Kshatakshina Chikitsa

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Kshatakshina Chikitsa
Section/Chapter Chikitsa Sthana Chapter 11
Preceding Chapter Apasmara Chikitsa
Succeeding Chapter Shvayathu Chikitsa
Other Sections Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

Chikitsa Sthana Chapter 11, Chapter on the Management of Kshata-kshina (Emaciation due to Trauma)

Abstract

Kshatakshina is a condition with kshaya (wasting, debility, emaciation) due to injury/trauma. Trauma is usually from external injury but in the present context this term signifies rupture of lung tissue due to exogenous as well as endogenous causes. The etiology includes significant exertion beyond one’s capacity. The disease shows close resemblance with rajayakshma in pathogenesis, as both involve anuloma kshaya (the depletion of dhatus takes place in the direction of their nourishment i.e. rasa then rakta then mamsa and so on) and pratiloma kshaya (depletion of dhatus in the direction opposite to their nourishment i.e. shukra then majja then asthi and so on). Nourishment therapy is the principle of management in kshatakshina. Various formulations to regain strength and replenishment of depleted tissues are described in this chapter.

Keywords: Kshatakshina, adventures, occupational disease, pneumo-thorax, tuberculosis, nourishment therapy.

Introduction

In Ayurveda, rather than disease, mainly the syndromes are described and kshatakshina is also a syndrome. Kshata means injury and kshina means depletion of tissue. The term literally means depletion of tissues due to injury. It includes various pathologies leading to depletion of tissues in the body as a result of external and internal injuries. It shows close resemblance with tuberculosis, however the cardinal cause in kshatakshina is injury. Hemoptysis (symptom of pulmonary tuberculosis), hematuria (symptom of renal tuberculosis) and diarrhea (symptom of intestinal tuberculosis) all have cardinal symptoms of tuberculosis which are described as the symptom of kshatakshina. It refers to those dreaded complications of tuberculosis that appear suddenly and require prompt treatment just as acute onset of chest-pain in patient of tuberculosis who suddenly develops pneumothorax due to rupture of subpleural blebs and massive painless hematuria in the patient of genitourinary tuberculosis. Similar to tuberculosis, there is impaired immunity in kshatakshina patients also. Kshatakshina refers to cluster of diseases like spontaneous pneumothorax and renal tuberculosis, whereas presence of hemoptysis and hematuria in a single disease suggests a pulmonary-renal syndrome (eg, Goodpasture's syndrome, Wegener's granulomatosis). The diseases due to excess exertion during work or occupational hazards can also be referred to kshatakshina.

Sanskrit text, Transliteration and English Translation

अथातः क्षतक्षीणचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātaḥ kṣatakṣīṇacikitsitaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAtaH kShatakShINacikitsitaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

We shall now expound the chapter on the treatment of Kshatakshina.

Thus, said Lord Atreya. [1-2]

उदारकीर्तिर्ब्रह्मर्षिरात्रेयः परमार्थवित्| क्षतक्षीणचिकित्सार्थमिदमाह चिकित्सितम्||३||

udārakīrtirbrahmarṣirātrēyaḥ paramārthavit| kṣatakṣīṇacikitsārthamidamāha cikitsitam||3||

udArakIrtirbrahmarShirAtreyaH paramArthavit| kShatakShINacikitsArthamidamAha cikitsitam||3||

Atreya, the illustrious sage, the brahmin-seer and the knower of ultimate truth, (thereafter) expounded therapeutics for the treatment of kshatakshina, as given below. [3]

Nidana (Etiology) of kshatakshina

धनुषाऽऽयस्यतोऽत्यर्थं भारमुद्वहतो गुरुम्| पततो विषमोच्चेभ्यो बलिभिः सह युध्यतः||४||

वृषं हयं वा धावन्तं दम्यं वाऽन्यं निगृह्णतः| शिलाकाष्ठाश्मनिर्घातान्क्षिपतो निघ्नतः परान्||५||

अधीयानस्य वाऽत्युच्चैर्दूरं वा व्रजतो द्रुतम्| महानदीं वा तरतो हयैर्वा सह धावतः||६||

सहसोत्पततो दूरं[१] तूर्णं चातिप्रनृत्यतः| तथाऽन्यैः कर्मभिः क्रूरैर्भृशमभ्याहतस्य च||७||

विक्षते वक्षसि व्याधिर्बलवान् समुदीर्यते| स्त्रीषु चातिप्रसक्तस्य रूक्षाल्पप्रमिताशिनः||८||

dhanuṣāyasyatō'tyarthaṁ bhāramudvahatō gurum| patatō viṣamōccēbhyō balibhiḥ saha yudhyataḥ||4||

vr̥ṣaṁ hayaṁ vā dhāvantaṁ damyaṁ vā'nyaṁ nigr̥hṇataḥ| śilākāṣṭhāśmanirghātān kṣipatō nighnataḥ parān||5||

adhīyānasya vā'tyuccairdūraṁ vā vrajatō drutam| mahānadīṁ vā taratō hayairvā saha dhāvataḥ||6||

sahasōtpatatō dūraṁ [1] tūrṇaṁ cātipranr̥tyataḥ| tathā'nyaiḥ karmabhiḥ krūrairbhr̥śamabhyāhatasya ca||7||

vikṣatē vakṣasi vyādhirbalavān samudīryatē| strīṣu cātiprasaktasya rūkṣālpapramitāśinaḥ||8||

dhanuShA~a~ayasyato~atyarthaM bhAramudvahato gurum| patato viShamoccebhyo balibhiH saha yudhyataH||4||

vRuShaM hayaM vA dhAvantaM damyaM vA~anyaM nigRuhNataH| shilAkAShThAshmanirghAtAn kShipato nighnataH parAn||5||

adhIyAnasya vA~atyuccairdUraM vA vrajato drutam| mahAnadIM vA tarato hayairvA saha dhAvataH||6||

sahasotpatato dUraM tUrNaM cAtipranRutyataH| tathA~anyaiH karmabhiH krUrairbhRushamabhyAhatasya ca||7||

vikShate vakShasi vyAdhirbalavAn samudIryate| strIShu cAtiprasaktasya rUkShAlpapramitAshinaH||8||

The person who (beyond his own power) subjects himself to following activities:

  1. Straining in excess with a hard bow
  2. Carrying heavy weight
  3. Falling or jumping over uneven place or from high altitude.
  4. Wrestling or fighting with stronger persons.
  5. Restraining a running bull, stallion or any other strong animal requiring control
  6. Throwing heavy stones, wooden blocks, or equipment made of stone or beating others with these
  7. Reciting scriptures loudly
  8. Running a long distance or walking too fast.
  9. Crossing a big river by swimming
  10. Running along with horse
  11. Sudden long and high jump
  12. Practicing violent dance for a long time; and
  13. Being excessively injured by other violent and cruel acts.
  14. One who indulges excessively in sexual intercourse
  15. Who indulges in excess dry, less quantity food or limited food

Kshatakshina, the formidable disease, gets manifested, as a result of the injury to the chest due to the above causative factors. [4-8]

Pathogenesis and clinical features

उरो विरुज्यते तस्य भिद्यतेऽथ विभज्यते| प्रपीड्येते ततः पार्श्वे शुष्यत्यङ्गं प्रवेपते||९||

क्रमाद्वीर्यं बलं वर्णो रुचिरग्निश्च हीयते| ज्वरो व्यथा मनोदैन्यं विड्भेदोऽग्निवधादपि||१०||

दुष्टः श्यावः सुदुर्गन्धः पीतो विग्रथितो बहुः| कासमानस्य च[१] श्लेष्मा सरक्तः सम्प्रवर्तते||११||

स क्षतः क्षीयतेऽत्यर्थं तथा शुक्रौजसोः क्षयात्|१२|

urō virujyatē tasya bhidyatē'tha vibhajyatē| prapīḍyētē tataḥ pārśvē śuṣyatyaṅgaṁ pravēpatē||9||

kramādvīryaṁ balaṁ varṇō ruciragniśca hīyatē| jvarō vyathā manōdainyaṁ viḍbhēdō'gnivadhādapi||10||

duṣṭaḥ śyāvaḥ sudurgandhaḥ pītō vigrathitō bahuḥ| kāsamānasya ca [1] ślēṣmā saraktaḥ sampravartatē||11||

sa kṣataḥ kṣīyatē'tyarthaṁ tathā śukraujasōḥ kṣayāt|

uro virujyate tasya bhidyate~atha vibhajyate| prapIDyete tataH pArshve shuShyatya~ggaM pravepate||9||

kramAdvIryaM balaM varNo ruciragnishca hIyate| jvaro vyathA manodainyaM viDbhedo~agnivadhAdapi||10||

duShTaH shyAvaH sudurgandhaH pIto vigrathito bahuH| kAsamAnasya ca shleShmA saraktaH sampravartate||11||

sa kShataH kShIyate~atyarthaM tathA shukraujasoH kShayAt|12|

Because of the above mentioned causative factors, the chest gets broken, punctured and cracked; sides of the chest get pressed and there is emaciation as well as tremor in the limbs. Gradually the potency, strength, complexion, appetite and agni (the power of digestion) of the patient get reduced. The patient suffers from fever, pain, mental depression and diarrhea even with the diminution of agni (decreased power of digestion).

While coughing, the patient spits out phlegm which is putrid, grayish in color, foul smelling, and yellow and knotty, in large quantities along with blood. The person suffering from kshatakshina becomes excessively emaciated due to further wastage of shukra and ojas. [9-12]

Prodromal signs and symptoms

अव्यक्तं लक्षणं तस्य पूर्वरूपमिति स्मृतम्||१२||

उरोरुक्शोणितच्छर्दिः कासो वैशेषिकः क्षते| क्षीणे सरक्तमूत्रत्वं पार्श्वपृष्ठकटिग्रहः||१३||

avyaktaṁ lakṣaṇaṁ tasya pūrvarūpamiti smr̥tam||12||

urōrukśōṇitacchardiḥ kāsō vaiśēṣikaḥ kṣatē| kṣīṇē saraktamūtratvaṁ pārśvapr̥ṣṭhakaṭigrahaḥ||13||

avyaktaM lakShaNaM tasya pUrvarUpamiti smRutam||12||

urorukshoNitacchardiH kAso vaisheShikaH kShate| kShINe saraktamUtratvaM pArshvapRuShThakaTigrahaH||13||

Signs and symptoms in unmanifested form (less manifested) constitute the premonitory signs and symptoms of this disease. (There is no appearance of premonitory sings).

However, if there is kshata (injury), pain in the chest, blood vomiting and cough are specially manifested, and if there is kshaya (diminution of tissue elements), then hematuria and stiffness of the sides of the chest, back and lumbar region are specially manifested [121/2-13]

Prognosis

अल्पलिङ्गस्य दीप्ताग्नेः साध्यो बलवतो नवः| परिसंवत्सरो याप्यः सर्वलिङ्गं तु वर्जयेत्||१४||

alpaliṅgasya dīptāgnēḥ sādhyō balavatō navaḥ| parisaṁvatsarō yāpyaḥ sarvaliṅgaṁ tu varjayēt||14||

alpali~ggasya dIptAgneH sAdhyo balavato navaH| parisaMvatsaro yApyaH sarvali~ggaM tu varjayet||14||

If the signs and symptoms are mild, the power of digestion (of the patient) is strong, patient has enough strength and if the disease is new (freshly occurred), then it is curable. If the disease is chronic i.e. more than one year, then it is yapya (palliable). If however, all the signs and symptoms of the disease are simultaneously manifested, then such a patient should not be treated, because the condition is incurable.[14]

Management

उरो मत्वा क्षतं लाक्षां पयसा मधुसंयुताम्| सद्य एव पिबेज्जीर्णे पयसाऽद्यात् सशर्करम्||१५||

पार्श्वबस्तिरुजी चाल्पपित्ताग्निस्तां सुरायुताम्| भिन्नविट्कः समुस्तातिविषापाठां सवत्सकाम्||१६||

लाक्षां सर्पिर्मधूच्छिष्टं जीवनीयगणं सिताम्| त्वक्क्षीरीं समितां क्षीरे पक्त्वा दीप्तानलः पिबेत्||१७||

इक्ष्वालिकाबिसग्रन्थिपद्मकेशरचन्दनैः| शृतं पयो मधुयुतं सन्धानार्थं पिबेत् क्षती||१८||

यवानां चूर्णमादाय क्षीरसिद्धं घृतप्लुतम्| ज्वरे दाहे सिताक्षौद्रसक्तून् वा पयसा पिबेत्||१९||

मधूकमधुकद्राक्षात्वक्क्षीरीपिप्पलीबलाः| कासी पार्श्वास्थिशूली च लिह्यात्सघृतमाक्षिकाः||२०||

urō matvā kṣataṁ lākṣāṁ payasā madhusaṁyutām| sadya ēva pibējjīrṇē payasā'dyāt saśarkaram||15||

pārśvabastirujī cālpapittāgnistāṁ surāyutām| bhinnaviṭkaḥ samustātiviṣāpāṭhāṁ savatsakām||16||

lākṣāṁ sarpirmadhūcchiṣṭaṁ jīvanīyagaṇaṁ sitām| tvakkṣīrīṁ samitāṁ kṣīrē paktvā dīptānalaḥ pibēt||17||

ikṣvālikābisagranthipadmakēśaracandanaiḥ| śr̥taṁ payō madhuyutaṁ sandhānārthaṁ pibēt kṣatī||18||

yavānāṁ cūrṇamādāya kṣīrasiddhaṁ ghr̥taplutam| jvarē dāhē sitākṣaudrasaktūn vā payasā pibēt||19||

madhūkamadhukadrākṣātvakkṣīrīpippalībalāḥ| kāsī pārśvāsthiśūlī ca lihyātsaghr̥tamākṣikāḥ||20||

Uro matvA kShataM lAkShAM payasA madhusaMyutAm| sadya eva pibejjIrNe payasA~adyAt sasharkaram||15||

pArshvabastirujI cAlpapittAgnistAM surAyutAm| bhinnaviTkaH samustAtiviShApAThAM savatsakAm||16||

lAkShAM sarpirmadhUcchiShTaM jIvanIyagaNaM sitAm| tvakkShIrIM samitAM kShIre paktvA dIptAnalaH pibet||17||

ikShvAlikAbisagranthipadmakesharacandanaiH| shRutaM payo madhuyutaM sandhAnArthaM pibet kShatI||18||

yavAnAM cUrNamAdAya kShIrasiddhaM ghRutaplutam| jvare dAhe sitAkShaudrasaktUn vA payasA pibet||19||

madhUkamadhukadrAkShAtvakkShIrIpippalIbalAH| kAsI pArshvAsthishUlI ca lihyAtsaghRutamAkShikAH||20||

If there is fresh injury to the chest, then the patient should be given laksha (lac) along with milk and honey. After the potion is digested, he should be given food along with milk and sugar.

If there is pain in the sides of the chest or in the region of the urinary bladder, and if there is less of pitta and agni (digestive power), then the patient should be given laksha (lac) along with sura (alcoholic drink).

If there is diarrhea, then the patient should be given laksha along with musta, ativisha, patha and vatsaka.

If the patient has strong power of digestion, then he should be given milk cooked with laksha, ghee, bee’s wax, and drugs belonging to jivaniya group, sugar and tvaksiri.

For healing of the injury, the patient should take milk boiled with ikshuvalika, bisagranthi, padma kesara and chandana with added honey.

If there is fever and burning sensation in the body, then the patient should take barley powder cooked with milk and added ghee. Alternatively, such a patient should take sugar, honey and saktu (roasted corn-flour) mixed with milk.

If the patient is suffering from cough and pain in the sides of the chest as well as bones, then he should take linctus prepared of the powder madhuka (flower), madhu, draksha, tvakshiri, pippali and bala mixed with ghee and honey. [15-20]

Eladi gutika

एलापत्रत्वचोऽर्धाक्षाः पिप्पल्यर्धपलं तथा| सितामधुकखर्जूरमृद्वीकाश्च पलोन्मिताः||२१||

सञ्चूर्ण्य मधुना युक्ता गुटिकाः सम्प्रकल्पयेत्| अक्षमात्रां ततश्चैकां भक्षयेन्ना दिने दिने||२२||

कासं श्वासं ज्वरं हिक्कां छर्दिं मूर्च्छां मदं भ्रमम्| रक्तनिष्ठीवनं तृष्णां पार्श्वशूलमरोचकम्||२३||

शोषप्लीहाढ्यवातांश्च स्वरभेदं क्षतं क्षयम्| गुटिका तर्पणी वृष्या रक्तपित्तं च नाशयेत्||२४||

इत्येलादिगुटिका|

ēlāpatratvacō'rdhākṣāḥ pippalyardhapalaṁ tathā| sitāmadhukakharjūramr̥dvīkāśca palōnmitāḥ||21||

sañcūrṇya madhunā yuktā guṭikāḥ samprakalpayēt| akṣamātrāṁ tataścaikāṁ bhakṣayēnnā dinē dinē||22||

kāsaṁ śvāsaṁ jvaraṁ hikkāṁ chardiṁ mūrcchāṁ madaṁ bhramam| raktaniṣṭhīvanaṁ tr̥ṣṇāṁ pārśvaśūlamarōcakam||23||

śōṣaplīhāḍhyavātāṁśca svarabhēdaṁ kṣataṁ kṣayam| guṭikā tarpaṇī vr̥ṣyā raktapittaṁ ca nāśayēt||24||

ityēlādiguṭikā

elApatratvaco~ardhAkShAH pippalyardhapalaM tathA| sitAmadhukakharjUramRudvIkAshca palonmitAH||21||

sa~jcUrNya madhunA yuktA guTikAH samprakalpayet| akShamAtrAM tatashcaikAM bhakShayennA dine dine||22||

kAsaM shvAsaM jvaraM hikkAM chardiM mUrcchAM madaM bhramam| raktaniShThIvanaM tRuShNAM pArshvashUlamarocakam||23||

shoShaplIhADhyavAtAMshca svarabhedaM kShataM kShayam| guTikA tarpaNI vRuShyA raktapittaM ca nAshayet||24||

ityelAdiguTikA|

Half aksha (five grams) each of ela, patra and tvak, half pala (twenty grams) of pippali, one pala each of sita(forty grams), madhuka, kharjura and mridvika should be made to a powder. Honey should be added to this powder to make a paste. From this paste, pills of one aksha each should be prepared. One such pill should be taken every day. It cures kasa (cough), shvasa (dyspnea), jwara (fever), hiccup, vomiting, fainting, hemoptysis, morbid thirst, pain in the sides of the chest, anorexia, consumption, splenic enlargement, adhyavata (rheumatoid arthritis), hoarseness of voice, kshata (injury to the chest), kshaya (diminution of tissues elements) and raktapitta (a condition charcterised by bleeding from different parts of the body). This pill is refreshing and aphrodisiac. [21-24]

Treatment of excessive bleeding

रक्तेऽतिवृत्ते दक्षाण्डं यूषैस्तोयेन वा पिबेत्| चटकाण्डरसं वाऽपि रक्तं वा छागजाङ्गलम्||२५||

चूर्णं पौनर्नवं रक्तशालितण्डुलशर्करम्| रक्तष्ठीवी पिबेत् सिद्धं द्राक्षारसपयोघृतैः||२६||

raktē'tivr̥ttē dakṣāṇḍaṁ yūṣaistōyēna vā pibēt| caṭakāṇḍarasaṁ vā'pi raktaṁ vā chāgajāṅgalam||25||

cūrṇaṁ paunarnavaṁ raktaśālitaṇḍulaśarkaram| raktaṣṭhīvī pibēt siddhaṁ drākṣārasapayōghr̥taiḥ||26||

rakte~ativRutte dakShANDaM yUShaistoyena vA pibet| caTakANDarasaM vA~api raktaM vA chAgajA~ggalam||25||

cUrNaM paunarnavaM raktashAlitaNDulasharkaram| raktaShThIvI pibet siddhaM drAkShArasapayoghRutaiH||26||

If there is excessive bleeding, then the patient should take eggs of daksha (wild hen) along with green gram soup or water. He may also take the soup of eggs of sparrow or (preparations) of the blood of goat or wild animals (like deer, etc).

The patient having hemoptysis should take the powder of punarnava, red variety of shali rice and sugar cooked along with grape juice, milk and ghee. [25-26]

Various formulations

मधूकमधुकक्षीरसिद्धं वा तण्डुलीयकम्| मूढवातस्त्वजामेदः सुराभृष्टं ससैन्धवम्||२७||

क्षामः क्षीणः क्षतोरस्कस्त्वनिद्रः सबलेऽनिले| शृतक्षीरसरेणाद्यात् सक्षौद्रघृतशर्करम्||२८||

शर्करां यवगोधूमौ जीवकर्षभकौ मधु| शृतक्षीरानुपानं वा लिह्यात् क्षीणः क्षती कृशः||२९||

क्रव्यादमांसनिर्यूहं घृतभृष्टं पिबेच्च सः| पिप्पलीक्षौद्रसंयुक्तं मांसशोणितवर्धनम्||३०||

न्यग्रोधोदुम्बराश्वत्थप्लक्षशालप्रियङ्गुभिः| तालमस्तकजम्बूत्वक्प्रियालैश्च सपद्मकैः||३१||

साश्वकर्णैः शृतात् क्षीरादद्याज्जातेन सर्पिषा| शाल्योदनं क्षतोरस्कः क्षीणशुक्रश्च मानवः||३२||

यष्ट्याह्वनागबलयोः क्वाथे क्षीरसमं घृतम्| पयस्यापिप्पलीवांशीकल्कसिद्धं क्षते शुभम्||३३||

कोललाक्षारसे तद्वत् क्षीराष्टगुणसाधितम्| कल्कैः कट्वङ्गदार्वीत्वग्वत्सकत्वक्फलैर्घृतम्||३४||

madhūkamadhukakṣīrasiddhaṁ vā taṇḍulīyakam| mūḍhavātastvajāmēdaḥ surābhr̥ṣṭaṁ sasaindhavam||27||

kṣāmaḥ kṣīṇaḥ kṣatōraskastvanidraḥ sabalē'nilē| śr̥takṣīrasarēṇādyāt sakṣaudraghr̥taśarkaram||28||

śarkarāṁ yavagōdhūmau jīvakarṣabhakau madhu| śr̥takṣīrānupānaṁ vā lihyāt kṣīṇaḥ kṣatī kr̥śaḥ||29||

kravyādamāṁsaniryūhaṁ ghr̥tabhr̥ṣṭaṁ pibēcca saḥ| pippalīkṣaudrasaṁyuktaṁ māṁsaśōṇitavardhanam||30||

nyagrōdhōdumbarāśvatthaplakṣaśālapriyaṅgubhiḥ| tālamastakajambūtvakpriyālaiśca sapadmakaiḥ||31||

sāśvakarṇaiḥ śr̥tāt kṣīrādadyājjātēna sarpiṣā| śālyōdanaṁ kṣatōraskaḥ kṣīṇaśukraśca mānavaḥ||32||

yaṣṭyāhvanāgabalayōḥ kvāthē kṣīrasamaṁ ghr̥tam| payasyāpippalīvāṁśīkalkasiddhaṁ kṣatē śubham||33||

kōlalākṣārasē tadvat kṣīrāṣṭaguṇasādhitam| kalkaiḥ kaṭvaṅgadārvītvagvatsakatvakphalairghr̥tam||34||

madhUkamadhukakShIrasiddhaM vA taNDulIyakam| mUDhavAtastvajAmedaH surAbhRuShTaM sasaindhavam||27||

kShAmaH kShINaH kShatoraskastvanidraH sabale~anile| shRutakShIrasareNAdyAt sakShaudraghRutasharkaram||28||

sharkarAM yavagodhUmau jIvakarShabhakau madhu| shRutakShIrAnupAnaM vA lihyAt kShINaH kShatI kRushaH||29||

kravyAdamAMsaniryUhaM ghRutabhRuShTaM pibecca saH| pippalIkShaudrasaMyuktaM mAMsashoNitavardhanam||30||

nyagrodhodumbarAshvatthaplakShashAlapriya~ggubhiH| tAlamastakajambUtvakpriyAlaishca sapadmakaiH||31||

sAshvakarNaiH shRutAt kShIrAdadyAjjAtena sarpiShA| shAlyodanaM kShatoraskaH kShINashukrashca mAnavaH||32||

yaShTyAhvanAgabalayoH kvAthe kShIrasamaM ghRutam| payasyApippalIvAMshIkalkasiddhaM kShate shubham||33||

kolalAkShArase tadvat kShIrAShTaguNasAdhitam| kalkaiH kaTva~ggadArvItvagvatsakatvakphalairghRuta ||34||

Milk should be boiled with the paste of madhooka and madhuka. With this milk, tanduliyaka should be cooked (which is useful for the patient suffering from the hemoptysis).

If there is mudhavata (claudication of vata), the patient should take the fat of goat fried with sura (type of liquor) and mixed with rock salt.

If the patient is weak, emaciated and having injury in the chest, sleeplessness and excessive aggravation of vayu, then he should take goat’s fat boiled with the cream of milk and added with honey, ghee and sugar.

If the patient is emaciated, having injury in the chest and cachectic, he may be given sugar, barley, wheat, jivaka, rushabhaka and honey in linctus form. Thereafter, he should take boiled milk.

The above mentioned patient should take the decoction of the meat of carnivorous animal sizzled with ghee and added with pippali and honey. This potion promotes muscles tissues and blood.

The patient having injury to the chest and diminution of semen, should take sali rice mixed with ghee which latter is prepared of the milk boiled with nyagrodha, udumbara, ashvattha, plaksha, sala, priyangu, tuft of tala, bark of jambu, priyala, padmaka and asvakarna.

Yashtyavahadi ghrita

Ghee should be cooked with equal quantity of milk, the decoction of madhuyashti and nagabala (four times of ghee in total), and the paste of payasya, pippali and vamshi (one fourth in total of ghee). The medicated ghee is useful in the treatment of kshata (injury to chest).

Koladi ghrita

Similarly, ghee should be cooked with the decoction of kola and laksha (four times in total of ghee), eight times of milk, and the paste of the bark of kaivanga, bark of darvi, bark of kutaja and fruit of kutaja (one fourth in total of ghee). This medicated ghee is useful in the treatment of kshata.[27-34]

Amritaprasha ghee

जीवकर्षभकौ वीरां जीवन्तीं नागरं शटीम्| चतस्रः पर्णिनीर्मेदे काकोल्यौ द्वे निदिग्धिके||३५||

पुनर्नवे द्वे मधुकमात्मगुप्तां शतावरीम्| ऋद्धिं परूषकं भार्गीं मृद्वीकां बृहतीं तथा||३६||

शृङ्गाटकं तामलकीं पयस्यां पिप्पलीं बलाम्| बदराक्षोटखर्जूरवातामाभिषुकाण्यपि||३७||

फलानि चैवमादीनि कल्कान् कुर्वीत कार्षिकान्| धात्रीरसविदारीक्षुच्छागमांसरसं पयः||३८||

कुर्यात् प्रस्थोन्मितं तेन घृतप्रस्थं विपाचयेत्| प्रस्थार्धं मधुनः शीते शर्करार्धतुलां तथा||३९||

द्विकार्षिकाणि[१] पत्रैलाहेमत्वङ्मरिचानि च| विनीय चूर्णितं तस्माल्लिह्यान्मात्रां सदा नरः||४०||

अमृतप्राशमित्येतन्नराणाममृतं घृतम्| सुधामृतरसं प्राश्यं क्षीरमांसरसाशिना||४१||

नष्टशुक्रक्षतक्षीणदुर्बलव्याधिकर्शितान्| स्त्रीप्रसक्तान् कृशान् वर्णस्वरहीनांश्च बृंहयेत्||४२||

कासहिक्काज्वरश्वासदाहतृष्णास्रपित्तनुत्| पुत्रदं वमिमूर्च्छाहृद्योनिमूत्रामयापहम्||४३||

इत्यमृतप्राशघृतम्|

jīvakarṣabhakau vīrāṁ jīvantīṁ nāgaraṁ śaṭīm| catasraḥ parṇinīrmēdē kākōlyau dvē nidigdhikē||35||

punarnavē dvē madhukamātmaguptāṁ śatāvarīm| r̥ddhiṁ parūṣakaṁ bhārgīṁ mr̥dvīkāṁ br̥hatīṁ tathā||36||

śr̥ṅgāṭakaṁ tāmalakīṁ payasyāṁ pippalīṁ balām| badarākṣōṭakharjūravātāmābhiṣukāṇyapi||37||

phalāni caivamādīni kalkān kurvīta kārṣikān| dhātrīrasavidārīkṣucchāgamāṁsarasaṁ payaḥ||38||

kuryāt prasthōnmitaṁ tēna ghr̥taprasthaṁ vipācayēt| prasthārdhaṁ madhunaḥ śītē śarkarārdhatulāṁ tathā||39||

dvikārṣikāṇi [2] patrailāhēmatvaṅmaricāni ca| vinīya cūrṇitaṁ tasmāllihyānmātrāṁ sadā naraḥ||40||

amr̥taprāśamityētannarāṇāmamr̥taṁ ghr̥tam| sudhāmr̥tarasaṁ prāśyaṁ kṣīramāṁsarasāśinā||41||

naṣṭaśukrakṣatakṣīṇadurbalavyādhikarśitān| strīprasaktān kr̥śān varṇasvarahīnāṁśca br̥ṁhayēt||42||

kāsahikkājvaraśvāsadāhatr̥ṣṇāsrapittanut| putradaṁ vamimūrcchāhr̥dyōnimūtrāmayāpaham||43||

ityamr̥taprāśaghr̥tam

jIvakarShabhakau vIrAM jIvantIM nAgaraM shaTIm| catasraH parNinIrmede kAkolyau dve nidigdhike||35||

punarnave dve madhukamAtmaguptAM shatAvarIm| RuddhiM parUShakaM bhArgIM mRudvIkAM bRuhatIM tathA||36||

shRu~ggATakaM tAmalakIM payasyAM pippalIM balAm| badarAkShoTakharjUravAtAmAbhiShukANyapi||37||

phalAni caivamAdIni kalkAn kurvIta kArShikAn| dhAtrIrasavidArIkShucchAgamAMsarasaM payaH||38||

kuryAt prasthonmitaM tena ghRutaprasthaM vipAcayet| prasthArdhaM madhunaH shIte sharkarArdhatulAM tathA||39||

dvikArShikANi patrailAhematva~gmaricAni ca| vinIya cUrNitaM tasmAllihyAnmAtrAM sadA naraH||40||

amRutaprAshamityetannarANAmamRutaM ghRutam| sudhAmRutarasaM prAshyaM kShIramAMsarasAshinA||41||

naShTashukrakShatakShINadurbalavyAdhikarshitAn| strIprasaktAn kRushAn varNasvarahInAMshca bRuMhayet||42||

kAsahikkAjvarashvAsadAhatRuShNAsrapittanut| putradaM vamimUrcchAhRudyonimUtrAmayApaham||43||

ityamRutaprAshaghRutam|

Two prasthas of ghee should be cooked with the juice dhatri (two prasthas), juice of vidari (two prasthas), sugarcane juice (two prasthas), soup of the meat of goat (two prasthas), milk (two prasthas), and the paste (one karsha each) of jivaka, rsabhaka, vira, jivanti, nagara, shati, shalaparni, prushniparni, mashaparni, mudgaparni,meda, mahameda, kakoli, kshirakakoli, kantakari, bruhati, shveta punarnava, rakta punarnava,madhuka, atmagupta, shatavari, riddhi,parushaka, bharangi, mridvika, brihati, shringataka,tamalaki, payasya (kshiravidari), pippali, badara, akshota, kharjura, vatama, abhishuka (pista) and such other fruits which alleviate vayu and pitta. After cooking when the the recipe is cooled, one prastha of honey, half tula of sugar, and the powder (two karshas each) of patra, ela, hema, tvak and maricha should be added to it. This medicated ghee should be taken by a person in appropriate dose regularly. This is called amrita prasa ghrita and it is like amrita (ambrosia) for human beings. This linctus is like sudha (ambrosia worth the consumption of worldly creatures) and the amrita (ambrosia worth the consumption of the gods). It should be taken along with milk and meat soup. It promotes nourishment of persons who had depleted shukra ( as in azoospermia or oligospermia), who are suffering from kshatakshina, who are weak, who are emaciated because of chronic diseases, who are cachectic and who have lost their complexion and voice. It cures cough, hiccup, fever, asthma, burning sensation, morbid thirst, rakta-pitta, vomiting, fainting and diseases of the heart, female genital tract and urinary tract. It helps in the treatment of infertility. [35-43]

Shvadamshtradi ghee

श्वदंष्ट्रोशीरमञ्जिष्ठाबलाकाश्मर्यकत्तृणम्| दर्भमूलं पृथक्पर्णीं पलाशर्षभकौ स्थिराम्||४४||

पलिकं साधयेत्तेषां रसे क्षीरचतुर्गुणे| कल्कः स्वगुप्ताजीवन्तीमेदर्षभकजीवकैः||४५||

शतावर्यृद्धिमृद्वीकाशर्कराश्रावणीबिसैः| प्रस्थः सिद्धो घृताद्वातपित्तहृद्द्र(द्भ)वशूलनुत्||४६||

मूत्रकृच्छ्रप्रमेहार्शःकासशोषक्षयापहः| धनुःस्त्रीमद्यभाराध्वखिन्नानां बलमांसदः||४७||

इति श्वदंष्ट्रादिघृतम्|

śvadaṁṣṭrōśīramañjiṣṭhābalākāśmaryakattr̥ṇam| darbhamūlaṁ pr̥thakparṇīṁ palāśarṣabhakau sthirām||44||

palikaṁ sādhayēttēṣāṁ rasē kṣīracaturguṇē| kalkaḥ svaguptājīvantīmēdarṣabhakajīvakaiḥ||45||

śatāvaryr̥ddhimr̥dvīkāśarkarāśrāvaṇībisaiḥ| prasthaḥ siddhō ghr̥tādvātapittahr̥ddra(dbha)vaśūlanut||46||

mūtrakr̥cchrapramēhārśaḥkāsaśōṣakṣayāpahaḥ| dhanuḥstrīmadyabhārādhvakhinnānāṁ balamāṁsadaḥ||47||

iti śvadaṁṣṭrādighr̥tam

shvadaMShTroshIrama~jjiShThAbalAkAshmaryakattRuNam| darbhamUlaM pRuthakparNIM palAsharShabhakau sthirAm||44||

palikaM sAdhayetteShAM rase kShIracaturguNe| kalkaH svaguptAjIvantImedarShabhakajIvakaiH||45||

shatAvaryRuddhimRudvIkAsharkarAshrAvaNIbisaiH| prasthaH siddho ghRutAdvAtapittahRuddra(dbha)vashUlanut||46||

mUtrakRucchrapramehArshaHkAsashoShakShayApahaH| dhanuHstrImadyabhArAdhvakhinnAnAM balamAMsadaH||47||

iti shvadaMShTrAdighRutam|

One pala of each of shvadamshtra, ushira, manjishtha, bala, kashmarya, katrna, the root of darbha, prithak parni, palasha, rishabhaka, and sthira should be made to decoction. Two prasthas of ghee should be mixed with the above mentioned decoction, eight prasthas of milk, and the paste of svagupta, jivanti, meda, rishabhaka, jivaka, shatavari, riddhi, mridvika, sharkara, shravani and bias (lotus stalk), (half prastha in total) and cooked. This medicated ghee cures hridaya shula caused by vayu and pitta, mutrakrucchra (dysuria), prameha (diabetes mellitus), piles, bronchitis, and consumption and kshatakshina. It promotes strength of muscles tissues of persons emaciated because of indulgence in archery, women, alcohol, carrying heavy weight and walking a long distance. [44-47]

Samasaktu ghee

मधुकाष्टपलद्राक्षाप्रस्थक्वाथे घृतं पचेत्| पिप्पल्यष्टपले कल्के प्रस्थं सिद्धे च शीतले||४८||

पृथगष्टपलं क्षौद्रशर्कराभ्यां विमिश्रयेत्| समसक्तु क्षतक्षीणे रक्तगुल्मे च तद्धितम्||४९||

madhukāṣṭapaladrākṣāprasthakvāthē ghr̥taṁ pacēt| pippalyaṣṭapalē kalkē prasthaṁ siddhē ca śītalē||48||

pr̥thagaṣṭapalaṁ kṣaudraśarkarābhyāṁ vimiśrayēt| samasaktu kṣatakṣīṇē raktagulmē ca taddhitam||49||

madhukAShTapaladrAkShAprasthakv the ghRutaM pacet| pippalyaShTapale kalke prasthaM siddhe ca shItale||48||

pRuthagaShTapalaM kShaudrasharkarAbhyAM vimishrayet| samasaktu kShatakShINe raktagulme ca taddhitam||49||

Two prasthas of ghee should be cooked by adding the decoction of madhuka (eight palas) and draksha (one prastha), and the paste of pippali (eight palas). After it is cooked and cooled, eight palas of each of honey and sugar should be added and mixed well. This medicated ghee should be administered by adding saktu (roasted barley flour) in equal quantity. It is useful in the treatment of kshatakshina and rakta gulma. [48-49]

Sarpi-gud

धात्रीफलविदारीक्षुजीवनीयरसैर्घृतम्| अजागोपयसोश्चैव सप्त प्रस्थान् पचेद्भिषक्||५०||

सिद्धशीते सिताक्षौद्रद्विप्रस्थं विनयेच्च तत्| यक्ष्मापस्मारपित्तासृक्कासमेहक्षयापहम्||५१||

वयःस्थापनमायुष्यं मांसशुक्रबलप्रदम्| घृतं तु पित्तेऽभ्यधिके लिह्याद्वातेऽधिके पिबेत्||५२||

लीढं निर्वापयेत् पित्तमल्पत्वाद्धन्ति नानलम्| आक्रामत्यनिलं पीतमूष्माणं निरुणद्धि च||५३||

क्षामक्षीणकृशाङ्गानामेतान्येव घृतानि तु| त्वक्क्षीरीशर्करालाजचूर्णैः स्त्यानानि योजयेत्||५४||

सर्पिर्गुडान् समध्वंशाञ्जग्ध्वा चानु पयः पिबेत्| रेतो वीर्यं बलं पुष्टिं तैराशुतरमाप्नुयात्||५५||

इति सर्पिर्गुडाः|

dhātrīphalavidārīkṣujīvanīyarasairghr̥tam| ajāgōpayasōścaiva sapta prasthān pacēdbhiṣak||50||

siddhaśītē sitākṣaudradviprasthaṁ vinayēcca tat| yakṣmāpasmārapittāsr̥kkāsamēhakṣayāpaham||51||

vayaḥsthāpanamāyuṣyaṁ māṁsaśukrabalapradam| ghr̥taṁ tu pittē'bhyadhikē lihyādvātē'dhikē pibēt||52||

līḍhaṁ nirvāpayēt pittamalpatvāddhanti nānalam| ākrāmatyanilaṁ pītamūṣmāṇaṁ niruṇaddhi ca||53||

kṣāmakṣīṇakr̥śāṅgānāmētānyēva ghr̥tāni tu| tvakkṣīrīśarkarālājacūrṇaiḥ [3] styānāni yōjayēt||54||

sarpirguḍān samadhvaṁśāñjagdhvā cānu payaḥ pibēt| rētō vīryaṁ balaṁ puṣṭiṁ tairāśutaramāpnuyāt||55||

iti sarpirguḍāḥ

dhAtrIphalavidArIkShujIvanIyarasairghRutam| ajAgopayasoshcaiva sapta prasthAn pacedbhiShak||50||

siddhashIte sitAkShaudradviprasthaM vinayecca tat| yakShmApasmArapittAsRukkAsamehakShayApaham||51||

vayaHsthApanamAyuShyaM mAMsashukrabalapradam| ghRutaM tu pitte~abhyadhike lihyAdvAte~adhike pibet||52||

lIDhaM nirvApayet pittamalpatvAddhanti nAnalam| AkrAmatyanilaM pItamUShmANaM niruNaddhi ca||53||

kShAmakShINakRushA~ggAnAmetAnyeva ghRutAni tu| tvakkShIrIsharkarAlAjacUrNaiH styAnAni yojayet||54||

sarpirguDAn samadhvaMshA~jjagdhvA cAnu payaH pibet| reto vIryaM balaM puShTiM tairAshutaramApnuyAt||55||

iti sarpirguDAH|

Two prasthas of ghee should be added with the juice of amalaka (two prasthas), vidari (two prasthas) and ikshu (two prasthas) decoction of drugs belonging to jivaniya group (two prasthas), goat’s milk (two prasthas) and cow’s milk (two prasthas) and cooked. After the cooking is over and the recipe is cooled, sugar (one prastha) and honey (two prasthas) should be added and mixed well. This medicated ghee is useful in the treatment of rajayaskshma, apasmara, raktapitta, prameha, and kshaya. It prevents aging, promotes longevity and endows the person with muscle tissues, semen as well as strength. If the disease is caused by excess of pitta, then this recipe should be used as linctus. If, however, the disease is caused by the excess of vayu, then it should be taken as a drink.

When this medicated ghee is used (licked) in the form of a linctus, it alleviates pitta. Since it is in small quantity, it however, doesn’t suppress the agni (power of digestion).

When it is used in the form of a drink, it alleviates vayu and obstructs pitta ushma.

This and such other medicated ghee should be made to a thick paste by adding the powder of tvakkshiri, sugar and lajja (fried paddy), which should then be given to persons who are tired, weak and emaciated.

This and such other recipes of sarpigud [recipes of medicated ghee in which sugar, honey etc. are added] should be added with honey (which should be equal in quantity with the powder of tvak-kshiri, etc.) and taken. Thereafter, the patient should drink milk. This instantaneously promotes semen, potency, strength and nourishment. [50-55]

Sarpi gud (second recipe)

बला विदारी ह्रस्वा च पञ्चमूली पुनर्नवा| पञ्चानां क्षीरिवृक्षाणां शुङ्गा मुष्ट्यंशका अपि||५६||

एषां कषाये द्विक्षीरे विदार्याजरसांशिके| जीवनीयैः पचेत् कल्कैरक्षमात्रैर्घृताढकम्||५७||

सितापलानि पूते च शीते द्वात्रिंशतं क्षिपेत्| गोधूमपिप्पलीवांशीचूर्णं शृङ्गाटकस्य च||५८||

समाक्षिकं कौडविकं तत् सर्वं खजमूर्च्छितम्| स्त्यानं सर्पिर्गुडान् कृत्वा भूर्जपत्रेण वेष्टयेत्||५९||

ताञ्जग्ध्वा पलिकान् क्षीरं मद्यं वाऽनुपिबेत् कफे| शोषे कासे क्षते क्षीणे श्रमस्त्रीभारकर्शिते||६०||

रक्तनिष्ठीवने तापे पीनसे चोरसि स्थिते| शस्ताः पार्श्वशिरःशूले भेदे च स्वरवर्णयोः||६१||

इति द्वितीयसर्पिर्गुडाः|

balā vidārī hrasvā ca pañcamūlī punarnavā| pañcānāṁ kṣīrivr̥kṣāṇāṁ śuṅgā muṣṭyaṁśakā api||56||

ēṣāṁ kaṣāyē dvikṣīrē vidāryājarasāṁśikē| jīvanīyaiḥ pacēt kalkairakṣamātrairghr̥tāḍhakam||57||

sitāpalāni pūtē ca śītē dvātriṁśataṁ kṣipēt| gōdhūmapippalīvāṁśīcūrṇaṁ śr̥ṅgāṭakasya ca||58||

samākṣikaṁ kauḍavikaṁ tat sarvaṁ khajamūrcchitam| styānaṁ sarpirguḍān kr̥tvā bhūrjapatrēṇa vēṣṭayēt||59||

tāñjagdhvā palikān kṣīraṁ madyaṁ vā'nupibēt kaphē| śōṣē kāsē kṣatē kṣīṇē śramastrībhārakarśitē||60||

raktaniṣṭhīvanē tāpē pīnasē cōrasi sthitē| śastāḥ pārśvaśiraḥśūlē bhēdē ca svaravarṇayōḥ||61||

iti dvitīyasarpirguḍāḥ

balA vidArI hrasvA ca pa~jcamUlI punarnavA| pa~jcAnAM kShIrivRukShANAM shu~ggA muShTyaMshakA api||56||

eShAM kaShAye dvikShIre vidAryAjarasAMshike| jIvanIyaiH pacet kalkairakShamAtrairghRutADhakam||57||

sitApalAni pUte ca shIte dvAtriMshataM kShipet| godhUmapippalIvAMshIcUrNaM shRu~ggATakasya ca||58||

samAkShikaM kauDavikaM tat sarvaM khajamUrcchitam| styAnaM sarpirguDAn kRutvA bhUrjapatreNa veShTayet||59||

tA~jjagdhvA palikAn kShIraM madyaM vA~anupibet kaphe| shoShe kAse kShate kShINe shramastrIbhArakarshite||60||

raktaniShThIvane tApe pInase corasi sthite| shastAH pArshvashiraHshUle bhede ca svaravarNayoH||61||

iti dvitIyasarpirguDAH|

Bala, vidari, hrasva panchamula (shalaparni, prsniparni, brihati, kantakari and gokshura), punarnava, and the sungas (terminal buds) of five kshirivrikshas (nyagrodha, udumbara, asvattha, madhuka and plaksha)- one pala of each of these drugs should be made to a decoction. To this, milk (two parts, i.e., double the quantity of the decoction), juice of vidari (one part), soup of goat meat (one part), ghee (two adhakas) (in the text, actually one adhaka is mentioned. But in practice, it is to be taken double the quantity according to the general rule), and the paste of drugs belonging to the jivaniya group (one aksa each) should be added and cooked. When it is well cooked and cooled, thirty two palas of sugar should be added. Thereafter, one kudava of each of the powder of godhuma, pippali, vamsha lochana, shringataka and honey should be added. All of them should be stirred with the help of a stirrer. When it becomes dense, cakes (sarpigud) should be prepared and each of them should be wrapped with thin bark of bhurja tree. Having taken this cake one pala in weight, the patient should take milk or alcohol as post-prandial drink. These are useful in the treatment of disease caused by kapha, sosha, kasa and kshatakshina. These are also helpful for persons who are emaciated because of excessive exertion, overindulgence in sex and exhaustion by lifting excessive weight. These cakes are efficacious in the treatment of rakta-nishthivana (hemoptysis), burning sensation, chronic rhinitis (pinasa), having residual infection in the chest, pain in the sides of the chest, headache, hoarseness of voice and loss of complexion. [56-61]

Sarpi gud(third recipe)

त्वक्क्षीरीश्रावणीद्राक्षामूर्वर्षभकजीवकैः| वीरर्धिक्षीरकाकोलीबृहतीकपिकच्छुभिः||६२||

खर्जूरफलमेदाभिः क्षीरपिष्टैः पलोन्मितैः| धात्रीविदारीक्षुरसप्रस्थैः प्रस्थं घृतात् पचेत्||६३||

शर्करार्धतुलां शीते क्षौद्रार्धप्रस्थमेव च| दत्त्वा सर्पिर्गुडान् कुर्यात्कासहिक्काज्वरापहान्||६४||

यक्ष्माणं तमकं श्वासं रक्तपित्तं हलीमकम्| शुक्रनिद्राक्षयं तृष्णां हन्युः कार्श्यं सकामलम्||६५||

इति तृतीयाः सर्पिर्गुडाः|

tvakkṣīrīśrāvaṇīdrākṣāmūrvarṣabhakajīvakaiḥ| vīrardhikṣīrakākōlībr̥hatīkapikacchubhiḥ||62||

kharjūraphalamēdābhiḥ kṣīrapiṣṭaiḥ palōnmitaiḥ| dhātrīvidārīkṣurasaprasthaiḥ prasthaṁ ghr̥tāt pacēt||63||

śarkarārdhatulāṁ śītē kṣaudrārdhaprasthamēva ca| dattvā sarpirguḍān kuryātkāsahikkājvarāpahān||64||

yakṣmāṇaṁ tamakaṁ śvāsaṁ raktapittaṁ halīmakam| śukranidrākṣayaṁ tr̥ṣṇāṁ hanyuḥ kārśyaṁ sakāmalam||65||

iti tr̥tīyāḥ sarpirguḍāḥ

tvakkShIrIshrAvaNIdrAkShAmUrvarShabhakajIvakaiH| vIrardhikShIrakAkolIbRuhatIkapikacchubhiH||62||

kharjUraphalamedAbhiH kShIrapiShTaiH palonmitaiH| dhAtrIvidArIkShurasaprasthaiH prasthaM ghRutAt pacet||63||

sharkarArdhatulAM shIte kShaudrArdhaprasthameva ca| dattvA sarpirguDAn kuryAtkAsahikkAjvarApahAn||64||

yakShmANaM tamakaM shvAsaM raktapittaM halImakam| shukranidrAkShayaM tRuShNAM hanyuH kArshyaM sakAmalam||65||

iti tRutIyAH sarpirguDAH|

One pala of each of tvak-kshiri, shravani (munditika), draksha, murva, rushabhaka, jivaka, vira (vidarikanda), riddhi, kshirakakoli, brihati, kapikacchu, fruit of kharjura and meda should be made into paste by triturating with milk. This paste, juice of dhatri (two prasthas), juice of vidari (two prasthas), sugarcane juice (two prasthas), and ghee (two prasthas) should be cooked together. After the ghee is well cooked and cooled, half tulas of sugar and one prastha of honey should be added, out of which cakes (sarpi gud) should be prepared. These cakes cures cough, hiccup, fever, rajayakshma, tamaka svasa, rakta-pitta, halimaka ( a serious type of jaundice), shukra kshaya (diminution of shukra), insomnia, trishna (morbid thirst), karshya (emaciation) and kamala (jaundice). (In transalation liquids, ghee and honey are taken double the prescribed quantity according to the rule) [ 62-65]

Sarpi gud (fourth recipe)

नवमामलकं द्राक्षामात्मगुप्तां पुनर्नवाम्| शतावरीं विदारीं च समङ्गां पिप्पलीं तथा||६६||

पृथग्दशपलान् भागान् पलान्यष्टौ च नागरात्| यष्ट्याह्वसौवर्चलयोर्द्विपलं मरिचस्य च||६७||

क्षीरतैलघृतानां च त्र्याढके शर्कराशते| क्वथिते तानि चूर्णानि दत्त्वा बिल्वसमान् गुडान्||६८||

कुर्यात्तान् भक्षयेत् क्षीणः क्षतः शुष्कश्च मानवः| तेन सद्यो रसादीनां वृद्ध्या पुष्टिं स विन्दति||६९||

इति चतुर्थसर्पिर्गुडाः|

navamāmalakaṁ drākṣāmātmaguptāṁ punarnavām| śatāvarīṁ vidārīṁ ca samaṅgāṁ pippalīṁ tathā||66||

pr̥thagdaśapalān bhāgān palānyaṣṭau ca nāgarāt| yaṣṭyāhvasauvarcalayōrdvipalaṁ maricasya ca||67||

kṣīratailaghr̥tānāṁ ca tryāḍhakē śarkarāśatē| kvathitē tāni cūrṇāni dattvā bilvasamān guḍān||68||

kuryāttān bhakṣayēt kṣīṇaḥ kṣataḥ śuṣkaśca mānavaḥ| tēna sadyō rasādīnāṁ vr̥ddhyā puṣṭiṁ sa vindati||69||

iti caturthasarpirguḍāḥ

navamAmalakaM drAkShAmAtmaguptAM punarnavAm| shatAvarIM vidArIM ca sama~ggAM pippalIM tathA||66||

pRuthagdashapalAn bhAgAn palAnyaShTau ca nAgarAt| yaShTyAhvasauvarcalayordvipalaM maricasya ca||67||

kShIratailaghRutAnAM ca tryADhake sharkarAshate| kvathite tAni cUrNAni dattvA bilvasamAn guDAn||68||

kuryAttAn bhakShayet kShINaH kShataH shuShkashca mAnavaH| tena sadyo rasAdInAM vRuddhyA puShTiM sa vindati||69||

iti caturthasarpirguDAH|

Freshly collected and dried amalaki (ten palas), draksha (ten palas), atmagupta (ten palas), punarnava (ten palas), shatavari (ten palas), vidari (ten palas), samanga (ten palas), pippali (ten palas), nagara (eight palas), madhuyashti (one palas), saurvachala (one pala) and maricha (two palas) – all these drugs should be made to powders. Milk (two adhakas), tila taila (two adhakas), ghee (two adhakas) and sugar (one hundred palas) should be cooked together. Thereafter, the above mentioned powder should be added to it. Out of this, cakes of one bilva or pala each should be prepared. These cakes should be taken by the person suffering from kshatakshina and consumption. Intake of these cakes instantaneously promote tissues elements like rasa etc. as a result of which the individual gets nourished. [66-69]

Sarpi modaka (fifth recipe)

गोक्षीरार्धाढकं सर्पिः प्रस्थमिक्षुरसाढकम्| विदार्याः स्वरसात्प्रस्थं रसात्प्रस्थं च तैत्तिरात्||७०||

दद्यात् सिध्यति तस्मिंस्तु पिष्टानिक्षुरसैरिमान्| मधूकपुष्पकुडवं प्रियालकुडवं तथा||७१||

कुडवार्धं तुगाक्षीर्याः खर्जूराणां च विंशतिम्| पृथग्बिभीतकानां च पिप्पल्याश्च चतुर्थिकाम्||७२||

त्रिंशत्पलानि खण्डाच्च मधुकात् कर्षमेव च| तथाऽर्धपलिकान्यत्र जीवनीयानि दापयेत्||७३||

सिद्धेऽस्मिन् कुडवं क्षौद्रं शीते क्षिप्त्वाऽथ मोदकान्| कारयेन्मरिचाजाजीपलचूर्णावचूर्णितान्||७४||

वातासृक्पित्तरोगेषु क्षतकासक्षयेषु च| शुष्यतां क्षीणशुक्राणां रक्ते चोरसि संस्थिते||७५||

कृशदुर्बलवृद्धानां पुष्टिवर्णबलार्थिनाम्| योनिदोषकृतस्रावहतानां चापि योषिताम्||७६||

गर्भार्थिनीनां गर्भश्च स्रवेद्यासां म्रियेत वा| धन्या बल्या हितास्ताभ्यः शुक्रशोणितवर्धनाः||७७||

इति पञ्चमसर्पिर्मोदकाः|

gōkṣīrārdhāḍhakaṁ sarpiḥ prasthamikṣurasāḍhakam| vidāryāḥ svarasātprasthaṁ rasātprasthaṁ ca taittirāt||70||

dadyāt sidhyati tasmiṁstu piṣṭānikṣurasairimān| madhūkapuṣpakuḍavaṁ priyālakuḍavaṁ tathā||71||

kuḍavārdhaṁ tugākṣīryāḥ kharjūrāṇāṁ ca viṁśatim| pr̥thagbibhītakānāṁ ca pippalyāśca caturthikām||72||

triṁśatpalāni khaṇḍācca madhukāt karṣamēva ca| tathā'rdhapalikānyatra jīvanīyāni dāpayēt||73||

siddhē'smin kuḍavaṁ kṣaudraṁ śītē kṣiptvā'tha mōdakān| kārayēnmaricājājīpalacūrṇāvacūrṇitān||74||

vātāsr̥kpittarōgēṣu kṣatakāsakṣayēṣu ca| śuṣyatāṁ kṣīṇaśukrāṇāṁ raktē cōrasi saṁsthitē||75||

kr̥śadurbalavr̥ddhānāṁ puṣṭivarṇabalārthinām| yōnidōṣakr̥tasrāvahatānāṁ cāpi yōṣitām||76||

garbhārthinīnāṁ garbhaśca sravēdyāsāṁ mriyēta vā| dhanyā balyā hitāstābhyaḥ śukraśōṇitavardhanāḥ||77||

iti pañcamasarpirmōdakāḥ

gokShIrArdhADhakaM sarpiH prasthamikShurasADhakam| vidAryAH svarasAtprasthaM rasAtprasthaM ca taittirAt||70||

dadyAt sidhyati tasmiMstu piShTAnikShurasairimAn| madhUkapuShpakuDavaM priyAlakuDavaM tathA||71||

kuDavArdhaM tugAkShIryAH kharjUrANAM ca viMshatim| pRuthagbibhItakAnAM ca pippalyAshca caturthikAm||72||

triMshatpalAni khaNDAcca madhukAt karShameva ca| tathA~ardhapalikAnyatra jIvanIyAni dApayet||73||

siddhe~asmin kuDavaM kShaudraM shIte kShiptvA~atha modakAn| kArayenmaricAjAjIpalacUrNAvacUrNitAn||74||

vAtAsRukpittarogeShu kShatakAsakShayeShu ca| shuShyatAM kShINashukrANAM rakte corasi saMsthite||75||

kRushadurbalavRuddhAnAM puShTivarNabalArthinAm| yonidoShakRutasrAvahatAnAM cApi yoShitAm||76||

garbhArthinInAM garbhashca sravedyAsAM mriyeta vA| dhanyA balyA hitAstAbhyaH shukrashoNitavardhanAH||77||

iti pa~jcamasarpirmodakAH|

Cow’s milk (one adhaka), ghee (two prasthas), sugar cane juice (two adhakas), juice of vidari (two prasthas) and soup of meat of tittira (two prasthas) should be cooked together. During the final stage of cooking, the paste of madhuka pushpa (one kudava), priyala (one kudava), tugakshiri (half kudava), kharjura (twenty fruits), bibhitaki (twenty fruits), pippali (one pala), sugar (thirty palas), madhuka (one karsa) and drugs belonging to jivaniya group (half pala each) should be added. The above mentioned drugs should be made to a paste by triturating with sugarcane juice before adding to the recipe. After the recipe is fully cooked and cooled, honey (two kudavas) should be added and from it, modaka (large size pills) should be prepared. Over these modakas, one pala of the powder of maricha and ajaji should be sprinkled. These modakas cure vatasruka, diseases caused by pitta, kshatakshina, kasa and kshaya. These are useful for persons suffering from emaciation, who have reduced semen, whose blood is blocked in the chest, who are thin, weak and old, and also for those desirous of having nourishment, complexion and strength. These modakas are also helpful for ladies suffering from exudations through the vitiated genital tract, who desire conception and who suffer from miscarriages and death of the fetus in the womb. By the use of these pills, ladies are endowed with auspiciousness strength and wholesomeness. These are promoters of shukra (sperm) and shonita (ovum). [70-77]

Recipes

बस्तिदेशे विकुर्वाणे स्त्रीप्रसक्तस्य मारुते| वातघ्नान् बृंहणान् वृष्यान् योगांस्तस्य प्रयोजयेत्||७८||

शर्करापिप्पलीचूर्णैः सर्पिषा माक्षिकेण च| संयुक्तं वा शृतं क्षीरं पिबेत् कासज्वरापहम्||७९||

फलाम्लं सर्पिषा भृष्टं विदारीक्षुरसे शृतम्| स्त्रीषु क्षीणः पिबेद्यूषं जीवनं बृंहणं परम्||८०||

सक्तूनां वस्त्रपूतानां मन्थं क्षौद्रघृतान्वितम्| यवान्नसात्म्यो दीप्ताग्निः क्षतक्षीणः पिबेन्नरः||८१||

जीवनीयोपसिद्धं वा जाङ्गलं घृतभर्जितम्| रसं प्रयोजयेत् क्षीणे व्यञ्जनार्थं सशर्करम्||८२||

गोमहिष्यश्वनागाजैः क्षीरैर्मांसरसैस्तथा| यवान्नं भोजयेद्यूषैः फलाम्लैर्घृतसंस्कृतैः||८३||

दीप्तेऽग्नौ विधिरेषः स्यान्मन्दे दीपनपाचनः| यक्ष्मिणां विहितो ग्राही भिन्ने शकृति चेष्यते||८४||

bastidēśē vikurvāṇē strīprasaktasya mārutē| vātaghnān br̥ṁhaṇān vr̥ṣyān yōgāṁstasya prayōjayēt||78||

śarkarāpippalīcūrṇaiḥ sarpiṣā mākṣikēṇa ca| saṁyuktaṁ vā śr̥taṁ kṣīraṁ pibēt kāsajvarāpaham||79||

phalāmlaṁ sarpiṣā bhr̥ṣṭaṁ vidārīkṣurasē śr̥tam| strīṣu kṣīṇaḥ pibēdyūṣaṁ jīvanaṁ br̥ṁhaṇaṁ param||80||

saktūnāṁ vastrapūtānāṁ manthaṁ kṣaudraghr̥tānvitam| yavānnasātmyō [4] dīptāgniḥ kṣatakṣīṇaḥ pibēnnaraḥ||81||

jīvanīyōpasiddhaṁ vā jāṅgalaṁ ghr̥tabharjitam| rasaṁ prayōjayēt kṣīṇē vyañjanārthaṁ saśarkaram||82||

gōmahiṣyaśvanāgājaiḥ kṣīrairmāṁsarasaistathā| yavānnaṁ [5] bhōjayēdyūṣaiḥ phalāmlairghr̥tasaṁskr̥taiḥ||83||

dīptē'gnau vidhirēṣaḥ syānmandē dīpanapācanaḥ| yakṣmiṇāṁ vihitō grāhī bhinnē śakr̥ti cēṣyatē||84||

Bastideshe vikurvANe strIprasaktasya mArute| vAtaghnAn bRuMhaNAn vRuShyAn yogAMstasya prayojayet||78||

sharkarApippalIcUrNaiH sarpiShA mAkShikeNa ca| saMyuktaM vA shRutaM kShIraM pibet kAsajvarApaham||79||

phalAmlaM sarpiShA bhRuShTaM vidArIkShurase shRutam| strIShu kShINaH pibedyUShaM jIvanaM bRuMhaNaM param||80||

saktUnAM vastrapUtAnAM manthaM kShaudraghRutAnvitam| yavAnnasAtmyo dIptAgniH kShatakShINaH pibennaraH||81||

jIvanIyopasiddhaM vA jA~ggalaM ghRutabharjitam| rasaM prayojayet kShINe vya~jjanArthaM sasharkaram||82||

gomahiShyashvanAgAjaiH kShIrairmAMsarasaistathA| yavAnnaM bhojayedyUShaiH phalAmlairghRutasaMskRutaiH||83||

dIpte~agnau vidhireShaH syAnmande dIpanapAcanaH| yakShmiNAM vihito grAhI bhinne shakRuti ceShyate||84||

In person induging in excess sexual intercourse with women, (vitiated) vayu afflicts pelvic region. To such patients, recipes which are alleviators of vayu, promoters of nourishment and aphrodisiacs are to be administered.

Sugar, powder of pippali ghee and/or honey should be added to milk and given to patient to drink for the cure of cough and fever. These ingredients can be added to milk after or before boiling, appropriately. (Whenever honey is to be used, it should be added to the milk after it is boiled and cooled.)

Phalamla should be fried in ghee and boiled with the juice of vidari and sugar-cane. The vegetable soup, thus prepared, is useful for a patient who is emaciated because of excessive indulgence in women. This is an excellent recipe for the promotion of longevity and nourishment.

Roasted barley flour should be sieved through a cloth, and mantha (thin gruel) should be prepared out of it. This gruel should be added with honey and ghee, and given to a patient suffering from kshatakshina, provided that he is accustomed to taking barley as one of the ingredients of the food and if he has strong power of digestion.

Alternatively, meat of animal inhabiting arid zone (jangala) should be boiled with the drugs belonging to the jivaniya group. The meat soup, thus prepared, should be sizzled with ghee, added with sugar and used as a said dish (vyanjana) for a patient suffering from kshatakshina.

Boiled barley should be given to a patient suffering from kshatakshina along with the milk of buffalo, mare, elephant and goat or with the meat soup or with vegetable soup or with phalamla sizzled with ghee.

The above mentioned recipes should be given to a patient having strong power of digestion. If the power of digestion is suppressed, then the patient should be given recipes which are stimulants of digestion and carminative. If there is diarrhea in a patient suffering from kshatakshina, then the bowel – binding recipes prescribed for the treatment of rajayakshma (chapter-8) should be used. [78-84]

Saindhavadi churna

पलिकं सैन्धवं शुण्ठी द्वे च सौवर्चलात् पले| कुडवांशानि वृक्षाम्लं दाडिमं पत्रमर्जकात्||८५||

एकैकं मरिचाजाज्योर्धान्यकाद्द्वे चतुर्थिके| शर्करायाः पलान्यत्र दश द्वे च प्रदापयेत्||८६||

कृत्वा चूर्णमतो मात्रामन्नपाने प्रयोजयेत्| रोचनं दीपनं बल्यं पार्श्वार्तिश्वासकासनुत्||८७||

इति सैन्धवादिचूर्णम्|

palikaṁ saindhavaṁ śuṇṭhī dvē ca sauvarcalāt palē| kuḍavāṁśāni vr̥kṣāmlaṁ dāḍimaṁ patramarjakāt||85||

ēkaikaṁ maricājājyōrdhānyakāddvē caturthikē| śarkarāyāḥ palānyatra daśa dvē ca pradāpayēt||86||

kr̥tvā cūrṇamatō mātrāmannapānē prayōjayēt| rōcanaṁ dīpanaṁ balyaṁ pārśvārtiśvāsakāsanut||87||

iti saindhavādicūrṇam

palikaM saindhavaM shuNThI dve ca sauvarcalAt pale| kuDavAMshAni vRukShAmlaM dADimaM patramarjakAt||85||

ekaikaM maricAjAjyordhAnyakAddve caturthike| sharkarAyAH palAnyatra dasha dve ca pradApayet||86||

kRutvA cUrNamato mAtrAmannapAne prayojayet| rocanaM dIpanaM balyaM pArshvArtishvAsakAsanut||87||

iti saindhavAdicUrNam|

Saindhava (one pala), shunthi (one pala), sauvarchala (two palas), vrikshamla (one kudava), dadima (one kudava), leaf of arjaka (one kudava), maricha (one pala), ajaji (one pala), dhanyaka (two palas) and sugar (twelve palas) should be made in to powder and mixed together. In appropriate quantity, this powder should be added to food and drinks. It is appetizer, stimulant of digestion and promoter of strength. It cures parshvashula (pain in the sides of the chest), shvasa (respiratory disorders including asthma) and kasa (cough). [85-87]

Shadava recipe

एका षोडशिका धान्याद्द्वे द्वेऽजाज्यजमोदयोः| ताभ्यां दाडिमवृक्षाम्लं द्विर्द्विः सौवर्चलात्पलम्||८८||

शुण्ठ्याः कर्षं दधित्थस्य मध्यात् पञ्च पलानि च| तच्चूर्णं षोडशपले शर्कराया विमिश्रयेत्||८९||

षाडवोऽयं प्रदेयः स्यादन्नपानेषु पूर्ववत्| मन्दानले शकृद्भेदे यक्ष्मिणामग्निवर्धनः||९०||

इति षाडवः|

ēkā ṣōḍaśikā dhānyāddvē dvē'jājyajamōdayōḥ| tābhyāṁ dāḍimavr̥kṣāmlaṁ dvirdviḥ sauvarcalātpalam||88||

śuṇṭhyāḥ karṣaṁ dadhitthasya madhyāt pañca palāni ca| taccūrṇaṁ ṣōḍaśapalē śarkarāyā vimiśrayēt||89||

ṣāḍavō'yaṁ pradēyaḥ syādannapānēṣu pūrvavat| mandānalē śakr̥dbhēdē yakṣmiṇāmagnivardhanaḥ||90||

iti ṣāḍavaḥ

ekA ShoDashikA dhAnyAddve dve~ajAjyajamodayoH| tAbhyAM dADimavRukShAmlaM dvirdviH sauvarcalAtpalam||88||

shuNThyAH karShaM dadhitthasya madhyAt pa~jca palAni ca| taccUrNaM ShoDashapale sharkarAyA vimishrayet||89||

ShADavo~ayaM pradeyaH syAdannapAneShu pUrvavat| mandAnale shakRudbhede yakShmiNAmagnivardhanaH||90||

iti ShADavaH|

Powders of dhanyaka (one pala), ajaji (two palas), ajamoda (two palas), dadima (four palas), vrikshamla (four palas), sauvarchala (one pala), shunthi (one karsa), pulp of kapittha (five palas) and sugar (sixteen palas) should be mixed together. Like the other recipe, the present shadava (delicious recipe having sweet and sour tastes) should be administered along with food and drinks for the treatment of mandanala (suppression of the power of digestion) and diarrhea. It promotes the digestive power of patients suffering from rajayakshma. [88-90]

Nagabala kalpa

पिबेन्नागबलामूलमर्धकर्षविवर्धितम्[ | पलं क्षीरयुतं मासं क्षीरवृत्तिरनन्नभुक्||९१||

एष प्रयोगः पुष्ट्यायुर्बलारोग्यकरः परः| मण्डूकपर्ण्याः कल्पोऽयं शुण्ठीमधुकयोस्तथा||९२||

pibēnnāgabalāmūlamardhakarṣavivardhitam [6] | palaṁ kṣīrayutaṁ māsaṁ kṣīravr̥ttiranannabhuk||91||

ēṣa prayōgaḥ puṣṭyāyurbalārōgyakaraḥ paraḥ| maṇḍūkaparṇyāḥ kalpō'yaṁ śuṇṭhīmadhukayōstathā||92||

pibennAgabalAmUlamardhakarShavivardhitam| palaM kShIrayutaM mAsaM kShIravRuttiranannabhuk||91||

eSha prayogaH puShTyAyurbalArogyakaraH paraH| maNDUkaparNyAH kalpo~ayaM shuNThImadhukayostathA||92||

Half karsha of the root (bark) of nagabala should be boiled with milk and given to the patient on the first day. Thereafter, the powder of nagabala root (bark) should be increased by half karsha every day, and given by boiling with milk. On eighth day, the quantity of nagabala- root will be one pala. Thereafter the patient should continue to take this drug in the dose of one pala for one month. While taking this drug boiled with milk, the patient should refrain from taking any cereals. Whenever he feels hungry, he should take only milk. The recipe is excellent for the promotion of nourishment, longevity, strength and immunity to diseases.

In the above mentioned manner, mandukaparni, sunthi and madhuka should be administered for therapeutic effects described above.[91-92]

Diet and Drinks

यद्यत् सन्तर्पणं शीतमविदाहि हितं लघु| अन्नपानं निषेव्यं तत्क्षतक्षीणैः सुखार्थिभिः||९३||

यच्चोक्तं यक्ष्मिणां पथ्यं कासिनां रक्तपित्तिनाम्| तच्च कुर्यादवेक्ष्याग्निं व्याधिं सात्म्यं बलं तथा||९४||

yadyat santarpaṇaṁ śītamavidāhi hitaṁ laghu| annapānaṁ niṣēvyaṁ tatkṣatakṣīṇaiḥ sukhārthibhiḥ||93||

yaccōktaṁ yakṣmiṇāṁ pathyaṁ kāsināṁ raktapittinām| tacca kuryādavēkṣyāgniṁ vyādhiṁ sātmyaṁ balaṁ tathā||94||

Yadyat santarpaNaM shItamavidAhi hitaM laghu| annapAnaM niShevyaM tatkShatakShINaiH sukhArthibhiH||93||

yaccoktaM yakShmiNAM pathyaM kAsinAM raktapittinAm| tacca kuryAdavekShyAgniM vyAdhiM sAtmyaM balaM tathA||94||

Food and drinks which are nourishing, cooling, avidahi (which do not cause burning sensation), wholesome and light to digest, should be used by the patient suffering from kshatakshina and who is desirous of regaining health. With due regard to the agni (power of digestion), nature of disease, wholesomeness of diet, and regimens prescribed for rajayakshma, kasa and raktapitta.[93-94]

Need for prompt attention

उपेक्षिते भवेत्तस्मिन्ननुबन्धो हि यक्ष्मणः| प्रागेवागमनात्तस्य तस्मात्तं त्वरया जयेत्||९५||

upēkṣitē bhavēttasminnanubandhō hi yakṣmaṇaḥ| prāgēvāgamanāttasya tasmāttaṁ tvarayā jayēt||95||

upekShite bhavettasminnanubandho hi yakShmaNaH| prAgevAgamanAttasya tasmAttaM tvarayA jayet||95||

If the patient suffering from kshatakshina is not given appropriate treatment on time, then this may lead to rajayakshma. Therefore well before the appearance of rajayakshma, the kshatakhsina should be treated, subdued (cured). [95]

Summary

तत्र श्लोकौ-

क्षतक्षयसमुत्थानं सामान्यपृथगाकृतिम्| असाध्ययाप्यसाध्यत्वं साध्यानां सिद्धिमेव च||९६||

उक्तवाञ्ज्येष्ठशिष्याय क्षतक्षीणचिकित्सिते| तत्त्वार्थविद्वीतरजस्तमोदोषः[१] पुनर्वसुः||९७||

tatra ślōkau-

kṣatakṣayasamutthānaṁ sāmānyapr̥thagākr̥tim| asādhyayāpyasādhyatvaṁ sādhyānāṁ siddhimēva ca||96||

uktavāñjyēṣṭhaśiṣyāya kṣatakṣīṇacikitsitē| tattvārthavidvītarajastamōdōṣaḥ [7] punarvasuḥ||97||

tatra shlokau-

kShatakShayasamutthAnaM sAmAnyapRuthagAkRutim| asAdhyayApyasAdhyatvaM sAdhyAnAM siddhimeva ca||96||

uktavA~jjyeShThashiShyAya kShatakShINacikitsite| tattvArthavidvItarajastamodoShaH punarvasuH||97||

To sum up:

In this chapter, on the treatment of kshatakshina, Lord Punarvasu who is conversant with truth and who is free from rajas (one of the three attributes representing fickle mindedness including passion) and tamas (one of the three attributes representing slackness including ignorance) imparted instincts to the senior disciple on the following points:

  1. Etiology of kshatakshina;
  2. Signs and symptoms of kshatakshina in general and of each variety;
  3. Incurability, palliability and curability of kshatakshina; and
  4. Successful treatment of curable variety of kshatakshina. [96-97]

इत्यग्निवेशकृते तन्त्रेऽप्राप्ते दृढबलपूरिते चिकित्सितस्थाने क्षतक्षीणचिकित्सितं नामैकादशोऽध्यायः||११||

ityagnivēśakr̥tē tantrē'prāptē dr̥ḍhabalapūritē cikitsitasthānē kṣatakṣīṇacikitsitaṁ nāmaikādaśō'dhyāyaḥ||11||

ityagniveshakRute tantre~aprApte dRuDhabalapUrite cikitsitasthAne kShatakShINacikitsitaM nAmaikAdasho~adhyAyaH||11||

Thus, ends the eleventh chapter (on the treatment of Kshatakshina) of the Chikitsa Sthana; in the section on the therapeutics of Agnivesha’s work as redacted by Charaka and not being available, restored by Dridhabala.

Tattva Vimarsha

  • In Kshatakshina, kshata (injury) is caused due to indulgence in various physical activities beyond one’s capacity. Kshina is a consequence of that injury with improper dietary habit and excess sexual intercourse.
  • The dhatu kshaya (depletion of tissues) is major pathological event in this disease. Hence brihana(nourishment) and replenishment of depleted tissues is principle of management.
  • The onset is acute without appearance of any premonitory symptom.
  • If the manifestation of disease is mild, the power of digestion (of the patient) is strong, patient has enough strength and if the disease is new (freshly occurred), then it is curable. The disease is yapya (palliable), if the disease is chronic i.e. more than one year. If however, all the signs and symptoms of the disease are simultaneously manifested, then the condition is incurable.
  • Milk, meat, ghee and honey processed with jivaniya herbs have significant role in treatment of kshatakshina. Fresh blood of animals is also used in treatment of excess bleeding.
  • Food and drinks which are nourishing, cooling, avidahi (which do not cause burning sensation), wholesome and light to digest, should be used by the patient suffering from kshatakshina.
  • With due regard to the agni (power of digestion), nature of disease, wholesomeness of diet, and regimens prescribed for rajayakshma, kasa and raktapitta.
  • Kshatakshina , if untreated, results in rajayakshma. Therefore, treatment at appropriate time is necessary to prevent rajayakshma.

Vidhi Vimarsha

Kshatakshina is a disease characterized by depletion of body tissues due to chest injury. In present era, the condition occurs due to over exertion, strenuous work beyond one’s capacity, direct or indirect injury to the chest. The conditions like pneumothorax, pleural effusion and related respiratory conditions need to be addressed simultaneously by the surgical team to prevent progression of emaciation and complications of injury to vital lung tissues.

Etiopathology

The etiological factors can be divided into two categories viz. (1) Exogenous factors related to over-exertion/ strenuous physical activity that causes trauma to the lung tissues, excess weight lifting and excess sexual intercourse. Studies showed that strenuous athletic activities like vigorous swimming, heavy weight lifting, jolting, etc. can cause pneumothorax (PTX), pleural effusion and pneumomediastinum (PTM) etc. (2) Endogenous factors related to malnutrition that cause depletion of body tissues and excess intake of food having dry properties (less intake of unctuous dietary substances like ghee, oil, fats. Lipids leading to dryness in body) The etiological factors described for kshata are related to those that cause spontaneous lung injury.

Pathogenesis

The disease has acute onset without any premonitory signs. This shows sudden appearance of clinical features due to traumatic etiology. As disease progresses, it leads to depletion of body tissues causing emaciation.

  • Dosha : Vata-pitta aggravation, kapha depletion
  • Dhatu: Rasa, shukra, mamsa and ojas
  • Samprapti type: Atipravritti and dhatukshaya janya
  • Clinical features and conditions resembling the disease

The patient suffers from fever, pain, mental depression, diarrhea, anorexia, indigestion, cough with putrid sputum grayish in color, foul smelling, and yellow and knotty, in large quantities, with blood.

  • Subjective and objective parameters (scales with references)
  • Clinical examination: Chest auscultation for added sounds, decreased air entry, Body mass index. Lung function tests including spirometry
  • Pathological/radiological/ investigations: Sputum test for presence of Acid fast bacilli, RBCs, Chest X ray for fracture of ribs, opacity in lungs, pneumonia patch, pneumothorax, plural effusion etc.
  • Differential diagnosis:Pulmonary tuberculosis, Carcinoma of lungs, oesophageal varieces
  • Complications
    • Pulmonary tuberculosis
  • Prognosis: Curable if newly developed, and mildly emaciated, palliable in chronic stage, incurable in advanced stage and severely emaciated with multiple system involvement
Management of disease
  • Experience based clinical practices:
    • Applied principles in management of disease conditions
    • Styptic agents to stop bleeding
    • Binding agents for union of bones and injured tissues
    • Nourishing regimen for depletion of body tissues
    • Rejuvenation therapies
Shodhana chikitsa (body purification treatments) and procedures

Purification treatments are not indicated in this disease.

Therapeutic massage with kshirabala oil, Bala-ashwagandha lakshadi oil is done.

Chest physiotherapy for improving lung functions is advised.

Shamana chikitsa (pacification treatments) with list of formulations and medicines
S.No. Name of Medicine Dose Time of Administration Mode of Administration (Anupana)
1 Laksha Mixture 10-20 grams Frequently Vasavaleha
2 Amritaprasha ghee 10-20 grams After meals Milk
3 Suvarna malini vasanta 120-240 mg In between two meals Milk
4 Lakshmi Vilasa 60-120 mg In between two meals Milk
5 Vanga mishrana 250-500 mg In between two meals Milk
  • Pathya or recommended diet: Light to digest food like shali rice, wheat, green gram, pomegranate, dry grapes, mango, amalaka, goat milk and ghee prepared of it, medicated milk, meat juice of goat
  • Pathya or recommended activity: Total bed rest
  • Apathya or contraindicated diet: Excess hot, pungent, salty food causing burning sensation, heavy to digest food.
  • Apathya or contraindicated activity: Over exertion, strenuous exercise, weight lifting etc.
Parallel management of chest injury

Use of sandhaniya drugs like laksha (mainly indicated for the healing of fracture of bone) and madhuyashti clearly indicates that in kshatakshina there is external trauma (ribs fracture leading to pneumothorax) that should be managed with quick remedies. As only conservative management for the kshatakshina is described, it excludes the possibility of surgical interventions in kshatakshina in that era. However nowadays the surgical procedures like tube drainage with or without medical pleurodesis, vacuum-assisted thoracostomy (VATS) with pleurodesis and/or closure of leaks and bullectomy, and open surgical procedures such as thoracotomy for pleurectomy or pleurodesis) are conducted to decrease the chances of incurability of kshatakshina. At the present time, it is necessary to elaborate the management of acute dreaded complications like pneumothorax and hematuria in separate chapter.

Future Scope for Research

  • Exploring the clinical evidences for the immunomodulator and hemostatic properties of Sida Veronicaefolia Lam. (Nagabala).
  • In-vitro and in-vivo evaluation of hemostatic property of Boerhavia diffusa and clinical demonstration of its use in hemoptysis.
  • Exploring the role of auto-antibodies in the pathogenesis of tuberculosis and its relation with genetic suspectibility.
  • Evaluating the role of laksha (Laccifer lacca) and madhuyasti (Glycyrrhiza glabra) in rehabilitating pulmonary tissues in acute pulmonary injury.
  • Evaluating role of anti-oxidant drugs [like amalaki (Emblica officinalis)] and vitamin C in the management of chronic inflammatory as well as infectious pulmonary diseases.

Further reading

  1. Curtin SM, Tucker AM, Gens DR. Pneumothorax in sports: issues in recognition and follow-up care. Phys Sportsmed 2000;28:23 – 32.
  2. Miles JW, Barrett GR. Rib fractures in athletes. Sports Med 1991;12:66 – 9.
  3. Garcia VF, Gotschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker of severe trauma. J Trauma 1990;30:695 – 700.
  4. Armstrong CP, Vanderspuy J. The fractured scapula: importance in management based on series of 62 patients. Injury 1984;15:324 – 9.
  5. Ferro RT, McKeag DB. Neck pain and dyspnea in a swimmer. Phys Sports Med 1999;27.
  6. Neer II CS. Fractures about the shoulder. In: Rockwood Jr CA, Green DP, editors. Fractures. Philadelphia: JD Lippincott; 1984. p. 713 – 21.
  7. Pfeiffer RP, Young TR. Case report: spontaneous pneumothorax in a jogger. Phys Sportsmed 1980;8:65 – 7.
  8. Marnejon T, Sarac S, Cropp AJ. Spontaneous pneumothorax in weightlifters. J Sports Med Phys Fitness 1995;35:124 – 6.
  9. Simoneaux SF, Murphy BJ, Tehranzadeh J. Spontaneous pneumothorax in a weightlifter. Am J Sports Med 1990;18:647 – 8.
  10. Harker CP, Neuman TS, Olson LK, et al. The roentgenographic findings associated with air embolism in sport scuba divers. J Emerg Med 1993;11:443 – 9.
  11. Curtin SM, Tucker AM, Gens DR. Pneumothorax in sports: issues in recognition and follow-up care. Phys Sportsmed 2000;28:23 – 32.
  12. Partridge RA, Coley A, Bowie R, Woolard RH. Sports-related pneumothorax. Ann Emerg Med1997;30:539 – 41.
  13. Funk DA, McGanity PL, Hagemeier III KF, Schenck Jr RC. Pneumothorax in high school football. Tex Med 1998;94:72 – 4.
  14. Ziser A, Vaananen A, Melamed Y. Diving and chronic spontaneous pneumothorax. Chest 1985;87:264 – 5.
  15. Belham GJ, Adler M. Pneumothorax in a boxer. Br J Sports Med 1985;19:45.
  16. Sadat-Ali M, Al-Arfaj AL, Mohanna J. Pneumothorax due to soccer injury. Br J Sports Med 1986;20(2):91.
  17. Ciocca M. Pneumothorax in a weight lifter. Phys Sportsmed 2000;28.
  18. Harmer PA, Moriarty J, Walsh M, Bean M, Cramer J. Distant entry pneumothorax in a competitive fencer. Br J Sports Med 1996;30:265–6.
  19. Fischer RP, Flynn TC, Miller PW, Thompson DA. Scapular fractures and major ipsilateral upper torso injuries. Curr Concepts Trauma Care 1985;1:14– 6.
  20. Morgan EJ, Henderson DA. Pneumomediastinum as a complication of athletic competition. Thorax 1981;36:155–6.
  21. O’Kane J, O’Kane E, Marquet J. Delayed complication of a rib fracture. Phys Sports med 1998;26.
  22. Kizer KW, MacQuarrie MB. Pulmonary air leaks resulting from outdoor sports. A clinical series and literature review. Am J Sports Med 1999;27:517– 20.
  23. Volk CP, McFarland EG, Horsmon G. Pneumothorax: on field recognition. Phys Sportsmed 1995;23:43 – 6.
  24. Pasternak, M.S., & Rubin, R.H. (2001). Urinary tract tuberculosis. In R.W. Schrier (Ed.), Diseases of the kidney and urinary tract. (7th ed.) (pp. 1017-1037). Philadelphia: Lippincott Wil liams & Wilkins.
  25. Gibson, M.S., Puckett, M.L., & Shelly, M.E. (2004). Renal tuberculosis. RadioGraphics, 24, 251-256.
  26. Anwar, N., & Azher, A. (2002). Tuberculosis in a solitary kidney. Pakistan Journal of Medical Research, 41(4), 173-174.
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  28. Centers for Disease Control and Prevention. (2005). Controlling tuberculosis in the United States. Mortality and Morbidity Weekly Reports (MMWR): Recommended Reports 54 (RR-12), 1-77.
  29. Khan, A.N., Chandramohan, M., & MacDonald, S. (2004, November 5). Tuberculosis, genitourinary tract. Retrieved March 11, 2007from http://www.emedicine.com/radio/topic721.ht
  30. Ahmed, M., & Murty, K. V. (2003). Isolated tuberculous pyonephrosis of a native kidney in a renal allograft recipient,an unusual manifestation of tuberculosis – A case report. Indian Journal of Nephrology, 13, 75-79.
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