Varma Kalai - Treatment

Last Updated by Guruji Murugan Chillayah on 13 February 2019 (Wed) 01:00 AM (GMT+8)

Important : QUALIFIED VARMA GURU (INSTRUCTOR) GUIDANCE REQUIRED PRIOR TO PRACTICE THIS ARTS. Below information and essential knowledge were shared for everyone, therefore copy / ammend of any information strictly not allowed.

English pronunciation : not_available / Sanskrit संस्कृतम् : not_available / Tamil தமிழ் : வைத்திய முறை
Bahasa Melayu : not_available / Malayalam : not_available / Telugu : not_available / Français : Traitement


Studies in varma kalai ( Tamil தமிழ் : வர்மக்கலை , Telugu : మర్మయుద్దకళ ) about each varmam's ( pressure points ) characteristics like location of the varmam, depth and width of varmam, the pressure with which the varmam has to be tuned to cure diseases constitutes the mainstream study in varma therapy.

IMAGE BELOW: basic knowledge of pressure points to stop blood flow at wound. Proper pressure required at different points, as some required mild pressure and some may required harder pressure, to stop wound.

Pressure Points to Prevent Wound

  • by using chakra energy
  • at nerve system ( narambu ) / nadi ( meridian )
  • at bones / ligaments
  • at muscles
  • at internal organs
  • Animal / Birds essence based treatment
  • Air based treatment
  • Herbal based treatment
  • Physiotheraphy based treatment
  • Celestial Planets / Energy based treatment
  • Tantric based treatment

Varmam related injuries developed due to the following reasons :

  • Lifting heavy loads
  • Excessive pleasure
  • Excessive sorrow
  • Excessive sleep
  • Accidents
  • Engaging in fights
  • Giving birth to a child
  • Etc.

The various techniques that can be applied to cure varmam related injuries are :

  • Marukaalam - are used for instant relief
  • Thirumal Murai **(should be done at least for 3 consecutive days to give relief from varmam related injuries)
  • Adangal Murai
  • Thiravukozh ( method to open varmam ) Murai - are used for instant relief
  • Thadaval Murai ( Applying massage techniques ) **(should be done at least for 3 consecutive days to give relief from varmam related injuries)
  • Marunthu Murai ( Applying medicines )
  • Vayu Nilai Amarthal
  • Kattu Murai

Reviving of a Fainted Individual

If an individual has fainted due to varmam attack, he or she first should be diagnosed by a Varmaani ( Varmam Doctor / Varmam Master / Varmam Asan ).


1) Varmaani should start the diagnostics by observing the color of cornea and the color of the teeth of the patient.
2) Then varmaani checks the flow in Vata, Pita, and Kapha nadis.
3) If he is satisfied with the flows in these nadis, varmaani should proceed to the next step in the treatment.
4) Now, varmaani should apply the Kavzhi Adangal ( Adangal - technique in which pressure points are tuned in specific pattern ) to regulate blood flow, temperature and pranic flow in the patient's body.
5) Then varmaani should apply Puzhimuthu Adangal to stimulate the Kalai Nerves ( major nerves through which pranic energy flow in the body ).
6) At this point, varmaani can notice the patient starting to regain the consciousness and tiredness being reduced.
7) Then on applying Nasiyam in patient's nose or using blowing techniques in patient's nose or ears, the patient will completely regain consciousness.
8) Then Thiravukozh ( method to open varmam ) should be applied to release the affected varmams.

Once the patient has attainted stable condition, varmaani should either enquire the patient about the accident to know the area in which patient was hit or should analyze the flow of nadis to locate the affected region. Then, varmaani should apply the proper Thadavazh Murai ( massaging techniques ).

Based on the area in the body that was affected, the varmaani should know the diseases that might arise in the future. According both internal medication and external medication should be prescribed. Such treatment should consider the varmams located in nerves, muscles and bones.

Dealing with Fractures

Varmaani should have knowledge about bone structure and joints. When a patient with bone fracture approaches him, first he should stop the wastage of blood by blocking the required nerves. He should then use the necessary pads to fix veins and arteries and should put a proper dressing using cloths. The technique in which the dressing is done varies depending up on the location on the fracture. To heal the fracture, the dressing should allow path for proper air circulation and also should have provision to administer herbal oils to cure the wounds. The dressing should be removed and redone for 7 times and each time the dressing should be done based on the current condition of the bones. In addition, internal medicines should also be prescribed to the patient.

VARMA KAAYANILAI ( for Disorders )
Various disorders that can be cured with the help of varma therapy are :

  • Varmam treatment ( வர்ம இளக்குமுறை - Varma illakkumurai )
  • Nerves weakness
  • Body shivering / Nervous disorder
  • Paralysis ( Loss of the ability to move a body part )
  • Hemiplegia ( பக்கவாதம் - Pakka vatham )
  • Heart diseases ( இருதய நோய்கள் - Iruthaya noikal )
  • Dehydration
  • Disk prolapse
  • Gastro intestinal diseases ( வயிறு மற்றும் குடல் சம்பந்த நோய்கள் - Vayuru mattrum kudal sambantha noikal )
  • Head ache
  • Sciatic Problems
    • Sciatica ( பேராசன நரம்பு தாபிதம் - Perasana naramubu thabitham )
  • Eye problems
  • ENT ( Ear, Nose, and Throat ) problems
  • Bone joints and arthritics
    • Osteo arthritis ( மூட்டு வலி - Moottu vali )
    • Fractures ( எலும்பு முறிவு - Ellumbu murivu )
    • Bone dislocation ( மூட்டு விலகல் - Moottu vilagal )
    • Ligament injury ( தசைநார் காயம் - Thasai nar kayam )
  • Spinal diseases ( தண்டுவட நோய்கள் - Thanduvada noikal )
  • Spondylitis ( Inflammation of a spinal joint; characterized by pain and stiffness )
  • Spondylosis
    • Cervical spondylosis ( சகன வாதம் - Sagana vatham )
    • Lumbar spondylosis ( தண்டகவாதம் - Thandagavatham )
  • Gland disorders ( like Diabetes, etc. )
  • Rechannelizing Saram (vital energy) ( சர ஓட்டம் சரிசெய்தல் - Sara ottam sariseithal )
  • Etc.

The treatment method for varma kaayanilai is in many methods, the main methods are :

  1. Adangal methods – the treatment that given immediately after varmam injury
  2. Ilakku murai – the treatment that given immediately after varmam injury
  3. Thadavu murai – treatment method for Pazhaya varmam
  4. Marunthugal – treatment method for Pazhaya varmam

Now we can see some Adangal points. Adangal 108, Rathina kodi thiravugol and "Narambu Vagada Soothiram Thiravukol" are the literatures which contain the Adangal points.

  1. Alagu kamoodhari adangal – after varmam point injury if jaw lock happen do this adangal, the mathirai level is ½.
  2. Thavala adangal – after varmam injury if the patient couldn’t take water do this adangal.
  3. Poigai adangal – after varmam injury if the eyes directed upwards and couldn’t hear the sounds does this adangal, the mathirai level is ½.
  4. Uchi adangal – if the patient is unconscious do this adangal, if he does not get conscious that is Asathiam.
  5. Suzhimunai adangal – this adangal is very useful, all varmam injuries in head can be relieved by this adangal.
  6. Alagu sennadi adangal – after varmam injury if the patient is in sleep with snoring do this adangal.
  7. Mudi sudi adangal – after varmam injury if the patient's mouth deviated with salivation do this adangal.
  8. Kurundhu adangal – after varmam injury if the patient is in the stage of delirium do this adangal.
  9. Prana sadhana adangal – after varmam injury if the patient's tongue extended away from mouth do this adangal.
  10. Pen kuzhi adangal  – after varmam injury if the patient's tongue pulled inside the mouth do this adangal.
  11. Udhira narambu adangal – after varmam injury if the patient developing high grade fever and rigors do this adangal.
  12. Eeradangal – after varmam injury if the patient is with fully opened mouth do this adangal


Varmam has relationship with other fields like Siddha Medicine, Áyurveéda, Yoga, Astronomy, Psychology, Tantra, Anka Sasthra and many others.

A. Varmam and Siddha Medicine
Siddha medicine is the one of the oldest medical systems originated from India. Varmam is one the main streams within siddha medicine. For example, if a patient is suffering from pain in some part of the body, siddha medicine will externally apply herb medicines, which after absorbed by the body, produce the cure. But based on varmam, certain pressure points are tuned to regulate the blood flow, which gives immediate relief to the pain. Siddha doctors in South India ( notably in Kanyakumari District of TamilNadu ) use this technique of combined medication to give faster and better relief to the patients.

B. Varmam and Áyurveéda
Ayurveda is one another oldest forms of medical systems from India. Among Áyurveédic text, there is no separate text for varmam. But in the text 'Astangahridayam', written by Vakpatar, he speaks about 107 varmam points in human body. Some other Áyurveédic texts also contain sparse information about varmam points. Hence, we can conclude that concept of varmam exist within Ayurveda also.

C. Varmam and Yoga
Yoga is classified into 2 main streams. One based on breathing; and another based on body postures. They work in tandem and culminate to form today's yoga. If yoga asanas ( yoga postures ) are properly practiced, it will result in good health. The basic reason for that is yoga asanas properly tunes the nerves system ( along with varmam points present in the nerves system ), resulting in regulated blood flow throughout the body. Every yoga asanas has its effect on certain group of varma points enabling proper health, flexibility, mobility and physique.

For example, if you consider Padmasana ( one yoga posture ), it produces mild pressure on these varmam points which located at lower legs :

Because of that, Iddakala (Left) and Pingala (Right) nerves gets tuned and strengthens the vertebral column. It increases concentration, memory, serenity on one's face, and etc.

D. Varmam and Astronomy
Rays from all the planets and moons in the solar system reaches Earth. They are responsible for health and illness amongst the living beings. Siddhas, who developed varmalogy, studied where and when these rays act on human body and based on their studies, they have created various varmam texts which studies varmam points in relationship with the rays from the planets and moons and their consequence on human body. Such studies are taught only through guru-sishya (teacher-student) heritage. Such studies can be used to stop occurrence of heart diseases and kidney diseases. Even the diseases that are present can be systematically cured.

Varmam's relation with other fields like Psychology, Tantra, Anka Sasthra, Philosophy, Kama śāstra, etc. will be discussed in our web site in due course of time.

Varma Kalai based on Vaidhiya Murai ( Ancient Healing Therapy )
An English Translation Of The Sushruta Saṃhitā Based On Original Sanskrit Text.
Edited And Published By : Kaviraj Kunja Lal Bhishagratna
Data Organized and Presented (for general knowledge) by : Guruji Murugan Chillayah


Varma kalai and Varma Kalai based on Vaidhiya murai has explained the minute details of our body. Father of Surgery Achãrya Susrutha has explained about all these details 5000 years back in his book named "Susrutha Samhitha". Definition of Marma as follows " Maarayathithe marma " means if any individual gets trauma to this point, he will die. The marma points are of great importance to a person's body, mind and spirit. The word 'marma' was used for the first time in Atharvavéda ( ancient Indian scripture ). Marma points are positions on the body where muscles, veins, arteries, nerves, tendon, bones and joints meet. While a healer uses these points to heal, for a warrior the very same spots could be used to harm.

Achãrya Susrutha has mentioned regarding the Marma in detail. Susrutha Samhitha Shareera Sthana Chapter 6th mentions - 107 marma points present on the body. This makes it much easier to remember and work with, compared with the thousands of points in Chinese acupuncture. áyurvéda details major (mahá) and minor marma points. The major points correspond to the major shad chakras in the body, while the minor points are found around the torso and limbs. Thus, healing through marma abhyañga affects the chakras, physical health, and the doshas. Like acupuncture, finger units ( anguli or angula ) to detect their correct locations measure these points.

If these points are pierced or hit forcefully, it could result in disease, trauma or even death. For example, if lohit marma present on the leg, is struck, it results in paralysis. But the same marma is treated with moderate circular and deep pressure to treat paralysis.

Similarly, marma vipat near the groin, when struck, can cause impotency while the same marma, when massaged, cures impotency. When somebody hits the marma, the flow of prana is disturbed and can be treated either by marma itself or acupressure. in Ayurveda importance is given to Abyanga or snehana. It is said that when oil is applied daily to a dry stick it is found that over a period of time, dry stick can be bent into a different shape. However a dry stick without applying oil breaks when it is bent. In the same way if a person is massaged with oil daily he can overcome many diseases. Many marma points are larger than acupuncture points. Thus, they can be found more easily. The marma points are similar to Chinese acupuncture, but NO invasive needles used. The only difference between them is in the mode of treatment. This means in acupuncture needles are used for pricking and in Ayurveda these points are massaged. Abyanga at this marma sthansa will be helpful in restructure or rebalance the system to function normally. Further, abhyañga helps to develop the health and longevity of the body and mind by ensuring the proper balance and flow of hormones, fluids, immune factors, etc. The purpose of a marma abhyañga is to stimulate the various bodily organs and systems. In case of Shirodhara a medicated oil or decoction is poured on the head for a certain period of time and from a particular height. The medicated oil falls on the vital marma points and this helps to overcome the diseases. In case of Nasya Karma also massage is done on the face systamatically especially on Marma points to get relief from headaches, migraines, sinusitus, and other ENT problems. Marma are not only the weak points but also strong points at the same time. This is because on treating these points it helps in over coming the disease. For example a warrior may use these points to harm enemies, whereas a Vaidya can use the same points to cure the disease.

Another form of abhyañga is the use of the major and minor marma points. Marma is discussed in 1 of the 4 main Védas, and also detailed in the classical áyurVédic text, Sushruta Saṃhitā. Marma points are positions on the body where flesh, veins, arteries, tendons, bones, and joints meet. They may be seen as the junctions where Váyu, Pitta, and Kapha meet; where sattwa, rajas, and tamas meet; or where eternity and relativity meet; these are the points that could be used to heal or harm. In short, they are points that have great importance to a person's body, mind and spirit. Although the Marma are the junctions of all 5 principles ( i.e., flesh, veins and arteries, tendons, bones, and joints ), at each point a predominance of 1 principle exists. It is at these points where abhyañga can most effectively restructure or rebalance the system to function most healthily.

Sushruta - His Age And Personality

A few preliminary observations regarding the technique of the Áyurveédic system of medicine are necessary at the outset to correctly understand the aim and scope of the Sushruta Saṃhitā. Who was Sushruta? When and where did he live and flourish? These are questions that would naturally suggest themselves to the readers of the following pages; but they can only be imperfectly answered like all similar questions respecting the lives of our ancient worthies. In a country like India where life itself was simply regarded as an illusion, the lives of kings or commoners were deemed matters of little moment to the vital economy of the race; and all histories and biographies were looked upon as the embodiment of the flimsy vanities of life. Lives of saints and canonised kings had been made use of in certain instances as themes of national epics. But they were intended more to elucidate or enunciate the doctrines of certain schools of Ethics or Metaphysics than to record any historical fact or event. Authentic history we have none beyond chronicles of state events and royal names in some instances; and those which are usually found in the Sanskrit Puranas are strange combinations of myths and legends, which often contradict each other. Hence the utter futility of attempts to explain a historical fact by the light of a votive medal or tablet unearthed perhaps from the ruins of one of our ancient cities. Such an endeavour serves, in most cases, only to make the "darkness visible," and the confusion more confounded.

Identity Of Sushruta And Divodasa

It is only safe to assert that Sushruta was of the race of Vishvamitra. The Mahābhāratam (I) represents him as a son of that royal sage. This coincides with the description given of him in the present recension of the Saṃhitā. The Garuda Puranam (2) places Divodasa as fourth in descent from Dhanvantari, the first propounder of medical science on earth, whereas the Sushruta Saṃhitā describes the two as identical persons. But this apparent anomaly in the Saṃhitā can be accounted for, if we consider that in some parts of India the custom still prevails of appending, for the purposes of better identification, the name of one's father, or of a glorious ancestor to one's name, and it is therefore not surprising that Divodasa (the preceptor of Sushruta), who was a firm believer in the doctrine of psychic transmigration, should represent himself as an incarnation of Dhanvantari, and assume his name and style in the usual way. Beyond this meagre genealogy we possess no trustworthy information regarding the life and personalitv of Sushruta, the father of Indian Surgery.

Age Of The Sushruta Saṃhitā

We have no means of ascertaining what the Saṃhitā was like as originally written by Sushruta, the present being only a recension or rather a recension of recensions, made by Nagarjuna (1). All opinions concur in identifying him With the celebrated founder of the Madhyamika school of Buddhistic philosophy - a fact which materially assists us in fixing the age of the present Saṃhitā. A few quotations from the Vriddha (old) Sushruta are all that are preserved of the original Saṃhitā. But their genuineness, is of a problematic character, and we are not sure whether they are the productions of lesser lights, or of ancient though less renowned commentators, attributed to the master to invest them with a greater sanctity and authority - a practice which was quite common amongst the bibliographers of Ancient India.

Mahābhāratam - Anushasan Parva, Ch. IV.

Garuda Puranam, Chap. 139. Vs. 8-11.


Date Of Nagarjuna

At all events Nagarjuna who redacted the Sushruta Saṃhitā lived about the latter part of the fourth century before the Christian era;(2) and the original or vriddha Sushruta must have been written at least two centuries earlier in order to acquire that hoary authority and prescription of age, which alone could have given its right to a recension at the time. Several scholars on the authority of a very vague and general statement concerning the recension of the Saṃhitā in Dallana's commentary, ascribe the authorship of the Uttaratantram (latter portion of the Sushruta Saṃhitā) to Nagarjuna. We on the other hand, hold the Uttaratantram to be neither an interpolation, nor a subsequent addition, but that it forms an integral portion of the book as it was originally written, though not planned by the Rishi. In the first Chapter of Sũtrasthanam Divodasa formally divides the Science of Ayurveda into eight subdivisions, such as, the Shalya (surgery), Shalakya (portion treating of diseases restricted to super-clavicular regions such as the eyes, etc.), Kaya-Chikitsa (general diseases such as, fever, etc.), but does not speak anything about them in the first five Sthanas or subdivisions of the book. It is only once in the 25th chapter of the Sũtrasthanam that he mentions the name of Netravartma (diseases of the eyelids) in connection with the classification of surgical operations. It is impossible that Divodasa would fall short of his duties by omitting to give instructions on all the subdivisions of the Áyurveéda as he promises at the outset, or that Sushruta would leave his Saṃhitā, which is pre-eminently a work on surgery, incomplete by banishing ophthalmic surgery, laryngotomy or fever-therapeutics from his work. From the general plan of the book we can safely assert that Sushruta dealt with easier or more elementary topics in the first five subdivisions of his Saṃhitā in the manner of our modern progressive readers, reserving the discussion of those requiring a more advanced knowledge and skill for the Uttaratantram. The Uttaratantram has not been included within the five original subdivisions of the Saṃhitā in as much as it embraces and more elaborately discusses topics which legitimately belong to, .or are but incidentally mentioned in those subdivisions. Hence it is more of the nature of an appendix or supplement, arising out of the exigencies of the original subdivisions. It is probable that Nagarjuna might have redacted this part of the Saṃhitā in common with its other portions.

Dallana's Commentary, Sũtrasthanam, Ch. I. 1.

Dallana mentions the names of Jejjada, Gayadasa etc., as the redactors of the original Saṃhitā, and rejects as spurious or of questionable authority the texts which cannot be found in their editions of the work. Most probably the authoritative verses are quotations from the Vriddha Sushruta.

Recension or Pratisamskara consists in curtailing statements that have been made inordinately elaborate, and in dilating upon truths that have been very succinctly dealt with in the original book. A Redactor or Pratisamaskarta makes an old book new again.

A Saṃhitā, on the other hand, deals with aphorisms contained in the Védas.

Rajatarangini I. Taranga. Vs. 172-173.


Western Opinions On The Subject

The consensus of western opinions is to place Nagarjuna in the first quarter of the third Century B. C. (2). and for fixing Sushruta as a contemporary of Sakya Sinha Buddha. It is contended that the age immediately preceding Sakya Muni was a period of decadence in Hindu thought ; and the Sushruta Saṃhitā must have been the fruit of a revived intellectual activity which usually follows the advent of a new creed - an assumption which is in favour of the hypothesis of Greek influence on the Hindu system of medicine. But great men there had been in India before Buddha. The age which immediately preceded the age of Buddha was by no means an age of decadence properly speaking, the age which followed the downfall of Buddhism shows, on the contrary, signs of true decadence. India had had eminent philosophers and scientists almost contemporaneously with the great Buddha. The chronological facts collected above from the Mahābhāratam, and the Garuda Puranam could have been construed to prove that the age of Sushruta was prior to that of the Mahābhāratam but for the internal evidence furnished by the Saṃhitā itself as to the probable date of its composition which we shall have occasion to deal with later on.

Extraneous Evidence

Sushruta is mentioned in the

(1) Mahāmahopadhyaya Kaviraj Dvaraka Nath Sen Kaviratna of Calcutta subscribes to this opinion - Tr.

(2) Bael's Buddhistic Records of the Western World. Vol.11. P. 212. Stein's Rajatarangini.

(3) Lalita Vistaram - Raja R. L. Mitter's Edition, Chapter I (Medical Treatment Of The Two Kinds Of Inflamed Ulcers (Dvivraniya Chikitsitam)).

Vartikas of (1) Kātyāyana (4 Century B. C.) and we have no hesitation in saying tha the original Saṃhitā was written at least two centuries before the birth of Buddha. We are equally ready to admit, on the other hand, that the final recension of the Saṃhitā by Nagarjuna, at least the form in which we have it, was made about the second Century B.C.

Two Nagarjunas

Several scholars, on the authority of Dallana (the celebrated commentator of the Sushruta Saṃhitā) endeavour to establish the identity of Nagarjuna (the redactor of this Saṃhitā) with his namesake, the celebrated alchemist of the tenth Century (2). But their contentions fall to the ground when we know that many verses of the Sushruta Saṃhitā occur in the works of Bagbhat (Ashtangahridayam) and Madhava (Nidanam), which are two of the works which were translated by the order of the Kaliph (3) in the eighth century. The internal evidences of the book do not supply us with any authentic material to compose anything like a biography of this father of Hindu Surgery.

Internal Evidence

The line in the Saṃhitā, which has formed the veritable bone of contention amongst scholars of all shades of opinion as throwing a light upon the probable date of its composition, occurs in the Sharira - Sthanam, in connection with the development of the foetal body and reads as "Subhuti Gautama said that it is the trunk that first developed."


Conflicting Testimonies And The Uncertain Indication Of Materials At Our Disposal It is a matter of historic certainty that Subhuti was one of the personal disciple of Sakya Sinha Buddha, and that it was customary amongst the contemporary Buddhists to append the appela-, tion of their (I) lord (Gautama or Bodhisattva) to the name of a proselyte to accentuate his wisdom and sanctity in the world. A certain section of scholars is never tired of setting up this line as a conclusive evidence of the fact that the Saṃhitā was, at best, a contemporary production of early Buddhism. But they shut their eyes to opinions of Shaunaka and others on the subject quoted exactly in the same portion of the book, which places the date of its composition at least several centuries earlier. Shaunaka, who was the sixth in remove from the immortal Vyāsa in direct line of discipleship, was the author of the renowned Shaunaka Saṃhitā of the Atharvan. These facts lend a very plausible colour to our hypothesis that the original Sushruta Saṃhitā which, was first composed perhaps contemporaneously with the latter portions of the Atharvan, naturally discussed the opinions of Shaunaka and other Védic embryologists, while Nagarjuna, at the time of redacting that book, quoted the opinion of his contemporary Subhuti for the purpose of giving him an equal status with the Védic Rishis, if for nothing else.

Kilyayana's Vartikas to Panini's Grammar.

Chakra Dutta - Rashayandhikara. (3) P. C. Roy - Hindu Chemistry p. XVIII. (1902).

Greek Influence

As regards Hellenic influence on the Hindu system of medicine and on the Sushruta Saṃhitā in special, we must disabuse our mind of all sentiments of racial vanity and proceed to investigate the case in a scientific and unprejudiced spirit before giving a more detailed account of the contents of the Sushruta Saṃhitā.

(I) Nagarjuna Bodhisattva was well practised in the art of compounding medicine. Nagarjuna Bodhisattva by moistening all the great stones with a divine and superior decoction changed them into gold. - Bael's Buddhistic Records of the western world Vol. II.

Anuvak 19. 45. 46. 5.

Sushruta And Hippocrates

From the very apparent similarity which exists between the contents of this Saṃhitā and the aphorisms of Hippocrates, many western scholars are apt to conclude too hastily that the ancient Indians drew their inspiration in the healing art from the medical works of the Greeks. But the reverse may be said of the Greeks as well with the greater confidence because such an assertion is supported by historic facts, and confirmed by the researches of the scholars of the west (I). According to all accounts Pythagoras was the founder of the healing art amongst the Greeks and the Hellenic peoples in general (2). This great philosopher imbibed his mysteries and metaphysics from the Brāhmaṇās of India. Mr. Pocock in his India in Greece identifies him with Buddhagurus or Buddha, and it is but an easy inference to suppose that he carried many recipes and aphorisms of his master's Áyurveéda with him. The sacred bean of Pythagoras is thought to have been the (5) Indian Nelumbium (Utpalam). We know that simultaneously with the birth of Buddhism, Buddhist Sramanas were sent out to Greece, Asia minor, Egypt and other distant countries to preach their new religion. They were known to the Greeks and there is good reason to believe that the Greek Simnoi (venerable) were no other than the Buddhist Sramanas (4). Now a missionary usually teaches the sciences of his country in addition to the preaching of his gospel. The distant mission stations or monasteries of Buddhism were the principal centres for disseminating Brāhmaṇic culture in distant lands, and Hippocrates, though he did his utmost to liberate medical science from the thraldom of speculative philosophy, yet might have thought it necessary to retain only those truths of the Áyurveéda which Pythagoras and the Buddhistic brotherhood might have imported into his country, and which do not exactly appertain to the domain of pure metaphysics. Of course, it is quite possible for men of different nationalities to arrive at the same truth or conclusion independently. There are coincidences in science as in art and philosophy, (I) Gravitation and circulation of blood (2) were known to the Indians long before the births of Newton and Harvey in Europe. The celebrated atomic theory was preached in the Gangetic valley some five hundred years before the birth of Christ (3). But well may we ask those, who still adhere to this Hellenic hobby, to look at the reverse side of the picture as well. It may be stated without the least fear of contradiction that the Charaka and Sushruta, through the Channel of Arabic, Persian and Latin translations still form the

(1) There is no ground whatever to suppose that Sushruta borrowed his system of medicine from the Greeks. On the contrary, there is much to tell against such an idea - Weber's History of Indian Literature.

(2) The Origin and Growth of the Healing Art - Bedroe P. 162.

(3) Pratt's Flowering Plants. Vol. I P. 57.

(4) These Simoi (venerable) whom Clement of Alexandria has narrated to have rendered worship to a pyramid originally dedicated to the relics of a god, were the Buddhist Arhats (venerables) Sramanas.

Lalita-Vistaram - Raja Rajendra I.ala Mitter's Edition. Ch. 1.

Siddhanta Shiromani (BhaskarAchãryaya) Golodhyava.


The Harita Saṃhitā, which according to certain scholars, is older than the Sushruta Saṃhitā, refers to the circulation of blood in describing Panduroga (Anaemia). The disease, he observes, is caused by eating clay which thus blocks the lumen of veins and obstructs the circulation of blood. Bhavamisra, the celebrated author of Bhavaprakasham, and who is a century older than Harvey, has the above couplets bearing on the subject.

(3) Vaiseshika Darshana by Kanada.

basis of all systems of scientific medicines in the world (1).

Of these, the Sushruta Saṃhitā is the most representative work of the Hindu system of medicine. It embraces all that can possibly appertain to the science of medicine (2).


Sushruta Prior To Charaka

The general consensus of expert opinion is to place Charaka prior to Sushruta in respect of time. But the Puranas unanimously describe Sushruta as a disciple of Dhanvantari, the first-propounder of medical science. The long compounds (samasas) used by him, the prose and metrical portions of the Sushruta after the models of Jaimini, Pātañjali, and other philosophical writers who had adopted prose or metre according to the exegetic or rationalistic tenor of the subjects in their works, have all been cited to prove Sushruta a contemporary of the Darshanas, or of Buddha. But these may serve, at least, to fix the date of the recension by Nagarjuna, i.e., the Sushruta Saṃhitā as we have it, but can never help to determine the chronology of Sushruta, the disciple of Dhanvantari "who was churned out of the primordial ocean in the golden age (Satya Yuga) (3). On the other hand, if the testimonies of the Puranas have any historical worth, we can safely place him somewhere in the Satya Yuga, (age) at least in those dim centuries which immediately succeeded the composition of the Atharvan. Charaka, too. in connection with his discourse on the development of the foetal body has cited the opinion of Dhanvantaii (I) on the subject (the same as promulgated in the Sushruta Saṃhitā) & referred his disciples to the Dhanvantari school of surgeons (meaning Sushruta and his school) in cases where surgical aid and knowledge are necessary; this proves that Sushruta was before Charaka.

(1) A. "The great works of Charaka and Sushruta were translated into Arabic, under the patronage of Kaliph Almansur, in the seventh century. The Arabic version of Sushruta is known by the name of "Kelale-Shawshoore-al-Hindi."' These translations in their turn were rendered into Latin. The Latin versions formed the basis of European medicine, which remained indebted to the Eastern science of medicine down to the seventeenth century." - History of the Aryan Medical science (Thakore Saheb of Gondal) P. 196.

B. For the indebtedness of Arabic school of Medicine to the works of Indian masters, see Puschmann P. 162.

C. Bedro'e. Book IV. Ch. II. 286 - 299.

(2) Dr. Wise (Hindu system of medicine).

Garuda Puranam. Chap. 142. Vs. 5-6.

Sushruta As A Surgeon

Sushruta was emphatically a surgeon, and the Sushruta Saṃhitā is the only complete ok we have which deals with the problems of practical surgery and midwifery. Almost all the other Saṃhitās written by Sushruta's fellow students are either lost to us, lor are but imperfectly preserved. To Sushruta may be attributed the glory of elevating the art of handling a lancet or forceps to the status of a practical science, and it may not be out of place here to give a short history of the Áyurveéda as it was practised and understood in Pre-Suhsrutic times if only to accentuate the improvements which he introduced in every branch of medical science.


Commentators Of The Sushruta Saṃhitā

We would be guilty of ingratitude if we closed this portion of our dissertation without expressing a deep sense of our obligation to Jejjada Acharva, Gayadasa, Bhaskara, Madhava, Brāhmadeva, Dallana and Chakrapani Datta, the celebrated commentators and scholiasts of the Saṃhitā, who have laboured much to make the book a repository of priceless wisdom and experience. Dallana has made use of all the commentaries in revising and collating the texts of .Sushruta Saṃhitā.

Charaka, Sharirasthanam. Chap. V.

Charaka, Chikitshasthanam. Chap. V.

Origin And History Of The Ayurveda

In the science of medicine, as in all other branches of study, the ancient Aryans claim to have derived their knowledge from the gods through direct revelation. Sushruta in his Saṃhitā has described the Áyurveéda as a subdivision (Upanga) of the Atharvan (1), while according to others the science of the Áyurveéda has its origin in the verses of the Rik Saṃhitā (2). Indeed the origin of the science is lost in dim antiquity. Death and disease there had been in the world since the advent of man; it was by following the examples of lower animals in disease, that our primitive ancestors acquired by chance the knowledge about the properties of many valuable medicinal drugs. There is a verse in the Rigvéda which shows that the lower animals were the preceptors of man in matters of selecting food stuffs and medicinal simples (3) Individual experiences in the realms of cure and hygiene were collected, and codified, and thus formed the bases of the present Áyurveéda. The verses in the Védas clearly mark each step in the progress of medical knowledge. The properties of a new drug were always hymned in a Védic verse with a regularity which enables us to put our finger upon the very time when a particular drug of our Materia Medica first came to be of service of man.

(l) Sushruta Saṃhitā, Sũtrasthanam. Ch. I. 3.

Charana Vyuha by Vyāsa.

(4) A.

Atharvan Saṃhitā B. See also Ibid I 2 II. 4. 7. 9. 25, 27 and 36.

Discrepancies Accounted For

Verses on medicine, hygiene, and surgery, etc. lie scattered throughout the four Védas. Those having bearing on Medicine proper occur most in the Rigvéda, and perhaps it was for this reascn that Agnivesha, who was a physician, has ascribed the origin of the Áyurveéda to revelations in the Rik Saṃhitā. Precepts relating to the art and practice of surgery are found most in the Atharvan (I), which amply accounts for the fact of Sushruta's opinion of holding the Áyurveéda as a subdivision of the Atharvan, as he was pre-eminently a surgeon himself.

The Marma Or Vital Parts Of The Body

Chapter VI. Sáriram Which Specifically Treats Of The Marma / Vital Parts Of The Body ( Pratyeka-Marma-Nirdesa Sáriram )

Names and distributions of Marma ( IN SANSKRIT ):

Varmam Point - face varmam

Varmam Point - front varmam

Varmam Point - back varmam

The Marma which are situated in each leg are known as :

  • Kshipra
  • Tala-Hridaya
  • Kurchcha
  • Kurchcha-Sirah
  • Gulpha
  • Indravasti
  • Jánu
  • Ani
  • Urvi
  • Lohitáksha
  • Vitapa

The 12 Marma which are situated in the places where veins, arteries, ligaments, joints and muscles unite and an injury to which proves generally fatal.

The Marma which are situated at thorax and the abdomen ( Udara ) are :

  • Guda ( anus )
  • Vasti ( bladder )
  • Nabhi ( umbilicus )
  • Hridaya ( heart )
  • Stanamula ( the roots of 2 breasts )
  • Stana-Rohita ( muscles of the breasts )
  • 2 Apalaps
  • 2 Apastambhas

The 14 Marma to be found in the back are the :

  • Katika-tarunas ( Taruna-bones of the waist )
  • 2 Kukundaras
  • 2 Nitamvas ( hips )
  • Párs'va-Sandhis ( the 2 side-joints )
  • 2 Vrihatis
  • 2 Ansa-phahkas ( shoulder-blades )
  • 2 Ansas ( shoulders )

The 11 Marma to be found in an arm are known as the :

  • Kshipra
  • Tala-Hridaya
  • Kurchcha
  • Kurchcha-Sirah
  • Manivandha
  • Indravasti
  • Kurpara
  • Ani
  • Urvi
  • Lohitáksha
  • Kakshadhara

What is said of the one arm holds good of the other.

The Marma situated above the clavicle regions (Urddhva-Jatru) are known as the :

  • 4 Dhamanis ( arteries )
  • 8 Matrikas
  • 2 Krikatikás
  • 2 Vidhuras
  • 2 Phanas
  • 2 Apángas
  • 2 Avartas
  • 2 Utkshepa
  • 2 Sankhas
  • 1 Sthapani
  • 5 Simantas
  • 4 Sringátakas
  • 1 Adhipati

Traditionally marma points are grouped into 3 categories :

Part of Human body
Jatrurdhara marma Neck and Head
Madhayamanga marma Trunk / Body
Sankha marma Legs and Feet

Marma points are grouped according to the region of the body :

Vital Points
Part of Human body
22 Arms
22 ( 11 per limb ) Legs ( in the 2 lower extremities )
3 Abdomen ( Udara )
9 Chest
14 Back
37 Neck ( Grivá ) and above it ( head )

Firm unions of Mánsa ( muscles ), Sirá ( veins ), Snáyu ( ligaments ), Asthi ( bones or bone-joints ) are called Marma ( or vital parts of the body ) which naturally and specifically form the seats of life ( Prána ), and hence a hurt to any one of the Marma invariably produces such symptoms as arise from the hurt of a certain Marma.

107 Marma in the human organism, which divided into 5 Basic Categories / Classes Of Marma Points Indeed there are no other Marma ( vulnerable or vital parts ) to be found in the body than the preceding ones.

Classification Of Marma

Vital Points
Part of Human body
8 Asthi-Marma at bones / bone-unions such as :

  • Katika-taruna
  • Nitamva
  • Ansa-phalaka
  • Sankha

27 Snáyu-Marma at the Tendons & vital ligament-unions such as :

  • Ani
  • Vitapa
  • Kakshadhara
  • Kurchcha
  • Kurchcha-Sirah
  • Vasti
  • Kshipra
  • Ansas ( shoulders )
  • Vidhura
  • Utkshepa

20 Sandhi-Marma at the vulnerable joints such as :

  • Jánu
  • Kurpara
  • Simanta
  • Adhipati
  • Gulpha
  • Manivandha
  • Kukundara
  • Avarta and the Krikatika

11 Mamsa / Mánsa-Marma muscles / vulnerable muscle-joints ( "mamsa" in sanskrit means flesh ) such as :

  • Tala-Hridaya
  • Indravasti
  • Guda
  • Stana-rohita

41 Shira / Sirá-Marma ( vessels ) - nerves/veins/similar veins, arteries, anastomosis, lymphatic vessels as well, such as :

  • Nila-dhamani
  • Mátrika
  • Sringátaka
  • Apánga
  • Sthapani
  • Phana
  • Stana-mula
  • Apálapa
  • Apastambha
  • Hridaya
  • Nábhi (umbilicus at umbilical region)
  • Párs'va-Sandhi
  • Vrihati
  • Lohitaksha
  • Urvi

Marma points are also divided on the basis of their Pancha Mahābootas ( 5 elements ) /
under 5 distinct heads constitution into :

Vital Points
Explainatory - according as an injury respectively produces the aforesaid effects
19 Sadya Pránahara / Kshipra Pránaharam ( fire ) Sudden death on trauma if attacked on this point ( fatal within 24 hours ) belong the Marma, known as the :

  • 4 Sringatákas
  • 1 Adhipati
  • 2 Sankhas
  • 8 Kantha-Sirás
  • Guda
  • Hridaya
  • Vasti
  • Stana-rohita

The Marma belonging to the Sadya-Pránahara group are possessed of fiery virtues ( thermogenetic ); as fiery virtues are easily enfeebled, so they prove fatal to life ( in the event of being any way hurt )

33 Kálántara-Pránahara ( water ) Trauma that cause delays of time in death ( post-poned death ) ( fatal within a fortnight or a month ) belong the Marma, known as the :

  • 8 Vaksha-Marma
  • 5 Simantas
  • 4 Tala-Marma
  • 4 Kshipra-Marma
  • 4 Indravastis
  • 2 Katika-tarunas
  • 2 Párs'va-Sandhis
  • 2 Vrihatis
  • 2 Nitamvas

A piercing of the Kshipra-Marma ends in an instantaneous death; or death may follow at a later time. The Marma belonging to the Kálántara-Pránahara group are fiery and lunar (cool) in their properties. And as the fiery virtues are enfeebled easily and the cooling virtues take a considerable time in being so, the Marma of this group prove fatal in the long run (in the event of being any way hurt, if not instantaneously like the preceding ones)

03 Visályaghna (Vishalaya ghunam) ( air ) fatal as soon as a dart or any other imbedded foreign matter is removed / extracted therefrom belong the Marma, known as the :

  • 2 Utkshepa
  • 1 Sthapani

The Marma belonging to the Visályaghna Marma are possessed of Vataja properties (that is, they arrest the escape of the vital Váyu); so long as the dart does not allow the Váyu to escape from their injured interior, the life prolongs; but as soon as the dart is extricated, the Váyu escapes from the inside of the hurt and necessarily proves fatal.

44 Vaikalyakara ( earth ) Leads to maiming or deforming / resulting in permanent disfiguration belong the Marma, known as the :

  • 4 Lohitákshas
  • 4 Anis
  • 2 Jánus
  • 4 Urvis
  • 4 Kurchchas
  • 2 Vitapas
  • 2 Kurparas
  • 2 Kukundaras
  • 2 Kaksha-dharas
  • 2 Vidhuras
  • 2 Krikátikas
  • 2 Ansas (shoulder)
  • 2 Ansa-phalaka (shoulder-blades)
  • 2 Apángas (tips of eyes)
  • 2 Niáls
  • 2 Manyás
  • 2 Phanas
  • 2 Avartas

The Marma belonging to the Vaikalyakaras are possessed of Saumya (lunar properties) and they retain the vital fluid owing to their steady and cooling virtues, and hence tend only to deform the organism in the event of their being hurt, instead of bringing on death

08 Rujakara /
Rujákara ( space )
caused tremendous pain. A learned physician should know this is painful if hurt
( of the hands and legs ) belong the Marma, known as the :

  • 2 Gulphas
  • 2 Mani-vandhas
  • 4 Kurchcha-Sirah

The Marma belonging to the Rujákara Marma of fiery and Vátaja properties become extremely painful in as much as both of them are pain-generating in their properties.

Others, on the contrary, hold the pain to be the result of the properties of the 5 material components of the body (Páncha-bhautika).

Some are of opinion that hallucination, delirium, death, stupor and coma as described in the Sũtrastánam are the results of injuries to these Marma.

The Marma Or Vital Parts Of The Body. Part 3

Different Opinions On The Marma

Some assert that Marma, which are the firm union of the 5 bodily factors ( of veins, ligaments, muscles, bones and joints ), belong to the first group (Sadya-Prána-hara); that those, which form the junction of four such, or in which there is one in smaller quantity, will prove fatal in the long run, in the event of their being hurt or injured (Kálantara-Pránahara). Those, which are the junction of 3 such factors, belong to the Visálya-Pránahara group; those of the 2 belong to the Vaikalyakara.

The Marma, such as:

  • Stana-mula, Apalápa, Apastambha, Simanta, Katika-Taruna, Pársva-Sandhi, Vrihati, and Nitamva, belonging to the Kálántara-máraka group, are devoid of Mánsa (muscles);
  • Stanarohita, Talahridaya, Kshipra, and Indravasti, belonging to the same class, are devoid of Asthi (bones);
  • Utkshepa marma, belonging to the VisályaPránahara group, is devoid of Mánsa (muscles) and Sandhi (joint);
  • Sthapani-Marma, belonging to the Vaikalyakara class, is devoid of Mánsa (muscle), Sirá and Snáyu;
  • Lohitáksha-marma (of the same group) is devoid of Snáyu, Sandhi and Asthi (bones);
  • Jánu-marma (of the same group) is devoid of Mánsa, Sirá and Snáyu;
  • Urvi-marma (of the said group) is devoid of Asthi, Mánsa and Snáyu;
  • Vitapa-marma (of the same class) is devoid of Mánsa, Sirá and Asthi;
  • Kurpara-marma (of the same class) is devoid of Mánsa, Sirá, and Snáyu;
  • Kukundara-marma (of the same class) is devoid of Mánsa, Sirá and Sandhi;
  • Kakshadhara-marma (of the same class) is devoid of Sirá, Asthi, and Sandhi;
  • Vidhura-marma (of the said group) is devoid of Mánsa, Sirá and Sandhi;
  • Krikatika-marma is devoid of Mánsa, Sirá, and Sandhi;
  • Ansa-marma (of the same group) is devoid of Mánsa, Snáyu and Sandhi;
  • Ansa-phalaka-marma group; and those in which only one of them exists belongs to the last or pain-generating type (Rujakara)

But the fore going theory is not a sound one, in as much as blood is found to exude from an injured joint which would be an impossibility in the absence of any vein, ligament ( Snáyu ) and muscle being intimately connected with it. Hence every Marma should be understood as a junction or meeting place of the 5 organic principles of ligaments, veins, muscles, bones and joints.

This is further corroborated by the fact that the 4 classes of Sirá, or vessels (which respectively carry the Váyu, Pitta, Kapha and the blood) are found to enter into the Marma for the purpose of keeping or maintaining the moisture of the local ligaments ( Snáyu ), bones, muscles and joints and thus sustain the organism. The Váyu, aggravated by an injury to a Marma, blocks up (those 4 classes of vessels) in their entire course throughout the organism and gives rise to great pain which extends all over the body. All the internal mechanism of a man (of which a Marma has been pierced into with a shaft or with any other piercing matter) becomes extremely painful, and seems as if it were being constantly shaken or jerked, and symptoms of syncope are found to set in. Hence a careful examination of the affected Marma should precede all the foregoing acts of extricating a Salya from its inside. From that similar aggravated conditions and actions of the Pitta and the Kapha should be presumed in the event of a Marma being any way injured or pierced into.

(of the said group) is devoid of Mánsa, Snáyu and Sandhi; the Nilá, Manyá and Phana Marma (of the same group) are devoid of Mánsa, Sandhi and Asthi; the Avarta-marma is devoid of Sirá, Snáyu and Mánsa; the Apánga-marma (of the said class) is devoid of Mánsa, Snáyu and Sandhi.

The Gulpha, Manibandha, and Kurchcha-Sirá Marma, belonging to the Rujakara group, are devoid of Mánsa, Sirá, Snáyu and Asthi, i.e. Sandhi alone is present in these.

Hence the piercing of a bone is attended with bleeding.

A Marma of the Sadyah-Pranahara type being perforated at its edge brings on death at a later time (within 7 days), whereas a deformity of the organ follows from the piercing of a Kálántara-Máraka Marma at the side (instead of in the centre). Similarly, an excruciating pain and distressful after-effects mark a similar perforation of a Marma of the Visályaghna group. And a Marma of the Rujakara class produces an excruciating pain (instead of a sharp one) in the event of its being pierced at the fringe.

  • Sadyah-Pránahara type - injured marma terminates in death within 7 days of the injury
  • Kálántara type (one of it) - injured marma terminates in death within a fortnight / 1 month from the date of hurt (according to circumstances)
  • Kshipra-Marma - injured case seldom proves fatal before that time (7 days)
  • Visályaghna or Vaikalyakara group - injured marma may prove fatal in the event of its being severely injured

The Marma Or Vital Parts Of The Body. Part 4

Marma Of The Extremities

Now we shall describe the situation of every Marma. The Marma, known as the Kshipra, is situated in the region between the first and the second toes (Tarsal articulation), which, being injured or pierced, brings on death from convulsions. The Marma, known as the Tala-Hridaya, situated in the middle of the sole of the foot in a straight line drawn from the root of the middle toe. An injury to this Marma gives rise to extreme pain which ends in death. The Marma, known as the Kurchcha is situated 2 fingers' width above from the Kshipra one on each side of the foot. An injury to this Marma results in shivering and bending in of the foot. The Marma called Kurchcha-Sirah is situated under the ankle-joints, one on each side of the foot (Gulpha-Sandhi); an injury to it gives rise to pain and swelling of the affected part. A perforation of the Gulpha-Marma which is situated at the junction of the foot and the calf, results in pain, paralysis and maimedness of the affected leg.

If any of the Marma of the Kálántara-Pránahara group be deeply perforated, then this perforation is sure to bring on death within a day (i.e. it will act like a slightly injured Marma of the Sadyah-Pránahara group).

Any Marma of the Visályaghna-group, being deeply perforated, brings on death within 7 days (i, e. it will behave like a slightly injured Marma of the Kálántara-Pránahara class).

Any Marma of the Rujákara class, being deeply perforated (injured), is sure to bring excruciating pain etc. (i.e., it will act like a slightly injured Marma of the Visályaghna group).

An injury to the Marma which is situated in the middle muscle of the calf to the distance of between twelve and thirteen fingers' width from the ankle, and known as the Indravasti-Marma, results in excessive haemorrhage which ends in death.

It is a Snáyu-Marma (ligament) to the width of half a finger, and belongs to the Kálántara group.

It is a Mánsa-Marma to the width of half a finger and belongs to the Kálántara group.

It is a Snáyu-Marma to the length of 4 fingers' width, and belongs to the Vaikalyakara group.

It is a Snáyu-Marma, one finger in length and belongs to the Vaikalyakara group.

It is a Sandhi-Marma, to the length of 2 fingers', and belongs to the Vaikalyakara group.

Indravasti measures 2 fingers in length according to Bhoja and An injury to or piercing of the Jánu-Marma situated at the union of the thigh and the knee, results in lameness (disability of walking due to crippling of the legs or feet) of the patient.

A piercing of the Ani-Marma, situated on both the sides above 3 fingers' width from the Jánu (knee-joint), brings on swelling and paralysis (numbness) of the leg.

A perforation of the Urvi-Marma situated in the middle of the Uru (thigh) results in the atrophy of the leg, owing to the incidental haemorrhage. An injury to the Lohitaksha-Marma situated respectively a little above and below the Urvi-Marma and the Vankshana (groin-joint), and placed near the thigh, is attended with excessive haemorrhage and causes paralysis (of the leg).

An injury to the Vitapa-Marma situated between the Scrotum and the Vankshana (inguinal region), brings on loss of manhood or scantiness of semen. Thus the eleven Sakthi-Marma of one leg have been described; those in the other being of an identical nature with the preceding ones. The Marma in the hands are almost identical with those of the legs, with the exception that Manivandha, Kurpara and Kakshadhara Marma occur in the place of the Gulpha, Jánu and Vitapa Marma respectively. As the Vitapa-Marma is situated between the scrotum and the Vankshana (inguinal region), so the Kakshadhara-Marma is situated between the Vaksha (chest) and the Kaksha (armpit). An injury to these causes supervening symptoms. An injury to the Manivandha-Marma (wrist-marma) results specially in inoperativeness (Kuntha) of the affected hand; an injury to the Kurpara-Marma ends in dangling (Kuni) of the hand; and an injury to the Kakshadhara results in hemiplegia. Thus the 44 Marma of the upper and the lower extremities have been described.

Gayádása, though half a finger in width according to others. It is a Mánsa-Marma and belongs to the Kálántara group.

It is a joint-Marma, 3 fingers in length and belongs to the Vaikalyakara group.

It is a ligament-Marma, half a finger in length, (3 fingers according to Gayádása) and is of the Vaikalyakara class.

It is a Sirá-Marma, half a finger in length and of the Vaikalyakara group.

It is a Sirá-Marma, half a finger in length and of the Vaikalyakara group.

It is a Snáyu-Marma to the length of one finger and of the Vaikalyakara group.

The Marma Or Vital Parts Of The Body. Part 5

Marma On The Thorax Etc

Now we shall describe the Marma, situated in the region of the thorax and the abdomen (trunk). A hurt to the Guda-Marma, which is attached to the large intestine and serves as the passage of stool and flatus, ends fatally (within 24 hours of the hurt). An injury to the Vasti-Marma, situated inside the cavity of the pelvic region and the bladder and composed of small muscles and blood (and which serves as the receptacle of urine), proves fatal within the day, except in the cases of extracting the gravel, only when the injury to the organ is short of complete perforation of both of its walls. The urine oozes out through the aperture in the case where only one of its walls has been perforated, and which may be closed and healed up with proper and judicious medical treatment. An injury to the Nábhi-Marma, the root of all the Siras and situated between the Amás'aya (stomach) and the Pakvas'aya (intestines) ends in death within the day.

It is a Mánsa-Marma to the length of 4 fingers' width and belongs to the Sadyo-maraka class.

It is a ligament combination ( Snáyu marma ) to the length of 4 fingers, belonging to the Sadyah-Pránhara class,

A hurt to the Hridaya-Marma, which is situated in the thorax between the 2 breasts and above the pit of the Amas'aya and forms the seat of the qualities of Sattva, Rajas and Tamas, proves fatal within the day. An injury to the Stana-mula-Marma situated immediately below each of the breasts and about 2 fingers in width fills the Koshtha (thorax) with deranged Kapha, brings on cough, difficult breathing (asthma) and proves fatal. An injury to any of the Stana Rohita-Marma, situated above the nipples of the breasts about 2 fingers in width, fills the cavity of the Koshtha (thorax) with blood, producing symptoms of cough and asthma, and ends fatally. An injury to the Apalápa-Marma, situated below the Ansa-kuta ( balls of the shoulders ) and above the sides (meeting of the different branches of the sub-clavicle veins i.e. axilla), transforms the blood of the organism into pus and proves fatal thereby.

An injury to any of the Váyu-carrying vessels, known as the Apastambha-Marma ( meeting of the bifurcated branches of the bronchi lying on both the sides of the breast ), fills the Koshtha with the deranged Vayu ( tympanites ) accomapanied by cough and dyspepsia, and terminates in death. Thus the twelve Marma situated in the thorax and abdomen are described.

It is a Sirá-Marma to the length of 4 fingers, belonging to the Sadyah-Pránahara class.

It is a Sirá-Marma to the length of 4 fingers and of the Sadyah-Pranahara class.

It is a Sirá.Marma, 2 fingers in length and of the Kalantara class.

It is a Mánsa-Marma about half a finger in length and of the Kalantara class, (according to Vgabhata, of the Sadyo-Maraka class).

It is a Sirá-Marma, half a finger in length, and of the Kalantara class.

It is a Sirá-Marma, half a finger in length and belongs to the Kálántara class.

The Marma Or Vital Parts Of The Body. Part 6

Prishtha Marma

Now we shall discourse on the Marma in the back (of a man). An injury to any of the Katika-tarimas (sacro-iliac articulation), situated in the region of the S'roni (sacrum) on both sides of the spinal column, gives rise to an excessive haemorrhage and consequent pallor and ends in death. A hurt to any of the Kukundara Marma (lit: - a hollow - the great sacro-sciatic notch), situated on both sides of the spinal column and in the region slightly below the waist (in the loins), results in complete anaesthesia and inoperativeness of the lower extremities. A hurt to the Nitamva-Marma, attached to the side above the Sroni (pelvis) and attached inside to the muscles of the waists, gives rise to Sosha (atrophia) in the lower extremities, weakness and ultimately brings on death. An injury to the Pátrs'va-Sandhi-Marma (caelic axes) which are situated just at the middle below the extremities of the sides (Pars'va) and which lies attached at the middle between the loins at their lower regions, feels the Koshtha (abdomen) with the blood and results into death A hurt to the Vrihati-Marma which commencing from the roots of the breast course round both the sides of the spinal column (Pristha-vams'a), cause excessive bleeding, and the patient dies, as supervening symptoms arise from an excessive loss of blood. An injury to any of the 2 Arasa-phalaka-Marma situated on either side of the vertebral column and connected with the scapula brings on anesthesia or atrophy (Sosha) of the arms. There are 2 Marma known as Amsa-Marma which are situated on either side midway between the neck and the head of the arms and connect the Amsa-Pitha (glenoid cavity) and the Skandha (shoulder). An injury to any of these Marma is attended with an incapacity of moving the hands. Thus the 14 Marma in the back have been described.

It is an Asthi-Marma, half a finger in length and of the Kálantara-maraka class.

They are Joint-Marma (Sandhi), half a finger in length and of the Vaikalyakara group.

It is a bone Marma, half a finger in length, and of the Kálantara class.

It is a Sirá-Marma to the length of half a finger and belongs to the Kálantara class.

They are Sirá-Marma (arterial anestomsis) to the length of half a finger and belong to the Kálántara class.

The Jatrugata-Marma

Now we shall describe the Marma which are situated in the regions above the clavicles (Urddhva-Jatru). There are 4 Dhamani ( arteries ) about the 2 sides of the Kantha-Nadi (wind-pipe). 2 of them are known as Nilá, and the other 2 as Manyá. 1 Nila and 1 Manyá are situated on either side of the larynx, (i.e , anterior and posterior side of the larynx). An injury to any of them produces dumbness, and change of voice (hoarseness), and also the loss of the faculty of taste. An injury to any of the 8 Sirás ( arteries ), 4 being on each side of the neck (Grivá), and known as Sirá-Mátrika-Marma ends fatally within the day.

It is an Asthi-Marma, half a finger in length and is Vaikalyakara.

They are Snáyu Marma, half a finger in length and of the Vaikalyakara class.

They are Sirá-Marma, to the length of 4 fingers and of the Vaikalyakara class.

They are Sirá-Marma, 4 fingers in length and of the Sadyo-Maran class.

An injury to any of the 2 Marma lying at the junction of the head and neck (Grivá) and known as Krikátika (transverse process of the arch of the atlas) results in a free movement of the head. A hurt to any of the Marma attached to the lower end of an ear (posterior cxtrensic ligament) and known as the Vidhura Marma results in the loss of hearing. An injury to the Phana-Marma attached to the interior channels of both the nostrils, results in the loss of the faculty of smell. An injury to the Apánga-Marma (Anastomosis of the infra-orbital artery) situated below the tips of the eye-brows and about the external corners of the eyes, brings on blindness or defective vision. An injury to the Avarta-Marma situated above and below the eye-brows, brings on blindness and impaired vision. An injury to the Sankha-Marma (meeting or suture of the temporal, frontal and sphenoid bones - Pterion), situated over the tips of the eye-brows and between the ears and the forehead, results in death within the day. The Marma situated over the 2 temples (Sankha) and at the border of the hair (sculp) are called Utkshepa-Marnia (meeting of the posterior and anterior temporal arteries). An extraction of a shaft (Salya) or of any extraneous pointed thing lodged into these Marma, results in the death of the patient, who, on the contrary, lives as long as the shaft is allowed to remain inside or if the shaft comes out itself (after putrefaction). An injury to the Sthapani-Marma (nasal arch of the frontal veins), situated in the middle of the eyebrows, ends in the manner of the preceding one. An injury to any of the 5 joints of the head which are known as the Simanta-Marma, results in fear, insensibility and madness of the patient and terminates in death. An injury to any of the 4 Sringa'taka-Marma which forms the junction of the 4 Sirás ( nerves ), (branches of the facial artery) and soothes the nose, the eyes, the ears and the tongue, proves fatal within the day. An injury to the Adhipati-Marma (the vertical groove on the frontal bone) which is marked in the inner side of the roof of the cranium by the Sirá-Sannipáta (superior longitudinal sinus), and on the exterior side by the ringlet of the hair (Romávarta) proves fatal within the day. Thus we have described the 37 Marma, situated in the region above the clavicles (Urddhva-Jatru).

An incision should be made at the spot a finger's width remote from the Urvi, Kurchcha-Sirá, Vitapa, Kaksha and a Párs'va-Marma;

whereas, a clear space of 2 fingers should be avoided from its situation in making any incision about the Stanamula, Manivandha or Gulpha-Marma.

Similarly a space of 3 fingers should be avoided from the Hridaya, Vasti, Kurchcha, Guda or Nábhi Marma;

and a space of 4 fingers should be avoided in respect of the 4 Sringátakas, 5 Simantas and 10 Marma in the neck (Nilá etc.);

a space of half a finger being the rule in respect of the remaining (56) Men, versed in the science of surgery, have laid down the rule that, in a case of surgical operation, the situation and dimension of each local Marma should be first taken into account and the incision should be made in a way so as not to affect that particular Marma, in as much as an incision, even extending or affecting, in the least, the edge or the side of the Marma, may prove fatal. Hence all the Marma-Sthánas should be carefully avoided in a surgical operation.

The amputation of a hand or a leg may not prove fatal whereas a wound in any of the Marma situated therein is sure to bring on death. The vessels become contracted in the case of a cut in the leg or in the hand of a man, and hence the incidental bleeding is comparatively scantier. Therefore it is that a cut in any of these parts of the body, however painful, does not necessarily prove fatal, like the lopping off of the branches of a tree. On the contrary, a man pierced into in any such Marma, as the Kshipra or the Tala, suffers from excessive haemorrhage (from the affected part) and attended with an excruciating pain, owing to the derangement of the Váyu, and meets his doom like a tree whose roots have been severed. Hence, in a case of piercing or of injury to any of these Marma, the hand or the leg should be immediately amputated at the wrist or at the ankle (respectively).

Some are of opinion that a surgical operation (in the case of the remaining 56) should be made, leaving a space equal in measurement to the dimensions of a palm (from the affected part). Gayádása, having learnt from Bhoja, explains that a space of 2 fingers should be left (from the affected part) in making surgical operations of the ten Marma, namely, the 2 Gulphas, the roots of the 2 breasts, the 4 Indravastis, and the 2 Manivaudhas.

The medical authorities have described the Marma to have covered half in the scope of Salya Tantra (Surgery), in as much as a person hurt in any of the Marma dies presently (i.e., within 7 days of the hurt). A deformity of the organ is sure to result from an injury to one of these Marma, even if death be averted by a course of judicious and skillful medical treatment.

The life of the patient is not to be despaired of even in the case of fracture or crushing of a bone of the Koshtha, Sirah and Kapála or perforation of the intestines etc , if the local Marma are found not to be in any way hurt or affected. Recovery is common in cases of cuts (pierce) in the Sakthi, Bhuja, Páda and Kara or in any other part of the body and even where a whole leg or hand is found to be severed and carried away if the Marma are not in any way hurt or affected.

These Marma form the primary seats of the Váyu, the Soma (lunar) and Tejas (fiery principles of the organism), as well as of the 3 fundamental qualities of Satva, Rajas and Tamas, and that is the reason why a man, hurt in any of the Marma, does not live.

An injury to a Marma of the Sadyah-Pránahara class (in which death occurs within a day) is attended with the imperfection of the sense organs, loss of consciousness, bewilderment of Manah (mind) and Buddhi (intellect) and various kinds of pain. An injury to a Marma of the Kalántara group (of a person) is sure to be attended with the loss of Dhátus (blood etc.) and various kinds of supervening symptoms (Upadrava) which end in death. The body of a person, hurt in any of the Vaikalyakara Marma, may remain operative only under a skillful medical treatment; but a deformity of the affected organ is inevitable. An injury to any of the Visályaghna Marma ends in death for the reasons mentioned above. An injury to any of the Rujákara Marma gives rise to various kinds of pain in the affected organ, which may ultimately bring about a deformity of the same, if placed under the treatment of an ignorant and unskillful Vaidya (Surgeon).

An injury to the adjacent part of a Marma, whether incidental to a cut, incision, blow (Abhigháta), burn, puncture, or to any other cause exhibits the same series of symptoms as an actually affected one. An injury to a Marma, whether it be severe or slight, is sure to bring deformity or death.

The diseases which are seated in the Marma, are generally serious, but they may be made to prove amenable with the greatest care and difficulty.

Gayádása does not read this verse.

Thus ends the sixth Chapter of the S'árira Sthánam in the Sus'ruta Saṃhitā, which treats of Marma.

Chapter VII. Sáriram Which Treats Of The Description And Classification Of Sirá Or Vascular System

also known as : Sira-Varnana-VibhaktináMa Sariram

There are 700 Sirás ( vessels ) in the human organism (except those which cannot be counted for their extremely attenuated size). The vessels (Sirás) by their contractibility and expansibility etc. sustain and nourish the organism in the same manner as streamlets and canals serve to keep a field or a garden moist and fruitful. From the principal or central trunk hundreds of small and minute vessels branch off and spread all over the body, just as small or minute fibres are found to emanate from the large central vein of the leaf of a plant. They originate from the umbilical region and thence they spread all over the body upwards and downwards and obliquely.

All the Siras ( vessels ) that are found in the organisms of created beings, originate from the umbilical region ( Nabhi ) and thence they spread all over their bodies. The life of an organic animal is seated in the vessels surrounding its navel which forms their starting point. The navel in its turn rests on or is attached to the Pranas ( the life-carrying vessels - nerves attached to it ) in the same manner as the nave of a wheel supports the spokes, and the spokes in their turn support the nave.

The Sanskrita term Sirá denotes veins, nerves, arteries and lymphatic vessels as well. Some read Sirá- Varna ( different colours of the Sirás) in lieu of Sirá-varnana (description of Sirás ).

Most probably the idea is derive 1 from the appearance of the Sirás in their foetal state.

Principal Siras

Of these Siras ( vessels ), 40 are principal ones, of which:

  • 10 are Váyu-carrying Sirás ( nerves )
  • 10 are Pitta-carrying Sirás ( veins )
  • 10 convey Kapha (lymphatic vessels)
  • 10 are blood-carrying Sirás ( arteries )

Of these the Váyu-carrying Sirás, situated in the specific receptacle of that bodily principle (Váta), are again found to branch out in 175 smaller branches (ramifications). Similarly, each of the remaining Pitta-carrying, Kapha-carrying and blood-carrying vessels (Sirás) situated in their specific receptacles, (ie, in the receptacles of Pitta, Kapha and spleen and liver respectively) are found to branch out in as many numbers (175), - thus making a total of 700 in all.

Their Specific Locations

  • 25 Váyu-carrying Sirás ( nerves ) in one leg and the same count applies to the other.
  • 25 Váyu-carrying Sirás ( vessels ) in each of the hands.
  • 34 Váyu-carrying Sirás ( vessels in the Koshtha trunk ); of these
    • 8 occur in the pelvic regions attached with the anus and the penis;
    • 2 in each of the sides
    • 6 in the back
    • 6 in the Udara ( cavity of the abdomen )
    • 10 in the region of the chest
  • 41 Váyu-carrying Sirás ( vessels ) situated in the region above the clavicles. Of these
    • 14 occur in the neck
    • 4 in the 2 ears
    • 9 in the tongue
    • 6 in the nose
    • 8 in the 2 eyes

Thus we have finished the description of the 175 Sirás that carry Váyu. What has been said of these Váyu-carrying vessels ( Siras ) will also hold good to the rest ( in blood-carrying, Pitta-carrying and Kapha-carrying channels in the respective regions of the body ), with the exception that in these 3 cases, ( Pitta, Kapha and blood ) 10 occur in the eyes and 2 in the ears in lieu of 8 and 4 respectively, as in the case of Váyu-carrying Sirás ( vessels ).

Thus we have described the 700 Sirás with their branches.

The Váyu-Carrying Sirás

The Váyu in its normal state and coursing through its specific Sirás ( vessels ) helps the unobstructed performance of its specific functions viz., expansion, contraction, speech, etc. and produces the clearness and non-illusiveness of Buddhi (intellect) and the sense-organs, whereas a coursing of the said Váyu in a deranged condition through the aforesaid Sirás ( vessels ), gives rise to a host of such diseases as are due to the derangement of Váyu.

The Pitta Carrying Siras

The Pitta in its normal state and coursing through its specific Siras ( vessels ) produces the healthy glow of complexion, relish for food, kindling of the appetite, healthfulnoss and other good effects, characteristic of the Pitta, which however being aggravated and coursing through them gives rise to a host of Pittaja diseases.

The Kapha-Conveying Siras

The Kapha in its normal state and coursing through its specific Sirás ( vessels ) smoothes and contributes to the firmness of the limbs and joints, improves the strength and produces all other good effects specially belonging to it, whereas the same Kapha, flowing through them in an aggravated condition, ushers in a large number of the Kaphaja distempers of the body.

The Rakta Carrying Siras

The blood in its normal state and flowing through its specific Sirás ( vessels ) strengthens the other fundamental principles (Dhatus) of the body, improves the complexion, aids the organ of touch in the proper performance of its functions and produces other functions characteristic of it in the body. Flowing through them in a vitiated condition, it begets diseases which are due to the derangement of the blood.

There is not a single Sirá (vessel) in the body which carries either the Váyu, or the Pitta or the Kapha alone. Hence each of the vessels should be regarded as affording an opportunity for conveying all kinds of the Doshas of the body, for as soon as they are deranged and aggravated they seem to flow through all the Sirás promiscuously.

Hence they are called Sarvā-vahah.

The vessels which carry the bodily Váyu ( nerves ) have a vermilion (yellowish red) hue and seem to be stuffed with Váyu. The Pitta-carrying vessels ( veins ) are coloured blue and felt warm to the touch. The Kapha-carrying vessels are hard, cold to the touch and white-coloured. The blood-carrying vessels ( arteries ) are red and neither too hot, nor too cold.

Now we shall describe the Sirás ( veins ) which a surgeon should not pierce or open, in as much as it may result in death, or bodily deformity. An intelligent surgeon shall always bear in mind that (should not be opened or bled on any account.) :

  • 16 out of the 400 vessels in the extremities
  • 32 out of the 136 vessels in the trunk
  • 50 out of the 64 vessels in the region above the clavicles,

Of the 100 vessels in a single leg, the 1 Jáladhará (which is attached to the connective tissue of the Kurchcha-Sirah) as well as the 3 internal ones, of which 2 are known as the Urvi-veins and the other as the Lohitáksha, together with the corresponding ones in the other leg and in the 2 hands, thus making 16 in all, which are situated in the upper and lower extremities, should be held unfit for opening.

Of the 32 veins in the pelvic region ( Sroni ), 8 such, known as the 4 Vitapas (2 on each side of the testicles) and the 4 known as the Katika-tarun as (2 on each side) should be considered unfit for bleeding or opening.

Of the 16 veins (8 on each side) at the sides, the 1 which courses upward from each of the 2 sides and is attached to the Marma known as the Párs'va-Sandhi, should be considered unfit for similar purposes.

Of the 24 Sirás which are found in either side of the spinal column, an incision should not be made into any of the 2 Sirás (on each side) known as the Vrihati and which run upward along either side of it (spinal column).

Similarly of the 24 Sirás in the abdomen, the 2 along each of the 2 sides of symphis pubis should be held unfit for opening or bleeding.

Of the 40 veins in the chest, the 2 in the heart, 2 in the root of each breast and 2 in each of the Stana-rohita (muscle of the breast) and 1 in each of the Apastambhas and Apalápas, making 14 in all, should not be opened. Thus 32 Sirás in the regions of the back (i e., the sides and the pelvic regions), the abdomen and the chest should be regarded as unfit for opening or other surgical purposes. There are 164 Sirás in the region above the clavicles.

Of these the 8 and 4 (making 12 and respectively known as the 8 Mátrikás, the 2 Nilas and the 2 Manyás) out of the 56 in the neck and the throat, should be regarded as unfit for opening. Similarly the 2 veins in the 2 Krikátikás and 2 in the 2 Vidhuras, should be held unfit for similar purposes; thus making 16 in all in the neck.

Of the 16 vessels (8 on each side), of the Hanus (Jaws), the 2 Siras about each of the joint of the jaw-bones should never be opened.

Of the 36 vessels in the tongue, 16 are situated in the under-surface of that organ, 20 in the upper surface; of these the 2 speech-carrying and the 2 taste-carrying ones should be held unfit for venesection.

Of the 24 vessels in the nose, the 4 adjacent to the nose proper and the 1 running into the soft palate should be held unfit for similar purposes.

Of the 38 vessels in the 2 eyes, the 1 situated at each Apánga should not be opened.

Of the 10 vessels in the 2 ears, the sound-carrying 1 in either ear should not be opened.

Of the 60 vessels of the nose and eyes coursing through the region of the forehead, the 4 vessels adjacent to the sculp proper and the Avarta-Marma should be held unfit for opening or bleeding. 1 vessel (Sirá) in each of the 2 Avartas and the 1 in the Sthapani-marma should not be opened (on any account).

Of the 10 vessels in the temple, the 1 about each temple-joint should be held unfit for opening or bleeding.

Of the 12 vessels in the head, the 1 in each of the 2 Utkshepa-Marma, 1 in each of the (5) Simanta-Marma and 1 in the Adhipati-Marma, should be held unfit for the purpose.

No incision or opening should be made into any of these 50 vessels situated in the region above the clavicles.

Gayi asserts that there are 8 each of the Váyu-carrying, Pitta-carrying, Kapha-carrying and blood-carrying Sirás in the region of the neck, thus making a total of 32 in place of 36 of the text.

He also holds that there are :

  • 28 in place of 36 Sirás in the tongue
  • 16 in place of 24 in the nose
  • 24 in place of 38 in the eyes
  • 16 in place of 10 in the ears
  • 08 in place of 10 in the temple

In the counting of the Sirás situate in the other parts of the body, he, however, does not differ from the text.

As the stem and leaves etc., of a lotus plant, originated from its bulb, spread over the whole surface of a pool or tank (lit: water), so the vessels emanating from the umbilicus of a man spread over his whole organism.

Thus ends the seventh Chapter of the S'árira Sthánam in the Sus ruta Saṃhitā which treats of the description and classification of Sirás ( vessels ).

Chapter VIII. Sáriram Which Treats Of The Method Of Venesection Etc. (Sira-Vyadha-Vidhi -Sáriram)

Persons Unfit For Venesection

The vessel or vessels (Sirá) of an infant, an old man, a perched man, one fatigued and emaciated with endocarditis (Kshata-kshina), a person of timid or coward disposition, a person used up with excessive drinking or sexual enjoyments or tired with the troubles of long journey, an intoxicated person, a patient who has been treated with purgatives, emetics or with Anubásana and Asthápana measures (enemas), a man who has passed a sleepless night, an impotent (Kliva) or emaciated person, an enceinte, or one afflicted with cough, asthma, high fever, phthisis convulsions, paralysis, thirst, epilepsy, or effects of fasting, should not be pierced or opened. Incisions should not be made into those veins (Sirás) which are not fit for opening, or into the fit ones, if invisible; it should be the same with those which cannot be properly ligatured or even if ligatured cannot be raised up.

Diseases which are amenable to acts of venesection have been described before (Sonita-Varnaniya-Adhyaya). Venesection may be performed in the said diseases as well as in those which have not been enumerated in connection with them and also in other cases whether suppurated or unsuppurated, if such a proceeding is deemed necessary and after the application of Sneha and Svéda. Venesection should be made even in the cases declared unfit for it (such as in an infant etc.) in cases of blood-poisoning (such as snake-bite etc.) and in fatal diseases (Vidradhi etc.).

Preliminary Rules

The patient should be duly fomented (Svéda) and anointed (Sneha) with oily preparations. A liquid * food or diet consisting of articles which are antidotal to the bodily principles (Doshas) which engendered the disease or Yavágu (gruel) should be given to him at first. Then at the proper season (i.e., not in the rainy or winter season etc.) the patient should be brought near the surgeon and made to sit or lie down and the part to be incised upon should be bound, neither too loosely (eg , in the extremities etc.) nor too tightly (e.g., in the head etc.), with any of the accessories, such as cloth, linen, skin, the inner fibres of a bark, creepers etc., so as not to create any pain or agitation in his mind. Then the vein should be duly opened with proper instrument (and with a careful regard to the situation of any local Marma).

Venesection should not be performed in an extremely cold or hot, cloudy or windy day. It is forbidden to open a vein without necessity or in a healthy person, or in a disease in which such as a proceeding is absolutely prohibited.

The Yantra-Vidhi

The patient whose vein is to be operated upon should be seated on a stool to the height of an Aratni (distance of the elbow from the tip of the small finger) with his face turned towards the sun. He should keep his legs in a drawn up or contracted posture resting his elbows (Kurpara) on his knee-joints and the hands with his 2 thumbs closed in his fists placed on (the upper ends of his Manyas (sterno mastoid muscles), Then having cast the binding linen on the 2 closed fists thus placed on the neck, the surgeon should ask another man from the back side of the patient to take hold of the two ends of the cloth with his left hand having the palm turned upward, and then ask him to tie up with his right hand the bandage round the part, neither too diffusely nor too tightly nor too loosely, so as to raise the vein and to press the bandage round the back for a good out-flow of blood. Then he (surgeon) should perform the operation in the desired spot, the patient having been previously asked to sit with his mouth full of air (i.e., he should confine his breathing till the surgical operation is completed). This proceeding should be adopted in opening any vein of the head, save those which are situated in the cavity of the mouth,

* A liquid food is recommended for the purpose of liquefying the blood so as to bleed easily.

In the case of opening a vein (Sirá.) in the leg, the affected leg should be placed on a level ground, while the other leg should be held in a somewhat contracted posture, at a little higher place. The affected leg should be bound with a piece of linen below its knee-joint and pressed with the hands down to the ankle. A ligature of the above kind should then be tied four fingers above the region to be incised upon, after which the vein should be opened.

In the case of opening a vein (Sirá) in the arms, the patient should be caused to sit easily and fixedly with his 2 thumbs closed in his fists (as above). A ligature of the above-mentioned kind (rope etc.,) should be tied (four fingers above the part to be incised upon and the vein opened in the aforesaid manner. The knee-joint and the elbow should be held in a contracted or drawn up posture at the time of opening a vein in a case of Gridhrasi (Sciatica and Vis'vachi, respectively. The patient should hold his back raised up and expanded and his head (and shoulders) bent down at the time of opening a vein in the back, shoulders and the Sroni ( hips ). He should hold his head thrust back and his chest and body expanded at the time of opening a vein in the chest or in the abdomen.

He shall embrace his own body with his arms at the time of opening a vein in his sides. The penis should be drawn downward (i.e., in an flaccid state) on a similar occasion in that region. The tongue should be raised up to the roof of the mouth and its fore-part supported by the teeth at the time of opening a vein in its under-surface. The patient should be told to keep his mouth fully open at the time of opening a vein in the gums or in the palate. Similarly a Surgeon should devise proper and adequate means for the purpose of raising up (distinct appearance of a Sirá ( vein ) and determine the nature of the bandage to be used therein according to the exigencies (i.e., the health and the kind of diseases of the patient), of each case.

An incision to the depth of a barley-corn should be made with a Vrihimukha instrument (into a vein situated) in the muscular parts of the body, whereas the instrument should be thrust only half that depth or to the depth of a Vrihi seed in other places (Vrihi here signifies S'ukadhdnya as well as Rakta-sáliy. An incision over a bone should be made with the Kutháriká (small surgical axe) to the half depth of a barleycorn.

An opening should be effected in such a day in the rainy season as would be devoid of the rumblings of a thunder-cloud, during the cold (i.e., in the fourth) part of the day in summer, and at noon in the winter season (Hemanta). These are the only three times of opening a vein. A well and successfully pierced vein bleeds in streams (almost simultaneously with the thrusting of the knife) and spontaneously stops after a Muhurta (a little while). The vitiated blood is seen first to flow out of an opened vein, like the drop of yellow pigment first coming out of a Kusumbha flower. Blood does not flow out from an incision made into a vein of an unconscious (Murchchhita), much frightened, or a thirsty patient. An incision of a vein without proper bandaging and raising up is attended with a similar result.

A weak person, or one affected with the unusual derangement of the bodily Doshas etc., or one fainted (under operation), should not be subjected to a measure of continuous blood-letting at a time; instead of that, the vein should be opened afresh in the same afternoon or on the following day, or on the third day (as the exigency requires). An intelligent surgeon should not allow the flow of blood to an excess but should stop the flow even with a remnant of the diseased blood in the system and administer soothing internal remedies (Sams'amana) for the purification of the diseased remnant. Bleeding to the quantity of a Prastha * measure should be deemed sufficient for a strong and adult patient, stuffed with a large quantity of the deranged Doshas (in the body).

The vein should be incised with a Vrihimukha instrument at a distance of two fingers above the seat of the Kshipra-marma in such diseases as Pádadáha, Páda-harsha, Ava-váhuka, Chippa, Visarpa, Váta-rakta, Váta-kantaka, Vicharchiká, Pádadári etc. The mode of opening a vein in the case of Slipada (Elephantiasis)

* In medicinal preparations, a Prastha measure is understood to be four seers in the case of liquids, but in cases of excreta due to emetic and putative measures and of blood-letting. a Prastha is meant to be thirteen Palas and a half only.

would be described under the treatment of that disease.

In Váta-rogas, such as Kroshtuka-Siráh (Synovites), maimedness (Pangu) and lameness (disability of walking due to crippling of the legs or feet) (Khanja) the Sirá ( vein ) of the Janghá (lower leg-calf), four fingers above the Gulpha, should be opened.

In cases of Apachi (scrofula), the vein should be opened simultaneously with the appearance of the disease two fingers below the Indravasti-marma.

In a case of Gridhrasi (sciatica), the vein should be opened four fingers above or below the Jánu (knee-joint).

In a case of goitre, the veins attached to the roots of the Uru (thighs) should be opened. The instructions regarding the opening of a vein in one leg shall hold good in the case of that in the other, as well as in cases of those situated in the two upper extremities (hands), but the speciality is that in a case of enlarged spleen, the vein near the Kurpara-sandhi (elbow-joint) of the left hand or that inside the fourth and the fifth fingers should be opened.

Similarly in a case of Yakriddályodara or Kaphodara, the corresponding vein in the right hand should be opened. Several authorities advise the opening of the same vein in cases of cough and asthma * due to the action of the deranged Kapha.

In a case of Vis'vachi, the same argument holds good four fingers above or below the Kurpara-sandhi as in a case of Gridhrasi.

In a case of Praváhiká (diarrhoea) attended with Sula (colic) - The vein within two fingers width around of the Pelvis ( Sroni ) should be opened.

In a case of Parikartiká. (D.R.-Parivartiká), Upadansa, Suka-dosha and seminal disorders - The vein of the penis should be opened.

In a case of hydrocele (Mutra-Vriddhi) - The vein on either side of the scrotum should be opened.

* Gayi holds that in cases of asthma and cough venesection should be had recourse to only when they are in a mild form.

The vein four fingers below the navel and on the left side of the Sevani (suture) should be opened in a case of Dakodara (ascites).

In a case of internal abscess and colic in the sides (Pleurodynia), the vein in the region between the breast and the left armpit should be opened.

Several authorities assert that in a case of Avaváhuka and Váhus'osha (atrophy of the hand), the vein between the Amsas (shoulders) should be opened.

In a case of Tritiyaka (Tertian) fever, the vein inside the Trika-Sandhi should be opened.

In a case of Chaturtliaka fever, a vein joined with either side of and below the shoulder-joint should be opened.

In a case of Apasmára, the middle vein adjacent to the joint of the jaw-bones (Hanu-Sandhi) should be opened.

In a case of insanity and hysteria * (Apasmára), the vein between the temple and the edge of the sculp or those in the Apánga (tips of the eyes), the forehead or the chest should be opened.

In cases of the diseases of the tongue and the teeth, the veins on the under-surface (Adho-Jihvá) of the tongue should be opened.

In the case of a disease of the palate, the local vein should be opened.

In diseases of the ears and specially in a case of inflammatory ear-ache (Karna-Sula), the vein along the region above the ears should be opened.

In diseases of the nose and specially in a case of the loss of the smelling faculty, the vein at the tip of the nose should be opened.

In cases of eye-diseases, such as Timira (blindness), Akshipáka (ophthalmia) etc., as well as in diseases of the head and in Adhimantha, the veins about the nose, the forehead and the Apánga (the outer canthus of the eyes), should be opened.

* Dallana, however, differs here from the text. He says, on the authority of Vágbhata, that the opening of a vein between the temple and the edge of the sculp or those in the Apánga, the forehead and the chest should be recommended in cases of insanity only, and not in the case of of Apasmára as well (as in the text).

Defective Venesection

Now we shall describe the twenty kinds of defects relating to an opened vein (Dushta-vyadhāna). They are as follows :

  • Durviddhá
  • Atividdhá
  • Kunchitá
  • Pichchitá
  • Kuttitá
  • Aprasrutá
  • Atyudirná
  • Ante-abhihatá
  • Paris'ushká
  • Kunitá
  • Vepitá
  • Anutthita-viddhá
  • śāstrahatá
  • Tiryag-viddhá
  • Apaviddhá
  • Avyadhyá
  • Vidrutá
  • Dhenuká
  • Punhpunarviddhá
  • Marmaviddhá

i.e., incised about the Sirá-marma, the Snáyu-marma, the Asthi-marma and the Sandhi-marma.

Durviddhá (badly incised) - The vein in which an act of venesection is unattended with a satisfactory outflow of blood owing to its being incised with an extremely slender instrument and is marked by an extremely painful swelling in consequence thereof called this name.

Atividdhá (over-incised) - The vein in which the incision becomes excessive and no blood comes out properly or enters an internal channel owing to the largeness of the incision.

Kunchitá(crooked or contracted) - An opened vein in which the incision has been made in a curving manner and is attended with the foregoing results.

Pichchitá (thrashed) - An incised vein presenting a flattened or thrashed appearance on account of its being opened with a blunt knife (Kantha-śāstra).

Kuttitá (lacerated) - The vein at the sides of which incisions have been successively made, instead of in its body.

Aprasrutá (unbleeding) - An incised vein, unattended with any bleeding owing to the patient's fright, coldness or loss of consciousness.

Atyudirná (improperly wide-incised) - A vein with a large incision in its body made with a sharp and flat-edged instrument.

Ante-abhihatá (struck in the interior) - An opened vein in which blood oozes out in small quantity.

Paris'ushká (dried up) - An opened vein in an anaemic patient (marked by a total absence of bleeding and) stuffed with Váyu (lit., as if the flow has been dried up by the Váyu).

Kuuitá (partially incised) - A vein opened but to a quarter part of the proper length and attended with a scanty outflow of blood.

Vepitá (quivering) - A vein which trembles owing to its being bandaged at a wrong place and from which blood does not flow out in consequence.

Anntthita-viddhá - A vein incised without being previously properly raised up and attended with a similar result (ie., absence of blood).

śāstrahatá (knife-cut) - A vein cut into two and attended with excessive bleeding and inoperativeness of the organ.

Tiryag-viddhá (obliquely incised) - A vein incis:d with an instrument applied slantingly and (consequently) not fully opened.

Apaviddha (wrongly incised) - A vein incised several times and (every time) with an improper instrument.

Avyádhyá (unfit for opening) - A vein unfit for opening (i.e., whose opening has been forbidden in the Sástras).

Vidrutá (erratic) - A vein opened carelessly and hastily.

Dhenuká - A vein bleeding continuously owing to its being repeatedly pressed and successively opened.

Punah-punarvidahá (repeatedly incised) - A vein variously cut owing to its being pierced into the same part with an extremely slender-pointed instrument.

If a vein in the Snáyu-Marma, the Asthi-Marma, the Sirá-Marma or the Sandhi-Marma be opened, it is called Marma-viddhá and in such cases severe pain, emaciation (Sosha) deformity or (even) death may be the result.

Practice (even) docs not give the necessary skill in surgical operation of the veins etc., as they are naturally unsteady and changing like fishes. Hence a vein should be opened with the greatest care. An opening into the body, made by an ignorant and unskilful surgeon, is attended with the aforesaid dangers and many other distressing symptoms. An act of venesection, properly performed, gives more speedy relief than that derived from the application of medicated oil etc , or of plaster as well. Venesection (bleeding) properly performed is half of the treatment described in surgery like the application of Vasti-karmas (enematic measures) in therapeutics.

A man medically anointed (Sneha-karma), diapho-rised (Svéda) vomited (Vamana), purged (Virechana), or treated with both the Vasti-karmas (Anuvásana and Asthápana) or bled shall forego anger, physical labour, sexual intercourse, sleep in the day time, excessive talking, physical exerciser, riding or driving etc., sitting on his haunches, frequent ramblings, exposure to cold, winds and the sun, hardly digestible, uncongenial and incompatible food until the strength is perfectly restored or, according to some authorities, for a month. These subjects will be fully dealt with later on Aturopa-drava-chikitsá. (ch. - 39).

The vitiated blood incarcerated in any part of the body should be abstracted therefrom by scarifying it, by cupping it with a Sirá (pipe), a horn, a gourd, or leeches, or by the opening of a vein respectively, according to the density of the blood. (Others assert that) leeches should be applied in the case of the (vitiated) blood being confined deep into the body, scarification with a surgical instrument should be made in the case of clotted blood, with a pipe in the case of extensive vitiation of the blood throughout the body and with a horn or a gourd in the case of the deranged blood having been seated in the skin.

Thus ends the eighth Chapter of the Sárira Sthánam in the Sus'rutá Saṃhitā which treats of venesection.

Chapter IX. Sáriram Which Treats Of The Description Of The Arteries, Nerves And Ducts, Etc.

also known as : Dhamani-VyáKarana-Sáriram

There are 24 Dhamanies ( ducts ) in all, and all of them have their origins in the naval region (which includes the whole abdominal region ). Several authorities assert that no arbitrary distinctions should be made among the Siras ( veins ), Dhamanis ( arteries ), and the Srotas, ( channels ), since Dhamanis and Srota are but different modifications of one original kind of Sirá ( vessels ). But this opinion is not a sound one in as much as they have got different natures, origins and functions and as being described so in the Áyurveéda. But owing to their adjacent positions, the existence of several authoritative dicta (Apta-vak) regarding the oneness of their character, similarity of their functions, and the minute nature of their shape, they appear to be homologous in their action, even amidst the real diversities in their work and office.

Of the twenty-four Dhamanis, which (originally) have their roots in the naval region (Nábhi), ten have upward course, ten have downward course, and four flow laterally or transversely.

Functions Of The Up-Coursing Dhamanis

The 10 up-coursing Dhamanis ( nerves )

* Sans. Dhama - to be filled with air, so called from the fact of their being distended with air after death.

+ So far, as in foetal life, allantoic arteries and the unbilical veins subserve the purposes of nutrition, excretion, etc , and reflects the rudimentary vascular system.

perform such specific functions of the body, as sound, touch, taste, sight, smell, inspiration, sighing, yawning, sneezing, laughter, speech, and weeping, etc., and tend to maintain the integrity of the body. These Dhamanis, reaching the heart, respectively ramify themselves into three branches, thus making thirty (ramifications in all). 10 of these serve the following purposes, viz :

  • 2 serve as the channels of the bodily Váyu,
  • 2 of the Pitta,
  • 2 of the Kapha,
  • 2 of the blood,
  • 2 of the Rasa (lymph chyle)

Eight of the remaining ones (twenty), serve the following functions, viz., two of them carry sound, two sight or colour, two smell, and two taste. Moreover a man speaks with the help of another two, makes sound with the help of another couple, sleeps through the instrumentality of another pair (couple), and wakes up with the help of another couple. Two of the Dhamanis ( ducts ) carry the fluid of lachry-mation, two of them ( ducts ), attached to the breasts of a woman, carry milk of her breasts, which, coursing through the breast of a man, convey his seminal fluid. Thus we have described the thirty Dhamanis with their ramifications. These sustain and maintain the integrity (of the limbs and members of the body) above the (line of) umbilicus, such as the Udara, the sides, the back the chest, the neck, the shoulders and the arms.

The up-coursing Dhamanis duly perform the offices stated above. Now I shall describe the specific functions, etc., (i.e., nature, office, and situations, etc.) of the down-coursing ones.

Functions Of The Down-Coursing Dhamanis

The down-coursing Dhamanis respectively form the channels for the downward conveyance of Váyu (flatus), urine, stool, semen, and catamenial fluid, etc. These Dhamanis reaching down into the Pittás'aya (receptacle of the Pitta) separate the serum prepared out of the food and drink through the agency of the local heat and pitta, and carry it to the remotest parts of the organism maintaining their healthy moisture, supplying them with the necessary principles of nutrition and (ultimately) conveying them to the up-coursing and lateral Dhamanis, in order to be conveyed to the parts traversed by them respectively. Thus they indirectly serve to supply the heart with its quota of healthy Rasa (serus fluid), if not in a direct way. Moreover they tend to separate the effetematter (urine, stool and sweat) from the fully transformed lymph-chyle in the abdomen, the stomach and the small intestines (Amás'aya and Pakvás'aya). Each of the down-coursing Dhamanis is found to ramify into three branches at a place midway between the Amás'aya (stomach) and the Pakvás'aya (intestines).

Thus they number 30 in all.

The functions of the 10 out of these (30 vessels) are as follows, viz. :

  • 2 serve to carry Váyu
  • 2 Pitta
  • 2 Kapha
  • 2 blood
  • 2 Rasa (lymph-chyle)

  • 2 of these Dhamanis, running into the intestines, carry the food
  • another 2 carry the Toya * (watery) part
  • another 2 running into the bladder, serve to carry out the urine (from the bladder)
  • another 2 carry the semen
  • another 2 serve as the channels of transmission and emission of the same fluid and serve to carry the ovarian discharge in women

  • 2 Dhamanis, attached to the large intestine (Sthulántra), serve as the channels of faecal matter
  • while the remaining 8 convey perspiration to the lateral-coursing Dhamanis

Thus we have finished describing these 30 Dhamanis with their ramifications.

These sustain and maintain the integrity of the parts of the body below the naval region, such as the Pakvás'aya (Intestine), the waist, the organic principles of stool and urine, the organs of generation, the anus, the bladder, and the lower limbs of the body (Sakthi) (according to their utility in the physical economy of the organism).

* This watery part reaching the bladder is transformed into urine.

These down-coursing Dhamanis perform the afore-said functions. Now I shall describe the specific functions (i.e., nature, office, and situations, etc.,) of the lateral-coursing Dhamanis.

Functions Of The Lateral Coursing Dhamanis

The four lateral-coursing Dhamanis, gradually ramifying themselves into hundreds and thousands of branches, simply baffle counting. The net-work of these Dhamanis spreads over the whole orgnism and maintain its integrity. Their exterior orifices are attached to the roots of hairs (pores of the skin) through which they convey the perspiration and the Rasa ( serum ), thus supplying the body, both internally and externally, with the soothing nutritions (moisture of healthy lymph-chyle). The effects and potencies of the articles of anointment, sprinkling, immersion, and plasters, enter through these orifices into the internal organism through the agency of the heat in the skin, and sensations of a pleasant or painful contact are experienced through their instrumentality. Thus we have finished describing the four lateral-coursing Dhamanis with their ramifications throughout the whole organism.

The Dhamanis have got pores in their sides through which they carry the Rasa (lymph-chyle) throughout the organism, like the filaments and fibres of water-lily and lotus. There Dhamanis furnish the self-conscious Ego, confined in the material body, which is the resultant of the combination of the 5 material elements, with a distinct sensation * peculiar to each of the five sense-organs and break up the combination (of the 5 material elements) at the time of death.

Now we shall describe the symptoms produced by a Srota (duct or channel) pierced at its root or starting point. The ducts or channels respectively conveying the life, the food, the water, (the organic principle of) the Rasa ( serum ), the blood, the muscles, the fat, the urine, the stool, the semen, and the cata-menial blood, naturally fall within the scope of Surgery (Salya-tantra). Several authorities assert that the Srota ( vessels ) are innumerable , and perform different functions in their different aspects.

The two Srota ( channels ) of Prána (bronchi) have their roots in the heart and the Rasa-carrying Dhama-nis (pulmonary arteries). An injury to any of these Srota ( vessels ) produces groaning, bending down of the body, loss of consciousness (Moha), illusion, and shivering, or may ultimately prove fatal. The food-carrying Srota (AEsophagus) have their roots in the Amásaya (stomach) and in the food-carrying Dhamanis (intestines). An injury to or piercing of such a duct (Srota), gives rise to tympanites, colic pain, aversion to food, vomiting, thirst, blindness or darkness of vision, or may even end in death. There are two water-carrying (Udaka-vaha) ducts or channels which have their roots in the palate and the Kloma, and a piecing of any

* Hearing, touch, smell, taste, and sight.

Eyes, ears, nose, tongue and skin.

But this science does not take any cognisance of them, since the pain incidental to a piercing of, or an injury to, any of these extremely attenuated channels, must be slight in its character, of these makes the patient thirsty and ends in his instantaneous death (i.e. within seven days).

  • The serum carrying (Rasa-vaha) ducts are 2 in number and have their roots in (the viscus of) the heart and the serum-carrying Dhamanis ( vessels ).
    An injury to or piercing of any of these ducts gives rise to Sosha ( consumption ) and symptoms identical with those developed by a hurt to the Prana-vaha channels of the body, ending in death.
  • The blood-carrying Srota ( channels ) are 2 in number and have their roots in the spleen and the liver, and the blood-carrying Dhamanis (capillaries in general).
    An injury to any of these channels is attended with pallor, bluishness of complexion, fever, burning sensations, excessive haemorrhage, and redness of the eyes.
  • The 2 muscle-carrying Srota (ducts or channels) have their roots in the ( Snáyu ), nerves Tvak ( serum ), and the blood-carrying Dhamanis (capillaries).
    An injury to any of these channels is characterised by swelling, loss or atrophy of the muscles, appearance of varicose veins or may (ultimately) result in death.
  • The fat-carrying Srota ( ducts ) are 2 in number and have their roots in the region of the Kati (waist) and the Vrikkas (kidneys).
    An injury to any of these bring in (a copious flow of) perspiration, oily gloss of the skin, parched condition of the palate, extensive swelling (of the affected locality) and thirst.
  • The 2 urine carrying Srota ( channels ) have their roots in the bladder and the penis (urethra).
    An injury to any of these is marked by constipation or epistaxis in the bladder, retention of urine, and numbness of the genitals.
  • The 2 stool-carrying Srota ( ducts ) have their roots in the Guda (anus) and the Pakvás'aya (intestines).
    An injury to any of these is characterised by complete retention of stool (in the bowels), accompanied by a distention of the abdomen, foul smell and intussusception of the intestine (as in a case of enterites).
  • The 2 semen-carrying Srota ( ducts ) have their roots in the breasts and the testes.
    An injury to any of them leads to loss of manhood, delayed emission of semen, or blood-streaked character of that fluid.
  • The 2 Artava-carrying Srota ( ducts ) have their roots in the uterus as well as in the Dhamanis which carry the Artava (ovarian product).
    An injury to any of these brings on sterility, suppression of the menses and incapacity for copulation.

A cutting to the Sevani (median raphe of the perineum) exhibits symptoms identical with those of a case of injured bladder or anus, described before. A physician may take in hand the medical treatment of a case of a Srota which has been pierced, but he shall not necessarily entertain any hope of ultimate success. (But time works wonders, and such a case may sometimes end in recovery). A case of pierced duct, from which the dart (Salya, or the like piercing matter) has been extricated, may be medically treated (without holding out any prospect of recovery to the friends of the patient), according to the direction laid down under the head of ulcer ( Vrana ).

The ducts emanating from the cavity of the heart, other than the Sirás( veins ), Dhamanis ( arteries ), and found to course through the whole body, arc called Srota (lit. channels or currents).

Thus ends the ninth Chapter of the S'árira Sthánam in the Sus'ruta Saṃhitā which treats of the descriptions of the arteries, cucts and nerves.

Chapter X. Sariram Which Treats Of The Nursing And Management, Etc.,

Of Pregnant Women From The Day Of Conception Till Parturition

also known as : Garbhini -VyáKarana-Sariram

General Rules

An enciente, from the first day of conception, should always cherish a clear joyful spirit in a clem body. She should wear clean and white garments, ornaments, etc. engage herself in the doing of peace-giving and benedictory rites and live in devotion to the gods, the Brāhmiṇs and her elders and superiors. She should not touch nor come into contact with unclean, deformed or maimed persons, and should forego the use of fetid smelling things, avoid dreadful sights and painful or agitating sounds and the use of dry, stale and dirty food as well as that prepared overnight. Long and distant walks from home, resorts to cremation-grounds or to a solitary retreat, or to a Chaitya *, and sitting under the shadow of a tree should be absolutely forbidden (to her during the period of gestation). Indulgence in anger, fright or other agitating emotions of the mind should be deemed injurious. To carry a heavy load, to talk in a loud voice and all other things which might occasion injury to the foetus, (sexual intercourse, etc.) should be refrained from. The practice of constant anointment and the cleansing of the body, etc. (with Amalaki, Haridrá, etc. - lit. cosmetics) should be given up. All fatiguing exercises should be discontinued and the rules laid down for the guidance of a woman in her menses should be strictly-adhered to. The couch and the bed of a pregnant woman should be low, soft and guarded on all sides by a number of soft pillows or cushions. The food should be amply sweet, palatable (Hridya) * well-cooked, prepared with appetising drugs and abounding in fluid substances. These rules should be followed up till delivery.

* Chaitya - is a haunted or diefied tree, or according to others a Budhistic monastery.

Special Regimen During The Period Of Gestation

During the first three months of pregnancy an enciente should partake of food abounding in sweet, cool and fluid articles. Several medical authorities recommend a food made of Shashtika rice with milk, to be given to her specially in the third month of gestation, with curd in the fourth, with milk in the fifth and with clarified butter in the sixth month of pregnancy. Food largely composed of milk and butter, as well as relishing (Hridya) food with the soup of the flesh of jángala (wild) animals should be given to her in the fourth, food with milk and clarified butter in the fifth, adequate quantity of clarified butter prepared with (the decoction of) Svadamshtrá, or gruel (Yavágu) in the sixth; and clarified butter prepared with (the decoction of) the Prithak-parnyádi group in adequate quantities in the seventh month of gestation. These help the foetal development. For the purpose of restoring the Váyu of her body (nervous system) to the normal course and condition and for the cleansing of the bowels, the enciente should be given an Asthápana (enema), composed of a decoction of Vadara mixed with Valá, Ativalá, Satapushpá, Palala (flesh), milk, cream of curd, oil, Saindhava salt, Madana fruit, honey and clarified butter. After that she should have an Anuvásana (enema) made up of oil prepared with milk and decoction of the drugs known as the Madhurádi-gana. This restores the Váyu to its normal course and condition, which brings on an easy and natural parturition unattended with any puerperal disorders. Henceforth up to the time of delivery the enciente should have liquid food (Yavágu) made up of emollient substances (fats; and soup of the flesh of Jángala animals (deer, etc.). If treated on these lines the enciente remains healthy and strong, and parturition becomes easy and unattended with evils. An enciente should be made to enter the lying-in chamber in the ninth month of her pregnancy and under the auspices of happy stars and propitious lunar conditions. The chamber of confinement (Sutiká-griha) in respect of a Brāhmiṇ, Kshatriya, Vais'ya and Sudra mother should be raised on grounds respectively possessed of white, red, yellow and black soils, and made of Vilva, Vata, Tinduka and Bhallátaka wood. Couches should be made of these woods respectively in cases of the different social orders. The walls of the room should be well-plastered and the furniture (necessary accessories) should be placed tidy in their proper places. The door of a lying-in chamber should be made to face the south or the east, and the inner dimensions of the room should be eight cubits in length and four in breadth. Religious rites for warding off the visitation of evil spirits and malignant stars should be undertaken at (the door of) the room.

* "Hridya" here means the diet in which there is an abundance of Ojo-producing (albuminous) properties.

The Nursing And Management Of Pregnant Women. Part 2

Signs Of Imminent Parturition - (M. - T.)

A looseness of the sides of the abdomen and untying of the umbilical cord of the child (from the cardiac cord of its mother) and a perception of the characteristic pain at the waist would indicate the approach of the time of delivery. A constant and severe pain at the waist and the back, constant (involuntary) motions of the bowels and micturition and mucous discharge from the vulva arc the symptoms which are manifest at the time (i.e., a little before) of parturition.

Preliminary Measures

Rites of benediction should be performed for the safety of the enciente in her travail and she should be made to pronounce benedictory Mantras surrounded by male babies on all sides. A fruit with a masculine name should be given in her hand. Her body should be anointed with oil and washed with warm water and she should be made to drink largely a gruel (Yavágu) made of articles (which exert a beneficial virtue at the time). Then she should be laid on her back on a soft and sufficiently spacious bed, her head being placed on a pillow and her legs slightly flexed and drawn up. Four elderly ladies with paired finger-nails and skilled in the art of accouchement and with whom she feels no delicacy, should attend and nurse her at the time.

Then after having gently lubricated the mouth of the parturient canal along the natural direction of the pubic hairs (Anuloma) (so as not to create any discomfort in the part) one of them (elderly ladies) should address the enciente as follows: - "O fortunate damsel, try to bear down the child, but do not make such an attempt in the absence of real pain." On experiencing an untying of the umbilical cord of the child, the enciente should gently make such urgings, whenever she will experience pain in the pelvic, pudendal and pubic regions and in the region between the neck of the bladder and the pelvis. Deep urgings should be made on the exit of the foetus out of the uterus, and after that deeper urgings should be made during the passage of the child through the canal until delivery.

An urging (made by the enciente) in the absence of any real pain may lead to deafness, dumbness and deformity of the jaw-bones of the child or subject it to attacks of cough, asthma, consumption, etc., or lead to the diseases of its head, or to the birth of a haunch-backed or deformed child. A case of abnormal presentation (Pratiloma) should be converted into the normal or cephalic one (Anuloma) by version *.

In the case of protracted delivery, e.g., an obstruction of the child at the vagina, - the vagina should be fumigated with the fumes of the slough (cast-off skin) of a cobra (snake) or with the fumes of Pinditaka (Madana) or the roots of Hiraṇyapushpi (Kantakári) should be tied (round the neck or the waist) or Suvar-chala (Atasi) or Vis'alyá (Pátalá) should be tied round the hand (wrist) and leg (ankle) of the parturient woman.

Post-Parturient Measures

The shreds or membranes lying on the body of the child should be removed immediately after its birth and its mouth should be cleansed with clarified butter and rock-salt. Then a linen pad soaked in clarified butter should be applied on the head of the new-born baby. Then the umbilical cord, after having been slightly drawn out, should be ligatured with one end of a string at a point eight fingers apart from its navel, the other end of the string being tied round its neck; then the umbilical cord should be severed immediately above the ligature.

* The various forms of (Pratiloma) abnormal presentations have been described under MuJha-Garbha Nidánam (Nidán-Sthána - Chap. IX.) and their treatment is to be found in Chikitsá-Sthána - Chap. XV.

Brāhmadcva recommends Valá-Taila instead of clarified butter.

The Nursing And Management Of Pregnant Women. Part 3

Natal Rites

Then having sprayed (the face of) the baby with cold water, the post-natal rites should be performed unto it. After that the baby should be made to lick an electuary composed of honey, clarified butter and the expressed juice of Bráhmi leaves and Anantá, mixed with (half a Rati weight of) gold dust and given with the ring-finger of the feeder. Then the body of the child should be anointed with Valá-taila and it should be bathed in an infusion of the barks of Kshiri trees, or in the washings (decoctions) of drugs known as the Sarvāgandha (Eládi group), or in water in which red-hot gold or silver bar has been immersed, or in a tepid decoction of Kapittha leaves, according to the nature of the season, the preponderance of the deranged Doshas in its body and according to its physical conditions.

Diet For The Child-(M.-T)

The milk in the breasts of a newly parturient woman sets in three or four days after parturition owing to the dilation of the orifices of the milk ducts (galactoferous ducts). Hence the baby should be fed thrice daily (morning, noon and evening) on a handful child's own hand) of clarified butter and honey mixed with (a Rati weight of) pulverized Anantá roots sanctified with Mantras on the first day; and on the second and third days the child should be fed on clarified butter prepared with the Lakshaná (root). On the following (fourth) day the child should be fed on its handful of honey and clarified butter only twice (i.e. in the morning and at noon). (From the evening of fourth day) the mother should first squeeze off a quantity of her milk and then give the child her breast. (This rule should be observed at the time of tending the child every day).

Treatment Of The Mother

The body of the mother should be anointed (after parturition) with the Valá-Taila and treated (both internally and externally) with a decoction of Váyu-subduing drugs (such as the Bhadra-Dárvádigroup, etc.). If still there be any abnormality in the condition of the Doshas (the discharge of vitiated blood i e, lochia), the mother should be given to drink a luke-warm solution of treacle mixed with powders of Pippali, Pippali roots, Hasti-pippall, Chitraka and S'ringavera, and the medicine should be continued for two or three days or longer, (if necessary), till the disappearance of the vitiated blood (lochia). When the discharge gets normal (i e., on the appearance of healthy lochia), the mother should be made to take for three days a gruel (Yavágu) prepared with the decoction of the drugs constituting the Vidári-Gandhddi Gana and mixed with (a good quantity of; clarified butter or a Yavágu prepared in milk. After that a meal of boiled Sáli-rice and a broth made from the meats of Jángala animals boiled with barley, Kola and Kulattha pulse, should be prescribed for her, taking into consideration the strength and the condition of her appetite (Agni or digesting power). The mother should observe this regimen of diet and conduct for one month and a half (after delivery). After this period she may be at liberty to choose any food to her liking and revert to her natural mode of living. According to several authorities, however, a woman does not regain her natural temperament of body till the reappearance of the healthy menstruation (after parturition).

A strong but newly delivered woman, born and bred up in a Jángala country should be given to drink, for three or five nights, either oil or clarified butter in an adequate quantity with an after-potion consisting of the decoction of drugs constituting the group known as the Pippalyádi Gana. She should be daily anointed with oil, etc. If, however, of delicate health, she should be made to take, for three or five nights in succession, a medicated Yavágu (gruel) as described in the last para. Thenceforth a diet of demulcent properties should be prescribed for her and her body should be regularly washed with a copious quantity of tepid water. A mother, after parturition, should forego (for a considerable time) sexual intercourse, physical labour and indulgence in irascible emotions * etc.

Any disease acquired by a newly delivered mother (Sutiká) by her injudicious conduct of life soon lapses into one of a difficult type (hard to cure); and it becomes incurable if it be due to too much fasting. Hence a wise physician should treat her with such measures as are natural and congenial to her temperament, the time, the place and the nature of the disease, so that she may not be afflicted with any evil effect.

A placenta retained in the uterus causes constipation (Anáha) of the bowels and distention of the abdomen (tympanites). Hence in such a case her throat should be tickled with a finger covered with hair; or the exterior orifice of the vagina should be fumigated with the fumes of the cast-offskin of a snake, Katuka, Alavu, Kritavedhāna and mustard seeds mixed with mustard oil. In the alternative, a plaster of Lángali roots should be applied to the palms and soles of her hands and feet; or the milky juice of Snuki tree should be applied over her scalp; or a compound made of pasted Lángali roots and Kushtha mixed with either wine or the cow's urine should be given her for drink. A Kalka either of S'áli roots or of the drugs constituting the Pippalyadi Gana mixed with wine (Surá) should be given her for the purpose In the alternative, an Asthápana (enema) of white mustard seeds Kushtha (Kuda), Lángali, and the milky juice of Mahá-vriksha, mixed with Surá-manda should be prescribed. (If the above measures fail) an Uttara-Vasti (uterine douche) prepared with the aforesaid drugs and boiled in mustard oil should be applied; or else the placenta should be removed by the hand lubricated with an oleaginous substance and with the nails clipped off.

* Fifteen kinds of emotions as described in the thirty-ninth chapter of the Chikitsa-sthanam.

The Nursing And Management Of Pregnant Women. Part 4

Makkalla And Its Treatment

The lochia of a newly delivered woman whose organism has become excessively dry on account of profuse use of absorbants or deranged by any other causes, - the lochia being obstructed in its exit by the local Váyu, - gives rise to Granthis (nodules) which may appear below the navel, on the sides of the pelvis about the region of the bladder or of the pubis. Severe piercing pain (Sula) is felt about the region of the navel, the stomach and the bladder and a sensation of pricking with needle and cutting pain in the intestines. At the same time the abdomen becomes distended with the retention of urine. These are the symptoms of Makkalla. In such a case, a decoction of the drugs of the Viratarvddi Gana mixed with a powdered compound of the Ushakádi Gana should be given her. In the alternative, a potion of carbonate of potash [Vavakshára) dissolved in tepid water or in clarified butter; of rocksalt dissolved in the decoction of the Pippalyádi Gana; of a compound made of the powdered drugs of the latter Gana with Surá-manda; of the powders of cardamom and Pancha-kolas dissolved in the decoction of the drugs of the Varunádi Gana; of the powders of pepper and Bhadraddru dissolved in the decoction of the Prithakparnyddi Gana; or of pulverized Trikatu, Chaturjátaka and Kustumburu mixed with old treacle; or of simple Arishta, should be prescribed.

Management Of The Child

The baby being wrapped up in silk should be laid on a bed covered with a silken sheet; it should be fanned with the branches of a Pilu, Nimba, Vadari, or Parushaka tree. A (thin) pad (Pichu) soaked in oil should be constantly kept on the head of the child, and its body should be fumigated with the fumes of drugs (e,g., Vacha, mustard, etc.) potent enough to keep off the (evil) influences of demons and evil spirits. The same drugs should be tied round the neck, hands, legs and head of the infant and the floor of the lying-in room should be kept strewn over with pounded sesamum, mustard, linseed (Atasi). A fire should also be kept kindled in the chamber. Measures laid down in the chapter on the nursing of an Ulcer-patient (chapter IX (Sáriram Which Treats Of The Description Of The Arteries, Nerves And Ducts, Etc. (Dhamani-VyáKarana-Sáriram)). Sũtra.) should be observed in the present case as well.

Then on the tenth day of its birth the parents having performed the necessary rites of benediction and celebrated the occasion with suitable festivities, shall give the child a name of their own choice or one determined by its natal astrism, etc.

Lactation And Selection Of A Wet-Nurse

For the healthy growth of the child a wet-nurse should be selected from among the matrons of its own caste (Varna) and possessed of the following necessary qualifications. She should be of middle stature, neither too old nor too young (middle-aged), of sound health, of good character (not irascible or easily excitable), not fickle, ungreedy, neither too thin nor too corpulent, with lips unprotruded, and with healthy and pure milk in her breasts which should neither be too much pendulent nor drawn up. It should be carefully observed that her skin is healthy and unmarked by any moles or stains, she being free from any sort of crime (such as gambling, day-sleep, debauchery, etc.). She should be of an affectionate heart, and with all her children living.

She should be of respectable parentage and consequently possessed of many good qualities, with an exuberance of milk in her breasts, and not in the habit of doing anything that degrades woman in life. A "Syama" girl possessed of the aforesaid qualities makes a good wet-nurse. A child nursed at the breast of a woman with upturned or unprominent nipples is apt to be deformed (Karála) in features, while extremely pendulous (large and flabby) breasts may suffocate the child by covering its mouth and nostrils. Having chosen a wet-nurse of the commendable type, the child with its head well-washed should, on an auspicious day, be laid on her lap wrapped in a clean and untorn linen. The face of the child should be turned towards the north, while the nurse should look to the east at the time. Then, after first having a small quantity of the milk pressed out and the breast washed and consecrated with the following Mantras (incantations) the child should be made to suck her right breast.

"O, thou beautiful damsel, may the four oceans of the earth contribute to the secretion of milk in thy breasts for the purpose of improving the bodily strength of the child. O, thou with a beautiful face, may the child, reared on your milk, attain a long life, like the gods made immortal with drinks of ambrosia".

A child nursed at the breast of any and every woman for want of a nurse of the commendable type, may fall an easy prey to disease, owing to the fact of the promiscuous nature of the milk proving incongenial to its physical temperament. The milk of a nurse not being pressed out and spelled off at the outset may produce cough, difficulty of breathing, or vomiting of the child, owing to the sudden rush of the accumulated milk into its throat choking up the channels. Hence a child should not be allowed to suck in such milk.

The loss or suppression of the milk in the breasts of a woman is usually due to anger, grief, and the absence of natural affection for her child, etc. For the purpose of establishing a flow in her breast, her equanimity should be first restored, and diets consisting of Sáli-rice, barley, wheat, Shashtika, meat-soup, wine (Surá) Souviraka, sesamum-paste, garlic, fish, Kas'eruka, S'ringdtaka, lotus-stalk, Vidári-Kāṇḍa, Madhuka flower, S'atátari, Naliká, Alávu, and Kála-S'dka, etc. should be prescribed.

The Nursing And Management Of Pregnant Women. Part 5

Examination, Etc. Of Milk

The breast-milk of a nurse or a mother should be tested by casting it in water. The milk which is thin, cold, clear, and tinged like the hue of a conch-shell, is found to be easily miscibre with water, does not give rise to froths and shreds, and neither floats nor sinks in water, should be regarded as pure and healthy. A child fed on such milk is sure to thrive and gain in strentgh and health. A child should not be allowed to take the breast of a hungry, aggrieved, fatigued, too thin, too corpulent, fevered, or a pregnant woman, nor of one in whom the assimilated food is followed by an acid reaction, or of one who is fond of incongenial and unhealthy dietary, or whose fundamental principles are vitiated. A child should not be given the breast until an administered medicine is assimilated in its organism, lest this should give rise to a violent aggravation of the pharmacological action of the medicine, as well as of the deranged Doshas (Váyu, Pitta, etc.),and the refuse matters (Malas) of its body.

The Doshas (Váyu, Pitta and Kapha) of a wet-nurse arc aggravated by ingestion of indigestible or incompatible food, or of those articles which tend to derange the Doshas of the body, and hence her milk may be vitiated. A child, fed on the vitiated milk of a woman, vitiated by the deranged Doshas owing to injudicious and intemperate eating and living, falls an easy prey to physical disease, An intelligent physician in such a case should devise means for the purification of the milk as well as of the deranged Doshas which account for such vitiation (in as much as the medication of the child alone will not produce any satisfactory effect).

Infantile Diseases And Their Diagnosis

A child constantly couches its diseased part or organ and cries for the least touch (by another of that part of its body). If the seat of disease be its head, the child cannot raise nor move that organ and remains with its eyes closely shut. A disease seated in its bladder gives rise to retention of urine, thirst, pain and occasional fainting fits. A retention of urine and stool, discolouring of complexion, vomiting, distention of the abdomen, and gurgling in the intestines indicate the seat of the disease to be its Koshtha (colon). A constant crying (and the child's refusal to be consoled) would signify that the diseased principle (morbiferous diathesis) extends all through its organism.

Treatment Of Infants

Medicines laid down under the head of a particular disease should likewise be prescribed in the case of its appearance in a child or an infant; but then only the remedies of mild potency and those which do not tend to disintegrate the bodily fat and Kapha should be given in adequate doses (according to age, etc.) as mentioned hereafter and administered through the vehicle of milk and clarified butter, to a child living on milk alone, while the nurse also is to take the same medicines as well. * In the case of a child fed both on milk and (boiled) rice (Kshiránnada, i.e., living on both solid and liquid food) the medicine should be administered both to the child and its wet-nurse. In the case of a child living on solid food only, decoctions (Kashaya) etc. should be given to the child and not to the nurse. Medicines to the quantity of a small pinchful may be prescribed for a suckling who has completed its first month of life. Kalkas (medicated pastes) should be given to a child fed on both milk and rice to the size of a stone of a plum-fruit (Kola), and the dose for a child fed on rice (solid food) only being to the size of a plum (Kola). ‼/p>

* Milk and clarified butter being congenial to the constitution of infants should be used as vehicles for drugs in their cases but, these are not necessary in the case of the nurse.

According to several other authorities, the dosage in the case of children is to be regulated as follows:-

In the case of a child, one month old, drugs should be given in the form of an electuary through the vehicle of milk, honey, syrup, clarified butter, etc. - the dose being one Rati (about two grains) at first, and gradually increased by a Rati a month, till it completes one year. After this time the dose is to be one Máshá (about twenty grains) for each year of age till he is fifteen.

This dosage, however, does not apply in the present age. - Ed.

In the case of any disease of a child nursed at the breast, the breasts of the nurse should be plastered with the pastes of drugs recommended by physicians for the particular malady (instead of giving the drugs to the child), and the child made to suck the same. The use of clarified butter is not beneficial to a child on the first day of an attack of Váta-jvara (fever due to the derangement of the bodily Váyu), within the first 2 days of an attack of Pittaja fever, and within the first 3 days of that of Kaphaja fever. But the use of clarified butter may be prescribed for an infant fed on milk and boiled rice, or on boiled rice alone, according to requirements.

In case of fever a child should be given no suck at all, lest the symptoms of thirst might develop. Purgatives, Vastis, or emetics are forbidden in the disease of children, unless the disease threatens to take a fatal course.

If the local Váyu aggravated by the waste of brain-materials ( Mastulunga ), bends down the palate bone of a child attended with an excessive thirst and agony, clarified butter boiled with ( the decoction and Kalka of ) the drugs of the Madhura Gana, should be used both internally and externally, and the patient should as well be treated with spray of cold water ( to stimulate him ).

The disease in which the navel of a child becomes swollen and painful, is called Tundi. It should be remedied by applying fomentations, medicated oils, Upanáhas, etc., possessed of the virtue of subduing the Váyu. A suppuration of the anal region (Guda-páka) of a child should be treated with Pittaghna ( Pitta-destroying ) measures and medicines. Rasánjana used internally and externally (as an unguent) proves very efficacious in these cases.

The Nursing And Management Of Pregnant Women. Part 6

Infantile Elixirs

Infant fed exclusively on milk, should be given:

Clarified butter cooked with ( the decoction and Kalka of ) white mustard seeds, Vachá, Mánsi, Payasyá, Apámdrga, S'atávari, Sárivá, Bráhmi, Pippali, Haridrá, Kushtha and Saindkava salt.

Infant fed both on milk and ( boiled ) rice ( solid and liquid food ), should be given:

Clarified butter prepared with ( the docoction and Kalka of ) Madhuka ( Yashtimadhu ), Vacha, Chitraka, Pippali and Triphalá.

Infant fed on ( boiled ) rice ( solid food ), should be given:

Clarified butter boiled with ( the decoction and Kalka of ) Das'amula, milk, Tagara, Bhadmáru, Maricha, honey, Vidanga, Drákshá and the two sorts of Bráhmis.

By these the health, strength, intellect and longivity of the child is improved.

A child should be so handled or lifted as not to cause any discomfort. A baby should not be scolded, nor suddenly roused up ( from sleep ), lest it might get awfully frightened. It should not be suddenly drawn up nor suddenly laid down, lest this should result in the derangement of its bodily Váyu. An attempt to seat it (before it has learnt to sit steadily), may lead to haunch-back ( Kyphosis ). Lovingly should a child be fondled and amused with toys and play-things. A child unruffled by any of the above ways becomes healthy, cheerful and intelligent as it grows older. An infant should be guarded against any exposure to the rains, the sun,or the glare of lightning. He should not be placed under a tree or a creeper, in low lands, and in lonely houses or in their shades (caves); and it should be protected from the malignant influences of evil stars and occult powers.

A child should not be left ( alone ) in an unclean and unholy place, nor under the sky (uncovered place), nor over an undulating ground, nor should it be exposed to heat, storm, rain, dust, smoke and water. Milk is congenial to the organism of a chiid, ie., it is its proper food. Hence in the absence of sufficient breast-milk, the child should be given the milk of a cow or of a she-goat in adequate quantities.

In the sixth month of its birth the child should be fed on light and wholesome boiled rice. A child should always be kept in an inner apartment of the house, and religious rites should be performed on its behalf for the propitiation of evil deities, and it should be carefully guarded against the influences of evil stars.

Symptoms When A Malignant Star, Etc., Strikes

The child looks frightened and agitated, cries, becomes unconscious at times, wounds himself or its nurse with its teeth and finger-nails, gnashes its teeth, crooks, yawns, or moves its eye-brows with upturned eyes, vomits frothy matter, bites its lips, becomes cross, passes loose stool mixed with shreds of mucus, cries in an agonised voice, becomes dull in complexion, becomes weak, does not sleep in the night, does not suck the breast as before, or emits a fishy, bug-like or mole-like smell from its body - these are the general symptoms exhibited by a child under the influence of a malignant star or planet which will be specifically described later on in the Uttara-Tantra.

The Nursing And Management Of Pregnant Women. Part 7

Education And Marriage

The education of a child should be commenced at a suitable age and with subjects proper to the particular social Varna or order it belongs to. On attaining the 25th year he should marry a girl of 12yrs old. A conformity to these rules, is sure to crown him with health, satisfaction, progeny and a capacity for fully discharging the religious rites and paying off his parental debts.

An offspring of a girl below the age of 16 by a man below twenty-five is usually found to die in the womb. Such a child, in the event of its being born alive, dies a premature death or else becomes weak in organs ( Indriyas ). Hence a girl of extremely tender age should not be fecundated at all. An extremely old woman, or one suffering from a chronic affection ( of the generative organ ), or afflicted with any other disease, should not be likewise impregnated. A man with similar disabilities should be held likewise unfit.

A foetus, on the point of being miscarried on account of the above-mentioned causes, produces pain in the uterus, bladder, waist ( Kati ), and the inguinal regions ( Vamkshana ) and bleeding. In such a case, the patient should be treated with cold baths, sprays of cold water and medicated plaster ( Pradeha ) etc. at the time, and milk * boiled with drugs constituting the Jivaniya group, should be given to her for drink. In case of unusual movements of the foetus in the womb, the enciente should be given a drink of milk boiled with the drugs of Utpaládi Gana, for soothing and making it steady in its place.

A foetus being displaced from its normal position produces the following symptoms, viz , pain or spasms in the back and the sides ( Pars'va ), burning sensation, excessive discharge of blood and retention of urine and foeces A foetus changing place or shifting from one place to another, swells up the abdomen ( Koshtha ). Cooling and soothing measures should be adopted in such cases.

* Jivaniya drugs 2 Tolas, milk 16 Tolas and water 64 Tolas, to be boiled and reduced to 16 Tolas, i e., to weight of the milk.

Medical Treatment

In a case of pain under the circumstances, the enciente should be made to drink a potion consisting of milk boiled with Mahá-sa/ia, Kshudrasahá, Madhuka flower, S'vadanstrá and Kantakári, mixed with sugar and honey.

In the case of retention of urine, the patient should be made to drink a potion of milk boiled with drugs known as the Dárvádi Gana ( mixed with sugar and honey ).

In the case of A'náha ( retention of stool attended with distention of the abdomen ), a potion consisting of milk boiled with asafetida, Sauvarchala salt,garlic and Vacha (mixed with honey and sugar) should be given.

In cases of excessive bleeding, linctus made of the powdered chamber of a Koshthágáriká insect *, Samangá Dhátaki flowers, Navamáliká, Gairika, resin and Rasán-jana, or of as many of them as would be available, mixed with honey, should be licked.

In the alternative, the bark and sprouts of the drugs known as the Nya-grodhádi Gana mixed with boiled milk should be administered, or a Kalka of the drugs of the Utpaládi group mixed with boiled milk should be used, or a Kalka of S'áluka, S'ringataka and Kas'eru mixed with boiled milk should be given.

As a further alternative, the enciente may be made to eat cakes made of powdered Sáli rice with the decoction of Udumbara fruit and Audaka-Kāṇḍa, mixed with honey and sugar. A piece of linen or a plug soaked in the expressed juice of the drugs of the Nyagrodhádi group should be inserted into the passage of the vagina.

In a case of pain unattended with bleeding, the enciente should be made to drink a potion composed of milk-boiled with Madhuka (Yashtimadhu), Devaddru and Payasyá; or with As'mantaka, Satávari and Payasyá; or with the drugs of the group of Vidárigandhádi Gana; or with Vriháti, Kantakári, Utpala, S'atávari, Sárivá, Payasyá and Madhuka ( Yashtimadhu ). These remedies speedily applied tend to alleviate the pain and make the foetus steady in the womb.

* There is a kind of insect which makes its chamber with earth generally under the ceiling or on the walls, This earth should be used.

After the foetus has been steadied by the aforesaid mesaures, a diet consisting of ( boiled rice and ) cow's milk, boiled with the dried tender fruits of Udumvara, should be prescribed for the patient. In the event of miscarriage, the patient should be made to drink a Yavágu ( gruel ) of the Uddálaka rice, etc. cooked with the decoction of the Páchaniya group ( Pippalyádi ) and devoid of all saline and fatty matter, for a number of days corresponding to that of the month of gestation. Old treacle mixed with the powdered drugs of the Dipaniya group ( Pancha-kola ), or simply some Arishta ( Abhayárishta, etc. ), should be given, in the event of there being pain in the pelvis, bladder and abdomen.

The internal ducts and channels ( Srota ) stuffed with aggravated Váyu lead to the weakening ( Laya ) of the foetus and, if the state continues, it leads even to its death. Hence the case should be treated with mild anointing measures, etc., ( Sneha-karma, etc. ) and gruels made of the flesh of the birds of the Utkros'a species and mixed with a sufficient quantity of clarified butter, should be given to her. As an alternative, Kulmasha * boiled with Másha, sesamum and pieces of dried ( tender ) Vilva fruit should be given her, after which she should be made to drink, for a week, honey and Máddhvika ( a kind of weak wine ). At the non-delivery of the child even after the lapse of the full term of gestation, the enciente should be made to thrash corn with a pestle in an Udukhala or mortar ( husking apparatus ) or should be made to|sit or move (on legs or by conveyance), on an uneven ground.

* "Kulmasha" may mean either Kulattha pulse or half boiled wheat, barley, etc.

Atrophy of a foetus in the womb should be ascribed to the action of the deranged Váyu. This is detected by the comparatively lesser fulness of the abdomen of the enciente and slow movement of the foetus in the womb. In such a case, the enciente should be treated with milk, with the Vrimhaniya ( of restorative and constructive properties ) drugs, and with meat-soup.*

A combination of ovum and semen affected by the deranged Váyu in the womb, may not give rise to a successful fecundation ( living impregnated matter ), but leads to a distention of the abdomen (as in pregnancy), which again, at any time, may disappear of itself. And this is ascribed by the ignorant to the malignant influence of Naigamesha (spirits). Such an impregnated matter, sometimes lying concealed in the uterus, is called Nágodara, which should be treated with the remedies laid down under the head of Lina-Garbha ( weak foetus ).

Now we shall discourse on the management of pregnancy according to the months (period) of gestation. Metrical Texts: - The following receipes, such as :

( 1 ) Madhuka (Yashtimadhu), S'ákavija, Payasyá, and Devadáru;
( 2 ) As'mantaka, black sesamum, pippali, Manjishthá, Támra-valli and Satávari;
( 3 ) Vrikshádani, Payasyá, Latá, (Durvá), Utpala and Sárivá;
( 4 ) Anantá, Sárivá, Rásná, Padma, and Madhuka (Yashtimadhu);
( 5 ) Vrihati, Kantakári, Kas'mari, sprouts (Sunga) and barks of milk-exuding trees (as, Vata, etc.), and clarified butter ;
( 6 ) Pris'ni-parni, Valá, Sigru, S'vadanshtrá and Madhuparnika; and
( 7 ) S'ring'taka, Visa (stalks of lotus), Drákshá, Kas'aru, Madhuka (Yashtimadhu), and sugar; should successively be given with milk * to an enciente, from the first to the seventh month of her gestation, in the case of a threatened miscarraige or abortion.

* The particle "cha" in the text signifies the use of any other constructive tonic,

An enciente should be made to drink milk boiled with the roots of Kapittha, Vrihati, Vilva, Patola, Ikshu and Kantakári, (in case of impending or threatened miscarraige) in the eighth month of her pregnancy. In the ninth month (and under similar conditions), the potion should be made up of Madhuka ( Yashtimadhu ), Ananta-mula, Payashá and Sárivá. In the tenth month (and under similar conditions), a potion consisting of milk boiled with Sunthi and Payasyá is beneficial,or, in the alternative, may be given a potion made up of milk with Sunthi, Madhuka (Liquorice; and Devadáru. The severe pain would vanish and the foetus would continue to develop safely in the womb, under the aforesaid mode of treatment.

A child born of a woman, who had remained sterile ( not-conceived ) for a period of 6 years ( Niviitta-prasavá ) * after a previous child-birth, becomes a shortlived one.

* Chakradatta reads "Visam" ( stalks of lotus ) instead of "Ghritam" ( clarified butter ).

If a conception does not, occur in a woman for a period of more than five years after a child-birth, she is called Nivritta-prasavsá.

* Sivadása also says that powders of these drugs should be given with boiled milk, but he adds that some authorities recommend theae drugs to be boiled in milk according to Kshira-páka-vidhi.

Application of mild emetic medicines, ( though forbidden in the case of a pregnant woman ), may be resorted to, in the case of a fatal disease, ( even in that stage ). A diet consisting of sweet and acid things should be prescribed for her, so as to bring the deranged Doshas to the normal state; mild Sams'amaniya ( soothing and pacifying ) medicines should be applied and food and drink consisting of articles mild in their potency, predominently sweet-tasting and not injurious to the foetus, should be advised and mild ( external ) measures not baneful to the foetus should be resorted to, according to the requirements of the case.

The growth, memory, strength and intellect of a child are improved by the use of the following 4 medicinal compounds, used as linctus ( Prás'a ) viz.,

( 1 ) well-powdered gold, Kushtha, honey, clarified butter and Vacha;
( 2 ) Matsyákshaka * (Bráhmi), Sankha-puspi, powdered gold, clarified butter and honey;
( 3 ) Arkapuspi, honey, clarified butter powdered gold and Vacha; and
( 4 ) powdered gold, Kaitaryyah (Mahá-Nimba), white Durbá, clarified butter and honey.

Thus ends the tenth Chapter of the S'árira Sthánam in the Sus'iuta Saṃhitā, which treats of the nursing and management etc. of pregnant women.

* Some, however, explain Matsyákshaka to be Dhuslura; others again say it is a kind of red-flowered shrub grown in the Anupa country.

The word "5'veta," in the Text, may either be adjective to "Durva" and mean "white" or it may mean white Vacha or white Aparajitá or white Durvá.

Here ends the Sárira Sthánam.


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