The Compendium of Caraka 6.29: ekonatriṃśo 'adhyāyaḥ/

Now we shall explain the treatment of gout (vātaśoṇita).

Thus spoke the venerable Ātreya.

Agniveśa questioned his concentrated teacher Punarvasu, / resplendent as fire, seated among the sages having offered the agnihotra:

The teacher told him the causes, symptoms, and remedies / of the combination of wind and blood, which resembles fire and wind:

By eating salty, sour, pungent, alkaline, unctuous, and hot foods, and by indigestion; / by wet, dried, aquatic, or marshy meat, oil cake, and radishes;

by horse gram, black gram, flat beans, leafy vegetables, pounded grains, and sugarcane; / by curd, fermented gruel, saubīraka, fermented vinegar, buttermilk, surā, and āsava;

by incompatible foods, overeating, anger, daytime sleep, and insomnia; / mostly in delicate persons who eat sweet and pleasurable foods

and are unaccustomed to walking, gout is aggravated; / also when people's blood is corrupted through trauma and non-purification;

from astringent, pungent, bitter, sparse, and dry food, from fasting, / and by riding horses or camels, traveling in conveyances, water-sports, swimming, and leaping;

in the heat, from irregular long-distance travel, sexual intercourse, and suppression of urges; / wind, greatly increased, blocked in its path by increased blood,

vitiates the whole blood; that is known as gout (vātaśoṇita), / and by the names khuḍa, vātabalāsa, and āḍhyavāta.

Its seat is the hands, feet, fingers and toes, and all joints; / making its root first in the hands and feet, it runs through the body.

Because of subtlety and pervasive mobility of wind, and of blood / due to its liquidity and mobility, coursing through the body via the vein pathways,

struck and agitated at the joints, it settles there owing to their crookedness; / staying there combined with pitta and the others, it produces various pains.

It causes suffering in those very joints; therefore, predominantly in the joints / arise those various pains, exceedingly unbearable for men.

Excessive sweating or its absence, blackness, lack of sensation to touch, intense pain on injury, / looseness of joints, lassitude, depression, emergence of boils,

in the knees, shanks, thighs, waist, shoulders, hands, feet, and limb-joints / piercing pain, twitching, splitting pain, heaviness, and numbness,

itching in the joints, pain that repeatedly appears and disappears, / discoloration, and appearance of round patches—this is the premonitory symptom of gout.

They declare it to be of two kinds: superficial and deep. / The superficial resides in the skin and flesh, while the deep resides internally.

Accompanied by itching, burning sensation, pain, extension, piercing pain, twitching, and contraction, / the skin in the superficial [type] is regarded as dark-red and coppery.

In the deep type, the swelling is rigid, hard, with severe internal agony, / dark-gray or coppery, accompanied by burning sensation, piercing pain, twitching, and suppuration.

Accompanied by constant pain and burning, moving violently / in the joints, bones, and marrow as if cutting them apart and twisting them crooked,

roaming everywhere in the body, it causes lameness or paralysis; / and when characterized by all symptoms, gout should be known as seated in both.

Hear the symptoms of that when wind is predominant, or blood, pitta, or phlegm, / or when combined in dual combinations, or in all together:

In predominance of wind, especially, dilatation of veins, aching pain, twitching, and piercing pain, / blackness, dryness, and darkness of swelling, with fluctuation of swelling,

constriction of arteries, fingers, and joints, limb-stiffness, intense pain, / contraction, rigidity, and aversion to cold.

In [predominance of] blood, swelling with severe pain, piercing pain, coppery color, and tingling; / it does not subside with unctuous or dry [measures], and is accompanied by itching and moistness.

Burning sensation, pain, fainting, sweating, thirst, intoxication, dizziness, / redness, suppuration, splitting pain, and wasting are stated in the pitta-predominant type.

A feeling of being covered with a wet cloth, heaviness, unctuousness, numbness, and mild pain in [predominance of] phlegm. / From the combination of causes and symptoms, one should diagnose the dual-doṣa and triple-doṣa types.

That arising from a single doṣa and of recent origin is curable; that from two doṣas is palliable; / that arising from all three doṣas is incurable, as is that which has complications.

Sleeplessness, anorexia, dyspnea, sloughing of flesh, head-stiffness, / fainting, intoxication, pain, thirst, fever, delusion, tremors,

hiccup, suppuration of toes/fingers, erysipelas, suppuration, piercing pain, dizziness, exhaustion, / curvature of fingers and toes, blisters, burning sensation, stiffness of vital points, and nodules:

with these complications, or even with delusion alone, it should be rejected; / and that which oozes, is discolored, rigid, and produces nodules,

and causes contracture and torment of the senses, one should reject. / That with incomplete complications is palliable, and without complications is curable.

Wind quickly strikes the pathway of blood in the extremities and joints; / settling there and mutually obstructing each other, they take away life with their pains.

In that case, one should let blood by means of a horn, leeches, needles, gourds, / scarification, or venesection, according to the doṣa and according to strength.

From [a swelling] afflicted with pain, burning, aching, and piercing pain, blood should be let with a leech; / with horns or gourds one should draw it out in case of numbness, itching, and tingling.

When it moves from place to place, it should be evacuated through venesection or scarification; / but when there is exhaustion of the body, or it is dry and wind is predominant, it should not be let.

Because of loss of blood, wind may cause deep swelling, stiffness, / tremors, disorders of ligaments and vessels, exhaustion, and contracture;

it may cause wind disorders such as lameness, and death from excessive bloodletting; / therefore, one should draw blood in proper measure from one who has been lubricated.

Having first lubricated the patient, he should be purged with unctuous purgatives / or with dry and mild ones; and repeated enema treatment is recommended.

Affusions, inunctions, poultices, and dietary unctuous substances that are generally non-burning / are praised in gout; now learn the distinction from me:

One should treat the superficial type with plasters, inunctions, affusions, and warm poultices; / and the deep type with purgation, non-unctuous enemas, and drinking of unctuous substances.

One should treat [gout] with a predominance of wind through the drinking, inunction, and enemas / of ghee, oil, fat, and marrow, and through comfortably warm poultices.

One should conquer [gout] with a predominance of blood and bile through purgatives, drinking of ghee and milk, / affusions with enemas, and also cool soothing applications.

Mild, not excessively intense emesis, unctuous affusions, fasting, / and lukewarm plasters are praised in gout with a predominance of phlegm.

If gout with a predominance of phlegm and wind is plastered with cool things, / an increase in burning, swelling, pain, and itching occurs due to the arrest [of the doshas].

And in [gout] with a predominance of blood and bile, burning, moistness, and cracking of the skin / would occur from warm things; therefore, the physician, having understood the strength of the doṣas, should perform the treatment.

One should avoid daytime sleeping, exposure to heat, physical exercise, and copulation, / as well as pungent, hot, heavy, channel-blocking, salty, and sour food.

Aged barley, wheat, wild rice, śāli rice, and ṣaṣṭika rice / are beneficial for food, or the broth of scratching and pecking birds for meat-juice.

Pigeon peas, chickpeas, green gram, lentils, along with moth beans, / prepared as soup with plenty of ghee, are praised in gout.

Suniṣaṇṇaka, cane shoots, kākamācī, śatāvarī, / goosefoot, upodikā potherb, and sauvarcala potherb,

fried in ghee and meat-juice, should be given as a side-dish / to one accustomed to vegetables; likewise, cow's, buffalo's, and goat's milk are beneficial.

Thus the treatment of gout has been stated in brief; / this very treatment will now be spoken of entirely in detail.

Ghee cooked with equal parts of śrāvaṇī, kṣīrakākolī, jīvaka, and ṛṣabhaka, / together with liquorice and with milk, destroys gout.

One should crush balā, atibalā, medā, ātmaguptā, śatāvarī, / kākolī, kṣīrakākolī, rāsnā, and ṛddhi.

Ghee cooked with these, with four parts of milk, destroys gout, / and eliminates heart disease, anemia, erysipelas, jaundice, and fever.

With the decoction of kaśeruka and pastes of trāyantikā, tāmalakī, / the two kākolīs, and śatāvarī, one should cook ghee,

having added equal parts of the juices of parūṣaka, grapes, kāśmarya, and sugarcane, / the expressed juice of vidārī separately, and likewise four parts of milk.

This ghee, intended for clinical use, is known as Pārūṣaka Ghṛta; / [it is used] in gout, trauma, emaciation, erysipelas, and bilious fever. // Thus ends Pārūṣaka Ghṛta.
The two pañcamūlas, varṣābhū, castor, with punarnavā, / mudgaparṇī, mahāmedā, māṣaparṇī, śatāvarī,

śaṅkhapuṣpī, avākpuṣpī, rāsnā, atibalā, and balā, / taking two palas of each, one should boil down in a droṇa of water.

When a quarter remains, combining it with equal juices of milk, āmalakī, sugarcane, and goat [meat broth] / and an āḍhaka of ghee, one should cook it slowly over a gentle fire,

adding as pastes the two medās, kāśmarya fruit, blue water-lily, / bamboo manna, pippalī, grapes, lotus seeds, punarnavā,

ginger, kṣīrakākolī, padmaka, the two bṛhatīs, / vīrā, water chestnut, bhavya, pomegranate, nikocaka,

dates, walnut, almond, muñjāta, and pistachios. / When the āḍhaka of ghee is cooked with these and cooled, one should add honey.

And knowing it to be properly cooked, one should store it well-concealed; / having performed protective rites, one should consume an akṣa-measure of it in a clean place.

It destroys anemia, fever, hiccups, hoarseness, fistula-in-ano, / flank pain, consumption, cough, spleen disorder, gout,

chest-wound phthisis, epilepsy, urinary calculus, gravel, / diseases of the whole body or of a single limb, and urinary retention.

Conferring strength and complexion, auspicious, destroying wrinkles and greying, / this Jīvanīya Ghṛta is aphrodisiac and grants sons to barren women.

Or one should drink ghee cooked with decoctions of grapes and madhūka, / with sugar candy; likewise, milk boiled in the fresh juice of guḍūcī.

Jīvaka, ṛṣabhaka, medā, ṛṣyaproktā, śatāvarī, / liquorice, madhuparṇī, and the two kākolīs,

mudgaparṇī, māṣaparṇī, daśamūla, punarnavā, / balā, amṛtā, vidārī, with aśvagandhā and aśmabhedaka—

with a decoction and paste of these, one should prepare ghee and oil, / and, as available, the fat and marrow of desert-dwelling pecking and scratching birds,

cooked with four times as much milk. This destroys gout / residing in the entire body and terrible diseases born of wind.

Sthirā, gokṣura, bṛhatī, sārivā, with śatāvarī, / kāśmarya fruits, ātmaguptā, vṛścīra, and the two balās—

in a decoction of these, with four parts of milk, oil separately and ghee separately / cooked with medā, śatāvarī, liquorice, jīvantī, jīvaka, and ṛṣabhaka

in proper measure; then, churned with a churning stick / with three times as much milk and one and a half parts of sugar, it should be drunk in gout born of all three doṣas.

Or one should make the patient drink oil, milk, and sugar well-blended; / or he may drink milk mixed with ghee, oil, sugar, and honey.

A prastha of milk boiled with śālaparṇī and containing two parts of sugar candy / is praised for drinking; likewise, [milk] boiled with pippalī and ginger.

Milk boiled with balā, śatāvarī, rāsnā, and daśamūla, along with pīlu, / śyāmā, castor, and sthirā, destroys distress caused by wind.

Milk, warm from the udder, or combined with urine, which directs the doṣas downwards, / or taken with trivṛt powder, should be drunk by one whose wind is obstructed by bile and blood.

Or a man should drink castor oil regularly with milk / for purgation when doṣas are copious, eating rice with milk once it is digested.

Or a man should drink a decoction of harītakī fried in ghee, / or trivṛt powder with milk as an after-drink, or with grape juice.

One should drink a decoction of kāśmarya, trivṛt, grapes, triphalā, with parūṣaka, / combined with salt and honey, for purgation.

Or one should drink a decoction of triphalā combined with honey; / or, if phlegm is predominant, a decoction of āmalakī, turmeric, and mustā.

And one should repeatedly purge him with the formulations prescribed in the Kalpasthāna, / mild and combined with unctuous substances, having recognized that wind is obstructed by waste matter.

Or one should eliminate his waste matter with milk enemas containing ghee; / for there is no treatment for gout equal to the enema.

In pain of the urinary bladder, groin, flanks, thighs, joints, bones, and abdomen, / and in upward movement of wind, non-unctuous enemas accompanied by unctuous enemas are praised.

And the wise physician should administer these oils in enema treatment, / in errhines, inunctions, and affusions, for the pacification of burning and colic:

In a decoction of one tulā of liquorice reduced to a quarter, / one should cook an āḍhaka of oil with an equal amount of milk and one-pala pastes of

śatapuṣpā, śatāvarī, mūrvā, payasyā, aguru, sandalwood, / sthirā, haṃsapadī, jaṭāmāṃsī, the two medās, and madhuparṇī.

with kākolī, kṣīrakākolī, tāmalakī, ṛddhi, padmaka, / jīvaka, ṛṣabhaka, jīvantī, cinnamon bark, patra, nakha, vālaka,

prapauṇḍarīka, mañjiṣṭhā, sārivā, aindrī, and vitunnaka. / Through the four modes of administration, that oil destroys wind-blood,

together with complications, with aching of the limbs, and that which has spread through the whole body; / it cures wind-blood, burning pain from pitta, and fever, and produces strength and complexion.
Thus ends the oil beginning with madhuparṇī.
A hundred [palas] of liquorice, grapes, dates, parūṣaka, / and both madhūka and odanapākī, and a prastha of muñjātaka,

and an āḍhaka of kāśmarya—all this one should cook in four droṇas of water; / when a one-eighth portion remains and is strained, in that one should cook an āḍhaka of oil,

likewise with equal parts of juice of āmalaka, kāśmarya, vidārī, and sugar cane, / with four droṇas of milk, adding a one-pala paste of

kadamba, āmalaka, walnuts, lotus seeds, kaśeruka, / śṛṅgāṭaka, ginger, salt, pippalī, sugar,

and the vitalising [drugs]; when properly cooked, one should mix it with a prastha of honey, / and apply it in errhines, inunctions, drinks, and also in enemas.

In all wind disorders, in torticollis, lockjaw, / in whole-body and one-limbed wind disorders, in phthisis from injury, and in fever from chest-wound,

this oil called Sukumāyaka destroys wind-blood disease, / promotes voice and complexion, and gives health, strength, and nourishment.
Thus ends the Sukumāraka oil.
Guḍūcī, liquorice, the lesser pañcamūla, punarnavā, / rāsnā, castor root, and the vitalising [drugs] as available,

in portions of one hundred palas each, five hundred [palas] of balā, / and jujube, bilva, barley, black gram, and horse gram measuring an āḍhaka each,

and a droṇa of well-dried kāśmarya fruits, in a hundred droṇas of water; / bruised and washed, one should cook it and reduce it to four droṇas.

With that, one should cook a droṇa of oil, having added five times as much milk, / and having ground three palas each of sandalwood, uśīra, keśara,

patra, cardamom, aguru, kuṣṭha, tagara, liquorice, / and eight palas of mañjiṣṭhā; when prepared, it is suitable for all applications.

In wind-blood, in phthisis from injury, in those afflicted by heavy loads, in those with depleted semen, / for those suffering from trembling, convulsions, and fractures, and patients with whole-body or single-limb disease,

it destroys vaginal disorders, epilepsy, insanity, limping, and lameness, / and this supreme oil called Amṛta promotes childbearing.
Thus ends the oil beginning with amṛtā.
Lotus, vetasa, liquorice, phenilā, padmaka, blue lotus, / darbha, balā, sandalwood, and kiṃśuka, five palas each,

boiled in water; with this one should cook a prastha of oil with an equal amount of sauvīraka, / together with lodhra, kālīyaka, uśīra, jīvaka, ṛṣabhaka, keśara,

madayantī, latāpatra, padmakeśara, padmaka, / prapauṇḍarīka, kāśmarya, māṃsī, medā, priyaṅgu,

with half a pala of saffron, and a pala of mañjiṣṭhā. / This Mahāpadma oil destroys wind-blood and fever.
Thus ends the Mahāpadma oil.
Cooked with a decoction of padmaka, uśīra, liquorice, and turmeric, / with ground sarja-resin, mañjiṣṭhā, vīrā, kākolī, and sandalwood,

this Khuḍḍūkapadmaka oil destroys wind-blood and burning pain.
Thus ends the Khuḍḍūkapadmaka oil.
Ten times as much milk should be boiled with a hundred [palas] of liquorice;

in four droṇas of oil with that [milk], prepared with a pala of liquorice / or with the juices of liquorice and kāśmarya, it destroys wind-blood.

Having ground a pala of madhuparṇī, a prastha of oil should be cooked in four times as much / milk, doing so a hundred times; similarly, prepared a hundred times with liquorice,

it should be given in wind-blood caused by all three doṣas; it cures dyspnea and cough, / and destroys heart disease, anemia, erysipelas, jaundice, and burning pain.
Thus ends the hundred-times cooked liquorice oil.
One should cook oil with a decoction and paste of balā, with an equal amount of milk, / a thousand or a hundred times; it destroys wind-blood and wind disorders.

This is a supreme rejuvenator, a clarifier of the sense organs, / life-giving, nourishing, voice-improving, and a destroyer of semen and menstrual disorders.
Thus ends the thousand-times or hundred-times cooked Balā oil.
Oil prepared with guḍūcī juice and milk, or with grape juice, / or with the juices of liquorice and kāśmarya, destroys wind-blood.

Oil cooked with a quarter part of sarja-resin in an āḍhaka of fermented gruel / and churned in abundant water is supreme in relieving fever, burning, and pain.

Containing beeswax, mañjiṣṭhā, sarja-resin, and sārivā, / this Piṇḍataila by inunction relieves the pain of wind-blood.
Thus ends Piṇḍataila.
Milk boiled with daśamūla immediately relieves pain; / affusion [is applied] similarly with lukewarm ghee when wind predominates.

Or one should perform affusion with the four unctuous substances prepared with sweet drugs / lukewarm for one afflicted with stiffness, convulsions, and pain, but cold during burning pain.

Likewise, the physician [should perform affusion] with cow, sheep, or goat milks mixed with oil, / or with decoctions of the vitalising [drugs] or of pañcamūla.

Grape juice, sugarcane juice, wines, curd whey, sour fermented gruel, / and water with rice, honey, and sugar are praised for affusion.

Sprinkling with cold water and contact with white water-lilies, blue lotuses, pink lotuses, / and jewel garlands along with sandalwood are beneficial during burning pain;

on a bed strewn with linen and lotus petals, sprayed with moonbeam-like water, / fanned by cool breezes that feel like riverbanks,

beloved women with sweet speech, whose breasts and hands are moist with sandalwood, / cool to the touch and pleasant to feel, dispel burning, pain, and fatigue.

When there is burning with redness and pain, having drained blood, one should apply a plaster / of liquorice, aśvattha bark, māṃsī, vīrā, udumbara, and young grass;

or with aquatic plants, or barley powder with liquorice, milk, and ghee; / or a plaster ground with ghee and vitalising [drugs] relieves pain and burning.

Sesame, priyāla, liquorice, lotus rhizome, and root of vetasa, / ground with goat's milk and applied as a plaster, relieves burning and redness.

With prapauṇḍarīka, mañjiṣṭhā, dārvī, liquorice, sandalwood, / sugar candy, airakā, roasted grain flour, lentils, uśīra, and padmaka,

a plaster wards off pain, burning, erysipelas, redness, and swelling. / These are for when pitta and blood predominate; now hear the plasters when wind predominates:

An unctuous warm poultice prepared with wind-destroying [drugs], / milk-rice pudding with mung bean, or balls of sesame and mustard, dispels pain.

Well-prepared veśavāra minced meats of aquatic, predatory, and marshland animals / combined with vitalising drugs and unctuous substances should be used in warm poulticing;

they destroy stiffness, piercing pain, aching, bending, swelling, and limb rigidity; / or muscle fat prepared with vitalising drugs along with milk.

Ghee, sahacara root, jīvantī, and goat's milk / form a plaster; likewise sesame seeds ground, roasted, and cooled in milk.

Linseed ground with milk and castor seeds as a plaster / should be applied to relieve pain, as well as śatāhvā when wind is excessive.

In a decoction of castor plant including root, tip, and leaves, two prasthas each / of ghee, oil, muscle fat, and marrow of marshland beasts and birds

along with cow's milk or goat's milk; for the paste, vitalising drugs, / turmeric, blue water lily, kuṣṭha, cardamom, śatāhvā, white yam leaves,

each in the measure of a bilva, and flowers of kakubha should be cooked. / One should add eight palas of beeswax when it has cooled after being taken down.

This is commended as a plaster for those whose limbs are afflicted with pain, when wind has entered the joints, / in gout, dislocation, fracture, lameness, and hunchback.

When this [disease] is accompanied by swelling, heaviness, itching, and so forth, with a predominance of kapha, / ghee cooked with cow's urine, alkali, and surā wine is beneficial for inunction.

Padmaka, cinnamon, madhuka, and sārivā: ghee prepared with these / along with honey and fermented gruel serves for affusion and massage when kapha predominates.

Alkali, oil, cow's urine, and water boiled with pungent drugs / they recommend for affusion in gout when kapha predominates.

A plaster of mustard, neem, arka, hiṃsrā, milk, and sesame is beneficial; / best is that prepared from kapittha bark, ghee, milk, and parched grain flour.

Soot, vacā, kuṣṭha, śatāhvā, and the two turmerics: / this plaster relieves pain in gout when wind and kapha predominate.

Tagara, cinnamon, śatāhvā, cardamom, kuṣṭha, musta, hareṇukā, / devadāru, and vyāghranakha ground with sour liquids destroy wind-kapha-blood [disorder].

Likewise, seeds of madhuśigru combined with sour fermented gruel are beneficial; / after applying the plaster for a muhūrta, one should sprinkle sour liquids when wind and kapha predominate.

Triphalā, the three pungents, cinnamon leaf, cardamom, cinnamon bark, bamboo manna, plumbago, vacā, / viḍaṅga, pippalī root, romaśa, and vṛṣaka bark,

ṛddhi, tāmalakī, and cavya in equal parts should be ground. / Having smeared [it] in an iron vessel at dawn, one should consume it at midday;

one should avoid curd, fermented vinegars, milk, and incompatible foods. / It is supremely beneficial in wind-blood involving all doṣas, even when afflicted with colic.

Recognising the particular locations and the strength and weakness of the doṣas, / one who knows reasoning, exclusion, and alternatives should administer this treatment.

When wind is provoked through blockage of channels due to fat or kapha, / or by extreme increase [of itself], oleation and nourishment are not commended at first.

By means of exercise, purifications, ariṣṭa wines, drinks of cow's urine, purgatives, / and administrations of buttermilk and abhayā, one should deplete kapha and fat.

One should drink a decoction of the bodhi tree along with honey; / it quickly overcomes gout, even the dread form involving all three doṣas,

along with old barley, wheat, sīdhu wine, ariṣṭa wine, surā wine, and āsava wines, / and administrations of bitumen, guggulu, and honey.

If blood has been invaded in the deep [variety], one should overcome it like wind; / afterwards, in wind, one should perform procedures that pacify gout.

Due to extreme increase of blood and pitta, it quickly proceeds to suppuration; / burst open, it discharges blood or suppurated pus.

Treatment for the two should be performed through incision, purification, and healing; / and for complications, one should perform their respective treatments from their [relevant] therapeutic chapters.

Here are the summary verses: —

The etiology, the locations, and the root, why it mostly / provokes in the joints, its prodrome, and the symptoms of the two varieties,

the signs of each distinct type, the predominance of doṣas, complications, / the curable, the manageable, and the incurable, and all the treatment for the curable

of gout has thus been declared in brief and at length / by the great sage to Agniveśa, as well as the stage-specific treatment.

Thus ends the twenty-ninth chapter, named "Treatment of Wind-Blood", in the Section on Therapeutics of the compendium composed by Agniveśa, redacted by Caraka, and, being incomplete, completed by Dṛḍhabala. // 29