The Compendium of Caraka 8.2: dvitīyo 'adhyāyaḥ/

Now we shall expound the chapter on success in the five procedures.

Thus spoke the venerable Ātreya.

To whom and for what reason one should not administer the five procedures, O Agniveśa, / and to whom one should administer them—all that will be explained in full.

Fierce, reckless, timid, ungrateful, agitated, / a hater of the virtuous, kings, and physicians, hated by them, afflicted with grief,

unpredictable, wishing to die, destitute of resources, / hostile, pretending to know medicine, lacking faith, overly suspicious,

and disobedient to physicians: these should not be treated by a knowledgeable physician; / treating these, a physician would incur many faults.

Men other than these should be treated with all procedures. / Having classified their condition, what is to be avoided and what is to be done will be stated.

To begin with, those not to be vomited are: the injured and depleted, the exceedingly obese, the exceedingly emaciated, children, the elderly, the weak, the fatigued, the thirsty, the hungry, those overcome by heavy labor, travel, fasting, sexual intercourse, study, exercise, and constant anxiety, the emaciated, the pregnant, the delicate, those with constricted bowels, those difficult to vomit, those suffering from upward bleeding, continuous vomiting, upward vāta, those who have received an asthāpana enema or an anuvāsana enema, and those afflicted with heart disease, udāvarta, suppression of urine, spleen disease, abdominal swellings, enlargement of the abdomen, prostate enlargement, impairment of voice, timira, and aching in the head, temples, ears, and eyes.

Therein, in the injured, excessive flow of blood would occur due to further wounding; in the depleted, exceedingly obese, emaciated, children, elderly, and weak, obstruction of vital breath [would occur] due to inability to endure the strength of medicine; likewise in the fatigued, thirsty, and hungry; in those worn out by constant heavy labor, travel, fasting, sexual intercourse, study, exercise, and anxiety, there would be danger of vāta, bleeding, laceration, or wound due to dryness; in the pregnant woman, serious disease would be incurred due to affliction of the fetus or premature abortion; in the delicate, excessive discharge of blood upwards or downwards [would occur] due to traction on the heart; in those with constricted bowels and those difficult to vomit, the stirred-up doṣas, due to excessive straining, produce internal erysipelas, stiffness, stupor, distraction, or death in the internal viscera; in one suffering from upward bleeding, [vomiting] would destroy the vital breath by thrusting upward the udāna [vāta] and cause excessive flow of blood; likewise in one vomiting incessantly; in those with upward vāta and those who have received an asthāpana enema or an anuvāsana enema, excessive upward movement of vāta [would occur]; in one suffering from heart disease, obstruction of the heart; in one with udāvarta, a more terrible udāvarta would occur that kills more swiftly; in those afflicted with suppression of urine and the like, appearance of sharper pain; in those afflicted with timira, extreme increase of timira; in those suffering from headache and the like, extreme increase of pain; therefore these are not to be vomited.

However, even among all these, [emesis] is not forbidden in cases caused by poisoning, artificial poison, unwholesome diet, or indigestion of food and āma, because of their more rapid action.

The rest, however, are to be vomited; especially those suffering from catarrh, kuṣṭha, acute fever, rājayakṣma, cough, dyspnea, obstruction of the throat, goitre, elephantiasis, meha, sluggish digestive fire, unwholesome and undigested food, visūcikā, alasaka, ingestion of poison and artificial poison, bites, arrow wounds with poisoned tips, downward bleeding, excessive salivation, hemorrhoids, nausea, anorexia, indigestion, apacī, epilepsy, insanity, diarrhea, swelling, pāṇḍuroga, stomatitis, vitiated breast milk, and the like; especially the diseases of śleṣman, and those stated in the Chapter on Major Diseases; for among these, emesis has been declared foremost, just as, when a field's embankment is breached, there is no withering of rice and the destruction of defects.

Those not to be purged, however, are: the prosperous, those with an injured rectum, those with an open sphincter, those suffering from downward bleeding, those weakened by fasting, those with weak faculties, those with poor digestive fire, those who have received a nirūha enema, those occupied with passion and the like, those suffering from indigestion, those with acute fever, those with alcoholism, those with distended abdomen, those afflicted with foreign bodies, those traumatized, the exceedingly unctuous, the dry, those of cruel bowels, and those beginning with the injured up to the pregnant woman.

Therein, in the prosperous, the fault mentioned for the delicate would occur; in one with an injured rectum, it would produce pain causing obstruction of vital breath in the injured rectum; it would kill one with an open sphincter by excessive discharge; likewise one suffering from downward bleeding; those weakened by fasting, with weak faculties, poor digestive fire, and those who have received a nirūha enema could not endure the force of medicine; in one whose mind is agitated with passion and the like, it does not act, or, acting with difficulty, it would produce the faults of insufficient evacuation; in one with indigestion, disorder of āma would occur; in one with acute fever, it would not expel the unripened doṣas and would only aggravate vāta; in one with alcoholism, vāyu would cause obstruction of vital breath in the body depleted by alcohol; in one who is distended or becoming distended, vāyu accumulated in the bowel, spreading, would suddenly produce severe flatulence or death; in those afflicted with foreign bodies and traumatized, vāyu lodging in the wound would destroy life; in the exceedingly unctuous, there would be fear of excessive evacuation; in the dry, vāyu would produce stiffness of the limbs; in one of cruel bowels, the doṣas stirred up by purgation would kill the vital breath after producing cardiac pain, cutting pain in the joints, abdominal distension, body ache, vomiting, fainting, and exhaustion; in those beginning with the injured up to the pregnant woman, the faults mentioned for vomiting would occur; therefore these are not to be purged.

The rest, however, are to be purged; especially those suffering from kuṣṭha, fever, meha, upward bleeding, fistula-in-ano, abdominal disease, hemorrhoids, inguinal hernia, enlargement of the spleen, gulma, tumors, goitre, glandular enlargement, visūcikā, alasaka, suppression of urine, intestinal worms, erysipelas, pāṇḍuroga, headache, pain in the flanks, udāvarta, burning of the eyes and mouth, heart disease, melasma, nīlikā, discharge from the eyes, nose, and mouth, halīmaka, dyspnea, cough, jaundice, apacī, epilepsy, insanity, vātarakta, disorders of the female and male reproductive elements, cataract, anorexia, indigestion, vomiting, edema, abdominal swelling, eruptive boils, and the like; especially diseases of pitta, and those stated in the Chapter on Major Diseases; for among these, purgation is declared foremost, just like [quenching fire] in an ignited house for the pacification of fire.

Those not to be given an āsthāpana enema, however, are: those with indigestion, the exceedingly unctuous, those who have drunk fat, those with stirred-up doṣas, those with low digestive fire, those fatigued from vehicular travel, the exceedingly weak, those afflicted with hunger, thirst, and fatigue, the exceedingly emaciated, those who have eaten food, those who have drunk water, those who have vomited, those who have purged, those who have undergone errhine therapy, the angry, the frightened, the intoxicated, the fainted, those suffering from continuous vomiting, excessive spitting, dyspnea, cough, hiccough, baddhagudodara, chidrodara, dakodara, abdominal distension, alasaka, visūcikā, the recently delivered woman with āma, those suffering from diarrhea with āma, madhumeha, and kuṣṭha.

Therein, in those with indigestion, the exceedingly unctuous, and those who have drunk fat, dūṣyodara, fainting, or swelling would occur; in those with stirred-up doṣas and sluggish digestive fire, severe anorexia; in one fatigued from vehicular travel, the enema, ruined by agitation, would quickly dry up the body; in the exceedingly weak and those afflicted with hunger, thirst, and fatigue, the aforementioned fault would occur; in the exceedingly emaciated, it would again produce emaciation; in those who have eaten food and drunk water, vāyu, becoming aggravated and casting the enema upward or downward, would quickly produce dreadful disorders; in those who have vomited and purged, however, a nirūha enema would burn their dry body just like alkali on a wound; in one who has undergone errhine therapy, it would cause disorientation and severely obstruct the channels; in the angry and the frightened, the enema would rush upward; in the intoxicated and the fainted, their consciousness being deeply disturbed, a complication would occur due to affliction of the mind; in those afflicted with continuous vomiting, excessive spitting, dyspnea, cough, and hiccough, the upward-turned vāyu would lead the enema upward; in those afflicted with baddhagudodara, chidrodara, dakodara, and abdominal distension, the enema, causing severe distension, would destroy the vital breath; in those suffering from alasaka, visūcikā, the recently delivered woman with āma, and those with diarrhea with āma, faults caused by āma would occur; in those with madhumeha and kuṣṭha, recurrence of the disease would result; therefore these are not to be given an āsthāpana enema.

The rest, however, are to be given an āsthāpana enema; especially those suffering from diseases of the entire body, of a single limb, or of the abdomen; retention of flatus, stool, urine, and semen; loss of strength, complexion, flesh, and semen; tympanites caused by doṣas; numbness of limbs; intestinal worms; udāvarta; non-bloody diarrhea; pain in the small joints; internal burning; enlargement of the spleen; gulma; abdominal colic; heart disease; fistula-in-ano; insanity; fever; inguinal hernia; pain in the head and ears; stiffness in the cardiac region, flanks, back, and hips; tremors; convulsive seizures; heaviness; excessive lightness; amenorrhea; irregular digestive fire; pain, wasting, and stiffness in the buttocks, knees, calves, thighs, ankles, heels, forefeet, vagina, arms, fingers, inter-mammary region, teeth, nails, joints, and bones; intestinal rumbling; cutting pain in the rectum; evacuation [of stool] little by little, with sound, and of fierce odor; and particularly the vāta diseases declared in the 'Chapter on Major Diseases.' In these, an āsthāpana enema is said to be the foremost, like felling a tree at its root.

Those indeed who are unfit for āsthāpana would be unfit for anuvāsana; especially those who have not eaten food, and those suffering from acute fever, pāṇḍuroga, jaundice, prameha, hemorrhoids, catarrh, anorexia, sluggish digestive fire, weakness, splenic enlargement, kaphodara, urustambha, loose stools, poison, ingested artificial poison, abhiṣyanda of pitta and kapha, heavy bowels, elephantiasis, goitre, apacī, and intestinal worms.

Therein, in one who has not eaten food, the fat moves exceedingly upward because the passage is unobstructed; in those with acute fever, pāṇḍuroga, jaundice, and prameha, it would stir up the doṣas and cause abdominal enlargement; in one with hemorrhoids, it would cause excessive secretion in the hemorrhoids and produce tympanites; in one afflicted with anorexia, it would further destroy desire for food; in the weak with sluggish digestive fire, it would make the digestive fire even more sluggish; in those with catarrh, splenic disease, etc., whose doṣas are severely stirred up, it would increase the doṣa all the more; therefore, these are not to be given an anuvāsana enema.

Those indeed who are fit for āsthāpana are fit for anuvāsana; especially those who are dry, those with sharp digestive fire, and those afflicted with purely vāta diseases; for in these an anuvāsana enema is said to be the foremost, like watering a tree at its root.

Those unfit for head evacuation, however, are: those with indigestion, those who have eaten food, those who have drunk fat, alcohol, or water, or wish to drink them, one who has washed the head, one who wishes to wash the head, those afflicted with hunger, thirst, or fatigue, the intoxicated, the fainted, those struck by weapon or stick, those fatigued from intercourse, exercise, or drinking, those afflicted with acute fever or grief, the purged, the given an anuvāsana enema, the pregnant woman, those suffering from acute catarrh, outside the proper season, and on a cloudy day.

Therein, in those with indigestion and those who have eaten food, the doṣa, obstructing the channels flowing upward, would produce cough, dyspnea, vomiting, and catarrh; in those who have drunk fat, alcohol, or water, and in those who drink them after it is performed, it would produce discharge from the mouth and nose, film over the eyes, timira, and diseases of the head; in one who has washed the head, and from washing the head after it is performed, [it would produce] catarrh; in one afflicted with hunger, aggravation of vāta; in one afflicted with thirst, further increase of thirst and dryness of the mouth; in those afflicted with fatigue, the intoxicated, and the fainted, it would produce the harm described for the āsthāpana enema; in those struck by weapon or stick, it would produce more severe pain; in those fatigued from intercourse, exercise, or drinking, distress in the head, shoulders, eyes, and chest; in those afflicted with acute fever or grief, the heat, following the vessels of the eyes, would cause timira and increase of fever; in one who has been purged, vāyu would cause impairment of the sense faculties; in one given an anuvāsana enema, kapha would produce heaviness of the head, itching, and worm disorders; in a pregnant woman, it would stiffen the fetus, and it is born one-eyed, with a crippled arm, paralyzed in one half, or a paraplegic; in one suffering from acute catarrh, it would vitiate the channels; and outside the proper season and on a cloudy day, it would produce cold-disorders, putrid rhinitis, and head disease; therefore, these are not fit for head evacuation.

The rest, however, are fit; especially those with stiffness of the head, teeth, and nape; lockjaw; chronic coryza; uvulitis; tonsillitis; corneal opacity; timira; diseases of the eyelids; melasma; epiglottitis; hemicrania; diseases of the neck, shoulder, scapula, mouth, nose, ears, eyes, cranium, and head; facial paralysis; apatantraka; apatānaka; goitre; toothache, hypersensitivity, and looseness; red streaks in the eyes; tumors; hoarseness of voice; speech arrest; stammering; stertorous breathing; and other disorders of vāta, etc., located above the clavicles that are fully matured. In these, head evacuation is said to be the foremost, for having penetrated into the supreme organ, it draws out entirely the disease-causing doṣa adhering there, like an internal stalk from muñja grass.

In seasons other than the rainy season, autumn, and spring, one should administer the errhine in emergency diseases by supplying artificial qualities: in the forenoon during summer, at midday in cold [weather], and on a non-cloudy day during the rains.

Here are the verses—

Thus the fivefold procedure has been shown in detail,
for whom which procedure is not beneficial and why, and for whom which is beneficial.

Nor should the wise physician adhere unconditionally
even to a stated matter; here the intelligent physician must also deliberate for himself.

For such a condition may arise with regard to place, time, and strength,
in which what should not be done becomes to be done, and what should be done is to be avoided.

In their own therapeutics, emesis is prescribed for vomiting, heart disease, and gulma,
upon reaching a [particular] stage, as is enema therapy for those with kuṣṭha.

Therefore, even when there is an explicit instruction, one should act after reasoning with one's own intellect;
for success achieved without reasoning is merely success by chance.

Thus, in the Siddhisthāna of the treatise composed by Agniveśa, redacted by Caraka, and, being incomplete, filled up by Dṛḍhabala, the second chapter named 'Successful Application of the Five Procedures' is concluded. //2