Vyadhita Rupiya Vimana

Vimana Sthana Chapter 7. Types of patients and organisms affecting Human Body

Vyadhita Rupiya Vimana

Section/Chapter	Vimana Sthana Chapter 7
Preceding Chapter	Roganika Vimana
Succeeding Chapter	Rogabhishagjitiya Vimana
Other Sections	Sutra Sthana, Nidana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana
Translator and commentator	Baghel M.S., Mandal S.K.
Reviewer	Paliwal M., Tengase V.
Editors	Khandel S.K., Bhagwat M., Deole Y.S., Basisht G.
Year of publication	2020
Publisher	Charak Samhita Research, Training and Skill Development Centre
DOI	10.47468/CSNE.2020.e01.s03.008

Abstract

In this chapter, two subjects are described viz. 1. Two types of patients, based on the psychological types and physical strength are seen; 2. Knowledge of micro and macro organisms that affect human body is given. These two topics seem different, however are connected in view of varied response of humans to exogenous causative factors of disease. The first type of responding individual exaggerates their symptoms (guruvyadhita) and other type understate their symptoms (laghuvyadhita). It is important to make correct assessment of their condition to know the prognosis for proper treatment. Knowledge of micro and macro organisms affecting the body, their etiological factors, site (location), classification, morphology, pathology, nomenclature and treatment is described. These organisms termed as ‘krimi’ have both internal and external manifestations. Three internal types explained on the basis of their origin are raktaja (originating in blood), shleshmika (originating due to kapha predominant factors), and purishaja (originating in feces). Three step treatment protocol has been mentioned i.e., nidana parivarjana (giving up etiological factors), apakarshana (extraction) and Prakritivighata (creating unsuitable environment for parasites). Thus the chapter narrates in detail about the methodology of analysis of krimi, their origin and ill effects and also the modes and medicaments to treat them.

Keywords: Vyadhita Roopiya, Guru Vyadhita, Sattvabala, Laghu Vyadhita, Krimi, Shleshmika, Purishaja, Raktaja, Nidana Parivarjan, Apakarshan, Prakritivighta, Parasites, worms, response of patient to disease, micro-organisms.

Introduction

The chapter deals with importance of dehabala (physical strength) and sattvabala (psychological strength) in assessing the severity and prognosis of diseases. If a physician masters the art of assessing properly the physical and psychological strength, he never fails in proper prognosis and management of patients.

• Parasitology and Bacteriolgy in Ayurveda –Oldest recording of classification and treatment of krimi (parasites and microbes) is found in Charak Samhita. It is obvious that they had knowledge of parasites and invisible microorganisms and their role in pathogenesis and symbiosis. Details of krimis is described under seven subheadings i.e., aetiology, nomenclature, site, morphology, colour, pathogenesis and treatment, in the text total number of krimi is mentioned as twenty.

• Classification – The krimis are classified as external and internal. Internal type has been further classified under three subtypes i.e. raktaja (originating in blood), shleshmika (originating due to kapha predominant factors), and purishaja (originating in feces).

• Morphology – Charak has described three morphological types of shlaishmika krimi which is consistent with present day parasitology, three types include platy helminths, large nematodes and small nematodes.

• Pathogenesis – Raktaja krimi are invisible and produce the symptomatology like kushtha hence they are to be treated like the disease kushtha. However, The shleshmika and purishaja variety has more academic importance than therapeutic as their etiological factor and treatment is the same but the presenting symptomatology is different.

• Treatment - In this section the management principle has been described which is unique and applicable to the management of most diseases. Treatment is described predominantly for intestinal parasites. Long list of plants is mentioned for the treatment of parasites and their expulsion from the body. Per the advancement in technology and pharmaceuticals, the parasites and micro-organisms are studied in detail in modern medicine. Specific ante-helminthics and anti-microbial drugs with good clinical efficacy are available. The description of methods of removal of parasites in Ayurveda seems to be inconvenient in today’s era, where convenient therapeutic modalities are developed by modern science. The ayurvedic drugs also need to be used in larger doses. Modern medicine drugs, for removal of common parasites are effective with convenient dosage schedule. However, these drugs are potentially toxic and are to be used with careful watch of physician.

Sanskrit Text, Transliteration and English Translation

अथातो व्याधितरूपीयं विमानं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātō vyādhitarūpīyaṁ vimānaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAto vyAdhitarUpIyaM vimAnaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter "Vyadhita Rupiya Vimana" (Types of patients and organisms affecting human Body). Thus said Lord Atreya. [1-2]

Two types of patients based on severity of disease and clinical presentation

इह खलु द्वौ पुरुषौ व्याधितरूपौ भवतः- गुरुव्याधितः, लघुव्याधितश्च| तत्र- गुरुव्याधित एकः सत्त्वबलशरीरसम्पदुपेतत्वाल्लघुव्याधित इव दृश्यते, लघुव्याधितोऽपरः सत्त्वादीनामधमत्वाद्गुरुव्याधित इव दृश्यते| तयोरकुशलाः केवलं चक्षुषैव रूपंदृष्ट्वाऽध्यवस्यन्तो व्याधिगुरुलाघवे विप्रतिपद्यन्ते||३||

iha khalu dvau puruṣau vyādhitarūpau bhavataḥ- guruvyādhitaḥ, laghuvyādhitaśca| tatra- guruvyādhita ēkaḥ sattvabalaśarīrasampadupētatvāllaghuvyādhita iva dr̥śyatē, laghuvyādhitō'paraḥsattvādīnāmadhamatvādguruvyādhita iva dr̥śyatē| tayōrakuśalāḥ kēvalaṁ cakṣuṣaiva rūpaṁ dr̥ṣṭvā'dhyavasyantō vyādhigurulāghavē vipratipadyantē||3||

iha khalu dvau puruShau vyAdhitarUpau bhavataH- guruvyAdhitaH, laghuvyAdhitashca | tatra- guruvyAdhita ekaH sattvabalasharIrasampadupetatvAllaghuvyAdhita iva dRushyate, laghuvyAdhito~aparaH sattvAdInAmadhamatvAdguruvyAdhita iva dRushyate | tayorakushalAH kevalaM cakShuShaiva rUpaM dRuShTvA~adhyavasyanto vyAdhigurulAghave vipratipadyante ||3||

There are two types of individuals having disease i.e. one with serious illness and other from mild disease. However, one who may be suffering from a severe disease but due to strong mental and physical constitution may project himself/herself to be suffering from a mild disease. The other one is that who may be suffering from a mild disorder but gives the impression of suffering from a severe disorder. The physicians who are not well versed in this regard fail to diagnose properly mild and severe stage of disease, merely on the basis of observation of symptoms.[3]

Consequence of improper diagnosis

नहि ज्ञानावयवेन कृत्स्ने ज्ञेये विज्ञानमुत्पद्यते| विप्रतिपन्नास्तु खलु रोगज्ञाने उपक्रमयुक्तिज्ञाने चापि विप्रतिपद्यन्ते | ते यदा गुरुव्याधितं लघुव्याधितरूपमासादयन्ति, तदा तमल्पदोषं मत्वा संशोधनकालेऽस्मै मृदु संशोधनं प्रयच्छन्तो भूय एवास्य दोषानुदीरयन्ति| यदा तु लघुव्याधितं गुरुव्याधितरूपमासादयन्ति, तदा तं महादोषं मत्वा संशोधनकालेऽस्मै तीक्ष्णं संशोधनं प्रयच्छन्तो दोषानतिनिर्हृत्य शरीरमस्य क्षिण्वन्ति| एवमवयवेन ज्ञानस्य कृत्स्ने ज्ञेये ज्ञानमभिमन्यमानाः परिस्खलन्ति| विदितवेदितव्यास्तु भिषजः सर्वं सर्वथा यथासम्भवं परीक्ष्यं परीक्ष्याध्यवस्यन्तो न क्वचिदपि विप्रतिपद्यन्ते, यथेष्टमर्थमभिनिर्वर्तयन्ति चेति ||४||

nahi jñānāvayavēna kr̥tsnē jñēyē vijñānamutpadyatē| vipratipannāstu khalu rōgajñānē upakramayuktijñānē cāpi vipratipadyantē| tē yadā guruvyādhitaṁ laghuvyādhitarūpamāsādayanti, tadā tamalpadōṣaṁ matvā saṁśōdhanakālē'smaimr̥du saṁśōdhanaṁ prayacchantō bhūya ēvāsya dōṣānudīrayanti| yadā tu laghuvyādhitaṁ guruvyādhitarūpamāsādayanti, tadā taṁ mahādōṣaṁ matvāsaṁśōdhanakālē'smai tīkṣṇaṁ saṁśōdhanaṁ prayacchantō dōṣānatinirhr̥tya śarīramasya kṣiṇvanti| ēvamavayavēna jñānasya kr̥tsnē jñēyē jñānamabhimanyamānāḥ pariskhalanti| viditavēditavyāstu bhiṣajaḥ sarvaṁ sarvathā yathāsambhavaṁ parīkṣyaṁ parīkṣyādhyavasyantō nakvacidapi vipratipadyantē, yathēṣṭamarthamabhinirvartayanti cēti||4||

nahi j~jAnAvayavena kRutsne j~jeye vij~jAnamutpadyate | vipratipannAstu khalu rogaj~jAne upakramayuktij~jAne cApi vipratipadyante | te yadA guruvyAdhitaM laghuvyAdhitarUpamAsAdayanti, tadA tamalpadoShaM matvA saMshodhanakAle~asmai mRudu saMshodhanaM prayacchanto bhUya evAsya doShAnudIrayanti | yadA tu laghuvyAdhitaM guruvyAdhitarUpamAsAdayanti, tadA taM mahAdoShaM matvA saMshodhanakAle~asmai tIkShNaM saMshodhanaM prayacchanto doShAnatinirhRutya sharIramasya kShiNvanti | evamavayavena j~jAnasya kRutsne j~jeye j~jAnamabhimanyamAnAH pariskhalanti | viditaveditavyAstu bhiShajaH sarvaM sarvathA yathAsambhavaM parIkShyaM parIkShyAdhyavasyanto na kvacidapi vipratipadyante, yatheShTamarthamabhinirvartayanti ceti ||4||

A partial knowledge of any subject does not provide thorough understanding of the entire scientific concept. Those who fail to diagnose a case properly, also fail to prescribe a rational remedy for the same. For instance, when they consider the severely ill person having mild disease and, administer mild evacuative drug which fails to expel (udeerana) out dosha. Similarly, when they consider mildly ill patient to have severe disease and administer strong evacuative drug which eliminates the doshas excessively causing weakness in the body. Thus those who regard the partial knowledge as sufficient to provide complete understanding of the entire object, fail in their pursuit. On the other hand, the physicians who have thorough knowledge from all aspects and take action after examining the entire situation by all means as far as possible they achieve the desired objective.[4]

भवन्ति चात्र- सत्त्वादीनां विकल्पेन व्याधिरूपमथातुरे| दृष्ट्वा विप्रतिपद्यन्ते बाला व्याधिबलाबले||५||

ते भेषजमयोगेन कुर्वन्त्यज्ञानमोहिताः | व्याधितानां विनाशाय क्लेशाय महतेऽपिवा||६||

प्राज्ञास्तु सर्वमाज्ञाय परीक्ष्यमिह सर्वथा | न स्खलन्ति प्रयोगेषु भेषजानां कदाचन ||७|

bhavanti cātra- sattvādīnāṁ vikalpēna vyādhirūpamathāturē [1] | dr̥ṣṭvā vipratipadyantē bālā vyādhibalābalē||5||

tē bhēṣajamayōgēna kurvantyajñānamōhitāḥ| vyādhitānāṁ vināśāya klēśāya mahatē'pi vā||6||

prājñāstu sarvamājñāya parīkṣyamiha sarvathā| na skhalanti prayōgēṣu bhēṣajānāṁ kadācana||7||

bhavanti cAtra- sattvAdInAM vikalpena vyAdhirUpamathAture [1] | dRuShTvA vipratipadyante bAlA vyAdhibalAbale ||5||

te bheShajamayogena kurvantyaj~jAnamohitAH | vyAdhitAnAM vinAshAya kleshAya mahate~api vA ||6||

prAj~jAstu sarvamAj~jAya parIkShyamiha sarvathA | na skhalanti prayogeShu bheShajAnAM kadAcana ||7||

Here are the verses,

The inexperienced physicians may wrongly diagnose the severity of the disease by seeing only the appearance of the patient having psychic disorder. These ignorant ones, by administering improper remedies, cause end of the patient or severe misery to the patient. The learned ones, (on the other hand), after examining the patient by all means never commit mistakes in administration of remedial measure. [5-7]

इति व्याधितरूपाधिकारे व्याधितरूपसङ्ख्याग्रसम्भवं व्याधितरूपहेतुविप्रतिपत्तौ कारणं सापवादं सम्प्रतिपत्तिकारणं चानपवादं निशम्य, भगवन्तमात्रेयमग्निवेशोऽतः परंसर्वक्रिमीणां पुरीष संश्रयाणां समुत्थानस्थानसंस्थानवर्णनामप्रभावचिकित्सितविशेषान्पपच्छोपसङ्गृह्य पादौ ||८||

iti vyādhitarūpādhikārē vyādhitarūpasaṅkhyāgrasambhavaṁ vyādhitarūpahētuvipratipattau kāraṇaṁsāpavādaṁ sampratipattikāraṇaṁ cānapavādaṁ niśamya, bhagavantamātrēyamagnivēśō'taḥ paraṁsarvakrimīṇāṁ purīṣasaṁśrayāṇāṁ samutthānasthānasaṁsthānavarṇanāmaprabhāvacikitsitaviśēṣānpapracchōpasaṅgr̥hya pādau||8||

iti vyAdhitarUpAdhikAre vyAdhitarUpasa~gkhyAgrasambhavaM vyAdhitarUpahetuvipratipattau kAraNaM sApavAdaM sampratipattikAraNaM cAnapavAdaM nishamya, bhagavantamAtreyamagnivesho~ataH paraM sarvakrimINAM purIShasaMshrayANAM samutthAnasthAnasaMsthAnavarNanAmaprabhAvacikitsitavisheShAn papacchopasa~ggRuhya pAdau ||8||

After the proper knowledge regarding the classification of patients on the basis of their psychological and physical strength and its consequences in proper diagnosis and treatment resulting in success or failure of physician, bowing on the feet of worshipful Atreya, Agnivesha put query about all parasites inhabiting in the purisha (feces) of persons in respect of their etiology, habitat, morphological varieties, color, nomenclature, pathogenesis and treatment.[8]

Types of krimi

अथास्मै प्रोवाच भगवानात्रेयः- इह खल्वग्निवेश! विंशतिविधाः क्रिमयः पूर्वमुद्दिष्टा नानाविधेन प्रविभागेनान्यत्र सहजेभ्यः; ते पुनः प्रकृतिभिर्विभज्यमानाश्चतुर्विधा भवन्ति; तद्यथा- पुरीषजाः, श्लेष्मजाः, शोणितजा, मलजाश्चेति ||९||

athāsmai prōvāca bhagavānātrēyaḥ- iha khalvagnivēśa! viṁśatividhāḥ krimayaḥ pūrvamuddiṣṭānānāvidhēna pravibhāgēnānyatra sahajēbhyaḥ; tē punaḥ prakr̥tibhirvibhajyamānāścaturvidhā bhavanti;tadyathā- purīṣajāḥ, ślēṣmajāḥ, śōṇitajā, malajāścēti||9||

athAsmai provAca bhagavAnAtreyaH- iha khalvagnivesha! viMshatividhAH krimayaH pUrvamuddiShTA nAnAvidhena pravibhAgenAnyatra sahajebhyaH; te punaH prakRutibhirvibhajyamAnAshcaturvidhA bhavanti; tadyathA- purIShajAH, shleShmajAH, shoNitajA, malajAshceti ||9||

Lord Atreya replied to him—O Agnivesha! Twenty types of pathogenic parasites have been mentioned here from various points of view, the non-pathogenic are other ones described elsewhere. They, being divided as per their source of genesis, are of four types-developing in feces, in mucus, in blood and developing from external excreta.[9]

Malaja krimi (parasites originating from excreta)

तत्र मलो बाह्यश्चाभ्यन्तरश्च | तत्र बाह्यमलजातान्मलजान्सञ्चक्ष्महे | तेषांसमुत्थानं- मृजावर्जनं ; स्थानं- केशश्मश्रुलोमपक्ष्मवासांसि ; संस्थानम्- अणवस्तिलाकृतयो बहुपादाश्च ; वर्णः- कृष्णः, शुक्लश्च; नामानि- यूकाः, पिपीलिकाश्च; प्रभावः- कण्डूजननं, कोठपिडकाभिनिर्वर्तनं च; चिकित्सितं तु खल्वेषामपकर्षणं, मलोपघातः, मलकराणां चभावानामनुपसेवनमिति ||१०||

tatra malō bāhyaścābhyantaraśca| tatra bāhyamalajātān malajān sañcakṣmahē | tēṣāṁ samutthānaṁ- mr̥jāvarjanaṁ; sthānaṁ- kēśaśmaśrulōmapakṣmavāsāṁsi; saṁsthānam-aṇavastilākr̥tayō bahupādāśca; varṇaḥ- kr̥ṣṇaḥ, śuklaśca; nāmāni- yūkāḥ, pipīlikāśca; prabhāvaḥ-kaṇḍūjananaṁ, kōṭhapiḍakābhinirvartanaṁ ca; cikitsitaṁ tu khalvēṣāmapakarṣaṇaṁ, malōpaghātaḥ,malakarāṇāṁ ca bhāvānāmanupasēvanamiti||10||

tatra malo bAhyashcAbhyantarashca | tatra bAhyamalajAtAn malajAn sa~jcakShmahe | teShAM samutthAnaM- mRujAvarjanaM; sthAnaM- keshashmashrulomapakShmavAsAMsi; saMsthAnam- aNavastilAkRutayo bahupAdAshca; varNaH- kRuShNaH, shuklashca; nAmAni- yUkAH, pipIlikAshca; prabhAvaH- kaNDUjananaM, koThapiDakAbhinirvartanaM ca; cikitsitaM tu khalveShAmapakarShaNaM, malopaghAtaH, malakarANAM ca bhAvAnAmanupasevanamiti ||10||

Excreta are of two types-external and internal. Here the word malaja means parasites growing due to external excreta. Their etiological factor is lack of cleanliness of the body.

Habitat -hair, beard, moustaches, body hair, eyelashes and clothing.

Morphology –minute sesame seed shaped and multipedes.

Color- black or white;

Also known as- yuka (lice), pipilika(liksha, or nit).

Symptoms - itching, urticarial patches and papules.

Their treatment is - extraction, removal of external excreta from the body and to avoid the factors which are responsible for production of excreta. [10]

Shonitaja krimi (parasites in blood)

शोणितजानां तु खलु कुष्ठैः समानं समुत्थानं ; स्थानं- रक्तवाहिन्यो धमन्यः; संस्थानम्- अणवो वृत्ताश्चापादाश्च, सूक्ष्मत्वाच्चैके भवन्त्यदृश्याः; वर्णः- ताम्रः; नामानि- केशादा, लोमादा, लोमद्वीपाः, सौरसा, औडुम्बरा, जन्तुमातरश्चेति; प्रभावः- केशश्मश्रुनखलोमपक्ष्मापध्वंसः, व्रणगतानां च हर्षकण्डूतोदसंसर्पणानि, अतिवृद्धानां च त्वक्सिरास्नायुमांसतरुणास्थिभक्षणमिति; चिकित्सितमप्येषां कुष्ठैः समानं, तदुत्तरकालमुपदेक्ष्यामः ||११||

śōṇitajānāṁ tu khalu kuṣṭhaiḥ samānaṁ samutthānaṁ; sthānaṁ- raktavāhinyō dhamanyaḥ; saṁsthānam-aṇavō vr̥ttāścāpādāśca, sūkṣmatvāccaikē bhavantyadr̥śyāḥ; varṇaḥ- tāmraḥ; nāmāni- kēśādā, lōmādā,lōmadvīpāḥ, saurasā, auḍumbarā, jantumātaraścēti; prabhāvaḥ-kēśaśmaśrunakhalōmapakṣmāpadhvaṁsaḥ, vraṇagatānāṁ ca harṣakaṇḍūtōdasaṁsarpaṇāni,ativr̥ddhānāṁ ca tvaksirāsnāyumāṁsataruṇāsthibhakṣaṇamiti; cikitsitamapyēṣāṁ kuṣṭhaiḥ samānaṁ,taduttarakālamupadēkṣyāmaḥ||11||

shoNitajAnAM tu khalu kuShThaiH samAnaM samutthAnaM; sthAnaM- raktavAhinyo dhamanyaH; saMsthAnam- aNavo vRuttAshcApAdAshca, sUkShmatvAccaike bhavantyadRushyAH; varNaH- tAmraH; nAmAni- keshAdA, lomAdA, lomadvIpAH, saurasA, auDumbarA, jantumAtarashceti; prabhAvaH- keshashmashrunakhalomapakShmApadhvaMsaH, vraNagatAnAM ca harShakaNDUtodasaMsarpaNAni, ativRuddhAnAM ca tvaksirAsnAyumAMsataruNAsthibhakShaNamiti; cikitsitamapyeShAM kuShThaiH samAnaM, taduttarakAlamupadekShyAmaH ||11||

Etiological factors for raktaja (growing due to the vitiation of blood) krimi are similar to those of kushtha;

Habitat- blood vessels;

Morphology -minute, round and having no feet and some of them are invisible due to their minuteness;

Color- coppery;

Also known as – keshada (destructing hair), lomada (destructing body hair), lomadwipa (residing in hair follicles of body), saurasa(insect infesting cartilages), audumbara(which appear like clusters of ficus racemosa/cluster fig tree) and jantumatarah(a kind of fly which produces worms);

They may produce pathogenesis like-falling of hair, beard and moustache, nails, body hair, eyelashes, when they infect a wound - (they cause) oversensitivity, itching, piercing pain and creeping sensation, when they are excessively grown - they eat away skin, blood vessels, ligaments, muscles and cartilage.

Their treatment is also similar to that for kushtha (variety of skin disorders) which will be described later on (in the chapter of kushtha). [11]

Shleshmaja krimi (parasites in mucus and other fluids)

श्लेष्मजाः क्षीरगुडतिलमत्स्यानूपमांसपिष्टान्नपरमान्नकुसुम्भस्नेहाजीर्णपूतिक्लिन्नसङ्कीर्णवि -रुद्धा सात्म्यभोजनसमुत्थानाः; तेषामामाशयः स्थानं, ते प्रवर्धमानास्तूर्ध्वमधो वा विसर्पन्त्युभयतोवा; संस्थानवर्णविशेषास्तु- श्वेताः पृथुब्रध्नसंस्थानाः केचित्, केचिद्वृत्तपरिणाहा गण्डूपदाकृतयः श्वेतास्ताम्रावभासाश्च, केचिदणवो दीर्घास्तन्त्वाकृतयः श्वेताः; तेषां त्रिविधानां श्लेष्मनिमित्तानां क्रिमीणां नामानि- अन्त्रादाः, उदरादाः, हृदयचराः , चुरवः, दर्भपुष्पाः, सौगन्धिकाः, महागुदाश्चेति; प्रभावो- हृल्लासः, आस्यसंस्रवणम्, अरोचकाविपाकौ, ज्वरः, मूर्च्छा, जृम्भा, क्षवथुः, आनाहः, अङ्गमर्दः, छर्दिः कार्श्यं, पारुष्यं, चेति ||१२||

ślēṣmajāḥkṣīraguḍatilamatsyānūpamāṁsapiṣṭānnaparamānnakusumbhasnēhājīrṇapūtiklinnasaṅkīrṇaviruddhāsātmyabhōjanasamutthānāḥ;tēṣāmāmāśayaḥ sthānaṁ, tē pravardhamānāstūrdhvamadhō vā visarpantyubhayatō vā; saṁsthānavarṇaviśēṣāstu- śvētāḥpr̥thubradhnasaṁsthānāḥ kēcit, kēcidvr̥ttapariṇāhā gaṇḍūpadākr̥tayaḥ śvētāstāmrāvabhāsāśca, kēcidaṇavō dīrghāstantvākr̥tayaḥśvētāḥ; tēṣāṁ trividhānāṁ ślēṣmanimittānāṁ krimīṇāṁ nāmāni- antrādāḥ, udarādāḥ, hr̥dayacarāḥ , curavaḥ, darbhapuṣpāḥ,saugandhikāḥ, mahāgudāścēti; prabhāvō- hr̥llāsaḥ, āsyasaṁsravaṇam, arōcakāvipākau, jvaraḥ, mūrcchā, jr̥mbhā, kṣavathuḥ,ānāhaḥ, aṅgamardaḥ, chardiḥ kārśyaṁ, pāruṣyaṁ, cēti||12||

shleShmajAH kShIraguDatilamatsyAnUpamAMsapiShTAnnaparamAnnakusumbhasneh- AjIrNapUti klinnasa~gkIrNaviruddhAsAtmyabhojanasamutthAnAH; teShAmAmAshayaH sthAnaM, te pravardhamAnAstUrdhvamadho vA visarpantyubhayato vA; saMsthAnavarNavisheShAstu- shvetAH pRuthubradhnasaMsthAnAH kecit, kecidvRuttapariNAhA gaNDUpadAkRutayaH shvetAstAmrAvabhAsAshca, kecidaNavo dIrghAstantvAkRutayaH shvetAH; teShAM trividhAnAM shleShmanimittAnAM krimINAM nAmAni- antrAdAH, udarAdAH, hRudayacarAH , curavaH, darbhapuShpAH, saugandhikAH, mahAgudAshceti; prabhAvo- hRullAsaH, AsyasaMsravaNam, arocakAvipAkau, jvaraH, mUrcchA, jRumbhA, kShavathuH, AnAhaH, a~ggamardaH, chardiH kArshyaM, pAruShyaM, ceti ||12||

The parasites growing due to the vitiation of shleshma may be caused due to food consisting of milk, jaggery, sesame, flesh of marshy animals, (rice) flour preparations, rice cooked in milk, oil of kusumbha (safflower-Schleichera oleosa), uncooked, putrefied, stale, infected, antagonistic and unsuitable items;

Their habitat is in amashaya (stomach and duodenum); when developed they move upwards or downwards or both ways;

These shlaishmika krimis on the basis of morphology and color are of three types-

1. Those which are white, broad and like a tape.
2. Those which are round like earthworms and white & coppery tinge in color;
3. Others which are small, like long thread and white;

These three types of worms can have the names like -antrada (damaging intestines), udarada (damaging abdomen), hridayachara (moving in the cardiac area), curu, darbhapushpa (like the flowers of darbha), saugandhika (having specific smell), mahaguda(which reside in gastrointestinal tract);

They may produce symptoms like- nausea, excessive salivation, anorexia, indigestion, fever, fainting, yawning, sneezing, constipation, body-ache, vomiting, emaciation and roughness. [12]

Purishaja krimi (parasites in feces)

पुरीषजास्तुल्यसमुत्थानाः श्लेष्मजैः; तेषां स्थानं पक्वाशयः, ते प्रवर्धमानास्त्वधो विसर्पन्ति, यस्य पुनरामाशयाभिमुखाः स्युर्यदन्तरं तदन्तरं तस्योद्गारनिःश्वासाः पुरीषगन्धिनः स्युः; संस्थानवर्णविशेषास्तु- सूक्ष्मवृत्तपरीणाहाः श्वेता दीर्घा ऊर्णांशुसङ्काशाः केचित्, केचित्पुनः स्थूलवृत्तपरीणाहाः श्यावनीलहरितपीताः; तेषां नामानि ककेरुकाः, मकेरुकाः, लेलिहाः; सशूलकाः, सौसुरादाश्चेति; प्रभावः- पुरीषभेदः, कार्श्यं, पारुष्यं, लोमहर्षाभिनिर्वर्तनं च, त एव चास्य गुदमुखं परितुदन्तः कण्डूं चोपजनयन्तो गुदमुखं पर्यासते, त एव जातहर्षा गुदनिष्क्रमणमतिवेलं कुर्वन्ति; इत्येष श्लेष्मजानां पुरीषजानां च क्रिमीणां समुत्थानादिविशेषः ||१३||

purīṣajāstulyasamutthānāḥ ślēṣmajaiḥ; tēṣāṁ sthānaṁ pakvāśayaḥ, tē pravardhamānāstvadhō visarpanti,yasya punarāmāśayābhimukhāḥ syuryadantaraṁ tadantaraṁ tasyōdgāraniḥśvāsāḥ purīṣagandhinaḥsyuḥ; saṁsthānavarṇaviśēṣāstu- sūkṣmavr̥ttaparīṇāhāḥ śvētā dīrghā ūrṇāṁśusaṅkāśāḥ kēcit, kēcitpunaḥ sthūlavr̥ttaparīṇāhāḥ śyāvanīlaharitapītāḥ; tēṣāṁ nāmāni kakērukāḥ, makērukāḥ, lēlihāḥ; saśūlakāḥ,sausurādāścēti; prabhāvaḥ- purīṣabhēdaḥ, kārśyaṁ, pāruṣyaṁ, lōmaharṣābhinirvartanaṁ ca, ta ēva cāsyagudamukhaṁ paritudantaḥ kaṇḍūṁ cōpajanayantō gudamukhaṁ paryāsatē, ta ēva jātaharṣāgudaniṣkramaṇamativēlaṁ kurvanti; ityēṣa ślēṣmajānāṁ purīṣajānāṁ ca krimīṇāṁsamutthānādiviśēṣaḥ||13||

purIShajAstulyasamutthAnAH shleShmajaiH; teShAM sthAnaM pakvAshayaH, te pravardhamAnAstvadho visarpanti, yasya punarAmAshayAbhimukhAH syuryadantaraM [1] tadantaraM tasyodgAraniHshvAsAH purIShagandhinaH syuH; saMsthAnavarNavisheShAstu- sUkShmavRuttaparINAhAH shvetA dIrghA [2] UrNAMshusa~gkAshAH kecit, kecit punaH sthUlavRuttaparINAhAH shyAvanIlaharitapItAH; teShAM nAmAni kakerukAH, makerukAH, lelihAH; sashUlakAH, sausurAdAshceti; prabhAvaH- purIShabhedaH, kArshyaM, pAruShyaM, lomaharShAbhinirvartanaM ca, ta eva cAsya gudamukhaM paritudantaH kaNDUM copajanayanto gudamukhaM paryAsate, ta eva jAtaharShA gudaniShkramaNamativelaM kurvanti; ityeSha shleShmajAnAM purIShajAnAM ca krimINAM samutthAnAdivisheShaH ||13||

The parasites growing in feces grow due to the same etiological factor which cause shleshmaja krimi -

Their habitat is pakwashaya (large intestine and rectum); when developed they move downwards or both ways; however if they tend to move (upwards) towards stomach, eructation and breath of the patient may have fecal odor.

Their morphology and color- these purishaja krimi are morphologically of two types :

1. some are minute round in circumference white in color and like hair of goat (wool);
2. whereas others are big, round in circumference and may have the colors like blackish, blue, green and yellow;

These two types of worms can have the names like - kakeruka, makeruka, leliha(which lick), sashulaka(which cause pain), sausurada;

They may produce symptoms like- diarrhea, emaciation, roughness, and horripilation; on reaching the anus, they produce piercing pain and itching there; when they are exhilarated, they come out of anus frequently.

Thus these are the characteristics of the worms grown due to the vitiation of shleshma and purisha. [13]

Principles of management

चिकित्सितं तु खल्वेषां समासेनोपदिश्य पश्चाद्विस्तरेणोपदेक्ष्यामः | तत्र सर्वक्रिमीणामपकर्षणमेवादितः कार्यं, ततः प्रकृतिविघातः, अनन्तरं निदानोक्तानां भावानामनुपसेवनमिति ||१४||

cikitsitaṁ tu khalvēṣāṁ samāsēnōpadiśya paścādvistarēṇōpadēkṣyāmaḥ| tatra sarvakrimīṇāmapakarṣaṇamēvāditaḥ kāryaṁ, tataḥ prakr̥tivighātaḥ, anantaraṁ nidānōktānāṁbhāvānāmanupasēvanamiti||14||

cikitsitaM tu khalveShAM samAsenopadishya pashcAdvistareNopadekShyAmaH | tatra sarvakrimINAmapakarShaNamevAditaH kAryaM, tataH prakRutivighAtaH, anantaraM nidAnoktAnAM bhAvAnAmanupasevanamiti ||14||

Their treatment will be mentioned here in brief which will be described in detail later. Parasites should be extracted, then destroyed by modifying the factors responsible for their generation and development and there after abstinence from the etiological factors should be followed. [14]

तत्रापकर्षणं- हस्तेनाभिगृह्य विमृश्योपकरणवताऽपनयनमनुपकरणेन वा; स्थानगतानां तु क्रिमीणां भेषजेनापकर्षणं न्यायतः, तच्चतुर्विधं; तद्यथा- शिरोविरेचनं, वमनं, विरेचनम्, आस्थापनंच; इत्यपकर्षणविधिः | प्रकृतिविघातस्त्वेषां कटुतिक्तकषायक्षारोष्णानां द्रव्याणामुपयोगः, यच्चान्यदपिकिञ्चिच्छ्लेष्मपुरीषप्रत्यनीकभूतं तत्स्यात्; हतिप्रकृतिविघातः | अनन्तरं निदानोक्तानां भावानामनुपसेवनं- यदुक्तं निदानविधौ तस्य विवर्जनं तथाप्रायाणां चापरेषां द्रव्याणाम् | इति लक्षणतश्चिकित्सितमनुव्याख्यातम् | एतदेव पुनर्विस्तरेणोपदेक्ष्यते ||१५||

tatrāpakarṣaṇaṁ- hastēnābhigr̥hya vimr̥śyōpakaraṇavatā'panayanamanupakaraṇēna vā; sthānagatānāṁtu krimīṇāṁ bhēṣajēnāpakarṣaṇaṁ nyāyataḥ, taccaturvidhaṁ; tadyathā- śirōvirēcanaṁ, vamanaṁ,virēcanam, āsthāpanaṁ ca; ityapakarṣaṇavidhiḥ| prakr̥tivighātastvēṣāṁ kaṭutiktakaṣāyakṣārōṣṇānāṁ dravyāṇāmupayōgaḥ, yaccānyadapikiñcicchlēṣmapurīṣapratyanīkabhūtaṁ tat syāt; hati prakr̥tivighātaḥ| anantaraṁ nidānōktānāṁ bhāvānāmanupasēvanaṁ- yaduktaṁ nidānavidhau tasya vivarjanaṁtathāprāyāṇāṁ cāparēṣāṁ dravyāṇām| iti lakṣaṇataścikitsitamanuvyākhyātam| ētadēva punarvistarēṇōpadēkṣyatē||15||

tatrApakarShaNaM- hastenAbhigRuhya vimRushyopakaraNavatA~apanayanamanupakaraNena vA; sthAnagatAnAM tu krimINAM bheShajenApakarShaNaM nyAyataH, taccaturvidhaM; tadyathA- shirovirecanaM, vamanaM, virecanam, AsthApanaM ca; ityapakarShaNavidhiH | prakRutivighAtastveShAM kaTutiktakaShAyakShAroShNAnAM dravyANAmupayogaH, yaccAnyadapi ki~jcicchleShmapurIShapratyanIkabhUtaM tat syAt; hati prakRutivighAtaH | anantaraM nidAnoktAnAM bhAvAnAmanupasevanaM- yaduktaM nidAnavidhau tasya vivarjanaM tathAprAyANAM cApareShAM dravyANAm | iti lakShaNatashcikitsitamanuvyAkhyAtam | etadeva punarvistareNopadekShyate ||15||

Apakarshana: Extraction (removal) can be done by hands with or without the help of instruments as may be the requirement.

• Parasites located inside the organs are extricated, as a rule, by the (eliminative) therapy. These are of four types such as nasal errhines - nasya, emesis, purgation and non-unctuous enema.

Prakritivighata: Destruction of the source of their origin and development consists of the use of pungent, bitter, astringent, alkaline and hot drugs, and other measures which are contrary to kapha and feces.

Nidanaparivarjana: Thereafter abstinence from the etiological factors-whatever is mentioned as causative factor and similar other substances should be avoided. Thus the principle of treatment is said, which will be further described in detail. [15]

Various therapeutic modalities

अथैनं क्रिमिकोष्ठमातुरमग्रे षड्रात्रं सप्तरात्रं वा स्नेहस्वेदाभ्यामुपपाद्य श्वोभूते एनं संशोधनं पाययिताऽस्मीति क्षीरगुडदधितिलमत्स्यानूपमांसपिष्टान्नपरमान्नकुसुम्भस्नेहसम्प्रयुक्तैर्भोज्यैः सायं प्रातश्चोपपादयेत्समुदीरणार्थं क्रिमीणां कोष्ठाभिसरणार्थं च भिषक् | अथ व्युष्टायां रात्र्यां सुखोषितं सुप्रजीर्णभक्तं च विज्ञायास्थापनवमनविरेचनैस्तदहरेवोपपादयेदुपपादनी -यश्चेत्स्यात्सर्वान्परीक्ष्य विशेषान्परीक्ष्य सम्यक् ||१६||

athainaṁ krimikōṣṭhamāturamagrē ṣaḍrātraṁ saptarātraṁ vā snēhasvēdābhyāmupapādya śvōbhūtē ēnaṁsaṁśōdhanaṁ pāyayitā'smītikṣīraguḍadadhitilamatsyānūpamāṁsapiṣṭānnaparamānnakusumbhasnēhasamprayuktairbhōjyaiḥ sāyaṁprātaścōpapādayēt samudīraṇārthaṁ krimīṇāṁ kōṣṭhābhisaraṇārthaṁ ca bhiṣak| atha vyuṣṭāyāṁ rātryāṁ sukhōṣitaṁ suprajīrṇabhaktaṁ cavijñāyāsthāpanavamanavirēcanaistadaharēvōpapādayēdupapādanīyaścēt syāt sarvān parīkṣyaviśēṣānparīkṣya samyak||16||

athainaM krimikoShThamAturamagre ShaDrAtraM saptarAtraM vA snehasvedAbhyAmupapAdya shvobhUte enaM saMshodhanaM pAyayitA~asmIti kShIraguDadadhitilamatsyAnUpamAMsapiShTAnnaparamAnnakusumbhasnehasamprayuktairbhojyaiH sAyaM prAtashcopapAdayet samudIraNArthaM krimINAM koShThAbhisaraNArthaM ca bhiShak | atha vyuShTAyAM rAtryAM sukhoShitaM suprajIrNabhaktaM ca vij~jAyAsthApanavamanavirecanaistadaharevopapAdayedupapAdanIyashcet syAt sarvAn parIkShyavisheShAn parIkShya samyak ||16||

The patient infested with worms should be first treated with oleation and fomentation for six or seven nights and a day before administration of evacuative therapy he should be given diet consisting mainly of milk, jaggery, curd, sesame, fish, meat of marshy animals, (rice) flour preparation, rice cooked in milk and kusumbha oil in morning and evening, in order to stimulate the worms and bring them to the alimentary tract. Next morning, when the patient is comfortably seated and his previous meal properly digested, the evacuative therapy-non unctuous enema, emesis and purgation- should be administered to him on the same day after examining all the aspects properly. [16]

अथाहरेतिब्रूयात्- मूलकसर्षपलशुनकरञ्जशिग्रुमधुशिग्रुखरपुष्पाभूस्तृणसुमुखसुरसकुठेरकगण्डीरकालमालकपर्णासक्षवकफणिज्झकानि सर्वाण्यथवा यथालाभं; तान्याहृतान्यभिसमीक्ष्य खण्डशश्छेदयित्वा प्रक्षाल्य पानीयेन सुप्रक्षालितायां स्थाल्यां समावाप्य गोमूत्रेणार्धोदकेनाभिषिच्य साधयेत्सततमवघट्टयन्दर्व्या, तमुपयुक्तभूयिष्ठेऽम्भसि गतरसेष्वौषधेषु स्थालीमवतार्य सुपरिपूतं कषायं सुखोष्णं मदनफलपिप्पलीविडङ्गकल्कतैलोपहितंस्वर्जिकालवणितमभ्यासिच्य बस्तौ विधिवदास्थापयेदेनं; तथाऽर्कालर्ककुटजाढकीकुष्ठकैडर्यकषायेण वा, तथा शिग्रुपीलुकुस्तुम्बुरुकटुकासर्षपकषायेण, तथाऽऽमलकशृङ्गवेरदारुहरिद्रापिचुमर्दकषायेण मदनफलादिसंयोगसम्पादितेन, त्रिवारं सप्तरात्रं वाऽऽस्थापयेत् ||१७||

athāharēti brūyāt- mūlakasarṣapalaśunakarañjaśigrumadhuśigrukharapuṣpābhūstr̥ṇasumukhasurasakuṭhērakagaṇḍīrakālamālakaparṇāsakṣavakaphaṇijjhakānisarvāṇyathavā yathālābhaṁ; tānyāhr̥tānyabhisamīkṣya khaṇḍaśaśchēdayitvā prakṣālya pānīyēna suprakṣālitāyāṁ sthālyāṁ samāvāpyagōmūtrēṇārdhōdakēnābhiṣicya sādhayēt satatamavaghaṭṭayan darvyā, tamupayuktabhūyiṣṭhē'mbhasi [1] gatarasēṣvauṣadhēṣusthālīmavatārya suparipūtaṁ kaṣāyaṁ sukhōṣṇaṁ madanaphalapippalīviḍaṅgakalkatailōpahitaṁ svarjikālavaṇitamabhyāsicya bastauvidhivadāsthāpayēdēnaṁ; tathā'rkālarkakuṭajāḍhakīkuṣṭhakaiḍaryakaṣāyēṇa vā, tathā śigrupīlukustumburukaṭukāsarṣapakaṣāyēṇa,tathāmalakaśr̥ṅgavēradāruharidrāpicumardakaṣāyēṇa madanaphalādisaṁyōgasampāditēna, trivāraṁ saptarātraṁ vāsthāpayēt||17||

athAhareti brUyAt- mUlakasarShapalashunakara~jjashigrumadhushigrukharapuShpAbhUstRuNasumukhasurasakuTherakagaNDIrakAlamAlakaparNAsakShavakaphaNijjhakAni sarvANyathavA yathAlAbhaM; tAnyAhRutAnyabhisamIkShya khaNDashashchedayitvA prakShAlya pAnIyena suprakShAlitAyAM sthAlyAM samAvApya gomUtreNArdhodakenAbhiShicya sAdhayet satatamavaghaTTayan darvyA, tamupayuktabhUyiShThe~ambhasi [1] gataraseShvauShadheShu sthAlImavatArya suparipUtaM kaShAyaM sukhoShNaM madanaphalapippalIviDa~ggakalkatailopahitaM svarjikAlavaNitamabhyAsicya bastau vidhivadAsthApayedenaM; tathA~arkAlarkakuTajADhakIkuShThakaiDaryakaShAyeNa vA, tathA shigrupIlukustumburukaTukAsarShapakaShAyeNa, tathA~a~amalakashRu~ggaveradAruharidrApicumardakaShAyeNa madanaphalAdisaMyogasampAditena, trivAraM saptarAtraM vA~a~asthApayet ||17||

Now the patient should be asked to bring the drugs-

Mulaka (radish), sarshapa (mustard), lashuna (garlic), karanja (pongamia), shigru (drum stick), madhu shigru (a kind of drumstick), kharapushpa(katphala or vana tulasi), bhustruna, sumukha(a type of tulasi), surasa(type of tulasi), kutheraka(type of tulasi), gandira(Canthium parviflorum Lamk), kalamalaka(type of tulasi), parnasa(type of tulasi), kshavka(type of tulasi), phaninjaka(type of tulasi)- all or whichever are available, should be cut into pieces, washed well with water, put in well-cleaned cooking pot and after dipping them in cow urine diluted with half water they are cooked being stirred constantly with a ladle. When the water is mostly consumed and the drugs well-extracted the cooking pot should be brought down and the extract be taken by filtering it properly.

The tolerably warm decoction is added with the paste of the madanaphala pulp, vidanga oil, and swarjika kshara and put into the enema pot and with this non-unctuous enema should be administered to the patient properly. This enema may also be prepared with the decoction of arka, alarka, kulaja, adhaki, kushtha, kaidarya, shigru, pilu, dhanyaka, katuka and sarshapa, amalaka, shringabera, daruharidra and nimba, in combination with madanaphala etc. and is administered to the patient for three or seven days. [17]

प्रत्यागते च पश्चिमे बस्तौ प्रत्याश्वस्तं तदहरेवोभयतोभागहरं संशोधनं पाययेद्युक्त्या; तस्य विधिरुपदेक्ष्यते- मदनफलपिप्पलीकषायस्यार्धाञ्जलिमात्रेण त्रिवृत्कल्काक्षमात्रमालोड्य पातुमस्मै प्रयच्छेत्, तदस्य दोषमुभयतो निर्हरति साधु; एवमेव कल्पोक्तानि वमनविरेचनानि प्रतिसंसृज्य पाययेदेनं बुद्ध्या सर्वविशेषानवेक्षमाणो भिषक् ||१८||

pratyāgatē ca paścimē bastau pratyāśvastaṁ tadaharēvōbhayatōbhāgaharaṁ saṁśōdhanaṁpāyayēdyuktyā; tasya vidhirupadēkṣyatē- madanaphalapippalīkaṣāyasyārdhāñjalimātrēṇatrivr̥tkalkākṣamātramālōḍya pātumasmai prayacchēt, tadasya dōṣamubhayatō nirharati sādhu; ēvamēvakalpōktāni vamanavirēcanāni pratisaṁsr̥jya pāyayēdēnaṁ buddhyā sarvaviśēṣānavēkṣamāṇō bhiṣak||18||

pratyAgate ca pashcime bastau pratyAshvastaM tadaharevobhayatobhAgaharaM saMshodhanaM pAyayedyuktyA; tasya vidhirupadekShyate- madanaphalapippalIkaShAyasyArdhA~jjalimAtreNa trivRutkalkAkShamAtramAloDya pAtumasmai prayacchet, tadasya doShamubhayato nirharati sAdhu; evameva kalpoktAni vamanavirecanAni pratisaMsRujya pAyayedenaM buddhyA sarvavisheShAnavekShamANo bhiShak ||18||

After the last enema, the patient should be assured and on the same day evacuative drugs acting from both ways be administered to him properly. Its method is like this-

One aksha (l0 gm. ) of the paste of trivrit mixed with half anjali ( 80 ml. ) decoction of the madanaphala pulp should be administered to the patient, this eliminates the noxious material from both upper and lower routes. In this way the emetics and purgatives mentioned in the Kalpa Sthana chapter may be administered after properly examining the patient from all aspects.[18]

अथैनं सम्यग्विरिक्तं विज्ञायापराह्णे शैखरिककषायेण सुखोष्णेन परिषेचयेत् | तेनैव च कषायेण बाह्याभ्यन्तरान्सर्वोदकार्थान्कारयेच्छश्वत्; तदभावे कटुतिक्तकषायाणामौषधानां क्वाथैर्मूत्रक्षारैर्वा परिषेचयेत् | परिषिक्तं चैनं निवातमागारमनुप्रवेश्य पिप्पलीपिप्पलीमूलचव्यचित्रकशृङ्गवेरसिद्धेन यवाग्वादिना क्रमेणोपाचरेत्, विलेपीक्रमागतं चैनमनुवासयेद्विडङ्गतैलेनैकान्तरं द्विस्त्रिर्वा ||१९||

athainaṁ samyagviriktaṁ vijñāyāparāhṇē śaikharikakaṣāyēṇa sukhōṣṇēna pariṣēcayēt| tēnaiva ca kaṣāyēṇa bāhyābhyantarān sarvōdakārthān kārayēcchaśvat; tadabhāvēkaṭutiktakaṣāyāṇāmauṣadhānāṁ kvāthairmūtrakṣārairvā pariṣēcayēt| pariṣiktaṁ cainaṁ nivātamāgāramanupravēśya pippalīpippalīmūlacavyacitrakaśr̥ṅgavērasiddhēnayavāgvādinā kramēṇōpācarēt, vilēpīkramāgataṁ cainamanuvāsayēdviḍaṅgatailēnaikāntaraṁdvistrirvā||19||

athainaM samyagviriktaM vij~jAyAparAhNe shaikharikakaShAyeNa sukhoShNena pariShecayet | tenaiva ca kaShAyeNa bAhyAbhyantarAn sarvodakArthAn kArayecchashvat; tadabhAve kaTutiktakaShAyANAmauShadhAnAM kvAthairmUtrakShArairvA pariShecayet | pariShiktaM cainaM nivAtamAgAramanupraveshya pippalIpippalImUlacavyacitrakashRu~ggaverasiddhena yavAgvAdinA krameNopAcaret, vilepIkramAgataM cainamanuvAsayedviDa~ggatailenaikAntaraM dvistrirvA ||19||

When the patient is purged well, he should be bathed with the warm decoction of vidanga in afternoon and he should use this decoction for all purposes of external as well as internal use in place of water regularly; if it is not available, decoction of other pungent, bitter and astringent drugs or urine or alkalis may be used for bath. After bath patient should be taken into a room which is devoid of wind and should be managed with dietetic regimen starting with yavagu (liquid gruel) cooked with the drugs like pippali, pippalimula, chavya, chitraka and shunthi. In this way when he reaches the stage of vilepi (paste gruel) unctuous enema should be administered to him with vidanga taila twice or thrice on alternate days.[19]

यदिपुनरस्यातिप्रवृद्धाञ्छीर्षादान्क्रिमीन्मन्येत शिरस्यैवाभिसर्पतः कदाचित्, ततः स्नेहस्वेदाभ्यामस्य शिर उपपाद्य विरेचयेदपामार्गतण्डुलादिना शिरोविरेचनेन ||२०||

yadi punarasyātipravr̥ddhāñchīrṣādān krimīn manyēta śirasyaivābhisarpataḥ kadācit, tataḥsnēhasvēdābhyāmasya śira upapādya virēcayēdapāmārgataṇḍulādinā śirōvirēcanēna||20||

yadi punarasyAtipravRuddhA~jchIrShAdAn krimIn manyeta shirasyaivAbhisarpataH kadAcit, tataH snehasvedAbhyAmasya shira upapAdya virecayedapAmArgataNDulAdinA shirovirecanena ||20||

If the parasites affecting the head are too many and sometimes seen creeping on the head, then after applying oil and fomentation on the head the patient he should be administered with nasal evacuation therapy with the seeds of apamarga, etc. [20]

यस्त्वभ्यवहार्यविधिः प्रकृतिविघातायोक्तः क्रिमीणामथ तमनुव्याख्यास्यामः- मूलकपर्णीं [१] समूलाग्रप्रतानामाहृत्य खण्डशश्छेदयित्वोलू(दू)खले क्षोदयित्वा पाणिभ्यां पीडयित्वा रसंगृह्णीयात्, तेन रसेन लोहितशालितण्डुलपिष्टं समालोड्य पूपलिकां कृत्वा विधूमेष्वङ्गारेषूपकुड्य [२] विडङ्गतैललवणोपहितां क्रिमिकोष्ठाय भक्षयितुं प्रयच्छेत्, अनन्तरं चाम्लकाञ्जिकमुदश्विद्वा पिप्पल्यादिपञ्चवर्ग संसृष्टं सलवणमनुपाययेत् | अनेन कल्पेन मार्कवार्कसहचरनीपनिर्गुण्डीसुमुखसुरसकुठेरकगण्डीरकालमालकपर्णासक्षवकफणिज्झक- बकुलकुटजसुवर्णक्षीरीस्वरसानामन्यतमस्मिन्कारयेत्पूपलिकाः; तथा किणिहीकिराततिक्तकसुवहामलकहरीतकीबिभीतकस्वरसेषुकारयेत्पूपलिकाः; स्वरसांश्चैतेषामेकैकशो द्वन्द्वशः सर्वशो वा मधुविलुलितान्प्रातरनन्नाय पातुं प्रयच्छेत् ||२१||

yastvabhyavahāryavidhiḥ prakr̥tivighātāyōktaḥ krimīṇāmatha tamanuvyākhyāsyāmaḥ- mūlakaparṇīṁ [1]samūlāgrapratānāmāhr̥tya khaṇḍaśaśchēdayitvōlū(dū)khalē kṣōdayitvā pāṇibhyāṁ pīḍayitvā rasaṁgr̥hṇīyāt, tēna rasēna lōhitaśālitaṇḍulapiṣṭaṁ samālōḍya pūpalikāṁ kr̥tvā vidhūmēṣvaṅgārēṣūpakuḍya [2]viḍaṅgatailalavaṇōpahitāṁ krimikōṣṭhāya bhakṣayituṁ prayacchēt, anantaraṁ cāmlakāñjikamudaśvidvāpippalyādipañcavargasaṁsr̥ṣṭaṁ salavaṇamanupāyayēt| anēna kalpēnamārkavārkasahacaranīpanirguṇḍīsumukhasurasakuṭhērakagaṇḍīrakālamālakaparṇāsakṣavakaphaṇijjhaka-bakulakuṭajasuvarṇakṣīrīsvarasānāmanyatamasmin kārayēt pūpalikāḥ; tathākiṇihīkirātatiktakasuvahāmalakaharītakībibhītakasvarasēṣu kārayēt pūpalikāḥ; svarasāṁścaitēṣāmēkaikaśōdvandvaśaḥ sarvaśō vā madhuvilulitān prātaranannāya pātuṁ prayacchēt||21||

yastvabhyavahAryavidhiH prakRutivighAtAyoktaH krimINAmatha tamanuvyAkhyAsyAmaH- mUlakaparNIM samUlAgrapratAnAmAhRutya khaNDashashchedayitvolU(dU)khale kShodayitvA pANibhyAM pIDayitvA rasaM gRuhNIyAt, tena rasena lohitashAlitaNDulapiShTaM samAloDya pUpalikAM kRutvA vidhUmeShva~ggAreShUpakuDya viDa~ggatailalavaNopahitAM krimikoShThAya bhakShayituM prayacchet, anantaraM cAmlakA~jjikamudashvidvA pippalyAdipa~jcavargasaMsRuShTaM salavaNamanupAyayet | anena kalpena mArkavArkasahacaranIpanirguNDIsumukhasurasakuTherakagaNDIrakAlamAlakaparNAsakShavakaphaNijjhaka- bakulakuTajasuvarNakShIrIsvarasAnAmanyatamasmin kArayet pUpalikAH; tathA kiNihIkirAtatiktakasuvahAmalakaharItakIbibhItakasvaraseShu kArayet pUpalikAH; svarasAMshcaiteShAmekaikasho dvandvashaH sarvasho vA madhuvilulitAn prAtaranannAya pAtuM prayacchet ||21||

Now we shall describe some medicated food preparations for destroying the environment for growth of the parasites-the whole plant of mulakaparni along with root, top and branches should be collected and the juice should be extracted out of it after cutting it into pieces pounding in a mortar and pressing with the hands. Mixing the flour of the red rice (shali) with this juice pupalika (cake mantle) and cooked on smokeless charcoal. These cakes along with vidanga, oil and salt should be given to the patient infested with parasites for eating. Afterwards he should be given to drink the sour vinegar or diluted buttermilk mixed with five drugs of pippalyadi group (pippali, pippalimula, cavya, citraka, shunthi ) salt. In the same way, cake may be prepared with the juice of one of these drugs bhringaraja, arka, sahacara, nipa, nirgundi, sumukha, surasa, kutheraka, gandira, kalamalaka, parnasa, kshavaka, phanijjaka, bakula, kutaja and suvarnakshiri. Moreover, cake may be prepared from amalaka, haritaki and bibhitaka. The juice of kirlihi, kiratatikta, suvaha, drugs should also be administered alone, or in combination with another drug or all together mixed with honey to the patient on empty stomach in the morning. [21]

अथाश्वशकृदाहृत्य महति किलिञ्जके प्रस्तीर्यातपे शोषयित्वोदूखले क्षोदयित्वा दृषदि पुनः सूक्ष्मचूर्णानि कारयित्वा विडङ्गकषायेण त्रिफलाकषायेण वाऽष्टकृत्वो दशकृत्वो वाऽऽतपे सुपरिभावितानि भावयित्वा दृषदि पुनः सूक्ष्माणि चूर्णानि कारयित्वा नवे कलशे समावाप्यानुगुप्तं निधापयेत् | तेषां तु खलु चूर्णानां पाणितलं यावद्वा साधु मन्येत तत्क्षौद्रेण संसृज्य क्रिमिकोष्ठिने लेढुं प्रयच्छेत् ||२२||

athāśvaśakr̥dāhr̥tya mahati kiliñjakē prastīryātapē śōṣayitvōdūkhalē kṣōdayitvā dr̥ṣadi punaḥsūkṣmacūrṇāni kārayitvā viḍaṅgakaṣāyēṇa triphalākaṣāyēṇa vā'ṣṭakr̥tvō daśakr̥tvō vātapē [1]suparibhāvitāni bhāvayitvā dr̥ṣadi punaḥ sūkṣmāṇi cūrṇāni kārayitvā navē kalaśē samāvāpyānuguptaṁnidhāpayēt| tēṣāṁ tu khalu cūrṇānāṁ pāṇitalaṁ yāvadvā sādhu manyēta tat kṣaudrēṇa saṁsr̥jya krimikōṣṭhinē lēḍhuṁprayacchēt||22||

athAshvashakRudAhRutya mahati kili~jjake prastIryAtape shoShayitvodUkhale kShodayitvA dRuShadi punaH sUkShmacUrNAni kArayitvA viDa~ggakaShAyeNa triphalAkaShAyeNa vA~aShTakRutvo dashakRutvo vA~a~atape suparibhAvitAni bhAvayitvA dRuShadi punaH sUkShmANi cUrNAni kArayitvA nave kalashe samAvApyAnuguptaM nidhApayet | teShAM tu khalu cUrNAnAM pANitalaM yAvadvA sAdhu manyeta tat kShaudreNa saMsRujya krimikoShThine leDhuM prayacchet ||22||

Collecting the horse dung, it is spread over a big mat and dried up in the sun. Then fine powder is made by pounding in a mortar and again grinding on stone slab it should be dipped well in the decoction of vidanga or triphala and dried well in the sun. This process is repeated eight or ten times. Finally grinding it on stone slab, fine powder is made and stored in a new jar in a protected place. This powder in the dose of l0 gm., or whatever is appropriate, mixed with honey should be administered to the patient. [22]

तथा भल्लातकास्थीन्याहृत्य कलशप्रमाणेन चापोथ्य स्नेहभाविते दृढे कलशे सूक्ष्मानेकच्छिद्रब्रध्ने शरीरमुपवेष्ट्य मृदावलिप्ते समावाप्योडुपेन पिधाय भूमावाकण्ठं निखातस्य स्नेहभावितस्यैवान्यस्य दृढस्य कुम्भस्योपरिसमारोप्य समन्ताद्गोमयैरुपचित्यदाहयेत्, स यदा जानीयात्साधुदग्धानि गोमयानि विगतस्नेहानि च भल्लातकास्थीनीति ततस्तं कुम्भमुद्धरेत् | अथ तस्माद्द्वितीयात्कुम्भात्स्नेहमादाय विडङ्गतण्डुलचूर्णैः स्नेहार्धमात्रैः प्रतिसंसृज्यातपे सर्वमहः स्थापयित्वा ततोऽस्मै मात्रां प्रयच्छेत्पानाय; तेन साधु विरिच्यते, विरिक्तस्य चानुपूर्वीयथोक्ता | एवमेव भद्रदारुसरलकाष्ठस्नेहानुपकल्प्य पातुं प्रयच्छेत् ||२३||

अनुवासयेच्चैनमनुवासनकाले ||२४||

tathā bhallātakāsthīnyāhr̥tya kalaśapramāṇēna cāpōthya snēhabhāvitē dr̥ḍhē kalaśēsūkṣmānēkacchidrabradhnē śarīramupavēṣṭya [1] mr̥dāvaliptē samāvāpyōḍupēna pidhāyabhūmāvākaṇṭhaṁ nikhātasya snēhabhāvitasyaivānyasya dr̥ḍhasya kumbhasyōpari samārōpyasamantādgōmayairupacitya dāhayēt, sa yadā jānīyāt sādhu dagdhāni gōmayāni vigatasnēhāni cabhallātakāsthīnīti tatastaṁ kumbhamuddharēt| atha tasmāddvitīyāt kumbhāt snēhamādāya viḍaṅgataṇḍulacūrṇaiḥ snēhārdhamātraiḥ pratisaṁsr̥jyātapēsarvamahaḥ sthāpayitvā tatō'smai mātrāṁ prayacchēt pānāya; tēna sādhu viricyatē, viriktasya cānupūrvīyathōktā| ēvamēva bhadradārusaralakāṣṭhasnēhānupakalpya pātuṁ prayacchēt||23||

anuvāsayēccainamanuvāsanakālē ||24||

tathA bhallAtakAsthInyAhRutya kalashapramANena cApothya snehabhAvite dRuDhe kalashe sUkShmAnekacchidrabradhne sharIramupaveShTya] mRudAvalipte samAvApyoDupena pidhAya bhUmAvAkaNThaM nikhAtasya snehabhAvitasyaivAnyasya dRuDhasya kumbhasyopari samAropya samantAdgomayairupacitya dAhayet, sa yadA jAnIyAt sAdhu dagdhAni gomayAni vigatasnehAni ca bhallAtakAsthInIti tatastaM kumbhamuddharet | atha tasmAddvitIyAt kumbhAt snehamAdAya viDa~ggataNDulacUrNaiH snehArdhamAtraiH pratisaMsRujyAtape sarvamahaH sthApayitvA tato~asmai mAtrAM prayacchet pAnAya; tena sAdhu viricyate, viriktasya cAnupUrvI yathoktA | evameva bhadradArusaralakAShThasnehAnupakalpya pAtuM prayacchet ||23||

anuvAsayeccainamanuvAsanakAle ||24||

Stony fruits of bhallataka taken in the quantity of a kalasha (10.24 kg. rushed and kept in a strong jar smeared inside with ghee having many fine holes in the bottom and wrapped all over with clay (and dried). This jar having been covered with a lid is put on another strong and ghee-smeared jar which is buried under ground up to neck. Now it should be covered with cow-dung from all sides and ignited. When it is observed that the cow dung is well-burnt and the stony fruits of bhallataka are free from oil, the (upper) jar is taken out. Now from the lower jar the oil is collected. It is mixed with double quantity of the powder of vidanga seeds and dried up in the sun for the whole day. A dose of it is administered to the patient by which he is purged well. The after-management should be as said above. By the same method, the oil obtained from the wood of devadaru and sarala may be administered. Then at the appropriate time, unctuous enema should be given. [23-24]

अथाहरेति ब्रूयात्- शारदान्नवांस्तिलान्सम्पदुपेतान्; तानाहृत्यसुनिष्पूतान्निष्पूय, सुशुद्धान्शोधयित्वा , विडङ्गकषाये सुखोष्णे प्रक्षिप्य निर्वापयेदादोषगमनात्, गतदोषानभिसमीक्ष्य, सुप्रलूनान् प्रलुञ्च्य, पुनरेवसुनिष्पूतान् निष्पूय, सुशुद्धान्शोधयित्वा, विडङ्गकषायेण त्रिःसप्तकृत्वः सुपरिभावितान् भावयित्वा, आतपे शोषयित्वा, उलू(दू)खले सङ्क्षुद्य, दृषदि पुनः श्लक्ष्णपिष्टान्कारयित्वा, द्रोण्यामभ्यवधाय, विडङ्गकषायेण मुहुर्मुहुरवसिञ्चन्पाणिमर्दमेवमर्दयेत्; तस्मिंस्तु खलु प्रपीड्यमाने यत्तैलमुदियात्तत्पाणिभ्यांपर्यादाय, शुचौ दृढे कलशे न्यस्यानुगुप्तं निधापयेत् ||२५||

athāharēti brūyāt- śāradānnavāṁstilān sampadupētān; tānāhr̥tya suniṣpūtānniṣpūya, suśuddhānśōdhayitvā , viḍaṅgakaṣāyē sukhōṣṇē prakṣipya nirvāpayēdādōṣagamanāt, gatadōṣānabhisamīkṣya,supralūnān praluñcya, punarēva suniṣpūtān ] niṣpūya, suśuddhān śōdhayitvā, viḍaṅgakaṣāyēṇatriḥsaptakr̥tvaḥ suparibhāvitān bhāvayitvā, ātapē śōṣayitvā, ulū(dū)khalē saṅkṣudya, dr̥ṣadi punaḥślakṣṇapiṣṭān kārayitvā, drōṇyāmabhyavadhāya, viḍaṅgakaṣāyēṇa muhurmuhuravasiñcan pāṇimardamēvamardayēt; tasmiṁstu khalu prapīḍyamānē yattailamudiyāttat pāṇibhyāṁ paryādāya, śucau dr̥ḍhē kalaśēnyasyānuguptaṁ nidhāpayēt||25||

athAhareti brUyAt- shAradAnnavAMstilAn sampadupetAn; tAnAhRutya suniShpUtAnniShpUya, sushuddhAn shodhayitvA , viDa~ggakaShAye sukhoShNe prakShipya nirvApayedAdoShagamanAt, gatadoShAnabhisamIkShya, supralUnAn pralu~jcya, punareva suniShpUtAn niShpUya, sushuddhAn shodhayitvA, viDa~ggakaShAyeNa triHsaptakRutvaH suparibhAvitAn bhAvayitvA, Atape shoShayitvA, ulU(dU)khale sa~gkShudya, dRuShadi punaH shlakShNapiShTAn kArayitvA, droNyAmabhyavadhAya, viDa~ggakaShAyeNa muhurmuhuravasi~jcan pANimardameva mardayet; tasmiMstu khalu prapIDyamAne yattailamudiyAttat pANibhyAM paryAdAya, shucau dRuDhe kalashe nyasyAnuguptaM nidhApayet ||25||

Now ask the patient to collect, sesame seeds endowed with all qualities and harvested in the autumn. After winnowing and cleaning these seeds, they should be immersed in the lukewarm decoction of vidanga till the noxious material comes out.

Then again cleaning them well, they should be dipped in the decoction of vidanga and dried in the sun. The process should be repeated for twenty one times. There after powdering it in a mortar and again grinding it finely on stone slab one should keep it in a tub and sprinkling the vidanga decoction over it again and again one should press it with hands. During this process, whatever oil comes out, should be collected by hands and kept in a clean and strong jar which should be stored in a protected place. [25]

अथाहरेतिब्रूयात्- तिल्वकोद्दालकयोर्द्वौ बिल्वमात्रौ पिण्डौ श्लक्ष्णपिष्टौ विडङ्गकषायेण, तदर्धमात्रौ श्यामात्रिवृतयोः, अतोऽर्धमात्रौ दन्तीद्रवन्त्योः, अतोऽर्धमात्रौ च चव्यचित्रकयोरिति | एतं सम्भारं विडङ्गकषायस्यार्धाढकमात्रेण प्रतिसंसृज्य, तत्तैलप्रस्थं समावाप्य, सर्वमालोड्य, महति पर्योगे समासिच्याग्नावधिश्रित्यासने सुखोपविष्टः सर्वतः स्नेहमवलोकयन्नजस्रं मृद्वग्निना साधयेद्दर्व्या सततमवघट्टयन् | स यदा जानीयाद्विरमतिशब्दः, प्रशाम्यति च फेनः, प्रसादमापद्यते स्नेहः, यथास्वं च गन्धवर्णरसोत्पत्तिः, संवर्तते च भैषज्यमङ्गुलिभ्यां मृद्यमानमनतिमृद्वनतिदारुणमनङ्गुलिग्राहि चेति, स कालस्तस्यावतारणाय | ततस्तमवतार्य शीतीभूतमहतेन वाससा परिपूय, शुचौ दृढे कलशे समासिच्य, पिधानेन पिधाय, शुक्लेन वस्त्रपट्टेनावच्छाद्य, सूत्रेण सुबद्धं सुनिगुप्तं निधापयेत् | ततोऽस्मै मात्रां प्रयच्छेत्पानाय, तेन साधु विरिच्यते; सम्यगपहृतदोषस्य चानुपूर्वी यथोक्ता | ततश्चैनमनुवासयेदनुवासनकाले |एतेनैव च पाकविधिना सर्षपातसीकरञ्जकोषातकीस्नेहानुपकल्प्य पाययेत्सर्वविशेषानवेक्षमाणः | तेनागदोभवति ||२६||

athāharēti brūyāt- tilvakōddālakayōrdvau bilvamātrau piṇḍau ślakṣṇapiṣṭau viḍaṅgakaṣāyēṇa,tadardhamātrau śyāmātrivr̥tayōḥ, atō'rdhamātrau dantīdravantyōḥ, atō'rdhamātrau ca cavyacitrakayōriti| ētaṁ sambhāraṁ viḍaṅgakaṣāyasyārdhāḍhakamātrēṇa pratisaṁsr̥jya, tattailaprasthaṁ samāvāpya,sarvamālōḍya, mahati paryōgē samāsicyāgnāvadhiśrityāsanē sukhōpaviṣṭaḥ sarvataḥsnēhamavalōkayannajasraṁ mr̥dvagninā sādhayēddarvyā satatamavaghaṭṭayan| sa yadā jānīyādviramati śabdaḥ, praśāmyati ca phēnaḥ, prasādamāpadyatē snēhaḥ, yathāsvaṁ cagandhavarṇarasōtpattiḥ, saṁvartatē ca bhaiṣajyamaṅgulibhyāṁmr̥dyamānamanatimr̥dvanatidāruṇamanaṅguligrāhi cēti, sa kālastasyāvatāraṇāya| tatastamavatārya śītībhūtamahatēna vāsasā paripūya, śucau dr̥ḍhē kalaśē samāsicya, pidhānēna pidhāya,śuklēna vastrapaṭṭēnāvacchādya, sūtrēṇa subaddhaṁ suniguptaṁ nidhāpayēt| tatō'smai mātrāṁ prayacchēt pānāya, tēna sādhu viricyatē; samyagapahr̥tadōṣasya cānupūrvī yathōktā| tataścainamanuvāsayēdanuvāsanakālē| ētēnaiva ca pākavidhinā sarṣapātasīkarañjakōṣātakīsnēhānupakalpya pāyayēt sarvaviśēṣānavēkṣamāṇaḥ| tēnāgadō bhavati||26||

athAhareti brUyAt- tilvakoddAlakayordvau bilvamAtrau piNDau shlakShNapiShTau viDa~ggakaShAyeNa, tadardhamAtrau shyAmAtrivRutayoH, ato~ardhamAtrau dantIdravantyoH, ato~ardhamAtrau ca cavyacitrakayoriti | etaM sambhAraM viDa~ggakaShAyasyArdhADhakamAtreNa pratisaMsRujya, tattailaprasthaM samAvApya, sarvamAloDya, mahati paryoge samAsicyAgnAvadhishrityAsane sukhopaviShTaH sarvataH snehamavalokayannajasraM mRudvagninA sAdhayeddarvyA satatamavaghaTTayan | sa yadA jAnIyAdviramati shabdaH, prashAmyati ca phenaH, prasAdamApadyate snehaH, yathAsvaM ca gandhavarNarasotpattiH, saMvartate ca bhaiShajyama~ggulibhyAM mRudyamAnamanatimRudvanatidAruNamana~gguligrAhi ceti, sa kAlastasyAvatAraNAya | tatastamavatArya shItIbhUtamahatena vAsasA paripUya, shucau dRuDhe kalashe samAsicya, pidhAnena pidhAya, shuklena vastrapaTTenAvacchAdya, sUtreNa subaddhaM suniguptaM nidhApayet | tato~asmai mAtrAM prayacchet pAnAya, tena sAdhu viricyate; samyagapahRutadoShasya cAnupUrvI yathoktA | tatashcainamanuvAsayedanuvAsanakAle | etenaiva ca pAkavidhinA sarShapAtasIkara~jjakoShAtakIsnehAnupakalpya pAyayet sarvavisheShAnavekShamANaH | tenAgado bhavati ||26||

Now ask (the patient) to bring two boluses each of bilwa pramana (40 gm.) weight of the finely made paste of tilwaka and uddalaka with the decoction of vidanga, two similar boluses of shyama and trivrit in half quantity (20gm), boluses of danti and dravanti in further half quantity (l0 gm) and two boluses of chavya and chitraka in further half quantity (5 gm). Combining all the above material with vidanga decoction in quantity of 1.28 liter and vidanga taila in that of 640 ml. and mixing well ne should keep it in a big vessel which should be put over fire. A person sitting comfortably on a seat and keeping eye constantly on the oil from all sides should cook it on mild fire while stirring with a ladle constantly. When one observes that sound is stopped, foam is subsided, oil is clarified, proper smell, color and taste appear, the drug-paste pressed with the fingers is made into a wick, not adhering to the fingers and not being too soft or too hard. This is the time for bringing down the vessel. After the vessel is brought down and cooled, the content should be filtered through undamaged cloth and kept in a clean and strong jar closed with lid and covered with a piece of' white cloth and tied well with threads should be stored in a protected place. Appropriate dose of this should be administered to the patient to be purged well. After proper elimination of the noxious material he should be managed as said before. Then at appropriate time, unctuous enema should be administered to him. By the same method one should prepare oils of sarshapa, atasi, karanja and koshataki and administer to the patient considering all the aspects. Thus he becomes free from the disorders. [26]

एवं द्वयानां श्लेष्मपुरीषसम्भवानां क्रिमीणां समुत्थानसंस्थानवर्णनामप्रभावचिकित्सितविशेषाव्याख्याताः सामान्यतः | विशेषतस्तु स्वल्पमात्रमास्थापनानुवासनानुलोमहरणभूयिष्ठं तेष्वेवौषधेषु पुरीषजानां क्रिमीणां चिकित्सितं कर्तव्यं, मात्राधिकं पुनः शिरोविरेचनवमनोपशमनभूयिष्ठं तेष्वेवौषधेषु श्लेष्मजानां क्रिमीणां चिकित्सितं कार्यम्; इत्येष क्रिमिघ्नो भेषजविधिरनुव्याख्यातो भवति | तमनुतिष्ठता यथास्वं हेतुवर्जने प्रयतितव्यम् | यथोद्देशमेवमिदं क्रिमिकोष्ठचिकित्सितं यथावदनुव्याख्यातं भवति ||२७||

ēvaṁ dvayānāṁ ślēṣmapurīṣasambhavānāṁ krimīṇāṁsamutthānasaṁsthānavarṇanāmaprabhāvacikitsitaviśēṣā vyākhyātāḥ sāmānyataḥ| viśēṣatastu svalpamātramāsthāpanānuvāsanānulōmaharaṇabhūyiṣṭhaṁ tēṣvēvauṣadhēṣu purīṣajānāṁkrimīṇāṁ cikitsitaṁ kartavyaṁ, mātrādhikaṁ punaḥ śirōvirēcanavamanōpaśamanabhūyiṣṭhaṁtēṣvēvauṣadhēṣu ślēṣmajānāṁ krimīṇāṁ cikitsitaṁ kāryam; ityēṣa krimighnō bhēṣajavidhiranuvyākhyātōbhavati| tamanutiṣṭhatā yathāsvaṁ hētuvarjanē prayatitavyam| yathōddēśamēvamidaṁ krimikōṣṭhacikitsitaṁ yathāvadanuvyākhyātaṁ bhavati||27||

evaM dvayAnAM shleShmapurIShasambhavAnAM krimINAM samutthAnasaMsthAnavarNanAmaprabhAvacikitsitavisheShA vyAkhyAtAH sAmAnyataH | visheShatastu svalpamAtramAsthApanAnuvAsanAnulomaharaNabhUyiShThaM teShvevauShadheShu purIShajAnAM krimINAM cikitsitaM kartavyaM, mAtrAdhikaM punaH shirovirecanavamanopashamanabhUyiShThaM teShvevauShadheShu shleShmajAnAM krimINAM cikitsitaM kAryam; ityeSha krimighno bheShajavidhiranuvyAkhyAto bhavati | tamanutiShThatA yathAsvaM hetuvarjane prayatitavyam | yathoddeshamevamidaM krimikoShThacikitsitaM yathAvadanuvyAkhyAtaM bhavati ||27||

Thus in respect of both types of parasites grown in mucus as well as in feces, causes, form, colour, names, effects and treatment have been described in common. Specifically, in case of parasites grown in feces, the same drugs should be used in lower dose and mostly by the route of non-unctuous and unctuous enema and purgatives. In case of those grown in mucus, the same should be administered in high doses mostly by the route of head-cleansing, emesis and pacification. Thus the procedure of anthelmintic management is described while observing that one should be particularly cautious in avoiding the respective etiological factors. Thus, as proposed, the therapeutic management of the patient suffering from parasites is described properly.[27]

Summary

भवन्तिचात्र- अपकर्षणमेवादौ क्रिमीणां भेषजं स्मृतम् | ततो विघातः प्रकृतेर्निदानस्य च वर्जनम् ||२८||

अयमेव विकाराणां सर्वेषामपिनिग्रहे | विधिर्दृष्टस्त्रिधा योऽयं क्रिमीनुद्दिश्य कीर्तितः ||२९||

संशोधनं संशमनं निदानस्य च वर्जनम् | एतावद्भिषजाकार्यं रोगे रोगे यथाविधि ||३०||

तत्रश्लोकौ- व्याधितौ पुरुषौ ज्ञाज्ञौ भिषजौ सप्रयोजनौ | विंशतिः क्रिमयस्तेषां हेत्वादिः सप्तकोगणः||३१||

उक्तो व्याधितरूपीये विमाने परमर्षिणा | शिष्यसम्बोधनार्थाय व्याधिप्रशमनाय च ||३२||

bhavanti cātra- apakarṣaṇamēvādau krimīṇāṁ bhēṣajaṁ smr̥tam| tatō vighātaḥ prakr̥tērnidānasya ca varjanam||28||

ayamēva [1] vikārāṇāṁ sarvēṣāmapi nigrahē| vidhirdr̥ṣṭastridhā yō'yaṁ krimīnuddiśya kīrtitaḥ||29||

saṁśōdhanaṁ saṁśamanaṁ nidānasya ca varjanam| ētāvadbhiṣajā kāryaṁ rōgē rōgē yathāvidhi||30||

tatra ślōkau- vyādhitau puruṣau jñājñau bhiṣajau saprayōjanau| viṁśatiḥ krimayastēṣāṁ hētvādiḥ saptakō gaṇaḥ||31||

uktō vyādhitarūpīyē vimānē paramarṣiṇā| śiṣyasambōdhanārthāya vyādhipraśamanāya ca||32||

bhavanti cAtra- apakarShaNamevAdau krimINAM bheShajaM smRutam | tato vighAtaH prakRuternidAnasya ca varjanam ||28||

ayameva vikArANAM sarveShAmapi nigrahe | vidhirdRuShTastridhA yo~ayaM krimInuddishya kIrtitaH ||29||

saMshodhanaM saMshamanaM nidAnasya ca varjanam | etAvadbhiShajA kAryaM roge roge yathAvidhi ||30||

tatra shlokau- vyAdhitau puruShau j~jAj~jau bhiShajau saprayojanau | viMshatiH krimayasteShAM hetvAdiH saptako gaNaH ||31||

ukto vyAdhitarUpIye vimAne paramarShiNA | shiShyasambodhanArthAya vyAdhiprashamanAya ca ||32||

Here are the verses -

The remedy of the parasites is firstly by their extraction, then destruction of their favourable environment and avoidance of etiological factors. The three fold management which is mentioned in respect of parasites is applicable for controlling all disorder as well. Evacuation, pacification and avoidance of etiological factors-these three treatment procedures should be applied properly in every disease as per the requirement of that particular disease.[28-30]

To sum up the chapter as said in two verses- Two types of the diseased persons, for the physicians learned and ignorant along with reasoning, twenty types of parasites along with their description in seven terms such as cause etc.-all this is said by the great sage in the chapter on specific features of the appearance of the diseased etc. for the knowledge of the disciples as well as alleviation of disorders. [31-32]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते विमानस्थाने व्याधितरूपीयविमानं नाम सप्तमोऽध्यायः ||७||

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē vimānasthānē vyādhitarūpīyavimānaṁ nāmasaptamō'dhyāyaḥ||7||

ityagniveshakRute tantre carakapratisaMskRute vimAnasthAne vyAdhitarUpIyavimAnaM nAma saptamo~adhyAyaH ||7||

Thus ends the seventh chapter on the Vyadhita Rupiya Vimana in Vimana Sthana in the treatise composed by Agnivesha and redacted by Charak.

Tattva Vimarsha (Fundamental Principles)

This chapter has two parts in which first eight stanzas are concerned with the efficiency of physician in diagnostic accuracy whereas second part deals with parasitology. Thus, tatva and vidhi vimarsha is being described separately for both portion.

Part A: Importance of correct diagnosis

1. The partial knowledge is not sufficient to have proper understanding of that subject. Thus, the knowledge of all aspects of the concept with all the possible tools is essential for complete understanding of that concept.
2. Understanding of physical and mental strength is essential for assessing the proper diagnosis and the severity of disease.

Part B : Krimi (parasitology)

1. Krimis are classified as external and internal variety mainly. They are further sub classified based upon etiology, habitat, morphology, color, nomenclature, pathogenesis and treatment.
2. The four categories based on their habitat are: purishaja (origin in fecal matter), shleshmaja (origin in shleshma including body fluids, mucosal layers), raktaja (origin in blood), malaja (origin in body impurities).
3. Management principles given for krimi are nidana parivarjana (removal of causative factor), apakarshana (removal of krimi) and prakritivighata (eradicating favorable environment for growth of krimi). This is collectively a complete management principle (Chikitsa Sutra) in Charak Samhita in all aspects, as all other principles are ekangika (pertaining only to one or two components of disease process).

Vidhi Vimarsha (Applied Inferences)

Part A : Importance of correct diagnosis

In the era of clinical diagnosis it was very important that the physician should not do only proper diagnosis but should also assess the severity of disease so he is able to provide proper treatment without causing any harm to the patient. Hence patients should have thorough physical examination and appropriate diagnostic tests.Vimana Sthana predominantly contains the diagnostic tools. The ten point examination method of drugs is also mentioned.

Part B: Krimi (parasitology)

Ayurveda describes two kinds of organisms, namely prakrita (non-pathogenic), and vaikrita (pathogenic). Also described are two categories of pathogens/parasites, namely, external and internal. The internal organisms are mainly of three categories in terms of their natural environments: those that thrive on mucus (shleshma), those thriving in fecal matter, and those thriving in blood. Some of these, particularly the ones thriving in fecal matter seem to be intestinal parasites while others simulate microbes. The texts repeatedly advocate protecting surgical wounds from these organisms. There is also a clear description of vector borne diseases and that diseases such as leprosy, tuberculosis, conjunctivitis and fever as contagious diseases spread by contact with other patients or vectors.

It is interesting to note that these ancient texts recognized the existence of “friendly” non-pathogenic organisms and their functions - something that is only now being considered the greatest discovery in microbiology. It is claimed by modern scientists that our living body is made up of 10 trillion somatic cells and is home to some 100 trillion friendly microbes. This “empire” of microbes is called Microbiome. Understanding the relationship between the microbiome and the human being, the animal and the environment - is as important as unravelling human genome. The microbiome is like a well-structured organ with unique functions and hence needs to be protected in the same way as we protect our other vital organs like liver, heart or kidney.

This recognition of the existence of these friendly prakrita (non-pathogenic organisms) by Ayurveda thousands of years ago is of great historical significance.

Management of krimi roga

Since Charak Samhita was written, there has been enormous advancement in the field of infectious diseases, especially in the last one hundred years. This advancement is mainly in the field of Apakarshana (removal of micro-organisms and parasites) but old principles of prevention are still current. This edition of Charak Samhita has brief mention of those and reader is referred to infectious disease books for detailed knowledge.

The management principles of krimi roga are unique and applicable for management of all diseases. The three components of treatment are:

1. Nidana Parivarjana (removal of cause)
2. Apakarshana (removal of krimi)
3. Prakritivighata (eradication of favorable condition preventing recurrence)
4. Enhancing yuktikrita bala or artificially-induced immunity.

Nidana Parivarjana (removal of cause)

The most important aspect of the management of any disease specifically krimi roga is the avoidance of aetiological factors by following good hygiene like clean water and food and avoid transmission from direct contact like clothing and physical contact etc. Infestation by parasites is common in people who eat food before the digestion of previous meals, excessive sweet and sour food prepared of flour, jaggery like cake/pastries etc. and sedentary lifestyle. Hence consumption of these items can be avoided for the proper treatment and prevention of re-infestation.

Apakarshana (removal of krimi)

Ayurvedic management of parasites is recommended for expulsion of worms/parasites from gut, skin and wounds. Most of the drugs mentioned for the management are for the intestinal worms. Some drugs have also been specified for parasites of skin like lice. A long list of drugs is available in various classical texts, however following few drugs has been used widely by Ayurvedic researchers. Most commonly used drugs are:

• Embelia ribes - Vidanga
• Butea monospermem- Palasha
• Carum roxburghii –Ajamoda
• Trachysspermum amami – Yavani
• Cyperus rotundus – Mustak
• Malluctus philippinensis –Kampillaka
• Azadirecta indica – Nimba
• Holorrhena antidysentrica – Indrayava
• Piper longum - Pippali
• Artemisia obsinthiuum – Keetmari Yavani
• Hyocyamus reticulatus - Paribhadra
• Ailantus excelsa - Aralu
• Kaempferia galanga -Seeds/bark of Shigru (Twak/Beeja)
• Costus speciosus – Kebuk
• Leucas aspera Spreng (Dronapushpi)

One day Panchakarma has been used for removal of krimi but because of availability of effective oral anti-parasitic agents, it is seldom used.

In comparison to modern medicine, the removal of parasites in Ayurveda seems to be inconvenient to the patient. The drugs are to be used in larger doses with limited efficacy. Modern medicine drugs, for removal of common parasites are effective with convenient dosage schedule. However, these drugs are potentially toxic and are to be used with careful watch of physician.

Prakritivighata (creation of unfavorable condition preventing recurrence)- Prakritvighata means to create the environment so that dosha cannot lodge themselves in the dhatu/krimi. This includes measures promoting agni and nourishing dhatu with rasayana therapy. The role of the rasayana is to create the healthy tissues so that vitiated dosha cannot lodge (sthana samshraya). As per the Ayurvedic concept, increased dosha circulates in the body and on finding a weak and suitable tissue they lodge there causing the initiation of disease process. Use of certain herbs like Shigru, Paribhadra, etc. may create an environment to prevent growth of parasitic ova/cyst.

Mass deworming is done by World Health Organization (WHO) in certain areas of the world where helminthiasis is common. Although deworming improves the health of an individual, outcomes from mass deworming campaigns, such as reduced deaths or increases in cognitive ability, nutritional benefits, physical growth, and performance, are uncertain or not apparent.

Enhancing yuktikrita bala or artificially-induced immunity

In case of recurrent worm infestations, emerging drug resistance to known anti-parasitic agents, together with the inability of these agents to prevent re-infection and relapse, further complicates the disease scenario. In such cases, nidana parivarjana and prakrityvighata becomes important to follow for prevention. Drug Resistance is a big problem in the field of infectious diseases.

The spread of such diseases can be prevented by observing personal hygiene and promoting vyadhiksamatva or immunity with the help of leading a healthy lifestyle, following good nutrition and through administration of rasayana therapy.

Ayurveda recognizes and describes a less-known concept of ojas (vital essence of the body) which gives biological strength (including immunity).Ojas is the final product of tissue nourishment and is the final product of all the seven dhatu namely rasa dhatu, rakta dhatu, mamsa dhatu, meda dhatu, asthi dhatu, majja dhatu, and shukra dhatu. Ojas is of two types called para ojas and apara ojas. Para ojas is subtle and present in very minute quantity in the heart while apara ojas is gross and amounts to handful in quantity, spread all over the body. Para ojas is vital to life and any damage or vitiation to it can result in sudden death. Apara ojas gives gross immune strength to the body and can be compared to immunity described by modern medical science. This immune strength is also called ojabala and is categorized to be of three kinds: sahaja bala or primary immunity, kalaja bala or acquired immunity through environmental factors and yuktikrita bala or artificially-induced immunity by rasayana, lifestyle and suitable diet. The classics prompt to utilize these three resources to enhance the bala/immunity in order to prevent all ailments especially chronic diseases and contagious diseases.

Three categories of bala-dosha or immune disorders are described in the Ayurvedic texts which are comparable to three categories of immune disorders described in modern medical system:

1. Oja-vyapat (immune-aberrations and allergies),
2. Oja-visransa(dislodged immunity and autoimmune disorders) and
3. Oja-kshaya (immunodeficiency).

There are specific methods and approaches to tackle the categories of immune disorders. It is evident from the description of ojabala and bala-dosha that immunology was highly advanced in samhita period of Ayurveda and the knowledge in this field was comparable to the current knowledge of immunology.

Microbiology in Ayurveda

Even though microscopy became available in 17th century, microbiology and parasitology was known and described in Ayurvedic classics in the context of immunity and body resistance. For an individual to possess immunity adequate ojas, bala and vyadhiksamatva is necessary. Role of microbes in causing disease became known to modern medicine in the last two centuries and since then discovery of antibiotics and vaccination there has been rapid advancements in the field of infectious diseases and saved millions of lives. However, indiscriminate use of antibiotics has caused change in body microbiome with resultant increase in various chronic and autoimmune diseases. Use of vaccination is also under cloud these days. Ayurvedic knowledge of yuktikrit bala or artificially-induced immunity by rasayana, lifestyle and suitable diet can be very useful in prevention and treatment of microbial diseases.

Research studies

• Seed oils of Gynandropsis gynandra, impatiens balsamina, Celastrus paniculata, Embelia ribes and Mucuna pruriens exhibited moderate to significant anhelminthic activity. Embelia ribes showed the best anthelminthic property in parameters of time of paralysis and death of the worm.(SS Jalalpure, KR Alagawadi, CS Mahajanashetti, MN Shah, Salahuddin, Vijay Singh, JK Patil; Dept of pharmacognocy and phytochemistry, KLESC Belgaum, 2007, vol-69-p158-160)
• Anthelminthic activity of fruits of Embelia ribes; Invitro study in comparision with the drugs Ivermectin and Levamisole done by GP Choudhary, School of pharmacy, Indore, MP, India.

Further reading

1. Charak Samhita, Shri Chakrapani virachita Ayurveda deepika vyakhya, Yadavaji Trikamji Acharya Sampadita, Choukhamba Surabharati Prakashana.
2. Charak Samhita, Shri Chakrapani virachita Ayurveda Deepika tatha Shri Gangadhara viracita Jalpakalpataru Teeka, Choukhamba publishers.
3. Charak Samhita, Edited with Vaidyamanorama Hindi commentary by Acharya Vidyadhara Shukla and Prof Ravidatta Tripathi, Choukhamba Sanskrit Pratishthana.
4. Charak Samhita, Edited with Caraka Chndrika Hindi commentary by Dr. Brahmanand Tripathi, Chaukhamba Surbharati Prakashan.
5. Charak Samhita, Edited with Hindi commentary, Vidyotini by Shri Kashinath Shastry and Gorakhnath Chaturvedi, Choukhamba Orientalia.
6. Charak Samhita, Bhashatrayanuvada, Edited and published by Shri Gulabakumvarava Ayurvedic Society, Jamnagar, India.
7. Charak Samhita, Edited with English commentary by Shri Priyavrita Sharma, Choukhamba Orientalia.
8. Ashtanga Hrdayam, Nidana Sathana, 14/44
9. Sushrutha Samhita Uttara Tantra, 54/15
10. Harita Samhita, Prathamasthaanam, 5/9-15
11. Bhava Prakasha, Krimirogaadhikara/3
12. Sharangadhara Samhita Krimigananaadhikara, Purvakhanda,7/14-18,
13. Yogaratnakara Snayuka Nidana and Chikitsa/2
14. Sushrutha Uttara 54/19
15. Charak Samhita,Vimana 7/11
16. Charak Samhita Vimana 7/11
17. Sushrutha Samhita, Uttara Tantra, 54/18
18. Chakrapani on Charak Samhita, Vimana 7/14-15
19. Chakrapani on Charak Samhita Vimana, 7/16
20. Shabda Stoma Mahanidhi, Sanskrit Dictionary by Shri Taranath Bhattacharya, Choukhamba Sanskrit Series, Varanasi.
21. Vachaspatyam, Sanskrit Dictionary, by Taranath Tarka Vachaspati, Choukhamba Sanskrit Series, Varanasi.
22. Sir Monier Williams Sanskrit English Dictionary, Cognate Indo European Languages, Motilal Banarasi Das.
23. Stedman’s Medical Dictionary by The Williams and Wilkins Company, Baltimore.

Video links

• Video by Prof.M.S.Baghel on Parasitology in Ayurveda available on ayushguru project link retrieved on May 30, 2019

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