Charaka Siddhisthana Chapter 6 - Vamana Virechana Vyapat Siddhi

This article explains the 6th chapter of siddhisthana of Charaka samhita called 'Vamana Virechana vyapat Siddhi Adhyaya'. In this chapter, seasons for Vamana, Virechana, necessity of snehana and swedana, appropriate dosage, signs of shodhana, dietetic regimen, adverse effects, causes, Ayoga, Atiyoga, their management, etc. have been explained.

????? ??????????????????????? ??????????????|
??? ? ????? ????????????||?||
athato vamanavirecanavyapatsiddhim vyakhyasyamah|
iti ha smaha bhagavanatreyah||2||
Now we shall explore the chapter on "Vamana Virechana Vyapat Siddhi". Thus said Lord Atreya [1-2]

Table of Contents

Topics to be discussed:Suitable seasonsAdministration of Snehana and Swedana in IntervalsProhibition of Excessive OleationNature of Purgation RecipeConditions responsible for Appropriate EffectNeed for Snehana, Swedana Digestion of foodAppropriate DoseConcentration of mindPreparatory MeasuresSigns of Appropriate purificationMeasures to remove Residual Drugs (Shesha Aushadha)After-careNeed for regulated Diet Dietetic RegimenSigns of Drug- Digestion (Jirna Aushadhi)Signs of residual Drugs (Shesha Aushadha)Characteristics of Drugs Producing Undesirable effectsAdverse effects and their causative factorsDifferent types of Actions of Elimination therapiesMovement in reverse directionIndigestion of recipeRepetition of TherapyAvoiding Repeat- doseCauses and Complications of AyogaAnother type of Ayoga and its management Treatment of AyogaSigns and treatment of Ati-YogaRecipes for treatment of over-action of Purgation TherapiesTreatment of over-action of emetic TherapyNeed for Regulated dietEtiology, signs and Treatment of AdhmanaEtiology, signs and treatment of ParikartikaRecipes for ParikartikaEtiology, signs and treatment of ParisravaEtiology, signs and treatment of HrdayopasaranaEtiology, Signs and Treatment of AngaGrahaEtiology, signs and Treatment of Jivadana (Bleeding)Etiology, Signs and Treatment of VibhramsaEtiology, Signs and Treatment of StambhaEtiology, signs and Treatment of UpadravasEtiology, Signs and Treatment of KlamaEpilogue

Topics to be discussed:

?? ??????? ??????????????????????????| ????????????????? ?????? ????????? ???????||?||
atha sodhanayoh samyagvidhimurdhvanulomayoh| asamyakkrtayoscaiva dosan vaksyami sausadhan||3||
Now the topics to be described in this chapter are as follows:
Appropriate methods for the administration of the upward and downward purificatory therapies (Vamana, Virechana);
Complications arising out of the improper administration of these therapies and
Treatment of these complications [3]
Read: Vamana Therapy - Right Method, Side Effects, Management

Suitable seasons

???????????????? ?? ????????????????????| ??????? ??????????????????? ??????????????||?||
???????? ??????? ?????? ?????????? ????| ???????? ???????? ?????? ????? ?????||?||
????????? ??????????? ??????? ??????? ?????| ????????????????????? ?????? ?????????? ??||?||
atyusnavarsasita hi grismavarsahimagamah| tadantare pravrdadyastesam sadharanastrayah||4||
pravrt sucinabhau jneyau saradurjasahau punah| tapasyasca madhuscaiva vasantah sodhanam prati||5||
etanrtun vikalpyaivam dadyat samsodhanam bhisak| svasthavrttamabhipretya vyadhau vyadhivasena tu||6||

Greeshma (summer), Varsha (rainy season) and Himagama or Hemanta (winter) are characterised by excessive heat, rain and cold respectively.
The three intervening seasons, viz.,
Pravrt (end of rainy season)
Sharat Rutu - Autumn or fall
and
Vasanta or spring (the period between winter and summer)] are of general nature.

The months composing the three seasons of general nature are as follows:
Pravrt (approx, June- August) is composed of Suci or Aasada (June- July) and Nabha or Sravana (july- August);
Sarat or autumn (approx October- December) is composed of urja or Kartika (October - November) and Saha or Margasira (November- December) and
Vasanta or spring (February- April) is composed of Tapasya or Phalguna (February- March) and Madhu or Caitra (March- April).

The above mentioned three seasons i.e.,
Pravrit (end of raining season)
Sharat (Autumn / fall)
and
Vasanta Rutu (Spring) are suitable for the administration of elimination therapies.

After determining the exact months consisting of the above-mentioned seasons, the physician should give appropriate elimination therapies to a healthy person. However, for a patient, the appropriateness of the time (season) is determined on the basis of the nature of the diseases. [4-6]

Administration of Snehana and Swedana in Intervals

??????? ???????????????????????? ?| ??????????? ?????????? ?????? ?????? ??????????||?||
karmanam vamanadinamantaresvantaresu ca| snehasvedau prayunjita sneham cante prayojayet||7||
During the interval between two therapies, viz., emesis, etc., the patient is given oleation and fomentation therapies, and at the end of such therapy, oleation therapy should again be given. [7]

Prohibition of Excessive Oleation

???????????????????????????????|?????????????????? ?????????????? ?????????||?||
visarpapidakasophakamalapanduroginah|abhighatavisartamsca natisnigdhan virecayet||8||
Purgation therapy is to be given to the patient suffering from Visarpa (Erysipelas), Pidaka (acne, cysts), Sopha (oedema), Kamala (Jaundice), Pandu (anaemia), injury and poisoning only when the patient is not excessively oleated. [8]

Nature of Purgation Recipe

????????????????? ??????? ?????????????| ????????????????????? ?????? ???????????????||?||
natisnigdhasariraya dadyat snehavirecanam| snehotklistasariraya ruksam dadyadvirecanam||9||
Sneha Virechana (unctuous recipe for purgation) should not be given to a patient whose body is Ati Snigdha (excessively oleated). If the unctuous element in the body of the patient is excited (Sneha Utklishta), then he is given a purgation therapy recipe which is dry in nature. [9]
Read: Virechana Therapy - Right Method, Side Effects, Management

Conditions responsible for Appropriate Effect

?????????????????? ?????? ?????????????| ?????????? ???? ??????????? ??????||??||
snehasvedopapannena jirne matravadausadham| ekagramanasa pitam samyagyogaya kalpate||10||
Factors responsible for appropriate effect (Samyag Yoga) are the following;
The patient should have taken snehana and swedana therapies; [further explained in verse 11-13]
The purgation therapy is given only after the previous meal is digested [to be further explained in verse 14]
The purgation therapy is given in appropriate dose; [further explained in verse 15-16] and
The patient should take the therapy with concentration of mind. [further explained in verse 17] [10]

Need for Snehana, Swedana

?????????? ??????????? ?????????? ??????????| ?????? ???????????? ???????????????????????||??||
??????? ?????? ??? ?????????????????? ??????| ??? ?????????? ?? ?????? ?????? ???????????? ????????||??||
???????? ???? ???????????? ??? ???????????????| ????????????????????????? ??????? ?????????? ||??||
snigdhat patradyatha toyamayatnena pranudyate| kaphadayah pranudyante snigdhaddehattathausadhaih||11||
ardram kastham yatha vahnirvisyandayati sarvatah| tatha snigdhasya vai dosan svedo visyandayet sthiran||12||
klistam vaso yathotklesya malah samsodhyate'mbhasa| snehasvedaistathotklesya sodhyate sodhanairmalah ||13||

Kapha, etc. morbid doshas can be taken out easily by therapies from the body of the patient who is oleated just like the water can be taken out easily from a pot smeared with oil.
The fomentation therapy helps the stable (adhered) Doshas in an oleated person to get eliminated completely just like the fire makes the liquid content of a piece of wet wood to ooze out in all the directions.
The Malas (morbid and Adhered Doshas) become detached by the application of oleation and fomentation therapies, and elimination therapy just like the dirt adhered to a piece of dirty cloth gets detached [by the application of heat or hot steam and alkaline] which can be washed out easily by rinsing with water. [11-13]

Digestion of food

??????? ?????? ???????????????????? ?????| ???? ??????? ??? ??????? ?????????||??||
ajirne vardhate glanirvibandhascapi jayate| pitam samsodhanam caiva viparitam pravartate||14||
If elimination therapies are administered before the previous meal (Ajeerne) is digested, then it gives rise to the following complications:
glani (depression)
vibandha (constipation) and
the therapy works in the opposite way (i.e., the emetic therapy causes purgation and the purgative therapy causes emesis) [14]

Appropriate Dose

?????????? ??????? ????????? ?????| ??????? ?????????? ??????? ????????????||??||
??????? ? ????????? ????????????? ? ???| ??????????????? ?????????????????????||??||
alpamatram mahavegam bahudosaharam sukham| laghupakam sukhasvadam prinanam vyadhinasanam||15||
avikari ca vyapattau natiglanikaram ca yat| gandhavarnarasopetam vidyanmatravadausadham||16||

Appropriate dose of the recipe for Shodhana is characterised as follows:
It should be small in quantity, but quick in action
It should be able to eliminate morbid Doshas in large quantity but easily
It should be light for digestion, palatable, pleasing and curative of the concerned diseases
It should not cause serious complications
It should not cause depression/fatigue in excess and
It should possess agreeable smell, colour and taste [15-16]

Concentration of mind

????? ??????? ?????? ???????????????? | ?????????? ???? ??????????? ??????||??||
vidhuya manasan dosan kamadinasubhodayan | ekagramanasa pitam samyagyogaya kalpate||17||

Lust, distraction, desire etc. are inauspicious impurities of the mind. If a person whose mind is cleansed of these impurities, and whose mind is concentrated on the therapy, takes recipes for the elimination of morbid matter, then appropriate effects (Samyag Yoga) of the therapy are produced. [17]
Read: Vamana in Fever

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????????????????????? ???????? ????? ???????? ??|??|
narah svo vamanam pata bhunjita kaphavardhanam| sujaram dravabhuyistham, laghvasitam virecanam||18||
utklistalpakaphatvena ksipram dosah sravanti hi|19|

The person scheduled to take Vamana the next day should eat a Kapha aggravating diet which is easy for digestion and which is mostly of liquid nature (in the night of the previous day). The person scheduled to take purgation therapy the next day should take a diet which is light and hot.
Because of the aforesaid diet, the Kapha gets excited or aggravated (in the patient who is to be given emesis the next morning). In the case of the patient who is to be given purgation therapy in the next morning, intake of the above mentioned light and hot diet during the previous night causes reduction of kapha. As a result of this [the emesis and purgation therapies] helps in the elimination of Doshas quickly. [18- 1/2 19]
Read: Rules For Vamana and Virechana Treatment- Charak Samhita Sutrasthan 15

Preparatory Measures

Signs of Appropriate purification

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??????? ????? ???????????????? ???? ??????||??||
pitausadhasya tu bhisak suddhilingani laksayet||19|| urdhvam kaphanuge pitte vitpitte'nukaphe tvadhah|
hrtadosam vadet karsyadaurbalye cet salaghave||20||
After the therapy is administered, the physician should keep observing the appearance of signs of appropriate purification which are as follows:
o In the case of emesis, the bile appears after the elimination of kapha;
o In the case of purgation, Kapha appears after the voiding of stool and bile
o After the therapies (both emesis and purgation) the body becomes emaciated, weak and light
Appearance of the above signs indicates appropriate elimination of the (morbid) Doshas). [19 1/2 - 20]

Measures to remove Residual Drugs (Shesha Aushadha)

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?????????????????? ????????? ??? ?????|??|
vamayettu tatah sesamausadham na tvalaghave| staimitye'nilasange ca nirudgare'pi vamayet||21||
alaghavattanutvacca kaphasyapat param bhavet|22|

The patient is given emetic therapy to remove the residual drugs (provided all the signs of appropriate administration of elimination therapy are observed). But if only lightness of the body is not observed (in spite of the presence of the remaining signs), then emesis should not be given.
If there is Staimitya (a feeling as if the body is covered with a wet skin) and occlusion of Vata, the emetic therapy is administered, even if there is no eructation, till there is lightness of the body and thinness of Kapha. Giving emesis thereafter leads to serious consequences. [21- 1/2 22]
Read: Benefits of Vamana and Virechana Treatment - Charaka Sutrasthana 16

After-care

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???? ???????? ?? ??????????? ????????? ???????||??||
vamite vardhate vahnih samam dosa vrajanti hi||22|| vamitam langhayet samyagjirnalinganyalaksayan|
tani drstva tu peyadikramam kuryanna langhanam||23||

Vamana promotes the Agni [after some time], and alleviates Doshas. After Vamana, the patient should keep fasting till the appearance of the signs of proper digestion of the medicines. After having observed these signs, the patient is given a regulated diet in the form of Peya (thin gruel), etc. and he should not be made to keep fast any more. [22 1/2 -23]

Need for regulated Diet

???????????? ???????? ???????????????| ?????????????????? ??????? ????? ?????????????||??||
samsodhanabhyam suddhasya hrtadosasyadehinah| yatyagnirmandatam tasmat kramam peyadimacaret||24||

[Immediately] after purification of the body, and elimination of Doshas from the body by emetic and purgative therapies, the Agni (power of digestion and metabolism) in a person gets subdued. Therefore, for him, a controlled diet in the form of Peya (thin gruel), etc., is recommended. [24]

Dietetic Regimen

???????? ????????????? ?????? ???????????| ????????????? ???????? ??????????????????? ????||??||
kaphapitte visuddhe'lpam madyape vatapaittike| tarpanadikramam kuryat peya'bhisyandayeddhi tan||25||

If Kapha and Pitta are cleansed partially because of Alpa Yoga or less effect (of emetic and purgative therapies), if the patient is addicted to alcohol, and if he suffers from Vatika or Paittika diseases, then he is given the regulated diet in the form of Tarpana - Nourishing, calming or demulcent drinks, etc., because Peya (thin gruel), etc. produces Abhisyandi effect (i.e., obstruction to the channels of circulation) in such cases. [25]

Signs of Drug- Digestion (Jirna Aushadhi)

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anulomo'nilah svasthyam ksuttrsnorjo manasvita| laghutvamindriyodgarasuddhirjirnausadhakrtih||26||

Signs of complete digestion of drugs used in the recipe are as follows:
Anuloma Anila - Downward movement of the wind in the intestine
Svasthya - A sense of well being
Kshrut, Trut - Proper hunger and thirst
Urja, Manasvita - Feeling of energy (promotion of strength) and self confidence
Laghutva - Lightness of the body
Indriya Shuddhi - Clarity (excellence in the functioning) of sense; and
Udgara Shuddhi - Purity of eructation (without the smell of drugs) are the signs of digestion and utilization of Shodhana Aushadha. [26]

Signs of residual Drugs (Shesha Aushadha)

????? ???????????? ????? ???????? ????????| ??????????????? ???????????????||??||
klamo daho'ngasadanam bhramo murccha siroruja| aratirbalahanisca savasesausadhakrtih||27||

If the drugs of the recipe are not fully digested, and a part remains undigested, then this gives rise to the following signs:
Klama (mental fatigue), Daha - Burning sensation,
Anga Sadana - Prostration of limbs, Bhrama, Murcha - Giddiness, Fainting,
Shiroruja - Headache,
Arati, Balahani Disliking for everything around and, Diminution of strength. [27]

Characteristics of Drugs Producing Undesirable effects

?????????????????? ? ?????? ? ? ???????| ??????????????? ??? ?????????????? ???????||??||
akale'lpatimatram ca puranam na ca bhavitam| asamyaksamskrtam caiva vyapadyetausadham drutam||28||

Drugs of the following nature, if used in the recipes for elimination therapies, produce adverse effects quickly:
Akala - Unseasonal and untimely collected
Alpa, Atimatra - Administration in less or excess dose
Purana - old medicine, stored for a longer period after collection
Na bhavita - Used without proper impregnation and
Asamyak Samskrita - Improperly processed [28]

Adverse effects and their causative factors

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??????????????? ????? ??????? ????| ?????????????????????? ???????????????? ?||??||
adhmanam parikartisca sravo hrdgatrayorgrahah| jivadanam savibhramsah stambhah sopadravah klamah||29||
ayogadatiyogacca dasaita vyapado matah| presyabhaisajyavaidyanam vaigunyadaturasya ca||30||
Emetic and purgative therapies may produce ten adverse effects (vyapat) as follows:
Adhmana or Flatulence (caused by Ayoga or under action of the recipe)
Parikartika or gripping pain (caused by Atiyoga or over action of the recipe)
Srava or excessive discharge (caused by Ayoga)
Hrdgraha or stiffness in the cardiac region (caused by Ayoga)
Gatragraha or stiffness of the body (caused by Ayoga)
Jivadana or bleeding (caused by Atiyoga)
Vibhramsa, i.e. Guda-Bhramsa or Prolapsed rectum
Sanjna-Bhramsa or mental perversion (caused by atiyoga) and others like itching (caused by Ayoga):
Stambha or rigidity
Upadrava or complications (caused by Ayoga) and
Klama or mental fatigue (caused by Ayoga)
The above mentioned adverse effects arise out of the Ayoga (under action) and Ati Yoga (over action) of the recipe because of the following.
Presya Vaigunya (defect in the attendant)
Bhaisajya Vaigunya (defect in the recipe)
Vaidya Vaigunya (defect in the physician) and
Atura Vaigunya (defect in the patient) [29-30]

Different types of Actions of Elimination therapies

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yogah samyakpravrttih syadatiyogo'tivartanam| ayogah pratilomyena na calpam va pravartanam||31||

Emesis and purgation therapies act in three different ways as follows:
Yoga or appropriate action resulting in proper elimination of Doshas
Atiyoga or over action which causes excessive elimination of Doshas and
Ayoga or under action which causes movement of drugs in reverse direction (Pratiloma Gati), non-elimination of Doshas, or their elimination in less quantity. [31]

Movement in reverse direction

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???????????????????????? ???????????????????? ??| ???????? ???? ?????? ???????? ???? ??????????????||??||
????????????? ??????? ???????? ????????????| ???????????, ????????? ???? ???? ?????????||??||
slesmotklistena durgandhamahrdyamati va bahu| virecanamajirne ca pitamurdhvam pravartate||32||
ksudhartamrdukosthabhyam svalpotklistakaphena va| tiksnam pitam sthitam ksubdham vamanam syadvirecanam||33||
pratilomyena dosanam haranatte hyakrtsnasah| ayogasanjne, krcchrena yati doso nava'lpasah||34||

Intake of purgation therapy by a person with excited (aggravated) Kapha may produce action in reverse direction (it may cause Vamana) because of the following factors:
Durgandha - Foul odour of the recipe
Ahridya - Non-palatability of the recipe
Ati / Bahu - Larger quantity of the recipe and
Ajirne peetam - Intake of the recipe before the previous meal has been digested

Similarly, Vamana dravya may produce Virechana because of the following factors
Kshudha Arta - Affliction of the patient with hunger
Mrudu Koshta - Lax bowel / smooth intestinal lumen,
Svalpa Utklishta Kapha - Less excitement of kapha
Tikshna (sharp) nature of the drug
Sthita or stagnation of the recipe and
Kshubdham or agitating nature of the recipe.

If the emetic and purgative therapies produce action in the reverse order, then they become incapable of eliminating the morbid matter entirely. Thus, these conditions are called Ayoga (inappropriate or under action). In these conditions, the morbid Doshas get eliminated with difficulty or they do not get eliminated at all or they get eliminated only in small quantities. [32-34]
Read: Vamana And Virechana In The Treatment Of Kushta

Indigestion of recipe

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pitausadho na suddhascejjirne tasmin punah pibet| ausadham na tvajirne'nyadbhayam syadatiyogatah||35||

If the medicine taken for emesis and purgation does not produce the appropriate cleansing effects, then after its digestion, the therapy is administered again (on the same day). Before the digestion of the earlier recipe, the therapy should not be administered. Repetition of the therapy may lead to AtiYoga (excessive action). [35]

Repetition of Therapy

???????? ??????? ???????? ??????? ????? ?| ????? ???? ?? ?????????? ?????????? ??||??||
kosthasya gurutam jnatva laghutvam balameva ca| ayoge mrdu va dadyadausadham tiksnameva va||36||

If there is Ayoga (no action), then after ascertaining the nature of the Koshta (hard or soft bowel) and the strength, the patient is given [repeated dose] of the medicine which is either Mrdu (mild) or Tikshna (Sharp or strong) in nature. [36]

Avoiding Repeat- dose

???? ? ?? ????????? ?????????? ? ????????| ?????????? ???? ??????? ???? ??????? ??||??||
vamanam na tu duschardam duskostham na virecanam| payayetausadham bhuyo hanyat pitam punarhi tau||37||

If the patient is a bad subject (not an ideal candidate) for emesis, then a second emetic dose should not be given. Similarly, a second purgative dose should not be given if the patient has a hard bowel. Repeat doses of emesis and purgation to these two categories of patients may lead to their death. [37]

Causes and Complications of Ayoga

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???????? ??????? ??????? ???? ?????? ????? | ????????????????? ???????????? ???? ??????????||??||
asnigdhasvinnadehasya ruksasyanavamausadham| dosanutklisya nirhartumasaktam janayedgadan||38||
vibhramsam svayathum hikkam tamaso darsanam bhrsam | pindikodvestanam kandumurvoh sadam vivarnatam||39||

Asnigdha, Asvinna - If the patient is not oleated and fomented,
Rooksha - if there is dryness in his body and
Anava Aushadha - the ingredients of the recipe have become old (stored for a long time beyond shelf life), then in such a situation the therapy becomes incapable of (completely) eliminating the morbid Doshas in spite of having caused their excitation.

This gives rise to ailments like
Vibhramsa (action in reverse direction),
Shvayathu (oedema),
Hikka (hiccup),
Tamaso Darshana (excessive fainting), and
Pindikodveshtana cramps in the calf region,
(Kandu) itching,
Uru Sada - asthenia of the thighs and
Vivarnata (discoloration of the skin). [38-39]

Another type of Ayoga and its management

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????? ??????????????? ???? ?? ??| ??????? ???????????? ???????? ??????? ????????||??||
snigdhasvinnasya catyalpam diptagnerjirnamausadham| sitairva stabdhamame va dosanutklisya naharet||40||
taneva janayedroganayogah sarva eva sah| vijnaya matimamstatra yathoktam karayet kriyam||41||

Even in a person who is properly oleated and fomented, the Doshas which are already excited do not get eliminated because of the following factors:
Atyalpa - If the recipe is administered in a very small dose
Deepta Agni - If the patient has strong power of digestion as a result of which the recipe administered in small dose itself gets digested (without producing its effects)
Sheeta - If the recipe has become ineffective because of cold ingredients and
Stabdha, Ama - If the recipe is taken when the body of the patient is afflicted with Ama (product of improper digestion and metabolism)
In the above-mentioned conditions, all the complications (like Vibhramsa-Vide verse nos. 38-39 above) are manifested.

All the conditions are the result of Ayoga (under action of the purificatory recipe). Having determined this condition, a wise physician should treat them on the suggested lines (vide verse nos. 35-42) [40-41]

Treatment of Ayoga

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?????? ? ????????????????????????????????| ??????????????????????? ???????||??||
???????? ??????? ??????? ?????????????? ???????| ? ????????????? ??? ???????????? ?????||??||
tam tailalavanabhyaktam svinnam prastarasankaraih|payayeta punarjirne samutrairva niruhayet||42||
nirudham ca rasairdhanvairbhojayitva'nuvasayet| phalamagadhikadarusiddhatailena matraya||43||
snigdham vataharaih snehaih punastiksnena sodhayet| na catitiksnena tato hyatiyogastu jayate||44||

After digestion of the previously administered recipe, the patient is given Abhyanga with oil mixed with salt, and fomented with Prastara and Sankara type of fomentation therapies (vide sutra 14:41 & 42). Thereafter, he is given another dose of the Virechana recipe or may be given Niruha type of enema mixed with cow's urine.
After Niruha Basti, the patient is given food along with the soup of the meat of animals living in arid zones. Thereafter, Anuvasana Basti is given to him with the medicated oil prepared by boiling with Phala (madana phala), Magadhika (pippali) and Daru (Devadaru) in appropriate doses.
Thereafter, he is oleated with medicated fat prepared by cooking with Vata alleviating drugs, and then purificatory therapy with recipe containing Teekshna (sharp) ingredients is given again. The ingredients should not be exceedingly sharp because that may result in Ati Yoga (over action). [42-44]

Signs and treatment of Ati-Yoga

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??????????? ???? ???????? ????? ??????| ????????? ??????????? ?????????????????||??||
???? ?? ?????? ???????????? ???? ???? | ????????????????? ??????? ??????????? ???||??||
?????????? ????????????????????| ??????????????????????????????????||??||
atitiksnam ksudhartasya mrdukosthasya bhesajam| hrtva"su vitpittakaphan dhatunvisravayeddravan||45||
balasvaraksayam daham kanthasosam bhramam trsam| kuryacca madhuraistatra sesamausadhamullikhet||46||
vamane tu virekah syadvireke vamanam punah | parisekavagahadyaih susitaih stambhayecca tat||47||
kasayamadhuraih sitairannapanausadhaistatha| raktapittatisaraghnairdahajvaraharairapi||48||

Exceedingly Teekshna medicine given to a patient who is hungry, and who has soft bowel (Mrudu koshta), quickly eliminates not only stool, Pitta (bile) and kapha (phlegm), but also the Dhatus - liquid elements of tissues of the body.
As a result of this, loss of strength and voice, burning sensation, dryness of the throat, giddiness and morbid thirst are manifested.
In such a condition, the residual drugs are eliminated with ingredients belonging to the group of sweet drugs (madhura-gana).
In case of Ati Yoga (over-action) of emetic therapy, the patient is given purgation therapy, and in case of atiyoga (over action) of purgation therapy he is given emesis.
The urge for vomiting and purgation in excess because of over-action may be arrested by the following:
Exceedingly cold Pariseka (sprinkling of water), Avagaha (bath) etc. measures,
Intake of food, drinks and medications which are cooling, astringent as well as sweet in taste and
Therapies which are curative of Rakta-Pitta (an ailment characterised by bleeding from different parts of the body), Atisara (diarrhoea), Daha (burning sensation) and Jvara (fever). [45-48]

Recipes for treatment of over-action of Purgation Therapies

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???????????? ???????? ??????? ????? ???????????| ?????????????????? ?????? ?????? ?????? ? ???????||??||
??????????? ??????????? ?????????????? ??????| ???????????????? ??????? ????????????||??||
anjanam candanosiramajjasrksarkarodakam| lajacurnaih pibenmanthamatiyogaharam param||49||
sungabhirva vatadinam siddham peyam samaksikam| varcahsangrahikaih siddham ksiram bhojyam ca dapayet||50||
jangalairva rasairbhojyam picchabastisca sasyate| madhurairanuvasyasca siddhena ksirasarpisa||51||

The patient suffering from the complications of over action of purgative therapies should take the following recipes:
Mantha (demulcent drink) prepared with Anjana (daruharidra), Candana, Usira, bone marrow, blood, sugar and water along with the powder of the roasted paddy. This is an excellent recipe for curing over action of elimination therapies.
Peya (thin gruel) prepared of the Sunga (still root) of Vata, etc. (nyagroda, Udumbara, Asvattha and Kapitana), mixed with honey.
Milk and food articles prepared by boiling with drugs which are Varcas Sangrahika or intestinal astringents (vide Sutra 4:5: 15).
Food along with the soup of the meat of animals inhabiting arid zone,
Piccha Basti (sticky medicated enema);
Anuvasana Basti or unctuous enema of Ksira Sarpis belonging to Madhura varga (group of drugs having sweet taste) [49-51]

Treatment of over-action of emetic Therapy

????????????? ?? ?????????????????| ?????? ???????????? ??????????????????||??||
??????????? ???? ?????? ??????????? ?????????????| ??????????? ?????? ?????????????????||??||
????????????????????? ????????? ?????????| ???????????????????????????????????????????||??||
???????????? ???????????? ???????????? ????| ???????? ?? ?????????????????????? ??????????||??||
?????????????????? ?????????????????| ?????? ?????? ??????? ??????????? ? ??????????||??||
vamanasyatiyoge tu sitambuparisecitah| pibet kaphaharairmantham saghrtaksaudrasarkaram||52||
sodgarayam bhrsam vamyam murcchayam dhanyamustayoh| samadhukanjanam curnam lehayenmadhusamyutam||53||
vamato'ntahpravistayam jihvayam kavalagrahah| snigdhamlalavanairhrdyairyusaksirarasairhitah||54||
phalanyamlani khadeyustasya canye'grato narah| nihsrtam tu tiladraksakalkaliptam pravesayet||55||
vaggrahanilarogesu ghrtamamsopasadhitam| yavagum tanukam dadyat snehasvedau ca buddhiman||56||

If there is atiYoga (over action) of the emetic therapy, then the patient is sprinkled with cold water. He is given Mantha (demulcent drink) prepared of kapha alleviating ingredients and added with ghee, honey and sugar.
In the case of excessive vomiting associated with eructation or fainting, the patient is given to lick, the powder of Dhanya, Musta, Madhuka and Anjana (solid extract of Daruharidra) mixed with honey.
While vomiting, if the tongue gets drawn inside, then Kavala Graha (recipe used for rinsing the mouth) with the vegetable soup, milk or meat soup prepared by adding unctuous, sour, saline and palatable ingredients is given. Another person may eat sour fruits in front of the patient (to cause salivation of the patient which helps the indrawn tongue to come to its normal position).
If the tongue is protruded out, then it is smeared with the paste of til and Draksa, and pushed back to its normal position.
If there is Vak Graha (obstruction in speech) or other disorders caused by Vata, then a wise physician should give thin gruel prepared with ghee and meat for the patient to eat. In addition, the patient may be given with oleation and fomentation therapies. [52-56]

Need for Regulated diet

??????? ?????????? ???????????? ?????????| ??????????????????????? ????? ???????? ????? ||??||
vamitasca viriktasca mandagnisca vilanghitah| agnipranavivrddhyartham kramam peyadikam bhajet ||57||

A person who has Mandagni (suppressed power of digestion and metabolism) and who was fasting because of emetic and purgative therapies is given regulated diet in the form of Peya (thin gruel), etc. for the promotion of his Agni and Prana (Vitality) [57]

Etiology, signs and Treatment of Adhmana

????????? ???????? ??????????????????| ??????????? ??????????? ????????????????????? ?||??||
??????????????????? ?????????????????????| ????????????????????? ????? ????????? ???????||??||
????????????????????? ???????????????| ?????????? ????? ????????????? ??????||??||
bahudosasya ruksasya hinagneralpamausadham| sodavartasya cotklisya dosanmargannirudhya ca||58||
bhrsamadhmapayennabhim prsthaparsvasirorujam| svasavinmutravatanam sangam kuryacca darunam||59||
abhyangasvedavartyadi saniruhanuvasanam| udavartaharam sarvam karmadhmatasya sasyate||60||

If medicines for purifications are administered in a small dose to a patient who is afflicted with excess of morbid Doshas, whose body is dry, who has less of Agni (power of digestion), and who is suffering from Udavarta (upward movement of wind), the medicines while exciting Doshas may cause obstruction to the channels. This causes frequent Adhmana (distension) in the umbilical region, pain in the back, side of the chest as well as head, and serious obstruction to the passage of breath, stool, urine and flatus.
For the treatment of these complications, the patient is given
Abhyanga (massage),
Svedana (fomentation),
Varti (medicated suppository),
Svedana (fomentation)
Varti (medicated suppository), etc., along with Niruha (evacuative) and Anuvasana (unctuous) types of enema.
All the therapies prescribed for the treatment of Udavarta (vide Chikitsa 26: 11-31) are useful for the treatment of the present ailment i.e adhmana (flatulence). [58-60]

Etiology, signs and treatment of Parikartika

????????? ??????????? ???? ?????????|??????? ??????????? ????????????????? ??||??||
???? ????? ???? ??????? ???? ?????? ?|?????????? ???????????? ????? ????????????||??||
?????? ????? ???? ?????????? ?????????|???????? ????? ????? ???????? ?????????||??||
snigdhena gurukosthena same balavadausadham|ksamena mrdukosthena srantenalpabalena va||61||
pitam gatva gudam samamasu dosam nirasya ca|tivrasulam sapicchasram karoti parikartikam||62||
langhanam pacanam same ruksosnam laghubhojanam|brmhaniyo vidhih sarvah ksamasya madhurastatha||63||

Snigdha - If a person who is oleated,
Guru Koshta - who has constipated bowel and
Ama - who is afflicted with Ama (product of improper digestion and metabolism),
or if a person who is weak (Kshama),
who has lax bowel (Mrudu koshta),
who is fatigued (shranta) and
who has taken a quick acting medicine for purification, then the recipe reaches the rectum to cause excruciating sawing kind of pain (Teevra shoola) accompanied with slimy and bloody discharge (Piccha Asra), and parikartika - cutting type of pain in the anal region.

In this condition associated with Ama, the patient should keep fasting; take Pachana (digestive stimulants) and food which is dry, hot and light for digestion.
If the patient is weak, then all the nourishing therapies and recipes containing drugs having sweet taste are taken. [61- 63]

Recipes for Parikartika

??? ??????????????????? ?????????? ??? ??????| ???????????????? ?? ??????? ????? ??||??||
????????? ?????? ??????????????? ???| ???????? ????? ???? ???????? ??????????||??||
?????????????? ?? ???????????????? ??????| ?????????????????????????????? ???? ???||??||
????????? ???? ???????????????? ??| ??????????????? ?? ??????????? ??????????||??||
ame jirne'nubandhascet ksaramlam laghu sasyate| puspakasisamisram va ksarena lavanena va||64||
sadadimarasam sarpih pibedvate'dhike sati| dadhyamlam bhojane pane samyuktam dadimatvaca||65||
devadarutilanam va kalkamusnambuna pibet| asvatthodumbaraplaksakadambairva srtam payah||66||
kasayamadhuram sitam picchabastimathapi va| yastimadhukasiddham va snehabastim pradapayet||67||

If Parikartika (sawing pain) continues even after the Ama (product of improper digestion and metabolism) gets cooked, intake of alkaline, light to digest and sour foods are beneficial.
If there is predominance of Vata (aggravated), the below mentioned recipes are useful:
Ghee along with pomegranate-juice added with Puspa-kasisa or alkalies or salt
Food and drinks containing sour curd mixed with the skin of the pomegranate;
Paste of Devadaru and Tila should be given for drinking mixed in hot water.
Milk boiled and processed with Ashwattha, Udumbara, Plaksha and Kadamba should be given for drinking.
Cold enemas prepared with astringent and sweet tasting herbs or Pichcha Basti type of enema shall be administered.
Anuvasana Basti with oil/ghee prepared with paste and decoction of Yashtimadhu. [64-67]
Read: Vamanopaga Gana: Emesis Aiding Herbs: Review, Benefits, Formulations

Etiology, signs and treatment of Parisrava

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???????????????????????????????????????????????| ????????? ?, ?? ???? ??????????????||??||
???????? ?? ????????????? ??????? ????????| ?????? ????????????????? ???????????? ??????????||??||
alpam tu bahudosasya dosamutklisya bhesajam| alpalpam sravayet kandum sopham kusthani gauravam||68||
kuryaccagnibalotklesastaimityarucipandutah| parisravah sa, tam dosam samayedvamayedapi||69||
snehitam va punastiksnam payayet virecanam| suddhe curnasavaristan samskrtamsca pradapayet||70||

Purificatory recipe given in a small dose to a person having excessively aggravated Doshas causes excitation of the morbid material and eliminates them frequently in small quantities, this gives rise to itching, oedema, Kustha (skin diseases), heaviness of the body, diminution of the power of Agni (digestion) and strength, Staimitya (a feeling as if the body has been covered with a wet leather), anorexia and anaemia. This condition is called Parisrava.
This morbidity may be corrected either by alleviation therapy (if there is less of morbid matter) or by emesis (if the morbid material is present in large quantities).
After oleation, the patient may be given with strong purgation therapy again. After purgation, the patient is given recipes of powders, Asavas and Aristas processed with appropriate ingredients (as described in the treatment of Arsas or piles and Grahani or spure syndrome (vide Chikitsa 14, 15). [68-70]

Etiology, signs and treatment of Hrdayopasarana

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? ??????????????????????????????????????????| ??????? ????? ?????????? ??????? ????????????||??||
? ?????????????? ???? ????????? ?? ?????| ?????? ????????????????? ?????? ?????????????||??||
?????????????????? ??????? ?????????| ????????? ? ??? ????? ??????????????????? ||??||
???????????? ????? ???? ???????| ????? ??????????????? ??????? ??????????????||??||
pitausadhasya veganam nigrahanmarutadayah| kupita hrdayam gatva ghoram kurvanti hrdgraham||71||
sa hikkakasaparsvartidainyalalaksivibhramaih| jihvam khadati nihsanjno dantan kitikitapayan||72||
na gacchedvibhramam tatra vamayedasu tam bhisak| madhuraih pittamurcchartam katubhih kaphamurcchitam||73||
pacaniyaistatascasya dosasesam vipacayet| kayagnim ca balam casya kramenotthapayettatah ||74||
pavanenativamato hrdayam yasya pidyate| tasmai snigdhamlalavanam dadyat pittakaphe'nyatha||75||

Because of the suppression of the manifested natural urges in a person who has taken purificatory recipes, Vata, etc., get aggravated. Pertaining to the heart, these aggravated Doshas give rise to serious ailments like Hrd-Graha (cardiac spasm).
The patient afflicted with these conditions suffers from hiccup, cough, and pain in the sides of the chest, prostration, ptyalism and agitation of the eyes. He bites his tongue, becomes unconscious and gnashes his teeth.
The physician should not commit a mistake. If the patient faints because of aggravated pitta he should immediately administer emetic therapy with sweet ingredients.
If the patient faints because of aggravated Kapha, then the emetic therapy is given with pungent ingredients, thereafter, the residual Doshas are digested by the administration of digestive stimulants after which his Kayagni (digestive power) and strength are restored gradually.
Because of vomiting in excess, if the heart is afflicted by aggravated Vata, then the patient is given unctuous, sour and saline drugs, if this is caused by Pitta or Kapha, then drugs having opposite attributes (like dryness and bitter as well as pungent tastes) are given. [71-75]

Etiology, Signs and Treatment of AngaGraha

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?????????????????????????????????????| ???? ?????? ????? ????????????? ??????? [?] ||??||
pitausadhasya veganam nigrahena kaphena va| ruddho'ti va visuddhasya grhnatyangani marutah||76||
stambhavepathunistodasadodvestanamanthanaih| tatra vataharam sarvam snehasvedadi karayet [2] ||77||

If a person who has taken purificatory therapy, suppresses his manifested natural urges, or if the Vata in his body gets occluded by Kapha, or if the purification is done in excess, then the aggravated Vata causes spasm in different parts of the body of the patient. This produces Stambha (stiffness), Vepathu (trembling), Nistodu (pain), Sada (prostration), Udvestana (spasm) and Manthana (twisting)
For these ailments, all the Vata alleviating therapies like oleation and fomentation are administered. [76-77]

Etiology, signs and Treatment of Jivadana (Bleeding)

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???????? ???????? ????????????? ??????? ??| ???????? ???????????????? ? ???????? ?????????????||??||
?????? ?? ?????? ???????????? ???????????| ??????????? ??????? ?????? ?????? ?????? ?? ??????||??||
??????????????????????? ?????????????? ????????| ???? ????????? ???????????? ? ?? ???? ||??||
??????????????? ???????? ??????????| ??????????????????? ???? ????????? ?????? ||??||
???? ?????????? ????? ?????? ??????????| ????????????????????????????? ???? ???||??||
???????????????? ???? ?????? ??????????| ???????????? ?????? ?? ????????????????||??||
atitiksnam mrdau kosthe laghudosasya bhesajam| dosan hrtva vinirmathya jivam harati sonitam||78||
tenannam misritam dadyadvayasaya sune'pi va| bhunkte taccedvadejjivam na bhunkte pittamadiset||79||
suklam va bhavitam vastramavanam kosnavarina| praksalitam vivarnam syat pitte suddham tu sonite||80||
trsnamurcchamadartasya kuryadamaranat kriyam| tasya pittaharim sarvamatiyoge ca ya hita ||81||
mrgagomahisajanam sadyaskam jivatamasrk| pibejjivabhisandhanam jivam taddhyasu gacchati ||82||
tadeva darbhamrditam raktam bastim pradapayet| syamakasmaryabadaridurvosiraih srtam payah||83||
ghrtamandanjanayutam sitam bastim pradapayet| picchabastim susitam va ghrtamandanuvasanam||84||

If a strong purificatory recipe is given to a person who has a laxed bowel, and who has less of morbid Doshas, then after eliminating the morbid Doshas, the recipe causes churning (of the intestine) which results in bleeding.
This (fluid) is mixed with food and given to crows and dogs to eat. If they eat it then it is to be considered as Jiva-Rakta (live or pure blood), and if it is not eaten by them, it should be considered as raktapitta i.e., polluted blood.
A piece of white cloth is impregnated with this fluid and then dried. When washed with lukewarm water, if the piece of cloth becomes/remains discoloured, then the bleeding is to be treated as caused by Raktapitta, and if it becomes absolutely clean, then this is to be treated as Jiva-Rakta (live or pure blood).
If the patient having bleeding suffers from morbid thirst, fainting and intoxication, then the physician should treat him till the last moment of his life. All the therapies which are meant for the alleviation of Pitta, and which are useful for the management of over-action of purificatory therapies (as described in the verse no. 47) are given to him.
He is given to drink the fresh blood of a living deer, cow, buffalo or goat which is life-supporting because it immediately gets transformed into the live-blood. This blood [of animals] may be mixed with the powder of Darbha and used for Basti (medicated enema).
The milk cooked by adding Syama (Priyangu), Kasmarya, Badari, Durva, and Usira is mixed with Ghrta-Manda (supernatant part of ghee) and Anjana (solid extract of daruharidra), and cooled. This may be administered as medicated enema). He may be given very cold Piccha-Basti (mucilaginous enema) or Anuvasana-Basti (unctuous enema) prepared of Ghrta-manda. [78-84]

Etiology, Signs and Treatment of Vibhramsa

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??? ??????? ???? ???????????????| ???? ????????? ?? ??????????????? ???????||??||
??? ????????? ??????????? ????? ????????? ?????| ? ???????? ???????? ??????????????? ??????||??||
gudam bhrastam kasayaisca stambhayitva pravesayet| sama gandharvasabdamsca sanjnanase'sya karayet||85||
yada virecanam pitam vidantamavatisthate| vamanam bhesajantam va dosanutklisya navahet||86||
tada kurvanti kandvadin dosah prakupita gadan| sa vibhramso matastatra syadyathavyadhi bhesajam||87||

If there is prolapse of the rectum (Guda-Bhramsa), it is made stiff by applying astringent drugs, and pushed back into its own location.
If there is unconsciousness (Sanjna-Bhramsa), then the patient is consoled and he is entertained with soothing music.
If the intake of purgative recipe stops action after the elimination of stool and doesn't expel morbid pitta and kapha, if the intake of emetic recipe stops action after the elimination of emetic medicine without removing the morbid kapha and pitta, then the aggravated Doshas give rise to ailments like Kandu (itching) etc. This is called Vibhramsa (wrong action) these ailments are to be appropriately treated according to their nature. [85-87]

Etiology, Signs and Treatment of Stambha

???? ????????? ??????? ???????????????????????| ? ?????? ????????? ??????????? ??????????????????||??||
????????????????????? ?????? ???????| ???????? ?????? ?????? ?? ??????? ????????????||??||
pitam snigdhena sasneham taddosairmardavadvrtam| na vahayati dosamstu svasthanat stambhayeccyutan||88||
vatasangagudastambhasulaih ksarati calpasah| tiksnam bastim virekam va so'rho langhitapacitah||89||

Unctuous type of purificatory recipe taken by an oleated person gets occluded by Doshas because of its mild nature. It becomes incapable of expelling the Doshas. The Doshas displaced from their locations thus get obstructed. This causes obstruction to flatus, stiffness in the anal region and pain in anal region associated with expulsion of faeces (morbid doshas) in smaller quantities. Such a patient is treated by strong enema or purgation after Langhana (fasting therapy) and Pachana (carminative therapy). [88-89]

Etiology, signs and Treatment of Upadravas

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???????????? ?????? ???????????? ???????|???????????????????? ?????? ?????? ?????||??||
ruksam virecanam pitam ruksenalpabalena va|marutam kopayitva"su kuryaddhoranupadravan||90||
stambhasulani ghorani sarvagatresu muhyatah|snehasvedadikastatra karyo vataharo vidhih||91||

Intake of dry type of purgation therapy by a person whose body is dry and who is weak aggravates Vata immediately to cause serious type of complications like serious type of Stambha (stiffness) and colic pain all over the body of the patient who gradually loses consciousness.
In such cases, oleation, fomentation and such other therapies for alleviation of Vata are administered. [90-91]

Etiology, Signs and Treatment of Klama

?????????? ???????????? ????????????????? ????| ?????? ???? ? ??????? ????????????? ??????||??||
????????? ????????? ? ?????????? ???????????| ?????? ????? ????? ???????? ???????? ? ??????||??||
snigdhasya mrdukosthasya mrdutklisyausadham kapham| pittam vatam ca samrudhya satandragauravam klamam||92||
daurbalyam cangasadam ca kuryadasu tadullikhet| langhanam pacanam catra snigdham tiksnam ca sodhanam||93||

Mild purificatory recipe administered to an oleated person having lax bowel excites Kalpha and Pitta because of which the Vata gets obstructed leading to the manifestation of klama (mental fatigue) associated with drowsiness and heaviness. This causes weakness and prostration of limbs.
Such a patient is administered emetic therapy quickly. Langhana (fasting) and Pachana (carminative drugs) are given to the patient followed by purificatory therapy containing unctuous and sharp drugs. [92-93]

Epilogue

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??????? ??????? ????????? ?????? ????????????| ?????? ???????? ???????????????????? ||??||
??? ??????? ???????????????? ????????| ??????? ??????? ???????????????? ????? ???||??||
ityeta vyapadah proktah sarupah sacikitsitah| vamanasya virekasya krtasyakusalairnrnam ||94||
eta vijnaya matimanavasthascaiva tattvatah| dadyat samsodhanam samyagarogyarthi nrnam sada||95||

To sum up: - The complications along with signs, symptoms and treatment arising out of the administration of emetic and purgative therapies by the unskilled physician are described in this chapter. A wise physician having correct knowledge of these states (complications) should appropriately administer purifictory therapies (free from complications) with the objective of providing good health to the people. [94-95]

??????????????? ??????? ????????????????????????? ?????????????? ???????????? ??????????????????????????? ????????????||?||
ityagnivesakrte tantre carakapratisamskrte'prapte drdhabalasampurite siddhisthane vamanavirecanavyapatsiddhirnama sastho'dhyayah||6||

Thus, end the sixth chapter of siddhi-Sthana dealing with "successful treatment of Complications of emetic and Purgation Therapies" in Agnivesha's work as redacted by Charaka, and because of its non- availability, supplemented by Drdhabala.

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