Ashtanga Hridayam Chikitsa sthanam Chapter 10: Atisara Chikitsitam Adhyaya (Treatments of diarrhea)        

The 10th chapter of Cikitsasthanam of Ashtanga Hridayam is named as Grahanidosha chikitsitam Adhyayah. This chapter deals with the explanation of treatment of duodenal disorders.

The topics covered in this chapter include –

• Treating duodenal disorders on the lines of indigestion
• Gruels and light food in duodenal disorders
• Gruels and other useful drinks in presence of ama in duodenal disorders
• Utility of buttermilk in duodenal disorders
• Amladi Curnam
• Ama destroying measures
• Kalingadi Curna
• Pippalyadi Curna
• Patvadi Curna
• Talisadi Curna
• Deepana Ghrta and Niruha Basti
• Anuvasana and Niruha Vasti, Virechana, Laghu Anna
• Pancamuladi Ghrta
• Pancamuladi Ghrta
• Pittaja Grahani Cikitsa
• Patoladi Curna
• Bhunimbadi Curna
• Nagaradi Curna
• Candanadi Ghrta
• Kaphaja Grahani Cikitsa
• Madhuka Puspasava
• Madhuka Puspasava
• Hingvadi Curnam
• Bhunimbadi Curna
• Haridradi Ksara
• Ksara yogas
• Medicated ghee in Kaphaja Grahani associated with Vata
• Ksara Grta
• Panchakarma
• Treatment of praseka and other associated conditions
• Appraisal of sneha (fats) as best remedy for weak digestive fire
• Balancing samana vata and digestive fire
• Treatment of hardness of faeces
• Treatment of weakness of fire caused due to various causes
• Use of meat and meat soup
• Use of fats and alcoholic drinks
• Importance of fire in the alimentary tract
• Atyagni – Hyperactive digestive system

Pledge by the author (s)

अथातो ग्रहणीदोषचिकित्सितं 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 duodenal disorders. Thus say (pledge) Atreya and other sages.

Treating duodenal disorders on the lines of indigestion

ग्रहणीमाश्रितं दोषमजीर्णवदुपाचरेत् ।
अतीसारोक्तविधिना तस्यामं च विपाचयेत् ॥ १ ॥
The doshas localized in the Grahani (duodenum) should be treated in the same way as treating ajirna (indigestion). The ama (undigested material) should be cooked by treatments described for Diarrhea.

Gruels and light food in duodenal disorders

अन्नकाले यवाग्वादि पञ्चकोलादिभिर्युतम् ।
वितरेत्पटुलघ्वन्नं पुनर्योगांश्च दीपनान् ॥ २ ॥
At the times of food, Yavagu (thin gruel) etc. added with Panchakola etc. ingredients, light foods added with salt should be given; recipes which increase the digestive power should also be given.

Gruels and other useful drinks in presence of ama in duodenal disorders

दद्यात्सातिविषां पेयामामेसाम्लां सनागराम्।
पानेऽतीसारविहितं वारितक्रं सुरादि च॥३॥
If Ama is present, Peya (thin gruel) containing ativiṣāṃ – Aconitum heterophyllum, sour juice, and nāgara – Zingiber officinale should be given as food. Water, buttermilk and alcoholic drinks, prescribed for Diarrhea should be administered as a drink.

Utility of buttermilk in duodenal disorders

ग्रहणीदोषिणां तक्रं दीपनग्राहिलाघवात् ।
पथ्यं मधुरपाकित्वान्न च पित्तप्रदूषणम् ॥ ४ ॥
कषायोष्णविकाशित्वाद्रूक्षत्वाच्च कफे हितम् ।
वाते स्वाद्वम्लसान्द्रत्वात्सद्यस्कमविदाहि तत् ॥ ५ ॥
For patients of Grahani (duodenal disorder), buttermilk is suited because of its properties such as Dipana (kindling the digestive power), water absorbing, and lightness. Owing to the sweet post-digestion effect, it does not aggravate Pitta. Since it is astringent (in taste), hot (in potency), dilating the channels (tissue Pores) and dry (non-unctuous) it is good for Kapha. Due to sweet and sour tastes, it is good for Vata. By its thick consistency, fresh origin it does not cause burning sensation (during or after digestion).

Amladi Curnam

चतुर्णां प्रस्थमम्लानां त्र्यूषणाच्च पलत्रयम् ।
लवणानां च चत्वारि शर्करायाः पलाष्टकम् ॥ ६ ॥
तच्चूर्णं शाकसूपान्नरागादिष्ववचारयेत् ।
कासाजीर्णारुचिश्वासहृत्पाण्डुप्लीहगुल्मनुत् ॥ ७ ॥

768 grams of the four Sours i.e; Kola (Ziziphus jujuba), Dadima (Punica granatum), Vrksamla (Garcinia indica) and Cukrika (Rumex vesicarius), three Pala (144 grams) of Piper longum, Piper nigrum and Zingiber officinale, four Pala (192 grams) of all the salts (saindhava, Sauvarcala, Bida, samudra) eight Pala (384 grams) of sugar together converted into fine powder and used along with vegetables, soup, rice, sweet syrup etc., kāsa – cures cough, ajīrṇa – indigestion, aruci – loss of taste / appetite, śvāsa – dyspnoea, hṛt – heart disease, pāṇḍu – anemia, plīha – splenic disorders, gulma – and abdominal tumors.

Ama destroying measures

नागरातिविषामुस्तं पाक्यमामहरं पिबेत् ।
उष्णाम्बुना वा तत्कल्कं नागरं वाऽथवाऽभयाम् ॥ ८ ॥
ससैन्धवं वचादिं वा तद्वन्मदिरयाऽथवा ।
nāgara – Zingiber officinale, ativiṣā – Aconitum heterophyllum, mustaṃ – and Cyperus rotundus made into decoction and consumed relieves Ama; or the paste of these herbs mixed with hot water; or the paste of Zingiber officinale or of abhayā – Terminalia chebula (with hot water), Or vacā – Acorus calamus etc. herbs, along with rock salt should be used in the same way (with hot water) or with madira (fermented liquor).

Ama destroying measures

वर्चस्यामे सप्रवाहे पिबेद्वा दाडिमाम्बुना ॥ ९ ॥
विडेन लवणं पिष्टं बिल्वचित्रकनागरम् ।
सामे कफानिले कोष्ठरुक्करे कोष्णवारिणा ॥ १० ॥
If the feces are associated with Ama and eliminated with straining, viḍena lavaṇaṃ – Vida salt made into a paste with decoction (or juice) of Punica granatum should be consumed; if Vata and Kapha are mixed with Ama and producing pain in the alimentary tract, the paste of bilva – Aegle marmelos, citraka – Plumbago zeylanica, nāgaram – Zingiber officinale should be consumed with lukewarm water.

Kalingadi Curna

कलिङ्गहिङ्ग्वतिविषावचासौवर्चलाभयम् ।
छर्दिहृद्रोगशूलेषु पेयमुष्णेन वारिणा ॥ ११ ॥
पथ्यासौवर्चलाजाजीचूर्णं मरिचसंयुतम् ।
If there is vomiting, heart disorder, and abdominal pain, then (the powder of) Holarrhena antidysenterica, Ferula narthex, Aconitum heterophyllum, Acorus calamus, Black salt and Terminalia chebula; or the powder of Terminalia chebula Black salt Cuminum cyminum and Piper nigrum should be consumed along with hot water.

Pippalyadi Churna

पिप्पलीं नागरं पाठां शारिवां बृहतीद्वयम् ॥ १२ ॥
चित्रकं कौटजं क्षारं तथा लवणपञ्चकम् ।
चूर्णीकृतं दधिसुरातन्मण्डोष्णाम्बुकाञ्जिकैः ॥ १३ ॥
पिबेदग्निविवृद्ध्यर्थं कोष्ठवातहरं परम् ।
pippalīṃ – Piper longum, nāgaraṃ – Zingiber officinale, pāṭhāṃ – Cissampelos pareira, śārivāṃ – Hemidesmus indicus, bṛhatīdvayam – the two Brthati (Solanum indicum and Solanum xanthocarpum), citrakaṃ – Plumbago zeylanica, kauṭajaṃ – seeds of Holarrhena antidysenterica, kṣāraṃ – Yavaksara – alkali of Hordeum vulgare, and the five Lavana (salts); all these are powdered nicely and consumed along with curds, scum of beer, hot water or rice gruel for increasing the strength of the digestive fire and is best for mitigating Vata present in the alimentary tract.

Patvadi Churna

पटूनि पञ्च द्वौ क्षारौ मरिचं पञ्चकोलकम् ॥ १४ ॥
दीप्यकं हिङ्गु गुटिका बीजपूररसे कृता ।
कोलदाडिमतोये वा परं पाचनदीपनी ॥ १५ ॥
Pills made from the powder of the five salts, two alkali, maricaṃ – Piper nigrum, Pancakola (Piper longum, Piper nigrum, Piper retrofractum, Plumbago zeylanica and Zingiber officinale), dīpyakaṃ – Cuminum cyminum, hiṅgu – Ferula narthex, and using the juice of bījapūra – Citrus medica or juice of kola – Ziziphus jujube or dāḍima – Punica granatum are best digestive and carminative.

Talisadi Churna

तालीशपत्रचविकामरिचानां पलं पलम् ।
कृष्णातन्मूलयोर्द्वे द्वे पले शुण्ठीपलत्रयम् ॥ १६ ॥
चतुर्जातमुशीरं च कर्षांशं श्लक्ष्णचूर्णितम् ।
गुडेन वटकान् कृत्वा त्रिगुणेन सदा भजेत् ॥ १७ ॥
मद्ययूषरसारिष्टमस्तुपेयापयोऽनुपः ।
वातश्लेष्मात्मनां छर्दिग्रहणीपार्श्वहृद्रुजाम् ॥ १८ ॥
ज्वरश्वयथुपाण्डुत्वगुल्मपानात्ययार्शसाम् ।
प्रसेकपीनसश्वासकासानां च निवृत्तये ॥ १९ ॥
अभयां नागरस्थाने दद्यात्तत्रैव विड्ग्रहे ।
छर्द्यादिषु च पैत्तेषु चतुर्गुणसितान्विताः ॥ २० ॥
पक्वेन वटकाः कार्या गुडेन सितयापि वा ।
परं हि वह्निसम्पर्काल्लघिमानं भजन्ति ते ॥ २१ ॥
One Pala (48 grams) each of : tālīśapatra – Abies webbiana, cavikā – Piper retrofractum, marica – and Piper nigrum, two Pala (96 grams) each of kṛṣṇā – Piper longum tat mūlayo: – and its Mula (roots of Piper longum), three pala (144 grams) of śuṇṭhī – Zingiber officinale, one Karsa (12 grams) each of, caturjātaṃ – Cinnamomum zeylanica, Cinnamomum tamala, Elettaria cardamom and Messua ferrea and uśīraṃ– Vetiveria zizanioides are powdered nicely and rolled into pills with three parts of jaggery, should be consumed daily along with wine, soup, meat-soup, fermented decoction, whey, thin gruel or milk as after drinks. It cures chardi – vomiting, grahaṇī – duodenal disorders, pārśva hṛt rujām – pain of the flanks and region of the hearts; jvara – fever, śvayathu – dropsy, pāṇḍutva – anemia, gulma – abdominal tumor, pānātyaya – alcoholism, arśas – piles, praseka – excess salivation, pīnasa – nasal catarrh, śvāsa – dyspnea and kāsa – cough arising from Vata and Kapha. If there is obstruction to feces, abhaya – Terminalia chebula should be used in place of nāgara – Zingiber officinale, if there is vomiting etc. symptoms arising from Pitta, pills should be prepared using sugar four times the quantity, or Pills prepared by cooking the powder either with jaggery or sugar, since these become easily digestible from contact with fire.

Deepana Ghrita and Niruha Basti

अथैनं परिपक्वामं मारुतग्रहणीगदम् ।
दीपनीययुतं सर्पिः पाययेदल्पशो भिषक् ॥२२॥
किञ्चित्सन्धुक्षिते त्वग्नौ सक्तविण्मूत्रमारुतम् ।
द्व्यहं त्र्यहं वा संस्नेह्य स्विन्नाभ्यक्तं निरूहयेत्॥२३॥
तत एरण्डतैलेन सर्पिषा तैल्वकेन वा ।
सक्षारेणानिले शान्ते स्रस्तदोषं विरेचयेत् ॥ २४ ॥
Next, when the Ama gets digested, in duodenal disease of Vata origin, the physician should make the patient consume little quantity of ghee processed with herbs that increase digestive power; After the digestive power gets slightly increased and if there is obstruction to feces, urine and flatus, decoction enema should be administered, once in two days or once in three days. After giving oleation and sudation therapies; when Vata gets mitigated and other Doshas are being eliminated out, the person should be given purgation therapy using either castor oil or tilvaka Ghrta (chapter 21), mixed with alkali.

Anuvasana and Niruha Vasti, Virechana, Laghu Anna

शुद्धरूक्षाशयं बद्धवर्चस्कं चानुवासयेत् ।
दीपनीयाम्लवातघ्नसिद्धतैलेन तं ततः ॥ २५ ॥
निरूढं च विरिक्तं च सम्यक्चाप्यनुवासितम् ।
लघ्वन्नप्रतिसंयुक्तं सर्पिरभ्यासयेत्पुनः ॥ २६ ॥
The patient who has developed constipation due to purification and consequent dryness of the alimentary tract should be given anuvasana (oil enema) with oil prepared from digestion, kindling, sour and anti-vata herbs.

Next, he should be treated with decoction enema, and purgation. After proper oil enema, light foods should be given and use of ghee habitually is resorted to.

Panchamuladi Ghrita

पञ्चमूलाभयाव्योषपिप्पलीमूलसैन्धवैः ।
रास्नाक्षारद्वयाजाजीविडङ्गशठिभिर्घृतम् ॥ २७ ||
शुक्तेन मातुलुङ्गस्य स्वरसेनार्द्रकस्य च ।
शुष्कमूलककोलाम्लचुक्रिकादाडिमस्य च ॥ २८ ॥
तक्रमस्तुसुरामण्डसौवीरकतुषोदकैः ।
काञ्जिकेन च तत्पक्वमग्निदीप्तिकरं परम् ॥ २९ ॥
शूलगुल्मोदरश्वासकासानिलकफापहम् ।
Medicated ghee is prepared with (decoction of) panchamula, abhayā – Terminalia chebula, vyoṣa – Piper longum, Piper nigrum and Zingiber officinale, pippalīmūla – roots of Piper longum, saindhava – rock salt, rāsnā – Pluchea lanceolata, kṣāradvaya – two alkali, ajājī – Cuminum cyminum, viḍaṅga – Embelia ribes, śaṭhi – and Curcuma zedoaria, fermented buttermilk, juice of mātuluṅgasya – Citrus medica, ardraka – Zingiber officinale, śuṣkamūlaka – dry Raphanus sativus, kola – Ziziphus mauritiana, amla cukrikā – sour Rumex vesicarius, sour dāḍima – Punica granatum, buttermilk, whey, scum of beer, sour gruel, water processed with chaff of grains and sour grain, cooked together;

This is best for augmenting digestive fire, śūla – and to cure colic pain, gulma – abdominal tumor, udara – enlargement of the abdomen, śvāsa – dyspnoea, kāsa – cough and aggravated Vata and Kapha.

Panchamuladi Ghrita

सबीजपूरकरसं सिद्धं वा पाययेद्घृतम् ॥ ३० ॥
तैलमभ्यञ्जनार्थं च सिद्धमेभिश्चलापहम् ।
एतेषामौषधानां वा पिबेच्चूर्णं सुखाम्बुना ॥ ३१ ॥
वाते श्लेष्मावृते सामे कफे वा वायुनोद्धते ।
Or ghee prepared with the juice of bījapūraka – Citrus medica should be consumed. Oil prepared from these herbs (pancamula etc.) should be used for massage to mitigate Cala (vata). Or powder of these medicines should be consumed with warm water, if Vata is encircled by Kapha, Kapha is mixed with Ama or Kapha is aggravated by Vata.

Pittaja Grahani Chikitsa

अग्नेर्निर्वापकं पित्तं रेकेण वमनेन वा ॥ ३२ ॥
हत्वा तिक्तलघुग्राहिदीपनैरविदाहिभिः ।
अन्नैः सन्धुक्षयेदग्निं चूर्णैः स्नेहैश्च तिक्तकैः ॥ ३३ ॥
Pitta which afflicts digestive fire (which has undergone increase) should be mitigated either with purgation or emesis therapies and by foods that are bitter, easily digestible, water absorbing, carminative and not causing burning sensation inside. Then after the digestive fire augmented by the use of powder or fats prepared from medicines of bitter taste.

Patoladi Churna

पटोलनिम्बत्रायन्तीतिक्तातिक्तकपर्पटम् ।
कुटजत्वक्फलं मूर्वा मधुशिग्रुफलं वचा ॥ ३४ ॥
दार्वीत्वक्पद्मकोशीरयवानीमुस्तचन्दनम् ।
सौराष्ट्र्यतिविषाव्योषत्वगेलापत्रदारु च ॥ ३५ ॥
चूर्णितं मधुना लेह्यं पेयं मद्यैर्जलेन वा ।
हृत्पाण्डुग्रहणीरोगगुल्मशूलारुचिज्वरान् ॥ ३६ ॥
कामलां सन्निपातं च मुखरोगांश्च नाशयेत् ।
Powder of paṭola – Trichosanthes dioica, nimba – Azadirachta indica, trāyantī – Gentiana kurroo, tiktā – Picrorhiza kurroa, tiktaka – Swertia chirata, parpaṭa – Fumaria parviflora, kuṭaja tvak – bark of Holarrhena antidysenterica, fruits of phala – Holarrhena antidysenterica, mūrvā – Marsdenia tenacissima, madhuśigru – Moringa oleifera, phalaṃ – Randia dumetorum, vacā – Acorus calamus, dārvītvak – bark of Berberis aristata, padmaka – Prunus cerasoides, uśīra – Vetiveria zizanioides, yavānī – Trichosanthes dioica, musta – Cyperus rotundus, candanam – Santalum album, saurāṣṭrī – Coccinia grandis, ativiṣā – Aconitum heterophyllum, vyoṣa – Piper longum, Piper nigrum and Zingiber officinale, tvak – Cinnamomum zeylanica, elā – Elettaria cardamom, patra – Cinnamomum tamala and dāru – Cedrus deodara; consumed either with honey, wine or water cures hṛt –diseases of the heart, pāṇḍu – anemia, grahaṇīroga – duodenal disease, gulma – abdominal tumor, śūla – pain of the abdomen, aruci – loss of taste / appetite, jvara – fever, kāmalā – Jaundice, sannipātaṃ ca – increase of all the doshas, mukharogāṃśca – and disease of the mouth – cures all these diseases.

Bhunimbadi Churna

भूनिम्बकटुकामुस्तात्र्यूषणेन्द्रयवान् समान् ॥ ३७ ॥
द्वौ चित्रकाद्वत्सकत्वग्भागान् षोडश चूर्णयेत् ।
गुडशीताम्बुना पीतं ग्रहणीदोषगुल्मनुत् ॥ ३८ ॥
कामलाज्वरपाण्डुत्वमेहारुच्यतिसारजित् ।
Powder prepared with equal quantities of bhūnimba – Andrographis paniculata, kaṭukā – Picrorhiza kurroa, mustā – Cyperus rotundus, tryūṣanā – Piper longum, Piper nigrum and Zingiber officinale, indrayavān – and Indrayava (seeds of Holarrhena antidysenterica), dvau citrakāt – two parts of Plumbago zeylanica, and sixteen parts of vatsakatvak – bark of Holarrhena antidysenterica, if consumed along with jaggery or cold water, grahaṇīdoṣa – duodenal disorders and gulma – abdominal tumor will be cured. kāmalā – Jaundice, jvara – fever, pāṇḍutva – anaemia, meha – diabetics, aruci – loss of taste / appetite and atisāra – diarrhea also gets cured.

Nagaradi Churna

नागरातिविषामुस्तापाठाबिल्वं रसाञ्जनम् ॥ ३९ ॥
कुटजत्वक्फलं तिक्ता धातकी च कृतं रजः ।
क्षौद्रतण्डुलवारिभ्यां पैत्तिके ग्रहणीगदे ॥ ४० ॥
प्रवाहिकार्शोगुदरुग्रक्तोत्थानेषु चेष्यते । Equal quantities of nāgara – Zingiber officinale, ativiṣā – Aconitum heterophyllum, mustā – Cyperus rotundus, pāṭhā – Cissampelos pareira, bilva – Aegle marmelos, rasāñjanam – aqueous extract of Berberis aristata, kuṭajatvak phalaṃ – bark and fruit of Holarrhena antidysenterica, tiktā – Swertia chirata, and dhātakī – Woodfordia fruiticosa – all these herbs should be powdered and used along with honey and rice wash is beneficial for duodenal diseases of Pitta origin, pravāhika – dysentery, arśo – piles, gudaruk – and pain in the rectum, rakta utthāneṣu ceṣyate – and diseases arising from blood.

Chandanadi Ghrita

चन्दनं पद्मकोशीरं पाठां मूर्वां कुटन्नटम् ॥ ४१ ॥
षड्ग्रन्थाशारिवास्फोतासप्तपर्णाटरूषकान् ।
पटोलोदुम्बराश्वत्थवटप्लक्षकपीतनान् ॥ ४२ ॥
कटुकां रोहिणीं मुस्तां निम्बं च द्विपलांशकान् ।
द्रोणेऽपां साधयेत्तेन पचेत्सर्पिः पिचून्मितैः ॥ ४३ ॥
किराततिक्तेन्द्रयववीरामागधिकोत्पलैः ।
पित्तग्रहण्यां तत्पेयं कुष्ठोक्तं तिक्तकं च यत् ॥ ४४ ॥
Medicated ghee is prepared with two Pala (96 grams) each of – candanaṃ – Santalum album, padmaka – Prunus cerasoides, uśīraṃ – Vetiveria zizanioides, pāṭhāṃ – Cissampelos pareira, mūrvāṃ – Marsdenia tenacissima, kuṭannaṭam – Oroxylum indicum, ṣaḍgranthā – root of Piper longum, śārivā – Hemidesmus indicus, asphotā – variety of Hemidesmus indicus, saptaparṇa – Alstonia scholaris, āṭarūṣakān – Adhatoda vasica, paṭola – Trichosanthes dioica, udumbara – Ficus racemosa, aśvattha – Ficus religiosa, vaṭa – Ficus benghalensis, plakṣa – Ficus variens, kapītanān – Feronia limonia, kaṭukāṃ rohiṇīṃ – Picrorrhiza kurroa, mustāṃ – Cyperus rotundus, nimbaṃ ca – and Azadirachta indica are boiled in one Drona (12 Litre 228 ml) of water and decoction reduced to one fourth. To this, is added the paste of one picu each of kirātatikta – Swertia chirata, seeds of Holarrhena antidysenterica, Andropogon muricatum, māgadhikā – Piper longum, utpalaiḥ – Nymphaea stellata (and medicated ghee prepared). This should be consumed in duodenal diseases of Pitta origin Tiktaka ghrita described in the treatment of Kustha (chapter 10) may also be used.

Kaphaja Grahani Chikitsa

ग्रहण्यां श्लेष्मदुष्टायां तीक्ष्णैः प्रच्छर्दने कृते ।
कट्वम्ललवणक्षारैः क्रमादग्निं विवर्धयेत् ॥ ४५ ॥
In duodenal disease caused by an increase of Kapha, vomiting should be done by using strong emetic herbs first and then the digestive fire is augmented by the use of herbs of pungent, sour, salted tastes and alkalis in that order.

Kaphaja Grahani Chikitsa

पञ्चकोलाभयाधान्यपाठागन्धपलाशकैः ।
बीजपूरप्रगाढैश्च सिद्धैः पेयादि कल्पयेत् ॥ ४६ ॥
Thin gruel etc. should be prepared, made into thick consistency with pañcakola – Piper longum, roots of Piper longum, Piper retrofractum, Plumbago zeylanica and Zingiber officinale, abhayā – Terminalia chebula, dhānya – Coriandrum sativum, pāṭhā – Cissampelos pareira, gandhapalāśakaiḥ – Curcuma zedoaria and more quantity bījapūra – Citrus medica.

Madhuka Pushpasava

द्रोणं मधूकपुष्पाणां विडङ्गं च ततोऽर्धतः ।
चित्रकस्य ततोऽर्धं च तथा भल्लातकाढकम् ॥ ४७ ॥
मञ्जिष्ठाष्टपलं चैतज्जलद्रोणत्रये पचेत् ।
द्रोणशेषं शृतं शीतं मध्वर्धाढकसंयुतम् ॥ ४८ ॥
एलामृणालागुरुभिश्चन्दनेन च रूषिते ।
कुम्भे मासं स्थितं जातमासवं तं प्रयोजयेत् ॥ ४९ ॥
ग्रहणीं दीपयत्येष बृंहणः पित्तरक्तनुत् ।
शोषकुष्ठकिलासानां प्रमेहाणां च नाशनः ॥ ५० ॥
One drona (12 Kg 228 grams) of flowers of madhūka – Madhuca longifolia half of it (6 Kg 114 grams) viḍaṅgaṃ – Embelia ribes, half of it (quarter drona – 3 Kg 57 grams) citraka – Plumbago zeylanica, one Adhaka (3 Kg 72 grams) of bhallātakā – Semecarpus anacardium, eight pala (384 grams) of mañjiṣṭhā – Rubia cordifolia all these are boiled in three Drona (36 Litres 684 ml) of water and decoction reduced to one drona (12 Litre 228 ml). After cooling, half adhaka (1.536 kg) of honey is added, made fragrant by the powder of elā – Elettaria cardamom, mṛṇāla – Nymphaea stellata, aguru – Aqualaria agallocha, candana – Santalum album, poured into a pot and kept undisturbed for one month. Afterwards, this fermented Asava should be consumed. It stimulates the duodenum, bestows nourishment, mitigates Pitta and Rakta, cures śoṣa – consumption, kuṣṭha – skin disease, kilāsa – leucoderma and prameha – diabetes.

Madhuka Pushpasava

मधूकपुष्पस्वरसं शृतमर्धक्षयीकृतम् ।
क्षौद्रपादयुतं शीतं पूर्ववत् सन्निधापयेत् ॥ ५१ ॥
तत्पिबन् ग्रहणीदोषान् जयेत्सर्वान् हिताशनः ।
Juice of flowers of Madhuca longifolia boiled and reduced to half, is mixed with one fourth quantity of honey cooled, and allowed to undergo fermentation as described earlier.

By its use, the person who partakes all suitable foods gets cured of duodenal disorder. Similar to this, the fermented liquid prepared from the juices of drākṣā – Vitis vinifera, ikṣu – Saccharum officinarum, kharjūra – Phoenix dactylifera should be consumed.  

Hingvadi Churnam

तद्वद्द्राक्षेक्षुखर्जूरस्वरसानासुतान् पिबेत् ॥ ५२ ॥
हिङ्गुतिक्तावचामाद्रीपाठेन्द्रयवगोक्षुरम् ।
पञ्चकोलं च कर्षांशं पलांशं पटुपञ्चकम् ॥ ५३ ॥
घृततैलद्विकुडवे दध्नः प्रस्थद्वये च तत् ।
आपोथ्य क्वाथयेदग्नौ मृदावनुगते रसे ॥ ५४ ॥
अन्तर्धूमं ततो दग्ध्वा चूर्णीकृत्य घृताप्लुतम् ।
पिबेत् पाणितलं तस्मिञ्जीर्णे स्यान् मधुराशनः॥५५॥
वातश्लेष्मामयान् सर्वान् हन्याद्विषगरांश्च सः ।
Similarly drākshā – Vitis vinifera, ikṣu – Saccharum officinarum, kharjūra – Phoenix dactylifera, juice of above three should be consumed Karsha (12 grams) each of hiṅgu – Ferula narthex, tiktā – Swertia chirata, vacā – Acorus calamus, mādrī – Gliricidia sepium (?), pāṭhā – Cissampelos pareira, indrayava – seeds of Holarrhena antidysenterica, gokṣuram – Tribulus terrestris and Pancakola (Piper longum, roots of Piper longum, Piper retrofractum, Plumbago zeylanica and Zingiber officinale), one Pala (48 grams) each of the five salts, two Kudava (192 grams) each of ghee and oil, two Prastha (1536 grams) of curds and boiled into decoction over mild fire; when the water gets evaporated and fumes appear inside, the burnt material is taken out, powdered and consumed in doses of one Panitala (12 grams) mixed with ghee, partaking sweet foods only. This cures all diseases arising from Vata and Kapha, also poison and artificial poisons

Bhunimbadi Churna

भूनिम्बं रोहिणीं तिक्तां पटोलं निम्बपर्पटम् ॥ ५६ ॥
दग्ध्वा माहिषमूत्रेण पिबेदग्निविवर्धनम् ।
bhūnimba – Andrographis paniculata, rohiṇī – Picrorhiza kurroa, tiktā – Swertia chirata, paṭola – Trichosanthes dioica, nimba – Azadirachta indica, parpaṭa – Fumaria parviflora are burnt to ashes, which is consumed along with urine of the buffalo, increases digestive power.

Haridradi Kshara

द्वे हरिद्रे वचा कुष्ठं चित्रकः कटुरोहिणी ॥ ५७ ॥
मुस्ता च छागमूत्रेण सिद्धः क्षारोऽग्निवर्धनः ।
Alkali of – dve haridre – Curcuma longa, Berberis aristata, vacā – Acorus calamus, kuṣṭhaṃ – Saussurea lappa, citrakaḥ – Plumbago zeylanica, kaṭurohiṇī – Picrorhiza kurroa and mustā – Cyperus rotundus processed with goats urine increases digestive power.

Kshara yogas

चतुःपलं सुधाकाण्डात्त्रिपलं लवणत्रयात् ॥ ५८ ॥
वार्ताककुडवं चार्कादष्टौ द्वे चित्रकात् पले ।
दग्ध्वा रसेन वार्ताकाद्गुटिका भोजनोत्तराः ॥ ५९ ॥
भुक्तमन्नं पचन्त्याशु कासश्वासार्शसां हिताः ।
विषूचिकाप्रतिश्यायहृद्रोगशमनाश्च ताः ॥ ६० ॥
Four pala (192 grams) of stem of sudhā – Euphorbia neriifolia, three pala (144 grams) of the three salt, one Kudava (192 grams) of Solanum indicum, eight pala (384 grams)of Calotropis gigantean, two pala (96 grams) of Citraka (Plumbago zeylanica) are burnt to ashes and made into pills with the juice of Solanum indicum, and consumed after food; digests the food taken quickly; beneficial in kāsa – cough, śvāsa – dyspnoea, arśasāṃ – piles cures viṣūcikā – a severe form of indigestion having diarrhea and vomiting together, pratiśyāya – nasal catarrh and hṛdroga – heart disease.

Kshara yogas

मातुलुङ्गशठीरास्नाकटुत्रयहरीतकि ।
स्वर्जिकायावशूकाख्यौ क्षारौ पञ्चपटूनि च ॥६१॥
सुखाम्बुपीतं तच्चूर्णं बलवर्णाग्निवर्धनम् ।
Powder of mātuluṅga – Citrus medica, śaṭhī – Curcuma zedoaria, rāsnā – Pluchea lanceolata, kaṭutraya – Piper longum, Piper nigrum and Zingiber officinale, harītaki – Terminalia chebula svarjikā – Sodium carbonate, alkali of yava – Hordeum vulgare and the five salts consumed with warm water enhances strength, complexion and digestive fire.

Medicated ghee in Kaphaja Grahani associated with Vata

श्लैष्मिके ग्रहणीदोषे सवाते तैर्घृतं पचेत् ॥ ६२ ॥
धान्वन्तरं षट्पलं च भल्लातकघृताभयम् ।
In duodenal disease arising from kapha associated with vata, medicated ghee should be prepared with these herbs and consumed, Dhanvantara Ghrita (vide chapter 5) Shatpala Ghrta, Bhallataka Ghrta (chapter 14) or Abhaya Ghrta (chapter 15) may be used instead.

Kshara Ghrita

विडकाचोषलवणस्वर्जिकायावशूकजान् ॥ ६३ ॥
सप्तलां कण्टकारीं च चित्रकं चैकतो दहेत् ।
सप्तकृत्वः स्रुतस्यास्य क्षारस्यार्धाढके पचेत् ॥ ६४ ॥
आढकं सर्पिषः पेयं तदग्निबलवृद्धये ।
Bida (type of black salt), Sodium chloride, alkaline salt, Sodium carbonate, alkali of yava – Hordeum vulgare, saptalāṃ – Euphorbia dracunculoides, kaṇṭakārī – Solanum xanthocarpum, and citraka – Plumbago zeylanica are burnt together half adhaka (1536 grams) of its alkali / ash seven times filtered should be cooked in one adhaka (3 Kg 72 grams) of ghee, this should be consumed to increase the strength of the digestive fire.

Panchakarma

निचये पञ्च कर्माणि युञ्ज्याच्चैतद्यथाबलम् ॥ ६५ ॥
In duodenal disorders arising from all the Doshas together, Pancakarma (the five purifactory therapies, viz emesi purgation, decoction enema, fat-enema, and nasal mediation) should be adopted, suitable to the strength of the patient.

Treatment of praseka and other associated conditions

प्रसेके श्लैष्मिकेऽल्पाग्नेर्दीपनं रूक्षतिक्तकम् ।
योज्यं कृशस्य व्यत्यासात्स्निग्धरूक्षं कफोदये ॥६६॥
क्षीणक्षामशरीरस्य दीपनं स्नेहसंयुतम् ।
दीपनं बहुपित्तस्य तिक्तं मधुरकैर्युतम् ॥६७॥
स्नेहोऽम्ललवणैर्युक्तो बहुवातस्य शस्यते ।
For praseka (excess salivation) arising from slesma in the person who has poor digestive fire (but not emaciated), the digestive fire should be augmented by herbs which are dry (non-unctuous) and bitter, and in the emaciated having more of kapha, by herbs which are unctuous and non-unctuous used alternately; for the person who is emaciated and debilitated, increasing the power of digestive fire should be done with herbs mixed with fats (oil, ghee). For the person who has a great increase of Pitta, augmentation of digestive fire should be done by bitter herbs added with sweet herbs; For the person who has great increase of Vata, it is best done by use of fats mixed with herbs of sour and salt tastes.

Appraisal of sneha (fats) as best remedy for weak digestive fire

स्नेहमेव परं विद्याद्दुर्बलानलदीपनम् ॥ ६८ ॥
नालं स्नेहसमिद्धस्य शमायान्नं सुगुर्वपि ।
Fats alone are best to augment the weak digestive fire, even very heavy foods (not easily digestible or more in quantity) are incapable of mitigating / weakening the digestive fire, augmented by fats.

Balancing samana vata and digestive fire

योऽल्पाग्नित्वात्कफे क्षीणे वर्चः पक्वमपि श्लथम् ॥ ६९ ॥
मुञ्चेत् पट्वौषधयुतं स पिबेदल्पशो घृतम् ।
तेन स्वमार्गमानीतः स्वकर्मणि नियोजितः ॥ ७० ॥
समानो दीपयत्यग्निमग्नेः सन्धुक्षको हि सः ।
The patient who, because of poor digestion and decrease of Kapha, eliminates loose feces, though well cooked, should be given to drink little quantities of ghee processed with salt and Zingiber officinale, by this the Samana Vata brought into its normal path, engaged to do its normal function, it augments the digestive fire because it is the (Samana Vata) that enhances the strength of the digestive fire.

Treatment of hardness of faeces

पुरीषं यश्च कृच्छ्रेण कठिनत्वाद्विमुञ्चति ॥७१॥
स घृतं लवणैर्युक्तं नरोऽन्नावग्रहं पिबेत् ।
The person, who eliminates feces with difficulty, because of its hardness, should drink ghee mixed with salt and prevent it from coming out in the upward direction by consuming food immediately.

Treatment of weakness of fire caused due to various causes

रौक्ष्यान्मन्देऽनले सर्पिस्तैलं वा दीपनैः पिबेत् ॥७२॥
क्षारचूर्णासवारिष्टान् मन्दे स्नेहातिपानतः ।
उदावर्तात्तु योक्तव्या निरूहस्नेहवस्तयः ॥ ७३ ॥
दोषातिवृद्ध्या मन्देऽग्नौ संशुद्धोऽन्नविधिं चरेत् ।
व्याधिमुक्तस्य मन्देऽग्नौ सर्पिरेव तु दीपनम् ॥७४॥
In case of weak digestive activity caused by dry things (foods and activities), he should drink ghee or oil processed with carminative herbs. If weakness of digestive activity results from overdrinking of fats, powder of alkalies should be added to asava or arista (fermented decoction) and consumed. If Udavarta (upward movement of Vata) is present, then decoction enema and oil enema should be administered. If weak digestion function is due to great increase of the Dosha, purifactory therapies followed by regimen of diet should be adopted. In case of weakness of digestive activity, occurring after the cure of the disease, ghee only is the best carminative.

Treatment of weakness of fire caused due to various causes

अध्वोपवासक्षामत्वैर्यवाग्वा पाययेद्घृतम् ।
अन्नावपीडितं बल्यं दीपनं बृंहणं च तत् ॥७५॥
When weakness (of digestive activity) is due to long distance walking, fasting and emaciation. The person should drink yavagu (gruel) or ghee, in the middle of the meal. This confers strength, increases hunger and stoutens the body.

Use of meat and meat soup

दीर्घकालप्रसङ्गात्तु क्षामक्षीणकृशान् नरान् ।
प्रसहानां रसैः साम्लैर्भोजयेत्पिशिताशिनाम् ॥७६॥
लघूष्णकटुशोधित्वाद्दीपयन्त्याशु तेऽनलम् ।
मांसोपचितमांसत्वात्परं च बलवर्धनाः ॥ ७७ ॥
The person who has become incapable of doing any work, debilitated, and emaciated, because of chronic suffering from diseases, should be made to consume food along with juice (soup) of meat of Carnivorous animals of Prasaha kind (vide-chapter of Sustrasthana) mixed with sour subtances, to those accustomed to eat meat; these being easily digestible, hot in potency, pungent and purifactory, augment the digestive fire quickly, and are best to increase the strength (of the person) because these are nourished by meat (of other animals).

Use of fats and alcoholic drinks

स्नेहासवसुरारिष्टचूर्णक्वाथहिताशनैः ।
सम्यक्प्रयुक्तैर्देहस्य बलमग्नेश्च वर्धते ॥ ७८ ॥
With the proper use of fats, Asava, Sura, Arista (fermented drinks) powders and decoctions (of herbs) and suitable foods, when used properly, both the strength and digestive capacity of the person, get increased.

Importance of fire in the alimentary tract

दीप्तो यथैव स्थाणुश्च बाह्योऽग्निः सारदारुभिः ।
सस्नेहैर्जायते तद्वदाहारैः कोष्ठगोऽनलः ॥ ७९ ॥
Just as the external fire burns well and remains steady when fed with hard wood (faggots) and fats, similarly, the fire in the alimentary tract (remains activity and steady) with foods (healthy and mixed with fats).

Importance of fire in the alimentary tract

नाभोजनेन कायाग्निर्दीप्यते नातिभोजनात् ।
यथा निरिन्धनो वह्निरल्पो वाऽतीन्धनावृतः ॥८०॥
The digestive fire does not get kindled by not taking the food and also doesn’t get kindled by eating too much food just like the (external) small quantity of fire not offered with fuel or covered with too much fuel (doesn’t kindle the fire, in fact put it off).

Atyagni: Hyperactive digestive system

यदा क्षीणे कफे पित्तं स्वस्थाने पवनानुगम् ।
प्रवृद्धं वर्धयत्यग्निं तदाऽसौ सानिलोऽनलः ॥ ८१ ॥
पक्त्वाऽन्नमाशु धातूंश्च सर्वानोजश्च सङ्क्षिपन् ।
मारयेत् स्यात् स ना स्वस्थो भुक्ते जीर्णे तु ताम्यति ॥८२॥
तृट्कासदाहमूर्छाद्या व्याधयोऽत्यग्निसम्भवाः ।
When Kapha is decreased, pitta gets increased in its own seat (Amasaya – stomach) followed by Pavana (Vata), getting increased, further increases the digestive fire, then both anila (vata) and anala (pitta) together digests the food quickly and causes depletion of all the tissues of the body and Ojas, and kills the person. Such a person finds comfort by eating food and suffers when it gets digested. tṛṭ – Thirst, kāsa – cough, dāha – burning sensation, mūrchā – fainting etc., are some diseases arising from atyagni (greatly increased digestive activity).

Atyagni: Hyperactive digestive system

तमत्यग्निं गुरुस्निग्धमन्दसान्द्रहिमस्थिरैः ॥ ८३ ॥
अन्नपानैर्नयेच्छान्तिं दीप्तमग्निमिवाम्बुभिः ।
मुहुर्मुहुरजीर्णेऽपि भोज्यान्यस्योपहारयेत् ॥ ८४ ॥
निरिन्धनोऽन्तरं लब्ध्वा यथैनं न विपादयेत् ।
कृशरां पायसं स्निग्धं पैष्टिकं गुडवैकृतम् ॥ ८५ ॥
अश्नीयादौदकानूपपिशितानि भृतानि च ।
मत्स्यान् विशेषतः श्लक्ष्णान् स्थिरतोयचराश्च ये ॥ ८६ ॥
आविकं सुभृतं मांसमद्यादत्यग्निवारणम् ।
Such a greatly increased digestive fire should be brought under control by foods and drinks which possess qualities such as heaviness, unctuous, fatty, slow, solid, cold in potency, and static, just as controlling the external fire by water. He should be given food, again and again, even though he has indigestion, so that it (increased digestive fire) should not kill the person, when there is no fuel (food). After obtaining strength rice boiled with green gram sweet pudding prepared from milk mixed with fats / ghee eatables prepared from corn flour, and derivatives of jaggery, meat of well-fed animals living in water and marshy regions, especially the fish, which are smooth (soft) and living in stagnant water should be consumed. Meat of sheep which is well–fed should be consumed for mitigating greatly increased digestive fire.

Atyagni: Hyperactive digestive system

पयः सहमधूच्छिष्टं घृतं वा तृषितः पिबेत् ॥ ८७ ॥
गोधूमचूर्णं पयसा बहुसर्पिःपरिप्लुतम् ।
आनूपरसयुक्तान् वा स्नेहांस्तैलविवर्जितान् ॥८८॥
श्यामात्रिवृद्विपक्वं वा पयो दद्याद्विरेचनम् ।
असकृत् पित्तहरणं पायसप्रतिभोजनम् ॥ ८९ ॥
When he is thirsty, should drink milk or ghee added with beeswax, milk mixed with flour of wheat and added with more of ghee or drink the soup of meat of animals of marshy land, mixed with fats except oil; milk boiled with Operculina turpethum, should be given to induce purgation, and partake Payasa (milk pudding) repeatedly, at each meal in order to mitigate pitta.

Atyagni: Hyperactive digestive system

यत्किञ्चिद्गुरु मेद्यं च श्लेष्मकारि च भोजनम् ।
सर्वं तदत्यग्निहितं भुक्त्वा च स्वपनं दिवा ॥९०॥
All kinds of foods which are heavy / not easily digestible, fatty and producing Kapha, are good for generally increased digestive fire, so also sleeping during the day after taking food.

Atyagni: Hyperactive digestive system

आहारमग्निः पचति दोषानाहारवर्जितः ।
धातून् क्षीणेषु दोषेषु जीवितं धातुसङ्क्षये ॥९१॥
Fire (digestive fire) cooks the food, in the absence of food, it cooks the Doshas, when the Doshas become decreased, it (fire) cooks the tissues and when the tissues become depleted, it cooks (cuts shorts) the life itself.

Atyagni: Hyperactive digestive system

एतत्प्रकृत्यैव विरुद्धमन्नं संयोगसंस्कारवशेन चेदम् ।
इत्याद्यविज्ञाय यथेष्टचेष्टाश्चरन्ति यत्साऽग्निबलस्य शक्तिः ॥ ९२ ॥
तस्मादग्निं पालयेत्सर्वयत्नैस्तस्मिन्नष्टे याति ना नाशमेव ।
दोषैर्ग्रस्ते ग्रस्यते रोगसङ्घैर्युक्ते तु स्यान्नीरुजो दीर्घजीवी ॥ ९३ ॥
He who indulges in food, as and how he desires without considering whether the food is incompatible by its very nature, by its combination (with other substances), processing etc. and lives on happily, does so by the strength of his digestive fire. Hence the digestive fire should be protected (looked after carefully) by every effort, because when it is lost, the person also becomes lost (dies), when it gets seized by the Doshas, the person gets seized by group of diseases, when it is normal, the person enjoys long life free of diseases.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने ग्रहणीदोषचिकित्सितं नाम दशमोऽध्याय: ॥१॥
Thus ends the chapter Grahanidosha Cikitsita- the tenth of Cikitsita Sthana of Asthangahrdaya Samhita, composed by Srimad Vagbhata, son of sri Vaidyapati Simhagupta.