Complications of purification therapies

In smoking, ayoga is the use by which the disease increases.

A footnote adds that some call ayoga the use by which the disease is not calmed.

Using suitable drugs in a larger measure than proper is called atiyoga; yoga, ayoga and atiyoga are to be considered in every medicinal procedure.

The text says that in emesis galakshati occurs in place of the parikartika of purgation, kapha dripping in place of downward discharge, and dry belching in place of pravahika; thus fifteen complications each of emesis and purgation have been described with their remedies.

The editor's footnote says each of emesis and purgation has fifteen complications, as stated earlier; since parikartika arises only when purgation goes wrong and parisrava and the like cannot occur in emesis, emesis is given its own complications to make up its fifteen.

The complications are said to arise from faults of the nozzle, of the bag and of the insertion, among others.

In a dry person whose body has not been prepared by oleation and sweating, a dry medicine of weak potency or too small a dose goes neither up nor down, so neither vomiting nor purgation occurs; this is called ayoga.

Very sharp medicine given for emesis or purgation to a person thoroughly oleated and sweated, with a very soft bowel, is said to cause atiyoga (excessive vomiting or purging).

The text says an enema with very cold drugs, drugs of little strength or too small a quantity causes ayoga.

The text says that a very sharp enema, in large quantity according to the commentary, given suddenly to a person with few doshas, a soft bowel or a body that has been well sweated, causes severe atiyoga.

It agitates the mass of doshas and causes bloating (adhmana), seizure of the heart (hridgraha), thirst, burning and fainting; the patient is then made to vomit fully again (with strong drugs), and the verse also allows oleating him and purging downward.

In one who has vomited poorly (durvanta), the great doshas stirred up and rising through the body cause swelling, fever, small boils, itching with kushtha, weak digestive fire and beating and splitting pains, so he should be purified completely; the commentary does not paraphrase this half-verse.

In excessive emesis too much pitta comes out, with exhaustion, loss of strength and provoked vata; the patient is bathed with cold water and purged with sugarcane juice and drugs of cooling quality.

In excessive purgation much kapha comes out and then blood as well, with loss of strength and provoked vata; the patient is quickly bathed or sprinkled with cold water, given asthapana and anuvasana enemas of cold milk and ghee, and treated with the medicines and diet laid down for diarrhoea.

When excessive emesis grows worse, blood appears in the spittle and is vomited, both eyes bulge, the tongue loses its sense of taste and protrudes, and hiccup, belching, thirst, fainting and stiffness of the jaw follow.

When excessive purgation grows worse, clear water with a peacock-feather sheen (chandrika) comes out, then water like the washings of meat, then life-blood (jivashonita), followed by prolapse of the rectum, trembling of the limbs and the complications described for excessive emesis.

The enema goes upward and does not come out, causing severe bloating and intense pain.

Excessive smoking is said to cause constant ringing in the ears, headache, weakness of sight, loss of taste, burning and thirst.

Note: The commentary writes अयोग where the verse has अतियोग.

If the purgative does not move the bowels properly or at all and stays in the stomach, hot water is drunk at once and the back, both flanks and abdomen are fomented with heated palms, so that the doshas liquefy and flow out within moments.

If only a little dosha comes out and the medicine is digested, then, knowing that much dosha remains, the patient is strong and much of the day is left, an unfailing dose is given again; if purgation still does not occur, the body is prepared daily with oleation and sweating and with asthapana and anuvasana enemas before a beneficial purgation is given.

For spitting and vomiting of blood, the treatment prescribed for excessive bleeding is followed; hiccup, belching, thirst and the like get their own prescribed treatments.

The physician treats these with the measures given for heavy bleeding; the prolapsed rectum is smeared with warm oil (or oiled and fomented) and pushed back in, as in the treatment of rectal prolapse among the minor diseases, and trembling is always treated as a vata disorder.

These complications of excessive smoking are overcome with nourishing of the head, nasya and ghees.

The treatment given for the complications of excessive smoking is also to be used when nasya has been excessive.

A footnote gives वियोग as a variant reading in verse 65, where the text prints अयोगविशेष followed by a query mark.

An editor's footnote gives the variant reading इंदुकरसंशीतौषधैः in verse 68, which would mean seating the patient in moonlight and using cooling drugs.