The 3rd chapter of KalpaSiddhiSthanam of Ashtanga Hridayam is named as Vamana Virecana Vyāpat Siddhi. This chapter deals with the explanation of ‘Management of complications of emesis and purgation therapies.’

The topics covered in this chapter include –

• Vamana Ayoga – Inadequacy of emesis therapy
• Virecana Ayoga – Inadequacy of purgation therapy
• Mithya Yoga – Improper therapy
• Pippalyadi Curna
• Vamana Atiyoga – Excessive emesis therapy
• Virecana Atiyoga – Excessive of purgation therapy

Pledge by the author(s)

अथातो विरेचनकल्पं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘management of complications of emesis and purgation therapies. Thus say (pledge) Atreya and other sages.

Vamana Ayoga: Inadequacy of emesis therapy

वमनं मृदुकोष्ठेन क्षुद्वताऽल्पकफेन वा ।
अतितीक्ष्णहिमस्तोकमजीर्णे दुर्बलेन वा ॥ १ ॥
पीतं प्रयात्यधस्तस्मिन्निष्टहानिर्मलोदयः ।
वामयेत्तं पुनः स्निग्धं स्मरन् पूर्वमतिक्रमम् ॥ २ ॥
Emetic herb administered to those who have soft bowels, who are hungry, who have slight increase of Kapha, if the recipe is very strong, very cold, or very little in quantity, consumed by persons who have indigestion and who are debilitated, comes out by the downward route (through the rectum). By that, there is loss of purpose (emetic medicine not bringing in fruitful results i.e. not causing vomiting), and there is increase of the mala (Dosha). Such a patient should be made to vomit again (by administering the emetic recipe) after making him lubricated (by oleation therapy) and remembering the mistake committed earlier.

Virechana Ayoga: Inadequacy of purgation therapy

अजीर्णिनः श्लेष्मवतो व्रजत्यूर्ध्वं विरेचनम् ।
अतितीक्ष्णोष्णलवणमहृद्यमतिभूरि वा ॥ ३ ॥
तत्र पूर्वोदिता व्यापत्सिद्धिश्च न तथापि चेत् ।
आशये तिष्ठति ततस्तृतीयं नावचारयेत् ॥ ४ ॥
अन्यत्र सात्म्याद्धृद्याद्वा भेषजान्निरपायतः ।
Purgative recipe administered to those who have indigestion and accumulation of Kapha if the recipe if very strong, very hot (in potency), salty, unpleasant or large in quantity comes out through the upper route, (through the mouth), by that the same hazards described earlier (loss of purpose and increase of Dosha) occur. The treatment for that is also the same described earlier (administration of a second dose of medicine after giving oleation therapy). f even by this the purgative medicine does not remain inside the abdomen (alimentary tract), then a third dose should not be administered except when the herb is habituated, pleasant and harmless.

अस्निग्धस्विन्नदेहस्य पुराणं रूक्षमौषधम् ॥ ५ ॥
दोषान् उत्क्लेश्य निर्हर्तुमशक्तं जनयेद्गदान् ।
विभ्रंशं श्वयथुं हिध्मां तमसो दर्शनं तृषम् ॥ ६ ॥
पिण्डिकोद्वेष्टनं कण्डूमूर्वोः सादं विवर्णताम् ।
स्निग्धस्विन्नस्य वाऽत्यल्पं दीप्ताग्नेर्जीर्णमौषधम् ॥ ७ ॥
शीतैर्वा स्तब्धमामे वा समुत्क्लेश्याहरन् मलान् ।
तानेव जनयेद्रोगान् अयोगः सर्व एव सः ॥ ८ ॥
Purgative recipe administered to the person who has not been given oleation and sudation therapies, the medicine which is old and dry (non- unctuous) leads to excitation / increase of the Doshas, and being unable to expel them out of the body gives rise to diseases such as Vibhramsa (absence of desire in anything), swelling, hiccup, seeing darkness (fainting), thirst, twisting pain in the calves, contraction itching, weakness of the thighs and discoloration. Very little quantity of purgative recipe administered to the person who has been given oleation and sudation therapies, when the medicine gets digested by strong digestive fire, when it becomes inactive by cold (use of cold water for drinking and ablutions, eating cold foods etc.) or ama the malas (dosas) get exacerbated by the foods. All these are Ayoga (inadequacy of purgative therapy) and they themselves cause diseases.

Remedy for Virechana Ayoga: Inadequacy of purgation therapy

तं तैललवणाभ्यक्तं स्विन्नं प्रस्तरसङ्करैः ।
निरूढः जाङ्गलरसैर्भोजयित्वाऽनुवासयेत् ॥ ९ ॥
फलमागधिकादारुसिद्धतैलेन मात्रया ।
स्निग्धं वातहरैः स्नेहैः पुनस्तीक्ष्णेन शोधयेत् ॥ १० ॥
Such a patient should be anointed with oil mixed with salt, made to perspire by Prastara and Samkara methods (two kinds of sudation therapies), then administered a Niruha (decoction enema). He should then be given food along with juice of meat of animals of desert- like regions, followed by an anuvasana (oil enema), using the oil prepared with phala – Randia dumetorum, māgadhikā – Piper longum dāru mātrayā – and Berberis aristata. After this, he should be given oleation therapy, using fats which mitigate Vata and then purified (administered purgative therapy) with strong herbs.

Mithya Yoga: Improper therapy

बहुदोषस्य रूक्षस्य मन्दाग्नेरल्पमौषधम् ।
सोदावर्तस्य चोत्क्लेश्य दोषान् मार्गान्निरुध्य तैः ॥ ११ ॥
भृशमाध्मापयेन्नाभिं पृष्ठपार्श्वशिरोरुजम् ।
श्वासं विण्मूत्रवातानां सङ्गं कुर्याच्च दारुणम् ॥ १२ ॥ अभ्यङ्गस्वेदवर्त्यादि सनिरूहानुवासनम् ।
उदावर्तहरम्सर्वं कर्माध्मातस्य शस्यते ॥ १३ ॥
पञ्चमूलयवक्षारवचाभूतिकसैन्धवैः ।
यवागूः सुकृता शूलविबन्धानाहनाशनी ॥ १४ ॥
Small quantity of the (purgative) recipe administered to person having profound increase of Doshas, to those who are dry, who have weak digestive activity, and who have Udavarta (upward movement of Vata), increases the Doshas and blocks the passages by the same doshas (getting hindered in their movement of the increased Doshas) produce profound distension of the (area around) umbilicus, pain in the back, flanks and head, dyspnoea and it will develop severe obstruction of the feces, urine and flatus. For such conditions, oil massage, sudation, rectal wick (suppository), decoction enema oil enema and all other therapies which relive Udavarta (bloating) are beneficial; for the person having distension of the abdomen, Yavagu (thin gruel) prepared with Pancamula (group of five roots), alkali prepared of Hordeum vulgare, vacā – Acorus calamus, bhūtika – Trachysperum ammi, saindhavaiḥ – and rock salt and well processed (with addition of and fats) cures colic, obstruction of feces etc., and distension of the abdomen will be destroyed (cured).

Pippalyadi Churna

पिप्पलीदाडिमक्षारहिङ्गुशुण्ठ्यम्लवेतसान् ।
ससैन्धवान् पिबेन्मद्यैः सर्पिषोष्णोदकेन वा ॥ १५ ॥
प्रवाहिकापरिस्राववेदनापरिकर्तने ।
pippalī – (Powder of) Piper longum, dāḍima – Punica granatum, kṣāra – alkali of Hordeum vulgare, hiṅgu – Ferula foetida, śuṇṭhi – Zingiber officinale, amlavetasān – Garcinia pedunculata sa saindhavān – and rock salt should be consumed along with either Madya (wine), ghee or warm water for the cure of dysentery, slimy discharge from the rectum and cutting pain in the rectum.

Remedy for unconsciousness episode during Vamana / Virechana

पीतौषधस्य वेगानां निग्रहान्मारुतादयः ॥ १६ ॥
कुपिता हृदयं गत्वा घोरं कुर्वन्ति हृद्ग्रहम् ।
हिध्मापार्श्वरुजाकासदैन्यलालाक्षिविभ्रमैः ॥ १७ ॥
जिह्वां खादति निःसञ्ज्ञो दन्तान् कटकटाययन् ।
न गच्छेद्विभ्रमं तत्र वामयेदाशु तं भिषक् ॥ १८ ॥
मधुरैः पित्तमूर्छार्तं कटुभिः कफमूर्छितम् ।
पाचनीयैस्ततश्चास्य दोषशेषं विपाचयेत् ॥ १९ ॥
कायाग्निं च बलं चास्य क्रमेणाभिप्रवर्धयेत् ।
By suppressing the urges (of purgation) arising after the consumption of the medicines, Vata and others (Doshas) get aggravated / Increased and produce severe catching pain in the heart after getting settled in the heart, accompanied with hiccup, pain in the flanks, cough, helplessness, excess salivation and rolling of the eye balls; the patient chews his tongue, loses consciousness and grinds his teeth. At such a state the physician should not become agitated but should make the patient vomit immediately by administering emetic herbs of sweet taste, if the patient is unconscious by Pitta, with those of pungent taste, if he is unconscious by Kapha, next by herbs which promote digestion the residual Doshas should be got cooked (mitigated). His digestive activity and strength of the body should be improved. His digestive activity and strength of the body should be improved gradually.

Vamana Atiyoga: Excessive emesis therapy

पवनेनातिवमतो हृदयं यस्य पीड्यते ॥ २० ॥
तस्मै स्निग्धाम्ललवणान् दद्यात्पित्तकफेऽन्यथा ।
By excess of vomiting, there arises pain in the heart due to (increase of) Vata For such a patient medicines which possess unctuousness, sour and salt taste should be administered. In case of (increase of) Pitta and Kapha, the herbs of opposite qualities (dry, sweet and cold) should be given.

Vamana Atiyoga: Excessive emesis therapy and line of management

पीतौषधस्य वेगानां निग्रहेण कफेन वा ॥ २१ ॥
रुद्धोऽति वा विशुद्धस्य गृह्णात्यङ्गानि मारुतः ।
स्तम्भवेपथुनिस्तोदसादोद्वेष्टार्तिभेदनैः ॥ २२ ॥
तत्र वातहरं सर्वं स्नेहस्वेदादि शस्यते ।
After consuming the medicine, if the urges (of vomiting) are suppressed or their channels are obstructed by Kapha or by excess of purification (by more of vomiting) Vata (getting increased) seizes the body producing rigidity, tremors, continuous pricking pain, debility, twisting pain and cutting pain. In such a condition oleation, sudation and all other remedial measures which mitigate Vata are recommended.

Vamana Atiyoga: Excessive emesis therapy, treatment

बहुतीक्ष्णं क्षुधार्तस्य मृदुकोष्ठस्य भेषजम् ॥ २३ ॥ योज्योऽतिवमने रेको विरेके वमनं मृदु ।
परिषेकावगाहाद्यैः सुशीतैः स्तम्भयेच्च तम् ॥ २५ ॥ अञ्जनं चन्दनोशीरमजासृक्शर्करोदकम् ।
लाजचूर्णैः पिबेन्मन्थमतियोगहरं परम् ॥ २६ ॥
Very powerful medicine administered to the patient who is suffering from hunger or who is having soft bowels, in case of excess vomiting, mild purgation should be administered. In case of excess purgation mild emesis, excess bouts should be controlled by Pariseka (pouring cold water on the body) by immersing the body in medicated liquids, applying cold packs, fanning and other methods of cooling the body groats/sweet paste prepared from añjanaṃ – Berberis aristata, candana – Santalum album, uśīraṃ – Vetiveria zizanioides, ajāsṛk – goats blood śarkara udakam – and sugar water, lājacūrṇaiḥ – powder of parched grains which is best to control excess bouts should be consumed.

Vamana Atiyoga: Excessive emesis therapy

वमनस्यातियोगे तु शीताम्बुपरिषेचितः ।
पिबेत्फलरसैर्मन्थं सघृतक्षौद्रशर्करम् ॥ २७ ॥
सोद्गारायां भृशं छर्द्यां मूर्वाया धान्यमुस्तयोः ।
समधूकाञ्जनं चूर्णं लेहयेन्मधुसंयुतम् ॥ २८ ॥
In case of excess bouts of vomiting, cold water should be poured over the body and Mantha (groats) prepared with juice of fruits mixed with ghee, honey and sugar should be consumed. When there is severe eructation (belching) associated with excess of vomiting, powder of mūrvāyā – Marsdenia tenacissima, dhānya – Coriandrum sativum, mustayoḥ – Cyperus rotundus, sa madhūka – Madhuca longifolia añjanaṃ – and Berberis aristata mixed with honey should be licked.

वमतोऽन्तः प्रविष्टायां जिह्वायां कवलग्रहाः ।
स्निग्धाम्ललवणा हृद्या यूषमांसरसा हिताः ॥ २९ ॥ फलान्यम्लानि खादेयुस्तस्य चान्येऽग्रतो नराः ।
निःसृतां तु तिलद्राक्षाकल्कलिप्तां प्रवेशयेत् ॥ ३० ॥
If the tongue has gone deep inside due to excess vomiting, mouth gargling with soups and meat juices added with fats, sours and salts and pleasant to the mind are beneficial. Another person should sit in front of the patient and eat sour fruits. When the tongue comes out, it should be smeared with the paste of Sesamum indicum and Vitis vinifera and then pushed in.

वाग्ग्रहानिलरोगेषु घृतमांसोपसाधिताम् ।
यवागूं तनुकां दद्यात्स्नेहस्वेदौ च कालवित् ॥ ३१ ॥
In case of obstruction to speech and such other disorders of Vata, thin gruel processed with ghee and meat should be given, oleation and sudation therapies suitable to the time (season) administration.

अतियोगाच्च भैषज्यं जीवं हरति शोणितम् ।
तज्जीवादानमित्युक्तमादत्ते जीवितं यतः ॥ ३२ ॥
शुने काकाय वा दद्यात्तेनान्नमसृजा सह ।
भुक्तेऽभुक्ते वदेज्जीवं पित्तं वा भेषजेरितम् ॥ ३३ ॥ शुक्लं वा भावितं वस्त्रमावानं कोष्णवारिणा ।
प्रक्षालितं विवर्णं स्यात्पित्ते शुद्धं तु शोणिते ॥ ३४ ॥
That medicine which by excess bouts (of vomiting) takes away the Jiva Sonita (life supporting blood) is known as Jivadana, since it takes away the life. The food mixed with the blood (coming out by excess bouts) should be given to either a dog or a crow, if the animal eats, it is considered as jiva i.e. pure blood and if the animal rejects it, it is considered as pitta / raktapitta i.e. blood contaminated by pitta which are caused by medicine. If a white cloth soaked and made wet with blood, when washed with warm water if it becomes discoloured then it is Pitta if it remains clean white, then it is pure blood.

Remedy for Virecana Atiyoga: Excessive of purgation therapy

तृष्णामूर्छामदार्तस्य कुर्यादामरणात्क्रियाम् ।
रक्तपित्तातिसारघ्नीं तस्याशु प्राणरक्षणीम् ॥ ३५ ॥
मृगगोमहिषाजानां सद्यस्कं जीवतामसृक् ।
पिबेज्जीवाभिसन्धानं जीवं तद्ध्याशु गच्छति ॥ ३६ ॥
The patient having thirst, fainting (unconsciousness) and toxicity (intoxication) should be administered therapies that are used to treat bleeding disorders and atisara (diarrhoea) till the last moment of death. He should be made to drink fresh blood of the animals like deer, cow, buffalo or goat, which protects the life quickly and replenishes the blood lost and the same also quickly replenishes (restores) the life.

तदेव दर्भमृदितं रक्तं वस्तौ निषेचयेत् ।
श्यामाकाश्मर्यमधुकदूर्वोशीरैः शृतं पयः ॥ ३७ ॥
घृतमण्डाञ्जनयुतं वस्तिं वा योजयेद्धिमम् ।
पिच्छावस्तिं सुशीतं वा घृतमण्डानुवासनम् ॥ ३८ ॥
The same blood churned along with Desmostachya bipinnata should be administered as an enema, milk boiled with śyāmā – Ipomoea petaloides, kāśmarya – Gmelina arborea, madhuka – Glycyrrhiza glabra, dūrvā – Cynodon dactylon uśīraiḥ – and Vetiveria zizanioides as an enema, milk boiled with scum of ghee and Berberis aristate should be administered as enema in cold state or a Piccha basti (lubricating retention enema) should be administered or cold scum of ghee as lubricating enema.

गुदं भ्रष्टं कषायैश्च स्तम्भयित्वा प्रवेशयेत् ।
विसञ्ज्ञं श्रावयेत्सामवेणुगीतादिनिस्वनम् ॥ ३९ ॥
The protruded rectum (prolapsed of the rectum) should be made static / hard by application of paste of astringent herbs and then pushed in the unconscious patient should be made to listen to the melodious notes of Samaveda hymns, the flute and other songs.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां पञ्चमे कल्पसिद्धिस्थाने वमनविरेचनव्याप्त्सिद्धिर्नाम तृतीयोऽध्याय: ॥ ३ ॥
Thus, ends the chapter Vamana-Virecana Vyapat Siddhi the third in Kalpa- Siddhi Sthana of Astangahrdaya Sambhita composed by Srimad Vagbhata, son of sri Vaidyapati Simhagupta.