अथाविस्राव्याः- सर्वाङ्गशोफः, क्षीणस्य चाम्लभोजननिमित्तः, पाण्डुरोग्यर्शसोदरिशोषिगर्भिणीनां च श्वयथवः ||२४||
Meaning of the śloka
The text excludes the following swellings from bloodletting: swelling of the whole body; swelling caused by sour food in an emaciated person; and swelling in someone with pandu, arshas, udara or shosha, or in a pregnant woman.
The swelling associated with sour food is specifically that of a depleted person. Swellings in the other listed groups are also excluded. Even wound-associated swelling confined to a single part in these people is not to be subjected to bloodletting in this account.
When blood does not flow, the historical procedure describes rubbing the wound opening with a powder of three, four or all of the available listed substances, made rich in salt and oil. The list comprises ela, shitashiva, kushtha, tagara, patha, bhadradaru, vidanga, chitraka, trikatuka, household soot, haridra, arka shoots and naktamala fruit. The text states that the blood then flows properly.
The commentary introduces this as a means of setting non-flowing blood in motion. Shitashiva is identified as camphor and naktamala as the larger karanja. Specifying three or four ingredients excludes using only one or two. The salt and oil are specifically saindhava and sesame oil, used abundantly.
For excessive bleeding, the text describes gently dusting the wound opening with powders of rodhra, madhuka, priyangu, pattanga, gairika, sarjarasa, rasanjana, shalmali flowers, conch, shell, masha, barley and wheat, then pressing with a fingertip. Alternatives include powdered bark of sala, sarja, arjuna, arimeda, meshashringa, dhava and dhanvana; burnt linen; or samudraphena and laksha powder. It also names firm bandaging, cooling coverings, food and accommodation, cooling pastes and pouring treatments, and cauterisation by kshara or fire as previously described. The passage also describes puncturing the same excessively bleeding sira in relation to the earlier puncture. Internally it names a kakolyadi decoction sweetened with sugar and honey, or blood from ena, harina, sheep, hare, buffalo or boar. Food is accompanied by well-uncted milk, pulse soup or meat broth, and complications are treated individually. The following verses explain that tissue depletion after blood loss weakens digestive fire and greatly aggravates vata. The stated diet is therefore light, unctuous, blood-replenishing and not excessively cold, with a slightly sour or non-sour taste.
Pattanga is identified as red sandalwood, sarjarasa as rala, and shukti as aquatic shell. Sala is called shanku, sarja a kind of sala, arjuna kakubha, arimeda the locally known arimanja, meshashringa karkatashringa, and dhanvana the locally known dhammana. The same dusting and fingertip-pressure instruction applies to the bark powders and burnt linen. Bandaging materials include linen and cotton cloth. Pradeha means paste and parisheka a poured stream. The reference to cauterisation includes the previously stated ring, dot and related forms. The second puncture is explained as below the original puncture in the same sira, with the aim of interrupting blood movement. Ena is the black deer and harina a copper-coloured deer. The animal blood is described as unvitiated and unprocessed, and its stated purpose is replenishing blood. Yusha means mudga soup, rasa meat broth, and unctuous means properly enriched with ghee; rice is eaten moistened with these liquids or milk. One explanation assigns milk to pitta-affected blood loss or a pitta constitution, pulse soup to kapha-affected loss or a kapha constitution, and meat broth to vata-affected loss or a vata constitution. Others assign milk, pulse soup and meat broth respectively to strong, moderate and weak digestive fire. Others base the choice on accustomed suitability. Complications such as headache receive their own treatments. The final dietary instructions aim to stimulate digestive fire, replenish blood and prevent complications. Slight sourness is exemplified by dadima and amalaka, regarded here as foremost among sour substances.
Key terms
sAtmya (sātmya)
Accustomed suitability, one basis given for choosing food after blood loss.
susnigdhaiH (susnigdhaiḥ)
Properly made unctuous with ghee, according to the commentary.
Four methods of stopping blood are named: sandhana, skandana, pachana and dahana. Astringent substances close the wound, cold causes the blood to coagulate, ash produces pachana, and burning contracts the sira.
Sandhana concerns closing the instrument wound. Skandana means making blood coagulate or become dense. Pachana and dahana concern the instrument wound. Astringent substances include lodhra and similar drugs; others specify haritaki or the panchavalkala group. Hima means cold. Ash is derived from linen and similar materials. Burning is performed with shalaka and related implements.
Key terms
sandhAnaM (sandhānam)
Closing or joining the instrument wound.
skandanaM (skandanam)
Coagulation or thickening of blood.
pAcanaM (pācanam)
The local ash-based action named as a method of stopping blood.