आमपक्वैषणीयाध्यायः
अथात आमपक्वैषणीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
"Now, we shall expound the chapter on the examination of uncooked and cooked (incomplete and complete digestion) food."
"Thus said the venerable Dhanvantari."
This introduction sets the stage for a discussion on how to examine and understand the stages of digestion, specifically focusing on incomplete and complete digestion, as instructed by Dhanvantari.
शोफसमुत्थाना ग्रन्थिविद्रध्यलजीप्रभृतयः प्रायेण व्याधयोऽभिहिता अनेकाकृतयः, तैर्विलक्षणः पृथुर्ग्रथितः समो विषमो वा त्वङ्मांसस्थायी दोषसङ्घातः शरीरैकदेशोत्थितः शोफ इत्युच्यते ||३||
"Diseases such as granulomas, abscesses, and boils are often mentioned as varied in forms. Among them, Shotha (swelling) is described as a significant condition characterized by a mass of doshas (bodily humors) that is large, knotted, smooth, or uneven, situated in the skin and muscle tissues, and arising in a specific part of the body."
This shloka explains that various diseases, including granulomas, abscesses, and boils, come in different forms. It highlights Shotha (swelling) as a significant condition involving a mass of doshas in the skin and muscle tissues, which can be large, knotted, smooth, or uneven, and appears in specific body parts.
स षड्विधो वातपित्तकफशोणितसन्निपातागन्तुनिमित्तः |
तस्य दोषरूपव्यञ्जनैर्लक्षणानि व्याख्यास्यामः |
तत्र, वातशोफः कृष्णोऽरुणो वा परुषो मृदुरनवस्थितास्तोदादयश्चात्र वेदनाविशेषा भवन्ति; पित्तशोफः पीतो मृदुः सरक्तो वा शीघ्रानुसार्योषादयश्चात्र वेदनाविशेषा भवन्ति; श्लेष्मश्वयथुः पाण्डुः कठिनः स्निग्धः शीतो स्निग्धो मन्दानुसारी कण्ड्वादयश्चात्र वेदनाविशेषा भवन्ति; सर्ववर्णवेदनः सन्निपातश्वयथुः; पित्तवच् छोणितजोऽतिकृष्णश्च; पित्तरक्तलक्षण आगन्तुर्लोहितावभासश्च ||४||
"Swelling can be of six types: caused by Vata, Pitta, Kapha, blood, a combination of all three doshas, or external factors. We will describe the symptoms according to the nature of these doshas. Vata-induced swelling is blackish or reddish, rough, soft, unstable, with piercing pain. Pitta-induced swelling is yellow, soft, mixed with blood, spreading quickly, with burning pain. Kapha-induced swelling is pale, hard, smooth, cold, slowly spreading, with itching. Combination swelling shows all colors and pains; blood-induced swelling is very black. Symptoms of external swelling are similar to those of Pitta-induced swelling, with a reddish hue."
This shloka explains that swelling can be caused by six different factors: Vata, Pitta, Kapha, blood, a combination of all three doshas, or external factors. Each type has distinct symptoms such as color, texture, and specific sensations, which help in identifying the cause and choosing the appropriate treatment.
स यदा बाह्याभ्यन्तरैः क्रियाविशेषैर्न सम्भावितः प्रशमयितुं क्रियाविपर्ययाद्बहुत्वाद्वा दोषाणां तदा पाकाभिमुखो भवति |
तस्यामस्य पच्यमानस्य पक्वस्य च लक्षणमुच्यमानमुपधारय- |
तत्र, मन्दोष्मता त्वक्सवर्णता शीतशोफता स्थैर्यं मन्दवेदनताऽल्पशोफता चामलक्षणमुद्दिष्टं; सूचिभिरिव निस्तुद्यते, दश्यत इव पिपीलिकाभिः, ताभिश्च संसर्प्यत इव, छिद्यत इव शस्त्रेण, भिद्यत इव शक्तिभिः, ताड्यत इव दण्डेन, पीड्यत इव पाणिना, घट्यत इव चाङ्गुल्या, दह्यते पच्यत इव चाग्निक्षाराभ्याम्, ओषचोषपरीदाहाश्च भवन्ति, वृश्चिकविद्ध इव च स्थानासनशयनेषु न शान्तिमुपैति, आध्मातबस्तिरिवाततश्च शोफो भवति , त्वग्वैवर्ण्यं शोफाभिवृद्धिर्ज्वरदाहपिपासा भक्तारुचिश्च पच्यमानलिङ्गं; वेदनोपशान्तिः पाण्डुताऽल्पशोफता वलीप्रादुर्भावस्त्वक्परिपुटनं निम्नदर्शनमङ्गुल्याऽवपीडिते प्रत्युन्नमनं, बस्ताविवोदकसञ्चरणं पूयस्य प्रपीडयत्येकमन्तमन्ते चावपीडिते, मुहुर्मुहुस्तोदः कण्डूरुन्नतता व्याधेरुपद्रवशान्तिर्भक्ताभिकाङ्क्षा च पक्वलिङ्गम् |
कफजेषु तु रोगेषु गम्भीरगतित्वादभिघातजेषु वा केषुचिदसमस्तं पक्वलक्षणं दृष्ट्वा पक्वमपक्वमिति मन्यमानो भिषङ्मोहमुपैति; तत्र हि त्वक्सवर्णता शीतशोफता स्थैर्यमल्परुजताऽश्मवच्च घनता, न मोहमुपेयादिति ||५||
"When swelling cannot be managed by internal and external treatments due to excessive doshas or incorrect treatments, it tends to suppurate. The signs of a swelling about to suppurate and already suppurated are as follows: Initial signs include mild heat, unchanged skin color, cold, stable, mild pain, and small swelling. Symptoms progress to pricking pain, sensation like ant bites, sharp cutting pain, burning as if by fire or alkali, redness, fever, and increased thirst. If the swelling is suppurated, it shows pallor, reduced size, wrinkling, softening, and sensation of fluid movement. Immediate pricking pain, itching, elevation, and exudation may occur. In Kapha conditions, the deep-seated symptoms can be confusing. Even if some signs of suppuration are absent, consider it suppurated if it has dense, stone-like hardness without discoloration, cold, stable, and less painful."
This shloka explains the progression of swelling that cannot be managed by treatments, leading to suppuration. Early signs include mild heat, unchanged skin color, coldness, stability, mild pain, and small swelling. Symptoms may worsen to pricking pain, sensations like ant bites, sharp cutting pain, burning as if by fire or alkali, redness, fever, and increased thirst. If the swelling suppurates, signs include pallor, reduced size, wrinkling, softening, fluid movement sensation, immediate pricking pain, itching, elevation, and exudation. In Kapha conditions, deep-seated symptoms can be confusing, but the swelling should be treated as suppurated if it has dense, stone-like hardness, no discoloration, cold, stability, and less pain.
भवन्ति चात्र-
आमं विपच्यमानं च सम्यक् पक्वं च यो भिषक् |
जानीयात् स भवेद्वैद्यः शेषास्तस्करवृत्तयः ||६||
"He who knows how to distinguish between uncooked (Ama), being-cooked (Vipachyamana), and well-cooked (Samyak Pakva) stages of swelling is a true physician; the rest have the nature of thieves."
This shloka emphasizes the importance of a physician’s ability to differentiate between the various stages of swelling: uncooked (Ama), being-cooked (Vipachyamana), and well-cooked (Samyak Pakva). It suggests that only those who can accurately identify these stages are true physicians, while others are akin to thieves in their practice.
वातादृते नास्ति रुजा न पाकः पित्तादृते नास्ति कफाच्च पूयः |
तस्मात् समस्तान् परिपाककाले पचन्ति शोफांस्त्रय एव दोषाः ||७||
कालान्तरेणाभ्युदितं तु पित्तं कृत्वा वशे वातकफौ प्रसह्य |
पचत्यतः शोणितमेव पाको मतोऽपरेषां विदुषां द्वितीयः ||८||
"Without Vata, there is no pain; without Pitta, there is no suppuration; without Kapha, there is no pus. Therefore, during the process of suppuration, the three doshas are involved in causing swelling. Over time, Pitta takes control, subdues Vata and Kapha, and causes suppuration. According to some experts, the second type of suppuration involves blood."
This shloka explains that pain, suppuration, and pus formation are governed by Vata, Pitta, and Kapha respectively. During suppuration, all three doshas contribute to the swelling. Over time, Pitta dominates and suppresses Vata and Kapha, leading to suppuration. Some scholars believe that the second type of suppuration involves blood.
तत्र, आमच्छेदे मांससिरास्नायुसन्ध्यस्थिव्यापादनमतिमात्रं शोणितातिप्रवृत्तिर्वेदनाप्रादुर्भावोऽवदरणमनेकोपद्रवदर्शनं क्षतविद्रधिर्वा भवति |
स यदा भयमोहाभ्यां पक्वमप्यपक्वमिति मन्यमानश्चिरमुपेक्षते व्याधिं वैद्यस्तदा गम्भीरानुगतो द्वारमलभमानः पूयः स्वमाश्रयमवदार्योत्सङ्गं महान्तमवकाशं कृत्वा नाडीं जनयित्वा कृच्छ्रसाध्यो भवत्यसाध्यो वेति ||९||
"If an uncooked (Ama) swelling is incised, it may result in severe damage to muscles, veins, ligaments, joints, or bones, excessive bleeding, sudden onset of pain, tearing, multiple complications, or ulceration. When a physician, out of fear or ignorance, delays treating a condition thinking it to be unripe (Ama) even when it is ripe (Pakva), the pus penetrates deeply, creating a large cavity and forming a sinus, making it very difficult or even impossible to treat."
This shloka warns against incising an uncooked swelling as it can cause extensive damage and complications. It also highlights the danger of delaying treatment due to misjudgment, which can lead to deep infection and formation of a sinus, making it very difficult or impossible to treat.
भवति चात्र-
यश्छिनत्त्याममज्ञानाद्यश्च पक्वमुपेक्षते |
श्वपचाविव मन्तव्यौ तावनिश्चितकारिणौ ||१०||
"One who incises an uncooked (Ama) swelling out of ignorance, and one who neglects a ripe (Pakva) swelling, should both be regarded as similar to outcasts for their uncertain actions."
This shloka strongly criticizes those who incise an uncooked swelling out of ignorance and those who neglect a ripe swelling. Such actions are deemed highly irresponsible and are compared to the behavior of outcasts.
अल्पो महान् वा क्रियया विना यः समुच्छ्रितः पाकमुपैति शोफः |
विशालमूलो विषमं विदग्धः स कृच्छ्रतां यात्यवगाढदोषः ||१४||
"Whether small or large, a swelling that develops without proper treatment, with a broad base, uneven, and inflamed, becomes difficult to treat due to deeply rooted doshas."
This shloka explains that a swelling, regardless of its size, which develops without proper treatment and exhibits a broad base, uneven surface, and inflammation, becomes very difficult to treat due to the deeply rooted doshas.
आलेपविस्रावणाशोधनैस्तु सम्यक् प्रयुक्तैर्यदि नोपशाम्येत् |
पच्येत शीघ्रं सममल्पमूलः स पिण्डितश्चोपरि चोन्नतः स्यात् ||१५||
"If a swelling does not subside despite proper applications of pastes, draining, and cleansing, it should be quickly incised. The incision should be even, with a small base, rounded, and elevated at the top."
This shloka advises that if a swelling does not reduce with the use of pastes, draining, and cleansing, it should be quickly incised. The incision should be made evenly, with a small base, and should be rounded and elevated at the top for proper treatment.
कक्षं समासाद्य यथैव वह्निर्वाय्वीरितः सन्दहति प्रसह्य |
तथैव पूयोऽप्यविनिःसृतो हि मांसं सिराः स्नायु च खादतीह ||१६||
"Just as fire spread by wind rapidly burns down a forest, similarly, pus that is not released swiftly consumes flesh, veins, and ligaments."
This shloka compares untreated pus to a wildfire. If pus is not drained promptly, it spreads rapidly and aggressively, destroying surrounding tissues, veins, and ligaments, similar to how wind-fanned fire quickly devastates a forest.
आदौ विम्लापनं कुर्याद्द्वितीयमवसेचनम् |
तृतीयमुपनाहं तु चतुर्थीं पाटनक्रियाम् ||१७||
पञ्चमं शोधनं कुर्यात् षष्ठं रोपणमिष्यते |
एते क्रमा व्रणस्योक्ताः सप्तमं वैकृतापहम् ||१८||
"First, perform Vimlapana (mild fomentation), second, perform Avasechana (draining), third, apply Upanaha (poultice), fourth, perform Patana (incision). Fifth, perform Shodhana (cleansing), sixth, perform Ropana (healing). These are the sequential steps for treating a wound; the seventh step is Vaikritapaha (removal of deformities)."
This shloka outlines the sequential steps for treating a wound: starting with mild fomentation, followed by draining, applying a poultice, making an incision, cleansing, healing, and finally removing any deformities to ensure complete recovery.
इति सुश्रुतसंहितायां सूत्रस्थाने आमपक्वैषणीयो नाम सप्तदशोऽध्यायः ||१७||
"Thus ends the seventeenth chapter named 'Amapakvaishaniyo' in the Sutra Sthana section of the Sushruta Samhita."
This closing statement signifies the end of the seventeenth chapter, which discusses the examination of uncooked and cooked (incomplete and complete digestion) conditions in the Sushruta Samhita.