The Compendium of Caraka 6.30: triṃśo 'adhyāyaḥ/

Now we shall expound the treatment of vaginal disorders.

Thus spoke the venerable Ātreya:

On the holy slope of the Himālaya, possessing divine pilgrimage places and medicinal herbs, / rich in variegated minerals and stones, frequented by gods, siddhas, and ṛṣis,

Agniveśa questioned Punarvasu, who was wandering there through ascetic practice, / who beheld the true nature of reality, and had conquered himself:

"O Venerable One! Since women are the supreme root of offspring for men, / and their injury is caused by diseases seated in the vagina,

therefore I wish to hear their origin, the characteristics of those that have arisen, / along with their remedies, out of a desire to benefit mankind."

Thus questioned by his pupil, the best of ṛṣis, born of Atri, said: / "Twenty vaginal disorders have been listed in the compendium of diseases.

They arise in women through improper conduct, vitiated menstrual blood, / defect of the seed, and fate; hear of them individually:

In a woman of wind-aggravating diet and activities, wind, / having increased and settled in the vagina, causes piercing pain in the vagina with aching,

stiffness, a sensation as of crawling ants, roughness, / numbness, fatigue, and other disorders born of wind.

It has noisy pain, and frothy, thin, rough menstrual discharge due to wind. / The disorder born of pitta arises from pungent, sour, salty, and alkaline substances.

Afflicted with burning, suppuration, fever, and heat, with blue, yellow, or black menstrual blood, / and discharge that is extremely hot and smells of a corpse, the vagina becomes vitiated by pitta.

If kapha, increased by channel-clogging foods, vitiates the vagina of a woman, / it makes it slimy, cold, seized by itching, and having little pain,

pale in color, and discharging pale, slimy menstrual blood. / In a woman consuming all tastes equally, the three wastes, having become vitiated,

settled in the vagina and uterus, endow the vagina with their respective signs. / It is afflicted with burning and colic, and discharges white, slimy fluid.

Through blood-pitta-producing causes, a woman's blood is vitiated by pitta / and flows excessively from the vagina, even when a pregnancy has been attained; this is asṛgdara.

If pitta situated in the vagina and uterus vitiates the blood, / that [condition] is regarded as arajaskā, causing severe emaciation and discoloration.

Due to non-washing of the vagina, organisms that arise produce itching; / that is acaraṇā, and because of that itching she desires men excessively.

Wind provoked by excessive intercourse causes swelling, / numbness, and pain in the vagina of a woman; that is considered aticaraṇā.

Due to sexual intercourse in a very young girl, wind, / aching the back, hips, thighs, and groin, vitiates the vagina; this is prākcaraṇā.

In a pregnant woman, through habituation to kapha-increasing foods and suppression of vomiting and exhalation, / wind, enraged, conveys kapha to the vagina and vitiates it.

She discharges pale fluid with piercing pain, or discharges white kapha; / that vagina, pervaded by diseases of kapha and wind, is upaplutā.

In a woman of pitta nature, during sexual intercourse, due to the retention of sneezing and belching, / wind combined with pitta vitiates the vagina of the woman.

Swollen, tender to the touch, and painful, she discharges blue and yellow blood; / afflicted with pain in the pelvis, groin, and back, and with fever, this is pariplutā.

Due to the upward inversion of urges, wind inverts the vagina upwards; / suffering from pain, she releases upward-turned menstrual blood with difficulty.

When the menstrual blood is released, she instantly obtains ease; / because of the upward movement of the menstrual blood, this should be known by the wise as udāvartinī.

In a woman bearing down at the wrong time, wind obstructed by the fetus, / combined with kapha and blood, produces an fleshy growth in the vagina.

Because of that growth obstructing the channel of blood, it is regarded as karṇinī. / When, due to roughness, wind destroys fetus after fetus as soon as it is formed,

arising from vitiated blood of the woman, it is known by the name putraghnī. / In a woman engaging in sexual intercourse when excessively full, pressed upon by food,

wind, seated in the vaginal channel of a woman whose limbs are positioned improperly, / bends the orifice of the vagina; she, through pain caused by wind in the bones and flesh,

is intensely pained and incapable of sexual intercourse; this vagina is regarded as antarmukhī. / In a female fetus, due to roughness, wind vitiating the vagina

owing to a maternal defect, makes it have a minute aperture; this is sūcīmukhī. / In a woman suppressing urges at the time of sexual intercourse, enraged wind

causes pain with retention of feces and urine, and dryness of the vaginal orifice. / After six days or seven nights, the semen that had entered the uterus

is discharged with pain or without pain; that woman is vāminī. / From an ovum defect, her reproductive organs being struck by wind while residing in the womb,

she becomes a ṣaṇḍhī, averse to men, without breasts, and incurable. / From intercourse in an uneven position on an uncomfortable bed, enraged wind

rigidly obstructs the orifice of the uterus and vagina of the woman; / with an unclosed orifice, painful, discharging dry and frothy fluid,

with protruding flesh and an enlarged vagina, having acute pain in the joints and groin. / Thus, by these characteristics, the twenty vaginal diseases have been declared.

Afflicted by these doshas, the vagina does not retain semen; / therefore she does not conceive a fetus, and the woman falls into many diseases,

such as abdominal lump, hemorrhoids, menorrhagia, and intense affliction caused by wind and the other [doshas]. / Of these, the final sixteen—the first two arise from pitta defect;

pariplutā and vāminī are considered to be of the nature of wind and pitta; / karṇinī and upaplutā are from wind and kapha; while the remainder are born of wind.

Wind and the other [doshas] indeed afflict their bodies with their own specific symptoms. / Oleation, sudation, enema, and the like, which remove wind, in those born of wind

should be administered, and that which destroys internal hemorrhage and is cooling in those caused by pitta; / in those born of kapha, the discerning physician should carry out a dry and warm regimen.

In a combined condition, however, a mixed treatment should be given, as also in combined doshas. / Likewise, having lubricated and sweated the misplaced vagina, one should restore it to its position again.

With the hand one should straighten the crooked one, expand again the constricted one, / insert the prolapsed one, and reposition the dilated one.

For a vagina displaced from its position is regarded as a foreign body for a woman. / In every disordered vagina, however, by procedures beginning with emesis,

by the five gentle methods, one should treat the woman after she is oleated and fomented. / When she is thoroughly cleansed in every respect, the rest of the treatment is prescribed.

A regimen curing wind disorder is always beneficial for those afflicted by wind: / with meat of aquatic and marsh animals, with milk, with sesame and rice,

together with wind-destroying medicines, one should treat her with tube and pot fomentations; / smeared with salted oil, with stone-slab and mixed-poultice fomentations.

When fomented and her body sprinkled with lukewarm water, one should feed her with wind-destroying meat soups. / In a decoction of two droṇas of balā, one should cook an āḍhaka of ghee and oil

with sthirā, payasyā, jīvantī, vīrā, ṛṣabhaka, jīvaka, / śrāvaṇī, pippalī, mudgaparṇī, māṣaparṇī, and pīlu,

and indeed with sugar, kṣīrakākolī, and kākanāsā; / ground, with four times as much milk, when prepared it should be drunk according to strength.

Having destroyed diseases caused by wind and pitta, it supports conception. / With kāśmarya, triphalā, drākṣā, kāsamarda, parūṣaka,

punarnavā, the two rajanīs, kākanāsā, sahācara, / śatāvarī, and guḍūcī, each equal to an akṣa, a prastha of ghee

prepared [with these], supreme in destroying vaginal wind and granting conception, she should drink. / Pippalī, kuñcikā, ajājī, vṛṣaka, rock salt, vacā,

yavakṣāra, ajamodā, sugar, and citraka: / having ground these and fried them in ghee, one should administer them to drink with clear wine

for the cessation of pain in the vagina and flanks, heart disease, abdominal lump, and hemorrhoids. / Vṛṣaka, roots of citron, and madayantikā

she should drink with salted wines, and likewise pippalī and kuñcikā. / She should drink milk boiled with rāsnā, gokṣura, and vṛṣaka in case of acute pain,

and one should irrigate with decoctions of guḍūcī, triphalā, and dantī. / Rock salt, tagara, kuṣṭha, bṛhatī, and devadāru:

oil prepared with equal parts of these pastes should be retained to relieve pain. / With guḍūcī, mālatī, rāsnā, balā, madhuka, citraka,

nidigdhikā, devadāru, and yūthikā, each measuring a karṣa, / one should cook a prastha of oil in cow's urine and double the quantity of milk.

One should give a tampon to the woman afflicted by wind and then insert it into the vagina. / For vaginas afflicted by wind, irrigation, inunction, and tampon procedures

should be done warm, unctuous, and with oleating oils. The woman afflicted by wind, having anointed [herself], should insert warm hiṃsrā paste; / the woman afflicted by pitta, [paste] of the pañcavalkas; the woman afflicted by kapha, of the śyāmā group and others.

For pitta-afflicted vaginas, however, procedures of irrigation, inunction, and tampons / should be cooling and pitta-pacifying, and ghees should be used for the purpose of oleation.

Likewise, preparations processed with pitta-destroying medicines should be made by the physician. / One should press out four tulās of śatāvarī root;

with that juice, equal to the milk, one should cook an āḍhaka of ghee / along with the jīvanīya drugs, śatāvarī, grapes, parūṣaka,

ground priyāla, each in the measure of an akṣa, and two measures of yaṣṭimadhuka, by the physician. / When prepared and cooled, mixed with eight palas of honey, of pippalī,

and ten palas of sugar, she should lick a palmful of it thereafter. / It cures defects of the vagina, blood, and semen, is aphrodisiac, and produces male offspring;

it conquers phthisis, wounds, internal hemorrhage, cough, dyspnea, halīmaka, / jaundice, gout, erysipelas, stiffness of heart and head,

madness, anxiety, and epilepsy caused by wind and pitta. / Thus ends the Great Śatāvarī Ghee. / In the very same way, ghee prepared from milk with the jīvanīya herbs

is conducive to conception and is the physician's cure for pitta-afflicted vaginas. / When the vagina is vitiated by kapha, a purifying suppository is beneficial.

[A suppository] made of shreds of cloth soaked repeatedly in boar's bile; / or barley flour soaked in milk of arka, together with rock salt,

made into a suppository, should be retained repeatedly and then rinsed with comfortably warm water. / [Or a suppository] made with long pepper, black pepper, black gram, dill, kuṣṭha, and rock salt,

equal [in thickness] to the index finger, should be retained to purify the vagina. / One droṇa of unripe udumbara fruits together with one droṇa of water,

along with the pañcavalkala, kulaka, and tender shoots of mālatī and neem, / having been left in water overnight, one should boil therein one prastha of oil

with a paste of lac, and the bark exudates of dhava and palāśa, and of śālmali. / With this prepared oil, one should insert a swab into the vagina,

and perform irrigation with cold decoctions mixed with sugar. / A vagina that is slimy, dilated, chronically vitiated, and severe,

becomes purified within seven days quickly, and she also obtains offspring. / From sesame seeds soaked six times in the milk of udumbara,

an oil prepared with the decoction of that same [tree] should be retained as before. / With dhātakī, leaves of āmalakī, antimony, licorice, water lily,

the seeds of jambū and mango, ferrous sulfate, lodhra, kaṭphala, and tinduka, / saurāṣṭrikā, pomegranate bark, and unripe udumbara fruits,

in the measure of one akṣa each, one should boil one prastha of oil in goat's urine and twice as much milk; / one should apply a swab and introduce it into the vagina.

One should administer anointing to the hips, back, and sacrum, and an unctuous enema. / A vagina that is slimy, discharging, as well as viplutā, upaplutā,

shallow, elevated, swollen, eruptive, and painful is cured. / With decoctions of karīra, dhava, neem, arka, bamboo, kośāmra, jambū,

jiṅginī, and the roots of vṛṣa; or with grape wine and sīdhu, / mixed with vinegar, moderate washing destroys vaginal discharge.

Or one should perform it with triphalā juice combined with buttermilk, cow's urine, and vinegar. / Administrations of long pepper, iron powder, and chebulic myrobalan with honey are beneficial.

When kapha is predominant, predominantly pungent enemas with cow's urine are beneficial; / in pitta, [enemas] with sweet substances and milk; in wind, combined with oil and sour liquids.

For that arising from all three doṣas, mixed therapy is beneficial. / In menorrhagia, having observed the secondary connection from the colors of the blood,

one should then administer hemostatic medicine according to the doṣa: / sesame powder, curd, ghee, molasses, boar's fat,

mixed with honey, should be drunk to destroy wind-induced menorrhagia; / or fatty broth of boar with horse gram when wind is excessive;

or curd mixed with sugar, honey, licorice, and dry ginger. / Payasyā, blue water lily, lotus rhizome root, lotus root, kālīyaka, and nut grass,

with milk, sugar, and honey, she should drink in pitta-induced menorrhagia. / Pāṭhā, seeds of jambū and mango, silicious extract, rasāñjana,

ambaṣṭhā, exudate of śālmali, samaṅgā, vatsaka bark, / bāhlīka, ativiṣā, bilva, musta, lodhra, along with red ochre,

kaṭvaṅga, black pepper, dry ginger, dried grapes, red sandalwood, / kaṭphala, vatsaka seeds, anantā, dhātakī, licorice, and arjuna,

gathered under the asterism Puṣya, should be made into equal parts of fine powder. / Having mixed them with honey, she should drink them with rice water.

Blood that is passed in hemorrhoids and in diarrhea, / and those [afflictions] of children caused by the doṣas and extrinsic factors, it destroys;

vaginal defects, menstrual disorders—white, blue, yellowish, / and whatever is greyish or reddish in women—it forcibly checks.

This powder, named Puṣyānuga, is beneficial and praised by Ātreya. / Thus ends the Puṣyānuga powder. / The root of taṇḍulīyaka with honey and rice water,

and rasāñjana and lac, one should drink with goat's milk. / A paste of the leaves of rājādana and kapittha fried in ghee

pacifies pitta and wind; in a pitta condition, it overcomes bleeding disorders in every way. / Licorice, triphalā, lodhra, musta, saurāṣṭrikā, and honey,

or neem and guḍūcī, she should drink with alcoholic drinks in kapha-induced menorrhagia. / One should drink the Mahātikta purgative in pitta-induced menorrhagia.

And whatever has been stated as beneficial in miscarriage, one should carry out that. / Ghee prepared with a decoction of kāśmarya and kuṭaja, administered by urethral or vaginal douche,

is beneficial for raktayoni, arajaskā, and putraghnī. / With the blood of deer, goat, sheep, or boar, curd, sour fruit, and ghee,

an arajaskā patient should drink, or milk boiled with jīvanīya herbs. / And in karṇinī, acaraṇā, śuṣkā, and prākcaraṇā,

and in disorders of kapha and wind, oil should be given by urethral or vaginal douche. / Linen cloth soaked twenty-one times in cow's bile or fish bile,

or yeast powder with honey, one should apply to destroy acaraṇā; / and that clears the channels and removes itching, moistness, and swelling.

With wind-destroying oils boiled a hundred times, a patient with prākcaraṇā or aticaraṇā / should be given decoction enemas and unctuous enemas, and fermented with wind-destroying agents,

with unctuous substances, and foods and poultices properly applied. / With dill, barley, wheat, yeast, kuṣṭha, priyaṅgu,

balā, ākhuparṇikā, and śṛṅgī, a thick porridge is prescribed to be retained. / And for vāminī and upaplutā, the course of unction, sudation, and so forth

should be done; after that, an unctuous swab; after that, saturation should take place. / An unctuous swab prepared with the decoction of barks of śallakī, jiṅginī, jambū, and dhava, and the pañcavalkala,

removes viplutā. / In karṇinī, a suppository made of kuṣṭha, long pepper, buds of arka, and rock salt

with goat's urine should be retained, and everything that destroys kapha is beneficial. / Unction with Traivṛta, sudation, meat soups of domestic, wetland, and aquatic animals,

and a milk enema with daśamūla in udāvarta and wind afflictions; / and an unctuous enema with Traivṛta, and the enema termed uttarabasti.

This very same [regimen] is prescribed in mahāyoni and in prolapse. / Fat of bear and boar, and ghee boiled with sweet herbs,

having filled the mahāyoni [with these], one should bind it with linen rags. / Having smeared the prolapsed [vagina] with ghee, fomented it with milk, and reduced it,

one should bind it with a bolus of veśavāra until the time of urination. / And whatever procedure has been stated for wind disorders, one should carry out that

in all vaginal disorders, an intelligent physician, especially in mahāyoni; / for indeed, without wind, the vagina of women is never vitiated.

Having pacified that, one should administer remedy for the other doṣa. / In pale menorrhagia, one should drink paste of the roots of rohītaka,

or āmalakī seeds with water, or paste [thereof] with sugar and honey; / or one should make her lick powder or juice of āmalaka with honey;

likewise, one should drink paste of lodhra with a decoction of banyan bark; / or in vaginal discharge, one should retain a linen cloth soaked therewith.

Or she should insert a ball of powdered bark of plakṣa made with honey, / or of lodhra, priyaṅgu, and madhuka, into the vagina anointed with unctuous substance.

A suppository mixed with honey and made of astringent [substances] of all kinds should be inserted; / or, to arrest vaginal discharge, the anointed [vagina] should be fumigated with [substances] soaked in ghee:

with saralā, guggulu, barley, and pungent fish along with oil. / Kāsīsa, triphalā, alum, samaṅgā, mango stone, dhātakī—

in unctuousness, [this] powder combined with honey is a producer of clarity. / Bark of palāśa, sarja, and jambū, samaṅgā, mocā, and dhātakī:

a paste [of these] is desired as an arrester of sliminess and excessive moistness. / For [vaginas that are] stiff and rough, a softener must be applied.

One should insert veśavāra, milk-rice, or kṛśarā; / for foul-smelling ones, there should be a decoction or paste of tuvaraka,

or a powder of all aromatic substances, which removes foul odors. / In this way, when their vaginas are purified, women attain pregnancy,

provided the seed is incorrupt and natural, and descent of the living soul takes place. / And having examined the semen of a man purified by the five actions

according to the colors of the doṣas, if it is vitiated, one should treat it with [remedies] that destroy them. / Here occur [verses]: The disorders of the vagina together with symptoms, etiology, and treatment,

have been stated in detail properly by the sage who sees the truth. / Agniveśa, however, once again inquired of the best of physicians,

having approached Ātreya: 'O sinless one! The semen disorders / described by you completely in the chapter on diseases are indeed eight for men.

Their etiology, O best of physicians, the form of the vitiated and unvitiated, / the treatment in its entirety, and impotence which is of four kinds,

and the menorrhagia that is mentioned among the complications of vaginal [disorders]— / their etiology, symptoms, and treatment indeed according to truth,

declare in brief and in detail, O best of physicians!' / To him desiring to hear, the foremost of sages spoke:

'Since in sexual intercourse the seed arising from the source of pleasure / is called male semen, therefore I will declare it; listen to that:

Just as a seed spoiled by untimely water, worms, insects, or fire / does not germinate when vitiated, so also the semen of living beings [fails].

From excessive sexual intercourse, physical exercise, and use of unwholesome things; / or when practicing coitus at an improper time, in an improper organ, or not [properly];

from use of dry, bitter, astringent, excessively salty, sour, and hot things; / from copulation with women devoid of desire, and through old age;

from anxiety, grief, lack of trust, mishap with surgical instruments, caustic alkali, or fire; / from fear, anger, black magic, and in one emaciated by diseases;

from suppression of natural urges, injury, and corruption of the tissues— / the doṣas, individually or collectively, having reached the semen-carrying channels,

swiftly vitiate the semen; that I shall explain in parts: / frothy, thin, dry, discolored, putrid, slimy,

mixed with other tissues, and sediment-forming as the eighth. / Frothy, thin, dry, and passed with difficulty and in small quantity due to wind—

the semen becomes impaired [thus]; it does not serve for pregnancy. / Semen vitiated by pitta comes out burning the penis,

bluish or yellow, exceedingly hot, and foul-smelling. / Obstructed in its path by phlegm, however, it becomes exceedingly slimy.

From excessive indulgence in women, injury, or wound, / the semen of a man issues generally accompanied by blood.

From suppression of natural urges, the semen checked in its passage by wind / comes out with difficulty, knotted, and sediment-forming as the eighth.

Thus the eight disorders of semen have been stated along with their symptoms. / Unctuous, dense, slimy, sweet, non-burning,

white, and resembling crystal—one should know such semen to be pure. / By means of beneficial aphrodisiac formulations agreeable in use,

by recipes that remove bleeding disorders, and likewise those for vaginal disorders, / when semen becomes vitiated, then one should treat it.

Ghee prepared with vitalizing herbs, cyavanaprāśa, / and the administration of bitumen remove defects of semen.

In semen affected by wind, non-unctuous enemas accompanied by unctuous enemas are beneficial; / and in that of pitta, the Abhayāmalakīya rasāyana is recommended.

The rasāyana of māgadhī, amṛtā, iron, and triphalā, / and that of bhallātaka destroy semen disorders arising from phlegm.

Semen that is mixed with other tissues: examining that skillfully, / one should apply medicine according to the doṣa and the tissue, in keeping with the doṣas.

Ghee, milk, meat broths, śāli rice, barley, wheat, and ṣaṣṭika rice / are praised in semen disorders, especially the procedure of enema.

Thus the treatment of the eight semen disorders has been stated by the sage. / Because impotence arising from semen defects is cured precisely by purification,

therefore I shall explain to you properly, O Agniveśa, according to the facts: / From injury to the seed, from injury to the penis, from old age, and from loss of semen,

impotence is produced; listen to its general symptom: / Though constantly inclined by desire toward a beloved and compliant woman,

he does not engage because of flaccidity of the penis; or if he engages at any time, / afflicted with panting, with limbs perspiring, his intentions and actions futile,

with flaccid penis and seedless—this is the sign of impotence. / This is indeed the general symptom; it will now be declared in detail:

From cold, dry, scanty, contaminated, incompatible, and undigested food; / from grief, anxiety, fear, and terror, and excessive indulgence in women;

from sorcery, lack of confidence, depletion of plasma and other tissues, / disharmony of wind and other doṣas, likewise from fasting and fatigue;

from insensitivity to women, and misconduct in the five cleansing procedures— / through injury to the seed, a man becomes pale-colored, very weak,

with little vitality and little pleasure regarding women, / afflicted with heart disease, anemia, bronchial asthma, jaundice, and fatigue,

suffering from vomiting, diarrhea, and colic, afflicted with cough and fever. / Impotence born of seed-injury [is thus explained]; hear now that produced by collapse of the penis:

From excessively sour, salty, alkaline, incompatible, and unwholesome food; / from drinking excessive water, irregular eating, and heavy meals of flour preparations;

from using curd, milk, and wetland meat; from emaciation through disease; / from coitus with young girls, and from unnatural intercourse;

with one suffering from chronic disease, one abandoned long ago, and likewise one menstruating, / foul-smelling, with diseased vagina, and likewise one with discharge—

whoever approaches such a woman out of delusion, excited by lust; / from coitus with quadrupeds, and from trauma to the penis;

or from not washing the penis, from injury by weapon, teeth, or nails; / from blows with sticks, crushing, and excessive application of irritating beetles—

And from suppression of semen, collapse of the penis arises. / I shall now declare the symptoms that belong to it: swelling, pain, and redness are observed in the penis,

severe eruptions appear, and suppuration of the penis also occurs; / fleshy growth may arise in it, and ulcers quickly form.

Discharge resembling thin grain-wash water, dusky and reddish in hue, appears, / and circular constriction with hard induration develops.

Fever, thirst, dizziness, fainting, and vomiting arise in him, / and blood discharges—black, dark-blue, or turbid-red.

There is severe burning pain accompanied by distress, as if burnt by fire, / in the bladder, testicles, perineal raphe, or groins.

Sometimes the discharge becomes slimy or pale; / a mild swelling appears, indolent and with little exudate;

it ripens slowly or is quickly released; / worms arise, and it becomes moist and foul-smelling.

The glans penis sloughs away, as well as the shaft and both testicles. / This is described as impotence caused by collapse of the penis.

Some describe this collapse of the penis as being of five kinds. / Now listen as I declare the impotence that arises from old age.

Age is said to be of three kinds: inferior, middle, and advanced. / In those of advanced age, men's semen generally diminishes,

due to the depletion of chyle and the other tissues, and likewise from using non-aphrodisiacs, / and from the gradual decline of strength, vigor, and the sense faculties;

and from the exhaustion of life-span, from fasting, exertion, and fatigue. / From these causes impotence arising from old age occurs in men.

Because of that, having excessively depleted tissues and being very weak, / discolored, feeble, and miserable, he quickly incurs disease.

This is that arising from old age; now listen to the fourth kind, born of depletion: / from excessive worrying, grief, anger, and fear,

a man who constantly falls into envy, longing, intoxication, and agitation, / or who, emaciated, partakes of unctuous-less food, drink, and medicine,

is of weak constitution, and remains without food; / and from unwholesome eating, that which resides in the heart—

the chyle, which is indeed the foremost tissue—rapidly diminishes in men; / and then blood and the other tissues of that embodied soul diminish,

ending with semen; and of these, semen is considered the supreme seat. / Or if one indulges excessively in coitus through great excitement of the mind,

his semen rapidly declines, and thence he reaches total wasting; / he incurs dreadful disease or meets death.

Therefore, semen must be protected especially by one desiring health. / Thus impotence of four kinds has been spoken of by etiology and signs.

Some, however, declare two types of impotence to be incurable: those born of collapse of the penis and of depletion; / [and also] from excision of the penis and tearing out of the testicles.

From defects in the seeds of mother and father, and from evil deeds of one whose mind was uncontrolled, / when the doshas, reaching the semen-carrying channels of the embryo,

quickly dry them up, through their destruction the semen is also ruined; / therein, though complete in all limbs, the man becomes a non-man.

These are explained as incurable because of the culmination of all three doshas combined. / Hear now, in brief and in detail, the treatment thereafter:

Whatever remedy was prescribed by me for seminal disorders, O sinless one, / and whatever is beneficial for the depleted and chest-injured, one should employ to pacify impotence.

Enemas, milk-ghees, aphrodisiac formulations, / and rasāyana regimens—all these one should employ,

having evaluated the body, doshas, digestive fire, and strength, knowing the proper time for medicine. / In impotence born of excessive coitus, as well as from disorder of the tissues,

and in that born of sorcery, spiritual therapy [is prescribed]. / In brief, this remedy has been indicated for pacifying impotence;

I will state again the treatment for the forms of impotence in detail: / for one whose body has been well sweated and unctuated, purgation combined with unctuous substance [is administered].

Then one should give food, or again non-unctuous enema / the intelligent physician should administer; then he should give an unctuous enema.

Afterward he should administer a non-unctuous enema with palāśa, eraṇḍa, mustā, and the like; / and the aphrodisiac formulations described previously

should be administered by the physician in impotence born of seed injury. / Having identified impotence caused by collapse of the penis, one should carry out its management:

one should apply poultices, irrigation, or bloodletting; / and one should administer intake of unctuous substance and unctuous purgation;