The Compendium of Caraka 6.29

English (machine translation) 6.29

Language: English

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Now we shall explain the treatment of gout (vātaśoṇita).

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Agniveśa questioned his concentrated teacher Punarvasu, / resplendent as fire, seated among the sages having offered the agnihotra:

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The teacher told him the causes, symptoms, and remedies / of the combination of wind and blood, which resembles fire and wind:

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By eating salty, sour, pungent, alkaline, unctuous, and hot foods, and by indigestion; / by wet, dried, aquatic, or marshy meat, oil cake, and radishes;

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by horse gram, black gram, flat beans, leafy vegetables, pounded grains, and sugarcane; / by curd, fermented gruel, saubīraka, fermented vinegar, buttermilk, surā, and āsava;

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by incompatible foods, overeating, anger, daytime sleep, and insomnia; / mostly in delicate persons who eat sweet and pleasurable foods

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and are unaccustomed to walking, gout is aggravated; / also when people's blood is corrupted through trauma and non-purification;

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from astringent, pungent, bitter, sparse, and dry food, from fasting, / and by riding horses or camels, traveling in conveyances, water-sports, swimming, and leaping;

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in the heat, from irregular long-distance travel, sexual intercourse, and suppression of urges; / wind, greatly increased, blocked in its path by increased blood,

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vitiates the whole blood; that is known as gout (vātaśoṇita), / and by the names khuḍa, vātabalāsa, and āḍhyavāta.

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Its seat is the hands, feet, fingers and toes, and all joints; / making its root first in the hands and feet, it runs through the body.

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Because of subtlety and pervasive mobility of wind, and of blood / due to its liquidity and mobility, coursing through the body via the vein pathways,

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struck and agitated at the joints, it settles there owing to their crookedness; / staying there combined with pitta and the others, it produces various pains.

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It causes suffering in those very joints; therefore, predominantly in the joints / arise those various pains, exceedingly unbearable for men.

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Excessive sweating or its absence, blackness, lack of sensation to touch, intense pain on injury, / looseness of joints, lassitude, depression, emergence of boils,

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in the knees, shanks, thighs, waist, shoulders, hands, feet, and limb-joints / piercing pain, twitching, splitting pain, heaviness, and numbness,

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itching in the joints, pain that repeatedly appears and disappears, / discoloration, and appearance of round patches—this is the premonitory symptom of gout.

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They declare it to be of two kinds: superficial and deep. / The superficial resides in the skin and flesh, while the deep resides internally.

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Accompanied by itching, burning sensation, pain, extension, piercing pain, twitching, and contraction, / the skin in the superficial [type] is regarded as dark-red and coppery.

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In the deep type, the swelling is rigid, hard, with severe internal agony, / dark-gray or coppery, accompanied by burning sensation, piercing pain, twitching, and suppuration.

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Accompanied by constant pain and burning, moving violently / in the joints, bones, and marrow as if cutting them apart and twisting them crooked,

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roaming everywhere in the body, it causes lameness or paralysis; / and when characterized by all symptoms, gout should be known as seated in both.

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Hear the symptoms of that when wind is predominant, or blood, pitta, or phlegm, / or when combined in dual combinations, or in all together:

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In predominance of wind, especially, dilatation of veins, aching pain, twitching, and piercing pain, / blackness, dryness, and darkness of swelling, with fluctuation of swelling,

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constriction of arteries, fingers, and joints, limb-stiffness, intense pain, / contraction, rigidity, and aversion to cold.

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In [predominance of] blood, swelling with severe pain, piercing pain, coppery color, and tingling; / it does not subside with unctuous or dry [measures], and is accompanied by itching and moistness.

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Burning sensation, pain, fainting, sweating, thirst, intoxication, dizziness, / redness, suppuration, splitting pain, and wasting are stated in the pitta-predominant type.

A feeling of being covered with a wet cloth, heaviness, unctuousness, numbness, and mild pain in [predominance of] phlegm. / From the combination of causes and symptoms, one should diagnose the dual-doṣa and triple-doṣa types.

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That arising from a single doṣa and of recent origin is curable; that from two doṣas is palliable; / that arising from all three doṣas is incurable, as is that which has complications.

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Sleeplessness, anorexia, dyspnea, sloughing of flesh, head-stiffness, / fainting, intoxication, pain, thirst, fever, delusion, tremors,

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hiccup, suppuration of toes/fingers, erysipelas, suppuration, piercing pain, dizziness, exhaustion, / curvature of fingers and toes, blisters, burning sensation, stiffness of vital points, and nodules:

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with these complications, or even with delusion alone, it should be rejected; / and that which oozes, is discolored, rigid, and produces nodules,

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and causes contracture and torment of the senses, one should reject. / That with incomplete complications is palliable, and without complications is curable.

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Wind quickly strikes the pathway of blood in the extremities and joints; / settling there and mutually obstructing each other, they take away life with their pains.

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In that case, one should let blood by means of a horn, leeches, needles, gourds, / scarification, or venesection, according to the doṣa and according to strength.

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From [a swelling] afflicted with pain, burning, aching, and piercing pain, blood should be let with a leech; / with horns or gourds one should draw it out in case of numbness, itching, and tingling.

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When it moves from place to place, it should be evacuated through venesection or scarification; / but when there is exhaustion of the body, or it is dry and wind is predominant, it should not be let.

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Because of loss of blood, wind may cause deep swelling, stiffness, / tremors, disorders of ligaments and vessels, exhaustion, and contracture;

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it may cause wind disorders such as lameness, and death from excessive bloodletting; / therefore, one should draw blood in proper measure from one who has been lubricated.

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Having first lubricated the patient, he should be purged with unctuous purgatives / or with dry and mild ones; and repeated enema treatment is recommended.

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Affusions, inunctions, poultices, and dietary unctuous substances that are generally non-burning / are praised in gout; now learn the distinction from me:

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One should treat the superficial type with plasters, inunctions, affusions, and warm poultices; / and the deep type with purgation, non-unctuous enemas, and drinking of unctuous substances.

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One should treat [gout] with a predominance of wind through the drinking, inunction, and enemas / of ghee, oil, fat, and marrow, and through comfortably warm poultices.

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One should conquer [gout] with a predominance of blood and bile through purgatives, drinking of ghee and milk, / affusions with enemas, and also cool soothing applications.

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Mild, not excessively intense emesis, unctuous affusions, fasting, / and lukewarm plasters are praised in gout with a predominance of phlegm.

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If gout with a predominance of phlegm and wind is plastered with cool things, / an increase in burning, swelling, pain, and itching occurs due to the arrest [of the doshas].

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And in [gout] with a predominance of blood and bile, burning, moistness, and cracking of the skin / would occur from warm things; therefore, the physician, having understood the strength of the doṣas, should perform the treatment.

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One should avoid daytime sleeping, exposure to heat, physical exercise, and copulation, / as well as pungent, hot, heavy, channel-blocking, salty, and sour food.

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Aged barley, wheat, wild rice, śāli rice, and ṣaṣṭika rice / are beneficial for food, or the broth of scratching and pecking birds for meat-juice.

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Pigeon peas, chickpeas, green gram, lentils, along with moth beans, / prepared as soup with plenty of ghee, are praised in gout.

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Suniṣaṇṇaka, cane shoots, kākamācī, śatāvarī, / goosefoot, upodikā potherb, and sauvarcala potherb,

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fried in ghee and meat-juice, should be given as a side-dish / to one accustomed to vegetables; likewise, cow's, buffalo's, and goat's milk are beneficial.

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Thus the treatment of gout has been stated in brief; / this very treatment will now be spoken of entirely in detail.

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Ghee cooked with equal parts of śrāvaṇī, kṣīrakākolī, jīvaka, and ṛṣabhaka, / together with liquorice and with milk, destroys gout.

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One should crush balā, atibalā, medā, ātmaguptā, śatāvarī, / kākolī, kṣīrakākolī, rāsnā, and ṛddhi.

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Ghee cooked with these, with four parts of milk, destroys gout, / and eliminates heart disease, anemia, erysipelas, jaundice, and fever.

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With the decoction of kaśeruka and pastes of trāyantikā, tāmalakī, / the two kākolīs, and śatāvarī, one should cook ghee,

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having added equal parts of the juices of parūṣaka, grapes, kāśmarya, and sugarcane, / the expressed juice of vidārī separately, and likewise four parts of milk.

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This ghee, intended for clinical use, is known as Pārūṣaka Ghṛta; / [it is used] in gout, trauma, emaciation, erysipelas, and bilious fever. // Thus ends Pārūṣaka Ghṛta.
The two pañcamūlas, varṣābhū, castor, with punarnavā, / mudgaparṇī, mahāmedā, māṣaparṇī, śatāvarī,

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śaṅkhapuṣpī, avākpuṣpī, rāsnā, atibalā, and balā, / taking two palas of each, one should boil down in a droṇa of water.

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When a quarter remains, combining it with equal juices of milk, āmalakī, sugarcane, and goat [meat broth] / and an āḍhaka of ghee, one should cook it slowly over a gentle fire,

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adding as pastes the two medās, kāśmarya fruit, blue water-lily, / bamboo manna, pippalī, grapes, lotus seeds, punarnavā,

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ginger, kṣīrakākolī, padmaka, the two bṛhatīs, / vīrā, water chestnut, bhavya, pomegranate, nikocaka,

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dates, walnut, almond, muñjāta, and pistachios. / When the āḍhaka of ghee is cooked with these and cooled, one should add honey.

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And knowing it to be properly cooked, one should store it well-concealed; / having performed protective rites, one should consume an akṣa-measure of it in a clean place.

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It destroys anemia, fever, hiccups, hoarseness, fistula-in-ano, / flank pain, consumption, cough, spleen disorder, gout,

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chest-wound phthisis, epilepsy, urinary calculus, gravel, / diseases of the whole body or of a single limb, and urinary retention.

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Conferring strength and complexion, auspicious, destroying wrinkles and greying, / this Jīvanīya Ghṛta is aphrodisiac and grants sons to barren women.

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Or one should drink ghee cooked with decoctions of grapes and madhūka, / with sugar candy; likewise, milk boiled in the fresh juice of guḍūcī.

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Jīvaka, ṛṣabhaka, medā, ṛṣyaproktā, śatāvarī, / liquorice, madhuparṇī, and the two kākolīs,

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mudgaparṇī, māṣaparṇī, daśamūla, punarnavā, / balā, amṛtā, vidārī, with aśvagandhā and aśmabhedaka—

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with a decoction and paste of these, one should prepare ghee and oil, / and, as available, the fat and marrow of desert-dwelling pecking and scratching birds,

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cooked with four times as much milk. This destroys gout / residing in the entire body and terrible diseases born of wind.

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Sthirā, gokṣura, bṛhatī, sārivā, with śatāvarī, / kāśmarya fruits, ātmaguptā, vṛścīra, and the two balās—

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in a decoction of these, with four parts of milk, oil separately and ghee separately / cooked with medā, śatāvarī, liquorice, jīvantī, jīvaka, and ṛṣabhaka

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in proper measure; then, churned with a churning stick / with three times as much milk and one and a half parts of sugar, it should be drunk in gout born of all three doṣas.

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Or one should make the patient drink oil, milk, and sugar well-blended; / or he may drink milk mixed with ghee, oil, sugar, and honey.

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A prastha of milk boiled with śālaparṇī and containing two parts of sugar candy / is praised for drinking; likewise, [milk] boiled with pippalī and ginger.

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Milk boiled with balā, śatāvarī, rāsnā, and daśamūla, along with pīlu, / śyāmā, castor, and sthirā, destroys distress caused by wind.

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Milk, warm from the udder, or combined with urine, which directs the doṣas downwards, / or taken with trivṛt powder, should be drunk by one whose wind is obstructed by bile and blood.

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Or a man should drink castor oil regularly with milk / for purgation when doṣas are copious, eating rice with milk once it is digested.

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Or a man should drink a decoction of harītakī fried in ghee, / or trivṛt powder with milk as an after-drink, or with grape juice.

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One should drink a decoction of kāśmarya, trivṛt, grapes, triphalā, with parūṣaka, / combined with salt and honey, for purgation.

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Or one should drink a decoction of triphalā combined with honey; / or, if phlegm is predominant, a decoction of āmalakī, turmeric, and mustā.

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And one should repeatedly purge him with the formulations prescribed in the Kalpasthāna, / mild and combined with unctuous substances, having recognized that wind is obstructed by waste matter.

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Or one should eliminate his waste matter with milk enemas containing ghee; / for there is no treatment for gout equal to the enema.

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In pain of the urinary bladder, groin, flanks, thighs, joints, bones, and abdomen, / and in upward movement of wind, non-unctuous enemas accompanied by unctuous enemas are praised.

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And the wise physician should administer these oils in enema treatment, / in errhines, inunctions, and affusions, for the pacification of burning and colic:

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In a decoction of one tulā of liquorice reduced to a quarter, / one should cook an āḍhaka of oil with an equal amount of milk and one-pala pastes of

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śatapuṣpā, śatāvarī, mūrvā, payasyā, aguru, sandalwood, / sthirā, haṃsapadī, jaṭāmāṃsī, the two medās, and madhuparṇī.

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with kākolī, kṣīrakākolī, tāmalakī, ṛddhi, padmaka, / jīvaka, ṛṣabhaka, jīvantī, cinnamon bark, patra, nakha, vālaka,

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prapauṇḍarīka, mañjiṣṭhā, sārivā, aindrī, and vitunnaka. / Through the four modes of administration, that oil destroys wind-blood,

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together with complications, with aching of the limbs, and that which has spread through the whole body; / it cures wind-blood, burning pain from pitta, and fever, and produces strength and complexion.
Thus ends the oil beginning with madhuparṇī.
A hundred [palas] of liquorice, grapes, dates, parūṣaka, / and both madhūka and odanapākī, and a prastha of muñjātaka,

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and an āḍhaka of kāśmarya—all this one should cook in four droṇas of water; / when a one-eighth portion remains and is strained, in that one should cook an āḍhaka of oil,

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likewise with equal parts of juice of āmalaka, kāśmarya, vidārī, and sugar cane, / with four droṇas of milk, adding a one-pala paste of

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kadamba, āmalaka, walnuts, lotus seeds, kaśeruka, / śṛṅgāṭaka, ginger, salt, pippalī, sugar,

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and the vitalising [drugs]; when properly cooked, one should mix it with a prastha of honey, / and apply it in errhines, inunctions, drinks, and also in enemas.

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In all wind disorders, in torticollis, lockjaw, / in whole-body and one-limbed wind disorders, in phthisis from injury, and in fever from chest-wound,

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this oil called Sukumāyaka destroys wind-blood disease, / promotes voice and complexion, and gives health, strength, and nourishment.
Thus ends the Sukumāraka oil.
Guḍūcī, liquorice, the lesser pañcamūla, punarnavā, / rāsnā, castor root, and the vitalising [drugs] as available,

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in portions of one hundred palas each, five hundred [palas] of balā, / and jujube, bilva, barley, black gram, and horse gram measuring an āḍhaka each,

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and a droṇa of well-dried kāśmarya fruits, in a hundred droṇas of water; / bruised and washed, one should cook it and reduce it to four droṇas.

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With that, one should cook a droṇa of oil, having added five times as much milk, / and having ground three palas each of sandalwood, uśīra, keśara,

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patra, cardamom, aguru, kuṣṭha, tagara, liquorice, / and eight palas of mañjiṣṭhā; when prepared, it is suitable for all applications.

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In wind-blood, in phthisis from injury, in those afflicted by heavy loads, in those with depleted semen, / for those suffering from trembling, convulsions, and fractures, and patients with whole-body or single-limb disease,

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it destroys vaginal disorders, epilepsy, insanity, limping, and lameness, / and this supreme oil called Amṛta promotes childbearing.
Thus ends the oil beginning with amṛtā.
Lotus, vetasa, liquorice, phenilā, padmaka, blue lotus, / darbha, balā, sandalwood, and kiṃśuka, five palas each,

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boiled in water; with this one should cook a prastha of oil with an equal amount of sauvīraka, / together with lodhra, kālīyaka, uśīra, jīvaka, ṛṣabhaka, keśara,

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madayantī, latāpatra, padmakeśara, padmaka, / prapauṇḍarīka, kāśmarya, māṃsī, medā, priyaṅgu,

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with half a pala of saffron, and a pala of mañjiṣṭhā. / This Mahāpadma oil destroys wind-blood and fever.
Thus ends the Mahāpadma oil.
Cooked with a decoction of padmaka, uśīra, liquorice, and turmeric, / with ground sarja-resin, mañjiṣṭhā, vīrā, kākolī, and sandalwood,

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this Khuḍḍūkapadmaka oil destroys wind-blood and burning pain.
Thus ends the Khuḍḍūkapadmaka oil.
Ten times as much milk should be boiled with a hundred [palas] of liquorice;

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in four droṇas of oil with that [milk], prepared with a pala of liquorice / or with the juices of liquorice and kāśmarya, it destroys wind-blood.

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Having ground a pala of madhuparṇī, a prastha of oil should be cooked in four times as much / milk, doing so a hundred times; similarly, prepared a hundred times with liquorice,

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it should be given in wind-blood caused by all three doṣas; it cures dyspnea and cough, / and destroys heart disease, anemia, erysipelas, jaundice, and burning pain.
Thus ends the hundred-times cooked liquorice oil.
One should cook oil with a decoction and paste of balā, with an equal amount of milk, / a thousand or a hundred times; it destroys wind-blood and wind disorders.

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This is a supreme rejuvenator, a clarifier of the sense organs, / life-giving, nourishing, voice-improving, and a destroyer of semen and menstrual disorders.
Thus ends the thousand-times or hundred-times cooked Balā oil.
Oil prepared with guḍūcī juice and milk, or with grape juice, / or with the juices of liquorice and kāśmarya, destroys wind-blood.

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Oil cooked with a quarter part of sarja-resin in an āḍhaka of fermented gruel / and churned in abundant water is supreme in relieving fever, burning, and pain.

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Containing beeswax, mañjiṣṭhā, sarja-resin, and sārivā, / this Piṇḍataila by inunction relieves the pain of wind-blood.
Thus ends Piṇḍataila.
Milk boiled with daśamūla immediately relieves pain; / affusion [is applied] similarly with lukewarm ghee when wind predominates.

Linked texts (1)

Carakasaṃhitā — Agniveśa (Āyurveda) & Caraka, Sanskrit