Ashtanga Hridayam Cikitsasthanam Chapter 20: Shvitra Krimi Chikitsitam (Treatment of leucoderma and worms)

The 20^th chapter of Cikitsasthanam of Ashtanga Hridayam is named as Svitra Krimi Cikitsitam Adhyayah. This chapter deals with the explanation of ‘treatment of leucoderma and worms.

The topics covered in this chapter include –

• Dreadful nature of Svitra
• Shodhana in Svitra
• Pricking and draining the vesicles
• Phalgvadi Kashayam
• Chitrakadi Churna
• Use of Markava
• Putikadi Lepa
• Lepa for svitra
• Use of Sphotahetu
• Use of Akshataila
• Use of Avalguja
• Bhallatakadi Lepam
• Papa Kshaya
• Krimi Cikitsa – treatment of intestinal worms / parasites

Pledge by the author(s)

अथातो श्वित्रकृमिचिकित्सितं 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 leucoderma and worms (intestinal parasites)’. Thus say (pledge) Atreya and other sages.

Dreadful nature of Svitra

कुष्ठादपि बीभत्सं यच्छीघ्रतरं च यात्यसाध्यत्वम् ।
श्वित्रमतस्तच्छान्त्यै यतेत दीप्ते यथा भवने ॥ १ ॥
Leucoderma is more dreadful than even skin disease and very soon it attains incurability.Hence urgent efforts should be done for its cure,just as a house which is on fire.

Shodhana in Svitra

संशोधनं विशेषात्प्रयोजयेत्पूर्वमेव देहस्य ।
श्वित्रे स्रंसनमग्र्यं मलयूरस इष्यते सगुडः ॥ २ ॥
तं पीत्वाऽभ्यक्ततनुर्यथाबलं सूर्यपादसन्तापम् ।
सेवेत विरिक्ततनुर्त्र्यहं पिपासुः पिबेत्पेयाम् ॥ ३ ॥

Cow urine mixed with (powder of) Plumbago zeylanica and vyosha (Piper longum, Piper nigrum and Zingiber officinale) and added with honey is poured in a pot smeared with ghee in its interior and kept undisturbed for a fortnight, then patient of leucoderma should consume it.  The treatment prescribed for skin disease should be adopted.

Use of Markava

मार्कवमथवा स्वादेद्भृष्टं तैलेन लोहपात्रस्थम् ।
बीजकशृतं च दुग्धं तदनु पिबेच्छ्वित्रनाशाय ॥ ८ ॥
Eclipta alba fried in oil in an iron vessel or kept in an iron vessel should be consumed, next, milk boiled with Pterocarpus marsupium should be consumed after meals this cures leucoderma.

Putikadi Lepa

पूतीकार्कव्याधिघातस्नुहीनां मूत्रे पिष्टाः पल्लवा जातिजाश्च
घ्नन्त्यालेपाच्छ्वित्रदुर्नामदद्रूपामाकोठान् दुष्टनाडीव्रणांश्च ॥ ९ ॥
Tender leaves of Holoptelea integrifolia, Calotropis gigantea, Cassia fistula, Euphorbia neriifolia, and Jasminum grandiflorum, macerated in cow urine and applied on the skin cures leucoderma, hemorrhoids, ringworm,scabies,skin rashes and chronic sinus ulcers.

Lepa for svitra

द्वैपं दग्धं चर्म मातङ्गजं वा श्वित्रे लेपस्तैलयुक्तो वरिष्ठः ।
पूतिः कीटो राजवृक्षोद्भवेन क्षारेणाक्तः श्वित्रमेकोऽपि हन्ति ॥ १० ॥
Skin of the leopard or the elephant, burnt to ashes and applied mixed with oil is best for leukoderma. Putikita (a kind of foul-smelling insect appearing in rainy season) made into a paste along with ash of rajavrksa (Cassia fistula) and applied, cures leucoderma solely by itself.

Use of Sphotahetu

रात्रौ गोमूत्रे वासितान् जर्जराङ्गानह्नि च्छायायां शोषयेत् स्फोटहेतून् ।
एवं वारांस्त्रींस्तैस्ततः श्लक्ष्णपिष्टैः स्नुह्याः क्षीरेण श्वित्रनाशाय लेपः ॥ ११ ॥
(Bhallataka) Semecarpus anacardium crushed well is kept immersed in cow urine at night and dried in shade during day; after doing so for three days it should be made into a fine paste along with milky sap of Euphorbia neriifolia and applied to the skin for destroying leucoderma.

Use of Akshataila

अक्षतैलद्रुता लेपः कृष्णसर्पोद्भवा मषी ।
शिखिपित्तं तथा दग्धं ह्रीवेरं वा तदाप्लुतम् ॥ १२ ॥
Paste ofash of black serpent mixed with aksa taila (oil of vibhitaka – Terminalia bellirica); likewise, the bile of a peacock mixed with it (aksha taila) or ash of Pavonia odorata (mixed with aksa taila) isapplied on the skin (cures leucoderma).

Use of Avalguja

कुडवोऽवल्गुजबीजाद्धरितालचतुर्भागसम्मिश्रः ।
मूत्रेण गवां पिष्टः सवर्णकरणं परं श्वित्रे ॥ १३ ॥
One kudava (192 grams) of Psoralea corylifolia seeds one-fourth quantity of Arsenic trisulfide together ground with cow urine is best to bestow the normal color of the skin in leucoderma.

Use of Avalguja

क्षारे सुदग्धे गजलिण्डजे च गजस्य मूत्रेण परिस्रुते च ।
द्रोणप्रमाणे दशभागयुक्तं दत्त्वा पचेद्बीजमवल्गुजानाम् ॥ १४ ॥
श्वित्रं जयेच्चिक्कणतां गतेन तेन प्रलिम्पन् बहुशः प्रघृष्टं ।
कुष्ठं मषं वा तिलकालकं वा यद्वा व्रणे स्यादधिमांसजातम् ॥ १५ ॥

Ash of well burnt dung of an elephant is boiled in one drona (12 litre 228 ml) of urine of the elephant filtered, mixed with ten parts of seeds of Psoralea corylifolia. Leucoderma should be won (destroyed) till which has been made rough (its smoothness gone) applied with the above medicament by rubbing, cures skin disease, warts, black moles and wounds arising from muscular tumor.

Bhallatakadi Lepam

भल्लातकं द्वीपिसुधार्कमूलं गुञ्जाफलं त्र्यूषणशङ्खचूर्णम् ।
तुत्थं सकुष्ठं लवणानि पञ्च क्षारद्वयं लाङ्गलिकां च पक्त्वा ॥ १६ ॥
स्नुगर्कदुग्धे घनमायसस्थं शलाकया तद्विदधीत लेपम् ।
कुष्ठे किलासे तिलकालकेषु मषेषु दुर्नामसु चर्मकीले ॥ १७ ॥
Semecarpus anacardium, roots of citric – Plumbago zeylanica, Euphorbia neriifolia, and Calotropis gigantea, seeds of Abrus precatorius, Piper longum, Piper nigrum and Zingiber officinale powder of conch, Copper sulphate, Saussurea lappa, five kinds of salt, the two alkalis, and Gloriosa superba are cooked along with the milky sap of snuhi (Euphorbia neriifolia) and arka (Calotropis gigantea), and preserved in an iron vessel, applied as thick paste with the help of a rod in prescribed manner, cures skin disease, leucoderma, black moles, warts, moles, hemorrhoids and warts.

Blood-letting etc. treatment

शुद्ध्या शोणितमोक्षैर्विरूक्षणैर्भक्षणैश्च सक्तूनाम् ।
श्वित्रं कस्यचिदेव प्रशाम्यति क्षीणपापस्य ॥ १८ ॥
By purifactory therapies, blood-letting, use of dry methods (moisture free and fat free), corn flour as food, leucoderma of someone gets cured, of the person whose sins have decreased. Thus ends the treatment of leucoderma.

Krimi Chikitsa: Treatment of intestinal worms / parasites

स्निग्धस्विन्ने गुडक्षीरमत्स्याद्यैः कृमिणोदरे ।
उत्क्लेशितकृमिकफे शर्वरीं तां सुखोषिते ॥ १९ ॥
सुरसादिगणं मूत्रे क्वाथयित्वाऽर्धवारिणि ।
तं कषायं कणागालकृमिजित्कल्कयोजितम् ॥ २० ॥
सतैलस्वर्जिकाक्षारं युञ्ज्याद्वस्तिं ततोऽहनि ।
तस्मिन्नेव निरूढं तं पाययेत विरेचनम् ॥ २१ ॥
त्रिवृत्कल्कं फलकणाकषायालोडितं ततः ।
ऊर्ध्वाधःशोधिते कुर्यात् पञ्चकोलयुतं क्रमम् ॥ २२ ॥
कटुतिक्तकषायाणां कषायैः परिषेचनम् ।
काले विडङ्गतैलेन ततस्तमनुवासयेत् ॥ २३ ॥
The patient of worms in the abdomen (intestines) should be administered oleation and sudation therapies first, then both the worms and kapha is excited by consuming jaggery, milk fish etc. The patient is allowed to sleep comfortably in the night.   Next morning, a niruha basti (decoction enema) should be administered using the decoction of herbs of surasadigana (chapter 15 of sutrasthana) boiled in cow urine and reduced to half, added with the paste of Piper longum Symplocos racemosa, and Embelia ribes oil of sesamum indicum and sarjikaksara. On the same day, niruha (decoction enema) is given, he should be given a virecana (purgative therapy) using paste of Operculina turpethum mixed with decoction of Randia dumetorum and Piper longum.

After purification of the both the upper and lower parts of the body, he should follow the regimen of liquid diet (peya, vilepi, yusa etc) processed with pancakola (Piper longum, roots of Piper longum, Piper retrofractum, Plumbago zeylanica and Zingiber officinale). He should take bath with the decoction of herbs which are pungent, Bitterand astringent. Then at the appropriate time he should be given an anuvasana (oil enema) with vidanga taila.

शिरोरोगनिषेधोक्तमाचरेन् मूर्धगेष्वनु ।
उद्रिक्ततिक्तकटुकमल्पस्नेहं च भोजनम् ॥ २४ ॥
In case of worms residing in the head, treatments mentioned for prevention of diseases of the head (chapter 24 of uttarasthana) should be administered. His meals should be predominant with bitter and pungent tastes and with less fats.

विडङ्गकृष्णामरिचपिप्पलीमूलशिग्रुभिः ।
पिबेत् सस्वर्जिकाक्षारैर्यवागूं तक्रसाधिताम् ॥ २५ ॥
Gruel processed with Embelia ribes, Piper longum, Piper nigrum, roots of Piper longum Moringa oleifera consumed processed with sodium carbonate and buttermilk.

रसं शिरीषकिणिहीपारिभद्रककेम्बुकात् ।
पलाशबीजपत्तूरपूतिकाद्वा पृथक् पिबेत् ॥ २६ ॥
सक्षौद्रं सुरसादीन् वा लिह्यात् क्षौद्रयुतान् पृथक् ।
Juice (decoction) of Albizia lebbeck, Achyranthes aspera, Erythrina indica Costus speciosus seeds of Butea monosperma, Caesalpinia sappan, or Holoptelea integrifolia each one separately, mixed with honey should be consumed; or of herbs of surasadigana (chapter 15 of sutrasthana) should be licked each separately mixed with honey.

शतकृत्वोऽश्वविट्चूर्णं विडङ्गक्वाथभावितम् ॥ २७ ॥
कृमिमान् मधुना लिह्याद्भावितं वा वरारसैः ।
Powder of horse dung should be macerated several times (hundred times) in the decoction of Embelia ribes or of decoction of triphala – Terminalia chebula, Terminalia bellirica and Emblica officinalis) processed and should be licked with honey by the patient of worms.

शिरोगतेषु कृमिषु चूर्णं प्रधमनं च तत् ॥ २८ ॥
In case of worms of the head, pradhamana (blowing the powder of herbs into the nose though a tube) as described in the prevention of diseases of the head. (chapter 24 of uttarasthana) should be done.

आखुकर्णीकिसलयैः सुपिष्टैः पिष्टमिश्रितैः ।
पक्त्वा पूपलिकां खादेद्धान्याम्लं च पिबेदनु ॥ २९ ॥
सपञ्चकोललवणमसान्द्रं तक्रमेव वा ।
नीपमार्कवनिर्गुण्डीपल्लवेष्वप्ययं विधिः ॥ ३० ॥
विडङ्गचूर्णमिश्रैर्वा पिष्टैर्भक्ष्यान् प्रकल्पयेत् ।
Tender leaves of Ipomea reniformis macerated well with corn flour and pancake prepared. This should be consumed followed by drinking of fermented water in which corns are soaked) or thin buttermilk added with panchakola (Piper longum, roots of Piper longum, Piper retrofractum, Plumbago zeylanica and Zingiber officinale) and rock salt. The same procedure holds good even with tender leaves of Azadirachta indica and Achyranthes aspera, Eclipta alba, or Vitex negundo, eatables (snacks) may be prepared with corn flour mixed with powder of Embelia ribes.

विडङ्गतण्डुलैर्युक्तमर्धांशैरातपे स्थितम् ॥ ३१ ॥
दिनमारुष्करं तैलं पाने वस्तौ च योजयेत् ।
सुराह्वसरलस्नेहं पृथगेवं च कल्पयेत् ॥ ३२ ॥
Oil of Semecarpus anacardium mixed, with half its quantity of seeds of Embelia ribes kept in the sun for one day should be made use of for drinking (of fats) and enema therapies; Oil of Cedrus deodara Pinus roxburghii may be used separately (processed in the same way).

Treatment plans for parasites

पुरीषजेषु सुतरां दद्याद्वस्तिविरेचने ।
शिरोविरेकं वमनं शमनं कफजन्मसु ॥ ३३ ॥
रक्तजानां प्रतीकारं कुर्यात् कुष्ठचिकित्सितात् ।
इन्द्रलुप्तविधिश्चात्र विधेयो रोमभोजिषु ॥ ३४ ॥
In case of worms arising in the feces, enema and purgation therapies should be administered mainly.  For worms arising from Kapha, purgation for the head (nasal medication) emesis and palliative therapy are the chief treatments.  For worms arising from blood, treatments described in the treatment of skin disease (previous chapter) should be done.  For worms which destroys the hair, the treatment prescribed for (the disease) indralupta (chapter 24 of uttarasthana) should be followed.

Diet restrictions: Intestinal worms / parasites

क्षीराणि मांसानि घृतं गुडं च दधीनि शाकानि च पर्णवन्ति ।
समासतोऽम्लान् मधुरान् रसांश्च कृमीञ्जिहासुः परिवर्जयेत ॥ ३५ ॥
Who desires to get rid of worms should avoid partaking milk, meat, ghee, jaggery, curds, leafy vegetables, succinctly sour and sweet foods, and drinks.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने श्वित्रकृमिचिकित्सितं नाम विंशोऽध्याय: ॥ २० ॥
Thus, ends the chapter svitra-krmicikitsita- the twentieth in cikitsita sthana of Astangahrdayasamhita composed by srmadvagbhata, son of Sri Vaidyapati Simhagupta.