The Compendium of Caraka 2

English (machine translation) 2

Language: English

2.1 — 64 parts
2.2 — 34 parts
2.3 — 28 parts
2.4 — 62 parts
2.5 — 33 parts
2.6 — 41 parts
2.7 — 28 parts
2.8 — 53 parts

2.1.1

Now we shall expound the etiology of fever.

2.1.3

Here, indeed, hetu, nimitta, āyatana, kartṛ, kāraṇa, pratyaya, samutthāna, and nidāna are synonymous.

2.1.3_1

It is threefold: unwholesome contact with sense objects, error in judgment, and transformation.

2.1.4

From these, three kinds of diseases arise: fiery, watery, and airy; and others are twofold: rajasic and tamasic.

2.1.5

There, vyādhi, āmaya, gada, ātaṅka, yakṣman, jvara, vikāra, and roga are synonymous.

2.1.6

Its apprehension is by means of etiology, premonitory symptoms, symptoms, therapeutic suitability, and pathogenesis.

2.1.7

There, etiology (nidāna) has been stated previously as ‘cause’.

2.1.8

Premonitory symptom (pūrvarūpa) is the sign of a disease prior to its arising.

2.1.9

Symptom (liṅga), on the other hand, is the manifested sign. There, liṅga, ākṛti, lakṣaṇa, cihna, saṃsthāna, vyañjana, and rūpa are synonymous.

Therapeutic suitability (upaśaya), moreover, is the application of medicines, diet, and conduct that are contrary to the cause or disease, or that produce an effect contrary to them, resulting in relief.

2.1.11

Pathogenesis (saṃprāpti), jāti, and āgati are synonymous with respect to disease.

2.1.12

It is differentiated by distinctions of number, dominance, variety, fractional distribution, strength, and time.

2.1.12_2

Number, to begin with, is such as: eight fevers, five abdominal swellings, seven dermatoses, and so forth.

2.1.12_3

Dominance, moreover, is discerned through the degrees and superlative degrees of the doṣas.

2.1.12_1

Between two [doṣas], there is the comparative degree (-tara); among three, the superlative (-tama).

2.1.12_4

Variety (vidhi) is twofold by the division into innate and exogenous; threefold by the division into the three doṣas; and fourfold by the division into curable, incurable, mild, and severe.

2.1.12_5

Fractional distribution (vikalpa), moreover, in this context means the breakdown according to the fractional strength of each combined doṣa.

2.1.12_6

The distinction of strength and time (balakālaviśeṣa) of diseases, furthermore, is determined by the specific rules governing seasons, day and night, and meal times.

2.1.13

Therefore, a physician whose mind and intellect are unimpaired should properly understand diseases through factors such as etiology and the rest.

2.1.14

Thus the concise summary of the subject matter of the Nidānasthāna has been set forth.

2.1.14_1

Teaching it in detail, we shall explain it further from this point onward.

2.1.15

There, first of all, we shall explain the first eight diseases arising from greed, malice, and anger in regular order beginning with their etiology, as well as a mere aphoristic summary of their therapeutics.

2.1.15_1

And in the [section on] therapeutics, we shall subsequently explain the accumulated disorders in detail.

2.1.16

Here indeed, fever is taught first among disorders, because it is the foremost among somatic diseases.

2.1.17

Now indeed, fever arises in human beings from eight causes; that is to say: from vāta, from pitta, from kapha, from vāta and pitta, from vāta and kapha, from pitta and kapha, from vāta, pitta, and kapha, and from an exogenous [factor] as the eighth cause.

2.1.18

We shall explain its distinctive etiologies, premonitory symptoms, signs, and therapeutic suitabilities.

2.1.19

Vāyu becomes aggravated by excessive indulgence in dry, light, and cold [foods and regimens]; excessive application of emesis, purgation, non-unctuous enema, and errhines; exercise; suppression of natural urges; fasting; trauma; sexual intercourse; anxiety; grief; excessive bloodletting; staying awake at night; and awkward bodily postures.

2.1.20

When aggravated, it enters the stomach, mixes with the bodily heat, reaches the primary tissue resulting from the digestion of food called chyle (rasa), blocks the channels carrying chyle and sweat, impairs the digestive fire, expels the heat outward from the seat of digestion, and spreads through the entire body; then it produces fever.

2.1.21

Its signs are as follows: irregular onset and relief; irregularity of temperature; instability of fever between mild and intense states; arrival or increase of fever at the end of digestion, at the end of day, at the end of night, or at the end of summer; especially a rough, reddish-brown discoloration and excessive emaciation of nails, eyes, face, urine, feces, and skin; various types of shifting pains in various body parts, such as: numbness in the feet, cramps in the calves, a sense of dislocation in the knees and in all joints, fatigue in the thighs, and a feeling as if broken, aching, crushed, churned, cracked, torn, and compressed in the waist, flanks, back, shoulders, arms, scapulae, and chest; stiffness of the jaws; ringing in the ears; piercing pain in the temples; astringent taste in the mouth or tastelessness; dryness of the mouth, palate, and throat; thirst; tightness in the chest; dry vomiting; dry cough; suppression of sneezing and belching; aversion to the taste of food; excessive salivation, anorexia, and indigestion; dejection, yawning, bending of the body, trembling, exhaustion, giddiness, delirium, sleeplessness, horripilation, and teeth-chattering; desire for warmth; unsuitability of things mentioned in the etiology and suitability of their opposites—these are the signs of vāta fever.

2.1.22

Pitta becomes aggravated by excessive indulgence in hot, sour, salty, alkaline, pungent foods, and eating before the previous meal is digested; as well as from intense exposure to the sun and fire, exertion, anger, and irregular diet.

2.1.23

When aggravated, it approaches the heat of the stomach, reaches the primary tissue resulting from the digestion of food called chyle, blocks the channels carrying chyle and sweat, impairs the digestive fire due to its liquidity, expels the heat outward from the seat of digestion, and, causing distress, spreads through the entire body; then it produces fever.

2.1.24

Its signs are as follows: simultaneous arrival or increase of fever throughout the entire body, especially at the time of digestive combustion, at midday, at midnight, or in autumn; pungent taste in the mouth; inflammation of the nose, mouth, throat, lips, and palate; thirst; intoxication; giddiness; fainting; vomiting of bile; diarrhea; aversion to food; prostration; exhaustion; delirium; appearance of red circular eruptions on the body; greenish-yellow discoloration of nails, eyes, face, urine, feces, and skin; excessive intensity of temperature; extreme burning sensation; desire for coldness; unsuitability of things mentioned in the etiology and suitability of their opposites—these are the signs of pitta fever.

2.1.25

Śleṣman becomes aggravated by excessive indulgence in unctuous, heavy, sweet, slimy, cold, sour, and salty [foods]; daytime sleep; rejoicing; and lack of physical exercise.

2.1.26

When aggravated, it enters the stomach, mixes with the bodily heat, reaches the primary tissue resulting from the digestion of food called chyle, blocks the channels carrying chyle and sweat, impairs the digestive fire, expels the heat outward from the seat of digestion, and, causing distress, spreads through the entire body; then it produces fever.

2.1.27

Its signs are as follows: simultaneous arrival or increase of fever throughout the entire body, especially immediately after eating, in the forenoon, in the early part of the night, or in spring; heaviness of the body; lack of desire for food; excessive salivation of phlegm; sweetness in the mouth; nausea; sensation of coating in the heart region; feeling of being wrapped in a wet cloth; vomiting; sluggishness of the digestive fire; excessive sleep; stiffness; drowsiness; cough; dyspnea; catarrh; coldness, and whiteness of nails, eyes, face, urine, feces, and skin; and cold eruptions arising profusely on the limbs; desire for warmth; unsuitability of things mentioned in the etiology and suitability of their opposites; thus are the signs of śleṣman fever.

2.1.28

Due to irregular eating, fasting, change of diet, vitiation of the seasons, smelling unsuitable odors, consuming poisoned water, slow poisons, proximity to mountains, improper administration of unction, fomentation, emesis, purgation, non-unctuous enema, unctuous enema, and head evacuation, or faulty post-therapeutic regimens, and in women due to abnormal childbirth and improper care after delivery, as well as due to a combination of the aforementioned causes, either any one pair of doshas or all three doshas simultaneously become aggravated according to their etiologies; being aggravated, they produce fever following that very same sequence.

2.1.29

There, one should recognize either a dual-dosha fever or a fever born of all three doshas (sānnipātika) by observing the specific combination of the symptoms of fever described in that manner.

2.1.30

Fever arising from external causes (āgantu) is indeed the eighth, preceded by pain, originating from trauma, possession or emotional affliction, sorcery, and curses.

2.1.30_1

Existing for some time purely as an external affliction, it is later joined by the doshas.

2.1.30_2

Among these, that born of trauma is accompanied by vāta residing in vitiated blood; that born of possession or emotional affliction by vāta and pitta; but those born of sorcery and curses are accompanied by all three doshas together.

2.1.31

It should be understood as distinct from the seven varieties of fever because of its distinct signs, therapeutic management, and onset; and it is treated with common therapy.

2.1.31_1

Thus the eightfold nature of fever has been declared.

2.1.32

Fever, however, is singular in having burning heat (saṃtāpa) as its characteristic.

2.1.32_1

Physicians declare it to be of two kinds according to specific intention, and by virtue of the distinction between innate (nija) and external (āgantu).

2.1.32_2

There, physicians declare the innate to be of two kinds, three kinds, four kinds, and seven kinds, according to the fractional distribution of vāta and the others.

2.1.33

Its premonitory symptoms are as follows: bad taste in the mouth, heaviness of the body, lack of desire for food, blurred eyes, watering of the eyes, excessive sleep, restlessness, yawning, stooping, trembling, fatigue, giddiness, delirium, sleeplessness, horripilation, tingling teeth, alternating tolerance and intolerance of sound, cold, wind, and sunshine, anorexia, indigestion, weakness, body aches, malaise, shortness of breath, procrastination, laziness, decline in regular duties, aversion to one's own tasks, indignation at the words of elders, dislike for children, unconcern for one's duties, discomfort from garlands, unguents, and food, aversion to sweet edibles, and fondness for sour, salty, and pungent things—these are the premonitory symptoms of fever before burning heat occurs; and they continue to accompany the sufferer even when afflicted by burning heat.

2.1.34

In this way, these symptoms of fever have been explained one by one, in detail and in brief.

2.1.35

Fever, indeed, originated from the anger of Maheśvara; it takes the life of all living beings, causes burning torment to the body, sense organs, and mind, diminishes intelligence, strength, complexion, joy, and enthusiasm, and produces fatigue, exhaustion, confusion, and obstruction to food intake. It is called jvara because it torments (jvarayati) the body; no other diseases are so dreadful, so full of complications, and so difficult to cure as this one.

2.1.35_1

It is the overlord of all diseases, and it is designated by diverse names among various animal species.

2.1.35_2

All living beings are born with fever and die with fever; it is the great delusion, overcome by which embodied beings do not remember any deed of their previous life, and in the end it is fever alone that takes away the lives of all living beings.

2.1.36

There, upon seeing the premonitory symptoms or at the onset of fever, a light diet or reducing therapy (apatarpaṇa) is beneficial, because fever originates in the stomach; thereafter, decoction drinks, massage, unction, fomentation, poultices, affusion, unguents, emesis, purgation, non-unctuous enema, unctuous enema, pacification therapy, errhine therapy, fumigation, medicated smoking, collyrium, and regimen of milk and food should be administered appropriately according to reason.

2.1.37

In all chronic fevers, however, the drinking of clarified butter prepared with appropriate drugs is praised; for clarified butter pacifies vāta due to unctuousness, kapha due to processing, and pitta and bodily heat due to coolness; therefore, in all chronic fevers, clarified butter is beneficial like water on things scorched by fire.

2.1.38

And here are [the verses]:

2.1.38_1

Just as people sprinkle a blazing house with water / desiring it to be extinguished, so is ghee in chronic fever.

2.1.39

Due to unctuousness it pacifies vāta, due to coolness it restrains pitta; / though having qualities similar to the dosha, ghee overcomes kapha by processing.

2.1.40

No other unctuous substance adapts to processing in such a manner / as clarified butter; hence clarified butter is considered the best of all unctuous substances.

2.1.41

A subject stated in prose that is subsequently sung in verses / to clarify its meaning is not censured as redundant.

2.1.42

Here are the verses:

2.1.42_1

The three kinds of synonyms for etiology, the fivefold disease, / the synonyms for disease symptoms, the fivefold comprehension of disease,

2.1.43

The eightfold fever, its remote and immediate causes, / its premonitory symptoms, symptoms, and treatment in brief—

2.1.44

All this the venerable Punarvasu, free from fever [and grief], expounded / in the section on etiology regarding fever,

2.1.44_1

To the bowed Agniveśa.

2.1.44_2

Thus, in the section on etiology of the compendium composed by Agniveśa and redacted by Caraka, ends the first chapter, entitled "Etiology of Fever." //1

2.2.1

Now we shall explain the etiology of bleeding disorders (raktapitta).

2.2.2

Thus spoke the venerable Ātreya.

2.2.3

How pitta in reality acquires the designation 'lohitapitta' [blood-bile], that we shall explain.

2.2.4

When a person mostly eats grains such as wild barley, uddālaka, and koradūṣa, or other food that is intensely hot and sharp, accompanied by alkaline preparations and soups of flat beans, black gram, and horse gram; or moistened with curd, curd water, buttermilk, whey, or sour kāñjika; or meat of wild boar, buffalo, sheep, fish, or cattle, served with oil-cake, piṇḍālu, and dried leafy greens; or side-dishes of radish, mustard, garlic, karañja, moringa, red moringa, sour buttermilk soup, ginger-grass, sumukha, basil, kuṭheraka, gaṇḍīra, kālamālaka, parṇāsa, kṣavaka, and phaṇijjaka; or with after-drinks mostly consisting of surā, sauvīraka, tuṣodaka, maireya, medaka, madhūlaka, vinegar, and sour preparations of jujube or small jujube; or eats excessively of flour-based pastries; or, oppressed by heat, drinks unboiled milk in excessive amounts or out of season; or consumes along with milk the flesh of rauhiṇīka or a one-eyed pigeon cooked in mustard oil and alkali; or, oppressed by heat, drinks milk together with horse gram, oil-cake, rose-apple, monkey-jack cooked preparations, or vinegars—as he behaves in this manner, his pitta becomes provoked, and his blood exceeds its own normal measure.

2.2.4_1

When that [blood] exceeds its normal measure, the provoked pitta, spreading throughout the body, reaches the orifices of the blood-carrying channels that arise from the liver and spleen—which are heavy due to the congestion of blood—blocks them, and corrupts that very blood.

2.2.5

Because of contact [with blood], because of corrupting blood, and because of taking on the smell and colour of blood, pitta is called lohitapitta [blood-bile].

2.2.6

Its premonitory symptoms are these: namely—aversion to food; digestive combustion of what has been eaten; eructations having the smell and taste of vinegar-sourness; frequent emergence of vomiting; disgusting appearance of what has been vomited; hoarseness of voice; lassitude of the limbs; burning sensation all over; a feeling as if smoke were issuing from the mouth; a smell of iron, blood, or raw fish in the mouth; redness, greenness, or yellowness of the limbs, body parts, feces, urine, sweat, saliva, nasal mucus, and the excretions of the mouth and ears, as well as eruptions and boils; aching in the limbs; and frequent seeing in dreams of objects that are red, blue, yellow, or greyish-black and radiating light—[these are the premonitory symptoms of lohitapitta].

2.2.7

Its complications indeed are: debility, anorexia, indigestion, dyspnea, cough, fever, diarrhea, swelling, consumption, jaundice, and hoarseness of voice.

2.2.8

Moreover, its pathways are two: the upward and the downward.

2.2.8_1

In a body abounding in phlegm, moving upward owing to its association with phlegm, it flows out from the ears, nose, eyes, and mouth; but in a body abounding in wind, moving downward owing to its association with wind, it flows out from the pathways of urine and feces; and in a body abounding in both phlegm and wind, owing to its association with phlegm and wind, it takes to both pathways, and taking to those two pathways, it flows out from all the aforesaid orifices of the body.

2.2.9

Among these, that which takes the upward path is curable, because it can be treated by purgation and because of the abundance of medicines [available for it]; that which takes the downward path is manageable, because it can be treated by emesis and because of the scarcity of medicines; that which takes both paths is incurable, because emesis and purgation are not applicable and because no medicines can be employed.

2.2.10

The provocation of raktapitta indeed arose in ancient times upon the destruction of Dakṣa's sacrifice, following fever, in living beings whose bodies and vital breaths were pervaded by the fire of Rudra's wrath and fury.

2.2.11

For the swift pacification of this fast-acting, urgent affliction that has fallen like a forest fire, an attentive [physician] must make an effort, having considered the dosage, the habitat, and the season, by means of nourishing therapy or reducing therapy, with articles of food and drink that are mild, sweet, cooling, bitter, and astringent, or with poultices, sprinklings, immersion baths, tactile applications, or emesis and the like.

2.2.12

And here are [the verses]:

2.2.12_1

That lohitapitta is curable which moves upward,
because purgation is applicable and because medicines are plentiful.

2.2.13

Purgation is the supreme medicine for conquering pitta,
and for the phlegm that is associated with it there, it is traditionally regarded as not inferior.

2.2.14

Sweet medicine would also be suitable in that condition;
therefore, the blood that moves upward is considered curable.

2.2.15

The blood, however, that moves downward is determined to be manageable,
because emesis has limited applicability and because medicines are scarce.

2.2.16

For emesis is not declared to be best in expelling pitta,
and for the pacification of the wind that is associated with it there, it is traditionally regarded as inferior.

2.2.17

Astringent and bitter [medicines] are also unsuitable in that condition;
therefore, that which moves downwards is declared to be manageable.

2.2.18

The raktapitta, however, that takes to both pathways
should be known as incurable, precisely for the reason stated earlier.

2.2.19

For there is no purification whatsoever that acts counter to its path,
and elimination in the direction opposite to the path is prescribed in raktapitta.

2.2.20

Likewise, no pacification is found that works in every way,
and when doshas are combined, a pacifying treatment is thought to be one that conquers all.

2.2.21

Thus has blood[-bile] of three kinds of outcome been described according to the difference in pathways;
but for the following reasons a curable condition may fail to be cured:

2.2.22

Due to absence of attendants and equipment, wicked conduct [of the patient], error of the physician,
or lack of proper treatment, a disease transgresses its curability.

2.2.23

In that matter, [one form of] incurability would arise from the transition out of curability and manageability;
this diagnostic knowledge of raktapitta is taught for it:

2.2.24

That which is black or blue, or resembles a rainbow,
and that raktapitta which stains cloth, is incurable;

2.2.25

and that which is intensely foul-smelling, excessive, accompanied by all complications,
and occurs during loss of strength and muscle tissue—that blood is incurable.

2.2.26

And a man afflicted with raktapitta who sees
visible objects and the sky as red—that is incurable without a doubt.

2.2.27

Among these, the incurable should be rejected; the manageable, one should sustain with effort;
and the curable, the attentive physician should cure with proven remedies.

2.2.28

Here are the two concluding verses:

2.2.28_1

The cause, the derivation of the name, the premonitory symptoms, the complications,
the two pathways, the secondary association of doshas, and curability or non-curability with reasons—

2.2.29

Punarvasu, free from delusion, passion, faults, greed, pride, intoxication, and longing,
has proclaimed in this etiology of raktapitta.

2.2.29_1

Thus ends the second chapter, titled 'The Etiology of Bleeding Disorders (Raktapitta)', in the Section on Etiology (Nidānasthāna) of the treatise composed by Agniveśa and redacted by Caraka. //2

2.3.1

Now we shall explain the etiology of abdominal swellings (gulma).

2.3.2

Thus spoke the venerable Ātreya.

2.3.3

Here, indeed, there are five abdominal swellings (gulma); they are as follows: wind gulma, bile gulma, phlegm gulma, gulma from accumulation [of all three doshas], and blood gulma.

2.3.4

To the venerable Ātreya speaking thus, Agniveśa said: 'How, O venerable one, do we distinguish among the five gulmas here? For a physician, even if knowledgeable about remedies, is not capable of alleviating diseases if he does not know their distinguishing features.'

2.3.5

The venerable Ātreya said to him: 'O Agniveśa, the distinguishing knowledge of gulmas as well as of other diseases arises from the specific differences in their etiology, premonitory symptoms, signs, pains, and therapeutic suitability. Listen to that as it is declared regarding gulmas.

2.3.6

When a person of wind constitution, emaciated especially by any one manifestation among fever, vomiting, purgation, or diarrhea, takes wind-increasing food, or especially cold [food] in excessive quantity; or drinks emetics or purgatives without prior unction; or induces unprovoked vomiting, or suppresses the provoked urges of flatus, urine, and feces; or, having overeaten, drinks freshly drawn water in excessive quantity; or travels by an excessively jarring vehicle; or is fond of excessive sexual intercourse, exercise, wine, and grief; or sustains trauma; or is accustomed to improper sitting, lying, standing, and walking; or undertakes any other such improper and excessive form of physical exertion—from his improper conduct, the wind becomes provoked.

2.3.7

That provoked wind, having entered the great channel (mahāsrotas), having enveloped [the part] that has become hardened through dryness, becomes massed into a ball and establishes a seat in the heart, in the urinary bladder, in the flanks, or in the navel; it produces colic and diverse kinds of nodular lumps, and remains massed into a ball; because it is massed into a ball (piṇḍita), it is called "gulma"; it swells at one moment and subsides at another moment; its pain is indefinite, broad, or minute because of the instability of wind; it frequently feels as if ants are crawling over the limbs; it abounds in the sudden onset and disappearance of pricking, bursting, throbbing, stretching, constriction, numbness, horripilation, and fainting; the patient afflicted with it considers himself pierced as if with needles or stakes; moreover, at the end of the day he develops fever, his mouth becomes dry, his breathing is obstructed, and his body hair stands on end when the pain manifests; splenomegaly, abdominal distension with rumbling, intestinal gurgling, indigestion, upward movement of wind, body aches, stiffness of the neck, and pain in the head, temples, and groin afflict him; his skin, nails, eyes, face, urine, and feces become blackish-red and rough; things declared as its etiology do not suit him, and opposite things do suit him—thus is wind gulma.

2.3.8

However, in one emaciated by those very same reducing factors, through the use of sour, salty, pungent, alkaline, hot, sharp, spoiled vinegar, wine, green vegetables, sour fruits, and burning foods such as greens, grains, meats, and the like; through eating before the previous meal is digested and overeating; and in one whose stomach has become dry, through excessively untimely vomiting, through suppression [of urges], and through excessive exposure to wind and sun—the bile becomes provoked along with the wind.

2.3.9

That provoked wind, having gathered the bile in a portion of the stomach, produces those very varieties of pain that were described in wind gulma; but the bile burns him in the abdomen, in the heart, in the chest, and in the throat; being burnt, he belches a smoky-like eructation accompanied by sourness; the site of his gulma burns, aches, fumes, feels heated, perspires, becomes moist, feels relaxed, becomes intolerant to touch, and has slight horripilation; fever, dizziness, burning sensation, thirst, dryness of the throat, palate, and mouth, bewilderment, and loose stools afflict him; his skin, nails, eyes, face, urine, and feces become green or yellow; things declared as its etiology do not suit him, and opposite things do suit him—thus is bile gulma.

2.3.10

However, in one emaciated by those very same reducing factors, through overeating; through eating foods that are excessively unctuous, heavy, sweet, and cold; through consuming flour products, sugarcane, milk, sesame, black gram, and molasses preparations; through excessive drinking of immature wine; through excessive consumption of fresh greens; through excessive eating of meat from marshland, aquatic, and domesticated animals; through suppression [of urges]; through excessive drinking of water when not hungry; or through violent agitation of the body—the phlegm becomes provoked along with the wind.

2.3.11

That provoked wind, having gathered the phlegm in a portion of the stomach, produces those very varieties of pain that were described in wind gulma; but the phlegm produces in him cold fever, anorexia, indigestion, body aches, horripilation, heart disease, vomiting, sleepiness, laziness, rigidity, heaviness, and burning headache; furthermore, stability, heaviness, hardness, deep-seatedness, and numbness of the gulma; likewise, when excessively increased, it produces cough, dyspnea, coryza, and consumption (rājayakṣmā); it produces whiteness in the skin, nails, eyes, face, urine, and feces; things declared as its etiology do not suit him, and opposite things do suit him—thus is phlegm gulma.

2.3.12

However, upon the combination of the causes and signs of all three doshas, the experts designate it as a gulma born of all three doshas (sānnipātika).

2.3.12_1

That gulma from accumulation [of all three doshas] (nicayagulma) is incurable because its treatments are mutually contradictory.

2.3.13

Blood gulma, however, occurs only in a woman, not in a man, on account of the distinction of the womb and the flow of menstrual blood.

2.3.13_1

In a woman who, out of dependence, lack of confidence, or constant deference to etiquette, suppresses provoked urges; or who, when an immature fetus has recently miscarried, or when she has recently given birth, or during menstruation, indulges in wind-provoking factors, the wind quickly becomes provoked.

2.3.14

That provoked wind, entering the mouth of the vagina, obstructs the menstrual blood; that menstrual blood, being obstructed month after month, enlarges the abdomen.

2.3.14_1

In her, colic, cough, diarrhea, vomiting, anorexia, indigestion, body aches, sleepiness, laziness, rigidity, and excessive salivation of phlegm arise; milk appears in the breasts; blackness of the lips and the areolas of the breasts; extreme fatigue of the eyes, fainting, nausea, pregnancy cravings, swelling of the feet, slight emergence of the abdominal line of hair, widening of the vaginal orifice, and also foul odor and discharge from the vagina arise; and her gulma throbs only as a solid mass; fools declare her, who is not pregnant, to be pregnant.'

2.3.15

Prior to the manifest appearance of these five gulmas, these premonitory symptoms arise; namely: lack of desire for food, anorexia and indigestion, irregularity of the digestive fire, burning of what has been eaten, untimely vomiting and eructation at the time of digestion, non-appearance of the urges of wind, urine, and feces, and non-passage or slight passage of those that have appeared, wind colic, abdominal distension, rumbling in the intestines, lack of erection, retention of feces, lack of hunger, debility, and intolerance of satiety.

2.3.16

In all these gulmas, indeed, no gulma arises without wind.

2.3.16_1

Among them, knowing one born of all three doshas to be incurable, he should not undertake its treatment at all; but in one born of a single dosha, he should apply the procedure specific to it, and he should treat those born of combined doshas with a combined measure.

2.3.16_2

Whatever else he considers unopposed [to the treatment], that too he should administer, distinguishing the gravity and lightness of the complications; acting with urgency, he should treat the severe complications, and the others subsequently.

2.3.16_3

If acting with urgency and not discerning any particular [dosha], he should apply the treatment for wind in emergencies involving gulmas: unction and sudation which remove wind, mild purgation combined with unctuous substances, and enemata; and he should administer sour, salty, and sweet tastes with proper method.

2.3.16_4

For when wind has been pacified, any other dosha too can be controlled in gulmas with even slight effort.

2.3.17

And on this there is [a verse]:

2.3.17_1

The pacification of wind in gulma patients must be carried out in every way according to rule by appropriate means;
for when wind is conquered, even a slight measure destroys any other aggravated dosha.

2.3.18

There is a verse here:

2.3.18_1

The number, etiology, symptoms, and also the premonitory symptom,
and a part of the therapeutic measures for gulmas have been stated in [this] etiology section.

2.3.18_2

Thus ends the third chapter, named 'Etiology of Gulma', in the Section on Etiology in the compendium composed by Agniveśa and redacted by Caraka. 3.

2.4.1

Now we shall explain the etiology of prameha [urinary disorders].

2.4.2

Thus spoke the venerable Ātreya.

2.4.3

Due to provocation of all three doshas, there are twenty varieties of prameha, and countless other disorders.

2.4.3_1

Here, we shall expound how provocation of the three doshas brings about the pramehas.

2.4.4

In this world, indeed, from the particular variations in etiology, doshas, and dūṣyas [vitiable tissues], there arise the specific variations in the existence or non-existence of prevention of disease.

2.4.4_1

For when these three particular factors—etiology and so forth—do not combine with one another, or are weaker due to the lapse of time, or do not combine [completely], then manifestation of disease does not occur; or they manifest after a long time, or are slight, or lack all the stated symptoms; in the opposite case, it is the reverse. Thus the cause of the particular variation in the existence or non-existence of prevention of all diseases has been stated.

2.4.5

Here, these three particular factors, beginning with etiology, bring about the rapid manifestation of pramehas caused by phlegm; namely: excessive and excessively large intake of newly harvested hāyanaka, yavaka, cīnaka, uddālaka, naiṣadha, itkaṭa, mukundaka, mahāvrīhi, pramodaka, and sugandhaka rice; likewise, the intake of newly harvested hareśu and māṣa pulses prepared with ghee, meats of domestic, wetland, and aquatic animals, greens, sesame, sesame paste, flour preparations, milk pudding, kṛśarā, vilepikā, and sugarcane products; intake mostly of milk, fresh wine, mandaka yogurt, and liquid, sweet, and fresh substances; avoidance of bodily cleansing and physical exercise; indulgence in sleep, lying down, and sitting; and whatever other regimen engenders phlegm, fat, and urine—all that is the particular etiology.

2.4.6

Abundant, liquid phlegm is the particular dosha.

2.4.7

Abundant, uncompacted fat, flesh, bodily moisture, semen, blood, muscle fat, bone marrow, lymph, and nutrient fluid, designated as ojas—these are the particular dūṣyas.

2.4.8

Upon the combination of these three particular factors, beginning with etiology, phlegm is quickly provoked on account of its prior excessive abundance; being provoked, it quickly spreads in the body because of the body's looseness; spreading in the body, it enters into mixture with fat from the very start, because fat is abundant and uncompacted, and because it largely shares identical qualities with fat; mixing with fat, it corrupts it because it is [itself] abnormal; becoming abnormal and conjoined with corrupted fat, it enters into contact with the body's moisture and flesh, because the moisture and flesh are excessively increased; in the flesh, through corruption of the flesh, it produces putrid flesh carbuncles such as śarāvikā and kacchapikā, because it has become unnatural; corrupting further the bodily moisture, it transforms it into urine, and reaching the openings of the urine-carrying channels that arise from the groins and bladder, which have become heavy when laden with fat and moisture, it is obstructed; then it produces the pramehas, or their chronicity or incurability, because it has become of an abnormal nature.

2.4.9

The bodily moisture, mixed with phlegm and fat, entering the urinary bladder and turning into urine, is affected by these ten qualities of phlegm associated with morbid increase; namely: white, cold, solid, slimy, clear, unctuous, heavy, sweet, dense, bright, and sluggish; there, by whichever single quality or multiple qualities it is more affected, it acquires a secondary specific name according to that designation.

2.4.10

These ten pramehas, indeed, are distinguished by specific names; namely: udakameha, ikṣuvālikārasameha, sāndrameha, sāndraprasādameha, śuklameha, śukrameha, śītameha, sikatāmeha, śanairmeha, and ālālameha.

2.4.11

These ten pramehas are curable, because the prameha and its site share similar qualities, because phlegm is predominant, and because the treatments are concordant.

2.4.12

Here are verses for the purpose of distinguishing the varieties of phlegm prameha:

2.4.13

Clear, copious, white, cold, odorless, and resembling water:
from provocation of phlegm, a man suffering from udakameha urinates [such] urine.

2.4.14

Extremely sweet, cold, slightly slimy, turbid,
and resembling sugarcane stalk juice, he urinates from provocation of phlegm.

2.4.15

One whose urine, having stayed overnight in a vessel, becomes dense:
that man they call a sāndramehin, from provocation of phlegm.

2.4.16

One whose urine solidifies [at the bottom] and becomes somewhat clear [above]:
they call him a sāndraprasādamehin, from provocation of phlegm.

2.4.17

One who repeatedly urinates white urine resembling flour paste:
that man they call a śuklamehin, from provocation of phlegm.

2.4.18

The man who frequently passes urine resembling semen or mixed with semen:
that man they call a śukramehin, from provocation of phlegm.

2.4.19

The man who passes excessively sweet and cold urine in great quantity:
that man they call a śītamehin, from provocation of phlegm.

2.4.20

The man who passes solid, minute impurities present in the urine:
one should recognize that man as a sikatāmehin, from provocation of phlegm.

2.4.21

One who urinates slowly, sluggishly, without urge, and with difficulty:
that man they call a śanairmehin, from provocation of phlegm.

2.4.22

One who passes slimy urine full of saliva-like threads, as if bound by fibers:
one should recognize that man as an ālālamehin, from provocation of phlegm.

2.4.23

Thus, these ten pramehas caused by the provocation of phlegm have been explained.

2.4.24

In a person who indulges in hot, sour, salty, alkaline, pungent, and undigested food, and who likewise indulges in excessively intense sunshine, heat from fire, exertion, anger, and irregular diet, in just such a body pitta is swiftly provoked; and provoked, in that very sequence, it produces these six pramehas even more swiftly.

2.4.25

Their distinct names also arise entirely from the particular qualities of pitta; namely: kṣārameha, kālameha, nīlameha, lohitameha, māñjiṣṭhameha, and hāridrameha.

2.4.26

They are endowed, as before, with the six qualities of pitta: alkaline, sour, salty, pungent, foul-smelling, and hot.

2.4.27

All of them are only manageable, because their seat involves mingled doshas and fat, and because the treatments are mutually contradictory.

2.4.28

Here are the verses for understanding the distinctions among the pitta pramehas:

2.4.29

In smell, color, taste, and touch, just as an alkali is, such urine
a man passes from provocation of pitta as a kṣāramehin.

2.4.30

One who continuously passes hot urine the color of ink:
one should recognize him as a kālamehin, from provocation of pitta.

2.4.31

The man who passes sour urine resembling the wing of a blue jay:
one should recognize him as a nīlamehin, from provocation of pitta.

2.4.32

The man who passes foul-smelling, salty, hot, and red urine:
one should recognize him as a raktamehin, from provocation of pitta.

2.4.33

One who passes urine resembling madder water, very foul-smelling:
one should recognize him as a māñjiṣṭhamehin, from provocation of pitta.

2.4.34

One who passes pungent urine resembling turmeric water:
one should recognize him as a hāridramehin, from provocation of pitta.

2.4.35

Thus, these six pramehas caused by the provocation of pitta have been explained.

2.4.36

In one who indulges in astringent, pungent, bitter, dry, light, and cold foods, sexual intercourse, physical exercise, excess of emesis, purgation, non-unctuous enema, and errhines, suppression [of natural urges], fasting, physical trauma, sunshine, anxiety, grief, excessive loss of blood, staying awake at night, and awkward bodily postures, in just such a body vāta is swiftly provoked.

2.4.37

Provoked and spreading throughout such a body, when it takes hold of the muscle fat and enters the urine-carrying channels, it produces vasāmeha; when it draws bone marrow into the urinary bladder, it produces majjameha; but when, carrying lymph to the urinary bladder, it causes continuous dripping of urine, and because of the excessive abundance of lymph and the dispersiveness of vāta, it causes an obstruction to excessive discharge of urine, then like an elephant in rut he continuously discharges urine without urge; they call him a hastimehin. Ojas, moreover, is sweet by nature; when vāta, through its dryness, combines with it as astringent and carries it to the urinary bladder, then it produces madhumeha.

2.4.38

These four pramehas born of vāta physicians declare to be incurable, because of their extreme danger and because the treatments are mutually contradictory.

2.4.39

Their distinct names also arise, as before, from specific qualities; namely: vasāmeha, majjameha, hastimeha, and madhumeha.

2.4.40

Here are the verses for understanding the distinctions among the vāta pramehas:

2.4.41

The man who frequently passes urine mixed with muscle fat or resembling muscle fat:
they call him an incurable vasāmehin, from provocation of vāta.

2.4.42

The man who frequently passes bone marrow together with urine:
they call him an incurable majjamehin, from provocation of vāta.

2.4.43

One who, like an elephant in rut, continuously and copiously discharges urine:
they call him an incurable hastimehin, from provocation of vāta.

2.4.44

The man who passes astringent, sweet, pale, and un-unctuous urine:
one should recognize him as an incurable madhumehin, from provocation of vāta.

2.4.45

Thus, these four pramehas caused by the provocation of vāta have been explained.

2.4.46

Thus, the twenty pramehas caused by the provocation of the three doshas have been explained.

2.4.47

The three doshas, indeed, when provoked and about to produce pramehas, manifest these premonitory symptoms; namely: matting of the hair, sweetness in the mouth, numbness and burning sensation in the hands and feet, dryness of the mouth, palate, and throat, thirst, laziness, accumulation of filth on the body, coating in the bodily orifices, burning sensation and numbness in the limbs, bees and ants flocking to the body and urine, impurities in the urine, foul body odor, somnolence, and drowsiness at all times.

2.4.48

The complications of those with prameha arising from its chronicity are thirst, diarrhea, fever, burning sensation, debility, anorexia, indigestion, and putrid fleshy boils such as alajī and vidradhi.

2.4.49

Among them, one should treat the curable pramehas by administering purifying and pacifying therapies according to what is appropriate.

2.4.50

And on this there are [verses]:
Upon one greedy for food, who hates bathing and walking,

2.4.50_1

prameha swiftly descends, like a bird upon a tree with its nest.

2.4.51

One lacking zeal, excessively obese, excessively unctuous, an excessive eater—

2.4.51_1

death, in the form of prameha, swiftly takes away and departs.

2.4.52

But the man who partakes of food that brings equilibrium to the bodily tissues,

2.4.52_1

and engages in various other [healthy] activities, attains happiness.

2.4.53

Here are the summary verses:

2.4.53_1

The cause of the disease varieties and the etiology of the pramehas,
the combination of doshas and tissues, and their varied symptoms;

2.4.54

the reason why ten pramehas are caused by phlegm and six born of pitta,
and how powerful vāta produces four pramehas;

2.4.55

the distinctions between curable and incurable, the premonitory symptoms, the complications,
and the guidelines of treatment have been spoken in this etiology of pramehas.

2.4.55_1

Thus ends the fourth chapter, entitled "The Specification of Prameha", in the Section on Etiology in the treatise composed by Agniveśa and redacted by Caraka. //4

2.5.1

Now we shall explain the etiology of kuṣṭha.

2.5.2

Thus spoke the venerable Ātreya:

2.5.3

Seven substances constitute the primary materials of kuṣṭhas when they have undergone alteration.

2.5.3_1

Namely: the three doshas—vāta, pitta, and phlegm—altered by provoking causes; and the fourfold corruptible body tissues—skin, flesh, blood, and lymph—altered through the pathogenic impact of the doshas.

2.5.3_2

This combination of seven, comprising seven bodily elements, is the origin of kuṣṭhas in such manner; arising from this, they manifest and torment the entire body.

2.5.4

No kuṣṭha whatever is caused by the provocation of a single dosha; yet, even among kuṣṭhas of identical constitution, distinctions arise regarding pain, colour, shape, influence, name, and treatment, according to the fractional division of doshas, accessory factors, and location.

2.5.4_1

It is of seven kinds, eighteen kinds, or of innumerable kinds.

2.5.4_2

For the doshas, when differentiated by permutations, differentiate the disorders, except where there is incurability.

2.5.4_3

Having observed that excessive proliferation occurs in enumerating their permutations and varieties, we shall declare the distinctions of kuṣṭha as merely sevenfold.

2.5.5

Here, when the three [doshas] beginning with vāta are provoked and corrupt the four [tissues] beginning with skin: if vāta is predominant, kapālakuṣṭha develops; if pitta [is predominant], audumbara; if phlegm [is predominant], maṇḍalakuṣṭha; if vāta and pitta [predominate], ṛṣyajihva; if pitta and phlegm [predominate], puṇḍarīka; if phlegm and vāta [predominate], sidhmakuṣṭha; and upon the increase of all doshas, kākaṇaka develops. Thus is this sevenfold distinction of kuṣṭha.

2.5.5_1

And when this constitution is differentiated in terms of more, most, and comparative degrees, it attains a far greater number of varieties of the disorder.

2.5.6

In this regard, we shall declare concisely the etiology of all kuṣṭhas: In one who indulges alternately in cold and hot without proper sequence, and similarly in the alternation of nourishing and reducing diets; who constantly and excessively eats honey, molasses, fish, lakuca, radish, and kākamācī during indigestion, or cilicima fish with milk; whose meals consist mostly of hāyanaka, yavaka, cīnaka, uddālaka, and koradūṣa grains accompanied by milk, curd, buttermilk, kola, kulattha, māṣa, flaxseed, and safflower oil; who, having excessively overeaten with these very foods, indulges excessively in sexual intercourse, physical exercise, and heat; who, afflicted by fear, exhaustion, and heat, suddenly plunges into cold water; who partakes of foods causing digestive burning without vomiting out corrupted food; who suppresses vomiting; and who overuses unctuous substances—all three doshas simultaneously undergo provocation. The four [tissues] beginning with skin undergo laxity. When these are lax, the provoked doshas, finding a seat and settling there, corrupt those very [tissues] beginning with skin and produce kuṣṭhas.

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Commentaries (1)

Jalpakalpataru — Gaṅgādhara Kaviratna 1860, Sanskrit

Linked texts (1)

Carakasaṃhitā — Agniveśa (Āyurveda) & Caraka, Sanskrit

The Compendium of Caraka 2

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