Cakradatta (Cikitsasangraha) 71: Adhikāra 71

When doṣas are aggravated by emesis, or when vāta is aggravated, an enema is prescribed. / Having fed [the patient] one-fourth less than usual, one should administer an unctuous enema. (1)

And unctuous substance should by no means be applied to one who has not eaten; / because of the subtleness and emptiness of the alimentary tract, it would quickly rush upwards. (2)

Six palas is the best dose, medium is two palas, / the lowest is one and a half palas; the dose in an unctuous enema is threefold. (3)

Two palas should first be given in the first [type], with an increase of half a pala; / in the second, one pala with an increase of an akṣa; / or two karṣas with an increase of eight māṣas / in the third enema: this is said to be the sequence. (4)

In a pala of unctuous substance there should be a measure of one māṣa of rock salt and dill. / And that, combined with rock salt powder and dill, (5)

should be comfortably warm, and in that way it immediately comes out through the nozzle. / If one who has been purged is to receive an unctuous enema, it should then be given after seven nights. (6)

Nozzles with good rings are to be made of gold, silver, tin, copper, brass, / bronze, iron, bone, wood, bamboo, ivory, / reeds, horns, or various gems. (7)

They should measure six, twelve, and eight finger-breadths / for persons of six, twenty, and twelve years of age; / their orifices should admit a mudga bean, a jujube fruit, or a pea, / and they should also be plugged with a wick. (8)

They should have a circumference like that of a barley corn, a thumb, and a little finger / at the base and tip respectively. (9a)

They should be straight, shaped like a cow's tail, / smooth, and have rounded ends. (9b)

There should be one ring at a fourth part from the tip, / and two at the base for tying the bladder. / The bladder should be of an old bull, a buffalo, or a deer, / or of a boar or a goat. (10)

Firm, thin, with its vessel attachments removed, / dyed with decoction, very soft, and well cleaned: / having observed the age of the patient suitably, / it is to be fastened to the nozzles with well-tied cord. (11)

The dose for a non-unctuous enema in the first year is one prakuñca; thereafter, / there is an increase of one prakuñca every year until there are six prasṛtas. (12)

Beyond [that age], one should increase by a prasṛta up to twelve years; for an eighteen-year-old, however, / this measure is ten prasṛtas up to seventy years, which is the maximum. // 13

The dose in an unctuous enema is properly one quarter of that of a non-unctuous enema. / Having strolled and evacuated feces and urine, [the patient], resting comfortably on a bed // 14

that is neither too high nor with an elevated headrest, lying on his left side, / contracting his right thigh and extending the other, / having taken the enema bag in his left hand, [the physician] should compress it with the right. // 15

Then he should introduce its nozzle, whose tip is lubricated, into the lubricated rectum, / letting out the air from the mouth of the enema bag, tying it, and keeping the hand unshakeable. // 16

Then toward the vertebral column, neither too fast nor too slow, / neither with excessive force nor too sluggishly, he should press it in a single motion; / he should leave a residue, for vāyu resides in the remainder. // 17

The very same method is stated also in the administration of a non-unctuous enema. / Then, once the unctuous substance has been introduced, he should lie supine for the duration of a hundred words, / with all limbs outstretched; thus the potency spreads. // 18

Thereafter, he should slowly flex his thighs and arms three times each; / he should tap gently on his soles three times each. // 19

And then [the attendant] should gently raise the bed three times at his buttocks and pelvis. / When the enema has been administered in this way, exerting little effort and speaking softly, // 20

he may lie at ease on a spread bed, observing proper conduct. / If it comes out promptly, another should be administered; an unctuous substance that does not stay achieves nothing. // 21

He in whom the unctuous substance returns along with vāyu and feces / without pain, having remained for three yāmas, is properly given an unctuous enema. // 22

In the morning, he should drink coriander-and-dry-ginger water in half the dose of a decoction; / when pitta predominates, he should drink the same amount of lukewarm water afterward. // 23

Thereby his digestive fire is stimulated and a desire for food arises. / Even if returning after a day and night, the unctuous substance causes no harm; // 24

moreover, it produces the benefits of the enema, but when digested its effect is minimal. / If the unexpelled unctuous enema causes no complication in a person, // 25

whether it is retained entirely or partially due to dryness, the wise physician should ignore it. / If it does not come out after a day and night and is accompanied by complications, he should extract it. // 26

When the unctuous enema has not returned, no other wash is prescribed. / When, however, the unctuous substance mixed with impurities does not return in an unpurified person, // 27

then fatigue of the limbs, flatulence, colic, dyspnoea arise, / along with heaviness in the large intestine; in that condition, he should administer a non-unctuous enema // 28

that is sharp, and also an unctuous enema prepared with sharp medicaments. / An unctuous enema must not be administered to an unpurified person; // 29

when given in that condition, the potency of the unctuous substance does not permeate. / Yet even if unpurified, one who is afflicted by pure vāta // 30

should be given an unctuous enema at all times of day and night. / One should administer an unctuous enema to him again on the third or fifth day, // 31

or according to the digestion of the unctuous substance; moreover, those with aggravated vāta, / those who constantly exercise, those with a stimulated digestive fire, and the unctuous-depleted should receive it every day. // 32

Thus, when the patient is oleated by three or four unctuous substances, for clearing the channels / one should apply a purifying non-unctuous enema; in the un-oleated body, [first] oleation. // 33

In an inadequate unctuous enema, vāyu, feces, and urine are obstructed; / in an excessive unctuous enema, burning sensation, fever, and distress of thirst are produced. // 34

One should not resort excessively to only one—either an unctuous enema or a non-unctuous enema: / from oleation arises aggravation of pitta and kapha; from a non-unctuous enema, danger from vāta. // 35

Those declared unfit for non-unctuous enemas are also considered unfit for unctuous enemas, / particularly these: those with anaemia, jaundice, urinary disorders, chronic rhinitis, // 36

splenomegaly with loss of sourness, diarrhoea, heavy bowel, kapha-induced abdominal disease, / conjunctivitis, severe obesity, intestinal worms, and vāta associated with rakta (āḍhyavāta); // 37

one who has drunk poison or artificial poison, one with scrofula, elephantiasis, or goitre. / Unfit for a non-unctuous enema is one who is excessively oleated, one with chest injury, one who is severely emaciated, // 38

one suffering from dysentery with āma, vomiting, one who has undergone purification, one given nasal medication, / those with dyspnoea, cough, excessive salivation, haemorrhoids, hiccup, flatulence, and weak digestive fire, // 39

one with rectal colic, one who has just eaten, one with intestinal obstruction, intestinal perforation, or ascites, / one suffering from skin disease, one with diabetes mellitus, and a woman pregnant for seven months. // 40

Nor should the wise physician adhere rigidly to what is stated exclusively here: / sometimes a procedure, even though considered contraindicated, may have to be performed. // 41

Emesis is well-directed in one suffering from vomiting, heart disease, or abdominal lump, / and enema therapy is prescribed for patients with skin disease according to the stage of the condition. // 42