The Compendium of Caraka 6.13: trayodaśo 'adhyāyaḥ/

Now we shall explain the treatment of abdominal enlargements (udara).

Thus spoke the venerable Ātreya:

On Kailāsa, crowded with siddhas and vidyādharas, resembling the Nandana garden, / to [him] practicing intense austerities, standing like dharma incarnate,

The best among the knowers of Āyurveda, the promoter of medical science, / to Punarvasu, who had conquered himself, Agniveśa addressed these words:

"Revered sir, men are indeed seen afflicted by miserable abdominal enlargements, / with parched mouths, emaciated limbs, and distended bellies and flanks,

Lost of digestion, strength, and food intake, incapable of any activity, / wretched, abandoning their lives like orphans due to lack of remedy.

I desire to hear their etiology, enumeration, premonitory symptoms, signs, and medicine / properly expounded by the master as it truly is."

Thus prompted by his disciple, the sage, devoted to the welfare of all beings, / began to utter words beneficial to all beings:

"Due to the impairment of the digestive fire, manifold groups of diseases arise in men / from the increase of waste products, but particularly abdominal enlargements (udara).

When the digestive fire is dull, due to indigestion caused by impure foods, an accumulation of doṣas / vitiates the prāṇa, agni, and apāna, and blocks the lower and upper channels;

Entering between the skin and flesh, greatly distending the belly, / it produces udara; listen to its etiology along with symptoms:

From consuming foods that are excessively hot, salty, alkaline, burning, sour, and artificial poison, / from improper restorative regimen, from dry, incompatible, and impure food;

From emaciation caused by spleen disorders, hemorrhoids, and grahaṇī disorders; from errors in treatment procedures; / from non-remedying of exhausted [tissues], from dryness, from suppression of urges;

From vitiation of channels, from āma, from physical agitation, from over-filling; / from obstruction by hemorrhoids, hair, or feces; from perforation and rupture of the intestine;

In those whose doṣas are excessively accumulated and who perform sinful deeds, / abdominal enlargements arise, especially in those with dull digestive fire.

Loss of appetite; sweet, overly unctuous, and heavy food digests slowly; / whatever is eaten causes a burning sensation, and one does not know whether it is digested or undigested;

One cannot tolerate excessive fullness, and there is slight swelling in the feet; / constantly there is loss of strength, and upon even slight exertion one suffers from dyspnea.

There is enlargement and accumulation of feces caused by unctuousness and udāvarta; / pain and distension in the bladder joint increases, and there is also a splitting sensation.

And the belly distends even from light and sparse food; / the appearance of streaks and the disappearance of skin-folds are the signs of what is to come.

Having obstructed the sweat- and water-carrying channels, the accumulated doṣas, / corrupting prāṇa, agni, and apāna, produce abdominal enlargement in humans.

Distension of the belly, rumbling, swelling of the hands and feet, / dull digestive fire, smoothness of the cheeks, and emaciation are the characteristics of abdominal enlargement.

From the individual doṣas, from all combined, and through plīhan, obstruction, injury, and water, / eight abdominal enlargements arise; hear their signs individually.

By dry and sparse food, physical fatigue, and suppression of urges, udāvarta, and emaciating factors, / vāyu is aggravated, moving into the channels of the belly, heart, bladder, and rectum;

Having destroyed the digestive fire and driven up kapha, its course obstructed thereby, / it settles between the skin and flesh and accumulates the abdomen in the person.

Its signs are: swelling of the belly, hands, feet, and testicles; tearing pain in the abdomen; irregular increase and decrease; colic in the belly and sides, udāvarta, body-aches, cracking in the joints, dry cough, emaciation, weakness, tastelessness, and indigestion; heaviness in the lower body, retention of flatus, feces, and urine; a grayish-red tint of the nails, eyes, face, skin, urine, and feces; moreover, the abdomen is covered with thin, dark streaks and veins, sounds like an inflated bellows when struck, and vāyu moves upward, downward, and transversely with colic and rumbling—this one should recognize as vātodara.

By the intake of pungent, sour, salty, excessively hot, and sharp foods, and fire and sunshine, / and by burning food, eating before previous food is digested, and indigestion, pitta is rapidly accumulated;

Reaching and obstructing vāyu and kapha, having entered improper pathways, / it destroys the fire in the stomach and thereupon produces abdominal enlargement.

Its signs are: burning sensation, fever, thirst, fainting, diarrhea, and dizziness; bitter taste in the mouth; green and turmeric-yellow coloration of the nails, eyes, face, skin, urine, and feces; moreover, the abdomen is wrapped in blue, yellow, turmeric-yellow, green, and copper-colored streaks and veins, burns, aches, fumes, radiates heat, sweats, becomes moist, is soft to the touch, and suppurates quickly—this one should recognize as pittodara.

By lack of exercise, daytime sleeping, and sweet, excessively unctuous, and slimy foods, / and by excessive intake of yogurt, milk, and meat of aquatic and marshland animals,

When the channels are obstructed by enraged śleṣman, vāyu is enveloped, / and compressing that very [śleṣman], moving outside the intestines, it produces abdominal enlargement.

Its signs are: heaviness, tastelessness, indigestion, body-aches, numbness, swelling of the hands, feet, scrotum, and thighs, nausea, drowsiness, cough, dyspnea, and whiteness of the nails, eyes, face, skin, urine, and feces; moreover, the abdomen is covered with white streaks and veins, is heavy, motionless, steady, and hard—this one should recognize as śleṣmodara.

In one with weak digestive fire, by unwholesome, raw, incompatible, and heavy foods, / and by menstrual blood, hair, feces, urine, bones, nails, and the like administered by women,

And by mild poisons, the three aggravated [doṣas], beginning with vāta, / gradually forming an accumulation in the belly, produce abdominal enlargement in humans.

Its signs are: all the signs of all the doṣas combined are observed, all colors appear on the nails and other parts, and the abdomen too is covered with streaks and veins of various colors—this one should recognize as sannipātodara.

From excessive agitation when one has eaten, from travel in vehicles and excessive exertion, / from excessive sexual intercourse, carrying loads, walking, vomiting, and emaciation due to diseases,

The plīhan situated in the left flank, displaced from its seat, enlarges, / or blood increased from the rasa and other tissues enlarges it.

Its plīhan, enlarging initially hard like an aṣṭhīlā stone, is felt in the shape of a tortoise; and when neglected, gradually enclosing the belly, stomach, and the seat of the digestive fire, it brings about abdominal enlargement.

Its signs are: weakness, tastelessness, indigestion, retention of feces and urine, entering into darkness, thirst, body-aches, vomiting, fainting, languor of limbs, cough, dyspnea, mild fever, abdominal distension with constipation, loss of digestive fire, emaciation, bad taste in the mouth, cracking in the joints, and colicky vāta pain in the belly; moreover, the abdomen becomes reddish or discolored, with blue, green, and turmeric-yellow streaks; in this very manner the liver too situated in the right flank may cause [enlargement], and because of the equality of causes, signs, and medications, its inclusion is within plīhodara itself—this one should recognize as plīhodara.

When the passage in the rectum is blocked by eyelashes or hairs eaten along with food, / or by udāvarta, hemorrhoids, or entanglement of the intestines,

Apāna vāyu, enraged by the obstruction of its passage and destroying the digestive fire, / obstructs feces, pitta, and kapha, and thereupon produces abdominal enlargement.

Its signs are: thirst, burning sensation, fever, dryness of mouth and palate, weakness in the thighs, cough, dyspnea, weakness, tastelessness, indigestion, retention of feces and urine, distension, vomiting, sneezing, and pain in the head, heart, navel, and rectum; moreover, the abdomen has impeded vāta, is firm, reddish, with blue streaks, or covered with vein-streaks, usually developing above the navel like a cow's tail—this one should recognize as baddhagudodara.

When the intestine is pierced by grit, grass, wood, bone, or thorns mixed with food eaten, / or by yawning, or by overeating,

The digested food-juice flows outward from those perforations and undergoes suppuration; / filling the rectum and intestine, it thereupon produces abdominal enlargement.

Its signs are: developing mostly below the navel, it becomes udakodara, and shows the symptoms of the doṣas according to their strength; moreover, the patient passes āma feces that are reddish, blue, yellow, slimy, and have a cadaverous smell, and is afflicted with hiccup, dyspnea, cough, thirst, prameha, tastelessness, indigestion, and weakness—this one should recognize as chidrodara.

In one who has drunk unctuous substances, who has dull digestive fire, or is depleted or extremely emaciated, / when the fire is extinguished by drinking excessive water, māruta residing in the kloman,

And kapha, combined with water when the channels have their paths obstructed, / increase that very water from its own seat into the abdomen.

Its signs are: lack of desire for food, thirst, discharge from the rectum, colic, dyspnea, cough, and weakness; moreover, the abdomen is covered with streaks and veins of various colors, and has the feel of the agitation of a water-filled skin-bag—this one should recognize as udakodara.

There, the physician should treat with haste an abdominal enlargement that has arisen recently, is free from complications, and has not yet become watery; for if these [enlargements] are neglected, the doṣas, shifted from their own seat and liquefied by cooking, moisten the joints and the channels; and sweat, its passage obstructed in the external channels, remaining transversal, nourishes that very water; then, when slimy matter is produced, the abdomen becomes circular, heavy, sluggish, soundless on tapping, soft to the touch, devoid of streaks, and when pressed down it extends only up to the navel.

Immediately after that comes the manifestation of water.

Its signs are: excessive enlargement of the belly, disappearance of the veins, and the feel of agitation like a water-filled skin-bag.

Then complications afflict the patient: vomiting, diarrhea, dark-out dyspnea, thirst, dyspnea, cough, hiccups, weakness, pain in the flanks, lack of appetite, loss of voice, retention of urine, and the like; such a condition one should know to be incurable.

And on this there are [verses]:

From vāta, from pitta, from kapha, from the spleen, from sannipāta, and likewise from water, / the physician should declare abdominal enlargement progressively more difficult to cure.

Beyond a fortnight baddhagudodara, all [cases] that have generated water, / and an abdomen with perforated intestines generally lead to demise for men.

One should avoid a patient whose eyes are swollen, whose penis is curved, whose skin is moist and thinned, / and who is completely depleted of strength, blood, flesh, and digestive fire.

Swelling arising from all vital organs, dyspnea, hiccups, anorexia accompanied by thirst, / fainting, vomiting, and diarrhea kill a man suffering from abdominal enlargement.

By its very nature, all abdominal enlargement is generally considered most difficult to cure; / in a strong person, when newly arisen and not yet producing fluid, it is curable with effort.

When it has not developed swelling, is reddish, produces sound, is not excessively heavy, / always gurgles, is latticed with a network of veins,

Having stiffened the navel, after producing an urge at the anus it abates, / and one has distinct colic in the heart, navel, groin, hips, and rectum,

When one expels rough wind and the digestive fire is not excessively dull, / when the tongue lacks saliva and the mouth is unpalatable, the urine is scanty, and the feces are compacted,

Having recognized it accurately as not yet having produced water by these signs, / the physician, knowing the particulars of doṣas, strength, and time, should proceed to treat it.

Hence, one should first treat strong vātodara with unctuous substances; / to one who is unctuated and whose limbs have been sweated, one should administer unctuous purgation.

When the doṣa has been removed, one should wrap the limp abdomen with a cloth; / thus, due to the lack of space, vāyu will not distend it again.

Abdominal enlargement arises from excessive accumulation of doṣas and obstruction of the path of the channels; / therefore, one should purge constantly.

Having cleansed and administered a restorative regimen, he should give milk to drink for strength; / and before nausea occurs, milk should be discontinued gradually once strength is gained.

When the digestive fire has been stimulated with vegetable broths or meat broths with mild sour and salty tastes, / one should again apply an unctuous, non-unctuous enema to a man who has been unctuated and sweated and has udāvarta.

In twitching, convulsions, and pain in joints, bones, flanks, back, and sacrum, / one should administer an unctuous enema even to a dry patient who has a blazing fire and bound feces and wind.

His non-unctuous enema of Daśamūla is combined with sharp downward-moving drugs; / the unctuous enema is prepared with castor and sesame oils boiled with vāta-dispelling sour substances.

However, one who is known to be unfit for purgation—weak, aged, an infant, / delicate by nature, with mild doṣas, or with predominant vāta—

That patient the wise physician should treat with pacifying ghees, vegetable broths, meat broths, and boiled rice, / and with enemas, anointings, unctuous enemas, and milk.

In pittodara, however, one should purge a strong patient at the very outset; / but a weak one, after administering an unctuous enema first, one should cleanse with a milk-enema.

When strength, body, and digestive fire have been established, one should again unctuate and purge / with milk combined with paste of trivṛt or boiled with castor,

Or boiled with sātalā and trāyamāṇā, or with āragvadha; / if accompanied by kapha, with urine, or if accompanied by vāta, with bitter ghee.

And repeating the application of milk, enema therapy, and purgation, / adhering steadily to the regimen, an attentive physician will conquer pittodara.

A patient suffering from kaphodara who is unctuated, sweated, and properly cleansed, / one should subject to a restorative regimen with pungent and alkali-rich foods that remove kapha.

And with drinks of cow's urine and ariṣṭas, as well as powders and iron preparations, / and with drinks of oil containing alkalis, one should pacify kaphodara.

In sannipātodara, one should employ all the measures as prescribed; / but if fully formed with complications, it should be rejected by the discerning [physician].

By udāvarta, pain, and abdominal distension; by burning, confusion, thirst, and fever; / by heaviness, anorexia, and hardness, for vāyu and the others respectively,

Seeing these aggravated signs in the spleen, and also blood by its own symptoms, / one should perform treatment according to the doṣa and according to strength.

Unction, sudation, purgation, non-unctuous enema, and unctuous enema, / after examination, one should carry out, or venesect a vein in the left arm.

One should administer six-pala ghee, or apply pippalī, / or abhayā with jaggery, or groups of alkalis and ariṣṭas.

This procedure of treatment has been declared; listen to the pacifying formulations: / pippalī, dried ginger, dantī, citraka, double amount of abhayā,

Combined with a part of viḍaṅga—one should drink this powder with hot water. / Viḍaṅga, citraka, dry ginger with ghee, rock salt, and vacā,

Burned on an earthen potsherd, one should drink with milk to remove gulma and splenic disease. / The stems of the rohītaka creeper in water of abhayā,

Or one should steep in urine, and after standing for seven nights, drink it; / jaundice, gulma, urinary disorders, hemorrhoids, splenic disease, all abdominal enlargements, and parasites

It will destroy; and when it has digested, food here should be taken with wild meat broths. / Taking twenty-five palas of rohītaka bark,

One should prepare a decoction together with two prasthas of jujube; / with one pala each of the pañcakola drugs, and with an equal amount to all those

Of ground rohītaka bark, one should cook one prastha of ghee; / this, when administered, quickly pacifies enlargement of the spleen,

As well as gulma, abdominal enlargement, dyspnea, parasites, anemia, and jaundice; / and the physician should perform cauterization when vāta and kapha are predominant.

In the paittika variety, ghees with vitalizing drugs, milk enemas, / bloodletting, thorough purification, and the drinking of milk are commended;

And with vegetable broths and meat broths combined with appetizer drugs; / in the case of the liver, all medicine is considered like that of the spleen, owing to their similarity.

Having prepared light foods, the physician should administer them in plīhodara; / to a sweated patient suffering from baddhodara, [an enema] with urine and sharp drugs,

With oil and salt, one should give a non-unctuous enema along with an unctuous enema, / and laxative foods, and sharp purgation.

Measures alleviating udāvarta and counteracting vāta should be carried out; / in chidrodara, one should manage it like śleṣmodara, except for sweating.

As water accumulates again and again, it should be drained; in this way the physician should palliate it. / But one afflicted with thirst, cough, and fever, whose muscle tissue, digestive fire, and food intake are depleted,

Suffering from dyspnoea, colic, and weak sensory organs—such a patient one should reject. / In udakodara, one should first administer remedies that eliminate defects of water,

Sharp, combined with urine, containing various alkalis; / and one should treat him with appetizer and kapha-alleviating diets.

And one should restrict liquid substances such as water and the like gradually. / Almost every udara is considered to arise from an aggregation of doṣas;

Therefore, one should apply measures that pacify all three doṣas in all cases. / Indeed, when the belly is filled with doṣas, the digestive fire undergoes weakness;

Therefore, foods that are appetizer and light should be consumed: / red śāli rice, barley, mung beans, and wild animals and birds;

Milk, urine, asava and ariṣṭa wines, honey-sīdhu wine, as well as surā wine; / or one should eat gruel and cooked rice along with vegetable broths or meat broths,

With mild sourness, unctuousness, and pungency, prepared with the pañcamūla. / Meat of aquatic and wetland animals, leafy vegetables, pastry preparations, sesame seeds,

Exercise, travel on foot, day-sleep, and riding in vehicles one should avoid; / likewise hot, salty, sour, burning, and heavy items

The patient with belly disease should not eat, and should avoid drinking water. / Buttermilk that is not too thick, sweet, and not thin is beneficial to drink.

A patient suffering from nicayodara should drink it combined with the three pungents, alkali, and salt; / a patient suffering from vātodara should drink buttermilk mixed with pippalī and salt;

A patient suffering from pittodara should drink sweet buttermilk combined with sugar and liquorice; / a patient suffering from kaphodara, with yavānī, rock salt, ajājī, and the three pungents;

He should drink buttermilk mixed with honey, lukewarm, and not too thin; / with honey, oil, vacā, dry ginger, śatāhvā, kuṣṭha, and rock salt

A patient suffering from plīhodara should take it; a patient with udakodara when [water has] formed should take it with the three pungents; / a patient suffering from baddhodara, however, with hapuṣā, yavānī, ajājī, and rock salt;

A patient suffering from chidrodara should drink buttermilk combined with pippalī and honey. / For those afflicted with heaviness and anorexia, having sluggish digestive fire and diarrhoea,

And afflicted with vāta and kapha, buttermilk serves as nectar. / For one tormented by swelling, constipation, pain, thirst, and fainting, camel milk [is indicated];

For those purified and with emaciated bodies, cow's, goat's, or buffalo's milk. / With devadāru, palāśa, arka, hastipippalī, and śigru,

Along with aśvagandhā, in equal parts, with cow's urine, one should plaster the abdomen. / Vṛścikālī, vacā, kuṣṭha, the smaller pañcamūla, punarnavā,

Bhūtīka, dry ginger, and coriander boiled in water—with this one should sprinkle [the abdomen]; / palāśa, kattṛṇa, and rāsnā boiled likewise—with this one should sprinkle.

One should employ the eight urines for sprinkling and for drinking in patients with belly disease; / for those who are ununctuous, with an excess of vāta, and similarly desirous of purification,

We shall declare appetizer ghees that destroy belly disease: / with pippalī, pippalī-root, cavya, citraka, and dry ginger,

Along with alkali, half a pala each, one should cook two prasthas of ghee / with pastes of the two pañcamūlas and half a tulā of fresh juice [of the same],

Combined with an āḍhaka of curd supernatant: this ghee dispels belly disease; / it destroys swelling, vāta-distension, gulma, and piles.

Having prepared one prastha of dry ginger and triphalā, with an āḍhaka each of ghee, oil, / and whey, one should drink this: it removes all belly diseases;

And it is praised in gulma arising from kapha and vāta. / In four parts of water, two parts of urine, with one pala of paste of citraka,

One prastha of ghee prepared with alkali: the patient with belly disease should drink this; / or one should drink ghee prepared with the decoction of barley, kola, and horse gram, and of the pañcamūla,

And with surā wine and sauvīraka vinegar. / For him unctuated by these, when strength has arisen and vāta has calmed,

And the receptacle of the doṣas has relaxed, one should administer the purgative prescribed in the section on formulations. / Patolamūla, yellow turmeric, tree turmeric, viḍaṅga, rind of triphalā,

Kampillaka, nīlinī, and trivṛt: one should powder these; / having made a powder of the first six of one karṣa each, and the last three of two-, three-, and fourfold [that amount],

A man should drink a fistful of this with cow's urine; / purged, he should eat soft food with broths of wild game;

Having drunk clear gruel and thin gruel, a man should drink milk boiled with the three pungents for six days; / thereafter he should drink the powder again and again in this manner.

This powder destroys all belly diseases, even those where fluid has formed; / it removes jaundice, anaemia, and swelling.

This paṭolādya powder is highly revered in belly diseases. / Gavākṣī, śaṅkhinī, dantī, bark of tilvaka, and vacā

One should drink with grape water, cow's urine, kola-fruit wine, or karkandhu-fruit wine. / Yavānī, hapuṣā, coriander, triphalā, and upakuñcikā,

Kāravī, pippalī-root, ajagandhā, śaṭī, vacā, / śatāhvā, cumin, the three pungents, svarṇakṣīrī, and citraka,

The two alkalis, puṣkaramūla, kuṣṭha, the five salts, / and viḍaṅga in equal parts; likewise three parts of dantī,

Two parts each of trivṛt and viśālā, and four parts of sātalā: / this powder, named Nārāyaṇa, dispels hosts of diseases;

Encountering it, diseases do not endure, just as the Asuras before Viṣṇu. / It should be drunk with buttermilk by those with belly disease; with jujube water by those with gulma;

With surā wine in distended vāta; with clear supernatant wine in vāta-disease; / with curd supernatant in retention of feces; with pomegranate water by those with piles;

With vṛkṣāmla in cutting pain; with hot water in indigestion; / in bhagandara, anaemia, dyspnoea, cough, throat obstruction,

Heart disease, impairment of the grahaṇī, skin diseases, sluggish digestive fire, fever, / fang-venom, root-poison, gara poison, and artificial poison,

This purgative should be drunk as appropriate by one whose alimentary tract is unctuated. / Thus ends the Nārāyaṇa powder. / Hapuṣā, kāñcanakṣīrī, triphalā, kaṭurohiṇī,

Nīlinī, trāyamāṇā, sātalā, trivṛt, vacā, / rock salt, black salt, and pippalī: one should powder these;

This should be drunk with pomegranate juice, triphalā water, meat broth, urine, or lukewarm water, / in all forms of gulma, in the spleen, and in all belly diseases;

In vitiligo, skin disease, painful conditions, vāta conditions, irregular digestive fire, / in swelling, piles, anaemia, jaundice, and halīmaka;

Through purgation it quickly resolves vāta, pitta, and kapha. / Thus ends the hapuṣādya powder. / Nīlinī, nicula, the three pungents, the two alkalis, and the salts,

And citraka: one should drink this powder with ghee to remove belly disease and gulma. / Thus ends the nīlinyādya powder. / A droṇa of milk, together with half a prastha of euphorbia milk, curds

Once [curd] is formed, churn it and skillfully prepare ghee cooked with trivṛt, and drink it; / likewise, one should drink a prastha of ghee prepared in eight times as much milk

With a paste of one pala of euphorbia milk and six palas of trivṛt, / for the pacification of gulmas, poison afflictions, and belly diseases. / Thus ends the snuhīkṣīraghṛta. / From a prastha of ghee cooked in an āḍhaka of curd scum with a paste of one pala of euphorbia milk, / one should drink a dose likewise for the pacification of belly disease.

And after these, one should drink peyā, milk, or sweet broth. / When the ghee is digested and the patient is purged, [he should drink] lukewarm [water] boiled with dried ginger;

After that he should drink water, then peyā, and then horsegram soup. / The unctuated person should drink thus for three days, or fed again repeatedly,

He should drink ghee again and again in that very order. / A skilled physician should administer these prepared ghees

For the pacification of gulmas, poison afflictions, and belly diseases; / or ghee cooked with a paste of pīlu, which breaks distension,

Or one should drink gulma-destroying nīlinī-ghee or the miśraka fat. / For those whose doshas have been eliminated in stages and who eat game meat, / I will declare formulations from here onwards to remove the remainder of the doshas: / a man should drink a paste of citraka and devadāru with milk

For a month, properly applied; likewise, hastipippalī, dried ginger, / viḍaṅga, citraka, dantī, cavya, and the three pungents: milk with these

Pastes equal in size to a jujube fruit, having drunk [it], one overcomes advanced belly disease. / One should drink a decoction boiled with triphalā, dantī, and rohītaka,

Combined with the three pungents and alkali; when it is digested, he should eat with game meat broths / or eat a meal of meat combined with euphorbia milk ghee.

Or he should administer abhayā with cow's urine, followed by a drink of milk. / Abstaining from grain food, he should drink buffalo urine and milk for a week,

Or camel milk for a month, or goat milk with the three pungents for three months, / or a thousand harītakī fruits, or living on milk, śilājatu,

Or he should administer guggulu according to the rule for śilājatu. / Fresh ginger juice is beneficial for drinking, equal in quantity to milk;

Oil prepared with that very juice or with ten times as much; / oil made from the fruits of dantī and dravantī is beneficial in dūṣyodara.

In colic, distension, and constipation, [administered] with whey, soup, meat broth, and the like; / oils from the seeds of saralā, horseradish tree, and radish,

For inunction and drinking, destroy colic in vātodara. / In numbness, anorexia, nausea, dull digestive fire, and for a wine-drinker,

He should administer ariṣṭas and alkalis in rigid belly disease with coagulated kapha. / In order to liquefy kapha, the excellent physician, having examined the dosha,

Having prepared pippalī, tilvaka, asafoetida, ginger, hastipippalī, / bhallātaka, horseradish-tree fruit, triphalā, kaṭurohiṇī,

Devadāru, the two turmerics, saralā, ativiṣā, vacā, / kuṣṭha, musta, and the five salts,

Combined with curd, ghee, muscle fat, bone marrow, and oil, should burn them [into alkali]. / From this alkali, he should drink a biḍālapada dose after food

With madirā, curd scum, warm water, ariṣṭas, surā, or āsavas. / It destroys heart disease, swelling, gulma, spleen disease, piles, belly diseases,

Visūcikā, udāvarta, and vātāṣṭhīlā. / And alkali from goat dung, strained, he should boil with urines

With a karṣa each of pippalī-root, the five salts, / pippalī, citraka, dried ginger, triphalā, trivṛt, vacā,

The two alkalis, sātalā, dantī, svarṇakṣīrī, and viṣāṇikā. / He should drink a pill the size of a jujube fruit with sauvīra vinegar

In swelling, indigestion, and in advanced dakodara. / With grains of ṣaṣṭika rice macerated in cow's urine,

He should feed the person gruel cooked with milk to his satisfaction; / and after that he should drink sugarcane juice for the cessation of belly diseases.

Thus pitta, kapha, and vāta go to their respective seats. / With tender shoots of śaṅkhinī, euphorbia, trivṛt, dantī, cirabilva, and the like,

The physician should give vegetable before food to one with hard stool. / Then, to him whose stool and doshas have become loosened, the one learned in the treatises

Should give auspicious milk with urine, which removes the remainder of the doshas. / If vāta should cause flank pain, rigidity,

And cardiac constriction, he should make him drink oil with bilva alkali; / likewise, with alkalis from agnimantha, śyonāka, palāśa, and sesame stalks,

And with alkalis from balā, plantain, and apāmārga, each strained separately, / the physician, having cooked oil, should administer it for the pacification of belly diseases.

And cardiac constriction arising from vāta subsides in those suffering from belly disease. / When kapha is occluded by vāta or by pitta, or when vāta is occluded by both,

Castor oil combined with their appropriate medicines is beneficial for a strong person. / But if a man, having been well purged, should become bloated again,

One should treat him with well-unctuated, sour, and salty nirūha enemata. / Or if rigid vāyu bloats a man,

One should treat him with sharp enemata containing alkali and cow's urine. / When belly disease exceeds treatment and tridoṣa disease does not subside,

Having obtained the consent of kinsmen, friends, wives, brāhmaṇas, kings, and elders, / the physician, stating the doubt [of survival], should undertake the procedure:

"In the absence of action, death is certain; in action, there is a doubt." / Having spoken thus, and permitted by his circle of friends,

He should administer poison to him combined with drink and food; / or on whatever fruit an angered serpent has discharged its poison,

The excellent physician, having deliberated, should feed that to the belly-diseased patient. / By that, his mass of doshas—firm, hidden, and gone into wrong pathways—

Being quickly broken by the poison on account of its fast-churning quality, moves out. / When his doshas have been evacuated by the poison, sprinkled with cold water,

The physician should make him drink milk or gruel according to his strength. / And greens of trivṛt and maṇḍūkaparṇī along with barley and vāstuka,

Or he should eat kālaśāka cooked in its own juice and water, / devoid of sour, salt, and unctuous substances, steamed or unsteamed, eating no grain food,