The Compendium of Caraka 6.19: ekonaviṃśo 'adhyāyaḥ/

Now we shall explain the treatment of diarrhoea.

Thus spoke the venerable Ātreya.

Indeed, when the venerable Ātreya had performed his daily rituals, offered the agnihotra, and was seated surrounded by a host of sages on the northern side of the Himavat, Agniveśa approached with deference, saluted him, and said: 'O venerable one! You ought to expound the initial origin, causes, symptoms, and pacification of diarrhoea for the welfare of living beings.'

Then the venerable Punarvasu Ātreya, having heard that speech of Agniveśa, said: 'Listen, Agniveśa! All of this is being explained in full.

In the primal age, indeed, animals were to be touched in sacrifices; they were not slaughtered.

Then, in a later time after Dakṣa's sacrifice, in the sacrifices of the sons of Manu—Nariṣyanta, Nābhāga, Ikṣvāku, Nṛga, Śaryāti, and others—because animals were authorized [for sacrifice], animals were sprinkled [for slaughter].

And in a time later than that, by Pṛṣadhra performing a long sacrificial session, the slaughter of cattle was introduced because of the unavailability of animals.

Seeing that, the hosts of living beings were deeply distressed; and from the consumption of those slaughtered cattle, because of [their meat's] heaviness, heat, unwholesomeness, and unprescribed use, diarrhoea first arose at the sacrifice of Pṛṣadhra in those whose digestive fire was impaired and whose minds were disturbed.

Then, in later times, in a person of vāta constitution who indulges excessively in wind, sun, and exercise, who eats dry, little, and measured food, who is constantly habituated to sharp alcohol and sexual intercourse, and who suppresses natural urges, vāta becomes aggravated, and the digestive fire is impaired; that aggravated vāta, when the fire is impaired, draws urine and sweat into the receptacle of feces, liquefies the feces with them, and brings about diarrhoea.

Its symptoms: slimy, āma, floating, sinking, dry, liquid, painful, with the smell of raw meat, with slight sound or soundless, with retention of urine and flatus, feces is passed, and vāta moves transversely with sound and pain in the inner belly, obstructed: this is āmātisāra from vāta.

Or, digested or obstructed, very little by little, with sound, with pain, froth, slime, and cutting pain, with horripilation, sighing, dry mouth, suffering from pain in the hips, thighs, sacrum, knees, back, and sides, with prolapsed rectum, knotty feces is repeatedly evacuated from vāta; some call that anugrathita, because the feces is knotted by vāta.

In a person of pitta constitution, moreover, who indulges excessively in sour, salty, pungent, alkali, hot, and sharp things, whose body is afflicted by continuous heat of fire and the sun and by hot winds, and who is prone to anger and envy, pitta becomes aggravated.

That [pitta], aggravated, impairs the bodily heat on account of its liquidity, spreads into the receptacle of feces, breaks down the feces on account of its heat, liquidity, and mobility, and brings about diarrhoea.

Its symptoms: yellow, green, blue, black, mixed with blood and pitta, exceedingly foul-smelling feces is passed, accompanied by thirst, burning, sweating, fainting, pain, groin-heat, and suppurative burning: this is pittātisāra.

In a person of kapha constitution, on the other hand, who indulges in heavy, sweet, cold, and unctuous food, who overeats, is free from worries, addicted to day-sleeping, and lazy, śleṣman becomes aggravated.

It, by its nature heavy, sweet, cold, and unctuous, slipping down, impairs the digestive fire; having impaired the receptacle of feces on account of its watery nature, moistening the feces, it brings about diarrhoea.

Its symptoms: unctuous, white, slimy, thread-like, āma, heavy, foul-smelling, accompanied by mucus, with continuous colic, little by little, frequently, it is passed with straining; the regions of the abdomen, rectum, bladder, and groins feel heavy; even after defecation, there is a feeling of not having defecated; accompanied by horripilation, nausea, drowsiness, and laziness, depressed, and disliking food: this is śleṣmātisāra.

From eating food that is excessively cold, unctuous, dry, hot, heavy, rough, hard, irregular, incompatible, and unwholesome, from fasting, from eating past the proper time, from eating anything haphazardly, from drinking spoiled wine and water, from excessive drinking of wine, from non-administration of purificatory treatments, from irregular movement during purificatory procedures, from improper regimen, from excessive indulgence in fire, sun, wind, and water, from sleeplessness, from excessive sleep, from suppression of natural urges, from perversion of the seasons, from undertaking activities beyond one's strength, from excessive fear, grief, and mental agitation, or from extreme emaciation due to worms, wasting, fever, and piles: in one whose digestive fire is ruined, the three doṣas become aggravated, further impair the digestive fire, enter the pakvāśaya, and produce diarrhoea bearing the signs of all the doṣas.

Moreover, by exceedingly corrupting blood and the other dhātus, they display colours of diarrhoea caused by the nature of the dhātus and doṣas.

There, when blood and the other dhātus are excessively corrupted, feces resembling turmeric, green, blue, madder, meat-washings, red, black, white, or pig's fat is evacuated, with continuous pain or without pain, irregularly combined or alternating, sometimes knotted, sometimes āma, and sometimes digested, in a patient whose flesh, blood, and strength are not overly diminished, whose digestive fire is weak, and whose taste in the mouth is impaired; such a patient one should know to be curable with difficulty.

One should declare a patient discharging these colours, accompanied by complications, to be incurable; that is to say: passing [stools] resembling mature blood, resembling a piece of liver, resembling fat-and-flesh water, resembling curd, ghee, marrow, oil, muscle fat, milk, or vesavāra, exceedingly blue, exceedingly red, exceedingly black, clear like water, or shiny black, excessively unctuous, green, blue, or astringent in colour, variegated, turbid, slimy, thread-like, āma, marked with iridescent rings, smelling excessively like a corpse, putrid, like pus, raw meat, or fish, swarmed by flies, with rotting copious discharges of dhātus, with little feces or without feces, accompanied by thirst, burning, fever, giddiness, tamakaśvāsa, hiccup, and dyspnoea, with excessive pain or painless, with prolapsed and inflamed rectum, with the rectal folds turned outward, with the orifice gaping open, with strength, flesh, and blood exceedingly wasted, with pain in all joints and bones, overwhelmed by anorexia, restlessness, delirium, and confusion, or one with diarrhoea whose illness suddenly ceases—one should know him to be untreatable: thus is sannipātātisāra.

When it has not reached incurability, one should treat it according to the principal line of management, by examining the specific causes, pacifying factors, and doṣas.

There are two exogenous diarrhoeas of mental origin, born of fear and grief; / their symptoms are the same as the symptoms of diarrhoea from vāta.

For vāta is rapidly aggravated by fear and grief; / their treatment counteracts vāta and consists of cheerfulness and reassurance.

Thus the six diarrhoeas have been stated; hereafter I shall explain / properly the treatment of those that are curable in due order. Learn it.

When doṣas have accumulated and, intensified by improperly digested food, / cause diarrhoea, one should induce them to flow out even more.

An astringent should never be given at first to a person with āmātisāra; / for if the doṣas are arrested beforehand, they produce many diseases:

daṇḍakālasaka, tympanites, disorders of the grahaṇī and piles, / as well as swelling, pāṇḍu disease, spleen disorders, kuṣṭha, gulma, enlargement of the abdomen, and fever.

Therefore, one should leave irritated wastes that are flowing on their own alone; / or to those who pass them with difficulty, one should give abhayā to promote their expulsion.

When the doṣa has been expelled by it, the abdominal disease subsides; / lightness of the body arises, and the digestive fire increases.

For moderate doṣas, one should give an appetising and digestive pramathyā decoction; / and fasting is recommended for patients of diarrhoea who have mild doṣas.

Pippalī, dry ginger, dhānya, bhūtīka, abhayā, and vacā; / hrīvera, bhadramustā, bilva, dry ginger, and dhānyaka;

Pṛśniparṇī, śvadaṃṣṭrā, samaṅgā, and kaṇṭakārikā: / three pramathyā decoctions are prescribed by these half-verses for patients with diarrhoea.

Or one should have him drink water boiled with vacā and prativiṣā, / or with musta and parpaṭaka, or with hrīvera and dry ginger.

At the proper mealtime, when he is emaciated with hunger, one should feed him light foods; / thus he quickly regains appetite, digestive strength, and bodily strength.

At first, one should treat him according to suitability / with buttermilk, avantisoma, gruel, tarpaṇa draught, surā, or honey.

After this, there should be a gradual regimen of gruels, thick gruels, / khaḍas, vegetable broths, and boiled rice with meat broth combined with appetising and astringent drugs.

Śālaparṇī, pṛśniparṇī, bṛhatī, kaṇṭakārikā, / balā, śvadaṃṣṭrā, bilva fruit, pāṭhā, dry ginger, dhānyaka,

Śaṭī, palāśa, hapuṣā, vacā, cumin, pippalī, / yavānī, pippalī-root, citraka, hastipippalī,

Vṛkṣāmla, sour pomegranate, together with asafoetida, biḍa salt, and rock salt: / one should employ these properly prepared as a soup in food and drink.

For this group destroys vāta and śleṣman, stimulates digestion, digests āma, / is bowel-binding, strengthening, and appetite-promoting; therefore it is commendable for patients with diarrhoea.

When āma has matured, but one evacuates with obstruction, / with pain, mucus, little by little, frequently, and with tenesmus,

One should feed him with soup of radish, or jujube fruits, / or of upodikā, kṣīriṇī, yavānī, or vāstuka,

Or with greens of suvarcalā, cañcu, or avalguja, / of śaṭī, karkāruka, jīvantī, or cirbhaṭa,

Or with dried greens of loṇikā along with pāṭhā, / cooked with curd and pomegranate and with plenty of unctuous substance.

Paste of young bilva fruits and an equal amount of sesame paste, / curd-cream, sour substances, unctuous matter, and the rest: such a khaḍa soup destroys tenesmus.

One should prepare a grain-soup of barley, mudga, māṣa, / śāli rice, sesame, jujube fruits, and young bilva fruits,

Fried together in yamaka, with curd and pomegranate juice; / when faeces are depleted and the mouth is dry, one should feed him cooked śāli rice with it.

Or one should give curd-cream fried in yamaka with jaggery and dry ginger, / or surā fried in yamaka, to serve as a condiment.

Or fruit-sours fried in yamaka, or soup of gṛñjanaka, / or sour soup of fox, or unctuous and sour soup of tortoise,

Likewise, unctuous and sour broths of peacock, francolin, cock, / or quail, along with excellent śāli rice, dispel the pain from loss of faeces.

Straining the broth of the carcass and the blood of a ram together, / one should cook it made sour with pomegranate juice, with coriander, fat, and dry ginger.

One should eat cooked red śāli rice with that and drink it; / thus one is freed from the diseases caused by depletion of faeces.

In prolapse of the rectum and pain, drinking sour ghee / is commended for those free of āma, or else an unctuous enema.

Ghee boiled with cāṅgerī, jujube, sour curd, dry ginger, and alkali / should be drunk to dispel prolapse of the rectum and pain.
— Thus Cāṅgerīghṛta. —
Sour ghee prepared appropriately with cavya, pippalī-root, / three pungents, biḍa salt, pomegranate, dhānya, cumin, and citraka should be drunk.
— Thus Cavyādighṛta for rectal prolapse. —
Or an unctuous enema prepared with the ten roots and bilva, / or with śaṭī, śatāhvā, and bilva, or with vacā, or with citraka.
— Thus unctuous enemas for rectal prolapse. —
When the rectum is stiffened and prolapsed, one should first apply oleation and sudation; / when well sweated and softened, one should reduce it with a cotton pad.

One whose flatus and faeces are obstructed, who has severe pain and tenesmus, / with blood and mucus, and afflicted by thirst, deserves satiation with milk.

A man should drink milk warm from the udder over yamaka, / or milk boiled with castor root or with young bilva fruit.

By this use of milk, blood and mucus are pacified, / and pain, tenesmus, and obstruction are also relieved.

Furthermore, having recognised pittātisāra to be associated with āma by its etiology, relieving factors, and symptoms, one should treat it according to strength with fasting and digestive measures.

For one who is thirsty, management is with water boiled with musta, parpaṭaka, uśīra, sārivā, sandalwood, kirātatikta, and udīcya.

And at mealtime for one who has fasted, management is in gradual stages according to suitability with gruel, scum of gruel, and the like, or tarpaṇa and the like, combined with a decoction of balā, atibalā, sūrpaparṇī, śālaparṇī, pṛśniparṇī, bṛhatī, kaṇṭakārikā, śatāvarī, and śvadaṃṣṭrā.

Or with soups of mudga, masūra, hareṇu, makuṣṭhaka, or āḍhakī, or slightly sour or non-sour broths of lava, kapiñjala, hare, blackbuck, eṇa deer, or black-tailed deer, one should gradually kindle the digestive fire.

When it persists, however, one should administer appetising, digestive, pacifying, and bowel-binding formulations.

Having ground the fruit and bark of vatsaka with honey and ativiṣā, / one should drink it mixed with rice water; it cures pittātisāra.

Kirātatikta, musta, vatsaka together with rasāñjana, / bilva, dāruharidrā, tvak, hrībera with durālabhā,

Sandalwood, lotus stalk, dry ginger, lodhra, utpala, / sesame, mocarasa, lodhra, samaṅgā, lotus, and blue lotus,

Utpala, dhātakī flowers, pomegranate bark, ginger, / kaṭphala, dry ginger, pāṭhā, jambu seeds, mango seeds, and durālabhā:

These six formulations, set forth in half-verses, / should be taken with honey and rice-water to cure pittātisāra.

When the medicine has digested, old red śāli rice is commended, / combined with bowel-binding meat-soups prepared as appropriate.

The pittātisāra of a person with stimulated digestive fire quickly subsides, / and strength and complexion increase, through the use of goat's milk.

If the pittātisāra does not stop in one with abundant doshas, / stimulated digestive fire, and good strength, one should purge him with milk.

One should have him drink a decoction of palāśa fruit together with milk, / and thereafter give him lukewarm milk alone to drink according to his strength.

When the waste matter is eliminated by this, the abdominal disease subsides; / or trāyamāṇā, which purges, may be employed like the palāśa.

If colic persists while the dietetic sequence is being carried out / in one whose doshas have been drained, one should quickly give him an unctuous enema in the proper manner:

Ghee cooked with śatapuṣpā and śatāvarī, with milk and madhuka, / with one-fourth part oil, and with bilva, serves as an unctuous enema.

If diarrhea still persists in him who has received the unctuous enema / and has completed the dietetic sequence, then after this, a picchābasti [is indicated]:

Wrapping moist stalks of śālmali with fresh kuśa grass / and smearing them with black clay, one should sweat them over a fire of cow dung.

Knowing the clay to be well dried, one should pound those stalks of śālmali / in a mortar and then crush them in boiled milk.

Having strained that fist-sized lump in a prastha [of milk], it is unctuated / with an appropriate amount of oil and ghee, and combined with a paste of madhuka.

One should administer this enema to him after his body is anointed; then, after it has returned / and he has bathed, he should eat with milk or with the meat-soup of arid-zone animals.

This enema quickly overcomes very severe pittātisāra, fever, swelling, gulma, / chronic diarrhea, and disorders of the grahaṇī, as well as [complications of] purgation and non-unctuous enemas.

If one suffering from pittātisāra, abandoning this treatment, indulges / in pitta-aggravating foods and drinks, his exceedingly strong pitta,

causing raktātisāra, will rapidly corrupt the blood / and produce thirst, colic, severe burning sensations, and intense inflammation of the rectum.

In that condition, cold goat's milk with honey and sugar is recommended / for drinking, for meals, and likewise for washing the rectum.

One should feed him boiled red śāli rice with that milk, / or with the meat-soups of pigeons and the like, fried in ghee and mixed with sugar,

and with the meat-soups of hares, birds, and deer living in arid zones, which are cooling, / non-sour, prepared with ghee, and mixed with sugar.

Blood of deer or of a goat fried in ghee is commended, / or a soup of kāśmarya fruit that is slightly sour and sweetened with sugar.

One should administer blue lotus, mocarasa, samaṅgā, and lotus stamens / along with goat's milk, and when it is digested, boiled rice with milk.

Or, having given it to a weak person to drink, one should feed him immediately after; / or one should administer fresh butter with honey and sugar before a meal.

Having consumed ghee churned directly from milk, and subsisting on the meat-soup of kapiñjala / or subsisting on milk and taking milk, he attains health in three days.

Drinking paste of śatāvarī with milk, while subsisting on milk, / or drinking ghee cooked with it, a man overcomes raktātisāra.

Ghee cooked with the seeds of kuṭaja alongside the scum of yavāgū / should be drunk; after that, thin peyā should be consumed to pacify the bleeding.

Bark of dāruharidrā, seeds of kuṭaja, / pippalī, dry ginger, drākṣā, and kaṭukarohiṇī—

ghee cooked with these six and administered with the scum of peyā / quickly overcomes diarrhea, even the dread [variety] born of all three doshas.

Black clay, madhuka, conch shell, blood, and rice-water, / drunk together with honey, is superior for checking bleeding.

A paste of priyaṅgu taken with honey and rice-water / quickly overcomes hemorrhage in one who eats the meat-soup of arid-zone animals.

A paste of black sesame seeds with one-fifth part sugar, / drunk with goat's milk, immediately restrains blood.

Boiling one pala of vatsaka seeds, one should drink the liquid; / he who subsists on meat-soup will quickly conquer that paitta abdominal disease.

Having drunk sandalwood with sugar and honey in rice-water, / one is freed from burning sensation, thirst, prameha, and hemorrhage.

When the rectum becomes inflamed by pitta due to frequent bowel movements, / one should irrigate it with very cold water of paṭola and madhuka,

or with decoctions of the pañcavalkas and madhūka, with sugarcane juice, with ghee, / or with goat's or cow's milk combined with sugar and honey.

Or one should smear it with the pastes of the washing drugs along with ghee, / or dust that rectum with their finely prepared powders.

Or one should dust it with equal parts of powders of dhātakī and lodhra; / dusted with these, the rectum no longer bleeds,

the inflammation subsides, and the pain is relieved. / If blood flows excessively even with the cooling irrigations as described,

one should irrigate the rectum, groin, lower back, and thighs, already saturated with ghee, / with candanādya oil or hundred-times-washed ghee,

or irrigate the rectum and groin with cotton dipped in them. / When a little blood is passed frequently with colic,

and vāyu is obstructed and moves with difficulty or not at all, / then one should prepare for him a picchābasti as described,

and give an unctuous enema with ghee prepared with prapauṇḍarīka. / Generally, those with long-standing diarrhea have weak rectums;

therefore, one should frequently apply unctuous substances to their rectum. / For wind that is excessively increased in its own site gains greater

strength; to overcome it when combined with pitta, an enema is best. / He who passes blood along with feces, either before or after,

for him one should prepare śatāvarīghṛta as an electuary. / Freshly churned butter with half its part of sugar, licked

with a quarter part of honey, quickly conquers that disorder in one who eats wholesome food. / Pounding the leaf-buds of nyagrodha, udumbara, and aśvattha, one should steep them

for a day and night in warm water, and cook ghee with that water; / combined with half as much sugar, he should lick it with a quarter part of honey.

When blood flows either downward or upward, / but the weak person out of delusion indulges in pitta-aggravating things,

he develops severe suppuration of the anal folds and quickly perishes. / In śleṣmātisāra, fasting and digestive measures are beneficial at the outset.

And the group of digestive-stimulant [drugs] that overcomes āmātisāra as described should be applied; / and when, after fasting and adhering to the regimen, it does not subside,

if the diarrhoea is born of kapha, one should treat it with kapha-destroying remedies: / bilva, karkaṭikā, musta, abhayā, ginger,

vacā, viḍaṅga, bhūtīka, coriander, and devadāru; / kuṣṭha, ativiṣā, pāṭhā, cavya, kaṭukarohiṇī;

pippalī, pippalī root, citraka, hastipippalī— / one should administer these four formulations set forth in half-verses,

boiled [in decoction], in cases of śleṣmātisāra, enhancing the power of the bodily digestive fire. / Black ajājī, pāṭhā, dry ginger, and black pepper,

with twice as much dhātakī, soaked in mātuluṅga juice, one should give. / Rasāñjana, ativiṣā, and seeds of kuṭaja,

with twice as much dhātakī, one should administer to drink with honey and dry ginger. / Dhātakī, dry ginger, bilva, lodhra, filaments of lotus,

bark of jambū, dry ginger, coriander, pāṭhā, mocārasa, balā; / samaṅgā, dhātakī, pulp of bilva, bark of jambū and mango;

kapittha, viḍaṅga, dry ginger, and black pepper: / [one should administer] these four, made sour with cāṅgerī, jujube, and buttermilk, when kapha predominates,

prescribed in half-verses, as khaḍa preparations, combined with fat and salt. / Licking the pulp of kapittha with the three pungents, honey, and sugar,

or kaṭphala with honey, one is freed from the abdominal illness; / drinking kaṇā mixed with honey, or drinking buttermilk with citraka,

or eating tender bilva fruits, one is freed from the abdominal illness. / Young bilva, jaggery, oil, pippalī, and ginger: / one should lick this when vāta is obstructed, with colic and straining.

Food [should be taken] with decoction of radish and with vāta-destroying sauces, / with soups, meat broths, and khaḍas prescribed for vātātisāra,

or the previously mentioned sour ghee, or six-pala [ghee] according to one's strength; / or one should give aged ghee mixed with the scum of yavāgū.

When there is obstruction of vāta and śleṣman, or when kapha discharges excessively, / or in colic or straining, one should administer a picchābasti.

Combined with pastes of pippalī, bilva, kuṣṭha, / as well as śatāhvā and vacā, together with salt, one should introduce the previously described [enema].

When it has returned, after he has bathed comfortably and eaten food at the close of the day, / the wise physician should give an unctuous enema with lukewarm bilva oil.

Or cooking oil with pastes ending with vacā, he should give an unctuous enema / repeatedly to the patient afflicted by kapha and vāta; thus he obtains relief.

Wind inevitably increases in its own site upon the exhaustion of kapha; / having increased, it may kill him suddenly; therefore, one should overcome it quickly.

After vāta, one should overcome pitta; after pitta, one should overcome kapha; / or, of the three, one should first overcome whichever is strongest.

Here is a verse:

Primary causes of onset, signs, curability and incurability, / and successful situational treatment for patients with diarrhoea have indeed been taught.

Thus ends the nineteenth chapter, titled 'The Treatment of Diarrhoea', in the Cikitsāsthāna of the compendium composed by Agniveśa and redacted by Caraka. //19