The Compendium of Caraka 6.5: pañcamo 'adhyāyaḥ/

Now we shall explain the treatment of abdominal lumps.

Thus spoke the venerable Ātreya:

A refuge like a father to all creatures, Punarvasu, lord of the past and future,
best among speakers, declared the proven treatment for the destruction of abdominal lumps.

From excessive discharge of feces, kapha, or pitta, or from compression by those same humors when increased,
or from downward natural urges that have arisen and been suppressed, or from external injuries, or excessive compressions;

Or from excessive consumption of dry food and drink, from grief, from incorrect medical procedures,
or from irregular and excessive physical activities, vāyu becomes aggravated in the abdomen.

That vitiated vāyu, having agitated kapha and pitta and blocked the channels with both of them,
causes colic in the heart, navel, flanks, abdomen, and urinary bladder, and then, its channels obstructed, it does not move.
Situated in the colon or in the seats of pitta and kapha, independent or dependent on others,
palpable by touch due to forming a mass, it receives the name 'abdominal lump' according to the humor [involved].

In the bladder, at the navel, in the heart, or in the two flanks—there are five locations for an abdominal lump.
Now I shall speak of the origin, symptoms, and treatment of this fivefold [disease].

Dry food and drink, irregular and excessive physical exertion, suppression of urges,
grief, trauma, excessive loss of wastes, and starvation are the cause of a wind-lump.

That which varies in location, form, and pain, with obstruction of feces and wind, dryness of throat and mouth,
grayish-red coloration, fever with chills, and pain in the heart, belly, flanks, shoulders, and head;

Which produces greater aggravation after digestion, and becomes mild when one has eaten,
that is an abdominal lump from vāta; and there, dry, astringent, bitter, and pungent [things] do not suit [the patient].

Pungent, sour, sharp, hot, burning, and dry foods, anger, excessive wine, and exposure to the sun and fire,
undigested matter, trauma, and vitiated blood are stated as the cause of a pitta-lump.
Fever, thirst, redness of face and body, severe pain while food is being digested,
sweating, burning sensation, and an abdominal lump like an ulcer, intolerant of touch, are the symptoms of a pitta-lump.

Cold, heavy, unctuous food, inactivity, over-satiation, and sleeping by day
are the cause of a kapha-born abdominal lump; but all [these factors] are stated for one caused by a combination [of all three].

Numbness, cold fever, lassitude of limbs, nausea, cough, anorexia, heaviness,
coldness, mild pain, hardness, and elevation are the symptoms of an abdominal lump of kapha nature.

Recognizing the causes and symptoms in a two-humor lump and the strength and weakness of the humors,
one should diagnose three other lumps with mixed symptoms for the purpose of formulating medication.

Causing great pain, surrounded by burning sensation, hard as stone, dense, elevated, rapidly burning, dreadful,
and robbing the mind, body, and digestive fire of strength—one should diagnose a tridoshic abdominal lump as incurable.

During the fertile period, through lack of food, through fear, drying practices, suppression of urges,
excessive astringent treatment, emesis, and disorders of the female reproductive tract, a blood-born abdominal lump attacks a woman.

That which throbs only as a lump and not with limbs, takes a long time, has colic, and has all the signs of pregnancy—
that is an abdominal lump of blood, occurring only in women; it should be treated when the tenth month has passed.

Hereafter, I shall declare the proven course of action destructive of abdominal lumps for those suffering from them,
and after that the formulations that eliminate abdominal lumps.

An abdominal lump born of dryness and exertion, of vātika nature, with acute pain,
and retention of feces and flatus, should be treated with unctuous substances from the beginning.

By meals, massages, drinks, decoction-enemas, along with oil-enemas—
once he is oleated, the physician must perform sudation to pacify the abdominal lump.

Producing softness of the channels, conquering the dominant wind,
and breaking obstruction, sudation in an oleated patient dispels an abdominal lump.

Drinking unctuous substances is beneficial in an abdominal lump, especially one arising above the navel;
an enema in one located in the colon; both in one resting in the stomach.

When the digestive fire is ignited in a vātika abdominal lump, with obstruction of flatus and feces,
one should employ nourishing, unctuous, and warm food and drink.

Repeated drinking of unctuous substances, and decoction-enemas with oil-enemas,
should be administered in vāta-lumps, while watching over kapha and pitta.

If kapha, or pitta, or indeed blood becomes provoked
when vāta is mostly overcome while the treatment is being carried out,

The physician should apply medication there according to whichever humor is predominant,
while protecting wind at the beginning, at the end, and in the middle.

If in a vāta-lump, kapha has increased and, impairing the digestive fire, produces anorexia,
nausea, heaviness, and drowsiness, one should induce emesis.

In colic, distension, and constipation in an abdominal lump dominated by vāta and kapha,
suppositories, pills, and powder that remove kapha and vāta are beneficial.

Or if pitta, greatly increased, causes burning fever in one suffering from a vāta-lump,
he should be purged with unctuous medicines that direct the humors downward.

If an abdominal lump caused by wind and the like, even after proper treatment is performed by the physician,
does not subside, it subsides from blood-letting.

In a pitta-born lump that has arisen from unctuous and hot things, mild purgation is beneficial;
but when it has arisen from dry and hot things, ghee is the supreme pacifier.

Or, knowing pitta or a pitta-lump to be situated in the colon,
the [physician] knowing the proper time should immediately eliminate it with milk-enemas containing bitters.

Or he should purge [the patient] with pleasantly warm milk containing bitters,
or with tilvaka ghee, the physician taking into consideration the strength of the digestive fire.

In thirst, fever, severe burning, colic, sweating, weakness of the digestive fire,
and also in aversion to food in those suffering from an abdominal lump, he should definitely let blood.

Once their root is severed, abdominal lumps do not become inflamed and do go to destruction;
for blood turns to excessive sourness, and when that is absent, pain also is absent.

When the humor is removed, [the patient] is languid, nourished with meat-soups of arid-land animals,
comforted, but still has some pain remaining, he should administer ghee again and again.

If, because of the extreme increase of blood and pitta and from not receiving treatment,
an abdominal lump should suppurate, surgery is the treatment there.

Heavy, hard in form, deeply seated within the muscles,
not discolored, and indeed firm—such an abdominal lump is called unsuppurated.

One should know an abdominal lump to be suppurating by burning, colic, distress, agitation,
loss of sleep, restlessness, and fever; he should poultice it.

When an abdominal lump shows signs of suppurating, is high and elevated on the outside,
dusky with reddish borders, and feels like a bladder upon touch;

Rising when pressed down, rigid, numb, due to pressure on its side
with the colic gathered right there—one should declare the abdominal lump fully suppurated.
In this, the authority in the procedure of treatment belongs to the followers of Dhanvantari,
surgeons trained in incision, purification, and healing.

This is also the sign of an internally suppurating [lump]:
swelling of the hollow of the heart when located inside, and emergence at the side when located outside.
Having suppurated and moistened the channels, it moves upward or downward;
he should leave that humor that has started forth on its own alone, while the patient eats wholesome food,
for ten or twelve days, the physician guarding against complications;
after that, drinking ghee combined with purifying drugs is beneficial.

For one who is purified, bitter ghee with honey is prescribed for administration.
When an abdominal lump of kapha nature has arisen from cold, heavy, and unctuous things,

In one who should not be vomited and whose bodily digestive fire is weak, he should first perform fasting.
When the digestive fire is weak, the pain is dull, the alimentary tract is heavy and sluggish,

And there is nausea and aversion to food, that patient with an abdominal lump is fit for emesis.
And once emesis and fasting have been performed, he should be treated with hot things alone.

And an appropriate dietary regimen should be administered with pungent and bitter medicines.
Having seen a hard, elevated abdominal lump with abdominal distension and constipation,

The physician should first foment it appropriately, and once fomented, dissolve it.
When fasting, emesis, and fomentation have been performed and the digestive fire is well kindled,

The patient with a kapha-lump should drink at the proper time ghee prepared with alkali and pungents.
Knowing the kapha-lump to have moved from its place, he should cleanse it with purgatives

Or with unctuous enemas prepared with the ten roots.
When the digestive fire is weak, wind is confounded, and knowing the receptacle to be unctuous,

Pills, powders, and decoctions should be administered to those with a kapha-lump.
One should conquer a kapha-born abdominal lump that has taken root, has an extensive site, is hard, sluggish, and heavy,

By means of alkali, ariṣṭas, and fire-cautery.
Knowing the humor, constitution, the lump, the season, and their combination, in an excess of kapha,

The physician who knows the measure of strength and humors should apply alkali to the abdominal lump,
at intervals of one day, or two days, or resting for three days and then again,

Skilled in the increase and reduction of the body's strength and humors.
In one who eats meat, milk, and ghee, the sweet and unctuous kapha,

The alkali, severing it again and again from the receptacle, causes it to trickle downward because of its caustic nature.
In weak digestive fire, aversion to food, in those accustomed to alcohol who eat with fat,

Ariṣṭas should be administered for clearing the channels in those with a kapha-lump.
Through fastings, emetics, fomentations, draughts of ghee, purgatives,

Enemas, pills, powders, alkalis, and groups of ariṣṭas,
whose kapha-born abdominal lump does not subside because it has taken root,

For him, after blood is extracted, cautery with arrows, iron, and the like is beneficial.
Because of heat and sharpness, fire pacifies kapha and wind in an abdominal lump,

And from their pacification, the agglomeration of the abdominal lump turns away.
In cautery, the authority belongs here too to the physicians following Dhanvantari.

In the administration of alkali, the authority belongs to the physicians knowing the science of alkali.
In a mixed humor, this very sequence of treatment is applied in combination.

Henceforth I shall proclaim proven formulations that destroy abdominal lumps:
With the three pungents, triphalā, coriander, viḍaṅga, cavya, and citraka,

Made into a paste, ghee prepared with milk removes vāta-lumps.
Thus [ends] Tryūṣaṇādya-ghṛta.
And with these very pastes and a decoction of the five roots,
or of the ten roots, that ghee is supreme in removing abdominal lumps.
Thus [ends] another Tryūṣaṇādya-ghṛta.
(Or he should drink the six-pala ghee that was spoken of in consumption.)

Or with clear liquor, for the purpose of milk, with surā or with pomegranate,
or with the cream of curd, ghee should be made that removes wind-lumps.
With asafoetida, sauvarcala salt, ajājī, viḍa salt, pomegranate, dīpyaka,

Puṣkara, the three pungents, coriander, vetasa, alkali, citraka,
śaṭī, vacā, ajagandhā, cardamom, and holy basil, cooked
with curd, ghee removes colic and abdominal distension in those with a wind-lump.
Thus [ends] Hiṅgusauvarcalādya-ghṛta.
With hapuṣā, the three pungents, pṛthvīkā, cavya, citraka, rock salt,
ajājī, pippalī-root, and dīpyaka, he should cook ghee

Along with jujube and radish juices, with milk, curd, and pomegranate;
that is supreme in destroying vāta-lumps, and relieves colic and abdominal distension.

Disorders of the female genital tract, piles, disorders of the duodenal tract, dyspnea, cough, aversion to food, fevers,
and colic in the bladder, heart, and sides, this ghee removes.
Thus [ends] Hapuṣādya-ghṛta.
One and a half picus of pippalī, two palas of pomegranate, one pala
of coriander, five of ghee, a karṣa of dry ginger, and four times as much milk—

Ghee prepared with these immediately removes a vāta-lump,
pain in the female genitals, headache, piles, and intermittent fever.
Thus [ends] Pippalyādya-ghṛta.
These groups of medicines that have been proclaimed for ghees
may be used as powder-formulations, wicks, and decoctions for those with abdominal lumps.

With jujube, pomegranate, hot water, scum of surā, sour gruel,
or with citron juice, a gruel relieves colic and abdominal distension.

Or powders impregnated with the juice of citron
one should make into wicks along with pills to alleviate the pain of abdominal lumps and distension.

Asafoetida, the three pungents, pāṭhā, hapuṣā, abhayā, śaṭī,
ajamodā and ajagandhā, tintiḍīka and amlavetasa,

pomegranate, puṣkara, coriander, ajājī, citraka, vacā,
two alkalis, two salts, and cavya—one should powder together.

This powder should be administered in food and drink harmlessly,
or should be drunk before meals with liquor or with hot water,

in colic of the sides, heart, and bladder; in abdominal lumps caused by vāta and kapha;
in abdominal distension and dysuria; and in colic arising from the rectum and female genitals;

in disorders of the duodenal tract and piles; in spleen disease, anemia, and anorexia;
in chest congestion, hiccup, cough, dyspnea, and constriction of the throat.

Or, impregnated many times with the juice of citron, this powder
should be made into pills; they will be even more efficacious.
Thus [ends] Hiṅgvādi powder and pills.
Citron juice, asafoetida, pomegranate, and biḍa and rock salts,
to be drunk with the scum of surā, remove the pain of a vāta-lump.

Śaṭī, puṣkara, asafoetida, amlavetasa, alkali, citraka,
coriander, yavānī, viḍaṅga, rock salt, vacā,

along with cavya, pippalī root, ajagandhā, together with pomegranate,
ajājī, and ajamodā—having made a powder, one should employ it,

or again impregnated with the juice of citron or honey-vinegar,
having made it into well-ground pills the size of a jujube.

An abdominal lump, spleen disease, abdominal distension, dyspnea, cough, loss of appetite,
hiccup, heart disease, piles, diverse pains in the head,

anemia, excitation of kapha, tenesmus of all kinds,
and colic in the sides, heart, and bladder—this pill removes.

Having ground half a pala of dry ginger, two palas of husked
sesame, and one pala of jaggery, a man should drink it with warm milk.

It destroys vāta-lump, upward movement of vāyu, and pain in the female genitals.
One should drink castor oil mixed with the scum of vāruṇī;

a man suffering from a vāta-lump may drink that same oil with milk.
The former is beneficial when kapha is the secondary humor; the latter is superior when pitta is secondary.

One should cook four palas of cleaned, dry garlic
in eight times as much milk and water, and a man should drink it when the milk remains.
Vāta-lump, upward movement of vāyu, sciatica, intermittent fever,
heart disease, internal abscess, and swelling—that milk cures rapidly.
Thus [ends] Garlic-milk.
Oil, clear wine, cow urine, sour fermented gruel, and barley-ash—
drunk together, it cures abdominal lump, belly disease, and abdominal distension.
Thus [ends] the Five Oils.
With a decoction of the five roots containing alkali, one should drink
śilājatu; by its use one is freed from a vāta-lump.
Thus [ends] the formulation of śilājatu.
Having eaten parched barley paste with soup of pippalī or with radish juice,
unctuous, one is freed from upward movement of vāyu and from vāta-lump.

One afflicted with colic, abdominal distension, and constipation, suffering from a vāta-lump, one should sweat
with the sudations described in the procedure for sudation: tube, bed, and mixed sudations.

One should recognize enema therapy as the supreme destroyer of abdominal lumps; for, having conquered vāyu
first in its own site, it immediately removes an abdominal lump.

Therefore, when non-unctuous enemas accompanied by unctuous enemas are applied
frequently, abdominal lumps caused by vāta, pitta, and kapha subside.

Various successful enemas that destroy abdominal lumps have been prescribed in the Siddhisthāna,
and oils that destroy abdominal lumps will be spoken of in the chapter on vāta disorders.

Applied in a lump born of vāta by way of drinks, massage, and unctuous enemas,
they quickly succeed, for oil is the foremost conqueror of vāta.
The previously spoken ghee combined with powder of nīlinī
should be given as an evacuation to one with a vāta-lump who has accumulation of impurities.

Ghee along with nīlinī, trivṛt, dantī, pathyā, and kampillaka,
containing biḍa salt, alkali, and dry ginger, should be given for evacuation.

Nīlinī, triphalā, rāsnā, balā, kaṭukarohiṇī,
viḍaṅga, and vyāghrī—one pala each—one should cook in an āḍhaka of water.

With that reduced to a fourth, one should cook a prastha of ghee,
combining it with a prastha of curd and a pala of euphorbia milk.

Then one should give a pala of the ghee mixed with the scum of gruel;
when it is digested and the patient is well purged, one should feed him a meal with meat broth.

Abdominal lumps, skin diseases, belly diseases, dark facial spots, swelling, anemia, fevers,
leukoderma, spleen disease, and insanity—this ghee removes.
Thus [ends] Nīlinyādya-ghṛta.
Chickens, peacocks, partridges, krauñca herons, and quails,
śāli rice, madirā liquor, and clarified butter are the remedy for a vāta-lump.

A hot, liquid, and unctuous meal is wholesome for those with a vāta-lump,
a drink of vāruṇī along with its scum, or water boiled with coriander.

When the digestive fire is dull, an abdominal lump increases, and when the fire is kindled, it subsides;
therefore, a man should not over-satiate nor over-fast.

In every abdominal lump, whatever treatment is carried out
after first applying unction and sudation reaches success, not when the patient is dried out.

Recognizing an emergency, the physician should treat a pitta-lump
with ghee prepared with purgatives or with bitter [ghee].
Rohiṇī, kaṭukā, neem, madhuka, triphalā, and cinnamon—
one karṣa each—and trāyamāṇā, and two palas of paṭola and trivṛt,

and two palas of lentils are to be cooked in eight times as much water;
of the boiled [decoction] the remainder equal to the ghee, and four palas of clarified butter,

he should drink blended together; through that a paittika lump subsides,
as well as fever, thirst, colic, giddiness, fainting, and anorexia.
Thus [ends] Rohiṇyādya-ghṛta.
Four palas of trāyamāṇā are to be cooked in ten times as much water;
when a fifth part remains, strained, combining it with pastes of a karṣa each:

rohiṇī, kaṭukā, mustā, trāyamāṇā, durālabhā,
with pastes of tāmalakī, vīrā, jīvantī, sandalwood, and blue water-lily;

and adding eight palas each of juice of āmalaka,
milk, and ghee, one should cook it thoroughly.

This supreme ghee destroys a lump born of pitta and blood, erysipelas, paittika fever,
heart disease, jaundice, and skin diseases.
Thus [ends] Trāyamāṇādya-ghṛta.
One should cook a fourth part of ghee with juice of āmalaka and sugarcane,
and drink that ghee prepared with a fourth part of pathyā; it eliminates a paittika lump.
Thus [ends] Āmalakādya-ghṛta.
One should cook drākṣā, madhūka, dates, vidārī along with śatāvarī,
parūṣaka fruits, and triphalā, measured at a pala each,

in an āḍhaka of water; when a fourth part remains, [one should cook]
ghee with juice of āmalaka, sugarcane juice, milk, and a fourth part of paste of abhayā.

One should cook that ghee; once prepared, [mixed with] a fourth part of sugar and honey,
through administration it destroys a paittika lump and eliminates all pitta disorders.
Thus [ends] Drākṣādya-ghṛta.
Crushing vṛṣa along with its roots, one should cook it in eight times as much water;
when an eighth part remains, one should add a paste of the flowers of that very [plant].

The ghee prepared with that, cooled, with honey, eliminates a paittika lump,
and destroys bleeding disease, fever, dyspnea, cough, and heart disease.
Thus [ends] Vāsāghṛta.
Two palas of trāyamāṇā cooked in two prasthas of water,
reduced to an eighth part and strained, one should drink lukewarm with an equal amount of milk.

On top of that, he should drink only hot milk according to his strength;
by that, when the humor is evacuated, his paittika lump subsides.

In a paittika lump, one should drink the juice of drākṣā and abhayā with jaggery,
or lick kampillaka liquefied with honey for purgation.

For those with a paittika lump, an inunction that relieves burning is [done] with ghee,
with Candanādya oil, or with oil of madhuka.

And the milk enemas with bitter [substances] that eliminate paittika fever,
as well as those that will be described in the [section on] Successful Treatments, are beneficial for those with a paittika lump.
Śāli rice, meat of wild animals, cow and goat milk, ghee,
dates, āmalaka, drākṣā, pomegranate along with parūṣaka

should be administered for food; for drinking, water boiled
with balā, the vidārīgandhā group, and the like. [Such is] the treatment of a paittika lump.

When a paittika lump is accompanied by āma, or when one of kapha and vāta is accompanied by āma,
after fasting, the fire is to be kindled with gruels, khaḍas, and soups.

The pacification and aggravation of all humors depend upon the fire;
therefore, one should always protect the fire and avoid the causal factors.

The physician should administer emesis to one fit for emesis who has a kapha lump,
whose body has been unctuated and fomented, once looseness has come to the lump.

Wrapping burning balvaja or kuśa grass [inside a vessel],
the physician, having placed it in an earthen jar, should set the mouth of the jar over the lump.

When the lump is grasped, he should then remove the jar;
then, placing a cloth between, one who knows measurements should break open the lump.
He should compress it with whatever is available—vimārga, ajapada, or mirrors;
he should knead the lump alone, but should not touch the intestines or the heart.
And having smeared it with sesame, castor, linseed, and mustard seeds,
the physician should foment the phlegm lump with pleasantly warm iron vessels.

Ghee cooked with the Daśamūla, along with the three pungents, alkali, and salt,
together with asafoetida, biḍa salt, and pomegranate, quickly conquers a kapha lump.
Thus [ends] Daśamūlīghṛta.
Two palas of bhallātaka and the pañcamūla measured at a pala,
crushed with the vidārīgandhā group, are to be cooked in an āḍhaka of water.

When a fourth part remains of that decoction, the physician, grinding pippalī, dry ginger, vacā,
viḍaṅga, rock salt, asafoetida, barley-ash, biḍa salt, śaṭī,

citraka, madhuka, and rāsnā, equal to a karṣa [each],
and adding a prastha of milk, should cook a prastha of ghee.

This Bhallātaka-ghṛta is supreme in removing a kapha lump;
it eliminates spleen disease, anemia, dyspnea, disorders of the duodenum, and cough.
Thus [ends] Bhallātakādya-ghṛta.
With a pala each of pippalī, pippalī-root, cavya, citraka, and dry ginger,
along with barley-ash, one should cook a prastha of ghee

and a prastha of milk. That ghee destroys a lump composed of kapha;
it removes disorders of the duodenum and anemia, and takes away spleen disease, cough, and fever.
Thus [ends] Kṣīraṣaṭpalaka-ghṛta.
Cooking trivṛt, triphalā, dantī, and the Daśamūla, measured at a pala [each],
in four times as much water, when the decoction remains at a fourth part,

one should cook ghee, castor oil, and milk together [with it].
That prepared Miśraka unctuous substance, with honey, removes a kapha lump.

In obstructions of kapha and vāta, and in skin diseases, spleen disease, and abdominal enlargement,
Miśraka unctuous substance should be employed, and especially in pain of the female genital tract.
Thus [ends] Miśraka unctuous substance.
The laxative Nīlinī-ghṛta which was mentioned as destroying a vāta lump
should be employed doubled for the purpose of purgation in those with a kapha lump.

Powder of trivṛt thoroughly soaked in the liquid of euphorbia milk,
taken at a karṣa and licked with honey and ghee, purges well.
In a droṇa of water, twenty-five abhayā fruits are to be cooked,
and as many palas of dantī and likewise of citraka.

When an eighth part remains, one should pour in the strained liquid;
one should add strained jaggery equal to the dantī, and those abhayā fruits there,

and half a kuḍava of oil, four palas of trivṛtā,
and one pala of powdered pippalī and dried ginger.
That is to be cooked like an electuary; when it has cooled, one should add honey equal to the oil,
and one pala of powder made from cinnamon bark, cardamom, patra, and nāgakeśara.

Then, having licked a pala of the electuary and eaten one harītakī,
an unctuated person is comfortably purged of a prastha of humors, free from disease.

A lump, swelling, hemorrhoids, anemia, anorexia,
heart disease, duodenal impairment, jaundice, intermittent fever,

skin diseases, spleen disease, and tympanites—these it destroys when consumed.
And the regimen for it is free from danger: liquid food with meat broth.
Thus [ends] Dantīharītakī.
The non-unctuous enemas proven for those with a kapha lump will be spoken of in the [section on] Successful Treatments,
as well as the proven formulations of fermented liquor in the treatment of duodenal impairment and hemorrhoids.

The powder and the pills that have been prescribed for those with a vāta lump,
with doubled alkali, asafoetida, and sour vetasa, are beneficial in kapha.

The very alkalis that are in duodenal impairment are proven and free from danger
and recommended for those with a kapha lump; cauterisation, however, is praised at the end.

Old grains, arid-land game and birds, / horsegram and mung bean soup, and [soup] of pippalī and ginger,

and dried radish soup, [soup] of bilva and varuṇa, / of cirabilva shoots, of yavānī and citraka;
with citron, asafoetida, sour vetasa, alkali, and pomegranates, / buttermilk, oil, and ghee, one should prepare condiments.

Water boiled with the five roots, aged vāruṇī liquor, / or aged mādhvīka wine at the proper time one with a kapha lump should drink.

He should drink buttermilk powdered with yavānī and salted with viḍ salt, / which stimulates the digestive fire and directs vāta, kapha, and urine downward.
When a lump accumulated by degrees, occupying a great site, / deeply rooted, encircled with vessels, elevated like a tortoise,

is accompanied by weakness, anorexia, nausea, cough, vomiting, restlessness, fever, / thirst, stupor, and catarrh, it cannot be cured.
Seizing [him] with fever and dyspnea, afflicted by vomiting and diarrhea, / swelling in the heart, navel, hands, and feet wastes the person with a lump.

In a blood lump, however, once the term of gestation has passed, / for a woman whose body has been unctuated and fomented, one should give an unctuous purgative.

Two pātras of palāśa alkali, two pātras each of oil and ghee: / having cooked them, one should administer a dose that induces softening of the lump.

If it does not break thus, one should administer a vaginal purifier: / sesame paste combined with alkali, or else with euphorbia milk;
or one should insert into the vagina pungent fish steeped in these two, / or cloth rags well steeped in boar and fish bile,

or steeped in downward-clearing and upward-clearing [drugs] together with honey; / or one should administer yeast with jaggery and alkali as a vaginal purifier.

She should lick alkali that removes raktapitta with honey and ghee; / and one should give her garlic, sharp wine, and fish.

An enema with milk and cow's urine, with alkali, [prepared with] the ten roots, / one should give to break the lump when the blood is not seen.

When the blood begins to flow, one should give food with meat broth, / inunction with ghee and oil, and young wine to drink.

When the blood flows excessively, however, treatments that remove raktapitta / should be performed; and for one afflicted with vāta pain, all vāta-removing measures.

Affusions with ghee and oil, francolins and cocks, / wine with its scum, and first the drinking of sour ghee [should be employed];

or one should administer an urethral/vaginal enema with jīvanīya-ghee; / when blood flows excessively, an unctuous enema with bitter [drugs].

Here are the verses: Unction, fomentation, ghee, enema, powders, nourishing therapy, pills, / emesis, purgation, and bloodletting for those with a vāta lump;

ghee prepared with bitters, milk, mild laxative, and non-unctuous enemas, / blood-letting, comforting, and soothing formulations;

poultice with surgical intervention when ripe and broken internally: / purificatory and soothing treatments for a lump arising from pitta;

unction, fomentation, breaking, lightening, upward clearing, and purgation, / ghee, enema, pills, powders, and fermented liquors with alkalis,

cauterisation at the end for a kapha lump; for a blood lump / occurring in women, after the blood has been removed, the course of treatment has been declared.

Use of wholesome food and drink, avoidance of their respective causes, / constant concentration on the digestive fire, and all procedures on an unctuated patient;
cause, signs, success, course of treatment, curability, non-curability, and formulations— / this entire summary of the treatment of gulma has been spoken to Agniveśa.

Thus ends the fifth chapter, named the Treatment of Gulma, in the Cikitsitasthāna of the treatise composed by Agniveśa and redacted by Caraka.