Charak Samhita – Sutrasthana – Chapter 15 (Upakalpaniya Adhyaya)

Abstract

This chapter continues the topic of cleansing techniques (Samshodhana karmas) from the previous chapters by focusing on the requirements for building a fully-equipped healthcare facility that is appropriate for the administering of Panchakarma therapies. In this chapter, specific pre-procedure, major procedure, and postoperative instructions have been provided. The details of medication doses for therapeutic emesis (Vamana) and therapeutic purgation (Virechana) are thorough, along with assessments of insufficient, appropriate, and excessive purification. Dosha-related ailments, side effects, and a thorough explanation of the recommended diet (Samsarjana karma) prior to and following therapy have also been provided.

Introduction

The Kalpana Chatushka tetrad’s Upakalpaniya Adhyaya continues with the sections on pre-purification techniques (Oleation and Sudation). According to the chapter’s order, the vitiated doshas enter the gut (koshtha) after finishing the pre-purification steps and need to be ejected using the appropriate techniques, such as therapeutic purgation or therapeutic emesis. This chapter includes instructions for managing cleansing therapies and setting up an effective Panchakarma centre with all the necessary facilities and medical equipment. In order to ensure that patients receive rapid medical attention should issues emerge, rules for the construction of hospitals are supplied. Planning for the necessary tools and medications for Panchakarma as well as any associated medical treatment has received particular attention. Therapies, if delivered correctly, can treat diseases and decrease their tendency to recur, however if not administered correctly, they can lead to complications, necessitating a thorough comprehension of the Panchakarma recommendations (or protocols).

Recommendations For Physicians To Follow Before Starting Treatment

A physician who wants to deliver various purifying therapies, particularly to a king, member of the royal family, and a wealthy individual, should prepare all essential medications and tools as well in advance of the treatments and be knowledgeable about the proper administration of counteractive medications in the event of obstacles or complications. Because it is difficult and time-consuming to arrange for the import or sale of pharmaceuticals in an emergency or if issues arise.

Doubt By Agnivesha About The Success Rate Of The Treatment

Agnivesha reacted in Lord Atreya’s words, “O Lord! A skilled doctor should design a course of treatment such that it will unquestionably and always be effective. All treatments must be administered correctly to be effective, and poor administration might lead to consequences. But occasionally, a treatment’s failure or success defies the laws of correct or wrong administration, making ignorance and knowledge equal.

Answer From Atreya

Lord Atreya answered- Agnivesha! It is possible for me or person like me to counteract in such a way that the treatment succeeds invariably and also to impart instruction in proper methods of administration, but there is none to come forward for receiving these instructions or thereafter deciding a course of action or administering the remedy, because the variations in condition of morbidity, place, strength, drug, time, mind, body, suitability, age, diet, and constitution are quite subtle which, while being considered, confuse the mind of even great scholars what to say of those having low intelligence. Hence, we shall discuss both well- proper administration of therapy and in case of failure, management of complications later on in siddhi sthana.

Purification Therapy Equipment And Setups

In the interim, we’ll briefly go through a number of prerequisites to deliver purification therapies. An architect should first look for a large, well-constructed building that has good ventilation, plenty of room for movement, is not too close to other large structures, and is devoid of hazardous smoke, extreme light, dust, wetness, annoying noise, sights, textures, tastes, and odours. It should include the bare necessities, such as a water reservoir, lavatories, bathrooms, and a kitchen containing a pestle and mortar.

Arrangements And Accessories For Hospital Employees

The following accessories ought to be kept available after constructing the hospital building:

1. Attending Staff:- Workers with good morals, character, cleanliness, dexterity, commitment, compassion, nursing expertise, and expertise in delivering therapies ought to be selected. They should have the necessary skills to handle (bedridden) patients, give baths, massages, prepare rice, make soups, and formulate (grind, etc.) medicines. All tasks should be willingly accepted by the personnel.
2. Other Staff:- There should also be experts in vocal music, speech, instrumental music stories, verses, history, ancient lores, narratives and also companions who know the desires, are favourites and are acquainted with place and time.
3. Animals in the Hospital Campus:- The presence of the following animals is required on the hospital campus: common quail (Lava), grey partridge (Kapinjala), rabbit (Shasha), black buck (Harina), antelope (Ena), black-tailed deer (Kalapucchaka), red/hog deer (Mrigamaika), and wild sheep (Urabhra). A good, healthy cow that is still nursing her calf should be present, along with enough fresh grass for food, shelter, and water.
4. Vessels and Pots:- Arrangements should also be made for dish, water reservoir, waterpot, small and big earthen jars, and pitcher, boiling pan, big and small pictures, ladle, saucer, bucket, mat, churning stick, cooking utensils, cloth, leather, wool, thread, cotton, etc.
5. Sitting and Bedding Arrangements:- Beds and chairs should be provided with a flower vase and spitoon, bed well equipped with carpet, pillow and bed sheets along with supporting pillows, and should be comfortable for attending to lying down, unction, sitting, fomentation, pasting, massage, after paste, showering, emesis, non unctuous and unctuous enema, purgation, urination, defecation, and head evacuation.
6. Equipment For Purification:- There should be stone slabs for grinding-smooth, coarse and medium-along with well washed pestles, sharp equipment like scissors, spade, etc., smoking pipe, pipe for douches and enema, weighing scales, broom and measuring vessels.
7. Medicine and Food for Patients:- Articles like oil, honey, marrow, ghee, fat, phanita (A type of jaggery), fuel, wines, salt, water, vinegar of various types, curd, buttermilk, curdwater, and urines, grains like a variety of Oryza sativa Linn (Shashtika rice), Oryza sativa Linn. (Shali rice), black gram- Phaseolus radiatus Linn. (Masha), green gram- phaseolus mungo Linn. (Mudga), sesamum indicum Linn. (Tila), Hordeum vulgare Linn. (Yava), Dolichos biflorus Linn. (Kulattha), vitis vinifera Linn. (Mridvika), Grewia asiatica Linn. (Parushaka), zizyphus jujube Lam. (Badara), Gmelina arborea Linn. (Kashmarya), Terminalia chebula Linn. (Abhaya), Terminalia bellerica (Bibhitaki), Emblica officinalis (Amalaki). Various accessories for unction, fomentation, and drugs for astringent, emetic, appetiser, purgative, digestive, emetic-purgative, etc. In addition to the listed above, whatever equipment is necessary for counteracting the complications and promoting pleasure should be arranged.

Patient Preparation Prior To Therapeutic Emesis

Then the patient should be administered with unction and fomentation as said earlier. During this period if he is attacked suddenly with some severe mental or physical disorder, he should be reverted back cautiously and meanwhile the same treatment should continue. After he is treated with unction and fomentation and is cheerful and having observed that-he is seated comfortably, his food is well digested, he has taken bath by head, anointed his body, put on a garland and undamaged cloth has worshipped the deity, brahmana, fire, elderly persons, preceptor, and the physician, the physician should, in auspicious time (Naksatra, karana and muhurta), should request brahmanas to recite mantras and bestow their recital blessings on the drug- a dose of the decoction of madanaphala (Randia dumetorum) added with honey, madhuka (Glycyrrhiza glabra), rock salt and phanita- which should then be administered to the patient.

Procedure For Therapeutic Emesis

Dosage Of Emetics

The measure of the dose of the madanaphala decoction and also of all the evacuative drugs is to be determined according to the person concerned. The quantity which on administration to a person eliminates the abnormal dosha but does not produce conditions of under use or overuse should be taken as the measure of dose for that person.

Monitoring The Patient After Administering The Dose

The patient needs to be watched closely for some time after taking the medication. Sweating suggests that your dosha has liquified when it appears to be sweating. Similarly, horripilation will show that the dosha has changed from its upwards inclination. The patient is now placed on the cot that is comfortable, knee-height, and fully furnished with a carpet, pillow and bed sheet, in order to provide additional support. Spittoons ought to be stored there as well. His close companions and kind favourites, whose existence is not embarrassing, can provide their assistance by holding his sides and head, massaging the back and navel.

Advice Given To The Patient Throughout The Procedure

Now, the doctor should advise the patient to keep their throat, lips, and palates open while exerting moderately to cause unexplained urges to vomit. At the same time, they should bend their head and upper bodies slightly and touch their throats with their two cut-nail fingers, or water lily stalks, or saugandhika (A type of lotus). He ought to act appropriately. The doctor should then keep a close eye on the vomit bouts that have been gathered inside the spittoon. The only person who is highly skilled in this understands what constitutes proper, excessive and insufficient administration through observing. He can decide what has to be done based on symptoms after analyzing the characteristics of bouts. Therefore, one should pay close attention to the bouts.

The Sign And Symptoms Of Adequate And Inadequate Emesis Procedure

The following are indications that a medicine has been administered insufficiently, correctly, or excessively:-

Symptoms of inadequate administration of drugs are few or lack of bout, complete drug vomiting only and obstructed bouts.

Symptoms of properly administered drugs are the doshas will be eliminated in the proper order, the vomiting will end on its own, and it will occur at the right moment with little discomfort.

According to the amount of eliminated doshas, this has been classified into three categories: intense, moderate, and mild.

These are the indications of excessive administration including the presence of foam, brightness or blood in the vomit when the medicine is taken in an excessive dose.
The complications brought on by inadequate and excessive administration are- flatulence, secretion, cutting pain, bodyache, palpitation, viscera displacement, pure blood discharge, exhaustion and stiffness.

Post-Procedure Guidelines

On adequate administration of medicines, after a patient has thoroughly vomited, he ought to clean his feet, face and hands properly and after being comforted for some time, he should choose among the three varieties of smoking (Evacuative, unctuous and pacifying) depending on his physical condition. After that, he should ablution.

After this, the patient ought to be taken into a wind free room and be asked to lie down. The following things should be avoided by him such as loud speaking, long time standing, sitting or walking, grief, the sun, dew, anger, snow, storm, sexual intercourse, travelling on vehicles, day sleep, stay awake at night, antagonistic, unwholesome, during indigestion, untimely, heavy or irregular diet, less in nutritive and quantity value, suppression of natural urges- these things should be avoided by the patient.

Sansarjana Karma (Rehabilitation Diet) After Purification

After therapeutic emesis (Vamana), rehabilitation diet (Sansarjana karma) should start on the same evening or the following day. Warm water should be used for the patient’s bath.

First, Second And Third Meal

He should have lukewarm gruel (manda) as his first meal, which should be made using an older, Oryza sativa Linn. (Red variety of shali rice), properly cooked with fourteen times as much water as rice. Given the patient’s impaired digestive capacity, the gruel ought to be extremely watery and thin. The second and third meals should be followed by doing it again.

Fourth, Fifth And Sixth Meal

The fourth meal should consist of a gruel (vilepi), which should be made with red shali rice and with four times water that has been properly cooked and warmed, and with a little or without unction content or salt, or with a modest amount of both. After eating gruel, drink some warm water. For the fifth and sixth meals, the same kind of diet is to be maintained.

Seventh, Eighth And Ninth Meal

At the seventh meal time, red shali rice of two prasarita (About 160 grams) should be used to prepare well-cooked rice (Odana), which should be served with a thin soup of green gram (Mudga) which should also contain salt and a tiny amount of unctuous substance. Warm water should be taken after food. This is to be repeated for eighth and ninth meal times.

Tenth, Eleventh And Twelfth Meal

In the tenth meal time, cooked rice, along with light and dilute meat soup of birds like grey partridge, common quail, etc., added with salt should be taken and warm water should be taken after meals. This is followed in eleventh and twelfth meal times. After this, the patient assimilating nutrition from the diet gradually, should revert to normal diet in seven nights.

Procedure Of Therapeutic Purgation (Virechana)

For administration of purgative the patient should again be prepared by subjecting him to unction and fomentation. Thereafter, when he is cheerful, seated comfortably, has food well digested, has done oblation, offering, auspicious and expiatory rites, after recitation of mantras by brahmanas, on a day having auspicious date, nakshatra, karana and muhurta, he should be asked to take the paste of trivrit (Operculina turpethum) in the dose of karsha (10 gm) suspended in a proper vehicle. The drug should be administered keeping in view the conditions of disorder, place, drug, time, body, strength, diet, mind, wholesomeness, age and constitution and also the disorders. When the patient is purgatory well, he should follow the regimen except smoking as said in the context of emesis till he regains complexion, strength and normalcy. When he is endowed with complexion and strength, is cheerful, comfortable and with his food well digested, he should take bath by head, anoint his body, wear garlands, wear undamaged dress and wear suitable ornaments. Then he should meet his friends and be allowed to do his normal duties.

The methods of cleansing or purification described above are recommended for kings, royalty, or those with enormous riches.

Poor people are able to be administered medication for any condition that requires purifying therapy without being forced to acquire all the expensive equipment. Because the average person cannot afford to prepare for all the suggested resources and because they may also experience the severity of the sickness, patients should have access to emergency supplies such medications, clothing, and food items.

Purification Treatment Advantages

A correctly administered cleansing therapy has several advantages, including the removal of vitiated dosha, the easing of disease, enhancement of strength, longevity and complexion.

Conclusion

The management of purgation and emesis for the kings and the wealthy persons, equipments required, the dosage, symptoms of adequate, inadequate and excessive administrative doses, the complications, the things prohibited for the evacuated and the dietetic order-all this has been said by Punarvasu in the chapter on arrangements for equipments etc.