhitām| yavāgūṃ tanukāṃ dadyāt snehasvedau ca buddhimān||56||

If there is atiYoga (over action) of the emetic therapy, then the patient is sprinkled with cold water. He is given Mantha (demulcent drink) prepared of kapha alleviating ingredients and added with ghee, honey and sugar.
In the case of excessive vomiting associated with eructation or fainting, the patient is given to lick, the powder of Dhanya, Musta, Madhuka and Anjana (solid extract of Daruharidra) mixed with honey.
While vomiting, if the tongue gets drawn inside, then Kavala Graha (recipe used for rinsing the mouth) with the vegetable soup, milk or meat soup prepared by adding unctuous, sour, saline and palatable ingredients is given. Another person may eat sour fruits in front of the patient (to cause salivation of the patient which helps the indrawn tongue to come to its normal position).
If the tongue is protruded out, then it is smeared with the paste of til and Draksa, and pushed back to its normal position.
If there is Vak Graha (obstruction in speech) or other disorders caused by Vata, then a wise physician should give thin gruel prepared with ghee and meat for the patient to eat. In addition, the patient may be given with oleation and fomentation therapies. [52-56]

Need for Regulated diet

वमितश्च विरिक्तश्च मन्दाग्निश्च विलङ्घितः| अग्निप्राणविवृद्ध्यर्थं क्रमं पेयादिकं भजेत् ||५७||
vamitaśca viriktaśca mandāgniśca vilaṅghitaḥ| agniprāṇavivṛddhyarthaṃ kramaṃ peyādikaṃ bhajet ||57||

A person who has Mandagni (suppressed power of digestion and metabolism) and who was fasting because of emetic and purgative therapies is given regulated diet in the form of Peya (thin gruel), etc. for the promotion of his Agni and Prana (Vitality) [57]

Etiology, signs and Treatment of Adhmana

बहुदोषस्य रूक्षस्य हीनाग्नेरल्पमौषधम्| सोदावर्तस्य चोत्क्लिश्य दोषान्मार्गान्निरुध्य च||५८||
भृशमाध्मापयेन्नाभिं पृष्ठपार्श्वशिरोरुजम्| श्वासविण्मूत्रवातानां सङ्गं कुर्याच्च दारुणम्||५९||
अभ्यङ्गस्वेदवर्त्यादि सनिरूहानुवासनम्| उदावर्तहरं सर्वं कर्माध्मातस्य शस्यते||६०||
bahudoṣasya rūkṣasya hīnāgneralpamauṣadham| sodāvartasya cotkliśya doṣānmārgānnirudhya ca||58||
bhṛśamādhmāpayennābhiṃ pṛṣṭhapārśvaśirorujam| śvāsaviṇmūtravātānāṃ saṅgaṃ kuryācca dāruṇam||59||
abhyaṅgasvedavartyādi sanirūhānuvāsanam| udāvartaharaṃ sarvaṃ karmādhmātasya śasyate||60||

If medicines for purifications are administered in a small dose to a patient who is afflicted with excess of morbid Doshas, whose body is dry, who has less of Agni (power of digestion), and who is suffering from Udavarta (upward movement of wind), the medicines while exciting Doshas may cause obstruction to the channels. This causes frequent Adhmana (distension) in the umbilical region, pain in the back, side of the chest as well as head, and serious obstruction to the passage of breath, stool, urine and flatus.
For the treatment of these complications, the patient is given
Abhyanga (massage),
Svedana (fomentation),
Varti (medicated suppository),
Svedana (fomentation)
Varti (medicated suppository), etc., along with Niruha (evacuative) and Anuvasana (unctuous) types of enema.
All the therapies prescribed for the treatment of Udavarta (vide Chikitsa 26: 11-31) are useful for the treatment of the present ailment i.e adhmana (flatulence). [58-60]

Etiology, signs and treatment of Parikartika

स्निग्धेन गुरुकोष्ठेन सामे बलवदौषधम्|क्षामेण मृदुकोष्ठेन श्रान्तेनाल्पबलेन वा||६१||
पीतं गत्वा गुदं साममाशु दोषं निरस्य च|तीव्रशूलां सपिच्छास्रां करोति परिकर्तिकाम्||६२||
लङ्घनं पाचनं सामे रूक्षोष्णं लघुभोजनम्|बृंहणीयो विधिः सर्वः क्षामस्य मधुरस्तथा||६३||
snigdhena gurukoṣṭhena sāme balavadauṣadham|kṣāmeṇa mṛdukoṣṭhena śrāntenālpabalena vā||61||
pītaṃ gatvā gudaṃ sāmamāśu doṣaṃ nirasya ca|tīvraśūlāṃ sapicchāsrāṃ karoti parikartikām||62||
laṅghanaṃ pācanaṃ sāme rūkṣoṣṇaṃ laghubhojanam|bṛṃhaṇīyo vidhiḥ sarvaḥ kṣāmasya madhurastathā||63||

Snigdha – If a person who is oleated,
Guru Koshta – who has constipated bowel and
Ama – who is afflicted with Ama (product of improper digestion and metabolism),
or if a person who is weak (Kshama),
who has lax bowel (Mrudu koshta),
who is fatigued (shranta) and
who has taken a quick acting medicine for purification, then the recipe reaches the rectum to cause excruciating sawing kind of pain (Teevra shoola) accompanied with slimy and bloody discharge (Piccha Asra), and parikartika – cutting type of pain in the anal region.

In this condition associated with Ama, the patient should keep fasting; take Pachana (digestive stimulants) and food which is dry, hot and light for digestion.
If the patient is weak, then all the nourishing therapies and recipes containing drugs having sweet taste are taken. [61- 63]

Recipes for Parikartika

आमे जीर्णेऽनुबन्धश्चेत् क्षाराम्लं लघु शस्यते| पुष्पकासीसमिश्रं वा क्षारेण लवणेन वा||६४||
सदाडिमरसं सर्पिः पिबेद्वातेऽधिके सति| दध्यम्लं भोजने पाने संयुक्तं दाडिमत्वचा||६५||
देवदारुतिलानां वा कल्कमुष्णाम्बुना पिबेत्| अश्वत्थोदुम्बरप्लक्षकदम्बैर्वा शृतं पयः||६६||
कषायमधुरं शीतं पिच्छाबस्तिमथापि वा| यष्टीमधुकसिद्धं वा स्नेहबस्तिं प्रदापयेत्||६७||
āme jīrṇe’nubandhaścet kṣārāmlaṃ laghu śasyate| puṣpakāsīsamiśraṃ vā kṣāreṇa lavaṇena vā||64||
sadāḍimarasaṃ sarpiḥ pibedvāte’dhike sati| dadhyamlaṃ bhojane pāne saṃyuktaṃ dāḍimatvacā||65||
devadārutilānāṃ vā kalkamuṣṇāmbunā pibet| aśvatthodumbaraplakṣakadambairvā śṛtaṃ payaḥ||66||
kaṣāyamadhuraṃ śītaṃ picchābastimathāpi vā| yaṣṭīmadhukasiddhaṃ vā snehabastiṃ pradāpayet||67||

If Parikartika (sawing pain) continues even after the Ama (product of improper digestion and metabolism) gets cooked, intake of alkaline, light to digest and sour foods are beneficial.
If there is predominance of Vata (aggravated), the below mentioned recipes are useful:
Ghee along with pomegranate-juice added with Puspa-kasisa or alkalies or salt
Food and drinks containing sour curd mixed with the skin of the pomegranate;
Paste of Devadaru and Tila should be given for drinking mixed in hot water.
Milk boiled and processed with Ashwattha, Udumbara, Plaksha and Kadamba should be given for drinking.
Cold enemas prepared with astringent and sweet tasting herbs or Pichcha Basti type of enema shall be administered.
Anuvasana Basti with oil/ghee prepared with paste and decoction of Yashtimadhu. [64-67]
Read: Vamanopaga Gana: Emesis Aiding Herbs: Review, Benefits, Formulations

Etiology, signs and treatment of Parisrava

अल्पं तु बहुदोषस्य दोषमुत्क्लिश्य भेषजम्| अल्पाल्पं स्रावयेत् कण्डूं शोफं कुष्ठानि गौरवम्||६८||
कुर्याच्चाग्निबलोत्क्लेशस्तैमित्यारुचिपाण्डुताः| परिस्रावः स, तं दोषं शमयेद्वामयेदपि||६९||
स्नेहितं वा पुनस्तीक्ष्णं पाययेत् विरेचनम्| शुद्धे चूर्णासवारिष्टान् संस्कृतांश्च प्रदापयेत्||७०||
alpaṃ tu bahudoṣasya doṣamutkliśya bheṣajam| alpālpaṃ srāvayet kaṇḍūṃ śophaṃ kuṣṭhāni gauravam||68||
kuryāccāgnibalotkleśastaimityārucipāṇḍutāḥ| parisrāvaḥ sa, taṃ doṣaṃ śamayedvāmayedapi||69||
snehitaṃ vā punastīkṣṇaṃ pāyayet virecanam| śuddhe cūrṇāsavāriṣṭān saṃskṛtāṃśca pradāpayet||70||

Purificatory recipe given in a small dose to a person having excessively aggravated Doshas causes excitation of the morbid material and eliminates them frequently in small quantities, this gives rise to itching, oedema, Kustha (skin diseases), heaviness of the body, diminution of the power of Agni (digestion) and strength, Staimitya (a feeling as if the body has been covered with a wet leather), anorexia and anaemia. This condition is called Parisrava.
This morbidity may be corrected either by alleviation therapy (if there is less of morbid matter) or by emesis (if the morbid material is present in large quantities).
After oleation, the patient may be given with strong purgation therapy again. After purgation, the patient is given recipes of powders, Asavas and Aristas processed with appropriate ingredients (as described in the treatment of Arsas or piles and Grahani or spure syndrome (vide Chikitsa 14, 15). [68-70]

Etiology, signs and treatment of Hrdayopasarana

पीतौषधस्य वेगानां निग्रहान्मारुतादयः| कुपिता हृदयं गत्वा घोरं कुर्वन्ति हृद्ग्रहम्||७१||
स हिक्काकासपार्श्वार्तिदैन्यलालाक्षिविभ्रमैः| जिह्वां खादति निःसञ्ज्ञो दन्तान् किटिकिटापयन्||७२||
न गच्छेद्विभ्रमं तत्र वामयेदाशु तं भिषक्| मधुरैः पित्तमूर्च्छार्तं कटुभिः कफमूर्च्छितम्||७३||
पाचनीयैस्ततश्चास्य दोषशेषं विपाचयेत्| कायाग्निं च बलं चास्य क्रमेणोत्थापयेत्ततः ||७४||
पवनेनातिवमतो हृदयं यस्य पीड्यते| तस्मै स्निग्धाम्ललवणं दद्यात् पित्तकफेऽन्यथा||७५||
pītauṣadhasya vegānāṃ nigrahānmārutādayaḥ| kupitā hṛdayaṃ gatvā ghoraṃ kurvanti hṛdgraham||71||
sa hikkākāsapārśvārtidainyalālākṣivibhramaiḥ| jihvāṃ khādati niḥsañjño dantān kiṭikiṭāpayan||72||
na gacchedvibhramaṃ tatra vāmayedāśu taṃ bhiṣak| madhuraiḥ pittamūrcchārtaṃ kaṭubhiḥ kaphamūrcchitam||73||
pācanīyaistataścāsya doṣaśeṣaṃ vipācayet| kāyāgniṃ ca balaṃ cāsya krameṇotthāpayettataḥ ||74||
pavanenātivamato hṛdayaṃ yasya pīḍyate| tasmai snigdhāmlalavaṇaṃ dadyāt pittakaphe’nyathā||75||

Because of the suppression of the manifested natural urges in a person who has taken purificatory recipes, Vata, etc., get aggravated. Pertaining to the heart, these aggravated Doshas give rise to serious ailments like Hrd-Graha (cardiac spasm).
The patient afflicted with these conditions suffers from hiccup, cough, and pain in the sides of the chest, prostration, ptyalism and agitation of the eyes. He bites his tongue, becomes unconscious and gnashes his teeth.
The physician should not commit a mistake. If the patient faints because of aggravated pitta he should immediately administer emetic therapy with sweet ingredients.
If the patient faints because of aggravated Kapha, then the emetic therapy is given with pungent ingredients, thereafter, the residual Doshas are digested by the administration of digestive stimulants after which his Kayagni (digestive power) and strength are restored gradually.
Because of vomiting in excess, if the heart is afflicted by aggravated Vata, then the patient is given unctuous, sour and saline drugs, if this is caused by Pitta or Kapha, then drugs having opposite attributes (like dryness and bitter as well as pungent tastes) are given. [71-75]

Etiology, Signs and Treatment of AngaGraha

पीतौषधस्य वेगानां निग्रहेण कफेन वा| रुद्धोऽति वा विशुद्धस्य गृह्णात्यङ्गानि मारुतः||७६||
स्तम्भवेपथुनिस्तोदसादोद्वेष्टनमन्थनैः| तत्र वातहरं सर्वं स्नेहस्वेदादि कारयेत् [२] ||७७||
pītauṣadhasya vegānāṃ nigraheṇa kaphena vā| ruddho’ti vā viśuddhasya gṛhṇātyaṅgāni mārutaḥ||76||
stambhavepathunistodasādodveṣṭanamanthanaiḥ| tatra vātaharaṃ sarvaṃ snehasvedādi kārayet [2] ||77||

If a person who has taken purificatory therapy, suppresses his manifested natural urges, or if the Vata in his body gets occluded by Kapha, or if the purification is done in excess, then the aggravated Vata causes spasm in different parts of the body of the patient. This produces Stambha (stiffness), Vepathu (trembling), Nistodu (pain), Sada (prostration), Udvestana (spasm) and Manthana (twisting)
For these ailments, all the Vata alleviating therapies like oleation and fomentation are administered. [76-77]

Etiology, signs and Treatment of Jivadana (Bleeding)

अतितीक्ष्णं मृदौ कोष्ठे लघुदोषस्य भेषजम्| दोषान् हृत्वा विनिर्मथ्य जीवं हरति शोणितम्||७८||
तेनान्नं मिश्रितं दद्याद्वायसाय शुनेऽपि वा| भुङ्क्ते तच्चेद्वदेज्जीवं न भुङ्क्ते पित्तमादिशेत्||७९||
शुक्लं वा भावितं वस्त्रमावानं कोष्णवारिणा| प्रक्षालितं विवर्णं स्यात् पित्ते शुद्धं तु शोणिते||८०||
तृष्णामूर्च्छामदार्तस्य कुर्यादामरणात् क्रियाम्| तस्य पित्तहरीं सर्वामतियोगे च या हिता ||८१||
मृगगोमहिषाजानां सद्यस्कं जीवतामसृक्| पिबेज्जीवाभिसन्धानं जीवं तद्ध्याशु गच्छति ||८२||
तदेव दर्भमृदितं रक्तं बस्तिं प्रदापयेत्| श्यामाकाश्मर्यबदरीदूर्वोशीरैः शृतं पयः||८३||
घृतमण्डाञ्जनयुतं शीतं बस्तिं प्रदापयेत्| पिच्छाबस्तिं सुशीतं वा घृतमण्डानुवासनम्||८४||
atitīkṣṇaṃ mṛdau koṣṭhe laghudoṣasya bheṣajam| doṣān hṛtvā vinirmathya jīvaṃ harati śoṇitam||78||
tenānnaṃ miśritaṃ dadyādvāyasāya śune’pi vā| bhuṅkte taccedvadejjīvaṃ na bhuṅkte pittamādiśet||79||
śuklaṃ vā bhāvitaṃ vastramāvānaṃ koṣṇavāriṇā| prakṣālitaṃ vivarṇaṃ syāt pitte śuddhaṃ tu śoṇite||80||
tṛṣṇāmūrcchāmadārtasya kuryādāmaraṇāt kriyām| tasya pittaharīṃ sarvāmatiyoge ca yā hitā ||81||
mṛgagomahiṣājānāṃ sadyaskaṃ jīvatāmasṛk| pibejjīvābhisandhānaṃ jīvaṃ taddhyāśu gacchati ||82||
tadeva darbhamṛditaṃ raktaṃ bastiṃ pradāpayet| śyāmākāśmaryabadarīdūrvośīraiḥ śṛtaṃ payaḥ||83||
ghṛtamaṇḍāñjanayutaṃ śītaṃ bastiṃ pradāpayet| picchābastiṃ suśītaṃ vā ghṛtamaṇḍānuvāsanam||84||

If a strong purificatory recipe is given to a person who has a laxed bowel, and who has less of morbid Doshas, then after eliminating the morbid Doshas, the recipe causes churning (of the intestine) which results in bleeding.
This (fluid) is mixed with food and given to crows and dogs to eat. If they eat it then it is to be considered as Jiva-Rakta (live or pure blood), and if it is not eaten by them, it should be considered as raktapitta i.e., polluted blood.
A piece of white cloth is impregnated with this fluid and then dried. When washed with lukewarm water, if the piece of cloth becomes/remains discoloured, then the bleeding is to be treated as caused by Raktapitta, and if it becomes absolutely clean, then this is to be treated as Jiva-Rakta (live or pure blood).
If the patient having bleeding suffers from morbid thirst, fainting and intoxication, then the physician should treat him till the last moment of his life. All the therapies which are meant for the alleviation of Pitta, and which are useful for the management of over-action of purificatory therapies (as described in the verse no. 47) are given to him.
He is given to drink the fresh blood of a living deer, cow, buffalo or goat which is life-supporting because it immediately gets transformed into the live-blood. This blood [of animals] may be mixed with the powder of Darbha and used for Basti (medicated enema).
The milk cooked by adding Syama (Priyangu), Kasmarya, Badari, Durva, and Usira is mixed with Ghrta-Manda (supernatant part of ghee) and Anjana (solid extract of daruharidra), and cooled. This may be administered as medicated enema). He may be given very cold Piccha-Basti (mucilaginous enema) or Anuvasana-Basti (unctuous enema) prepared of Ghrta-manda. [78-84]

Etiology, Signs and Treatment of Vibhramsa

गुदं भ्रष्टं कषायैश्च स्तम्भयित्वा प्रवेशयेत्| साम गान्धर्वशब्दांश्च सञ्ज्ञानाशेऽस्य कारयेत्||८५||
यदा विरेचनं पीतं विडन्तमवतिष्ठते| वमनं भेषजान्तं वा दोषानुत्क्लिश्य नावहेत्||८६||
तदा कुर्वन्ति कण्ड्वादीन् दोषाः प्रकुपिता गदान्| स विभ्रंशो मतस्तत्र स्याद्यथाव्याधि भेषजम्||८७||
gudaṃ bhraṣṭaṃ kaṣāyaiśca stambhayitvā praveśayet| sāma gāndharvaśabdāṃśca sañjñānāśe’sya kārayet||85||
yadā virecanaṃ pītaṃ viḍantamavatiṣṭhate| vamanaṃ bheṣajāntaṃ vā doṣānutkliśya nāvahet||86||
tadā kurvanti kaṇḍvādīn doṣāḥ prakupitā gadān| sa vibhraṃśo matastatra syādyathāvyādhi bheṣajam||87||

If there is prolapse of the rectum (Guda-Bhramsa), it is made stiff by applying astringent drugs, and pushed back into its own location.
If there is unconsciousness (Sanjna-Bhramsa), then the patient is consoled and he is entertained with soothing music.
If the intake of purgative recipe stops action after the elimination of stool and doesn’t expel morbid pitta and kapha, if the intake of emetic recipe stops action after the elimination of emetic medicine without removing the morbid kapha and pitta, then the aggravated Doshas give rise to ailments like Kandu (itching) etc. This is called Vibhramsa (wrong action) these ailments are to be appropriately treated according to their nature. [85-87]

Etiology, Signs and Treatment of Stambha

पीतं स्निग्धेन सस्नेहं तद्दोषैर्मार्दवाद्वृतम्| न वाहयति दोषांस्तु स्वस्थानात् स्तम्भयेच्च्युतान्||८८||
वातसङ्गगुदस्तम्भशूलैः क्षरति चाल्पशः| तीक्ष्णं बस्तिं विरेकं वा सोऽर्हो लङ्घितपाचितः||८९||
pītaṃ snigdhena sasnehaṃ taddoṣairmārdavādvṛtam| na vāhayati doṣāṃstu svasthānāt stambhayeccyutān||88||
vātasaṅgagudastambhaśūlaiḥ kṣarati cālpaśaḥ| tīkṣṇaṃ bastiṃ virekaṃ vā so’rho laṅghitapācitaḥ||89||

Unctuous type of purificatory recipe taken by an oleated person gets occluded by Doshas because of its mild nature. It becomes incapable of expelling the Doshas. The Doshas displaced from their locations thus get obstructed. This causes obstruction to flatus, stiffness in the anal region and pain in anal region associated with expulsion of faeces (morbid doshas) in smaller quantities. Such a patient is treated by strong enema or purgation after Langhana (fasting therapy) and Pachana (carminative therapy). [88-89]

Etiology, signs and Treatment of Upadravas

रूक्षं विरेचनं पीतं रूक्षेणाल्पबलेन वा|मारुतं कोपयित्वाऽऽशु कुर्याद्धोरानुपद्रवान्||९०||
स्तम्भशूलानि घोराणि सर्वगात्रेषु मुह्यतः|स्नेहस्वेदादिकस्तत्र कार्यो वातहरो विधिः||९१||
rūkṣaṃ virecanaṃ pītaṃ rūkṣeṇālpabalena vā|mārutaṃ kopayitvā”śu kuryāddhorānupadravān||90||
stambhaśūlāni ghorāṇi sarvagātreṣu muhyataḥ|snehasvedādikastatra kāryo vātaharo vidhiḥ||91||

Intake of dry type of purgation therapy by a person whose body is dry and who is weak aggravates Vata immediately to cause serious type of complications like serious type of Stambha (stiffness) and colic pain all over the body of the patient who gradually loses consciousness.
In such cases, oleation, fomentation and such other therapies for alleviation of Vata are administered. [90-91]

Etiology, Signs and Treatment of Klama

स्निग्धस्य मृदुकोष्ठस्य मृदूत्क्लिश्यौषधं कफम्| पित्तं वातं च संरुध्य सतन्द्रागौरवं क्लमम्||९२||
दौर्बल्यं चाङ्गसादं च कुर्यादाशु तदुल्लिखेत्| लङ्घनं पाचनं चात्र स्निग्धं तीक्ष्णं च शोधनम्||९३||
snigdhasya mṛdukoṣṭhasya mṛdūtkliśyauṣadhaṃ kapham| pittaṃ vātaṃ ca saṃrudhya satandrāgauravaṃ klamam||92||
daurbalyaṃ cāṅgasādaṃ ca kuryādāśu tadullikhet| laṅghanaṃ pācanaṃ cātra snigdhaṃ tīkṣṇaṃ ca śodhanam||93||

Mild purificatory recipe administered to an oleated person having lax bowel excites Kalpha and Pitta because of which the Vata gets obstructed leading to the manifestation of klama (mental fatigue) associated with drowsiness and heaviness. This causes weakness and prostration of limbs.
Such a patient is administered emetic therapy quickly. Langhana (fasting) and Pachana (carminative drugs) are given to the patient followed by purificatory therapy containing unctuous and sharp drugs. [92-93]

Epilogue

तत्र श्लोकौ-
इत्येता व्यापदः प्रोक्ताः सरूपाः सचिकित्सिताः| वमनस्य विरेकस्य कृतस्याकुशलैर्नृणाम् ||९४||
एता विज्ञाय मतिमानवस्थाश्चैव तत्त्वतः| दद्यात् संशोधनं सम्यगारोग्यार्थी नृणां सदा||९५||
ityetā vyāpadaḥ proktāḥ sarūpāḥ sacikitsitāḥ| vamanasya virekasya kṛtasyākuśalairnṛṇām ||94||
etā vijñāya matimānavasthāścaiva tattvataḥ| dadyāt saṃśodhanaṃ samyagārogyārthī nṛṇāṃ sadā||95||

To sum up: – The complications along with signs, symptoms and treatment arising out of the administration of emetic and purgative therapies by the unskilled physician are described in this chapter. A wise physician having correct knowledge of these states (complications) should appropriately administer purifictory therapies (free from complications) with the objective of providing good health to the people. [94-95]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते सिद्धिस्थाने वमनविरेचनव्यापत्सिद्धिर्नाम षष्ठोऽध्यायः||६||
ityagniveśakṛte tantre carakapratisaṃskṛte’prāpte dṛḍhabalasampūrite siddhisthāne vamanavirecanavyāpatsiddhirnāma ṣaṣṭho’dhyāyaḥ||6||

Thus, end the sixth chapter of siddhi-Sthana dealing with “successful treatment of Complications of emetic and Purgation Therapies” in Agnivesha’s work as redacted by Charaka, and because of its non- availability, supplemented by Drdhabala.