Someone who is ailing but can walk around healthy is forbidden to take medicine. No therapy is allowed even by means of a gentile. (ShA 1)
If he is in severe pain or is bedridden, he is allowed to take medicine. Even if there is no sakanna, he may instruct a non-Jew to do a melacha to provide relief. (MB 1)
There is a mitzva to be m’challel Shabbos for someone who has a life-threatening illness. The quicker you act the better. (ShA 2)
The refua must be a well known procedure or advised by an expert. (MB 5)
One who is afraid to be m’challel Shabbos before asking a rov is shedding innocent blood. While he goes to ask, the choleh could deteriorate. (ShA 2 – MB 6)
A rov must inform the people not to ask him shaylos of urgent pikuach nefesh on Shabbos. (MB 6)
If the patient himself is afraid of the chillul Shabbos, force him and convince him that there is no room for piety in his case. (MB 6)
Any internal wound is life threatening. This means from the teeth and inward – including the teeth. Gums are also included. If a tooth is in severe pain and makes his entire body ill – it is life threatening, even though he is not in bed because of it. Be m’challel Shabbos unless the patient or a doctor says it can wait. (ShA3 – MB 7, 8)
Since extracting a tooth is not a sure remedy for a severe toothache, it may not be done by a Jew – only by a gentile. (Rama 3 – MB 10)
The definition of an internal “wound” is not merely an ache. It’s a dysfunction resulting from a blow or infection. (ShA 3)
You do not need a doctor or even the patient to pronounce the wound life threatening. Even if they say nothing, do any action which will either remove the patient from danger or strengthen any of his limbs. Any other melacha that you might do for him during the week, allow it to be done only by a non-Jew. (ShA 9 – MB 14 – BeH “kol”)
There is a case that you should not m’challel Shabbos for an internal wound – when it is known that such an illness will definitely not get worse by waiting until Motzoay Shabbos. (ShA 4 – MB 16)
Below is a list of life threatening cases that are not internal wounds:
An expert says that there’s a chance that it can become life-threatening. (ShA 5 – MB 17)
An unusual wound on top of the hand or foot. (ShA 6)
Swallowed a leech. (ShA 6)
A rabid dog bite. (ShA 6)
Snake bite (that may be venomous.) (ShA 6)
A wound from an iron object anywhere on the body. (ShA 7)
Boil on the rectum. (ShA 7)
High fever (typhus) or slight fever accompanied by shivers. (ShA 7)
High blood pressure that is more than just a mere discomfort. (ShA 8 – MB 21)
If the eye has almost healed but has residual excretions, it’s not dangerous. (MB 24)
A regular fever without shivers is not dangerous. You are allowed to instruct a non-Jew to be m’challel Shabbos for it. (MB 20)
If a doctor or the patient says that the patient is in sakanna, we are m’challel Shabbos for him even though his malady looks benign. (ShA 10 – MB 25)
Any Jewish person who claims that the patient is in sakanna is believed to make at least a sofek nefashos. Therefore you must be lenient and be m’challel Shabbos. (ShA 10)
If there is an argument among the doctors, all of similar expertise then follow the majority. If one doctor is an extraordinary expert, follow him. This is true whether they are lenient or strict. (ShA 10 – BeH “v’im”)
What happens when there is an argument: The doctors say he is not in danger and the patient claims that he is in danger?
We listen to the patient when he says “I feel weak in this area and a particular remedy will be beneficial.”
If it is an uncommon malady and the patient gives his opinion how a particular remedy can cure it – we listen instead to the doctor.
However if the patient says that the remedy has helped him in the past, we could listen to him. A patient knows his body better than 100 doctors.
If the patient could get into psychological sakanna by being disobeyed, be m’challel Shabbos regardless of the absurdity of his claim. (BeH “v’rofay”)
Should you do the chillul Shabbos with a shinui? If no delay will occur because of it, then yes. Even if there will be a slight delay but the patient is not in an emergency, also employ a shinui. (ShA 12 – MB 35)
Should you ask a goy to do the chillul Shabbos? Yes, unless there is a chance that the goy will not be as quick as a yid. The Ta”z holds that a yid is always faster – so use a yid instead. (Rama 12 – MB 37)
In a case of sakanna, hurry to be m’challel Shabbos even if you will get a side benefit from it. An example: Say a child is locked behind a door. If the child becomes frightened he will be in sakanna. Break down the door even though the broken pieces are just what you need for the fireplace or the like. Do not attempt to calm the child behind the door while someone goes to get a key. (ShA 13 – MB 38)
In the above case, you are not allowed to intend to do the melacha for the side benefit. (MB 38)
Let’s say the doctor says that the choleh needs some freshly cooked food. Then, ten people race, each one intending to save the choleh’s life first. Each person gets a good reward from Hashem even though the choleh has recovered already from the winner’s food. (ShA 15 – MB 40, 42)
Even in cases of pikuach nefesh, you are not allowed to make more chillul Shabbos than necessary. For example: if the choleh needs one pound of cooked meat, you are not allowed to put two pounds of meat into the pot. If it’s an emergency case, do not be particular about the amounts. (MB 44)
Going back to the case of a choleh who is **not** in life threatening danger – the definition is either he needs to go to bed or that his whole body is affected by the pain, even if he is walking around. This category of choleh has a hetter of amira l’nochri. Meaning, you may instruct a non-Jew to do any melacha like cooking and baking if the choleh needs it. If the choleh does not need the refua on Shabbos, wait until after Shabbos. All k'tannim are in the same category of such a choleh. (ShA 17 – MB 45, 46, 47)
Is the above choleh allowed to do any issur d’rabbonon? Yes, but only with a shinui. If you do a shinui, you aren’t required to search for a non-Jew to help you. (ShA 17 – MB 54)
Another category of a choleh is someone whose limb is at risk of being lost. In this case, any issur d’rabbonon can be transgressed to save the limb, even without a shinui. (ShA 17 – MB 57)
When asking a non-Jew to cook for a choleh, be sure not to fill the pot yourself while it's cold. Filling the pot also is an issur d’rabbonon. (MB 58)
Something that you aren’t allowed to do for a choleh, the choleh may not do for himself. (Rama 17)
If a person is chilled due to letting blood, you are allowed to make a bonfire for him even in the heat of the summer. In fact, any choleh sheyaish bo sakkana is in even more danger when he is cold. (ShA 18 – MB 62)
You are allowed to remove a scab on Shabbos. (ShA 22)
You are allowed to dress wounds just to protect them from being scratched. It is not considered a refua. (ShA 23, 24)
If there is a gauze covering your wound, do not pour water on top of it. It’s ossur because of S’chitta. However, you can put oil on the gauze. (MB 75)
You aren’t allowed to apply a medicated bandage on a wound on Shabbos for the first time. However, if it was on you before Shabbos and fell off, you can put the bandage back on. Some poskim permit you to even take it off on purpose, with the intention of adjusting its position. (ShA 25 – MB 82)
A medicated bandage is allowed to be applied to a healed wound in order to protect it. (ShA 27)
You are allowed to open a painful blister to drain any pus and blood that has collected there. Do not intend to keep the hole open – it’s a melacha. But now that your intention is just to let out the pressure, the melacha is not needed – it's only d’rabbonon and bimkom tzaar lo gozru. (ShA 28 – MB 90)
Do not push the blister in a way to make new blood come out. (MB 89)
You are allowed to use a needle to dig out a splinter – just be careful not to bleed. If the splinter is painful and there is no way to remove it without bleeding, it’s mutar similar to the painful blister above. (MB 88)
Do not scratch a boil in a way that will make you bleed (new blood that isn’t collected in the boil already). (MB 90)
You aren't allowed to apply to a bleeding cut anything that will cause refua. But if it merely stops the bleeding it’s fine. (ShA 29)
A painful hangnail can be removed by hand if it is mostly hanging off your finger. Make sure it doesn’t bleed. (ShA 31 – MB 96)
Strips of skin hanging by your cuticles are not allowed to be removed on Shabbos, even if they are painful. (ShA 31 – MB 99)
It is forbidden to hold liquid (e.g. vinegar, whiskey) in your mouth to relieve an aching tooth. However, if it isn’t evident that you are having the drink for refua (e.g. you swallow the whiskey) it’s okay. (ShA 32 – MB 102)
Cloves have a numbing effect for a toothache. Do not apply them on Shabbos. (MB 102)
If your whole body is weak because of the toothache, you can instruct a gentile to do any melacha for your relief. (MB 100)
A nursing mother should not express milk into a container for her baby to eat – it’s Mefarayk. (ShA 34 – MB 111)
The mother can squeeze milk from her breast directly into the baby’s mouth to get the baby to latch on. (ShA 35 – MB 112)
Someone with bad breath may chew sweet smelling sap – it’s not refua. (ShA 36 – MB 116)
Any food or drink which is maachal b’riyim can be consumed for refua. Even if the food is harmful in other ways – it’s just food and is not perceived as an act of refua. (ShA 37 – MB 117)
Maachal b’riyim changes with the times and with the location. (MB 105)
As long as **some** healthy people eat it, the food is considered maachal b’riyim. (MB 321:72)
You aren’t allowed to drink medicinal laxatives unless you are sick in bed. (MB 118)
A person who is perfectly healthy is allowed to eat medicinal foods but not with the intention of strengthening his constitution. (ShA 37 – MB 120)
A person who is sick in bed is allowed to take medicine himself. The gezaira against refua was suspended in his case. (Rama 37 – MB 121)
You are allowed to swallow a raw egg to improve your voice on Shabbos – it’s not refua. (ShA 38 – MB 122)
It is an avaira for someone to make himself vomit in order to have room to eat more. He’s ruining food. (ShA 39 – MB 123)
If you are uncomfortable from overeating, you can induce vomiting but on Shabbos you must not use a syrup, rather induce vomiting manually. (ShA 39)
It is not considered refua to employ therapy which will remove intoxication. (MB 127)
Sniffing snuff tobacco is done for pleasure, therefore you can even sniff it to remove a headache. (MB 127)
It is considered refua to exercise your limbs in order to work up a sweat. (ShA 42 – MB 129, 130)
You aren’t allowed to massage a child's belly in order to loosen his bowels. (ShA 42)
Any therapy whose goal is normally not attained with medicine is mutar on Shabbos. There is no concern of grinding herbs. However, if a kli is used, it’s ossur because of uvdin d’chol – unless you are in discomfort. (ShA 43 – MB 136 – ShaH 104)
There are bodies of (salt) water that help heal the skin. Are you allowed to wade in them on Shabbos? If the water is only used for therapy, it is ossur to stay inside the water. However, to splash on some water and then go is fine because it merely looks like you are cooling off. But if the water is enjoyable even for healthy individuals, a person who wants to heal his cuts can go wade in it. (ShA 44 – MB 137, 138)
You are allowed to use cold objects to stop a swelling wound. Medicine is not used to reduce topical swelling.. (ShA 46 – ShaH 104)
A broken or dislocated bone can be manipulated back into place without a shinui, otherwise the patient could lose his limb. (ShA 47 – MB 145)
You aren’t allowed to put a cloth on a bleeding wound. The blood will “dye” the cloth. You can be maykil if you don’t have anything else, reasoning that it’s derech lichluch. (ShA 48 – MB 140)
You are permitted to cut a turnip into the shape of a tool on Shabbos. Food is not restricted by tikkun kli. (MB 152)