Ashtanga Hridayam Chikitsa Sthanam Chapter 15: Udara Chikitsitam Adhyaya (Treatments of abdominal enlargements)      

The 15th chapter of Chikitsasthanam of Ashtanga Hridayam is named as Udara Chikitsitam Adhyayah. This chapter deals with the explanation of ‘treatment of abdominal enlargements.’

The topics covered in this chapter include –

• Udara Samanya Cikitsa
• Consumption of Eranda Taila
• Use of Satphala Ghrta
• Use of Nagaradhya Ghrta
• Chitraka Ghrta
• Yavadi Ghrta
• Virechana
• Patoladi Curna
• Gavakshyadi Curna
• Narayana Curna
• Hapushadhya Curna
• Nilinyadi Curna
• Purgative therapies
• Sneha Virecana – Unctuous purgative therapies
• Haritakyadi Ghrta
• Use of Snuk and Trivrt
• Use of ghee
• Use of medicated ghee
• Use of Haritaki, Pippali and Vardhamana Pippali
• Use of Chitraka and other herbs
• Vidangadi Kalka
• Use of Snuhi
• Combating increased vata with medicated oils
• Use of Eranda Taila
• Application of Devadarvadi Pralepa
• Pouring of Vriscikalyadi Kvatha
• Svedana – sudation
• Administering Niruha Vasti
• Administering Tikshna Vasti
• Summary of general treatment of abdominal enlargement
• Vataja Udara Cikitsa
• Pittaja Udara Cikitsa
• Kaphaja Udara Cikitsa
• Sannipataja Udara Cikitsa
• Plihodara Cikitsa
• Rohitaka Ghrta
• Kshara Taila
• Use of Agnikarma, Ksiravasti and other measures
• Baddhodara Cikitsa
• Chidrodara Cikitsa
• Udakodara Cikitsa
• Sastra Cikitsa – surgical operation
• Self control
• Balancing doshas in Udara
• Diet and activities
• Use of Takra (buttermilk) in different Udaras
• Appraisal of Takra (buttermilk)

Pledge by the author (s)

अथात उदरचिकित्सितं 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 abdominal enlargement’. Thus say (pledge) Atreya and other sages.

Udara Samanya Chikitsa

दोषातिमात्रोपचयात्स्रोतोमार्गनिरोधनात् ।
सम्भवत्युदरं तस्मान्नित्यमेनं विरेचयेत् ॥ १ ॥
Udara (enlargement of the abdomen) arises from great increase of the Doshas and consequent obstruction of the orifices of the channels. Hence the patient of Udara should be given purgative therapy every day.

Consumption of Eranda Taila

पाययेत्तैलमैरण्डं समूत्रं सपयोऽपि वा ।
मासं द्वौ वाऽथवा गव्यं मूत्रं माहिषमेव वा ॥ २ ॥
पिबेद्गोक्षीरभुक् स्याद्वा करभीक्षीरवर्तनः ।
दाहानाहातितृण्मूर्छापरीतस्तु विशेषतः ॥ ३ ॥
Castor oil – oil of eraṇḍa – Ricinus communis mixed with cow urine or with cow milk should be consumed for one month or two months or cow urine or buffalo urine may be consumed partaking either milk of cow or of camel only as food; especially so when he is afflicted with burning sensation, distention, severe thirst and fainting.

Consumption of herbal ghees

रूक्षाणां बहुवातानां दोषसंशुद्धिकाङ्क्षिणाम् ।
स्नेहनीयानि सर्पींषि जठरघ्नानि योजयेत् ॥ ४ ॥
Those who are dry, having great increase of Vata, who desire to be cleansed of the Doshas should be administered medicated ghee recipes which produce unctuousness inside and cure enlargement of the abdomen.

Use of Satphala Ghrita

षट्पलं दशमूलाम्बुमस्तुद्व्याढकसाधितम् ।
Satpala Ghrta (chapter 5/22 of Cikitsasthana) prepared with two Adhaka (6 litres 146 ml) of decoction of Dasamula and whey (one Adhaka – 3 litres 72 ml each) should be used.

Use of Nagaradhya Ghrita

नागरत्रिपलं प्रस्थं घृततैलात्तथाऽऽढकम् ॥ ५ ॥
मस्तुनः साधयित्वैतत्पिबेत्सर्वोदरापहम् ।
कफमारुतसम्भूते गुल्मे च परमं हितम् ॥ ६ ॥
Three Palas (144 grams) of Zingiber officinale, one Prastha (768 grams) each of ghee and oil and one Adhaka (3 litres 72 ml) of whey are cooked to form a Medicated ghee and consumed for the cure of all varieties of abdominal enlargements. It is especially suitable in abdominal tumor arising from Kapha and vata.

Chitraka Ghrita

चतुर्गुणे जले मूत्रे द्विगुणे चित्रकात्पले ।
कल्के सिद्धं घृतप्रस्थं सक्षारं जठरी पिबेत् ॥ ७ ॥
Medicated ghee is prepared with four parts of water, two parts of cow urine, paste of one Pala (48 grams) of Plumbago zeylanica and one Prastha (768 grams) of ghrta. This should be consumed mixed with yavaksara by the person having enlargement of the abdomen.

Yavadi Ghrita

यवकोलकुलत्थानां पञ्चमूलस्य चाम्भसा ।
सुरासौवीरकाभ्यां च सिद्धं वा पाययेद्घृतम् ॥ ८ ॥
Medicated ghee prepared with the decoction of yava – Hordeum vulgare, kola – Ziziphus jujube, kulattha – Dolichos biflorus, pañcamūlasya ca – and Pancamula (five roots), added with liquor and sour gruel can also be consumed.

Virechana

एभिः स्निग्धाय सञ्जाते बले शान्ते च मारुते ।
स्रस्ते दोषाशये दद्यात्कल्पदृष्टं विरेचनम् ॥ ९ ॥
The person who, by the use of these recipes has become well lubricated, gains strength, vata mitigated and the seats of Doshas debilitated, then virecana (purgative) recipes mentioned in Kalpasthana (chapter 2) should be administered.

Patoladi Churna

पटोलमूलं त्रिफलां निशां वेल्लं च कार्षिकम् ।
कम्पिल्लनीलिनीकुम्भभागान् द्वित्रिचतुर्गुणान् ॥ १० ॥
पिबेत्सञ्चूर्ण्य मूत्रेण पेयापूर्वं ततो रसैः ।
विरिक्तो जाङ्गलैरद्यात्ततः षड्दिवसं पयः ॥ ११ ॥
शृतं पिबेद्व्योषयुतं पीतमेवं पुनः पुनः ।
हन्ति सर्वोदराण्येतच्चूर्णं जातोदकान्यपि ॥ १२ ॥
Root of paṭolamūla – Trichosanthes dioica, triphalāṃ – Terminalia chebula, Terminalia bellirica and Emblica officinalis, niśāṃ – Curcuma longa and vellaṃ – Embelia ribes each one Karsa (12 grams), kampilla – Mallotus philippensis, nīlinī – Indigofera tinctoria and kumbha – Careya arborea two, three and four parts respectively are made into a nice powder and consumed mixed with cow urine, after purgation. The patient should drink thin gruel first, followed by partaking ricemess mixed with soup of meat of animals of desert-like land. For the next six days, milk boiled with Vyosa (Piper longum, Piper nigrum, Zingiber officinale) only should be taken as food. This powder consumed this way, repeated again and again cures all the varieties of abdominal enlargement even after the collection of fluid inside.

Gavakshyadi Churna

गवाक्षीं शङ्खिनीं दन्तीं तिल्वकस्य त्वचं वचाम् ।
पिबेत्कर्कन्धुमृद्वीकाकोलाम्भोमूत्रसीधुभिः ॥ १३ ॥
Powder of gavākṣīṃ – Citrullus colocynthis, śaṅkhinīṃ – Euphorbia dracunculoides / Canscora decussata, dantīṃ – Baliospermum montanum, tilvakasya tvacaṃ – Bark of Symplocos racemosus and vacām – Acorus calamus should be consumed with either juice of karkandhu – Ziziphus mauritiana, mṛdvīkā – Vitis vinifera, kola – Ziziphus jujube, cow urine or fermented sugarcane juice.

Narayana Churna

यवानी हपुषा धान्यं शतपुष्पोपकुञ्चिका ।
कारवी पिप्पलीमूलमजगन्धा शठी वचा ॥ १४ ॥
चित्रकोऽजाजिकं व्योषं स्वर्णक्षीरी फलत्रयम् ।
द्वौ क्षारौ पौष्करं मूलं कुष्ठं लवणपञ्चकम् ॥ १५ ॥
विडङ्गं च समांशानि दन्त्या भागत्रयं तथा ।
त्रिवृद्विशाले द्विगुणे सातला च चतुर्गुणा ॥ १६ ॥
एष नारायणो नाम चूर्णो रोगगणापहः ।
नैनं प्राप्याभिवर्धन्ते रोगा विष्णुमिवासुराः ॥ १७ ॥
तक्रेणोदरिभिः पेयो गुल्मिभिर्बदराम्बुना ।
आनाहवाते सुरया वातरोगे प्रसन्नया ॥ १८ ॥
दधिमण्डेन विट्सङ्गे दाडिमाम्भोभिरर्शसैः ।
परिकर्ते सवृक्षाम्लैरुष्णाम्बुभिरजीर्णके ॥ १९ ॥
भगन्दरे पाण्डुरोगे कासे श्वासे गलग्रहे ।
हृद्रोगे ग्रहणीदोषे कुष्ठे मन्देऽनले ज्वरे ॥ २० ॥
दंष्ट्राविषे मूलविषे सगरे कृत्रिमे दोषे ।
यथार्हं स्निग्धकोष्ठेन पेयमेतद्विरेचनम् ॥ २१ ॥
Equal quantities of yavānī – Trachyspermum ammi, hapuṣā – Juniperus communis, dhānyaṃ – Coriandrum sativum, śatapuṣpa – Anethum sowa, upakuñcikā – Nigella sativa, kāravī – Carum carvi, pippalīmūlaṃ – roots of Piper longum, ajagandhā – Cleome gynandra, śaṭhī – Curcuma zedoaria, vacā – Acorus calamus, citrako – Plumbago zeylanica, ajājikaṃ – Cuminum cyminum, vyoṣaṃ – Piper longum, Piper nigrum and Zingiber officinale, svarṇakṣīrī – Argemone Mexicana, phalatrayam – Terminalia chebula, Terminalia bellirica and Emblica officinalis, the two alkalis, pauṣkaraṃmūlaṃ – Inula racemosa, kuṣṭhaṃ – Saussurea lappa, the five salts, viḍaṅgaṃ ca – Embelia ribes – (all together forming one part), dantyā – and Baliospermum montanum – three parts; two parts each of trivṛt – Operculina turpethum and viśāle – Citrullus colocynthis four parts of sātalā ca – Euphorbia dracunculoides / Acacia concinna – are all powdered together. This powder known as Narayana curna destroys bunch of diseases. Diseases won’t increase after consuming this just like demons in front of God Vishnu. It should be consumed with buttermilk by patients of enlargement of the abdomen; with juice of Ziziphus jujube by patients of abdominal tumor; with beer in flatulence; with scum of wine in diseases caused by Vata; fluid of curds in constipation; with juice of dāḍima – Punica granatum in hemorrhoids; with vṛkṣāmla – Garcinia indica in cutting pain of the rectum; with hot water in indigestion, with suitable liquids in rectal fistula, anaemia, cough, dyspnoea, hoarseness, heart diseases, disorders of the duodenum, skin disease poor digestion, fever, poisonous bites, root poisons, homicidal poisoning, and arteficial poison. It should be consumed after making the alimentary tract well lubricated (by drinking of fats) this acts as an ideal purgative.

Hapushadhya Churna

हपुषां काञ्चनक्षीरीं त्रिफलां नीलिनीफलम् ।
त्रायन्तीं रोहिणीं तिक्तां सातलां त्रिवृतां वचाम् ॥ २२ ॥
सैन्धवं काललवणं पिप्पलीं चेति चूर्णयेत् ।
दाडिमत्रिफलामांसरसमूत्रसुखोदकैः ॥ २३ ॥
पेयोऽयं सर्वगुल्मेषु प्लीह्नि सर्वोदरेषु च ।
श्वित्रे कुष्ठेष्वजरके सदने विषमेऽनले ॥ २४ ॥
शोफार्शःपाण्डुरोगेषु कामलायां हलीमके ।
वातपित्तकफांश्चाशु विरेकेण प्रसाधयेत् ॥ २५ ॥
Fine powder should be prepared with equal quantities of hapuṣā – Juniperus communis, kāñcana kṣīrī – Argemone Mexicana, triphalā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, nīlinīphalam – fruit of Indigofera tinctoria, trāyantīṃ – Gentiana kurroo, rohiṇīṃ – Picrorhiza kurroa, tiktāṃ – Swertia chirata, sātalāṃ – Euphorbia dracunculoides, trivṛtāṃ – Operculina turpethum, vacām – Acorus calamus, rock salt, black salt and pippalī – Piper longum and consumed with either the juice of dāḍima – Punica granatum, triphalā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, soup of meat, cow urine, or warm water. This recipe is useful in case of abdominal tumour diseases of spleen, all types of enlargement of the abdomen, leucoderma, skin diseases, weak digestion, erratic digestion, dropsy, hamemorrhoids, anaemia, jaundice, advanced state of Jaundice and increase of Vata Pitta and Kapha, by producing quick purgation.

Nilinyadi Churna

नीलिनीं निचुलं व्योषं क्षारौ लवणपञ्चकम् ।
चित्रकं च पिबेच्चूर्णं सर्पिषोदरगुल्मनुत् ॥ २६ ॥
Powder of nīlinīṃ – Indigofera tinctoria, niculaṃ – Barringtonia acutangula, vyoṣaṃ – Piper longum, Piper nigrum and Zingiber officinale, the two alkali the five salts, citrakaṃ ca – and Plumbago zeylanica, consumed with ghee cures enlargement of the abdomen and abdominal tumours.

Purgative therapies

पूर्ववच्च पिबेद्दुग्धं क्षामः शुद्धोऽन्तरान्तरा ।
कारभं गव्यमाजं वा दद्यात् ॥ २७ ॥
The patient who has become thin / weak by these purgative recipes should drink milk of the camel, cow or goat, in between, in the disease associated with complications / in emergency, in the same manner as described earlier (in verses 11-12)

Sneha Virecana: Unctuous purgative therapies

आत्ययिकेगदे ॥ २७ ॥
स्नेहानेव विरेकार्थे दुर्बलेभ्यो विशेषतः।
In case of emergency in the disease, fat (any purgative oil) only can be given to produce purgation especially so to the weak patients.

Haritakyadi Ghrita

हरीतकीसूक्ष्मरजःप्रस्थयुक्तं घृताढकम् ॥ २८ ॥
अग्नौ विलाप्य मथितं खजेन यवपल्लके ।
निधापयेत्ततो मासादुद्धृतं गालितं पचेत् ॥ २९ ॥
हरीतकीनां क्वाथेन दध्ना चाम्लेन संयुतम् ।
उदरं गरं अष्ठीलामानाहं गुल्मविद्रधी ॥ ३० ॥
हन्त्येतत्कुष्ठमुन्मादमपस्मारं च पानतः ।
One prastha (768 grams) of fine powder of harītakī – Terminalia chebula is added to one Adhaka (3 Kg 73 grams) of ghee, melted by fire, churned well with a churner, put into a pot and kept concealed in a heap of barley. After one month it is taken out and filtered, mixed with decoction of harītakī -Terminalia chebula and sour curds and cooked for some time. This ghee consumed (daily) cures enlargement of the abdomen, homicidal poisoning, prostate enlargement, flatulence, abdominal tumour, abscess, skin diseases, insanity and epilepsy.

Ghrita with Snuk Ksheera: Snuk Ksheeradi ghrita

स्नुक्क्षीरयुक्ताद्गोक्षीराच्छृतशीतात्खजाहतात् ॥ ३१ ॥
यज्जातमाज्यं स्नुक्क्षीरसिद्धं तच्च तथागुणम् ।
क्षीरद्रोणं सुधाक्षीरप्रस्थार्धसहितं दधि ॥ ३२ ॥
जातं मथित्वा तत्सर्पिस्त्रिवृत्सिद्धं च तद्गुणम् ।
तथा सिद्धं घृतप्रस्थं पयस्यष्टगुणे पिबेत् ॥ ३३ ॥
स्नुक्क्षीरपलकल्केन त्रिवृताषट्पलेन च ।
एषां चानु पिबेत्पेयां रसं स्वादु पयोऽथवा ॥ ३४ ॥
Ghee, obtained by churning cow milk mixed with milky sap of Euphorbia neriifolia boiled and cooled or ghee processed (boiled) with milky sap of Euphorbia neriifolia, have the same properties (cure diseases enumerated above). Ghee obtained from curds, by churning one drona (12 litres 228 ml) of milk mixed with half prastha (384 ml) of a milky sap of Euphorbia neriifolia and boiled again with (powder of) Operculina turpethum, also acts similarly. One Prastha (768 grams) of ghee, boiled with eight parts of milk; one pala (48 ml) of milky sap of Euphorbia neriifolia and its paste and six pala (288 grams) of trivṛt – Operculina turpethum should be consumed (in suitable dose daily). Each of these recipes should be consumed followed with thin gruel sweet juices or milk.

Regimen to follow after ghee intake

घृते जीर्णे विरिक्तश्च कोष्णं नागरसाधितम् ।
पिबेदम्बु ततः पेयां ततो यूषं कुलत्थजम् ॥ ३५ ॥
After the ghee has been digested, the patient had good purgation, lukewarm water boiled with nāgara – Zingiber officinale should be consumed first, next the thin gruel and the soup of kulattha – Dolichos biflorus should be administered.

Use of ghee

पिबेद्रूक्षस्त्र्यहं त्वेवं भूयो वा प्रतिभोजितः ।
पुनः पुनः पिबेत्सर्पिरानुपूर्व्याऽनयैव च ॥ ३६ ॥
The patient who is dry (abstaining from food) should drink ghee as above, for three days in succession or drinking it in large doses after taking meals daily. In this manner ghee should be consumed again and again.

Use of medicated ghee

घृतान्येतानि सिद्धानि विदध्यात्कुशलो भिषक् ।
गुल्मानां गरदोषाणामुदराणां च शान्तये ॥ ३७ ॥
These medicated ghee recipes are of proven efficacy. The wise physician should administer them for the cure of abdominal tumours, chronic poisoning and enlargement of the abdomen.

Use of medicated ghee

पीलुकल्कोपसिद्धं वा घृतमानाहभेदनम् ।
तैल्वकं नीलिनीसर्पिः स्नेहं वा मिश्रकं पिबेत् ॥ ३८ ॥
Ghee processed with paste of Salvadora persica relieves distension of the abdomen. Either Tilvaka ghrta (vide chapter 21) Nilini sarpis (chapter 14) or Misraka sneha (vide chapter 14) may be consumed (for the same purpose).

Use of Haritaki, Pippali and Vardhamana Pippali

हृतदोषः क्रमादश्नन् लघुशाल्योदनप्रति ।
उपयुञ्जीत जठरी दोषशोषनिवृत्तये ॥ ३९ ॥
हरीतकीसहस्रं वा गोमूत्रेण पयोऽनुपः ।
सहस्रं पिप्पलीनां वा स्नुक्क्षीरेण सुभावितम् ॥ ४० ॥
पिप्पलीवर्धमानं वा क्षीराशी वा शिलाजतु ।
तद्वद्वा गुग्गुलुं क्षीरं तुल्यार्द्रकरसं तथा ॥ ४१ ॥
After the elimination of the Doshas, the Patient should eat little quantity of rice mess in a gradual way. To eliminate the residue of the Doshas, the patient of udara should consume either harītakī – Terminalia chebula a thousand of which, is soaked and macerated with cow urine; or pippalī – Piper longum a thousand of which, is soaked and macerated with milky sap of Euphorbia neriifolia; or Pippali Vardhamana (by increasing the quantity daily) as described for Rasayana therapy (in chapter 39 of uttarasthana) or Silajatu (Asphaltum) or Commiphora mukul or milk mixed with equal quantity of juice of Zingiber officinale; these recipes should be consumed followed by drinking of milk.

Use of Chitraka and other herbs

चित्रकामरदारुभ्यां कल्कं क्षीरेण वा पिबेत् ।
मासं युक्तस्तथा हस्तिपिप्पलीविश्वभेषजम् ॥ ४२ ॥
Paste of citrakā – Plumbago zeylanica, and amaradāru – Cedrus deodara may be consumed along with milk, hastipippalī – or paste of Scindapsus officinalis and viśvabheṣajam – Zingiber officinale may be consumed with milk for a month.

Vidangadi Kalka

विडङ्गं चित्रको दन्ती चव्यं व्योषं च तैः पयः ।
कल्कैः कोलसमैः पीत्वा प्रवृद्धमुदरं जयेत् ॥ ४३ ॥
Paste of viḍaṅgaṃ – Embelia ribes, citraka – Plumbago zeylanica, dantī – Baliospermum montanum, cavyaṃ – Piper retrofractum, and vyoṣaṃ – Piper longum, Piper nigrum and Zingiber officinale, one kola (6 grams) in quantity consumed along with milk, cures abdominal enlargement though advanced.

Use of Snuhi

भोज्यं भुञ्जीत वा मासं स्नुहीक्षीरघृतान्वितम् ।
उत्कारिकां वा स्नुक्क्षीरपीतपथ्याकणाकृताम् ॥ ४४ ॥
Food mixed with snuhī kṣīra – milky sap of Euphorbia neriifolia and ghee should be partaken for one month; or Utkarika (bread/cake) prepared with snukkṣīra – addition of yellow coloured milky sap of Euphorbia neriifolia, pathyā – Terminalia chebula and kaṇā – Piper longum.

Combating increased vata with medicated oils

पार्श्वशूलमुपस्तम्भं हृद्ग्रहं च समीरणः ।
यदि कुर्यात्ततस्तैलं बिल्वक्षारान्वितं पिबेत् ॥ ४५ ॥
पक्वं वा टुण्टुकबलापलाशतिलनालजैः ।
क्षारैः कदल्यपामार्गतर्कारीजैः पृथक्कृतै: ॥ ४६ ॥
When vata has given rise to pain in the flanks, slight rigidity and catching pain in the (region of) the heart, then oil (of Sesamum indicum) mixed with ash of Aegle marmelos should be consumed or oil boiled with alkali of any one of ṭuṇṭuka – Oroxylum indicum, balā – Sida cordifolia, palāśa – Butea monosperma, stem of plant of tila – Sesamum indicum, kadali – Musa paradisiaca, apāmārga – Achyranthes aspera, or tarkārī – Clerodendrum phlomidis may be consumed.

Use of Eranda Taila

कफे वातेन पित्ते वा ताभ्यां वाऽप्यावृतेऽनिले ।
बलिनः स्वौषधयुतं तैलमेरण्डजं हितम् ॥ ४७ ॥
When either kapha or Pitta are covered / hindered by Vata or vata being covered by them (Kapha and pitta) in a strong patient, drinking castor oil mixed with suitable herbs appropriate to the covering Dosha is beneficial.

Application of Devadarvadi Pralepa

देवदारुपलाशार्कहस्तिपिप्पलिशिग्रुकैः ।
साश्वकर्णैः सगोमूत्रैः प्रदिह्यादुदरं बहिः ॥ ४८ ॥
The abdomen should be covered externally with a warm paste of devadāru – Cedrus deodara, palāśa – Butea monosperma, arka – Calotropis gigantea, hastipippali – Scindapsus officinalis, śigru – Moringa oleifera and, aśvakarṇaiḥ – Shorea robusta macerated with cow urine.

Pouring of Vrischikalyadi Kvatha

वृश्चिकालीवचाशुण्ठीपञ्चमूलपुनर्नवात् ।
वर्षाभूधान्यकुष्ठाच्च क्वाथैर्मूत्रैश्च सेचयेत् ॥ ४९ ॥
Decoction of vṛścikālī – Tragia involucrata, vacā – Acorus calamus, śuṇṭhī – Zingiber officinale, pañcamūla – group of five roots, punarnava – Boerhavia diffusa, varṣābhū – Boerhavia diffusa, dhānya – Coriandrum sativum, and kuṣṭha – Saussurea lappa or cow urine, should be used for Sechana (pouring over the abdomen).

Svedana: Sudation

विरिक्तम्लानमुदरं स्वेदितं शाल्वणादिभिः ।
वाससा वेष्टयेदेवं वायुर्नाध्मापयेत्पुनः ॥ ५० ॥
The abdomen which has decreased in size by Purgations should be given sudation/ fomentation by Salvana Sveda etc. and wrapped with a band of cloth so that Vayu (air / gas) does not fill-up the abdomen distending it again.

Administering Niruha Vasti

सुविरिक्तस्य यस्य स्यादाध्मानं पुनरेव तम् ।
सुस्निग्धैरम्ललवणैर्निरूहैः समुपाचरेत् ॥ ५१ ॥
He who develops distension of the abdomen even after proper purgation should be treated with administration of decoction enema with the liquid containing fats, sours and salts.

Administering Tikshna Vasti

सोपस्तम्भोऽपि वा वायुराध्मापयति यं नरम् ।
तीक्ष्णाः सक्षारगोमूत्राः शस्यन्ते तस्य वस्तयः ॥ ५२ ॥
When vata which is obstructed found to produce distension of the abdomen, then for such a person strong enemas with liquid mixed with alkalics and cow urine are ideally suited.

Summary of general treatment of abdominal enlargement

इति सामान्यतः प्रोक्ताः सिद्धा जठरिणां क्रियाः ।
Thus was described the general (common to all varieties) treatments and also those of proven efficacy for the management of patient of abdominal enlargement.

Vataja Udara Chikitsa

वातोदरेऽथ बलिनं विदार्यादिशृतं घृतम् ॥ ५३ ॥
पाययेत ततः स्निग्धं स्वेदिताङ्गं विरेचयेत् ।
बहुशस्तैल्वकेनैनं सर्पिषा मिश्रकेण वा ॥ ५४ ॥
In abdominal enlargement arising from vata if the Patient is strong, he should be asked to drink ghee boiled with herbs of Vidaryadi Gana (chapter 25 of sutrasthana), next after giving him oleation and sudation therapies, purgative therapy should be given either by using Tilvaka Ghrta (chapter 21/32) or Misraka Sneha (chapter 14/89) in higher doses.

Vataja Udara Chikitsa

कृते संसर्जने क्षीरं बलार्थमवचारयेत् ।
प्रागुत्क्लेशान्निवर्त्यं च बले लब्धे क्रमात्पयः ॥ ५५ ॥
After regimen of liquid diet, milk should be consumed, to regain strength before the appearance of nausea; after obtaining strength, milk should be consumed gradually.

Vataja Udara Chikitsa

यूषै रसैर्वा मन्दाम्ललवणैरेधितानलम् ।
सोदावर्तं पुनः स्निग्धस्विन्नमास्थापयेत्ततः ॥ ५६ ॥
तीक्ष्णाधोभागयुक्तेन दशमूलिकवस्तिना ।
तिलोरुबूकतैलेन वातघ्नाम्लशृतेन च ॥ ५७ ॥
स्फुरणाक्षेपसन्ध्यस्थिपार्श्वपृष्ठत्रिकार्तिषु ।
रूक्षं बद्धशकृद्वातं दीप्ताग्निमनुवासयेत् ॥ ५८ ॥
The digestive fire having been augmented by use of soups and meat soups which possesses slight sour and salt tastes, but upward movement inside the alimentary tract persisting, again the patient should be given oleation and sudation and then admininstered with decoction enema with dasamulika Basti (chapter 4 of kalpasiddhi sthana), processed with herbs of strong action capable of eliminating the Doshas in the downward route. The patient who has throbbing, convulsions, pain in the joints, bones, flanks, back and upper back pain, dryness and obstruction of feces and flatus, and whose digestive fire is keen (strong) should be given oil enema using sesame oil and castor oil boiled with herbs which mitigate Vata and which are sour.

Pittaja Udara Chikitsa

अविरेच्यस्य शमना वस्तिक्षीरघृतादयः ।
बलिनं स्वादुसिद्धेन पैत्ते संस्नेह्य सर्पिषा ॥ ५९ ॥
श्यामात्रिभण्डीत्रिफलाविपक्वेन विरेचयेत् ।
सितामधुघृताढ्येन निरूहोऽस्य ततो हितः ॥ ६० ॥
न्यग्रोधादिकषायेण स्नेहवस्तिश्च तच्छृतः ।
दुर्बलं त्वनुवास्यादौ शोधयेत्क्षीरवस्तिभिः ॥ ६१ ॥
In a person who is not eligible for purgation therapy shamana vasti (palliative enema) mixed with milk and ghee (should be administered). In enlargement of the abdomen caused by Pitta the patient who is strong should be given oleation therapy using ghee processed with herbs of sweet taste and then given purgative therapy with Ghrita boiled with śyāmā – Ipomoea turpethum, tribhaṇḍī – Operculina turpethum, triphalā – and Terminalia chebula, Terminalia bellirica and Emblica officinalis. Next decoction enema with decoction of herbs of Nyagrodhyadi Gana, mixed with sugar, honey and ghee is beneficial, so also the oil enema cooked with the same (nyagrodhadi kwatha). The person who is weak should be given oil enema initially followed by cleansing effected by Ksira-basti (enema with milk and herbs).

Pittaja Udara Chikitsa

जाते चाग्निबले स्निग्धं भूयो भूयो विरेचयेत् ।
क्षीरेण सत्रिवृत्कल्केनोरुबूकशृतेन वा ॥ ६२ ॥
सातलात्रायमाणाभ्यां शृतेनारग्वधेन वा ।
सकफे वा समूत्रेण सतिक्ताज्येन सानिले ॥ ६३ ॥
पयसाऽन्यतमेनैषां विदार्यादिशृतेन वा ।
भुञ्जीत जठरं चास्य पायसेनोपनाहयेत् ॥ ६४ ॥
When the strength of the digestive fire is found increased, the patient should be given oleation therapy followed by repeated purgation therapy using milk boiled with the paste of Operculina turpethum or decoction of Ricinus communis, with the paste of Euphorbia dracunculoides and Gentiana kurroo or processed with Cassia fistula. If it (Pittta) is associated with Kapha, milk processed with the above herbs should be consumed added with cow urine, and if associated with vata it should be mixed with ghee processed with bitter herbs; or purgation may be produced by any other recipe or boiled with herbs of Vidaryadi Gana (chapter 15 of Sutrasthana). He should take food with milk boiled with these herbs the abdomen should be given fomentation with this milk.

Pittaja Udara Chikitsa

पुनः क्षीरं पुनर्वस्तिं पुनरेव विरेचनम् ।
क्रमेण ध्रुवमातिष्ठन् यत्तः पित्तोदरं जयेत् ॥ ६५ ॥
Ingestion of milk, enema, purgation therapies administered one after the other, repeatedly with great care, cures enlargement of the abdomen caused by Pitta.

Kaphaja Udara Chikitsa

वत्सकादिविपक्वेन कफे संस्नेह्य सर्पिषा ।
स्विन्नं स्नुक्क्षीरसिद्धेन बलवन्तं विरेचितम् ॥ ६६ ॥
संसर्जयेत्कटुक्षारयुक्तैरन्नैः कफापहैः ।
In abdominal enlargement caused by Kapha the patient should be given oleation therapy using ghee boiled with decoction of herbs of Vatsakadi Gana (vide chapter 15 of sutrasthana) and then sudation therapy; next purgation therapy using ghee processed with milky sap of Euphorbia nerifolia and milk should be given if the patient is strong. This should be followed by regimen of liquid diet with foods processed with herbs of pungent and alkaline actions, which mitigate Kapha.

Kaphaja Udara Cikitsa

मूत्रत्र्यूषणतैलाढ्यो निरूहोऽस्य ततो हितः ॥ ६७ ॥
मुष्ककादिकषायेण स्नेहवस्तिश्च तच्छृतः ।
भोजनं व्योषदुग्धेन कौलत्थेन रसेन वा ॥ ६८ ॥
Next, decoction enema with more quantity of cow urine, tryūṣaṇa – Piper longum, Piper nigrum and Zingiber officinale, tailāḍhyo – and oil is beneficial; oil enema with ghee processed with decoction of herbs of Muskakadi Gana (vide chapter 15 of utrasthana) is beneficial. Food should be partaken either with milk boiled with Piper longum, Piper nigrum and Zingiber officinale or with soup of Dolichos biflorus.

Kaphaja Udara Chikitsa

स्तैमित्यारुचिहृल्लासे मन्देऽग्नौ मद्यपाय च ।
दद्यादरिष्टान् क्षारांश्च कफस्त्यानस्थिरोदरे ॥ ६९ ॥
When lassitude, stiffness, loss of taste, nausea and weakness of digestive fire is present and the abdomen being rigid due to solidified kapha, if the patient is accustomed to drinking wine, he should be given fermented decoction and alkalies.

Hingvadi Kshara

हिङ्गूपकुल्ये त्रिफलां देवदारु निशाद्वयम् ।
भल्लातकं शिग्रुफलं कटुकां तिक्तकं वचां ॥ ७० ॥
शुण्ठीं माद्रीं घनं कुष्ठं सरलं पटुपञ्चकम् ।
दाहयेज्जर्जरीकृत्य दधिस्नेहचतुष्कवत् ॥ ७१ ॥
अन्तर्धूमं ततः क्षाराद्बिडालपदकं पिबेत् ।
मदिरादधिमण्डोष्णजलारिष्टसुरासवैः ॥ ७२ ॥
उदरं गुल्ममष्ठीलां तूण्यौ शोफं विषूचिकाम् ।
प्लीहहृद्रोगगुदजान् उदावर्तं च नाशयेत् ॥ ७३ ॥
hiṅgu – Ferula narthex, upakulya – Piper longum, triphalāṃ – Terminalia chebula, Terminalia bellirica and Zingiber officinale, devadāru – Cedrus deodara, niśā dvayam – the two Nisa (Curcuma longa and Berberis aristata), bhallātaka – Semecarpus anacardiumm, śigruphalaṃ – Moringa oleifera, kaṭukā – Picrorhiza kurroo, tiktakaṃ – Swertia chirata, vacāṃ – Acorus calamus, śuṇṭhīṃ – Zingiber officinale, mādrīṃ – Gliricidia sepium, ghanaṃ – Cyperus rotundus, kuṣṭhaṃ – Saussurea lappa, saralaṃ – Pinus roxburghii, paṭupañcakam – and the five salts, should be cooked should be crushed together, mixed with curds and the four fats (oil, ghee fat and marrow) put into a pot and burnt to ashes sealing the mouth of the pot, this Kshara (ash) consumed in dose of 12 grams quantity along with either wine watery portion of curds warm / hot water, fermented decoction, wine or fermented liquids cures enlargement of the abdomen, abdominal tumor, enlargement of the prostate, the two kinds of pain of the bladder (Tuni, Pratituni), dropsy, visuchika (severe form of indigestion), diseases of the spleen, heart disease, haemorrhois and upward movement inside the alimentary tract.

Kaphaja Udara Chikitsa

जयेदरिष्टगोमूत्रचूर्णायस्कृतिपानतः ।
सक्षारतैलपानैश्च दुर्बलस्य कफोदरम् ॥ ७४ ॥
Kaphaja Udara present in weak persons should be won over by the drinking of arista, cow urine, powders of herbs, drinking of Ayaskrti (chapter 12) and oils mixed with Alkalies

Kaphaja Udara Chikitsa: Upanaha (poultice)

उपनाह्यं ससिद्धार्थकिण्वैर्बीजैश्च मूलकात् ।
कल्कितैरुदरं स्वेदमभीक्ष्णं चात्र योजयेत् ॥ ७५ ॥
The abdomen should be fomented with paste made of siddhārtha – Brassica nigra fermenting enzymes and seeds of Raphanus sativus applied as poultice, without break (daily)

Sannipataja Udara Chikitsa

सन्निपातोदरे कुर्यान्नातिक्षीण बलानले ।
दोषोद्रेकानुरोधेन प्रत्याख्याय क्रियामिमाम् ॥ ७६ ॥
For the patient of abdominal enlargement caused by all the three Doshas in whom the strength of the body and of the digestive fire are not decreased very much, the following methods of treatment tocontrol the aggravation of the Doshas should be adopted, after informing (the patient and his kin) the incurability of the disease.

Sannipataja Udara Chikitsa

दन्तीद्रवन्तीफलजं तैलं पाने च शस्यते ।
Oil obtained from the fruits (seeds) of Baliospermum montanum and Jatropha curcas is ideally suitedfor drinking (as oleation therapy).

Sannipataja Udara Chikitsa

क्रियानिवृत्ते जठरे त्रिदोषे तु विशेषतः ॥ ७७ ॥
दद्यादापृच्छ्य तज्ज्ञातीन् पातुं मद्येन कल्कितम् ।
मूलं काकादनीगुञ्जाकरवीरकसम्भवम् ॥ ७८ ॥
In abdominal enlargement arising from all the three Doshas, if it goes beyond the scope of treatment, then the physician after informing the relatives of the patient (of the uncertainty of action of the medicine) administer wine mixed with the paste of roots of Cardiospermum halicacabum, Abrus precatorius, and Nerium indicum (all these are minor poisons).

Sannipataja Udara Chikitsa

पानभोजनसंयुक्तं दद्याद्वा स्थावरं विषम् ।
यस्मिन् वा कुपितः सर्पो विमुञ्चति फले विषम् ॥ ७९ ॥
तेनास्य दोषसङ्घातः स्थिरो लीनो विमार्गगः ।
बहिः प्रवर्तते भिन्नो विषेणाशु प्रमाथिना ॥ ८० ॥
तथा व्रजत्यगदतां शरीरान्तरमेव वा ।
Or administer any one of the Sthavara Visa (vegetable poisons) such as Roots, leaves etc., of Aconitum ferox, Kallakuta, Halahala etc. mixed with foods and drinks; or the fruit in to which enraged serpent has deposited its poison. By the pramathi property (expelling the doshas from their places forcibly) of the poison, the compact doshas which are adherent, dissolved (in the tissues) and moving in wrong passages are expelled out quickly after getting destroyed or rendered incapable of producing any diseases though remaining inside the body.

Sannipataja Udara Chikitsa

हृतदोषं तु शीताम्बुस्नातं तं पाययेत्पयः ॥ ८१ ॥
पेयां वा त्रिवृतः शाकं माण्डूक्या वास्तुकस्य वा ।
कालशाकं यवाख्यं वा खादेत्स्वरससाधितम् ॥ ८२ ॥
निरम्ललवणस्नेहं स्विन्नास्विन्नमनन्नभुक् ।
मासमेकं ततश्चैव तृषितः स्वरसं पिबेत् ॥ ८३ ॥
After the doshas have been eliminated out, the person should bath in cold water and he should drink milk or thin gruel, eat the leaves of trivṛtaḥ – Operculina turpethum, māṇḍūkyā – Centella asiatica, vāstuka – Chenopodium album, kālaśākaṃ – Tephrosia purpurea or yava – Hordeum vulgare, processed in their own fresh juices should be eaten, without adding sours, salt and fats, either steam cooked or not steamed and without partaking any other solid food, for a period of one month; if thirsty he should drink the fresh juice (of the above plants) only.

Sannipataja Udara Chikitsa

एवं विनिर्हृते शाकैर्दोषे मासात्परं ततः ।
दुर्बलाय प्रयुञ्जीत प्राणभृत्कारभं पयः ॥ ८४ ॥
By this regimen of partaking leafy vegetables for one month, the doshas get expelled (or mitigated) completely, and then the person who has become debilitated should be given camel milk which restores life.

Plihodara Chikitsa

प्लीहोदरे यथादोषं स्निग्धस्य स्वेदितस्य च ।
सिरां भुक्तवतो दध्ना वामबाहौ विमोक्षयेत् ॥ ८५ ॥
Plihodara (enlargement of the abdomen due to enlargement of spleen) the patient should be given oleation – and sudation therapies, appropriate to the Dosha, made to take meals along with curds and then vein in the left arm should be cut (to let out blood).

Plihodara Chikitsa

लब्धे बले च भूयोऽपि स्नेहपीतं विशोधितम् ।
समुद्रशुक्तिजं क्षारं पयसा पाययेत्तथा ॥ ८६ ॥
अम्लस्रुतं विडकणाचूर्णाढ्यं नक्तमालजम् ।
शौभाञ्जनस्य वा क्वाथं सैन्धवाग्निकणान्वितम् ॥ ८७ ॥
हिङ्ग्वादिचूर्णं क्षाराज्यं युञ्जीत च यथाबलम् ।
After he gains strength, he should be given more quantity of fat (oil or ghee) to drink (as oleation therapy) and then administered with purificatory therapies. Then, he should be made to drink milk mixed with ash of ocean oyster shells or naktamālajam – alkali of Pongamia pinnata mixed with sour liquids added more with of powder of vida salt and Piper longum; or drink the decoction of śaubhāñjana – Moringa oleifera mixed with the powder of rock salt, agni – Plumbago zeylanica and kaṇā – Piper longum; or consume Hingvadi Curna (chapter 14/31-36) added with Yavakshara and ghee depending on his strength.

Plihodara Chikitsa: Pippalyadi Churna

पिप्पलीनागरं दन्तीसमांशं द्विगुणाभयम् ॥ ८८ ॥
विडार्धांशयुतं चूर्णमिदमुष्णाम्बुना पिबेत् ।
Equal quantities of pippalī – Piper longum, nāgaraṃ – Zingiber officinale, dantī – and Baliospermum montanum – (together making one part) two parts of abhayam – Terminalia chebula and half part of vida salt are powdered together; this should be consumed with warm water.

Plihodara Chikitsa

तैलोन्मिश्रैर्बदरकपत्रै: सम्मर्दितैः समुपनद्धः ॥ ९० ॥
मुसलेन पीडितोऽनु च याति प्लीहा पयोभुजो नाशम् ।
Leaves of badaraka – Gleome gynandra / Ziziphus jujube cut into small pieces mixed with oil, beaten by a pestle (thus made into a soft paste) squeezed well, the person partakes milk only (as food) gets cured of the diseases of the spleen.

Plihodara Chikitsa

रोहीतकलताः क्लृप्ता: खण्डशः साभया जले ॥ ९१ ॥
मूत्रे वाऽऽसुनुयात्तच्च सप्तरात्रस्थितं पिबेत् ।
कामलाप्लीहगुल्मार्शःकृमिमेहोदरापहम् ॥ ९२ ॥
Creeper of rohītaka – Tecomella undulata cut into bits is soaked either in the decoction of Terminalia chebula or in cow urine filtered by pressingfor seven days, and then consumed. It cures Jaundice, disease of the spleen, abdominal tumour, haemorrhoids, intestinal worms, diabetes, and enlargement of abdomen.

Rohitaka Ghrita

रोहीतकत्वचः कृत्वा पलानां पञ्चविंशतिम् ।
कोलद्विप्रस्थसंयुक्तं कषायमुपकल्पयेत् ॥ ९३ ॥
पालिकैः पञ्चकोलैस्तु तैः समस्तैश्च तुल्यया ।
रोहीतकत्वचा पिष्टैर्घृतप्रस्थं विपाचयेत् ॥ ९४ ॥
प्लीहाभिवृद्धिं शमयत्येतदाशु प्रयोजितम् ।
Twenty-five pala (1.2 Kg) of bark of rohītaka – Tecomella undulata, two Prastha (1536 grams) o kola – Ziziphus jujuba are put together and decoction prepared. A paste is prepared with one pala (48 grams) of each of the herbs of Pancakola (Piper longum, root of Piper longum, Piper retrofractum, Plumbago zeylanica and Zingiber officinale) equal quantity of bark of rohītaka – Tecomella undulata and one prastha (768 grams) of ghee are added to the decoction and medicated ghee cooked. This recipe consumed (daily) quickly cures enlargement of spleen.

Kshara Taila

कदल्यास्तिलनालानां क्षारेण क्षुरकस्य च ॥ ९५ ॥
तैलं पक्वं जयेत्पानात्प्लीहानं कफवातजम् ।

Medicated oil prepared by cooking oil with the ash / alkali of kadalyā: – Musa paradisiaca stem of tila – Sesamum indicum and kṣuraka – Hydrophilia auriculata. This oil by drinking (daily) cures, enlargement of the spleen caused by Kapha and Vata.

Use of Agnikarma, Ksheeravasti and other measures

अशान्तौ गुल्मविधिना योजयेदग्निकर्म च ॥ ९६ ॥
अप्राप्तपिच्छासलिले प्लीह्नि वातकफोल्बणे ।
पैत्तिके जीवनीयानि सर्पींषि क्षीरवस्तयः ॥ ९७ ॥
रक्तावसेकः संशुद्धिः क्षीरपानं च शस्यते ।
If by these methods the abdominal tumour does not subside, then Agnikarma (branding by fire) should be resorted to, and when slimy fluid has not collected inside the abdomen and in pliha of Vata and Kapha origin. In the splenic disease of Pitta origin, use of ghee boiled with herbs of Jivaniya Gana (chapter 15 of Sutrasthana), Ksirabasti (enema with milk etc.), blood-letting, purificatory therapies (purgation especially) and drinking of milk are ideally suited.

Yakrutodara Chikitsa

यकृति प्लीहवत्कर्म दक्षिणे तु भुजे सिराम् ॥ ९८ ॥
In enlargement of liver, the treatments is the same as of the spleen, inclusive of cutting the vein of the right arm.

Baddhodara Chikitsa

स्विन्नाय बद्धोदरिणे मूत्रतीक्ष्णौषधान्वितम् ।
सतैललवणं दद्यान्निरूहं सानुवासनम् ॥ ९९ ॥
परिस्रंसीनि चान्नानि तीक्ष्णं चास्मै विरेचनम् ।
उदावर्तहरं कर्म कार्यं यच्चानिलापहम् ॥ १०० ॥
The patient of baddhodara (enlargement of abdomen due to intestinal obstruction) should be given sudation therapy. Then decoction enema should be given with cow urine, decoction of herbs having penetrating and quick acting properties, mixed with oil and salt; and then anuvasana (oil enemas) is given. Foods which are laxative in action and strong purgation therapieswhich cure upward movement in the alimentary tract, those actions which mitigate Vata should be done.

Chidrodara Chikitsa

छिद्रोदरमृते स्वेदाच्छ्लेष्मोदरवदाचरेत् ।
जातं जातं जलं स्राव्यमेवं तद्यापयेद्भिषक् ॥ १०१ ॥
In chidrodara (enlargement of the abdomen due to perforation of alimentary tract) all the treatment prescribed for slesmodara (udara arising from increase of Kapha) excepting sveda (sudation) should be adopted. The fluid should be removed as and when it collects inside; by this way the physician should maintain the patient.

Udakodara Chikitsa

अपां दोषहराण्यादौ योजयेदुदकोदरे ।
मूत्रयुक्तानि तीक्ष्णानि विविधक्षारवन्ति च ॥ १०२ ॥
दीपनीयैः कफघ्नैश्च तमाहारैरुपाचरेत् ।
In Udakodara (enlargement of the abdomen due to collection of fluid / ascities), application of treatment / medicines which mitigate the doshas and collection of fluid should be done at the beginning. Different kinds of strong alkalies mixed with cow urine should be administered. He should be nursed with foods which improve digestive power and mitigate Kapha.

Udakodara Chikitsa

क्षारं छागकरीषाणां स्रुतं मूत्रेऽग्निना पचेत् ॥ १०३ ॥
घनीभवति तस्मिंश्च कर्षांशं चूर्णितं क्षिपेत् ।
पिप्पली पिप्पलीमूलं शुण्ठी लवणपञ्चकम् ॥ १०४ ॥
निकुम्भकुम्भत्रिफलास्वर्णक्षीरीविषाणिकाः ।
स्वर्जिकाक्षारषड्ग्रन्थासातलायवशूकजम् ॥ १०५ ॥
कोलाभा गुटिकाः कृत्वा ततः सौवीरकाप्लुताः ।
पिबेदजरके शोफे प्रवृद्धे चोदकोदरे ॥ १०६ ॥
Ash / alkali of excreta of the goat, dissolved in cow urine and filtered, is cooked on fire till it becomes solid, then one Karsa (12 grams) each of powder of (the below mentioned herbs) should be added – Piper longum, roots of pippalī – Piper longum, śuṇṭhī – Zingiber officinale, five types of salt, nikumbha – Baliospermum montanum, kumbha – Careya arborea, triphalā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, svarṇakṣīrī – Argemone Mexicana, viṣāṇikāḥ – Pistacia integerrima, svarjikākṣāra – Sodium carbonate, ṣaḍgranthā – Acorus calamus, sātalā – Euphorbia dracunculoides, yavaśūkajam – alkali of Hordeum vulgare, kolābhā – all Ziziphus jujube made into tablet. This should be consumed dissolved in fermented barley wash. This is administered in loss of digestive power, dropsy, and advanced stage of accumulation of fluid in the abdomen.

Shastra Chikitsa: Surgical operation

इत्यौषधैरप्रशमे त्रिषु बद्धोदरादिषु ।
प्रयुञ्जीत भिषक् शस्त्रमार्तबन्धुनृपार्थितः ॥ १०७ ॥
If the three kinds of Udara, enumerated commencing with Baddhodara, (Baddhodara, chidrodara and Udkodrara) do not subside with the above medicines (medical treatment) then the physician should resort to surgical treatment after obtaining permission from the patient, his relatives and the king or administrative officer.

Shastra Chikitsa: Surgical operation

स्निग्धस्विन्नतनोर्नाभेरधो बद्धक्षतान्त्रयोः ।
पाटयेदुदरं मुक्त्वा वामतश्चतुरङ्गुलात् ॥ १०८ ॥
चतुरङ्गुलमानं तु निष्कास्यान्त्राणि तेन च ।
निरीक्ष्यापनयेद्वालमललेपोपलादिकम् ॥ १०९ ॥
छिद्रे तु शल्यमुद्धृत्य विशोध्यान्त्रपरिस्रवम् ।
मर्कोटैर्दंशयेच्छिद्रं तेषु लग्नेषु चाहरेत् ॥ ११० ॥
कायं मूर्ध्नोऽनु चान्त्राणि यथास्थानं निवेशयेत् ।
अक्तानि मधुसर्पिर्भ्यामथ सीव्येद्बहिर्व्रणम् ॥ १११ ॥
ततः कृष्णमृदालिप्य बध्नीयाद्यष्टिमिश्रया ।
निवातस्थः पयोवृत्तिः स्नेहद्रोण्यां वसेत्ततः ॥ ११२ ॥
In case of Baddha (obstruction) and Ksata (perforation) of the intestines (in Baddhodara and chidrodara) the patient should be given oleation and sudation therapies first and then the abdomen is cut, below the umbilicus leaving a space of four Angula (7.8 Cm) from the left side (flank), the incised wound being four Angula (7.8 Cm) in length, the intestine is pulled out, through the wound, is carefully examined, the obstructing material such as hair, faeces, stone etc. (in case of baddhodara) removed. In case of chidrodara, the foreign body is removed, the intestines cleared, of fluid and other materials; The wound of the intestines is then closed by making big front jaws of the ants bite them. When they are thus holding the edges tight with their head, their bodies should be cut off. Afterwards the intestines should be inserted into the abdomen, placed in the normal place, anointed with a mixture of honey and ghee and the wound sutured from outside. Then the abdomen should be given a coating of black mud mixed with (powder of) Glycyrrhiza glabra and a bandage is tied. The patient is then moved to a place devoid of breeze and made to lie inside a tub filled with fats (oil) consuming only milk as food.

Shastra Chikitsa: Surgical operation for fluid collection in Udakodara

सजले जठरे तैलैरभ्यक्तस्यानिलापहैः ।
स्विन्नस्योष्णाम्बुनाकक्षमुदरे पट्टवेष्टिते ॥ ११३ ॥
बद्धच्छिद्रोदितस्थाने विध्येदङ्गुलमात्रकम् ।
निधाय तस्मिन्नाडीं च स्रावयेदर्धमम्भसः ॥ ११४ ॥
अथास्य नाडीमाकृष्य तैलेन लवणेन च ।
व्रणमभ्यज्य बद्ध्वा च वेष्टयेद्वाससोदरम् ॥ ११५ ॥
तृतीयेऽह्नि चतुर्थे वा यावदाषोडशं दिनम् ।
तस्य विश्रम्य विश्रम्य स्रावयेदल्पशो जलम् ॥ ११६ ॥
विवेष्टयेद्गाढतरं जठरं वाससा श्लथम् ।
निःस्रुते लङ्घितः पेयामस्नेहलवणां पिबेत् ॥ ११७ ॥
In case of the abdomen having accumulation of fluid, the patient should be anointed with oil, which mitigates Vata and should be given sudation with hot water, then his abdomen should be wrapped with bands of cloth up to the level of the axillae, a puncture is made at the same site, as indicated in the treatment of baddhodara and Chidrodara, its depth being one Angula (1.95 Cm), a tube is inserted into thin hole and the water (fluid) drained to half of its quantity then the tube is removed; the wound is bathed with oil mixed with salt, and tied with a bandage; then the whole of the abdomen wrapped (tight) with cloth. On the third day or the fourth day the fluid should be drained out in small quantities, with intervals of rest, till a period of sixteen days. The abdomen should be wrapped tight with loose cloth. When the fluid has been completely drained out, the patient who has fasted, should be given thin gruel without adding fats and salt, to drink.

Post surgical diet for Jalodara

स्यात्क्षीरवृत्तिः षण्मासांश्त्रीन् पेयां पयसा पिबेत् ।
त्रींश्चान्यान् पयसैवाद्यात्फलाम्लेन रसेन वा ॥ ११८ ॥
अल्पशोऽस्नेहलवणं जीर्णं श्यामाककोद्रवम् ।
प्रयतो वत्सरेणैवं विजयेत जलोदरम् ॥ ११९ ॥
He should take only milk as food for six months. The first three months, he should drink thin gruel mixed with milk and the next three months he should eat food prepared from old Echinochloa esculenta or kodravam – Paspalum scrobiculatum, along with milk, also sour fruit juice, meat juice (soup) in little quantity, without fats and salt. Continuing to live in this way for one year, the patient gets cured of Jalodara (ascitis)

Self-control

वर्ज्येषु यन्त्रितो दिष्टे नात्यदिष्टे जितेन्द्रियः ।
The patient should be under strict control in the use of things (food, drinks and activities) which are mentioned as rejectables and capable of controlling his senses in the use of things which are not mentioned (as rejectables).

Balancing doshas in Udara

सर्वमेवोदरं प्रायो दोषसङ्घातजं यतः ॥ १२० ॥
अतो वातादिशमनी क्रिया सर्वत्र शस्यते ।
वह्निर्मन्दत्वमायाति दोषैः कुक्षौ प्रपूरिते ॥ १२१ ॥
तस्माद्भोज्यानि भोज्यानि दीपनानि लघूनि च ।
सपञ्चमूलान्यल्पाम्लपटुस्नेहकटूनि च ॥ १२२ ॥
Gradually all the varieties of enlargement of the abdomen arise from the combination of the doshas; Hence in all cases, therapies mitigating the Vata and other Doshas are highly beneficial. When the doshas get filled in the abdomen the digestive fire becomes weak. Hence foods which kindle digestion and foods and easily digestible, should be consumed along with herbs of five roots, added with less of sour, salt, fats and pungent.

Balancing doshas in Udara

भावितानां गवां मूत्रे षष्टिकानां च तण्डुलैः ।
यवागूं पयसा सिद्धां प्रकामं भोजयेन् नरम् ॥ १२३ ॥
पिबेदिक्षुरसं चानु जठराणां निवृत्तये ।
स्वं स्वं स्थानं व्रजन्त्येषां वातपित्तकफास्तथा ॥ १२४ ॥

Gruel prepared from bits of sastika rice, soaked in cow urine can be consumed mixed with milk as much as desired, sugar-cane juice may be used as an after-drink, for the cure of abdominal enlargement. By this, Vata, Pitta and kapha get back to their own seats.

Diet and activities

अत्यर्थोष्णाम्ललवणं रूक्षं ग्राहि हिमं गुरु ।
गुडं तैलकृतं शाकं वारि पानावगाहयोः ॥ १२५ ॥
आयासाध्वदिवास्वप्नयानानि च परित्यजेत् ।
Things (foods, drinks, herbs etc.) which are very hot (heat producing) sour, salt, dry (non unctous), absorbent and constipating, cold (in potency) and heavy (not easily digestible), molassses/Jaggery, vegetable, cooked in oil, water for drinking and immersion, exertion, long distance walk, sleeping during day and riding on vehicles should be avoided.

Use of Takra (buttermilk) in different Udaras

नात्यच्छसान्द्रमधुरं तक्रं पाने प्रशस्यते ॥ १२६ ॥
सकणालवणं वाते पित्ते सोषणशर्करम् ।
यवानीसैन्धवाजाजीमधुव्योषैः कफोदरे ॥ १२७ ॥
त्र्यूषणक्षारलवणैः संयुतं निचयोदरे ।
मधुतैलवचाशुण्ठीशताह्वाकुष्ठसैन्धवैः ॥ १२८ ॥
प्लीह्नि बद्धे तु हपुषायवानीपट्वजाजिभिः ।
सकृष्णामाक्षिकं छिद्रे व्योषवत्सलिलोदरे ॥ १२९ ॥
Drinking of buttermilk which is not very thin, slightly thick in consistence and sweet in taste is highly beneficial. It should be consumed mixed with Piper longum and salt in Vataja Udara. Mixed with Piper nigrum and sugar in Pittaja Udara. yavānī – With Trachyspermum ammi, saindhava – rock salt, ajājī – Cuminum cyminum, madhu – honey, vyoṣaiḥ – and Piper longum, Piper nigrum and Zingiber officinale in Kaphaja udara. Along with Piper longum, Piper nigrum and Zingiber officinale alkali and salt in Sannipatodara; with honey, oil, vacā – Acorus calamus, śuṇṭhī – Zingiber officinale, śatāhvā – Anethum graveolens, kuṣṭha – Saussurea lappa, and rock salt in Plihodara. With hapuṣā – Juniperus communis, yavānī – Trachyspermum ammi, salt and ajāji – Cuminum cyminum in Baddhodara. With kṛṣṇā – Piper longum and honey in chidrodara and with Piper longum, Piper nigrum and Zingiber officinale in Jalodara.

Appraisal of Takra (Buttermilk)

गौरवारोचकानाहमन्दवह्न्यतिसारिणाम् ।
तक्रं वातकफार्तानाममृतत्वाय कल्पते ॥ १३० ॥
For those who are having feeling of heaviness of the body, loss of taste, flatulence, weak digestive force and diarrhoea, who are suffering from increase of vata and Kapha, buttermilk acts as nectar.

Appraisal of Takra (Buttermilk)

प्रयोगाणां च सर्वेषामनुक्षीरं प्रयोजयेत्।
स्थैर्यकृत्सर्वधातूनां बल्यं दोषानुबन्धहृत् ॥ १३१ ॥
After every therapy, milk should be administered. It strengthens all the Dhatus (tissues), improves the strength of the body, destroy the accompanying Doshas.  

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने उदरचिकित्सितं नाम पञ्चदशोऽध्याय: ॥ १५ ॥
Thus ends the chapter-Udara cikitsita – the fifteenth in Cikitsita Sthana of Astangahrdaya Samhita composed by Srimad Vagbhata, son of Vaidyapati Simhagupta.