The Compendium of Caraka 8.6: ṣaṣṭho 'adhyāyaḥ/

Now we shall explain the success [in treating] complications of emesis and purgation.

Thus spoke the venerable Ātreya.

Now I shall describe the correct procedure for the two purifications, the upward and the downward, / and the faults of their improper performance along with their remedies.

Summer, the rainy season, and winter have excessive heat, rain, and cold respectively; / intervening between them are the three common seasons beginning with prāvṛṣ.

Prāvṛṣ is to be known as Śuci and Nabhas; autumn as Ūrja and Saha; / and spring as Tapasya and Madhu, for the purpose of purification.

Having thus determined these seasons, the physician should administer purification, / keeping the regimen of the healthy in mind; but in disease, according to the disease.

Between each of the procedures beginning with emesis, / one should employ unction and fomentation, and one should apply unction at the end.

Those suffering from erysipelas, boils, swelling, jaundice, and anemia, / and those afflicted by trauma and poison, one should purge without excessive unction.

To one whose body is not excessively unctuous, one should give an unctuous purgative; / to one whose body is agitated by fats, one should give a dry purgative.

For one endowed with unction and fomentation, after [previous food] is digested, a measured medicine, / drunk with a focused mind, leads to proper application.

Just as water is dislodged without effort from an unctuous vessel, / so kapha and the others are expelled from an unctuous body by medicines.

Just as fire liquefies wet wood completely, / so fomentation liquefies the firm doṣas of an unctuous person.

Just as dirt is cleansed by water after agitating a soiled cloth, / so waste is eliminated by purifications after being agitated by unction and fomentation.

During indigestion, exhaustion increases and obstruction also arises, / and the purification drunk acts adversely.

Small in dose, of great force, expelling many doṣas, comfortable, / light in digestion, pleasant in taste, pleasing, destroying disease,

not causing adverse changes upon complication, and not causing excessive exhaustion, / possessing [good] smell, color, and taste: one should know such as a measured medicine.

Having cast off mental afflictions such as desire, which lead to misfortune, / [the medicine] drunk with a focused mind leads to proper application.

A man who is to drink an emetic tomorrow should eat [food] that increases kapha, / easily digestible, and mostly liquid; for purgation, light and un-cold [food].

For when kapha is agitated and slight, the doṣas flow quickly; / after the medicine is drunk, the physician should observe the signs of purification.

Upward when pitta follows kapha, and downward when feces and pitta are followed by kapha, / one should state that the doṣas are expelled, if accompanied by emaciation, weakness, and lightness.

Then one should vomit the remaining medicine, but not if lightness is absent; / one should also induce vomiting in the presence of stiffness, obstruction of flatus, and absence of eructation.

Until lightness and thinness of kapha occur, further complication would arise; / for when one has vomited, the digestive fire increases and the doṣas subside.

One should fast the vomited person properly if not observing signs of digestion; / but having seen them, one should adopt the regimen of gruel and so forth, not fasting.

For an embodied being who is cleansed by the two purifications and whose doṣas are eliminated, / the digestive fire becomes weak; therefore, one should adopt the regimen of gruel and so forth.

When kapha and pitta are only slightly purified, in a wine-drinker, or in a person of vātapitta constitution, / one should adopt the regimen of refreshing drinks and so forth, for gruel would cause obstruction in them.

Downward movement of flatus, well-being, hunger, thirst, energy, mental clarity, / lightness, purity of the senses and of eructations: these are the characteristics of digested medicine.

Fatigue, burning, exhaustion of the limbs, dizziness, fainting, headache, / restlessness, and loss of strength: these are the characteristics of undigested medicine.

Administered at the wrong time, in too small or too large a dose, old, uninfused, / and improperly prepared, medicine quickly undergoes complication.

Distension, cutting pain, discharge, stiffness of the chest and limbs, / loss of blood, prolapse, rigidity, complications, and fatigue:

these ten are considered complications arising from inadequate and excessive administration, / and from the faults of the attendant, medicine, physician, and patient.

Proper application is proper evacuation; excessive application is excessive evacuation; / inadequate application is inverse, absent, or scanty evacuation.

When [a person] has provoked kapha, or when it is foul-smelling, unpalatable, or taken in great excess, / or during indigestion, a purgative drunk travels upward.

In one afflicted by hunger, having soft bowels, or having very slightly provoked kapha, / a sharp emetic that is drunk, remaining agitated, becomes a purgative.

Because they expel the doṣas inversely, and not entirely, / they are designated as inadequate applications; the doṣa passes with difficulty, or not at all, or in small amounts.

If one who has drunk the medicine is not cleansed, he should drink the medicine again when it is digested; / but he should not drink another while it is undigested, for fear of excessive application.

Recognising the heaviness, lightness, and strength of the bowels, / in inadequate application [the physician] should give either a mild or a sharp medicine.

One should not give an emetic to one who vomits with difficulty, nor a purgative to one with difficult bowels; / for the medicine, drunk again, would kill them.

In one whose body is un-unctuated and un-sudated, who is dry, an old medicine, / unable to dislodge and eliminate the doṣas, produces diseases:

Prolapse, swelling, hiccups, intense vision of darkness, / cramps in the calves, itching, weakness of the thighs, and discoloration.

And in one unctuated and sudated, whose digestive fire is blazing, a very small dose of medicine that is digested, / or obstructed by cold, or in the presence of āma, does not dislodge and eliminate the doṣas.

It produces those very same diseases; all of that is inadequate application. / Discerning this, the intelligent physician should carry out the prescribed treatment.

Anointing him with oil and salt, and sweating him with prastara and saṅkara beds, / he should make him drink [it] again once it is digested, or administer a non-unctuous enema with urine.

When he has received the non-unctuous enema, having fed him with meat broth of arid-zone animals, he should administer an unctuous enema / in proper measure with oil prepared with madana fruit, piper longum, and devadāru.

Unctuated with vāta-alleviating fats, he should cleanse him again with a sharp [medicine]; / and not with an excessively sharp one, for from that, excessive application arises.

An excessively sharp medicine in one afflicted by hunger and having soft bowels, / quickly eliminating feces, pitta, and kapha, causes the fluid dhātus to flow out.

It causes loss of strength and voice, burning, dryness of the throat, giddiness, and thirst; / and in that case, [the physician] should vomit the remainder of the medicine with sweet drugs.

In [excess of] emesis, there should be purgation, but in [excess of] purgation, emesis; / and one should check it with very cold sprinklings, tub baths, and the like,

And with astringent, sweet, and cold foods, drinks, and medicines, / which alleviate bleeding and diarrhea, and also relieve burning and fever.

He should drink a churned drink with roasted-grain flour, añjana, sandalwood, uśīra, marrow, blood, and sugar water, / which is supreme in curing excessive application.

Or he should give thin gruel prepared with the shoots of the vaṭa and other [trees], with honey, / and milk and food boiled with stool-binding drugs.

Or food with meat broth of arid-zone animals is praised, and a mucilage enema; / and he should be given an unctuous enema with sweet [drugs] prepared with ghee from milk.

In excessive application of emesis, sprinkled with cold water, / he should drink a churned drink with kapha-alleviating drugs, containing ghee, honey, and sugar.

In vomiting accompanied by severe eructation and fainting, he should make him lick / a powder of coriander and mustā with madhūka and añjana, mixed with honey.

When the tongue is retracted inside in one who is vomiting, mouthful gargles / with unctuous, sour, salty, and heart-pleasing vegetable soups, milk, and meat broths are beneficial.

And other men should eat sour fruits in front of him; / but when [the tongue] is protruded, he should reinsert it anointed with a paste of sesame and grapes.

In loss of voice and vāta disorders, the wise physician should give thin gruel / prepared with ghee and meat, as well as unction and sudation.

One who has vomited, one who has purged, one with sluggish digestive fire, and one who has fasted / should follow the regimen of thin gruel and the like to increase digestive fire and vitality.

A small dose of medicine in one with abundant doṣas, dry, with diminished digestive fire, / and having upward movement of vāyu, by agitating the doṣas and obstructing the channels,

Severely distends the navel, and causes pain in the back, flanks, and head, / and severe retention of breath, feces, urine, and flatus.

Inunction, sudation, suppositories, and the like, together with non-unctuous and unctuous enemas: / all procedures that relieve upward movement of vāyu are recommended for one who is distended.

A strong medicine drunk by one unctuated, with heavy bowels, having āma, / or by one emaciated, with soft bowels, exhausted, or of little strength,

Reaching the rectum along with āma, quickly expelling the doṣas, / produces cutting pain with severe colic, accompanied by mucilage and blood.

Fasting, digestives, and dry, hot, light food are [prescribed] in āma; / all nourishing, sweet regimens are likewise [prescribed] for the emaciated.

If the condition persists when the āma is digested, an alkaline, sour, and light [diet] is recommended, / or [ghee] mixed with copperas or with alkali and salt.

When vāta is increased, he should drink ghee with pomegranate juice; / and sour curds mixed with pomegranate rind in food and drink.

Or he should drink a paste of devadāru and sesame with hot water; / or milk boiled with aśvattha, udumbara, plakṣa, and kadamba.

Or he should administer an astringent, sweet, cold mucilage enema, / or an unctuous enema prepared with yaṣṭīmadhu.

A small amount of medicine in one with abundant doṣas, having dislodged the doṣa, / causes it to discharge in small amounts, [producing] itching, swelling, dermatoses, heaviness,

Suppression of digestive fire, nausea, stiffness, anorexia, and anemia; / that is discharge; [the physician] should pacify that doṣa or induce emesis.

Or, once unctuated, he should make him drink a sharp purgative again; / and when he is cleansed, he should give powders, āsavas, and prepared ariṣṭas.

From suppression of the urges in one who has drunk the medicine, vāta and the other [doṣas], / aggravated, reach the heart and produce severe chest tightness.

Accompanied by hiccups, cough, pain in the flanks, misery, salivation, and rolling of the eyes, / he bites his tongue, unconscious, grinding his teeth.

The physician should not be bewildered there, but should quickly cause him to vomit: / with sweets in one fainting from pitta, and with pungents in one fainting from kapha.

Then, with digestive medicines, he should cause the remainder of the doṣas to be digested; / and thereafter he should gradually restore his bodily fire and strength.

To him whose heart is afflicted by vāta from excessive vomiting, / he should give unctuous, sour, and salty [substances]; and otherwise in [aggravation of] pitta and kapha.

From suppression of the urges in one who has drunk the medicine, or obstructed by kapha, / or in one excessively purified, vāta seizes the limbs,

With stiffness, trembling, piercing pain, weakness, cramps, and churning pain; / there, he should administer everything that alleviates vāta, beginning with unction and sudation.

An excessively sharp medicine in one with soft bowels and slight doṣa, / having eliminated the doṣas and agitated [the body], carries away vital blood.

He should give food mixed with it to a crow or to a dog; / if it eats it, he should declare it vital blood; if it does not eat it, he should designate it pitta.

Or a white cloth soaked [in it], immersed and washed with lukewarm water, / becomes discoloured in the case of pitta, but clean in the case of [vital] blood.

For one afflicted with thirst, fainting, and intoxication, he should perform treatment until death [is averted]: / everything that alleviates pitta for him, and that which is beneficial in excessive action [of purgation].

He should drink the fresh blood of living deer, cows, buffaloes, or goats, / which restores life; for [that] vital [blood] quickly passes away.

He should administer that very blood crushed with darbha grass as an enema; / or milk boiled with śyāmā, kāśmarya, badarī, dūrvā, and uśīra,

combined with ghee scum and añjana, he should administer as a cold enema; / or a very cold mucilage enema (picchābasti), or an unctuous enema with ghee scum.

And when the rectum is prolapsed, having checked it with astringents, he should reduce it; / and he should cause Sāman chants and Gandharva music to be played for him upon loss of consciousness.

When a purgative, having been drunk, stops with the end of the feces, / or an emetic with the end of the medicine, and does not bring forth the aggravated doṣas,

then the provoked doṣas produce diseases beginning with itching; / that is considered a lapse (vibhraṃśa); there, the medicine should be according to the disease.

Drunk by an unctuous person, oily, surrounded by the doṣas on account of softness, / it does not carry away the doṣas, but arrests them after they have moved from their own sites.

And with retention of wind, stiffness of the rectum, and colicky pain, it discharges in small amounts; / he, having undergone fasting and digestion, is fit for a sharp enema or purgative.

A dry purgative, drunk by an unctuous person or one of weak strength, / having quickly provoked the wind, would produce terrible complications:

terrible stiffness and colicky pains in all the limbs for one who is swooning; / there, a wind-alleviating procedure beginning with unction and sudation is to be performed.

For an unctuous person with soft bowels, a mild medicine, having provoked kapha / and obstructed pitta and vāta, causes drowsiness, heaviness, exhaustion,

weakness, and prostration of the limbs; he should vomit it immediately; / and here, fasting, digestion, and unctuous, sharp cleansing [are indicated].

There are two verses on this—

Thus these complications of emesis and purgation performed by unskilled men / on persons have been declared, together with their symptoms and treatments.

Having understood these and the stages truly, the intelligent [physician], / ever desiring health for persons, should properly administer cleansing.

Thus ends the sixth chapter, named Success [in Treating] Complications of Emesis and Purgation (Vamanavirecanavyāpatsiddhi), in the Siddhisthāna of the treatise composed by Agniveśa, redacted by Caraka, and, being incomplete, filled out by Dṛḍhabala. //6