The Compendium of Caraka 6.16: ṣoḍaśo 'adhyāyaḥ/

Now we shall expound the treatment of anemia (pāṇḍuroga).

Thus declared the revered Ātreya.

Anemia disorders are taught to be five: three due to vāta, pitta, and kapha; / the fourth due to their combination; and the fifth from eating earth.

In a person whose doṣas, dominated by pitta, become provoked in the bodily tissues, / flaccidity and heaviness of his bodily tissues arise.

Thereupon, complexion, strength, unctuousness, and whatever other qualities of ojas there are / undergo extreme wasting on account of the vitiation of the doṣas and tissues.

Having scanty blood, scanty fat, being devoid of vitality, with slackened faculties, / he undergoes discoloration; listen to its cause along with symptoms:

from the consumption of alkaline, sour, salty, excessively hot, incompatible, and unwholesome foods; / from indulging in niṣpāva beans, black gram, oil cake, and sesame oil;

from daytime sleep, physical exercise, and sexual intercourse while food is acidifying; / from improper application of therapies, and from the suppression of natural urges;

When pitta located in the heart of one whose mind is stricken
by passion, worry, fear, anger, or grief becomes agitated,

impelled by powerful vāyu, reaching the ten vessels,
it spreads through the entire body and lodges between the skin and muscle.

Corrupting kapha, vāta, blood, skin, and muscle, it produces
pale, turmeric-yellow, and greenish shades of many kinds in the skin.

That is termed pāṇḍuroga. Its premonitory signs are:
palpitations of the heart, dryness, lack of sweating, and exhaustion.

When this [disease] is fully formed, every person develops ringing in the ears, extinguished digestive fire,
weakness, prostration, aversion to food, and is afflicted by fatigue and dizziness.

The man experiences aching limbs, fever, dyspnea, heaviness, and anorexia,
as if his limbs were bruised, crushed, or pounded.

He has swollen eye sockets, a greenish tint, falling hair, lost luster,
irritability, aversion to cold, somnolence, excessive spitting, and speaks little.

Cramping of the calves, and pain and weakness in the hips, thighs, and feet
occur upon the exertion of climbing. Now its specific varieties will be described.

Vāta, provoked by vāta-increasing foods and regimens,
causes a blackish-pale discoloration and a rough, reddish body.

It also causes body-ache, pain, piercing pains, tremors, pain in the flanks and head,
dryness of stools, bad taste in the mouth, swelling, abdominal distension, and loss of strength.

Pitta, accumulated in one prone to pitta through its own aforementioned provoking causes,
corrupts blood and the other [dhātus], bringing about pāṇḍuroga.

The man becomes yellow or greenish in complexion, accompanied by fever and burning sensation;
he is distressed by thirst, fainting, and craving for water, with yellow urine and feces.

He sweats, desires cold things, and does not relish food;
he has a pungent taste in the mouth, and neither hot nor sour things agree with him.

When his food turns acidic, sour eructation and internal burning arise;
there is foul odor, loose stools, debility, and darkening of vision.

Kapha increased by kapha-producing factors produces pāṇḍuroga as described before,
causing heaviness, drowsiness, vomiting, a whitish appearance,

excessive salivation, horripilation, prostration, fainting, dizziness, exhaustion,
dyspnea, cough, indolence, anorexia, and obstruction of speech and voice.

There is white urine, eyes, and stools, a craving for pungent, dry, and hot things,
swelling, and a sweet taste in the mouth: this is pāṇḍuroga due to kapha.

In one who indulges in all sorts of foods, all the corrupted doṣas produce
pāṇḍuroga born of the three doṣas, characterized by the signs of all three and very hard to endure.

In one habituated to eating earth, one or another doṣa is provoked:
astringent earth provokes vāta; alkaline earth, pitta; and sweet earth, kapha.

Earth provokes the chyle and other [dhātus], and by its dryness makes food dry;
it remains undigested, fills the channels, and obstructs them.

Destroying the strength of the sense faculties, radiance, vigor, and ojas,
it swiftly produces pāṇḍuroga, destroying strength, complexion, and the digestive fire.

His cheeks, eye sockets, and eyebrows are swollen, as are his feet, navel, and genitalia;
his belly is infested with worms, and he passes stools mixed with blood and kapha.

Pāṇḍuroga that has arisen long ago and become hardened cannot be cured;
nor can a man who is swollen after a prolonged period and sees things as yellow,

or one who passes constipated, scanty feces, or greenish [stools] accompanied by kapha;
who is dejected, whose body is excessively smeared with white, and who is distressed by vomiting, fainting, and thirst.

He does not survive; nor does one who, pale from loss of blood, turns entirely white.
Thus are described the symptoms of the five types of pāṇḍuroga.

When a patient with pāṇḍuroga excessively consumes pitta-provoking substances,
his pitta, having scorched the blood and muscle, turns into a disease:

his eyes are intensely turmeric-yellow, as are his skin, nails, and face;
his feces and urine are reddish-yellow, he has the color of a frog, and his faculties are impaired.

Exhausted by burning sensation, indigestion, weakness, prostration, and anorexia,
this is kāmalā, rich in pitta, known to lodge in the belly and the extremities.

When it becomes hardened over time, it becomes difficult to treat as kumbhakāmalā.
A man whose feces and urine are blackish-yellow, and who is severely swollen,

whose eyes, face, vomitus, stools, and urine are mixed with blood, and who faints,
accompanied by burning sensation, anorexia, thirst, abdominal distension, drowsiness, and stupor,

whose digestive fire and consciousness are lost, swiftly perishes with kāmalā.
I shall now expound the treatment for those that are curable.

In that case, the patient with pāṇḍuroga, having been unctuated, should be cleansed
with sharp upward- and downward-evacuating drugs; but the patient with kāmalā, with mild, bitter purgatives.

To both of them, once their belly is thoroughly cleansed, wholesome foods should be given:
aged śāli rice, along with barley and wheat, accompanied by soups

of mung beans, pigeon peas, or lentils, and wholesome broths of arid-zone meats.
And for both of them, specific medicine should be administered according to the doṣa.

One should administer Pañcagavya, Mahātikta, or Kalyāṇaka
ghṛta for unctuation to a patient with kāmalā or pāṇḍuroga.

A kuḍava of pomegranate, half a kuḍava of coriander, one pala each
of citraka and ginger, and an eighth of a pala of long pepper:

twenty palas of ghṛta prepared with these pastes in an āḍhaka of water
relieves heart disease, pāṇḍuroga, gulma, piles, spleen disease, vāta, and kapha.

It stimulates digestion, cures dyspnea and cough, and is praised in obstructed vāta;
it produces pregnancy in women with difficult labor and in barren women.
Thus Dāḍimādya Ghṛta.
One pala each of kaṭukā, rohiṇī, musta, the two turmerics, and bark of vatsaka,
with paṭola, sandalwood, mūrvā, trāyamāṇā, durālabhā,

long pepper, parpaṭaka, neem, bhūnimba, and devadāru—
with a karṣa each of these, a prastha of ghṛta is cooked with four times as much milk.

It cures bleeding disorder, fever, burning sensation, swelling along with fistula-in-ano,
piles, menorrhagia, and likewise skin eruptions.
Thus Kaṭukādya Ghṛta.
A prastha of ghṛta cooked in the juice of a hundred pathyā fruits with a paste of fifty pathyā stalks
should be drunk; it destroys pāṇḍuroga and gulma.
Thus Pathyāghṛta.
A prastha of ghṛta prepared similarly in the juice of four palas of dantī with ground unripe fruits of dantī
conquers spleen disease, pain of pāṇḍuroga, and swelling.
Thus Dantīghṛta.
A prastha of aged clarified butter prepared with half a prastha of grapes
removes kāmalā, gulma, the pain of pāṇḍuroga, fever, urinary disorders, and belly disease.
Thus Drākṣāghṛta.
Buffalo's clarified butter prepared with turmeric, triphalā, neem, balā, and madhuka,
along with milk, is excellent for removing kāmalā.
Thus Haridrādi Ghṛta.
[A prastha of buffalo's clarified butter] prepared in twice as much cow's urine with two akṣas of dāruharidrā paste;
another prepared in a decoction of five palas of dāruharidrā with a paste of kālīyaka:

the former [is made] from a prastha of buffalo's clarified butter in the former [disease, pāṇḍuroga], the latter in the latter [kāmalā].
Having treated [the patient] with these unctuous preparations and knowing him to be well unctuated, one should purge him.

with milk mixed with urine, repeatedly, or alone,
or boiled in lukewarm juice of dantī fruits with an añjali of kāśmarya,

or having crushed an añjali of grapes, he should administer it; it removes pāṇḍuroga.
A patient suffering from pitta should drink half a pala of trivṛt powder with twice as much sugar.

A patient with kapha-pāṇḍu, however, [should take] harītakī softened in cow's urine,
or āragvadha with juice of sugarcane, vidārī, and āmalaka.

A man should drink bael leaf with the three pungents; it removes kāmalā;
or half a pala of dantī paste with twice as much jaggery, accompanied by cold water.

Or a person with kāmalā should drink trivṛt with juices of triphalā.
Viśālā, triphalā, musta, kuṣṭha, devadāru, kaliṅgaka,

taking one karṣa of each, and one should take half a karṣa of ativiṣā,
and two karṣas of madhurasā; having crushed all of this with warm water,

and having drunk that strained juice, he should afterwards lick honey.
It destroys cough, dyspnoea, fever, burning sensation, pāṇḍuroga, anorexia,

gulma, abdominal distension, āmavāta, and bleeding disorder.
The juice of triphalā, or of guḍūcī, or of dārvī, or of neem,

cold and mixed with honey, a man suffering from kāmalā should drink in the morning;
or he should drink milk mixed with urine—bovine or buffalo—for a fortnight,

or the juice of triphalā mixed with cow's urine for seven days, if suffering from pāṇḍuroga.
Having quenched glowing sprouts born from a tree in urine and having crushed them,

[namely,] of citron, he should drink that strained [liquid]; it removes pāṇḍu and swelling.
Svarṇakṣīrī, trivṛt, śyāmā, bhadradāru together with dry ginger,

ground with an añjali of cow's urine or boiled in urine, he should drink;
or he should drink milk boiled with these, which promotes the downward movement of the doṣas.

Or he should systematically drink harītakī with cow's urine;
when it is digested, he should take food with milk or with sweet meat broth.

Or iron powder macerated for seven nights in cow's urine,
the physician should make him drink with milk for the relief of pāṇḍuroga.

Equal parts of the three pungents, triphalā, musta, viḍaṅga, and citraka,
and nine parts of iron powder: that powder, with honey and clarified butter,

he should consume; it removes pāṇḍu, heart disease, skin diseases, piles, and kāmalā.
This powder called Navāyasa was spoken by Kṛṣṇātreya.
Thus Navāyasacūrṇa.
Equal parts by weight of jaggery, dry ginger, maṇḍūra, and sesame seeds,
and double of pippalī, one should make into a pill for a patient of pāṇḍuroga.

The three pungents, triphalā, musta, viḍaṅga, cavya, and citraka,
bark of dārvī, mākṣika ore, granthika, and devadāru—

one should make a powder of each of these separately in two-pala portions;
maṇḍūra, double the amount of the powder, purified and resembling collyrium,

having cooked in eight times as much cow's urine, one should then throw those [powders] into it.
Having made them into boluses equal to an udumbara fruit, according to digestive power a man

should take them with buttermilk, and consume suitable food when it is digested.
For these Maṇḍūra boluses are life-giving to patients of pāṇḍuroga;

and they pacify skin diseases, indigestion, swelling, stiffness of the thighs, kapha disorders,
piles, kāmalā, urinary disorders, and spleen enlargement.
Thus Maṇḍūravaṭakas.
Tāpya, adrijatu, and slag of silver and iron, five palas each separately,
along with one pala each of citraka, triphalā, the three pungents, and viḍaṅga,

mixed with eight palas of sugar, powdered, and drenched with honey,
are indeed to be used habitually in doses of an akṣa by one who eats wholesome, moderate food once it is digested,

avoiding horsegram, kākamācī, pigeon, and the like.
Three parts of triphalā and three parts of the three pungents,

one part of citraka root, and likewise of viḍaṅga,
five parts of aśmajatu, and likewise of silver slag,

and of purified mākṣika, as well as of iron powder,
and eight parts of white sugar: all that is powdered finely,

drenched with honey, and kept in an auspicious iron vessel.
Then, according to digestive power, a man should eat a dose equal to an udumbara fruit;

he should employ it day by day; when it is digested, food as desired [may be taken],
avoiding horsegram, kākamācī, and pigeon.

Known as Yogarāja, this recipe is like nectar;
this is an excellent rejuvenator, auspicious, removing all diseases.

Pāṇḍuroga, poison, cough, consumption, irregular fever,
skin diseases, indigestion, urinary disorders, wasting, dyspnoea, anorexia,

and especially it destroys epilepsy, kāmalā, and anal growths.
Thus Yogarāja.
With [the decoctions of] kutaja, triphalā, neem, paṭola, musta, and dry ginger,

macerated for ten days with two or three times the quantity of juices:
eight palas of śilājatu, and the same amount of white sugar;

bamboo manna, pippalī, dhātrī, and karkaṭa-named [galls], measuring a pala each;
one pala of fruit and root of nidigdhikā, and by rule the three aromatics;

powdered, one should make them with three palas of honey into akṣa-sized boluses.
Pomegranate water, milk, meat broth of wild birds, water, surā, or āsava,

he should drink after consuming them, either on an empty stomach or having just eaten.
Pāṇḍu, skin diseases, fever, spleen enlargement, bronchial asthma, piles, fistula-in-ano,

fetidness, heart disease, disorders of semen, urine, and digestive fire, wasting, poison-induced abdominal enlargement,
cough, menorrhagia, bleeding disorder, swelling, gulma, and throat diseases,

and they destroy all ulcers; they are auspicious, dispelling all diseases.
Thus Śilājatuvaṭakas.
Punarnavā, trivṛt, the three pungents, viḍaṅga, devadāru, citraka,

kuṣṭha, the two haridrās, triphalā, dantī, cavya, kaliṅgaka,
pippalī, pippalī root, and musta—each measuring a pala;

maṇḍūra, double the powder, one should cook in two āḍhakas of cow's urine;
having made pills the size of a jujube berry, a man should stir [one] in buttermilk and drink it.

They destroy pāṇḍuroga, spleen enlargement, piles, irregular fever,
swelling, grahaṇī disorder, skin diseases, and likewise worms.
Thus Punarnavamaṇḍūra.
Bark of dārvī, triphalā, the three pungents, viḍaṅga, and iron powder,
mixed with honey and clarified butter, one suffering from kāmalā and pāṇḍuroga should lick.

Equal parts of iron powder, pathyā, and haridrā,
powdered, a person with kāmalā should lick with honey and clarified butter, or abhayā with jaggery and honey.

Triphalā, the two haridrās, kaṭurohiṇī, and iron powder,
powdered with honey and clarified butter—that electuary removes kāmalā.

Bamboo manna, dry ginger, and liquorice, two palas each,
a prastha each of pippalī and grapes, half a tulā of fine sugar,

powdered, one should cook in a droṇa of the juice of dhātrī fruits like an electuary;
cooled and mixed with a prastha of honey, he should then lick a palmful of it.

This destroys kāmalā, pitta, pāṇḍu, cough, and halīmaka.
Thus Dhātryavaleha.
The three pungents, triphalā, cavya, citraka, and devadāru,

Then viḍaṅga, mustā, and vatsaka: one should powder these.
Powder equal in quantity to the maṇḍūra, one should boil in eight times as much cow's urine.

Slowly prepared and then cooled, pills equal to a karṣa should be made;
they should be eaten according to digestive fire, destroying spleen disorders and pāṇḍu,

and known to remove grahaṇī disorders and piles for one eating a diet of buttermilk and parched grain gruel.
Thus Maṇḍūravaṭaka.
Mañjiṣṭhā, turmeric, grapes, balā roots, iron filings,

and lodhra: from these a jaggery-based ariṣṭa should be made for pāṇḍu patients.
Thus the Jaggery-based Ariṣṭa.
Sixteen palas of bījaka, twenty of triphalā,

five of grapes, and seven of lākṣā, in a droṇa of water:
that should be boiled down to a quarter, and into the strained residue one should throw

a tulā of sugar, a prastha of honey, and a karṣa each of
the three pungents, vyāghranakha, uśīra, kramuka, sailavāluka,

madhuka, and kuṣṭha, powdered, into a ghee-smeared vessel.
Kept within barley grains for ten nights in summer, or twice that in winter,

one should drink that: it dispels grahaṇī, pāṇḍu, piles, swelling, and gulma,
and overcomes dysuria, gravel, meha, kāmalā, and sannipāta.

This is celebrated as Bījakāriṣṭa by Ātreya.
Thus Bījakāriṣṭa.
Having pressed out two thousand dhātrī fruits, that juice,

combined with one-eighth part of honey, half a kuḍava of kṛṣṇā,
and mixed with half a tulā of sugar, kept in an unctuous jar for a fortnight,

one should drink in proper measure in the morning, taking suitable and moderate food when it has digested.
Kāmalā, pāṇḍu, heart disease, vātāsra, irregular fever,

cough, hiccup, anorexia, and dyspnea—this ariṣṭa destroys them.
Thus Dhātryariṣṭa.
Water boiled with the sthirā group of drugs is commended for drink and food

in pāṇḍu, and grape and āmalakī juice for those afflicted with kāmalā.
This has been spoken by the great sage for the relief of pāṇḍu.

This should be varied by the physician according to the strength of each doṣa:
in a vātika case, predominantly unctuous; in a paittika case, bitter and cooling;

in a ślaiṣmika case, pungent, bitter, and hot; and combined in a sānnipātika case.
The physician should expel the eaten clay from the body

with sharp purifications, knowing the appropriate measures and considering the patient's strength and weakness;
for one whose body has been purified, he should administer strength-giving ghees.

The three pungents, bilva, the two turmerics, triphalā, the two punarnavās,
mustā, iron filings, pāṭhā, viḍaṅga, devadāru,

vṛścikālī, and bhārgī: with these in equal parts along with milk, cooking ghee,
a man afflicted by the affliction of clay should drink it properly.

Likewise with saffron, yaṣṭīmadhu, pippalī, alkali, and śādvala.
For a patient who does not desist from clay-eating out of greed,

one may freely give clay impregnated with remedies that destroy that disorder to induce disgust:
with viḍaṅga, elā, ativiṣā, nimba leaves, pāṭhā,

vārtāka, kaṭurohiṇī, kuṭaja seeds, or mūrvā.
One should treat pāṇḍu patients according to the doṣa:

this specific treatment is considered necessary because of the specific cause.
When, however, a person with kāmalā passes stool resembling sesame paste,

he should overcome that pitta whose path is blocked by kapha with remedies that pacify kapha.
Through dry, cold, heavy, and sweet foods, exercise, and suppression of natural urges,

vāyu, intensifying with kapha, forcibly expels pitta from its site;
then a person develops turmeric-yellow eyes, urine, and skin, and white stool;

he has flatulent rumbling and obstruction, with heaviness in the chest,
and weakness, diminished digestive fire, pain in the flanks, hiccup, dyspnea, anorexia, and fever

gradually follow, with pitta being deficient and having resorted to the periphery.
With dry, sour, and pungent broths of peacock, partridge, and jungle fowl,

and with soups of dry radish and kulattha, he should feed him meals.
He should drink citron juice mixed with honey, pippalī, black pepper,

and dry ginger; in this way, his pitta returns to its proper reservoir.
Treatment with pungent, sharp, hot, salty, and intensely sour substances

should continue until pitta's color reappears in the feces and vāyu is pacified.
When pitta has returned to its proper site and feces are stained by pitta,

and the complications have ceased, the earlier regimen for kāmalā should be adopted.
When, however, the complexion of a pāṇḍu patient becomes greenish-blackish-yellow,

and there is loss of strength and enthusiasm, lethargy, sluggish digestive fire, mild fever,
absence of sexual desire, body ache, dyspnea, thirst, anorexia, and dizziness,

then one should know it as halīmaka, caused by vāta and pitta.
Buffalos' ghee prepared with the fresh juice of guḍūcī and milk

he should drink; and having been unctuated, he should take trivṛt with āmalaka juice.
Purged, he should adopt a largely sweet regimen that removes pitta and vāta,

and the grape electuary previously mentioned, sweet ghees,
and should practice palliative milk enemas along with unctuous enemas.

He should also drink grape-ariṣṭa preparations appropriately for increasing digestive fire;
and the abhayā electuary for cough, pippalī, madhuka, and balā

he should administer with milk according to the doṣa and according to strength.

Here are the two summary verses:—

The etiology, symptoms, and treatment of the five kinds of pāṇḍu have been stated,

and the two varieties of kāmalā, along with their curability and incurability;
and their further variation, which is the major disease halīmaka,
its characteristics and its treatment have also been concisely declared.

Thus, in the treatise composed by Agniveśa, which was lost and restored by Dṛḍhabala, in the section on therapeutics, the sixteenth chapter, entitled "The Treatment of Pāṇḍuroga."