The Compendium of Caraka 6.4: caturtho 'adhyāyaḥ/

Now we shall explain the treatment of bleeding disorder.

Thus spoke the venerable Ātreya.

To Punarvasu, who was wandering at Pañcagaṅgā, self-controlled, free of delusion,
and having the radiance of fire, Agniveśa bowed and said:

“Venerable sir, the cause of bleeding disorder has been stated along with its symptoms;
whatever remains to be said about it, that you ought to speak, O teacher.”

The teacher said: “It is a great disease, of great violence, acting quickly like fire;
knowing its causes and symptoms, one should treat bleeding disorder quickly.

Hot, sharp, sour, pungent, and salty things,
heat, and burning during digestion of food were shown earlier as its cause.

Excited by these causes, pitta enters the blood;
and having entered it because of having the same source, it increases, vitiating it.

Due to its heat, the liquid tissue is poured forth from tissue to tissue
as they sweat, and thereby it undergoes further increase.

Because of combination, vitiation, and similarity in smell and colour
with blood, that pitta is called ‘bleeding disorder’ by the wise.

Taking its seat in the spleen and the liver, it proceeds;
for the blood-bearing channels of embodied beings have those as their roots.

Dense, pale, unctuous, and slimy when accompanied by kapha;
greyish-red, frothy, thin, and dry when caused by vāta;

bleeding disorder resembles an astringent decoction, is black, resembles cow’s urine,
resembles antimony, soot from the house, or collyrium when caused by pitta.

With combined symptoms from combination of two, and with three sets of symptoms when born of all three doshas;
that following a single dosha is curable, that with two doshas is called manageable,

and that with all three doshas is incurable; as is that in one with dull digestive fire, of excessive violence,
in one whose body is wasted by diseases, in the aged, and in one who does not eat.

The course of bleeding disorder has been shown to be upward and downward;
the upward course has seven doors, whereas the downward course has two doors.

There are seven openings in the head and two below; that moving upward is curable,
that moving downward is manageable, but that which takes both paths is incurable.

When, however, it proceeds from all orifices and from the hair pores as well,
they call that course unreckonable and fatal.

And that which proceeds excessively through both channels,
equal to the smell of a corpse, and the blood is exceedingly black,

combined with kapha and vāta, and adheres in the throat;
and that which is beset with all the aforementioned complications,
marred by turmeric-yellow, blue, green, and copper colours,
and in a wasted person who is coughing—that does not succeed.

That which follows two doshas, or which flares up again and again after being calmed,
or which moves from tract to tract—that pitta and blood is manageable.
That of a single tract, in a strong person, not excessively violent, freshly arisen,
in a comfortable season, and free of complications, is curable.

Unctuous-and-hot, and hot-and-dry are the causes of bleeding disorder;
generally, the latter is for the downward, and the former for the upward.

The upward is combined with kapha, the downward is attended by vāta;
that of two paths is accompanied by both kapha and vāta.

When bleeding disorder occurs in one who eats while their strength and flesh are undiminished,
vitiated by doshas and stirred up, it does not initially merit astringent stoppage.

Throat obstruction, putrid nasal discharge, swooning, anorexia, fever,
abdominal lump, spleen disorder, abdominal distension, white leprosy, difficulty in urination,

skin diseases, piles, erysipelas, loss of complexion, fistula-in-ano,
and impairment of the intellect and sense organs would be caused if it is checked at the outset.

Therefore, in a strong person, bleeding disorder that has surged should initially be left alone
by one who considers the strength and the doshas and desires success;
for, generally, the blood-pitta of embodied beings increases
when stirred up by the dosha of āma; therefore, it should initially be managed by fasting.

Having thoroughly examined the two tracts, the secondary dosha involved, and the cause,
one should employ fasting or a refreshing drink at the beginning of bleeding disorder.

Boiled with hrībera, sandalwood, uśīra, mustā, and parpaṭaka,
or plain water boiled and cooled, should be given to one who is thirsty.

In the upward course, a refreshing drink comes first; in the downward course, a gruel comes first;
knowing time, suitability, and secondary conditions, and knowing constitution and preparation, one should administer [it].

Water boiled and cooled with dates, raisins, madhūka, and parūṣaka,
together with sugar, should be employed for the purpose of a refreshing drink.

One should administer a refreshing drink with ghee and honey, made of parched-grain flour;
drunk at the proper time, it dispels upward bleeding disorder.

For one with low digestive fire and accustomed to sour things, he should prepare it sour as well;
and for the sake of sourness, the wise practitioner should also add pomegranate and āmalaka.
Śāli, ṣaṣṭika, nīvāra, koradūṣa, and praśāntikā,
as well as śyāmāka and priyaṅgu, are food for sufferers of bleeding disorder.

Mung beans, lentils, chickpeas, along with wild beans and the fruit of pigeon pea,
are commended when prepared as soup or broth for sufferers of bleeding disorder.

Snake gourd, neem, rattan shoots, sprouts of plakṣa and vetasa,
kirātatikta as a vegetable, gaṇḍīra along with kaṭhillaka,
flowers of kovidāra, of kāśmarya, and of śālmali,
and whatever other vegetable cures bleeding disorder, in the regimen of food and drink—

that is commended as a vegetable for those sufferers of bleeding disorder who are accustomed to vegetables,
steamed, fried with ghee, or cooked in the manner of a soup.

Pigeons and doves, quails, red-eyed partridges,
rabbits, grey partridges, blackbucks, spotted deer, and black-tailed antelopes—

one should know their broths to be wholesome in bleeding disorder and employ them,
slightly sour or non-sour, fried in ghee, and with sugar.

When kapha is secondary, one should give soup and vegetables; when vāta is secondary, meat-broth.
Next, the preparation of gruels in bleeding disorder will be explained:

Filaments of lotus and blue water lily, pṛśniparṇī, and priyaṅgu
are to be cooked in water; a drink prepared in that broth is suitable for sufferers of bleeding disorder.

Likewise in a decoction of sandalwood, uśīra, and lodhra, with dried ginger;
and just so in one of kirātatikta, uśīra, and mustā.

Or cooked in a decoction of dhātakī, dhanvayāsa, ambu, and bilva;
or in a broth of lentils and pṛśniparṇī, or in one of sthirā and mung beans;

or in a decoction of hareṇukā with ghee and balā juice,
or prepared severally in the meat-broth of pigeons and the like.

Thus are described the gruels that destroy bleeding disorder, cold and with honey and sugar;
and this method of preparation should also be used with meat-broths.

Rabbit with vāstuka is commended in constipation for sufferers of bleeding disorder;
when vāta is predominant, partridge cooked in a decoction of udumbara is suitable.

Peacock in a decoction of plakṣa, and chicken in that of nyagrodha;
quail and krakara are wholesome in a broth of bilva, blue water lily, and the like.
To one who is thirsty, [water] prepared with bitters or fruit water that quenches thirst,
prepared with vidārigandhā and the rest, or boiled and cooled,
having known the doshas and secondary humors, strength, and food intake,
one should give water to the thirsty person upon evacuation or in small quantities.
Whatever has been set forth as the etiology of bleeding disorder
must not be indulged in by sufferers of bleeding disorder who desire life and health.

Thus the regimen of food and drink that destroys bleeding disorder has been taught in order;
what is to be done for those who are strong and have abundant doshas will now be stated:

In an embodied being whose strength and flesh are not diminished, whose condition arose from over-nourishment,
who has abundant doshas and is strong, bleeding disorder

that is free from complications should be removed at the proper time in one fit for purification:
the upward type by purgation, and the downward by emesis.

Trivṛt, abhayā, or the fruits of āragvadha,
trāyamāṇā, or the root of gavākṣī, or āmalaka fruits—

the wise physician should administer as a purgative with abundant honey and sugar;
their decoction is especially commended in bleeding disorder.

As an emetic, a potion mixed with madana, with honey and sugar,
or water with sugar, or sugarcane juice itself.

Seeds of vatsaka, mustā, madana, madhuka, and honey
are stated to be the foremost emetic in downward bleeding disorder.
In the upward type, for one whose bowel is purified, the sequence beginning with refreshing drinks is wholesome;
in the downward type, gruel and the like, provided vāta is not strong.

One completely wasted in strength and flesh, emaciated by grief, heavy loads, or long journeys,
scorched by fire or the sun, or wasted by other illnesses,

a pregnant woman, an old person, a child, one eating dry, meager, or measured amounts of food,
or whatever sufferer of bleeding disorder one sees who should not be vomited or purged,

or one accompanied by wasting—for that person pacifying treatment
is commended for bleeding disorder; that excellent treatment will now be spoken of.

A decoction of aṭarūṣaka, raisins, and pathyā, taken with sugar
and mixed with honey, destroys dyspnea, cough, and bleeding disorder.

Having dissolved priyaṅgu, red ochre, collyrium,
lodhra, and honey in an extract of aṭarūṣaka, one should drink it to cure bleeding disorder.

Padmaka, lotus filaments, dūrvā, vāstūka, blue water lily,
nāgapuṣpa, and lodhra one should drink according to that very same method.

Prapauṇḍarīka, madhuka, and honey in horse dung juice,
or the root of yavāsa and bhṛṅgarāja in cow dung juice,

dissolved [therein] and taken with rice-water, destroys bleeding disorder;
or, mixed with honey and ghee, a man should lick horse dung juice or cow dung juice.

A man suffering from bleeding disorder should lick with honey
the flower powders of khadira, priyaṅgu, kovidāra, and śālmali.

One should also lick with honey the powders of śṛṅgāṭaka,
parched grains, musta, date, lotus, and [lotus] stamens.

One should lick the blood of animals and birds native to arid lands with honey;
when the blood is clotted, one should lick pigeon dung with honey.

Uśīra, kālīyaka, lodhra, padmaka, priyaṅgu, kaṭphala, conch-shell, and red ochre,
each in equal parts with sandalwood, combined with sugar and flooded with rice-washings,

when drunk, immediately pacify blood with pitta, feeling of darkness, thirst, and burning.
Kirātatikta, kramuka, together with musta, prapauṇḍarīka, and lotus and blue water-lily;

Hrībera roots, paṭola leaves, durālabhā, parpaṭaka, lotus stalk,
bark of dhanañjaya, udumbara, and vetasa, nyagrodha, śāleya, and bark of yavāsaka;

Tugālatā, vetasa, taṇḍulīya, together with sārivā, mocarasa, and samaṅgā,
combined individually with sandalwood in the same formulation, are beneficial in that condition.
Kept overnight, or made into fresh juice, or made into paste, or crushed, or boiled,
these formulations, taken together, in groups, or individually, pacify blood with pitta.
Mudga with parched grains, with barley, with pippalī, with uśīra and musta, together with sandalwood,
left overnight in balā decoction—these astringents pacify aggravated blood with pitta.

From the drinking of waters [treated with] cat's eye, pearl, gems, red ochre,
earth, conch, gold, and āmalaka,
and of honey-water and sugarcane juice, bleeding disorder goes to rest.

The clear water of uśīra, lotus, blue water-lily, sandalwood,
and a burnt clod of earth,
with sugar, mixed with honey, and very cold, should be given to pacify excessive bleeding.

The water of priyaṅgu, sandalwood, lodhra, sārivā, madhūka, musta, abhayā, and dhātakī,
together with the clear extract of earth and with licorice water, mixed with sugar, is supreme in destroying bleeding.
When, through the various astringent formulations as prescribed, the digestive fire is kindled and kapha is overcome,
yet the bleeding disorder does not subside, vāta must be [involved] there; thereupon this should be done:

Goat's milk would be the foremost in application, or cow's milk boiled in five parts of water,
with sugar, mixed with honey, or boiled with the vidārigandhādi group [of herbs];

Or boiled with raisins, or boiled with ginger, or boiled with balā, or boiled with gokṣura,
or with jīvaka, with ṛṣabhaka, with ghee, or milk boiled with white sugar should be administered;

Or boiled with śatāvarī and gokṣura, or milk boiled with the [four] parṇinī herbs,
especially destroys quickly blood that passes painfully from the urinary tract.

Especially when it is discharged from the path of feces, milk is considered [best] when prepared with mocarasa,
or with aerial roots of the banyan, or with leaf-buds of the banyan, or with hrībera, blue water-lily, and dried ginger.

Having first drunk astringent preparations with milk, one should then eat śāli rice with milk alone;
or, in case of excessive discharge, one should drink ghee cooked with these astringent preparations.

Having made a decoction of vāsā with branches and leaves and root, and adding its flowers
as a paste, one should cook that ghee; with honey, it quickly destroys bleeding.
Thus [ends] Vāsāghṛta.
Prepared with the fresh juice of palāśa petioles and a paste of the same, with liquid honey,
one should lick ghee prepared with a paste of vatsaka; likewise [ghee] prepared with samaṅgā, blue water-lily, and lodhra.

This very procedure applies to trāyamāṇā, and to udumbara along with paṭola leaves;
and all ghees that destroy pitta fever are commended in bleeding disorder.

The applications of inunction, affusions, sprinkling and immersion baths, beds, dwelling,
the cooling regimen, and the foremost procedure of enema, which were prescribed for the pacification of pitta fever,

all that should be carried out entirely in bleeding disorder, having first considered the season and the dosage;
and the ghee-jaggery preparations that are beneficial for the wounded pacify bleeding disorder at once.

When kapha is secondary, and the blood accompanied by pitta is stuck in the throat and clotted, there should be administration,
combined skillfully, of honey, ghee, and alkali derived from lotus stalks;

Likewise the alkalis of lotus filaments, white lotus, and blue water-lily, and of palāśa, and of priyaṅgu,
and of madhūka, and of asana, are to be administered by that very same procedure.

Having crushed śatāvarī, pomegranate, tamarind, kākolī, medā, madhuka, vidārī,
and the root of citron, the wise physician should cook ghee with four times as much milk.

That ghee destroys cough, fever, abdominal distension, constipation, colic, and bleeding disorder;
and that ghee which is cooked with the five pañcamūlas also produces that same effect.
Thus [ends] Śatāvaryādighṛta.
Those astringent formulations that have been taught here should also be applied by the physician as a nasal press,
when blood accompanied by pitta has issued from the nose and its corrupted doṣa has exited.

For if the nasal press is blocked while the blood is corrupted, vitiated catarrh and head disorders arise,
as well as blood mixed with pus, a corpse-like odor, loss of smell, and harmful worms.
Blue water-lily with red ochre and conch, together with sandalwood, in sugar water
should be used as nasal drops; likewise the juice of mango stone, samaṅgā, with dhātakī, mocarasa, and lodhra.

Nasal drops of grape juice, of sugarcane juice, of milk, and of fresh dūrvā juice,
and roots of yavāsa, onion root, and juice of pomegranate flowers should be used as nasal drops.

Priyāla oil, madhuka, and milk, or ghee of buffalo or goat prepared [with them];
or nasal drops made with milk, with the [ingredients] beginning with mango stone, along with sārivā, white lotus, and blue water-lily.

White sandalwood, red sandalwood, prapauṇḍarīka, lotus, and blue water-lily,
uśīra, vānīra, water, lotus stalk, sahasravīryā, madhuka, payasyā,

Roots of śāli rice and sugarcane, roots of yavāsa, gundrā, reeds, kuśa, and kāśa,
red sandalwood, aquatic moss, anantā, kālānusāryā, grass roots, ṛddhi,

Roots and flowers of aquatic plants, a paste of mud from lotus ponds,
udumbara, aśvattha, madhūka, lodhra, and all astringent and cooling trees [should be applied as external pastes].

In the form of a poultice, in sprinkling, as well as in immersion, and prepared in ghee and oil,
desiring the pacification of blood and pitta, the physician should use [the drugs] beginning with white sandalwood.

A shower-chamber, an underground chamber that is very cool, and a delightful forest cooled by water and breeze;
and touches of vessels of cat's-eye gem and pearl cooled by cold water [are beneficial] in burning sensation.

Leaves and flowers of water-plants, cool linen, and banana leaves,
and petals of lotuses and blue water-lilies are recommended for covering beds and seats.

The touches of beloved, excellent women smeared with priyaṅgu and sandalwood,
and the breezes from fans of lotus and blue water-lily wet with water and very cool, are praised in burning sensation.

Pleasant and cool stories about rivers, lakes, caves of the Himalayas,
moonrises, and lotus pools pacify pitta combined with blood.

Here are two verses:

The cause, the increase, the name, the location, the separate symptom of the vitiated [pitta],
the two pathways, curable, incurable, maintainable, and the course of action;

Food and drink desired, to be avoided, cleansing, and pacifying measures—
the teacher has properly stated in the treatment of bleeding disorders.

Thus, in the treatise made by Agniveśa and redacted by Caraka, in the Cikitsāsthāna, the fourth chapter entitled 'Treatment of Bleeding Disorders'. [4]