The Compendium of Caraka 8.9: navamo 'adhyāyaḥ/

Now we shall explain the success [of treatment] regarding the three vital points.

Thus said the venerable Ātreya:

There are one hundred and seven vital points in this body, residing in the trunk and the limbs, O Agniveśa!

When any one of them is injured, excessive pain arises, because of the special attachment of consciousness [to them].

Among them, those residing in the trunk are more significant than those residing in the limbs, because the limbs depend on it; and even among those residing in the trunk, the heart, urinary bladder, and head are [paramount], because the body is rooted in them.

Therein, ten vessels, prāṇa and apāna, the mind, intellect, consciousness, and the great elements are established in the heart like spokes in a nave; in the head, the sense organs and the channels carrying senses and life reside like rays in the sun; the bladder, however, situated in the midst of the rectum, scrotum, perineal raphe, and channels carrying semen and urine, is the reservoir of urine, the foundation of all water-bearing channels just as the ocean is for rivers; and this body is permeated by numerous channels having those [three] as their roots and called vital points, like the sky by the rays of the sun.

From the destruction of even one of these three, rapid destruction of the body would occur, for when the substrate is destroyed, the supported also perishes; but from their impairment, most frightful diseases appear; therefore, these must be protected especially from external trauma and from vāta and the other [doṣas].

Therein, when the heart is injured, there may be cough, dyspnea, loss of strength, dryness of the throat, drawing up of the kloman, protrusion of the tongue, dryness of the mouth and palate, epilepsy, insanity, delirium, loss of mind, and the like; when the head is injured, stiffness of the neck, facial paralysis, rolling of the eyes, stupor, convulsions, loss of motor function, cough, dyspnea, lockjaw, muteness, stammering, closure of the eyes, twitching of the cheeks, yawning, salivation, loss of voice, crookedness of the face, and the like; and when the bladder is injured, suppression of flatus, urine, and feces, pain in the groin, penis, and bladder, urinary colic, upward movement of vāyu, abdominal lump, prostatic enlargement, rigidity, gripping pain in the navel, belly, rectum, and pelvis, and the like. But the symptoms and therapeutic regimens for these when afflicted by vāta and the other [doṣas] have been stated in the [section on] Therapeutics.

However, these must be protected especially from vāyu; for vāyu is the cause of the excitation of pitta and kapha and is the root of life; it is most curable by enema treatment; therefore, there is no treatment equal to enema for protecting the vital points.

Therefore, considering with intellect the six groups for non-unctuous enemas and the two groups for unctuous enemas in the Vimānasthāna, as well as the enemas prescribed here, one should apply them, as well as the treatment of vāta disorders, for the sake of protecting the great vital points.

Moreover, when the heart is afflicted, one should make [the patient] drink asafoetida powder combined with powder of any of the salts with the juice of citron or another sour or heart-pleasing [liquid]; the juice of the sthirādi pañcamūla with sugar for drinking; gruel prepared with the juice of the bilvādi pañcamūla; and the treatment prescribed for heart disease. When the head is afflicted by vāta: massage, sudation, poultice, intake of unctuous substances, errhine therapy, nasal drops, medicated smoking, and the like. When the bladder [is afflicted]: pot-sudation, suppositories, a non-unctuous enema prepared with cow's urine with śyāmā and the others, or with surā with bilva and the others, or a non-unctuous enema prepared with milk boiled with roots of śara, kāśa, ikṣu, darbha, and gokṣura, and pasted with trapuṣa, ervāru, kharāśvā seeds, barley, ṛṣabhaka, and vṛddhi; an unctuous enema with oil prepared with pītadāru; tailvaka ghee for purgation; or an oil cooked with a decoction of four parts of milk and the roots of śatāvarī, gokṣuraka, bṛhatī, kaṇṭakārikā, guḍūcī, punarnavā, uśīra, madhuka, both sārivās, lodhra, śreyasī, kuśa, and kāśa, with a paste of balā, vṛṣa, ṛṣabhaka, kharāśvā, upakuñcikā, vatsaka, seeds of trapuṣa and ervāru, śitivāraka, madhuka, vacā, śatapuṣpā, aśmabhedaka, varṣābhū, and madanaphala, [administered] as an uttarabasti or a non-unctuous enema to one who is cleansed, oleated, and fomented, which dispels bladder pain and urinary disorders.

And here are the verses:—

[Prāṇas] are established in the heart, in the head, and in the bladder of humans; / therefore, one should always make an effort in protecting them.

Constant avoidance of afflictions, following a healthy regimen, / and checking pain that has arisen is the protection of the vital points.

Hereafter, whatever disorders arising from vital points were not mentioned / in the treatment of the trio of three vital points, I shall describe some of them along with their remedies.

Vāyu, provoked by its own aggravating causes, rises upward from its site, / afflicting the heart as it goes, and pressing the head and the temples,

It bends the limbs like a bow, convulses them, and causes delusion; / he breathes with difficulty, his eyes fixed or closed,

And he coos like a dove, unconscious; that is apatantraka. / Paralyzing the gaze and destroying consciousness, he groans from the throat.

When the heart is released, the man attains wellness; when it is covered again, he enters delusion; / some call that severe condition caused by vāyu apatānaka.

One should free his respiration, which is obstructed by kapha and vāta; / through sharp blow-errhines he regains consciousness when they are freed.

Black pepper, śigru seeds, viḍaṅga, and phaṇijjhaka— / one should administer these fine powders as a head-clearing errhine.

Tumburu, abhayā, asafoetida, pauṣkara, and the three salts / should be drunk with barley decoction water in constriction of the heart and in apatantraka.

One should drink asafoetida, amlavetasa, dry ginger, with sauvarcala and pomegranate; / and treatment that destroys vāta and kapha, which dispels heart disease, is beneficial.

Sharp cleansing enemas are not beneficial for him at all; / ghee prepared with sauvarcala, abhayā, and tryūṣaṇa is beneficial for him.

From taking sweet, unctuous, and heavy food, from worrying, from exhaustion, / from grief, and from persistence of disease, kapha is stirred up by vāyu;

When it assails the heart and shrouds knowledge / and the like residing in the heart, then drowsiness arises.

Agitation in the heart, heaviness of speech, movements, and sense organs, / and lack of clarity of mind and intellect is considered the symptom of drowsiness.

In that condition, kapha-destroying cleansing and pacifying measures should be carried out, / physical exercise, bloodletting, and pungent and bitter food.

Mūtraukasāda, [mūtra]jaṭhara, [mūtra]kṛcchra, [mūtr]otsaṅga, [mūtra]saṃkṣaya, / mūtrātīta, anilāṣṭhīlā, vātabasti, uṣṇavāta,

Vātakuṇḍalikā, granthi, viḍghāta, and bastikuṇḍala— / these are the thirteen disorders of urine; hear them by their symptoms:

When pitta, kapha, or both are congealed in the bladder / by vāyu, then one discharges red, yellow, and thick urine,

With burning sensation, or white and dense, or endowed with all the symptoms; / one should know that as mūtraukasāda, and conquer it with remedies that remove pitta and kapha.

When urine, obstructed by suppression and turned upward by vāyu, / fills the abdomen, then it causes causeless pain,

Indigestion, and retention of urine and feces; one should call that mūtrajaṭhara; / therein one should employ treatment that purges urine.

The Hiṅgudviruttara powder mentioned in [the chapter on] the Trio of Three Vital Points / destroys swelling of the abdomen due to urine, and distension in the rectum and penis.

When semen, provoked by vāyu, is dislodged through sexual intercourse while having the urge to urinate, / and flows out before or after the urine, that is called [mūtra]kṛcchra.

Due to defect of the channel and vāyu's convulsion, some urine also remains / in the glans junction and trickles afterward, either painless or extremely painful;

That is mūtrotsaṅga, [characterized by] interrupted flow and a remaining heavy penis; / when vāta characteristics appear due to vāta and urine dries up, it is [mūtra]saṃkṣaya.

When one suppresses [the urge] for a long time, urine does not pass promptly / when he urinates, or passes slowly, that is called mūtrātīta.

Vāyu, distending the bladder and rectum, obstructing them, produces a mobile, elevated / aṣṭhīlā causing intense pain, which blocks the passages of urine and feces.

When one suppresses urine, vāyu is enraged in the bladder due to the suppression;
that is called vātabasti, [characterized] by urinary retention, pain, and itching.

Uṣṇavāta, drying the urine with its heat so that it becomes hot, reddish, and yellowish,
discharges it with difficulty, accompanied by pain and burning in the bladder and penis.

Vitiated by the obstruction of its passage, vāyu moves upward in the receptacle and tract
of the urine; bent, distorted, and coiled,

it impairs the urine with rigidity, aches, heaviness, and cramping,
accompanied by severe pain and retention of urine and feces; this is vātakuṇḍalikā.

Blood vitiated by vāta and kapha forms a very severe nodule
at the bladder outlet; obstructed by it, one discharges urine with difficulty.

They declare that to be raktagranthi, with pain resembling that of a calculus.
When, in one who is dry and weak, feces moved upward by vāta

enters the urinary channels, then the man urinates mixed with feces
and smelling of feces with difficulty; one should diagnose it as viḍvighāta.

From rapid travel, leaping, exertion, trauma, or compression,
the bladder, displaced from its proper place, rests enlarged like a fetus.

Afflicted with colic, throbbing, and burning, he passes urine even drop by drop;
when pressed, however, he emits a stream, afflicted by rigidity and cramping pain.

They call that bastikuṇḍala, dreadful, resembling a weapon or poison,
predominantly caused by vāta, and usually hard to avert by the ignorant.

When it is accompanied by pitta, there is burning, colic, and discoloration of urine;
by kapha, heaviness, swelling, and unctuous, thick, white urine.

The bladder whose opening is blocked by kapha, or violently excited by pitta, is not cured;
that with an undisplaced opening is curable, but not that which has become coiled.

When the bladder has become coiled, there would be fainting of the heart and dyspnea;
having observed the excess of the doṣas, one should overcome these with remedies that remove dysuria.

For all of them, one should administer an enema and an uttarabasti;
the urethral pipe for the uttarabasti should be made of gold, smooth,

equal [in thickness] to the stalk of a mālati flower or the aśvahan flower, shaped like a cow's tail,
or made of silver, with an aperture the size of a mustard seed, having two ears, and twelve finger-breadths long.

Using that, attached to a goat's bladder, one should administer half a pala of unctuous substance,
or determine the dosage of unctuous substance according to the particular age.

When he has bathed, eaten a meal with meat soup or milk,
and passed the urges of feces and urine, seated comfortably erect on a soft stool level with his knees,

while the penis is erect, having probed the passage with a probe smeared with ghee,
if it passes unhindered,

one should then insert the urethral pipe according to the length of the penis;
just as in the case of the rectum, one should guide it along the raphe through the urinary tract.

Inserted too far, it injures the bladder; if too shallow, the unctuous substance does not enter.
Pressing comfortably without shaking, one should withdraw the pipe.

When it has returned, one should administer a second and a third;
if it does not return, it should be disregarded; and for one who has stayed overnight,

having prepared a suppository with pippalī, salt, soot, apāmārga, and mustard,
with juice of vārtāku, nirguṇḍī, śampāka, and sahācara,

ground with urine and sour liquid, along with jaggery, one should insert it,
shaped like a mustard seed at the tip, and measured like a black gram in its rear half,

of the length of the pipe, smeared with ghee, delicate, and unbreakable,
into the urinary tube as with the pipe, and into the rectum measured like a thumb.

When the unctuous substance has returned from both, the regimen is that of an unctuous enema,
as well as the period of avoidance, along with the complications and the characteristics of proper administration.

For women, however, one should perform that treatment at the time of menstruation;
for then, her womb being receptive, she easily takes up the unctuous substance, since it is open.

Then, once vāta is subdued, the vagina quickly receives the embryo.
In disorders originating in the bladder, in those arising from prolapse of the uterus,

in severe uterine pain, in uterine disorders, in menorrhagia,
and when urine does not flow, or flows drop by drop,

one should administer an uttarabasti prepared with appropriate medicaments.
The length of the pipe for women, however, should be ten finger-breadths,

having the circumference of the urinary channel and an aperture carrying a mung bean;
into the genital tract of women, it should be inserted four finger-breadths,

two finger-breadths into the urinary passage, but one finger-breadth for a young girl;
lying on her back, having properly drawn up both thighs,

one should then guide her pipe comfortably following the spinal axis;
one should apply the unctuous substances two, three, or four times in a day and night

into the bladder; and when administered into the bladder, the suppository should be thicker.
One should perform the procedure for three nights, increasing the dose of unctuous substance.

By this very method, one should perform the procedure again after three days.
Hereafter, some varieties of head disorders will be described.

Blood, pitta, and vāta, vitiated and intensified in the temporal region,
produce a severe swelling accompanied by intense pain, burning, and redness.

That, possessing the velocity of poison, rapidly obstructing the head as well as the throat,
destroys life in three nights; by name, it is called śaṅkhaka.

If he survives beyond three days, having pronounced it incurable, one should perform treatment:
head purgation, pouring of liquids, and everything that relieves erysipelas.

By dry food, excessive eating, east wind, frost, sexual intercourse,
suppression of natural urges, strain, and physical exercise, vāta is aggravated;

either alone or with kapha, seizing half of the head,
it produces severe pain in the neck, eyebrow, temple, ear, eye, and half the forehead,

resembling [being pierced by] a weapon or a fire-churn; that is ardhāvabhedaka;
if excessively aggravated, it may destroy the eye or the ear.

The highest dose of the four fats, purgation of head and body,
tube fomentation, old ghee, enema treatment, and unctuous enemas,

poultices, head enemas, and cauterization are praised here,
as well as whatever treatment is prescribed for chronic catarrh and head disease.

From suppression [of urges], indigestion, and the like, vitiated blood and vāyu
vitiate the brain; and that [brain], vitiated and intensified by them,

melts slowly from the heat of the rays at sunrise;
then during the day the headache increases with the progress of the day.

At the decline of day, when the brain solidifies, it completely subsides;
that would be sūryāvarta. For that, ghee taken after a meal,

purgation of the head and body, applying three fats to the head,
poultices with meat of arid-land animals, and affusion with ghee and milk [are indicated].

Ghee obtained from milk boiled with peacock, partridge, common quail, and the like,
prepared with the vitalizing group and eight parts of milk, should be used as nasal drops.

Due to fasting, excessive grief, and eating food that is excessively dry, cold, or meager, the three doṣas are vitiated,
[producing] pain in the neck, back of the head, and temples.

cause severe [pain], which settles in the eyes, brows, and temples, / producing twitching of the cheeks and face, eye diseases, and lockjaw.

That is anantavāta; one should overcome it by vein venesection and remedies that pacify sūryāvarta. / Vāta, aggravated by dry things and the like, may produce tremor of the head.

In that condition, unction, sudation, and the like that pacify vāta using amṛtā, balā, rāsnā, mahāśvetā, and aśvagandhā, / as well as nourishing nasal medication, are commended.

And one who knows the scriptures should administer nasal procedures in diseases of the head, / for the nose is the gateway to the head; having pervaded it through that [channel], it destroys them.

Nasal drops, pressed juice [instillation], powder blowing, smoking, / and touch-inunction are to be known as the fivefold nasal procedure.

Nasal drops are taught to be of two kinds: oleating and purifying; / and the pressed juice [instillation] is considered twofold: purifying and arresting.

Blowing of powder purifies the bodily channels; / and smoking, previously explained as soothing and so forth, is known to be of three kinds.

Touch-inunction should be an unctuous [application], harmless, accomplishing both purposes; / thus that procedure is threefold: evacuating, nourishing, and soothing.

In head disorders caused by kapha, such as stiffness, numbness, heaviness, and the like, / the nasal procedure of head purgation is praised.

And in diseases born of vāta, such as tremor of the head, facial paralysis, and the like, / the nasal procedure of nourishing the head is praised.

In diseases such as internal hemorrhage, soothing nasal medication is desired; / blowing and inhalation of smoke are commended in appropriate cases.

[Having carefully examined the doṣas and other factors, the physician should properly perform it.] The medicine consisting of fruits and the like that is taught for head purgation—

one should prepare that as a powder, and with it cook an unctuous medicine for purgation. / The medicine taught in the sweet group should be used for nourishing.

Having prepared the unctuous substance, the physician who knows the rules should administer nasal drops / early when the sun rises, or at midday, to one who has already attended to necessary duties,

lying supine comfortably on a well-spread bed, / with the head hanging down slightly and the feet slightly raised.

The intelligent physician should instill the nourishing unctuous substance into the nostrils. / Nasal medication given to one whose head is not lowered does not reach the head;

the nasal medication of one whose head is excessively lowered remains in the brain. / Therefore, for one lying in this manner, he should foment the head for purification.

Having fomented it, raising the nose with the thumb-joint of the left / hand, he should then administer it equally in both nostrils with the right.

With a tube or a cotton swab, he should administer the nasal unctuous substance according to rule; / and when it is done, he should foment again and draw out repeatedly

that unctuous substance along with kapha, so that the fat does not remain; / for kapha excited by the fomentation, present during the nasal procedure,

thickens subsequently in the head due to the coldness of the unctuous substance; / thence it leads to disorders in the ears, neck, throat, and so on.

Therefore, when the nasal procedure is completed, he should inhale smoke that destroys kapha; / he should eat wholesome food, stay in a wind-free and warm place, and control his senses.

This procedure is for the pressed juice [instillation]; as for powder blowing, / he should blow the powder into the nose with a tube of six aṅgulas by mouth.

Having made one whose head is purged drink warm water, [the physician] should feed him / food that is light and not incompatible with the three [doṣas], staying alert in a wind-free place.

If a person purified by evacuation indulges in things that provoke a doṣa, / that doṣa, circulating there, produces many of its own disorders.

The wise [physician] should perform the treatment prescribed for each of them, / in accordance with the diseases arising from unseasonable action.

In indigestion, after taking a meal, after drinking water, on a cloudy day, / in fresh coryza, after bathing, after drinking fat, and after an unctuous enema,

oleating nasal drops produce many diseases born of kapha; / there, all methods that remove kapha, sharp, warm, and the like, are beneficial.

In an emaciated person, one purged, in pregnancy, one fatigued by exercise, or in thirst, / vāta, enraged by dry nasal medication, may produce its own disorders.

There, every regimen that pacifies vāta, oleating and nourishing, / fomentation, and so forth, is [prescribed]; ghee and milk especially for a pregnant woman.

One should manage cataract in those tormented by fever and grief, and in a drinker of liquor, / by means of dry, cold collyriums, pastes, and cup-cookings.

Nasal drops are considered twofold: oleating and purifying; / but touch-inunction serves the purpose of nasal medication and is without fault.

One should always apply an unctuous finger to the nose in the morning and at night, / and should not forcefully inhale; that touch-inunction produces firmness in the healthy.

Here are two verses:

Since there are three primary vital points, when they are afflicted, / the symptoms, treatment, and varieties of diseases along with their medicaments,

the procedure of the urethral/vaginal enema, and the procedure of nasal medication, / along with the treatment of complications, have been proclaimed in the Success Regarding Vital Points.

Thus, in the treatise made by Agniveśa, redacted by Caraka, and, being incomplete, completed by Dṛḍhabala, in the section on Successful Formulations, the ninth chapter entitled 'Success [in Treating] the Trio of Vital Points' is concluded. //9