The Compendium of Caraka 6.12: dvādaśo 'adhyāyaḥ/

Now we shall expound the treatment of swelling.

Thus declared the venerable Ātreya.

Agniveśa questioned the foremost of physicians, attended by gods and siddhas, / the lord of sages, son of Atri, concerning the aggravation, signs, and pacification of swelling, a great disease, as they truly are.

The son of Atri, the best of mountains from which the ocean of the science of medicine flows forth, spoke those to him, / regarding the three types according to the distinction of vāta and the others, correctly, innate and accidental, occurring in a single limb and in the whole body.

For those who are weakened and emaciated through evacuation, illness, or fasting, the indulgence in alkali, sour, sharp, hot, and heavy foods; / the consumption of curd, unripened foods, earth, potherbs, incompatible foods, contaminated foods, and foods affected by artificial poison;

piles, lack of movement, lack of body purification, injury to vital organs, difficult childbirth, / and improper application of evacuative therapies are declared the causes of innate swelling.

External trauma that vitiates the skin by wood, stone, weapon, fire, poison, iron, and the like / is the accidental cause; and the innate is threefold, from being localized in the whole, in half, or in a part of the body.

When vāyu, reaching the external vessels, vitiates kapha, blood, and pitta here, / then, with its pathway blocked by them, spreading outward, it produces swelling characterized by an elevation.

By [doṣas] situated in the chest, [swelling is] in the upper part; below by those situated in the seat of vāyu; in the middle by those gone to the middle; / affecting all limbs by those pervasive everywhere; situated somewhere by doṣas situated somewhere—it takes that name.

Local heat, likewise burning sensation, and distension of the vessels are the premonitory symptoms; / all [swellings] involve the three doṣas; through the signs of the predominant doṣa it acquires its name and treatment.

Heaviness, instability, elevation, heat, and thinning of the vessels,
along with horripilation and discoloration of the limbs, are declared the general signs of swelling.

Movable, thin-skinned, rough, reddish-brown or black, accompanied by numbness, tingling, and pain, / subsiding without cause, pitting and rising again when pressed, and stronger during the day is the swelling due to vāta.

Soft, malodorous, blackish-yellow or red in color, accompanied by giddiness, fever, perspiration, thirst, and intoxication, / causing a burning sensation, painful to the touch, and causing redness of the eyes—that is pitta-swelling, having severe burning and suppuration.

Heavy, firm, pale, accompanied by anorexia, causing excessive salivation, sleep, vomiting, and dullness of the digestive fire, / slow to arise and slow to subside, pitting and not rising again when pressed, and stronger at night is [the swelling] of the nature of kapha.

That which occurs in an emaciated patient, or in one weakened by diseases, or accompanied by complications beginning with vomiting, / or that which has reached the vital points, or has streaks, or discharges fluid in one with diminished strength, or has spread to all limbs—kills.

That which is born of a single doṣa, is acute, and occurs in a patient of unreduced flesh and established strength, is easy to cure; / one who knows strength, the doṣas, and time should treat it with regimens contrary to the etiology, the doṣas, and the season.

Then, one should treat that born of āma with fasting and digestive regimens, and that with aggravated doṣas initially with purification procedures: / that located in the head with head-evacuations, that located in the lower parts with purgatives, and that arising in the upper parts with emetics.

One should treat that arising from unction with drying measures, and devise a regimen of unction in that arising from dryness; / in that born of vāta with obstructed feces, [one should use] an unctuous enema, but in that born of pitta and vāta, ghee with bitter [substances].

Milk is indicated when there is fainting, restlessness, burning, and thirst; but when purification is required, [milk] with urine [is indicated]; / one should overcome that arising from kapha with combinations of urine, buttermilk, and āsavas prepared with alkalis, pungents, and hots.

Flesh of domestic, wetland, and marsh animals, dried vegetables, newly harvested grains, molasses products, flour preparations, curd, sesame preparations, slimy [foods], sour wine, / parched grain, dried meat, mixed eating, and heavy, unwholesome, and burning foods, daytime sleep, and sexual intercourse: these the patient with swelling disease should avoid.

Vyoṣa, trivṛt, kaṭurohiṇī, and triphalā along with iron dust, drunk with the decoction of triphalā, / or harītakī drunk with cow's urine, will pacify swelling arising from kapha.

Harītakī, dry ginger, and devadāru, taken with warm water, or with punarnavā, / or all taken with urine in all three [doṣic types]; and when it is digested, having bathed, one should eat food with milk.

A wise man should drink a karṣa dose of pastes of punarnavā, dry ginger, and mustā with a prastha of milk; / or, when vāta is present, he should drink mayūraka or pippalī with its root and dry ginger.

Or a man should drink milk boiled with dantī, trivṛt, the three pungents, and citraka, which removes the doṣas— / two prasthas [of milk boiled] with half a pala of each of these, reduced to half—when vāta is accompanied by pitta.

The juice of yellow-wood with dry ginger should be administered; or [milk] prepared with śyāmā, castor root, and black pepper; / or with tvak, dāru, punarnavā, and dry ginger; or with guḍūcī, dry ginger, and dantī.

Or he should drink camel milk for seven days or for a month, avoiding food and water; / or cow's milk with urine, or buffalo milk while on a milk diet, or cow's urine.

Or one whose stools are heavy and broken should drink buttermilk with vyoṣa, sauvarcala salt, and honey; / or one whose stools are broken, with āma and doṣa, or obstructed, should take molasses with abhayā or molasses with dry ginger.

When there is retention of stool and flatus, one should take castor oil before food with milk or meat broth; / when there is obstruction of the channels and loss of digestive fire and taste, one should drink well-prepared wines and ariṣṭas.

Gaṇḍīra, bhallātaka, citraka, vyoṣa, viḍaṅga, and the two bṛhatīs, / two prasthas [in all], one should boil with cow-dung fire in a droṇa of curd-cheese whey;

and when reduced to a third, well strained and cooled, combined with a droṇa of ordinary whey / and one hundred [palas] of sugar candy, in a jar smeared with citraka and pippalī,

placed in the open air for ten days—administering it, one destroys swellings, / fistula-in-ano, piles, worms, kuṣṭha, urinary disorders, discoloration, emaciation, and vāta-hiccough.
Thus ends the Gaṇḍīrādyariṣṭa.
One hundred [fruits] each of kāśmarya, dhātrī, black pepper, abhayā, akṣa, / drākṣā, along with pippalī, and a tulā of old molasses, having crushed them into a jar smeared with honey,

kept for seven days in a warm place, but double [that time] in the cold, combined with a droṇa of water, a man should drink: / this Aṣṭaśata-ariṣṭa destroys swellings, obstructions, and those born of kapha and vāta, and kindles the digestive fire.
Thus ends the Aṣṭaśato-'ariṣṭa.
Having boiled the two punarnavās, the two balās along with pāṭhā, dantī, guḍūcī, and citraka, / and nidigdhikā and triphalā, in water reduced to a droṇa, then having strained that decoction,

and two tulās of old molasses with a prastha of honey, well cooled, / one should place it in a ghee vessel in a heap of barley for a month; then after a month,

combined with fragrant powders, half a pala each, of patra, tvak, elā, black pepper, ambu, and iron / in [a vessel] smeared with honey and ghee—when it is matured, one should drink it, having observed the strength of the disease.

Heart disease, pāṇḍuroga, advanced swelling, spleen disorders, fever, anorexia, urinary disorders, gulma, / fistula-in-ano, the six abdominal diseases, cough, dyspnea, disorders of the duodenum, kuṣṭha, itching,

vāta in the peripheral limbs, constipation, hiccough, kilāsa, and halīmaka / he quickly overcomes, endowed with complexion, strength, longevity, ojas, and vital glow, while eating meals with meat broth.
Thus ends the Punarnavādyariṣṭa.
The three fruits, dīpyaka, citraka, along with pippalī, iron powder, and viḍaṅga, / powdered, a kuḍava of each, twice that amount of honey, and a tulā of old molasses,

one should place in a ghee vessel among barley for a month: it destroys those very diseases; / and whichever ariṣṭas are declared beneficial in piles and in those suffering from pāṇḍu, they are also [beneficial] in patients with swelling.
Thus ends the Triphalādyariṣṭa.
Pippalī with pāṭhā, gajapippalī, nidigdhikā, citraka, and dry ginger, / along with pippalī root, haridrā, ajājī, and mustā—this powder, drunk with warm water,

destroys [swelling] born of the three doṣas and of chronic origin; as does the paste of bhūnimba and dry ginger; / or iron powder, the three pungents, and barley-alkali powder drunk with the decoction of triphalā.

There should be the two alkalis, four salts, iron powder, vyoṣa, the three fruits, / pippalī root, viḍaṅga seeds, mustā, ajamodā, devadāru, and bilva,

kaliṅgaka, citraka root, pāṭhā, yaṣṭyāhvaya, along with ativiṣā, one pala each, / with a karṣa of asafoetida, finely powdered when dry, and a droṇa of dried radish pieces.

That [mass] should be cooked by stirring with ash-water until it becomes thick without burning. / When it has congealed, one should make pills of the size of a jujube, dry them thoroughly, and administer them according to rule.

It dispels spleen enlargement, abdominal diseases, śvitra, halīmaka, piles, anaemia, anorexia, consumption, swelling, / visūcikā, gulma, artificial poisons, and urinary stones, along with dyspnoea, cough, and skin diseases.
Thus ends [the formula for] the alkali pill.
Alternatively, one should take fresh ginger or dry ginger equal in measure to jaggery, increasing by half a pala, / up to a maximum dose of five palas, for a month; when it is digested, milk, soup, meat juice, and boiled rice [should be taken].

This application overcomes gulma, abdominal disease, piles, swelling, urinary disorders, dyspnoea, rhinitis, alasaka, indigestion, / along with jaundice, consumption, mental disorders, cough, and kapha.

In the same way, the juice of fresh ginger and dry ginger is to be drunk; when it is digested, one should eat food with milk. / And śilājatu taken with the decoction of triphalā forcibly destroys swelling caused by the three doṣas.
Thus ends the application of śilājatu.
One should cook a kaṃsa of jaggery and a hundred abhayā fruits in the decoction of the two pañcamūlas; / when the electuary is properly prepared, one stirs in the powder of vyoṣa and trisaugandhya; and when it has cooled down,

half a prastha of honey and also a little barley-alkali powder [are added]. / Eating one abhayā and then a śukti of the electuary destroys severe swelling,

dyspnoea, fever, anorexia, meha, gulma, spleen enlargement, abdominal diseases from the three doṣas, anaemia, / emaciation, āmavāta, bleeding disorders, acid dyspepsia, discolouration, and disorders of the urine, vāta, and semen.
Thus ends Kaṃsaharītakī.
Paṭola root, devadāru, dantī, trāyantī, pippalī, abhayā, viśālā, / yaṣṭyāhvaya, katukā, red and white sandalwood, nicula, and dārvī—

the decoction boiled with these, measuring a karṣa each, should be drunk mixed with a kuḍava of ghee. / It destroys erysipelas, burning sensation, fever, sannipāta, thirst, poisons, and swelling.

Citraka, coriander, yavānī, cumin, sauvarcala salt, the three pungents, amlavetasa, / fruit of bilva, pomegranate, barley-alkali, along with pippalī root and cavya—

grinding [these] to the measure of an akṣa each, cooking them with an āḍhaka of water and a prastha of ghee, one should then administer it. / It destroys piles, gulma, and difficult swelling, and kindles the digestive fire.

Or one should drink ghee of great potency cooked with eight times [its measure] of water and citraka-alkali; / or Kalyāṇaka [ghee], or [ghee] with pañcagavya, Mahātiktaka, or Tiktaka [ghee].

Milk curdled in a pot smeared with citraka paste, properly churned— / the ghee born from that, containing citraka root as its paste and cooked with buttermilk, is supreme in destroying swelling.

And it destroys piles, diarrhoea, vāta-gulma, and meha, and imparts strength to the digestive fire; / one should eat foods or prepared yavāgū with that buttermilk accompanied by the ghee.
Thus ends Citrakaghṛta.
With jīvantī, cumin, śaṭī, puṣkaramūla, along with kāravī, citraka, bilva pulp, / and barley-alkali, each in the measure of a jujube, mixed with vṛkṣāmla and fried in ghee and oil—

such a yavāgū is beneficial for piles, diarrhoea, vāta-gulma, swelling, heart disease, and sluggish digestion. / That which is prepared according to the very same rule with the pañcakola is likewise identical [in benefit].

And soup of kulattha with pippalī, soup of mudga with the three pungents and barley-alkali, / and likewise the meat juice of wild gallinaceous birds, together with tortoise, monitor lizard, peacock, and porcupine [are beneficial].

Suvarcalā, gṛñjanaka, paṭola, vāyasī, radish, cane shoots, and nimba: / this pot-herb is commended for those desiring greens; and old barley along with śāli rice for food.

This internal medicine has been declared; listen duly to that which is beneficial externally: / for one with prominent vāta, one should apply unctuous substances, poultices, affusions, and sudations.

With śaileya, kuṣṭha, aguru, devadāru, kauntī, tvak, padmaka, cardamom, bālaka, palāśa, mustā, / priyaṅgu, sthauṇeyaka, saffron, māṃsī, tālīśapatra, plava, tejapatra, coriander,

śrīveṣṭaka, dhyāmaka, pippalī, spṛkkā, and nakha, as available, / they commend an oil cooked [with these] for massage, and also a poultice with them finely ground, when vāta is present.

And fanned with water prepared from leaves of vāsā, arka, karañja, śigru, kāśmarya, and arjaka, / fomented with lukewarm water heated by the sun, and bathed, he should be anointed with fragrant pastes.

The barks of latex-bearing trees with vetasa, along with mañjiṣṭhā, latā, and lotus stalks, / with sandalwood, padmaka, and bālaka; but in a pitta condition, a poultice cooked with oil [is used].

For one anointed with that, sun-heated water with sandalwood, abhayā, and padmaka / is beneficial for bathing; or a decoction of latex-bearing [trees], milk and water, and anointment with sandalwood.

In kapha, however, a paste of black sand, old oil-cake, śigru bark, and linseed [is indicated], / affusion with kulattha and ginger water or urine, and anointment with caṇḍā and aguru.

A paste of the marrow of vibhītaka fruits is declared to relieve the distress of burning in all [types]; / a paste of yaṣṭyāhva, mustā, kapittha leaves, and sandalwood is [applied] on the eruptions that occur in it.

Rāsnā, vṛṣa, arka, triphalā, viḍaṅga, śigru bark, mūṣikaparṇikā, / nimba, arjaka, vyāghranakha, dūrvā, suvarcalā, and katukā,

along with kākamācī, bṛhatī, kuṣṭha, punarnavā, citraka, and dry ginger, / ground with urine, is commended as an inunction in swelling patients, and likewise affusion with radish water.

Those swellings which are located in individual limbs of the body, due to distinctions of site, vitiated element, shape, and name, / are innumerable; hear a few of them as I describe them by way of illustration:

The three doṣas, aggravated by their respective causative factors, produce a dreadful swelling of the head, / and inside the throat, accompanied by a gurgling sound, a śālūka that obstructs respiration.

At the junction of the throat, on the chin, and on the throat, accompanied by burning sensation, redness, and severe respiratory distress, / a swelling with acute pain is biḍālikā; it kills if it encircles the throat.

There is also tāluvidradhi on the palate, accompanied by burning, redness, and suppuration, born of the three doṣas; / upon the tongue there is upajihvikā from kapha, and below it, adhijihvikā.

The suppuration that occurs in the gums from raktapitta is declared to be upakuśa; / there may also be dantavidradhi, a swelling in the gums arising from kapha and an accumulation of blood.

On the side of the throat, a single one is a galagaṇḍa, but a gaṇḍamālā consists of many swellings; / [these] are regarded as curable, but accompanied by chronic rhinitis, pain in the flanks, cough, fever, and vomiting, they are incurable.

For these, bloodletting from the veins, evacuation of the body and head, medicated smoking, and drinking of old ghee [are indicated]; / fasting, abrasive powder, and gargles should also be used for those occurring in the mouth.

In a part of the body, through vāta and the other [doṣas], bearing their respective characters, pulsating, accompanied by veins, / there is a granthi; born of flesh, it is large and painless; born of fat, it is exceedingly unctuous and mobile.

Once [the patient] is purified, [the physician] should dissolve the unsuppurated [granthi] after sweating it with stones, wood, and poles along with the thumbs; / and after cutting open and extracting it along with its capsule with a knife, and cauterizing it, the physician should treat it like a wound.

If uncauterized and left even slightly remaining, it increases again slowly; / therefore, taking into account the regions of the body, it should be excised entirely all around by skilled [physicians].

If a residue is left, it may break down due to suppuration; from that, visarpa arising from trauma may spread; / considering that complication, one who knows it, using those previously stated medicines,

Should ward it off right from the start with effort, the knower of procedures having performed the respective procedure; / then, in due course and according to the rules, the knower of wounds should treat his wound with dispatch.

One should avoid that which is situated in the pelvic cavity and abdomen, and likewise that which is situated in the throat and vital spots; / that which is large and rough should also be avoided, as well as that in children, the elderly, and the debilitated.

Since between granthis and arbudas there is no difference with respect to site, etiology, form, doṣas, and dūṣyas, / the physician who knows the procedure should therefore treat arbudas with the treatment for granthi.

The copper-colored, painful boil whose tip discharges is called alajī; / an uninjured swelling between the skin and the nails that vitiates flesh and blood and suppurates very quickly,

Accompanied by fever, arising in the groins or armpits, elongated like a wick, painless, hard, and broad, / is vidārikā, from kapha and vāta; their management should be according to the doṣa.

Bloodletting, poulticing with a lump [of medicaments], and in the suppurated ones, treatment like a wound [should be done]; / but visphoṭakas are blisters spreading over the whole body, accompanied by redness, fever, and thirst.

Kakṣās, resembling a sacred thread and abundant, are produced by pitta and vāta; / and the other scattered boils, large, small, or medium, are also born of pitta.

Small-sized boils over the whole body, accompanied by fever, burning, thirst, / itching, anorexia, and excessive salivation, are declared to be romāntikā, from pitta and kapha.

Those that are of the size of lentils all over the body are declared to be masūrikā, from pitta and kapha; / the therapy prescribed for the alleviation of visarpa and that which is beneficial in kuṣṭha should be applied in these.

Bradhna occurs in the scrotum from vāta and the others, with their own symptoms; the intestine repeatedly protrudes and enters; / one should know the swelling filled with urine as soft, and if from fat, unctuous and hard.

Purgation, anointing, non-unctuous enemas, and pastes [are indicated], and in the suppurated ones, treatment like a wound; / there should be irrigation with urine; after cutting open that born of kapha and purifying it, one should suture it, and when suppurated, [treat it] like a wound.

By worms, small sharp bones, excessive intercourse, straining, squatting, and [riding on] horse-back, / a boil on the side of the anus with intense pain, when suppurated and burst open, becomes bhagandara.

Purgation, probing, and incision, and cauterization with oil of the purified tract [are indicated]; / and when cut by means of a well-prepared medicated alkali-cord (kṣārasūtra), its treatment should be like a wound.

In the shanks, above the calves and forefeet, ślīpada occurs from the disorder of flesh, kapha, and blood; / vein-puncturing and the entire regimen that destroys kapha are desired there, as well as the application of mustard paste.

The doṣas, dull but with pitta predominant and vitiated, produce an intense swelling / with thin and bloody suppuration, accompanied by fever and thirst, spreading, named jālakagardabha.

Fasting, bloodletting, roughening therapies, purification of the body, / uses of emblic myrobalan (dhātrī), and cooling plasters should always be applied for jālakagardabha.

Having examined other such varieties of swelling according to the signs of vāta and the others, / one should bring them to pacification with doṣa-relieving measures according to their nature, by pastes, excision, incising, and cauterization.

Mostly from trauma, vāta combined with blood causes a reddish swelling; there, / measures dispelling visarpa and dispelling vātarakta should be carried out, and in that born of poison, poison-destroying measures.

Here is a verse:

The signs and treatment have been stated for the threefold swelling based on the classification of doṣas, / and also for the twofold based on the division of the whole, half, and parts of the body.

Thus ends the twelfth chapter, named Treatment of Swellings (Śvayathu), in the Cikitsāsthāna of the compendium composed by Agniveśa, unavailable [in parts] and restored by Dṛḍhabala. //12