Udara Chikitsitam Adhyaya (Treatments of abdominal enlargements)  

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.