The Compendium of Caraka 8.3: tṛtīyo 'adhyāyaḥ/

Now we shall explain the chapter on Successful Formulation of Enemas.

Thus spoke the venerable Ātreya.

To Punarvasu, who, having leisure, was seated in a charming part of the excellent mountain
beside the abode of the Lord of Wealth, surrounded by hosts of great sages, Agniveśa asked with cupped hands:

"In consideration of what should an enema be given to men so that it is successful? Of what material should its pipe be made,
of what dimension, shape, and properties? For whom, and of what origin and properties should the enema-bladder be?

What is the procedure for nirūha, what is the dosage for administration of fat, or what is the rule regarding the bed?
Which enemas are beneficial in which [conditions]?" Hearing this, the great sage spoke the replying words:

"An enema administered after considering the doṣas, drugs, place, time, suitability, digestive fire, mental constitution, age, and strength,
will invariably lead to benefit, and all procedures will be successful.

The pipes should be made with gold, silver, tin, copper, brass, bell-metal, bone, weapon-wood, bamboo, ivory,
reeds, horns, and various gems, and provided with three rings.

They should measure six, twelve, and eight finger-breadths
for those aged six, twenty, and twelve years;
their orifices should allow a mudga bean, a jujube fruit, and a pea to pass, and should be plugged with a wick.

According to age, their circumferences at base and tip should match the thumb and the little finger;
they should be straight, shaped like a cow's tail, smooth, and have rounded, pill-like tips.

There should be one ring at the fourth part from the tip, and two rings at the base to tie the bladder.
The bladder should be of an old bull, a buffalo, a deer, a boar, or a goat.

Firm, thin, devoid of veins, free of foul odor, tanned with astringent decoction, very soft, and thoroughly cleansed,
it should be attached to the pipes according to the age of the patients, with its urinary canal tightly bound.

In the absence of a bladder, the neck-skin of a swimming bird, or a spotted deer's foot, or a very dense cloth may be used.
Having examined a person fit for a non-unctuous enema, the expert in procedure, on an auspicious day in the bright fortnight,

under an auspicious asterism and muhūrta, when food has digested, should attend to the focused patient:
balā, guḍūcī, triphalā along with rāsnā, and both pañcamūlas, each measured at one pala,

eight [madana] fruits, and half a tulā of goat's meat should be boiled in water until a fourth remains;
[the decoction], strained, is combined with pastes of yavānī, [madana] fruit, bilva, kuṣṭha, vacā, śatāhvā, ghana, and pippalī,

pleasantly warm, in the measure of a picu, along with jaggery, honey, ghee, and oil;
one pala of jaggery, a two-prasṛti dose of unctuous substance, and honey and rock salt appropriately.

Having poured it into the bladder, churned it with a churning stick, tied it tightly, inflated it, and freed it of folds,
covering the orifice with the center of the thumb, and having removed the wick placed at the tip of the pipe,

the person, his limbs smeared with oil, having passed urine and feces, not overly afflicted by hunger, on a bed
that is level or slightly lowered at the head, not too high, and furnished with a good mattress,

lying comfortably on his left side, making his body straight, with his own arm as a pillow,
flexing his right leg and extending the left one, he should then administer it to him.

Into the unctuous rectum, a fourth part of the pipe, lubricated, straight, slowly, along the vertebral column,
while demonstrating the virtues of the hands, such as absence of trembling, absence of shaking, and lightness,

and pressing it, given with a single squeeze, he should then withdraw the pipe slowly.
If introduced obliquely, the stream does not flow; if the pipe moves, an ulcer forms in the rectum.

Administered slowly, the enema does not reach the receptacle; overly compressed, it rushes to the throat.
Cold, it produces excessive stiffness; excessively hot, it causes a burning sensation and fainting.

Overly unctuous, it causes excessive sluggishness; rough, it provokes vāta; thin, deficient in dose, or deficient in salt, it yields inadequate action;
in excessive dose, it causes excessive action; thick, it causes emaciation and emerges after a very long time.

With too much salt, it produces burning and diarrhea; therefore, one should give it properly balanced.
First, indeed, one should put in honey and rock salt, then unctuous substance after churning, next the paste;

churning them together, one should then combine them with liquids, churn with a churning stick, and place into the bladder.
Because the duodenum and rectum lie on the left side, one lying on that side attains comfort.

Thus the rectal folds yield; therefore, one lying on the left side is fit for the administration of an enema.
And if an urge for feces or flatus arises when half is given, he should withdraw it, and once released, administer the remainder.

He should lie supine with a pillow arranged; thus its potency pervades his body.
The first enema draws out vāta from its passage; the second, pitta; and the third, kapha.

When it has returned, sprinkled with warm water, he should eat śāli rice with thin meat soup.
When digested in the evening, having eaten lightly and in small measure, he is to be given an unctuous enema for nourishment.

With oil equal to a fourth part of the non-unctuous enema, prepared with sour and vāta-destroying drugs,
having administered it, he should slap the buttocks with the palm of his hand to prevent the rapid exit of the unctuous substance.

He should pull slightly the pair of big toes; he should rub the soles of him lying supine
with unctuous substance, as well as the heels, toes, calves, and whichever parts of his body are afflicted with pain.

And he should gently massage them; thereafter, having arranged a pillow, he should take rest in sleep.
The parts of the decoction are five; in [predominance of] pitta, the unctuous substance is a sixth, and also when dosas are in their normal state;

in aggravated vāta, it is a fourth part; in kapha, the dose in non-unctuous enemas is an eighth part.
The dose of a non-unctuous enema is half a prasṛti in the first year; thereafter, an increase of half a prasṛti [per year]

up to twelve years; there should be an increase of one prasṛti [per year] up to eighteen; beyond twelve, there are [increases],
up to seventy years, that prescribed measure holds; beyond that, it should be administered as for a sixteen-year-old.

The dose of a non-unctuous enema is one prasṛti in measure; in the child and in the aged, mildness is the special rule.
A bed that is neither too high nor too low at the feet, provided with a footstool, is praised,

furnished with an excellent, soft mattress, head facing east, with a white cloth covering.
The diet, moreover, having considered the disease, should be arranged accordingly with vegetable soup, milk, meat soup, and the like.

One should know this primary procedure in all cases; henceforth I shall describe further enemas.
The juice of both pañcamūlas, combined with sour substances, with goat's meat broth, and with the aforementioned paste,

combined with three fats, is declared an excellent non-unctuous enema that removes all vāta diseases.
Of the group beginning with sthirā, combined with balā, paṭola, trāyantikā, eraṇḍa, and barley,

one prastha of decoction, combined with half a prastha of goat's meat soup, is to be cooked down again until it equals one prastha;
combined with pastes of priyaṅgu, kṛṣṇā, and ghana, along with oil, ghee, honey, and rock salt,

this enema stimulates digestion, gives flesh and strength, and also imparts strength to the eyes.
Three palas of castor root, palāśa, and those that are the five minor roots,

rāsnā, aśvagandhā, atibalā, guḍūcī, punarnavā, āragvadha, and devadāru,
in parts of one pala each, combined with eight madana fruits, boiled in two kaṃsas of water until an eighth remains;

the pastes are śatāhvā, hapuṣā, priyaṅgu, together with pippalī, madhuka, and balā,
rasāñjana, seeds of vatsaka, and musta, each part in the measure of an akṣa, combined with a portion of salt,

together with honey, combined with oil and with urine, this enema stimulates digestion and scrapes tissue in men.
Pain in the calves, thighs, feet, sacrum, and back, obstruction by kapha, suppression of wind,

retention of feces, urine, and flatus with pain, tympanites, urinary calculus and gravel,
flatulence, hemorrhoids, and disorders of the duodenum—the eraṇḍa enema, when administered, pacifies these.

From half a śata of goat's meat fried in four palas of oil and ghee, the broth, soured with curd and pomegranate,
combined with pastes, bestows strength, flesh, complexion, semen, and digestive fire, and is praised for blindness and head ailments.

Having boiled eight palas of palāśa in two kaṃsas of water until the decoction is reduced to half an āḍhaka,
combined with pastes of vacā and māgadhikā, one pala each, and two palas of śatāhvā,

with rock salt, with honey, and with oil, this non-unctuous enema should be administered; it produces strength and complexion,
and destroys abdominal distension, lateral thoracic disorders, afflictions of the female genital tract, abdominal lumps, udāvarta, and pain.

Milk boiled with eight palas of yaṣṭyāhva, combined with śatāhvā
and seeds of the fruit [of madana], along with ghee and honey, is a non-unctuous enema beneficial for vātarakta, disorders of voice, and visarpa.

Milk boiled with yaṣṭyāhva, lodhra, abhayā, candana, and lotus and blue water lily—an excellent [remedy]—
with sugar, with honey, thoroughly cooled, and with vitalising drugs, destroys pitta disorders.

Two karṣas each of candana, padmaka, ṛddhi, yaṣṭyāhva, rāsnā, vṛṣa, sārivā,
with lodhra, mañjiṣṭhā, and also anantā, balā, sthirā and the others, and the five grass roots,

having boiled well in water, with that decoction half an āḍhaka of milk is boiled until free of water;
with jīvantī, medā, ṛddhi, śatāvarī, vīrā, the two kākolīs, kaśeruka,

sugar candy, jīvaka, pollen of lotus, prapauṇḍarīka, lotus and blue water lily,
lodhra, ātmaguptā, madhuka, vidārī, muñjātaka, saffron, and candana,

ground and combined with ghee and honey, with rock salt, one should administer this non-unctuous enema only when cool.
When it has returned, with broth of arid animals one should eat śāli rice, or with milk, having sprinkled his limbs [with water].

Burning sensation, diarrhea, menorrhagia, bleeding disorders, heart disease, anemia, and irregular fever,
together with abdominal lumps, urinary retention, jaundice and the rest—it destroys all disorders produced by pitta.

With drākṣā and the rest, kāśmarya, madhūka, sevya, with sārivā, candana, and śītapākī,
milk boiled with pastes of śrāvaṇī, mudgaparṇī, tugā, ātmaguptā, and madhuyaṣṭī,

and with wheat flour in measures of an akṣa, with honey, ghee, and liquorice oil,
combined with the juices of pathyā, vidārī, and sugarcane, and with jaggery, one should prepare an enema that removes pitta.

In burning of the heart, navel, flanks, and upper body, in internal burning, and in dysuria,
in emaciation, chest lesions, lost semen, and in diarrhea due to pitta, it is praised for men.

Having boiled koṣātaka, āragvadha, devadāru, śārṅgeṣṭā, mūrvā, kuṭaja, arka, pāṭhā,
horse gram, and bṛhatī in water, of that decoction there should be ten prasṛtas.

Combined with mustard, cardamom, and madana with kuṣṭha, in measures of an akṣa, and prasṛtas
of oil of fruit, with honey, alkali, and mustard oil,

the wise physician should administer this non-unctuous enema to a patient with kapha, with weak digestive fire, and averse to food;
or with paṭola, pathyā, and devadāru, along with pippalī, boiled in water over fire,

the two pañcamūlas, the three myrobalans with bilva, [and madana] fruits, a decoction combined with cow's urine,
with a paste of kaliṅga, pāṭhā, fruit, and mustā, with rock salt, with alkali, and with oil,

this foremost of non-unctuous enemas destroys kapha-born disorders, anemia, sluggish digestion, and digestive toxins,
as well as obstruction of flatus and urine, and also terrible rumbling in the bladder.

With rāsnā, amṛtā, eraṇḍa, viḍaṅga, dārvī, saptacchada, uśīra, surāhva, nimba,
śampāka, bhūnimba, paṭola, pāṭhā, tiktā, ākhuparṇī, daśamūla, mustā,

trāyantikā, śigru, and the three fruits, a decoction with piṇḍītaka, water, and urine,
with yaṣṭyāhva, kṛṣṇā, phalinī, śatāhvā, rasāñjana, śvetā, vacā, viḍaṅga,

kaliṅga, pāṭhā, ambuda, and rock salt, as pastes mixed with ghee, honey, and oil—
this non-unctuous enema is for patients suffering from parasites, skin diseases, urinary disorders, inguinal swelling, abdominal enlargement, indigestion, and kapha.

Administered even to those emaciated by drying medicines when these diseases are present,
having destroyed vāta, kindled the fire, and overcome the diseases, it produces strength.

Punarnavā, eraṇḍa, vṛṣa, aśmabheda, vṛścīra, bhūtīka, balā, palāśa,
and the two pañcamūlas, in portions of a pala, crushed and washed, and eight [madana] fruits,

bilva, barley, kola, horse gram, and coriander fruits, measured in prasṛtas,
boiled with milk and water equal to two āḍhakas, reduced to the milk alone, and filtered through a white cloth,

combined with pastes of vacā, śatāhvā, devadāru, kuṣṭha, yaṣṭyāhva, white mustard, pippalī,
yavānī, and madana, neither too hot nor cold, smeared with jaggery and rock salt,

likewise combined with three prasṛtas of honey, oil, and ghee,
the discerning physician should administer this non-unctuous enema properly; it destroys disorders produced by all combinations [of doṣas].

One unctuous and warm, with meat, in wind; two sweet and cool, with milk, in pitta;
three with urine, pungent, hot, and sharp, in kapha—no further non-unctuous enemas should be prescribed.

The following meal should be with meat broth in vāta, but with milk in pitta, and with vegetable soups in kapha;
and in unctuous enemas there should be bilva oil, [oil] with vitalising drugs, and [oil] prepared with [madana] fruit.

Thus this entire foremost procedure of enema administration has been stated as it is;
the learned physician who, having studied this, performs the practice of enemas in the world attains success.

Thus, in the treatise composed by Agniveśa, redacted by Caraka, and, being incomplete, restored by Dṛḍhabala, in the Siddhisthāna, the third chapter entitled "Success in Guidelines for Enemas".