The Compendium of Caraka 6.14: caturdaśo 'adhyāyaḥ/

Now we shall expound the treatment of hemorrhoids (Arśaścikitsita).

Thus spoke the venerable Ātreya.

To the seated sage, calm, his prayers completed, his leisure attained, / Agniveśa asked Punarvasu about the proper [treatment] of hemorrhoids.

The cause of aggravation, the shape, the site, the symptoms, the treatment, / and the distinction between the curable and incurable—the sage explained that to him:

Indeed here, O Agniveśa! Hemorrhoids are of two kinds: some are congenital, and some arise later in life after birth.

Among them, the seed, defective in the seed of the rectal folds, is the source of congenital hemorrhoids.

Here, the cause of the seed's defect is two-fold: the misconduct of the mother and father, and deed done in a previous life; and so it is for other congenital disorders as well.

Among them, "congenital" means born together with the body; "hemorrhoids" (arśas) are disorders characterized by polypoid muscular growths.

And the site of all hemorrhoids: in the space of four and a half finger-breadths of the rectum, the three rectal folds separated by a third [of that length] are the site; however, some instruct that the region of hemorrhoids is even broader: the penis, the birth canal, the throat, palate, mouth, nose, ears, eyelids, and skin.

That exists because those are sites of polypoid muscular growths; but in this treatise, the term "hemorrhoids" (arśas) applies to those arising in the rectal folds. And the substratum of all hemorrhoids is fat, flesh, and skin.

Among them, some congenital hemorrhoids are minute, some large, some long, some short, some round, some irregularly spread, some curved inward, some curved outward, some intertwined, some facing inward, having colors corresponding to their associated doṣa.

Afflicted by them from birth, he becomes extremely emaciated, discolored, wasted, miserable, with excessive retention of flatus, urine, and stool, suffering from gravel and urinary calculi; likewise, his stool is irregularly obstructed or loose, ripe or unripe, dry or broken, passing occasionally white, pale, green, yellow, red, brownish-red, thin, thick, slimy, corpse-smelling, and undigested feces; accompanied by intense cutting pain in the region of the navel, bladder, and groin; with anal pain, tenesmus, goosebumps, excessive urination, persistent distension of the abdomen, intestinal gurgling, upward movement of wind, and a sensation of a coating over the heart and sense organs; having excessive, suppressed bitter or sour belching; very weak, with very weak digestive fire, with little semen, irritable, habitually difficult to manage, beset with cough, dyspnea, bronchial asthma, thirst, nausea, vomiting, anorexia, indigestion, coryza, and sneezing; suffering from blurred vision, having headache, with an emaciated, cracked, weak, hoarse, and broken voice, suffering from ear disease, with swollen hands, feet, face, and orbital rims, febrile, with generalized body-aches, and pain in all joints and bones, from time to time afflicted by spasms in the flanks, abdomen, bladder, heart, back, and sacral region, given to deep brooding, and excessively indolent. From birth, obstructed by the [growths] born in the rectum, due to the blockage of the passage, the apāna wind ascends and aggravates the samāna, vyāna, prāṇa, and udāna, as well as pitta and kapha; all these aggravated five winds, along with pitta and kapha, assailing the hemorrhoids, produce these disorders. Thus have congenital hemorrhoids been described.

Hereafter we shall explain those arising later in life after birth: due to the intake of foods that are heavy, sweet, cold, unctuous, channel-blocking, burning, incompatible, undigested, or defective in quantity, or unwholesome foods; from eating the flesh of cattle, fish, boar, buffalo, goat, and sheep; from consuming emaciated, dried, or putrid meat, flour-based foods, milk puddings, milk, curd, whey, and preparations of sesame and jaggery; from the use of black gram soup, sugarcane juice, oil-cake, yam, dried vegetables, fermented vinegar, garlic, curd-cheese, buttermilk coagulum, lotus rhizomes, lotus stalks, śālūka, lotus seeds, water chestnuts, water caltrop, tarūṭa, sprouted grains, new awned grains, legumes, and raw radishes; from eating heavy fruits, vegetable relishes, green herbs, mardaka, marrow, head, and feet, and stale, putrid, cold, and mixed foods; from drinking insufficiently fermented or over-fermented wine; from drinking vitiated or heavy water; from excessive intake of unctuous substances; from non-purification; from errors in enema procedures; from lack of physical exercise; from abstinence from sexual intercourse; from daytime sleep; from the habit of comfortable beds, seats, and resting postures—due to these, when the digestive fire is impaired, the accumulation of waste matter occurs in excessive measure; likewise, from using an elevated, uneven, or hard seat; from riding in a jostling carriage or on a camel; from excessive sexual intercourse; from improper insertion of the enema nozzle; from rectal abrasion; from frequent contact with cold water; from friction by clothes, clods of earth, grass, and the like; from continuous and excessive straining; from prematurely provoking the urges of flatus, urine, and stool, or from suppressing aroused urges; and in women, from miscarriage of an unripe fetus, from pressure of the fetus, and from abnormal childbirth—the aggravated apāna wind, reaching that accumulated waste matter moving downwards, deposits it in the rectal folds; from that, hemorrhoids appear in them.

They generally have the shapes of mustard seed, lentil, black gram, green gram, moth bean, barley, pea, piṇḍīṭaka, tiṇṭīka, erakebuka, tinduka, karkandhu, kākaṇantikā, bimbī, jujube, karīra, udumbara, date, jambu fruit, cow's teat, thumb, kaśeru, śṛṅgāṭaka, śṛṅgī, cock's comb, parrot's beak, tongue, lotus bud, or lotus seed-pod, and are dominated by vāta, pitta, and kapha.

Their distinctive characteristics are as follows: those that are dry, withered, hard, rough, arid, dusky; having sharp tips, crooked, with fissured openings, irregularly spread; accompanied by colic, spasms, pricking pain, twitching, tingling, and goosebumps; relieved by unctuous and hot things; accompanied by severe tenesmus, flatulence, cardiac constriction and constriction of the penis, testicles, bladder, and groin, body aches, and palpitation; with persistently obstructed flatus, urine, and stool; causing pain in the thighs, hips, back, sacrum, flanks, belly, and bladder, headache, heat in the head, sneezing, belching, coryza, cough, udāvarta, tetany, emaciation, swelling, fainting, anorexia, bad taste in the mouth, visual impairment, itching, pain in the nose, ears, and temples, and loss of voice; in a patient whose nails, eyes, face, skin, urine, and stool are dusky, reddish, and rough—these should be recognized as hemorrhoids dominated by vāta.

And on this there are [the following verses]:

Foods that are astringent, pungent, and bitter, dry, cold, and light, / defective or scanty eating, use of strong wine and sexual intercourse;

fasting, cold regions and seasons, physical exercise, / grief, exposure to wind and sun—this is held to be the cause of vāta-hemorrhoids.

Those that are soft, loose, delicate, intolerant of touch; red, yellow, blue, or black; characterized by copious sweating and moisture; discharging a thin, yellow, or red fluid with a fleshy smell; bleeding; accompanied by burning sensation, itching, colic, piercing pain, and suppuration; relieved by cold; accompanied by loose, yellow, or green stool, and copious yellow urine and feces with a fleshy smell; causing thirst, fever, bronchial asthma, confusion, and aversion to food; in a patient whose nails, eyes, skin, urine, and stool are yellow—these should be recognized as hemorrhoids dominated by pitta.

And on this there are [the following verses]:

Pungent, hot, salty, and alkaline foods, physical exercise, the glow of fire and sun, / regions and seasons that are not cold, anger, wine, intolerance;

every burning, sharp, and hot drink, food, and medicine— / this should be recognized as the cause of the provocation of hemorrhoids dominated by pitta.

Among them, those that are of large size, plump, smooth, tolerant of touch; unctuous, white, pale, slimy; stiff, heavy, sluggish, completely numb, with firm swelling; extremely itchy; discharging copious, persistent, reddish-yellow, white, and red slimy fluid; with heavy, slimy, white urine and stool; relieved by dry and hot things; accompanied by tenesmus, excessively frequent urges, and distension of the groin; causing cutting pain, nausea, excessive spitting, cough, anorexia, coryza, heaviness, vomiting, dysuria, wasting, swelling, anemia, fever with chills, gravel, urinary calculi, coating over the heart and sense organs, sweetness in the mouth, and urinary disorders; long-standing in duration; causing extreme impairment of digestive fire and impotence; dominated by disorders of āma; in a patient whose nails, eyes, face, skin, urine, and stool are white—these should be recognized as hemorrhoids dominated by kapha.

And on this there are [the following verses]:

Foods that are sweet, unctuous, and cold, salty, sour, and heavy, / lack of exercise, day-sleep, fondness for the comfort of bed and seat;

exposure to the east wind, cold regions and seasons, and lack of mental activity— / this is designated as the cause of kapha-hemorrhoids.

From the combination of causes and symptoms, one should recognize those dominated by two doṣas; / all the causes combined produce [hemorrhoids] of the three doṣas, with symptoms identical to the congenital ones.

Sluggish digestion of food, debility, rumbling in the belly, / emaciation, frequent belching, weakness of the thighs, scantiness of feces,

and suspicion of grahaṇī disorder, anemia, and belly disease— / these are declared to be the premonitory symptoms for the development of hemorrhoids.

Indeed, hemorrhoids do not arise without all three doṣas combining; / yet their distinction is determined by the predominant doṣa.

The fivefold wind, pitta, kapha, and the three rectal folds— / all of these become provoked in the origin of anal growths.

Therefore hemorrhoids are painful, bring on many diseases, / afflict the entire body, and are generally extremely difficult to treat.

He in whom there is swelling in the hands, feet, face, navel, anus, and testicles, / as well as pain in the heart and flanks, is incurable from hemorrhoids.

Pain in the heart and flanks, confusion, vomiting, body ache, fever, / thirst, and ulceration of the rectum kill the patient suffering from anal growths.

Those that are congenital, tridoṣic, and arise situated in the innermost rectal fold— / one should declare those hemorrhoids to be incurable.

If a lifespan remains and the four pillars of medicine are present, / they are palliable in one whose internal digestive fire is bright; otherwise they should be rejected.

Those caused by two doṣas, those situated in the second rectal fold, / and those that are one year old, are said to be curable with difficulty.

Those that arise in the outermost rectal fold, are dominated by a single doṣa, / and are not long-standing, are easily curable hemorrhoids.

The wise physician should quickly make an effort for their pacification, / for they quickly obstruct the rectum and produce baddhagudodara.

Regarding this, some recommend excision of hemorrhoids with a knife, / some cauterization with alkali, and others cauterization with fire.

This is indeed so: this threefold procedure is performed by one versed in many treatises, / wise, and experienced in practice; yet an error therein is exceedingly dreadful:

loss of virility, swelling, retention of urges in the rectum, / severe distension, agonizing pain, distress, excessive bleeding,

recurrence of healed ones, discharge, and prolapse of the rectum, / or death may occur rapidly due to errors in knife, alkali, or fire.

Therefore I shall explain the procedure which is easy, of little risk of error, and free from cruelty, / for the complete eradication of hemorrhoids with their roots.

Those who know call hemorrhoids dominated by vāta and kapha 'dry', / and those that discharge and are moist, dominated by blood and pitta, 'wet'.

Among them, I shall first describe the treatment of dry hemorrhoids: / one should first foment those that are stiff, swollen, and painful.

The wise physician, having anointed [them] with oil of citraka, alkali, and bilva, / [should foment them] with boluses of barley, black gram, horse gram, and empty grain husks;

or with boluses of dung of cow, donkey, or horse, with sesame paste, with chaff, / or with comfortably warm boluses of vacā and śatāhvā combined with unctuous substance;

or with boluses of roasted barley flour unctuated with oil and ghee, / or with boluses of dried radish, or with boluses of kārṣṇagandhika.

or with comfortably warm boluses of rāsnā, or with unctuated [boluses] of hāpuṣā, / of brick, of kharāhvā, or with leaves of gṛñjanaka.

Having anointed [them] with kuṣṭha oil, he should foment [them] with boluses made into poultices; / and he should sprinkle them with decoctions of leaves of vṛṣa, arka, eraṇḍa, and bilva,

and with leaves of mūlaka, triphalā, arka, / bamboo, varuṇa, / agnimantha, śigru, and aśmantaka.

Having boiled [these] in water, he should immerse the patient afflicted with pain, well anointed; / or in a warm decoction of kola, or in sauvīraka vinegar or tuṣodaka,

or in a decoction of bilva, or buttermilk, curd scum, sour kāñjika, / or comfortably warm cow's urine, he should immerse him when well anointed.

He should give the muscle fat of a black snake, boar, camel, bat, or cat / for anointing; and fumigation is beneficial for hemorrhoids.

Human hair, slough of a snake, skin of a cat, / root of arka, and leaves of śamī are a beneficial fumigation for hemorrhoids.

Tumburu, viḍaṅga, devadāru, unbroken grains, and ghee; / bṛhatī, aśvagandhā, pippalī, surasā, and ghee;

dung of a boar and a bull, together with roasted flour and ghee, for fumigation; / elephant dung, ghee, and also resin of sarja [serve as fumigation].

Sudhā latex combined with turmeric powder is an external paste; / pippalī ground with ox bile along with turmeric is an external paste.

Śirīṣa seed, kuṣṭha, pippalī, rock salt, jaggery, / arka latex, sudhā latex, and triphalā are an external paste.

Pippalī, citraka, śyāmā, yeast, and seeds of madana; / cock dung combined with turmeric and jaggery is an external paste.

Dantī, śyāmā, amṛtāsaṅga, pigeon dung, and jaggery / should be an external paste; elephant bones, nimba, and bhallātaka

should be an external paste; [or] warm realgar mixed with the muscle fat of a vāsantaka [bird], / which removes pain and swelling, or mixed with dolphin fat.

Latex of arka, a stem of sudhā, shoots of bitter bottle gourd, / karañja, and goat urine are an excellent paste for hemorrhoids.

These measures described, beginning with anointing and ending with poultices, / are considered to relieve stiffness, swelling, itching, and pain of hemorrhoids.

Indeed, hemorrhoids treated with [measures] ending in poultices discharge / accumulated corrupt blood; then [the patient] becomes comfortable.

Indeed, when the blood is vitiated, the disease is not pacified by cold, hot, unctuous, or dry [treatments]; / therefore, the physician should let only blood flow.

By means of leeches, or likewise with surgical instruments or needles, / he should repeatedly evacuate non-flowing blood from bleeding hemorrhoids.

Him who suffers from swelling and pain in the rectum and has weak digestive fire, he should make drink / the three pungents, pippalī root, pāṭhā, asafetida, together with citraka,

sauvarcala salt, that called puṣkara, cumin, crushed pulp of bilva, / biḍa salt, yavānī, hapuṣā, viḍaṅga, rock salt, vacā,

and tamarind, with supernatant gruel, wine, or hot water; / thus he is freed from hemorrhoids, duodenal disease, pain, and abdominal distension.

Or he should make him drink the digestive remedy that was spoken of in the treatment of diarrhea; / or he should make him consume abhayā with jaggery before a meal;

or he should make him drink powder of trivṛt mixed with juice of triphalā. / When the doṣa residing in the rectum is eliminated, the hemorrhoids perish.

He should give harītakī soaked in cow's urine, or harītakī with jaggery; / or he should administer triphalā combined with buttermilk.

He should administer citraka with dry ginger, combined with sīdhu wine; / or he should give sīdhu combined with cavya, cumin, and citraka.

He should give surā wine with hapuṣā and pāṭhā, combined with sauvarcala salt; / or a buttermilk-tarpaṇa combined with wood apple and bilva, or combined with cavya and citraka,

or even combined with bhallātaka, he should administer; / or [buttermilk] combined with bilva and dry ginger, along with yavānī and citraka.

Or he should give citraka, hapuṣā, and asafetida combined with buttermilk; / or he should give him buttermilk combined with pañcakola.

Hapuṣā, kuñcikā, coriander, cumin, caraway, śaṭī, / pippalī, pippalī root, citraka, hastipippalī,

yavānī, and ajamodā powdered, combined with buttermilk, / mildly sour and pungent, the wise physician should place in a vessel smeared with ghee.

When it has become distinctly sour and pungent, pleasing to the mouth, this takrāriṣṭa / the thirsty [patient] should drink in proper measure at the three meal-times.

It stimulates digestion, improves taste, enhances complexion, promotes downward movement of kapha and vāta, / destroys rectal swelling, itching, and pain, and increases strength.
Thus ends takrāriṣṭa.
Having ground the bark of citraka root, one should coat a pot with it; / the buttermilk or curd that forms therein, which destroys hemorrhoids, he should drink.

For hemorrhoids caused by vāta and kapha, there is no medicine superior here to buttermilk; / it should be administered according to the doṣa, either unctuated or dry,

for seven days, ten days, a fortnight, or a month; / knowing the differences of strength and season, the physician should administer buttermilk.

For one whose digestive fire is exceedingly sluggish, he should administer only buttermilk; / or in the evening he should give an electuary of buttermilk with roasted grain flour.

When the buttermilk is digested, he should give gruel made with buttermilk and rock salt; / thereafter, cooked rice prepared with buttermilk, unctuated, with buttermilk as an after-drink.

Or he should feed him with vegetable soups or meat broths mixed with buttermilk; / or thereafter he should feed him with soups or meat broth prepared with buttermilk.

Knowing the proper stages of time, he should not discontinue buttermilk all at once; / the use of buttermilk lasting up to a month is beneficial when stopped by degrees.

The reduction should be as was the increase, but he should not be reduced from food, / for the sake of preserving and restoring strength, and for firmness of the digestive fire.

This regimen is prescribed for the sake of strength, bodily buildup, and complexion. / Since [buttermilk may be] dry, with half its unctuousness extracted, or with its butter unextracted,

knowing the doṣas, digestive fire, and strength, he should administer that three-fold buttermilk. / Hemorrhoids destroyed by buttermilk indeed do not grow again.

Even when poured on the ground, that buttermilk can burn up grass and shrubs; / what then of the dry hemorrhoids of an embodied being whose bodily fire is kindled?

When the channels are purified by buttermilk, the chyle that properly enters them / produces nourishment, strength, complexion, and cheerfulness.

And a hundred disorders of vāta and kapha are averted; / there is no medicine superior to buttermilk in disorders born of kapha and vāta.

Pippalī, pippalī root, citraka, hastipippalī, / ginger, cumin, caraway, coriander, tumburu,

bilva, karkaṭaka, and pāṭhā—having ground [these], he should cook a gruel; / soured with fruits and fried in two unctuous substances, he should give it to remove anal growths.

And with these [ingredients] he should prepare khaḍa-buttermilks, and with these he should boil water; / and with these ghee should be prepared for the alleviation of piles.

Or he should give a gruel prepared with śaṭī and palāśa, or with pippalī and dry ginger, / soured with buttermilk, and sprinkled with black pepper.

Or soup of dried radish, or soup of horsegram, / or soup of wood apple and bilva, with horsegram, without kuṣṭha.

Or he should give goat meat juice mixed with these soups, / or [meat juice] of quail and the like, soured with fruits, with buttermilk, combined with bowel-binding substances.

Red rice, mahāśāli, kalama, lāṅgala, white [rice], / autumn rice, and ṣaṣṭika should be the dietary regimen of cereals for piles.

Thus has been stated the course of treatment for those with piles having loose stools; / I shall now declare the medicine for those whose stools are excessively hard.

Clear supernatant wine mixed with unctuous roasted barley flour, salted, / he should give, having first had [the patient] consume candised sugar along with dry ginger.

And he should make him drink jaggery with dry ginger, pāṭhā, soured with fruits; / or he should administer jaggery combined with ghee and barley-alkali.

Ajwain, dry ginger, pāṭhā, pomegranate juice, jaggery, / with buttermilk and salt, he should give to promote the downward movement of vāta and feces.

Pāṭhā combined even with a single one—with duḥsparśaka, bilva, / ajwain, or dry ginger—destroys the pain of piles.

Before meals, he should give young leaves of karañja fried in two unctuous substances / and sprinkled with roasted barley flour, which promote the downward movement of vāta and feces.

Or he should drink salted madirā liquor, sīdhu, or sauvīra vinegar / combined with jaggery and dry ginger, before eating.

With pippalī, dry ginger, alkali, caraway, coriander, and cumin, / and combined with treacle, soured with fruits, he should administer ghee.

Pippalī, pippalī root, citraka, hastipippalī, / ginger, and barley-alkali—or he should drink ghee prepared with these.

Or [ghee] prepared with cavya and citraka, accompanied by jaggery and alkali; / or prepared with pippalī root, with jaggery, alkali, and dry ginger.

With pippalī, pippalī root, curd, pomegranate, and coriander / prepared ghee should be prescribed, which removes obstruction of vāta and feces.

Cavya, the three pungents, pāṭhā, alkali, coriander, / ajwain, pippalī root, and both salts—viḍa and rock salt—

citraka, bilva, and abhayā—having ground [these], he should cook ghee / in four times as much curd that has formed, for the sake of the downward movement of feces and vāta.

Tenesmus, rectal prolapse, dysuria, discharge, / and pain in the rectum and groin—this ghee dispels [them].

Dry ginger, pippalī root, citraka, hastipippalī, / gokṣura, pippalī, coriander, bilva, pāṭhā, ajwain—

in fresh juice of cāṅgerī he should cook ghee with these pastes / and four times as much curd; that ghee removes kapha and vāta.

Piles, grahaṇī disorder, dysuria, tenesmus, / distress of rectal prolapse, and abdominal distension—this ghee dispels [them].

Pippalī, dry ginger, pāṭhā, and gokṣura—each separately— / making parts of three palas, he should prepare a decoction.

Gaṇḍīra, pippalī root, the three pungents, cavya, and citraka— / having ground [them], the physician should stir in two palas [of each] into the strained decoction.

Into it he should add forty palas of ghee, / fresh juice of cāṅgerī equal to the ghee, and six times as much curd.

Then it should be cooked on a gentle fire; when cooked, he should store the ghee. / That should be prescribed in food, in drink, and in habitual application.

It destroys grahaṇī and piles disorders, cures abdominal swellings and heart diseases, / and removes swelling, enlargement of the spleen, belly disease, abdominal distension, dysuria, and fever.

It eliminates cough, hiccup, anorexia, and dyspnea, relieves pain in the flanks, / produces strength and nourishment, improves complexion, and is supreme in kindling the digestive fire.

He should eat harītakī fried in ghee, mixed with jaggery and pippalī, / or accompanied by trivṛt and dantī, to promote downward evacuation.

When downward movement of feces, vāta, kapha, and pitta has been achieved / and comfort is restored to the rectum, the piles subside and the digestive fire flares up.

Un-soured, well-seasoned meat juices of peacock, partridge, and quail, / of cocks and quails, he should give in retention of feces and vāta.

Vegetables of trivṛt, dantī, and palāśa, / of cāṅgerī, and of citraka, fried in two unctuous substances, he should give combined with curd.

Upodikā, taṇḍulīya, vīrā, shoots of vāstuka, / suvarcalā, with loṇīkā, barley greens, avalguja,

kākamācī, ruhāpatra, mahāpatra, as well as amlikā, / jīvantī, śaṭi greens, and the vegetable of gṛñjanaka—

prepared with curd and pomegranate, fried in two unctuous substances, / and combined with coriander and dry ginger, he should administer these vegetables.

Even of monitor lizard, fox, cat, porcupine, camel, and cow, / and of turtle and pangolin, he should prepare meat juices like vegetables.

He should give boiled red rice with these meat juices for the pacification of vāta, / having recognized the patient suffering from anal growths to be dominated by vāta, un-unctuous, and with weak digestive fire.

Madirā liquor, sugary beverage, fermented liquor, buttermilk, bran water, / ariṣṭa wine, supernatant of curd, or boiled or cold water,

or boiled with kaṇṭakārī, or boiled with dry ginger and coriander— / the physician should give as an after-drink to promote the downward movement of vāta and feces.

Those afflicted with upward movement of vāta, those excessively dried, / whose vāta moves in the reverse direction, and who suffer from colic—for them unctuous enema is recommended.

Pippalī, madana, bilva, śatāhvā, madhuka, vacā, / kuṣṭha, śaṭī, puṣkara root, citraka, and devadāru—

having ground [these], oil should be cooked with twice as much milk; / that is the best unctuous enema for piles and bewildered vāta.

Rectal prolapse, colic, dysuria, tenesmus, / weakness of the hips, thighs, and back, abdominal distension located in the groin,

slimy discharge, swelling in the rectum, retention of vāta and feces, / and frequent urges to defecate—all that one conquers by unctuous enema.

With the ingredients of the unctuous enema, ending with devadāru, ground, comfortably warm, and mixed with fat, / he should plaster the stiff and painful anal growths.

Smeared with these, they quickly discharge slimy kapha accompanied by blood; / once discharged, itching, stiffness, painful swelling ceases.

Or he should administer an evacuating enema made with the ten roots along with milk, / with urine, unctuous substance, and salt, combined with pastes of madana fruit and the rest.

There should be half a prastha of harītakīs, and a prastha of āmalaka; / of kapittha there should be ten palas, and half that of indravāruṇī;

viḍaṅga, pippalī, lodhra, black pepper, and elavāluka, / two palas each of these—he should boil in four droṇas of water.

When the decoction is reduced to one droṇa, strained, and cooled, he should add / two hundred [palas] of jaggery; that should stand for a fortnight in a ghee vessel.

After a fortnight, a dose of it should be drunk according to strength; / through the regular use of this ariṣṭa, anal growths go to extinction.

It dispels grahaṇī disorders, anemia, heart disease, spleen disease, gulma, and belly disease; / it removes kuṣṭha, swelling, and anorexia, and increases strength, complexion, and digestive fire.

This is the accomplished abhayāriṣṭa, which destroys jaundice and leucoderma, / and puts an end to worms, granthi, arbuda, facial discolorations, consumption, and fever.
Thus ends abhayāriṣṭa.
Taking roots of dantī and citraka, and of both pañcamūlas, / bruised in portions of one pala each, he should boil them in a droṇa of water.

And there he should add three palas of fragments of triphalā; / when the decoction is reduced to a fourth, strained, and cooled, he should add

a tulā of jaggery; that should stand for half a month in a ghee vessel. / Drinking that regularly in proper dose, one is freed from piles.

It destroys grahaṇī disorders and anemia, promotes the downward movement of vāta and feces, / stimulates the digestive fire, and cures anorexia; this they know as dantyariṣṭa.
Thus ends dantyariṣṭa.
One prastha of harītakī fruits and a prastha of āmalaka; / of viśālā, dadhittha, and the roots of pāṭhā and citraka,

two palas each, bruised together, he should boil in two droṇas of water; / when reduced to a quarter and strained, into that decoction he should add

one tulā of jaggery; the physician should store it in a ghee vessel. / Standing for a fortnight, he who suffers from grahaṇī and piles disorders should drink it.

Heart disease, anemia, spleen disease, jaundice, irregular fever, / obstructions caused by feces, urine, and flatus, sluggishness of the digestive fire,

cough, gulma, and udāvarta this phalāriṣṭa banishes; / for it was declared by Kṛṣṇa Ātreya to kindle the digestive fire.
Thus ends phalāriṣṭa.
There should be a prastha of durālabhā, and of citraka and vṛṣa, / and of pathyā, āmalaka, pāṭhā, and dry ginger,

and two-pala parts of dantī; he should boil them in a droṇa of water. / When reduced to a quarter, strained, and thoroughly cooled, a hundred [palas] of sugar

he should throw in and place in a jar seasoned with ghee for half a month, / smeared with pippalī, cavya, priyaṅgu, honey, and ghee.

At the proper time he should drink a dose of this sugar-preparation according to strength; / piles, grahaṇī defect, udāvarta, anorexia,

obstructions of feces and urine, turbid eructations, sluggishness of the digestive fire, / heart disease, and anemia—all these he cures with this.
Thus ends the second phalāriṣṭa.
One should take one tulā of fresh, crushed āmalaka; / and kuḍava portions of pippalī, viḍaṅga, and black pepper,

and one-pala portions each of pāṭhā, pippalī root, kramuka, cavya, citraka, / mañjiṣṭhā, elavāluka, and lodhra should be prepared.

Kuṣṭha, dāruharidrā, surāhva, the two kinds of sārivā, / indrāhva, and bhadramusta he should measure at half a pala each;

and four palas of fresh nāgapuṣpa; / having boiled them with two droṇas of water, he should take it down [from the fire].

When reduced to a quarter, strained, and cooled, into that he should add / two āḍhakas of grape juice, cooled and equal in volume to the decoction,

and he should add a doubled tulā of broken sugar, / and one and a half prasthas of fresh honey.

Having powdered cinnamon, cardamoms, plava, patra, hrībera, / sevyā, kramuka, and keśara, the intelligent physician should add karṣa portions of them here.

He should store all that for a fortnight in a very clean ghee vessel, / slightly smeared with ghee and fumigated with sugar and aguru.

After a fortnight, this ariṣṭa, known by the name of kanaka, / is to be drunk; sweet in taste, pleasing to the heart, through its administration it stimulates appetite for food.