Sushruta Samhita Sutrasthana Chapter 39 Samshodhana Samshamaniya Adhyaya (Purificatory and Palliative Drugs)

The 39th chapter of Sutrasthana of Sushruta Samhita is named as Samshodhana Samshamaniya Adhyaya. This chapter deals with Purificatory and Palliative Drugs.

अथातः संशोधनसंशमनीय्मध्यायं व्याख्यास्यामः ॥१॥
यथोवाच भग्वान् धन्वन्तरीः ॥२॥

 We will now expound the chapter by name Samshodhana Samsamaniya Purificatory and Palliative drugs; as revealed by the venerable Dhanvantari.

1.  Samshodhana: Purificatory drugs

1.  Vamana dravya: Emetics

मदनकुटजजीमूतकेक्ष्वाकुधामार्गवकृतवेधनसर्षपविडङ्गपिप्पलीकरञ्जप्रपुन्नाडकोविदारकर्बुदाररिष्टाश्वगन्धाविदुलबन्धुजीवकश्वेताशणपुष्पीबिम्बीवचामृगेर्वारवश्चित्रा चेत्यूर्ध्वभागहराणि । तत्र, कोविदारपूर्वाणां फलानि, कोविदारादीनां मूलानि ॥३॥

Urdhwa Bhaga Hara Dravya / Vamaka Dravya – Below mentioned drugs are said to be urdhva bhaga hara in action i.e. they remove the doshas from the upper part of the body. To put it in other words, these drugs produce vomiting. Therefore these can be considered as emetic drugs. They are –

•   Mandana – Randia dumetorum
•   Kutaja – Holarrhena antidysenterica
•   Jimutaka,
•   Iksvaku,
•   Dhamargava,
•   Krtavedhana,
•   Sarsapa – Brassica juncea
•   Vidanga – Embelia ribes  
•   Pippali – Piper longum
•   Karanja – Pongamia pinnnata
•   Prapunnada,
•   Kovidara,
•   Karbudara,
•   Arista,
•   Ashwagandha – Withania somnifera
•   Vidula,
•   Bandhu Jivaka,
•   Sveta,
•   Sanapuspi,
•   Bimbi,
•   Vaca,
•   Mrgervaru and
•   Citra

Only fruits of the drugs mentioned prior to Kovidara should be used whereas only roots of the drugs mentioned from Kovidara onwards should be used.

2.    Virechana Dravya: Purgatives

त्रिवृच्छ्यामादन्तीद्रवन्तीसप्तलाशङ्खिनीविषाणिकागवाक्षीच्छगलान्त्रीस्नुक्सुवर्णक्षीरीचित्रककिणिहीकुशकाशतिल्वककम्पिल्लकरम्यपाटलापूगहरीतक्यामलकविभीतकनीलिनी चतुरङ्गुलैरण्डपूतीकमहावृक्षसप्तच्छदार्का ज्योतिष्मति चेत्यधोभागहरणि। तत्रतिल्वकपूर्वाणां मूलानि, तिल्वकादीनां पाटलान्तानां त्वचः, कम्पिल्लकफलरज्ः, पूगादीनामेरणडान्तानाफलानि, पुतीकारग्वध्योः पत्राणि, शोषाणां  क्षीराणीति॥४॥ 

Adho Bhaga Hara Dravya / Virechaka Dravya – Below mentioned drugs are said to be adho bhaga hara in action i.e. they remove the doshas from the lower parts of the body. To put it in other words, these drugs produce purgation. Therefore these can be considered as purgatory drugs. They are –

•   Mandana – Randia dumetorum
•   Kutaja – Holarrhena antidysenterica
•   Jimutaka,
•   Iksvaku,
•   Dhamargava,
•   Krtavedhana,
•   Sarsapa – Brassica juncea
•   Vidanga – Embelia ribes  
•   Pippali – Piper longum
•   Karanja – Pongamia pinnnata
•   Prapunnada,
•   Kovidara,
•   Karbudara,
•   Arista,
•   Ashwagandha – Withania somnifera
•   Vidula,
•   Bandhu Jivaka,
•   Sveta,
•   Sanapuspi,
•   Bimbi,
•   Vaca,
•   Mrgervaru and
•   Citra

Only roots of the drugs mentioned before Tilvaka should be used.  Only bark should be used on the drugs starting with Tilvaka and ending with Patala.

As far as Kampillaka is concerned, only the dust on its fruits should be used. Only fruits should be used of the drugs commencing with Puga and ending with Eranda.

When it is Putika and Aragvadha, only leaves of them need to be used. Regarding the other remaining drugs, their milky sap should be used.

Vamana Virechana dravya

कोशातकी सप्तला शङ्खिनीं देवदाली कारवेल्लिका चेत्युभयतोभगहराणि । एषां स्वरसा इति॥५॥ 

Ubhaya Bhagahara Dravyas – The below mentioned drugs are called as ubhaya bhagahara which means that they can expel the doshas from both parts i.e. upper and lower parts. Therefore they are useful in causing both vomiting and purgation –

•   Kosataki,
•   Saptala,
•   Sankhini,
•   Devadali,
•   Karavella

 It is their fresh juice only that is to be used. 

3.    Shiro Virechana: Purgatives to the head

पिप्पलीविडङ्गापामार्गशिग्रुसिद्धार्थकशिरीषमरिचकरवीरबिम्बिगिरिकर्णिकाकिणिहीवचाज्योतिष्मतीकरञ्जार्कालर्कलशुनातिविषाशृङ्गवेरतालीशतालीशतमालसुरसार्जकेङ्गुदीमेषशृङ्गीमातुलुङ्गीमुरङ्गीपीलुजातीशालतालमधूकलाक्षाहिङ्गुलवणमद्यगोशकृद्रसमूत्राणीति शिरोविरेचनानि। तत्र करवीरपूर्वाणां फलानि, करवीरादीनामर्कान्तानां मूलानि, तालीशपूर्वाणां  कन्दाः, तालीशादीनामर्जकान्तानां पत्राणि, इङ्गुदीमेषशृङ्गचोस्त्वचः, मातुलुङ्गीमुरङ्गीपीलुजातीनां  पुष्पाणि, शालतालमधूकानां साराः, हिङ्गुलाक्षे निर्यासौ, लवणानि, पार्थिवविशेषाः; मद्यान्यासुतसंयोगाः, शुकृद्रसमुत्रे मलाविति॥६॥

Shirovirechana – Below mentioned drugs are said to cause shirovirechana i.e. head purging –

•   Pippali – Piper longum
•   Vidanga – Embelia ribes
•   Apamarga,
•   Sigru – Moringa oliefera
•   Siddhartha,
•   Sirisa,
•   Marica – Piper nigrum, black pepper
•   Karavira,
•   Bimbi,
•   Girukarnika,
•   Kinihi,
•   Vaca – Acorus calamus
•   Jyothismati,
•   Karanja – Pongamia pinnata
•   Arka,
•   Alarka,
•   Lasuna – Allium sativum
•   Ativisa – Aconitum heterophyllum
•   Srngavera – Zingiber officinale
•   Talisa – Abies webbiana
•   Tamala,
•   Surasa,
•   Arjaka,
•   Ingudi,
•   Mesasrngi,
•   Matulungi,
•   Murangi,
•   Pilu,
•   Jati,
•   Sala,
•   Tala,
•   Madhuka,
•   Laksa,
•   Hingu – Ferula narthex
•   Lavana – salts
•   Madya – wines
•   Gosakrt rasa (juice of fresh cow dung) and
•   Mutra (urines)

Among these,

–   drugs mentioned earlier to Karavira, their fruits only are to  be used;
–   those from Karavira and ending with Arka their roots only are to be used;
–   those earlier to Talisa, their rhizomes only to be used;
–   those from Talisa and ending with Arjaka, their leaves only to be used; 
–   the barks only of Ingudi and Mesasrngi should be used
–   flowers only one of Matulungin, Murangi, Pilu and Jati to be used;
–   pith only of Sala, Tala and Madhuka is to be used; 
–   gum only of Hingu and Laksa is to be used;
–   salts are products of the earth (ores); wines are products of  fermentation , juice of cow dung and urines are waste products (of animals)

II. Samsamana: Palliative drugs

1.  VataSamsamana – Palliative of vata;-

संशमनान्यत ऊर्ध्वं वक्ष्याम:- तत्र भद्रदारुकुष्ठहरिद्रावरुणमेशृङ्गीबलातिबलार्तगलकच्छुराशल्लकीकुबेराक्षीवीरतरुसहचराग्रिमन्थवत्सादन्येरण्डाश्मभेदकालर्कार्कशातावरीपुन्नर्न्स्वावसुक
वशिरकाञ्जनकभार्गीकार्पासिवृश्चिकालीपत्तूरबदरयवकोलकुलत्थप्रभृतीनि विदारिगन्धादिश्चद्वेचाद्ये पञ्जमूल्यौ समासेन  वातसंशमने वर्गः ॥७॥

Here after, the palliative drugs will be enumerated.

The herbs belonging to the ‘vata samshamana’ i.e. vata mitigating group are mentioned below –

•   Bhadradaru – Cedrus deodara
•   Kustha – Saussurea lappa
•   Haridra – Curcuma longa  
•   Varuna,
•   Mesasrangi,
•   Bala – Sida cordifolia
•   Atibala,
•   Artagala,
•   Kacchura,
•   Sallaki, 
•   Kuberaksi,
•   Virataru,
•   Sahacara,
•   Agnimantha,
•   Vatsadani,
•   Eranda – Ricinus communis
•   Asmabheda,
•   Kalaka,
•   Arka,
•   Satavari – Asparagus racemosa
•   Punarnava – Boerhavia diffusa  
•   Vasuka,
•   Vasira,
•   Kancanaka,
•   Bharngi,
•   Karpasai,
•   Vracikali, 
•   Pattura,
•   Badara,
•   Yava – Hordeum vulgare – barley
•   Kola,
•   Kulattha,
•   Drugs of Vidarigandhadi gana,
•   the first two Pancamula drugs

This in brief is the group mitigating vata.

2.    Pitta Samsamana: Palliatives of Pitta

चन्दनकुचन्दनह्रीबेरोशीरमञ्जिष्ठापयस्याविदारीशातवरीगुन्द्राशैवलकह्लारकुमुदोत्पलकन्दलीदूर्वामूर्वाप्रभृतीनि काकोल्यादिः सारिवादिरञ्जनादिरुत्पलादिर्न्यग्रोधादिस्तृणपञ्च- मूलमिति समासेन पित्तसंशमनो वर्गः ॥८॥

Below mentioned are the herbs belonging to the ‘pitta mitigating’ group –

•   Candana – Santalum album
•   Kucandana,
•   Hribera,
•   Usira – Vetiveria zizanoides
•   Manjistha – Rubia cordifolia
•   Payasya,
•   Vidari,
•   Satavari – Asparagus racemosa
•   Gundra,
•   Saivala,
•   Kalhara,
•   Kumuda,
•   Utpala,
•   Durva,
•   Murva etc.
•   drugs of Kakolyadi, Sarivadi, Anjanadi, Utpaladi, Nyagrodhadi  gana and Trna Pancamula

This in brief is the group mitigating Pitta.

3. Kapha samsamana: Palliatives of Kapha

कालेयकागुरुतिलपर्णीकुष्ठहरिद्राशीतशितपुष्पासरलारास्नाप्रकीर्योदकीर्येङ्गुदीसुमनाकाकादनीलाङ्गलकीहस्तिकर्णमुञ्जातकलामज्जकप्रभृतीनि वल्लीकण्टकपञ्चमूल्यौ पिप्पल्यादिर्बृहत्यादिर्मुष्ककादिर्वचादिः सुरसादिरारग्वधादिरिति समासेन श्लेष्पसंशमनो वर्गः ॥ ९॥

Below mentioned are the herbs belonging to the ‘kapha mitigating’ group –

•   Kaleeka,
•   Aguru,
•   Tilaparni,
•   Kustha – Saussurea lappa
•   Haridra – Curcuma longa  
•   Sitasiva,
•   Satapuspa
•   Sarala,
•   Rasna – Pluchea lanceolata
•   Prakriya,
•   Udakirya,
•   Ingudi,
•   Sumana,
•   Kakadani, 
•   Langalaki,
•   Hastikarna,
•   Munjataka,
•   Lamajjaka, etc.
•   drugs of Valli Pancamula, Kantaka Pancamula; Pippalyadi, Brihatyadi, Muskakadi, Vacadi, Surasadi   and Aragvadhadi  gana

In brief, this is the Sleshma Samshamana Varga i.e. group of herbs which mitigate kapha.

Samapramana upayoga: Use in appropriate dose

तत्र सर्वाण्येवौषधानि  व्याध्यग्रिपुरुषबलान्यभिसमिक्ष्य विदध्यात्। तत्र, व्याघिबलादधिकमौषधमुपयुक्तं तमुपशम्य व्याधिं  व्याधिमन्यमावहति; अग्रिबलादधिकमजीर्णं विष्टभ्य वा वच्यते; पुरुषबलादधिकं ग्लानिमूर्च्छामदानावहति  संशमनम् ; एवं संशोधनमतिपातयति। हीनमेभ्यो दन्तमकिंचित्करं  भवति। तस्मात् सममेव विदध्यात् ॥१०॥

All the above-mentioned herbs shall be administered after having considered the below mentioned factors in relation to the patient –

–       strength of the disease,
–       strength of the digestive fire and
–       strength of the body of the patient

Palliative medicines would give rise to another disease after relieving that disease, if they are used in excessive dosage of the strength of the disease.

Medicine if used in excess of digestion power (agni) will cause vistabdha i.e. painful conditions in the abdomen and get digested after a long time.

When these medicines are used in excess of the strength of the patient, they would give rise to –

–       exhaustion,
–       fainting and
–       intoxication / toxicity

Similarly, if administered in excess of the strength of the disease, digestive fire and body of the patient, the purificatory drugs would trouble the patient.

Medicines given in insufficient quantities of the strength of the disease, digestive fire and patient will become futile (do not produce any effect).

Therefore, these medicines should be used only in suitable quantities as appropriate to the strength of vyadhi – disease, agni – digestive fire and atura – patient.

रोगे  शोधनसाध्ये  तु यो भवेद्दोषदुर्बलः ॥
तस्मै दद्याद्भिषक  प्राज्ञो दोषप्रच्यावनं मृदु॥११॥
चले दोषे मृदौ कोष्टे नेक्षेतात्र  बलं नृणाम्॥
अव्याधिदुर्बलस्यापि शोधनं हि तदा भवेत्॥१२॥
स्वयं प्रवृत्तदोषस्य  मृदुकोष्टस्य शोधनम् ॥
भवेदल्पबलस्यापि प्रयुक्तं व्याधिनाशनम् ॥१३॥

Some verses here;-

A wise physician should administer shodhana – purificatory medicines in mild doses to eliminate slightly increased doshas in a smooth way in –

–       in shodhana sadhya vyadhi i.e. diseases which can be treated with purificatory therapies
–       in patients who have become weak due to the impact of strong and morbid doshas

The strength of the person should not be considered when –

–       the doshas are not steady i.e. they are in circulation and
–       the bowel movement is soft

This is because even in persons who are not debilitated by diseases, purification is beneficial.

The purificatory drugs when administered would cure the diseases when –

–       the doshas are going out of the body on their own and
–       in those having soft bowel movements

Purgatives would cure the disease even when the person has poor strength.

Aushada matra: Dose of medicine

व्याध्यादिषु तु  मध्येषु क्वाथस्याञ्जलिरिष्यते ॥
बिडालपदकं चुर्णं देयः कल्कोऽक्षसंमितः ॥१४॥

Below mentioned are the doses of various drug forms when the strength of the disease, digestive fire and patient are moderate –

–       dose of decoction should be 1 anjali – 160 gm / ml
–       dose of powders should be 1 bidalapadaka or aksha – 10 grams
–       dose of paste of herbs should be 1 aksha – 10 grams

इति श्रीसुश्रूतसंहितायां सूत्रस्थाने  संशोधनसंशमनीयोनामैकोनचत्वारिंशोऽध्यायः ॥३९॥

Thus ends the chapter by name Samsodhana- Samsamaniya in Sutra sthana samhita.