Ashtanga Hridayam Chikitsa sthanam Chapter 5: Rajayakshmadi Chikitsitam Adhyaya (Treatments of pulmonary tuberculosis etc.)   

The 5th chapter of Cikitsasthanam of Ashtanga Hridayam is named as Rajayaksmadi Cikitsitam Adhyayah. This chapter deals with the explanation of ‘treatment of chronic respiratory disorders including pulmonary tuberculosis’.

The topics covered in this chapter include –

–        Sodhana – purifactory therapies
–        Vamana – emesis
–        Virechana – purgation
–        Brimhana and Dipana – Nourishing and carminative therapies
–        Dietetic regimen
–        Meat of different animals and birds given in disguised form
–        Mamsa, mamsarasa, yusa – meat, meat-soup and soup
–        Aja mamsarasa in pulmonary tuberculosis
–        Wines in pulmonary tuberculosis
–        Ghrta Yogas
–        Ghrta Yogas – Jivantyadi Ghrta
–        Ghrta Yogas – Kharjuradi Ghrta
–        Ghrta Yogas – Dasamula Ghrta
–        Ghrta Yogas – Panca Pancamuli Ghrta
–        Ghrta Yogas – Satpala Ghrta
–        Ghrta Yogas – Rasnadi Ghrta
–        Ghrta Yogas – Mamsa Sarpi
–        Ghrta Yogas – Eladi Ghrta
–        Sarpiguda
–        Svarasada Cikitsa – treatment of hoarseness of voice
–        Treatment of hoarseness of voice caused by vitiated vata
–        Badaripatra kalka
–        Madhukadi Taila Nasya
–        Gudodana, snehana and swedana in pulmonary tuberculosis
–        Treatment of hoarseness of voice caused by vitiated pitta
–        Baladi Ghrita
–        Prapaundarikadi Ghrita Nasya
–        Sweet tasting medicines
–        Treatment of hoarseness of voice caused by vitiated kapha
–        Use of Yavagu (gruel)
–        Treatment of hoarseness of voice caused due to speaking loudly
–        Treatment of arocaka – loss of taste and appetite
–        Treatment of vataja arocaka
–        Treatment of doshaja arocaka
–        Samasarkara Curna (Eladi Curna)
–        Yavanyadi Curna
–        Talisadi Curna
–        Use of flour paste, emesis and meat
–        Similar treatments for nasal catarrh and vomiting
–        Treatment for nasal catarrh
–        Treatment of conditions caused by aggravation of two doshas
–        Various kinds of suitable therapies
–        Bloodletting, poultice, anointing and pouring medicines
–        Feces as strength of the person suffering from pulmonary tuberculosis
–        Massages in pulmonary tuberculosis
–        Jivantyadi Churna for Massage in pulmonary tuberculosis
–        Herbal water for bathing in pulmonary tuberculosis
–        Daivavyapasraya in pulmonary tuberculosis

Pledge by the author(s)

अथातो राजयक्ष्मादिचिकित्सितं व्याख्यास्याम:  व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘treatment of pulmonary tuberculosis etc’. Thus say (pledge) Atreya and other sages.

Sodhana: Purifactory therapies

बलिनो बहुदोषस्य स्निग्धस्विन्नस्य शोधनम् ।
ऊर्ध्वाधो यक्ष्मिणः कुर्यात्सस्नेहं यन्न कर्शनम् ॥ १ ॥ The patient of yaksmawho is strongwho has great increase of Doshas,who has been administered oleationand sudation therapiesshould be given purifactory therapies ofboth the upward and downward parts (emesis and purgation respectively)using slightly unctuous (fatty) materials,without causing debility.

Vamana: Emesis

पयसा फलयुक्तेन मधुरेण रसेन वा ।
सर्पिष्मत्या यवाग्वा वा वमनद्रव्यसिद्धया ॥ २ ॥
He should be given emesisi therapy using Randia dumetorum mixed with either milk, sweet syrups, or juice (soup) of meat, with the use of thin gruel processed with emetic herbs and added with ghee.

Virechana: Purgation

वमेद्विरेचनं दद्यात्त्रिवृच्छ्यामानृपद्रुमान् ।
शर्करामधुसर्पिर्भिः पयसा तर्पणेन वा ॥ ३ ॥
द्राक्षाविदारीकाश्मर्यमांसानां वा रसैर्युतान् ।
After Vamana therapy, purgation may be produced trivṛt – with the use of Operculina turpethum, śyāmā – variety of Operculina turpethum, nṛpadrumān – and Cassia fistula mixed with sugar, honey and ghee; or with milk mixed together with nutritive juices drākṣā – of Vitis vinifera, vidārī – Pueraria tuberosa, kāśmarya – Gmelina arborea, māṃsānāṃ vā rasai: – or meat juice.

Brimhana and Deepana: Nourishing and digestion kindling therapies

शुद्धकोष्ठस्य युञ्जीत विधिं बृंहणदीपनम् ॥ ४ ॥
हृद्यानि चान्नपानानि वातघ्नानि लघूनि च ।
After the alimentary tract is purified, nourishing and digestion improving therapies should be adopted. Foods and drinks are good to the heart, which mitigate Vata and easily digested should be administered.

Dietetic regimen

शालिषष्टिकगोधूमयवमुद्गं समोषितम् ॥ ५ ॥
लघुमच्युतवीर्यं च सुजरं बलकृच्च यत् ॥ ५+(१)॥
आजं क्षीरं घृतं मांसं क्रव्यान्मांसं च शोषजित् ।
śāli – Oryza sativa, ṣaṣṭika – paddy grown in 60 days, godhūma – Triticum aestivum, yava – Hordeum vulgare, mudgaṃm – Vigna radiata; which are old by one year, which are light, not lost their potency, easily digestible, and strengthening, milk, ghee and flesh of goat, and meat of carnivorous animals all these cure consumption.

Meat of different animals and birds given in disguised form

काकोलूकवृकद्वीपिगवाश्वनकुलोरगम् ॥ ६ ॥
गृध्रभासखरोष्ट्रं च हितं छद्मोपसंहितम् ।
ज्ञातं जुगुप्सितं तद्धि च्छर्दिषे न बलौजसे ॥ ७ ॥
Meat of Crow, Owl, Jackal, Tiger, Ox, Horse, Mongoose, Snake, Hawk, Bird vulture, Donkey, or Camel, is beneficial when administered secretly (without revealing their name to the patients) because, if made known, it will create disgust and vomiting and does not increase strength and vigor.

Mamsa, mamsarasa, yusa: Meat, meat-soup and soup

मृगाद्याः पित्तकफयोः पवने प्रसहादयः ।
वेसवारीकृताः पथ्या रसादिषु च कल्पिताः ॥ ८ ॥
भृष्टाः सर्षपतैलेन सर्पिषा वा यथायथम् ।
रसिका मृदवः स्निग्धाः पटुद्रव्याभिसंस्कृताः ॥ ९ ॥
हिता मौलककौलत्थास्तद्वद्यूषाश्च साधिताः ।
Meat of deer etc., made into Vesavara (meat steamed and mixed with Ghee, sugar, Pippali and marica) or juice (soup) of meat is formulated and prepared. Fried in the oil of Mustard or ghee whichever is suitable, juicy dish, soft, unctuous (fatty), processed with salt etc. (spices etc.) is good when Pitta and Kapha are predominant meat of Prasaha etc, when Vata is Predominant. Gruel of maulaka – Raphanus sativus, kaulatthā: ca – or Dolichos bifolrus prepared in the same manner (with addition of salt, spices ghee etc.)

Aja mamsarasa in pulmonary tuberculosis

सपिप्पलीकं सयवं सकुलत्थं सनागरम् ॥ १० ॥
सदाडिमं सामलकं स्निग्धमाजं रसं पिबेत् ।
तेन षड्विनिवर्तन्ते विकाराः पीनसादयः ॥ ११ ॥
Juice (soup) of meat of goat should be consumed with pippalīkaṃ – Piper longum, sayavaṃ – Hordeum vulgare, sakulatthaṃ – Dolichos biflorus, sanāgaram – Zingiber officinale, dāḍimaṃ – Punica granatum, āmalakaṃ – Emblica officinalis and made unctuous (and mixed with fats such as ghee). By this the six abnormalities (symptoms) such as nasal catarrh etc. get relieved.

Wines in pulmonary tuberculosis

पिबेच्च सुतरां मद्यं जीर्णं स्रोतोविशोधनम् ।
पित्तादिषु विशेषेण मध्वरिष्टाच्छवारुणीः ॥ १२ ॥
सिद्धं वा पञ्चमूलेन तामलक्याथवा जलम् ।
पर्णिनीभिश्चतसृभिर्धान्यनागरकेण वा ॥ १३ ॥
कल्पयेच्चानुकूलोऽस्य तेनान्नं शुचि यत्नवान् ।
Old wine which purifies (clears) Kapha and the channels (tissue pores) should be consumed frequently fermented liquid of honey, scum of varuni liquor, or water boiled with pañcamūlena – herbs of pancamula (Laghu), tāmalakyā – Phyllanthus niruri, parṇinībhi: catasṛbhi: – or with catasparni (the four parni- Saliparni, Prsniparni, Masaparni, and Mudgaparni), dhānya – Coriandrum sativum, nāgara – Zingiber officinale, whichever is suitable to him; should be made use of to prepare the food by the cook who is clean and skillful, especially in those caused by pitta etc.

Ghrita Yogas

दशमूलेन पयसा सिद्धं मांसरसेन वा ॥ १४ ॥
बलागर्भं घृतं योज्यं क्रव्यान्मांसरसेन वा ।
Medicated ghee prepared with decoction of herbs of Dasamula along with either milk or meat juice and Sida cordifolia, (made into paste to be inside) should be added followed by drinking of juice of meat of carnivorous animals; or ghee prepared from ten parts of milk and (one part of paste of Sida cordifolia) consumed along with honey.

Ghrita Yogas: Jivantyadi Ghrita

जीवन्तीं मधुकं द्राक्षां फलानि कुटजस्य च ।
पुष्कराह्वं शठीं कृष्णां व्याघ्रीं गोक्षुरकं बलाम् ॥ १६ ॥
नीलोत्पलं तामलकीं त्रायमाणां दुरालभाम् ।
कल्कीकृत्य घृतं पक्वं रोगराजहरं परम् ॥ १७ ॥
jīvantīṃ – Leptadenia reticulata,madhukaṃ – Glycyrrhiza glabra,drākṣāṃ – Vitis vinifera,phalāni kuṭajasya ca – Fruits of Holarrhena antidysenterica,puṣkarāhvaṃ – Inula racemosa,śaṭhīṃ – Curcuma zedoaria,kṛṣṇāṃ – Piper longum,vyāghrīṃ – Solanum xanthocarpum,gokṣurakaṃ – Tribulus terrestris,balām – Sida cordifolia,nīlotpalaṃ – Nymphaea nouchali,tāmalakīṃ – Phyllanthus fraternus,trāyamāṇāṃ – Gentiana kurroo,durālabhām – Fagonia cretica,  (all these) made into pasteand ghee processed with them (when used)is the best in curing the king of diseases (pulmonary tuberculosis).

Ghrita Yogas: Kharjuradi Ghrita

घृतं खर्जूरमृद्वीकामधुकैः सपरूषकैः ।
सपिप्पलीकं वैस्वर्यकासश्वासज्वरापहम् ॥ १८ ॥
Medicated ghee prepared withkharjūra – Phoenix dactylifera,mṛdvīkā – Vitis vinifera,madhuka – Glycyrrhiza glabra,saparūṣak – Grewia asiatica, pippalīka – Piper longum vaisvarya – cures hoarseness of voice,kāsa – cough,śvāsa – dysponeajvara – and fever.

Ghrita Yogas: Dasamula Ghrita

दशमूलशृतात्क्षीरात्सर्पिर्यदुदियान्नवम् ।
सपिप्पलीकं सक्षौद्रं तत्परं स्वरबोधनम् ॥ १९ ॥
शिरःपार्श्वांसशूलघ्नं कासश्वासज्वरापहम् ।
पञ्चभिः पञ्चमूलैर्वा शृताद्यदुदियाद्घृतम् ॥ २० ॥
Milk is cooked with daśamūla – group of 10 herbs and fresh ghee obtained from it (boiled milk is churned butter obtained and melted) added with pippalīka – Piper longum and honey is best to restore the voice, relieve the pain of the head, flanks and shoulders; kāsa – cough, dysponea, jvara – fever. Ghee obtained from milk boiled with herbs of the five Panchamula (vide chapter 6 of Sutrasthana) (acts similarly).

Ghrita Yogas: Pancha Panchamuli Ghrita

पञ्चानां पञ्चमूलानां रसे क्षीरचतुर्गुणे ।
सिद्धं सर्पिर्जयत्येतद्यक्ष्मणः सप्तकं बलम् ॥ २१ ॥
Ghee prepared from the juice (decoction) of the herbs of the five Panchamula, and four parts of milk wins (cures) the seven battalions (symptoms) of Rajayakshma.

Ghrita Yogas: Satpala Ghrita

पञ्चकोलयवक्षारषट्पलेन पचेद्घृतम् ।
प्रस्थोन्मितं तुल्यपयः स्रोतसां तद्विशोधनम् ॥ २२ ॥
गुल्मज्वरोदरप्लीहग्रहणीपाण्डुपीनसान् ।
श्वासकासाग्निसदनश्वयथूर्ध्वानिलाञ्जयेत् ॥ २३ ॥
Six pala (in total) of – 288gherbs Panchakola (1 pala each – 240 g)and alkali of Hordeum vulgare (1 pala – 48 g) are made into a paste,added to one Prastha of Grtha – 768 g and equal quantity of milk and medicated ghee prepared.This clearsthe channels,cures gulma – abdominal tumors, jvara – fever,udara – enlargement of the abdomen,plīha – disorders of the spleen,grahaṇī – duodenum,pāṇḍu – anaemia,pīnasa – nasal catarrh,śvāsa – dyspnea,kāsa – cough,agnisadana – weak digestion,śvayathu – dropsyand ūrdhva anilān – upward movement of vata.

Ghrita Yogas: Rasnadi Ghrita

रास्नाबलागोक्षुरकस्थिरावर्षाभुवारिणि ।
जीवन्तीपिप्पलीगर्भं सक्षीरं शोषजिद्घृतम् ॥ २४ ॥
अश्वगन्धाशृतात्क्षीराद्घृतं च ससितापयः ।
Medicated ghee prepared with decoction of rāsnā – Pluchea lanceolata, balā – Sida cordifolia, gokṣuraka – Tribulus terrestris, sthirā – Terminalia chebula, varṣābhu – Boerhavia diffusa, jīvantī – paste of Leptadenia reticulata, pippalīgarbhaṃ – Piper longum and milk, cures śoṣa – consumption. Likewise the ghee obtained from milk boiled with decoction of Withania somnifera along with sugar and milk.

Ghrita Yogas: Mamsa Sarpi

साधारणामिषतुलां तोयद्रोणद्वये पचेत् ॥ २५ ॥
तेनाष्टभागशेषेण जीवनीयैः पलोन्मितैः ।
साधयेत्सर्पिषः प्रस्थं वातपित्तामयापहम् ॥ २६ ॥
मांससर्पिरिदं पीतं युक्तं मांसरसेन वा ।
कासश्वासस्वरभ्रंशशोषहृत्पार्श्वशूलजित् ॥ २७ ॥
One Tula of (4.8 kg) meat of animals of temperate regions is cooked in two drona of water (12.288 liters) and reduced to one eighth part, to this are added, the paste of one pala (48g) each of the herbs of Jivaniya Gana (vide chapter 15 of Sutrasathana) and one Prastha of ghee and medicated ghee prepared. This recipe Mamsa sarpi, consumed either alone or along with meat juice (soup) cures disorders of vata, Pitta, kāsa – cough, śvāsa – dyspnea, svarabhraṃśa – loss of voice, śoṣa – consumption, hṛt pārśva śūlajit – pain of the heart and flanks.

Ghrita Yogas: Eladi Ghrita

एलाजमोदात्रिफलासौराष्ट्रीव्योषचित्रकान् ।
सारानरिष्टगायत्रीशालबीजकसम्भवान् ॥ २८ ॥
भल्लातकं विडङ्गं च पृथगष्टपलोन्मितम् ।
सलिले षोडशगुणे षोडशांशस्थितं पचेत् ॥ २९ ॥
पुनस्तेन घृतप्रस्थं सिद्धे चास्मिन्पलानि षट् ।
तवक्षीर्याः क्षिपेत्त्रिंशत्सिताया द्विगुणं मधु ॥ ३० ॥
घृतात्त्रिजातात्त्रिपलं ततो लीढं खजाहतम् ।
पयोऽनुपानं तत्प्राह्णे रसायनमयन्त्रणम् ॥ ३१ ॥
मेध्यं चक्षुष्यमायुष्यं दीपनं हन्ति चाचिरात् ।
मेहगुल्मक्षयव्याधिपाण्डुरोगभगन्दरान् ॥ ३२ ॥
Eight pala each of (384 g) elā – Elettaria cardamom, ajamodā – Trachyspermum ammi, triphalā – fruits of Terminalia chebula, Terminalia bellirica and Emblica officinalis, saurāṣṭrī – Tribulus terrestris, vyoṣa – Piper longum, Piper nigrum and Zingiber officinale, citraka – Plumbago zeylanica; essence of – ariṣṭa – Azadirachta indica, gāyatrī – Acacia catechu, bījaka – Pterocarpus marsupium, bhallātakaṃ – Semecarpus anacardium, viḍaṅgaṃ ca – Embelia ribes are boiled in sixteen times of water and decoction reduced to one- sixteenth part. To this is, added one Prastha – 768 g of ghee and medicated ghee is prepared. To this, after cooling six pala (288 g) of tavakṣīryāḥ – Bamboo manna, thirty pala of(1440 g) sugar, honey double the quantity of ghee (two Prastha -1536g ) is added and three pala (144 g of powder of) trijātāt – Trijataka, all these are mixed by stirring with a ladle and licked(consumed). This recipe consumed in the morning (daily) followed by drinking of milk, without much restrictions (in diet and activities) rasāyanaṃ – is a rejuvenator, medhyaṃ – improves intelligence, cakṣuṣyaṃ – eyesight, āyuṣyaṃ – lifespan, dīpanaṃ – and hunger, and cures without delay; meha – diseases such as diabetes, gulma – abnormal tumor, kṣayavyādhi – consumption, pāṇḍuroga – anemia, and bhagandarān – rectal fistula.

Sarpiguda

ये च सर्पिर्गुडाः प्रोक्ताः क्षते योज्याः क्षयेऽपि ते ।
Those sarpiguda recipe described in the treatment of ksata type of Kasa (vide – chapter 3) may be used even in Ksaya (Rajaksama).

Sarpiguda

त्वगेलापिप्पलीक्षीरीशर्करा द्विगुणाः क्रमात् ॥ ३३ ॥
चूर्णिता भक्षिताः क्षौद्रसर्पिषा वावलेहिताः ।
स्वर्याः कासक्षयश्वासपार्श्वरुक्कफनाशनाः ॥ ३४ ॥
tvak – Cinnamomum zeylanica, elā – Elettaria cardamomum, pippalī – Piper longum, kṣīrī – Bamboo manna, śarkarā – sugar, double in quantity in the succeeding order (one, two, four, eight and sixteen parts) consumed either in the form of powder or confection mixed with honey or ghee; is good for the voice, kāsa – and cures cough, kṣaya – consumption, śvāsa – dyspnea, pārśvaruk – pain in the flanks kaphanāśanāḥ – and increase of kapha.

Svarasada Chikitsa: Treatment of hoarseness of voice

विशेषात्स्वरसादेऽस्य नस्यधूमादि योजयेत् ।
For a person who is having hoarseness of voice, nasal medications, inhalation of smoke and such other therapies should be specially administered.

Treatment of hoarseness of voice caused by vitiated vata

तत्रापि वातजे कोष्णं पिबेदौत्तरभक्तिकम् ॥ ३५ ॥
कासमर्दकवार्ताकीमार्कवस्वरसैर्घृतम् ।
साधितं कासजित्स्वर्यं सिद्धमार्तगलेन वा ॥ ३६ ॥
Especially the medicated ghee prepared with fresh juice of kāsamardaka – Cassia occidentalis, vārtākī – Solanum indicum, mārkava – Eclipta alba should be consumed warm in case of (hoarseness) arising from vata after meals. It cures cough and is good for voice. Similarly the ghee prepared from (juice of) ārtagalena vā – Acanthus ilicifolius.

Badaripatra kalka

बदरीपत्रकल्कं वा घृतभृष्टं ससैन्धवम् ।
Paste of leaves of badarī patra – Ziziphus mauritiana fried in ghee and consumed after mixing with Rock salt (acts likewise).

Madhukadi Taila Nasya

तैलं वा मधुकद्राक्षापिप्पलीकृमिनुत्फलैः ॥ ३७ ॥
हंसपद्याश्च मूलेन पक्वं नस्तो निषेचयेत् ।
Medicated oil prepared with (decoction and paste) of madhuka – Glycyrrhiza glabra, drākṣā – Vitis vinifera, pippalī – Piper longum, kṛminut – Embelia ribes, phalaiḥ – Randia dumetorum and roots of haṃsapadyāśca mūlena – Adiantum lunulatum should be instilled into the nose.

Gudodana, snehana and swedana in pulmonary tuberculosis

सुखोदकानुपानं च ससर्पिष्कं गुडौदनम् ॥ ३८ ॥
अश्नीयात् पायसं चैवं स्निग्धं स्वेदं नियोजयेत् ।
The patient should eat cooked rice mixed with jaggery and added with ghee followed by drinking warm water sweet pudding prepared with milk) in the same way. He should be administered sweating therapy preceded by oleation therapy.

Treatment of hoarseness of voice caused by vitiated pitta

पित्तोद्भवे पिबेत्सर्पिः शृतशीतपयोऽनुपः ॥ ३९ ॥
क्षीरिवृक्षाङ्कुरक्वाथकल्कसिद्धं समाक्षिकम् ।
अश्नीयाच्च ससर्पिष्कं यष्टीमधुकपायसम् ॥ ४० ॥
In that (voice hoarseness) arising from Pitta, medicated ghee prepared with decoction and paste of tender leaves of trees with milky sap to be consumed, added with honey and followed by drinking of boiled and cooled milk. He should drink payasa prepared with yaṣṭīmadhuka – Glycirrhiza glabra added with ghee.

Baladi Ghrita

बलाविदारिगन्धाभ्यां विदार्या मधुकेन च ।
सिद्धं सलवणं सर्पिर्नस्यं स्वर्यमनुत्तमम् ॥ ४१ ॥
Medicated ghee prepared with balā – Sida cordifolia, vidārigandhābhyāṃ – Desmodium gangeticum, vidāri – Pueraria tuberose, madhuka – Glycyrrhiza glabra and added with salt instilled into the nose is best for the voice.

Prapaundarikadi Ghrita Nasya

प्रपौण्डरीकं मधुकं पिप्पली बृहती बला ।
साधितं क्षीरसर्पिश्च तत्स्वर्यं नावनं परम् ॥ ४२ ॥
Milk or ghee boiled with prapauṇḍarīkaṃ – Nelumbo nucifera, madhukaṃ – Glycyrrhiza glabra, pippalī – Piper longum, bṛhatī – Solanum indicum, balā – Sida cordifolia, used as Nasal drops is best for voice.

Sweet tasting medicines

लिह्यान्मधुरकाणां च चूर्णं मधुघृताप्लुतम् ।
Powder of herbs of sweet taste, mixed with honey and ghee should be licked.

Treatment of hoarseness of voice caused by vitiated kapha

पिबेत् कटूनि मूत्रेण कफजे रूक्षभोजनः ॥ ४३ ॥
कट्फलामलकव्योषं लिह्यात्तैलमधुप्लुतम् ।
व्योषक्षाराग्निचविकाभार्गीपथ्यामधूनि वा ॥ ४४ ॥
In that (hoarseness of voice) arising from kapha, should consume (powder of) pungent taste along with cow urine should be consumed and dry (fat free, moisture less) foods. Lick the powder of kaṭphala – Myrica esculenta, āmalaka – Emblica officinalis, vyoṣaṃ – Piper longum, Piper nigrum and Zingiber officinale; kṣāra – alkali, agni – Plumbago zeylanica, cavikā – Piper retrofractum, bhārgī – Clerodendrum serratum, pathyā – Terminalia chebula, mixed with honey and mixed with sesame oil and honey.

Use of Yavagu (gruel)

यवैर्यवागूं यमके कणाधात्रीकृतां पिबेत् ।
भुक्त्वाद्यात् पिप्पलीं शुण्ठीं तीक्ष्णं वा वमनं भजेत् ॥ ४५ ॥
Gruel prepared from yava – Hordeum vulgare, ghee and oil, kaṇā – Piper longum, dhātrī – Emblica officinalis should be drunk; or eat (paste of) pippalīṃ – Piper longum, śuṇṭhīṃ – Zingiber officinale after meals. Next, he should be given strong emesis therapy.

Treatment of hoarseness of voice caused due to speaking loudly

शर्कराक्षौद्रमिश्राणि शृतानि मधुरैः सह ।
पिबेत्पयांसि यस्योच्चैर्वदतोऽभिहतः स्वरः ॥ ४६ ॥
He, whose voice is lost due to speaking in high pitch for a long time, should drink milk boiled with herbs of sweet taste added with sugar and honey.

Treatment of Arochaka: loss of taste and appetite

विचित्रमन्नमरुचौ हितैरुपहितं हितम् ।
बहिरन्तर्मृजा चित्तनिर्वाणं हृद्यमौषधम् ॥ ४७ ॥
द्वौ कालौ दन्तपवनं भक्षयेन्मुखधावनैः ।
कषायैः क्षालयेदास्यं धूमं प्रायोगिकं पिबेत् ॥ ४८ ॥
तालीशचूर्णवटकाः सकर्पूरसितोपलाः ।
शशाङ्ककिरणाख्याश्च भक्ष्या रुचिकराः परम् ॥ ४९ ॥
For arochaka (loss of taste and appetite, lack of desire for food) vicitraṃ annaṃ – use of different kinds of food prepared from healthy articles is ideal. And also, external and internal cleanliness, untroubled mind, medicines which are good to the heart (or mind), cleaning the teeth for two times, mouth should be rinsed / washed with the decoctions prepared for mouth wash, prayogika dhuma (inhaling lubricating smoke) should be smoked powder of pills of tālīśa – Abbies webbiana mixed with karpūra – Cinnamomum camphora and sugar candy powder, snacks known as Sasanka Kirana – all these are best to bestow taste.

Treatment of vataja arochaka

वातादरोचके तत्र पिबेच्चूर्णं प्रसन्नया ।
हरेणुकृष्णाकृमिजिद्द्राक्षासैन्धवनागरात् ॥ ५० ॥
एलाभार्गीयवक्षारहिङ्गुयुक्ताद्घृतेन वा ।
In tastelessness arising from Vata, the powder of hareṇu – Pisum sativum, kṛṣṇā – Piper longum, kṛmijit – Embelia ribes, drākṣā – Vitis vinifera, saindhava – rock salt, nāgara – Zingiber officinale; elā – Elettaria cardamomum, bhārgī – Clerodendrum serratum, yava kṣāra – alkali of whole plant of Hordeum vulgare, hiṅgu – and Ferula narthex added with ghee should be licked followed by Prasanna (scum of Varuni wine).

Treatment of doshaja arochaka

छर्दयेद्वा वचाम्भोभिः पित्ताच्च गुडवारिभिः ॥ ५१ ॥
लिह्याद्वा शर्करासर्पिर्लवणोत्तममाक्षिकम् ।
कफाद्वमेन्निम्बजलैर्दीप्यकारग्वधोदकम् ॥ ५२ ॥
पानं समध्वरिष्टाश्च तीक्ष्णाः समधुमाधवाः ।
पिबेच्चूर्णं च पूर्वोक्तं हरेण्वाद्युष्णवारिणा ॥ ५३ ॥
Vomiting induced by drinking the water boiled with Acorus calamus (in Vataja), by drinking solution of Jaggery or by licking sugar, ghee, rock salt, and honey in Pittaja; in that caused by Kapha, vomiting should be induced by drinking decoction of Azadirachta indica, dīpyaka – Cuminum cyminum, āragvadha udakam – decoction of Cassia fistula or drinking strong Madhvarishta (aristas – fermented decoction prepared from honey) mixed with honey (at the time of drinking) or alcohol prepared with honey or drink warm water mixed with the powder of herbs mentioned earlier; or with that off Pisum sativum.

Samasharkara Churna (Eladi Churna)

एलात्वङ्नागकुसुमतीक्ष्णकृष्णामहौषधम् ।
भागवृद्धं क्रमाच्चूर्णं निहन्ति समशर्करम् ॥ ५४ ॥
प्रसेकारुचिहृत्पार्श्वकासश्वासगलामयान् ।
elā -Elettaria cardamomum, tvak – Cinnamomum zeylanicum, nāgakusuma – Mesua ferrea, tīkṣṇa – Aconitum ferox, kṛṣṇā – Piper longum, mahauṣadham – Zingiber officinale each increases by one part in succeeding order, and added with equal quantity of sugar; destroys – praseka – excessive salivation (nausea), aruci – tastelessness, hṛt pārśva – diseases of the heart and flank, galāmayān – diseases of throat, kāsa – cough śvāsa – and dyspnea.

Yavanyadi Churna

यवानीतिन्तिडीकाम्लवेतसौषधदाडिमम् ॥ ५५ ॥
कृत्वा कोलं च कर्षांशं सितायाश्च चतुःपलम् ।
धान्यसौवर्चलाजाजीवराङ्गं चार्धकार्षिकम् ॥ ५६ ॥
पिप्पलीनां शतं चैकं द्वे शते मरिचस्य च ।
चूर्णमेतत्परं रुच्यं हृद्यं ग्राहि हिनस्ति च ॥ ५७ ॥
विबन्धकासहृत्पार्श्वप्लीहार्शोग्रहणीगदान् ।
One Karsa each of(12g) yavānī – Trachyspermum ammi, tintiḍīka – Rhus parviflora, amlavetasa – Garcinia pedunculata, auṣadha – Zingiber officinale, dāḍimam – Punica granatum, kolaṃ ca – Ziziphus mauritiana. Four pala (192g) of sugar, half Karsa each of(6g) dhānya – Coriandrum sativum, sauvarcala – Sauvarchala salt, ajājī – Cuminum cyminum, varāṅgaṃ ca – Cinnamomum zeylanicum, pippalīnāṃ – Piper longum one hundred (in number), two hundred (by numbers) Piper nigrum all are powdered nicely. This is good for improving the taste, for the heart; and is water absorbent, vibandha – and cures constipation, kāsa – cough, hṛt pārśva – pain in the heart and flanks, plīha – diseases of the spleen, arśo – hemorrhoids, grahaṇīgadān – and duodenal diseases.

Talisadi Churna

तालीशपत्रं मरिचं नागरं पिप्पली शुभा ॥ ५८ ॥
यथोत्तरं भागवृद्ध्या त्वगेले चार्धभागिके ।
तद्रुच्यं दीपनं चूर्णं कणाष्टगुणशर्करम् ॥ ५९ ॥
कासश्वासारुचिच्छर्दिप्लीहहृत्पार्श्वशूलनुत् ।
पाण्डुज्वरातिसारघ्नं मूढवातानुलोमनम् ॥ ६० ॥
tālīśapatraṃ – Abies webbiana, maricaṃ – Piper nigrum, nāgaraṃ – Zingiber officinale, pippalī – Piper longum,  śubhā – Bamboo manna increased in quantity in the succeeding order; half part each of tvak – Cinnamomum zeylanicum, ele ca – and Elettaria cardamomum, and mixed with śarkaram – sugar, eight times in quantity of Piper longum are all converted into nice powder. This recipe improves taste dīpanaṃ – and hunger, kāsa – cures cough, śvāsa – dysponea, aruci: – loss of taste and appetite, chardi – vomiting, plīha – enlargement of spleen, hṛt pārśva śūlanut – pain in the heart and flanks, pāṇḍu – anaemia, jvara – fever, atisāraghnaṃ – and diarrhea, mūḍhavāta anulomanam – initiates the downward movement of inactive vata.

Use of flour paste, emesis and meat

अर्कामृताक्षारजले शर्वरीमुषितैर्यवैः ।
प्रसेके कल्पितान्सक्तून्भक्ष्यांश्चाद्याद्बली वमेत् ॥ ६१ ॥
कटुतिक्तैस्तथा शूल्यं भक्षयेज्जाङ्गलं पलम् ।
शुष्कांश्च भक्ष्यान् सुलघूंश्चणकादिरसानुपः ॥ ६२ ॥
Paste of flour of yava soaked in water containing the alkali or ash of Calotropis gigantea and Tinospora cordifolia and kept over- night should be consumed when there is excess salivation. If the patient is strong, he should be made to vomit initially by the use of herbs of pungent and bitter tastes. He should eat roasted meat of animals of desert-like regions, eatables which are dry (moisture or fat free) and easily digestible, followed by drinking the soup of caṇaka – Cicer arietinum etc.

Similar treatments for nasal catarrh and vomiting

पीनसेऽपि क्रममिमं वमथौ च प्रयोजयेत् ।
The same methods should be adopted for the treatment of both pīnasa – nasal catarrh and vamathau – vomiting.

Treatment for nasal catarrh

विशेषात्पीनसेऽभ्यङ्गान्स्नेहान्स्वेदांश्च शीलयेत् ॥ ६४ ॥
स्निग्धानुत्कारिकापिण्डैः शिरःपार्श्वगलादिषु ।
लवणाम्लकटूष्णांश्च रसान्स्नेहोपसंहितान् ॥ ६५ ॥
Especially for pīnasa – nasal catarrh, oil massage, oleation and sudation therapies should be administered,thick paste of herbs, added with fat (oil) should be applied (as poultice) on the head, flanks and throat; meat soup having lavaṇa – salt, amla – sour kaṭu – and pungent tastes, warmed and mixed with fats (ghee etc) should be consumed.

Treatment of conditions caused by aggravation of two doshas

शिरोंऽसपार्श्वशूलेषु यथादोषविधिं चरेत् ।
औदकानूपपिशितैरुपनाहाः सुसंस्कृताः ॥ ६६ ॥
तत्रेष्टाः सचतुःस्नेहा दोषसंसर्ग इष्यते ।
प्रलेपो नतयष्ट्याह्वशताह्वाकुष्ठचन्दनैः ॥ ६७ ॥
बलारास्नातिलैस्तद्वत्ससर्पिर्मधुकोत्पलैः ।
पुनर्नवाकृष्णगन्धाबलावीराविदारिभिः ॥ ६८ ॥
In case of pain in the head, shoulders and flanks, treatments appropriate to the aggravated dosha should be done; application of warm poultice prepared from meat of animals living in water and marshy lands processed with all the four fats (ghee, oil, muscle fat and marrow), is desirable. In case of aggravation of two doshas, application of paste (as poultice) either of nata – Oroxylum indicum / Holoptelea integrifolia, yaṣṭyāhva – Glycyrrhiza glabra, śatāhvā – Anethum graveolens, kuṣṭha – Saussurea lappa, candana – Santalum album; balā – Sida cordifolia, rāsnā – Pluchea lanceolata, tila – Sesamum indicum; punarnavā – Boerhavia diffusa, kṛṣṇa – Piper longum, gandhā – Paederia foetida, Sida cordifolia, vīrā – Jasminum multiflorum, vidāri – Pueraria tuberose, madhuka – Glycyrrhiza glabra, utpalaiḥ – Nymphaea stellata tadvat sasarpi: – mixed with ghee should be done.

Various kinds of suitable therapies

नावनं धूमपानानि स्नेहाश्चौत्तरभक्तिकाः ।
तैलान्यभ्यङ्गयोगीनि वस्तिकर्म तथा परम् ॥ ६९ ॥
Nasal medication, inhalation of smoke (of herbs), drinking of fats after meals (oleation therapy), massaging (the body and head) with suitable oil and enema therapy are also best suited.

Bloodletting, poultice, anointing and pouring medicines

शृङ्गाद्यैर्वा यथादोषं दुष्टमेषां हरेदसृक् ।
प्रदेहः सघृतैः श्रेष्ठः पद्मकोशीरचन्दनैः ॥ ७० ॥
दूर्वामधुकमञ्जिष्ठाकेसरैर्वा घृताप्लुतैः ।
वटादिसिद्धतैलेन शतधौतेन सर्पिषा ॥ ७१ ॥
अभ्यङ्गः पयसा सेकः शस्तश्च मधुकाम्बुना ।
By the use of Shringa (sucking horn) and others (leech, gourd and lancet) according to the dosha aggravated, vitiated blood should be removed. Application of warm paste (in the form of poultice) of either of padmaka – Prunus cerasoides, uśīra – Vetiveria zizanioides, candana – Santalum album mixed with ghee is the best. dūrvā – Cynodon dactylon, madhuka – Glycyrrhiza glabra, mañjiṣṭhā – Rubia cordifolia, kesara – Mesua ferrea mixed with ghee should be used for bathing. Anointing the body with oil prepared from Ficus benghalensis and other trees or massage using with ghee washed a hundred times, followed with pouring warm milk or water boiled with Glycyrrhiza glabra are beneficial.

Feces as strength of the person suffering from pulmonary tuberculosis

प्रायेणोपहताग्नित्वात्सपिच्छमतिसार्यते ॥ ७२ ॥
तस्यातीसारग्रहणीविहितं हितमौषधम् ।
पुरीषं यत्नतो रक्षेच्छुष्यतो राजयक्ष्मिणः ॥ ७३ ॥
सर्वधातुक्षयार्तस्य बलं तस्य हि विड्बलम् ।
मांसमेवाश्नतो युक्त्या मार्द्वीकं पिबतोऽनु च ॥ ७४ ॥
अविधारितवेगस्य यक्ष्मा न लभतेऽन्तरम् ।
सुरां समण्डां मार्द्वीकमरिष्टान्सीधुमाधवान् ॥ ७५ ॥
यथार्हमनुपानार्थं पिबेन्मांसानि भक्षयन् ।
स्रोतोविबन्धमोक्षार्थं बलौजःपुष्टये च तत् ॥ ७६ ॥
Probably because of destruction of digestive power, the patient develops diarrhea with slimy feacal matter; for this condition, the treatments are suitable which are indicated for diarrhea and duodenal disorders. The faeces should be retained by all effects in a patient of Rajayakshma (pulmonary tuberculosis) who is becoming emaciated (debilitated) for, a patient depleted of all the dhatus, all his strength is from the faeces only. Meat only should be eaten skillfully and drink prepared with honey should be consumed as after drink. Non-suppression of the urges of the body, not allowing the Yaksma to develop further. surāṃ sa maṇḍāṃ – Scum of Sura, mārdvīkaṃ – Mardvika (wine), ariṣṭa – fermented decoction, sīdhu – liquor prepared from sugarcane juice, mādhavān – liquor prepared from honey, according to the requirement should be used as an after drink, after a meal or meat, in order to clear the obstruction of the channels and increase the strength, immunity and vigour.

Massages in pulmonary tuberculosis

स्नेहक्षीराम्बुकोष्ठेषु स्वभ्यक्तमवगाहयेत् ।
उत्तीर्णं मिश्रकैः स्नेहैर्भूयोऽभ्यक्तं सुखैः करैः ॥ ७७ ॥
मृद्नीयात्सुखमासीनं सुखं चोद्वर्तयेत्परम् ।
The patient should be anointed, then made to sit inside a tub filled with oil, milk and water. After getting out,the whole body should once again be smeared with copious quantity of mishraka sneha (mixture of four fats, viz, oil, ghee, marrow and animal fat) and massaged comfortably, rubbing of the body is done gently by making the person seated comfortably, and then given a comfortable dry massage.

Jivantyadi Churna for Massage in pulmonary tuberculosis

जीवन्तीं शतवीर्यां च विकसां सपुनर्नवाम् ॥ ७८ ॥
अश्वगन्धामपामार्गं तर्कारीं मधुकं बलाम् ।
विदारीं सर्षपान्कुष्ठं तण्डुलानतसीफलम् ॥ ७९ ॥
माषांस्तिलांश्च किण्वं च सर्वमेकत्र चूर्णयेत् ।
यवचूर्णं त्रिगुणितं दध्ना युक्तं समाक्षिकम् ॥ ८० ॥
एतदुद्वर्तनं कार्यं पुष्टिवर्णबलप्रदम् ।
jīvantīṃ – Leptadenia reticulata, śatavīryāṃ ca – Asparagus racemosus, vikasāṃ – Rubia cordifolia, punarnavām – Boerhavia diffusa, aśvagandhām – Withania somnifera, apāmārgaṃ – Achyranthes aspera, tarkārīṃ – Clerodendrum phlomidis, madhukaṃ – Glycyrrhiza glabra, balām – Sida cordifolia, vidārīṃ – Pueraria tuberosa, sarṣapān – Brassica nigra, kuṣṭhaṃ – Saussurea lappa, taṇḍulān – Oryza sativa, atasīphalam – Linum usitatissimum, māṣāṃ – Vigna mungo, tila – Sesamum indicum kiṇvaṃ ca – fermenting agent (one part) are all powdered together; yavacūrṇaṃ – flour of Hordeum vulgare is taken three times and this powder mixed with curds and honey should be used for massaging the body; it bestows nourishment, color, complexion and strength.

Herbal water for bathing in pulmonary tuberculosis

गौरसर्षपकल्केन स्नानीयौषधिभिश्च सः ॥ ८१ ॥
स्नायाद्ऋतुसुखैस्तोयैर्जीवनीयोपसाधितैः ।
He should be given bath daily in water boiled with paste of gaurasarṣapa – white variety of Brassica nigra and prepared with and herbs which are suitable for preparing bathing water, and water boiled with herbs of Jivaniaya gana; such water should be used for bath, made comfortable to the season.

Daivavyapashraya in pulmonary tuberculosis

गन्धमाल्यादिकां भूषामलक्ष्मीनाशनीं भजेत् ॥ ८२ ॥
सुहृदां दर्शनं गीतवादित्रोत्सवसंश्रुतिः ।
वस्तयः क्षीरसर्पींषि मद्यमांससुशीलता ॥ ८३ ॥
दैवव्यपाश्रयं तत्तदथर्वोक्तं च पूजितम् ॥ ८३ऊअब् ॥
Decorating the body with scents, garlands, ornaments etc, which disport inauspiciousness, should be done. Meeting with friends, hearing of songs, playing musical instruments, festivities (celebrations) and hearing auspicious things herbal enemas, ghee extracted from milk daily, use of wine and meat, adopting of good conduct, activities to please benevolent gods and ward off malevolent spirits and methods mentioned in atharva veda all are highly beneficial.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने राजयक्ष्मादिचिकित्सितं नाम पञ्चमोऽध्याय: ॥५॥
Thus, ends the chapter- Rajayaksmadi cikitsita- the fifth in Cikitsita Sthana of Asthanga hrdaya Samhita – composed by Srimad vagbhata, son of Sri Vaidyapati Simhagupta