The Compendium of Caraka 3.7: saptamo 'adhyāyaḥ/

Now we shall explain the specific determination of the manifest forms of the diseased.

Thus spoke the venerable Ātreya.

Here indeed are two persons who show the appearance of the diseased: the severely diseased, and the mildly diseased.

Among them, one who is severely diseased appears as if mildly diseased because he is endowed with excellence of mental strength and bodily physique; another who is mildly diseased appears as if severely diseased because of the inferiority of his mental strength and other qualities.

Regarding them, unskilled [physicians], determining solely upon seeing their outward appearance with the eyes alone, become confused concerning the severity or mildness of the disease.

For knowledge of the entire knowable object does not arise from a single fraction of knowledge.

Those who are confused in the diagnosis of the disease also become confused in the knowledge of the correct application of therapy.

When they encounter a severely diseased person who has the appearance of being mildly diseased, then, considering him to have few doshas, they administer a mild evacuative therapy at the time of evacuation, and thereby only further excite his doshas.

When, however, they encounter a mildly diseased person who has the appearance of being severely diseased, then, considering him to have abundant doshas, they administer a sharp evacuative therapy at the time of evacuation, and by excessively expelling the doshas, they destroy his body.

Thus, presuming knowledge of the entire knowable object from merely a part of knowledge, they falter.

Physicians, however, who know what ought to be known, determining after having thoroughly examined in every way whatever is to be examined to the extent possible, do not err anywhere, and achieve their desired aim.

And on this point there are [verses]:

Having observed the appearance of the disease in the patient based on differences in mental strength and other factors,
the ignorant become confused regarding the strength or weakness of the disease.

Deluded by ignorance, they administer medicine improperly,
leading to the destruction or great suffering of the diseased.

The wise, however, fully understanding all that is to be examined in this world in every respect,
never falter in the applications of medicines.

Having thus heard, in this topic of the appearance of the diseased, the primary occurrence of the classification of the appearances of the diseased, the flawed cause of error regarding the signs of the diseased, and the flawless cause of correct discernment, Agniveśa then touched the feet of the venerable Ātreya and questioned him about the origins, locations, forms, colors, names, specific effects, and treatments of all intestinal worms that dwell in feces.

Then the venerable Ātreya said to him: "Here indeed, Agniveśa, twenty varieties of worms have previously been declared under various divisions, aside from the innate ones. They, in turn, when divided according to their origins, become of four kinds, namely: born from feces, born from phlegm, born from blood, and born from bodily excreta."

"Among them, excreta is both external and internal."

"Among them, we describe those born of excreta as born of external excreta:"

"Their origin is the neglect of personal cleanliness; location: the hair of the head, beard, body hair, eyelashes, and clothes; form: minute, shaped like sesame seeds, and having many feet; color: black and white; names: lice (yūkā) and nits (pipīlikā); effect: producing itching and giving rise to urticarial rashes and boils. Their treatment, however, is extraction, destruction of excreta, and non-use of factors that generate excreta."

"The origin of those born from blood is identical to that of kuṣṭha; location: blood-carrying vessels; form: minute, round, and footless, and some, due to their subtleness, are invisible; color: coppery; names: keśāda, lomāda, lomadvīpa, saurasa, auḍumbara, and jantumātṛ; effect: falling out of the hair of the head, beard, nails, body hair, and eyelashes, and when in wounds, tingling, itching, pricking pain, and crawling sensations, and when excessively multiplied, the eating away of the skin, vessels, ligaments, flesh, and cartilages; their treatment is also identical to that of kuṣṭha, which we shall explain later."

"Those born from phlegm have their origin in the consumption of milk, jaggery, sesame, fish, meat of marshy animals, flour preparations, milk-rice pudding, safflower oil, unwholesome, putrid, moist, mixed, incompatible, and unaccustomed food; their location is the stomach, and as they grow, they spread upward, downward, or in both directions. Their distinctions of form and color are: some are white, broad, and shaped like straps; some are circular in girth, shaped like earthworms, white, and coppery in appearance; some are minute, long, shaped like threads, and white. The names of these three types of worms caused by phlegm are: antrāda, udarāda, hṛdayacara, curu, darbhapuṣpa, saugandhika, and mahāguda. Their effects are nausea, salivation, anorexia, indigestion, fever, fainting, yawning, sneezing, distension of the abdomen, body aches, vomiting, emaciation, and roughness of the skin."

"Those born from feces have an origin similar to those born from phlegm. Their location is the large intestine; as they grow, they crawl downward, but if they should turn toward the stomach, from time to time the patient's belching and respiration will smell of feces. Their distinctions of form and color are: some are minute and round in girth, white, long, and resembling wool fibers; some, however, are thick and round in girth, dusky, blue, green, and yellow. Their names are kakeruka, makeruka, leliha, saśūlaka, and sausurāda. Their effects are diarrhea, emaciation, roughness, and the production of goose bumps; and these very worms, pricking and causing itching at the anal orifice, dwell around the anal orifice, and having become stimulated, they emerge through the anus excessively. Such is the specific origin and so forth of worms born of phlegm and feces."

"Their treatment, however, having been taught in brief, we shall explain later in detail."

"Among them, extraction of all worms must be performed first, then destruction of their supportive habitat, and immediately after, non-use of the factors mentioned as causative agents."

"Among them, extraction is removal by grasping with the hand and inspecting, either with instruments or without instruments; but for worms located in the internal organs, extraction is performed systematically with medicine, and that is of four kinds, namely: head-purging, emesis, purgation, and non-unctuous enema. Such is the procedure of extraction."

"Destruction of their supportive habitat, however, is the use of substances that are pungent, bitter, astringent, alkaline, and hot, and whatever else is antagonistic to phlegm and feces. Such is the destruction of their supportive habitat."

"Immediately after, non-use of the factors mentioned as causative agents means the complete avoidance of what was stated in the etiology section, as well as of other substances of similar nature."

"Thus the treatment has been explained according to its characteristics."

"This very matter will again be taught in detail."

"Then, first preparing this patient having worms in the alimentary tract for six or seven nights with oleation and sudation, thinking 'tomorrow I shall administer a purificatory therapy to him', the physician should feed him in the evening and morning with foods prepared with milk, jaggery, curd, sesame, fish, meat of marshy animals, flour preparations, milk-rice pudding, and safflower oil, in order to excite the worms and draw them into the gut."

"Then, when the night has passed, having ascertained that he has slept comfortably and that his food is well digested, he should treat him that very day with a non-unctuous enema, emesis, and purgation—if he is fit to be treated—after examining properly all the points to be examined."

"Then he should say, 'Bring radish, mustard, garlic, karañja, śigru, madhuśigru, kharapuṣpā, bhūstṛṇa, sumukha, surasā, kuṣṭha, erakā, gaṇḍīra, kālamālaka, parṇāsa, kṣavaka, and phaṇijjhadka, all of them or as available.' Having examined them when brought, cutting them into pieces, washing them with water, placing them in a thoroughly washed pot, pouring cow urine with half as much water, he should cook it while constantly stirring with a ladle; when the water is mostly used up and the essence of the medicinal drugs is extracted, removing the pot, he should pour the well-filtered, lukewarm decoction mixed with the paste of madanaphala, pippalī, and viḍaṅga, oil, and seasoned with svarjikā, into an enema apparatus and properly administer a non-unctuous enema to him; or likewise with a decoction of arka, alarka, kuṭaja, āḍhakī, kuṣṭha, and kaiḍarya; or likewise with a decoction of śigru, pīlu, kustumburu, kaṭukā, and sarṣapa; or likewise with a decoction of āmalaka, ginger, devadhāru, haridrā, and picumarda, prepared in combination with madanaphala and the others; he should administer the non-unctuous enema three times or for seven nights."

And when the last enema has returned and he has regained his strength, on that very day one should administer with proper judgment an eliminative therapy acting in both directions. Its procedure will be explained: stirring one akṣa-measure of the paste of trivṛt into half an añjali of the decoction of madanaphala and pippalī, he should give it to him to drink; that completely expels his dosha from both directions. In the very same way, combining emetics and purgatives taught in the Kalpasthāna, the physician, discerning all specific conditions with his intellect, should make him drink [it].

Then, having ascertained that he has purged properly, he should sprinkle him in the afternoon with lukewarm decoction of śaikharika.

And with that very decoction he should always carry out all water purposes, both external and internal; in its absence, he should sprinkle him with decoctions of pungent, bitter, and astringent medicinal herbs, or with urines and alkalis.

And having entered him, after sprinkling, into a windless chamber, he should treat him with the sequential regimen beginning with thin gruel prepared with pippalī, pippalī root, cavya, citraka, and dry ginger; and when he has reached the stage of thick gruel, he should give him an unctuous enema with viḍaṅga oil on alternate days, twice or thrice.

If, however, he should consider his head-eating worms to be excessively aggravated and occasionally crawling in the head itself, then, after preparing his head with oleation and sudation, he should purge it with head-cleansing medicines beginning with apāmārga seeds.

We shall now explain the dietary regimen that has been prescribed for the destruction of the supportive habitat of worms: Bringing mūlakaparṇī together with its roots, shoots, and tendrils, cutting it into pieces, pounding it in a mortar, and pressing it with both hands, one should extract the juice. Stirring flour of red rice with that juice, making small cakes, baking them on smokeless coals, and seasoning them with viḍaṅga oil and salt, he should give them to the patient with intestinal worms to eat; and immediately thereafter, he should make him drink sour fermented gruel or udaśvid mixed with the group of five beginning with pippalī, along with salt. According to this method, he should prepare cakes in any one of the fresh juices of mārkava, arka, sahacara, nīpa, nirguṇḍī, sumukha, surasā, kuṭheraka, gaṇḍīra, kālamālaka, parṇāsa, kṣavaka, phaṇijjhadka, bakula, kuṭaja, and suvarṇakṣīrī; likewise, he should prepare cakes in the fresh juices of kiṇihī, kirātatikta, suvahā, āmalaka, harītakī, and bibhītaka; and in the morning, before food, he should give him to drink the fresh juices of these, individually, in pairs, or all together, stirred with honey.

Then, taking horse dung, spreading it on a large mat, drying it in the sun, pounding it in a mortar, and making it into a fine powder again on a grindstone, saturating it thoroughly eight or ten times in the sun with a decoction of viḍaṅga or a decoction of triphalā, reducing it again to a fine powder on a grindstone, and putting it in a new jar, he should keep it carefully stored.

Of that powder, he should give a handful, or as much as he deems appropriate, mixed with honey, to the patient with intestinal worms to lick.

Likewise, taking seeds of bhallātaka and crushing them to the capacity of a jar, placing them in a sturdy jar impregnated with oil, perforated with many small holes at the bottom, wrapped around the body, and smeared with clay, covering it with a lid, mounting it on top of another sturdy pot also impregnated with oil and buried in the ground up to its neck, heaping cow dung around it, he should burn it; when he knows that the cow dung is completely burned and the seeds of bhallātaka are devoid of oil, he should then lift that pot off.

Then, taking the oil from that second pot, combining it with powder of viḍaṅga seeds measuring half the quantity of the oil, and keeping it in the sun for an entire day, he should then give him a dose to drink; by this he is well purged, and after he is purged, the sequential regimen is as described.

In this very way, preparing the oils of devayaru and sarala wood, he should give them to drink.

And he should administer an unctuous enema to him at the time for unctuous enemas.

Then he should say, 'Bring fresh autumnal sesame seeds endowed with good qualities.' Having brought them, winnowing them very clean, washing them thoroughly, throwing them into a lukewarm decoction of viḍaṅga, he should steep them until the impurities come out; seeing that the impurities are gone, thoroughly dehulling them by peeling, winnowing them clean once again, washing them thoroughly, saturating them well twenty-one times with the decoction of viḍaṅga, drying them in the sun, pounding them in a mortar, having them ground smooth on a grindstone, placing them in a trough, and repeatedly sprinkling with the decoction of viḍaṅga, he should knead them with his hands alone; when they are being pressed, whatever oil rises, gathering it with both hands, placing it in a clean, sturdy jar, he should store it securely.

Then he should say, 'Bring two lumps, each the size of a bilva fruit, of tilvaka and uddālaka finely ground with a decoction of viḍaṅga; half that measure each of śyāmā and trivṛt; half that measure each of dantī and dravantī; and half that measure each of cavya and citraka.'

Combining this material with half an āḍhaka measure of viḍaṅga decoction, adding one prastha of that oil, stirring everything, pouring it into a large cooking vessel, placing it over the fire, sitting comfortably on a seat, constantly observing the oil from all sides, he should cook it over a gentle fire, continuously stirring it with a ladle.

When he knows that the sound ceases, the foam subsides, the oil becomes clear, the characteristic smell, color, and taste are produced, and the medicinal paste, rolled between two fingers, turns neither too soft nor too hard, and does not stick to the fingers—that is the time for taking it down.

Then, having taken it down, strained it when cooled through an unwashed cloth, poured it into a clean, sturdy jar, covered it with a lid, draped it with a white cloth piece, and tied it securely with string, he should store it well concealed.

Then he should give him a dose to drink; by this he is well purged; and for one whose doshas have been properly eliminated, the sequential regimen is as described.

And then he should administer an unctuous enema to him at the time for unctuous enemas.

And by this very method of cooking, he should prepare fats of sarṣapa, atasī, karañja, and koṣātakī, and have him drink them, observing all specific factors.

By this he becomes free from disease.

Thus, in general, the specific etiologies, locations, colors, names, effects, and treatments of the two types of worms—those originating from kapha and those originating from feces—have been explained.

Specifically, however, using those very medicinal substances, the treatment of feces-born worms should consist predominantly of small doses, unctuous and non-unctuous enemas, and downward purgation; whereas using those very medicinal substances, the treatment of kapha-born worms should consist predominantly of larger doses, errhines, emesis, and pacifying therapy. In this way, this medicinal regimen destroying worms has been systematically explained.

One who undertakes it should strive to avoid the causes, each according to its type.

Thus this treatment for worms in the gastrointestinal tract has been explained properly according to the initial outline.

And here are [the verses]:

Extraction alone is regarded as the primary remedy for worms; / thereafter, destruction of their supportive habitat and avoidance of the etiology.

This very threefold regimen described with respect to worms / is seen to apply to the suppression of all disorders whatsoever:

Purification, pacification, and avoidance of the etiology— / this much should be performed by the physician according to rule in each and every disease.

Here are the two summary verses:

The two kinds of diseased persons, the wise and ignorant physicians along with their purposes, / the twenty worms, their group of seven beginning with etiology—

all this was spoken in the Specific Determination on the Manifestations of Diseased Persons by the supreme ṛṣi, / for the awakening of his disciples and for the pacification of disease.

Thus ends the seventh chapter, titled Specific Determination on the Manifestations of Diseased Persons, in the section on specific determination in the treatise composed by Agniveśa and redacted by Caraka.