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Upakalpaniya Adhyaya (view source)

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{{#seo:

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|title=Upakalpaniya Adhyaya

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|titlemode=append

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|keywords=Pre-requisites for Panchakarma hospital, vamana, virechana, therapeutic emesis, therapeutic purgation, hospital management

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|description=Sutra Sthana Chapter 15. Guidelines for Hospital Management and Purification Treatment

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}}

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<big>'''Sutra Sthana Chapter 15. Guidelines for Hospital Management and Purification Treatment'''</big>

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===Sanskrit text, Transliteration and English Translation===

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अथात उपकल्पनीयमध्यायं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athāta upakalpanīyamadhyāyaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

Now we shall expound the chapter upakalpaneeyam (guidelines for hospital management), thus said Lord Atreya.[1-2]

==== Guidelines for physicians before commencing treatment ====

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इह खलु राजानं राजमात्रमन्यं वा विपुलद्रव्यं वमनं विरेचनं वा पाययितुकामेन भिषजा प्रागेवौषधपानात् सम्भारा उपकल्पनीयाभवन्ति सम्यक्चैव हि गच्छत्यौषधे प्रतिभोगार्थाः, व्यापन्ने चौषधे व्यापदः परिसङ्ख्याय प्रतीकारार्थाः; न हि सन्निकृष्टे कालेप्रादुर्भूतायामापदि सत्यपि क्रयाक्रये सुकरमाशु सम्भरणमौषधानां यथावदिति||३||

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iha khalu rājānaṁ rājamātramanyaṁ vā vipuladravyaṁ Vamanaṁ virēcanaṁ vā pāyayitukāmēna bhiṣajāprāgēvauṣadhapānāt sambhārā upakalpanīyā bhavanti samyakcaiva hi gacchatyauṣadhē pratibhōgārthāḥ,vyāpannē cauṣadhē vyāpadaḥ parisaṅkhyāya pratīkārārthāḥ; na hi sannikr̥ṣṭē kālē prādurbhūtāyāmāpadisatyapi krayākrayē sukaramāśu sambharaṇamauṣadhānāṁ yathāvaditi||3|| iha khalu rAjAnaM rAjamAtramanyaM vA vipuladravyaM VamanaM virecanaM vA pAyayitukAmena bhiShajAprAgevauShadhapAnAt sambhArA upakalpanIyA bhavanti samyakcaiva hi gacchatyauShadhepratibhogArthAH, vyApanne cauShadhe vyApadaH parisa~gkhyAya pratIkArArthAH; na hi sannikRuShTekAle prAdurbhUtAyAmApadi satyapi krayAkraye sukaramAshu sambharaNamauShadhAnAMyathAvaditi||3||

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</div></div>

A physician willing to administer various purification therapies, especially to a king, royalty or a wealthy person, should arrange various necessary drugs and equipments well in advance of the procedures and know correct administration of counter-acting drugs in case of complications. Because, in case of emergency, if complications occur, it is not possible to easily and immediately arrange drugs through sale or import. [3]

==== Query by Agnivesha about success of treatment ====

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एवंवादिनं भगवन्तमात्रेयमग्निवेश उवाच- ननु भगवन्! आदावेव ज्ञानवता तथा प्रतिविधातव्यं यथा प्रतिविहितेसिध्येदेवौषधमेकान्तेन, सम्यक्प्रयोगनिमित्ता हि सर्वकर्मणां सिद्धिरिष्टा, व्यापच्चासम्यक्प्रयोगनिमित्ता; अथसम्यगसम्यक् च समारब्धं कर्म सिद्ध्यति व्यापद्यते वाऽनियमेन, तुल्यं भवति ज्ञानमज्ञानेनेति||४||

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ēvaṁvādinaṁ bhagavantamātrēyamagnivēśa uvāca- nanu bhagavan! ādāvēva jñānavatā tathāpratividhātavyaṁ yathā prativihitē sidhyēdēvauṣadhamēkāntēna, samyakprayōganimittā hisarvakarmaṇāṁ siddhiriṣṭā, vyāpaccāsamyakprayōganimittā; atha samyagasamyak ca samārabdhaṁkarma siddhyati vyāpadyatē vā'niyamēna, tulyaṁ bhavati jñānamajñānēnēti||4||

evaMvAdinaM bhagavantamAtreyamagnivesha uvAca- nanu bhagavan! AdAveva j~jAnavatA tathApratividhAtavyaM yathA prativihite sidhyedevauShadhamekAntena, samyakprayoganimittA hisarvakarmaNAM siddhiriShTA, vyApaccAsamyakprayoganimittA; atha samyagasamyak ca samArabdhaMkarma siddhyati vyApadyate vA~aniyamena, tulyaM bhavati j~jAnamaj~jAneneti||4||

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</div></div>

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When Lord Atreya said this, Agnivesha said, “O Lord! A learned physician should prescribe a treatment in such a way that it should surely and invariably be successful. The success of all treatments depends upon proper administration and complications due to improper administration. However, sometimes, the success or failure of treatment doesn’t follow the rules of proper or improper administration, hence knowledge and ignorance becomes equal.” [4]

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==== Reply by Atreya ====

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तमुवाच भगवानात्रेयः- शक्यं तथा प्रतिविधातुमस्माभिरस्मद्विधैर्वाऽप्यग्निवे श!

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सूक्ष्माणि हि दोषभेषजदेशकालबलशरीराहारसात्म्यसत्त्वप्रकृतिवयसामवस्थान्तराणि, यान्यनुचिन्त्यमानानिविमलविपुलबुद्धेरपि बुद्धिमाकुलीकुर्युः किं पुनरल्पबुद्धेः;

तस्मादुभयमेतद्यथावदुपदेक्ष्यामः- सम्यक्प्रयोगं चौषधानां,व्यापन्नानां च व्यापत्साधनानि सिद्धिषूत्तरकालम्||५||

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tamuvāca bhagavānātrēyaḥ- śakyaṁ tathā pratividhātumasmābhirasmadvidhairvā'pyagnivēśa!

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sUkShmANi hidoShabheShajadeshakAlabalasharIrAhArasAtmyasattvaprakRutivayasAmavasthAntarANi,yAnyanucintyamAnAni vimalavipulabuddherapi buddhimAkulIkuryuH kiM punaralpabuddheH;

tasmAdubhayametadyathAvadupadekShyAmaH- samyakprayogaM cauShadhAnAM, vyApannAnAM cavyApatsAdhanAni siddhiShUttarakAlam||5||

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</div></div>

Lord Atreya replied, “Oh Agnivesha!, it is possible for us to treat the patients successfully and also impart instructions for correct administration. But there is none who is able to grasp such instructions or having grasped it, is able to apply it or put it into practice. The variations in conditions of dosha, drugs, place, time, strength, body, diet, suitability, mind pattern, constitution, and age are subtle to understand. While considering these factors, when even a person with great intellect and pure knowledge gets confused, then what will be the condition of a person with less intellect? [5]

==== Equipments and arrangements for purification therapy ====

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इदानीं तावत् सम्भारान् विविधानपि समासेनोपदेक्ष्यामः; तद्यथा- दृढं निवातं प्रवातैकदेशं सुखप्रविचारमनुपत्यकंधूमातपजलरजसामनभिगमनीयमनिष्ठानां च शब्दस्पर्शरसरूपगन्धानां सोदपानोदूखलमुसलवर्चःस्थानस्नानभूमिमहानसंवास्तुविद्याकुशलः प्रशस्तं गृहमेव तावत् पूर्वमुपकल्पयेत्||६||

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idānīṁ tāvat sambhārān vividhānapi samāsēnōpadēkṣyāmaḥ; tadyathā- dr̥ḍhaṁ nivātaṁ pravātaikadēśaṁsukhapravicāramanupatyakaṁ dhūmātapajalarajasāmanabhigamanīyamaniṣṭhānāṁ caśabdasparśarasarūpagandhānāṁ sōdapānōdūkhalamusalavarcaḥsthānasnānabhūmimahānasaṁvāstuvidyākuśalaḥ praśastaṁ gr̥hamēva tāvat pūrvamupakalpayēt||6||

idAnIM tAvat sambhArAn vividhAnapi samAsenopadekShyAmaH; tadyathA- dRuDhaM nivAtaMpravAtaikadeshaM sukhapravicAramanupatyakaM dhUmAtapajalarajasAmanabhigamanIyamaniShThAnAMca shabdasparsharasarUpagandhAnAM sodapAnodUkhalamusalavarcaHsthAnasnAnabhUmimahAnasaMvAstuvidyAkushalaH prashastaM gRuhameva tAvat pUrvamupakalpayet||6||

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</div></div>

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Until then, we will briefly describe various pre-requisites recommended for administering purification therapies. First of all, an architect should search for a spacious building that is well-built, with good ventilation, comfortable moving space, located at a distance from other big buildings, free from harmful smoke, excessive light, dust, moisture, undesirable noise, scenes, touch, taste and smell. It should consist of basic amenities such as access to water, sanitation (lavatory and bathroom) and a kitchen with mortar-pestle[6]

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==== Arrangements for hospital staff and accessories ====

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ततः शीलशौचाचारानुरागदाक्ष्यप्रादक्षिण्योपपन्नानुपचारकुशलान् सर्वकर्मसु पर्यवदातान्सूपौदनपाचकस्नापकसंवाहकोत्थापकसंवेशकौषधपेषकांश्च परिचारकान् सर्वकर्मस्वप्रतिकूलान्, तथागीतवादित्रोल्लापकश्लोकगाथाख्यायिकेतिहासपुराणकुशलानभिप्रायज्ञाननुमतांश्च देशकालविदः पारिषद्यांश्च, तथालावकपिञ्जिलशशहरिणैणकालपुच्छकमृगमातृकोरभ्रान्, गां दोग्ध्रीं शीलवतीमनातुरां जीवद्वत्सांसुप्रतिविहिततृणशरणपानीयां, पात्र्याचमनीयोदकोष्ठमणिकघटपिठरपर्योगकुम्भीकुम्भकुण्डशराव-दर्वीकटोदञ्चनपरिपचनमन्थानचर्मचेलसूत्रकार्पासोर्णादीनि च, शयनासनादीनि चोपन्यस्तभृङ्गारप्रतिग्रहाणिसुप्रयुक्तास्तरणोत्तरप्रच्छदोपधानानि सोपाश्रयाणि [१]संवेशनोपवेशनस्नेहस्वेदाभ्यङ्गप्रदेहपरिषेकानुलेपनवमनविरेचनास्थापनानुवासन-शिरोविरेचनमूत्रोच्चारकर्मणामुपचारसुखानि, सुप्रक्षालितोपधानाश्च सुश्लक्ष्णखरमध्यमा दृषदः, शस्त्राणि चोपकरणार्थानि,धूमनेत्रं च, बस्तिनेत्रं चोत्तरबस्तिकं च, कुशहस्तकं च, तुलां च, मानभाण्डं च,घृततैलवसामज्जक्षौद्रफाणितलवणेन्धनोदकमधुसीधुसुरासौवीरकतुषोदक- मैरेयमेदकदधिदधिमण्डोदस्विद्धान्याम्लमूत्राणिच, तथा शालिषष्टिकमुद्गमाषयवतिलकुलत्थबदरमृद्वीकाकाश्मर्यपरूषकाभयामलकबिभीतकानि, नानाविधानि चस्नेहस्वेदोपकरणानि द्रव्याणि, तथैवोर्ध्वहरानुलोमिकोभयभाञ्जि,सङ्ग्रहणीयदीपनीयपाचनीयोपशमनीयवातहरादिसमाख्यातानि चौषधानि; यच्चान्यदपि किञ्चिह्यापदः परिसङ्ख्यायप्रतीकारार्थमुपकरणं विद्यात्, यच्च प्रतिभोगार्थं, तत्तदुपकल्पयेत्||७||

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tataḥ śīlaśaucācārānurāgadākṣyaprādakṣiṇyōpapannānupacārakuśalān sarvakarmasu paryavadātānsūpaudanapācakasnāpakasaṁvāhakōtthāpakasaṁvēśakauṣadhapēṣakāṁśca paricārakānsarvakarmasvapratikūlān, tathāgītavāditrōllāpakaślōkagāthākhyāyikētihāsapurāṇakuśalānabhiprāyajñānanumatāṁśca dēśakālavidaḥpāriṣadyāṁśca, tathā lāvakapiñjilaśaśahariṇaiṇakālapucchakamr̥gamātr̥kōrabhrān, gāṁ dōgdhrīṁśīlavatīmanāturāṁ jīvadvatsāṁ suprativihitatr̥ṇaśaraṇapānīyāṁ,pātryācamanīyōdakōṣṭhamaṇikaghaṭapiṭharaparyōgakumbhīkumbhakuṇḍaśarāva-darvīkaṭōdañcanaparipacanamanthānacarmacēlasūtrakārpāsōrṇādīni ca, śayanāsanādīnicōpanyastabhr̥ṅgārapratigrahāṇi suprayuktāstaraṇōttarapracchadōpadhānāni sōpāśrayāṇi [1]

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tataH shIlashaucAcArAnurAgadAkShyaprAdakShiNyopapannAnupacArakushalAn sarvakarmasu paryavadAtAnsUpaudanapAcakasnApakasaMvAhakotthApakasaMveshakauShadhapeShakAMshca paricArakAnsarvakarmasvapratikUlAn, tathAgItavAditrollApakashlokagAthAkhyAyiketihAsapurANakushalAnabhiprAyaj~jAnanumatAMshca deshakAlavidaHpAriShadyAMshca, tathA lAvakapi~jjilashashahariNaiNakAlapucchakamRugamAtRukorabhrAn, gAM dogdhrIMshIlavatImanAturAM jIvadvatsAM suprativihitatRuNasharaNapAnIyAM,pAtryAcamanIyodakoShThamaNikaghaTapiTharaparyogakumbhIkumbhakuNDasharAva-darvIkaToda~jcanaparipacanamanthAnacarmacelasUtrakArpAsorNAdIni ca, shayanAsanAdInicopanyastabhRu~ggArapratigrahANi suprayuktAstaraNottarapracchadopadhAnAni sopAshrayANi [1]saMveshanopaveshanasnehasvedAbhya~ggapradehapariShekAnulepanaVamanavirecanAsthApanAnuvAsana-shirovirecanamUtroccArakarmaNAmupacArasukhAni, suprakShAlitopadhAnAshcasushlakShNakharamadhyamA dRuShadaH, shastrANi copakaraNArthAni, dhUmanetraM ca, bastinetraMcottarabastikaM ca, kushahastakaM ca, tulAM ca, mAnabhANDaM ca,ghRutatailavasAmajjakShaudraphANitalavaNendhanodakamadhusIdhusurAsauvIrakatuShodaka-maireyamedakadadhidadhimaNDodasviddhAnyAmlamUtrANi ca, tathAshAliShaShTikamudgamAShayavatilakulatthabadaramRudvIkAkAshmaryaparUShakAbhayAmalakabibhItakAni,nAnAvidhAni ca snehasvedopakaraNAni dravyANi, tathaivordhvaharAnulomikobhayabhA~jji,sa~ggrahaNIyadIpanIyapAcanIyopashamanIyavAtaharAdisamAkhyAtAni cauShadhAni; yaccAnyadapiki~jcihyApadaH parisa~gkhyAya pratIkArArthamupakaraNaM vidyAt, yacca pratibhogArthaM,tattadupakalpayet||7||

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</div></div>

After setting up the hospital building, the following accessories should be kept ready:

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==== Preparation of patient before therapeutic emesis ====

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ततस्तं पुरुषं यथोक्ताभ्यां स्नेहस्वेदाभ्यां यथार्हमुपपादयेत्, तं चेदस्मिन्नन्तरे मानसः शारीरो वा व्याधिः कश्चित्तीव्रतरःसहसाऽभ्यागच्छेत्तमेव तावदस्योपावर्तयितुं [१] यतेत, ततस्तमुपावर्त्य तावन्तमेवैनं कालं तथाविधेनैव कर्मणोपाचरेत्||८||

ततस्तं पुरुषं स्नेहस्वेदोपपन्नमनुपहतमनसमभिसमीक्ष्य सुखोषितं सुप्रजीर्णभक्तं शिरःस्नातमनुलिप्तगात्रंस्रग्विणमनुपहतवस्त्रसंवीतं देवताग्निद्विजगुरुवृद्धवैद्यानर्चितवन्तमिष्टे नक्षत्रतिथिकरणमुहूर्ते कारयित्वा ब्राह्मणान्स्वस्तिवाचनं प्रयुक्ताभिराशीर्भिरभिमन्त्रितां मधुमधुकसैन्धवफाणितोपहितां मदनफलकषायमात्रां पाययेत्||९||

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tatastaṁ puruṣaṁ yathōktābhyāṁ snēhasvēdābhyāṁ yathārhamupapādayēt, taṁ cēdasminnantarēmānasaḥ śārīrō vā vyādhiḥ kaścittīvrataraḥ sahasā'bhyāgacchēttamēva tāvadasyōpāvartayituṁ [1] yatēta,tatastamupāvartya tāvantamēvainaṁ kālaṁ tathāvidhēnaiva karmaṇōpācarēt||8||

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tatastaM puruShaM yathoktAbhyAM snehasvedAbhyAM yathArhamupapAdayet, taM cedasminnantaremAnasaH shArIro vA vyAdhiH kashcittIvrataraH sahasA~abhyAgacchettameva tAvadasyopAvartayituM [1]yateta, tatastamupAvartya tAvantamevainaM kAlaM tathAvidhenaiva karmaNopAcaret||8||

tatastaM puruShaM snehasvedopapannamanupahatamanasamabhisamIkShya sukhoShitaMsuprajIrNabhaktaM shiraHsnAtamanuliptagAtraM sragviNamanupahatavastrasaMvItaMdevatAgnidvijaguruvRuddhavaidyAnarcitavantamiShTe nakShatratithikaraNamuhUrte kArayitvAbrAhmaNAn svastivAcanaM prayuktAbhirAshIrbhirabhimantritAMmadhumadhukasaindhavaphANitopahitAM madanaphalakaShAyamAtrAM pAyayet||9||

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</div></div>

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Thereafter, patients are to be admitted to the hospital and treated by means of oleation and fomentation therapies as required. If an acute and serious psychological or somatic disease occurs during the course of this treatment, the physician should treat it first. Even after curing it, the same treatment should be continued for an equivalent duration.[8]

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==== Procedure of therapeutic emesis ====

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मदनफलकषायमात्राप्रमाणं तु खलु सर्वसंशोधनमात्राप्रमाणानि च प्रतिपुरुषमपेक्षितव्यानि भवन्ति; यावद्धि यस्य संशोधनं पीतंवैकारिकदोषहरणायोपपद्यते न चातियोगायोगाय, तावदस्य मात्राप्रमाणं वेदितव्यं भवति||१०||

पीतवन्तं तु खल्वेनं मुहूर्तमनुकाङ्क्षेत, तस्य यदा जानीयात् स्वेदप्रादुर्भावेण दोषं प्रविलयनमापद्यमानं, लोमहर्षेण चस्थानेभ्यः प्रचलितं, कुक्षिसमाध्मापनेन च कुक्षिमनुगतं, हृल्लासास्यस्रवणाभ्यामपि चोर्ध्वमुखीभूतम्, अथास्मैजानुसममसम्बाधं सुप्रयुक्तास्तरणोत्तरप्रच्छदोपधानं सोपाश्रयमासनमुपवेष्टुं प्रयच्छेत्, प्रतिग्रहांश्चोपचारयेत्,लालाटप्रतिग्रहे पार्श्वोपग्रहणे नाभिप्रपीडने पृष्ठोन्मर्दने चानपत्रपणीयाः सुहृदोऽनुमताः प्रयतेरन्||११||

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madanaphalakaṣāyamātrāpramāṇaṁ tu khalu sarvasaṁśōdhanamātrāpramāṇāni capratipuruṣamapēkṣitavyāni bhavanti;

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pItavantaM tu khalvenaM muhUrtamanukA~gkSheta, tasya yadA jAnIyAt svedaprAdurbhAveNa doShaMpravilayanamApadyamAnaM, lomaharSheNa ca sthAnebhyaH pracalitaM, kukShisamAdhmApanena cakukShimanugataM, hRullAsAsyasravaNAbhyAmapi cordhvamukhIbhUtam, athAsmaijAnusamamasambAdhaM suprayuktAstaraNottarapracchadopadhAnaM sopAshrayamAsanamupaveShTuM prayacchet, pratigrahAMshcopacArayet, lAlATapratigrahe pArshvopagrahaNe nAbhiprapIDanepRuShThonmardane cAnapatrapaNIyAH suhRudo~anumatAH prayateran||11||

+

</div></div>

==== Dose of emetics ====

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==== Instructions to patient during procedure ====

+

अथैनमनुशिष्यात्- विवृतोष्ठतालुकण्ठो नातिमहता व्यायामेन वेगानुदीर्णानुदीरयन् किञ्चिदवनम्यग्रीवामूर्ध्वशरीरमुपवेगमप्रवृत्तान् प्रवर्तयन् सुपरिलिखितनखाभ्यामङ्गुलिभ्यामुत्पलकुमुदसौगन्धिकनालैर्वा कण्ठमभिस्पृशन्सुखं प्रवर्तयस्वेति, स तथाविधं कुर्यात्; ततोऽस्य वेगान् प्रतिग्रहगतानवेक्षेतावहितः, वेगविशेषदर्शनाद्धि कुशलोयोगायोगातियोगविशेषानुपलभेत, वेगविशेषदर्शी पुनः कृत्यं यथार्हमवबुध्येत लक्षणेन; तस्माद्वेगानवेक्षेतावहितः||१२||

+

athainamanuśiṣyāt- vivr̥tōṣṭhatālukaṇṭhō nātimahatā vyāyāmēna vēgānudīrṇānudīrayan kiñcidavanamyagrīvāmūrdhvaśarīramupavēgamapravr̥ttān pravartayansuparilikhitanakhābhyāmaṅgulibhyāmutpalakumudasaugandhikanālairvā kaṇṭhamabhispr̥śan sukhaṁpravartayasvēti, sa tathāvidhaṁ kuryāt; tatō'sya vēgān pratigrahagatānavēkṣētāvahitaḥ,vēgaviśēṣadarśanāddhi kuśalō yōgāyōgātiyōgaviśēṣānupalabhēta, vēgaviśēṣadarśī punaḥ kr̥tyaṁyathārhamavabudhyēta lakṣaṇēna; tasmādvēgānavēkṣētāvahitaḥ||12||

athainamanushiShyAt- vivRutoShThatAlukaNTho nAtimahatA vyAyAmena vegAnudIrNAnudIrayanki~jcidavanamya grIvAmUrdhvasharIramupavegamapravRuttAn pravartayansuparilikhitanakhAbhyAma~ggulibhyAmutpalakumudasaugandhikanAlairvA kaNThamabhispRushansukhaM pravartayasveti, sa tathAvidhaM kuryAt; tato~asya vegAn pratigrahagatAnavekShetAvahitaH,vegavisheShadarshanAddhi kushalo yogAyogAtiyogavisheShAnupalabheta, vegavisheShadarshI punaHkRutyaM yathArhamavabudhyeta lakShaNena; tasmAdvegAnavekShetAvahitaH||12||

+

</div></div>

+

Thereafter, the treating physician should instruct the patient to vomit without straining himself excessively by aiding his urge to vomit, by opening mouth, palate and throat widely, by slightly bending the neck and upper part of body forward, by provoking the urge that is not well apparent, by inserting well manicured two fingers, or stalks of blue lily, night lotus or while water lily (Nymphaea alba Linn.) in the throat. The patient should follow this advice. The physician should carefully observe the patient and episodes of the vomiting, keep a count of those events, and monitor the nature of the vomitus in the container to understand the proper functioning of medicine. The physician should then assess the character of ''vamana'' and decide its proper, inadequate or excessive nature. It is from this observation that the physician can determine the subsequent line of treatment. [12]

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==== The signs of proper and improper emesis procedure ====

+

तत्रामून्ययोगयोगातियोगविशेषज्ञानानि भवन्ति; तद्यथा- अप्रवृत्तिः कुतश्चित् केवलस्य वाऽप्यौषधस्य विभ्रंशो विबन्धोवेगानामयोगलक्षणानि भवन्ति; काले प्रवृत्तिरनतिमहती व्यथा यथाक्रमं दोषहरणं स्वयं चावस्थानमिति योगलक्षणानिभवन्ति, योगेन तु दोषप्रमाणविशेषेण तीक्ष्णमृदुमध्यविभागो ज्ञेयः; योगाधिक्येन तुफेनिलरक्तचन्द्रिकोपगमनमित्यतियोगलक्षणानि भवन्ति|

तत्रातियोगायोगनिमित्तानिमानुपद्रवान् विद्यात्- आध्मानं परिकर्तिका परिस्रावो हृदयोपसरणमङ्गग्रहो जीवादानं विभ्रंशःस्तम्भः क्लमश्चेत्युपद्रवाः||१३||

+

tatrāmūnyayōgayōgātiyōgaviśēṣajñānāni bhavanti; tadyathā- apravr̥ttiḥ kutaścit kēvalasyavā'pyauṣadhasya vibhraṁśō vibandhō vēgānāmayōgalakṣaṇāni bhavanti; kālē pravr̥ttiranatimahatī vyathāyathākramaṁ dōṣaharaṇaṁ svayaṁ cāvasthānamiti yōgalakṣaṇāni bhavanti, yōgēna tudōṣapramāṇaviśēṣēṇa tīkṣṇamr̥dumadhyavibhāgō jñēyaḥ; yōgādhikyēna tuphēnilaraktacandrikōpagamanamityatiyōgalakṣaṇāni bhavanti|

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tatrAmUnyayogayogAtiyogavisheShaj~jAnAni bhavanti; tadyathA- apravRuttiH kutashcit kevalasyavA~apyauShadhasya vibhraMsho vibandho vegAnAmayogalakShaNAni bhavanti; kAlepravRuttiranatimahatI vyathA yathAkramaM doShaharaNaM svayaM cAvasthAnamiti yogalakShaNAnibhavanti, yogena tu doShapramANavisheSheNa tIkShNamRudumadhyavibhAgo j~jeyaH; yogAdhikyena tuphenilaraktacandrikopagamanamityatiyogalakShaNAni bhavanti|

tatrAtiyogAyoganimittAnimAnupadravAn vidyAt- AdhmAnaM parikartikA parisrAvohRudayopasaraNama~ggagraho jIvAdAnaM vibhraMshaH stambhaH klamashcetyupadravAH||13||

+

</div></div>

+

Now the signs to decide the proper, inadequate and excessive administration of ''vamana karma'' are explained. Inadequate ''vamana'' (''ayoga'') has absence of emesis, emesis of drug only or obstruction during the episodes or may lead to purgation. If the medicine is administered properly, there will be proper emesis depending upon time of administration, quantity of medicine administered, and level of comfort of the patient. There may be three types of properly administered ''vamana'', categorized by the amount of evacuated ''dosha'' as ''mridu'' (mild), ''madhyama'' (moderate) and ''tikshna'' (maximum). Over-administration of therapy may lead to frothy or blood stained vomitus. The following complications may arise due to over-administration or inadequate administration of the therapy: distension of abdomen, searing or cutting pain, excessive salivation, palpitation, rigidity, stiffness, displacement of the viscera of the body, hematemesis, and fatigue.[13]

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==== Post procedure instructions ====

+

योगेन तु खल्वेनं छर्दितवन्तमभिसमीक्ष्य सुप्रक्षालितपाणिपादास्यं मुहूर्तमाश्वास्य, स्नैहिकवैरेचनिकोपशमनीयानांधूमानामन्यतमं सामर्थ्यतः पाययित्वा, पुनरेवोदकमुपस्पर्शयेत्||१४||

उपस्पृष्टोदकं चैनं निवातमागारमनुप्रवेश्य संवेश्य चानुशिष्यात्- उच्चैर्भाष्यमत्याशनमतिस्थानमतिचङ्क्रमणंक्रोधशोकहिमातपावश्यायातिप्रवातान् यानयानं ग्राम्यधर्ममस्वपनं निशि दिवा

स्वप्नंविरुद्धाजीर्णासात्म्याकालप्रमितातिहीनगुरुविषमभोजनवेगसन्धारणोदीरणमिति भावानेतान्मनसाऽप्यसेवमानः सर्वमहोगमयस्वेति | स तथा कुर्यात्||१५||

+

yōgēna tu khalvēnaṁ charditavantamabhisamīkṣya suprakṣālitapāṇipādāsyaṁ muhūrtamāśvāsya,snaihikavairēcanikōpaśamanīyānāṁ dhūmānāmanyatamaṁ sāmarthyataḥ pāyayitvā,punarēvōdakamupasparśayēt||14||

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upaspRuShTodakaM cainaM nivAtamAgAramanupraveshya saMveshya cAnushiShyAt-uccairbhAShyamatyAshanamatisthAnamatica~gkramaNaM krodhashokahimAtapAvashyAyAtipravAtAnyAnayAnaM grAmyadharmamasvapanaM nishi divA svapnaMviruddhAjIrNAsAtmyAkAlapramitAtihInaguruviShamabhojanavegasandhAraNodIraNamitibhAvAnetAnmanasA~apyaseVamanaH sarvamaho gamayasveti |

sa tathA kuryAt||15||

+

</div></div>

+

After proper emesis (''vamana''), the patient is advised to wash his face, hands and feet, and then take rest for one ''muhurta'' (48 minutes). Thereafter, he is directed to inhale medicated smoke (''dhumapana'') made up of ingredients that are ''snaihika'' (unctuous), ''vairechanika'' (errhine) or ''upashamaniya'' (sedative) – whatever is suitable for him - and then made to wash again . [14]

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==== Rehabilitation diet after purification ====

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अथैनं सायाह्ने परे वाऽह्नि सुखोदकपरिषिक्तं पुराणानां लोहितशालितण्डुलानां स्ववक्लिन्नां मण्डपूर्वां सुखोष्णां यवागूंपाययेदग्निबलमभिसमीक्ष्य, एवं द्वितीये तृतीये चान्नकाले, चतुर्थे त्वन्नकाले तथाविधानामेव शालितण्डुलानामुत्स्विन्नांविलेपीमुष्णोदकद्वितीयामस्नेहलवणामल्पस्नेहलवणां वा भोजयेत्, एवं पञ्चमे षष्ठे चान्नकाले, सप्तमे त्वन्नकालेतथाविधानामेव शालीनां द्विप्रसृतं सुस्विन्नमोदनमुष्णोदकानुपानं तनुना तनुस्नेहलवणोपपन्नेन मुद्गयूषेण भोजयेत्,एवमष्टमे नवमे चान्नकाले, दशमे त्वन्नकले लावकपिञ्जलादीनामन्यतमस्य मांसरसेनौदकलावणिकेन नातिसारवताभोजयेदुष्णोदकानुपानम्; एवमेकादशे द्वादशे चान्नकाले; अत ऊर्ध्वमन्नगुणान् क्रमेणोपभुञ्जानः सप्तरात्रेणप्रकृतिभोजनमागच्छेत्||१६||

+

athainaṁ sāyāhnē parē vā'hni sukhōdakapariṣiktaṁ purāṇānāṁ lōhitaśālitaṇḍulānāṁ svavaklinnāṁmaṇḍapūrvāṁ sukhōṣṇāṁ yavāgūṁ pāyayēdagnibalamabhisamīkṣya, ēvaṁ dvitīyē tr̥tīyē cānnakālē,caturthē tvannakālē tathāvidhānāmēva śālitaṇḍulānāmutsvinnāṁvilēpīmuṣṇōdakadvitīyāmasnēhalavaṇāmalpasnēhalavaṇāṁ vā bhōjayēt, ēvaṁ pañcamē ṣaṣṭhēcānnakālē, saptamē tvannakālē tathāvidhānāmēva śālīnāṁ dviprasr̥taṁsusvinnamōdanamuṣṇōdakānupānaṁ tanunā tanusnēhalavaṇōpapannēna mudgayūṣēṇa bhōjayēt,ēvamaṣṭamē navamē cānnakālē, daśamē tvannakalē lāvakapiñjalādīnāmanyatamasyamāṁsarasēnaudakalāvaṇikēna nātisāravatā bhōjayēduṣṇōdakānupānam; ēvamēkādaśē dvādaśēcānnakālē; ata ūrdhVamananaguṇān kramēṇōpabhuñjānaḥ saptarātrēṇa prakr̥tibhōjanamāgacchēt||16||

athainaM sAyAhne pare vA~ahni sukhodakapariShiktaM purANAnAM lohitashAlitaNDulAnAM svavaklinnAMmaNDapUrvAM sukhoShNAM yavAgUM pAyayedagnibalamabhisamIkShya, evaM dvitIye tRutIyecAnnakAle, caturthe tvannakAle tathAvidhAnAmeva shAlitaNDulAnAmutsvinnAMvilepImuShNodakadvitIyAmasnehalavaNAmalpasnehalavaNAM vA bhojayet, evaM pa~jcame ShaShThecAnnakAle, saptame tvannakAle tathAvidhAnAmeva shAlInAM dviprasRutaMsusvinnamodanamuShNodakAnupAnaM tanunA tanusnehalavaNopapannena mudgayUSheNa bhojayet,evamaShTame navame cAnnakAle, dashame tvannakale lAvakapi~jjalAdInAmanyatamasyamAMsarasenaudakalAvaNikena nAtisAravatA bhojayeduShNodakAnupAnam; evamekAdashe dvAdashecAnnakAle; ata UrdhVamananaguNAn krameNopabhu~jjAnaH saptarAtreNaprakRutibhojanamAgacchet||16||

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</div></div>

''Sansarjana karma'' (rehabilitation diet) should be initiated from the same evening or the next day after ''vamana'' (therapeutic emesis).

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==== Procedure of ''virechana'' (therapeutic purgation) ====

+

अथैनं पुनरेव स्नेहस्वेदाभ्यामुपपाद्यानुपहतमनसमभिसमीक्ष्य सुखोषितं सुप्रजीर्णभक्तंकृतहोमबलिमङ्गलजपप्रायश्चित्तमिष्टे तिथिनक्षत्रकरणमुहूर्ते ब्राह्मणान् स्वस्ति वाचयित्वा त्रिवृत्कल्कमक्षमात्रंयथार्हालोडनप्रतिविनीतं पाययेत् प्रसमीक्ष्य दोषभेषजदेशकालबलशरीराहारसात्म्यसत्त्वप्रकृतिवयसामवस्थान्तराणिविकारांश्च, सम्यक् विरिक्तं चैनं वमनोक्तेन धूमवर्जेन विधिनोपपादयेदाबलवर्णप्रकृतिलाभात्, बलवर्णोपपन्नंचैनमनुपहतमनसमभिसमीक्ष्य सुखोषितं सुप्रजीर्णभक्तं शिरःस्नातमनुलिप्तगात्रंस्रग्विणमनुपहतवस्त्रसंवीतमनुरूपालङ्कारालङ्कृतं सुहृदां दर्शयित्वा ज्ञातीनां दर्शयेत्, अथैनं कामेष्ववसृजेत्||१७||

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अनेन विधिना राजा राजमात्रोऽथवा पुनः|

यस्य वा विपुलं द्रव्यं स संशोधनमर्हति||१८||

+

athainaṁ punarēva snēhasvēdābhyāmupapādyānupahatamanasamabhisamīkṣya sukhōṣitaṁsuprajīrṇabhaktaṁ kr̥tahōmabalimaṅgalajapaprāyaścittamiṣṭē tithinakṣatrakaraṇamuhūrtē brāhmaṇānsvasti vācayitvā trivr̥tkalkamakṣamātraṁ yathārhālōḍanaprativinītaṁ pāyayēt prasamīkṣyadōṣabhēṣajadēśakālabalaśarīrāhārasātmyasattvaprakr̥tivayasāmavasthāntarāṇi vikārāṁśca, samyakviriktaṁ cainaṁ Vamanaōktēna dhūmavarjēna vidhinōpapādayēdābalavarṇaprakr̥tilābhāt,balavarṇōpapannaṁ cainamanupahatamanasamabhisamīkṣya sukhōṣitaṁ suprajīrṇabhaktaṁśiraḥsnātamanuliptagātraṁ sragviṇamanupahatavastrasaṁvītamanurūpālaṅkārālaṅkr̥taṁ suhr̥dāṁdarśayitvā jñātīnāṁ darśayēt, athainaṁ kāmēṣvavasr̥jēt||17||

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anena vidhinA rAjA rAjamAtro~athavA punaH|

yasya vA vipulaM dravyaM sa saMshodhanamarhati||18||

+

</div></div>

+

On completion of the post-therapeutic, rehabilitative, dietetic program, oleation and fomentation therapies should be administered again. When the patient has come to normalcy, has slept well, and the food taken by him has been digested, he should be asked to offer homage to ''agni'' (fire) and the Gods, and perform auspicious chants. Brahmins should then be invited to recite the ''svastivachanas'' (auspicious chants) on an auspicious day with favorable ''nakshatra'' (star constellation), ''karana'' and ''muhurta''. The patient should thereafter be given a drink made up of the paste of root of ''trivrit'' (Operculina turpethum R. B.) in one ''karsha'' (12 gm) dose after stirring and mixing up with suitable liquids. Variations in ''dosha'', medicinal drugs, place of residence, time, strength, body, diet, suitability, mind, constitution, and age should be factored in while administering this therapy. After the patient has been administered purgation therapy properly, the complete regimen prescribed for ''vamana'' (therapeutic emesis), except herbal smoking, should be followed till he regains normal strength, complexion and health. After he feels physically and mentally normal, has slept well and the food taken by him is fully digested, he should take full bath, apply unction, wear garlands, untorn cloths and favorite ornaments, and appear before friends and relatives. Thereafter, he should be free to lead a normal life. [17]

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The above mentioned ways of carrying out purification or cleansing procedures are prescribed for a king, royalty or for the people having immense wealth. [18]

</div>

+

+

दरिद्रस्त्वापदं प्राप्य प्राप्तकालं विशोधनम्|

पिबेत् काममसम्भृत्य सम्भारानपि दुर्लभान्||१९||

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यद्यच्छक्यं मनुष्येण कर्तुमौषधमापदि|

तत्तत् सेव्यं यथाशक्ति वसनान्यशनानि च||२१||

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daridrastvāpadaṁ prāpya prāptakālaṁ viśōdhanam|

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yadyacchakyaM manuShyeNa kartumauShadhamApadi|

tattat sevyaM yathAshakti vasanAnyashanAni ca||21||

+

</div></div>

+

In case of any disorder requiring purification therapy, poor people can be prescribed the medication without being made to collect all the rare equipment. Because common people cannot afford to have all the recommended resources arranged, but because they can also suffer from the severe nature of the disease, emergency provisions, including drugs, cloths, and food articles should be made easily available and accessible to the patients. [19-21]

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==== Benefits of purification therapy ====

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मलापहं रोगहरं बलवर्णप्रसादनम्|

पीत्वा संशोधन सम्यगायुषा युज्यते चिरम्||२२||

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malāpahaṁ rōgaharaṁ balavarṇaprasādanam|

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malApahaM rogaharaM balavarNaprasAdanam|

pItvA saMshodhana samyagAyuShA yujyate ciram||22||

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The benefits of a properly administered purification therapy include elimination of vitiated ''dosha'', alleviation of disease, improvement in strength, complexion and longevity. [22]

==== Summary ====

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तत्र श्लोकाः-

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यदसेव्यं विशुद्धेन यश्च संसर्जनक्रमः|

तत् सर्वं कल्पनाध्याये व्याजहार पुनर्वसुः||२५||

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tatra ślōkāḥ-

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yadasevyaM vishuddhena yashca saMsarjanakramaH|

tat sarvaM kalpanAdhyAye vyAjahAra punarvasuH||25||

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In summary, all the prerequisites for the administration of therapeutic emesis and purgation to resourceful persons (i.e., kings and members of the royalty), including their utility, dose, signs and symptoms of inadequate administration, proper administration, and over-administration, afflicted dosha, complications, regimen prescribed during the therapy and those prescribed in the course of the post-therapeutic rehabilitative dietetic program have been explained by the Lord Punarvasu in this Kalpana Chapter.[23-25]

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इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते श्लोकस्थाने उपकल्पनीयो नाम पञ्चदशोऽध्यायः||१५||

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ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē ślōkasthānē upakalpanīyō nāma pañcadaśō'dhyāyaḥ||15||

ityagniveshakRute tantre carakapratisaMskRute shlokasthAne upakalpanIyo nAmapa~jcadasho~adhyAyaH||15||

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Thus ends the fifteenth chapter on “Prerequisites for therapeutic ([[Panchakarma]]) treatment” of [[Sutra Sthana]] , of Agnivesha’s work as redacted by Charak.

Agnivesha

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