The Compendium of Caraka 8.7: saptamo 'adhyāyaḥ/

Now we shall explain the chapter on success [in treating] complications of enemas (bastivyāpatsiddhi).

Thus spoke the revered Ātreya.

The assembly of disciples, filled with humility, asked Punarvasu, / a treasury of intellect, fortitude, generosity, depth, forbearance, self-restraint, and asceticism:

"Which and how many are the complications of the enema? What are their causes and symptoms? / What is the treatment?" Having heard these questions, the teacher said to them:

"Deficient action, excessive action, exhaustion, distension, hiccup, reaching the heart, upward movement, / tenesmus, pain in the head and limbs, cutting pain, discharge—

these are the twelve complications of the enema arising from improper application; / learn their symptoms and treatment one by one.

In one with heavy bowels, predominantly windy, dry, or with aggravated vāta, / a cold enema, or one with little salt, unction, or liquid measure, or dense,

having agitated that doṣa, not eliminating it on account of weakness, / produces heaviness of the bowels, and retention of wind, urine, and feces;

pain in the navel and bladder, burning sensation, coating of the heart, swelling in the rectum, / itching, swellings, discolouration, anorexia, and weakness of the digestive fire.

There, the drinking of hot pramathyā, sudations of various kinds, / or fruit suppositories [are indicated]; or, having known the proper time, purgation is praised.

An enema having bilva root, trivṛt, devadāru, barley, kola, and kulattha, / along with surā, etc., and urine, with the earlier paste, should bring it out.

In one who is unctuous and fomented, with soft bowels, an excessively sharp and hot [enema] is applied to excess; / its signs and treatment are equal to [those of the excessive action of] the two cleansings.

Having pounded pṛśniparṇī, sthirā, padma, kāśmarya, madhuka, and balā, / and drākṣā and madhūka in milk or rice water,

and dissolving [them] in an infusion of drākṣā, baked clod of earth, and madhuka, / he should administer an enema with ghee for burning sensation arising from excessive action.

When raw residue remains, the doṣa stirred up by a mild non-unctuous enema / obstructs the passage of vāta, destroys the digestive fire, and even causes fainting;

it causes exhaustion, burning, cardiac colic, confusion, cramps, and heaviness; / he should treat him with dry sudations and with digestives.

He should drink water boiled with pippalī, kattṛṇa, uśīra, devadāru, and mūrvā, / mixed with sauvarcala salt, which stimulates the digestive fire and cleanses the heart.

Vacā, ginger, śaṭī, and cardamom infused with whey / should be drunk with prasannā, or with ariṣṭa or āsava.

Having pounded devadāru, trikaṭu, pathyā, palāśa, citraka, śaṭī, / and kuṣṭha with urine, he should drink it, and digestive alkalines.

And he should administer an enema prepared with daśamūla along with urine, / or an enema containing honey and oil (mādhutailika) with urine and prominent salt.

Administered with weak potency in one with great doṣa, dry, and with hard bowels, / the enema, covered by the doṣas, its passage obstructed, obstructs the wind.

That wind, moving in the wrong path, produces distension, oppression of the vital parts, / burning sensation, heaviness of the bowels, and pain in the scrotum and groins;

it obstructs the heart with colicky pains, and darts here and there. / Made with śyāmā, fruit [of madana], etc., kuṣṭha, black pepper, salt, and mustard,

soot, black gram, vacā, yeast, alkaline powder, and jaggery, / he should insert a suppository resembling the thumb of the hand, thick in the middle like barley,

smeared with oil, into the lubricated rectum of one whose limbs have been anointed and fomented; / or one made with salt, soot from the house, and white mustard.

There should be a non-unctuous enema with bilva, etc., along with pīlu, mustard, and urine; / and an unctuous enema prepared with saralā and amaradāru.

In one with soft bowels and weak strength, an excessively sharp enema, eliminating excessively, / would produce hiccup; beneficial for him is whatever destroys hiccup and nourishes.

Having cooked oil with balā, sthirā, etc., kāśmarya, triphalā, jaggery, and rock salt, / along with prasannā and sour fermented gruel (aranāla), he should administer an unctuous enema.

He should drink an akṣa of black pepper and rock salt combined with hot water; / and smoking, electuaries, meat broth, milk, sudations, and wind-alleviating food [are beneficial].

Excessively sharp, accompanied by air, or not properly compressed, / the enema strikes the heart; there, with kāśa, kuśa, and itkaṭa,

along with the sour and saline groups, karīra, and badarī fruits, / boiled, an enema is beneficial, and an unctuous enema prepared with wind-alleviating herbs.

When an enema has been administered, if [the patient] forcefully suppresses the urges of flatus, urine, and feces, / or if it is excessively compressed, the enema emerges forcefully through the mouth.

Seeing in him the symptom of fainting first, one should sprinkle his face with cold water, / stroke his flanks and abdomen downwards, and fan him.

Holding him by the hair, one should shake him in the air and frighten him / with cows, donkeys, horses, elephants, lions, royal messengers, or snakes,

and with torches; thus, when he is terrified, [the enema] moves downwards. / One should constrict his throat by holding it with cloth or hands, so that he does not die.

For by blocking prāṇa and udāna, apāna wind, / having its path made clearer, quickly pulls that enema downwards.

Then, one should make him drink an akṣa of areca nut paste combined with sour [liquids]; / through its heat, sharpness, and laxative property, it moves his enema downward.

When it remains in the colon, after fomentation, a non-unctuous enema of daśamūla / prepared with barley, kola, and kulattha, boiled with urine, should be administered.

When it remains in the chest, an enema prepared with the pañcamūla beginning with bilva [is indicated]; / when it remains in the head, errhines and smoking [should be used], and the head should be covered with mustard [paste].

In one unctuated and fomented, who has great morbidity, a mild enema with little medicine, / aggravating the morbid matter, removes only a small amount and produces tenesmus.

Due to swelling of the enema-bladder and anus, or prostration of the calves and thighs, / with wind obstructed, that person strains repeatedly.

One should administer fomentations, inunctions, and non-unctuous enemas that cleanse and move downward; / having fasted him, one should maintain the regimen as for a purged person.

In a weak person, one with hard bowels, and one with fierce morbidity, a thin, mild, / cold, and small enema is enveloped by the morbid matter; wind obstructed by that,

coursing through the channels of the limbs, strikes upwards in the head; / it seizes the neck and nape, and splits the head and throat;

it causes deafness, ringing in the ears, chronic coryza, and dizziness of the eyes. / One should perform inunction with oil and salt according to rule;

one should employ insufflations, errhines, and purge him with smokes; / then, having unctuated him with sharp, downward-moving [drugs], one should administer an unctuous enema after meals.

Without preparing [the patient] with unction and fomentation, if a heavy, sharp enema / is administered in excessive measure, it causes excessive evacuation.

When his morbid matter has flowed out in excess after being evacuated by a non-unctuous enema, / the wind of one whose bowels are stiff and afflicted by upward-moving wind is obstructed.

Arising from its reversal of course, it causes pain in the person's limbs / with twisting of the body, pricking pain, cutting pain, twitching, and yawning.

One should anoint him with oil and salt and sprinkle him with hot water; / and one should treat him with decoctions of castor leaves and prastara fomentations.

Boiling barley, kulattha, kola, and both pañcamūlas / in two āḍhakas of water down to a fourth,

one should administer a non-unctuous enema with that along with bilva oil, hot [water], and salt. / After he has been evacuated by the non-unctuous enema and comforted, one should immerse him in a tub.

Then, after he has eaten, the physician should have an unctuous enema / administered to him with yaṣṭīmadhuka oil or bilva oil.

In one with soft bowels and little morbidity, an unctuous, sharp, excessively measured / enema, expelling the morbid matter quickly, produces cutting pain in the rectum.

Pricking pain in the sacrum, groin, and bladder, pain below the navel, / obstruction, and passing stool in tiny amounts occur due to the scraping by the enema.

There, milk boiled with sweet, cold drugs and sugar cane and the like, / along with paste of yaṣṭīmadhuka and sesame, should be the enema for one eating a milk diet.

Sarjarasa, yaṣṭīmadhuka, jiṅginī, and rasāñjana, / dissolved in milk, should be the enema for one eating food that is mildly sour and soft.

In pitta disorders, a sour, hot, sharp, or salty / enema scrapes the anus, injures it, and even burns it.

Inflamed, he discharges blood and bile of many colors; / he is purged with many urges and falls into fainting repeatedly.

One should administer to him a cold enema made of goat's milk boiled / with crushed fresh stalks of śālmali, combined with ghee.

This preparation is also praised with sprouts of vaṭa and others, with barley and sesame, / with suvarcalā and upodikā, and with karbudāra.

In the anus, washings and plasters should be cold and sweet; / and measures that cure bleeding disorders and diarrhea are praised here.

Sharpness should be produced appropriately with urine, pīlu, citraka, salt, alkali, and mustard; / likewise, mildness with milk and the like.

Staying in the colon, the enema draws out morbid matters located from the soles of the feet to the head / by its potency, just as the sun in the sky draws up the juices of the earth.

Just as a cloth extracts color from water mixed with safflower, / so does a non-unctuous enema eliminate wastes from the liquefied body.

Here is a verse:

Thus these complications of enemas have been stated along with their symptoms and medicines; / having understood them completely, one does not err when administering those enemas.

Thus ends the seventh chapter, named Success [in Treating] Complications of Enemas, in the Siddhisthāna of the treatise composed by Agniveśa, redacted by Caraka, and completed by Dṛḍhabala where unavailable.