Changes

==== Chapter authority ====

==== Chapter authority ====

It is the pattern of this classic that in the beginning of every chapter, acārya propose the topic which is to be discussed and secondly the common sentence for all the chapter i.e. ‘इति ह स्माह भगवानात्रेयः’ is used which shows the authenticity of the text. There are number of discourses in medical science and it is not possible for all to discuss them completely and meticulously that’s why Agniveśa declares very honestly in the beginning of all the chapters that whatever has been discussed is as per the preaching of his teacher Lord Punarvasu Ātreya. The title ‘Bhagavān’ (lord) itself reveals that Punarvasu Ātreya was an extraordinary personality who could completely discuss the medical science without any mistake and lacunae. [1]                                                               [1-2]

It is the pattern of this classic that in the beginning of every chapter, acārya propose the topic which is to be discussed and secondly the common sentence for all the chapter i.e. ‘इति ह स्माह भगवानात्रेयः’ is used which shows the authenticity of the text. There are number of discourses in medical science and it is not possible for all to discuss them completely and meticulously that’s why Agniveśa declares very honestly in the beginning of all the chapters that whatever has been discussed is as per the preaching of his teacher Lord Punarvasu Ātreya. The title ‘Bhagavān’ (lord) itself reveals that Punarvasu Ātreya was an extraordinary personality who could completely discuss the medical science without any mistake and lacunae. [1]

Success of treatment:

Chikitsā is indicated in curable disease [2] and another important concept of Āyurveda in this regard is that chatuṣpāda-upapatti (desired qualities of four limbs of treatment) are one of the important cause in the success of treatment [3]. In the above mentioned verses the desired qualities of patients are lacking and patient is one of the important components among chatuṣpāda.       In such situations chances of complications are also high.  

==== Success of treatment ====

Contraindications of vamana:

 

The above mentioned contra-indications are as per general rule but in specific conditions exceptions are also found such as generally vamana is contra-indicated in gulma-roga but when kapha is increased and causing diminution of digestive fire, anorexia, nausea etc. in vātika-gulma, vamana is indicated exceptionally. [5] Similarly vamana is advised in vomiting and heart disease according to condition [6] which is the exception of the general instruction. In all the above mentioned states of contra-indications, vamana is not contra-indicated in the conditions of poisons, artificial poisons, incompatible food, intake of food during indigestion and ama (ailment caused by the product of improper digestion and metabolism) because these conditions are of emergent nature. [7]   [8]

Chikitsā is indicated in curable disease [2] and another important concept of Āyurveda in this regard is that chatuṣpāda-upapatti (desired qualities of four limbs of treatment) are one of the important cause in the success of treatment [3]. In the above mentioned verses the desired qualities of patients are lacking and patient is one of the important components among chatuṣpāda. In such situations chances of complications are also high.  

Indications of vamana:

 

Vamana-karma is mainly indicated in the diseases caused by kapha dossha reason being it is considered the best therapy among all causing elimination of kapha dosha.[8] Ācārya Vāgbhaṭa says that vamana is indicated in the kapha dosha as well as in the combination of dosha where kapha is dominant. In the commentary of the view of Vāgbhaṭa, Aruṇadatta in his Sarvāngasundarā commentary says that here combination of dosha should be understood as kapha-pitta association.[9]      

==== Contraindications of vamana ====

 

The above mentioned contra-indications are as per general rule but in specific conditions exceptions are also found such as generally vamana is contra-indicated in gulma-roga but when kapha is increased and causing diminution of digestive fire, anorexia, nausea etc. in vātika-gulma, vamana is indicated exceptionally. [5] Similarly vamana is advised in vomiting and heart disease according to condition [6] which is the exception of the general instruction. In all the above mentioned states of contra-indications, vamana is not contra-indicated in the conditions of poisons, artificial poisons, incompatible food, intake of food during indigestion and ama (ailment caused by the product of improper digestion and metabolism) because these conditions are of emergent nature. [7]

 

==== Indications of vamana ====

 

Vamana-karma is mainly indicated in the diseases caused by kapha dossha reason being it is considered the best therapy among all causing elimination of kapha dosha.[8] Ācārya Vāgbhaṭa says that vamana is indicated in the kapha dosha as well as in the combination of dosha where kapha is dominant. In the commentary of the view of Vāgbhaṭa, Aruṇadatta in his Sarvāngasundarā commentary says that here combination of dosha should be understood as kapha-pitta association.[9]  

As per the view of Āchārya Charaka, one predominant in kapha vomits easily. [10] This should be accepted as an ideal condition for vamana-karma. Therefore, either it is the diseased or healthy condition, predominance of kapha should be observed or produced (by the application of snehana and swedana), then one should administer vamana-karma. In the context of jwara-chikitsā, achārya Charaka has given the specific view for the application of vamana which can be accepted in all the cases if kapha dosha is dominant with tendency to come out and situated in amāśaya (stomach). [11]                                                                                                                                                   

As per the view of Āchārya Charaka, one predominant in kapha vomits easily. [10] This should be accepted as an ideal condition for vamana-karma. Therefore, either it is the diseased or healthy condition, predominance of kapha should be observed or produced (by the application of snehana and swedana), then one should administer vamana-karma. In the context of jwara-chikitsā, achārya Charaka has given the specific view for the application of vamana which can be accepted in all the cases if kapha dosha is dominant with tendency to come out and situated in amāśaya (stomach). [11]                                                                                                                                                   

Contraindications of virechana:

==== Contraindications of virechana ====

 

Virechana is not advised in the conditions when kapha dosha is increased because manda (alpa) kapha is considered as an ideal condition for proper administration of virechana-karma.[12]  Panchkarma is not administered in the state of indigestion.[13]

Virechana is not advised in the conditions when kapha dosha is increased because manda (alpa) kapha is considered as an ideal condition for proper administration of virechana-karma.[12]  Panchkarma is not administered in the state of indigestion.[13]

Cakrapāṇidatta, the commentator of Caraka-Saṃhitā has interpreted the term “subhaga-kṣata-guda” as “subhaga-guda” (one who has delicate anus) and “kshata-guda” (one who has anal injury). He has also mentioned “subhagam means sukhasaṃvardhita (those who has never faced any hardship)” according to the view of other scholars in his commentary. Virechana applied in the person having injury to anus or delicate anus causes harm to the patients. In the person who has taken the nirūha type of enema, at least seven days gap is essential to perform virechana-karma and vice-versa. Virechana in pregnant woman is contra-indicated up to seventh month except in emergency. In eighth month if disease is curable by vamana or virechana, then mṛdu vamana (mild emesis) or mṛdu virechana (mild purgative) can be given.[14]   [11]

Cakrapāṇidatta, the commentator of Caraka-Saṃhitā has interpreted the term “subhaga-kṣata-guda” as “subhaga-guda” (one who has delicate anus) and “kshata-guda” (one who has anal injury). He has also mentioned “subhagam means sukhasaṃvardhita (those who has never faced any hardship)” according to the view of other scholars in his commentary. Virechana applied in the person having injury to anus or delicate anus causes harm to the patients. In the person who has taken the nirūha type of enema, at least seven days gap is essential to perform virechana-karma and vice-versa. Virechana in pregnant woman is contra-indicated up to seventh month except in emergency. In eighth month if disease is curable by vamana or virechana, then mṛdu vamana (mild emesis) or mṛdu virechana (mild purgative) can be given.[14]

Indications of vamana:

 

==== Indications of vamana ====

 

Virechana is considered the best therapy to purify pitta doṣa especially. [15] Virecana eliminates pitta or kapha-pitta situated in pittāśaya. [16]  

Virechana is considered the best therapy to purify pitta doṣa especially. [15] Virecana eliminates pitta or kapha-pitta situated in pittāśaya. [16]  

Virechana treatments are of many types such as mṛdu-virechana, sukha-virechana and tikṣṇa-virechana. All the persons are not treated by the same medicines. So the application depends upon the nature of koṣṭha, nature of the disease, strength of the person, age, season and many other considerable issues. Mṛdu virechana is not appropriate for the person having krūrakoṣṭha and tikṣṇa virechana is not suitable for mṛdu koṣṭha. Tikṣṇa-virechana is advised in mṛttikā-bhakṣanajanya pānḍu-roga and baddhodara in Charak-Saṃhitā but it cannot be given to the patient suffering from the heart disease. Mṛdu-virechana is advised in kāmalā-roga . [17] Virechana given to the patients suffering from paittika disorders cannot be given to those suffering from pitta-shlaiṣmika disorders. Again virechana medicines are of two types i.e. snigdha-virechana and rukṣa-virechana. Snigdha-virechana is used in the person having dryness in the body and rukṣa-virechana is used in the persons who have unctuousness in the body. For example snighdha-virechana is advised in vātodara. [18] Tikshna vamana and virechana, and other painful procedures are generally not advised in children and old, if required then mṛdu vamana and virechana should be administered .[19]  Virechana-karma should be administered in sharad ṛtu (autumn season) in healthy individuals because the aggravation of pitta-dosha takes place in this season naturally. Generally it should not be administered in peak of summer and peak of winter season as it may lead to atiyoga and ayoga respectively. [20]                                                       [13]

Virechana treatments are of many types such as mṛdu-virechana, sukha-virechana and tikṣṇa-virechana. All the persons are not treated by the same medicines. So the application depends upon the nature of koṣṭha, nature of the disease, strength of the person, age, season and many other considerable issues. Mṛdu virechana is not appropriate for the person having krūrakoṣṭha and tikṣṇa virechana is not suitable for mṛdu koṣṭha. Tikṣṇa-virechana is advised in mṛttikā-bhakṣanajanya pānḍu-roga and baddhodara in Charak-Saṃhitā but it cannot be given to the patient suffering from the heart disease. Mṛdu-virechana is advised in kāmalā-roga . [17] Virechana given to the patients suffering from paittika disorders cannot be given to those suffering from pitta-shlaiṣmika disorders. Again virechana medicines are of two types i.e. snigdha-virechana and rukṣa-virechana. Snigdha-virechana is used in the person having dryness in the body and rukṣa-virechana is used in the persons who have unctuousness in the body. For example snighdha-virechana is advised in vātodara. [18] Tikshna vamana and virechana, and other painful procedures are generally not advised in children and old, if required then mṛdu vamana and virechana should be administered .[19]  Virechana-karma should be administered in sharad ṛtu (autumn season) in healthy individuals because the aggravation of pitta-dosha takes place in this season naturally. Generally it should not be administered in peak of summer and peak of winter season as it may lead to atiyoga and ayoga respectively. [20]  

Contraindications of asthapana basti:

==== Contraindications of asthapana basti ====

 

Āsthāpana basti is contra-indicated in the stage of ajīrṇa[21] or ama.  Āsthāpana and anuvāsana basti are indicated in the treatment of baddhodara[22], so baddhodara mentioned in the contra-indications of asthāpana should be read as baddhodarādhmāna means it is contraindicated in adhmāna due to baddhodara[23]. Āsthāpana basti is contraindicated in kuṣṭha-roga but in a particular stage of the disease, achārya has exceptionally indicated the asthāpana and Anuvāsana basti [24]. [14]  

Āsthāpana basti is contra-indicated in the stage of ajīrṇa[21] or ama.  Āsthāpana and anuvāsana basti are indicated in the treatment of baddhodara[22], so baddhodara mentioned in the contra-indications of asthāpana should be read as baddhodarādhmāna means it is contraindicated in adhmāna due to baddhodara[23]. Āsthāpana basti is contraindicated in kuṣṭha-roga but in a particular stage of the disease, achārya has exceptionally indicated the asthāpana and Anuvāsana basti [24]. [14]  

Indications of asthapana basti:

 

Āsthāpana-basti is considered the best therapy in vātika disorders. [25] It is given in disorders caused by other dosha. Basti can be administered in the vitiation of vāta, pitta, kapha, saṃsarga (vitiation of two dosha), sannipāta (vitiation of all the three dosha) and even in vitiation of rakta (blood) also.[26]  Application of first asthāpana-basti removes or purifies vāta, second basti removes or purifies pitta and third to kapha dosha [27] , purification of three dosha should be understood of either occlusion or association of vāta with other dosha. Different  applications of asthāpana-basti show that by processing and combination with different medicines, it exerts many effects such as saṃśodhana, saṃśamana, saṃgrahaṇa, vājīkaraṇa, bṛṃhaṇa, karśaṇa, vayaḥsthāpana [28]  etc. Type of basti depends upon the nature of disease such as basti given in the condition of vāta-mala sanga will be different in comparison to basti given in shuddhātisāra, basti applied in the case of bala-kṣaya, māṃsa-kṣaya and retas-kṣaya will be of different composition in comparison to basti administered in kṛmikoṣhṭha. In vātika disorders also, only asthāpana-basti is not given for longer duration that’s why karma-basti, kāla-basti and yoga-basti have been discussed by ancient Ācāryas for the rational use of the therapy. In all these types, asthāpana and qnuvāsana basti are administered in a particular sequence for the better efficacy

==== Indications of asthapana basti ====

Contraindications of anuvasana basti:

 

Anuvāsana basti is not advised in kaphaja-disorders, medo-vṛddhi and ama-dosha. Contraindications given in the text are as per general rule. Exceptional instructions are also found in the text considering the need of therapy in particular stage of disease such as in the patient suffering from piles if patient comes with associated symptoms like udāvarta, excessive dryness of the body, abnormal movement of vāta and pain, then anuvāsana basti is advised. [29] Anuvāsana is contraindicated in the patients suffering from kṛmikoṣhṭha also because initially he should not be treated with this type of basti as it will increase the disease.  In the patient of kṛmikoṣhṭha, initially asthāpana basti followed by vamana and virechana should be applied and when koṣṭha is completely purified, anuvāsana basti with viḍanga-oil can be administered. [30]                                                                                                               [17]

Āsthāpana-basti is considered the best therapy in vātika disorders. [25] It is given in disorders caused by other dosha. Basti can be administered in the vitiation of vāta, pitta, kapha, saṃsarga (vitiation of two dosha), sannipāta (vitiation of all the three dosha) and even in vitiation of rakta (blood) also.[26]  Application of first asthāpana-basti removes or purifies vāta, second basti removes or purifies pitta and third to kapha dosha [27] , purification of three dosha should be understood of either occlusion or association of vāta with other dosha. Different  applications of asthāpana-basti show that by processing and combination with different medicines, it exerts many effects such as saṃśodhana, saṃśamana, saṃgrahaṇa, vājīkaraṇa, bṛṃhaṇa, karśaṇa, vayaḥsthāpana [28]  etc. Type of basti depends upon the nature of disease such as basti given in the condition of vāta-mala sanga will be different in comparison to basti given in shuddhātisāra, basti applied in the case of bala-kṣaya, māṃsa-kṣaya and retas-kṣaya will be of different composition in comparison to basti administered in kṛmikoṣhṭha. In vātika disorders also, only asthāpana-basti is not given for longer duration that’s why karma-basti, kāla-basti and yoga-basti have been discussed by ancient Ācāryas for the rational use of the therapy. In all these types, asthāpana and qnuvāsana basti are administered in a particular sequence for the better efficacy.

Indications of anuvasana basti:

 

==== Contraindications of anuvasana basti ====

 

Anuvāsana basti is not advised in kaphaja-disorders, medo-vṛddhi and ama-dosha. Contraindications given in the text are as per general rule. Exceptional instructions are also found in the text considering the need of therapy in particular stage of disease such as in the patient suffering from piles if patient comes with associated symptoms like udāvarta, excessive dryness of the body, abnormal movement of vāta and pain, then anuvāsana basti is advised. [29] Anuvāsana is contraindicated in the patients suffering from kṛmikoṣhṭha also because initially he should not be treated with this type of basti as it will increase the disease.  In the patient of kṛmikoṣhṭha, initially asthāpana basti followed by vamana and virechana should be applied and when koṣṭha is completely purified, anuvāsana basti with viḍanga-oil can be administered. [30]  

==== Indications of anuvasana basti ====

 

Anuvāsana-basti and asthāpana basti are considered the best therapy in vātika disorders.[ 31] It has been stated that patients suitable for asthāpana basti are suitable for anuvāsana basti  is general instruction, because kṛmikoṣṭhī and patient suffering from heaviness in the body are suitable for asthāpana basti but not for anuvāsana basti. In kṛmikoṣṭhī, first of all asthāpana-basti is administered, then vamana and virechana to purify the koṣṭha. When koṣṭha is purified, then anuvāsana basti is advised as it is discussed in Vimānasthāna. So it should be accepted that instructions given in the text are applicable in most cases, but not in all cases.    [19]

Anuvāsana-basti and asthāpana basti are considered the best therapy in vātika disorders.[ 31] It has been stated that patients suitable for asthāpana basti are suitable for anuvāsana basti  is general instruction, because kṛmikoṣṭhī and patient suffering from heaviness in the body are suitable for asthāpana basti but not for anuvāsana basti. In kṛmikoṣṭhī, first of all asthāpana-basti is administered, then vamana and virechana to purify the koṣṭha. When koṣṭha is purified, then anuvāsana basti is advised as it is discussed in Vimānasthāna. So it should be accepted that instructions given in the text are applicable in most cases, but not in all cases.    [19]

Indications of Shirovirechana:

 

==== Indications of Shirovirechana ====

 

Shirovirecana type of nasya is mainly beneficial in kaphaja disorders.[ 32]                                 

Shirovirecana type of nasya is mainly beneficial in kaphaja disorders.[ 32]                                 

Shirovirechna is mainly beneficial in kaphaja disorders where as Ācārya Caraka says that it is beneficial in vātādi-vikāras which are free from ama-dosha. Here vātādi-vikāras means vāta-shlaiṣmika-vikāra of the head region are cured by proper administration of shirovirechana.[33]  Pīnasa-roga mentioned in the indications should be accepted as pakva-pratiśyāya (chronic coryza) [34] as shirovirechna is contraindicated in the patients suffering from nava-pratiśyāya (acute coryza).                                                                       [22]

Shirovirechna is mainly beneficial in kaphaja disorders where as Ācārya Caraka says that it is beneficial in vātādi-vikāras which are free from ama-dosha. Here vātādi-vikāras means vāta-shlaiṣmika-vikāra of the head region are cured by proper administration of shirovirechana.[33]  Pīnasa-roga mentioned in the indications should be accepted as pakva-pratiśyāya (chronic coryza) [34] as shirovirechna is contraindicated in the patients suffering from nava-pratiśyāya (acute coryza).   [22]

References: 

 

=== References ===

 

1. Agniveśa, Caraka-Saṃhitā, with the “Āyurveda-Dīpikā” commentary by Cakrapāṇidatta and  

1. Agniveśa, Caraka-Saṃhitā, with the “Āyurveda-Dīpikā” commentary by Cakrapāṇidatta and  

Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi  

Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi  

(India), reprint edition-2000, Page No.-690.

(India), reprint edition-2000, Page No.-690.

Glossary of technical terms

=== Glossary ===

 

1. Siddhisthāna (siddhisthAna; सिद्धिस्थान): - Section dealing with such measures leading to the success in the administration of Panchkarma.

1. Siddhisthāna (siddhisthAna; सिद्धिस्थान): - Section dealing with such measures leading to the success in the administration of Panchkarma.

2. Panchkarma (pa~jcakarma; पञ्चकर्म): - Internal bio-cleansing therapy.   

2. Panchkarma (pa~jcakarma; पञ्चकर्म): - Internal bio-cleansing therapy.   

16. Aśirovirecanārha (अशिरोविरेचनार्ह) - Person unfit for shirovirechna.

16. Aśirovirecanārha (अशिरोविरेचनार्ह) - Person unfit for shirovirechna.

17. Śirovirecanārha (शिरोविरेचनार्ह) - Person fit for shirovirechna.

17. Śirovirecanārha (शिरोविरेचनार्ह) - Person fit for shirovirechna.

Bibliography  

 

=== Bibliography ===

 

1.  Agniveśa, Caraka-Saṃhitā, with the Āyurveda-Dīpikā Commentary by Cakrapāṇidatta  

1.  Agniveśa, Caraka-Saṃhitā, with the Āyurveda-Dīpikā Commentary by Cakrapāṇidatta  

and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi  

and Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi