An alkali should be prepared from the ashes of the drugs used in the preparation of the aforesaid medicated clarified butters, by dissolving and filtering them in ewe's urine The alkali should then be slowly boiled with an alkali similarly prepared from the dung of domestic animals, with the powders of Trikatu and the drugs of the Ushakádi group thrown into them as an after-throw. It proves curative in cases of stone, Gulma, and gravel. Alkalies † from burnt bark of sesamum, Apámárga, plantain, Palás'a and barley taken with the urine of an ewe destroy the gravel (S'arkará). As an alternative, the alkalies of Pátalá and Karavira should be used in the preceding manner. 8-9. Two Tola (Aksha) weights of the pastes of S'va-damstrá, Yashti-madhu and Bráhmi (mixed with ewe's urine) should be given to the patient; or the expressed juice of the Edaká, S'obhánjana and Márkava (with the said urine) should be given, or a potion consisting of the pasted roots of the Kapotavamka with Kánjika, or Sura, etc., should be administered. Milk boiled with the aforesaid drug (Kapotavamka) should be taken by a patient in case there is pain (in urinating). Milk boiled with Triphalá or Varshábhu should be administered as a drink and a decoction of the drugs of the Vira-tarádi group should be employed in all these cases. * 10.
* Some explain it as "Gokshura-seeds" and others as ' Markataka-seeds."
† Four or six Tolá weight of an alkali should be dissolved and filtered for a number of times before use.
A physician should have recourse to the following measures (surgical operations) in cases where the above-mentioned decoctions, medicated milk, alkalies, clarified butter and Uttara-vasti (urethral syringe) of the aforesaid drugs, etc., would prove ineffective. Surgical operations in these cases do not prove successful even in the hands of a skilful and experienced surgeon; so a surgical (Lithotomic) operation should be considered a remedy that has little to recommend itself. The death of the patient is almost certain without a surgical operation and the result to be derived from it is also uncertain. Hence a skilled surgeon should perform such operations only with the permission of the king. 11-12.
The patient should be soothed (Snigdha) by the application of oleaginous substances, his system should be cleansed with emetics and purgatives and be slightly reduced thereby; he should then be fomented after being anointed with oily unguents; and be made to pertake of a meal. Prayers, offerings and prophylactic charms should be offered and the instruments and surgical accessories required in the case should be arranged in the order laid down in the Agropaharaniya chapter of the present work (Sutra-sthánam, ch. V.). The surgeon should use his best endeavours to encourage the patient and infuse hope and confidence in the patient's mind. A person of strong physique and un-agitated mind should be first made to sit on a level board or table as high as the knee-joint. The patient should then be made to lie on his back on the table placing the upper part of his body in the attendant's lap, with his waist resting on an elevated cloth cushion. Then the elbows and knee-joints (of the patient) should be contracted and bound up with fastenings (S'átaka) or with linen. After that the umbelical region (abdomen) of the patient should be well rubbed with oil or with clarified butter and the left side of the umbelical region should be pressed down with a closed fist so that the stone comes within the reach of the operator. The surgeon should then introduce into the rectum, the second and third fingers of his left hand, duly anointed and with the nails well pared. Then the fingers should be carried upward towards the rope of the perineum i.e, in the middle line so as to bring the stone between the rectum and the penis, when it should be so firmly and strongly pressed as to look like an elevated Granthi (tumour), taking care that the bladder remains contracted but at the same time even.
* Dallana recommends the use of Triphalá boiled with milk in cases of pain accompanying Plttaja As'mari, while that boiled with Varshábhu is advised to be given for the alleviation of pain in a case of Vátaja or Kaphaja As'mari. The drugs of Vira-tarádi group should be used with milk, clarified butter, a decoction, Yavágu (gruel), food, etc., and also for bath, immersion, etc.