AIAPGET Points
– Amajirna leads to Visuchika. Visthabdhajirna leads to Alasaka. Vidagdhajirna causes Vilambika.
– Vilambika is a disease in which the food vitiated by kapha and vata does not come out either from upward (mouth) or downward (anus) routes. It will stay in the abdomen for long periods of time and trouble the person. Ref – Su.Ut.56/9
– In treatment of Visuchika, Dahana or Agnikarma has been indicated to be done to the HEEL with heated iron. (Su.Ut.56/12)
– Kshara Agada has been prescribed in the treatment of Visuchika.
– Kalyanaka Lavana described in the Treatment of Vata Roga has also been indicated in the treatment of Visuchika.
– Vyoshadi Anjana has been prescribed in the treatment of Visuchika. Su.Ut.56/18
– Purisha-Mutra Stambha and Shakrd-Vamana are the symptoms of Purishaja Anaha.
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The 56th chapter of Uttaratantra of Sushruta Samhita is named as Pratişedha Pratiședha. This chapter deals with Treatment of Gastroenteritis.
अथातो विसूचिकाप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound Visciuka pratiṣedha- treatment of Gastroenteritis as revealed by the venerable Dhanvantari.
अजीर्णमामं विष्टब्धं विदग्धं च यदीरितम् |
विसूच्यलसकौ तस्माद्भवेच्चापि विलम्बिका ||३||
Visucika, Alaska and Vilambika arise from the three kinds of ajirna – indigestion namely – Amajirna, Visthabdhajirna and Vidagdhajirna.
Causes and pathogenesis of Visucika
सूचीभिरिव गात्राणि तुदन् सन्तिष्ठतेऽनिलः |
यस्याजीर्णेन सा वैद्यैरुच्यते ति विसूचिका ||४||
न तां परिमिताहारा लभन्ते विदितागमाः |
मूढास्तामजितात्मानो लभन्ते कलुषाशयाः ||५||
Consequent to ajirna, vata gets aggravated and gives rise to pricking pain in the body. Physicians call this condition Visucika.
This disease will not affect the persons who consume foods in proper quantities as permitted by the texts and adhere to the proper regimens of foods. On the other hand, it will affect those persons who do not have control over themselves and also vitiate their stomach with unhealthy foods.
Lakşana – clinical features
मूर्च्छातिसारौ वमथुः पिपासा शूलं भ्रमोद्वेष्टनजृम्भदाहाः |
वैवर्ण्यकम्पौ हृदये रुजश्च भवन्ति तस्यां शिरसश्च भेदः ||६||
Below mentioned are the symptoms of Visucika –
– fainting,
– diarrhoea,
– vomiting,
– thirst,
– abdominal pain,
– giddiness,
– rigidity of extremities,
– excessive yawning,
– feeling of burning sensation,
– discolouration,
– shivering,
– pain in the region of the heart and
– headache
Alasaka
कुक्षिरानह्यतेऽत्यर्थं प्रताम्यति विकूजति |
निरुद्धो मारुतश्चापि कुक्षौ विपरिधावति ||७||
वातवर्चोनिरोधश्च कुक्षौ यस्य भृशं भवेत् |
तस्यालसकमाचष्टे तृष्णोद्गारावरोधकौ ||८||
Alasaka – The disease characterized with the below mentioned features is called Alasaka –
– severe distension of the abdomen,
– unconsciousness and moaning,
– vata which is obstructed moves upwards in the stomach and
– there is obstruction to flatus and faeces and
– their accumulation in excess inside the abdomen, accompanied by
– thirst and
– excessive belching
Vilambikā
दुष्टं तु भुक्तं कफमारुताभ्यां प्रवर्तते नोर्ध्वमधश्च यस्य |
विलम्बिकां तां भृशदुश्चिकित्स्यामाचक्षते शास्त्रविदः पुराणाः ||९||
The ancient physicians have documented a condition / disease which is difficult to cure and have named it as Vilambika. In this condition, the food we consume gets vitiated by kapha and vata. Such vitiated food will not come out either from upward (mouth) or downward (anus) paths. It will stay inside the abdomen for a long period of time and trouble the person.
यत्रस्थमामं विरुजेत्तमेव देशं विशेषेण विकारजातैः |
दोषेण येनावततं स्वलिङ्गैस्तं लक्षयेदामसमुद्भवैश्च ||१०||
The place in which āma is present gives rise to pain i.e. in whichever place of the body ama is located, that place would develop pain. The place of the body in which ama is present and gives rise to pain should be considered (that place) as the origin of diseases caused by the doshas. That further should be determined by the presence of own (specific to it) symptoms of ama in that place.
यः श्यावदन्तौष्ठनखोऽल्पसञ्ज्ञश्छर्द्यर्दितोऽभ्यन्तरयातनेत्रः |
क्षामस्वरः सर्वविमुक्तसन्धिर्यायान्नरः सोऽपुनरागमाय ||११||
The person presenting with the below mentioned features is said to walk away never to return (would die) –
– teeth (gums), lips and nails turning blue,
– very less movements of body parts,
– vomiting,
– eyes gone deep inside (the eye socket),
– very feeble voice and
– looseness of all the joints
Cikitsā – treatment
साध्यासु पार्ष्ण्योर्दहनं प्रशस्तमग्निप्रतापो वमनं च तीक्ष्णम् |
पक्वे ततोऽन्ने तु विलङ्घनं स्यात् सम्पाचनं चापि विरेचनं च ||१२||
विशुद्धदेहस्य हि सद्य एव मूर्च्छातिसारादिरुपैति शान्तिम् |
आस्थापनं चापि वदन्ति पथ्यं सर्वासु योगानपरान्निबोध ||१३||
Curable forms of Visucika should be treated. In these conditions, it is ideal to do the below mentioned treatments –
– burn the heel of the patient i.e. branding should be done with heated iron,
– digestive fire should be augmented and
– strong emetics shall be administered so as to produce vomiting
Once the food gets digested, the patient should be made to fast. Digestive herbs should be used and purgatives should be administered.
The symptoms such as fainting, diarrhoea etc. immediately subside in persons who are purified by undergoing vomiting and purgation therapies. It is said that the decoction enema is also beneficial in this disease. Now, I shall describe the other medicinal formulae, listen to the same.
पथ्यावचाहिङ्गुकलिङ्गगृञ्जसौवर्चलैः सातिविषैश्च चूर्णम् |
सुखाम्बुपीतं विनिहन्त्यजीर्णं शूलं विसूचीमरुचिं च सद्यः ||१४||
Powder of the below mentioned ingredients should be prepared –
– Pathya,
– Vaca,
– Hingu,
– Kalingaka,
– Grnjanaka,
– Sauvarcala and
– Ativisa
This powder should be consumed mixed in comfortably warm water. It immediately cures indigestion, abdominal pain, visucika and loss of taste.
क्षारागदं वा लवणं विडं वा गुडप्रगाढानथ सर्षपान् वा |
अम्लेन वा सैन्धवहिङ्गुयुक्तौ सबीजपूर्णौ सघृतौ त्रिवर्गौ ||१५||
कटुत्रिकं वा लवणैरुपेतं पिबेत् स्नुहीक्षीरविमिश्रितं तु |
कल्याणकं वा लवणं पिबेतु यदुक्तमादावनिलामयेषु ||१६||
Below mentioned are also beneficial and hence should be consumed –
– Ksara Agada – described in kalpa sthana section, chapter 6,
– Bida Lavana or Sarsapa added with more quantity of jaggery or
– Saindhava Lavana and Hingu mixed with sour gruel, or
– Juice of Bijapura mixed with trivarga (trikatu), added with saindhava lavana and mixed with snuhi ksira or
– Kalyanaka Lavana – described in the treatment of vata roga (cikitsa sthana, chapter 4)
कृष्णाजमोदक्षवकाणि वाऽपि तुल्यौ पिबेद्वा मगधानिकुम्भौ |
दन्तीयुतं वा मगधोद्भवानां कल्कं पिबेत् कोषवतीरसेन ||१७||
उष्णाभिरद्भिर्मगधोद्भवानां कल्कं पिबेन्नागरकल्कयुक्तम् |१८|
Equal parts of the below mentioned ingredients should be taken and their powder is prepared –
– Krishna,
– Ajamoda and
– Ksavaka
This powder may be consumed with sour liquids.
The other beneficial formulae are –
– Powder of Magadha and Nikumbha or
– Paste of Magadha and Danti may be consumed with juice of Kosavati (mixed in this juice or
– Paste of Magadodbhava (Pippali) added with paste of Nagara should be consumed along with warm water
व्योषं करञ्जस्य फलं हरिद्रे मूलं समं चाप्यथ मातुलुङ्ग्याः ||१८||
छायाविशुष्का गुटिकाः कृतास्ता हन्युर्विसूचीं नयनाञ्जनेन |१९|
Equal parts of Vyosa, fruits (seeds) of Karanja and roots of Haridra are taken. They are macerated with Matulunga juice and made into pills. These pills are dried in shade. They are later used for application to the eyes in the form of collyrium. This medicine would cure Visucika.
सुवामितं साधुविरेचितं वा सुलङ्घितं मनुजं विदित्वा ||१९||
पेयादिभिर्दीपनपाचनीयैः सम्यक्क्षुधार्तं समुपक्रमेत |२०|
The patient should be treated with peya i.e. thin gruel etc. processed with carminative and digestive herbs after determining the below said things –
– that the patient has had satisfactory vomiting and purgation (the therapies have been implemented properly and the signs of proper administration of these therapies have been documented),
– that the patient has fasted well and
– that he has obtained hunger properly
Anāha – flatulence
आमं शकृद्वा निचितं क्रमेण भूयो विबद्धं विगुणानिलेन ||२०||
प्रवर्तमानं न यथास्वमेनं विकारमानाहमुदाहरन्ति |२१|
Anaha is a condition which is marked by the below mentioned events / features –
– ama i.e. undigested food or sakrt – faeces gradually accumulates inside the alimentary canal and
– they get obstructed from going out by the aggravated vata and hence,
– they do not come out in their own routes i.e. ama does not come out in upward (mouth) direction and purisa – faeces does not come out in the downward (anus) route
तस्मिन् भवन्त्यामसमुद्भवे तु तृष्णाप्रतिश्यायशिरोविदाहाः ||२१||
आमाशये शूलमथो गुरुत्वं हृल्लास उद्गारविघातनं च |२२|
Below mentioned are the symptoms of anaha produced by ama – the undigested food –
– thirst,
– running nose,
– burning sensation in the head,
– pain and heaviness in the stomach,
– nausea and
– obstruction to belching
स्तम्भः कटीपृष्ठपुरीषमूत्रे शूलोऽथ मूर्च्छा स [१] शकृद्वमेच्च ||२२||
श्वासश्च पक्वाशयजे भवन्ति लिङ्गानि चात्रालसकोद्भवानि |२३|
Below mentioned are the symptoms of anaha caused by purisa – faeces –
– stiffness (loss of movement) of the waist and back,
– non-elimination of faeces and urine,
– pain in the abdomen,
– fainting,
– faecal vomiting,
– dyspnoea and
– symptoms of alasaka
Cikitsā – treatment
आमोद्भवे वान्तमुपक्रमेत संसर्गभक्तक्रमदीपनीयैः ||२३||
अथेतरं यो न शकृद्वमेत्तमामं जयेत् स्वेदनपाचनैश्च |२४|
Vomiting should be administered in anaha caused by ama. Following this, regimen of liquid diet (peya, vilepi etc) should be implemented along with administration of herbs which increase hunger.
In the other kind of anaha i.e. that caused by faeces, ama should be treated by administering sudation and digestives, if there is no faecal vomiting.
विसूचिकायां परिकीर्तितानि द्रव्याणि वैरेचनिकानि यानि ||२४||
तान्येव वर्तीर्विरचेद्विचूर्ण्य महिष्यजावीभगवां तु मूत्रैः |
स्विन्नस्य पायौ विनिवेश्य ताश्च चूर्णानि चैषां प्रधमेत्तु नाड्या ||२५||
The herbs which are described as purgatives (virecana dravyas) should be macerated with urine of buffalo, goat, sheep, elephant or cow and made into recta wicks / suppositories. These wicks should be introduced into the rectum (anus) of the person suffering from Visucika. Alternatively, powder of the purgative herbs may be blown into the rectum through a tube.
मूत्रेषु संसाध्य यथाविधानं द्रव्याणि यान्यूर्ध्वमधश्च यान्ति |
क्वाथेन तेनाशु निरुहयेच्च मूत्रार्धयुक्तेन समाक्षिकेण ||२६||
त्रिभण्डियुक्तं लवणप्रकुञ्चं दत्त्वा विरिक्तक्रममाचरेच्च |
एष्वेव तैलेन च साधितेन प्राप्तं यदि स्यादनुवासयेच्च ||२७||
The herbs which produce upward movement (emetics) and those which produce downward movement (purgatives) should be boiled in urines in the usual way. Then, half the quantity of the paste of tribhandi, one prakunca (40 gm) quantity of saindhava lavana and honey are added to this and mixed thoroughly. The resultant liquid is administered as decoction enema. Afterwards, the regimen of post-purgation therapy should be adopted. For giving Anuvasana Basti i.e. oil enema, the oil boiled and processed with the same herbs may be used.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे विसूचिकाप्रतिषेधो नाम
(अष्टादशोऽध्यायः, आदितः ) षट्पञ्चाशत्तमोऽध्यायः ||५६||
Thus ends the fifty-sixth chapter by name Visucikā pratiṣedha in Uttarasthana of Suśruta samhita.
